Коронарное шунтирование и механическая поддержка кровообращения при проникающем ранении сердца: клинический случай

Цель: клинический случай применения веноартериальной экстракорпоральной мембранной оксигенации (ВА-ЭКМО) при сочетании проникающего ранения сердца, инфаркта миокарда и экстренного аортокоронарного шунтирования (АКШ).
Материалы и методы. Пациент 37 лет с проникающим ножевым ранением передней грудной стенки, осложненным гемоперикардом, кардиогенным шоком и острым инфарктом миокарда. На фоне сохраняющейся нестабильной системной гемодинамики после первичного хирургического вмешательства была инициирована периферическая ВА-ЭКМО, после чего выполнено экстренное АКШ.
Результаты. Применение ВА-ЭКМО позволило стабилизировать гемодинамику и создать оптимальные условия для последующего шунтирования без пережатия аорты. После 72 ч механической поддержки кровообращения достигнута положительная динамика с восстановлением фракции выброса левого желудочка (ФВ ЛЖ) до 52% к моменту выписки.
Заключение. Представленное наблюдение демонстрирует потенциальную эффективность ВА-ЭКМО как элемента комплексной терапии у пациентов с сочетанным поражением сердца. Ведущую роль в достижении положительного исхода сыграл мультидисциплинарный подход.

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