sechenovSechenov Medical JournalСеченовский вестник2218-73322658-3348Сеченовский Университетsechenov-5Research ArticleCLINICAL MEDICINEУСПЕХИ КЛИНИЧЕСКОЙ МЕДИЦИНЫPulmonary and pleura damage in the process cardiosurgical intervention: etiology, pathogenesis, prevention (Review)Повреждение легких и плевры при кардиохирургических операциях: этиология, патогенез, профилактика (Обзор)БеловЮ. В.BelovYu. V.belovmed@gmail.comЛитвицкийП. Ф.LitvitskyP. F.litvicki@mma.ruВинокуровИ. А.VinokurovI. A.docvin.med@gmail.comФГБНУ РНЦХ имени академика Б.В. ПетровскогоРоссияFederal State Scientific Institution Petrovsky Russian Scientific Center of SurgeryRussian FederationФГАОУ ВО Первый МГМУ имени И.М. Сеченова Минздрава России (Сеченовский Университет)РоссияI.M. Sechenov First MSMU (Sechenov University)Russian Federation201730032017012025Copyright © Belov Y.V., Litvitsky P.F., Vinokurov I.A., 20172017Белов Ю.В., Литвицкий П.Ф., Винокуров И.А.Belov Y.V., Litvitsky P.F., Vinokurov I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sechenovmedj.com/jour/article/view/5

Pulmonary and pleura damage are one of the most common postoperative complications. The prevalence of pulmonary dysfunction following cardiac surgery is 76%. The risk factors are: preoperative respiratory disease, body mass index over 30 kg/m2, intraoperational heart ice encasing, duration of cardiopulmonary bypass period. From a heart surgeon and pathophysiologist prospective, the paper discusses the mechanisms of lung tissue destruction and patient preparation to reduce the incidence and/severity of complications. The data analysis suggests that this factors should be accounted for when planning the operation to reduce the risk of life-threatening complications.

Повреждение легких и плевры - одно из наиболее частых осложнений послеоперационного периода кардиохирургических вмешательств. Дисфункция легких и дыхательная недостаточность после таких операций наблюдается у 6-76% пациентов. К наиболее частым факторам риска таких осложнений относят: наличие до операции заболеваний дыхательных путей и легких; индекс массы тела более 30 кг/м2; обкладывание сердца льдом во время основного этапа операции; использование искусственного кровообращения и его большая продолжительность. В настоящей работе анализируются с позиций кардиохирурга и патофизиолога наиболее частые причины, факторы риска и ключевые звенья патогенеза поражений легких и плевры после кардиохирургических вмешательств, способы подготовки пациентов для снижения частоты и/или тяжести дисфункции легких и дыхательной недостаточности. Учет таких сведений при планировании и проведении кардиохирургических операций позволит существенно снизить риск развития жизнеугрожающих осложнений.

кардиохирургияповреждение легкихэтиологияпатогенезпрофилактикаcardiac surgerypulmonary damageetiologypathogenesispreventionReferencesБабринская И.Г., Уклонский А.Н. Дыхательная недостаточность послеоперационного периода у торакальных больных. Вестник Кыргызско-Российского славянского университета. 2014; 5: 35-38Бабринская И.Г., Уклонский А.Н. Дыхательная недостаточность послеоперационного периода у торакальных больных. Вестник Кыргызско-Российского славянского университета. 2014; 5: 35-38Ferguson M.K. Preoperative assessment of pulmonary risk. Chest. 1999; 115(5 Suppl): 58S-63SFerguson M.K. Preoperative assessment of pulmonary risk. Chest. 1999; 115(5 Suppl): 58S-63STrouillet J.L., Luyt C.E., Guiguet M. et al. Earlypercutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann. Intern. Med. 2011; Mar 15; 154(6): 373-383Trouillet J.L., Luyt C.E., Guiguet M. et al. Earlypercutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann. Intern. Med. 2011; Mar 15; 154(6): 373-383Cordeiro A.L., Melo T.A., Neves D. et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Cardiovasc. Surg. 2016; Apr; 31(2): 140-144Cordeiro A.L., Melo T.A., Neves D. et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Cardiovasc. Surg. 2016; Apr; 31(2): 140-144Freitas E.R., Soares B., Cardoso J.R., Atallah Á.N. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft (Review). The Cochrane Library. 2009; Iss. 1Freitas E.R., Soares B., Cardoso J.R., Atallah Á.N. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft (Review). The Cochrane Library. 2009; Iss. 1Felcar J.M., Guitti J.C., Marson A.C., Cardoso J.R. Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery. Rev. Bras. Cir. Cardiovasc. 2008; 23(3): 383-388Felcar J.M., Guitti J.C., Marson A.C., Cardoso J.R. Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery. Rev. Bras. Cir. Cardiovasc. 2008; 23(3): 383-388Yamashiro S., Kuniyoshi Y., Arakaki K., Inafuku H., Morishima Y., Kise Y. Aortic replacement via median sternotomy with left anterolateral thoracotomy. Asian Cardiovasc. Thorac. Ann. 2009; 17: 373-377Yamashiro S., Kuniyoshi Y., Arakaki K., Inafuku H., Morishima Y., Kise Y. Aortic replacement via median sternotomy with left anterolateral thoracotomy. Asian Cardiovasc. Thorac. Ann. 2009; 17: 373-377Mehran R.J., Martin L.W., Baker C.M. et al. Pain management in an enhanced recovery pathway after thoracic surgical procedures. Ann. Thorac. Surg. 2016; Dec; 102(6): e595-e596Mehran R.J., Martin L.W., Baker C.M. et al. Pain management in an enhanced recovery pathway after thoracic surgical procedures. Ann. Thorac. Surg. 2016; Dec; 102(6): e595-e596Muehling B.M., Halter G.L., Schelzig H., Meierhenrich R., Steffen P., Sunder-Plassmann L., Orend K. Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway. Eur. J. of Cardio-thoracic Surg. 2008; 34: 174-180Muehling B.M., Halter G.L., Schelzig H., Meierhenrich R., Steffen P., Sunder-Plassmann L., Orend K. Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway. Eur. J. of Cardio-thoracic Surg. 2008; 34: 174-180Rudra A., Das S. Postoperative pulmonary complications. Indian J. of anaesthesia. 2006; 50(2): 89-98Rudra A., Das S. Postoperative pulmonary complications. Indian J. of anaesthesia. 2006; 50(2): 89-98Suemitsu R., Sakoguchi T., Morikawa K., Yamaguchi M., Tanaka H., Takeo S. Effect of body mass index on perioperative complications in thoracic surgery. Asian Cardiovasc. Thorac. Ann. 2008; 16: 463-467Suemitsu R., Sakoguchi T., Morikawa K., Yamaguchi M., Tanaka H., Takeo S. Effect of body mass index on perioperative complications in thoracic surgery. Asian Cardiovasc. Thorac. Ann. 2008; 16: 463-467Авдеев С.Н. Плевральные выпоты в интенсивной терапии. Consilium Medicum. Приложение «Пульмонология». 2009; 1: 21-26Авдеев С.Н. Плевральные выпоты в интенсивной терапии. Consilium Medicum. Приложение «Пульмонология». 2009; 1: 21-26Merino-Ramirez M.A., Juan G., Ramón M. et al. Electrophysiologic evaluation of phrenic nerve and diaphragm function after coronary bypass surgery: prospective study of diabetes and other risk factors. J. Thorac. Cardiovasc. Surg. 2006; Sep; 132(3): 530-536, 536.e1-2Merino-Ramirez M.A., Juan G., Ramón M. et al. Electrophysiologic evaluation of phrenic nerve and diaphragm function after coronary bypass surgery: prospective study of diabetes and other risk factors. J. Thorac. Cardiovasc. Surg. 2006; Sep; 132(3): 530-536, 536.e1-2Гасанов А.Ф. Легочно-плевральные осложнения в хирургии нисходящего отдела грудной аорты. Автореферат … канд. мед. наук. М.; 2012: 24Гасанов А.Ф. Легочно-плевральные осложнения в хирургии нисходящего отдела грудной аорты. Автореферат … канд. мед. наук. М.; 2012: 24Westerdahl E., Jonsson M., Emtner M. Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery. J. Cardiothorac. Surg. 2016; Jul 8; 11(1): 99Westerdahl E., Jonsson M., Emtner M. Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery. J. Cardiothorac. Surg. 2016; Jul 8; 11(1): 99Savas O.Z.B., Kaya E., Arslan G. et al. Pre-treatment before coronary artery bypass surgery improves post-outcomes in moderate chronic obstruction pulmonary disease patients. Cardiovasc. J. of Africa. 2013; 24(5): 184-187Savas O.Z.B., Kaya E., Arslan G. et al. Pre-treatment before coronary artery bypass surgery improves post-outcomes in moderate chronic obstruction pulmonary disease patients. Cardiovasc. J. of Africa. 2013; 24(5): 184-187Apostolakis E., Filos K., Koletsis E., Dougenis D. Lung dysfunction following cardiopulmonary bypass. J. Card. Surg. 2010; 25(1): 47-55Apostolakis E., Filos K., Koletsis E., Dougenis D. Lung dysfunction following cardiopulmonary bypass. J. Card. Surg. 2010; 25(1): 47-55Massoudy P., Zahler S., Becker B.F., Braun S.L., Barankay A., Meisner H. Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass. Chest. 2001; 119: 31-36Massoudy P., Zahler S., Becker B.F., Braun S.L., Barankay A., Meisner H. Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass. Chest. 2001; 119: 31-36Roth-Isigkeit A., Hasselbach L., Ocklitz E. et al. Inter-individual differences in cytokine release in patients undergoing cardiac surgery with cardiopulmonary bypass. Clin. Exp. Immunol. 2001; 125: 80-88. Conti V.R. Pulmonary injury after cardiopulmonary bypass. Chest. 2001; 119: 2-4Roth-Isigkeit A., Hasselbach L., Ocklitz E. et al. Inter-individual differences in cytokine release in patients undergoing cardiac surgery with cardiopulmonary bypass. Clin. Exp. Immunol. 2001; 125: 80-88. Conti V.R. Pulmonary injury after cardiopulmonary bypass. Chest. 2001; 119: 2-4Gu Y.J., de Vries A.J., Vos P., Boonstra P.W., van Oeveren W. Leukocyte depletion during cardiac operation: a new approach through the venous bypass circuit. Ann. Thorac. Surg. 1999; 67: 604-609Gu Y.J., de Vries A.J., Vos P., Boonstra P.W., van Oeveren W. Leukocyte depletion during cardiac operation: a new approach through the venous bypass circuit. Ann. Thorac. Surg. 1999; 67: 604-609Goldman M., Webert K.E., Arnold D.M., Freedman J., Hannon J., Blajchman M.A. Proceedings of a consensus conference: towards an understanding of TRALI. Transfus. Med. Rev. 2005; 19(1): 2-31Goldman M., Webert K.E., Arnold D.M., Freedman J., Hannon J., Blajchman M.A. Proceedings of a consensus conference: towards an understanding of TRALI. Transfus. Med. Rev. 2005; 19(1): 2-31Stainsby D., Jones H., Asher D. et al. Serious hazards of transfusion: a decade of hemovigilance in the UK. Transfus. Med. Rev. 2006; 20(4): 273-282Stainsby D., Jones H., Asher D. et al. Serious hazards of transfusion: a decade of hemovigilance in the UK. Transfus. Med. Rev. 2006; 20(4): 273-282Bux J., Sachs U.J. The pathogenesis of transfusion-related acute lung injury (TRALI). Br. J. Haematol. 2007; 136(6): 788-799Bux J., Sachs U.J. The pathogenesis of transfusion-related acute lung injury (TRALI). Br. J. Haematol. 2007; 136(6): 788-799Vlaar A.P., Porcelijn L., Van Rooijen Schreurs I., Lardy N.M., Kersten M.J., Juffermans N.P. The divergent clinical presentations of transfusion-related acute lung injury illustrated by two case reports. Med. Sci. Monit. 2010; 16(10): CS129-CS134Vlaar A.P., Porcelijn L., Van Rooijen Schreurs I., Lardy N.M., Kersten M.J., Juffermans N.P. The divergent clinical presentations of transfusion-related acute lung injury illustrated by two case reports. Med. Sci. Monit. 2010; 16(10): CS129-CS134Kumar R., Sedky M.J., Varghese S.J. et al. Transfusion related acute lung injury (TRALI): A single institution experience of 15 years. Indian J. Hematol. Blood Transfus. 2016; Sep; 32(3): 320-327Kumar R., Sedky M.J., Varghese S.J. et al. Transfusion related acute lung injury (TRALI): A single institution experience of 15 years. Indian J. Hematol. Blood Transfus. 2016; Sep; 32(3): 320-327Asimakopoulos G., Smith P.L.C., Ratnatunga C.P., Taylor K.M. Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass. Ann. Thorac. Surg. 1999; 68: 1107-1115Asimakopoulos G., Smith P.L.C., Ratnatunga C.P., Taylor K.M. Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass. Ann. Thorac. Surg. 1999; 68: 1107-1115Lohser J., Slinger P. Lung injury after one-lung ventilation: A review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesth. Analg. 2015; Aug; 121(2): 302-318Lohser J., Slinger P. Lung injury after one-lung ventilation: A review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesth. Analg. 2015; Aug; 121(2): 302-318Akbariasbagh P., Mirzaghayan M.R., Akbariasbagh N. et al. Risk ractors for post-cardiac surgery diaphragmatic paralysis in children with congenital heart disease. J. Tehran. Heart. Cent. 2015; Jul 3; 10(3): 134-139Akbariasbagh P., Mirzaghayan M.R., Akbariasbagh N. et al. Risk ractors for post-cardiac surgery diaphragmatic paralysis in children with congenital heart disease. J. Tehran. Heart. Cent. 2015; Jul 3; 10(3): 134-139Bougioukas I., Didilis V., Emigholz J. et al. The effect of amifostine on lung ischaemia-reperfusion injury in rats. Interact. Cardiovasc. Thorac. Surg. 2016; Aug; 23(2): 273-279Bougioukas I., Didilis V., Emigholz J. et al. The effect of amifostine on lung ischaemia-reperfusion injury in rats. Interact. Cardiovasc. Thorac. Surg. 2016; Aug; 23(2): 273-279Matata B., Galinanes M. Peroxynitrite is an essential component of cytokines production mechanism in human monocytes through modulation of nuclear factor-kappa B DNA binding activity. J. Biol. Chem. 2002; 277: 2330-2335Matata B., Galinanes M. Peroxynitrite is an essential component of cytokines production mechanism in human monocytes through modulation of nuclear factor-kappa B DNA binding activity. J. Biol. Chem. 2002; 277: 2330-2335Perrot M., Liu M., Waddell T., Keshavjee S. Ischemia-reperfusion-induced lung injury. Am. J. Respir. Crit. Care. Med. 2003; 167: 490-511Perrot M., Liu M., Waddell T., Keshavjee S. Ischemia-reperfusion-induced lung injury. Am. J. Respir. Crit. Care. Med. 2003; 167: 490-511Fisher A.B. Reactive oxygen species and cell signaling with lung ischemia. Undersea Hyperb. Med. 2004; Spring; 31(1): 97-103Fisher A.B. Reactive oxygen species and cell signaling with lung ischemia. Undersea Hyperb. Med. 2004; Spring; 31(1): 97-103Colombat M., Castier Y., Leseche G., Rufat P., Mal H., Thabut G. et al. Early expression of adhesion molecules after lung transplantation: evidence for a role of aggregated P-selectin-positive platelets in human primary graft failure. J. Heart. Lung. Transplant. 2004; 23(9): 1087-1092Colombat M., Castier Y., Leseche G., Rufat P., Mal H., Thabut G. et al. Early expression of adhesion molecules after lung transplantation: evidence for a role of aggregated P-selectin-positive platelets in human primary graft failure. J. Heart. Lung. Transplant. 2004; 23(9): 1087-1092Cadenas E. Mitochondrial free radical production and cell signaling. Mol. Aspects. Med. 2004; 25(1-2): 17-26Cadenas E. Mitochondrial free radical production and cell signaling. Mol. Aspects. Med. 2004; 25(1-2): 17-26Kadenbach B. Intrinsic and extrinsic uncoupling of oxidative phosphorylation. Biochim. Biophys. Acta. 2003; Jun 5; 1604(2): 77-94Kadenbach B. Intrinsic and extrinsic uncoupling of oxidative phosphorylation. Biochim. Biophys. Acta. 2003; Jun 5; 1604(2): 77-94Landmesser U., Dikalov S., Price S.R., McCann L., Fukai T., Holland S.M., Mitch W.E., Harrison D.G. Oxidation of tetrahydrobiopterin leads to uncoupling of endothelial cell nitric oxide synthase in hypertension. J. Clin. Invest. 2003; 111(8): 1201-1209Landmesser U., Dikalov S., Price S.R., McCann L., Fukai T., Holland S.M., Mitch W.E., Harrison D.G. Oxidation of tetrahydrobiopterin leads to uncoupling of endothelial cell nitric oxide synthase in hypertension. J. Clin. Invest. 2003; 111(8): 1201-1209Esme H., Fidan H., Koken T., Solak O. Effect of lung ischemia-reperfusion on oxidative stress parameters of remote tissues. Eur. J. Cardiothorac. Surg. 2006; 29(3): 294-298Esme H., Fidan H., Koken T., Solak O. Effect of lung ischemia-reperfusion on oxidative stress parameters of remote tissues. Eur. J. Cardiothorac. Surg. 2006; 29(3): 294-298Murphy M.P., Holmgren A., Larsson N.G., Halliwell B., Chang C.J., Kalyanaraman B. et al. Unraveling the biological roles of reactive oxygen species. Cell. Metab. 2011; 13: 361-366Murphy M.P., Holmgren A., Larsson N.G., Halliwell B., Chang C.J., Kalyanaraman B. et al. Unraveling the biological roles of reactive oxygen species. Cell. Metab. 2011; 13: 361-366Du S., Ai J., Zeng X., Wan J. et al. Plasma level of advanced oxidation protein products as a novel biomarker of acute lung injury followingcardiac surgery. Springerplus. 2016; Feb 29; 5: 231Du S., Ai J., Zeng X., Wan J. et al. Plasma level of advanced oxidation protein products as a novel biomarker of acute lung injury followingcardiac surgery. Springerplus. 2016; Feb 29; 5: 231Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr. Opin. Anaesthesiol. 2006; 19(1): 5-10Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr. Opin. Anaesthesiol. 2006; 19(1): 5-10Zhang X., Gao F., Yan Y. et al. Combination therapy with human umbilical cord mesenchymal stem cells and angiotensin-converting enzyme 2 is superior for the treatment of acute lung ischemia-reperfusion injury in rats. Cell Biochem. Funct. 2015; Apr; 33(3): 113-120Zhang X., Gao F., Yan Y. et al. Combination therapy with human umbilical cord mesenchymal stem cells and angiotensin-converting enzyme 2 is superior for the treatment of acute lung ischemia-reperfusion injury in rats. Cell Biochem. Funct. 2015; Apr; 33(3): 113-120Den Hengst W., Gielis J., Lin J., Van Schil P., De Windt L., Moens A. Lung ischaemia-reperfusion injury: a molecular and clinical view on a complex pathophysiological process. Am. J. Physiol. Circ. Physiol. 2010; 299: H1283-1299Den Hengst W., Gielis J., Lin J., Van Schil P., De Windt L., Moens A. Lung ischaemia-reperfusion injury: a molecular and clinical view on a complex pathophysiological process. Am. J. Physiol. Circ. Physiol. 2010; 299: H1283-1299Bougioukas I., Didilis V., Emigholz J. et al. The effect of amifostine on lung ischaemia-reperfusion injury in rats. Interact. Cardiovasc. Thorac. Surg. 2016; Aug; 23(2): 273-279Bougioukas I., Didilis V., Emigholz J. et al. The effect of amifostine on lung ischaemia-reperfusion injury in rats. Interact. Cardiovasc. Thorac. Surg. 2016; Aug; 23(2): 273-279Roberts A.M., Ovechkin A.V., Mowbray J.G., Robinson T.W., Lominadze D. Effects of pulmonary ischemia-reperfusion on platelet adhesion in subpleural arterioles in rabbits. Microvasc. Res. 2004; 67(1): 29-37Roberts A.M., Ovechkin A.V., Mowbray J.G., Robinson T.W., Lominadze D. Effects of pulmonary ischemia-reperfusion on platelet adhesion in subpleural arterioles in rabbits. Microvasc. Res. 2004; 67(1): 29-37

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