Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya7126810.26442/00403660.2021.04.200688ReviewsОбзорыReview ArticleCentral hemodynamic monitoring in patients with cardiogenic shockМониторинг центральной гемодинамики у пациентов с кардиогенным шокомhttps://orcid.org/0000-0001-5581-5387SyrkinaAnna G.СыркинаАнна Геннадьевна
Russian Federation

к.м.н., науч. сотр. отд-ния неотложной кардиологии

sag@cardio-tomsk.ruhttps://orcid.org/0000-0002-4358-7329RyabovVyacheslav V.РябовВячеслав Валерьевич
Russian Federation

д.м.н., рук. отд-ния неотложной кардиологии

sag@cardio-tomsk.ruCardiology Research Institute, Tomsk National Research Medical CentreНаучно-исследовательский институт кардиологии ФГБНУ «Томский национальный исследовательский медицинский центр» Российской академии наук150420219345025080306202103062021Copyright ©; 2021, Consilium MedicumCopyright ©; 2021, ООО "Консилиум Медикум"2021Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/71268

Cardiogenic shock is the pathology most commonly encountered by intensive care physicians. Its frequency averages 4–10% in STEMI (ST-elevation myocardial infarction) patients and 2–4% in NONSTEMI (non-ST-elevation myocardial infarction) patients. Effective shock therapy is impossible without understanding the hemodynamic mechanisms of its occurrence. Many authors emphasize that cardiac output is the most important indicator of cardiac function, which necessitates its monitoring. Meanwhile, the cardiac output monitoring is associated with a number of difficulties, including those related to the technology of recording this function. In this article, the authors emphasize the importance of measuring central hemodynamic parameters in patients with predominantly cardiogenic shock. We have tried to structure the knowledge about different techniques of central hemodynamics monitoring, considered advantages and disadvantages of each of them. We believe that the data obtained by hemodynamic monitoring should be closely studied and used, because sometimes multidirectional mechanisms may be involved in the genesis of shock; therefore, therapy should be based on the data obtained in a particular patient.

Кардиогенный шок – патология, с которой чаще всего сталкиваются врачи-реаниматологи. Частота его составляет в среднем 4–10% у пациентов с STEMI (коронарный синдром с подъемом сегмента ST) и 2–4% – с NONSTEMI (коронарный синдром без подъема сегмента ST). Эффективная терапия шока невозможна без понимания гемодинамических механизмов его возникновения. Многие авторы подчеркивают, что сердечный выброс является важнейшим показателем функции сердца, что обусловливает необходимость его мониторинга. Между тем именно мониторинг сердечного выброса сопряжен с рядом трудностей, в том числе связанных с технологией регистрации этой функции. В статье авторы акцентируют внимание на важности измерения показателей центральной гемодинамики у больных преимущественно кардиогенным шоком. Мы попытались структурировать знания о различных методиках мониторинга центральной гемодинамики, рассмотрели преимущества и недостатки каждой из них. Считаем, что нужно пристально изучать и использовать данные, полученные с помощью мониторинга гемодинамики, поскольку иногда в генезе шока могут принимать участие разнонаправленные механизмы, следовательно, терапия должна отталкиваться от полученных данных конкретного пациента.

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