Institut neotlozhnoy i vosstanovitel'noy hirurgii im. V. K. Gusaka
Institut neotlozhnoy i vosstanovitel'noy hirurgii im. V. K. Gusaka
Institut neotlozhnoy i vosstanovitel'noy hirurgii im. V. K. Gusaka
Antraciklinovye antibiotiki shiroko primenyayutsya v lechenii onkologicheskih zabolevaniy. Odnako kardiotoksichnost', obuslovlennaya ih primeneniem, v znachitel'noy stepeni limitiruet ih ispol'zovanie. Odnim iz vozmozhnyh patogeneticheskih mehanizmov toksicheskogo ih deystviya na serdce yavlyaetsya disfunkciya simpatoadrenalovoy sistemy. Cel' issledovaniya – izuchenie dinamiki pokazateley variabel'nosti serdechnogo ritma (VSR) u pacientov razlichnyh vozrastnyh grupp, poluchayuschih terapiyu antraciklinami. Material i metody. Obsledovano 155 pacientov (88 muzhchin i 67 zhenschin), ne imevshih patologii serdechno - sosudistoy sistemy v anamneze, poluchavshih antracikliny v sostave razlichnyh shem polihimioterapii po povodu onkogematologicheskih zabolevaniy. Bol'nye byli razdeleny na dve gruppy v zavisimosti ot vozrasta – 1-yu gruppu sostavili 67 bol'nyh v vozraste ot 21 do 44-h let, 2-yu – 88 pacientov v vozraste ot 45 do 74-h let. Pacientam provodilos' sutochnoe monitorirovanie elektrokardiogrammy s posleduyuschey ocenkoy parametrov VSR dvazhdy: do nachala lecheniya i posle okonchaniya antraciklin-soderzhaschey himioterapii. Rezul'taty. Ishodno v processe sutochnogo monitorirovaniya EKG u pacientov razlichnyh vozrastnyh grupp do provedeniya himioterapii byli vyyavleny statisticheski znachimye razlichiya – v starshey vozrastnoy gruppe statisticheskie pokazateli VSR, srednyaya ChSS byli dostoverno nizhe (p<0,05). Pri povtornom monitorirovanii, posle provedeniya polihimioterapii, u molodyh pacientov bylo vyyavleno dostovernoe uvelichenie sredney ChSS i snizhenie VSR v sravnenii s dannymi obsledovaniya do nachala terapii (p<0,05). V starshey vozrastnoy gruppe na fone himioterapii statisticheski znachimyh izmeneniy chastotnyh i vremennyh pokazateley VSR vyyavleno ne bylo (p>0,05). Vyvody. U pacientov molodogo vozrasta antraciklinovye antibiotiki vyzyvayut snizhenie VSR, aktivaciyu simpaticheskoy i ugnetenie parasimpaticheskoy nervnoy sistemy. U pacientov starshey vozrastnoy gruppy antraciklinovye antibiotiki ne okazyvayut vliyaniya na VSR.
chemotherapy, cardiotoxicity, anthracycline-induced cardiomyopathy, heart rate variability
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