ENHANCING INTENSIVE CARE FOR PATIENTS FOLLOWING CORONARY ARTERY BYPASS GRAFTING (LITERATURE REVIEW)

Аннотация

Among the leading causes of death in the adult population, coronary heart disease (CHD) is one of the foremost. Both international and Russian guidelines for the treatment of CHD recommend a collaborative approach when selecting surgical revascularization, particularly coronary artery bypass grafting (CABG). Generally, CABG can be performed using two types of surgical interventions: one with cardiopulmonary bypass (CPB) and cardiac arrest, and another on a beating heart without CPB. The key difference between these approaches lies in the use of CPB and the stoppage of the heart during surgery in the first method, while the second involves surgery on a functioning heart. Both surgical interventions and the use of CPB activate the complement system and trigger the release of cytokines, leading to a systemic inflammatory response. IL-6, IL-1b, and tumor necrosis factor alpha (TNF-a) are the primary mediators of the acute phase of the inflammatory response. Analysis indicates that the early postoperative administration of ulinastatin inhibits the sequestration and activation of neutrophils, reduces the typical postoperative rise in cytokine levels, and alleviates systemic inflammatory response syndrome, pulmonary microvessel permeability, and postoperative pulmonary edema.