Острая сердечная недостаточность – критический обзор и адаптация рекомендаций для врачей-терапевтов Европейской федерации внутренней медицины


DOI: https://dx.doi.org/10.18565/therapy.2024.4.8-25

В.А. Кокорин, А. Гонсалес-Франко, А. Читтадини, О. Калейс, В.Н. Ларина, А.М. Марра, Ф.Х. Медрано, З. Монхарт, Л. Морбидони, Ж. Пимента, В. Лесняк

1) ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, г. Москва, Россия; 2) ФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы», г. Москва, Россия; 3) Центральный госпиталь университета Астурии, г. Овьедо, Испания; 4) Университетская больница и медицинский факультет «Федерико II», г. Неаполь, Италия; 5) Рижский университет им. Страдиня, Латвийский кардиологический центр, Клинический университетский госпиталь им. П. Страдиня, г. Рига, Латвия; 6) Клиника грудной патологии при университетском госпитале Гейдельберга, г. Гейдельберг, Германия; 7) Институт биомедицины Севильи (Университетская больница Вирхен дель Росио, Университет Севильи), г. Севилья, Испания; 8) Центр биомедицинских исследований в эпидемиологии и общественном здравоохранении Университета Севильи, г. Севилья, Испания; 9) Госпиталь Зноймо, г. Зноймо, Чешская Республика; 10) Университет Масарика, г. Брно, Чешская Республика; 11) Госпиталь принца Пьемонтского, г. Сенигаллия, Италия; 12) Больничный центр Вила-Нова-де-Гайя/Эшпиньо, г. Вила-Нова-де-Гайя, Португалия; 13) Университет Порту, г. Порту, Португалия; 14) Польский институт доказательной медицины, г. Краков, Польша
Аннотация. В последние два десятилетия проведен ряд исследований, изменивших ведение пациентов с острой сердечной недостаточностью (ОСН) с точки зрения диагностики и лечения. Обновленные международные клинические рекомендации (КР) поддержали результаты этих исследований. Цель данного документа – адаптировать положения существующих КР для помощи врачам-терапевтам в принятии решений относительно сложных сценариев, связанных с ОСН.
Методы. Процедура адаптации заключалась в выявлении нерешенных ключевых клинических вопросов со структурой PICO (популяция, вмешательство, сравнение и исходы) в ведении пациентов с ОСН, с последующей критической оценкой существующих КР и выбором рекомендаций, наиболее применимых к этим специфическим и сложным сценариям.
Результаты. Были идентифицированы 7 ключевых вопросов (PICO) и проведен анализ КР. Не существует единственного метода, позволяющего клиницистам дифференцировать причину острой одышки, застойных явлений или гипоксемии. С этой целью рекомендованы проведение эхокардиографии и оценка уровня натрийуретического пептида, а также может быть рассмотрено проведение рентгенографии органов грудной клетки и ультразвукового исследования легких. Стратегии лечения пациентов с артериальной гипотензией и низким сердечным выбросом включают кратковременную непрерывную внутривенную инотропную поддержку, назначение вазопрессоров, заместительную почечную терапию и временную механическую поддержку кровообращения. Приведены наиболее современные рекомендации по лечению пациентов с ОСН и некоторыми сопутствующими заболеваниями, а также по снижению риска смерти и повторной госпитализации после выписки из стационара. Всего представлена 51 рекомендация с обоснованиями и комментариями.
Заключение. Благодаря использованию надлежащей методологии процесса адаптации этот документ предлагает простые и современные рекомендации для практикующих врачей, занимающихся ведением пациентов с ОСН.

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