Стратегия диагностики и лечения ишемической болезни сердца в торако-абдоминальной онкохирургии
Показатель 1-летней выживаемости больных злокачественнымиI новообразованиями торако-абдоминальной локализации при сопутствующей ИБС определяется в том числе индексом летальности онкологических заболеваний (до 95%) и летальностью вследствие ИБС (2%). Несмотря на низкие ожидаемые расчетные показатели^ продолжительности жизнипредставляется возможным. предотвратить терапевтические (кардиологические… Читать ещё >
Содержание
- ГЛАВА 1. ОБЗОР ЛИТЕРАТУРЫ
- 1. 1. СОСТОЯНИЕ ДИАГНОСТИКИ И ЛЕЧЕНИЯ СОЧЕТАННЫХ ОНКОЛОГИЧЕСКИХ И СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ
- 1. 2. ФАКТОРЫ РИСКА ПОСЛЕОПЕРАЦИОННЫХ СЕРДЕЧНОСОСУДИСТЫХ ОСЛОЖНЕНИЙ И ЛЕТАЛЬНЫХ ИСХОДОВ, ОБУСЛОВЛЕННЫХ СОПУТСВУЮЩЕЙ ИБС, У БОЛЬНЫХ ХИРУРГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ. МЕТОДИКИ ОЦЕНКИ ОПЕРАЦИОННОГО РИСКА
- 1. 3. ПРЕДОПЕРАЦИОННАЯ ДИАГНОСТИКА ИБС ПРИ СОЧЕТАННЫХ КАРДИОЛОГИЧЕСКИХ И НЕ КАРДИОЛОГИЧЕСКИХ ЗАБОЛЕВАНИЯХ
- 1. 4. ВОЗМОЖНОСТИ ПРЕДОПЕРАЦИОННОЙ ТЕРАПЕВТИЧЕСКОЙ ПОДГОТОВКИ ДЛЯ УСТРАНЕНИЯ ПРОЯВЛЕНИЙ- И ОСЛОЖНЕНИЙ ИБС. КОРРЕКЦИЯ СОСТОЯНИЙ, ОТЯГОЩАЮЩИХ ЕЕ ТЕЧЕНИЕ
- 1. 5. РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ, ПРОДОЛЖИТЕЛЬНОСТЬ ЖИЗНИ, ИЗЛЕЧЕННОСТЬ БОЛЬНЫХ ПРИ СОЧЕТАННЫХ ОНКОЛОГИЧЕСКИХ И КАРДИОЛОГИЧЕСКИХ ЗАБОЛЕВАНИЯХ
- ВЫВОДЫ К ГЛАВЕ 1
- ГЛАВА 2. ОБЩАЯ ХАРАКТЕРИСТИКА БОЛЬНЫХ, ДИАГНОСТИЧЕСКИХ И ЛЕЧЕБНЫХ МЕТОДОВ
- 2. 1. ЧИСЛО НАБЛЮДЕНИЙ, АНАЛИЗИРУЕМЫЕ ГРУППЫ, 67 СТАТИСТИЧЕСКАЯ ОБРАБОТКА МАТЕРИАЛОВ ИССЛЕДОВАНИЯ
- 2. 1. 1. Число наблюдений исследования
- 2. 1. 2. Анализируемые группы (группы сравнения)
- 2. 1. 2. 1. Группы сравнения в оценке переносимости хирургических вмешательств
- 2. 1. 2. 2. Группы сравнения в оценке эффективности предоперационной подготовки
- 2. 1. 3. Статистическая обработка материалов исследования
- 2. 2. РАСПРОСТРАНЕННОСТЬ ОПУХОЛЕВОГО ПРОЦЕССА, ОБЩАЯ ХАРАКТЕРИСТИКА ЛЕЧЕНИЯ ЗЛОКАЧЕТСВЕННЫХ НОВООБРАЗОВАНИЙ ТОРАКО-АБДОМИНАЛЬНОЙ ЛОКАЛИЗАЦИИ
- 2. 3. ХАРАКТЕРИСТИКА ОБЩЕГО СОСТОЯНИЯ ПАЦИЕНТОВ- ПОЛ И ВОЗРАСТ БОЛЬНЫХ
- 2. 4. ВЫРАЖЕННОСТЬ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА КАК СОПУТСТВУЮЩЕГО ЗАБОЛЕВАНИЯ
- 2. 5. МЕТОДЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ СОПУТСТВУЮЩЕЙ ИБС
2.5.1. Методы диагностики ИБС (оценка факторов риска ИБС и ее осложнений- ЭКГ покоя и амбулатороное ЭКГ-мониторирование- ЭКГ-проба с физической нагрузкой- трансторакальная эхокардиография- коронароангиография).
2.5.2. Методы диагностики осложнений ИБС и коморбидных состояний (шкала оценки клинического состояния при ХСН (ШОКС) — шестиминутный тест ходьбы (6-МТХ) — определение плазменного маркера сердечной недостаточности МТргоВЫР- исследование вентилляционной и диффузионной функции легких, измерение газов крови и кислотно-щелочного состояния- психологическое тестирование).
2.5.3. Характеристика предоперационной подготовки и лечения при сопутствующей ИБС.
ОБСУЖДЕНИЕ.
ВЫВОДЫ К ГЛАВЕ 2.
ГЛАВА 3. АЛГОРИТМ ПРЕДОПЕРАЦИОННОЙ ДИАГНОСТИКИ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА И ФАКТОРЫ РИСКА ВЕРОЯТНЫХ ПОСЛЕОПЕРАЦИОННЫХ СЕРДЕЧНОСОСУДИСТЫХ ОСЛОЖНЕНИЙ.
3.1. ПРЕДВАРИТЕЛЬНАЯ ДИАГНОСТИКА ИБС (ВЫЯВЛЕНИЕ ТРАДИЦИОННЫХ ФАКТОРОВ СЕРДЕЧНО-СОСУДИСТОГО РИСКА).
3.2. ОБЯЗАТЕЛЬНАЯ ДИАГНОСТИКА ИБС (ВЫПОЛНЕНИЕ СТАНДАРТНЫХ ИНСТРУМЕНТАЛЬНЫХ МЕТОДОВ ИССЛЕДОВАНИЯ).
3.3. ДОПОЛНИТЕЛЬНАЯ ДИАГНОСТИКА ИБС И КОМОРБИДНЫХ СОСТОЯНИЙ (ПРОВЕДЕНИЕ НЕ ИНВАЗИВНЫХ И ИНВАЗИВНЫХ МЕТОДОВ ДИАГНОСТИКИ СОСТОЯНИЯ КРОВОСНАБЖЕНИЯ МИОКАРДА).
3.3.1. Не инвазивные методы диагностических исследований.
3.3.2. Инвазивные методы диагностических исследований.
3.3.3. Диагностика коморбидных состояний.
3.4. ОЦЕНКА ВЛИЯНИЯ ФАКТОРОВ РИСКА ПОСЛЕОПЕРАЦИОННЫХ СЕРДЕЧНО-СОСУДИСТЫХ ОСЛОЖНЕНИЙ НА РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ 127 3.4.1. Оценка влияния факторов риска послеоперационных сердечнососудистых осложнений на результаты хирургического лечения по критерию ^.
3.4.2. Уточнение влияния факторов риска послеоперационных сердечно-сосудистых осложнений на результаты хирургического лечения при однофакторном анализе.
3.4.3. Уточнение влияния факторов риска послеоперационных сердечно-сосудистых осложнений на результаты хирургического лечения больных злокачественными новообразованиями торако-абдоминальной локализации и сопутствующей ИБС по результатам многофакторного анализа.
ОБСУЖДЕНИЕ.
ВЫВОДЫ К ГЛАВЕ 3.
ГЛАВА 4. ТЕРАПЕВТИЧЕСКИЕ ВОЗМОЖНОСТИ СОВЕРШЕНСТВОВАНИЯ ПРЕДОПЕРАЦИОННОЙ ПОДГОТОВКИ К ХИРУРГИЧЕСКИМ ВМЕШАТЕЛЬСТВАМ ПО ПОВОДУ ЗЛОКАЧЕСТВЕННЫХ НОВООБРАЗОВАНИЙ ТОРАКО-АБДО-МИНАЛЬНОЙ ЛОКАЛИЗАЦИИ ПРИ СОПУТСТВУЮЩЕЙ ИБС
4.1. СТАНДАРТЫ ТЕРАПЕВТИЧЕСКОЙ ПОДГОТОВКИ К ОПЕРАЦИЯМ ПО ПОВОДУ ОПУХОЛЕЙ ТОРАКО-АБДОМИНАЛЬНОЙ ЛОКАЛИЗАЦИИ ПРИ СОПУТСТВУЮЩЕЙ ИБС.
4.2. НОРМАЛИЗАЦИЯ НАРУШЕНИЙ СЕРДЕЧНОГО РИТМА.
4.3. МЕДИКАМЕНТОЗНОЕ И ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ТЯЖЕЛОЙ ИБС.
4.4. ЛЕЧЕНИЕ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ.
4.5. НОРМАЛИЗАЦИЯ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ.
4.6. КОРРЕКЦИЯ МЕТАБОЛИЧЕСКОГО СИНДРОМА.
4.7 .ПРЕДОПЕРАЦИОННАЯ ПОДГОТОВКА ПРИ
СОПУТСТВУЮЩЕЙ ИБС И ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ.
4.8. ПСИХОЛОГИЧЕСКАЯ КОРРЕКЦИЯ ТРЕВОЖНО-ДЕПРЕССИВ НОГО СОСТОЯНИЯ.
ОБСУЖДЕНИЕ.
ВЫВОДЫ К ГЛАВЕ IV.
ГЛАВА 5. НЕПОСРЕДСТВЕННЫЕ И ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ БОЛЬНЫХ ЗЛОКАЧЕСТВЕННЫМИ НОВООБРАЗОВАНИЯМИ ТОРАКО-АБДОМИНАЛЬНОЙ ЛОКАЛИЗАЦИИ ПРИ СОПУТСТВУЮЩЕЙ ИБС.
5.1. НЕПОСРЕДСТВЕННАЯ ЛЕТАЛЬНОСТЬ, ЕЕ «ХИРУРГИЧЕСКИЕ» И «ТЕРАПЕВТИЧЕСКИЕ» ПРИЧИНЫ.
5.1.1. Хирургические осложнения.
5.1.2.Терапевтические осложнения.
5.2. ПРОДОЛЖИТЕЛЬНОСТЬ ЖИЗНИ ПОСЛЕ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПО ПОВОДУ ЗЛОКАЧЕСТВЕННЫХ НОВООБРАЗОВАНИЙ ТОРАКО-АБДОМИНАЛЬНОЙ ЛОКАЛИЗАЦИИ И СОПУТСТВУЮЩЕЙ ИБС.
5.3. КАЧЕСТВО ЖИЗНИ, ВОЗМОЖНОСТИ РЕАБИЛИТАЦИИ БОЛЬНЫХ * СОЧЕТАННЫМИ ОНКОЛОГИЧЕСКИМИ И
КАРДИОЛОГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ.
ОБСУЖДЕНИЕ.
ВЫВОДЫ К ГЛАВЕ 5.
- 2. 1. ЧИСЛО НАБЛЮДЕНИЙ, АНАЛИЗИРУЕМЫЕ ГРУППЫ, 67 СТАТИСТИЧЕСКАЯ ОБРАБОТКА МАТЕРИАЛОВ ИССЛЕДОВАНИЯ
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