Американские рекомендации по коронарному шунтированию 2011 года

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<ul><li><p> 1 </p><p>2011 </p></li><li><p> 2 </p><p> . - , 2011. </p><p> , , -</p><p> - , : L. David Hillis, Peter K. Smith, Jeffrey L. Anderson, John A. Bittl, Charles R. </p><p>Bridges, John G. Byrne, Joaquin E. Cigarroa, Verdi J. DiSesa, Loren F. Hiratzka, </p><p>Adolph M. Hutter, Jr, Michael E. Jessen, Ellen C. Keeley, Stephen J. Lahey, Richard A. </p><p>Lange, Martin J. London, Michael J. Mack, Manesh R. Patel, John D. Puskas, Joseph F. </p><p>Sabik, Ola Selnes, David M. Shahian, Jeffrey C. Trost, and Michael D. Winniford </p><p>Nallamothu, Henry H. Ting </p><p> 7 2011 . :10.1016/j.jacc.2011.08.009 </p><p> 15 2011 . </p><p> : http://content.onlinejacc.org/cgi/content/full/j.jacc.2011.08.007v1 </p><p> ACCF/AHA/ 2011 </p><p> - . </p><p> , - - </p><p> * L. David Hillis, MD, FACC, </p><p>K. Smith, MD, FACC, -* </p><p>Jeffrey L. Anderson, MD, FACC, FAHA* John A. Bittl, MD, FACC Charles R. Bridges, MD, SCD, FACC, </p><p>FAHA* John G. Byrne, MD, FACC Joaquin E. Cigarroa, MD, FACC Verdi J. DiSesa, MD, FACC Loren F. Hiratzka, MD, FACC, FAHA Adolph M. Hutter, JR, MD, MACC, FAHA Michael E. Jessen, MD, FACC* Ellen C. Keeley, MD, MS </p><p>Stephen J. Lahey, MD Richard A. Lange, MD, FACC, </p><p>FAHA Martin J. London, MD| </p><p>Michael J. Mack, MD, FACC* Manesh R. Patel, MD, FACC John D. Puskas, MD, FACC* Joseph F. Sabik, MD, FACC*# </p><p>Ola Selnes, PHD David M. Shahian, MD, FACC, </p><p>FAHA** </p><p>Jeffrey C. Trost, MD, FACC* Michael D. Winniford, MD, FACC </p><p>* , </p></li><li><p> 3 </p><p> , - , ; . 1 . ACCF/AHA.. ACCF/AHA - . - || - . - # - ** ACCF/AHA . </p><p> ACCF/AHA Alice K. Jacobs, MD, FACC, FAHA, Jeffrey L. Anderson, MD, FACC, FAHA, Nancy Albert, PHD, CCNS, CCRN, FAHA </p><p>Mark A. Creager, MD, FACC, FAHA </p><p>Steven M. Ettinger, MD, FACC, Robert A. Guyton, MD, FACC Jonathan L. </p><p>Halperin, MD, FACC, FAHA Judith S. Hochman, MD, FACC, FAHA Frederick G. </p><p>Kushner, MD, FACC, FAHA E. Magnus Ohman, MD, FACC William Stevenson, </p><p>MD, FACC, FAHA Clyde W. Yancy, MD, FACC, FAHA </p><p> - , - - 2011 ., - 2011 . - 2011 . </p><p> - : Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, DiSesa VJ, Hiratzka LF, </p><p>Hutter AM Jr, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, </p><p>Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 </p><p>ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American </p><p>College of Cardiology Foundation/American Heart Association Task Force on Practice </p><p>Guidelines. J Am Coll Cardiol 2011;58:xxxxxx. Circulation. : -</p><p> (www.cardiosource.org) (my.americanheart.org) . , , Elsevier Inc., (212) 633-3820, . : reprints@elsevier.com. </p><p> : , , , - / - . . : healthpermissions@ elsevier.com. </p></li><li><p> 4 </p><p>: 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association </p><p>Task Force on Practice Guidelines. J Am Coll Cardiol 2011;58:xxxxxx. </p><p> - - : www.npsaik.ru </p><p> : : ... .. ... .. .. ... .. .. .. .. </p><p> , , - - : - . , - , - , , 1999 . - ; - ; - - ; -. </p><p> , -, , . </p></li><li><p> 5 </p><p>: </p><p> .................................................................................................... 6 ................................................................................................................ 7 1. .............................................................................................................. 15 1.1. .................................................................... 15 1.2. ...................................................................... 16 1.3. ................................................................... 16 2. ....................................................................... 16 2.1. ........................................................................ 16 2.1.1. : ............................................................................ 16 2.1.2. ................................................................. 21 2.1.3. ..................................................................................... 22 2.1.4. : ...................................................................... 25 2.1.4.1. ........................................................................ 25 2.1.4.2. ................................................................... 26 2.1.4.3. , - ......... 28 2.1.5. .............................................................................................. 28 2.1.6. ................................................................. 29 2.1.7. : ......................................................................................................... 30 2.1.8. / : ......................................................................................................... 33 2.2. .......................... 35 2.2.1. : ............ 35 2.2.2. : ................... 39 2.2.3. : ....................... 40 2.2.4. : .......................................................................... 41 3. ............................................................................... 42 3.1. : ................................................ 43 3.2. : ...... 48 3.3. : ............ 50 3.4. ...................... 51 3.5. ........................................... 52 3.6. ................................................................................... 53 3.6.1. BMS .... 53 3.6.2. DES ....................................................... 54 3.7. ................................ 56 3.7.1. .......................................................................................... 56 3.7.2. .......................................... 56 </p></li><li><p> 6 </p><p>3.7.3. ....................................... 58 3.8. ......................................................... 59 3.9. , - ..................................................................................... 59 3.9.1. .......................................................................................... 59 3.9.2. ......................................................................... 60 3.9.3. .......................................................................... 60 3.9.4. .................................................................. 61 3.9.5. ............................................................................... 62 3.9.6. / ST ........................................................................................ 62 3.9.7. : .................. 62 3.10. ................................................................................................... 63 3.11. : ........................ 63 4. ............................................................................... 65 4.1. : ..................... 65 4.2. : ............ 67 4.3. : ..................................................... 68 4.3.1. ................................................. 70 4.3.1.1. ................................................................ 70 4.4. : .............................. 71 4.4.1. ........................................................................................ 71 4.4.2. .............................................. 73 4.4.3. ................................................................... 74 4.5. -: ............. 74 4.6. /: ......................................................... 76 4.7. : .......................................................... 77 4.8. : ......................................................................................... 79 4.8.1. ...... 80 4.8.2. , ....................................... 81 4.9. : ......................................... 81 4.10. .................................................................. 83 4.10.1. : ...................... 83 4.10.2. : ................................... 83 4.10.3. : ................. 84 5. , : ............................................................................ 86 5.1. : ............................................................................ 86 5.1.1. : ....................................................... 88 </p></li><li><p> 7 </p><p>5.2. ...................................................................................................... 90 5.2.1. ................................................... 90 5.2.1.1. ...................................... 91 5.2.1.1.2. : ...................................................................................... 92 5.2.1.2. ...................................................................................................... 95 5.2.1.3. ....................................... 95 5.2.2. / : ......................................................................................................... 96 5.2.3. : ............................................. 100 5.2.4. : ......... 102 5.2.4.1. : ........................................................ 104 5.2.5. : ............... 104 5.2.6. /: ..... 106 6. ............................................................................... 108 6.1. ....................................................................................... 108 6.2. ....................................................................................................... 109 6.3. .................................................................. 110 6.4. : ......................................... 112 6.5. / : ................................... 113 6.6. , : .................................................... 115 6.7. : ....................................................................................................... 116 6.8. : .............................. 116 6.8.1. ................................................................. 116 6.8.2. ................................................................................... 117 6.8.3. ......................................................................... 117 6.9. ........................................................... 118 6.10. ............................... 118 7. .................................................................................. 119 7.1. ........................................................................... 119 7.1.1. .................................................... 120 7.1.2. DES ........................................... 121 8. ............................................................. 121 8.1. / ...................................................................................... 123 8.2. ............................................................................. 123 8.3. : ...................................................... 124 ....................................................................................................................... 125 .............................................................................................. 126 </p></li><li><p> 8 </p><p> - - ( - P2Y12) ST ST ST - ST - -, - (hazard ratio) - - </p><p> - - - - - </p><p>AHA - ACCF American College of Cardiolo-gy ( -) BMS (baremetal stents) DES - (drugeluting stents) GP IIbIIIa IIbIIIa FDA - (Food and Drug Administration) </p><p> major adverse cardiac events ( ) </p></li><li><p> 9 </p><p> , , - , . , , - . , - . , , -, - , , - . </p><p> (ACCF) (AHA) 1980. ACCF AHA, - , - . - . </p><p> ACCF AHA . - , - ; , . - , -, , . , , - , - . </p><p> , - , , (1). - - / , - () / , - , . () . - : A, B , -</p></li><li><p> 10 </p><p> 1. , , -, , . , - , C. -, C, ( ), . , - C, - . 1, - . </p><p> III - (): . , - , I II ( A B) - - . </p><p> - , () - ACCF/AHA ( , - I). . </p><p> ACCF/AHA - , , , . , -, , - , - . </p><p> ACCF/AHA - , - , . . - , . , - , . - . -, -</p></li><li><p> 11 </p><p> , - . , - ; . </p><p> , , . , - - , - , - - . , -, , , IIa IIb, - . </p><p> , - , , - . - , , , 12 . 2009 ACCF AHA - (RWI), - 50% (. 1 ). - - / . - - . , , - . , , , 1. , , - 1 2, . , , , , - , - , -. : www.cardiosource.org/ACC/About-ACC/Leadership/ Guidelines-and-Documents-Task-Forces.aspx. </p></li><li><p> 12 </p><p> 1 </p><p> I IIa IIb III III &gt;&gt;&gt; &gt;&gt; </p><p> - . </p><p> - - ; </p><p> / / -. </p><p> / . </p><p> - / . </p><p> / </p><p> III - - </p><p> - </p><p> III </p><p> A * - - - </p><p> , / . - -, - -. </p><p> , / -. - , - - -. </p><p> / - -. - - , - -. </p><p> , - - / . , -. </p><p> -</p><p> -</p><p> B , / , </p></li><li><p> 13 </p><p> - -* - - </p><p> / . , - - - . </p><p> , - / . , - - -. </p><p> - . - , - - . </p><p> / -. , . </p><p> - -* , </p><p> , / . -, . </p><p> , - / . , - . </p><p> / . , - . </p><p> , / -. , - . </p><p> -: </p><p> / / - </p><p> / / / , </p><p> / / / / / </p><p> III _________ </p><p> -, , / - / .. / / </p><p> III </p><p>___________ </p><p> -, , - / - / - </p><p> # </p><p>/ / - - B , , </p><p> / , , - B , , </p></li><li><p> 14 </p><p> B C . , , - . . </p><p>*, , - / , , , , , -. </p><p># ( I IIa; A B) , . </p><p> ACCF AHA . . </p><p> -, . -, , - ( PubMed). </p><p> 2011. : , : (Finding What Works in Health Care: Standards for Systematic Reviews) - , (Clinical Practice Guidelines We Can Trust) (2,3). , ACCF/AHA , , . , - . </p><p> , . ACCF AHA. </p><p> . (Alice K. Jacobs), MD, ACCF, AHA, - ACCF AHA </p></li><li><p> 15 </p><p>1. 1.1. </p><p> , , , , . - , 10 2011., 2011. , , - . , , , , : analgesia, anastomotic techniques, antiplatelet agents, automated proximal clampless anastomosis device, asymptomatic ischemia, Cardica C-port, cost effective-</p><p>ness, depressed left ve...</p></li></ul>

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