Оптимизация внутрибольничной транспортировки кардиохирургических больных

Objective: to optimize the transportation of cardiosurgical patients from the operating-room to an intensive care unit (ICU), by developing and introducing a pathogenetically grounded measure to prevent poor circulatory reactions. Materials and methods. 94 patients operated on under extracorporeal circulation for coronary heart disease and transferred to an ICU for sustained artificial ventilation (AV) during moderate sympathomimetic therapy. The patients were prospectively divided into 2 groups: 1) patients who were transported during sympathomimetic therapy selected by the end of an operation; 2) those who were additionally given dobutamine in a dose of 2—3 (2.5±0.01) ^g/kg/min just before putting them from the operating table to the intensive care bed if this drug was not used, or its dosage was increased by 25% of the administered dose. The patients of the identified groups did not differ in age, severity, and undergone operations. In the groups, the sympathomimetic therapy selected by the end of an operation was virtually identical. Central hemodynamics (CHD) and blood oxygen-transporting function (BOTF) were examined before placing the patients from the operating table to the intensive care bed and after referral to the ICU. During transportation, circulatory parameters were recorded every minute and Holter ECG monitoring was done. Results. During transportation blood pressure significantly elevated, cardiac pump function and BOTF parameters decreased. Holter monitoring demonstrated substantial changes that may reflect the activation of the sympathetic and parasympathetic parts of the autonomic nervous system. The use of dobutamine (Group 2) effectively prevented cardiac depression in the patients transferring to the ICU. Conclusion. During transportation of cardiosurgical patients who are on AV and receive moderate sympathomimetic therapy, there may be a worse cardiac pump function due to a complex of autonomic reactions that alter vascular tone and, possibly, myocardial contractility. Dobutamine-induced enhanced inotropic support may prevent circulatory changes.