Hirurško lečenje bolesnika sa trosudovnom koronarnom bolesti, koji su različito tretirani u akutnom infarktu, izazvanim okluzijom desne koronarne arterije

Abstract

Ishemijska bolest srca je od strane Svetske zdravstvene organizacije (SZO) definisana kao "oštećenje srca, akutno ili hronično, koje nastaje zbog smanjenja ili prestanka dotoka krvi u srčani mišić, kao posledica patoloških promena u koronarnim arterijama". Nastaje usled neadekvatnog odnosa između potrebe i snabdevenosti srčanog mišića krvlju. Prema podacima SZO, svake godine u svetu umire od kardiovaskularnih bolesti 17 miliona ljudi, što čini oko 30% ukupnog mortaliteta. Od toga, kod 43% bolesnika uzrok smrti je koronarna bolest. Razumljiv je pojačan interes za njeno izučavanje, blagovremenu prevenciju, ranu dijagnozu i adekvatno lečenje. Bolest je višestruki problem za privredu svake zemlje. Prvo, pogađa najproduktivniji deo stanovništva petu i šestu deceniju, sa tendencijom obolevanja u četvrtoj deceniji, dovodeći do njihovog odsustva sa posla. Drugo, dovodi do invalidnosti, delimične ili potpune nesposobnosti za rad. Treće, savremeno lečenje je veliki trošak za budţet svake zemlje. Akutni infarkt miokarda (AIM) je jedan od vodećih kliničkih problema, kako u smislu tretmana, tako i u organizaciji zdravstvene sluţbe, širom sveta. Stalni porast akutnih formi ishemijske bolesti srca, njegov maligni potencijal, visoka stopa smrtnosti i invaliditeta preţivelih, svrstava ovo oboljenje u najvaţnije probleme društva. Osim direktnog učinka savremenih terapijskih postupaka, na tok i prognozu AIM utiču i mere organizacije zdravstvene sluţbe. Rano pronalaţenje obolelih od AIM i dobra komunikacija primarne, sekundarne i tercijarne zdravstvena sluţbe. U poslednje tri decenije intrahospitalni mortalitet zbog AIM je značajno smanjen. Primena reperfuzione terapije, ponovno uspostavljanje protoka kroz koronarnu arteriju, pre nego što se razvila kompletna nekroza, je revolucionarno promenilo prognozu bolesnika sa AIM...

According to World Health Organisation (WHO), ischemic heart disease is acute or chronic heart damage, caused by the reduction or cessation of blood flow to the heart muscle, as a consequence of pathological changes of the coronary arteries. The disease occurs due to improper relationship between need and supply of the heart muscle with blood. According to the WHO, each year, worldwide, 17 million people die from cardiovascular disease, which is about 30% of total mortality. Of these, in 43% of the patients the cause of death was coronary heart disease. Therefore, the growing interest in the study, timely prevention, early diagnosis and adequate treatment is understandable. Coronary heart disease is a multiple problem for the economy of each country. First, the most productive segment of the population, in fifth and sixth decade is affected, with the tendency of the disease in the fourth decade. This leads to their absence from the work. Second, the disease causes disability and partial or complete inability to work. Third, modern treatment is a major expense for the budget of each country. Acute myocardial infarction (AMI) is a major clinical problem, both in terms of treatment, and in the organization of health services, around the world. The constant increase of the acute forms of ischemic heart disease, its malignant potential, high rates of mortality and disability, classifies this disease in the most important problems of the society. Besides direct effect of the modern therapy, course and prognosis of AMI depend on health services organisation. Early diagnosis of AMI and good communication between primary, secondary and tertiary health services??. In the last three decades, hospital mortality after AMI is significantly reduced. Administration of the reperfusion therapy and restoration of the blood flow through the coronary artery, before complete necrosis developed, revolutionary changed the prognosis in patients with AMI...