medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-14-88-95medsovet-6431Research ArticleАНТИТРОМБОТИЧЕСКАЯ ТЕРАПИЯANTITHROMBOTIC THERAPYВосьмилетнее наблюдение успешного исхода массивной тромбоэмболии легочной артерии с кардиогенным шоком8-year follow-up of a successful outcome of massive pulmonary embolism with cardiogenic shockhttps://orcid.org/0000-0003-4168-1853СемиголовскийН. Ю.SemigolovskiiN. Yu.

Семиголовский Никита Юрьевич, д.м.н., профессор кафедры пропедевтики внутренних болезней; заведующий отделением реанимации и интенсивной терапии (кардиореанимации)

194291, Санкт- Петербург, проспект Культуры, д. 4

199034, Россия, Санкт- Петербург, Университетская наб., д. 7–9

Nikita Yu. Semigolovskii, Dr. Sci. (Med.), Professor of Department of Internal Diseases Propedeutics; Head of Resuscitation and Intensive Care Unit (Cardiac Intensive Care)

4, Kultury Ave.,St Petersburg, 194291

7–9, Universitetskaya Emb., St Petersburg, 199034

semigolovski@yandex.ruhttps://orcid.org/0000-0002-1915-2237МазуренкоС. О.MazurenkoS. O.

Мазуренко Сергей Олегович, д.м.н., профессор, заведующий кафедрой пропедевтики внутренних болезней

199034, Россия, Санкт- Петербург, Университетская наб., д. 7–9

Sergey O. Mazurenko, Dr. Sci. (Med.), Professor, Head of Department of Internal Diseases Propedeutics

7–9, Universitetskaya Emb., St Petersburg, 199034

dr_mazurenko@mail.ruhttps://orcid.org/0000-0001-8572-1023ШабалинаМ. О.ShabalinaM. O.

Шабалина Марина Олеговна, к.м.н., ассистент кафедры пропедевтики внутренних болезней

199034, Россия, Санкт- Петербург, Университетская наб., д. 7–9

Marina O. Shabalina, Cand. Sci. (Med.), Teaching Assistant of Department of Internal Diseases Propedeutics

7–9, Universitetskaya Emb., St Petersburg, 199034

marina.shabalina.1956@mail.ruhttps://orcid.org/0000-0002-8017-3395СемиголовскийС. Н.SemigolovskiiS. N.

Семиголовский Савва Никитович, сердечно-сосудистый хирург

190031, Санкт- Петербург, Спасский пер., д. 14/35

Savva N. Semigolovskii, Cardiovascular Surgeon

14/35, Spassky Lane, St. Petersburg, 190031

semigolovski@yandex.ruКлиническая больница №122 Северо- Западного окружного научно-клинического центра имени Л.Г. Соколова; Санкт-Петербургский государственный университетРоссияClinical Hospital No. 122 of the North- Western District Scientific and Clinical Center named after L.G. Sokolov; St Petersburg State UniversityRussian FederationСанкт- Петербургский государственный университетРоссияSt Petersburg State UniversityRussian FederationХирургия Гранд МедРоссияGrandMed SurgeryRussian Federation2021171020210148895Copyright © Семиголовский Н.Ю., Мазуренко С.О., Шабалина М.О., Семиголовский С.Н., 20212021Семиголовский Н.Ю., Мазуренко С.О., Шабалина М.О., Семиголовский С.Н.Semigolovskii N.Y., Mazurenko S.O., Shabalina M.O., Semigolovskii S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6431

Тромбоэмболия легочной артерии (ТЭЛА) в настоящее время находится уже на 3-м месте по частоте встречаемости среди сосудистых заболеваний, причем отмечается мировая тенденция к росту ее частоты. ТЭЛА рассматривается и как самая частая причина предотвратимой смерти в  больнице. В  странах Европы, Азии и  США наметилась тенденция к  снижению случаев фатальной ТЭЛА вследствие использования более эффективной консервативной терапии, инвазивных вмешательств и следования рекомендациям. С 2019 г. европейские рекомендации по диагностике и лечению ТЭЛА сделали использование прямых оральных антикоагулянтов более предпочтительными в сравнении с оральными антагонистами витамина К. Рассматривается случай больной 42 лет с массивной ТЭЛА, развившейся в профильном отделении больницы вскоре после перевода из отделения реанимации с верифицированной ТЭЛА мелких ветвей (Д-димер, сцинтиграфия легких, эхокардиография). Дебют массивной ТЭЛА в виде синкопального состояния с кардиогенным шоком потребовал срочного перевода больной на  искусственную вентиляцию легких (ИВЛ), использования вазопрессоров и  проведения системного тромболизиса. При эхокардиографии лоцирован подвижный тромб в  правом предсердии. Выполнена экстренная тромбэктомия из  легочного ствола и легочных артерий в условиях искусственного кровообращения, позже установлен кава-фильтр. Анализируются характерные для ТЭЛА особенности анамнеза (гормональные контрацептивы), жалобы (внезапная одышка, тяжесть за грудиной при поступлении) и сопутствующая патология (медикаментозный тиреотоксикоз). Рассматриваются итоги последующего 8-летнего наблюдения без рецидивов ТЭЛА, особенностью которого было использование ривароксабана в качестве антикоагулянта и ангиовита (витамины группы В – В6, В9 и В12) с целью коррекции наследственной гипергомоцистеинемии. Обсуждаются факторы риска и современные стандарты лечения массивной ТЭЛА в остром периоде и в отдаленной перспективе.

Currently pulmonary embolism (PE) is already on the 3rd place in terms of the frequency of occurrence among vascular diseases, and there is a global trend towards an increase in its frequency. PE is also considered as the most common cause of preventable death in the hospital. In the countries of Europe, Asia and the USA, there is a tendency to reduce the cases of fatal PE due to the  use of  more effective conservative therapy, invasive interventions and following the  Recommendations. Since 2019, the European Guidelines for the diagnosis and treatment of PE have made the use of direct oral anticoagulants preferable in comparison with oral vitamin K antagonists.A case of massive PE in a 42-year-old patient developed in the specialized department of the hospital shortly after being transferred from the intensive care unit with verified PE of small branches (D-dimer, lung scintigraphy, Echo-cardiography) is presented. The debut of a massive PE in the form of a syncopal state with cardiogenic shock, required an urgent transfer of the patient to artificial lung ventilation, the use of vasopressors and systemic thrombolysis. During Echo-cardiography, a mobile blood clot was located in the right atrium. An emergency thrombectomy was performed from the pulmonary trunk and pulmonary arteries in conditions of artificial blood circulation, later a cava filter was installed. The features of anamnesis characteristic of PE (hormonal contraceptives), complaints (sudden shortness of breath, heaviness behind the sternum at admission) and concomitant pathology (drug-induced thyrotoxicosis) are analyzed.The  results of  the  subsequent 8-year follow-up without relapses of  PE are considered, the  feature of  which was the  use of Rivaroxaban as an anticoagulant and angiovit (B vitamins – 6, 9 and 12) for the correction of hereditary hyperhomocysteinemia. Risk factors and modern standards of treatment of massive PE in the acute period and in the long term are discussed.

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The authors declare that there are no conflicts of interest present.