pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2022-32-6-854-861pulmo-4152Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESХроническая обструктивная болезнь легких и результаты реваскуляризации миокарда: взаимосвязь с качеством жизниChronic obstructive pulmonary disease and miocardial revascularisation outcomes: relationship with self-reported quality of lifehttps://orcid.org/0000-0001-8488-0858КаменскаяО. В.KamenskayaO. V.

Каменская Оксана Васильевна – доктор медицинских наук, заведующая лабораторией клинической физиологии научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

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Oksana V. Kamenskaya - Doctor of Medicine, Head of Laboratory of clinical physiology, Department of Anesthesiology and Intensive Care, Federal State Budgetary Institution National Medical Research Center named after Academician E.N. Meshalkin, Healthcare Ministry of Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

tel.: (383) 347-60-66

o_kamenskaya@meshalkin.ruhttps://orcid.org/0000-0002-3219-0107ЛогиноваИ. Ю.LoginovaI. Yu.

Логинова Ирина Юрьевна - кандидат биологических наук, старший научный сотрудник лаборатории клинической физиологии научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

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Irina Yu. Loginova - Candidate of Biology, Senior Researcher, Laboratory of clinical physiology, Department of Anesthesiology and Intensive Care, Federal State Budgetary Institution National Medical Research Center named after Academician E.N. Meshalkin, Healthcare Ministry of Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

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i_loginova@meshalkin.ruhttps://orcid.org/0000-0003-2845-930XКлинковаА. С.KlinkovaA. S.

Клинкова Ася Станиславовна – кандидат медицинских наук, научный сотрудник лаборатории клинической физиологии научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

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Asya S. Klinkova - Candidate of Medicine, Researcher, Laboratory of clinical physiology, Department of Anesthesiology and Intensive Care, Federal State Budgetary Institution National Medical Research Center named after Academician E.N. Meshalkin, Healthcare Ministry of Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

tel.: (383) 347-60-66

a_klinkova@meshalkin.ruhttps://orcid.org/0000-0002-0061-2205ПоротниковаС. С.PorotnikovaS. S.

Поротникова Светлана Сергеевна - младший научный сотрудник лаборатории клинической физиологии научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

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Svetlana S. Porotnikova - Junior Researcher, Laboratory of Clinical Physiology, Research Department of Anesthesiology and Intensive Care, Federal State Budgetary Institution National Medical Research Center named after Academician E.N. Meshalkin, Healthcare Ministry of Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

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porotnikova_s@meshalkin.ruhttps://orcid.org/0000-0001-8591-6461ЛомиворотовВ. Н.LomivorotovV. N.

Ломиворотов Владимир Николаевич - доктор медицинских наук, профессор, руководитель научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

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Vladimir N. Lomivorotov - Doctor of Medicine, Professor, Head of the Department of Anesthesiology and Intensive Care, Federal State Budgetary Institution National Medical Research Center named after Academician E.N. Meshalkin, Healthcare Ministry of Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

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v_lomivorotov@meshalkin.ruhttps://orcid.org/0000-0003-2399-563XЛомиворотовВ. В.LomivorotovV. V.

Ломиворотов Владимир Владимирович - доктор медицинских наук, профессор, член-корреспондент Российской академии наук, главный научный сотрудник научно-исследовательского отдела анестезиологии и реаниматологии.

630055, Новосибирск, ул. Речкуновская, 15

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Vladimir V. Lomivorotov - Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Head Researcher of the Department of Anesthesiology and Intensive Care, Federal State Budgetary Institution National Medical Research Center named after Academician E.N.Meshalkin, Healthcare Ministry of Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

tel.: (383) 347-60-66

vv_lomivorotov@meshalkin.ruhttps://orcid.org/0000-0001-9818-8678ЧернявскийА. М.CherniavskyA. M.

Чернявский Александр Михайлович – доктор медицинских наук, профессор, член-корр. Российской академии наук, генеральный директор.

630055, Новосибирск, ул. Речкуновская, 15

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Alexander M. Chernyavsky - Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Director, Federal State Budgetary Institution National Medical Research Center named after Academician E.N. Meshalkin, Healthcare Ministry of Russian Federation.

Rechkunovskaya ul. 15, Novosibirsk, 630055

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a_cherniavsky@meshalkin.ruНациональный медицинский исследовательский центр имени академика Е.Н. Мешалкина Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Institution National Medical Research Center named after Academician E.N. Meshalkin, Healthcare Ministry of Russian FederationRussian Federation202212122022326854861Copyright © Каменская О.В., Логинова И.Ю., Клинкова А.С., Поротникова С.С., Ломиворотов В.Н., Ломиворотов В.В., Чернявский А.М., 20222022Каменская О.В., Логинова И.Ю., Клинкова А.С., Поротникова С.С., Ломиворотов В.Н., Ломиворотов В.В., Чернявский А.М.Kamenskaya O.V., Loginova I.Y., Klinkova A.S., Porotnikova S.S., Lomivorotov V.N., Lomivorotov V.V., Cherniavsky A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/4152

Целью исследования явилась оценка влияния хронической обструктивной болезни легких (ХОБЛ) на результаты реваскуляризации миокарда (РМ) и качество жизни (КЖ) пациентов в долгосрочном периоде наблюдения. Материалы и методы. В проспективное когортное исследование включены пациенты (n = 454) с ишемической болезнью сердца, госпитализированные для проведения плановой РМ. Период наблюдения составил 3 года после вмешательства. До хирургического лечения у пациентов проводились легочные функциональные тесты. Диагноз ХОБЛ верифицирован в соответствии с критериями Глобальной инициативы диагностики лечения и профилактики ХОБЛ (Global Initiative for Chronic Obstructive Lung Disease (GOLD)). Оценка КЖ проводилась до и через 3 года после хирургического вмешательства по данным опросника SF-36. Результаты. Диагноз ХОБЛ верифицирован в 14,5 % случаев. Смертность при 3-летнем наблюдении после РМ составила 5 % со значительным преобладанием среди пациентов с ХОБЛ. Независимо от наличия ХОБЛ, исходно сниженный уровень КЖ отмечен у всех кардиохирургических пациентов по шкале SF-36 (физический и психоэмоциональный компоненты КЖ). Установлено значимое негативное влияние ХОБЛ на динамику КЖ после РМ по шкале физического компонента КЖ (отношение шансов (ОШ) — 0,95 (0,91—0,99); р = 0,043). Предикторами отсутствия положительной динамики КЖ также явились такие показатели, как объем форсированного выдоха за 1-ю секунду (ОШ — 1,02 (1,00—1,07); р = 0,048) и впервые возникшая в раннем послеоперационном периоде фибрилляция предсердий (ОШ - 0,54 (0,33-0,88); р = 0,036). В данном исследовании не показано значимой связи ХОБЛ с динамикой психоэмоционального компонента КЖ. Заключение. У пациентов, перенесших РМ, ХОБЛ оказывает независимое негативное влияние на клинический исход, включая выживаемость и КЖ (физический компонент здоровья), при этом подчеркивается важность предоперационной оценки функции внешнего дыхания у пациентов кардиохирургического профиля.

Aim. To assess the impact of chronic obstructive pulmonary disease (COPD) on the outcomes of myocardial revascularisation and the self-reported quality of life (QoL) during long-term follow-up. Methods. This prospective cohort study included 454 consecutive patients who underwent scheduled myocardial revascularisation. The follow-up continued for 3 years after the surgery. All patients underwent pulmonary functional tests before the surgery. The diagnosis of COPD was verified according to the Global Initiative for Obstructive Lung Disease criteria. QoL assessment was performed before and 3 years after the surgery using the 36-Item Short-Form Health Survey (SF-36). Results. In the study group, the diagnosis of COPD was verified in 14.5% of cases. The mortality rate was 5%, and was significantly higher in patients with COPD. The baseline QoL level was reduced in all patients, regardless of the presence of COPD, with an average of 50 points both in the physical and mental health scores of the SF-36 questionnaire. COPD had a significant negative impact on the QoL physical health score after myocardial revascularisation (odds ratio (OR) 0.95 (0.91 - 0.99), p = 0.043). The forced expiratory volume in the first second (OR 1.02 (1.00 - 1.07), p = 0.048) and new-onset atrial fibrillation in the early postoperative period (OR 0.54 (0.33 - 0.88), p = 0,036) were predictors of lack of QoL improvement. COPD did not correlate with the changes in the psychoemotional component of QoL. Conclusion. COPD has an independent negative impact on the clinical outcomes of myocardial revascularisation, including survival and health-related QoL (physical health score). Thereby, preoperative assessment of the respiratory function is important in these patients.

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