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К патофизиологическим аспектам электрокардиотерапии (обзор литературы)

https://doi.org/10.29001/2073-8552-2015-30-1-7-16

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Аннотация

По мере развития электрокардиотерапии, применяемой сегодня, и для лечения сердечной недостаточности (СН) все большее значение приобретает решение задачи физиологичности терапии и предупреждения ятрогенных эффектов. Поиск направлен на достижение физиологичной частоты и последовательности возбуждения миокарда при искусственной стимуляции, минимизацию нарушений контуров регуляции работы сердечно-сосудистой системы (ССС). Критерием физиологичности элекгрокардиотерапии могло бы считаться улучшение гемодинамики без усиления системы неспецифической нейрогуморальной регуляции (НГР), свидетельствующей о стрессе. Частотно-адаптивная электрокардиотерапия, учитывающая состояние инотропной функции миокарда, прямым регулятором которой со стороны автономной нервной системы является β-адренергическая сигнальная сеть, может способствовать снижению адренергической стимуляции миокарда и таким образом может принести положительный эффект пациентам, в том числе больным СН. Наряду с нейрогуморальными факторами, являющимися основной причиной развития синдрома СН, ключевую роль играют различные провоспалительные цитокины, модулирующие функции ССС. Практически при всех основных формах кардиальной патологии и развитии нарушений ритма сердца независимо от локализации присутствует в той или иной форме воспаление, которое имеет единую патогенетическую и морфологическую картину, обусловленную различными системными маркерами, включая эндотоксин. Соответственно, различные биологические маркеры, участвующие в процессах НГР, специфической и неспецифической адаптации организма к метаболическим требованиям, имеют важное значение для определения физиологичности лечения, в том числе и на фоне проводимой электрокардиотерапии. Дальнейший поиск ведется на основе знаний как о принципах регуляции ССС, так и о различных механизмах специфической и неспецифической адаптации человеческого организма к различным факторам, таким как физическая нагрузка или психоэмоциональный стресс.

Об авторе

Ильдар Шамильевич Хасанов
Университет Эрланген-Нюрнберг им. Фридриха-Александра
Россия


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Для цитирования:


Хасанов И.Ш. К патофизиологическим аспектам электрокардиотерапии (обзор литературы). Сибирский медицинский журнал. 2015;30(1):7-16. https://doi.org/10.29001/2073-8552-2015-30-1-7-16

For citation:


Khassanov I.S. On pathophysiological aspects of electrotherapy of the heart. The Siberian Medical Journal. 2015;30(1):7-16. (In Russ.) https://doi.org/10.29001/2073-8552-2015-30-1-7-16

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