Nizamov Kh.Sh., Lakhanov A.O., Ruziyeva A.A.
ORGANIZATION OF MEASURES TO PROVIDE EMERGENCY HIGH-TECH MEDICAL CARE IN THE FIELD OF CARDIOLOGY *
Аннотация:
this article contains statistically processed analysis data on the organization of emergency high-tech cardiological care for patients with acute coronary syndrome, after contacting the Samarkand regional branch of the Republican Specialized Scientific and Practical Medical Center of Cardiology. Stages of compliance with the algorithm developed in our center based on clinical recommendations for the management of patients with acute coronary syndrome; leading to a significant improvement in the quality of medical care based on their own experience. Including reducing the time of the index event from the initial stage to the beginning of the reperfusion therapy stage.
Ключевые слова:
cardiovascular system, cardiovascular diseases, high-tech cardiological medical care, endovascular cardiac surgery, interventional cardiac surgery.
Relevance. A significant reduction in mortality from diseases of the cardiovascular system (CV) in the last twenty years has been achieved by the development of cardiological, interventional and cardiac surgical care for patients with acute coronary syndrome (ACS), the introduction of effective methods of preventive medicine, in particular early diagnosis; treatment and medical rehabilitation measures for patients with/without disability of diseases of the circulatory system (DCS); preparation and improvement of highly qualified specialists in cardiac surgery, etc. [1-3]. The number of performed coronary angiography (CAG), percutaneous interventions (PCI), and coronary artery bypass grafting (CABG) is growing year after year in Uzbekistan. Among the three leaders in this developing high-tech direction among all administrative-territorial units of the country is the city of Samarkand, where cardiological specialized and highly specialized care is represented by a center with expanded cardiology departments: the Samarkand regional branch of the Republican Specialized Scientific and Practical Medical Center of Cardiology.The purpose of the study: to analyze the organization of cardiac surgical care for patients with acute coronary syndrome, at the hospital level to residents in developing cities, which is the city of Samarkand.Materials and methods: statistical electronic data of the Samarkand regional branch of the Republican Specialized Scientific and Practical Medical Center of Cardiology for the period from January to May 2023 Results and discussions: In this medical organization in Samarkand, the number of PCI 393 and CABG 161 cases is increasing every year only for 5 months of 2023. The total number of patients with ACS who underwent PCI, residents of Samarkand turned out to be 357 (28.4%), most of them were hospitalized urgently (97.8%). Patients with ACS with PCI are more often admitted to hospitals for emergency medical care (77.9%); less are sent by primary health care organizations (PHC) - 5.6%, by another hospital - 2.8%; the same number – by the independent treatment of the patients themselves (9.7%), organizations providing consultative and diagnostic assistance (8.67%) and less often in other ways (2.35%). When distributed over a time interval, hospitalization from the onset of pain syndrome leads to a shift in the results towards an increase in duration. So, if 31.9% were hospitalized within 6 hours, then from 6 to 24 hours – 21.34% and more than 24 hours – 43.21%. There were cases of planned hospitalization of patients with ACS for PCI: in Samarkand - 4.6%. In Samarkand, 208 planned hospitalized patients at the prehospital stage were diagnosed with unstable angina (UA) – 182 (83.72%), myocardial infarction (MI) - 53 (21.24%). The quality of diagnosis in a hospital directly depends on the frequency of coincidence / discrepancy between the preliminary and final diagnosis, i.e. the diagnosis that was established at the correctional stage of emergency conditions and the diagnosis at the stage of ending therapy. In the city of Samarkand, the number of coincident diagnosis established on prehospital tap and final diagnosis in a hospital was 98.1% (p<0.0014), preliminary and final diagnosis in a hospital was 99.05% (p<0.0011), which is significantly higher compared with the national average data. Another interesting data is the calculation of the time of observation of a patient with ACS ( ST-segment elevation myocardial infarction (STEMI) to and non–ST-segment elevation myocardial infarction (NSTEMI)) in specialized departments before resolving issues about PCI. In Samarkand, the average time from admission to surgery in minutes was 877.84 ±1813.21 (median – 209.48, FINITE DIFFERENCE METHOD (FDM) (72.23-1046.4) (p<0.0011), which is better than the indicators of other cities of the Republic of Uzbekistan. Also, as in the whole country in Samarkand, indications for PCI are myocardial infarction (MI) among both men (68.30%) and women (67.4%), as well as unstable angina (UA) – 33.62 and 34.75%%, respectively (p<0.0012). The proportion of patients with MI among all patients who underwent surgery was 68.79%. Of all possible cases of lesion: MI with ST segment elevation was observed in 70.25% of cases, without ST segment elevation – 35.69%. When taking into account the timing of occurrence, the share of primary MI account for 73.41%, repeated – 27.63%. Patients with ACS in emergency cardiological and cardiac surgery centers underwent myocardial revascularization by coronary artery stenting (98.71%) and balloon angioplasty of heart vessels (2.45%) (p<0.0012). In contrast to the republican data in Samarkand, the number of stenting was slightly lower (95.92%), and the number of balloon angioplasty of heart vessels was higher (4.35%) (p<0.0012). Postoperative complications, such as postoperative hematoma at the site of access, internal and/or external bleeding, development of myocardial infarction with 4 types, ischemic complications in the brain, cardiovascular insufficiency, rhythm disturbance, conduction disorder, pulmonary edema, retrombosis, pericarditis, peritonitis) PCI was observed quite rarely: in January 2023 – 0.31%, in February 2023 – 0.24%, in March 2023 – 0.16%, in April 2023-0%, in May 2023-0% of cases. ACS in PCI, in hospitals in Samarkand was 14.6±3.4 (median – 12.2, FDM (9.03-13.03). The maximum bed-day spent was 18, the minimum was 2. In the conditions of the intensive care unit, patients spent an average of 2.18 ± 2.1 (median- 1.0; FDM (1.033-2.045), a maximum of 28 days. The maximum number of days spent by a patient in our Samarkand regional branch of the Republican Specialized Scientific and Practical Medical Center of Cardiology, as a whole and in the intensive care unit, is almost 2.1 times less than the national average values. When conducting statistical processing of treatment results in the form of positive dynamics: recovery and improvement, in Samarkand, 98.82% of patients with ACS were found after PCI. Of all ACS patients who underwent CABG, about 88.16% of patients were hospitalized for emergency indications. When distributing this indicator, the following data were obtained: from the period of the onset of pain syndrome to hospitalization within 6 hours – 27.23%; from 7 to 24 hours (up to the 1st day) - 22.44%; and more than 24 hours (more than a day) – 37.63%. The above data indicate that there are more patients hospitalized in Samarkand in the first 6 hours from the onset of pain syndrome. Although patients hospitalized for more than 24 hours (more than 1 day). Data on planned hospitalization in Samarkand (15.12%) were also obtained.This indicator is almost twice as high as the national average (8.07%). But at the same time, at the prehospital stage, these patients have already been diagnosed with US and MI. In Samarkand, patients are more often admitted to hospitals by EMERGENCY MEDICAL CARE (EMC), in 64.92% of cases. Patients who are admitted by other means account for a smaller proportion: PHC organizations – 19.37%, after self–treatment of patients - 12.43%, organizations of consultative and diagnostic care – 8.3%, other hospitals – 5.13% and other possible ways – 0.82%. The frequency of coincidence of the diagnosis established at the prehospital stage and the final diagnosis established in the hospital in Samarkand was 76.47% (p<0.0011), which is considered lower throughout the Republic. In 28.42% of cases, patients are delivered with a diagnosis of other DCS. The frequency of coincidence of the preliminary and final diagnosis is also lower in Samarkand (92.35%) (p<0.0011). In 11.28% of cases, patients in the emergency department were diagnosed with other DCS. In In Samarkand, the distribution of the main indications for CABG is characterized by a large proportion: MI among both men – 61.83%, and among women – 58.41%, UA - 42.36% and 44.37%, respectively (p=0.121). In general, according to the results of statistical data, the proportion of patients with MI out of all operated patients was 61.07%. Whereas, the number of patients with MI by the depth of the lesion: MI with ST elevation is 73.05%, without ST elevation – 31.24%. According to the terms of development, they account for 69.14% of the primary, 32.63% of the secondary. Patients with ACS in the conditions of our center underwent operations for myocardial revascularization by coronary artery bypass grafting (CABG).In Samarkand, CABG is performed in 79.41% of cases in the amount of 1 to 5 shunts: three–shunt operations were performed more often – 41.08%, less often - two-shunt (23.02%), four-shunt or more (14.26%) and one-shunt (4.08%). Simultaneous CABG in combination with percutaneous coronary intervention (PCI) was used in 2.1%; the combination of CABG and prosthetic heart valves, as well as CABG and radiofrequency ablation in patients with atrial fibrillation was 0.855% (p<0.0011). Postoperative complications, in the form of: internal and external bleeding, type 5 myocardial infarction, cerebral circulation disorders, pulmonary embolism, mediastenitis, wound suppuration, cardiovascular insufficiency, respiratory failure, retrombosis, wound divergence, pneumonia, pleurisy, in Samarkand were observed only in 0.831% of cases. On average, the number of beds spent by patients with ACS in hospitals in Samarkand was less (16.92±4.4) (median - 17.5, FDM (14.3–21.22), maximum - 69.63, minimum – 1. In the intensive care unit, patients spent an average of 2.91±2.03 (median – 2.2, FDM (1.1-3.2), the maximum is 31. A positive effect, which manifested itself in the form of positive dynamics: recovery, improvement, or even without changes; was observed in 96.35% of patients after CABG. All these patients were either discharged or transferred to other hospitals. Deterioration of the condition and/or well-being was observed only in 1.27% of the detected cases.Conclusions: This research conducted by us, first of all, allowed us to:- To identify and establish reserves of increased effectiveness of therapy in ACS, in particular, reducing the time from the onset of symptoms to the beginning of the pathogenetic approach to therapy;- The reserve was also established in the period of reducing the time interval from the moment of hospitalization to surgery, due to timely diagnosis using coronary angiography (CAG). That first of all allows us to identify one or another approach to solving questions about the tactics of therapy, according to existing algorithms and/ or clinical recommendations.
Номер журнала Вестник науки №11 (68) том 1
Ссылка для цитирования:
Nizamov Kh.Sh., Lakhanov A.O., Ruziyeva A.A. ORGANIZATION OF MEASURES TO PROVIDE EMERGENCY HIGH-TECH MEDICAL CARE IN THE FIELD OF CARDIOLOGY // Вестник науки №11 (68) том 1. С. 964 - 970. 2023 г. ISSN 2712-8849 // Электронный ресурс: https://www.вестник-науки.рф/article/10717 (дата обращения: 17.05.2024 г.)
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