Периоперационные и отдаленные нежелательные события у пациентов с детским церебральным параличом

Введение. Выявление и профилактика нежелательных инцидентов периоперационного и отдаленного периодов являются основными условиями безопасного оказания хирургической помощи пациентам с детским церебральным параличом (ДЦП), тяжелой коморбидной патологией.

Цель исследования — на основании ретроспективного анализа медицинской документации выявить триггеры, а также оценить частоту развития нежелательных событий периоперационного и отдаленного периодов у детей с тяжелыми формами ДЦП в сочетании с эпилепсией, получавших хирургическое ортопедическое лечение по поводу спастических вывихов (подвывихов) бедер.

Материалы и методы. В ретроспективное сравнительное исследование включено 50 пациентов с тяжелыми формами ДЦП и эпилепсией, которым проводились ортопедические вмешательства на тазобедренном суставе. В зависимости от двигательных расстройств все пациенты разделены на 2 группы. Оценивались нежелательные события периоперационного и отдаленного периодов.

Результаты. После операции на основании лабораторных тестов в обеих группах диагностирована анемия легкой степени, гиперфибриногенемия. Зарегистрирован 1 случай рецидива эпилепсии и 1 эпизод массивного носового кровотечения. В течение года после операции возобновление эпилептических приступов зарегистрировано у 2 детей, о летальном исходе пациентов сообщили родители (опекуны) 2 больных.

Заключение. Нежелательные события периоперационного периода у детей с ДЦП и эпилепсией в 10 % случаев обусловлены влиянием антиконвульсантов на систему гемостаза, рецидивом судорог. Отдаленный послеоперационный период у детей с ДЦП и эпилепсией в 4 % случаев может быть отягощен возобновлением судорожных приступов на фоне отмены или снижения дозы антиконвульсантов. Сочетание соматической патологии, церебральной недостаточности и эпилепсии на фоне ДЦП способно инициировать в отдаленном послеоперационном периоде тяжелые нежелательные события вплоть до летального исхода.

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