UDC 616.3.27 (1)

VALIDITY OF OPERATIONS OF STENTING IN THE MEDICAL ORGANIZATIONS OF THE REPUBLIC OF KAZAKHSTAN

Dubitsky of A.A., Keruyenovа Z.I.

Medical university Astana

Relevance. With introduction of Uniform national health system availability of a general population to highly specialized medical care is provided, also there was a possibility of financing of innovative medical technologies in regions [1.2.3].

At the moment practically in all areas of the Republic, there is an opportunity to carry out stenting of vessels and to carry out many other difficult surgical interventions on heart which were provided earlier with only republican clinics [4.5].

Purpose. To carry out the examination review regarding validity of carrying out stenting, timeliness of carrying out operations, complications and quantity of lethal cases.

Materials and methods. In the real work are studied medical documentation 5 656 patients in a control system of quality of medical services. Results of research are ranged in the corresponding tables.

Results and discussion. As a whole on the Republic in 1 half-year 2013 highly specialized medical help was given 5 656 patients, from them 4 111 (72,7%) the patient carried out stenting.

From total operated with a sharp coronary syndrome there were 3 332 patients or 58,9%. 1 545 operations of aortokoronar shunting from which in four operations besides shunting stenting of coronary vessels was carried out also are performed.

On country regions the greatest number of stenting is carried out in the city of Astana - 669 (16,3%), in the Karaganda region the help received 558 (13,6%) patients, in Southern Kazakhstan - 491 (11,9%) and in East Kazakhstan - 335 (8,1%) patients.

Operations on stenting of 1 vessel were performed in 3 175 cases (77,2%), on stenting of 2 and more vessels - in 895 that makes 21,8%.

Stentings of the 1st vessel it is more noted in the city of Astana - 565 (17,8%), in the Karaganda region - 404 (12,7%), in Southern Kazakhstan - 376 (11,8%) and the East Kazakhstan region - 254 (8%).

Stentings of the 2nd and more vessels in the Karaganda region it is carried out 149 (16,6%), in Southern Kazakhstan - 115 (12,8%), in the city of Astana - 86 (9,6%), in the Pavlodar region - 75 (8,4%).

From total of stentings by results of examination of 39 cases (0,9%) are carried out without sufficient indications on that, from them 38 in the city of Alma-Ata and 1 in Kyzylordinsky area.

Before operation of stenting consultation of the cardio surgeon was carried out, the following treatment-and-prophylactic events are held: trombolisis, an electrocardiogram, EHOKG, KAG, blood clot aspiration, introduction of a preparation of Integrelin (Eftifibatid) during operation.

Trombolizis was carried out in 239 cases (5,8%). Most of all in the Southern Kazakhstan area - 53 cases (22,2%), West Kazakhstan - 32 (13,4%) and Karaganda areas - 23 (9,6%).

The electrocardiogram is made in 4 075 cases (99,1%). In a section of regions the greatest number of an electrocardiogram is observed in the city of Astana - 648 (15,9%), the Karaganda region - 558 (14,8%), Southern Kazakhstan - 489 (13,7%), the East Kazakhstan 334 (8,2) areas.

Echocardiography it is made in 3 673 cases or 99,1%. In a section of regions the greatest number of an electrocardiogram is observed in the city of Astana - 646 (17,6%), the Karaganda region - 558 (15,2%), Southern Kazakhstan - 487 (13,3%) and Pavlodar 319 (8,7%) areas.

The coronary angiography was carried out in 4073 cases (99,1%). On regions the greatest number of the specified procedure is carried out in the city of Astana - 653 (16%), the Karaganda region - 558 (13,7%), Southern Kazakhstan 486 (11,9%) and East Kazakhstan 327 (8%) areas.

Aspiration of blood clot was observed in 185 cases i.e. 4,5% of all operated. In a section of regions the greatest number of this procedure is carried out in Pavlodar 49 (26,5%), Kostanay 33 (17,8%), North Kazakhstan 28 (15,1%) and Akmolinskoy 21 (11,4%) areas.

The preparation Integrilin was applied in 122 cases (3%). It was used only in 6 regions from which it is most used in Atyrausky area - 84 (68,9%), Kyzylorda area - 16 (13,1%), the Kostanay region 14 (11,5%).

Advice of the cardiosurgeon was got by 2 933 patients or 71,3% of all operated patients.

Postoperative complications when stenting are noted in 29 cases (0,7%). All complications are received at transactions of indications. Most of all complications it is noted in the Karaganda region - 7 cases (24,1%), the East Kazakhstan region - 6 (20,7%), Kostanay and Southern Kazakhstan areas - on 3 (10,3%) a case.

The lethality was observed in 161 cases (3,9%). From them 160 (99,4%) cases at transactions of indications and 1(0,6%) an episode at operations without indications.

From lethality cases at transactions of indications it is more noted in the Karaganda region - 78 (48,4%), Kostanay - 16 (9,9%) and West Kazakhstan 11 (6,8%) areas. 1 case of a lethality in the city of Alma-Ata is noted when stenting without indications.

Conclusions. Thus, practically in all regions of the Republic of Kazakhstan operation of stenting of coronary vessels is performed. Generally all operations were performed according to indications, preoperative examination was conducted from 87% to 99,1%. Complications when stenting made 0,7%. Thus, it should be noted that low-quality filling of medical documentation in some cases complicated determination of validity of indications to operation.

Literature.

1. The message of the Head of state to the people of Kazakhstan of January 28, 2011. (An assignment on completion of process of introduction of Uniform national health system by 2013).

2. State program "Salamatta Қазақстан" for 2011-2015 of the President of the Republic of Kazakhstan approved by the Decree of November 29, 2010 No. 1113.

3. The order of the Minister of Health of the Republic of Kazakhstan No. 96 "About system of the accounting of defects of rendering medical services" of 22.02.2013.

4. Rules of the organization and carrying out internal and external examinations of quality of the medical services, approved by the resolution of the government of the Republic of Kazakhstan of December 23, 2011 No. 1577.

5. Rules of involvement of independent experts of the health care, approved by the resolution of the government of the Republic of Kazakhstan of November 7, 2011 No. 1304.