rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2020-4-72-89rmt-1943Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSФормирование коморбидности у пациентов с тяжелым повреждением мозга и исходом в хроническое критическое состояние (обзор)Comorbidity Development in Patients with Severe Brain Injury Resulting in Chronic Critical Condition (Review)ПарфеновА. Л.ParfenovA. L.

Александр Леонидович Парфенов

141534, Московская область, Солнечногорский район, д. Лыткино, д. 777

Alexander L. Parfenov

777 Lytkino 141534, Solnechnogorsk district, Moscow region

alpar45@mail.ruПетроваМ. В.PetrovaM. V.

141534, Московская область, Солнечногорский район, д. Лыткино, д. 777; 

117198, г. Москва, ул. Миклухо-Маклая, д. 6

777 Lytkino 141534, Solnechnogorsk district, Moscow region; 

6 Miklukho-Maсlaya Str., 117198 Moscow

ПичугинаИ. М.PichuginaI. M.ЛугининаЕ. В.LugininaE. V.Федеральный научно-клинический центр реаниматологии и реабилитологииРоссияFederal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian FederationФедеральный научно-клинический центр реаниматологии и реабилитологии; Российский университет дружбы народовРоссияFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology; Peoples’ Friendship University of RussiaRussian Federation2020290820201647289Copyright © Парфенов А.Л., Петрова М.В., Пичугина И.М., Лугинина Е.В., 20202020Парфенов А.Л., Петрова М.В., Пичугина И.М., Лугинина Е.В.Parfenov A.L., Petrova M.V., Pichugina I.M., Luginina E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1943

Достижения интенсивной терапии позволяют пережить острое критическое состояние, в результате чего создается растущая популяция пациентов в хроническом критическом состоянии с длительной зависимостью от методов интенсивной терапии. Указанные пациенты составляют 5–10% от всех пациентов с острой дыхательной недостаточностью, требуют непропорционально высокой доли ресурсов отделений реанимации и интенсивной терапии при общей выживаемости в течение года в 40–50%.

Цель обзора

Цель обзора. Выявить влияние коморбидных осложнений на течение и исходы пациентов с тяжелыми повреждениями головного мозга.

Критериями отбора 96 источников являлись сведения, характеризующие клиническую (синдромальную) модель пациента, в которой рассмотрен синдром пациента с посткоматозными нарушениями сознания различной этиологии. Данная модель учитывает стадии и фазы синдрома, а также перечень коморбидных заболеваний, которые определяют течение и исход заболевания.

В перечень источников вошли работы, посвященные проблеме коморбидности, у пациентов с повреждениями и заболеваниями головного мозга (инсульты, последствия тяжелой черепно-мозговой травмы и операций на головном мозге).

Рассмотрены источники, отражающие наиболее значимые механизмы последовательного формирования коморбидных заболеваний. К ним относятся: нарушения метаболизма с последующим развитием белково-энергетической недостаточности; коморбидные заболевания желудочно-кишечного тракта. Определена роль микробиома в формировании коморбидности у пациентов в хроническом критическом состоянии.

Заключение

Заключение. Формирование коморбидности начинается с момента повреждения головного мозга и продолжается до стойкой стабилизации состояния или до полиорганной недостаточности и летального исхода. Своевременное выявление и коррекция коморбидных состояний позволит оптимизировать лечение и повысить эффективность реабилитационных мероприятий у пациентов с тяжелыми повреждениями головного мозга.

Advances in intensive care have enabled patients to survive an acute critical condition, producing a growing population of patients in a chronic critical condition with long-term dependence on intensive care. These patients make up 5–10% of all patients with acute respiratory failure and require a disproportionate share of resources in the intensive care units, with an overall yearly survival rate of 40–50%.The aim of review is to identify the impact of comorbid complications on the course and outcome of patients with severe brain injury.Ninety-six sources were selected according to the data characterizing the clinical (syndromic) model of the patient with consciousness disorders after coma of different etiologies. This model takes into account the stages and phases of the syndrome as well as a number of comorbid conditions that determine the course and outcome of the disease.The list of sources includes papers addressing the issues of comorbidity in patients with brain injury and conditions such as strokes, consequences of severe brain injury and brain surgery.The sources reflecting the most significant mechanisms of consistent development of comorbidities were examined. These include metabolic disorders with subsequent protein and energy deficiency and comorbidities of the gastrointestinal tract. The role of microbiome in the development of comorbidity in patients in chronic critical condition was also identified.Conclusion. The comorbidity development starts from the moment of brain injury and extends until sustained stabilization or multi-organ failure and death. Timely detection and correction of comorbidities allows optimizing treatment and increasing efficiency of rehabilitation in patients with severe brain injury.

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