rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2022-4-55-67rmt-2254Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSСиндром пароксизмальной симпатической гиперактивности (обзор)Paroxysmal Sympathetic Hyperactivity Syndrome (Review)ЦенциперЛ. М.TsentsiperL. M.

Любовь Марковна Ценципер

191014, Санкт-Петербург, ул. Маяковского, д. 12

Lyubov M. Tsentsiper

12 Mayakovsky Str., 191014 St. Petersburg

lmt1971@yandex.ruТереховИ. С.TerekhovI. S.

191014, Санкт-Петербург, ул. Маяковского, д. 12

Igor S. Terekhov

12 Mayakovsky Str., 191014 St. Petersburg

ШевелевО. А.ShevelevO. A.

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

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

Oleg A. Shevelev

777 Lytkino village, 141534, Solnechnogorsk district, Moscow region

6 Miklukho-Maсlaya Str., 117198 Moscow

ПетроваМ. В.PetrovaM. V.

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

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

Marina V. Petrova

777 Lytkino village, 141534, Solnechnogorsk district, Moscow region

6 Miklukho-Maсlaya Str., 117198 Moscow

КондратьевА. Н.KondratievA. N.

191014, Санкт-Петербург, ул. Маяковского, д. 12

Anatoly N. Kondratiev

12 Mayakovsky Str., 191014 St. Petersburg

Российский научно-исследовательский нейрохирургический институт им. проф. А. Л. Поленова, филиал НМИЦ им. В. А. Алмазова Минздрава РоссииРоссияA. L. Polenov Russian Research Institute for Neurosurgery, V. A. Almazov National Research CenterRussian FederationНИИ реабилитологии им. проф. И. В. Пряникова Федерального научно-клинического центра реаниматологии и реабилитологии (ФНКЦ РР); Медицинский институт Российского университета дружбы народовРоссияResearch Institute for Rehabilitology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology; Medical Institute, Peoples Friendship University of RussiaRussian Federation2022260820221845567Copyright © Ценципер Л.М., Терехов И.С., Шевелев О.А., Петрова М.В., Кондратьев А.Н., 20222022Ценципер Л.М., Терехов И.С., Шевелев О.А., Петрова М.В., Кондратьев А.Н.Tsentsiper L.M., Terekhov I.S., Shevelev O.A., Petrova M.V., Kondratiev A.N.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/2254

Одним из осложнений острого тяжелого повреждения мозга (черепно-мозговая травма, внутричерепные кровоизлияния, ишемия, постгипоксические состояния) как у взрослых, так и у детей является развитие синдрома пароксизмальной симпатической гиперактивности (ПСГА). Высокая частота его встречаемости и тяжелые негативные последствия: органная дисфункция, инфекционные осложнения, нарушения трофики органов и тканей, приводят к повышению инвалидизации и смертности. Сложности в подборе эффективной терапии связаны с многообразием симптомов, трудностями диагностики, отсутствием четкого понимания патофизиологии ПСГА. В настоящее время существуют различные зарубежные и отечественные схемы лечения ПСГА.

Цель обзора — обобщить данные клинических и научных исследований по диагностике и лечению синдрома ПСГА для облегчения подбора эффективной терапии.

Материал

Материал. В базах данных Web of Science, Scopus и РИНЦ отобрали 80 источников, содержавших актуальные данные клинических и научных исследований по теме данного обзора.

Результаты

Результаты. Рассмотрели основные принципы диагностики и лечения пароксизмальной симпатической гиперактивности; описали современные представления об этиологии и патогенезе развития пароксизмальной симпатической гиперактивности; привели клинические данные, касающиеся развития осложнений пароксизмальной симпатической гиперактивности; проанализировали клинические последствия и описали современные методы профилактики развития синдрома пароксизмальной симпатической гиперактивности.

Заключение

Заключение. Профилактика развития ПСГА, его адекватное и своевременное лечение позволяют предотвратить формирование патологической доминанты (мы рассматриваем ПСГА именно как одну из патологических доминант, формирующихся при тяжелом повреждении ГМ), уменьшить негативные последствия этого синдрома, снизить число осложнений, длительность ИВЛ и пребывания боль- ного в ОРИТ, инвалидизацию и смертность. Подбор патогенетической, симптоматической, а затем поддерживающей терапии значительно улучшает реабилитационный потенциал пациентов.

Paroxysmal sympathetic hyperactivity (PSH) is one of the complications of acute severe brain injuries (traumatic brain injury, intracranial hemorrhage, ischemia, and posthypoxic conditions) in both adults and children. Its high incidence and severe sequelae including organ dysfunction, infectious complications, impaired blood supply to organs and tissues associate with increased disability and mortality. The choice of effective therapy can be challenging because of multifaceted manifestations, diagnostic difficulties, and lack of a clear understanding of the pathophysiology of PSH. Currently, there are various local and international treatment strategies for PSH.

The aim of the review is to summarize clinical and scientific research data on diagnosis and treatment of PSH to aid in the selection of an effective therapy.

Material and methods

Material and methods. Web of Science, Scopus and RSCI databases were employed to select 80 sources containing relevant clinical and research data on the subject of this review.

Results

Results. The key principles of diagnosis and treatment of paroxysmal sympathetic hyperactivity have been reviewed. The current views on etiology and pathogenesis of paroxysmal sympathetic hyperactivity development were outlined. The clinical data concerning complications and sequelae of paroxysmal sympathetic hyperactivity were analyzed. We conclude the review with a discussion of current methods of the syndrome prevention.

Conclusion

Conclusion. Preventing PSH and its adequate and prompt treatment could help avoid the abnormal pathway development following a severe brain injury, reduce its negative consequences and rate of complications, along with the duration of mechanical lung ventilation, patient's stay in ICU, disability and mortality rates. Careful selection of pathogenetic, symptomatic and supportive therapy significantly improves the rehabilitation potential of patients.

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