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ИВЛ-индуцированная дисфункция диафрагмы (обзор)

https://doi.org/10.15360/1813-9779-2018-3-82-103

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Аннотация

Искусственная вентиляция легких связана с развитием ряда осложнений, увеличивающих затраты на лечение и госпитальную летальность. В 2004 году был предложен термин ИВЛ-индуцированной (вентилятор-индуцированной) дисфункции диафрагмы (ИИДД) в качестве одной из причин неудачного прекращения респираторной поддержки. В настоящее время под этим термином понимают сочетание атрофии и слабости сократительной функции диафрагмы, вызываемые непосредственно длительной искусственной вентиляцией легких. В патогенезе ИИДД важную роль играют оксидативный стресс, протеолиз, митохондриальная дисфункция, а также пассивное перерастяжение волокон диафрагмы. Учитывая, что необходимость в механической респираторной поддержке испытывают 30—80% больных в ОРИТ, а даже 6—8-и часовая искусственная вентиляция легких может способствовать развитию значительной слабости диафрагмы, можно сделать вывод, что ИИДД является крайне актуальной проблемой у большинства пациентов. Ее типичная клиническая картина характеризуется нарушениями механики дыхания и неудачными попытками перевода пациента на самостоятельное дыхание при отсутствии других веских причин респираторных нарушений. Наиболее информативным и доступным методом диагностики является УЗИ, а перспективным подходом к профилактике и коррекции считается сохранение активности спонтанного дыхания и использование новейших вспомогательных режимов вентиляции. Поиск оптимальной стратегии вентиляции легких, развитие диагностических и физиотерапевтичеких методов, а также консолидация работы многопрофильной команды специалистов (анестезиологов и реаниматологов, неврологов, пульмонологов, хирургов и др.) могут помочь в решении этой серьезной проблемы. В обзоре 122-х источников об ИИДД представили данные по истории вопроса, определению проблемы, этиологии и патогенезу, клиническим проявлениям, методам диагностики, влиянию лекарственных средств, путям профилактики и терапии.

Об авторах

М. А. Бабаев
Российский Научный Центр Хирургии им. Б. В. Петровского; Первый московский государственный медицинский университет им. И. М. Сеченова
Россия

119881, Москва, Абрикосовский пер. 2 ; 

119991, Москва, ул. Трубецкая, д.8, стр. 2



Д. Б. Быков
Российский Научный Центр Хирургии им. Б. В. Петровского
Россия
119881, Москва, Абрикосовский пер. 2 


Т. М. Бирг
Национальный Медицинский Исследовательский Центр нейрохирургии им. Н. Н. Бурденко
Россия
125047, Москва, 4-я Тверская-Ямская, д.16


М. А. Выжигина
Российский Научный Центр Хирургии им. Б. В. Петровского; Первый московский государственный медицинский университет им. И. М. Сеченова
Россия

119881, Москва, Абрикосовский пер. 2 ; 

119991, Москва, ул. Трубецкая, д.8, стр. 2



А. А. Еременко
Российский Научный Центр Хирургии им. Б. В. Петровского
Россия
119881, Москва, Абрикосовский пер. 2 


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Для цитирования:


Бабаев М.А., Быков Д.Б., Бирг Т.М., Выжигина М.А., Еременко А.А. ИВЛ-индуцированная дисфункция диафрагмы (обзор). Общая реаниматология. 2018;14(3):82-103. https://doi.org/10.15360/1813-9779-2018-3-82-103

For citation:


Babaev M.A., Bykov D.B., Birg Т.M., Vyzhigina M.А., Eremenko A.A. Ventilator-Induced Diaphragm Dysfunction (Review). General Reanimatology. 2018;14(3):82-103. (In Russ.) https://doi.org/10.15360/1813-9779-2018-3-82-103

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