ИВЛ-индуцированная дисфункция диафрагмы (обзор)

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.

: искусственная вентиляция легких, ИВЛ-индуцированная дисфункция диафрагмы, окидантный стресс, митохондриальная дисфункция, режимы вентиляции легких

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