Персонализированная медицина критических состояний (обзор)

Персонализированная медицина (ПМ) является главным вектором развития здравоохранения в XXI веке и включает направления, касающиеся факторов риска развития заболевания (предикативность), мероприятия по предотвращению заболевания (профилактика), индивидуализацию диагностики и лечения (персонализация), информирование пациента по вопросам профилактики и лечения заболевания (партисипативность). В последние годы ведется активная исследовательская работа, направленная на внедрение принципов ПМ в процесс оказания помощи пациентам, находящимся в критических состояниях. Это касается выделения групп пациентов на основе исследования генома, разработки диагностических тестов с использованием молекулярных маркеров, создания нового класса лекарств с учетом индивидуальных характеристик пациентов.

Цель обзора — обобщить имеющиеся данные о внедрении принципов ПМ в практику работы медицинских учреждений, обеспечивающих лечение пациентов, находящихся в критическом состоянии.

Провели анализ более 300 источников литературы международных баз данных Pubmed, Scopus и РИНЦ. Из общего массива отобрали 85 источников, которые в наибольшей степени соответствуют цели обзора.

В обзоре представили сведения об организации и результатах внедрения принципов и передовых технологий ПМ, таких как банк образцов неотложной медицины — EMSB, в работу клиник, оказывающих неотложную помощь при критических состояниях. Рассмотрели формирование представлений о ПМ, в том числе признаки новой концепции, ориентированной на лечение пациентов в критическом состоянии. Изложили сведения о специфике развития конкретных критических состояний (острых нарушений мозгового кровообращения, острого респираторного дистресс-синдрома, черепно-мозговой травмы, шока, инфаркта миокарда, нарушений ритма и проводимости), а также об эффективности применения лекарственных препаратов, в зависимости от индивидуальных генетических особенностей пациентов.

Ограничений исследований по вопросам темы не выявили.

Заключение. Анализ данных литературы свидетельствует о позитивных результатах внедрения принципов ПМ в профилактику, диагностику и лечение больных в критических состояниях. Создание биобанков, разработка учебных программ и нормативной документации, активизация научных исследований, внедрение новых методов диагностики и лечения способствуют реализации принципов ПМ в практическом здравоохранении.

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