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Хроническое критическое заболевание: современные аспекты проблемы (обзор)

Хроническое критическое заболевание: современные аспекты проблемы (обзор)

А.Л. Парфёнов, В.П. Разживин, М.В. Петрова
Ключевые слова: хроническое критическое заболевание; персистирующее воспаление; синдром персистирующего воспаления, иммуносупрессии и катаболизма; синдром последствий интенсивной терапии; микробиом.
2022, том 14, номер 3, стр. 70.
DOI: https://doi.org/10.17691/stm2022.14.3.08

Полный текст статьи

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Хронические реанимационные больные, пережившие острую фазу заболевания, представляют собой быстро растущую популяцию пациентов, нуждающихся в специализированной медицинской помощи в условиях отделения реанимации и интенсивной терапии (ОРИТ) в течение нескольких месяцев или лет. В середине 80-х гг. XX в. для таких больных был предложен термин «хроническое критическое заболевание» (chronic critical illness — CCI). Пациенты с CCI составляют от 5 до 20% пациентов ОРИТ. С течением времени у них развиваются нарушения гомеостаза, приводящие к полиорганной недостаточности и летальному исходу. Смертность при CCI превышает таковую при большинстве злокачественных новообразований, а у большинства выживших пациентов сохраняется функциональная зависимость.

В настоящем обзоре предпринята попытка показать основные звенья патогенеза CCI, воздействиями на которые можно предотвратить неблагоприятный исход. Проанализированы публикации, описывающие эпидемиологию CCI, его исходы, а также клинический фенотип.

Многие исследователи рассматривают CCI как следствие формирования синдрома персистирующего воспаления, иммуносупрессии и катаболизма. Ряд работ свидетельствует о важности питания в условиях ОРИТ. Отмечена роль желудочно-кишечного тракта в формировании CCI. Показано влияние интенсивной терапии на микробиоту пациентов ОРИТ. Рассмотрены нарушения микробиома при дисбактериозе, сепсисе, а также влияние микробиома кишечника на отдаленные органы.

Значимой составляющей CCI является синдром последствий интенсивной терапии (post intensive care syndrome). Отмечены основные последствия синдрома, а также общие вопросы его профилактики и лечения.

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