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«Клиническая физиология кровообращения»

Главный редактор

Лео Антонович Бокерия, доктор медицинских наук, профессор, академик РАН и РАМН, директор ФГБУ «НМИЦССХ им. А.Н. Бакулева» МЗ РФ

Влияние искусственной вентиляции легких в prone-position на оксигенацию и выживаемость при остром респираторном дистресс-синдроме и возможности применения у кардиохирургических больных

Авторы: Леушин К.Ю.

Организация:
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» (президент – академик РАН и РАМН Л.А. Бокерия) Минздрава России, Рублевское ш., 135, Москва, 121552, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Обзоры

DOI: https://doi.org/10.24022/1814-6910-2020-17-4-257-265

УДК: 616.24-008.4-085:615.816.2

Библиографическая ссылка: Клиническая физиология кровообращения. 2020; 4 (17): 257-265

Цитировать как: Леушин К.Ю.. Влияние искусственной вентиляции легких в prone-position на оксигенацию и выживаемость при остром респираторном дистресс-синдроме и возможности применения у кардиохирургических больных. Клиническая физиология кровообращения. 2020; 4 (17): 257-265. DOI: 10.24022/1814-6910-2020-17-4-257-265

Ключевые слова: острый респираторный дистресс-синдром, компьютерная томография; искусственная вентиляция легких, prone-position, оксигенация, выживаемость, кардиохирургия, осложнения

Поступила / Принята к печати:  28.08.2020 / 06.09.2020

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Аннотация

Острый респираторный дистресс-синдром (ОРДС) является одним из основных осложнений различных жизнеугрожающих состояний. В зависимости от причины ОРДС, тяжести его течения, наличия полиорганной недостаточности летальность в таких случаях составляет в среднем 35–45%. После операций на сердце ОРДС развивается в 0,4–20% случаев. Данные о летальности при ОРДС у кардиохирургических пациентов противоречивы и варьируют в пределах 22–80%.

Патофизиологическое обоснование применения ИВЛ в положении на животе (prone-position) состоит в том, что под действием сил гравитации, за счет декомпрессии и открытия коллабированных и ателектазированных альвеол дорсальных – наиболее пораженных – отделов легких происходит улучшение газообмена и оксигенации артериальной крови. Все исследователи отмечали увеличение оксигенации у большинства пациентов с ОРДС. При вентиляции в prone-position в течение 17±3 ч летальность на 28-й день составила 16,0%, а в группе supine-position – 32,8%, на 90-й день – 23,6 и 41,0% соответственно.

Применениe ИВЛ в prone-position при ОРДС у кардиохирургических больных ограничено при нестабильной гемодинамике, может сопровождаться пролежнями и осложнениями со стороны стернотомной раны, но вместе с тем является эффективным методом повышения оксигенации при тяжелой гипоксемии с индексом PaO2/FiO2 < 150. Меры по предотвращению пролежней лица и грудной клетки являются обязательными.

Литература

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Об авторах

Леушин Константин Юрьевич, врач – анестезиолог-реаниматолог; ORCID

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