nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2020-9-1-108-122nmp-910Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSРеспираторная нейромиопатия как важный компонент полинейромиопатии критических состоянийRespiratory Neuropathy as an Important Component of Critical Illness Polyneuromyopathyhttps://orcid.org/0000-0002-9661-0182РахимовР. Т.RakhimovR. T.

соискатель

Degree-seeking student

rakhimovmed@mail.ruhttps://orcid.org/0000-0001-8519-7145ЛейдерманИ. Н.LeydermanI. N.

Лейдерман Илья Наумович, доктор медицинских наук, профессор

Dr. Med. Sci., Professor

inl230970@gmail.comhttps://orcid.org/0000-0002-0544-1492БелкинА. А.BelkinA. A.

доктор медицинских наук, профессор, директор

Dr. Med. Sci., Director

belkin@neuro-ural.ruКафедра анестезиологии, реаниматологии, трансфузиологии и токсикологии, ООО «Клиника Института Мозга»РоссияDepartment of Anesthesiology, Resuscitation, Transfusiology and Toxicology, Clinic of Institute of BrainRussian FederationКафедра анестезиологии, реаниматологии, трансфузиологии и токсикологии, ООО «Клиника Института Мозга»; ФГБОУ ВО «Уральский государственный медицинский университет» МЗ РФРоссияDepartment of Anesthesiology, Resuscitation, Transfusiology and Toxicology, Clinic of Institute of Brain; Ural State Medical University of the Ministry of Health of the Russian FederationRussian Federation20201910202091108122Copyright © Рахимов Р.Т., Лейдерман И.Н., Белкин А.А., 20202020Рахимов Р.Т., Лейдерман И.Н., Белкин А.А.Rakhimov R.T., Leyderman I.N., Belkin A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/910

РЕЗЮМЕ. В последние годы внимание неврологов, нейрохирургов и анестезиологов-реаниматологов привлекает новый симптомокомплекс PICS (Post Intensive Care Syndrome) (англ.), или ПИТ-синдром — синдром «После интенсивной терапии». Одним из наиболее тяжелых вариантов течения ПИТ- синдрома является полимионейропатия критических состояний (ПМКС). Полинейропатия (Critical illness polyneuropathies, или CIP) и миопатия (Critical illness myopathies, или CIМ) критических со- стояний являются общими осложнениями тяжелой системной воспалительной реакции и полиорганной дисфункции. Несколько синдромов мышечной слабости объединены под термином «слабость, приобретенная в отделении реанимации и интенсивной терапии (ОРИТ)» (Intensive care unit-acquired weakness, или ICUAW). Респираторная нейромиопатия является компонентом ПМКС, в котором на первое место выходит проблема дыхательной недостаточности, связанной с поражением, в первую очередь, нервно-мышечного аппарата внешнего дыхания. Клиническим последствием респираторной нейропатии является неудачное отлучение от искусственной вентиляции легких и длительное нахождение пациента в ОРИТ. Данный систематический обзор литературы представляет собой анализ публикаций, посвященных основным патогенетическим механизмам развития CIP и респираторной нейромиопатии, методам диагностики и новым терапевтическим подходам к лечению пациентов ОРИТ с респираторной нейромиопатией. Особое внимание об- ращено на проблему острого мышечного истощения, диагностику и коррекцию расстройств белково-энергетического обмена у пациентов с респираторной нейромиопатией.

ABSTRACT. The attention of neurologists, neurosurgeons, intensive care physicians has been attracted recently by the new PICS (Post Intensive Care Syndrome) symptom complex (PIC) or PIC syndrome — Post Intensive Care Syndrome. One of the most severe options for PIT syndrome is critical illness polymyoneuropathy (CIP). Polyneuropathy (Critical illness polyneuropathies, or CIP) and myopathy (Critical illness myopathies, or CIM) are common complications of critical care. Several syndromes of muscle weakness are combined under the term «Intensive care unit-acquired weakness» or ICUAW. Respiratory neuropathy is a special case of PMCS, where respiratory failure is associated with damage to the neuromuscular apparatus of external respiration. The clinical consequence of respiratory neuropathy is an unsuccessful weaning from ventilator and a long stay of patients in ICU. This systematic review of the literature is an analysis of publications devoted to the main pathogenetic mechanisms of the development of CIP and respiratory neuropathy, diagnostic methods, new therapeutic approaches to the treatment of ICU patients with respiratory neuropathy. The special attention is given to the problem of acute muscle wasting, diagnosis and correction of proteinenergy metabolism disorders in patients with respiratory neuropathy.

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The authors declare that there are no conflicts of interest present.