Респираторная нейромиопатия как важный компонент полинейромиопатии критических состояний

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.

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