kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”kpccz-1782Research ArticleАНАЛИТИЧЕСКИЙ ОБЗОР. Анестезиология и реаниматологияREVIEWS. Anaesthesiology and intensive careМИКРОЦИРКУЛЯЦИЯ ПРИ КРИТИЧЕСКИХ СОСТОЯНИЯХ: АКТУАЛЬНАЯ ПАТОФИЗИОЛОГИЯ И МЕСТО ТЕХНОЛОГИЙ В СТРАТЕГИИ КЛИНИЧЕСКОГО МОНИТОРИНГА ПАЦИЕНТОВMICROCIRCULATION IN CRITICAL CARE: CURRENT PATHOPHYSIOLOGY AND PLACE IN THE STRATEGY OF MONITORING CRITICAL CONDITIONS AS A MONITORING TECHNOLOGYhttps://orcid.org/0000-0003-0301-5358ПлехановАнтон АндреевичPlekhanovAnton A.

кандидат медицинских наук младший научный сотрудник лаборатории оптической когерентной томографии научно-исследовательского института экспериментальной онкологии и биомедицинских технологий федерального государственного бюджетного образовательного учреждения высшего образования «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской Федерации, Нижний Новгород, Российская Федерация

Candidate of Medical Sciences, Junior Researcher at the Laboratory of Optical Coherence Tomography of the Scientific Research Institute of Experimental Oncology and Biomedical Technologies of the Federal State Budgetary Educational Institution of Higher Education "Volga Research Medical University" of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russian Federation

strike_gor@mail.ruhttps://orcid.org/0000-0002-0631-5666РыжковИван АлександровичRyzhkovIvan A.

кандидат медицинских наук заведующий лабораторией экспериментальных исследований, ведущий научный сотрудник, врач – анестезиолог-реаниматолог федерального государственного бюджетного научного учреждения «Федеральный научно-клинический центр реаниматологии и реабилитологии», Москва, Российская Федерация

Candidate of Medical Sciences, Head of the Laboratory of Experimental Research, Leading Researcher, Anesthesiologist and Intensive Care Physician at the Federal State Budgetary Scientific Institution Federal Scientific and Clinical Center for Intensive Care and Rehabilitation, Moscow, Russian Federation

riamed21@gmail.comhttps://orcid.org/0000-0003-4769-417XКиселеваЕлена БорисовнаKiselevaElena B.

кандидат биологических наук старший научный сотрудник лаборатории оптической когерентной томографии федерального государственного бюджетного образовательного учреждения высшего образования «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской Федерации, Нижний Новгород, Российская Федерация

Candidate of Biological Sciences, Senior Researcher at the Laboratory of Optical Coherence Tomography of the Federal State Budgetary Educational Institution of Higher Education "Volga Research Medical University" of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russian Federation

https://orcid.org/0000-0000-0000-0001ПанфиловСергей ВалерьевичPanfilovSergey V.

врач – анестезиолог-реаниматолог ГАУЗ НО «НИИКО «Нижегородский областной клинический онкологический диспансер», врач анестезиолог-реаниматолог федерального государственного бюджетного образовательного учреждения высшего образования «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской Федерации, Нижний Новгород, Российская Федерация

Intensive Care anesthesiologist at the Nizhny Novgorod Regional Clinical Oncology Dispensary, Intensive Care anesthesiologist at the Federal State Budgetary Educational Institution of Higher Education Volga Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russian Federation

panfilov-sergy1986@yandex.ruhttps://orcid.org/0000-0003-0246-3466МихайловаАлена АлександровнаMikhailovaAlyona A.

врач – анестезиолог-реаниматолог, младший научный сотрудник Лаборатории анестезиологии, реаниматологии и патофизиологии критических состояний Федерального государственного бюджетного научного учреждения «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний», Кемерово, Российская Федерация

Intensive care anesthesiologist, Junior Researcher at the Laboratory of Anesthesiology, Intensive Care Medicine and Pathophysiology of Critical Conditions of the Federal State Budgetary Scientific Institution Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russian Federation

carfagenez@mail.ruhttps://orcid.org/0000-0002-4665-8292СироткинаМарина АлександровнаSirotkinaMarina A.

кандидат биологических наук директор федерального государственного бюджетного образовательного учреждения высшего образования «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской Федерации, Нижний Новгород, Российская Федерация

Candidate of Biological Sciences, Director of the Federal State Budgetary Educational Institution of Higher Education "Volga Research Medical University" of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russian Federation

https://orcid.org/0000-0002-8386-7157ГладковаНаталья ДорофеевнаGladkovaNatalia D.

доктор медицинских наук, профессор заведующая лабораторией оптической когерентной томографии федерального государственного бюджетного образовательного учреждения высшего образования «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской Федерации, Нижний Новгород, Российская Федерация

MD, Professor, Head of the Laboratory of Optical Coherence Tomography of the Federal State Budgetary Educational Institution of Higher Education "Volga Research Medical University" of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russian Federation

https://orcid.org/0000-0001-8370-3083ГригорьевЕвгений ВалерьевичGrigorievEvgeny V.

член-корреспондент РАН заместитель директора по научной и лечебной работе Федерального государственного бюджетного научного учреждения «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний», Кемерово, Российская Федерация

Corresponding Member of the Russian Academy of Sciences, Deputy Director for Scientific and Therapeutic Work of the Federal State Budgetary Scientific Institution "Scientific Research Institute of Complex Problems of Cardiovascular Diseases", Kemerovo, Russian Federation

grigorievev2017@gmail.comФедеральное государственное бюджетное образовательное учреждение высшего образования «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияPrivolzhsky Research Medical UniversityRussian FederationФедеральное государственное бюджетное научное учреждение «Федеральный научно-клинический центр реаниматологии и реабилитологии»РоссияFederal State Budgetary Institution “Federal Scientific and Clinical Center of Intensive Care and Rehabilitation”Russian FederationГосударственное автономное учреждение здравоохранения Нижегородской области «Научно-исследовательский институт клинической онкологии «Нижегородский областной клинический онкологический диспансер»РоссияResearch Institute of Clinical Oncology “Nizhny Novgorod Regional Clinical Oncological Dispensary”Russian FederationФедеральное государственное бюджетное научное учреждение «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»РоссияFederal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”Russian Federation202512112025145139159Copyright © Плеханов А.А., Рыжков И.А., Киселева Е.Б., Панфилов С.В., Михайлова А.А., Сироткина М.А., Гладкова Н.Д., Григорьев Е.В., 20252025Плеханов А.А., Рыжков И.А., Киселева Е.Б., Панфилов С.В., Михайлова А.А., Сироткина М.А., Гладкова Н.Д., Григорьев Е.В.Plekhanov A.A., Ryzhkov I.A., Kiseleva E.B., Panfilov S.V., Mikhailova A.A., Sirotkina M.A., Gladkova N.D., Grigoriev E.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/1782Основные положения

Основные положения

 

 

Резюме

Резюме

Важнейшей проблемой проведения мероприятий интенсивной терапии пациентам в условиях отделения реанимации/операционной при развитии системной воспалительной реакции (связанной как с агрессивной хирургией, так и с шоком, ишемией и реперфузией) является явный недостаток эффективных клинических и лабораторных инструментов диагностики ухудшения микроциркуляции в органах и тканях (периферической гипоперфузии). Стоит отметить, что диагностика и терапия уже возникших нарушений макрогемодинамики не гарантирует улучшения микроциркуляции и достаточного купирования гипоксии органов, что подтверждается современными тенденциями сохранения высоких показателей смертности критических пациентов при развитии шока и полиорганной недостаточности. Поэтому необходима разработка новых и адаптированных к клиническому использованию инструментов и стратегий их применения для прямой диагностики микроциркуляторных нарушений в целях прогнозирования развития полиорганной недостаточности и своевременного оказания целевой терапии. Данный обзор подробно раскрывает основные аспекты этиологии и патогенеза нарушений микроциркуляции при критических состояниях, патофизиологию механизмов микроциркуляторной дисфункции, а также, возможную роль перспективных инструментальных технологий прямого мониторинга за изменениями микроциркуляции у постели больного. Учитывая многогранность и взаимосвязь процессов, происходящих при нарушении микроциркуляторной гемодинамики и органной перфузии, подчеркнута острая необходимость во внедрении клинически эффективного метода диагностики и прогноза развития полиорганной недостаточности у пациентов группы риска для заблаговременной и обоснованной коррекции терапевтических действий. В обзоре рассмотрены потенциальные для клинического использования методы витальной видеомикроскопии и оптической когерентной томографии ангиографии, их достоинства и недостатки для решения задач прикроватной прямой диагностики микроциркуляторной дисфункции.

Highlights

Highlights

 

 

Abstract

Abstract

The most important problem of intensive care measures for patients in the intensive care unit/operating room with the development of a systemic inflammatory reaction (associated with both aggressive surgery and shock, ischemia and reperfusion) is the obvious lack of effective clinical and laboratory diagnostic tools for the deterioration of microcirculation in organs and tissues (peripheral hypoperfusion). It is worth noting that the diagnosis and therapy of macrohemodynamic disorders that have already occurred does not guarantee improved microcirculation and sufficient relief of organ hypoxia, which is confirmed by current trends in maintaining high mortality rates in critical patients with shock and multiple organ failure. Therefore, it is necessary to develop new tools and strategies adapted to clinical use for the direct diagnosis of microcirculatory disorders in order to predict the development of multiple organ failure and timely targeted therapy. This review reveals in detail the main aspects of the etiology and pathogenesis of microcirculation disorders in critical conditions, the pathophysiology of the mechanisms of microcirculatory dysfunction, as well as the possible role of promising instrumental technologies for direct monitoring of microcirculation changes at the patient’s bedside. Taking into account the versatility and interrelation of the processes occurring in violation of microcirculatory hemodynamics and organ perfusion, the urgent need for the introduction of a clinically effective method of diagnosis and prognosis of the development of multiple organ failure in patients at risk for early and informed correction of therapeutic actions is emphasized. The review examines the potential methods of vital video microscopy and optical coherence tomography angiography for clinical use, their advantages and disadvantages for solving the problems of bedside direct diagnosis of microcirculatory dysfunction.

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