МИКРОЦИРКУЛЯЦИЯ ПРИ КРИТИЧЕСКИХ СОСТОЯНИЯХ: АКТУАЛЬНАЯ ПАТОФИЗИОЛОГИЯ И МЕСТО ТЕХНОЛОГИЙ В СТРАТЕГИИ КЛИНИЧЕСКОГО МОНИТОРИНГА ПАЦИЕНТОВ

Основные положения

• Данный литературный обзор охватывает классические и современные представления о патофизиологии микроциркуляции, нарушения которой лежат в основе большинства критических состояний. Такие осложнения могут развиваться у пациентов после разных хирургических вмешательств и приводить к развитию полиорганной недостаточности, в лечении которой и в настоящее время остается множество нерешенных задач.
• Разработка стандарта мониторинга микроциркуляторно-митохондриальной дисфункции улучшит исходы критических пациентов и позволит профилактировать органную гипоперфузию в периоперационном периоде и во время лечения в отделениях реанимации и интенсивной терапии.

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.

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