Возможности и показания к применению методов экстракорпоральной гемокоррекции в комплексном лечении пациентов с новой коронавирусной инфекцией

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Методы экстракорпоральной гемокоррекции широко используются в лечении сепсиса, системного воспалительного ответа и полиорганной недостаточности. Имеющийся спектр этих методов достаточно широк, вместе с тем продолжается их активное развитие и совершенствование. Новая коронавирусная инфекция (COVID-19), проявляющаяся при тяжелых формах как сепсис или септический шок, характеризуется выраженным дисбалансом концентраций про- и противовоспалительных медиаторов — цитокиновым штормом, который обусловливает развитие и прогрессирование полиорганной недостаточности. При этом особое внимание уделяется нарушению функции почек, поскольку развитие острого почечного повреждения при COVID-19 является предиктором неблагоприятного исхода. В данной ситуации методы экстракорпорального очищения крови имеют патогенетически обоснованные механизмы действия — купирование цитокинового шторма, с одной стороны, и лечение/предупреждение острого почечного повреждения — с другой. В статье представлены технологии экстракорпоральной гемокоррекции, которые в настоящее время успешно применяются в лечении сепсиса и септического шока и могут использоваться в лечении COVID-19. При этом некоторые из них уже имеют научно-клиническое подтверждение эффективности. Рассматриваются также вопросы острого почечного повреждения и варианты заместительной почечной терапии.

Ключевые слова:

COVID-19

цитокиновый шторм

сепсис

острое почечное повреждение

заместительная почечная терапия

Авторы:

Ярустовский М.Б.

ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России

Шукевич Д.Л.

ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний» Минобрнауки России

Ушакова Н.Д.

ФГБУ «Национальный медицинский исследовательский центр онкологии» Минздрава России

Соколов А.А.

ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России

Рей С.И.

ГБУЗ города Москвы «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»

Даты поступления:

05.04.2020

Даты принятия в печать:

12.07.2020

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