Рецепт. 2019; : 752-760
Применение антиоксидантов при острой ишемии. Обзор литературы
Аннотация
В прогрессировании любого острого патологического процесса огромную роль играет развитие острой гипоксии. Терапия острой ишемии сложна, разнонаправленна и многогранна. Несмотря на внедрение в практику новых хирургических, эндоскопических и медикаментозных методов лечения, летальность в группе пациентов с тяжелой кровопотерей остается высокой и составляет от 15% до 80%. Основной причиной летальности является прогрессирование полиорганной недостаточности. В патогенезе острой постгеморрагической гипоксии в последнее время значительное место уделяется нарушению свободнорадикальных процессов, что сопровождается поступлением продуктов перекисного окисления в системный кровоток и усугубляет органную дисфункцию. Считается, что некомпенсированная активация перекисного окисления при острой кровопотере является важным звеном в патогенезе полиорганной недостаточности, определяющей исход заболевания. Остается не изученным нарушение баланса антипрооксидантной системы организма пациентов с различной интенсивностью кровотечения и степенью кровопотери, не определены методы медикаментозной коррекции развивающихся свободнорадикальных нарушений. Все вышеизложенное и определяет актуальность, научно-практическую значимость проведения исследований по оптимизации патогенетического лечения пациентов данной категории с учетом состояния баланса антипрооксидантных систем организма.
Список литературы
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2. Afanas`ev V. (2005) Citoflavin v intensivnoj terapii. Posobie dlya vrachej [Cytoflavin in intensive care. Manual for doctors]. SPb.: Taktik-Studio. (in Russian)
3. Kozhura V., Novoderzhkina I., Kirsanova A. (2002) Ostraya massivnaya krovopoterya: mexanizmy` kompensacii i povrezhdeniya [Acute massive blood loss: the compensatory mechanisms and damage]. Anesteziologiya i reanimatologiya, no 6, pp. 9–13.
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8. Bansal V., Fortlage D., Lee J.G., Costantini T., Potenza B., Coimbra R. (2009) Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours. Eur. J. Trauma Emerg. Surgery, vol. 35, pp. 26–30.
9. Astapenko V., Alekseev S. (2011) Ostry`e gastroduodenal`ny`e krovotecheniya. Uchebno-metodicheskoe posobie [Acute gastroduodenal bleeding. Training manual]. Mn.: BGMU. (in Russian)
10. Butrov A., Borisov A., Galenko S. (2006) Racional`naya infuzionnaya terapiya u bol`ny`x v kriticheskix sostoyaniyax [Rational infusion therapy in patients in critical conditions]. Trudny`j pacient, vol. 4, no 10, pp. 19–23.
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14. Marmy`sh G., Dubrovshhik O., Dovnar I., Koleshko S., Deshuk A., Brejdo G. (2018) Taktika lecheniya pacientov s yazvenny`mi gastroduodenal`ny`mi krovotecheniyami [Tactics of treatment of patients with ulcerative gastroduodenal bleeding]. Zhurnal Grodnenskogo gosudarstvennogo medicinskogo universiteta, vol. 16, no 2, pp. 223–227.
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25. Matheson P.J., Hurt R.T., Franklin G.A., McClain C.J., Garrison R.N. (2009) Obesity-induced hepatic hypoperfusion primes for hepatic dysfunction after resuscitated hemorrhagic shock. Surgery, vol. 4, pp. 739–47.
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Recipe. 2019; : 752-760
Use of Antioxidants in Acute Ischemia. Literature Review
Abstract
In the progression of any acute pathological process, the development of acute hypoxia plays a huge role. Therapy of acute ischemia is complex, multidirectional and multifaceted. Despite the introduction of new surgical, endoscopic and drug treatment methods into practice, mortality in the group of patients with severe blood loss remains high and ranges from 15% to 80%. The main cause of mortality is the progression of multiple organ failure. Recently, a significant place in the pathogenesis of acute posthemorrhagic hypoxia has been devoted to the violation of free radical processes, which is accompanied by the entry of peroxidation products into the systemic circulation and exacerbates organ dysfunction. There is considered that uncompensated activation of peroxidation in acute blood loss is an important link in the pathogenesis of multiple organ failure, which determines the outcome of the disease. The unbalance of the anti-prooxidant system of the patient’s body with different intensity of bleeding and the degree of blood loss remains unstudied, methods for drug correction of developing free radical disorders have not been determined. All of the above determines the relevance, research importance of conducting studies to optimize the pathogenetic treatment of patients in this category, taking into account the state of balance of the anti-prooxidant systems of the organism.
References
1. Luk`yanova L. (2004) Rol` bioe`nergiticheskix narushenij v patogeneze gipoksii [The role of bioenergetic disorders in the pathogenesis of hypoxia]. Patologicheskaya fiziologiya i e`ksperimental`naya terapiya, no 2, pp. 2–11.
2. Afanas`ev V. (2005) Citoflavin v intensivnoj terapii. Posobie dlya vrachej [Cytoflavin in intensive care. Manual for doctors]. SPb.: Taktik-Studio. (in Russian)
3. Kozhura V., Novoderzhkina I., Kirsanova A. (2002) Ostraya massivnaya krovopoterya: mexanizmy` kompensacii i povrezhdeniya [Acute massive blood loss: the compensatory mechanisms and damage]. Anesteziologiya i reanimatologiya, no 6, pp. 9–13.
4. Yakovlev A., Emel`yanov N., Muxina I., Dvornikov A., Snopova L., Kalent`ev G., Ryabikov D., Mineeva N. (2010) Vy`bor infuzionnogo preparata dlya profilaktiki poliorgannoj nedostatochnosti pri ostroj massivnoj krovopotere (e`ksperimental`noe issledovanie) [The choice of infusion solution to prevent multiorgan failure in acute massive blood loss (an experimental study)]. Obshhaya reanimatologiya, vol. 6, no 3, pp. 48–51.
5. Savel`ev V. (2009) Klinicheskaya xirurgiya: nacional`noe rukovodstvo [Clinical surgery: national guidelines]. M.: GE`OTAR-Media. (in Russian)
6. Marmy`sh G., Cilindz` I., Rusin I., Kotov A., Lishhiner A. (1999) Xirurgicheskoe lechenie yazvennogo krovotecheniya u bol`nogo s krupnoochagovy`m transmural`ny`m infarktom miokarda [Surgical treatment of ulcerative bleeding in a patient with large-focal transmural myocardial infarction]. Zdravooxranenie, no 7, pp. 56–57.
7. Hilbert P., Nieden K., Kaden I., Hofmann G.O., Stuttmann R. (2013) Early and Rapid Diagnosis with Multislice CT Reduces Lethality in Trauma Patients Requiring Intensive Care: Findings of a Prospective Study. ISRN Emergency Medicine, vol. 2013, pp. 1–8.
8. Bansal V., Fortlage D., Lee J.G., Costantini T., Potenza B., Coimbra R. (2009) Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours. Eur. J. Trauma Emerg. Surgery, vol. 35, pp. 26–30.
9. Astapenko V., Alekseev S. (2011) Ostry`e gastroduodenal`ny`e krovotecheniya. Uchebno-metodicheskoe posobie [Acute gastroduodenal bleeding. Training manual]. Mn.: BGMU. (in Russian)
10. Butrov A., Borisov A., Galenko S. (2006) Racional`naya infuzionnaya terapiya u bol`ny`x v kriticheskix sostoyaniyax [Rational infusion therapy in patients in critical conditions]. Trudny`j pacient, vol. 4, no 10, pp. 19–23.
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12. Kligunenko E., Kravecz O. (2005) Intensivnaya terapiya krovopoteri [Intensive therapy of blood loss]. Moscow: MEDpress-inform. (in Russian)
13. Kondratenko G. (2002) Gastroduodenal`ny`e krovotecheniya yazvennoj e`tiologii: Metod. rekomendacii [Gastroduodenal bleeding of ulcerative etiology: Methodical recommendations]. Mn.: BGMU. (in Russian)
14. Marmy`sh G., Dubrovshhik O., Dovnar I., Koleshko S., Deshuk A., Brejdo G. (2018) Taktika lecheniya pacientov s yazvenny`mi gastroduodenal`ny`mi krovotecheniyami [Tactics of treatment of patients with ulcerative gastroduodenal bleeding]. Zhurnal Grodnenskogo gosudarstvennogo medicinskogo universiteta, vol. 16, no 2, pp. 223–227.
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16. Golubev A., Tamaeva F. (2007) Korrekciya metabolicheskix narushenij v pochkax pri ostroj massivnoj krovopotere (e`ksperimental`noe issledovanie) [Correction of metabolic disorders in patients with acute massive blood loss (an experimental study)]. Obshhaya reanimatologiya, no 5, pp. 38–42.
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18. Cook D.J., Griffith L.E., Walter S.D. (2001) The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care, vol. 5, no 6, pp. 368–375.
19. Morgunov S.S. (2011) Korrekciya tkanevoj gipoksii i processov svobodnoradikal`nogo okisleniya pri gastroduodenal`ny`x krovotecheniyax [Correction of tissue hypoxia and free radical oxidation processes in gastroduodenal bleeding]. Xirurgiya. Zhurnal im. N.I. Pirogova, no 9, pp. 71–75.
20. Silina E., Stupin V., Sabirov M., Bolevich S., Smirnova G., Siluyanov S., Martirosov A., Men`shova N. (2011) Svobodno-radikal`ny`e processy` u bol`ny`x s zheludochno-kishechny`mi krovotecheniyami [Free radical processes in patients with gastrointestinal bleeding]. Xirurgiya. Zhurnal im N.I. Pirogova, no 12, pp. 64–70.
21. Joseph R.S., Amanda R.K., Jessica L.Z., Dawn A., Janet D.P. (2007) Fluid Resuscitation Therapy for Hemorrhagic Shock. Journal of Trauma Nursing, vol. 14, no 3, pp. 152–160.
22. Tret`yak S., Protasevich P. (2004) Izmeneniya bioximicheskix pokazatelej krovi i koagulogrammy` u xirurgicheskix bol`ny`x, perenesshix ostruyu massivnuyu krovopoteryu [Changes in biochemical parameters of blood and coagulogram in surgical patients undergoing acute massive blood loss]. Belorusskij medicinskij zhurnal, no 3, pp. 103–106.
23. Benson A.B., Moss M. (2009) Trauma and Acute Respiratory Distress Syndrome: Weighing the Risks and Benefits of Blood Transfusions. Anesthesiology, vol. 110, no 2, pp. 216–217.
24. Yang S., Hu S., Chen J., Choudhry M.A., Rue L.W., Bland K.I., Chaudry I.H. (2009) Mechanism of hepatoprotection in proestrus female rats following trauma-hemorrhage: heme oxygenase-1-derived normalization of hepatic inflammatory responses. Journal of leukocyte biology, vol. 6, pp. 1015–1026.
25. Matheson P.J., Hurt R.T., Franklin G.A., McClain C.J., Garrison R.N. (2009) Obesity-induced hepatic hypoperfusion primes for hepatic dysfunction after resuscitated hemorrhagic shock. Surgery, vol. 4, pp. 739–47.
26. Zinchuk V. (2002) Problema formirovaniya prooksidantno-antioksidantnogo sostoyaniya organizma [The problem of formation of prooxidant-antioxidant state of the organism]. Medicinskie novosti, no 4, pp. 9–14.
27. Bagnenko S., Shax B., Lapshin V., Teplov V. (2007) Korrekciya rasstrojstv mikrocirkulyacii i profilaktika reperfuzionny`x narushenij u postradavshix s sochetannoj travmoj [Correction of microcirculation disorders and prevention of reperfusion disorders in patients with combined trauma]. Klinicheskaya fiziologiya krovoobrashheniya, no 4, pp. 49–55.
28. Zy`blev S., Dundarov Z. (2013) Dinamika metabolicheskogo statusa u e`ksperimental`ny`x zhivotny`x pri krovopotere [Dynamics of metabolic status in experimental animals at blood loss]. Xirurgiya. Vostochnaya Evropa, vol. 7, no 3, pp. 62–68.
29. So A., Thorens B. (2010) Uric acid transport and disease. J Clin Invest, vol. 120, no 6, pp. 1791–1799.
30. Pochepen` O. (2009) Nutriitivnaya podderzhka u tyazheloobozhzhyonny`x. Uchebno-metodicheskoe posobie [Nutritive support in severely burnt patients. Training manual]. Minsk: BelMAPO. (in Russian)
31. Mesejoa A., Alonsob C.V., Escribanoc J.A., Leibadand C.O., González J.C.M. (2011) Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Introduction and methodology. Nutr Hosp, vol. 26 (Supl. 2), pp. 1–6.
32. Iapichino G., Radrizzani D., Destrebecq A., Vincenzi M., Zanello M. (2008) Metabolic support of the critically ill: 2008 update. Minerva Anestesiol, no 12, pp. 709–713.
33. Afanas`ev V. (2005) Klinicheskaya farmakologiya reamberina (ocherk): Posobie dlya vrachej [Clinical pharmacology of Reamberin (essay): a Manual for physicians]. SPb.: Taktik-Studio. (in Russian)
34. Simonenkov A., Fyodorov V. (2000) O edinstve tkanevoj gipoksii i shoka [On the unity of tissue hypoxia and shock]. Anesteziologiya i reanimatologiya, no 6, pp. 73–76.
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