pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2010-3-31-38pulmo-1644Research ArticleСтатьиВысокие дозы N-ацетилцистеина при остром респираторном дистресс-синдромеАвдеевС. Н.noemail@neicon.ruБатынС. З.noemail@neicon.ruМержоеваЗ. М.noemail@neicon.ruЧучалинА. Г.noemail@neicon.ruФГУ "НИИ пульмонологии ФМБА России"Russian Federation201028062010033138Copyright © Авдеев С.Н., Батын С.З., Мержоева З.М., Чучалин А.Г., 20102010Авдеев С.Н., Батын С.З., Мержоева З.М., Чучалин А.Г.Авдеев С.Н., Батын С.З., Мержоева З.М., Чучалин А.Г.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1644

Целью исследования была оценка клинической эффективности Nацетилцистеина (NAC) у больных с ранними стадиями острого респираторного дистресссиндрома (ОРДС). Исследование было проспективным открытым сравнительным, длительность его составляла 7 дней. Больным основной группы назначали NAC (Флуимуцил) в дозе 70 мг/кг массы тела в виде постоянной внутривенной инфузии в течение 10-12 ч в сутки. В исследование были включены 37 больных ОРДС в возрасте 46 ± 8 лет (основная причина ОРДС - пневмония, в т. ч. вызванная вирусом гриппа A (H1N1)). В ходе исследования у больных ОРДС проводились инвазивная (катетеризация легочной артерии) и неинвазивная (эхокардиографическая) оценка центральной гемодинамики, оценка газового состава крови, фибробронхоскопическое исследование с выполнением цитограммы бронхоальвеолярного лаважа (БАЛ) и оценка параметров механики дыхания. У больных ОРДС, получавших терапию NAC, был отмечен быстрый и значительный прирост показателей РаО2 / FiO2, по сравнению с группой контроля, через 1 сут. терапии (253 ± 29 vs 178 ± 24 мм рт. ст.; p = 0,050), в дальнейшем различие стало еще более выраженным. У больных группы NAC наблюдались достоверное повышение сердечного индекса (от 2,52 ± 0,11 до 2,66 ± 0,13 л/мин/м2; р = 0,034) и ударного объема левого желудочка (ЛЖ) (прирост - от 50 ± 6 до 58 ± 8 мл; р = 0,041). У больных группы NAC происходило небольшое снижение общего числа нейтрофилов БАЛ (от 376 ± 125 до 223 ± 78 клеток/мм3; р = 0,066). Летальность была приблизительно одинаковой в обеих группах (38,5 % - в группе NAC и 42,9 % - в группе контроля; р = 0,873), была отмечена тенденция к меньшему сроку респираторной поддержки и времени нахождения больных в ОРИТ и в стационаре у больных, получавших NAC. Также была выявлена тенденция к уменьшению числа случаев синдрома полиорганной недостаточности (СПОН) на фоне использования NAC (23,1 % vs 64,3 %; р = 0,077). Таким образом, терапия NAC у больных ОРДС приводит к быстрому и значительному улучшению показателей оксигенации, повышению сердечного индекса и ударного объема ЛЖ, к уменьшению числа случаев СПОН, но не снижает летальность больных ОРДС.

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