pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2020-30-4-493-503pulmo-2156Research ArticleОБЗОРЫREVIEWФакторы риска и профилактика нозокомиальной пневмонии при политравмеRisk factors and prevention of nosocomial pneumonia in polytraumaШапкинЮ. Г.ShapkinYu. G.

Шапкин Юрий Григорьевич – доктор медицинских наук, профессор, заведующий кафедрой общей хирургии

410012, Саратов, ул. Б. Казачья, 112

Yuriy G. Shapkin, Doctor of Medicine, Professor, chief of chair of general surgery

ul. Bol. Kazach'ya 112, Saratov, 410012

shapkinyurii@mail.ruСеливерстовП. А.SeliverstovP. A.

Селиверстов Павел Андреевич – кандидат медицинских наук, ассистент кафедры общей хирургии

410012, Саратов, ул. Б. Казачья, 112

Pavel A. Seliverstov, Candidate of Medicine, Assistant Lecturer of general surgery chair

ul. Bol. Kazach'ya 112, Saratov, 410012

seliwerstov.pl@yandex.ruСтекольниковН. Ю.Stekol'nikovN. Yu.

Стекольников Николай Юрьевич – кандидат медицинских наук, доцент кафедры общей хирургии

410012, Саратов, ул. Б. Казачья, 112

Nikolay Yu. Stekol'nikov, Candidate of Medicine, Associate Professor of chair of general surgery

ul. Bol. Kazach'ya 112, Saratov, 410012

nimph2008@yandex.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Саратовский государственный медицинский университет имени В.И.Разумовского» Министерства здравоохранения Российской ФедерацииРоссияV.I.Razumovskiy Saratov State Medical University, Healthcare Ministry of RussiaRussian Federation202017102020304493503Copyright © Шапкин Ю.Г., Селиверстов П.А., Стекольников Н.Ю., 20202020Шапкин Ю.Г., Селиверстов П.А., Стекольников Н.Ю.Shapkin Y.G., Seliverstov P.A., Stekol'nikov N.Y.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/2156

Нозокомиальная пневмония (НКП) относится к наиболее частым осложнениям политравмы (ПТ), приводящим к смерти. Между тем рекомендации по профилактике НКП при ПТ к настоящему времени не конкретизированы. Во многом это связано с недостаточной изученностью патофизиологии тяжелой сочетанной травмы. В обзоре представлены результаты современных экспериментальных и клинических исследований влияния шока, иммунного дистресс-синдрома, посттравматической иммуносупрессии, феномена взаимного отягощения повреждений, возраста, пола, сопутствующей патологии на риск развития НКП при ПТ. Определена роль ятрогенных факторов риска НКП при ПТ – интубации трахеи и искусственная вентиляция легких (ИВЛ), массивные гемотрансфузии, иммобилизации, феномен «второго удара» после множественных операций. Наиболее эффективными мерами профилактики НКП являются сокращение продолжительности ИВЛ, предупреждение колонизации ротоглотки и аспирации при ИВЛ, применение ингаляционных антибактериальных препаратов, противошоковые мероприятия, ранняя мобилизация пациента, максимально ранний стабильно-функциональный остеосинтез малотравматичными методами. Данные об эффективности селективной деконтаминации кишечника, пробиотиков и глюкокортикостероидов для профилактики НКП при ПТ противоречивы. Перспективным направлением профилактики НКП может быть разработка средств, при помощи которых регулируются сложные механизмы иммунного ответа на ПТ и предупреждающих вторичное острое повреждение легких и посттравматическую иммуносупрессию.

Nosocomial pneumonia (NK) is one of the most frequent complications of polytrauma leading to death. Meanwhile, the recommendations on prevention of NK in case of polytrauma have not been specified so far. This is due in large part to the lack of study of the pathophysiology of severe combined trauma. The review presents the results of modern experimental and clinical studies of the effect of shock, immune distress syndrome, posttraumatic immunosuppression, the phenomenon of mutual aggravation of lesions, age, sex, concomitant pathology on the risk of NK in polytrauma. The role of iatrogenic risk factors for NK in polytrauma – intubation of trachea and artificial lung ventilation (AVL), massive hemotransfusions, immobilization, the phenomenon of “second strike” after multiple surgeries has been determined. The most effective measures of NK prevention are reduction of the duration of AVL, prevention of oropharyngeal colonization and aspiration in case of AVL, use of inhalation antibacterial drugs, antishock measures, early mobilization of the patient, the earliest possible stable functional osteosynthesis by minimally traumatic methods. The data on the effectiveness of selective decontamination of intestines, probiotics and glucocorticosteroids for the prevention of NK in polytrauma are inconsistent. A promising area of NK prophylaxis may be the development of agents that regulate the complex mechanisms of immune response to polytrauma and prevent secondary acute lung injury and post-traumatic immunosuppression.

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