Факторы риска и профилактика нозокомиальной пневмонии при политравме

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.

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