Передозировка ацетаминофеном в практике интенсивной терапии: патофизиологические механизмы и методы лечения

Введение. Отравление ацетаминофеном (АМ) — распространенная токсикологическая проблема с высоким риском развития острой почечной недостаточности и летального исхода. Рассмотрение вопросов оказания неотложной помощи и поиск альтернативных методов интенсивной терапии пациентам с этой патологией является актуальным направлением анестезиологии-реаниматологии.

Цель работы — определение современного состояния проблемы патогенеза, клинических проявлений и интенсивной терапии при острых передозировках АМ, в т. ч. разбор новых и экспериментальных методов лечения.

Материалы и методы. Выполнен поиск и анализ научных работ с использованием баз данных Cochrane Library, PubMed и Medscape по поисковым словам: acetaminophen, overdose, intensive therapy, N-acetylcysteine, mitochondrial dysfunction, oxidative stress. Для обзора отобрано 76 источников.

Результаты и обсуждение. В патогенезе гепатои нефротоксичности при острой передозировке АМ лежат процессы митохондриального оксидативного стресса, воспаления, аутофагии, апоптоза и нарушение эндоплазматического ретикулума. Клинические проявления включают в себя 4 основные фазы, начинаются от тошноты и рвоты с постепенным нарастанием острой печеночной недостаточности и могут заканчиваться церебральной и кардиальной недостаточностью вплоть до летального исхода. Неотложная помощь при передозировках АМ оказывается в условиях отделения анестезиологии и реанимации, которая направлена на удаление яда, поддержание гемодинамики и борьбу с отеком головного мозга. Единственным одобренным антидотом с доказанной эффективностью при отравлении АМ является N-ацетилцистеин. Ведутся поиски новых альтернативных методов лечения на основе коррекции митохондриального оксидативного стресса и нарушений эндоплазматического ретикулума, инактивации воспаления и активации аутофагии.

Заключение. Интенсивная терапия острого отравления АМ, основанная на патогенетических подходах, имеет недостаточную эффективность, что служит основанием для более углубленных исследований в этой области для повышения качества оказания экстренной помощи указанному контингенту пациентов.

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