Гипофосфатемия у взрослых пациентов в критическом состоянии (обзор литературы)

Гипофосфатемия является распространенным метаболическим изменением у пациентов отделения интенсивной терапии. Дефицит сывороточного фосфата может развиться главным образом по трем причинам: снижение всасывания фосфата в кишечнике, перераспределение фосфата из внеклеточного во внутриклеточный компартмент (трансцеллюлярный сдвиг), увеличение почечной экскреции фосфата или любая комбинация этих факторов. Осложнения острой гипофосфатемии вызваны нарушением энергетического обмена из-за снижения синтеза аденозинтрифосфата и ухудшения насыщения тканей кислородом в результате истощения запасов 2,3-дифосфоглицерата, что приводит к клеточной дисфункции во многих системах организма. Симптоматическая гипофосфатемия (при уровне фосфата < 0,32 ммоль/л) характеризуется развитием дыхательной недостаточности, необходимостью искусственной вентиляции легких, снижением сократимости миокарда, рабдомиолизом и нарушениями со стороны ЦНС. Гипофосфатемия является одним из электролитных нарушений при сепсисе, выраженном истощении, рефидинг-синдроме, инсулинотерапии при диабетическом кетоацидозе и других состояниях с высоким процентом летальности. Исследования влияния гипофосфатемии на пациентов ОРИТ, а также подходы к ее коррекции на протяжении многих лет давали противоречивые результаты. В настоящее время в России отсутствуют лекарственные препараты фосфатов (для энтерального или парентерального введения), что делает невозможным проведение коррекции острой гипофосфатемии в отделениях интенсивной терапии и в итоге влияет на качество оказания медицинской помощи. Настоящий обзор посвящен проблеме гипофосфатемии у пациентов ОРИТ, влиянию на исход и подходам к лечению этого состояния.

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