НЕЙРОГЕННЫЙ ОТЕК ЛЕГКИХ

Нейрогенный отек легких (НОЛ) является одним из осложнений острых заболеваний и травм головного мозга (ГМ) и сопровождается развитием тяжелой дыхательной недостаточности. Его возникновение связано с высоким уровнем летальности. Существует несколько теорий развития НОЛ. Наиболее современной и обсуждаемой среди них является теория «двойного удара». В ее основе лежит повреждение легких за счет системной воспалительной реакции, источником медиаторов воспаления для которой становится глиальная ткань поврежденного ГМ. Сходство патогенеза позволяет рассматривать НОЛ как одну из форм острого респираторного дистресс-синдрома (ОРДС). Для его диагностики используются общие с ОРДС критерии, выявляемые на фоне острого повреждения ГМ и не имеющие связи с другими этиологическими факторами. Эффективных мер профилактики и лечения НОЛ в настоящее время не разработано. Ведущее место в его терапии занимает поддержание газообмена с помощью искусственной вентиляции легких, которую рекомендуется проводить в соответствии с принципами протективной вентиляции. При этом использование ее отдельных подходов возможно только в условиях нейромониторинга.

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