57 research outputs found
EFFECT OF FLUOXETINE ON SLEEP ARCHITECTURE IN PATIENTS WITH METABOLIC SYNDROME AND OBSTRUCTIVE SLEEP APNEA SYNDROME
Aim. To study effect of fluoxetine on sleep architecture in patients with metabolic syndrome and obstructive sleep apnea syndrome.Material and methods. 98 patients with obstructive sleep apnea syndrome and metabolic syndrome (aged 54.3Β±8.7 y.o.) were included into the study. All patients received fluoxetine 20 mg once daily during 6 months. Influence of fluoxetine on sleep architecture was evaluated with special questionnaire and by polysomnography, including electroencephalogram, electrooculogram, mentalis electromyogram and pulseoxymetry.Results. Decrease in wake time after sleep onset (Ξ33%; Ρ<0.05) was found at the end of treatment. It resulted in improvement of sleep efficacy index. Decrease in respiratory sleep disorders index (Ξ20%) and rising of blood oxygen saturation (Ξ12%; Ρ<0.05) was also found. Improvement of the sleep architecture (reduction in the 2nd phase of slow wave sleep by 15%, increase in delta-sleep (Ξ71%) and rapid eye movement sleep (Ξ25%; Ρ<0.05) was also observed. Besides reduction in body mass index after fluoxetine therapy (Ξ12%; Ρ<0.05) was found. Serious adverse effects were not registered.Conclusion. Fluoxetine use in patients with metabolic syndrome and obstructive sleep apnea syndrome shown positive effect on objective indices of sleep architecture and respiratory sleep disorders. It improved adaptive function of the sleep and contributed to reduction in sleep disorders
ΠΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠ°Ρ Π½Π°ΡΡΠΎΡΠΎΠΆΠ΅Π½Π½ΠΎΡΡΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ΅Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ
The processes that vary in nature and underlie the pathogenesis of malignant neoplasms (MNs) and immune-mediated inflammatory rheumatic diseases (RDs) share just the same some common features. Thus, many early-stage neoplasias can mask autoimmune diseases, requiring that physicians of various specialties should comply with the principle of cancer alertness. When specific cancer treatments (immunotherapy, cytostatic therapy, radiotherapy) are performed, there may be certain rheumatic syndromes (arthritis, myalgia, serositis, etc.) that require a differential diagnosis. At the same time, the course of a number of RDs (rheumatoid arthritis, SjΓΆgren's syndrome, and polymyositis) can be accompanied by the development of MNs, which is relevant for real clinical practice and calls for further investigation.The community of etiological factors and a genetic predisposition in the development of RDs and MNs remain to be of no less importance. At the same time, therapists should pay attention to the presence of rheumatic masks in many MNs, which undoubtedly prolongs the time between onset of the first symptoms and correct diagnosis.Π Π°Π·Π»ΠΈΡΠ½ΡΠ΅ ΠΏΠΎ ΡΠ²ΠΎΠ΅ΠΉ ΠΏΡΠΈΡΠΎΠ΄Π΅ ΠΏΡΠΎΡΠ΅ΡΡΡ, Π»Π΅ΠΆΠ°ΡΠΈΠ΅ Π² ΠΎΡΠ½ΠΎΠ²Π΅ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π° Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
Π½ΠΎΠ²ΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠΉ (ΠΠ) ΠΈ ΠΈΠΌΠΌΡΠ½ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΡΠ΅Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ (Π Π), ΡΠ΅ΠΌ Π½Π΅ ΠΌΠ΅Π½Π΅Π΅ ΠΈΠΌΠ΅ΡΡ ΠΈ Π½Π΅ΠΊΠΎΡΠΎΡΡΠ΅ ΠΎΠ±ΡΠΈΠ΅ ΡΠ΅ΡΡΡ. Π’Π°ΠΊ, ΠΌΠ½ΠΎΠ³ΠΈΠ΅ Π½Π΅ΠΎΠΏΠ»Π°Π·ΠΈΠΈ Π½Π° Π½Π°ΡΠ°Π»ΡΠ½ΡΡ
ΡΡΠ°Π΄ΠΈΡΡ
ΠΌΠΎΠ³ΡΡ ΠΏΡΠΎΡΠ΅ΠΊΠ°ΡΡ ΠΏΠΎΠ΄ ΠΌΠ°ΡΠΊΠΎΠΉ Π°ΡΡΠΎΠΈΠΌΠΌΡΠ½Π½ΡΡ
Π±ΠΎΠ»Π΅Π·Π½Π΅ΠΉ, ΡΡΠΎ ΡΡΠ΅Π±ΡΠ΅Ρ ΡΠΎΠ±Π»ΡΠ΄Π΅Π½ΠΈΡ ΠΏΡΠΈΠ½ΡΠΈΠΏΠ° ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π½Π°ΡΡΠΎΡΠΎΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΡΠΎ ΡΡΠΎΡΠΎΠ½Ρ Π²ΡΠ°ΡΠ΅ΠΉ ΡΠ°Π·Π½ΡΡ
ΡΠΏΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΡΡΠ΅ΠΉ. Π Ρ
ΠΎΠ΄Π΅ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ (ΠΈΠΌΠΌΡΠ½ΠΎ- ΠΈ ΡΠΈΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, Π»ΡΡΠ΅Π²ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ) ΠΌΠΎΠ³ΡΡ ΡΠ°Π·Π²ΠΈΠ²Π°ΡΡΡΡ ΡΠ΅ ΠΈΠ»ΠΈ ΠΈΠ½ΡΠ΅ ΡΠ΅Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠΈΠ½Π΄ΡΠΎΠΌΡ (Π°ΡΡΡΠΈΡ, ΠΌΠΈΠ°Π»Π³ΠΈΠΈ, ΡΠ΅ΡΠΎΠ·ΠΈΡ ΠΈ Π΄Ρ.), ΡΡΠ΅Π±ΡΡΡΠΈΠ΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ. ΠΠΌΠ΅ΡΡΠ΅ Ρ ΡΠ΅ΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΡΡΠ΄Π° Π Π (ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΠΎΠ³ΠΎ Π°ΡΡΡΠΈΡΠ°, ΡΠΈΠ½Π΄ΡΠΎΠΌΠ° Π¨ΡΠ³ΡΠ΅Π½Π°, ΠΏΠΎΠ»ΠΈΠΌΠΈΠΎΠ·ΠΈΡΠ°) ΠΌΠΎΠΆΠ΅Ρ ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π°ΡΡΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΠΌ ΠΠ, ΡΡΠΎ ΡΠ²Π»ΡΠ΅ΡΡΡ Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠΎΠΉ Π΄Π»Ρ ΡΠ΅Π°Π»ΡΠ½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ ΠΈ ΡΡΠ΅Π±ΡΠ΅Ρ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠ΅Π³ΠΎ ΠΈΠ·ΡΡΠ΅Π½ΠΈΡ.ΠΠ΅ ΠΌΠ΅Π½Π΅Π΅ Π²Π°ΠΆΠ½ΡΠΌ ΠΎΡΡΠ°Π΅ΡΡΡ ΡΠ°ΠΊΡ ΠΎΠ±ΡΠ½ΠΎΡΡΠΈ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΠΈ Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ΅Π΄ΡΠ°ΡΠΏΠΎΠ»ΠΎΠΆΠ΅Π½Π½ΠΎΡΡΠΈ Π² ΡΠ°Π·Π²ΠΈΡΠΈΠΈ Π Π ΠΈ ΠΠ. ΠΠΌΠ΅ΡΡΠ΅ Ρ ΡΠ΅ΠΌ Π²ΡΠ°ΡΠ°ΠΌ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΈΠ»Ρ ΡΠ»Π΅Π΄ΡΠ΅Ρ ΠΎΠ±ΡΠ°ΡΠ°ΡΡ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ Π½Π° Π½Π°Π»ΠΈΡΠΈΠ΅ Ρ ΠΌΠ½ΠΎΠ³ΠΈΡ
ΠΠ ΡΠ΅Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Β«ΠΌΠ°ΡΠΎΠΊΒ», ΡΡΠΎ, Π½Π΅ΡΠΎΠΌΠ½Π΅Π½Π½ΠΎ, ΡΠ΄Π»ΠΈΠ½ΡΠ΅Ρ Π²ΡΠ΅ΠΌΡ ΠΎΡ ΠΏΠΎΡΠ²Π»Π΅Π½ΠΈΡ ΠΏΠ΅ΡΠ²ΡΡ
ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² Π΄ΠΎ ΠΌΠΎΠΌΠ΅Π½ΡΠ° ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠ°Π²ΠΈΠ»ΡΠ½ΠΎΠ³ΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π°
Π Π°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡ ΠΈ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²Ρ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΡΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ
Tsel' issledovaniya. Opredelit' rasprostranennost', techenie i effektivnost' profilaktiki i lecheniya osteoporoza (OP) u patsientov, perenesshikh perelom sheyki bedrennoy kosti.
Materialy i metody. Na pervom etape issledovaniya izuchali dannye 117 patsientov (28 muzhchin i 89 zhenshchin posle atravmaticheskogo pereloma sheyki bedrennoy kosti; sredniy vozrast - 76,8Β±7,4 goda). U vsekh bol'nykh utochnyali, diagnostirovalsya li do pereloma OP, vyyavlyali faktory riska OP v sootvetstvii s mezhdunarodnym minutnym testom. Vtoroy etap - izuchali dve gruppy patsientov: 1-ya gruppa - 396 bol'nykh s arterial'noy gipertenziey (AG) i ishemicheskoy bolezn'yu serdtsa (IBS); 2-ya gruppa -194 patsienta bez somaticheskoy patologii. Patsientam s AG provodili sutochnoe monitorirovanie AD, patsientam s IBS - kholterovskoe monitorirovanie EKG po standartnoy metodike. Krome togo, vypolnyali EkhoKG, izuchali pokazateli lipidnogo obmena. U vsekh patsientov otsenivali uroven' bolevogo sindroma v spine po VAIII, opredelyali mineral'nuyu plotnost' kostnoy tkani (MPK). Zaklyuchitel'nyy etap issledovaniya - metodom sluchay-kontrol' otobran 151 patsient iz 1-y gruppy. V zavisimosti ot vida osteoporoticheskoy terapii patsienty byli razdeleny na 3 podgruppy. Nablyudenie za patsientami provodili v techenie 12 mes, posle chego otsenivali obshchee sostoyanie, dinamiku MPK po dannym densitometrii, dinamiku klinicheskikh i instrumental'nykh priznakov serdechno-sosudistykh zabolevaniy.
Rezul'taty issledovaniya. Atravmaticheskiy perelom sheyki bedra u muzhchin otmechalsya v srednem na 7,1 goda ran'she, chem u zhenshchin. Gospital'naya letal'nost' pri perelome sheyki bedra - 6,8%; eshche okolo 25% bol'nykh umirayut v techenie goda. U bol'shinstva patsientov imelas' kardi-ovaskulyarnaya patologiya, po povodu kotoroy oni nablyudalis' u terapevta, pri etom OP ili faktory ego riska do pereloma ni v odnom sluchae ne byli diagnostirovany. Faktory riska OP pri kardiovaskulyarnoy patologii vstrechalis' v 86,6% sluchaev, u patsientov bez takovoy - v 81,4%. Nizkaya MPK vyyavlena u 65,2% bol'nykh s serdechno-sosudistymi zabolevaniyami i sostavlyala pri IBS -1,9 SD, pri AG-1,6 SD, a u patsientov bez kardiovaskulyarnoy patologii etot pokazatel' dostigal -0,9 SD. Pri nekontroliruemoy AG, gipertrofii levogo zheludochka s narusheniem ego sokratimosti poterya MPK bolee vyrazhennaya. Otmecheny prirost MPK i znachitel'noe klinicheskoe uluchshenie sostoyaniya u patsientov s kardiovaskulyarnoy patologiey i OP na fone terapii kal'tsitoninom lososya i preparatami kal'tsiya v sochetanii s vitaminom Ds. Zaklyuchenie. Privedennye dannye rasshiryayut nashi predstavleniya o svyazi kardiovaskulyarnoy patologii so snizheniem MPK. Vysokaya obrashchaemost' patsientov s sosudistoy patologiey k kardiologam, terapevtam, nevrologam trebuet sozdaniya usloviy dlya uluchsheniya diagnostiki OP.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ. ΠΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡ, ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π° (ΠΠ) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΏΠ΅ΡΠ΅Π½Π΅ΡΡΠΈΡ
ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌ ΡΠ΅ΠΉΠΊΠΈ Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΡΡΠΈ.
ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ° ΠΏΠ΅ΡΠ²ΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΈΠ·ΡΡΠ°Π»ΠΈ Π΄Π°Π½Π½ΡΠ΅ 117 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (28 ΠΌΡΠΆΡΠΈΠ½ ΠΈ 89 ΠΆΠ΅Π½ΡΠΈΠ½ ΠΏΠΎΡΠ»Π΅ Π°ΡΡΠ°Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠ° ΡΠ΅ΠΉΠΊΠΈ Π±Π΅Π΄ΡΠ΅Π½Π½ΠΎΠΉ ΠΊΠΎΡΡΠΈ; ΡΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ - 76,8Β±7,4 Π³ΠΎΠ΄Π°). Π£ Π²ΡΠ΅Ρ
Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΡΠΎΡΠ½ΡΠ»ΠΈ, Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π»ΡΡ Π»ΠΈ Π΄ΠΎ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠ° ΠΠ, Π²ΡΡΠ²Π»ΡΠ»ΠΈ ΡΠ°ΠΊΡΠΎΡΡ ΡΠΈΡΠΊΠ° ΠΠ Π² ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠΈ Ρ ΠΌΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΡΠΌ ΠΌΠΈΠ½ΡΡΠ½ΡΠΌ ΡΠ΅ΡΡΠΎΠΌ. ΠΡΠΎΡΠΎΠΉ ΡΡΠ°ΠΏ - ΠΈΠ·ΡΡΠ°Π»ΠΈ Π΄Π²Π΅ Π³ΡΡΠΏΠΏΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²: 1-Ρ Π³ΡΡΠΏΠΏΠ° - 396 Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΠ΅ΠΉ (ΠΠ) ΠΈ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΡΠ΅ΡΠ΄ΡΠ° (ΠΠΠ‘); 2-Ρ Π³ΡΡΠΏΠΏΠ° -194 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π±Π΅Π· ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ. ΠΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ ΠΠ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΡΡΡΠΎΡΠ½ΠΎΠ΅ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΠ, ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ ΠΠΠ‘ - Ρ
ΠΎΠ»ΡΠ΅ΡΠΎΠ²ΡΠΊΠΎΠ΅ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΠΠ ΠΏΠΎ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ΅. ΠΡΠΎΠΌΠ΅ ΡΠΎΠ³ΠΎ, Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ ΠΡ
ΠΎΠΠ, ΠΈΠ·ΡΡΠ°Π»ΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ Π»ΠΈΠΏΠΈΠ΄Π½ΠΎΠ³ΠΎ ΠΎΠ±ΠΌΠ΅Π½Π°. Π£ Π²ΡΠ΅Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΡΡΠΎΠ²Π΅Π½Ρ Π±ΠΎΠ»Π΅Π²ΠΎΠ³ΠΎ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ° Π² ΡΠΏΠΈΠ½Π΅ ΠΏΠΎ ΠΠIII, ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ ΠΌΠΈΠ½Π΅ΡΠ°Π»ΡΠ½ΡΡ ΠΏΠ»ΠΎΡΠ½ΠΎΡΡΡ ΠΊΠΎΡΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ (ΠΠΠ). ΠΠ°ΠΊΠ»ΡΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΡΡΠ°ΠΏ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ - ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΡΠ»ΡΡΠ°ΠΉ-ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ ΠΎΡΠΎΠ±ΡΠ°Π½ 151 ΠΏΠ°ΡΠΈΠ΅Π½Ρ ΠΈΠ· 1-ΠΉ Π³ΡΡΠΏΠΏΡ. Π Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ Π²ΠΈΠ΄Π° ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π±ΡΠ»ΠΈ ΡΠ°Π·Π΄Π΅Π»Π΅Π½Ρ Π½Π° 3 ΠΏΠΎΠ΄Π³ΡΡΠΏΠΏΡ. ΠΠ°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ Π·Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 12 ΠΌΠ΅Ρ, ΠΏΠΎΡΠ»Π΅ ΡΠ΅Π³ΠΎ ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΠΎΠ±ΡΠ΅Π΅ ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅, Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΡ ΠΠΠ ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ Π΄Π΅Π½ΡΠΈΡΠΎΠΌΠ΅ΡΡΠΈΠΈ, Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΡ
ΠΏΡΠΈΠ·Π½Π°ΠΊΠΎΠ² ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ.
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ. ΠΡΡΠ°Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌ ΡΠ΅ΠΉΠΊΠΈ Π±Π΅Π΄ΡΠ° Ρ ΠΌΡΠΆΡΠΈΠ½ ΠΎΡΠΌΠ΅ΡΠ°Π»ΡΡ Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ Π½Π° 7,1 Π³ΠΎΠ΄Π° ΡΠ°Π½ΡΡΠ΅, ΡΠ΅ΠΌ Ρ ΠΆΠ΅Π½ΡΠΈΠ½. ΠΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½Π°Ρ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ ΠΏΡΠΈ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠ΅ ΡΠ΅ΠΉΠΊΠΈ Π±Π΅Π΄ΡΠ° - 6,8%; Π΅ΡΠ΅ ΠΎΠΊΠΎΠ»ΠΎ 25% Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΠΌΠΈΡΠ°ΡΡ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π³ΠΎΠ΄Π°. Π£ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠΌΠ΅Π»Π°ΡΡ ΠΊΠ°ΡΠ΄ΠΈ-ΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½Π°Ρ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡ, ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΠΊΠΎΡΠΎΡΠΎΠΉ ΠΎΠ½ΠΈ Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈΡΡ Ρ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠ°, ΠΏΡΠΈ ΡΡΠΎΠΌ ΠΠ ΠΈΠ»ΠΈ ΡΠ°ΠΊΡΠΎΡΡ Π΅Π³ΠΎ ΡΠΈΡΠΊΠ° Π΄ΠΎ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠ° Π½ΠΈ Π² ΠΎΠ΄Π½ΠΎΠΌ ΡΠ»ΡΡΠ°Π΅ Π½Π΅ Π±ΡΠ»ΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½Ρ. Π€Π°ΠΊΡΠΎΡΡ ΡΠΈΡΠΊΠ° ΠΠ ΠΏΡΠΈ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ Π²ΡΡΡΠ΅ΡΠ°Π»ΠΈΡΡ Π² 86,6% ΡΠ»ΡΡΠ°Π΅Π², Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±Π΅Π· ΡΠ°ΠΊΠΎΠ²ΠΎΠΉ - Π² 81,4%. ΠΠΈΠ·ΠΊΠ°Ρ ΠΠΠ Π²ΡΡΠ²Π»Π΅Π½Π° Ρ 65,2% Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΡΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ ΠΈ ΡΠΎΡΡΠ°Π²Π»ΡΠ»Π° ΠΏΡΠΈ ΠΠΠ‘ -1,9 SD, ΠΏΡΠΈ ΠΠ-1,6 SD, Π° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±Π΅Π· ΠΊΠ°ΡΠ΄ΠΈΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΡΡΠΎΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ Π΄ΠΎΡΡΠΈΠ³Π°Π» -0,9 SD. ΠΡΠΈ Π½Π΅ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΡΠ΅ΠΌΠΎΠΉ ΠΠ, Π³ΠΈΠΏΠ΅ΡΡΡΠΎΡΠΈΠΈ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° Ρ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π΅Π³ΠΎ ΡΠΎΠΊΡΠ°ΡΠΈΠΌΠΎΡΡΠΈ ΠΏΠΎΡΠ΅ΡΡ ΠΠΠ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½Π°Ρ. ΠΡΠΌΠ΅ΡΠ΅Π½Ρ ΠΏΡΠΈΡΠΎΡΡ ΠΠΠ ΠΈ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΠΈ ΠΠ Π½Π° ΡΠΎΠ½Π΅ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΊΠ°Π»ΡΡΠΈΡΠΎΠ½ΠΈΠ½ΠΎΠΌ Π»ΠΎΡΠΎΡΡ ΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ ΠΊΠ°Π»ΡΡΠΈΡ Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ Π²ΠΈΡΠ°ΠΌΠΈΠ½ΠΎΠΌ Ds. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΠΈΠ²Π΅Π΄Π΅Π½Π½ΡΠ΅ Π΄Π°Π½Π½ΡΠ΅ ΡΠ°ΡΡΠΈΡΡΡΡ Π½Π°ΡΠΈ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ΠΈΡ ΠΎ ΡΠ²ΡΠ·ΠΈ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ²Π°ΡΠΊΡΠ»ΡΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΠΠΠ. ΠΡΡΠΎΠΊΠ°Ρ ΠΎΠ±ΡΠ°ΡΠ°Π΅ΠΌΠΎΡΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΠΊ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ»ΠΎΠ³Π°ΠΌ, ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠ°ΠΌ, Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³Π°ΠΌ ΡΡΠ΅Π±ΡΠ΅Ρ ΡΠΎΠ·Π΄Π°Π½ΠΈΡ ΡΡΠ»ΠΎΠ²ΠΈΠΉ Π΄Π»Ρ ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΠ
Effective tissue antiischemic therapy of etiologically various vascular diseases of the brain
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Treatment of covid-19 from the perspective of endotheliopathy correction and prevention of thrombotic complications. The agreed position of the experts
The proposed consensus position of the experts present approaches to the diagnosis, treatment and secondary prevention of throm-botic complications and endothelial dysfunction in COVID-19 for their use in outpatient visits. Experts confirmed the position of LMWH in hospitalized patients. Parnaparin sodium is the optimal choice for these patients, due to strong anti-inflammatory effect and a convenient dosing regimen. Experts confirmed endothelial damage as an important factor in the development of hyper-coagulation in outpatients with COVID-19. According to expertβs consensus position, sulodexide may be a pathogenetic approach for the problem of endothelial dysfunction, especially β for period of convalescence. Experts recommend to introduce of sulo-dexide into the Temporary methodological recommendations of the Ministry of Health of the Russian Federation: for outpatients with light forms COVID-19, for patients with high risk of bleeding, also β for patients at the stage of rehabilitation to prevent recurrent VTE and reduce the risk of developing pulmonary fibrosis
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