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"Emergency medicine" Том 16, №8, 2020

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Persistent inflammation, immunosuppression and catabolism syndrome: mechanisms of sarcopenia and ways of correction

Authors: Чуклін С.М., Чуклін С.С., Шершень Г.В.
Львівська обласна клінічна лікарня, м. Львів, Україна

Categories: Medicine of emergency

Sections: Specialist manual

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Summary

Завдяки прогресу в галузі інтенсивної терапії багато пацієнтів із тяжкою патологією виписуються з відділень інтенсивної терапії. Проте у частини хворих зберігається тривале, слабкого ступеня запалення, відновлення є затяжним, розвивається хронічний критичний стан. Крім того, у деяких пацієнтів поряд зі стійким запаленням виникають імуносупресія та катаболізм. У 2012 році цей стан був виділений в окремий синдром, який може спостерігатися після тяжкої травми й опіків, сепсису, некротичного панкреатиту. Одним із провідних клінічних проявів при цьому є значна втрата м’язової маси тіла, що погано піддається корекції. При використанні літератури з бази MedLine описано сучасні уявлення про механізми саркопенії при синдромі стійкого запалення, імуносупресії та катаболізму і можливі шляхи оптимальної анаболічної підтримки.

Благодаря прогрессу в области интенсивной терапии многие пациенты с тяжелой патологией выписываются из отделений интенсивной терапии. Однако у части больных сохраняется длительное слабой степени воспаление, восстановление является затяжным, и у них развивается хроническое критическое состояние. Кроме того, у некоторых пациентов наряду с устойчивым воспалением возникают иммуносупрессия и катаболизм. В 2012 году это состояние было выделено в отдельный синдром, который может наблюдаться после тяжелой травмы и ожогов, сепсиса, некротического панкреатита. Один из ведущих клинических проявлений при этом — значительная потеря мышечной массы тела, плохо поддающаяся коррекции. При использовании литературы из базы MedLine описываются современные представления о механизмах саркопении при синдроме устойчивого воспаления, иммуносупрессии и катаболизма и возможные пути оптимальной анаболической поддержки.

Due to advances in intensive care, many patients with severe pathology are discharged from intensive care units. However, prolonged mild degree inflammation persists in some patients, recovery is protracted, and chronic critical illness develops in them. In addition, persistent inflammation, immunosuppression and catabolism arise. In 2012, this condition was identified as a separate syndrome, which can be observed after severe trauma and burns, sepsis, necrotizing pancreatitis. Significant loss of muscle mass that is difficult to correct is one of the leading clinical manifestations in this case. Using literature from the MEDLINE database, modern ideas about the mechanisms of sarcopenia in the persistent inflammation, immunosuppression and catabolism syndrome and possible ways of optimal anabolic support are described.


Keywords

саркопенія; запалення; катаболізм; харчова підтримка

саркопения; воспаление; катаболизм; пищевая поддержка

sarcopenia; inflammation; catabolism; nutrition


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