ПОЛИТРАВМА / POLYTRAUMA

Цель — представление новых аспектов клинико-лабораторной диагностики в международных  рекомендациях  SSC 2021 по лечению  взрослых пациентов с сепсисом или септическим шоком в условиях больницы.

Материалы и методы. Проведено сравнение  международных диагностических критериев сепсиса и органной дисфункции начиная с рекомендаций ACCP/SCCM 1992 г.  до обновленных  рекомендаций  по лечению сепсиса и септического шока SSC 2021 г.

Представлены опубликованные ранее результаты исследований авторов статьи по сочетанию определения в крови уровня лактата,  ЛПС-СП, аполипопротеинов А1 и В, индекса ApoA1/ApoB, СРБ, ПКТ, расширенных параметров воспаления статуса активации различных популяций лейкоцитов для диагностики сепсиса, оценки тяжести состояния и эффективности  лечения.

Результаты.  Отличительной особенностью рекомендаций SSC 2021  является  отражение конкретных характеристик, таких как Recommendation Strength — Strong, Weak (Сила рекомендации — Убедительная, Слабая) и  Quality of Evidence — Best practice statement, Very low quality of evidence (Качество доказательств — Лучший практический опыт, Очень низкое качество доказательств и т. д.) с учетом принципов доказательной медицины и передового практического опыта. При этом характер рекомендаций по их практическому использованию весьма неоднозначен.

С учетом данных наших исследований универсально доступными лабораторными показателями в ранней диагностике сепсиса являются следующие: лактат в качестве независимого прогностического фактора летальности; ЛПС-СП для подтверждения инфицирования грамотрицательной флорой; мониторинг расширенных показателей воспаления — активация нейтрофилов (NEUT-RI и NEUT-GI), незрелых гранулоцитов (IG) и лимфоцитов  (AS-LYMP, RE-LYMP) в дифференциальной диагностике вирусной и бактериальной инфекции; биологические маркеры воспаления С-реактивного белка (СРБ), прокальцитонина (ПКТ), аполипопротеина А1, В (АpoA1, ApoB), индекса АpoA1/ ApoB  для оценки генерализации процесса и эффективности лечения.

Заключение. Рекомендации не могут заменить знания,  опыт и способность лечащего врача принимать решения — как с использованием клинической оценки течения заболевания, так и уникальных клинико-диагностических параметров с учетом передовой врачебной практики.

Проведение предложенных лабораторных исследований доступно для большинства лабораторий Российской Федерации. По-видимому, целесообразно было бы подготовить методические рекомендации по ранней диагностике сепсиса для здравоохранения РФ с учетом лучших отечественных практик.

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