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ТЕРАПИЯ ОИП

Прочитайте:
  1. B. физиоем, механотерапия, ЛФК
  2. E Диетотерапия
  3. I. Антибактериальная терапия
  4. I. Противовоспалительная терапия (для быстрого уменьшения боли, явлений воспаления в суставе).
  5. I. Химиотерапия хламидиоза
  6. II. Гормональная медикаментозная терапия
  7. II. Ежедневная терапия
  8. II. Терапия, направленная на снижение давления в МКК
  9. III. 6. Кинезитерапия
  10. III. Витаминотерапия.

Эффективной терапии ОИП в настоящее время не существует. В большинстве описанных случаев ОИП больные получали высокие дозы глюкокортикостероидов, однако, несмотря на это, летальность при этом заболевании очень высока. Относительно недавно была показана эффективность метилпреднизолона у больных с фибропролиферативной фазой ОРДС (позже 5 - 10го дня от начала заболевания): отмечено улучшение индекса повреждения легких, полиорганной недостаточности и улучшение выживаемости больных в течение 60 дней. Однако, несмотря на сходную морфологическую картину при ОИП и ОРДС, данные заболевания имеют различный патогенез, что, вероятно, может объяснить различную эффективность терапии стероидами - очень часто при ОИП они не приводят к улучшению клинической картины. Тем не менее эксперты рекомендуют использование при ОИП метилпреднизолона в/в в дозе 2 мг/(кгxсут).

В ранних работах при быстро прогрессирующем легочном фиброзе была отмечена эффективность внутривенной комбинированной терапии преднизолоном (250 мг/сут), циклофосфамидом (1,5 г/сут) и винкристином (2 мг/сут). Robinson и соавт. описали случай эффективной терапии больного с ОИП комбинацией циклоспорина, азатиоприна и преднизолона. Недавно Suratt и соавт. представили положительный опыт использования интерферона-гамма (50 - 100 мкг 3 раза в неделю) у пациента с ОИП, индуцированной кармустином и лучевой терапией.

Обязательными компонентами терапии ОИП являются кислородотерапия и респираторная поддержка. Тактика респираторной поддержки не отличается от той, что принята в настоящее время при ОРДС - протективная вентиляция легких. Возможно, улучшить прогноз при ОИП помогут новые препараты - экзогенный сурфактант, антицитокиновые антитела, оксид азота.

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