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ТЕРАПИЯ ОИПЭффективной 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. СПИСОК ЛИТЕРАТУРЫ 1.Akira M, Hamada H, Sakatani M, et al. 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document: $pr: version: 01-2007.1 codepage: windows-1251 type: klinrek id: kli57158322 : 11.2. ПОРАЖЕНИЯ ОРГАНОВ ДЫХАНИЯ ПРИ СИСТЕМНЫХ ЗАБОЛЕВАНИЯХ СОЕДИНИТЕЛЬНОЙ ТКАНИ meta: author: fio[ru]: Л.П. Ананьева, А.В. Волков, А.В. Смирнов, О.А. Антелава codes: next: type: dklinrek code: III.VI type: dkli00023 Дата добавления: 2015-01-18 | Просмотры: 991 | Нарушение авторских прав |