inovmedИнновационная медицина КубаниInnovative Medicine of Kuban2541-9897Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 110.35401/2541-9897-2025-10-2-143-148inovmed-1184Research ArticleОБЗОРЫREVIEWSДисхлоремия при критических состояниях у детей как фактор риска неблагоприятного исхода заболеванияDyschloremia in Critically Ill Children as a Risk Factor for an Unfavorable Disease Outcomehttps://orcid.org/0000-0003-4705-3823БыковЮ. В.BykovYu. V.

Быков Юрий Витальевич, к. м. н., доцент кафедры анестезиологии и реаниматологии с курсом ДПО.

355017, Ставрополь, ул. Мира, 310

Yuri V. Bykov - Cand. Sci. (Med.), Associate Professor at the Department of Anesthesiology and Intensive Care with the Additional Professional Education Course, Stavropol State Medical University.

ulitsa Mira 310, Stavropol, 355017

yubykov@gmail.comhttps://orcid.org/0000-0002-9990-7272ОбединА. Н.ObedinA. N.

Обедин Александр Николаевич - д. м. н., доцент, заведующий кафедрой анестезиологии и реаниматологии с курсом ДПО.

Ставрополь

Alexander N. Obedin - Dr. Sci. (Med.), Associate Professor, Head of the Department of Anesthesiology and Intensive Care with the Additional Professional Education Course, Stavropol State Medical University.

Stavropol

https://orcid.org/0000-0002-4460-870XМуравьёваА. А.MuravyovaA. A.

Муравьёва Алла Анатольевна - к. м. н., доцент кафедры анестезиологии и реаниматологии с курсом ДПО.

Ставрополь

Alla A. Muravyova - Cand. Sci. (Med.), Associate Professor at the Department of Anesthesiology and Intensive Care with the Additional Professional Education Course, Stavropol State Medical University.

Stavropol

https://orcid.org/0000-0003-4729-5101ЗинченкоО. В.ZinchenkoO. V.

Зинченко Олег Васильевич - к. м. н., доцент кафедры анестезиологии и реаниматологии с курсом ДПО.

Ставрополь

Oleg V. Zinchenko - Cand. Sci. (Med.), Associate Professor at the Department of Anesthesiology and Intensive Care with the Additional Professional Education Course, Stavropol State Medical University.

Stavropol

https://orcid.org/0000-0003-1494-1613ФишерВ. В.FisherV. V.

Фишер Василий Владимирович - к. м. н., доцент кафедры анестезиологии и реаниматологии с курсом ДПО.

Ставрополь

Vasily V. Fisher - Cand. Sci. (Med.), Associate Professor at the Department of Anesthesiology and Intensive Care with the Additional Professional Education Course, Stavropol State Medical University.

Stavropol

https://orcid.org/0000-0001-5482-8581ЯцукИ. В.YatsukI. V.

Яцук Иван Викторович - к. м. н., доцент кафедры анестезиологии и реаниматологии с курсом ДПО.

Ставрополь

Ivan V. Yatsuk - Cand. Sci. (Med.), Associate Professor at the Department of Anesthesiology and Intensive Care with the Additional Professional Education Course, Stavropol State Medical University.

Stavropol

https://orcid.org/0000-0002-9841-6930ВолковЕ. В.VolkovE. V.

Волков Евгений Владимирович - к. м. н., доцент кафедры анестезиологии и реаниматологии с курсом ДПО.

Ставрополь

Evgeny V. Volkov - Cand. Sci. (Med.), Associate Professor at the Department of Anesthesiology and Intensive Care with the Additional Professional Education Course, Stavropol State Medical University.

Stavropol

Ставропольский государственный медицинский университетРоссияStavropol State Medical UniversityRussian Federation202530062025102143148Copyright © Быков Ю.В., Обедин А.Н., Муравьёва А.А., Зинченко О.В., Фишер В.В., Яцук И.В., Волков Е.В., 20252025Быков Ю.В., Обедин А.Н., Муравьёва А.А., Зинченко О.В., Фишер В.В., Яцук И.В., Волков Е.В.Bykov Y.V., Obedin A.N., Muravyova A.A., Zinchenko O.V., Fisher V.V., Yatsuk I.V., Volkov E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.innovmedkub.ru/jour/article/view/1184Актуальность

Актуальность: Дисхлоремия – распространенное электролитное нарушение, ухудшающее течение многих критических состояний у детей.

Цель исследования

Цель исследования: Анализ этиологии и механизмов патогенеза дисхлоремии, ее влияния на исход критических состояниях у детей на основании данных литературы.

Материалы и методы

Материалы и методы: Выполнен поиск и анализ работ с использованием баз данных Cochrane Library, PubMed и Medscape по ключевым словам: «дисхлоремия, гипохлоремия, гиперхлоремия, дети, подростки, интенсивная терапия, критические состояния». Для обзора отобрано 45 источников. Критерии включения работ в обзор: наличие описания этиологии и влияние дисхлоремии на течение критических состояний в детском и подростковом возрасте. Критерием исключения работ из обзора являлись статьи, содержащие информацию по этиологии и влиянию дисхлоремии на течение заболевания тяжелобольных пациентов взрослого и пожилого возраста.

Результаты

Результаты: Дисхлоремия достаточно часто диагностируются у тяжелобольных детей и подростков в условиях отделений анестезиологии и реанимации. Гипохлоремия, провоцируемая различными этиологическими факторами, может увеличивать летальность при острой сердечной недостаточности и остром поражении почек. Гиперхлоремия на фоне чрезмерного введения физиологического раствора, гиперхлоремического метаболического ацидоза и нарушения функции почек отражается на повышении показателей смертности при критических состояниях, в первую очередь при тяжелой травме и септических состояниях.

Заключение

Заключение: Нарушение баланса хлора имеет важное значение в педиатрической интенсивной терапии. Необходим тщательный мониторинг данного электролита у детей, находящихся в критическом состоянии.

Background

Background: Dyschloremia is a common electrolyte imbalance that exacerbates many critical conditions in children.

Objective

Objective: To analyze etiology and pathogenic mechanisms of dyschloremia, its impact on an outcome of pediatric critical conditions based on literature data.

Materials and methods

Materials and methods: We searched for and analyzed publications in the Cochrane Library, PubMed, and Medscape using the following keywords: dyschloremia, hypochloremia, hyperchloremia, children, adolescents, intensive care, critical conditions. A total of 45 sources were selected for review. To be included in the review, a paper had to describe the etiology and impact of dyschloremia on the course of critical conditions in children and adolescents. The exclusion criterion was the information on the etiology and impact of dyschloremia on the disease course in seriously ill adults and older people.

Results

Results: Dyschloremia is quite often discovered in seriously ill children and adolescents treated in intensive care units. Hypochloremia caused by a variety of etiological factors can increase mortality in patients with acute heart failure and acute kidney injury. Hyperchloremia, which develops from excessive saline infusion, hyperchloremic acidosis, and kidney failure, increases mortality in critically ill patients, primarily in cases of severe trauma and sepsis.

Conclusions

Conclusions: Disturbed chloride balance plays an important role in pediatric intensive care. The chloride levels should be closely monitored in critically ill children.

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The authors declare that there are no conflicts of interest present.