Дисхлоремия при критических состояниях у детей как фактор риска неблагоприятного исхода заболевания

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

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

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

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