Ключові ланки патогенезу легеневої недостатності при COVID-19 та шляхи фармакокорекції
DOI:
https://doi.org/10.11603/bmbr.2706-6290.2022.2.13082Ключові слова:
COVID-19, патогенез, цитокіни, фармакокорекція, противірусні лікарські засобиАнотація
Резюме. Виникнення та поширення нового коронавірусного захворювання COVID-19 стало всеохоплюючою кризою, що кинула виклик медицині й соціуму в усьому світі. Тяжкий перебіг COVID-19 являє собою клінічну картину вірусної пневмонії з вираженим респіраторним синдромом, що в подальшому може призводити до розвитку гострого респіраторного дистрес-синдрому (ГРДС) та летальних наслідків. Правильне розуміння ключових патофізіологічних детермінант ускладнень з боку дихальної системи та гіпоксемії сприятиме проведенню максимально раціональної фармакотерапії даного критичного стану.
Мета дослідження – проаналізувати та систематизувати дані щодо патогенезу ГРДС при коронавірусній хворобі та його фармакокорекції. Розуміння ланок патогенезу дасть змогу не лише виявити певні аспекти лікування COVID-19, а й попередити розвиток ускладнень у хворих.
Матеріали і методи. Опрацьовано матеріали з інформаційних Internet-ресурсів, публікації закордонних та українських фахових видань, медичної бази даних Medscape/PubMed за останні роки.
Результати. Проведено аналіз ключових ланок патогенезу ГРДС при COVID-19, роль цитокінового шторму в прогресуванні захворювання та розвитку артеріальної гіпоксемії і дихальної недостатності. Проведено огляд розвитку й «еволюцію» підходів до лікування захворювання, починаючи від спроб застосування похідних хлорохіну на початкових етапах до лікування етіотропними противірусними лікарськими засобами (типу «Ремдесивір», комбінації «Лопінавір»/«Ритонавір» та «Паксловід»), біосимілярів – моноклональних антитіл та їх комбінацій, проведення профілактики та лікування тромбоутворення та мікротромбозів, які можуть розвиватися внаслідок ендотеліальної дисфункції у таких пацієнтів, особливо при наявності коморбідної патології (до прикладу, гіпертонічна хвороба, цукровий діабет, ожиріння). Узагальнено останні рекомендації та американські та європейські протоколи лікування коронавірусної хвороби.
Висновки. Проведений огляд найбільш популярних та доступних засобів фармакотерапії COVID-19 вказує на необхідність та раціональність у пошуку нових більш ефективних та менш токсичних засобів для боротьби з інфекцією та її ускладненнями.
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