Выпуск 23-4, 2024

Диссертационная орбита

https://doi.org/10.38025/2078-1962-2024-23-4-92-100

Вторичная саркопения у пациентов с двигательными нарушениями: распространенность, диагностика и медицинская реабилитация. Обзор

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1 ORCIDКузнецов К.Д.,1 ORCIDМарченкова Л.А..

1ФГБУ «Национальный медицинский исследовательский центр реабилитации и курортологии» Министерства здравоохранения Российской Федерации, Москва, Россия


РЕЗЮМЕ

ВВЕДЕНИЕ. Разработка методов реабилитации пациентов с саркопенией — генерализованной возраст-ассоциированной потерей массы и силы скелетной мускулатуры имеет важное значение, поскольку саркопения приводит к выраженной слабости, функциональным и двигательным нарушениям и повышению риска смерти пожилых людей. Среди вторичных форм наибольшее клиническое значение имеет саркопения на фоне последствий острого нарушения мозгового кровообращения (ОНМК), вследствие мышечной атрофии, связанной с параличом и обездвиженностью, спастичностью, воспалением и денервацией мышц, нарушением питания и всасывания в кишечнике белка и витамина D. Недавние исследования показывают, что распространенность саркопении у пациентов с инсультом в стационарах неотложной помощи составляет 8,5–33,8 %, по другим данным — более 42 %.

ЦЕЛЬ. Проанализировать распространенность, особенности патогенеза, диагностики вторичной саркопении, в том числе на фоне двигательных нарушений вследствие перенесенного ОНМК, а также методы лечения и медицинскую реабилитации таких пациентов.

ОСНОВНОЕ СОДЕРЖАНИЕ. Мышечная слабость после инсульта способствует снижению физических функций и развитию инвалидности, а саркопения приводит к неблагоприятным исходам через 90 дней после перенесенного ОНМК. По данным метаанализа, включавшего 7 когортных исследований с общей выборкой 1774 пациента, перенесших ОНМК, 27,1 % из них имели саркопению. Причем наличие саркопении негативно влияло на клинические и функциональные исходы ОНМК, а также на результаты медицинской реабилитации (отношение шансов: 2,42, 95 % доверительный интервал: 1,76–3,33, p < 0,001).

ЗАКЛЮЧЕНИЕ. Несмотря на распространенность и актуальность данной патологии, программы реабилитации пациентов с саркопенией на фоне последствий ОНМК не разработаны. Единичные зарубежные публикации демонстрируют эффективность отдельных методов лечебной физкультуры и электрической стимуляции, однако доказательная база их эффективности невысока.


КЛЮЧЕВЫЕ СЛОВА: саркопения, острое нарушение мозгового кровообращения, медицинская реабилитации, механотерапия, электрическая стимуляция

ИСТОЧНИК ФИНАНСИРОВАНИЯ: Данное исследование не было поддержано никакими внешними источниками финансирования.

КОНФЛИКТ ИНТЕРЕСОВ: Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.

ДЛЯ ЦИТИРОВАНИЯ:

Кузнецов К.Д., Марченкова Л.А. Вторичная саркопения у пациентов с двигательными нарушениями: распространенность, диагностика и медицинская реабилитация. Обзор литературы. Вестник восстановительной медицины. 2024; 23(4):92-100. https://doi.org/10.38025/2078-1962-2024-23-4-92-100 [Kuznetsov K.D., Marchenkova L.A. Secondary Sarcopenia in Patients with Locomotor Disorders: Prevalence, Diagnosis and Medical Rehabilitation. A Review. Bulletin of Rehabilitation Medicine. 2024; 23(4):92-100. https://doi.org/10.38025/2078-1962-2024-23-4-92-100 (In Russ.).]

ДЛЯ КОРРЕСПОНДЕНЦИИ:

Кузнецов Кирилл Дмитриевич, Е-mail: kuznetsovkd@nmicrk.ru


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