СОВРЕМЕННЫЕ ПОДХОДЫ К ИНТЕНСИВНОЙ ТЕРАПИИ И ПРОГНОЗИРОВАНИЮ КЛИНИЧЕСКИХ ИСХОДОВ ПРИ ОСТРОМ ИШЕМИЧЕСКОМ ИНСУЛЬТЕ
Ключевые слова:
острый ишемический инсульт, интенсивная терапия, нейрореаниматология, реперфузионная терапия, гемодинамическое ведение, респираторная поддержка, прогнозирование клинических исходов, искусственный интеллектАннотация
Острый ишемический инсульт – одна из ведущих причин смертности и инвалидизации. В обзоре проанализированы современные подходы к интенсивной терапии тяжелого инсульта – реперфузия, респираторное и гемодинамическое ведение, контроль температуры и гликемии, седация, – а также прогнозирование исходов на основе неврологических шкал, нейровизуализации, биомаркеров и искусственного интеллекта. Обоснована необходимость региональных исследований в Узбекистане.
Библиографические ссылки
Anderson C.S., Arima H., Lavados P., et al. Cluster-randomized, crossover trial of head positioning in acute stroke (HeadPoST). N Engl J Med. 2017;376(25):2437-2447.
Bath P.M., Sprigg N. Blood pressure management in acute ischemic stroke. Stroke Vasc Neurol. 2021;6(3):351-358.
Battaglini D., Robba C., Ball L., et al. Ventilatory management in neurocritical care patients. J Clin Med. 2023;12(9):3221.
Berge E., Whiteley W., Audebert H., et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021;6(1):I–LXII.
Campbell B.C.V., Mitchell P.J., Churilov L., et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke (EXTEND-IA TNK). N Engl J Med. 2018;378(17):1573-1582.
Cook A.M., Geocadin R.G., Greer D.M., et al. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocrit Care. 2020;32:647-666.
Czap A.L., Mayer S.A. Modern neurocritical care management of acute ischemic stroke. Neurol Clin. 2023;41(2):317-336.
den Hertog H.M., van der Worp H.B., van Gemert H.M., et al. The Paracetamol (Acetaminophen) In Stroke (PAIS) trial: long-term follow-up and clinical implications. Stroke. 2021;52:e173-e176.
Feigin V.L., Brainin M., Norrving B., Martins S., Sacco R.L., Hacke W. et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2025. Int J Stroke. 2025;20(1):5-30.
Fisher M, Saver JL. Future directions of acute ischaemic stroke therapy. Lancet Neurol. 2021;20(7):561-572.
Foerch C., Wunderlich M.T., Dvorak F., et al. Biomarkers in acute ischemic stroke: current status and future perspectives. Lancet Neurol. 2023;22(7):612-624.
GBD 2021 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2021. Lancet Neurol. 2024;23(8):761-782.
Heo J., Yoon J.G., Park H., et al. Machine learning–based model for prediction of outcomes in acute stroke. Stroke. 2019;50(5):1263-1265.
Jiang J., Lu Y., Wang H., et al. Artificial intelligence in acute ischemic stroke: current applications and future perspectives. Front Neurol. 2024;15:1356248.
Johnston K.C., Bruno A., Pauls Q., Hall C.E., Barrett K.M., Barsan W., et al. Intensive vs standard treatment of hyperglycemia and functional outcome in patients with acute ischemic stroke (SHINE). JAMA. 2019;322(4):326-335.
Johnston S.C., Easton J.D., Farrant M, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk transient ischemic attack (POINT). N Engl J Med. 2018;379(3):215-225.
Kim B.J., Hong K.S., Heo J.H., et al. Optimal blood pressure after successful endovascular therapy (OPTIMAL-BP). JAMA Neurol. 2023;80(9):900-909.
Kondziella D., Frontera J.A., Helbok R., et al. Neurocritical care of acute ischemic stroke: recent advances and future perspectives. Lancet Neurol. 2023;22(11):1018-1032.
Li S., Pan Y., Wang D., et al. Tenecteplase versus alteplase in acute ischemic stroke (TRACE-2). Lancet. 2023;401(10391):1655-1665.
Lyden P., Hemmen T.M., Grotta J.C., et al. Therapeutic hypothermia for acute ischemic stroke: current evidence and future directions. Stroke. 2021;52(6):2265-2273.
Mascia L., Grasso S., Fiore T., et al. Lung protective ventilation in patients with acute brain injury: physiology and clinical practice. Crit Care. 2021;25:318.
Menon B.K., Buck B.H., Singh N., et al. Intravenous tenecteplase compared with alteplase for acute ischemic stroke (AcT). Lancet. 2022;400(10347):161-169.
Monteiro A., Fonseca A.C., Freitas A.T., et al. Machine learning approaches for outcome prediction after endovascular treatment in acute ischemic stroke: a systematic review. Front Neurol. 2023;14:1184567.
Moullaali T.J., Wang X., Martin R.H., et al. Pre-thrombolysis blood pressure reduction and outcomes after intravenous thrombolysis (TRUTH). Stroke. 2022;53(8):2494-2502.
Moullaali T.J., Wang X., Sandset E.C., et al. Blood pressure variability after acute ischemic stroke and clinical outcomes. Stroke. 2023;54(4):1117-1126.
Murray N.M., Unberath M., Hager G.D., Hui F.K. Artificial intelligence to diagnose ischemic stroke and identify large vessel occlusions: a systematic review. J Neurointerv Surg. 2020;12(2):156-164.
Oddo M., Citerio G., Taccone F.S., et al. Respiratory management in acute brain-injured patients: an international consensus. Crit Care. 2020;24:190.
Oddo M., Robba C., Citerio G., et al. Management of sedation in neurocritical care patients: an international consensus statement. Neurocrit Care. 2021;35(2):435-449.
Palaiodimou L., Lioutas V.A., Lambadiari V., et al. Stress hyperglycemia and outcome in acute ischemic stroke: a systematic review and meta-analysis. Front Neurol. 2022;13:841872.
Powers W.J., Rabinstein A.A., Ackerson T, et al. Advances in reperfusion therapy for acute ischemic stroke. Stroke. 2023;54(5):e150-e250.
Prabhakaran S., Gonzalez N.R., Zachrison K.S., Adeoye O.M. et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2026.
Robba C., Battaglini D., Ball L., et al. Personalized physiological management in neurocritical care. Crit Care. 2022;26:201.
Robba C., Poole D., Citerio G., et al. Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus. Intensive Care Med. 2020;46(12):2397-2410.
Roffe C., Nevatte T., Sim J., et al. Effect of routine low-dose oxygen supplementation on death and disability in adults with acute stroke (SO₂S): a randomized clinical trial. JAMA. 2017;318(12):1125-1135.
Santamarina E., et al. Normobaric oxygen therapy after mechanical thrombectomy in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2023;32(4):107257.
Taccone F.S., Robba C., Citerio G. Airway management and extubation strategies in neurocritical care patients. Neurocrit Care. 2022;36(2):420-432.
Wang Y., Pan Y., Zhao X., et al. Dual antiplatelet treatment after ischemic stroke or transient ischemic attack (INSPIRES). N Engl J Med. 2023;389:2153-2164.
World Health Organization. Noncommunicable Diseases Country Profiles 2024. Geneva: WHO; 2024.
Yang P., Song L., Zhang Y., et al. Intensive blood pressure control after endovascular thrombectomy (ENCHANTED2/MT). Lancet. 2022;400(10358):1585-1596.
Zhou Y., et al. Normobaric hyperoxia after successful endovascular thrombectomy in acute ischemic stroke. Front Neurol. 2022;13:890923.
