СОВРЕМЕННЫЕ ТЕХНОЛОГИИ И РЕАЛЬНЫЕ ВОЗМОЖНОСТИ ПОСТИНСУЛЬТНОЙ РЕАБИЛИТАЦИИ (обзор литературы)
Ключевые слова:
неврология, цереброваскулярные заболевания, цереброваскулярные заболевания (ЦВЗ), реабилитация, постинсультные нарушения, ишемический инсульт, острое нарушение мозгового кровообращения (ОНМК), Мексидол, Мексидол ФОРТЕ 250.Аннотация
Введение. Инсульт – одна из основных причин заболеваемости, смертности и инвалидизации. В настоящее время во всем мире насчитывается более 77 миллионов человек, перенесших ишемический инсульт. 63% людей, перенесших инсульт и живущих в настоящее время, моложе 70 лет. Частыми исходами инсульта являются двигательные и когнитивные расстройства, нарушающие повседневное функционирование и ухудшающие качество жизни.
Цель исследования. Изучение современных литературных данных о методах и возможностях реабилитации у пациентов, перенесших инсульт, механизмах действия препарата Мексидол (этилметилгидроксипиридина сукцинат) на различные звенья при восстановлении неврологических нарушений.
Методы. Систематический поиск осуществлен в таких электронных библиографических базах данных, как PubMed, MEDLINE, Google Scholar, на электронных ресурсах, русскоязычных и англоязычных сайтах по опубликованным в открытом доступе статьям по проблеме постинсультной реабилитации, а также по препарату Мексидол на официальных интернет-страницах медицинских журналов. Проанализированы 42 статьи, опубликованные в период с 2000 по 2024 годы. Критерии поиска: рандомизированные контролируемые исследования, метаанализы, литературные обзоры, оригинальные исследования и клинические случаи. Критериями исключения служили исследования с низким уровнем достоверности, ретроспективные исследования, научные обзоры, систематические отчеты.
Результаты и обсуждение. Недавние клинические исследования показали, что фармакологическое вмешательство способно стимулировать эндогенную нейропластичность и, в сочетании с ранней двигательной реабилитацией, может значительно снизить инвалидизацию после инсульта. В идеале, нейропротекторная терапия должна начинаться как можно раньше, еще на догоспитальном этапе лечения, и комбинироваться с такими подходами, как нейровизуализация с последующей фибринолитической терапией или эндоваскулярной реваскуляризацией. Включение препарата Мексидол в комплекс восстановительного лечения после перенесенного острого нарушения мозгового кровообращения (ОНМК) достоверно улучшает результаты реабилитации, способствуя восстановлению неврологических функций, уменьшению симптомов и функциональных нарушений, улучшает качество жизни и уровень бытовой адаптации, снижает неврологический дефицит.
Выводы. Исследования, длительный практический опыт, клиническая эффективность, безопасность и хорошая переносимость препарата мексидол позволяют рекомендовать длительную последовательную терапию препаратом в комплексной реабилитации пациентов, перенесших ишемический инсульт.
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