Array ( [NAME] => Норадреналин при септическом шоке: всегда ли? [~NAME] => Норадреналин при септическом шоке: всегда ли? [PREVIEW_PICTURE] => Array ( [ID] => 4478 [TIMESTAMP_X] => 27.10.2022 12:41:54 [MODULE_ID] => iblock [HEIGHT] => 507 [WIDTH] => 739 [FILE_SIZE] => 20681 [CONTENT_TYPE] => image/png [SUBDIR] => iblock/6a2/wh1d5js2x6103o3err082jc4zq25fu1h [FILE_NAME] => Noradrenaline_chemical_structure.png [ORIGINAL_NAME] => Noradrenaline_chemical_structure.png [DESCRIPTION] => [HANDLER_ID] => [EXTERNAL_ID] => 6a28813b066b630c53ef3e756fdeab2a [VERSION_ORIGINAL_ID] => [META] => [SRC] => /upload/iblock/6a2/wh1d5js2x6103o3err082jc4zq25fu1h/Noradrenaline_chemical_structure.png [UNSAFE_SRC] => /upload/iblock/6a2/wh1d5js2x6103o3err082jc4zq25fu1h/Noradrenaline_chemical_structure.png [SAFE_SRC] => /upload/iblock/6a2/wh1d5js2x6103o3err082jc4zq25fu1h/Noradrenaline_chemical_structure.png [ALT] => Норадреналин при септическом шоке: всегда ли? [TITLE] => Норадреналин при септическом шоке: всегда ли? ) [~PREVIEW_PICTURE] => 4478 [DETAIL_TEXT] => <div class="article-paragraph_block"><div class="text-block"></div></div> [~DETAIL_TEXT] =>[DETAIL_PICTURE] => [~DETAIL_PICTURE] => [DATE_ACTIVE_FROM] => 04.07.2018 [~DATE_ACTIVE_FROM] => 04.07.2018 [ACTIVE_FROM] => 04.07.2018 [~ACTIVE_FROM] => 04.07.2018 [SHOW_COUNTER] => 167 [~SHOW_COUNTER] => 167 [ID] => 1065 [~ID] => 1065 [IBLOCK_ID] => 18 [~IBLOCK_ID] => 18 [IBLOCK_SECTION_ID] => [~IBLOCK_SECTION_ID] => [DETAIL_TEXT_TYPE] => text [~DETAIL_TEXT_TYPE] => text [PREVIEW_TEXT] => [~PREVIEW_TEXT] => [PREVIEW_TEXT_TYPE] => text [~PREVIEW_TEXT_TYPE] => text [TIMESTAMP_X] => 27.10.2022 12:41:54 [~TIMESTAMP_X] => 27.10.2022 12:41:54 [LIST_PAGE_URL] => /council/cases-from-practice/ [~LIST_PAGE_URL] => /council/cases-from-practice/ [DETAIL_PAGE_URL] => /council/cases-from-practice/noradrenalin-pri-septicheskom-shoke-vsegda-li/ [~DETAIL_PAGE_URL] => /council/cases-from-practice/noradrenalin-pri-septicheskom-shoke-vsegda-li/ [LANG_DIR] => / [~LANG_DIR] => / [CODE] => noradrenalin-pri-septicheskom-shoke-vsegda-li [~CODE] => noradrenalin-pri-septicheskom-shoke-vsegda-li [EXTERNAL_ID] => 1065 [~EXTERNAL_ID] => 1065 [IBLOCK_TYPE_ID] => cases [~IBLOCK_TYPE_ID] => cases [IBLOCK_CODE] => cases [~IBLOCK_CODE] => cases [IBLOCK_EXTERNAL_ID] => [~IBLOCK_EXTERNAL_ID] => [LID] => s1 [~LID] => s1 [NAV_RESULT] => [NAV_CACHED_DATA] => [DISPLAY_ACTIVE_FROM] => 4 июля 2018 [IPROPERTY_VALUES] => Array ( ) [FIELDS] => Array ( [NAME] => Норадреналин при септическом шоке: всегда ли? [PREVIEW_PICTURE] => Array ( [ID] => 4478 [TIMESTAMP_X] => 27.10.2022 12:41:54 [MODULE_ID] => iblock [HEIGHT] => 507 [WIDTH] => 739 [FILE_SIZE] => 20681 [CONTENT_TYPE] => image/png [SUBDIR] => iblock/6a2/wh1d5js2x6103o3err082jc4zq25fu1h [FILE_NAME] => Noradrenaline_chemical_structure.png [ORIGINAL_NAME] => Noradrenaline_chemical_structure.png [DESCRIPTION] => [HANDLER_ID] => [EXTERNAL_ID] => 6a28813b066b630c53ef3e756fdeab2a [VERSION_ORIGINAL_ID] => [META] => [SRC] => /upload/iblock/6a2/wh1d5js2x6103o3err082jc4zq25fu1h/Noradrenaline_chemical_structure.png [UNSAFE_SRC] => /upload/iblock/6a2/wh1d5js2x6103o3err082jc4zq25fu1h/Noradrenaline_chemical_structure.png [SAFE_SRC] => /upload/iblock/6a2/wh1d5js2x6103o3err082jc4zq25fu1h/Noradrenaline_chemical_structure.png [ALT] => Норадреналин при септическом шоке: всегда ли? [TITLE] => Норадреналин при септическом шоке: всегда ли? ) [DETAIL_TEXT] => <div class="article-paragraph_block"><div class="text-block"></div></div> [DETAIL_PICTURE] => [DATE_ACTIVE_FROM] => 04.07.2018 [ACTIVE_FROM] => 04.07.2018 [SHOW_COUNTER] => 167 ) [PROPERTIES] => Array ( [KEYWORDS] => Array ( [ID] => 129 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Ключевые слова [ACTIVE] => Y [SORT] => 100 [CODE] => KEYWORDS [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Ключевые слова [~DEFAULT_VALUE] => ) [DESCRIPTION] => Array ( [ID] => 130 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Описание [ACTIVE] => Y [SORT] => 200 [CODE] => DESCRIPTION [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Описание [~DEFAULT_VALUE] => ) [BROWSER_TITLE] => Array ( [ID] => 131 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Заголовок окна браузера [ACTIVE] => Y [SORT] => 300 [CODE] => BROWSER_TITLE [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Заголовок окна браузера [~DEFAULT_VALUE] => ) [MAIN] => Array ( [ID] => 132 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Показывать на главной странице [ACTIVE] => Y [SORT] => 500 [CODE] => MAIN [DEFAULT_VALUE] => [PROPERTY_TYPE] => L [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => C [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [VALUE_ENUM_ID] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Показывать на главной странице [~DEFAULT_VALUE] => ) [vote_count] => Array ( [ID] => 133 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Количество проголосовавших [ACTIVE] => Y [SORT] => 500 [CODE] => vote_count [DEFAULT_VALUE] => [PROPERTY_TYPE] => N [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 821968 [VALUE] => 6 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 6 [~DESCRIPTION] => [~NAME] => Количество проголосовавших [~DEFAULT_VALUE] => ) [vote_sum] => Array ( [ID] => 134 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Сумма оценок [ACTIVE] => Y [SORT] => 500 [CODE] => vote_sum [DEFAULT_VALUE] => [PROPERTY_TYPE] => N [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 821969 [VALUE] => 15 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 15 [~DESCRIPTION] => [~NAME] => Сумма оценок [~DEFAULT_VALUE] => ) [rating] => Array ( [ID] => 135 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Рейтинг [ACTIVE] => Y [SORT] => 500 [CODE] => rating [DEFAULT_VALUE] => [PROPERTY_TYPE] => N [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 821970 [VALUE] => 2.5 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 2.5 [~DESCRIPTION] => [~NAME] => Рейтинг [~DEFAULT_VALUE] => ) [MATERIALS] => Array ( [ID] => 142 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Материалы к статье [ACTIVE] => Y [SORT] => 500 [CODE] => MATERIALS [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Материалы к статье [~DEFAULT_VALUE] => ) [FAVORITES] => Array ( [ID] => 170 [TIMESTAMP_X] => 2017-09-28 13:51:18 [IBLOCK_ID] => 18 [NAME] => Избранное [ACTIVE] => Y [SORT] => 500 [CODE] => FAVORITES [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => UserID [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Избранное [~DEFAULT_VALUE] => ) [DIAGNOSIS] => Array ( [ID] => 191 [TIMESTAMP_X] => 2018-03-06 14:59:44 [IBLOCK_ID] => 18 [NAME] => Диагноз [ACTIVE] => Y [SORT] => 500 [CODE] => DIAGNOSIS [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Диагноз [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [ANAMNESIS] => Array ( [ID] => 192 [TIMESTAMP_X] => 2018-03-06 15:04:16 [IBLOCK_ID] => 18 [NAME] => Анамнез [ACTIVE] => Y [SORT] => 500 [CODE] => ANAMNESIS [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 8093 [VALUE] => Array ( [TEXT] => <p> Течение последствий ожоговой травмы (ожог пламенем туловища, верхних и нижних конечностей I-II-III ст. 30% п.т. (III ст. 20% п.т.)) у пациента В. 67 лет ( с тяжелой сопутствующей патологией: состояние после ОНМК в 2016 году) осложнилось развитием инвазивной раневой инфекции, ассоциированной с полирезистентной нозокомиальной микрофлорой (при микробилогическом исследовании тканевого биоптата из зон раневого инфекционного процесса были выделены A.baumanii 10<sup>8</sup> КОЕ; K.pneumoniae 10<sup>4</sup>КОЕ, чувствительные к карбапенемам, аминогликозидам, защищённым цефалоспоринам). У больного в ходе наблюдения сохранялась фебрильная лихорадка, в клиническом анализе крови – лейкоцитоз со сдвигом формулы до юных форм, гнойное раневое отделяемое. </p> [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] =>Течение последствий ожоговой травмы (ожог пламенем туловища, верхних и нижних конечностей I-II-III ст. 30% п.т. (III ст. 20% п.т.)) у пациента В. 67 лет ( с тяжелой сопутствующей патологией: состояние после ОНМК в 2016 году) осложнилось развитием инвазивной раневой инфекции, ассоциированной с полирезистентной нозокомиальной микрофлорой (при микробилогическом исследовании тканевого биоптата из зон раневого инфекционного процесса были выделены A.baumanii 108 КОЕ; K.pneumoniae 104КОЕ, чувствительные к карбапенемам, аминогликозидам, защищённым цефалоспоринам). У больного в ходе наблюдения сохранялась фебрильная лихорадка, в клиническом анализе крови – лейкоцитоз со сдвигом формулы до юных форм, гнойное раневое отделяемое.
[TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Анамнез [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [THERAPY] => Array ( [ID] => 193 [TIMESTAMP_X] => 2018-03-06 15:04:57 [IBLOCK_ID] => 18 [NAME] => Терапия [ACTIVE] => Y [SORT] => 500 [CODE] => THERAPY [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 8094 [VALUE] => Array ( [TEXT] => <p> К 12 суткам наблюдения и лечения, у пациента было отмечено развитие гипотензии (84/45 мм.рт.ст) и прогрессирование энцефалопатии со снижением уровня сознания до сопора (10 баллов по шкале ком Глазго); оценка по qSOFA-2 балла. Пациент был переведён в отделение реанимации с диагнозом «сепсис, септический шок». В ходе дополнительного обследования были получены данные клинического анализа крови с увеличением уровня лейкоцитоза до 47×10<sup>9</sup>л ( п/я до 23%); прокальцитонин 3, 78 нг/мл, пресепсин 3200 пг/мл, С-реактивный белок 320 мг/л. На момент подключения к монитору зафиксирована гипотермия, до 34,6 ℃. Была проведена смена антибактериальной терапии – с целью преодоления возможной резистентности выделенных возбудителей к проводимому антимикробному лечению. Были назначены – меропенем 1 г/3 раза в сутки, внутривенная инфузия, тигацил -100 мг в сутки, внутривенно (с нагрузочной дозой в 100 мг). Была начата инфузионная терапия кристаллоидными растворами, однако, после введения 500 мл р-ра Рингера- у больного было отмечено появление тахипное до 32 в минуту, развитие одышки с преобладанием экспираторного компонента и удлинением выдоха, появление свистящих хрипов при аускультации лёгких, снижение индекса оксигенации до 240%. При этом центральное венозное давление достигало 12 мм.рт.ст. , сохранялась гипотензия ( 84/47 мм.рт.ст.), уровень лактата 4,9 ммоль/л. </p> [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] =>К 12 суткам наблюдения и лечения, у пациента было отмечено развитие гипотензии (84/45 мм.рт.ст) и прогрессирование энцефалопатии со снижением уровня сознания до сопора (10 баллов по шкале ком Глазго); оценка по qSOFA-2 балла. Пациент был переведён в отделение реанимации с диагнозом «сепсис, септический шок». В ходе дополнительного обследования были получены данные клинического анализа крови с увеличением уровня лейкоцитоза до 47×109л ( п/я до 23%); прокальцитонин 3, 78 нг/мл, пресепсин 3200 пг/мл, С-реактивный белок 320 мг/л. На момент подключения к монитору зафиксирована гипотермия, до 34,6 ℃. Была проведена смена антибактериальной терапии – с целью преодоления возможной резистентности выделенных возбудителей к проводимому антимикробному лечению. Были назначены – меропенем 1 г/3 раза в сутки, внутривенная инфузия, тигацил -100 мг в сутки, внутривенно (с нагрузочной дозой в 100 мг). Была начата инфузионная терапия кристаллоидными растворами, однако, после введения 500 мл р-ра Рингера- у больного было отмечено появление тахипное до 32 в минуту, развитие одышки с преобладанием экспираторного компонента и удлинением выдоха, появление свистящих хрипов при аускультации лёгких, снижение индекса оксигенации до 240%. При этом центральное венозное давление достигало 12 мм.рт.ст. , сохранялась гипотензия ( 84/47 мм.рт.ст.), уровень лактата 4,9 ммоль/л.
[TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Терапия [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [PATIENTS_SEX] => Array ( [ID] => 194 [TIMESTAMP_X] => 2018-03-06 15:05:22 [IBLOCK_ID] => 18 [NAME] => Пол пациента [ACTIVE] => Y [SORT] => 500 [CODE] => PATIENTS_SEX [DEFAULT_VALUE] => [PROPERTY_TYPE] => L [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 827879 [VALUE] => Не знаю [DESCRIPTION] => [VALUE_ENUM] => Не знаю [VALUE_XML_ID] => UNKNOWN [VALUE_SORT] => 500 [VALUE_ENUM_ID] => 25 [~VALUE] => Не знаю [~DESCRIPTION] => [~NAME] => Пол пациента [~DEFAULT_VALUE] => ) [PATIENTS_AGE] => Array ( [ID] => 195 [TIMESTAMP_X] => 2018-03-07 12:37:41 [IBLOCK_ID] => 18 [NAME] => Возраст пациента [ACTIVE] => Y [SORT] => 500 [CODE] => PATIENTS_AGE [DEFAULT_VALUE] => [PROPERTY_TYPE] => N [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => Y [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 8096 [VALUE] => 67 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 67 [~DESCRIPTION] => [~NAME] => Возраст пациента [~DEFAULT_VALUE] => ) [RESULT_DETAIL] => Array ( [ID] => 196 [TIMESTAMP_X] => 2018-03-06 14:59:44 [IBLOCK_ID] => 18 [NAME] => Результат [ACTIVE] => Y [SORT] => 500 [CODE] => RESULT_DETAIL [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 8097 [VALUE] => Array ( [TEXT] => <p> Проведение инфузионной терапии было приостановлено, с целью стабилизации гемодинамики начато введение норадреналина (0,17 мкг/кг/мин). Больной был переведён на ИВЛ. В ходе ЭКГ мониторинга у пациента отмечали наличие атрио-вентрикулярной блокады I ст (рисунок 1). </p> [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] =>Проведение инфузионной терапии было приостановлено, с целью стабилизации гемодинамики начато введение норадреналина (0,17 мкг/кг/мин). Больной был переведён на ИВЛ. В ходе ЭКГ мониторинга у пациента отмечали наличие атрио-вентрикулярной блокады I ст (рисунок 1).
[TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Результат [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [SPECIALIST] => Array ( [ID] => 197 [TIMESTAMP_X] => 2018-03-06 14:59:44 [IBLOCK_ID] => 18 [NAME] => Специалист [ACTIVE] => Y [SORT] => 500 [CODE] => SPECIALIST [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => UserID [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Специалист [~DEFAULT_VALUE] => ) [SPECIALIST_COMMENT] => Array ( [ID] => 198 [TIMESTAMP_X] => 2018-03-06 14:59:44 [IBLOCK_ID] => 18 [NAME] => Комментарий [ACTIVE] => Y [SORT] => 500 [CODE] => SPECIALIST_COMMENT [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Комментарий [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [SUBTITLE] => Array ( [ID] => 136 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Подзаголовок [ACTIVE] => Y [SORT] => 501 [CODE] => SUBTITLE [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Подзаголовок [~DEFAULT_VALUE] => ) [AUTHOR] => Array ( [ID] => 137 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Автор [ACTIVE] => Y [SORT] => 502 [CODE] => AUTHOR [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => Y [VERSION] => 1 [USER_TYPE] => UserID [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => Array ( [0] => 8091 ) [VALUE] => Array ( [0] => 8 ) [DESCRIPTION] => Array ( [0] => ) [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [0] => 8 ) [~DESCRIPTION] => Array ( [0] => ) [~NAME] => Автор [~DEFAULT_VALUE] => ) [QUOTE] => Array ( [ID] => 138 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Цитата [ACTIVE] => Y [SORT] => 503 [CODE] => QUOTE [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Цитата [~DEFAULT_VALUE] => ) [SLIDER] => Array ( [ID] => 139 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Слайдер [ACTIVE] => Y [SORT] => 503 [CODE] => SLIDER [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => jpg, gif, bmp, png, jpeg [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Слайдер [~DEFAULT_VALUE] => ) [SLIDER_DESC] => Array ( [ID] => 140 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Слайдер описание [ACTIVE] => Y [SORT] => 504 [CODE] => SLIDER_DESC [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Слайдер описание [~DEFAULT_VALUE] => ) [INFO_SOURCES] => Array ( [ID] => 141 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Информация и источники [ACTIVE] => Y [SORT] => 505 [CODE] => INFO_SOURCES [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Информация и источники [~DEFAULT_VALUE] => ) [SUBJECTS] => Array ( [ID] => 143 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Тематика [ACTIVE] => Y [SORT] => 5000 [CODE] => SUBJECTS [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => Y [VERSION] => 1 [USER_TYPE] => directory [USER_TYPE_SETTINGS] => Array ( [size] => 1 [width] => 0 [group] => N [multiple] => N [TABLE_NAME] => b_hlbd_subjects ) [HINT] => [PROPERTY_VALUE_ID] => Array ( [0] => 8092 ) [VALUE] => Array ( [0] => sluchayizpraktiki ) [DESCRIPTION] => Array ( [0] => ) [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [0] => sluchayizpraktiki ) [~DESCRIPTION] => Array ( [0] => ) [~NAME] => Тематика [~DEFAULT_VALUE] => ) [COMMENTS_COUNT] => Array ( [ID] => 144 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Количество комментариев [ACTIVE] => Y [SORT] => 5010 [CODE] => COMMENTS_COUNT [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Количество комментариев [~DEFAULT_VALUE] => ) [FB2] => Array ( [ID] => 174 [TIMESTAMP_X] => 2017-10-12 14:43:54 [IBLOCK_ID] => 18 [NAME] => FB2 [ACTIVE] => Y [SORT] => 5020 [CODE] => FB2 [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => fb2 [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => FB2 [~DEFAULT_VALUE] => ) [ADD_DATES] => Array ( [ID] => 208 [TIMESTAMP_X] => 2018-05-11 11:01:55 [IBLOCK_ID] => 18 [NAME] => Даты добавления материалов [ACTIVE] => Y [SORT] => 5030 [CODE] => ADD_DATES [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => Date [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Даты добавления материалов [~DEFAULT_VALUE] => ) [LENGHT] => [VIDEO_PREVIEW] => [VIDEO_FULL] => ) [DISPLAY_PROPERTIES] => Array ( [rating] => Array ( [ID] => 135 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Рейтинг [ACTIVE] => Y [SORT] => 500 [CODE] => rating [DEFAULT_VALUE] => [PROPERTY_TYPE] => N [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 821970 [VALUE] => 2.5 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 2.5 [~DESCRIPTION] => [~NAME] => Рейтинг [~DEFAULT_VALUE] => [DISPLAY_VALUE] => 2.5 ) [AUTHOR] => Array ( [ID] => 137 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Автор [ACTIVE] => Y [SORT] => 502 [CODE] => AUTHOR [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => Y [VERSION] => 1 [USER_TYPE] => UserID [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => Array ( [0] => 8091 ) [VALUE] => Array ( [0] => 8 ) [DESCRIPTION] => Array ( [0] => ) [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [0] => 8 ) [~DESCRIPTION] => Array ( [0] => ) [~NAME] => Автор [~DEFAULT_VALUE] => [DISPLAY_VALUE] => [8] (info@sepsisforum.ru) Команда Сепсис Форума ) [SUBJECTS] => Array ( [ID] => 143 [TIMESTAMP_X] => 2017-09-08 11:11:31 [IBLOCK_ID] => 18 [NAME] => Тематика [ACTIVE] => Y [SORT] => 5000 [CODE] => SUBJECTS [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => Y [VERSION] => 1 [USER_TYPE] => directory [USER_TYPE_SETTINGS] => Array ( [size] => 1 [width] => 0 [group] => N [multiple] => N [TABLE_NAME] => b_hlbd_subjects ) [HINT] => [PROPERTY_VALUE_ID] => Array ( [0] => 8092 ) [VALUE] => Array ( [0] => sluchayizpraktiki ) [DESCRIPTION] => Array ( [0] => ) [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [0] => sluchayizpraktiki ) [~DESCRIPTION] => Array ( [0] => ) [~NAME] => Тематика [~DEFAULT_VALUE] => [DISPLAY_VALUE] => Случай из практики ) ) [IBLOCK] => Array ( [ID] => 18 [~ID] => 18 [TIMESTAMP_X] => 10.10.2022 16:07:08 [~TIMESTAMP_X] => 10.10.2022 16:07:08 [IBLOCK_TYPE_ID] => cases [~IBLOCK_TYPE_ID] => cases [LID] => s1 [~LID] => s1 [CODE] => cases [~CODE] => cases [API_CODE] => [~API_CODE] => [NAME] => Случаи из практики [~NAME] => Случаи из практики [ACTIVE] => Y [~ACTIVE] => Y [SORT] => 500 [~SORT] => 500 [LIST_PAGE_URL] => /council/cases-from-practice/ [~LIST_PAGE_URL] => /council/cases-from-practice/ [DETAIL_PAGE_URL] => /council/cases-from-practice/#ELEMENT_CODE#/ [~DETAIL_PAGE_URL] => /council/cases-from-practice/#ELEMENT_CODE#/ [SECTION_PAGE_URL] => [~SECTION_PAGE_URL] => [CANONICAL_PAGE_URL] => [~CANONICAL_PAGE_URL] => [PICTURE] => [~PICTURE] => [DESCRIPTION] => [~DESCRIPTION] => [DESCRIPTION_TYPE] => text [~DESCRIPTION_TYPE] => text [RSS_TTL] => 24 [~RSS_TTL] => 24 [RSS_ACTIVE] => Y [~RSS_ACTIVE] => Y [RSS_FILE_ACTIVE] => N [~RSS_FILE_ACTIVE] => N [RSS_FILE_LIMIT] => [~RSS_FILE_LIMIT] => [RSS_FILE_DAYS] => [~RSS_FILE_DAYS] => [RSS_YANDEX_ACTIVE] => N [~RSS_YANDEX_ACTIVE] => N [XML_ID] => [~XML_ID] => [TMP_ID] => [~TMP_ID] => [INDEX_ELEMENT] => Y [~INDEX_ELEMENT] => Y [INDEX_SECTION] => N [~INDEX_SECTION] => N [WORKFLOW] => N [~WORKFLOW] => N [BIZPROC] => N [~BIZPROC] => N [SECTION_CHOOSER] => L [~SECTION_CHOOSER] => L [LIST_MODE] => [~LIST_MODE] => [RIGHTS_MODE] => S [~RIGHTS_MODE] => S [SECTION_PROPERTY] => Y [~SECTION_PROPERTY] => Y [PROPERTY_INDEX] => I [~PROPERTY_INDEX] => I [VERSION] => 1 [~VERSION] => 1 [LAST_CONV_ELEMENT] => 0 [~LAST_CONV_ELEMENT] => 0 [SOCNET_GROUP_ID] => [~SOCNET_GROUP_ID] => [EDIT_FILE_BEFORE] => [~EDIT_FILE_BEFORE] => [EDIT_FILE_AFTER] => [~EDIT_FILE_AFTER] => [SECTIONS_NAME] => [~SECTIONS_NAME] => [SECTION_NAME] => [~SECTION_NAME] => [ELEMENTS_NAME] => Случаи [~ELEMENTS_NAME] => Случаи [ELEMENT_NAME] => Случай [~ELEMENT_NAME] => Случай [REST_ON] => N [~REST_ON] => N [EXTERNAL_ID] => [~EXTERNAL_ID] => [LANG_DIR] => / [~LANG_DIR] => / [SERVER_NAME] => sepsisforum.ru [~SERVER_NAME] => sepsisforum.ru ) [SECTION] => Array ( [PATH] => Array ( ) ) [SECTION_URL] => [META_TAGS] => Array ( [TITLE] => Норадреналин при септическом шоке: всегда ли? [BROWSER_TITLE] => [KEYWORDS] => [DESCRIPTION] => ) )
Возраст: 67
Течение последствий ожоговой травмы (ожог пламенем туловища, верхних и нижних конечностей I-II-III ст. 30% п.т. (III ст. 20% п.т.)) у пациента В. 67 лет ( с тяжелой сопутствующей патологией: состояние после ОНМК в 2016 году) осложнилось развитием инвазивной раневой инфекции, ассоциированной с полирезистентной нозокомиальной микрофлорой (при микробилогическом исследовании тканевого биоптата из зон раневого инфекционного процесса были выделены A.baumanii 108 КОЕ; K.pneumoniae 104КОЕ, чувствительные к карбапенемам, аминогликозидам, защищённым цефалоспоринам). У больного в ходе наблюдения сохранялась фебрильная лихорадка, в клиническом анализе крови – лейкоцитоз со сдвигом формулы до юных форм, гнойное раневое отделяемое.
К 12 суткам наблюдения и лечения, у пациента было отмечено развитие гипотензии (84/45 мм.рт.ст) и прогрессирование энцефалопатии со снижением уровня сознания до сопора (10 баллов по шкале ком Глазго); оценка по qSOFA-2 балла. Пациент был переведён в отделение реанимации с диагнозом «сепсис, септический шок». В ходе дополнительного обследования были получены данные клинического анализа крови с увеличением уровня лейкоцитоза до 47×109л ( п/я до 23%); прокальцитонин 3, 78 нг/мл, пресепсин 3200 пг/мл, С-реактивный белок 320 мг/л. На момент подключения к монитору зафиксирована гипотермия, до 34,6 ℃. Была проведена смена антибактериальной терапии – с целью преодоления возможной резистентности выделенных возбудителей к проводимому антимикробному лечению. Были назначены – меропенем 1 г/3 раза в сутки, внутривенная инфузия, тигацил -100 мг в сутки, внутривенно (с нагрузочной дозой в 100 мг). Была начата инфузионная терапия кристаллоидными растворами, однако, после введения 500 мл р-ра Рингера- у больного было отмечено появление тахипное до 32 в минуту, развитие одышки с преобладанием экспираторного компонента и удлинением выдоха, появление свистящих хрипов при аускультации лёгких, снижение индекса оксигенации до 240%. При этом центральное венозное давление достигало 12 мм.рт.ст. , сохранялась гипотензия ( 84/47 мм.рт.ст.), уровень лактата 4,9 ммоль/л.
Проведение инфузионной терапии было приостановлено, с целью стабилизации гемодинамики начато введение норадреналина (0,17 мкг/кг/мин). Больной был переведён на ИВЛ. В ходе ЭКГ мониторинга у пациента отмечали наличие атрио-вентрикулярной блокады I ст (рисунок 1).
|
[TypeError] Cannot access offset of type string on string (0) /home/u45255/sepsisforum.ru/www/local/templates/vjweb_sepsisforum/components/bitrix/news/articles/bitrix/news.detail/.default/template.php:92 #0: include /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component_template.php:790 #1: CBitrixComponentTemplate->__IncludePHPTemplate(array, array, string) /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component_template.php:885 #2: CBitrixComponentTemplate->IncludeTemplate(array) /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component.php:776 #3: CBitrixComponent->showComponentTemplate() /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component.php:716 #4: CBitrixComponent->includeComponentTemplate() /home/u45255/sepsisforum.ru/www/bitrix/components/bitrix/news.detail/component.php:515 #5: include(string) /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component.php:607 #6: CBitrixComponent->__includeComponent() /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component.php:684 #7: CBitrixComponent->includeComponent(string, array, object, boolean) /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/main.php:1072 #8: CAllMain->IncludeComponent(string, string, array, object) /home/u45255/sepsisforum.ru/www/local/templates/vjweb_sepsisforum/components/bitrix/news/articles/detail.php:17 #9: include(string) /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component_template.php:790 #10: CBitrixComponentTemplate->__IncludePHPTemplate(array, array, string) /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component_template.php:885 #11: CBitrixComponentTemplate->IncludeTemplate(array) /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component.php:776 #12: CBitrixComponent->showComponentTemplate() /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component.php:716 #13: CBitrixComponent->includeComponentTemplate(string) /home/u45255/sepsisforum.ru/www/bitrix/components/bitrix/news/component.php:336 #14: include(string) /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component.php:607 #15: CBitrixComponent->__includeComponent() /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/component.php:684 #16: CBitrixComponent->includeComponent(string, array, boolean, boolean) /home/u45255/sepsisforum.ru/www/bitrix/modules/main/classes/general/main.php:1072 #17: CAllMain->IncludeComponent(string, string, array, boolean, array) /home/u45255/sepsisforum.ru/www/council/cases-from-practice/index.php:5 #18: include_once(string) /home/u45255/sepsisforum.ru/www/bitrix/modules/main/include/urlrewrite.php:184 #19: include_once(string) /home/u45255/sepsisforum.ru/www/bitrix/urlrewrite.php:2 ----------