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Про внесення змін до протоколу "Надання медичної допомоги для лікування коронавірусної хвороби (COVID-19)"

Міністерство охорони здоровя України  | Наказ від 20.09.2021 № 1979
Реквізити
  • Видавник: Міністерство охорони здоровя України
  • Тип: Наказ
  • Дата: 20.09.2021
  • Номер: 1979
  • Статус: Документ діє
  • Посилання скопійовано
Реквізити
  • Видавник: Міністерство охорони здоровя України
  • Тип: Наказ
  • Дата: 20.09.2021
  • Номер: 1979
  • Статус: Документ діє
Документ підготовлено в системі iplex
Застереження: Внаслідок лікування препаратами імуноглобуліну може виникнути тромбоз. Перед застосуванням препарату слід переконатися у належному рівні гідратації пацієнта. У пацієнтів з ризиком виникнення підвищеної в'язкості слід здійснювати контроль симптомів тромбозу та оцінку в'язкості крові. Ризик виникнення побічних явищ зростає із збільшенням дози та швидкості вливання імуноглобуліну людини нормального для внутрішньовенного введення, особливо при інфузії першої дози.
Друга лінія терапії - розгляньте можливість застосування системних кортикостероїдів у пацієнтів, у яких відсутній ефект через 24 години після введення імуноглобуліну людини нормального для внутрішньовенного введення (тахікардія, необхідність вазоактивної підтримки), особливо при наявності лихоманки.
Кортикостероїди в низьких та середніх дозах можуть розглядатися для лікування мультисистемного запального синдрому. Пульс-терапія глюкокортикоїдами у високих дозах може бути розглянута для лікування пацієнтів із загрожуючими для життя ускладненнями, такими як шок, а особливо, якщо пацієнту потрібні високі або повторні дози інотропів та/або вазопресорів.
Терапію системними кортикостероїдами слід розпочинати внутрішньовенно із застосуванням метилпреднізолону в дозі 2 мг/кг/добу розділену на 2 введення. У разі тяжкого мультисистемного запального синдрому (шок, значні системні прояви) слід розглянути внутрішньовенне введення метилпреднізолону у якості пульс-терапії в дозі 10 - 30 мг/кг/добу (не більше 1 г).
Одночасне застосування метилпреднізолону та імуноглобуліну людини нормальним для внутрішньовенного введення рекомендується пацієнтам із:
Тяжким або рефрактерним шоком.
Клінічним перебігом, що повністю або частково відповідає хворобі Кавасакі ТА є фактори ризику резистентності до імуноглобуліну людини нормального, які полягають у змінах коронарних артерій або віці менше 12 місяців.
Стійкою лихоманкою та динамічно зростаючими маркерами запалення (C-реактивний білок, D-димери, феритин) під час введення імуноглобуліну людини нормального.
Тривалість лікування метилпреднізолоном для внутрішньовенного введення становить 5 днів або до тих пір, поки стан пацієнта стабілізується та дозволить перейти на пероральний шлях введення кортикостероїдів (наприклад, преднізолону).
Після застосування метилпреднізолону для внутрішньовенного введення лікування продовжують перорально преднізолоном із поступовим зменшенням дози.
Загальна тривалість лікування кортикостероїдами зазвичай становить 15 днів, але може тривати до 6 тижнів, якщо хвороба триває довго.
Якщо терапію кортикостероїдами починають з метилпреднізолону у пульс-дозі, то відбувається перехід на пероральну терапію преднізолоном у дозі 1 мг/кг/добу розділену на 2 рази. Для подальшого поступового зменшення кортикостероїдів бажана консультація ревматолога.
Пацієнти, у яких було діагностовано мультисистемний запальний синдром, повинні проходити амбулаторне кардіологічне спостереження протягом 6 тижнів після виписки із закладу охорони здоров'я.
IV. Перелік літературних джерел, використаних при розробці клінічного протоколу медичної допомоги
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