medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-025medsovet-7359Research ArticleБРОНХОПУЛЬМОНОЛОГИЯ И ОТОЛАРИНГОЛОГИЯBRONCHOPULMONOLOGY, OTORHINOLARYNGOLOGYСовременный взгляд на проблему деструктивных пневмоний у детейA contemporary view of the problem of destructive pneumonia in childrenhttps://orcid.org/0000-0001-8340-3064ТолстоваЕ. М.TolstovaE. M.

Толстова Евгения Михайловна - кандидат медицинских наук, доцент кафедры педиатрии.

127473, Москва, ул. Делегатская, д. 20, стр. 1

Evgeniya M. Tolstova - Cand. Sci. (Med.), Assistant Professor, Yevdokimov Moscow State University of Medicine and Dentistry.

20, Bldg. 1, Delegatskaya St., Moscow, 127473

tepec@yandex.ruhttps://orcid.org/0000-0003-3426-3426ЗайцеваО. В.ZaytsevaO. V.

Зайцева Ольга Витальевна - доктор медицинских наук, профессор, заведующая кафедрой педиатрии.

127473, Москва, ул. Делегатская, д. 20, стр. 1

Olga V. Zaytseva - Dr. Sci. (Med.), Professor, Head of the Department of Pediatrics, Yevdokimov Moscow State University of Medicine and Dentistry.

20, Bldg. 1, Delegatskaya St., Moscow, 127473

olga6505963@yandex.ruhttps://orcid.org/0000-0003-1160-7855БесединаМ. В.BesedinaM. V.

Беседина Марина Валерьевна - кандидат медицинских наук, доцент кафедры педиатрии.

127473, Москва, ул. Делегатская, д. 20, стр. 1

Marina V. Besedina - Cand. Sci. (Med.), Assistant Professor, Yevdokimov Moscow State University of Medicine and Dentistry.

20, Bldg. 1, Delegatskaya St., Moscow, 127473

mari-bese@yandex.ruhttps://orcid.org/0000-0002-6808-7670ХаспековД. В.KhaspekovD. V.

Хаспеков Дмитрий Викторович - заведующий торакальным хирургическим отделением.

107014, Москва, ул. Рубцовско-Дворцовая, д. 1/3

Dmitry V. Khaspekov - Chief of Department of Thoracal Surgery, Children’s State Hospital of St. Vladimir.

1/3, Rubtsovsko-Dvortsovaya St., Moscow, 107014

khaspekov@mail.ruhttps://orcid.org/0000-0002-5277-9808БеляеваТ. Ю.BelyaevaT. Yu.

Беляева Татьяна Юрьевна - заместитель главного врача по лечебной работе.

107014, Москва, ул. Рубцовско-Дворцовая, д. 1/3

Tatiana Yu. Belyaeva - Deputy Chief Physician for Clinical Work, Children’s State Hospital of St. Vladimir.

1/3, Rubtsovsko-Dvortsovaya St., Moscow, 107014

dgkbsv@zdrav.mos.ruМосковский государственный медико-стоматологический университет имени А.И. ЕвдокимоваРоссияYevdokimov Moscow State University of Medicine and DentistryRussian FederationДетская городская клиническая больница Святого ВладимираРоссияChildren’s State Hospital of St VladimirRussian Federation202312032023012833Copyright © Толстова Е.М., Зайцева О.В., Беседина М.В., Хаспеков Д.В., Беляева Т.Ю., 20232023Толстова Е.М., Зайцева О.В., Беседина М.В., Хаспеков Д.В., Беляева Т.Ю.Tolstova E.M., Zaytseva O.V., Besedina M.V., Khaspekov D.V., Belyaeva T.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7359

Проблема внебольничных пневмоний у детей остается актуальной в настоящее время. Осложненных форм, к которым относят эмпиему плевры, абсцесс, некротизирующую  или  деструктивную  пневмонию, бронхоплевральную  фистулы и острый респираторный дистресс-синдром, не становится меньше, несмотря на современную антибактериальную терапию и доступность вакцинации против пневмококка. Основными возбудителями, ассоциированными с деструкцией легких у детей, остаются S. pneumoniae и S. aureus, нередко MRSA. Значительно реже сообщается о роли других возбудителей при некротизирующих пневмониях: Streptococcus pyogenes, Haemophilus influenzae, Pseudomonas aeruginosa, Fusobacterium nucleatum, Legionella pneumophila, Klebsiella pneumoniae, анаэробов. Однако в патогенезе заболевания имеют значение не только патогенные факторы возбудителя. Зачастую вирусная продрома, нередко ассоциированная с вирусом гриппа A (H1N1), предшествует развитию осложненной пневмонии. В период эпидемии новой коронавирусной инфекции эндотелиальное повреждение с высокой долей вероятности явилось предрасполагающим фактором к развитию вторичной бактериальной инфекции с некрозом легочной ткани. До настоящего времени патогенез деструктивных пневмоний отчетливо не описан. Значительное разрушение и разжижение легочной ткани может развиваться несмотря на адекватную антибактериальную терапию. Большое значение в развитии деструкции придается активации гемостаза и тромбообразованию в сосудах легких. Преобладание общих симптомов над местными, особенно у детей раннего возраста, наличие клинических синдромов, маскирующих легочный процесс, усложняют своевременную диагностику. Рентгенография органов грудной клетки является стандартом диагностики пневмонии. Однако диагностические возможности этого метода при деструктивных пневмониях ограниченны. Для оценки ряда параметров состояния плевральной полости и легочной ткани предпочтительно ультразвуковое исследование. Необходим анализ современных особенностей течения деструктивных пневмоний у детей и разработка клинических рекомендаций по ведению пациентов в остром периоде и реабилитации.

The problem of community-acquired pneumonia in children remains relevant at the present time. Complicated forms, which include pleural empyema, abscess, necrotizing pneumonia, bronchopleural fistulas and acute respiratory distress syndrome do not decrease, despite modern antibacterial therapy and the availability of vaccination against pneumococcus. The main pathogens associated with lung destruction in children are S. pneumoniae and S. aureus, often MRSA. The role of other pathogens in necrotizing pneumonia is much less frequently reported: Streptococcus pyogenes, Haemophilus influenzae, Pseudomonas aeruginosa, Fusobacterium nucleatum, Legionella pneumophila, Klebsiella pneumoniae, anaerobes. However not only pathogenic factors of the pathogen are important for necrotizing pneumonia development. Often, a viral prodrome, often associated with the influenza A (H1N1) virus, precedes complicated pneumonia. During the epidemic of COVID-19, endothelial damage with a high degree of probability was a predisposing factor for the development of a secondary bacterial infection with lung tissue necrosis. Significant destruction and liquefaction of the lung tissue may develop despite adequate antibiotic therapy. Great importance in the development of necrosis is attached to the activation of hemostasis and thrombus formation in the vessels of the lungs. Timely diagnosis often is difficult due to the predominance of general symptoms over local ones, especially in young children. Chest x-ray is the standard for diagnosing. However, the diagnostic capabilities of this method in necrotizing pneumonia are limited. To assess a number of parameters of the state of the pleural cavity and lung tissue, ultrasound is preferred. It is necessary to analyze the current features of the course of necrotizing pneumonia in children and develop clinical guidelines for the management of patients in the acute period and rehabilitation.

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The authors declare that there are no conflicts of interest present.