Алкогольный делирий: ранняя диагностика и принципы интенсивной терапии. Обзор литературы
№ 1 (2020) , ДИАГНОСТИКА И ИНТЕНСИВНАЯ ТЕРАПИЯ ЦЕРЕБРАЛЬНОЙ НЕДОСТАТОЧНОСТИ
№ 1 (2020)
ДИАГНОСТИКА И ИНТЕНСИВНАЯ ТЕРАПИЯ ЦЕРЕБРАЛЬНОЙ НЕДОСТАТОЧНОСТИ

Алкогольный делирий: ранняя диагностика и принципы интенсивной терапии. Обзор литературы

https://doi.org/10.21320/1818-474X-2020-1-53-65
Опубликован 02.03.2020
Алексей Евгеньевич Муронов
ФГБОУ ВО «Кубанский государственный медицинский университет» МЗ РФ, Краснодар, Россия
https://orcid.org/0000-0002-5156-4469
#2020-1
PDF_2020-01_53-65
HTML_2020-01_53-65

Ключевые слова

алкогольный абстинентный синдром
алкогольный делирий
интенсивная терапия
бензодиазепины
пропофол
фенобарбитал
галоперидол
дексмедетомидин

Как цитировать

Муронов АЕ Алкогольный делирий: ранняя диагностика и принципы интенсивной терапии. Обзор литературы. Вестник интенсивной терапии имени А.И. Салтанова. 2020;(1):53–65. doi:10.21320/1818-474X-2020-1-53-65.
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver AMA ГОСТ

Скачать ссылку

Endnote/Zotero/Mendeley (RIS) BibTeX

Статистика

Просмотров аннотации: 135
PDF_2020-01_53-65 загрузок: 0
HTML_2020-01_53-65 загрузок: 4

Язык

English Русский

Объявления

Мы в соцсетях

Ключевые слова

Аннотация

Алкогольный делирий — грозное осложнение тяжелого алкогольного абстинентного синдрома. Он нередко формируется у пациентов стационаров и отделений анестезиологии и реанимации в результате вынужденного прекращения употребления алкоголя. Его формирование связано с увеличением сроков пребывания в стационаре и летальности. В обзоре рассматриваются современные подходы к диагностике, особенно ранней, этого состояния, его интенсивной терапии и методам немедикаментозной коррекции.
https://doi.org/10.21320/1818-474X-2020-1-53-65
PDF_2020-01_53-65
HTML_2020-01_53-65

Библиографические ссылки

  1. Bryson E.O., Frost E.A.M. Perioperative Addiction. Clinical Management of the Addicted Patient. Springer Science+Business Media, LLC; 2012.
  2. World Health Organization. Management of substance abuse: alcohol. http://wwwwhoint/substance_abuse/facts/alcohol/en/indexhtml. Accessed February 5, 2020.
  3. Poznyak V., Fleischmann A., Rekve D., et al. The world health organizationʼs global monitoring system on alcohol and health. Alcohol Res. 2014; 35(2): 244.
  4. de Wit M., Jones D.G., Sessler C.N., et al. Alcohol-use disorders in the critically ill patient. Chest. 2010; 138: 994–1003. DOI: 10.1378/chest.09-1425
  5. Saitz R. Clinical practice. Unhealthy alcohol use. N Engl J Med. 2005; 352(6): 596–607. DOI: 10.1056/NEJMcp042262
  6. Perry E.C. Inpatient management of acute alcohol withdrawal syndrome. CNS Drugs. 2014; 28: 401–410. DOI: 10.1007/s40263-014-0163-5
  7. Mennecier D., Thomas M., Arvers P., et al. Factors predictive of complicated or severe alcohol withdrawal in alcohol dependent inpatients. Gastroenterol Clin Biol. 2008; 32(8–9): 792–977. DOI: 10.1016/j.gcb.2008.06.004
  8. Chan G.M., Hoffman R.S., Gold J.A., et al. Racial variations in the incidence of severe alcohol withdrawal. J Med Toxicol. 2009; 5: 8–14. DOI: 10.1007/bf03160974
  9. Grover S., Ghosh A. Delirium Tremens: Assessment and Management. J Clin Exp Hepatol. 2018; 8(4): 460–470. DOI: 10.1007/bf03160974
  10. Soyka M. Prevalence of delirium tremens. Am J Addict. 2008; 17(5): 452. DOI: 10.1080/10550490802268868
  11. Perälä J., Kuoppasalmi K., Pirkola S., et al. Alcohol-induced psychotic disorder and delirium in the general population. Br J Psychiatry. 2010; 197(3): 200–206. DOI: 10.1192/bjp.bp.109.070797
  12. Moore D.T., Fuehrlein B.S., Rosenheck R.A. Delirium tremens and alcohol withdrawal nationally in the Veterans Health Administration. Am J Addict. 2017; 26(7): 722–730. DOI: 10.1111/ajad.12603
  13. Freyer-Adam J., Coder B., Baumeister S.E., et al. Brief alcohol intervention for general hospital inpatients: a randomized controlled trial. Drug Alcohol Depend. 2008; 93: 233–243. DOI: 10.1016/j.drugalcdep.2007.09.016
  14. Saitz R., Freedner N., Palfai T.P., et al. The severity of unhealthy alcohol use in hospitalized medical patients. The spectrum is narrow. JGIM. 2006; 21: 381–385. DOI: 10.1111/j.1525-1497.2006.00405.x
  15. Salottolo K., McGuire E., Mains C.W., et al. Occurrence, predictors, and prognosis of alcohol withdrawal syndrome and delirium tremens following traumatic injury. Crit Care Med. 2017; 45(5): 867–874. DOI: 10.1097/CCM.0000000000002371
  16. Jesse S., Bråthen G., Ferrara M., et al. Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurol Scand. 2017; 135(1): 4–16. DOI: 10.1111/ane.12671
  17. Grover S., Sharma A., Kate N., et al. Symptom profile and outcome of delirium associated with alcohol withdrawal syndrome: a study from India. Am J Addict. 2013; 22(5): 503–509. DOI: 10.1111/j.1521-0391.2013.12063.x
  18. Schuckit M.A. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014; 371(22): 2109–2113. DOI: 10.1056/NEJMra1407298
  19. Calvo M.E., Gunnarsson T., Smith L., Hao M. Delirium tremens in an AUD patient after an intrathecal baclofen pump induced total alcohol abstinence. Eur Rev Med Pharmacol Sci. 2018; 22(16): 5371–5376. DOI: 10.26355/eurrev_201808_15738
  20. Mainerova B., Prasko J., Latalova K., et al. Alcohol withdrawal delirium — diagnosis, course and treatment. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015; 159: 44–52. DOI: 10.5507/bp.2013.089
  21. Martin C.S., Vergés A., Langenbucher J.W., et al. Algorithm Analysis of the DSM-5 Alcohol Withdrawal Symptom. Alcohol Clin Exp Res. 2018; 42(6): 1073–1083. DOI: 10.1111/acer.13633
  22. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Association.
  23. Schmidt K.J., Doshi M.R., Holzhausen J.M., et al. Treatment of Severe Alcohol Withdrawal. Ann Pharmacother. 2016; 50(5): 389–401. DOI: 10.1177/1060028016629161
  24. Sullivan J.T., Sykora K., Schneiderman J., et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989; 84: 1353–1357. DOI: 10.1111/j.1360-0443.1989.tb00737.x
  25. Littlefield A.J., Heavner M.S., Eng C.C., et al. Correlation Between mMINDS and CIWA-Ar Scoring Tools in Patients With Alcohol Withdrawal Syndrome. Am J Crit Care.2018; 27(4): 280–286. DOI: 10.4037/ajcc2018547
  26. Foy A., March S., Drinkwater V. Use of an objective clinical scale in the assessment and management of alcohol withdrawal in a large general hospital. Alcohol Clin Exp Res.1988; 12(3): 360–364. DOI: 10.1111/j.1530-0277.1988.tb00208.x
  27. Wetterling T., Kanitz R.D., Besters B., et al. A new rating scale for the assessment of the alcohol-withdrawal syndrome (AWS scale). Alcohol Alcohol. 1997; 32: 753–760. DOI: 10.1093/oxfordjournals.alcalc.a008326
  28. Goodson C.M., Clark B.J., Douglas I.S. Predictors of severe alcohol withdrawal syndrome: a systematic review and meta-analysis. Alcohol Clin Exp Res. 2014; 38(10): 2664–2677. DOI: 10.1111/acer.12529
  29. Eyer F., Schuster T., Felgenhauer N., et al. Risk assessment of moderate to severe alcohol withdrawal-predictors for seizures and delirium tremens in the course of withdrawal. Alcohol Alcohol. 2011; 46(4): 427–433. DOI: 10.1093/alcalc/agr053
  30. Kim D.W., Kim H.K., Bae E.K., et al. Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures. Am J Emerg Med. 2015; 33(5): 701–704. DOI: 10.1016/j.ajem.2015.02.030
  31. Thiercelin N., Rabiah Lechevallier Z., Rusch E., Plat A. Risk factors for delirium tremens: a literature review. Rev Med Interne. 2012; 33(1): 18–22. DOI: 10.1016/j.revmed.2011.08.002
  32. Kattimani S., Bharadwaj B. Clinical management of alcohol withdrawal: A systematic review. Ind Psychiatry J. 2013; 22: 100–108. DOI: 10.4103/0972–6748.132914
  33. Stephane M., Arnaout B., Yoon G. Alcohol withdrawal hallucinations in the general population, an epidemiological study. Psychiatry Res. 2018; 262: 129–134. DOI: 10.1016/j.psychres.2018.02.021
  34. Ikeda H., Yamamoto M., Hashimoto E., Saito T. Alcohol hallucinosis. Ryoikibetsu Shokogun Shirizu. 2003; (40): 441–444.
  35. Platz W.E., Oberlaender F.A., Seidel M.L. The phenomenology of perceptual hallucinations in alcohol-induced delirium tremens. Psychopathology. 1995; 28(5): 247–255. DOI: 10.1159/000284935
  36. Beghi E., Carpio A. Forsgren L., et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia. 2010; 51: 671–675. DOI: 10.1111/j.1528-1167.2009.02285.x
  37. McMicken D., Liss J.L. Alcohol-related seizures. Emerg Med Clin North Am. 2011; 29(1): 117–124. DOI: 10.1016/j.emc.2010.08.010
  38. Lutz U.C., Batra A. Diagnostics and therapy of alcohol withdrawal syndrome: focus on delirium tremens and withdrawal seizure. Psychiatr Prax. 2010; 37(6): 271–278. DOI: 10.1055/s-0030-1248443
  39. Muncie JrHL, Yasinian Y., Oge’ L. Outpatient management of alcohol withdrawal syndrome. Am Fam Physician. 2013; 88(9): 589–595.
  40. Mayo-Smith M.F. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA. 1997; 278(2): 144–151. DOI: 10.1001/jama.278.2.144
  41. Rathlev N.K., Ulrich A.S., Delanty N., D’Onofrio G. Alcohol-related seizures. J Emerg Med. 2006; 31: 157–163. DOI: 10.1016/j.jemermed.2005.09.012
  42. Kim D.W., Kim H.K., Bae E.K., et al. Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures. Am J Emerg Med. 2015; 33(5): 701–704. DOI: 10.1016/j.ajem.2015.02.030
  43. Jackson A., Teo L., Seneviratne U. Challenges in the first seizure clinic for adult patients with epilepsy. Epileptic Disord. 2016; 18(3): 305–314. DOI: 10.1684/epd.2016.0853
  44. Driessen M., Lange W., Junghanns K., Wetterling T. Proposal of a comprehensive clinical typology of alcohol withdrawal–a cluster analysis approach. Alcohol Alcohol. 2005; 40: 308–313. DOI: 10.1093/alcalc/agh167
  45. Sarkar S., Choudhury S., Ezhumalai G., Konthoujam J. Risk factors for the development of delirium in alcohol dependence syndrome: Clinical and neurobiological implications. Indian J Psychiatry. 2017; 59(3): 300–305. DOI: 10.4103/psychiatry.IndianJPsychiatry_67_17
  46. Inouye S.K., Westendorp R.G., Saczynski J.S. Delirium in elderly people. Lancet. 2014; 383(9920): 911–922. DOI: 10.1016/S0140–6736(13)60688-1
  47. Lawlor P.G., Bush S.H. Delirium diagnosis, screening and management. Curr Opin Support Palliat Care. 2014; 8(3): 286–295. DOI: 10.1097/SPC.0000000000000062
  48. Grover S., Ghormode D., Ghosh A., et al. Risk factors for delirium and inpatient mortality with delirium. J Postgrad Med. 2013; 59(4): 263–270. DOI: 10.4103/0022–3859.123147
  49. Inouye S.K., vanDyck C.H., Alessi C.A., et al. Clarifying confusion: The Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med. 1990; 113: 941–948. DOI: 10.7326/0003-4819-113-12-941
  50. Grover S., Kate N. Assessment scales for delirium: a review. World J Psychiatry. 2012; 2(4): 58–70. DOI: 10.5498/wjp.v2.i4.58
  51. Ely E.W., Inouye S.K., Bernard G.R., et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM–ICU). JAMA. 2001; 286: 2703–2710; 51. DOI: 10.1001/jama.286.21.2703
  52. Ely E.W., Margolin R., Francis J., et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001; 29: 1370–1379. DOI: 10.1097/00003246-200107000-00012
  53. Trzepacz P.T., Mittal D., Torres R., et al. Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J Neuropsychiatry Clin Neurosci. 2001; 13: 229–242. DOI: 10.1176/jnp.13.2.229
  54. Grover S., Kate N., Sharma A., et al. Symptom profile of alcohol withdrawal delirium: factor analysis of Delirium Rating Scale-Revised-98 version. Am J Drug Alcohol Abuse. 2016; 42(2): 196–202. DOI: 10.3109/00952990.2015.1130711
  55. Schmidt K.J., Doshi M.R., Holzhausen J.M., et al. A review of the treatment of severe alcohol withdrawal. Ann Pharmacother. 2016; 50(5): 389–401. DOI: 10.3109/00952990.2015.1130711
  56. Roerecke M., Rehm J. Chronic heavy drinking and ischaemic heart disease: a systematic review and meta-analysis. Open Heart. 2014; 1(1): e000135. DOI: 10.1136/openhrt-2014-000135
  57. Mukamal K.J., Tolstrup J.S., Friberg J., et al. Alcohol consumption and risk of atrial fibrillation in men and women: the Copenhagen City Heart Study. Circulation. 2005; 112(12): 1736–1742. DOI: 10.1161/CIRCULATIONAHA.105.547844
  58. Piano M.R. Alcoholʼs effects on the cardiovascular system. Alcohol Res. 2017; 38(2): 219–241.
  59. Shield K.D., Gmel G., Mäkelä P., et al. Risk, individual perception of risk and population health. Addiction. 2017; 112(12): 2272– 2273. DOI: 10.1111/add.14011
  60. Rehm J., Gmel G.E. Sr., Gmel G., et al. The relationship between different dimensions of alcohol use and the burden of disease-an update. Addiction. 2017; 112(6): 968–1001. DOI: 10.1111/add.13757
  61. Russell M., Chu B.C., Banerjee A., et al. Drinking patterns and myocardial infarction: a linear dose-response model. Alcohol Clin Exp Res. 2009; 33(2): 324–331. DOI: 10.1111/j.1530-0277.2008.00836.x
  62. Thomson A.D., Cook C.C.H., Touquet R., Henry J.A. The Royal College of Physicians report on alcohol: guidelines for managing Wernickeʼs encephalopathy in the accident and emergency department. Alcohol Alcohol. 2002; 37: 513–521. DOI: 10.1093/alcalc/37.6.513
  63. Cook C.C.H., Hallwood P.M., Thomson A.D. B vitamin deficiency and neuropsychiatric syndromes in alcohol misuse. Alcohol Alcohol. 1998; 33: 317–336. DOI: 10.1093/oxfordjournals.alcalc.a008400
  64. Marik P.E., Liggett A. Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders. Crit Care. 2019; 23(1): 165. DOI: 10.1186/s13054-019-2435-4
  65. Sechi G., Serra A. Wernickeʼs encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007; 6(5): 442–455. DOI: 10.1016/S1474-4422(07)70104-7
  66. Marinella M.A. Pharmacologic treatment of alcohol withdrawal. JAMA. 1997; 278(16): 1317. DOI: 10.1001/jama.278.16.1317b
  67. DeCarolis D.D., Rice K.L., Ho L., et al. Symptom-driven lorazepam protocol for treatment of severe alcohol withdrawal delirium in the intensive care unit. Pharmacotherapy. 2007; 27(4): 510–518. DOI: 10.1592/phco.27.4.510
  68. DeBellis R., Smith B.S., Choi S., Malloy M. Management of delirium tremens. J Intensive Care Med. 2005; 20(3): 164–173. DOI: 10.1177/0885066605275353
  69. Sarai M., Tejani A.M., Chan A.H., et al. Magnesium for alcohol withdrawal. Cochrane Database Syst Rev. 2013; (6): CD008358. DOI: 10.1002/14651858.CD008358.pub2
  70. Mayo-Smith M.F., Beecher L.H., Fischer T.L., et al. Working Group on the Management of Alcohol Withdrawal Delirium, Practice Guidelines Committee, American Society of Addiction Medicine. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med. 2004; 164(13): 1405–1412. DOI: 10.1001/archinte.164.13.1405
  71. Muzyk A.J., Leung J.G., Nelson S., et al. The role of diazepam loading for the treatment of alcohol withdrawal syndrome in hospitalized patients. Am J Addict. 2013; 22(2): 113–118. DOI: 10.1111/j.1521-0391.2013.00307.x
  72. Guirguis J., Chhatwal J., Dasarathy J., et al. Clinical impact of alcohol-related cirrhosis in the next decade: estimates based on current epidemiological trends in the United States. Alcohol Clin Exp Res. 2015; 39(11): 2085–2094. DOI: 10.1111/acer.12887
  73. Osna N.A., Donohue T.M. Jr., Kharbanda K.K. Alcoholic liver disease: pathogenesis and current management. Alcohol Res. 2017; 38(2): 147–161.
  74. Gold J.A., Rimal B., Nolan A., Nelson L.S. A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit Care Med. 2007; 35(3): 724–730. DOI: 10.1097/01.CCM.0000256841.28351.80
  75. Hack J.B., Hoffmann R.S., Nelson L.S. Resistant alcohol withdrawal: does an unexpectedly large sedative requirement identify these patients early? J Med Toxicol. 2006; 2(2): 55–60. DOI: 10.1007/bf03161171
  76. Cagetti E., Liang J., Spigelman I., Olsen R.W. Withdrawal from chronic intermittent ethanol treatment changes subunit composition, reduces synaptic function, and decreases behavioral responses to positive allosteric modulators of GABAA receptors. Mol Pharmacol. 2003; 63(1): 53. DOI: 10.1124/mol.63
  77. Lorentzen K., Lauritsen A.Ø., Bendtsen A.O. Use of propofol infusion in alcohol withdrawal-induced refractory delirium tremens. Dan Med J. 2014; 61: A4807.
  78. Hjermø I., Anderson J.E., Fink-Jensen A., et al. Phenobarbital versus diazepam for delirium tremens — a retrospective study. Dan Med Bull. 2010; 57: A4169.
  79. Gold J.A., Rimal B., Nolan A., Nelson L.S. A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit Care Med. 2007; 35(3): 724–730. DOI: 10.1097/01.CCM.0000256841.28351.80
  80. Brotherton A.L., Hamilton E.P., Kloss H.G., Hammond D.A. Propofol for treatment of refractory alcohol withdrawal syndrome: a review of the literature. Pharmacotherapy. 2016; 36(4): 433–442. DOI: 10.1002/phar.1726
  81. Dixit D., Endicott J., Burry L., Ramos L., et al. Management of acute alcohol withdrawal syndrome in critically ill patients. Pharmacotherapy. 2016; 36(7): 797–822. DOI: 10.1002/phar.1770
  82. Wong A., Benedict N.J., Armahizer M.J., Kane-Gill S.L. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann Pharmacother. 2015; 49(1): 14–19. DOI: 10.1177/1060028014555859
  83. Stewart R., Perez R., Musial B., et al. Outcomes of patients with alcohol withdrawal syndrome treated with high-dose sedatives and deferred intubation. Ann Am Thorac Soc. 2016; 13(2): 248–252. DOI: 10.1513/AnnalsATS.201507-448BC
  84. Linn D.D., Loeser K.C. Dexmedetomidine for alcohol withdrawal syndrome. Ann Pharmacother. 2015; 49(12): 1336–1342. DOI: 10.1177/1060028015607038
  85. Wong A., Benedict N.J., Armahizer M.J., Kane-Gill S.L. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann Pharmacother. 2015; 49(1): 14–19. DOI: 10.1177/1060028014555859
  86. Rayner S.G., Weinert C.R., Peng H., et al. Study Institution. Dexmedetomidine as adjunct treatment for severe alcohol withdrawal in the ICU. Ann Intensive Care. 2012; 2(1): 12. DOI: 10.1186/2110-5820-2-12
  87. Muzyk A.J., Fowler J.A., Norwood D.K., Chilipko A. Role of a2-agonists in the treatment of acute alcohol withdrawal. Ann Pharmacother. 2011; 45: 649–657. DOI: 10.1345/aph.1P575
  88. Hedges D., Jeppson K., Whitehead P. Antipsychotic medication and seizures: a review. Drugs Today (Barc). 2003; 39(7): 551–557. DOI: 10.1358/dot.2003.39.7.799445
  89. Kuchly B., Tiksrail A., Baglioni P. Electrolyte disturbances in chronic alcohol-use disorder. N Engl J Med. 2018; 378(2): 203. DOI: 10.1056/NEJMc1714331
  90. Bannon L., McGaughey J., Clarke M., et al. Impact of non-pharmacological interventions on prevention and treatment of delirium in critically ill patients: protocol for a systematic review of quantitative and qualitative research. Syst Rev. 2016; 5: 75. DOI: 10.1186/s13643-016-0254-0
  91. Vagts D.A., Iber T., Nöldge-Schomburg G.F. Alcohol-a perioperative problem of anaesthesia and intensive care medicine. Anasthesiol Intensivmed Notfallmed Schmerzther. 2003; 38(12): 747–761. DOI:10.1055/s-2003-45400
  92. Острые психотические расстройства в интенсивной терапии: практическое руководство для анестезиологов-реаниматологов, хирургов, неврологов, психиатров. Под ред. акад. РАН проф. Б.Р. Гельфанда и проф. В.Н. Краснова. М.: ООО «Издательство “Медицинское информационное агентство”», 2014. [Ostrye psihoticheskie rasstrojstva v intensivnoj terapii: Prakticheskoe rukovodstvo dlya anesteziologov-reanimatologov, hirurgov, nevrologov i psihiatrov. Pod red. akad. RAN prof. B.R. Gelʼfanda I prof. V.N. Krasnova. M.: OOO “Izdatelʼstvo ‘Medicinskoe informacionnoe agentstvo»’, 2014. (In Russ)]
Лицензия Creative Commons

Это произведение доступно по лицензии Creative Commons «Attribution-NonCommercial-ShareAlike» («Атрибуция — Некоммерческое использование — На тех же условиях») 4.0 Всемирная.

Copyright (c) 2020 ВЕСТНИК ИНТЕНСИВНОЙ ТЕРАПИИ имени А.И. САЛТАНОВА