avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2018-8-1-5-11avk-740Research ArticleЛЕКЦИИLECTURESПУТЕШЕСТВИЕ В СТРАНУ ЯТРОГЕНИЯ. ЯТРОГЕНИИ ДИАГНОСТИЧЕСКИХ ПРОЦЕДУР (Сообщение 3)TRAVEL TO COUNTRY IATROGENIC. YATROGENIYA DIAGNOSTIC PROCEDURES (Message 3)ДворецкийЛ. И.DvoretskyL. I.

кафедра госпитальной терапии № 2

Faculty of Medicine, Chair of Internal Medicine № 2

dvoretski@mail.ruФГБОУ ВО Первый Московский Государственный Медицинский Университет им. И.М. СеченоваРоссияI.M. Sechenov First Moscow State Medical UniversityRussian Federation20180502201881511Copyright © Дворецкий Л.И., 20182018Дворецкий Л.И.Dvoretsky L.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/740

Особую группу ятрогений составляют осложнения, связанные с различными диагностическими манипуляциями — от физикального обследования больного до  ангиографических исследований, диагностической лапароскопии или торакоскопии. В  статье приводятся данные о частоте и характере диагностических ятрогений в клинической  практике. Диапазон диагностических ятрогений по своим проявлениям, тяжести и прогнозу  достаточно широк — от раздражения кожи гелем при проведении УЗИ до диссекции  коронарной артерии во время коронароангиографии. В статье представлены примеры  ятрогений диагностических процедур, начиная с процесса клинического обследования (сбор жалоб и анамнеза, физикальное исследование), и заканчивая сложными инвазивными  обследованиями. Подробно рассмотрены ятрогении, возникающие при применении  препаратов, содержащих контраст (в частности йодсодержащих препаратов), которые  достаточно широко используются в клинической практике (КТ с контрастированием,  ангиографии и др.) с диагностической целью. В статье рассказывается о факторах риска,  знание которых и осведомленность об их наличии у пациента обязательны перед введением препаратов, содержащих контраст. Проведен обзор осложнений, возникающих при  эндоскопических исследованиях. Автор напоминает, что ятрогенные события при эндоскопических процедурах могут проявляться не только осложнениями со стороны  исследуемого органа (пищевод, желудок, кишечник), но зависят также и от состояния  больного, его подготовки к проведению процедуры, владения специалистом техникой  эндоскопии. В заключение автор приводит клиническое наблюдение, в котором фактором  риска ятрогенного события было наличие у больной аномалии протоковых систем печени и  поджелудочной железы. Автор статьи призывает коллег более внимательно относиться к  процессу принятия решения о проведении диагностического исследования, всегда  оценивать соотношение польза/риск с точки зрения реальной пользы диагностического исследования для больного и риска развития осложнения.

A special group of iatrogenic complications are associated with various diagnostic manipulations — from a physical examination of the patient to angiographic studies, diagnostic laparoscopy or  thoracoscopy. The article presents data on the frequency and nature  of diagnostic iatrogenic in clinical practice. The range of diagnostic  iatrogenesis in terms of its manifestations, severity and prognosis is  wide enough — from skin irritation with gel during ultrasound to  dissection of the coronary artery during coronary angiography. The  article presents examples of iatrogenic diagnostic procedures,  starting with the clinical examination process (collection of  complaints and anamnesis, physical examination), and ending with  complex invasive examinations. Yatrogenia, which occur with the use of preparations containing contrast (in particular iodine-containing  drugs), which are widely used in clinical practice (CT with contrasting, angiography, etc.) with a diagnostic purpose, are considered in detail. The article describes the risk factors, knowledge of which and awareness of their presence in the patient are  mandatory before the introduction of drugs containing contrast. The  review of complications arising during endoscopic examinations was  carried out. The author reminds that iatrogenic events in endoscopic procedures can be manifested not only by complications  from the organ under examination (esophagus, stomach, intestines), but also depend on the patient’s condition, his preparation for the procedure, and the specialist’s possession of endoscopic technique. In conclusion, the author gives a clinical observation in which the  risk factor of the iatrogenic event was the presence of an anomaly in the liver and pancreas duct systems in the patient. The author of the article encourages colleagues to pay more attention to the process of making a decision to conduct a diagnostic study, always to evaluate  the benefit / risk ratio in terms of the real usefulness of the  diagnostic study for the patient and the risk of complication development.

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