Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Диагностика и лечение нейрогенной дисфагии у больных с острым нарушением мозгового кровообращения
Диагностика и лечение нейрогенной дисфагии у больных с острым нарушением мозгового кровообращения
Петриков С.С., Солодов А.А. Диагностика и лечение нейрогенной дисфагии у больных с острым нарушением мозгового кровообращения. Неврология и Ревматология (Прил. к журн. Consilium Medicum). 2018; 1: 21–27. DOI: 10.26442/2414-357X_2018.1.21-27
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Нейрогенная дисфагия является одним из наиболее частых осложнений у больных с острым нарушением мозгового кровообращения (ОНМК). Нарушение глотания может приводить к нутритивной недостаточности и аспирационной пневмонии, что ухудшает клинико-неврологические исходы у пациентов с церебральным повреждением. Скрининг на эффективность глотания среди пациентов, перенесших ОНМК, очень важен для профилактики осложнений дисфагии и позволяет определить стратегию питания. Диагностика дисфагии включает в себя оценку клинических проявлений нарушения глотания, ларингоскопию и видеофлюороскопию. Основными методами лечения пациентов с нейрогенной дисфагией являются тренировка глотания с применением питательных смесей с разной консистенцией и вязкостью, выполнение комплекса упражнений для восстановления подвижности, а также чувствительности в области рта и гортани, подбор искусственного питания и профилактика аспирационных осложнений.
Ключевые слова: острое нарушение мозгового кровообращения, внутричерепное кровоизлияние, нейрогенная дисфагия, видеофлюороскопия, искусственное питание.
Key words: acute impairment of cerebral circulation, intracranial hemorrhage, neurogenic dysphagia, videofluoroscopy, artificial nutrition.
Ключевые слова: острое нарушение мозгового кровообращения, внутричерепное кровоизлияние, нейрогенная дисфагия, видеофлюороскопия, искусственное питание.
________________________________________________
Key words: acute impairment of cerebral circulation, intracranial hemorrhage, neurogenic dysphagia, videofluoroscopy, artificial nutrition.
Полный текст
Список литературы
1. Нейрохирургия и нейрореаниматология. Под ред. В.В.Крылова. М.: АБВ-пресс, 2018. / Neirokhirurgiia i neiroreanimatologiia. Pod red. V.V.Krylova. M.: ABV-press, 2018. [in Russian]
2. Крылов В.В. и др. Нейрореаниматология: практическое руководство. 2-е изд., перераб. и доп. М.: ГЭОТАР-Медиа, 2016. / Krylov V.V. i dr. Neiroreanimatologiia: prakticheskoe rukovodstvo. 2-e izd., pererab. i dop. M.: GEOTAR-Media, 2016. [in Russian]
3. Rofes L, Vilardell N, Clavé P. Post-stroke dysphagia: progress at last. Neurogastroenterol Motil 2013; 25 (4): 278–82. DOI: 10.1111/nmo.12112
4. Hinchey JA, Shephard T, Furie K et al. Formal dysphagia screening protocols prevent pneumonia. Stroke J Cereb Circ 2005; 36: 1972–6.
5. Altman KW. Oropharyngeal dysphagia pathophysiology, complications and science-based interventions. Nestle Nutr Inst Workshop Ser 2012; 72: 119–26. DOI: 10.1159/000340000
6. Malagelada JR, Bazzoli F, Boeckxstaens G et al. World gastroenterology organisation global guidelines: dysphagia – global guidelines and cascades update September 2014. J Clin Gastroenterol 2015; 49 (5): 370–8. DOI: 10.1097/MCG.0000000000000307
7. Martin RE, Sessle BJ. The role of the cerebral cortex in swallowing. Dysphagia 1993; 8 (3): 195–202;
8. Lee WK, Yeom J, Lee WH et al. Characteristics of Dysphagia in Severe Traumatic Brain Injury Patients: A Comparison With Stroke Patients. Ann Rehabil Med 2016; 40 (3): 432–9. DOI: 10.5535/arm.2016.40.3.432
9. Seung Hwa Rhie, Ji Won Choi, Se Jeong Jeon et al. Characteristics and risk factors of patients with aneurysmal subarachnoid hemorrhages related to dysphagia. Ann Rehabil Med 2016; 40 (6): 1024–32.
10. Donovan NJ, Daniels SK, Edmiaston J et al. Dysphagia screening: state of the art: invitational conference proceeding from the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. Stroke J Cereb Circ 2013; 44: e24–31.
11. Sasegbon A, Hamdy S. The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia. Neurogastroenterol Motil 2017; 29 (11). DOI: 10.1111/nmo.13100
12. Громова Д.О., Захаров В.В. Нарушения глотания после инсульта. Неврология, нейропсихиатрия, психосоматика. 2015; 7 (4): 50–6. / Gromova D.O., Zakharov V.V. Narusheniia glotaniia posle insul'ta. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2015; 7 (4): 50–6. [in Russian]
13. Chang YC, Chen SY, Lui LT et al. Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia 2003; 18: 135–43.
14. Daniels SK, Brailey K, Priestly DH et al. Aspiration in patients with acute stroke. Arch Phys Med Rehabil 1998; 79 (1): 14–9.
15. Falsetti P, Acciai C, Palilla R et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis 2009; 18 (5): 329–35. DOI: 10.1016/j.jstrokecerebrovasdis.2009.01.009
16. Rosenbek JC, Robbins JA, Roecker EB et al. A penetration-aspiration scale. Dysphagia 1996; 11 (2): 93–8.
17. Warnecke T, Ritter MA, Kroger B. Fiberoptic endoscopic Dysphagia severity scale predicts outcome after acute stroke. Cerebrovasc Dis 2009; 28 (3): 283–9. DOI: 10.1159/000228711
18. Singer P, Berger MM, Van den Berghe G. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr 2009; 28 (4): 387–400. DOI: 10.1016/j.clnu.2009.04.024
19. Logemann JA. Behavioural management for oropharyngeal dysphagia. Folia Phoniatr Logop 1999; 51: 199–212.
20. Pelletier CA, Lawless HT. Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia 2003; 18: 231–41.
21. Robbins J, Butler SG, Daniels SK et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res 2008; 51 (1): S276–300.
22. Steele CM, Van Lieshout PHM. Influence of bolus consistency on lingual behaviours in sequential swallowing. Dysphagia 2004; 19: 192–206.
23. Clark HM. Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol 2003; 12: 400–15.
24. Crary MA, Carnaby GD, Groher ME, Helseth E. Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback. Dysphagia 2004; 19: 160–4.
25. Crary MA, Carnaby GD. Adoption into clinical practice of two therapies to manage swallowing disorders: exercise-based swallowing rehabilitation and electrical stimulation. Curr Opin Otolaryngol Head Neck Surg 2014; 22: 17–80.
26. Humbert IA. The argument against electrical stimulation for dysphagia. AHSA Lead 2012; 17 (5): 13, 15.
27. Авдюнина И.А., Гречко А.В., Бруно Е.В. Основные принципы организации трапезы больных с нейрогенной дисфагией. Consilium Medicum. 2016; 18 (2.1): 53–8. / Avdyunina I.A., Grechko A.V., Bruno E.V. The basic feeding principles in cases of neurogenic dysphagia. Consilium Medicum. 2016; 18 (2.1): 53–8. [in Russian]
2. Krylov V.V. i dr. Neiroreanimatologiia: prakticheskoe rukovodstvo. 2-e izd., pererab. i dop. M.: GEOTAR-Media, 2016. [in Russian]
3. Rofes L, Vilardell N, Clavé P. Post-stroke dysphagia: progress at last. Neurogastroenterol Motil 2013; 25 (4): 278–82. DOI: 10.1111/nmo.12112
4. Hinchey JA, Shephard T, Furie K et al. Formal dysphagia screening protocols prevent pneumonia. Stroke J Cereb Circ 2005; 36: 1972–6.
5. Altman KW. Oropharyngeal dysphagia pathophysiology, complications and science-based interventions. Nestle Nutr Inst Workshop Ser 2012; 72: 119–26. DOI: 10.1159/000340000
6. Malagelada JR, Bazzoli F, Boeckxstaens G et al. World gastroenterology organisation global guidelines: dysphagia – global guidelines and cascades update September 2014. J Clin Gastroenterol 2015; 49 (5): 370–8. DOI: 10.1097/MCG.0000000000000307
7. Martin RE, Sessle BJ. The role of the cerebral cortex in swallowing. Dysphagia 1993; 8 (3): 195–202;
8. Lee WK, Yeom J, Lee WH et al. Characteristics of Dysphagia in Severe Traumatic Brain Injury Patients: A Comparison With Stroke Patients. Ann Rehabil Med 2016; 40 (3): 432–9. DOI: 10.5535/arm.2016.40.3.432
9. Seung Hwa Rhie, Ji Won Choi, Se Jeong Jeon et al. Characteristics and risk factors of patients with aneurysmal subarachnoid hemorrhages related to dysphagia. Ann Rehabil Med 2016; 40 (6): 1024–32.
10. Donovan NJ, Daniels SK, Edmiaston J et al. Dysphagia screening: state of the art: invitational conference proceeding from the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. Stroke J Cereb Circ 2013; 44: e24–31.
11. Sasegbon A, Hamdy S. The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia. Neurogastroenterol Motil 2017; 29 (11). DOI: 10.1111/nmo.13100
12. Gromova D.O., Zakharov V.V. Narusheniia glotaniia posle insul'ta. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2015; 7 (4): 50–6. [in Russian]
13. Chang YC, Chen SY, Lui LT et al. Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia 2003; 18: 135–43.
14. Daniels SK, Brailey K, Priestly DH et al. Aspiration in patients with acute stroke. Arch Phys Med Rehabil 1998; 79 (1): 14–9.
15. Falsetti P, Acciai C, Palilla R et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis 2009; 18 (5): 329–35. DOI: 10.1016/j.jstrokecerebrovasdis.2009.01.009
16. Rosenbek JC, Robbins JA, Roecker EB et al. A penetration-aspiration scale. Dysphagia 1996; 11 (2): 93–8.
17. Warnecke T, Ritter MA, Kroger B. Fiberoptic endoscopic Dysphagia severity scale predicts outcome after acute stroke. Cerebrovasc Dis 2009; 28 (3): 283–9. DOI: 10.1159/000228711
18. Singer P, Berger MM, Van den Berghe G. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr 2009; 28 (4): 387–400. DOI: 10.1016/j.clnu.2009.04.024
19. Logemann JA. Behavioural management for oropharyngeal dysphagia. Folia Phoniatr Logop 1999; 51: 199–212.
20. Pelletier CA, Lawless HT. Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia 2003; 18: 231–41.
21. Robbins J, Butler SG, Daniels SK et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res 2008; 51 (1): S276–300.
22. Steele CM, Van Lieshout PHM. Influence of bolus consistency on lingual behaviours in sequential swallowing. Dysphagia 2004; 19: 192–206.
23. Clark HM. Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol 2003; 12: 400–15.
24. Crary MA, Carnaby GD, Groher ME, Helseth E. Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback. Dysphagia 2004; 19: 160–4.
25. Crary MA, Carnaby GD. Adoption into clinical practice of two therapies to manage swallowing disorders: exercise-based swallowing rehabilitation and electrical stimulation. Curr Opin Otolaryngol Head Neck Surg 2014; 22: 17–80.
26. Humbert IA. The argument against electrical stimulation for dysphagia. AHSA Lead 2012; 17 (5): 13, 15.
27. Avdyunina I.A., Grechko A.V., Bruno E.V. The basic feeding principles in cases of neurogenic dysphagia. Consilium Medicum. 2016; 18 (2.1): 53–8. [in Russian]
2. Крылов В.В. и др. Нейрореаниматология: практическое руководство. 2-е изд., перераб. и доп. М.: ГЭОТАР-Медиа, 2016. / Krylov V.V. i dr. Neiroreanimatologiia: prakticheskoe rukovodstvo. 2-e izd., pererab. i dop. M.: GEOTAR-Media, 2016. [in Russian]
3. Rofes L, Vilardell N, Clavé P. Post-stroke dysphagia: progress at last. Neurogastroenterol Motil 2013; 25 (4): 278–82. DOI: 10.1111/nmo.12112
4. Hinchey JA, Shephard T, Furie K et al. Formal dysphagia screening protocols prevent pneumonia. Stroke J Cereb Circ 2005; 36: 1972–6.
5. Altman KW. Oropharyngeal dysphagia pathophysiology, complications and science-based interventions. Nestle Nutr Inst Workshop Ser 2012; 72: 119–26. DOI: 10.1159/000340000
6. Malagelada JR, Bazzoli F, Boeckxstaens G et al. World gastroenterology organisation global guidelines: dysphagia – global guidelines and cascades update September 2014. J Clin Gastroenterol 2015; 49 (5): 370–8. DOI: 10.1097/MCG.0000000000000307
7. Martin RE, Sessle BJ. The role of the cerebral cortex in swallowing. Dysphagia 1993; 8 (3): 195–202;
8. Lee WK, Yeom J, Lee WH et al. Characteristics of Dysphagia in Severe Traumatic Brain Injury Patients: A Comparison With Stroke Patients. Ann Rehabil Med 2016; 40 (3): 432–9. DOI: 10.5535/arm.2016.40.3.432
9. Seung Hwa Rhie, Ji Won Choi, Se Jeong Jeon et al. Characteristics and risk factors of patients with aneurysmal subarachnoid hemorrhages related to dysphagia. Ann Rehabil Med 2016; 40 (6): 1024–32.
10. Donovan NJ, Daniels SK, Edmiaston J et al. Dysphagia screening: state of the art: invitational conference proceeding from the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. Stroke J Cereb Circ 2013; 44: e24–31.
11. Sasegbon A, Hamdy S. The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia. Neurogastroenterol Motil 2017; 29 (11). DOI: 10.1111/nmo.13100
12. Громова Д.О., Захаров В.В. Нарушения глотания после инсульта. Неврология, нейропсихиатрия, психосоматика. 2015; 7 (4): 50–6. / Gromova D.O., Zakharov V.V. Narusheniia glotaniia posle insul'ta. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2015; 7 (4): 50–6. [in Russian]
13. Chang YC, Chen SY, Lui LT et al. Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia 2003; 18: 135–43.
14. Daniels SK, Brailey K, Priestly DH et al. Aspiration in patients with acute stroke. Arch Phys Med Rehabil 1998; 79 (1): 14–9.
15. Falsetti P, Acciai C, Palilla R et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis 2009; 18 (5): 329–35. DOI: 10.1016/j.jstrokecerebrovasdis.2009.01.009
16. Rosenbek JC, Robbins JA, Roecker EB et al. A penetration-aspiration scale. Dysphagia 1996; 11 (2): 93–8.
17. Warnecke T, Ritter MA, Kroger B. Fiberoptic endoscopic Dysphagia severity scale predicts outcome after acute stroke. Cerebrovasc Dis 2009; 28 (3): 283–9. DOI: 10.1159/000228711
18. Singer P, Berger MM, Van den Berghe G. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr 2009; 28 (4): 387–400. DOI: 10.1016/j.clnu.2009.04.024
19. Logemann JA. Behavioural management for oropharyngeal dysphagia. Folia Phoniatr Logop 1999; 51: 199–212.
20. Pelletier CA, Lawless HT. Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia 2003; 18: 231–41.
21. Robbins J, Butler SG, Daniels SK et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res 2008; 51 (1): S276–300.
22. Steele CM, Van Lieshout PHM. Influence of bolus consistency on lingual behaviours in sequential swallowing. Dysphagia 2004; 19: 192–206.
23. Clark HM. Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol 2003; 12: 400–15.
24. Crary MA, Carnaby GD, Groher ME, Helseth E. Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback. Dysphagia 2004; 19: 160–4.
25. Crary MA, Carnaby GD. Adoption into clinical practice of two therapies to manage swallowing disorders: exercise-based swallowing rehabilitation and electrical stimulation. Curr Opin Otolaryngol Head Neck Surg 2014; 22: 17–80.
26. Humbert IA. The argument against electrical stimulation for dysphagia. AHSA Lead 2012; 17 (5): 13, 15.
27. Авдюнина И.А., Гречко А.В., Бруно Е.В. Основные принципы организации трапезы больных с нейрогенной дисфагией. Consilium Medicum. 2016; 18 (2.1): 53–8. / Avdyunina I.A., Grechko A.V., Bruno E.V. The basic feeding principles in cases of neurogenic dysphagia. Consilium Medicum. 2016; 18 (2.1): 53–8. [in Russian]
________________________________________________
2. Krylov V.V. i dr. Neiroreanimatologiia: prakticheskoe rukovodstvo. 2-e izd., pererab. i dop. M.: GEOTAR-Media, 2016. [in Russian]
3. Rofes L, Vilardell N, Clavé P. Post-stroke dysphagia: progress at last. Neurogastroenterol Motil 2013; 25 (4): 278–82. DOI: 10.1111/nmo.12112
4. Hinchey JA, Shephard T, Furie K et al. Formal dysphagia screening protocols prevent pneumonia. Stroke J Cereb Circ 2005; 36: 1972–6.
5. Altman KW. Oropharyngeal dysphagia pathophysiology, complications and science-based interventions. Nestle Nutr Inst Workshop Ser 2012; 72: 119–26. DOI: 10.1159/000340000
6. Malagelada JR, Bazzoli F, Boeckxstaens G et al. World gastroenterology organisation global guidelines: dysphagia – global guidelines and cascades update September 2014. J Clin Gastroenterol 2015; 49 (5): 370–8. DOI: 10.1097/MCG.0000000000000307
7. Martin RE, Sessle BJ. The role of the cerebral cortex in swallowing. Dysphagia 1993; 8 (3): 195–202;
8. Lee WK, Yeom J, Lee WH et al. Characteristics of Dysphagia in Severe Traumatic Brain Injury Patients: A Comparison With Stroke Patients. Ann Rehabil Med 2016; 40 (3): 432–9. DOI: 10.5535/arm.2016.40.3.432
9. Seung Hwa Rhie, Ji Won Choi, Se Jeong Jeon et al. Characteristics and risk factors of patients with aneurysmal subarachnoid hemorrhages related to dysphagia. Ann Rehabil Med 2016; 40 (6): 1024–32.
10. Donovan NJ, Daniels SK, Edmiaston J et al. Dysphagia screening: state of the art: invitational conference proceeding from the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. Stroke J Cereb Circ 2013; 44: e24–31.
11. Sasegbon A, Hamdy S. The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia. Neurogastroenterol Motil 2017; 29 (11). DOI: 10.1111/nmo.13100
12. Gromova D.O., Zakharov V.V. Narusheniia glotaniia posle insul'ta. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2015; 7 (4): 50–6. [in Russian]
13. Chang YC, Chen SY, Lui LT et al. Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia 2003; 18: 135–43.
14. Daniels SK, Brailey K, Priestly DH et al. Aspiration in patients with acute stroke. Arch Phys Med Rehabil 1998; 79 (1): 14–9.
15. Falsetti P, Acciai C, Palilla R et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis 2009; 18 (5): 329–35. DOI: 10.1016/j.jstrokecerebrovasdis.2009.01.009
16. Rosenbek JC, Robbins JA, Roecker EB et al. A penetration-aspiration scale. Dysphagia 1996; 11 (2): 93–8.
17. Warnecke T, Ritter MA, Kroger B. Fiberoptic endoscopic Dysphagia severity scale predicts outcome after acute stroke. Cerebrovasc Dis 2009; 28 (3): 283–9. DOI: 10.1159/000228711
18. Singer P, Berger MM, Van den Berghe G. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr 2009; 28 (4): 387–400. DOI: 10.1016/j.clnu.2009.04.024
19. Logemann JA. Behavioural management for oropharyngeal dysphagia. Folia Phoniatr Logop 1999; 51: 199–212.
20. Pelletier CA, Lawless HT. Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia 2003; 18: 231–41.
21. Robbins J, Butler SG, Daniels SK et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res 2008; 51 (1): S276–300.
22. Steele CM, Van Lieshout PHM. Influence of bolus consistency on lingual behaviours in sequential swallowing. Dysphagia 2004; 19: 192–206.
23. Clark HM. Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol 2003; 12: 400–15.
24. Crary MA, Carnaby GD, Groher ME, Helseth E. Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback. Dysphagia 2004; 19: 160–4.
25. Crary MA, Carnaby GD. Adoption into clinical practice of two therapies to manage swallowing disorders: exercise-based swallowing rehabilitation and electrical stimulation. Curr Opin Otolaryngol Head Neck Surg 2014; 22: 17–80.
26. Humbert IA. The argument against electrical stimulation for dysphagia. AHSA Lead 2012; 17 (5): 13, 15.
27. Avdyunina I.A., Grechko A.V., Bruno E.V. The basic feeding principles in cases of neurogenic dysphagia. Consilium Medicum. 2016; 18 (2.1): 53–8. [in Russian]
Авторы
С.С.Петриков1,2, А.А.Солодов2
1. ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В.Склифосовского» Департамента здравоохранения г. Москвы. 129090, Россия, Москва, Большая Сухаревская пл., д. 3;
2. ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
*docsol@mail.ru
1. N.V.Sklifosovsky Research Institute of Emergency Medicine of the Department of Health of Moscow. 129090, Russian Federation, Mosсow, Bolshaya Sukharevskaya pl., d. 3;
2. A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1
*docsol@mail.ru
1. ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В.Склифосовского» Департамента здравоохранения г. Москвы. 129090, Россия, Москва, Большая Сухаревская пл., д. 3;
2. ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
*docsol@mail.ru
________________________________________________
1. N.V.Sklifosovsky Research Institute of Emergency Medicine of the Department of Health of Moscow. 129090, Russian Federation, Mosсow, Bolshaya Sukharevskaya pl., d. 3;
2. A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1
*docsol@mail.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.