За гранью выживания: переосмысление подходов к реабилитации пациентов с венозной тромбоэмболией

Венозная тромбоэмболия (ВТЭ) является значимой причиной смертности и инвалидизации во всем мире. Снижение летальности в острой фазе заболевания привело к росту популяции пациентов, сталкивающихся с долгосрочными последствиями, такими как посттромботический синдром (ПТС) и хроническая тромбоэмболическая легочная гипертензия (ХТЭЛГ), что существенно снижает качество их жизни и накладывает колоссальное экономическое бремя. В статье обоснована необходимость смены парадигмы ведения пациентов с ВТЭ: от лечения острого состояния к модели управления хроническим заболеванием с непрерывным реабилитационным процессом. Подробно рассмотрены фазы заболевания (острая, подострая, хроническая), определяющие характер реабилитационных вмешательств. Пред ставлена этапность медицинской реабилитации, а также описаны структура и функции мультидисциплинарной реабилитационной команды. Особое внимание уделено персонализированным подходам к реабилитации в различных клинических ситуациях: после тромбоэмболии легочной артерии, при тяжелом ПТС и трофических язвах, ХТЭЛГ, у онкологических пациентов, беременных, пожилых, спортсменов и лиц с имплантированным кава-фильтром. Перспективным потенциалом обладают клеточные технологии, внедрение искусственного интеллекта для прогнозирования рисков и телемедицины для повышения приверженности к лечению. Организационными барьерами являются недостаточная доступность и отсутствие стандартизированных протоколов реабилитации. Интеграция реабилитации как  обязательного компонента на всех этапах ведения пациента с ВТЭ – ключевое условие для предотвращения инвалидизирующих осложнений, восстановления функционального статуса, психосоциальной адаптации и улучшения качества жизни данной категории больных.

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