zabmedvestnikЗабайкальский медицинский вестникTransbaikalian Medical Bulletin1998-6173Читинская государственная медицинская академия10.52485/19986173_2025_4_96zabmedvestnik-499Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSПАТОГЕНЕТИЧЕСКИЕ МЕХАНИЗМЫ ГИПОКСИЧЕСКИ-ИШЕМИЧЕСКОГО ПОВРЕЖДЕНИЯ МОЗГА У ДЕТЕЙ ПОСЛЕ КЛИНИЧЕСКОЙ СМЕРТИPATHOGENETIC MECHANISMS OF HYPOXIC-ISCHEMIC BRAIN INJURY IN CHILDREN AFTER CLINICAL DEATHhttps://orcid.org/0000-0003-4705-3823БыковЮ. В.BykovYu. V.

Быков Юрий Витальевич, к.м.н., доцент кафедры анестезиологии, реаниматологии с курсом ДПО 

355017., г. Ставрополь, ул. Мира, 310

Bykov Yu.V., Candidate of Medical Sciences, Assistant of the Department of Anesthesiology and Intensive Care with a course of additional professional education 

310 Mira str., Stavropol, 355017

yubykov@gmail.comhttps://orcid.org/0000-0002-9990-7272ОбединА. Н.ObedinA. N.

Обедин Александр Николаевич, д.м.н., заведующий кафедрой анестезиологии, реаниматологии с курсом ДПО 

355017., г. Ставрополь, ул. Мира, 310;355002., г. Ставрополь, ул. Семашко, 3/1

Obedin A.N., Doctor of Medical Sciences, Head of the Department of Anesthesiology, Intensive Care with the course of additional professional education 

310 Mira str., Stavropol, 355017;355002, Stavropol, Semashko str. 3/1

volander@mail.ruhttps://orcid.org/0000-0003-4729-5101ЗинченкоО. В.ZinchenkoO. V.

Зинченко Олег Васильевич, к.м.н., доцент кафедры анестезиологии, реаниматологии с курсом ДПО 

355017., г. Ставрополь, ул. Мира, 310

Zinchenko O.V., Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology, Intensive Care with the course of additional professional education 

310 Mira str., Stavropol, 355017

regionar2008@yandex.ruhttps://orcid.org/0000-0001-5482-8581ЯцукИ. В.YatsukI. V.

Яцук Иван Викторович, к.м.н., доцент кафедры анестезиологии, реаниматологии с курсом ДПО 

355017., г. Ставрополь, ул. Мира, 310;355032, г. Ставрополь, ул. Тухачевского, 17

Yatsuk I.V., Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology, Intensive Care with the course of additional professional education 

310 Mira str., Stavropol, 355017;17 Tukhachevsky str., Stavropol, 355032

yatsukiv@gmail.comhttps://orcid.org/0000-0002-9841-6930ВолковЕ. В.VolkovE. V.

Волков Евгений Владимирович, к.м.н., доцент кафедры анестезиологии, реаниматологии с курсом ДПО 

355017., г. Ставрополь, ул. Мира, 310;355002., г. Ставрополь, ул. Семашко, 1

Volkov E.V., Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology, Intensive Care with the course of additional professional education 

310 Mira str., Stavropol, 355017;1 Semashko str., Stavropol, 355002

volkov26@mail.ruhttps://orcid.org/0000-0003-1494-1613ФишерВ. В.FischerV. V.

Фишер Василий Владимирович, к.м.н., доцент кафедры анестезиологии, реаниматологии с курсом ДПО 

355017., г. Ставрополь, ул. Мира, 310;356240., г. Ставрополь, ул. Ленина, 1

Fischer V.V., Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology, Intensive Care with the course of additional professional education 

310 Mira str., Stavropol, 355017;1 Lenin str., Stavropol, 356240

vvfisher26@gmail.comФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФ.РоссияStavropol State Medical UniversityRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФ; ГБУЗ Ставропольского края «Ставропольский краевой клинический перинатальный центр № 1» Министерства здравоохранения РФРоссияStavropol State Medical University; Stavropol Regional Clinical Perinatal Center No. 1Russian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФРоссияStavropol State Medical UniversityRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФ; Государственное бюджетное учреждение здравоохранения Ставропольского края «Городская клиническая больница скорой медицинской помощи города Ставрополя» Министерства здравоохранения РФРоссияStavropol State Medical University; Stavropol City Clinical Emergency HospitalRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФ; ГБУЗ Ставропольского края «Ставропольская краевая клиническая больница» Министерства здравоохранения РФРоссияStavropol State Medical University; Stavropol Regional Clinical HospitalRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФ; ГБУЗ Ставропольского края «Шпаковская районная больница» Министерства здравоохранения РФРоссияStavropol State Medical University; Shpakovskaya District HospitalRussian Federation2025190220260496111Copyright © Быков Ю.В., Обедин А.Н., Зинченко О.В., Яцук И.В., Волков Е.В., Фишер В.В., 20262026Быков Ю.В., Обедин А.Н., Зинченко О.В., Яцук И.В., Волков Е.В., Фишер В.В.Bykov Y.V., Obedin A.N., Zinchenko O.V., Yatsuk I.V., Volkov E.V., Fischer V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.zabmedvestnik.ru/jour/article/view/499

Смерть мозга у детей после перенесённой клинической смерти является одной из наиболее сложных и актуальных проблем современной педиатрической реаниматологии. Незрелость нервной системы, высокая метаболическая активность, функциональная нестабильность гематоэнцефалического барьера и незавершённая миелинизация определяют повышенную уязвимость головного мозга ребёнка к ишемии и гипоксии. В статье рассматриваются основные звенья патогенеза: первичные механизмы (глобальная ишемия, энергетический дефицит, ионный дисбаланс, эксайтотоксичность), вторичные повреждения (митохондриальная дисфункция, реперфузионный синдром, оксидативный стресс, нарушение проницаемости гематоэнцефалического барьера, нейровоспаление), а также формы клеточной гибели (апоптоз, некроз, патологическая аутофагия). Особое внимание уделено морфологическим последствиям для развивающегося мозга – повреждению белого вещества, задержке процессов миелинизации и утрате нейрональных сетей. У детей переход от обратимых к необратимым повреждениям происходит быстрее, чем у взрослых, что существенно осложняет прогнозирование и терапевтическое воздействие. Современное понимание молекулярных и морфологических механизмов смерти мозга имеет практическое значение для совершенствования диагностики, прогнозирования и лечения в педиатрической интенсивной терапии.

Brain death in children after clinical death is one of the most complex and urgent problems of modern pediatric intensive care. Immaturity of the nervous system, high metabolic activity, functional instability of the blood–brain barrier, and incomplete myelination determine the increased vulnerability of the child’s brain to ischemia and hypoxia. This article reviews the main pathogenetic mechanisms: primary (global ischemia, energy deficit, ion imbalance, excitotoxicity), secondary (mitochondrial dysfunction, reperfusion injury, oxidative stress, blood–brain barrier disruption, neuroinflammation), as well as different forms of cell death (apoptosis, necrosis, pathological autophagy). Particular attention is paid to the morphological consequences for the developing brain, including white matter injury, delayed myelination, and loss of neuronal networks. In children, the transition from reversible to irreversible damage occurs faster than in adults, which significantly complicates prognosis and therapeutic interventions. Current understanding of the molecular and morphological mechanisms of brain death has practical significance for improving diagnostics, prognosis, and treatment in pediatric intensive care.

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