#1
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Ïðîôèëàêòè ÒÝËÀ ó áîëüíûõ â/ì êðîâîèçëèÿíèÿìè
Çäðàâñòâóéòå! Ïîäñêàæèòå ïîæàëóéñòà ñòàíäàðòû òðîìáîýìáîëè÷åñêèõ îñëîæíåíèé ó áîëüíûõ ñ â/ì êðîâîèçëèÿíèÿìè???
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#2
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Åäèíñòâåííîé ðåêîìåíäàöèåé â äàííûõ óñëîâèÿõ ÿâëÿåòñÿ ïðîâåäåíèå intermittent pneumatic compression; õîòÿ âîò ýòà íåäàâíÿÿ ðàáîòà ïîêàçûâàåò, ÷òî è ôàðì. ïðîôèëàêòèêà íå ïðèâîäèò ê äàëüíåéøåìó ðîñòó ãåìàòîì:
Pharmacological Deep Vein Thrombosis Prophylaxis Does Not Lead to Hematoma Expansion in Intracerebral Hemorrhage With Intraventricular Extension [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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åñòü âîò òàêîé åùå ýâèäåíñ:
in patients with hemorrhagic stroke, early anticoagulation is associated with a significant reduction in PE and a nonsignificant reduction in mortality, with the trade-off of a nonsignificant increase in hematoma enlargement. Efficacy and safety of anticoagulants in the prevention of venous thromboembolism in patients with acute cerebral hemorrhage: a meta-analysis of controlled studies [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#4
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Ñïàñèáî! Ñ êàêèõ ñóòîê,â êàêîé äîçå è ïðòèâîïîêàçàíèÿ? Àíòèâàðèêîçíûé òðèêîòàæ ðàáîòàåò?
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#5
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ôàðì. ïðîôèëàêòèêà ÍÅ âõîäèò â ñòàíäàðòû: íàçâàíèÿ ëåêàðñòâ, äîçû è ñðîêè íàïèñàíû â ññûëêàõ.
Ñòàíäàðòíûå ðåêîìåíäàöèè: intermittent pneumatic compression, êîòîðîå áîëåå åôôåêòèâíî, ÷åì åëàñòè÷åñêèé òðèêîòàæ.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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Ó ìåíÿ ïðèíÿòî îäåâàòü îáà. È òðèêîòàæ ýëàñòè÷íûé, è ïíåâìàòèêó ñâåðõó.
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#7
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Ïðèíÿòî ñîãëàñíî êàêèì ãàéäëàéíàì è êëèíè÷åñêèì ðåêîìåíäàöèÿì?
Åñëè æå "ïðèíÿòî" ïðîñòî ó îòäåëüíî âçÿòîãî ïàöèåíòà, òî íàïîìíþ Ïðàâèëà ôîðóìà - îáùåíèå ìåæäó ïàöèåíòàìè çàïðåùåíî.  òåìàõ èìåþò ïðàâî îòâå÷àòü òîëüêî âðà÷è. Äëÿ îáìåíà îêîëîìåäèöèíñêèì æèòåéñêèì îïûòîì åñòü äðóãèå ïëîùàäêè.
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×òîáû ïîñòàâèòü äèàãíîç íåïðàâèëüíî, íàäî èìåòü îñîáûé òàëàíò è ïðåìíîãî ïîñòàðàòüñÿ: ñäåëàòü ÌÐÒ è ÊÒ âñåõ ëþáîïûòíûõ ìåñò áîëüíîãî, ðåíòãåíîâñêèå ñíèìêè îò ãîëîâû äî ïÿò, àíàëèçû âñåõ áèîæèäêîñòåé, ïðèãëàñèòü ïÿòîê-äðóãîé êîíñóëüòàíòîâ… Ñàì ÷åðò ïîòîì âî âñåì ýòîì íå ðàçáåðåòñÿ! Ï. Ðóäè÷ |
#8
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Íó à íà ÷òî òîãäà îäåâàòü ïíåâìîêîìïðåññèþ? Íà ãîëóþ íîãó? Íàäåâàåì íà òðèêîòàæ ïíåâìî, â ñëó÷àå ÷àñòûõ êàçóñîâ-çàãðÿçíåíèé ÷óëêè äîëîé èëè â ñòèðêó.
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#9
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 îñòðåéøåì ïåðèîäå âûñîê ðèñê óâåëè÷åíèÿ â/ì ãåìàòîì è õèð âìåøàòåëüñòâà, ïîýòîìó òîëüêî ïíåâìîïðîôèëàêòèêà, â äàëüíåéøåì áëèæå ê îñòðî-ïîäîñòðîìó íå äóìàþ, ÷òî ïîäêëþ÷åíèå ôàð ïðîôèëàêòèêè áóäåò çàñ÷èòàíî çà ìèñïðàêòèñ. Ïðîáëåìîé îñòàþòñÿ ÑÀÊ , ãäå ÷¸òêî â ãàéäå íàïèñàíî ïîêà íå âêëþ÷åíà àíåâðèçìà íèêàêèõ ãåïàðèíîâ, èíîãäà õèðóðãè æäóò õîëîäíîãî ïåðèîäà.
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