#1
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Òðîìáýêñòðàêöèÿ
Óâàæàåìûå êîëëåãè.  íàøåì îòäåëåíèè íåêîòîðîå âðåìÿ íàçàä ïîÿâèëèñü óñòðîéñòâà äëÿ ìàíóàëüíîé âàêóóìíîé àñïèðàöèè òðîìáîâ èç êîðîíàðíûõ àðòåðèé (QuickCat, Diver, V-Max). Âñå áû õîðîøî, íî ïî íåáîëüøîìó îïûòó è ñóáúåêòèâíûì îùóùåíèÿì äîëæíîãî ýôôåêòà îò èñïîëüçîâàíèÿ äàííûõ äåâàéñîâ ïîëó÷èòü êàê-òî íå óäàåòñÿ (ìîãó îòâå÷àòü òîëüêî çà ñâîè êðèâûå ðóêè).
Ïîñëåäîâàòåëüíîñòü äåéñòâèé ïðèìåðíî òàêàÿ: 1. ïðîìûòü ñèñòåìó. 2. øïðèö íà âàêóóì (3õ õîäîâîé êðàíèê çàêðûò) 3. ïîäâåñòè ïî ïðåäóñòàíîâëåííîìó ïðîâîäíèêó ê çîíå èíòåðåñà. 4. îòêðûâàåì 3õ õîäîâîé êðàíèê è âûïîëíÿåì 3 òðàêöèè àñïèðàöèîííûì êàòåòåðîì âïåðåä è îáðàòíî. 5. "ýêñòðàêò" ôèëüòðóåì, øïðèö íà âàêóóì -> çàáèðàåì ñèñòåìó â ïðîâîäíèêîâûé êàòåòåð. Óáåäèòåëüíî ïðîøó ïîäåëèòüñÿ ïðàêòè÷åñêèì îïûòîì èñïîëüçîâàíèÿ äàííûõ óñòðîéñòâ, ïîñêîëüêó àñïèðèðîâàòü ÷òî-ëèáî êðîìå êðîâè íå óäàëîñü íè ðàçó. (ó÷èòûâàÿ âîñõèòèòåëüíûå êàðòèíêè âûëîæåííûå â ïðåäûäóùèõ òåìàõ) |
#2
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Ìû îáû÷íî äåëàåì 1-2 òðàêöèè, ïðè÷åì ñòàðàåìñÿ ïðîäâèãàòü êàòåòåð âïåðåä î÷åíü-î÷åíü ìåäëåííî, ÷òîáû íå ïðîòîëêíóòü òðîìá â äèñòàëüíîå ðóñëî (1 øïðèö - äâèæåíèå âïåðåä, 1 øïðèö - äâèæåíèå íàçàä). Òðîìáû â êîðçèíêå áûâàþò ïðèìåðíî â 50%, ÷àùå ÷òî-òî òèïà ìåëêèõ êðóïèíîê. Èíîãäà áûâàåò íåâîçìîæíî ïðîâåñòè êàòåòåð ÷åðåç çîíó ïîðàæåíèÿ - òîãäà àñïèðèðóåì 1-2 øïðèöà ó ïðîêñèìàëüíîé ÷àñòè îêëþçèè. Åñëè íå ïîìîãëî - áàëëîí 1,5-2,0 ìì.
(êàòåòåðû ó íàñ Export è Diver). |
#3
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Èñïîëüçóåì î÷åíü ÷àñòî, êðàñèâûå ôîòîãåíè÷íûå òðîìáû óäàåòñÿ ïîëó÷èòü ðåäêî, ïðèìåðíî â ÷åòâåðòè ñëó÷àåâ, íî êðîâîòîê óëó÷øàåòñÿ, ìîðôîëîãèÿ ïîðàæåíèÿ èçìåíÿåòñÿ â ëó÷øóþ ñòîðîíó. ×àñòî - ìåëêèå áåëûå êðóïèíêè (àòåðîìà?).
Àñïèðèðóåì äî ïî÷òè ïîëíîãî íàïîëíåíèÿ øïðèöà, óäàëÿåì àñïèðàöèîííûé êàòåòåð èç ãàéäà íå îòñîåäèíÿÿ îò øïðèöà, ñ íåãàòèâíûì äàâëåíèåì, ÷òîáû ïðåäîòâðàòèòü ïîâòîðíóþ ýìáîëèçàöèþ òåì, ÷òî âîçìîæíî íàõîäèòñÿ â àñïèðàöèîííîì êàòåòåðå. Òðàêöèè êàòåòåðîì íå òàêèå ìåäëåííûå, íî îäíîãî øïðèöà ìîæåò çàïðîñòî õâàòèòü íà 5-8 òðàêöèé â êðóïíîé àðòåðèè ïðè ïîñòóïëåíèè êðîâè ïî êàòåòåðó. |
#4
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To Angio: ïðèêîëüíî, äåâàéñû óæå ñ ãîä, êàê åñòü...
Íà ñàìîì äåëå, êàê "ãîâîðÿò", äàæå åñëè "íè÷åãî íå îòñîñàë", äëÿ êîðîíàðîâ è ïåðôóçèè - ýòî "â ïëþñ"... Íå íàäî, èìõî, òðîìáû ñåðäå÷êàìè ñêëàäûâàòü, äàæå åñëè "òðîìáîâ" íåò, ðåçóëüòàò ëó÷øå! |
#5
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Íå ñîâñåì ïî òåìå, íî íåñìîòðÿ íà ïðèìåíåíèå òðîìáýêñòðàêòîðîâ, ïðîáëåìà slow- è no-reflow îñòàåòñÿ àêòóàëüíîé. Êòî ÷åì ëå÷èò êðîìå íèòðàòîâ "ìåñòíî" è 2b3a?
P.S.: êòî-òî äèïèðèäàìîëîì ïðîáîâàë? Catheter Cardiovasc Interv. 2010 Nov 15;76(6):787-93. doi: 10.1002/ccd.22724. Epub 2010 Aug 24. Dipyridamole versus verapamil for treatment of no-reflow during primary angioplasty. Tanzilli G, Greco C, Pasceri V, Pelliccia F, Arrivi A, Placanica A, Mangieri E. Source Dipartimento Cuore e Grossi Vasi A. Reale, Policlinico Umberto I, Universita' La Sapienza, Roma, Italy. Abstract BACKGROUND: No previous study has assessed the possible role of dipyridamole for treatment of no-reflow during acute myocardial infarction (AMI). METHODS AND RESULTS: Forty-six consecutive patients (age 64 ± 13 years, 37 men) with no reflow during primary percutaneous coronary intervention were randomized to initial treatment with either dipyridamole (0.56 mg/kg i.c.) or verapamil (1 mg i.c.). Patients with unsuccessful response to the first drug were then switched to the second one (from dipyridamole to verapamil and vice versa). Angiographic end-points were similar in the two groups: TIMI flow was 2.9 ± 0.3 versus 2.8 ± 0.4 (P = 0.28), corrected TIMI frame count (cTFC) 26.4 ± 8.8 versus 31.6 ± 11.4 (P = 0.14) and TIMI myocardial perfusion grade (TMPG) 2.1 ± 1.2 versus 1.7 ± 1.2 (P = 0.12) in dipydidamole and verapamil group, respectively. Optimal myocardial perfusion (TMPG-3) was achieved by 56% of patients with dipyridamole and 39% with verapamil (P = 0.38). In patients with persistent no-reflow administration of dipyridamole on top of verapamil resulted in a significant further improvement of cTFC (from 31.6 ± 11.4 to 24.6 ± 5.7 P = 0.009) and of TMPG (from 1.7 ± 1.2 to 2.6 ± 0.7, P = 0.007). Conversely, verapamil did not induce a significant improvement in coronary flow (cTFC changed from 26.4 ± 8.8 to 24.5 ± 8.5, P = 0.28 and TMPG from 2.1 ± 1.2 to 2.4 ± 1.2, P = 0.13). There were no significant side effects induced by dipyridamole, while verapamil caused AV block in 9% of cases. CONCLUSIONS: Dipyridamole is a safe and effective first-line drug for treatment of no-reflow. Dipyridamole can also be successfully used in patients with incomplete response to verapamil. |
#6
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ÈÌÕÎ, ðåçóëüòàòû óëó÷øàòñÿ, åñëè ïîìåíÿòü ìåñòàìè ïóíêòû 2 è 3.  ìàíóàëå äîëæíî áûòü íàïèñàíî. Ïðè ïðîâåäåíèè âïåðåä êàòåòåðà íà âàêóóìå îí ÷àñòî ïðèñàñûâàåòñÿ ê ñòåíêàì àðòåðèè (ýòî ìîæåò ïðèâåñòè äàæå ê óõóäøåíèþ ñèòóàöèè) èëè ñðàçó çàáèâàåòñÿ òðîìáàìè â ïðîêñèìàëüíîì îòäåëå àðòåðèè, è ïîòîì íå âûïîëíÿåò ñâîåé ôóíêöèè.  îáùåì, ñíà÷àëà êàòåòåð ïðîâîäèì ïîäàëüøå, ñòàâèì íà âàêóóì è óæå ïîòîì ìåäëåííî îòòÿãèâàåì îáðàòíî. Ìû îáû÷íî äåëàåì òðàêöèè 2-3, íî áûâàåò è áîëüøå. Êòî-òî åùå íà ôîðóìå ïèñàë, ÷òî ïðè îáðàòíûõ òðàêöèÿõ ëó÷øå íåìíîæêî ïîääåðãèâàòü êàòåòåð, ìû òàê òîæå èíîãäà äåëàåì. Ýëåìåíòû øàìàíèçìà ïðèñóòñòâóþò, â îáùåì
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#7
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Öèòàòà:
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#8
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Ïîèñêàë â àðõèâàõ: íà òåìó "ïàðêèíñîíè÷åñêèõ" äâèæåíèé ïðè îòòÿãèâàíèè êàòåòåðà ïèñàë Sergnt, âîò çäåñü:
http://forums.rusmedserv.com/showthr...370#post981370 Êñòàòè, îïûò òðîìáýêñòðàêöèé ó íåãî óæå òîãäà áûë áîëåå 100, âïå÷àòëÿåò |
#9
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Â.ä. ó íàñ òàêèå äåâàéñû íå òàê äàâíî. îêîëî 2 ëåò. âûðó÷àþò åñëè ÎÊÑ äî 2 ÷àñîâ
äàëüøå ðàáîòàþò ïëîõî. Êëàññíî ïîìàãàþò ïðè äèñòàëüíîé ýìáîëèçàöèè. |