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#1
21.12.2004, 13:01
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Òðàõåîòîìèÿ
Ñîçäàâàÿ ýòó òåìó ÿ ïîäóìàë ÷òî ìíîãèì ïðîôåññèîíàëàì åñòü ÷òî ñêàçàòü ïî ýòîìó ïîâîäó. õîòåëîñü áû óñëûøàòü ïî êàêîé ìåòîäèêå, ñ êàêèìè ïðåïàðàòàìè, â êàêèå ñðîêè, ïî êàêèì ïîêàçàíèÿì âû ïðîâîäèòå ýòó îïåðàöèþ.
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#2
21.12.2004, 13:42
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Èíòåðåñíàÿ òåìà: âûñêàæèòåñü ïî ïîâîäó ïîêàçàíèé äëÿ òðàõåîñòîìèè, åñëè ïðè äëèòåëüíîé ÈÂË òî â êàêèå ñðîêè, èñïîëüçóåòå ëè Âû ÷ðåçêîæíóþ ìåòîäèêó, êòî âûïîëíÿåò ïðîöåäóðó òðàõåîñòîìèè â âàøåì îòäåëåíèè?
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#3
21.12.2004, 20:16
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Öèòàòà:
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#4
22.12.2004, 15:09
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Ñêàæèòå, êàêîé ñìûñë ïðîèçâîäèòü òðàâìàòè÷íîå âìåøàòåëüñòâî ó ïàöèåíòà, êîòîðûé ïðîâåäåò íà ÈÂË 4, 5, 6 äíåé? Äàæå, åñëè áîëüøå...
À îñëîæíåíèÿ? ×àñòî ïîêàçàíèåì äëÿ òðàõåîñòîìèè ÿâëÿåòñÿ äëèòåëüíàÿ âåíòèëÿöèÿ ëåãêèõ... Íî ïîä äëèòåëüíîé âåíòèëÿöèåé ëåãêèõ ïîíèìàþò âåíòèëÿöèþ ñâûøå òðåõ íåäåëü (21 äåíü)!!!
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#5
22.12.2004, 18:18
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Öèòàòà:
Âîîáùå òðàõåîòîìèþ ïðåäïî÷èòàåì ðàííþþ – ìîæåò áûòü, ïîýòîìó ëåò ïÿòü óæå íå áûëî íàçîòðàõåàëüíûõ èíòóáàöèé. IMHO, ïðè íàçîòðàõåàëüíîé èíòóáàöèè ñèíóñèòû ïðè ÊÒ â 100% ñëó÷àåâ (÷àñòàÿ çàìåíà òðóáêè íå ïîìîãàåò), êîìôîðòíîñòü î÷åíü ñîìíèòåëüíàÿ (â îäíîé íîçäðå èíòóáàöèîííàÿ òðóáêà, â äðóãîé – çîíä, äà è ñàì ïðîöåññ èíòóáàöèè ðàäîñòè íå äîñòàâëÿåò), áðîíõîñêîïèþ âûïîëíèòü íåëüçÿ, ñàíèðîâàòü íîðìàëüíî íåëüçÿ… Âïå÷àòëÿþùåå èññëåäîâàíèå ïî òåìå: Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004 Aug; 32(8):1689-94. OBJECTIVE: The timing of tracheotomy in patients requiring mechanical ventilation is unknown. The effects of early percutaneous dilational tracheotomy compared with delayed tracheotomy in critically ill medical patients needing prolonged mechanical ventilation were assessed. DESIGN: Prospective, randomized study. SETTING: Medical intensive care units. PATIENTS: One hundred and twenty patients projected to need ventilation >14 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were prospectively randomized to either early percutaneous tracheotomy within 48 hrs or delayed tracheotomy at days 14-16. Time in the intensive care unit and on mechanical ventilation and the cumulative frequency of pneumonia, mortality, and accidental extubation were documented. The airway was assessed for oral, labial, laryngeal, and tracheal damage. Early group showed significantly less mortality (31.7% vs. 61.7%), pneumonia (5% vs. 25%), and accidental extubations compared with the prolonged translaryngeal group (0 vs. 6). The early tracheotomy group spent less time in the intensive care unit (4.8 +/- 1.4 vs. 16.2 +/- 3.8 days) and on mechanical ventilation (7.6 +/- 2.0 vs. 17.4 +/- 5.3 days). There was also significantly more damage to mouth and larynx in the prolonged translaryngeal intubation group. CONCLUSIONS: This study demonstrates that the benefits of early tracheotomy outweigh the risks of prolonged translaryngeal intubation. It gives credence to the practice of subjecting this group of critically ill medical patients to early tracheotomy rather than delayed tracheotomy. Ñ óâàæåíèåì.
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#6
22.12.2004, 21:20
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Öèòàòà:
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#7
22.12.2004, 22:54
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Ïðèíöèïèàëüíîé ðàçíèöû ïðè ñàíàöèè ÷åðåç ýíäîòðàõåàëüíóþ òðóáêó è òðàõåîñòîìè÷åñêóþ íå âèæó. Ìåðòâîå ïðîñòðàíñòâî - è íà ñêîëüêî æå óìåíüøèòñÿ? Óäîáñòâî äëÿ ïàöèåíòà, óõîä çà ðîòîâîé ïîëîñòüþ - âîçìîæíî, â êàêîé-òî ñòåïåíè äà. Åñëè âåíòèëÿöèÿ äåéñòâèòåëüíî äëèòåëüíàÿ. ×åòêèõ ñòàíäàðòîâ ó íàñ íåò.
Ó íàñ òðàõåîñòîìèÿ äåëàåòñÿ äîñòàòî÷íî ðåäêî, îáû÷íî ïðè òÿæåëîé ×ÌÒ, âûïîëíÿåòñÿ ËÎÐ-âðà÷àìè, àíåñòåçèÿ ("ñ êàêèìè ïðåïàðàòàìè" - îá ýòîì?) îáû÷íàÿ - ãèïíîòèê, àíàëãåòèê... Äåëàë è ñàì, íî, ÷åñòíî, íå ëþáëþ... (Îäíî âðåìÿ ó íàñ â ÖÐÁ íå áûëî òðóáîê, ñòàâèëè âìåñòî òðàõåîñòîìè÷åñêîé îáû÷íóþ èíòóáàöèîííóþ - ýòî âîîáùå óæàñ, ëåòÿùèé íà êðûëüÿõ íî÷è. ×ðåñêîæíàÿ òðàõåîñòîìèÿ - óâû, òîëüêî ÷èòàëè...)
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#8
23.12.2004, 01:26
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 äîïîëíåíèå ê âûøåñêàçàííîìó... Âòîðîå ñîîáùåíèå, â êîòîðîì ïðåïÿòñòâèåì ê íàçîòðàõåàëüíîé èíòóáàöèè ÿâëÿåòñÿ áðîíõîñêîïèÿ...
ß ñàì âûïîëíÿë áðîíõîñêîïèè è ïîâåðüòå ìíå íóæäû ïðîõîäèòü çà ñóáñåãìåíòû ó ìåíÿ íå áûëî íèêîãäà, à äëÿ ýòîé öåëè äëèíû õâàòàåò... çàòåì ñêîëüêî ðàç âû ñîáèðàåòåñü äåëàòü áðîíõîñêîïèþ è ñ êàêîé öåëüþ? Òîëüêî äëÿ ñàíàöèè?... òàê ëó÷øå ïðîâîäèòü èíòðàòðàõåàëüíóþ õèìèîòåðàïèþ (àíòèñåïòèê, áðîíõîäèëÿòàòîð, ìóêîëèòèê) è òùàòåëüíóþ ñàíàöèþ âåðõíèõ äûõàòåëüíûõ ïóòåé, à òàêæå ïîâîðîòû òåëà (õîòÿ áû áîê-ñïèíà-áîê)... òîãäà íå áóäåò ïðè÷èí äëÿ ïðîâåäåíèÿ áðîíõîñêîïèè. Ïëþñ ÿ ïðîøó Âàñ âñïîìíèòü ïðî ñòðèêòóðû òðàõåè, ñ êîòîðûìè ÷àùå ñòàëêèâàåìñÿ íå ìû ñ Âàìè, à ËÎÐ âðà÷è, à ïàöèåíòû æèâóò ñ íèìè...
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#9
23.12.2004, 18:14
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Ìîæåò êîìó èíòåðåñíà ñòàòüÿ áóäåò: Ôîëîìååâ Â. Í., Ïàíôåðîâà À. Â., Ìàëüöåâà È. Ì., Ëàôóòêèíà Í. Â.,
Êåëåõñàåâà À. Ñ., Áåðåçèíà Í. Í., Øàäðèí Ã. Á., Ìîðîçîâà Î. À. Òðàõåîñòîìèÿ â îòäåëåíèè ðåàíèìàöèè. Ïîêàçàíèÿ, ïðîòèâîïîêàçàíèÿ, ìåòîäèêà. Îñëîæíåíèÿ è èõ ïðîôèëàêòèêà, (Êëèíè÷åñêàÿ àíåñòåçèîëîãèÿ è ðåàíèìàòîëîãèÿ íîìåð ÄÂÀ (ñì àðõèâ), òàì æå êñòàòè, êòî íåçíàåò áåñïëàòíî ïîäïèñàòñÿ íà æóðíàë ìîæíà....) [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#10
29.12.2004, 01:24
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À â çàêëþ÷åíèè, åñëè â âàøåì îòäåëåíèè õîðîøèå ðåçóëüòàòû ïðè âåäåíèè ïàöèåíòîâ ñ òðàõåîñòîìèåé íà ôîíå äëèòåëüíîé ÈÂË, òî ïðîäîëæàéòå âåñòè èõ ýòèì ñïîñîáîì, åñëè Âû ïðåäïî÷èòàåòå âåñòè èõ ïîñðåäñòâîì íàçîòðàõåàëüíîé èíòóáàöèè èëè èíà÷å è Âû äîâîëüíû ðåçóëüòàòàìè, òî ïðîäîëæàéòå â ýòîì æå ðóñëå...
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#11
30.12.2004, 06:43
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Öèòàòà:
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#12
12.03.2005, 20:36
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Öèòàòà:
Òàì, ãäå ÿ ðàáîòàëà ðàíüøå, òðàõåîñòîìèþ âûïîëíÿëè îáùèå õèðóðãè, à èç ðåàíèìàòîëîãîâ ìàëî êòî ýòèì áàëîâàëñÿ.  äðóãîì ó÷ðåæäåíèè - âñå æå ðåàíèìàòîëîãè. Êñòàòè îäíà ìîÿ çíàêîìàÿ äîêòîð íåçàâèñèìî îò â/âåííîãî îáåçáîëèâàíèÿ î÷åíü ëþáèëà äåëàòü èíôèëüòðàöèîííóþ àíåñò.: ãèäðàâëè÷åñêàÿ ïðåïàðîâêà òêàíåé è âñå òàêîå...
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#13
12.03.2005, 21:05
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Òðàõåîñòîìèÿ ì.á. çíà÷èòåëüíî îáëåã÷àåò ñàíàöèþ... Íî ðîñò ñòðèêòóð ó ïàöèåíòîâ â Ìîñêâå è îáëàñòè çíà÷èòåëüíûé. Ïðîãíîç ó ýòèõ áîëüíûõ òîæå ãðóñòíûé. Íåëüçÿ ÷ðåçìåðíî ðàñøèðÿòü ïîêàçàíèÿ è âûïîëíÿòü ýòó îïåðàöèþ ëþáîìó äåæóðíîìó. Ïî ïîêàçàíèÿì äîëæåí äåëàòü Ëîð âðà÷ èëè îáó÷åíûå 2-3 âðà÷à â áîëüíèöå.
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#14
13.03.2005, 19:59
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[quote=reopoliglucin]Ìîæåò êîìó èíòåðåñíà ñòàòüÿ áóäåò: Ôîëîìååâ Â. Í., Ïàíôåðîâà À. Â., Ìàëüöåâà È. Ì., Ëàôóòêèíà Í. Â.,
Êåëåõñàåâà À. Ñ., Áåðåçèíà Í. Í., Øàäðèí Ã. Á., Ìîðîçîâà Î. À. Òðàõåîñòîìèÿ â îòäåëåíèè ðåàíèìàöèè. Ïîêàçàíèÿ, ïðîòèâîïîêàçàíèÿ, ìåòîäèêà. Îñëîæíåíèÿ è èõ ïðîôèëàêòèêà, (Êëèíè÷åñêàÿ àíåñòåçèîëîãèÿ è ðåàíèìàòîëîãèÿ íîìåð ÄÂÀ (ñì àðõèâ), òàì æå êñòàòè, êòî íåçíàåò áåñïëàòíî ïîäïèñàòñÿ íà æóðíàë ìîæíà....) [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ][/QUOTE ß ÷òî - òî íå íàøåë ðàçäåëà ïîäïèñêà
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#15
14.03.2005, 17:17
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[quote=Kosolapov]
Öèòàòà:
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Ëèíåéíûé âèä
