#1
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Ñóðôàêòàíò -ðåøåíèå âñåõ ïðîáëåì?
Èíòåðåñíî,íàñêîëüêî âåðîÿòíà ñâÿçü ìåæäó ïðèìåíåíèåì ñóðôàêòàíòà è âîçíèêàþùèìè çàòåì ïíåâìîòîðàêñàìè. Ñóðôàêòàíò äëÿ ìíîãèõ ñïåöèàëèñòîâ âûçûâàåò îäíè ëèøü ïîëîæèòåëüíûå ýìîöèè, òàê ëè âñå õîðîøî? ÿ èìåþ â âèäó êóðîñóðô
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#2
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Àâñòðàëèéñêèå ïåäèàòðû íàøëè ñíèæåíèå ÷àñòîòû ïíåâìîòîðàêñà (âûäåëåíî ìíîé):
J Paediatr Child Health. 1996 Jun;32(3):257-60. Improved outcomes following the introduction of surfactant to an Australian neonatal unit. Beeby P, Chan D, Henderson-Smart D. Department of Perinatal Medicine, King George V Hospital for Mothers and Babies, Camperdown, New South Wales, Australia. OBJECTIVE: To study the impact of the introduction of artificial surfactant therapy for hyaline membrane disease (HMD) in an Australian neonatal intensive care unit. METHODOLOGY: Infants < 32 weeks gestation admitted between June 1991 and Dec 1993 who received treatment with artificial surfactant were compared with infants admitted during the preceding 30 months who would have been candidates for such treatment. RESULTS: For treated infants with gestations in the range 24-27 weeks, there was a significant reduction in neonatal death (adjusted odds ratio 0.28) and a significant increase in the incidence of chronic lung disease (CLD) (adjusted odds ratio 3.4). With gestations in the range 28-31 weeks, there was no significant change in neonatal death or CLD, but there was a significant reduction in incidence of pneumothorax (adjusted odds ratio 0.32). CONCLUSIONS: A reduced incidence of pneumothorax and neonatal death following the introduction of artificial surfactant therapy was readily demonstrable in the Australian setting. |
#3
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Ñïàñèáî çà òàêóþ îäó î ñóðôàêòàíòå, âîçìîæíî ó íàñ ñòðàäàåò òåõíèêà ââåäåíèÿ, íî íà ïðàêòèêå, ïîñëå òîãî, êàê ìû ñòàëè øèðå åãî ïðèìåíÿòü ó íàñ çàìåòíî âûðîñëè ñëó÷àè ïíåâìîòîðàêñà. Âîçìîæíî ñòå÷åíèå îáñòîÿòåëüñòâ!?
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#4
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Åñòü ëè ïðèíöèïèàëüíàÿ ðàçíèöà â ñàìîì ïðåïàðàòå?
Ìû,íàïðèìåð, ââîäèì àëüâåîôàê. |
#5
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Dilbar! Õîðîøèé âîïðîñ! Ñòðàííî, ÷òî ìàëî îòâåòîâ, îñîáåííî èç Ïèòåðà. Äëÿ íàøèõ âðà÷åé (Òâåðü) èìïîðòíûé ïðåïàðàò ÿâëÿåòñÿ ðåäêîñòüþ ââèäó äîðîãîâèçíû, îòå÷åñòâåííûé ÷àùå äàåò îñëîæíåíèÿ - ñèíäðîì óòå÷êè âîçäóõà. Ìîãó ñêàçàòü, ÷òî ñ ïðèìåíåíèåì êóðîñóðôà ó íåäîíîøåííûõ óìåíüøèëàñü äëèòåëüíîñòü ÈÂË, ñîîòâåòñòâåííî îñëîæíåíèÿ, íàïðèìåð ÷èñëî ïîñòãåìîððàãè÷åñêèõ ãèäðîöåôàëèé. Ò.å. ðîäèòåëè ïîëó÷àþò îòíîñèòåëüíî "õîðîøåãî" ìàëûøà. Ìîæåò ÿ íå ïðàâ, íî ïóñòü ïîïðàâÿò.
 îòäåëåíèè, ãäå ÿ ðàáîòàþ, ëå÷èòñÿ äåâî÷êà 26 ñóò, ïîñòóïèâøàÿ ñ âåñîì 1.4 êã ñ ÐÄÑ òÿæåëîé ñòåïåíè ñ èìåþùèìèñÿ Â×Ê. Áåç ñóðôàêòàíòîâ ó íåå ðàçâèëñÿ ïíåâìîòîðàêñ, à ñåãîäíÿ ïîñëå ïåðåíåñåííîãî ìåíèíãèòà îêðóæíîñòü ãîëîâû âûðîñëà íà 3 ñì è øâû îòêðûòû íà 1-1.5 ñì. Äàæå åñëè óäàñòñÿ åå ýêñòóáèðîâàòü (àïïàðàò Bear-Cub 2001), òî âûïèñàòü äîìîé - äóìàþ íåò. ÁðîíÅâ |
#6
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Ê íàì â ãîðîä ïðèåõàëè Ìîñòîâîé è åãî êîìàíäà, ñåãîäíÿ ÷èòàëè ëåêöèþ î ñóðôàêòàíòå, ïðèâîäèëè ðåçóëüòàòû ëå÷åíèÿ è ñðàâíèòåëüíóþ õàðàêòåðèñòèêó ðàçëè÷íûõ âèäîâ ñóðôàêòàíòà, â îñíîâíîì ýòî âñå áûëè äàííûå êîêðàíîâñêîé áèáëèîòåêè. Íàñêîëüêî ìíå èçâåñòíî ó È.Ñàôîíîâà áûëà äèññåðòàöèÿ ïî ñðàâíèòåëüíûì ýôôåêòàì ñóðôàêòàíòà, õîòåëîñü áû åãî ïîñëóøàòü åñëè íå â ðåàëèè, òî õîòÿ áû çäåñü. Òàê è íå ÿñíî êàêîâà æå äîçà è êðàòíîñòü ââåäåíèÿ, ñåãîäíÿ ãîâîðèëè ÷åì áîëüøå , òåì ëó÷øå (!?).
Êñòàòè ïî÷åìó ó âàñ òàêîé ïåññèìèñòè÷åñêèé ïðîãíîç â îòíîøåíèè âàøåé äåâî÷êè, ïðîëå÷èòå ìåíèíãèò, çàòåì ñäåëàéòå øóíòèðîâàíèå. Âû ñ÷èòàåòå ÷òî âñå ýòî ïðîèçîøëî îò òîãî, ÷òî íå ââåëè ñóðôàêòàíò? Íî íàñêîëüêî ìíå èçâåñòíî ïðè ââåäåíèè ñóðôàêòàíòà, îñîáåííî ñèíòåòè÷åñêîãî, ðèñê ÂÆÊ âîçðàñòàåò. |
#7
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Êñòàòè Ëàíà, â àëüâåîôàêå íà 50 % ìåíüøå ôîñôîëèïèäíîé ôðàêöèè ÷åì â êóðîñóðôå è äîçà ââåäåíèÿ åãî ñîîòâåñòâåííî ïî÷òè â 2 ðàçà áîëüøå
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#8
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Óâ. Dilbar! Óáåäèë Âàñ À.Â.Ìîñòîâîé, ÷òî êóðîñóðâ - íåçàìåíèìîå ëåêàðñòâî? ß áû õîòåë ïîðàáîòàòü ñ òàêèì ëåêàðñòâîì è íà ñîîòâåòñòâóþùåé àïïàðàòóðå! Íî, íàâåðíîå, íå ñóäüáà.. Íå ñ÷èòàþ, ÷òî ýòî ïàíàöåÿ, îäíàêî äóìàþ, ÷òî ýòî áîëüøîå äîñòèæåíèå â íåîíàòîëîãèè è â ìåäèöèíå âîîáùå. À áåçîïàñíîñòü çàâèñèò âî ìíîãîì è îò âðà÷à. Óâåðåí, ÷òî îñëîæíåíèÿ áûëè ïîíà÷àëó è â òîé êîìàíäå, êîòîðàÿ ó Âàñ ïîáûâàëà. Íî òåïåðü îíè äàëåêî âïåðåäè, à ìîè êîëëåãè - ... Ìîÿ áîëüíàÿ È. ïî-ïðåæíåìó íà ÈÂË, ïàðàìåòðû ñíîâà óâåëè÷åíû (40 â ìèí-50%-20 ñì-3 ñì-ïðè ýòîì ñàòÎ2=94%, êàïèë. ÐÑÎ2=48 ÐÎ2=65) è ïîïûòîê îòëó÷èòü îò ðåñïèðàòîðà íå ïðåäïðèíèìàþ (äî ýòîãî íà ÑÐÀÐ ÐÑÎ2=80 ìì ðò ñò ÐÎ2=56 ïðè FiÎ2=50%). À åñëè áû âî âðåìÿ ïîëó÷èëà ïàðó äîç - ìîæåò âñå áûëî ïî-äðóãîìó.  ëèêâîðå ñåé÷àñ áåëîê 3.3 (áûë 6.6), öèòîç óìåíüøèëñÿ äî 35 (íåéòð. îêîëî 30%), â âåñå ïðèáàâèëà - óæå âåñèò 1.6 êã â 1 ìåñ. Ñïàñèáî çà ïîäñêàçêó ïðî øóíò, õîòÿ âðÿä-ëè êòî ó íàñ âîçìåòñÿ çà ýòî! Ñ óâ.ÁðîíÅâ
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#9
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Dilbar, íà ÷òî âû íàìåêàåòå?..
Öèòàòà:
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#10
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Ýêçîãåííûå ñóðôàêòàíòû
Âû âñå òàê èëè èíà÷å ïðàâû... Âûñîêàÿ êîíöåíòðàöèÿ ôîñôîëèïèäîâ â ïðåïàðàòå Êóðîñóðô (80 ìã/ìë), à òàêæå íàëè÷èå ñóðôàêòàíò-àññîöèèðîâàííûõ ïðîòåèíîâ, âî ìíîãîì îáóñëàâëèâàþò ýôôåêòèâíîñòü ïðåïàðàòà ïðè ÐÄÑ è íåêîòîðîå ïðåèìóùåñòâî ïåðåä äðóãèìè ôîðìàìè. Òàêæå ìàëûå ðàñ÷åòíûå îáúåìû ïîçâîëÿþò ââîäèòü åãî áîëþñíî. Íî áûñòðîå íà÷àëî äåéñòâèÿ (ïî äàííûì ðÿäà àâòîðîâ ÷åðåç 5 ìèíóò) ñîçäàåò è íåêîòîðûå ñëîæíîñòè - íåîáõîäèìîñòü ñîîòâåòñòâóþùåé íàñòðîéêè âåíòèëÿòîðà. Åñëè ýòî íå äåëàòü ïîâûøàåòñÿ âåðîÿòíîñòü ðàçâèòèÿ ñèíäðîìà óòå÷êè âîçäóõà (âêëþ÷àÿ ïíåâìîòîðàêñ).
×òî êàñàåòñÿ áîëüøèõ îáúåìîâ ââåäåíèÿ äëÿ äðóãèõ ïðåïàðàòîâ ýêçîãåííîãî ñóðôàêòàíòà, òî Âû ìîæåòå èñïîëüçîâàòü íåáóëàéçåð. Ïðàâäà ñïåöèàëüíûé - ïðîèçâîäÿùèé ðàçìåð ÷àñòèö ñî ñòðîãî îïðåäåëåííûìè ðàçìåðàìè (2-5 ìêì). |
#11
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Âîïðîñ Dr. Makhotin
 êàêîå ìåñòî äûõàòåëüíîãî êîíòóðà ïîäêëþ÷àòü íåáóëàéçåð, êàêóþ ìàðêó èñïîëüçîâàòü?
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#12
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Íåáóëàéçåð
Ïðîèçâîäèòåëåé ìíîãî (Hudson RCI, Intersurgical è ò.ä.), ìîäåëåé åùå áîëüøå... Èñïîëüçóéòå ëþáîé âñòðå÷àþùèéñÿ â Âàøåì ðåãèîíå íåáóëàéçåð ñ âûøåóïîìÿíóòûìè õàðàêòåðèñòèêàìè ïî ðàçìåðó àýðîçîëüíûõ ÷àñòèö.
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