#1
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×òî òàêîå ÌÍÎ ?
Ïîäñêàæèòå, ïîæàëóéñòà, ÷òî òàêîå àíàëèç êðîâè íà ÌÍÎ ? Çíàþ, ÷òî ñâÿçàíî ñî ñâ¸ðòûâàåìîñòüþ, íî êàêèå íîðìû; èç ïàëüöà èëè èç âåíû áåðóò ?
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#2
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Ìåæäóíàðîäíîå íîðìàëèçîâàííîå îòíîøåíèå.
Ó îáû÷íîãî ÷åëîâåêà íå îïðåäåëÿåòñÿ. Åäèíñòâåííîå ïðåäíàçíà÷åíèå - êîíòðîëü ýôôåêòèâíîñòè íåïðÿìûõ àíòèêîàãóëÿíòîâ (êîòîðûå ÿâëÿþòñÿ àíòàãîíèñòàìè âèòàìèíà Ê) - íàïðèìåð, êóìàäèíà, âàðôàðèíà. Êðîâü áåðóò èç âåíû (ýòî åñëè â ëàáîðàòîðèè äåëàòü) - ñòàíäàðòíî - 5 ìë Åñëè åñòü ÌÍÎ-ìåòð, êàê ãëþêîìåòð äëÿ áîëüíûõ ñàõàðíûì äèàáåòîì, òî èç ïàëüöà. Ïåðâîå âðåìÿ îò íà÷àëà òåðàïèè ïðèõîäèòñÿ áðàòü ÷àñòî, ðàçà 3 â íåäåëþ, ïîòîì - ïîñòåïåííî ÷àñòîòó êîíòðîëÿ ñíèæàþò, îáû÷íî - îò 1 ðàçà â íåäåëþ,äî 1 ðàçà â ìåñÿö. |
#3
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Åùå èíôîðìàöèÿ çäåñü: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#4
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INR (International normal ratio) èëè ÌÍÎ.
 ñîîòâåòñòâèè ñ ðåêîìåíäàöèåé ÂÎÇ è Ìåæäóíàðîäíîãî Êîìèòåòà ïî Òðîìáîçàì è Ãåìîñòàçó ðåçóëüòàòû èçìåðåíèÿ ÐÒ ( Prothrombin Time) äëÿ ïàöèåíòîâ ïðèíèìàþùèõ àíòèêîàãóëÿíòû äîëæíû áûòü ïðåäñòàâëåíû â âèäå INR óðîâíÿ.×òî ïîçâîëÿåò óíèôèöèðîâàòü ðåçóëüòàò íå çàâèñèìî îò ðåàãåíòîâ è ìåòîäà èñïîëüçóåìîãî ïðè èññëåäîâàíèè. INR ðàññ÷èòûâàåòñÿ ïî ôîðìóëå : INR = R â ñòåïåíè ISI, ãäå R = PT ïàöèåíòà/mean normal PT, à ISI Internftionfl Sensitivity Index çàâèñÿùèé îò êîìáèíàöèè ðåàãåíòîâ è ïðèáîðà Íå âäàâàÿñü â ñïåöèôèêó ðàññ÷åòîâ çàìå÷ó ,÷òî ó íàñ ïðèíÿòî îïðåäåëÿòü INR âñåì ïàöèåíòàì ïðè èññëåäîâàíèè ïîêàçàòåëåé ãîìåîñòàçà íå çàâèñèìî îò ïðèåìà àíòèêîàãóëÿíòîâ. Âåëè÷èíà INR äî 1,3 - íîðìà. Äëÿ ïàöèåíòîâ ïðèíèìàþùèõ àíòàãîíèñò âèòàìèíà Ê: 2 - 3, 3.5. Âåëè÷èíà INR áîëüøå 5 - âåðîÿòíîñòü êðîâîòå÷åíèÿ , îïàñíîñòü äëÿ æèçíè. Êðîâü áåðåòñÿ èç âåíû â ïëàñòèêîâûå âàêóóìíûå ïðîáèðêè ñ öèòðàòîì íà 5 è 3 ìë. äëÿ âçðîñëûõ è 1 ìë. äëÿ äåòåé. Àíàëèç âûïîëíÿåòñÿ íå ïîçäíåå 4 ÷àñîâ ñ ìîìåíòà âçÿòèÿ êðîâè. Ñ óâàæåíèåì |
#5
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#6
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#7
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#8
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Öèòàòà:
Âîçìîæíî ýòî è íå î÷åâèäíî, íî òåìà êîíòðîëÿ êà÷åñòâà àíàëèçîâ íèêàê íå ìîæåò áûòü "çàâåäîìî ëèøíÿÿ". Ñ óâàæåíèåì. |
#9
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ÎÊ
Íà ñàìîì äåëå ó íàñ ïëàòíûå ëàáîðàòîðèè òîæå äåëàþò ÌÍÎ íå ïîäåëó. À âîò "â ðåãèîíàõ" íå äåëàþò è êîãäà íàäî. |
#10
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Óâàæàåìûå êîëëåãè,
Äåéñòâèòåëüíî ñèñòåìà ÌÍÎ ñïåöèàëüíî ðàçðàáîòàíà òîëüêî äëÿ ïàöèåíòîâ íà íåïðÿìûõ àíòèêîàãóëÿíòàõ è íå ìîæåò ðàñïðîñòðàíÿòüñÿ íà äð. âèäû ïàòîëîãèé, ãäå èìååòñÿ óäëèíåíèå ïðîòðîìáèíîâîãî âðåìåíè (íàðóøåíèå ôóíêöèè ïå÷åíè, ÄÂÑ). Äëÿ íîðì çíà÷åíèÿ ïðîòðîìáèíîâîãî êîýôôåöèåíòà è ÌÍÎ ïðèìåðíî îäèíàêîâû, òàê êàê â êàêóþ áû ñòåïåíü íå âîçâîäèëè çíà÷åíèÿ, áëèçêèå ê åäèíèöå, åäèíèöåé îíè è îñòàíóòñÿ. Òåîðåòè÷åñêè ëàáîðàòîðèÿ, íå çíàÿ ñ êàêîé ïàòîëîãèåé íàõîäèòñÿ ïàöèåíò â êëèíèêå, äîëæíà âûäàâàòü ðåçóëüòàò êàê â âèäå ïðîòðîìáèíîâîãî êîýôôèöèåíòà (èëè èíäåêñà), òàê è â ÌÍÎ.  Öþðèõå íàïðèìåð åùå è òðåòèé âàðèàíò äàâàëè - ïðîòðîìáèí ïî Êâèêó (íàâåðíîå äëÿ äîêòîðîâ, êîòîðûå åùå íå óñïåëè çà 10-15 ëåò ïåðåñòðîèòüñÿ íà ìåæäóíàðîäíûå ñòàíäàðòû): The international normalised ratio (INR) system for reporting of prothrombin times was created to minimise variations in clotting times measured by use of thromboplastins with varying degrees of sensitivity. The INR calibration model was based exclusively on the analysis of pooled plasma from patients receiving stable warfarin anticoagulation.1 Therapeutic monitoring has been further improved by the introduction of highly sensitive thromboplastins with a low international sensitivity index (ISI). Because of its omnipresence on reports of prothrombin times, the INR has been inadvertently applied to patients other than those treated with war far in, such as patients with disseminated intravascular coagulation and liver disease.2 Èç Deitcher SR. Interpretation of the international normalised ratio in patients with liver disease. Lancet. 2002 Jan 5;359(9300):47-8.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#11
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#12
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#13
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Öèòàòà:
Ìû äàåì â áëàíêå ÏÒÈ è ÌÍÎ. Íåêòîðûå äàþò ïðîòðîìáèí ïî Êâèêó è ÌÍÎ. Áîëüøå ïðîáëåì , ÷òî ìàëî êòî çíàåò, ÷òî òàêîå ÌÍÎ. Ãîðàçäî áîëüøå íàçíà÷àåòñÿ íèêîìó íå íóæíûõ êîàãóëîãðàìì. |
#14
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Öèòàòà:
Nonsurgical Hospitalized Patients Testing should be performed only when there are specific clinical indications on the basis of the history or physical examination (Grade 1C). Measurement of the platelet count is recommended before heparin therapy is initiated; monitoring of platelet counts during treatment is also recommended because of the possibility of heparin-induced thrombocytopenia (Grade 1C). Surgical Patients Patients without evidence of historical risk factors or physical findings suggestive of a bleeding disorder have a low risk for peri- and postoperative hemorrhage. Abnormal test results for hemostasis occur infrequently in patients without these risk factors. When test results are abnormal in these patients, they perform poorly in predicting postoperative hemorrhage. Therefore, routine preoperative coagulation testing is not recommended (Grade 1C). Preoperative testing with the partial thromboplastin time, prothrombin time, and platelet count is warranted for patients with clinical evidence to suggest a bleeding disorder (Grade 2C). It is reasonable to obtain routine preoperative partial thromboplastin time on Ashkenazic Jewish persons because of the increased prevalence of occult factor XI deficiency (Grade 2C). Èç Ann Intern Med. 2003 Feb 4;138(3):W15-24. Screening for the risk for bleeding or thrombosis
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#15
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