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Promising ways to treat unpromising uterine fibroids 有希望的方法来治疗没有希望的子宫肌瘤
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-202-203
O. Manzhura
Background. Preventive check-ups reveal uterine fibroids for the first time in 1-5 % of women. In the presence of gynecological diseases this number is about 30-35 %. Pathomorphological examination of deceased women of different ages reveals fibroids in 77-85 % of them. The age of this diagnosis has become significantly younger, and it is important, because uterine fibroids are associated with problems with fertilization and pregnancy. Myomas are divided into types by localization (interstitial, intraligamentary, subserous, interstitial-subserous, submucosal, etc.). Objective. To describe current trends in the treatment of uterine fibroids. Materials and methods. Analysis of own experience in the treatment of fibroids and literature sources on this topic. Results and discussion. Conservative myomectomy can be performed laparotomically, laparoscopically and hysteroscopically. It is often impossible to perform a traditional conservative myomectomy of large nodes of II-V grades without significant damage to the uterine wall, so as a result, conservative myomectomy turns into a hysterectomy. HiFu ablation is an another method of treating fibroids. This method is based on the influence of a high-power ultrasonic wave, which is generated by a radiating lens and passes through the patient’s body to the pathological focus. Degasated water acts as a conductor between the patient’s body and the lens. The goals of treatment are to preserve the uterus and to create the possibility of pregnancy. Before treatment, magnetic resonance imaging of the pelvic organs and assessment of the potential for malignancy must be performed. Criteria for the selection for ablation include the desire to preserve the uterus; established diagnosis of uterine fibroids, local adenomyosis; obvious symptoms of fibroids (abnormal uterine bleeding, dysmenorrhea, pain, secondary anemia); node size 1-15 cm (submucosal or intramural type of growth). The preservation of a woman’s fertility is a main indication for ablation. There are no alternative methods to HiFu ablation in terms of efficacy and safety, but if the nodes were too large or too numerous, conservative myomectomy is performed after significant tumor regression after two sessions of HiFu. The nodal bed and pelvic floor should be washed with decamethoxine solution during the operation. The required volume of solution is about 2 liters. The advantages of decamethoxine include the lack of absorption by the wound surface and a powerful bactericidal effect. If the walls of the uterus are thin and it is not possible to preserve their integrity during myomectomy, plastic surgery is performed with the introduction of high molecular weight hyaluronic acid to prevent the formation of adhesions and accelerate regenerative processes. Conclusions. 1. Uterine fibroids are common tumors that in young women are accompanied by problems of fertilization and pregnancy. 2. It is often impossible to perform traditional conservative myomectomy
背景。在1- 5%的女性中,预防性检查首次发现子宫肌瘤。在患有妇科疾病的情况下,这一数字约为30- 35%。不同年龄的已故妇女病理形态学检查显示肌瘤占77- 85%。这种诊断的年龄明显变得更年轻,这很重要,因为子宫肌瘤与受精和怀孕问题有关。肌瘤按定位分为不同类型(间质、韧带内、浆膜下、间质-浆膜下、粘膜下等)。目标。描述当前子宫肌瘤治疗的趋势。材料和方法。分析自身治疗肌瘤的经验及相关文献来源。结果和讨论。保守性子宫肌瘤切除术可采用腹腔镜、腹腔镜和宫腔镜。对于II-V级大淋巴结,传统的保守性子宫肌瘤切除术往往不可能对子宫壁造成明显损伤,因此保守性子宫肌瘤切除术就变成了子宫切除术。超声消融术是治疗肌瘤的另一种方法。这种方法是基于高功率超声波的影响,它是由一个辐射透镜产生的,穿过病人的身体到达病理病灶。脱水后的水在病人身体和晶状体之间起着导体的作用。治疗的目的是保存子宫并创造怀孕的可能性。治疗前,盆腔器官的磁共振成像和评估潜在的恶性肿瘤必须进行。选择消融术的标准包括保留子宫的愿望;确定诊断子宫肌瘤,局部子宫腺肌病;肌瘤症状明显(子宫异常出血、痛经、疼痛、继发性贫血);淋巴结大小1- 15cm(粘膜下或壁内型生长)。保留妇女的生育能力是消融术的主要指征。在有效性和安全性方面,没有其他方法可以替代HiFu消融,但如果淋巴结太大或太多,则在两次HiFu后肿瘤明显消退后进行保守性子宫肌瘤切除术。术中应用十甲氧辛溶液清洗淋巴结床和盆底。所需的溶液体积约为2升。十甲氧辛的优点包括不被伤口表面吸收和强大的杀菌作用。如果子宫壁很薄,在子宫肌瘤切除术中不可能保持其完整性,则在进行整形手术时引入高分子量透明质酸,以防止粘连的形成并加速再生过程。结论:1。子宫肌瘤是一种常见的肿瘤,在年轻女性中伴随着受精和怀孕问题。2. 传统保守的大淋巴结子宫肌瘤切除术通常不可能对子宫壁造成明显损害。3.超声消融术是治疗肌瘤的现代方法。4. 维持妇女的生育能力是消融术的主要指征。
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引用次数: 0
Features of short-term and long-term infusion therapy: review of the vascular access technologies from the point of view of the nurse. Catheterization of peripheral veins 短期和长期输液治疗的特点:从护士的角度回顾血管通路技术。外周静脉插管
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-60-62
Ye.V. Hryzhymalskyi
Background. Infusion therapy (IT) has a number of features that both doctors and nurses need to know. IT can be performed via a needle, a peripheral intravenous catheter (PIC), and an implanted system for long-term infusions (ISLI). Objective. To describe the features of short-term and long-term IT. Materials and methods. Analysis of literature sources on this topic. Results and discussion. First of all, every healthcare worker should remember that the patient should be identified before any manipulation and then the procedure may start. IT via the needle has a number of disadvantages: complications due to the frequent punctures and prolonged stay of needle in the vein; limited possibility of long-term IT; increased risk of needle injuries among medical staff. The advantages of PIC above needle include the lower risk of infection, better safety, the possibility of rapid administration of drugs in various combinations, easy use of IT and parenteral nutrition, and the ability to monitor central venous pressure. PIC are classified by the presence of an additional injection port, by the material from which they are made, by the shape of the needle tip sharpening, by the visibility on X-ray and size. Venoport Plus (“Yuria-Pharm”) is an elastic teflon catheter with a low coefficient of surface friction, X-ray contrast strips and the possibility of a long stay in a vein (up to 72 hours). The advantages of the Venoport Plus PIC are the adaptive shape of the cap, the optimal inclination angle and SMART SLOT – a hole near the tip of the needle, which allows you to visualize the blood between the catheter and the needle without waiting for it to appear in the indicator chamber. The most suitable for the PIC placement veins are located on the outside of the hand and on the inner surface of the forearm. It is recommended to use the ulnar vein only for laboratory blood sampling and emergency medical care. When choosing PIC one should take into account the vein diameter, necessary speed of infusion, potential time of stay of a catheter in a vein, and features of the infused solution. After installing PIC, it is advisable to use special transparent aseptic bandages. Bandage replacement is performed as needed; daily replacement is not required. After PIC installation and after infusion, PIC should be washed with 0.9 % NaCl, heparin (1:100 dilution), or Soda-Bufer solution (“Yuria-Pharm”). If the catheter is not used, washing should be performed once a day. ISLI Yu-Port (“Yuria-Pharm”) provides long-term venous access and can be used if the patient needs multiple administrations of drugs during a long course of therapy. Conclusions. 1. IT can be conducted via a needle, PIC, or ISLI. 2. The advantages of PIC over the needle injection are lower risk of infection, better safety, the possibility of rapid administration of drugs in various combinations, facilitated use of IT and parenteral nutrition, and the ability to monitor central venous pressure. 3. PIC Venopo
背景。输液疗法(IT)有许多特点,医生和护士都需要知道。它可以通过针头、外周静脉导管(PIC)和长期输液植入系统(ISLI)进行。目标。描述短期和长期IT的特点。材料和方法。对这一主题的文献来源进行分析。结果和讨论。首先,每个医护人员都应该记住,在进行任何操作之前,应该先确认病人的身份,然后才能开始操作。通过针头进行IT有许多缺点:由于频繁穿刺和针头在静脉中停留时间长而导致并发症;长期IT的可能性有限;医务人员被针刺伤的风险增加。PIC高于针头的优点包括感染风险较低,安全性较好,可以快速给药,多种组合,易于使用IT和肠外营养,能够监测中心静脉压。PIC的分类是根据是否有额外的注射口、制作它们的材料、针尖的形状、x射线上的可见度和尺寸。Venoport Plus(“Yuria-Pharm”)是一种弹性聚四氟乙烯导管,具有低表面摩擦系数,x射线对比条和长时间停留在静脉(长达72小时)的可能性。Venoport Plus PIC的优点是帽的自适应形状,最佳倾斜角度和SMART插槽-针尖附近的一个孔,可以让您看到导管和针头之间的血液,而无需等待它出现在指示室中。最适合放置PIC的静脉位于手的外侧和前臂的内表面。建议仅在实验室采血和急诊时使用尺静脉。在选择PIC时,应考虑静脉直径、必要的输注速度、导管在静脉中可能停留的时间以及输注溶液的特点。PIC安装后,建议使用专用透明无菌绷带。根据需要更换绷带;不需要每天更换。PIC安装后和输注后,PIC应用0.9% NaCl、肝素(1:100稀释)或苏打缓冲溶液(“Yuria-Pharm”)清洗。如果不使用导管,则应每天清洗一次。ISLI玉港(“玉港”)提供长期静脉通路,可用于患者在长期治疗过程中需要多次给药。结论:1。它可以通过针头、PIC或ISLI进行。2. 与针头注射相比,PIC的优点是感染风险较低,安全性更好,可以以各种组合快速给药,便于使用IT和肠外营养,以及能够监测中心静脉压。3.PIC Venoport Plus(“Yuria-Pharm”)是一种弹性聚四氟乙烯导管,具有自适应的帽形和最佳角度。4. 在选择PIC时,应考虑静脉直径、所需的输注速度、导管在静脉中可能停留的时间以及输注溶液的特点。5. ISLI玉港提供长期静脉通路,如有必要,可在长期治疗过程中多次给药。
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引用次数: 0
Experience in the open multicenter randomized controlled trial of Rheo-STAT on the efficacy and safety of Reosorbilact in patients with sepsis Reosorbilact对脓毒症患者的疗效和安全性的开放多中心随机对照试验的经验
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-154-155
V. Cojocaru
Background. Elimination of intoxication syndrome is one of the main components of sepsis treatment. The Rheo-STAT study is an interventional open multicenter randomized controlled trial of the efficacy of Reosorbilact (“Yuria-Pharm”) in the treatment of intoxication syndrome. The study was conducted in 7 countries, patients of the sepsis subgroup were recruited in 5 of them (Ukraine, Moldova, Georgia, Kazakhstan, Uzbekistan). Objective. To determine the efficacy and safety of Reosorbilact in patients with sepsis. Materials and methods. The study involved 628 adult patients with sepsis, peritonitis, pneumonia and burns. The subgroup of sepsis consisted of 180 people (72 % males, mean age – 41.3 years), the most common comorbidities were cardiovascular diseases (24 %), diabetes mellitus (15 %), and infectious diseases (8 %). The inclusion criteria were the following: age 18-60 years, diagnosis of sepsis, established by the ACCP/SCCM criteria ≤24 hours before the initial visit, obtaining of the informed consent, baseline SOFA scale value ≥2. The primary endpoint was the total score on the SOFA scale on the 3rd day of treatment compared to the baseline value. The secondary endpoints included the change in the overall score according to the APACHE II, SAPS II, MODS, PSI/PORT, CURB-65 scales; changes in biochemical, immunological and integral markers of endogenous intoxication. Results and discussion. Low-volume infusion therapy with Reosorbilact (200-400 ml per day) resulted in an increase in circulating blood volume and a decrease in the total volume of infusions required without the risk of volume overload, which is especially important for critically ill patients. Exogenous lactate in Reosorbilact did not increase the content of endogenous lactate (1st day – 2.27 mmol/L, 3rd day – 1.63 mmol/L), which indicates the high safety of the solution. In the complex of intensive care administration of Reosorbilact helped to reduce hyperthermia (1st day – 38.2 °C, 3rd day – 36.8 °C, p<0.001), heart rate (1st day – 95.43 beats/min, 3rd day – 81.13 beats/min, p<0.001) and the number of leukocytes (1st day – 14.5×109/L, 3rd day – 8.8×109/L) as a marker of endogenous intoxication. During 3 days of therapy Reosorbilact also normalized the acid-base composition of the blood. Conclusions. 1. Elimination of intoxication syndrome is one of the main components of sepsis treatment. 2. Reosorbilact infusion therapy increases the volume of circulating blood without the risk of volume overload. 3. The inclusion of Reosorbilact in the complex treatment of sepsis after 3 days provides a decrease in body temperature, heart rate, white blood cell count and normalization of the acid-base composition of the blood.
背景。消除中毒综合征是脓毒症治疗的主要组成部分之一。Rheo-STAT研究是一项介入性开放多中心随机对照试验,研究Reosorbilact(“Yuria-Pharm”)治疗中毒综合征的疗效。该研究在7个国家进行,其中5个国家(乌克兰、摩尔多瓦、格鲁吉亚、哈萨克斯坦、乌兹别克斯坦)招募了脓毒症亚组患者。目标。目的:探讨Reosorbilact治疗脓毒症的疗效和安全性。材料和方法。这项研究涉及628名患有败血症、腹膜炎、肺炎和烧伤的成年患者。脓毒症亚组包括180人(72%男性,平均年龄- 41.3岁),最常见的合并症是心血管疾病(24%),糖尿病(15%)和传染病(8%)。纳入标准为:年龄18-60岁,诊断为脓毒症,就诊前≤24小时根据ACCP/SCCM标准确定,获得知情同意,基线SOFA量表值≥2。主要终点是治疗第3天SOFA量表的总得分与基线值的比较。次要终点包括APACHE II、SAPS II、MODS、PSI/PORT、CURB-65量表的总分变化;内源性中毒的生化、免疫学和整体标志物的变化。结果和讨论。Reosorbilact小容量输注治疗(每天200- 400ml)可增加循环血容量,减少所需输注总量,且无容量过载风险,这对危重患者尤为重要。外源乳酸加入Reosorbilact后,内源乳酸含量未增加(第1天- 2.27 mmol/L,第3天- 1.63 mmol/L),说明该溶液安全性高。在重症监护复诊中,给予Reosorbilact有助于降低高热(第1天- 38.2°C,第3天- 36.8°C, p<0.001),心率(第1天- 95.43次/分钟,第3天- 81.13次/分钟,p<0.001)和白细胞数量(第1天- 14.5×109/L,第3天- 8.8×109/L),这是内源性中毒的标志。在3天的治疗期间,Reosorbilact也使血液的酸碱组成正常化。结论:1。消除中毒综合征是脓毒症治疗的主要组成部分之一。2. Reosorbilact输注疗法增加了循环血容量而没有容量过载的风险。3.在脓毒症3天后的复杂治疗中加入Reosorbilact可以降低体温、心率、白细胞计数和血液酸碱组成的正常化。
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引用次数: 0
Obstetric blood loss: priorities in the choice of infusion solutions 产科失血:输注液选择的优先事项
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-117-119
Kim Jong-Din
Background. Bleeding accounts for 34 % of maternal mortality. Every 7 minutes 1 woman dies from bleeding during the labour. Retrospective analysis of medical records shows that in 60-80 % of cases, fatal consequences can be avoided. Criteria for defining the concept of “massive blood loss” are the loss of 100 % of circulating blood volume (CBV) within 24 hours or 50 % of CBV within 3 hours, loss of 150 ml/min, of 2 % of body weight within 3 hours, reduction of hematocrit by 10 % in combination with hemodynamic disturbances, one-time blood loss more than 1500-2000 ml or 25-35 % CBV, the need for transfusion of >10 doses of erythromass for 24 hours. The main causes of bleeding in obstetrics include uterine atony, premature placental abruption, uterine rupture, placental abruption, hereditary blood diseases, coagulopathy, sepsis, amniotic fluid embolism. Objective. To describe infusion therapy (IT) for obstetric bleeding. Materials and methods. Analysis of literature data on this issue. Results and discussion. Strategies for the treatment of obstetric hemorrhage include restriction of the traditional massive crystalloid-based IT, applying the principle of antihypertensive resuscitation, using of adequate doses of tranexamic acid, fibrinogen concentrate and prothrombin complex concentrate, early informed use of blood components, and low-volume IT. Routine use of unbalanced crystalloid solutions in critically severe patients is dangerous. Infusion of large amounts of 0.9 % NaCl may cause metabolic hyperchloremic acidosis. Therefore, except in cases of hypochloremia, it is advisable to replace saline with balanced solutions. Reosorbilact (“Yuria-Pharm”) is the most suitable solution for this purpose. It mobilizes the own fluid of the organism, helping it to move from the intercellular space into the vessels. Hypotensive resuscitation involves the introduction of limited amounts of fluid in the early stages of treatment of hemorrhagic shock (until the bleeding stops). Low-volume IT program is a part of hypotensive resuscitation. In this case, the following solutions can be used: Reosorbilact, Sorbilact, Gekoton (“Yuria-Pharm”), 130/0.4 hydroxyethyl starch (HES), hypertonic NaCl solutions (including combined solutions with colloids), polyhydric alcohols. It should be noted that the new generation of HEC has less effect on coagulation than older drugs. Due to the risk of kidney damage, HEC solutions should be used in the lowest effective dose for as shortest period of time as possible. HEC infusion should be stopped as soon as hemodynamic targets are reached. Solutions containing polyhydric alcohols (Reosorbilact, Sorbilact, Xylate) occupy an important position in IT of critically ill patients. Due to their high osmolarity, Reosorbilact and Sorbilact cause fluid to move from the intercellular space into the vascular bed, improving microcirculation and tissue perfusion. The polyhydric alcohol sorbitol contained in these solutions creates increased osmot
背景。出血占孕产妇死亡率的34%。每7分钟就有一名妇女在分娩过程中死于出血。对医疗记录的回顾性分析表明,在60- 80%的病例中,致命后果是可以避免的。定义“大量失血”概念的标准是:24小时内失去100%的循环血容量(CBV)或3小时内失去50%的CBV,损失150毫升/分钟,3小时内体重下降2%,血液动力学紊乱合并红细胞压积下降10%,一次性失血超过1500-2000毫升或25- 35%的CBV,需要输血10剂量的红细胞24小时。产科出血的主要原因包括子宫张力不全、胎盘早剥、子宫破裂、胎盘早剥、遗传性血液病、凝血功能障碍、败血症、羊水栓塞。目标。描述输注治疗(IT)产科出血。材料和方法。对这一问题的文献资料进行分析。结果和讨论。产科出血的治疗策略包括限制传统的以大体积晶体为基础的信息技术,应用抗高血压复苏原则,使用足够剂量的氨甲环酸、纤维蛋白原浓缩物和凝血酶原复合物浓缩物,早期知情使用血液成分,以及小容量信息技术。危重病人常规使用不平衡晶体溶液是危险的。大量输注0.9% NaCl可引起代谢性高氯血症性酸中毒。因此,除低氯血症外,建议用平衡溶液代替生理盐水。Reosorbilact(“Yuria-Pharm”)是最适合这一目的的解决方案。它调动机体自身的液体,帮助液体从细胞间隙进入血管。低血压复苏包括在失血性休克治疗的早期阶段引入有限数量的液体(直到出血停止)。小容量IT程序是低血压复苏的一部分。在这种情况下,可以使用以下溶液:Reosorbilact, Sorbilact, Gekoton(“Yuria-Pharm”),130/0.4羟乙基淀粉(HES),高渗NaCl溶液(包括与胶体的组合溶液),多羟基醇。值得注意的是,新一代HEC对凝血的影响小于老药。由于存在肾脏损害的风险,HEC溶液应在最短的时间内以最低的有效剂量使用。HEC输注应在血液动力学指标达到后立即停止。含多羟基醇(山梨醇、山梨醇、木酸酯)的溶液在危重患者的IT中占有重要地位。由于它们的高渗透压,Reosorbilact和Sorbilact使液体从细胞间隙进入血管床,改善微循环和组织灌注。这些溶液中含有的多羟基醇山梨醇会增加肾小管的渗透压,从而起到利尿作用。当I-II功能类失血量达1500ml且止血时,以受限模式进行IT。静脉输注量连同血液成分不应超过失血量的200%。Reosorbilact (10- 15ml /kg)初始溶液与0.9% NaCl (20- 30ml /kg)混合。在血流动力学不稳定的情况下,可以添加HEC(最多1.5 L)。血液成分仅在确认凝血功能障碍和持续出血的情况下使用。大量危重失血1500ml - 2000ml时,宜采用大量输血1:1:1:1的方案。为了减少内皮细胞对IT的病理反应,建议使用一种合成一氧化氮的底物,即Tivortin(“Yuria-Pharm”)。为了防止危及生命的产科出血,CBV必须通过大量输血和自动回注、催产素和前列腺素类似物来纠正子宫张力、子宫按摩、纠正凝血功能障碍、子宫球囊填塞等方案进行补充。结论:1。产科大出血的急诊护理是降低产妇发病率和死亡率的优先事项之一。2. 失血的强化治疗应基于现代建议和现代药物的使用。3.输血时应明确适用血液成分的适应症。
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引用次数: 0
Perioperative anesthesia 围手术期麻醉
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-178-179
І.І. Lisnyi
Background. Ensuring adequate analgesia is a prerequisite for rapid recovery after surgery. Improving the management of acute pain is important to ensure the safe and effective analgesia needed for early mobilization and for avoidance of organ dysfunction due to inadequate analgesia. For this purpose, multimodal analgesia (MMA) is used. It includes opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAID), paracetamol or metamizole, local anesthetics and ancillary drugs. Objective. To describe modern views on perioperative analgesia. Materials and methods. Analysis of literature data on this issue. Results and discussion. MMA involves an opioid-preserving approach (reducing the dose of opioids without reducing the quality of analgesia), procedure and patient specificity. The postoperative recovery improvement program includes several items, three of which have been associated with a reduction in treatment duration, namely, multimodal prevention of postoperative nausea and vomiting, perioperative NSAID use, and post-operative opioid protocol. The combined use of NSAID and paracetamol provides a better result than the use of each of these drugs alone. At the correct dose, paracetamol (Infulgan, “Yuria-Pharm”) is an effective non-opioid analgesic for the treatment of acute pain with minimal side effects for a long time. Pre- and intraoperative administration of paracetamol is recommended in a number of guidelines. Intravenous administration of local anesthetics is an another important component of MMA. The 2016 Cochrane review showed that long-term intravenous perioperative infusion of lidocaine significantly reduced the postoperative need for opioids. However, the meta-analysis of 10 randomized controlled trials found that perioperative intravenous lidocaine did not differ from placebo in post-operative pain assessed with the help of a visual analog scale and in opioid requirements (Rollins K.E., 2020). Similar results have been obtained in other studies in recent years. Inclusion of nefopam in MMA can reduce the dose of opioids. The use of nefopam, paracetamol and deksketoprofen makes it possible to dramatically reduce the use of morphine. Neither pain nor postoperative recovery can be adequately controlled with a single treatment due to the multifactorial nature of the problem. It is recommended to use MMA, but there are no recommendations for optimal combinations of analgesics for specific procedures. Administration of paracetamol and NSAID in combination with the use of regional techniques is a golden standard of MMA. Conclusions. 1. After the surgery, the patient should be adequately anesthetized. 2. To achieve optimal, preferably non-opioid, analgesia, it is recommended to use MMA. 3. NSAID, paracetamol, nefopam and regional techniques are the important components of MMA.
背景。确保足够的镇痛是术后快速恢复的先决条件。改善急性疼痛的管理对于确保早期活动所需的安全有效的镇痛和避免由于镇痛不足导致的器官功能障碍是重要的。为此,采用多模态镇痛(MMA)。它包括阿片类镇痛药,非甾体抗炎药(NSAID),扑热息痛或metamizole,局部麻醉剂和辅助药物。目标。介绍围手术期镇痛的现代观点。材料和方法。对这一问题的文献资料进行分析。结果和讨论。MMA涉及阿片类药物保留方法(在不降低镇痛质量的情况下减少阿片类药物的剂量)、程序和患者特异性。术后恢复改善方案包括几个项目,其中三个项目与缩短治疗时间有关,即多模式预防术后恶心和呕吐、围手术期使用非甾体抗炎药和术后阿片类药物方案。非甾体抗炎药和扑热息痛联合使用比单独使用这些药物效果更好。在正确的剂量下,扑热息痛(Infulgan,“Yuria-Pharm”)是一种有效的非阿片类镇痛药,可长期治疗急性疼痛,副作用最小。术前和术中使用扑热息痛在一些指南中被推荐。局部麻醉剂的静脉注射是MMA的另一个重要组成部分。2016年Cochrane综述显示,围手术期长期静脉输注利多卡因可显著减少术后对阿片类药物的需求。然而,对10项随机对照试验的荟萃分析发现,围手术期静脉注射利多卡因与安慰剂在通过视觉模拟量表评估的术后疼痛和阿片类药物需求方面没有差异(Rollins k.e., 2020)。近年来的其他研究也得到了类似的结果。在MMA中加入尼福泮可以减少阿片类药物的剂量。nefopam, paracetamol和deksketoprofen的使用可以显著减少吗啡的使用。由于该问题的多因素性质,单次治疗无法充分控制疼痛和术后恢复。建议使用MMA,但没有针对特定手术的最佳镇痛药组合的建议。扑热息痛和非甾体抗炎药的联合使用是MMA的黄金标准。结论:1。手术后,病人应充分麻醉。2. 为了达到最佳的非阿片类镇痛效果,建议使用MMA。3.NSAID、扑热息痛、nefopam和局部技术是MMA的重要组成部分。
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引用次数: 0
Endothelial dysfunction and its role in the prevention, treatment and complications of critical conditions in obstetrics 内皮功能障碍及其在产科危重症的预防、治疗和并发症中的作用
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-120-122
Kim Jong-Din
Background. Preeclampsia (PE) remains the leading cause of maternal and perinatal morbidity and mortality. As of today, there is no treatment for PE, and the childbirth is the only way to completely eliminate this condition. However, early childbirth is associated with a high risk of fetal morbidity and mortality. Objective. To describe the role of endothelial dysfunction (ED) in the development of PE and the possibility of its correction; to evaluate the effectiveness of Tivortin (“Yuria-Pharm”) in the correction of uterine-fetal-placental dysfunction. Materials and methods. Analysis of literature sources on this topic; own PLACENTA study. The study involved 535 women with mild PE at 26-29 weeks of gestation. Group I received standard therapy, group II – standard therapy in combination with Tivortin (4.2 g per day for 7-10 days). Results and discussion. Until the fetus reaches viability, PE treatment is aimed at correcting hypertension, however, antihypertensive therapy does not have a beneficial effect on the condition of the kidneys and placental blood flow. Decreased blood flow in placenta leads to the syndrome of limited fetal development (SLFD) and multisystem ED. The development of PE is inextricably linked with the systemic damage to maternal endothelial cells and a further decrease in endothelium-dependent vasodilators, which promotes vasospasm and activates the coagulation cascade. PE is accompanied by the imbalance in the systems of prostacyclin and nitric oxide (NO), as well as thromboxane and endothelin. Superficial placentation with insufficient remodeling of the spiral arteries and impaired response to changes in blood flow is one of the main causes of PE. ED is the most studied pathogenetic mechanism of PE. NO has a potent vasodilating effect and is involved in inhibiting thromboxane formation, platelet aggregation and stimulating prostacyclin formation. NO-synthase of endothelial cells, the substrate of which is L-arginine, is the main enzyme of NO production. Disorders of vasodilation in pregnant women with PE can be eliminated by prescribing L-arginine. Literature data show that L-arginine is successfully used in the need to continue pregnancy, as well as to eliminate hypertension and correct SLFD. Canadian guidelines for the treatment of hypertensive complications of pregnancy state that L-arginine is able to improve uteroplacental blood flow. According to a study by J. Chen (2016), the inclusion of L-arginine contributes to both maternal and perinatal outcomes of pregnancy. The effect of L-arginine on fetal growth is mediated by promoting the production of creatine, skeletal muscle protein and growth hormone. L-arginine also promotes the synthesis of polyamines, which can stimulate the growth and development of placenta. Own studies have shown that the use of L-arginine (Tivortin, “Yuria-Pharm”) in the combined PE therapy had improved the growth rate of the fetus and its functional condition, which allowed to prolong pregn
背景。先兆子痫(PE)仍然是孕产妇和围产期发病率和死亡率的主要原因。到目前为止,还没有治疗PE的方法,分娩是完全消除这种情况的唯一方法。然而,早产与胎儿发病率和死亡率的高风险有关。目标。描述内皮功能障碍(ED)在PE发展中的作用及其纠正的可能性;目的:评价替沃汀(“Yuria-Pharm”)对子宫-胎儿-胎盘功能障碍的矫正效果。材料和方法。本课题文献来源分析;自己的胎盘研究。该研究涉及535名妊娠26-29周的轻度PE妇女。I组采用标准治疗,II组采用标准治疗联合替沃汀(每天4.2 g,连用7-10天)。结果和讨论。在胎儿达到生存能力之前,PE治疗的目的是纠正高血压,然而,降压治疗对肾脏和胎盘血流的状况没有有益的影响。胎盘血流减少可导致胎儿发育受限综合征(SLFD)和多系统ED。PE的发展与母体内皮细胞的全身损伤和内皮依赖性血管扩张剂的进一步减少有着密不可分的联系,内皮依赖性血管扩张剂会促进血管痉挛并激活凝血级联。PE伴随着前列环素和一氧化氮(NO)系统以及血栓素和内皮素系统的失衡。螺旋动脉重构不足和对血流变化的反应受损的浅表胎盘是PE的主要原因之一。ED是目前研究最多的PE发病机制。NO具有强大的血管舒张作用,参与抑制血栓素的形成、血小板聚集和刺激前列环素的形成。内皮细胞的NO合成酶是产生NO的主要酶,其底物为l -精氨酸。妊娠PE患者血管舒张障碍可通过l -精氨酸处方消除。文献资料显示,l -精氨酸在需要继续妊娠,以及消除高血压和纠正SLFD时使用成功。加拿大妊娠高血压并发症治疗指南指出,l -精氨酸能够改善子宫胎盘血流量。根据J. Chen(2016)的一项研究,l -精氨酸的加入对妊娠的孕产妇和围产期结局都有影响。l -精氨酸对胎儿生长的影响是通过促进肌酸、骨骼肌蛋白和生长激素的产生来介导的。l -精氨酸还能促进多胺的合成,从而刺激胎盘的生长发育。自己的研究表明,在PE联合治疗中使用l -精氨酸(Tivortin,“Yuria-Pharm”),可以改善胎儿的生长速度和功能状况,从而延长妊娠至最佳分娩足月,并改善新生儿早期的分娩后果和新生儿的适应。蒂沃汀并不是唯一应用于PE的领域,在孕妇社区获得性肺炎和肾盂肾炎中静脉给药有助于迅速消除病理过程。胎盘研究的结果发现,Tivortin有助于改善子宫-胎儿-胎盘的血液流动,减少血液循环的集中。在Tivortin组中,剖宫产的数量较少,出血量较低(19.5%),新生儿在阿普加量表上的平均得分较高。临床和形态学变化的比较表明,在妊娠第二晚期和第三早期给予Tivortin可使胎盘早成熟的可能性降低2.1%,使胎盘坏死的可能性降低一半,使缺氧的迹象降低10倍。结论:1。由NO减少引起的ED是PE发病的主要环节。2. 在人体内,一氧化氮是由l -精氨酸产生的。3.l-精氨酸(Tivortin)的使用改善子宫-胎儿-胎盘的血流量,生长速度和胎儿的功能状态,减少胎儿窘迫,并允许延长妊娠至最佳分娩足月。
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引用次数: 0
Legal liability and risks during infusion therapy 输液治疗过程中的法律责任和风险
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-175-177
N. Lisnevska
Background. The issue of legal liability is extremely important for all healthcare workers (HCW). HCW are solely responsible for medical violations during the performance of their professional duties. There is a misconception that in case of non-provision or error in the provision of medical care outside the medical institution, the HCW will be liable. However, this is not always so, as in this case the HCW is considered an ordinary citizen and bears ordinary civil liability. Objective. To describe the legal aspects of MP liability, in particular, during infusion therapy (IT). Materials and methods. Analysis of the legal framework. Results and discussion. The public consciousness has formed the idea of the great responsibility of HCW for human life and health. Unfortunately, in Ukraine, people often do not care about their own health and do not take preventive measures, shifting all responsibility to HCW. Citizens have the right to receive health care and the right for the compensation of improper medical care and damage caused by the actions of the HCW. According to surveys, a lawsuit from a patient is the leading fear of HCW. This fear needs to be reduced, as the doctor and nurse should not be afraid of their patients. According to the objective model of liability, the HCW is guilty of the damage caused to the victim (patient), if the average citizen believes that the actions of HCW were the cause of the unfavorable course of events. This model is often used by domestic media, although in Ukraine it is not enshrined in law. For a long time, criminal liability for medical crimes has dominated Ukraine. Currently, there are criminal, administrative, disciplinary and civil kinds of liability. According to the criminal legislation of Ukraine, criminal liability arises for a crime that contains a crime according to the Criminal Code. Criminal activity contradicts the very essence of medical activity, so special attention is paid to such crimes. It should be noted that the intentional crimes committed by HCW are much less common than crimes of negligence. An important problem is that lawyers do not always understand the specifics of the nature of a medical crime. There are circumstances in which HCW are released from liability for a crime. These circumstances include actions of extreme necessity and actions in risk settings. Extreme necessity often takes place in urgent medical interventions. These circumstances often accompany emergency care in case of accidents, military problems and disasters. IT is often a kind of experiment, because the drugs administered may be perceived differently by the patient, even with a normal previous history. Because treatment is often associated with risk, for example, in case of IT side effects, a nurse who continues to administer the drug on a protocol or off-protocol (subject to consultation with the patient and/or the board of physicians) will not be criminally liable. Similarly, a nurse will not be criminally
背景。法律责任问题对所有卫生保健工作者(HCW)极为重要。医护人员在履行其专业职责期间对医疗违规行为负全部责任。有一种误解认为,如果在医疗机构以外提供医疗服务时没有提供或出现错误,医疗保健中心将承担责任。然而,情况并非总是如此,因为在这种情况下,HCW被视为普通公民并承担普通民事责任。目标。描述MP责任的法律方面,特别是在输液治疗(IT)期间。材料和方法。法律框架分析。结果和讨论。公众意识形成了卫生保健对人类生命和健康负有重大责任的观念。不幸的是,在乌克兰,人们往往不关心自己的健康,也不采取预防措施,把所有责任都推给了氯氟烃。公民有权获得医疗保健,有权要求对卫生保健委员会的不当医疗和行为造成的损害进行赔偿。根据调查,患者的诉讼是对HCW的最大恐惧。这种恐惧需要减少,因为医生和护士不应该害怕他们的病人。根据客观责任模型,如果普通公民认为HCW的行为是造成不利事件的原因,则HCW对受害者(患者)造成的损害负有责任。这种模式经常被国内媒体使用,尽管在乌克兰并没有明文规定。长期以来,医疗犯罪的刑事责任在乌克兰占主导地位。目前,有刑事责任、行政责任、纪律责任和民事责任。根据乌克兰的刑事立法,对包含《刑法》规定的罪行的罪行产生刑事责任。犯罪活动与医疗活动的本质相矛盾,因此对此类犯罪给予了特别关注。应当指出的是,故意犯罪远不如过失犯罪常见。一个重要的问题是,律师并不总是了解医疗犯罪性质的具体细节。在某些情况下,HCW可以免除对犯罪的责任。这些情况包括极端必要的行动和风险环境中的行动。在紧急医疗干预中经常发生极端需要。这些情况往往伴随着事故、军事问题和灾难的紧急护理。这通常是一种实验,因为即使患者以前有正常的病史,也可能对所给药物有不同的看法。由于治疗通常与风险相关,例如,在出现IT副作用的情况下,按照协议或非协议(取决于与患者和/或医师委员会的协商)继续给药的护士将不承担刑事责任。同样,如果护士因患者病情恶化而决定停止治疗,也不承担刑事责任。在这种情况下,护士应尽快将情况告知医生,尽快消除对患者的危险。为了有用的目的而故意造成损害的案件是另一类案件。这在化疗和实验研究中最为常见。医护人员应采取他认为足够和适合他的资格的措施,以改善病人的情况。有时护士不得不在时间短缺的情况下做出决定,例如,为患有精神疾病的患者采取措施,该患者会威胁到其他人。在这种情况下,也不承担刑事责任,因为该行为是为了挽救他人的生命和健康。医疗犯罪分为职业犯罪和公务犯罪。第一类与履行专业职责直接相关(艾滋病毒/艾滋病、非法堕胎、泄露患者个人信息、侵犯患者权利、不提供医疗服务等)。应该指出的是,如果卫生保健专员不符合他/她的资格,就不能指责他/她不提供医疗服务。结论:1。HCW必须了解自己的权利,并为患者的利益而行动。2. 医疗犯罪分为职业犯罪和公务犯罪。3.在某些情况下,HCW可以免除刑事责任。
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引用次数: 0
The experience of management of COVID-19: focus on the pneumonia 新冠肺炎防控经验:以肺炎为重点
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-218-220
L. Moroz
Background. Coronaviruses are the RNA viruses, which have a crown-shaped outer layer. These viruses have a tropism to the respiratory epithelium. SARS-CoV (coronavirus of the severe acute respiratory syndrome), MERS-CoV (coronavirus of the Middle East respiratory syndrome) and the new coronavirus SARS-CoV-2 are the most significant coronaviruses, able to affect a human organism. Coronavirus disease (COVID-19) pathogenesis includes the coronavirus replication in the respiratory epithelium and the diffuse alveolocyte injury with the development of viral pneumonia or acute respiratory distress syndrome. The main symptoms of COVID-19 include fever (83-99 %), appetite loss (40-84 %), cough (59-82 %), fatigue (44-70 %), anosmia (15-30 %), myalgia (11-35 %). Apart from that, COVID-19 is often accompanied by coagulopathies together with venous thrombosis, myocardial infarction and disseminated intravascular coagulation syndrome. Risk factors of coagulopathies include sepsis, history of chronic obstructive pulmonary diseases and liver disorders, malignant tumors, fever and acute course of COVID-19. Objective. To describe the peculiarities of coronavirus pneumonias treatment. Materials and methods. Analysis of literature data and clinical cases from own practice. Results and discussion. 40 % of COVID-19 patients have a mild course, 40 % – moderate, 15 % – severe, and 5 % – critical. The majority of patients with lethal outcomes have at least one from the listed parameters: malignant tumor, morbid obesity, diabetes mellitus, cardiovascular diseases, diseases of kidneys and lungs, hypoalbuminemia, age >60 years old. Diagnosis of coronavirus pneumonia needs to be proved with the help of computer tomography (CT) during the initial visit or hospitalization, then in 2-3 days in case of the absence of improvement, in case of clinical condition worsening, in 5-7 days in case of no dynamics or of positive dynamics. Lung affection according to CT is divided into 4 grades according to the presence of frosted glass symptom, consolidation presence and the percentage of lung parenchyma involvement. Pathogenetic treatment, including off-label drug usage, can decrease the risk of fatal complications. Edaravone (Ksavron, “Yuria-Pharm”) is an antioxidant drug with an anti-inflammatory effect due to cytokine storm inhibition and the possibility to decrease the lung vessels’ endothelium permeability. Edaravone neutralizes free radicals; inhibits lipid peroxidation; activates own antioxidant protection (enzymes superoxiddysmutase, catalase, glutathione peroxidase). It underlines the reasonability of edaravone usage in acute respiratory distress-syndrome. Edaravone prevents the increase of permeability of lung vessels’ endotheliocytes similarly to dexamethasone, but has a lower amount of side effects. L-arginine and L-carnitine (Tivorel, “Yuria-Pharm”) are also actively studied. L-arginine improves microcirculation, promotes vasodilatation, activates Т-cell immunity, stabili
背景。冠状病毒是RNA病毒,它有一个冠状的外层。这些病毒对呼吸道上皮有趋向性。SARS-CoV(严重急性呼吸综合征冠状病毒)、MERS-CoV(中东呼吸综合征冠状病毒)和新型冠状病毒SARS-CoV-2是能够影响人体有机体的最重要的冠状病毒。冠状病毒病(COVID-19)的发病机制包括冠状病毒在呼吸道上皮内复制和弥漫性肺泡细胞损伤,并发病毒性肺炎或急性呼吸窘迫综合征。新冠肺炎的主要症状包括发热(83- 99%)、食欲不振(40- 84%)、咳嗽(59- 82%)、疲劳(44- 70%)、嗅觉丧失(15- 30%)、肌痛(11- 35%)。此外,COVID-19常伴有凝血功能障碍,包括静脉血栓形成、心肌梗死和弥散性血管内凝血综合征。凝血功能障碍的危险因素包括败血症、慢性阻塞性肺疾病和肝脏疾病史、恶性肿瘤、发烧和COVID-19急性病程。目标。描述冠状病毒肺炎治疗的特点。材料和方法。文献资料及临床病例分析。结果和讨论。40%的COVID-19患者病程为轻度,40%为中度,15%为重度,5%为危重。大多数致死性结局的患者至少有以下所列参数中的一项:恶性肿瘤、病态肥胖、糖尿病、心血管疾病、肾脏和肺部疾病、低白蛋白血症、年龄>60岁。冠状病毒肺炎的诊断需要在首次就诊或住院期间通过计算机断层扫描(CT)进行证实,如果没有好转,则在2-3天内,如果临床情况恶化,则在5-7天内,如果没有动态或积极动态。根据有无磨砂玻璃症状、有无实变及肺实质受累比例,CT将肺部病变分为4个级别。病原治疗,包括超说明书用药,可降低致命并发症的风险。依达拉奉(Ksavron,“Yuria-Pharm”)是一种抗氧化药物,由于抑制细胞因子风暴和可能降低肺血管内皮通透性而具有抗炎作用。依达拉奉能中和自由基;抑制脂质过氧化;激活自身抗氧化保护(酶超氧化物歧化酶,过氧化氢酶,谷胱甘肽过氧化物酶)。强调依达拉奉治疗急性呼吸窘迫综合征的合理性。依达拉丰与地塞米松类似,可以阻止肺血管内皮细胞通透性的增加,但副作用较小。l -精氨酸和l -肉碱(Tivorel,“Yuria-Pharm”)也在积极研究中。l -精氨酸改善微循环,促进血管扩张,激活Т-cell免疫,稳定细胞膜,保护细胞,具有抗氧化作用,减少支气管痉挛和肺动脉痉挛。反过来,左旋肉碱具有免疫调节作用,减少促炎细胞因子的释放,具有抗氧化、抗凋亡和心脏保护作用。替佛瑞尔降低了冠状病毒附着在细胞上的能力,抵消了它们的复制,减少了内皮功能障碍。结论:1。病原治疗,包括超说明书用药,可以减少COVID-19的不良后果。2. 依达拉奉能中和自由基;抑制脂质过氧化;激活自身抗氧化保护。3.l -精氨酸和l -肉碱改善微循环,促进血管舒张,具有免疫调节、抗氧化和心脏保护作用。
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引用次数: 0
2020 challenge: the potential options of COVID-19 therapy 2020年挑战:COVID-19治疗的潜在选择
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-149-150
S. Kovalenko
Background. Coronavirus disease (COVID-19) is a new disease, and there is no vaccine, specific drugs and treatment protocols. In 15-20 % of patients the course is severe course, and 4 % of cases are fatal. 15 % of adults infected with the SARS-CoV-2 coronavirus develop pneumonia. In 5 % pneumonia progresses to a critically severe condition with the development of respiratory failure and acute respiratory distress syndrome. Objective. To describe the potential options of COVID-19 therapy. Materials and methods. Analysis of literature sources on this topic and the own clinical study, which involved 60 patients with COVID-19 (main and control groups, standardized by age and sex). In the control group, standard treatment was prescribed, and in the main group – basic therapy and Ksavron tid, Tivorel once a day and Reosorbilact once a day (all medications – by “Yuria-Pharm”). Results and discussion. Antiviral drugs (nelfinavir, remdesivir, favipiravir), recombinant human monoclonal antibodies to interleukin-6 receptors tocilizumab, and chloroquine-related drugs (sometimes in combination with azithromycin) are used for COVID-19 pharmacotherapy. Usage of edaravone (Ksavron) to inhibit the cytokine storm and of Reosorbilact to reduce the incidence of pulmonary complications, the duration of mechanical ventilation, and the volume of infusions has a great potential. The use of the latter is especially appropriate under the conditions of restrictive infusion regimen. In addition, L-arginine and L-carnitine (Tivorel) can be used. L-arginine reduces spasm of smooth bronchial muscles and improves the vasomotor function of the pulmonary endothelium. L-carnitine has anti-inflammatory and immunomodulatory effects. The own study found out that the level of C-reactive protein in the main group (standard therapy + Ksavron, Tivorel and Reosorbilact) has decreased from 39.45 to 7.5 mg/L, and in the control group – from 46.26 to 12.50 mg/L, indicating a more pronounced reduction of inflammation in the main group. In addition, the content of D-dimer and ferritin decreased more markedly in the main group (by 24.1 % and 27.1 % respectively). The additional pathogenetic treatment listed above helped to improve blood oxygen saturation, reduce the number of leukocytes and decrease the length of hospital stay. Conclusions. 1. Antiviral drugs, tocilizumab, chloroquine-related drugs, and azithromycin are used to treat COVID-19. 2. Potential treatment options include the usage of Ksavron, Reosorbilact and Tivorel. 3. According to own research, the inclusion of these drugs into the combined therapy reduces the activity of the inflammatory process in the lungs and counteracts the tendency to thrombosis.
背景。冠状病毒病(COVID-19)是一种新疾病,目前还没有疫苗、特异性药物和治疗方案。15- 20%的患者病程为重症,4%的病例是致命的。感染SARS-CoV-2冠状病毒的成年人中有15%会患上肺炎。5%的肺炎发展为严重的呼吸衰竭和急性呼吸窘迫综合征。目标。描述COVID-19治疗的潜在选择。材料和方法。本课题文献来源及自身临床研究分析,该研究涉及60例COVID-19患者(主要和对照组,按年龄和性别标准化)。在对照组中,给予标准治疗,在主要组中-基础治疗和Ksavron tid,每天一次替佛瑞尔和一天一次Reosorbilact(所有药物-由“Yuria-Pharm”)。结果和讨论。抗病毒药物(奈非那韦、瑞德西韦、法匹拉韦)、重组人白细胞介素-6受体单克隆抗体tocilizumab和氯喹相关药物(有时与阿奇霉素联合使用)用于COVID-19药物治疗。利用依达拉奉(Ksavron)抑制细胞因子风暴和Reosorbilact减少肺部并发症的发生率、机械通气时间和输注量具有很大的潜力。后者的使用在限制性输注方案的条件下尤其合适。此外,l -精氨酸和l -肉碱(Tivorel)也可以使用。l -精氨酸可减少支气管平滑肌痉挛,改善肺内皮的血管舒缩功能。左旋肉碱具有抗炎和免疫调节作用。自己的研究发现,主治疗组(标准治疗+ Ksavron, Tivorel和Reosorbilact)的c反应蛋白水平从39.45 mg/L降至7.5 mg/L,对照组从46.26 mg/L降至12.50 mg/L,表明主治疗组炎症减轻更为明显。此外,d -二聚体和铁蛋白含量在主组下降更为明显(分别下降24.1%和27.1%)。上述附加的致病治疗有助于改善血氧饱和度,减少白细胞数量,缩短住院时间。结论:1。抗病毒药物、托珠单抗、氯喹相关药物和阿奇霉素用于治疗COVID-19。2. 潜在的治疗方案包括使用Ksavron、Reosorbilact和Tivorel。根据自己的研究,将这些药物纳入联合治疗可减少肺部炎症过程的活动,并抵消血栓形成的倾向。
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引用次数: 0
Care for critically ill patients on the example of patients with severe burns 危重病人护理以严重烧伤病人为例
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-141-143
O. Kovalenko
Background. More than 200,000 patients with burns in Europe and the United States need inpatient treatment every year. In Ukraine, 35,000 people suffer thermal injuries each year. Medical care for burns in Ukraine is provided on 1,060 specialized beds (875 – for adults, 175 – for children). Indications for transporting people to the burn center include burn area >10 % of the body surface in adults; burns of the face, hands, feet, perineum, genitals, large joints; deep burns >3 %; electrical or chemical burns; inhalation burns; circular burns of the extremities or chest; burns in pregnant women, children, the elderly, patients with severe comorbid conditions; burns in combination with polytraumas. Objective. To describe the management of critically ill patients with burns. Materials and methods. Analysis of literature sources on this issue. Results and discussion. Care for patients with burns is divided into general and special. The use of specialized beds “Clinitron” and air-insolating complexes is of paramount importance. Since the heat loss from the burn wound is 580 kcal/h, the temperature in the burn rooms should be maintained at 26-30 °C. Wound surfaces are easily infected with nosocomial microorganisms, so it is necessary to carefully maintain hand hygiene of healthcare workers (HCW). The latter are the cause of the hospital infections in 50-80 % of cases, so when caring for different patients and before the transition from a bacteria-contaminated area of the body to a clean one, the gloves should be changed. All works near the patient must be carried out in the nitrile gloves without powder, as the latter increases the risk of infection and allergies. It is advisable to use high-strength gloves with an elongated cuff. After removing the gloves, hand hygiene must be carried out. To disinfect the hands of HCW in order to prevent the spread of transient microflora, you can use Gorosten (“Yuria-Pharm”) – a solution based on decamethoxine. Gorosten has antibacterial, antifungal, antiviral, anti-inflammatory and desensitizing properties. Hand hygiene should be performed before the contact with the patient, before clean/aseptic procedures, after contact / risk of contact with the patient’s biological fluids, after contact with the patient and his surroundings, after contact with him-/herself and personal protective equipment. In case of big burn area, bandages are changed under general anesthesia, in some cases after a bath with 0.05-0.1 % potassium permanganate solution. Improper care of patients with burns and other patients with severe conditions can cause the following complications: contractures, bedsores, infectious processes in the lungs, injuries and more. For the prevention and treatment of bedsores, it is advisable to use modern dressings: hydrocolloid, semi-permeable film, sponge, and silicone. Conclusions. 1. Indications for the transporting people to the burn center include the area of the burn >10 % of the body surface in adults
背景。在欧洲和美国,每年有超过20万名烧伤患者需要住院治疗。在乌克兰,每年有3.5万人遭受热伤。乌克兰有1 060张烧伤专科病床(875张为成人,175张为儿童)。将人送往烧伤中心的适应症包括:成人烧伤面积为体表的10%;面部、手、脚、会阴、生殖器、大关节烧伤;深度烧伤> 3%;电或化学灼伤;吸入燃烧;四肢或胸部的圆形烧伤;孕妇、儿童、老人、严重合并症患者的烧伤;烧伤合并多处创伤。目标。目的描述烧伤危重病人的处理。材料和方法。对这一问题的文献来源进行分析。结果和讨论。烧伤病人的护理分为一般和特殊。使用专门的床“Clinitron”和空气辐照复合物是至关重要的。烧伤创面散热量为580千卡/小时,烧伤室温度应保持在26-30℃。创面易被医院微生物感染,医护人员应注意手卫生。后者是50- 80%的医院感染病例的原因,所以当照顾不同的病人时,在从身体被细菌污染的区域过渡到干净的区域之前,应该更换手套。所有靠近病人的工作必须戴无粉丁腈手套进行,因为无粉丁腈手套会增加感染和过敏的风险。建议使用长袖口的高强度手套。脱下手套后,必须进行手部卫生。为了对HCW的手进行消毒,以防止瞬时微生物群的传播,你可以使用Gorosten(“Yuria-Pharm”)——一种基于十甲氧辛的溶液。枸杞具有抗菌、抗真菌、抗病毒、抗炎和脱敏的特性。在与患者接触之前、清洁/无菌程序之前、与患者的生物液体接触/有接触风险之后、与患者及其周围环境接触之后、与患者本人和个人防护装备接触之后,均应进行手卫生。如果烧伤面积大,在全身麻醉下更换绷带,在某些情况下,用0.05- 0.1%高锰酸钾溶液浸泡。对烧伤患者和其他病情严重的患者护理不当可导致以下并发症:挛缩、褥疮、肺部感染过程、损伤等。预防和治疗褥疮,建议使用现代敷料:水胶体、半透膜、海绵、硅胶。结论:1。将人送往烧伤中心的适应症包括:成人烧伤面积为体表的10%;面部、手、脚、会阴、生殖器、大关节烧伤;深度烧伤> 3%;电或化学灼伤;吸入燃烧;四肢或胸部的圆形烧伤;孕妇、儿童、老人、严重合并症患者的烧伤;烧伤合并多处创伤。2. 创面容易被医院微生物感染,因此有必要认真保持手部卫生。3.所有靠近病人的工作都应戴无粉丁腈手套。4. 脱下手套后,应进行手部卫生。5. 为防止瞬间微生物菌群的传播,可使用葛洛斯腾消毒双手。
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引用次数: 0
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Infusion & Chemotherapy
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