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×èòàòåëü Íåäóã.Ðó
Ïðîâîäèòñÿ ëè ýòî è íàñêîëüêî ðàñïðîñòðàíåíî â Ðîññèè? Åñëè äà, òî ïðè êàêèõ äèàãíîçàõ?
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×èòàòåëü Íåäóã.Ðó
Âû èìåëè â âèäó àíòèáèîòèêîïðîôèëàêòèêó?
Èíòåðåñíûå òåðìèíû èñïîëüçóåòå - âåñåëÿùèé ãàç âìåñòî çàêèñè àçîòà, òåïåðü ïðåìåäèêàöèÿ àíòèáèîòèêîì
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×èòàòåëü Íåäóã.Ðó
Âû èìåëè â âèäó àíòèáèîòèêîïðîôèëàêòèêó?
Èíòåðåñíûå òåðìèíû èñïîëüçóåòå - âåñåëÿùèé ãàç âìåñòî çàêèñè àçîòà, òåïåðü ïðåìåäèêàöèÿ àíòèáèîòèêîì
Àãà, àãà, èìåííî ýòî!
Èçâèíÿþñü, åñëè âûðàæóñü êàê-òî íå òàê... Ïðîñòî çà 10 ëåò ðàáîòû â ÑØÀ ìíîãèå òåðìèíû ñìåíèëèñü íà "ìåñòíûå" è â ïðÿìîì ïåðåâîäå çâó÷àò çàáàâíî. À åù¸ ðÿäà íàçâàíèé òîãäà åù¸ ïðîñòî íå áûëî... Íî, íàäåþñü, êîëëåãè ìåíÿ ïîéìóò
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×èòàòåëü Íåäóã.Ðó
Íåêîòîðûå ëþáÿò òàêóþ ñõåìó: ââåäåíèå à/á äî è ïîñëå è âñå. Íåêîòîðûå ïðîñòî íàçíà÷àþò ïðèåì ïðåïàðàòà ïîñëå âìåøàòåëüñòâà. Ïîìîéìó î÷åíü îïðàâäàíî ê ïðèìåðó ïðè óäàëåíèè âîñüìûõ â ðÿäå ñëó÷àåâ.
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×èòàòåëü Íåäóã.Ðó
Íåêîòîðûå ëþáÿò òàêóþ ñõåìó: ââåäåíèå à/á äî è ïîñëå è âñå. Íåêîòîðûå ïðîñòî íàçíà÷àþò ïðèåì ïðåïàðàòà ïîñëå âìåøàòåëüñòâà. Ïîìîéìó î÷åíü îïðàâäàíî ê ïðèìåðó ïðè óäàëåíèè âîñüìûõ â ðÿäå ñëó÷àåâ.
Íå ñîâñåì òî... Òàê, â ÑØÀ â ðÿäå ñëó÷àåâ, òàêèõ, êàê íàëè÷èå èñêóññòâåííûõ ñóñòàâîâ èëè ïðè íåêîòîðûõ ñåðäå÷íûõ ñîñòîÿíèÿõ (òèïà ìèòðàëüíîãî ïîðîêà) îáÿçàòåëüíà ïðîôèëàêòèêà: 500ìã àìîêñèöèëèí èëè 600ìã êëèíäàìèöèí çà 1 ÷àñ äî ëþáîãî "êðîâàâîãî" âìåøàòåëüñòâà, âêëþ÷àÿ ÷èñòêó è äàæå èíòðàëèãàìåíòàðíóþ àíåñòåçèþ. Ðàíüøå áûë îáÿçàòåëüíûì ïðè¸ì ïîñëå ïðîöåäóðû, íî íåñêîëüêî ëåò íàçàä îòìåíèëè. Äåëàåòñÿ ñ öåëüþ ïðîôèëàêòèêè âòîðè÷íîãî áàêòåðèàëüíîãî ýíäîêàðäèòà.
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×èòàòåëü Íåäóã.Ðó
Íå ñîâñåì òî... Òàê, â ÑØÀ â ðÿäå ñëó÷àåâ, òàêèõ, êàê íàëè÷èå èñêóññòâåííûõ ñóñòàâîâ èëè ïðè íåêîòîðûõ ñåðäå÷íûõ ñîñòîÿíèÿõ (òèïà ìèòðàëüíîãî ïîðîêà) îáÿçàòåëüíà ïðîôèëàêòèêà: 500ìã àìîêñèöèëèí èëè 600ìã êëèíäàìèöèí çà 1 ÷àñ äî ëþáîãî "êðîâàâîãî" âìåøàòåëüñòâà, âêëþ÷àÿ ÷èñòêó è äàæå èíòðàëèãàìåíòàðíóþ àíåñòåçèþ. Ðàíüøå áûë îáÿçàòåëüíûì ïðè¸ì ïîñëå ïðîöåäóðû, íî íåñêîëüêî ëåò íàçàä îòìåíèëè. Äåëàåòñÿ ñ öåëüþ ïðîôèëàêòèêè âòîðè÷íîãî áàêòåðèàëüíîãî ýíäîêàðäèòà.
Íó è ÷òî â ýòîì óäèâèòåëüíîãî? Äà, îòìåíèëè, ïðè÷åì óæå ãîäà 4 êàê ìèíèìóì.
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×èòàòåëü Íåäóã.Ðó
Ñõåìû àíòèáèîòèêîïðîôèëàêòèêè â õèðóðãèè îáû÷íî ñõîäíû ñ çàðóáåæíûìè, òê ñ íèõ è ñîäðàíû. Íàïðèìåð http://www.rmj.ru/kah/t1/n1/8.htm
Åñëè ó Âàñ åñòü ññûëêè, ïîäåëèòåñü
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×èòàòåëü Íåäóã.Ðó
Ñõåìû àíòèáèîòèêîïðîôèëàêòèêè â õèðóðãèè îáû÷íî ñõîäíû ñ çàðóáåæíûìè, òê ñ íèõ è ñîäðàíû. Íàïðèìåð http://www.rmj.ru/kah/t1/n1/8.htm
Åñëè ó Âàñ åñòü ññûëêè, ïîäåëèòåñü
Íàïðèìåð:
Table 11-1. Cardiac conditions associated with endocarditis.1
Endocarditis prophylaxis recommended
High-risk category:
Prosthetic cardiac valves, including bioprosthetic and homograft valves
Previous bacterial endocarditis
Complex cyanotic congenital heart disease (eg, single ventricle states, transposition of the great arteries, tetralogy of Fallot)
Surgically constructed systemic pulmonary shunts or conduits
Moderate-risk category:
Most other congenital cardiac malformations (other than above and below)
Acquired valvar dysfunction (eg, rheumatic heart disease)
Hypertrophic cardiomyopathy
Mitral valve prolapse with valvar regurgitation, thickened leaflets, or both
Endocarditis prophylaxis not recommended
Negligible-risk category (no greater risk than the general population):
Isolated secundum atrial septal defect
Surgical repair of atrial septal defect, ventricular septal defect, or patent ductus arteriosus (without residua beyond 6 mo)
Previous coronary artery bypass graft surgery
Mitral valve prolapse without valvar regurgitation
Physiologic, functional, or innocent heart murmurs
Previous Kawasaki disease without valvar dysfunction
Previous rheumatic fever without valvar dysfunction
Cardiac pacemakers (intravascular and epicardial) and implanted defibrillators
1Source: JAMA 1997; 277:1794-1801.
 ÃÝÎÒÀÐîâñêèõ ðåêîìåäàöèÿõ òîæå, êàæåòñÿ, åñòü. Ïðè÷åì ìíîãî âñåãî
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×èòàòåëü Íåäóã.Ðó
Ýòè èçâåñòíû
ß è ñàìà ïåðåâîäèëà íåñêîëüêî è èñïîëüçîâàëà äëÿ ðàçðàáîòêè ïðîòîêîëîâ â íàøåé áîëüíè÷êå. Ñåé÷àñ êàê ðàç ïûòàþñü íàéòè ïåðåâîäû â ñâîåì àðõèâå, íî ÷òî-òî íåò, íàâåðíîå íà ðàáîòå.
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×èòàòåëü Íåäóã.Ðó
Ýòè èçâåñòíû
ß è ñàìà ïåðåâîäèëà íåñêîëüêî è èñïîëüçîâàëà äëÿ ðàçðàáîòêè ïðîòîêîëîâ â íàøåé áîëüíè÷êå. Ñåé÷àñ êàê ðàç ïûòàþñü íàéòè ïåðåâîäû â ñâîåì àðõèâå, íî ÷òî-òî íåò, íàâåðíîå íà ðàáîòå.
Ìîãó ïðåäëîæèòü òîëüêî ýòî http://www.rcseng.ac.uk/dental/fds/clinical_guidelines/ie_recs.pdf
PS. Êñòàòè, ïðàâäà ëè íàñ÷åò 500ìã àìîêñèöèëëèíà? Âûãëÿäèò ìàëîâàòî, äà è îáû÷íî êàïèòàëèñòû ïèøóò (è ïèñàëè) ïðî 3 ã. PO, â íåêîòîðûõ ñëó÷àÿõ - 2 ã. IV
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×èòàòåëü Íåäóã.Ðó
Dr_S: Ïðåìåäèêàöèÿ àíòèáèîòèêîì
Ïðîâîäèòñÿ ëè ýòî è íàñêîëüêî ðàñïðîñòðàíåíî â Ðîññèè? Åñëè äà, òî ïðè êàêèõ äèàãíîçàõ?
Ïîëíîñòüþ ñîãëàñåí ñ Íàòàëüåé, ëó÷øå ýòî íàçûâàòü àíòèáèîòèêîïðîôèëàêòèêîé.
Ïðèìèíèòåëüíî ê ñòîìàòîëîãèè ÿ áû õîòåë ïðèâåñòè àáñòðàêò ñòàòüè Ý.È.Áàñèòõàíîâîé "Ïðîôèëàêòèêà ïîñëåîïåðàöèîííûõ âîñïàëèòåëüíûõ îñëîæíåíèé ó áîëüíûõ ñ ïàòîëîãèåé ÷åëþñòíî-ëèöåâîé îáëàñòè" èç æóðíàëà ÑÒÎÌÀÒÎËÎÃÈß ¹2 çà 2005 ãîä.
 öåëÿõ ïðîôèëàêòèêè ïîñëåîïåðàöèîííûõ îñëîæíåíèé ïðèìåíÿëè öåôòðèàêñîí (ðîöåôèí) è ëèíêîìèöèí, êîòîðûå ââîäèëè âíóòðèâåííî îäíîêðàòíî ïåðåä íàðêîçîì â óäâîåííûõ äîçàõ. Óñòàíîâëåíî, ÷òî ýòà ìåðà ïîçâîëÿåò èñêëþ÷èòü ïîñëåîïåðàöèîííûå ãíîéíûå îñëîæíåíèÿ ïðè îïåðàöèÿõ ïî ïîâîäó çàêðûòûõ ïåðåëîìîâ íèæíåé ÷åëþñòè è ðåêîíñòðóêòèâíûõ îïåðàöèÿõ íà ÷åëþñòíî-ëèöåâîé îáëàñòè è ñíèçèòü èõ ÷àñòîòó ïðè âìåøàòåëüñòâàõ ïî ïîâîäó îòêðûòûõ ïåðåëîìîâ íèæíåé ÷åëþñòè è êîñòåé íîñà.
Öåôòðèàêñîí (ðîöåôèí) ââîäèëè â äîçå 2,0 ã âíóòðèâåííî, à òàêæå ëèíêîìèöèí (â äîçå 600 ìã âíóòðèâåííî), ïðè íàëè÷èè ïîêàçàíèé ïîâòîðíûå èíúåêöèè ïðîèçâîäèëèñü ñîîòâåòñòâåííî ÷åðåç 12 è 8 ÷àñîâ.
Ïðîôèëàêòè÷åñêîå ïðèìåíåíèå àíòèáèîòèêîâ ñëåäóåò ñ÷èòàòü ýôôåêòèâíîé ìåðîé ñíèæåíèÿ ÷àñòîòû ïîñëåîïåðàöèîííûõ ãíîéíûõ îñëîæíåíèé. Îïòèìàëüíûé ìîìåíò íà÷àëà àíòèáèîòèêîïðîôèëàêòèêè - ïåðåä íàðêîçîì.
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×èòàòåëü Íåäóã.Ðó
Êñòàòè, ïðàâäà ëè íàñ÷åò 500ìã àìîêñèöèëëèíà?
Óïñ...
Êîíå÷íî, íå ïðàâäà... 500 - ýòî åãî äîçèðîâêà â êàïñóëå
4 ïî 500ìã, ò.å. 2ã çà 1 ÷àñ äî ïðîöåäóðû. Ñïàñèáî, ÷òî çàìåòèëè!
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×èòàòåëü Íåäóã.Ðó
Ìîãó ÷åñòíî ñêàçàòü: îáû÷íî öåôòðèàêñîíà âîâñå íå òðåáóåòñÿ. À åñëè èìååò ìåñòî îñêîëü÷àòûé ïåðåëîì ñ âûñîêîé âåðîÿòíîñòüþ âîñïàëèòåëüíûõ îñëîæíåíèé - ó íàñ ïðàêòèêóþò êàòåòåðèçàöèþ ïîâ. âèñî÷íîé âåíû è ââåäåíèå à/á ïðåïàðàòîâ â/àðòåðèàëüíî. Ïîñëåäíèé ðàç ýòî áûë öåôàçîëèí, ïðåäïîñëåäíèé - ëèíêîìèöèí. Íè÷åãî õâàòèëî.
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×èòàòåëü Íåäóã.Ðó
Íà ïóòè ê àðòåðèè àíòèáèîòèê ïðîõîäèò ìàëûé êðóã êðîâîîáðàùåíèÿ?
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×èòàòåëü Íåäóã.Ðó
À, ïîíÿë. Âèñî÷íàÿ àðòåðèÿ è êàòåòåð çà áèôóðêàöèþ?