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Priniesla zmena manažmentu u chorých s ťažkou akútnou pankreatitídou očakávaný výsledok?


Authors: J. Bober;  P. Harbuľák;  V. Uram;  L. Lakyová;  D. Leško;  J. Radoňak
Authors‘ workplace: Univerzita Pavla Jozefa Šafárika v Košiciach, Lekárska fakulta, 1. chirurgická klinika FNLP, Slovenská republika
Published in: Čas. Lék. čes. 2010; 149: 372-377
Category: Original Article

Overview

Východisko.
Ťažká forma akútnej pankreatitídy (AP) zaznamenala v ostatných desaťročiach zníženie mortality na 10–20 %. Viaceré otázky liečby tohto ochorenia sú však stále otvorené. K najnovšej odbornej literatúre v oblasti riešeného problému pričleniť vlastné skúsenosti získané súborom liečených chorých na pracovisku autorov.

Metódy.
Pod vplyvom literárnych správ, ako aj okolností na vlastnom pracovisku, bolo rozhodnuté pre zmenu manažmentu liečby chorých s AP, ktorý sa dotýkal enterálnej výživy, epidurálnej analgézie, antibiotickej profylaxie, odsúvania operačných výkonov pri infikovaní nekróz na neskoršie obdobie. Porovnaním dvoch súborov – A (2003–2005) a B (2006–2008) autori zaznamenali zaujímavé výsledky.

Výsledky. Po aplikácii nového protokolu sme zaznamenali:
zvýšenie percenta chorých so sterilnou nekrózou zo 46 % na 58 %, zníženie počtu reoperovaných zo 43 % na 33 % a zníženie mortality z 53,8 % na 18 %.

Závery.
Aplikáciou zmeny manažmentu u chorých s ťažkou formou akútnej pankreatitídy sa podarilo autorom dosiahnuť pozoruhodné výsledky, ktoré je však potrebné hodnotiť veľmi opatrne, pretože sú zaťažené málopočetným súborom liečených.

Kľúčové slová:
ťažká akútna pankreatitída, zmena manažmentu.

Adresa na korešpondenciu:
prof. MUDr. Juraj Bober, CSc.
I. chirurgická klinika LF UPJŠ a FN LP
Trieda SNP 1, 040 66 Košice, SR
fax: +421 055 640 3808, e-mail: juraj.bober@upjs.sk


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