#1
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ÎÀÏ è èíäîìåòàöèí
Öèòàòà:
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#2
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Öèòàòà:
Çàðàíåå ñïàñèáî. |
#3
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Îäîáðÿëêà, ê ñîæàëåíèþ, íå ñðàáîòàëà. Îäîáðÿþ Êèðó!
Åñëè íå îøèáàþñü, òî è ðàçìåðû ïðè ýòîì áîëüøîãî çíà÷åíèÿ íå èìåþò, ãëàâíîå, ÷òîá áûëà èñêëþ÷åíà äóêòóñ-çàâèñèìîñòü. |
#4
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#5
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âîò âñå ðàáîòû êàê ðàç ïî íèì
Öèòàòà:
ïîïðàâêà: äåéñòâèòåëüíî ñ íèçêèì âåñîì, èíîãî íå íàøåë íî Äæ. Áîóòìàí ïèøåò â êíèãå êàðäèîëîãèÿ â ñõåìàõ è òàáëèöà Ì. Ôðèä, Ñ. Ãðàéíñ (ðåä.) èç Ïðàêòèêà 1996 ãîä Öèòàòà:
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#6
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äà è ïî íåäîíîøåííûì âñå ïîä âîïðîñîì
Indomethacin prophylaxis for preterm infants: the impact of 2 multicentered randomized controlled trials on clinical practice. Clyman RI, Saha S, Jobe A, Oh W. Cardiovascular Research Institute and Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0544, USA. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] OBJECTIVES: Two multicenter randomized controlled trials (RCTs) in premature infants (Ment et al, 1994 and TIPP, 2001) found beneficial effects of indomethacin prophylaxis on the incidences of patent ductus arteriosus (PDA), PDA ligation, and severe intracranial hemorrhage (ICH). The Ment trial recommended the use of indomethacin prophylaxis. The TIPP trial failed to find a benefit in its primary outcome (improved survival/neurodevelopmental outcome); this negative result may have discouraged indomethacin prophylaxis use. STUDY DESIGN: We used the National Institute of Child Health and Development's Neonatal Network Registry to determine the association between the 2 trials and the use of indomethacin prophylaxis. We also statistically assessed the assumptions that led to the TIPP trial's negative results. RESULTS: Use of indomethacin prophylaxis among network clinicians increased after publication of the Ment trial and decreased after the TIPP trial. Analysis of the TIPP trial showed that the primary outcome's anticipated effect size (> or = 20%) was too large; a smaller effect size (< 3%) would have been more appropriate based on the incidence of ICH in their population and its association with neurodevelopmental outcome. CONCLUSIONS: Two multicenter RCTs were associated with changes in indomethacin prophylaxis. After the Ment trial, the use of indomethacin prophylaxis increased. After the TIPP trial, which reported negative results based on an excessively large anticipated effect size, its use decreased. |
#7
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Öèòàòà:
Ó íàñ åñòü õîðîøèé îáçîð ïî ýòîé òåìå, êîòîðûé íàâåðíîå áóäåò èíòåðåñåí ñïåöèàëèñòàì, òåì áîëåå, ÷òî åãî íåò â ñâîáîäíîì äîñòóïå: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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#8
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to Fro
À êàê íàñ÷åò çíà÷èìîñòè/íå çíà÷èìîñòè äèàìåòðà ÎÀÏ? |
#9
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Âîò èç ýòîé ôðàçû:
ìíå íå ïîêàçàëîñü, ÷òî ðå÷ü èäåò î íåäîíîøåííîì ðåáåíêå. Êðîìå òîãî, â ñèòóàöèÿõ, êîãäà íàçíà÷åíèå ïðåïàðàòà ïîêàçàíî, âîò ýòà ôðàçà êàæåòñÿ íåóìåñòíîé: Äóìàþ, òîãäà áûâàåò íå äî îáñóæäåíèÿ êàæäîãî ëåêàðñòâà ñ ðîäèòåëÿìè.  ëþáîì ñëó÷àå áóäåò ïðàâèëüíûì, åñëè NadyaTim óòî÷íèò, íà êàêîì ñðîêå è ñ êàêèì âåñîì ðîäèëñÿ ðåáåíîê, êîãäà áûë âûïèñàí äîìîé, íà êàêîì íàõîäèòñÿ âñêàðìëèâàíèè, ñêîëüêî ïðèáàâèë â âåñå, ïî÷åìó, ñ êàêèì äèàãíîçîì íàõîäèòñÿ ñåé÷àñ â áîëüíèöå, êàê îöåíèâàþò âðà÷è åãî ñîñòîÿíèå íà íàñòîÿùèé ìîìåíò. Ðàçóìååòñÿ, æåëàòåëåí îòñêàíèðîâàííûé ïðîòîêîë ÝõîÊÃ. Ñ óâàæåíèåì, Êèðà. |
#10
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ß òîæå ïîèñêàë (ò.ê. íå ïðàêòèê â âîïðîñàõ íàçíà÷åíèÿ èíäîìåòàöèíà íîâîðîæäåííûì ). Âî âñòðåòèâøèõñÿ ïîëíîòåêñòîâûõ ñòàòüÿõ â êðèòåðèÿõ âêëþ÷åíèÿ ôèãóðèðóþò: 1) gestational age <32 weeks and <1500 g (ò.å. "âûðàæåííàÿ íåäîíîøåííîñòü"), 2) postnatal age between 48 and 96 hours (ò.å. âðåìÿ äî òåðàïèè èíäîìåòàöèíîì èçìåðÿåòñÿ ñóòêàìè), 3) echocardiographic evidence of hemodynamically significant PDA (ýõîêàðäèîãðàôè÷åñêîå äîêàçàòåëüñòâî ãåìîäèíàìè÷åñêîé çíà÷èìîñòè ÎÀÏà) - â ÷àñòíîñòè, åãî äèàìåòð > 1,5 ìì.
Âñòðåòèëèñü ðàáîòû ïî ïåðîðàëüíîìó èáóïðîôåíó (ñóñïåíçèè), íî, ðàçóìååòñÿ, íå â âàðèàíòå "ïåäèàòð ðåêîìåíäîâàë ïðèíèìàòü". PS. Ó÷èòûâàÿ òàêîé ðåçîíàíñ, ìîæåò èìååò ñìûñë äèñêóññèîííûå ïîñòû ïåðåíåñòè â ðàçäåë äëÿ âðà÷åé? |
#11
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Tschuppert S, Doell C. The effect of ductal diameter on surgical and medical closure of patent ductus arteriosus in preterm neonates: size matters. J Thorac Cardiovasc Surg. 2008 Jan;135(1):78-82. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïîäîéäåò? Òàì åñòü ôðàçû è ïðî âåñ ðåáåíêà. Íàñ÷åò ïåðåíîñà äèñêóññèè â ïðîôåññèîíàëüíûé îòäåë, ÈÌÕÎ, àáñîëþòíî ïðàâèëüíîå çàìå÷àíèå. |
#12
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Ñïàñèáî çà ñòàòüþ! Òåïåðü ïîíÿòíî, â ÷åì ïðè÷èíà ðàñõîæäåíèÿ âçãëÿäîâ íà âîïðîñ. Èñõîäíî â ïîíÿòèå "óçêèé" ïðîòîê ìû âêëàäûâàëè ðàçíûé ñìûñë: ãåìîäèíàìè÷åñêàÿ çíà÷èìîñòü ÎÀÏ ðàññìàòðèâàåòñÿ è ýòîé ñòàòüå â âàðèàíòå äèëàòàöèè ËÏ (left atrium/aortic root ratio > 1.5) è ïîÿâëåíèè äâóíàïðàâëåííîãî ñáðîñà, ÷òî â äðóãîé ðàáîòå, âñòðåòèâøåéñÿ ìíå (ïðàâäà, óæå ñòàðîâàòîé), äîïîëíåíî ôðàçîé " or ductal size >1.5 mm". Ìåíüøåãî (ò.å. ìåíüøå ÷åì 1,5 ìì) ðàçìåðà ÎÀÏ íåò è â ýòîé âûáîðêå.
Íó à åñëè ÎÀÏ ðàçìåðîì ïî÷òè ñ àîðòó, òóò óæ, äåéñòâèòåëüíî, êàêîé ñìûñë "èíäîìåòàöèíèòü"? |
#13
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Öèòàòà:
Îñíîâíàÿ ôðàçà ðàáîòû, êàê ìíå ïîêàçàëîñü: "PDA closure is still achieved in a very high percentage of premature neonates with medical treatment when the index of PDA diameter squared/birth weight is less than 9 mm2/kg... Patients with an index of greater than 9 mm2/kg would probably benefit from early direct surgical ñlosure without delay at the end of any given medical protocol..." Õîòåëà áû åùå îáðàòèòü âíèìàíèå êîëëåã íà òàêîé ìîìåíò. Íà ôîðóìå ñóùåñòâóåò çàáàâíàÿ ïðàêòèêà, ÷òî ëþáîå ñàìîå íåçàòåéëèâîå è áåçîáèäíîå çàìå÷àíèå íåðåäêî âûçûâàåò ðåàêöèþ, â âèäå òðåáîâàíèÿ íåìåäëåííî âûëîæèòü «ññûëêè íà ðàíäîìèçèðîâàííûå ïëàöåáî-êîíòðîëèðóåìûå èññëåäîâàíèÿ». Ñòåïåíü òðåáîâàòåëüíîñòè çàâèñèò îò ðàçíûõ ôàêòîðîâ è âàðüèðóåò îò ãðóáîé äî äåëàííî èëè èñòèííî âåæëèâîé. Àâòîð áåçîáèäíîãî çàìå÷àíèÿ íà÷èíàåò ñóäîðîæíî ðûñêàòü â ïàáìåäå, ìåäêîíñàëòå è äð. ìåñòàõ, â çàâèñèìîñòè îò ñîáñòâåííûõ âîçìîæíîñòåé, ÷òî êîíå÷íî ïîëåçíî, íî ñîãëàñèòåñü ãîðàçäî ïðèÿòíåé çàíèìàòüñÿ ýòèì âàæíûì äåëîì áåç ïðèíóæäåíèÿ. Ìíå èçâåñòíû ñëó÷àè, êîãäà íîâûå ó÷àñòíèêè ôîðóìà (äîñòàòî÷íî ãðàìîòíûå âðà÷è) óâèäåâ òàêîå îòíîøåíèå, ôàêòè÷åñêè ýëåìåíòû äåäîâùèíû, ïåðåñòàëè â íåì ó÷àñòâîâàòü. Äàííûé òîïèê ÿâëÿåòñÿ èëëþñòðàöèåé ê ìîèì ñëîâàì. Ðàçâå áûëà îøèáêîé ìîÿ ôðàçà: «Ïðèìåíåíèå èíäîìåòàöèíà ïîêàçàíî ïðè óçêèõ ÎÀÏ, ïîýòîìó ñîîáùèòå, ïîæàëóéñòà, ïîëíûå ýõîêàðäèîãðàôè÷åñêèå äàííûå». Ïðè ýòîì ÿ îõîòíî ïðèçíàþ, ÷òî ìîå çàìå÷àíèå áûëî êðàéíå íåïîëíûì, äàæå ñ ó÷åòîì òîãî, ÷òî åå àíàëîã âîøåë îäíèì èç ïóíêòîâ â ôèíàëüíûé îòâåò ðîäñòâåííèêó áîëüíîãî. Ìû âñå ó÷èëèñü ïðèìåðíî ïî îäíèì êíèãàì, èñòî÷íèêè èíôîðìàöèè ó íàñ îäíè è òå æå. Ìíå áûëî âî ñòî êðàò ïðèÿòíåå, åñëè áû çàìå÷àíèå ê ìîåìó ñîîáùåíèþ âûãëÿäåëî ïðèìåðíî òàê: «Â äîïîëíåíèå ê ïðåäûäóùåìó çàìå÷àíèþ îòìå÷ó, ÷òî ýòîò âèä òåðàïèè ïðîâîäèòñÿ ïðàêòè÷åñêè èñêëþ÷èòåëüíî ó íåäîíîøåííûõ íîâîðîæäåííûõ, ïîýòîìó ñîîáùèòå, ïîæàëóéñòà, äîïîëíèòåëüíî íà êàêîì ñðîêå è ñ êàêèì âåñîì ðîäèëñÿ ðåáåíîê, êîãäà áûë âûïèñàí äîìîé, è òä äàëåå ïî òåêñòó... Ñ ó÷åòîì âûñêàçàííîãî âûøå ïîæåëàíèÿ î íåîáõîäèìîñòè ïðåäñòàâèòü ïîëíûé ÝÕÎ ïðîòîêîë» Áûëà ðàäà, ïîäåëèòñÿ èìåþùèìèñÿ ó ìåíÿ ññûëêàìè ïî äàííîé ïðîáëåìå. |
#14
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Öèòàòà:
Öèòàòà:
Öèòàòà:
 ëþáîì ñëó÷àå, ïðèíîøó Âàì èçâèíåíèÿ, åñëè â õîäå äèñêóññèè Âàñ ÷òî-òî îáèäåëî. Ìû âñåãäà ðàäû íîâûì âðà÷àì íà ôîðóìå. P.s. ÿ áû íè êàê íå ïðè÷èñëèë ó÷àñòíèêîâ äèñêóññèè ê «äåäàì» ÐÌÑ , òàê ÷òî äåäîâùèíû â äàííîì êîíêðåòíîì ñëó÷àå íå áûëî )) |
#15
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Öèòàòà:
Ñ óâàæåíèåì, Êèðà. |