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Õèìè÷åñêèé îæîã
Çäðàâñòâóéòå óâàæàåìûå êîëëåãè! Î÷åíü íðàâèòñÿ ÷èòàòü ôîðóì, è äëÿ ìåíÿ îí ñòàë íàñòîÿùèì îòêðûòèåì!!! Ñïàñèáî âàì!!! Õî÷ó ïîñîâåòîâàòüñÿ ñ âàìè ïî äàëüíåéøåé òàêòèêå â ñëåäóþùèé ñèòóàöèè. 10 äíåé íàçàä íà ïðè¸ì ïðèøëà ïàöèåíòêà ñ õèìè÷åñêèé îæîãîì ðîãîâèöû è êîíúþíêòèâû, ïîëó÷åííûì åé íàêàíóíå óêñóñíîé êèñëîòîé. Ñðàçó ïîñëå ñëó÷èâøåãîñÿ ïàöèåíòêà ñàìà ïðîìûëà ãëàç âîäîé ñ ñîäîé. È îáðàòèëàñü â ãëàçíîé òðàâìïóíêò, ãäå åé íàçíà÷åíî ëå÷åíèå: öèïðîëåò 6 ðàç, òàóôîí 6 ðàç è êîðíåðåãåëü 4 ðàçà. Êî ìíå îíà ïðèøëà íà ñëåäóþùèé äåíü ïîñëå ýòèõ ñîáûòèé. Ïðè îñìîòðå: visus Os -0,7. Ãëàçíàÿ ùåëü ñóæåíà. Õåìîç è âûðàæåííàÿ ãèïåðåìèÿ êîíüþíêòèâû, åäèíè÷íûå ïåòåõèàëüíûå êðîâîèçëèÿíèÿ.  öåíòðå îïòè÷åñêîé çîíû ðîãîâèö
û ýðîçèÿ 1,5*1,5 ìì, ðîãîâèöà ñëåãêà îòå÷íàÿ. Ãëóáëåæàùèå ñðåäû áåç îñîáåííîñòåé.  òå÷åíèå 10 äíåé ïàöèåíòêà äîïîëíèòåëüíî ê âûøåïåðå÷èñëåííûì ïðåïàðàòàì ïîëó÷àëà áàëàðïàí, äåêñàìåòàçîí. Íà ñåãîäíÿøíèé äåíü ýðîçèÿ çàýïèòåëèçèðîâàëàñü, íà ðîãîâèöå âûðàæåííûé îòåê, êîíúþíêòèâà áëåäíàÿ, òîëüêî âî âíóòðåííåì óãëó ðàñøèðåííûå, ïîëíîêðîâíûå ñîñóäû ê-âû, âèçóñ 0,2. Ñåãîäíÿ ðåêîìåíäîâàëà íà÷àòü ôîðñàæ 40% ãëþêîçîé. À ó ñàìîé äóøà áîëèò! Êàê áûòü äàëüøå, êîëëåãè? Ïîäñêàæèòå!!! |
#2
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à çà÷åì ãëþêîçíûé ôîðñàæ? êðîìå ñòåðîèäîâ, ïðè õèìè÷åñêîì îæîãå ãëàç ðåêîìåíäóåòñÿ àñêîðáèíêà âíóòðü è ìåñòíî è èíãèáèòîðû êîëëàãåíàçû, ïîäðîáíåå íà àíãëèéñêîì:
Drugs that support repair and minimizing ulceration Ascorbate: Ascorbate is an essential water soluble vitamin that is a cofactor in rate limiting step of collagen formation. Supplementation of ascorbate by restoring depleted aqueous ascorbate levels reduces the incidence of corneal thinning and ulceration. Oral ascorbate (2 g/day) and topical 10% solution formulated in artificial tears are effective Collagenase inhibitors: Collagenase inhibitors promote wound healing by inhibiting collagenolytic activity and thus preventing stromal ulceration. Several collagenase inhibitors including cysteine, acetylcysteine, sodium ethylenediamine tetra acetic acid (EDTA), calcium EDTA, penicillamine and citrate have been reported to be efficacious. Only 10-20% acetylcysteine (mucomist) is available commercially. It is an unstable solution and has to be refrigerated and used within 1 week of its preparation. --- Ocular chemical injuries and their management [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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Ïîäðîáíåå î äîçèðîâêå è % ìåñòíûõ ðàñòâîðîâ â òàáëèöå 4 ïî ññûëêå íèæå, òàì æå î èñïîëüçîâàíèè àóòîñûâîðîòêè êðîâè èëè åé æå, íî îáîãàùåííîé òðîìáîöèòàìè, íå çíàþ, íàâåðíîå ó Âàñ íåò òåõíè÷åñêîé âîçìîæíîñòè ãîòîâèòü è ïðèìåíÿòü òðîìáîöèòàðíóþ ïëàçìó:
Current and Upcoming Therapies for Ocular Surface Chemical Injuries [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#4
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Ôîðñàæ ãëþêîçîé, ýòî âðîäå êàê àíàëîã âàííî÷åê ñ ãëþêîçîé, êîòîðûå èñïîëüçóþòñÿ ïðè îò¸êàõ ðîãîâèöû ( íàïðèìåð ïîñëåîïåðàöèîííûõ). Àñêîðáèíîâóþ êèñëîòó çàêàïûâàòü ðåêîìåíäîâàëà, íî ïàöèåíòêà íå ñìîãëà èç çà æóòêîãî ææåíèÿ îò çàêàïûâàíèÿ, ñ å¸ ñëîâ ãëàç ñèëüíî äåð¸ò, íåâîçìîæíî òåðïåòü. Ñïàñèáî çà ïðåäîñòàâëåííóþ èíôîðìàöèþ, ñåé÷àñ îçíàêîìëþñü.
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#5
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ýòî ïîòîìó, ÷òî ðÍ ó ðàñòâîðà àñêîðáèíîâîé êèñëîòû íèçêèé, îôòàëüìîëîãè èñïîëüçóþò 10% ðàñòâîð àñêîðáàòà êàëèÿ, êàê ïðèìåð èç àïòåê Áðèòàíèè:
Potassium Ascorbate (Ascorbic acid) (eye drops) Formulary: drops 10% (Unlicensed Product) Sodium Citrate (eye drops) Formulary: drops 10.11% (preservative free) (Unlicensed Product) Used for acid and alkali burns to the cornea êàê ïîíèìàþ, åãî â àìáóëàòîðíûõ óñëîâèÿõ ìîæíî ïðèãîòîâèòü èç ðàñòâîðà âèòàìèíà Ñ â àìïóëàõ è ýêâèìîëÿðíîãî êîëè÷åñòâà ïèòüåâîé ñîäû: Ascorbic acid and potassium bicarbonate are refined to a purity of at least 97% These two chemicals are then mixed in cold water to produce potassium ascorbate. Potassium ascorbate is a less acidic form of vitamin C than ascorbic acid...
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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Ñïàñèáî çà ðàçúÿñíåíèÿ. ×åñòíî ãîâîðÿ ñàìà ïîáàèâàþñü ðàçâîäèòü. Óçíàþ, ñìîãóò ëè â àïòåêå ó íàñ ýòî ñäåëàòü. Ïðèøëà èäåÿ, à ÷òî åñëè ïåðåä çàêàïûâàíèåì àñêîðáèíêè èñïîëüçîâàòü àíåñòåòèê??
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#7
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íå óâåðåí, ÷òî åòî áóäåò õîðîøî, òàê êàê çàêèñëåííàÿ ñðåäà â ãëàçó ìîæåò ïëîõî âëèÿòü íà çàæèâëåíèå, äàæå åñëè ïàöèåíò íå áóäåò ÷óâñòâîâàòü
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#8
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×òî ñ ðàäóæêîé, å¸ âèäíî? Òàì èðèäîöèêëèòà íåò?
Öèêëîïëåãèêè íå íàçíà÷àëè?
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Ñ óâàæåíèåì, Àéñëó Æàðìóõàíîâà |
#9
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Ðàäóæêà è çðà÷îê ïðîñìàòðèâàþòñÿ. Ðàäóæêà ñòðóêòóðíà, íå èçìåíåíà â öâåòå, çðà÷îê îêðóãëîé ôîðìû, 3-4ìì, ðåàãèðóåò íà ñâåò æèâî. Ñèíåõèé íåò. ÂÃÄ = 22,0 ïî Ìàêëàêîâó. Öèêëîïëåãèêè íå íàçíà÷àëèñü.
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