#61
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 îêòÿáðå 2005 â Ðîñòîâå íà ñüåçäå õèðóðãîâ â ðàçäåëå ôëåáîëîãèè ïðîçâó÷àëî íåñêîëüêî (!) ñîîáùåíèé î ïðèìåíåíèè ëèãèðîâàíèÿ íå òîëüêî áåäðåííîé, íî è, êàæåòñÿ, ïîëîé âåíû! ß äóìàë, îñëûøàëñÿ.  ìàòåðèàëàõ äîëæíî áûòü, åñëè õîòèòå - ïîñìîòðþ.
Âíÿòíîãî îòðàñëåâîãî ñòàíäàðòà, êîòîðûé áû áûë ïðèíÿò ïðèêàçîì ïî ÌÇ è ðåãëàìåíòèðîâàë áû ïðèìåíåíèå ôèëüòðîâ è òðîìáýêòîìèè ÿ íå âèäåë. Ïðîöèòèðóéòå, åñëè ìîæíî? |
#62
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Common sense is not common...unfortunately. |
#63
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thorn
[Íàäåþñü, ÌÍÎ êîíòðîëèðóåòå?]
Äà, âñå ïîä êîíòðîëåì, ò.ê. ó ìåíÿ êî âñåìó ìíîæåñòâåííàÿ ìèåëîìà â ñòàäèè ðåìèññèè ïîñëå ÒÊÌ. Ìíå ñòàâèëè êàâàôèëüòð â 1 ãðàäñêîé, ðå÷è î òîì ÷òîáû ñíÿòü ôèëüòð íå áûëî. Ñêàçàëè, ÷òî îí óõóäøàåò êà÷åñòâî æèçíè. Íàäî ëè ñíèìàòü? |
#64
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Ýòî åùå ðàç äåìîíñòðèðóåò óðîâåíü ôëåáîëîãèè â íàøåé ñòðàíå. Ïî-ïîâîäó ñòàíäàðòîâ. Äîëæåí çàìåòèòü, ÷òî ðå÷ü èäåò î ñòàíäàðòàõ ÎÌÑ, â êîòîðûå ýíäîâàñêóëÿðíàÿ õèðóðãèÿ íå âêëþ÷åíà ïî îïðåäåëåíèþ. Ýòè ñòàíäàðòû âîîáùå î÷åíü äàëåêè îò òîãî êàê íà ñàìîì äåëå íóæíî ëå÷èòü ïàöèåíòîâ â 21 âåêå. Åñëè ìèíçäðàâ âêëþ÷èò â ñòàíäàðò ëå÷åíèÿ êàâà-ôèëüòðû, òî èì ïðèäåòñÿ èõ îïëà÷èâàòü. À äåíüãè ãäå? |
#65
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#66
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#67
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#68
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Îé, áîëüíîå ìåñòî... Ïðî áèíòû è ïð.
Ñíà÷àëà ó ìåíÿ áûë áèíò. Ýòî ãàäîñòü, òàê êàê ñàìà ÿ çàáèíòîâàòüñÿ íå óìåëà è òàê è íå íàó÷èëàñü. 200 ð ïñó ïîä õâîñò. Íà òðåòèé äåíü ÿ êóïèëà 2 ïàðû êîëãîòîê è 2 ïàðû êîðîòêèõ ÷óëêîâ (ãîëüôû) - êîëãîòêè ïî 1000 ð, ãîëüôû - 450. È ýòî íå î÷åíü õîðîøåå ïî êà÷åñòâó (õîðîøåãî ó íàñ â ãîðîäå ïðîñòî íåò). Êîíå÷íî, áûëî áû î÷åíü çäîðîâî, åñëè áû ýòî õîòÿ áû ÷àñòè÷íî âõîäèëî â ÎÌÑ. Ïëþñ âàðôàðèí, àñïèðèí, äåòðàëåêñ... |
#69
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#70
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Ðàçãîâîð êàê-òî èñ÷åðïàë ñåáÿ, íî ìíå õîòåëîñü áû êîå ÷òî óòî÷íèòü.
Senya-122 äâà ðàçà ïèñàë çäåñü î ïðèêàçå 233 îò 2003 ãîäà. ß òàê ïîíèìàþ, ðå÷ü èäåò îá " Îòðàñëåâîé ñòàíäàðò ÎÑÒ 91500.11.0007-2003 Ñèñòåìà ñòàíäàðòèçàöèè â çäðàâîîõðàíåíèè Ðîññèéñêîé Ôåäåðàöèè "Ïðîòîêîë âåäåíèÿ áîëüíûõ. ïðîôèëàêòèêà òðîìáîýìáîëèè ëåãî÷íîé àðòåðèè ïðè õèðóðãè÷åñêèõ è èíûõ èíâàçèâíûõ âìåøàòåëüñòâàõ"". [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Íî ýòî ñòàíäàðò ïðîôèëàêòèêè ïðè âìåøàòåëüñòâàõ, à ÿ, ãîâîðÿ îá îòñóòñòâèè âíÿòíûõ ðåãëàìåíòèðîâàííûõ ïîêàçàíèé ê ôèëüòðàì è òðîìáýêòîìèè, èìåë ââèäó ñîáñòâåííî ÒÃÂ. Îòíîñèòåëüíî ñâåæèå(2005Ã) ðåêîìåíäàöèè ðàáî÷åé ãðóïïû ýêñïåðòîâ îò Âñåðîññèéñêîé àññîöèàöèè ïî èçó÷åíèþ òðîìáîçîâ, ãåìîððàãèé è ïàòîëîãèè ñîñóäîâ èìåíè À.À.Øìèäòà-Á.À.Êóäðÿøîâà è Àññîöèàöèè ôëåáîëîãîâ Ðîññèè - ïðàêòè÷åñêè öèòèðîâàíèå ðåêîìåíäàöèé ÀÑÑÐ. Ïî ôèëüòðàì è òðîìáýêòîìèÿì - äâà ñëîâà. ×òî êàñàåòñÿ ôëîòèðóþùèõ òðîìáîâ - î÷åíü ÿñíî è àðãóìåíòèðîâàííî ãîâîðèë òóò Êîíñòàíòèí Ïàíêîâ, íî ìàëîâàòî äàííûõ îäíîãî èññëåäîâàíèÿ, ÷òîáû óâåðîâàòü â ðàâíóþ îïàñíîñòü ôëîòèðóþùèõ è îêëþçèîííûõ òðîìáîâ. Êñòàòè, óâàæàåìûé Êîíñòàíòèí, âîò ñêóïàÿ èíôîðìàöèÿ ïî äðóãîìó ïðñïåêòèâíîìó èññëåäîâàíèþ, ïðàâäà î÷åíü ñòàðîìó, ñ èíûìè âûâîäàìè. "We have prospectively studied a series of 121 consecutive patients with venous thromboembolism (38 with pulmonary embolism, 83 with venous thrombosis of the lower extremities) searching for recurrences of pulmonary embolism despite adequate heparin therapy. A baseline ventilation-perfusion lung scan was obtained initially in every patient, whether the original diagnosis was pulmonary embolism or venous thrombosis. Repeat chest roentgenograms and lung scans were obtained routinely at eight days of heparin treatment. The primary trial endpoints were a finding of a clinically apparent recurrent pulmonary embolism, or laboratory evidence of subclinical pulmonary embolism. Eight items of clinical and laboratory information were recorded at admission and then correlated with the lung scan results. Recurrences were seen in seven of 38 patients with an original diagnosis of pulmonary embolism, and in five of 83 patients admitted because of venous thrombosis (p = 0.034). Recurrences were also more frequent in patients with a free-floating thrombus on venography (p = 0.014). The risk of new defects in patients with venous thrombosis and without free-floating thrombus was 3.05 percent, venous thrombosis with free-floating thrombus, 13.33 percent; patients with pulmonary embolism without free-floating thrombus, 11.42 percent; and with free-floating thrombus, 38.67 percent. Venography seems thus mandatory in patients with pulmonary embolism, as it recognizes a subgroup of patients at a high risk of recurrences." Chest. 1989 May;95(5):976-9. Related Articles, Links Recurrent pulmonary embolism. A prospective study. Monreal M, Ruiz J, Salvador R, Morera J, Arias A. |
#71
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#72
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Ñïàñèáî, ÷òî âûâåñèëè ýëåêòðîííûé âàðèàíò ñòàíäàðòà. Ñïðàøèâàòü áóäóò ñ ýòîãî ñòàíäàðòà, à íå ñ ìíåíèÿ êîãî-òî. È ïîñòóïàòü íåîáõîäèìî òàê. À îòðàñëåâîé ñòàíäàðò è ÎÌÑ - ýòî ðàçíûå âåùè. À äåíüãè , è çäîðîâüå - ýòî Âàøå.
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#73
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Ïîñòîÿííûé êàâà-ôèëüòð
Ó ìåíÿ âîïðîñ ïî ïîâîäó ïîñòîÿííîã êàâà-ôèëüòðà? Ñêàæèòå ïîæàëóéñòà íóæíî ëè ïðè óñòàíîâêå ïîñòîÿííîãî êàâà-ôèëüòðà ïîæèçíåííî ïðèíèìàòü âàðôàðèí, ëèáî äîñòàòî÷íî ïðèåì ýòîãî ëåêàðñòâà 6 ìåñ. è íîñèòü êîìïðåññèîííûé òðèêîòàæ. Ïîÿñíþ: ó ìîåé ìàìû ïîñëå òðàâìû íîãè áûë îáíàðóæåí òðîìáîç ãëóáîêèõ âåí, íåñìîòðÿ íà ïðîâîäèìóþ àíòèêîàãóëÿíòíóþ òåðàïèþ òðîìáîç íàðàñòàë è áûëî ïðèíÿòî ðåøåíèå óñòàíîâèòü ôèëüòð. Õèðóðã, óñòàíàâëèâàþùèé ôèëüòð ñêàçàë, ÷òî ïðèíèìàòü âàðôàðèí äîñòàòî÷íî 6 ìåñ., îäíàêî çàâåäóþùèé îòäåëåíèåì ñ íèì íå ñîãëàñåí è âåäåò ðå÷ü î ïîæèçíåííîì ïðèåìå ýòîãî ëåêàðñòâà. Õîòåëîñü áû óñëûøàòü âàøå ìíåíèå ïî ýòîìó âîïðîñó!
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#74
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Íàñêîëüêî ÿ çíàþ - âî âðåìÿ âïåðâûå âîçíèêøåãî òðîìáîôëåáèòà ãëóáîêèõ âåí âàðôàðèí ïðèíèìàþò 3-6 ìåñÿöåâ, â ñëó÷àå ïîâòîðíîãî òðîìáîôëåáèòà - íå ìåíåå ãîäà.
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#75
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