|
#1
19.06.2009, 20:38
|
||||
|
||||
|
Ферментые препараты после резекции желудка
Одобрялка на Еgor1974 не работает.
From the Department of Surgery, Mount Sinai Hospital, New York, N. Y. Summary and Conclusions Resection of the stomach—total, proximal, or distal—accompanied or not by vagisection, is followed by physiologic derangements which derive from mechanical and anatomic alterations, functional disorganization, and metabolic aberration. These derangements manifest themselves in various syndromes which may be grouped as: (1) deficiency syndromes, (2) cardio-respiratory syndromes, (3) syndromes of homeostatic over-reaction, and (4) syndromes reflecting discoordination of normal feedback mechanisms. Elucidation of the basic etiologic physiology has tremendously enhanced our comprehension of pathogenesis but considerable gaps in knowledge still hinder our goal of a postgastrectomy patient without dyspepsia. True, there are certain metabolic alterations which are inherent in the anatomic changes wrought by gastric surgery, but we must not be overawed by these impediments, and, above all, we must not forget that a patient exists surrounding the stomach, so that the results of gastric surgery must be profoundly influenced by extragastric and even extrasomatic or psychic factors. Physiologic derangements following gastric resection Journal Digestive Diseases and Sciences Volume 7, Number 3 
|
|
#2
19.06.2009, 20:54
|
||||
|
||||
|
Цитата:
Цитата:
Цитата:
|
|
#4
19.06.2009, 21:01
|
||||
|
||||
|
А я не спорю с тем, что удаление части или всего желудка может сопровождаться рядом серьезных проблем. Но это огромный раздел хирургии, именно - огромный.
Был конкретный вопрос: Цитата:
Цитата:
Цитата:
|
|
#5
19.06.2009, 21:32
|
||||
|
||||
|
Цитата:
 Кстати, я так и не разобрался, там в баночках панкреатины содержатся?
|
|
#6
19.06.2009, 21:37
|
|||
|
|||
|
Цитата:
Цитата:
|
|
#7
19.06.2009, 21:45
|
||||
|
||||
|
Кажется, что-то подобное было упомянуто:
Guidelines for Pancreatic Enzyme Supplementation • Take capsules or tablets with meals or snacks. Typical dose is 2-3 capsules with meals and 1–2 capsules with snacks (lipase units vary per brand). Titrate dose as needed based on clinical response such as continued diarrhea or weight loss. • To protect enteric coating, do not crush or chew the microspheres or microtablets. If swallowing of the capsules is difficult, open and shake contents into a small quantity of soft non-hot food (applesauce, jello) and swallow immediately. Viokase powder may be another alternative to opening capsules. • Viokase Powder (Axcan Scandipharm) may be used with tube feeding. Administer 1/2 tsp/can tube feeding. *Adapted from [Ссылки доступны только зарегистрированным пользователям ] Drug Facts and Comparisons From: Post-Gastrectomy: Managing the Nutrition Fall-Out
|
|
|
|
#8
19.06.2009, 21:50
|
||||
|
||||
|
Цитата:
|
|
#10
19.06.2009, 22:35
|
||||
|
||||
|
В целом, это прерогатива леч. врача - заподозрить патологию на основании жалоб или анализов и рекомендовать лечение или диету, но с учетом белорусских особенностей врачевания, лучше всего самостоятельно ознакомиться с мировыми рекомендациями (напр. перевести эти данные [Ссылки доступны только зарегистрированным пользователям ] ) и самим их придерживаться (напр. не ждать когда разовьются симптомы железодеф. анемии или дефицита кобаламина, а давать профилактически согласно изложенному в тексте).
|
|
#11
19.06.2009, 22:40
|
||||
|
||||
|
Цитата:
|
|
#12
19.06.2009, 22:47
|
||||
|
||||
|
PHP код:
А энзимы,пусть полежат на поках в аптеке,поскольку профилактически они НЕ нужны,а исходя из того,что дедушка не имеет диспептических расстройств,и хорошо переносит кашки с котлетками,то и в лечении ими,он НЕ нуждается.
|
|
#13
20.06.2009, 07:16
|
|||
|
|||
|
Существует мнение, что ферменты необходимо назначать всем больным с тотальной
гастрэктомией по поводу рака желудка. Подразумевается, что сопутствующая региональная лимфодиссекция денервирует поджелудочную железу и нормальная внешнесекреторная функция при этом сохранится не может - ...In our study, all of the patients underwent total gastrectomy because of gastric cancer. Because of this, all patients underwent lymph node dissection. During this procedure, most gastropancreatic nerves are destroyed. Together with the truncal vagotomy, this operative procedure results in a nearly complete extrinsic denervation of the pancreas.... Maldigestion after Total Gastrectomy is Associated with Pancreatic Insufficiency American Journal of Gastroenterology - Volume 91, Issue 2 (February 1996) Objectives: Subsequent to total gastrectomy, many patients develop maldigestion and weight loss. The mechanisms that underlie these changes are not known. Therefore, in a prospective study, we have analyzed endocrine and exocrine pancreatic function in patients before and 3 months after total gastrectomy. Methods: In 15 patients (12 male, three female, median age 62.4 yr) undergoing total gastrectomy due to gastric cancer, a direct exocrine pancreatic function test (secretin-cerulein test) was performed. In addition, a standard test meal was given to all patients to study endocrine pancreatic function and the pattern of hormones that influence exocrine pancreatic secretion. In nine patients, both function tests were repeated 3 months after total gastrectomy. Before and at 11 points after the application of the test meal, blood samples were taken for the measurement of glucose, insulin, glucagon, gastrin, pancreatic polypeptide, and cholecystokinin. In addition, a secretin-cerulein test was performed to analyze trypsin, chymotrypsin, amylase, bicarbonate, and the juice volume in the duodenal aspirates. Results: Three months after total gastrectomy, all patients exhibited severe primary exocrine pancreatic insufficiency. Secretin-cerulein tests revealed that pancreatic juice secretion, trypsin, chymotrypsin, and amylase were significantly reduced by 76%, 89%, 91%, and 72%, respectively, 3 months after total gastrectomy and secretin and cerulein stimulation. Postoperatively, the patients had a pathological glucose tolerance with increased postprandial insulin and glucagon secretion. The baseline and postprandial gastrin and pancreatic polypeptide secretion were significantly decreased after total gastrectomy. In contrast, early postprandial cholecystokinin secretion was significantly increased postoperatively. Conclusions: After total gastrectomy, patients develop severe primary exocrine pancreatic insufficiency with decreased gastrin, decreased late postprandial pancreatic polypeptide, and increased cholecystokinin levels. These findings may explain why many patients with total gastrectomy have maldigestion and weight loss postoperatively. Therefore, gastrectomized patients should be given pancreatic enzymes to avoid these symptoms. P.S. Статья есть в mdconsult
|
|
#14
20.06.2009, 12:55
|
||||
|
||||
|
У нас больным, перенесшим гаcтректомию даётся ( Pancreatin
Supplements of pancreatin are given by mouth to compensate for reduced or absent exocrine secretion in cystic fibrosis, and following pancreatectomy, gastrectomy, or chronic pancreatitis. They assist the digestion of starch, fat, and protein различной "силы"). Компенсированным: Pancrex V®(Paines & Byrne) Capsules, pancreatin (pork), providing minimum of: protease 430 units, lipase 8000 units, amylase 9000 units.
|
|
#15
23.06.2009, 09:02
|
||||
|
||||
|
И все же я не увидел оснований для профилактического назначения энзимов. Цитированная работа - одна из немногих в Пабмеде на эту тему. При этом, мы говорим об эффективности лечения, а работа:
- не РКИ; - экзокринная функция железы оценивалась по функциональным тестам, без рассмотрения клинической картины; Вообще непонятно, была ли клиника ферментной недостаточности. В выводах: Цитата:
Цитата:
Цитата:
|
Линейный вид
