{"id":107104,"date":"2017-09-10T10:49:58","date_gmt":"2017-09-10T09:49:58","guid":{"rendered":"http:\/\/zakrasnejsivimperk.cz\/?p=107104"},"modified":"2017-09-10T13:19:55","modified_gmt":"2017-09-10T12:19:55","slug":"ceske-budejovice-v-kraji-se-podarilo-zpetinasobit-pocet-uspesne-akutne-lecenych-pacientu-s-mrtvici","status":"publish","type":"post","link":"https:\/\/zakrasnejsivimperk.cz\/?p=107104","title":{"rendered":"\u010cESK\u00c9 BUD\u011aJOVICE: V kraji se poda\u0159ilo zp\u011btin\u00e1sobit po\u010det \u00fasp\u011b\u0161n\u011b akutn\u011b l\u00e9\u010den\u00fdch pacient\u016f s mrtvic\u00ed"},"content":{"rendered":"
Kdy\u017e se \u0159ekne neurologie, ve\u0159ejnost si v\u011bt\u0161inou vybav\u00ed bolesti hlavy \u010di zad. To je v\u0161ak jen pomysln\u00e1 kapka v\u00a0mo\u0159i pr\u00e1ce \u010deskobud\u011bjovick\u00fdch neurolog\u016f, kte\u0159\u00ed jsou nenahraditeln\u00ed nap\u0159\u00edklad p\u0159i l\u00e9\u010db\u011b mozkov\u00fdch p\u0159\u00edhod. O bolestech zad, l\u00e9\u010db\u011b ikt\u016f i o dal\u0161\u00ed p\u00e9\u010di poskytovan\u00e9 na Neurologick\u00e9m odd\u011blen\u00ed jsme si pov\u00eddali s\u00a0prim\u00e1\u0159em MUDr. Svatoplukem Ostr\u00fdm, Ph.D.<\/h6>\n

Na bolesti zad si ob\u010das st\u011b\u017euje snad ka\u017ed\u00fd. Jak\u00e9ho p\u016fvodu b\u00fdvaj\u00ed bolesti zad, a je v\u00a0jejich l\u00e9\u010db\u011b rozd\u00edl?<\/strong><\/p>\n

\"\"Prost\u00e9 akutn\u00ed bolesti zad maj\u00ed velk\u00e9 mno\u017estv\u00ed p\u0159\u00ed\u010din, v\u010detn\u011b psychick\u00fdch. Naprost\u00e1 v\u011bt\u0161ina bolest\u00ed v\u0161ak nen\u00ed pro pacienta z\u00e1va\u017en\u00e1, l\u00e9\u010dba je dob\u0159e zn\u00e1m\u00e1 a dostupn\u00e1 prakticky v\u0161ude. T\u00e9m\u011b\u0159 v\u0161ichni pacienti se vyl\u00e9\u010d\u00ed v\u00a0\u0159\u00e1du n\u011bkolika dn\u016f a\u017e t\u00fddn\u016f bez n\u00e1sledk\u016f. Potenci\u00e1ln\u011b z\u00e1va\u017en\u00e9 p\u0159\u00ed\u010diny bolest\u00ed zad tvo\u0159\u00ed malou skupinu. Proto bylo p\u0159ed v\u00edce ne\u017e 30 lety ve Velk\u00e9 Brit\u00e1nii vytvo\u0159eno sch\u00e9ma tzv. \u010derven\u00fdch prapork\u016f, kter\u00e9 slou\u017e\u00ed k\u00a0rozpozn\u00e1n\u00ed pacient\u016f vy\u017eaduj\u00edc\u00edch intenzivn\u00ed a kvalifikovanou p\u00e9\u010di od m\u00e9n\u011b z\u00e1va\u017en\u00fdch p\u0159\u00edpad\u016f. Neurolog pacienty s\u00a0leh\u010d\u00edmi formami bolest\u00ed prim\u00e1rn\u011b nel\u00e9\u010d\u00ed, nen\u00ed k\u00a0tomu \u017e\u00e1dn\u00fd medic\u00ednsk\u00fd d\u016fvod.<\/em><\/p>\n

Tak\u017ee neurologie se t\u00fdkaj\u00ed hlavn\u011b z\u00e1va\u017en\u011bj\u0161\u00ed p\u0159\u00edpady? Jak jejich l\u00e9\u010dba prob\u00edh\u00e1?<\/strong><\/p>\n

P\u0159irozen\u00fd pr\u016fb\u011bh akutn\u00edch bolest\u00ed zad vede ke spont\u00e1nn\u00ed n\u00e1prav\u011b v\u00a0\u0159\u00e1du n\u011bkolika m\u00e1lo t\u00fddn\u016f. Na\u0161im hlavn\u00edm c\u00edlem je vy\u0159e\u0161it pacient\u016fv probl\u00e9m brzy, aby se akutn\u00ed stav nezm\u011bnil v chronick\u00fd. \u010c\u00e1st l\u00e9\u010dby je farmakologick\u00e1. \u00da\u010dinek jednotliv\u00fdch analgetik je na ti\u0161en\u00ed bolesti a zlep\u0161en\u00ed funkce zad velmi mal\u00fd! U\u00a0chronick\u00fdch bolest\u00ed jsou \u00fa\u010dinky analgetik je\u0161t\u011b men\u0161\u00ed.<\/em><\/p>\n

Druh\u00e1 \u010d\u00e1st l\u00e9\u010dby, ta nejz\u00e1sadn\u011bj\u0161\u00ed, je rehabilita\u010dn\u00ed. Kl\u00ed\u010dem k\u00a0\u00fasp\u011bchu je \u201evt\u00e1hnout pacienta\u201c do l\u00e9\u010dby, aktivn\u011b jej zapojit do p\u00e9\u010de o sebe. Pacient mus\u00ed na z\u00e1klad\u011b kvalifikovan\u00e9 instrukt\u00e1\u017ee fyziatrem nebo fyzioterapeutem za\u010d\u00edt co nejd\u0159\u00edve pracovat s\u00e1m na sob\u011b. Rehabilitace by m\u011bla b\u00fdt pacientovi u\u0161ita na m\u00edru, pacient pak cvi\u010d\u00ed s\u00e1m v\u00a0dom\u00e1c\u00edm prost\u0159ed\u00ed. P\u0159edm\u011btem kontrol jsou korekce cvi\u010den\u00ed a \u00faprava jeho sch\u00e9matu. Pokud se pacient intenzivn\u011b nepod\u00edl\u00ed na sv\u00e9 l\u00e9\u010db\u011b, efekt se nedostav\u00ed a\u00a0doch\u00e1z\u00ed \u010dasto ke vzniku chronick\u00fdch obt\u00ed\u017e\u00ed.<\/em><\/p>\n

T\u0159et\u00ed, av\u0161ak nem\u00e9n\u011b d\u016fle\u017eitou \u010d\u00e1st\u00ed l\u00e9\u010dby je psychoterapie. Dle posledn\u00edch doporu\u010den\u00ed by m\u011bla b\u00fdt b\u011b\u017enou sou\u010d\u00e1st\u00ed l\u00e9\u010dby, proto\u017ee bolesti zad jsou nej\u010dast\u011bj\u0161\u00ed transformac\u00ed stresov\u00fdch z\u00e1\u017eitk\u016f do t\u011blesn\u00fdch stesk\u016f.<\/em><\/p>\n

M\u016f\u017eeme bolestem zad p\u0159edch\u00e1zet?<\/strong><\/p>\n

Samoz\u0159ejm\u011b, je to civiliza\u010dn\u00ed nemoc! Hlavn\u00ed p\u0159\u00ed\u010dinou bolest\u00ed zad je \u017eivotn\u00ed styl. Do n\u011bj pat\u0159\u00ed nejen pracovn\u00ed zat\u00ed\u017een\u00ed, ale zejm\u00e9na n\u00e1pl\u0148 volno\u010dasov\u00fdch aktivit, d\u00e1le v\u00fd\u017eiva, resp. obezita.<\/em><\/p>\n

V\u00a0r\u00e1mci Oborov\u00e9 konference jiho\u010desk\u00fdch neurolog\u016f jste na ja\u0159e p\u0159edstavili novinky v\u00a0l\u00e9\u010db\u011b c\u00e9vn\u00edch mozkov\u00fdch p\u0159\u00edhod (d\u00e1le jen CMP). V\u00a0\u010dem spo\u010d\u00edvaj\u00ed?<\/strong><\/p>\n

Novinek je n\u011bkolik. Jednou z\u00a0nich je zkr\u00e1cen\u00ed \u010dasu od ohl\u00e1\u0161en\u00ed p\u0159\u00edpadu do l\u00e9\u010dby. To se t\u00fdk\u00e1 hlavn\u011b pacient\u016f s\u00a0t\u011b\u017ekou mrtvic\u00ed, kte\u0159\u00ed jsou nejv\u00edc ohro\u017eeni invaliditou. Tuto dobu jsme zkr\u00e1tili d\u00edky jednoduch\u00e9mu a z\u00e1rove\u0148 spolehliv\u00e9mu syst\u00e9mu p\u0159ednemocni\u010dn\u00ed p\u00e9\u010de, kter\u00fd zrychluje dopravu \u201espr\u00e1vn\u00e9ho\u201c pacienta do \u201espr\u00e1vn\u00e9ho\u201c centra tak, aby dostal adekv\u00e1tn\u00ed l\u00e9\u010dbu co nejd\u0159\u00edv. To je nejv\u00fdznamn\u011bj\u0161\u00ed faktor ovliv\u0148uj\u00edc\u00ed v\u00fdsledek.<\/em><\/p>\n

Druhou novinkou je emergentn\u00ed neurochirurgick\u00e1 l\u00e9\u010dba akutn\u00ed mrtvice. Nadstandardn\u00ed spolupr\u00e1ce v\u00a0Komplexn\u00edm cerebrovaskul\u00e1rn\u00edm centru na\u0161\u00ed nemocnice umo\u017enila poskytnout opera\u010dn\u00ed \u0159e\u0161en\u00ed uz\u00e1v\u011bru tepny t\u011bm pacient\u016fm s\u00a0iktem (c\u00e9vn\u00ed mozkov\u00e1 p\u0159\u00edhoda, pozn. red.), u kter\u00fdch ji\u017e jin\u00e1 akutn\u00ed l\u00e9\u010dba nebyla mo\u017en\u00e1. N\u011bkter\u00e9 z\u00a0akutn\u00edch operac\u00ed se dokonce \u017e\u00e1dn\u00e9mu jin\u00e9mu z\u00a0center v\u00a0\u010cesk\u00e9 republice zat\u00edm nepoda\u0159ilo prov\u00e9st.<\/em><\/p>\n

Po\u010det zem\u0159el\u00fdch na CMP v\u00a0posledn\u00edch dvaceti letech v\u00fdrazn\u011b kles\u00e1, ale incidence a prevalence onemocn\u011bn\u00ed se v\u00fdznamn\u011b nesn\u00ed\u017eily. Ni\u017e\u0161\u00ed \u00famrtnost je tedy d\u00e1na zkvalitn\u011bn\u00edm l\u00e9\u010dby?<\/strong><\/p>\n

Ano, vd\u011b\u010d\u00edme za to v\u00fdvoji l\u00e9\u010dby. P\u0159ed 20 lety za\u010daly p\u0159ich\u00e1zet v\u016fbec prvn\u00ed zpr\u00e1vy o akutn\u00ed l\u00e9\u010db\u011b mozkov\u00e9 p\u0159\u00edhody. Pokud bychom se na to pod\u00edvali dne\u0161n\u00edma o\u010dima, tak jsme tehdy pacient\u016fm nebyli schopni nab\u00eddnout zhola nic. To neznamen\u00e1, \u017ee jsme nic ned\u011blali! Neexistovaly v\u0161ak iktov\u00e9 jednotky, c\u00edlen\u00e1 rehabilitace, nato\u017e trombolytick\u00e1 a radiointerven\u010dn\u00ed l\u00e9\u010dba. Pokud by stejn\u00fd trend rozvoje l\u00e9\u010dby CMP trval, pak bych se za dal\u0161\u00edch 20 let asi mrtvice za\u010dal b\u00e1t o n\u011bco m\u00e9n\u011b.<\/em><\/p>\n

Kdy\u017e k\u00a0mrtvici ji\u017e dojde, tak l\u00e9\u010dba je mnohem \u00fasp\u011b\u0161n\u011bj\u0161\u00ed ne\u017e d\u0159\u00edve. Ale jak je to s\u00a0jej\u00ed prevenc\u00ed?<\/strong><\/p>\n

Nejlep\u0161\u00ed je, kdy\u017e k\u00a0mrtvici v\u016fbec nedojde! Nedok\u00e1\u017eeme ani l\u00e9\u010dit, nato\u017e vyl\u00e9\u010dit v\u0161echny bez n\u00e1sledk\u016f. Riziko iktu p\u0159irozen\u011b stoup\u00e1 s\u00a0v\u011bkem. Tak\u00e9 se objevuj\u00ed mrtvice v\u00a0mlad\u00e9m v\u011bku (do 45 let), kter\u00e9 d\u0159\u00edve nebyly tak \u010detn\u00e9. Prevence, zvl\u00e1\u0161t\u011b ta sekund\u00e1rn\u00ed, se st\u00e1le zlep\u0161uje. V\u00edce pacient\u016f je l\u00e9\u010den\u00fdch, m\u00e1me nov\u00e9 l\u00e9ky, l\u00e9pe zn\u00e1me rizikov\u00e9 faktory. M\u016fj dojem je, \u017ee lid\u00e9 asi v\u00edce spol\u00e9haj\u00ed na to, \u017ee v\u017edy mus\u00ed b\u00fdt n\u011bkde n\u011bkdo, kdo jim pom\u016f\u017ee a vyl\u00e9\u010d\u00ed je, ne\u017e aby spol\u00e9hali na sebe a sami sv\u00fdmi \u010diny p\u0159isp\u011bli k sn\u00ed\u017een\u00ed rizika. St\u00e1le jim nedoch\u00e1z\u00ed, \u017ee jde jen o n\u011b sam\u00e9.<\/em><\/p>\n

P\u0159i p\u00e9\u010di o pacienty s\u00a0CMP spolupracujete s\u00a0dal\u0161\u00edmi odd\u011blen\u00edmi v\u00a0r\u00e1mci Komplexn\u00edho cerebrovaskul\u00e1rn\u00edho centra. V\u00a0\u010dem je pro l\u00e9ka\u0159e i pacienty z\u00e1sadn\u00ed?<\/strong><\/p>\n

Bez spolupr\u00e1ce by nebyla l\u00e9\u010dba tak \u00fasp\u011b\u0161n\u00e1. V\u00a0akutn\u00ed f\u00e1zi jde hlavn\u011b o\u00a0\u010das. Zde mus\u00ed ka\u017ed\u00fd zn\u00e1t svou \u00falohu a vykonat ji, jak nejl\u00e9pe a nejrychleji um\u00ed. Pokud v\u0161e nenavazuje, pak se zah\u00e1jen\u00ed l\u00e9\u010dby ne\u00fam\u011brn\u011b oddaluje! V\u00a0dal\u0161\u00ed f\u00e1zi jde o koordinaci l\u00e9\u010dby pacienta jako celku, proto\u017ee \u010dasto doch\u00e1z\u00ed ke zhor\u0161en\u00ed jeho chronick\u00fdch chorob. Z\u00e1rove\u0148 se sna\u017e\u00edme co nejd\u0159\u00edve pacienta, lidov\u011b \u0159e\u010deno, dostat z\u00a0postele. Jen tak jej m\u016f\u017eeme uchr\u00e1nit p\u0159ed nej\u010dast\u011bj\u0161\u00edmi komplikacemi iktu.<\/em><\/p>\n

P\u016fvodn\u011b jsme se domn\u00edvali, \u017ee jedin\u00e9 Komplexn\u00ed centrum v\u00a0kraji s\u00a0omezenou dopravn\u00ed dostupnost\u00ed je hendikepem. Zm\u011bnou postup\u016f v\u00a0nemocnici, intenzivn\u00ed spoluprac\u00ed se\u00a0Zdravotnickou z\u00e1chrannou slu\u017ebou J\u010dK a s ostatn\u00edmi nemocnicemi v\u00a0kraji se n\u00e1m v\u0161ak poda\u0159ilo zp\u011btin\u00e1sobit po\u010det \u00fasp\u011b\u0161n\u011b akutn\u011b l\u00e9\u010den\u00fdch pacient\u016f s\u00a0mrtvic\u00ed.<\/em><\/p>\n

Jakou dal\u0161\u00ed p\u00e9\u010di zaji\u0161\u0165uje Neurologick\u00e9 odd\u011blen\u00ed v\u00a0\u010cesk\u00fdch Bud\u011bjovic\u00edch?<\/strong><\/p>\n

Mimo mozkov\u00e9 p\u0159\u00edhody, kter\u00fdch na\u0161\u00edm odd\u011blen\u00edm projde t\u00e9m\u011b\u0159 1\u00a0200 ro\u010dn\u011b, a bolesti zad, kter\u00e9 vypl\u0148uj\u00ed v\u011bt\u0161inu kapacity ambulance, se star\u00e1me o neurologicky nemocn\u00e9 v\u00a0cel\u00e9 \u0161\u00ed\u0159i oboru.\u00a0<\/em>Pacienty s\u00a0roztrou\u0161enou skler\u00f3zou l\u00e9\u010d\u00edme centr\u00e1ln\u011b v\u00a0tzv. MS centru, zde maj\u00ed adekv\u00e1tn\u00ed zaji\u0161t\u011bn\u00ed l\u00e9\u010dby specifick\u00fdmi prepar\u00e1ty imunomodula\u010dn\u00ed a biologick\u00e9 l\u00e9\u010dby. Sou\u010d\u00e1st\u00ed neurologie je Region\u00e1ln\u00ed centrum spasticity, kde jej\u00ed l\u00e9\u010dba prob\u00edh\u00e1 ve spolupr\u00e1ci s\u00a0Rehabilita\u010dn\u00edm odd\u011blen\u00edm. Vznik\u00e1 nej\u010dast\u011bji jako n\u00e1sledek CMP nebo RS (roztrou\u0161en\u00e1 skler\u00f3za). Epileptologick\u00e1 ambulance sleduje pacienty s\u00a0epilepsi\u00ed, vyhled\u00e1v\u00e1 v\u00a0jiho\u010desk\u00e9m kraji pacienty s\u00a0farmakorezistentn\u00ed epilepsi\u00ed, tzn. ty, kte\u0159\u00ed nedostate\u010dn\u011b, nebo v\u016fbec nereaguj\u00ed na l\u00e9\u010dbu antiepileptiky. Tito pacienti mohou b\u00fdt kandid\u00e1ty p\u0159\u00edpadn\u00e9 epileptochirurgick\u00e9 l\u00e9\u010dby.<\/em><\/p>\n

Diagnostiku nervosvalov\u00fdch chorob zaji\u0161\u0165uje na\u0161e laborato\u0159 EMG. Pro pacienty s\u00a0neurodegenerativn\u00edmi chorobami m\u00e1me specializovanou extrapyramidovou poradnu. Krom\u011b diagnostiky a standardn\u00ed farmakologick\u00e9 l\u00e9\u010dby zde \u0159e\u0161\u00edme komplikace l\u00e9\u010dby, nebo z\u00e1va\u017en\u00e9 dekompenzace stav\u016f v\u00a0r\u00e1mci t\u011bchto chorob. Vhodn\u00ed pacienti s\u00a0Parkinsonovou chorobou jsou odes\u00edl\u00e1ni ke konzultaci do vy\u0161\u0161\u00edch center s\u00a0c\u00edlem nab\u00eddnout jim \u00fa\u010dinnou a bezpe\u010dnou invazivn\u00ed l\u00e9\u010dbu, tzv. hlubokou mozkovou stimulaci.<\/em><\/p>\n

Text a foto: (tznem)<\/strong><\/p>\n

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Kdy\u017e se <\/p>\n","protected":false},"author":2,"featured_media":60741,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"gallery","meta":{"footnotes":""},"categories":[7],"tags":[],"jetpack_featured_media_url":"https:\/\/zakrasnejsivimperk.cz\/wp-content\/uploads\/2016\/05\/18\/nemocnice-cb2.jpg","_links":{"self":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts\/107104"}],"collection":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=107104"}],"version-history":[{"count":4,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts\/107104\/revisions"}],"predecessor-version":[{"id":108852,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts\/107104\/revisions\/108852"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/media\/60741"}],"wp:attachment":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=107104"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=107104"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=107104"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}