Nevzhledn\u00e9 k\u0159e\u010dov\u00e9 \u017e\u00edly na noh\u00e1ch jsou mnohdy jen estetick\u00fd probl\u00e9m, ov\u0161em jen do t\u00e9 doby, ne\u017e za\u010dnou bolet. V tu chv\u00edli je t\u0159eba nav\u0161t\u00edvit specialistu. K t\u00e9to problematice hovo\u0159il chirurg MUDr. Ji\u0159\u00ed Chv\u00e1la.<\/p>\n
– Co je to \u017eiln\u00ed tromb\u00f3za a jakou \u010d\u00e1st na\u0161eho t\u011bla postihuje?<\/p>\n
\u017diln\u00ed tromb\u00f3za je z\u00e1n\u011bt \u017eil, kter\u00fd m\u016f\u017ee postihnout kteroukoliv \u017e\u00edlu v lidsk\u00e9m t\u011ble, nej\u010dast\u011bji v\u0161ak postihuje povrchn\u00ed \u010di hlubok\u00e9 \u017e\u00edly doln\u00edch kon\u010detin.<\/p>\n
– Existuj\u00ed rizikov\u00e9 skupiny lid\u00ed, u kter\u00fdch se toto onemocn\u011bn\u00ed objevuje \u010dast\u011bji?<\/p>\n
Ano. Mezi rizikov\u00e9 faktory pat\u0159\u00ed genetick\u00e9 predispozice zd\u011bd\u011bn\u00e9 po p\u0159edc\u00edch, p\u0159edchoz\u00ed chirurgick\u00e9 v\u00fdkony, \u00farazy, n\u00e1dory, kou\u0159en\u00ed i u\u017e\u00edv\u00e1n\u00ed hormon\u00e1ln\u00ed antikoncepce. D\u00e1le del\u0161\u00ed upout\u00e1n\u00ed na l\u016f\u017eko, znehybn\u011bn\u00ed kon\u010detiny nap\u0159. p\u0159i zlomenin\u011b nebo p\u0159i poru\u0161e nervov\u00e9ho z\u00e1soben\u00ed. A kone\u010dn\u011b i obezita, t\u011bhotenstv\u00ed, srde\u010dn\u00ed selh\u00e1n\u00ed, poopera\u010dn\u00ed infekce a v\u011bk nad 50 60 let.<\/p>\n
– Jak\u00e9 jsou p\u0159\u00edznaky?<\/p>\n
P\u0159i z\u00e1n\u011btu povrchn\u00edch \u017eil je posti\u017een\u00e9 m\u00edsto zarudl\u00e9, na pohmat bolestiv\u00e9, \u010dasto zatvrdl\u00e9. Kon\u010detina ale neot\u00e9k\u00e1. P\u0159i tromb\u00f3ze hlubok\u00fdch \u017eil je kon\u010detina otekl\u00e1, bol\u00ed a to hlavn\u011b po do\u0161l\u00e1pnut\u00ed. \u010casto se vyskytuje pocit pnut\u00ed v l\u00fdtku. Kon\u010detina m\u016f\u017ee b\u00fdt zarudl\u00e1, bled\u00e1 anebo tak\u00e9 m\u00edt namodralou barvu. Hlubok\u00e1 tromb\u00f3za je velmi zr\u00e1dn\u00e1, nebo\u0165 m\u016f\u017ee vzniknout i bez v\u00fdrazn\u011bj\u0161\u00edch obt\u00ed\u017e\u00ed a projev\u00ed se a\u017e komplikuj\u00edc\u00ed plicn\u00ed emboli\u00ed.<\/p>\n
– M\u016f\u017eeme toto onemocn\u011bn\u00ed l\u00e9\u010dit doma nebo je v\u017edy nutn\u00e9 vyhledat l\u00e9ka\u0159e?<\/p>\n
Doporu\u010duji v\u017edy p\u0159i podez\u0159en\u00ed na tromb\u00f3zu nav\u0161t\u00edvit l\u00e9ka\u0159e.<\/p>\n
– Co n\u00e1s \u010dek\u00e1 v l\u00e9ka\u0159sk\u00e9 ordinaci?<\/p>\n
Nejprve d\u016fkladn\u00e9 vy\u0161et\u0159en\u00ed l\u00e9ka\u0159em. Pot\u00e9 laboratorn\u00ed odb\u011br krve na D \u2013 dimery, jejich\u017e negativita \u017eiln\u00ed tromb\u00f3zu s velkou pravd\u011bpodobnost\u00ed vylu\u010duje. A kone\u010dn\u011b v p\u0159\u00edpad\u011b pot\u0159eby i vy\u0161et\u0159en\u00ed \u017eil pomoc\u00ed ultrazvuku.<\/p>\n
– Jak se toto onemocn\u011bn\u00ed l\u00e9\u010d\u00ed a m\u00e1 nel\u00e9\u010den\u00fd stav n\u011bjak\u00e1 rizika?<\/p>\n
P\u0159i prok\u00e1z\u00e1n\u00ed \u017eiln\u00ed tromb\u00f3zy n\u00e1sleduje bezodkladn\u00e9 zah\u00e1jen\u00ed pod\u00e1v\u00e1n\u00ed protisr\u00e1\u017eliv\u00e9 (antikoagula\u010dn\u00ed) l\u00e9\u010dby, aby se p\u0159ede\u0161lo embolizaci do plicn\u00edho \u0159e\u010di\u0161t\u011b. L\u00e9\u010dbu zahajujeme injekcemi heparinu nitro\u017eiln\u011b \u010di podko\u017en\u011b, po n\u011bkolika dnech je pak pacient p\u0159eveden na antikoagula\u010dn\u00ed terapii tabletami warfarinu. Pot\u00e9 je t\u0159eba pravideln\u011b, nejm\u00e9n\u011b v\u0161ak jednou m\u011bs\u00ed\u010dn\u011b, kontrolovat hladinu krevn\u00ed sr\u00e1\u017elivosti pomoc\u00ed tzv. Quickova testu, podle n\u011bho\u017e se pak upravuje denn\u00ed d\u00e1vka l\u00e9ku. Antikoagula\u010dn\u00ed terapie trv\u00e1 r\u016fzn\u011b dlouho s ohledem na rizika, zpravidla 6 a\u017e 12 m\u011bs\u00edc\u016f, n\u011bkdy v\u0161ak m\u016f\u017ee b\u00fdt i celo\u017eivotn\u00ed, a to zejm\u00e9na u pacient\u016f po prod\u011blan\u00e9 v\u00edcen\u00e1sobn\u00e9 \u017eiln\u00ed tromb\u00f3ze \u010di se z\u00e1va\u017en\u00fdmi vrozen\u00fdmi poruchami sr\u00e1\u017elivosti. P\u0159i l\u00e9\u010db\u011b warfarinem je nutn\u00e9 pe\u010dliv\u011b dodr\u017eovat \u017eivotospr\u00e1vu a vyh\u00fdbat se alkoholu a n\u011bkter\u00fdm potravin\u00e1m, zejm\u00e9na n\u011bkter\u00fdm zelenin\u00e1m, kter\u00e9 mohou \u00fa\u010dinek warfarinu ovliv\u0148ovat. D\u00e1le je nezbytn\u00e9, aby ka\u017ed\u00fd pacient u\u017e\u00edvaj\u00edc\u00ed warfarin m\u011bl u sebe karti\u010dku se z\u00e1znamem o l\u00e9\u010db\u011b warfarinem a informoval ka\u017ed\u00e9ho l\u00e9ka\u0159e o t\u00e9to skute\u010dnosti, proto\u017ee p\u0159ed n\u011bkter\u00fdmi z\u00e1kroky, zejm\u00e9na chirurgick\u00fdmi \u010di stomatologick\u00fdmi, je t\u0159eba warfarin v dostate\u010dn\u00e9m p\u0159edstihu vysadit, jinak hroz\u00ed velk\u00e9 riziko krv\u00e1cen\u00ed. Ke zm\u00edrn\u011bn\u00ed n\u00e1sledk\u016f \u017eiln\u00ed tromb\u00f3zy je doporu\u010dov\u00e1no no\u0161en\u00ed kompresivn\u00edch pun\u010doch a pod\u00e1v\u00e1n\u00ed n\u011bkter\u00fdch podp\u016frn\u00fdch l\u00e9k\u016f (nap\u0159. Detralex). Pacient po prod\u011blan\u00e9 \u017eiln\u00ed tromb\u00f3ze by m\u011bl pravideln\u011b cvi\u010dit a m\u011bl by se vyh\u00fdbat del\u0161\u00ed statick\u00e9 z\u00e1t\u011b\u017ei, del\u0161\u00edmu st\u00e1n\u00ed \u010di sezen\u00ed. Nel\u00e9\u010den\u00e1 choroba m\u016f\u017ee v\u00e9st vz\u00e1cn\u011b i ke ztr\u00e1t\u011b kon\u010detiny a k \u010dast\u011bj\u0161\u00edmu vzniku komplikac\u00ed ve smyslu plicn\u00ed embolie a tzv. posttrombotick\u00e9ho syndromu (chronick\u00e9 otoky, zm\u011bny zbarven\u00ed k\u016f\u017ee a obt\u00ed\u017en\u011b se hoj\u00edc\u00ed v\u0159edy b\u00e9rce).<\/p>\n
– Jak m\u016f\u017eeme t\u00e9to chorob\u011b p\u0159edch\u00e1zet?<\/p>\n
V z\u00e1t\u011b\u017eov\u00fdch situac\u00edch u lid\u00ed se zv\u00fd\u0161en\u00fdm rizikem (\u00farazy, operace, cestov\u00e1n\u00ed, s\u00e1drov\u00e1 dlaha) lze aplikovat podko\u017en\u011b n\u00edzkomolekul\u00e1rn\u00ed heparin. I ostatn\u00ed jedinci mohou riziko \u017eiln\u00ed tromb\u00f3zy sn\u00ed\u017eit, a to zejm\u00e9na p\u0159i dlouh\u00e9m cestov\u00e1n\u00ed nebo v letn\u00edm obdob\u00ed pravideln\u00fdmi zast\u00e1vkami, cvi\u010den\u00edm, dostate\u010dn\u00fdm p\u0159\u00edjmem tekutin a pokud trp\u00ed k\u0159e\u010dov\u00fdmi \u017eilami, pravideln\u00fdm no\u0161en\u00edm kompresivn\u00edch pun\u010doch.<\/p>\n","protected":false},"excerpt":{"rendered":"
Nevzhledn\u00e9 k\u0159e\u010dov\u00e9 \u017e\u00edly na noh\u00e1ch jsou mnohdy jen estetick\u00fd probl\u00e9m, ov\u0161em jen do t\u00e9 doby, ne\u017e za\u010dnou bolet. V tu chv\u00edli je t\u0159eba nav\u0161t\u00edvit specialistu. […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":39486,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-15057","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/15057","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15057"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/15057\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/39486"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15057"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15057"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15057"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}