{"id":17623,"date":"2014-09-25T08:27:51","date_gmt":"2014-09-25T06:27:51","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=17623"},"modified":"2014-09-25T08:30:29","modified_gmt":"2014-09-25T06:30:29","slug":"provedli-dve-operace-najednou-aby-zachranili-zivot-rodicky-i-ditete","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=17623","title":{"rendered":"Provedli dv\u011b operace najednou, aby zachr\u00e1nili \u017eivot rodi\u010dky i d\u00edt\u011bte"},"content":{"rendered":"

\u017denu ve vysok\u00e9m stupni t\u011bhotenstv\u00ed operovali v pra\u017esk\u00e9 nemocnici Na Homolce kv\u016fli praskl\u00e9 v\u00fdduti na mozkov\u00e9 c\u00e9v\u011b. Sou\u010dasn\u011b porodn\u00edk ze zn\u00e1m\u00e9 porodnice v Podol\u00ed, kter\u00e9ho do Homolky p\u0159ivolali, provedl porod c\u00edsa\u0159sk\u00fdm \u0159ezem.\u00a0<\/strong> <\/p>\n

Ane\u017eka je v\u00a0cel\u00e9 historii Nemocnice Na Homolce prvn\u00edm a na dlouho asi posledn\u00edm miminkem, kter\u00e9 se narodilo na zdej\u0161\u00edm neurochirurgick\u00e9m opera\u010dn\u00edm s\u00e1le. P\u0159i\u0161la na sv\u011bt za p\u0159\u00edtomnosti zku\u0161en\u00e9ho porodn\u00edka z\u00a0\u00dastavu pro p\u00e9\u010di o matku a d\u00edt\u011b. Ihned po jej\u00edm narozen\u00ed toti\u017e museli neurochirurgov\u00e9 na Homolce vy\u0159e\u0161it prasklou v\u00fddu\u0165 mozkov\u00e9 c\u00e9vy, kter\u00e1 t\u011bhotnou maminku, a t\u00edm i jej\u00ed dcerku, ohro\u017eovala na \u017eivot\u011b. Tato spolupr\u00e1ce odborn\u00edk\u016f ze dvou pra\u017esk\u00fdch specializovan\u00fdch zdravotnick\u00fdch za\u0159\u00edzen\u00ed je zcela unik\u00e1tn\u00ed a nebyla nikdy p\u0159ed t\u00edm vyzkou\u0161ena. P\u0159esto hned napoprv\u00e9 skv\u011ble zafungovala.<\/p>\n

Pan\u00ed Jana Soustru\u017en\u00edkov\u00e1 byla v\u00a0druh\u00e9 polovin\u011b \u010dervna v\u00a039. t\u00fddnu t\u011bhotenstv\u00ed, kdy\u017e ji jedn\u00e9 noci p\u0159epadly obrovsk\u00e9 bolesti v\u00a0podb\u0159i\u0161ku, pokra\u010duj\u00edc\u00ed do ky\u010dl\u00ed. Jen malou chv\u00edli je pova\u017eovala za posl\u00ed\u010dky bl\u00ed\u017e\u00edc\u00edho se porodu. \u201ePot\u00e9 se p\u0159idalo \u00faporn\u00e9, nep\u0159etr\u017eit\u00e9 zvracen\u00ed, t\u0159e\u0161tila mi hlava, brn\u011bla polovina obli\u010deje a strnula mi \u0161\u00edje, tak\u017ee jsem hlavou nemohla hnout,\u201c vzpom\u00edn\u00e1 pan\u00ed Jana, co ji a jej\u00edho p\u0159\u00edtele Zde\u0148ka p\u0159im\u011blo okam\u017eit\u011b volat z\u00e1chrannou slu\u017ebu.<\/p>\n

\u201ePacientka k\u00a0n\u00e1m dorazila s\u00a0neurologick\u00fdmi p\u0159\u00edznaky, proto byla p\u0159evezena k\u00a0neurologick\u00e9mu konziliu a na CT vy\u0161et\u0159en\u00ed do V\u0161eobecn\u00e9 fakultn\u00ed nemocnice,\u201c popisuje MUDr. Jan Draho\u0148ovsk\u00fd, n\u00e1m\u011bstek \u0159editele \u00dastavu pro p\u00e9\u010di o matku a d\u00edt\u011b. Neurologov\u00e9 u \u017eeny prok\u00e1zali na CT krv\u00e1cen\u00ed pod tenkou plenu mozkovou, u kter\u00e9ho se p\u0159edpokl\u00e1d\u00e1 jako zdroj praskl\u00e9 aneurysma, \u010dili v\u00fddu\u0165 na mozkov\u00e9 c\u00e9v\u011b. Bylo t\u0159eba jednat rychle.<\/p>\n

Nemocnice Na Homolce je cerebrovaskul\u00e1rn\u00edm centrem, to znamen\u00e1, \u017ee m\u00e1 pot\u0159ebn\u00e9 technologie i odborn\u00edky a poskytuje \u0161pi\u010dkovou p\u00e9\u010di o pacienty s\u00a0onemocn\u011bn\u00edm mozku, v\u010detn\u011b c\u00e9vn\u00edch probl\u00e9m\u016f. \u201eKrv\u00e1cen\u00ed pod tenkou plenu mozkovou z\u00a0praskl\u00e9ho aneurysmatu je z\u00e1va\u017en\u00e9 onemocn\u011bn\u00ed, na kter\u00e9 velk\u00e9 mno\u017estv\u00ed pacient\u016f um\u00edr\u00e1 bezprost\u0159edn\u011b po vzniku krv\u00e1cen\u00ed a dal\u0161\u00ed \u010d\u00e1st z\u00a0t\u011bch, kte\u0159\u00ed se dostanou do zdravotnick\u00e9ho za\u0159\u00edzen\u00ed, m\u016f\u017ee b\u00fdt n\u00e1sledn\u011b velice t\u011b\u017ece neurologicky posti\u017eena. Nav\u00edc hroz\u00ed, \u017ee v\u00fddu\u0165 po \u010dase praskne znovu a dal\u0161\u00ed krv\u00e1cen\u00ed bude m\u00edt hor\u0161\u00ed n\u00e1sledky, ne\u017e to prvn\u00ed,\u201c vysv\u011btluje MUDr. Franti\u0161ek Reme\u0161, z\u00e1stupce prim\u00e1\u0159e Neurochirurgick\u00e9ho odd\u011blen\u00e9 Nemocnice Na Homolce.<\/p>\n

Pacienti s\u00a0praskl\u00fdm aneurysmatem na mozkov\u00e9 c\u00e9v\u011b se k\u00a0l\u00e9ka\u0159\u016fm dost\u00e1vaj\u00ed v\u00a0r\u016fzn\u00e9m stavu: n\u011bkte\u0159\u00ed jsou v\u00a0bezv\u011bdom\u00ed, jin\u00ed mohou b\u00fdt p\u0159i v\u011bdom\u00ed a m\u00edvaj\u00ed typick\u00e9 p\u0159\u00edznaky \u2013 jsou zmaten\u00ed, neklidn\u00ed, bol\u00ed je hlava, maj\u00ed strnulou \u0161\u00edji. To byl i p\u0159\u00edpad pan\u00ed Jany.<\/p>\n

Zat\u00edmco p\u0159\u00edznaky krv\u00e1cen\u00ed pod tenkou mozkovou plenu m\u011bla pan\u00ed Jana typick\u00e9, jej\u00ed stav byl naopak pro Nemocnici Na Homolce zcela netypick\u00fd. \u201eSna\u017eili jsme se spole\u010dn\u011b s\u00a0neurochirurgy Nemocnice Na Homolce vymyslet pro pacientku nejoptim\u00e1ln\u011bj\u0161\u00ed zp\u016fsob \u0159e\u0161en\u00ed jej\u00edho akutn\u00edho zdravotn\u00edho probl\u00e9mu. Situace byla komplikov\u00e1na skute\u010dnost\u00ed, \u017ee Nemocnice Na Homolce disponuje pot\u0159ebnou technologi\u00ed a zku\u0161enostmi s\u00a0neurochirurgick\u00fdm \u0159e\u0161en\u00edm t\u011bchto stav\u016f, ale nem\u00e1 vlastn\u00ed porodnici,\u201c \u0159\u00edk\u00e1 doktor Draho\u0148ovsk\u00fd.<\/p>\n

P\u0159i p\u0159evozu rodi\u010dky zp\u011bt do porodnice by v\u0161ak hrozilo kv\u016fli jej\u00ed neurologick\u00e9 diagn\u00f3ze nebezpe\u010d\u00ed z\u00a0prodlen\u00ed. Proto nakonec l\u00e9ka\u0159i obou nemocnic jako nejbezpe\u010dn\u011bj\u0161\u00ed zp\u016fsob zvolili netradi\u010dn\u00ed \u0159e\u0161en\u00ed – sou\u010dasn\u00e9 proveden\u00ed c\u00edsa\u0159sk\u00e9ho \u0159ezu a neurochirurgick\u00e9 operace na Neurochirurgick\u00e9m odd\u011blen\u00ed NNH za pomoci v\u00fdjezdn\u00ed porodnicko \u2013 neonatologick\u00e9 skupiny z\u00a0\u00daPMD..<\/p>\n

Okam\u017eit\u011b pot\u00e9, co pan\u00ed Janu p\u0159ijali na jednotku intenzivn\u00ed p\u00e9\u010de Neurochirurgick\u00e9ho odd\u011blen\u00ed NNH, p\u0159istoupili l\u00e9ka\u0159i pod veden\u00edm porodn\u00edka z \u00daPMD k\u00a0porodu c\u00edsa\u0159sk\u00fdm \u0159ezem. \u201eZ\u00a0porodnick\u00e9ho hlediska jsem byl vybaven pouze pot\u0159ebn\u00fdm \u0161ic\u00edm materi\u00e1lem pro c\u00edsa\u0159sk\u00fd \u0159ez, ostatn\u00ed zaji\u0161\u0165oval t\u00fdm neurochirurgick\u00e9ho opera\u010dn\u00edho s\u00e1lu. Asistoval mi prim\u00e1\u0159 Petr Popelka z\u00a0Gynekologick\u00e9ho odd\u011blen\u00ed Nemocnice Na Homolce. Podm\u00ednky pro proveden\u00ed c\u00edsa\u0159sk\u00e9ho \u0159ezu nebyly z\u00a0hlediska porodn\u00edka nijak mimo\u0159\u00e1dn\u00e9,\u201c konstatuje doktor Draho\u0148ovsk\u00fd. Ihned po p\u0159\u00edchodu mal\u00e9 Ane\u017eky na sv\u011bt ji do p\u00e9\u010de p\u0159evzal p\u0159\u00edtomn\u00fd neonatolog \u00daPMD MUDr. Jan \u0160irc, kter\u00fd m\u011bl k\u00a0dispozici specializovanou transportn\u00ed slu\u017ebu, zaji\u0161\u0165uj\u00edc\u00ed p\u0159evoz novorozenc\u016f mezi nemocnicemi, a Ane\u017eka putovala do \u00daPMD.<\/p>\n

Sou\u010dasn\u011b s\u00a0porodem museli \u017een\u011b za\u010d\u00edt pom\u00e1hat i neurochirurgov\u00e9 NNH. \u201eStav \u017eeny se rychle zhor\u0161oval u\u017e b\u011bhem jej\u00edho p\u0159ijet\u00ed, vznikal u n\u00ed takzvan\u00fd hydrocefalus, co\u017e je roz\u0161\u00ed\u0159en\u00ed komorov\u00e9ho syst\u00e9mu mozku v\u00a0d\u016fsledku m\u011bstn\u00e1n\u00ed mozkom\u00ed\u0161n\u00edho moku,\u201c vysv\u011btluje doktor Reme\u0161, pro\u010d pan\u00ed Jan\u011b ihned zavedli komorovou dren\u00e1\u017e s\u00a0\u010didlem pro kontrolu nitrolebn\u00edho tlaku. Dren\u00e1\u017e zajistila odvod tekutiny, kter\u00e1 by jinak mozek utla\u010dovala.<\/p>\n

Po porodu okam\u017eit\u011b p\u0159evezli pacientku na vedlej\u0161\u00ed angiografick\u00fd s\u00e1l, kde ji\u017e byli p\u0159ipraveni dal\u0161\u00ed l\u00e9ka\u0159i. Angiografick\u00e9 vy\u0161et\u0159en\u00ed potvrdilo jako zdroj krv\u00e1cen\u00ed aneurysma na jedn\u00e9 z\u00a0c\u00e9v. L\u00e9ka\u0159i proto ihned provedli takzvan\u00fd coiling \u2013 pod rentgenovou kontrolou zajistili uz\u00e1v\u011br c\u00e9vn\u00ed v\u00fddut\u011b, aby ji\u017e nezp\u016fsobovala \u017e\u00e1dn\u00e9 zdravotn\u00ed nebezpe\u010d\u00ed. \u201eTo v\u0161e se odehr\u00e1lo b\u011bhem n\u011bkolika hodin. \u017dena tedy v\u00a0rychl\u00e9m sledu prod\u011blala porod, neurochirurgickou operaci a endovaskul\u00e1rn\u00ed uz\u00e1v\u011br v\u00fddut\u011b,\u201c shrnuje doktor Reme\u0161 a dod\u00e1v\u00e1, \u017ee v\u0161e dob\u0159e dopadlo a pan\u00ed Jana je podle posledn\u00ed kontroly na neurochirurgii ji\u017e v\u00a0po\u0159\u00e1dku.<\/p>\n

Pan\u00ed Janu te\u010f je\u0161t\u011b ob\u010das pobol\u00edv\u00e1 hlava, m\u00edv\u00e1 n\u00e1valy \u00fanavy \u010di reaguje na zm\u011bny po\u010das\u00ed. Ve srovn\u00e1n\u00ed se dny bezprost\u0159edn\u011b po c\u00e9vn\u00ed mozkov\u00e9 p\u0159\u00edhod\u011b se to v\u0161ak v\u016fbec ned\u00e1 srovnat. \u201eM\u011bla jsem velk\u00e9 \u0161t\u011bst\u00ed, kter\u00e9 se opakovalo v\u00a0\u0159ad\u011b moment\u016f,\u201c \u0159\u00edk\u00e1 \u0161\u0165astn\u00e1 maminka t\u0159\u00edm\u011bs\u00ed\u010dn\u00ed Ane\u017eky, je\u017e si nem\u016f\u017ee vynachv\u00e1lit l\u00e9ka\u0159e, kte\u0159\u00ed ji i dcerku zachr\u00e1nili. Sou\u010dasn\u011b ale ned\u00e1 dopustit na sv\u00e9ho p\u0159\u00edtele a otce Ane\u017eky: \u201eDostal z\u00a0porodnice dom\u016f \u010dty\u0159denn\u00ed d\u00edt\u011b a postaral se o n\u011b naprosto skv\u011ble. \u0160vagrov\u00e1 mu uk\u00e1zala, jak sterilizovat lahvi\u010dky a poradila se z\u00e1kladn\u00edmi v\u011bcmi. S\u00a0pomoc\u00ed sv\u00e9 maminky, Ane\u017e\u010diny babi\u010dky, pak ji\u017e v\u0161e zvl\u00e1dl doma s\u00e1m a\u017e do doby ne\u017e mne z\u00a0Homolky propustili dom\u016f. A to za mnou do nemocnice je\u0161t\u011b ka\u017ed\u00fd den jezdil!\u201c<\/p>\n

Zat\u00edmco porod na neurochirurgick\u00e9m s\u00e1le byl v\u00a0Nemocnici Na Homolce zcela ojedin\u011bl\u00fdm, nen\u00ed mal\u00e1 Ane\u017eka \u00fapln\u011b prvn\u00edm miminkem, kter\u00e9 v\u00a0t\u00e9to nemocnici p\u0159i\u0161lo na sv\u011bt. V\u00fdjime\u010dn\u011b se st\u00e1v\u00e1, \u017ee z\u00e1va\u017en\u00e9 onemocn\u011bn\u00ed t\u011bhotn\u00e9 \u017eeny vy\u017eaduje okam\u017eit\u00fd odborn\u00fd z\u00e1sah specialist\u016f z\u00a0Homolky, p\u0159i\u010dem\u017e p\u0159ed samotnou operac\u00ed matky je t\u0159eba porodit d\u00edt\u011b.<\/p>\n

\u201eNa na\u0161em odd\u011blen\u00ed jsme takto v\u00a0posledn\u00edm desetilet\u00ed s\u00a0pomoc\u00ed porodn\u00edk\u016f z\u00a0Fakultn\u00ed nemocnice Motol p\u0159ivedli na sv\u011bt dv\u011b miminka. V\u00a0roce 2007 se tu narodilo d\u00edt\u011b maminky, kterou postihlo krv\u00e1cen\u00ed do mozku, o rok pozd\u011bji pak miminko \u017eeny, trp\u00edc\u00ed zhoubn\u00fdm n\u00e1dorem v\u00a0p\u00e1te\u0159i,\u201c dod\u00e1v\u00e1 prim\u00e1\u0159 Popelka.<\/p>\n

\"\"Ot\u00e1zka na MUDr. Franti\u0161ka Reme\u0161e,<\/b><\/p>\n

z\u00e1stupce prim\u00e1\u0159e Neurochirurgick\u00e9ho odd\u011blen\u00ed Nemocnice Na Homolce:<\/p>\n

Co to je coiling?<\/b><\/p>\n

Jedn\u00e1 se o uz\u00e1v\u011br aneurysmatu p\u0159\u00edstupem z\u00a0vnit\u0159ku c\u00e9vy, \u010dili endovaskul\u00e1rn\u011b. Do c\u00e9vn\u00edho \u0159e\u010di\u0161t\u011b z\u00a0t\u0159\u00edsla zavedeme katetr, jeho\u017e konec se dostane a\u017e do v\u00fddut\u011b mozkov\u00e9 c\u00e9vy. Postup kateru sledujeme pod rentgenem. Dut\u00fdm katetrem pot\u00e9 do aneurysmatu zavedeme speci\u00e1ln\u00ed platinov\u00e9 spir\u00e1lky. Ty maj\u00ed tvarovou pam\u011b\u0165, rozt\u00e1hnou se, v\u00fddu\u0165 vypln\u00ed a postupn\u011b se na nich vytvo\u0159\u00ed koagulovan\u00e1, \u010dili sra\u017een\u00e1 krev. V\u00fddu\u0165 tedy ztrombotizuje a uzav\u0159e se.<\/p>\n

\"\"Ot\u00e1zky na MUDr. Jana Draho\u0148ovsk\u00e9ho,<\/b><\/p>\n

n\u00e1m\u011bstka \u0159editele \u00dastavu pro p\u00e9\u010di o matku a d\u00edt\u011b<\/p>\n

Je n\u011bjak\u00fd rozd\u00edl, prov\u00e1d\u00edte-li c\u00edsa\u0159sk\u00fd \u0159ez zdrav\u00e9 matce, a kdy\u017e se jedn\u00e1 o porod u \u017eeny s\u00a0\u017eivot ohro\u017euj\u00edc\u00ed diagn\u00f3zou?<\/b><\/p>\n

Z\u00a0hlediska pr\u016fb\u011bhu operace nikoliv. Existuj\u00ed situace, kter\u00e9 zvy\u0161uj\u00ed riziko c\u00edsa\u0159sk\u00e9ho \u0159ezu. V\u00a0tomto p\u0159\u00edpad\u011b se v\u0161ak jednalo sp\u00ed\u0161e o riziko z\u00a0pohledu anesteziologa a neurochirurga, a tam jsme m\u011bli jistotu, \u017ee je pacientka velmi dob\u0159e zaji\u0161t\u011bna. Z\u00a0hlediska porodnick\u00e9ho se jednalo a standardn\u00ed c\u00edsa\u0159sk\u00fd \u0159ez, by\u0165 v\u00a0ne zcela obvykl\u00fdch podm\u00ednk\u00e1ch.<\/p>\n

M\u011bl jste u\u017e podobnou zku\u0161enost v\u00fdjezdu na porod mimo \u00daPMD Vy nebo Va\u0161i kolegov\u00e9?<\/b><\/p>\n

Pokud v\u00edm, tak z\u00a0porodnick\u00e9ho hlediska se jednalo o ojedin\u011blou situaci a nev\u00edm o podobn\u00e9m p\u0159\u00edpadu. V\u00a0\u00daPMD koncentrujeme t\u011bhotensk\u00e9 patologie z\u00a0cel\u00e9 \u010cesk\u00e9 republiky, ale standardem je \u0159e\u0161en\u00ed na na\u0161em dom\u00e1c\u00edm pracovi\u0161ti. Nev\u00edm o \u017e\u00e1dn\u00e9m jin\u00e9m p\u0159\u00edpadu, kdy by porodn\u00edk z\u00a0\u00daPMD \u010di jin\u00e9 pra\u017esk\u00e9 kliniky vyj\u00ed\u017ed\u011bl k\u00a0porodu do jin\u00e9ho zdravotnick\u00e9ho za\u0159\u00edzen\u00ed. Jin\u00e1 situace to je z\u00a0hlediska neonatologick\u00e9ho \u2013 transportn\u00ed slu\u017eba pro novorozence m\u00e1 dlouhodobou tradici s\u00a0v\u00fdjezdy k\u00a0p\u0159ed\u010dasn\u00fdm \u010di patologick\u00fdm porod\u016fm do mal\u00fdch nemocnic. Ty nejsou vybaven\u00e9 pro p\u00e9\u010di o nezral\u00e9 novorozence, a\u00a0v p\u0159\u00edpadech, kdy ji\u017e nen\u00ed dostatek \u010dasu na p\u0159evoz t\u011bhotn\u00e9 \u017eeny je\u0161t\u011b p\u0159ed porodem, vyj\u00ed\u017ed\u00ed neonatolog za nimi.<\/p>\n

Tiskov\u00e1 zpr\u00e1va<\/p>\n

Nemocnice Na Homolce<\/p>\n

ilustra\u010dn\u00ed foto: Adam-Ciesielski-sxc.hu<\/p>\n","protected":false},"excerpt":{"rendered":"

\u017denu ve vysok\u00e9m stupni t\u011bhotenstv\u00ed operovali v pra\u017esk\u00e9 nemocnici Na Homolce kv\u016fli praskl\u00e9 v\u00fdduti na mozkov\u00e9 c\u00e9v\u011b. Sou\u010dasn\u011b porodn\u00edk ze zn\u00e1m\u00e9 porodnice v Podol\u00ed, kter\u00e9ho […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":14511,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-17623","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\/17623","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=17623"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/17623\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/14511"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17623"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17623"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17623"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}