\/ROZHOVOR\/ Nemocnice v Most\u011b za\u010dala poskytovat neurologick\u00fdm pacient\u016fm superakutn\u00ed centrovou p\u00e9\u010di, od \u00fanora tam funguje centrum vysoce specializovan\u00e9 p\u00e9\u010de o pacienty s iktem.<\/p>\n\n\n\n
Iktov\u00e9 centrum je sou\u010d\u00e1st\u00ed neurologick\u00e9ho odd\u011blen\u00ed mosteck\u00e9 nemocnice pod veden\u00edm prim\u00e1\u0159e Stanislava Slav\u00edka. Podrobnosti p\u0159ibl\u00ed\u017e\u00ed vedouc\u00ed iktov\u00e9ho centra mosteck\u00e9 nemocnice J\u00e1n Macko.<\/p>\n\n\n\n
\u010c\u00edm se zab\u00fdv\u00e1 iktov\u00e9 centrum?<\/p>\n\n\n\n
Iktov\u00e9 centrum je pracovi\u0161t\u011b z\u0159\u00edzen\u00e9 v r\u00e1mci na\u0161eho neurologick\u00e9ho odd\u011blen\u00ed poskytuj\u00edc\u00ed rychlou diagnostiku a l\u00e9\u010dbu pacient\u016fm s c\u00e9vn\u00ed mozkovou p\u0159\u00edhodou (CMP). Disponuje mezioborov\u00fdm t\u00fdmem specialist\u016f. Pe\u010dujeme o pacienty se v\u0161emi typy mozkov\u00fdch p\u0159\u00edhod. V indikovan\u00fdch p\u0159\u00edpadech prov\u00e1d\u00edme l\u00e9\u010dbu intraven\u00f3zn\u00ed trombol\u00fdzou, kter\u00e1 spo\u010d\u00edv\u00e1 v pod\u00e1n\u00ed l\u00e9ku do \u017e\u00edly, kter\u00fd na\u0159ed\u00ed krev a rozpou\u0161t\u00ed krevn\u00ed sra\u017eeniny, a ve spolupr\u00e1ci s komplexn\u00edm centrem v Masarykov\u011b nemocnici v \u00dast\u00ed nad Labem zaji\u0161\u0165ujeme pro na\u0161e pacienty i l\u00e9\u010dbu mechanickou rekanalizac\u00ed \u2013 vyjmut\u00ed krevn\u00ed sra\u017eeniny z c\u00e9vy. Pacienti, kte\u0159\u00ed jsou l\u00e9\u010den\u00ed v iktov\u00e9m centru, maj\u00ed prokazateln\u011b ni\u017e\u0161\u00ed riziko \u00famrt\u00ed na c\u00e9vn\u00ed mozkovou p\u0159\u00edhodu a v\u00fdrazn\u011b men\u0161\u00ed riziko z\u00e1va\u017en\u00fdch n\u00e1sledk\u016f.<\/p>\n\n\n\n
Co je vlastn\u011b c\u00e9vn\u00ed mozkov\u00e1 p\u0159\u00edhoda a jak\u00e9 jsou p\u0159\u00ed\u010diny jej\u00edho vzniku?<\/p>\n\n\n\n
C\u00e9vn\u00ed mozkov\u00e1 p\u0159\u00edhoda neboli mozkov\u00e1 mrtvice, zn\u00e1m\u00e1 i pod pojmem iktus, je akutn\u00ed, n\u00e1hle vznikaj\u00edc\u00ed onemocn\u011bn\u00ed, kter\u00e9 \u010dlov\u011bka m\u016f\u017ee p\u0159\u00edmo ohrozit na \u017eivot\u011b nebo zanechat t\u011b\u017ek\u00e9 zdravotn\u00ed posti\u017een\u00ed. \u010casto p\u0159ich\u00e1z\u00ed bez varov\u00e1n\u00ed. V z\u00e1sad\u011b rozli\u0161ujeme dva typy mozkov\u00fdch p\u0159\u00edhod. S ischemickou CMP se v na\u0161\u00ed praxi setk\u00e1v\u00e1me nej\u010dast\u011bji. Tvo\u0159\u00ed a\u017e 90 procent v\u0161ech mozkov\u00fdch p\u0159\u00edhod. Podstatou jejich vzniku je porucha z\u00e1soben\u00ed mozkov\u00e9 tk\u00e1n\u011b krv\u00ed p\u0159i z\u00fa\u017een\u00ed nebo uz\u00e1v\u011bru tepny. K tomu m\u016f\u017ee doj\u00edt nap\u0159\u00edklad ateroskler\u00f3zou, tromb\u00f3zou tepny nebo emboli\u00ed, nap\u0159\u00edklad uvoln\u011bn\u00edm krevn\u00ed sra\u017eeniny ze srdce p\u0159i poru\u0161e srde\u010dn\u00edho rytmu. M\u00e9n\u011b \u010dast\u00fdmi p\u0159\u00ed\u010dinami, vyskytuj\u00edc\u00edmi se zejm\u00e9na v mlad\u00e9m v\u011bku, jsou t\u0159eba z\u00e1n\u011bty c\u00e9v, autoimunitn\u00ed nemoci, \u00farazy, poruchy sr\u00e1\u017elivosti krve, vrozen\u00e9 anom\u00e1lie srdce a dal\u0161\u00ed. Prognosticky z\u00e1va\u017en\u011bj\u0161\u00ed, s vy\u0161\u0161\u00ed \u00famrtnost\u00ed, jsou hemoragick\u00e9 mozkov\u00e9 p\u0159\u00edhody \u2013 takzvan\u00e9 \u201ekrv\u00e1cen\u00ed do mozku\u201c. Krv\u00e1cen\u00ed m\u016f\u017ee nastat p\u0159\u00edmo do mozkov\u00e9 tk\u00e1n\u011b nebo mezi mozek a mozkov\u00e9 obaly. Typicky z v\u00fddut\u011b, takzvan\u00e9 subarachnoid\u00e1ln\u00ed krv\u00e1cen\u00ed. Riziko vzniku mrtvice zvy\u0161uje p\u0159\u00edtomnost rizikov\u00fdch faktor\u016f.<\/p>\n\n\n\n
Jak\u00e9 jsou nej\u010dast\u011bj\u0161\u00ed rizikov\u00e9 faktory?<\/p>\n\n\n\n
Mezi nej\u010dast\u011bj\u0161\u00ed rizikov\u00e9 faktory ischemick\u00e9 CMP \u0159ad\u00edme vysok\u00fd krevn\u00ed tlak, kou\u0159en\u00ed, nemoci srdce – p\u0159edev\u0161\u00edm arytmie \u010di chlopenn\u00ed vady, vysokou hladinu tuk\u016f v krvi, cukrovku, nedostatek pohybu, obezitu a dal\u0161\u00ed. \u010casto v\u00edd\u00e1me u na\u0161ich pacient\u016f kombinaci n\u011bkolika rizikov\u00fdch faktor\u016f najednou, co\u017e riziko vzniku CMP n\u00e1sob\u00ed. Nap\u0159\u00edklad sou\u010dasn\u00fd v\u00fdskyt vysok\u00e9ho krevn\u00edho tlaku, cukrovky a obezity nen\u00ed vz\u00e1cnost\u00ed. U mlad\u00fdch \u017een je rizikov\u00e1 kombinace hormon\u00e1ln\u00ed antikoncepce a kou\u0159en\u00ed. Hlavn\u00edm rizikov\u00fdm faktorem krv\u00e1cen\u00ed do mozku je nedostate\u010dn\u00e9 l\u00e9\u010den\u00fd nebo nel\u00e9\u010den\u00fd vysok\u00fd krevn\u00ed tlak.<\/p>\n\n\n\n
Jak\u00e9 jsou p\u0159\u00edznaky c\u00e9vn\u00ed mozkov\u00e9 p\u0159\u00edhody?<\/p>\n\n\n\n
Zm\u011bna v\u00fdrazu tv\u00e1\u0159e, neschopnost d\u00e1t sousto j\u00eddla do \u00fast nebo udr\u017eet hrnek v ruce, p\u0159\u00edpadn\u011b n\u00e1hle vznikl\u00e9 probl\u00e9my s ch\u016fz\u00ed, by m\u011bly vzbudit podez\u0159en\u00ed na mozkovou mrtvici. Pr\u00e1v\u011b pokles \u00fastn\u00edho koutku, porucha hybnost\u00ed kon\u010detin a porucha \u0159e\u010di pat\u0159\u00ed k nej\u010dast\u011bj\u0161\u00edm projev\u016fm mrtvice. Na z\u00e1klad\u011b t\u011bchto p\u0159\u00edznak\u016f byl vytvo\u0159en FAST test \u2013 jednoduch\u00e1 pom\u016fcka pro z\u00e1chran\u00e1\u0159e, ale vyu\u017eiteln\u00e1 i \u0161irokou ve\u0159ejnost\u00ed, k rychl\u00e9mu rozpozn\u00e1n\u00ed mrtvice. FAST je zkratkou anglick\u00fdch slov FACE (tv\u00e1\u0159 – poklesl\u00fd koutek, \u010dlov\u011bk se symetricky neusm\u011bje, nevycen\u00ed zuby, nezap\u00edsk\u00e1), ARM (ruka – pokles kon\u010detiny po p\u0159edpa\u017een\u00ed), SPEECH (porucha \u0159e\u010di – \u010dlov\u011bk nedok\u00e1\u017ee zopakovat jasn\u011b v\u011btu nebo \u0159e\u010d je set\u0159el\u00e1, \u0161patn\u011b srozumiteln\u00e1), tak T zna\u010d\u00ed \u010das (TIME) a zd\u016fraz\u0148uje nutnost okam\u017eit\u00e9 pomoci, nebo\u0165 \u201e\u010das je mozek\u201c.<\/p>\n\n\n\n
Jak se zachovat v p\u0159\u00edpad\u011b podez\u0159en\u00ed na CMP?<\/p>\n\n\n\n
Pokud zpozorujete alespo\u0148 jeden z v\u00fd\u0161e popsan\u00fdch p\u0159\u00edznak\u016f, nap\u0159\u00edklad u va\u0161eho p\u0159\u00edbuzn\u00e9ho nebo zn\u00e1m\u00e9ho, kontaktujte okam\u017eit\u011b z\u00e1chrannou slu\u017ebu. Nesna\u017ete se posti\u017een\u00e9ho odv\u00e9st k praktick\u00e9mu l\u00e9ka\u0159i nebo do nejbli\u017e\u0161\u00ed nemocnice. D\u016fle\u017eit\u00e9 je kontaktovat pr\u00e1v\u011b z\u00e1chrannou slu\u017ebu, kter\u00e1 v\u00ed, kam pacienta sm\u011b\u0159ovat, kter\u00e9 iktov\u00e9 centrum je pro n\u011bj nejdostupn\u011bj\u0161\u00ed. Ne ka\u017ed\u00e1 nemocnice m\u00e1 neurologick\u00e9 odd\u011blen\u00ed a u\u017e v\u016fbec ne ka\u017ed\u00e1 provozuje iktov\u00e9 centrum. Pro pacienta je z\u00e1sadn\u00ed dos\u00e1hnout na l\u00e9\u010dbu v co nejkrat\u0161\u00edm \u010dase. V \u010cesk\u00e9 republice jsou postupy diagnostiky a l\u00e9\u010dby nastaveny velmi kvalitn\u011b a v organizaci p\u00e9\u010de o pacienty s mrtvic\u00ed pat\u0159\u00edme ke sv\u011btov\u00e9 \u0161pi\u010dce.<\/p>\n\n\n\n
A jedno takov\u00e9 centrum nyn\u00ed vzniklo v Most\u011b.<\/p>\n\n\n\n
Ano, mosteck\u00e1 nemocnice z\u00edskala statut iktov\u00e9ho centra v \u0159\u00edjnu lo\u0148sk\u00e9ho roku. Z d\u016fvodu koronavirov\u00e9 pandemie bylo zah\u00e1jen\u00ed provozu komplikovan\u00e9. Zna\u010dn\u00e1 \u010d\u00e1st na\u0161eho person\u00e1lu se pod\u00edlela na zaji\u0161t\u011bn\u00ed akutn\u00ed p\u00e9\u010de o pacienty s onemocn\u011bn\u00edm covid-19. Nyn\u00ed ji\u017e na\u0161e centrum poskytuje nep\u0159etr\u017eitou p\u00e9\u010di o pacienty s mrtvic\u00ed.<\/p>\n\n\n\n
Co se vznikem iktov\u00e9ho centra zm\u011bnilo pro person\u00e1l nemocnice?<\/p>\n\n\n\n
Museli jsme roz\u0161\u00ed\u0159it odd\u011blen\u00ed intenzivn\u00ed p\u00e9\u010de, pos\u00edlit person\u00e1l \u2013 l\u00e9ka\u0159sk\u00fd i sestersk\u00fd, zav\u00e9st do b\u011b\u017en\u00e9 praxe na\u0161eho odd\u011blen\u00ed nov\u00e9 postupy. D\u016fle\u017eit\u00e9 bylo zkoordinovat spolupr\u00e1ci n\u011bkolika pracovi\u0161\u0165 \u2013 centr\u00e1ln\u00edho p\u0159\u00edjmu, RTG pracovi\u0161t\u011b \u2013 p\u0159edev\u0161\u00edm CT, neurologick\u00e9 a intern\u00ed \u010d\u00e1sti multioborov\u00e9 jednotky intenzivn\u00ed p\u00e9\u010de a ARO odd\u011blen\u00ed. Toto \u201elad\u011bn\u00ed strun\u201c bylo docela n\u00e1ro\u010dn\u00e9, ale p\u0159ineslo sv\u00e9 ovoce. Za sou\u010dasn\u00e9ho stavu jsme schopni pacienta s mrtvic\u00ed klinicky vy\u0161et\u0159it a v indikovan\u00fdch p\u0159\u00edpadech zal\u00e9\u010dit trombol\u00fdzu za dobu krat\u0161\u00ed ne\u017e 20 minut. V\u00fdznamnou sou\u010d\u00e1st\u00ed na\u0161eho iktov\u00e9ho centra je i odd\u011blen\u00ed akutn\u00ed rehabilitace.<\/p>\n\n\n\n
A co se zm\u011bnilo pro pacienty?<\/p>\n\n\n\n
Jednozna\u010dn\u011b dostupnost a rychlost diagnostiky a l\u00e9\u010dby. Nemocnice Most m\u00e1 nadregion\u00e1ln\u00ed charakter, velkou sp\u00e1dovou oblast, je druh\u00fdm nejv\u011bt\u0161\u00edm zdravotnick\u00fdm za\u0159\u00edzen\u00edm v kraji. Pacient s mrtvic\u00ed nemus\u00ed b\u00fdt p\u0159ev\u00e1\u017een z\u00e1chrannou slu\u017ebou do okoln\u00edch okres\u016f, aby dos\u00e1hl na modern\u00ed a \u00fa\u010dinnou l\u00e9\u010dbu. Jak jsem ji\u017e uvedl, rozhoduj\u00edc\u00edm faktorem p\u0159i l\u00e9\u010db\u011b mozkov\u00e9 p\u0159\u00edhody je \u010das, to znamen\u00e1, \u017ee \u010d\u00edm d\u0159\u00edve pacient l\u00e9\u010dbu podstoup\u00ed, t\u00edm m\u00e1 v\u011bt\u0161\u00ed \u0161anci na \u00fapln\u00e9 vyl\u00e9\u010den\u00ed nebo na dosa\u017een\u00ed dobr\u00e9ho celkov\u00e9ho stavu s minim\u00e1ln\u00edmi n\u00e1sledky. Ka\u017ed\u00e1 u\u0161et\u0159en\u00e1 minuta m\u00e1 smysl\u2026<\/p>\n\n\n\n
Jak\u00e1 je aktu\u00e1ln\u011b \u00fasp\u011b\u0161nost l\u00e9\u010dby mozkov\u00e9 mrtvice?<\/p>\n\n\n\n
V sou\u010dasnosti m\u00e1me mo\u017enost mozkov\u00fd infarkt zal\u00e9\u010dit intraven\u00f3zn\u00ed trombol\u00fdzou, kter\u00e1 je indikov\u00e1na do 4,5 hodiny od po\u010d\u00e1tku p\u0159\u00edznak\u016f. Pacienti s uz\u00e1v\u011brem velk\u00fdch tepen dos\u00e1hnou na l\u00e9\u010dbu mechanickou rekanalizac\u00ed do 6 hodin od vzniku, ve v\u00fdjime\u010dn\u00fdch p\u0159\u00edpadech m\u016f\u017ee b\u00fdt tato doba i del\u0161\u00ed. Pokud l\u00e9\u010dbu trombol\u00fdzou provedeme do jedn\u00e9 hodiny od za\u010d\u00e1tku nemoci, m\u016f\u017eeme dos\u00e1hnout \u00fapln\u00e9ho vyl\u00e9\u010den\u00ed v 50 % a\u017e 70 % p\u0159\u00edpad\u016f. Nicm\u00e9n\u011b i p\u0159es v\u00fdrazn\u00e9 pokroky, kter\u00e9 byly v prevenci a l\u00e9\u010db\u011b c\u00e9vn\u00edch mozkov\u00fdch p\u0159\u00edhod v posledn\u00ed dob\u011b dosa\u017eeny, z\u016fst\u00e1v\u00e1 toto onemocn\u011bn\u00ed jedn\u00edm z nej\u010dast\u011bj\u0161\u00edch p\u0159\u00ed\u010din \u00famrt\u00ed a invalidity.<\/p>\n\n\n\n
Rozhovor poskytla Krajsk\u00e1 zdravotn\u00ed, kter\u00e1 Nemocnici Most provozuje.<\/p>\n\n\n\n
Zden\u011bk Plach\u00fd<\/p>\n\n\n\n
Mosteck\u00fd den\u00edk<\/p>\n\n\n\n
https:\/\/mostecky.denik.cz\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":" \/ROZHOVOR\/ Nemocnice v Most\u011b za\u010dala poskytovat neurologick\u00fdm pacient\u016fm superakutn\u00ed centrovou p\u00e9\u010di, od \u00fanora tam funguje centrum vysoce specializovan\u00e9 p\u00e9\u010de o pacienty s iktem. Iktov\u00e9 centrum […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":15438,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-37224","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/37224","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=37224"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/37224\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/15438"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=37224"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=37224"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=37224"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}