\u010cT1<\/p>\n\n\n\n
Na\u0161\u00edm t\u00e9matem jsou bariatrick\u00e9 operace. Na\u0161imi hosty jsou pan prof. Martin Matoulek a Dr. Tom\u00e1\u0161 Z\u00e1hora. P\u00e1nov\u00e9, dobr\u00fd den. My jsme zmi\u0148ovali v t\u00e9 p\u0159\u00edprav\u011b na beiatrickou operaci, kter\u00e9 se \u0159\u00edk\u00e1 prerehabilitace, nebo vy jste mluvil o fyzioterapii, o dechov\u00e9m cvi\u010den\u00ed? M\u016f\u017eete je\u0161t\u011b jednou p\u0159ipomenout, pro\u010d je to d\u016fle\u017eit\u00e9 v t\u00e9 f\u00e1zi. <\/p>\n\n\n\n
mluv\u010d\u00ed 5,<\/strong> Tzv. prerehabilitace nebo prehabilitace je vlastn\u011b p\u0159\u00edprava pacienta na jakoukoliv operaci, nejenom na bariatrickou operaci, ale obecn\u011b pacienti, kte\u0159\u00ed jsou ob\u00e9zn\u00ed, \u010dasto sly\u0161\u00ed u sv\u00e9ho chirurga, \u017ee by m\u011bli p\u0159ed operac\u00ed zhubnout. Ano, a my \u00fapln\u011b nechceme, aby dr\u017eeli p\u0159\u00edsn\u00e9 reduk\u010dn\u00ed diety t\u011bsn\u011b p\u0159ed operac\u00ed, proto\u017ee vlastn\u011b se dost\u00e1vaj\u00ed do katabolick\u00e9ho stavu, kdy se pak zhor\u0161uje hojen\u00ed a vlastn\u011b to m\u016f\u017ee b\u00fdt i kontraproduktivn\u00ed, tak\u017ee my s nima sna\u017e\u00edme se \u0159e\u0161it v\u00fd\u017eivu, aby m\u011bl dostatek protein\u016f a fyzioterapeut s nimi cvi\u010d\u00ed t\u0159eba dechovou rehabilitac\u00ed u\u017e p\u0159ed operac\u00ed a aby l\u00e9pe ud\u00fdchali po anestezii nebo zrychlili ten n\u00e1vrat do b\u011b\u017en\u00e9ho \u017eivota. <\/p>\n\n\n\n mluv\u010d\u00ed 1,<\/strong> Z hlediska t\u00e9 operace. Pane doktore, popi\u0161te to n\u00e1m laik\u016fm, pro\u010d je d\u016fle\u017eit\u00e9, aby t\u0159eba pacient n\u011bjak\u00e9 to kilo shodil? <\/p>\n\n\n\n mluv\u010d\u00ed 6,<\/strong> U n\u00e1s to velice d\u016fle\u017eit\u00e9, proto\u017ee ob\u00e9zn\u00ed pacient, on nen\u00ed ob\u00e9zn\u00ed jenom navenek, on je ob\u00e9zn\u00ed i vevnit\u0159, m\u00e1 vnit\u0159n\u00ed org\u00e1ny pln\u00e9 tuku a n\u00e1m to, p\u0159i t\u00e9 operaci, d\u011bl\u00e1 probl\u00e9my p\u0159i preparaci tk\u00e1n\u00ed a p\u0159i prov\u00e1d\u011bn\u00ed t\u00e9 vlastn\u00ed operace, kdy\u017e pacient p\u0159ed operac\u00ed zhubne t\u0159eba 10\u201320 kg, dojde ke zmen\u0161en\u00ed jatern\u00ed tk\u00e1n\u011b, to je n\u00e1\u0161 nejv\u011bt\u0161\u00ed nep\u0159\u00edtel p\u0159i t\u00e9 operaci a t\u00edm p\u00e1dem operace se n\u00e1m snad da\u0159\u00ed snadn\u011bji ud\u011blat, n\u011bkdy i operaci kv\u016fli ve velk\u00fdm j\u00e1tr\u016fm mus\u00edme zru\u0161it, proto\u017ee nejsme schopni tu danou operaci ud\u011blat. Kdy\u017e prob\u00edh\u00e1 \u0159\u00e1dn\u00e1 p\u0159\u00edprava pacienta p\u0159ed operac\u00ed, tak n\u00e1m to velice pom\u00e1h\u00e1.<\/p>\n\n\n\n mluv\u010d\u00ed 1,<\/strong> Jak je to n\u00e1ro\u010dn\u00e1 operace. <\/p>\n\n\n\n mluv\u010d\u00ed 6,<\/strong> Tak my t\u011bch operac\u00ed d\u00e1me kolem stovky ro\u010dn\u011b, m\u00e1me skv\u011bl\u00fd t\u00fdm a ta operace trv\u00e1 standardn\u011b od hodiny, hodiny a p\u016fl a operace jsou n\u00e1ro\u010dn\u011bj\u0161\u00ed, proto\u017ee ty pacienti jsou konstitu\u010dn\u011b ob\u00e9zn\u011bj\u0161\u00ed, h\u016f\u0159 se preparuj\u00ed tk\u00e1n\u011b, tak\u017ee je pot\u0159eba, aby operat\u00e9r ty operace d\u011blal co nej\u010dast\u011bji, t\u00edm p\u00e1dem se ta obesita centralizuje do center. <\/p>\n\n\n\n mluv\u010d\u00ed 1,<\/strong> Jak je to n\u00e1ro\u010dn\u00e1 operace pro samotn\u00e9ho pacienta? Ot\u00e1zka rekonvalescence….<\/p>\n\n\n\n mluv\u010d\u00ed 6,<\/strong> ob\u00e9zn\u011bj\u0161\u00ed pacienti vlastn\u00ed operaci zvl\u00e1daj\u00ed h\u016f\u0159e ne\u017e pacienti s norm\u00e1ln\u00ed hmotnost\u00ed. D\u016fle\u017eit\u00e1 je dechov\u00e1 rehabilitace. Tak\u017ee na\u0161t\u011bst\u00ed d\u00edky modern\u00edm metod\u00e1m, jako je laparoskopie, d\u00edky kter\u00e9 opravdu do\u0161lo k boomu t\u011bchto operac\u00ed, jsme schopni z mal\u00fdch \u0159ez\u016f ud\u011blat velk\u00e9 z\u00e1kroky a t\u00edm p\u00e1dem to hojen\u00ed je lep\u0161\u00ed, ne\u017e kdybysme to d\u011blali jin\u00fdm zp\u016fsobem. <\/p>\n\n\n\n mluv\u010d\u00ed 5,<\/strong> Je to vysoce rizikov\u00e1 operace u pacient\u016f s obezitou t\u0159et\u00edho stupn\u011b a dal\u0161\u00edmi nemocemi, kter\u00e9 si s sebou nesou a my opravdu mus\u00edme popsat ten stav, jak\u00e9 je riziko t\u00e9 operace, tak\u017ee v\u017edycky na\u0161e role je vlastn\u011b p\u0159edstavit tu \u0161anci na tu zm\u011bnu a to riziko mus\u00edme posoudit spolu s pacientem, ale samoz\u0159ejm\u011b to posuzuje i anesteziolog, cel\u00fd ten t\u00fdm, proto\u017ee nikdo nem\u00e1 z\u00e1jem toho pacienta p\u0159iv\u00e9st do v\u011bt\u0161\u00edho rizika, ale to riziko s t\u011bmi nemocemi a s vysokou hmotnost\u00ed je opravdu extr\u00e9m. <\/p>\n\n\n\n mluv\u010d\u00ed 1,<\/strong> Jak vypad\u00e1 poopera\u010dn\u00ed p\u00e9\u010de. <\/p>\n\n\n\n mluv\u010d\u00ed 6,<\/strong> Ta popera\u010dn\u00ed p\u00e9\u010de je dost specifick\u00e1, proto\u017ee ty pacienti mus\u00ed p\u0159ej\u00edt na ur\u010dit\u00fd re\u017eim. Te\u010f prov\u00e1z\u00ed hojen\u00ed po t\u011bch z\u00e1kroc\u00edch, to znamen\u00e1, \u017ee oni se mus\u00ed p\u0159ipravit na to, \u017ee nebudou u\u017e moct p\u0159ij\u00edmat potravu jako p\u0159edt\u00edm. Men\u0161\u00ed porce za\u010d\u00ednaj\u00ed prvn\u00edch 14 dn\u00ed \u010dist\u011b tekutou dietou. Pot\u00e9 p\u0159ech\u00e1z\u00ed na \u010dtrn\u00e1ctidenn\u00ed ka\u0161ovitou a postupn\u011b potom p\u0159ech\u00e1z\u00ed na tuhou stravu. Je to kv\u016fli tomu, \u017ee si mus\u00ed vyhojit ty tk\u00e1n\u011b a ten pacient se mus\u00ed adaptovat na tu dietu. Dal\u0161\u00ed v\u011bc je, oni u\u017e nejsou schopni vyp\u00edt t\u0159eba jednor\u00e1zov\u011b p\u016fllitr tekutiny najednou a mus\u00ed t\u0159eba pravideln\u011b pop\u00edjet dou\u0161ky ka\u017edou p\u016flhodinu, tak\u017ee pro ty pacienty je to ta poopera\u010dn\u00ed p\u00e9\u010de velice n\u00e1ro\u010dn\u00e1 a je to prevence k\u00fdl, tak\u017ee se mus\u00ed v\u0161echny ty r\u00e1ny po t\u011bch operac\u00edch, kdy\u017e my operujeme dneska miniinvazivn\u011b z drobn\u00fdch \u0159ez\u016f, tak se mus\u00ed vyhojit. <\/p>\n\n\n\n mluv\u010d\u00ed 5,<\/strong> To je v z\u00e1sad\u011b zr\u00e1dn\u00e9, proto\u017ee ty laparoskopick\u00e9 \u0159ezy se zhoj\u00ed na prvn\u00ed pohled velmi rychle. N\u011bkte\u0159\u00ed pacienti se velmi rychle s\u017eijou i s tou stravou a maj\u00ed pocit, \u017ee v\u0161echno je vy\u0159e\u0161eno, a proto v\u00edd\u00e1me \u010das od \u010dasu, \u017ee vlastn\u011b ta operace p\u0159estane fungovat, proto\u017ee oni, jak je ty chut\u011b ob\u010das \u017eenou, tak prost\u011b se pomalu hledaj\u00ed…. Pol\u00edvky, pudinky a hezky se i p\u0159es tu bariatrii dok\u00e1\u017eou zase vy\u017eivit. Ale pak je tam mnohem z\u00e1sadn\u011bj\u0161\u00ed v\u011bc, a to je hybn\u00fd syst\u00e9m, proto\u017ee kdy\u017e zhubnete des\u00edtky kilogram\u016f v horizontu t\u00fddn\u016f a m\u011bs\u00edc\u016f, tak skute\u010dn\u011b se m\u011bn\u00ed to dr\u017een\u00ed t\u011bla, pohybov\u00e9 stereotypy, zat\u011b\u017eujete klouby v jin\u00e9m sm\u011bru a paradoxn\u011b se m\u016f\u017eou objevit v\u011bt\u0161\u00ed bolesti ne\u017e p\u0159ed tou operac\u00ed, a to je t\u0159eba s t\u011bmi lidmi \u0159e\u0161it i s fyzioterapeutem, prost\u011b ty stereotypy tr\u00e9novat a zpevnit. A tzv. hlubok\u00fd stabiliza\u010dn\u00ed syst\u00e9m, o kter\u00e9m se st\u00e1le mluv\u00ed, oni nejsou schopni vlastn\u011b vybudovat, proto\u017ee nejsou ve stabiln\u00ed v\u00e1ze, to se n\u00e1m povede, a\u017e zastabilizujou v\u00e1hu. Pak jim vis\u00ed k\u016f\u017ee, \u010dasto jim nen\u00ed v tom prvn\u00edm roce \u00fapln\u011b p\u0159\u00edjemn\u011bji, mo\u017en\u00e1 prvn\u00ed t\u00fddny, kdy\u017e je v\u0161ichni chv\u00e1l\u00ed, tak to dok\u00e1\u017eou p\u0159ekonat, ale potom to m\u016f\u017ee b\u00fdt velmi nep\u0159\u00edjemn\u00e9, a proto pot\u0159ebujeme psychology i v t\u00e9to f\u00e1zi, ne\u017e t\u0159eba p\u0159ijdou k plastice b\u0159icha, a tak tu rekonstrukci, jak j\u00e1 \u0159\u00edk\u00e1m, dokon\u010d\u00ed. <\/p>\n\n\n\n mluv\u010d\u00ed 1,<\/strong> Jak\u00e1 je budouc\u00ed cesta v tomto va\u0161em oboru? Proto\u017ee jak jsme tedy \u0159ekli, tak je n\u00e1s docela dost i v \u010cesk\u00e9 republice, lid\u00ed, kte\u0159\u00ed maj\u00ed tenhle probl\u00e9m a d\u00e1 se mo\u017en\u00e1 o\u010dek\u00e1vat, \u017ee to t\u0159eba nebude lep\u0161\u00ed, \u017ee ob\u00e9zn\u00edch lid\u00ed bude p\u0159ib\u00fdvat. Tak jak\u00e1 je cesta? Co by pomohlo i ve va\u0161\u00edm oboru. <\/p>\n\n\n\n mluv\u010d\u00ed 5,<\/strong> Tak z m\u00e9ho pohledu jednozna\u010dn\u011b zkr\u00e1tit \u010dekac\u00ed doby, dostat se k odborn\u00edkovi, aby na\u0161i pacienti nekon\u010dili u r\u016fzn\u00fdch r\u00e1doby poradc\u016f na hubnut\u00ed, kte\u0159\u00ed nab\u00edzej\u00ed ketodiety, r\u016fzn\u00fd ty p\u0159\u00edsn\u00fd prost\u011b reduk\u010dn\u00ed re\u017eimy a skon\u010d\u00ed v bioefektu, kde za mnoho pen\u011bz prost\u011b dostanou zase k t\u00e9 nejvy\u0161\u0161\u00ed hmotnosti. Tak to je prvn\u00ed v\u011bc, druh\u00e1 v\u011bc je, pot\u0159ebujeme, aby se d\u011bti h\u00fdbaly, to mysl\u00edm je ten nejv\u011bt\u0161\u00ed rozd\u00edl, kter\u00fd je proti t\u00e9 populaci p\u0159ed t\u011bma 40 lety, kdy obezita nebyla zdaleka tak roz\u0161\u00ed\u0159en\u00e1, opravdu dramaticky jsme omezili pohyb, to zhor\u0161ilo psychiku v populaci a tu psychiku kompenzujeme \u010dasto j\u00eddlem, n\u011bkdy alkoholem a m\u00e1lokdy pohybem. <\/p>\n\n\n\n mluv\u010d\u00ed 1,<\/strong> Nechceme jenom stra\u0161it div\u00e1ky samoz\u0159ejm\u011b, ale stejn\u011b mo\u017en\u00e1 to v tom \u00favodu \u00fapln\u011b nezazn\u011blo. Ta obezita je spojen\u00e1 s celou \u0159adou dal\u0161\u00edch chorob, onemocn\u011bn\u00ed, kter\u00e9 to jsou nej\u010dast\u011bj\u0161\u00ed, mluv\u00ed se o cukrovce.<\/p>\n\n\n\n mluv\u010d\u00ed 5,<\/strong> Cukrovka je u ob\u00e9zn\u00edch asi tak p\u011bti- \u0161estin\u00e1sobn\u011b \u010dast\u011bji ne\u017e u \u0161t\u00edhl\u00fdch. Vysok\u00fd krevn\u00ed tlak asi p\u011btkr\u00e1t \u010dast\u011bji a jedno velmi z\u00e1sadn\u00ed onemocn\u011bn\u00ed je syndrom sp\u00e1nkov\u00e9 apnoe u t\u011bchto pacient\u016f s vysokou obezitou, a to je takov\u00fd nekvalitn\u00ed. Sp\u00e1nek v noci, p\u0159idu\u0161ov\u00e1n\u00ed, chr\u00e1p\u00e1n\u00ed a p\u0159es den obrovsk\u00e1 \u00fanava. Jedna z nej\u010dast\u011bj\u0161\u00edch p\u0159\u00ed\u010din autonehod. I mikrosp\u00e1nky za volantem nejsou \u00fanavou celkovou, ale pr\u00e1v\u011b z nel\u00e9\u010denou sp\u00e1nkovou apno\u00ed a pravd\u011bpodobnost n\u00e1hl\u00e9 smrti p\u0159i sp\u00e1nku je vysok\u00e1. Tak\u017ee pakli\u017ee pacient s obezitou trp\u00ed, trp\u00ed chr\u00e1p\u00e1n\u00edm a \u00fanavou, tak je mo\u017en\u00e1 prvn\u00ed volbou vy\u0161et\u0159it sp\u00e1nek, a to m\u016f\u017ee velmi pomoci cel\u00fd ten proces nastartovat. <\/p>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":" \u010cT1 Na\u0161\u00edm t\u00e9matem jsou bariatrick\u00e9 operace. Na\u0161imi hosty jsou pan prof. Martin Matoulek a Dr. Tom\u00e1\u0161 Z\u00e1hora. P\u00e1nov\u00e9, dobr\u00fd den. My jsme zmi\u0148ovali v t\u00e9 […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":43083,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-61700","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\/61700","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=61700"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/61700\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/43083"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=61700"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=61700"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=61700"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}