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Serbian Journal of Experimental and Clinical Research
2013, vol. 14, br. 4, str. 181-187
jezik rada: engleski
vrsta rada: pregledni članak
doi:10.5937/sjecr14-4363


Sepsa i kardio-renalni sindrom - etiopatogeneza, dijagnostika i lečenje
aKlinički centar Kragujevac, Klinika za urologiju i nefrologiju, Centar za urologiju i nefrologiju, Kragujevac
bKlinički centar Kragujevac, Klinika za infektivne bolesti, Kragujevac
cKlinički centar Kragujevac, Klinika za kardiologiju, Kragujevac
dKlinički centar Kragujevac, Klinika za hematologiju, Kragujevac

Projekat

Analiza strukture troškova i uticaja na zdravstveni budžet Republike Srbije epidemiološki najmasovnijih i/ili najskupljih oboljenja i procena odnosa troškovi / efektivnost / korisnost medicinskih intervencija (MPNTR - 175014)

Sažetak

Uvod. Sepsa je najčešći uzrok akutnog oštećenja bubrega u jedinicama intenzivnog lečenja. Cilj. Rad je imao za cilj da analizira etiopatogenezu sepse i klinički značaj ranog otkrivanja i pravovremenog lečenja sepse kod bolesnika u jedinicama intenzivnog lečenja. Metodologija. Analizirani su stručni radovi i kliničke studije koje se bave etiopatogenezom, dijagnostikovanjem i lečenjem sindroma sepse. Rezultati. Jednogodišnja stopa porasta broja bolesnika sa sepsom iznosi 1.5%. Teška sepsa se definiše kao sepsa sa hipotenzijom, hipoperfuzijom i poremećajem funkcije organa. Sepsa se odlikuje aktivacijom imunskog sistema bolesnika i pojačanim stvaranjem pro- i antiinflamatornih medijatora. Pojačan i neregulisan odgovor imunskog sistema i pojačano stvaranje medijatora imaju značajnu ulogu u razvoju insuficijencije više sistema organa kod bolesnika sa sepsom. Strategija za prevenciju razvoja akutnog oštećenja bubrega kod bolesnika sa sepsom uključuje ranu ciljnu terapiju (u prvih 6 sati), koja se sastoji u ranoj pojačanoj nadoknadi zapremine krvi u cirkulaciji tečnostima (najmanje 20 ml/kg kristaloida u prvom satu). Početnom terapijom treba da se postigne centralni venski pritisak od 8-12 mmHg, srednji arterijski krvni pritisak veći od 65 mmHg, diureza veća od 0.5 ml/kg/h i zasićenost centralne venske krvi kiseonikom veća od 70%. Strategija ventilacije za zaštitu pluća i bubrega kod bolesnika na mehaničkoj ventilaciji uključuje tajdl volumen od 6 ml/kg i pritisak end-inspiratornog platoa manji od 30 cmH2O. Za odstranjivanje medijatora iz seruma bolesnika koriste se visoko-volumenska hemofiltracija i kontinuirana hemodijafiltracija sa PMMA membranom. Zaključak. Rano praćenje bolesnika i primena rane ciljne terapije imaju ključnu ulogu u sprečavanju razvoja akutnog oštećenja srca i bubrega.

Ključne reči

sepsa; kardio-renalni sindrom; dijaliznaterapija

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