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2018, vol. 75, br. 11, str. 1076-1082
Kontinuirana intratekalna primena baklofena kod teškog onesposobljavajućeg spasticiteta
Gülhane Military Medical Academy, Haydarpasa Teaching Hospital, Istambul, Turkey

e-adresadrhakansimsek@hotmail.com
Ključne reči: baklofen; infuzione pumpe; anestezija; spinalna; kateteri; trajni; mišići; spastičnost; mozak; bolesti; kičmena moždina; bolesti; prognoza
Sažetak
Uvod/Cilj. Spasticitet je posledica nekoliko kliničkih stanja kao što su cerebralna paraliza, povrede mozga, povrede kičmene moždine, multipla skleroza, ruptura neurizme sa krvarenjem, kao i neki drugi neurološki poremećaji. Cilj ove studije bio je da se utvrdi efikasnost primene intratekalnog baklofena (ITB) u lečenju upornog teškog onesposobljavajućeg spasticiteta, kao i izazovi sa kojima se susrećemo tokom hirurške ugradnje pumpe kod ovih bolesnika. Metode. Iz kliničkih protokola u periodu 2012-2015. godina izdvojili smo bolesnike kojima je ugrađena baklofenska pumpa intratekalno uz minimlno praćenje od šest meseci. Dvadeset dva bolesnika sa teškim spasticitetom koji su imali modifikovani Asworth skor spasticiteta (MASS) između 3 i 4 bili su uključena u studiju. Osam od 22 bolesnika bila su u dečjem uzrastu i svi su bili nepokretni pre hirurškog zahvata. Rezultati. Svi bolesnici bili su podvrgnuti hirurškoj implantaicji programabilne intratekalne baklofenske pumpe. Kateteri su postavljeni perkutano u subarahnoidni prostor kod 18 bolesnika, dok smo parcijalnu hemilaminektomiju primenili za ugradnju katetera kod četiri bolesnika. Kod svih bolesnika javilo se značajno poboljšanje, 5 bolesnika počelo je da koristi gornje ekstremitete, a tri odrasla bolesnika postala su ambulantna tokom fizikalne terapije. Srednji MASS skorovi poboljšali su se od 3.59 do 1.32 (p < 0.001). Zaključak. ITB terapija je očigledno popravila kvalitet života i funkcionalnu sposobnost bolesnika sa onesposobljavajućim spasticitetom. Zahvaljujući tome fizikalna terapija bila je mnogo korisnija kod ovih bolesnika. Iako neke abnormalnosti zbog spasticiteta mogu zahtevati parcijalnu hemilaminektomiju da bi se ugradila pumpa, bolesnicima sa upornim spasticitetom treba pružiti šansu za primenu ITB lečenja u najranijem periodu njihove doživotne onesposobljenosti.
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O članku

jezik rada: engleski
vrsta rada: originalan članak
DOI: 10.2298/VSP160508039S
objavljen u SCIndeksu: 25.04.2019.
metod recenzije: dvostruko anoniman
Creative Commons License 4.0

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