{"id":3044,"date":"2023-02-10T20:35:27","date_gmt":"2023-02-10T20:35:27","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=3044"},"modified":"2023-02-23T17:02:22","modified_gmt":"2023-02-23T17:02:22","slug":"10-1-priprema-bolesnika-za-rekonstrukciju-supraortalnih-grana","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=3044","title":{"rendered":"10.1. PRIPREMA BOLESNIKA ZA REKONSTRUKCIJU SUPRAORTALNIH GRANA"},"content":{"rendered":"

\"\"<\/a><\/p>\n

<\/p>\n

OP\u0160TI PRINCIPI REKONSTRUKCIJA
SUPRAAORTALNIH GRANA<\/h1>\n

<\/a><\/h1>\n

\n

\n

10.1. PRIPREMA BOLESNIKA ZA REKONSTRUKCIJU
SUPRAORTALNIH GRANA<\/p>\n

<\/h3>\n<\/div>\n
\n

PRIPREMA BOLESNIKA ZA REKONSTRUKCIJU SUPRAORTALNIH GRANA<\/h3>\n

V<\/span>e\u0107in<\/span>a<\/span> <\/span>vaskularno-hirur\u0161ki<\/span>h<\/span> <\/span>pacijenat<\/span>a<\/span> <\/span>(osi<\/span>m<\/span> <\/span>oni<\/span>h<\/span> <\/span>s<\/span>a<\/span> <\/span>povredam<\/span>a<\/span> <\/span>arterija<\/span>)<\/span> <\/span>pripadaju<\/span> <\/span>starijoj<\/span> <\/span>\u017eivotnoj<\/span> <\/span>dobi.<\/span> <\/span>Naj\u010de\u0161\u0107e<\/span> <\/span>se<\/span> <\/span>radi<\/span> <\/span>o<\/span> <\/span>arterioskleroti\u010dnim<\/span> <\/span>lezijama<\/span> <\/span>sa<\/span> <\/span>prate\u0107im<\/span> <\/span>lezijama<\/span> <\/span>vi\u0161e<\/span> <\/span>arterija.<\/span> <\/span>Neophodno<\/span> <\/span>je<\/span> <\/span>eliminisati<\/span> <\/span>faktore<\/span> <\/span>rizika.<\/span><\/p>\n

Moraju<\/span> <\/span>se<\/span> <\/span>proceniti<\/span> <\/span>i<\/span> <\/span>le\u010diti<\/span> <\/span>konkomitiraju\u0107a<\/span> <\/span>oboljenja.<\/span> <\/span>Kardiorespiratorni<\/span> <\/span>status<\/span> <\/span>i<\/span> <\/span>bubre\u017enu<\/span> <\/span>funkciju<\/span> <\/span>moramo<\/span> <\/span>proceniti<\/span> <\/span>rutinskim<\/span> <\/span>metodama,<\/span> <\/span>ali<\/span> <\/span> <\/span>po-<\/span> <\/span>nekad<\/span> <\/span>i<\/span> <\/span>funkcionalnim<\/span> <\/span>testovima.<\/span> <\/span>Metaboli\u010dko-imunolo\u0161ki<\/span> <\/span>parametri<\/span> <\/span>moraju<\/span> <\/span>zadovoljavati<\/span> <\/span>op\u0161te<\/span> <\/span>kriterijume<\/span> <\/span>operabiliteta.<\/span><\/p>\n

<\/span>Koagulacioni sistem mo\u017ee biti poreme\u0107en u smislu hipo ili hiper koagulabilnosti.
Pre, intra i postoperativno, koagulacioni status se mo\u017ee poremetiti antikoagulantnim, antitrombocitnim i tromboliti\u010dkim lekovima. Preoperativno treba isklju\u010diti ove lekove ako je mogu\u0107e. Koagulacioni status treba proveriti baterijom \u201cscreenig\u201d testova. Ako sumnjamo na delikatniji poreme\u0107aj koagulacionog sistema treba selektivno ispitati faktore koagulacije (antitrombin III, aktivnost trombocita, plazminogen itd.) i korigovati ih.<\/p>\n

Antibiotska<\/span> <\/span>pro<\/span>fi<\/span>laksa<\/span> <\/span>je<\/span> <\/span>potrebna<\/span> <\/span>kod<\/span> <\/span>hroni\u010dnih<\/span> <\/span>infekcija,<\/span> <\/span>starijih<\/span> <\/span>pacijenata<\/span> <\/span>u<\/span> <\/span>lo\u0161em<\/span> <\/span>op\u0161tem<\/span> <\/span>stanju<\/span> <\/span>i<\/span> <\/span>u<\/span> <\/span>slu\u010daju<\/span> <\/span>reoperacije.<\/span><\/p>\n

Zavisno<\/span> <\/span>od<\/span> <\/span>veli\u010dine<\/span> <\/span>planirane<\/span> <\/span>operacije<\/span> <\/span>moramo<\/span> <\/span>pripremiti<\/span> <\/span>dovoljnu<\/span> <\/span>nadoknadu<\/span> <\/span>gubitaka<\/span> <\/span>krvi:<\/span> <\/span>eritrociti,<\/span> <\/span>plazma<\/span> <\/span>i<\/span> <\/span>trombociti.<\/span> <\/span>Preoperativno<\/span> <\/span>deponovanje<\/span> <\/span>vlastite<\/span> <\/span>krvi<\/span> <\/span>bolesnika<\/span> <\/span>mo\u017ee,<\/span> <\/span>pomo\u0107u<\/span> <\/span>autotransfuzije<\/span> <\/span>i<\/span> <\/span>izovolemi\u010dne<\/span> <\/span>hemodilucije<\/span> <\/span>da<\/span> <\/span>isklju\u010di<\/span> <\/span>potrebu<\/span> <\/span>za<\/span> <\/span>transfuzijom.<\/span><\/p>\n

Preoperativni<\/b><\/span> <\/b><\/span>razgovor<\/b><\/span> <\/b><\/span>sa<\/b><\/span> <\/b><\/span>pacijentom<\/b><\/span> <\/b><\/span>u<\/span> <\/span>kome<\/span> <\/span>se<\/span> <\/span>ozbiljnost<\/span> <\/span>operacije<\/span> <\/span>ne<\/span> <\/span>podcenjuje,<\/span> <\/span>ali<\/span> <\/span>i<\/span> <\/span>ne<\/span> <\/span>prenagla\u0161ava,<\/span> <\/span>pru\u017ea<\/span> <\/span>pacijentu<\/span> <\/span>mogu\u0107nost<\/span> <\/span>da<\/span> <\/span>bude<\/span> <\/span>relaksiran<\/span> <\/span>i<\/span> <\/span>stvara<\/span> <\/span>atmosferu<\/span> <\/span>poverenja.<\/span> <\/span>Tako<\/span> <\/span>\u0107e<\/span> <\/span>i<\/span> <\/span>pacijent<\/span> <\/span>i<\/span> <\/span>hirurg<\/span> <\/span>biti<\/span> <\/span>maksimalno<\/span> <\/span>moti-<\/span><\/p>\n

visani.<\/span> <\/span>Bolesnik<\/span> <\/span>mora<\/span> <\/span>da<\/span> <\/span>zna:<\/span><\/p>\n

    \n
  • kakvi<\/span> <\/span>se<\/span> <\/span>korisni<\/span> <\/span>efekti<\/span> <\/span>dobijaju<\/span> <\/span>revaskularizacijom<\/span> <\/span>mozga<\/span> <\/span>(prevencija<\/span> <\/span>\u0161loga,<\/span> <\/span>povla\u010denje<\/span> <\/span>tegoba,<\/span> <\/span>spre\u010davanje<\/span> <\/span>demencije),<\/span><\/li>\n
  • kakav<\/span> <\/span>je<\/span> <\/span>rizik<\/span> <\/span>prirodnog<\/span> <\/span>toka<\/span> <\/span>bolesti,<\/span><\/li>\n
  • koje<\/span> <\/span>su<\/span> <\/span>mogu\u0107e<\/span> <\/span>komplikacije<\/span> <\/span>hirur\u0161kog<\/span> <\/span>zahvata,<\/span><\/li>\n
  • kakav<\/span> <\/span>je<\/span> <\/span>kvalitet<\/span> <\/span>\u017eivota<\/span> <\/span>sa<\/span> <\/span>i<\/span> <\/span>bez<\/span> <\/span>operacije,<\/span> <\/span>kao<\/span> <\/span>i<\/span><\/li>\n
  • kako<\/span> <\/span> <\/span>treba<\/span> <\/span> <\/span>\u017eiveti<\/span> <\/span> <\/span>dalje<\/span> <\/span> <\/span>(higijensko-dijetetski<\/span> <\/span> <\/span>re\u017eim,<\/span> <\/span> <\/span>medikamentozna<\/span> <\/span>terapija).<\/span><\/li>\n<\/ul>\n

    Preoperativna<\/b><\/span> <\/b><\/span>priprema<\/b><\/span> <\/b><\/span>operativnog<\/b><\/span> <\/b><\/span>polja<\/b><\/span> <\/b><\/span>na<\/span> <\/span>odeljenju<\/span> <\/span>treba<\/span> <\/span>da<\/span> <\/span>bude<\/span> <\/span>potpuna.<\/span> <\/span>Dan<\/span> <\/span>ranije<\/span> <\/span>treba<\/span> <\/span>obrijati<\/span> <\/span>odgovaraju\u0107e<\/span> <\/span>regione,<\/span> <\/span>izbegavaju\u0107i<\/span> <\/span>lezije<\/span> <\/span>ko\u017ee.<\/span> <\/span>Posle<\/span> <\/span>toga<\/span> <\/span>ko\u017eu<\/span> <\/span>u<\/span> <\/span>ovom<\/span> <\/span>predelu<\/span> <\/span>treba<\/span> <\/span>premazati<\/span> <\/span>dezinfekcionim<\/span> <\/span>sredstvom<\/span> <\/span>(Polyvinil-Pyrrolidon-Jod).<\/span><\/p>\n

    Podrazumeva<\/span> <\/span>se<\/span> <\/span>po\u0161tovanje<\/span> <\/span>mera<\/span> <\/span>asepse<\/span> <\/span>i<\/span> <\/span>antisepse<\/span> <\/span>pri<\/span> <\/span>uvodjenju<\/span> <\/span>pacijenta<\/span> <\/span>u<\/span> <\/span>anesteziju<\/span> <\/span>i<\/span> <\/span>sterilno<\/span> <\/span>(benzin,<\/span> <\/span>alkohol,<\/span> <\/span>jod)<\/span> <\/span>garniranje<\/span> <\/span>operativnog<\/span> <\/span>polja.<\/span> <\/span>Posle<\/span> <\/span>antisepti\u010dke<\/span> <\/span>pripreme<\/span> <\/span>dezinfekcionim<\/span> <\/span>rastvorima<\/span> <\/span>treba<\/span> <\/span>osu\u0161iti<\/span> <\/span>operativno<\/span> <\/span>polje.<\/span> <\/span>Sterilnim<\/span> <\/span>kompresama<\/span> <\/span>i<\/span> <\/span>\u010dar\u0161avima<\/span> <\/span>ogra\u0111ujemo<\/span> <\/span>ga<\/span> <\/span>od<\/span> <\/span>nesterilne<\/span> <\/span>okoline.<\/span> <\/span>Lepljenje<\/span> <\/span>sterilne<\/span> <\/span>samolepljive<\/span> <\/span>folije<\/span> <\/span>(<\/span>steril<\/i><\/span> <\/i><\/span>drape<\/i><\/span>)<\/span> <\/span>prevenira<\/span> <\/span>infekciju<\/span> <\/span>od<\/span> <\/span>strane<\/span> <\/span>ko\u017ene<\/span> <\/span>fl<\/span>ore<\/span> <\/span>pacijenta.<\/span> <\/span>Sterilno<\/span> <\/span>pripremljeno<\/span> <\/span>operativno<\/span> <\/span>polje<\/span> <\/span>mora<\/span> <\/span>biti<\/span> <\/span>dovoljno<\/span> <\/span>veliko<\/span> <\/span>da<\/span> <\/span>se<\/span> <\/span>dodatnom<\/span> <\/span>incizijom<\/span> <\/span>mogu<\/span> <\/span>re\u0161iti<\/span> <\/span>mogu\u0107e<\/span> <\/span>komplikacije.<\/span><\/p>\n

    Polo\u017eaj<\/span> <\/span>pacijenta<\/span> <\/span>na<\/span> <\/span>operacionom<\/span> <\/span>stolu<\/span> <\/span>je<\/span> <\/span>bitan<\/span> <\/span>jer:<\/span><\/p>\n

      \n
    1. \n

      olak\u0161ava<\/span> <\/span>ili<\/span> <\/span>ote\u017eava<\/span> <\/span>operaciju<\/span><\/p>\n<\/li>\n

    2. \n

      prevenira<\/span> <\/span>lezije<\/span> <\/span>(nerava<\/span> <\/span>i<\/span> <\/span>ko\u017ee)<\/span> <\/span>zbog<\/span> <\/span>dugotrajnog<\/span> <\/span>pritiska<\/span> <\/span>u<\/span> <\/span>neprirodnom<\/span> <\/span>polo\u017eaju.<\/span><\/p>\n<\/li>\n<\/ol>\n

      Osnovno<\/span> <\/span>je<\/span> <\/span>pravilo<\/span> <\/span>da<\/span> <\/span>mesto<\/span> <\/span>na<\/span> <\/span>kome<\/span> <\/span>\u0107e<\/span> <\/span>biti<\/span> <\/span>hirur\u0161ki<\/span> <\/span>rez<\/span> <\/span>treba<\/span> <\/span>da<\/span> <\/span>bude<\/span> <\/span>najvi\u0161i<\/span> <\/span>region<\/span> <\/span>tela<\/span> <\/span>pacijenta.<\/span><\/p>\n

      Arterioskleroti\u010dni<\/span> <\/span>pacijenti<\/span> <\/span>su<\/span> <\/span>skloni<\/span> <\/span>intraoperativnim<\/span> <\/span>dekubitalnim<\/span> <\/span>lezijama<\/span> <\/span>(sakralni<\/span> <\/span>region,<\/span> <\/span>peta).<\/span> <\/span>Dobar<\/span> <\/span>polo\u017eaj<\/span> <\/span>i<\/span> <\/span>meki<\/span> <\/span>podmeta\u010di<\/span> <\/span>na<\/span> <\/span>ugro\u017eenim<\/span> <\/span>mestima<\/span> <\/span>\u0107e<\/span> <\/span>spre\u010diti<\/span> <\/span>kompresiju<\/span> <\/span>na<\/span> <\/span>nerve<\/span> <\/span>i<\/span> <\/span>osetljiva<\/span> <\/span>meka<\/span> <\/span>tkiva.<\/span> <\/span>Elektroda<\/span> <\/span>za<\/span> <\/span>dijatermiju<\/span> <\/span>mora<\/span> <\/span>biti<\/span> <\/span>postavljena<\/span> <\/span>sa<\/span> <\/span>dobrim<\/span> <\/span>kontaktom,<\/span> <\/span>a<\/span> <\/span>okolina<\/span> <\/span>suva<\/span> <\/span>da<\/span> <\/span>bi<\/span> <\/span>se<\/span> <\/span>izbegle<\/span> <\/span>opekotine.<\/span><\/p>\n

      Neophodna<\/b><\/span> <\/b><\/span>je<\/b><\/span> <\/b><\/span>dobra<\/b><\/span> <\/b><\/span>saradnja<\/b><\/span> <\/b><\/span>sa<\/b><\/span> <\/b><\/span>anesteziologom<\/b><\/span>.<\/span> <\/span>Odluka<\/span> <\/span>o<\/span> <\/span>vrsti<\/span> <\/span>i<\/span> <\/span>tipu<\/span> <\/span>anestezije<\/span> <\/span>zavisi<\/span> <\/span>od<\/span> <\/span>hirur\u0161ke<\/span> <\/span>strategije,<\/span> <\/span>ozbiljnosti<\/span> <\/span>zahvata<\/span> <\/span>i<\/span> <\/span>op\u0161teg<\/span> <\/span>stanja<\/span> <\/span>pacijenta.<\/span> <\/span>Mnogi<\/span> <\/span>ozbiljni<\/span> <\/span>zahvati<\/span> <\/span>na<\/span> <\/span>spraaortalnim<\/span> <\/span>granama<\/span> <\/span>(karotidna<\/span> <\/span>endarterektomija<\/span> <\/span>itd.)<\/span> <\/span>se<\/span> <\/span>mogu<\/span> <\/span>izvesti<\/span> <\/span>u<\/span> <\/span>regionalnoj<\/span> <\/span>anesteziji.<\/span> <\/span>U<\/span> <\/span>tom<\/span> <\/span>slu\u010daju<\/span> <\/span>imamo<\/span> <\/span>najbolji<\/span> <\/span>mogu\u0107i<\/span> <\/span>monitoring<\/span> <\/span>funkcije<\/span> <\/span>mozga<\/span> <\/span>i<\/span> <\/span>preveniramo<\/span> <\/span>kardiorespiratorne<\/span> <\/span>komplikacije<\/span> <\/span>povezane<\/span> <\/span>sa<\/span> <\/span>op\u0161tom<\/span> <\/span>endovaskularnom<\/span> <\/span>anestezijom.<\/span> <\/span>Odluku<\/span> <\/span>o<\/span> <\/span>tipu<\/span> <\/span>anestezije<\/span> <\/span>donose<\/span> <\/span>anasteziolog<\/span> <\/span>i<\/span> <\/span>hirurg<\/span> <\/span>u<\/span> <\/span>dogovoru.<\/span><\/p>\n

      Speci<\/span>fi<\/span>\u010dnost<\/span> <\/span>rekonstrukcija<\/span> <\/span>na<\/span> <\/span>supraaortalnim<\/span> <\/span>granama<\/span> <\/span>je<\/span> <\/span>neophodnost<\/span> <\/span>privremenog<\/span> <\/span>klemovanja<\/span> <\/span>da<\/span> <\/span>bi<\/span> <\/span>reparacija<\/span> <\/span>arterijskog<\/span> <\/span>stabla<\/span> <\/span>bila<\/span> <\/span>mogu\u0107a.<\/span> <\/span>To<\/span> <\/span>podrazumeva<\/span> <\/span>neophodnost<\/span> <\/span>monitoringa<\/span> <\/span>cerebralnih<\/span> <\/span>funkcija<\/span> <\/span>tokom<\/span> <\/span>operacije,<\/span> <\/span>uz<\/span> <\/span>\u0161to<\/span> <\/span>kra\u0107e<\/span> <\/span>klemovanje<\/span> <\/span>arterija<\/span> <\/span>i\/ili<\/span> <\/span>plasiranje<\/span> <\/span>protektivnog<\/span> <\/span>intraluminalnog<\/span> <\/span>shunt-a.<\/span> <\/span>Intraoperativni<\/span> <\/span>monitoring<\/span> <\/span>mo\u017edanih<\/span> <\/span>funkcija<\/span> <\/span>se<\/span> <\/span>vr\u0161i<\/span> <\/span>elektroencefalogra<\/span>fi<\/span>jom,<\/span><\/p>\n

      transkranijalnim Dopplerom ili kontaktiranjem sa pacijentom ako je budan (regionalna anestezija). Intraoperativni monitoring kardiorespiratornih parametara i diureze se podrazumeva.<\/p>\n

      Instrumentarijum za preparisanje arterija mora biti \u201catraumatski\u201d.<\/p>\n<\/div>\n


      \n<\/p>\n","protected":false},"excerpt":{"rendered":"

      OP\u0160TI PRINCIPI REKONSTRUKCIJASUPRAAORTALNIH GRANA 10.1. PRIPREMA BOLESNIKA ZA REKONSTRUKCIJU SUPRAORTALNIH GRANA PRIPREMA BOLESNIKA ZA REKONSTRUKCIJU SUPRAORTALNIH GRANA Ve\u0107ina vaskularno-hirur\u0161kih pacijenata (osim onih sa povredama arterija) pripadaju starijoj \u017eivotnoj dobi. Naj\u010de\u0161\u0107e se radi o arterioskleroti\u010dnim lezijama sa prate\u0107im lezijama vi\u0161e arterija. Neophodno je eliminisati faktore rizika. Moraju se proceniti i le\u010diti konkomitiraju\u0107a oboljenja. Kardiorespiratorni status i […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3044","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n10.1. PRIPREMA BOLESNIKA ZA REKONSTRUKCIJU SUPRAORTALNIH GRANA - KAROTIDNA HIRURGIJA<\/title>\n<meta name=\"description\" content=\"Vaskularna hirurgija ne toleri\u0161e gre\u0161ke, posebno ne kod operacija na arterijama koje dovode krv do mozga. Lo\u0161a indikacija ili tehni\u010dka gre\u0161ka dovodi do komplikacije. Gre\u0161ka se u vaskularnoj hirurgiji ne pra\u0161ta, te\u0161ko se ispravlja, a dugo se ispa\u0161ta.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.karotidnahirurgija.com\/?page_id=3044\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"10.1. 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