AKUTNA DISEKCIJA AORTE: VISOKA SMRTNOST I PORED PRAVOVREMENO POSTAVLJENE DIJAGNOZE
Abstract
Akutna disekcija aorte se najčešće manifestuje fudrojantnom kliničkom slikom i često završava smrtnim ishodom i pored preuzimanja adekvatnih mera lečenja. Pravovremeno sprovođenje hirurškog lečenja može smanjiti rani mortalitet. Cilj rada bio je da analizira učestalost pojave akutne disekcije aorte, njene kliničke manifestacije, modalitete lečenja i smrtnost bolesnika sa akutnom disekcijom aorte. Rezultati: U periodu od 2008. do 2010. godine u internističkom odeljenju Centra za urgentnu medicinu KC „Kragujevac“ lečeno je 26 bolesnika sa akutnom disekcijom aorte (14 žena prosečne starosti 61.9 ± 14.8 godina i 12 muškaraca prosečne starosti 64.8 ± 10.0 godina). Dominantni simptomi kod većine bolesnika bili su bolovi u grudima i trbuhu, ali su kod pet bolesnika dominirali simptomi od strane centralnog nervnog sistema (glavobolja, smetnje govora, hemipareza, gubitak svesti i dr.). Radna dijagnoza aortne disekcije postavljena je nakon fizikalnog pregleda kod sedam bolesnika (pet su već imali dijagnostikovanu aneurizmu aorte), a nakon ultrazvučnog pregleda kod četrnaest bolesnika. Samo dva bolesnika su operisana u referentnoj ustanovi van KC „Kragujevac“, kod devet bolesnika je stanje stabilizovano medikamentoznim lečenjem, a smrtni ishod je registrovan kod 15 bolesnika (57.7%) – jedanaest u Centru za urgentnu medicinu unutar prvih šest sati hospitalizacije; četiri bolesnika u drugim klinikama KC „Kragujevac“. Zaključak: Potreban je multidisciplinaran i standardizovanan pristup u dijagnostikovanju i zbrinjavanju pacijenta sa akutnom disekcijom aorte u cilju skraćenja kritičnog perioda između postavljanja dijagnoze i hirurškog tretmana kao i dobra organizacija službe za zbrinjavanje ovih bolesnika u smislu organizovanog adekvatnog transporta u ustanovu u kojoj se može uraditi hitna hirurška intervencija.
Ključne reči: disekcija aorte, smrtnost, lečenje
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