Analiza baze podataka o lečenju infantilne hipertrofične stenoze pilorusa oralnom primenom atropina. Desetogodišnje iskustvo jednog centra

  • Dragana Vujović University Children's HospitalFaculty of Medicine University of Belgrade
  • Marija Lukač University Children's HospitalFaculty of Medicine University of Belgrade
  • Aleksandar Sretenović University Children's HospitalFaculty of Medicine University of Belgrade
  • Jelena Pejanović University Children's HospitalFaculty of Medicine University of Belgrade
  • Branislav Jovanović University Children's HospitalFaculty of Medicine University of Belgrade
  • Polina Pavićević University Children's HospitalFaculty of Medicine University of Belgrade
  • Tamara Krstajić University Children’s Hospital, Belgrade, Serbia
  • Goran Trajković Faculty of Medicine University of BelgradeInstitut for Medical Statistics and Informatics
  • Vedrana Pavlović Faculty of Medicine University of BelgradeInstitut for Medical Statistics and Informatics
  • Djordje Topličić University Children’s Hospital, Belgrade, Serbia
  • Sanja Sindjić-Antunović University Children's HospitalFaculty of Medicine University of Belgrade
DOI: https://doi.org/10.2298/VSP190204047V
Ključne reči: atropin;, odojče;, antimuskarinici;, pilorus, stenoza, hipertrofička;, faktori rizika;, hirurgija, operativne procedure;, lečenje, ishod

Sažetak


Uvod/Cilj. Infantilna hipertrofična stenoza pilorusa (IHSP) je najčešći razlog za hiruršku intervenciju u uzrastu novorođenčeta i mladog odojčeta, a efikasan konzervativni tretman je od velikog značaja, jer se na taj način novorođeno dete ne izlaže stresu uzrokovanom hirurškom intervencijom i opštom anestezijom. Cilj rada bio je procena uticaja različitih režima oralne primene atropina na njegovu efikasnost u lečenju IHSP. Metode. Studijom je bilo obuhvaćeno 45 bolesnika konzervativno lečenih oralnom primenom atropin sulfata zbog IHSP, u periodu od 2006. do 2016. godine. Klinički pregled, laboratorijske analize i ehosonografija urađeni su kod svih ispitanika na prijemu. Analizirana je efikasnost konzervativnog tretmana, s posebnim naglaskom na efekat doziranja leka i definisanje potencijalnih prediktivnih faktora negativnog ishoda. Procena uspešnosti lečenja analizirana je korišćenjem modela multivarijantne logističke regresije. Rezultati. Konzervativno je lečeno 45 bolesnika, od kojih je 36 (80%) bilo uspešno izlečeno (p = 0,0008, bez potrebe za hirurškom intervencijom i bez komplikacija. Polna zastupljenost, uzrast, porođajna telesna masa, telesna masa na prijemu, trajanje simptoma, kao i dužina i debljina pilorusnog mišića nisu imali statistički značajan pojedinačni uticaj na uspeh medikamentnog lečenja. Ispitanici kod kojih je primenjeno progresivno povećanje doze atropina imali su 18 puta viši rizik da će biti operisani, ispitanici koji su na prijemu imali hipohloremijsku alkalozu 15 puta viši rizik, dok su oni sa više od 5 povraćanja u prva tri dana od početka primene atropina imali 9 puta viši rizik od primene hirurškog lečenja. Zaključak. Visoka stopa uspešnosti lečenja oralnom primenom atropin sulfata čini ga validnim alternativnim lekom za neoperativni tretman IHSP. Pokazalo se da je primena inicijalno visokih doza efikasnija u odnosu na postepeno povećavane oralne doze atropin sulfata.

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Objavljeno
2021/02/11
Broj časopisa
Vol. 78 Br. 1 (2021): Vojnosanitetski Pregled
Rubrika
Originalni članak