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H crhsh tou sUnolou anosopihtukou
paraskeuasmatos kata thn qerapeian ths duskoiliothths G. A. Kopaneou, A. L. Sokoloou
Se brefh h diorqwsh twn diataraxwn ths autopanidas me thn bohqeia tou
SAP, twn bakthriofagwn kai twn eubiwtikwn mporei na ferei thn exaleipyh ths duslitourgias
tou gastroenterikou swlhnos kai antistoica thn dieuqethsh ths kenwsews, kiolas dicws thn
entolh ths qerapeias twn sumptwmwn. S` enhlikous asqenes me tis cronies duskoiliothtes h
qerapeia twn sumptwmwn me thn crhsh olwn twn proanaferqwn paraskeuasmatwn, kai epishs twn
eidikwn giatrikwn pou ephreazoun tis peristaltikes kinhseis (motilium,
debridatum, cisapridum) bazetai sthn prwth grammh. Kai
omws sthn diataraxh ths autopanidas gia tetoious asqenes prepei na apokatastaqei h
diorqwsh ths dusbakthrioshs me thn crhsh tou SAP, twn bakthriofagwn kai twn eubiwtikwn.
Oi anepiqumhtes energeies tou sunolou anosopoihtikou paraskeuasmatos
(SAP) sthn corhghsh apo to stoma kai apo ta upoqeta sta paidia kai stous enhlikous
B. A. Alioskin, A. L. Sokoloou, G. A. Kopaneou ktl.
Oi epithrhses pou efarmozontan sth diarkeia twn triwn etwn tous scedon
4000 asqenes pou epairnan to SAP gia thn diorqwsh twn diataraxwn ths mikrobiokenoshs tou
enterou, twn gennhtikwn organwn stis asqenses tou anapneustikou susthmatos (AAS), ecoun
emfanisei to akinduno tou paraskeuasmatos. Kaneis asqenhs den edeixe tis klinikes
allergikes antidraseis pou qa empore na sundesei kaneis akribws me thn lhyh tou SAP. Oi
upodeiknuomenes stis odhgies sto SAP kai sto SAP sta upoqeta antendeixes kai h anepiqumhth
drash me th morfh twn allergikwn antidraswn ferei mallon ton qewrhtikon carakthra para ton
pragmatiko kinduno gia tous asqenes.
H klinikh epibebaiwsh tou ergasthriou ths drashs tou sunolikou
anosopoihtikou paraskeuasmatos sthn sumbatikh paqogonh panida
B. A. Alioskin, A. L. Sokoloou, G. A. Kopaneou ktl.
Caris eis to periecomeno sto SAP twn entupwsiakwn immounogloboulinwn
gia ta enterobakthria, to paraskeuasma ecei thn ameshn antimikrobiotikhn drash. Auto to
apotelesma epibebaiwqhke sta 352 brefh pou epairnan to SAP me thn idiothta tou monadikou
antibakthrikou mesou kata tis dusbakthrioses tou enterou pou sunodeuontan me to uywmeno
epipedo ths sumbatikhs paqogonhs panidas, metaxu twn opoiwn tou gemolitikou enterikou
bakillou, proteiou, klebsiellae, tou crusou stafulokokkou. H apodotikothta ths
antibakthrikhs drashs tou SAP eftane 95%, gia thn pleioyhfia twn bakthriwn - 80%. Mazi m`auto shmeiwnotan o arketa mikroteros ariqmos twn parenediwn
drasewn para thn qerapeia me tous fagous h me ta antibiwtika. Kat`auto to tropo, mporoume
na sustaisoume to SAP gia thn diorqwsh twn dusbakthrioswn tou enterou pou akolouqountai me
to uywmeno epipedo ths sumbatikhs paqogonhs panidas dicws thn sunodeutikh qerapeia me tous
bakthriofagous.
H crhsh tou sunolikou anosopoihtikou paraskeuasmatos (SAP) stis
asqeneies tou anapneustikou susthmatos
A. L. Sokoloou, B. A. Alioskin, I. B. Mporisoba
Dipla me thn diorqwsh twn dusbakthrioswn to SAP mporei na
crhsimopoieitai gia thn qerapeia kai thn profulaxh asqeneiwn tou anapneustikou susthmatos
(AAS). En toiauth periptwsei auto dinetai stis prwtes meres tou arrwsthmatos h se
epikoinwnia me ton asqenh akoma sto prodromo. Antiqeta apo thn entolh gia thn diorqwsh ths
diataraxhs ths autopanidas tou enterou sto AAS to SAP dinetai mazi me to faghto merikes
fores to meronucto me thn koura 1 - 5 meres. O mhcanismos ths drashs tou SAP den einai
basizomeno sto periecomeno sto paraskeuasma mono ta antiswmata gia ta enterobakthria, alla
kai gia thn pleioyhfia twn iwn pou prokaloun to AAS. Metaxu thn lhyh tou SAP me to faghto
to paraskeuasma upoballetai sthn baquterh zumwtikh katergasia para thn lhyh nhstikos, kai
gi`auto h megalhterh posothta twn drasthriwn stoiceiwn mpainei sthn susthmatikh kukloforia
tou aimatos, epidrwntas to anosopoihtiko susthma. Me auto to schma ths qerapeias kontainan
ta diasthmata tou arrwsthmatos, kai epishs h periodos ths anarrwshs. Me thn crhsh tou SAP
stous profulaktikous skopous petucaine sucna na apotrepei kaneis thn anaptuxh tou
arrwsthmatos. Oute allergikes oute oi alles antidrases den snmeiwnontan, to paraskeuasma
egine dekto m1eukolia me to organismo.
Ta schmata ths crhshs tou sunolikou anosopoihtikou paraskeuasmatos (SAP)
sthn paidiatria
A. L. Sokoloou, G. A. Kopaneou
H sustainomenh diarkeia ths kouras tou SAP gia thn qerapeia twn
enterikwn loimwn kai thn diorqwsh twn diataraxwn ths autopanidas kanei 5 meres. Omws, kata
tis dusbakthrioses tou enterou pou sunodeuontai me thn auxhsh tou epipedou twn sumbaitikwn
paqogonwn bakthriwn pleon apo 50%
scetika me thn kanonikh enterikh panida h me thn polumorfia twn eidwn ths sumbatikhs
pawogonhs panidos, h apodotikothta tou tetoiou schmatos ths qerapeias mporei na einai mh
plhrhs. Protaqhkan oi paratetamenes koures me thn crhsh tou S?P sth diarkeia twn 10 merwn.
H apodotikothta tetoiwn kourwn fanhke yhloterh. To paraskeuasma ginetai dekto m`eukolia me
to organismo, h sucnothta twn parenediwn apotelesmatwn se sugkrish me to 5-hmero schma den
auxanetai.
H crhsh tou sunolikou anosopoihtikou paraskeuasmatos (SAP) apo ta
upoqeta sta brefh
G. A. Kopaneou. A. L. Sokoloou
To SAP apo ta upoqeta ecei thn topikh drash sta tmhmata tou tacu
enterou, carakthrizetai me to auxameno epipedo twn antiswmatwn sta enterobakthria (tis
sigellas, salmonellas, esericies, priteious klebsiello ktl.), Ps.
aegeruginosa, tous stafilokokkous, kai epishs tous
rotaious kai tis genikes diegertikes drases tou anosopoihtikou susthmatos. H upoqetikh
morfh tou SAP sta brefh crhshmopoihtai kata thn kolitea, thn flegmonh sto aphuqusmenon
entero, ton kinduno ths anaptuxhs twn sobarwn allergikwn antidraswn, kai ephshs gia thn
entash ths diegertikhs drashs sta paidia me tis cronikes h oxies loimwxeis. To SAP apo ta
upoqeta mporei na crusimopoihtai kaneis apo twn prwtwn ebdomadwn ths zwhs, h piqanothta
ths anaptuxhs twn parenediwn draswn den einai megalh, to paraskeuasma ginetai dekto
m`eukolia me to organismo. H koura ths qerapeias me to SAP apo ta upoqeta kanei 5 - 10
meres. H beltiwsh ths idioqeshs tou paidiou arcizei sthn poreia ths qerapeias h meta thn
apoperatwsh ths kouras. To qerapeutiko apotelesma ths crhshs tou SAP apo ta upoqeta
epibebaiwnetai me tis ereunes tou ergasthriou.
Pote den prepei na qerapeuei kaneis thn dusbakthriosh
G. A. Kopaneou, A. L. Sokoloou
Se merikes katastaseis oi diataraxes sthn sunqesh ths kanonikhs
enterikhs mikropanidas den creiazontai thn mikrobiologikh diorqwsh. Autes einai prin
ap`ola oi dusbakthrioses pou den sunodeuontai me tis staqeres klinikes ekdhlwses. Se
periptwsei pou h dusbakthriosh einai ena apotelesma kapoiou arrwsthmatos, einai anagkh
prin ap`ola na qerapeuei kaneis to basiko arrwsthma, s`auth th periptwsei h apokatastash
ths kanonikhs mikrobiokenoshs dicws thn mikrobiologikh diorqwsh einai piqanh. Uparcoun
merikes apocrwseis, pou den prepei na ermhneuei kaneis ws tis diataraxeis ths
mikrobiokenoshs tou enterou kai antistoica na diorqwnei.
H crhsh tou sunolikou anosopoihtikou paraskeuasmatos (SAP) sthn
paidiatria
A. L. Sokoloou, G. A. Kopaneou, L. G. Kouzimenko ktl.
To SAP sthn paidiatria crhsimopoihtai gia thn diorqwsh twn diataraxwn
ths mikrobiokenoshs tou enterou pou sunodeuontai me to auxameno epipedo twn sumbatikwn
paqogonwn bakthriwn, gia thn qerapeia twn enterikwn loimwxewn kai epishs gia thn qerapeia
kai thn profulaxh twn asqeneiwn tou anapneustikou susthmatos. H diarkeia ths kouras
exartatai apo to baqmo ths disbakthrioshs kai kanei 5-10 meres. Kata tia asqeneies tou
anapneustikou susthmatos to SAP mporei na crhsimopoihtai me tis bracuteres koures. To
paraskeuasma ginetai dekto m`eukolia me ton organismo, h apodotikothta kai to akinduno tou
paraskeuasmatos einai uyhloi.
H anosodiorqwsh kata tis dusbakthrioses tou enterou
B. A. Alioskin, I. B. Mporisoba, G. A. Kopaneou, A, L, Sokoloou
Th bash ths anaptuxhs ths disbakthrioshs tou enterou apotelei h
exasqenish ths topikhs anosias tou enterou, gi`auto h basikh kateuqunsh ths qerapeias
einai h anosodiorqwsh, tou opoiou to basiko paraskeuasma einai to sunoliko anosopoihtiko
paraskeuasma (SAP). O mhcanismos ths epidrashs tou SAP einai basizomenos sto topiko
antibakthriotiko apotelesma sthn antinoskophsh tou enterou eneka tous drastikous
immounogloboulinous twn taxwn M kai A, kai ephshs eneka thn diegersh ths topikhs anosias
tou enterou mesw twn immounogloboulinwn ths taxhs G.
H epidrash tou molusmenou mhtrikou galaktos sthn mikropanida tou enterou
twn paidiwn pou trefontai me mhtriko gala h lambanoun kai sumplhrwmatikh trofh
G. A. Kopaneou, A. L. Sokoloou
Exatasthke h drash tou molusmenou mhtrikou galaktos sthn sunqesh ths
mikropandas tou enterou twn paidiwn pou trefontai me mhtriko gala h lambanoun kai
sumplhrwmatikh trofh. Sucna to mhtriko gala einai molusmeno me stoicia ths kokkodous
panidas. H sumptwsh twn bakthriwn sto mhtriko gala kai sto entero tou paidiou shmeiwnotan
se 28%, ek autwn twn periptwsewn
se 12% shmeiwnotan o epidermikos
stafulokokkos, arketa sucnotera (63%) o crusos stafulokokkos. S`uyhlo baqmo ths molunshs tou mhtrikou galaktos, sthn
emfanish s`auto ths Gram-arnhtikhs panidas h twn merikwn eidwn ths sumbatikhs paqogonhs
panidas, to paidi ecei kanonika tis shmantikes parekklises ths sunqeshs ths autopanidas (h
dusbakthriosh tou enterou me to auxameno epipedo ths sumbatikhs paqogonhs panidas). To
molusmeno mhtriko gala einai mono ena apo tous paragontes ths anaptuxhs ths dusbakthrioshs
tou enterou sto paidi, auth h katastash diorqwnetai kai den creiazetai thn katarghsh tou
mhtrikou galaktos kai thn metafora tou paidiou sthn xenh trofh, kiolas kata tis diarkeies
ths qerapeias.
To epipedo tou enterikou bakillou sthn sunqesh ths autopanidas tou
enterou ws o shmeiwths twn enterikwn elmintwswn
G. A. Kopaneou, A. L. Sokoloou
Oi enterikes elmintes mporoun na epidroun sthn sunqesh ths autopanidas
tou gastroenterikou swlhnh (GES), prokalwntas thn dusbakthriosh tou enterou. Shmeiwsame,
oti oi elmintikes eisboles sucna sunodeuontai me thn elattwsh sthn sunqesh ths autopanidas
tou GES tou enterikou bakillou me thn kanonikh zumwtikh energhtikothta. Upologizontas tis
duskolies ths diagnwsthkhs twn elmintwn kata ta perittiumata, sthn dusbakthriosh tou
enterou me to elattomeno epipedo tou enterikou bakillou sto sunduasmo me tis merikes
klinikes ekdhlwses, mporei na orixetai h qerapeia ex juvantibus me ta elminqoktona paraskeuasmata. 70% twn paidiwn pou epairnan thn qerapeian ex
juvantibus eite eftasan to qetiko apotelesma eite
emfanisan tis elmintes. H elminqoktonh qerapeia epitrepei na ekdhlwnei kaneis tis
enterikes elmintes pou mporoun na diagnostoun duskola apo ta perittiumata kai na beltiwnei
shmantika thn idioqesh tou.
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