Žaneta Petrulionienė
Mieli skaitytojai,

tęsiant temą apie kardiologijos naujienas, norėčiau paminėti vieną svarbų susitarimo dokumentą, kurį 2017 metais parengė ir publikavo Europos kardiologų draugija ir kurio vertimą jums pateiksime. Dokumentas skirtas kardiologijos intensyviosios terapijos skyrių struktūrai, darbo organizavimui ir funkcijoms nustatyti. Jame teigiama, kad keičiantis kasdienei medicinos praktikai tokiuose skyriuose šiandien gydoma gerokai daugiau ūminių širdies ir kraujagyslių ligų (ŠKL). Pasikeitė ir ŠKL diagnostikos bei gydymo algoritmai. Europoje gerėjant asmens sveikatos priežiūrai ir senstant visuomenei, į intensyviosios kardiologijos skyrius šiandien patenka daugiau vyresnių pacientų. Daugybė priežasčių lėmė, kad šiuolaikiniame intensyviosios kardiologijos skyriuje šiandien gydomi komplikuotu ir nekomplikuotu ūminiu koronariniu sindromu sergantys pacientai, taip pat sergantys širdies nepakankamumu ir kardiogeniniu šoku, sunkiomis vožtuvų ligomis, ypač infekciniu endokarditu, sunkiais širdies ritmo ir laidumo sutrikimais (pvz., atrioventrikulinio mazgo blokada ar skilvelinės aritmijos, vidutinės bei didelės rizikos plaučių tromboembolija, širdies tamponada, aortos disekacija). Šiuose padaliniuose gydomi ir pacientai po sėkmingo gaivinimo dėl staigios mirties bei tie, kuriems diagnozuojamos įvairių invazinių procedūrų komplikacijos. Maža to, šios sunkios ir gyvybei grėsmingos ligos dažniausiai pasireiškia su kitomis ūminėmis ar lėtinėmis ne ŠKL, kurių gydymas neretai tampa svarbesnis už ŠKL gydymą. Būtent dėl šių priežasčių vainikinių arterijų ligų gydymo skyriai visoje Europoje pavirto kompleksiniais kardiologijos intensyviosios terapijos skyriais.

Šis susitarimo dokumentas aktualus ir Lietuvai. Kaip žinome, mūsų šalyje pagrindinė mirčių priežastis tebėra ŠKL, o pirmą vietą užima mirtys nuo išeminės širdies ligos. Tačiau būtume neteisūs, jeigu neprisimintume ir daug pozityvių dalykų, vykstančių Lietuvoje: daugelyje regionų gerokai sumažėjo mirštamumas nuo miokardo infarkto, pagerėjo ūminių išeminių sindromų diagnostika, sutrumpėjo laikas nuo ligos simptomų pradžios iki patekimo į gydymo įstaigą ir kraujagyslės atvėrimo, pagerėjo moderniausių gydymo technologijų prieinamumas, optimizuotas kardiologinės pagalbos tinklas.

Lietuvoje sukako 10 metų nuo svarbaus kardiologijos projekto įgyvendinimo. Idėją apie tai, kad būtina sukurti rytų ir pietryčių Lietuvos kardiologijos programą, pasiūlė akademikas Aleksandras Laucevičius. Nuo 2008-ųjų šalyje startavusi programa – akivaizdus įrodymas, kad galima išgelbėti daug gyvybių. Tai kompleksinis projektas, įgyvendintas 15-oje Rytų ir Pietryčių Lietuvos regiono savivaldybių, apimantis visus 3 sveikatos priežiūros paslaugų teikimo lygius. Projektas sukūrė prielaidas visoms sveikatos priežiūros įstaigoms tolygiai didinti veiklos efektyvumą vykdant ŠKL prevenciją, diagnostiką, gydymą ir reabilitaciją.

Įgyvendinus projektą, ambulatorines paslaugas teikiančios sveikatos priežiūros įstaigos aprūpintos reikiama įranga ankstyvajai ŠKL diagnostikai ir klinikinei prevencijai. Visų lygių stacionarines paslaugas teikiančios sveikatos priežiūros įstaigos aprūpintos būtiniausia įranga efektyviai ŠKL diagnostikai ir gydymui. Sukurtos mobiliosios komandos, kurios užtikrina specializuotos skubiosios pagalbos teikimą rytų ir pietryčių Lietuvos regiono rajonuose bei saugų grėsmingos būklės pacientų pervežimą į specializuotos pagalbos centrą.

Gerų naujienų Lietuvoje vis daugiau, nes atsirado galimybė pervežti ligonius iš rajonų į centrus ir suteikti operatyvią aukščiausio lygio pagalbą. Šalyje pagalbą teikia visas tinklas kiaurą parą veikiančių Intervencinės kardiologijos centrų Vilniuje, Kaune, Klaipėdoje, Panevėžyje ir Šiauliuose. Tikrai turime kuo pasidžiaugti: triskart mažesnis mirštamumas nuo miokardo infarkto Alytaus ir Utenos ligoninėse, o Vilniuje, Kaune, Klaipėdoje, kur 24 val. per parą ir 7 dienas per savaitę dirba intervencinės kardiologijos specialistai, šis rodiklis – kaip ir visoje Vakarų Europoje. Už tokius laimėjimus Lietuvos medikai giriami tarptautinėse intensyviosios ir intervencinės kardiologijos konferencijose.

Naujai paskelbtas Europos kardiologų draugijos susitarimo dokumentas turėtų padėti optimizuoti kardiologijos intensyviosios terapijos skyrių tinklą Lietuvoje, siekiant toliau mažinti mirštamumą nuo ŠKL.

   Su geriausiais linkėjimais

prof. Žaneta Petrulionienė


143 mintys apie “

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