Serebrovasküler Olaylarda Damar Açıcı Tedaviler: Acil Trombolitik Uygulama İlkeleri
Özet
İskemik inme, serebral damar tıkanıklığı neticesinde gelişen beyin infarktına bağlı 24 saatten uzun süren fokal ya da lateralizan nörolojik defisit olarak tanımlanır. Son yıllarda yaygın olarak kullanılan trombolitik tedaviler ile mortalite ve morbidite azalmıştır. Trombolitik tedaviler plazminojeni trombüs materyalinde bulunan fibrinler arası bağları parçalayan plazmine çevirerek çalışır. Etkileri kısa sürede alfa-2 antiplazmin tarafından sonlandırılır. Ülkemizde Sosyal Güvenlik Kurumu tarafından geri ödemesi yapılan tek trombolitik ilaç alteplazdır. Şikayetlerinin başlangıcının ilk 4.5 saatinde kesin kontrendikasyonu olmayan hastalara verilebilir. Zaman beyindir prensibi unutulmamalı ve uygun hastalara zaman kaybetmeden ilaç uygulanmalıdır. Göreceli kontrendikasyonu olan hastalar için ise hasta özelinde yarar zarar hesabı yapılmalıdır. Tedavi öncesinde hasta ve yakınları mutlaka potansiyel riskler açısından bilgilendirilmelidir. Tedavi yoğun bakım şartlarında uygulanmalı, hem tedavi uygulanması sırasında hem de sonrasında hastalar yakın takip edilmeli ve kanama komplikasyonu açısından dikkatli olunmalıdır.
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