{"id":11385573,"date":"2012-10-15T00:00:00","date_gmt":"2012-10-14T22:00:00","guid":{"rendered":"https:\/\/alertdiver.eu\/uncategorized-cs_cz\/potapet-se-nebo-ne-potapet-se-s-bleomycinem\/"},"modified":"2012-10-15T00:00:00","modified_gmt":"2012-10-14T22:00:00","slug":"potapet-se-nebo-ne-potapet-se-s-bleomycinem","status":"publish","type":"post","link":"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/potapet-se-nebo-ne-potapet-se-s-bleomycinem\/","title":{"rendered":"Pot\u00e1p\u011bt se nebo ne pot\u00e1p\u011bt se s bleomycinem"},"content":{"rendered":"

(Pozn\u00e1mka redakce: Toto je zkr\u00e1cen\u00e1 verze \u010dl\u00e1nku, kter\u00fd vy\u0161el v Aviation, Space, and environmental Medicine – Vol. 82, No 8, August 2011)<\/em><\/p>\n

\u00davod<\/strong><\/p>\n

Bleomycin je cytostatikum pou\u017e\u00edv\u00e1n k l\u00e9\u010db\u011b varlatov\u00e9 a lymfomat\u00f3zn\u00ed rakoviny. Ovsem pokusy z 1960 odhalily jeho plicn\u00ed toxicitu, naz\u00fdvanou bleomycinova-indukovan\u00e1 pneumonitida (BIP).<\/strong><\/p>\n

Plicn\u00ed toxicita je p\u0159ev\u00e1\u017en\u011b fibr\u00f3zn\u00ed, a detekce plicn\u00ed fibr\u00f3zy m\u016f\u017ee b\u00fdt dosa\u017eena se s\u00e9riov\u00fdm m\u011b\u0159en\u00edm kapacity dif\u00faze oxidu uhelnat\u00e9ho (DLCO) kter\u00fd m\u016f\u017ee nazna\u010dit p\u0159\u00edtomnost okultn\u00edch zm\u011bn na plic\u00edch. Vystaven\u00ed vysok\u00e9 FiO2 b\u011bhem periopera\u010dn\u00edho a poopera\u010dn\u00edho obdob\u00ed u pacienta s p\u0159edchoz\u00ed expozic\u00ec bleomycinu m\u016f\u017ee produkovat okultn\u00ed plicn\u00ed fibr\u00f3zu. Rakovina varlat je nej\u010dast\u011bj\u0161\u00ed zhoubn\u00fd n\u00e1dor u mu\u017e\u016f ve v\u011bku mezi 20-34 lety; jejich p\u0159e\u017eit\u00ed dosahuje vice ne\u017e 90%. V t\u00e9to v\u011bkov\u00e9 kategorii, mnoho tech co p\u0159e\u017eili, provozuj\u00ec venkovn\u00ed sporty, jako je nap\u0159\u00edklad pot\u00e1p\u011bn\u00ed, kde se vyu\u017e\u00edv\u00e1 p\u0159edev\u0161\u00edm stla\u010den\u00fd vzduch ( 21% kysl\u00edku, FiO2 = 0,21 bar) pro d\u00fdch\u00e1n\u00ed. <\/p>\n

B\u011bhem ponoru parci\u00e1ln\u00ed tlak kysl\u00edku se zvy\u0161uje v z\u00e1vislosti na zv\u00fd\u0161eni tlaku vody. P\u0159i hloubce ponoru 20 m, kde tlak vzduchu je 3 bar, inspira\u010dn\u00ed frakce kysl\u00edku (FiO2) bude 0,63 bar. Na z\u00e1klad\u011b tohoto v\u00fdpo\u010dtu, po l\u00e9\u010db\u011b bleomycinem v\u011bt\u0161ina l\u00e9ka\u0159\u016f by v\u00e1hala schvalovat pot\u00e1p\u011bn\u00ed vzhledem k riziku plicn\u00ed toxicity zp\u016fsoben\u00e9 t\u00edmto vysoce FiO2.  Ov\u0161em u pacient\u016f l\u00e9\u010den\u00fdch bleomycinem, jedna studie uk\u00e1zala, \u017ee zv\u00fd\u0161en\u00ed FiO2 (0.40-0.87) b\u011bhem periopera\u010dn\u00edho obdob\u00ed v\u00fdznamn\u011b p\u0159isp\u00edv\u00e1 ke komplikac\u00edm pozdn\u00edmu n\u00e1stupu BIP nebo fibr\u00f3zy a byl u\u010din\u011bn z\u00e1v\u011br, \u017ee omezen\u00ed periopera\u010dn\u00edho kysl\u00edku nebylo nutn\u00e9. <\/p>\n

N\u011bkte\u0159\u00ed l\u00e9ka\u0159i povoluji pacient\u016fm l\u00e9\u010den\u00fdch bleomycinem pokra\u010dovat pot\u00e1p\u011bn\u00ed bez jak\u00e9hokoliv omezen\u00ed; nekteri se odkazuj\u00ed na zku\u0161enosti pot\u00e1p\u011b\u010d\u016f v jejich klinick\u00e9 populaci, kte\u0159\u00ed pokra\u010dovali v pot\u00e1p\u011bn\u00ed bez komplikac\u00ed pozdn\u00edho n\u00e1stupu BIP, fibr\u00f3zy nebo plicn\u00edho barotrauma. Uv\u00e1d\u00edm zde algoritmus, na z\u00e1klad\u011b nejlep\u0161\u00edch d\u016fkaz\u016f z literatury onkologie, anesteziologie a pot\u00e1p\u011b\u010dsk\u00e9 medic\u00edny, kter\u00e9 mohou b\u00fdt pou\u017eity k hodnocen\u00ed pacient\u016f l\u00e9\u010den\u00fdch bleomycinem, kte\u0159\u00ed cht\u011bj\u00ed pokra\u010dovat s pot\u00e1p\u011bn\u00edm nebo teprve za\u010d\u00edt. Pou\u017eili jsme algoritmus pro zkoumani vhodnosti 16 sportovn\u00edch pot\u00e1p\u011b\u010d\u016f (14 mu\u017e\u016f, 2 \u017een ) l\u00e9\u010denych bleomycinem bu\u010f pro l\u00e9\u010dbu rakoviny varlat v z\u00e1rode\u010dn\u00fdch bu\u0148k\u00e1ch nebo pro Hodgkinovu nemoc.<\/p>\n

Methody<\/strong><\/p>\n

Algoritmus (Obr.1) byl rozd\u011blen do dvou \u010d\u00e1st\u00ed. Prvn\u00ed \u010d\u00e1st obsahuje v\u0161eobecnou l\u00e9ka\u0159skou historii, a specifickou anamn\u00e9zu vztahu rakoviny a l\u00e9\u010dby bleomycinem, dokumentaci ponor\u016f p\u0159ed a (p\u0159\u00edpadn\u011b) po rakovin\u011b, a rozs\u00e1hl\u00e9 plicn\u00ed funk\u010dn\u00ed testy, v\u010detn\u011b spirometrie, zbytkov\u00fd objem a dif\u00fazn\u00ed kapacita jedno dechu. Plicn\u00ed funk\u010dn\u00ed testy by m\u011bly vylou\u010dit jak\u00e9koliv abnormality, kter\u00e9 by mohly zp\u016fsobit pot\u00e1p\u011b\u010di ohro\u017een\u00ed p\u0159i plicn\u00edm barotraumatu. Druha zkou\u0161ka se skl\u00e1da z testu na kole s p\u0159\u00edm\u00fdm m\u011b\u0159en\u00edm VO2 max, m\u011b\u0159en\u00ed krevn\u00edch plyn\u016f a monitorov\u00e1n\u00ed EKG. Vzhledem k tomu, \u017ee existuj\u00ed d\u016fkazy, \u017ee chemoterapie zvy\u0161uje riziko vzniku kardiovaskul\u00e1rn\u00edch chorob u pacient\u016f s rakovinou varlat n\u00e1\u0161 algoritmus zahrnoval zkou\u0161ku na kole b\u011bhem ktereho \u00farove\u0148 aerobn\u00edho \u00fasil\u00ed mus\u00ed b\u00fdt alespo\u0148 80% odhadovan\u00e9 hodnoty. Jsou m\u011b\u0159eny tak\u00e9 krevn\u00ed plyny na za\u010d\u00e1tku z\u00e1t\u011b\u017eov\u00e9ho testu a p\u0159i maxim\u00e1ln\u00ed z\u00e1t\u011b\u017ei k posouzen\u00ed dif\u00fazn\u00ed abnormality, kter\u00e9 nemus\u00ed b\u00fdt nutn\u011b z\u0159ejm\u00e9 v plicn\u00edch dif\u00fazn\u00edch testech v klidu.<\/p>\n

Kone\u010dn\u00e1, vysok\u00e1 rozli\u0161en\u00ed (HR) CT vy\u0161et\u0159en\u00ed plic byla provedena. Hrudn\u00ed HR-CT skenov\u00e1n\u00ed, kter\u00e1 m\u00e1 v\u011bt\u0161\u00ed citlivost ne\u017e standardn\u00ed rtg hrudn\u00edku ke zji\u0161t\u011bn\u00ed abnormality plicn\u00edho parenchymu, byla tak\u00e8 zahrnuta do tohoto algoritmu. Plicn\u00ed funk\u010dn\u00ed testy byly provedeny pomoc\u00ed p\u0159\u00edstroje V-max Encore. Spirometrie, zbytkov\u00e9 objemy, t\u011blo box, single-dech rozptyln\u00e1 kapacita (DLCO) a sou\u010dinitel prostupu (DLCO\/VA) byly m\u011b\u0159eny podle n\u00e1vodu v\u00fdrobce. DLCO a DLCO \/ VA hodnoty byly korigov\u00e1ny hodnotami hemoglobinu (Hb). Z\u00e1t\u011b\u017eov\u00fd test byl proveden b\u011bhem trval\u00e9 p\u0159\u00edtomnosti l\u00e9ka\u0159e z d\u016fvodu \u010dten\u00ed EKG b\u011bhem cvi\u010den\u00ed a odeb\u00edr\u00e1ni vzorku krevn\u00edch plyn\u016f. Arteri\u00e1ln\u00ed krevn\u00ed plyny byly m\u011b\u0159eny konven\u010dn\u00edm analyz\u00e1torem.<\/p>\n

Diskuse<\/strong><\/p>\n

V\u0161ichni pacienti byli p\u0159ed onemocn\u011bn\u00edm aktivn\u00edmi sportovn\u00edmi pot\u00e1p\u011b\u010di; n\u011bkte\u0159\u00ed pokra\u010dovali s pot\u00e1p\u011bnim po l\u00e9\u010db\u011b, jin\u00ed se prestali na radu sv\u00e9ho l\u00e9ka\u0159e. Na z\u00e1klad\u011b na\u0161eho algoritmu, 12 z 16 pacient\u016f obdr\u017e\u00ed kladn\u00e9 stanovisko k obnoven\u00ed pot\u00e1p\u011bn\u00ed. Nicm\u00e9n\u011b, rozd\u00edl v po\u010dtu (b\u00fdval\u00fdch) pacientu naleze vhodn\u00e9 k pot\u00e1p\u011bn\u00ed ve dvou skupinach (testikul\u00e1rn\u00ed \/ rakoviny z\u00e1rode\u010dn\u00fdch bun\u011bk proti Hodgkin) nazna\u010duje, \u017ee zejm\u00e9na je pot\u0159ebn\u00e1 opatrnost u pacientu s Hodgkinsovou nemoci kombinovanou lecenim bleomycinem a radia\u010dn\u00ed terapi\u00ec vzhledem ke zv\u00fd\u0161en\u00e9mu riziku oz\u00e1\u0159en\u00ed, ktera vyvolaji plicn\u00ed probl\u00e9my.<\/p>\n

N\u00e1\u0161 algoritmus pro pot\u00e1p\u011b\u010de je zalo\u017een na riziku plicn\u00edho barotraumatu. Omezuj\u00edc\u00ed abnormality (jak je uk\u00e1z\u00e1no ve spirometrick\u00e9m testu) sni\u017euji plicn\u00ed dodr\u017eov\u00e1n\u00ed a naru\u0161uji p\u0159enos plynu: pot\u00e1p\u011bn\u00ed se proto nedoporucuje. Klinick\u00e0 a subklinick\u00e0 plicn\u00ed fibr\u00f3za ma za n\u00e1sledek mensi rozta\u017eitelnost plic, kter\u00e0 privadi pot\u00e1p\u011b\u010de k riziku pneumotoraxu, pneumomediastinu a arteri\u00e1ln\u00ed plynov\u00e8 embolii. Air trapping kv\u016fli plicn\u00edmu parenchymu abnormalit, m\u00edstn\u00ed fibr\u00f3zn\u00ed tk\u00e1n\u011b a tvorbe buly jsou tak\u00e9 rizikov\u00fdm faktorem. Proto, hrudn\u00ed HR-CT skenov\u00e1n\u00ed, s v\u011bt\u0161\u00ed citlivost\u00ec ne\u017e standardn\u00ed rtg hrudn\u00edku k odhalov\u00e1n\u00ed abnormality parenchymu plic, jsou nezbytn\u00fdm p\u0159edpokladem tohoto algoritmu.<\/p>\n

Pot\u00e1p\u011bn\u00ed je nam\u00e1hav\u00e1 \u010dinnost. Pot\u00e1p\u011b\u010d mus\u00ed b\u00fdt schopen splnit fyzick\u00e9 po\u017eadavky specifick\u00e9ho prost\u0159ed\u00ed pod vodou. Nap\u0159.siln\u00fd proud, (mo\u017en\u00e1) z\u00e1chrana buddyho, atd. L\u00e9ka\u0159i mus\u00ed m\u00edt jistotu, \u017ee kandid\u00e1t je t\u011blesn\u011b vhodn\u00fd s ohledem na aerobn\u00ed zdatnosti. Konkr\u00e9tn\u011b, v\u011bt\u0161ina mlad\u00fdch pacient\u016f s rakovinou pot\u0159ebuj\u00ed alespo\u0148 6 m\u011bs\u00edc\u016f a\u017e 1 rok p\u0159ed t\u00edm, nez jsou vhodn\u00ec k provozovani sportu jako napr. pot\u00e1p\u011bn\u00ed. Proto na\u0161 algoritmus obsahuje z\u00e1t\u011b\u017eovy test.<\/p>\n

Diskuse o pot\u00e1p\u011bn\u00ed po l\u00e9\u010db\u011b bleomycinem pokra\u010duje. Konzervativn\u00ed p\u0159\u00edstup je zalo\u017een na klinick\u00fdch studi\u00edch a studi\u00edch na zv\u00ed\u0159atech, kter\u00e9 siln\u011b podporuj\u00ed vztah mezi toxicitou bleomycinu a oxygenoterapi\u00ed. V\u011bt\u0161ina z t\u011bchto studi\u00ed poch\u00e1z\u00ed z 1980 vyslovuje podle neofici\u00e1ln\u00edch klinick\u00fdch n\u00e1lezech, ze plicn\u00ed komplikace jsou p\u0159ipisovan\u00e1 vysok\u00e9 frakci inspirovan\u00e9ho kysl\u00edku. Studie na zv\u00ed\u0159atech p\u0159inesly rozporn\u00e9 v\u00fdsledky: n\u011bkter\u00e9 prov\u011b\u0159ov\u00e1n\u00ed r\u016fzn\u00fdch faktor\u016f ovliv\u0148uj\u00edc\u00edch plicn\u00ed morbiditu spojen\u00e9 s expozic\u00ed bleomycinu uk\u00e1zal, \u017ee nem\u00e1 \u017e\u00e1dn\u00fd podstatn\u00fd vliv na plicn\u00ed toxicity. V\u011bt\u0161ina ostatn\u00edch studi\u00ed na zv\u00ed\u0159atech podpo\u0159ily \u00fadaje s ohledem na kysl\u00edkov\u00e9 toxicity.<\/p>\n

V\u00edce liber\u00e1ln\u00ed p\u0159\u00edstup v poradenstv\u00ed vztahuj\u00edc\u00ed se k pot\u00e1p\u011bn\u00ed se odvol\u00e1v\u00e1 na studie z anesteziologie, kter\u00e1 zjistila, \u017ee neexistuje \u017e\u00e1dn\u00fd n\u00e1r\u016fst pod\u00edlu plicn\u00edch probl\u00e9m\u016f (6.8%) u 835 pacient\u016f l\u00e9\u010den\u00fdch bleomycinem. Dal\u0161\u00ed skupina studovala 77 pacient\u016f s pr\u016fm\u011brn\u00fdm FiO2 0,87 pro 56 min a intraopera\u010dn\u00ed FiO2 0,4 p\u0159i 8 h; Auto\u0159i uzav\u00edraj\u00ed, \u017ee p\u0159i mnohorozm\u011brn\u00e9 anal\u00fdze FiO2 nebyl v\u00fdznamn\u00fdm faktorem, kter\u00fd p\u0159isp\u00edv\u00e1 ke komplikac\u00ed. Ve v\u00fdjime\u010dn\u00fdch situac\u00edch, pokud se pacient l\u00e9\u010den\u00fd bleomycinem vraci k pot\u00e1p\u011bni a rozv\u00edj\u00ed DCS, bude pot\u0159ebovat okam\u017eitou hyperbarickou l\u00e9\u010dbu. Tabulky standardn\u00ed l\u00e9\u010dby obsahuj\u00ed FiO2 o 2,0-2,8 bar pro 4-8 h, kter\u00e9 by mohly p\u0159\u00edpadn\u011b vyvolat plicn\u00ed po\u0161kozen\u00ed, fibr\u00f3zu a BIP, tak\u017ee je nutne aby pot\u00e1p\u011b\u010di byli dobre informov\u00e1ni o rizic\u00edch. <\/p>\n

Nicm\u00e9n\u011b, ve zpr\u00e1v\u011b o 11 bleomycinem lecenych pacient\u016f podstupuj\u00edc\u00edch hyperbarickou oxygenoterapii pro radia\u010dn\u00ed terapii, po\u010det hyperbarick\u00fdch o\u0161et\u0159en\u00ed se pohybovala 8-44 s FiO2 o 2,0 bar 2 h p\u0159i ka\u017ed\u00e9m o\u0161et\u0159en\u00ed. Pouze jeden pacient m\u011bl neprijemny pocit na hrudi a objektivn\u00ed pokles (50%) difuzn\u00ed kapacity, kter\u00e1 byla vyl\u00e9\u010dena s p\u0159est\u00e1vkou v l\u00e9\u010debn\u00e9ho cyklu. Obecn\u00e0 rada mezin\u00e1rodn\u00ed hyperbarick\u00e9 spole\u010denst\u00ed je, \u017ee jednolet\u00e9 obdob\u00ed je pravd\u011bpodobn\u011b bezpe\u010dn\u00e9 pro hyperbarickou oxygenoterapii po pod\u00e1n\u00ed bleomycinu. Na\u0161e studie m\u00e1 n\u011bkter\u00e1 omezen\u00ed. Za prv\u00e9, v\u00fdb\u011brov\u00e9 zkreslen\u00ed o studovan\u00e9 populace. Pouze pacienti, kte\u0159\u00ed jsou fyzicky zdatn\u00ed po l\u00e9\u010db\u011b bleomycinem budou pokra\u010dovat se sportem, zejm\u00e9na pot\u00e1p\u011bn\u00edm, a pod\u00edlet se na studii. Tak\u00e9 odborne \u010dasopisy o pot\u00e1p\u011bn\u00ed, ve kter\u00e9m byly publikov\u00e1ny na\u0161e vysledky p\u0159isp\u011bly k v\u00fdb\u011brov\u00e9 zaujatosti.<\/p>\n

Za druh\u00e9, studie se skl\u00e1d\u00e1 z mal\u00e9 skupiny pacient\u016f s varlatni \/ kl\u00ed\u010dkov\u00fd karcinomu nebo Hodgkinovu nemoci, kte\u0159\u00ed se mohou li\u0161it v obou typech a rozsahu \/ f\u00e1zi jejich onemocn\u011bn\u00ed. T\u0159i z 16 pacient\u016f (pova\u017eovan\u00ed jako nevhodn\u00ed pro sestup podle na\u0161ich protokolu) m\u011blo z\u00e1\u0159en\u00ed na hrudn\u00edku jako sou\u010d\u00e1st l\u00e9\u010dby Hodgkina; fibrotick\u00e9 zran\u011bn\u00ed na plic\u00edch bylo p\u0159i\u010d\u00edt\u00e1no z\u00e1\u0159en\u00ed a ne bleomycin\u00e8 terapii. Pl\u00edce jsou velmi citliv\u00e9 na z\u00e1\u0159en\u00ed, a abnorm\u00e1ln\u00ed RTG n\u00e1lezy nebo omezuj\u00edc\u00ed zm\u011bny plicn\u00ed funkce je uveden ve v\u00edce ne\u017e 30% u pacient\u016f l\u00e9\u010den\u00fdch p\u0159\u00edmo nebo nep\u0159\u00edmo z\u00e1\u0159en\u00edm plic.
Za t\u0159et\u00ed, poradenstv\u00ed pot\u00e1p\u011bt se do hloubky 25 m (FiO2 0.7 bar) bez pou\u017eit\u00ed nitroxu je\u0161t\u011b st\u00e1le nen\u00ed zalo\u017een\u00e1 na d\u016fkazech a stanoviska sou\u010dasn\u00fdch autor\u016f budou pova\u017eovan\u00e1 za m\u00edrn\u011b konzervativn\u00ed z hlediska v\u00edce zku\u0161en\u00e9ho pot\u00e1p\u011b\u010de nebo instruktora.<\/p>\n

Z\u00e1v\u011brem je t\u0159eba \u0159\u00edci ze c\u00edlem algoritmu je pomoci mezin\u00e1rodn\u00ed pot\u00e1p\u011b\u010dsk\u00e9 l\u00e9ka\u0159sk\u00e9 ve\u0159ejnosti p\u0159i zkoum\u00e1n\u00ed pot\u00e1p\u011b\u010d\u016f l\u00e9\u010den\u00fdch bleomycinem. Mezi miliony rekrea\u010dn\u00edch pot\u00e1p\u011b\u010d\u016f na sv\u011bt\u011b, podstatn\u00e1 \u010d\u00e1st mlad\u00fdch lid\u00ed bude l\u00e9\u010dena bleomycinem. Jsme p\u0159esv\u011bd\u010deni, \u017ee mnoho rozd\u00edln\u00fdch n\u00e1zor\u016f, kter\u00e9 se t\u00fdkaj\u00ed bleomycinu a pot\u00e1p\u011bn\u00ed, a\u010dkoli informace zat\u00edm nejsou zalo\u017een\u00e9 na d\u016fkazech, \u017ee n\u00e1\u0161 algoritmus bude cenn\u00fdm p\u0159\u00edsp\u011bvkem k tomuto sporu. Mysl\u00edme si, \u017ee je rozumn\u00e9, aby pe\u010dliv\u011b vybran\u00ed pacienti pokra\u010dovali s pot\u00e1p\u011bn\u00edm po bleomycinove terapii, ale s n\u011bkter\u00fdmi d\u016fle\u017eit\u00fdmi omezen\u00edmi.<\/p>\n

V\u00fdsledky<\/strong>
Z 16 pacient\u016f v na\u0161\u00ed studii, bylo 11 l\u00e9\u010deno bleomycinem pro rakovinu varlat nebo z\u00e1rode\u010dn\u00fdch bun\u011bk rakoviny. 5 pro Hodgkinovu chorobu. V\u0161ichni pacienti krom\u011b jednoho byli neku\u0159\u00e1ci.<\/p>\n

Spirometrie<\/strong>
Spirometrick\u00e9 hodnoty (v\u010detn\u011b pr\u016ftokov\u00e9-objemov\u00e9 k\u0159ivky) byly normalni. S v\u00fdjimkou jednoho pacienta (Hodgkinova skupina) kter\u00fd m\u011bl nejni\u017e\u0161\u00ed hodnoty VC a FEV1 p\u0159edpov\u00eddan\u00e9ho procenta. U tohoto druh\u00e9ho pacienta rozd\u011blen\u00ed rezidu\u00e1ln\u00edho objemu\/celkov\u00e1 kapacita plic (RV\/TLC) bylo p\u0159ibli\u017en\u011b 75% z p\u0159edpokl\u00e1dan\u00e9 hodnoty, nazna\u010dujici restriktivn\u00ed abnormality. Proto byl nevhodn\u00fd pro pot\u00e1p\u011bn\u00ed ji\u017e po spirometrii v algoritmu.<\/p>\n

Dif\u00fazn\u00ed kapacita<\/strong>
V\u011bt\u0161ina pacient\u016f m\u011bla n\u00edzk\u00e9 hodnoty rozptylu a dif\u00fazn\u00ed kapacity v klidu, byly v rozmez\u00ed referen\u010dn\u00edch hodnot.<\/p>\n

Z\u00e1t\u011b\u017eov\u00fd test \/ arteri\u00e1ln\u00ed krevn\u00ed plyny<\/strong>
B\u011bhem z\u00e1t\u011b\u017eov\u00e9ho testu, v\u0161ichni pacienti m\u011bli norm\u00e1ln\u00ed krevn\u00ed plyny signalizuj\u00edc\u00ed norm\u00e1ln\u00ed ventilaci a \u0161\u00ed\u0159en\u00ed, norm\u00e1ln\u00ed EKG a krevn\u00ed tlak. U 9 pacient\u016f hodnoty PaO2 se zvy\u0161ovaly p\u0159i maxim\u00e1ln\u00edm v\u00fdkonu, u 6 pacient\u016f m\u011bly nev\u00fdrazn\u00fd (<10%) pokles, ale norm\u00e1ln\u00ed toleranci cvi\u010den\u00ed, a u jednoho pacienta hodnoty krevn\u00edch plyn\u016f nebyly k dispozici kv\u016fli technick\u00fdm probl\u00e9m\u016fm…<\/p>\n

Vysok\u00e9 rozli\u0161en\u00ed CT<\/strong>
Z 16 pacient\u016f, 4 m\u011bli abnorm\u00e1ln\u00ed CT s fibrotick\u00fdm zran\u011bn\u00edm a\/nebo zachyceny vzduch: pacient 9 z varlatove skupiny (ku\u0159\u00e1k) a 3 z t\u011bchto 4 pacient\u016f bylo l\u00e9\u010deno pro Hodgkinovo onemocn\u011bn\u00ed s bleomycinem a dal\u0161\u00edm z\u00e1\u0159en\u00edm na hrudn\u00edku a plic\u00edch.
Podle na\u0161eho algoritmu, 10 z 11 pacient\u016f s varlatov\u00fdm \/ z\u00e1rode\u010dn\u00fdch bun\u011bk karcinomu, byli vhodn\u00ec k pot\u00e1p\u011bn\u00ed ve srovn\u00e1n\u00ed s 2 z 5 pacient\u016f s Hodgkinovou nemoci.<\/p>\n

Koresponden\u010dn\u00ed adresa:<\/strong><\/p>\n

Dr RA van Hulst
<\/strong>ravhulst@planet.nl<\/a>
ra.v.hulst@mindef.nl<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

(Pozn\u00e1mka redakce: Toto je zkr\u00e1cen\u00e1 verze \u010dl\u00e1nku, kter\u00fd vy\u0161el v Aviation, Space, and environmental Medicine – Vol. 82, No 8, August 2011) \u00davod Bleomycin je…<\/p>\n","protected":false},"author":1,"featured_media":11374343,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[384],"tags":[],"authors":[1648],"class_list":["post-11385573","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clanky","authors-robert-a-van-hulst-cs_cz"],"acf":[],"yoast_head":"\nPot\u00e1p\u011bt se nebo ne pot\u00e1p\u011bt se s bleomycinem - Alert Diver<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/potapet-se-nebo-ne-potapet-se-s-bleomycinem\/\" \/>\n<meta property=\"og:locale\" content=\"cs_CZ\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pot\u00e1p\u011bt se nebo ne pot\u00e1p\u011bt se s bleomycinem - 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