{"id":13566,"date":"2008-09-16T18:00:00","date_gmt":"2008-09-16T18:00:00","guid":{"rendered":""},"modified":"2008-09-16T18:00:00","modified_gmt":"2008-09-16T18:00:00","slug":"skausmo-gydymas-urologijoje-ir-nvpu-taikymas","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/skausmo-gydymas-urologijoje-ir-nvpu-taikymas\/13566\/","title":{"rendered":"Skausmo gydymas urologijoje ir NVPU taikymas"},"content":{"rendered":"<p>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\"><meta content=\"Word.Document\" name=\"ProgId\"><meta content=\"Microsoft Word 10\" name=\"Generator\"><meta content=\"Microsoft Word 10\" name=\"Originator\"><link href=\"file:\/\/\/C:DOCUME%7E1565LOCALS%7E1Tempmsohtml1%EF%BF%BD1clip_filelist.xml\" rel=\"File-List\"><link href=\"file:\/\/\/C:DOCUME%7E1565LOCALS%7E1Tempmsohtml1%EF%BF%BD1clip_editdata.mso\" rel=\"Edit-Time-Data\"><!--{12216449199020}--><!--{12216449199021}--><\/p>\n<style type=\"text\/css\">\n<!--{12216449199022}--><\/style>\n<p><!--{12216449199023}--><\/p>\n<p class=\"MsoNormal\"><b><span lang=\"LT\" style='font-family: \"Times New Roman\"'>\u012evadas<\/p>\n<p><\/span><\/b><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Remiantis tarptautin\u0117s skausmo tyrim\u0173 asociacijos apibr\u0117\u017eimu (<i>International Association for Study of Pain<\/i>) skausmas, tai \u2013 nemalonus sensorinis ir emocinis patyrimas, susij\u0119s su esamu ar galimu audini\u0173 pa\u017eeidimu, ar nusakomas kaip toks pa\u017eeidimas.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Taigi skausmas yra subjektyvus poj\u016btis ir d\u0117l to neretai gali b\u016bti nepakankamai \u012fvertinamas. Da\u017enai \u012f skausm\u0105 kreipiamas didelis d\u0117mesys kaip \u012f simptom\u0105 \u012fvairioms ligoms diagnozuoti, ta\u010diau atskirai skausmui gydyti ne visada \u0161io d\u0117mesio pakanka.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Urologams, kaip ir kit\u0173 sri\u010di\u0173 specialistams, b\u016btina \u017einoti neretai u\u017emir\u0161tam\u0105 skausmo problem\u0105, nes negydomas skausmas gali sukelti kitas nepageidaujamas b\u016bkles:<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{12216449199024}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>1.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{12216449199025}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Sutrik\u0119s kv\u0117pavimas. Per segmentinius reflekso lankus tiesiogiai padid\u0117ja kv\u0117pavime dalyvaujan\u010di\u0173 raumen\u0173 tonusas. Pilvo skausmas slopina gil\u0173 kv\u0117pim\u0105, ma\u017eina plau\u010di\u0173 ventiliacij\u0105 ir gali s\u0105lygoti atelektazij\u0173 bei plau\u010di\u0173 u\u017edegimo vystym\u0105si.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{12216449199026}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>2.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{12216449199027}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Sutrikusi \u017earnyno bei urogenitalin\u0117s sistemos lygi\u0173j\u0173 raumen\u0173 veikla. \u0160is fenomenas taip pat pasirei\u0161kia per segmentinius reflekso lankus bei s\u0105lygoja peristaltikos sul\u0117t\u0117jim\u0105, kuris gali sukelti \u017earn\u0173 nepraeinamum\u0105 bei \u0161lapimo susilaikym\u0105.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{12216449199028}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>3.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{12216449199029}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Neuroendokrinologinis atsakas \u012f stres\u0105. Tiesioginis simpatin\u0117s nerv\u0173 sistemos stimuliavimas skatina katecholamin\u0173 i\u0161siskyrim\u0105, kurie inotropi\u0161kai bei chronotropi\u0161kai veikia \u0161irdies raumen\u012f, didina kraujos\u016bd\u012f bei \u0161irdies deguonides poreik\u012f ir taip didina miokardo i\u0161emijos rizik\u0105. Vazokonstrikcija apsunkina mikrocirkuliacij\u0105, bei s\u0105lygoja prast\u0105 \u017eaizd\u0173 gijim\u0105. \u0160ie mechanizmai taip pat padidina smegen\u0173 kraujotakos sutrikim\u0173 rizik\u0105. Streso metu taip pat suaktyv\u0117ja kataboliniai hormonai (AKTH, kortizolis, gliukagonas), kurie s\u0105lygoja prast\u0105 \u017eaizd\u0173 gijim\u0105 bei imunosupresij\u0105 (kortizolis).<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><b><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Onkologini\u0173 lig\u0173 sukeltas skausmas<\/p>\n<p><\/span><\/b><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Prie\u0161in\u0117s liaukos v\u0117\u017eiu serga 11 proc. onkologin\u0117mis ligomis sergan\u010di\u0173 Europos vyr\u0173 (1). Europos S\u0105jungoje prostatos v\u0117\u017eys atsakingas u\u017e 9 proc. vis\u0173 su onkologin\u0117mis ligomis susijusi\u0173 mir\u010di\u0173 (1). Taigi ir urologams b\u016btina \u017einoti kaip gydyti skausm\u0105 onkologini\u0173 lig\u0173 metu.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>\u010cia pateikiami septyni Pasaulio sveikatos organizacijos (PSO) rekomendacijomis bei kitais \u0161altiniais (2,3,4,5) paremti skausmo gydymo principai (1 lentel\u0117).<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>1 lentel\u0117. Onkologini\u0173 lig\u0173 sukelto skausmo septyni gydymo principai<\/p>\n<p><\/span><\/p>\n<table class=\"MsoNormalTable\" style=\"border-right: medium none; border-top: medium none; border-left: medium none; border-bottom: medium none; border-collapse: collapse\" cellspacing=\"0\" cellpadding=\"0\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"border-right: black 1pt solid; padding-right: 5.4pt; border-top: black 1pt solid; padding-left: 5.4pt; padding-bottom: 0cm; border-left: black 1pt solid; width: 492.7pt; padding-top: 0cm; border-bottom: black 1pt solid\" valign=\"top\" width=\"657\">\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990210}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>1.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990211}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Aktyviai ie\u0161kokite skausmo ir gydym\u0105 prad\u0117kite nedelsdami.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990212}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>2.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990213}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Remkit\u0117s PSO skausmo gydymo pakop\u0173 sistema (1 pav.).<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990214}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>3.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990215}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Taikykite kiek \u012fmanoma ma\u017eiau invazin\u012f metod\u0105.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990216}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>4.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990217}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Skirkite ilgo veikimo preparatus tiksliai pasirinktu metu bei greito veikimo vaistus esant poreikiui.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990218}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>5.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990219}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Gydymas turi b\u016bti individualus.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990220}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>6.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990221}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Periodi\u0161kai steb\u0117kite pacient\u0105 bei keiskite vaisto dozavim\u0105.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990222}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>7.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990223}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Visuomet \u012fvertinkite, ar n\u0117ra poreikio skirti adjuvantin\u012f gydym\u0105.<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990224}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>1.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990225}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Skausm\u0105 b\u016btina prad\u0117ti gydyti i\u0161kart po pirmojo paciento skundo, nes d\u0117l sensitizacijos proces\u0173 skausmas gali tapti l\u0117tiniu ir sunkiai gydomu medikamentai.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990226}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>2.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990227}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Gydant reik\u0117t\u0173 remtis PSO skausmo gydymo pakop\u0173 sistema (1 pav.). <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'><img loading=\"lazy\" decoding=\"async\" height=\"319\" width=\"642\" alt=\"Skausmo gydymas urologijoje ir NVPU taikymas\" src=\"\"><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'><!--{122164491990228}--><!--{122164491990229}--><!--{122164491990230}--><\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>1 pav. PSO skausmo gydymo pakopos.<\/p>\n<p><\/span><\/p>\n<table class=\"MsoNormalTable\" style=\"border-right: medium none; border-top: medium none; border-left: medium none; border-bottom: medium none; border-collapse: collapse\" cellspacing=\"0\" cellpadding=\"0\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"border-right: black 1pt solid; padding-right: 5.4pt; border-top: black 1pt solid; padding-left: 5.4pt; padding-bottom: 0cm; border-left: black 1pt solid; width: 246.35pt; padding-top: 0cm; border-bottom: black 1pt solid\" valign=\"top\" width=\"328\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Stiprieji opiodiniai analgetikai<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>+ neopiodiniai analgetikai<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>+\/- adjuvantiniai medikamentai<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: black 1pt solid; padding-right: 5.4pt; border-top: black 1pt solid; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 246.35pt; padding-top: 0cm; border-bottom: black 1pt solid\" valign=\"top\" width=\"328\">\n<p class=\"MsoNormal\" style=\"text-align: center\" align=\"center\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>I pakopa<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: 1pt solid; width: 246.35pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"328\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Lengvo poveikio opioidiniai analgetikai<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>+ neopioidiniai analgetikai<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>+\/- adjuvantiniai medikamentai<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 246.35pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"328\">\n<p class=\"MsoNormal\" style=\"text-align: center\" align=\"center\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>II pakopa<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: 1pt solid; width: 246.35pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"328\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Neopioidiniai analgetikai<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>+\/- adjuvantiniai medikamentai<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 246.35pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"328\">\n<p class=\"MsoNormal\" style=\"text-align: center\" align=\"center\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>III pakopa<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='background: yellow; font-family: \"Times New Roman\"; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial'>Pirmojoje pakopoje naudojami neopioidiniai analgetikai, da\u017eniausiai klasikiniai NVNU: diklofenakas 3&#215;50 mg (pvz. <a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Dicloberl\">Dicloberl<\/a>) ar dexketoprofenas 25 mg x 3 <i>per os <\/i>(pvz. <a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Dolmen\">Dolmen<\/a>), taip pat galima skirti gaminamas prailginto veikimo diklofenako formas (pvz. <a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Dicloberl\">Dicloberl<\/a> retard). Skrand\u017eio opalige ar gastritu sergantiems pacientams reik\u0117t\u0173 skirti paracetamol\u012f 4&#215;1 arba naujesnius ciklooksigenaz\u0117s-2 inhibitoirus. Tyrimais \u012frodyta, kad vartojantiems nimesulid\u0105 (pvz. <a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Nimesil\">Nimesil<\/a>) kraujavimo i\u0161 vir\u0161kinamojo trakto bei opaliges atvej\u0173 pasitaiko re\u010diau, nes i\u0161saugoma prostagladin\u0173 gamyb\u0105 skrand\u017eio gleivin\u0117je (6,7). Klasikini\u0173 NVNU reik\u0117t\u0173 vengti esant inkst\u0173 funkcijos sutrikimui.<\/span><span lang=\"LT\" style='font-family: \"Times New Roman\"'><\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Jeigu pirmosios pakopos gydymo nepakanka, reik\u0117t\u0173 pereiti prie antrosios pakopos ir skirti lengvo poveikio opioidinius analgetikus <i>per os.<\/i> Bazinis gydymas NVNU tur\u0117t\u0173 i\u0161likti. Reik\u0117t\u0173 atminti, kad tramadolio maksimali paros doz\u0117, kuri\u0105 didinant vaisto analgetinis poveikis nebedid\u0117ja yra 8 x 50 mg<span style=\"background: yellow; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial\">. \u012edomu tai, kad jau senokai gyv\u016bn\u0173 modeliuose buvo pasteb\u0117tas sinerginis opioidini\u0173 analgetik\u0173 ir NVNU poveikis. Pavyzd\u017eiui tyrimuose su \u017eiurk\u0117mis dexketoprofenas (pvz. <a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Dolmen\">Dolmen<\/a>) du kartus prailgino sistemi\u0161kai suleisto fentanilio analgetin\u012f poveik\u012f (8).<\/span><\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Tre\u010diojoje pakopoje skiriami stirprieji opioidiniai analgetikai (pastoviai bei esant reikalui). Pavyzd\u017eiui galima skirti prailginto veikimo morfin\u0105 <i>per os<\/i> arba transdermalin\u0119 fentanilio form\u0105, kuri\u0173 poveikis pradedamas jausti po keli\u0173 valand\u0173. Stipri\u0173j\u0173 analgetik\u0173 poveikis skirtingai nuo tramadolio didinant doz\u0119 did\u0117ja. Kaip ir antrojoje pakopoje NVNU vartojim\u0105 reik\u0117t\u0173 t\u0119sti.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990231}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>3.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990232}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Reik\u0117t\u0173 taikyti kiek galima ma\u017eiau invazinius gydymo metodus. Tinkamiausi geriami ar transdermaliniai preparatai. Jeigu \u0161i\u0173 vaist\u0173 form\u0173 nepakanka, galima rinktis poodines, intravenines bei intratekalines vaist\u0173 formas.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990233}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>4.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990234}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Vaistus reik\u0117t\u0173 vartoti tam tikru nustatytu laiku skiriant ilgo veikimo medikamentus. Esant skausmo pa\u016bm\u0117jimui papildomai reik\u0117t\u0173 vartoti greito veikimo preparatus.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990235}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>5.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990236}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Skiriant gydym\u0105 reik\u0117t\u0173 atsi\u017evelgti \u012f ligos form\u0105 bei stadij\u0105 ir priderinti gydym\u0105 (\u017er. 7 punkt\u0105).<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990237}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>6.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990238}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Paciento prie\u017ei\u016bra tur\u0117t\u0173 b\u016bti vykdoma ambulatori\u0161kai. Apsilankymo metu reik\u0117t\u0173 i\u0161 naujo \u012fvetinti skausmo pob\u016bd\u012f, intensyvum\u0105 bei ligos progresavim\u0105.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 36pt; text-indent: -18pt\"><!--{122164491990239}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>7.<span style='font: 7pt \"Times New Roman\"; font-size-adjust: none; font-stretch: normal'>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><!--{122164491990240}--><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Adjuvantin\u012f gydym\u0105 galima skirti visose PSO skausmo gydymo pakopose. Pavyzd\u017eiui esant kaul\u0173 metastaz\u0117ms galima skirti steroidinius preparatus didel\u0117mis doz\u0117mis, esant neurogeniniams skausmams \u2013 neuroleptikus, kuriuos galima skirti kartu su tricikliais antidepresantais.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><b><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Inkst\u0173 dieglys<\/p>\n<p><\/span><\/b><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Viena svarbiausi\u0173 b\u016bkli\u0173, sukelianti nepakeliamus skausmus urologijoje yra inkst\u0173 dieglys. Su \u0161ia problema susiduria beveik vis\u0173 specialybi\u0173 gydytojai: beveik 12 proc. \u017emoni\u0173 bent kart\u0105 gyvenime patiria inkst\u0173 dieglius, o 50 proc. j\u0173 daugiau kaip vien\u0105 kart\u0105 (9). Moterims <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/inkstu-akmenlige\/4351\">inkst\u0173 akmenlig\u0117<\/a> pasitaiko re\u010diau. Rizika, kad baltaod\u0117 moteris per savo gyvenim\u0105 susirgs inkst\u0173 akmenlige yra apie 5-10 proc., o vyras 20 proc. (10).<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Inkst\u0173 dieglio skausmo mechanizmas n\u0117ra pilnai i\u0161ai\u0161kintas. Manoma, kad svarbiausi\u0105 vaidmen\u012f atlieka \u0161lapimtakyje ir geldel\u0117je esantys nociceptoriai. Skausmo signalas perduodamas d\u0117l \u0161i\u0173 strukt\u016br\u0173 i\u0161tempimo, ma\u017eesn\u0119 reik\u0161m\u0119 turi a\u0161traus akmens sukeltas tiesioginis \u0161lapimo tak\u0173 sienel\u0117s dirginimas. Taigi vienas gydymo tiksl\u0173 tur\u0117gt\u0173 b\u016bti \u0161io i\u0161tempimo ma\u017einimas. Be to apie \u0161lapimo takais keliaujant\u012f akmen\u012f susidaro raumen\u0173 spazmas, kurio tikslas akmen\u012f pa\u0161alinti (11). Manoma, kad gydymas taip pat tur\u0117t\u0173 b\u016bti nukreiptas \u012f \u0161io spazmo ma\u017einim\u0105.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Prostaglandinas E2 (PGE2) yra vienas pagrindini\u0173 inksto diegli\u0173 skausmo mediatori\u0173, kuris i\u0161siskiria d\u0117l sienel\u0117s i\u0161tempimo bei tiesioginio sienel\u0117s dirginimo (12,13). Skausmas pirmiausia pradedamas jausti, nes suaktyvinami ramyb\u0117s b\u016bsenoje esantys nociceptoriai. V\u0117liau atsiv\u0117rus aferentin\u0117ms arteriol\u0117ms padid\u0117ja inkst\u0173 perfuzija bei glomerul\u0173 filtracijos greitis, taip padid\u0117ja prie\u0161 kli\u016bt\u012f esantis sl\u0117gis bei sienel\u0117s dar labiau i\u0161sitempia. PGE2 yra vienas i\u0161 veiksni\u0173, atsaking\u0173 u\u017e u\u017edegimo bei patinimo i\u0161sivystym\u0105 \u0161lapimtakio sienel\u0117je. D\u0117l \u0161ios prie\u017easties NVNU yra labai svarb\u016bs inkst\u0173 dieglio gydyme. \u0160ie vaistai skausm\u0105 ramina tiesiogiai (suma\u017eina nociceptori\u0173 slenks\u010dio lyg\u012f) bei netiesiogiai (ma\u017eina glomerul\u0173 filtracijos greit\u012f bei u\u017edegimin\u012f atsak\u0105). Be to, keli darbai su gyv\u016bnais rodo, kad NVPU gali atpalaiduoti lygiuosius raumenis (13-15). Vaisto analgetinis poveikis nepriklauso nuo paskyrimo b\u016bdo, ta\u010diau suleistas parenteri\u0161kai pradeda veikti grei\u010diau. D\u0117l \u0161ios prie\u017easties \u0161iuo b\u016bdu si\u016bloma skirti vaisto pirm\u0105j\u0105 doz\u0119 (16-18).<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Spazmolitik\u0173 vartojimas literat\u016broje vertinamas prie\u0161taringai. Vieni autoriai laikosi nuomon\u0117s, kad spazmolitik\u0173 skirti nereik\u0117t\u0173, nes jie suma\u017eina \u0161lapimtakio peristaltik\u0105 ir taip apsunkina akmens pasi\u0161alinim\u0105. Kit\u0173 teigimu, spazmolitikai prie\u0161ingai atpalaiduodami \u0161lapimtakio lygiuosius raumenis palengvina akmens \u201ekelion\u0119\u201c \u0161lapimtakiu. Kai kurie tyrimai teigia, kad vienkartinis spazmolitik\u0173 skyrimas yra ma\u017eiau veiksmingas u\u017e NVNU poveik\u012f (19,20).Taip pat kitas dvigubai aklas kontroliuojamas tyrimas parod\u0117, kad anticholinerginiai vaistai juos skiriant kartu su NVNU nepasi\u017eymi didesniu skausm\u0105 ma\u017einan\u010diu poveikiu, ta\u010diau \u0161io tyrimo tiriamoji grup\u0117 buvo tik 43 pacientai (21). Galima rekomenduoti anticholingerginius preparatus esant reikalui skirti kartu su NVNU, ta\u010diau j\u0173 atskirai nevartoti (2 lentel\u0117).<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>2 lentel\u0117. Inkst\u0173 dieglio skausmo gydymo rekomendacijos (22).<\/p>\n<p><\/span><\/p>\n<table class=\"MsoNormalTable\" style=\"border-right: medium none; border-top: medium none; border-left: medium none; border-bottom: medium none; border-collapse: collapse\" cellspacing=\"0\" cellpadding=\"0\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"border-right: black 1pt solid; padding-right: 5.4pt; border-top: black 1pt solid; padding-left: 5.4pt; padding-bottom: 0cm; border-left: black 1pt solid; width: 111.75pt; padding-top: 0cm; border-bottom: black 1pt solid\" valign=\"top\" width=\"149\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>B\u016btini vaistai<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: black 1pt solid; padding-right: 5.4pt; border-top: black 1pt solid; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 380.95pt; padding-top: 0cm; border-bottom: black 1pt solid\" valign=\"top\" width=\"508\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='background: yellow; font-family: \"Times New Roman\"; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial'>NVNU (diklofenakas (pvz. <a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Dicloberl\">Dicloberl<\/a>), nimesulidas (pvz. <a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Nimesil\">Nimesil<\/a>), dexketoprofenas (pvz. <a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Dolmen\">Dolmen<\/a>) ir kt.)<\/span><span lang=\"LT\" style='font-family: \"Times New Roman\"'>, pirm\u0105j\u0105 vaisto doz\u0119 skirti parenteraliai, v\u0117liau <i>per os.<\/i><\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: 1pt solid; width: 111.75pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"149\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Esant reikalui<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 380.95pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"508\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Opioidiniai analgetikai, anticholinerginiai vaistai<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: 1pt solid; width: 111.75pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"149\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Skys\u010di\u0173 vartojimas<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 380.95pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"508\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Pagal poreik\u012f, diurez\u0117s neskatinti vaistais<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'><span>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i>Cochrane <\/i>ap\u017evalga<i><\/p>\n<p><\/i><\/span><\/p>\n<p class=\"MsoNormal\"><i><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Cochrane<\/span><\/i><span lang=\"LT\" style='font-family: \"Times New Roman\"'> bibliotekos pateiktoje ap\u017evalgoje, apiman\u010dioje dvivi de\u0161imtis kontroliuojam\u0173 atsitiktini\u0173 im\u010di\u0173 tyrim\u0173, atlikt\u0173 devyniose \u0161alyse NVNU taikymas inkst\u0173 digliui gydyti buvo palygintas su opioidiniais analgetikais (23). \u012e ap\u017evalg\u0105 buvo \u012ftraukta 1613 pacient\u0173. Tiek NVNU, tiek opioidiniai analgetikai suma\u017eino skausm\u0105 remiantis skausmo bal\u0173 sistema. Pacientams, kurie vartojo NVNU reik\u0161mingai re\u010diau reik\u0117jo skirti papildom\u0105 vaist\u0105 nuos skausmo lyginant su vartojusiais opioidinius analgetikus. Beveik visuose \u012f ap\u017evalg\u0105 \u012ftrauktuose tyrimuose buvo naudotas opioidinis analgetikas petidinas, o NVNU gretose vyravo <span style=\"background: yellow; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial\">diklofenakas (pvz. <a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Dicloberl\">Dicloberl<\/a>),<\/span> ketorolakas bei indometacinas. Apibendrintais duomenimis vien\u0105 kart\u0105 paskyrus NVNU daugiau vaist\u0173 nuo skausmo reikalavo 18,9 proc. paciet\u0173, o paskyrus opioidin\u012f analgetik\u0105 \u2013 25,4 proc. Nepageidaujam\u0173 poveiki\u0173 daugiau steb\u0117ta opioidinius analgetikus vartojantiems pacientams. NVNU vatrojantiems pacientams v\u0117mimas pasitaik\u0117 reik\u0161mingai re\u010diau (SR 0,35, 96 proc. PI 0,23-0,53, p&lt;0,00001). Kraujavimo i\u0161 vir\u0161kinamojo trakto bei inkst\u0173 funkcijos pablog\u0117jimo atvej\u0173 prane\u0161ta nebuvo.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><i><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Cochrane<\/span><\/i><span lang=\"LT\" style='font-family: \"Times New Roman\"'> ap\u017evalgos autoriai teigia, kad NVNU ir opioidiniai analgetikai gali palengvinti skausmus inkst\u0173 dieglio metu, ta\u010diau d\u0117l da\u017enai pasitaikan\u010dio v\u0117mimo nusprendus skirti opiodinius analgetikus patariama vengti skirti petidin\u0105.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><b><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Pooperacinis skausmas<\/p>\n<p><\/span><\/b><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Remiantis viena literat\u016bros ap\u017evalga taikant tinkam\u0105 pooperacin\u012f skausmo gydym\u0105 galima suma\u017einti pooperacinio mirtingumo rodiklius bei komplikacij\u0173 da\u017en\u012f (kv\u0117pavimo nepakankamumas 59 proc., plau\u010di\u0173 embolija 55 proc., transfuzij\u0173 poreikis 50 proc. <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/giliuju-venu-tromboze\/4507\">gili\u0173j\u0173 ven\u0173 tromboz\u0117<\/a> 44 proc., plau\u010di\u0173 u\u017edegimas 39 proc.) (24). Be to taikant adekvat\u0173 skausmo gydym\u0105 skausmas netampa l\u0117tiniu, sutaupomi ka\u0161tai bei pacientai b\u016bna labiau patenkinti gydymu. Remiantis 34 vokietijos urologijos klinik\u0173 duomenimis buvo sudarytas intervencij\u0173 s\u0105ra\u0161as, po kuri\u0173 pacientai jau\u010dia did\u017eiausius skausmus. \u0160ios intervencij\u0173 grup\u0117s bei rekomenduojamas skausmo gydymas pateikiamas 3 lentel\u0117je.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>3 lentel\u0117. Skausmas po tam tikros operacijos, bei rekomenduojamas gydymas (25)<\/p>\n<p><\/span><\/p>\n<table class=\"MsoNormalTable\" style=\"border-right: medium none; border-top: medium none; border-left: medium none; border-bottom: medium none; border-collapse: collapse\" cellspacing=\"0\" cellpadding=\"0\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"border-right: black 1pt solid; padding-right: 5.4pt; border-top: black 1pt solid; padding-left: 5.4pt; padding-bottom: 0cm; border-left: black 1pt solid; width: 97.55pt; padding-top: 0cm; border-bottom: black 1pt solid\" valign=\"top\" width=\"130\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>Skausmo stiprumas<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: black 1pt solid; padding-right: 5.4pt; border-top: black 1pt solid; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 155.95pt; padding-top: 0cm; border-bottom: black 1pt solid\" valign=\"top\" width=\"208\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>Operacija<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: black 1pt solid; padding-right: 5.4pt; border-top: black 1pt solid; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 239.2pt; padding-top: 0cm; border-bottom: black 1pt solid\" valign=\"top\" width=\"319\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>Gydymas<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: 1pt solid; width: 97.55pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"130\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>I grup\u0117<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 155.95pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"208\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>Transperitonin\u0117 nefrektomija, radikali cistektomija<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 239.2pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"319\" rowspan=\"2\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>Epidurinis kateteris. Paciento kontroliuojamoji analgezija, \u012fprastiniai analgetikai (3-4 pooperacin\u0119 par\u0105). Gydymas palaipsniui ma\u017einamas po 6 pooperacin\u0117s paros.<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: 1pt solid; width: 97.55pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"130\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>II grup\u0117<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 155.95pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"208\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>Radikali prostatektomija<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: 1pt solid; width: 97.55pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"130\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>III grup\u0117<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 155.95pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"208\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>Retroperitonin\u0117s operacijos (\u012fprastin\u0117 refrektomija, lumbotomija)<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 239.2pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"319\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>Palatos slaugytojos kontroliuojamoji bazin\u0117 bei IV analgezija pirmosiomis valandomis po operacijos, v\u0117liau paciento kontroliuojamoji bazin\u0117 bei IV analgezija. Gydymo ma\u017einimas 3-4 par\u0105 po operacijos.<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: 1pt solid; width: 97.55pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"130\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>IV grup\u0117<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 155.95pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"208\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>Lytini\u0173 organ\u0173 operacija<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 239.2pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"319\" rowspan=\"2\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>Palatos slaugytojos kontroliuojamoji bazin\u0117 bei IV analgezija pirmosiomis valandomis po operacijos. v\u0117liau palatos slaugytojos kontroliuojamoji bazin\u0117 bei poodin\u0117 analgezija esant poreikiui. Gydymo ma\u017einimas 3-4 par\u0105 po operacijos.<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: 1pt solid; width: 97.55pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"130\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>V grup\u0117<\/p>\n<p><\/span><\/p>\n<\/td>\n<td style=\"border-right: 1pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0cm; border-left: medium none; width: 155.95pt; padding-top: 0cm; border-bottom: 1pt solid\" valign=\"top\" width=\"208\">\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-size: 9pt; line-height: 115%; font-family: \"Times New Roman\"'>TUR<\/p>\n<p><\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>I grup\u0117 \u2013 did\u017eiausias skausmas; V \u2013 ma\u017eiausias skausmas.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><b><span lang=\"LT\" style='font-family: \"Times New Roman\"'><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p class=\"MsoNormal\"><b><span lang=\"LT\" style='font-family: \"Times New Roman\"'>L\u0117tinio dubens skausmo sindromas<\/p>\n<p><\/span><\/b><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Kiekvienas urologas praktikoje susiduria su l\u0117tinio dubens skausmo sindromu. Remiantis Abramsu su bendraautoriais (26) tai sindromas, kurio metu pasirei\u0161kia nuolatinis ar pasikartojantis dubens skausmas bei apatini\u0173 \u0161lapimo tak\u0173, lytin\u0117s veiklos, vir\u0161kinamojo trakto ar ginekologiniai simptomai, bei nepasiseka nustatyti infekcijos ar kitos ai\u0161kios patologijos. Vyrams \u0161iais atvejais da\u017eniausiai nustatoma l\u0117tinio prostatito diagnoz\u0117. <\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>Jeigu remdamiesi neurourologijos principu manysime, kad l\u0117tinio dubens skausmo sindromas i\u0161sivysto \u016bmiam procesui tapus l\u0117tiniu, galima teigti, kad svarbiausia \u0161ioje situacijoje imtis prevencini\u0173 priemoni\u0173. Pavyzd\u017eiui sergantiems \u016bminiu prostatitu reik\u0117t\u0173 skirti adekvat\u0173 gydyma ir stengtis, kad \u016bminis skausmas nevirstu l\u0117tiniu. \u0160iuo atveju b\u016btina skirti ilgalaik\u012f gydym\u0105 antibiotikais (fluorchinolonai 4 sav.) bei NVNU didel\u0117mis doz\u0117mis, kurias galima suma\u017einti po 1 savait\u0117s. <span style=\"background: yellow; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial\">D\u0117l skausmo lokalizacijos gali b\u016bti naudinga skirti rektalines vaisto formas, pavyzd\u017eiui diklofenako \u017evakutes (pvz. <a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Dicloberl\">Dicloberl<\/a> \u017evakutes).<\/span> Taip pat \u0161iais atvejais galima skirti lengvo veikimo opioidinius analgetikus. Jeigu vis d\u0117lto l\u0117tinio dubens skausmo sindromas i\u0161sivyst\u0117, j\u012f reik\u0117t\u0173 gydyti laikantis PSO skausmo gydymo pakop\u0173 sistemos.<\/p>\n<p><\/span><\/p>\n<p class=\"MsoNormal\"><b><span lang=\"LT\" style='font-family: \"Times New Roman\"'>I\u0161vados<\/p>\n<p><\/span><\/b><\/p>\n<p class=\"MsoNormal\"><span lang=\"LT\" style='font-family: \"Times New Roman\"'>PSO skausmo gydymo pakop\u0173 sistem\u0105 galima s\u0117kmingai taikyti gydant urologinius pacientus. NVNU urologiniams ligoniams skiriami prakti\u0161kai visose pakopose, auk\u0161tesn\u0117se pakopose papildomai skiriant opioidinius analgerikus bei adjunvantin\u012f gydym\u0105. Norint, kad skausmas nevirst\u0173 l\u0117tiniu j\u012f b\u016btina gydyti greitai ir veiksmingai.<\/p>\n<p><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/><br \/>\n<meta content=\"Word.Document\" name=\"ProgId\" \/><br \/>\n<meta content=\"Microsoft Word 10\" name=\"Generator\" \/><br \/>\n<meta content=\"Microsoft Word 10\" name=\"Originator\" \/>\n<link href=\"file:\/\/\/C:DOCUME~1565LOCALS~1Tempmsohtml1\ufffd1clip_filelist.xml\" rel=\"File-List\" \/>\n<link href=\"file:\/\/\/C:DOCUME~1565LOCALS~1Tempmsohtml1\ufffd1clip_editdata.mso\" rel=\"Edit-Time-Data\" \/><!--[if !mso]>\n\n\n<style>\nv:* {behavior:url(#default#VML);}\no:* {behavior:url(#default#VML);}\nw:* {behavior:url(#default#VML);}\n.shape {behavior:url(#default#VML);}\n<\/style>\n\n\n<![endif]--><!--[if gte mso 9]><xml>\n<w:WordDocument>\n<w:View>Normal<\/w:View>\n<w:Zoom>0<\/w:Zoom>\n<w:Compatibility>\n<w:BreakWrappedTables 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