EÏÏËÓÈ΋ AÓ·ÈÛıËÛÈÔÏÔÁ›·

¶EPIEXOMENA

KÏÈÓÈΤ˜ ÌÂϤÙ˜

º·ÚÌ·ÎÔ‰˘Ó·ÌÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ÙÔ˘ ÚÔÎÔ˘ÚÔÓ›Ô˘ Û ÂÓ‹ÏÈÎÔ ÏËı˘ÛÌfi ÁÈ· Á˘Ó·ÈÎÔÏÔÁÈΤ˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ 69¢. B·ÏÛ·Ì›‰Ë˜, ™. §ÂÔÓÙÔÔ‡ÏÔ˘, A. T˙·ÓÂÙ‹, A. §Ô˘Î¤ÚË, A. K·Ú·ı¿ÓÔ˜

E·Ó·Ï·Ì‚·ÓfiÌÂÓË ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÌÔÚÊ›Ó˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔͤԘ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡ fiÓÔ˘. ¶ÚÔÔÙÈ΋ ÌÂϤÙË 77¢. ¶··ÁfiÚ·˜, I. TÂÂÙ˙‹˜, I. TÚÔ‡ÁÎÔ˜, A. ¶ÈÙ¤Ó˘, N. Iˆ·ÓÓ›‰Ë˜, I. ZËÎfiÔ˘ÏÔ˜, X. ¶··˙‹Û˘

AÓ·ÛÎfiËÛË

H Û‡Á¯ÚÔÓË ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›·: TÈ Ú¤ÂÈ Ó· ÁÓˆÚ›˙ÂÈ Ô ·Ó·ÈÛıËÛÈÔÏfiÁÔ˜ ˆ˜ È·ÙÚfi˜ Ù˘ ÂÚÈÂÁ¯ÂÈÚËÙÈ΋˜ È·ÙÚÈ΋˜; M¤ÚÔ˜ 1Ô ·fi 4: EȉËÌÈÔÏÔÁ›· Î·È ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜, ·Ú¯È΋ ÂÎÙ›ÌËÛË ÙÔ˘ ÙÚ·˘Ì·Ù›·, ÂÍ·ÛÊ¿ÏÈÛË ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ Î·È ÂÎÙ›ÌËÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ 83XÚ. ™ÎÏ¿‚Ô˘, TÚ. ™›ÎÏ˘, K.™. º›ÏÔ˜

EȉÈÎfi ¿ÚıÚÔ

H ¯ÚËÛÈÌfiÙËÙ· Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒÚ·ÎÔ˜ ˆ˜ ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÂͤٷÛË ÚÔ˘Ù›Ó·˜ 101M. Mȯ·ËÏ›‰Ë˜, E. KˆÙ›‰Ë˜, A. M¤ÓÔ˜

EÈÛÙÔÏ‹ ÚÔ˜ ÙË ™‡ÓÙ·ÍË

H ¯ÔÚ‹ÁËÛË Ù˘ ÂÓÔÍ··Ú›Ó˘ Û ·ÛıÂÓ›˜ Ì ÚÔÛıÂÙÈΤ˜ ‚·Ï‚›‰Â˜ ÚÈÓ ·fi ¯ÂÈÚÔ˘ÚÁÈ΋ ÌË Î·Ú‰È·Î‹ ¤̂·ÛË 106°.N. MÔ‡ÙÔ˜, A.A. MËÙÚÔÔ‡ÏÔ˘, K.X. ¶··‰fiÔ˘ÏÔ˜, ¢.°. M·ÓÙ˙Ô˘Ú¿ÙÔ˜, ™.A. KÔ˘ÙÔ‡˙˘, °.§. TÚ¤ÓÙÛÈÔ˘, M. I·Î. AÌÌ¿ÚÈ°.I. ¶··‰fiÔ˘ÏÔ˜, A.K. X·ÚÎÈÔÏ¿ÎË

AÚ›ÏÈÔ˜ - IÔ‡ÓÈÔ˜ 2005, TfiÌÔ˜ 38, T‡¯Ô˜ 2

April - June 2005, Volume 38, No 2

Acta Anaesthesiologica Hellenica

CONTENTS

Clinical investigations

Pharmacodynamic characteristics of rocuronium bromide in adult female population during gynecologic surgery 69D. Valsamidis, S. Leontopoulou, A. Tzanetis, A. Loukeri, A. Karathanos

Intermittent intravenous administration of morphine compined with NSAID for acute postoperative pain treatmentA prospective study 77D. Papagoras, I. Tepetzis, I. Trugkos, A. Pitenis, N. Ioannidis, I. Zikopoulos, AC. Papazisis

Review

Management of the trauma patient: What the anaesthesiologist as a perioperative physician should know. First of four parts: Epidemiology and pathophysiology of trauma, initial evaluation, airway management and respiratory assessment in the trauma patient 83C. Sklavou, T. Siklis, K.S. Filos

Special article

The usefulness of preoperative chest x-ray as routine examination 101M. Michaelides, E. Kotidis, A. Benos

Letter to the Editor

Administration of low molecular weight herapin enoxaparin to patients with prosthetic cardiac valves prior to non-cardiacoperations 106G.N. Boutos, E.A. Mitropoulou, K.C. Papadopoulos, D.G. Matzouratos, S.A. Koutouzis, G.L. Trentsiou, M. Jac. Ammari, G.N. Papadopoulos, A.C. Harkiolaki

¶ÂÚ›ÏË„Ë

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÚ¢ӋıËÎ·Ó ÔÈ Ê·ÚÌ·ÎÔ‰˘Ó·ÌÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ÙÔ˘ ÚÔÎÔ˘ÚÔÓ›Ô˘ Û 60 ˘ÁÈ›˜ Á˘Ó·›Î˜(ASA I Î·È II) ηٿ ÙËÓ Ú·ÁÌ·ÙÔÔ›ËÛË Á˘Ó·ÈÎÔÏÔÁÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ¤̂·Û˘. EÚ¢ӋıËÎ·Ó ÔÈ Û˘Óı‹Î˜ ÂÓ‰Ô-ÙÚ·¯Âȷ΋˜ ‰È·ÛˆÏ‹ÓˆÛ˘, Ô ¯ÚfiÓÔ˜ ¤Ó·Ú͢ ‰Ú¿Û˘, Ë ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Ù˘ ·Ú¯È΋˜ Î·È ÙˆÓ Â·Ó·ÏËÙÈÎÒÓ ‰fiÛÂ-ˆÓ Î·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·ӷÊÔÚ¿˜ Ù˘ Ó¢ÚÔÌ˘˚΋˜ ÈÛ¯‡Ô˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÚÔÎÔ˘ÚÔÓ›Ô˘ (·Ú¯È΋ ‰fiÛË0,6mg.kg-1, ‰fiÛË Û˘ÓÙ‹ÚËÛ˘ 0,15 mg.kg-1 ÛÙËÓ Â·Ó·ÊÔÚ¿ Ù˘ T1 ÛÙÔ 25%) ηٿ ÙË ‰È¿ÚÎÂÈ· ÁÂÓÈ΋˜ ·Ó·ÈÛıËÛ›·˜ ÌÂÚÔÔÊfiÏË Î·È ÚÂÌÈÊÂÓÙ¿ÏË. H ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ Ó¢ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ ¤ÁÈÓ Ì ÙËÓ ÌÔÓ¿‰· M-NMT (Datex-Ohmeda® Division Instrumentarium Corp, Helsinki, Finland). OÈ Û˘Óı‹Î˜ ÂÓ‰ÔÙÚ·¯Âȷ΋˜ ‰È·ÛˆÏ‹ÓˆÛ˘ ‹Ù·Ó ÂÍ·›-ÚÂÙ˜ ‹ ηϤ˜ Û 56 ·ÛıÂÓ›˜ (93%) Û 90 sec ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ‰fiÛË ÚÔÎÔ˘ÚÔÓ›Ô˘. ™Â ‰‡Ô ·ÛıÂÓ›˜ ··ÈÙ‹ıËΠ·Ó·-ÌÔÓ‹ ̤¯ÚÈ 250 sec ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÈÙ¢¯ı› ÂÓ‰ÔÙÚ·¯Âȷ΋ ‰È·ÛˆÏ‹ÓˆÛË Ì ¿ÚÈÛÙ˜ Û˘Óı‹Î˜. H ̤ÛË ÙÈÌ‹ (ÛÙ·-ıÂÚ‹ ·fiÎÏÈÛË) ÙÔ˘ ¯ÚfiÓÔ˘ ¤Ó·Ú͢ ‰Ú¿Û˘ ÙÔ˘ ÚÔÎÔ˘ÚÔÓ›Ô˘ ‹Ù·Ó 32 (11) sec, ÙÔ˘ ¯ÚfiÓÔ˘ ›Ù¢Í˘ ̤ÁÈÛÙÔ˘ Ó¢-ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ 157 (67) sec, Ù˘ ‰È¿ÚÎÂÈ·˜ ‰Ú¿Û˘ Ù˘ 1˘ ‰fiÛ˘ 32 (10) min Î·È ÙˆÓ ˘ÔÏÔ›ˆÓ 15,4 (3,8),17,5 (4,5), 18,7 (6,3), 19,7 (6,7) Î·È 17,5 (7,8) ·ÓÙ›ÛÙÔȯ·. T· ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ·ӷÊÔÚ¿˜ ÙÔ˘ T1 ·fi 25 Û 75%‹Ù·Ó 15,7 (6,0) min, ÙÔ˘ T1 ·fi 25% ̤¯ÚÈ Ô ÏfiÁÔ˜ Ù˘ ™ÂÈÚ¿˜- ÙˆÓ-TÂÛÛ¿ÚˆÓ Ó· ·ӤÏıÂÈ ÛÙÔ 75% ‹Ù·Ó 21,1 (5,3)min Î·È Ô ¯ÚfiÓÔ˜ ·fi ÙË ¯ÔÚ‹ÁËÛË Ù˘ ÙÂÏÂ˘Ù·›·˜ ·ӷÏËÙÈ΋˜ ‰fiÛ˘ ̤¯ÚÈ Ô ÏfiÁÔ˜ Ù˘ ™ÂÈÚ¿˜- ÙˆÓ -TÂÛÛ¿ÚˆÓ Ó·Â·Ó¤ÏıÂÈ ÛÙÔ 75% ‹Ù·Ó 39,8 (9,7) min. OÈ ¯ÚfiÓÔÈ ·˘ÙÔ› ÂÈÙÚ¤Ô˘Ó ÙË ¯Ú‹ÛË ÙÔ˘ ÚÔÎÔ˘ÚÔÓ›Ô˘ ÙfiÛÔ Û ÂÂÌ‚¿ÛÂȘ‰È¿ÚÎÂÈ·˜

70 ¢. BA§™AMI¢H™ Î·È Û˘Ó.

ÛÙ‹˜ ÛÙÂÈÚÔÂȉԇ˜ Ù‡Ô˘ Ì ·ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙËÓÙ·¯Â›· ÂÁηٿÛÙ·ÛË Ó¢ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡, ÙË̤ÛË ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Î·È ÙȘ ÂÏ¿¯ÈÛÙ˜ ηډȷÁÁÂÈ·-Τ˜ ÂȉڿÛÂȘ. A˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ ÌÔÚ› Ó· ·ÓÙÈηٷ-ÛÙ‹ÛÂÈ ÙËÓ ÛÔ˘ÎÎÈÓ˘Ï¯ÔÏ›ÓË ÁÈ· ÂÈÛ·ÁˆÁ‹ Ù˘ ·Ó·È-ÛıËÛ›·˜ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ ÚԂϤÂÙ·È ‰‡ÛÎÔ-ÏË ‰È·ÛˆÏ‹ÓˆÛË Î·È ÙÔ Î·ıÈÛÙ¿ ÂÏ΢ÛÙÈÎfi Ó¢ÚÔÌ˘˚Îfi·ÔÎÏÂÈÛÙ‹ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ Ô˘ ‰È·Ú-ÎÔ‡Ó ÏÈÁfiÙÂÚÔ ·fi Ì›· ÒÚ·. OÈ ÂÚÈÛÛfiÙÂÚ˜ Á˘Ó·ÈÎÔ-ÏÔÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ ¤¯Ô˘Ó ‰È¿ÚÎÂÈ· 40-60 min.¶·ÚfiÏ· ·˘Ù¿ Â›Ó·È ÂӉ¯fiÌÂÓÔ Ë ‰È¿ÚÎÂÈ· ·˘Ù‹ Ó··Ú·Ù·ı› ·Úfi‚ÏÂÙ·. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘‹Ù·Ó Ó· ‰ÈÂÚ¢ÓËı› Ë Ê·ÚÌ·ÎÔ‰˘Ó·ÌÈ΋ ‰Ú¿ÛË ÙÔ˘ÚÔÎÔ˘ÚÔÓ›Ô˘ Û Á˘Ó·ÈÎÂ›Ô ÏËı˘ÛÌfi Î·È Û Á˘Ó·ÈÎÔ-ÏÔÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ.

MÂıÔ‰ÔÏÔÁ›·⁄ÛÙÂÚ· ·fi ¤ÁÎÚÈÛË ÙÔ˘ EÈÛÙËÌÔÓÈÎÔ‡

™˘Ì‚Ô˘Ï›Ô˘ ÙÔ˘ NÔÛÔÎÔÌ›Ԣ Ì·˜ ÂÈϤ¯ıËÎ·Ó 60Á˘Ó·›Î˜ ASA I-II, ËÏÈΛ·˜ 20-55 ÂÙÒÓ, Ô˘ ˘Ô‚Ï‹ıË-Î·Ó Û ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÂÓ‰ÔÂÚÈÙÔÓ·˚΋ ‹ Ï··ÚÔ-ÛÎÔÈ΋ Á˘Ó·ÈÎÔÏÔÁÈ΋ ¤̂·ÛË, ˘fi ÁÂÓÈ΋ ·Ó·È-ÛıËÛ›·. ŸÏ˜ ÔÈ ·ÛıÂÓ›˜ ¤‰ˆÛ·Ó ¤ÁÁÚ·ÊË Û˘Áηٿ-ıÂÛË ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÛÙË ÌÂϤÙË. EÍ·ÈÚ¤ıËÎ·Ó ·ÛıÂ-Ó›˜ Ì ÁÓˆÛÙ‹ Ë·ÙÈ΋, ÓÂÊÚÈ΋ ‹ Ó¢ÚÔÌ˘˚΋ ÓfiÛÔηıÒ˜ Î·È ÂΛӘ ÛÙȘ Ôԛ˜ Ô ‰Â›ÎÙ˘ ۈ̷ÙÈÎÔ‡‚¿ÚÔ˘˜ [‚¿ÚÔ˜ Û kgr/ (‡„Ô˜ Û m)2] ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ˜·fi 18 ‹ ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi 28. E›Û˘ ÂÍ·ÈÚ¤ıËηӷÛıÂÓ›˜ ·Ó ÚÔ‚ÏÂfiÙ·Ó ‰‡ÛÎÔÏË ‰È·ÛˆÏ‹ÓˆÛË ‹Ô˘ ·Ó¤ÊÂÚ·Ó ‰‡ÛÎÔÏÔ ·ÂÚÈÛÌfi ‹ ·‰‡Ó·ÙË ‰È·ÛˆÏ‹-ÓˆÛË ÛÙÔ ·ÚÂÏıfiÓ.

ŸÏ˜ ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó ·fi ÙÔ ÛÙfiÌ·, ÙÔ ‚Ú¿‰˘ÚÈÓ ·fi ÙËÓ Â¤Ì‚·ÛË, ηıÒ˜ Î·È ‰‡Ô ÒÚ˜ ÚÔÂÁ¯ÂÈ-ÚËÙÈο, ÏÔÚ·˙¿ÌË 1 mg. E›Û˘, 10 min ÚÈÓ ÙËÓÂÈÛ·ÁˆÁ‹ ÛÙËÓ ·Ó·ÈÛıËÛ›· ¯ÔÚËÁ‹ıËÎ·Ó ÂÓ‰ÔÊϤ‚È·10mg ÌÂÙÔÎÏÔÚ·Ì›‰Ë˜ Î·È 50 mg Ú·ÓÈÙȉ›Ó˘.¢ÈÂÁ¯ÂÈÚËÙÈο ¯ÚËÛÈÌÔÔÈ‹ıËΠËÏÂÎÙÚÔÓÈ΋ Û˘Û΢‹ÁÈ· ÙË Û˘Ó¯‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ HK°, Ù˘ ·ÏÌÈ΋˜Ô͢ÌÂÙÚ›·˜, Ù˘ ÌË ·ÈÌ·ÙËÚ‹˜ ̤ÙÚËÛ˘ Ù˘ ·ÚÙËÚÈ·-΋˜ ›ÂÛ˘ Î·È ÙÔ˘ ηÓÔÁÚ·Ê‹Ì·ÙÔ˜. H ÂÈÛ·ÁˆÁ‹ÛÙËÓ ·Ó·ÈÛıËÛ›· ¤ÁÈÓ Ì ÚÔÔÊfiÏË 2 mg.Kg-1 ηÈÚÂÌÈÊÂÓÙ·Ï›ÓË 0,5 Ìg.Kg-1 Î·È Ë ‰È·Ù‹ÚËÛ‹ Ù˘ Ì ¯ÔÚ‹-ÁËÛË ·ÙÌÔÛÊ·ÈÚÈÎÔ‡ ·¤Ú· ÂÌÏÔ˘ÙÈṲ̂ÓÔ˘ Û O2 35%Î·È Û˘Ó¯‹ ¤Á¯˘ÛË ÚÔÔÊfiÏ˘ 8 mg.kg-1.h-1 Î·È ÚÂÌÈ-ÊÂÓÙ·Ó›Ï˘ 0,1-0,4 Ìg.Kg-1.min-1 Ì ËÏÂÎÙÚÔÓÈ΋ ·ÓÙÏ›·[Grasby 3400, Graseby Medican LTD, Wattford Herts,UK].

¶ÚÈÓ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ·Ó·ÈÛıËÛ›· ÙÔÔıÂÙ‹-ıËÎ·Ó ÂÈÊ·ÓÂȷο ËÏÂÎÙÚfi‰È· ÛÙÔÓ ‰ÂÍÈfi ηÚfi ÛÙËÓÂÚÈÔ¯‹ ‰È·‰ÚÔÌ‹˜ ÙÔ˘ ˆÏ¤ÓÈÔ˘ Ó‡ÚÔ˘, ·ÊÔ‡ ηı·Ú›-ÛÙËΠÂÈÌÂÏÒ˜ ÙÔ ‰¤ÚÌ· ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈ-Ûı› Ë ËÏÂÎÙÚÈ΋ ·ÁˆÁÈÌfiÙËÙ·. MÂÙ¿ ÙËÓ ·ÒÏÂÈ· ÙÔ˘‚ÏÂÊ·ÚȉÈÎÔ‡ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÔ‡ ηıÔÚ›ÛıËÎÂ, ‡ÛÙÂÚ··fi ÂÚÂıÈÛÌfi Ì ·˘Í·ÓfiÌÂÓ˘ ¤ÓÙ·Û˘ ÂÚÂı›ÛÌ·Ù·, ÙÔ˘ÂṲ́ÁÈÛÙÔ ÂÚ¤ıÈÛÌ· ÛÙËÓ Î¿Ì„Ë ÙÔ˘ ·ÓÙ›¯ÂÈÚ· ÌÂÙËÓ ÌÔÓ¿‰· M-NMT (module M-NMT; Datex-Ohmeda®, Helsinki, Finland). AÊÔ‡ ÂȂ‚·ÈˆÓfiÙ·ÓÁÈ· 2 min Ë ÛÙ·ıÂÚfiÙËÙ· ÙÔ˘ Û‹Ì·ÙÔ˜, ¿Ú¯È˙Â Ô ¤ÏÂÁ-¯Ô˜ Ù˘ Ó¢ÚÔÌ˘˚΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ì ÙË ÛÂÈÚ¿ ÙˆÓ ÙÂÛ-Û¿ÚˆÓ (TOF) ‰ÈÂÁ¤ÚÛÂˆÓ (4 ‰ÈÂÁ¤ÚÛÂȘ ÌÂ Û˘¯ÓfiÙËÙ·2 Hz) οı 15 sec Î·È Ë Î·Ù·ÁÚ·Ê‹ ÙfiÛÔ Ù˘ T1 (Ë ·¿-ÓÙËÛË ÙÔ˘ Ì˘fi˜ ÛÙËÓ ÚÒÙË ‰È¤ÁÂÚÛË Ù˘ TOF Û ۯ¤ÛËÌ ÙËÓ ·¿ÓÙËÛË ÛÙËÓ ˘ÂṲ́ÁÈÛÙË ‰È¤ÁÂÚÛË) fiÛÔ Î·ÈÙÔ˘ ÏfiÁÔ˘ Ù˘ ÛÂÈÚ¿˜ ÙˆÓ ÙÂÛÛ¿ÚˆÓ (TR - Ô ÏfiÁÔ˜ Ù˘·¿ÓÙËÛ˘ ÙÔ˘ Ì˘fi˜ ÛÙËÓ Ù¤Ù·ÚÙË Û ۯ¤ÛË Ì ÙËÓ ·¿-ÓÙËÛË ÛÙËÓ ÚÒÙË ‰È¤ÁÂÚÛË Î¿ı ÛÂÈÚ¿˜).

AÎÔÏÔ‡ıˆ˜ ¯ÔÚËÁ‹ıËÎÂ Ë ·Ú¯È΋ ‰fiÛË ÚÔÎÔ˘ÚÔÓ›-Ô˘ (0,6mg.kg-1). H ÚÒÙË ÚÔÛ¿ıÂÈ· ‰È·ÛˆÏ‹ÓˆÛ˘Ù˘ ÙÚ·¯Â›·˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙ· 90 sec ÌÂÙ¿ Ù˯ÔÚ‹ÁËÛË ÚÔÎÔ˘ÚÔÓ›Ô˘, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÙÈÌ‹ ·¿-ÓÙËÛ˘ ÛÙË ‰È¤ÁÂÚÛË T1. AÓ ÔÈ Û˘Óı‹Î˜ ‰ÂÓ ‹Ù·Ó Èη-ÓÔÔÈËÙÈΤ˜ Ë ÚÔÛ¿ıÂÈ· ·ӷϷ̂·ÓfiÙ·Ó ÌfiÓÔfiÙ·Ó Î·Ù·ÁÚ·ÊfiÙ·Ó Ë Ì¤ÁÈÛÙË Ù˘ ÙÈÌ‹˜ Ù˘ T1.E·Ó·ÏËÙÈ΋ ‰fiÛË ÚÔÎÔ˘ÚÔÓ›Ô˘ 0.15mg.kg-1 ¯ÔÚËÁ›-ÙÔ fiÙ·Ó Ë ·¿ÓÙËÛË ÛÙË ‰È¤ÁÂÚÛË T1 ·ÓÂÚ¯fiÙ·Ó ÛÙÔ25%. K·Ù¿ Ù· ÙÂÏÂ˘Ù·›· ÙÚÈ¿ÓÙ· min ÚÈÓ ÙÔ Ù¤ÏÔ˜ Ù˘¤̂·Û˘ ‰ÂÓ ¯ÔÚËÁ‹ıËΠ·ӷÏËÙÈ΋ ‰fiÛËÚÔÎÔ˘ÚÔÓ›Ô˘ Î·È Ë Ó¢ÚÔÌ˘˚΋ ÏÂÈÙÔ˘ÚÁ›· ·Ê¤ıËΠӷ·ӤÏıÂÈ ·˘ÙfiÌ·Ù·. ŸÙ·Ó Ô TR ·ÓÂÚ¯fiÙ·Ó ÛÙÔ80% Î·È ÂÊfiÛÔÓ Â›¯Â ÙÂÚÌ·ÙÈÛÙ› Ë Â¤Ì‚·ÛË, ÛÙ·Ì·-ÙÔ‡ÛÂ Ë ¯ÔÚ‹ÁËÛË ·Ó·ÈÛıËÛ›·˜ Î·È Ë Î·Ù·ÁÚ·Ê‹ ÙÔ˘Ó¢ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡. ™ÙȘ ·ÛıÂÓ›˜ ¯ÔÚËÁ›ÙÔ O2Û ˘ÎÓfiÙËÙ· 100% Î·È Ë ·ÔۈϋӈÛË ÁÈÓfiÙ·Ó fiÙ·Ó˘‹Ú¯Â ÈηÓÔÔÈËÙÈ΋ ·Ó·Ó¢ÛÙÈ΋ Û˘¯ÓfiÙËÙ·(>9/min) Î·È ÙÂÏÔÂÎÓ¢ÛÙÈÎfi CO2(PETCO2

ºAPMAKO¢YNAMIKE™ ¶APAMETPOI POKOYPONIOY 71

Ù˘ ·¿ÓÙËÛ˘ ÛÙË ‰È¤ÁÂÚÛË T1 ‹ ÙÔ˘ TR (lag-t)3. OÈ Û˘Óı‹Î˜ Ì ÙȘ Ôԛ˜ ‰È·ÛˆÏËÓÒıËÎ·Ó ÔÈ

·ÛıÂÓ›˜ Û ÙÂÙÚ¿‚·ıÌË Îϛ̷η (ηΤ˜/̤ÙÚȘ/ηϤ˜/¿ÚÈÛÙ˜), ·Ó¿ÏÔÁ· Ì ÙËÓ ·ÓÙ›‰Ú·Û‹ ÙÔ˘˜ ÛÙËÓÏ·Ú˘ÁÁÔÛÎfiËÛË (·‰˘Ó·Ì›· Ï·Ú˘ÁÁÔÛÎfiËÛ˘/¤ÓÙÔÓËΛÓËÛË Ô˘ fï˜ ‰ÂÓ ÂÌfi‰ÈÛ ÙËÓ ÚÔÛ¿ıÂÈ· Ï·Ú˘Á-ÁÔÛÎfiËÛ˘/ÌÈÎÚ‹ ·ÓÙ›‰Ú·ÛË Ô˘ ‰ÂÓ ÚÔοÏÂÛ‰˘ÛÎÔϛ˜ ÛÙËÓ ÚÔÛ¿ıÂÈ· ‰È·ÛˆÏ‹ÓˆÛ˘/η̛··ÓÙ›‰Ú·ÛË) ηıÒ˜ Î·È ÔÈ ÂÚÈÙÒÛÂȘ ÛÙȘ Ôԛ˜ ‰ÂÓ·ÚÎÔ‡Û·Ó Ù· 90sec.

4. O ¯ÚfiÓÔ˜ ·fi ÙË ÛÙÈÁÌ‹ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ÚÔÎÔ˘ÚÔÓ›Ô˘ ¤ˆ˜ ÙË Ì¤ÁÈÛÙË ÙÒÛË Ù˘ ·¿ÓÙËÛ˘ ÛÙˉȤÁÂÚÛË T1 (t

max).5. H ÙÈÌ‹ Ù˘ ̤ÁÈÛÙ˘ ÙÒÛ˘ ÛÙË ‰È¤ÁÂÚÛË T1 (T1

max).6. H ‰È¿ÚÎÂÈ· ÙÔ˘ Ó¢ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ Ù˘

·Ú¯È΋˜ Î·È ÙˆÓ Â·Ó·ÏËÙÈÎÒÓ ‰fiÛÂˆÓ (·fi ÙË ¯ÔÚ‹-ÁËÛË Ù˘ ‰fiÛ˘ ̤¯ÚÈ ÙËÓ Â·Ó·ÊÔÚ¿ Ù˘ ·¿ÓÙËÛ˘ÛÙË ‰È¤ÁÂÚÛË T1 ÛÙÔ 25%).

7. O ¯ÚfiÓÔ˜ Ô˘ ··ÈÙ‹ıËΠÁÈ· Ó· ·ӤÏıÂÈ·˘ÙfiÌ·Ù· Ë ·¿ÓÙËÛË ÛÙË ‰È¤ÁÂÚÛË T1 ·fi 25% ÛÂ75% (t25-75).

8. O ¯ÚfiÓÔ˜ Ô˘ ·Ú‹Ïı ·fi ÙËÓ ÛÙÈÁÌ‹ Ô˘ Ë·¿ÓÙËÛË ÛÙË ‰È¤ÁÂÚÛË T1 ‹Ù·Ó 25% ̤¯ÚÈ Ô TR Ó·Á›ÓÂÈ 75% (tr25-75).

9. O ¯ÚfiÓÔ˜ ·fi ÙËÓ ÙÂÏÂ˘Ù·›· ¯ÔÚ‹ÁËÛË ÚÔÎÔ˘ÚÔ-Ó›Ô˘ ̤¯ÚÈ ÙËÓ Â·Ó·ÊÔÚ¿ ÙÔ˘ TR ÛÙÔ 75% (ttot).

10. H ·ÍÈÔÏfiÁËÛË ÙˆÓ Û˘ÓıËÎÒÓ ¯¿Ï·Û˘ ·fi ÙÔÓÁ˘Ó·ÈÎÔÏfiÁÔ Û ÙÂÙÚ¿‚·ıÌË Îϛ̷η [¿ÚÈÛÙ˜, ηϤ˜,̤ÙÚȘ, ηΤ˜].

11. H ‰È¿ÚÎÂÈ· Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ¤̂·Û˘ ηÈ12. O ¯ÚfiÓÔ˜ ¯ÔÚ‹ÁËÛ˘ ·Ó·ÈÛıËÛ›·˜ (·fi ÙËÓ

ÂÈÛ·ÁˆÁ‹ ̤¯ÚÈ ÙËÓ ·ÔۈϋӈÛË).

H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô ANOVAÛ fiϘ ÙȘ ·Ú·Ì¤ÙÚÔ˘˜. E›Û˘ ÂÊ·ÚÌfiÛÙËΠËpaired student-t ‰ÔÎÈÌ·Û›· ‰ÈÏ‹˜ ηÙ‡ı˘ÓÛ˘ ÁÈ· ÙËÛ‡ÁÎÚÈÛË ÙˆÓ Â·Ó·ÏËÙÈÎÒÓ ‰fiÛÂˆÓ ÚÔÎÔ˘ÚÔÓ›Ô˘ÌÂٷ͇ ÙÔ˘˜. ™Â ·˘Ù¤˜ ÙȘ Û˘ÁÎÚ›ÛÂȘ ÛÙ·ÙÈÛÙÈ΋ ‰È·ÊÔ-Ú¿ ıˆڋıËΠfiÙÈ ˘‹Ú¯Â ·Ó p

72 ¢. BA§™AMI¢H™ Î·È Û˘Ó.

·ÓÙ›ÛÙÔȯ· ·fi ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÚÔÎÔ˘ÚÔÓ›Ô˘. ™Â ‰‡Ô·ÛıÂÓ›˜ ÔÈ Û˘Óı‹Î˜ ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó Ì¤ÙÚȘ, ÛÂÙÚÂȘ ηϤ˜ Î·È ÛÙȘ ˘fiÏÔȘ 53 ¿ÚÈÛÙ˜ (EÈÎfiÓ· 1).

T· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Ê·ÚÌ·ÎÔ‰˘Ó·ÌÈÎÒÓ ·Ú·-̤ÙÚˆÓ Ê·›ÓÔÓÙ·È ·Ó·Ï˘ÙÈο ÛÙÔÓ ›Ó·Î· 3. O ¯ÚfiÓÔ˜lag-t [̤ÛË ÙÈÌ‹ (ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË)] ‹Ù·Ó 32 (11) secÂÓÒ Ô tmax ‹Ù·Ó 157(67) sec. H ̤ÁÈÛÙË ÙÒÛË Ù˘ T1ÛÙÔ ˘ÂṲ́ÁÈÛÙÔ ÂÚ¤ıÈÛÌ· ‹Ù·Ó 0% Û 55 ·ÛıÂÓ›˜,1% Û 2 Î·È 2% Û 3. EÙ¿ ·ÛıÂÓ›˜ ‰ÂÓ ¤Ï·‚·Ó ·-Ó·ÏËÙÈ΋ ‰fiÛË ÚÔÎÔ˘ÚÔÓ›Ô˘, 12 ¤Ï·‚·Ó Ì›·, 22 ¤Ï·-‚·Ó ‰‡Ô, 9 ¤Ï·‚·Ó ÙÚÂȘ, 3 ¤Ï·‚·Ó Ù¤ÛÛÂÚȘ Î·È 7 ¤Ï·-‚·Ó ¤ÓÙ ·ӷÏËÙÈΤ˜ ‰fiÛÂȘ ÚÔÎÔ˘ÚÔÓ›Ô˘. ™ÙËÓÂÈÎfiÓ· 2 Ê·›ÓÂÙ·È Ë ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ ÙˆÓ ‰fiÛÂˆÓ ÙÔ˘ÚÔÎÔ˘ÚÔÓ›Ô˘ ÙˆÓ ÔÔ›ˆÓ Ë Ì¤ÛË ‰È¿ÚÎÂÈ· ‹Ù·Ó ÁÈ· ÙËÓ1Ë ‰fiÛË 32,3 (SD 9,5) min Î·È ÙˆÓ Â·Ó·ÏËÙÈÎÒÓ15,4(3,8), 17,5(4,5), 18,7(6,3), 19,7(6,7), 17,5(7,8) min·ÓÙ›ÛÙÔȯ·. H ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë ·‡ÍËÛË Ù˘ ‰È¿Ú-ÎÂÈ·˜ ‰Ú¿Û˘ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p

ºAPMAKO¢YNAMIKE™ ¶APAMETPOI POKOYPONIOY 73

Û‡Ìʈӷ Ì ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ Á˘Ó·ÈÎÔÏfiÁˆÓ ‹Ù·Ó¿ÚÈÛÙ˜ Û 58 ·ÛıÂÓ›˜ Î·È Î·Ï¤˜ Û 2. K·È ÔÈ ‰‡Ô·˘Ù¤˜ ÂÚÈÙÒÛÂȘ ·ÊÔÚÔ‡Û·Ó ÂÂÌ‚¿ÛÂȘ ÚÈ˙È΋˜˘ÛÙÂÚÂÎÙÔÌ‹˜ Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó fiÙ·Ó Ë ·¿ÓÙËÛË ÛÙˉȤÁÂÚÛË T1 ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ·fi 20% ·ÏÏ¿ ·ÎfiÌ·ÌÈÎÚfiÙÂÚË ·fi 25%.

™˘˙‹ÙËÛËOÈ Á˘Ó·ÈÎÔÏÔÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ, ·Ó Î·È ÛÙËÓ ÌÂÁ·-

χÙÂÚ‹ ÙÔ˘˜ ÏÂÈÔ„ËÊ›· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ ̤Û˘‰È¿ÚÎÂÈ·˜, ÂÓ ÙÔ‡ÙÔȘ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ¿ÏË ‰È·Î‡Ì·ÓÛËÛÙÔÓ ¯ÚfiÓÔ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· Ó· ‰ÈÂÎÂڷȈıÔ‡Ó.EȉÈο Û ÂÍÂȉÈÎÂ˘Ì¤ÓÔ NÔÛÔÎÔÌ›Ô, fiˆ˜ Â›Ó·È ÙÔ‰ÈÎfi Ì·˜, ÛÙÔ ÔÔ›Ô ÛÙÂÁ¿˙ÂÙ·È Ë A’ M·È¢ÙÈ΋ -°˘Ó·ÈÎÔÏÔÁÈ΋ ÎÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, ˉȷ·̷ÓÛË ·˘Ù‹ Â›Ó·È Ôχ ÌÂÁ¿ÏË, ÂÍ ·ÈÙ›·˜ ÙfiÛÔ ÙÔ˘ÂÎ·È‰Â˘ÙÈÎÔ‡ ¯·Ú·ÎÙ‹Ú· ÙˆÓ ÂÚÈÛÛÔÙ¤ÚˆÓ ¯ÂÈÚÔ˘Ú-ÁÈÎÒÓ ÂÂÌ‚¿ÛˆÓ, fiÛÔ Î·È Ù˘ ÌÂÁ¿Ï˘ ÔÈÎÈÏ›·˜Ù¯ÓÈ΋˜ ‰˘ÛÎÔÏ›·˜ Ô˘ ˘¿Ú¯ÂÈ ÌÂٷ͇ ÙÔ˘˜, ÏfiÁˆÚÔÛ¤Ï¢Û˘ Û ·˘Ù‹Ó Á˘Ó·ÈÎÔÏÔÁÈÎÒÓ ¯ÂÈÚÔ˘ÚÁÈÎÒÓÂÚÈÛÙ·ÙÈÎÒÓ ·fi fiÏË ÙËÓ EÏÏ¿‰·. A˘Ùfi Ê·›ÓÂÙ·È Î·ÈÛÙÔÓ ›Ó·Î· 2, fiÔ˘ Ë ÌÈÎÚfiÙÂÚË ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ·‹Ù·Ó 45min Î·È Ë ÌÂÁ·Ï‡ÙÂÚË 210 ÂÓÒ Ë ÌÈÎÚfiÙÂÚË ‰È·-·̷ÓÛË ¯ÚÔÓÈ΋˜ ‰È¿ÚÎÂÈ·˜ ‹Ù·Ó 30min Î·È Ë ÌÂÁ·Ï‡-ÙÂÚË 145. ¢ÈηÈÔÏÔÁÂ›Ù·È ÂÔ̤ӈ˜ Ë ¯ÔÚ‹ÁËÛË ÂÓfi˜Ó¢ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈÛÙ‹ Ô˘ Ó· ÂÌÊ·Ó›˙ÂÈ Ù·¯Â›·¤Ó·ÚÍË Î·È ÂÁηٿÛÙ·ÛË ‰Ú¿Û˘, ÂÏ¿¯ÈÛÙË ‰È¿ÚÎÂÈ·‰Ú¿Û˘ 30min ·ÏÏ¿ Î·È ·Ô˘Û›· ·Ú¿Ù·Û˘ Ó¢ÚÔÌ˘-˚ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ ·Ó ··ÈÙËı› Ó· ¯ÔÚËÁËı› ·Ó·È-ÛıËÛ›· ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 120 min.

H ¯Ú‹ÛË Ù˘ ÛÔ˘ÎÎÈÓ˘Ï¯ÔÏ›Ó˘ ÂÎÙfi˜ ·fi ÙȘ ÁÓˆ-ÛÙ¤˜ Î·È ·fiÏ˘Ù˜ ·ÓÙÂӉ›ÍÂȘ Ù˘ (.¯. ˘ÂÚηÏÈ·È-Ì›·, ‰È·Ù·Ú·¯‹ Ù˘ Ó¢ÚÔÌ˘˚΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È Ó¢-ÚÔÌ˘˚Τ˜ ·ı‹ÛÂȘ), ¤¯ÂÈ Î·È ¿ÏϘ Û¯ÂÙÈΤ˜ ·ÓÙÂӉ›-ÍÂȘ (·‰È¿ÁÓˆÛÙ˜ - Û˘Ó‹ıˆ˜ - ·ı‹ÛÂȘ fiˆ˜ .¯. ÌÂÈ-ˆÌ¤ÓË ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ „¢‰Ô¯ÔÏÈÓÂÛÙÂÚ¿Û˘ ‹Î·ÎÔ‹ıË ˘ÂÚ˘ÚÂÍ›·, Ú·‚‰ÔÌ˘fiÏ˘ÛË) ·ÏÏ¿ Î·È ·ÓÂ-Èı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ (Ì˘·ÏÁ›Â˜). °È’ ·˘Ùfi Î·È ¤¯ÂÈ ÚÔ-Ù·ı› Ë ·ÓÙÈηٿÛÙ·Û‹ Ù˘, ÂȉÈο Û ¢·›ÛıËÙÔ˘˜ ÏË-ı˘ÛÌÔ‡˜ (.¯. ·È‰È¿).1 M¤Û· Û 90 sec ·fi ÙË ¯ÔÚ‹ÁË-ÛË ÙÔ˘ ÚÔÎÔ˘ÚÔÓ›Ô˘ Û 56 ·fi ÙȘ 60 Á˘Ó·›Î˜ ›¯·Ì¿ÚÈÛÙ˜ ‹ ηϤ˜ Û˘Óı‹Î˜ ‰È·ÛˆÏ‹ÓˆÛ˘ (93%, ÂÈÎfiÓ·1), ÂÓÒ Û fiϘ ÙȘ ·ÛıÂÓ›˜ Ì ·Ú¿Ù·ÛË Ù˘ ·Ó·ÌÔÓ‹˜(̤¯ÚÈ 250sec), ÂÈÙ‡¯ıËÎÂ Ë ‰È·ÛˆÏ‹ÓˆÛË Î·È Ì¿ÏÈ-ÛÙ· Û ¿ÚÈÛÙ˜ Û˘Óı‹Î˜. AÓ ·˘ÍËı› Ë ‰fiÛË ÙÔ˘ÚÔÎÔ˘ÚÔÓ›Ô˘ ÙfiÙ ·˘Í¿ÓÂÙ·È Î·È Ë Ù·¯‡ÙËÙ· ·ÏÏ¿ Î·È ËÔÈfiÙËÙ· ÙˆÓ Û˘ÓıËÎÒÓ ‰È·ÛˆÏ‹ÓˆÛ˘, ·ÏÏ¿ ı· ·Ú·-

Ù·ı› Î·È Ë ‰È¿ÚÎÂÈ· ‰Ú¿Û˘.2 EÔ̤ӈ˜, Û ÚÔÁÚ·Ì-Ì·ÙÈṲ̂ÓË ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Î·È fiÙ·Ó ÚԂϤÂ-Ù·È Â‡ÎÔÏË ‰È·ÛˆÏ‹ÓˆÛË ÙÔ ÚÔÎÔ˘ÚfiÓÈÔ, ÛÙË ‰fiÛË Ô˘¯ÚËÛÈÌÔÔÈ‹ıËÎÂ, ·ÔÙÂÏ› ÂÍ·›ÚÂÙÔ Ó¢ÚÔÌ˘˚Îfi ·Ô-ÎÏÂÈÛÙ‹ ÁÈ· ÙË ‰È¢ÎfiÏ˘ÓÛË Ù˘ ‰È·ÛˆÏ‹ÓˆÛ˘, ·ÊÔ‡Û ÌÈÎÚfi Û¯ÂÙÈο ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÂÍ·ÛÊ·Ï›˙ÂÈ È‰·ÓÈ-Τ˜ Û˘Óı‹Î˜. ™Ù· ›‰È· Û˘ÌÂÚ¿ÛÌ·Ù· ηٷϋÁÔ˘Ó Î·È¿ÏÏÔÈ Û˘ÁÁÚ·Ê›˜.3

H ̤ÁÈÛÙË ÙÒÛË Ù˘ T1 ÛÙÔ 0% ÛÙÔ 92% ÙˆÓ ·ÛıÂ-ÓÒÓ (n=55) ‹Ù·Ó ·Ó·ÌÂÓfiÌÂÓË, ·ÊÔ‡ Ë ‰fiÛË ÙˆÓ0,6mg.kg -1 Â›Ó·È ÂÚ›Ô˘ 2 ÊÔÚ¤˜ Ë ED95 ÙÔ˘ ÚÔÎÔ˘ÚÔ-Ó›Ô˘.4 ¶·ÚfiÏ· ·˘Ù¿, ‰ÂÓ ·ÔÎÏ›ÂÙ·È Û ÌÂÁ·Ï‡ÙÂÚԉ›ÁÌ·, Ó· ˘¿ÚÍÔ˘Ó ·ÛıÂÓ›˜ ÛÙȘ Ôԛ˜ Ë ·Ú¯È΋‰fiÛË ÙˆÓ 0,6mg.Kg-1 ‰ÂÓ ÂÈÙ˘Á¯¿ÓÂÈ Ï‹ÚË Ó¢ÚÔÌ˘˚-Îfi ·ÔÎÏÂÈÛÌfi Î·È Ó· ··ÈÙËı› ÌÂÁ·Ï‡ÙÂÚË ‹ Û˘ÌÏË-ڈ̷ÙÈ΋ ‰fiÛË, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÛËÌÂȈı› T1

74 ¢. BA§™AMI¢H™ Î·È Û˘Ó.

Â›Ó·È Ù·¯Â›·. ™Â Û˘Ó‰˘·ÛÌfi Ì ÙÔ˘˜ ¯ÚfiÓÔ˘˜ t25-75 (16min) Î·È tr25-75 (21 min) Ô˘ ηٷÁÚ¿ÊËÎ·Ó ÛÙË ‰È΋̷˜ ÌÂϤÙË, Ê·›ÓÂÙ·È fiÙÈ fiÙ·Ó Ë ÚÔ‚ÏÂfiÌÂÓË ‰È¿Ú-ÎÂÈ· ¤̂·Û˘ Â›Ó·È Ì›· ÒÚ·, ÙfiÙ ˘¿Ú¯ÂÈ Ë ‰˘Ó·Ùfi-ÙËÙ· Ó· ·ÔÊ¢¯ı› Ë ¯ÔÚ‹ÁËÛË ·Ó·ÛÙÚÔÊ‹˜ ÙÔ˘ ·Ô-ÎÏÂÈÛÌÔ‡, ÂȉÈο ÛÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ Ô˘ ·ÓÙÂÓ-‰ÂÈÎÓ‡ÂÙ·È Ë ¯ÔÚ‹ÁËÛË ÓÂÔÛÙÈÁÌ›Ó˘. AÛÊ·ÏÒ˜ ÚÔ·-·ÈÙÔ‡ÌÂÓÔ ÁÈ· ÌÈ· Ù¤ÙÔÈ· ·fiÊ·ÛË Â›Ó·È Ë ‡·ÚÍË·ÍÈfiÈÛÙ˘ ÌÂıfi‰Ô˘ ÂϤÁ¯Ô˘ ÙÔ˘ Ó¢ÚÔÌ˘˚ÎÔ‡ ·Ô-ÎÏÂÈÛÌÔ‡. ¶·ÚfiÌÔÈÔ˘˜ ¯ÚfiÓÔ˘˜ ¤¯Ô˘Ó ηٷÁÚ¿„ÂÈ ÛÂÁ˘Ó·ÈÎÔÏÔÁÈÎfi ÏËı˘ÛÌfi Î·È ÔÈ Bevan JC Î·È Û˘Ó.6

™‡Ìʈӷ Ì ٷ ‰Èο Ì·˜ Â˘Ú‹Ì·Ù·, Ë ÌÈÎÚ‹ ‰È¿Ú-ÎÂÈ· ‰Ú¿Û˘ ÙˆÓ Â·Ó·ÏËÙÈÎÒÓ ‰fiÛÂˆÓ (16-20 min),ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·Ô˘Û›· ÛËÌ·ÓÙÈÎÒÓ Û˘ÛˆÚ¢ÙÈ-ÎÒÓ Ê·ÈÓÔÌ¤ÓˆÓ (ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 6 ·ӷÏËÙÈΤ˜‰fiÛÂȘ), ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ηχÙÂÚÔ˘ ¯ÂÈÚÈÛÌÔ‡ ÙÔ˘Ó¢ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ ‰ÈÂÁ¯ÂÈÚËÙÈο Î·È Î·ÏÒÓÛ˘ÓıËÎÒÓ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ¯¿Ï·Û˘ ¯ˆÚ›˜ ·Ú¿Ù·ÛË Ù˘‰Ú¿Û˘ ÙÔ˘ Û ÂÚÈÙÒÛÂȘ ÌÂÁ¿Ï˘ ‰È¿ÚÎÂÈ·˜ ¤Ì-‚·Û˘. H ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Î·Ù¿ 1 minοı ÂfiÌÂÓ˘ ·ӷÏËÙÈ΋˜ ‰fiÛ˘, ‰ÂÓ ÌÔÚ› Ó·ıˆÚËı› Î·È ÎÏÈÓÈο ÛËÌ·ÓÙÈ΋, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ·ÂÂÌ‚¿ÛÂȘ Ô˘ ‰È·ÚÎÔ‡Ó ÏÈÁfiÙÂÚÔ ·fi 2 ÒÚ˜. ™ÙˉÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ‚Ú¤ıËΠÌfiÓÔ ÌÈ· ÌÂϤÙË Ô˘ Ó··Ó·˙‹ÙËÛ ·Ú¿Ù·ÛË Â·Ó·ÏËÙÈÎÒÓ ‰fiÛÂˆÓ ÚÔÎÔ˘-ÚÔÓ›Ô˘.8 ™ÙË ÌÂϤÙË ·˘Ù‹ ¯ÔÚËÁ‹ıËÎ·Ó ÌfiÓÔ 3 ·ӷ-ÏËÙÈΤ˜ ‰fiÛÂȘ, ¯ˆÚ›˜ Ó· ÂÌÊ·ÓÈÛı› ·Ú¿Ù·ÛË. H‰È·ÊÔÚ¿ Ù˘ Û ۯ¤ÛË Ì ÙË ‰È΋ Ì·˜ ÌÂϤÙË ‹Ù·Ó fiÙȉÂÓ ¯ÔÚËÁ‹ıËΠÔÏÈ΋ ÂÓ‰ÔÊϤ‚È· ·Ó·ÈÛıËÛ›· ·ÏÏ¿ÂÈÛÓ¢ÛÙÈ΋ ·Ó·ÈÛıËÛ›· Ì ·ÏÔı¿ÓÈÔ. TÔ fiÙÈ ÔȉfiÛÂȘ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‹Ù·Ó ›‰È˜ Ì ‰fiÛÂȘ Ù˘‰È΋˜ Ì·˜ ÌÂϤÙ˘ Î·È ÂÓÙÔ‡ÙÔȘ ‰ÂÓ Î·Ù·ÁÚ¿ÊËηڿٷÛË ÙÔ˘ ·ÔÎÏÂÈÛÌÔ‡, fiˆ˜ ·Ô‰Â‰ÂÈÁ̤ӷ·Ú·ÙËÚÂ›Ù·È Ì ÙË Û˘Á¯ÔÚ‹ÁËÛË ÂÈÛÓ¢ÛÙÈÎÒÓ ·Ó·È-ÛıËÙÈÎÒÓ, Èı·Ófiٷٷ ÔÊ›ÏÂÙ·È ÛÙÔ ‰È·ÊÔÚÂÙÈÎfiÙÚfiÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ˘ Ó¢ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈ-ÛÌÔ‡.9,10

H ÌÔÓ¿‰· M-NMT Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙË ‰È΋̷˜ ÌÂϤÙË, ‰ÂÓ ¤¯ÂÈ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Ì˯·ÓÔ-Ì˘ÔÁÚ¿ÊÔ˘, Ô˘ ıˆÚÂ›Ù·È Ô «¯Ú˘Ûfi˜ ηÓfiÓ·˜» ÁÈ·ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ Ó¢ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡. ™ÂÛ¯¤ÛË Ì ÙË Ì˯·ÓÔÌ˘ÔÁÚ·ÊÈ΋ ÂÎÙ›ÌËÛË ÂÌÊ·Ó›˙ÂÈÌÈÎÚfiÙÂÚ˜ ÙÈ̤˜, fiÙ·Ó Ô Ì˯·ÓÔÌ˘ÔÁÚ¿ÊÔ˜ ‰Â›¯ÓÂÈÙÈ̤˜ T1

ºAPMAKO¢YNAMIKE™ ¶APAMETPOI POKOYPONIOY 75

·ÔÎÏÂÈÛÙ‹˜ ̤Û˘ ‰È¿ÚÎÂÈ·˜ ‰Ú¿Û˘ Î·È Ì ٷ¯‡¯ÚfiÓÔ ¤Ó·Ú͢ Î·È ÂÁηٿÛÙ·Û˘ ‰Ú¿Û˘. ™Â ‰fiÛËÂÈÛ·ÁˆÁ‹˜ 0.6 mg.Kg-1 Î·È Â·Ó·ÏËÙÈΤ˜ ‰fiÛÂȘ 0.15mg.Kg-1 ÚÔηÏ› ÈηÓÔÔÈËÙÈΤ˜ Û˘Óı‹Î˜ Ó¢ÚÔÌ˘˚-ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ ÁÈ· ÙËÓ ÂÎÙ¤ÏÂÛË ÂÓ‰ÔÙÚ·¯Âȷ΋˜

‰È·ÛˆÏ‹ÓˆÛ˘ Î·È ÙËÓ Ú·ÁÌ·ÙÔÔ›ËÛË ÂÓ‰ÔÎÔÈÏÈ·-ÎÒÓ Î·È Ï··ÚÔÛÎÔÈÎÒÓ Á˘Ó·ÈÎÔÏÔÁÈÎÒÓ ÂÂÌ‚¿ÛÂ-ˆÓ Î·È Ì ÚԂϤ„ÈÌ· Ê·ÚÌ·ÎÔ‰˘Ó·ÌÈο ¯·Ú·ÎÙËÚÈ-ÛÙÈο, Û Á˘Ó·›Î˜ ËÏÈΛ·˜ ·fi 20 ¤ˆ˜ 55 ÂÙÒÓ, fiÙ·Ó ËÚÔ‚ÏÂfiÌÂÓË ‰È¿ÚÎÂÈ· Ù˘ ¤̂·Û˘ Â›Ó·È ÌÈÎÚfiÙÂ-

BÈ‚ÏÈÔÁÚ·Ê›·

1. Fisher DM. Neuromuscular blocking agents in paediatricanaesthesia. Br J Anaesth 1999; 83:58-64.

2. Heier T, Caldwell JE. Rapid Tracheal Intubation withLarge-Dose Rocuronium: A Probability-BasedApproach. Anesth Analg 2000; 90:175-9.

3. Magorian T, Flannery KB, Miller RD. Comparison ofrocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anaesthesia in adult patients.Anesthesiology 1993; 79:913-8.

4. Foldes FF, Nagashima H, Nguyen H, Schiller WS, MasonMM, Ohta Y. The neuromuscular effect of ORG9426 inpatients receiving balanced anesthesia. Anesthesiology1991; 75:191-6.

5. Zhou T, White PF, Chiu JW, Joshi GP, Dullye KK, DuffyLL, Tongier WK. Onset/offset characteristics andintubating conditions of rapacuronium: a comparisonwith rocuronium. Br J Anaesth 2000; 85:246-50.

6. Bevan JC, Collins L, Fowler CM, Kahwaji R, Rosen HD,Smith MF, Scheepers LV, Stephenson CA, Bevan DR.Early and Late Reversal of Rocuronium andVecuronium with Neostigmine in Adults and Children.Anesth Analg 1999; 89:333-9.

7. McCourt KC, Mirakhur RK, Lowry DW, Carroll MT,

Sparr H. Spontaneous or neostigmine-induced recoveryafter maintenance of neuromuscular block with Org 9487(rapacuronium) or rocuronium following an initial doseof Org 9487. Br J Anaesth 1999; 82:755-6.

8. Khuenl-Brady KS, Puhringer F, Koller J,Mitterschiffthaler G. Evaluation of the time course ofaction of maintenance doses of rocuronium (ORG 9426)under halothane anaesthesia. Acta Anaesthesiol Scand1993; 37:137-9.

9. Maidatsi PG, Zaralidou AT, Gorgias NK, Amaniti EN,Karakoulas KA, Giala MM. Rocuronium duration ofaction under sevoflurane, desflurane or propofolanaesthesia. Eur J Anaesthesiol 2004; 21:781-6.

10. Bock M, Klippel K,Nitsche B, Bach A, Martin E, MotschJ. Rocuronium potency and recovery characteristicsduring steady-state desflurane, sevoflurane, isoflurane orpropofol anaesthesia. Br J Anaesth 2000; 84:43-7.

11. Hemmerling TM, Donati F, Dahaba AA. The M-NMTMechanosensor Cannot be Considered as a ReliableClinical Neuromuscular Monitor in Daily AnesthesiaPractice. Anesth Analg 2002; 95:1827.

12. Dahaba AA, von Klobucar F, Rehak PH, List WF. TheNeuromuscular Transmission Module Versus the

Summary

D. VALSAMIDIS, S. LEONTOPOULOU, A. TZANETIS, A. LOUKERI, A. KARATHANOS. Pharmacodynamiccharacteristics of rocuronium bromide in adult female population during gynecologic surgery. Acta Anaesthesiol Hell2005; 38: 69-76

We studied the pharmacodynamic variables of rocuronium bromide during total intravenous anaesthesia withpropofol and remifentanil in 60 adult female patients undergoing gynecological surgery. The intubating conditions, theonset, maintenance and recovery characteristics of rocuronium bromide (first dose 0.6 mg.kg-1, maintenance dose 0.15mg.kg-1 when T1 recovery = 25%) were studied. The neuromuscular block was evaluated with the M-NMT module(Datex-Ohmeda®). The lag-t was 32 (SD 11) sec and the time to maximum block 157 (67) sec. The intubatingconditions were excellent or good in 56 patients (93%) 90 sec after the first rocuronium dose. The mean duration ofthe first dose was 32 (SD 10) min and of the subsequent doses 15,4(3,8) 17,5(4,5) 18,7(6,3) 19,7(6,7) and 17,5(7,8) minrespectively. The interval 25-75% of T1 recovery was 15,7 (6,0) min, T1 25% to Train-of-Four ratio 75% recovery21,1(5,3) min and the time from the last maintenance dose to Train-of-Four ratio 75% recovery 39,8 (9,7). The musclerelaxation was classified by the gynaecologist in 56 procedures as excellent and in 2 as good. We conclude that theneuromuscular blocking characteristics of rocuronium in the selected doses when used in combination withpropofol/remifentanil anaesthesia fulfill the requirements for gynaecological surgical procedures.

76 ¢. BA§™AMI¢H™ Î·È Û˘Ó.

Relaxometer Mechanomyograph for NeuromuscularBlock Monitoring. Anesth Analg 2002; 94:596.

13. Cammu G, Coddens J, Hendrickx J, Deloof T. Doserequirements of infusions of cisatracurium orrocuronium during hypothermic cardiopulmonarybypass. Br J Anaesth 2000; 84:587-90.

14. Munir MA, Jaffar M, Arshad M, Akhter MS, Zhang J.Reduced duration of muscle relaxation with rocuroniumin a normocalcemic hyperparathyroid patient. Can JAnesth 2003; 50:558-61.

15. Arain SR, Kern S, Ficke DJ, Ebert TJ. Variability ofduration of action of neuromuscular-blocking drugs inelderly patients. Acta Anaesthesiol Scand 2005; 49:312-5.

16. Cooper RA, Maddineni VR,Mirakhur RK, WierdaJMKH, Brady M, Fitzpatrick KTJ. Time course andpharmacokinetics of rocuronium bromide (Org 9426)during isoflurane anaesthesia in patients with andwithout renal failure. Br J Anaesth 1993; 71:222-6.

17. Servin FS, Lavaut E, Kleef U, Desmonts JM. RepeatedDoses of Rocuronium Bromide Administered toCirrhotic and Control Patients Receiving Isoflurane: AClinical and Pharmacokinetic Study. Anesthesiology1996; 84:1092-100.

18. McCoy EP, Mirakhur RK, Maddineni VR, WierdaJMKH, Proost JH. Pharmacokinetics of rocuroniumafter bolus and continuous infusion during halothaneanaesthesia. Br J Anaesth 1996; 76:29-33.

19. Jellish WS, Brody M, Sawicki K, Stephen S. Recoveryfrom Neuromuscular Blockade After Either Bolus andProlonged Infusions of Cisatracurium or RocuroniumUsing Either Isoflurane or Propofol-Based Anesthetics.Anesth Analg 2000; 91:1250-5.

20. Sparr HJ, Wierda JM, Proost JH, Keller C, Khuenl-Brady KS. Pharmacodynamics and pharmacokinetics ofrocuronium in intensive care patients. Br J Anaesth 1997;78:267-73.

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XÂÈÚÔ˘ÚÁÈ΋ ÎÏÈÓÈ΋, AÓ·ÈÛıËÛÈÔÏÔÁÈÎfi ηȶÓ¢ÌÔÓÔÏÔÁÈÎfi TÌ‹Ì·, °ÂÓÈÎfi NÔÛÔÎÔÌ›Ô

EÏÏËÓÈ΋ AÓ·ÈÛıËÛÈÔÏÔÁ›· 2005; 38: 77-82

78 ¢. ¶A¶A°OPA™ Î·È Û˘Ó.

ÎÔ‡.4, 5

H ·ӷϷ̂·ÓfiÌÂÓË ¯ÔÚ‹ÁËÛË Ù˘ ÌÔÚÊ›Ó˘ ·Ó¿Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, ¤¯ÂÈ ÚÔÙ·ı› Û·Ó È‰È·›ÙÂ-Ú· ·Ïfi Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi Û¯‹Ì· ·ÓÙÈÌÂÙÒÈÛ˘¤ÓÙÔÓÔ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡ ¿ÏÁÔ˘˜.6 øÛÙfiÛÔ, ‰ÂÓ ¤¯ÂÈÙ‡¯ÂÈ Â˘Ú›·˜ ‰È¿‰ÔÛ˘ Ô‡Ù ¤¯ÂÈ ·ÔÎÚ˘ÛÙ·Ïψı›οÔÈÔ «ÁÂÓÈÎfi» ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì·.8 Afi fiÛÔ Ì·˜Â›Ó·È ÁÓˆÛÙfi ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÏÏË ÌÂϤÙË ÛÙË ‰ÈÂıÓ‹‚È‚ÏÈÔÁÚ·Ê›· Ô˘ Ó· ÂÍÂÙ¿˙ÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·Î·È ·ÛÊ¿ÏÂÈ· Ù˘ ÂÓ‰ÔÊϤ‚È·˜ ¯ÔÚ‹ÁËÛ˘ Ù˘ ÌÔÚÊ›-Ó˘ Û ÛÙ·ıÂÚ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂM™Aº ÛÙ· Ï·›ÛÈ· Ù˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ·Ó·ÏÁËÛ›·˜.™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë ÂÎÙ›ÌËÛË Ù˘·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Î·È ·ÛÊ¿ÏÂÈ·˜ Ù˘ ÂÓ‰ÔÊϤ‚È·˜¯ÔÚ‹ÁËÛ˘ ÌÔÚÊ›Ó˘ ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔͤԘ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡fiÓÔ˘.

MÂıÔ‰ÔÏÔÁ›·MÂÙ¿ ·fi ¤ÁÎÚÈÛË ÙÔ˘ EÈÛÙËÌÔÓÈÎÔ‡ ™˘Ì‚Ô˘Ï›Ô˘

ÙÔ˘ NÔÛÔÎÔÌ›Ԣ, ·fi ÙȘ 01.06.2002 ̤¯ÚÈ ÙȘ01.07.2004 Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó 137 ·ÛıÂÓ›˜ ËÏÈΛ·˜ 12-92 ÂÙÒÓ, Ô˘ ÂÚfiÎÂÈÙÔ Ó· ˘Ô‚ÏËıÔ‡Ó Û ÚÔÁÚ·ÌÌ·-ÙÈṲ̂Ó˜ ‹ ›ÁÔ˘Û˜ ÂÂÌ‚¿ÛÂȘ ÁÂÓÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ-΋˜, ÔÈ Ôԛ˜ Û˘Óԉ‡ÔÓÙ·È ·fi ¤ÓÙÔÓÔ ÌÂÙÂÁ¯ÂÈÚËÙÈ-Îfi fiÓÔ, ηıÈÛÙÒÓÙ·˜ ·Ó·Áη›· ÙË ¯ÔÚ‹ÁËÛË ÙˆÓÔÈÔÂȉÒÓ ÁÈ· ·Ú·¿Óˆ ·fi ¤Ó· 24ˆÚÔ.9

EÍ·ÈÚ¤ıËÎ·Ó ÔÈ ÂÂÌ‚¿ÛÂȘ Ù˘ ÂȉÈfiÚıˆÛ˘ ‚Ô˘‚ˆ-ÓÔ΋Ï˘, ÂÍ·›ÚÂÛ˘ ı˘ÚÂÔÂȉԇ˜, ηıÒ˜ ›Û˘ ÔÈÏ··ÚÔÛÎÔÈΤ˜ ¯ÔÏÔ΢ÛÙÂÎÙÔ̤˜ Î·È ÔÈ ÛΈÏËÎÔÂÈ-‰ÂÎÙÔ̤˜ ÔÈ Ôԛ˜ ۯ‰fiÓ ÔÙ¤ ‰ÂÓ ··ÈÙÔ‡Ó ÔÈÔÂȉ‹ÁÈ· ·Ú·¿Óˆ ·fi ¤Ó· 24ˆÚÔ. O οı ·ÛıÂÓ‹˜ ÂÓËÌÂ-ÚÒÓÂÙÔ ·Ó·Ï˘ÙÈο ÁÈ· ÙÔ Â›‰Ô˜ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ¤Ì-‚·Û˘, Ù˘ ·Ó·ÈÛıËÙÈ΋˜ Ù¯ÓÈ΋˜, Ù˘ ÚÔ‚ÏÂfiÌÂÓ˘ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÔÚ›·˜ Î·È Ù˘ ·Ó·ÌÂÓfiÌÂÓ˘ ¤ÓÙ·-Û˘ ÙÔ˘ fiÓÔ˘ ÌÂÙ¿ ÙËÓ ÂÁ¯Â›ÚËÛË. ¢È·‚‚·ÈˆÓfiÙ·ÓfiÙÈ ı· ÙÔ˘ ¯ÔÚËÁËı› Ë Î·Ù¿ÏÏËÏË ·Ó·ÏÁËÙÈ΋ ·ÁˆÁ‹Î·È ÙÔ˘ ÂÈÛËÌ·›ÓÂÙÔ Ë ÛËÌ·Û›· Ù˘ Ù·¯Â›·˜ ÎÈÓËÙÔÔ›-ËÛ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈο. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ¤ÓÙ·-Û˘ ÙÔ˘ fiÓÔ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÚÔÊÔÚÈ΋ Îϛ̷η‰È·‚¿ıÌÈÛ˘ ÙÔ˘ fiÓÔ˘, fiˆ˜ ÂÚÈÁÚ¿ÊÂÙ·È ·fi ÙÔ˘˜Jensen M.P. Î·È Karolly P.10 Î·È Û‡Ìʈӷ Ì ÙËÓ ÔÔ›·Ô οı ·ÛıÂÓ‹˜ ηٷٿÛÛÂÈ ÙÔÓ fiÓÔ ÙÔ˘ Û ÌÈ· ·fiÙȘ ÂÍ‹˜ ηÙËÁÔڛ˜: ۯ‰fiÓ Î·ıfiÏÔ˘ fiÓÔ˜, ̤ÙÚÈÔ˜fiÓÔ˜, ÈÛ¯˘Úfi˜ fiÓÔ˜, ·Ó˘fiÊÔÚÔ˜ fiÓÔ˜. ™Â οı·ÛıÂÓ‹ Î·È ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ¤̂·Û˘ ›¯ÂÚÔËÁËı› ·Ó¿Ï˘ÛË Ù˘ ¤ÓÓÔÈ·˜ Ù˘ ‰È·‚¿ıÌÈÛ˘ ÙÔ˘

fiÓÔ˘. TÔ ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì· Ù˘ ¯ÔÚ‹ÁËÛ˘ Ù˘ ÌÔÚ-Ê›Ó˘ ·Ó·ÁÚ¿ÊÂÙ·È ÛÙÔÓ ›Ó·Î· 1. TËÓ ÚÒÙË Ì¤Ú· (ÔÈÚÒÙ˜ 24 ÒÚ˜ ÌÂÙ¿ ·fi ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË) ˯ÔÚ‹ÁËÛË Ù˘ ÌÔÚÊ›Ó˘ Û˘Ó‰˘¿ÛÙËΠ̠¤Ó· M™Aº:›Ù ÏÔÚÓÔÍÈοÌË 8 mg 1 x 2, ›Ù ‰ÈÎÏÔÊÂÓ¿ÎË 75 mg 1x 2, ›Ù ·ÚÂÎÔÍ›ÌË 40 mg 1 x 2, ·Ó¿ÏÔÁ· Ì ÙËÓ ÚÔ-Ù›ÌËÛË ÙÔ˘ È·ÙÚÔ‡. Afi ÙË ‰Â‡ÙÂÚË Ì¤Ú· (‰Â‡ÙÂÚÔ24ˆÚÔ ¯ÔÚ‹ÁËÛ˘ ÌÔÚÊ›Ó˘) ÂÓÈ·›· Û fiÏÔ˘˜ ÙÔ˘˜·ÛıÂÓ›˜ ¯ÔÚËÁ›ÙÔ ˆ˜ M™Aº ˘fiıÂÙÔ ÓÈÌÂÛÔ˘Ï›‰Ë˜200 mg 1 x 2 ÙËÓ Ë̤ڷ, ÁÈ· Ù¤ÛÛÂÚȘ Ë̤Ú˜. I‰È·›ÙÂÚËÛËÌ·Û›· ‰fiıËΠÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fiÙÔÓ fiÓÔ ·Ì¤Ûˆ˜ ÌÂÙ¿ ·fi ÙËÓ ·Ó¿ÓË„Ë ·fi ÙËÓ ·Ó·È-ÛıËÛ›· ¤ÙÛÈ ÒÛÙ ӷ ÌËÓ ÌÂٷʤÚÂÙ·È Ô ·ÛıÂÓ‹˜ ·fiÙÔ ¯ÒÚÔ Ù˘ ·Ó¿Ó˄˘ ÚÔ˜ ÙÔ ı¿Ï·ÌÔ ÓÔÛËÏ›·˜ ·Ó·Ó¤ÊÂÚ ·Ó˘fiÊÔÚÔ fiÓÔ. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·Ó¤ÊÂ-Ú·Ó Ì¤ÙÚÈÔ ‹ ÈÛ¯˘Úfi fiÓÔ ÌÂÙ¿ ·fi ¤Ó· 24ˆÚÔ Ï‹„˘ÌÔÚÊ›Ó˘ Û˘Ó¯›˙ÂÙÔ ÙÔ ›‰ÈÔ Û¯‹Ì· ÌÔÚÊ›Ó˘ Î·È Ùԉ‡ÙÂÚÔ 24ˆÚÔ ÌÂÙÂÁ¯ÂÈÚËÙÈο, Âȉ¿Ïψ˜ Ë ÌÔÚÊ›Ó˯ÔÚËÁ›ÙÔ ÙÔ ‰Â‡ÙÂÚÔ 24ˆÚÔ ÛÙËÓ ›‰È· ‰fiÛË ·Ó¿ ÂÍ¿-ˆÚÔ, Î·È ÙÔ ÙÚ›ÙÔ 24ˆÚÔ ·Ó¿ ÔÎÙ¿ˆÚÔ ÁÈ· Ó· ·ÎÔÏÔ˘-ı‹ÛÂÈ Ë ‰È·ÎÔ‹ Ù˘ ÙËÓ Ù¤Ù·ÚÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ̤ڷ.¶·Ú¿ÏÏËÏ· ¯ÔÚËÁ‹ıËÎÂ Î·È Á·ÛÙÚÔÚÔÛٷ٢ÙÈ΋·ÁˆÁ‹ ·Ó¿ÏÔÁ· Ì ÙËÓ ÚÔÙ›ÌËÛË ÙÔ˘ È·ÙÚÔ‡. OÈ ·ÛıÂ-Ó›˜ ÂÚˆÙ‹ıËÎ·Ó ÌÂÙÂÁ¯ÂÈÚËÙÈο ÁÈ· ÙËÓ ¤ÓÙ·ÛË ÙÔ˘fiÓÔ˘ Û ËÚÂÌ›·, ÚÈÓ ·fi οı ÚÔ‚ÏÂfiÌÂÓË ¯ÔÚ‹-ÁËÛË ÌÔÚÊ›Ó˘ ÁÈ· fiÏÔ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙˆÓ ÙÚÈÒÓÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ËÌÂÚÒÓ, ÂÓÒ ¤Ï·‚·Ó Ô‰ËÁ›Â˜ Û ÂÚ›-ÙˆÛË ¤ÓÙÔÓÔ˘ fiÓÔ˘ Ó· ÂÓËÌÂÚÒÛÔ˘Ó ÙÔ ÓÔÛËÏ¢ÙÈÎfi

¶›Ó·Î·˜ 1. EÚÁԉȿÁÚ·ÌÌ· ¯ÔÚ‹ÁËÛ˘ ÌÔÚÊ›Ó˘. °È· ÙË

‰ÔÛÔÏÔÁ›· Î·È ÙÔ Â›‰Ô˜ ‚Ϥ Î›ÌÂÓÔ.

ANTIMETø¶I™H O•EO™ METE°XEIPHTIKOY ¶ONOY 79

ÚÔÛˆÈÎfi. H ÙÂÏÈ΋ ‚·ıÌÔÓfiÌËÛË Ù˘ ¤ÓÙ·Û˘ ÙÔ˘fiÓÔ˘ ÁÈ· οı ·ÛıÂÓ‹ / Ë̤ڷ, ıˆڋıËÎÂ Ô Ì¤ÛÔ˜fiÚÔ˜ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜. OÈ·ÛıÂÓ›˜, ÂϤÁ¯ıËÎ·Ó ÁÈ· ÙÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘(ÂÁÚ‹ÁÔÚÛË, ·Ó·ÊÂÚfiÌÂÓË ˘ÓËÏ›·, ‡ÓÔ˜ Ì ‡ÎÔÏ˷ʇÓÈÛË, ‡ÓÔ˜ Ì ‰‡ÛÎÔÏË ·Ê‡ÓÈÛË). °ÈÓfiÙ·Ó Î·Ù·-ÁÚ·Ê‹ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ Û˘¯ÓfiÙËÙ·˜, ηıÒ˜ ›Û˘·Ó ˘‹Ú¯Â Ù¿ÛË ÁÈ· ¤ÌÂÙÔ - Ó·˘Ù›· ‹ Î·È ¤ÌÂÙÔ˜. ™ÂÂÚ›ÙˆÛË Ì›ˆÛ˘ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·Ó·ÓÔÒÓ < 10Î·È Û ηٿÛÙ·ÛË ‚·ı‡ ‡ÓÔ˘ ˘‹Ú¯·Ó Û·Ê›˜ Ô‰ËÁ›Â˜Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÙËÓ ÎÏ‹ÛË È·ÙÚÔ‡ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛËÙÔ˘ ·ÛıÂÓÔ‡˜ ¤ÙÛÈ ÒÛÙ ӷ ·ÔÊ·ÛÈÛÙ› ¤Ó· ·fi Ù··ÎfiÏÔ˘ı·: ‰È·ÎÔ‹ Ê·ÚÌ¿ÎÔ˘ Î·È ÂÓÙ·ÙÈ΋ ·Ú·ÎÔ-ÏÔ‡ıËÛË, ¯ÔÚ‹ÁËÛË Ó·ÏÔÍfiÓ˘ 0.3 - 0.4 mg / ÒÚ· ̤¯ÚÈÓ· ·ӤÏıÂÈ ÙÔ ÂÈı˘ÌËÙfi Â›Â‰Ô Û˘Ó›‰ËÛ˘, ‰È·-ۈϋӈÛË. ™Â ÂÚ›ÙˆÛË Ô˘ Ô ·ÛıÂÓ‹˜ ·Ó¤ÊÂÚÂÈÛ¯˘Úfi fiÓÔ ¯ÔÚËÁ›ÙÔ Ë ‰ÈÏ¿ÛÈ· Ù˘ ÚÔËÁËı›۷˜‰fiÛË ÌÔÚÊ›Ó˘. ™Â ÂÚ›ÙˆÛË ÂÌÊ¿ÓÈÛ˘ ÂÌÂÙÒÓ, Ô˘‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ·Ô‰ÔıÔ‡Ó Ô˘ıÂÓ¿ ·ÏÏÔ‡ ÂÎÙfi˜·fi ÙË ÌÔÚÊ›ÓË, ÁÈÓfiÙ·Ó ‰È·ÎÔ‹ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ÔÈÔÂȉԇ˜ Î·È ·ÓÙÈηٿÛÙ·Û‹ ÙÔ˘ Ì ·Ó·ÏÁËÙÈÎfi Ù˘ÂÈÏÔÁ‹˜ ÙÔ˘ ÂÊËÌÂÚ‡ÔÓÙÔ˜ È·ÙÚÔ‡. OÈ ·ÛıÂÓ›˜ ÌÂÏ‹„Ë ÌÔÚÊ›Ó˘ ÁÈ· ÙÚ›· ÂÈÎÔÛÈÙÂÙÚ¿ˆÚ· Î·È Ì ‰È¿Ú-ÎÂÈ· ÓÔÛËÏ›·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤ÍÈ ËÌÂÚÒÓ ÂÍÂÙ¿ÛÙËηÓÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ‹ fi¯È ÂÈÏÂÔ‡. «EÈÏÂfi˜» ¯·Ú·ÎÙËÚ›-ÛÙËÎÂ Ë ·Ô˘Û›· ·Ô‚ÔÏ‹˜ ·ÂÚ›ˆÓ ‹ / Î·È ÎÂÓÒÛˆÓ̤¯ÚÈ Î·È ÙËÓ ¤ÎÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ̤ڷ.

AÔÙÂϤÛÌ·Ù·™ÙË ÌÂϤÙË Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó 137 ·ÛıÂÓ›˜. T· ÂÈ-

‰ËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ Î·È ÔÈÂÂÌ‚¿ÛÂȘ ÛÙȘ Ôԛ˜ ˘Ô‚Ï‹ıËÎ·Ó ·Ó·ÁÚ¿ÊÔÓÙ·È

ÛÙÔÓ ›Ó·Î· 2. Afi ·˘ÙÔ‡˜ ÔÈ 4 ·ÛıÂÓ›˜ Ì ‰È¿ÙÚËÛËÂÙÈÎÔ‡ ¤ÏÎÔ˘˜ ¤Ï·‚·Ó ÌfiÓÔ ÌÔÚÊ›ÓË ¯ˆÚ›˜ M™AºÎ·È ÂÍ·ÈÚ¤ıËÎ·Ó ÙÂÏÈο ·fi ÙË ÌÂϤÙË. ™Â ηӤӷӷfi ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·ÛıÂÓ›˜ ‰ÂÓ ··ÈÙ‹ıËΠËÛ˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË Ù˘ ÌÔÚÊ›Ó˘ (‰ÈÏ·ÛÈ·-ÛÌfi˜ Ù˘ ‰fiÛ˘) ÌÂÙ¿ ·fi ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ·fi ÙÔ¯ÒÚÔ Ù˘ ·Ó¿Ó˄˘ ÛÙÔ ı¿Ï·ÌÔ ÓÔÛËÏ›·˜. H ¯ÔÚ‹ÁË-ÛË Ù˘ ÌÔÚÊ›Ó˘ ‰È·ÎfiËΠÙÔ ÚÒÙÔ 24ˆÚÔ Û ‰˘Ô·ÛıÂÓ›˜ ÏfiÁˆ ¤ÓÙÔÓÔ˘ ·ÈÛı‹Ì·ÙÔ˜ Ó·˘Ù›·˜. ¶¤ÓÙ·ÛıÂÓ›˜ ÌÂÙ¿ ·fi ˘ÛÙÂÚÂÎÙÔÌ‹ ¯ÚÂÈ¿ÛÙËΠӷ Ï¿‚Ô˘ÓÎ·È ÙÔ ‰Â‡ÙÂÚÔ 24ˆÚÔ ÙËÓ ›‰È· ‰fiÛË ÌÔÚÊ›Ó˘ / 4ˆÚÔ.H ‰È·‚¿ıÌÈÛË ÙÔ˘ fiÓÔ˘ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÂ Û˘Ó¿Ú-ÙËÛË Ì ÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ̤ڷ Ê·›ÓÂÙ·È ÛÙËÓ ÂÈÎfiÓ·1. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ÚÂÓ¤ÚÁÂȘ ·fi ÙÔ ·Ó·Ó¢-ÛÙÈÎfi Û‡ÛÙËÌ· ‹ ‰È·Ù·Ú·¯¤˜ ÂȤ‰Ô˘ Û˘Ó›‰ËÛ˘,Ô‡Ù ÛÙÔ ¯ÒÚÔ Ù˘ ·Ó¿Ó˄˘ Ô‡Ù ÛÙË Û˘Ó¤¯ÂÈ· ÛÙÔ˘˜ı·Ï¿ÌÔ˘˜ ÓÔÛËÏ›·˜ (¶›Ó·Î·˜ 3). ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ÓÔÛËχÙËÎ·Ó ÛÂ Û˘Ì‚·ÙÈÎÔ‡˜ ı·Ï¿ÌÔ˘˜ ÓÔÛËÏ›·˜.

¶›Ó·Î·˜ 2. EȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·ÛıÂÓÒÓ Ô˘ ¤Ï·‚·Ó ÌÔÚÊ›ÓË Î·È M™Aº ÁÈ· ÙÚÂȘ ̤Ú˜.

E›‰Ô˜ ¤̂·Û˘ AÚÈıÌfi˜ º‡ÏÔ HÏÈΛ· E›‰Ô˜ ÙÔÌ‹˜(n=133) (ÕÓ‰Ú˜/Á˘Ó·›Î˜)

AÓÔȯً ¯ÔÏÔ΢ÛÙÂÎÙÔÌ‹ 45 19 / 26 38-82 EÁοÚÛÈ·XÔÏÔÂÙÈ΋ ·Ó·ÛÙfïÛË 8 2 / 6 77-82 EÁοÚÛÈ·E¯ÈÓfiÎÔÎÎÔ˜ ·ÛÙË ‹·ÙÔ˜ 1 1/0 76 EÁοÚÛÈ·OÏÈ΋ Á·ÛÙÚÂÎÙÔÌ‹ 4 1 / 3 67-80 EÁοÚÛÈ·EÓÙÂÚÂÎÙÔÌ‹ (ÏÂÙfi ¤ÓÙÂÚÔ) 14 9 / 5 12-82 M¤ÛËKÔÏÂÎÙÔÌ‹ 15 7 / 8 25-72 M¤ÛË™ÏËÓÂÎÙÔÌ‹ 2 2 / 0 44-55 M¤ÛËEÍ·ÚÙËÌ·ÙÂÎÙÔÌ‹ 8 18-59 ¶·Ú¿ÌÂÛ˙ΈÏËÎÔÂȉÂÎÙÔÌ‹ 8 2 / 6 23-70 ¶·Ú¿ÌÂÛËYÛÙÂÚÂÎÙÔÌ‹ 8 36-72 EÁοÚÛÈ·™˘ÌÊ˘ÛÈfiÏ˘ÛË 8 2 /6 29-92 M¤ÛË°ÈÁ·ÓÙÈ·›· MTX ΋ÏË 6 4 / 2 46-77 M¤ÛËAÈÌÔÚÚÔ˚‰ÂÎÙÔÌ‹ 2 1 / 1 74, 70

EÈÎfiÓ· 1. EÎÙ›ÌËÛË ‰È·‚¿ıÌÈÛ˘ ÙÔ˘ fiÓÔ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜(n=133) Ô˘ ¤Ï·‚·Ó ÌÔÚÊ›ÓË 24 ÒÚ˜, 48 ÒÚ˜ Î·È 72 ÒÚ˜ÌÂÙ¿ ·fi ÙËÓ ÂÁ¯Â›ÚËÛË.

80 ¢. ¶A¶A°OPA™ Î·È Û˘Ó.

K·Ó¤Ó·˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ‰ÂÓ ·ÚÔ˘Û›·Û ÂÈÏÂfi.ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ·Ó¤ÊÂÚ·Ó ÎÂÓÒÛÂȘ Î·È ·Ô‚ÔÏ‹·ÂÚ›ˆÓ ÙÔ ·ÚÁfiÙÂÚÔ Ì¤¯ÚÈ ÙËÓ Ù¤Ù·ÚÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋̤ڷ. H ‰È·ÎÔ‹ Ù˘ ÌÔÚÊ›Ó˘ ‰ÂÓ Û˘Óԉ‡ÙËΠ·fi·‡ÍËÛË ÙÔ˘ fiÓÔ˘ ÛÂ Î·Ó¤Ó·Ó ·fi ÙÔ˘˜ ·ÛıÂÓ›˜.

™˘˙‹ÙËÛËH ÌÔÚÊ›ÓË ·ÔÙÂÏ› Ô˘Û›· ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂ-

ÙÒÈÛË ÔͤԘ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡ ¿ÏÁÔ˘˜.13 T· ·ÔÙÂϤ-ÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÌÔÚÊ›ÓË ÌÔÚ› Ó·¯ÔÚËÁËı› ÂÓ‰ÔÊϤ‚È· ÛÙ· Û˘Ì‚·ÙÈο ÙÌ‹Ì·Ù· ÓÔÛË-Ï›·˜ Ì ۯ‰fiÓ ·Ó‡·ÚÎÙÔ ÙÔÓ Î›Ó‰˘ÓÔ ÙˆÓ Â›ÊÔ‚ˆÓ·ÚÂÓÂÚÁÂÈÒÓ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ÙÔ ÎÂÓÙÚÈÎfiÓ¢ÚÈÎfi Û‡ÛÙËÌ·, ÛÙ· Ï·›ÛÈ· ÂÓfi˜ ·ÏÔ‡, ·ÔÙÂÏÂ-ÛÌ·ÙÈÎÔ‡ Î·È Ú·ÎÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜·Ó·ÏÁËÛ›·˜. øÛÙfiÛÔ, Ë Â·Ó·Ï·Ì‚·ÓfiÌÂÓË ÂÓ‰ÔÊϤ-‚È· ¯ÔÚ‹ÁËÛË – Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· – ÌÔÚÊ›-Ó˘ ηı’ fiÏÔ ÙÔ 24ˆÚÔ, ·Ú¿ Ù· ÛËÌ·ÓÙÈο ÏÂÔÓÂÎÙ‹-Ì·Ù¿ Ù˘, ‰ÂÓ ¤¯ÂÈ Ù‡¯ÂÈ Â˘Ú›·˜ ·Ô‰Ô¯‹˜,6 ÂÓÒ ÛÙȘÂÏ¿¯ÈÛÙ˜ ÌÂϤÙ˜ Ô˘ ÂÍ¤Ù·Û·Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙËÙ· Î·È ·ÛÊ¿ÏÂÈ¿ Ù˘, Ë ÌÔÚÊ›ÓË ¯ÔÚËÁ‹ıËΠÂÓ‰ÔÌ˘-˚ο ‹ ˘Ô‰ÔÚ›ˆ˜, Ì ÔÏÏ¿ ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÛÙËÓ ·ÓÙÈ-ÌÂÙÒÈÛË ÙÔ˘ ÔͤԘ fiÓÔ˘.14

H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡ fiÓÔ˘ Ú¤ÂÈÓ· ·ÔÙÂÏ› ·Ó·fiÛ·ÛÙÔ Ì¤ÚÔ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÊÚÔ-ÓÙ›‰·˜ Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ó·Ê¤ÚÔ˘Ó·ÊfiÚËÙÔ fiÓÔ ÌÂÙÂÁ¯ÂÈÚËÙÈο ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›-ÓÂÈ ÙÔ 5% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ¯ÂÈÚÔ˘ÚÁË̤ӈÓ.4 ™‡ÌʈӷÌ ÙË ‚È‚ÏÈÔÁÚ·Ê›· Ê·›ÓÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ ¤Ó· ¯¿ÛÌ·ÌÂٷ͇ Ù˘ Ú¿Í˘ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙÔ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡ fiÓÔ˘ Î·È ÙËÓ ·ÍÈÔÔ›ËÛË ÙˆÓÏËÚÔÊÔÚÈÒÓ Ô˘ ÌÔÚÔ‡Ó Ó· ·ÓÙÏËıÔ‡Ó ·fi ÙËÓÈ·ÙÚÈ΋ ‚¿ÛË ‰Â‰Ô̤ӈÓ.15 ŒÙÛÈ, ÂÓÒ Â›Ó·È ÙÂÎÌËÚȈ-̤ÓË Ë ¯ÔÚ‹ÁËÛË Ù˘ ÌÔÚÊ›Ó˘ ˆ˜ ÙÔ ·Ú¯¤Ù˘Ô ÔÈÔÂÈ-‰¤˜ Ì ÙËÓ ÈÛ¯˘ÚfiÙÂÚË ·Ó·ÏÁËÙÈ΋ ‰Ú¿ÛË, ˘¿Ú¯Ô˘Ó·ÚÎÂÙÔ› È·ÙÚÔ› Ô˘ ‰ÈÛÙ¿˙Ô˘Ó Ó· ÙË ¯ÚËÛÈÌÔÔÈ‹ÛÔ˘Ó,ÏfiÁˆ ÙÔ˘ Êfi‚Ô˘ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Î˘Ú›ˆ˜ ÂÈÏÔ-ÎÒÓ.16 ™ÙÔ ÚfiÙ˘Ô ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ·Ó·ÏÁËÛ›·˜ Ô˘ÂÈϤͷÌÂ, Ë ÌÔÚÊ›ÓË, Ô˘ ¤¯ÂÈ Ì¤ÁÈÛÙÔ ¯ÚfiÓÔ ‰Ú¿Û˘

ÙÔ˘Ï¿¯ÈÛÙÔÓ 3-4 ÒÚ˜, Ì ٷ¯‡ÙËÙ· ¤Ó·Ú͢ ÙÔ˘ ·Ó·Ï-ÁËÙÈÎÔ˘ Ù˘ ·ÔÙÂϤÛÌ·ÙÔ˜ ̤۷ Û ¤Ó· ÏÂÙfi fiÙ·Ó‰›ÓÂÙ·È ÂÓ‰ÔÊϤ‚È·, ¯ÔÚËÁ‹ıËΠ·Ó¿ ÙÂÙÚ¿ˆÚÔ. OÛ˘Ó‰˘·ÛÌfi˜ Ù˘ ÌÔÚÊ›Ó˘ Ì M™Aº Û˘ÓÈÛÙ¿ ÈÛÔÚÚÔ-Ë̤ÓË ÌÔÚÊ‹ ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·Ó·ÏÁËÛ›·˜.17 HÚÔÛı‹ÎË ÙÔ˘ M™Aº ÌÂÈÒÓÂÈ ÙËÓ ··ÈÙÔ‡ÌÂÓË ÔÛfi-ÙËÙ· ÙÔ˘ ÔÈÔÂȉԇ˜ ̤¯ÚÈ Î·È 30%.8 A·Ú·›ÙËÙË ÚÔ-¸fiıÂÛË ÁÈ· ÙË ÛˆÛÙ‹ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÊ·ÚÌÔÁ‹ÔÔÈ·Û‰‹ÔÙ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ·Ó·ÏÁËÛ›·˜ ·ÔÙÂÏ› ˛٢ÍË ÌÈ·˜ ÂÏ¿¯ÈÛÙ˘ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ Û˘ÁΤÓÙÚˆ-Û˘ ·Ó·ÏÁËÙÈÎÒÓ, ¿ÌÂÛ· ÌÂÙÂÁ¯ÂÈÚËÙÈο, ¤ÙÛÈ ÒÛÙ ӷ‰È·ÙËÚËıÔ‡Ó ·˘Ù¿ Ù· ›‰· Ì ÙËÓ ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈ-ο ‰È·ÛÙ‹Ì·Ù· ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ.8

T· ·ÔÙÂϤÛÌ·Ù· ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ ¤‰ÂÈÍ·Ó fiÙÈÙÔ ¯ÚÔÓÔÂÍ·ÚÙÒÌÂÓÔ Û¯‹Ì· Ù˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ·Ó·Ï-ÁËÙÈ΋˜ ·ÁˆÁ‹˜ Ì ÌÔÚÊ›ÓË Î·È M™Aº, ÂÎÙfi˜ ·fi ÙËÓ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙÔÓ Ô͇ fiÓÔ ÛÙÔÓ¯ÒÚÔ Ù˘ ·Ó¿Ó˄˘, ÂÍ·ÛÊ·Ï›˙ÂÈ ·ÔÙÂÏÂÛÌ·ÙÈ΋·Ó·ÏÁËÛ›·. E›Û˘ Â›Ó·È Â‡ÎÔÏ· ˘ÏÔÔÈ‹ÛÈÌÔ ·fi ÙÔÓÔÛËÏ¢ÙÈÎfi Î·È È·ÙÚÈÎfi ÚÔÛˆÈÎfi. øÛÙfiÛÔ Ë Â·Ó·-Ï·Ì‚·ÓfiÌÂÓË ·Ó¿ ÙÂÙÚ¿ˆÚË ¯ÔÚ‹ÁËÛË ÌÔÚÊ›Ó˘ ‰ÂÓÂÍ·Ï›ÊÂÈ ÙËÓ ·Ó·ÁηÈfiÙËÙ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ˘·ÛıÂÓÔ‡˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ·Ó·ÏÁËÙÈ-΋˜ ·ÁˆÁ‹˜ Î·È ÙˆÓ ÂӉ¯fiÌÂÓˆÓ ÂÈÏÔÎÒÓ Ù˘.MÔÚ› Ó· ˘¿ÚÍÔ˘Ó ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔ-ÓÙ·È, Û˘Ó¯›˙ÔÓÙ·˜ Ó· ·Ó·Ê¤ÚÔ˘Ó ÈÛ¯˘Úfi ‹ ·Ó˘fiÊÔÚÔfiÓÔ, Î·È Ó· ··ÈÙËı› ·‡ÍËÛË Ù˘ ‰fiÛ˘ Ù˘ ÌÔÚÊ›-Ó˘, ‹ ·ÓÙ›ıÂÙ·, Ë ‰fiÛË ÙˆÓ 3 mg Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ·Ó¿ÁΘ ÙÔ˘ ·ÛıÂÓÔ‡˜, ÔfiÙ ı· Ú¤ÂÈ Ó· ·˘ÍËıÔ‡ÓÙ· ¯ÚÔÓÈο ÌÂÛԉȷÛÙ‹Ì·Ù· ¯ÔÚ‹ÁËÛ˘, ·Ó Î·È ÛÙ·‰Èο Ì·˜ ÂÚÈÛÙ·ÙÈο ‰ÂÓ ·Ú·ÙËÚ‹ıËΠοÙÈ Ù¤ÙÔÈÔ.°È’ ·˘Ùfi Ë Â·Ó·Ï·Ì‚·ÓfiÌÂÓË ¯ÔÚ‹ÁËÛË Ù˘ ÌÔÚÊ›Ó˘·ÔÙÂÏ› ·ÁˆÁ‹ Ô˘ ··ÈÙ› ‰˘Ó·ÌÈ΋ (Û˘Ó¯‹) ·Ú·-ÎÔÏÔ‡ıËÛË Î·È ÂÙÔÈÌfiÙËÙ· ÂΠ̤ÚÔ˘˜ ÙÔ˘ È·ÙÚÔ‡ Ó·ÙÚÔÔÔÈ‹ÛÂÈ ÙËÓ ‰ÔÛÔÏÔÁ›· ·Ó¿ÏÔÁ· Ì ÙȘ ·Ó¿ÁΘÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È fi¯È ¿Î·ÌÙË ·ÁˆÁ‹. ŒÓ· ÂÈϤÔÓÛ˘Ì¤Ú·ÛÌ· Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó fiÙÈ ·Ú¿ ÙÔ ¿ÁÈÔÙÔ˘ Û¯‹Ì·ÙÔ˜ ηÈ, ÂÓÒ ‰ÂÓ ¯ÚÂÈ¿ÛÙËΠÔÙ¤ Ó· ·˘ÍËıÂ›Ë ‰fiÛË Ù˘ ÌÔÚÊ›Ó˘ ÌÂÙ¿ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÙÂÙÚ¿ˆ-Ú˘ ¯ÔÚ‹ÁËÛ˘ ÛÙÔ ı¿Ï·ÌÔ, ηӤӷ˜ ·ÛıÂÓ‹˜ ‰ÂÓ·Ú·ÔÓ¤ıËΠÁÈ· ·Ó˘fiÊÔÚÔ fiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·Ù˘ ·Ó·ÏÁËÙÈ΋˜ ·ÁˆÁ‹˜. E›Û˘ Ë ·Ú·›ˆÛË ÙˆÓ ÌÂÛÔ-‰È·ÛÙËÌ¿ÙˆÓ ¯ÔÚ‹ÁËÛ˘ Ù˘ ÌÔÚÊ›Ó˘ ÙÔ 2Ô Î·È 3Ô

24ˆÚÔ ‰ÂÓ Û˘Óԉ‡ÙËΠ·fi ·‡ÍËÛË ÙÔ˘ ¿ÏÁÔ˘˜, ·ÏÏ¿·ÂÓ·ÓÙ›·˜ Ë ‚·ıÌÔÓfiÌËÛË Ù˘ ¤ÓÙ·Û˘ ÙÔ˘ fiÓÔ˘‹Ù·Ó ÙËÓ ÙÚ›ÙË Ì¤Ú· ηχÙÂÚË ·fi ·˘Ù‹ Ù˘ ÚÒÙ˘̤ڷ˜ ¯ÔÚ‹ÁËÛ˘, ۯ‰fiÓ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜.

¶›Ó·Î·˜ 3. ¶·ÚÂÓ¤ÚÁÂȘ - ÂÈÏÔΤ˜ ·fi ÙË ¯ÔÚ‹ÁËÛË ÌÔÚ-

Ê›Ó˘ ÛÙÔ˘˜ 133 ·ÛıÂÓ›˜.

EÈÏÔΤ˜ 1Ô 24ˆÚÔ

AÓ·ÓÔ¤˜ < 8 ÏÂÙfi 0

N·˘Ù›· 3 (2%)

EÌÂÙfi˜ 4 (3%)

¢‡ÛÎÔÏË ·Ê‡ÓÈÛË 0

ANTIMETø¶I™H O•EO™ METE°XEIPHTIKOY ¶ONOY 81

T· ·ÔÙÂϤÛÌ·Ù· ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ËÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÌÔÚÊ›Ó˘ Â›Ó·È ÌÈ· ·ÛÊ·Ï‹˜Ì¤ıÔ‰Ô˜ ·Ó·ÏÁËÛ›·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙȘ ‰fiÛÂȘ ÛÙȘÔԛ˜ ¯ÔÚËÁ‹ıËΠ۠·˘Ù‹ ÙË ÌÂϤÙË.

H ÏÂÈÔÓfiÙËÙ· ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ ‰˘ÛÎÔχÙË-Πӷ ηٷÓÔ‹ÛÂÈ ÙÈ ÂÓÓÔԇ̠̠ÙËÓ ÂÚÒÙËÛË ÈÛ¯˘Úfi˜- ·Ó˘fiÊÔÚÔ˜ fiÓÔ˜. øÛÙfiÛÔ Ù· ÔÛÔÙÈο Ì·˜ ·ÔÙÂ-ϤÛÌ·Ù· ·ÓÙ·Ó·ÎÏÔ‡Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·˘Ùfi Ô˘ ›Ûˆ˜‰ÂÓ ÌÔÚ› Ó· ÂÎÊÚ·ÛÙ› Ì ÙÔ˘˜ ·ÚÈıÌÔ‡˜.¶Èı·Ófiٷٷ ·˘Ù‹ Ë ıÂÙÈ΋ ÛÙ¿ÛË ÙˆÓ ·ÛıÂÓÒÓ Ó· ›ӷÈ

·ÔÙ¤ÏÂÛÌ·, fi¯È ÌfiÓÔ Ù˘ ·Ó·Ï˘ÙÈ΋˜ ÚÔÂÁ¯ÂÈÚËÙÈ΋˜ÂÓË̤ڈÛ˘, ·ÏÏ¿ Î·È Ù˘ „˘¯È΋˜ ¢‰È·ıÂÛ›·˜ Ô˘ÚÔηÏ› Ë ÌÔÚÊ›ÓË.20

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Â·Ó·Ï·Ì‚·ÓfiÌÂÓË ÂÓ‰ÔÊϤ-‚È· ¯ÔÚ‹ÁËÛË Ù˘ ÌÔÚÊ›Ó˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì M™Aº·ÔÙÂÏ› Û¯‹Ì· Ô˘ ÚÔÛʤÚÂÈ Ôχ ηϋ ·Ó·ÏÁËÛ›·¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ Î·È ·ÚÂ-Ó¤ÚÁÂȘ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ·,ÌÔÚ› ‰Â Ó· ÂÊ·ÚÌÔÛÙ› Ì ·ÛÊ¿ÏÂÈ· Î·È Â˘ÎÔÏ›· ÛÂÛ˘Ì‚·ÙÈÎfi ÙÌ‹Ì· ÓÔÛËÏ›·˜.

¶ÂÚ›ÏË„Ë

D. PAPAGORAS, I. TEPETZIS, I. TRUGKOS, A. PITENIS, N. IOANNIDIS, I. ZIKOPOULOS, AC. PAPAZISIS.Intermittent intravenous administration of morphine combined with NSAID for acute postoperative paintreatment. A prospective study. Acta Anaesthesiol Hell 2005; 38:77-82

The aim of the study was to investigate the efficacy and safety of intravenous morphine combined with a nonsteroidantinflammatory drug, in the postoperative setting of acute pain treatment on surgical ward (time - contingentschedule). Hundred and thirty three patients predicted to require pain treatment with opiods more than one day afterplanned or emergency procedures were enrolled. After dose titration of morfphine in the post - anaesthesia care unitpatients received between 2.5 - 4 mg morphine intravenously every four hours in combination with NSAID around theclock. Verbal rating scale was used to estimate the response to pain treatment of each patient. The second endpointwas the opioid related complication rate in particular respiratory insufficiency, nausea, vomiting and disturbance of thelevel of consciousness. After 24 hours of treatment 23% of the patients reported almost no pain, 74% of patientsmoderate pain and only 3% severe pain. On the third postoperative day the percentage of patients with almost no painwas 94% in contrast to 6% with moderate pain. There were no complications from the respiratory system, all patientswere awake and the vomiting rate noticed was 4%. In conclusion, the time contingent or around the clock schedulewith intravenously applied morphine combined with NSAID is effective and very safe and constitutes a rather simplepain treatment regime which can be incorporated easily in the postoperative orders on surgical ward.

BÈ‚ÏÈÔÁÚ·Ê›·

1. Kehlet H. Acute pain control and accelerated postoperativesurgical recovery. Surg Clin N Am 1999; 79:431-42.

2. Berry PH, Chapman CR, Katz JA. Prevalence,consequences, and costs of pain. In: NationalPaharmaceutical Council and Joint Commission onAccreditation of Healthcare Organisations. Currentunderstanding of assessment, management and treatments.2001, pp. 13-5, www.jcaho.org

3. Wilder-Smith OH, Mohrle JJ, Martin NC. Acute painmanagement after surgery or in the emergency room inSwitzerland: a comparative survey of Swissanaesthesiologists and surgeons. Eur J Pain 2002; 189-201.

4. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acutepostoperative pain management: I. Evidence frompublished data. Br J Anasth 2002; 87:409-23.

5. Lempa M, Gerads P, Eypash E, Sauerland S, Dietrich J,

Vestweber E, Neugebauer G. Organisation derSchmerztherapie in der Chirurgie. Chirurg 2003; 74:821-6.

6. Riddel RR, Craig KD. Time contingent schedules forpostoperative analgesia: a review of the literature. J Pain2003; 4:169-75.

7. Mc Caffery M, Passero C. Assessment: underlyingcomplexities, misconceptions and practical tools. In: Pain.Clinical manual. Edited by Mc Caffery M, Passero C. StLouis, Mosby inc, 1999, pp. 35-102.

8. Etches RC. Patient controlled analgesia. Surg Clin N Am1999; 79:297-313.

9. Dahmani S, Dupont H, Mantz JM, Desmonts JM, Keita H.Predictive factors of early morphine requirements in thepost-anaesthesia care unit. Br J Anaesth 2001; 87:385-9.

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Edited by Turk DC, Melzack R. New York, Giulford Press,1992, pp. 135-51.

11. Institute for clinical systems improvement (ICSI) WorkGroup. Assessment and management of acute pain. ICSIHealthcare Guideline 2000, www.icsi.org.

12. American Pain Society. Principles of analgesic use in thetreatment of acute pain and cancer pain. 4th edition.Glenview, IL, American Pain Society, 1999.

13. Austrup ML, Korean G. Analgesic agents for thepostoperative period. Surg Clin N Am 1999; 79:253-73.

14. Max MP, Payne R, Edwards WT. Principles of analgesic usein the treatment of acute pain and cancer pain. 4th ed.Glenview, IL. American Pain Society, 1999.

15. Berry PC, Chapman CR, Katz JA. Barriers to theappropriate assessment and management of pain. In:National Pharmaceutical Council and Joint Commission onAccreditation of Healthcare Organisations. Currentunderstanding of assessment, management and treatments.2001, pp. 15-21, www.jcaho.org.

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17. The American Society of Anesthesiologists, Task Forceon acute pain Management. Practice guidelines for acutepain management in the perioperative setting: an updatedreport by the American Society of Anesthesiologists TaskForce on Acute Pain Management. Anesthesiology. 2004;100:1573-81.

18. Yang JC, Clark WC, Tsui SL, Ng KF, Clark SB.Preoperative multidimensional affect and pain survey(MAPS) scores predict postcolectomy analgesiarequirement. J Clin Anesth 2000; 12:531-6.

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20. Haemmig RP, Tchacher W. Effects of high dose heroinversus morphine in intravenous drug users. J PsychoactiveDrugs 2001; 33:105-10.

¢. ¶A¶A°OPA™ Î·È Û˘Ó.

OÎÏÈÓÈÎfi˜ fiÚÔ˜ «ÔÏ˘ÙÚ·˘Ì·Ù›·˜» ·ÊÔÚ¿ ÛÙÔÓÙÚ·˘Ì·Ù›· Ì οΈÛË Û ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚ· ˙ˆÙÈ-ο fiÚÁ·Ó·, Ô˘ ÙÔ ¤Ó· ÙÔ˘Ï¿¯ÈÛÙÔÓ ·ÂÈÏ› ÙË ˙ˆ‹.¶ÔÏ˘ÙÚ·˘Ì·Ù›·˜ ıˆÚÂ›Ù·È ÙÔ ÂοÛÙÔÙ ı‡Ì· ÔÔÈÔ˘-‰‹ÔÙÂ Ù‡Ô˘ ÙÚ·˘Ì·ÙÈÛÌÔ‡ (Ì·˙ÈΤ˜ ηٷÛÙÚÔʤ˜,ÙÚÔ¯·›·, ÙÒÛË ·fi ‡„Ô˜, ˘ÚÔ‚ÔÏÈÛÌfi˜ Î.·.) ¤ˆ˜

fiÙÔ˘ ·Ô‰Âȯı› ÙÔ ·ÓÙ›ıÂÙÔ. H ‰˘ÛÎÔÏ›· ·Ó·ÁÓÒÚÈÛË˜ÙˆÓ ··ÈÙÔ‡ÌÂÓˆÓ ¯ÂÈÚÈÛÌÒÓ Ô˘ Ú¤ÂÈ Ó· Á›ÓÔ˘ÓÛÙÔÓ ÙfiÔ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜, Ë ÔÚı‹ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜¯ˆÚ›˜ Ó· ÚÔÎÏËı› ÂÚ·ÈÙ¤Úˆ ‚Ï¿‚Ë, Ë ÂÍÔÈÎÔÓfiÌËÛ˯ÚfiÓÔ˘, Ë ·fiÊ·ÛË ÁÈ· ÙÔÓ ÙÚfiÔ Î·È ÙÔÓ ÙfiÔ Ù˘ۈÛÙ‹˜ ÌÂÙ·ÊÔÚ¿˜ ÙÔ˘ οı ÙÚ·˘Ì·Ù›·, Ë ÂÈÏÔÁ‹ ÙÔ˘ÂȤ‰Ô˘ Âη›‰Â˘Û˘ ÙˆÓ ÓÔÛËÏ¢ÙÒÓ Î·È È·ÙÚÒÓ Ô˘ÂÌϤÎÔÓÙ·È ÛÙËÓ ÚÔÓÔÛÔÎÔÌÂȷ΋ Ê¿ÛË Î·È Ù¤ÏÔ˜ Ë·Ó·ÁηÈfiÙËÙ· ·ÚÔ˘Û›·˜ È·ÙÚÔ‡ Û˘ÓÙÔÓÈÛÙ‹ Î·È ·fi

¶ÂÚ›ÏË„Ë

O ÔÏ˘ÙÚ·˘Ì·Ù›·˜ ·ÔÙÂÏ› ¤Ó· ÔÏ˘Û‡ÓıÂÙÔ Úfi‚ÏËÌ· ÁÈ· Ù· Û‡Á¯ÚÔÓ· ™˘ÛÙ‹Ì·Ù· YÁ›·˜. H ·ıÔÊ˘ÛÈÔÏÔÁ›·ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÓÙ›‰Ú·ÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÛÙÔ ÙÚ·‡Ì· Î·È ÙËÓ ·Ó·Ú΋ ÂÚÈÊÂÚÈ΋ ÈÛÙÈ΋Ô͢ÁfiÓˆÛË Î·È, ·Ó¿ÏÔÁ· Ì ÙË ‚·Ú‡ÙËÙ· ÙˆÓ Î·ÎÒÛˆÓ, ¤¯ÂÈ ÔÏϤ˜ ÊÔÚ¤˜ Û·Ó Â·ÎfiÏÔ˘ıÔ ÙÔ Û‡Ó‰ÚÔÌÔ ‰˘ÛÏÂÈ-ÙÔ˘ÚÁ›·˜ ÔÏÏÒÓ ÔÚÁ¿ÓˆÓ (MODS), ÙËÓ ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ· Î·È ÙËÓ ÊÙˆ¯‹ ÏÂÈÙÔ˘ÚÁÈ΋ ¤Î‚·ÛË. OÛÎÔfi˜ ÙÔ˘ ·ÚfiÓÙÔ˜ ¿ÚıÚÔ˘ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ó· ·Ó·‰Â›ÍÂÈ ÙÔ ÚfiÏÔ ÙÔ˘ ·Ó·ÈÛıËÛÈÔÏfiÁÔ˘ ÛÙËÓ ÚÒÈÌË, ·ÎfiÌ·Î·È ÚÔ-ÓÔÛÔÎÔÌÂȷ΋, ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›· Î·È ÛÙËÓ ÔÚı‹ ‰È·¯Â›ÚÈÛË fiÏˆÓ ÙˆÓ Â› ̤ÚÔ˘˜ ÚÔ‚ÏËÌ¿-ÙˆÓ ÂÚÈÂÁ¯ÂÈÚËÙÈο, Ì ÛÙfi¯Ô ÙËÓ ·ÔÊ˘Á‹ ÙˆÓ ÂÈÏÔÎÒÓ Ô˘ ı· ÂÈ‚·Ú‡ÓÔ˘Ó ÙËÓ ÌÂÙ¤ÂÈÙ· ÔÚ›· ÙÔ˘. ™ÙÔÚÒÙÔ Ì¤ÚÔ˜, ¤Ú· ·fi Ù· ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· Î·È ÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›· ı· ·Ó·Ù˘¯ı› ÔÚfiÏÔ˜ ÙÔ˘ ·Ó·ÈÛıËÛÈÔÏfiÁÔ˘ ÛÙËÓ ·Ú¯È΋ ÂÎÙ›ÌËÛË ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›·, ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ (Î·È Ë ÂÈÛ·-ÁˆÁ‹ ÛÙËÓ ·Ó·ÈÛıËÛ›·) Î·È ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·Ó·ÓÔ‹˜. ¶·Ú¿ÏÏËÏ·, Á›ÓÂÙ·È ·Ó·ÛÎfiËÛË ÛÙȘ Û‡Á¯ÚÔÓ˜ ÂÍÂȉÈ΢-̤Ó˜ ·Ó·ÈÛıËÛÈÔÏÔÁÈΤ˜ Ù¯ÓÈΤ˜ Î·È ·Ó·‰ÂÈÎÓ‡ÂÙ·È Ë Èı·Ó‹ ÂÓۈ̿وۋ ÙÔ˘˜ Û ηıÈÂڈ̤ӷ ÂÎ·È‰Â˘ÙÈο ÚÔ-ÁÚ¿ÌÌ·Ù· ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ÙÚ·˘Ì·Ù›·, fiˆ˜ ÙÔ ATLS (Advanced Trauma Life Support).

§¤ÍÂȘ ÎÏÂȉȿ: AÂÚ·ÁˆÁfi˜. AÂÚÈÛÌfi˜. AÓ·ÈÛıËÛÈÔÏfiÁÔ˜. AÓ·ÈÛıËÙÈο ÂÓ‰ÔÊϤ‚È·. AÓ·ÏÁËÛ›·. AÓ·ÏÁËÙÈο-ÔÈÔ-Âȉ‹. AÓ·ÓÔ‹. ¢È·ÛˆÏ‹ÓˆÛË (ÂÓ‰ÔÙÚ·¯Âȷ΋). ¢ÈÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη. EÈÏÔΤ˜. K·Ù·ÛÙÔÏ‹. K˘ÎÏÔÊÔÚ›·.MÈÎÚÔ΢ÎÏÔÊÔÚ›·. O͢ÁfiÓÔ. ¶·Ú·ÎÔÏÔ‡ıËÛË Î·È Î·Ù·ÁÚ·Ê‹ (monitoring). ¶Ó‡ÌÔÓ˜ (ÙÚ·¯Â›· - ‚ÚfiÁ¯ÔÈ).™˘Û΢¤˜. YÓˆÙÈο. YÔÍ›·.

AÓ·ÛÎfiËÛË

H Û‡Á¯ÚÔÓË ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›·: TÈ Ú¤ÂÈ Ó·ÁÓˆÚ›˙ÂÈ Ô ·Ó·ÈÛıËÛÈÔÏfiÁÔ˜ ˆ˜ È·ÙÚfi˜ Ù˘ ÂÚÈÂÁ¯ÂÈÚËÙÈ΋˜È·ÙÚÈ΋˜; M¤ÚÔ˜ 1Ô ·fi 4: EȉËÌÈÔÏÔÁ›· Î·È ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜, ·Ú¯È΋ ÂÎÙ›ÌË-ÛË ÙÔ˘ ÙÚ·˘Ì·Ù›·, ÂÍ·ÛÊ¿ÏÈÛË ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ Î·È ÂÎÙ›ÌËÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡

XÚ. ™ÎÏ¿‚Ô˘, TÚ. ™›ÎÏ˘ Î·È K.™. º›ÏÔ˜

KÏÈÓÈ΋ AÓ·ÈÛıËÛÈÔÏÔÁ›·˜ Î·È EÓÙ·ÙÈ΋˜¶·Ú·ÎÔÏÔ‡ıËÛ˘, ¶·ÓÂÈÛÙ‹ÌÈÔ ¶·ÙÚÒÓ, ¶.°.N.

EÏÏËÓÈ΋ AÓ·ÈÛıËÛÈÔÏÔÁ›· 2005; 38:83-100

84 XP. ™K§ABOY Î·È Û˘Ó.

ÔÈ· ÂȉÈÎfiÙËÙ· Â›Ó·È ı¤Ì·Ù· Ô˘ ¤¯Ô˘Ó ··Û¯ÔÏ‹ÛÂÈÙË ‚È‚ÏÈÔÁÚ·Ê›· ¤ÓÙÔÓ· ÂÓÒ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË ‰È¢ÎÚÈ-ÓÈÛı›.

EÎ·È‰Â˘ÙÈο ÚÔÁÚ¿ÌÌ·Ù· fiˆ˜ ÙÔ ATLS(Advanced Trauma Life Support) Î·È ÙÔ PHTLS (Pre-Hospital Trauma Life Support) ÚÔÙ›ÓÔ˘Ó ÙËÓ ¿ÌÂÛË·ÓÙÈÌÂÙÒÈÛË ·fi ηٿÏÏËÏ· ÂÎ·È‰Â˘Ì¤ÓÔ˘˜, ÌË ÂȉÈ-ÎÔ‡˜, È·ÙÚÔ‡˜ Î·È Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ô˘ ·˘Ù¿‰È‰¿ÛÎÔ˘Ó, ÂÓÒ ÙÔÓ›˙Ô˘Ó fiÙÈ ÔÈ ı¿Ó·ÙÔÈ Ù˘ ‰Â‡ÙÂÚ˘·È¯Ì‹˜ ı· ÌÔÚÔ‡Û·Ó Ó· ÌÂȈıÔ‡Ó ÛËÌ·ÓÙÈο.1

OÈ ·Ó·ÈÛıËÛÈÔÏfiÁÔÈ, ÏfiÁˆ Ù˘ ηıËÌÂÚÈÓ‹˜ ÙÔ˘˜ÂÌÂÈÚ›·˜ ÛÙÔÓ ¯ÂÈÚÈÛÌfi ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡, Ê·›ÓÂÙ·È fiÙÈÂ›Ó·È ÔÈ Ï¤ÔÓ Î·Ù¿ÏÏËÏÔÈ ÁÈ· ÙËÓ ·Ú¯È΋ ·ÓÙÈÌÂÙÒÈ-ÛË ÙˆÓ ÙÚ·˘Ì·ÙÈÒÓ ‰Â‰Ô̤ÓÔ˘ ÙÔ˘ ˘„ËÏÔ‡ ‚·ıÌÔ‡‰˘ÛÎÔÏ›·˜ ¯ÂÈÚÈÛÌÔ‡ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ ÛÙÔ˘˜ ÔÏ˘ÙÚ·˘-̷ٛ˜, ·ÎfiÌË Î·È ÁÈ· ÙÔÓ ÂȉÈÎfi. TÔ ˙‹ÙËÌ· Ù˘ ·Ó·-ÁηÈfiÙËÙ·˜ ÂÍ·ÛÊ¿ÏÈÛ˘ ÌfiÓÈÌÔ˘ ·ÂÚ·ÁˆÁÔ‡ ÛÙËÓÚÒÈÌË Ê¿ÛË Î·È Ë Â›‰Ú·Û‹ ÙÔ˘ ÛÙËÓ ÙÂÏÈ΋ ıÂÙÈ΋¤Î‚·ÛË ÙˆÓ ÙÚ·˘Ì·ÙÈÒÓ ‰Â ÌÔÚ› Ó· ÍÂÂÚ·Ûı›‡ÎÔÏ· Î·È ·ÔÙÂÏ› ı¤Ì· ÚÔ˜ ‰ÈÂÚ‡ÓËÛË Û fiÏ· Ù·™˘ÛÙ‹Ì·Ù· YÁ›·˜. H ÚÒÈÌË ÂÌÏÔ΋ ÙÔ˘ ·Ó·ÈÛıË-ÛÈÔÏfiÁÔ˘ Î·È ÂȉÈÎfiÙÂÚ· ÂΛÓÔ˘ Ô˘ ¤¯ÂÈ ÂÍÂȉÈ΢ı›ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÙÚ·˘Ì·ÙÈÎÒÓ, Ê·›ÓÂÙ·È fiÙÈϤÔÓ Â›Ó·È ÂȂ‚ÏË̤ÓË.

H ÔÏ˘ÏÔÎfiÙËÙ· ÙˆÓ Î·ÎÒÛˆÓ, Ë ··›ÙËÛË ÁÈ·ÙË ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÚÒÈÌË ·Ó·ÁÓÒÚÈÛË ÙˆÓÙ·¯‡Ù·ÙˆÓ Î·È ÂÓ›ÔÙ ÛËÌ·ÓÙÈÎÒÓ ·ÏÏ·ÁÒÓ ÛÙ· ‰È¿ÊÔ-Ú· ÔÚÁ·ÓÈο Û˘ÛÙ‹Ì·Ù·, Ë Û˘ÓÙÔÓÈṲ̂ÓË ·ÓÙÈÌÂÙÒÈÛËÙˆÓ ¿ÌÂÛˆÓ Î·È Û ÂͤÏÈÍË Î·ÎÒÛÂˆÓ Û‡Ìʈӷ ÌÂÚÔÛ˘ÌʈÓË̤ӷ ÚˆÙfiÎÔÏÏ· ÂÈ‚¿ÏÂÈ ÙËÓ ·ÚÔ˘Û›·È·ÙÚÔ‡ Î·È Ì¿ÏÈÛÙ· ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ ÛÙÔ ÙÚ·‡Ì· ÛÂı¤ÛË Û˘ÓÙÔÓÈÛÙ‹. ¶ÂÔ›ıËÛ‹ Ì·˜ Â›Ó·È fiÙÈ ÏfiÁˆ Ù˘ʇÛ˘ Ù˘ ÂȉÈÎfiÙËÙ·˜ Î·È Ì ÙÔ ¤Ú·ÛÌ· ÙÔ˘ ¯ÚfiÓÔ˘ ËAÓ·ÈÛıËÛÈÔÏÔÁ›·, ˆ˜ ÂȉÈÎfiÙËÙ· ¶ÂÚÈÂÁ¯ÂÈÚËÙÈ΋˜I·ÙÚÈ΋˜, ı· ÎÚÈı› Èı·ÓfiÓ ˆ˜ Ë Ï¤ÔÓ Î·Ù¿ÏÏËÏËÂȉÈÎfiÙËÙ· fi¯È ÌfiÓÔ ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÙˆÓ ‚·Ú¤ˆ˜·Û¯fiÓÙˆÓ, ÙÚ·˘Ì·ÙÈÛÌ¤ÓˆÓ ·ÛıÂÓÒÓ ·fi ÙÔÓ ÙfiÔÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ ÛÙ· TE¶, ÛÙ· ‰È¿ÊÔÚ· ‰È·ÁÓˆÛÙÈοÙÌ‹Ì·Ù· (·ÍÔÓÈÎfi˜ ÙÔÌÔÁÚ¿ÊÔ˜, ·ÁÁÂÈÔÁÚ·Ê›·) ηıÒ˜Î·È ÛÙÔ ¯ÒÚÔ ÙÔ˘ ¯ÂÈÚÔ˘ÚÁ›Ԣ ‹ ÙË MÔÓ¿‰· EÓÙ·ÙÈ΋˜£Âڷ›·˜ (ME£), ·ÏÏ¿ ˆ˜ Ë ÂȉÈÎfiÙËÙ· Ì ÛËÌ·ÓÙÈ-΋ ÚÔÛÊÔÚ¿ ηٿ ÙËÓ ÚÒÈÌË ·Ó·˙ˆÔÁfiÓËÛË Î·ÈÔ˘ÛÈ·ÛÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›· ÚÈÓ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙË ME£. EÍ¿ÏÏÔ˘, ‰ÂÓ Â›Ó·È¿ÁÓˆÛÙË Û ηӤӷ Ë ·Ó¿ÁÎË Û˘Ó¯ÒÓ ÎÏ‹ÛÂˆÓ ÚÔ˜ÙÔ˘˜ ·Ó·ÈÛıËÛÈÔÏfiÁÔ˘˜ ÁÈ· ‚Ô‹ıÂÈ· ‰ÈÂÎÂÚ·›ˆÛË˜ÙˆÓ ÙÚ·˘Ì·ÙÈÒÓ Ô˘ ÂÚÈʤÚÔÓÙ·È ÛÙ· ‰È¿ÊÔÚ· ÙÌ‹-

Ì·Ù· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ‹ ıÂڷ¢ÙÈ-ÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜. K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÒ‰˘Ó˘ ηÈȉȷ›ÙÂÚ· ¯ÚÔÓÔ‚fiÚ·˜ ηٿ ÂÚ›ÙˆÛË ÌÂÙ·ÊÔÚ¿˜, Ô·Ó·ÈÛıËÛÈÔÏfiÁÔ˜ ηÏÂ›Ù·È Ó· ÂÎÙÈÌ¿ Û˘Ó¯Ҙ ÙËÓ ÎÚÈ-ÛÈÌfiÙËÙ· Ù˘ ηٿÛÙ·Û˘, Ó· ˘ÔÛÙËÚ›˙ÂÈ ÙÔÓ ÙÚ·˘Ì·-Ù›·, Ó· Û˘ÓÙÔÓ›˙ÂÈ ÔÏϤ˜ ÊÔÚ¤˜ ÙȘ ˘fiÏÔȘ ÂȉÈÎfi-ÙËÙ˜, Ó· ·Ú·‰ÒÛÂÈ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÏËÚÔÊÔÚÈÒÓ,ηıÒ˜ Î·È Ó· ηıÔÚ›ÛÂÈ Ù· ‰È·ÁÓˆÛÙÈο ‹/Î·È ıÂÚ·-¢ÙÈο ‚‹Ì·Ù· Ô˘ ı· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó.

EÈÚfiÛıÂÙ· Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı›, fiÙÈ ËEÓÙ·ÙÈ΋ £Âڷ›· ‰ÂÓ Â›Ó·È ÌÈ· «ÂÚÈÔ¯‹ ÙÔ˘ ÓÔÛÔ-ÎÔÌ›Ԣ» Ô˘ ÛÙÂÁ¿˙ÂÙ·È Ë ME£, ·ÏÏ¿ ·ÔÙÂÏ› ÌÈ·‰˘Ó·ÌÈ΋ ıÂڷ¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ô˘ ÔÊ›ÏÂÈ Ó·ÍÂÎÈÓ¿ ¿ÌÂÛ· ÌÂÙ·ÙÚ·˘Ì·ÙÈο. MfiÓÔ ¤ÙÛÈ ÌÔÚÔ‡Ó Ó·ÌÂȈıÔ‡Ó ÔÈ Î·ı˘ÛÙÂÚË̤ÓÔÈ ı¿Ó·ÙÔÈ Ô˘ ÔÊ›ÏÔÓÙ·È΢ڛˆ˜ ÛÙÔ Û‡Ó‰ÚÔÌÔ ÔÏ˘ÔÚÁ·ÓÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜(Multiple Organ Dysfunction Syndrome, MODS).2

TÂÎÌËÚȈ̤ÓÔ ‚È‚ÏÈÔÁÚ·ÊÈο ·Ú¿‰ÂÈÁÌ· ·˘Ù‹˜ Ù˘‰˘Ó·ÌÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ÚÈÓ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËME£ ·ÔÙÂÏÔ‡Ó ÔÈ ÙÚ·˘Ì·Ù›Â˜ Ì ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋οΈÛË (KEK) Ô˘ ·Ó·Ù‡ÛÛÔ˘Ó ˘ÔÍ·ÈÌ›· ‹/Î·È˘fiÙ·ÛË ¿ÌÂÛ·, ¤ˆ˜ Î·È ÙȘ ÚÒÙ˜ ÒÚ˜ ÌÂÙ·ÙÚ·˘Ì·-ÙÈο ÛÙÔ ¯ÒÚÔ ÙˆÓ TE¶ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈο·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ·Ó¿Ù˘Í˘ ‰Â˘ÙÂÚÔÁÂÓÒÓ ÂÁÎÂ-Ê·ÏÈÎÒÓ ‚Ï·‚ÒÓ Ì ·ÎfiÏÔ˘ıË Î·ı˘ÛÙÂÚË̤ÓË·ÚÓËÙÈ΋ ¤Î‚·ÛË ÛÙË ME£.3 ™˘ÓÂÒ˜, Ë ¤ÁηÈÚË Î·È·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›· ·fiÙÔÓ ÙfiÔ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ ̤¯ÚÈ ÙËÓ ÙÂÏÈ΋ ·Ôηٿ-ÛÙ·Û‹ ÙÔ˘ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ fi¯È ÌfiÓÔ ÙË ıÓËÙfiÙËÙ·,·ÏÏ¿ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÌfiÓÈÌˆÓ ·Ó·‹ÚˆÓ Ô˘ ·Ó¤Ú-¯ÔÓÙ·È ÛÙË ¯ÒÚ· Ì·˜ ηْ ÂÎÙ›ÌËÛË Û ~75.000 ÂÙË-Û›ˆ˜.3

™ÎÔfi˜ ÙÔ˘ ·ÚfiÓÙÔ˜ ¿ÚıÚÔ˘ ·Ó·ÛÎfiËÛ˘ ›ӷÈÓ· ηٷ‰Â›ÍÂÈ ÙËÓ ·Ó¿ÁÎË ÁÈ· ÂÓÂÚÁfi Û˘ÌÌÂÙÔ¯‹ ÙÔ˘·Ó·ÈÛıËÛÈÔÏfiÁÔ˘ ÛÙËÓ ÂÚ›ı·Ï„Ë ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›··fi ÙË ÛÙÈÁÌ‹ Ù˘ ÌÂÙ·ÊÔÚ¿˜ ÙÔ˘ ÛÙÔ ¯ÒÚÔ ÙˆÓ TE¶ (‹·ÎfiÌ· Î·È ÚÔ-ÓÔÛÔÎÔÌÂȷο) ̤¯ÚÈ Î·È ÙË ME£ ÒÛÙÂÓ· ·ÔʇÁÔÓÙ·È, ηٿ ÙÔ ‰˘Ó·Ùfi, fiϘ ÔÈ ÂÈÏÔΤ˜Ô˘ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÚÓËÙÈ΋ ÙÔ˘ ¤Î‚·ÛË.O ·Ó·ÈÛıËÛÈÔÏfiÁÔ˜ ‰ÂÓ Ú¤ÂÈ Ó· ıˆÚÂ›Ù·È Ï¤ÔÓ,Î·È ÛÙË ¯ÒÚ· Ì·˜, ˆ˜ Ô È·ÙÚfi˜ ÂϤÁ¯Ô˘ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ÂÓÒ ·Ú¿ÏÏËÏ· ηÏÂ›Ù·È Ó· ·Ú·ÎÔÏÔ˘ı› ÂÂÌ‚·ÙÈο‹ ÌË ÙÔÓ ÔÏ˘ÙÚ·˘Ì·Ù›· ηٿ ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ·Ó¿ÌÂ-Û· ÛÙ· ÂÈ̤ÚÔ˘˜ ÙÌ‹Ì·Ù· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ‹ ηٿ ÙˉȷÎÔÌȉ‹ ÙÔ˘ ·fi ÓÔÛÔÎÔÌÂ›Ô Û ÓÔÛÔÎÔÌ›Ô.4

AÓÙ›ıÂÙ·, Ú¤ÂÈ Ó· ·Ó·Ï¿‚ÂÈ ÂÓÂÚÁfi ÚfiÏÔ ÛÙË Û˘ÓÔ-ÏÈ΋ ‰È·¯Â›ÚÈÛË ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›·. °È· Ó· ηٷÛÙ›

85¶O§YTPAYMATIA™: APXIKH EKTIMH™H

ÂÊÈÎÙfi οÙÈ Ù¤ÙÔÈÔ ÂӉ¯Ô̤ӈ˜ Ó· ··ÈÙËı› Ë ·Ó·-‰ÈÔÚÁ¿ÓˆÛË ÙˆÓ TE¶ fiÏˆÓ ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ ÒÛÙ¢‡ı˘ÓÔÈ ÁÈ· ÙËÓ ‰È·¯Â›ÚÈÛË ÙˆÓ ÔÏ˘ÙÚ·˘Ì·ÙÈÒÓ Ó·ÔÚÈÛÙÔ‡Ó È·ÙÚÔ› ÂÍÂȉÈÎÂ˘Ì¤ÓÔÈ ÛÙËÓ E›ÁÔ˘Û·I·ÙÚÈ΋ Î·È ÙËÓ EÓÙ·ÙÈ΋ £Âڷ›· (·Ó·ÈÛıËÛÈÔÏÔÁ›·‹ ÌË) Ô˘ ı· Â›Ó·È Û ÌfiÓÈÌË ‚¿ÛË ¿ÌÂÛ· ‰È·ı¤ÛÈÌÔÈÛÙ· TE¶.4

™Ù· Ù¤ÛÛÂÚ· ÙÌ‹Ì·Ù· ÙÔ˘ ·ÚfiÓÙÔ˜ ¿ÚıÚÔ˘ ·Ó·-ÛÎfiËÛ˘ ı· ·Ó·Ù˘¯ı› Û˘ÓÂÒ˜ Ì›· Ó¤· ÚÔÛ¤ÁÁÈÛËÙÔ˘ ÚfiÏÔ˘ ÙÔ˘ ·Ó·ÈÛıËÛÈÔÏfiÁÔ˘ ÛÙ· Ï·›ÛÈ· Ù˘ Û‡Á-¯ÚÔÓ˘ ¶ÂÚÈÂÁ¯ÂÈÚËÙÈ΋˜ I·ÙÚÈ΋˜ ̤۷ ·fi ÙËÓ ·Ó·-ÛÎfiËÛË Ù˘ ·ıÔÊ˘ÛÈÔÏÔÁ›·˜ ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›·, Ù˘·Ú¯È΋˜ ÂÎÙ›ÌËÛ˘ Î·È ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘ ÛÙ· TE¶ (ÌÂȉȷ›ÙÂÚË ‚·Ú‡ÙËÙ· ÛÙȘ Ù¯ÓÈΤ˜ ÂÍ·ÛÊ¿ÏÈÛ˘ ÙÔ˘·ÂÚ·ÁˆÁÔ‡), ÙËÓ ·Ó·˙ˆÔÁfiÓËÛË, ÂÓÒ ı· Û¯ÔÏÈ·ÛÙÔ‡ÓÙ· ȉȷ›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÂÈ̤-ÚÔ˘˜ ηÎÒÛÂȘ, Ë ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÚÔÂÙÔÈÌ·Û›· Ô˘··ÈÙ›ٷÈ, Ë ‰ÈÂÁ¯ÂÈÚËÙÈ΋ ·Ó·ÈÛıËÛÈÔÏÔÁÈ΋ ÚÔÛ¤Á-ÁÈÛ‹ ÙÔ˘, Ë ÌÂÙ·ÊÔÚ¿ ¤Ó‰Ô- Î·È ‰È·-ÓÔÛÔÎÔÌÂȷο ηÈÙ¤ÏÔ˜ Ë ÓÔÛËÏ›· ÙÔ˘ ÛÙË ME£.

E¶I¢HMIO§O°IA TOY TPAYMATO™™ÙËÓ E˘Úˆ·˚΋ ŒÓˆÛË (EE) Ù· ÙÚÔ¯·›· ·Ù˘¯‹-

Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙËÓ ÚÒÙË ·ÈÙ›· ı·Ó¿ÙÔ˘ ¤ˆ˜ ÙËÓ ËÏÈ-Λ· ÙˆÓ 45 ÂÙÒÓ, ÂÓÒ ÛÙËÓ EÏÏ¿‰· ÂÙËÛ›ˆ˜ ÔÈ ÓÂÎÚÔ›·Ó¤Ú¯ÔÓÙ·È ÛÙÔ˘˜ ~3000 Î·È ÔÈ ÔÏϤ˜ ÊÔÚ¤˜ ÌfiÓÈÌ··Ó¿ËÚÔÈ ÛÙÔ˘˜ ~75.000. ™ÙÔ ÂÚÈÔ‰ÈÎfi LANCET‰ËÌÔÛȇÙËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ì›·˜ ÚÔÛ¿ıÂÈ·˜Î·Ù·ÁÚ·Ê‹˜ Î·È ÂÎÙ›ÌËÛ˘ ÙˆÓ ·ÈÙÈÒÓ ı·Ó¿ÙÔ˘ ·Ó¿ÂÚÈÔ¯‹ Î·È Û ·ÁÎfiÛÌÈ· Îϛ̷η.5 TÔ 5.1% ÙˆÓı·Ó¿ÙˆÓ ÙÔ˘ 1990 ·Ô‰fiıËΠ۠ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·,ÙËÓ ¤Ó·ÙË ·ÈÙ›· ı·Ó¿ÙÔ˘ ·ÁÎfiÛÌÈ·, ÂÓÒ Ë ÂÎÙ›ÌËÛËÁÈ· ÙÔ 2020 ¤‰ÂÈÍ fiÙÈ ÙÔ ÙÚ·‡Ì· ı· ·ÔÙÂÏ› ÙËÓ ÙÚ›ÙË·ÈÙ›· ı·Ó¿ÙÔ˘ ‹ ÌfiÓÈÌ˘ ·ÓÈηÓfiÙËÙ·˜, ÁÂÁÔÓfi˜ Ô˘ÂȂ‚·ÈÒÓÂÈ ÙË ÛÔ‚·ÚfiÙËÙ· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ·ÁÎÔ-ÛÌ›ˆ˜.5

¢‡Ô ‚·ÛÈΤ˜ ȉ¤Â˜ - ¤ÓÓÔȘ ¤¯Ô˘Ó ÛËÌ·ÓÙÈο ÂË-Ú¿ÛÂÈ ÙËÓ ÚÔ-ÓÔÛÔÎÔÌÂȷ΋ Î·È ÙËÓ ÚÒÈÌË ÂÓ‰ÔÓÔ-ÛÔÎÔÌÂȷ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔÏ˘ÙÚ·˘Ì·Ù›·. O R.Cowley ıˆÚÂ›Ù·È ˆ˜ Ô ·Ù¤Ú·˜ Ù˘ ȉ¤·˜ Ù˘ «¯Ú˘Û‹˜ÒÚ·˜» (golden hour) fiÚÔ˜ Ô˘ ·ÓÙÈηÙÔÙÚ›˙ÂÈ ÙËÓ·Ó¿ÁÎË Ù˘ ·ÌÂÛfiÙÂÚ˘ ‰˘Ó·Ù‹˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ÙÚ·˘Ì·Ù›· Ô˘ ı· ÙÔ˘ ÂÍ·ÛÊ·Ï›ÛÂÈ ÙË ¯·ÌËÏfiÙÂÚËÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·.6 H ȉ¤· ·˘Ù‹ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÚÔÓÔÛÔÎÔÌÂÈ·ÎÔ‡ ÛΤÏÔ˘˜ ·ÓÙÈ-ÌÂÙÒÈÛ˘ ÙÔ˘ ÙÚ·˘Ì·Ù›· Ì ‰È·ÛÒÛÙ˜ Ô˘ ÂÊ·ÚÌfi˙Â-Ù·È ÛÙȘ H¶A Î·È ÛÙË BÚÂÙ·Ó›· (EMS, “scoop and

run”). ŸÌˆ˜, ÙÔ Û‡ÛÙËÌ· EMS ‰ÂÓ Ê·›ÓÂÙ·È Ó· ·ÔÙÂ-Ï› ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÙÚfiÔ ·ÓÙÈÌÂÙÒÈÛ˘ ÁÈ· ÏÈÁfiÙÂÚÔ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜.7

H ‰Â‡ÙÂÚË ¤ÓÓÔÈ· ‚·Û›˙ÂÙ·È Û ̛· ·Ú·Ù‹ÚËÛËÙÔ˘ Trunkey ·fi ÙÔ 1983,8 Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· ÔÈÌÂÙ·ÙÚ·˘Ì·ÙÈÎÔ› ı¿Ó·ÙÔÈ Û˘Ì‚·›ÓÔ˘Ó Û ÙÚÂȘ ·ÚȘ¯ÚÔÓÈΤ˜ ÂÚÈfi‰Ô˘˜: (·) ¿ÌÂÛ· (Ï›Á· ‰Â˘ÙÂÚfiÏÂÙ·¤ˆ˜ Î·È ÌÂÚÈο ÏÂÙ¿ ÌÂÙ·ÙÚ·˘Ì·ÙÈο, ÔÛÔÛÙfi ¤ˆ˜Î·È 50%) Î·È ÔÊ›ÏÔÓÙ·È Û ÌÂÁ¿Ï˘ ‚·Ú‡ÙËÙ·˜, ÌË·Ó·ÛÙÚ¤„È̘ ηÎÒÛÂȘ Û ˙ˆÙÈο fiÚÁ·Ó·, (‚) Úfiˆ-Ú· (ÌÂÚÈο ÏÂÙ¿ ¤ˆ˜ Î·È 4 ÒÚ˜, ~30%). E‰Ò ·Ó‹-ÎÔ˘Ó ÔÈ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈΤ˜ ηÎÒÛÂȘ Î·È ÔÈ Î·Ù·ÎÏ˘-ÛÌÈ·›Â˜ ·ÈÌÔÚÚ·Á›Â˜ ÔfiÙ ÌÈ· ηϿ ÔÚÁ·ÓˆÌ¤ÓË ÚÔ-Î·È ‰È·ÓÔÛÔÎÔÌÂȷ΋ ·ÓÙÈÌÂÙÒÈÛË ÌÔÚ› Ó· ÌÂÈÒÛÂÈÛËÌ·ÓÙÈο ÙÔ ÔÛÔÛÙfi ÙÔ˘ ı·Ó¿ÙÔ˘ Î·È (Á) ηı˘ÛÙÂÚË-̤ӷ (4 ÒÚ˜ ¤ˆ˜ ‚‰ÔÌ¿‰Â˜, ~20%) ·ÔÙ¤ÏÂÛÌ·Û‹„˘ Î·È ÔÏ˘ÔÚÁ·ÓÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ÙˆÓ ÔÔ›ˆÓ ËıÓËÙfiÙËÙ· ηıÔÚ›˙ÂÙ·È ·fi ÙÔ Â›Â‰Ô ÔÚı‹˜ ·ÓÙÈÌÂ-ÙÒÈÛ˘ ηٿ ÙËÓ ¿ÌÂÛË ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋ Ê¿ÛË.MÂϤÙË Ù˘ KÏÈÓÈ΋˜ Ì·˜ Ô˘ ·ÊÔÚÔ‡Û ÛÙË ÌÂÙ·ÊÔÚ¿1011 ÙÚ·˘Ì·ÙÈÒÓ ·fi ÙÔÓ ÙfiÔ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ ÛÙ·TE¶, ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 1997-98, ÂȂ‚·›ˆÛÂÙÔ ‰Â‡ÙÂÚÔ ÌÔÓÙ¤ÏÔ ÙÔ˘ Trunkey. Œ‰ÂÈÍ fiÙÈ ··ÈÙÔ‡-ÓÙ·È ÂÚ›Ô˘ 80 min Î·È fiÙÈ Ô ¯ÚfiÓÔ˜ ‰È·ÎÔÌȉ‹˜ ‰ÂÓ·ÔÙÂÏ› ·ÓÂÍ¿ÚÙËÙÔ ·ÚÓËÙÈÎfi ·Ú¿ÁÔÓÙ· ¤Î‚·Û˘·fi ÙË ME£ ÛÙÔ˘˜ ‚·ÚÈ¿ ÙÚ·˘Ì·Ù›Â˜.9 EÈϤÔÓ, ÙÔÂ›Â‰Ô Ù˘ ÚÔÓÔÛÔÎÔÌÂȷ΋˜ ÊÚÔÓÙ›‰·˜ ÛÂ Û˘Ó‰˘·-ÛÌfi ȉȷ›ÙÂÚ· Ì ÙËÓ ÚÒÈÌË ÂÓ‰ÔÙÚ·¯Âȷ΋ ‰È·ÛˆÏ‹-ÓˆÛË (“scene stabilization”) Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈ-΋ ıÂÙÈ΋ ›‰Ú·ÛË ÛÙËÓ Î·ı˘ÛÙÂÚË̤ÓË ¤Î‚·ÛË ÙˆÓ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·ÛıÂÓÒÓ ÛÙË ME£.9 A˘Ùfi ÂÈ‚Â-‚·ÈÒÓÂÙ·È Î·È ·fi ÙË ÌÂϤÙË ÙˆÓ Androulakis Î·È Û˘Ó.Ô˘ ¤‰ÂÈÍ fiÙÈ 47% ÙˆÓ ı·Ó¿ÙˆÓ ÔÏ˘ÙÚ·˘Ì·ÙÈṲ̂ӈӷÛıÂÓÒÓ ÌÔÚÔ‡Û·Ó Ó· ÚÔÏËÊıÔ‡Ó ÚÔ-ÓÔÛÔÎÔÌÂÈ·-ο.10

øÛÙfiÛÔ, ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÏÂÈÔ„Ë-Ê›· ÙˆÓ ÚÔ-ÓÔÛÔÎÔÌÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ Â›Ó·È ·Ó·fi-Ê¢ÎÙÔÈ.7 ¶Ú¤ÂÈ fï˜ Ì ÙÔÓ Ï¤ÔÓ Î·ÙËÁÔÚËÌ·ÙÈÎfiÙÚfiÔ Ó· ÂÈÛËÌ·Óı› fiÙÈ ‡„ÈÛÙÔ˜ ÛÙfi¯Ô˜ ÛÙËÓ EE·Ú·Ì¤ÓÂÈ Ë Ì›ˆÛË ·ÎfiÌ· Î·È ÂÓfi˜ ÌÈÎÚÔ‡ ÔÛÔÛÙÔ‡ı·Ó¿ÙÔ˘ Û ÚÔ-ÓÔÛÔÎÔÌÂÈ·Îfi ›‰Ô.7 ™ÙÔ Hӈ̤ÓÔB·Û›ÏÂÈÔ ¤¯ÂÈ ‹‰Ë ·fi ÙÔ 1993 ÂÎÙÈÌËı› fiÙÈ Î¿ı ˙ˆ‹ÙÚ·˘Ì·Ù›· Ô˘ ÛÒ˙ÂÙ·È ÌÔÚ› Ó· ·ÔÙÈÌËı› Û ÔÈÎÔ-ÓÔÌÈο ÌÂÁ¤ıË ÁÈ· ÙËÓ ÎÔÈÓˆÓ›· ‡„Ô˘˜ 774.000 í.7

A˘Ùfi Ê·›ÓÂÙ·È fiÙÈ ÛÙË ¯ÒÚ· Ì·˜ ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ·ÎfiÌ··ÓÙÈÏËÙfi, ÒÛÙ ÌÂ Û˘ÓÙÔÓÈṲ̂Ó˜ ÚÔÛ¿ıÂȘ fiψÓÙˆÓ ÂÌÏÂÎfiÌÂÓˆÓ ÊÔÚ¤ˆÓ (.¯. YÔ˘ÚÁ›·

86 XP. ™K§ABOY Î·È Û˘Ó.

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