COLANGITA ACUTÃ SEVERÃ PRIN PRISMA GHIDULUI DE LA TOKYO 2013
Gh. Ghidirim, Ala Suman, V. Gheorghiåa, S. Suman, S. Berliba, Diana Zagadailov Universitatea de Medicinã æi Farmacie ”N. Testemiåanu”, Institutul de Medicinã Urgentã, or. Chiæinãu. Moldova Introducere: Evaluarea criteriilor severitãåii sunt importante, pentru tactica de tratament cât mai promtã æi eficientã, drenaj biliar urgent (în primile 24h) la indicaåii vitale în cazurile severe a colangitei acute. Ghidul de la Tokyo 2013, propune criterii de diagnos- tic æi criterii de evaluare a severitãåii pentru colangita acutã. Scopul: Obåinerea rezultatelor cât mai promte dupã o evaluare cât mai urgentã æi corectã, conform Ghidului de la Tokyo 2013. Rezultate: Au fostexaminatefiæe a 51pacienåi cu clinicã de colangitãacutã (febrã, ictermecanic, frisoane). Repartizareadupã sex femei n=28, bãrbaåi n= 22 (raportul 1,3:1), a predominatvârstãcuprinsãîntre 56 – 65 ani cu o frecvenåã de 35%, 66 – 70 ani în 21%, iargrupapeste 70 ani a constituit 14%. Analiza datelor de laborator a permis divizarea dupã severitate a colangitei acute, æi anume: leucocitoza – 99% (19-20000); proteina C-reactivã – în 99% a constituit 96 – 214 ng/ml (norma 6 mg/ml), bilirubinemie – 45% (82-128 mmol/l) pînã la decompresia biliarã. În dependenåã de indicatorii se decide gradul de severitate æi volumul intervenåiei. Dupã repetarea analizelor de laborator la 3-5 zi, post-decompresie biliarã, nivelul seric al proteinei C-reactive a fost în limitele normei, iar leucocitoza æi bilirubinemia se micæoreazã mai lent. Concluzia: Marcherii inflamatori (leucocite, proteina C-reactivã ect.) æi probele hepatice ne permit evaluarea gradului de severitate a colangitei acute în: uæor, mediu, sever æi iniåierea tratamentului cât mai urgent (ERCP+STE, drenarea cãii biliare pricipale).
SEVERE ACUTE CHOLANGITIS FROM THE PERSPECTIVE OF THE TOKYO GHIDE 2013 Introduchion: Severity criteria are important for a trinely and effective treatment, urgently biliary drenage(in fiest 24h) at the vital indications in cases of severe acute colongite. The Tokyo Ghide 2013, proposes us diagnostic criteria and assessment of severity criteria for acute cholangitis. Scope: Getting the quickest results ofter au urgent and a correct evolution, according the Tokyo Ghide 2013. Rezults: There were examined records of 51 pations with acute cholangitis (fever, mechanical jaundice, chills). Distribution by gender, women (n=28), men (n=22), ratio 1,3:1. Prevailing age betwan 56-65 years with a frequency of 35%; 66-70 years – 21%; and the group with over 70 years, constituted 14%. Analysis of laboratory date, permitedt us colangits by its severity: leukocytosis – 99% (19-20000); C- reactive Protein – in 99%, was 96 – 214 ng/ml (N – 6 ng/ml); bilirubinemia – 45% (82 – 128 mkmol/l), until the bile decompression. According to the indicators, are dicided degree of severity and volume of the surgery by endoscopy inter- ventions. Afte repeating the laboratory test at 3-5 days, post biliary decompression, the serum level of the C-reactive protein was in
the norm, and leukocytes and bilirubinemia decreases slower. Conlusion: According Tokyo Ghide 2013 - Inflamatory markers (leukocytes, C-reactive protein etc.) and lever test, allow us to assess the degree of severity of acute cholangitis in: light, medium, severe and the initiation of the most urgent treatment (ERCP + STE, the drainage of the main biliary path).
