OPTIMIZATION OF DIAGNOSIS OF COMORBID PATHOLOGY OF THE CHEST ORGANS AT THE PREHOSPITAL STAGE IN PATIENTS WITH ISCHEMIC STROKE
About the author:
Muratova T. M., Khramtsov D. M., Busel S. V., Batashova-Galinska V. A., Bobrovsky K. A.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
In the structure of the comorbidity of a stroke, an important part is presented by diseases of the respiratory organs, including pneumonia. Due to the fact that in Ukraine patients are still admitted to treatment facilities outside the therapeutic window, not only late nosocomial poststroke pneumonia, but also nonhospital, becomes relevant. The purpose of the study was to evaluate the effectiveness of the diagnosis of comorbid pathology of the chest organs at the prehospital stage in patients with ischemic stroke. Object and methods. The research was carried out on the basis of CRRM of ONMEDU during 2016-2018. The results of CT scan analysis of 247 patients who were candidates for hospitalization to the stroke center of the clinic were analyzed. The tests were performed on 16 cutting units Aquillon – 16 TOSHIBA (Japan). There were evaluated the frequency of detection of extubation pneumonia, signs of chronic obstructive pulmonary disease, disseminated processes, metatuberculous changes, primary and secondary tumor lesions. Comparison of identified nosologies with localization and severity of stroke was performed. Statistical processing was carried out using frequency analysis methods using the Statistica 10.0 (Dell StatSoft Inc., USA) software. Research results. An analysis of the frequency of detection at the pre-hospital stage was performed during MSCT screening of out-hospital and late hospital pneumonia, pulmonary hypostases, COPD and tumor pathology. The role of the severity of a stroke and the period since the onset of the first symptoms of a stroke in the occurrence of broncho-pulmonary pathology has been determined. The expediency of the use of MSCT screening in specialized medical institutions that help with acute cerebrovascular disruption is discussed. Conclusions 1. At the time of admission to the hospital, 12.6% of patients with ischemic stroke had signs of extubation pneumonia. 2. Late hospitalized pneumonia is detected in 11.3% of patients with stroke whereas only 6.1% of the diagnosis was established prior to hospitalization. 3. A common occurrence in patients with stroke is hypostasis in the lungs, which is determined in 44.1% of patients. 4. In a large number of patients (19.8%), CT scan of chest was detected during MSCT screening and 2.0% had tumor pathology. 5. Pneumonia is more frequently detected in patients who arrived in the hospital 48 hours or later after symptoms (rA = 0.71), as well as with more severe stroke (NIHSS> 8 points) – rA = 0.64. Instead, the localization of the stroke had little effect on the incidence of bronchopulmonary disease – rA = 0.37. 6. The use of MSCT screening can improve the efficiency of the diagnosis of comorbid pathology of the chest organs in patients with ischemic stroke in the prehospital stage. 7. MSCT-screening of diseases of the chest organs can be recommended for the primary examination of patients with acute cerebrovascular disorder for facilities of the 3rd level of medical care and university clinics that have their own stroke centers.
stroke, comorbid pathology, computed tomography, chest organs
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 Part 1 (148), 2019 year, 144-148 pages, index UDK 616.24-002+616.831-005