{"id":212,"date":"2014-07-16T19:58:30","date_gmt":"2014-07-16T18:58:30","guid":{"rendered":"http:\/\/mudr-nosek-sro.cz\/wordpress\/?p=212"},"modified":"2014-07-16T21:01:19","modified_gmt":"2014-07-16T20:01:19","slug":"pristrojova-a-laboratroni-vysetreni-dostupna-primo-v-nasi-ordinaci","status":"publish","type":"post","link":"https:\/\/mudr-nosek-sro.cz\/wordpress\/?p=212","title":{"rendered":"P\u0159\u00edstrojov\u00e1 a laboratron\u00ed vy\u0161et\u0159en\u00ed dostupn\u00e1 p\u0159\u00edmo v na\u0161\u00ed ordinaci"},"content":{"rendered":"

CRP – POCT<\/h1>\n
\"CRP\"<\/a>
P\u0159\u00edstroj na vy\u0161et\u0159en\u00ed CRP<\/figcaption><\/figure>\n

Je laboratorn\u00ed vy\u0161et\u0159en\u00ed z kapil\u00e1rn\u00ed krve z\u00edskan\u00e9 vpichem do prstu<\/strong>. Vyhodnocen\u00ed testu je prov\u00e1d\u011bno p\u0159\u00edstrojem v ordinaci ihned po odb\u011bru.<\/p>\n

C-reaktivn\u00ed protein (CRP) je protein akutn\u00ed f\u00e1ze, jeho\u017e hladina stoup\u00e1 p\u0159i prob\u00edhaj\u00edc\u00edm z\u00e1n\u011btu<\/strong>.\u00a0M\u011b\u0159en\u00ed koncentrace CRP pom\u00e1h\u00e1 p\u0159i rozli\u0161en\u00ed bakteri\u00e1ln\u00ed a virov\u00e9 infekce<\/strong>. B\u011b\u017en\u00e1 koncentrace v s\u00e9ru zdrav\u00fdch jedinc\u016f je n\u00edzk\u00e1 (0 \u2013 7 mg\/l), p\u0159i bakteri\u00e1ln\u00ed infekci se v\u00fdrazn\u011b zvy\u0161uje b\u011bhem 6 \u2013 12 hodin, p\u0159i\u010dem\u017e ve v\u011bt\u0161in\u011b p\u0159\u00edpad\u016f plat\u00ed, \u017ee mnohon\u00e1sobn\u011b zv\u00fd\u0161en\u00e9 koncentrace CRP jsou typick\u00e9 pro bakteri\u00e1ln\u00ed onemocn\u011bn\u00ed, na rozd\u00edl od virov\u00e9ho, kdy se koncentrace CRP zvy\u0161uje jen m\u00edrn\u011b nebo z\u016fst\u00e1v\u00e1 v norm\u00e1ln\u00edm rozmez\u00ed.<\/p>\n

Proveden\u00edm tohoto jednoduch\u00e9ho testu lze p\u0159edej\u00edt zbyte\u010dn\u00e9mu p\u0159edepisov\u00e1n\u00ed antibiotik<\/strong> pacient\u016fm, pro n\u011b\u017e nemaj\u00ed v\u00fdznam p\u0159i virov\u00e9m typu infekce. P\u0159\u00edpadn\u011b lze odhalit prob\u00edhaj\u00edc\u00ed z\u00e1n\u011btliv\u00e9 onemocn\u011bn\u00ed<\/strong>, kter\u00e9 nemus\u00ed m\u00edt je\u0161t\u011b zcela typick\u00e9 klinick\u00e9 p\u0159\u00edznaky.<\/p>\n

Kvantitativn\u00ed FOB – POCT<\/h1>\n
\"FOB\"<\/a>
Sada na testov\u00e1n\u00ed okultn\u00edho krv\u00e1cen\u00ed ve stolici<\/figcaption><\/figure>\n

je imunologick\u00fd test ur\u010den\u00fd k\u00a0detekci<\/strong> okultn\u00edho (b\u011b\u017en\u00fdm okem neviditeln\u00e9ho)\u00a0krv\u00e1cen\u00ed ve vzorc\u00edch lidsk\u00e9 stolice<\/strong> v\u00a0p\u0159\u00edpadech, kdy existuje podez\u0159en\u00ed na krv\u00e1cen\u00ed z koncov\u00fdch \u010d\u00e1st\u00ed tr\u00e1vic\u00edho traktu. Typicky se prov\u00e1d\u00ed po 50 letech v\u011bku jako prevence<\/strong>\u00a0rakoviny tlust\u00e9ho st\u0159eva<\/strong>, kdy nepatrn\u00e9 krv\u00e1cen\u00ed m\u016f\u017ee b\u00fdt jedin\u00fdm p\u0159\u00edznakem jinak nezjistiteln\u00e9ho n\u00e1doru.<\/p>\n

Jeliko\u017e jde o imunologickou metodu s\u00a0protil\u00e1tkami reaguj\u00edc\u00edmi pouze na lidsk\u00fd hemoglobin, nen\u00ed nutn\u00e9 <\/strong>p\u0159ed odb\u011brem vzorku dodr\u017eovat speci\u00e1ln\u00ed dietn\u00ed omezen\u00ed<\/strong>.\u00a0B\u011bhem obdob\u00ed testov\u00e1n\u00ed by pouze\u00a0nem\u011bly b\u00fdt u\u017e\u00edv\u00e1ny l\u00e9ky zp\u016fsobuj\u00edc\u00ed gastrointestin\u00e1ln\u00ed podr\u00e1\u017ed\u011bn\u00ed<\/strong> jako nap\u0159. nesteroidn\u00ed protiz\u00e1n\u011btliv\u00e9 l\u00e9ky, nebo\u0165 jejich u\u017e\u00edv\u00e1n\u00ed m\u016f\u017ee zp\u016fsobovat krv\u00e1cen\u00ed.<\/p>\n

V\u00fdhoda n\u00e1mi u\u017e\u00edvan\u00e9 kvantitativn\u00ed metody spo\u010d\u00edv\u00e1 v minimalizaci rizika \u0161patn\u00e9ho vyhodnocen\u00ed testu na podklad\u011b subjektivn\u00edho zrakov\u00e9ho vjemu osoby, kter\u00e1 test vyhodnocuje. M\u00edsto rozd\u00edlu ve zm\u011bn\u011b barvy prou\u017eku vy\u0161et\u0159ovac\u00edho setu je zde k dispozici jasn\u00e9 numerick\u00e1 hodnota z\u00edskan\u00e1 na podklad\u011b standardizovan\u00e9ho p\u0159\u00edstrojov\u00e9ho m\u011b\u0159en\u00ed.<\/p>\n

INR – POCT<\/h1>\n
\"INR\"<\/a>
P\u0159\u00edstroj na stanoven\u00ed INR p\u0159i pou\u017eit\u00ed v ordinaci<\/figcaption><\/figure>\n

je vy\u0161et\u0159en\u00ed sr\u00e1\u017elivosti krve<\/strong>\u00a0pou\u017e\u00edvan\u00e9 nej\u010dast\u011bji k\u00a0monitorov\u00e1n\u00ed l\u00e9\u010dby <\/strong>warfarinem<\/strong>.<\/p>\n

Jde o\u00a0kvantitativn\u00edmu stanoven\u00ed protrombinov\u00e9ho \u010dasu (PT\/hodnoty Quickova testu\/INR) s pou\u017eit\u00edm kapil\u00e1rn\u00ed krve odebran\u00e9 z kone\u010dku prstu<\/strong> nebo neo\u0161et\u0159en\u00e9 \u017eiln\u00ed pln\u00e9 krve. Vyhodnocen\u00ed je prov\u00e1d\u011bno p\u0159\u00edstrojem okam\u017eit\u011b po odb\u011bru a v\u00fdsledky jsou zn\u00e1my v \u0159\u00e1du minut. Oproti klasick\u00e9 kontrole odpad\u00e1 zpracov\u00e1n\u00ed krve v laborato\u0159i<\/strong>.<\/p>\n

HP antigen test – POCT<\/h1>\n

 <\/p>\n

\"Helicobacter<\/a>
Helicobacter pylori je druh gramnegativn\u00ed patogenn\u00ed bakterie, je\u017e napad\u00e1 sliznici \u017ealudku. Odhaduje se, \u017ee je ve vysp\u011bl\u00fdch zem\u00edch touto bakteri\u00ed infikov\u00e1na v\u00edce ne\u017e polovina dosp\u011bl\u00fdch po 60 letech v\u011bku, a\u010dkoliv nemus\u00ed v\u017edy vyvolat onemocn\u011bn\u00ed. (Wikipedie)<\/figcaption><\/figure>\n

je test ur\u010den\u00fd na stanoven\u00ed antigenu Helicobactera pylori ve\u00a0stolici<\/strong>.<\/span><\/p>\n

Helicobacter pylori je pova\u017eov\u00e1n za hlavn\u00ed p\u0159\u00ed\u010dinu z\u00e1n\u011btu \u017ealude\u010dn\u00ed sliznice<\/strong>. Sehr\u00e1v\u00e1 v\u00fdznamnou roli ve v\u00fdvoji v\u0159edov\u00e9ho onemocn\u011bn\u00ed \u017ealudku a dvan\u00e1ctn\u00edku<\/strong>. Dok\u00e1zalo se, \u017ee je p\u0159\u00edtomen u 80% \u017ealude\u010dn\u00edch a 95% dvan\u00e1ctn\u00edkov\u00fdch v\u0159ed\u016f. Pokud se tzv. chronick\u00fd z\u00e1n\u011bt (gastritida) nevyl\u00e9\u010d\u00ed, m\u016f\u017ee se st\u00e1t p\u0159\u00ed\u010dinou nejen zhor\u0161en\u00e9ho hojen\u00ed samotn\u00e9ho v\u0159edu, ale po letech m\u016f\u017ee m\u00edt vliv i na v\u00fdvoj rakoviny \u017ealudku<\/strong>.<\/span><\/p>\n

V\u00fdhodou tohoto testu je, \u017ee je zpracov\u00e1n p\u0159\u00edmo v ordinaci<\/strong> a v\u00fdsledek je zn\u00e1m b\u011bhem n\u011bkolika minut<\/strong>.\u00a0Test bohu\u017eel nen\u00ed hrazen z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed<\/strong>. Cena jednoho vy\u0161et\u0159ovac\u00edho setu se pohybuje kolem 200 K\u010d. Aktu\u00e1ln\u00ed cenu sd\u011bl\u00edme v ordinaci na po\u017e\u00e1d\u00e1n\u00ed.<\/p>\n

M\u011b\u0159en\u00ed indexu ABI<\/h1>\n
\"P\u0159\u00edstroj<\/a>
P\u0159\u00edstroj pro m\u011b\u0159en\u00ed indexu kotn\u00edk-pa\u017ee<\/figcaption><\/figure>\n

Jde o neinvazivn\u00ed m\u011b\u0159en\u00ed krevn\u00edho tlaku na v\u0161ech kon\u010detin\u00e1ch sou\u010dasn\u011b.\u00a0Index kotn\u00edk \u2013 pa\u017ee<\/strong> (angl. Ankle Brachial Index – ABI) m\u00e1 vysokou v\u00fdpov\u011bdn\u00ed hodnotu v\u00a0p\u0159edpov\u011bdi celkov\u00e9ho kardivaskul\u00e1rn\u00edho rizika (ischemick\u00e1 choroba doln\u00edch kon\u010detin, infarkt myokardu, mozkov\u00e1 p\u0159\u00edhoda)<\/strong>, jeliko\u017e aterosklerotick\u00fd proces stoj\u00edc\u00ed za t\u011bmito chorobami je syst\u00e9mov\u00e9 onemocn\u011bn\u00ed postihuj\u00edc\u00ed soub\u011b\u017en\u011b v\u00edce tepenn\u00fdch oblast\u00ed.<\/p>\n

Hodnota ABI indexu <0,9 upozor\u0148uje<\/strong> s\u00a0p\u0159esnost\u00ed 95%, v\u00a0porovn\u00e1n\u00ed s\u00a0angiogramem jako zlat\u00fdm standardem, na nebezpe\u010d\u00ed ICHDK <\/strong>(ischemick\u00e9 choroby doln\u00edch kon\u010detin – tedy jejich nedostate\u010dn\u00e9 prokrven\u00ed) a\u00a0s\u00a0t\u00e9m\u011b\u0159 100% jistotou vyselektuje zdrav\u00e9 pacienty.<\/p>\n

Metoda dostupn\u00e1 v na\u0161\u00ed ordinaci stanov\u00ed tuto hodnotu tak jednodu\u0161e, rychle a\u00a0p\u0159esn\u011b, \u017ee toto vy\u0161et\u0159en\u00ed m\u016f\u017ee b\u00fdt u\u00a0ka\u017ed\u00e9ho pacienta provedeno jako preventivn\u00ed kontrola.<\/p>\n

24 hodinov\u00e9 ambulantn\u00ed monitorov\u00e1n\u00ed krevn\u00edho tlaku (AMTK)<\/h1>\n

 <\/p>\n

\"Ambulantn\u00ed<\/a>
Ambulantn\u00ed monitor tlaku krve<\/figcaption><\/figure>\n

24-hodinov\u00fd monitor krevn\u00edho tlaku se vyu\u017e\u00edv\u00e1 v situac\u00edch, kdy b\u011b\u017en\u00e1 ambulantn\u00ed kontrola krevn\u00edho tlaku nen\u00ed dostate\u010dn\u011b spolehliv\u00e1.\u00a0<\/span>Tato exaktn\u00ed metoda umo\u017e\u0148uje na z\u00e1klad\u011b cca <\/span>50\u00a0<\/strong>spolehliv\u00fdch <\/span>m\u011b\u0159en\u00ed<\/strong> krevn\u00edho tlaku pomoc\u00ed z\u00e1znamn\u00edku kapesn\u00ed velikosti a p\u0159ehlednosti vyhodnocovac\u00edho programu z\u00edskat l\u00e9ka\u0159i dokonalou p\u0159edstavu o\u00a0<\/span>\u00a0<\/span><\/strong>pr\u016fm\u011brn\u00e9m krevn\u00edm tlaku<\/strong>, z\u00e1t\u011b\u017ei c\u00e9vn\u00edho \u0159e\u010di\u0161t\u011b<\/strong> krevn\u00edm tlakem jako odpov\u011b\u010f na psychickou a fyzickou aktivitu a o cirkadi\u00e1nn\u00ed variabilit\u011b\u00a0<\/strong><\/span>b\u011bhem cel\u00fdch 24 hodin<\/strong>.\u00a0<\/span>U\u00a0pacient\u016f l\u00e9\u010den\u00fdch antihypertenzivy dovoluje p\u0159esn\u011bji kontrolovat \u00fa\u010dinnost l\u00e9\u010dby<\/strong>.<\/span><\/p>\n

D\u00edky mal\u00fdm rozm\u011br\u016fm, velmi tich\u00e9mu provozu a bezdr\u00e1tov\u00e9 konektivit\u011b n\u00e1mi pou\u017e\u00edvan\u00e9ho z\u00e1znamn\u00edku je 24-hodinov\u00e9 monitorov\u00e1n\u00ed pro pacienta velmi \u0161etrn\u00e9<\/strong>.<\/span><\/p>\n

Mo\u010dov\u00fd analyz\u00e1tor<\/h1>\n
\"Mo\u010dov\u00fd<\/a>
Mo\u010dov\u00fd analyz\u00e1tor<\/figcaption><\/figure>\n

N\u00e1mi pou\u017e\u00edvan\u00fd p\u0159\u00edstroj je reflektan\u010dn\u00ed fotometr ur\u010den\u00fd k semikvantitativn\u00edmu vyhodnocen\u00ed diagnostick\u00fdch prou\u017ek\u016f<\/strong>. \u00a0Prou\u017eek\u00a0je analyzov\u00e1n a stanoven barevn\u00fd odst\u00edn jednotliv\u00fdch z\u00f3n, na jeho\u017e z\u00e1klad\u011b je ur\u010dena koncentrace p\u0159\u00edslu\u0161n\u00fdch analyt\u016f. Tento zp\u016fsob vyhodnocen\u00ed zabra\u0148uje vzniku subjektivn\u00ed chyby, kter\u00e1 m\u016f\u017ee vzniknout p\u0159i vn\u00edm\u00e1n\u00ed barevn\u00fdch odst\u00edn\u016f vy\u0161et\u0159uj\u00edc\u00edmi nebo kv\u016fli rozd\u00edln\u00fdm sv\u011bteln\u00fdm podm\u00ednk\u00e1m.V\u00fdsledky jsou dostupn\u00e9 bezprost\u0159edn\u011b po zm\u011b\u0159en\u00ed<\/strong>. Pou\u017e\u00edvan\u00fdmi prou\u017eky um\u00edme stanovit a\u017e 11 parametr\u016f<\/strong>:\u00a0Bilirubin, Urobilinogen, Ketony, Kyselina askorbov\u00e1, Glukoza, B\u00edlkovina, Krev, Ph, Dusitany, Leukocyty, Specifick\u00e1 hmotnost.<\/p>\n

REBOX physioterapie<\/h1>\n
\"Rebox<\/a>
Rebox elektroterapie<\/figcaption><\/figure>\n

Transkut\u00e1nn\u00ed neinvazivn\u00ed elektroterapeutick\u00fd p\u0159\u00edstroj\u00a0Rebox-Physio\u00a0je konstruov\u00e1n pro l\u00e9\u010dbu<\/strong> a diagnostiku\u00a0poruch pohybov\u00e9ho apar\u00e1tu\u00a0a\u00a0neurologick\u00fdch onemocn\u011bn\u00ed<\/strong>. Je efektivn\u00ed v l\u00e9\u010db\u011b\u00a0akutn\u00ed i chronick\u00e9 bolesti<\/strong>.<\/p>\n

V p\u0159\u00edstroji jsou generov\u00e1ny elektrick\u00e9 obd\u00e9ln\u00edkov\u00e9 impulzy o frekvenci 2-4 kHz. Reboxov\u00e9 proudy jsou transkut\u00e1nn\u011b p\u0159ivedeny do l\u00e9\u010den\u00e9 oblasti dotykem l\u00e9\u010debn\u00e9\u00a0elektrody. Druh\u00e1 v\u00e1lcov\u00e1 elektroda je ve styku s extracelul\u00e1rn\u00edmi tekutinami.<\/p>\n

B\u011bhem n\u011bkolika sekund dojde ke korekci lok\u00e1ln\u00ed acid\u00f3zy v l\u00e9\u010den\u00e9 oblasti (analgetick\u00fd efekt<\/strong>), zv\u00fd\u0161\u00ed se\u00a0mikrocirkulace krve a lymfy <\/strong>(antiedemat\u00f3zn\u00ed efekt<\/strong>)\u00a0a je pozorovateln\u00fd\u00a0myorelaxa\u010dn\u00ed efekt<\/strong>. Tyto t\u0159i fyziologick\u00e9 efekty jsou pozorovateln\u00e9 obvykle ihned po aplikaci reboxov\u00fdch proud\u016f.<\/p>\n

Doba aplikace reboxov\u00fdch proud\u016f je \u0159\u00edzena v z\u00e1vislosti na osmotick\u00fdch a onkotick\u00fdch pom\u011brech ve tk\u00e1ni. Zpravidla trv\u00e1 3 a\u017e 5 sekund v jednom bod\u011b. Reboxov\u00e9 proudy ovlivn\u00ed tk\u00e1\u0148 v oblasti o polom\u011bru asi 1,5 cm od bodu dotyku. P\u0159i jedn\u00e9 procedu\u0159e je Rebox aplikov\u00e1n celkem ve 20-30 bodech jak v pasivn\u00ed, tak aktivn\u00ed (tj. bolestiv\u00e9) poloze.<\/p>\n

Sledov\u00e1n\u00ed st\u0159edn\u00ed hodnoty reboxov\u00e9ho proudu v z\u00e1vislosti na \u010dase m\u00e1\u00a0diagnostickou hodnotu\u00a0a umo\u017e\u0148uje monitorovat a \u0159\u00eddit l\u00e9\u010debn\u00fd proces.<\/p>\n","protected":false},"excerpt":{"rendered":"

CRP – POCT Je laboratorn\u00ed vy\u0161et\u0159en\u00ed z kapil\u00e1rn\u00ed krve z\u00edskan\u00e9 vpichem do prstu. Vyhodnocen\u00ed testu je prov\u00e1d\u011bno p\u0159\u00edstrojem v ordinaci ihned po odb\u011bru. C-reaktivn\u00ed protein (CRP) je protein akutn\u00ed f\u00e1ze, jeho\u017e hladina stoup\u00e1 p\u0159i prob\u00edhaj\u00edc\u00edm z\u00e1n\u011btu.\u00a0M\u011b\u0159en\u00ed koncentrace CRP pom\u00e1h\u00e1 p\u0159i rozli\u0161en\u00ed bakteri\u00e1ln\u00ed a virov\u00e9 infekce. B\u011b\u017en\u00e1 koncentrace v s\u00e9ru zdrav\u00fdch jedinc\u016f je n\u00edzk\u00e1 (0 \u2013 … Pokra\u010dov\u00e1n\u00ed textu P\u0159\u00edstrojov\u00e1 a laboratron\u00ed vy\u0161et\u0159en\u00ed dostupn\u00e1 p\u0159\u00edmo v na\u0161\u00ed ordinaci<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":235,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_crdt_document":"","footnotes":""},"categories":[2],"tags":[],"class_list":["post-212","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uzi"],"_links":{"self":[{"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/212","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=212"}],"version-history":[{"count":18,"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/212\/revisions"}],"predecessor-version":[{"id":236,"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/212\/revisions\/236"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=\/wp\/v2\/media\/235"}],"wp:attachment":[{"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=212"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=212"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mudr-nosek-sro.cz\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=212"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}