| Abstract | Plućna embolija je hitno stanje nastalo zbog opstrukcije u plućnoj cirkulaciji ugruškom krvi. Akutna plućna embolija (PE) ometa i izmjenu plinova i cirkulaciju, te se primarnim uzrokom smrti smatra zatajenje desne klijetke zbog preopterećenja tlakom. Već dobro poznati uzročnici PE su genetski faktori, velike traume, opsežni operativni zahvati, prijelomi donjih ekstremiteta, ozljede leđne moždine, karcinomi, oralna kontracepcija i infekcije.
Relativno novi „uzročnik“ PE je bolest COVID-19 koju uzrokuje virus SARS-CoV-2. Dosadašnjim istraživanjima otkriveno je da spomenuti virus izaziva infekciju koja posljedično dovodi do poremećaja mikrocirkulacije, ali i do stvaranja ugrušaka koji mogu biti uzrok moždanom udaru ili plućnoj emboliji. PE se mogu javiti u akutnoj fazi COVID-a 19 kao dio patofiziološkog zbivanja, no najčešće se javljaju nakon preboljenja infekcije u samoj fazi oporavka. Glavni uzrok tome je dugotrajno mirovanje takvih pacijenata, te upravo to dovodi i do oslabljenog protoka ili zastoja u venskom sustavu. Zatim stanje hipoksije, pretilost i visoka životna dob su isto tako bitni uzročnici.
Pacijent može biti bez simptoma ali može doći i do iznenadne smrti. Najčešći simptomi koji dominiraju u kliničkoj slici su: bol u prsima, dispneja, sinkopa, hipotenzija, tahikardija i hipoksija.
Liječenje pacijenata s PE započinje davanjem kisika, lijekovima protiv bolova i intravenskom primjenom fibrinolitičkih preparata (najčešće streptokinaza). U dobro opremljenim medicinskim centrima pristupiti se može perkutanoj ili kirurškoj embolektomiji. U sprječavanju recidiva daju se antikoagulansi.
Pacijenti oboljeli od PE nakon preboljelog COVID-a 19 najčešće su smješteni u jedinicu intenzivne skrbi, gdje o njima brinu dobro educirane medicinske sestre/tehničari. Upravo oni imaju veliku ulogu u njezi takvih pacijenata, potrebno im je veliko stručno znanje i vještine. Osim u njezi takvih pacijenata, medicinska sestra/tehničar ima veliku ulogu u pravovremenom uočavanju potencijalnih znakova i simptoma PE, provođenju preventivnih mjera ali i edukacija o zdravstvenom ponašanju.
U radu će biti prikazan prikaz slučaja pacijenta s plućnom embolijom nakon preboljenja COVID-a 19, njegova klinička slika, tijek bolesti i liječenje. |
| Abstract (english) | Pulmonary embolism is an emergency caused by obstruction in the pulmonary circulation by a blood clot. Acute pulmonary embolism (PE) interferes with both gas exchange and circulation, and the primary cause of death is considered to be right ventricular failure due to pressure overload. Already well-known causes of PE are genetic factors, major trauma, extensive surgery, lower extremity fractures, spinal cord injuries, cancers, oral contraceptives, and infections.
A relatively new "cause" of PE is COVID-19 disease, which is caused by the SARS-CoV-2 virus. Previous research has shown that the mentioned virus causes an infection that consequently leads to microcirculation disorders, but also to the formation of clots that lead to pulmonary embolism or stroke. PE can occur in the acute phase of COVID-19 as part of a pathophysiological event, but most often occurs after overcoming the infection in the recovery phase itself. The main cause of this is the long-term rest of such patients, and this is what leads to impaired flow or congestion in the venous system, then a state of hypoxia, obesity and old age.
The patient may be asymptomatic but may die suddenly. The most common symptoms that dominate the clinical picture are: chest pain, dyspnea, syncope, hypotension, tachycardia and hypoxia.
Treatment of patients with PE begins with the administration of oxygen, painkillers and intravenous fibrinolytic preparations (most often streptokinase). Surgical or percutaneous embolectomy can be performed in well-equipped centers. Anticoagulants are given to prevent recurrence.
Patients with PE after COVID-19 are most often placed in an intensive care unit, where they are cared for by well-trained nurses / technicians. They play a big role in the care of such patients, they need great professional knowledge and skills. In addition to the care of such patients, the nurse / technician has a major role in the timely detection of potential signs and symptoms of PE, the implementation of preventive measures and education on health behavior.
The paper will present a case report of a patient with pulmonary embolism after COVID-19, his clinical picture, disease course and treatment. |
