Acil serviste akut pulmoner emboli tanısı alan hastalarda kabuldeki laktat düzeyi, arter kan gazı parametreleri, ekokardiyografi bulguları ve tedavi yöntemleri ile prognoz arasındaki ilişki
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Dosyalar
Tarih
2021
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Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Pulmoner emboli, pulmoner arterin bir veya daha fazla dalının trombüsle tıkanması sonucu meydana gelen potansiyel hayatı tehdit edici kardiyovasküler acillerdendir. Pulmoner emboli hastaneye yatış nedenlerinin %0.4'ünü oluşturur ve kardiyovasküler ölüm nedenleri arasında 3. Sırada yer alır. Uygun tedavi yönteminin zamanında uygulanması ile mortalite oldukça azalmaktadır. Bu çalışmanın amacı, Selçuk Üniversitesi Tıp Fakültesi Acil Tıp Kliniği'nde akut pulmoner emboli tanısı konulmuş hastalarda kan laktat düzeyi, arteriyel kan gazı parametreleri, ekokardiyografi bulguları ve tedavi yöntemleri ile yoğun bakımda yatış süresi, hastanede yatış süresi ve hastane içi mortalite arasındaki ilişkinin araştırılmasıdır. Yöntem: Çalışma retrospektif bir çalışma olup, hasta verilerine Hastane Bilgi Yönetim Sistemi'nden ulaşılmıştır. Çalışmaya Selçuk Üniversitesi Tıp Fakültesi Acil Tıp Kliniği'nde 01.01.2017 – 01.11.2019 tarihleri arasında pulmoner emboli tanısı almış 18 yaş üstü hastalar dahil edilmiştir. Her hasta için tedavi seçimi, hastanede ( yoğun bakım ve/veya servis ) yatış süresi ve sonuç (taburculuk, exitus) tespit edilip, her grup için ayrı ayrı kan laktat düzeyi, labaratuvar ve kan gazı parametreleri ve EKO bulguları ile karşılaştırılmıştır. İstatistiksel Analiz: Çalışmanın analizleri SPSS ile gerçekleştirilmiştir. Değişkenler ortalama±SS ve frekans (yüzde oranı) şeklinde sunulmuştur. Sürekli sayısal değişkenlerin normal dağılıma uygunluğu için Kolmogorov-Smirnov testi gruplar arasındaki farklılığın görülmesi için, bağımsız örneklemler için t-testi, çoklu gruplar için ise tek yönlü varyans analizi yapıldı. Ayrıca kategorik değişkenler arasındaki ilişkilerin belirlenmesi için Ki-kare analizi, Mortalite ve PESI risk grupları üzerindeki prognostik faktörlerin belirlenmesi için Forward LR aşamalı binary lojistik regresyon modeli kurulmuştur. Bulgular ve Sonuç: Çalışmadaki 219 hastada mortalite oranı %19,1 bulunmuştur. Laktat düzeyi, SO2 ve HCO3 değerleri mortaliteye göre anlamlı farklılık göstermiştir. Sağ ventrikül dilatasyonu, PAB yüksekliği ve serbest duvar hipokinezisi exitus olan hastalarda anlamlı derecede yüksek bulundu. Laktat düzeyi ile YBÜ yatış süresi arasında anlamlı ilişki bulunmuştur. PH değerinin 21 gün üzeri YBÜ de kalan hastalarda düşük ve plazma laktat düzeyinin yüksek seyrettiği gözlendi. Servis yatış süreleri anlamlı farklılık göstermedi.
Objective: Pulmonary embolism is one of the potentially life-threatening cardiovascular emergencies caused by thrombus occlusion of one or more branches of the pulmonary artery. Pulmonary embolism constitutes 0.4% of the reasons for hospitalization and ranks 3rd among the causes of cardiovascular death. Mortality decreases considerably with application of the appropriate treatment method. The aim of this study is to investigate the relationship between blood lactate level, arterial blood gas parameters, echocardiography findings and treatment methods, length of stay in the intensive care unit, length of hospital stay and in-hospital mortality in patients diagnosed with acute pulmonary embolism in the Emergency Medicine Clinic of Selcuk University Faculty of Medicine. Method: The study is a retrospective study, and patient data have been accessed from the Hospital Information Management System. Patients over the age of 18 who were diagnosed with pulmonary embolism between 01.01.2017 and 01.11.2019 in the Emergency Medicine Clinic of Selçuk University Faculty of Medicine were included in the study. Treatment selection for each patient, length of stay in hospital (intensive care and / or ward) and outcome (discharge, exitus) were determined, and compared with blood lactate level, laboratory and blood gas parameters and echocardiography findings for each group separately. Statistical Analysis: The analysis of the study was performed by SPSS. The variables are presented as mean ± SD and frequency (percentage rate). Kolmogorov-Smirnov test was used for the e of continuous numerical variables to normal distribution, independent samples t-test was performed to see the difference between groups, and One-Way analysis of variance was performed for multiple groups. In addition, Chi-square analysis for determining the relationships between categorical variables, binary logistic regression model with forward LR stepwise method was established to determine the prognostic factors on mortality and PESI risk groups. Results and Conclusion: Mortality rate in 219 patients in the study was found to be 19.1%. Lactate level, SO2 and HCO3 values differed significantly according to mortality. Right ventricular dilatation, PAP elevation and free wall hypokinesia were found to be significantly higher in patients with exitus. A significant relationship was found between lactate level and length of stay in the ICU. It was observed that PH value was low and plasma lactate level was high in patients who stayed in the ICU for more than 21 days. The length of stay in clinics did not differ significantly.
Objective: Pulmonary embolism is one of the potentially life-threatening cardiovascular emergencies caused by thrombus occlusion of one or more branches of the pulmonary artery. Pulmonary embolism constitutes 0.4% of the reasons for hospitalization and ranks 3rd among the causes of cardiovascular death. Mortality decreases considerably with application of the appropriate treatment method. The aim of this study is to investigate the relationship between blood lactate level, arterial blood gas parameters, echocardiography findings and treatment methods, length of stay in the intensive care unit, length of hospital stay and in-hospital mortality in patients diagnosed with acute pulmonary embolism in the Emergency Medicine Clinic of Selcuk University Faculty of Medicine. Method: The study is a retrospective study, and patient data have been accessed from the Hospital Information Management System. Patients over the age of 18 who were diagnosed with pulmonary embolism between 01.01.2017 and 01.11.2019 in the Emergency Medicine Clinic of Selçuk University Faculty of Medicine were included in the study. Treatment selection for each patient, length of stay in hospital (intensive care and / or ward) and outcome (discharge, exitus) were determined, and compared with blood lactate level, laboratory and blood gas parameters and echocardiography findings for each group separately. Statistical Analysis: The analysis of the study was performed by SPSS. The variables are presented as mean ± SD and frequency (percentage rate). Kolmogorov-Smirnov test was used for the e of continuous numerical variables to normal distribution, independent samples t-test was performed to see the difference between groups, and One-Way analysis of variance was performed for multiple groups. In addition, Chi-square analysis for determining the relationships between categorical variables, binary logistic regression model with forward LR stepwise method was established to determine the prognostic factors on mortality and PESI risk groups. Results and Conclusion: Mortality rate in 219 patients in the study was found to be 19.1%. Lactate level, SO2 and HCO3 values differed significantly according to mortality. Right ventricular dilatation, PAP elevation and free wall hypokinesia were found to be significantly higher in patients with exitus. A significant relationship was found between lactate level and length of stay in the ICU. It was observed that PH value was low and plasma lactate level was high in patients who stayed in the ICU for more than 21 days. The length of stay in clinics did not differ significantly.
Açıklama
Anahtar Kelimeler
Akut Tromboemboli, Hastanede Kalış Süresi, Mortalite, Acute Pulmonary Embolism, Length of Hospital Stay, Mortality
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Cömert, F. (2021). Acil serviste akut pulmoner emboli tanısı alan hastalarda kabuldeki laktat düzeyi, arter kan gazı parametreleri, ekokardiyografi bulguları ve tedavi yöntemleri ile prognoz arasındaki ilişki. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
