Çocuklarda QT Uzaması Yapan İlaçlarla Zehirlenmelerde Düzeltilmiş QT ve Tp-e/QTc Süreleri Karşılaştırması

Year 2021, Volume: 19 Issue: 1, 92 - 99, 09.04.2021

Sinem Sarı Gökay Buğra Tutun

Abstract

Giriş: Çocukluk çağı zehirlenmeleri sık görülen acile başvuru nedenleri
arasındadır. Bu çalışmada amacımız aritmiye neden olarak ölümcül olabilecek
QTc uzaması yapan ilaçlarla zehirlenmelerde QT, QTc, QT/QTc, Tp-e/QT, Tp-e/
QTc oranlarını karşılaştırarak çocuklarda aritmi riskini belirleyebilecek öncelikli
bir belirteç olup olmadığını değerlendirmektir.
Gereç ve Yöntem: Çalışmamızda Ocak 2018 ve Ağustos 2019 tarihleri arasında
Eğitim ve Araştırma Hastanesi Çocuk Acil servisine QTc uzaması yapan ilaçlarla
zehirlenme nedeniyle ilk 6 saat içerisinde başvuran ve çocuk acilimizde takip
edilen 55 hastanın dosyası retrospektif olarak incelenmiştir. Hasta dosyalarındanyaş, cinsiyet, aldığı ilaç, müracaat süresi, klinik bulgu ve fizik muayene bulgusu,vital bulgular, yapılan tedavi ve sonuçları laboratuar
bulguları ve başvuru anı ve kontrol bakılan 6. saat EKG (elektrokardiyogram) bulguları, QT, QTc, Tp-e, Tp-e/QT ve Tp-e/QTc
süreleri kaydedilmiştir.
Bulgular: Çalışmaya alınan hastaların yaş ortancası 155±77,2 ay idi. Kız hasta sayısı 33(%60), erkek hasta sayısı 22 (%40) idi.
Çalışmamızda hastaların başvuru anı ve 6. saatte bakılan lökosit sayısı, hemoglobin, platelet, bun, kreatinin, SGPT ve kalsiyum
değerleri arasında istatistiksel olarak anlamlı farklılık saptandı (p<0.05). CK-MB ve troponin arasında istatistiksel olarak anlamlı
farklılık yoktu (p>0,05).EKG’lerinde QT, QTc, QT/QTc, Tp-e/QT ve Tp-e/QTc süreleri arasında istatistiksel olarak anlamlı fark
saptanmadı (p>0,05). Tp-e/QTc süreleri ve cinsiyet arasında istatistiksel olarak anlamlı bir farklılık mevcuttu (p<0,05).
Sonuç: Çocuklarda QTc uzatan ilaçlarla zehirlenmelerde aritmi riskini belirlemek için QTc süresi kullanılmaya devam etmekle
birlikte Tp-e ve Tp-e/QTc sürelerinin öncelik bir belirteç olup olmadığını belirlemek için daha fazla sayıda hasta populasyonu içeren
çalışmalara ihtiyaç duyulmaktadır.

Comparison of Corrected QT and Tp-e/QTc Interval in Intoxication with Drugs That Cause QT Prolongation in Children

Abstract

Introduction: Childhood intoxications are among the most common reasons for admission to the emergency department. The aim of this study is to evaluate whether
there is a primary marker that can determine the risk of arrhythmia by comparison of QT, QTc, QT/QTc, Tp-e/QT, Tp-e/QTc intervals in drug intoxications with
prolonging QTc which can be fatal by causing arrhythmia in children.

Materials and Methods: In this study, 55 patients who were admitted to Pediatric Emergency Department of Training and Research Hospital between January 2018
and August 2019 within the first 6 hours due to intoxication with QTc prolongation and followed up in our pediatric emergency department were retrospectively
reviewed. In patients hospital records, age, sex, medication, time of application, clinical and physical examination findings, vital signs, treatments and results,
laboratory findings, electrocardiogram findings at the time of admission hospital and in the 6. hour control, QT, QTc, Tp-e, Tp-e/QT and Tp-e/QTc times were
recorded.

Results: The median age of the patients in study was 155±77.2 months. The number of female patients was 33 (60%) and the number of male patients was 22. There
was a statistically significant difference between leukocyte count, hemoglobin,platelet,bun, creatinine, SGPT and calcium values at the time of admission and
control at the 6th hour. There was no statistically significant difference between CK-MB and troponin levels. Also, there was no statistically significant difference
between QT, QTc, QT/QTc, Tp-e/QT and Tp-e/QTc intervals. But there was a statistically significant difference between Tp-e/QTc ratio and gender.

Conclusions: Although QTc interval continues to be used to determine the risk of arrhythmia in children with drugs prolonging QTc, it may be significant to
compare Tp-e and Tp-e/QTc ratio. However, studies involving a larger number of patients are needed to determine whether Tp-e interval and Tp-e/QTc ratio are a
priority marker.

Keywords

Children, Tp-e/QTc ratio, intoxication,

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