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Reanimasyon Yoğun Bakım Ünitesindeki İskemik Strok Hastaların Mortalitesini Etkileyen Faktörler

Yıl 2016, Cilt: 7 Sayı: 26, 0 - 0, 30.06.2016
https://doi.org/10.17944/mkutfd.37013

Öz

mortalite sebeplerinden biridir ve yoğun bakım ünitelerindeki hastalarının büyük bir kısmını oluşturur. Bu hastaların morbidite ve mortalite oranlarını doğru tahmin etmek, uygun tedaviyi uygulamak ve sonrasındaki süreci yönetmek için önemlidir.

Gereç ve Yöntem: Retrospektif olarak anesteziyoloji ve reanimasyon yoğun bakım ünitesine yatan 96'sı akut olmak üzere 203 iskemik inme hastasının verileri incelendi. Hastalar ölenler ve yaşayanlar olmak üzere iki gruba ayrıldı. Hastaların yoğun bakım ünitesine kabulü sırasındaki APACHE II (Acute Physiological and Chronic Health Evaluation), GKS (Glaskow Koma Skalası) ve hemodinamik değerleri ile yandaş hastalıkların varlığı ve bazı laboratuar parametreler karşılaştırıldı.

Bulgular: Çalışmaya dahil edilen hastaların %55.7’i kadın, %44.3’ü erkek, ortalama yaş 74.5 ve mortalite oranı %74.4 idi. Sırasıyla ölenlerde ve yaşayanlarda; APACHE II skoru 28.34±7.23 ve 23.83±6.4 (p<0.0001), GKS skoru 7.07±3.10 ve 10.02±2.82 (p<0.0001), ünitede kalma süresi 6.34±28.26 ve 7.48±8.45 gün (p=0.005), mekanik ventilasyon süresi 13.53±25.36 ve 1.29±3.12 gün (p<0.0001) olarak saptandı. Ölen hastaların %55.6’sı (n=84) entübe halde üniteye yatırılırken, bu oran yaşayanlarda %80.8 (n=42) idi (p=0.001). Başlangıç total kolesterol ve kreatinin ölen hastalarda yaşayanlara göre daha yüksek iken (sırayla; p=0.002, p=0.038), RDW (red cell distribution width) değeri daha düşüktü (p=0.027). Yandaş hastalıklar arasında birinci sırada hipertansiyon (%38.4), ikinci sırada akut böbrek yetmezliği (%30.5) ve üçüncü sırada ise atrial fibrilasyon (%23.6) yer aldı.

Sonuç: Anesteziyoloji ve reanimasyon yoğun bakım ünitesine alınan iskemik inme hastaları mortalitesi yüksek bir hasta grubudur. Bu hasta grubunun mortalitesini tahmin etmek için skorlama sistemlerinden APACHE II, GKS, laboratuar parametrelerden ise başlangıç düşük RDW, yüksek kreatinin ve total kolesterol seviyeleri faydalı olabilir.

Anahtar kelimeler: İskemik inme,  Mortalite, risk faktörleri, Yoğun bakım

Kaynakça

  • Hong YC, Lee JT, Kim H, Kwon HJ. Air pollution: a new risk factor in ischemic stroke mortality. Stroke; a jo-urnal of cerebral circulation 2002;33:2165-9.
  • Sudlow CL, Warlow CP. Comparing stroke incidence worldwide: what makes studies comparable? Stroke; a journal of cerebral circulation 1996;27:550-8.
  • Hankey GJ. Stroke. How large a public health problem, and how can the neurologist help? Archives of neuro-logy 1999;56:748-54.
  • Bonita R, Beaglehole R, K. A. The worldwide problem of stroke. Curr Opin Neurol 1994;7:5-10.
  • Rordorf G, Koroshetz W, Efird JT, Cramer SC. Predic-tors of mortality in stroke patients admitted to an in-tensive care unit. Critical care medicine 2000;28:1301-5.
  • Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Burvill PW, Anderson CS, et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke; a journal of cerebral circulation 2000;31:2080-6.
  • Berrouschot J, Rossler A, Koster J, Schneider D. Mec-hanical ventilation in patients with hemispheric isc-hemic stroke. Critical care medicine 2000;28:2956-61.
  • MacWalter RS. Secondary prevention of stroke. Thrombosis and haemostasis 1999;82 Suppl 1:95-103.
  • Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L, Soriano Y, Roman-Sanchez P, Illa FB, et al. Continuous positive airway pressure treatment redu-ces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. American journal of respiratory and critical care me-dicine 2009;180:36-41.
  • Sarıkaya M. Skorlama sistemleri. Türk Yoğun Bakım Derneği Dergisi 2006;4:66-73.
  • Steiner T, Mendoza G, De Georgia M, Schellinger P, Holle R, Hacke W. Prognosis of stroke patients requiring mechanical ventilation in a neurological cri-tical care unit. Stroke; a journal of cerebral circula-tion 1997;28:711-5.
  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical care medicine 1985;13:818-29.
  • Nijsten MW, ten Duis HJ, Zijlstra JG, Porte RJ, Zwave-ling JH, Paling JC, et al. Blunted rise in platelet count in critically ill patients is associated with worse outcome. Critical care medicine 2000;28:3843-6.
  • Zampieri FG, Ranzani OT, Sabatoski V, de Souza HP, Barbeiro H, da Neto LM, et al. An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients. Annals of in-tensive care 2014;4:20.
  • Wang F, Pan W, Pan S, Ge J, Wang S, Chen M. Red cell distribution width as a novel predictor of mortality in ICU patients. Annals of medicine 2011;43:40-6.
  • Hooman N, Mehrazma M, Nakhaii S, Otukesh H, Mo-radi-Lakeh M, Dianati-Maleki N, et al. The value of se-rum uric Acid as a mortality prediction in critically ill children. Iranian journal of pediatrics 2010;20:323-9.
  • Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB. Red cell distribution width and all-cause mortality in critically ill patients. Critical care medicine 2011;39:1913-21.
  • Milionis HJ, Kalantzi KJ, Goudevenos JA, Seferiadis K, Mikhailidis DP, Elisaf MS. Serum uric acid levels and risk for acute ischaemic non-embolic stroke in elderly subjects. Journal of internal medicine 2005;258:435-41.
  • Moreau D, Timsit JF, Vesin A, Garrouste-Orgeas M, de Lassence A, Zahar JR, et al. Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays. Chest 2007;131:1735-41.
  • Li M, Hou W, Zhang X, Hu L, Tang Z. Hyperuricemia and risk of stroke: a systematic review and meta-analysis of prospective studies. Atherosclerosis 2014;232:265-70.
  • Weir CJ, Muir SW, Walters MR, Lees KR. Serum urate as an independent predictor of poor outcome and fu-ture vascular events after acute stroke. Stroke; a jo-urnal of cerebral circulation 2003;34:1951-6.
  • Dogan A, Köse Dönmez B, Nakipoğlu G, Özgirgin N. The complication and comorbid medical diseases of geriatric stroke patients. Turkish Journal of Geriatrics 2009;12:118-23.
  • Feigin VL, Wiebers DO, Nikitin YP, O'Fallon WM, Whisnant JP. Risk factors for ischemic stroke in a Rus-sian community: a population-based case-control study. Stroke; a journal of cerebral circulation 1998;29:34-9.
Yıl 2016, Cilt: 7 Sayı: 26, 0 - 0, 30.06.2016
https://doi.org/10.17944/mkutfd.37013

Öz

Kaynakça

  • Hong YC, Lee JT, Kim H, Kwon HJ. Air pollution: a new risk factor in ischemic stroke mortality. Stroke; a jo-urnal of cerebral circulation 2002;33:2165-9.
  • Sudlow CL, Warlow CP. Comparing stroke incidence worldwide: what makes studies comparable? Stroke; a journal of cerebral circulation 1996;27:550-8.
  • Hankey GJ. Stroke. How large a public health problem, and how can the neurologist help? Archives of neuro-logy 1999;56:748-54.
  • Bonita R, Beaglehole R, K. A. The worldwide problem of stroke. Curr Opin Neurol 1994;7:5-10.
  • Rordorf G, Koroshetz W, Efird JT, Cramer SC. Predic-tors of mortality in stroke patients admitted to an in-tensive care unit. Critical care medicine 2000;28:1301-5.
  • Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Burvill PW, Anderson CS, et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke; a journal of cerebral circulation 2000;31:2080-6.
  • Berrouschot J, Rossler A, Koster J, Schneider D. Mec-hanical ventilation in patients with hemispheric isc-hemic stroke. Critical care medicine 2000;28:2956-61.
  • MacWalter RS. Secondary prevention of stroke. Thrombosis and haemostasis 1999;82 Suppl 1:95-103.
  • Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L, Soriano Y, Roman-Sanchez P, Illa FB, et al. Continuous positive airway pressure treatment redu-ces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. American journal of respiratory and critical care me-dicine 2009;180:36-41.
  • Sarıkaya M. Skorlama sistemleri. Türk Yoğun Bakım Derneği Dergisi 2006;4:66-73.
  • Steiner T, Mendoza G, De Georgia M, Schellinger P, Holle R, Hacke W. Prognosis of stroke patients requiring mechanical ventilation in a neurological cri-tical care unit. Stroke; a journal of cerebral circula-tion 1997;28:711-5.
  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical care medicine 1985;13:818-29.
  • Nijsten MW, ten Duis HJ, Zijlstra JG, Porte RJ, Zwave-ling JH, Paling JC, et al. Blunted rise in platelet count in critically ill patients is associated with worse outcome. Critical care medicine 2000;28:3843-6.
  • Zampieri FG, Ranzani OT, Sabatoski V, de Souza HP, Barbeiro H, da Neto LM, et al. An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients. Annals of in-tensive care 2014;4:20.
  • Wang F, Pan W, Pan S, Ge J, Wang S, Chen M. Red cell distribution width as a novel predictor of mortality in ICU patients. Annals of medicine 2011;43:40-6.
  • Hooman N, Mehrazma M, Nakhaii S, Otukesh H, Mo-radi-Lakeh M, Dianati-Maleki N, et al. The value of se-rum uric Acid as a mortality prediction in critically ill children. Iranian journal of pediatrics 2010;20:323-9.
  • Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB. Red cell distribution width and all-cause mortality in critically ill patients. Critical care medicine 2011;39:1913-21.
  • Milionis HJ, Kalantzi KJ, Goudevenos JA, Seferiadis K, Mikhailidis DP, Elisaf MS. Serum uric acid levels and risk for acute ischaemic non-embolic stroke in elderly subjects. Journal of internal medicine 2005;258:435-41.
  • Moreau D, Timsit JF, Vesin A, Garrouste-Orgeas M, de Lassence A, Zahar JR, et al. Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays. Chest 2007;131:1735-41.
  • Li M, Hou W, Zhang X, Hu L, Tang Z. Hyperuricemia and risk of stroke: a systematic review and meta-analysis of prospective studies. Atherosclerosis 2014;232:265-70.
  • Weir CJ, Muir SW, Walters MR, Lees KR. Serum urate as an independent predictor of poor outcome and fu-ture vascular events after acute stroke. Stroke; a jo-urnal of cerebral circulation 2003;34:1951-6.
  • Dogan A, Köse Dönmez B, Nakipoğlu G, Özgirgin N. The complication and comorbid medical diseases of geriatric stroke patients. Turkish Journal of Geriatrics 2009;12:118-23.
  • Feigin VL, Wiebers DO, Nikitin YP, O'Fallon WM, Whisnant JP. Risk factors for ischemic stroke in a Rus-sian community: a population-based case-control study. Stroke; a journal of cerebral circulation 1998;29:34-9.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Bölüm Original Articles
Yazarlar

Zakir Arslan

Özgür Özmen Bu kişi benim

Mehmet Çömez Bu kişi benim

Yayımlanma Tarihi 30 Haziran 2016
Gönderilme Tarihi 8 Mart 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 7 Sayı: 26

Kaynak Göster

Vancouver Arslan Z, Özmen Ö, Çömez M. Reanimasyon Yoğun Bakım Ünitesindeki İskemik Strok Hastaların Mortalitesini Etkileyen Faktörler. mkutfd. 2016;7(26).