KAN ALMA ÜNİTESİNDE KAN ÖRNEĞİ VERİRKEN BAYILAN HASTALAR VE BİR STRESS MEDYATÖRÜ: KORTİZOL

Year 2022, Volume: 32 Issue: 6, 666 - 669, 31.12.2022

Mevlana Ömeroğlu Şenol Arslan

https://doi.org/10.54005/geneltip.1136552

Abstract

AMAÇ : Kortizol bir glukokortikoiddir ve adrenal yetmezlikle ilişkili olarak stress mediatörü olarak kullanılabilir. Epizodik olarak salınan kortizol seviyelerinin tek ölçümle 3 mcg/dl nin altında olması ile adrenal yetmezlik tanısı konur. Çalışmamızda kan verme ünitesinde kan verme aşamasında bayılan ve ilk müdahalesi hastane mavi kod ekibi tarafından yapıldıktan sonra aynı ekiple acile gelen hastaların kortizol seviyelerini görüntüleyerek altta yatan adrenal yetmezlik varlığını tespit etmek amaçlanmıştır.
GEREÇ VE YÖNTEM: Gözlemsel, prospektif çalışma; 2017 ve 2020 yılları arasında acil servise senkop ön tanısıyla mavi kod tarafından getirilen 28 hastadan oluşmaktadır. Fizik muayene ve elektrokardiyogram (EKG) değerlendirildikten sonra tam kan sayımı, biyokimyasal paramatreler, venöz kan gazı, kardiyak biyobelirteçler ve kortizol ölçümü için örnekler alındı. Başvuru anında alınan kanlar; acil laboratuvarında aynı gün çalışıldı. Elde edilen sonuçlar SPSS 22 ile analiz edildi.
BULGULAR: En düşük kortizol düzeyi 9 mcg/dl, en yüksek kortizol düzeyi 40,4 olarak ölçüldü. Kortizol düzeyleri erkeklere nazaran kadınlardan daha yüksek olarak ölçüldü. T-test analizi; cinsiyetin, kortizol düzeylerinde belirleyici faktör olmadığını ortaya koydu(p=0,26). Kan alma zamanıyla kortizol değerleri arasındaki korelasyon sıfıra yakın olarak hesaplandı (r2=0,09) . Tek ölçümle adrenal yetmezlik tanısı alan hasta, çalışma popülasyonunda tanımlanmadı.
SONUÇ: Akut adrenal yetmezlik tanılı hastalar, acil servise ortostatik hipotansiyon, ajitasyon, senkop, karın ağrısı ve ateş ile gelebilir, tedavi edilmezse ölümle sonuçlanabilir (1). Adrenal krizin presipitan faktörleri arasında %20 oranla emosyonel stres olmasına rağmen bizim çalışmamızda stres ve kortizol arasında anlamlı bir ilişki bulunamamıştır (2). Çalışmamızın kısıtlılıkları sadece mesai saatleri içerisinde yürütülebilmesi, ileri tanı tetkiklerinin acilde uygulanamıyor olmasıdır.

Keywords

SENKOP, KORTİZOL, ADRENAL YETMEZLİK

Patients Who Fainted Whilst Giving a Blood Sample in the Blood Collectıon Unit and a Stress Mediator: Cortisol

Abstract

OBJECTIVE: Cortisol is a glucocorticoid and can be used as a stress mediator in association with adrenal insufficiency. A diagnosis of adrenal insufficiency is made when the episodically released cortisol levels are below 3 mcg/dl by making a single measurement at any time of the day. We aimed to determine the presence of underlying adrenal insufficiency by measuring cortisol levels in patients brought to the emergency room by the hospital code blue team that firstly performed their critical care, who fainted whilst giving blood samples in the blood collection unit.
MATERIAL AND METHODS: Observational, prospective study; It consists of 28 patients brought to emergency department by Code Blue Team between 2017 and 2020. After physical examination and electrocardiogram(ECG) evaluation, samples were taken for complete blood count, biochemical parameters, venous blood gas, cardiac biomarkers and cortisol measurement. Obtained results were analyzed with SPSS 22.
RESULTS: The lowest cortisol level was 9 mcg/dL, and the highest cortisol level was 40,4 mcg/dL. Cortisol levels were higher in women than men. But T-test analysis revealed that gender is not a determining factor in cortisol levels (p=0,26). The correlation between blood collection time and cortisol values was calculated close to zero (r2=0.09). The patient diagnosed with adrenal insufficiency with a single measurement was not defined in the study population.
CONCLUSIONS: Patients with acute adrenal insufficiency may come to the emergency department with orthostatic hypotension, agitation, syncope, abdominal pain and fever, and may result in death if left untreated (1). Although emotional stress is 20% among the precipitating factors of adrenal crisis, no significant relationship was found between stress and cortisol in our study (2). The limitations of our study are that it can only be carried out during working hours, and advanced diagnostic tests can not be performed in the emergency room.

Keywords

SYNCOPE, ADRENAL INSUFFICIENCY, CORTISOL

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