İnvaziv Olmayan Ventilasyon Kullanan Kronik Solunum Yetersizlikli Kifoskolyoz Hastalarının Kardiyak Fonksiyonlarının ve Total Mortalitenin Değerlendirilmesi

Year 2015, Volume: 18 Issue: 1, 19 - 28, 06.04.2015

Yusuf Karavelioğlu Hekim Karapınar Zuhal Karakurt Göksel Açar Özlem Yazıcıoğlu Moçin Nalan Adıgüzel Murat Yüksel Gökay Güngör Ali Metin Esen

Abstract

Giriş: Biz bu
çalışmada kronik solunum yetersizliği nedeniyle uzun dönem invaziv olmayan
ventilasyon tedavisi alan kifoskolyoz hastalarında kardiyak fonksiyonlar ve
mortalite oranları değerlendirmeyi amaçladık.

Hastalar ve Yöntem: İnvaziv
olmayan ventilasyon kullanan kifoskolyoz hastaları bu çalışmaya alındı. Hasta
özellikleri ve kardiyovasküler risk faktörleri kaydedildi. Tüm hastalara
ambulatuvar ritim monitorizasyonu ve ekokardiografi yapıldı. Sonuçlar 26
yaş-cinsiyet ayarlanmış dispnesi olmayan gönüllüler ile karşılaştırıldı.
Hastalar beş yıl süreyle takip edildi.

Bulgular: Yirmi üç
kifoskolyoz hastası (54 ± 13 yaş, 15 erkek) çalışmaya alındı. Hipertansiyon ve
paroksismal atrial fibrilasyon hasta grubunda daha sık izlendi. Sol ventrikül
sistolik fonksiyonları normal iken diastolik fonsiyonları bozulmuş izlendi. Sağ
ventrikül çapları normal iken sistolik/diyastolik fonksiyonları ortalama
pulmoner arter basınçları kifoskolyoz hastalarında yüksek idi. Dört hasta
takipte öldü. Ölümlerin ikisi ciddi hipoksemi nedeniyle diğer ikisi de sepsis
nedeniyle gerçekleşti. Klinik, laboratuvar, ekokardiografi ve kardiyovasküler
risk parametreler açısında ölenler ile hayatta kalanlar arasında fark
izlenmedi.

Sonuç: Kifoskolyoz hastalarında
hipertansiyon ve aritmi sık izlendi. Sol ventrikül hafif derecede fakat sağ
ventrikül ciddi ölçüde etkilendiği ve pulmoner arter basınçlarının arttığı
gözlendi. Uzun dönem invaziv olmayan ventilasyon tedavisi alan kifoskolyoz
hastalarında kardiyovasküler fonksiyonlar mortaliteyi öngörmediği tespit
edildi.

Keywords

Kifoskolyoz, mekanik ventilasyon, iki-düzeyli pozitif hava yolu basıncı, kardiyak fonksiyon testleri, pulmoner hipertansiyon

Cardiac Functions and All-Cause Mortality in Kyphoscoliosis Patients with Chronic Respiratory Failure Using Non-invasive Ventilation

Abstract

Introduction: We aimed to evaluate
cardiac functions and mortality rate in kyphoscoliosis patients with chronic
respiratory failure under long term non-invasive ventilation (NIV).

Patients and Methods: Kyphoscoliosis patients,
who used NIV, were included in the study. Patients’ characteristics and
cardiovascular risk factors were recorded. Ambulatory rhythm monitoring and
echocardiography were performed for all patients. Results were compared with 26
age-gender matched volunteers without dyspnea. Patients had been followed for
five years.

Results: Twenty-three
kyphoscoliosis patients (54 ± 13 years, 15 male) were included in the study.
Hypertension and paroxysmal atrial fibrillation were more frequent in patients.
Left ventricular systolic functions were normal but diastolic functions were
worsened. Right ventricular sizes were normal but systolic and diastolic
functions were worsened and the mean pulmonary artery pressure was higher in
kyphoscoliosis patients. Four patients were died in follow up. Two of patients
died due to severe hypoxia and two of them died due to sepsis. Clinical and
laboratory properties including cardiovascular risk factors, echocardiographic
examination were not different between the survived patients and dying ones.

Conclusion:
Hypertension and arrhythmia are more frequent. The left
ventricle is slightly affected but the right ventricle is severely affected and
pulmonary pressure is increased in kyphoscoliosis. Cardiovascular functions do
not predict mortality in kyphoscoliosis patients under long term NIV treatment.

Keywords

Kyphoscoliosis, mechanical ventilation, bi-level continucus positive airway pressure, cardiac function tests, pulmonary hypertension

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