Çocuk Yoğun Bakım Hastalarında Hiponatreminin Klinik Önemi

Öz

Hiponatremi çocuk acil ve yoğun bakım ünitelerinde sık görülen bir elektrolit bozukluğudur. Yetişkin hastalarda hiponatreminin mortalite için bağımsız bir risk faktörü olduğu gösterilmesine karşın özellikle çocuk yoğun bakım (ÇYB) hastalarında hiponatreminin klinik önemi ve prognoza etkisi yeterince irdelenmemiştir. Bu çalışmada çocuk yoğun bakım ünitesi’nde (ÇYBÜ) yatırılan hastalarda ilk gün hiponatremi sıklığı ve erken dönem prognoz ile olan ilişkisinin araştırılması planlanmıştır. Ekim 2016 ile Mart 2018 tarihleri arasında yatırılan tüm hastaların verileri geriye dönük olarak incelenmiştir. Çalışmaya alınan 435 hastanın 22’sinde orta ve ağır düzeyde hiponatremi saptandı. Hastaların 12’si (%54,5) erkek, 10’u (%45,5) kızdı. Yaş dağılımları 1,5 ay ile 17 yaş arasında olup ortalama hasta yaşı 3,67±2,00 yıldı. Hiponatremi saptanan hastaların ortalama yatış süresi 14,91±22,17 gündü. Serum sodyum (Na) düzeyinin düşüklüğü (Na<130 mmol/L) ile mekanik ventilatöre bağlanma, inotrop ilaç kullanımı, ÇYBÜ yatış süresi, çocuk mortalite  (PRISM ) skoru, kan ürünü kullanımı, ölüm, akut böbrek hasarı ve kalp yetmezliği arasında istatistiksel anlamlı ilişki saptandı. Çocuk hastalarda ilk başvuru sırasında Na<130mml/L olması mortalite ve morbidite ile ilişkili önemli bir prognostik belirteç olarak değerlendirilmelidir.

Anahtar Kelimeler

• Çocuk yoğun bakım,prognoz,hiponatremi,mortalite

The Clinical Importance of Hyponatremia in Pediatric Intensive Care Unit

Abstract

Circulating tumor cells (CTCs) play a crucial role in the metastatic spread of carcinoma. Therefore, CTC has been interest of a subject in the past few decades in terms of prognosis and response to the therapy in several cancer diseases. Recent improvements in technical approaches maintain to identify CTCs from whole blood have demonstrated the potential value of CTC detection as a liquid biopsy especially in those tumors where tissue accessibility is often challenging as in lung cancer. Lung cancer is the most common cause of death from cancer worldwide in both men and women which is commonly metastasize before it is diagnosed. The aim of this study is to enumerate of CTCs in peripheral blood sample (7.5 mL) of lung cancer patients by flow cytometry.  Our modified method which consists of enrichment and detection steps get involved in 9 patients with lung cancer and 9 healthy volunteers. We performed a density-based ficoll gradient centrifugation and a immunomagnetic separation technique (CD45 negative selection) for the enrichment step.  Next, multi-parameter flow cytometry based on the expression of anti-epithelial cell adhesion molecule and cytokeratins was used to detect circulating tumor cells among enriched cells. According to our results,  circulating tumor cells were not detected on healthy volunteers but circulating tumor cells were found in all of patients with lung cancer (Z=3.823; p<0.001). We demonstrate that circulating tumor cells were detectable in peripheral blood sample of lung cancer patients by our modified method.

Keywords

• pediatric intensive care unit,prognosis,hyponatremia,mortality

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