Çocuk Yoğun Bakım Hastalarında Hiponatreminin Klinik Önemi

Year 2018, Volume: 3 Issue: 4, 206 - 214, 29.12.2018

Fatih Aygün , Seda Aras Fatih Varol Ahmet İrdem

https://doi.org/10.26453/otjhs.434105

Abstract

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.

Keywords

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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