Künt Gövde Travmalı Hastalarda İnferior Vena Cava Düzlük İndeksinin Erken Hipovolemik Şoktaki Rolü

Öz

AMAÇ: Amacımız künt gövde travmalı hastalarda vena kava inferior (VCI) düzlük indeksinin erken hipovolemik şokdaki rolünü değerlendirmektir. GEREÇ VE YÖNTEM: Bilgisayarlı tomografi (BT) taramasında düzlük indeksi 2'nin altında olan hastalar düzleşmiş VCI’lu hastalar, 2 veya üstünde olanlar düzleşmemişVCI’lu hastalar olarak kabul edildi. Düzleşmiş VCI’lu hastalar ve düzleşmemiş VCI’lu hastaların demografik verileri, komorbiditeleri, travma mekanizması, Yaralanma Ciddiyet Skoru (YCS), Glasgow Koma Skoru (GKS), laktat düzeyi, baz fazlalığı, şok indeksi (SI), 24 saat içindeki klinik sonuçları ve mortalite karşılaştırıldı. BULGULAR: 116 (30,6%) hasta düzleşmiş VCI’lu, 263 hasta (69,4%) düzleşmemiş VCI’lu idi. Düzleşmiş VCI’lu hastalar ve düzleşmemiş VCI’lu hastalar arasında yaş, cinsiyet, komorbitite ve travma mekanizması açısından anlamlı farklıklık saptanmadı (p>0.05). Düzleşmiş VCI’lu hastaların SI değeri 0,9 ve üzerindeydi (p<0,001). Düzleşmiş VCI’lu hastaların YCS'si daha yüksekti (p<0,001). Düzleşmiş VCI’lu hastalar ve düzleşmemiş VCI’lu hastalarında GCS skoru açısından fark yoktu (p>0.05). Düzleşmiş VCI’lu hastalarda laktat düzeyi daha yüksek bulundu (p<0,001). Düzleşmiş VCI’lu hastalarındaki baz fazlalığı, düzleşmiş VCI’lu hastalara göre daha düşük bulundu (p<0,001). Düzleşmiş VCI’lu hastalarda volüm replasmanı, operasyon, hastaneye yatış ve hastane mortalitesi daha yüksekti (p<0,001). Hastaların VCI düzlük indeksi ile laktat değeri ve YCS arasında negatif (sırasıyla r=-0.353 p<0.001; r=-0.702 p<0.001), baz fazlalığı arasında ise pozitif korelasyon bulundu. (r=0.656; p<0.001). SONUÇ: Künt gövde travmalı hastaların ilk BT incelemesinde VCI düzlük indeks’i erken hipovolemik şok ile ilişkilidir. VCI düzlük indeks’inin intravasküler volüm değerlendirilmesinde yol gösterici olabileceğini düşünmekteyiz.

Anahtar Kelimeler

• künt travma
• bilgisayarlı tomografi
• inferior vena kava

The Role of Flatness Index of Inferior Vena Cava in Early Hypovolemic Shock Concerning Blunt Torso Trauma Patients

Öz

AIM: Our aim is to evaluate the role of flatness of index of Inferior Vena Cava (IVC) with early hypovolemic shock in blunt torso trauma patients. MATERIAL AND METHOD: In the computed tomography (CT) scan, patients with flatness index below 2 were considered as flat IVC patients, and those with 2 or more were considered as non-flattened IVC patients. Demographic data, comorbidities, trauma mechanism, Injury Severity Score (ISS), Glasgow Coma Score (GCS), lactate level, base excess, shock index (SI), clinical outcomes within 24 hours, and mortality of the flat IVC patients and non-flattened IVC patients were compared. RESULTS: 116 (30.6%) were found to have a flat IVC and 263 (69.4%) patients were found to have a non-flattened IVC. There was no significant difference between flat IVC patients and non-flattened IVC patients in terms of age, gender, comorbidity, and trauma mechanism (p>0.05). Flat IVC patients had a higher SI of 0.9 and above (p<0.001). ISS of flat IVC patients was higher (p<0.001). There was no difference in GCS score between patients with a flat IVC and patients with a non-flattened IVC (p>0.05). Lactate level was found to be higher in flat IVC patients (p<0.001). Base excess in flat IVC patients was found inferior to that of non-flattened IVC patients (p<0.001). Volume replacement, operation, hospitalization, and hospital mortality were higher in patients with flat IVC (p<0.001). A negative correlation was found between the patients' flatness index of IVC and, lactate level and ISS (r=-0.353 p<0.001; r=-0.702 p<0.001, respectively), and a positive correlation was found between the base excess. (r=0.656; p<0.001). CONCLUSION: In the initial CT scan of blunt torso trauma patients, the flatness of the IVC index is associated with early hypovolemic shock. The flatness of the IVC index can be used as a guide in the evaluation of intravascular volume in these patients.

Anahtar Kelimeler

• blunt travma
• computed tomogarphy
• inferior vena cava

Kaynakça

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