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Acil Serviste Pulmoner Tromboembolili Hastaların Farklı Puanlama Araçları İle Değerlendirilmesi

Yıl 2018, Cilt: 28 Sayı: 4, 151 - 156, 01.12.2018

Muhammet Raşit Özer Mehmet Ergin Fatih Altunay Aliye Nur Gökal Zerrin Defne Dündar Emin Fatih Vişneci Sedat Koçak Mehmet Gül

Öz

Amaç: Acil serviste pulmoner tromboemboli PTE tanısı alan hastaların mortalite ile demografik, klinik, laboratuvar ve skorlama özellikleri arasındaki ilişkiyi araştırmak.Gereç ve Yöntem: Bu retrospektif çalışmada, 2012-2015 yılları arasında acil servise başvuran torasik bilgisayarlı tomografi BT veya pulmoner BT anjiyografisi ile PTE tanısı alan 166 hasta çalışmaya dahil edildi. Hasta grubu Grup I sağ kalan ve Grup -II hayatta kalmayan olarak iki gruba ayrıldı. Hematolojik ve biyokimyasal laboratuvar parametreleri, laktat içeren arteriyel kan gazı değerleri ve tüm hastaların klinik şiddeti MWS, PESI ve MEWS skorlama sistemleri kullanılarak değerlendirildi.Bulgular: Arteriyel oksijen basıncı PaO2 ve laktat düzeyleri açısından, hasta grupları arasında istatistiksel olarak anlamlı bir fark bulundu. Grup II'de, PESI ve MEWS skorları Grup-I hastaları ile karşılaştırıldığında anlamlı olarak yüksek bulundu. Grup II hastalarında MWS skoru daha yüksekti.Sonuç: Burada kullanılan parametreler ve skorlama araçları sayesinde, PTE olgularını tanılamayı amaçladık. PTE'nin bu bulguların yardımıyla klinisyen tarafından daha erken teşhis edildiğinde, mortalite ve morbidite oranlarının azaltılacağını ve tedavinin daha etkili olacağını düşünmekteyiz

Anahtar Kelimeler

Acil servis MEWS PESI laktat lulmoner tromboembolizm

Kaynakça

  • British Thoracic Society. Suspected acute pulmonary embo- lism: a practical approach. Thorax 1997; 52:1–24.
  • PIOPED Investigators. Value of the ventilation-perfusi- on lungs can in acute pulmonary embolism. JAMA 1990; 263:2753-9.
  • Lucena J, Rico A, Vázquez R et al. Pulmonary embolism and sudden-unexpected death: prospective study on 2477 forensic autopsies performed at the Institute of Legal Medi- cine in Seville. J Forensic Leg Med 2009;16:196–201.
  • Soydinç H E, Yüce M, Sarı E. et al. Pulmonary Embolism in a Pregnant Patient Using Valproic Acid. JAEM 2012: 52-4.
  • Pulido T, Aranda A, Zevallos MA et al. Pulmonary embo- lism as a cause of death in patients with heart disease: an autopsy study. Chest 2006; 129: 1282-7.
  • Corrigan D, Prucnal C, Kabrhel C. Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients. Clin Exp Emerg Med 2016; 3: 117-25.
  • RD, Leeper KV Jr, Sostman HD et al.. Clinical characteris- tics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120: 871-9.
  • Goldhaber SZ. Pulmonary embolism. In: Mann D, Zipes D, Libby P, Bonow R, editors. Braunwald's heart disease: a textbook of cardiovascular medicine. tenth ed. Philadelp- hia: Saunders; 2015. p. 1664–81.
  • Kucher N, Rossi E, De Rosa M et al. Massive pulmonary embolism. Circulation 2006;113:577–82.
  • Sakuma M, Nakamura M, Nakanishi N et al. Inferior vena cava filter is a new additional therapeutic option to reduce mortality from acute pulmonary embolism. Circ J 2004;68:816-21.
  • Kasper W, Konstantinides S, Geibel A et al. Management strategies and determinants of outcome in acute major pul- monary embolism: results of a multicenter registry. J Am Coll Cardiol 1997;30:1165–71.
  • Wells PS, Anderson DR, Rodger M et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000;83:416– 20.
  • Wells PS, Anderson DR, Rodger M et al. Excluding pulmo- nary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary em- bolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001;135:98-107.
  • Xiao-Yu Z, Su-Qin B, Hong-Lin C et al. The prognostic value of pulmonary embolism severity index in acute pul- monary embolism: a meta-analysis. Respiratory Research 2012; 13:111.
  • Kruisselbrink R, Kwizera A, Crowther M et al. Modified EarlyWarning Score (MEWS) Identifies Critical Illness among Ward Patients in a Resource Restricted Setting in Kampala, Uganda: A Prospective Observational Study. PLoS One 2016;11:e0151408.
  • Salottolo K, Carrick M, Johnson et al. A retrospective co- hort study of the utility of the modified early warning score for interfacility transfer of patients with traumatic injury. BMJ Open 2017;7:e016143.
  • Van Galen L S, Dijkstra C C, Ludikhuize J et al. A Protoco- lised Once a Day Modified Early Warning Score (MEWS) Measurement Is an Appropriate Screening Tool for Major Adverse Events in a General Hospital Population. PLoS One 2016;11:e0160811.
  • Guzel A, Yavuz Y, Şişman B et al. A Retrospective Evalua- tion of Patients Admitted to Emergency Departments with Pulmonary Thromboembolism. JAEM 2015; 14: 8-11.
  • Hirsh J, Bates SM. Prognosis in acute pulmonary embolism. Lancet 1999; 353:1375-6.
  • Yücel N, Yetkin Ö Acil Serviste Pulmoner Tromboemboli Tanısı Alan Hastaların Retrospektif Olarak Değerlendi- rilmesi İnönü Üniversitesi Tıp Fakültesi Dergisi 2009; 16: 233-6.
  • Yolbaş İ, Şen V, Boşnak M et al. The relationship between blood lactate levels and mortality in pediatric intensive care patients. JCEI 2013; 4: 269-73.
  • Jansen TC, van Bommel J, Woodward R et al. Association between blood lactate levels, Sequential Organ Failure As- sessment subscores, and 28-day mortality during early and late intensive care unit stay: A retrospective observational study. Crit Care Med 2009;37:2369-74.
  • Acutepulmonaryembolism: part I: epidemiology, pathop- hysiology, and diagnosis. Goldhaber SZ, Elliott CG. Circu- lation 2003; 108:2726-9.
  • Arterial blood gas analysis and alveolar-arterial oxygen gradient in diagnosis and prognosis of elderly patients with suspected pulmonary embolism. Masotti L, Ceccarelli E, Cappelli R et al. Biol Sci Med Sci 2000; 55:M761-4.
  • Kearon C. Diagnosis of pulmonary embolism. Canadian Medical Association Journal 2003; 168: 183-94.
  • Elias A, Mallett S, Daoud-Elias M et al. Prognostic models in acute pulmonary embolism: a systematic review and meta- analysis. BMJ Open 2016;6:e010324.
  • Filho RR, Rocha LL, Corrêa TD, et al. Blood lactate levels cutoff and mortality prediction in sepsis time for a reapp- raisal? A retrospective cohort study. Shock 2016;46:480-5.
  • Ho L O, Li H, Shahidah N et al. Poor performance of the modifi ed early warning score for predicting mortality in critically ill patients presenting to an emergency depart- ment. World J Emerg Med 2013;4:273-8.
  • Bach AG, Taute BM, Baasai N et al. 30-Day Mortality in Acu- te Pulmonary Embolism: Prognostic Value of Clinical Sco- res and Anamnestic Features. PLoS One 2016;11:e0148728.

Yıl 2018, Cilt: 28 Sayı: 4, 151 - 156, 01.12.2018

Muhammet Raşit Özer Mehmet Ergin Fatih Altunay Aliye Nur Gökal Zerrin Defne Dündar Emin Fatih Vişneci Sedat Koçak Mehmet Gül

Öz

Objective: To investigate the association between the mortality, and the demographic, clinical, laboratory and scoring features of the patients diagnosed with pulmonary thromboembolism PTE in the emergency department.Material and Methods: This retrospective study included 166 patients diagnosed with PTE through thoracic computerized tomography CT or pulmonary CT angiography referred to emergency services between 2012 and 2015. The patients group was classified into two groups as Group-I survival and Group-II non-survival . Hematological and biochemical laboratory parameters, arterial blood gas values including lactate and the clinical severity of all patients were assessed using MWS, PESI and MEWS scoring systems.Results: In terms of arterial oxygen tension PaO2 and lactate levels, a statistically significant difference was observed between the patient groups p=0,043, p

Anahtar Kelimeler

Emergency MEWS PESI lactat pulmonary thromboembolism

Kaynakça

  • British Thoracic Society. Suspected acute pulmonary embo- lism: a practical approach. Thorax 1997; 52:1–24.
  • PIOPED Investigators. Value of the ventilation-perfusi- on lungs can in acute pulmonary embolism. JAMA 1990; 263:2753-9.
  • Lucena J, Rico A, Vázquez R et al. Pulmonary embolism and sudden-unexpected death: prospective study on 2477 forensic autopsies performed at the Institute of Legal Medi- cine in Seville. J Forensic Leg Med 2009;16:196–201.
  • Soydinç H E, Yüce M, Sarı E. et al. Pulmonary Embolism in a Pregnant Patient Using Valproic Acid. JAEM 2012: 52-4.
  • Pulido T, Aranda A, Zevallos MA et al. Pulmonary embo- lism as a cause of death in patients with heart disease: an autopsy study. Chest 2006; 129: 1282-7.
  • Corrigan D, Prucnal C, Kabrhel C. Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients. Clin Exp Emerg Med 2016; 3: 117-25.
  • RD, Leeper KV Jr, Sostman HD et al.. Clinical characteris- tics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120: 871-9.
  • Goldhaber SZ. Pulmonary embolism. In: Mann D, Zipes D, Libby P, Bonow R, editors. Braunwald's heart disease: a textbook of cardiovascular medicine. tenth ed. Philadelp- hia: Saunders; 2015. p. 1664–81.
  • Kucher N, Rossi E, De Rosa M et al. Massive pulmonary embolism. Circulation 2006;113:577–82.
  • Sakuma M, Nakamura M, Nakanishi N et al. Inferior vena cava filter is a new additional therapeutic option to reduce mortality from acute pulmonary embolism. Circ J 2004;68:816-21.
  • Kasper W, Konstantinides S, Geibel A et al. Management strategies and determinants of outcome in acute major pul- monary embolism: results of a multicenter registry. J Am Coll Cardiol 1997;30:1165–71.
  • Wells PS, Anderson DR, Rodger M et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000;83:416– 20.
  • Wells PS, Anderson DR, Rodger M et al. Excluding pulmo- nary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary em- bolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001;135:98-107.
  • Xiao-Yu Z, Su-Qin B, Hong-Lin C et al. The prognostic value of pulmonary embolism severity index in acute pul- monary embolism: a meta-analysis. Respiratory Research 2012; 13:111.
  • Kruisselbrink R, Kwizera A, Crowther M et al. Modified EarlyWarning Score (MEWS) Identifies Critical Illness among Ward Patients in a Resource Restricted Setting in Kampala, Uganda: A Prospective Observational Study. PLoS One 2016;11:e0151408.
  • Salottolo K, Carrick M, Johnson et al. A retrospective co- hort study of the utility of the modified early warning score for interfacility transfer of patients with traumatic injury. BMJ Open 2017;7:e016143.
  • Van Galen L S, Dijkstra C C, Ludikhuize J et al. A Protoco- lised Once a Day Modified Early Warning Score (MEWS) Measurement Is an Appropriate Screening Tool for Major Adverse Events in a General Hospital Population. PLoS One 2016;11:e0160811.
  • Guzel A, Yavuz Y, Şişman B et al. A Retrospective Evalua- tion of Patients Admitted to Emergency Departments with Pulmonary Thromboembolism. JAEM 2015; 14: 8-11.
  • Hirsh J, Bates SM. Prognosis in acute pulmonary embolism. Lancet 1999; 353:1375-6.
  • Yücel N, Yetkin Ö Acil Serviste Pulmoner Tromboemboli Tanısı Alan Hastaların Retrospektif Olarak Değerlendi- rilmesi İnönü Üniversitesi Tıp Fakültesi Dergisi 2009; 16: 233-6.
  • Yolbaş İ, Şen V, Boşnak M et al. The relationship between blood lactate levels and mortality in pediatric intensive care patients. JCEI 2013; 4: 269-73.
  • Jansen TC, van Bommel J, Woodward R et al. Association between blood lactate levels, Sequential Organ Failure As- sessment subscores, and 28-day mortality during early and late intensive care unit stay: A retrospective observational study. Crit Care Med 2009;37:2369-74.
  • Acutepulmonaryembolism: part I: epidemiology, pathop- hysiology, and diagnosis. Goldhaber SZ, Elliott CG. Circu- lation 2003; 108:2726-9.
  • Arterial blood gas analysis and alveolar-arterial oxygen gradient in diagnosis and prognosis of elderly patients with suspected pulmonary embolism. Masotti L, Ceccarelli E, Cappelli R et al. Biol Sci Med Sci 2000; 55:M761-4.
  • Kearon C. Diagnosis of pulmonary embolism. Canadian Medical Association Journal 2003; 168: 183-94.
  • Elias A, Mallett S, Daoud-Elias M et al. Prognostic models in acute pulmonary embolism: a systematic review and meta- analysis. BMJ Open 2016;6:e010324.
  • Filho RR, Rocha LL, Corrêa TD, et al. Blood lactate levels cutoff and mortality prediction in sepsis time for a reapp- raisal? A retrospective cohort study. Shock 2016;46:480-5.
  • Ho L O, Li H, Shahidah N et al. Poor performance of the modifi ed early warning score for predicting mortality in critically ill patients presenting to an emergency depart- ment. World J Emerg Med 2013;4:273-8.
  • Bach AG, Taute BM, Baasai N et al. 30-Day Mortality in Acu- te Pulmonary Embolism: Prognostic Value of Clinical Sco- res and Anamnestic Features. PLoS One 2016;11:e0148728.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Original Article
Yazarlar

Muhammet Raşit Özer Bu kişi benim

Mehmet Ergin Bu kişi benim

Fatih Altunay Bu kişi benim

Aliye Nur Gökal Bu kişi benim

Zerrin Defne Dündar Bu kişi benim

Emin Fatih Vişneci Bu kişi benim

Sedat Koçak Bu kişi benim

Mehmet Gül Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 28 Sayı: 4

Kaynak Göster

Vancouver Özer MR, Ergin M, Altunay F, Gökal AN, Dündar ZD, Vişneci EF, Koçak S, Gül M. Acil Serviste Pulmoner Tromboembolili Hastaların Farklı Puanlama Araçları İle Değerlendirilmesi. Genel Tıp Derg. 2018;28(4):151-6.

Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.