PULMONER EMBOLİDE TROMBOLİTİK TEDAVİ VE KONVANSİYONEL TEDAVİ ETKİNLİĞİNİN 10. GÜNDE KARŞILAŞTIRILMASI

Yıl 2017, Cilt: 31 Sayı: 3, 135 - 144, 01.12.2017

Gökhan Aykun Mükremin Er Ayşegül Karalezli H.canan Hasanoğlu

Öz

Amaç: Trombolitik tedavinin hastaya sadece ilk
birkaç gün fayda sağladığı, 1. haftadan sonra ise
sadece antikoagülan tedavi alanların da benzer
trombüs erime oranlarına sahip oldukları düşünülmektedir.
Bu çalışmanın amacı trombolitik tedavinin
10. gününde hastaların klinik parametrelerine
ve Pulmoner Arter BT Obstrüksiyon İndeksi açılma
oranlarına etkisinin olup olmadığının araştırılmasıdır.

Yöntem ve Gereç: Çalışmaya pulmoner tromboemboli
tanısı konmuş 28 olgu alındı. Trombolitik
tedavi verilmesinin uygun görüldüğü 15 hasta
çalışma grubuna (grup 1), kalan 13 hasta ise
konvansiyonel tedavi(antikoagülan tedavi) grubuna
(grup 2) alındı. Tedavinin semptomların başlamasından
sonraki ilk 14 günde başlandığı hastalardan
trombolitik (r-TPA) verilenler grup 3, verilmeyenler
grup 4 olarak planlandı. Çalışma grubundaki hastalara
tanı konulduğu anda protokole göre trombolitik
tedavi uygulandı ve ardından antikoagülan
tedavi ile devam edildi. Kontrol grubundaki
hastalara sadece antikoagülan tedavi verildi. Geliş
sırasında ve 10. günde pulmoner BT anjiyografi,
transtorasik ekokardiyografi, arteryel kan gazı
çalışıldı. PABTOİ hesaplandı. Veriler tedaviden önce
ve tedaviden sonra 10. günde gruplar arasında
karşılaştırıldı. Bulgular: Gruplar arasında başlangıç kriterlerinde
istatistiksel olarak anlamlı farklılık saptanmadı.
Grup 1’de 10. günde %52.8±25.5’lük açılma oranı
elde edilirken, grup 2’de bu oran %42.5±20.0
olarak saptandı. Grup 3’de10. günde açılma oranı
%58.4±24.5’e ulaşırken, grup 4‘de bu oran
%42.2±22.2 bulundu. Tedavinin 10. gününde grup
3’deki hastalarda grup 4’e göre PO2, SaO2 ve PAB
değerlerinde anlamlı düzelme bulundu (p<0.05).
Sonuç: Sonuç olarak, pulmoner embolinin akut
döneminde yararı bilinen trombolitik tedavinin,
yalnız konvansiyonel antikoagülan verilen gruba
göre daha iyi BT açılma oranları, AKG ve EKO
bulgularının olması tedavinin 10. gününde bile
yararlı olduğunu göstermiştir.

Anahtar Kelimeler

Pulmoner emboli, pulmoner BT anjiyografi, r-TPA

COMPARISON OF THROMBOLYTIC AND CONVANSIONAL TREATMENT EFFICIENCY IN PULMONARY EMBOLISM ON THE 10TH DAY OF TREATMENT

Öz

Aim: Benefit of thrombolytic therapy for the
patients with pulmonary embolism is thought to
be in only the first few days and it’s considered
that after the first week anticoagulation therapy
has similar rates of resolution. The purpose of the
study is to investigate the effect of thrombolytic
therapy on the patient's clinical parameters and
Pulmonary Artery CT Obstruction Index opening
rates on the tenth day.
Material and Methods: In this study, 28
pulmonary embolism cases were investigated.
Taken in to consideration clinical, radiographic,
echocardiographic, biochemical findings, and
contraindications to thrombolytic therapy, 15
patients enrolled to the thrombolytic therapy
group (group 1) and the remaining 13 patients
were included in the conventional therapy (group
2).Patients given thrombolytic therapy(r-TPA) in
the first 14 days after pulmonary embolism was
planned as group 3 and treated with
anticoagulants only as group 4. Pulmonary CT
angiography, transthoracic echocardiography
(ECHO), arterial blood gasses were studied on
admission and tenth day. PACTOI was calculated
from pulmonary CT angiography. Results: Differences were insignificant between
the groups for the initial criteria. Opening rate on
the tenth day was 52.8%±25.5 in group 1 and
42.5%±20.0 in group 2. In patients of group 3
opening rate was 58.4%±24.5 on the tenth day,
whereas in group 4 it was 42.2%±22.2. Significant
improvements on PO2, SaO2 and PAP was seen in
group 3 patients at the tenth day when compared
with group 4 (p<0.05).
Conclusion: As a conclusion it is shown that
patients receiving thrombolytic therapy had better
PACTOI and ABG and ECHO findings at the tenth
day.

Anahtar Kelimeler

Pulmonary embolism, pulmonary CT angiography, r-TPA

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