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Acil Servise Epistaksis İle Başvuran Hastalarda Anterior Ve Posterior Kanamaların Karşılaştırılması

Yıl 2022, Cilt: 7 Sayı: 2, 49 - 54, 02.08.2022

Öz

Amaç: Epistaksis, dünya genelinde olduğu gibi ülkemizde de yaygın bir sorun olması bununla birlikte nadiren acil servis başvurusu gerektirmesi nedeniyle halen önemini kaybetmemiştir. Etiyolojide birçok faktör yer almaktadır. Değişen çevresel etkenle, hasta özellikleri (ek hastalık öyküsü, ilaç kullanımı vb.) ve laboratuvar değerleri gibi birçok değişken her epistaksis hastasını kendine özgü kılmaktadır.
Çalışmamızda acil servisimize epistaksis ile başvuran hastalarda ayaktan ve yatarak tedavi gerektiren vakalar hakkında popülasyona dayalı veriler belirlenerek acil servis yönetimine katkısı araştırıldı.
Gereç ve Yöntemler: Acil servise epistaksis ile başvuran hastaların; demografik özellikleri, komorbiditeleri, başvuru anındaki hemodinamik ve laboratuvar parametreleri, uzman konsültasyon ihtiyacı ve ayaktan/yatarak tedavi ihtiyaçları retrospektif olarak değerlendirildi.
Bulgular: Çalışmaya 69’u (%60) erkek, 46’sı (%40) kadın toplam 115 hasta dahil edildi. Bu hastaların yaş ortalaması 55,4 (±19,1)yıldı. Komorbid hastalıkların ve ilaç kullanım öyküsünün, anterior veya posterior kanamayla başvuran hastalar arasında istatistik olarak anlamlı bir fark yaratmadığı saptanmadı. Posterior kanaması olan hastaların yatış oranı %63,6 (n=14), anterior kanamalarda bu oran %36,4 olarak saptandı. Bu fark istatistiksel olarak da anlamlı bulunmuştur (p<0,001). Laboratuvar parametreleri değerlendirildiğinde; nötrofil sayısı (p=0,015), Lenfosit sayısı (p=0,008), platelet lenfosit oranı (PLR) (p=0,000), nötrofil lenfositoranı (NLR) (p=0,003) posterior kanamalarda istatistiksel olarak da
anlamlı şekilde artmış saptandı.
Sonuç: Bu çalışmanın sonuçlarında inflamatuar belirteçler olan nötrofil, lenfosit, PLR ve NLR değerlerinin; posterior kanamalarda anlamlı şekilde artması, inflamatuar faktörlerin posterior kanamalarda etkisi olduğunu göstermektedir.

Destekleyen Kurum

Balıkesir Üniversitesi

Proje Numarası

2020/247

Kaynakça

  • Ceng-Jung L, Chen-June S, Pin-Chieh L, Chia-Hsun C, I-Shiang T, Po-Jen H, et al. Evaluation of the relationship between blood pressure control and epistaxis recurrence after achieving effective hemostasis in the emergency department. J acute med. 2020; 10(1): 27–39.
  • Krulewitz NA, Fix ML. Epistaxis. Emergency Medicine Clinics of North America 2019 ;37(1): 29-39.
  • Neshewat J, Wasserman A, Souphis CA, Haymart B, Feldeisen D, Kong X, et al. Reduction in epistaxis and emergency department visits in patients taking warfarin after implementation of an education program. Thrombosis Research, 2021;199:119-22.
  • Kuo CL. Updates on the Management of Epistaxis. Clinical medicine and therapeutics 2019;1(1):5.
  • Passali D, Damiani V, Passali FM, Tosca MA, Motta G, Giorgio Ciprandi G, et al. An International survey on the pragmatic management of epistaxis. Acta Biomed 2020;91(1):5-10.
  • Chaaban MR, Zhang D, Resto V, Goodwin JS. Demographic, seasonal, and geographic differences in emergency department visits for epistaxis. Otolaryngology Head and Neck Surgery 2017;156(1): 81–6.
  • Christensen NP, Smith DS, Barnwell SL,Wax MK. Arterial embolization in the management of posterior epistaxis. Otolaryngology Head and Neck Surgery 2005; 133: 748-53.
  • Pallin DJ, Chng YM, Emond JA, Pelletier AJ, Camargo CA. Epidemiology of epistaxis in us emergency departments, 1992 to 2001. Annals of Emergency Medicine, 2005; 46(1): 177-81.
  • Chaaban MR, Zhang D, Resto V, Goodwin JS. Factors influencing recurrent emergency department visits for epistaxis in the elderly. Auris Nasus Larynx, 2018; 45(4): 760-4.
  • Sarhan NA, Algamal AM. Relationship between epistaxis and hypertension:a cause and effect or coincidence? J Saudi Heart Assoc. 2015; 27:79-84.
  • Min HJ, Kang H, Joo G Choi, Kim KS. Association between hypertansiyon and epistaxis: systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2017 ; 157(6):921-7.
  • Karaman K, Enhoş Ş, Oskay A, Armağan HH. Can red cell distrubition width predict severity of episthaxis in emergency department? Med J SDU, 2019:26(2):159-63.
  • Tunkel DE, Anne S, Payne SC,İshman SL, Rosenfeld RM, Abramson PJ et al. Clinical practice guideline: Nose bleed (Epistaxis). Otolaryngology Head and Neck Surgery 2020;162(1) :1–38.
  • Yaniv D, Zavdy O, Sapir E, Levi L,Soudry E. The impact of traditional anticoagulants, novel antikoagulants and antiplatelets on epistaxis. The laryngoscope 2021;131:1946-51.
  • Aydın A, Ağıllı M, Aydın FN, Kurt YG, Çaycı T, Taş A, ve ark. Farklı yaş gruplarında nötrofil/lenfosit oranı referans aralıkları. Gülhane Tıp Derg. 2015;57:414-8.
  • Aksakal C, Şahin M. Evaluation of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in recurrent epistaxis in childhood: case controlled study. Pan Afr Med J. 2019; 32:154.

Comparison of Anterior and Posterior Hemorrhages in Patients Presenting to the Emergency Department with Epistaxis

Yıl 2022, Cilt: 7 Sayı: 2, 49 - 54, 02.08.2022

Öz

Objective: Epistaxis has still not lost its importance because it is a common problem in our country as well as in the world, and it rarely requires emergency service admission.. Many factors are involved in the etiology. Many variables such as changing environmental factors, patient characteristics (additional disease history, drug use, etc.) and laboratory values make each epistaxis patient unique. In our study, population-based data on cases requiring outpatient and inpatient treatment in patients who applied to our emergency department with epistaxis were determined and their contribution to emergency department management was investigated.
Material and Methods: Patients admitted to the emergency department with epistaxis; Demographic characteristics, comorbidities, hemodynamic and laboratory parameters at admission, need for specialist consultation and outpatient/inpatient treatment needs were evaluated retrospectively.
Results: İn our study were included a total of 115 patients, 69 (60%) male and 46 (40%) female. The mean age of these patients was 55,4 (±19,1) years. No statistically significant difference was found between patients presenting with anterior or posterior bleeding in comorbid diseases and drug use history. The hospitalization rate of patients with posterior bleeding was 63,6% (n=14), and this rate was 36,4% in anterior hemorrhages. This difference was also statistically significant (p<0,001). When laboratory parameters are evaluated; neutrophil count (p=0,015), lymphocyte count (p=0,008), platelet lymphocyte ratio (PLR) (p=0,000), neutrophil lymphocyte ratio (NLR) (p=0,003) were also found to be statistically increased in posterior hemorrhages.
Conclusion: In the results of this study, neutrophil, lymphocyte, PLR and NLR values, which are inflammatory markers; significant increase in posterior hemorrhages indicate that inflammatory factors have an effect on posterior hemorrhages.

Proje Numarası

2020/247

Kaynakça

  • Ceng-Jung L, Chen-June S, Pin-Chieh L, Chia-Hsun C, I-Shiang T, Po-Jen H, et al. Evaluation of the relationship between blood pressure control and epistaxis recurrence after achieving effective hemostasis in the emergency department. J acute med. 2020; 10(1): 27–39.
  • Krulewitz NA, Fix ML. Epistaxis. Emergency Medicine Clinics of North America 2019 ;37(1): 29-39.
  • Neshewat J, Wasserman A, Souphis CA, Haymart B, Feldeisen D, Kong X, et al. Reduction in epistaxis and emergency department visits in patients taking warfarin after implementation of an education program. Thrombosis Research, 2021;199:119-22.
  • Kuo CL. Updates on the Management of Epistaxis. Clinical medicine and therapeutics 2019;1(1):5.
  • Passali D, Damiani V, Passali FM, Tosca MA, Motta G, Giorgio Ciprandi G, et al. An International survey on the pragmatic management of epistaxis. Acta Biomed 2020;91(1):5-10.
  • Chaaban MR, Zhang D, Resto V, Goodwin JS. Demographic, seasonal, and geographic differences in emergency department visits for epistaxis. Otolaryngology Head and Neck Surgery 2017;156(1): 81–6.
  • Christensen NP, Smith DS, Barnwell SL,Wax MK. Arterial embolization in the management of posterior epistaxis. Otolaryngology Head and Neck Surgery 2005; 133: 748-53.
  • Pallin DJ, Chng YM, Emond JA, Pelletier AJ, Camargo CA. Epidemiology of epistaxis in us emergency departments, 1992 to 2001. Annals of Emergency Medicine, 2005; 46(1): 177-81.
  • Chaaban MR, Zhang D, Resto V, Goodwin JS. Factors influencing recurrent emergency department visits for epistaxis in the elderly. Auris Nasus Larynx, 2018; 45(4): 760-4.
  • Sarhan NA, Algamal AM. Relationship between epistaxis and hypertension:a cause and effect or coincidence? J Saudi Heart Assoc. 2015; 27:79-84.
  • Min HJ, Kang H, Joo G Choi, Kim KS. Association between hypertansiyon and epistaxis: systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2017 ; 157(6):921-7.
  • Karaman K, Enhoş Ş, Oskay A, Armağan HH. Can red cell distrubition width predict severity of episthaxis in emergency department? Med J SDU, 2019:26(2):159-63.
  • Tunkel DE, Anne S, Payne SC,İshman SL, Rosenfeld RM, Abramson PJ et al. Clinical practice guideline: Nose bleed (Epistaxis). Otolaryngology Head and Neck Surgery 2020;162(1) :1–38.
  • Yaniv D, Zavdy O, Sapir E, Levi L,Soudry E. The impact of traditional anticoagulants, novel antikoagulants and antiplatelets on epistaxis. The laryngoscope 2021;131:1946-51.
  • Aydın A, Ağıllı M, Aydın FN, Kurt YG, Çaycı T, Taş A, ve ark. Farklı yaş gruplarında nötrofil/lenfosit oranı referans aralıkları. Gülhane Tıp Derg. 2015;57:414-8.
  • Aksakal C, Şahin M. Evaluation of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in recurrent epistaxis in childhood: case controlled study. Pan Afr Med J. 2019; 32:154.
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makale
Yazarlar

Eylem Ersan 0000-0002-1756-0261

Meliha Fındık Bu kişi benim 0000-0002-7570-4200

Muhammet Çakas 0000-0003-3764-4398

Meliha Miray Çantal Bu kişi benim 0000-0001-5561-2192

Proje Numarası 2020/247
Yayımlanma Tarihi 2 Ağustos 2022
Kabul Tarihi 1 Ağustos 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 7 Sayı: 2

Kaynak Göster

Vancouver Ersan E, Fındık M, Çakas M, Çantal MM. Acil Servise Epistaksis İle Başvuran Hastalarda Anterior Ve Posterior Kanamaların Karşılaştırılması. JAMER. 2022;7(2):49-54.