İnvaziv Olmayan Ventilasyon Kullanan Kronik Solunum Yetersizlikli Kifoskolyoz Hastalarının Kardiyak Fonksiyonlarının ve Total Mortalitenin Değerlendirilmesi

Abstract

Giriş: Biz bu çalışmada kronik solunum yetersizliği nedeniyle uzun dönem invaziv olmayan ventilasyon tedavisi alan kifoskolyoz hastalarında kardiyak fonksiyonlar ve mortalite oranları değerlendirmeyi amaçladık.

Hastalar ve Yöntem: İnvaziv olmayan ventilasyon kullanan kifoskolyoz hastaları bu çalışmaya alındı. Hasta özellikleri ve kardiyovasküler risk faktörleri kaydedildi. Tüm hastalara ambulatuvar ritim monitorizasyonu ve ekokardiografi yapıldı. Sonuçlar 26 yaş-cinsiyet ayarlanmış dispnesi olmayan gönüllüler ile karşılaştırıldı. Hastalar beş yıl süreyle takip edildi.

Bulgular: Yirmi üç kifoskolyoz hastası (54 ± 13 yaş, 15 erkek) çalışmaya alındı. Hipertansiyon ve paroksismal atrial fibrilasyon hasta grubunda daha sık izlendi. Sol ventrikül sistolik fonksiyonları normal iken diastolik fonsiyonları bozulmuş izlendi. Sağ ventrikül çapları normal iken sistolik/diyastolik fonksiyonları ortalama pulmoner arter basınçları kifoskolyoz hastalarında yüksek idi. Dört hasta takipte öldü. Ölümlerin ikisi ciddi hipoksemi nedeniyle diğer ikisi de sepsis nedeniyle gerçekleşti. Klinik, laboratuvar, ekokardiografi ve kardiyovasküler risk parametreler açısında ölenler ile hayatta kalanlar arasında fark izlenmedi.

Sonuç: Kifoskolyoz hastalarında hipertansiyon ve aritmi sık izlendi. Sol ventrikül hafif derecede fakat sağ ventrikül ciddi ölçüde etkilendiği ve pulmoner arter basınçlarının arttığı gözlendi. Uzun dönem invaziv olmayan ventilasyon tedavisi alan kifoskolyoz hastalarında kardiyovasküler fonksiyonlar mortaliteyi öngörmediği tespit edildi.

Keywords

• Kifoskolyoz,mekanik ventilasyon,iki-düzeyli pozitif hava yolu basıncı,kardiyak fonksiyon testleri,pulmoner hipertansiyon

Cardiac Functions and All-Cause Mortality in Kyphoscoliosis Patients with Chronic Respiratory Failure Using Non-invasive Ventilation

Abstract

Introduction: We aimed to evaluate cardiac functions and mortality rate in kyphoscoliosis patients with chronic respiratory failure under long term non-invasive ventilation (NIV).

Patients and Methods: Kyphoscoliosis patients, who used NIV, were included in the study. Patients’ characteristics and cardiovascular risk factors were recorded. Ambulatory rhythm monitoring and echocardiography were performed for all patients. Results were compared with 26 age-gender matched volunteers without dyspnea. Patients had been followed for five years.

Results: Twenty-three kyphoscoliosis patients (54 ± 13 years, 15 male) were included in the study. Hypertension and paroxysmal atrial fibrillation were more frequent in patients. Left ventricular systolic functions were normal but diastolic functions were worsened. Right ventricular sizes were normal but systolic and diastolic functions were worsened and the mean pulmonary artery pressure was higher in kyphoscoliosis patients. Four patients were died in follow up. Two of patients died due to severe hypoxia and two of them died due to sepsis. Clinical and laboratory properties including cardiovascular risk factors, echocardiographic examination were not different between the survived patients and dying ones.

Conclusion: Hypertension and arrhythmia are more frequent. The left ventricle is slightly affected but the right ventricle is severely affected and pulmonary pressure is increased in kyphoscoliosis. Cardiovascular functions do not predict mortality in kyphoscoliosis patients under long term NIV treatment.

Keywords

• Kyphoscoliosis,mechanical ventilation,bi-level continucus positive airway pressure,cardiac function tests,pulmonary hypertension

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