Acil Servise Başvuran Pnömotoraks Hastalarında EKG Değerlendirilmesi: Üç Yıllık Bir Analiz

Yıl 2021, Cilt: 13 Sayı: 3, 634 - 639, 18.10.2021

Salih Karakoyun , Mertay Boran , Ayhan Sarıtaş , Ertay Boran

https://doi.org/10.18521/ktd.895831

Cited By: 1

Öz

Amaç: Pnömotoraks, nefes darlığı ve göğüs ağrısı ile acil servise başvuran hastaların hayatı tehdit eden ayırıcı tanılarından biridir. Dinamik elektrokardiyografi (EKG) değişikliklerinin pnömotoraks tanısındaki yeri iyi tanımlanmamıştır. Çalışmamızın amacı, pnömotoraksta EKG'nin klinik önemini ortaya çıkarmaktır.
Gereç ve Yöntem: 01.04.2014 – 01.04.2017 tarihleri arasında acil servisimize başvuran ve pnömotoraks tanısı alan 147 hasta geriye dönük olarak incelendi. Hastalar Grup 1 (pnömotoraks hacmi <% 20) ve grup 2 (pnömotoraks hacmi>% 20) olarak ayrıldı. Hasta demografik özellikleri, pnömotoraks oluşum mekanizması (travmatik veya spontan), Röntgen ve tomografi bulguları, EKG bulguları, hastanede yatış-takip süreleri, tedavi yöntemleri; hastanenin veri kayıt sisteminden elde edildi ve gruplar arasında karşılaştırıldı.
Bulgular: 147 hastanın 109'unda (% 74,1) travmatik pnömotoraks, 38'inde (% 25,8) spontan pnömotoraks vardı (p <0,001). Spontan pnömotoraks vakalarından 21'i (% 55,2) birincil spontan pnömotoraks (PSP) idi. Hastaların% 64.6'sında (n = 95) göğüs ağrısı vardı. İki hasta grubu yaş, hemoglobin düzeyi, GKS, takip edilen gün sayısı, cinsiyet ve sigara içme durumu açısından birbirinden farklı değildi (p> 0.05). EKG verileri incelendiğinde iki grup arasında fark bulundu; Grup 1'deki hastaların% 52,8'inde EKG değişiklikleri varken, grup-2'deki tüm hastaların (% 100) olağandışı EKG bulguları vardı (p = 0,004).
Sonuç: Pnömotoraks acil serviste gözden kaçırılmaması gereken bir durumdur. EKG'sinde anormal bulgular olan durumlarda pnömotoraks (Klinik olarak anlamlı pnömotoraks, boyut>% 20) hatırlanmalıdır.

Anahtar Kelimeler

elektrokardiyografi, spontan pnömotoraks, travmatik pnömotoraks

ECG Evaluation in Patients with Pneumothorax Admitted to the Emergency Department: A Three years Analysis

Öz

Objective: Pneumothorax is one of the life-threatening differential diagnoses of patients presenting to emergency department (ED) with shortness of breath and chest pain. The place of dynamic electrocardiography (ECG) changes in diagnosis of pneumothorax was not well defined. The aim of our study was to reveal the clinical importance of ECG in pneumothorax.
Methods: Between 01.04.2014 and 01.04.2017, 147 patients who applied to our ED and take a diagnosis of pneumothorax were retrospectively examined. The patients were divided as Group 1 (with pneumothorax volume <20%), and group 2 (with pneumothorax volume> 20%). Patient demographics, mechanism of pneumothorax formation (traumatic or spontaneous), X ray and tomographic findings, ECG findings, hospitalization-follow-up periods, treatment methods; were derived from the hospital's data recording system and compared between groups.
Results: 109 (74.1 %) of 147 patients had a traumatic pneumothorax, and 38 (25.8%) had a spontaneous pneumothorax (p <0.001). 21 (55.2%) of the spontaneous pneumothorax cases are primary spontaneous pneumothorax. 64.6% (n=95) of the patients had chest pain. The two groups were similar in terms of age, hemoglobin level, GCS, number of days followed, gender and smoking status, (p> 0.05). When the ECG data was analyzed, a difference was found between the two groups. While 52.8% of the patients in group 1 had ECG changes, all of the patients in group-2 (100%) had unusual ECG findings (p = 0.004).
Conclusion: Pneumothorax is a condition that should not be overlooked at ED. Pneumothorax especially with large volume size (size> 20%) should be remembered in cases with abnormal findings in their ECG.

Anahtar Kelimeler

electrocardiography, spontaneous pneumothorax, traumatic pneumothorax

Kaynakça

• de Hoyos A, Fry WA. Pneumothorax. Chapter 58. In Shields, MD, Thomas W.; LoCicero, Joseph; Reed, Carolyn E.; Feins, Richard H, editors. General Thoracic Surgery, 7th edition, Lippincott Williams & Wilkins; 2009.p. 740-763.
• Bret A. Nicks, David E. Manthey. Pneumothorax. In Tintinalli JE, John Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, Thomas S, editors. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th Edition. McGraw-Hill Education; 2020.p.1-13.
• Pan H, Johnson SB. Blunt and Penetrating Injuries of the chest wall, pleura, diaphragm and lungs. In Loci cero III J, Feins RH, Colson YL, Rocco G, editors. Shields’ general thoracic surgery 8th edition, Copyright Wolters Kluwer. 2019. p. 2843-2879.
• Haynes D, Baumann MH. Management of Pneumothorax. Semin Respir Crit Care Med. 2010; 31(6): 769-80.
• Hallifax RJ, Goldacre R, Landray MJ, Rahman NM, Goldacre MJ. Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968-2016. JAMA. 2018; 320(14): 1471-1480.
• Baumann MH , Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax. An American College of Chest Physicians Delphi Consensus Statement. Chest 2001; 119(2): 590-602.
• Yeom SR, Park SW, Kim YD, Ahn BJ, Ahn JH, Wang IJ. Minimal pneumothorax with dynamic changes in ST segment similar to myocardial infarction. Am J Emerg Med. 2017; 35(8): 1210.e1-1210.e4.
• Tomiyama Y, Higashijima S, Kadota T, Kume K, Kawahara T, Ohshita N. Trends in electrocardiographic R-wave amplitude during intraoperative pneumothorax. Send to J Med Invest. 2014; 61(3-4): 442-5.
• Lin GM, Huang SC, Li YH, Han CL. Electrocardiographic changes in young men with left-sided spontaneous pneumothorax. Int J Cardiol. 2014; 177(1): e9.
• Huang SC, Lin GM, Li YH, Lin CS, Kao HW, Han CL. Abnormal Changes of a 12-Lead Electrocardiogram in Male Patients with Left Primary Spontaneous Pneumothorax. Acta Cardiol Sin. 2014; 30(2): 157-64.
• Krenke R, Nasilowski J, Przybylowski T, Chazan R. Electrocardiographic changes in patients with spontaneous pneumothorax. J Physiol Pharmacol. 2008; 59(6): 361–73.
• Sevinc S, Kaya SO, Unsal S, Koc S, Alar T, Gunay S, et al. Electrocardiographic changes in primary spontaneous pneumothorax. Turkish Journal of Thoracic and Cardiovascular Surgery. 2014; 22(3):601-609.
• Shiyovich A, Vladimir Z, Lior Nesher. Left spontaneous pneumothorax presenting with ST-segment elevations: A case report and review of the literature. Heart & Lung, 2011; 40(1), 88-91.
• Paul A. Laizzo. Basic ECG Theory, Recordings, and Interpretation. In: Anthony Dupre, Sarah Vincent editors. Handbook of Cardiac Anatomy, Physiology, and Devices. Humana Press; 2005. p. 191-201.
• Kircher LT, Swartzel RL. Spontaneous pneumothorax and its treatment. JAMA. 1954(1); 155: 24-9.
• Kearns MJ, Walley KR. Tamponade: Hemodynamic and Echocardiographic Diagnosis. Chest 2018; 153(5):1266-1275.
• Costin NI, Korach A , Loor G , Peterson MD, Desai ND , Trimarchi S, et al. Patients With Type A Acute Aortic Dissection Presenting With an Abnormal Electrocardiogram. Ann Thorac Surg 2018; 105(1): 92-99.
• Reamy BV, Williams PM, Michael Ryan Odom MR. Pleuritic Chest Pain: Sorting Through the Differential Diagnosis. Am Fam Physician 2017; 96(5):306-312.
• Kaya A, Y Arslan Y, Ozdogan O, Tokucoglu F, Sener U, Zorlu Y. Electrocardiographic Changes and Their Prognostic Effect in Patients with Acute Ischemic Stroke without Cardiac Etiology. Turkish Journal of Neurology 2018; 24(2): 137.
• Agrawal A, Anand Kumar A, Consul S, and Yadav A. Scorpion bite, a sting to the heart! Indian J Crit Care Med. 2015; 19(4): 233–236.
• Rudenko MY, Voronova OK, Zernov VA. Basic criteria of finding the markers of hemodynamic self-regulation mechanism on ECG and Rheogram and analysis of compensation mechanism performance in maintaining hemodynamic parameters at their normal levels. Cardiometry. 2012; 1: 31-47.
• Botz G, Brock-Utne JG. Are electrocardiogram changes the first sign of impending perioperative pneumothorax? Anaesthesia.1992; 47(12): 1057-1059.
• Vodička J, Špidlen V, Třeška V, Vejvodová Š, Doležal J, Židková A, et al. Traumatický pneumotorax - diagnostika a léčba 322 případů v pětiletém období [Traumatic pneumothorax - diagnosis and treatment of 322 cases over a five-year period]. Rozhl Chir. 2017; 96(11): 457-462.
• Saritas A, Kul C, Kandis H, Cıkman M, Candar M, Karadas S, et al. Traumatic Bilateral Pneumothorax: Three Case Reports. Konuralp Medical Journal 2011; 3(1): 28-31.
• Melton LJ, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950-1974. Am Rev Respir Dis 1979; 120(6): 1379-82.
• Kul C, Saritas A, Aydın LY. Treatment of Seconder Spontaneous Pneumothorax with “Otolog Blood Patch” Pleurodesis. Konuralp Medical Journal. 2013; 5(1): 31-33.
• Olesen WH, Katballe N, Sindby JE, Titlestad IL, Andersen PE, Lindahl-Jacobsen R, et al. Surgical treatment versus conventional chest tube drainage in primary spontaneous pneumothorax: a randomized controlled trial. Eur J Cardiothorac Surg. 2018; 54(1): 113-121.
• Thelle A, Gjerdevik M, SueChu M, Hagen OM, Bakke P. Randomised comparison of needle aspiration and chest tube drainage in spontaneous pneumothorax. European Respiratory Journal. 2017; 49(1601296); 1-9.