Çocuklarda Plevral Ampiyem Tedavisi Sonrası Uzun Süreli İzlemde Akciğer Fonksiyonları

Yıl 2010, Cilt: 8 Sayı: 1, 117 - 124, 01.06.2010

Ayhan Kırkpınar Yakup Canıtez , Solmaz Çelebi Nihat Sapan Mustafa K. Hacımustafaoğlu Arif Gürpınar

Öz

Giriş: Çocukluk çağında ampiyem tedavisi sonrası uzun süreli izlemde akciğer fonksiyonlarının değerlendirilmesi ile ilgili çalışmalar az sayıdadır. Bu çalışmada ampiyemliçocuklarda antibiyotik AB veya antibiyotik + tüp torakostomi TT veya AB+TT+fibrinolitik FT tedavileri sonrası geç dönem solunum fonksiyon testleri sonuçlarının araştırılması amaçlandı.Gereç ve Yöntem: Ampiyem nedeniyle 1-13 yaşlarında tedavi edilmiş 45 olgu çalışmaya alındı. Hastaların yaş, cinsiyet, başlangıç ve izlem süresince saptanan klinikbulguları, radyoloji ve laboratuvar sonuçları, uygulanan tedaviler AB veya AB+TTveya AB+TT+FT incelendi. İzlem süreleri sonunda solunum fonksiyon testleri yapılarak değerlendirildi. Bulgular: Olguların ortalama yaşları ilk başvuruda 6,3±3,3 yaş 1-13 yaş , izlem süresisonunda ortalama 9,3±3,4 yaş 4-17 yaş , ortalama izlem süreleri 30,4±13,5 ay 6-54 ay olarak bulundu. İlk başvurularında ampiyemli olguların 14’ü %31,1 akut eksudatif evre Evre 1 , 19’u %42,2 fibropürülan evre Evre 2 ve 12’si %26,7 kronik organize evre Evre 3 olarak sınıflandırılmıştı. Yirmi bir %46,7 olgu AB, 8 %17,8 olgu AB+TT ve16 %35,5 olgu da AB+TT+FT tedavisi almıştı. İzlem süresinde akciğer grafilerinde 3.ayda 15 %33,3 , 6. ayda 3 %6,6 olguda patolojik bulgu bulundu, 12. ayda tamamı normaldi. Yirmibeş olguya solunum fonksiyon testleri yapılabildi. Bu olguların ortalama izlem süreleri 32,7±11,9 ay idi. Yirmibeş olgunun 3’ünde %12 minimal restriktif bulgularsaptandı, bu 3 olgunun izlem süreleri daha kısa idi 8,3±3,3 ay . Solunum fonksiyontestleri yapılan 25 olgudan 6’sı %24 Evre 1, 12’si %48 Evre 2, 7’si %28 Evre 3 ampiyem olarak sınıflandırılmıştı ve 12 olgu %48 AB, 4 olgu %16 AB+TT, 9 olgu %36 AB+TT+FT tedavisi almıştı. Evrelere ve tedavi yöntemlerine göre olguların VC, FVC,FEV1/FVC, FEV1, FEF25-75% ve PEF değerleri ortalamaları karşılaştırıldığında gruplararasında istatistiksel anlamlı farklılıklar bulunmadı p>0,05 .Sonuç: Çocuklarda ampiyem tedavisi sonrası izlem süresinde 3.- 6. aylar arasında akciğer grafilerinde belirgin düzelmenin gözlendiği ve geç dönemde solunum fonksiyontestlerinin genel olarak normal sınırlar içinde olduğu belirlendi. Sonuçlarımız çocuklarda ampiyem tedavisi sonrası uzun dönemde akciğer fonksiyonlarında belirgin birbozulma gelişmediğini düşündürmektedir

Anahtar Kelimeler

Ampiyem, akciğer, çocuk, solunum fonksiyon testleri

Lung Functions During Long Term Follow-Up After Pleural Empyema Treatment in Children

Öz

Introduction: Studies on lung functions at the long term follow-up of pleural empyema treatment in children are limited. The aim of this study was to evaluate the longterm pulmonary function test results in childhood empyema cases treated with antibiotic AB or AB+tube thoracostomy TT or AB+TT+fibrinolytics FT . Materials and Method: In this study, 45 cases 1 to 13 years old treated for empyemawere included. The age, gender, clinical characteristics, radiological findings and laboratory results at baseline and during the follow-up periods and the treatment modalities AB or AB+TT or AB+TT+FT were evaluated. Pulmonary function tests were performed at the end of the follow-up periods. Results: The mean ages at baseline and at the end of follow-up period of 30.4±13.5 months were 6.3±3.3 years and 9.3±3.4 years, respectively. Stages of the disease at admission was acute exudative stage 1 in 14 31.1% cases, fibrinopurulent stage 2 in 19 42.2% and chronic organizing stage 3 in 12 26.7% . Twenty one cases 46.7% were treated with AB, 8 17.8% with AB+TT and 16 35.5% with AB+TT+FT. Chest roentgenograms showed abnormal findings in 15 cases 33.3% at the 3rdmonth, in 3 cases 6.6% at the 6thmonth and none at the 12thmonth. Pulmonary function tests were available in 25 children. The mean follow-up period of these cases was 32.7±11.9 months after the empyema treatment. Three cases 12% with a shorter mean follow-up 8.3±3.3 months had minimal restrictive patterns. Six of25 24% cases having pulmonary function tests were classified as stage 1, 12 48% as stage 2, and 7 28% as stage 3 empyema at admission. Of 25 cases having pulmonary function tests, 12 48% were treated with AB, 4 16% withAB+TT and 9 36% with AB+TT+FT. Mean VC, FVC, FEV1/FVC, FEV1, FEF25-75% and PEF values did not significantly differaccording to stages and treatment modalities p>0.05 .Conclusion: It was seen that after the treatment of empyema, remarkable improvements were seen in chest roentgenographic findings between 3rdand 6thmonths and in general, pulmonary function tests revealed normal resultsin long term. Our results suggest that lung functions are not significantly compromised at long term after empyema

Anahtar Kelimeler

Empyema, lung, children, pulmonary function tests

Kaynakça

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