Bronkopulmoner displazi tedavisinde sistemik steroid kullanımı

Yıl 2015, Cilt 46, Sayı 2, 80 - 83, 16.03.2015

Selahattin AKAR Sevilay TOPÇUOĞLU Güner KARATEKİN Fahri OVALI

https://doi.org/10.16948/zktb.26917

Öz

Amaç: Bronkopulmoner displazi (BPD) oksijen ve pozitif basınçlı ventilasyon ile tedavi edilen prematüre bebeklerde gelişen kronik bir akciğer hastalığıdır. Bu çalışmada, BPD gelişen, sistemik steroid kullanılan olgularda tedavi etkinliğinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Çalışmaya 1 Ocak 2012 ile 31 Aralık 2012 tarihleri arasında Yenidoğan Yoğun Bakım Ünitesine yatırılarak izlenen, BPD gelişen ve solunum destek tedavisi gereken 18 prematüre bebek alındı. Steroid kullanım öncesi ve sonrası solunum destek durumları değerlendirildi.

Bulgular: Hastaların gestasyon yaşları ortalama 26,81±1,87 (24-31) hafta, yatış süresi ortalama 77,5±12,92 (23-142) gün, steroid tedavi süresi ortalama 7,85±3,43 (3-11) gün, postanatal steroid başlanma zamanı ortalama 39,8±17,11 (14-79) gün,kümülatif steroid dozu ortalama 0,65±0,27 (0,3-1,2) mg/kg, steroid başlandıktan sonra ekstube olduğu gün ortalama 7,82±8,14 (1-28), steroid başlandıktan sonra nazal CPAP’ın  (Continuous Positive Airway Pressure)  kesildiği  gün ortalama 16,6±14,4 (4-61) idi. Steroid başlandığında 14 hasta entübe,4 hasta  nazal CPAP tedavisi almaktaydı. Steroid sonlandığında nazal CPAP alan 4 hastadan birinin oksijeni kesilmiş, biri hood içi oksijenle izlenmeye geçmiş, biri kövöz içi oksijenle izleme geçmiş, biri nazal CPAP’ta izlenmeye devam edilmişti. Entübe olan 14 hastadan 5’i nazal CPAP’a geçmiş, 1’i küvöz içi oksijenle izleme alınmış,1’i hood içi oksijen ile 7’si entübe olarak izlenmeye devam edilmişti.

Sonuç: Bronkopulmoner displazi tedavisinde steroidler birçok merkezde farklı şekilde kullanılmasına rağmen kısa dönemdeki etkileri tartışmalıdır. Bu konuyla ilgili randomize kontrollü çalışma yapılması birçok nedenden dolayı zor olduğu için ancak bildirilen vaka grupları ile karar vermek gerekecektir.

Anahtar Kelimeler

Bronkopulmoner displazi, steroid, kronik akciğer hastalığı

Steroid treatment in bronchopulmonary dysplasia

Öz

Objective: Bronchopulmonary Dysplasia (BPD) is a chronic lung disease of premature newborns treated with positive pressure ventilation and oxygen. In this study we aimed to evaluate the efficiency of steroid usage in BPD patients.

Material and Method: Eighteen preterm newborn born between 01.01.2012 and 21.12.2012 were enrolled to the study. The oxygen need before and after treatment was evaluated. 

Results: The mean gestational age of patients were 26.81±1.87(24-31) weeks, length of hospital stay 77.5±12.92(23-142) days, length of steroid treatment 7.85±3.43 (3-11 ) days, starting with treatment 39.8±17.11 (14-79) days,  mean cumulative  dosage of steroid 0.65±0.27(0.3-1.2) mg/kg, extubation day after  treatment 7.82±8.14 (1-28), leaving CPAP after treatment 16.6±14.4(4-61). At the beginning of the treatment 14 patients were intubated and 4 were in CPAP. After treatment one of the four patients in CPAP stayed in CPAP, one needed oxygen in hood, one in free flow and the other no more oxygen treatment, from 14 intubated patients 5 needed nasal CPAP, one  oxygen in hood, one in free flow and the other 7 stated intubated.

Discussion: Although steroids are used in many centers in different therapy schedules, short term effects are still controversial. Since many factors confine to perform a randomized controlled study on this subject, observational studies are very important to gather more information.

Anahtar Kelimeler

bronchopulmonary dysplasia, steroid, chronic lung disease

Kaynakça

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