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Giriş ve Amaç: Üst gastrointestinal sistem kanaması çocukluk çağında çoğunlukla hafif olmakla birlikte, hayatı tehdit eden ciddi kanama şeklinde de görülebilmektedir. Bu çalışmada klinik olarak anlamlı üst gastrointestinal sistem kanamasına işaret eden bulguların ve risk faktörlerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Çalışmaya üst gastrointestinal sistem kanaması tanısı alan, 0-18 yaş aralığında çocuklar alındı. Tanı anındaki yaşı, cinsiyeti, kanama miktarı, hematemez, melena varlığı, başvuru anındaki yakınmaları, eşlik eden hastalıkları, kanamaya yatkınlık yaratan ilaç kullanımı, vital bulguları, kapiller dolum zamanı ve sistemik fizik muayene bulguları kaydedildi. Laboratuvar tetkiklerinden hemogram, biyokimya, koagülasyon testleri, endoskopik işlem bulguları, eritrosit transfüzyonu sayısı, uygulanan medikal ve/veya endoskopik tedaviler, acilde ya da serviste izlemleri ve kanama açısından konulan son tanısı kaydedildi. Sheffield skorlamasına göre 8 puan ve üzeri alanlar anlamlı üst gastrointestinal sistem kanaması olanlar olarak gruplandı, veriler gruplar arasında karşılaştırıldı. Bulgular: Elli beş çocuk [29 (%52.7) kız, 26 (%47.3) erkek ortalama tanı yaşı 8.4±5.4 yıl] çalışmaya alındı. Başvuru anında 22 hastada anemi, 20 hastada kan üre azotu yüksekliği, 14 hastada eritrosit sayısında düşüklük, 5 hastada hipoalbüminemi vardı. Anlamlı kanaması olan 17 hastada melena (%76.5 vs. %21.1, p <0.001), solukluk (%52.9 vs %5.3, p <0.001), splenomegali (%23.5 vs %2.6, p <0.001), özofageal varis (%23.5 vs. %2.6, p=0.02), bolus sıvı (%41.2 vs. %5.3, p <0.001) ve transfüzyon gereksinimi (%70.6 vs. %5.3, p <0.001) daha sık, kalp hızı (137.4±22.1 vs 117.5±21.3, p=0.01), kapiller dolum zamanı (%35.3 vs. %2.6, p <0.001) ve kan üre azotu (19.2±8.4 mg/dL vs 13.3±4.8 mg/dL, p=0.01) düzeyi daha yüksek, hemoglobin (9.8±2.2 mg/dL vs 11.7±2.1mg/dL, p=0.02), eritrosit sayısı (3.78×106/μL vs 4.29×106/μL, p <0.001) ve albümin (3.94±0.47 vs 4.38±0.51, p=0.03) düzeyleri ise daha düşük bulundu. En sık saptanan üst gastrointestinal sistem kanaması nedenleri gastrit (%20), Mallory Weiss (%16.4), özofajit (%12.2), ülser (%12.2) ve özofagus varisleri (%9.1) idi. Sonuç: Üst gastrointestinal sistem kanaması olan hastanın riskini tahmin etmek ve zamanında gerekli girişimleri yapmak için anlamlı üst gastrointestinal sistem kanamasının klinik ve laboratuvar parametrelerini bilmek önemlidir. Sheffield skorlamasında yer alan kriterlerin yanında çalışmamızda, fizik incelemede solukluk ve splenomegali, laboratuvar incelemede ise eritrosit sayısında ve albüminde düşüklük ile kan üre azotu yüksekliği anlamlı üst gastrointestinal sistem kanamaya işaret eden bulgular olarak saptanmıştır.
Introduction and Purpose: Upper gastrointestinal system bleeding is often mild in childhood, but it can also be seen in the form of a serious life-threatening bleeding. This study was aimed at determining the findings and risk factors that indicate clinically meaningful upper gastrointestinal system bleeding. Method and method: Children between 0 and 18 years of age who were diagnosed with upper gastrointestinal system bleeding were taken to study. Age at the moment of diagnosis, gender, amount of bleeding, hematoma, the presence of melena, immediate proximity of application, accompanying diseases, the use of drugs that cause the tendency to bleeding, vital findings, time of filling of capillaries and systemic physical examination findings were recorded. Laboratory examinations recorded hemogram, biochemistry, coagulation tests, endoscopic process findings, number of erythrosite transfusions, medical and/or endoscopic treatments, emergency or service observations, and the final diagnosis of bleeding. According to Sheffield scores, the areas of 8 points and above were grouped as those with significant upper gastrointestinal system bleeding, the data was compared between the groups. The findings: Fifty five children [29 (52.7) girls, 26 (47.3) men; an average diagnosed age of 8.4±5.4 years] were taken to study. At the time of application, 22 patients had anemia, 20 patients had a high blood uric nitrate, 14 patients had a low number of erythrosites, 5 patients had hypoalbuminemia. In 17 patients with meaningful bleeding; melena (%76.5 vs.%21.1, p <0.001), breathing (%52.9 vs.%5.3, p <0. 001), splenomegali (%23.5 vs.%2.6, p <0.001), ozofageal varis (%23.5 vs.%2.6, p=0.02), bolus fluid (%41.2 vs.%5.3, p <0.001) and transfusion requirements (%70.6 vs.%5.3, p <0.001) more frequently, heart rate (137.4±22.1 vs. 117.5±21.3, p=0.01), capillary filling time (%35.3 vs.%2.6, p <0.001) and blood urogenital nitrogen (19.2±8.4 mg/dL vs. 13.3±4.8 mg/dL, p=0.01) levels higher, hemoglobin (%9.2±2.2 mg/dL vs. 11.7 mg/dL = 11.7 mg/dL = 11.7 mg/dL = 4.7 mg/dL = 4.7 mg/dL = 4.7 mg/dL = 4.7 The most frequently detected causes of upper gastrointestinal system bleeding were gastritis (%20), Mallory Weiss (%16.4), ozofaith (%12.2), ulcer (%12.2) and ozofagus varices (%9.1). It is important to predict the risk of the patient with upper gastrointestinal system bleeding and to know the clinical and laboratory parameters of significant upper gastrointestinal system bleeding to take the necessary efforts in time. In addition to the criteria contained in the Sheffield scores, in our study, breathing and splenomegaly in the physical examination, and in the laboratory examination, the number of erythrosites and low in the albumin with the blood uric nitrogen height were identified as the findings indicating significant upper gastrointestinal system bleeding.
Background and Aims: Although most of the upper gastrointestinal system bleedings are self-limited, it can be life threating in a small portion of patients. The aim of this study is to determine the risk factors predicting clinically significant upper gastrointestinal system bleeding in children. Material and Method: Patients with upper gastrointestinal system bleeding and aged between 0-18 years old were enrolled. Age at diagnosis, gender, amount of bleeding, hemathemesis, melena, complaints, accompanying diseases, medication that is prone to bleeding, vital signs, capillary refill time and phsical examination findings were recorded. Hemogram, biochemistry, coagulation tests, endoscopic findings, erythrocyte transfusion, medical and/or endoscopic treatments applied, follow-ups in emergency or service and final diagnosis of bleeding were recorded. Patients with ≥ 8 points according to Sheffield scoring system defined as clinically significant upper gastrointestinal system bleeding and data were compared between groups. Results Fifty five children [29 (52.7%) girls, 26 (47.3%) boys; mean 8.4±5.4 years] were enrolled to the study. Seventeen children (26.8%) had clinically significant gastrointestinal system bleeding. We detected anemia in 22 children, high blood urea nitrogen level in 20 children, low count of erythrocyte in 14 children and hypoalbuminemia in 5 children at presentation. Patients with significantly upper gastrointestinal bleeding more commonly have symptoms of melena (%76.5 vs. %21.1, p <0.001), pallor (%52.9 vs %5.3, p <0.001), splenomegaly (%23.5 vs %2.6, p <0.001), esophageal varice (23.5% vs 2.6%, p=0.02), need for a fluid bolus (41.2% vs 5.3%, p <0.001), blood transfusion (70.6% vs 5.3% p<0.001), prolonged capillary refill time (35.3% vs 2.6%, p <0.001) and tachycardia (137.4±22.1 vs 117.5±21.3, p=0.01), and laboratory findings of lower erythrocyte (3.78×106/μL vs 4.29×106/μL, p <0.001), hemoglobin (9.8±2.2 mg/dL vs 11.7±2.1mg/dL, p=0.02) and albumin (3.94±0.47 vs 4.38±0.51, p=0.03) levels with higher blood urea nitrogen (19.2±8.4 mg/dL vs 13.3±4.8 mg/dL, p=0.01) levels. The most common final diagnosis were gastritis (20%), Mallory Weiss tears (16.4%), esophagitis (%12.2), ulcer (%12.2) and esophageal varices (%9.1). Conclusion: It is important to know that clinical and laboratory signs of significant upper gastrointestinal system bleeding to predict patient at risk and timely intervention. Pallor and splenomegaly, low count of erythrocyte, hypoalbuminemia and high level of blood urea nitrogen were detected as findings showing significant upper gastrointestinal system bleeding, in addition to Sheffield scoring system.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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