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Bu çalışmanın amacı karbon monoksit intoksikasyon tanılı hastaların etyolojik ve demografik özelliklerini belirlerken, klinik bulguların tedavi sürecine ve prognoza etkisini araştırmaktır. Çalışmaya 2014-2017 yılları arasında Yoğun Bakım Ünitemizde karbon monoksit intoksikasyon tanısı ile yatan 63 hasta dahil edildi. Yaş ortalaması 44.49 yıl olan hastaların 32’si kadın, 31’i erkek idi. Maruziyet sonrası acil servise başvuru süresi ortalama 6.22 saat idi. Başvuru anında COHb değeri ortalama %27 idi. En sık maruziyet %61.9 ile kış mevsiminde iken en sık maruziyet kaynağı %93.7 ile soba idi. Acil servise başvuru anında ortalama GKS puanı 14.1 puan idi. Hastaların %79.4’ünde nöropsikiyatrik semptomlar, %36.5’inde gastrointestinal semptomlar, %23.8’inde solunum sistemi semptomları, %15.9’unda otolojik semptomlar, %11.1’inde ise kardiyovasküler semptomlar vardı. İki hastada mekanik ventilatör, 57 hastada noninvazif mekanik ventilatör (NIMV) ve 12 hastada hiperbarik oksijen tedavisi ihtiyacı oldu. Hastaların çıkış GKS değerleri ortalama 15 idi. Hastanede ortalama yatış süreleri 1.71 gün idi. Hastalar başvuru anındaki COHb düzeylerine göre COHb düzeyi %10’nun altında hafif (grup 1), %11-25 arası orta (grup 2), %26-40 arası ağır (grup 3), %41 üzeri çok ağır (grup 4) olarak gruplandırıldı. Gruplar arasında pH, GKS geliş puanı, otolojik semptomlar, NIMV ihtiyacı, SpO2, CK-CKMB düzeyi değerleri arasında istatistiksel olarak anlamlı fark bulundu. Hastalar hastaneye başvuru anındaki GKS puanlarına göre grup A (GKS=15) ve grup B (GKS<15) olarak sınıflandırıldı. gruplar arasında COHb geliş düzeyi, KVS semptomlar, ek hastalık varlığı, solunum sistemi semptomları, mekanik ventilatör ihtiyacı, HBO ihtiyacı, CK ve troponin düzeyi açısından istatistiki olarak anlamlı fark vardı. Hiperbarik oksijen tedavisi alan (grup I) ve almayan (grup II) hastalar da karşılaştırmalı olarak değerlendirildi. grup I’de troponin-I (p=0.015), CK(p=0.032) düzeylerinde ve mekanik ventilasyon ihtiyacında (p=0.003) belirgin artış olduğu, GKS’nun düşük olduğu (p<0.001) tespit edildi. Bununla birlikte HBO tedavisi gereksinimi ile troponin ve CK seviyesi arasında pozitif yönde korelasyon olduğu görüldü. Bu çalışma sonunda karbon monoksit intoksikasyon tanılı hastalarda başvuru anındaki GKS puanı, COHb, CK-CKMB ve laktat değerlerinin klinik bulgular ile birlikte yorumlanmasının hem tedavi hem de prognoz üzerinde önemli etkilerinin olabileceği düşünüldü.
The aim of this study is to determine the ethological and demographic characteristics of patients diagnosed with carbon monoxide intoxication, while researching the treatment process and the effect of the forecast of clinical findings. The study included 63 patients diagnosed with carbon monoxide intoxication in our Intensive Care Unit between 2014 and 2017. The average age of the patients was 44.49 years, 32 were women and 31 were men. The time of application for the emergency service after exposure was an average of 6.22 hours. At the time of the application, the COHb value was 27%. The most common exposure was 61.9 percent and in the winter the coherent exposure source was 93.7 percent. The average GKS score at the time of emergency service application was 14.1 points. 79.4 percent of patients have neuropsychiatric symptoms, 36.5 percent have gastrointestinal symptoms, 23.8 percent have respiratory symptoms and 15 percent have respiratory symptoms. 9 people had autological symptoms and 11.1 percent had cardiovascular symptoms. Two patients needed mechanical ventilator, 57 patients needed non-invasive mechanical ventilator (NIMV) and 12 patients needed hyperbaric oxygen treatment. The patient’s output GKS values were 15 in average. The average stay period in the hospital was 1.71 days. Patients according to the COHb levels at the time of application; the COHb levels were grouped under 10% light (Group 1), 11-25% medium (Group 2), 26-40% heavy (Group 3), 41% over very heavy (Group 4) and 4%. The groups found a statistically significant difference between pH, GKS outcome score, autological symptoms, NIMV need, SpO2, CK-CKMB level values. Patients were classified as group A (GKS=15) and group B (GKS<15) according to the GKS points at the time of application to the hospital. Among the groups; there were statistically significant differences in terms of COHb entry levels, KVS symptoms, the presence of additional diseases, respiratory symptoms, mechanical ventilator needs, HBO needs, CK and troponin levels. Patients who received hyperbaric oxygen treatment (Group I) and who did not receive (Group II) were also compared. In group I, troponin-I (p=0.015), CK(p=0.032) levels and mechanical ventilation needs (p=0.003) were markedly increased, and GKS was low (p<0.001). However, there was a positive correlation between the need for HBO treatment and troponin and CK levels. At the end of this study, the patient diagnosed with carbon monoxide intoxication thought that the interpretation of the GKS point at the moment of application, COHb, CK-CKMB and laktate values along with clinical findings could have significant effects on both treatment and prognosis.
In this study, we aimed to determine the etiological and demographic characteristics of patients with carbon monoxide intoxication to reveal their relationship with the clinical findings, and to investigate the treatment processes and prognoses of these patients. A total of 63 patients diagnosed with carbon monoxide intoxication and hospitalized in the Department of Anesthesiology and Reanimation Intensive Care Unit between 2014 and 2017. The age avarage of the patients was 44.9 years. 32 patients were female and 31 patients were male. The avarage duration between exposion and reffering to emergency department was 6.22 hours. Initial COHb value avarage was 27%. Most common exposion to carbonmonoxide was 61,9% winter and common source of exposion was 93,7% heating stove. Avarage GCS at emergency admission was 14.1. Neuropsychiatric symptoms were observed in 79.4%, gastointestinal symptoms were observed in 36.5%, respiratory symptoms were observed in 15.9% and cardiovascular symptıms were observed in 11.1% of the patients. Two patients required mechanical ventilation, 57 patients required noinvasive mechanical ventilation (NIMV) and 12 patients required hyperbaric oxygen (HBO) treatment. The avarage of GCS at discharge was 15. Hospital stay duration avarage was 1.71 days. Patients were divided into three groups according to their COHb levels at admission, COHb levels under 10% mild (Group 1), between 11-25% intermediate (Group 2), between 26-45% serious (Group 3) and over 41% very serious (Group 4). There were statistically significant difference between groups in means of pH levels, admission GCS, otologic symptoms, NIMV requirement, SpO2 levels and CK, CK-MB levels. Patient were also divided into two groups according to their GCS scores at admission, Group A (GCS=15) and Group B (<15). There were statistically significant difference between groups in means of COHb levels at admission, cardiovascular symptoms, presence of comorbidities, respiratory symptoms, HBO requirement, CK and troponin levels and mechanical ventilation requirement. Patients who had HBO treatment (Group I) and who had not hyperbaric oxygen treatment (Group II) were comperatively evaluated. Troponin-I (p=0,015) , CK (P=0,032) levels and mechanical ventilation requirement (p=0,003) were significantly higher but GCS scores (p<0,001) were significantly lower at Group I. At the same time a significant positive corelation between HBO treatment requirement and troponin,CK levels was found. As a result, management of the patients that diagnosed as carbon monoxide intoxication along with GCS scores at admission, COHb, CK,CK-MB and lactate levels is very important effects on prognosis and treatment of the patients.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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