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Amaç: Beyin kan akımını ve dokulara oksijen sunumunu etkileyen çeşitli durumlarda (boğulma, arrest, asfiksi gibi) gelişebilen hipoksik iskemik beyin hasarı önemli bir morbidite ve mortalite nedenidir. Bu çalışmanın amacı son iki yılda çocuk yoğun bakım ünitesi'nde akut hipoksi nedeniyle yatan hastaların etyoloji, klinik özellikler, tedavi ve yakın dönem nörolojik takip sonuçlarının değerlendirilmesidir. Gereç ve Yöntemler: Çalışmaya Mayıs2017- Nisan 2019 tarihleri arasında ÇYBÜ'ye yatırılan 1 ay-18 yaş arası daha öncesinden sağlıklı , mental ve motor gelişim basamakları normal olan akut hipoksi nedeniyle yatırılan 25 hasta alındı.ÇYBÜ'de arrest sonrası değerlendirme için Pediatrik Serebral Performans Kategori Skorlama Sistemi (PCPC) kullanıldı. Bulgular:Hastaların geliş Glaskow koma skalası (GKS) median:6 (min:3 max:15) iken; yoğun bakımdan çıkış GKS: 10 (min:6 max:15) olarak tespit edildi(p<0,05).. Hastaların arrest olduktan hemen sonra kan gazında asidozda oldukları, Hco3'ün belirgin düşük olduğu,pH: (min:6.91 - max: 7.49); Laktat'ın yüksek (min:8 - max: 145); AST'nin min:21 - max:712 ve CK'nın yüksek (min:47 - max:3351) olduğunu ve ÇYBÜ'ye yatırılıp hızlıca uygun tedavi başlandıktan 24 saat sonra hastaların asidozdan çıktığı pH: (min:7.23 - max:7.61); AST (min:15 - max:83) ;ALT (min:6 - max:45)ve CK (min:16 - max:258) ve Laktat'ın (min:8 - max:93) gerilediğini gördük ve bu sonuçlar istatiksel olarak anlamlı saptandı.( p<0,05) Sonuç: Akut Hipoksinin patofizyolojisinin iyi anlaşılması, erken dönemde tedavi stratejilerinin geliştirilerek beynin hasardan korunması gereklidir.Olguların nörolojik izlemi ve yardımcı görüntüleme tetkikleri ile hasarın ciddiyeti ve prognoz üzerine etkileri araştırılıp en uygun tedavi yapılmalıdır. Akut hipoksiden geçen çocuklarda nörolojik sekel riskini en aza indirmek için hastalar resusitasyon sonrası en erken dönmede ÇYBÜ'ye yatırılmalı ve multidisipliner tedavi edilmelidir.
Hypoxic ischemic brain injury is an important cause of morbidity and mortality in all age groups. It may develop in various conditions (such as drowning, arrest, asphyxia) affecting brain blood flow and oxygen supply to tissues. The aim of this study was to evaluate the etiology, clinical features, treatment and recent neurological follow-up outcomes of the patients hospitalized for acute hypoxia in the pediatric intensive care unit (PICU) in the last two years. Material and Methods: The study included 25 patients whose age was 1 month-18 years and hospitalized in the PICU with complaint of acute hypoxia in between May 2017 and April 2019. The patients were previously having normal mental and motor development levels. Pediatric Cerebral Performance Category Scoring System (PCPC) was used for evaluation. Results: The median Glaskow coma scale (GCS) was 6 (min: 3 max: 15) at admission compared with the median GCS: 10 (min: 6 max: 15) at the time of discharge from PICU (p<0,05). The tests immediately after the cardiac arrest revealed that the patients were in acidosis in blood gas test pH: (min:6.91 - max: 7.49);, Hco3 was lower, Laktat was high (min:8 - max: 145); AST (min:21 - max:712) and CK was high (min:47 - max:3351) compared with the results measured 24 hours after the appropriate treatment was started the patients were released from acidosis pH: (min:7.23 - max:7). 61); AST (min:15 - max:83) ; ALT (min:6 - max:45) and CK (min:16 - max:258) and Lactate (min:8 - max:93) were measured as in between normal limits and the differences were found to be statistically significant (p <0.05). Conclusion: It is necessary to understand the pathophysiology of acute hypoxia and to protect the brain from damage by developing treatment strategies in the early period. The most appropriate treatment should be started while making close neurological follow up and trying to understand the severity of damage and effects on the prognosis of these patients. To minimize the risk of neurological sequelae in pediatric patients undergoing acute hypoxia, in earlier period of admission these patients should be hospitalized in the PICU and managed by a multidisciplinary team.
Aim: Hypoxic ischemic brain injury is an important cause of morbidity and mortality in all age groups. It may develop in various conditions (such as drowning, arrest, asphyxia ) affecting brain blood flow and oxygen supply to tissues. The aim of this study was to evaluate the etiology, clinical features, treatment and recent neurological follow-up outcomes of the patients hospitalized for acute hypoxia in the pediatric intensive care unit (PICU) in the last two years. Material and Methods: The study included 25 patients whose age was 1 month-18 years and hospitalized in the PICU with complaint of acute hypoxia in between May 2017 and April 2019. The patients were previously having normal mental and motor development levels. Pediatric Cerebral Performance Category Scoring System (PCPC) was used for evaluation. Results: The median Glaskow coma scale (GCS) was 6 (min: 3 max: 15) at admission compared with the median GCS: 10 (min: 6 max: 15) at the time of discharge from PICU (p<0,05). The tests immediately after the cardiac arrest revealed that the patients were in acidosis in blood gas test pH: (min:6.91 - max: 7.49);, Hco3 was lower, Laktat was high (min:8 - max: 145); AST (min:21 - max:712) ve CK was high (min:47 - max:3351) compared with the results measured 24 hours after the appropriate treatment was started the patients were released from acidosis pH: (min:7.23 - max:7.61); AST (min:15 - max:83) ;ALT (min:6 - max:45)ve CK (min:16 - max:258) ve Laktat'ın (min:8 - max:93) were measured as in between normal limits and the differences were found to be statistically significant (p <0.05). Conclusion: It is necessary to understand the pathophysiology of acute hypoxia and to protect the brain from damage by developing treatment strategies in the early period. The most appropriate treatment should be started while making close neurological follow up and trying to understand the severity of damage and effects on prognosis of these patients. To minimize the risk of neurological sequelae in pediatric patients undergoing acute hypoxia, in earlier period of admission these patients should be hospitalized in the PICU and managed by multidisciplinary team.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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