Kafa travması tanısıyla acil operasyon geçiren hastalarda elektrolit imbalansı ve glikoz metabolizma bozukluğunun mortalite ve morbiditeye etkisi
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Date
2018
Authors
Yaldız, Mehmet
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Publisher
Uludağ Üniversitesi
Abstract
Travmaya bağlı oluşan beyin hasarı, travmanın direk etkisi ile oluşan primer (birincil) hasar ve daha sonra gelişen çeşitli metabolik olayların zincirleme reaksiyonu sonucu oluşan sekonder (ikincil) hasar şeklinde oluşmaktadır (3). Bu retrospektif çalışma, kafa travması nedeniyle acil operasyona alınan hastalarda elektrolit imbalansı ve glikoz metabolizma bozukluğu başta olmak üzere sekonder hasara neden olabilecek faktörlerin mortalite ve morbidite üzerine etkisini araştırmak amacıyla yapılmıştır. Bu inceleme 2013-2017 yılları arasında Uludağ Üniversitesi Sağlık Uygulama ve Araştırma Merkezi'ne (UÜSUAM) travmatik beyin hasarı nedeniyle başvuran ve başvurudan sonraki ilk 24 saat içinde acil olarak operasyona alınan hastaların kayıtları UÜSUAM arşivinden incelenerek yapıldı. Hastalar postoperatif (postop) surveyleri incelenerek 3 gruba ayrıldı: 1. Sağlıklı Grubu: Travmadan sonra uygulanan tedaviler sonucu tamamen iyileşen ve travmadan önceki fiziksel ve kognitif fonksiyonlarına tekrar sahip olan hastalar dahil edildi. 2. Sekel Grubu: Travmadan sonra uygulanan tedaviler sonucu tamamen iyileşemeyip, travmadan önceki fiziksel ve kognitif fonksiyonlarında kayıplar yaşayan hastalar dahil edildi. 3. Eksitus Grubu: Travmadan sonra uygulanan tedavilere cevap vermeyen, hastaneye başvurusundan sonra 28 gün içerisinde hayatını kaybeden hastalar dahil edildi. Verilerin tanımlayıcı istatistiklerinde; ortalama (ort.), standart sapma (s.s.), medyan (med.), en düşük, en yüksek, frekans ve oran değerleri kullanılmıştır. Değişkenlerin dağılımı, Kolmogorov-Simirnov testi ile ölçüldü. Nicel bağımsız verilerin analizinde Kruskal-Wallis ve Mann-Whitney U testi kullanıldı. Bağımlı nicel verilerin analizinde Wilcoxon testi kullanıldı. Nitel bağımsız verilerin analizinde Ki-kare testi; Ki-kare test koşulları sağlanmadığında Fischer testi kullanıldı. Analizlerde SPSS 22.0 istatistik programı kullanıldı. Travmatik beyin hasarı sonrası 24 saat içerisinde acil operasyona alınan hastalarda mortalite ve morbiditeyi incelediğimiz bu çalışmada, ileri yaş, yüksek ASA skoru, travma sonrası düşük GKS skoru, düşük DAB değeri ve inotrop ajan infüzyon tedavisi oranının fazla olmasının mortalite ve morbiditeyi artırdığı tespit edilmiştir. Hipernatremi, hipokalsemi, hipokalemi, kreatinin yüksekliği ve düşük platelet sayısının da mortalite ve morbiditeyi artırdığı sonuçları bulunmuştur. Ayrıca hastalarımızda incelediğimiz KAH, SAB, vücut sıcaklığı, SpO₂, kan WBC ve Cl değerlerinin hastalarımızın prognozlarında etkisinin olmadığı görülmüştür.
Traumatic brain injury is secondary (secondary) damage that occurs as a result of a chain reaction of various metabolic events that develop after primary(primary) damage caused by the direct effect of trauma (3). This retrospective study was conducted to investigate the effect of factors that may cause secondary damage, especially electrolyte imbalance and glucose metabolism disorders, on mortality and morbidity in patients undergoing emergency surgery due to head trauma. This study was carried out in UUSUAM archives of patients who were admitted to Uludag University Health Application and Research Center (UUSUAM) between 2013 and 2017 for traumatic brain injury and who were taken to the operation within the first 24 hours after admission. Patients were divided into 3 groups by examining postoperative surveillance: 1. Healthy Group: Patients who completed treatment after trauma and who recovered physically and cognitive functions before the trauma were included. 2. Neurological Deficit Group: After the trauma treatment, the result was not fully improved, and the patients who lost their physical and cognitive functions before the trauma were included. 3. Exitus Group: Patients who did not respond to the treatments after the trauma and who lost their lives within 28 days of admission to the hospital were included. In the descriptive statistics of the data; average, standard deviation, median, lowest, highest, frequency and ratio values were used. The distribution of the variables was measured by the Kolmogorov-Simirnov test. Kruskal-Wallis and Mann-Whitney U test were used in the analysis of quantitative independent data. The Wilcoxon test was used for the analysis of the dependent quantitative data. Chi-square test in the analysis of qualitative independent data; The Fischer test was used when chi-square test conditions were not met. SPSS 22.0 statistical program was used in the analyzes. We investigated mortality and morbidity in patients who underwent emergency operation within 24 hours after traumatic brain injury. It was found that higher age, higher ASA score, lower GCS score after trauma, lower diastolic arterial pressure measurements and inotropic agent infusion treatment increased mortality and morbidity. Hypernatremia, hypocalcemia, hypokalemia, high creatinine levels and low platelet counts have also been found to increase mortality and morbidity. In addition, we have not seen the effects of heart rate, sistolic arterial pressure, body temperature, SpO2, blood WBC and Cl- values on the prognosis of our patients.
Traumatic brain injury is secondary (secondary) damage that occurs as a result of a chain reaction of various metabolic events that develop after primary(primary) damage caused by the direct effect of trauma (3). This retrospective study was conducted to investigate the effect of factors that may cause secondary damage, especially electrolyte imbalance and glucose metabolism disorders, on mortality and morbidity in patients undergoing emergency surgery due to head trauma. This study was carried out in UUSUAM archives of patients who were admitted to Uludag University Health Application and Research Center (UUSUAM) between 2013 and 2017 for traumatic brain injury and who were taken to the operation within the first 24 hours after admission. Patients were divided into 3 groups by examining postoperative surveillance: 1. Healthy Group: Patients who completed treatment after trauma and who recovered physically and cognitive functions before the trauma were included. 2. Neurological Deficit Group: After the trauma treatment, the result was not fully improved, and the patients who lost their physical and cognitive functions before the trauma were included. 3. Exitus Group: Patients who did not respond to the treatments after the trauma and who lost their lives within 28 days of admission to the hospital were included. In the descriptive statistics of the data; average, standard deviation, median, lowest, highest, frequency and ratio values were used. The distribution of the variables was measured by the Kolmogorov-Simirnov test. Kruskal-Wallis and Mann-Whitney U test were used in the analysis of quantitative independent data. The Wilcoxon test was used for the analysis of the dependent quantitative data. Chi-square test in the analysis of qualitative independent data; The Fischer test was used when chi-square test conditions were not met. SPSS 22.0 statistical program was used in the analyzes. We investigated mortality and morbidity in patients who underwent emergency operation within 24 hours after traumatic brain injury. It was found that higher age, higher ASA score, lower GCS score after trauma, lower diastolic arterial pressure measurements and inotropic agent infusion treatment increased mortality and morbidity. Hypernatremia, hypocalcemia, hypokalemia, high creatinine levels and low platelet counts have also been found to increase mortality and morbidity. In addition, we have not seen the effects of heart rate, sistolic arterial pressure, body temperature, SpO2, blood WBC and Cl- values on the prognosis of our patients.
Description
Keywords
Travmatik beyin hasarı, Acil operasyon, Mortalite, Morbidite, Traumatic brain injury, Emergency operation, Mortality, Morbidity
Citation
Yaldız, M. (2018). Kafa travması tanısıyla acil operasyon geçiren hastalarda elektrolit imbalansı ve glikoz metabolizma bozukluğunun mortalite ve morbiditeye etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.