Kronik obstrüktif akciğer hastalığı olan hastalarda akut alevlenmelerin kardiyak etkileri
Loading...
Files
Date
2012
Authors
Özyılmaz, Sinem Özbay
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Kronik obstrüktif akciğer hastalığında, akut alevlenme, hipoksemi ve sistemik inflamasyon gibi bir çok nedenler ile kardiyak etkiler meydana gelmektedir. Bu çalışmanın amacı, KOAH akut atak ile hastaneye başvuran hastaların ürik asit, ürik asit kreatinin oranı ve kardiyak etkilerinin araştırılmasıdır.Çalışmaya Uludağ Üniversitesi Göğüs Hastalıkları Kliniğine, Mayıs 2011 ile Aralık 2011 tarihleri arasında başvuran ve GOLD Tanı ve Tedavi Rehberi kriterlerine göre KOAH tanısı alan, KOAH akut ataklı olgularda ürik asit düzeylerinin ve kardiyak değişikliklerinin araştırıldığı 25 hasta alındı.Arteryel kan gazı parametrelerinde hipoksemi sınıflamasına göre olguların sırasıyla ürik asit ve ürik asit/kreatinin ortalama değerleri hafif derece hipoksemiye sahip olanlarda 5,7±2,09 mg/dl ve 7,32±3,0; orta derece hipoksemiye sahip olanlarda 6,4±2,1 mg/dl ve 7,01±2,9; ileri derecede hipoksemiye sahip olanlarda 6,7±2,0 mg/dl ve 9,1±1,8 olarak saptandı. Üç gruptaki ürik asit ve ürik asit/kreatinin değerleri arasında istatiksel olarak anlamlılık saptanmamasına (sırasıyla p:0,97 ve 0,76) rağmen, hipoksi değerlerinin artması ile ürik asit ve ürik asit/kreatinin değerlerinin yükseldiği görüldü.Olguların standart EKG' lerinde aritmi olmayan 8 olgu bulundu. Aritmi olanlardan 8 tanesinde AES, 4 tanesinde VES, 6 tanesinde AF gözlenirken 19 olgu NSR' de idi. Holter EKG' de tüm olgularda aritmi gözlendi. Olguların 20 tanesinde AES, 24 tanesinde VES, 13 tanesinde AF, 6 tanesinde VR gözlenirken 19 olgu NSR' de idi.Olguların standart EKG' lerinde aritmi sıklığı %64 idi. Aritmilerin %77' sini atriyal, %23' ünü ventriküler aritmiler oluşturuyordu. Holter EKG' de tüm olgularda aritmi vardı. Aritmilerin %52' sini atriyal, %48' ini ventriküler aritmiler oluşturuyordu.Standart EKG' sinde aritmi tespit edilen akut ataktaki 17 KOAH hastasının holter EKG' leri detaylı olarak incelendi. Atriyal aritmisi yüksek derecede saptanan hastalarda yüksek dereceli ventriküler aritmi olduğu, atriyal aritmisi düşük dereceli olanlarda ise düşük dereceli ventriküler aritmilerin olduğu görüldü.Olguların arteryel kan gazı parsiyel oksijen basıncı, hipoksi sınıflandırılmasına göre atriyal ve ventriküler aritmi derece sıklığı incelendi. Hipoksemi derinleştikçe aritmilerin derecesinin arttığı görüldü. Fakat istatiksel olarak anlamlılık saptanmadı. (Sırasıyla p= 0,729; 0, 405)Olgulardaki atriyal aritmilerin yüksek derecede ve ventriküler aritmilerin ise daha çok düşük derecede olduğu görüldü.Arteryel kan gazı parametrelerinde hipoksi sınıflamasına göre olguların sırasıyla AS ortalama değerleri hafif derece hipoksemiye sahip olanlarda 1498,00±699,35; orta derece hipoksemiye sahip olanlarda 2095,09±883,31; ileri derecede hipoksemiye sahip olanlarda 2077,66±99,15 olarak saptandı. Tüm olguların arteryel kan gazı parametrelerinde PaO2 düzeylerine göre, AS değerleri 846-3382 arasında değişmekte olup ortalama 1859,17±788,10 idi. Olguların arteryel parsiyel oksijen basıncının hipoksi dereceleri ile AS ölçümleri arasında istatiksel olarak anlamlılık bulundu. (p=0,017)Arteryel kan gazı parametrelerinde hipoksi sınıflamasına göre olguların sırasıyla ejeksiyon fraksiyon ortalama değerleri hafif derece hipoksemiye sahip olanlarda %58,81±6,38; orta derece hipoksemiye sahip olanlarda %60,54±7,21; ileri derecede hipoksemiye sahip olanlarda %65,00±9,64 olarak saptandı. Tüm olguların arteryel kan gazı parametrelerinde PaO2 düzeylerine göre, ejeksiyon fraksiyon değerleri %50-72 arasında değişmekte olup ortalama %60,32±7,08 idi. Olguların arteryel parsiyel oksijen basıncının hipoksemi dereceleri ile ejeksiyon fraksiyon ölçümleri arasında istatiksel olarak anlamlılık bulunmadı (p= 0,67).Kronik obstrüktif akciğer hastalığının akut atağı olan hastaların ortalama PAB ile EF arasında pozitif korelasyon olduğu gözlendi (r=0.550, p<0.05).Arteryel kan gazı parametrelerinde hipoksemi sınıflamasına göre olguların sırasıyla çıkan aorta çapı ortalama değerleri hafif derece hipoksemiye sahip olanlarda 36,54±2,84 mm; orta derece hipoksemiye sahip olanlarda 34,00±4,31 mm; ileri derecede hipoksemiye sahip olanlarda 33,00±7,00 mm olarak saptandı. Tüm olguların arteryel kan gazı parametrelerinde PaO2 düzeylerine göre, çıkan aorta değerleri 25-41 mm arasında değişmekte olup ortalama 35,00±4,15 mm idi. Olguların arteryel parsiyel oksijen basıncının hipoksi dereceleri ile çıkan aorta ölçümleri arasında istatiksel olarak anlamlılık bulundu (p= 0,041). Kronik obstrüktif akciğer hastalığının akut atağı olan hastalarda, hipoksemi derinliği şiddetlendikçe çıkan aorta çapının daha az olduğu görüldü. Uzun süreli KOAH aort genişlemeleri için bir risk faktörü olsada, KOAH atak atağının hipoksemi şiddeti ile aort genişlemeleri arasında bir ilişki olmadığı bu çalışma sonucunda söylenebilir. Sistemik bir hastalık olan KOAH' ın akut alevlenme döneminde hipoksemi arttıkça UA ve UA/Kr oranının etkilenmediği, arteryel sertliğin arttığı, ejeksiyon fraksiyonun etkilenmediği, kardiyak aritmilerin ve çıkan aorta çapının azaldığı saptanmıştır. Ayrıca, KOAH akut atağında PAB ile EF arasında pozitif korelasyon olduğu gözlenmiştir.
Chronic obstructive pulmonary disease (COPD) can result in cardiac effects due to acute exacerbation, hypoxemia and systemic inflammatio. In our study, we invastigated uric acid, uric acid kreatinin ratio and cardiac effects of COPD with the acute exacerbation in patients who were admitted to the hospital.This study includes 25 patiens who had been admitted with acute exacerbation of COPD according to GOLD Diagnosis and treatment guidelines between May and December 2011 uric acid levels measured blood samples which was taken from patintes , cardiac arrhythmias were investigated with holter elektrokardigram device, ejection fraction and pulmonary artery pressure values were calculated by echocardiography .arterial stifness parameters were measured from left radial arter with applanation tonometry method at supine pozitions.Hypoxemia was classified as mild, moderate and severe according to arterial blood gas parameters (partial pressure of oxygen PaO2). Average uric acid (UA) and uric acid to creatinine ratio (UA/C) values were respectively 5.7±2.09 mg/dl and 7.32±3.0 in patients with mild hypoxemia, 6.4±2.1 mg/dl and 7.01±2.9 in those with moderate hypoxemia, and 6.7±2.0 mg/dl and 9.1±1.8 in those with severe hypoxemia. While no statistically significant correlation was found between UA and UA/C values in the three groups (respectively, p=0.97, p=0.76), these values were found to increase along with increasing severity of hypoxemia.Standard ECG showed no arrhythmia in 8 patients, atrial extrasystoles (AEs) in 8 and ventricular extrasystoles (VEs) in 4. Atrial fibrillation (AF) was observed in 6 patients and normal sinus rhythm (NSR) - in 19. Holter ECG showed arrhythmia in all patients. AEs were seen in 20 patients, VEs - in 24 and AF - in 13. Ventricular rhythm was observed in 6 patients and NSR - in 19.According to standard ECG, arrhythmia incidence was 64%. Atrial arrhythmias constituted 77% of cases, while 23% were ventricular. According to Holter ECG, the incidence was 100%, with 52% of the arrhythmias atrial and 48% ventricular.The Holter ECGs of 17 patients whose standard ECGs showed arrhythmias were examined in detail. Patients with high-rate atrial arrhythmias were seen to have high-rate ventricular arrhythmias, while those with low-rate atrial arrhythmias had low-rate ventricular arrhythmias.Atrial and ventricular arrhythmia rates were examined in correlation with the degree of hypoxemia. Arrythmia rates were seen to increase along with increasing severity of hypoxemia, although the correlation was not statistically significant (respectively, p=0.729, p=0.405).Atrial arrhythmias tended to be high-rate while ventricular arrhythmias were generally low-rate.Average arterial stiffness (AS) measurements was 1498.00±699.35 dyne.sn.cm-5 in patients with mild hypoxemia, 2095.09±883.31 dyne.sn.cm-5 in those with moderate hypoxemia, and 2077.66±99.15 dyne.sn.cm-5 in those with severe hypoxemia. Arterial stiffness measurements varied between 846-3382 dyne.sn.cm-5, with the total average being 1859.17±788.10 dyne.sn.cm-5. There was a statistically significant correlation between severity of hypoxemia and AS measurements (p=0.017).Average ejection fraction (EF) rate was 58.81±6.38% in those with mild hypoxemia, 60.54±7.21% in those with moderate hypoxemia, and 65.00±9.64% in those with severe hypoxemia. EF rate varied between 50-72%, with the total average being 60.32±7.08%. No statistically significant correlation was found between EF and the severity of hypoxemia (p=0.67).A positive correlation was found between average pulmonary artery pressure and EF (r=0.550, p<0.05).Average ascending aortic diameter (AOD) was 36.54±2.84 mm in patients with mild hypoxemia, 34.00±4.31 mm in those with moderate hypoxemia, and 33.00±7.00 mm in those with severe hypoxemia. AOD varied between 25-41 mm, with the total average being 35.00±4.15 mm. A statistically significant correlation was found between AOD and the severity of hypoxemia (p=0.041). AOD generally tended to be lower in COPD patients with higher degree of hypoxemia. While long-term COPD is considered a risk factor for aortic dilation, we found no correlation between hypoxemia during COPD attacks and aortic dilation in our study.As severity of hypoxemia during acute exacerbations of COPD increases, UA, UA/C and ejection fraction remain unchanged, while arterial stiffness increases and cardiac arrhythmias and ascending aorta diameter decrease. There is also a positive correlation between pulmonary artery pressure and ejection fraction.
Chronic obstructive pulmonary disease (COPD) can result in cardiac effects due to acute exacerbation, hypoxemia and systemic inflammatio. In our study, we invastigated uric acid, uric acid kreatinin ratio and cardiac effects of COPD with the acute exacerbation in patients who were admitted to the hospital.This study includes 25 patiens who had been admitted with acute exacerbation of COPD according to GOLD Diagnosis and treatment guidelines between May and December 2011 uric acid levels measured blood samples which was taken from patintes , cardiac arrhythmias were investigated with holter elektrokardigram device, ejection fraction and pulmonary artery pressure values were calculated by echocardiography .arterial stifness parameters were measured from left radial arter with applanation tonometry method at supine pozitions.Hypoxemia was classified as mild, moderate and severe according to arterial blood gas parameters (partial pressure of oxygen PaO2). Average uric acid (UA) and uric acid to creatinine ratio (UA/C) values were respectively 5.7±2.09 mg/dl and 7.32±3.0 in patients with mild hypoxemia, 6.4±2.1 mg/dl and 7.01±2.9 in those with moderate hypoxemia, and 6.7±2.0 mg/dl and 9.1±1.8 in those with severe hypoxemia. While no statistically significant correlation was found between UA and UA/C values in the three groups (respectively, p=0.97, p=0.76), these values were found to increase along with increasing severity of hypoxemia.Standard ECG showed no arrhythmia in 8 patients, atrial extrasystoles (AEs) in 8 and ventricular extrasystoles (VEs) in 4. Atrial fibrillation (AF) was observed in 6 patients and normal sinus rhythm (NSR) - in 19. Holter ECG showed arrhythmia in all patients. AEs were seen in 20 patients, VEs - in 24 and AF - in 13. Ventricular rhythm was observed in 6 patients and NSR - in 19.According to standard ECG, arrhythmia incidence was 64%. Atrial arrhythmias constituted 77% of cases, while 23% were ventricular. According to Holter ECG, the incidence was 100%, with 52% of the arrhythmias atrial and 48% ventricular.The Holter ECGs of 17 patients whose standard ECGs showed arrhythmias were examined in detail. Patients with high-rate atrial arrhythmias were seen to have high-rate ventricular arrhythmias, while those with low-rate atrial arrhythmias had low-rate ventricular arrhythmias.Atrial and ventricular arrhythmia rates were examined in correlation with the degree of hypoxemia. Arrythmia rates were seen to increase along with increasing severity of hypoxemia, although the correlation was not statistically significant (respectively, p=0.729, p=0.405).Atrial arrhythmias tended to be high-rate while ventricular arrhythmias were generally low-rate.Average arterial stiffness (AS) measurements was 1498.00±699.35 dyne.sn.cm-5 in patients with mild hypoxemia, 2095.09±883.31 dyne.sn.cm-5 in those with moderate hypoxemia, and 2077.66±99.15 dyne.sn.cm-5 in those with severe hypoxemia. Arterial stiffness measurements varied between 846-3382 dyne.sn.cm-5, with the total average being 1859.17±788.10 dyne.sn.cm-5. There was a statistically significant correlation between severity of hypoxemia and AS measurements (p=0.017).Average ejection fraction (EF) rate was 58.81±6.38% in those with mild hypoxemia, 60.54±7.21% in those with moderate hypoxemia, and 65.00±9.64% in those with severe hypoxemia. EF rate varied between 50-72%, with the total average being 60.32±7.08%. No statistically significant correlation was found between EF and the severity of hypoxemia (p=0.67).A positive correlation was found between average pulmonary artery pressure and EF (r=0.550, p<0.05).Average ascending aortic diameter (AOD) was 36.54±2.84 mm in patients with mild hypoxemia, 34.00±4.31 mm in those with moderate hypoxemia, and 33.00±7.00 mm in those with severe hypoxemia. AOD varied between 25-41 mm, with the total average being 35.00±4.15 mm. A statistically significant correlation was found between AOD and the severity of hypoxemia (p=0.041). AOD generally tended to be lower in COPD patients with higher degree of hypoxemia. While long-term COPD is considered a risk factor for aortic dilation, we found no correlation between hypoxemia during COPD attacks and aortic dilation in our study.As severity of hypoxemia during acute exacerbations of COPD increases, UA, UA/C and ejection fraction remain unchanged, while arterial stiffness increases and cardiac arrhythmias and ascending aorta diameter decrease. There is also a positive correlation between pulmonary artery pressure and ejection fraction.
Description
Keywords
Kronik obstrüktif akciğer hastalığı akut alevlenme, Ürik asit, Kardiyak aritmiler, Arteryel sertlik, Ejeksiyon fraksiyon, Acute exacerbation in chronic obstructive pulmonary disease, Uric acid, Cardiac arrhythmias, Arterial stiffness, Ejection fractio
Citation
Özyılmaz, S. Ö. (2012). Kronik obstrüktif akciğer hastalığı olan hastalarda akut alevlenmelerin kardiyak etkileri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.