Acil servise başvuran hastalarda asit-baz bozukluklarının analizi
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Date
2012
Authors
Öner, Nuran
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Çalışmamız acil serviste asit-baz bozuklarını; tipleri, sıklığı, semptomları, bulguları, tanıları, tedavileri ve sonuçlarına göre incelemeyi amaçlamaktadır. Ayrıca kan gazı elektrolit değerlerinin kan biyokimyası ile uyumlu olup olmadığı, kritik hastalarda laboratuar testleri yerine kan gazı elektrolit değerlerinin kullanılabilirliğini araştırmaktır.Uludağ Üniversitesi Tıp Fakültesi acil servisine Temmuz ve Ekim 2011 tarihleri arasında başvuran ve kan gazı bakılan 18 yaş ve üzeri hastaların; demografik özellikleri, şikayetleri, FM bulguları, AKG ve biyokimyasal parametreler, ABB tipleri, tanı, tedavi ve sonuçları belirlenen form aracılığı ile toplandı.Çalışmamıza AKG bakılan 1007 hasta alındı; %24.9'unde normal asid-baz dengesi, %75,1'inda ise asit-baz bozukluğu saptandı. ABB saptanan hastaların %62,8'inde mikst tip bozukluk mevcuttu. MMASRAL %40,3 oranla en fazla saptanan bozukluk iken en az MMRAL ve MAL saptandı. Yaş gruplarından en fazla >65 yaş üstü grupta ABB saptandı. Basit ve mikst tip ABB'larının yaş gruplarına göre dağılımının istatistiksel olarak anlamlı olduğu saptandı (p=0.02). Genel olarak tüm ABB tiplerinde en sık geliş şikayeti nefes darlığı, genel durum bozukluğu iken, en sık tanılar ise pnömoni, ARY, KKY, malignitedir. ABB saptanan hastaların %45,7'si acil serviste tedavi edilip taburcu edildi ve %36,4'ü hastaneye yatırıldı. %12,3'ü başka bir kuruma tedavi amaçlı sevk edildi ve %2,4'ünde ölüm gerçekleşti. Metabolik asidoz saptanan hastalar AG açısından karşılaştırıldığında mikst tip metabolik asidozlarda yüksek AG saptanması; anlamlı olarak farklı bulundu (p=0,27). Artmış AG mortalite ve morbidite ile ilişkili olabileceği düşünüldü.Çalışmamız acil serviste asit-baz bozuklarını inceleyen Türkiyede ilk çalışmadır. Mevsimsel olarak acil servise başvuran hasta popülasyonu değişken olduğu için daha uzun süreli çalışmalara ihtiyaç vardır. Yine de acil servise başvuran hastalarda asit baz bozuklarının bilinmesi hastaların tanı, tedavi ve erken dönem prognozunda bize önemli ipuçları verebilir.
The study aims to investigate the acid-base disorders (ABD) in emergency department in terms of types, frequencies, symptoms, findings, diagnoses, treatments, and results. Besides, it is aimed to search whether blood gas electrolyte values are compatible with blood biochemistry and the usability of blood gas electrolyte values instead of laboratory tests in critically ill patients.By means of a form determined before the data was obtained from the patients, at the age of 18 and over 18, who applied to Uludağ University Medicine Faculty Emergency Department between July 2011 and October 2011, and whose blood gases were analysed. The gathered data comprised demographic characteristics, complaints, physical examination (PE) findings, arterial blood gas (ABG) and chemical parameters, the types of acid-base disorder, diagnosis, treatment, and results.1007 patients were included in the study and acid-base balance and acid-base disorder were detected in 24.9% and in 75.1% of patients respectively. In 62.8% of ABD detected patients mixed type disorder was present. While acidosis and respiratory alkalosis (MMASRAL) was the most frequent disorder with the rate of 40.3%, mixed metabolic and respiratory alkalosis (MMRAL) and metabolic alkalosis (MAL) were also determined. Mostly in 65+ age group had ABD. The distribution of simple and mixed type ABD was statistically significant (p=0.02) according to the age groups. In general, the most frequent hospital visit complaint in ABD types are shortness of breath and general condition disorder while the most frequent diagnoses are pneumonia, acute renal failure (ARF), congestive heart failure (CHF), and malignancy. 45.7% of ABD detected patients were treated in emergency department and then were discharged, 36.4% were hospitalized, 12.3% were transferred to another health institution for treatment, and 2.4% were resulted in death. When metabolic acidosis diagnosed patients were compared in terms of anion gap (AG), high AG determination in mixed type metabolic acidosis was found significantly different (p=0.27). Increased AG was thought to be related with mortality and morbidity.Investigating acid-base disorders in emergency department, our study is the first in Turkey. Since patient population applying to emergency department varies seasonally, longer period studies are needed. However, when acid-base disorders in patients applying to emergency department are known well, might give important hints in diagnosis, treatment, and early period prognosis of the patients.
The study aims to investigate the acid-base disorders (ABD) in emergency department in terms of types, frequencies, symptoms, findings, diagnoses, treatments, and results. Besides, it is aimed to search whether blood gas electrolyte values are compatible with blood biochemistry and the usability of blood gas electrolyte values instead of laboratory tests in critically ill patients.By means of a form determined before the data was obtained from the patients, at the age of 18 and over 18, who applied to Uludağ University Medicine Faculty Emergency Department between July 2011 and October 2011, and whose blood gases were analysed. The gathered data comprised demographic characteristics, complaints, physical examination (PE) findings, arterial blood gas (ABG) and chemical parameters, the types of acid-base disorder, diagnosis, treatment, and results.1007 patients were included in the study and acid-base balance and acid-base disorder were detected in 24.9% and in 75.1% of patients respectively. In 62.8% of ABD detected patients mixed type disorder was present. While acidosis and respiratory alkalosis (MMASRAL) was the most frequent disorder with the rate of 40.3%, mixed metabolic and respiratory alkalosis (MMRAL) and metabolic alkalosis (MAL) were also determined. Mostly in 65+ age group had ABD. The distribution of simple and mixed type ABD was statistically significant (p=0.02) according to the age groups. In general, the most frequent hospital visit complaint in ABD types are shortness of breath and general condition disorder while the most frequent diagnoses are pneumonia, acute renal failure (ARF), congestive heart failure (CHF), and malignancy. 45.7% of ABD detected patients were treated in emergency department and then were discharged, 36.4% were hospitalized, 12.3% were transferred to another health institution for treatment, and 2.4% were resulted in death. When metabolic acidosis diagnosed patients were compared in terms of anion gap (AG), high AG determination in mixed type metabolic acidosis was found significantly different (p=0.27). Increased AG was thought to be related with mortality and morbidity.Investigating acid-base disorders in emergency department, our study is the first in Turkey. Since patient population applying to emergency department varies seasonally, longer period studies are needed. However, when acid-base disorders in patients applying to emergency department are known well, might give important hints in diagnosis, treatment, and early period prognosis of the patients.
Description
Keywords
Acil servis, Asit-baz bozukluğu, Kan gazı elektrolit, Biyokimya elektrolit, Emergency department, Acid-base disorder, Blood gas electrolyte, Biochemistry electrolyte
Citation
Öner, N. (2012). Acil servise başvuran hastalarda asit-baz bozukluklarının analizi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.