Yoğun bakım hastalarında aritmi insidansı ve risk faktörleri
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Date
2014
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Uludağ Üniversitesi
Abstract
Kalbin elektriksel sisteminin her türlü bozukluğuna aritmi denir. Kritik hastalarda yoğun bakıma uzun ya da kısa dönemli yatışlar süresinde her an kardiyak aritmi gözlenebilmekte ve hastanın prognozu aritmiler nedeniyle tamamen bozulabilmektedir. Çalışmamızda yoğun bakım (YB) ünitemizde tedavi edilmekte olan kritik hastalarda aritmi insidansını, etiyolojik risk faktörlerini, uygulanan tedavileri ve sonuçlarını araştırmayı amaçladık. Uludağ Üniversitesi Tıp Fakültesi Hastanesi Anesteziyoloji ve Reanimasyon Anabilim Dalı Yoğun Bakım Ünitesi'nde Haziran 2012 ve Haziran 2013 tarihleri arasında tedavi edilen mekanik ventilasyon (MV) uygulanan ve bir ya da daha fazla organ yetersizliği olan 18 yaş üzeri, kalp kapak hastalığı ve 6 ay içinde geçirilmiş kardiyak cerrahi ya da miyokard infarktüsü öyküsü bulunmayan hastalar çalışmamıza dahil edildi Yaş, cinsiyet, yatış tanısı, yatış arteryel kan basıncı, kalp atım hızı, santral venöz basınç değerleri, APACHE (akut fizyolojik ve kronik sağlık değerlendirme) II skoru, yatış sırasındaki laboratuar parametreleri trakeostomi ve santral venöz kateter varlığı, YB tedavi döneminde cerrahi uygulanması, inotropik ve vazoaktif ilaç kullanımları, YB süresince sepsis, akut renal yetmezlik (ARY), miyokard infarktüsü (MI), ventilatör ile ilişkili pnömoni (VİP) gelişimleri, YB ve hastanede yatış süreleri ve YB tedavi sonucu kayıt edildi. Kardiyak aritmi gelişen hastalardan aritmi sırasında EKG dökümleri alındı. Aritmi geliştiği andaki hemodinamik parametreler, laboratuar verileri, inotropik ve vazoaktif ilaç kullanımları, sepsis, ARY, MI ve pnömoni tanılarının varlığı kayıt edildi. Aritmi için uygulanan tedaviler ve sonuçları kayıt edildi. Çalışmamıza 214 hasta dahil edildi. 92'si kadın (%43), 122'si erkek (%57)'ti. Hastaların yaş ortalaması 60.5 yıl (19-90) saptandı. Bu hastaların %26.1 (n=56)'inde yatış süresinde aritmi gelişmiş olup, bunların %44.6 (n=25)'sı erkek, %55.4 (n=31)'ü kadındı. Kadınlarda aritmi insidansı yüksekti (p=0.045). Aritmi gelişen hastaların yaş ortalaması 69 (19-86) yıl olup, aritmi gelişmeyenlere göre daha yaşlıydılar (p<0.001). Tüm hastaların APACHE II skoru ortalaması 21.5 (8-46) idi. Aritmi gelişen olgularda APACHE II skoru daha yüksekti (p=0.001). Yoğun bakıma SVO (serebrovasküler olay) ve travma tanıları ile kabul edilme aritmi gelişimi ile ilişkili idi (sırasıyla; p=0.021, p=0.032). Yoğun bakım yatışı süresince VİP ve sepsis gelişimi ile aritmi arasında da anlamlı ilişki saptandı (p<0.001, (p<0.001). En sık gözlenen aritmi tipi atriyal fibrilasyon (%53), en sık uygulanan tedavi de diltiazem (%28.5) idi. Hastaların YB yatış süresi 1330 gün olup, aritmi gelişen hastaların YB yatış süresi anlamlı olarak uzundu (1939 gün, p=0.021). Hastaların 103'ünün (%48.1) YB tedavisi eksitus ile sonuçlandı. Aritmi gelişen 56 olgunun 32'si (%57.1), gelişmeyen 158 olgunun ise 71'i (%44.9) tedavi sonunda kaybedilmişti. Aritmi gelişimi ile mortalite arasında istatistiksel anlamlı ilişki yoktu (p>0.05). Eksitus nedeni aritmi olan 3 (tüm olguların %1.4'ü, aritmi gelişen 56 olgunun %5.4'ü: 1 olgu supraventriküler taşikardi, 2 olgu yüksek hızlı atriyal fibrilasyon) hasta saptandı. Sonuç olarak; aritmi kritik hastalarda prognozu kötü yönde etkileyen, çeşitli etiyolojik nedenlerin bir sonucudur. Travma, SVO, VİP ve sepsis aritmi riskini artırır. En sık AF olmak üzere tüm aritmi tipleri gözlenebilir. En yaygın uygulanan tedavi diltiazemdir. Yoğun bakımda aritmi risk faktörleri ve önlenmesi üzerine protokoller oluşturulması amacıyla daha geniş çalışmalara ihtiyaç vardır.
Every kind of disorder of heart's electrical system is named arrythmia. Cardiac arrythmias may be observed in any moment during intensive care unit stay and as lots of intensivists observed while everything goes right prognosis of the patient may blow out. In our study we aimed to evaluate incidence and risk factors of arrythmias occured in critical patients of our intensive care unit. Patients who admissioned Uludag University Medical Faculty Hospital Reanimation Department Intensive Care Unit between Jun 2012- Jun 2013, older than 18, had no cardiac valvular disease, no cardiac surgery in recent 6 months period, no myocardial infarctious history, had mechanical ventilation requirement, one or more organ failure, were included to our study. Cases' ages, gender, blood pressure, heart rate, central venous pressure diagnoses with comorbidities and APACHE (acute physiological and chronical health evaluation) II score, laboratory parameters during admission, presence of central line and tracheostomy, surgical procedures during ICU stay, vasoactive drug usage, during ICU stay presence of sepsis, ARF (acute renal failure), MI (myocardial infarctions), VIP (ventilator induced pneumonia) were recorded. ECG (electrocardiography) records were printed during arrhythmias. During arrhythmia episode hemodynamic parameters, laboratory datas, vasoactive drug usage, presence of sepsis, ARF, MI, pneumonia were recorded. Therapies used for arrhythmia and responses were also recorded. In our study 214 patients were included. 43% (92) of them were female and 57% (122) were male. 26.1% (56) of patients had arrhythmias during ICU stay, 44.6% (25) were male and 55.4% (31) were female. Arrytmia incidence in females were higher (p=0.045). Age average of arrhythmic patients were 69 (19-86), and they were older than patients who did not have arrhythmia attacks (p<0,001). APACHE II score average was 21,5 (8-46) in all patients. APACHE II score was higher in patients who had arrhythmias (p=0.001). Admission to ICU with CVE (cerebrovascular event), trauma were related with arrhythmia presence during ICU stay (respectively; p=0.021, p=0.032). A significant relationship was determined between VIP and sepsis presence during ICU stay (p<0.001, p<0.001). Atrial fibrillation was most frequent arrhythmia type (53%), and most frequent medication was diltiazem (28.5%). ICU stay was 13±30 day for all patients and patients who had arrythmias had longer ICU stay significantly (19±39 day, p=0.021). 103 (48.1%) of patients' ICU stay was ended with exitus. 32 (57.1%) of 56 patients who had arrythmia episodes, and 71(44.9%) of 158 patients who did not have arrythmias died in ICU. There was no statistically significant relationship between arrythmia and mortality (p>0.05). 3 patients died primarly because of arrythmias (1.4% of all cases, 5.4% of 56 patients who had arrythmias: 1 case with supraventricular tachycardia, 2 cases with high ventricul rate atrial fibrilation. Consequently, in critically ill patients arrythmia, which effects prognosis badly, is a result of various ethiological causes. Trauma, CVE, VIP and sepsis increases arrythmia risk. All arrythmia types may ocur, but AF is more common. The most common treatment is diltiazem. Further studies are required for preparing protocols in order to prevent arrythmias and risk factors in ICU.
Every kind of disorder of heart's electrical system is named arrythmia. Cardiac arrythmias may be observed in any moment during intensive care unit stay and as lots of intensivists observed while everything goes right prognosis of the patient may blow out. In our study we aimed to evaluate incidence and risk factors of arrythmias occured in critical patients of our intensive care unit. Patients who admissioned Uludag University Medical Faculty Hospital Reanimation Department Intensive Care Unit between Jun 2012- Jun 2013, older than 18, had no cardiac valvular disease, no cardiac surgery in recent 6 months period, no myocardial infarctious history, had mechanical ventilation requirement, one or more organ failure, were included to our study. Cases' ages, gender, blood pressure, heart rate, central venous pressure diagnoses with comorbidities and APACHE (acute physiological and chronical health evaluation) II score, laboratory parameters during admission, presence of central line and tracheostomy, surgical procedures during ICU stay, vasoactive drug usage, during ICU stay presence of sepsis, ARF (acute renal failure), MI (myocardial infarctions), VIP (ventilator induced pneumonia) were recorded. ECG (electrocardiography) records were printed during arrhythmias. During arrhythmia episode hemodynamic parameters, laboratory datas, vasoactive drug usage, presence of sepsis, ARF, MI, pneumonia were recorded. Therapies used for arrhythmia and responses were also recorded. In our study 214 patients were included. 43% (92) of them were female and 57% (122) were male. 26.1% (56) of patients had arrhythmias during ICU stay, 44.6% (25) were male and 55.4% (31) were female. Arrytmia incidence in females were higher (p=0.045). Age average of arrhythmic patients were 69 (19-86), and they were older than patients who did not have arrhythmia attacks (p<0,001). APACHE II score average was 21,5 (8-46) in all patients. APACHE II score was higher in patients who had arrhythmias (p=0.001). Admission to ICU with CVE (cerebrovascular event), trauma were related with arrhythmia presence during ICU stay (respectively; p=0.021, p=0.032). A significant relationship was determined between VIP and sepsis presence during ICU stay (p<0.001, p<0.001). Atrial fibrillation was most frequent arrhythmia type (53%), and most frequent medication was diltiazem (28.5%). ICU stay was 13±30 day for all patients and patients who had arrythmias had longer ICU stay significantly (19±39 day, p=0.021). 103 (48.1%) of patients' ICU stay was ended with exitus. 32 (57.1%) of 56 patients who had arrythmia episodes, and 71(44.9%) of 158 patients who did not have arrythmias died in ICU. There was no statistically significant relationship between arrythmia and mortality (p>0.05). 3 patients died primarly because of arrythmias (1.4% of all cases, 5.4% of 56 patients who had arrythmias: 1 case with supraventricular tachycardia, 2 cases with high ventricul rate atrial fibrilation. Consequently, in critically ill patients arrythmia, which effects prognosis badly, is a result of various ethiological causes. Trauma, CVE, VIP and sepsis increases arrythmia risk. All arrythmia types may ocur, but AF is more common. The most common treatment is diltiazem. Further studies are required for preparing protocols in order to prevent arrythmias and risk factors in ICU.
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Keywords
Aritmi, Yoğun bakım, Risk faktörleri, Arrythmia, Intensive care, Critically ill, Risk factor
Citation
Taşdemir, G. (2014). Yoğun bakım hastalarında aritmi insidansı ve risk faktörleri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.