Preterm doğumlarda yenidoğan respiratör distress sendromunun pulmoner arter doppler incelemesi ile öngörülmesi
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Dosyalar
Tarih
2018
Yazarlar
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada Pulmoner basıncın dolaylı değerlendirilmesine yol açan fetal pulmoner arter Doppler indekslerinin, neonatal RDS'yi dolaylı olarak öngörmede kullanılabileceğini düşünmekteyiz. Bu nedenle bu çalışmada preterm doğumlarda yenidoğan respiratör distress sendromunun pulmoner arter doppler incelemesi ile öngörülmesi amaçlanmıştır. Prospektif kohort araştırması olarak yürütülen bu çalışmada, Temmuz 2018- Aralık 2018 tarihleri arasında Ege Üniversitesi Kadın Hastalıkları ve Doğum Anabilim Dalı'nda 37. gebelik haftasından önce doğum yapmış doğumsal anomali ve gebelik komplikasyonu olmayan gebelerden doğan 32 preterm yenidoğan çalışmaya dahil edilmiştir. Tek bir deneyimli perinatoloji hekimi tarafından tüm hastalara fetal pulmoner arter Doppler akımları elde etmek için ultrason muayenesi yapıldı. Doppler ultrason muayenesi doğum öncesi son 3 gün içerisinde bakıldı. Pulmoner arter akselerasyon zamanı(AT), pulmoner arter ejeksiyon zamanı(ET) ve akselerasyon zamanının ejeksiyon zamanına oranı (PATET) hesaplandı. Çalışmağa dahil edilen tüm gebelere kortikosteroid tedavisi uygulandı . Doğumdan sonra yenidoğanlar RDS (+) ve RDS (-) olarak RDS tanısına göre gruplandırıldı. İstatatistiksel analizlerde SPSS 23.0 (Statistical Packages for Socia Sciences; SPSS Inc., Chicago, Illinois, USA) programı kullanılmıştır. Tüm istatistiksel değerlendirmelerde α yanılma düzeyi 0.005 olarak alındı ve p≤0.05 anlamlı kabul edilmiştir. Çalışma sonucunda, 4 hastada RDS(+) ve 28 hastada RDS(-)'di. RDS (+) hastaların yaş ortalaması 29,25±8,42 yıl olurken, RDS (-) olan hastaların yaş ortalaması 32,57±4,58 yıl olarak saptanmıştır. RDS(+) ve RDS(-) gruplarının yaş ortalamaları arasında istatistiksel farklılık gözlenmiştir (p<0,05). Fakat gruplar arsında boy, kilo, BMI,gravida ve parite açısından anlamlı bir ilişki saptanmamıştır (p>0,05). Pulmoner Arter Akselerasyon Süresi RDS(+) olan grupta 76,01±10,86 sn olurken, RDS (-) olan grupta 70,04±21,92 sn olarak tespit edilmiştir. Gruplar arasında istatistiksel farklılık gözlenmiştir (p=0,002). Pulmoner Arter Ejeksiyon Süresi açısından değerlendirildiklerinde RDS(+) olan grupta 233,51±127,58 sn olurken, RDS (-) olan grupta 244,14±52,14 sn olarak tespit edilmiştir. Gruplar arasında istatistiksel farklılık gözlenmiştir (p=0,004). Hasta grupları PATET açısından değerlendirildiklerinde RDS(+) olan grupta 0,38±0,13 olurken, RDS (-) olan grupta 0,29±0,08 olarak tespit edilmiştir. RDS(+) ve RDS (-) gruplarının PATET ortalamaları arasında istatistiksel farklılık gözlenmiştir (p=0,003). Bu çalışmanın sonuçları fetal PATET değerleri ile neonatal RDS varlığı arasında ters bir korelasyon olduğunu göstermiştir. Bu nedenle, fetal PATET oran ölçümünün umut verici, invazif olmayan, tekrarlanabilir ve kabul edilebilir düzeyde özgüllük, duyarlılık ve negatif öngörü değerleri olarak güvenilir bir yöntem olduğunu öneriyoruz.
In this study, we think that fetal pulmonary artery Doppler indices, which indirectly leads to indirect evaluation of pulmonary pressure, can be used to predict neonatal RDS indirectly. Therefore, in this study, pulmonary artery doppler examination of neonatal respiratory distress syndrome in preterm delivery was aimed. In this study, which was carried out as a prospective cohort study, 32 preterm babies born from pregnant women who didn't have congenital anomaly and pregnancy complication that gave birth before 37th gestational week in Ege University Department of Obstetrics and Gynecology between July 2018 and December 2018 were included in the study. All patients underwent ultrasound examination to obtain fetal pulmonary artery Doppler by a single experienced specialist. After birth, newborns were grouped according to RDS (+) and RDS (-) as RDS. SPSS 23.0 (SPSS Inc., Chicago, Illinois, USA) program was used for statistical analysis. In all statistical evaluations, α error level was taken as 0.005 and p düzey0.05 was considered significant. At the end of the study, 4 patients had RDS (+) and 28 patients had RDS (-). The mean age of RDS (+) patients was 29.25 ± 8.42 years, and the mean age of patients with RDS (-) was 32.57 ± 4.58 years. There was a statistically significant difference between the mean age of RDS (+) and RDS (-) groups (p <0.05). However, no significant relationship was found between the groups in terms of height, weight, BMI, gravida and parity (p> 0.05). Pulmonary Artery Acceleration Time was 76.01 ± 10.86 sec in RDS (+) group and 70.04 ± 21.92 sec in RDS group. There was a statistically significant difference between the groups (p = 0.002). When evaluated in terms of Pulmonary Artery Ejection Time, it was 233,51 ± 127,58 sec in the RDS (+) group and 244,14 ± 52,14 sec in the RDS (-) group. There was a statistically significant difference between the groups (p = 0.004). When the patient groups were evaluated in terms of PATET, it was 0.38 ± 0.13 in the RDS (+) group and 0.29 ± 0.08 in the RDS (-) group. There was a statistically significant difference between the mean scores of the RDS (+) and RDS (-) groups (p = 0.003). The results of this study showed an inverse correlation between fetal PATET values and the presence of neonatal RDS. Therefore, we suggest that fetal PATET ratio measurement is a highly reliable method with promising, noninvasive, reproducible and acceptable levels of specificity, sensitivity and negative predictive values.
In this study, we think that fetal pulmonary artery Doppler indices, which indirectly leads to indirect evaluation of pulmonary pressure, can be used to predict neonatal RDS indirectly. Therefore, in this study, pulmonary artery doppler examination of neonatal respiratory distress syndrome in preterm delivery was aimed. In this study, which was carried out as a prospective cohort study, 32 preterm babies born from pregnant women who didn't have congenital anomaly and pregnancy complication that gave birth before 37th gestational week in Ege University Department of Obstetrics and Gynecology between July 2018 and December 2018 were included in the study. All patients underwent ultrasound examination to obtain fetal pulmonary artery Doppler by a single experienced specialist. After birth, newborns were grouped according to RDS (+) and RDS (-) as RDS. SPSS 23.0 (SPSS Inc., Chicago, Illinois, USA) program was used for statistical analysis. In all statistical evaluations, α error level was taken as 0.005 and p düzey0.05 was considered significant. At the end of the study, 4 patients had RDS (+) and 28 patients had RDS (-). The mean age of RDS (+) patients was 29.25 ± 8.42 years, and the mean age of patients with RDS (-) was 32.57 ± 4.58 years. There was a statistically significant difference between the mean age of RDS (+) and RDS (-) groups (p <0.05). However, no significant relationship was found between the groups in terms of height, weight, BMI, gravida and parity (p> 0.05). Pulmonary Artery Acceleration Time was 76.01 ± 10.86 sec in RDS (+) group and 70.04 ± 21.92 sec in RDS group. There was a statistically significant difference between the groups (p = 0.002). When evaluated in terms of Pulmonary Artery Ejection Time, it was 233,51 ± 127,58 sec in the RDS (+) group and 244,14 ± 52,14 sec in the RDS (-) group. There was a statistically significant difference between the groups (p = 0.004). When the patient groups were evaluated in terms of PATET, it was 0.38 ± 0.13 in the RDS (+) group and 0.29 ± 0.08 in the RDS (-) group. There was a statistically significant difference between the mean scores of the RDS (+) and RDS (-) groups (p = 0.003). The results of this study showed an inverse correlation between fetal PATET values and the presence of neonatal RDS. Therefore, we suggest that fetal PATET ratio measurement is a highly reliable method with promising, noninvasive, reproducible and acceptable levels of specificity, sensitivity and negative predictive values.
Açıklama
Anahtar Kelimeler
Preterm Doğum, Doppler Ultrason, Prenatal Tanı, Pulmoner Arter Akselerasyon Zamanı, Pulmoner Arter Ejeksiyon Zamanı, Akselerasyon Zamanının Ejeksiyon Zamanına Oranı, Respiratuvar Distres Sendromu, Preterm Delivery, Doppler Ultrasound, Prenatal Diagnosis, Pulmonary Artery Acceleration to Ejection Time Ratio, Respiratory Distress Syndrome
