Umbilikal kateterizasyon ilişkili portal ven trombozu, portal hipertansiyon ve diğer sorunların gelişme insidansı
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Yenidoğan portal ven trombozu için umbilikal ven kateterizasyonu (UVK) en önemli risk faktörlerinden biridir. Yenidoğan yoğun bakım ünitelerinde özellikle son zamanlarda giderek artan sıklıkta UVK uygulanmaktadır. Portal ven trombozunda (PVT) doğru tanı ve etkin tedavi, komplikasyonların yönetimi açısından oldukça önemlidir. Bu çalışmada, hastanemizde uygulanan umblikal venöz kateterlerin, portal ven trombozu ve portal hipertansiyon (PHT) gibi sorunlarla ilişkisinin ve risk faktörlerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Retrospektif olarak, Ocak 2014- Mart 2022 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Yenidoğan Bakım Ünitesi'nde ve Çocuk Sağlığı ve Hastalıkları Yenidoğan Yoğun Bakım Ünitesi'nde izlenen, umbilikal venöz kateter (UVK) ile tedavi uygulanmış olan toplam 506 hasta çalışmaya dahil edilmiştir. Hastaların demografik verileri, umbilikal kateter yerleşim düzeyleri, uç noktaları, kateter kalış süreleri değerlendirilmiş, yatarak tedavilerinde ve taburculuklarında bakılan portal venöz doppler/Gri skala ultrasonografileri (USG), portal venöz tromboz (PVT) ve/veya PVT şüpheli anomali ve diğer patolojiler açısından incelenmiştir. Bulgular: Toplam UVK uygulanan 506 hastadan, 18'inde PVT saptanırken, 488'inde PVT gelişmediği gözlendi. Çalışmada PVT gelişen yenidoğanlarda (13 erkek, 5 kız) erkek kız oranı 1:2,6, PVT gelişmeyen yenidoğanlarda ise (263 erkek, 225 kız) erkek kız oranı 1:1,17 olarak saptanmıştır. Kateter yerleşim düzeyi uygun olmayan yerleşime sahip yenidoğanların, uygun yerleşime sahip yenidoğanlardan gestasyonel hafta ve doğum ağırlıklarının anlamli olarak daha yüksekdi ve düşük doğum ağırlığının PVT gelişimi üzerinde etkili değildi. 506 hastanın 21'inde (%4,15) kateter ilişkili tromboz saptandı. 21 hastadan 18'inde (%3,55) PVT, 3'ünde atrial trombüs bulundu. PVT görülme sıklığı ile UVK yerleşim düzeyleri arasındaki fark anlamlıydı (p<0,05). Anormal yerleşimin PVT grubunda PVT gelişimine katkıda bulunduğu, yüksek yerleşimin ise PVT olmayan grupta bir faktör olduğu saptandı. PVT tespit edilen 18 hastadan 10'u erken dönemde DMAH tedavisi aldı ve 5 hastanın trombüsü çözündü. Kalan 5 hasta DMAH tedavisi almadı ve kronik PVT olarak kabul edildi. Toplamda 12 hastada kronik PVT tespit edildi (hiç tedavi almayan 7 hasta ve tedavi almasına ragmen trombüsü çözünmeyen 5 hasta). UVK yerleşim yerlerinin uygunluğu ile bebeklerin doğum ağırlıkları arasındaki farklar anlamlıydı ve bu fark AGA bebeklerden kaynaklanmaktaydı. UVK kalış süresi ortalaması en yüksek çok yüksek düzeyde kateter yerleştirilen grupta bulunurken, en düşük malpoze seviyesinde kateter yerleştirilen grupta yer aldığı ve gruplar arası bu farkların anlamlı olduğu saptandı (p<0,05). Trombüs yerinin en çok sol portal ven (PV) olduğu belirlendi. ROC analizine göre, UVK kateter kalış süresi için kesme noktası 7,5 olarak bulundu. Bebeklerde sepsis gelişiminde UVK kalış süresinin risk faktörü olduğu, konjenital anomali varlığının PVT gelişimini etkilediği, komplikasyonların kümülatif insidansının ise 5. günde %17, 10. günde %34 ve 14. gününde istikrarlı bir şekilde %42'ye yükseldiği görüldü. UVK ilişkili PVT, portal hipertansiyon gelişimi üzerinde etkili olduğu saptandı. Gri skala/Doppler USG'lerde ilk trombüs boyutlarının, trombüsün spontan rezolüsyonu üzerinde etkili olup olmadığı çalışmamızdaki veri yetersizlikleri nedeniyle değerlendirilemedi. Sonuç: UVK uygulaması sırasında kateter ucunun uygun şekilde yerleştirilmesi, UVK ilişkili PVT'yi önlemede oldukça önemlidir. Anormal uç yerleşimleri ile daha yüksek PVT riski mevcuttur. Yenidoğan UVK uygulaması ile PVT gelişiminin iyileştirilmesi için yenidoğan yoğun bakım ünitelerinde UVK uygulamasına yönelik standartlaştırılmış kılavuzlar gerekmektedir. Anahtar Sözcükler: Portal Ven Trombozu (PVT), Umbilikal Ven Kateterizasyonu (UVK), Preterm, Portal Hipertansiyon (PHT), Venöz Tromboz
Purpose: Umbilical vein catheterization (UVC) is one of the most important risk factors for neonatal portal vein thrombosis. UVC is being applied with increasing frequency in neonatal intensive care units, especially recently. Accurate diagnosis and effective treatment of portal vein thrombosis (PVT) are very important for the management of complications. This study aimed to determine the relationship and risk factors of umbilical venous catheters used in our hospital with problems such as portal vein thrombosis and portal hypertension (PHT). Materials and Methods: Retrospectively, a total of 506 patients were treated with an umbilical venous catheter (UVK) and were monitored in the Ege University Faculty of Medicine, Pediatric Surgery Neonatal Care Unit and Pediatric Health and Diseases Neonatal Intensive Care Unit between January 2014 and March 2022. The patient was included in the study. Demographic data of the patients, umbilical catheter placement levels, end points, catheter stay times were evaluated, and portal venous Doppler/Gray scale ultrasonography (USG), portal venous thrombosis (PVT) and/or PVT were examined in terms of suspected anomalies and other pathologies during their inpatient treatment and discharge. Results: Of the 506 patients who underwent UVC, PVT was detected in 18 patients, while PVT did not develop in 488 patients. In the study, the boy-girl ratio was found to be 1:2.6 in newborns who developed PVT (13 boys, 5 girls), and the boy-girl ratio was 1:1.17 in newborns who did not develop PVT (263 boys, 225 girls). The gestational week and birth weights of newborns with inappropriate catheter placement were significantly higher than newborns with appropriate placement, and low birth weight had no effect on the development of PVT. Catheter-related thrombosis was detected in 21 of 506 patients (4.15%). PVT was found in 18 of 21 patients (3.55%) and atrial thrombus was found in 3 patients. The difference between the incidence of PVT and UVC location levels was significant (p<0.05). It was determined that abnormal location contributed to the development of PVT in the PVT group, while high location was a factor in the non-PVT group. Of the 18 patients with PVT, 10 received early LMWH treatment and the thrombus resolved in 5 patients. The remaining 5 patients did not receive LMWH treatment and were considered to have chronic PVT. Chronic PVT was detected in 12 patients in total (7 patients who received no treatment and 5 patients whose thrombus did not dissolve despite receiving treatment). The differences between the suitability of UVK settlements and the birth weights of babies were significant, and this difference was due to AGA babies. It was determined that the mean UVC stay duration was highest in the group with very high catheter placement, while it was lowest in the group with malposition level catheter placement, and these differences between the groups were significant (p<0.05). The most common thrombus location was determined to be the left portal vein (PV). According to ROC analysis, the cut-off point for UVK catheter stay time was found to be 7.5. It was observed that the duration of UVC stay was a risk factor in the development of sepsis in infants, the presence of congenital anomalies affected the development of PVT, and the cumulative incidence of complications increased steadily to 17% on the 5th day, 34% on the 10th day, and 42% on the 14th day. UVC-related PVT was found to be effective on the development of portal hypertension. It could not be evaluated whether the initial thrombus sizes in gray scale/Doppler USGs had an impact on the spontaneous resolution of the thrombus due to insufficient data in our study. Conclusion: Appropriate placement of the catheter tip during UVK application is very important in preventing UVK-related PVT. There is a higher risk of PVT with abnormal tip placement. To improve the development of PVT with neonatal UVC application, standardized guidelines for UVC application in neonatal intensive care units are required. Key Words: Portal Vein Thrombosis (PVT), Umbilical Vein Catheterization (UVK), Preterm, Portal Hypertension (PHT), Venous Thrombosis
Purpose: Umbilical vein catheterization (UVC) is one of the most important risk factors for neonatal portal vein thrombosis. UVC is being applied with increasing frequency in neonatal intensive care units, especially recently. Accurate diagnosis and effective treatment of portal vein thrombosis (PVT) are very important for the management of complications. This study aimed to determine the relationship and risk factors of umbilical venous catheters used in our hospital with problems such as portal vein thrombosis and portal hypertension (PHT). Materials and Methods: Retrospectively, a total of 506 patients were treated with an umbilical venous catheter (UVK) and were monitored in the Ege University Faculty of Medicine, Pediatric Surgery Neonatal Care Unit and Pediatric Health and Diseases Neonatal Intensive Care Unit between January 2014 and March 2022. The patient was included in the study. Demographic data of the patients, umbilical catheter placement levels, end points, catheter stay times were evaluated, and portal venous Doppler/Gray scale ultrasonography (USG), portal venous thrombosis (PVT) and/or PVT were examined in terms of suspected anomalies and other pathologies during their inpatient treatment and discharge. Results: Of the 506 patients who underwent UVC, PVT was detected in 18 patients, while PVT did not develop in 488 patients. In the study, the boy-girl ratio was found to be 1:2.6 in newborns who developed PVT (13 boys, 5 girls), and the boy-girl ratio was 1:1.17 in newborns who did not develop PVT (263 boys, 225 girls). The gestational week and birth weights of newborns with inappropriate catheter placement were significantly higher than newborns with appropriate placement, and low birth weight had no effect on the development of PVT. Catheter-related thrombosis was detected in 21 of 506 patients (4.15%). PVT was found in 18 of 21 patients (3.55%) and atrial thrombus was found in 3 patients. The difference between the incidence of PVT and UVC location levels was significant (p<0.05). It was determined that abnormal location contributed to the development of PVT in the PVT group, while high location was a factor in the non-PVT group. Of the 18 patients with PVT, 10 received early LMWH treatment and the thrombus resolved in 5 patients. The remaining 5 patients did not receive LMWH treatment and were considered to have chronic PVT. Chronic PVT was detected in 12 patients in total (7 patients who received no treatment and 5 patients whose thrombus did not dissolve despite receiving treatment). The differences between the suitability of UVK settlements and the birth weights of babies were significant, and this difference was due to AGA babies. It was determined that the mean UVC stay duration was highest in the group with very high catheter placement, while it was lowest in the group with malposition level catheter placement, and these differences between the groups were significant (p<0.05). The most common thrombus location was determined to be the left portal vein (PV). According to ROC analysis, the cut-off point for UVK catheter stay time was found to be 7.5. It was observed that the duration of UVC stay was a risk factor in the development of sepsis in infants, the presence of congenital anomalies affected the development of PVT, and the cumulative incidence of complications increased steadily to 17% on the 5th day, 34% on the 10th day, and 42% on the 14th day. UVC-related PVT was found to be effective on the development of portal hypertension. It could not be evaluated whether the initial thrombus sizes in gray scale/Doppler USGs had an impact on the spontaneous resolution of the thrombus due to insufficient data in our study. Conclusion: Appropriate placement of the catheter tip during UVK application is very important in preventing UVK-related PVT. There is a higher risk of PVT with abnormal tip placement. To improve the development of PVT with neonatal UVC application, standardized guidelines for UVC application in neonatal intensive care units are required. Key Words: Portal Vein Thrombosis (PVT), Umbilical Vein Catheterization (UVK), Preterm, Portal Hypertension (PHT), Venous Thrombosis
Açıklama
Anahtar Kelimeler
Çocuk Cerrahisi, Pediatric Surgery
