Acil servise kalp yetmezliği bulguları ile gelen hastaların tanı ve tedavisinde düzeltilmiş karotis akım zamanı ve vena kava indeksin etkinliği
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kalp yetmezliği(KY) ile acil servise başvuran hastaların volüm durumunun ve tedavi yanıtlarının değerlendirilmesinde İnferior vena kava kolapsibilite indeksinin (İVKKİ) ve düzeltilmiş karotis akım zamanının (FTc) karşılaştırılmasıdır. Burada elde edilecek veriler daha kolay uygulanabilen yeni bir yöntemin KY hastalarının tanı ve takip sürecinde de kullanılmasını sağlayabilir. Gereç ve Yöntem: Bu araştırma prospektif, gözlemsel, analitik çalışma olarak tasarlandı. Çalışma için Ege Üniversitesi Girişimsel Olmayan Araştırmalar Etik Kurulundan alınan izin ile Eylül 2018 – Şubat 2019 tarihleri arasında Ege Üniversitesi, Acil Servis Kliniğine Dekompanze KY ön tanısı ile başvuran 125 hasta çalışmaya alınmıştır. Hastalara ait yaş, cinsiyet, acil servise başvuru şikayetleri, eşlik eden komorbid hastalıklar, kullandığı kardiyak ilaçlar, vitalller kaydedildikten sonra acil servis hekimi tarafından fizik muayeneleri (ral,PTÖ,JVD) ve yatak başı ultrasonografi (USG) ile inferior vena kava (İVK) çapları, İVKKİ, karotis akımı, akciğer ve kardiyak değerlendirmeleri yapıldı. Sonrasında hastaların acil servis tanı, tetkik ve tedavi sürecine müdahale edilmedi. Acil serviste tedavisi sonuçlanan hastalarda USG ile İVK çapları, İVKKİ ve karotis akımları tekrar değerlendirildi ve kaydedildi. Kaydedilen veriler doğrultusunda istatistiksel analizler yapıldı. Bulgular: Kalp yetmezliği hastalarında Ejeksiyon fraksiyonlarına (EF) göre gruplandırılarak düzeltilmiş karotis akım zamanı ile arasındaki ilişkiler incelendi. EF değeri 40 altında olan grup ile 40-50 arsında ki grup arasında istatistiksel bir ilişki varken(p=0,01) diğer gruplar arasında bir ilişki görülmedi. KY hastalarında hem İVKKİ hem de İVK çaplarının sağ ve sol EF ile arasında ilişki olduğu görüldü. Hastalar EF'ye göre gruplandığında %40 altında kalan grup ile üstündeki grup arasında belirgin fark vardı. İVKKİ %40 üstündeki grupta daha etkin olarak değişti. İVKKİ'ndeki değişim ile FTc'deki değişim(%) karşılaştırıldığında aralarında negatif yönde bir ilişki görüldü. Fakat bu istatistiksel olarak anlamlı değildi. (Rho=-0,027) Sonuç: Acil servise başvuran KY hastalarının tanı ve takip sürecinde yatak başı USG etkilidir. İVKKİ kalp yetmezliği hastalarının tanı ve tedavi süreçlerinde kullanılabilir. İVKKİ EF değeri 40 üstündeki hastalar için daha kullanışlı bir yöntemdir. FTc ise KY hastaların tanı ve tedavi sürecinde çoklu etkileşim sebebiyle kullanımı uygun değildir.
Purpose: Aim of this study is the comparison of vena cava inferior collapsibility index(VCCI) and corrected carotis flow time (FTc) for assement of volume status and treatment response of patients who admitted to emergency department wih congestive heart failure(HF).Data acquiered from this study may provide the use of a new more applicable method for diagnosis and treatment of heart failiure patients. Material and Methods: this study was designed as a prospective, observational, analytical study. 125 patients who were admitted to the Emergency Department of Ege University between September 2018 and February 2019 with the preliminary diagnosis of Decompansated Heart Failure were included in the study with the permission of Ege University Non-Interventional Research Ethics Committee. Patient's age, sex, complaints to the emergency department, comorbid diseases, cardiac medications and vitals were recorded.Physical examination (Rales, PTE, JVD) and inferior vena cava (IVC) diameter , IVCCI, carotis flow rate , lung and cardiac ultrasonography evaluated by bedside ultrasonography by the emergency physician. . Afterwards, the patients were not intervened in the process of diagnosis, examination and treatment in emergency department. In patients who were treated in the emergency department, IVC diameters, IVCCI and carotid flow were reevaluated and recorded by USG. Statistical analyzes were performed according to the recorded data. Findings : In heart failiure patients ,relationship between Corrected carotis flow time and classified Ejection fractions were analysed. There was a statistically significant relationship between the group with EF value below 40 and the group between 40-50 (p = 0.01).However this relationship did not observed with other groups. In patients with HF, both IVCCI and IVC diameters were correlated with right and left ventricle EF. When the patients were grouped according to EF, there was a significant difference between the group below 40% EF and the group above %40 EF . IVCCI changed more effectively in the group above 40% EF. There was a negative correlation between change in IVCCI and change in FTc (%). But this was not statistically significant (Rho = -0.027). Conclusion: Bedside USG is effective in the diagnosis and follow-up of HF patients admitted to the emergency department. IVCCI can be used in the diagnosis and treatment of heart failure patients. IVCCI is a more useful method for patients with EF above 40%. FTc is not suitable for ithe diagnosis and treatment of HF patients because of multiple interactions.
Purpose: Aim of this study is the comparison of vena cava inferior collapsibility index(VCCI) and corrected carotis flow time (FTc) for assement of volume status and treatment response of patients who admitted to emergency department wih congestive heart failure(HF).Data acquiered from this study may provide the use of a new more applicable method for diagnosis and treatment of heart failiure patients. Material and Methods: this study was designed as a prospective, observational, analytical study. 125 patients who were admitted to the Emergency Department of Ege University between September 2018 and February 2019 with the preliminary diagnosis of Decompansated Heart Failure were included in the study with the permission of Ege University Non-Interventional Research Ethics Committee. Patient's age, sex, complaints to the emergency department, comorbid diseases, cardiac medications and vitals were recorded.Physical examination (Rales, PTE, JVD) and inferior vena cava (IVC) diameter , IVCCI, carotis flow rate , lung and cardiac ultrasonography evaluated by bedside ultrasonography by the emergency physician. . Afterwards, the patients were not intervened in the process of diagnosis, examination and treatment in emergency department. In patients who were treated in the emergency department, IVC diameters, IVCCI and carotid flow were reevaluated and recorded by USG. Statistical analyzes were performed according to the recorded data. Findings : In heart failiure patients ,relationship between Corrected carotis flow time and classified Ejection fractions were analysed. There was a statistically significant relationship between the group with EF value below 40 and the group between 40-50 (p = 0.01).However this relationship did not observed with other groups. In patients with HF, both IVCCI and IVC diameters were correlated with right and left ventricle EF. When the patients were grouped according to EF, there was a significant difference between the group below 40% EF and the group above %40 EF . IVCCI changed more effectively in the group above 40% EF. There was a negative correlation between change in IVCCI and change in FTc (%). But this was not statistically significant (Rho = -0.027). Conclusion: Bedside USG is effective in the diagnosis and follow-up of HF patients admitted to the emergency department. IVCCI can be used in the diagnosis and treatment of heart failure patients. IVCCI is a more useful method for patients with EF above 40%. FTc is not suitable for ithe diagnosis and treatment of HF patients because of multiple interactions.
Açıklama
Anahtar Kelimeler
Kalp Yetmezliği, Vena Kava İnferior Kollapsibilite İndeksi, Düzeltilmiş Karotis Akım Zamanı, Heart Failure, Collapsiability İndex Of Vena Cava İnferior, Corrected Carotis Flow Time
