Noninvaziv mekanik ventilatöre bağlı hastalarda iskemi belirteçlerinin değerlendirilmesi
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Dosyalar
Tarih
2013
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Noninvaziv mekanik ventilasyon (NIMV), solunum yetmezliği ve kronik obstriktif akciğer hastalığının (KOAH) tedavisinde yaygın olarak kullanılmaktadır NIMV akciğerlerin ventilasyonunu artırıp, sol ventrikül ile kalbin iş yükü ve oksijen tüketimini azaltarak etki göstermektedir. NIMV tedavisinin olumlu etkilerine karşı bu şekilde tedavi edilen hastalarda kardiyak hasarın arttığı bildirilmiştir. Bu çalışmanın amacı, solunum yetmezliği şikâyetiyle başvuran ve noninvaziv mekanik ventilasyona bağlanan hastalarda, bu uygulamanın çizgili kas ve kalp kasına olan etkilerini değerlendirmek üzere bazı iskemi belirteçlerinin araştırılmasıdır. Bu amaçla, KOAH tanılı 64 hasta çalışmaya alındı ve üç gruba ayrıldı. Çalışmaya dâhil edilen hastalardan, hafif solunum yetmezliği olan ve ventilatöre bağlanmayanlar, Grup I (kontrol grubu) (n=31) olarak alındı. Ağır solunum yetmezliği olan ve ventilatöre bağlananların ventilatöre bağlanma öncesi değerleri Grup II (öncesi)'yi (n=33), ventilatöre bağlanma sonrası (3. gün) değerleri ise Grup II (sonrası)'i (n=33) oluşturdu. Her üç gruptaki hastalarda pH, pO2 ve pCO2 seviyeleri ile serum troponin, miyoglobulin, kreatin kinaz (CK), CK-MB, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT) laktat dehidrogenaz (LDH), albumin ve iskemi modifiye albumin (İMA) düzeyleri ölçüldü. Serum troponin değerlerinin; NIMV öncesi grupta (Grup II (öncesi)) kontrol grubuna (Grup I) göre yüksek olduğu, keza NIMV sonrası grupta da (Grup II (sonrası)) anlamlı bir artışın olduğu (p=0.000) tespit edilmiştir. Serum AST ve İMA değerlerinde de; NIMV sonrası grupta (Grup II (sonrası)) kontrol grubuna (Grup I) göre anlamlı bir artışın olduğu saptanmıştır (sırasıyla p=0.031, p= 0.008). Serum miyoglobin, CK-MB, ALT, CK, LDH düzeylerinde ise, istatistiksel olarak anlamlı olmasa da troponin, AST ve İMA değerlerine benzer şekilde, gruplar arasında bir farklılığın olduğu tespit edilmiştir (p>0.05). Sonuç olarak, solunum yetmezliğinin şiddetine bağlı olarak iskemi belirteçlerinden serum troponin, AST ve İMA seviyelerinin arttığı, NIMV uygulamasının bu artışa katkısının sınırlı olduğu ve noninvaziv mekanik ventilasyon uygulaması sırasında kardiyak fonksiyonların daha dikkatli takip edilmesi gerektiği kanaatine varılmıştır
The noninvasive mechanical ventilation (NIMV) is widely used for the treatment of the patients' chronic obstructive pulmonary disease (COPD) and respiratory failure. NIMV is effective in increasing the ventilation of the lungs and decreasing the work of the heart on the left ventricle and the consumption of the oxygen. In spite of the positive effects of the NIMV treatment, an increase of cardiac damage is seen in the patients to whom the NIMV treatment has been applied. The aim of this study is to search certain ischemia markers in order to assess and measure the impact of this treatment on the striated muscle and the cardiac muscle of the patients who have been tied to the noninvasive mechanical ventilator, due to their suffering from the difficulty of breathing. With this objective, 64 patients with the diagnosis of COPD are included in this research, and they are divided into three groups. Group I (control group, n=31) consists of the patients who are suffering from mild respiratory failure and not connected to the ventilator. The patients with the severe respiratory failure, prior to their being tied to the ventilator, constitute Group II (before) (n=33), after their having been connected to the ventilator (3rd day), are the members of Group II (after) (n=33). The levels of blood pH, pO2 and pCO2, serum troponin, myoglobin, creatine kinase (CK), CK-MB, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), albumin, and the ischemia modified albumin (IMA) have been measured in the patients. The level of serum troponin has been observed higher in prior to NIMV (Group II (before)) than control group (Group I). Likewise, it has been noted significant increase (p=0.000) in group after NIMV (Group II (after)). Serum AST and IMA has also been seen a significant increase (respectively p=0.031, p= 0.008) in group after NIMV (Group II (after)) as compared to the control group (Group I). It has been statistically although not significant difference among the groups (p>0.05) at the levels of serum myoglobin, CK-MB, ALT, CK, LDH, similar to the levels of troponin, AST and IMA. It was concluded that, depending on the severity of respiratory failure, that are markers of ischemia, serum troponin, AST and IMA levels increased, NIMV application contributed to this increase is limited and cardiac function more careful should be followed during the non-invasive mechanical ventilation application.
The noninvasive mechanical ventilation (NIMV) is widely used for the treatment of the patients' chronic obstructive pulmonary disease (COPD) and respiratory failure. NIMV is effective in increasing the ventilation of the lungs and decreasing the work of the heart on the left ventricle and the consumption of the oxygen. In spite of the positive effects of the NIMV treatment, an increase of cardiac damage is seen in the patients to whom the NIMV treatment has been applied. The aim of this study is to search certain ischemia markers in order to assess and measure the impact of this treatment on the striated muscle and the cardiac muscle of the patients who have been tied to the noninvasive mechanical ventilator, due to their suffering from the difficulty of breathing. With this objective, 64 patients with the diagnosis of COPD are included in this research, and they are divided into three groups. Group I (control group, n=31) consists of the patients who are suffering from mild respiratory failure and not connected to the ventilator. The patients with the severe respiratory failure, prior to their being tied to the ventilator, constitute Group II (before) (n=33), after their having been connected to the ventilator (3rd day), are the members of Group II (after) (n=33). The levels of blood pH, pO2 and pCO2, serum troponin, myoglobin, creatine kinase (CK), CK-MB, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), albumin, and the ischemia modified albumin (IMA) have been measured in the patients. The level of serum troponin has been observed higher in prior to NIMV (Group II (before)) than control group (Group I). Likewise, it has been noted significant increase (p=0.000) in group after NIMV (Group II (after)). Serum AST and IMA has also been seen a significant increase (respectively p=0.031, p= 0.008) in group after NIMV (Group II (after)) as compared to the control group (Group I). It has been statistically although not significant difference among the groups (p>0.05) at the levels of serum myoglobin, CK-MB, ALT, CK, LDH, similar to the levels of troponin, AST and IMA. It was concluded that, depending on the severity of respiratory failure, that are markers of ischemia, serum troponin, AST and IMA levels increased, NIMV application contributed to this increase is limited and cardiac function more careful should be followed during the non-invasive mechanical ventilation application.
Açıklama
Anahtar Kelimeler
İskemi, IMA, Kardiyak hasar, NIMV, Troponin, Ischemia, Cardiac damage
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Şahin, H. (2013). Noninvaziv mekanik ventilatöre bağlı hastalarda iskemi belirteçlerinin değerlendirilmesi. (Yayınlanmamış yüksek lisans tezi). Necmettin Erbakan Üniversitesi Sağlık Bilimleri Enstitüsü Tıbbi Biyokimya Anabilim Dalı, Konya.
