Diyabetik ketoasidoz tanılı çocuklarda elektrokardiyografik bulguların değerlendirilmesi
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çocuklarda diyabetik ketoasidoz (DKA) tablosunun oluşturduğu metabolik bozuklukların (hiperglisemi, ketonemi, metabolik asidoz, elektrolit düzensizlikleri vs.) elektrokardiyografi (EKG) üzerine olan etkilerinin araştırılması amaçlanmıştır. Yöntem: Çalışma Aralık 2018 – Mart 2020 tarihleri arasında yapıldı ve DKA tanılı 39 çocuk ile yaş ve cinsiyet olarak uyumlu 40 sağlıklı çocuk dâhil edildi. Hasta grubundan birincisi DKA anında, ikincisi DKA düzeldikten 3-7 gün sonra ve üçüncüsü taburculuktan yaklaşık 1-2 hafta sonra olmak üzere toplamda üç ve kontrol grubundan ise bir adet EKG kaydı alındı. Tüm olguların demografik özellikleri incelendi, elektrokardiyografik olarak P dispersiyonu (Pd), QT dispersiyonu (QTd), QTc dispersiyonu (QTcd) ve Tp-e intervali ile Tp-e/QT ve Tp-e/QTc oranları değerlendirildi. Bulgular: Hasta grubunun yaş ortalaması 10,50±4,12 yıl ve kontrol grubunun ise 10,47±4,11 yıl idi. Hasta grubunun %59,0'u kız (n=23) ve %41,0'i erkek (n=16), ve kontrol grubunun %60,0'ı kız (n=24) ve %40,0'ı (n=16) erkek idi. Hasta ve kontrol grupları arasında cinsiyet ve yaş bakımından istatistiksel olarak anlamlı fark yoktu (p>0,05). Hasta grubunda Pd, QTd ve QTcd değerleri açısından birinci EKG ile ikinci ve üçüncü EKG'leri arasında istatistiksel olarak anlamlı artış saptandı (p<0,05). Ayrıca birinci ile üçüncü EKG karşılaştırıldığında bu parametrelere ilave olarak Tp-e ve Tp-e/QT'de anlamlı artış eklendi. Diyabetik ketoasidoz tedavisi öncesinde çekilen birinci EKG'lerde kontrol grubuna göre anlamlı olarak artmış Pd, QTd, QTcd, Tp-e ve Tp-e/QT değerlerinin olması dikkat çekmekteydi (p<0,05). Sonuç: Bu çalışmada DKA'lı çocuklarda kardiyak aritmi riski belirteçlerinin arttığı tespit edildi. Bu nedenle, klinisyenler DKA tedavisi sırasında yeni aritmilerin gelişme olasılığı konusunda dikkatli olmalıdır. Ancak büyük serilerle uzun dönemli çalışmalara ihtiyaç vardır.
We aimed to study the effects of metabolic disorders (hyperglycemia, ketonemia, metabolic acidosis, electrolyte irregularities, etc.) on electrocardiography (ECG) as a result of the diabetic ketoacidosis in children. Method: This study was performed between December 2018 and March 2020 and included 39 children with diabetic ketoacidosis (DKA) and age and gender matched 40 healthy children. Three ECGs were obtained from the patient group; first at the moment of DKA, second after the DKA recovered (3-7 days later), and third approximately 1-2 weeks later after discharge from hospital. Demographic characteristics of all cases were examined, and also P dispersion (Pd), QT dispersion (QTd), QTc dispersion (QTcd), Tp-e intervals, and the ratios of Tp-e/QT and Tp-e/QTc were measured electrocardiographically. Results: The mean age of the patient group was 10.50±4.12 years and of the control group was 10.47±4.11 years. Of the cases: 59.0% were female (n=23) and 41.0% were male (n=16) in patient group, and 60.0% were female (n=24) and 40.0% were male (n=16) in control group. There was no statistically significant difference between the patient and control groups in terms of gender and age (p>0.05). There was a statistically significant increase in Pd, QTd and QTcd in first ECGs compared to second and third ECGs (p<0.05). Also, when the first and third ECGs are compared, a significant increase in Tp-e and Tpe/QT was added in addition to these parameters. It was noteworthy that there was a significant increase in the values of Pd, QTd, QTcd, Tp-e and Tp-e/QT in the first ECGs, obtained before DKA treatment, compared to control group ECGs (p<0.05). Conclusion: In this study, cardiac arrhythmia risk markers were detected to be increased in children with DKA. Therefore, clinicians should be careful about the possibility of development of new arrhythmias during DKA treatment. However long term studies with large series are required
We aimed to study the effects of metabolic disorders (hyperglycemia, ketonemia, metabolic acidosis, electrolyte irregularities, etc.) on electrocardiography (ECG) as a result of the diabetic ketoacidosis in children. Method: This study was performed between December 2018 and March 2020 and included 39 children with diabetic ketoacidosis (DKA) and age and gender matched 40 healthy children. Three ECGs were obtained from the patient group; first at the moment of DKA, second after the DKA recovered (3-7 days later), and third approximately 1-2 weeks later after discharge from hospital. Demographic characteristics of all cases were examined, and also P dispersion (Pd), QT dispersion (QTd), QTc dispersion (QTcd), Tp-e intervals, and the ratios of Tp-e/QT and Tp-e/QTc were measured electrocardiographically. Results: The mean age of the patient group was 10.50±4.12 years and of the control group was 10.47±4.11 years. Of the cases: 59.0% were female (n=23) and 41.0% were male (n=16) in patient group, and 60.0% were female (n=24) and 40.0% were male (n=16) in control group. There was no statistically significant difference between the patient and control groups in terms of gender and age (p>0.05). There was a statistically significant increase in Pd, QTd and QTcd in first ECGs compared to second and third ECGs (p<0.05). Also, when the first and third ECGs are compared, a significant increase in Tp-e and Tpe/QT was added in addition to these parameters. It was noteworthy that there was a significant increase in the values of Pd, QTd, QTcd, Tp-e and Tp-e/QT in the first ECGs, obtained before DKA treatment, compared to control group ECGs (p<0.05). Conclusion: In this study, cardiac arrhythmia risk markers were detected to be increased in children with DKA. Therefore, clinicians should be careful about the possibility of development of new arrhythmias during DKA treatment. However long term studies with large series are required
Açıklama
Anahtar Kelimeler
Diyabetis mellitus, Diabetes mellitus, Diyabetik ketoasidoz, Diabetic ketoacidosis, Ekokardiyografi, Echocardiography
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Eğil, O. (2020). Diyabetik ketoasidoz tanılı çocuklarda elektrokardiyografik bulguların değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
