Acil servise üst gastrointestinal sistem kanama semptomları ile başvuran hastalarda endoskopik tedavi yöntemlerinin değerlendirilmesi
Yükleniyor...
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Üst gastrointestinal sistem (GİS) kanaması mortalite ve morbiditesi yüksek olan acil bir durumdur. Üst GİS kanamaları acil servislere başvurunun sık sebepleri arasında yer alır ve önemli morbidite ve mortalite nedenidir. Bu çalışmada üst GİS kanama semptomları ile başvuran hastaların demografik özellikleri, geliş şikayetleri, komorbid hastalıkları, predispozan ilaç kullanım öyküleri, endoskopik bulguları ve uygulanan tedavi yöntemleri ile ilgili güncel veri elde etmek ve literatürle karşılaştırmak amaçlanmıştır. Yöntem:Çalışmamızda Ocak 2018 ve Ocak 2022 tarihleri arasında Üst Gastrointestinal Sistem Kanama ön tanısı ile Acil Servisten Gastroenteroloji Kliniğine danışılan, 18 yaş üzerinde olan,travmaya sekonder kanaması olmayan ve hastane elektronik sisteminde ICD tanı kodu mevcut olan, Üst Gastrointestinal Sistem Endoskopisi yapılmış 790 hasta yer almaktadır.Hastaların,demografik özellikleri, acil servise geliş prezentasyonları, ek hastalıkları, ilaç kullanımları, alışkanlıkları, geliş hemogram ve biyokimya değerleri, endoskopi sonuçları, uygulanan tedaviler, nüks kanama varlığı, transfüzyon ihtiyaçları, hastanede kalış süreleri ve prognozları hastane elektronik sisteminden retrospektif olarak incelendi. Bulgular:Çalışmamızdaki hastaların %61,40'ı (n=485) erkekti ve tüm hastaların yaş ortalaması 67,45±16,88 yıl idi. Hastaların %70,50'sinde (n=557) en az 1 kronik hastalık mevcuttu ve en sık görülen hastalık %27,70 (n=219) oranı ile hipertansiyondu. Katılımcıların %60,50'sinde (n=478) en az 1 GİS kanamasını presipite edici ilaç kullanımı olduğu ve en sık kullanılan ilacın %23,70 (n=187) oranı ile asetil salisilik asit (ASA) olduğu belirlendi. Çalışmaya alınan hastaların %66,80'nin (n=528) melena, %37,80'nin (n=299) hematemez, %9,10'unun (n=72) hematokezya, %2,00'ının (n=16) senkop ile hastaneye başvurduğu ve %26,70'inde (n=211) aktif kanama olduğu tespit edildi. . Hastaların %27,20'sinde (n=215) duedonal ülser, %14,40'ında (n=114) gastrik ülser, %13,80'inde (n=109) eritematöz gastrit, %13,80'inde (n=109) özefagus varis kanaması tespit edildi. GİS kanama ile başvuran hastaların %62,40'ına (n=493) izole medikal tedavi, %22,30'una (n=176) hemoklips, %15,40'ına (n=122) adrenalin, %8,20'sine (n=65) bant ligasyonu uygulandığı, %1,40'ına (n=11) girişimsel embolizasyon yapıldığı belirlendi. 62 hastada (%7,80) nüks geliştiği ve toplamda 57 hastanın (%7,20) exitus olduğu kaydedildi. İzole medikal tedavi uygulanan hastalarda nüks daha düşük oranda, hemoklips, adrenalin, bant ligasyonu, cerrahi / girişimsel embolizasyon uygulanan hastalarda nüks daha yüksek tespit edildi.Aynı şekilde yatış süresi uzun olan hastalarda, ES ihtiyacı fazla olan hastalarda nüksün daha fazla geliştiği tespit edildi. GİS kanaması ile başvuran hastalardan ek hastalığı, hipertansiyonu, koroner arter hastalığı, kronik böbrek yetmezliği, serebrovasküler olay, romatizmal hastalığı ve ritim bozukluğu olanlarda GİS kanamasını presipite edici ilaç kullanımı daha yüksek, karaciğer sirozu olanlarda daha düşük belirlendi. GİS kanaması ile başvuran hastalardan ASA, NSAİİ, Klopidogrel ve heparin kullananlarda INR düzeyi daha düşük, varfarin, yeni nesil oral antikoagülan kullananlarda INR düzeyi daha yüksek kaydedildi. Endoskopi sonucunda duedonal ülser tespit edilen hastalarda yatış süresinin daha kısa, özefagus varis kanaması, mide kanseri, dieulafoy lezyonu tespit edilen hastalarda daha uzun yatış süresi olduğu belirlendi.İzole medikal tedavi uygulanan hastalarda yatış süresinin istatistiksel olarak anlamlı düzeyde düşük; hemoklips, adrenalin, bant ligasyonu, cerrahi / girişimsel embolizasyon uygulanan hastalarda yatış süresinin istatistiksel olarak anlamlı düzeyde daha uzun olduğu saptandı. Sonuç:Sonuç olarak yapmış olduğumuz bu çalışmada üst GİS kanamalarınınhalen önemli bir mortalite ve morbidite sorunu olduğunu saptadık. Üst GİSkanamaya sebep olabilecek ilaçların kullanım oranının, ek hastalıkların birlikteliğininyüksek olduğunu, yaşlılarda sık görüldüğünü ve yaşla birlikte mortalitenin arttığını ayrıca günümüzde endoskopik ve anjiyografik tedavi metodlarının gelişmesi ile birlikte cerrahi tedavi ihtiyacının azaldığını tespit ettik.
Upper gastrointestinal tract (GI) bleeding is an emergency condition with high mortality and morbidity. Upper gastrointestinal bleeding is one of the most common reasons for admission to emergency departments and is an important cause of morbidity and deceleration. Methods:In this study, it was aimed to obtain up-to-date data on the demographic characteristics, development complaints, comorbid diseases, history of predisposing drug use, endoscopic findings and treatment methods of patients admitted with upper GI bleeding symptoms and compare them with the literature. Results:Our study between January 2018 and January 2022 dates from the emergency room with the diagnosis of upper gastrointestinal bleeding Gastroenterology Polyclinic, over the age of 18 trauma and bleeding secondary to non-hospital ICD diagnosis code is available with the electronic system, made of upper gastrointestinal endoscopy 790 patient is located.The demographic features,on arrival to the emergency room presentation, additional diseases, drug usage habits, hemogram and biochemical values of arrival, endoscopy results, treatment, recurrence, presence of bleeding, transfusion needs, hospital stay times and prognoses were retrospectively examined from the hospital electronic system.61.40% (n=485) of the patients in our study were male and the average age of all patients was 67.45±16.88 years. At least 1 chronic disease was present in 70.50% (n=557) of the patients and the most common disease was hypertension with a rate of 27.70% (n=219). It was determined that 60.50% (n=478) of the participants had at least 1 GI bleeding precipitating drug use and the most commonly used drug was acetyl salicylic acid (ASA) with a rate of 23.70% (n=187).66,80 of the study patients (n=528) melena, % of 37,80 (n=299) Hematemesis, %9,10 percent (n=72) Hematochezia, %2,00% of (N=16) refers to the hospital with syncope and %26,70% (n=211) active bleeding was found. . Duodenal ulcer, gastric ulcer in 14.40% (n=114), erythematous gastritis in 13.80% (n=109), esophageal varicose bleeding were detected in 27.20% (n=215) of the patients, erythematous gastritis in 13.80% (n=109). Of patients admitted with gastrointestinal bleeding 62,40% (n=493) medical treatment, %to 22.30 percent (n=176) hemoklips, %15,40% (n=122) adrenaline, %8,20% (N=65) applied band ligation, %1,40% (N=11) interventional embolization was performed. it was noted that relapse developed in 62 patients and a total of 57 patients (7.20%) had exitus.Recurrence was found to be lower in patients who underwent medical treatment, and recurrence was higher in patients who underwent hemoclips, adrenaline, band ligation, surgical / interventional embolization.In the same way, it was found that relapse develops more in patients with a long hospitalization period, in patients with a high need for ES. Additional patients admitted with GI bleeding from disease, hypertension, coronary artery disease, chronic renal failure, cerebrovascular event, rheumatic disease, and the use of therapeutic drugs precipitating arrhythmia in patients with gastrointestinal bleeding was higher in those with cirrhosis of the liver were lower. Among the patients admitted with GI bleeding, the INR level was lower in those who used ASA, NSAIDS, Clopidogrel and heparin, and the INR level was higher in those who used warfarin, a new generation oral anticoagulant. As a result of endoscopy, it was determined that the hospitalization period was shorter in patients with duodenal ulcer, esophageal varicose bleeding, stomach cancer, and longer hospitalization time in patients with dieulafoy lesion. Patients who have undergone medical treatment statistically significantly lower length of stay; hemoklips, adrenaline, band ligation, surgical / interventional embolization was found to be statistically significantly longer in patients who underwent the duration of hospitalization. Conclusion:As a result, in this study we have done, the upper gastrointestinal bleeding we have determined that there is still a significant mortality and morbidity problem. Upper gastrointestinal bleeding the rate of use of drugs that may cause bleeding, the coexistence of additional diseases We found that it is high, it is common in the elderly, and the mortality increases with age, and the need for surgical treatment has decreased with the development of endoscopic and angiographic treatment methods.
Upper gastrointestinal tract (GI) bleeding is an emergency condition with high mortality and morbidity. Upper gastrointestinal bleeding is one of the most common reasons for admission to emergency departments and is an important cause of morbidity and deceleration. Methods:In this study, it was aimed to obtain up-to-date data on the demographic characteristics, development complaints, comorbid diseases, history of predisposing drug use, endoscopic findings and treatment methods of patients admitted with upper GI bleeding symptoms and compare them with the literature. Results:Our study between January 2018 and January 2022 dates from the emergency room with the diagnosis of upper gastrointestinal bleeding Gastroenterology Polyclinic, over the age of 18 trauma and bleeding secondary to non-hospital ICD diagnosis code is available with the electronic system, made of upper gastrointestinal endoscopy 790 patient is located.The demographic features,on arrival to the emergency room presentation, additional diseases, drug usage habits, hemogram and biochemical values of arrival, endoscopy results, treatment, recurrence, presence of bleeding, transfusion needs, hospital stay times and prognoses were retrospectively examined from the hospital electronic system.61.40% (n=485) of the patients in our study were male and the average age of all patients was 67.45±16.88 years. At least 1 chronic disease was present in 70.50% (n=557) of the patients and the most common disease was hypertension with a rate of 27.70% (n=219). It was determined that 60.50% (n=478) of the participants had at least 1 GI bleeding precipitating drug use and the most commonly used drug was acetyl salicylic acid (ASA) with a rate of 23.70% (n=187).66,80 of the study patients (n=528) melena, % of 37,80 (n=299) Hematemesis, %9,10 percent (n=72) Hematochezia, %2,00% of (N=16) refers to the hospital with syncope and %26,70% (n=211) active bleeding was found. . Duodenal ulcer, gastric ulcer in 14.40% (n=114), erythematous gastritis in 13.80% (n=109), esophageal varicose bleeding were detected in 27.20% (n=215) of the patients, erythematous gastritis in 13.80% (n=109). Of patients admitted with gastrointestinal bleeding 62,40% (n=493) medical treatment, %to 22.30 percent (n=176) hemoklips, %15,40% (n=122) adrenaline, %8,20% (N=65) applied band ligation, %1,40% (N=11) interventional embolization was performed. it was noted that relapse developed in 62 patients and a total of 57 patients (7.20%) had exitus.Recurrence was found to be lower in patients who underwent medical treatment, and recurrence was higher in patients who underwent hemoclips, adrenaline, band ligation, surgical / interventional embolization.In the same way, it was found that relapse develops more in patients with a long hospitalization period, in patients with a high need for ES. Additional patients admitted with GI bleeding from disease, hypertension, coronary artery disease, chronic renal failure, cerebrovascular event, rheumatic disease, and the use of therapeutic drugs precipitating arrhythmia in patients with gastrointestinal bleeding was higher in those with cirrhosis of the liver were lower. Among the patients admitted with GI bleeding, the INR level was lower in those who used ASA, NSAIDS, Clopidogrel and heparin, and the INR level was higher in those who used warfarin, a new generation oral anticoagulant. As a result of endoscopy, it was determined that the hospitalization period was shorter in patients with duodenal ulcer, esophageal varicose bleeding, stomach cancer, and longer hospitalization time in patients with dieulafoy lesion. Patients who have undergone medical treatment statistically significantly lower length of stay; hemoklips, adrenaline, band ligation, surgical / interventional embolization was found to be statistically significantly longer in patients who underwent the duration of hospitalization. Conclusion:As a result, in this study we have done, the upper gastrointestinal bleeding we have determined that there is still a significant mortality and morbidity problem. Upper gastrointestinal bleeding the rate of use of drugs that may cause bleeding, the coexistence of additional diseases We found that it is high, it is common in the elderly, and the mortality increases with age, and the need for surgical treatment has decreased with the development of endoscopic and angiographic treatment methods.
Açıklama
Anahtar Kelimeler
Üst Gastrointestinal Kanama, Endoskopik Tedavi, Upper Gastrointestinal Bleeding, Endoscopic Treatment
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Demir. Ö. F. (2022). Acil servise üst gastrointestinal sistem kanama semptomları ile başvuran hastalarda endoskopik tedavi yöntemlerinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
