Acil tıp kliniğinde kafa travması dışı sebeplerle tedavi gören erişkin hastalarda, dehidratasyonun klinik ve laboratuvar bulgularının ultrasonografik ölçümlerle korelasyonu
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Tarih
2021
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada, dehidratasyon nedeni ile takip edilen hastaların değerlendirilmesi ve tedavilerinin düzenlemesi sırasında non-invaziv bir yöntem olarak öne çıkan bazı yatakbaşı ultrasonografik ölçümlerin (vena cava inferiorun kollapsibilite indeksi, maksimum ve minimum çap ölçümleri, optik sinir kılıf çapı ölçümleri, göz küresi transvers ve anteroposterior çap ölçümleri), klinik ve laboratuvar bulguları ile birlikte değerlendirilmesi, etkinliğinin araştırılması amaçlanmıştır. Yöntem: Çalışmaya acil servisimize başvuran 18 yaş ve üzeri, dışlama kriterlerini bulundurmayan ve çalışmaya katılmaya onam vermiş 300 hasta dahil edildi. Hastalar belirli klinik dehidratasyon bulgularından en az birini taşıyan ve bu klinik dehidratasyon bulgularından herhangi birisinin mevcut olmadığı 150'şer kişilik iki grupta değerlendirildi. Tek bir çalışmacı tarafından değerlendirilen hastaların başvuru vital bulguları, klinik dehidratasyon bulguları, tedavi sürecindeki laboratuvar bulguları ve yatakbaşı ultrasonografik ölçüm değerleri kaydedildi. Klinik dehidratasyon bulguları yeni gelişen bilinç değişikliği, oral mukoza kuruluğu, cilt turgoru azalması, vena cava inferiorun kollapsibilite indeksinin %50 ve üzeri olması olarak tanımlandı. Dehidratasyonun laboratuvar bulguları plazma ozmolaritesinin 295 mOsm ve üzeri olması, BUN/Kreatinin oranının 20 ve üzeri olması, düzeltilmiş serum sodyum değerinin 145 mEq/L ve üzeri olması olarak tanımlandı. Veriler SPSS 20.0 programına girildikten sonra verilerin normallik analizi yapıldı. Kategorik değişkenler n (%), normal dağılıma uyan numerik değikenler ortalama±SD ve normal dağılıma uymayan numerik değişkenler medyan olarak ifade edildi. Bulgular: Klinik dehidratasyon bulguları olmayan (kontrol) ve olan (vaka) grupların yaş ortanca değerleri sırasıyla 46 ve 72 idi (p<0,001). Kontrol grubunun %48,7'sini kadınlar ve %51,3'nü erkekler oluştururken, vaka grubunun %50'sini kadınlar ve %50'sini erkekler oluşturdu (p=0,817). Klinik dehidratasyon gruplarında komorbit hastalık özgeçmişi açısından farklılık saptandı (p<0,001). Klinik dehidratasyon gruplarının WBC, hemoglobin, hematokrit, BUN, üre, kreatinin, glukoz, albümin, total protein, plazma ozmolaritesi (Posm), BUN/Kreatinin oranı laboratuvar değerleri arasında istatistiksel olarak anlamlı fark saptandı (p<0,001). Klinik dehidratasyon gruplarında VCİ çapının maksimum (VCİmax), minimum değerleri (VCİmin), VCİ kollapsibilite indeksi (VCİKİ), her iki gözdeki optik sinir kılıf çapları (OSKÇ), transvers çaplar (Tçap), anteroposterior çaplar (APçap) arasında istatistiksel olarak anlamlı farklılık saptandı (p<0,001). Posm ile BUN/ Kreatinin oranı, Na⁺, VCİKİ arasında istatiksel olarak anlamlı pozitif; Posm ile CVP, VCİmax, VCİmin, her iki göz OSKÇ, Tçap ve APçap ortalamaları arasında istatiksel olarak anlamlı negatif korelasyon saptandı. VCİmax ve VCİmin, OSKÇ, Tçap, APçap değerleri korele idi. Posm (mOsm) ≥295 olması klinik dehidratasyonun tespitinde %78,6 sensitivite, %84,6 spesifite, %79,6 PPD ve %67,9 NPD ile öne çıkan laboratuvar bulgusu idi. Oral mukoza kuruluğu, Posm'ye göre dehidratasyonun tespitinde %77,8 sensitivite, %71,1 spesifite, %61,9 PPD ve %84,1 NPD ile öne çıkan klinik bulgu idi. OSKÇ ölçümleri %80 üzerindeki sensitivite değerleri ile diğer oküler ultrasonografik ölçümlerin önüne geçmiştir. Sonuç: Hasta kliniği, subjektif değerlendirme gibi sebeplerle yanıltıcı olabilen klinik bulgular ve geç sonuçlanabilen laboratuvar bulguları ile birlikte değerlendirilen ultrasonografik VCİmax, VCİmin ve VCİKİ ölçümleri dehidratasyonun erken tespitinde faydalıdır. Oküler ultrasonografik değerlendirmelerden OSKÇ, Tçap ve APçap ölçümleri ise vena cava inferior ultrasonografik ölçümleri ile koreledir ve uygun hastalarda kullanılabilir. Anahtar Kelimeler: Dehidratasyon, Ultrasonografi, Vena cava inferior, Optik sinir kılıf çapı, Göz küresi
In this study, it was aimed to evaluate and investigate the effectiveness of some bedside ultrasonographic measurements (vena cava inferior collapsibility index, maximum and minimum diameter measurements, optic nerve sheath diameter measurements, eyeball transverse and anteroposterior measurements), which stand out as a non-invasive method in the evaluation of patients followed for dehydration and in the regulation of their treatment, together with clinical and laboratory findings. Method: The study included 300 patients aged 18 years and older, who were treated in the emergency department, did not meet the exclusion criteria and volunteered to participate in the study. The patients were evaluated in two groups of 150, each with at least one of the clinical signs of dehydration and without any of these clinical signs of dehydration. Patients were evaluated by a single investigator. Admission vital signs, clinical signs of dehydration, laboratory findings during treatment, and bedside ultrasonographic measurement values were recorded. Clinical signs of dehydration; It was defined as newly developed consciousness change, dryness of the oral mucosa, decreased skin turgor, and a collapsibility index of the inferior vena cava of 50% or more. Laboratory findings of dehydration; It was defined as a plasma osmolarity of 295 mOsm and above, a BUN/creatinine ratio of 20 and above, and a serum corrected sodium value of 145 mEq/L and above. After the data were entered into the SPSS 20.0 program, the data were analyzed for normality. Categorical variables were expressed as n (%), numerical variables conforming to normal distribution were expressed as mean±SD, and numerical variables not conforming to normal distribution were expressed as median. Results: The median age of the clinically dehydrated and non-dehydrated groups was 46 and 72, respectively (p<0.001). While the control group consisted of 48.7% women and 51.3% men; case group consisted of 50% women and 50% men (p=0.817). There was a difference in clinical dehydration groups in terms of history of comorbid disease (p<0.001). A statistically significant difference was found between the laboratory values of the clinical dehydration groups, such as WBC, hemoglobin, hematocrit, BUN, urea, creatinine, glucose, albumin, total protein, plasma osmolarity (Posm), BUN/creatinine ratio (p<0.001). There was a statistically significant difference between the clinical dehydration groups in terms of the maximum (VCİmax) and minimum (VCİmin) values of the VCI diameter, the value of the VCI collapsibility index (VCİKİ). There was a statistically significant difference between the clinical dehydration groups in terms of the optic nerve sheath diameters (OSKÇ), transverse diameters (Tçap) and anteroposterior diameters (APçap) of both eyes (p<0.001). There was a statistically significant positive correlation between Posm and BUN/creatinine ratio, Na⁺, VCİKİ. There was a statistically significant negative correlation between Posm and CVP, VCİmax, VCİmin. There was a statistically significant negative correlation between Posm and OSKÇ, Tçap and APçap of both eyes. VCİmax, VCİmin, OSKÇ, Tçap and APçap values were correlated. Posm being 295 mOsm and above was the prominent laboratory finding with 78.6% sensitivity, 84.6% specificity, 79.6% PPD and 67.9% NPD in the detection of clinical dehydration. Oral mucosa dryness was the prominent clinical finding with 77.8% sensitivity, 71.1% specificity, 61.9% PPD and 84.1% NPD in the detection of dehydration according to Posm. OSKÇ measurements outweighed other ocular ultrasonographic measurements with sensitivity values above 80%. Conclusion: Clinical findings may be affected by the patient's clinic and may be subjective. Laboratory results may be delayed. Ultrasonographic VCİmax, VCİmin and VCİKİ measurements evaluated together with clinical and laboratory findings are useful in the early detection of dehydration. Ocular ultrasonographic measurements such as OSKÇ, Tçap and APçap correlate with ultrasonographic measurements of the inferior vena cava. It can be used in suitable patients. Keywords: Dehydration, Ultrasonography, Vena cava inferior, Optic nerve sheath diameter, Eyeball
In this study, it was aimed to evaluate and investigate the effectiveness of some bedside ultrasonographic measurements (vena cava inferior collapsibility index, maximum and minimum diameter measurements, optic nerve sheath diameter measurements, eyeball transverse and anteroposterior measurements), which stand out as a non-invasive method in the evaluation of patients followed for dehydration and in the regulation of their treatment, together with clinical and laboratory findings. Method: The study included 300 patients aged 18 years and older, who were treated in the emergency department, did not meet the exclusion criteria and volunteered to participate in the study. The patients were evaluated in two groups of 150, each with at least one of the clinical signs of dehydration and without any of these clinical signs of dehydration. Patients were evaluated by a single investigator. Admission vital signs, clinical signs of dehydration, laboratory findings during treatment, and bedside ultrasonographic measurement values were recorded. Clinical signs of dehydration; It was defined as newly developed consciousness change, dryness of the oral mucosa, decreased skin turgor, and a collapsibility index of the inferior vena cava of 50% or more. Laboratory findings of dehydration; It was defined as a plasma osmolarity of 295 mOsm and above, a BUN/creatinine ratio of 20 and above, and a serum corrected sodium value of 145 mEq/L and above. After the data were entered into the SPSS 20.0 program, the data were analyzed for normality. Categorical variables were expressed as n (%), numerical variables conforming to normal distribution were expressed as mean±SD, and numerical variables not conforming to normal distribution were expressed as median. Results: The median age of the clinically dehydrated and non-dehydrated groups was 46 and 72, respectively (p<0.001). While the control group consisted of 48.7% women and 51.3% men; case group consisted of 50% women and 50% men (p=0.817). There was a difference in clinical dehydration groups in terms of history of comorbid disease (p<0.001). A statistically significant difference was found between the laboratory values of the clinical dehydration groups, such as WBC, hemoglobin, hematocrit, BUN, urea, creatinine, glucose, albumin, total protein, plasma osmolarity (Posm), BUN/creatinine ratio (p<0.001). There was a statistically significant difference between the clinical dehydration groups in terms of the maximum (VCİmax) and minimum (VCİmin) values of the VCI diameter, the value of the VCI collapsibility index (VCİKİ). There was a statistically significant difference between the clinical dehydration groups in terms of the optic nerve sheath diameters (OSKÇ), transverse diameters (Tçap) and anteroposterior diameters (APçap) of both eyes (p<0.001). There was a statistically significant positive correlation between Posm and BUN/creatinine ratio, Na⁺, VCİKİ. There was a statistically significant negative correlation between Posm and CVP, VCİmax, VCİmin. There was a statistically significant negative correlation between Posm and OSKÇ, Tçap and APçap of both eyes. VCİmax, VCİmin, OSKÇ, Tçap and APçap values were correlated. Posm being 295 mOsm and above was the prominent laboratory finding with 78.6% sensitivity, 84.6% specificity, 79.6% PPD and 67.9% NPD in the detection of clinical dehydration. Oral mucosa dryness was the prominent clinical finding with 77.8% sensitivity, 71.1% specificity, 61.9% PPD and 84.1% NPD in the detection of dehydration according to Posm. OSKÇ measurements outweighed other ocular ultrasonographic measurements with sensitivity values above 80%. Conclusion: Clinical findings may be affected by the patient's clinic and may be subjective. Laboratory results may be delayed. Ultrasonographic VCİmax, VCİmin and VCİKİ measurements evaluated together with clinical and laboratory findings are useful in the early detection of dehydration. Ocular ultrasonographic measurements such as OSKÇ, Tçap and APçap correlate with ultrasonographic measurements of the inferior vena cava. It can be used in suitable patients. Keywords: Dehydration, Ultrasonography, Vena cava inferior, Optic nerve sheath diameter, Eyeball
Açıklama
Anahtar Kelimeler
Dehidratasyon, Ultrasonografi, Vena cava inferior, Optik sinir kılıf çapı, Göz küresi, Dehydration, Ultrasonography, Vena cava inferior, Optic nerve sheath diameter, Eyeball
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Künye
Yılmaztürk, Y. (2021). Acil tıp kliniğinde kafa travması dışı sebeplerle tedavi gören erişkin hastalarda, dehidratasyonun klinik ve laboratuvar bulgularının ultrasonografik ölçümlerle korelasyonu. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı Tez Koleksiyonu, Konya.
