Sirozlu hastalarda sağlıkla ilgili yaşam kalitesini belirleyen faktörler- otonom disfonksiyonun etkisi
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Date
2015
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Trakya Üniversitesi Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Abstract
Çalışmamızın amacı; sirozlu hastalarda sağlıkla ilgili yaşam kalitesini belirleyen faktörlerin tespit edilmesi ve otonom disfonksiyonun bu konudaki etkisinin belirlenmesidir. Çalışmamıza karaciğer sirozu tanısı bulunan toplam 100 hasta dahil edildi. Tüm hastalara otonom disfonksiyonunu gösterebilmek amacıyla Ewing ve Clarke tarafından standardize edilmiş postural değişiklik, derin nefes alma, valsalva manevrası sırasında kan basıncı değişikliği ve kalp hızının nicel ölçümü uygulandı. Medical Outcomes Study: 36 -Item Short Form Survey Instrument anketi kullanılarak sirozun hastaların yaşam kalitesi üzerine olan etkileri saptanmaya çalışıldı. Çalışmamıza yaşları 24 ile 84 arasında değişen 25'i kadın, 75'i erkek toplam 100 hasta dahil edildi. Hastaların 35'i Child A, 36'sı Child B ve 29'u Child C grubunda idi. Çalışmamızda siroz hastalarındaki otonom disfonksiyonu sıklığı %52 olarak tespit edildi. (%21 erken parasempatik hasar, %17 kesin parasempatik hasar, %14 kombine sempatik ve parasempatik hasar). Test sonuçlarına göre hastaların %48'i normal olarak saptandı. Otonom disfonksiyonu olan hastaların SF-36 ile belirlenen yaşam kalitesi puanları, otonom disfonksiyonu olmayanlara göre anlamlı derecede düşük olduğu saptandı. Hastaların yaşam kalitesi puanlarını belirleyen alt gruplardan fiziksel fonksiyon, genel sağlık durumu, canlılık değerlendirme puanlarının otonom disfonksiyon varlığı arasındaki ilişki istatiksel olarak anlamlı derecede daha fazla etkilendiği gözlendi (p<0,005). Çalışmamızdaki hastaların Child sınıflaması ve MELD skoru puanları otonom disfonksiyonu olanlarda anlamlı derecede daha yüksek olduğu saptanmıştır. Sirotik hastalardaki otonom disfonksiyonu sıklığı %52 olarak saptandı. Otonom disfonksiyon; özefagus varis kanaması, asit, hepatik ensefalopati gibi siroz hastalarının yaşam kalitesini olumsuz etkileyen kötü prognostik faktörlerden birisidir.
abstract
The aim of our study is to evaluate the factors which may affect health related quality of life and the contribution of autonomic dysfunction in patients with liver cirrhosis. One hundred patients with liver cirrhosis were enrolled in our study. To assess autonomic dysfunction, blood pressure and heart rate were determined during postural diversification, deep inspiration and valsalva maneuvre which were standardized by Ewing and Clarke. Quality of life was evaluated by using Medical Outcomes Study: 36 Item Short Form Survey Instrument Questionnaire. This survey was consisted of 36 items over 8 dimensions. These dimensions were physical role functioning, social role functioning, vitality, bodily pain, general health perceptions, emotional role functioning, physical functioning and mental health. Twenty five female and seventy five male patients with age 24 to 84 were enrolled in our study. 35 of the patients had Child A, 36 Child B and 29 were Child C liver cirrhosis. 52% patients had autonomic dysfunction. 21% had parasympathetic damage, 17% had absolute parasympathetic damage. Combined sympatheticand parasympathetic damage prevalence was 14%. According to test results, 48% of the patients were normal. SF-36 scores of patients with autonomic dysfunction were significantly lower than patients who do not have autonomic dysfunction. Dimensions such as physical functioning, vitality and general ehalth perceptions were significantly related with autonomic dysfunction and were considered as poor prognostic risk factors (p<0.005). Child and MELD scores of patients with autonomic dysfunctions were higher with statistical significance. Patients with these complications showed worse SF-36 scores and had poor prognosis. The prevalence of autonomic dysfunction in patients with cirrhosis is 52%. Autonomic dysfunction is a poor prognostic factor affecting quality of life like esophageal variceal bleeding, scites and hepatic encephalopathy.
abstract
The aim of our study is to evaluate the factors which may affect health related quality of life and the contribution of autonomic dysfunction in patients with liver cirrhosis. One hundred patients with liver cirrhosis were enrolled in our study. To assess autonomic dysfunction, blood pressure and heart rate were determined during postural diversification, deep inspiration and valsalva maneuvre which were standardized by Ewing and Clarke. Quality of life was evaluated by using Medical Outcomes Study: 36 Item Short Form Survey Instrument Questionnaire. This survey was consisted of 36 items over 8 dimensions. These dimensions were physical role functioning, social role functioning, vitality, bodily pain, general health perceptions, emotional role functioning, physical functioning and mental health. Twenty five female and seventy five male patients with age 24 to 84 were enrolled in our study. 35 of the patients had Child A, 36 Child B and 29 were Child C liver cirrhosis. 52% patients had autonomic dysfunction. 21% had parasympathetic damage, 17% had absolute parasympathetic damage. Combined sympatheticand parasympathetic damage prevalence was 14%. According to test results, 48% of the patients were normal. SF-36 scores of patients with autonomic dysfunction were significantly lower than patients who do not have autonomic dysfunction. Dimensions such as physical functioning, vitality and general ehalth perceptions were significantly related with autonomic dysfunction and were considered as poor prognostic risk factors (p<0.005). Child and MELD scores of patients with autonomic dysfunctions were higher with statistical significance. Patients with these complications showed worse SF-36 scores and had poor prognosis. The prevalence of autonomic dysfunction in patients with cirrhosis is 52%. Autonomic dysfunction is a poor prognostic factor affecting quality of life like esophageal variceal bleeding, scites and hepatic encephalopathy.
Description
Tıpta Uzmanlık Tezi
Keywords
Siroz, Yaşam Kalitesi, Otonomik Hastalıklar, Cirrhosis, Quality of Life, Autonomic Diseases
