Mekanik ventilasyon gerektiren kronik obstrüktif akciğer hastalığı olgularında uzun dönem sağ kalım ve mortaliteyi etkileyen faktörler
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Date
2013
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Trakya Üniversitesi
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Abstract
Bu çalışmanın amacı, yoğun bakım gerektiren kronik obstrüktif akciğer hastalığı olgularında, uzun dönem sağ kalım ve uzun dönem sağ kalımı etkileyen potansiyel faktörlerin belirlenmesidir.Trakya Üniversitesi Tıp Fakültesi Hastanesi Dahili Yoğun Bakım Ünitesinin arşiv kayıtları kullanılarak Kasım 2006 ile Haziran 2011 tarihleri arasında yoğun bakıma başvuran 1801 hasta arasından Kronik Obstrüktif Akciğer Hastalığı'na bağlı akut solunum yetmezliği tanısı ile yatırılan 151 hasta belirlendi. Hastaların yoğun bakımdan taburcu olduktan sonraki yaşam süreleri, telefon numaralarından ve bölgesel nüfus kayıtlarından ulaşılarak elde edildi. 13 hastaya ulaşılamadığından çalışma dışı bırakıldı. 37 hasta yoğun bakımda kaybedildiğinden, yoğun bakım mortalitesi belirlenip çalışmaya kalan 101 hasta ile devam edildi.Çalışmaya alınan 101 hastanın yaş ortalaması 66.66±10.78, 81'i erkek, 20'si kadındı. Yoğun bakımda ortalama kalış süresi 8.30±7.94 gün olarak belirlendi. Yoğun bakım mortalitesi %24.5 (n:37) idi. Uzun dönem sağ kalım oranları; 1 yıl %60.6 (n:62), 2 yıl %45.4 (n:49) ve 3 yıllık %40 (n:45) idi. Tek değişkenli analiz sonuçlarına göre yaş (yaşayan: 63.31±10.22, ölen: 68.77±10.68, p: 0.012), yoğun bakım tekrarı (yaşayan: 3 (%7.7), ölen: 17 (%27.4), p: 0.015) ve 1. saniye zorlu ekspiratuar volüm düzeyi (yaşayan: 1.45±0.64, ölen: 1.13±0.59, p: 0.029) uzun dönem sağ kalıma etkili faktörlerdir. Çok değişkenli Cox regresyon analizinde yaş (p: 0.027, OR: 1.047, %95 GA: 1.005-1.091) ve Acute Physiology and Chronic Health Evaluation II skorunun (p: 0.026, OR: 1.106, %95 GA: 1.012-1.210) uzun dönem sağ kalıma etkili olduğu saptanmıştır.Sonuç olarak ileri yaş ve yüksek Acute Physiology and Chronic Health Evaluation II skoru kronik obstrüktif akciğer hastalığı nedeniyle yoğun bakım gerektiren olgularda uzun dönem mortaliteyi olumsuz yönde etkileyen faktörler olarak öne çıkmıştır.Anahtar kelimeler: Mortalite, mekanik ventilasyon, solunum yetmezliği, prognostik faktörler, kronik obstrüktif akciğer hastalığı
The aim of this study to identify the potential factors affecting long-term survival and mortality in patients with Chronic Obstructive Pulmonary Disese requiring intensive care.Using archival records of Trakya University Medical Faculty Hospital İnternal İntensive Care Unıt. Among 1801 patients admitted to İntensive Care Unıt between November 2006 and June 2011, 151 patients hospitalized with the diagnosis acute respiratory failure due to Chronic Obstructive Pulmonary Disese were determined. Survival of patients after discharge from İntensive Care Unıt were obtained from phone numbers, and by accessing the regional population records. Fifty patients (37 died in the İntensive Care Unıt and 13 lost on follow-up) were excluded from the study and the remaining 101 patients were included fort he analysis.Mean age was 66.66 ± 10.78 and 81 of them were male. Average length of stay in İntensive Care Unıt was 8.30 ± 7.94 days. İntensive Care Unıt mortality was %24,5 (n:37). One, 2, and 3-year survival rates were 60.6%, 45.4%, and 40%, respectively. According to the results of the univariate analysis, age (alive: 63.31 ± 10.22, died: 68.77 ± 10.68, p: 0.012), intensive care unit re-hospitalization (alive: 3 (7.7%), died: 17 (27.4%), p: 0.015) and FEV1 level (alive: 1.45 ± 0.64, dead: 1.13 ± 0.59, p: 0.029) were effective factors in long-term survival. According to multivariate Cox regression analysis, age (p: 0.027, OR: 1.047, 95% CI: 1.005-1.091), and Acute Physiology and Chronic Health Evaluation II score (p: 0.026, OR: 1.106, 95% CI: 1.012-1.210) weree detected to be effective in long-term survival.As a result, older age and high Acute Physiology and Chronic Health Evaluation II scores came forward as negative factors affecting long-term mortality in patients with Chronic Obstructive Pulmonary Disese requiring intensive care unit.Key words: Mortality, mechanical ventilation, respiratoryfailure, prognosticfactors, chronic obstructive pulmonary disease
The aim of this study to identify the potential factors affecting long-term survival and mortality in patients with Chronic Obstructive Pulmonary Disese requiring intensive care.Using archival records of Trakya University Medical Faculty Hospital İnternal İntensive Care Unıt. Among 1801 patients admitted to İntensive Care Unıt between November 2006 and June 2011, 151 patients hospitalized with the diagnosis acute respiratory failure due to Chronic Obstructive Pulmonary Disese were determined. Survival of patients after discharge from İntensive Care Unıt were obtained from phone numbers, and by accessing the regional population records. Fifty patients (37 died in the İntensive Care Unıt and 13 lost on follow-up) were excluded from the study and the remaining 101 patients were included fort he analysis.Mean age was 66.66 ± 10.78 and 81 of them were male. Average length of stay in İntensive Care Unıt was 8.30 ± 7.94 days. İntensive Care Unıt mortality was %24,5 (n:37). One, 2, and 3-year survival rates were 60.6%, 45.4%, and 40%, respectively. According to the results of the univariate analysis, age (alive: 63.31 ± 10.22, died: 68.77 ± 10.68, p: 0.012), intensive care unit re-hospitalization (alive: 3 (7.7%), died: 17 (27.4%), p: 0.015) and FEV1 level (alive: 1.45 ± 0.64, dead: 1.13 ± 0.59, p: 0.029) were effective factors in long-term survival. According to multivariate Cox regression analysis, age (p: 0.027, OR: 1.047, 95% CI: 1.005-1.091), and Acute Physiology and Chronic Health Evaluation II score (p: 0.026, OR: 1.106, 95% CI: 1.012-1.210) weree detected to be effective in long-term survival.As a result, older age and high Acute Physiology and Chronic Health Evaluation II scores came forward as negative factors affecting long-term mortality in patients with Chronic Obstructive Pulmonary Disese requiring intensive care unit.Key words: Mortality, mechanical ventilation, respiratoryfailure, prognosticfactors, chronic obstructive pulmonary disease
Description
Tıpta Uzmanlık
Keywords
Göğüs Hastalıkları, Chest Diseases
