Genel yoğun bakımda takip edilen politravma hastalarının retrospektif değerlendirmesi
Evaluating the polytrauma patient retrospectively in intensive care unit
Yazar: FATMA PELİN DELİAGA
Danışman: DOÇ.DR. ALİ AYDIN ALTUNKAN
Mersin Üniversitesi / Tıp Fakültesi / Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2007
Konu: Anestezi ve Reanimasyon = Anesthesiology and Reanimation

Özet:
1. ÖZETÇal mam zda, 23.11.1998-31.08.2006 tarihleri aras nda MersinÜniversitesi T p Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dal , Yo+unbak m klini+inde takip edilen, 123 politravmal hastan n retrospektif olarakincelenmesi amaçlanm t r.Hastalar n ya ortalamas , 31.95Â±17.27 ve 37'si kad n, 86's erkek olaraktespit edilmi tir. Ortalama Glasgow Koma Skalas (GKS) 8.52Â±4.98, ortalamaTravma Skoru (TS) 7.60Â±3.48 olarak saptanm t r. 107 hastaya mekanikventilasyon uygulan rken, 16's na uygulanmam t r. 31 hastaya beslenmedestek tedavisi ba lanmazken, 53 tanesine paranteral, 38 tanesine paranteralve enteral, 1 tanesine ise enteral beslenme ba lanm t r. Hastalar m zda %79,9oran nda Sistemik inflamatuar yan t sendromu (SIRS), %38,2 oran nda Sepsis,%50,1 oran nda, çoklu organ yetmezli+i (MOF) tespit edilmi tir.Dü ük GKS ve TS de+erlerinde mortalite, mekanik ventilasyonuygulamas ihtiyac , SIRS ve MOF geli iminin artt + saptan rken, GKS ve TS ilesepsis aras nda, bir ili ki tespit edilmemi tir. Mortalite gözlenen grupta GKS veTS aras nda kuvvetli bir korelasyon oldu+u saptanm t r. GKS'n n 5'in alt ndakide+erlerinde mortalitenin, 8'in alt ndaki de+erlerinde mekanik ventilasyonihtiyac n n ve TS'nun 6'n n alt ndaki de+erlerinde mortalite, mekanik ventilasyonuygulamas ihtiyac , SIRS, sepsis ve MOF geli iminin artt + tespit edilmi tir.Mekanik ventilasyon ihtiyac , mekanik ventilasyon uygulanma süresi vebeslenme destek tedavisi ile mortalite, SIRS, sepsis ve MOF aras nda kuvvetlibir korelasyon oldu+u gösterilmi tir. Çal mam zda SIRS ve MOF oran artt kçamortalitenin artt + tespit edilirken, sepsis ile mortalite aras nda böyle bir ili kitespit edilmemi tir. Hastalar m z n yo+un bak m kal süreleri artt kça mortalite,SIRS, sepsis, MOF oran n artt + görülmü tür.Sonuç olarak; politravma hastalar n n kliniklerinin, birbirlerini de oldukças k olarak etkileyen bir seri parametreyle belirlendi+i gösterildi. Bu hastalar nprognozlar n n, pek çok klinik durumun bir arada, dikkatli ve özenli bir ekildede+erlendirilmesi ve erken dönemden itibaren Genel Yo+un Bak m ko ullar ndatakibiyle iyile tirilebilece+i kan s na var ld .Anahtar Kelimeler: Glasgow Koma Skalas , Mortalite, Politravma, TravmaSkoru.

Abstract:
2. ABSTRACTEVALUATING THE POLYTRAUMA PATIENT RETROSPECTIVELYIN INTENSIVE CARE UNITIn this study we aimed to retrospectively review 123 patients admittedwith polytrauma in intensive care unit (ICU), in University of Mersin of School ofMedicine between November 23, 1998 and August 31, 2006.Patient?s mean age was 31.95Â±17.27 and 37 of them were female, 89 ofthem were male. Mean Glascow Coma Scale (GCS) was 8.52Â±4.98, and MeanTrauma Score(TS) was 7.60Â±3.48. While 107 patients were mechanicallyventilated, only 16 patients were not required mechanic ventilation. 31 of 123had no nutritional support, but 53 patients had parenteral, 38 had parenteraland enteral, only 1 patient had enteral nutritional supports. SystemicInflammatory Response Syndrome (SIRS) was accounted for 79,9% of patients,sepsis 38,2%, and Multiple Organ Failure(MOF) 50,1%.Low GCS and TS was associated with increased mortality, mechanicventilation requirement, SIRS, and MOF, however had no correlation withsepsis. GCS and TS was strongly correlated with mortality. We found thatpatients with GCS <5 had increased risk of mortality, GCS <8 had increasedmechanic ventilation requirement. And patient with TS<6 was higher risk of bothmortality, mechanic ventilation requirement, SIRS, sepsis, MOF. :ncreased riskof mortality, SIRS, sepsis and MOF was significantly correlated with mechanicventilation requirement, prolonged mechanic ventilation and nutritional supporttherapy. Mortality was increased in patients with SIRS and MOF, however hadno correlation with sepsis. And also prolonged ICU stay was correlated withmortality, SIRS, sepsis and MOF.We concluded that survival, functional outcome of polytraumatic patientswere determined with multiple parameters. Prognosis of polytraumatic patientswill require multidicipliner approach, exact and carefull assessments, and earlyadministration to ICU.Key words: Glasgow Coma Scale, Mortality, Polytrauma, Trauma Score