Ondokuz Mayıs Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Kliniği Mikail Yüksel Yoğun Bakım Ünitesi'nde 2005-2011 yılları arasında yatmış olan obstetri ve jinekoloji hastalarının retrospektif incelenmesi
Retrospective analysis of obstetric and gynecologic patients admitted to the Ondokuzmayıs University Medical Faculty Department of Anesthesiology and Reanimation Mikail Yüksel Intensive Care Unit, between 2005-2011
Yazar: HATİCE ALVER
Danışman: DOÇ. DR. FATMA ÜLGER
Ondokuz Mayıs Üniversitesi / Tıp Fakültesi / Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2012
Konu: Anestezi ve Reanimasyon = Anesthesiology and Reanimation
Dizin: Jinekoloji = Gynecology ; Mortalite = Mortality ; Obstetrik = Obstetrics ; Retrospektif çalışmalar = Retrospective studies ; Yoğun bakım = Intensive care

Özet:
Ama~: <;ah~mamlzm amacI, obstetri ve jinekoloji hastalanmn yogun bakIma kabulkriterlerini, tedavi ba~anlanm ve prognozlanm degerlendirmek ve bu siirec;te ortaya C;lkan yada yIkabilecek olan sorunlan belirleyerek, tedavi ve izlemin daha etkin bir duruma getirilmesiiC;in veri kaynagl hazlrlamaktIr.Gere~ ve yontem: Bu c;ah~mada, Ondokuz MaYls Universitesi Anesteziyoloji veReanimasyon Klinigi Mikail YUksel Yogun Babm Unitesinde Ocak 2005 -Ekim 2011 yIllanarasmda izlenmi~ ve tedavi gormu~ obstetri ve jinekoloji hastalarlilln dosyalarl, OMU TIPFakUltesi Hastanesi Ar~ivinden ve nUkleus medikal bilgi sisteminden yararlamlarakretrospektif olarak incelendi. Bu verilerden elde edilen bilgiler, SPSS 16 programl ile analizedildi ve p<0.05 degeri istatistiksel olarak anlamh kabul edildi.Bulgular: <;ah~mamlzda, 6 Yllhk siirec;te YBU'ne kabul edilen obstetri ve jinekolojihastalarmm 382'sinin verilerine ula~lldl. Bu hastalarm 234(%61,3)'ii obstetri ve 148(%38,7)'ijinekoloji hastalarl idi. Kabul tanllanna babldlgmda birinci SITaYI kanser hastalarl ahrken,ikinci slrada preeklampsi/eklamsilHELLP sendromu hastalan aldlgl goruldu. 360 hastaservise devredilirken, 22 hasta olmu~ ve mortalite oram %5,8 olarak bulunmu~tur. Obstetrihastalarmda mortalite oram %4,7 iken jinekoloji hastalarmda mortalite oram %7,4 olarakbulunmu~tur.Olen hasta grubunda, APACHE II skorlarl, transfiizyon slkllgl, enmbe kaldlgl gUnsaylSl, YBU'nde kah~ siiresi ya~ayan hasta grubuna gore istatistiksel olarak anlamh farkhbulunmu~tur. Olen hasta grubunda APACHE II skoru 14,1±5,3 iken ya~ayan hasta grubunda7,08±3,4, yogun bakImda kah~ siireleri olen hasta grubunda 1O±11,2 iken ya~ayan hastagrubunda 2,3±3,2 olarak bulunmu~tur. Transfiizyon slkllklarma babldlgmda, 115(%30,1)hastaya eritrosit siispansiyonu, 179(%46,9) hastaya taze donmu~ plazma verildigisaptanml~tlr .Hastalarm 24'tinde dissemine intravaskUler koagiilopati (DIC) geli~tigi gorulmu~tiir.Bu hastalarm 5 tanesinde septik abortus sonraSI DIC geli~irken geri kalan 19 hastada CISkomplikasyonlarma bagh DIC gorulmu~tiir.Enfeksiyon oranlarma bakIldlgmda birinci sIkllkta 11 (%37,9) hasta ile cerrahi ili~kilienfeksiyon saptanml~tIT. ikinci sIkllkta gorulen enfeksiyon 8 (%27,6) hasta ile trakeal aspiratkiiltiiriinde(T AK) ve kan kUltiiriinde birlikte iireme olan hastalardIT. Aynca yatI~ siiresiuzadlkc;a enfeksiyon oranlarmm anlamh derecede arttIgl gorulmu~tiir. Bu enfeksiyonlardanbaglmslz olarak septik abortus ve buna bagh komplikasyonlar nedeniyle 6(%1,6) hastaYBU'ne kabul edilmiştir.Sonu-r: Kritik durumdaki gebe hasta ile kar~Ila~ma yogun balam ekibi iyin nadir birdurum degildir. Gebelik siirecinde veya peripartum donemde, kadmlarm yiizde 1 'inden azmdayogun balam ihtiyacl olmakla birlikte, bu balamm gerekli oldugu hastalarda anne ve bebekmortalitesi normal popUlasyona gore daha fazla goriilmektedir. Bu hastalarm yogun balamiinitesine erken kabulii ve tedavi yonetimleri anne ve bebek mortalitesini onemli 51yiideazaltmaktadlr. Jinekoloji hastalarmda ise daha yok kanser cerrahilerine bagh hasta kabuliiolmu~tur. Bu hastalarm yonetiminde cerrahi oncesi planlamanm iyi yapllmasl ve gereklihallerde yogun balam ihtiyacmm ongoriilerek cerrahiye almmasl mortalite ve morbiditeninazaltllmasl aylsmdan faydah olacaglm dii~iinmekteyiz.Bu dogrultuda, yapllan retrospektif yah~malar bu tiir sonuylarl onleme ve ders almakonusunda yol gostericidir. Hangi hasta grubu yogun balama alma konusunda risklidir tahminetme, kapsamh tedavi stratejileri geli~tirme, hastalarm yogun balama devri slrasmdaolu~abilecek aksakllklarl ve gecikmeleri onleme, erken tam ve etkin tedavi saglayabilmekonusunda yardlmcl olacaktlr.Anahtar kelimeler: Y o gun baktm, obstetri, jinekoloji, mortalite.

Abstract:
Purpose: The purpose of our study is evaluating admission to intensive care unitcriterias of obstetrics and gynecologic patients and the prognoses, determining the problemsmay occur in this period and preparing a database for supporting treatment and follow up.Materials and Methods: In this study, files of obstetrics and gynecologic patientswho were admitted to Ondokuz Mayis University Medical Faculty Anaethesiology andReanimation Department Intensive Care unit between Janurary 200S-0ctober 2011, hasanalyzed retrospectively. Files and documents has acquired from the hospital archive andhospital computer database (Nucleus medical information system). Data analyzed via SPSS16 programme and p<0.05 value has accepted as significiant.Results: In our study we had obtain 382 of our patients data. 234(61.3%) of them wereobstetrics, 148(38.7%) of them were gynecologic patients. In terms of admission diagnoses,cancer was at the first rank. Preeclampsia-eclampsia-HELLP syndrome was following this.360 patients were transferred to their services but 22 of them has died. Mortality rate was5.8%. Mortality rate was 4.7% in obstetrics patients and 7.4% in gynecology patients. In themortal population, APACHE II scores, blood transfussion amounts, number of intubated days,total ICU days were significiantly different from the living population. In the mortal groupaverage APACHE II score was 14.1±5.3 but in the living population it was 7,08±3.4. Totalleu days in the mortal population was 1 O± 11.2, in living population 2.3±3 .2. In terms ofblood transfusion rate, erytrocite transfussion has given to 115(%30.1) patients, fresh frozenplasm has given to 179(%46.9) patients.Dissemine intravascular coagulation occured in 24 of patients. DIC has occured afterseptic abortus in 5 ofthem and in 19 patients as a complications of CIS. Surgery dependedinfections 11(39.7) were the most common cause of infections. Tracheal aspirates, and bloodcultures with both of reproductive 8(%27.6) were following this. We found that infection rateswere correlated with prolonged intensive care unit stay. Independed from these infections6(%1.6) patients admitted to ICU because of septic abortus and related complications.Conclusion: It is not a rare case to confront a critical pregnant patient for intensivecare unit stuff. In pregnancy period and peripartum period less than % 1 of women needintensive care. However in this population maternal and fetal mortality is higher than otherpopulation. With early admission to ICU of these patients, maternal and fetal mortality can bedecreased significiantly. In gynecologic patients, the most common cause for admission toICU was cancer related operations. We suggest that well preoperative management planningand cooperation with intensive care unit may decrease mortality and morbidity.For this purpose, this kind of retrospective studies are benefitical to prevent thesecomplications. They will be helpful to predict which patients will need intensive care,improve detailed treatment strategies, to prevent faulties and retardings in intensive care unitadmission period and for early diagnosis and effective treatment.Keywords: Intensive care, obstetrics, gynecology, mortality.