Akut gastroenteritli çocuklarda dehidratasyon derecesi ile periferik perfüzyon indeksinin ilişkisi
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Dosyalar
Tarih
2020
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Yayıncı
Hatay Mustafa Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çocuklarda akut gastroentritle (AGE) ilişkili dehidratasyonun değerlendirilmesinde periferik perfüzyon indeksi (PI) ölçümlerinin, Dünya Sağlık Örgütü'nün (DSÖ) Dehidratasyon Ölçeği ile karşılaştırılması, buna göre elde edilen değerlerden dehidratasyonda kullanılabilecek ayırt edici cut-off değerlerinin bulunması ve intavenöz sıvı tedavisine yanıtın objektif göstergesi olarak perfüzyon indeksinden faydalanabilmenin mümkün olup olmayacağının araştırılması planlanmıştır. Yöntem: Bu çalışmaya Hatay Mustafa Kemal Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi Çocuk Sağlığı ve Hastalıkları Polikliniklerine ve Çocuk Acil Servisine başvuran 5 yaş altı AGE'li çocuklar (hasta grubu) ve rutin çocuk izlemi amacıyla polikliniklere başvuran 5 yaş altı sağlıklı çocuklar (kontrol grubu) dahil edilmiştir. AGE'li çocuklar DSÖ Dehidratasyon Ölçeğine göre hafif, orta ve ağır dehidrate olarak gruplandırılmıştır. Standart sıvı tedavisi protokolü öncesi, tedavi sürerken ve tedavi sonrası hastaların periferik PI, ateş, nabız, saturasyon, kan basıncı, solunum sayısı, kapiller dolum zamanı ve venöz kan gazına bakılmıştır. Hastaların takipleri 4 saat boyunca kayıt altına alınmıştır. Kontrol grubunun da periferik PI, nabız ve saturasyon değerlerine bakılarak kayıt altına alınmıştır. Bulgular: Çalışmaya 38 AGE'li hasta, 47 sağlıklı çocuk dahil edildi. 38 hastanın %47,3'ü (18) kız, %52,7'si (20) erkek, kontrol grubunun %46,8'i (22) kız, %53,2'si (25) erkekti. Hasta grubunun yaş ortalaması 24,7±19,4 ay, kontrol grubunun yaş ortalaması 27,3±21,3 ay idi. Hastaların %47,4'ü (18) hafif dehidrate, %26,3'ü (10) orta dehidrate ve %26,3'ü (10) ağır dehidrate idi. AGE'li hastaların tedavi öncesi PI değerleri kontrol grubundan anlamlı olarak düşük bulunmuştur. Ağır dehidrate hastaların PI değeri sıvı tedavisi ile anlamlı bir şekilde yükselmiştir. PI'nın dehidratasyonu tahmin etme yeteneğinin ROC analizine göre istatistiksel olarak anlamlı olduğu belirlendi. Ağır dehidrate olan hastalar için cut off periferik PI değeri ≤ 1,15, orta dehidrate hastalar için ≤ 1,60 ve hafif dehidrate olan hastalar için ise ≤ 2,0 bulunmuştur. Sonuç: Perfüzyon indeksi, çocuklarda periferik perfüzyonu sürekli izlemek, gastroenterit ile ilişkili dehidrasyonu tespit etmek ve tedavinin etkinliğini anlamak için noninvaziv bir parametre olarak kullanılabilir.
Aim: It is planned to compare peripheral perfusion index measurements with the World Health Organization's Dehydration Scale in the evaluation of acute gastroenteritis-related dehydration in children to find distinctive cut-off values that can be used in dehydration and to investigate whether it is possible to benefit from the perfusion index as an objective indicator of response to intravenous fluid therapy. Methods: Patients diagnosed with acute gastroenteritis under the age of 5 (patient group) at Child Health and Diseases Polyclinics and Child Emergency Department of Hatay Mustafa Kemal University Hospital and healthy children under the age of 5 (control group) who applied to the polyclinics for routine examination were consecutively enrolled. Children with acute gastroenteritis are grouped as mild, moderate and severe dehydrate according to the World Health Organization Dehydration Scale. Perfusion index and vital parameters of all patients were measured before and after treatment, blood samples were taken for venous blood gases. Hemodynamic monitoring was done for 4 h. Peripheral PI, pulse and saturation of the control group were measured. Results: A total of 38 patients and 47 healthy child were included in the study, 47,3 % (18) of patients were girl, 52,7 % (20) were boy; 46,8 % (22) of the control group were girl, 53,2 % (25) were boy. The mean age of the patient group was 24.7 ± 19.4 months, and the mean age of the control group was 27.3 ± 21.3 months. 47,4% (18) of the patients were mild dehydrated, 26.3% (10) were moderate dehydrated and 26,3% (10) were severe dehydrated. As compared with the control group, patient group had a significantly lower perfusion index value on admission. Peripheral PI value of severe dehydrated patients increased significantly with fluid therapy. The ability of the perfusion index to predict dehydration was statistically significant according to the ROC analysis. Clinical gastroenteritis-related dehydration can be reasonably detected when perfusion index value is less than 1,15 in severe dehydration, less than 1,60 in moderate dehydration, less than 2,05 in mild dehydration in children less than 5 year of age. Conclusion: Perfusion index can be used as a non-invasive, continuous parameter to monitor peripheral perfusion in children, to detect gastroenteritis-related dehydration and to understand effectiveness of the treatment.
Aim: It is planned to compare peripheral perfusion index measurements with the World Health Organization's Dehydration Scale in the evaluation of acute gastroenteritis-related dehydration in children to find distinctive cut-off values that can be used in dehydration and to investigate whether it is possible to benefit from the perfusion index as an objective indicator of response to intravenous fluid therapy. Methods: Patients diagnosed with acute gastroenteritis under the age of 5 (patient group) at Child Health and Diseases Polyclinics and Child Emergency Department of Hatay Mustafa Kemal University Hospital and healthy children under the age of 5 (control group) who applied to the polyclinics for routine examination were consecutively enrolled. Children with acute gastroenteritis are grouped as mild, moderate and severe dehydrate according to the World Health Organization Dehydration Scale. Perfusion index and vital parameters of all patients were measured before and after treatment, blood samples were taken for venous blood gases. Hemodynamic monitoring was done for 4 h. Peripheral PI, pulse and saturation of the control group were measured. Results: A total of 38 patients and 47 healthy child were included in the study, 47,3 % (18) of patients were girl, 52,7 % (20) were boy; 46,8 % (22) of the control group were girl, 53,2 % (25) were boy. The mean age of the patient group was 24.7 ± 19.4 months, and the mean age of the control group was 27.3 ± 21.3 months. 47,4% (18) of the patients were mild dehydrated, 26.3% (10) were moderate dehydrated and 26,3% (10) were severe dehydrated. As compared with the control group, patient group had a significantly lower perfusion index value on admission. Peripheral PI value of severe dehydrated patients increased significantly with fluid therapy. The ability of the perfusion index to predict dehydration was statistically significant according to the ROC analysis. Clinical gastroenteritis-related dehydration can be reasonably detected when perfusion index value is less than 1,15 in severe dehydration, less than 1,60 in moderate dehydration, less than 2,05 in mild dehydration in children less than 5 year of age. Conclusion: Perfusion index can be used as a non-invasive, continuous parameter to monitor peripheral perfusion in children, to detect gastroenteritis-related dehydration and to understand effectiveness of the treatment.
Açıklama
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases, Perfüzyon indeksi, Gastroenterit, İshal, Pulse Oksimetre, Dehidratasyon, Perfusion index, Acute Gastroenteritis, Diarrhea, Pulse Oxymeter, Dehydration
