Pnömoni tanısıyla değerlendirilen çocuk hastaların kardiyolojik bulguları
Amaç: Pnömoniler önemli bir sağlık sorunudur. Hastalığın seyrinde kardiyovasküler sisteme ait değişik düzeyde etkilenmeler görülebilir. Bu çalışmayla toplum kökenli pnömoni tanısı konulan çocuk hastaların değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Bir ay–16 yaş arası çocuklar prospektif olarak değerlendirilmiş, bu hastaların bazı klinik, laboratuvar, radyolojik ve ekokardiyografik bulguları araştırılmıştır. Ayrıca altta yatan kalp-dışı kronik hastalığı olan hastalarla, olmayanlar karşılaştırılmıştır.Bulgular: Hastaların ortanca yaşı 32 aydı. Kırksekiz (%76.2) hasta yatırılarak izlendi. Hastaların yaklaşık dörtte birinde konjenital kalp hastalığı mevcuttu. Bu hastaların 5’inde (%31.2) kalpte hemodinamik instabilite oluşturan yapısal defekt varken, 11’inde (%68.7) hemodinamik önemi olmayan yapısal lezyonlar mevcuttu. Ondört (%22.2) hastada triküspit yetmezliği, 10 (%15.9) hastada değişik derecelerde pulmoner hipertansiyon saptandı. Hastaların üçte birinde tekrarlayan akciğer enfeksiyonu bildirildi. Onsekiz (%28.6) hastada kalp-dışı kronik hastalık mevcuttu. Hastaların akciğer grafilerinde çoğunlukla lober tutulum (%49.2) gözlendi. Dörtte bir hastada akciğerlerde pnömoniye bağlı komplikasyon gözlenirken, bunların çoğunluğu parapnömonik efüzyondu. Altta yatan kalp-dışı kronik hastalığı olan hastaların, tekrarlayan akciğer enfeksiyonu geçirme, ekokardiyografide triküspit yetmezliği ve pulmoner hipertansiyon bulunma ve hospitalizasyon oranlarının, kronik hastalığı olmayanlara göre daha yüksek olduğu saptandı.Sonuç: Pnömoniler önemli kardiyak komplikasyonlara yol açabilmektedir. Altta yatan non-kardiyak bir kronik hastalığın varlığı, pnömoninin hem rekürens riskini hem de morbiditesini artırmaktadır.
Cardiological findings of pediatric patients with the diagnosis of pneumonia
Purpose: Pneumonia is an important health problem. Cardiovascular system is involved variously during course of disease. This study aims to investigate children with community-acquired pneumonia.Material Methods: Children aged one month-16 years were prospectively evaluated about some of their clinical, laboratory, radiological, and echocardiographical findings. Also, children with non-cardiac chronic diseases were compared with children having no chronic disease. Results: Median age of patients was 32 months. Fortyeight (76.2%) patients were hospitalized. One fourth of children had congenital heart disease. Among these, 5 (31.2%) had hemodynamically instable cardiac defect, while 11 (68.7%) had hemodynamically insignificant cardiac lesions. Tricuspid insufficiency was present in 14, various degrees of pulmonary hypertension were present in 10 (15.9%) patients. One third reported recurrent pulmonary infections. Eighteen (28.6%) patients had non-cardiac chronic diseases. Mostly lobar infiltration (49.2%) was present. One quarter had pulmonary complications, most of which were parapneumonic effusion. Patients with non-cardiac chronic diseases had more prevalent recurrent pulmonary infections, tricuspid insufficiency and pulmonary hypertension, and hospitalization than children having no chronic disease.Conclusion: Serious cardiac complications can be encountered during course of pneumonia. Presence of an underlying non-cardiac chronic disease increase both recurrence and morbidity of pneumonia.
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