Yataklı serviste takip edilirken yoğun bakım ihtiyacı gelişen inme hastalarında kalp hastalıkları ve sigara içiminin rolü

Amaç: Bu çalışmada iskemik inme tanısı ile nöroloji servisinde yatarak takip edilirken nörolojik durumda kötüleşme nedeni ile Yoğun Bakım Ünitesi (YBÜ)'ne nakledilen hastalardaki Atriyal Fibrilasyon (AF), Ekokardiyografi (EKO)’da tespit edilebilen en az bir kardiyak patoloji varlığı ve sigara içiminin YBÜ‘ne gidiş üzerindeki etkisinin değerlendirilmesi amaçlanmıştır. Akut iskemik inme nedeniyle yatarak tedavi gören ve nörolojik durumda kötüleşme nedeni ile YBÜ'ne nakil edilen hastaların kayıtları retrospektif olarak incelendi. Hastaların sigara içim öyküleri, nörolojik muayene bulguları, kranyal alan görüntülemeleri (Kranyal MRI), enfarkt lokalizasyonu, EKG ve EKO bulguları kaydedildi. YBÜ’ne nakil edilen hastaların EKG, EKO bulguları ve sigara içim öyküleri incelendi. Bulgular: Kayıtlı 612 inme hastasının 298’ü (%56,9) erkek, 264’ü (%43,1) kadın cinsiyette idi. YBÜ nakil edilen hasta sayısı 100(16.3%) ve nakil edilmeyen hasta sayısı 512 (83,7%) idi.Nörolojik durumda kötüleşme nedeni ile YBÜ’ne nakil edilen hasta sayısı 100 idi. YBÜ‘ne nakil edilenlerin ise 36(%36)’inde EKO'da tespit edilebilen en az bir kardiyak patoloji ve AF saptandı. YBÜ‘ne nakil edilen hastalar ile edilmeyenler arasında AF varlığı ve kardiyak patoloji varlığı arasında istatistiksel olarak anlamlı ilişki saptandı (sırasıyla p:0,01, p:0,014). Sonuç: Çalışmamız, iskemik inmeli hastalarda EKO'da tespit edilebilen kardiyak patolojilerin ve AF varlığının YBÜ‘ne nakil için bir risk faktörü olduğunu gösterdi. EKO ile tespit edilebilen kardiyak patolojilerin ve AF'nin yakın takip ve tedavisinin inme prognozu üzerinde belirleyici olduğunu ortaya koyması bakımından önemlidir.

Anahtar Kelimeler:

Ekokardiyografi, Atriyal Fibrilasyon, sigara içimi, felç

The role of cardiac diseases and smoking in stroke patients who developed need for intensive care during follow-up in inpatient

Objective: This study is intended to evaluate effect on transferring to Intensive Care Unit (ICU) of smoking and presence of at least one of cardiac pathologies, which can be detected Echocardiography (ECHO), and of Atrial Fibrillation (AF) in patients who were transferred to the ICU due to deterioration in their neurological condition while they were under inpatient follow-up in neurology service with ischemic stroke diagnosis.Materials and Method: The records of the patients who received inpatient treatment due to acute ischemic stroke and were transferred to the ICU for neurological deterioration were retrospectively studied. Smoking history, neurological examination, Cranial MRI, infarct localization, ECG and ECHO findings of the patients were recorded. ECG, ECO findings and smoking stories of the patients who were transferred to the ICU were examined.Findings: Of 612 stroke patients registered, 298 (56.9%) were male and 264 (43.1%) were female. The number of patients transferred to ICU was 100 (16.3%) and the number of patients not transferred was 512 (83.7%). At least one ECHO-detectable cardiac pathology and AF was determined in 36 (36%) of the patients who were transferred to the ICU. There was a statistically significant relationship determined in terms of the presence of AF and cardiac pathology between the patients who were transferred to ICU and those who were not (p:0.01, p:0.014, respectively). Conclusion: Our study showed that presence of ECHO-detectable cardiac pathologies and AF in ischemic stroke patients were the risk factors for transferring to ICU. It is important to suggest that close follow-up and treatment of ECHO-detectable cardiac pathologies and AF are determinants for stroke prognosis.

Keywords:

ECHO, AF, Smoking, Stroke,

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1. Ralph L. Patogenenesis, classification and epidemiology of cerebrovascular disease. Rowland PL. Merritt’s Neurology. Tenth Edition 2000; 35:217-274
2. Adams RD, Victor M, Ropper HA. Principles Of Neurology. Six Edition 1997; 34:777-873
3. Appelros P, Nydevik I, Viitanen M. Poor Outcome After First-Ever Stroke: Predictors for Death, Dependency and Recurrent Stroke Wihin the First Year. Stroke 2003; 34:122-126
4. WHO MONICA Project (Prepared by Stegmayer B, Asplund K, Kuulasmaa K et al.) Stroke Incidence and Mortality Correlated to Stroke Risk Factors in the WHO MONICA Project. An Ecological Study of 18 populations. Stroke 1997; 28: 1367-1374 .
5- Manolia TA, Kronmal RA., Burke GL., et al. Short-term predictors of incident stroke in older adults: the cardiovascular Health Study. Stroke 1996; 27:1479-1486)
6- Uludüz D. Duman T. Kardiyak Hastalıklar ve İnme Turkiye Klinikleri J Neurol-Special Topics 2014; 7(4):1-9).
7- Carolei A, Sacco S, De Santis F, Marini C. Epidemiology of stroke. Clinical and Experimental hypertension 2002; 24:479-483.
8. Laskowitz Daniel T, Kasner Scott E, Jeffrey S, Remmel Kerri S, Jauch Edward C. Clinical Usefulness of a Biomarker-Based Diagnostic Test for Acute Stroke: The Biomarker Rapid Assessment in Ischemic Injury (BRAIN) Study. Stroke 2009;40:77-85.
9. Kumral E, Ozkaya B, Sagduyu A, Sirin H, Vardarli E, Pehlivan M. The Ege Stroke Registry: a hospital-based study in the Aegean region, Izmir, Turkey. Analysis of 2,000 stroke patients. Cerebrovasc Dis 1998; 8:278-88.
10. Apelros P, Nydevik I, Viitanen M. Poor outcome after-everstroke: Predictors for death, dependency, and recurrent stroke within the first year. Stroke 2003; 34:122- 126.
11. Heuschmann PU, Wiedmann S, Wellwood I, Rudd A, Di Carlo A, Bejot Y, Ryglewicz D, Rastenyte D, Wolfe CD; European Registers of Stroke. Three-month stroke outcome: The European Registers of Stroke (EROS) Investigators. Neurology 2011; 76:159-165.
12. Weimar C, Ziegler A, Konig IR, Diener HC. Predicting functional outcome and survival after acute ischemic stroke. J Neurol 2002; 249:888-895.
13. Aksoy D, İnanır A, Ayan M, Cevik B, Kurt S, Karaer Unaldı H . Akut İskemik İnmede Mortalite ve Morbidite Belirtecleri Nöropsikiyatri Arşivi 2013; 50: 40-44.
14. Meschia JF, Bushnellet C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, et al. Guidelines for the Primary Prevention of Stroke. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2014; DOI: 10.1161/STR.0000000000000046.
15. Hart RG, Halperin JL, Pearce LA, et al. Stroke Prevention in Atrial Fibrilation Investigators. Lessons from the Stroke Prevention in Atrial Fibrilation trials. Ann Intern Med. 2003; 138:831-838).
16. Goldstein LB, Adams R, Alberts MJ, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Stroke 2006; 37: 1583-1633.
17. Di Pasquale G, Urbinati S, Pinelli G. Cardiac investigation in patients with cerebrovascular disease. In: Ginsberg M, Bogousslavsky J, eds. Cerebrovascular Disease: Pathophysiology, Diagnosis, and Management. Malden, Mass: Blackwell Science; 1998.).
18. http://www.itfnoroloji.org/svh/iskemik.htm