DEMET DEMİRKOL, Metin KARABÖCÜOĞLU, Agop ÇITAK, Raif ÜÇSEL, Nedret UZEL

Çocuklarda vazoaktif tedavide kullanılan ilaçların karşılaştırılması ve mortalite belirteçlerinin saptanması

Amaç: Yoğun bakım ünitemizde vazoaktif ilaç uygulanan hastaların tedavi etkinliği açısından değerlendirilmesi ve etkinlik yönünden ilaçların karşılaştırılmasıdır. İkinci amacı ise vazoaktif ilaç kullanılan hastalarda prognostik faktörleri belirlemektir. Yöntem: İstanbul Tıp Fakültesi Çocuk Yoğun Bakım Ünitesi’nde Ocak 2004- Ocak 2005 tarihleri arasında yatırılan hastaların kayıtları geriye dönük olarak değerlendirildi. Sonuçlar: Çalışmanın yapıldığı dönemde toplam 63 hastada vazoaktif ilaç (dobutamin ve/veya dopamin, epinefrin) kullanıldı. Hastaların yaş ortancası 96.5 (1–192) aydı; %52.4’ü (n=33) erkekti. Hastaların %28.6’sı (n=18) öldü. Epinefrin tedavisi uygulanan gruptaki hastalar daha ağırdı; gruplar arasında mortalite açısından fark bulunmadı. Epinefrin tedavisi uygulanan grupta pH ve baz açığı dopamin ve/veya dobutamin tedavisi alanlardan daha hızlı düzeldi. Laktat düzeyi, epinefrin tedavisi uygulanan grupta arttı, sekizinci saatte başlangıç değerine indi. Ölen hastalarda başlangıçta ve izlemde kalp tepe atımı yaşayanlardan yüksekti, istatistiksel anlamlı bulunmadı. Laktat düzeyi artışı mortalite açısından yol gösterici tek değişken olarak bulundu (p

Anahtar Kelimeler:

Epinefrin, Dobutamin, Dopamin, Tıbbi kayıtlar, Ölüm oranı, Geriyedönük çalışma, Şok, Vazokonstriktör ajanlar, Laktik asit

Comparison of vasoactive medications and investigation determinants of mortality in children

Objective: To review the current use of vasoactive medications in our intensive care unit and compare vasoactive medications with respect to therapeutic end points and the choice of agent. The second objective is to determine prognostic factors that effect survival in vasoactive medications. Methods: The data of the patients who admitted to Istanbul Faculty of Medicine Pediatric Intensive Care Unit between dates January 2004 to January 2005 were investigated retrospectively. Results: During the study period vasoactive medications (dobutamine or/and dopamine, epinephrine) were used in 63 patients. Median age of the patients was 96.5 months (1-192) and 52.4% (n=33) of the patients were male. Twenty eight point six percent of the patients (n=18) died. The patients in the epinephrine treatment group were sicker than the dobutamine or/and dopamine groups. The pH and base deficit levels improved earlier in the epinephrine therapy than in the dobutamine or/and dopamine therapies. In the patients treated with epinephrine, the lactate concentration initially increased, but decreased to the basal level in the 8±1.6 observation period. The heart rate was higher at admission and during the follow up in nonsurvivors than survivors but was not found statistically significant. The relationship between increasing lactate concentration and mortality was found statistically significant (p<0.01). Conclusions: Early initiation of epinephrine may offer survival benefit to critically ill pediatric shock patients. The lactate concentration may increase transiently in patients treated with epinephrine. The decrease in the heart rate and lactate concentration are important determinants of outcome.

Keywords:

Epinephrine, Dobutamine, Dopamine, Medical Records, Mortality, Retrospective Studies, Shock, Vasoconstrictor Agents, Lactic Acid,

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