Yahya GÜNAYDIN, Kubilay VURAL, Mehtap OK, Yavuz KATIRCI, Dilber KOCAŞABAN, Yavuz YİĞİT, Figen COŞKUN

Kömür sobası ve doğal gaz kaynaklı karbonmonoksit zehirlenmelerinin karşılaştırılması ve Nötrofil/Lenfosit oranının değerlendirilmesi

Amaç: Bizim çalışmamızdaki amacımız ülkemizde karbonmonoksit (CO) zehirlenmesinin en sık nedeni olan kömür sobasından kaynaklanan zehirlenmeler ile doğal gaz kaçaklarının yol açtığı zehirlenmeler arasındaki epidemiyolojik, klinik, laboratuar ve prognoz farklılıklarını ortaya koymaktır. Ayrıca CO zehirlenmelerinde oluşan klinik tablonun şiddeti, prognozu, komplikasyonları ile başvuru sırasındaki nötrofil/lenfosit oranı ( NLO ) arasındaki ilişkiyi incelemeyi amaçladık.Yöntemler: Bu prospektif çalışmaya Ankara Eğitim ve Araştırma Hastanesi Acil Tıp Kliniği’ne 2009 Ekim – 2010 Nisan tarihleri arasında başvuran akut karbonmonoksit zehirlenmesi olgularının tümü alındı. CO zehirlenmesi tanısı, anemnezinde CO zehirlenmesine neden olabilecek öykünün olması ile birlikte karboksihemoglobin (COHb) konsantrasyonunun % 10’nun üstünde olması şeklinde konuldu. Çalışmamıza toplam 100 hasta dahil edildi.Bulgular: 55 (%55) hasta kömür sobasıyla zehirlenirken, 45 (%45) hasta doğal gaz kaynaklı zehirlenmişti. Doğal gazdan zehirlenen grubun ortalama COHb düzeyi anlamlı bir şekilde daha yüksekti (p=0,01). Doğal gaz grubunun ortalama Glaskow koma skoru (GKS) değeri anlamlı bir şekilde daha düşüktü (p=0,018). Doğal gazdan zehirlenen grupta 17 hastanın HBO (hiperbarik oksijen) tedavisi ihtiyacı olurken, kömür sobasından zehirlenen grupta ise sadece 6 hastanın HBO tedavisi ihtiyacı oldu. Doğal gazdan zehirlenen grupta kömür sobasından zehirlenen gruba göre anlamlı bir şekilde HBO tedavisi ihtiyacı daha fazlaydı. (p=0,001) NLO ile COHb oranı, troponin ve GKS değerleri arasında istatistiki olarak anlamlı bir ilişki bulunmadı (Sırasıyla; p=0,872, p=0,470, p=0,896).Sonuç: Doğal gaz kaynaklı CO zehirlenmeleri kömür sobası zehirlenmelerine göre daha toksik olabilmektedir. CO zehirlenmelerinde oluşan klinik tablonun şiddeti, prognozu, komplikasyonları ile başvuru sırasındaki NLO arasında her hangi bir ilişki yoktur

Anahtar Kelimeler:

Karbonmonoksit zehirlenmesi, kömür sobası, doğal gaz, Nötrofil/Lenfosit oranı

Comparison of carbon monoxide poisonings originated from coal stove and natural gas and the evaluation of Neutrophil/Lymphocyte ratio

Objective: The aim of our study is to present the epidemiologic, clinical, laboratory and prognosis differences between the coal stove origin poisoning and natural gas leakages. We also aimed to investigate relationship between the severity of clinical picture, prognosis, complications develop in CO poisoning with neutrophil/lymphocyte ratio (NLR) at the initial admission.Methods: All the acute carbon monoxide cases who applied to Ankara Training and Research Hospital Emergency Medicine Clinic between October 2009 and April 2010 were included to this prospective study. CO poisoning diagnosis was made by the history of CO poisoning with carboxyl hemoglobin (COHb) concentration is over 10%. 100 patients were included to our study.Results: Of the patients, 55(55%) were poisoned from the coal-stove and 45(45%) from natural gas leakage. The mean COHb level of the natural gas group was significantly high (p=0.01). The mean value of GCS of the natural gas group was significantly lower (p=0.018). The number of patients with indication for HBO therapy were 17 and 6 in the natural gas group and coal-stove group, respectively, being significantly higher in the natural gas group(p=0.001). There was no statistically significant relationship between the value of NLR and values of COHb, troponin, and GCS (p=0.872, p=0.470, and p=0.896, respectively).Conclusions: Carbon monoxide poisoning from natural gas leakage is more toxic than that from the coal-stove. There is no relationship between NLR at the time of presentation and the severity of clinical findings, prognosis and complications.Key words: Carbon monoxide poisoning, coal-stove; natural gas, Neutrophil/lymphocyte ratio

Keywords:

Carbon monoxide poisoning, coal-stove; natural gas, Neutrophil/lymphocyte ratio,

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