Hayrettin GÖÇMEN, Dane EDİGER, Esra USAZLAN, Ercüment EGE

Stabil KOAH'lı hastalarda hastanede yatış anamnezi ile spirometrik değerler ve amfizem paterni arasındaki ilişki

Amaç: KOAH alevlenmelerle seyreden bir hastalıktır. Hastalığın progresyonuyla alevlenmeye bağlı hastanede yatışlarda artmaya başlar. İleri evre amfizematöz KOAH hastalarında bu yatışlar anlamlı derecede artış gösterir. Çalışmamızda stabil KOAH hastalarında hastanede yatış öyküsüyle hastalığın ağırlığı ve amfizematöz yapısı arasındaki ilişkisini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya (81 E, 19 K) 100 stabil KOAH'lı hasta dahil edildi. Olguların alevlenme, hastanede toplam yatış ve toplam yatış günü sayıları, spirometrik, antropometrik ve demografik verileri kaydedilerek değerlendirildi. Bulgular: Olguların ortalama yıllık atak sayısı 1.4±0.1, toplam yatış sayısı 1.2±0.1 ve toplam yatış günü 11.2±1.7 idi. Hastanede toplam yatış sayısı ile %FEV1, FEV1/FVC, göğüs ekspansasyon kapasitesi, kardiyofrenik ve kostofrenik sinüs uçlarını birleştiren çizginin diyafragma en uç noktasına uzaklığı arasında negatif; retrosternal mesafe arasında pozitif korelasyon saptandı. Hastanede toplam yatış günü sayısıyla Saint George Respiratory Questionnaire skoru arasında pozitif, %FEV1, FEV1/FVC değerleri arasında negatif korelasyon saptandı. Daha önce KOAH alevlenmesi nedeniyle hastanede en az bir kez yatmış olan olguların (n=51), hiç yatmamış olgulara oranla %FEV1 ve FEV1/FVC değerlerinin anlamlı derecede düşük olduğu belirlendi. Hastanede yatan olguların göğüs ekspansasyon kapasitesinin, kardiyofrenik ve kostofrenik sinüs uçlarını birleştiren çizginin diyafragma en uç noktasına uzaklığının daha düşük, SGRQ skorunun daha yüksek olduğu gözlendi. Sonuç: KOAH'ta hastalığın süresi ve şiddeti arttıkça alevlenmeye bağlı hastanede yatışlar da artar. Hastalığın ağırlığını gösteren düşük spirometrik değerler, yaşam kalitesindeki bozulma ve amfizem göstergeleri, bu yatışların sayısı ve sıklığıyla koreledir.

The relationship between hospitalization with spirometric findings and emphysema pattern in patients with stable COPD

Objective: COPD is a progressive disease that develops with acute exacerbations. The hospitalizations related to exacerbation increase together with progression of disease. Are waited that significantly increases the frequency of hospitalizations in COPD patients with emphysema who have worse respiratory functions. Materials and Methods: Were included 100 stable COPD cases to study. Numbers of acute exacerbations, hospitalization and hospitalization days, spirometric, anthropometric and demographic characteristics of cases were recorded and were evaluated prospectively. Results: Mean numbers were 1.4±0.1 for yearly exacerbation, 1.2±0.1 for hospitalization and 11.2±1.7 days for hospitalization day. Were observed that total hospitalization numbers correlated with %FEV1(r=-0.367 p<0.001), FEV1/FVC(r=-0.239 p=0.017) values, chest expansasion capacities (r=- 0.204 p=0.041) and distances of intersinusal line to dome of diaphragm (r=-0.317 p=0.001) negatively and with retrosternal distances(r=0.282 p=0.004) positively. There was positive correlation between total hospitalization days and SGRQ scores(r=0.423 p<0.001). Were found that total hospitalization days correlated with %FEV1(r=-0.308 p=0.002) and FEV1/FVC values (r=-0.273 p=0.020) negatively. Fiftyone cases were hospitalized at least one time because of acute exacerbation in COPD. In these cases %FEV1(p=0.001) and FEV1/FVC(p=0.012) values were significantly lower than cases that didn't hospitalize. Chest expansasion capacities(p=0.001), distances of intersinusal line to dome of diaphragm(p=0.001) were statistically lower and Saint George Respiratory Questionnaire (SGRQ) scores were higher (p=0.007) in cases who were hospitalized. Conclusion: When COPD progresses, hospitalizations related to acute exacerbation increase too. Lower spirometric values, deterioration of life quality and emphysematous changes correlate with number and frequency of hospitalization.

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