Yavuz HAVLUCU, Levent ÖZDEMİR, Burcu ÖZDEMİR, Binnur TAVAŞLI

İkinci basamakta pulmoner emboli tanısı

İkinci Basamak sağlık kuruluşunda pulmoner emboli tanısı konulabilir mi sorusuna cevap aramak amaçlanmıştır. Aralık 2007-Ekim 2008 tarihleri arasında Dörtyol Devlet hastanesi göğüs hastalıkları polikliniği ve acil servisine başvuran klinik skorlamada pulmoner emboli olasılığı yüksek olarak sınıflanan, yaş ortalaması 56±18, 6'sı erkek 19 olgu prospektif olarak değerlendirildi. Hastaların hepsine standart toraks BT, Alt ekstremite doppler USG ve arteryel kan gazı analizi yapıldı. Alveolo arteryel oksijen gradientleri hesaplandı.Başvuru sırasında en sık rastlanan semptom ve bulgular nefes darlığı %94.7 (n=18), bacakta şişlik, kızarıklık ve ağrı %84.2 (n=16) ile yanağrısı %57.9 (n=11) idi. Tromboemboliye zemin hazırlayan faktörler incelendiğinde 9 olguda immobilizasyon, 3 olguda obezite, 1 olguda pelvik operasyon, 1 olguda SLE'ye bağlı nefrotik sendrom, 1 olguda faktör V leiden eksikliği, 1 olguda da prostat malignitesi vardı. Tüm olguların alt ekstremite dopplerlerinde akut/subakut/kronik evre trombüs saptandı. A-a O2 gradienti tüm hastalarda artmıştı (ort: 52±40 mmHg). Olguların standart toraks bt'leri incelendiğinde 10 olguda (%52.6) BT'nin normal olduğu, 9 olguda da ise pulmoner emboli bulgularının saptandığı görüldü.Sonuç olarak, 2. basamak hastanelerde pulmoner emboli tanısı için klinik skorlama, doppler USG, standart toraks BT ve gradient hesaplaması rahatlıkla kullanılabilir.

Diagnosis of pulmonary embolism in secondary care

Finding a n answer of if the pulmoner embolism can be diagnosed in a secondary care health institution. 19 patients who were admitted to Dörtyol Public Hospital chest diseases polinic and emergency service in december 2007-october 2008 with diagnosed as high clinical probability of pulmonary embolism according to clinical scoring system were evaluated prospectively. 6 patients were men and mean age was 56±18. Standart thorax CT, lower limb doppler ultrasonography and blood gas analysis were applied to all patients. Alveoloarterial (A-a) oxygen gradient was calculated.Most frequent symptoms and signs were dyspnea 94.7% (n=18), leg swelling and pain 84.2% (n=16) and chest pain 57.9% (n=11). Patients risk factors for thromboembolism were immobilization (n=9), obesity (n=3), pelvic operation (n=1), nephrotic syndrome due to SLE (n=1), factor V Leiden deficiency and prostate cancer (n=1). Acute/ subacute/chronic phase thrombosis were established in all patients lower limb doppler ultrasonography. Alveolo-arterial gradient were increased in all patients. (mean 52±40). When we determined the torax CT findings 10 patients had normal and 9 patients had pulmonary embolism signs in torax CT.Pulmonary embolism can be diagnosed in second care hospitals clinical score system, doppler ultrasonography, standart torax CT and aveoloarterial gradient.

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