Gökhan AYKUN, Mükremin ER, Ayşegül KARALEZLİ, H.canan HASANOĞLU

PULMONER EMBOLİDE TROMBOLİTİK TEDAVİ VE KONVANSİYONEL TEDAVİ ETKİNLİĞİNİN 10. GÜNDE KARŞILAŞTIRILMASI

Amaç: Trombolitik tedavinin hastaya sadece ilk birkaç gün fayda sağladığı, 1. haftadan sonra ise sadece antikoagülan tedavi alanların da benzer trombüs erime oranlarına sahip oldukları düşünülmektedir. Bu çalışmanın amacı trombolitik tedavinin 10. gününde hastaların klinik parametrelerine ve Pulmoner Arter BT Obstrüksiyon İndeksi açılma oranlarına etkisinin olup olmadığının araştırılmasıdır. Yöntem ve Gereç: Çalışmaya pulmoner tromboemboli tanısı konmuş 28 olgu alındı. Trombolitik tedavi verilmesinin uygun görüldüğü 15 hasta çalışma grubuna (grup 1), kalan 13 hasta ise konvansiyonel tedavi(antikoagülan tedavi) grubuna (grup 2) alındı. Tedavinin semptomların başlamasından sonraki ilk 14 günde başlandığı hastalardan trombolitik (r-TPA) verilenler grup 3, verilmeyenler grup 4 olarak planlandı. Çalışma grubundaki hastalara tanı konulduğu anda protokole göre trombolitik tedavi uygulandı ve ardından antikoagülan tedavi ile devam edildi. Kontrol grubundaki hastalara sadece antikoagülan tedavi verildi. Geliş sırasında ve 10. günde pulmoner BT anjiyografi, transtorasik ekokardiyografi, arteryel kan gazı çalışıldı. PABTOİ hesaplandı. Veriler tedaviden önce ve tedaviden sonra 10. günde gruplar arasında karşılaştırıldı. Bulgular: Gruplar arasında başlangıç kriterlerinde istatistiksel olarak anlamlı farklılık saptanmadı. Grup 1’de 10. günde %52.8±25.5’lük açılma oranı elde edilirken, grup 2’de bu oran %42.5±20.0 olarak saptandı. Grup 3’de10. günde açılma oranı %58.4±24.5’e ulaşırken, grup 4‘de bu oran %42.2±22.2 bulundu. Tedavinin 10. gününde grup 3’deki hastalarda grup 4’e göre PO2, SaO2 ve PAB değerlerinde anlamlı düzelme bulundu (p<0.05). Sonuç: Sonuç olarak, pulmoner embolinin akut döneminde yararı bilinen trombolitik tedavinin, yalnız konvansiyonel antikoagülan verilen gruba göre daha iyi BT açılma oranları, AKG ve EKO bulgularının olması tedavinin 10. gününde bile yararlı olduğunu göstermiştir.

Anahtar Kelimeler:

Pulmoner emboli, pulmoner BT anjiyografi, r-TPA

COMPARISON OF THROMBOLYTIC AND CONVANSIONAL TREATMENT EFFICIENCY IN PULMONARY EMBOLISM ON THE 10TH DAY OF TREATMENT

Aim: Benefit of thrombolytic therapy for the patients with pulmonary embolism is thought to be in only the first few days and it’s considered that after the first week anticoagulation therapy has similar rates of resolution. The purpose of the study is to investigate the effect of thrombolytic therapy on the patient's clinical parameters and Pulmonary Artery CT Obstruction Index opening rates on the tenth day. Material and Methods: In this study, 28 pulmonary embolism cases were investigated. Taken in to consideration clinical, radiographic, echocardiographic, biochemical findings, and contraindications to thrombolytic therapy, 15 patients enrolled to the thrombolytic therapy group (group 1) and the remaining 13 patients were included in the conventional therapy (group 2).Patients given thrombolytic therapy(r-TPA) in the first 14 days after pulmonary embolism was planned as group 3 and treated with anticoagulants only as group 4. Pulmonary CT angiography, transthoracic echocardiography (ECHO), arterial blood gasses were studied on admission and tenth day. PACTOI was calculated from pulmonary CT angiography. Results: Differences were insignificant between the groups for the initial criteria. Opening rate on the tenth day was 52.8%±25.5 in group 1 and 42.5%±20.0 in group 2. In patients of group 3 opening rate was 58.4%±24.5 on the tenth day, whereas in group 4 it was 42.2%±22.2. Significant improvements on PO2, SaO2 and PAP was seen in group 3 patients at the tenth day when compared with group 4 (p<0.05). Conclusion: As a conclusion it is shown that patients receiving thrombolytic therapy had better PACTOI and ABG and ECHO findings at the tenth day.

Keywords:

Pulmonary embolism, pulmonary CT angiography, r-TPA,

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