Gülçin AYDIN, İşın GENÇAY, Selim ÇOLAK, Burak AKTAN, Ünase BÜYÜKKOÇAK

Karbonmonoksit İntoksikasyon Tanısı ile Yoğunbakımda Tedavi Edilen Olguların Analizi

Bu çalışmanın amacı karbon monoksit intoksikasyon tanılı hastaların etyolojik ve demografik özelliklerini belirlerken, klinik bulguların tedavi sürecine ve prognoza etkisini araştırmaktır. Çalışmaya 2014-2017 yılları arasında Yoğun Bakım Ünitemizde karbon monoksit intoksikasyon tanısı ile yatan 63 hasta dahil edildi. Yaş ortalaması 44.49 yıl olan hastaların 32’si kadın, 31’i erkek idi. Maruziyet sonrası acil servise başvuru süresi ortalama 6.22 saat idi. Başvuru anında COHb değeri ortalama %27 idi. En sık maruziyet %61.9 ile kış mevsiminde iken en sık maruziyet kaynağı %93.7 ile soba idi. Acil servise başvuru anında ortalama GKS puanı 14.1 puan idi. Hastaların %79.4’ünde nöropsikiyatrik semptomlar, %36.5’inde gastrointestinal semptomlar, %23.8’inde solunum sistemi semptomları, %15.9’unda otolojik semptomlar, %11.1’inde ise kardiyovasküler semptomlar vardı. İki hastada mekanik ventilatör, 57 hastada noninvazif mekanik ventilatör (NIMV) ve 12 hastada hiperbarik oksijen tedavisi ihtiyacı oldu. Hastaların çıkış GKS değerleri ortalama 15 idi. Hastanede ortalama yatış süreleri 1.71 gün idi. Hastalar başvuru anındaki COHb düzeylerine göre; COHb düzeyi %10’nun altında hafif (grup 1), %11-25 arası orta (grup 2), %26-40 arası ağır (grup 3), %41 üzeri çok ağır (grup 4) olarak gruplandırıldı. Gruplar arasında pH, GKS geliş puanı, otolojik semptomlar, NIMV ihtiyacı, SpO2, CK-CKMB düzeyi değerleri arasında istatistiksel olarak anlamlı fark bulundu. Hastalar hastaneye başvuru anındaki GKS puanlarına göre grup A (GKS=15) ve grup B (GKS<15) olarak sınıflandırıldı. gruplar arasında; COHb geliş düzeyi, KVS semptomlar, ek hastalık varlığı, solunum sistemi semptomları, mekanik ventilatör ihtiyacı, HBO ihtiyacı, CK ve troponin düzeyi açısından istatistiki olarak anlamlı fark vardı. Hiperbarik oksijen tedavisi alan (grup I) ve almayan (grup II) hastalar da karşılaştırmalı olarak değerlendirildi. grup I’de troponin-I (p=0.015), CK(p=0.032) düzeylerinde ve mekanik ventilasyon ihtiyacında (p=0.003) belirgin artış olduğu, GKS’nun düşük olduğu (p<0.001) tespit edildi. Bununla birlikte HBO tedavisi gereksinimi ile troponin ve CK seviyesi arasında pozitif yönde korelasyon olduğu görüldü. Bu çalışma sonunda karbon monoksit intoksikasyon tanılı hastalarda başvuru anındaki GKS puanı, COHb, CK-CKMB ve laktat değerlerinin klinik bulgular ile birlikte yorumlanmasının hem tedavi hem de prognoz üzerinde önemli etkilerinin olabileceği düşünüldü.

Anahtar Kelimeler:

Karbonmonoksit intoksikasyonu, karboksihemoglobin, hiperbarik oksijen tedavisi

Carbon Monoxide Intoxication Treatment in Intensive Care; Retrospective Analysis of the Cases

In this study, we aimed to determine the etiological and demographic characteristics of patients with carbon monoxide intoxication to reveal their relationship with the clinical findings, and to investigate the treatment processes and prognoses of these patients. A total of 63 patients diagnosed with carbon monoxide intoxication and hospitalized in the Department of Anesthesiology and Reanimation Intensive Care Unit between 2014 and 2017. The age avarage of the patients was 44.9 years. 32 patients were female and 31 patients were male. The avarage duration between exposion and reffering to emergency department was 6.22 hours. Initial COHb value avarage was 27%. Most common exposion to carbonmonoxide was 61,9% winter and common source of exposion was 93,7% heating stove. Avarage GCS at emergency admission was 14.1. Neuropsychiatric symptoms were observed in 79.4%, gastointestinal symptoms were observed in 36.5%, respiratory symptoms were observed in 15.9% and cardiovascular symptıms were observed in 11.1% of the patients. Two patients required mechanical ventilation, 57 patients required noinvasive mechanical ventilation (NIMV) and 12 patients required hyperbaric oxygen (HBO) treatment. The avarage of GCS at discharge was 15. Hospital stay duration avarage was 1.71 days. Patients were divided into three groups according to their COHb levels at admission, COHb levels under 10% mild (Group 1), between 11-25% intermediate (Group 2), between 26-45% serious (Group 3) and over 41% very serious (Group 4). There were statistically significant difference between groups in means of pH levels, admission GCS, otologic symptoms, NIMV requirement, SpO2 levels and CK, CK-MB levels. Patient were also divided into two groups according to their GCS scores at admission, Group A (GCS=15) and Group B (<15). There were statistically significant difference between groups in means of COHb levels at admission, cardiovascular symptoms, presence of comorbidities, respiratory symptoms, HBO requirement, CK and troponin levels and mechanical ventilation requirement. Patients who had HBO treatment (Group I) and who had not hyperbaric oxygen treatment (Group II) were comperatively evaluated. Troponin-I (p=0,015) , CK (P=0,032) levels and mechanical ventilation requirement (p=0,003) were significantly higher but GCS scores (p<0,001) were significantly lower at Group I. At the same time a significant positive corelation between HBO treatment requirement and troponin,CK levels was found. As a result, management of the patients that diagnosed as carbon monoxide intoxication along with GCS scores at admission, COHb, CK,CK-MB and lactate levels is very important effects on prognosis and treatment of the patients.

Keywords:

Carbon monoxide intoxication, carboxyhemoglobin,

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