Mehmet Ali Aslaner, Necmi Baykan

İkinci basamak bir acil serviste trombolitik tedavi deneyimi

Amaç: Trombolitik tedavi, ülkemizde üniversite ve eğitim-araştırma hastanelerinde sıklıkla uygulanmakta ve kullanım oranları daha net olarak tanımlanmış olmasına rağmen, ulusal literatürde ikinci basamak acil servis kullanım oranları bilinmemektedir. Bu çalışma ile ülkemizde eksik olan, ikinci basamağa ait yeni bir veri seti oluşturmak amaçlanmıştır. Yöntem: Çalışma 2006-2008 yılları arasında geriye dönük olarak, ........... ilinin en büyük hastanesinin ikinci basamak acil servisinde gerçekleştirildi. Veri seti; demografik özelliklerin yanı sıra, tanılar, kullanılan etken madde, komplikasyon durumu ve 3 aylık mortalite olarak belirlendi. Bulgular: Çalışma periyodu boyunca 57 hastaya trombolitik tedavi verildi. Hastaların ortanca yaşı 68 (IQR 54-79) ve erkek cinsiyet oranı %70,2 idi. Tüm çalışma boyunca trombolitik tedavi kullanım sıklığı 1,8/10.000 acil servis başvurusu olarak saptandı. Trombolitik tedavi uygulanan tanılar içerisinde; iskemik inme %50,9 oranında, akut miyokard enfarktüsü %29,8, arrest etiyolojisi %10,5 ve pulmoner tromboemboli %8,8 oranındaydı. Kullanılan ajanlardan alteplaz %75,4 oranında ve tenekteplaz %24,6 oranında uygulandı. Tedavi uygulanan tüm hastaların 3 aylık mortalite oranı %57,9’ idi. Sonuç: Çalışmada, trombolitik tedavi uygulamasının daha sıklıkla iskemik inme hastalarında uygulandığı görüldü. Alteplaz, geniş endikasyon spektrumu nedeniyle en sık kullanılan trombolitik ajandı. Çalışma sonucunda trombolitik kullanımının, özellikle ikinci basamak acil servislerde oldukça düşük oranda olduğu düşünüldü.

Anahtar Kelimeler:

acil servis, trombolitik tedavi, alteplaz, tenekteplaz

Thrombolytic therapy experience in an secondary care emergency department

Purpose: Although thrombolytic therapy is frequently used and the usage rates are well defined in university and education-research hospitals in our country, secondary care emergency departments (ED) utilization rates in national literature are not known. With this study, it was aimed to create a new data set which is insufficient in our country.Materials and Methods: The study was carried out retrospectively between 2006 and 2008 in the secondary care ED of the biggest hospital of ........... province. Data set were included diagnoses, active substance, complication status and 3-months mortality in addition to demographic characteristics.Results: During the study period, 57 patients received thrombolytic therapy. The median age of the patients was 68 (IQR 54-79) and the male gender ratio was 70.2%. The frequency of thrombolytic therapy was 1.8 / 10.000 in all ED visits. Of all diagnoses; the incidence of ischemic stroke was 50.9%, acute myocardial infarction was 29.8%, arrest etiology was 10.5% and pulmonary thromboembolism was 8.8%. Alteplase was used in 75.4% of the cases and tenecteplase was used in 24.6%. The mortality rate was 57.9% in all patients. Conclusion: Thrombolytic therapy was more frequently performed in patients with ischemic stroke. Alteplase was the most commonly used thrombolytic agent because of its wide spectrum of indications. It was thought that thrombolytic usage is very low in in the secondary care emergency departments.

Keywords:

emergency department, thrombolytic therapy, alteplase, tenekteplase,

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