Halil KESKİN, Filiz KESKİN, Ibrahim BASASLAN, Hüseyin TAN

Çocuk Yoğun Bakım Ünitesinde Takip Edilen Guillain Barre Sendromu Olguları; 3 Yıllık Deneyim

Amaç: Poliomiyelit eradike edildikten sonra akut flask paralizinin sğlıklı çocuklardaki en sık nedeni Guillain-Barre Sendromu (GBS) olmuştur. GBS, çocuk yoğun bakım (ÇYB) ünitesinde tedavi olmayı gerektiren nöromusküler hastalıklardan birisidir. Bu çalışmanın amacı, GBS tanısı ile ÇYB ünitesinde yatırılarak tedavi edilen hastalarla ilgili bir üniversite hastanesinin üç yıllık deneyimini sunmaktır. Gereç ve Yöntemler: Mart 2016 ve Mart 2019 tarihleri arasında GBS tanısı ile ÇYB ünitesinde takip edilen hastalar retrospektif olarak değerlendirildi. Bulgular: Çalışma süresi boyunca 22 hasta GBS tanısı aldı. Bu hastalardan 7 tanesinin ÇYB ünitesinde takip edilmesi gerekti. Bu 7 hastanın 8 yatışı çalışma grubunu oluşturdu. Dürt tanesi kız, 3 tanesi erkek idi. Yaşları 3 ile 12 yıl arasındaydı. Hastaların tümü solunum sıkıntısı semptomları ile ÇYB ünitesine yatırıldı. Hastalarda asendan paralizinin başlangıcından 3 ile 7 gün önce nonspesifik bir solunum yolu enfeksiyonu veya gastrointestinal enfeksiyon vardı. Tüm hastalara intravenöz immunoglobulin infüzyonu verildi. Beş hasta yatışında plazmaferez tedavisine ve mekanik ventilasyon desteğine ihtiyaç duyuldu. ÇYB ünitesinde yatış süresi 2 ile 87 gün ve hastanede yatış süresi 14 ile 98 gün idi. Hastaların hepsi taburcu edildi ve yardımsız yürüyebildi. Sonuç: Sonuçlarımız, GBS tanılı hastalarda ÇYB takibinin çok önemli olduğunu gösterdi. Mekanik ventilatörde kalma süresi ve hastanede yatış süresi çok uzun olmasına rağmen, etkili bir ÇYB desteği ile bu hastalarda prognoz iyidir.

Anahtar Kelimeler:

Guillain-Barre sendromu, plasmaferez, intravenöz immunoglobulin, çocuk yoğun bakım ünitesi

Guillain-Barre Syndrome Followed in the PICU; 3-year Experience

Objective: After the poliomyelitis eradicated, Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis in healthy child. It is one of the neuromuscular disorders required treatment to pediatric intensive care unit. Aim of this study is to present the three-year’s experience of caring for patients with GBS admitted the PICU in the university hospital. Materials and Methods: Patients who were admitted to the PICU with diagnosed GBS between March 2016 and March 2019 were evaluated retrospectively. Results: Twenty-two patients were diagnosed with GBS during study period. Seven of them needed PICU in 8 admissions, and they formed the study group. Four of them were female and 3 of them were male. They were 3 to12 years old. All of them were admitted in the PICU because of respiratory distress symptoms. The paralysis followed a nonspecific respiratory or gastrointestinal infection by 3 to 7 days, and ascending progress was present. Intravenous immunoglobulin infusion was administered in all patients. Five of them need to plasmapheresis and mechanical ventilator support. Stay to PICU length was 2 to 87 days and hospitalization length was 14 to 98 days. All of them were discharged, and became able to walk unaided. Conclusion: Our results show that PICU follow-up is very important in children with GBS. Although duration of mechanical ventilation, and hospitalization length is long, prognosis is good with effective management strategies.

Keywords:

Guillain-Barre syndrome, plasmapheresis, intravenous immunoglobulin, pediatric intensive care unit,

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