Levent Cem Mutlu, Süleyman Savaş Hacıevliyagil, Hakan Günen, Özkan Kızkın

Akut Solunum Yetmezliği Olan KOAH Hastalarında İlave Oksijen Tedavisinin Hipoksi Ve Hiperkapniye Etkisi

Giriş: Kronik obstruktif akciğer hastalığı (KOAH) akut atağında; hipoksemi ve hiperkapniye sıklıkla rastlanılmaktadır. Amaç: Solunum yetmezliği olan KOAH hastalarında, nazal kanül ile verilen 2 L/dk oksijenin, hipoksemi ve hiperkapniye etkisini araştırmaktır. Gereç ve Yöntem: Yirmi altı tip I (Grup I) ve 36 tip II (Grup II) solunum yetmezlikli hasta çalışmaya alındı. Hastaların başvuru klinik ve laboratuar bulguları kaydedildi. Hastalar tam tıbbi tedavi yanısıra nazal kanülle 2 L/dk ilave oksijen aldıktan sonra, solunum fonksiyon testleri ve arter kan gazı (AKG) ölçümleri tekrar edildi. Tedavi ile PaCO2 değerleri 10 mmHg'dan daha fazla yükselenler Grup III'ü oluşturdu ve geri kalan hastalarla (Grup 4) karşılaştırılmaları yapıldı. Bulgular: Başlangıç laboratuvar parametrelerinden; PaO2 Grup II'de daha düşüktü. Her iki grupta tedavi sonrası saptanan PaO2 değerlerindeki artış istatistiksel olarak anlamlıydı (p<0.001). Tedavinin sonunda PaO2 değerleri, Grup I ve II'de sırasıyla 23 hasta (%88.5) ve 26 hastada (%77.2) 60 mmHg'nın altında kaldı. Tedavi sonrası PaCO2 değeri 21 hastada (%28.8) yüksek bulunurken, 7 hastada (%11.3) 10 mmHg'nin üzerinde artış saptandı (Grup III). Biri hariç bu hastaların tümü Grup II'ye aitti (p>0.05). Grup 3'de Grup 4'e göre hastalık süresinin daha uzun olması ve kor pulmonale'nin daha fazla olması istatistiksel olarak anlamlı saptandı (p<0.05). Sonuçlar: KOAH akut atak hastalarında nazal kanülle 2 L/dk oksijen verilmesinin hastaların önemli bir kısmında hipokseminin düzeltilmesinde yeterli olmayacağı ve hiperkapnik hastalarda söz konusu oksijen tedavisinin %15-20 olguda PaCO2'yi daha fazla yükseltebileceği bulunmuştur. Anahtar kelimeler: KOAH, İlave oksijen tedavisi, Hipoksi, Hiperkapni.

Anahtar Kelimeler:

KOAH, İlave oksijen tedavisi, Hipoksi, Hiperkapni.

The Effect of Supplemental Oxygen on Hypoxemia and Hypercapnia in COPD Patients with Acute Respiratory Failure

Background: Hypoxemia and hypercapnia are frequently encountered in chronic obstructive pulmonary disease (COPD) patients with acute attack. Objectives: To investigate the effect of 2 L/min oxygen given with nasal cannula on hypoxemia and hypercapnia in COPD patients with respiratory failure. Methods: Twenty-six type I (Group I) and 36 type II (Group II) respiratory failure patients were included in the study. The patients' initial clinical and laboratory findings were obtained. Spirometric examination and arterial blood gas (ABG) analysis were repeated after the administration of optimal medical therapy including 2 L/min oxygen given with nasal cannula. The patients whose PaCO2 values increased more than 10 mmHg with the treatment were also grouped as Group III, and their comparison was made with the rest of the patients (Group IV). Results: Among the initial laboratory parameters; PaO2 was lower in Group II (p<0.001). Increases in PaO2 values with the treatment in both groups were statistically significant (p<0.001). With the treatment PaO2 value stayed under 60 mmHg in 23 patients (88.5%) and 26 patients (77.2%) in Group I and II, respectively (p<0.05). Final PaCO2 values were found higher in 21 patients (28.8%), and this was more than 10 mmHg in 7 (11.3%) patients (Group III). All but one of these patients belonged to Group II (p>0.05). In Group III, longer disease duration and higher rate of cor pulmonale were found to be statistically significant when compared with Group IV (p<0.05). Conclusion: Two L/min oxygen given with nasal cannula is usually not sufficient to improve hypoxemia in COPD patients with acute attack, and oxygen therapy mentioned increases PaCO2 further in 15-20% of hypercapneic patients. Key words: COPD, Supplemental oxygen therapy, Hypoxemia, Hypercapnia.

Keywords:

COPD, Supplemental oxygen therapy, Hypoxemia, Hypercapnia.,

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Corresponding Author: Dr.Levent Cem Mutlu
İnönü Üniversitesi Turgut Özal Tıp Merkezi
Göğüs Hastalıkları Anabilim Dalı, 44069 Malatya Tel : 422 341 06 69 Fax : 422 341 07 28
E-mail : cemmutlu68@yahoo.co.uk