Akciğer dekortikasyon ameliyatı yapılan erişkin hastaların preoperatif ve postoperatif olarak arteryel kan gazı,solunum fonksiyon testleri ve akciğer perfüzyon sintigrafilerinin karşılaştırılması
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2017
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info:eu-repo/semantics/openAccess
Özet
Plevral ampiyem geniú spektrumlu antibiyotik tedavisine ve enfekte plevral boúlu÷un drenajÕ için birçok yönteme ra÷men yüksek mortalite ve morbidite oranlarÕna sahip bir enfeksiyondur. Az geliúmiú veya geliúmekte olan ülkelerde ampiyem insidansÕ geliúmiú ülkelere göre daha yüksektir. Bunun sebeplerinden biri az geliúmiú ülkelerde modern alt yapÕ ve kanalizasyon sistemlerinin, halk sa÷OÕ÷Õ e÷itiminin yetersiz olmasÕ, bunun sonucunda da hijenin yeterli sa÷lanamamasÕ, bir di÷eri ise hastalÕ÷Õn tanÕVÕQÕn yanlÕú ya da geç konulmasÕ sonucu plevral ampiyem oluúumu kaçÕQÕlmazdÕr. Akci÷er ekspansiyonunu sÕQÕrlayan aúÕUÕ plevral kabuk nedeniyle hastalarda fibrotoraks geliúir. Fibrotoraks geliúen hastalara tüp torakostomi’den fayda görmezler, etkilenen tarafta solunum hareketleri azalÕr ve kaybolur. Dekortikasyon, akci÷erin üzerindeki akci÷er parankimini sÕNÕúWÕran ve baskÕlayan kabu÷un oÕkarÕlmasÕ olarak tanÕmlanmÕúWÕr. Fibrotoraks sonrasÕ akci÷er parankimi üzerindeki plevral kabu÷un dekortikasyon iúlemi sonrasÕ solunum fonksiyonlarÕQÕn NÕsmen düzelmesini amaçladÕk. Dicle Üniversitesi TÕp Fakültesi Gö÷üs Cerrahi Klini÷inde Ocak 2000-KasÕm 2008 tarihleri arasÕnda, kronik ampiyem tanÕVÕ konulan olgularÕn dosyalarÕ retrospektif olarak tarandÕ. Bu olgularÕn dosyalarÕnda rutin olarak preoperatif ve postoperatif olarak solunum fonksiyon testi (SFT) arteryel kan gazÕ ve akci÷er perfüzyon sintigrafisi çekilmiú olan 37 hasta incelemeye alÕndÕ. Bu olgularÕn yaúlarÕ 15–73 ortalama (37,3) arasÕnda, 25’i erkek (%67,6), 12’si kadÕn (%32,4) dÕ. OlgularÕn 15’ine (%40,5) sa÷ torakotomi, 22’sine (%59,5) ise sol torakotomi yapÕldÕ÷Õ tespit edildi. 28 olgununun patolojik raporu kronik fibrinöz plevrit (%75,6), 9’unun ise tüberküloz plevrit (%24,3) olarak tespit edildi. ÇalÕúmamÕzda dekortikasyon operasyonu yapÕlan 37 hastanÕn postoperatif dönemdeki FEV1% ve FVC% de÷erleri preoperatif dönemdeki de÷erlere göre VÕrasÕyla ortalama %24,74 ve %24,35 artmÕú olarak bulundu ve istatistiksellarak anlamlÕydÕ (p<0,001). HastalarÕPÕ]Õn plevral dekortikasyon öncesi ve sonrasÕnda perfüzyon sintigrafisi ölçüldü. Opere edilen tarafta hastalarÕn sa÷ akci÷er perfüzyonunda ortalama %28,1 ve sol akci÷er perfüzyonunda da ortalama %32 düzelme tespit edildi. ÇalÕúmamÕzda dekortikasyon operasyonu yapÕlan 37 hastanÕn preoperatif ve postoperatif dönemdeki arteryel kan gazÕ parametreleri karúÕlaúWÕUÕldÕ. Bu karúÕlaúmada postoperatif olarak parsiyel oksijen basÕncÕda (PO2) %5,17’lik artÕú meydana gelmiútir. østatistiksel olarak anlamlÕ bulunmuútur. (p<0,01) Bir di÷er parametre olan SO2 de÷erinde preoperatif döneme göre postoperatif olarak %2,47 ‘lik artÕú olmuútur østatistiksel olarak anlamlÕ bulunmuútur (p<0,05). Sonuç olarak; kr. plevral ampiyem nedeniyle dekortikasyon operasyonu yapÕlan olgularÕn postoperatif solunum fonksiyon testlerinde anlamlÕ derecede artÕú izlenmektedir. Etkilenen akci÷er alanlarÕndaki perfüzyon bariz úekilde bozuktu, dekortikasyon sonrasÕnda önemli oranda artÕú gözlemledik. østatistiksel olarakta anlamlÕ idi. Arteryel kan gazÕ incelemesinde preoperatif parsiyel oksijen basÕncÕ düúük idi, operasyon sonrasÕnda anlamlÕ artÕú gösterdi. Yine kandaki oksijen satürasyon düzeyi postoperatif dönemde ileri düzeyde arttÕ. Parsiyel karbondioksit basÕncÕ ve PH düzeylerinde postoperatif dönemde önemli de÷Lúiklik görülmedi. østatistikî olarak anlamlÕ de÷ildi (p>0,05).
Pleural empyema is an infective process with high mortality and morbidity despite broad-spectrum antibiotics and drainage of infected pleural cavity. Empyeme is more frequently observed in underdeveloped or developing countries due to inadequacy of sanitation, substructure and sewer system or misdiagnosis of disease. Fibrothorax may develop due to pleural peel that would restrict expansion of lung. Patients with fibrothorax would not response to tube thoracostomy and respiration reduces or annihilates. Decortication is described as removing the peel that restricts lung parenchyme. Our aim is to improve respiratory functions by decortication of pleural peel subsequent to fibrothorax. Registrations of 37 patients with chronic empyema between January 2000 and November 2008 that were followed-up in Chest Surgery Clinics of Medical School in Dicle University were examined retrospectively. Patients with preoperative and postoperative respiratory function tests, arteriel blood gas analysis and lung perfusion scintigraphy were included. Age disturbance was 15–73 years (37,3). 25 patients were male (%67,6), and 12 patients were female (%32,4). Right and left thoracotomy were performed in 15 (%40,5) and 22 (%59,5) patients, respectively. 28 patients (%75,6) had chronic fibrinous pleuritis and 9 patients (%24,3) had tuberculous pleuritis. Postoperative ratios of FEV1% and FVC% were augmented by 24,74% and 24,35%, respectively and results were statistically significant (p‹0,001). Preoperative and postoperative perfusion scintigraphic examination was carried out. Improvement ratios were 28,1% in right and 32% in left lung perfusion. Preoperative and postoperative blood gas analysis were compared. Postoperatve partial oxygen pressure was increased by 5,17% (p<0,01). Improvement ratio of oxygen saturation was 2,47% (p<0,05).Both was significant. In conclusion, respiratory function tests were significantly improved subsequent to decortication of patients with chronic pleural empyema. Lung perfusion of effected side were apparently disordered. Improvement was significant subsequent to decortication. Both partial oxygen pressure and oxygen saturation that were preoperatively low, significantly improved. No significant improvement obtained in partial carbondioxyte and pH levels (p>0,05).
Pleural empyema is an infective process with high mortality and morbidity despite broad-spectrum antibiotics and drainage of infected pleural cavity. Empyeme is more frequently observed in underdeveloped or developing countries due to inadequacy of sanitation, substructure and sewer system or misdiagnosis of disease. Fibrothorax may develop due to pleural peel that would restrict expansion of lung. Patients with fibrothorax would not response to tube thoracostomy and respiration reduces or annihilates. Decortication is described as removing the peel that restricts lung parenchyme. Our aim is to improve respiratory functions by decortication of pleural peel subsequent to fibrothorax. Registrations of 37 patients with chronic empyema between January 2000 and November 2008 that were followed-up in Chest Surgery Clinics of Medical School in Dicle University were examined retrospectively. Patients with preoperative and postoperative respiratory function tests, arteriel blood gas analysis and lung perfusion scintigraphy were included. Age disturbance was 15–73 years (37,3). 25 patients were male (%67,6), and 12 patients were female (%32,4). Right and left thoracotomy were performed in 15 (%40,5) and 22 (%59,5) patients, respectively. 28 patients (%75,6) had chronic fibrinous pleuritis and 9 patients (%24,3) had tuberculous pleuritis. Postoperative ratios of FEV1% and FVC% were augmented by 24,74% and 24,35%, respectively and results were statistically significant (p‹0,001). Preoperative and postoperative perfusion scintigraphic examination was carried out. Improvement ratios were 28,1% in right and 32% in left lung perfusion. Preoperative and postoperative blood gas analysis were compared. Postoperatve partial oxygen pressure was increased by 5,17% (p<0,01). Improvement ratio of oxygen saturation was 2,47% (p<0,05).Both was significant. In conclusion, respiratory function tests were significantly improved subsequent to decortication of patients with chronic pleural empyema. Lung perfusion of effected side were apparently disordered. Improvement was significant subsequent to decortication. Both partial oxygen pressure and oxygen saturation that were preoperatively low, significantly improved. No significant improvement obtained in partial carbondioxyte and pH levels (p>0,05).
Açıklama
Anahtar Kelimeler
Akciğer hastalıkları, Solunum sistemi
