Plasenta akreata spektrumu ve plasenta previa tanılı hastalarda 10 yıllık anestezi yönetiminin retrospektif değerlendirilmesi
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Tarih
2022
Yazarlar
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Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Ülkemizde ve dünyada artan sezaryen sayısı ve buna bağlı olarak artış gösteren plasenta akreata spektrumu ve plasenta previa tanılı gebeler anestezistlerin karşısına sıklıkla çıkabilmektedir.Bu çalışmada Dicle Üniversitesi Tıp Fakültesi Hastaneleri'nde Ocak 2010 – Aralık 2020 tarihleri arasında plasenta akreata spektrum bozukluğu ve plasenta previa tanılı sezaryen operasyonu geçirmiş 631 olgu anestezi yönetimi incelenmiş ve sonuçların literatürler eşliğinde değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya dahil edilen 631 hastanın yaş, gestasyonel yaş, gravida, parite, önceki sezaryen sayısı, uygulanan anestezi yöntemi, preoperatif hemoglobin, platelet değerleri ve postoperatif hemoglobin değerleri kaydedildi. Transfüzyon uygulamaları (eritrosit süspansiyonu, taze donmuş plazma), kolloid, traneksamik asit, fibrinojen konsantresi kullanımı kaydedildi. Peroperatif dönemde gelişen komplikasyonlar (DİC, ABY) 3. basamak yoğun bakım ünitesinde kalış süresi ve mortalite gelişip gelişmediği rapor edildi. Bulgular: Vakaların %40,1'inde genel anestezi, %59,9'unda spinal anestezi tercih edildiği ve anne mortalitesinin görülmediği tespit edildi. Genel anestezi yapılan gebelerde 3. basamak yoğun bakım ihtiyacı oranı %9,9 ve spinal anestezi uygulanan gebelerde oran %0,8 olarak bulundu. Genel anestezi alan gebelerin kan ürünü ve fibrinojen konsantresi ihtiyacı spinal anestezi alanlara göre anlamlı olarak daha yüksek saptandı. Sonuç: Çalışmamızda acil, kanama ihtimali yüksek, histerektomi endikasyonu olanlarda genel anestezinin daha çok tercih edildiği görüldü. Çalışmamıza dâhil olan gebelerde mortalite saptanmadı. Genel anestezi grubunda daha fazla kan ürünü ihtiyacı ve 3. basamak yoğun bakım ihtiyacı olduğu bulundu. Uygun olan hastalarda spinal anestezinin genel anesteziye göre tercih edilmesi gerektiğini düşünmekteyiz.
Introduction and Objective: The increasing number of cesarean sections in our country and in the world and due to the increasing spectrum of placenta accreta and pregnant women with a diagnosis of placenta previa can frequently come before anesthesiologists. In this study, anesthesia management of 631 cases with a diagnosis of placenta accreta spectrum disorder and placenta previa who had undergone cesarean section between January 2010 and December 2020 in Dicle University Medical Faculty Hospitals were examined and the results were evaluated in the highlights of the literature. Materials and Methods: Age, gestational age, gravida, parity, previous cesarean section number, anesthesia method applied, preoperative hemoglobin, platelet counts and postoperative hemoglobin values of 631 patients included in the study were recorded. Transfusion applications (erythrocyte suspension, fresh frozen plasma), use of colloid, tranexamic acid, and fibrinogen concentrate were recorded. Complications that developed in the peroperative period (DIC, ARF), length of stay in the tertiary intensive care unit and whether mortality developed or not were reported. Results: It was determined that general anesthesia was preferred in 40.1% of the cases, spinal anesthesia was preferred in 59.9% of the cases, and maternal mortality was not observed. The rate of need for tertiary intensive care in pregnant women who underwent general anesthesia was 9.9%, and the rate was 0.8% in pregnant women who underwent spinal anesthesia. Blood product and fibrinogen concentrate needs of pregnant women who received general anesthesia were found to be significantly higher than those who received spinal anesthesia. Conclusion: In our study, it was observed that general anesthesia was preferred more in patients with an emergency, high probability of bleeding and hysterectomy indication. There was no mortality in the pregnant women included in our study. It was found that the need for more blood products and the need for tertiary intensive care in the general anesthesia group. We think that spinal anesthesia should be preferred over general anesthesia in suitable patients.
Introduction and Objective: The increasing number of cesarean sections in our country and in the world and due to the increasing spectrum of placenta accreta and pregnant women with a diagnosis of placenta previa can frequently come before anesthesiologists. In this study, anesthesia management of 631 cases with a diagnosis of placenta accreta spectrum disorder and placenta previa who had undergone cesarean section between January 2010 and December 2020 in Dicle University Medical Faculty Hospitals were examined and the results were evaluated in the highlights of the literature. Materials and Methods: Age, gestational age, gravida, parity, previous cesarean section number, anesthesia method applied, preoperative hemoglobin, platelet counts and postoperative hemoglobin values of 631 patients included in the study were recorded. Transfusion applications (erythrocyte suspension, fresh frozen plasma), use of colloid, tranexamic acid, and fibrinogen concentrate were recorded. Complications that developed in the peroperative period (DIC, ARF), length of stay in the tertiary intensive care unit and whether mortality developed or not were reported. Results: It was determined that general anesthesia was preferred in 40.1% of the cases, spinal anesthesia was preferred in 59.9% of the cases, and maternal mortality was not observed. The rate of need for tertiary intensive care in pregnant women who underwent general anesthesia was 9.9%, and the rate was 0.8% in pregnant women who underwent spinal anesthesia. Blood product and fibrinogen concentrate needs of pregnant women who received general anesthesia were found to be significantly higher than those who received spinal anesthesia. Conclusion: In our study, it was observed that general anesthesia was preferred more in patients with an emergency, high probability of bleeding and hysterectomy indication. There was no mortality in the pregnant women included in our study. It was found that the need for more blood products and the need for tertiary intensive care in the general anesthesia group. We think that spinal anesthesia should be preferred over general anesthesia in suitable patients.
Açıklama
Anahtar Kelimeler
Plasenta akreata spektrum bozukluğu, Plasenta previa, Anestezi yönetimi, Kan ürünleri transfüzyonu, Yoğun bakım ihtiyacı, Spectrum disorder of placenta accreta, Placenta previa, Anesthesia management, Transfusion of blood products, Need for intensive care
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Künye
Oygen, Ö. (2022). Plasenta akreata spektrumu ve plasenta previa tanılı hastalarda 10 yıllık anestezi yönetiminin retrospektif değerlendirilmesi. Yayımlanmamış uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
