Acil tıp kliniğine 2010-2020 yılları arasında başvuran 50 yaşın üstündeki hastaların intihar girişimlerinin araştırılması
Yükleniyor...
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada Dicle Üniversitesi Tıp Fakültesi Hastanesi Acil Tıp Kliniğine intihar girişiminde kimyasal madde kullanarak başvuran hastaların; zehirlenme şekillerinin, mortaliteyi etkileyen faktörlerinin ve cinsiyetler arasındaki farklarının araştırılması amaçlandı. Çalışmamız etik kurul onayı alındıktan sonra, Dicle Üniversitesi Tıp Fakültesi Acil Tıp kliniğine 1 Ocak 2010 ve 31 Eylül 2020 tarihleri arasında intihar girişimi sonrası başvuran 50 yaşın üstündeki 72 hasta ile yapılmıştır. Hastalar retrospektif şekilde taranarak demografik özellikleri (yaş, cinsiyet, mevsim) , vital bulguları (tansiyon, ortalama arter basıncı, nabız, saturasyon), elektrokardiyografik özellikleri, kronik hastalıkları, travma skoru (Glasgow koma skalası: GKS) , kullanılan ilaç grubu, kan gazı değerleri (pH, laktat ve HCO3) , hemogram değerleri (hemoglobin, lökosit, platelet düzeyleri), koagulasyon değerleri (APTT, PT, INR düzeyleri), Aktif kömür ve lavaj uygulamaları, tedavi yöntemleri, mekanik ventilatör ihtiyaçları, takip durumları ve sonlanımları incelendi. Değişkenlere Kolmogorov-Smirnov testi kullanılarak normallik testi yapıldı. Normal olan veriler ortalama değer±standart sapma şeklinde, normal olmayan kategorik veriler n (%) olarak ifade edildi. Sürekli olan değişkenleri analiz etmek için Student-t testi kullanıldı. Kategorik değişkenler Ki-kare testi kullanılarak karşılaştırıldı. Bütün parametrelerde anlamlı değer olarak p<0,05 değeri belirlenmiştir. Hastaların 35 (% 48,6 ) 'i Kadın, 37 (%51,4 ) 'si Erkekti. Erkek Kadın oranının 1,05/1 olduğu belirlendi. Hastaların yaş ortalaması 63.0 ± 9,84 yıl idi. Erkekler ile kadınlar arasında yaş ortalamalarında fark izlenmedi(p>0,05). Yaş ve Cinsiyet açısından ölenler ve sağ kalanlar arasında fark bulunmadı (p>0,05). En çok hasta 50 - 59 yaş aralığındaki grupta, en az hasta ise 80 yaş üstü olan grupta bulundu. En çok başvurunun ilkbahar mevsiminde saptandı. Cinsiyetler arasında mevsimlere göre fark bulunmadığı görüldü. Mevsimlerin mortalite üzerindeki etkisinde anlamlı fark bulunmadı (p> 0,05). Cinsiyetler arasında ek hastalık varlığına (komorbidite) göre fark bulunmadı (p>0,05). Kardiyovasküler problemleri ve Psikiyatrik problemleri olan hastaların sayısının daha fazla olduğu izlendi. Geliş kan basıncı ile mortalite arasında ilişki saptanmadı (p>0,05). Cinsiyetler arasında ilaç seçimlerine göre fark bulunmadı (p>0,05). En çok tarım-böcek ilaçlarının kullanıldığı saptandı. Erkeklerin daha çok yoğun bakımda takip edildiği izlendi. Erkekler ve kadınlar arasında Mortalite açısından fark bulunmadığı saptandı(p>0,05). OAB 'nın, Bradikardi-Taşikardi-Normal ritmin ve de Oksijen Saturasyonun mortaliteyi etkilmediği izlendi. pH, Laktat, HCO3, WBC ve INR değerlerine göre ölenler ve sağ kalanlar arasında fark olduğu saptandı (p<0,05). GKS puanının 15'in altında olması mortaliteyi etkilediği görüldü. Geliş kan basıncı ile mortalite arasında fark olmadığı saptandı(p>0,05) pH'nın 7,35 değerinin altında olması mortaliteyi etkilediği izlendi(p<0,05). Laktat değerinin 2 mmol/l'nin altında olması sağkalımı, 4 mmol/l'nin üstünde olması mortaliteyi etkilediği saptandı (p<0,05).HCO3 değerinin 22 mmol/l'nin altında olmasının mortaliteyi etkilediği tespit edildi (p<0,05). Lökositoz varlığının mortaliteyi etkilediği görüldü (p<0,05). INR değerinin 1,2'nin üzerinde olmasının mortaliteyi artırdığı saptandı(p<0,05). Mekanik ventilatör kullanımı ile ölenler ve sağ kalanlar arasında mortalite açısından fark bulunmadı(p>0,05). Yoğun bakım takibi ile ölenler ve sağ kalanlar arasında sonlanım açısından fark olmadığı tespit edilmiştir(p>0,05). Sonuç olarak acil servislere intihar girişimi sonucu başvuran ileri erişkin ve geriatrik hastaların olgu sayılarını ve mortalitelerini azaltmak amacıyla uygun tedavinin sağlanması, mortaliteyi artırdığını tespit ettiğimiz durumlara yönelik olarak olguyu yöneten ekibin acil tıp uzmanı gibi deneyimli kişiler tarafından organize edilmesi ile psikoterapi ve sosyal desteğinin sağlanması gerektiği düşüncesindeyiz.
In this study, the patients who applied to Dicle University Faculty of Medicine Emergency Medicine Clinic by using chemical substances in suicide attempt; It was aimed to investigate the types of poisoning, the factors affecting mortality and the differences between genders. After the approval of ethics comitee, our study was conducted with 72 patients over the age of 50 who applied into the Dicle Univesity Faculty of Medicine Emergency Clinic with a suicide attemp between January 1, 2010 and September 31, 2020. The patients were screened retrospectively by their demograpohic characteristics (age, gender, season), their vital signs (blood pressure, mean arterial blood pressure, pulse, saturation) electrocardiographic features, chronic illnesses, trauma score (Glasgow coma scale: GCS), group of drugs used, blood gas values (pH, lactate and HCO3), hemogram values (hemoglobin, leukocyte, platelet levels), coagulation values (APTT, PT, INR levels), active carbon and lavage application, treatment methods, mechanic ventilator needs, follow-up status and outcomes were analzyed. The variables were conducted for normality test by using Kolmogorov-Smirnow test. The data that were normal were stated as mean value ± standart deviation, and the categorical data that weren't normal were stated as n (%). To analyze the constant variables, Student-t test was used. Categorical differences were compared by using Chi-Square test. In all of the parameters, p<0,05 is stated as significant. Thirty-five (%48,6) of the patiens were female while 37 (%51,4) of them were male. It is stated that male-female ratio was 1,05/1. Average age of patients was 63.0 ± 9,84 years. There seemed to be no difference in average age between men and women (p>0,05). In terms of age and gender, no difference was found between the deceased and survivors. The majority of the patients were in the group between 50-59 years of age, while the least patients were in the group over 80 years old. Most of the applications were detected in the spring season. No difference were found between genders in terms of seasons. No significant difference was found in the effect of seasons on mortality (p> 0,05). No difference was found between genders based on the presence of additional disease (comorbidity) (p> 0,05). The number of patients with cardiovascular problems and psychiatric problems was observed to be higher. No relation between the initial blood pressure and mortality were found. No difference was found between the genders in terms of drug choice (p> 0,05). It was found that agro-pesticides were most frequently used. It was detected that men were mostly monitered in intensive care unit. No difference were found in male and female in terms of mortality (p> 0,05). It was observed that MAP, bradycardia-tachycardia-normal rhythm and oxygen saturation did not affect mortality. It was found that there was a difference between the dead and the survivors in terms of pH, lactate, HCO3, WBC, and INR values. Having a GCS score below 15 was found to affect mortality (p> 0,05). No relation between the initial blood pressure and mortality were found. pH below 7.35 was observed to have an affect on mortality (p> 0,05). Lactate value below 2 mmol/l was found to affected survival and above 4 mmol/L affected mortality (p> 0,05). It was found that the HCO3 value below 22 mmol/l had an affect on mortality (p<0.05). The presence of leukocytosis was seen to affect mortality (p<0.05). It was found that the INR value above 1.2 increased mortality(p<0.05). No difference in mortality was found between deceased and survivors using mechanical ventilators (p>0.05). It was detected that there was no difference in outcome between those who died and those who survived with intensive care follow-up (p>0.05). In conclusion, we are of the opinion that appropriate treatment to reduce the number of cases and mortality of advanced adult and geriatric patients admitted to emergency departments as a result of suicide attempts, organizing the team that manages the case by experienced people, such as an emergency medicine specialist, for situations that we have found increase mortality, psychotherapy and social support should be provided.
In this study, the patients who applied to Dicle University Faculty of Medicine Emergency Medicine Clinic by using chemical substances in suicide attempt; It was aimed to investigate the types of poisoning, the factors affecting mortality and the differences between genders. After the approval of ethics comitee, our study was conducted with 72 patients over the age of 50 who applied into the Dicle Univesity Faculty of Medicine Emergency Clinic with a suicide attemp between January 1, 2010 and September 31, 2020. The patients were screened retrospectively by their demograpohic characteristics (age, gender, season), their vital signs (blood pressure, mean arterial blood pressure, pulse, saturation) electrocardiographic features, chronic illnesses, trauma score (Glasgow coma scale: GCS), group of drugs used, blood gas values (pH, lactate and HCO3), hemogram values (hemoglobin, leukocyte, platelet levels), coagulation values (APTT, PT, INR levels), active carbon and lavage application, treatment methods, mechanic ventilator needs, follow-up status and outcomes were analzyed. The variables were conducted for normality test by using Kolmogorov-Smirnow test. The data that were normal were stated as mean value ± standart deviation, and the categorical data that weren't normal were stated as n (%). To analyze the constant variables, Student-t test was used. Categorical differences were compared by using Chi-Square test. In all of the parameters, p<0,05 is stated as significant. Thirty-five (%48,6) of the patiens were female while 37 (%51,4) of them were male. It is stated that male-female ratio was 1,05/1. Average age of patients was 63.0 ± 9,84 years. There seemed to be no difference in average age between men and women (p>0,05). In terms of age and gender, no difference was found between the deceased and survivors. The majority of the patients were in the group between 50-59 years of age, while the least patients were in the group over 80 years old. Most of the applications were detected in the spring season. No difference were found between genders in terms of seasons. No significant difference was found in the effect of seasons on mortality (p> 0,05). No difference was found between genders based on the presence of additional disease (comorbidity) (p> 0,05). The number of patients with cardiovascular problems and psychiatric problems was observed to be higher. No relation between the initial blood pressure and mortality were found. No difference was found between the genders in terms of drug choice (p> 0,05). It was found that agro-pesticides were most frequently used. It was detected that men were mostly monitered in intensive care unit. No difference were found in male and female in terms of mortality (p> 0,05). It was observed that MAP, bradycardia-tachycardia-normal rhythm and oxygen saturation did not affect mortality. It was found that there was a difference between the dead and the survivors in terms of pH, lactate, HCO3, WBC, and INR values. Having a GCS score below 15 was found to affect mortality (p> 0,05). No relation between the initial blood pressure and mortality were found. pH below 7.35 was observed to have an affect on mortality (p> 0,05). Lactate value below 2 mmol/l was found to affected survival and above 4 mmol/L affected mortality (p> 0,05). It was found that the HCO3 value below 22 mmol/l had an affect on mortality (p<0.05). The presence of leukocytosis was seen to affect mortality (p<0.05). It was found that the INR value above 1.2 increased mortality(p<0.05). No difference in mortality was found between deceased and survivors using mechanical ventilators (p>0.05). It was detected that there was no difference in outcome between those who died and those who survived with intensive care follow-up (p>0.05). In conclusion, we are of the opinion that appropriate treatment to reduce the number of cases and mortality of advanced adult and geriatric patients admitted to emergency departments as a result of suicide attempts, organizing the team that manages the case by experienced people, such as an emergency medicine specialist, for situations that we have found increase mortality, psychotherapy and social support should be provided.
Açıklama
Anahtar Kelimeler
İlaç ilişkili intihar, İntihar girişimi, Toksikasyon, Orta-ileri yaş, Geriatri, Mortalite, Drug-related suicide, Suicide attempt, Intoxication, Middle-advanced age, Geriatrics, Mortality
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Polat, D. (2021). Acil tıp kliniğine 2010-2020 yılları arasında başvuran 50 yaşın üstündeki hastaların intihar girişimlerinin araştırılması. Yayımlanmamış uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
