Akut pankreatitli olguların retrospektif değerlendirilmesi
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Dosyalar
Tarih
2016
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/restrictedAccess
Özet
Bu çalışmada akut pankreatit tanısı ile yatarak tedavi görmüş hastaların demografik özelliklerini, hastalık etiyolojilerini tanımlamak; klinik, laboratuvar ve görüntüleme verilerini inceleyerek son yıllarda tedavi yaklaşımlarında ve hastalık sonuçlarındaki değişiklikleri incelemeyi amaçladık. Çalışmamızda Trakya Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı'nda 01.01.2010 ila 01.08.2015 tarihleri arasında akut pankreatit tanısı ile yatarak tedavi görmüş olan 190 hasta retrospektif olarak incelendi. Hastaların %45.7' si kadın (87 hasta), %54.3' ü erkek (103 hasta) ,yaş ortalaması 58.6±16.7 (18-93) yıldı. Etiyolojide en sık biliyer nedenler saptanırken, bunu sırasıyla idiyopatik ve alkole bağlı pankreatitler izledi. Hastaların 182' sinde (%95.8) akut ödematöz pankreatit, 8' inde (%4.2) ise nekrotizan pankreatit olduğu görüldü. Alkolik pankreatit erkeklerde, biliyer pankreatit kadınlarda daha fazla gözlendi. Tüm hastaların %8.4' ünün ölmüş olduğu saptandı. İleri yaşta şiddet ve mortalitenin arttığı saptandı. CRP düzeyi yüksek olan hastalarda daha fazla organ yetmezliği ve ölüm görüldü. Hastalarda üre, kreatinin, LDH yüksekliği ve kan gazında düşük bikarbonat ile parsiyel karbondioksit basıncı varlığında artmış mortalite tespit edildi. Özellikle APACHE II ve Modifiye Marshall skorlama sistemleri kullanılmasının şiddetli pankreatit ve mortalite öngörüsünde başarılı olduğu izlendi. Nekroz tahmininde Ranson skorunun daha fazla vaka belirleyebildiği tespit edildi. Hastaların yarısının çeşitli nedenlerle antibiyotik kullandığı saptandı. Sonuç olarak; incelediğimiz hasta grubunda etyolojide en sık biliyer nedenlerin olduğunu, pankreas şiddetinin yaş ile birlikte arttığını, etiyolojik nedenler arasında mortalite oranları arasında fark olmadığı görüldü. Klinik skorlama sistemleri ile birlikte özellikle CRP düzeyinin takibinin hastalık gidişini öngörmede önemli olduğu ve antibiyotik tedavisinin sağkalım üzerine etkisi bulunmadığı tespit edildi.
abstract
In this study, we aimed to define demographic characteristics and disease etiologies of patients who had received inpatient treatment with the diagnosis of acute pancreatitis; and to assess the changes in therapeutic approaches and disease outcomes in recent years by evaluating clinical, laboratory and imaging data. In our study, 190 patients who had received inpatient treatment with the diagnosis of acute pancreatitis between 01.01.2010-08.01.2010 in Trakya University Faculty of Medicine, Department of Gastroenterology were studied retrospectively. 45.7% of patients were female(87 patients) and 54.3% were male(103 patients), mean age was 58.6 ± 16.7 (18-93) years. Most commonly detected etiology were biliary causes, they were followed by idiopathic and alcohol-related pancreatitis, respectively. Acute edematous pancreatitis was seen in 182 patients(95.8%) and necrotizing pancreatitis was seen in 8 (4.2%) patients. Alcoholic pancreatitis was seen more in men, biliary pancreatitis was seen more in women. 8.4% of all patients had died. The severity and mortality of disease were higher in advanced age. More organ failures and deaths were observed in patients with high CRP levels. Increase in mortality was detected in patients with the presence of high urea, creatinine, LDH levels and low bicarbonate and partial carbon dioxide pressure in blood gas. Especially, the use of APACHE II and Modified Marshall scoring systems were found to be successful in severe pancreatitis and mortality prediction. It was found that Ranson score can identfy more cases in necrosis prediction. According to study, the half of the patients had been used antibiotics for various reasons. To conclude; in group of patients we studied, most commonly detected etiology were biliary causes, severity of pancreatitis increased with the age and there was no difference in mortality ratios between etiological factors. It was found that the clinical scoring systems and especially monitoring of CRP levels were important to predict the disease course and antibiotic treatment had no effect on survival.
abstract
In this study, we aimed to define demographic characteristics and disease etiologies of patients who had received inpatient treatment with the diagnosis of acute pancreatitis; and to assess the changes in therapeutic approaches and disease outcomes in recent years by evaluating clinical, laboratory and imaging data. In our study, 190 patients who had received inpatient treatment with the diagnosis of acute pancreatitis between 01.01.2010-08.01.2010 in Trakya University Faculty of Medicine, Department of Gastroenterology were studied retrospectively. 45.7% of patients were female(87 patients) and 54.3% were male(103 patients), mean age was 58.6 ± 16.7 (18-93) years. Most commonly detected etiology were biliary causes, they were followed by idiopathic and alcohol-related pancreatitis, respectively. Acute edematous pancreatitis was seen in 182 patients(95.8%) and necrotizing pancreatitis was seen in 8 (4.2%) patients. Alcoholic pancreatitis was seen more in men, biliary pancreatitis was seen more in women. 8.4% of all patients had died. The severity and mortality of disease were higher in advanced age. More organ failures and deaths were observed in patients with high CRP levels. Increase in mortality was detected in patients with the presence of high urea, creatinine, LDH levels and low bicarbonate and partial carbon dioxide pressure in blood gas. Especially, the use of APACHE II and Modified Marshall scoring systems were found to be successful in severe pancreatitis and mortality prediction. It was found that Ranson score can identfy more cases in necrosis prediction. According to study, the half of the patients had been used antibiotics for various reasons. To conclude; in group of patients we studied, most commonly detected etiology were biliary causes, severity of pancreatitis increased with the age and there was no difference in mortality ratios between etiological factors. It was found that the clinical scoring systems and especially monitoring of CRP levels were important to predict the disease course and antibiotic treatment had no effect on survival.
Açıklama
Anahtar Kelimeler
Akut Pankreatit, Ranson Skoru, Nekroz, Etiyoloji, Acute Pancreatitis, Ranson Score, Necrosis, Etiology
