Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Yoğun Bakımda İzlenen Akut Servikal Spinal Kord Travmalı Hastaların Mortalite ve Morbiditesini Etkileyen Faktörlerin Değerlendirilmesi
Evaluation of Factors Effecting Mortality and Morbidity of Patients with Acute Cervical Spinal Cord Trauma in Intensive Care Unit
Fatma ÜLGERa, Ahmet DİLEKa, A.Yaşar ŞAHİNLERa, Yaşar BAYRİb, Sibel BARIŞa, Fahrettin ÇELİKb, Binnur SARIHASANa
aAnesteziyoloji ve Reanimasyon AD, bNöroşirürji AD, Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Samsun
Turkiye Klinikleri J Anest Reanim. 2010;8(1):14-22
Article Language: TR
Full Text
ÖZET
Amaç: Spinal kord travmaları tüm dünyada sıklıkla genç ve sağlıklı bireyleri etkileyen yıkıcı bir durumdur. Bu yıkıcı durum sadece ağır fiziksel ve duygusal kayıplar yaratmakla kalmayıp, aynı zamanda topluma da belirgin ekonomik yük getirmektedir. Travmatik servikal spinal kord yaralanmaları sıklıkla genç erkek hastalarda görülür ve sonuç olarak artmış hastane bakım masrafları, rehabilitasyon, iş gücü ve üretkenlik kaybına yol açar. Servikal spinal kord travması (SSKT) ile ortaya çıkan nörolojik kayıplar, belirgin havayolu desteği gereksinimi ve/veya uzamış mekanik ventilasyon süreçlerine neden olmaktadır. Bu çalışma ile izole SSKT geçiren hastaların (komplet-inkomplet) etiyolojik faktörleri, yoğun bakım süreçleri ve karşılaşılan komplikasyonlar tanımlanmaya çalışılmıştır. Gereç ve Yöntemler: Mart 2000 ile Eylül 2007 tarihleri arasında yoğun bakımda izlenen 152 spinal kord travmalı hastanın içinden seçilen 42 izole servikal spinal kord travmalı hastanın demografik özellikleri, nörolojik hasar seviyeleri, mekanik ventilasyon gereksinimleri, yoğun bakım ve hastanede kalış süreleri ve mortaliteleri retrospektif olarak değerlendirilmiştir. Hastaların travma seviyeleri American Spinal Injury Association (ASIA) standartları ile sınıflandırılmıştır. Bulgular: Belirtilen tarihler arasında izlenen, nörolojik defisiti olan 152 spinal kord hasarlı hasta belirlenmiştir. Servikal travmalı (komplet, inkomplet) %76.2'si erkek (n: 32), %23.8'i kadın (n: 10) 42 hasta çalışmaya alınmıştır. Hastaların yaş ortalamaları 15-70 (39.9 ± 14.8) olarak belirlenmiştir. Bu hastaların %95.2'sinde (n: 40) künt travma, %4.8'inde (n: 2) penetre travma tanımlanmıştır. Hastaların %31.0'inin (n: 13) travma seviyeleri C1-C4 vertebraları, %69.0'unun (n: 29) travma seviyeleri C5-C7 vertebraları arasında saptanmıştır. Hastanede kalış süreleri 31.2 ± 38.0 gün ve yoğun bakımda kalış süreleri 26.6 ± 36.6 gün arasında bulunmuştur. İzlenen hastaların mortalite hızı %61.9 (n: 26) olarak belirlenmiştir. Sonuç: Servikal spinal kord travmalı hastalarda solunum yolu komplikasyonları mortalite ve morbiditeyi etkileyen faktörler arasında ilk sırayı almaktadır. Çalışmamızın sonuçları göstermiştir ki, mekanik ventilasyon gereksinimi olan servikal spinal kord travmalı hastalarda mortalite yüksek izlenmiştir. Bu hasta popülâsyonunda, hastalar genç olmasına rağmen SSKT kliniğinden kaynaklanan komplikasyonlar mortaliteyi arttırmıştır.

Anahtar Kelimeler: Spinal kord travmaları; etiyoloji; yoğun bakım; komplikasyonlar; morbidite; mortalite
ABSTRACT
Objective: Spinal cord injury (SCI) is a devastating condition often affecting young and healthy individuals around the world. This debilitating condition not only creates enormous physical and emotional cost to individuals but also is a significant financial burden to society at large. Traumatic cervical spinal cord injury (CSCI) typically occurs in young male patients and results in significant economic costs including hospital stay, rehabilitation, loss of employment, and productivity. Patients who sustain CSCI with neurologic deficit may require a definitive airway and/or prolonged mechanical ventilation. The aim of this study was to follow the intensive care unit (ICU) period and identify etiologic factors and complications associated in patients with isolated CSCI (complete-incomplete). Material and Methods: Forty two patients with isolated CSCI and neurologic deficit who were admitted to our ICU service between March 2000 and September 2007 were selected among the 152 patients, and retrospectively reviewed for demographic data, level and completeness of neurologic deficit, need for definitive airway and mechanical ventilation, length of stay in ICU and hospital and mortality. The level and completeness of injury were defined by American Spinal Injury Association standards (ASIA). Results: One hundred fifty two patients with CSCI and neurologic deficit were identified in this period. There were 76.2% males (n: 32) and 23.8% females (n: 10) with 42 cervical trauma(complete or incomplete) patients who were included to the study. There were 95.2% (n: 40) blunt and 4.8% (n: 2) penetrating injuries, the average age of these patients were 15-70 (39.9 ± 14.8), cervical trauma was between C1-C4 in %31.0 (n: 13) and C5-C7 69.0 % (n: 29). Mean length of stay in ICU was 26.6 ± 36.6 days and mean duration of stay in hospital was 31.2 ± 38.0 days. Of these patients mortality rate was 61.9% (n: 26). Conclusions: Respiratory complications are encountered in the first factor affecting mortality and morbidity in patients with cervical spinal cord trauma. The result of this study showed that, mortality rate is increased in the patients with cervical spinal cord trauma requiring mechanical ventilation. Although these patients were young mortality rate was high because of complications originated from CSCI.

Keywords: Spinal cord injuries; etiology; intensive care; complications; morbidity; mortality

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