Dahiliye Yoğun Bakım Ünitesinde yatan hastalarda yapılan endoskopi ve kolonoskopi işlemlerinin retrospektif analizi
Küçük Resim Yok
Tarih
2025
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Düzce Üniversitesi
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info:eu-repo/semantics/openAccess
Özet
Bu retrospektif çalışma, dahiliye yoğun bakım ünitesine yatırılan, endoskopi ve kolonoskopi girişimi yapılan hastaların klinik ve demografik verilerini incelemek amacıyla yapılmıştır. Bu amaç doğrultusunda çalışmaya 1 Ocak 2013-30 Aralık 2023 tarihleri arasında dahili yoğun bakım ünitesin'de (DYBÜ) takip edilen 158 hasta alınmıştır. Hastaların yaşları 18-98 arasında değişmekte olup yaş ortalaması 69,8±15,0 idi. Çalışmaya dahil edilen hastaların %60,1'i erkek, %39,9'u kadındı. Hastaların 82'sinde (%51,9) hipertansiyon, 53'ünde (%33,5) diyabetes mellitus, 45'inde (%28,5) koroner arter hastalığı, 25'inde (%15,2) konjestif kalp yetmezliği, 24'ünde (%12,7) kronik böbrek hasarı, 20'sinde (%12,7) kronik obstrüktif akciğer ve 18'inde (%11,4) siroz hastalığı komorbid hastalıkları vardı. Hastaların 61'i (%38,6) gastrointestinal sistem kanaması (GİS), 40'ı (%25,3) pnömoni, 27'si (%17) septisemi, 11'i (%7,0) serebrovasküler olay, 7'si (%4,4) postoperatif takip ve 12'si (%10,6) diğer nedenlerden DYBÜ'ye yatışı yapılmış. Çalışmaya dahil edilen hastaların DYBÜ'ye giriş Glaskow koma skalası (GKS) ortalaması 9,0±4,1, yoğun bakıma giriş ardışık organ yetmezliği değerlendirme skoru (SOFA- Sequential Organ Failure Assessment Score) ortalaması 9,2±3,7, akut fizyoloji ve kronik sağlık değerlendirmesi II skoru (APACHE II- Acute Physiology and Choronic Heath Evaluation II) ortalaması 32,7±9,8 olarak saptanmıştır. Çalışmaya dahil edilen hastaların 132'sine (%83,5) endoskopi, 11'ine (%7) kolonoskopi, 15'ine (%9,5) endoskopi-kolonoskopi işlemi yapılmıştır. Çalışmamızda, endoskopi-kolonoskopi işlemlerinin en sık yapılma endikasyonu gastrointestinal sistem (GİS) kanaması (%77,2) olarak saptanmıştır. Diğer endoskopi-kolonoskopi endikasyonlar ise perkütan enteral gastrostomi işlemi (%13,9), obstrüksiyon (%7,6), trakea-özofagus fistülü (%0,6), ve koroziv madde (%0,6) alımıydı. Hastaların 134'ünde (%85) endoskopi-kolonoskopi klinik bulgusu saptanmış olup bunların 48'inde (%35,8) melena, 17'sinde hemotokezya (%12,7), 13'ünde (%9,7) hematemez, 13'ünde (%9,7) kahve telvesi kusma, 11'inde (%8,2) nazogastrik sondada kan gelmesi, 29'unda da (%21,6) diğer endoskopi-kolonoskopi klinik bulguları vardı. Endoskopi ve kolonoskopi işlemlerinde en sık saptanan bulgular özofagusta varisler (%38,8), midede mide ülseri (%35,2) , eroziv gastrit (%35,2) ve duodenumda duodenal ülser (%82,1) idi. Hastaların 83'üne (%52) endoskopik-kolonoskopik terapötik işlem uygulanmıştır. Bunların 45'ine (%28,5) koterizasyon, 11'ine (%7) band ligasyonu, 7'sine (%4,4) skleroterapi, 6'sına (%3,8) stent, 14'üne (%8,9) de diğer terapötik işlemler uygulanmıştır. Hastalarda 28 günlük mortalite oranı %47,5, 3. ay mortalite %53,2, 1. yıl mortalite %56,5 idi. Pnömoni tanısı ile DYBÜ'ye yatırılan hastaların (%25,3), ölüm oranı (%36,0) diğer tanılara kıyasla yüksek olduğu saptanmakla birlikte yatış tanısıyla ile DYBÜ'den taburculuk durumu arasındaki ilişki saptanmadı (p>0,05). Yoğun bakımda ölen hastalarda giriş GKS (yaşayan, 11,2±4,0; ölen 7,6±3,4; p=0,016) skorunun yaşayan hastalara kıyasla anlamlı şekilde daha düşük olduğu görüldü. Yoğun bakımda ölen hastalarda giriş APACHE II skorunun (yaşayan, 27,8±9,0; ölen 39,7±5,5; p<0,001) ile yatış günü hesaplanan SOFA (yaşayan, 8,0±3,4; ölen 10,9±3,1; p<0,001) skorlarının yaşayan hastalara kıyasla anlamlı şekilde daha yüksek olduğu görüldü. Yoğun bakımda ölen hastalarda invaziv mekanik ventilasyon uygulama oranının (yaşayan, %37,2; ölen, %92,2; p<0,001), akut böbrek hasarı gelişme durumu (yaşayan, %38,3; ölen, %73,4; p<0,001), hemodiyaliz ihtiyacı gelişme durumu (yaşayan, %11,7; ölen, %42,2; p<0,001), kanamaya ikincil entübasyon (yaşayan, %6,4; ölen, %23,4; p=0,002), vazopressör desteği (yaşayan, %63,0; ölen, %95,0; p<0,001) yaşayan hastalara kıyasla daha yüksek olduğu saptandı. Yoğun bakımda ölen hastalarda kan transfüzyon sayısı (yaşayan, 3,6±2,2; ölen, 3,2±2,0; p=0,289) ve kan transfüzyon ihtiyacı gelişme durumu oranı (yaşayan, %73,4; ölen, %85,9; p=0.06) yaşayan hastalara kıyasla anlamlı bir ilişki saptanmadı. Yoğun bakımda ölen hastalarda yapılan endoskopi-kolonoskopi işlem türü (p=0,243), hastaların endoskopi-kolonoskopi işlemi klinik bulgusu (p=0,921), endoskopi-kolonoskopi yapılma endikasyonu (p=0,570), endoskopi ve kolonoskopide saptanan bulgular (p>0,05), endoskopi-kolonoskopi terapötik işlem türü (p=0,776) ve DYBÜ'de tekrarlayan endoskopi-kolonoskopi işlem durumu (p=0,346) yaşayan hastalarara benzer bulundu.
This retrospective study examined the clinical and demographic data of patients admitted to the internal medicine intensive care unit (ICU) who underwent endoscopy and colonoscopy. A total of 158 patients were included from January 1, 2013, to December 30, 2023. The mean age of the patients was 69.8 years with a standard deviation of ±15.0 years. Among the participants, 60.1% were male and 39.9% were female. Comorbidities among the patients included hypertension (51.9%), diabetes mellitus (33.5%), coronary artery disease (28.5%), congestive heart failure (15.2%), chronic kidney disease (12.7%), chronic obstructive pulmonary disease (12.7%) and cirrhosis (11.4 %). Of the patients, 61 (38.6%) were admitted to the ICU due to gastrointestinal bleeding (GIS), 40 (25.3%) due to pneumonia, 27 (17%) due to septicemia, 11 (7.0%) due to cerebrovascular accident, 7 (4.4%) due to postoperative follow-up, and 12 (10.6%) due to other reasons. The mean Glasgow Coma Scale (GCS) score at admission was 9.0 (±4.1), the mean Sequential Organ Failure Assessment (SOFA) score was 9.2 (±3.7), and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 32.7 (±9.8). Of the patients included in the study, 132 (83.5%) underwent endoscopy, 11 (7%) underwent colonoscopy, and 15 (9.5%) underwent both procedures. The most common indication for these procedures was gastrointestinal system (GIS) bleeding, accounting for 77.2% of cases. Other indications included percutaneous enteral gastrostomy (13.9%), gastrointestinal obstruction (7.6%), tracheoesophageal fistula (0.6%), and ingestion of corrosive substances (0.6%). Clinical findings were detected in 134 patients (85%), which included melena (35.8%), hematochezia (12.7%), hematemesis (9.7%), coffee ground vomiting (9.7%), blood in the nasogastric tube (8.2%), and other clinical findings (21.6%). The most common findings in endoscopy and colonoscopy procedures were gastric ulcer, erosive gastritis and duodenal ulcer. Endoscopic and colonoscopic therapeutic procedures were performed in 83 patients (52%), including cauterization (28.5%), band ligation (7%), sclerotherapy (4.4%), stent placement (3.8%), and other therapeutic procedures (8.9%). The 28-day mortality rate for patients was 47.5%, the 3-month mortality rate was 53.2%, and the 1-year mortality rate was 56.5%. The admission GCS score was significantly lower in patients who died in the ICU compared to those who survived (survived: 11.2±4.0; deceased: 7.6±3.4; p=0.016). Additionally, the admission APACHE II score (survived: 27.8±9.0; deceased: 39.7±5.5; p<0.001) and the SOFA score calculated at admission (survived: 8.0±3.4; deceased: 10.9±3.1; p<0.001) were significantly higher in patients who did not survive. Among those who died in the ICU, the rates of needing invasive mechanical ventilation (survived: 38.3%; deceased: 92.2%; p<0.001), developing acute kidney injury (survived: 38.3%; deceased: 73.4%; p<0.001), requiring hemodialysis (survived: 11.7%; deceased: 42.2%; p<0.001), intubation due to bleeding (survived: 6.4%; deceased: 23.4%; p=0.002), and requiring vasopressor support (survived: 63.0%; deceased: 95.0%; p<0.001) were significantly higher compared to those who survived. However, no significant differences were found regarding the number of blood transfusions (survived: 3.6±2.2; deceased: 3.2±2.0; p=0.289) or the rates of requiring a blood transfusion (survived: 73.4%; deceased: 85.9%; p=0.06). The types of endoscopy and colonoscopy procedures performed in patients who died in the ICU (p=0.243), clinical findings during the procedures (p=0.921), indications for the procedures (p=0.570), findings detected in endoscopy and colonoscopy (p>0.05), types of therapeutic procedures performed (p=0.776), and the status of repeated procedures in the ICU (p=0.346) were found to be similar to those in patients who survived.
This retrospective study examined the clinical and demographic data of patients admitted to the internal medicine intensive care unit (ICU) who underwent endoscopy and colonoscopy. A total of 158 patients were included from January 1, 2013, to December 30, 2023. The mean age of the patients was 69.8 years with a standard deviation of ±15.0 years. Among the participants, 60.1% were male and 39.9% were female. Comorbidities among the patients included hypertension (51.9%), diabetes mellitus (33.5%), coronary artery disease (28.5%), congestive heart failure (15.2%), chronic kidney disease (12.7%), chronic obstructive pulmonary disease (12.7%) and cirrhosis (11.4 %). Of the patients, 61 (38.6%) were admitted to the ICU due to gastrointestinal bleeding (GIS), 40 (25.3%) due to pneumonia, 27 (17%) due to septicemia, 11 (7.0%) due to cerebrovascular accident, 7 (4.4%) due to postoperative follow-up, and 12 (10.6%) due to other reasons. The mean Glasgow Coma Scale (GCS) score at admission was 9.0 (±4.1), the mean Sequential Organ Failure Assessment (SOFA) score was 9.2 (±3.7), and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 32.7 (±9.8). Of the patients included in the study, 132 (83.5%) underwent endoscopy, 11 (7%) underwent colonoscopy, and 15 (9.5%) underwent both procedures. The most common indication for these procedures was gastrointestinal system (GIS) bleeding, accounting for 77.2% of cases. Other indications included percutaneous enteral gastrostomy (13.9%), gastrointestinal obstruction (7.6%), tracheoesophageal fistula (0.6%), and ingestion of corrosive substances (0.6%). Clinical findings were detected in 134 patients (85%), which included melena (35.8%), hematochezia (12.7%), hematemesis (9.7%), coffee ground vomiting (9.7%), blood in the nasogastric tube (8.2%), and other clinical findings (21.6%). The most common findings in endoscopy and colonoscopy procedures were gastric ulcer, erosive gastritis and duodenal ulcer. Endoscopic and colonoscopic therapeutic procedures were performed in 83 patients (52%), including cauterization (28.5%), band ligation (7%), sclerotherapy (4.4%), stent placement (3.8%), and other therapeutic procedures (8.9%). The 28-day mortality rate for patients was 47.5%, the 3-month mortality rate was 53.2%, and the 1-year mortality rate was 56.5%. The admission GCS score was significantly lower in patients who died in the ICU compared to those who survived (survived: 11.2±4.0; deceased: 7.6±3.4; p=0.016). Additionally, the admission APACHE II score (survived: 27.8±9.0; deceased: 39.7±5.5; p<0.001) and the SOFA score calculated at admission (survived: 8.0±3.4; deceased: 10.9±3.1; p<0.001) were significantly higher in patients who did not survive. Among those who died in the ICU, the rates of needing invasive mechanical ventilation (survived: 38.3%; deceased: 92.2%; p<0.001), developing acute kidney injury (survived: 38.3%; deceased: 73.4%; p<0.001), requiring hemodialysis (survived: 11.7%; deceased: 42.2%; p<0.001), intubation due to bleeding (survived: 6.4%; deceased: 23.4%; p=0.002), and requiring vasopressor support (survived: 63.0%; deceased: 95.0%; p<0.001) were significantly higher compared to those who survived. However, no significant differences were found regarding the number of blood transfusions (survived: 3.6±2.2; deceased: 3.2±2.0; p=0.289) or the rates of requiring a blood transfusion (survived: 73.4%; deceased: 85.9%; p=0.06). The types of endoscopy and colonoscopy procedures performed in patients who died in the ICU (p=0.243), clinical findings during the procedures (p=0.921), indications for the procedures (p=0.570), findings detected in endoscopy and colonoscopy (p>0.05), types of therapeutic procedures performed (p=0.776), and the status of repeated procedures in the ICU (p=0.346) were found to be similar to those in patients who survived.
Açıklama
Anahtar Kelimeler
İç Hastalıkları, Internal diseases
