Renal transplant hastalarının acil servise başvurularının irdelenmesi
Loading...
Files
Date
2011
Authors
Kocabaş, Egemen
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Transplantasyon bir organın cerrahi olarak çıkarılarak başka bir kişiye yerleştirilmesidir. Dünyada böbrek transplantasyonu en yaygın olarak yapılan transplantasyondur. İlk başarılı böbrek nakli 1954'de Boston'da Dr. Murray ve ekibi tarafından, Türkiye'de 1975 yılında Dr. Haberal ve ekibi tarafından yapılmıştır.Kronik böbrek hastalığında özellikle glomerüler filtrasyon oranı 10ml/dak/1,73m²'nin altına indikten sonra sağ kalım ve yaşam kalitesindeki avantajlarla ilişkili olarak en iyi tedavi seçeneği böbrek naklidir. Nakil sırasında veya sonrasında teknik nedenlere bağlı komplikasyonlar meydana gelebilir. Uzun dönemde ise kullanılan güncel immünsupresif tedaviler neticesinde çeşitli enfeksiyonlar ve metabolik bozukluklar oluşabilmektedir. Nakil hasta acil başvurularının giderek artması nedeniyle başvuru nedenlerini ve hastaların yönetimindeki kritik durumları saptamak amacıyla bu çalışmayı planladık.Çalışmamızda Mart 2009 ? Haziran 2010 tarihleri arasında UÜTF acil servisine başvuran 172 renal transplant olgusunu prospektif olarak inceledik. Hastaların %45.5'i erkek (n:30), %54.5'i kadın (n:36), yaş ortalamaları 35 olup %65.2'si canlı verici (n:43), %34.8'i kadavra vericiden (n:23) transplant olmuşlardı. Toplamda 172 başvuru kayıt edildi. Başvuran hastaların %37.8'i (n:65) interne edildi, %62.2'si (n:105) taburcu edildi. Enfeksiyon nedenli başvurular %66.3 (n:114) idi. Başvuruların %22.8'i (n:26) sepsis ile uyumluydu ve bu hastalarda akut rejekt açısından anlamlı fark saptandı (P<0.001). Akut rejekt grubunun MEW skoru daha yüksekti (p:0.001). Hipertansiyonu olanlarda kreatinin yüksekliği de mevcuttu (p<0.05). Proteinürisi olan hastalar incelendiğinde uzun dönem kreatinin yüzde değişimi ile proteinüri arasında pozitif koreleasyon saptandı.Sonuç olarak renal transplant hastalarının ülkemizdeki ve dünyadaki sayıları, dolayısıyla acil servislere başvuruları artmaktadır ve acil hekiminin bu hastaların başvuru nedenlerini, spesifik tanı ve tedavi yönetimlerini bilmeli ve bilgilerini güncel tutmaları gerekmektedir.
Transplantation is to extract an organ and place to another person operationally. The most common transplant type is kidney transplantation in the world. The first succesful kidney transplantation was performed by Dr. Murray in 1954 in the world and by Dr. Haberal in 1975 in Turkey.Renal replacement treatment is the best alternative, especially after glomerular filtration rate decrase under 10mg/min/1.73m2 related to survival and life quality advantage in end-stage chronic renal failure. Complications can occur at the time of transplant and after transplant technically. The current immunsupressive treatment cause to infections and metabolic abnormalities in the long term.We designed this study because of increasing renal transplant applications in emergency department (ED) and we planned to determine the management of patients with critical situations. We investigated the 172 patient referred to Uludag University ED between March 2009 ? June 2010 prospectively in our study. The patients referred to ED more than one time so 172 referrences were detected totally. %45.5 (n: 30) of patients were men and %54.5 (n: 36) were women, %65.2 (n: 43) transplated from alive donor and %34.8 (n: 23) from cadaveric donor. %37.8 (n: 65) of patients were hospitalized and %62.2 (n: 105) were discharged. %66.3 (n: 114) of references diagnosed with infection and %22.8 (n: 26) with sepsis and there is significal difference between two groups according to acute rejection (p<0.001). The MEW score of acute reject group was higher (p=0.000). There was creatinin elevation in patient with hypertension (p<0.05). There was positive correlation between long term creatinin percentage and proteinuria.At finally; the number of renal transplant patients is increasing in world and in our country so referring to ED are increasing. The ED physicians should be aware of the reasons of references, specific diagnosis and treatment managements and should have current informations.
Transplantation is to extract an organ and place to another person operationally. The most common transplant type is kidney transplantation in the world. The first succesful kidney transplantation was performed by Dr. Murray in 1954 in the world and by Dr. Haberal in 1975 in Turkey.Renal replacement treatment is the best alternative, especially after glomerular filtration rate decrase under 10mg/min/1.73m2 related to survival and life quality advantage in end-stage chronic renal failure. Complications can occur at the time of transplant and after transplant technically. The current immunsupressive treatment cause to infections and metabolic abnormalities in the long term.We designed this study because of increasing renal transplant applications in emergency department (ED) and we planned to determine the management of patients with critical situations. We investigated the 172 patient referred to Uludag University ED between March 2009 ? June 2010 prospectively in our study. The patients referred to ED more than one time so 172 referrences were detected totally. %45.5 (n: 30) of patients were men and %54.5 (n: 36) were women, %65.2 (n: 43) transplated from alive donor and %34.8 (n: 23) from cadaveric donor. %37.8 (n: 65) of patients were hospitalized and %62.2 (n: 105) were discharged. %66.3 (n: 114) of references diagnosed with infection and %22.8 (n: 26) with sepsis and there is significal difference between two groups according to acute rejection (p<0.001). The MEW score of acute reject group was higher (p=0.000). There was creatinin elevation in patient with hypertension (p<0.05). There was positive correlation between long term creatinin percentage and proteinuria.At finally; the number of renal transplant patients is increasing in world and in our country so referring to ED are increasing. The ED physicians should be aware of the reasons of references, specific diagnosis and treatment managements and should have current informations.
Description
Keywords
Renal transplantasyon, Enfeksiyon, Acil servis, Renal transplantation, Infection, Emergency medicine
Citation
Kocabaş, E. (2011). Renal transplant hastalarının Acil Servise başvurularının irdelenmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.