Acil serviste pulmoner emboli öntanılı hastalarda pulmoner emboli şiddet skorunun ve alveolo-arteriyel gradientin prognoz üzerine etkisinin değerlendirilmesi

Abstract

Giriş: Pulmoner emboli acil serviste sık görülen bir durum olduğu gibi tanıdan 1- 3 ay sonra kardiyovasküler morbidite ve mortalitede ortalama % 10-15 ölüm oranıyla önde gelen nedenlerinden biri olmaya devam etmektedir. Pulmoner emboli (PE) hastalarının risk sınıflamasında uygun yönetimi belirlemek önemlidir.Amaç: Acil servise gelen PE olan hastalara biz A-a gradiyent yüksekliği ve PESI skorlaması olmak üzere iki risk belirleme aracı kullandık. A-a gradiyent normali, (1) değerleri

Introduction: Pulmonary embolism is a frequent condition in the emergency department and remains one of the leading causes of cardiovascularmorbidity and mortality with an average of 10?15% death during the first 1? 3 months after diagnosis. Risk stratification of pulmonary embolism (PE) patients is important to determine appropriate management.Objectives: We evaluated two risk-stratification tools in emergency department (ED) PE patients: elevated alveolar-arterial (A-a) gradient and the Pulmonary Embolism Severity Index (PESI). Normal values of the A-a gradient were defined in three ways: (1) values < or = 20 mm Hg; (2) values < or = age/4 + 4; and (3) values based on age from the literature. Wechose to use the normal value for A-a gradients based on < or = age/4 +4 or less.Methods: Electronic medical records of all patients suspected with PE were abstracted toidentify their triage vital signs, co-morbidities and laboratory blood gas studies for A-a gradient and their mortality in ED, during 30 days or 90 days . We applied these models to our ED PE patients and assessed their prognosis.Results: There were 546 PE suspected patients identified in this study between January 2007 and December 2010. 90 patients (16,5%) had angiographically documented PE. There was 53 (58.9%) males and 37 (41.1%) females . The normal value for A-a gradients based on formulated : age/4 +4 or less. There were 85 PE patients identified, with an elevated alveolar-arterial gradient rate of 94,4% (85/90), including a 40 % mortality rate. There were 5 PE patients identified, with normal alveolar arterial gradient rate of 5% (5/90) ,including a 72.9% mortality rate. PESI classified 17/90 patients as low risk (class I or II): 18,8% with, 21,8% mortality and 73/90 were classified as high risk (class III, IV, or V): 81,1% , with 32,9 % mortality.Conclusion: Both PESI and elevated A-a gradients are significantly effect PE patients mortality.In ED every PE patient should be evaluate according to PESI and A-a gradients for their prognosis.