Acil servise başvuran bilgisayarlı tomografi çekimi sırasında intravenöz kontrast madde kullanılan hastalarda kontrast madde nefropatisi ve allerjik reaksiyon gelişiminin retrospektif analizi
Contrast induced nephropathy and retrospective analyses of allergic reaction in patients who consulted to emergency department and who were given intravenous contrast material during computed tomography scan
- Tez No: 660642
- Danışmanlar: DOÇ. DR. ERDEN EROL ÜNLÜER
- Tez Türü: Tıpta Uzmanlık
- Konular: İlk ve Acil Yardım, Emergency and First Aid
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2013
- Dil: Türkçe
- Üniversite: İzmir Katip Çelebi Üniversitesi
- Enstitü: İzmir Atatürk Eğitim ve Araştırma Hastanesi
- Ana Bilim Dalı: Acil Tıp Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 91
Özet
Giriş: Çalışmamızda 01 Ocak 2012 ile 31 Aralık 2012 tarihleri arasında İzmir Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi Acil Servisinde çekilen iv kontrastlı bilgisayarlı tomografi sonrası ortaya çıkan kontrast madde nefropatisi gelişimini ve allerjik reaksiyonları; bunların sıklığını, risk faktörlerini, prognozlarını, mortalite ve morbidite oranlarını, kontrast madde nefropatisi gelişimini önlemeye yönelik yapılan uygulamaları, allerjik reaksiyon tedavilerini araştırmayı amaçladık. Yöntem: 01 Ocak 2012 ile 31 Aralık 2012 tarihleri arasında İzmir Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi Acil Servis' ine başvuran hastalar içerisinden bilgisayarlı tomografi görüntülemesi yapılırken iv kontrast madde kullanılan hastalar belirlendi. Acil Servise başvuran hastalar içerisinden bilgisayarlı tomografi görüntülemesi yapılırken iv kontrast madde kullanılan 16 yaş ve üstü tüm hastalar çalışmaya dahil edildi. Daha sonra kontrast madde nefropatisi ve allerji grubu olan hastalar ayrı ayrı değerlendirilerek her iki grup için dışlama kriterleri oluşturuldu. Dışlama kriterleri bulunan hastalar çalışma dışı bırakıldı. Tüm veriler çalışma için hazırlanmış standart bilgi formlarına kaydedildi ve daha sonra istatiksel analizleri“Statistical Package for Social Sciences for Windows 15.0”paket programında % 95 güvenle yapıldı. Bulgular: 01 Ocak 2012 ile 31 Aralık 2012 tarihleri arasında İzmir Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi Acil Servis' inde 1463 hastaya iv kontrast madde uygulanarak bilgisayarlı tomografi görüntülemesi uygulanmıştır. Çalışmaya dahil edilen olguların 37'sinde (% 9.39) kontrast madde nefropatisi geliştiğini saptadık. Çalışmamızda kontrast madde nefropatisi gelişen olguların % 70.2 'sinin 60 yaş ve üstünde olduğu görüldü ve 60 yaş üstündeki olgularda kontrast madde nefropatisi gelişiminin istatistiksel olarak anlamlı derecede arttığı saptandı (p
Özet (Çeviri)
Background: The aim of this study is to research the development of contrast induced nephropathy and allergic reaction after an iv contrast-enhanced computed tomography scan between 1 January 2012 and 31 December 2012 in Izmir Katip Çelebi University Atatürk Training and Research Hospital Emergency Department; risk factors, prognosis, mortality and morbidity rates as well as implementations applied to prevent contrast induced nephropathy. Materials – Methods: Patients who admitted to Katip Çelebi University Atatürk Training and Research Hospital Emergency Department between 1 January 2012 and 31 December 2012 and who were used iv contrast material during a computed tomography scan were determined. All 16 year-old and older patients who admitted to Emergency Department and who used IV contrast material during a computed tomography scan were included in the study. Afterward, patients with contrast induced nephropathy and allergy group were evaluated separately and excluding criteria were constituted for both groups. All data were recorded into standard information forms prepared for the study; thereafter their statistical analyses were conducted by“ Statistical Package for Social Sciences for Windows 15.0 ”package program with 95 % confidence. Results: Between 1 January 2012 and 31 December 2012, 1463 patients were scanned through a computed tomography by implementing iv contrast material at Izmir Katip Çelebi University Atatürk Training and Research Hospital Emergency Department. In 37 (9.39 %) of the patients included in the study, contrast induced nephropathy developed. In our study, it was seen that 70.2 % of patients developing contrast induced nephropathy were over 60 and the development of contrast induced nephropathy in patients over 60 increased statistically in a significant level (p < 0,05). The developmental risk of contrast induced nephropathy was determined to increase in patients with diabetes, hypertension, congestive heart failure, hyperlipidemia, chronic obstructive lung disease/asthma, cerebrovascular event additional disease. In our study, incompatible with literature, as GFR (Glomerular filtration rate) increased, development rate of contrast induced nephropathy decreased. In patients with eGFR < 60 ml/dk/1.73 m2, statistically more contrast induced nephropathy was determined (p < 0,05). Upon analyses of developmental distribution of contrast induced nephropathy depending on rates of medical treatment taken at home during the last week; it was established that contrast induced nephropathy developed in higher levels in patients who took NSAII, diuretic, metformin, ACEI. A highly increased risk of contrast induced nephropathy was determined in patients with multiple organ failure, sepsis, congestive heart failure, myocardial infarction, major abdominal surgery and trauma. 5.4 % of patients developing contrast induced nephropathy also developed chronic renal failure (CRF) which didn't necessitate hemodialysis and again 5.4% of them were taken into dialysis. None of the patients developing contrast induced nephropathy needed permanent hemodialysis. After contrast material implementation, (n=13) 0.88 % of 1463 patients developed allergic reaction. In our study, after contrast material implementation, as symptoms of allergic reactions, complexion findings (itching, rash, angioedema, redness) simultaneously more than one in some of the patients (92.3 %), central nervous system findings in 2 patients (15.4%) and gastrointestinal system findings in 2 patients (15.4 %) were determined; no cardiovascular system findings were determined in any patients. It was determined that all patients were applied a treatment and all of them were in combined treatments. After contrast material implementation, it was determined that none of the patients needed epinephrine. None of the clinics of the patients concluded in mortality. Conclusion: We believe it is beneficial to determine risk factors of patients who are to be given contrast material before contrast material implementation for prevention of contrast induced nephropathy and early diagnosis; to plan contrast induced nephropathy prevention treatment, to inform patients at high risk, and to follow creatine of patients at high risk. In patients with contrast material history; contrast agents with low level of allergy development should be preferred. It shouldn't be forgotten that contrast material implementation might cause allergic reactions, might cause life-threatening situations like anaphylaxis and these situations might lengthen the duration of hospital stays and treatments as well as might cause additional costs.
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