{"id":487,"date":"2023-03-16T16:33:47","date_gmt":"2023-03-16T13:33:47","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=487"},"modified":"2023-03-16T16:33:49","modified_gmt":"2023-03-16T13:33:49","slug":"yasli-hastalarda-sarkopeni-ve-travma-ile-iliskisi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yasli-hastalarda-sarkopeni-ve-travma-ile-iliskisi\/","title":{"rendered":"Ya\u015fl\u0131 Hastalarda Sarkopeni ve Travma ile \u0130li\u015fkisi<\/strong>"},"content":{"rendered":"\n

Acil servislere ba\u015fvuran geriatrik hastalarda g\u00f6r\u00fclen, s\u0131kl\u0131kla \u015fikayet konusu olan, morbidite ve mortalite oran\u0131n\u0131 art\u0131ran bir durum sarkopeni olarak bilinen bir klinik tablodur. Sarkopeni klinik olarak geriatrik sendromlardan biri olarak tan\u0131mlanm\u0131\u015ft\u0131r. Di\u011fer geriatrik sendromlar ise; deliryum, demans, senkop, d\u00fc\u015fme, polifarmasi, k\u0131r\u0131lganl\u0131k, inkontinans gibi durumlard\u0131r. Sarkopeni 2010 y\u0131l\u0131nda European Working Group on Sarcopenia in Older People (EWGSOP)<\/strong> taraf\u0131ndan fiziksel harekette k\u0131s\u0131tl\u0131l\u0131k, d\u00fc\u015f\u00fck ya\u015fam kalitesi ve \u00f6l\u00fcm gibi olumsuz sonu\u00e7lar\u0131n g\u00f6r\u00fclme riskini art\u0131ran, iskelet kas\u0131 k\u00fctlesi ile g\u00fcc\u00fcnde ilerleyici ve yayg\u0131n kay\u0131p ile karakterize bir sendrom \u015feklinde yeniden tan\u0131mlanm\u0131\u015ft\u0131r. Sarkopeni ya\u015fl\u0131 bireylerde yayg\u0131n olarak g\u00f6r\u00fcld\u00fc\u011f\u00fc halde erken ya\u015flarda da ortaya \u00e7\u0131kabilir. Sarkopeni metaanalizlere g\u00f6re, 60 ya\u015f ve \u00fczeri erkeklerde %11 ve kad\u0131nlarda %9 prevalans ile g\u00f6r\u00fcl\u00fcr. T\u00fcrkiye\u2019 de sarkopeni prevalans\u0131 65 ya\u015f ve \u00fczeri bireylerdeki kad\u0131nlarda %4,1, erkeklerde %6,7 oran\u0131ndad\u0131r. <\/p>\n\n\n\n

Sarkopeni, olumsuz sa\u011fl\u0131k \u00e7\u0131kt\u0131lar\u0131na sebep olmas\u0131 y\u00f6n\u00fcyle t\u00fcm toplumlar i\u00e7in \u00f6nemli bir sendrom olarak ele al\u0131nmaktad\u0131r. Sarkopeni ile g\u00fc\u00e7 kayb\u0131, d\u00fc\u015fme, kemik k\u0131r\u0131lganl\u0131\u011f\u0131nda artma, sakatl\u0131k, hareketsizlik, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n bask\u0131lanmas\u0131, solunum fonksiyonlar\u0131n\u0131n bozulmas\u0131, ya\u015fam kalitesinin azalmas\u0131, morbidite ve mortalite riskinin artmas\u0131 gibi olumsuz sa\u011fl\u0131k \u00e7\u0131kt\u0131lar\u0131n\u0131n artmas\u0131 aras\u0131nda ili\u015fki oldu\u011fu \u00e7al\u0131\u015fmalarla g\u00f6sterilmi\u015ftir. Ayr\u0131ca sarkopeni hastaneye yat\u0131\u015f riskini, yat\u0131\u015f s\u00fcresini ve bak\u0131m maliyetini de art\u0131rmaktad\u0131r. Sarkopeni, g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 ve neden oldu\u011fu sonu\u00e7lar g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, sa\u011fl\u0131k profesyonelleri i\u00e7in ayr\u0131ca \u00f6nem ta\u015f\u0131yan bir konu haline gelmektedir. <\/p>\n\n\n\n

Sarkopeninin olu\u015fumunda bir\u00e7ok mekanizma rol oynamaktad\u0131r. Baz\u0131 klinik durumlarda sarkopeni olu\u015fumunda rol oynayan nedenler net bir \u015fekilde tan\u0131mlanabilirken, baz\u0131 durumlarda belirgin bir neden belirlenememektedir. Bu nedenle sarkopeni primer ve sekonder sarkopeni \u015feklinde s\u0131n\u0131fland\u0131r\u0131lmaktad\u0131r. Primer sarkopeni, ya\u015flanmaya ba\u011fl\u0131 geli\u015fen sarkopenidir. Sekonder sarkopeni ise, birden \u00e7ok nedene ba\u011fl\u0131 olarak ortaya \u00e7\u0131kan sarkopeni \u015feklinde tan\u0131mlanmaktad\u0131r. Ya\u015fl\u0131 bireylerde sarkopeni olu\u015fum mekanizmalar\u0131 multifakt\u00f6riyel olabilmekte ve \u00e7o\u011fu zaman primer ya da sekonder \u015feklinde s\u0131n\u0131fland\u0131r\u0131lamamaktad\u0131r. Ya\u015flanma s\u00fcreci ile birlikte kas dokusundaki homeostazis ve apoptozis mekanizmalar\u0131nda de\u011fi\u015fiklikler g\u00f6r\u00fclmektedir. Protein sentezi kapasitesindeki azal\u0131r, miyofibril olu\u015fumu yava\u015flar, k\u00f6k h\u00fccre rejenerasyonu yava\u015flar, ya\u011f dokusu artar, inflamatuar sitokinler artar ve kas kitlesi azal\u0131r. Progresif n\u00f6ron kayb\u0131na ba\u011fl\u0131 kas liflerinin atrofiye u\u011framas\u0131 ve ins\u00fclin, cinsiyet hormonlar\u0131, b\u00fcy\u00fcme hormonu (GH) gibi anabolik hormonlar\u0131n d\u00fczenlenmesinde bozulmalar g\u00f6r\u00fclmektedir. Ya\u015flanmaya ba\u011fl\u0131 iskelet kas k\u00fctlesinin kayb\u0131 ile kas g\u00fcc\u00fcnde azal\u0131r, kas fonksiyonu k\u0131s\u0131tlan\u0131r, mobilite azal\u0131r. Bu h\u00fccresel ve fonksiyonel gerilemeler, sarkopeni tablosunun g\u00f6r\u00fclmesine neden olmaktad\u0131r. Ek olarak d\u00fc\u015f\u00fck derecedeki inflamasyona uzun s\u00fcreli maruziyet i\u015ftahta azalmaya, dengeli ve yeterli g\u0131da al\u0131m\u0131nda azalmaya, anoreksi, kilo kayb\u0131 ve sonu\u00e7 olarak da sarkopeniye neden olmaktad\u0131r.<\/p>\n\n\n\n

Sarkopeni riskini art\u0131ran birden fazla fakt\u00f6r bulunmaktad\u0131r. Bu fakt\u00f6rlerden en \u00f6nemlisi ve en \u00f6nde geleni ya\u015ft\u0131r. Yap\u0131lan ara\u015ft\u0131rmalarda ya\u015f artt\u0131k\u00e7a, sarkopeni prevalans\u0131n\u0131n da artt\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. Ayr\u0131ca yap\u0131lan \u00e7al\u0131\u015fmalarda sarkopeni prevalans\u0131n\u0131n erkek cinsiyette daha fazla oldu\u011fu g\u00f6r\u00fclmektedir. Erkek cinsiyette daha fazla olmas\u0131 nedeni y\u00fcksek sigara i\u00e7me oran\u0131, i\u015f ya\u015fam\u0131n\u0131n bitmesi ile d\u00fc\u015f\u00fck aktivite d\u00fczeyi, alt ekstremite bozukluklar\u0131 gibi durumlar\u0131n ve bunlara ba\u011fl\u0131 kas kayb\u0131n\u0131n kad\u0131nlara g\u00f6re erkeklerde daha fazla olmas\u0131d\u0131r. Yaln\u0131z ya\u015f\u0131yor olmak, huzurevinde ya da hastanede kal\u0131yor olmak, sosyal izolasyon, yetersiz g\u0131da al\u0131m\u0131, protein al\u0131m\u0131n\u0131n azalmas\u0131, d\u00fc\u015f\u00fck D vitamini d\u00fczeyi, sigara ve alkol kullan\u0131m\u0131, fiziksel inaktivite ve uzam\u0131\u015f yatak istirahatinin de sarkopeni riskini art\u0131ran fakt\u00f6rler oldu\u011fu \u00e7al\u0131\u015fmalarla ortaya konulmu\u015ftur. Ayr\u0131ca emilim bozuklu\u011fu, gastrointestinal hastal\u0131klar, tiroid fonksiyonundaki bozulmalar, demans, malignite gibi hastal\u0131k durumlar\u0131n\u0131n ve kullan\u0131lan ila\u00e7lar\u0131n diyare, konstipasyon, kusma gibi yan etkilerinin de sarkopeni riskini art\u0131rd\u0131\u011f\u0131 bilinmektedir. <\/p>\n\n\n\n

Leeper ve arkada\u015flar\u0131n\u0131n retrospektif olarak 23622 eri\u015fkin travma hastas\u0131n\u0131 analiz ettikleri \u00e7al\u0131\u015fmada hastalar\u0131n %71\u2019i 65 ya\u015f alt\u0131nda iken, %29\u2019u 65 ya\u015f \u00fczerindedir. Bu \u00e7al\u0131\u015fmada Computed Tomography Abbreviated Assessment of Sarcopenia for Trauma (yani k\u0131saca CAAST<\/strong>) \u00e7ekimleri sonu\u00e7lar\u0131n\u0131, psoas kas\u0131n\u0131n kesitsel alan\u0131n\u0131 hastan\u0131n ya\u015f ve a\u011f\u0131rl\u0131\u011f\u0131na g\u00f6re hesaplam\u0131\u015flard\u0131r. 65 ya\u015f alt\u0131ndaki travma hastalar\u0131nda mortalite oran\u0131 %1,96 iken, 65 ya\u015f \u00fczerinde bu oran %7,19 bulunmu\u015ftur (p<0.05). Taburcu edildikten sonra bu travma hastalar\u0131n\u0131n 6 ayl\u0131k mortalite oranlar\u0131 65 ya\u015f alt\u0131nda %1,1 iken, 65 ya\u015f \u00fczerinde %12,86 bulunmu\u015ftur. Hastane i\u00e7i ve taburculuk sonras\u0131 mortalitede predikt\u00f6rler; hastaneye ba\u015fvuru zaman\u0131ndaki vital bulgular, kafa travmas\u0131 ve ISS (travma ciddiyet skoru) olarak bulunmu\u015ftur. D\u00fc\u015fme nedeniyle gelen travma hastalar\u0131 i\u00e7inde en g\u00fc\u00e7l\u00fc hastane d\u0131\u015f\u0131 mortalite predikt\u00f6r\u00fc Sarkopeni olarak saptanm\u0131\u015ft\u0131r (HR:4.77). Sarkopeninin erken tan\u0131s\u0131 travma hastalar\u0131 i\u00e7inde geli\u015febilecek yan etkileri saptamaya yard\u0131mc\u0131 olur. Geriatrik k\u00fcnt travmada sarkopeni hastane i\u00e7i mortalite art\u0131\u015f\u0131 ile ili\u015fkilidir (OR: 1.61) ve hastanede yat\u0131\u015f s\u00fcresi daha uzundur (OR: 1.21). Travmatik beyin hasar\u0131 ge\u00e7iren ya\u015fl\u0131 bireylerde sarkopeni mevcut ise, 30 g\u00fcnl\u00fck mortalite sarkopeni olmayanlara g\u00f6re daha y\u00fcksektir (%80 vs. %50,6; p<0.05). Masseter kas\u0131 kesitsel alan\u0131 \u00f6l\u00e7\u00fcmleri ile yap\u0131lan \u00e7al\u0131\u015fmalarda 30 g\u00fcnl\u00fck mortalite art\u0131\u015f\u0131 ile masseter kas\u0131n\u0131n kesitinin azalmas\u0131 aras\u0131nda ili\u015fki g\u00f6sterilmi\u015ftir.<\/p>\n\n\n\n

Sarkopeni tan\u0131 kriterleri EWGSOP2 taraf\u0131ndan belirlenmi\u015ftir (\u015eekil-1). Sarkopeninin birincil parametresi olarak d\u00fc\u015f\u00fck kas g\u00fcc\u00fcn\u00fcn kullan\u0131lmas\u0131n\u0131 \u00f6nerilmi\u015ftir. D\u00fc\u015f\u00fck kas g\u00fcc\u00fc tespit edildi\u011finde sarkopeni olas\u0131d\u0131r. Sarkopeni te\u015fhisi, d\u00fc\u015f\u00fck kas miktar\u0131 veya kalitesi ile do\u011frulanmaktad\u0131r. D\u00fc\u015f\u00fck kas g\u00fcc\u00fc, d\u00fc\u015f\u00fck kas miktar\u0131, d\u00fc\u015f\u00fck fiziksel performans parametrelerinin tamam\u0131 tespit edildi\u011finde sarkopeni \u015fiddetli olarak kabul edilmektedir. Klinik pratikte ve ara\u015ft\u0131rmalarda, sarkopeni tarama ve tan\u0131s\u0131 i\u00e7in \u00e7e\u015fitli testler ve \u00f6l\u00e7\u00fcm ara\u00e7lar\u0131 kullan\u0131lmaktad\u0131r. \u00d6l\u00e7\u00fcm arac\u0131 se\u00e7imi, bireyin durumuna (engellilik, hareketlilik), sa\u011fl\u0131k hizmeti ortam\u0131ndaki (toplum, klinik, hastane veya ara\u015ft\u0131rma merkezi) teknik kaynaklara eri\u015fime veya testin amac\u0131na (rehabilitasyon veya iyile\u015fmeyi izleme) g\u00f6re de\u011fi\u015fkenlik g\u00f6sterebilmektedir. <\/p>\n\n\n\n

Son g\u00fcncellemelerle EWGSOP2, sarkopeni belirtileri g\u00f6steren bireylerin kolay belirlenmesinin bir yolu olarak SARC-F anketinin kullan\u0131lmas\u0131n\u0131 \u00f6nermektedir. SARC-F, toplum sa\u011fl\u0131\u011f\u0131 alan\u0131nda ve di\u011fer klinik ortamlarda sarkopeni riski taramas\u0131nda kolayl\u0131kla kullan\u0131labilen, de\u011ferlendirmenin bireylerin kendi ifadelerine dayanarak yap\u0131ld\u0131\u011f\u0131, kas g\u00fcc\u00fc, d\u00fc\u015fme deneyimi, y\u00fcr\u00fcme yetene\u011fi, sandalyeden kalkma ve merdiven \u00e7\u0131kma deneyimlerini i\u00e7eren 5 maddelik bir ankettir (Tablo-1). SARC-F, sarkopeni risk taramas\u0131 i\u00e7in ucuz ve uygun bir y\u00f6ntemdir. SARC-F bireylerin kendi ifadeleri yans\u0131tt\u0131\u011f\u0131 i\u00e7in, sonu\u00e7lar birey i\u00e7in \u00f6nemli olan olumsuz sonu\u00e7lar\u0131n alg\u0131s\u0131n\u0131 yans\u0131tmaktad\u0131r.<\/p>\n\n\n\n

Sonu\u00e7 olarak sarkopeni, travmada mortalite ve morbiditeyi art\u0131ran risk fakt\u00f6r\u00fcd\u00fcr. Ancak ya\u015ftan ba\u011f\u0131ms\u0131z olarak sedanter hayat, protein sentezinde bozulma ile seyreden kronik karaci\u011fer hastal\u0131klar\u0131, kronik kalp yetmezli\u011fi, hormon ve sitokin dengesizli\u011fi ile seyreden kronik hastalarda s\u0131k g\u00f6r\u00fcl\u00fcr. Bu kronik hastalardaki s\u00fcre\u00e7 eksersiz kapasitenin giderek azalmas\u0131, kas kitlesinin azalmas\u0131, kas rejenerasyonun bozulup adipoz dokunun art\u0131\u015f\u0131 ile ilerler. Acil servislere ba\u015fvuran hastalarda sarkopeni tan\u0131s\u0131 i\u00e7in anketler, radyolojik \u00f6l\u00e7\u00fcmler ve kas kitlesi formulleri kullan\u0131labilir. Uygulamalar \u00fczerinden de hesaplanabilen Boer, Hume veya James form\u00fcllerinin kullan\u0131m\u0131 hastaya ilk yakla\u015f\u0131mda faydal\u0131 olacak \u015fekilde kas ve ya\u011f kitlesini hesaplamaya yard\u0131mc\u0131 olacakt\u0131r.\u00a0<\/p>\n\n\n\n

Tablo-1:<\/strong>\u00a0SARC- F anketi.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

\u015eekil-1:<\/strong>\u00a0EWGSOP2 taraf\u0131ndan \u00f6nerilen sarkopeni tan\u0131 algoritmas\u0131.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Kaynaklar<\/strong><\/p>\n\n\n\n

    \n
  1. Wahlen BM et al. Impact of sarcopenia in trauma and surgical patient population: A literature review. Asian J Surg. doi.org\/10.1016\/j.asjsur.2019.10.010.<\/li>\n\n\n\n
  2. Edwards et al. Osteoporosis and Sarcopenia in Older Age. Bone. doi:10.1016\/j.bone.2015.04.016.<\/li>\n\n\n\n
  3. EWGSOP2 recommendation. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing 2019; 48: 16\u201331 doi: 10.1093\/ageing\/afy169.<\/li>\n\n\n\n
  4. Sa\u011flam B\u00d6 ve ark. Ya\u015fl\u0131larda Sarkopeni ve Hem\u015firelik. DO\u0130: 10.46483\/deuhfed.925813.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Acil servislere ba\u015fvuran geriatrik hastalarda g\u00f6r\u00fclen, s\u0131kl\u0131kla \u015fikayet konusu olan, morbidite ve mortalite oran\u0131n\u0131 art\u0131ran bir durum sarkopeni olarak bilinen bir klinik…<\/p>\n","protected":false},"author":1185,"featured_media":491,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10020,10018,10025,10035],"class_list":["post-487","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil-tip","tag-geriatri","tag-geriatrik-travma","tag-sarkopeni"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/487","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=487"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/487\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/491"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=487"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=487"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=487"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}