{"id":2186,"date":"2017-10-24T00:00:00","date_gmt":"2017-10-23T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/27\/fast-d-protokolu-alt-ekstremitelerin-travmaya-bagli-damarsal-hasarlanmalarini-dislamak-icin-basit-bir-yontem\/"},"modified":"2022-03-02T15:39:31","modified_gmt":"2022-03-02T12:39:31","slug":"fast-d-protokolu-alt-ekstremitelerin-travmaya-bagli-damarsal-hasarlanmalarini-dislamak-icin-basit-bir-yontem","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2017\/10\/24\/fast-d-protokolu-alt-ekstremitelerin-travmaya-bagli-damarsal-hasarlanmalarini-dislamak-icin-basit-bir-yontem\/","title":{"rendered":"FAST-D protokol\u00fc: Alt ekstremitelerin travmaya-ba\u011fl\u0131 damarsal hasarlanmalar\u0131n\u0131 d\u0131\u015flamak i\u00e7in basit bir y\u00f6ntem"},"content":{"rendered":"\r\n\r\n\r\n

Giri\u015f<\/strong><\/p>\r\n\r\n\r\n\r\n

Bu \u00e7al\u0131\u015fma penetran travmaya ba\u011fl\u0131 alt ekstremite arter yaralanmas\u0131n\u0131n triyaj\u0131nda FAST Doppler protokol\u00fcn\u00fcn do\u011frulu\u011funu de\u011ferlendirmek amac\u0131yla ger\u00e7ekle\u015ftirilmi\u015ftir. 10.1186\/s13089-017-0063-2<\/a><\/p>\r\n\r\n\r\n\r\n

Y\u00f6ntem<\/strong><\/p>\r\n\r\n\r\n\r\n

D\u00f6rt y\u0131ll\u0131k uzmanl\u0131k program\u0131 i\u00e7eren Ultrason B\u00f6l\u00fcm\u00fcnce, \u015eubat 2011 ile Aral\u0131k 2015 aras\u0131nda, Arjantin, Rosario, Santa Fe \u2018de 1. seviye travma merkezinde ger\u00e7ekle\u015ftirilen prospektif bir \u00e7al\u0131\u015fmad\u0131r. Bu \u00e7al\u0131\u015fmada alt ekstremitede ate\u015fli silah yaralanmas\u0131 olan t\u00fcm stabil hastalar \u00e7al\u0131\u015fmaya al\u0131nd\u0131. Kullan\u0131lan y\u00f6ntem; \u0130ki-noktada FAST Doppler (2PFD) olarak adland\u0131r\u0131lm\u0131\u015ft\u0131r ve standard Renkli Dupleks Doppler* (SD)uygulamas\u0131ndan \u00f6nce dorsalis pedis arter (DPA) ve posterior tibial arter (PTA)\u2019in ak\u0131m ve Doppler dalga formunu 2 noktada de\u011ferlendirmektir.<\/p>\r\n\r\n\r\n\r\n

\"\"<\/figure>\r\n\r\n\r\n\r\n
\"\"\r\n
PMID:28324353<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

Her iki arterin 2 alan\u0131nda anl\u0131k nab\u0131z sikl\u00fcs\u00fcnce g\u00f6r\u00fcngesel** Doppler geni\u015fli\u011fin 3-evreli*** model olmas\u0131 normal, arterlerin en az birinde ak\u0131m modelinin olmamas\u0131, Tek-evreli ya da \u00c7ift-evreli olmas\u0131 ise anormal olarak yorumlanm\u0131\u015ft\u0131r.<\/p>\r\n\r\n\r\n\r\n

Daha sonra ise 2PFD verilerinin; Dorsalis pedis, posterior tibial, fibular, anterior tibial, popliteal, femoral, y\u00fczeysel femoral ve iliak arterleri i\u00e7eren t\u00fcm arter sisteminin de\u011ferlendirilmesini i\u00e7eren SD ile kar\u015f\u0131la\u015ft\u0131r\u0131larak do\u011frulu\u011fu de\u011ferlendirildi.<\/p>\r\n\r\n\r\n\r\n

\u00a0Her g\u00f6r\u00fcnt\u00fcleme, ultrason ve Doppler konusunda sertifikal\u0131 hekim veya uzman hekimler taraf\u0131ndan ger\u00e7ekle\u015ftirildi. \u0130kinci de\u011ferlendirmeler k\u00f6r ba\u015fka bir doktor taraf\u0131ndan ger\u00e7ekle\u015ftirildi.<\/p>\r\n\r\n\r\n\r\n

Ultrason uygulamas\u0131nda 5-12 MHz’lik geni\u015f d\u00fcz prob (Toshiba Xario; Tokyo, Japonya) kullan\u0131ld\u0131.<\/p>\r\n\r\n\r\n\r\n

Damarlar\u0131n transvers ve longitudinal g\u00f6r\u00fcnt\u00fcleri supin pozisyonunda elde edildi. Derinlik DPA ve TPA taramas\u0131 i\u00e7in 2-3 cm, proksimal uyluk (femoral arter, y\u00fczeyel femoral arter ve derin femoral arter) i\u00e7in 5-6 cm idi.<\/p>\r\n\r\n\r\n\r\n

\u0130ki \u00e7e\u015fit Doppler ultrason y\u00f6ntemi kullan\u0131ld\u0131; Bunlar; 1. \u0130ki boyutlu g\u00f6r\u00fcnt\u00fclemede, arterleri tan\u0131mlamak i\u00e7in, gri-skala B-Mod doku g\u00f6r\u00fcnt\u00fcs\u00fc \u00fczerinde renkli-dizgile\u015fmi\u015f harita olarak, ortalama ak\u0131m h\u0131z da\u011f\u0131l\u0131m\u0131n\u0131 g\u00f6steren Renkli Ak\u0131m Doppler (CFD), 2. Longitudinal planda se\u00e7ilen anl\u0131k \u00f6rnek hacim (PWD) ile zaman-de\u011fi\u015fimli ak\u0131m h\u0131z da\u011f\u0131l\u0131m\u0131n\u0131 g\u00f6steren G\u00f6r\u00fcngesel Doppler g\u00f6r\u00fcnt\u00fcleme idi.<\/p>\r\n\r\n\r\n\r\n

PWD’de do\u011fru \u00f6l\u00e7\u00fcmde tekrarlanabilir g\u00f6r\u00fcnt\u00fclere ait bilgi elde etmek i\u00e7in, h\u0131z \u00f6l\u00e7e\u011fi saniyede 10 ila 60 cm aras\u0131nda ayarland\u0131 ve 60 \u00b0’ye e\u015fit veya daha d\u00fc\u015f\u00fck bir insonasyon a\u00e7\u0131s\u0131**** uyguland\u0131.<\/p>\r\n\r\n\r\n\r\n

2PFD sonu\u00e7lar\u0131 SD sonu\u00e7 verileriyle kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. T\u00fcm patolojik olgulara (SD +) bilgisayarl\u0131 tomografi anjiyografisi veya arteriografi ile do\u011frulama sa\u011fland\u0131 ve cerrahi tedaviye ge\u00e7ildi.<\/p>\r\n\r\n\r\n\r\n

\"\"\r\n
3 evreli ak\u0131m dalga formu (PMID:28324353)<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
\"\"\r\n
2 evreli ak\u0131m dalga formu (PMID:28324353)<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
\"\"\r\n
Tek evreli ak\u0131m dalga formu (PMID:28324353)<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

Sonu\u00e7lar<\/strong><\/p>\r\n\r\n\r\n\r\n

Ate\u015fli silah yaralanmas\u0131 olan 140 hastan\u0131n toplam 149 alt ekstremitesi \u00e7al\u0131\u015fmaya dahil edildi. Ya\u015f ortalamas\u0131 27.15 \u00b1 10.64 idi. Hi\u00e7birinde DM yoktu.<\/p>\r\n\r\n\r\n\r\n

Patolojik olmayan sonu\u00e7lar (2PFD-) olan grup A (n = 134) ve patolojik bulgular\u0131 olan grup B (n = 15) (2PFD +) olarak belirlendi.<\/p>\r\n\r\n\r\n\r\n

2PFD protokol\u00fc, % 100 duyarl\u0131l\u0131k ve % 100 \u00f6zg\u00fcll\u00fck ve alt ekstremite arter yaralanmalar\u0131n\u0131 d\u0131\u015flamak i\u00e7in SD tekni\u011finin referans sonu\u00e7lar\u0131 ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda % 100 pozitif prediktif de\u011fere sahipti.<\/p>\r\n\r\n\r\n\r\n

T\u00fcm patolojik olgular anjiyografi sonu\u00e7lar\u0131 ile do\u011frulanm\u0131\u015ft\u0131r.<\/p>\r\n\r\n\r\n\r\n

Varg\u0131<\/strong><\/p>\r\n\r\n\r\n\r\n

2PFD protokol\u00fc arter ak\u0131m\u0131n\u0131 h\u0131zla tan\u0131mlayabilir ve distal damarlarda Doppler analizleriyle normal olan\u0131 anormalden ay\u0131rt edebilir.<\/p>\r\n\r\n\r\n\r\n

Arterioven\u00f6z fist\u00fcller, travmaya-ba\u011fl\u0131 tromboze arter t\u0131kan\u0131kl\u0131klar\u0131, yalanc\u0131- anevrizmalar veya arterleri bask\u0131layan d\u0131\u015f hematomlar da dahil olmak \u00fczere herhangi bir lezyon, distal ak\u0131ma etki ederek, Tek-evre, \u00c7ift-evre ya da ak\u0131m-olmayan anormal Doppler bulgular\u0131na neden olurlar. Di\u011fer yandan, Standard Doppler bak\u0131s\u0131 \u00a0zaman al\u0131c\u0131 olmas\u0131 nedeniyle s\u0131n\u0131rlay\u0131c\u0131d\u0131r ve her acil durumda bir radyolog bulunmamaktad\u0131r.<\/p>\r\n\r\n\r\n\r\n

Alt ekstremitede 2-Noktada, normal olan 3-evreli ak\u0131m\u0131n varl\u0131\u011f\u0131, standart Renkli Doppler Dupleks de\u011ferlendirmesi kadar duyarl\u0131d\u0131r.<\/p>\r\n\r\n\r\n\r\n

\"\"\r\n
Fast D Protokol\u00fc\u00a0(PMID:28324353)<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

Teknik Notlar;<\/strong><\/p>\r\n\r\n\r\n\r\n

+ Doppler \u00f6l\u00e7\u00fcmleri kan ak\u0131m\u0131na paralel varsay\u0131 ile yap\u0131l\u0131r.<\/p>\r\n\r\n\r\n\r\n

++ Ak\u0131m yolunu uzunlamas\u0131na tam izleyebilir halde iken trasenizi kalp ve b\u00fcy\u00fck damarlarda ak\u0131ma tamamen, distalde olabildi\u011fince paralel hale getirerek \u00f6l\u00e7\u00fcme dikkat ediniz.<\/p>\r\n\r\n\r\n\r\n

+++ Trase; Doppler analizi hemen \u00f6ncesinde ultrason ekran\u0131nda kenarda duran uygulay\u0131c\u0131n\u0131n ultrason klavyesinde dokunarak ya da \u00e7evirerek ekranda ak\u0131ma paralel hale getirmesi gerekti\u011fi ve yerini de\u011fi\u015ftirebildi\u011fi \u00e7izgi.<\/p>\r\n\r\n\r\n\r\n

++++ Arter, ultrason dalgas\u0131na paralele yak\u0131n seyrederse bu a\u00e7\u0131 \u201c0\u201d dereceye ve kosin\u00fcs \u201c1\u201d e yak\u0131nd\u0131r. A\u00e7\u0131n\u0131n art\u0131\u015f\u0131 frekans de\u011fi\u015fiminin ve Doppler sinyalinin azalmas\u0131na neden olur.<\/p>\r\n\r\n\r\n\r\n

*Anl\u0131k De\u011fi\u015fken dalgal\u0131 Doppler (Pulsed Wave = PW), e\u015f zamanl\u0131 gri skala g\u00f6r\u00fcnt\u00fcleme kullan\u0131ld\u0131\u011f\u0131nda Dupleks Doppler ad\u0131 verilir.<\/p>\r\n\r\n\r\n\r\n

**G\u00f6r\u00fcngesel (Spektral) Doppler<\/p>\r\n\r\n\r\n\r\n

*** Trifazik (3-Evreli)<\/p>\r\n\r\n\r\n\r\n

****\u0130nsonasyon<\/em>\u00a0a\u00e7\u0131s\u0131, Doppler ultrason demedi ile kan ak\u0131m y\u00f6n\u00fc aras\u0131ndaki a\u00e7\u0131d\u0131r. Bu a\u00e7\u0131n\u0131n distalde 0-30\u00b0 idealdir, 60\u00b0\u2019yi a\u015f\u0131lmamal\u0131d\u0131r.<\/p>\r\n","protected":false},"excerpt":{"rendered":"

Giri\u015f Bu \u00e7al\u0131\u015fma penetran travmaya ba\u011fl\u0131 alt ekstremite arter yaralanmas\u0131n\u0131n triyaj\u0131nda FAST Doppler protokol\u00fcn\u00fcn do\u011frulu\u011funu de\u011ferlendirmek amac\u0131yla ger\u00e7ekle\u015ftirilmi\u015ftir. 10.1186\/s13089-017-0063-2 Y\u00f6ntem D\u00f6rt y\u0131ll\u0131k…<\/p>\n","protected":false},"author":1539,"featured_media":2193,"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":[19,12],"tags":[42,107],"class_list":["post-2186","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","tag-e-fast","tag-vaskuler-usg"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2186","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/users\/1539"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2186"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2186\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2193"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2186"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2186"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2186"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}