{"id":2204,"date":"2017-11-17T00:00:00","date_gmt":"2017-11-16T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/27\/hemotoraks-tayininde-ultrasonografi-ve-radyografi-uygulamasi-azalmis-sol-ventrikul-ejeksiyon-fraksiyonu-olan-hastalarda-egzersizle-artan-b-cizgilerinin-fonksiyonel-ve-prognostik-degeri\/"},"modified":"2022-03-02T16:46:41","modified_gmt":"2022-03-02T13:46:41","slug":"hemotoraks-tayininde-ultrasonografi-ve-radyografi-uygulamasi-azalmis-sol-ventrikul-ejeksiyon-fraksiyonu-olan-hastalarda-egzersizle-artan-b-cizgilerinin-fonksiyonel-ve-prognostik-degeri","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2017\/11\/17\/hemotoraks-tayininde-ultrasonografi-ve-radyografi-uygulamasi-azalmis-sol-ventrikul-ejeksiyon-fraksiyonu-olan-hastalarda-egzersizle-artan-b-cizgilerinin-fonksiyonel-ve-prognostik-degeri\/","title":{"rendered":"Hemotoraks Tayininde Ultrasonografi ve Radyografi Uygulamas\u0131 &amp; Azalm\u0131\u015f Sol Ventrik\u00fcl Ejeksiyon Fraksiyonu Olan Hastalarda Egzersizle Artan B-\u00c7izgilerinin Fonksiyonel ve Prognostik De\u011feri"},"content":{"rendered":"\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><strong>Hemotoraks Tayininde Ultrasonografi ve Radyografi Uygulamas\u0131; Sistematik \u0130nceleme ve Meta-Analiz<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>Vafa Rahimi-Movagar, Mahmoud Yousefifard, Parisa Ghelichkhani, Masoud Baikpour, Abbas Tafakhori, Hadi Asady, Ghoamreza Far,daalaee, Mostafa Hosseini, Saeed Safari<\/p>\r\n\r\n\r\n\r\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4902204\/\">Emergency (2016); 4(3):116-126<\/a><\/p>\r\n\r\n\r\n\r\n<p>Yaz\u0131n\u0131n giri\u015f k\u0131sm\u0131nda hemotoraks\u0131n travmaya ba\u011fl\u0131 \u00f6l\u00fcmlerin % 25\u2019inden sorumlu oldu\u011fu vurgulanm\u0131\u015f. Toraks travmalar\u0131n\u0131n %83\u2019\u00fcnde hemotoraks ve pn\u00f6motoraks g\u00f6r\u00fcld\u00fc\u011f\u00fc belirtilmi\u015f. Yaz\u0131n\u0131n amac\u0131 olarak USG ve radyografinin hemotoraks tayinindeki yeterlili\u011finin de\u011ferlendirilmesi ve kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 sunulmu\u015f.<\/p>\r\n\r\n\r\n\r\n<p>Medline (PubMed), EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library ve ProQuest veri tabanlar\u0131 taranarak konu ile ilgili yaz\u0131lar \u00e7\u0131kar\u0131lm\u0131\u015f. \u00c7al\u0131\u015fmaya d\u00e2hil etme kriterleri do\u011frultusunda elenerek yaz\u0131 say\u0131s\u0131 12\u2019ye d\u00fc\u015f\u00fcr\u00fclm\u00fc\u015f. Bu 12 \u00e7al\u0131\u015fman\u0131n toplam\u0131nda 7361 hastal\u0131k bir pop\u00fclasyon de\u011ferlendirme dahilinde yer alm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n<p>7361 hastan\u0131n 487\u2019sinde hemotoraks saptanm\u0131\u015f. 6874 tanesinde hemotoraks bulunmam\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n<p>Ultrasonografinin sensitivitesi % 67 olarak saptanm\u0131\u015f. Spesitifitesi % 99 olarak hesaplanm\u0131\u015f. Yap\u0131lan alt grup analizinde USG\u2019nin acil uzman\u0131 taraf\u0131ndan yap\u0131lmas\u0131 durumunda sensitivitesinin % 70\u2019e \u00e7\u0131kt\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015f. Direk grafi sensitivitesi ise % 54 olarak bulunmu\u015f. Spesifitesi % 99 olarak hesaplanm\u0131\u015f. Buna g\u00f6re USG\u2019nin direk grafiden daha sensitif oldu\u011fu fakat iki tetkikin de hemotoraks tayini i\u00e7in orta derecede de\u011ferli oldu\u011fu yorumu yap\u0131lm\u0131\u015f. Hasta ba\u015f\u0131nda kolayca uygulanabilir olmas\u0131 ve ucuz olmas\u0131 USG\u2019nin tercih edilirli\u011fini artt\u0131rd\u0131\u011f\u0131 yorum olarak eklenmi\u015f.<\/p>\r\n\r\n\r\n\r\n<p><strong>\u00c7evirenin Notu<\/strong>:\u00a0Pn\u00f6motoraks tayini i\u00e7in USG\u2019nin direk grafiden daha \u00fcst\u00fcn bir tetkik oldu\u011fu bilmekteyiz. Bu \u00e7al\u0131\u015fma ile g\u00f6r\u00fclmektedir ki hemotoraks tespiti i\u00e7in de USG daha \u00fcst\u00fcn bir tetkiktir. Ancak toraks travmalar\u0131 i\u00e7in halen alt\u0131n standart g\u00f6r\u00fcnt\u00fcleme y\u00f6nteminin BT oldu\u011fu unutulmamal\u0131d\u0131r.\u00a0<\/p>\r\n\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><strong>Azalm\u0131\u015f Sol Ventrik\u00fcl Ejeksiyon Fraksiyonu Olan Hastalarda Egzersizle Artan B-\u00c7izgilerinin Fonksiyonel ve Prognostik De\u011feri<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>Maria Chiara Scali, Lauro Cortigiani, Anca Simionuc, Dario Gregori, Mario Marzilli ve Eugenio Picano<\/p>\r\n\r\n\r\n\r\n<p>European Journal of Heart Failure (2017). Doi:<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ejhf.776\/abstract\">10.1002\/ejhf.776<\/a><\/p>\r\n\r\n\r\n\r\n<p>Yaz\u0131n\u0131n giri\u015f k\u0131sm\u0131nda kalp yetmezli\u011fi olan hastalarda egzersiz stres ekokardiyografisinin hem Avrupa Kardiyoloji Cemiyetince hem de Avrupa Kardiyoloji Cemiyetince \u00f6nerildi\u011fi belirtilmi\u015f (\u00f6neri d\u00fczeyi IIb, kan\u0131t d\u00fczeyi B). Buna ek olarak B-\u00e7izgilerinin tespit edilmesinin kalp yetmezli\u011fi tan\u0131s\u0131 i\u00e7in \u00f6nemi vurgulanm\u0131\u015f. B-\u00e7izgilerinin intravask\u00fcler hacim veya bas\u0131nc\u0131 de\u011fi\u015ftiren manevralardan (di\u00fcretik, diyaliz, egzersiz) h\u0131zla etkilendi\u011fi belirtilmi\u015f. \u00c7al\u0131\u015fman\u0131n amac\u0131 dinlenme ve egzersiz s\u0131ras\u0131nda tespit edilen B-\u00e7izgilerinin kalp yetmezli\u011finin derecesinin ve prognozunun anla\u015f\u0131lmas\u0131ndaki \u00f6neminin anla\u015f\u0131lmas\u0131 olarak belirlenmi\u015f.<\/p>\r\n\r\n\r\n\r\n<p>\u00c7al\u0131\u015fmaya 103 hasta d\u00e2hil edilmi\u015f. EKO\u2019da EF\u2019si % 45\u2019in alt\u0131nda olan New York Kalp Yetmezli\u011fi s\u0131n\u0131flamas\u0131na g\u00f6re evre I-III olan hastalar \u00e7al\u0131\u015fmaya d\u00e2hil edilmi\u015f. Evre IV olan hastalar efor kapasitesinin d\u00fc\u015f\u00fck olmas\u0131 nedeniyle \u00e7al\u0131\u015fmaya al\u0131nmam\u0131\u015f. Akci\u011fer toplamda 28 b\u00f6lgeden incelenmi\u015f ve toplamdaki B-\u00e7izgisi say\u0131s\u0131 kaydedilmi\u015f.<\/p>\r\n\r\n\r\n\r\n<p>\u00c7al\u0131\u015fma sonucunda ortalama B-\u00e7izgisi say\u0131s\u0131 5\u2019den 12\u2019ye \u00e7\u0131kt\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015f (p&lt;0,0001). Egzersiz s\u0131ras\u0131nda B-\u00e7izgilerinin art\u0131\u015f\u0131na g\u00f6re hastalar 3 gruba ayr\u0131lm\u0131\u015f. Dinlenme esnas\u0131nda da B-\u00e7izgileri fazla olan hastalar kalp yetmezli\u011fi a\u015fik\u00e2r olan hastalar olarak adland\u0131r\u0131lm\u0131\u015f. Egzersiz sonras\u0131 B-\u00e7izgileri artan hastalar kalp yetmezli\u011fi geli\u015fme riski olan hastalar olarak de\u011ferlendirilmi\u015f. B-\u00e7izgileri artmayan hastalar ise kalp yetmezli\u011fi olmayan hastalar olarak de\u011ferlendirilmi\u015f. Hastalar 8 ayl\u0131k boyunca takip edilmi\u015f.<\/p>\r\n\r\n\r\n\r\n<p>Sonu\u00e7 olarak B-\u00e7izgilerinin g\u00f6r\u00fclmesinin kalp yetmezli\u011fi tan\u0131s\u0131 i\u00e7in \u00f6nemli oldu\u011fu vurgulanm\u0131\u015f. Egzersiz s\u0131ras\u0131nda B-\u00e7izgisi say\u0131s\u0131 artan hastalar\u0131n ise gelecekte kalp yetmezli\u011finin klinik olarak daha belirgin hale gelece\u011fi \u00f6ng\u00f6r\u00fcs\u00fcnde bulunulmu\u015f. Toplamdaki B-\u00e7izgisi say\u0131s\u0131n\u0131n 30\u2019un \u00fczerinde olmas\u0131 durumunda kalp yetmezli\u011fi belirtilerinin daha belirgin olaca\u011f\u0131 vurgulanm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n<p>\u00c7al\u0131\u015fman\u0131n k\u0131s\u0131tlamalar\u0131n\u0131n birincisi olarak B-\u00e7izgilerinin olu\u015fmas\u0131n\u0131n di\u011fer nedenleri (\u00f6r. pulmoner fibrozis) g\u00f6sterilmi\u015f fakat bu nedenlerde egzersizin B-\u00e7izgisi say\u0131s\u0131n\u0131 artt\u0131rmad\u0131\u011f\u0131 vurgulanm\u0131\u015f. \u0130kinci k\u0131s\u0131tlama olarak takibin 8 ay gibi k\u0131sa bir s\u00fcre yap\u0131lmas\u0131 g\u00f6sterilmi\u015f. \u00dc\u00e7\u00fcnc\u00fc bir k\u0131s\u0131tlama olarak 28 b\u00f6lgeden inceleme yap\u0131lmas\u0131n\u0131n uygulama g\u00fc\u00e7l\u00fc\u011f\u00fc olu\u015fturdu\u011fu belirtilmi\u015f fakat di\u011fer \u00e7al\u0131\u015fmalarda kullan\u0131lan 4 veya 8 b\u00f6lgeden inceleme yap\u0131lmas\u0131 ile kar\u015f\u0131la\u015ft\u0131r\u0131l\u0131nca 28 b\u00f6lge incelemesinin daha g\u00fcvenilir oldu\u011fu belirtilmi\u015f.<\/p>\r\n\r\n\r\n\r\n<p><strong>\u00c7evirenin notu<\/strong>:\u00a0\u00c7al\u0131\u015fmada anlat\u0131lan protokol acil prati\u011fi a\u00e7\u0131s\u0131ndan kolay uygulanabilir olmasa da USG kullan\u0131m\u0131n\u0131n hangi noktalara geldi\u011finin g\u00f6r\u00fclmesi a\u00e7\u0131s\u0131ndan anlaml\u0131d\u0131r. Unutulmamal\u0131d\u0131r ki ultrasonografi prati\u011fi hayal g\u00fcc\u00fcn\u00fczle s\u0131n\u0131rl\u0131d\u0131r.\u00a0<\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>Hemotoraks Tayininde Ultrasonografi ve Radyografi Uygulamas\u0131; Sistematik \u0130nceleme ve Meta-Analiz Vafa Rahimi-Movagar, Mahmoud Yousefifard, Parisa Ghelichkhani, Masoud Baikpour, Abbas Tafakhori, Hadi Asady,&hellip;<\/p>\n","protected":false},"author":1500,"featured_media":2138,"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":[23,10034],"class_list":["post-2204","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","tag-akciger-usg","tag-hemotoraks"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2204","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\/1500"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2204"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2204\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2138"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2204"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2204"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2204"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}