{"id":599,"date":"2022-10-13T15:56:48","date_gmt":"2022-10-13T12:56:48","guid":{"rendered":"https:\/\/tatd.org.tr\/travma\/?p=599"},"modified":"2022-10-13T15:57:50","modified_gmt":"2022-10-13T12:57:50","slug":"travma-hastasinda-arteryel-ve-venoz-kan-gazi-uyumlulugu","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/travma\/genel\/travma-hastasinda-arteryel-ve-venoz-kan-gazi-uyumlulugu\/","title":{"rendered":"Travma Hastas\u0131nda Arteryel ve Ven\u00f6z Kan Gaz\u0131 Uyumlulu\u011fu"},"content":{"rendered":"\r\n<p>Travma bak\u0131s\u0131nda kan gaz\u0131 da senelerdir rutinimizde. Baz defisiti ve laktat ba\u015fta olmak \u00fczere, bir\u00e7ok parametreye pratik olarak kan gaz\u0131 ile eri\u015febiliyoruz. Ve hasta y\u00f6netimini bu sonu\u00e7lara g\u00f6re y\u00f6nlendiriyoruz. Peki bu de\u011ferlendirme i\u00e7in arter kan gaz\u0131nda \u0131srarc\u0131 olmal\u0131 m\u0131y\u0131z, yoksa ven\u00f6z kan gaz\u0131 da i\u015fimizi g\u00f6r\u00fcr m\u00fc?<\/p>\r\n\r\n\r\n\r\n<p>Singapur\u2019da y\u00fcr\u00fct\u00fclen bir \u00e7al\u0131\u015fmada<span id=\"cebe98a1-cbf4-4514-9ffe-6c62d99e8d0c\" class=\"abt-citation\" data-has-children=\"true\" data-items=\"[&quot;2743310719&quot;]\"><sup>\u200b1\u200b<\/sup><\/span>, bu sorunun yan\u0131t\u0131 aranm\u0131\u015f. \u00c7ok sade bir \u00e7al\u0131\u015fma oldu\u011funu \u015fimdiden belirteyim. Ancak belki bizlere de daha b\u00fcy\u00fck ve detayl\u0131 \u00e7al\u0131\u015fmalar i\u00e7in ilham olabilir.<\/p>\r\n\r\n\r\n\r\n<h4 class=\"wp-block-heading\" id=\"h-calisma-dizayni\">\u00c7al\u0131\u015fma dizayn\u0131<\/h4>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>Tek merkez<\/li>\r\n<li>Prospektif g\u00f6zlemsel \u00e7al\u0131\u015fma<\/li>\r\n<li>\u015eubat &#8211; Ekim 2016 aras\u0131<\/li>\r\n<li>21 ya\u015f \u00fczeri, kritik ve orta ciddiyette hastalar\u0131n al\u0131nd\u0131\u011f\u0131 alanda bak\u0131l\u0131p, arter kan gaz\u0131 g\u00f6nderilen travma hastalar\u0131 \u00e7al\u0131\u015fmaya dahil edilmi\u015f.<\/li>\r\n<li>Arter kan gaz\u0131 g\u00f6nderilen hastalardan 10 dakika i\u00e7inde damaryolundan ven\u00f6z kan gaz\u0131 da g\u00f6nderilmi\u015f.<\/li>\r\n<li>Arter kan gaz\u0131 ve ven\u00f6z kan gaz\u0131 aras\u0131ndaki pH, baz defisiti ve laktat a\u00e7\u0131s\u0131ndan de\u011ferlendirilmi\u015f.<\/li>\r\n<li>Aradaki fark\u0131n pH i\u00e7in art\u0131eksi 0.05, baz defisiti i\u00e7in art\u0131eksi 2, ve laktat i\u00e7in art\u0131eksi 1.5 mmol\/L s\u0131n\u0131rlar\u0131 i\u00e7inde olmas\u0131, uyumluluk olarak, bu s\u0131n\u0131rlar\u0131n d\u0131\u015f\u0131nda olmas\u0131 uyumsuzluk olarak belirlenmi\u015f.<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<h4 class=\"wp-block-heading\">Sonu\u00e7lar<\/h4>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>102 hasta analiz edilmi\u015f.<\/li>\r\n<li>Hastalar\u0131n bir \u00e7o\u011funda mekanizma k\u00fcnt travma olmu\u015f (%96.1)<\/li>\r\n<li>Veniz ph ve baz defisiti, \u00f6nceden belirlenmi\u015f klinik olarak kabul edilebilir e\u015fik s\u0131n\u0131rlar\u0131na g\u00f6re e\u015fde\u011fer bulunmam\u0131\u015f.<\/li>\r\n<li>pH i\u00e7in de\u011ferlerin sadece %72.6\u2019s\u0131 klinik olarak kabul edilebilir s\u0131n\u0131rlar i\u00e7erisindeyken, baz defisiti i\u00e7in %96.5\u2019i e\u015fik s\u0131n\u0131rlar i\u00e7inde bulunmu\u015f.<\/li>\r\n<li>Tersine, ven\u00f6z laktat, \u00f6nceden belirlenmi\u015f \u22121.5 ila 1.5 mmol\/L e\u015fik s\u0131n\u0131rlar\u0131na dayal\u0131 olarak klinik olarak e\u015fde\u011fer bulunmu\u015f ve de\u011ferlerin %96,0&#8217;\u0131 bu kabul edilebilir aral\u0131k i\u00e7inde oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f.<\/li>\r\n<\/ul>\r\n<div id=\"attachment_600\" style=\"width: 1034px\" class=\"wp-caption aligncenter\"><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-600\" class=\"wp-image-600 size-large\" src=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/6c2cfbe327667c658b3c654dab424146-1024x595.png\" alt=\"\" width=\"1024\" height=\"595\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/6c2cfbe327667c658b3c654dab424146-1024x595.png 1024w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/6c2cfbe327667c658b3c654dab424146-300x174.png 300w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/6c2cfbe327667c658b3c654dab424146-768x446.png 768w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/6c2cfbe327667c658b3c654dab424146-1536x892.png 1536w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/6c2cfbe327667c658b3c654dab424146-1085x630.png 1085w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/6c2cfbe327667c658b3c654dab424146.png 1904w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><p id=\"caption-attachment-600\" class=\"wp-caption-text\">pH, baz defisit ve laktat i\u00e7in Blant Altman plotu<\/p><\/div>\r\n<p>\u0130kincil olarak ise, arteriyel pH, baz defisiti ve laktat sonu\u00e7lar\u0131n\u0131 etkileyebilecek de\u011fi\u015fkenlerin basit lineer regresyon analizleri yap\u0131lm\u0131\u015f. De\u011fi\u015fkenlerin hi\u00e7biri, ayarlanm\u0131\u015f lineer regresyon sonucunda arteriyel\u00a0 pH ile \u00f6nemli \u00f6l\u00e7\u00fcde ili\u015fkili bulunmamakla birlikte, kalp h\u0131z\u0131 hem arteriyel BD hem de laktat ile istatistiksel olarak anlaml\u0131 \u015fekilde ili\u015fkili bulunmu\u015f.<\/p>\r\n<div id=\"attachment_601\" style=\"width: 1034px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" aria-describedby=\"caption-attachment-601\" class=\"wp-image-601 size-full\" src=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/421d786afc51af9e1820e2127606805d.png\" alt=\"\" width=\"1024\" height=\"363\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/421d786afc51af9e1820e2127606805d.png 1024w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/421d786afc51af9e1820e2127606805d-300x106.png 300w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2022\/10\/421d786afc51af9e1820e2127606805d-768x272.png 768w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><p id=\"caption-attachment-601\" class=\"wp-caption-text\">Arteryel ph, baz defisiti ve laktat i\u00e7in ayarlanm\u0131\u015f lineer regresyon sonu\u00e7lar\u0131<\/p><\/div>\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>Bir\u00e7ok \u00e7al\u0131\u015fmada oldu\u011fu gibi, bu \u00e7al\u0131\u015fman\u0131n da k\u0131s\u0131tl\u0131l\u0131klar\u0131 mevcut. \u00d6ncelikle, bu bir convenience sample \u00e7al\u0131\u015fmas\u0131: Yani \u00e7al\u0131\u015fmac\u0131 hekimlerin g\u00f6revli oldu\u011fu g\u00fcnlerde gelen hastalar \u00e7al\u0131\u015fmaya al\u0131nm\u0131\u015f.<\/li>\r\n<li>Bunun standardize edilmesi halinde, ekstremite yaralanmalar\u0131 olan hastalarda standart b\u00f6lgeden kan gaz\u0131 al\u0131nmas\u0131 problem olaca\u011f\u0131ndan, arteryel ve ven\u00f6z kan gazlar\u0131n\u0131n al\u0131naca\u011f\u0131 v\u00fccut b\u00f6lgesi standardize edilmemi\u015f.<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<h4 class=\"wp-block-heading\">Sonu\u00e7 olarak..<\/h4>\r\n\r\n\r\n\r\n<p>Sonu\u00e7 olarak, travma hastas\u0131n\u0131n de\u011ferlendirilmesi s\u0131ras\u0131nda pH ve baz defisiti de\u011ferlendirmesinin arter kan gaz\u0131 ile yap\u0131lmas\u0131n\u0131n daha y\u00fcksek do\u011frulukta sonu\u00e7 verece\u011fi g\u00f6r\u00fclm\u00fc\u015f. Laktat de\u011ferinin ise, ven\u00f6z kan gaz\u0131 ile de kabul edilebilir sapma ile sonu\u00e7 verdi\u011fi g\u00f6r\u00fclm\u00fc\u015f.<\/p>\r\n\r\n\r\n\r\n<p>Yani bu \u00e7al\u0131\u015fma sonu\u00e7lar\u0131na g\u00f6re, travma hastas\u0131n\u0131n pH ve baz defisitini arter kan gaz\u0131 ile de\u011ferlendirmek gerekiyor. Ancak bu tabi k\u00fc\u00e7\u00fck \u00f6l\u00e7ekli bir \u00e7al\u0131\u015fma. Umar\u0131m daha b\u00fcy\u00fck \u00e7al\u0131\u015fmalar ile bu sonu\u00e7lar de\u011fi\u015fir.<\/p>\r\n\r\n\r\n\r\n<h5 class=\"wp-block-heading\">Kaynaklar :<\/h5>\r\n\r\n\r\n\r\n<section class=\"wp-block-abt-bibliography abt-bibliography\" role=\"region\" aria-label=\"Bibliography\">\r\n<ol class=\"abt-bibliography__body\" data-entryspacing=\"1\" data-maxoffset=\"2\" data-linespacing=\"1\" data-second-field-align=\"flush\">\r\n<li id=\"2743310719\">\r\n<div class=\"csl-entry\">\r\n<div class=\"csl-right-inline\">Boon Y, Kuan WS, Chan YH, Ibrahim I, Chua MT. Agreement between arterial and venous blood gases in trauma resuscitation in emergency department (AGREE). <i>Eur J Trauma Emerg Surg<\/i>. Published online July 18, 2019:365-372. doi:<a href=\"https:\/\/doi.org\/10.1007\/s00068-019-01190-6\">10.1007\/s00068-019-01190-6<\/a><\/div>\r\n<\/div>\r\n<div>\u00a0<\/div>\r\n<\/li>\r\n<\/ol>\r\n\u00a0 * \u00d6ne \u00e7\u0131kan g\u00f6rsel telifi \u00f6denmi\u015ftir.<\/section>\r\n\r\n<figure class=\"wp-block-image size-full\">\r\n<figcaption><\/figcaption>\r\n<\/figure>\r\n<!-- \/wp:post-content -->","protected":false},"excerpt":{"rendered":"<p>Travma bak\u0131s\u0131nda kan gaz\u0131 da senelerdir rutinimizde. Baz defisiti ve laktat ba\u015fta olmak \u00fczere, bir\u00e7ok parametreye pratik olarak kan gaz\u0131 ile eri\u015febiliyoruz.&hellip;<\/p>\n","protected":false},"author":883,"featured_media":602,"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":[1,10010,10014],"tags":[10090,10089,10046,10091],"class_list":["post-599","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-slider","category-akademik-blog-yazisi","tag-arter-kan-gazi","tag-kan-gazi","tag-travma","tag-venoz-kan-gazi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/posts\/599","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/users\/883"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/comments?post=599"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/posts\/599\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/media\/602"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/media?parent=599"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/categories?post=599"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/tags?post=599"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}