ÖZET
Amaç:
Spontan subaraknoid kanamalı (sSAK) hastaların yoğun bakımcılar gözüyle değerlendirildiği az sayıda çalışma mevcuttur. Çalışmamızda; mortalitesi ciddi oranda yüksek böyle bir hastalığın beyin cerrahisi, girişimsel radyoloji, yoğun bakım alanında deneyimli bir ekiple takip edildiği bir high volume center’daki takip sonuçlarını paylaşmayı amaçladık.
Gereç ve Yöntem:
Yoğun bakım ünitemizde (YBÜ) Ocak 2014-Temmuz 2018 tarihleri arasındaki yaklaşık 5 yıl boyunca izlenen sSAK hastalarının verileri, YBÜ hasta izlem çizelgeleri, dosya kayıtları ve hastane otomasyon sistemi kullanılarak toplanmıştır.
Bulgular:
Çalışmaya 150 hasta dahil edildi ve bunların 61’i (%40,7) yoğun bakıma kabul edilmesine rağmen öldü. Vazospazmı olan (%42,8) ve olmayan (%40) hastalar arasındaki ölüm oranları benzerdi (p=0,917). Endovasküler koil uygulanan 45 hastanın %37,8’inde ve beyin cerrahisi klipsleme işlemi yapılan hastaların %19,2’sinde vazospazm gelişti (p=0,044). Endovasküler veya cerrahi prosedürlerden önce geçen medyan süre, hayatta kalan grupta 2,5 [çeyrekler arası aralık (IQR): 2-5] gün ve kaybedilen 2 (IQR: 1-5) gündü (p=0,164). Üçüncü günden itibaren kaybedilen grupta kan sodyum ve kan klorür seviyeleri anlamlı ölçüde yüksekti. Medyan kan sodyum düzeyi kaybedilen grupta 142 mEq/L’yi aştı, ancak hayatta kalan grupta aynı gün 142 mEq/L’den düşüktü.
Sonuç:
Bu çalışma ile YBÜ’ye kabulde Glasgow koma skalasının (GKS) tedavi başarısını etkileyen önemli etkilerden biri olduğunu söyleyebiliriz. GKS, yoğun bakım gerektiren sSAK hastalarının tedavisinde zamanlama veya tedavi türü (cerrahi/endovasküler klips) ve nimodipin gibi tıbbi tedavilere ek olarak önemli bir bağımsız faktörüdür. Takipteki sodyum ve klor değerlerinin artışı ise mortalite üzerinde anlamlı bulunan tek parametrelerdir.
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