Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 113-118

Erken hemorajik þokun bir belirleyicisi olarak inferior vena kava çapý: Karþýlaþtýrmalý bir çalýþma

Belgin Akýllý¹, Ayþegül Bayýr¹, Fatih Kara², Ahmet Ak¹, Baþar Cander^1
1Selçuk Üniversitesi Meram Týp Fakültesi, Acil Týp Anabilim Dalý, Konya, Türkiye
²Selçuk Üniversitesi Meram Týp Fakültesi, Halk Saðlýðý Anabilim Dalý, Konya, Türkiye

AMAÇ
Saðlýklý bireylerde ve künt travma hastalarýnda akut kan kaybýnýn tahmininde inferior vena kava (ÝVC) çapýnýn deðeri saptandý, hemorajik þokun diðer parametreleri ile karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Elli gönüllü ve 28 ardýþýk hemorajik þok hastasý çalýþmaya alýndý. Hayati bulgular, kan laktatý ve serum bikarbonatý ölçüldü, þok indeksi ve baz fazlasý hesaplandý. ÝVC’nin Antero-posterior (AP) ve mediyolateral (ML) çaplarý sað subkostal bölgede inspirasyon ve ekspirasyon sýrasýnda ölçüldü. Hemerajik þok hastalarýndaki ÝVC çaplarý ve diðer hemorajik þok parametreleri kontrol grubununkilerle karþýlaþtýrýldý.
BULGULAR
Kabulde çalýþma grubu ile kontrol grubunun inspirasyon ve ekspirasyon sýrasýndaki ortalama AP, ML ve ÝVC çaplarý arasýnda anlamlý iliþki saptandý (p=0,000, p=0,000, p=0,000, p=0,000). Serum laktat seviyeleri bütün ÝVC çaplarý ile özellikle exspirasyon sýrasýndaki ÝVC ML çapý ile anlamlý korele idi (r=55).
SONUÇ
Hemorajik þok hastalarýnda transabdominal ultrasonografiyle ölçülen ÝVC çapý; þok indeksi ve akut kan kaybýnýn tahmininde yaygýn olarak kullanýlan kan basýncý, dakikadaki nabýz sayýsý, serum laktat seviyesi ve baz açýðý gibi diðer non-invaziv prediktörlerinden daha doðru bir prediktördür.

Anahtar Kelimeler: Baz açýðý, hemorajik þok; inferior vena cava; laktat; þok indeksi; ultrason.

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Inferior vena cava diameter as a marker of early hemorrhagic shock: a comparative study

Belgin Akýllý¹, Ayþegül Bayýr¹, Fatih Kara², Ahmet Ak¹, Baþar Cander^1
1Emergency Department, Selçuk University, Meram Faculty Of Medicine, Konya, Turkey
²Public Healt Department, Selçuk University, Meram Faculty Of Medicine, Konya, Turkey

BACKGROUND
We determined the value of the inferior vena cava (IVC) diameter for predicting acute blood loss in control and blunt trauma patients and compared this with other parameters of hemorrhagic shock.
METHODS
Fifty volunteers and 28 consecutive hemorrhagic shock patients were recruited prospectively to participate in the study. Vital signs, blood lactate, and serum bicarbonate were measured, and shock index and base excess were calculated. Anteroposterior (AP) and mediolateral (ML) IVC diameters during inspiration and expiration were measured in the right subcostal region. IVC diameters in hemorrhagic shock patients were compared with those of controls and were also compared with other hemorrhagic shock parameters.
RESULTS
A significant relationship was determined between mean IVC AP and ML diameters during expiration and inspiration on admission in the study group and in the control group (p=0.000, p=0.000, p=0.000, p=0.000). Serum lactate levels correlated significantly with all IVC diameters (r=55), especially the IVC ML diameter during expiration.
CONCLUSION
IVC diameter, as measured by transabdominal ultrasound, was more accurate than the shock index and other commonly used non-invasive predictors of acute blood loss (blood pressure, heart rate per minute, serum lactate level, base deficit).

Keywords: Base deficit, hemorrhagic shock; inferior vena cava; lactate; shock index; ultrasound.

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