Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Hipoksik İskemik Ensefalopati Tanılı Bebeklerde Hipotermi Tedavisinin Sağ Ventrikül Sistolik Basıncı ve Pulmoner Tansiyon Üzerine Etkisi
The Effect of Hypothermia Treatment on Right Ventricular Systolic Pressure and Pulmonary Tension in Infants with Hypoxic Ischemic Encephalopathy
Melek BÜYÜKERENa,b, Hasan Tolga ÇELİKa,b, Hayrettin Hakan AYKANa,c, Kübra CEBECİa, Tevfik KARAGÖZa,c, Şule YİĞİTa,b, Murat YURDAKÖKa,b
aÇocuk Sağlığı ve Hastalıkları ABD,
bNeonatoloji BD,
cÇocuk Kardiyolojisi BD, Hacettepe Üniversitesi Tıp Fakültesi, Ankara, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2019;28(3):103-9
doi: 10.5336/pediatr.2019-66143
Article Language: TR
Full Text
ÖZET
 Amaç: Hipoksik iskemik ensefalopati (HİE), ciddi bir santral sinir sistemi hasarı nedenidir. Bu çalışmada, HİE tanısı ile hipotermi tedavisi uygulanan yenidoğanların tedavi öncesinde ve sonrasında sistemik sistolik basınçları ve ekokardiyografik olarak ölçülen sağ ventrikül sistolik basınçlarının karşılaştırılması, böylece hipoterminin pulmoner basınç üzerine bir etkisi olup olmadığının araştırılması planlandı. Gereç ve Yöntemler: Hacettepe Üniversitesi Tıp Fakültesi Yenidoğan Yoğun Bakım Ünitesinde 2010-2016 tarihleri arasında HİE tanısı ile yatan hastalar geriye dönük olarak tarandı. Toplam 43 hasta çalışmaya alındı. Hipotermi başlanmadan önce ve hipotermi tedavisinin ardından vücut sıcaklığı normale döndükten sonra yatak başında yapılan ekokardiyografi raporları değerlendirildi. Ekokardiyografi incelemesi ile belirlenen sağ ventrikül sistolik basıncı [right ventricular systolic pressure (RVSP)], apikal veya parasternal görünümde ölçülen pik triküspit regürjitasyon jet hızı sonuçları kaydedildi. Bulgular: Hipotermi tedavisi öncesinde pulmoner hipertansiyon saptanan 18 hastanın RVSP değerleri medyan (25-75p); 60 (57-81) mmHg iken, hipotermi tedavisi sonrasında RVSP değerleri 25 (14-38) mmHg olarak saptandı ve anlamlı ölçüde azalma olduğu gözlendi (p<0,05). Hipotermi tedavisi öncesinde pulmoner hipertansiyon saptanan tüm hastalarda hipotermi sonrasında pulmoner hipertansiyon düzeldi. Hipotermi tedavisi öncesinde pulmoner hipertansiyon nedeniyle ilaç tedavisi alan HİE tanılı bebeklerde, hipotermi tedavisi sonrasında pulmoner arter basınçlarında yükselme saptanmadı. Sonuç: Yenidoğanlarda HİE tedavisinde uygulanan hipotermi tedavisinin pulmoner hipertansiyona neden olmadığı görülmüştür.

Anahtar Kelimeler: Hipoksik iskemik ensefalopati; pulmoner hipertansiyon; yenidoğan; hipotermi
ABSTRACT
 Objective: Hypoxic ischemic encephalopathy (HİE) is a serious cause of central nervous system damage. To investigate the effect of hypothermia treatment on pulmonary arterial pressure and to compare the right ventricular systolic pressures before and after the hypothermia treatment in newborns with HİE who were treated with hypothermia. Material and Methods: The patients who were diagnosed as hypoxic-ischemic encephalopathy in Hacettepe University Faculty of Medicine Neonatal Intensive Care Unit between 2010-2016 were retrospectively reviewed. A total of 43 patients were included in the study. Echocardiography evaluation was carried out before and after the hypothermia treatment. Measurements of right ventricular systolic pressure (RVSP) and peak tricuspid regurgitation jet velocity were recorded. Results: RVSP values [median (25-75p) of 18 patients with pulmonary hypertension before and after the hypothermia treatment were 60 (57-81) and 25 (14-38) mmHg, respectively (p<0.05). Pulmonary hypertension improved after hypothermia in all patients who had pulmonary hypertension before hypothermia treatment. There was no increase in pulmonary artery pressures after hypothermia treatment in infants with HİE who were prescribed medication for pulmonary hypertension prior to hypothermia treatment. Conclusion: Hypothermia treatment in newborns with HİE did not increase in pulmonary arterial pressure.

Keywords: Hypoxic ischemic encephalopathy; pulmonary hypertension; newborn; hypothermia
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