Komada optik sinir k�l�f �ap�n�n prognostik de�eri

Mengi, Tu��e; Ka�maz, Mustafa; Yakar, H�seyin

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Volume : 28 Issue : 2 Year : 2024

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Komada optik sinir k�l�f �ap�n�n prognostik de�eri [T�rk Beyin Damar Hast Derg]

T�rk Beyin Damar Hast Derg. 2022; 28(2): 80-86 | DOI: 10.5505/tbdhd.2022.09216

Komada optik sinir k�l�f �ap�n�n prognostik de�eri

Tu��e Mengi¹, Mustafa Ka�maz², H�seyin Yakar³
¹Ni�de E�itim ve Ara�t�rma Hastanesi, N�roloji Klini�i, Yo�un Bak�m �nitesi, Ni�de
²Ni�de E�itim ve Ara�t�rma Hastanesi, Anestesteziyoloji ve Reanimasyon Klini�i, Yo�un Bak�m �nitesi, Ni�de
³Ni�de E�itim ve Ara�t�rma Hastanesi, Beyin Cerrahisi Klini�i, Ni�de

G�R�� ve AMA�: Bu �al��man�n amac�, akut yap�sal beyin hasar� ve d��k Glasgow koma skoru (GKS≤8) ile yo�un bak�m �nitesine yat�r�lan komat�z hastalarda optik sinir k�l�f �ap� ile prognoz aras�ndaki ili�kiyi de�erlendirmektir.
Y�NTEM ve GERE�LER: �al��mam�z prospektif, g�zlemsel bir klinik �al��ma olarak tasarland�. Bu �al��maya 18 ya� �zerinde, GKS≤8 olan, akut yap�sal beyin hasar� tan�s� koyulan, yo�un bak�m �nitesine kabul sonras� sonras� ilk 24 saatte ultrasonografi ile optik sinir k�l�f �ap� �l��m� karar� verilen komat�z hastalar dahil edildi. 28. g�ndeki modifiye Rankin skalas�na g�re hastalar iyi prognoz ve k�t� prognoz olmak �zere iki gruba ayr�ld�. Modifiye Rankin skalas�nda, skor 0, 1, 2 ve 3 iyi n�rolojik prognoz olarak kabul edilirken; 4, 5 ve 6 k�t� n�rolojik prognoz olarak kabul edildi.
BULGULAR: K�t� n�rolojik prognozu olan hastalarda optik sinir k�l�f� �ap�, iyi n�rolojik prognozu olan hastalardan anlaml� olarak daha geni�ti (7,04�0,75'e kar�� 6,02�0,62 mm, p<0,01). Lojistik regresyon analizinde optik sinir k�l�f �ap� ile 28. g�ndeki modifiye Rankin skalas� aras�nda anlaml� ili�ki mevcuttu [OR 1,224 (1,087-1,595), p=0,005]. Benzer anlaml� ili�ki optik sinir k�l�f �ap� ile yo�un bak�m mortalitesi ve hastane i�i mortalite aras�nda da mevcuttu [s�ras�yla OR 1,124 (1,006-1,256), p=0,039 ve OR 1,131 (1,012-1,264), p=0,031].
TARTI�MA ve SONU�: Optik sinir k�l�f �ap� ile prognostik parametreler aras�ndaki anlaml� ili�ki, yo�un bak�m �nitesinde akut yap�sal beyin hasar�na ba�l� koma nedeniyle takip edilen hastalarda optik sinir k�l�f �ap�n�n prognozu �ng�rmede kullan�labilece�ini g�stermektedir.

Anahtar Kelimeler: �nme, koma, optik sinir k�l�f �ap�, prognoz, yo�un bak�m.

Prognostic value of optic nerve sheath diameter in coma

Tu��e Mengi¹, Mustafa Ka�maz², H�seyin Yakar³
¹Ni�de Training and Research Hospital, Clinic of Neurology, Intensive Care Unit, Ni�de, Turkey
²Ni�de Training and Research Hospital, Clinic of Anesthesiology and Reanimation, Intensive Care Unit, Ni�de, Turkey
³Ni�de Training and Research Hospital, Clinic of Neurosurgery, Ni�de, Turkey

INTRODUCTION: The aim of this study was to evaluate the relationship between optic nerve sheath diameter and prognosis in comatose patients admitted to the intensive care unit with acute structural brain injury and low Glasgow coma score (GCS≤8).
METHODS: Our study was designed as a prospective, observational clinical study. In this study, comatose patients over 18 years of age, with GCS ≤8, diagnosed with acute structural brain injury, and the decision to measure optic nerve sheath diameter by ultrasonography in the first 24 hours after admission to the intensive care unit were included. According to the modified Rankin scale on the 28th day, the patients were divided into two groups as good prognosis and poor prognosis. In the modified Rankin scale, scores of 0, 1, 2 and, 3 were considered good neurological prognosis, while scores of 4, 5, and 6 were considered poor neurological prognosis.
RESULTS: Optic nerve sheath diameter in patients with poor neurological prognosis was significantly greater than that in patients with good neurological prognosis (7.04�0.75 vs. 6.02�0.62 mm, p<0.01). In logistic regression analysis, there was a significant correlation between optic nerve sheath diameter and modified Rankin scale at 28th day [OR 1.224 (1.087-1.595), p=0.005]. A similarly significant relationship was also found between optic nerve sheath diameter and intensive care unit mortality and in-hospital mortality [OR 1.124 (1.006-1.256), p=0.039 and OR 1.131 (1.012-1.264), p=0.031, respectively].
DISCUSSION AND CONCLUSION: The significant relationship between optic nerve sheath diameter and prognostic parameters shows that optic nerve sheath diameter can be used to predict prognosis in patients followed up in the intensive care unit for coma due to acute structural brain injury.

Keywords: Stroke, coma, optic nerve sheath diameter, prognosis, intensive care.

Sorumlu Yazar: Tu��e Mengi, T�rkiye
Makale Dili: T�rk�e

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Komada optik sinir k�l�f �ap�n�n prognostik de�eri

Prognostic value of optic nerve sheath diameter in coma