AKUT İSKEMİK STROK TEDAVİSİNDE HEMODİLÜSYON'UN ETKİNLiGİ (Prospektif, Randomize, Kontrollu Çalışma)

Akut iskemik strok'un erken fazında, o/o6'lık hidroksietilstarch (HFS) 200/0.5 ve veneseksiyon kombinasyonuyla gerçeklejtirilen hemodilüsyon tedav.isi prospektif, randomize, kontrollü çahıımayla değerlendirildi. 95 hasta (ort. Yaş 61.4 ± 11.7) hemodilüsyon tedavi grubuna (HG), 84 hasta (ort. yaıı 62.,3 ± 13,5) ise kontrol grubuna (KG) alındı. Çalışmada yeralan hastalar cinsiyet, yaş, medikal öykü, semptomlann ortaya çıkı§ı ile tedaviye ba§lama arasındaki süre, atrial fibrilasyon varlığı, hastanede kalııı süreleri ve BT'deki infarkt lokalizasyonlanna göre aynlarak ölüm oranları ve nörolojik iyileşme sonuçlan açısından analiz edildi. Tedavinin 3. gününde HG hastalannın %81 'inde nörolojik skorlarda iyileşme gözlenirken bu oran KG' da %63 hastada görüldü (p<0.05). Beşinci günde HG hastalannın %83'ünde, KG'nun ise %76'sında iyileşme saptandı (p<0.05). Gruplar arasındaki bu anlamlı iyileııme farkı 3. aydaki prognostik skorlara yansımadı. Üçüncü ayda HG hastalannın %92'sinde, KG hastalannın ise %86'sında iyilejme vardı (p>0.05). Hemodilüsyon tedavisi uygulanan AFlu hastaların KG'daki AF'Iu hastalara göre üçüncü ay sonunda daha yüksek düzeyde iyilejme gösterdikleri belirlendi .

THE EFFECTS OF HEMODILUTION IN ACUTE ISCHEMIC STROKE

The effects of isovolemic hemodilution (IVHD) in patients with acute ischemk stroke (AlS) were studied in a randomized, controlled, dinical, single - centre trial. Patients with hernatoerit levels between 38% and 50% were randomized within 48 h of onset of symptoms to treatment with venesection and concomitant hydroxyethyl starch (HES 200/0.5) administration, or to a control group. Exclusion criteria were deep coma, dependence prior to stroke, intracranial haemorrhage, myocardial infaretion within last eight weeks, renal failure, terminal systemic illness, and to be on anticoagulant treatment. The study involved 179 patients (95 patients in the treatment group, 84 in control group)Jn the treatment group, the M-ID procedure reduced mean hernatoerit from 45.4+ 3.3% at entry to 37.6+2.6% over the first three days and was maintained at this level throughout the fırst 10 days. Mean hernatoerit level was essentially unchanged in control patients in this period. The only difference between the hemodiluted group and control group was seenin neurological score over the acute period. The proportion of patients who improved was significant_ly greater in hemodiluted than in non-hemodiluted patients (81% vs. 63% on day 3, and 83% vs. 76% on day 5). Neurological sooring and activity of daily living performance at the third ınonth was not significantly improved by hemodilution. Case fatality rate was not significantly affected by IVHD. Among hemodiluted patients, a smail subgroup with atrial fibrillation (AF) showed better long-term neurological outcome than patients without AF. Asa condusion, although it cannot be recommended for routine use. IVHD may have a benefidal effect in some selected patients with AlS.