{"id":327,"date":"2012-06-30T11:43:42","date_gmt":"2012-06-30T08:43:42","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=327"},"modified":"2012-06-30T11:43:42","modified_gmt":"2012-06-30T08:43:42","slug":"alfa-1-antitripsin-eksikligi-olan-pilot","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=327","title":{"rendered":"Alfa-1-Antitripsin eksikli\u011fi olan pilot"},"content":{"rendered":"
\n

\"\"<\/a>58 ya\u015f\u0131nda, 11,300 u\u00e7u\u015f saati olan erkek hava ambulans pilotu. 2. s\u0131n\u0131f sa\u011fl\u0131k raporu i\u00e7in ba\u015fvurdu\u011funda Alfa-1- antitripsin eksikli\u011fi (A1ATD) te\u015fhis edilmesinin hemen ard\u0131ndan, kendi iste\u011fi \u00fczerine genetik test taramas\u0131 yap\u0131ld\u0131. A1ATD hastas\u0131 3 karde\u015fi oldu\u011fu ve daha \u00f6nce genetik testi yap\u0131lmam\u0131\u015f karde\u015flerinden birinin karaci\u011fer kanserinden \u00f6ld\u00fc\u011f\u00fc \u00f6\u011frenildi. Hasta \u00e7ok aktif, d\u00fczenli olarak egzersiz yapmakta ve 1 y\u0131l \u00f6nceki muayenesinde efor dispnesi bulunmu\u015f. Hasta, durma ve dinlenme ihtiyac\u0131 olmadan 2,41 kilometre y\u00fcr\u00fcyebildi. G\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131, \u00f6ks\u00fcr\u00fck, kan t\u00fck\u00fcrmesi, \u00f6dem, paroksismal nokt\u00fcrnal nefes darl\u0131\u011f\u0131 yok. Daha \u00f6nce sigara kullanmam\u0131\u015f; bir aile ferdi Albuterol inhaler ile g\u00fcnde 3 kez kendi kendini tedavi etmekte ve ge\u00e7ici olarak egzersiz tolerans\u0131nda d\u00fczelme sa\u011flamakta. Solunum fonksiyon testi, FEV1 \u00f6l\u00e7\u00fcm\u00fcnde %20 oranda ve ciddi solunum azalmas\u0131 g\u00f6sterdi.<\/p>\n

Havac\u0131l\u0131k t\u0131bb\u0131 bak\u0131\u015f\u0131<\/strong>:<\/strong><\/p>\n

A1ATD, kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131, siroz ve hepatosell\u00fcler karsinom\u2019a zemin haz\u0131rlayan kal\u0131tsal bir hastal\u0131kt\u0131r. Kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131 (KOAH) olanlar i\u00e7in egzersiz tolerans\u0131nda azalma, oksijen yetmezli\u011fi ve G-tolerans\u0131 azalmas\u0131 gibi riskler s\u00f6z konusudur. Ayr\u0131ca bu hastalar, ivme atelektazisi ile sonu\u00e7lanabilecek k\u00fc\u00e7\u00fck havayolu hastal\u0131\u011f\u0131na meyillidir. KOAH b\u00fcll\u00f6z transformasyonu ve gaz hapsi ile ili\u015fkilendirilmi\u015f, akci\u011fer barotravmas\u0131 ve pn\u00f6motoraks riski artm\u0131\u015ft\u0131r. A1ATD\u2019n\u0131n karaci\u011fer belirtileri daha az g\u00f6r\u00fcl\u00fcr ve kronik karaci\u011fer hastal\u0131\u011f\u0131n\u0131n havac\u0131l\u0131k t\u0131bb\u0131 uygunlu\u011fu hastan\u0131n durumuna g\u00f6re belirlenir.<\/p>\n

U\u00e7u\u015f doktorunun rol\u00fc<\/strong>:<\/strong><\/p>\n

U\u00e7u\u015f doktorlar\u0131 \u00f6ncelikle A1ATD hastalar\u0131n\u0131n fonksiyonel ve fizyolojik bozukluk durumlar\u0131na bakmal\u0131d\u0131rlar. Hastal\u0131\u011f\u0131n ilerleme g\u00f6sterdi\u011fi olgularda u\u00e7u\u015f g\u00fcvenli\u011finin riske girip girmedi\u011fi karar\u0131 u\u00e7u\u015f doktoru sorumlulu\u011fundad\u0131r. Bu durumlarda u\u00e7u\u015f doktorlar\u0131, sa\u011fl\u0131k raporu lisanslama karar\u0131n\u0131 ertelemek zorunda kal\u0131rlar. Bu u\u00e7ucular ancak \u00f6zel u\u00e7u\u015f m\u00fcsaadesi ile u\u00e7abilirler; karar, sadece akci\u011fer hastal\u0131\u011f\u0131na ya da hem akci\u011fer hem de karaci\u011fer hastal\u0131\u011f\u0131na sahip olup olmamas\u0131na g\u00f6re de\u011fi\u015fir. FAA genelde FVC ve FeV1 \u00f6l\u00e7\u00fcm de\u011ferleri \u00f6ng\u00f6r\u00fclenden %50 daha az olan u\u00e7ucular\u0131n sa\u011fl\u0131k raporlar\u0131n\u0131 onaylamamaktad\u0131r. Dakika dakika nab\u0131z oksimetreyle \u00f6l\u00e7\u00fclen stres testi yap\u0131lmal\u0131d\u0131r. \u00d6zellikle apikal blebleri olan akci\u011fer b\u00fcll\u00f6z hastalar\u0131, rapor verilmeden \u00f6nce tekrar g\u00f6zden ge\u00e7irilmelidir. \u015eiddetli akci\u011fer bleb hastal\u0131\u011f\u0131 olanlarda spontan pn\u00f6motoraks olas\u0131l\u0131\u011f\u0131 y\u00fcksek oldu\u011fundan, \u00e7o\u011funlukla red karar\u0131 al\u0131r.<\/p>\n

Sonu\u00e7: <\/strong>\u0130lk ba\u015fvurusunda bu pilotun sa\u011fl\u0131k raporu red karar\u0131yla sonu\u00e7lanm\u0131\u015ft\u0131r. Ancak pilota, durumunun u\u00e7u\u015fa uygunlu\u011funu kan\u0131tlayabilecek nitelikteki \u015fu belgeleri toplad\u0131\u011f\u0131 takdirde sertifikasyon karar\u0131n\u0131n tekrar g\u00f6zden ge\u00e7irilebilece\u011fi notu iletilmi\u015ftir: KOAH durumunun yat\u0131\u015ft\u0131\u011f\u0131n\u0131 belgeleyen raporlar, FAA standartlar\u0131n\u0131 kar\u015f\u0131layan solunum fonksiyon testi sonu\u00e7lar\u0131, pulse oksimetreyle desteklenmi\u015f stres testi raporu, ve belirli kabin irtifa\u0131ndaki u\u00e7u\u015f g\u00f6revi becerisini g\u00f6steren anket formu \u00a0(FAA Form 8500-20).<\/p>\n

Kaynak<\/strong>: <\/strong>Kevin J. Brown. Alpha-1-Antitrypsin Deficiency. Case Report. Federal Air Surgeon\u2019s Medical Bulletin, Vol 48, No. 4. 2010<\/p>\n

\u00c7eviri<\/strong>: Dr. Abdullah \u00d6ks\u00fcz <\/strong>(Psikiyatri Uzman\u0131, Eski\u015fehir)<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

58 ya\u015f\u0131nda, 11,300 u\u00e7u\u015f saati olan erkek hava ambulans pilotu. 2. s\u0131n\u0131f sa\u011fl\u0131k raporu i\u00e7in ba\u015fvurdu\u011funda Alfa-1- antitripsin eksikli\u011fi (A1ATD) te\u015fhis edilmesinin hemen ard\u0131ndan, kendi iste\u011fi \u00fczerine genetik test taramas\u0131 yap\u0131ld\u0131. A1ATD hastas\u0131 3 karde\u015fi oldu\u011fu ve daha \u00f6nce genetik testi yap\u0131lmam\u0131\u015f karde\u015flerinden birinin karaci\u011fer kanserinden \u00f6ld\u00fc\u011f\u00fc \u00f6\u011frenildi. Hasta \u00e7ok aktif, d\u00fczenli olarak egzersiz yapmakta ve 1 y\u0131l \u00f6nceki muayenesinde […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-327","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/327","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=327"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/327\/revisions"}],"predecessor-version":[{"id":329,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/327\/revisions\/329"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=327"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=327"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=327"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}