{"id":621,"date":"2012-07-21T12:50:23","date_gmt":"2012-07-21T09:50:23","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=621"},"modified":"2012-07-21T12:50:23","modified_gmt":"2012-07-21T09:50:23","slug":"ucucularda-ambulatuar-kan-basinci-takibi","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=621","title":{"rendered":"U\u00e7ucularda Ambulatuar Kan Bas\u0131nc\u0131 Takibi"},"content":{"rendered":"
\n

\"\"<\/a>Hipertansiyon, kardiyovask\u00fcler ve koroner risk fakt\u00f6rleri aras\u0131nda en g\u00fc\u00e7l\u00fc ve prevalans\u0131 en y\u00fcksek olan fakt\u00f6rd\u00fcr. Profesyonel u\u00e7u\u015f m\u00fcrettebat\u0131n\u0131n sa\u011fl\u0131\u011f\u0131 ve u\u00e7u\u015f sertifikasyonunun devam\u0131 \u00fczerinde \u00f6nemli etkileri vard\u0131r. Hipertansiyon etkilerini en aza indirebilmek i\u00e7in, s\u0131k t\u0131bbi muayeneden ge\u00e7mesi gereken u\u00e7u\u015f m\u00fcrettebat\u0131n\u0131n iyi de\u011ferlendirilmesi gerekir. Ancak bazen AME\u2019ler taraf\u0131ndan atlanm\u0131\u015f, ya da \u00f6nemsenmemi\u015f ciddi hipertansiyon olgular\u0131 ile kar\u015f\u0131la\u015f\u0131labilmektedir. Bunun nedenleri aras\u0131nda ki\u015filerin semptomatik olmamas\u0131, lisans\u0131 etkileyebilecek sonu\u00e7lar do\u011furacak gereksiz giri\u015fimlerden ka\u00e7\u0131nma iste\u011fi ve hastal\u0131\u011f\u0131n ihmal edilmesi say\u0131labilir.<\/p>\n

Hipertansiyon % 95 oran\u0131nda sebebi tam bilinmeyen (esansiyel, idiyopatik) bir hastal\u0131kt\u0131r. % 5\u2019lik grupta ise (\u00f6zellikle gen\u00e7 ki\u015filer) b\u00f6brek, beyin, endokrin ve sistemik hastal\u0131klar etiyolojiden sorumlu tutulmaktad\u0131r. Hipertansiyon, g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131, y\u00fcksek mortalite ve morbiditesi ve ciddi ekonomik kay\u0131plara yol a\u00e7mas\u0131 nedeniyle dikkatli incelemeyi ve tedavi edilmeyi gerektirir. Tan\u0131 ile birlikte renal, kardiyak, serebral ve g\u00f6z gibi komplikasyonlar\u0131n olu\u015fup olu\u015fmad\u0131\u011f\u0131 ara\u015ft\u0131r\u0131lmal\u0131d\u0131r.<\/p>\n

Kan bas\u0131nc\u0131 de\u011ferlendirilirken, rutin veya tesad\u00fcfi \u00f6l\u00e7\u00fcmlerin ortalamas\u0131 al\u0131nmal\u0131, stresli olaylarda ve bazen belli bir dinlenme d\u00f6neminin ard\u0131ndan al\u0131nan \u00f6l\u00e7\u00fcmlerle bazal d\u00fczeyler aras\u0131nda fark da dikkate al\u0131narak karar verilmelidir. Sertifika i\u00e7in hem sistolik hem de diyastolik bas\u0131n\u00e7 en az 2 kez \u00f6l\u00e7\u00fclmelidir. Kalp at\u0131m\u0131 h\u0131zlanm\u0131\u015fsa bu \u00f6l\u00e7\u00fcmler tekrar edilmeli ya da ambulatuar kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fc yap\u0131lmal\u0131d\u0131r. Holter cihaz\u0131<\/strong>, kola ba\u011flanan bir man\u015fonla 24 saat s\u00fcreyle istenilen periyotlarda otomatik olarak kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fc yap\u0131lmas\u0131na ve verilerin bilgisayar ortam\u0131nda de\u011ferlendirilmesine imkan verir. Bu y\u00f6ntemle ki\u015filerin g\u00fcnl\u00fck faaliyetlerinde bir k\u0131s\u0131tlama yap\u0131lmadan, hastane ve beyaz g\u00f6mlek fobisi ya\u015fanmadan ger\u00e7ek hipertansiyonun olup olmad\u0131\u011f\u0131 anla\u015f\u0131labilir. Cihaz\u0131n tak\u0131l\u0131 oldu\u011fu s\u00fcrede hastadan g\u00fcnl\u00fck tutmas\u0131, ila\u00e7lar\u0131n\u0131, \u00e7al\u0131\u015fma saatlerini, uyku, yemek, \u00fcz\u00fclme ya da sinirlenme gibi d\u00f6nemlerini kaydetmesi istenir. Kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm s\u0131kl\u0131\u011f\u0131 saatte en az 2-4, tercihan 4-6 kez olmal\u0131d\u0131r. Gece boyunca kan bas\u0131nc\u0131 fazla de\u011fi\u015fmedi\u011fi i\u00e7in \u00f6l\u00e7\u00fcm s\u0131kl\u0131\u011f\u0131 yar\u0131ya indirilir. K\u0131sa d\u00f6nemli olaylarda, \u00f6rne\u011fin tekrarlayan senkop ataklar\u0131nda, daha s\u0131k (saatte 8 defa) \u00f6l\u00e7\u00fcmler \u00f6nerilir. PAMELA \u00e7al\u0131\u015fmas\u0131n\u0131n verilerine g\u00f6re, klinik ve 24 saatlik ortalama kan bas\u0131nc\u0131 de\u011ferleri aras\u0131ndaki fark\u0131n ya\u015fla ve klinik kan bas\u0131nc\u0131 de\u011feri ile do\u011fru orant\u0131l\u0131 olarak artmaktad\u0131r. 24 saatlik sistolik 119-126 mm Hg ve diyastolik 75-80 mm Hg kan bas\u0131nc\u0131 de\u011ferleri klinik \u00f6l\u00e7\u00fcmlerde 140\/90 mmHg\u2019ya denk gelmektedir. Sonu\u00e7 olarak ambulatuar \u00f6l\u00e7\u00fcmlerde hasta uyan\u0131kken kan bas\u0131nc\u0131 135\/85, uyurken 120\/75 mmHg\u2019dan daha d\u00fc\u015f\u00fck olmal\u0131d\u0131r.<\/p>\n

U\u00e7ucu personel hekim kar\u015f\u0131s\u0131na \u00e7o\u011funlukla artm\u0131\u015f sempatik aktivite (heyecan) ve beyaz g\u00f6mlek fobisi denilen abart\u0131lm\u0131\u015f bir alarm reaksiyonu ile gelirler. Bu ki\u015filerin kan bas\u0131n\u00e7lar\u0131 \u00f6l\u00e7\u00fcld\u00fc\u011f\u00fcnde y\u00fcksek de\u011ferler ve artm\u0131\u015f nab\u0131z ile kar\u015f\u0131la\u015f\u0131lmakta, biraz dinlendirilip heyecan\u0131n\u0131 yat\u0131\u015ft\u0131racak \u015fekilde sohbet edildikten sonra bu de\u011ferlerin normale yakla\u015ft\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. Bu ki\u015filerde genellikle ger\u00e7ek hipertansiyonun ve komplikasyonlar\u0131n\u0131n klinik bulgular\u0131 yoktur. Ambulatuar kan bas\u0131nc\u0131 takibinin do\u011fru tan\u0131 konulmas\u0131 yan\u0131nda, tedavinin takibinde de yararl\u0131 olabilece\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir. Kan bas\u0131nc\u0131n\u0131n ambulatuar olarak izlenmesinin klinikte yararl\u0131 oldu\u011fu durumlar \u015funlard\u0131r:<\/p>\n

1. Tan\u0131 amac\u0131yla<\/strong> (hedef organ hasar\u0131 olmayan \u201cbeyaz \u00f6nl\u00fck hipertansiyonu\u201d, hedef organ hasar\u0131 olan s\u0131n\u0131rda hipertansiyon, \u201cdipper\u201d ve \u201cnondipper\u201d hipertansifler, epizodik hipertansiyon, labil hipertansiyon, hipotansiyon, otonomik disfonksiyon, karotid sinus senkopu ve pacemaker sendromu, nokt\u00fcrnal angina veya pulmoner konjesyon.<\/p>\n

2. Prognozu belirleme amac\u0131yla<\/strong> (hedef organ hasar\u0131, kardiyovask\u00fcler olaylar).<\/p>\n

3. Tedaviyi de\u011ferlendirme amac\u0131yla<\/strong> (diren\u00e7li hipertansiyon, vadi-tepe oran\u0131).
\nKardiyolog u\u00e7u\u015f hekimleri \u00f6zellikle gen\u00e7 u\u00e7ucularda beyaz g\u00f6mlek hipertansiyonu ile s\u0131k\u00e7a kar\u015f\u0131la\u015f\u0131rlar. Ambulatuar kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fc, ger\u00e7ek hipertansiyonla beyaz g\u00f6mlek hipertansiyonunun ay\u0131rt edilmesinde \u00e7ok yararl\u0131 olur. Eski\u015fehir Hava Hastanesi U\u00e7ucu Muayene Merkezinde taraf\u0131m\u0131zdan yap\u0131lan geriye d\u00f6n\u00fck incelemelerde, ba\u015flang\u0131\u00e7 kan bas\u0131nc\u0131 y\u00fcksek u\u00e7ucularda 24 saatlik ambulatuar kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fc sonucu, bunlar\u0131n ancak %10-15\u2019inin ger\u00e7ek hipertansiyon oldu\u011fu anla\u015f\u0131lm\u0131\u015ft\u0131r. Dolay\u0131s\u0131yla, kan bas\u0131nc\u0131 y\u00fcksek olanlarda rutin olarak ambulatuar kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fc yap\u0131lmas\u0131 do\u011fru tan\u0131 i\u00e7in yarar sa\u011flayabilir.<\/p>\n

Kaynak:<\/strong> T\u00fcrk Kardiyoloji Derne\u011fi Ulusal Hipertansiyon Tedavi ve Takip K\u0131lavuzu<\/p>\n

Haz\u0131rlayan:<\/strong> Dr. Cengiz \u00d6ZT\u00dcRK. Eski\u015fehir Asker Hastanesi Kardiyoloji Uzman\u0131<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Hipertansiyon, kardiyovask\u00fcler ve koroner risk fakt\u00f6rleri aras\u0131nda en g\u00fc\u00e7l\u00fc ve prevalans\u0131 en y\u00fcksek olan fakt\u00f6rd\u00fcr. Profesyonel u\u00e7u\u015f m\u00fcrettebat\u0131n\u0131n sa\u011fl\u0131\u011f\u0131 ve u\u00e7u\u015f sertifikasyonunun devam\u0131 \u00fczerinde \u00f6nemli etkileri vard\u0131r. Hipertansiyon etkilerini en aza indirebilmek i\u00e7in, s\u0131k t\u0131bbi muayeneden ge\u00e7mesi gereken u\u00e7u\u015f m\u00fcrettebat\u0131n\u0131n iyi de\u011ferlendirilmesi gerekir. Ancak bazen AME\u2019ler taraf\u0131ndan atlanm\u0131\u015f, ya da \u00f6nemsenmemi\u015f ciddi hipertansiyon olgular\u0131 ile kar\u015f\u0131la\u015f\u0131labilmektedir. Bunun nedenleri aras\u0131nda ki\u015filerin […]<\/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-621","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\/621","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=621"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/621\/revisions"}],"predecessor-version":[{"id":623,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/621\/revisions\/623"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=621"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=621"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}