{"id":661,"date":"2012-07-22T10:44:38","date_gmt":"2012-07-22T07:44:38","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=661"},"modified":"2012-07-22T10:44:38","modified_gmt":"2012-07-22T07:44:38","slug":"ucucularda-koroner-gaz-embolisi","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=661","title":{"rendered":"U\u00e7ucularda Koroner Gaz Embolisi"},"content":{"rendered":"
\n

\"\"<\/a>Dekompresyon Hastal\u0131\u011f\u0131 (DKH), hem dokularda inert (asal) gaz kabarc\u0131klar\u0131 olu\u015fumunun neden oldu\u011fu dekompresyon rahats\u0131zl\u0131\u011f\u0131n\u0131, hem de ani bir dekompresyonda akci\u011ferlerde hava s\u0131k\u0131\u015fmas\u0131 ve alveol y\u0131rt\u0131lmas\u0131 sonucunda damar i\u00e7ine gaz girmesiyle olu\u015fan damarsal gaz embolisini i\u00e7erir.<\/p>\n

Koroner gaz embolisi, u\u00e7ucularda d\u00fc\u015f\u00fck bas\u0131n\u00e7 ortam\u0131na maruz kal\u0131nd\u0131\u011f\u0131nda g\u00f6r\u00fclebilir. Atmosfer bas\u0131nc\u0131ndaki h\u0131zl\u0131 d\u00fc\u015f\u00fc\u015flerde dokularda ve damarlarda a\u00e7\u0131\u011fa \u00e7\u0131kan azot gaz\u0131 kabarc\u0131\u011f\u0131n\u0131n (bubble<\/em>) boyutu d\u0131\u015f bas\u0131n\u00e7 d\u00fc\u015ft\u00fck\u00e7e artar; ancak klinik bulgu vermeyen \u201csessiz kabarc\u0131klar\u201d da vard\u0131r. Bunlar dola\u015f\u0131mda 3 g\u00fcne kadar kalabilmekte ve bu s\u00fcrede emboli riski devam etmektedir. U\u00e7u\u015fta veya sonras\u0131ndaki 72 saat i\u00e7inde ani ba\u015flayan g\u00f6\u011f\u00fcs a\u011fr\u0131lar\u0131, sol kol uyu\u015fmalar\u0131, bay\u0131lma, bilin\u00e7 bulan\u0131kl\u0131\u011f\u0131 gibi belirtiler kalp dekompresyon hastal\u0131\u011f\u0131n\u0131n habercisi olabilir. B\u00f6yle bir durumla kar\u015f\u0131la\u015f\u0131ld\u0131\u011f\u0131nda \u00f6ncelikle damar sertli\u011fine ba\u011fl\u0131 t\u0131kay\u0131c\u0131 kalp damar hastal\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fcl\u00fcr ve koroner anjiyografi planlan\u0131r, halbuki koroner gaz embolisi tan\u0131s\u0131 konursa, ki\u015finin acilen y\u00fcksek bas\u0131n\u00e7l\u0131 oksijen tedavisine al\u0131nmas\u0131 ile ya\u015fam\u0131 kurtar\u0131labilir.<\/p>\n

ABD Hava Kuvvetleri u\u00e7ucular\u0131nda yap\u0131lan ara\u015ft\u0131rmalarda, 1988-1992 y\u0131llar\u0131 aras\u0131nda 38 kalp olay\u0131 tespit edilmi\u015f olup, bunlar\u0131n 23\u2019\u00fc kalp krizi, 7\u2019si angina pectoris ve 8\u2019i ani kalp sebepli \u00f6l\u00fcm olarak kay\u0131tlara ge\u00e7mi\u015ftir. Bunlar\u0131n ne kadar\u0131n\u0131n ola\u011fan kalp damar hastal\u0131\u011f\u0131, ne kadar\u0131n\u0131n DKH oldu\u011fu belirtilmemi\u015ftir (1).<\/p>\n

Ba\u015fka bir \u00e7al\u0131\u015fmada y\u00fcksek irtifaya maruz kalan g\u00f6n\u00fcll\u00fclerde ultrasonik tekniklerle atardamar ve toplardamarlardaki hava kabarc\u0131klar\u0131 ve gaz embolisi ara\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. G\u00f6\u011f\u00fcs duvar\u0131ndan ve \u00f6sofagus yoluyla yap\u0131lan kalp ultrasonu ile 6 vakada sa\u011f ve sol kalp gaz embolisi tespit edilmi\u015f ve bunlar\u0131n 3\u2019\u00fcnde herhangi bir kalp defektinin olmad\u0131\u011f\u0131, 3\u2019\u00fcnde patent foramen ovale, 1\u2019inde de sin\u00fcs venosus oldu\u011fu, sadece 5\u2019inin hastal\u0131k belirtileri verdi\u011fi anla\u015f\u0131lm\u0131\u015ft\u0131r (2).<\/p>\n

Eski\u015fehir Hava Hastanesinde al\u00e7ak bas\u0131n\u00e7 (hipobarik \u00e7ember) e\u011fitiminden yakla\u015f\u0131k 24 saat sonra, gen\u00e7 bir jet pilotunda koroner gaz embolisine ba\u011fl\u0131 kalbin alt ve yan duvar\u0131n\u0131 tutan bir kalp krizi geli\u015fimi izlenmi\u015ftir. Bu pilotun EKG\u2019sinde MI bulgular\u0131 g\u00f6r\u00fcld\u00fckten sonra hemen hiperbarik oksijen tedavisine al\u0131nm\u0131\u015f ve belirtilerin s\u00fcratle d\u00fczelmesi nedeniyle tan\u0131n\u0131n kalp DKH oldu\u011fu sonucuna var\u0131lm\u0131\u015ft\u0131r (3).<\/p>\n

DKH klini\u011fi, ya kabarc\u0131klar\u0131n mekanik etkilerine ya da kan-kabarc\u0131k etkile\u015fimine ba\u011fl\u0131 olarak geli\u015fir. Doku i\u00e7inde olu\u015fan kabarc\u0131k sinir u\u00e7lar\u0131na bas\u0131 yaparak a\u011fr\u0131ya neden olurken, kom\u015fu dokular\u0131 da s\u0131k\u0131\u015ft\u0131r\u0131p hasara yol a\u00e7ar. Kabarc\u0131klar kaybolduktan sonra bile devam eden \u201cpost-exposure\u201d semptomlar\u0131n\u0131n nedeni bu doku travmas\u0131d\u0131r. Kabarc\u0131klar\u0131n di\u011fer bir mekanik etkisi de, damarlarda mekanik t\u0131kanma yaparak u\u00e7 b\u00f6lgelerde kan ak\u0131m\u0131n\u0131n azalmas\u0131 ya da kesilmesidir.<\/p>\n

Sonu\u00e7:<\/strong> DKH denizcilerin oldu\u011fu kadar havac\u0131lar\u0131n da sorunudur ve nadir de olsa, klini\u011fe kalp krizi g\u00f6r\u00fcn\u00fcm\u00fcnde yans\u0131yabilir. Tedavinin esas\u0131 rekompresyon\u2019dur ve hastan\u0131n en k\u0131sa s\u00fcrede hiperbarik oksijen tedavisine al\u0131nmas\u0131 ya\u015famsal \u00f6nemdedir.
\n<\/strong><\/p>\n

Kaynaklar:<\/strong>
\n1. Osswald S, Miles R, Nixon W, Celio P. Review of cardiac events in USAF aviators. Aviat Space Environ Med. 1996;67:1023-7<\/p>\n

2. Pilmanis AA, Meissner FW, Olson RM. Left ventricular gas emboli in six cases of altitude-induced decompression sickness. Aviat Space Environ Med. 1996;67:1092-6<\/p>\n

3. Ozturk C, Sen A, Akin A, Iyisoy A. Cardiac decompression sickness after hypobaric chamber training: case report of a coronary gas embolism. Anadolu Kardiyol Derg. 2004 Sep; 4(3):256-8<\/p>\n

Haz\u0131rlayanlar:<\/strong> Dr. Cengiz \u00d6zt\u00fcrk, Dr. Ahmet \u015eEN<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Dekompresyon Hastal\u0131\u011f\u0131 (DKH), hem dokularda inert (asal) gaz kabarc\u0131klar\u0131 olu\u015fumunun neden oldu\u011fu dekompresyon rahats\u0131zl\u0131\u011f\u0131n\u0131, hem de ani bir dekompresyonda akci\u011ferlerde hava s\u0131k\u0131\u015fmas\u0131 ve alveol y\u0131rt\u0131lmas\u0131 sonucunda damar i\u00e7ine gaz girmesiyle olu\u015fan damarsal gaz embolisini i\u00e7erir. Koroner gaz embolisi, u\u00e7ucularda d\u00fc\u015f\u00fck bas\u0131n\u00e7 ortam\u0131na maruz kal\u0131nd\u0131\u011f\u0131nda g\u00f6r\u00fclebilir. Atmosfer bas\u0131nc\u0131ndaki h\u0131zl\u0131 d\u00fc\u015f\u00fc\u015flerde dokularda ve damarlarda a\u00e7\u0131\u011fa \u00e7\u0131kan azot gaz\u0131 kabarc\u0131\u011f\u0131n\u0131n (bubble) boyutu d\u0131\u015f […]<\/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-661","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\/661","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=661"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/661\/revisions"}],"predecessor-version":[{"id":663,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/661\/revisions\/663"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=661"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=661"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=661"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}