Elektrokardiogrammas izmaiņu un to korelācijas ar laboratoriem rādītājiem un hospitalizācijas iznākumu plaušu artērijas trombembolijas (PATE) pacientiem
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Pētījuma mērķis: Izpētīt elektrokardiogrammas izmaiņu saistību ar laboratoriskajiem rādītājiem un hospitalizācijas iznākumu plaušu artēriju trombembolijas pacientiem. Pētījums atspoguļo klīniskās iespējas izvērtēt pacienta hospitalizācijas iznākumu izmantojot vienkāršākās un biežāk pieejamās izmeklēšanas metodes – elektrokardiogrammu un laboratoros rādītājus. Pētījuma materiāli un metode: šķērsgriezuma pētījums, kas tika veikts, atlasot RAKUS stacionārā “Gaiļezers” hospitalizēto pacientu medicīnas kartes ar akūtu plaušu atēriju trombemboliju, kuri bija stacionēti laika posmā no 01.01.2019. līdz 31.12.2019. Tika veikta pieejamo datu retrospektīva analīze ar datu apstrādes programmu SPSS Statistics 26 un Microsoft Excel for Microsoft 365. Rezultāti: pēc pieejamajām pacientu medicīniskajām kartēm ar akūtu PATE diagnozi 2019.gadā tika stacionēti 106 pacienti. Pētījumā tika iekļauti tie 84 no 106 pacientiem, kuriem PATE diagnoze bija apstiprināta izmantojot CTA. Šie pacienti bija vecumā no 31 līdz 101 gadiem. Pētījumā tika analizētas pirmās elektrokardiogrammas un laboratorie rādītāji pacientam iestājoties un EKG ar lielākajām izmaiņām un laboratoro datu lielākās izmaiņas no normas stacionēšanās laikā. Biežākās pētījumā novērotās elektrokardiogrammu izmaiņas bija nespecifiskas ST-T segmenta izmaiņas (64,3%), izmaiņas S1 novadījumā (53,6%) un invertēti T viļņi V1 novadījumā (51,2%). Pacienta slimības iznākumam statistiski nozīmīga korelācija tika novērota sinusa tahikardijas gadījumā (Chi square=7,955; p=0,005), kā arī tika novērota mēreni cieša attiecība (Chramers`s=0,308) starp šīm pazīmēm. Lielāks relatīvais risks sinusa tahikardijas gadījumā ir nelabvēlīgam slimības iznākumam (RR=3,143). Statistiski nozīmīga korelācija tika novērota arī pacientiem ar pilnu Hisa kūlīša labās kājiņas blokādi (Chi square=5,585; p=0,018). Starp Hisa kūlīša labā zara pilnu blokādi un slimības iznākumu tika atrasta mēreni cieša attiecība (Chramers`s=0,258). Lielāks relatīvais risks ar šādu atradni EKG ir nelabvēlīgam slimības iznākumam (RR=2,731). Analizējot pacientu laboratoriskos rādītājus, biežākās novērotās izmaiņas bija plazmas glikozes līmeņa izmaiņas (82,1%), troponīna T izmaiņas (84,1%), D-dimēru izmaiņas (98,7%), tiešā bilirubīna (75,4%), CRO (75,0%). Pacienta slimības iznākumam statistiski nozīmīga korelācija tika novērota ar ALAT izmaiņām (Chi square=3,895; p=0,048), ASAT izmaiņām (Chi square=11,758; p=0,001), urea izmaiņām (Chi square=15,515; p=0,00), kreatinīna izmaiņām (Chi square=4,056; p=0,044), troponīna T izmaiņām (Chi square=4,041; p=0,044), protrombīna laika izmaiņām (Chi square=7,512; p=0,006), kopējā bilirubīna izmaiņām (Chi square=0,001; p=0,0187). Lielākoties relatīvais risks lielāks bija šīm izmaiņām saistoties ar labvēlīgu slimības iznākumu.
Aim of the study was to analyze changes in electrocardigramms (ECG) and see if there is a relationship between them and patient hospitalisation result in patients with acute pulmonary artery thrombembolism (PATE). Analyze changes in laboratory biomarkers and see if there is a relatioship between them and patient hospitalisation result in patients with acute PATE. The study shows clinical posibilities to evaluate patients hospitalisation result by using easy, cheap and widely available diagnostic methods – ECG and laboratory data. Used materials are a study made in RAKUS hospital “Gailezers” by retrospectively analyzing patients medical histories. Patient selective criteries were diagnosis of PATE (SSK-10 I26) and the hospital admit was from 01.01.2019. till 31.12.2019. The data was collected in Microsoft Excel for Microsoft 365 and then analyzed with IBM SPSS Statistics 26 software. Study results: by the selected patient data there were 106 patients who were hospitalised with diagnosis of PATE in 2019. in the analyzed hospital. 84 out of all patients were included in the study. Inclusion criteria where confirmed PATE diagnosis using CTA. Patient age range were from 31 to 101 years. The study included first ECG and laboratoy results at the time of patients admission and the worst changes in ECG and in laboratory tests during the hospital stay. The most frequent ECG changes were unspecific ST-T segment changes (64,3%), changes in lead S1 (53,6%) and inverted T waves in lead V1 (51,2%). Statistically significant results showed between sinus tachycardia and result of hospitalisation (Chi square=7,955; p=0,005), the correlation between these data were with mild association (Chramers`s=0,308). Greater relative risk in patients with sinus tachycardia was for wore clinical outcome (RR=3,143). Statistically significant correlation showed between complete right bundle branch block and patients hospitalisation outcome (Chi square=5,585; p=0,018). Between these two factors there was mild association (Chramers`s=0,258). Greater relative risk in patients with complete right bundle branch block was with negative outcome (RR=2,731). Analyzing patients laboratory findings the most frequent chamges were in plasma glucose level (82,1%), troponin T (84,1%), D-dimers (98,7%), direct bilirubin (75,4%), CRO (75,0%). Statistically significant correlation between laboratory data and patients hospitalisation outcome was associated with changes in ALAT level (Chi square=3,895; p=0,048), ASAT level (Chi square=11,758; p=0,001), urea level (Chi square=15,515; p=0,00), creatinine level (Chi square=4,056; p=0,044), troponin T level (Chi square=4,041; p=0,044), prothrombin time (Chi square=7,512; p=0,006), total bilirubin level (Chi square=0,001; p=0,0187). In almost all cases greater relative risk was associated with better clinical outcome.
Aim of the study was to analyze changes in electrocardigramms (ECG) and see if there is a relationship between them and patient hospitalisation result in patients with acute pulmonary artery thrombembolism (PATE). Analyze changes in laboratory biomarkers and see if there is a relatioship between them and patient hospitalisation result in patients with acute PATE. The study shows clinical posibilities to evaluate patients hospitalisation result by using easy, cheap and widely available diagnostic methods – ECG and laboratory data. Used materials are a study made in RAKUS hospital “Gailezers” by retrospectively analyzing patients medical histories. Patient selective criteries were diagnosis of PATE (SSK-10 I26) and the hospital admit was from 01.01.2019. till 31.12.2019. The data was collected in Microsoft Excel for Microsoft 365 and then analyzed with IBM SPSS Statistics 26 software. Study results: by the selected patient data there were 106 patients who were hospitalised with diagnosis of PATE in 2019. in the analyzed hospital. 84 out of all patients were included in the study. Inclusion criteria where confirmed PATE diagnosis using CTA. Patient age range were from 31 to 101 years. The study included first ECG and laboratoy results at the time of patients admission and the worst changes in ECG and in laboratory tests during the hospital stay. The most frequent ECG changes were unspecific ST-T segment changes (64,3%), changes in lead S1 (53,6%) and inverted T waves in lead V1 (51,2%). Statistically significant results showed between sinus tachycardia and result of hospitalisation (Chi square=7,955; p=0,005), the correlation between these data were with mild association (Chramers`s=0,308). Greater relative risk in patients with sinus tachycardia was for wore clinical outcome (RR=3,143). Statistically significant correlation showed between complete right bundle branch block and patients hospitalisation outcome (Chi square=5,585; p=0,018). Between these two factors there was mild association (Chramers`s=0,258). Greater relative risk in patients with complete right bundle branch block was with negative outcome (RR=2,731). Analyzing patients laboratory findings the most frequent chamges were in plasma glucose level (82,1%), troponin T (84,1%), D-dimers (98,7%), direct bilirubin (75,4%), CRO (75,0%). Statistically significant correlation between laboratory data and patients hospitalisation outcome was associated with changes in ALAT level (Chi square=3,895; p=0,048), ASAT level (Chi square=11,758; p=0,001), urea level (Chi square=15,515; p=0,00), creatinine level (Chi square=4,056; p=0,044), troponin T level (Chi square=4,041; p=0,044), prothrombin time (Chi square=7,512; p=0,006), total bilirubin level (Chi square=0,001; p=0,0187). In almost all cases greater relative risk was associated with better clinical outcome.
Description
Pediatrija
Pediatrics
Veselības aprūpe
Health Care
Pediatrics
Veselības aprūpe
Health Care
Keywords
Plaušu artēriju trombembolija, elektrokardiogramma, D-dimēri, troponīns T, hospitalizācijas iznākums, Pulmonary artery thrombemboly, electrocardiogram, D-dimers, troponin T, hospitalisation outcome