Mekanik barsak tıkanıklığı olan hastalarda mortalite ve morbiditeye etki eden faktörler (retrospektif çalışma)

Abstract

8.SUMMARY Mechanical bowel obstruction is a disease that is frequently seen in emergency departments and that interest's emergency service physicians and surgents. The aim of this study is to determine the factors predicting morbidity and mortality on the people with mechanical bowel obstruction. In this study, the data of 171 patients who had mechanical bowel obstruction and who had administered to the Emergency Department of Dicle University between the dates of 01.01.2001 and 31.12.2004 were analyzed 119 Patients (70%) of 171 were males, while 52 patients (30%) were female, 21 patients (12.3%) died and complications occurred on 55 patients (32.2%) but 95 patients (55.5%) were discharged from the hospital without any complication. The mean age was 66(14-86) for the patients with mortality and 66.4 (37-95) for the patients with morbidity and 39.5 (36-90) for the patients discharged from the hospital without any complication. According to the statistical analyzes; the effects of old age (p=0.000), hypotension (p=0.000), tachicardia (p=0.000), leucopoenia or leukocytosis (p=0.018), serious anemia (p=0.0026), ' hyperuricemia (p=0.000), hypercreatinemia (p=0.048), additional illness (p=0.000) and necrosis (p=0.000) on mortality were evaluated as expressive, while the effects of old age (p=0.000), hypertension (p=0.000), leucopoenia or leukocytosis (p=0.0021) additional illness (p=0.000), various illness (p=0.000) and delayed application (p=0.021) on morbidity were evaluated as expressive. When multivariate analyzing the results; the reasons such as tachicardia (OR=0.151, CI=0.03 1-0.734, P=0.0019), leukocytosis or leucopoenia (OR=0.201, 0=0.044-0.912, P= 0.038), additional illness (OR=0.061, CI=0.006-0.660, P=0.021), necrosis (OR=0.114, 0=0.025-0.526, P=0.005) were determined as the most important factors affecting mortality, while the reasons such as hypertension (OR=0.368, CI=0. 157-0.863, P=0.021), leucopoenia or leukocytosis (OR=2.2002, CI=1. 0066-4.546, P=0.033) and additional illness (OR=0.362, 0=0.166-0.791), P=0.01 l)were determined effective on morbidity. Having analyzed the reasons of all mechanical bowel obstruction; the most common reason was adhesion by the rate of 45% (n=78). Other reasons were respectively incarsere hernia by the rate 17.5% (n=30), malignancy 16.4% (n=28), sigmoid volvulus 9.4% (n=16), meckel divertikülitis 1.2 % (n=2) and other resons7.0% (n=12). Analyzing the complications on patients, systemic complications were the most common ones. The most common application was respiratory system and the rate was 17% 54(n=59). The other complications were cardiac by the rate of 8.8% (n=15) and being various complications by the rate of 14% (n=25) respectively. Having evaluated the operations that patients had before appendectomy has been in the first place (14%), colorectal (9.4%) and genitourinary (7.6%) system surgery fallows appendix respectively. On the diagnosis and treatment of the patients who have mechanical bowel obstruction, the patients have to evaluate from various points. 55

8.SUMMARY Mechanical bowel obstruction is a disease that is frequently seen in emergency departments and that interest's emergency service physicians and surgents. The aim of this study is to determine the factors predicting morbidity and mortality on the people with mechanical bowel obstruction. In this study, the data of 171 patients who had mechanical bowel obstruction and who had administered to the Emergency Department of Dicle University between the dates of 01.01.2001 and 31.12.2004 were analyzed 119 Patients (70%) of 171 were males, while 52 patients (30%) were female, 21 patients (12.3%) died and complications occurred on 55 patients (32.2%) but 95 patients (55.5%) were discharged from the hospital without any complication. The mean age was 66(14-86) for the patients with mortality and 66.4 (37-95) for the patients with morbidity and 39.5 (36-90) for the patients discharged from the hospital without any complication. According to the statistical analyzes; the effects of old age (p=0.000), hypotension (p=0.000), tachicardia (p=0.000), leucopoenia or leukocytosis (p=0.018), serious anemia (p=0.0026), ' hyperuricemia (p=0.000), hypercreatinemia (p=0.048), additional illness (p=0.000) and necrosis (p=0.000) on mortality were evaluated as expressive, while the effects of old age (p=0.000), hypertension (p=0.000), leucopoenia or leukocytosis (p=0.0021) additional illness (p=0.000), various illness (p=0.000) and delayed application (p=0.021) on morbidity were evaluated as expressive. When multivariate analyzing the results; the reasons such as tachicardia (OR=0.151, CI=0.03 1-0.734, P=0.0019), leukocytosis or leucopoenia (OR=0.201, 0=0.044-0.912, P= 0.038), additional illness (OR=0.061, CI=0.006-0.660, P=0.021), necrosis (OR=0.114, 0=0.025-0.526, P=0.005) were determined as the most important factors affecting mortality, while the reasons such as hypertension (OR=0.368, CI=0. 157-0.863, P=0.021), leucopoenia or leukocytosis (OR=2.2002, CI=1. 0066-4.546, P=0.033) and additional illness (OR=0.362, 0=0.166-0.791), P=0.01 l)were determined effective on morbidity. Having analyzed the reasons of all mechanical bowel obstruction; the most common reason was adhesion by the rate of 45% (n=78). Other reasons were respectively incarsere hernia by the rate 17.5% (n=30), malignancy 16.4% (n=28), sigmoid volvulus 9.4% (n=16), meckel divertikülitis 1.2 % (n=2) and other resons7.0% (n=12). Analyzing the complications on patients, systemic complications were the most common ones. The most common application was respiratory system and the rate was 17% 54(n=59). The other complications were cardiac by the rate of 8.8% (n=15) and being various complications by the rate of 14% (n=25) respectively. Having evaluated the operations that patients had before appendectomy has been in the first place (14%), colorectal (9.4%) and genitourinary (7.6%) system surgery fallows appendix respectively. On the diagnosis and treatment of the patients who have mechanical bowel obstruction, the patients have to evaluate from various points. 55