Öz
Giriş
Pediyatrik akut karaciğer yetmezliği (PAKY), karaciğer fonksiyonlarının kısa sürede yerine getirilememesi sonucu gelişen, birden fazla organ sistemini etkileyebilen ve yaşamı ciddi biçimde tehdit eden bir hastalık tablosudur. Bu çalışmada, üçüncü basamak bir çocuk yoğun bakım ünitesine yatırılan PAKY tanılı çocukların etiyolojik dağılımları, yoğun bakım sürecindeki tedavileri ve klinik sonuçlarının değerlendirilmesi amaçlanmıştır.
Yöntemler
Ocak 2014 ile Aralık 2019 tarihleri arasında çocuk yoğun bakım ünitesine kabul edilen 53 PAKY tanılı çocuk geriye dönük olarak incelendi. Hastaların demografik özellikleri, hastalığa yol açan nedenler, uygulanan yoğun bakım tedavileri ve klinik sonuçları değerlendirildi.
Bulgular
En sık saptanan nedenler zehirlenme veya ilaca bağlı etiyolojiler (%43,4) ile nedeni belirlenemeyen olgular (%32,1) idi. Hastaların 20’sinde (%37,7) invaziv mekanik ventilasyon gereksinimi gelişti, 22’sine (%41,5) plazma değişimi uygulandı, 11’i (%20,8) sürekli böbrek destek tedavisi aldı ve 7 hastaya (%13,2) karaciğer nakli yapıldı. Çocuk yoğun bakım ünitesinde ortalama yatış süresi 7,4±9,0 gün olarak saptandı. Zehirlenme veya ilaca bağlı PAKY olgularında, diğer nedenlere bağlı olgulara kıyasla daha az yoğun bakım girişimi uygulandığı ve enfeksiyon gelişme oranlarının daha düşük olduğu görüldü (p<0,01).
Sonuç
PAKY tanılı çocuklarda erken tanı ve etkin destekleyici tedavi, klinik sonuçların iyileştirilmesinde belirleyici rol oynamaktadır. Zehirlenme veya ilaca bağlı PAKY olguları genellikle daha hafif bir klinik seyir göstermektedir. İzlem sürecinde hastalığın gidişatını gösteren bulguların düzenli olarak değerlendirilmesi, karaciğer nakli gereksiniminin zamanında belirlenmesi açısından büyük önem taşımaktadır.
Anahtar Kelimeler:
Pediyatrik akut karaciğer yetmezliği, çocuk yoğun bakım, hastalık gidişatı, karaciğer nakli, plazma değişimi
Kaynaklar
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