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Sendromunda perioperatif mortalite artar, nonkardiyak cerrahi kesinlikle gerekli ise
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RSHUDV\RQODUGD YHQWLODV\RQGD RSWLPDO NRQWURO VD÷ODPDVÕ QHGHQL LOH JHQHO DQHVWH]L WHUFLK
15
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Kaynaklar
1-Perioff JK, Warnes CA. Challenges posed by adults with repaired congenital heart disease.
Circulation 2001;103:2637-43
2-Cannesson M, Collange V, Lehot JJ. Anesthesia in adult patients with congenital heart
disease. Curr Opin Anaesthesiol 2009;22:88-94
3-Lee C, Mason L. Complications in pediatric anesthesia. Curr Opin Anaesthesiol 2006;19:262267
4-Cannesson M, Earing M.G, Collange V, Kersten J.D. Anesthesia for noncardiac surgery in
adults with congenital heart disease. Anesthesiology 2009;111:432-40
5-6PSHOPDQQ52VWKDXs W.A. The pediatric cardiac patient presenting for noncardiac
surgery. Curr Opin Anaesthesiol 2007;20:216-220
16
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tedavisinde yeni ufuklar. Turk Gogus Kalp Dama 2011;19(Suppl 2):27-32.
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$OÕúNDQOÕNODUÕQÕQ'H÷HUOHQGLULOPHVLGeriatri Dergisi 2001; 4: 100±6.
2.
http://www.akilciilac.gov.tr/content.php?Id=23.
3.
http://www.fda.gov/
4.
http://bulten.hasuder.org.tr/index.php/hg/article/download/291/488
5. Hug BL, Witkowski DJ, Sox, Colin M et al. Adverse Drug Event Rates in Six Community Hospitals and
the Potential Impact of Computerized Physician Order Entry for Prevention, Journal of General Internal
Medicine 2010; 25: 31±8.
6.
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10. Phillips DP. Morbidity and Mortality from Medical Errors: an Increasingly Serious Public Health
Problem. Annual Review of Public Health 2002; 23: 135-50.
11. 3ÕQDU1hONHPL]GHøODo+DUFDPDODUÕøQ|QhQLYHUVLWHVL7ÕS)DNOWHVL'HUJLVL 2012; 19: 59-65.
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Kaynaklar:
1. Slinger P, Kilpatrick B. Perioperative Lung Protection Strategies in Cardiothoracic
Anesthesia: Are They Useful? Anesthesiology Clin 30 (2012) 607±628
2. Searl CP, Perrino A. Fluid Management in Thoracic Surgery. Anesthesiology Clin 30
(2012) 641±655
3. Piette E, Daoust R, Denault A. Basic concepts in the use of thoracic and lung
ultrasound. Curr Opin Anaesthesiol 26 (2013) 20-30
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Kaynaklar:
1. Taylor CA: Surgical hypothermia. Pharmacol. Ther. 38: 169, 1988.
2. Garrat KN, Morgan JP. Cardiology Fundamentals and Practice 2nd. ed. Vol 2 Chap. 33,
1991;pp: 1150-58.
3. Cason B.A., Wisneski J.A., Neese R.A. Effects of high oxygen tension on function blood
flow distribution, and metabolism in ischemic myocardium. Circulation 1992 Feb; 85
(2): 828-38.
27
4. Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for
evaluating the results of surgery in acquired adult heart disease.Circulation
1989;79(suppl I):I-3-1-12.
5. Ranucci M, De Toffol B, Isgro G, Romitti F, Conti D, Vicentini M. Hyperlactatemia during
cardiopulmonary bypass:determinants and impact on postoperative outcome. Crit Care
Med 2006; 10(6)
6. Madias NE, Goorno We, Herson S: Severe lactic acidosis as a presenting feature of
pheochromocytoma. Am J Kidney Dis 1987; 10:250-253.
7. Demers P, Elkouri S, Martineau R, et al. Outcome with high blood lactate levels during
cardiopulmonary bypass in adult cardiac surgery. Ann Thorac Surg 2000;70:2082-2086
8. Raper RF, Cameron G, Walker D, et al. Type B lactic acidosis following cardiopulmonary
bypass. Crit Care Med 1997; 25:46-51. 4. Totaro R, Raper RF. Epinephrine induced
lactic acidosis
28
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35
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parametrelerini hesaba katmak gereklidir.
Loor G et all: Implications and management of anemia in cardiac surgery: Current state
of knowledge. J Thorac Cardiovasc Surg 2012; 144: 538-46
Spahn DR et all: Transfusion in the cardiac patient. Crit Care Clin 2004;20: 269-79
Vallet B et all: Venous oxygen saturation as a physiologic transfusion trigger. Critical
Care 2010; 14: 213-17
36
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Kaynaklar:
1- van Deursen VM, Damman K, Hillege HL, van Beek AP, van Veldhuisen DJ, Voors AA.
Abnormal liver function in relation to hemodynamic profile in heart failure patients. J
Card Fail. 2010 Jan;16(1):84-90.
2- Lau GT, Tan HC, Kritharides L.Type of liver dysfunction in heart failure and its relation
to the severity of tricuspid regurgitation. Am J Cardiol. 2002 Dec 15;90(12):1405-9.
3- Naschitz JE, Slobodin G, Lewis RJ, Zuckerman E, Yeshurun D. Heart diseases affecting
the liver and liver diseases affecting the heart. Am Heart J. 2000 Jul;140(1):111-20
38
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43
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5
7UDN\DhQLYHUVLWHVL 7ÕS)DNOWHVL.DOS9H'DPDU&HUUDKLVL$QD%LOLP'DOÕ(GLUQH
2
$0$d 7RUDNRWRPLLOH\DSÕODQRSHUDV\RQODUGDQVRQUDLQWUDYHQ|]KDVWDNRQWUROODQDOMH]Lø+.$
LOHPHSHULGLQYH\DPRUILQX\JXODPDODUÕQÕQKHPRGLQDPLNSDUDPHWUHOHUYHD÷UÕNRQWURO]HULQH
HWNLOHULQLQSRVWRSHUDWLIHUNHQG|QHPGHNDUúÕODúWÕUÕOPDVÕDPDoODQGÕ
*(5(d-<g17(0 140 hasta (ASA I-,,,SURVSHNWLIoDOÕúPDGDUDQGRPL]HPHSHULGLQ*UXS,YH
PRUILQ*UXS,,JUXSODUÕQDD\UÕOGÕ3RVWRSHUDWLILONVDDWWHNLø+.$NXOODQÕPÕ*UXS,¶GHPJ
\kleme dozu, 7 mg sa- ED]DOLQI]\RQ PJ EROXV GR]XQGD *UXS ,,¶GH LVH PJ \NOHPH
dozu, 0,5 mg sa- ED]DO LQI]\RQ PJ EROXV GR]XQGD X\JXODQÕUNHQ NLOLW ]DPDQ ¶HU
GDNLND\GÕ7RSODQDQYHULOHUVLVWROLNGLDVWROLNYHRUWDODPDNDQEDVÕQoODUÕNDOSDWÕPKÕ]ÕSXOVH
RNVLPHWUH VDWUDV\RQX YL]HO DQDORJ VNDOD 9$6 YH 5DPVH\ VHGDV\RQ VNDOD GH÷HUOHUL WRWDO
ve ek analjezikler ile yan etkilerdi.
BULGULAR: *UXS ,¶LQ VDDW 9$6 GH÷HUOHUL *UXS ,,¶\H J|UH DQODPOÕ GHUHFHGH
\NVHNWLS S S *UXSLoLNDUúÕODúWÕUPDODUGDKHULNLJUXSWDGDSRVWRSHUDWLI
ED]DO GH÷HUH J|UH GL÷HU WP VDDWOHUGHNL 9$6 GH÷HUOHUL LVWDWLVWLNVHO DQODPOÕ G]H\GH
GúNWS *UXS ,¶LQ WRWDO YH HN GR] PRUILQ WNHWLPL LQNRPSOHW NURV WROHUDQVD
J|UH
KHVDSODQDQ
PRUILQ
HúGH÷HU
GR]
NDUúÕOÕ÷Õ
*UXS
,,¶GHQ
\NVHN
EXOXQGXS S *UXS ,¶LQ SRVWRSHUDWLI VDDWOHUGHNL VLVWROLN YH RUWDODPD
NDQ EDVÕQFÕ GH÷HUOHUL LOH SRVWRSHUDWLI VDDW GLDVWROLN NDQ EDVÕQFÕ GH÷HUOHUL *UXS ,,¶GHQ
\NVHNWLS +LSRWDQVL\RQ LQVLGDQVÕ *UXS ,¶GH *UXS ,,¶GHQ GDKD
D]GÕS *UXS ¶GHQ ROJXGD VROXQXP GHSUHV\RQX JHOLúWL .DúÕQWÕ *UXS
¶GHROJXGD*UXS¶GHLVHROJXGDJ|]OHPOHQGL
6218d 7RUDNRWRPL D÷UÕVÕQGD ø+.$ \|QWHPL\OH YHULOHQ morfin tedavisi ile meperidinden daha
L\L DQDOMH]LN HWNLQOLN HOGH HGLOHELOLU 0RUILQ DQDOMH]LVLQGH KLSRWDQVL\RQ ROXúPDVÕ LODFÕQ ø+.$¶GD
NXOODQÕPÕQÕVÕQÕUODPDNWDYHGLNNDWOLELU\DNODúÕPÕJHUHNWLUPHNWHGLU
Anahtar Kelimeler: 7RUDNRWRPLD÷UÕKDVWDNRQWUROODQDOMH]LPHSHULGLQPRUILQ.
48
*UDILN,*UXSODUÕQ9L]HO$QDORJ6NDOD|NVUUNHQSUHRSHUDWLIED]DO
Student t testi, Mann-:KLWQH\8WHVWL*UXSODUDUDVÕNDUúÕODúWÕUPDGDS*UXS,¶GH
ED]DOGH÷HUHJ|UHS*UXS,,¶GHED]DOGH÷HUHJ|UHS
*UXSODUÕQSRVWRSHUDWLILONVDDWWHNLWRWDOYHHNDQDOMH]LNLODoWNHWLPOHUL
Meperidin
(n=70)
Morfin
(n=70)
7RWDOPHSHULGLQWNHWLPLPJ 7RWDOPRUILQWNHWLPLPJ
-
7RWDOPRUILQHúGH÷HUGR]PJ
P*
-
0,001*
(NPHSHULGLQWNHWLPLPJ
-
(NPRUILQWNHWLPLPJ
-

(NPRUILQHúGH÷HUGR]PJ

0,0001*
Diklofenak (mg)
150 mg
150 mg
AD
Parasetamol (mg)
3 gr
3 gr
AD
Efedrin (mg)

0,027*
Atropin (mg)

0,513
9HULOHURUWDODPD66RODUDNVXQXOPXúWXUNL-kare testi, student t testi ve Mann-Whitney U testi,
$'DQODPOÕGH÷LO*UXSODUDUDVÕNDUúÕODúWÕUPDGDSLVWDWLVWLNVHODQODPOÕ
49
S-03
(5øù.ø1$d,..$/3&(55$+ø6ø1'(121ø19$=ø975$16.87$1.$5%21'ø2.6ø7
021ø7g5ø=$6<218
3HULKDQ8oDU1*OoQ*D]LR÷OX1g]FDQ(UGHPOL3gPHU)DUXNdLoHN2$VOÕ'HPLU1
1
7UNL\H<NVHNøKWLVDV+DVWDQHVL$QHVWH]L.OLQL÷L
7UNL\H<NVHNøKWLVDV+DVWDQHVL.DOS&HUUDKLVL.OLQL÷L
3
$FÕEDGHPhQLYHUVLWHVL$QNDUD$FÕEDGHP+DVWDQHVL
2
*ø5øù
%X oDOÕúPDGD HULúNLQ DoÕN NDOS FHUUDKLVLQGH SURVSHNWLI RODUDN HQG WLGDO &2 DUWHUL\HO &2 YH
WUDQVNXWDQ&2PRQLW|UL]DV\RQXQXNDUúÕODúWÕUGÕN
METOD
$oÕN NDOS FHUUDKLVL JHoLUHQ $6$ -4 VÕQÕIÕ KDVWDQÕQ LQGNVL\RQ |QFHVL LQGNVL\RQ VRQUDVÕ
NDUGL\RSXOPRQHUED\SDV|QFHVLYHNDUGL\RSXOPRQHUED\SDVVRQUDVÕ&2GH÷HUOHULND\GHGLOGL
BULGULAR
<Dú RUWDODPDVÕ RODQ KDVWDQÕQ ¶ &$%* ¶ 095 ¶VL $95 YH VRQ ¶VL NRPELQH
SURVHGU LoLQ DPHOL\DWD DOÕQGÕ +DVWDODUÕQ ¶VL KLSHUWDQVLI ¶VÕ GL\DEHWLNWL øQGNVL\RQ
|QFHVL YH VRQUDVÕ G|QHPOHUGH KHU o &2 GH÷HUOHUL DUDVÕQGD IDUN EXOXQPD]NHQ
NDUGL\RSXOPRQHU ED\SDV |QFHVL YH VRQUDVÕQGDNL WUDQVNXWDQ &2 |OoPOHUL VÕUDVÕ\OD 27.6), arWHUL\HOVÕUDVÕ\OD-&2YHHQGWLGDO&2VÕUDVÕ\OD-GH÷HUOHULQGHQ
DQODPOÕúHNLOGHGúNEXOXQGX
7$57,ù0$
%X oDOÕúPDGD QRQLQYD]LY WUDQVNXWDQ|] &2¶QLQ NDUGL\RSXOPRQHU ED\SDV G|QHPLQLQ EDúODQJÕo
YHELWLúG|QHPOHULQGHHQGWLGDOYHDUWHU &2GH÷HUOHUL\OHNRUHODV\RQX ]D\ÕIEXOXQGX$UWHU YH
HQG WLGDO &2 DUDVÕQGD .3% G|QHPLQGH YHQWLODV\RQSHUI]\RQ X\XPVX]OX÷XQD ED÷OÕ JHOLúHQ
fark 3-PP+JLNHQWUDQNXWDQ|]|OoPGHEXIDUN-PP+JLGL%XJHQLúIDUNÕQ.3%VÕUDVÕQGD
uygulanan hipotermi, hemoGLOV\RQ LQIOPDWXDU VLWRNLQ VDOÕQÕPÕQD ED÷OÕ |GHP JLEL SDUPD÷ÕQ
SHULIHULNGRODúÕPÕQÕ]D\ÕIODWDQQHGHQOHUHED÷OÕROGX÷XGúQOG
6218d
6RQXo RODUDN GDKD oRN SHGLDWULGH NXOODQÕODQ YH LQWUDRSHUDWLI GH÷HUL KHQ] DUDúWÕUÕOPDNWD RODQ
WUDQVNXWDQ|] &2 PRQLW|UL]DV\RQXQXQ .3% NXOODQÕODQ DoÕN NDOS FHUUDKLVL ROJXODUÕQGD DUWHUL\HO
&2 LOH NRUHODV\RQXQX ]D\ÕI EXOGXN %X QHGHQOH ]DWHQ LQYD]LY DUWHU NDWHWHUL]DV\RQX \DSÕODQ
NDOS FHUUDKLVL DQHVWH]LVLQGH DUWHUL\HO NDQ JD]Õ |UQHNOHUL\OH &2 WDNLELQLQ GDKD X\JXQ ELU
\|QWHPRODFD÷ÕQÕGúQPHNWH\L]
Anahtar Kelimeler: WUDQVNXWDQ|] NDUERQGLRNVLW EDVÕQFÕ HQG WLGDO NDUERQGLRNVLW DoÕN NDOS
FHUUDKLVLDQHVWH]LPRQLW|UL]DV\RQX.
50
S-04
<h.6(.5ø6./ø+$67$'$$.6ø//2%ø)(025$/%YPASS GREFT UYGULAMASINDA
$1(67(=ø<g1(7ø0ø
Dilek Kutanis1(QJLQ(UWUN1$OL$NGR÷DQ1$KPHW%HúLU1$KPHW5Õ]Dg]NDQ1*|NDOS$OWXQ2
1
.DUDGHQL]7HNQLNhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$'7UDE]RQ
2
.DUDGHQL]7HNQLNhQLYHUVLWHVL7ÕS)DNOWHVL.DOSYH'DPDU&HUUDKLVL$'7UDE]RQ
*ø5øù
$NVLOORELIHPRUDO E\SDVV DPHOL\DWÕQGD JHQLú ELU FHUUDKL DODQÕ NDSVDGÕ÷ÕQGDQ VÕNOÕNOD JHQHO
DQHVWH]L X\JXODQÕU )DNDW FLGGL VLVWHPLN KDVWDOÕNODUÕ RODQ ROJXODUGD UHM\RQDO WHNQLNOHU WHUFLK
HGLOHELOLU %L] EX ROJXGD FLGGL LQWHUVWL\HO DNFL÷HU KDVWDOÕ÷Õ NRURQHU DUWHU KDVWDOÕ÷Õ
KLSHUWDQVL\RQX YH NURQLN E|EUHN \HWPH]OL÷L RODQ /HULFKH VHQGURPX QHGHQL\OH DNVLOORELIHPRUDO
E\SDVV\DSÕODFDNKDVWDPÕ]GDNLDQHVWH]LGHQH\LPLPL]LVXQPDNLVWHGLN
OLGU:
\DúÕQGDNL HUNHN KDVWDQÕQ SUHRSHUDWLI GH÷HUOHQGLULOPHVLQGH REVWUNWLI UHVWULNWLI SDWHUQGH
FLGGL DNFL÷HU KDVWDOÕ÷Õ NRURQHU DUWHU KDVWDOÕ÷Õ KLSHUWDQVL\RQX YH E|EUHN \HWPH]OL÷L ROGX÷X
|÷UHQLOGL %X KDVWDGD JHQHO DQHVWH]LQLQ ULVNOL ROGX÷X GúQOS LQWHUVNDOHQ EORN HSLGXUDO
DQHVWH]L\DSÕOPDVÕSODQODQGÕ+DVWD\D L2-3 seviyesinden epidural, C6 seviyesindan interskalen
NDWHWHU \HUOHúWLULOGL øQWHUVNDOHQ NDWHWHUGHQ PO HSLGXUDO NDWHWHUGHQ GH PO YROP LoLQGH
PJOHYREXSLYDNDLQPFJIHQWDQLOEROXVRODUDNYHULOGL&HUUDKLEDúODGÕNWDQVDDWVRQUD
LON GR]ODUÕQ \DUÕVÕ NDGDU LODYHOHUOH DQHVWH]L LGDPHVL VD÷ODQGÕ 2SHUDV\RQ VUHVLQFH PLGD]RODP
LOHVHGDWL]HHGLOHQKDVWD\DJUHIWLQFLOWDOWÕQGDQWQHOL]HHGLOGL÷LE|OJHOHUGHVHGRDQDOMH]LYHORNDO
DQHVWH]LN LQILOWUDV\RQODUÕ \DSÕOGÕ VDDW VUHQ RSHUDV\RQ ER\XQFD KDVWDQÕQ NDOS KÕ]Õ -84
DWÕPGN NDQ EDVÕQFÕ -135/65mmHg, SpO2:%96- DUDVÕQGD VH\UHWWL +HUKDQJL ELU
NRPSOLNDV\RQP JHOLúPH\HQ KDVWD\D SRVWRSHUDWLI G|QHPGH KHU LNL NDWHWHUGHQ KDVWD NRQWUROO
DQDOMH]LX\JXODQGÕ
6218d
%L]LP KDVWDPÕ]GDNL JLEL REVWUNWLI UHVWULNWLI SDWHUQGH FLGGL LQWHUVWLV\HO DNFL÷HU KDVWDOÕ÷Õ
NRURQHU DUWHU KDVWDOÕ÷Õ YH E|EUHN \HWPH]OL÷L RODQ ROJXODUGD JHQHO DQHVWH]LQLQ ULVNOHULQGHQ
NDoÕQPDN LoLQ HSLGXUDO DQHVWH]L JYHQOL ELU \|QWHP RODUDN WHUFLK HGLOHELOLU )DNDW
aksillobifemoral bypaV DPHOL\DWÕ HSLGXUDO DQHVWH]LQLQ \HWPH\HFH÷L NDGDU JHQLú DODQODUÕ LoHULU
%X \]GHQ KDVWDPÕ]GD HSLGXUDO DQHVWH]L\H LODYH RODUDN LQWHUVNDOHQ EORN X\JXODGÕN 6RQXo
RODUDN HSLGXUDO YH LQWHUVNDOHQ EORN JLEL LNL IDUNOÕ UHM\RQDO DQHVWH]L NRPELQDV\RQXQXQ
aksillobLIHPRUDOE\SDVVDPHOL\DWODUÕQGDL\LELUVHoLPRODELOHFH÷LNDQDDWLQGH\L]
Anahtar Kelimeler: DNVLOORELIHPRUDOHSLGXUDOLQWHUVNDOHQ\NVHNULVNOLKDVWD.
51
S-05
3(5.h7$1)(025$/$57(5.$1h/$6<218<$3,/ARAK VENO-$57(5ø<(/
EKSTRAKORPOREAL MEMBRAN 2.6ø-(1$7g5h7$.,/$1 <(7øù.ø1+$67$'$$/7
(.675(0ø7(3(5)h=<218181<(1ø'(16$ö/$10ASI
$\QXU&DPNÕUDQ1, Atilla Sezgin2, Arash Pirat1
1
%DúNHQWhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORML$%'$QNDUD
%DúNHQWhQLYHUVLWHVL7ÕS)DNOWHVL.DOS'DPDU&HUUDKLVLABD, Ankara
2
*ø5øù )HPRURDUWHUL\HO NDQODV\RQ VRQUDVÕ |]HOOLNOH DOW HNVWUHPLWH GLVWDOLQGH LVNHPL YH
NRPSDUWPDQ VHQGURPX J|UOHELOLU øVNHPL LKWLPDOLQL D]DOWPDNLoLQ oHúLWOL WHNQLNOHU NXOODQÕODUDN
LSVLODWHUDO HNVWUHPLWHQLQ UHSHUI]\RQX VD÷ODQPDNWDGÕU %XUDGD VSHUILV\DO IHPRUDO DUWHU
NDQODV\RQX \DSDUDN DOW HNVWUHPLWH UHSHUI]\RQX VD÷ODQDQ KDVWD VXQXOPDNWDGÕU
OLGU: \DúÕQGD KLSHUWDQVL\RQ GL\DEHWHV PHOOLWXV YH DWHURVNOHURWLN NDOS KDVWDOÕ÷Õ |\NV
RODQ HUNHN KDVWD VR÷XN WHUOHPH YH HSLJDVWULN D÷UÕ úLND\HWOHUL LOH DFLO VHUYLVLPL]H EDúYXUGX
+DVWD\D NDEXOQGHQ JQ VRQUD \DSÕODQ NRURQHU DQMLRJUDILVL VRQXFXQD J|UH PHGLNDO WDNLS
HGLOPHVLQH NDUDU YHULOGL $QFDN KDVWDGD D\QÕ JQ EDúOD\DQ VROXQXP VÕNÕQWÕVÕ HUWHVL JQ
úLGGHWOHQGL YH SXOPRQHU DUWHU EDVÕQFÕ PP+J¶\D NDGDU \NVHOGL <DSÕODQ
HNRNDUGL\RJUDILVLQGH PLWUDO \HWPH]OLN RODUDN VDSWDQPDVÕ VROXQXP \HWPH]OL÷LQLQ DUWPDVÕ
YH DNFL÷HU |GHPL JHOLúPHVL QHGHQL\OH SHUNWDQ IHPRUDO DUWHU YH YHQ NDQODV\RQODUÕ LOH
HNVWUDNRUSRUHDO PHPEUDQ RNVLMHQDW|U WDNÕOGÕ. Periferik tip veno-DUWHUL\HO (&02 WDNÕODQ
KDVWDGD IHPRUDO DUWHU NDQODV\RQXQGDQ JQ VRQUD DOW HNVWUHPLWH GLVWDOLQGH VROXNOXN
VR÷XNOXN JHOLúWL %XQXQ ]HULQH XOWUDVRQRJUDIL NÕODYX]OX÷XQGD )U NDQO VSHUILV\DO IHPRUDO
DUWHUH\HUOHúWLULOHUHNIHPRUDODUWHUGHNLNDQOGHQEDúNDELUKDWLOHUHWURJUDGDOWHNVWHUHPLWHQLQ
SHUI]\RQX VD÷ODQGÕ %LU JQ VRQUD \HWHUOL NDQ DNÕPÕQÕQ ROPDGÕ÷Õ GúQOHUHN )U NDQO )U
NDQOLOHGH÷LúWLULOGLEDFDNSHUI]\RQXQXQWDPDPHQG]HOGL÷LJ|UOG
6218d (&02 LoLQ \DSÕODQ IHPRUDO NDQODV\RQXQ QHGHQ ROGX÷X DUWHUL\HO \HWPH]OLN DOW
HNVWUHPLWHQLQ\HQLGHQSHUI]\RQXLOH|QOHQHELOLU3URILODNWLNVSHUILV\DODUWHULQNDQODV\RQXLVH
KHPLúOHPNROD\OÕ÷ÕQDKHPGHSHUIX]\RQSUREOHPL\DúDQPDPDVÕQDQHGHQROXU
Anahtar Kelimeler: ecmo, perkWDQIHPRUDONDQODV\RQLVNHPL.
52
S-06
ARDS'DE ECMO UYGULAMALARI
.DGLU'R÷UXHU 1LOIHUùHQEHFHULU<ÕOGÕ]<]EDúÕR÷OX
0HGLNDO3DUN%DKoHOLHYOHU+DVWDQHVL*HQHO<R÷XQ%DNÕPhQLWHVL
$5'6
GHKHGHIOHQHQYHQWLODV\RQXYHJD]GH÷LúLPLQLVD÷ODPDNLoLQPHNDQLNYHQWLODV\RQGHVWH÷L
VÕUDVÕQGD\NVHN3((3YH3,3LOHELUOLNWH\NVHN)L2GH÷HUOHULQHXODúÕOPDNWDGÕU*HUHN\NVHN
YHQWLODV\RQ EDVÕQo GH÷HUOHUL JHUHNVH \NVHN 2 GH÷HUOHUL ELU \DQGDQ YHQWLODV\RQ
SDUDPHWUHOHULQGH G]HOPH\L VD÷OÕ\RUNHQ ELU \DQGDQ GD EDURWUDYPD YROWUDYPD YH 2
KDVDUODQPDVÕ JLEL VRQXoODUD EXQD ED÷OÕ RODUDN PRUELGLWH\L DUWWÕUPDNWDGÕU (UNHQ G|QHPGH
NRUX\XFXYHQWLODV\RQVWUDWHMLOHULQLQWHUFLKL$5'6NOLQL÷LQGHGDKDKÕ]OÕVD÷DOWÕPÕQVD÷ODQPDVÕQD
\DUGÕPFÕROPDNWDGÕU
%XUDGD EHú DGHW ROJX VXQXOPDNWDGÕU 2OJXODUGDQ ELUL DUDo GÕúÕ WUDILN ND]DVÕ VRQUDVÕ PH\GDQD
JHOHQDNFL÷HUNRQW]\RQXDUGÕQGDQYHGL÷HUG|UWROJXLVHOREHUSQ|PRQLDUGÕQGDQJHOLúHQ$5'6
ROJXVXROXSEXROJXODUGDNRUX\XFXYHQWLODV\RQDPDFÕ\ODHUNHQSHUL\RGGD(&02X\JXODQGÕ<Dú
RUWDODPDVÕ RODQ EHúROJXGDQ
NDGÕQ VLHUNHNWL <NVHN 3((3 \NVHN 3,3 UHFUXLWPHQW
PDQHYUDODUÕ SURQH SR]LV\RQ X\JXODPDODUÕQD YH \NVHN )L2
\H UD÷PHQ HWNLQ YHQWLODV\RQ
VD÷ODQDPD\DQ YH KHGHIOHQHQ JD] GH÷LúLP RUDQODUÕ VD÷QDPD\DQ KDVWDODUD NDEXOOHrinden sonra
LON VDDW LoLQGH NRUX\XFX YHQWLODV\RQ DPDFÕ\OD 9-V ECMO (veno-YHQ|] HNVWUDNRUSRUHDO
PHPEUDQ RNVLMHQL]DV\RQX X\JXODQGÕ +DVWDGDQ oÕNDQ KDW Y MXJXODULV NDQODV\RQX KDVWD\D
JLGHQ KDW LVH Y IHPRUDOLV NDQODV\RQX LOH VD÷ODQGÕ øON DOWÕ VDDW LoLQGH S2 YH S&2
GH÷HUOHULQGHG]HOPHL]OHQHQKDVWDODUÕQYHQWLODV\RQEDVÕQoODUÕQGDJHULOHPH\DSÕOPD\DEDúODQGÕ
2UWDODPD JQ VUH\OH X\JXODQDQ (&02 X\JXODPDVÕQD GHYDP HGLOLUNHQ PHNDQLN
YHQWLODV\RQGHVWH÷L\DYDú\DYDúD]DOWÕODUDNVRQODQGÕUÕOGÕNWDQVRQUD(&02
GDQD\UÕOPDSODQODQGÕ
YHX\JXODQGÕ2OJXODUGDQELUL(UNHNMXJXOHUGHNDQODV\RQVRQUDVÕJHOLúHQNRPSOLNDV\RQODU
QHGHQL\OH HNOHQHQ oRN RUJDQ \HWPH]OL÷L VRQXFXQGD ND\EHGLOPLú GL÷HU ROJXODU SODQODQGÕ÷Õ
úHNLOGH PHNDQLN YHQWLODV\RQ GHVWH÷LQGHQ YH (&02 X\JXODPDVÕQGDQ D\UÕODUDN WDEXUFX
HGLOPLúOHUGLU
$5'6 ROJXODUÕQGD HUNHQ G|QHPGH (&02 X\JXODPDVÕ\OD PRUELGLWH YH PRUWDOLWHQLQ
D]DOWÕODELOHFH÷LNDQDDWLQHYDUÕOPÕúWÕU
Anahtar Kelimeler: ARDS, Koruyucu Ventilasyon, ECMO.
53
S-07
.$57$/<h.6(.ø+7ø6$S (öø7ø09($5$ù7,50$+$67$1(6ø&(55$+ø<2ö81
%$.,0h1ø7(6ø1'(9(175ø.8/'(67(.6ø67(0ø<$3,/$1+$67$/$5,1
.h/7h5/(5ø1ø1ø1&(/(10(6ø
Sibel Kaya1(FH$OWÕQD\32÷X].RQXNR÷OX2(NUHP<ÕOPD]2, Deniz Avan3&DQDQ*OHU3,
0XUDW5DEXú2, Ali Fedakar2, Mehmet Balkanay2, Zerrin Beykal1$\VX7UNPHQR÷OX4,
)XVQ*]HOPHULo3
1
.DUWDO.RúX\ROX<NVHNøKWLVDV(÷LWLPYH$UDúWÕUPD+DVWDQHVL(QIHNVL\RQ+DVWDOÕNODUÕYH.OLQLN
Mikrobiyoloji
2
.DUWDO.RúX\ROX<NVHNøKWLVDV(÷LWLPYH$UDúWÕUPD+DVWDQHVL.DUGL\RYDVNOHU&HUUDKL%|OP
3
.DUWDO.RúX\ROX<NVHNøKWLVDV(÷LWLPYH$UDúWÕUPD+DVWDQHVL$QHVWH]L5HDQLPDV\RQ.OLQL÷L
4
.DUWDO.RúX\ROX<NVHNøKWLVDV(÷LWLPYH$UDúWÕUPD+DVWDQHVL3HGL\DWUL%|OP
*ø5øù
.DOS\HWPH]OL÷LRODQKDVWDODUGDYHQWULNXOGHVWHNVLVWHPOHULKDVWDODUÕQKD\DWNDOLWHVLQLDUWÕUPDNOD
EHUDEHU LQIHNVL\RQ NRPSOLNDV\RQX GD EHUHEHULQGH JHWLUPHNWHGLU$VVLVW GHYLFH HQIHNVL\RQODUÕ
KDNNÕQGDVÕQÕUOÕPLNUREL\RORMLNYHHSLGHPL\RORMLNYHULOHUEXOXQPDNWDGÕU
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Anahtar Kelimeler: assist device, enfeksiyon.
54
S-08
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55
TABLO-1
TCI
Kontrol
p
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2/38
2 /21
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56
S-09
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8<*8/$1$10<$67(1ø$*5$9ø6/ø2/*8'$$1(67(=ø<g1(7ø0ø
Murat Aksun1, Volkan Kuru1, Ufuk Yetkin2, Senem Girgin1%LU]DW(PUH*|OER\X1$OL*UE]2,
Nagihan Karahan1
1
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2
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.OLQL÷Lø]PLU
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PJ PRUILQ YHULOGL %DúODQJÕo 72) GH÷HUL RODUDN VDSWDQDQ ROJX\D PJ URNXURQ\XP
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ROJXODUGD 10% LKWL\DFÕ EXOXQPDNWDGÕU %X GXUXP SRVWRSHUDWLI GHUOHQPHGH SUREOHP
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Anahtar Kelimeler: CABG cerrahisi, Myastenia gravis, TOF monitorizasyonu.
57
S-10
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Volkan Kuru1, Murat Aksun1, Nagihan Karahan1, Senem Girgin1$WLOODùHQFDQ1, Birzat Emre
*|OER\X1*OoLQ$UDQ12UKDQ*|NDOS2, Hasan Fatih Tanyeli1$OL*UE]2
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2
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operasyonu uygulanan 64 hastaya ait bilgiler retrospektif olarak incelendi.
BULGULAR: dDOÕúPD\DGDKLOHGLOHQKDVWDQÕQ¶LQ JHQHODQHVWH]LLOH¶
L Q UHM\RQHO DQHVWH]L LOH RSHUH ROGX÷X VDSWDQGÕ +DVWDODUÕQ \Dú RUWDODPDVÕ
idi.
.OHPS NDONPDVÕ VRQUDVÕ RUWDODPD DUWHU\HO EDVÕQo 2$% GH÷HUOHUL LOH RSHUDV\RQ VRQX 2$%
GH÷HUOHULUHM\RQHODQHVWH]LDOWÕQGDRSHUHRODQODUGDJHQHODQHVWH]LDOWÕQGDRSHUHRODQODUDJ|UH
DQODPOÕRODUDN\NVHNWL
+HU LNL JUXSWD NOHPS NDONPDVÕ VRQUDVÕ KHP VD÷ KHP GH VRO VHUHEUDO RNVLPHWUL GH÷HUOHULQLQ
\NVHOPHVL LVWDWLNVHO RODUDN DQODPOÕ EXOXQGX .OHPS NDONPDVÕ VRQUDVÕ YH RSHUDV\RQ VRQX VRO
VHUHEUDORNVLPHWULGH÷HUOHULUHM\RQHODQHVWH]LLOHRSHUHRODQKDVWDODUGDJHQHODQHVWH]LLOHRSHUH
RODQKDVWDODUGDQGDKD\NVHNEXOXQGX
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EDNÕOGÕ÷ÕQGD KHU LNL JUXS DUDVÕQGD LVWDWLVWLNVHO RODUDN DQODPOÕ ELU IDUN \RNWX 3RVWRSHUDWLI
NRPSOLNDV\RQ JHOLúLPL JHQHO DQHVWH]L LOH RSHUH HGLOHQ KDVWDODUGD UHM\RQHO DQHVWH]L LOH RSHUH
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WDNLS VUHOHUL NDUúÕODúWÕUÕOGÕ÷ÕQGD UHM\RQHO DQHVWH]L LOH RSHUH RODQ KDVWDODUÕQ GDKD NÕVD VUH
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PRUWDOLWH RUDQÕQÕQ GDKD D] ROPDVÕ \DQÕVÕUD KDVWDQÕQ X\DQÕN ROPDVÕ VHEHEL\OH LQWUDRSHUDWLI
Q|URORMLNNRPSOLNDV\RQODUÕQGDKDL\LGH÷HUOHQGLULOHELOPHVLUHM\RQHODQHVWH]L\|QWHPLQLQNDURWLV
HQGDUWHUHNWRPLRSHUDV\RQODUÕQGDWHUFLKHGLOHELOHFHNELU\|QWHPROGX÷XQXJ|VWHUPHNWHGLU
Anahtar Kelimeler: Karotis endarterektomi, genel anestezi, servikal blokaj.
58
Tablo 1: Postop Komplikasyon *HOLúHQ+DVWDODUÕQ'D÷ÕOÕPÕ
Genel Rejyonel
(n)
(n)
Hipertansiyon
6
3
.DQDPD\DED÷OÕUHYL]\RQ 1
1
%XODQWÕ-kusma
0
1
Exitus
2
0
1|URORMLN.RPSOLNDV\RQ
1
0
3RVWRS.RPSOLNDV\RQ*HOLúHQ+DVWDODUÕQ'D÷ÕOÕPÕ
59
60
*göh6.$/3'$0$5$1(67(=ø9(<2ö81%$.,0'(51(öø
8/86$/.21*5(6ø
6g=/h6818<$5,ù0$6,
17 MAYIS 2013, CUMA
11:30 ± 12:30
61
62
SSY-01
ON-PUMP KORONER ARTER B<3$66*5()7/(0(*(døREN HASTALARDA METAB2/ø.
SENDROMUN PULMONER .203/ø.$6<21/$5h=(5ø1((7.ø6ø
ùHEQHP%DQXùDUDo 7OD\gUNL$WDNDQ(UNÕOÕQo+DOLGH2÷Xú5H]DQ<DOWÕUÕN7XQFHU.RoDN
.DUWDO.RúX\ROX<NVHNøKWLVDV(÷LWLPYH$UDúWÕUPD+DVWDQHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ
.OLQL÷LøVWDQEXO
7P GQ\DGD PHWDEROLN VHQGURP VÕNOÕ÷Õ DUWPDNWDGÕU 0HWDEROLN VHQGURP NRPSRQHQWOHULQGHQ
RODQ REH]LWH GLVOLSLGHPL NDQ EDVÕQFÕ DUWÕúÕ KLSHUJOLVHPL KHU ELUL EHOLUJLQ RODUDN HQGRWHO
disfonksiyonuna neden olurlar. Hem metabolik sendrom hem de koroner arter bypass
greftleme operasyRQODUÕ SXOPRQHU IRQNVL\RQODUGD GH÷LúLNOLN PH\GDQD JHWLUHUHN SXOPRQHU
KDVWDOÕNODUÕQRUWD\DoÕNPDVÕQDQHGHQROXUODUdDOÕúPD\DNRURQHUDUWHUE\SDVVJUHIWOHPH&$%*
RSHUDV\RQX JHoLUHQ KDVWD GDKLO HGLOGL 0HWDEROLN VHQGURP WDQÕVÕ LoLQ EHO oHYUHVL
erkekOHUGH !FP NDGÕQODUGD!FP WULJOLVHULG G]H\L! PJGO +'/ G]H\LQLQ
HUNHNOHUGHPJGO NDGÕQODUGDPJGO NDQ EDVÕQFÕQÕQ ! PP+J DoOÕN NDQ
úHNHULQLQ! PJGOPDGGHOHULQGHQWDQHVLQLQEXOXQPDVÕNRúXOXQDEDNÕOGÕ7PKDVWDODUD
SUHRSHUDWLIKHPRJUDPYHEL\RNLP\DWHWNLNOHULYHVROXQXPIRQNVL\RQWHVWL\DSÕOGÕøQWUDRSHUDWLI
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edilene kadar ki seyirleri kaydedildi.
&$%* RSHUDV\RQX JHoLUHQ KDVWDQÕQ ¶LQGH PHWDEROLN VHQGURP VDSWDQGÕ +DVWDODU
metabolik sendromu olan [MetS(+)] ve olmayanlar [MetS(-@ RODUDN LNL\H D\UÕOGÕ
.DUGL\RSXOPRQHU E\SDVV VUHVL DRUWLN NURV NOHPS YH RSHUDV\RQ VUHVL DoÕVÕQGDQ LNL JUXS
benzer bulundu.
MetS (+) olan grupta YFXW NWOH LQGHNVL VHUXP OLSLG G]H\L GL\DEHW |\NV 0HW6 -) olan
JUXED J|UH DQODPOÕ RODUDN \NVHN EXOXQGX +DVWDODUÕQ \R÷XQ EDNÕPGD NDOÕú YH HNVWEDV\RQD
GHN JHoHQ VUHOHUL DoÕVÕQGDQ LNL JUXS DUDVÕQGD DQODPOÕ ELU IDUN EXOXQPDGÕ
MetS (+) olan grupta SRVWRSHUDWLI G|QHPGH DWHOHNWD]L YH SQ|PRQL J|UOPH \]GHVL YH
KDVWDQHGH NDOÕú VUHOHUL 0HW6 - JUXED J|UH DQODPOÕ RODUDN GDKD \NVHN EXOXQGX
6RQXo RODUDN PHWDEROLN VHQGURPXQ NRURQHU DUWHU E\SDVV JUHIW RSHUDV\RQX JHoLUHQOHUGH
postoperatif komplikasyonlDUGDQ DWHOHNWD]L ROXúXPX YH SQ|PRQL JHOLúLPL ]HULQH GDKD HWNLOL
ROGX÷XNDQÕVÕQDYDUGÕN
Anahtar Kelimeler: Koroner
komplikasyonlar
arter
bypass
greftleme,
Metabolik
senrdrom,
7DEOR,'HPRJUDILNYHULOHUYH(úOLNHGHQ+DVWDOÕNODU
Grup
Grup Met S (-) (n =108) Grup Met S(+) (n =245)
<Dú\ÕO

Cins (K/E)
22/86
27/218
Euro skoru

BMI (m2)

EF ( %)
48
50
Diyabetes Melitus (%)
6,1
55,2*
63
Pulmoner
Dislipidemi (%)
45,5
60,3*
Anstabil anjina
12
15
MI (%)
43,5
41,8
OAB (mmHg)
75,8
88,9*
6LJDUD|\NV
27,3
22,9
6ROXQXPVLVWHPLKDVWDOÕNODUÕ
14
18
5HQDOKDVWDOÕNODU
12
15
6HUHEUDOYDVNOHUKDVWDOÕNODU
1
3
3HULIHULNDUWHUKDVWDOÕ÷Õ
18
25
6RODQDNRURQHUDUWHUKDVWDOÕ÷Õ 2
3
*UHIWVD\ÕVÕ

*p<0.05
7DEOR,,øQWUDRSHUDWLI9HULOHU
Grup
Grup MetS(-) Grup MetS(+) p
&3%VUHVLGN

0,4
$..VUHVLGN

0,5

0,5
2SHUDV\RQ6UHVLGN
CPB: Kardiyopulmoner bypass, AKK: Aortik kros klemp
7DEOR,,,3XOPRQHU.RPSOLNDV\RQODUÕQGD÷ÕOÕPÕ
Grup
MetS (-) (n=108) MetS(+) (n=245)
Atelektazi
20
78*
3OHYUDOHII]\RQ
7
18
3Q|PRQL
2
16*
3XOPRQHU|GHP
8
18
3Q|PRWRUDNV
4
8
Hemotoraks
7
14
Pulmoner Emboli -
-
*p<0.05
64
SSY-02
752ø7&(55$+ø6ø1'(16215$326723(5$7ø)(5.(1'g1(0'(92.$/
.25'/$5,1'(ö(5/(1'ø5ø/0(6ø1'(<(1ø%ø57(.1ø.%21)ø/6(17hBASYON
)ø%(526.23ø
.DVÕP7X]FX10XUDW.DUFÕR÷OX1,úÕO'DYDUFÕ16HGDW+DNLPR÷OX1, Onur Koyuncu1,
$NÕQ$\GR÷DQ2, Muhyittin Temiz2&HQJL]dHYLN36HOLP7XUKDQR÷OX1
1
0XVWDID.HPDOhQLYHUVLWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ+DWD\
2
0XVWDID.HPDOhQLYHUVLWHVL*HQHO&HUUDKL+DWD\
3
0XVWDID.HPDOhQLYHUVLWHVL.XODN%XUXQ%R÷D]+DWD\
7URLW FHUUDKLOHULQGH DQHVWH]LVWLQ EDúOÕFD HQGLúHVL KDYD\ROX \|QHWLPL LOH LOJLOL SUREOHPOHU LNHQ
FHUUDKLLúOHPHED÷OÕRODUDNNDQDPDKLSRSDUDWURLGL]PYHUHNUUHQWODULQJHDOVLQLU5/1KDVDUÕ
JLEL NRPSOLNDV\RQODU VÕN J|UOU %X oDOÕúPD WURLW FHUUDKLVLQGHQ sonra postoperatif erken
G|QHPGH YRNDO NRUGODUÕQ GH÷HUOHQGLULOPHVL LoLQ X\JXODQDQ 0DFLQWRVK ODULQJRVNRSL LOH %RQILO
HQWEDV\RQ ILEHURVNRSL %,) WHNQLNOHULQLQ YRNDO NRUGODUÕ J|UQWOHPH EDúDUÕODUÕQÕ
NDUúÕODúWÕUPDN LoLQ GL]D\Q HGLOGL $\UÕFD KDVWD NRQIRUXQD YH KHPRGLQDPLN \DQÕWD HWNLOHUL
NDUúÕODúWÕUÕOGÕ (OHNWLI RODUDN WURLW FHUUDKLVL X\JXODQDFDN \DúODUÕ - DUDVÕQGD $6$ ,-II risk
JUXEX |WURLW WRSODP KDVWD oDOÕúPD\D DOÕQGÕ 3UHRSHUDWLI G|QHPGH ROJXODUÕQ PDOOHQSDWL
VÕQÕIODPDVÕ WLURPHQWDO PHVDIH VWHUQRPHQWDO PHVDIH PDNVLPXP D÷Õ] DoÕNOÕ÷Õ ER\XQ oHYUHVL
ER\XQ HNOHPLQLQ KDUHNHWOLOL÷L ND\GHGLOGL %WQ ROJXODUD DQHVWH]L LQGNVL\RQXQGD HQWEDV\RQ
LoLQ 0DFLQWRVK ODULQJRVNREXQ X\JXQ ER\GDNL EODGH¶L NXOODQÕOGÕ &RUPDFN DQG /HKDQH VNRUX LOH
JORWWLVLQ J|UQú ND\GHGLOGL 7P KDVWDODUGD HNVWEDV\RQ VRQUDVÕ YRNDO NRUGODUÕQ J|UQP
KHPPDFLQWRVKODULQJRVNRSODKHPGH%,)LOHGH÷HUOHQGLULOGL&RUPDFK-Lehane skoru not edildi.
+DVWDODUÕQ PDFLQWRVK ODULQJRVNRS YH %,) WHNQLNOHULQH NDUúÕ YHUGLNOHUL UHDNVL\RQODU EHú SXDQOÕ
KDVWD UHDNWLYLWH VNRUX LOH GH÷HUOHQGLULOGL $\UÕFD KHPRGLQDPLN \DQÕW ND\GHGLOGL %X oDOÕúPDGD
WUDNHDO HNVWEDV\RQ VRQUDVÕ YRNDO NRUGODUÕQ J|UQWOHQPHVLQGH %,) 0DFLQWRVK ODULQJRVNRED
J|UH LVWDWLVWLNVHO RODUDN GDKD EDúDUÕOÕ EXOXQGX S %,) LOH ³KDVWD UHDNWLYLWH VNRUX´QXQ
0DFLQWRVKODULQJRVNREDJ|UHLVWDWLVWLNVHORODUDNGDKDGúNROGX÷XJ|]OHQGL$\UÕFD0DFLQWRVK
ODULQJRVNRSL HVQDVÕQGDNL 0$3 %,)¶D J|UH LVWDWLVWLNVHO RODUDN DUWPÕúWÕ S 6RQXo RODUDN
WURLW FHUUDKLVLQGHQ VRQUD WUDNHDO HNVWEDV\RQXQ HUNHQ G|QHPLQGH YRNDO NRUGODUÕQ
GH÷HUOHQGLULOPHVL HVQDVÕQGD %,)¶ ÕQ 0DFLQWRVK ODULQJRVNRSWDQ GDKD L\L JORWWDO J|Uú VD÷OD\ÕS
GDKD D] KDVWD UDKDWVÕ]OÕ÷ÕQD YH KHPRGLQDPLN \DQÕWD QHGHQ ROGX÷X J|UOG %,)¶ ÕQ JHQHO
DQHVWH]LGHQ X\DQPD HVQDVÕQGD YRNDO NRUGODUÕQ J|UQWOHQPHVLQGH L\L ELU VHoHQHN RODELOHFH÷L
NDQÕVÕQDYDUÕOGÕ
Anahtar Kelimeler: YRFDONRUG%RQILOVHQWEDV\RQILEHURVNRSLWURLWFHUUDKLVL.
65
SSY-03
.21-(1ø7$/.$/3&(55$+ø6ø8<*8/$1$13('ø<$75ø.2/*8/$5'$
+ø323(5)h=<217$.ø%øNDE SEREBRAL 2.6ø0(75ø.8//$1,0,
Fatma Ukil1)LOL]&RúNXQ1, 7UNDQ.XGVLR÷OX1, Zeliha Tuncel1, Sezer Karabulut1,
%X÷UD+DUPDQGDU21LKDQ<DSÕFÕ1=XKDO$\NDo1
1
6L\DPL(UVHN*.'&(÷LWLPYH$UDúWÕUPD+DVWDQHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ.OLQL÷L
øVWDQEXO
2
Siyami (UVHN*.'&(÷LWLPYH$UDúWÕUPD+DVWDQHVL.DOSYH'DPDU&HU.OLQL÷LøVWDQEXO
.RQMHQLWDONDOSFHUUDKLVL\DSÕODQKDVWDODUGDGRNXYH RUJDQSHUI]\RQXQXQ\HWHUOLOL÷LYHEXQXQ
WDNLEL FHUUDKL DQHVWH]L YH SHUI]\RQ WHNQLNOHULQGH JHOLúPHOHUH NDUúÕQ NDOS FHUUDKLVLQLQ |QHPOL
VRUXQODUÕQGDQ ROPD\D GHYDP HWPHNWHGLU g]HOOLNOH NRQMHQLWDO NDOS FHUUDKLVL YH VRQUDVÕQGD
\HWHUVL] SHUI]\RQD ED÷OÕ KLSRNVHPL YH LVNHPL VÕNOÕNOD J|]OHQPHNWHGLU 3HGL\DWULN ROJXODUÕQ
SHUI]\RQ \HWHUOLOL÷LQLQ SHURSHUDWLI G|QHPGH GH÷HUOHQGLULOPHVLQGH LQYD]LY DUWHU NDQ EDVÕQFÕ
VDQWUDO YHQ EDVÕQFÕ WDNLEL JLEL KHPRGLQDPLN PRQLWRUL]DV\RQ \DQÕQGD NDQ JD]ODUÕ DQDOL]L NDQ
ODNWDW G]H\LQLQ UXWLQWDNLEL YH VDDWOLN LGUDU WDNLEL \DSÕOPDNWDGÕU %X PRQLWRUL]DV\RQ WHNQLNOHUL
LOH FHUUDKL HVQDVÕQGD ROXúDELOHFHN KDVDUÕQ HQ D]D LQGLULOPHVL DPDoODQPDNWDGÕU .RQMHQLWDO
NDOS FHUUDKLVLQGH JOREDO SHUI]\RQX GH÷HUOHQGLUPHN JHUHNPHNWHGLU +LSRSHUI]\RQD ED÷OÕ
PH\GDQDJHOHQNRPSOLNDV\RQODUKDVWDQHGHNDOÕúVUHVLQLX]DWPDNWDRQELQOHUOHLIDGHHGLOHELOHQ
PDOL\HWLDUWWÕUPDNWDGÕU
$PDFÕPÕ] oDOÕúPDPÕ]GD NRQMHQLWDO NDOS FHUUDKLVL X\JXODQDQDFDN SHGL\DWULN KDVWDODUGD
VHUHEUDO RNVLPHWUL PRQLW|UL]DV\RQX X\JXODPDVÕQÕQ VHUHEUDO RNVLMHQ GHQJHVL]OL÷LQL WDQÕPODPD
JHUHNOL G]HOWLFL JLULúLPOHULQ JHUoHNOHúWLULOPHVL YH JHUL ELOGLULP PHNDQL]PDVÕ LOH VHoLOHQ WHGDYL
\|QWHPLQLQHWNLQOL÷LQLQEHOLUOHQPHVLGLU
+DVWDODUÕQ \Dú NLOR 9<$FLQVL\HW NDOS DWÕP KÕ]Õ RUWDODPD DUWHU EDVÕQFÕ VDQWUDO YHQ EDVÕQFÕ
YFXWÕVÕVÕ3D&23D2)ø26D2laktat, hemoglobin ve Serebral oksimetri (FORE-SIGHT)
\]GHVL VD÷- VRO HNVWEDV\RQ VUHVL \R÷XQ EDNÕP YH KDVWDQHGH NDOÕú VUHOHUL ND\GHGLOGL
Serebral
oksimetri
(FORE-SIG+7
\]GHVL
VD÷-VRO
GH÷HUOHUL
hemoglonin,
laktat,ScVO2.PaCO2,OAB ile korelasyonuQDEDNÕOGÕ
2OJXODUÕQ ODNWDW YH KHPRJORELQ GH÷HUOHUL LOH VHUHEUDO RNVLPHWUL |OoPOHUL DUDVÕQGD NRUHODV\RQ
VDSWDQPÕúWÕU
.RQMHQLWDO NDOS FHUUDKLVL \DSÕODQ PHUNH]OHUGH KLSRSHUI]\RQX EHOLUOHPH\H \|QHOLN VLVWHPOHULQ
NXOODQÕOPDVÕ JLGHUHN \D\JÕQODúPDNWDGÕU (WNLOL ELU GH÷HUOHQGLUPH VLVWHPLQLQ |QHPL JLGHUHN
DUWPDNWDGÕU
6RQXo RODUDN NRQMHQLWDO NDOS FHUUDKLVL X\JXODQDQ ROJXODUGD LQWUDRSHUDWLI G|QHPGH SHUI]\RQ
WDNLELQGHVHUHEUDORNVLPHWUHGH÷HUOHUL|QHPOLELUJ|VWHUJHGLU
Anahtar Kelimeler: serebral oksimetri, Konjenital kalp FHUUDKLVLKLSRSHUI]\RQ
66
SSY-04
KORONER ARTER BYPASS &(55$+ø6ø1'(725$.$/ (3ø'85$/$1$/-(=øø/E
'(.60('(720ø'ø1ø1)h=<218181326723(5$7ø)(7.ø/(5ø1ø1
.$5ù,/$ù7,5,/0$6,
(QJLQ(UWUN1, Sibel Tetik1, Dilek Kutanis1$OL$NGR÷DQ1øVPHW'XUPXú2*|NDOSAltun3,
$KPHW%HúLU1$KPHW(UR÷OX1
1
.DUDGHQL]7HNQLNhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$'
2
.DUDGHQL]7HNQLNhQLYHUVLWHVL7ÕS)DNOWHVL.DUGL\RORML$'
3
.DUDGHQL]7HNQLNhQLYHUVLWHVL7ÕS)DNOWHVL.DOSYH'DPDU&HUUDKLVL$'
*ø5øù
7RUDNDO FHUUDKLOHUGH DOWÕQ VWDQGDUW RODUDN WDQÕPODQDQ HSLGXUDO DQDOMH]LQLQ DoÕN NDOS FHUUDKLVL
VRQUDVÕ NDUGL\RSXOPRQHU ROXPOX HWNLOHUL\OH L\L ELU KHPRGLQDPL VD÷ODGÕ÷Õ YH SXOPRQHU
NRPSOLNDV\RQODUÕ D]DOWWÕ÷Õ YXUJXODQPÕúWÕU 'HNVPHGHWRPLGLQ LVH DoÕN NDlp cerrahisinde
SRVWRSHUDWLI G|QHPGH VHGDV\RQ YH DQDOMH]L\L ELUOLNWH VD÷OD\DQ ROGXNoD HWNLOL Į-2 agonist bir
LODoWÕU %X oDOÕúPDGD NRURQHU DUWHU E\SDVV FHUUDKLVLQGH WRUDNDO HSLGXUDO DQDOMH]L LOH
GHNVPHGHWRPLGLQ LQI]\RQXQXQ SRVWRSHUDWLI HWNLOHULQLQ NDUúÕODúWÕUÕOPDVÕ DPDoODQPÕúWÕU
METOD:
.RURQHU E\SDVV \DSÕODFDN KDVWD HSLGXUDO DQDOMH]L YH GHNVPHGHWRPLGLQ LQI]\RQ JUXEX
*UXS( *UXS' RODUDN LNL\H D\UÕOGÕ (SLGXUDO JUXEXQ NDWHWHUL]DV\RQX LQGNVL\RQ |QFHVL
\DSÕOGÕ 7P KDVWDODUÕQ LQGNVL\RQX WL\RSHQWDO (4-PJNJ IHQWDQLO JNJ YH URNXURQ\XP
PJNJ LOH \DSÕOÕS LGDPH RNVLMHQ-KDYD NDUÕúÕPÕ LoLQGH - VHYRIOXUDQ LOH VD÷ODQGÕ
(SLGXUDO JUXED FHUUDKL EDúODQJÕFÕQGDQ SRVWRSHUDWLI VDDWH NDGDU GHYDP HGHQ -10 mg/sa
OHYREXSLYDNDLQLQI]\RQX\DSÕOGÕ'L÷HUJUXEXQLQWUDRSHUDWLIDQDOMH]LVL-JVDIHQWDQLOLOH
VD÷ODQÕS SRVWRSHUDWLI G|QHPGH VDDWH NDGDU GHYDP HGHQ -JNJVD
GHNVPHGHWRPLGLQ LQI]\RQX \DSÕOGÕ +DVWDODUÕQ GHPRJUDILN YH KHPRGLQDPLN YHULOHUL NDQ
JD]ODUÕ 9$6 GH÷HUOHUL YH HNVWEDV\RQ VUHOHUL ND\GHGLOGL 3RVRSHUDWLI VDDWH NDGDU +ROWHU
PRQLW|UL]DV\RQX \DSÕOÕS VWUHV \DQÕW |OoP LoLQ DQHVWH]L |QFHVL SRVWRSHUDWLI YH VDDWWH
NRUWL]ROYH$&7+G]H\OHULQHEDNÕOGÕ
BULGULAR:
*UXSODUÕQ GHPRJUDILN YH KHPRGLQDPLN YHULOHUL NDQ JD]ODUÕ YH HNVWEDV\RQ VUHOHUL DUDVÕQGD
IDUNEXOXQPDGÕ*UXS(¶GHNRUWL]ROYH$&7+G]H\OHULSRVWRSHUDWLIVDDWWH*UXS'¶GHQGúN
EXOXQGX 7DEOR 9$6 GH÷HUOHUL *UXS'¶GH *UXS(¶GHQ GúN EXOXQGX 7DEOR $ULWPL
DoÕVÕQGDQJUXSODUDUDVÕQGDIDUNEXOXQPDGÕ7DEOR
7$57,ù0$
6WUHV KRUPRQ DUWÕúÕ *UXS(¶GH GDKD D] ROPDVÕQD UD÷PHQ KHU LNLJUXSWD GD 9$6 GH÷HUOHUL ¶Q
DOWÕQGD NDOPÕú YH NOLQL÷H \DQVÕ\DQ NDUGL\RSXOPRQHU ELU IDUNOÕOÕN J|UOPHPLúWLU %XQXQ
sonucunda gerek epidural analjezi gerekse deksmedHWRPLGLQ LQI]\RQXQXQ EHQ]HU HWNLOHUH
VDKLSROGX÷XNDQDDWLQHYDUÕOPÕúWÕU
Anahtar Kelimeler: deksmedetomidin, epidural analjezi, koroner bypass
67
$&7+GH÷HUOHUL2UWDODPD6WDQGDUWVDSPD
Preoperatif
Postoperatif 4. saat Postoperatif 12. saat
Grup E

Grup D

3GH÷HUL 0,162
0,03
0,13
.RUWL]ROGH÷HUOHUL2UWDODPD6WDQGDUWVDSPD
Preoperatif
Postoperatif 4. saat Postoperatif 12. saat
Grup E 8,94

Grup D

3GH÷HUL 0,288
0,239
0,028
(NVWEDV\RQVRQUDVÕ9$6GH÷HUOHUL2UWDODPD6WDQGDUWVDSPD
30. dk
1. saat
2. saat
4. saat
6. saat
12. saat
24. saat
48. saat
Grup E

0,92

0,97

1,09

1,07

0,98

0,90

0,48
Grup D

1,53

1,47

1,20

1,25

1,34

1,07

0,77

0,56
0,003
0,020
0,011
0,005
0,002
0,03
0,47
3GH÷HUL 0,001
$ULWPLQLQYDUOÕ÷Õ
3RVWRSHUDWLIJQ 3RVWRSHUDWLIJQ
Grup E
Var: 8
Yok: 12
Var: 9
Yok: 11
Grup D
Var: 9
Yok: 11
Var: 9
Yok: 11
3GH÷HUL 0,88
0,97
68
SSY-05
$57(5ø<(/6:ø7&+$0(/ø<$7/$5,8<*8/$1$1<(1ø'2ö$1/$5'$0ø'$=OLAM VE
6(92)/85$1,10ø<2.$5'.25810$6,h=(5ø1( (7.ø/(5ø1ø1
.$5ù,/$ù7,5,/0$6,g16218d/$5,0,=
$\QXU&DPNÕUDQ10HOLV7UNHU1&RúNXQ$UD]10XUDWg]NDQ2, Arash Pirat1
1
%DúNHQWhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORML$%'$QNDUD
%DúNHQWhQLYHUVLWHVL7ÕS)DNOWHVL.DOS'DPDU&HUUDKLVL$%'$QNDUD
2
*ø5øù .DUGL\RSXOPRQHU ED\SDV NSE VUHVL X]D\DQ KDVWDODUGD |]HOOLNOH \HQLGR÷DQODUGD
SHULRSHUDWLIP\RNDUGKDVDUÕSRVWRSHUDWLINDUGL\DNGLVIRQNVL\RQROXúXPXQXHWNLOH\HQHQ|QHPOL
IDNW|UOHU DUDVÕQGD \HU DOÕU (ULúNLQ NDUGL\DN FHUUDKLOHUGH GDKD |QFH \DSÕODQ oDOÕúPDODU
LQKDODV\RQ DMDQODUÕQÕQ NDUGL\RSURWHNWLI HWNLOHULQLQ RODELOHFH÷LQL J|VWHUPLúWLU $QFDN SHGL\DWULN
NDOS FHUUDKLOHULQGH LQKDODV\RQ DMDQODUÕQÕQ NDUGL\RSURWHNWLI HWNLVL ]HULQH \DSÕOPÕú NDSVDPOÕ ELU
oDOÕúPDEXOXQPDPDNWDGÕU
dDOÕúPDQÕQ DPDFÕ E\N Drter transpozisyonu (TGA) nedeniyle arteriyel switch operasyonu
$62 \DSÕOPDVÕ SODQODQDQ \HQLGR÷DQODUGD PLGD]RODP YH VHYRIOXUDQÕQ NDUGL\RSURWHNWLI
HWNLOHULQLNDUúÕODúWÕUPDNWÕU
METOD: Haziran 2011-6XEDW WDULKOHUL DUDVÕQGD oDOÕúPD\D GDKLO RODQ \HQLGR÷DQÕQ
VRQXoODUÕ \HU DOPDNWDGÕU <HQLGR÷DQODU UDQGRPL]H RODUDN VHYRIOXUDQ Q YH PLGD]RODP
Q ROPDN ]HUH JUXED D\UÕOGÕ 0LGD]RODP JUXEXQGD \HU DODQ \HQLGR÷DQODU FHUUDKL
VUHVLQFH PJNJVW PLGD]RODP LQI]\RQX YHULOGL 6HYRIXODQ JUXEXQGDNLOHUH ise end-tidal
konsantrasyonu %1-RODFDNúHNLOGHVHYRIOXUDQLQWUDRSHUDWLIYHULOGL6HUXPNDUGL\DNWURSRQLQ-I
(cTn-, G]H\LQH LQVL]\RQ \DSÕOPDGDQ |QFH FHUUDKL ELWLPLQGH SRVWRSHUDWLI YH VDDWOHUGHROPDN]HUHWRSODPNH]EDNÕOGÕ
BULGULAR: 'HPRJUDILN|]HOOLNOHULDRUWNOHPSNSEYHFHUUDKLVUHOHULEHQ]HURODUDNVDSWDQGÕ
KHSVL LoLQ S! +HU LNL JUXEXQGD EDúODQJÕo VHUXP F7Q-I seviyeleri benzer bulundu
S!+HULNLJUXEXQEDúODQJÕoGH÷HUOHULLOHGL÷HU|OoP ]DPDQÕNDUúÕODúWÕUÕOGÕ÷ÕQGDJUXS
LoL IDUNOÕOÕN VDSWDQÕUNHQ S JUXSODU DUDVÕQGD IDUN EXOXQPDGÕ S! 3HULRSHUDWLI
NXOODQÕODQVÕYÕPLNWDUÕLGUDUoÕNÕúÕKHPRGLQDPLNSDUDPHWUHOHUSR]LWLILQRWURSGR]ODUÕPHNDQLN
YHQWLODV\RQVUHVLYH\R÷XQEDNÕPQLWHVLQGHNDOPDLOHKDVWDQH\DWÕúVUHOHULEHQ]HUEXOXQGX
KHSVLLoLQS!
6218d dDOÕúPDPÕ]ÕQ |Q VRQXoODUÕQD J|UH 7*$ QHGHQL\OH $62 X\JXODQDFDN \HQLGR÷DQODUGD
VHYRIOXUDQÕQNDUGL\RSURWHNWLIHWNLVLPLGD]RODPGDQGDKDID]ODGH÷LOGLU
Anahtar Kelimeler: konjenital kalp cerrahisi, miyokardiyal korunma, troponin-,DQHVWH]LN|Q
NRúXOODPD
69
SSY-06
(5øù.ø1.$/3&(55$+ø6ø1'(67$1'$57021ø7g5ø=$6<21/$0ø.52
6ø5.h/$6<21'(ö(5/(1'ø5ø/(%ø/ø50ø"
Fevzi Toraman1=HKUD6HUSLO8VWDODUg]JHQ13ÕQDU*oO2, Esin Erkek2, -OLGH6D\ÕQ Kart1,
8÷XU$NVX3&HP$UÕWUN2*O0HWH20XUDWgNWHQ2ùDKLQùHQD\4(úUHI+DVDQ.DUDEXOXW4,
Cem Alhan4
1
$FÕEDGHPhQLYHUVLWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$QDELOLP'DOÕ
2
$FÕEDGHP.DGÕN|\+DVWDQHVL.DOS'DPDU&HUUDKLVL.OLQL÷L
3
øVWDQEXOhQLYHUVLWHVL)HQ)DNOWHVL%L\RORML%|OP
4
$FÕEDGHPhQLYHUVLWHVL.DOS'DPDU&HUUDKLVL$QDELOLP'DOÕ
$0$d
(NVWUDNRUSRUHDO GRODúÕP (.' VÕUDVÕQGD NDQÕQ \DEDQFÕ \]H\H WHPDVÕQD ED÷OÕ PHGLDW|U
VDOÕQÕPÕQÕQ DUWPDVÕ DNÕPÕQ QRQ-SXOVDWLO ROPDVÕ KHPRGLOV\RQ YH KLSRWHUPLQLQ X\JXODQPDVÕ
PLNURVLUNODV\RQXQ ER]XOPDVÕQD QHGHQ RODELOLU 6WDQGDUW PRQLWRUL]DV\RQ SDUDPHWUHOHULQLQ
QRUPDO VÕQÕUODUGD ROPDVÕQD UD÷PHQ PLNURVLUNODV\RQXQ ER]XODELOPHVL PLNURVLUNODV\RQXQ
JHOLúPLúFLKD]ODUODL]OHQPHVLQLJHUHNWLUPHNWHGLU,QVSHFWUD6WR tissue oxygenation (Hutchinson
7HFKQRORJ\EXDPDoODNXOODQÕODQELUFLKD]GÕUdDOÕúPDPÕ]GDLQWUDRSHUDWLIYHHUNHQSRVWRSHUDWLI
G|QHPGH PLNURVLUNODV\RQX L]OH\HUHN PLNURVLUNODV\RQXQ ER]XOPD SRWDQVL\HOL HQ ID]OD RODQ
G|QHPL YH PLNURVLUNODV\RQOD NRUHOH RODQ GL÷HU KHPRGLQDPLN YH NDQ JD]Õ SDUDPHWUHOHULQL
EXOPD\ÕDPDoODGÕN
MATERYAL-METOD:
hQLYHUVLWHPL]HWLNNXUXOXYHKDVWDRQDPODUÕQÕDOÕQDQHOHNWLINRURQHUED\SDVFHUUDKLVLJHoLUHFHN
KDVWD\Õ oDOÕúPD\D DOGÕN 6WDQGDUW PRQLW|UL]DV\RQ VHUHEUDO RNVLMHQ saturasyonu (rSO2) ve
NDQ JD]ÕWDNLSOHUL \DSÕODFDN KDVWDODUD D\UÕFD PLNURVLUNODV\RQXQ WDNLELDPDFÕ\OD GRNX RNVLMHQ
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,VÕQPD
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,VÕ&

.DOSKÕ]Õ
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-
-

MAP
(mmHg)

PCO2
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PO2
(mmHg)

Hct (%)

Laktat

Sto2 (%)

RSO2 %
GH÷
0

-
-
-
-
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LSO2 %
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-
-
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71
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bulundu (p0,05). Kreatin klirensi anlamlÕ úekilde yksek bulundu (p0,05). Dopamin
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Anahtar
Kelimeler: Dopamin,
Kardiak
cerrahi,
N
Asetil
Sistein,
3DLU77HVWLOHLNLJUXEXQNUHDWLQGH÷HUOHULQLQNDUúÕODúWÕUÕOPDVÕ
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N Asetil Sistein Dopamin
Preoperatif

P
0,87
3RVWRSHUDWLI*Q
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0,001
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Kreatin Klirensi
N Asetil Sistein Dopamin
P
Preoperatif

0,14

3RVWRSHUDWLI*Q
0,001
3RVWRSHUDWLI*Q
0,001
72
Renal
Koruma
SSY-08
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7$57,ù0$
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OAB (mmHg)
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Hb (g/dl)
Hct (%)
øQG
gQFHVL
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6RQUDVÕ
EKD
20.dk
EKD Sonu
Post-op
2.saat
Post-op
4.saat
Grup
I
3.2

-

Grup
II

-

Grup
I

Grup
II

x

Grup
I

Grup
II

Grup
I

Grup
II

[
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[S7UDQVI]\RQJUXEXQDJ|UH
74

x

Tablo 2
Post-op 6.saat
Post-op
24.saat
Grup I
+
-
Grup
II

-
Grup I

++
Grup
II

Grup I

Grup
II

Grup I

Grup
II

Grup I

Grup
II

Grup I 122.9

Grup
II

105.6

173.6
Grup I

***
Grup
II

Grup I -

136.7

Grup
II
-
237.0

Pre-op
NGAL (ng/ml)
GFR (ml/dk/1,73 m2)
Kreatinin (mg/dl)
hUHPJGO
)1DLWUDKÕ
(%)
LOHULRNVLGHSURWHLQUQOHUL
(AOPP)(umol/l)
Total tiyol (nmol/l)
6ÕYÕGHQJHVLPO

x**

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77
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79
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81
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7+(&217ø18286 86(2)7+25$&ø&(3ø'85$/$1$/*(6ø$9(5686ø17(5&267$/
%/2&.)253$ø10$1$*EMENT AFTER THORACOTOMY
*|QO6D÷ÕUR÷OX1, Ayse Baysal2, Osman Gazi Kiraz27DPHU6D÷ÕUR÷OX3, Burhan Meydan4,
Ahmet Erdal Tasci5
1
Department of Anesthesiology, Trakya University, Faculty of Medicine, Edirne - TURKEY
'HSDUWPHQWRI$QHVWKHVLRORJ\7UNL\H<NVHNøKWLVDV7UDLQLQJDQG5HVHDUFK+RVSLWDO
øVWDQEXO- TURKEY
3
Department of General Surgery, Trakya University, Faculty of Medicine, Edirne - TURKEY
4
Department of Anesthesiology, Sureyyapasa Chest Disease and Thoracic Surgery Hospital,
øVWDQEXO- TURKEY
5
'HSDUWPHQWRI7KRUDFLF6XUJHU\7UNL\H<NVHNøKWLVDV7UDLQLQJDQG5HVHDUFK+RVSLWDO
øVWDQEXO
2
AIM: We aimed to compare the efficacy of continuous use of thoracic epidural and intercostal
block methods for post-thoracotomy pain.
MATERIALS-METHODS: Sixty patients completed a prospective, randomized, double-blinded
study. Patients were randomized to receive thoracic epidural (Group 1, n=30) or intercostal
block (Group 2, n=30) for 24 hours. In both groups, 0.5% bupivacaine was infused at a rate of
5 mL/hr from the inserted catheter. Visual analog scale (VAS) was used to evaluate pain at
rest (VAS-R) and after coughing (VAS-C) at baseline, 1, 6 and 24 hours after surgery.
Morphine
consumption,
complications
and
side
effects
were
collected.
RESULTS: VAS-R and VAS-C scores were similar at baseline however, 1st, 6th and 24th hour
scores of Group 1 were significantly lower than Group 2 (for VAS-R; P=0.017, P=0.001,
P=0.023, for VAS-C; P=0.006, P=0.002, P=0.032, respectively). 24-hour morphine
consumption was less in Group 1 in comparison to Group 2 (P=0.032). In Group 1, 5 of 30
patients (17%) experienced hypotension compared with none in Group 2 (P=0.02).
CONCLUSION: For post-thoracotomy pain, thoracic epidural shows better control of analgesia,
however, intercostal block is an alternative method as it has less incidence of hypotension.
Anahtar Kelimeler: Pain, thoracotomy, continue thoracic epidural block, continue intercostal
nerve block, regional analgesia
84
Table 1. The comparison of postoperative visual analog scale scores during rest
(VAS-R) at 0, 1, 6 and 24 hour postoperatively
Time
(hours)
Group
1
(n =
30)
Group
2
(n =
30)
Within group
comparison Group 1
(P**)
Within group
comparison Group 1
(P**)
Within group
comparison Group 2
(P**)
Basal

2.2

1.9
0.433
¨
¨
1

2.3

1.6
0.017*
<0.0001**
<0.0001**
6

2.3

1.8
0.001*
<0.0001**
<0.0001**
24

1.6

2.1
0.023*
<0.0001**
<0.0001**
*P < 0.05: statistically significant; group 1: thoracic epidural catheter, group 2: intercostal
EORFNDQGFDWKHWHUYDOXHVDUHPHDQVWDQGDUGGHYLDWLRQFRPSDULVRQEHWZHHQJURXSV3
0.05; **comparison to basal value in group 1, P = 0.0001; **comparison to basal value in
group 2, P = 0.0001
Tablo 2: The comparison of postoperative visual analog scale scores during coughing
(VAS-C) at 0, 1, 6 and 24 hour postoperatively.
Time
(hours)
Group
1
(n =
30)
Group
2
(n =
30)
Grup 1 vs
Grup 2 (P*)
Within group
comparison Group 1
(P**)
Within group
comparison Group 2
(P**)
Basa

0.9

1.4
0.969
¨
¨
1

0.9

1.2
0.006*
<0.001**
<0.001**
6

0.8

1.5
0.002*
<0.001**
<0.001**
24

0.8

1.8
0.032*
<0.001**
<0.001**
*P < 0.05: statistically significant; group 1: thoracic epidural catheter, group 2: intercostal
EORFNDQGFDWKHWHUYDOXHVDUHPHDQVWDQGDUGGHYLDWLRQFRPSDULVRQEHWZHHQJURXSV3
0.05; **comparison to basal value in group 1, P = 0.0001; **comparison to basal value in
group 2, P = 0.0001
85
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6218d *UXSODUÕQ ED]DO YH VDDW 9$6-R ve VAS-& VNRUODUÕ EHQ]HU EXOXQGX
(p>0.05). Epidural grubun hipotansiyon inVLGDQVÕGDKDID]ODS YHNDWHWHU\HUOHúWLUPH
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6218d Post-WRUDNRWRPL D÷UÕVÕQGD HSLGXUDO YH SDUDYHUWHEUDO EORN \|QWHPOHULQLQ KHU LNLVL LOH
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Paravertebral kateter daha kolay vH GDKD NÕVD VUHGH \HUOHúWLULOHELOPHVL LOH SRVWRSHUDWLI D÷UÕ
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Anahtar Kelimeler: Thoracotomy, postoperative analgesia, thoracic paravertebral block,
thoracic epidural analgesia.
86
Table 1. The comparison of postoperative visual analog scale scores during rest (0
cm =
Time
(hours)
Visual Analogue Visual Analogue Between
Score
Score
Group (P*)
Within Group
EPI (P*)
Within Group
PVB (P*)
Group EPI
(n=30)
Group PVB
(n=30)
Basal

4.8
0.82
¨
¨
2

0.074
<.0014a
<.0001b
4

0.054
<.0001a
<.0001b
12

0.06
<.0001a
<.0001b
24

0.104
<.0001a
<.0001b
*p<0.05, statistically significant; values are median (range), DEVROXWHQXPEHUVRUPHDQ
standard deviation; Group EPI: Thoracic epidural group, Group PVB: Paravertebral group;
aComparison to basal value in thoracic epidural group; bComparison to basal value in
paravertebral group.
Table 2. The comparison of postoperative visual analog scale scores during coughing
(0 cm = no pain, 10 cm = worst pain imaginable) in both groups*.
Time
(hours)
Visual Analogue Visual Analogue Between
Score
Score
Group (P*)
Within Group
EPI (P*)
Within Group
PVB (P*)
Group EPI
(n=30)
Group PVB
(n=30)
Basal

0.703
¨
¨
2

0.082
<.0001a
<.0001b
4

0.102
<.0001a
<.0001b
12

0.131
<.0001a
<.0001b
24

0.217
<.0001a
<.0001b
*p<0.05, VWDWLVWLFDOO\VLJQLILFDQWYDOXHVDUHPHGLDQUDQJHDEVROXWHQXPEHUVRUPHDQ
standard deviation; Group EPI: Thoracic epidural group, Group PVB: Paravertebral group;
aComparison to basal value in thoracic epidural group; bComparison to basal value in
paravertebral group.
87
Table 3. Side effects related to postoperative analgesia and complications
Group EPI (n,%) Group PVB (n,%) P
Nausea and vomiting
2 (6.7)
6 (20)
0.129
Hypotension
8 (26.7)
2 (6.7)
0.038*
Bradycardia
4 (13.3)
1 (3.3)
0.161
Bronchopleural fistula
2 (6.7)
2 (6.7)
1
Rethoracotomy
4 (13.3)
1 (3.3)
0.161
In-hospital 30-day mortality 2 (6.7)
1 (3.3)
0.554
Respiratory complications
18 (60)
9 (30)
0.02*
Respiratory failure
5 (16.7)
1 (3.3)
0.085
Atelectasis
4 (13.3)
1 (3.3)
0.161
Pneumonia
4 (13.3)
2 (6.7)
0.389
Bronchoscopy and suction
0
1 (3.3)
0.313
Minitracheostomy
1 (3.3)
2 (6.7)
0.554
Reintubated
4 (13.3)
2 (6.7)
0.389
Group EPI: Thoracic epidural group, Group PVB: Paravertebral group, *P < 0.05: statistically
significant
88
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HGLOPLúWLU+DVWDODU DQHVWH]L LGDmesinde
propofol
anestezisi
(n=20)
ve
desfluran
DQHVWH]LVLQ DODFDNúHNLOGHLNL\HD\UÕOPÕúWÕU'HVIOXUDQ0$&
GDQ3URSRIROPJKLYLQILOH
NXOODQÕOGÕ +HU LNL JUXSWD 5HPLIHQWDQ\O NXOODQÕOGÕ,/-6,IL-8, TNF-Į YH 6ǃ LoLQ NH] NDQ
|UQH÷L LQGXNVL\RQ |QFHVL&3% |QFHVL YH VRQUDVÕ SRVWRSHUDWLI K DOÕQGÕdDOÕúPDQÕQ VRQXQGD
NDQODUEL\RNLP\DFÕWDUDIÕQGDQDQDOL]HGLOGLøVWDWLNVHODQDOL]LoLQ.L-kare ve Mann Whitney U testi
NXOODQÕOGÕ
6RQXoWD6ǃSURSRIROJUXEXQGD,/-8 ve IL-G]H\OHULQLQGHGHVIOXUDQJUXEXQGDGDKDGúN
ROGX÷XQX EXOGXN &$%* FHUUDKLVL JHoLUHFHN KDVWDODUGD DQHVWH]L LGDPHVLQGH SURSRIROXQ 6ǃ
DoÕVÕQGDQ GDKD ID]OD WHUFLK HGLOHELOHFH÷LQL EXQXQOD ELUOLNWH LPPXQ \DQÕW DoÕVÕQGDQ GHVIOXUDQÕQ
GDKDJYHQOLROGX÷XQXV|\OH\HELOLUL]
Anahtar Kelimeler: NDUGL\RSXOPRQHUE\SDVVLQIODPDWXDU\DQÕW6RREHWDSURWHLQ
92
P-09
.$527ø6(1'$57(5(.720ø/(5'(ø175$23(5$7øF 4 KANALLI EEG
021ø7g5ø=$6<2189(326723(5$7ø)1g52/2-øK PROGNOZ
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1
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2
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intraoperatif EEG-spektral-edge-frekans-6() GH÷HUOHULQLQ Q|URORMLN SURJQR]OD LOLúNLVL JHUL\H
G|QNDUDúWÕUÕOGÕ
METOD
ø]ROH NDURWLV FHUUDKLVL JHoLUHQ KDVWDQÕQ GRV\DODUÕQGDQ NRPRUELGLWHOHU DQHVWH]L-cerrahi
bilgileri, YB takipleri incelendi. SEF-DPSOLWG GH÷HUOHUL ND\GHGLOGL ((* YHULOHULQLQ WPQH
XODúÕODPD\DQ KDVWD oDOÕúPD GÕúÕ EÕUDNÕOGÕ KDVWD GH÷HUOHQGLULOGL ((* LQGNVL\RQ
VRQUDVÕQGD |OoOHQ ED]DO GH÷HU NDURWLVH NURVNOHPS NRQPDGDQ |QFH NURV DoÕOGÕNWDQ VRQUD
|OoOHQGH÷HUOHURODUDNG|QHPGHLQFHOHQGL+DVWDODUÕQQ|URORMLNSURJQR]ODUÕSRVWRSHUDWLIPLQRU
VHUHEURYDVNOHU ROD\692 PDMRU VHUHEURYDVNOHU ROD\ RODUDN D\UÕOGÕ +DVWDODUÕQ GHPRJUDILN
YHPRUWDOLWHELOJLOHULGHGH÷HUOHQGLULOGL
BULGULAR
+DVWDODUÕQ \Dú RUWDODPDVÕ HUNHN FLQVL\HW VLJDUD GLDEHW
hipertansiyon%52.7,
obezite%18.2,
hiperlipidemi%43.6,
KAH%30.9,
KOAH%12.7,
VHPSWRPDWLN NDURWLV KDVWDOÕ÷Õ EXOXQGX 3UHRSHUDWLI G|QHPGH KDVWDGD
JHoLULOPLúPLQ|U692KDVWDGDPDMRU692KDVWDGDVHNHOWHVSLWHGLOGL2OJXODUÕQ
¶\DPDNXOODQÕODUDN¶VÕSULPHUWHGDYLHGLOGLùDQWKDVWDGDX\JXODQGÕ2OJXODUÕQ
VD÷-VRO6()OHULED]DO|OoPGHVÕUDVÕ\ODRUWDODPD-NURV|QFHVL-11.15 ve kros
DoÕOGÕNWDQ VRQUD -11 RODUDN VDSWDQGÕ 6D÷-VRO DPSOLWGOHU ED]DO |OoPGH VÕUDVÕ\OD
ortalama 18.31- NURV|QFHVL - NURV DoÕOGÕNWDQ VRQUD -15.84 olarak
VDSWDQGÕ6D÷-sol hemisfer SEF-DPSOLWG |OoPOHUL YH |OoP G|QHPOHUL DUDVÕQGD DQODPOÕ IDUN
VDSWDQPDGÕ 3RVWRSHUDWLI KDVWDGD PLQ|U 692 KDVWDGD PDMRU692 J|UOG
+DVWDQH PRUWDOLWHVL KDVWDGD JHoG|QHP PRUWDOLWH KDVWDGD ROXúWX
6()GH÷HUOHULSRVWRSHUDWLI692JHOLúLPOHULDUDVÕQGDDQODPOÕLOLúNLVDSWDQPDGÕ
7$57,ù0$
Karotid endarterektRPLGH EH\LQ LVNHPLVL KLSRSHUI]\RQ HPEROLQLQ PRQLW|UL]DV\RQXQGD ((*
66(3 7&' 1,56JGN EDVÕQFÕ |OoPOHUL JLEL \|QWHPOHU NXOODQÕOPDNWDGÕU 3RVWRSHUDWLI 692
JHOLúWL÷L J|]OHQHQ KDVWDODUÕQ LQWUDRSHUDWLI((*¶OHULQGH KHUKDQJL ELU SDWRORML VDSWDQPDGÕ gUQHN
VD\ÕVÕQÕQ D] ROPDVÕ ((*¶QLQ NRUWH[ DOWÕQGDNL NRUWH[WHNL NoN HQIDUNWODUÕ VDSWDPDGDNL
\HWHUVL]OL÷L((*¶QLQLVNHPL\HVSHVLILNROPDPDVÕDQHVWH]LNOHUÕVÕNDQ-EDVÕQFÕGH÷LúLNOLNOHUL\OHGH
HWNLOHQPHVL WURPERHPEROLNROD\ODUÕQ oR÷XQXQ RSHUDV\RQ VRQXQGDNL G|QHPGH ROXúPDVÕ JLEL
ELUoRNQHGHQLQ\DQOÕúQHJDWLIVRQXoYHUHELOHFH÷LGúQOG
Anahtar Kelimeler: Karotis endarterektomi, elektroensefalografi, spektral edge frekans,
JHQHODQHVWH]LVHUHEURYDVNOHUROD\.
93
P-10
KORONER ARTER BAYPAS GREFTLEME YAPILACAK 'hùh.(-(.6ø<21)5$.6ø<21/8
+$67$/$5'$ø1'h.6ø<2NDA KULLANILAN FARKL,23ø2ø'$-$1/$5,1
(17h%$6<216215$6,<$1,7$9(+(02'ø1$0ø<((7.ø6ø1ø1.$5ù,/$ùTIRILMASI
1NKHW%DGGDO1hPLW.DUDGHQL]16RQHU<DYDú3, %úUD7H]FDQ1<DVHPLQ6DYFÕ1,
$VOÕ'HPLU1, g]FDQErdemli2
1
7UNL\H<NVHNøKWLVDV(÷LWLP$UDúWÕUPD+DVWDQHVL$QHVWH]LYH5HDQLPDV\RQ.OLQL÷L$QNDUD
2
$FÕEDGHPhQLYHUVLWHVL$QHVWH]L9H5HDQLPDV\RQ%LOLP'DOÕ$QNDUD
3
7UNL\H<NVHNøKWLVDV(÷LWLP$UDúWÕUPD+DVWDQHVL.DOS'DPDU&HUUDKLVL.OLQL÷L$QNDUD
*ø5øù
+HPRGLQDPLN SDUDPHWUHOHULQ KÕ]OÕ GH÷LúWL÷L NDUGL\RSXOPRQHU ED\SDV JLEL \NVHN ULVNOL FHUUDKL
YDNDODUGDNDOSGHELVLYHRNVLMHQVXQXPXQXQHQX\JXQG]H\GHVUGUOPHVLDQHVWH]LQLQDQD
KHGHILGLUdDOÕúPDPÕ]GD NRURQHUED\SDVFHUUDKLVL\DSÕODQHMHNVL\RQIUDNVL\RQX¶QLQDOWÕQGD
RODQKDVWDODUGDLQGNVL\RQDúDPDVÕQGDIHQWDQLOYHUHPLIHQWDQLOLQKHPRGLQDPLYHHQWEDV\RQD
FHYDS]HULQHRODQHWNLOHULQLQNDUúÕODúWÕUÕOPDVÕQÕDPDoODGÕN
MATERYAL-METOD:
ASA II-III riVN JUXEXQGD KDVWD oDOÕúPD\D DOÕQGÕ 2OJXODU LNL JUXED Q D\UÕOGÕ *UXS
)HQWDQLO¶GH LQGNVL\RQGD PJNJ OLGRNDLQ PJNJ HWRPLGDW JNJ VQ EROXV GR]
VRQUDVÕ JNJGN IHQWDQLO LQI]\RQX YH PJNJ URNXURQ\XP X\JXODQGÕ *UXS
RemifentaniO¶GH LQGNVL\RQGD PJNJ OLGRNDLQ PJNJ HWRPLGDW JNJ VQ EROXV GR]
VRQUDVÕ JNJGN 5HPLIHQWDQLO LQI]\RQX YH PJNJ URNXURQ\XP X\JXODQGÕ +HU LNL
JUXSWDHWRPLGDWRSLRLGLQI]\RQXEDúODQPDVÕQGDQGNVRQUDWLWUHHGLOHUHNPJGNKÕ]GD%IS
GH÷HUL ¶ \H GúHQH NDGDU YHULOGL (Q VRQ URNXURQ\XP X\JXODQGÕ 7P KDVWDODUÕQ 6$% '$%
2$%.+632.'69%YH695GH÷HUOHUL7øQGNVL\RQGDQGDNLND|QFH7 øQGNVL\RQ
VRQUDVÕ 7 (QWEDV\RQ VRQUDVÕ RODFDN úHNLOGH ND\ÕW HGLOGL (QWEDV\RQ VÕUDVÕQGD oHQH
UHODNVDV\RQX ODULQJRVNRSL NROD\OÕ÷Õ YRNDO NRUGODUÕQ GXUXPX |NVUN YH HNVWUHPLWHOHUGH
KDUHNHWYDUOÕ÷ÕGH÷HUOHQGLULOGL
BULGULAR:
*UXSODUÕQ GHPRJUDILN YHULOHUL EHQ]HUGL 6$% '$% 2$% .+ 6$7 GH÷HUOHUL JUXSODU DUDVÕQGD
NDUúÕODúWÕUÕOGÕ÷ÕQGD 7 7 YH 7 G|QHPOHULQGH LVWDWLVWLNVHO RODUDN DQODPOÕ IDUN EXOXQPDGÕ
3! dDOÕúPDGD UHPLIHQWDQLO NXOODQÕPÕQGD NDOS GHELVLQGH GDKD ID]OD Gúú L]OHQPLúWLU
6218d
5HPLIHQWDQLONXOODQÕODUDN\DSÕODQELUoRNoDOÕúPDX\JXQGR]GDWLWUHHGLOHUHNYHULOGL÷LQGHIHQWDQLO
NDGDU JYHQLOLU ELU DMDQ ROGX÷XQX J|VWHUVH GH EL]LP oDOÕúPDPÕ] HMHNVL\RQ IUDNVL\RQX GúN
KDVWDODUÕQLQGNVL\RQDúDPDVÕQGDIHQWDQLOLQGDKDX\JXQELUVHoHQHNRODELOHFH÷LQLJ|VWHUPLúWLU
Anahtar Kelimeler: .$%* GúN HMHNVL\RQ IUDNVL\RQX UHPLIHQWDQLO IHQWDQLO LQGNVL\RQ
94
P-11
KORONER ARTER BAYPAS GREFTLEME YAPILACAK 'hùh.(-(.6ø<21)5$.6ø<21/8
+$67$/$5'$ø1'h.6ø<2NDA KULLANILAN FARKL,23ø2ø'$-$1/$5,1
(17h%$6<216215$6,<$1,7$9(+(02'ø1$0ø<((7.ø6ø1ø1.$5ù,/$ùTIRILMASI
1NKHW%DGGDO1, hPLW.DUDGHQL]16RQHU<DYDú1, %úUD7H]FDQ1$VOÕ'HPLU1g]FDQ(UGHPOL2
1
7UNL\H<NVHNøKWLVDV(÷LWLPYH$UDúWÕUPD+DVWDQHVL
2
$QNDUD$FÕEDGHP+DVWDQHVL
*ø5øù
+HPRGLQDPLN SDUDPHWUHOHULQ KÕ]OÕ GH÷LúWL÷L NDUGL\RSXOPRQHU ED\SDV JLEL \NVHN ULVNOL FHUUDKL
YDNDODUGD NDUGL\DN GHEL YH RNVLMHQ VXQXPXQXQ HQ X\JXQ G]H\GH VUGUOPHVL DQHVWH]LQLQ
DQD KHGHILGLUdDOÕúPDPÕ]GD NRURQHU ED\SDV FHUUDKLVL \DSÕODQ HMHNVL\RQ IUDNVL\RQX ¶ QLQ
DOWÕQGD RODQ KDVWDODUGD LQGNVL\RQ DúDPDVÕQGD IHQWDQLO YH UHPLIHQWDQLOLQ KHPRGLQDPL YH
HQWEDV\RQD
FHYDS
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RODQ
HWNLOHULQLQ
NDUúÕODúWÕUÕOPDVÕQÕ
DPDoODGÕN
MATERYALMETOD:
ASA II-,,, ULVN JUXEXQGD KDVWD oDOÕúPD\D DOÕQGÕ 2OJXODU LNL JUXED Q D\UÕOGÕ *UXS
)HQWDQLO¶GH LQGNVL\RQGD PJNJ OLGRNDLQ PJNJ HWRPLGDW JNJ VQ EROXV GR]
VRQUDVÕ JNJGN IHQWDQLO LQI]\RQX YH PJNJ URNXURQ\XP X\JXODQGÕ *UXS
5HPLIHQWDQLO¶GH LQGNVL\RQGD PJNJ OLGRNDLQ PJNJ HWRPLGDW JNJ VQ EROXV GR]
VRQUDVÕ JNJGN 5HPLIHQWDQLO LQI]\RQX YH PJNJ URNXURQ\XP X\JXODQGÕ +HU LNL
JUXSWDHWRPLGDWRSLRLGLQI]\RQXEDúODQPDVÕQGDQGNVRQUDWLWUHHGLOHUHNPJGNKÕ]GD%,6
GH÷HUL ¶ \H GúHQH NDGDU YHULOGL (Q VRQ URNXURQ\XP X\JXODQGÕ 7P KDVWDODUÕQ 6$% '$%
0$3 .+ 632 &2 &93 YH 695 GH÷HUOHUL 7 øQGNVL\RQGDQ GDNLND |QFH 7 øQGNVL\RQ
VRQUDVÕ 7 (QWEDV\RQ VRQUDVÕ RODFDN úHNLOGH ND\ÕW HGLOGL (QWEDV\RQ VÕUDVÕQGD oHQH
UHODNVDV\RQX ODULQJRVNRSL NROD\OÕ÷Õ YRNDO NRUGODUÕQ GXUXPX |NVUN YH HNVWUHPLWHOHUGH
KDUHNHWYDUOÕ÷ÕGH÷HUOHQGLULOGL
BULGULAR:
*UXSODUÕQ GHPRJUDILN YHULOHUL EHQ]HUGL 6$% '$% 2$% .+ 6$7 GH÷HUOHUL JUXSODU DUDVÕQGD
NDUúÕODúWÕUÕOGÕ÷ÕQGD 7 7 YH 7 G|QHPOHULQGH LVWDWLVWLNVHO RODUDN DQODPOÕ IDUN EXOXQPDGÕ
3!dDOÕúPDGDUHPLIHQWDQLONXOODQÕPÕQGDNDUGL\DNRXWSXWG]H\OHULQGHGDKDID]ODGúú
L]OHQPLúWLU
6218d
5HPLIHQWDQLONXOODQÕODUDN\DSÕODQELUoRNoDOÕúPDX\JXQGR]GDWLWUHHGLOHUHNYHULOGL÷LQGHIHQWDQLO
NDGDU JYHQLOLU ELU DMDQ ROGX÷XQX J|VWHUVH GH EL]LP oDOÕúPDPÕ] HMHNVL\RQ IUDNVL\RQX GúN
KDVWDODUÕQLQGNVL\RQDúDPDVÕQGDIHQWDQLOLQGDKDX\JXQELUVHoHQHNRODELOHFH÷LQLJ|VWHUPLúWLU
Anahtar Kelimeler: &$%*GúNHMHNVL\RQIUDNVL\RQXUHPLIHQWDQLOIHQWDQLOLQGNVL\RQ
95
P-12
3('ø<$75ø..$5'ø<$..$7$7(5ø=$6<212/*8/ARINDA SEDASYON:
<h.6(.ø+7ø6$6'(1(<ø0ø
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X\JXODQDQ JLULúLPOHUGLU.XOODQÕODFDN DQHVWH]LN DMDQÕQ SHGLDWULN NDWDWHUL]DV\RQ ROJXODUÕQGD
\HWHUOL VHGDV\RQ VD÷ODPDVÕQÕQ \DQÕ VÕUD KHPRGLQDPL ]HULQGH WDQÕ\Õ HWNLOH\HELOHFHN
GH÷LúLNOLNOHUHL]LQYHUPHPHVLJHUHNOLGLU%XUHWURVSHNWLIoDOÕúPDGDKDVWDQHVLPL]GHELU\ÕOOÕNVUH
LoHULVLQGH X\JXODQDQ SHGL\DWULN NDWDWHUL]DV\RQ LúOHPOHULQLQ ve sedasyon protokollerinin
GH÷HUOHQGLULOPHVLDPDoODQGÕ
MATERYAL VE METHOD
%X oDOÕúPDGD KDVWDQHPL]GH - WDULKOHUL DUDVÕQGD SHGLDWULN NDUGL\RORML
NOLQL÷LWDUDIÕQGDQ NDUGL\DN NDWDWHUL]DV\RQ X\JXODQDQ - \Dú DUDVÕ KDVWD GH÷HUOHQGLULOdi.
7P ROJXODUÕQ \Dú FLQVL\HW WDQÕ LúOHPLQ WDQÕVDO YH\D WHUDS|WLN DPDoOÕ \DSÕOÕS \DSÕOPDGÕ÷Õ
NXOODQÕODQ VHGDV\RQ DMDQODUÕ HQGRWUDNHDO HQWEDV\RQ YH\D ODU\QJHDO PDVNH WDNÕOÕS
WDNÕOPDGÕ÷ÕYRODWLODQHVWH]LNLKWL\DFÕDQHVWH]LWDNLSNDUWODUÕNXOODQÕODUDNkaydedildi.
BULGULAR
+DVWDODUÕQ \Dú RUWDODPDVÕ \ÕO-D÷ÕUOÕN RUWDODPDVÕ NJ -83),%44.4 erkek %56.4
NDGÕQ LGL +DVWDODUÕQ WDQÕODUÕ GH÷HUOHQGLULOGL÷LQGH 9HQWULNOHU 6HSWDO 'HIHNW Atriyal Septal Defekt, %12.5 Patent Ductus Arteriosus, %6 Tetra of Fallot,%3.2 Aort
.RDUNWDV\RQX NDOS NDSDN DQRUPDOOLNOHUL .DOS SLOL \HUOHúWLULOPHVL (36 *OHQQ ùDQWÕ YH GL÷HU NRPELQH SDWRORMLOHU ROGX÷X EHOLUOHQGL 3HGLDWULN NDWDWHUL]DV\RQ
X\JXODPDODUÕQÕQ VLQLQ GLDJQRVWLN DPDoOÕ \DSÕOÕUNHQ QQ WHUDS|WLN DPDoOÕ \DSÕOGÕ÷Õ
EHOLUOHQGL(QGRWUDNHDO HQWEDV\RQXQ ROJXGD ODU\QJHDO PDVNH
QLQ LVH ROJXGD
X\JXODQGÕ÷Õ EHOLUOHQGL (Q VÕN NXOODQÕODQ VHGDV\RQ DMDQODUÕ VÕUDVÕ\OD NHWDPLQ PLGD]RODP YH
propofol idi.
7$57,ù0$
øQYD]LY NDUGL\DN NDWHWHUL]DV\RQ LúOHPOHUL VÕUDVÕQGD DQHVWH]LVWOHULQ YH SHGLDWULN NDUGL\RORJODUÕQ
RUWDNDPDoODUÕ\HWHUOLVHGDV\RQG]H\LQLQVD÷ODQPDVÕYHX\JXODQDQVDGDV\RQXQWDQÕVDODPDoOÕ
\DSÕODQ NDWDWHUL]DV\RQ LúOHPLQLQ KHPRGLQDPLN YHULOHULQL GH÷LúWLUPHPHVLGLU%X |]HOOLNOHUH VDKLS
DQHVWH]LN DMDQ DUD\ÕúÕ ELUoRN IDUNOÕ DMDQÕQ WHN EDúÕQD YH NRPELQH NXOODQÕPODUÕQD QHGHQ
ROPXúWXU%X oDOÕúPDGD KDVWDQHPL]GH VHGDV\RQ DPDoOÕ HQ VÕN .HWDPLQPLGD]RODP YH SURSRIRO
NXOODQÕOGÕ÷ÕQÕEHOLUOHGLN
Anahtar Kelimeler: Pediatrik kataterizasyon,sedasyon.
96
P-13
KALP TRANSPLANTASYON8<$3,/0,ù+$67$/$5'$3(5ø23(5$7ø)9(5ø/(5ø1
.$5ù,/$ù7,5,/0$6,1,1 0257$/ø7(025%ø'ø7( 9(6$ö.$/,0h=(5ø1( (7.ø6ø
8PXW.|NVHO1, 1XUVHOùDKLQ2, Hanife Karakaya Kabukcu2gPHU%D\H]LG17OLQ$\GR÷GXTitiz2
1
$NGHQL]hQLYHUVLWHVL7ÕS)DNOWHVL.DOS'DPDU&HUUDKLVL$QWDO\D
$NGHQL]hQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$'$QWDO\D
2
*ø5øù .DOSWUDQVSODQWDV\RQXNOLQL÷LPL]GHVHQH\LDúNÕQVUHGLUX\JXODQPDNWDGÕU+DVWDODUÕQ
ELUGHQ ID]OD NDWHJRUL\H D\UÕOÕS WDQÕPOD\ÕFÕ DQDOL] \DSÕODUDN oRN GH÷LúNHQOL SDUDPHWUHOHULQ
NDUúÕODúWÕUÕOGÕ÷Õ ELU oDOÕúPD \DSÕOPDPÕúWÕU 0RUWDOLWH PRUELGLWH ULVN IDNW|UOHUL LOH LOJLOL YHULOHU
\HWHUOLGH÷LOGLU
METOD: 1998 ± WDULKOHUL DUDVÕQGD KDVWaya biatriyal ortotopik kalp transplantasyonu
RSHUDV\RQX X\JXODQGÕ7UDQVSODQWDV\RQX \DSÕOPÕú KDVWDODUÕQ HWL\RORMLOHUL KD\DWWD RODQND\EHGLOHQ KDVWD JUXSODUÕ YH HUNHQ-JHo G|QHP PRUWDOLWH JUXSODUÕ DUDVÕQGD NDUúÕODúWÕUPDOÕ
UHWURVSHNWLIDQDOL]L\DSÕOGÕYHPRUWDOLWHPRUELGLWHLOHVD÷NDOÕPGH÷HUOHQGLULOGLKDVWDQÕQ\Dú
RUWDODPDVÕ \ÕO LGL 6RQ G|QHP NDOS \HWPH]OL÷LQLQ HWL\RORMLVL KDVWDGD LVNHPLN
NDUGL\RPL\RSDWLø.03KDVWDGDQRQLVNHPLNNDUGL\RPL\RSDWL1ø.03LGL
BULGULAR: Biatriyal ortotoSLN NDOS WUDQVSODQWDV\RQX \DSÕODQ KDVWDQÕQ RUWDODPD WDNLS
VUHVL D\ LGL 7RSODP LVNHPL ]DPDQÕ GN *HQHO PRUWDOLWH WP KDVWDODU
LoLQ LNHQ HUNHQ PRUWDOLWH RUDQÕ JHo PRUWDOLWH RUDQÕ LGL .DSODQ ± Meier
DQDOL]L\OHWPKDVWDODULoLQYH\ÕOOÕNVD÷NDOÕPRUDQODUÕVÕUDVÕ\OD
YH RODUDN EXOXQGX <ÕOOÕN VD÷NDOÕP RUDQODUÕ 1ø.03 JUXEXQD J|UH ø.03 JUXEXQGD
DQODPOÕGHUHFHGHGúNEXOXQGXS <NVHN LVNHPL VUHVLQLQ YH SRVWRSHUDWLI \NVHN 3$%¶QÕQ ELU \ÕOGDQ GDKD X]XQ VUH KD\DWWD
NDOÕPÕ ROXPVX] HWNLOH\HQ ULVN IDNW|UOHUL ROGX÷X VDSWDQGÕ*UXSODUÕQ NDUúÕODúWÕUPD DQDOL]OHULQGH
GRQ|U\DúÕREH]LWHFLQVL\HWSUHRS/'/3&2΍ yksekli÷i, preop anemi, AF, LVEF, sol ventrikl
oaplarÕ, Euroskor, KPB sresi, iskemi sresi, hemofiltre kullanÕmÕ, kan rn transfzyonu,
postoperatif inotrop ihtiyacÕ, CVP, PAB de÷erleri, mekanik ventilasyon sresi, yo÷un bakÕm
kalÕú sUHVLSDUDPHWUHOHULQLQLVWDWLVWLNVHORODUDNDQODPOÕULVNIDNW|UOHULROGX÷XJ|UOG
6218d 0RUWDOLWH\L YH PRUELGLWH\L HWNLOH\HQ ULVN IDNW|UOHULQLQ L\L DQDOL] HGLOPHVL YH HUNHQ
G|QHPGHJHUHNOL|QOHPOHULQDOÕQPDVÕSURJQR]XHWNLOH\HFHNHQ|QHPOLXQVXUODUGÕU
Anahtar Kelimeler: .DOS WUDQVSODQWDV\RQX HWL\RORML PRUWDOLWH ULVN IDNW|UOHUL VD÷NDOÕP
analizi
97
P-14
KORONER ARTER CERRAHø6ø*(dø5(&(.2/*8/$5'$0ø'$=2/$09()(17$1ø/
ø1'h.6ø<2186,5$6,1'$<h.6(.'2=52.8521YUM8147&ø17(59$/øh=(5ø1(
(7.ø6ø
'R÷Xú$÷GDQOÕ1, 7OQg]WUN22]DQhWN3*|QO7H]FDQ.HOHú2
1
øSHN\ROX'HYOHW+DVWDQHVL9DQ
&HODO%D\DUhQLYHUVLWHVL7ÕS)DN$QHVWH]L\RORMLYH5HDQLPDV\RQ$%'0DQLVD
3
Grandmedikal Hastanesi. Manisa
2
$0$d .RURQHU DUWHU KDVWDODUÕQGD PHYFXW PL\RNDUG KDVDUÕQÕQ NHQGLVL X]XQ 47 VHQGURPX
ROXúXPXQDQHGHQROPDNWDGÕUdHúLWOLDQHVWHWLNPHGLNDV\RQODU da QT intervalini etkilemektedir.
dDOÕúPDQÕQSULPHUDPDFÕDQHVWH]LLQGNVL\RQXVRQUDVÕQGDURNXURQ\XPXQIDUNOÕGR]XQXQ
mg kg-1 ve 1,2 mg kg-47FLQWHUYDOL]HULQHHWNLOHULQLDUDúWÕUPDNWÕULNLQFLODPDFÕLVHDULWPL
VÕNOÕ÷ÕYHQLWHOL÷LQLVDSWDPDNWÕr.
<g17(0/(5 dDOÕúPD\D HOHNWLI NRURQHU DUWHU UHYDVNODUL]DV\RQ FHUUDKLVL JHoLUHFHN ROJX
DOÕQGÕ 2OJXODU LNL JUXSWDQ ELULQH GDKLO HGLOGLOHU *UXSODUGD NXOODQÕODQ PLGD]RODP YH IHQWDQLO¶ LQ
LQGNVL\RQGR]ODUÕD\QÕLGL*URXSPJNJ-1, Group 2; 1,2 mg kg-1 doz rokuronyum ile
HQWEH HGLOGLOHU .DOS DWÕP KÕ]Õ DUWHUL\HO EDVÕQo YH 47F LQGNVL\RQ |QFHVL 7 LQGNVL\RQ
VRQUDVÕ7URNXURQ\XPVRQUDVÕ7HQWEDV\RQVRQUDVÕGDNLND7GDNLND7
BULGULAR: *UXSLoLNDUúÕODúWÕUPDGD\DOQÕ]FDHQWEDV\RQVRQUDVÕGDNLNDGDNLRUWDODPD47F
GH÷HUOHUL*UXSYH*UXS¶GHVÕUDVÕLOHPVEDúODQJÕFDJ|UHVÕUDVÕ
LOH PV LVWDWLVWLNVHO RODUDN DQODPOÕ X]XQ EXOXQGX S *UXSODU
DUDVÕNDUúÕODúWÕUPDGDRUWDODPD47FWPoDOÕúPDSHUL\RGODUÕQGDEHQ]HUGLS!*UXS
Q LOH*UXSGHQ DULWPLJ|UOPHVÕNOÕ÷ÕEHQ]HUGLS +HULNLJUXSWD
GDDULWPLOHUQ HQWEDV\RQGDQVRQUDGDNLNDGDRUWD\DoÕNWÕODU
6218d: Koroner arter reYDVNODUL]DV\RQXX\JXODQDFDNKDVWDODUGDURNURQ\XPXQPJNJ
-GR]XHQWEDV\RQVRQUDVÕ47F¶\LX]DWWÕ(QWEDV\RQVRQUDVÕ47FX]DPDVÕ\ODLOJLOLDULWPLOHULQ
ROXúDELOHFH÷LGLNNDWHDOÕQPDOÕGÕU
Anahtar Kelimeler: URNXURQ\XP47FNRURQHUDUWHUKDVWDOÕ÷Õ
98
P-15
725$.2720ø6215$6,326723(5$7ø)$ö5,1,1*ø'(5ø/0(6ø1'(
/(92%83ø9$.$ø1ø/(725$.$/(3ø'85$/9(3ARAVER7(%5$/%/2ö81
.$5ù,/$ù7,5,/0$6,
7OQg]WUN1øVPHW7RSoX16DGÕN<DOGÕ]2.ÕYDQo$úÕN1$OS<HQWU1
1
&HODO%D\DUhQLYHUVLWHVL7ÕS)DNAnesteziyoloji ve Reanimasyon ABD. Manisa
2
&HODO%D\DUhQLYHUVLWHVL7ÕS)DN*|÷V&HUUDKLVL$%'0DQLVD
*ø5øù 7RUDNRWRPL D÷UÕVÕQÕQ JLGHULOPHVLQGH WRUDNDO HSLGXUDO DQDOMH]L \|QWHPL VÕN
NXOODQÕOPDNWDGÕU 3DUDYHUWHEUDO EORN VHoLOHQ GHUPDWRPODUGD WHN WDUDIOÕ VLQLU EOR÷X VD÷ODUNHQ
HSLGXUDO
DQDOMH]L
\|QWHPLQLQ
\DQ
HWNLOHULQL
HQJHOOH\HELOPHNWHGLU
%X oDOÕúPDQÕQ SULPHU DPDFÕ WRUDNRWRPL VRQUDVÕ D÷UÕQÕQ JLGHULOPHVLQGH HSLGXUDO YH\D
SDUDYHUWHEUDOEOR÷XQDQDOMH]LNHWNLQOL÷LQLQNDUúÕODúWÕUÕOPDVÕGÕU6HNRQGHUDPDFÕLVHROXúDQ\DQ
HWNLOHULQNDUúÕODúWÕUÕOPDVÕGÕU
<g17(0/(5: (OHNWLIDNFL÷HUFHUDKLVLJHoLUHFHNROJXODUHSLGXUDOEORNJUXEX*UXS('Q veya paravertebral blok grubuna (Grup PVB, n=17) randomize edildiler. T5-6 veya T6-7
DUDOÕ÷ÕQGDQ HSLGXUDO NDWHWHU *UXS (' YH\D XOWUDVRQ WHNQL÷L LOH SDUDYHUWHEUDO NDWHWHU *UXS
39 \HUOHúWLULOGL .DWHWHUOHUGHQ PJ PRUILQ PO YH PO OHYREXSLYDNDLQ NDUÕúÕPÕ
EROXV YHULOGL 3RVWRSHUDWLI DQDOMH]L PJOHYREXSLYDNDLQ YH PJ PRUILQLoHUHQ VROXV\RQXQ mOVDDWKÕ]GDVUHNOLHSLGXUDOYH\DSDUDYHUWHEUDODODQDLQI]\RQXYHNRQWUDPDO¶LQLQWUDYHQ|]
KDVWD NRQWUROO \|QWHPOH YHULOPHVL\OH VD÷ODQGÕ 9$6 VNRUODUÕ ROPDVÕ DPDoODQGÕ +.$
KDVWD VXQXPX GR]X PJ YH NLOLWOL NDOPD VUHVL GDNLND RODUDN D\DUODQGÕ
3UHRSHUDWLI SRVW RSHUDWLI YH VDDWOHUGH D÷UÕ G]H\L 9$6 2$% .$+
VROXQXP VD\ÕVÕ VHGDV\RQ YH NRQIRU VNRUODUÕ EXODQWÕ- NXVPD YH NDúÕQWÕ VÕNOÕ÷Õ ND\GHGLOGL
BULGULAR: *UXSODUGD
ROJXODUÕQ
NDUDNWHULVWLN
|]HOOLNOHUL
EHQ]HUGL
S!0.05).
2OJXODUÕQ LVWLUDKDW GHULQ LQVSLUDV\RQ YH |NVUN 9$6 GH÷HUOHUL DQODPOÕ IDUNOÕOÕN J|VWHUPHGL
6HGDV\RQ VNRUODUÕ (' JUXEXQGD DQODPOÕ RODUDN GDKD \NVHN VH\UHWWLS +HU LNL
JUXSWDQ LNL ROJXGD DQWLHPHWLN JHUHNWLUHQ EXODQWÕ YH KDILI NDúÕQWÕ PHYcuttu.
6RQXo RODUDN WRURNRWRPL D÷UÕVÕQÕQ JLGHULOPHVLQGH SDUDYHUWHEUDO EORN YH HSLGXUDO EORN EHQ]HU
HWNLQ DQDOMH]L VD÷ODGÕ 7( JUXSWD \NVHN VHGDV\RQ VNRUODUÕ WRUDNRWRPL VRQUDVÕ LVWHQPH\HQ
|]HOOLNWLU 739 DQDOMH]LQLQ GDKD D] \DQ HWNL LOH WRUDNRWRPL VRQUDVÕ (' DQDOMH]L\H DOWHUQDWLI
RODELOHFH÷LNDQÕVÕQGD\Õ]
Anahtar Kelimeler: paravertebral blok, torakal epidural blok, torakotomi, postopeartif
analjezi
99
P-16
.21-(1ø7$/.$5'ø<$.&(55$+ø'((.675$.25325($/'2/$ù,0,1
326723(5$7ø)&-5($.7ø)3527(ø1'h=(<ø1((7.ø6ø
+DOH(ULúLU1XUJO<XUWVHYHQøEUDKLP8÷XU0XUDW$FDUHO6HYLP&DQLN
6L\DPL(UVHN*|÷V.DOS'DPDU&HUUDKLVL(÷LWLPYH$UDúWÕUPD+DVWDQHVL
*ø5øù-$0$d %X oDOÕúPD NRQMHQLWDO NDOS FHUUDKLVLQGH HNVWUDNRUSHUHDO GRODúÕPÕQ
LQIODPDV\RQXQ GX\DUOÕ ELU LQGLNDW|U RODQ &-5HDNWLI 3URWHLQ &53 ]HULQH RODQ HWNLOHULQL
DUDúWÕUPDNDPDFÕ\OD\DSÕOPÕúWÕU
MATERYAL-METOD: dDOÕúPD\D GR÷XPVDO NDOS KDVWDOÕ÷Õ WDQÕVÕ LOH $UDOÕN - Nisan 2011
WDULKOHUL DUDVÕQGD DoÕN NDOS FHUUDKLVL X\JXODQDQ SHGL\DWULN KDVWD DOÕQGÕ 7P KDVWDODUÕQ
SUHRSHUDWLISRVWRSHUDWLIJQGHQJQHNDGDU&53GH÷HUOHULLQFHOHQGL+DVWDODU*UXS.%3
VUHVL GN DOWÕQGD RODQODU YH *UXS .3% VUHVL GN YH ]HULQGH RODQODU RODUDN LNL\H
D\UÕOGÕ
%X KDVWDODUGD DPHOL\DW |QFHVL VÕUDVÕ YH VRQUDVÕQGD DOÕQDQ NDQ |UQHNOHULQGH &53 G]H\OHUL
NDUúÕODúWÕUÕOGÕ øVWDWLNVHO VRQXoODU 0DQQ-Whitney U testi, basit linear regresyon analizi ve
6SHDUPDQ NRUHODV\RQ DQDOL]L LOH GH÷HUOHQGLULOGL YH S ROGX÷XQGD DQODPOÕ RODUDN NDEXO
edildi.
BULGULAR: OperDV\RQ oHúLGLQH YH VUHVLQH EDNÕOPDNVÕ]ÕQ KDVWDODUÕQ D\QÕ JQ |OoOHQ &53
VRQXoODUÕQDGH÷HUOHQGLULOGL÷LQGHDPHOL\DWWDQVRQUDJQ|OoOHQ&53GH÷HURUWDODPDODUÕGL÷HU
JQOHUHJ|UHGDKD\NVHNWLUS+DVWDODUÕQRSHUDV\RQ|QFHVLYHRSHUDV\RQVRQUDVÕtepe
&53 VHYL\HOHUL NDUúÕODúWÕUÕOGÕ÷ÕQGD SUHRSHUDWLI PHGLDQ &53 GH÷HUL ǋJGO SRVWRSHUDWLI
PHGLDQWHSH&53GH÷HULǋJGORODUDNWHVSLWHGLOPLúWLUS<DSÕODQRSHUDV\RQ
oHúLGL LOH RUWDODPD WHSH &53 GH÷HUOHUL NDUúÕODúWÕUÕOGÕ÷ÕQGD JUXSODU DUDVÕQGD LVWDWLVWLNVHO DQODPOÕ
IDUN EXOXQDPDPÕúWÕU S! *UXSODU WHSH &53 GH÷HUOHUL DoÕVÕQGDQ NDUúÕODúWÕUÕOGÕ÷ÕQGD
LVWDWLVWLNVHORODUDNDQODPOÕIDUNEXOXQPDPÕúWÕUS!
6218d 3HGL\DWULNNDOSFHUUDKLVLJHoLUHQKDVWDODUGD&53GH÷HUOHULROXúDQ LQIODPDWXYDU\DQÕWD
FHYDS RODUDN VDDWOHU LoHULVLQGH DUWPD\D EDúODU .RPSOLNDV\RQXQ ROPDGÕ÷Õ GXUXPGD VHYL\HVL
JQOHU LoLQGH QRUPDOH G|QHUNHQ HQIHNVL\RQ JLEL ELU NRPSOLNDV\RQ JHOLúLUVH NDQGDNL \NVHN
VHYL\HVLQL NRUXU %X QHGHQOH GH SRVWRSHUDWLI G|QHPGH VUHFLQ WDNLELQGH NXOODQÕODELOHFHN ELU
DNXWID]UHDNWDQÕROGX÷XNDQDDWLQGH\L]
Anahtar Kelimeler: C-Reaktif Protein Konjenital Kalp Cerrahisi.
100
P-17
.$5'ø<29$6.h/(5<2ö81%$.,0'$0(7$%2/ø.$/.$/2=ø/(0$6.(/(10øù
0(7$%2/ø.$6ø'2=ø16ø'$169((7<2/2-ø
Alper Kararmaz0XVWDID.HPDO$UVODQWDúøVPDLO&LQHO
0DUPDUDhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORML$'øVWDQEXO
*ø5øù $oÕNNDOSFHUUDKLVLX\JXODQDQKDVWDODUGDNDOSDNFL÷HUSRPSDVÕLQWUDRSHUDWLIX\JXODQDQ
VÕYÕODUNDQUQOHULWUDQVI]\RQODUÕYHGRNXRNVLMHQDV\RQER]XNOX÷XJLELQHGHQOHUOHPHWDEROLN
asidoz ve metabolik alkaloz birlikte olabilmektedir. Bu durumda Henderson-Hasselbalch ya da
EDVH H[FHVV %( LOH GH÷HUOHQGLUPH \DSÕOGÕ÷ÕQGD DVLGR]XQ úLGGHWL ROGX÷XQGDQ GDKD D] RODUDN
|OoOHELOLUdDOÕúPDPÕ]GDDoÕNNDOSFHUUDKLVLX\JXODQPÕúROJXODUGDHUNHQSRVWRSHUDWLIG|QHPGH
6WHZDUW \|QWHPL LOH NDQ JD]Õ DQDOL]L \DSDUDN PHWDEROLN DVLGR] YH DONDOR]XQ ELUOLNWH ROGX÷X
ROJXODUÕQLQVLGDQVÕQÕYHPLNVDVLWED]ER]XNOX÷XQDQHGHQRODQIDNW|UOHULVDSWDPD\ÕDPDoODGÕN
<g17(0 $PHOL\DWKDQHGHQ \R÷XQ EDNÕPD DOÕQDQ WRSODP KDVWDQÕQ YHULOHUL UHWURVSHNWULI
RODUDN WDUDQGÕ (ú ]DPDQOÕ NDQ JD]Õ YHrileri ve biyokimya parametreleri kaydedildi. Hasta
|]HOOLNOHUL \DSÕODQ RSHUDV\RQ YH VRQXoODU GD ND\GHGLOGL ³6WURQJ LRQ GLIIHUHQFH´ 6,' WRWDO
]D\ÕI DVLW PLNWDUÕ $WRW YH G]HOWLOPLú %( %(F KHVDSODPDODUÕ LoLQ IL]LNRNLP\DVDO DQDOL]
NXOODQÕOGÕ0HWDEolik alkaloz, SID>40, Atot<14 ya da BE>2, metabolik asidoz SID<38, Atot>20
ya da BE<-2 olarak belirlendi.
BULGULAR: %( LOH GH÷HUOHQGLULOGL÷LQGH WRSODP KDVWDGD PHWDEROLN DVLGR] WRSODP KDVWDGD PHWDEROLN DONDOR] VDSWDQGÕ 6WHZDUW \|QWHPL LOH PHWDEROLN alkaloz 33 hastada
VDSWDQGÕøNL\|QWHPDUDVÕQGDNLIDUNOÕOÕNODQODPOÕ\GÕS0HWDEROLNDVLGR]XRODQKDVWDODUÕQ
¶QGHPHWDEROLNDONDOR]GDYDUGÕ$VLGR]OXROJXODUGD%(-LNHQ%(F-
idi. Metabolik asidoz-DONDOR]XQ ELUOLNWH ROGX÷X ROJXODUGD HQ VÕN DONDOR] QHGHQL
hipoalbuminemiydi.
6218d .DUGL\RYDVNOHU FHUUDKL JHoLUHQ KDVWDODUGD PHWDEROLN DVLGR]-DONDOR] ELUOLNWH VÕNOÕNOD
J|UOPHNWHGLU $VLGR] GH÷HUOHQGLULOLUNHQ %(F KHVDSODQPD] \D GD HúOLN HGHQ PHWDEROLN DONDOR]
KHVDEDNDWÕOPD]LVHDVLGR]XQúLGGHWLGR÷UXRODUDNGH÷HUOHQGLULOHPH\HELOLU
Anahtar Kelimeler: DONDOR]NDQJD]ÕPHWDEROLNDVLGR]VWHZDUW\|QWHPL
101
P-18
ø6.(0ø5(3(5)h=<21+ASARINA MARUZ KALAN 7$9ù$1.$/%ø1'((3ø'URAL
8<*8/$1$168)(17$1ø/ø1.258<8&8(7.ø6ø
%OHQW6D\1, *DP]H6DUNÕODU2, Hasan Esen3$OL6DUÕJO4ùHUHI2WHOFLR÷OX2
1
ùemdinli Devlet Hastanesi, Hakkari
NHFPHWWLQ(UEDNDQhQLYHUVLWHVL0HUDP7ÕS)DNOWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$'.RQ\D
3
1HFPHWWLQ(UEDNDQhQLYHUVLWHVL0HUDP7ÕS)DNOWHVL Patoloji AD, Konya
4
1HFPHWWLQ(UEDNDQhQLYHUVLWHVL0HUDP7ÕS)DNOWHVL Kalp Damar Cerrahisi AD,
2
$0$d 6LVWHPLN YH LQWUDWHNDO RSLRLG X\JXODPDODUÕ PL\RNDUGL\DO LVNHPL UHSHUI]\RQ ø5
PRGHOLQGH LQIDUNW ER\XWXQX D]DOWÕU 6XIHQWDQLO \NVHN OLSLG o|]QUO÷QH VDKLS P opioid
UHVHSW|U DJRQLVWLGLU dDOÕúPDPÕ]GD HSLGXUDO \ROGDQ X\JXODQDQ VXIHQWDQLOLQ PL\RNDUGL\DO ø5
KDVDUÕQDNDUúÕPL\RNDUGL\DONRUX\XFXHWNLVLQLQROXSROPDGÕ÷ÕQÕDUDúWÕUPD\ÕDPDoODGÕN
*(5(d-<g17(0 'HQH\ +D\YDQODUÕ (WLN .XUXO RQD\Õ DOÕQGÕNWDQ VRQUD DGHt 'New Zeland'
FLQVLEH\D]HUNHNWDYúDQNXOODQÕOGÕ.RQWURO*UXSLVNHPL*UXSHSLGXUDOVXIHQWDQLO*UXS
YHLVNHPLHSLGXUDOVXIHQWDQLO*UXSRODUDNUDVWJHOHJUXEDD\UÕOGÕ6HGDV\RQYHDQDOMH]L
X\JXODQGÕNWDQ VRQUD (.* SXOV RNVLPHWUH UHNWDO ÕVÕ SUREX YH NDURWLV DUWHUH NDWHWHU
\HUOHúWLULOGL7UDNHRWRPL\DSÕOÕSPHNDQLNYHQWLODW|UHED÷ODQGÕø5ER\XQFDKHPRGLQDPLNYHULOHU
ND\GHGLOGL6ROWRUDNRWRPLLOHSHULNDUGDoÕOGÕø5X\JXODQDQJUXSODUDVRONRURQHUDUWHUHGN
LVNHPL YH DUGÕQGDQ GN VUH LOH UHSHUI]\RQ X\JXODQGÕ øVNHPL (.* WUDVHVLQGH 67
HOHYDV\RQXLOHGR÷UXODQGÕ(SLGXUDOVXIHQWDQLOX\JXODQDFDNJUXSODUGDHSLGXUDONDWHWHUGHQJ
VXIHQWDQLO YHULOGL 5HSHUI]\RQ VRQUDVÕ WDYúDQODU VDNULIL\H HGLOGL YH NDOSOHU LVNHPLN ]RQODUÕ
belirlemeN LoLQ oÕNDUÕOGÕ -7ULSKHQ\O WHWUD]ROLXP FKORULGH LoHULVLQGH LQNEH HGLOGL 'DKD
VRQUDNDOSGLOLPOHULIRUPDOGHKLWLoHULVLQHNR\XOGX5LVNDOWÕQGDNLDODQODUÕQ\]GHVLEHOLUOHQGL
BULGULAR: øQIDUNW ER\XWX LVNHPLHSLGXUDO VXIHQWDQLO LOH LNHQ, iskemi
JUXEXQGD RODUDN KHVDSODQGÕ %X IDUN LVWDWLVWLNVHO RODUDN DQODPOÕ LGL S 2UWDODPDDUWHUEDVÕQoODUÕJUXEODUDUDVÕQGDEHQ]HUEXOXQGX
6218d ø5 X\JXODQDQ GHQH\VHO oDOÕúPDODUGD LQWUDYHQ|] \ROGDQ X\JXODQDQ VXIHQWDQLOLQ
iskemik 'posWFRQGLWLRQLQJ
H EHQ]HU úHNLOGH PL\RNDUGL\DOLQIDUNW DODQÕQÕVÕQÕUODGÕ÷Õ YH DSRSWR]LVL
D]DOWWÕ÷Õ J|VWHULOPLúWLU 'DKD |QFH \DSWÕ÷ÕPÕ] GHQH\VHO oDOÕúPDGD LQWUDWHNDO VXIHQWDQLOLQ
PL\RNDUGL\DOø5KDVDUÕQDNDUúÕNRUX\XFXHWNLVLROGX÷XEXOXQPXúWX%XoDOÕúPDLOe de epidural
\ROGDQX\JXODPDQÕQGDLQIDUNWDODQÕQÕD]DOWWÕ÷ÕJ|VWHULOGL
Anahtar Kelimeler: PL\RNDUGL\DOLVNHPLUHSHUI]\RQVXIHQWDQLOHSLGXUDO
102
P-19
67$1'$57$1(67(=ø.7(.1ø.$/7,1'$0ø75$/ KAPAK ONARIMLARINDA VE
REPLASMANLARINDA QT 'ø63(56ø<218.$5ù,/$ù7,5,/0$6,
'LOHN.D]DQFÕ1(VOHPøQFH1, Sema Turan10HWLQ<ÕOPD]2%DKDU$\GÕQOÕ1$\úHJOg]J|N1
1
7UNL\H<NVHNøKWLVDV(÷LWLPYHDUDúWÕUPD+DVWDQHVL
2
'ÕúNDSÕ\ÕOGÕUÕP%H\D]ÕG(YH$+DVWDQHVL
*ø5øù
47 LQWHUYDOLQLQ X]DQDVÕ (.* GH÷LúLNOL÷LGLU YH GLULWPLOHUH VHEHS RODELOLU .OLQ÷LPL]GH RSHUH RODQ
KDVWDODUGDVÕNOÕNODUDVWODQDQELUSDWRORMLGLU47GLVSHUVL\RQXYH47&DUDOÕ÷ÕQGDNLSDWRORMLOHUEL]H
KDVWDQÕQULWPWDNLELLoLQIDW\GDOÕLSXoODUÕYHUHELOLU
Materyal ve mthod: Hastanemizde oSHUH HGLOHQ PLWUDO NDSDN RQDUÕPÕ YH UHSODVPDQÕ
KDVWDVÕQGD(.*GH÷úLNOLNOHULQLKHVDSODGÕN47GLVSHUVL\RQXYH47&DUDOÕ÷ÕKHVDSODQDKDVWDODUÕQ
NOLLNWDNLELGH\DSÕOGÕ
6RQXoODU 0LWUDO NDSDN UHSODVPDQÕ \DSÕODQ KDVWDGD YH RQDUÕP \DSÕODQ GL÷HU KDVWDGa
VWDQGDUW 7,9$ DOWÕGD \DSÕODQ ED]DO YH SRVWRSHUDWLI |OoPOHUOH NDSDN UHSODVPDQÕ \DSÕODQ
KDVWDODUGD 47&PD[ RODUDN VDSWDQGÕ YH EX GH÷HU 47& PD[ RQDUÕP KDVWDODUÕQD
J|UHDQODPOÕRODUDNGúNW
6218d 0LWUDO NDSDN RQDUÕPÕ VRQ \ÕOODUGD GDKD oRN GHQHPH\H EDúODQPÕú ELU RSHUDV\RQ
\|QWHPLGLU +DVWD EDNÕPÕQGDQ ID\GDODUÕ GHQHWOHQPHOLGLU 5HSODVPDQ SURVHGUOHUL
UHSRODUL]DV\RQDoÕVÕQGDQGDKDoRNDUDúWÕUÕOPDOÕGÕU
Anahtar Kelimeler: PLWUDONDSDN47&RQDUÕP
103
P-20
7$/$6(0ø/ø9(25$.+h&5(/ø$1(0ø/ø+$67$/$5'$$1(67(=ø'(1(<ø0/(5ø0ø=
.DVÕP7X]FX0XUDW.DUFÕR÷OX,úÕO'DYDUFÕ6HGDW+DNLPR÷OX2QXU.R\XQFXdD÷ODg]EDNÕú
$NNXUW.HUHPøQDQR÷OX0HQHNúH2NúDU$OL6DUÕ6HOLP7XUKDQR÷O
0XVWDID.HPDOQLYHUVLWHVLAnesteziyoloji ve Reanimasyon
*ø5øù %X oDOÕúPDGD NDOÕWVDO NDQ KDVWDOÕNODUÕQÕQ VÕN J|UOG÷ +DWD\ LOLQGH DQHVWH]L
X\JXODGÕ÷ÕPÕ]WDODVHPLYHRUDNKFUHOLDQHPL2+$JHQLWDúÕ\DQKDVWDODUÕQUHWURVSHNWLIRODUDN
dH÷HUOHQGLULOPHVLDPDoODQPÕúWÕU
*(5(d YH <gNTEMLER: 0XVWDID .HPDO hQLYHUVLWHVL KDVWDQHVLQGH DPHOL\DW RODQ WDODVHPL
YH\D 2+$ JHQL WDúÕ\DQ KDVWD UHWURVSHNWLI RODUDN LQFHOHQGL +DVWDODU WDODVHPLOL 7 RUDN
KFUHOLDQHPLOL2+$WDODVHPLWDúÕ\ÕFÕODUÕ77YHRUDNKFUHOLDQHPLWDúÕ\ÕFÕODUÕ2+$7olarak
JUXED D\UÕOGÕ *UXSODUGDNL KDVWDODU JHoLUGLNOHUL HQ VÕN RSHUDV\RQODU NXOODQÕODQ DQHVWH]LN
\|QWHPOHU NDQ WUDQVI]\RQX \DQGDú KDVWDOÕNODU YH NRPSOLNDV\RQODU DoÕVÕQGDQ NDUúÕODúWÕUÕOGÕ
BULGULAR: 8\JXODQDQ FHUUDKL LúOHPOHU DoÕVÕQGDQ JUXSODUÕ NDUúÕODúWÕUGÕ÷ÕPÕ]GD 7 JUXEXQGD
GLODWDV\RQNUHWDMYHDUWURVNRSLRSHUDV\RQXQXQHQVÕN\DSÕOGÕ÷ÕJ|UOG%XJUXSWDLNLKDVWDQÕQ
|]JHoPLúLQGH VSOHQHNWRPL RSHUDV\RQX YDUGÕ 2+$ JUXEXQGD LVH HQ VÕN NROHVLVWHNWRPL
RSHUDV\RQX X\JXODQPÕúWÕ 7DúÕ\ÕFÕODUÕQ ROGX÷X JUXSODU LQFHOHQGL÷LQGH LVH 77 JUXEXQGD HQ VÕN
VH]HU\DQ YH WRQVLOOHNWRPL 2+$7 JUXEXQGD NROHVLVWHNWRPL YH VH]HU\DQ RSHUDV\RQX \DSÕOPÕúWÕ
+DVWDODUÕQ SHULRSHUDWLI G|QHPGH NDQ WUDQVI]\RQODUÕ LQFHOHQGL÷LQGH *UXS 7¶ GH G|UW KDVWDGD*UXS2+$¶GDDOWÕKDVWDGD*UXS77¶GHLNLKDVWDGD*UXS2+$7¶GD
LVH ELU KDVWDGD NDQ WUDQVI]\RQX \DSÕOPÕúWÕ *UXSODU KHPDWRORMLN YHULOHU EDNÕPÕQGDQ
NDUúÕODúWÕUÕOGÕ÷ÕQGD KHPRJORELQ KHPDWRNULW O|NRVLW YH WURPERVLW GH÷HUOHUL DoÕVÕQGDQ IDUNOÕOÕN
istatistikVHORODUDNDQODPOÕ\GÕS
6218d dDOÕúPDPÕ]GD WDODVHPL YH RUDN KFUHOL DQHPL JHQL WDúÕ\DQ KDVWDODUGD OLWHUDWUOH
X\XPOX RODUDN VSOHQHNWRPL YH NROHVLVWHNWRPL RSHUDV\RQX GDKD VÕNWÕ 7DúÕ\ÕFÕ JUXSODU GD GDKLO
DQHPL \D\JÕQ ELU EXOJX\GX %X QHGHQOH WP KDVWDODUGD RSWLPDO SUHRSHUDWLI KD]ÕUOÕN \DSÕOPDVÕ
JHUHNWL÷LQL D\UÕFD KRPR]LJRW KDVWDODUGD J|UOHQ NRPSOLNDV\RQODUD NDUúÕ GLNNDWOL ROPDN
JHUHNWL÷LQLGúQ\RUX]
Anahtar Kelimeler: $QHPL$QHVWH]LRUDNKFUHOLDQHPL7DODVHPL
104
P-21
(/(.752.219h/6ø)7(5$3ø'(6(92)/85$1( 9(.(7$0ø1ø147ø17(59$/ø1(
(7.ø6ø
)HUDW$NJO(UGLO1=HNLQH%HJHo1*OD\(UGR÷DQ.D\KDQ16DLP<ROR÷OX2g]FDQ(UVR\1,
0DKPXW'XUPXú1
1
øQ|QhQLYHUVLWHVL7ÕSIDNOWHVL$QHVWH]LRORML9H5HDQLPDV\RQ$QDELOLP'DOÕ0DODW\D
2
øQ|QhQLYHUVLWHVLWÕSIDNOWHVL%LRLVWDWLVWLN$QDELOLP'DOÕ0DODW\D
(OHNWURNRQYXOVLI WHUDSL (.7¶QLQ 47 GLVSHUVL\RQXQX X]DWWÕ÷Õ ELOGLULOPLúWLU %X X]DPD DULWPL YH
DQL |OPH QHGHQ ROPDNOD ELUOLNWH VRQ ]DPDQODUGD 7S-H LQWHUYDOLQLQ DULWPL JHOLúLPLQGH GDKD
JYHQLOLUELUEHOLUWHoROGX÷XEHOLUWLOPLúWLU6HYRIOXUDQODDQHVWH]LLQGNVL\RQXLQWUDYHQ|]NDWHWHU
WDNÕOPDVÕVÕUDVÕQGDDMLWHSVLNL\DWULNROJXODUGDID\GDOÕRODELOLU.HWDPLQLQKÕ]OÕDQWLGHSUHVDQHWNLVL
QHGHQL\OH(.7LoLQVÕNOÕNODNXOODQÕOPDNWDGÕU$QFDNKHULNi ajan QT ve Tp-e intervalini uzatabilir.
%X oDOÕúPDQÕQ DPDFÕ (.7 X\JXODQDFDN PDM|U GHSUHV\RQX RODQ ROJXODUGD VHYRIOXUDQ YH
ketaminin QT ve Tp-e inteUYDOLQHHWNLVLQLDUDúWÕUPDNWÕU
<g17(0
(WLN NXUXO RQD\ÕQGDQ VRQUD PDM|U GHSUHV\RQ LoLQ (.7 SODQODQDQ ROJX oDOÕúPD\D DOÕQGÕ
$QHVWH]LLQGNVL\RQXLoLQ*UXS6¶GHVHYRIOXUDQLOHEDúODQÕSHOHNWULNVHOX\DUDQDNDGDU-4
RUDQÕQGD GHYDP HGLOGLYH VRQUD NDSDWÕOGÕ *UXS .¶GD PJNJ NHWDPLQ X\JXODQGÕ 6NVLQLONROLQ
PJNJ YHULOGLNWHQ VRQUD ROJXODU \] PDVNHVL\OH RNVLMHQOH VROXWXOGX 1|EHW VUHOHUL YH
RUWDODPD DUWHU EDVÕQFÕ 2$% NDOS DWÕP KÕ]Õ .$+ YH HOHNWURNDUGL\RJUDP DQHVWH]L
LQGNVL\RQXQGDQ|QFH7LQGNVL\RQGDQVRQUD7Q|EHWVRQODQGÕNWDQVRQUD7
T4), 3. (T5), 10. (T6) dakikada kaydedildi.
6218d
øNLJUXSWD47FLQWHUYDOLJLULúGH÷HULQHJ|UH7777¶GHX]XQGXS*UXS6¶GH47F
LQWHUYDOL 7 7 7¶ GD *UXS .¶\D J|UH GDKD X]XQGX *UXS 6¶GH JLULú GH÷HULQH J|UH 7S-e
LQWHUYDOLQGH IDUN \RNWX *UXS .¶GD LVH 7S-H LQWHUYDOL 7 G|QHPLQGH DQODPOÕ X]DGÕ *UXS 6¶GH
.$+7777¶GD*UXS.¶GD7777¶GDDUWWÕ*UXS6¶GH2$%JLULúGH÷HULQHJ|UH
7¶GH D]DOÕUNHQ 7 7 7 7¶ GD DUWÕ *UXS .¶GD 2$% JLULú GH÷HULQHJ|UH LQGNVL\RQ VRQUDVÕ
WPG|QHPOHUGHDUWPÕúROXSEXG|QHPOHUGH*UXS6¶\HJ|UHDQODPOÕ\NVHNWL
Anahtar Kelimeler: Elektrokonvulsif terapi, Ketamin, Sevofluran, QT, Tp interval.
105
P-22
*göh6&(55$+ø6ø1'(7EKRARLI OPERASYONLAR,15(75263(.7ø)
'(ö(5/(1'ø5ø/0(6ø$1(67(=ø'(23(5($.&øö(5'(7(.$.&øö(5
9(17ø/$6<218
/DOH.DUDEÕ\ÕN1)HUKDWùDPOÕ1%X÷UD6H]HQ2, Sedat Demircan2øUIDQ7DúWHSH2
1
*D]LhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$QDELOLP'DOÕ$QNDUD
2
*D]LhQLYHUVLWHVL7ÕS)DNOWHVL*|÷V&HUUDKLVL$QDELOLP'DOÕ$QNDUD
*ø5øù *|÷V FHUUDKLVLQGH |]HOOLNOH PDOLJQLWHVL RODQODU ROPDN ]HUH SHN oRN KDVWD WHNUDUOÕ
RSHUDV\RQODUD LKWL\Do GX\DELOPHNWHGLU =DWHQ PRUWDOLWHVL YH PRUELGLWHVL \NVHN RODQ J|÷V
FHUUDKLVL YH J|÷V FHUUDKLVL DQHVWH]LVLQGH WHNUDUOÕ RSHUDV\RQODUOD GXUXP GDKD NDUPDúÕN hale
JHOPHNWH YH DQHVWH]L X\JXODPDODUÕQGD DúÕOPDVÕ JHUHNHQ ]RUOXNODU GD JLGHUHN DUWPDNWDGÕU %X
oDOÕúPDGDDNFL÷HUUH]HNVL\RQXJHoLUPLúKDVWDODUÕQGDKDVRQUDGL÷HUWDUDIWDQDPHOL\DWROPDODUÕ
JHUHNWL÷LQGH UH]HNH DNFL÷HUGH WHN DNFL÷HU YHQWLODV\RQX X\JXODQPD RUDQÕ DUDúWÕUÕOGÕ YH
NDUúÕODúÕODQSUREOHPOHUGH÷HUOHQGLULOGL
*(5(d-<g17(0 2008-\ÕOODUÕDUDVÕQGDNLEHú\ÕOOÕNG|QHPGH*|÷V&HUUDKLVLQGHDQHVWH]L
X\JXODQDQKDVWDODUDDLWND\ÕWODUUHWURVSHNWLIRODUDNLQFHOHQGL2SHUHRODQKDVWDODULoLQGHELUGHQ
fazlD RSHUDV\RQ JHoLUHQOHU EHOLUOHQGL %X KDVWD JUXEX LoLQGH GH IDUNOÕ WDUDIODUGDQ WRUDNRWRPL
JHoLUHQOHUOLVWHOHQHUHNWHNDNFL÷HUYHQWLODV\RQXYHNRPSOLNDV\RQODUEDNÕPÕQGDQGH÷HUOHQGLULOGL
BULGULAR: %Hú \ÕOOÕN VUHGH *|÷V &HUUDKLVL $PHOL\DWKDQHVLQGH JHUoHNOHúWLULOHQ DPHOL\DWÕQ ¶ VLQH WRUDNRWRPL X\JXODQGÕ÷Õ EHOLUOHQGL %XQODUGDQ ¶XQXQ NLVW KLGDWLN
QHGHQL\OH JHUoHNOHúWL÷L J|UOG 7RUDNRWRPLOHULQ ¶VLQLQ WHNUDUOÕ RSHUH HGLOGL÷L ¶QQ LVH o
NH]WRUDNRWRPLJHoLUGL÷LJ|UOG%XWHNUDUOÕDPHOL\DWODUÕQ¶LQLQD\QÕWDUDIWD¶VLQLQLVHNDUúÕ
WDUDIWDQ ROGX÷X VDSWDQGÕ %X ROJXODUGDQ oQGH KHU LNL DPHOL\DWD DLW SDWRORMLOHULQ ELUELULQGHQ
IDUNOÕ EXOXQGX÷X J|]OHQGL $\QÕ YH IDUNOÕ WDUDIWDQ RSHUH RODQODUGDQ ELUHU KDVWD ROPDN ]HUH
WRSODPLNLKDVWDQÕQKDVWDQHGH\DWÕúÕVUHVLQFHHNVLWXVROGX÷XGLNNDWLoHNWL
7$57,ù0$ 7HN DNFL÷HU YHQWLODV\RQXQGD KDYD\ROX EDVÕQFÕ \NVHNOL÷L NDUERQGLRNVLW
UHWDQVL\RQX YH GHVDWUDV\RQ DQHVWH]LGH NDUúÕODúÕODQ |QHPOL ]RUOXNODUGÕU 2SHUH RODQ DNFL÷HULQ
izolasyonu sonucunda tek akcL÷HU YHQWLODV\RQX LoLQ YHQWLOH HGLOHQ DNFL÷HULQ GDKD |QFH UH]HNH
HGLOPLú ROPDVÕ GXUXPXQGD EX ]RUOXNODUÕQ GDKD HUNHQ RUWD\D oÕNPDVÕ YH GDKD EHOLUJLQ ROPDVÕ
EHNOHQLU 5H]HNVL\RQXQ JHQLúOL÷L KDYD\ROX EDVÕQFÕ \NVHNOL÷L NDUERQGLRNVLW UHWDQVL\RQX YH
GHVDWUDV\RQXQFLGGL\HWLQLEHOLUOH\HQDQDIDNW|UGU.
Anahtar Kelimeler: *|÷V &HUUDKLVL 5HRSHUDV\RQ 7HN $NFL÷HU 9HQWLODV\RQX 7RUDVLN
Anestezi
106
P-23
:$5)$5ø17('$9ø6ø1ø1 $17ø.2$*h/$1(7.ø6ø1ø1$&ø/&(55$+øg1&(6ø
3527520%ø1.203/(.6.216$175(6ø3&&ø/E 'h=(/7ø/0(6ø
-OLGH6D\ÕQ.DUW1&HP$UÕWUN26HUSLO8VWDODUg]JHQ1(\S0XUDWgNWHQ2, Fevzi Toraman1,
(úUHI+DVDQ.DUDEXOXW2, Cem Alhan2
1
$FÕEDGHPhQLYHUVLWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$QD%LOLP'DOÕøVWDQEXO
2
$FÕEDGHPhQLYHUVLWHVL.DOSYH'DPDU &HUUDKLVL$QD%LOLP'DOÕøVWDQEXO
:DUIDULQ DQWLNRDJODQ WHGDYL DPDoOÕ HQ VÕN NXOODQÕODQ LODo ROXS EX LODFÕ NXOODQDQ KDVWDODUGD
J|UOHQ HQ |QHPOL NRPSOLNDV\RQ NDQDPDGÕU 2UDO DQWLNRDJXODQ NXOODQDQ KDVWDODUGD NDQDPD\Õ
|QOHPHN LoLQ . YLWDPLQL 7D]H 'RQPXú 3OD]PD 7'3 YH øQVDQ 3URWURPELQ .RPSOHNVL 3&&
&RIDFWNXOODQÕOPDNWDGÕU$÷ÕUNDQDPDODUGDFHUUDKLYH\DJLULúLPVHOLúOHP\DSÕODFDNKDVWDODUGD
DQWLNRDJODQHWNLQLQKÕ]ODG]HOWLOPHVLJHUHNPHNWHGLU3&&&RIDFW|]HOOLNOHRUDODQWLNRDJODQ
NXOODQÕPÕQDED÷OÕROPDN]HUH,15GH÷HULQLQ\NVHNVH\UHWWL÷LDFLOFHUUDKLJLULúLPJHUHNOLOL÷L\D
GDKD\DWÕWHKGLWHGHQNDQDPDJLEL,15¶QLQNÕVDVUHGHQRUPDOL]HHGLOPHVLJHUHNHQGXUXPODUGD
NXOODQÕODQ\HQLQHVLOELUDMDQGÕU$FLOVHUYLVLPL]HGúPHVRQXFXEDúYXUDQVD÷UDGLXVDOWXoYH
VD÷ SHULWURNDQWHULN NÕUÕ÷Õ RODQ \DúÕQGDNL HUNHN KDVWDGD 3&& &RIDFW NXOODQÕPÕ |QFHVL YH
VRQUDVÕ,15VRQXoODUÕQÕNDUúÕODúWÕUDUDN&RIDFW¶ÕQ,15GH÷HUL\NVHNDQFDNDFLOYHPXWODNFHUUDKL
JLULúLPJHUHNWLUHQKDVWDODUGDNLHWNLQOL÷LQLJ|VWHUPH\LDPDoODGÕN
Anahtar Kelimeler: Cofact, Warfarin
Bulgular
INR (IU)
K&dPE^7
COFACT SONRASI
15.DK
COFACT SONRASI
28. SAAT
COFACT SONRASI
40. SAAT
3,46
1,7
3,11
1,71
+HGHI,15 ROPDVÕLoLQFRIDFWGR]XPO
INR (IU) 7,5 5,9 4,8 4,2 3,6 3,3 3,0 2,8 2,6 2,5 2,3 2,2
$ö,5/,.
50 kg
40 40 40 30 30 30 20 20 X
X
X
X
60 kg
50 50 40 40 30 30 30 20 X
X
X
X
70 kg
60 50 50 50 40 40 30 30 X
X
X
X
80 kg
60 60 60 50 50 40 40 30 X
X
X
X
90 kg
60 60 60 60 50 50 40 30 X
X
X
X
100 kg
60 60 60 60 60 50 40 40 X
X
X
X
107
P-24
.$5'ø<238/021(5%<3$666215$6,*(/øù(10$/ø*1+ø3(57(0ø2/*U
SUNUMU)
Deniz Karakaya1, Ebru Kelsaka1%LQQXU6DUÕKDVDQ1+DVDQ7DKVLQ.HoHOLJLO 2
1
2QGRNX]0D\ÕVhQLYHUVLWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$%'6DPVXQ
2
Ondokuz 0D\ÕVhQLYHUVLWHVL.DOSYH'DPDU&HUUDKLVL$%'6DPVXQ
*ø5øù $oÕN NDOS FHUUDKLVL JHoLUHQ KDVWDODUGD NDUGL\RSXOPRQHU E\SDVV YH ÕOÕPOÕ KLSRWHUPL
VHPSWRPODUÕ EDVNÕODGÕ÷Õ LoLQ PDOLJQ KLSHUWHUPL 0+ WDQÕVÕ NR\PDN JoWU %XUDGD
kardiyopulmoner bypass (KPBVRQUDVÕ0+JHOLúHQELUROJX\XVXQPDNLVWHGLN
OLGU: 9HQWULNOHU VHSWDO GHIHNW 96' WDQÕVÕ DOPÕú RODQ \DúÕQGDNL HUNHN KDVWD\D 96'
RQDUÕPÕ \DSÕOPDVÕ SODQODQGÕ $LOHVLQGH 0+ KLND\HVL \RNWX YH GDKD |QFH DQHVWH]L DOPDPÕúWÕ
5XWLQ PRQLW|UL]DV\RQGDQ VRQUD PLGD]RODPWLRSHQWDO YH URNXURQ\XP LOH DQHVWH]LLQGNVL\RQX
VHYRIOXUDQ 2NXUX KDYD UHPLIHQWDQLO YH URNXURQ\XP LOH DQHVWH]L LGDPHVL VD÷ODQGÕ .3%
VÕUDVÕQGDYFXWVÕFDNOÕ÷ÕR&¶DUHNWDOGúUOHQKDVWDGDKHUKDQJLELUVRUXQ\DúDQPDGÕYH
E\SDVV VRQXQGD UHNWDO VÕFDNOÕ÷Õ R& (W&2 PP+J LGL 2SHUDV\RQXQ VDDWLQGH
VWHUQXPNDSDWÕOÕUNHQ(W&2GH÷HULWHGULFHQPP+J¶\DYFXWVÕFDNOÕ÷ÕGDR&¶DNDOSKÕ]Õ
GN NDQ EDVÕQFÕ PP+J¶\D \NVHOGL $UWHUL\HO NDQ JD]Õ S+ S&2 PP+J
pO2 174 mmHg, BE - PPRO/ +&2 P(T/ . PPRO/ EXOXQGX 0+ JHOLúWL÷L
GúQOGYRODWLODQHVWH]LNOHUNHVLOHUHN2LOHYHQWLODV\RQDYHDNWLIRODUDNVR÷XWXOPD\D
EDúODQGÕ 'DQWUROHQ PJNJ LY X\JXODQGÕ 'DQWUROHQ YHULOPHVLQGHQ GN VRQUD DOÕQDQ NDQ
JD]ÕQRUPDOHG|QG<R÷XQEDNÕPDDOÕQDQKDVWD\DGDQWUROHQPJNJVDDWWHELUROPDN]HUH
VDDW VUH\OH X\JXODQGÕ %X VUHGH DWHúL \NVHOPH\HQ KDVWD VDDWWH HNVWEH HGLOdi.
.UHDWLQ NLQD] &. GH÷HUL 8/¶\H VDDWWH \NVHOGL 7DPDPHQ L\LOHúHQ KDVWD JQ
taburcu edildi.
7$57,ù0$ .3% KLSHUPHWDEROLN ELU GXUXPD \RO DoDUDN 0+ DWD÷ÕQÕ EDúODWDELOPHNWHGLU $LOH
|\NVROPD\DQKDVWDODUGD.3%¶GDQVRQUDGD0+JHOLúHELOHFH÷LDNÕOGDWXWXOPDOÕ\DNÕQL]OHPLOH
WDQÕNRQXOGX÷XQGDWHGDYL\HEDúODQÕSGDQWUROHQX\JXODQPDOÕGÕU
Anahtar Kelimeler: kardiyopulmoner bypass, malgn hipertermi
108
P-25
$d,..$/3&(55$+ø6øEKSTRAKORPOREAL DOLAù,0,6,5$6,1'$*(/øù(10$6ø)
$.&øö(5g'(0ø2/*U SUNUMU
*UD\'HPLU%HGLK%DONDQ0XUDW'R÷DQ+DOLOdHWLQJ|N*OD\(UHQ=DIHUdXNXURYD
2\D+HUJQVHO
%DNÕUN|\'U6DGL.RQXN(÷LWLPYH$UDúWÕUPD+DVWDQHVL$QHVWH]LYH5HDQLPDV\RQ.OLQL÷L
3RPSD DNFL÷HUL DoÕN NDOS FHUUDKLVL VRQUDVÕ LPPQ VLVWHPLQ aktivasyonu sonucu pulmoner
YDVNOHU JHoLUJHQOL÷LQ DUWPDVÕ VRQXFX J|UOHQ NOLQLN ELU WDEORGXU %X VXQXGD RSHUDV\RQ
VÕUDVÕQGD EHNOHQPHGLN DQL YH PDVLI JHOLúHQ ELU DNFL÷HU |GHPL WDUWÕúÕOPÕúWÕU
$WPÕúLNL \DúÕQGD KDVWD\D LNL GDPDU NRQRQHU E\-pass cerrahisi SODQODQPÕúWÕ (NRNDUGLRJUDILN
(.2 LQFHOHPHGH HMHNVL\RQ IUDNVL\RQX NDOS NDSDNODUÕ LVH GR÷DO RODUDN GH÷HUOHQGLULOGL
5XWLQ DQHVWH]L LQGNVL\RQX YH FHUUDKL SURVHGU LOH NDOS-DNFL÷HU SRPSDVÕ DOWÕQGD &$%*
RSHUDV\RQXQD EDúODQGÕ 3RPSD DOWÕQGD KHPRGLQDPLN bir sorunu olmayan hastada, distal
DQDVWRPR]ODU VRQUDVÕ DRUW NURV NOHPS NDOGÕUÕOÕS YHQWLOH HGLOPH\H EDúODQGÕ÷Õ VÕUDGD HQWEDV\RQ
WSQGHQ GÕúDUÕ oÕNDFDN PLNWDUGD DNFL÷HU GRNX VÕYÕVÕ LOH NDUúÕODúÕOGÕ +DVWD PO NJ-1 tidal
YROPYHFP+23((3EDVÕQoLOH YHQWLOHHGLOPH\HEDúODQGÕ2ODVÕQHGHQOHU|]HOOLNOHYROP
\NOHQPHVLJ|]GHQJHoLULOGL÷LQGHWDEOR\XDoÕNOD\DFDNELUVHEHEEXOXQDPDGÕ&HUUDKLELWLPLQGH
\DSÕODQ 7((¶GH SXOPRQHU DUWHU EDVÕQFÕQ PP+J oHNLOHQ DNFL÷HU JUDILVLQGH LVH ELODWHUDO
DNFL÷HU |GHPL WHVELW HGLOGL +DVWD X\JXQ YHQWLODV\RQ YH PHGLNDV\RQ LOH JQGH \R÷XQ
EDNÕPGDQ oÕNDUÕOGÕ 7HNUDUODQDQ (.2 LQFHOHPHVLQGH SXOPRQHU EDVÕQoODUÕQ QRUPDO VÕQÕUODUD
G|QPHVL UDG\RJUDILN YH NOLQLN WDNLSGH GH DNFL÷HU |GHPLQLQ ND\EROPDVÕ ]HULQH JQGH
hastaneden taburcu edildi.
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WL\RSHQWDO NJ IHQWDQLO YH PJNJ URNXURQ\XP LOH HQWEDV\RQ \DSÕOGÕ (QWEDV\RQGDn
VRQUDVD÷IHPRUDOYHQH69.X\JXODQGÕ$VVHQGDQDRUWD\DYHYHQDNDYDLQIHUL\RUDNDQODV\RQ
X\JXODQDUDN KDVWDGD HNVWUDNRUSRUHDO GRODúÕPD JHoLOGL 6D÷ DWUL\XP LoLQGH NDWHWHU XFXQGD
J|UOHQ WURPEV YH NDWHWHU XFX NHVLOHUHN DOÕQGÕ +DVWDQÕQ RSHUDV\RQ VUHVLQce hemodinamik
YHQ|URORMLNEXOJXODUÕVWDELOGL
(NVWUDNRUSRUHDOGRODúÕPVUHVLGNRSHUDV\RQVUHVLGNYHSRPSDVUHVLQFHh5%&YH
h7'3YHULOGL3RVWRSHUDWLIVDDWVRQUDHNVWEDV\RQ\DSÕOGÕ
6218d 6DQWUDONDWHWHUHED÷OÕWURPEVJHOLúLPLYHEXNRSOLNDV\RQEDúDUÕLOHWHGDYLHGLOPLúWLU
Anahtar Kelimeler: .DWHWHU7URPEV
114
P-31
%21=$ø278ødø0ø1(%$ö/,*(/øù(1.$5'ø<2PULMONER ARREST
2QXU3DODEÕ\ÕN Yakup Tomak6HUEOHQW*|NKDQ%H\D]$\oD7Dú7XQD$OL)XDW(UGHP
6DNDU\DhQLYHUVLWHVL(÷LWLP9H$UDúWÕUPD+DVWDQHVL
*ø5øù %RQ]DLRWXX\XúWXUXFX|]HOOL÷LRODQ\HQLELUVHQWHWLNNDQDELQRLGWUHYLGLU.H\LIYHULFL
HWNLVL LoLQ VLJDUD JLEL VDUÕODUDN GXPDQÕ LQKDODV\RQ \ROX LOH DOÕQPDNWDGÕU øoHUGL÷L PDGGHOHULQ
toksik ve metabolik etkileri tam bilinmemekle birlikte ciddi metabolik ve psikolojik problemlere
\RO DoDELOHFH÷L GúQOPHNWHGLU *HQHOOLNOH WRNVLN EHOLUWLOHULQ VRQ NXOODQÕPGDQ -4 saat sonra
EDúODGÕ÷Õ ELOGLULOPLúWLU /LWHUDWUGH VHQWHWLN NDQDELQRLG NXOODQÕPÕQÕ WDNLEHQ Q|EHW EDú D÷UÕVÕ
bulanWÕ NXVPD DMLWDV\RQ KDOVLQDV\RQ OHWDUML NRPD WDúLNDUGL EUDGLNDUGL KLSHUWDQVL\RQ
LQWUDNUDQL\DO KHPRUDML EXOJXODUÕQÕQ J|UOG÷ ELQOHUFH EDúYXUX ROPDVÕQD UD÷PHQ VDGHFH KDVWDGD |OP ELOGLULOPLúWLU %L] ERQ]DL RWX DOÕPÕ VRQUDVÕ VHQNRS QHGHQL\OH DFil servise
JHWLULOGLNWHQ NÕVD VUH VRQUD NDUGL\RSXOPRQHU DUUHVW JHOLúHQ WDNLSOHULQGH PHWDEROLN DVLGR]
VÕYÕ-HOHNWUROLW GHQJHVL]OL÷L NDUDFL÷HU \HWPH]OL÷L \D\JÕQ NDQDPDODU E|EUHN \HWPH]OL÷L JHOLúHQ
YHHNVLWXVODVRQXoODQDQROJX\XWDUWÕúPD\ÕDPDoODGÕN
OLGU: 6HQNRS QHGHQL\OH DFLO VHUYLVH EDúYXUDQ ROJXGD WDNLSOHUL VÕUDVÕQGD NDUGL\RSXOPRQHU
DUUHVWJHOLúWL.DUGL\RSXOPRQHUUHVHVWDV\RQDFHYDSYHUHQODERUDWXYDUWHWNLNOHULQGHPHWDEROLN
DVLGR]VÕYÕ-HOHNWUROLWGHQJHVL]OL÷LYHHQ]LP\NVHNOLNOHULVDSWDQDQROJX \R÷XQEDNÕPQLWHVLQH
DOÕQGÕ $QDPQH]LQGHQ LVPLQLQ ³%RQ]DL´ ROGX÷X V|\OHQHQ RWX DFLOH JHOLúLQGHQ \DNODúÕN VDDW
|QFH VLJDUD úHNOLQGH VDUDUDN LoWL÷L |÷UHQLOGL 7DNLSOHULQGH NRDJODV\RQ WHVWOHULQGH ER]XOPD
NDUGL\DN YH NDUDFL÷HU IRQNVL\RQ WHVWOHULQGH DúÕUÕ DUWÕú VDSWDQGÕ 7RNVLN PHWDEROLWOHUL
HOLPLQDV\RQ LoLQ KHPRGL\DOL]H EDúODQGÕ <R÷XQ EDNÕP WDNLSOHULQGH PXNR]D NDQDPDVÕ EDúOD\DQ
ROJXGD KDVWDQH\H JHOLúLQLQ VDDWLQGH WHNUDU NDUGL\DN DUUHVW JHOLúWL GDNLNDOÕN
NDUGL\RSXOPRQHU UHVVLWDV\RQD FHYDS DOÕQDmayan
olgu
eksitus
kabul
edildi.
7DUWÕúPDYH
6218d .H\LI YHULFL |]HOOL÷LQLQ ROPDVÕ NROD\ WHPLQ HGLOHELOPHVL YH NXOODQÕP úHNOLQLQ NROD\
ROPDVÕ QHGHQL\OH ERQ]DL RWX WRNVLNDV\RQXQD ED÷OÕ DFLO VHUYLVH EDúYXUXODUÕQ DUWÕú J|VWHUGL÷LQL
J|]OHPOHPHNWH\L] %RQ]DL RWXQXQ WRNVLNDV\RQ EHOLUWLOHUL KHQ] QHW RODUDN ELOLQPHVH GH FLGGL
VD÷OÕNSUREOHPOHULQLQ\DQÕVÕUD|OPHGH\RODoDELOHFH÷LELOLQPHOLGLU
Anahtar Kelimeler: Bonzai otu; sentetik kanabinoid; toksikasyon
115
P-32
3$56ø<(/%<3$66(ù/øöø1'(.$9$$75ø<$/7520%h6h2/$15(1$/7h0g5
9$.$6,1'$$1(67(=ø.<$./$ù,0
ùHULIH%HNWDú6HPD7XUDQ*|NKDQ3HNHU%HUQD(UJQhPLW.DUDGHQL]
%X ROJX VXQXPXQGD SDUVL\HO E\SDVV HúOL÷LQGH NDYRDWUL\DO WXWXOXPX RODQ UHQDO KFUHOL WP|U
RSHUDV\RQXQGDX\JXODGÕ÷ÕPÕ]DQHVWH]L\|QHWLPLQLVXQPD\ÕDPDoODGÕN
OLGU: \DúÕQGD HUNHN KDVWD NÕUPÕ]Õ LGUDU \DSPD úLND\HWL LOH KDVWDQH\H EDúYXUPXú<DSÕODQ
LONGH÷HUOHQGLUPHGH%LOJLVD\DUOÕ7RPRJUDILGH6D÷E|EUHNWHîPPNLWOHOH]\RQXL]OHQPLúWir
5&&"6RO UHQDO YHQ LoHULVLQGH 9&ø YH VD÷ DWULXP LoHULVLQH NDGDU X]DQDQ KLSRGHQV WURPEXV
PDWHU\DOL L]OHQGL (NRNDUGL\RJUDILN LQFHOHPHGH VD÷ DWUL\XPGD øQWHUDWUL\DO VHSWXPD \DNÕQ
KDUHNHWOL\DSÕJ|]OHQGL%XKDOL\OHKDVWD\DDoÕNUDGLNDOQHIUHNWRPLYHSDUVL\HOED\SDVHúOL÷LQGH
VD÷ DWUL\DO YH LQIHUL\RU YHQD FDYDGDQ WURPEV HNVL]\RQX \DSÕOPDVÕQD NDUDU YHULOGL2SHUDV\RQ
KD]ÕUOÕ÷Õ WDPDPODQDQ KDVWDQÕQ RSHUDV\RQ RGDVÕQD DOÕQGÕNWDQ VRQUD UXWLQ PRQLWRUL]DV\RQX
VD÷ODQGÕ $QHVWH]L LQGNVL\RQXQGD PLGD]RODPIHQWDQLOURNXURQ\XP EURPLG NXOODQÕOGÕ*HQLú
GDPDU\ROODUÕYHVDQWUDOYHQ|]NDQO\HUOHúWLULOGL7((SUREXLOHWPRUQVD÷DWULXPGDNLYDUOÕ÷Õ
YH NDWHWHULQ SR]LV\RQX GR÷UXODQGÕ 2SHUDV\RQ ER\XQFD 7(( LOH HPEROL DoÕVÕQGDQ VUHNOL WDNLS
\DSÕOGÕ$RUW9&6 YH 9&ø LQIUDUHQDO E|OJH GLVWDOLQGHQ NDQOH HGLOGL(NVWUDNRUSRUDO GRODúÕP
EDúODWÕOGÕ.DOS FHUUDKODUÕ WDUDIÕQGDQ VD÷ DWUL\RWRPL \DSÕODUDN DWUL\XP LoHULVLQGHNL WURPEV
LQIHUL\RUYHQDFDYDLoHULVLQHGR÷UXLWLOGL%XHVQDGD7((LOHWURPEVQVD÷DWUL\XPGDQLQIHUL\RU
vena cavaya gHoLúL J|UOGøQIHUL\RU 9HQD &DYD VD÷ DWUL\XPD JLULú DOWÕQGDQ YH LQIUDUHQDO
E|OJHGHQNOHPSHHGLOGL.OHPSOHUDUDVÕQGDNDODQLQIHUL\RU YHQD FDYDNÕVPÕFPOLNELUNHVLLOH
DoÕODUDNWURPEVoÕNDUWÕOGÕ+DVWDQÕQRSHUDV\RQELWLPLQGHDGUHQDOLQPJNJKYHGopamine
PLNURJUDPNJGN øQRWURSLN GHVWHN LOH 7$ PPKJNDOS DWÕP KÕ]Õ DWÕPGN LGL %X
KDOL\OH\R÷XQEDNÕPDWUDQVIHUHGLOGL2SHUDV\RQGDQJQVRQUDHNVWEHHGLOGL9LWDOEXOJXODUÕ
VWDELO RODQ KDVWD VHUYLVH oÕNDUÕOGÕ %X ROJX LOH NDYRDWUL\DO WURPEV RODQ UHQDO KFUHOL WP|U
ROJXODUÕQGD LQWUDRSHUDWLI 7((¶QLQ NDUGL\DN IRQNVL\RQODUÕQ GH÷HUOHQGLULOPHVLQGH YH WP|U
HPEROL]DV\RQXQXQ|QOHQPHVLQGH\DUDUOÕELUPRQLW|UROGX÷XVRQXFXQDYDUGÕN
Anahtar Kelimeler: 5HQDO+FUHOL7P|U3DUVL\HO%\SDVV.DYDDWUL\DO7URPEV.
116
P-33
$d,..$/3&(55$+ø6ø1'(.$5'ø<$..ø67+ø'$7ø.2/*8/$5,9($1(67(=ø
ùHULIH%HNWDú6HPD7XUDQ%HUQD(UJQ'LOHN.D]DQFÕ%OHQW<DPDNhPLW.DUDGHQL]
7UNL\H<NVHNøKWLVDV(÷LWLP9H$UDúWÕUPD+DVWDQHVL
*ø5øù
+LGDWLGRV (JUDQXORVXV¶XQ ODUYD IRUPXQXQ LQVDQGD QHGHQ ROGX÷X SDUD]LWLN NLVWLN ELU
HQIHNVL\RQXGXU .DOSWH ORNDOL]H KLGDWLG NLVWOHU oRN QDGLU ROXS WP KLGDWLN NLVWOHULQ \DNODúÕN 0,5-¶VL NDGDUGÕU (Q VÕN UDVWODQDQ ORNDOL]DV\RQODU VRO YHQWULNO VHUEHVW GXYDUÕ -77) ve
LQWHUYHQWULNOHU VHSWXPGXU %X oDOÕúPDGD DPDFÕPÕ] KDVWDQHPL]GH NDUGLDN NLVW KLGDWLN QHGHQL
LOHRSHUHHGLOHQROJXODUÕQSHURSHUDWLIWDNLSVRQXoODUÕQÕUHWURVSHNWLIRODUDNGH÷HUOHQGLUPHNWLU
MATERYAL VE METHOD
+DVWDQHPL] NDOS YH GDPDU FHUUDKLVL NOLQL÷LQGH - WDULKOHUL DUDVÕQGD NDUGL\DN WXWOXPOX
NLVW KLGDWLN WDQÕVÕ LOH RSHUH HGLOHQ KDVWD UHWURVSHNWLI RODUDN GH÷HUOHQGLULOGL 7P KDVWDODUÕQ
\DúFLQVL\HWNOLQLN VHPSWRPODUÕGL÷HU RUJDQ WXWXOXPODUÕ .DUGLD\DN NLVW ORNDOL]DV\RQODUÕNLVWLQ
ER\XWODUÕ X\JXODQDQ FHUUDKL SURVHGU YH PRUWDOLWH YDUOÕ÷Õ ND\GHGLOGL 7P KDVWDODUGD
LQWUDRSHUDWLI7g(LOHWDNLS\DSÕODUDNKHPNDUGL\DN\DSÕODUKHPGHWXWXOXP\HULQHJ|UHJ|]OHQHQ
NDSDNDQRUPDOOLNOHULGH÷HUOHQGLULOGL
BULGULAR
+DVWDODUÕQ \Dú RUWDODPDVÕ KDVWDQÕQ ¶Q HNVWUD NDUGLDN NLVW KLGDWLN \HUOHúLPL
PHYFXWWX %X KDVWDGDQ ELU WDQHVL DNFL÷HU NLVWKLGDWL÷L QHGHQLLOH RSHUH HGLOPLú LNHQ GL÷HU LNL
ROJXGD NDUDFL÷HUGH NLVW KLGDWLN ROGX÷X EHOLUOHQGL .DUGL\DN NLVW KLGDWLN ORNDOL]DV\RQODUÕ
ER\XWODUÕ YH X\JXODQDQ FHUUDKL SURVHGU WDEOR GH EHOLUWLOPLúWLU KDVWDQÕQ ¶VÕQD
NDUGL\RSXOPRQHU E\SDVVD JLULOPHGHQ FHUUDKL X\JXODQPÕúNHQ WDQHVLQH NDUGL\RSXOPRQHU
E\SDVV HúOL÷LQGH FHUUUDKL X\JXODQGÕ÷Õ EHOLUOHQGL KDVWDQÕQ VLQGH NLVW KLGDWLN oÕNDUÕOPDVÕ
\DQÕ VÕUD 7g( UHKEHUOL÷LQGH WULNVSLG NDSDN \HWPH]OL÷L J|]OHQGL YH WDNLEHQ GHYDJD DQORSODVWL
X\JXODQGÕKDVWDQÕQúLIDLOHWDEXUFXHGLOGL÷LEHOLUOHQGL
7$57,ù0$
.LVWKLGDWLNWXWXOXPXQDED÷OÕDoÕNNDOSFHUUDKLVLQDGLUNDUúÕODúÕODQELUGXUXPGXU%XUHWURVSHNWLI
GH÷HUOHQGLUPH LOH NDUGL\DN NLVW KLGDWLN RSHUDV\RQODUÕQGD 7g(¶QXQ HWNLOL ELU PRQLWRUL]DV\RQ
VHoHQH÷LROGX÷XNDQDDWLQHYDUGÕN
Anahtar Kelimeler: .LVW+LGDWLN$oÕNNDOSFHUUDKLVL.
117
Table 1. Kist hidatik ROJXODUÕQÕQGHPRJUDILNYHRSHUDV\RQ|]HOOLNOHUL
Vak \DúFLQVL\
a
et
semptomlar
No (years)
1
2
3
4
5
6
7
19/M
39/F
38/F
58/M
40/F
43/F
62/M
'L÷HU
organ
Kardiyak kist
tutulum lokalizasyonu
u
*|÷VD÷UÕVÕ -
*|÷VD÷UÕVÕ
ve nefes
GDUOÕ÷Õ
VROYHQWULNO
posterolateral
GXYDUÕ
arcus aorta sol
lateral
NRPúXOX÷XQGD
n
1HIHVGDUOÕ÷Õ -
VROYHQWULNO
posterior
GXYDUÕQGDQ
Rutin
Taramada
Kckist
hidatik
6ROYHQWULNO
apeks ve
anterolateral
GXYDUÕQGDQ
Rutin
taramada
$NFL÷HU
kist
hidatik VD÷YHQWULNO
nedeniy
le opere
1HIHVGDUOÕ÷Õ -
1HIHVGDUOÕ÷Õ -
6ROYHQWULNO
apeksinde
7ULNVSLW
anulusune
LQILOWUHVD÷
DWUXPLoLQH
GR÷UXNLVW
118
E\NO÷
(cm)
Cerrahi
SURVHGU
(úOLN
eden
SURVHGU
53*56 mm
kardiyak kist
hidatik
eksizyonu,
kardiyopulmo
ner bypas
ROPDNVÕ]ÕQ
-
102*68*10
2 mm
32*24*36
mm
kardiyak kist
hidatik
eksizyonu,
kardiyopulmo
ner bypas
ROPDNVÕ]ÕQ
-
2,5*3 cm
kardiyak kist
hidatik
eksizyonu,
kardiyopulmo
ner bypas
ROPDNVÕ]ÕQ
-
84*60*50
mm
kardiyak kist
hidatik
eksizyonu,
kardiyopulmo
ner bypas
ROPDNVÕ]ÕQ
-
10*10 cm
kardiyak kist
hidatik
eksizyonu,
kardiyopulmo
ner bypas
ROPDNVÕ]ÕQ
-
47*44 mm
kardiyak kist
hidatik
eksizyonu,
kardiyopulmo
ner bypas
ROPDNVÕ]ÕQ
-
kardiyak kist
hidatik
eksizyonu,
kardiyopulmo
ner bypas
DOWÕQGD
Trikuspit
kapakta
De Vega
anuloplas
ty
8
9
10
1HIHVGDUOÕ÷Õ -
øQWHUYHQWULNOH
r septum
2*2 cm
sol pulmoner
arter
21*18mm
NRPúXOX÷XQGD
kardiyak kist
hidatik
eksizyonu,
kardiyopulmo
ner bypas
DOWÕQGD
-
52/M
*|÷VD÷UÕVÕ -
CABG
vekardiyak
øQWHUYHQWULNOH
kist hidatik
2.0*2.5 cm
r septum
eksizyonu,
kardiyopulmo
ner bypas ile
-
40/F
Opere KC
kist
hidatik,kontr Kckist
ol
hidatik
tomografisin
de
øQWHUYHQWULNOH
r septumdan
Kardiyak kist
VD÷YHQWULNOH
hidatik
SURWU]H7ULNXV 1.8*2.6 cm eksizyonu,
pit septal
kardiyopulmo
leaflet alt
ner bypas ile
NÕVPÕQD
Trikuspit
kapakta
De Vega
anuloplas
ty
29/M
119
P-34
.$527ø'(1'$57(5(.720ø'(7(.(1-(.6ø<21<g17(0ø</(6(59ø.$/PLEKSUS
%/2ö88<*8/$0$0,=
2QXU3DODEÕ\ÕN$\oD7Dú7XQD)LNUHW%D\DU6HUEOHQW*|NKDQ%H\D] Yakup Tomak,
Ali Fuat Erdem
6DNDU\DhQLYHUVLWHVL(÷LWLPYH$UDúWÕUPD+DVWDQHVL
*ø5øù .DURWLGDUWHUVWHQR]OXKDVWDODUGD\HQLVHUHEURYDVNOHUROD\JHOLúPHLKWLPDOLQLD]DOWPDN
LoLQ NDURWLG HQGDUWHUHNWRPL JQFHO ELU X\JXODPDGÕU %X RSHUDV\RQODUGD VHUYLNDO SOHNVXV EOR÷X
LOH UHM\RQDO DQHVWH]L JQP]GH SRSODULWH ND]DQPÕúWÕU 6HUYLNDO SOHNVXV EOR÷X Q|URORMLN
IRQNVL\RQXQGLUHNL]OHQPHVLQHKDVWDQHGHNDOÕúVUHVLQLQNÕVDOPDVÕQD\R÷XQEDNÕPLKWL\DFÕQÕQ
PRUELGLWH YH PRUWDOLWHQLQ D]DOPDVÕQD NDWNÕGD EXOXQPDNWDGÕU %L] DFLO RSHUDV\RQ SODQODQDQ
NRURQHU DUWHU KDVWDOÕ÷Õ NURQLN REVWUNWLI DNFL÷HU KDVWDOÕ÷Õ SDWHQW IRUDPHQ RYDOH LQWHUDWUL\DO
VHSWDO DQHYUL]PD JHoLULOPLú VHUHEURYDVNOHU KDVWDOÕN VLJDUD YH DONRO ED÷ÕPOÕOÕ÷Õ RODQ ROJXGD
WHN HQMHNVL\RQ \|QWHPL\OH VHUYLNDO SOHNVXV EOR÷X X\JXODPDPÕ]Õ VXQPD\Õ DPDoODGÕN
OLGU: \DúÕQGD HUNHN ROJXQXQ IL]LN Puayenesinde
bilateral
kaba
raller;
HNRNDUGL\RJUDILVLQGH HMHNVL\RQ IUDNVL\RQX VRO YHQWULNO KLSHUWURILVL SDWHQW IRUDPHQ
ovale, interatriyal septal anevrizma ve grade 1 diyastolik disfonksiyon; solunum fonksiyon
WHVWLQGH RUWD GHUHFHGH REVWUNVL\RQ WHVSit edildi. Olgunun laboratuvar tetkiklerinde herhangi
ELU DQRUPDO EXOJX\D UDVWODQPDGÕ 2SHUDV\RQ RGDVÕQD DOÕQDQ ROJX\D UXWLQ PRQLW|UL]DV\RQ
X\JXODPDVÕQÕ WDNLEHQ LQWUDYHQ|] GDPDU \ROX DoÕOÕS 1D&O LQI]\RQX EDúODQGÕ 2OJX\D
:LQQLH YH DUNµQÕQ WDQÕPODGÕ÷Õ WHN HQMHNVL\RQ \|QWHPL\OH VRO & YHUWHEUD KL]DVÕQGDQ GHULQ YH
\]H\VHO VHUYLNDO SOHNVXV EOR÷X RUDQÕQGD PO OHYREXSLYDNDLQ YH OLGRNDLQ NRPELQDV\RQX\OD X\JXODQGÕ 3LQSLULN WHVWL LOH ER\XQ YH RPX] EDúODUÕQÕ LoLQH DODQ E|OJHGH
GX\XVDO EOR÷XQ WHVSLWL\OH ROJX FHUUDKL HNLEH GHYUHGLOGL GN VUHQ FHUUDKL ER\XQFD ROJXGD
VHUYLNDO SOHNVXV EOR÷XQD ED÷OÕ JHoLFL VHV NÕVÕNOÕ÷Õ GÕúÕQGD VROXQXPVDO Q|URORMLN KHUKDQJL ELU
NRPSOLNDV\RQYHKHPRGLQDPLNLQVWDELOLWHJ|]OHQPHGL
7$57,ù0$ YH 6218d Karotid endarWHUHNWRPLOHUGH SRSOHU RODQ VHUYLNDO SOHNVXV EOR÷XQXQ
WHN HQMHNVL\RQ \|QWHPL\OH \DSÕOPDVÕQÕQ KDVWD NRQIRUXQX DUWWÕUGÕ÷Õ EORN X\JXODPD VUHVLQL
NÕVDOWWÕ÷ÕYHEORNWHNQL÷L\OHROXúDELOHFHNNRPSOLNDV\RQODUÕD]DOWWÕ÷ÕNDQDDWLQGH\L]
Anahtar Kelimeler: ServikaOSOHNVXVEOR÷XNDURWLGHQGDUWHUHNWRPL
120
P-35
.2521(5$1-,2*5$)ø6,5$6,1'$5$'ø$/$57(R YARALANMASI (OLGU SUNUMU)
*|NKDQ3HNHU6HPD7XUDQùHULIH%HNWDúøKVDQ$\ÕN'LOHN.D]DQFÕ*|NoH6HOoXN
hPLW.DUDGHQL]
7UNL\H<NVHNøKWLVDV(÷LWLP9H$UDúWÕUPDHastanesi
%X \D]ÕGD PL\RNDUG LQIDUNWV |Q WDQÕVÕ\OD .RURQHU $QMLRJUDIL .$* SODQODQDQ YH .$*
VÕUDVÕQGD UDGLDO DUWHU NRSPDVÕ QHGHQL\OH DFLO RSHUDV\RQD DOÕQDQ ROJX VXQXOPXúWXU
OLGU:
\DúÕQGDHUNHNKDVWDJ|÷VD÷UÕVÕQHGHQL\OHKDVWDQHPL]DFLOVHUYLVLQHEDúYXUGX(.*¶GH67
HOHYDV\RQX YH NDUGLDN ELRPDUNHUODUÕQGD \NVHNOLN EHOLUOHQPHVL ]HULQH KDVWD .$* QLWHVLQH
DOÕQGÕ .DUGL\RORJODU WDUDIÕQGDQ UDGLDO DUWHUH ) NDQO \HUOHúWLULOGL$QMLRJUDIL WDPDPODQGÕøúOHP
ELWLPLQGHUDGLDODUWHUGHQDQMÕRNDWHWHULJHULoHNLOGL$QFDNNDWHWHUoÕNDUWÕODPDGÕ%XKDOL\OHKDVWD
DFLORODUDNKLEULGDPHOL\DWKDQHRGDVÕQDDOÕQGÕ$QHVWH]LWDUDIÕQGDQGH÷HUOHQGLULOHQKDVWDQÕQORNDO
DQHVWH]L HúOL÷LQGH UDGLDO DUWHUL HNVSORUH HGLOGL$QMÕR NDWHWHUL oÕNDUÕOGÕ $QFDN UDGLDO DUWHULQ
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122
P-37
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125
P-39
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126
P-40
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VROXQXPODUÕ NRUXQDUDN QD]DO RNVLMHQ YHULOGL 'L\DVWROLN GROXP ]DPDQÕQD L]LQ YHUHFHN úHNLOGH
WDúLNDUGLGHQ NDoÕQÕODUDN YH FHUUDKL NRQIRUD J|UH VHGRDQDOMH]L GHULQOL÷L G]HQOHQGL
7UDQV|]HIDJLDO (.2 \HUOHúWLULOGL +DVWDODU KHSDULQL]H h HGLOGL 2SHUDV\RQ ER\XQFD
LQRWURS LKWL\DFÕ ROPDGÕ KDVWDQÕQ KDUHNHW HWPHVLQGHQ ND\QDNODQDQ ELU VRUXQOD NDUúÕODúÕOPDGÕ
KHUELULúOHPEDúDUÕOÕELUúHNLOGH\DNODúÕNVDDWWHWDPDPODQGÕ
6218d &HUUDKL DoÕGDQ \NVHN ULVNOL DRUW VWHQR]OX KDVWDODUGD 7$9ø \|QWHPL DOWHUQDWLI ELU
\|QWHPGLU$QHVWH]LQLQNULWLNRODUDNEHOLUWLOHQEXKDVWDODUÕ\DQGDúKDVWDOÕNODUÕYHLúOHPLQULVNOHUL
QHGHQL\OH\DNÕQYHGLNNDWOLWDNLSHWPHVLJHUHNWL÷LQLGúQPHNWH\L]
Anahtar
Kelimeler: $RUW
.DSDN
øPplantasyonu,
129
Anestezi,
Sedoanaljezi
P-42
TRANSKATATER ATRIAL SEPTAL DEFEKT (ASD) KAPATMA SIRASINDA AN(67(=ø
021ø7g5ø=$6<2181g1(0ø
$EGXOPHQDS*]HO1(UGDO'R÷DQ1$GQDQ7IHN10HKPHW%HúLU<ÕOGÕUÕP1, Zeynep Baysal
<ÕOGÕUÕP1, Meki Bilici2øVPDLO%Dú\L÷LW3
1
'LFOHhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$'
2
'LFOHhQLYHUVLWHVL7ÕS)DNOWHVL.DUGL\RORML$'
3
'LFOHhQLYHUVLWHVL7ÕS)DNOWHVL.DOS'DPDU&HUUDKLVL$'
$WUL\DOVHSWDOGHIHNWWHSHUNWDQNDSDPDFHUUDKL\|QWHPOHUHDOWHUQDWLI RODUDNRUWD\DoÕNPÕúWÕU
'DKDD]KDVWDQHGHNDOÕúVUHVLGúNPRUELGLWHYHFHUUDKL\HDLWNRPSOLNDV\RQODUGDQNRUXQPD
JLEL DYDQWDMODUÕ PHYFXWWXU $QFDN QDGLU GH ROVD FLKD] LOH LOJLOL NRPSOLNDV\RQODU J|UOHELOLU
OLGU: \DúÕQGDNJ$6'WDQÕOÕKDVWDWUDQVNDWHWHU\|QWHPL\OHNDSDWPDX\JXODQPDN]HUH
SHGLDWULNNDUGL\RORMLNOLQL÷LQH\DWÕUÕOPÕú+DVWDDQMLRJUDILQLWHVLQGHPDVD\DDOÕQDUDN(.*632
YH LQYD]LY DUWHU EDVÕQFÕ PRQLW|UL]H HGLOGL 3URSRIRO -3 mg/kg/saat ve 0,5-1 mcg/kg/dk dan
UHPLIHQWDQLO LQI]\RQXQD EDúODQGÕ .HWDPLQ PJNJ YH KHSDULQ 8NJ \DSÕOGÕ +DVWD
spontan solunum ve nazal oksijen ile takip edildi.
6HGRDQDOMH]LVRQUDVÕ\DSÕODQWUDQV|]HIDJLDOHNRNDUGL\RJUDILGHVHNXQGXPORNDOL]DV\RQGDPP
oDSÕQGD $6' VDSWDQGÕ'HIHNWLQ PP VHSWDORFFOXGHU LOH NDSDWÕOPDVÕQD NDUDU YHULOGL 'HIHNW
NDSDWÕOÕS LúOHP VRQODQGÕUÕOGÕ 'HUOHQPH VÕUDVÕQGD PRQLW|UGH YHQWULNOHU HNVWUD DWÕPODUÕQ
EDúODGÕ÷Õ YH DQWLDULWPLN WHGDYLVLQH UD÷PHQ G]HOPH ROPDGÕ÷Õ J|UOQFH FHUUDKL HNLS X\DUÕOGÕ
Tekrarlanan transtorasLN HNRNDUGL\RJUDILGH FLKD]ÕQ VD÷ YHQWULNOH GúPú YH KDUHNHWOL ROGX÷X
DQFDNoÕNÕP\ROXQGDGDUOÕ÷D\RODoPDGÕ÷ÕJ|UOG9HQ|]X]XQNÕOÕI\HUOHúWLULOLSFLKD]VQDUHLOH
\DNDODQPD\D oDOÕúÕOGÕ DQFDN FLKD] \DNDODQDPDGÕ &LKD]ÕQ oÕNDUÕOPDVÕ YH $6' QLQ NDSDWÕOPDVÕ
DPDFÕ\OD NDOS GDPDU FHUUDKLVL NOLQL÷LQH \DWÕúÕ \DSÕODUDN KDVWD DFLO úDUWODUGD RSHUDV\RQD DOÕQGÕ
)XOO PRQLW|UL]DV\RQ \DSÕOGÕ $QHVWH]L LQGNVL\RQX \DSÕOGÕNWDQ VRQUD KDVWD HQWEH HGLOLS
PHNDQLN YHQWLODW|UH ED÷ODQGÕ <DEDQFÕ FLVLP oÕNDUÕOGÕ YH $6' RQDUÕPÕ \DSÕOGÕ +DVWD HQWEH
úHNLOGH\R÷XQEDNÕPDDOÕQGÕSRVWRSHUDWLIJQGHWDEXUFXHGLOGL
6218d YH 7$57,ù0$ $PHOL\DWKDQH GÕúÕ JLULúLPOHULQGH DQHVWH]L HNLELQLQ GLNNDWL YH FHUUDKL
HNLS LOH RODQ X\XPX ROGXNoD |QHPOLGLU YH ROXúDELOHFHN NRPSOLNDV\RQODUD HUNHQ PGDKHOH
RODQD÷ÕQÕ YHULU %X ROJX GHUOHQPH VÕUDVÕQGD GD DQHVWH]L HNLELQLQ \DNÕQ WDNLEL DOWÕQGD ROPDVÕ
JHUHNWL÷LQLYXUJXODPDNLoLQVXQXOPXúWXU
Anahtar Kelimeler: $PHOL\DWKDQH'ÕúÕ$QHVWH]L$6'0RQLW|UL]DV\RQ
130
P-43
:$5)$5ø1(%$ö/,68%'URAL HEMATOM G(/øù(1%ø52/*8'$&(55$+ø'(1g1&(
3527520%ø1.203/(.6.216$175(6ø&2)$&7.8//$1,0,2/*86UNUMU
%LOJH%DQX7DúGHPLUøVPDLO8U0HU\HP1LO.DDQ
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NDQDPD LQVLGDQVÕQGD GD EHOLUJLQ DUWÕú J|]OHQPHNWHGLU &HUUDKL JLULúLP JHUHNWLUHQ KHPRUDMLN
NRPSOLNDV\RQODUGD DQWLNRDJXODV\RQXQ QRUPDO G]H\OHUH KÕ]OÕ YH JYHQOL ELU úHNLOGH geri
G|QGUOPHVL KD\DWL |QHP WDúÕPDNWDGÕU %X DPDoOD WD]H GRQPXú SOD]PD . YLWDPLQL YH
SURWURPELQ NRPSOHNV NRQVDQWUHVL NXOODQÕPÕ |QHULOPHNWHGLU %X ROJX VXQXPXQGD ZDUIDULQH
ED÷OÕ VXEGXUDO KHPDWRP JHOLúHQ YH DFLO FHUUDKL JLULúLPGHQ |QFH SURWURPELQ NRPSOHks
NRQVDQWUHVL &2)$&7 NXOODQÕODUDN DQWLNRDJXODV\RQX QRUPDOL]H HGLOHQ ELU KDVWDQÕQ YHULOHULQL
sunduk.
OLGU: $FLOVHUYLVHELOLQoEXODQÕNOÕ÷ÕúLND\HWLLOHJHOHQED\DQKDVWDGD\DúÕQGDNJDNXW
VXEGXUDOKHPDWRPVDSWDQGÕYHDFLOFHUUDKL|QHULOGLg]JHoPLúLQGHLNL\ÕO|QFHVHUHEURYDVNOHU
DWDN JHoLUGL÷L DWUL\DO ILEULODV\RQX ROGX÷X YH RUDO ZDUIDULQ &RXPDGLQ NXOODQGÕ÷Õ |÷UHQLOGL
/DERUDWXDU WHWNLNOHULQGH ,15 RODUDN VDSWDQGÕ %XQXQ ]HULQH FHUUDKL JLULúLPGHQ |QFH
hastaya K vitamini ve 1000 IU prRWURPELQNRPSOHNVNRQVDQWUHVL&2)$&7ø9X\JXODQGÕ%LU
VDDW VRQUD ,15 RODUDN EXOXQXQFD ORNDO DQHVWH]L YH VHGDV\RQ X\JXODQDUDN FHUUDKL JLULúLP
JHUoHNOHúWLULOGL 3RVWRSHUDWLI G|QHPGH \R÷XQ EDNÕPGD WDNLS HGLOHQ KDVWDQÕQ VDDW VRQUDNL
,15 GH÷HUL RODUDN EXOXQGX KHPRUDMLN YH WURPERWLN NRPSOLNDV\RQ J|]OHQPHGL
6218d 2UDO DQWLNRDJXODQODUD ED÷OÕ LQWUDNUDQL\DO NDQDPDODUGD WD]H GRQPXú SOD]PD
X\JXODPDVÕQD NÕ\DVOD SURWURPELQ NRPSOHNV NRQVDQWUHVL &2)$&7 LOH ELUOLNWH . YLWDPLQL
WHGDYLVLQLQ ,15 GH÷HULQL GDKD KÕ]OÕ QRUPDOL]H HWWL÷L EHOLUWLOPHNWHGLU $QFDN WURPERWLN
NRPSOLNDV\RQODUGDQ NDoÕQPDN LoLQ GR] WLWUDV\RQXQXQ E\N |QHP WDúÕGÕ÷Õ KDVWDQÕQ NOLQLN
GXUXPXQDJ|UHWHGDYLSODQÕQYHGR]WLWUDV\RQXQXQ\DSÕOPDVÕQÕQX\JXQRODFD÷ÕKDWÕUODQPDOÕGÕU
Anahtar Kelimeler: Protrombin kompleks konsantresi, oral antikoagulan, subdural hematom
131
P-44
ALCAPA(BLAND-:+ø7(-GARLAND) SENDROMLU H$67$'$$1(67(=ø<g1(7ø0ø
$OHYùD\ODQ1hPLW.DUDGHQL]1*|NoH6HOoXN1, Ajda Mutlu2$\úHQXU3Do2
1
7UNL\H<NVHNøKWLVDV(÷LWLPYH $UDúWÕUPD+DVWDQHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ.OLQL÷L
Ankara
2
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*ø5øùALCAPA(Anomalous origin of the left coronary artery from pulmonary artery) sendromu
anRUPDO \HUOHúLPOL VRO NRURQHU DUWHULQ/&$ DRUWD \HULQH SXOPRQHU DUWHUGHQ3$ oÕNÕúÕ\OD
NDUDNWHUL]HQDGLU J|UOHQ ELU NRQMHQLWDO NRURQHU DUWHU DQRPDOLVLGLU%X ROJXGD $/&$3$
VHQGURPOXKDVWDPÕ]GDNLDQHVWH]L\|QHWLPLVXQXOPXúWXU
OLGU: \NÕ] KDVWDQÕQ |\NVQGH HJ]HUVL]OH J|÷V D÷UÕVÕGLVSQHoDEXN \RUXOPDVÕELU NDW
PHUGLYHQ oÕNWÕ÷ÕQGD GLQOHQPH LKWL\DFÕ ROGX÷X VDSWDQGÕ7HOHNDUGL\RJUDILGH .72(.*¶GH VRO
DNVLQNRPSOHWVD÷GDOEOR÷XPHYFXWWX(NRNDUGL\RJUDILVLQGH()DRUWLN-mitral kapakta eser
\HWHUVL]OLN
VDSWDQGÕ
7DQÕVDO NDOS NDWHWHUL]DV\RQX-NRURQHU DQMLRJUDILGH NRURQHU DUWHU G]H\LQGH VRO-VD÷ úDQW VD÷
NRURQHU DUWHULQ5&$ DRUWDGDQ oÕNWÕ÷ÕJHQLúOHGL÷L/&$¶LQ DRUW N|NQGHQ oÕNPDGÕ÷ÕVRO |Q-inen
NRURQHUDUWHU/$'YH/&$¶LQUHWURJUDG RODUDN5&$¶GHQGROGX÷XNRQWUDVWPDGGHQLQ3$¶HJHoWL÷L
L]OHQGL.DUGL\DN %7$¶GD 5&$ YH /$' HNWD]LNWL/$'-3$ DUDVÕQGD 3$ RULMLQOL /&$ DQRPDOLVLQL
L]OHQPLúWL+DVWD\D
G]HOWLFL
FHUUDKL
SODQODQGÕøQGNVL\RQGD
PLGD]RODP-fentanilURNURQ\XPLGDPHGH
KDYD-oksijen-dHVIOXUDQUHPLIHQWDQLOPLGD]RODPURNURQ\XP
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WUDQV|]HIDJHDO
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WDQÕ
GR÷UXODQGÕ
&HUUDKLGHDQRUPDOoÕNÕúOÕ/&$3$¶GHQD\UÕúWÕUÕOÕSDVHQGDQDRUWD\DUHLPSODQWHHGLOGL3$SHULNDUG
yamayla
anastomoze
edildi.Dopamin
LQI]\RQX\OD HQWEH RODUDN \R÷XQEDNÕPD
DOÕQGÕ3RVWRSHUDWLI JQ HNVWEH HGLOLS JQGH VHUYLVH DOÕQGÕ3RVWRSHUDWLI JQGH WDEXUFX
edildi.
7$57,ù0$$/&$3$ VHQGURPXQGD /&$¶GHNL NDQ GHVDWUHGLU.RURQHU NDQ DNÕPÕQGDNL
\DYDúODPDPL\RNDUGL\DO
LVNHPLLQIDNWPLtral
yetersizlik,iskemik
kardiyomiyopatiyle
VRQXoODQÕU3$ EDVÕQFÕ VROYHQWULNOGL\DVWROVRQXEDVÕQFÕ YH /&$-5&$ DUDVÕQGDNL NROODWHUDO
GRODúÕPÕQ \D\JÕQOÕ÷ÕVHPSWRPODUÕQ RUWD\D oÕNÕúÕQÕ EHOLUOHU+DVWDODU DVHPSWRPDWLN ROXS HULúNLQ
G|QHPH GHN \DúD\DELOLU<HWHUOL NROODWHUDO GRODúÕP JHOLúWL÷LQGH GDKD JHo EXOJX YHULUOHU
$QHVWH]L LQGNVL\RQ-LGDPHVLQGH PL\RNDUGL\DO NRQWUDNWLOLWHGH D]DOPD J|UOHELOHFH÷L\HWHUOL
GL\DVWROLN NDQ EDVÕQFÕQÕQ NRUXQPDVÕWDúLNDUGLQLQ |QOHQPHVL |QHPOLGLU<HWHUOL SHUI]\RQ YH
normal bir sistemLN YDVNOHU UH]LVWDQV VD÷ODQPDOÕGÕU'HVDWUH NDQ QHGHQL\OH PL\RNDUGL\DO
KLSRSHUI]\RQ YH PL\RNDUG LVNHPLVLQH NDUúÕ GLNNDWOL ROXQPDOÕGÕUNDUGL\DN DUUHVW-DQL |OP
JHOLúHELOLU.DUGL\RSXOPRQHU ED\SDV PDNLQHVLQGHQ D\UÕOPD G|QHPLQGH LQRWURSLN GHVWHN
gerekebilir.øQWUDRSHUDWLI7((NRQMHQLWDONDOSFHUUDKLVLQGHIRQNVL\RQHODQRUPDOOLNOHULQ-defektlerin
WDNLELQGH |QHPOLGLUøOHUL GHUHFHGH VHPSWRPDWLN YDNDODUGD (&02 YH /9$' X\JXODPDODUÕQD
gerek duyulabilir.
$/&$3$ VHQGURPXQGD EDúDUÕOÕ DQHVWH]L \|QHWLPLSDWRIL]\RORMLQLQ ELlinmesini gerektirir.Bu olgu
VXQXPX\ODGD$/&$3$VHQGURPXYHLOLúNLOLSHULRSHUDWLIROD\ODUJ|]GHQJHoLULOPLúWLU
Anahtar Kelimeler: Anestezi, aorta, koroner damar anomalisi, pulmoner arter, sendrom
132
$/&$3$VHQGURPXNDUGL\DN%7$J|UQWV
Sol koroner arWHULQDRUWD\HULQHSXOPRQHUDUWHUGHQoÕNÕúÕYHHNWD]LNVD÷NRURQHUDUWHULQ
NDUGL\DN%7$J|UQP
133
P-45
326767(512720ø1(95$/-øødø17('$9ø6(d(1(./(5ø9()$5./,%ø5<$./$ù,0
'LOHN.D]DQFÕ$\úHJOg]J|N6HPD7XUDQ%DKDU$\GÕQOÕ)DWPD(UDVODQ
7UNL\H<NVHNøKWLVDV(÷LWLPYHDUDúWÕUPD+DVWDQHVL
3RVWVWHUQRWRPL D÷UÕVÕ NDUGL\DN FHUUDKL\H JLUHQ KDVWDODUÕQ - VÕQGD J|UOPHNWHGLU
+DVWDODU KDIWD LOD D\ DUDVÕ NURQLN VWHUQXP D÷UÕVÕ LOH KDVWDQH\H EDúYXUPDNWDGÕUODU +DVWD
VUHNOL GHYDP HGHQ X\XWPD\DQ EÕoDN EDWPDVÕ JLEL NHVNLQ ELU D÷UÕGDQ EDKVHWPHNWHGLU
Materyal-METHOD: +DVWDQHPL] D÷UÕ SROLNOLQL÷LQH EDúYXUDQ KDVWDPÕ]GD VWHUQRWRPL VRQUDVÕ
úLGGHWOL \DQÕFÕ YH EDWÕFÕ D÷UÕ PHYFXWWX KDVWD VRO NROD \D\ÕODQ YH VWHUQXPXQ VRO PDUMLQLQGH
hissediOHQD÷UÕGDQKDVWDVWHUQXPXQLNLPDUMLQLQGH\DQÕFÕYHEDWÕFÕD÷UÕGDQYHVDGHFHKDVWD
KHULNLNROXQDGD\D\ÕODQYHHNVWUHPLWHKDUHNHWOHULQLNÕVÕWOD\DQEDWÕFÕELUD÷UÕGDQEDKVHGL\RUGX
+DVWDODUÕQ9$6VNRUODUÕ-DUDOÕ÷ÕQGDLGLKDVWDODUDPXD\HQH\DSÕODUDNHQoRND÷UÕ\DQUDGLDO
D÷UÕ \D\DQ QRNWD YH DODQODU EHOLUOHQGL +DVWDODU UHNUUHQ DQMLQD YH SRVWNDUGL\RWRPL
VHQGURPXQX
HNDUWH
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LoLQ
NDUGL\RORML
X]PDQ
KHNLPLQH
GDQÕúÕOGÕ
øúOHP LoLQ RQDP DOÕQGÕNWDQ YH KDVWD ELOJLOHQGLULOGLNWHQ VRQUD WHWLNQRNWDOara % 1lik lidokain ile
HQMHNVL\RQ \DSÕOGÕ YH \LQH OLGRNDLQ LOH DUGDUGD LQWHUNRVWDO DODQD EORN X\JXODQGÕ %ORNODU YH
WHWLNQRNWDHQMHNVL\RQXHUKDIWDDUDOÕNODUODWHNUDUODQGÕ
6218d YH 7$57,ù0$ ø]OHP VÕUDVÕQGD KDVWD WHNUDUOD\DQ JLULúLPVHO WHGDYL VRQUDVÕ 9$6
VNRUODUÕ - GH÷HULQH GúPúWU KDVWDPÕ] GHID WHNUDUODQDQ VHDQVODU VRQUDVÕ D÷UÕVÕ] ELU
G|QHPGH VH\UHWPHNWHGLU KDVWD\D LVH 6HDQV VRQUDVÕ D÷UÕ VNRUXQGD KLoELU GúPH
J|]OHQPHGL÷LQGHQ|QFH16$,'LOHWHGDYLEDúODQPÕúDQFDNEXQXQODGDL\LOHúPHVD÷ODQDPD\ÕQFD
6HDQV VRQUDVÕQGD KDVWDPÕ]D GúN GR] VHQWHWLN RSLRLG YH SDUDVHWDPRO NRPELQDV\RQX
EDúODQPÕúWÕU7PKDVWDODUÕQWHGDYLVUHFLVRQUDVÕ9$6VNRUODUÕ-DUDVÕRODUDNND\GHGLOPLúWLU
3RVWVWHQRWRPLQHYUDOMLOÕ\ÕOODUÕQEDúÕQGDWDQÕPODQPÕúELUVHQGURPGXUYHWHNUDUOD\DQVLQLU
EORNODUÕQÕQWHGDYLGHROXPOXVRQXoYHUHELOHFH÷LDUDúWÕUÕOPDVÕJHUHNHQELUNRQXGXU
Anahtar Kelimeler: SRVWVWHUQRWRPLLQWHUNRVWDOD÷UÕ.
134
P-46
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4
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.OLQL÷LøVWDQEXO
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NDUDFL÷HU WUDQVSODQWDV\RQX X\JXODQGÕ $QDPQH]LQGH WLS, GLDEHWHV PHOOLWXV $&( LQKLELW|U YH
EHWDEORNHULOHUHJOHKLSHUWDQVL\RQXYDUD\|QFH/$'¶\HX\JXODQDQ'(6QHGHQL\OHPJ
asetil salisilik asit (ASA) kullanÕ\RU (OHNWURNDUGL\RJUDILVLQGH VLQV EUDGLNDUGLVL YH LQNRPSOHW
VD÷ GDO EOR÷X GÕúÕQGD FHUUDKL\H HN ULVN \DUDWDFDN NDUGL\DN YH GL÷HU VLVWHP SDWRORMLOHULQH
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3UHDQKHSDWLN ID]ÕQ LOHUOH\HQ G|QHPOHULQGH VLVWHPLN YDVNOHU UH]LVWDQV LQGHNVLQ \NVHN YH
NDUGL\DNLQGHNVLQLVHGúNL]OHQPHVL]HULQH GREXWDPLQJNJGDNEDúODQGÕNWDQGDNLND
VRQUD JNJGDNLND LQI]\RQ KÕ]Õ LOH GHYDP HGLOHUHN KHPRGLQDPLN VWDELOLWH VD÷ODQGÕ
2SHUDV\RQ VUHVLQFH QLWH HULWURVLW VVSDQVL\RQX NXOODQÕODQ KDVWDGD WURPERHODVWRJUDP LOH
HOGH HGLOHQ YHULOHU DOWÕQGD WD]H GRQPXú SOD]PD WURPERVLW VVSDQVL\RQX JHUHNVLQLPL ROPDGÕ
3RVWRSHUDWLI \R÷XQ EDNÕPGD ELU JQ L]OHQHQ KDVWD NRPSOLNDV\RQVX] VHUYLVH HNVWHUQH HGLOGL
6218d .DUDFL÷HUWUDQVSODQWDV\RQXJLELoRNNDQDPOÕRODELOHFHNELURSHUDV\RQGDGDKL$6$
PJ NXOODQÕPÕQÕQ GHYDPÕQÕQ VRUXQ \DUDWPDGÕ÷Õ J|]OHPOHQPLúWLU *QP]GH JLGHUHN DUWDQ
VÕNOÕNWD NRURQHU VWDQG HQGLNDV\RQODUÕ YH EXQD ED÷OÕ $6$ NXOODQÕPÕ NDUDFL÷HU WUDQVSODQWDV\RQX
JLEL NDQDPDQÕQ oRN VRUXQ \DUDWDELOHFH÷L RSHUDV\RQODUGD GDKL JYHQOH NXOODQÕODELOHFH÷LQL
GúQ\RUX]
Anahtar Kelimeler: NRURQHU VWDQG DVHWLO VDOLVLOLN DVLW SURILODNVL NDUDFL÷HU WUDQVSODQWDV\RQX
135
P-47
21-+ø'52.6ø/$=(.6ø./øöø2/$12/*8'$$75ø<$L SEPTAL DEFEKT KAPATILMASI:
$1(67(=ø<$./$ù,0,
,úÕQ*QHú1, Zeynep Tosun1)DUXN6HUKDWOÕR÷OX2, /H\OD$NÕQ3, H. Cemal Kahraman2
1
(UFL\HVhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$QD%LOLP'DOÕ.D\VHUL
2
(UFL\HVhQLYHUVLWHVL7ÕS)DNOWHVL.DOS'DPDU&HUUDKLVL$QD%LOLP'DOÕ
3
(UFL\HVhQLYHUVLWHVL7ÕS)DNOWHVL3HGLDWULN(QGRNULQRORML%LOLPGDOÕ
*ø5øù Konjenital adrenal hiperplazi (KAHDGUHQDONRUWHNVWHNRUWL]ROVHQWH]LLoLQJHUHNOLRODQ
HQ]LPGHQ ELULQLQ HNVLNOL÷LQH ED÷OÕ RODUDN JHOLúHQ RWR]RPDO UHVHVLI JHoLúOL ELU KDVWDOÕN
JUXEXGXU (Q VÕN J|UOHQ WLS -hidroksilaz eksikligidir. Tedavide adrenal kortekste androjen
\DSÕPÕQÕEDVNÕODPDNLoLQ\NVHNGR]JOXNRNRUWLNRLGNXOODQÕOÕU0LQHUDORNRUWLNRLGUHSODVPDQÕLVH
IOXGURNRUWL]RQ LOH \DSÕOÕU %L]LP ROJXPX] -KLGURNVLOD] HNVLNOL÷L RODQ YH DWUL\DO VHSWDO GHIHNW
$6' WDPLUL \DSÕODQ KDVWDGÕU -KLGURNVLOD] HQ]LP HNVLNOL÷L RODQ YH DoÕN NDOp cerrahisi
RSHUDV\RQX\DSÕODQEDúNDELUROJX\DOLWHUDWUGHUDVWOD\DPDGÕN
OLGU: \DúÕQGDNJD÷ÕUOÕ÷ÕQGDNÕ]KDVWD-KLGURNVLOD]HNVLNOL÷LQHGHQL\OHWHGDYLDOWÕQGD
LNHQ $6' WDPLUL LoLQ RSHUDV\RQD DOÕQGÕ 3UHPHGLNDV\RQ RODUDN PJNJ QD]DO GRUPLkum
verildi. Hasta % 8 sevofluran-2LOHDQHVWH]LLQGNVL\RQXQXQDUGÕQGDQ2-KDYDNDUÕúÕPÕ
sevofluran ve fentanil ile anestezi idamesi sD÷ODQGÕ
3HGLDWULN HQGRNULQRORMLQLQ |QHUGL÷L SURWRNROH J|UH SHURSHUDWLI VWHURLG WHGDYLVL YHULOGL
Kardiyopulmoner ED\SDV LoLQ PHUNH]LPL]GH UXWLQ X\JXODPDPÕ] RODQ PJNJ PJ
PHWLOSUHGQL]RORQ NDUGL\RSXOPRQHU ED\SDVD .3% JLUPHGHQ |QFH X\JXODQGÕ øQWUDRSHUDWLI NDQ
úHNHUL G]H\OHUL QRUPDO VH\UHGHQ KDVWD LQRWURSLN GHVWHN JHUHNPHNVL]LQ SRVWRSHUDWLI \R÷XQ
EDNÕPQLWHsine devredildi.
7$57,ù0$ YH 6218d .ODVLN .$+ ROJXODUÕ VWUHV NRúXOODUÕQGD \HWHUOL NRUWL]RO \DQÕWÕ
YHUHPH]OHU %X QHGHQOH DWHúOL KDVWDOÕNODU FHUUDKL YH WUDYPD NRúXOODUÕQGD JOXNRNRUWLNRLG GR]
DUWÕúÕ \DSÕOPDOÕGÕU %X KDVWDODUGD HSLQHIULQ GH HNVLN ROGX÷XQGDQ VWUHV NRúXOODUÕQGD
KLSRJOLVHPL\HH÷LOLPGDKDGDDUWDU
3HGLDWULNHQGRNULQRORMLNOLQL÷LQLQ|QHUGL÷L-KLGURNVLOD]HNVLNOL÷LRODQKDVWDODULoLQSHURSHUDWLI
X\JXODQDQ NRUWL]RQ WHGDYL SURWRNRO X\JXODQPÕú YH KDVWD VRUXQVX] ELU úHNLOGH RSHUDV\RQGDQ
oÕNÕS \R÷XQ EDNÕPD DOÕQPÕú YH D\QÕ JQ HNVWEH HGLOPLú oQF JQ VHUYLVH oÕNDUÕOPÕúWÕU
Anahtar Kelimeler: 21-KLGURNVLOD]HNVLNOL÷L$6'NDSDPD.
136
P-48
$6)ø.6ø.725$6ø.'ø6752)ø/ø+$67$'$$1(67(=ø-(81(6(1'5208
0XVWDID.HPDO$UVODQWDú$\OLQ,úÕN$OSHUKararmaz
0DUPDUDhQLYHUVLWHVL3HQGLN(÷LWLPYH$UDúWÕUPD+DVWDQHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ
$QDELOLP'DOÕøVWDQEXO
*ø5øù -HXQH 6HQGURPX $VILNVLN WRUDVLN GLVWURIL GDU WRUDNV \DSÕVÕ NÕVD HNVWUHPLWHOHU JLEL
LVNHOHW JHOLúLP ER]XNOXNODUÕ YH oHúLWOL RUJDQ DQRPDOLOHUL LOH VH\UHGHQ RWR]RPDO UHVHVLI NDOÕWÕP
J|VWHUHQ QDGLU ELU KDVWDOÕNWÕU +DVWDODUGD JHQHOOLNOH \HQLGR÷DQ G|QHPL \D GD HUNHQ oRFXNOXN
oD÷ÕQGD D÷ÕU VROXQXP \HWPH]OL÷L VRQXFX |OP J|UOPHNWHGLU *QP]GH EX KDVWDODUÕQ
WHGDYLVLQGH PHGLNDO WHGDYLOHULQ \DQÕQGD ODWHUDO WRUDVLN JHQLúOHWPH DPDFÕ\OD VWHUQRWRPL YH
UHNRQVWUNVL\RQRSHUDV\RQXX\JXODQPDNWDGÕU
OLGU: g]JHoPLúLQGH VÕN VROXQXP \ROX HQIHNVL\RQX JHoLUPH VROXQXP VÕNÕQWÕVÕ VD÷ HOGH
SROLGDNWLOLE\PHJHOLúPHJHULOL÷L|\NVRODQD\OÕNJNÕ]KDVWD\DD\OÕNNHQJ|÷V
GXYDUGHIRUPLWHVLQHGHQL\OH-HXQH6HQGURPXWDQÕVÕNRQXOPXú7RUDNV%7
GHKHULNLKHPLWRUDNV
nRUPDOGHQ GDU YH oDQ úHNOLQGH VRO NODYLNXOD VD÷D J|UH GDKD \NVHN ELODWHUDO DNFL÷HU
ED]DOOHULQGH NRQVROLGDV\RQ DODQODUÕ L]OHQGL (NRNDUGL\RJUDILGH 3'$ PHYFXWWX +DVWD\D JHQHO
DQHVWH]L DOWÕQGD XQLODWHUDO WRUDNRSODVWL SODQODQGÕ $QHVWH]L LQGNVL\RQ YH LGDPHsinde,
VHYRIOXUDQ DOIHQWDQLO YH FLVDWUDNXU\XP NXOODQÕOGÕ )L2 YH 12 RODFDN úHNLOGH
PHNDQLN YHQWLODW|U 3&9 PRGXQGD 3((3 FP+2 3LQV FP+2 ø( VROXQXP VD\ÕVÕ
GN LOH KDVWDQÕQ YHQWLODV\RQ LGDPHVL VD÷ODQGÕ +DVWD SRVWRSHUDWLI G|QHPGH HQWEH úHNLOGH
SHGLDWULN FHUUDKL \R÷XQ EDNÕPÕQD WUDQVIHU HGLOGL 3RVWRSHUDWLI JQ HNVWEH HGLOHQ KDVWD JQVROXQXPVÕNÕQWÕVÕJHOLúPHVL]HULQHWHNUDUHQWEHHGLOGL3RVWRSHUDWLIJQKDVWD$5'6YH
úLGGHWOLVHSVLVJHOLúPHVL]HULQHND\EHGLOGL
7$57,ùMA: -HXQH 6HQGURPOX KDVWDODUÕQ WP PHYFXW DQRPDOL YH RUJDQ GLVIRQNVL\RQODUÕQÕQ
WDQÕVÕ SUHRSHUDWLI G|QHPGH JHUHNOLGLU 3HURSHUDWLI G|QHPGH RUJDQ SHUI]\RQODUÕQÕQ NRUXQPDVÕ
DoÕVÕQGDQ KHPRGLQDPLN VWDELOL]DV\RQXQ \DQÕVÕUD DNFL÷HU NRUX\XFX YHQWLODV\RQ VWUDWHMLOeri
X\JXODQPDVÕoRN|QHPOLGLU6|]NRQXVXX\JXODPDODUDUD÷PHQSUHRSHUDWLIG|QHPGHNLVXENOLQLN
HQIHNVL\RQODUÕQ YDUOÕ÷Õ DPHOL\DW YXUXVX\OD ELUOLNWH VLVWHPLN LQIODPDWXDU \DQÕWÕ YH VHSVLVL
WHWLNOH\LS|OPFOVRQXoODUGR÷XUDELOLU
Anahtar Kelimeler: Asfiksik Torasik Distrofi, Jeune Sendromu, Sepsis
Jeune Sendromu
$VILNVLNWRUDVLNGLVWURILOLKDVWDQÕQJ|÷VGHIRUPLWHVL
137
P-49
621'g1(035ø0(538/021(5+ø3(57$16ø)+$67$'$%ø/$7(5$/$.&øö(5
1$./ø'(1(<ø0ø0ø=
+DOLGH2÷Xú1(FH$OWÕQD\17XQFHU.RoDN1, Deniz Avan10HULK.DODPDQR÷OX2&HPDO$VÕP
Kutlu2
1
.DUWDO.RúX\ROX<NVHNøKWLVDV(÷LWLP$UDúWÕUPD+DVWDQHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ
.OLQL÷LøVWDQEXO
2
.DUWDO.RúX\ROX<NVHNøKWLVDV(÷LWLP$UDúWÕUPD+DVWDQHVL*|÷V&HUUDKLVL.OLQL÷LøVWDQEXO
Pulmoner arter\HO KLSHUWDQVL\RQ 3$+ DUWPÕú SXOPRQHU YDVNOHU GLUHQo QHGHQL\OH VD÷ NDOS
\HWHUVL]OL÷LQH \RO DoDQ LOHUOH\LFL ELU JUXS KDVWDOÕN LoLQ NXOODQÕODQ JHQHO ELU WHULPGLU øGL\RSDWLN
3$+¶GD WDQÕ NRQGXNWDQVRQUD WHGDYLVL] \DúDPVUHVL RUWDODPD \ÕOGÕU 6RQ G|Qem idiopatik
3$+ KDVWDODUÕQD \DSÕODQ oLIW DNFL÷HU YH\D NDOS-DNFL÷HU WUDQVSODQWDV\RQODUÕQÕQ KHPRGLQDPLN YH
VROXQXP IRQNVL\RQODUÕ DoÕVÕQGDQ EHQ]HU VRQXoODUÕ ROGX÷X ELOGLULOPLúWLU.DUWDO .RúX\ROX < ø (
$ +¶ GH VRQ G|QHP SULPHU SXOPRQHU KLSHUWDQVL\RQX EXOXQDQ \DúÕQGDNL KDVWD\D WDULKLQGH ELODWHUDO DNFL÷HU QDNOL \DSÕOPÕúWÕU $QHVWH]LLQGNVL\RQX VRQUDVÕ SXOPRQHU DUWHU
EDVÕQFÕ PP+JRUWDODPD PP+J VLVWHPLN DUWHU EDVÕQFÕQGDQ PP+J
RUWDODPD PP+J \NVHN RODUDN EXOXQDQ YH ELODWHUDO DNFL÷HU QDNOL (&02 HúOL÷LQGH
JHUoHNOHúWLULOHELOHQ EX ROJXPX]XQ LQWUDRSHUDWLI YH SRVWRSHUDWLI HUNHQ G|QHPGHNL VH\UL
ELOGLULOPLúWLU
Anahtar Kelimeler: %LODWHUDO$NFL÷HU1DNOLøGLRSDWLN3XOPRQHU+LSHUWDQVL\RQ
138
P-50
08.232/ø6$..$5ø'2=7ø39,¶/,0ø75$/9$/95(PLASMANI YAPILAN OLGUDA
$1(67(=ø<g1(7ø0ø
Dilek Koca1, Zeynep Tosun11DFL(PLUR÷XOODUÕ2)DUXN6HUKDWOÕR÷OX2
1
(UFL\HVhQLYHUVLWHVL7ÕSIDNOWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$QD%LOLP'DOÕ.D\VHUL
2
(UFL\HVhQLYHUVLWHVL7ÕS)DNOWHVL.DOS'DPDU&HUUDKLVL$QD%LOLP'DOÕ.D\VHUL
*ø5øù
0XNRSROLVDNNDULGR]ODU036 OL]R]RPDO HQ]LPOHULQ NDOÕWVDO HNVLNOL÷LQH ED÷OÕ RODUDN
JOXNR]DPLQRJOLNDQODUÕQ YFXWWD ELULNPHVL VRQXFX ROXúDQ ELU JUXS GHSR KDVWDOÕ÷ÕGÕU 7LS 9,
Mukopolisakkaridoz(Maroteaux-/DP\ 6HQGURPX¶GD $ULO VOIDWD]-B
enzimi
eksiktir.
%L] EX ROJXGD 7LS 9, 0XNRSROLVDNNDULGR] WDQÕVÕ LOH WDNLSWH RODQ PLWUDO YDOY UHSODVPDQÕ \DSÕODQ
KDVWDPÕ]GDDQHVWH]LGHQH\LPLPL]LVXQGXN
OLGU:
2OJXPX] DPFD oRFXNODUÕ RODQ DQQH YH EDEDQÕQ oRFX÷X ROXS \DúÕQGD NJ FP
ER\XQGD NÕVD YH NDOÕQ ELU ER\QX NDED \] GLOLQLQ E\NO÷ GLNNDW oHNL\RUGX
(NRNDUGL\RJUDILVLQGH GHUHFHGHQ PLWUDO \HWPH]OL÷L ROXS ()¶VL LGL 2OJX RSHUDV\RQ
|QFHVLVWDQGDUWPRQLW|UL]HHGLOGL$QHVWH]LLQGNVL\RQXPLGD]RORPIHQWDQLOYHURNURQ\XPLOH
VD÷ODQGÕ %HNOHQHQ ]RU KDYD \ROX LoLQ ILEHURSWLN ODULQJRVNRS KD]ÕUODQGÕ DQFDN VWLOH LOH HQWEH
HGLOGL$QHVWH]LLGDPHVLVHYRIOXUDQYHIHQWDQLOLQI]\RQXLOHVD÷ODQGÕ3RVWRSHUDWLIPFJNJGN
GRSDPLQ LQI]\RQX LOH KDVWD \R÷XQ EDNÕPD GHYUHGLOGL 3RVWRSHUDWLI VDDWWH HNVWEH HGLOHQ
hasta postopHUDWLIJQGHVHUYLVHDOÕQGÕ
7$57,ù0$YH 6218d
Maroteaux-lamy sendromunda GHUPDWDQ VOIDWÕQ PLWUDO YH DRUW NDSDNODUGD ELULNLPLQH ED÷OÕ
VWHQR] YH \HWPH]OLN EXOJXODUÕ RUWD\D oÕNDU $\UÕFD NDOELQ LOHWL VLVWHPLQGH GH ELULNHUHN LOHWLP
GHIHNWOHULQHGH\RODoPDNWDGÕU%XKDVWDJUXSODUÕQGDEDúYHER\XQGRNXVXQGD036ELULNLPLQLQ
DUWPDVÕQGDQ
GROD\Õ
]RU
KDYD\ROX
SUREOHPOHUL
\DúDQDELOLU
6RQXo RODUDN SHURSHUDWLI G|QHPGH RUWD\D oÕNDELOHFHN KDYD\ROX JoO÷ LOHWLP GHIHNWOHUL YH
DNFL÷HU|GHPLJLELSUREOHPOHUHNDUúÕKD]ÕUOÕNOÕROXQPDVÕJHUHNLU
Kaynaklar:
1. Toda Y, Takeuchi M, Morita K et al. Complete Heart Block during Anesthetic Management in
a Patient with Mucopolysaccharidosis Type VII. Anesthesiology 2001;95:1035-1037
2.Walker RWM, Colovic V, Robinson DN, Dearlove OV. Postobstructive pulmonary oedema
during anaesthesia in children with mucopolysaccharidoses. Paediatric Anaesthesia
2003;13:441-447
Anahtar Kelimeler: Mukopolisakkaridoz, zor hava yolu,iletim defektleri.
139
P-51
5(1$/7h0g5/h+$67$'$75$16g=2)$*ø$/(.2.$5'ø2*5$)øø/(6$37ANAN
ø175$23(5$7ø)38/021(5(0%2/ø9(7520%2(MBOLEK720ø
Alper Kararmaz0XVWDID.HPDO$UVODQWDúøVPDLO&LQHO
0DUPDUDhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORML$'øVWDQEXO
*ø5øù Bu olgu sunumunda renal kitle nedeniyle opere edilmekte olan hastada intraoperatif
G|QHPGHWUDQV|]RIDJLDOHNRNDUGLRJUDIL 7g(LOHVDSWDQDQDNXWPDVLISXOPRQHUWURPERHPEROL
37( ROJXVXQXQ LUGHOHQPHVL YH QRQNDUGLDN FHUUDKLGH 7g( PRQLWRUL]DV\RQXQXQ |QHPLQLQ
YXUJXODQPDVÕDPDoODQGÕ
OLGU: 3UHRSHUDWLIWRPRJUDILVLQGH%7VD÷UHQDONLWOHVLYH%7DQMLRJUDILGHYHQDFDYDLQIHULRUGD
WURPEVVDSWDQDQKDVWD\DRSHUDV\RQSODQODQGÕ5XWLQPRQLWRUL]DV\RQDHNRODUDNHQGRWUDNHDO
HQWEDV\RQGDQ VRQUD 7g( PRQLWRUL]DV\RQX \DSÕOGÕ %DúODQJÕo EXOJXODUÕ QRUPDOGL 2SHUDV\RQ
VÕUDVÕQGD VD÷ E|EUHN HNVSORUH HGLOL\RUNHQ DQL KLSRWDQVL\RQ GHVDWUDV\RQ YH WDúLNDUGL ROXúWX
7g( LQFHOHPHVLQGH DNXW VD÷ NDOS \NOHQPH EXOJXODUÕ YH VD÷ DWUL\XP LoLQGH KDUHNHWOL
WURPEVOHU J|]OHQGL 5HVLP +DVWDQÕQ KHPRGLQDPLVL YH RNVLMHQDV\RQX KÕ]OD ER]XOGX $FLO
VWHUQRWRPL\DSÕOGÕYHNDUGL\RSXOPRQHUE\-SDVV¶DJHoLOHUHNKDVWDVR÷XWXOGXYHWRWDOVLUNODWXDU
arrest (TSA) uygulanarak pulmoner tromboembolektomi ve pulmoner endarterektomi
X\JXODQGÕ76$¶GDQoÕNÕOGÕ6D÷DWUL\XPDoÕODUDNWURPEVOHUWHPL]OHQGL$UGÕQGDQQHIUHNWRPLYH
YHQD FDYD LQIHULRUD GDFURQ JUHIW X\JXODQGÕ +DVWD ÕVÕWÕODUDN SRPSDGDQ oÕNÕOGÕ 3RVWRS 7g(
LQFHOHPHVLQGHNDUGLDNIRQNVL\RQODUÕQQRUPDOHG|QG÷J|]OHQGL
7$57,ù0$ øQWUDRSHUDWLI 3( úSKHVL RODQ KDVWDODUGD 7g( GH÷HUOL ELU PRQLWRUL]DV\RQ DUDFÕ
ROXSED]ÕROJXODUGDWHNEDúÕQDWDQÕNR\PD\D\HWHUOLGLU 2OJXPX]GDNLJLEL3(ULVNL\NVHNRODQ
KDVWDODUGD H÷HU PPNQVH RSHUDV\RQXQ EDúODQJÕFÕQGDQ LWLEDUHQ 7g( PRQLWRUL]DV\RQXQXQ
\DSÕOPDVÕLOHDQHVWH]LYHFHUUDKLLOHLOJLOLKÕ]OÕYHGR÷UXNDUDUODUYHULOPHVLPPNQRODELOLU
Anahtar Kelimeler: nonkardiak cerrahLSXOPRQHUHPEROLWUDQV|]RIDJLDOHNRNDUGLRJUDIL
Resim 1
6D÷DWUL\XPLoLQGHKDUHNHWOLWURPEV
140
P-52
KALP TRANSPLANTASYON86215$6,*(/øù(1'(/ø5<807$%/268181
5ø63(5ø'21ø/(7('$9ø6ø
Ahmet Onat Bermede1, Eda Aksoy1, Serkan Durdu20XVWDID%DKDGÕUøQDQ25oKDQ$NDU2,
0XVWDIDùÕUODN2dL÷GHP<ÕOGÕUÕP*oO1dL÷GHP'HQNHU1
1
$QNDUDhQLYHUVLWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$QD%LOLP'DOÕ$QNDUD
2
$QNDUDhQLYHUVLWHVL.DOSYH'DPDU&HUUDKLVL$QD%LOLP'DOÕ$QNDUD
'HOLU\XP GLNNDW ELOLQo YH NRJQLWLI IRQNVL\RQODUGD GH÷LúLNOLNOH NDUDNWHUL]H DNXW YH GDOJDOÕ
NRQI]\RQYHGH]RU\DQWDV\RQGXUXPXGXU<DúSRVWRSHUDWLID÷UÕX\NXSUREOHPOHULRSHUDV\RQ
|QFHVL YH VRQUDVÕ NXOODQÕODQ LODoODU HQ |QHPOL ULVN IDNW|UOHULGLU .DUGL\DN FHUUDKL VRQUDVÕ
SRVWRSHUDWLI GHOLU\XP \R÷XQ EDNÕP YH KDVWDQHGH NDOÕú VUHVLQL X]DWWÕ÷Õ JLEL PRUELGLWH YH
PRUWDOLWHRUDQODUÕQÕGDDUWÕUÕU+X]XUVX]OXNDOJÕODPDER]XNOX÷XYHDMLWDV\RQQHGHQL\OHPHNDQLN
YHQWLODW|U GHVWH÷LQLQ VRQODQGÕUÕODPDPDVÕ oHúLWOL NRPSOLNDV\RQODUD QHGHQ ROPDNWDGÕU
Haloperidol ve ketiapin gibi antipsikotikler ve benzodiyazepinler postoperatif deliryum
WDEORVXQGD VÕN NXOODQÕODQ LODoODUGÕU %L] EX ROJXGD NDOS WUDQVSODQWDV\RQX VRQUDVÕ JHOLúHQ
haloperidol, ketiapin, midazolam tedavisine \DQÕW DOÕQDPD\DQ YH WHN GR] ULVSHULGRQ LOH WHGDYL
HGLOHQGHOLU\XPWDEORVXQXWDUWÕúPD\ÕDPDoODGÕN
Anahtar Kelimeler: postoperatif deliryum, kalp transplantasyonu, risperidon.
141
P-53
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$QDELOLP'DOÕ5L]H
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143
P-54
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Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare familial cardiac
arrhytmia that is characterized by RYR2 or CASQ2 gene mutation. This arrhytmia occurs in
patient with normal heart but that can cause sudden cardiac arrest due to exercise and/or
emotion related ventricular fibrilation (VF). Most often clinical symptom is syncope.
There
is
no
enough
description
of
anesthesia
for
such
patients.
Here we report a case of CPVT and described anesthetic management.
Keywords: Catecholaminergic polymorphic ventricular tachycardia,
Anahtar Kelimeler: CPVT,Left Cardiac Sympathetic Denervation,Torachal Epidural Anesthesia
exercise ECG
144
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145
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P-57
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147
P-58
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149
P-59
<(1ø'2ö$1'$6835$./$9ø.8/$58/75$621(ù/øöø1'(%5$.ø26()$/ø. VEN
.$7(7(5ø=$6<218
7D\IXQ$\GÕQ, Onur Balaban, Muhammet Hilmi Koputan
'XPOXSÕQDUhQLYHUVLWHVL7ÕS)DNOWHVL
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GD\HQLGR÷DQJLEL|]HOOLNOLROJXODUGDXOWUDVRQNXOODQÕOPDVÕVDQWUDOYHQ|]NDWHWHUL]DV\RQLúOHPLQL
NROD\ODúWÕUPÕúWÕU<D\JÕQ|GHPQHGHQL\OHSHULIHULNGDPDU\ROXDoÕODPD\DQJD÷ÕUOÕ÷ÕQGDNL
ROJXGD XOWUDVRQ HúOL÷LQGH VXSUDNODYLNXODU \DNODúÕPOD EUDNLRVHIDOLN YHQH NDWHWHU \HUOHúWLULOPHVL
DPDoODQGÕ
OLGU: <HQLGR÷DQ\R÷XQEDNÕPGDHQWEHWDNLSHGLOHQJD÷ÕUOÕ÷ÕQGD JQONDQHQVHIDOLN
ROJX 0HYFXW GDPDU \ROXQXQ oDOÕúPDPDVÕ YH \D\JÕQ |GHP VRQXFXQGD SHULIHULN GDPDU \ROX
DoÕODPDPDVÕ QHGHQL\OH VDQWUDO YHQ|] NDWHWHUL]DV\RQ LoLQ SHGLDWUL NOLQL÷LQFH WDUDIÕPÕ]GDQ
NRQVOWDV\RQ LVWHQGL %R\XQ NÕVD YH |GHPOL ROGX÷XQGDQ MXJXOHU YHQ \HULQH XOWDVRQ HúOL÷LQGH
EUDNL\RVHIDOLN YHQ NDWHWHUL]DV\RQX WHUFLK HGLOGL 6XSUDNODYLNXODU \DNODúÕPOD PHJDKHUW]
IUHNDQVWD OLQHHU SURE NXOODQÕODUDN ROJXQXQ ER\XQ E|OJHVLQGH NDURWLV DUWHUL YH MXJXOHU YHQ
J|UQWV WDNLS HGLOHUHN VXSUDNODYLNOHU E|OJHGH EUDNLRVHIDOLN YHQ J|UQWOHQGL *HUHNOL
VWHULOL]DV\RQ VD÷ODQGÕNWDQ VRQUD |QFHGHQ EHOLUOHQHQ \HUGHQ RXW RI SODQH WHNQL÷L LOH L÷QH XFX
J|UQWOHQHUHN EUDNL\RVHIDOLN YHQH JLULOGL 9HQ|] NDQ DVSLUH HGLOGLNWHQ VRQUD NODYX] WHO
\HUOHúWLULOGL .ODYX] WHO ]HULQGHQ JDXJH NDWHWHU \HUOHúWLULOGL $NFL÷HU JUDILVL oHNLOHUHN
NDWHWHULQ\HULGR÷UXODQGÕ
7$57,ù0$ øQWHUQDO MXJXOHU YHQ NDWHWHUL]DV\RQX LoLQ XOWUDVRQ HúOL÷LQGH JQP]GH DOWÕQ
VWDQGDUW RODUDN NDEXO HGLOPLúWLU 3HGL\DWULN ROJXODUGD YH \HQLGR÷DQGD VDQWUDO YHQ|]
NDWHWHUL]DV\RQ GHQH\LPOL DQHVWH]LVWOHU WDUDIÕQGDQ GDKL ]RU NDEXO HGLOPHNWHGLU 8OWUDVRQ
HúOL÷LQGH VXSUDNODYLNXODU \DNODúÕPOD EUDNL\RVHIDOLN YHQ \D GD VXENODY\HQ YHQ NDWHWHUL]DV\RQX
\HQL WDQÕPODQPÕúWÕU %R\QXQ NÕVD ROGX÷X \HQLGR÷DQ \D GD oRFXN ROJXODUGD 86 HúOL÷LQGH
VXSUDNODYLNXODU VXENODY\HQ YHQ NDWHWHUL]DV\RQX JYHQLOLU NRPSOLNDV\RQ RUDQÕ GúN ELU
\|QWHPRODUDN|QHULOPHNWHGLU
6218d 6XSUDNODYLNXODUXOWUDVRQHúOL÷LQGHEUDNL\RVHIDOLNYHQNDWHWHUL]DV\RQX\HQLGR÷DQGDYH
oRFXNODUGDLúOHPLNROD\ODúWÕUDQYHNRPSOLNDV\RQODUÕD]DOWDQ\HQLELU\|QWHPGLU
Anahtar Kelimeler: 6DQWUDOYHQ|]NDWHWHUL]DV\RQ\HQLGR÷DQVXSUDNODYLNXODU\DNODúÕP
ultrason
150
P-60
<$ù/,.$5'ø<$.&(55$+ø+$67$'$8=816h5(/ø%$ù$5,/,.$5'ø<23ULMONER
5(6h6ø7$6<21'(1(<ø0ø0ø=
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(JHhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORML9H5HDQLPDV\RQ$QD%LOLP'DOÕø]PLU
*ø5øù 1DGLU J|UOPHNOH ELUOLNWH RSHUDV\RQ VDORQXQGD NDUúÕODúÕODQ intraoperatif kardiyak
DUUHVWOHU NDWDVWURILN VRQXoODQDQ ROD\ODUGÕU %L] EXUDGD NRURQHU DUWHU ED\SDV JUHIWOHPH
FHUUDKLVLQLQ ELWLPLQLQ KHPHQ DNDELQGH \DúOÕ ELU ROJXGD X]XQ VUHOL EDúDUÕOÕ NDUGL\RSXOPRQHU
UHVVLWDV\RQGHQH\LPLPL]LSD\ODúPD\ÕDPDoODGÕN
OLGU: \DúÕQGD NLOR D÷ÕUOÕ÷ÕQGD |]JHoPLúLQGH KLSHUWDQVL\RQ YH GL\DEHWHV PHOOLWXV
KDVWDOÕ÷Õ RODQ $6$ KDVWD NRURQHU DUWHU KDVWDOÕ÷Õ QHGHQL LOH NRURQHU DUWHU ED\SDV JUHIWOHPH
FHUUDKLVLQHDOÕQGÕ+DVWDQÕQoNRURQHUGDPDUÕQDED\SDVX\JXODQGÕ.DOSDNFL÷HUSRPSDVÕQGDQ
GRSDPLQ GREXWDPLQ DGUHQDOLQ YH SDFHPDNHU GHVWH÷LQGH oÕNÕOGÕ +DVWDGD RSHUDV\RQ
VDORQXQGDQ oÕNPDGDQ |QFH NDUGL\DN DUUHVW PH\GDQD JHOGL .DUGL\RSXOPRQHU UHVVLWDV\RQ
HúOL÷LQGH \HQLGHQ RSHUDV\RQD DOÕQGÕ *|÷V NRPSUHV\RQODUÕQD VWHUQXP DoÕOGÕ÷ÕQGD da devam
HGLOGL <DSÕODQ DQDVWDPR]ODUGDQ ELULQLQ oDOÕúPDGÕ÷Õ J|UOG +DVWD\D PJ DGUHQDOLQ LOH
\DNODúÕN GDNLND NDUGL\RSXOPRQHU UHVVLWDV\RQ X\JXODQGÕ <DQÕW DOÕQDQ KDVWD KLSRWDQVLI
VH\UHWPHVL QHGHQL LOH DFLO RODUDN \HQLGHQ NDOS DNFL÷HU SRPSD GHVWH÷LQH DOÕQGÕ <HQL ELU
DQDVWRPR] \DSÕOGÕ +DVWDGDQ NDOS DNFL÷HU SRPSDVÕQGDQ oO LQRWURS YH LQWUDDRUWLN EDORQ
SRPSDVÕ GHVWH÷LQGH oÕNÕOGÕ 3RVWRSHUDWLI KHUKDQJL ELU Q|URORMLN VHNHOL ROPD\DQ KDVWDQÕQ
KHPRGLQDPLVLQLQ GH VWDELO ROPDVÕ ]HULQH LQWUDDRUWLN EDORQ SRPSDVÕ SRVWRSHUDWLI JQGH
oÕNDUÕOGÕ YH KDVWD D\QÕ JQ HNVWEH HGLOGL 3RVWRSHUDWLI JQGH VROXQXP \HWPH]OL÷L JHOLúHQ
KDVWD\DDUDOÕNOÕRODUDNPHNDQLNYHQWLODV\RQGHVWH÷LX\JXODQGÕ+DVWD SRVWRSHUDWLID\GD úLID
ile taburcu oldu
6218d Kardiyak
arrest
QHGHQLQLQ o|]PQH \|QHOLN \DSÕODQ NDUGL\RSXOPRQHU
UHVVLWDV\RQODUGD VUH YH \Dú IDNW|U J|] |QQH DOÕQPDGDQ EDúDUÕOÕ KDVWD VRQXoODUÕ HOGH
edilebilir.
Anahtar Kelimeler: øQWUDDRUWLN EDORQ SRPSDVÕ LQWUDRSHUDWLI NDUGL\DN DUUHVW X]XQ VUHOL
kardiyopulmoner
UHVVLWDV\RQ
151
P-61
75$16.$7(7(5$257ø..$3$.ø03/$17$6<2181'$$1(67(=ø'(1(<ø0ø0ø=
Zeynep Pestilci&HQJL]ùDKXWR÷OX6HGHQ.RFDEDú)DWPD=HNL\H$úNDU(VLQg]WUN%Dú
(JHhQLYHUVLWHVL7ÕS)DNOWHVL$QHVWH]L\RORML9H5HDQLPDV\RQ$QD%LOLP'DOÕø]PLU
*ø5øù 6RQ\ÕOODUGD7UDQVNDWHWHU$RUWLN.DSDNøPSODQWDV\RQX7$9ø FLGGLDRUWVWHQR]XRODQ
FHUUDKL ULVNL oRN \NVHN YH\D DPHOL\DW HGLOHPH] \DúOÕ SRSODV\RQ LoLQ X\JXODQDQ \HQL ELU
\|QWHPGLU$QHVWH]L\RORJODUEXJLULúLPOHUGHROGXNoD|QHPOLURODOPDNWDGÕU.
OLGU: \DúÕQGD (.2
ODUÕQGD FLGGL DRUW GDUOÕ÷Õ RODQ o NDGÕQ KDVWD\GÕ +DVWDODUGD
(.* SXOV RNVLPHWUH QD]DO ÕVÕ SUREX LQYD]LY DUWHUL\HO NDQ EDVÕQFÕ VDQWUDO NDWHWHU YH ULQHU
NDWHWHU LOH VWDQGDUW RODUDN PRQLW|UL]H HGLOGL $ULWPLOHULQ HUNHQ \|QHWLPL LoLQ HNVWHUQDO J|÷V
SDFLQJSHGOHUL\HUOHúWLULOGL+DVWDODUDJHQHODQHVWH]LX\JXODQGÕ$QHVWH]LLQGNVL\RQXIHQWDQLO
± JNJYHSHQWRWDOPJNJVRQUDVÕURNXURQ\XPPJNJLOHJHUoHNOHúWLULOGL$QHVWH]L
LGDPHVL RNVLMHQ KDYD NDUÕúÕPÕna % 4 ± GHVIOXUDQ LODYHVLLOH VD÷ODQGÕ +Õ]OÕ YHQWULNOHU
SDFLQJ\DSPDNYHRODVÕ$-9EORNJHOLúLPLQLLoLQIHPRUDOYHQ\ROX\ODVD÷YHQWULNOHWUDQVYHQ|]
SDFLQJX\JXODQGÕ(QWEDV\RQVRQUDVÕGHYDPOÕWUDQV|]HIDML\DO(.2PRQLW|UL]DV\RQXX\JXODQGÕ
Uygun hemRGLQDPLN VWDELOLWH\L VD÷ODPDN LoLQ LQWUDRSHUDWLI GRSDPLQ YH QLWURJOLVHULQ EDúODQGÕ
øúOHP VRQUDVÕQGD VXJDPPDGHNVLQ IDUPDNRORMLN DQWDJRQL]DV\RQX\OD KDVWDODU VDORQGD HNVWEH
HGLOHUHNNDOSGDPDUFHUUDKLVL\R÷XQEDNÕPDWUDQVIHUHGLOGL%LUJQVRQUDVÕQGDKHUoROJXGD
servise taburcu edildi. 1. olguda intraoperatif a-Y EORN JHOLúWL SDFHPDNHU X\JXODQGÕ
3RVWRSHUDWLI QLWH HULWURVLW VVSDQVL\RQX UHSODVPDQÕ X\JXODQGÕ JQGH úLID LOH HNVWHUQH
HGLOGL YH ROJXGD NDOS \HWPH]OL÷L JHOLúWL 0HGLNDO WHGDYL VRQUDVÕ QRUPDOH G|QHQ KDVWD
JQGHKDVWDLVHJQGHúLIDLOHHNVWHUQHHGLOGL
6218d 7$9øX\JXODQDFDNKDVWDODULoLQDQHVWH]LLOHLOJLOLLúOHPOHULQJoO÷FHUUDKLRODUDN$95
X\JXODQDQ KDVWDODU LOH D\QÕGÕU %X LúOHPOHU LoLQ DQHVWH]L SODQÕ ROXúWXUXOPDOÕ YH SRVWRSHUDWLI
G|QHPGHGHKDVWDODUNRPSOLNDV\RQODU\|QQGHQL]OHQPHOLGLU
Anahtar Kelimeler: *HQHO DQHVWH]L 7UDQVNDWHWHU $RUWLN .DSDN øPSODQWDV\RQX 7$9ø
152
P-62
08/7ø3/(.27)5$.7h5/h%ø52/*8'$.267$)ø.6$6<218ø/(<2ö81 BAKIMDA
.$/0$6h5(6ø1ø1KISALMASI
$\NXW6DUÕWDú1*|NKDQ*QHUHQ23HOLQ8]XQ6DUÕWDú1&HQJL]8JLú1
1
3URI'U$øOKDQg]GHPLU'HYOHW+DVWDQHVL*LUHVXQ
2
0X÷OD0LODV'HYOHW+DVWDQHVL
*ø5øù
dRNOXNRWNÕUÕNODUÕQGDoRNFLGGLVROXQXPVRUXQODUÕRUWD\DoÕNPDNWDGÕU%X nedenle cerrahi olarak
J|÷V GXYDUÕ VWDELOL]DV\RQXQ ELU oRN DYDQWDMÕ ELOGLULOPLúWLU %XQODU PHNDQLN YHQWLODV\RQ YH
\R÷XQEDNÕPGDNDOPDVUHVLQLQNÕVDOPDVÕGÕU
OLGU SUNUMU
\DúÕQGD HUNHN KDVWD WUDILN ND]DVÕ QHGHQL\OH *LUHVXQ 3URI 'U$øOKDQ g]GHPLU 'HYOHW
+DVWDQHVLDFLOVHUYLVHJHWLULOGLdHNLOHQWRUDNV%7GHoRNOXNRWIUDNWUL]OHQGL6ROXQXPVÕNÕQWÕVÕ
YH \HONHQ J|÷V ROPDVÕ VHEHEL\OH KDVWD HQWEH HGLOHUHN PHNDQLN YHQWLODW|UH ED÷ODQGÕ$÷UÕ
NRQWUROVD÷ODQPD\DoDOÕúÕODQKDVWDGDZHDQLQJSODQODQGÕIDNDWNRWIUDNWUQHGHQL\OHVROXQXP
SDWHUQL G]HQOL ROPD\DQ KDVWDGD ZHDQLQJ EDúDUÕODPDGÕ<DWÕúÕQÕQ JQQGH J|÷V FHUUDKL
WDUDIÕQGDQ RSHUDV\RQD DOÕQGÕ+DVWDQÕQ NRVWDODUÕ NÕUÕN XoODUÕ UHGNWH HGLOHUHN X\JXQ DQDWRPLN
pozisyona getirildi. Titanyum miniplaklar uygun ER\XWWD VHoLOHUHN úHNLOOHQGLULOGL YH GHOLNOHU
DoÕODUDN PLQL YLGDODU NXOODQÕODUDN ILNVDV\RQ X\JXODQGÕ 2SHUDV\RQ VRQUDVÕ DQDOMH]L LKWL\DoÕ
D]DODQ YH VROXQXP SDWHUQL G]HOHQ KDVWDRSHUDV\RQGDQ JQ VRQUD UDKDWOÕNOD H[WEH HGLOGL
*|JV GHIRUPLWHVL G]HOHQ KDVWD H[WEH HGLOGLNWHQ JQ VRQUD \R÷XQ EDNÕPGDQ oÕNDUÕODUDN
VHUYLVH DOÕQGÕ6HUYLV WDNLSOHULQGH SUREOHPL ROPD\DQ KDVWD ELUNDo JQ VRQUD \U\HELOLU YH
NRQXúDbilir vaziyette taburcu edildi.
7$57,ù0$
.RVWD NÕUÕNODUÕ JHQHOOLNOH WHGDYL HGLOPHNVL]LQ L\LOHúHQ YH KDVWDODUÕQ VHPSWRPDWLN RODUDN WHGDYL
HGLOGLNOHUL ROJXODUGÕU $QFDN oRNOX NRVWD NÕUÕ÷Õ RODQ GXUXPODUGD WHGDYL UHGNVL\RQD \|QHOLN
]RUXQOX KDOH JHOHELOPHNWHGLU $oÕN UHGNVL\RQ \DSÕODUDN NRVWD VWDELOL]DV\RQXQ KDVWD
PRUELGLWHVLQL D]DOWWÕ÷ÕYHQWLODW|U LKWL\DFÕQÕ D]DOWWÕ÷Õ YH SXOPRQHU HQIHNVL\RQ ULVNLQL PLQLPDOL]H
HWWL÷L
ELOGLULOPLúWLU
6RQXo RODUDN PLQL SODN LOH DoÕN UHGNVL\RQ YH NRVWD ILNVDV\RQX KDVWDODUGDNL \DúDP NDOLWHVLQL
DUWWÕUDQRODVÕNRPSOLNDV\RQODUÕD]DOWDQ\R÷XQEDNÕPGDNDOÕúVUHVLQLYHDQDOMHzik gereksinimini
D]DOWDQYHQLODW|UGHQHUNHQD\UÕODUDNYHQWLODW|ULOLúNLOLSQ|PRQL\L|QOH\HQ\DUDUOÕELU\|QWHPGLU
'R÷UX HQGLNDV\RQ LOH NRVWD ILNVDV\RQX \DSÕODQ KDVWDODUÕQ GDKD HUNHQ YH NRPSOLNDV\RQVX]
RODUDNWDEXUFXROGX÷XNDQÕVÕQDYDUGÕN.
Anahtar Kelimeler: ILNVDV\RQNRWIUDNWUPLQLSODNYLGD.
153
fiksasyonlu Kosta
IUDNWUOKosta
154
P-63
/$5ø1*($/+(0$1-ø2081(ù/ø.(77øöø3267ø17h%$6<2175$.($/67ENOZLU
+$67$'$+$9$<2/8<g1(7ø0ø
(OLI%RPEDFÕ 6HUKDQdRODNR÷OX$\úHQXU%R]WHSH1DJHKDQ*|]GH$WHúgPHU7DúDUJ|O$\úH
=H\QHS7XUDQ(QJLQ.ÕYUDN
'U/WIL.ÕUGDU.DUWDO(÷LWLPYH$UDúWÕUPD+DVWDQHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ.OLQL÷L
øVWDQEXO
*ø5øù /DULQJHDO KHPDQMLRPODU/+ HULúNLQOHUGH QDGLUHQ J|UOU 6HV NÕVÕNOÕ÷Õ YH QHIHV
GDUOÕ÷ÕQD QHGHQ ROXUODU %X VXQXGD /+
QLQ NRPSOLNH HWWL÷L SXOPRQHU VRUXQODU WDUWÕúÕOPÕúWÕU
OLGU: .2$+ KLSHUWDQVL\RQ ..< GLDEHWHV PHOOLWXV KLSRWURLGL WDQÕODUÕ RODQ VROXQXP VÕNÕQWÕVÕ
LOH KDVWDQHPL]H JHWLULOHQ <. KDVWD YRNDO NRUGODUÕQ DOWÕQGD NLWOH QHGHQL\OH HQWEH
HGLOHPHPLú$FLOWUDNHRVWRPLDoÕODQKDVWD\R÷XQEDNÕPQLWHPL]H<%hLQWHUQHHGLOGL6RQD\
LoLQGH NH] VROXQXP VÕNÕQWÕVÕ\OD <%h \DWÕú YH HQWEDV\RQ ELU KDIWDGÕU WUDNHDGD QHIHV DOÕUNHQ
WDNÕOPD KLVVL KLND\HVL |÷UHQLOGL 'LO GXGDN YH YFXGXQGD PDYL-mor renkte 0.5-FP oDSÕQGD
OH]\RQODU GLNNDW oHNPHNWH\GL5HVLP 'úN NRDJXODPHWUL SODWHOHW GH÷HUOHUL QHGHQL\OH
\DSÕODQ DUDúWÕUPDGD PL\HORGLVSODVWLN VHQGURP
WDQÕVÕ NRQXOGX 7HNUDUOD\DQ HQGRWUDNHDO
HQWEDV\RQODUD(( ED÷OÕ VXEJORWWLN VWHQR] JHOLúWL÷L GúQOHQ KDVWD\D JQQGH .%%
WDUDIÕQGDQ JUDQODV\RQ GRNXVXQD VWHURLG LQMHNWH HGLOGL 7UDNHDO DVSLUDV\RQODU VÕUDVÕQGD
NDQDPD\OD ROXúDQ NUXWODUGDQ KDYD\ROXQXQ WÕNDQPDVÕ QHGHQL\OH \DSÕODQ EURQNRVNRSLGH K\RLG
NHPLN KL]DVÕQGD KHPDQMLRP WHVELW HGLOGL5HVLPJQQGH JUDQODV\RQ GRNXVX .%%
WDUDIÕQGDQ WUDúODQGÕ JQQGH *ø6 NDQDPD JHOLúHQ KDVWD\D HQGRVNRSL \DSÕOGÕ hVW
|]DIDJXVWD oRN VD\ÕGD YHQH]HNWD]LOHU WHVSLW HGLOGL +DVWDQÕQ NDUGL\RSXOPRQHU SDWRORMLOHUL
QHGHQL\OH ³ZHDQLQJ´ EDúDUÕODPDGÕ <DWÕúÕQÕQ JQQGH oRNOX RUJDQ \HWPH]OL÷L LOH KDVWD
kaybedildi.
7$57,ù0$YH 6218d (ULúNLQGH/+HWL\RORMLVLQGHVLJDUDVHVLQN|WNXOODQÕPÕYHHQWEDV\RQ
WUDYPDVÕ JLEL IDNW|UOHU VXoODQPDNWDGÕU 2OJXPX]GD WHNUDUODQDQ (( YH PHNDQLN
YHQWLODV\RQODUGDQ GROD\Õ VXEJORWWLN VWHQR] JHOLúPHVLQLQ \DQÕVÕUD PXKWHPHOHQ D\QÕ E|OJHGH
GDKD |QFHGHQ YDU RODQ DQFDN VHPSWRP YHUPH\HQ KHPDQMLRPXQXQ WUDYPD\OD E\\HUHN YH
kanayarak, solunuPVDO SUREOHPLQL D÷ÕUODúWÕUGÕ÷ÕQÕ GúQPHNWH\L] %X ROJXGD ROGX÷X JLEL
WHNUDUOD\DQ HQWEDV\RQODUGDQ VRQUD ODULQJHDO KHPDQMLRP JHOLúHELOHFH÷L KDYD\ROXQGD GDUDOPD
YHNDQDPD\D\RODoDELOHFH÷LDNODJHOPHOLGLU
Anahtar Kelimeler: Laringeal, hemanjiom, subglottik, stenoz.
155
Resim 1
Resim 2
Resim 3
156
P-64
8=$0,ù.$/3&(55$+ø6ø1'(.$1$0$'ø<$7(=ø *(/øù(1+$67$'$)ø%5ø12-(1
KULLANIMI
Dilek Kutanis1(QJLQ(UWUN1*|NDOS$OWXQ2, Zerrin Pulathan2, Taner Toker1, Melek
+DP]DoHEL1, Mahmut Arslan1, Ali Civelek2, Erdem Duman1
1
.7h7ÕS)DNOWHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ$'7UDE]RQ
2
.7h7ÕS)DNOWHVL.DOSYH'DPDU&HUUDKLVL$'7UDE]RQ
*ø5øù
.DUGL\RSXOPRQHU E\SDVVWD NDQÕQ \DEDQFÕ ELU \]H\OH NDUúÕODúPDVÕ NRDJODV\RQ VLVWHPLQL
DNWLIOHU.ÕVDSRPSDVUHVLQGHVRUXQROXúWXUPD\DQEXGXUXPSRPSDVUHVLX]DGÕ÷ÕQGDNDQDPD
GL\DWH]LROXúWXUXUYHKHPRVWD]ÕVD÷ODPDNJoOHúLU%XROJXVXQXPXQGDWULNVSLWPLWUDOYHDRUW
NDSDN FHUUDKLVL YH VRQUDVÕQGD DVFHQGDQ DRUW UHSODVPDQÕ \DSÕODQ KDVWDPÕ]GDNL DQHVWH]L
\|QHWLPimizi sunduk.
OLGU:
'L\DEHWLYHKLSHUWDQVL\RQXRODQ\DúÕQGDNLHUNHNKDVWDQÕQWULNVSLWPLWUDOYHDRUW\HWPH]OL÷L
WDQÕODUÕ\ODDPHOL\DWÕSODQODQGÕ7URPERVLWVD\ÕVÕELQRODUDN|OoOHQKDVWD\DDQDOMH]LDPDFÕ\OD
T6-DUDOÕ÷ÕQGDQHSLGXUDONDWHWHU\HUOHúWLULOGL6WDQGDUWPRQLWRUL]DV\RQYHLQGNVL\RQODHQWEH
HGLOHQ KDVWDQÕQ PLWUDO YH WULNVSLW NDSDN UHSODVPDQÕ \DSÕOGÕ DRUW NDSD÷D ULQJ NRQXOGX GDNLNDOÕN NURV NOHPS NDOGÕUÕOGÕNWDQ VRQUD LQFH YH IUDMLO \DSÕ\D VDKLS VRO DWULXP WDYDQÕQGDQ YH
DRUW N|NQGHQ NDQDPD J|]OHQLQFH WHNUDU NDUGL\RSOHML YHULOLS NURV NOHPS NRQXOGX $WULXPGDNL
GHIHNW WDPLU HGLOLS DRUW NDSDNWDNL EL\RSURWH] oÕNDUÕOGÕ YH %HQWKDOO SURVHGU LOH DVFHQGDQ DRUW
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VHUHEUDO NRUXPD DPDFÕ\OD PHWLOSUHGQLVRORQ WL\RSHQWDO YH PDQQLWRO \DSÕOGÕ øON SRPSD |QFHVL
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fibrinojHQ G]H\LQLQ HNVLN ROGX÷X GúQOHQ ROJXODUGD UHSODVPDQ WHGDYLVLQLQ KHPRVWD] LoLQ
DOWHUQDWLIELU\DNODúÕPROGX÷XJ|UúQGH\L]
Anahtar Kelimeler: Kalp cerrahisi, Kanama diyatezi, Fibrinojen.
157
P-65
.$5'ø<238/021(5$55(ST SONRASI EKSTRAKORPORAL MEMBRAN
2.6ø-(1$6<2181'$1d,.,ù7$.$/31$./ø1(.g35h/(0($0$d/,62/
9(175ø.h/'(67(.&ø+AZI(LVAD) KULLANIMI: OLGU SUNUMU
$\WHQ6DUDoR÷OX1, (QJLQ8÷XU10HUWùHQWUN26LEHOùHQHU1, Nurcan Arat4=7XED'HPLU|]3,
Erman Pektok31XUDQ<D]ÕFÕR÷OX46KD.oNDNVX3
1
ùLúOL)ORUHQFH1LJKWLQJDOH+DVWDQHVL$QHVWH]L\RORML.OLQL÷LøVWDQEXO
2
øhøVWDQEXO7ÕS)DNOWHVL$QHVWH]L\RORML$'øVWDQEXO
3
ùLúOL)ORUHQFH1LJKWLQJDOH+DVWDQHVL.DOS1DNOLYH.DOS'HVWHN6LVWHPOHUL0HUNH]L
4
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*ø5øù %X ROJX VXQXPX LQRWURSLN GHVWHN DOWÕQGD 6WDWXV ,, DFLO NDOS EHNOHPH OLVWHVLQGH
\HU DODQ ELU KDVWDGD NDUGL\DN DUUHVW JHOLúPHVL VRQXFX )HPRUDO 9$ (NVWUDNRUSRUDO 0HPEUDQ
2NVLMHQDV\RQX (&02 LOH UHVVLWDV\RQX (&02 YH LQWUDDRUWLN EDORQ SRPSDVÕQÕQ ,$%3
NRPELQH NXOODQÕPÕ VRQUDVÕ 6RO 9HQWULNO 'HVWHN &LKD]Õ /9$' LOH NDOELQ WUDQVSODQWDV\RQ
VUHFLQHNDGDUGHVWHNOHQPHVLQLLoHUPHNWHGLU
OLGU: $LOHVHO KLND\HVL EXOXQDQ \ÕO |QFH &57-' WHGDYLVL DODQ YH \ÕOGÕU GLODWH
kardiyomyoSDWLWDQÕVÕLOHL]OHQHQKDVWDLQRWURSLNGHVWHNDOWÕQGDDFLONDOSEHNOHPHOLVWHVLQH
DOÕQGÕ /9('d FP /9 (MHNVL\RQ IUDNVL\RQX - VLVWROLN SXOPRQHU DUWHU EDVÕQFÕ mmHg, ciddi MY (3-RUWD7<5:69,JUPPVD÷DWULXPEDVÕQFÕPP+J idi. Ani
JHOLúHQDNXWSXOPRQHU|GHPQHGHQL\OH<%h¶GHL]OHQHQKDVWDGDNDUGL\RSXOPRQHUDUUHVWJHOLúWL
Hastaya 15- GDNLND VUHQ &35 X\JXODQGÕ YH EX GHVWHN DOWÕQGD IHPRUDO NDQODV\RQOD NDOSDNFL÷HU SRPSDVÕQD JLULOHUHN 9$ (&02¶\D JHoLOGL VRO YHQWULNO GHNRPSUHV\RQX LoLQ GL÷HU
IHPRUDODUWHUGHQ,$%3WDNÕOGÕVDDWVUHQ(&02GHVWH÷LQGHXOWUDILOWUDV\RQYH\R÷XQGLUHWLN
WHGDYLOHUOHDNFL÷HU|GHPLJHULOH\HQQ|URORMLNDoÕGDQGDQRUPDOVH\UHGHQKDVWD\DVROYHQWULNO
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VHUYLVHoÕNDUÕOGÕ3RVWRSHUDWLIJQGHHYLQHJ|QGHULOHQKDVWDKDOHQ1<+$.ODV,,RODUDN NDOS
naklini beklemektedir.
6218d Kalp Nakli bekleyen son evre kalp yetersizlikli hastalarda kardiyopulmoner arrest
VRQUDVÕ SHULIHULN WLSWH (&02 NXOODQÕPÕ KD\DW NXUWDUÕFÕ ELU X\JXODPDGÕU (&02¶QXQ ,$%3 JLEL
GL÷HU \|QWHPOHUOH GHVWHNOHQPHVL KHP VRO KHP GH VD÷ YHQWULNOQ NRUXQPDVÕQD YH KDVWDQÕQ
/9$'JLEL\|QWHPOHUOH\DúDWÕODELOPHVLQHRODQDNVXQPDNWDGÕU
Anahtar
Kelimeler: HNVWUDNRUSRUHDO PHPEUDQ RNVLMHQDW|U LQWUDDRUWLN EDORQ SRPSDVÕ
158
P-66
5($1ø0$6<21<2ö81%$.,0h1ø7(6ø1'(9(17ø/$7g5ø/øù.ø/ø31g021ø1ø1
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$\úH(UWUN1, Erkan Cure2$KPHWùHQ3, Aysel Kurt4%DúDU(UGLYDQOÕ30HGLQH&XPKXU&UH5
1
5HFHS7D\LS(UGR÷DQhQLYHUVLWHVL7ÕS)DNOWHVL(QIHNVL\RQ+DVWDOÕNODUÕYHKlinik Mikrobiyoloji
$QDELOLP'DOÕ5L]H
2
3
Rize
4
5HFHS7D\LS(UGR÷DQhQLYHUVLWHVL7ÕS)DNOWHVL*|÷V&HUUDKLVL$QDELOLP'DOÕ5L]H
5
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$0$d 9HQWLODW|U LOLúNLOL SQ|PRQL 9ø3 LQVLGDQVÕ YH ULVN IDNW|UOHULQL EHOLUOHPHN HWNHQ
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DQWLEL\RWLNNXOODQÕPVUHVLLOLúNLOHULQLDUDúWÕUPDNDPDoODQPÕúWÕU
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KHU KDVWDGD .OLQLN 3XOPRQHU (QIHNVL\RQ 6NRUX .3(6 KHVDSODQPÕú YH ! RODQ KDVWDODU 9ø3
olaUDNGH÷HUOHQGLULOPLúWLU
BULGULAR: 9ø3 JHOLúHQ YH 9ø3 JHOLúPH\HQ KDVWD VRQXoODUÕ DQDOL] HGLOGL 9ø3 JHOLúHQ
KDVWDODUÕQ\DúRUWDODPDVÕKDVWDQHGHNDOÕúYHDQWLEL\RWLNNXOODQÕPVUHOHULDQODPOÕ\NVHNWL+HU
LNL JUXSWD PDOL\HW KHVDEÕQGD 9ø3 JUXEXQGD PDOL\HWLQ DúÕUÕ \NVHN ROGX÷X J|UOG 7DEOR ¶GH
EXOJXODU YHULOGL 9L3 JHOLúLPLQLQ .2$+ LOH LOLúNLOL ROGX÷X J|UOG ǃ S 9ø3
PDOL\HWYHPRUWDOLWHQLQKHUELULLoLQED÷ÕPOÕIDNW|UDOÕQDUDN\DSÕODQORMLVWLNUHJUHV\RQDQDOL]LQGH
9ø3LoLQ\DWÕú VUHVLYHDQWLEL\RWLNNXOODQÕPVUHVLPDOL\HWLoLQ9ø3YDUOÕ÷ÕPRUWDOLWHLoLQ\DWÕú
YHDQWLEL\RWLNNXOODQÕPVUHVLSULPHUKDVWDOÕ÷DHúOLNHGHQKLSHUWDQVL\RQYHNDQVHUYDUOÕ÷Õ&53
NUHDWLQLQ EH\D] NUH \NVHNOL÷L DWHú YDUOÕ÷ÕQÕQ ED÷ÕPVÕ] ULVN IDNW|UOHUL ROGX÷X WHVSLW HGLOGL
6RQXoODUWDEOR¶GHYHULOGL
6218d/$5 +DVWDQHGH \DWÕú VUHVL DUWWÕNoD 9ø3 JHOLúPH ULVNLQLQ DUWWÕ÷Õ YH 9ø3 JHOLúLPLQLQ
PDOL\HWOHUL DEDUWÕOÕ úHNLOGH DUWÕUGÕ÷Õ WHVSLW HGLOGL 9ø3 JHOLúHQ KDVWDODUGD PRUWDOLWH RUDQÕQÕQ
¶OHULEXOGX÷XVDSWDQGÕ
Anahtar Kelimeler: 9HQWLODW|ULOLúNLOLSLQRPRQLPRUWDOLWHPDOL\HW
159
7DEOR+DVWDODUÕQVRV\RGHPRJUDILN|]HOOLNOHULYHEL\RNLP\DVDOGH÷HUOHUL
9ø3JHOLúHQQ 9ø3JHOLúPH\HQQ 3GH÷HUL
<Dú\ÕO

0.001
Cinsiyet (E/K)
17/10
156/96
0.545
WBC

0.001
CRP

0.140
Kreatinin

0.192
$WHú

0.861
$QWLEL\RWLN.XOODQÕP6UHVL

0.001
<DWÕú6UHVL

0.001
Maliyet (TL)

0.001
Mortalite (n,%)
19 (%70.3)
82 (%32.5)
0.001
7DEOR/RJLVWLNUHJUHV\RQDQDOL]LKHUELUED÷ÕPOÕIDNW|ULoLQED÷ÕPVÕ]ULVN
IDNW|UOHULQLQEHOLUOHQPHVL
%D÷ÕPOÕIDNW|U %D÷ÕPVÕ]IDNW|U
25RGGVRUDQÕ &OJYHQDUDOÕ÷Õ 3GH÷HUL
9ø3
1.157
1.03-1.235
<0.001
0.920
0.744-0.985
0.029
<DWÕúVUHVL
1.044
1.006-1.03
0.021
Hipertansiyon
8.656
3.203-23.390
<0.001
Kanser
51.610
5.259-506.519
<0.001
$WHú
1.875
1.079-3.258
0.026
%H\D]NUH
1.00
1.00-1.00
<0.001
CRP
1.093
1.040-1.149
<0.001
Kreatinin
1.453
1.167-1.809
0.001
$QWLEL\RWLNVUHVL 0.869
0.814-0.928
<0.001
6.357-197.220
<0.001
<DWÕúVUHVL
$QWLEL\RWLNVUHVL
Mortalite
Maliyet
9ø3
35.409
160
P-67
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2/'8ö8(1)(.6ø<21/$5
$\úH(UWUN1$KPHWùHQ2(UNDQ&UH3$\úHJXOdRSXU&LFHN4/H\OD.D]DQFÕR÷OX2, Aysel Kurt5,
0HGLQH&XPKXU&UH6
1
5HFHS7D\LS(UGR÷DQhQLYHUVLWHVL7ÕS)DNOWHVL(QIHNVL\RQ+DVWDOÕNODUÕYH.OLQLN0LNUREL\RORML
$QDELOLP'DOÕ5L]H
2
Rize
3
4
5HFHS7D\LS(UGR÷DQhQLYHUVLWHVL7ÕS)DNOWHVL0ikrobiyoloji ve Klinik Mikrobiyoloji Anabilim
'DOÕ5L]H
5
5HFHS7D\LS(UGR÷DQhQLYHUVLWHVL7ÕS)DNOWHVL*|÷V&HUUDKLVL$QDELOLP'DOÕ5L]H
6
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*(5(d-<g17(0 +DVWDODU
+(
JHOLúLPL
DFÕVÕQGDQ
DNWLI
VUYH\DQV
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GH÷HUOHQGLULOPLúWLU +( WDQÕVÕ &'& &HQWHUV IRU 'LVHDVH &RQWURO DQG 3UHYHQWLRQ NULWHUOHULQH
J|UH NRQXOPXúWXU ø]ROH HGLOHQ PLNURRUJDQL]PDODUÕQ WDQÕPODPDVÕQGD VWDQGDUW \RQWHPOHU YH
9ø7(. RWRPDWL]H EDNWHUL\DO WDQÕPODPD NXOODQÕOPÕúWÕU $\UÕFD DQWLPLNUREL\DOGX\DUOÕOÕN WHVWL KHU
L]RODW LoLQ &/6, &OLQLFDO DQG /DERUDWRU\ 6WDQGDUGV ,QVWLWXWH VWDQGDUWODUÕQD X\JXQ \DSÕOPÕúWÕU
%XOJXODU VD\ÕVDO YHYH\D LVWDWLVWLNL YHULOHU \ÕOÕQGD <%8sinde geliúen 35 hastane
enfeksiyonunun 19nde (%54,2) Acinetobacter trleri izole edilmiútir. Ventilator iliúkili
pnomonilerin (VøP); %53,8inde (14/24) Acinetobacter trleri izole edilmiúken, kateter iliúkili
uriner sistem enfeksiyonlarÕnÕn (Kø86( VDQWUDO YHQR] NDWHWHU LOLúNLOL NDQ GRODúÕPÕ
eQIHNVL\RQODUÕQÕQ 69.ø-.'( SULPHU EDNWHUHPLOHULQ YH FLOW\XPXúDN GRNX HQIHNVL\RQODUÕQGD
EXHWNHQJ|UOPHPLúWLU\ÕOÕQGD<%8sinde geliúen 51 hastane enfeksiyonunun 23nde
(%45) Acinetobacter trleri izole edilmiútir. Vø3¶OHULQ ¶LQGH $FLQHWREDFWHU WUOHULQLQL]ROH
HGLOGL÷L YH DQODPOÕ ELU Gúú ROPDGÕ÷Õ EXQXQ \DQÕ VÕUD GL÷HU KDVWDQH HQIHNVL\RQX WUOHULQGH
|QHPOL
HWNHQ
RODUDN
RUWD\D
oÕNWÕ÷Õ
J|UOPúWU
7DEOR
$QWLPLNUREL\DO GLUHQF RUDQODUÕQD EDNWÕ÷ÕPÕ]GD KHU LNL \ÕOda da tigesiklin ve kolistin direnci
VDSWDQPD]NHQ NDUEDSHQHP LPLSHQHP YH PHURSHQHP NLQRORQ NXúDN VHIDORVSRULQ YH
piperasilin/ tazobaktam (Pip-7D]R GLUHQF RUDQODUÕ YH \ÕOODUÕQGD FLYDUÕQGD
VDSWDQPÕúWÕU $PLQRJOLNR]LW GLUHQF RUDQODUÕ \ÕOÕQGD FLYDUÕQGD\NHQ netilmisin,
gentamisin ve amikasin icin sÕrayla %13, %58 ve %70 olarak saptanmÕútÕr. tablo 2
Sonuo(lar): Acinetobacter enfeksiyonlarÕnÕn tedavisi, bu mikroorganizmanÕn birook antibiyoti÷e
direncli (MDR) olmasÕndan dolayÕ ROGXNoD JoWU %X QHGHQOH DQWLEL\RWLN NXOODQÕPÕQGD ORNDO
HSLGHPL\RORMLN YHULOHULQ EHOLUOHQPHVL YH HQIHNVL\RQ NRQWURO |QOHPOHULQLQ VUGUOPHVL ID\GDOÕ
RODFDNWÕU
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161
<R÷XQEDNÕPQLWHVLQGHHWNHQRODQ$EDXPDQLLVXúODUÕQÕQDQWLEL\RWLNGLUHQo\]GH
GD÷ÕOÕPÕ-2012)
Antibiyotik
\ÕOÕGLUHQo\]GH \ÕOÕGLUHQo\]GH
Amikasin
80
70
Gentamisin
77
58
Ampisilin-sulbaktam
100
94
Trimetoprim-sulfametoksazol 90
85
øPLSHQHP
100
89
Meropenem
100
86
Kolistin
0
0
Netilmisin
0
13
Sefotaksim
100
100
Seftazidim
100
100
Seftriakson
100
100
Piperasilin-tazobaktam
100
100
Tigesiklin
0
0
Siprofloksasin
73
80
<R÷XQEDNÕPQLWHVLQGHVÕNJ|UOHQ+(HWNHQL$EDXPDQLLVXúODUÕQÕQGD÷ÕOÕPÕ2012)
2011
9ø3
(n=24 )
2012
Acinetobacter spp.
VD\ÕVÕ
%
14
53,8
Acinetobacter
VSSVD\ÕVÕ
%
9ø3
(n=27 )
14
51,8
(n= 4 )
.ø-h6(
(n=2 )
0
.ø-h6(
(n=2 )
2
100
69.ø-KDE
(n=2 )
0
69.ø-KDE
(n= 2 )
1
50
Primer bakteriemi
0
Primer bakteriemi
(n=1 )
1
100
&LOWYH\XPXúDN
doku enf.
(n= 1 )
0
&LOWYH\XPXúDN
doku enf.
(n= 2 )
2
100
162
P-68
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KDVDUÕJHOLULNHQ*UDILN\DUDODQPDWUOHULQHJ|UHGH÷HUOHQGLULOGL÷LQGHLONVÕUDGDDWHúOL
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\DUDODQPÕúODUGÕ DEGRPHQ E|OJHVL YH YDVNOHU \DUDODQPDODU GD GDKD ID]OD J|UOPúW *UDILN
4).
6218d 6DYDúQHGHQLLOHROXúDQ\DUDODQPDODUGDHQID]ODPRUWDOLWHEDúDEGRPHQE|OJHVL
\DUDODQPDODUÕQGDYHYDVNOHUQHGHQOHUHED÷OÕROGX÷XJ|UOPHNWHGLU(QID]OD\DUDODQPDODU
HNVWUHPLWHOHUGHJ|UOPúWU([LWXVRODQKDVWDODUGD\DúD\DQODUDJ|UHDQODPOÕGHUHFHGHID]OD
NDQQDNOL\DSÕOGÕ÷ÕJ|]OHPOHQPLúWLU
Anahtar Kelimeler: VDYDúSHULRSHUDWLf, travma anestezi
163
*UDILN<DUDODQPDE|OJHOHULQHJ|UHKDVWDVD\ÕODUÕ
*UDILN<DUDODQPDWUQHJ|UHVD\ÕODUÕ
164
*UDILN&DQOÕYHH[LWXVRODQODUDYHULOHQWRSODPNDQYHUQVD\ÕODUÕS
*UDILN&DQOÕYHH[LWXVRODQODUÕQ\DUDODQPDE|OJHOHULLOHLOLúNLVLSS
165
Tablo 1
Min Max
Ortalama SD
<Dú\ÕO
3
68
29,05
11,53
.$+DWÕPGN
7
171
99,05
22,53
SpO2 (%)
48
100
98,29
4,12
SAB (mmHg)
49
178
119,1
22,03
DAB (mmHg)
17
108
70,61
15,82
GSK
3
15
13,68
2,95
2SHUDV\RQVUHVLGN 20
475
149,74
96,7
$QHVWH]L<|QWHPL
Genel
Rejyonel
80,6
8,6
Erkek
.DGÕQ
94
6
Cinsiyet (%)
Demografik veriler
Tablo 2
Min
Max
Ortalama SD
Preoperatif Hgb (g/dl)
3,5
16,9 11
2,5
Preoperatif Htc (%)
9,9
47,9 32,7
8
3UHRSHUDWLISODWHOHWA/
16
1205 330,9
193,1
Postoperatif Hgb (g/dl)
5,9
15,1 10,3
2
Postoperatif Htc (%)
18,1 44,5 30,8
3RVWRSHUDWLISODWHOHWA/ 60,6 1146 338,6
6,2
225,2
(6VD\ÕVÕ
0
50
2,6
5,4
7DP.DQ6D\ÕVÕ
0
1
0
0,1
TDP 6D\ÕVÕ
0
22
0,8
2,6
7RSODPYHULOHQNDQUQVD\ÕVÕ 0
68
3,5
7,5
.DQ'H÷HUOHULYHNDQUQOHULNXOODQÕPÕ
166
P-69
%ø5ø1&ø%$6$0$.<2ö81%$.,0h1ø7(6ø1'(<ATAN HASTALARIN PROGNOZU
7X÷ED'R÷X1, Ziyaattin Karakuzu1ùHQQXU.DWÕ2'HU\Dg]GHQ2PD\JHQo3
1
dDQ'HYOHW+DVWDQHVL$QHVWH]L\RORMLYH5HDQLPDV\RQ.OLQL÷LdDQDNNDOH
2
dDQ'HYOHW+DVWDQHVL1|URORML.OLQL÷LdDQDNNDOH
3
+DVHNL(÷LWLPYH$UDúWÕUPD+DVWDQHVL$QHVWH]LYH5HDQLPDV\RQ.OLQL÷LøVWDQEXO
$0$d
dDQDNNDOH dDQ 'HYOHW +DVWDQHVL <R÷XQ %DNÕP hQLWHVL <%h¶QGH WDNLS HGLOHQ KDVWDODUÕQ
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EDNÕPGD NDOÕú VUHOHULQLQ VHYN RUDQODUÕQÕQ \R÷XQ EDNÕP PRUWDOLWHVL YH PRUWDOLWH\L HWNLOH\HQ
IDNW|UOHUin belirlenmesi hedeflenmLúWLU
MATERYAL ve METOD
1LVDQYH1LVDQWDULKOHULDUDVÕQGDELULQFLEDVDPDN<%h¶QGHWDNLSHGLOHQYHYHULOHULQH
WDPXODúÕODQKDVWDQÕQGRV\DODUÕWDUDQDUDNUHWURVSHNWLIELUoDOÕúPDG]HQOHQGL<%h¶PL]VHNL]
\DWDNOÕ ROXSDQHVWH]L YH Q|URORML X]PDQODUÕ WDUIÕQGDQ DNWLI RODUDN NXOODQÕOPDNWDGÕU
Bulgular
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intoksikasyonu(%22,5), serebURYDVNOHU ROD\ .2$+ DOHYOHQPHVL\GL +DVWDODU\R÷XQEDNÕPDoR÷XQOXNODDFLOVHUYLVWHQWUDQVIHUHGLOPLúWL1RQLQYD]LYPHNDQLN
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LGL øOHUL \Dú <%h¶QGH NDOÕú VUHVLQLQ JQGHQ X]XQ ROPDVÕDUWHUL\HO NDWHWHUL]DV\RQ
iKWL\DFÕ LOH <%h¶QH NDEXO VÕUDVÕQGD KHPRGLQDPLN LQVWDELOLWH J|UOPHVL YH RQNRORMLN KDVWDOÕNODU
<%h PRUWDOLWHVLQL DUWWÕUPÕúWÕU 6ROXQXP \HWPH]OL÷L LOH <%h¶QH \DWÕú YH PRQLWRUL]DV\RQ
JHUHNVLQLPLLOH<%h¶QH\DWÕú <%hPRUWDOLWHVLQLD]DOWPÕúWÕU
6218d
Solunum yHWPH]OL÷LLOH\DWÕúÕ\DSÕODQKDVWDODUÕQ<%hPRUWDOLWHVLQLGúUPHVLQLQ<%h¶QLQ1,09
RUDQÕQÕQ \NVHN ROPDVÕ LOH LOLúNLOL ROGX÷XQX NDQÕVÕQGD\Õ] (QWEH HGLOLS VHYN HGLOHQ KDVWDODUÕQ
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HNLSPDQYHGHVWHNLOHoQFEDVDPDN<%h¶OHULQLQLú\NQYHVRUXPOXOX÷XQXSD\ODúDELOHFHN
L\LDOWHUQDWLIOHUROGX÷XQXGúQ\RUX]
Anahtar Kelimeler: <R÷XQEDNÕPPRUWDOLWHVL<R÷XQEDNÕPQLWHVL
167
P-70
7h5.ø<(C'(.2521(5$RTER BAYPASS &(55$+ø6ø6,5$6,1'$%g/*(6(/
6(5(%5$/2.6ø-(16$7h5$6<2187$.ø%ø1ø1*(5øg'(0(%h7d(6ø1(
327$16ø<(/(7.ø6ø
Guvenc Kockaya2NDQ$NÕQ0DU\(UVORQ6FRWW.HOO\6XOWDQ2]FDQ
Covidien
$0$d .DUGL\RYDVNOHUKDVWDOÕNODUÕQEDNÕPÕVD÷OÕNVLVWHPOHULLoLQ |QHPOLELUNRQXGXU.RURQHU
DUWHU.$ KDVWDOÕ÷ÕQÕQ WHGDYLVLQGH NRURQHU DUWHU ED\SDVV JUHIW FHUUDKLVL.%*&
X\JXODQPDNWDGÕU 2SHUDV\RQ VRQUDVÕ PDOL\HWOHUGH \R÷XQ EDNÕP<% YH DNXW LQPH$ø |QHPOL
ELU\HUWXWPDNWDGÕU7UNL\H¶GH<%YH$ø6RV\DO*YHQOLN.XUXPX6*.¶QÕQ.%*&CLQHDLWSDNHW
|GHPHVLQH LODYH |GHPH DOPDNWDGÕU .%*& VÕUDVÕQGD E|OJHVHO VHUHEUDO RNVLMHQ
VDWXUDV\RQXU62WDNLELQLQHIHNWLINXOODQÕPÕ<%CGDNDOÕúVUHVLQLJQGHQJQH$ø
LQVLGDQVÕQÕGD¶GHQ¶HGúUPHNWHGLUdDOÕúPDQÕQDPDFÕ7UNL\H¶GH.%*&VÕUDVÕQGD
U62WDNLELQLQKDVWDJHUL|GHPHEWoHVLQHSRWDQVL\HOHWNLVLQLKHVDSODPDNYH6*.¶QÕQU62LoLQ
\DSDFD÷Õ HN |GHPHQLQ .%*& VRQUDVÕQG$ <% YH $ø LoLQ \DSWÕ÷Õ |GHPHOHUH SRWDQVL\HO HWNLVLQL
modellemektir.
<g17(0-*(5(d/(5 7UNL\H¶GHNL.%*&SURVHGUVD\ÕVÕQÕQ¶GHWDKPLQHQROGX÷X
(Covidien ICD- dDOÕúPDVÕ YH KHU \ÕO 8OXVDO .DOS 6D÷OÕ÷Õ 3ROLWLNDVÕ DUWWÕ÷Õ NDEXO
HGLOPLúWLU 6*.¶QÕQ SURVHGUOHULQ ¶LQL NDSVDGÕ÷Õ NDEXO HGLOPLúWLU <R÷XQ EDNÕP NDOÕú
maliyetleri 6*.¶GDQ DOÕQPÕúWÕU $NXW LQPH PDOL\HWL \D\ÕPODQPÕú YHULOHUGHQ HOGH HGLOPLúWLU
+DVWDEDúÕ U62 JHUL |GHPHVL 7/ RODUDN DOÕQPÕúWÕU &RYLGLHQ ,1926 WHN NXOODQÕPOÕN
VHQV|UOHULQLQ PDOL\HWL*HUL |GHQPH\OH ELUOLNWH .%*&CQGH U62 NXOODQÕP RUDQÕ ¶WH 20¶WH YH ¶WH LQGLUJHPH RUDQÕ LVH RODUDN NDEXO HGLOPLúWLU
BULGULAR: 0HYFXW GXUXPGD .%*&CVLQL WDNLEHQ <% YH $øCQLQ 6*. WDKPLQL PDOL\HWL YH \ÕOODUÕQGD VÕUDVÕ\OD YH PLO\RQ 7/ RODELOLU $QFDN HN |GHPH
KBGC`nde r62¶QLQ NXOODQÕPÕQÕ NROD\ODúWÕUÕUVD .%*&CQL WDNLEHQ ROXúDFDN <% YH $øCOHULQ
6*.¶\D SRWDQVL\HO PDOL\HWL GH EX \ÕOODUGD YH PLO\RQ 7/¶\H GúHELOLU
6218d/$5 .$%* VRQUDVÕ <% YH $ø PDOL\HWL ROGXNoD \NVHNWLU .%*& VÕUDVÕQGD U62¶\H HN
|GHPH <% YH $ø PDOL\HWOHULQL YH \ÕOODUÕ DUDVÕQGD WRSODPGD \DNODúÕN PLO\RQ 7/
azaltabilir.
Anahtar Kelimeler: VHUHEUDORNVLMHQPRQLW|UL]DV\RQXPDOL\HW-analizi
168
*göh6.$/3'$0$5$1(67(=ø9(<2ö81%$.,0'(51(öø
8/86$/.21*5(6ø
ø1'(.6
169
170
A
$EGONDGLU%87
$EGXOODKg='(0ø5
$EGXOPHQDS*h=(/
$GQDQ7h)(.
$KPHW%(ùø5
$KPHW(52ö/8
$KPHWù(1
$KPHW(UGDO7$6&ø
$KPHW.ø5'(0
Ahmet Onat BERMEDE
$KPHW5Õ]Dg=.$1
Ajda MUTLU
Akif YILDIRIM
$NÕQ$<'2ö$1
$OHYù$</$1
$OL$.'2ö$1
$OLdø)7dø
$OL&ø9(/(.
Ali FEDAKAR
$OL*h5%h=
Ali SARI
$OL6$5,*h/
$OL(PUHd$0&,
Ali Fuat ERDEM
$OS<(17h5
Alper KARARMAZ
$QGDo%XUWDQ'('(2ö/8
$UDVK3ø5$7
Asiye g='(0ø5
$VOÕ'(0ø5
$WDNDQ(5.,/,1d
$WLOODù(1&$1
$WLOOD6(=*ø1
$\oD7$ù781$
$\IHU$d,.*g=
$\NXW6$5,7$ù
$\OLQ,ù,.
Aynur CAMKIRAN
Ayse BAYSAL
$\úH%$<6$/
$\úH(57h5.
$\úH*Od(9ø.
$\úH=H\QHS785$1
$\úHJXOd2385&ø&(.
$\úHJOg=*g.
Aysel KURT
$\úHQXU%2=7(3(
$\úHQXU3$d
$\VX7h5.0(12ö/8
$\VXQ0,6,5/,2ö/8
$\WHQ6$5$d2ö/8
P-07, P-28
P-36
P-39, P-41, P-42, P-55
P-39, P-41, P-42
S-04, SSY-04
SSY-04
P-36, P-37, P-38, P-40, P-53, P-66, P-67
P-04
P-09
P-52
S-04
P-44
P-55
SSY-02
P-44
S-04, SSY-04
P-28
P-64
S-07
S-09, S-10
P-20, P-68
P-18
P-46
P-31, P-34
P-15
P-17, P-48, P-51
P-55
S-05, SSY-05
P-38
S-03, P-09, P-11, P-26
SSY-01, SSY-07
S-10
S-05
P-31, P-34
P-06
P-62
P-48
S-05, SSY-05
P-04
S-02, P-05
P-53, P-66, P-67
P-57, P-58
P-63
P-67
P-09, P-12, P-19, P-45
P-66, P-67
P-63
P-12, P-44
S-07
P-03
P-65
171
B
Bahar AYDINLI
%DúDU(5'ø9$1/,
Bedih BALKAN
%HUQD(5*h1
%LOJH%DQX7$ù'(0ø5
Binnur SARIHASAN
%LU]DW(PUH*g/%2<8
%RUD$<.$d
%X÷UD+$50$1'$5
%X÷UD6(=(1
%OHQW6$<
%OHQW<$0$.
Burhan MEYDAN
%úUD7(=&$1
P-09, P-19, P-26, P-27, P-45
P-36, P-37, P-38, P-40, P-66
P-25
P-32, P-33
P-43
P-24
S-09, S-10
P-06
SSY-03
P-22
P-18
P-12, P-33
S-02, P-02, P-03, P-04
P-10, P-11
C
dD÷DWD\7(=(/
dD÷ODg=%$.,ùAKKURT
Cahide KOZAN
&DQDQ*h/(5
&DQDQh1/h
Celalettin KARATEPE
Cem ALHAN
&HP$5,7h5.
&HPDO$VÕP.87/8
&HQJL]d(9ø.
&HQJL]ù$+872ö/8
&HQJL]8*øù
dL÷GHP'(1.(5
dL÷GHP<,/',5,0*hd/h
&RúNXQ$5$=
P-02, P-03
P-20
P-30
S-07
P-46
P-68
S-08, SSY-06, SSY-08, P-23
S-08, SSY-06, SSY-08, P-23
P-49
SSY-02
P-56, P-57, P-58, P-60, P-61
P-62
P-52
P-52
SSY-05
D
Demet ALTUN
Deniz AVAN
Deniz KARAKAYA
'HU\Dg='(120$<*(1d
Dilek KAZANCI
Dilek KOCA
'LOHN.87$1ø6
'R÷Xú$ö'$1/,
P-46
S-07, P-49
P-24
P-69
P-12, P-19 P-33, P-35, P-45,
P-50
S-04, SSY-04, P-64
P-14
E
Ebru KELSAKA
Ece ALTINAY
Eda AKSOY
Ekrem YILMAZ
Elif BOMBACI
P-24
S-07, P-49
P-52
S-07
P-63
172
(OLId23852ö/8
(OLI'2ö$1%$.,
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Engin (57h5.
Engin KIVRAK
(QJLQ8ö85
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Erdem DUMAN
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(UNDQ&h5(
Erman PEKTOK
Esin ERKEK
(VLQg=7h5.%$ù
(VOHPø1&(
Esra AYBAL
(úUHI+DVDQ.$5$%8/87
(\S0XUDWg.7(1
S-02, P-05
P-08
P-07, P-28
S-04, SSY-04, P-64
P-63
P-65
P-39, P-41, P-42, P-55
P-03
P-64
P-66
P-53, P-67
P-65
S-08, SSY-06, SSY-08
P-61
P-19
P-55
S-08, SSY-06, SSY-08, P-23
SSY-08, P-23
F
Fahri ADALI
)DUXN6(5+$7/,2ö/8
Fatma ERASLAN
)DWPD8.ø/
)DWPD=HNL\H$ù.$5
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Fevzi TORAMAN
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P-08
P-47, P-50
P-45
SSY-03
P-56, P-57, P-58, P-60, P-61
P-21
P-22
S-08, SSY-06, SSY-08, P-23
P-41
P-34
SSY-03
S-07, SSY-07
G
Gamze SARKILAR
*|NDOS$/781
*|NoH6(/d8.
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P-18
S-04, SSY-04, P-64
P-35, P-44
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P-32, P-35
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P-14
SSY-06
P-25
P-21
S-10
S-03
P-25
P-27
P-70
173
H
H. Cemal KAHRAMAN
+DFHU$\úHQ<$958
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Hanife KARAKAYA KABUKCU
Hanife UZEL
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P-47
P-46
P-41
P-36
P-16
SSY-01, SSY-07, P-49
P-25
P-08
P-13, P-30
P-08
P-18
S-10
P-24
P-36
P-29
P-29
I-ø
øEUDKLP8ö85
øKVDQ$<,.
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P-35
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174
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P-64
P-21
P-70
P-67
P-66
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S-07
P-39, P-42
P-55
P-41
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P-64
SSY-05
SSY-08
P-20, P-68
P-49
P-65
P-43
P-19
P-59
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P-16
S-09, S-10
P-25
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S-08, SSY-06
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S-07
P-08
P-08
P-29
P-03
P-54
P-52
P-52
P-17, P-48, P-51
N
1DFL(0ø52ö8//$5,
1DJHKDQ*|]GH$7(ù
Nagihan KARAHAN
P-50
P-63
S-09, S-10
175
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1LOJQ.$9587g=7h5.
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P-08
S-06
P-10, P-11
P-65
P-65
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Onur KOYUNCU
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S-07
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P-07, P-28
P-41
S-02, P-04
P-25
P-30
P-14
S-03, P-10, P-11
P-21
P-60
P-28
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P-55
P-56, P-57, P-58, P-60, P-61
P-68
SSY-02, P-20
P-12, P-19, P-32, P-33, P-35, P-45
S-09, S-10
P-69
P-31, P-34
P-08
P-18
P-63
P-12, P-32, P-33, P-35
P-52
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P-23
P-37, P-40
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P-65
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P-10, P-11
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P-70
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P-09
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Volkan KURU
9RONDQ<h.6(/
S-09, S-10
S-02
Y
Yakup TOMAK
P-31, P-34
Yasemin SAVCI
P-09, P-10
Yasemin YAVUZ
SSY-07
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P-53
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Zeliha TUNCEL
Zerrin BEYKAL
Zerrin PULATHAN
=H\QHS3(67ø/&ø
Zeynep TOSUN
Zeynep Baysal YILDIRIM
Ziyaattin KARAKUZU
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P-65
P-25
P-46
P-53
S-08, SSY-06, SSY-08
P-21
SSY-03
S-07
P-64
P-56, P-57, P-58, P-60, P-61
P-47, P-50
P-39, P-42, P-55
P-69
P-29
SSY-03, P-54
178
NOT
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
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͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
179
NOT
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
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͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
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͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
180
NOT
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
181
NOT
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
182
NOT
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
183
NOT
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
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͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
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͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
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͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙.͙͙͙͙͙͙͙͙͙
184
1990

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