| Abstract | Cilj istraživanja: Cilj je ovog istraživanja utvrditi korelaciju između trajanja resorpcije pneumotoraksa ovisno o dinamici kretanja vrijednosti parametara sistemskog upalnog odgovora (CRP-a i leukocita iz krvi). Drugi cilj je praćenje promjenu vrijednosti leukocita u krvi ispitanika, kao i praćenje promjene vrijednosti CRP-a unutar šest dana od prijema ovisno o metodi liječenja pneumotoraksa.
Ispitanici i metode: Ispitanici su svi bolesnici liječeni zbog pneumotoraksa na Klinici za kirurgiju u razdoblju od 1.siječnja 2015. do 31. prosinca 2017. godine. Ispitanicima su analizirani slijedeći parametri: spol, leukociti po prijemu, 24 sata i 2 - 6 dana nakon prijema, CRP po prijemu, 24 sata i 2 - 6 dana nakon prijema, vrsta pneumotoraksa, recidiv pneumotoraksa, način liječenja, trajanje drenaže te trajanje hospitalizacije.
Rezultati: Od 2015. do 2017. godine na Klinici za kirurgiju KBC-a Split liječeno je 170 bolesnika hospitaliziranih zbog pneumotoraksa (18% žena i 82% muškarca). Kumulativna incidencija pneumotoraksa za trogodišnje razdoblje od 2015. do 2017. godine iznosi 5,7 na 10 000 stanovnika Splitsko-dalmatinske županije (95% CI: 5,62-5,78). Za 1,6 puta je veći udio bolesnika koji su hospitalizirani zbog spontanog u odnosu na traumatski pneumotoraks. Od ukupnog broja bolesnika 23,5% je liječeno konzervativnim metodama, 65,9% drenažom i 10,6% operacijom. Postoji statistički značajna razlika vrijednosti CRP-a mjerenih u intervalu od drugog do šestog dana od prijema u bolnicu u odnosu na način liječenja (χ2=6,6 P=0,037). Medijan CRP-a 2 -6 dana od prijema u skupini operiranih za 53 mg/L je manji u odnosu na skupinu konzervativno liječenih bolesnike (P=0,033). U skupini bolesnika sa spontanim nerecidivirajućim pneumotoraksom, broj ispitanika koji su liječeni drenažom za 1,9 puta (66:35) je veći od onih liječenih konzervativnim pristupom (χ2=23; P<0,001). U istoj skupini smo dokazali statistički značajnu negativnu povezanost trajanja drenaže s vrijednostima leukocita 24 sata od prijema (rho=-0,406; P=0,036). U skupini bolesnika s nerecidivirajućim spontanim pneumotoraksom izdvojili smo dvije podskupine bolesnika (˝loši˝i ˝dobri reaktori˝) na temelju vrijednosti CRP-a (CRP < 25 mg/L u ˝loših˝; CRP> 50 mg/L u ˝dobrih˝) te utvrdili da je medijan duljine trajanja drenaže u skupini ˝dobrih reaktora˝ za 3 dana je manji nego u skupini ˝loših reaktora˝ (Z=2,7; P=0,008).
Zaključci: Mjerenjem dinamike promjene CRP-a u krvi dreniranih bolesnika možemo predvidjeti brzinu rezolucije pneumotoraksa. |
| Abstract (english) | Objectives: The aim of this study was to evaluate the correlation between the pneumothorax resorption duration and the dynamic of inflammatory response parameters (CRP and leukocytes). Additionally, we monitored the changes in leukocyte and CRP values in the blood of subjects during the period from admission to the 6th day depending on the method of pneumothorax treatment.
Patients and methods: All subjects included in the study were treated for pneumothorax at the Department of Surgery in the period from 1st January 2015 to 31st December 2017. The subjects were analysed according to the following parameters: gender, leukocytes upon addmision, 24 hours and 2 - 6 days after admission, CRP upon admission, 24 hours and 2 - 6 days after admission, type of pneumothorax, pneumothorax recurrence, treatment, drainage duration and hospitalization.
Results: From 2015 to 2017, 170 patients were hospitalized at University Hospital of Split (Department of Surgery) due to pneumothorax (18% were women and 82% were men). The cumulative incidence of pneumothorax for the three-year period from 2015 to 2017 amounted to 5.7 per 10 000 inhabitants of the Split-Dalmatia County (95% CI: 5.62-5.78). The proportion of patients hospitalized due to spontaneous pneumothorax was 1.6 times higher in comparison to the patients hospitalized due to traumatic pneumothorax. Out of the total number of patients, 23.5% was treated with conservative methods, 65.9% with drainage and 10.6% with surgery. There is a statistically significant difference between the CRP value 2-6 days after hospital admissions in relation to the treatment (χ2 = 6.6; P = 0.037). Median CRP 2-6 days after admission in the operated group was 53 mg/L lower in comparison to the group of conservatively treated patients (P = 0.033). In the group of patients with spontaneous non-relapse pneumothorax, the number of subjects treated with drainage was 1,9 times higher (66:35) than the number of those treated with the conservative approach (χ2 = 23; P <0.001). In the same group, we showed a statistically significant negative correlation of drainage duration and leukocyte values in 24 hours from reception (rho = -0.406; P = 0.036). In the group of patients with non-relapse spontaneous pneumothorax, we distinguished two subgroups of patients ("CRP <25 mg / L in ˝bad" CRP> 50 mg / L in "good" ) and found that the median duration of drainage in the "good reactor" group for 3 days was lower than in the group of "bad reactors" (Z = 2.7; P = 0.008).
Conclusion: By measuring dynamics of CRP change in the blood patients treated with drainage, we can predict the speed of the pneumothorax resolution. |
