عنوان

EVALUATION OF HYDRATION STATUS AND ELECTROLYTE IMBALANCE IN CHILDREN WITH ACUTE APPENDICITIS ADMITTED TO CHILDREN MEDICAL CENTRE HOSPITAL ” TEHRAN DURING THE YEAR 2021-2022, Iranian year 1399,بررسی وضعیت هیدراتاسیون و عدم تعادل الکترولیت در کودکان مبتلا به آپاندیسیت حاد بستری در مرکز طبی کودکان۱۳۹۹

شماره

99002P

زبان متن نوشتاري يا گفتاري و مانند آن

انگلیسی

عنوان اصلي

EVALUATION OF HYDRATION STATUS AND ELECTROLYTE IMBALANCE IN CHILDREN WITH ACUTE APPENDICITIS ADMITTED TO CHILDREN MEDICAL CENTRE HOSPITAL ” TEHRAN DURING THE YEAR 2021-2022, Iranian year 1399

عنوان اصلي

بررسی وضعیت هیدراتاسیون و عدم تعادل الکترولیت در کودکان مبتلا به آپاندیسیت حاد بستری در مرکز طبی کودکان۱۳۹۹

نام عام مواد

[Dissertation]

نام نخستين پديدآور

Bashee Ashraf

نام نخستين پديدآور

اشرف باشی

نام ناشر، پخش کننده و غيره

Tehran University of Medical Sciences, Medicine school

تاریخ نشرو بخش و غیره

1401

نام خاص و کميت اثر

53p

جزئيات پايان نامه و نوع درجه آن

Doctor Of Medicine(MD)

زمان اعطا مدرک

2023/03/07

امتياز متن

18

متن يادداشت

Appendicitis is caused either by obstruction of the appendicular lumen by a faecolith or lymphoid hyperplasia from primary (bacterial or viral) infection of the appendix. Acute appendicitis is one of the most common causes of acute abdomen in children. We sought to determine the pattern of presentation of acute appendicitis, and the presence of electrolytic disturbance and hydration status in children in Children's Medical Centre Tehran. While research activities in the subject appendicitis grow constantly, yet there is no study that completely explains electrolytic imbalance and hydration state pre and post-surgery altogether. This study aims to evaluate appendicitis cases in terms of hydration status, electrolytic disturbance, clinical signs as a response to body's hydration status, complications, and assessing certain parameters like bun and creatinine levels to understand the severity or progress/ course of the disease in CMC Tehran. Method: His cross-sectional retrospective study will include the medical records of all the appendicitis cases that have been admitted to cmc, tehran from 2021 to 2022. The study will be performed after gaining the code of ethics committee of tums. Patients’ information such as age, symptoms of dehydration, need for prolonged post-operative intervention etc. Will be documented. Medical records of patients will be archived so that these can be reviewed in future. All ethical considerations will be observed in this study. Results: In this study, the information of 63 patients was considered. The data comes from medical records in CMC, Tehran. In this study we considered the patient's system and file records. There were 63 patients for the study research, out of which 41 equal to 65% are males and 22 equal to 35% are females. We took 11 variables to record the data of patients from medical records including system files and reports in CMC, TehranOut of 10 variables, 3 were used to assess the dehydration status of the patients alongside the symptoms mentioned in the history of the patient's records, which includes:Bun/creatinine ratio (based on the results in table 4.5, the bun to creatinine ratio of the patients was between 5.71 to 38 with a mean of 19.25), metabolic acidosis, urea level and symptoms like sunken eyes, decreased urine output, vomiting, diarrhea etc., on basis of which we classified our patients as not dehydrated, mildly, moderately and severely dehydrated.Other 6 variables included 1) gender, in which males were the ones affected more by a percentage of 65%2) Age, with which there was no significant result of onset. Every age group was recorded from 3 to 14. 3) level of sodium before surgery, which was assessed as a measure of electrolytic imbalance under the evaluation of value between 135-145 with which 13 out of 63 patients presented with sodium level below 135 making it a 20.63% and no patient with sodium level above 145(0%) the total average amount of sodium in the non-hydrated level was 136.68, the slightly hydrated level was 136.11, and the moderately hydrated level was 137.10, which somehow shows that they are not much different from each other. 4) iv volume used before surgery/operation, in which iv volume in cc and type in normal saline was recorded and was all under "Maintenance normal saline" For all states of dehydration, no up to severe5) type of appendicitis: It was divided into "Simple" And complicated", the latter had subdivision under: Gangrenous, perforated, necrotizing, with lymphocytic infiltration etc. It was also taken into consideration for having dependency on dehydration level. Out of 63 patients, 57 of the admitted patients (about 90%) had simple appendicitis and the remaining 6 (10%) had complicated appendicitis some of those who had simple appendicitis were mildly dehydrated, or there was no person among the admitted patients who had both complicated appendicitis and severe dehydration.Conclusion: We observed significant difference in type of gender affected with appendicitis: Out of 63 admitted patients, 41 equal to 65% are male and 22 equal to 35% are female. There is no person admitted and whose gender is unknown in this research, concluding males are affected moreBased on the analysis, 57 of the admitted patients (about 90%) have simple appendicitis and the remaining 6 (10%) have complicated appendicitis, concluding simple appendicitis is the more prevailed one.Out of 63 admitted patients, 22 people are equal to 35% in the not dehydrated level, 19 people are equal to 30% in mild dehydrated level, 21 people are equal to 33% in moderate level and one person is equal to 2% in severe level, the highest frequency is related to people with not dehydrated status with a frequency of 22 people; after that, the moderate level is the most frequent with 21 people, and the severe level is the least frequent with one person. Concluding with appendicitis are typically at least mildly dehydrated and should receive supportive care prior to surgery,It is determined at any level of dehydration each type of appendicitis is located; for example, 18 of those who had simple appendicitis are mildly dehydrated, or there is no person among the admitted patients who has both complicated appendicitis and severe dehydration, concluding that there is no significant relationship between dehydration level and type of appendicitis. Regarding the effect of the dehydration variable on the amount of sodium before surgery, based on the value of the f test (f=1.179, sig=0.315), we see no significant difference in the amount of sodium with different levels of dehydration. That is, patients with different levels of dehydration do not have different levels of sodium.On the basis of the table 4.6, 48 patients (78.7%) had electrolytic balance and 21.3% had electrolytic imbalance There’s no patient with a record of sodium level higher than 145, hypernatremia among patients of simple appendicitis which are 57, (90 %)in number and for 2 patients, data was missing for sodium level, so among 55 simple appendicitis patient’s, 12 had sodium level less than 135, rest 43 had normal sodium level between 135-145 Among patients of complicated appendicitis, which are 6 (10%) in number, only 1 had sodium level less than 135 and no patient with sodium level more than 145, remaining 5 patients had a normal level between 135-145. Based on the chi square test, table 4.9, 4 patients (6.6%) among non-dehydrated patients had electrolytic imbalance. On contrary, 18 patients (6.6%) non dehydrated patients had no electrolytic imbalance. Similarly, 18 patients (29.5%) non dehydrated patients had electrolytic imbalance. 15 patients (24.6%) with mild dehydration had no electrolytic imbalance. Descriptively, with increase in dehydration, electrolytic imbalance increased and vice versa. But on the basis of chi square test results, there was no significant relation between electrolytic imbalance and hydration status in patients ( p> 0.05)All of this study was to assess the dehydration state and electrolytic imbalance in the children having appendectomy done, also to know if gender, age or sodium level or appendicitis type and how what type and amount of iv infusion was used to correct the abnormal hydration status of the patient considering different variables.

متن يادداشت

آپاندیسیت یا در اثر انسداد مجرای آپاندیکول توسط فکولیت یا هیپرپلازی لنفوئیدی ناشی از عفونت اولیه (باکتریایی یا ویروسی) آپاندیس ایجاد می شود. علائم و نشانه های بالینی آن عبارتند از درد پری ران، درد متاستاتیک سمت راست شکم، درد برگشتی، استفراغ، اسهال، تب و افزایش شمارش خون.هر چه کودک کوچکتر باشد، علائم غیر معمول تر، تشخیص دشوارتر و میزان سوراخ شدن بیشتر می شود. آپاندیسیت حاد یکی از شایع ترین علل شکم حاد در کودکان است. مداخله جراحی دیرهنگام اغلب با افزایش عوارض و گاهی اوقات نتیجه کشنده همراه است. ما به دنبال تعیین الگوی تظاهر آپاندیسیت حاد و تاثیر دیر مراجعه بر نتیجه جراحی و اختلالات الکترولیتی و وضعیت هیدراتاسیون کودکان در مرکز طبی کودکان تهران بودیم.در حالی که فعالیت های تحقیقاتی در موضوع آپاندیسیت به طور مداوم رشد می کند، هنوز مطالعه ای وجود ندارد که به طور کامل عدم تعادل الکترولیتی و وضعیت هیدراتاسیون را قبل از جراحی توضیح دهد. این مطالعه با هدف ارزیابی موارد آپاندیسیت از نظر وضعیت هیدراتاسیون، اختلال الکترولیتی، علائم بالینی به عنوان پاسخ به وضعیت هیدراتاسیون بدن، عوارض، و ارزیابی پارامترهای خاصی مانند سطوح bun و کراتینین برای درک شدت یا پیشرفت / سیر بیماری در مرکز طبی کودکان ٬ تهران انجام شد.نتیجه گیری : نتیجه گیری آپاندیسیت ساده شایع تر از نوع پیچیده است مبتلایان به آپاندیسیت معمولاً حداقل به طور خفیف کم آب هستند و باید قبل از جراحی تحت مراقبت های حمایتی قرار گیرند.بین سطح کم آبی بدن و نوع آپاندیسیت رابطه معنی داری وجود ندارد.هیچ بیماری با سابقه سطح سدیم بالاتر از 145 وجود ندارد، هیپرناترمی در میان بیماران مبتلا به آپاندیسیت ساده که تعداد آنها 57 نفر (90 درصد) است و برای 2 بیمار، اطلاعات مربوط به سطح سدیم وجود ندارد، بنابراین از بین 55 بیمار آپاندیسیت ساده، 12 نفر سطح سدیم کمتر از 135 داشتند، بقیه 43 نفر سطح سدیم طبیعی بین 135-145 داشتند. با افزایش کم آبی، عدم تعادل الکترولیتی افزایش یافت و بالعکس. اما بر اساس نتایج آزمون کای دو، ارتباط معنی داری بین عدم تعادل الکترولیتی و وضعیت هیدراتاسیون در بیماران وجود نداشت p> 0.05یافته ها: برای کودکانی که تحت عمل آپاندکتومی قرار می گیرند، باید هیدراتاسیون داخل وریدی ارائه شود. هر گونه ناهنجاری الکترولیتی شناسایی شده باید قبل از جراحی اصلاح شود. آبرسانی مجدد را می توان با دادن 20 میلی لیتر/کیلوگرم بولوس کریستالوئید ایزوتونیک تا زمانی که بیمار تخلیه شود، انجام داد. هنگامی که اوولمی ایجاد شد، کودک باید مایع IV 1-1.5 نگهدارنده دریافت کند. تلفات اضافی مایع باید جایگزین شود. کنترل درد و تب مهم است

موضوع مستند نشده

اختلالات الکترولیتی

موضوع مستند نشده

وضعیت هیدراتاسیون

موضوع مستند نشده

آپاندیسیت حاد

موضوع مستند نشده

Acute appendicitis

موضوع مستند نشده

Hydration status

موضوع مستند نشده

Electrolyte Imbalance

موضوع مستند نشده

IV volume

کد نقش

, Author

کد نقش

, Author

مستند نام اشخاص تاييد نشده

Ashraf, Bashee

مستند نام اشخاص تاييد نشده

اشرف، باشی

کد نقش

, Thesis advisor

کد نقش

, Thesis advisor

کد نقش

, Consulting advisor

کد نقش

, Consulting advisor

کد نقش

, Consulting advisor

کد نقش

, Consulting advisor

کد نقش

, Consulting advisor

کد نقش

, Consulting advisor

کد نقش

, Consulting advisor

کد نقش

, Consulting advisor

مستند نام اشخاص تاييد نشده

soti khayabani, Mahsa

مستند نام اشخاص تاييد نشده

صوتی خیابانی، مهسا

مستند نام اشخاص تاييد نشده

alimadadi, Hosseini

مستند نام اشخاص تاييد نشده

علی مددی، حسین

مستند نام اشخاص تاييد نشده

ashjaei, Bahar

مستند نام اشخاص تاييد نشده

اشجعی، بهار

مستند نام اشخاص تاييد نشده

asgarian, Fahimeh

مستند نام اشخاص تاييد نشده

عسگریان، فهیمه

مستند نام اشخاص تاييد نشده

mohammadi, Mahya

مستند نام اشخاص تاييد نشده

محمدی، مهیا

کشور

ایران

تاريخ عمليات

20230424

شماره بازیابی

26076Pardis

نام الکترونيکي

فرمت انتشار

p

نوع ماده

TL

کد کاربرگه

276903

سطح دسترسي

a

تكميل شده

Y