Posttravmatik Sepsis
Özet
Travma ve sepsis, 21. yüzyılın dikkati çeken önemli bir konusudur. Sepsis fizyopatolojisinde 2 önemli unsur görülmektedir. Birinci nokta ortaya çıkan inflamatuar yanıt ile koagülasyon sisteminin aktivasyonu iken ikinci önemli nokta yaşanan her travmanın farklı immünolojik cevabının olmasıdır. Travma hastalarında immün cevapta posttravmatik inflamasyon-immunsupresyon-infeksiyon- inflamasyon-immunsupresyon şeklinde bir kısır döngü görülmektedir. Travma hastasının hangi klinik fazda olduğuna dair klinisyeni zorlayabilecek bir durum olarak karşımıza çıkarak, mortaliteyi etkileyebilmektedir. Travma hastalarının ölüm nedeni olarak sepsis, acil yönetilmesi gereken bir tabloya yol açmaktadır. Sonuçta çoklu organ yetmezliği görülebilmektedir. Sepsis yönetiminde erken ve hızlı tanı acil serviste değerlidir. Tanı için pro-antiinflamatuar serum belirteçleri ve akut faz proteinlerinde değişiklikler saptanmış olsa bile bir bütün olarak değerlendirme yapılmalıdır. Posttravmatik sepsis yönetiminde, "erken hedefe yönelik tedavi" amaçlanmalıdır. Septik odağın eliminasyonu, antimikrobiyal tedavi ve destek tedavisi yapılmalıdır. Sonuç olarak posttravmatik sepsis, acil servisten başlayarak yoğun bakımda dahil yüksek morbidite ve mortaliteye sahiptir.
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