Massif Hemeoptizilerde Göğüs Cerrarhi Yaklaşımı ve Acil Servis Yönetimi
Özet
Massif hemoptizi, kısa süre içinde yaşamı tehdit eden miktarda kanama ile karakterize, acil ve multidisipliner yaklaşım gerektiren ciddi bir klinik tablodur. Güncel klinik pratikte kanamanın mutlak hacminden ziyade, hava yolu güvenliğini bozma potansiyeli, oksijenlenme üzerine etkileri ve hemodinamik sonuçları ön planda değerlendirilmektedir. En sık etiyolojik nedenler arasında bronşiektazi, akciğer tüberkülozu, akciğer maligniteleri, aspergillom ve pulmoner vasküler patolojiler yer almaktadır. Massif hemoptizi olgularında mortalite oranları yüksek olup, erken tanı ve hızlı müdahale prognozu belirgin şekilde iyileştirmektedir. Acil serviste ilk yaklaşımın temelini hava yolunun güvence altına alınması, yeterli oksijenasyonun sağlanması ve hemodinamik stabilizasyon oluşturur. Tanısal süreçte laboratuvar incelemeleri, akciğer grafisi, toraks bilgisayarlı tomografi ve BT anjiyografi önemli rol oynarken, bronkoskopi hem tanısal hem de terapötik açıdan kritik bir yöntemdir. Günümüzde bronkoskopik lokal hemostatik girişimler ve bronşiyal arter embolizasyonu, masif hemoptizi tedavisinde cerrahiye kıyasla daha düşük morbidite ve mortalite oranları ile etkili seçenekler sunmaktadır. Cerrahi tedavi ise genellikle diğer tedavi yöntemleriyle kontrol altına alınamayan, lokalize ve rezektabl olgularda son basamak olarak uygulanmaktadır. Sonuç olarak, masif hemoptizi yönetiminde hızlı, planlı ve multidisipliner yaklaşım esastır. Acil servis, göğüs cerrahisi, girişimsel radyoloji, anestezi ve yoğun bakım ekipleri arasındaki etkin koordinasyon, mortalite ve komplikasyon oranlarını azaltarak hasta prognozunu anlamlı ölçüde iyileştirmektedir.
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