Yaşlı Yanıklarının Önemi

Dr. Öğr. Üyesi Mehmet Özyıldız1
Doç. Dr. Ali Emre Akgün2

1SBÜ Hamidiye Tıp Fakültesi, Genel Cerrahi ABD, İstanbul, Türkiye Kocaeli Şehir Hastanesi, Yanık Bakım ve Yara Merkezi, Kocaeli, Türkiye
2Bilkent Şehir Hastanesi, Genel Cerrahi Kliniği, Ankara, Türkiye

ÖZET

Uzun süredir ülkemiz nüfusunda yaşlı oranı artmaktadır. Sınırlı hareket kabiliyeti, görme ve işitme bozuklukları ve yavaşlamış refleksler, yaşlı insanları yanıklara ve yanıkla ilişkili yaralanmalara daha yatkın hale getirir. Ülkemizde yapılan bir çalışmada hospitalize erişkin yanıklarının % 12.6’sının yaşlı olduğu ve daha düşük yanık yüzdesine rağmen yüksek mortaliteye sahip olduğu, haşlanma yanıklarının ilk sırada olduğu, özellikle ev yangını sırasında olan alev yanıklarının ve temas yanıklarının sırasıyla takip ettiği belirtilmiştir. Yaşlı yanık hastalarının genel yönetimi, genç hastalarla aynı stratejileri izler; ancak, fizyolojik farklılıkları yönetim zorlukları getirir. Yaşlı hastaların tekrar tekrar birden fazla, erken cerrahi prosedürü tolere edebildiği gösterilmiştir ve erken yara ka- patma bu hastalarda daha iyi bir sonuca karşılık gelir. Daha genç hastalarla karşılaştırıldığında, hipovolemiden kaçınmak için aynı yanık boyutuna sahip yaşlı hastaları resüsite etmek için daha fazla sıvı gerekir. Gecikmiş yara iyileşmesi ve düşük greft sağkalımı yaşlı yanık hastalarında önemli sorunlardır. Ağrı değerlendirmesi yapılarak, kabul sırasında mevcut olabilecek herhangi bir komorbid durumu da hesaba katması gereken kişiselleştirilmiş bir analjezi planı oluşturmak esastır. Yaşlı hastalar genç hastalarda görülen hipermetabolizma derecesini oluş- turmasa da, katabolik yanıt benzerdir ve günde 1,5 ila 2 g/kg protein alımını gerektirir. Hipermetabolizmayı modüle etmek için kullanılan farmakolojik ajanlar fayda sağlayabilir. Yaşlı yetişkinler, iyileşmesi zor olan daha fazla işlev veya güç kaybını önlemek için rehabilitasyon sırasında agresif bir şekilde yönetilmelidir.

Anahtar Kelimeler: Yanık; Geriatri; Debridman; İleri yaş

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