{"id":618,"date":"2019-08-05T15:37:14","date_gmt":"2019-08-05T12:37:14","guid":{"rendered":"http:\/\/dijimos.com\/bergamaasm1\/?p=618"},"modified":"2019-08-05T15:38:20","modified_gmt":"2019-08-05T12:38:20","slug":"kan-basincinin-olcumu","status":"publish","type":"post","link":"https:\/\/bergama11noluasm.gov.tr\/?p=618","title":{"rendered":"Kan Bas\u0131nc\u0131n\u0131n \u00d6l\u00e7\u00fcm\u00fc ve Klinik De\u011ferlendirme"},"content":{"rendered":"

Kan Bas\u0131nc\u0131n\u0131n \u00d6l\u00e7\u00fcm\u00fc ve Klinik De\u011ferlendirme<\/strong><\/em><\/h1>\n

a) Kan bas\u0131nc\u0131n\u0131n \u00f6l\u00e7\u00fclmesi<\/strong><\/em><\/u><\/h2>\n

Kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm y\u00f6ntemleri<\/strong><\/h3>\n

Hipertansiyonun tedavi edilebilmesi \u00f6ncelikle tan\u0131n\u0131n do\u011fru olarak konmas\u0131 ile m\u00fcmk\u00fcnd\u00fcr. Bu ama\u00e7la, kan bas\u0131nc\u0131n\u0131 saptamak i\u00e7in gerekli donan\u0131m ve \u00e7evre ko\u015fullar\u0131n\u0131n sa\u011flanmas\u0131 ve do\u011fru bir teknik ile \u00f6l\u00e7\u00fcm yap\u0131lmas\u0131 gerekmektedir. Ayr\u0131ca kan bas\u0131nc\u0131ndaki ciddi de\u011fi\u015fkenlikten dolay\u0131 \u00f6l\u00e7\u00fcmlerin tekrarlanmas\u0131, ba\u015flang\u0131\u00e7ta saptanan y\u00fcksek de\u011ferlerin devam edip etmedi\u011fini veya normale d\u00f6nerek yaln\u0131zca periyodik kontrollere mi ihtiya\u00e7 do\u011furdu\u011funu \u00f6\u011frenmemizi sa\u011flayacakt\u0131r.<\/p>\n

Kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fcnde kullan\u0131lan donan\u0131m<\/strong><\/h3>\n

Kan bas\u0131nc\u0131n\u0131 belirlemede alt\u0131n standart arter i\u00e7ine bir kateter konularak<\/p>\n

rekt y\u00f6ntemlerle, standart kriterlere uygun oldu\u011fu bilinen tansiyon aletleri (sfigmomanometre) kullan\u0131larak \u00f6l\u00e7\u00fclmelidir. \u00dc\u00e7 tip manometre kullan\u0131lmaktad\u0131r: c\u0131val\u0131, aneroid ve elektronik. \u00d6l\u00e7\u00fcmler tercihen c\u0131val\u0131 sfigmomanometre ile yap\u0131lmal\u0131d\u0131r. Bu tip manometrelerde rezervuar dolu, c\u0131va s\u00fctunu g\u00f6z seviyesinde olmal\u0131, bas\u0131n\u00e7 uygulanmad\u0131\u011f\u0131 s\u0131rada c\u0131va d\u00fczeyi mmHg olarak okunmal\u0131 ve bas\u0131n\u00e7 uygulan\u0131rken s\u00fctun oynamamal\u0131d\u0131r. C\u0131val\u0131 manometreler d\u0131\u015f\u0131nda kalibre edilmi\u015f bir aneroid manometre veya osillometrik \u00f6l\u00e7\u00fcm yapan elektronik bir tansiyon aleti kullan\u0131labilir. Bu cihazlar\u0131n kalibrasyonu en az alt\u0131 ayda bir c\u0131val\u0131 manometrelerle kar\u015f\u0131la\u015ft\u0131r\u0131larak kontrol edilmelidir. Vol\u00fcm-klamp pletismografi y\u00f6ntemiyle parmaktan \u00f6l\u00e7\u00fcm yapan cihazlar g\u00fcvenilir sonu\u00e7lar vermedikleri i\u00e7in kullan\u0131lmamal\u0131d\u0131r (28).<\/p>\n

Do\u011fru sonu\u00e7 al\u0131nabilmesi i\u00e7in tansiyon aleti man\u015fonunun boyutlar\u0131 hastaya uygun olmal\u0131 ve man\u015fon i\u00e7erisindeki \u015fi\u015fen kese b\u00f6l\u00fcm\u00fc kol \u00e7evresinin en az %80\u2019ini sarmal\u0131d\u0131r. Man\u015fonun geni\u015fli\u011fi ise kol uzunlu\u011funun \u00fc\u00e7te ikisi kadar olmal\u0131d\u0131r. Normal eri\u015fkinlerde kullan\u0131lan tansiyon aletlerinde man\u015fonun kesesi 12 cm eninde ve 35 cm boyunda olmal\u0131d\u0131r. Obezlerde ve kol yap\u0131s\u0131 kasl\u0131 ki\u015filerde kese geni\u015fli\u011fi 20 cm, uzunlu\u011fu 40 cm civar\u0131nda olmal\u0131d\u0131r. Kanada Hipertansiyon Birli\u011fi\u2019nin bu konudaki \u00f6nerisi \u015f\u00f6yledir (29)<\/p>\n\n\n\n\n\n\n
Eri\u015fkin kol \u00e7evresi<\/u><\/td>\nKese boyutlar\u0131<\/u><\/td>\n<\/tr>\n
< 33 cm<\/td>\n12 x 23 cm<\/td>\n<\/tr>\n
33-41 cm<\/td>\n15 x 33 cm<\/td>\n<\/tr>\n
> 41 cm<\/td>\n18 x 36 cm<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Kan bas\u0131nc\u0131n\u0131n hekim taraf\u0131ndan \u00f6l\u00e7\u00fclmesi<\/strong><\/h3>\n

Gerekli alt yap\u0131 ve \u00e7evre ko\u015fullar\u0131<\/em><\/u><\/h4>\n
    \n
  • \u00d6l\u00e7\u00fcm s\u0131ras\u0131ndaki ko\u015fullar kan bas\u0131nc\u0131n\u0131 \u00f6nemli derece etkilemektedir (28). \u00d6l\u00e7\u00fcm\u00fcn g\u00fcn\u00fcn hangi saatinde yap\u0131ld\u0131\u011f\u0131 bilinmelidir. Yemeklerden ya da egzersizden sonra al\u0131nan \u00f6l\u00e7\u00fcmler normalden d\u00fc\u015f\u00fck, sigara ya da kahve i\u00e7imi sonras\u0131 \u00f6l\u00e7\u00fcmler normalden y\u00fcksek \u00e7\u0131kabilir. Dolay\u0131s\u0131yla \u00f6l\u00e7\u00fcm \u00f6ncesindeki 30 dakikal\u0131k s\u00fcre i\u00e7inde hastan\u0131n sigara, \u00e7ay veya kahve i\u00e7memi\u015f, kafein almam\u0131\u015f ve tercihen yemek yememi\u015f olmas\u0131 gerekir. Fenilefrinli nazal dekonjestanlar veya benzeri adrenerjik uyar\u0131c\u0131lar\u0131n kullan\u0131m\u0131 da hatal\u0131 \u00f6l\u00e7\u00fcmlere neden olabilirler.<\/li>\n
  • \u00d6l\u00e7\u00fcmlere, hasta sessiz bir odada en az 5 dakika istirahat ettikten sonra ba\u015flanmal\u0131d\u0131r. Oda s\u0131cakl\u0131\u011f\u0131 ne so\u011fuk ne de \u00e7ok s\u0131cak olmal\u0131d\u0131r.<\/li>\n
  • Hasta s\u0131rt\u0131n\u0131 herhangi bir yere -\u00f6rne\u011fin arkal\u0131kl\u0131 bir sandalyeye- yaslayarak oturmal\u0131, tansiyon \u00f6l\u00e7\u00fclecek kolu \u00e7\u0131plak olmal\u0131d\u0131r. \u00d6l\u00e7\u00fcm s\u0131ras\u0131nda konu\u015fmamal\u0131, bacak bacak \u00fcst\u00fcne atmamal\u0131d\u0131r. Man\u015fon kalp d\u00fczeyinde duracak \u015fekilde sar\u0131lmal\u0131 ve hastan\u0131n kolu desteklenmelidir.<\/li>\n<\/ul>\n

    Kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm tekni\u011fi<\/em><\/u><\/h4>\n
      \n
    • Tansiyon aletinin man\u015fonu alt ucu dirsek \u00e7ukurunun 2.5-3 cm \u00fczerinde olacak \u015fekilde kolu sarmal\u0131d\u0131r. \u00d6l\u00e7\u00fcm s\u0131ras\u0131nda stetoskop man\u015fonun alt\u0131na s\u0131k\u0131\u015ft\u0131r\u0131lmamal\u0131d\u0131r. Stetoskop dirsek \u00e7ukurunda serbest durmal\u0131 ve cilde hafif\u00e7e bast\u0131r\u0131lmal\u0131d\u0131r.<\/li>\n
    • \u00d6l\u00e7\u00fcm i\u00e7in man\u015fonun kesesi brakial arter \u00fczerine yerle\u015ftirilir, osk\u00fcltatuar aray\u0131 \u00f6nlemek amac\u0131yla havas\u0131 radial nabz\u0131n kayboldu\u011fu d\u00fczeyin 20-30 mmHg \u00fcst\u00fcne kadar \u015fi\u015firilir. Stetoskop brakial arter \u00fczerine yerle\u015ftirilir ve kontrol valvi a\u00e7\u0131larak saniyede 2-4 mmHg h\u0131zla indirilir. Osk\u00fcltasyon y\u00f6ntemi ile \u00f6l\u00e7\u00fcm yap\u0131ld\u0131\u011f\u0131nda man\u015fonun bas\u0131nc\u0131 azalt\u0131lmaya ba\u015flad\u0131ktan sonra sesin ilk duyuldu\u011fu anda (Korotkoff faz 1) okunan de\u011fer, sistolik bas\u0131n\u00e7t\u0131r. Sesin art\u0131k i\u015fitilmez oldu\u011fu anda okunan de\u011fer ise (Korotkoff faz 5) diyastolik kan bas\u0131nc\u0131 olarak kabul edilir. Diyastolik bas\u0131n\u00e7 \u00e7ok d\u00fc\u015f\u00fck ise seslerin hafiflemeye ba\u015flad\u0131\u011f\u0131 d\u00fczey (Korotkoff faz 4) diyastolik bas\u0131n\u00e7 olarak kaydedilir.<\/li>\n
    • Man\u015fon uzun s\u00fcre \u015fi\u015firilmi\u015f b\u0131rak\u0131l\u0131rsa ven\u00f6z sistemde d\u00f6n\u00fc\u015f azalaca\u011f\u0131 i\u00e7in sesler g\u00fc\u00e7 duyulur. Ven\u00f6z konjesyonu \u00f6nlemek i\u00e7in \u00f6l\u00e7\u00fcmler aras\u0131nda en az bir dakika beklenmelidir. Bunun tersine, sesler zor duyuluyorsa hastan\u0131n kolu ba\u015f seviyesinin \u00fcst\u00fcne kald\u0131r\u0131l\u0131r, eli 5-10 kez a\u00e7\u0131p kapatt\u0131r\u0131larak venlerin bo\u015falmas\u0131 sa\u011flan\u0131r ve \u00f6l\u00e7\u00fcmler tekrarlan\u0131r.<\/li>\n
    • \u00d6l\u00e7\u00fcmler arada iki\u015fer dakika b\u0131rak\u0131lmak suretiyle en az iki defa yap\u0131lmal\u0131 ve bulunan sonu\u00e7lar\u0131n ortalamas\u0131 al\u0131nmal\u0131d\u0131r. E\u011fer iki de\u011fer aras\u0131ndaki fark 5 mmHg\u2019dan fazlaysa daha ba\u015fka \u00f6l\u00e7\u00fcmler de yap\u0131lmal\u0131 ve bunlar\u0131n sonu\u00e7lar\u0131n\u0131n ortalamas\u0131 al\u0131nmal\u0131d\u0131r. Aritmisi olan hastalarda ortalama sistolik ve diyastolik kan bas\u0131nc\u0131 de\u011ferlerini elde etmek i\u00e7in birka\u00e7 \u00f6l\u00e7\u00fcm yapmak gerekir.<\/li>\n
    • \u0130lk muayenedeki \u00f6l\u00e7\u00fcmler her iki koldan yap\u0131lmal\u0131, y\u00fcksek olan koldaki kan bas\u0131nc\u0131 hastan\u0131n kan bas\u0131nc\u0131 olarak kabul edilmelidir. \u0130zlemelerdeki kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcmleri tercihen sa\u011f koldan yap\u0131lmal\u0131d\u0131r.<\/li>\n
    • Ya\u015fl\u0131larda (65 ya\u015f \u00fczeri bireylerde), diyabetli hastalarda, ortostatik hipotansiyonun s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc durumlarda ve antihipertansif ila\u00e7 tedavisi alt\u0131ndaki hastalarda \u00f6l\u00e7\u00fcmlerin ayaktayken tekrar edilmesi gereklidir. Ayaktaki \u00f6l\u00e7\u00fcmler hasta hemen aya\u011fa kalkar kalkmaz ve aya\u011fa kalkt\u0131ktan 2 dakika sonra yap\u0131lmal\u0131d\u0131r. Gen\u00e7lerde (30 ya\u015f\u0131n alt\u0131nda) kan bas\u0131nc\u0131 y\u00fcksek bulunmu\u015f ise koarktasyonu ekarte etmek i\u00e7in bacaktan da \u00f6l\u00e7\u00fcmler yap\u0131lmal\u0131d\u0131r. Prognostik \u00f6nemi a\u00e7\u0131kl\u0131k kazanmad\u0131\u011f\u0131 i\u00e7in izometrik egzersiz ile kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcmlerinin rutin uygulamada yeri yoktur.<\/li>\n<\/ul>\n

      \u00d6l\u00e7\u00fcm\u00fcn hangi koldan ve hangi pozisyonda yap\u0131ld\u0131\u011f\u0131, sistolik ve diyastolik kan bas\u0131n\u00e7lar\u0131 kaydedilmelidir. Hekim \u00f6l\u00e7t\u00fc\u011f\u00fc de\u011fer hakk\u0131nda hastas\u0131n\u0131 bilgilendirmeli ve bulunan de\u011ferlere g\u00f6re periyodik \u00f6l\u00e7\u00fcmlerin ne kadar zamanda bir yap\u0131laca\u011f\u0131n\u0131 belirtmelidir (Tablo 3) (6).<\/p>\n\n\n\n
      \n\n\n\n\n\n\n\n\n
      Ba\u015flang\u0131\u00e7 kan bas\u0131nc\u0131 (mmHg)<\/strong><\/td>\n\u00d6nerilen takip s\u0131kl\u0131\u011f\u0131<\/strong><\/td>\n<\/tr>\n
      Sistolik<\/u><\/td>\nDivastolik<\/u><\/td>\n<\/td>\n<\/tr>\n
      <130<\/td>\n<85<\/td>\n2 y\u0131lda bir<\/td>\n<\/tr>\n
      130-139<\/td>\n85-89<\/td>\nSenede bir<\/td>\n<\/tr>\n
      140-159<\/td>\n90-99<\/td>\n2 ay i\u00e7erisinde kontrol edilecek* 160-179 100-109 1 ay i\u00e7erisinde de\u011ferlendirilecek<\/td>\n<\/tr>\n
      >180<\/td>\n>110<\/td>\nKlinik duruma g\u00f6re hemen ya da Ihafta i\u00e7erisinde de\u011ferlendirilecek<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      Klinikte hekim taraf\u0131ndan kan bas\u0131nc\u0131n\u0131n de\u011ferlendirilmesinin ba\u015fl\u0131ca iki avantaj\u0131 vard\u0131r. \u0130lki uygulaman\u0131n basitli\u011fi ve ucuzlu\u011fu, ikincisi ise hipertansiyonun tan\u0131 ve tedavisi ile ilgili kavramlar\u0131m\u0131z\u0131 dayand\u0131rd\u0131\u011f\u0131m\u0131z ara\u015ft\u0131rmalar\u0131n t\u00fcm\u00fcn\u00fcn bu y\u00f6ntemle kan bas\u0131nc\u0131n\u0131 belirlemi\u015f olmas\u0131d\u0131r. Sonu\u00e7 olarak hekimin \u00f6l\u00e7\u00fcmleri tedavide karar\u0131m\u0131z\u0131 y\u00f6nlendiren temel \u00f6l\u00e7\u00fcmlerdir.<\/p>\n

      Kan bas\u0131nc\u0131n\u0131n hekim taraf\u0131ndan \u00f6l\u00e7\u00fcm\u00fcn\u00fcn dezavantajlar\u0131 ise, bilindi\u011fi gibi kan bas\u0131nc\u0131ndaki ciddi de\u011fi\u015fkenlik ve beyaz g\u00f6mlek hipertansiyonudur. Bu nedenle g\u00fcn\u00fcm\u00fczde iki y\u00f6ntem yayg\u0131n \u015fekilde klinik kullan\u0131ma girmi\u015ftir. Bu y\u00f6ntemler evde kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fc ve ambulatuar kan bas\u0131nc\u0131 monitorizasyonudur.<\/p>\n

      Evde kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fc<\/strong><\/h3>\n

      Evde kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fcn\u00fcn \u00f6nemi<\/em><\/u><\/h4>\n

      Hipertansiflerin kan bas\u0131nc\u0131, muayenehanede veya klinikte \u00f6l\u00e7\u00fcld\u00fc\u011f\u00fcnde di\u011fer yerlerdeki \u00f6l\u00e7\u00fcm sonu\u00e7lar\u0131na g\u00f6re daha y\u00fcksek bulunma e\u011filimindedir. Kan bas\u0131nc\u0131n\u0131n muayenehane d\u0131\u015f\u0131nda \u00f6l\u00e7\u00fclmesi hipertansiyonlu hastalar\u0131n ilk de\u011ferlendirmesi ve tedaviye verdikleri cevab\u0131n izlenmesi a\u00e7\u0131s\u0131ndan de\u011ferli bilgiler verebilir. Son y\u0131llarda hastan\u0131n kan bas\u0131nc\u0131n\u0131n evde izlenmesi y\u00f6ntemi (self-monitoring) yayg\u0131n olarak uygulanmaya ba\u015flanm\u0131\u015ft\u0131r. Kan bas\u0131nc\u0131n\u0131n hastan\u0131n kendisi taraf\u0131ndan \u00f6l\u00e7\u00fclmesinin avantajlar\u0131 \u015funlard\u0131r (7):<\/p>\n

        \n
      1. Ger\u00e7ek hipertansiyonun \u201cbeyaz \u00f6nl\u00fck\u201d hipertansiyonundan ay\u0131rt edilmesi;<\/li>\n
      2. Yeni ba\u015flayan kan bas\u0131nc\u0131 y\u00fckselmelerinde ve s\u0131n\u0131rda hipertansiyonda g\u00fcnl\u00fck kan bas\u0131nc\u0131 de\u011ferlerinin belirlenmesi;<\/li>\n
      3. Antihipertansif ila\u00e7lara al\u0131nan terap\u00f6tik cevab\u0131n de\u011ferlendirilmesi;<\/li>\n
      4. Hastan\u0131n tedavi plan\u0131na daha iyi uymas\u0131;<\/li>\n
      5. Hasta izleme maliyetinin azalmas\u0131.<\/li>\n<\/ol>\n

        Ev \u00f6l\u00e7\u00fcmleri ile ambulatuar kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcmleri aras\u0131nda olduk\u00e7a iyi bir korelasyon g\u00f6zlenmi\u015ftir.<\/p>\n

        Ev \u00f6l\u00e7\u00fcmleri hem normotansif hem de hipertansif bireylerde muayenehane \u00f6l\u00e7\u00fcmlerinden daha d\u00fc\u015f\u00fckt\u00fcr. PAMELA \u00e7al\u0131\u015fmas\u0131nda muayenehanede \u00f6l\u00e7\u00fclen 140\/90 mmHg\u2019l\u0131k kan bas\u0131nc\u0131n\u0131n ev \u00f6l\u00e7\u00fcmlerinde sistolik 121-132 mm Hg ve diyastolik 75-81 mm Hg de\u011ferlerine denk d\u00fc\u015ft\u00fc\u011f\u00fc g\u00f6zlenmi\u015ftir (30). Bu nedenle ev \u00f6l\u00e7\u00fcmlerinde kan bas\u0131nc\u0131 de\u011ferlerinin \u00fcst s\u0131n\u0131r\u0131n\u0131 140\/90 mmHg de\u011fil, en fazla 135\/85 mmHg olarak kabul etmelidir.<\/p>\n

        Evdeki \u00f6l\u00e7\u00fcmlerin klasik \u00f6l\u00e7\u00fcmlere g\u00f6re morbidite ve mortaliteyi belirlemede daha de\u011ferli olup olmad\u0131klar\u0131n\u0131 anlamak i\u00e7in prospektif \u00e7al\u0131\u015fmalara ihtiya\u00e7 vard\u0131r. \u0130leri derecede obez veya kalp ritmi d\u00fczensiz ki\u015filerde ev izlemi yan\u0131lt\u0131c\u0131 olabilir. Dolay\u0131s\u0131yla evde \u00f6l\u00e7\u00fclen kan bas\u0131nc\u0131 de\u011ferleri tan\u0131 ve tedavi konusunda hekim taraf\u0131ndan \u00f6l\u00e7\u00fclen de\u011ferleri destekleyici bilgi olarak kabul edilmeli ve muayene \u00f6l\u00e7\u00fcmlerinin yerini almamal\u0131d\u0131r.<\/p>\n

        Evde kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fc yapmas\u0131 \u00f6nerilen hastalar\u0131n kan bas\u0131nc\u0131ndaki dalgalanmalardan korkmamalar\u0131, ancak hekimlerine haber vermeleri, tan\u0131 amac\u0131yla \u00f6l\u00e7\u00fcm yap\u0131l\u0131yorsa g\u00fcn\u00fcn farkl\u0131 zamanlar\u0131nda, tedaviyi izlemek i\u00e7in \u00f6l\u00e7\u00fcm yap\u0131l\u0131yorsa g\u00fcn\u00fcn ayn\u0131 saatlerinde (\u00f6zellikle sabah yataktan kalkt\u0131ktan sonra) \u00f6l\u00e7\u00fcm yapmalar\u0131 \u00f6nerilir. \u00d6l\u00e7\u00fcm s\u0131kl\u0131\u011f\u0131na hastan\u0131n klinik durumuna g\u00f6re karar verilmelidir.<\/p>\n

        Hasta ve \u00e7evresinin e\u011fitimi<\/em><\/u><\/h3>\n

        Ev \u00f6l\u00e7\u00fcmlerinde kullan\u0131lacak tansiyon aleti genellikle aneroid veya elektronik sfigmomanometrelerdir. Aneroid monitorler \u00f6ncelikle tercih edilmelidir. Bu cihazlar\u0131 kullanamayan veya i\u015fitme g\u00fc\u00e7l\u00fc\u011f\u00fc olan ya\u015fl\u0131 bireylerde elektronik cihazlar \u00f6nerilebilir. Bu cihazlar\u0131n do\u011fru sonu\u00e7 verip vermedi\u011fi e\u015fzamanl\u0131 olarak c\u0131val\u0131 bir tansiyon aletiyle yap\u0131lan \u00f6l\u00e7\u00fcm sonu\u00e7lar\u0131yla kar\u015f\u0131la\u015ft\u0131rmak suretiyle d\u00fczenli aral\u0131klarla kontrol edilmelidir. Evde yap\u0131lacak \u00f6l\u00e7\u00fcmlerde klinik \u00f6l\u00e7\u00fcmlerindeki teknik kullan\u0131l\u0131r, ancak hekimlerin hastalar\u0131n\u0131 ve hasta yak\u0131nlar\u0131n\u0131 kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm tekni\u011fi konusunda e\u011fitmeleri gereklidir.<\/p>\n

        Ambulatuar kan bas\u0131nc\u0131 izlemi<\/strong><\/h3>\n

        Ambulatuar kan bas\u0131nc\u0131 monitorizasyonu hastan\u0131n g\u00fcnl\u00fck aktivitesini engellemeden bir ya da birka\u00e7 g\u00fcnl\u00fck d\u00f6nemde otomatik olarak kan bas\u0131nc\u0131n\u0131 \u00f6l\u00e7me tekni\u011fidir. Tekrarlayan klinik ve ev \u00f6l\u00e7\u00fcmleri ambulatuar kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fcne e\u015fde\u011fer bilgiler sa\u011flasa da, bu y\u00f6ntemin avantaj\u0131 g\u00fcnl\u00fck \u00f6l\u00e7\u00fcmleri daha g\u00fcvenilir vermesi ve gece de\u011ferlerini de \u00f6l\u00e7mesidir.<\/p>\n

        \u0130lk \u00fcretilen ambulatuar kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm cihazlar\u0131n\u0131n aksine g\u00fcn\u00fcm\u00fczde kullan\u0131lan cihazlar otomatik, sessiz ve hafiftir. Kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fc i\u00e7in osk\u00fcltatuar ve ossilometrik olmak \u00fczere iki teknik geli\u015ftirilmi\u015ftir. Osk\u00fcltatuar teknikte man\u015fonun alt\u0131na yerle\u015ftirilen bir ya da iki piezoelektrik mikrofon Korotkoff seslerini kaydeder. Ossilometrik y\u00f6ntemde ise brakiyal arterden man\u015fona iletilen osilasyonlar kaydedilir. Baz\u0131 cihazlar her iki y\u00f6ntemi de kullanmaktad\u0131r. A\u011f\u0131r hipertansiyonlu hastalarda osilometrik cihazlar osk\u00fcltatuar cihazlara g\u00f6re daha hatal\u0131 sonu\u00e7lar vermektedir (31,32). Ancak iki y\u00f6ntemi kar\u015f\u0131la\u015ft\u0131ran \u00e7al\u0131\u015fmalar fazla de\u011fildir. Her ikisi de \u00e7e\u015fitli teknik hatalara a\u00e7\u0131kt\u0131r. Hata kaynaklar\u0131, ayg\u0131t kalibrasyonu d\u0131\u015f\u0131nda, hastan\u0131n kolunu fazla hareket ettirmesi, g\u00fcr\u00fclt\u00fc, vibrasyon veya statik enerji gibi ka\u00e7\u0131n\u0131lmaz fakt\u00f6rlerdir. Ayg\u0131t\u0131n tak\u0131lmadan hemen \u00f6nce ve kullan\u0131m sonras\u0131nda c\u0131val\u0131 bir sfigmomanometre ile kalibre edilmesi gerekti\u011fi unutulmamal\u0131d\u0131r.<\/p>\n

        Cihaz\u0131n tak\u0131l\u0131 oldu\u011fu s\u00fcrede hasta g\u00fcnl\u00fck tutmal\u0131, ila\u00e7lar\u0131n\u0131, \u00e7al\u0131\u015fma saatlerini, uyku, yemek yeme, \u00fcz\u00fclme ya da sinirlenme gibi d\u00f6nemlerini kaydetmelidir. Kan bas\u0131nc\u0131 izlenmesinde \u00f6l\u00e7\u00fcm s\u0131kl\u0131\u011f\u0131 saatte en az iki-d\u00f6rt, hatta tercihan d\u00f6rt-alt\u0131 kezdir. Gece boyunca kan bas\u0131nc\u0131 fazla de\u011fi\u015fiklik g\u00f6stermedi\u011fi i\u00e7in \u00f6l\u00e7\u00fcm s\u0131kl\u0131\u011f\u0131 yar\u0131ya indirilir. K\u0131sa d\u00f6nemli olaylarda, \u00f6rne\u011fin tekrarlayan senkop ataklar\u0131nda, daha s\u0131k (saatte sekiz defa) \u00f6l\u00e7\u00fcmler \u00f6nerilir. PAMELA \u00e7al\u0131\u015fmas\u0131n\u0131n (30) verilerine g\u00f6re klinik ve 24 saatlik ortalama kan bas\u0131nc\u0131 de\u011ferleri aras\u0131ndaki fark ya\u015fla ve klinik kan bas\u0131nc\u0131 de\u011feri ile do\u011fru orant\u0131l\u0131 olarak artmaktad\u0131r. Yirmid\u00f6rt saatlik sistolik 119-126 mm Hg ve diyastolik 75-80 mm Hg\u2019 l\u0131k kan bas\u0131nc\u0131 de\u011ferleri klinik \u00f6l\u00e7\u00fcmlerde 140\/90 mmHg\u2019 ya denk gelmektedir. Sonu\u00e7 olarak ambulatuar \u00f6l\u00e7\u00fcmlerde hasta uyan\u0131kken kan bas\u0131nc\u0131 135\/85 mmHg\u2019dan, uyurken 120\/75 mmHg\u2019dan daha d\u00fc\u015f\u00fck olmal\u0131d\u0131r.<\/p>\n

        Kan bas\u0131nc\u0131n\u0131n ambulatuar olarak izlenmesinin klinikte yararl\u0131 oldu\u011fu durumlar \u015funlard\u0131r (33,34):<\/p>\n

          \n
        1. Tan\u0131 amac\u0131yla (hedef organ hasar\u0131 olmayan \u201cbeyaz \u00f6nl\u00fck hipertansiyonu\u201d, hedef organ hasar\u0131 olan s\u0131n\u0131rda hipertansiyon,\u2019\u2019dipper\u201d ve \u201cnondipper\u201d hipertansifler, epizodik hipertansiyon, labil hipertansiyon, hipotansiyon, otonomik disfonksiyon (6,7,28-30), karotid sinus senkopu ve pacemaker sendromunda, nokt\u00fcrnal angina veya pulmoner konjesyon.<\/li>\n
        2. Prognozu belirleme amac\u0131yla (hedef organ hasar\u0131, kardiyovask\u00fcler olaylar) (38).<\/li>\n
        3. Tedaviyi de\u011ferlendirme amac\u0131yla (diren\u00e7li hipertansiyon, vadi-tepe oran\u0131) (38,39).<\/li>\n<\/ol>\n

          Man\u015fon distalinde pete\u015fi, \u00f6dem, dermatit ve ulnar sinir b\u00f6lgesinde uyu\u015fma, bildirilmi\u015f komplikasyonlard\u0131r. Pahal\u0131 bir y\u00f6ntem oldu\u011fu i\u00e7in gereksiz kullan\u0131mdan ka\u00e7\u0131n\u0131lmal\u0131d\u0131r.<\/p>\n

           <\/p>\n

          Kaynak:<\/p>\n

          https:\/\/www.tkd.org.tr\/kilavuz\/k03\/3_18530.htm?wbnum=1103<\/p>\n","protected":false},"excerpt":{"rendered":"

          Kan Bas\u0131nc\u0131n\u0131n \u00d6l\u00e7\u00fcm\u00fc ve Klinik De\u011ferlendirme a) Kan bas\u0131nc\u0131n\u0131n \u00f6l\u00e7\u00fclmesi Kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm y\u00f6ntemleri Hipertansiyonun tedavi edilebilmesi \u00f6ncelikle tan\u0131n\u0131n do\u011fru olarak konmas\u0131 ile m\u00fcmk\u00fcnd\u00fcr. Bu ama\u00e7la, kan bas\u0131nc\u0131n\u0131 saptamak i\u00e7in gerekli donan\u0131m ve \u00e7evre ko\u015fullar\u0131n\u0131n sa\u011flanmas\u0131 ve do\u011fru bir teknik ile \u00f6l\u00e7\u00fcm yap\u0131lmas\u0131 gerekmektedir. Ayr\u0131ca kan bas\u0131nc\u0131ndaki ciddi de\u011fi\u015fkenlikten dolay\u0131 \u00f6l\u00e7\u00fcmlerin tekrarlanmas\u0131, ba\u015flang\u0131\u00e7ta saptanan y\u00fcksek […]<\/p>\n","protected":false},"author":1,"featured_media":155,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[48,1],"tags":[8,47],"class_list":["post-618","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-faydali-bilgiler","category-genel","tag-kan-basinci","tag-tansiyon-olcumu"],"_links":{"self":[{"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=\/wp\/v2\/posts\/618","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=618"}],"version-history":[{"count":1,"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=\/wp\/v2\/posts\/618\/revisions"}],"predecessor-version":[{"id":619,"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=\/wp\/v2\/posts\/618\/revisions\/619"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=\/wp\/v2\/media\/155"}],"wp:attachment":[{"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=618"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=618"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bergama11noluasm.gov.tr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=618"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}