Göğüs cerrahisi ameliyatı geçiren torakal epidural kateter takılan hastalarda postoperatif bulantı/kusmayı öngörmedeki parametreler

Year 2022, , 22 - 28, 26.03.2022

Gülay Ülger , Ramazan Baldemir , Musa Zengin , Hilal Sazak , Ali Alagöz

https://doi.org/10.18663/tjcl.1019702

Abstract

Amaç: Ameliyat süresinin uzun olması ve volatil anesteziklerin kullanılması gibi birçok faktör göğüs cerrahisinde postoperatif bulantı/kusma (PONV) sıklığını artırabilir. Son çalışmalar, nötrofil lenfosit oranı (NLR) gibi inflamatuar parametrelerin PONV'yi öngörebileceğini düşündürmektedir. Bu çalışmanın amacı, torakotomi ameliyatı olan ve torasik epidural analjezi (TEA) uygulanan hastalarda postoperatif demografik, laboratuvar ve klinik verilerin PONV'yi öngörmedeki rolünü incelemektir.
Gereç ve Yöntemler:Mart 2017 - Aralık 2020 tarihleri arasında elektif göğüs cerrahisi geçiren ve TEA uygulanan hastaların verileri taranmıştır. Hastaların demografik verileri, laboratuvar parametreleri, ve Amerikan Anestezistler Birliği (ASA) I-II-III, eritrosit dağılım genişliği (RDW), NLR, postoperatif görsel analog skala (VAS) gibi klinik özellikleri incelenmiştir. PONV gelişen tüm hastalar Grup 1'e dahil edilmiştir. PONV gelişmeyen Grup 2 hastaların seçmek için hastane kayıtları kullanılmıştır.
Bulgular: PONV insidansı %14.77 olarak belirlendi. ASA ve 24 saatlik VAS skorları açısından gruplar arasında istatistiksel olarak anlamlı fark vardı (p < 0.05). PONV'li hastalarda istatistiksel olarak anlamlı şekilde daha yüksek 24 saatlik VAS skorları vardı (p < 0.05). ASA III olan hastalarda PONV Diğer ASA gruplarına göre istatistiksel olarak anlamlı şekilde daha fazla görüldü (p < 0.05). Çok değişkenli analiz; ASA, RDW ve 24 saatlik VAS'ın PONV'yi öngörmede önemli olduğunu göstermektedir. Daha düşük RDW, daha yüksek ASA ve 24 saatlik VAS, PONV riskini artırır.
Sonuç: Bu çalışmada demografik veriler, laboratuvar parametreleri ve klinik özellikler PONV ile korelasyonları açısından değerlendirildi. RDW düzeyi düşük olan hastalarda PONV sıklığının artabileceği gözlendi. Ayrıca torakotomi yapılan ve TEA uygulanan hastalarda yüksek VAS değerleri ve ASA fiziksel skorlarının da PONV riskini artırdığı bulundu.

Keywords

postoperatif bulantı/kusma, POBK, Torasik epidural analjezi, Torasik cerrahi

Demographic, clinical, and laboratory parameters in predicting postoperative nausea/vomiting in patients with thoracic epidural analgesia in thoracic surgery

Abstract

Aim: In thoracic surgery, many factors; such as long duration of surgery and the use of volatile anesthetics may increase the frequency of postoperative nausea/ vomiting (PONV). Recent studies suggests that inflammatory markers such as neutrophils lymphocytes ratio (NLR) can predict PONV. The aim of this study is to postoperatively examine the role of demographic, laboratory, and clinical data in predicting PONV in patients who underwent thoracotomy and received thoracic epidural analgesia (TEA).
Material and Methods:Data were collected for patients who underwent elective thoracic surgery and were administered TEA between March 2017 and December 2020. Patients' demographic data, laboratory parameters, and clinical characteristics; such as American Association of Anesthesiologists (ASA) I-II-III, erythrocyte distribution width (RDW), NLR, postoperative visual analog scale (VAS), were scanned. All patients who developed PONV were included in Group 1. Hospital records were used to select Group 2 patients who did not develop PONV.
Results: The incidence of PONV was determined as 14.77%. There was a statistically significant difference between the groups in terms of ASA and 24-hour VAS scores (p < 0.05). Patients with PONV had statistically significantly higher 24-hour VAS scores(p < 0.05). PONV was statistically significantly higher in patients with ASA III compared to other ASA groups (p < 0.05). Multivariate analysis suggests that ASA, RDW and 24-hour VAS are significant in predicting PONV. Lower RDW, higher ASA and 24-hour VAS increase the risk of PONV.
Conclusion: Demographic data, laboratory parameters, and clinical characteristics were evaluated concerning their correlation with PONV in this study. It was observed that the frequency of PONV might increase in patients with low RDW levels. In addition, higher VAS values and ASA physical score were also found to increase the risk of PONV in patients who underwent thoracotomy and administered TEA

Keywords

Postoperative nausea/vomiting, PONV, thoracic epidural analgesia, thoracic surgery

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