Soğuk uygulamanın medyan sternotomili hastalarda ağrı ve solunum egzersizlerine etkisi
Küçük Resim Yok
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmanın amacı soğuk uygulamanın medyan sternotomili hastalarda ağrı ve solunum egzersizlerine etkisini incelenmektir. Yöntem: Bu çalışma randomize, çapraz kontrollü klinik bir çalışma olarak 2 (tedavi) x 2 (period) x 2 (zaman) olarak tasarlanmıştır. Çalışma, Pamukkale Üniversitesi Sağlık Araştırma Uygulama Merkez Müdürlüğü Kalp Damar Cerrahisi servis ve yoğun bakımda yatan kardiyak cerrahi geçirmiş (koroner arter by-pass grefti ve kapak cerrahisi) sternotomisi olan hastalarda (n: 34), 14 Nisan-30 Eylül 2014 tarihleri arasında yapılmıştır. Verilerin toplanmasında, araştırmacı tarafından hazırlanan "Hasta Tanıtım ve İzlem Formu" ile "Görsel Kıyaslama Ölçeği Formu" kullanılmıştır. Araştırma, iki gün boyunca ekstübasyon sonrası sabah başlamak üzere sabah 08.00 ve öğleden sonra 14:00 saatleri arasında (arınma süresi altı saat olacak şekilde) yürütülmüştür. Müdahale: Sternotomi üzerine soğuk uygulama için soğuk jel paket (SJP) kullanılmıştır. Hastalara randomizasyona uygun önce SJP ile veya SJP'siz; daha sonra alternatifi uygulanmıştır. Her periyotta derin solunum-öksürük egzersizleri ve teşvik edici spirometre (DS-ÖE ve TES) uygulatılmıştır. Hastalara SJP uygulaması öncesi sonrası ile DS-ÖE ve TES öncesi ve sonrası GKÖ'yü işaretlemeleri sağlanmıştır. Bu çalışmada, tanımlayıcı istatistikler, Mann-Whitney U, Wilcoxon, McNemar chi-square ve Spearman correlation analizleri kullanılmıştır. Tedavi, period ve zaman arasındaki etkileşim Tekrarlayan Ölçümlerde Varyans analizi ile test edilmiştir. Bulgular: Hastaların ilk gün sabah DS-ÖE ve TES uygulama öncesi ağrı şiddeti ortalamaları 3.44±2.45 (ortancası: 2.95 (0.90-5.40)'dir. Hastaların DS-ÖE ve TES uygulama öncesi %50.7'sinin hafif, %39.0'ının orta ve %10.3'ünün şiddetli ağrı olmuşken DS-ÖE- ve TES uygulama sonrası %36.8'i hafif, %44.9'u orta ve %18.4'ü ise şiddetli ağrıları olmuştur (p<0.001). SJP uygulananlarda DS-ÖE ve TES uygulaması sonrası ağrı şiddetinde değişiklik olmaz (p>0.05) iken SJP uygulanmayanlarda anlamlı artışlar saptanmıştır (p<0.001). SJP uygulanan ve SJP uygulanmayan gruplarının ağrı şiddet puanlarına olan etkisi; tedavi, periyod ve zaman etkileşimleri, tedavi ve zaman arasındaki etkileşim olduğu saptanmıştır (p<0.001). Etkileşimin etki büyüklüğü orta düzeydedir (partial eta squared: 0.090). Bununla birlikte analjezik kullanımı ve ilk başlanan tedavi rejiminin etkileşim göstermediği saptanmıştır (p>0.05). Spirometrik volümler açısından tedavi, analjezik ve zaman etkileşim etkileri test edilmiş ve etkileşimin olmadığı gösterilmiştir (p>0.05). Yine SJP uygulananlar ve uygulanmayanlar ile DS-ÖE ve TES uygulama öncesi ve sonrası hastaların ağrı şiddetleri ile birinci gün ve ikinci gün spirometre değeri sonuçları arasında anlamlı bir korelasyon saptanmamıştır (p>0.05). Sonuç olarak; sternotomi üzerine yapılan SJP uygulaması, DS-ÖE ve TES uygulaması sonrasında ağrı şiddeti artışını azaltırken, solunum egzersizlerinin etkililiğini arttırmamıştır. Kardiyak cerrahi sonrası sternotomi ağrısının yönetiminde soğuk uygulama teşvik edilmelidir. Anahtar kelimeler: Post-operatif ağrı; soğuk uygulama; solunum egzersizleri; spirometre
The aim of this study was to investigate the effects on pain and breathing exercises of cold therapy intervention for cardiac surgery (CABG, valve replasman) patients with median sternotomy. Method: This research designed randomised crossover clinical trial (treatment-2 x session-2 x time-2) and conducted among cardiac surgery with sternotomy patients (n: 34) intensive care unit (ICU) of Pamukkale University by the 14 April to 30 September 2014. articipants used "Patient Identification and Monitoring Form" and a Visual Analog Scale (VAS) to rate their pain from 0 (no pain) to 10. Data was collected on post-surgical first two day between 8.00 am and 14.00 pm (washout period of six hours between DB&CE and incentive spirometer (IS) procedures). Intervention: For cold therapy intervention used the gel packs. Patients were randomly shared to either begin the DB&CE-IS with the gel pack or without the gel pack and then alternated with respect to the gel pack. Patients marked VAS for pain intensity at the DB&CE-IS session before and after. In thıs study, descriptive statistics, Mann-Whitney U, Wilcoxon, McNemar chi-square and Spearman correlation were used for statistical analysis. RM-ANOVA was conducted for interaction (treatment, session and time) on pain intensity scores and spirometric values Results: Average pain scores was 3.44 ± 2.45 (median: 2.95, quartiles: 0.90-5.40) baseline DB&CE-IS procedures at the morning of first day. The reported acute postoperative pain was mild in 50.7%, moderate in 39.0% and severe in 10.3% of patients baseline DB&CE-IS procedures; post DB&CE-IS procedures, reported acute postoperative pain was mild in 36.8%, moderate in 44.9% and severe in 18.4% of patients (p<0.001). At before and post DB&CE-IS, the reported acute postoperative pain with the gel pack were not significantly different but without the gel pack were significantly increased (p<0.001). The interaction between treatment and time was significant, and indicated that the changes in pain scores from baseline to post DB&CE-IS differed between with gel pack and without gel pack. With gel pack group according without gel pack group had lower increased of average pain scores. The eta-squared for the treatment (with gel pack and without gel pack) by time (baseline to post DB&CE-IS) interaction was 0.09 (moderate effect size). However, interaction between treatment, time and analgesics and sequence was non significant, The interaction between treatment and time was non significant, and indicated that the changes in spirometric values from post-operative first to second day. There was non-significant correlation between pain level (VAS) and spirometric values (according with gel pack or without gel pack; baseline or post DB&CE-IS; post-operative first day or second day). Conclusion: Cold therapy (the gel pack applying on sternotomy) is effective for decreasing the increase in pain post DB&CE-IS, but is not effective of breathing exercises post cardiac surgery. Cold therapy should be encouraged management of pain for post cardiac surgery. Key words: Postoperative pain; breathing exercises; cryotherapy; spirometry
The aim of this study was to investigate the effects on pain and breathing exercises of cold therapy intervention for cardiac surgery (CABG, valve replasman) patients with median sternotomy. Method: This research designed randomised crossover clinical trial (treatment-2 x session-2 x time-2) and conducted among cardiac surgery with sternotomy patients (n: 34) intensive care unit (ICU) of Pamukkale University by the 14 April to 30 September 2014. articipants used "Patient Identification and Monitoring Form" and a Visual Analog Scale (VAS) to rate their pain from 0 (no pain) to 10. Data was collected on post-surgical first two day between 8.00 am and 14.00 pm (washout period of six hours between DB&CE and incentive spirometer (IS) procedures). Intervention: For cold therapy intervention used the gel packs. Patients were randomly shared to either begin the DB&CE-IS with the gel pack or without the gel pack and then alternated with respect to the gel pack. Patients marked VAS for pain intensity at the DB&CE-IS session before and after. In thıs study, descriptive statistics, Mann-Whitney U, Wilcoxon, McNemar chi-square and Spearman correlation were used for statistical analysis. RM-ANOVA was conducted for interaction (treatment, session and time) on pain intensity scores and spirometric values Results: Average pain scores was 3.44 ± 2.45 (median: 2.95, quartiles: 0.90-5.40) baseline DB&CE-IS procedures at the morning of first day. The reported acute postoperative pain was mild in 50.7%, moderate in 39.0% and severe in 10.3% of patients baseline DB&CE-IS procedures; post DB&CE-IS procedures, reported acute postoperative pain was mild in 36.8%, moderate in 44.9% and severe in 18.4% of patients (p<0.001). At before and post DB&CE-IS, the reported acute postoperative pain with the gel pack were not significantly different but without the gel pack were significantly increased (p<0.001). The interaction between treatment and time was significant, and indicated that the changes in pain scores from baseline to post DB&CE-IS differed between with gel pack and without gel pack. With gel pack group according without gel pack group had lower increased of average pain scores. The eta-squared for the treatment (with gel pack and without gel pack) by time (baseline to post DB&CE-IS) interaction was 0.09 (moderate effect size). However, interaction between treatment, time and analgesics and sequence was non significant, The interaction between treatment and time was non significant, and indicated that the changes in spirometric values from post-operative first to second day. There was non-significant correlation between pain level (VAS) and spirometric values (according with gel pack or without gel pack; baseline or post DB&CE-IS; post-operative first day or second day). Conclusion: Cold therapy (the gel pack applying on sternotomy) is effective for decreasing the increase in pain post DB&CE-IS, but is not effective of breathing exercises post cardiac surgery. Cold therapy should be encouraged management of pain for post cardiac surgery. Key words: Postoperative pain; breathing exercises; cryotherapy; spirometry
Açıklama
Anahtar Kelimeler
Hemşirelik, Nursing
