Kardiyovasküler by-pass geçiren hastalarda postoperatif dönemde noninvaziv mekanik ventilasyon uygulamasının etkinliği
Yükleniyor...
Dosyalar
Tarih
2014
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kardiyopulmoner by-pass sonrası solunum yetmezliği ve atelektazi sık görülür. Noninvaziv pozitif basınç, hastayı ileri müdahalelerden korur. Çalışmamızda kardiyovasküler by-pass operasyonu geçiren hastalarda postoperatif dönemde profilaktik olarak ağız parçası ile noninvaziv mekanik ventilasyon uygulamasının etkinliğini belirlemek amaçlanmıştır. Aralık 2013 – Nisan 2014 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi Kliniği’nde, kardiyovasküler by-pass ameliyatı olan 66 hasta çalışmaya alındı. Çalışmamız prospektif, olgu- kontrol çalışma olarak planlandı. İki gruba ayrılan tüm hastaların demografik özellikleri, kardiyak cerrahinin çeşidi ve süresi, preoperatif değerlendirme (euroSCORE), tedavi öncesi (ekstübe edildikten 1 saat sonra), tedavi sonrası (24. saat) vital bulgular, arter kan gazı değerleri, Borg dispne skoru, alveoloarteriyel gradient, PaO2 /FiO2 oranı, Basitleştirilmiş Akut Fizyoloji II Skoru ve Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II Skoru değerleri, akciğer grafilerinin değerlendirilmesi kaydedildi. Her iki gruba monitarizasyon, nazal kanül ile O2, bronkodilatör tedavi uygulandı. 1. gruba ek olarak noninvaziv mekanik ventilasyon uygulanırken, 2. gruba tri-flo ile egzersiz uygulandı. İki grup arasında yaş, cinsiyet, sigara öyküsü, komorbit hastalıklar ve euroscore değerleri, operasyon çeşidi ve süresi arasında anlamlı fark saptanmadı (p>0.05). Noninvaziv mekanik ventilasyon uygulanan grupta PaO2, SaO2 ve PaO2/FiO2 oranında görülen artış ve yine bu grupta kalp tepe atımı, borg dispne skoru, alveoloarteriyel gradient değerlerinde görülen azalma istatistiksel açıdan anlamlı saptandı. (p<0.05). Akciğer grafileri karşılaştırıldığında noninvaziv mekanik ventilasyon uygulanan grupta daha az progresyon izlenirken (p<0.05), tedavi sonrası 1 hastada atelektazi izlenmiştir. Kontrol grubunda ise 10 hastada atelektazi izlenmiştir. Sonuç olarak postoperatif dönemde profilaktik amaçlı, ağız parçası ile noninvaziv mekanik ventilasyon uygulaması solunum yetmezliğini önlemede başarılı olmuştur.
Abstract
After cardiovascular by-pass surgery, respiratory failure and atelectasis are commonly seen. Noninvasive positive pressure keeps patients from further intervention. In our study, our intention was to determine the effectiveness of the noninvasive mechanical ventilation with mouth piece, in postoperative period of the patients who underwent cardiovascular by-pass surgery. 66 patients who underwent cardiovascular by-pass surgery in Trakya University, Faculty of Medicine of Cardiovascular Surgery Clinic have taken part in the study between December 2013 and April 2014. Our study was planned as a prospective, controlled study. Demographic characteristics, type and duration of the cardiac surgery, preoperative evaluation (Euroscore), vital symptoms before treatment (1 hour after extubating) and after treatment (at 24th hour), arterial blood gas values, Borg dyspnea score, alveoloarterial gradient, PaO2/FiO2 rate, Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II score values, chest radiography evaluation were recorded for all patients who were divided to two groups. Both groups have been monitored, given O2 with nasal cannula and had bronchodilator treatment. First group also had noninvasive mechanical ventilation but the second group had tri-flo exercises instead of noninvasive mechanical ventilation. There was no significant difference between two groups in terms of age, gender, smoking, comorbid diseases and Euroscore values, type or duration of the surgery (p>0.05). In the noninvasive mechanical ventilation performed group, there was a statistically significant increase at PaO2, SaO2, PaO2/FiO2 and a statistically significant decrease at heart rate, dyspne ascore, alveoloarterial gradient values (p<0.05). When chest x-ray graphies are compared in noninvasive mechanical ventilation performed group, less progression was observed (p<0.05); after treatment, only in 1 patient atelectasis was present. But in control group in 10 patients atelectasis was seen. As a result noninvasive mechanical ventilation performed with mouthpiece in postoperative period has been successful to prevent respiratory failure.
Abstract
After cardiovascular by-pass surgery, respiratory failure and atelectasis are commonly seen. Noninvasive positive pressure keeps patients from further intervention. In our study, our intention was to determine the effectiveness of the noninvasive mechanical ventilation with mouth piece, in postoperative period of the patients who underwent cardiovascular by-pass surgery. 66 patients who underwent cardiovascular by-pass surgery in Trakya University, Faculty of Medicine of Cardiovascular Surgery Clinic have taken part in the study between December 2013 and April 2014. Our study was planned as a prospective, controlled study. Demographic characteristics, type and duration of the cardiac surgery, preoperative evaluation (Euroscore), vital symptoms before treatment (1 hour after extubating) and after treatment (at 24th hour), arterial blood gas values, Borg dyspnea score, alveoloarterial gradient, PaO2/FiO2 rate, Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II score values, chest radiography evaluation were recorded for all patients who were divided to two groups. Both groups have been monitored, given O2 with nasal cannula and had bronchodilator treatment. First group also had noninvasive mechanical ventilation but the second group had tri-flo exercises instead of noninvasive mechanical ventilation. There was no significant difference between two groups in terms of age, gender, smoking, comorbid diseases and Euroscore values, type or duration of the surgery (p>0.05). In the noninvasive mechanical ventilation performed group, there was a statistically significant increase at PaO2, SaO2, PaO2/FiO2 and a statistically significant decrease at heart rate, dyspne ascore, alveoloarterial gradient values (p<0.05). When chest x-ray graphies are compared in noninvasive mechanical ventilation performed group, less progression was observed (p<0.05); after treatment, only in 1 patient atelectasis was present. But in control group in 10 patients atelectasis was seen. As a result noninvasive mechanical ventilation performed with mouthpiece in postoperative period has been successful to prevent respiratory failure.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Solunum Yetmezliği, Ağız Parçası ile Uygulama, Kardiyovasküler by-pass, Noninvaziv Mekanik Ventilasyon, Cardiovascular by-pass, Application of Mouthpiece, Noninvasive Mechanical Ventilation, Respiratory Failure
