doktorska disertacija
Zalika Klemenc-Ketiš (Author), Janko Kersnik (Mentor), Ivan Krajnc (Thesis defence commission member), Štefek Grmec (Co-mentor)

Abstract

Izhodišča Obsmrtne izkušnje so doživljanja globokih občutkov v smislu izventelesnih doživetij in vstopa v druge dimenzije izven običajnih meja časa in prostora, ki najpogosteje nastopijo, ko je človek soočen z življenjsko nevarno situacijo, je blizu smrti ali pa je celo klinično mrtev. Pojav obsmrtnih izkušenj skuša razložiti več teorij (fiziološke, psihološke in transcendentalne) in kombiniranih modelov, vendar zaenkrat enotno sprejeta razlaga ne obstaja. Doživetje obsmrtne izkušnje globoko spremeni nadaljnje življenje bolnika, vpliva pa tudi na fizično in psihološko okrevanje ter na odnose bolnika s partnerjem, otroci in sorodniki. Cilji Cilji raziskave so bili ugotoviti število oziroma odstotek bolnikov z obsmrtno izkušnjo po uspešnem oživljanju zaradi kardiogenega vzroka zastoja srca; ugotoviti vpliv obsmrtne izkušnje na življenje bolnika; preveriti povezanost med trajanjem oživljanja in prisotnostjo obsmrtne izkušnje; preveriti povezanost med starostjo bolnika in prisotnostjo obsmrtne izkušnje; ugotoviti vpliv aplikacije zdravil pred, med in po oživljanju na prisotnost obsmrtne izkušnje; ugotoviti vpliv aplikacije vazopresina na prisotnost obsmrtne izkušnje; ugotoviti vpliv vernosti bolnika na prisotnost obsmrtne izkušnje; ugotoviti vpliv nekaterih fizioloških stanj (hipoksija, hiperkarbija, elektrolitske motnje) na prisotnost obsmrtne izkušnje. Metode V treh največjih slovenskih bolnišnicah sem izvedla multicentrično prospektivno observacijsko raziskavo o psihokognitivnih doživljanjih bolnikov, ki so v času leta in pol na terenu doživeli kardiogeni srčni zastoj in bili uspešno oživljani. Ob prvem stiku z bolniki, ki je bil izveden takoj, ko je to bilo mogoče, sem uporabila Greysonov vprašalnik o obsmrtnih izkušnjah in Kaslov vprašalnik za določanje indeksa religioznosti. Iz medicinske dokumentacije sem pridobila demografske podatke in klinične podatke o poteku oživljanja ter zdravljenja v bolnišnici. Po 6 mesecih sem bolnike ponovno anketirala. Uporabila sem Greysonov vprašalnik o obsmrtnih izkušnjah in Ringov vprašalnik o življenjskih spremembah. V statistični analizi sem uporabila metode deskriptivne statistike, univariantno in multivariantno analizo. Rezultati Vzorec prvega stika je vseboval 52, vzorec drugega stika pa 37 bolnikov. Obsmrtno izkušnjo je doživelo 11 (21,2 %) bolnikov. Obsmrtne izkušnje so bile pogostejše pri bolnikih, ki so jih doživeli že ob prejšnjih srčnih zastojih, pri bolnikih, katerih EKG vzorec ob srčnem zastoju ni bil ventrikularna fibrilacija, pri bolnikih, pri katerih defibrilacija ni bila izvedena, pri bolnikih, ki so imeli višje vrednosti delnega tlaka ogljikovega dioksida v arterijski krvi, pri bolnikih, ki so pred oživljanjem prejeli enalapril, furosemid in inzulin ter pri bolnikih, ki so po oživljanju prejeli enalapril, diazepam in inzulin. Neodvisni napovedni dejavnik za doživetje obsmrtne izkušnje je bil diazepam, apliciran po oživljanju. Obsmrtne izkušnje so globoko posegle v nadaljnja življenja bolnikov, saj se je pri njih povečalo zanimanje za smisel življenja in njih same, za odnose do drugih in za duhovnost. Zaključki Vsak peti bolnik v Sloveniji med srčnim zastojem na terenu doživi obsmrtno izkušnjo, ki v njegovem življenju pusti globoko sled. Zato ti bolniki potrebujejo pozornost medicinskega osebja, ki jih mora znati prepoznati, se z njimi soočati in jih primerno obravnavati. Sam obstoj obsmrtnih izkušenj pa se lahko uporabi v obravnavi umirajočih bolnikov in njihovih svojcev. Za nadaljnje proučevanje fenomenologije obsmrtnih izkušenj bodo potrebne multicentrične prospektivne raziskave na velikih vzorcih.

Keywords

klinična smrt;fiziologija;psihologija;kvaliteta življenja;multivariantna analiza;

Data

Language: Slovenian
Year of publishing:
Typology: 2.08 - Doctoral Dissertation
Organization: UM MF - Faculty of Medicine
Publisher: Z. Klemenc-Ketiš]
UDC: 616.12-008.315(043.3)
COBISS: 251578112 Link will open in a new window
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Other data

Secondary language: English
Secondary title: Near-death experiences among the survivals of out-of-hospital cardiogenic cardiac arrest
Secondary abstract: Background Near-death experiences are experiences of deep feelings of out-of-body experiences and of entering other dimensions outside usual borders of time and space. They mostly occur when a person is facing a life-threatening situation, is near death or is even clinically death. A lot of theories (physiological, psychological and transcendental) and combined models tried to explain their existence, but so far none of them has provided an unified explanation. Near-death experiences deeply change the further lives of patients, affect both their physical and psychological recovery and also the relationship between the patients and their spouse, family and relatives. Aims The aims of this research were: to determine the number and percentage of the patients with near-death experiences after a successful resuscitation after out-of-hospital cardiac arrest; to determine the effect of near-death experiences on the lives of the patients; to test the relationship between the length of resuscitation and the incidence of near-death experiences; to test the relationship between the age of the patients and the incidence of near-death experiences; to determine the effect of given drugs before, during, and after the resuscitation on the incidence of near-death experiences; To determine the effect of the vazopresin on the incidence of near-death experiences; to determine the effect of religiousness of the patients on the incidence of near-death experiences; to determine the effect of some physiological states (hypoxia, hypercarbia, electrolyte changes) on the incidence of near-death experiences. Methods I conducted a multicentre prospective observational study in the three largest hospitals in Slovenia about psycho-cognitive experiences of the patients that were successfully resuscitated after out-of-hospital cardiogenic cardiac arrest in an 18 months period. I did the first interview with the patients as soon as they were able to cooperate. I used Greyson’s near-death experiences scale and Kasl’s index of religiousness scale. I obtained the demographic data and the data about the resuscitation and the clinical course of the patients from the patients’ records that were available in the hospital. I conducted the second interview with the patients after 6 months. I used Greyson’s near-death experiences scale and Ring’s life changing inventory. In the statistical analysis I used the methods of descriptive statistics, univariate and multivariate analyses. Results The sample upon the first interview contained 52 patients, and upon the second 37 patients. The near-death experiences were reported by 11 (21.2%) patients. The near-death experiences were more common among the patients that have had such experiences also in previous cardiac arrests, among the patients, whose ECG pattern during cardiac arrest was not ventricular fibrillation, among patients that were not defibrillated, among patients that had higher partial pressure of carboxic dioxide in the peripheral arterial blood, among patients that were given enalapril, furosemide, and insulin before the resuscitation, and among the patients that were given enalapril, diazepam, and insulin after the resuscitation. The independent predictor for the presence of near-death experiences was diazepam. Near-death experiences deeply affected the further lives of the patients. Their interest in the meaning of the life, the interest for themselves, the interest for the relationships with others, and for the spirituality has increased. Conclusions Every fifth out-of-hospital cardiac arrest patient in Slovenia experiences the near-death experience, which deeply affects his further life. Thus patients require attention of medical staff, that have to know how to identify such patients, how to cope with them, and how to properly manage them. The existence of near-death experiences can be used in the management of the dying patients and their relatives. Further studies of near-death experiences should focus on the multicentre prospective design and on large samples.
Secondary keywords: Srčni zastoj;Disertacije;Oživljanje;Bolniki;Obsmrtna doživetja;
URN: URN:SI:UM:
Type (COBISS): Dissertation
Thesis comment: Univ. Maribor, Medicinska fak.
Pages: 183 str.
ID: 8725896