doktorska disertacija
Irena Osojnik (Avtor), Mirt Kamenik (Mentor)

Povzetek

Po srčni operaciji učinkovita analgezija prepreči bolnikovo neugodje ter zmanjša obolevnost in dolžino hospitalizacije ter tako zmanjša stroške zdravljenja. Vodenje anestezije po srčni operaciji je multimodalni pristop in eden od pristopov je dodajanje nesteroidnega antirevmatika opiatnemu analgetiku. Nesteroidni antirevmatiki zmanjšajo porabo opiatov po operaciji in njihove stranske učinke. Uporaba nesteroidnih antirevmatikov lahko vpliva na krvavitev, moti ledvično funkcijo in povzroči možne ishemične dogodke. Z našo raziskavo smo nameravali ugotoviti, ali diklofenak zmanjša porabo opioidov in njihovih stranskih učinkov. Prav tako smo ugotavljali vpliv diklofenaka na krvavitev in funkcijo trombocitov po premostitvi venčnih arterij z uporabo zunajtelesnega krvnega obtoka. Izvedli smo kontrolirano randomizirano raziskavo, v katero je bilo zajetih 72 bolnikov. Razdelili smo jih v dve skupini. Skupina, ki je dobila diklofenak, je dobila 75 mg tega zdravila v obliki Neodolpasse v 250 ml infuziji v dveh odmerkih, prvega tri ure po operaciji in naslednjega po 12 urah. Skupina, ki ni dobila diklofenaka (kontrolna skupina), je dobila 250 ml fiziološke raztopine. Obe skupini sta dobili za analgezijo opioidni analgetik Dipidolor (piritramid) 5 mg na 8 ur in vmes po potrebi do zadovoljive analgezije. Pri bolnikih smo spremljali porabo opioidov, teste strjevanja krvi, funkcijo trombocitov in krvavitev ter porabo krvnih pripravkov po operaciji. Dodatno smo spremljali tudi morebitni porast vrednosti sečnine, kreatinina in troponina. Za analizo smo uporabili ustrezne statistične teste in p < 0,05 smo vzeli kot mejo statistične značilnosti. Z našo raziskavo pri bolnikih, ki so dobili diklofenak, nismo ugotovili manjše porabe opioidnih analgetikov po srčni operaciji in manj stranskih učinkov opioidov. Pri bolnikih, ki so dobili diklofenak, nismo ugotavljali krajšega časa do odstranitve dihalne cevke, hitrejšega odpusta iz enote intenzivne terapije in bolnišnice. Pri ugotavljanju testov funkcije trombocitov nismo ugotavljali motene agregacije trombocitov v skupini, ki je dobila diklofenak. Prav tako skupina z diklofenakom ni imela povečane krvavitve in povečane porabe krvnih pripravkov v zgodnjem pooperativnem obdobju.

Ključne besede

srčna kirurgija;premostitev venčnih arterij;zunajtelesni krvni obtok;nesteroidna protivnetna zdravila;diklofenak;agregacija trombocitov;krvavitev po srčni operaciji;pooperativna analgezija;

Podatki

Jezik: Slovenski jezik
Leto izida:
Tipologija: 2.08 - Doktorska disertacija
Organizacija: UM - Univerza v Mariboru
Založnik: I. Osojnik]
UDK: 616.132.2-089:615.212/.225(043.3)
COBISS: 6892095 Povezava se bo odprla v novem oknu
Št. ogledov: 913
Št. prenosov: 63
Ocena: 0 (0 glasov)
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Ostali podatki

Sekundarni jezik: Angleški jezik
Sekundarni naslov: THE EFFECT OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS ON BLEEDING, PLATELET FUNCTION AND CONSUMPTION OF OPIATES FOLLOWING CARDIAC SURGERY
Sekundarni povzetek: During the heart operation, a successful analgesia can not only prevent patients’ discomfort, but also reduce morbidity as well as the duration of hospitalisation and therefore reduce the overall treatment costs. One of the methods in the multimodal approach to anaesthesia after the heart surgery, is to add nonsteroidal antirheumatics to opioid analgesics. The use of nonsteroidal antirheumatics results in decreased consumption of opioid analgesics and their potential side effects after the surgery, however their usage can contribute to increased bleeding, impaired kidney function and possible ischemic events. The aim of the study is to establish weather using diclofenac reduces the usage of opioids and their resulting side effects. Consequences of the diclofenac usage on increased bleeding and impaired thrombocyte function, after the coronary artery bypass grafting (CABG surgery) with the use of extracorporeal circulation, were also examined. In the controlled, randomized, single-blind study, a total of 72 patients were divided in two groups. One of the groups was administered two 75 mg doses of diclofenac Neodolpasse in the form of 250 ml intravenous therapy (IV). The first dose was given three hours and the next one 12 hours after the first. The control group was administered two doses of 250 ml saline solution IV in the same time intervals. For analgesia, both groups were prescribed 5 mg of opioid analgesics Dipidolor (piritramid), every 8 hours, with increased dosage if needed. Opioid consumption, blood coagulation, thrombocyte function, rate of bleeding and usage of blood product were recorded after the surgery on all patients. Furthermore, possible increase of urea, creatinine or troponin were closely monitored. The data analysis was performed using suitable statistical tests, with p < 0.05 being set as the p-value. The study concluded that patients, administered with diclofenac after the heart surgery, did not consume less opioid analgesics and did not exhibit less symptoms linked to their consumption. Moreover, the time span of the respiratory tube usage and the duration of the time spend in intensive hospital care, were not reduced. In the assessment of platelet function tests, we did not detect impaired platelet aggregation in the group that received diclofenac. Likewise, the diclofenac group did not have increased bleeding and increased consumption of blood products in the early postoperative period.
Sekundarne ključne besede: Diclofenac;Diklofenak;Cardiac surgical procedures;Kardiokirurški postopki;Postoperative care;Pooperativna oskrba;Platelet aggregation;Agregacija trombocitov;Coronary artery bypass;Obvod koronarnih arterij;Hemorrhage;Krvavitev;Anti-inflammatory agents, non-steroidal;Nesteroidna protivnetna sredstva;Analgesia;Analgezija;
Vrsta dela (COBISS): Doktorska disertacija
Komentar na gradivo: Univ. v Mariboru, Medicinska fak.
Strani: 71 f.
ID: 11160166