Title Poslijeoperacijska mučnina i povraćanje nakon ginekoloških zahvata – “veliki mali problem“
Title (english) Postoperative nausea and vomiting following gynecological surgery – “the big little problem”
Author Antonia Zubčić
Mentor Tatjana Šimurina (mentor)
Committee member Boris Dželalija (predsjednik povjerenstva)
Committee member Tatjana Šimurina (član povjerenstva)
Committee member Marijana Matek Sarić (član povjerenstva)
Granter University of Zadar (Department of Health Studies) Zadar
Defense date and country 2022-09-16, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Nursing
Abstract Pojava i liječenje poslijeoperacijske mučnine i povraćanja (POMP) dobiva na važnosti zbog velikog utjecaja na odgodu otpusta i ponovni prijem operiranih bolesnika na liječenje. Poslijeoperacijska mučnina i povraćanje snažno pridonosi neugodnom iskustvu bolesnika i slabijoj kvaliteti poslijeoperacijskog oporavka. Postoje brojni čimbenici kao što su individualni, anesteziološki i kirurški koji utječu na mučninu i povraćanje u perioperacijskom razdoblju i valja ih procijeniti prije kirurške intervencije. U svrhu prevencije i tretmana poslijeoperacijske mučnine i povraćanja koriste se brojni antiemetici a njihova primjena ovisi o postojanju određenih čimbenika rizika kod pacijenta. Obzirom na nedostatnu literaturu vezanu za mjerenje kvalitete poslijeoperacijskog oporavka uz pomoć upitnika QoR 15 (engl. Quality of Recovery) nakon ginekoloških zahvata cilj ovog rada bio je utvrditi incidenciju poslijeoperacijske mučnine i povraćanja, učestalost primjene i uspješnost antiemetske farmakološke profilakse u bolesnica planiranih za ginekološke operacije (otvorena ili laparoskopska histerektomija, adneksektomija, odstranjenje cista jajnika, laparoskopska miomektomija, vaginalna histerektomija i prednja vaginalna plastika) na Odjelu za ginekologiju i porodništvo u OB Zadar od 01. veljače. 2022 – 01. srpnja. 2022. godine te utvrditi postoji li statistički značajna razlika u kvaliteti poslijeoperacijskog oporavka mjereno 24 sata nakon zahvata upitnikom QoR 15 između bolesnica koje su dobile antiemetsku zaštitu u odnosu na one koje su primile antiemetsku terapiju nakon zahvata. Istraživanje je provedeno na 67 ispitanica podvrgnutih ginekološkim zahvatima i dolazimo do rezultata da je mučninu i povraćanje tijekom 24 sata nakon zahvata imalo 26 (39%) ispitanica. Ukupno je antiemetik primilo 38 ispitanica. Ispitanice koje su primile antiemetik prije i tijekom zahvata 21/38 u odnosu na one koje su ga primile nakon zahvata u terapijske svrhe 17/38, značajno su bolje ocijenile uživanje u hrani (P = 0,03), ocijenile su boljom potporu odjelnih liječnika i medicinskih sestara (P = 0,008), te im je značajno slabija mučnina i povraćanje ( P = 0,001), kao i ukupna procjena kvalitete poslijeoperacijskog oporavka, u odnosu na ispitanice koje su antiemetik primile poslije zahvata u terapijske svrhe (P = 0,02). Zaključno, kvaliteta poslijeoperacijskog oporavka ovisi o uspješnosti primjene antiemetske profilakse koja u našoj instituciji nije dostatna. Unatoč napretku anestezije može se reći da je poslijeoperacijska mučnina i povraćanje i dalje “veliki mali“ problem.
Abstract (english) The occurrence and treatment of postoperative nausea and vomiting are gaining importance due to the great impact on the delay of discharge and hospital readmission. Postoperative nausea and vomiting also strongly contributes to the patient's unpleasant experience and thus to the quality of postoperative recovery. There are numerous factors such as individual, anesthesiological and surgical factors that influence nausea and vomiting in the perioperative period and should be evaluated on time. For the prophylaxis and treatment of postoperative nausea and vomiting, numerous antiemetics are used, and their use depends on the existence of certain risk factors in the patient. Considering the lack of literature related to measuring the quality of postoperative recovery with the help of the QoR 15 questionnaire (English Quality of Recovery) after gynecological procedures, the aim of this work was to determine the incidence of postoperative nausea and vomiting, the frequency of use and the success of antiemetic pharmacological prophylaxis in patients scheduled for gynecological operations (open or laparoscopic hysterectomy, adnexectomy, removal of ovarian cysts, laparoscopic myomectomy,vaginal hysterectomy and anterior vaginal plastic) at the Department of Gynecology and Obstetrics in Zadar General Hospital from February 1st 2022 to July 1st 2022 and determine whether there is a statistically significant difference in the quality of postoperative recovery measured 24 hours after the procedure with the QoR 15 questionnaire between patients who received antiemetic prophylaxis compared to those who receive antiemetic therapy after the procedure. The research was conducted on 67 subjects who underwent gynecological surgical procedures and we came to the result that 26 (39%) subjects had nausea and vomiting during the first 24 hours after the procedure. A total of 38 (47%) subjects received antiemetics for prophylaxis and/or treatment. A total of 38 subjects received antiemetics. Subjects who received an antiemetic before and during the procedure 21/38 compared to those who received it after the procedure for therapeutic purposes 17/38, rated the enjoyment of food significantly better (P = 0.03), rated the support of department doctors as better and nurses (P = 0.008), and their nausea and vomiting (P = 0.001), as well as the overall
assessment of the quality of postoperative recovery, were significantly lower compared to subjects who received antiemetic
received after the procedure for therapeutic purposes (P = 0.02). In conclusion, the quality of postoperative recovery depends on the success of antiemetic prophylaxis, which is not sufficient in our institution. Despite the progress of anesthesia, it can be said that postoperative nausea and vomiting remain a "big little" problem.
Keywords
antiemetik
poslijeoperacijska mučnina i povraćanje
kvaliteta poslijeoperacijskog oporavka
Keywords (english)
antiemetic
nausea
vomiting
postoperative nausea and vomiting
quality of postoperative recovery
Language croatian
URN:NBN urn:nbn:hr:162:410305
Study programme Title: Nursing Study programme type: university Study level: graduate Academic / professional title: Magistar/magistra sestrinstva (Magistar/magistra sestrinstva)
Type of resource Text
File origin Born digital
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Created on 2022-11-04 14:21:08