Tahir GÜVEN, Aysun YILMAZLAR, Mehmet URSAVAŞ, GÜVEN ÖZKAYA

Ortopedik cerrahide preoperatif solunumsal değerlendirme ve anestezi türü ile morbidite-mortalite ilişkisinin retrospektif olarak incelenmesi

Amaç: Cerrahi sonrası gelişen solunumsal komplikasyon önemli bir morbidite ve mortalite nedenidir. Bu çalışmanın amacı; ortopedik cerrahi geçirmiş olgularda gelişen pulmoner komplikasy onların; preoperatif risk faktörleri, pulmoner risk indeksi (PRİ) ve uygulanmış anestezi türleri ile ilişkisini araştırmaktır. Yöntem: Etik kurul onayı alındıktan sonra Ocak 2007 - Haziran 2008 tarihleri arasında, Uludağ Üniversitesi Ortopedi ve Travmatoloji Anabilim Dalı'nca öpere edilmiş 1406 elektif olgu çalışmaya alındı. Tüm olguların cinsiyetleri, yaşları, American Society of Anesthesiologist (ASA) klinik sınıflaması, anestezi türleri kaydedildi. Eşlik eden sistemik hastalıklar ve cerrahi türleri kaydedildi. Tüm hastaların PRİ'leri hesaplandı. Bu indekste 6 parametreye bakıldı. Ayrıca olguların postoperatif 24 saat içinde belirlenen postoperatif pulmoner komplikasyonları (PPK) ve mortaliteleri kaydedildi. Postoperatif pulmoner komplikasyon olarak atelektazi, pnömoni, solunum yetmezliği kaydedildi. Bulgular: Toplam 44 (%3,1) olguda PPK gelişti ve 1 olgu postoperatif erken dönemde yaşamını yitirdi. Yaş ortalaması yüksek olanlarda, ASA skoru yüksek olanlarda, ek hastalığı olanlarda, vücut kitle indeksi (VKI) yüksek olanlarda, preoperatif klinik değerlendirmede patolojisi olanlarda, solunum fonksiyon testinde (SFT) patolojisi olanlarda ve arter kan gazında PaC02 > 45mmHg olan olgularda, PPK gelişme oranı daha yüksek bulundu. Son 8 hafta sigara içilmesi ile PPK arsında ilişki saptanmadı. Genel anestezi uygulanan olgularda, rejyonal anestezi uygulananlara göre PPK daha sık görüldü. Postoperatif pulmoner komplikasyon gelişen olgularda PRI daha yüksek bulundu. Sonuç: Sonuç olarak preoperatif dönemde iyi bir anemnez ve fizik muayene, ayrıca gerekirse SFT gibi ek incelemeler yapılarak hastalar değerlendirilmeli, pulmoner risk faktörleri gözden geçirilmeli ve riskli olgularda rejyonal anestezi öncelikle akılda tutulmalıdır.

The retrospective investigation of relaion of preoperative respiratory evaluation and anesthesia types and morbidty-mortality in the orthopedic surgery

Objective: Pulmonary complications that occur postoperatively are important reasons of mortality and morbidity. The aim of this study is to research the relation between pulmonary complications, and preoperative risk factors, pulmonary risk index (PRI) and anesthesia type performed in patients who have undergone orthopedic surgery. Method: After Ethical Community consent, 1406 elective cases which were operated by Department of Orthopedics and Traumatology of Uludağ University Medical Faculty between January 2007- June 2008. Gender, age, clinical ASA status and anaesthesia types of all the subjects were recorded. Additional systemic diseases and operation types were also recorded. PRI of all patients were calculated. Six parameters were evaluated in this index. Postoperative pulmonary complications (PPC) determined in 24 hours postoperatively and mortality were also recorded. Atelectasis, pneumonia and respiratory failure were recorded as PPC. Results: Postoperative pulmonary complications developed in 44 (3.1%) subjects and 1 subject died in the early postoperative period. The rate of developing PPC was found out to be higher in patients older than mean age, with high ASA status, with additional diseases, with a high body mass index (BMI), with patology in preoperative clinical evaluation, with abnormal results in pulmonary function tests (PFTs) and the ones who had PaC02 > 45mmHg in arterial blood samples. There was no relation between smoking in the last 8 weeks and PPK. Postoperative pulmonary complications rate was higher in patients who were administered general anesthesia compared with patients who had regional anaesthesia. Pulmonary risk index was higher in the subjects who developed PPC. Conclusion: Eventually, in the preoperative period, patients must be evaluated by taking a good medical history, performing an appropriate physical examination and it if deemed neccessary, additional examinations like PFTs must be used. Pulmonary rise factors must be evaluated, and for critical patients, regional anaesthesia techniques should be retained.

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