Süleyman NOGAY, Cem ŞEN, Seyithan TAYSİ, Yılmaz SAFİ, Hasan ULUSAL, Cuma YILDIRIM, Suat ZENGİN, Mustafa SABAK

Kalıcı Tünelli Port Kateter Takılan Hastalarda Sedatif Ajanların Stress Hormonları ve High Sensitif Troponin Üzerine Etkileri

Amaç: Santral venöz kateter takılan hastalarda sedasyon ve analjezinin ağrı sakalaları, anksiyete; adrenokortikotropik hormon (ACTH), kortizol ve High-sensitif troponin üzerine etkilerini araştırmak. Yöntemler: Bu çalışma hematoloji ve onkoloji servisinde yatan ve acil serviste port kateterizasyon işlemi uygulanan 90 hastada yapılan prospektif bir çalışmadır. Çalışma 1 Mart- 1 Eylül 2015 tarihleri arasında Gaziantep Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı’nda yapıldı. Hastalar 30 kişilik gruplar halinde 3 gruba ayrıldı. Ağrı seviyeleri Visüel Anolog Skala (VAS), anksiyete seviyeleri Beck Anksiyete Skalası kullanılarak ölçüldü. İşleme başlandığı anda, işlem bittikten sonraki 30. dakikada kan alındı. ACTH, kortizol ve high sinsitif troponin seviyelerine bakıldı. Bulgular: Gruplar arasındaki yaş ve cinsiyet farkı istatistiksel olarak anlamsızdı (p=0,836 ve p=0,182). Anksiyete her üç grupta da belirgin azalmıştı. Midazolam-fentanil grubunda ve propofol alan hastalarda ağrıda belirgin azalma oldu. Bu hastalardan aynı zamanda her iki grupta da sistolik ve diastolik kan basınçlarında belirgin azalma oldu. Her 3 grupta da high sensitive troponin düzeylerinde belirgin değişiklik olurken kortizol seviyelerinde belirgin bir değişiklik olmadı. Gruplar arası farklılıklar anlamlı değildi. Sonuç: Özellikle santral venöz kateterizasyon olmak üzere küçük cerrahi girişimlerde sedatif ilaçların kullanımı etkili ve güvenlidir. Acil serviste yapılan invaziv işlemler sırasında anksiyolitik ve sedative ilaçların yanında analjezik ilaçların da kullanımını öneriyoruz.

The Effect of Sedative Agents on Stress Hormones and High-Sensitive Troponin in Patients Catheterized by Permanent-Tunnel Port Catheter

Objective: To evaluate the effects of sedation and analgesia combinations on pain scales, anxiety, adrenocorticotropic hormone(ACTH), cortisol, and high-sensitive troponin in patients with a central venous catheter.Methods: The present study was prospectively conducted in 90 patients who had been indicated for port catheterization in hematologyand oncology in the emergency medicine department of Gaziantep University Medical Faculty between March 1st and September1st, 2015. The patients were divided into three groups of 30 each. Pain levels were assessed using the Visual Analog Scale,anxiety levels using the Beck Anxiety Scale, and blood samples were collected before (0 min) and after (30 min) the procedure inorder to obtain ACTH, cortisol, and high-sensitive troponin values.Results: No statistically significant differences were observed between the groups with regard to gender and age (p=0.836 andp=0.182, respectively). Anxiety significantly decreased in all three groups. A significant decrease in level of pain was found in patientsadministering midazolam-fentanyl and those who received propofol; a significant decrease in systolic and diastolic bloodpressure was also observed in these two groups. In all three groups, no significant cortisol change was found; however, significanthigh-sensitive troponin values were observed. There was no significant difference between the groups.Conclusion: Sedative agents can be used efficiently, safely, and easily in minor surgical procedures, such as central venous catheterization.We also recommend the use of analgesic drugs, in addition to anxiolytic and sedative agents, during invasive proceduresconducted in the emergency room.

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