Perkütan taş cerrahisinde supin ve prone pozisyonlarında kan gazı değişiklikleri
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Perkütan nefrolitotomi (PNL) operasyonunda hemodinamik açıdan prone veya supin pozisyonlarından hangisinin avantajlı olduğunu bulmayı amaçladık. Gereç – Yöntem: Kliniğimizde PNL operasyonu planlanan 123 hasta randomize olarak iki gruba ayrıldı. Grup 1'deki 67 hastaya prone, grup 2'deki 56 hastaya supin pozisyonda PNL uygulandı. Hastaların preoperatif (pre-op) ve postoperatif (post-op) spontan solurken Arteriyel kan gazı değerlerine bakıldı. Bulgular: Grup 1 (prone) ve grup 2'deki (supin) hastalarının ortalama yaşları grup 1'de 49,2±13,5 yıl iken grup 2'de 57,3±12,8 yıldır. Grup 1'de ortalama taş boyutu 29,8±11,2 mm iken grup 2'de 20,8±7,2 mm'dir. Grup 1'de ortalama ameliyat süresi 109,9±40,4 dk iken grup 2'de 59±24 dk'dır. Grup 1 ve grup 2'deki tüm hastalara standart PNL yapılmıştır. Grup 1'in ve grup 2'nin pre-op ve post-op dönemlerde alınan kan gazı verilerine bakıldığında post-op dönemde her iki grupta da istatistiksel olarak anlamlı pH düşmesi görüldü. pH düşme farklarını karşılaştırdığımızda istatistiksel olarak anlamlı fark bulunamadı. Grup 1'in ve grup 2'nin pCO2 verilerini karşılaştırdığımızda her iki grupta da post-op dönemde pCO2 değerlerinde istatistiksel olarak anlamlı derecede artış bulundu. Her iki grubun pCO2 artış değerleri karşılaştırıldığında istatistiksel olarak anlamlı değildi. Grup 1'in pre-op ve post-op dönemde SpO2 değerleri arasında istatistiksel olarak anlamlı fark bulunmazken, grup 2'nin post-op SpO2 değerinde pre-op değere kıyasla istatistiksel olarak anlamlı düşme bulundu. Grup 1'in ve grup 2'nin pre-op ve post-op hemoglobin değerleri karşılaştırıldığında her iki grupta da istatistiksel olarak hemoglobin değerinde anlamlı düşme gördük. Grup 1'in ve grup 2'nin pre-op ve post-op bikarbonat değişimlerine bakıldığında her iki grupta da bikarbonatta istatistiksel olarak anlamlı düşme gördük. Grup 1'in ortalama taburculuk süresi 3,34±1,78 gün iken, grup 2'nin 3,05±1,1 gündür. Grup 1'in Stone Free (SF-Taşsızlık) değerlendirdiğimizde genel başarı %86,9 iken, grup 2'nin %92,9'dur. Grup 1'de staghorn taş sayısı 14 hastada mevcut iken grup 2'de staghorn taş yoktu. Sonuç: PNL hastalarının hemodinamisi operasyon sırasında ve sonrasındaki kısa dönemde bozulmaktadır. Supin ve prone pozisyon arasında bu açıdan bir fark olmadığı düşünülmektedir.
Aim: We aimed to find out which of the prone or supine positions is advantageous in terms of hemodynamics in percutaneous nephrolithotomy (PCNL) operation. Material and Method: 123 patients who were planned to undergo PCNL surgery in our clinic were randomly divided into two groups. PCNL was applied to 67 patients in group 1 in the prone position, and to 56 patients in group 2 in the supine position. The patients' preoperative (pre-op) and post-operative (post-op) arterial blood gas values were measured while they were breathing spontaneously. Results: The average age of the patients in group 1 (prone) and group 2 (supine) was 49.2±13.5 years in group 1 and 57.3±12.8 years in group 2. While the average stone size was 29.8±11.2 mm in group 1, it was 20.8±7.2 mm in group 2. While the average surgery time in group 1 was 109.9±40.4 minutes, it was 59±24 minutes in group 2. All patients in group 1 and group 2 underwent standard PCNL. When the blood gas data of group 1 and group 2 taken in the pre-operative and post-operative periods were examined, a statistically significant decrease in pH was observed in both groups in the post-operative period. When we compared the pH decrease differences, no statistically significant difference was found. When we compared the pCO2 data of group 1 and group 2, a statistically significant increase in pCO2 values was found in both groups in the post-operative period. When the pCO2 increase values of both groups were compared, it was not statistically significant. While there was no statistically significant difference between the SpO2 values of group 1 in the pre-op and post-op periods, a statistically significant decrease was found in the post-op SpO2 value of group 2 compared to the pre-op value. When the pre-op and post-op hemoglobin values of group 1 and group 2 were compared, we saw a statistically significant decrease in hemoglobin values in both groups. When we looked at the pre-operative and post-operative bicarbonate changes of group 1 and group 2, we saw a statistically significant decrease in bicarbonate in both groups. While the average discharge time for group 1 was 3.34±1.78 days, it was 3.05±1.1 days for group 2. When we evaluate the Stone Free (SF) score of group 1, the overall success rate is 86.9%, while group 2's is 92.9%. While the number of staghorn stones was present in 14 patients in group 1, there were no staghorn stones in group 2. Conclusion: The hemodynamics of PCNL patients deteriorate during and in the short term after the operation. It is thought that there is no difference between supine and prone positions in this respect.
Aim: We aimed to find out which of the prone or supine positions is advantageous in terms of hemodynamics in percutaneous nephrolithotomy (PCNL) operation. Material and Method: 123 patients who were planned to undergo PCNL surgery in our clinic were randomly divided into two groups. PCNL was applied to 67 patients in group 1 in the prone position, and to 56 patients in group 2 in the supine position. The patients' preoperative (pre-op) and post-operative (post-op) arterial blood gas values were measured while they were breathing spontaneously. Results: The average age of the patients in group 1 (prone) and group 2 (supine) was 49.2±13.5 years in group 1 and 57.3±12.8 years in group 2. While the average stone size was 29.8±11.2 mm in group 1, it was 20.8±7.2 mm in group 2. While the average surgery time in group 1 was 109.9±40.4 minutes, it was 59±24 minutes in group 2. All patients in group 1 and group 2 underwent standard PCNL. When the blood gas data of group 1 and group 2 taken in the pre-operative and post-operative periods were examined, a statistically significant decrease in pH was observed in both groups in the post-operative period. When we compared the pH decrease differences, no statistically significant difference was found. When we compared the pCO2 data of group 1 and group 2, a statistically significant increase in pCO2 values was found in both groups in the post-operative period. When the pCO2 increase values of both groups were compared, it was not statistically significant. While there was no statistically significant difference between the SpO2 values of group 1 in the pre-op and post-op periods, a statistically significant decrease was found in the post-op SpO2 value of group 2 compared to the pre-op value. When the pre-op and post-op hemoglobin values of group 1 and group 2 were compared, we saw a statistically significant decrease in hemoglobin values in both groups. When we looked at the pre-operative and post-operative bicarbonate changes of group 1 and group 2, we saw a statistically significant decrease in bicarbonate in both groups. While the average discharge time for group 1 was 3.34±1.78 days, it was 3.05±1.1 days for group 2. When we evaluate the Stone Free (SF) score of group 1, the overall success rate is 86.9%, while group 2's is 92.9%. While the number of staghorn stones was present in 14 patients in group 1, there were no staghorn stones in group 2. Conclusion: The hemodynamics of PCNL patients deteriorate during and in the short term after the operation. It is thought that there is no difference between supine and prone positions in this respect.
Açıklama
Tıp Fakültesi, Üroloji Ana Bilim Dalı
Anahtar Kelimeler
Üroloji, Urology
