Investigate of the Effects of Hypothermia Management on the Postoperative Delirium Development and Pain in Patients Undergoing Total Knee Arthroplasty
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2024
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Bu araştırma total diz artroplastisi yapılan hastalarda perioperatif hipotermi yönetiminin ameliyat sonrası deliryum gelişimine ve ağrıya etkisini incelemek amacıyla randomize kontrollü olarak yapıldı. Araştırmanın evrenini İstanbul ili Avrupa yakasında bulunan bir üniversite hastanesinde Ekim 2022-Haziran 2024 tarihleri arasında ameliyathane ve ortopedi ve travmatoloji kliniğinde total diz artroplastisi uygulanan tüm hastalar, örneklemini ise bu tarihler arasında araştırmaya dahil olma kriterlerini karşılayan 30 girişim 30 kontrol olmak üzere toplam 60 hasta oluşturdu. Girişim grubunda bulunan hastalara ameliyat öncesi, sırası ve sonrası sıcak hava üflemeli aktif ısıtma yapılırken kontrol grubuna pasif ısıtma yöntemi içeren standart bakım uygulandı. Bu araştırma Türkiye Bilimsel ve Teknolojik Araştırma Kurumu (TÜBİTAK, Proje No: 223S606) tarafından desteklendi. Araştırmanın verileri Hasta Bilgi Formu, Ameliyat Öncesi Hasta İzlem Formu, Ameliyat Sırası Hasta İzlem Formu, Ameliyat Sonrası Ayılma Odası Hasta İzlem Formu, Ameliyat Sonrası Klinik Hasta İzlem Formu, Standardize Mini Mental Test, Hemşirelik Deliryum Tarama Ölçeği (Nu-DESK) ve Sayısal Ağrı Ölçeği ile toplandı. Araştırmada elde edilen veriler SPSS (Statistical Package for Social Sciences) for Windows 25.0 programı kullanılarak analiz edildi. Verilerin değerlendirilmesinde tamımlayıcı istatistikler için frekans, yüzde, minimum, maksimum ve medyan değerleri, kategorik değişkenler için Ki kare Testi kullanıldı. Normal dağılıma uygunluk Q-Q Plot çizimi, çarpıklık ve basıklık katsayıları (±3) ile değerlendirdi. Normal dağılım gösteren değişkenlerin karşılaştırmak için Bağımsız Örneklem T Testi, normal dağılıma uymayan değişkenlerin karşılaştırılmasında Mann Whitney U Testi kullanıldı. Nicel değişkenlerin bağımlı iki grup arasındaki farkı test etmek için Wilcoxon testi, bağımlı örneklem t testi, tekrarlı ölçümlerde ANOVA (F) Testi, Friedman Testi, çoklu karşılaştırma testi Bonferroni Dunn uygulandı. Bağımlı iki grubun farklı zaman diliminde değişimini incelemek için McNemar Testi, 2'den fazla ölçümlerde Cochran's Q Testi kullanıldı. Ölçekler arasında ilişki Spearman korelasyon analizi ile test edildi. Araştırmada anlamlılık düzeyi p<0,05 kabul edildi. Anlamlılık gösteren testler için etki büyüklüğü hesaplandı. Girişim ve kontrol grubundaki hastaların sosyodemografik ve tanıtıcı özelliklerine göre gruplar arasında istatistiksel olarak anlamlı fark saptanmadı (p>0,05). Girişim grubunda ameliyat sırası hipotermi insidansının %43,3, kontrol grubunda %86,7 olduğu saptandı (p=0,001). Girişim grubundaki hastaların ameliyat sırası, ameliyat sonrası ayılma odası ve kliniğe alındığında ortalama vücut sıcaklığı kontrol grubuna göre istatistiksel olarak anlamlı düzeyde yüksek olduğu saptandı (p<0,05). Ameliyat sırasında ve sonrasında titreme sıklığının girişim grubunda kontrol grubuna göre anlamlı derecede düşük olduğu bulundu (p<0,05). Ameliyat sonrası 6., 12., 24., 36., 48 ve 60. saat ağrı puanları girişim grubunda, kontrol grubu ile karşılaştırıldığında anlamlı derecede düşük olduğu saptandı (p<0,05). Ameliyat sonrası deliryum gelişimi girişim grubunda %6,7, kontrol grubunda %20 olup iki grup arasındaki fark anlamlı bulunmadı (p>0,05; p=0,255). Grupların ağrı durumları ile deliryum arasında istatistiksel olarak anlamlı bir ilişki olmadığı saptandı (p>0,05). Bu araştırmada total diz artroplastisi olan hastalarda ameliyat öncesi, sırası ve sonrası aktif ısıtma ile yapılan hipotermi yönetiminin perioperatif istenmeyen hipotermiyi, titreme durumunu ve ameliyat sonrası ağrıyı azalttığı, deliryum gelişimini ve deliryum ile ağrı arasındaki ilişkiyi etkilemediği sonucuna varıldı. Araştırmanın büyük örneklem gruplarında farklı değişkenler ile tekrar edilmesi önerilir. Anahtar Kelimeler: Ameliyat sonrası deliryum, Ameliyat sonrası ağrı, Ameliyat sonrası titreme, Aktif ısıtma, Deliryum, İstenmeyen hipotermi, Total diz artroplastisi
This randomised controlled trial was conducted to investigate the effect of perioperative hypothermia management on the development of postoperative delirium and pain in patients undergoing total knee arthroplasty. The population of the study consisted of all patients who underwent total knee arthroplasty in the operating theatre and orthopaedics and traumatology clinic between October 2022 and June 2024 in a university hospital located on the European side of Istanbul, and the sample consisted of a total of 60 patients, 30 intervention and 30 control, who met the criteria for inclusion in study between these dates. Patients in the intervention group were applied actively warmed using forced-air warming before, during and after surgery while the control group applied standard care consisting of passive warming method. This study was supported by Scientific and Technological Research Council of Türkiye (TUBITAK, Proje No: 223S606). The data of the study were collected using the Patient Information Form, Preoperative Patient Monitoring Form, Intraoperative Patient Monitoring Form, Postoperative Recovery Room Patient Monitoring Form, Postoperative Clinical Patient Monitoring Form, Standardized Mini Mental Test, Nursing Delirium Screening Scale (Nu-DESK) and Numeric Pain Scale. SPSS (Statistical Package for Social Sciences) for Windows 25.0 program was used for statistical analysis of the data obtained as a result of the research. Descriptive statistics such as frequency, percentage, minimum, maximum, and median values were used for the evalulate the data, and the Chi-square Test was used for categorical variables. The normality of the measurement data was evaluadet using the Q-Q Plot, skewness, and kurtosis coefficients (±3). Independent Sample T-Test was used to comparison variables with normal distribution, and the Mann-Whitney U test was used for comparison variables that did not show normal distribution. Wilcoxon test, dependent sample t test, repeated measures ANOVA (F) test, Friedman test, and Bonferroni Dunn multiple comparison test were used to test the difference between quantitative variables in two dependent groups. McNemar Test was used to examine the change in two dependent groups over time, and Cochran Q Test was used for more than two measurements. Spearman correlation analysis was used to evelaute the relationships between scales. The significance level was accepted as p<0.05. Effect size was calculated for tests that showed significance. There was no statistically significant difference between the groups according to the sociodemographic and descriptive characteristics of the patients in the intervention and control groups (p>0.05). The incidence of intraoperative hypothermia was 43.3% in the intervention group and 86.7% in the control group (p=0.001). The mean body temperature values of the patients in the intervention group intraoperative, postoperative recovery room and in the clinic were found to be statistically significantly higher than in the control group (p<0.05). The incidence of intraoperative and postoperative shivering was found significantly lower in the intervention than in the control group (p<0.05). Postoperative pain scores at 6, 12, 24, 36, 48 and 60 hours were found significantly lower in intervention group compared to control group (p<0.05). Postoperative delirium development was 6.7% in the intervention group and 20% in the control group; there was no statistically significant difference between the groups (p>0.05; p=0.255). No statistically significant relationship was found between pain score and delirium in the groups (p>0.05). In this study, it was concluded that preoperative, intraoperative and postoperative hypothermia management with active heating decreased perioperative inadvertent hypothermia, shivering and postoperative pain in patients with total knee arthroplasty, but did not affect the development of delirium and the relationship between delirium and pain. It is recommended that the study be repeated on larger sample groups with different variables. Keywords: Postoperative delirium, Postoperative pain, Postoperative shivering, Active warming, Delirium, Inadvertent hypothermia, Total knee arthroplasty
This randomised controlled trial was conducted to investigate the effect of perioperative hypothermia management on the development of postoperative delirium and pain in patients undergoing total knee arthroplasty. The population of the study consisted of all patients who underwent total knee arthroplasty in the operating theatre and orthopaedics and traumatology clinic between October 2022 and June 2024 in a university hospital located on the European side of Istanbul, and the sample consisted of a total of 60 patients, 30 intervention and 30 control, who met the criteria for inclusion in study between these dates. Patients in the intervention group were applied actively warmed using forced-air warming before, during and after surgery while the control group applied standard care consisting of passive warming method. This study was supported by Scientific and Technological Research Council of Türkiye (TUBITAK, Proje No: 223S606). The data of the study were collected using the Patient Information Form, Preoperative Patient Monitoring Form, Intraoperative Patient Monitoring Form, Postoperative Recovery Room Patient Monitoring Form, Postoperative Clinical Patient Monitoring Form, Standardized Mini Mental Test, Nursing Delirium Screening Scale (Nu-DESK) and Numeric Pain Scale. SPSS (Statistical Package for Social Sciences) for Windows 25.0 program was used for statistical analysis of the data obtained as a result of the research. Descriptive statistics such as frequency, percentage, minimum, maximum, and median values were used for the evalulate the data, and the Chi-square Test was used for categorical variables. The normality of the measurement data was evaluadet using the Q-Q Plot, skewness, and kurtosis coefficients (±3). Independent Sample T-Test was used to comparison variables with normal distribution, and the Mann-Whitney U test was used for comparison variables that did not show normal distribution. Wilcoxon test, dependent sample t test, repeated measures ANOVA (F) test, Friedman test, and Bonferroni Dunn multiple comparison test were used to test the difference between quantitative variables in two dependent groups. McNemar Test was used to examine the change in two dependent groups over time, and Cochran Q Test was used for more than two measurements. Spearman correlation analysis was used to evelaute the relationships between scales. The significance level was accepted as p<0.05. Effect size was calculated for tests that showed significance. There was no statistically significant difference between the groups according to the sociodemographic and descriptive characteristics of the patients in the intervention and control groups (p>0.05). The incidence of intraoperative hypothermia was 43.3% in the intervention group and 86.7% in the control group (p=0.001). The mean body temperature values of the patients in the intervention group intraoperative, postoperative recovery room and in the clinic were found to be statistically significantly higher than in the control group (p<0.05). The incidence of intraoperative and postoperative shivering was found significantly lower in the intervention than in the control group (p<0.05). Postoperative pain scores at 6, 12, 24, 36, 48 and 60 hours were found significantly lower in intervention group compared to control group (p<0.05). Postoperative delirium development was 6.7% in the intervention group and 20% in the control group; there was no statistically significant difference between the groups (p>0.05; p=0.255). No statistically significant relationship was found between pain score and delirium in the groups (p>0.05). In this study, it was concluded that preoperative, intraoperative and postoperative hypothermia management with active heating decreased perioperative inadvertent hypothermia, shivering and postoperative pain in patients with total knee arthroplasty, but did not affect the development of delirium and the relationship between delirium and pain. It is recommended that the study be repeated on larger sample groups with different variables. Keywords: Postoperative delirium, Postoperative pain, Postoperative shivering, Active warming, Delirium, Inadvertent hypothermia, Total knee arthroplasty
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Hemşirelik, Nursing
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