Sezaryen doğumda ERAS (Enhanced Recovery After Surgery) (cerrahi sonrası hızlandırılmış iyileşme) protokolü uygulanan kadınların prospektif randomize çalışmada iyileşme süreçlerinin değerlendirilmesi
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Date
2021
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Düzce Üniversitesi
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info:eu-repo/semantics/openAccess
Abstract
Sezaryen doğumda ERAS (Enhanced Recovery After Surgery) (Cerrahi sonrası hızlandırılmış iyileşme) protokolü uygulanan kadınların erken iyileşme süreçlerinin değerlendirilmesi: prospektif randomize kontrollü bir çalışma Amaç: Çalışmamızın amacı sezaryen doğumda ERAS (Enhanced Recovery After Surgery) (Cerrahi sonrası hızlandırılmış iyileşme) protokolü uygulanan kadınların erken iyileşme süreçlerinin değerlendirilmesidir. Gereç ve Yöntemler: Kasım 2020- Şubat 2021 tarihleri arasında hastanemiz Kadın Hastalıkları ve Doğum Kliniğine başvuran 18 yaş ve üzeri, 37. gebelik haftası ve üzeri, sezaryenle doğum yapan, acil olmayan (preeklampsi, plasenta previa, dekolman plasenta, enfeksiyon, sistemik morbiditeye sebep olan hastalık, geçirilmiş operasyonlara sekonder barsak adezyonları gibi ek obstetrik patolojisi olmayan) doğum yapan gebeler randomize edildi. Gebeler postoperatif gaz deşarj zamanı, vizüel ağrı skoru, emzirme, emzirme zamanı, günlük faaliyetlere geri dönüş zamanı, postoperatif hemogram değeri, postoperatif bulantı ve kusma, hastaneye yeniden başvuru, postoperatif yara yeri enfeksiyonu, annelik hüznü ve kan transfüzyonu ihtiyacı açısından karşılaştırıldı. Bulgular: Çalışmaya 78 gebe ERAS grubuna, 78 gebe kontrol grubuna dahil olmak üzere 156 gebe dahil edilmiştir. Postoperatif gaz deşarj saati, vizüel ağrı skoru, emzirmeye başlama süresi, günlük normal faaliyetlere dönüş süresi ERAS grubunda anlamlı olarak düşük ve emzirme oranı anlamlı olarak yüksek bulundu(p<0,001). Bulantı kusma(p=0,442) hastaneye yeniden başvuru(p=0,39), yara yeri enfeksiyonu(p=0,245), ve doğum sonrası hüzün(p=0,428) oranları ERAS grubunda kontrol grubuna göre düşük bulundu fakat istatistiksel olarak anlamlı fark izlenmedi. Postoperatif hemogram ve hemogram farkı bulgularında istatistiksel olarak anlamlı fark izlenmemiştir (p=0,984). Kan transfüzyon ihtiyacı kontrol grubunda ERAS grubundan daha düşük bulunmuştur. Sonuç: Sonuçlarımız sezaryan doğumda ERAS'ın postoperatif iyileşmeyi hızlandırdığını, normal faaliyetlere erken dönüşe faydalı olduğunu, erken taburculuğu kolaylaştırdığını, anne memnuniyetini arttırdığını ve morbiditeyi azalttığını destekledi. ERAS'ın sezaryen doğumda yaygınlaşması hem maternal hem fetal açıdan faydalı görünmektedir.
Researching of the early recovery processes of woman who implemented ERAS protocol (Enhanced Recovery After Surgery) at cesarean section: a prospective randomized controlled trial Objective: The aim of our study was to evaluate the early recovery processes of women who implemented the ERAS (Enhanced Recovery after Surgery) protocol at cesarean delivery by caserean section. Materials and Methods: Between November 2020 February 2021, applying to our hospital Obstetrics and Gynecology Clinic 18 years and over, 37. week of pregnancy and over, delivered by caesarean section, non-urgent (preeclampsia, placenta previa, decolman placenta, infection, disease that causes systemic morbidity, no additional obstetric pathology, such as intestinal adhesions secondary to previous operations) pregnant women were randomized. In terms of postoperative flatus time, the visual pain score, breastfeeding, breastfeeding time, time to return to daily activities, postoperative hemogram values, postoperative nausea and vomiting, readmission to the hospital, postoperative wound infection, postpartum blues, the need for blood transfusion were compared. Results: 156 pregnant women were included in the study, including 78 pregnant ERAS groups and 78 pregnant control groups. Postoperative flatus time, visual pain score, time to start breastfeeding, time to return to normal daily activities were found to be significantly low in the ERAS group and the rate of breastfeeding was significantly high (p<0,001). Nausea and vomiting(p=0,442), readmission to the hospital(p=0,39), wound infection(p=0,245), and postpartum blues(p=0,428) rates were found to be low in the ERAS group compared to the control group, but no statistically significant difference was observed. No statistically significant difference was observed in postoperative hemogram and hemogram difference results (p=0,984). Blood transfusion needs were observed to be lower in the control group than in the ERAS group. Conclusion: Our results supported that ERAS at caesarean birth accelerated postoperative recovery, beneficial for an early return to normal activities, facilitates early discharge, increases maternal satisfaction, and reduces morbidity. The spread of ERAS in cesarean delivery seems to be beneficial both from a maternal and fetal point of view.
Researching of the early recovery processes of woman who implemented ERAS protocol (Enhanced Recovery After Surgery) at cesarean section: a prospective randomized controlled trial Objective: The aim of our study was to evaluate the early recovery processes of women who implemented the ERAS (Enhanced Recovery after Surgery) protocol at cesarean delivery by caserean section. Materials and Methods: Between November 2020 February 2021, applying to our hospital Obstetrics and Gynecology Clinic 18 years and over, 37. week of pregnancy and over, delivered by caesarean section, non-urgent (preeclampsia, placenta previa, decolman placenta, infection, disease that causes systemic morbidity, no additional obstetric pathology, such as intestinal adhesions secondary to previous operations) pregnant women were randomized. In terms of postoperative flatus time, the visual pain score, breastfeeding, breastfeeding time, time to return to daily activities, postoperative hemogram values, postoperative nausea and vomiting, readmission to the hospital, postoperative wound infection, postpartum blues, the need for blood transfusion were compared. Results: 156 pregnant women were included in the study, including 78 pregnant ERAS groups and 78 pregnant control groups. Postoperative flatus time, visual pain score, time to start breastfeeding, time to return to normal daily activities were found to be significantly low in the ERAS group and the rate of breastfeeding was significantly high (p<0,001). Nausea and vomiting(p=0,442), readmission to the hospital(p=0,39), wound infection(p=0,245), and postpartum blues(p=0,428) rates were found to be low in the ERAS group compared to the control group, but no statistically significant difference was observed. No statistically significant difference was observed in postoperative hemogram and hemogram difference results (p=0,984). Blood transfusion needs were observed to be lower in the control group than in the ERAS group. Conclusion: Our results supported that ERAS at caesarean birth accelerated postoperative recovery, beneficial for an early return to normal activities, facilitates early discharge, increases maternal satisfaction, and reduces morbidity. The spread of ERAS in cesarean delivery seems to be beneficial both from a maternal and fetal point of view.
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Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology, ERAS, SEZARYEN, GAZ, AĞRI, EMZİRME, ERAS, CESAREAN, FLATUS, PAIN, BREASTFEEDİNG
