Ağrılı Hastaya Yaklaşım
Özet
Amaç: Acil serviste yeterli analjezinin sağlanması gerekmektedir; ancak acil servisteki oligoanaljezi olarak adlandırılan yetersiz analjezi kullanımı halen büyük bir sorun olarak karşımıza çıkmaktadır. Bu araştırmada üçüncü basamak bir acil serviste hastalara verilen ağrı kesici tedavi protokolleri araştırılarak yeterli analjezik tedavi verilip verilmediği ve hasta memnuniyeti araştırılmak istendi.
Gereç ve Yöntemler: Çalışma prospektif bir çalışma olarak tasarlandı. Yerel etik kurul onayından sonra (25.02.2008/057) ağrı şikayeti ile başvuran ve araştırma kriterlerini kapsayan hastalar çalışmaya dahil edildi. Başvuru sırasındaki geliş şikayetleri, ağrı ölçeği ile ağrı düzeyinin değerlendirmesi, analjezik kullanımı, tanıları, hastaların eğitim düzeyleri ve meslekleri, acil serviste kalış süreleri, ilaç uygulama yolu ve ve taburculuk sırasındaki ağrı düzeyi ve hasta memnuniyeti sorgulandı. Çalışma boyunca on altı grup analjezik ilaç kaydedildi. Bu gruba adjuvan analjezikler olarak adlandırılan ilaçlar da dahil edildi.
Bulgular: Hastaların yaş ortalaması 40,7 (18-88) ve 465'i (%53,1) kadındı. En sık görülen ağrı tipi 191 hastada (%21,8) gözlenen karın ağrısı idi. En sık kullanılan ilaçlar NSAİİ grubundaydı. Ağrısı olan hastaların %21,1'ine herhangi bir analjezik tedavi verilmemiş ve %62,6'sı ilaç tedavisini takiben ilk bir saat içinde taburcu edilmişti. Başvuru sırasındaki ortalama ağrı skoru 7, taburculuk sırasındaki skor ise 5 idi. Acil serviste kalış süresi ağrı şiddetindeki değişimle doğrudan ilişkiliydi. Ağrı şiddeti ile yaş, cinsiyet, eğitim düzeyi veya ağrı süresi arasında herhangi bir korelasyon tespit edilmedi.
Sonuç: Oligoanaljezi acil servislerde hala önemli bir sağlık sorunudur. Acil hekimi tarafından ağrıya yaklaşım ve buna yönelik eğitim sistemi yeniden gözden geçirilmelidir.
Aim: Adequate analgesia should be provided in the emergency department; however, the use of inadequate analgesia called oligoanalgesia in the emergency department is still a major problem. In this study, we aimed to investigate whether adequate analgesic treatment is provided and patient satisfaction by investigating the pain relief treatment protocols given to patients in a tertiary emergency department.
Materials and Methods: The study was designed as a prospective study. After the approval of the local ethics committee (25.02.2008/057), patients who presented with complaints of pain and fulfilled the study criteria were included in the study. Complaints on admission, assessment of pain level with the pain scale, analgesic use, diagnoses, educational level and occupation of the patients, length of stay in the emergency department, route of drug administration, and pain level and patient satisfaction at discharge were questioned. Sixteen groups of analgesic drugs were recorded throughout the study. The so-called adjuvant analgesics were also included in this group.
Results: The mean age of the patients was 40.7 years (18-88) and 465 (53.1%) were female. The most common pain type was abdominal pain, which was observed in 191 patients (21.8%). The most commonly used drugs were in the NSAID group. No analgesic treatment was given to 21.1% of the patients with pain and 62.6% were discharged within the first hour following medication. The mean pain score at admission was 7 and at discharge was 5. Length of stay in the emergency department was directly related to the change in pain severity. There was no correlation between pain intensity and age, gender, educational level or duration of pain.
Conclusion :Oligoanalgesia is still an important health problem in emergency departments. The approach to pain by emergency physicians and the education system should be revised.
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