Ortopedide turnike kullanımı: İstanbul’daki ortopedistler ve uzmanlık öğrencileri arasında tanımlayıcı anket çalışması

Abstract

Amaç: Bu çalışmanın amacı, Türkiye’deki ortopedist ve uzmanlık öğrencilerinin turnike kullanımındaki eğilimlerini ve bu eğilimlerin dayandığı bilgilerin doğruluğunu yüz yüze uygulanmış bir anket ile araştırmak ve anket sonuçlarını yorumlamaktı.

Çalışma planı: On iki sorudan oluşan anket, Türkiye’de bulunan ve ortopedi ameliyatlarına aktif olarak katılan ortopedist ve uzmanlık öğrencilerine yüz yüze uygulandı. Ankette hekimlerin kişisel bilgileri, tercih ettikleri manşon basınçları (MB) ile turnike şişirme süreleri (TŞS) ve bu tercihlerin dayandığı bilgilerin kaynağı sorgulandı. Alınan yanıtlar istatistiksel olarak analiz edildi.

Bulgular: Ankete 211 ortopedist ve uzmanlık öğrencisi katıldı. Üst ekstremitede (ÜE) tercih edilen ortalama MB ve TŞS, sırasıyla, 247.1 mmHg ve 108.6 dakika iken, alt ekstremitede (AE) bu değerler, yine sırasıyla, 345.02 mmHg ile 122.4 dakika idi. Alt ekstremitede tercih edilen basınç miktarı ile meslekte çalışma süresi arasında istatistiksel olarak anlamlı düzeyde bir korelasyon saptandı; meslekte çalışma süresi arttıkça tercih edilen basınç miktarı da artıyordu (r=0.144, p=0.04). Üst ekstremite ve AE için, ankete katılanların sırasıyla %95.7 ile %84.8’i turnikeyi en fazla 120 dakika boyunca kullanmayı tercih etmişlerdi.

Çıkarımlar: Ortopedist ve uzmanlık öğrencilerinin tercih ettikleri MB’nin literatür bilgisi ile uyumlu olmadığı ve bilimsel önerilerin üstündeki MB’nin sıklıkla tercih edildiği saptandı. Çalışmanın sonuçları güncel turnike kullanımının gözden geçirilmesi konusunda uyarıcı niteliktedir. Turnike kullanımı konusunda deneyime dayalı uygulamaların ve kişisel öğretilerin yerini kanıta dayalı uygulamalar almalıdır.

Keywords

• Anket; kılavuz; ortopedik ameliyat; turnike.

Tourniquet use in orthopedic surgery: a descriptive survey study among Turkish orthopedic surgeons and residents in Istanbul

Abstract

Objective: The aim of this study was to investigate and interpret the trends in tourniquet use and the accuracy of knowledge among Turkish orthopedic physicians through face-to-face survey.

Methods: Turkish orthopedic physicians actively practicing operative orthopedics were questioned in a 12 question face-to-face survey. Personal information of physicians, preferred cuff pressure (CP) and tourniquet inflation time (TIT) and the source of the information for these preferences were questioned. Answers gathered were analyzed statistically.

Results: The survey was completed by 211 orthopedic physicians. Mean preferred CP and TIT was 247.1 mmHg and 108.6 minutes, respectively, in the upper limb (UL) and 345.02 mmHg and 122.4 minutes, respectively, in the lower limb (LL). A statistically significant correlation was found between the amount of pressure preferred in the LL and the years of practice; longer the years in practice, higher the amount of pressure preferred (r=0.144, p=0.04). Tourniquets were used for a maximum period of 120 minutes for the UL by 95.7% of participants and for the LL by 84.8%.

Conclusion: The amount of CP used by the orthopedic physicians surveyed is inconsistent with the literature with frequent use of CP higher than those scientifically recommended. The outcomes of the survey should be cautionary for orthopedic physicians to review the current utilization and replace personal teachings and experience-based methods with evidence-based best practices for tourniquet application.

Keywords

• Guideline
• orthopedic surgery
• survey
• tourniquet

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