OBEZ BİREYLERDE POZİSYONLARIN OKSİJEN SATURASYONUNA ETKİSİ

Yıl 2018, Cilt: 34 Sayı: 1, 54 - 65, 26.04.2018

Metin Tuncer , Leyla Khorshtd

Öz

Başlık: OBEZ BİREYLERDE POZİSYONLARIN
OKSİJEN SATURASYONUNA ETKİSİ

Title:    THE
EFFECT OF POSITIONS ON OXYGEN SATURATION IN OBESE INDIVIDUALS

Özet:

              Amaç:
Araştırma, obez hastalarda pozisyon değişiminin oksijen saturasyonuna etkisinin
incelenmesi amacıyla tanımlayıcı olarak yürütülmüştür.

Gereç-yöntem:
Araştırmanın evrenini 08.04.2017 - 01.08.2017 tarihleri arasında Ege
Üniversitesi Tıp Fakültesi Hastanesi’nde yatan obez hastalar oluşturmuştur.
Araştırmanın örneklemini ise 08.04.2017 - 01.08.2017 tarihleri arasında Ege
Üniversitesi Tıp Fakültesi Hastanesi’nde yatan obez hastalar (n=36)
oluşturmuştur. Çalışmanın yürütülmesi için Klinik Araştırmalar Etik Kurulundan
ve Ege Üniversitesi Tıp Fakültesi Hastanesi’nden gerekli yazılı izinler
alınmıştır. Verilerin analizinde
tekrarlayan ölçümlerde varyans analizi, Paired Sample t testi
kullanılmıştır.Verilerin toplanmasında “Hasta Tanıtım Formu” ile “Fizyolojik
Parametreler İzlem Formu” kullanılmıştır. Hastalardan bilgilendirilmiş onam alınmış ve hastalara 4 farklı pozisyon (dik oturur, supine, sağ
lateral, sol lateral) verilmiştir. Pozisyonların veriliş sırası kura çekilerek
randomize edilmiştir. Çalışma boyunca hastalar her pozisyonda 10 dakika
bekletilmiş ve pozisyonlar arasında 5 dakika fowlers pozisyonunda
dinlendirilmiştir. Her pozisyonda 0. dakikada ve 10. dakikada hastanın oksijen
saturasyonu, nabız hızı ve sistolik kan basıncı ölçülmüştür.

                Bulgular:
Araştırmaya katılan bireylerin %38,9’u 45-55 yaş grubundadır, %50’si kadındır,
%44,4’ünün beden kitle indeksi 30-34,9 kg/m²’dir,
%38,9’unun beden kitle indeksi 35-39,9 kg/m²’dir.
%16,7’sinin beden kitle indeksi 40 ve üzeri kg/m² ’dir. Yaş ortalaması 46.44 ±10.40 yıl (min:23,
max:64) olarak hesaplanmıştır. En Yüksek oksijen saturasyon ortalaması dik
oturur pozisyonda bulunurken en düşük oksijen saturasyonu ortalaması supine
pozisyonda bulunmuştur.

Sonuç:
En iyi oksijenizasyonun dik oturur pozisyonda olduğu bulunurken en düşük
oksijenizasyonun ise supine pozisyonda olduğu bulunmuştur.Obez hastalar 10
dakika süreyle aynı pozisyonda (supine, sol lateral, sağ lateral ve dik oturur)
kaldığında, sağ lateral pozisyonda sistolik kan basıncı artarken, supine, sol
lateral ve dik oturur pozisyonda sistolik kan basıncı azalmıştır.Pozisyonlar
arasında nabız hızı açısından fark bulunmamıştır. Hemşireler, obez hastalarda
en iyi oksijenizasyonu sağlamak için, hastaları dik oturur pozisyonda tutmalı
veya sağ lateral pozisyonda yatırmalıdır. Çalışma hastanede yatmayan ve
herhangi bir hastalığı olmayan obez bireylerde tekrarlanmalıdır.

Abstract:

              Aim:
The study was conducted as a descriptive study to investigate the effect of
positional change on oxygen saturation in obese patients.

Methods:
The population of the study was consisted of 
obese patients who hospitalized in Ege University Medical Faculty
Hospital between 2017/08/04 – 2017/01/08. The sample of the study consisted of
obese patients (n = 36) who were hospitalized at Ege University Medical Faculty
Hospital between 2017/08/04 – 2017/01/08. Written consent was obtained from
Clinical Research Ethical Commitee and Ege University Medical Faculty Hospital
for implementing the study. Repeated
measure variance analysis and Paired Sample t test was used in analysis of the
data.“Patients Information Form” and “Physiological Parameters Monitoring Form”
were used in the collection of data. Informed consent was obtained from patients and the patients were
given 4 different positions (upright, supine, right lateral, left lateral). The order of the positions is randomized by
drawing lots. During the study, the patient was kept in each position for 10
minutes and rested for 5 minutes between positions.  Oxygen saturation, pulse rate and systolic
blood pressure of the patients was measured at 0. minute and 10. minute at each
position.

Results:38.9%
of the subjects participating in the study were in the 45-55 age group, 50%
were females, 44.4% had body mass index of 30-34.9 kg / m2, 38.9% had body mass
index 35-39,9 kg / m2. 16,7% had body mass index of 40 and over kg / m2. The
mean age was calculated as 46.44 ± 10.40 years (min: 23, max: 64). The highest
oxygen saturation average was found in the upright position while the lowest
oxygen saturation average was found in the supine position.

Conclusion:
When obese patients stayed in the same position for 10 minutes (supine, left
lateral, right lateral, and upright sitting), systolic blood pressure increased
in the right lateral position while systolic blood pressure decreased in the
supine, left lateral and vertical sitting positions.

It was  determined that the pulse rate was not change
when the patients was positioned in the same positions (supine, left lateral,
right lateral ve sitting upright) during 10 minutes. To ensure optimal
oxygenation in obese patients, nurses should keep patients in a position to sit
upright or tilt in the right lateral position. The study should be repeated in
obese individuals who are not hospitalized and have no disease.

Anahtar kelimeler:   Vücut Pozisyonları; Obezite; Oksijenlenme; Pulse
Oksimetre

Keywords:                Body Positions; Obesity;Oxygenation; Pulse Oximeter

Destekleyen kurumlar: Destekleyen Kurum Bulunmamaktadır.

Kaynakça:

Benedik
PS, Baun MM, Keus L & et al. Effects of body position on resting lung volume
in overweight and mildly to moderately obese subjects. Respiratory care 2009;
54(3): 334-339.

Breiburg AN, Aitken L, Reaby L & et al.
Efficacy and safety of prone positioning for patients with acute respiratory
distress syndrome. Journal of advanced nursing 2000; 32(4): 922-929.

Ceylan B, Khorshid L, Güneş ÜY & et al.
Evaluation of oxygen saturation values in different body positions in healthy
individuals. Journal of clinical nursing 2016; 25: 1095-1100.

Dean E. Effect of body position on pulmonary function.
Physical Therapy 1985; 65(5): 613-618.

Fahy BG, Barnas GM, Nagle SE & et al. Effects
of Trendelenburg and reverse Trendelenburg postures on lung and chest wall
mechanics. Journal of clinical anesthesia 1996; 8(3): 236-244.

Fischer AJ, Kaese S, Lebiedz P. Management of obese
patients with respiratory failure–A practical approach to a healthcare issue of
increasing significance. Respiratory Medicine. 2016; 117: 174-178.

Fredheim JM. Obstructive sleep apnea in severely
obese subjects. Diagnosis, association with glucose intolerance and the effect
of surgical and non-surgical weight loss. Doctorate Dissertation
Oslo 2013.

Gordon S, Jones A, Sealey R & et al. Body
position and cardio-respiratory variables in older people. Archives of
gerontology and geriatrics 2011; 2(1): 23-27.

Göker M, İlkhan GD. Obezite Hipoventilasyon
Sendromu. Okmeydanı Tıp Dergisi 2014; 30 (Ek sayı 1) : 15-18.

Hakala K. Pulmonary Mechanics and
Gas Exchange in Obesity: Effects of weight reduction and body position.
Academic Dissertation Helsinki 2000b.

Hakverdi G. Oksijen Saturasyonunun
Değerlendirilmesinde Pulseoksimetre Kullanımı. Cumhuriyet Üniversitesi
Hemşirelik Yüksekokulu Dergisi 2007; 11(3); 45-48.

Hardie JA, Mørkve O, Ellingsen I. Effect of body
position on arterial oxygen tension in the elderly. Respiration 2002; 69(2):
123-128.

Jones AY, Dean E. Body position change and its
effect on hemodynamic and metabolic status. Heart & Lung: The Journal of
Acute and Critical Care, 2004; 33(5): 281-290.

Jones RL, Nzekwu MMU. The effects of body mass
index on lung volumes. Chest journal 2006; 130(3): 827-833.

Littleton SW. Impact of obesity on respiratory
function. Respirology 2012; 17(1): 43-49.

Manning F, Dean E, Ross J & et al. Effects of
side lying on lung function in older individuals. Physical therapy 1999; 79(5):
456-466.

Marklew A. Body positioning and its effect on
oxygenation–a literature review. Nursing in critical care 2006; 11(1): 16-22.

Mathew R, Castriotta RJ. High hypopnea / apnearatio
(HAR) in extreme obesity. Journal of clinical sleep medicine: JCSM: official
publication of the American Academy of Sleep Medicine 2014; 10(4): 391-396.

Mokdad AH, Ford ES, Bowman BA & et. al.
Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.
Jama 2003; 289(1): 76-79.

Petrofsky J, Laymon M, Khowailed IA & et al.
The Effect of BMI on Oxygen Saturation at Rest and during Mild Walking. Journal
of Applied Medical Sciences 2015; 4(2): 1-8.

Sabeti F, Soltanzadeh M, Mali S & et al. The
Effect of Semi Sitting, Supine and Lateral Positions on Results of Arterial
Blood Gases and Vital Signs in Patients undergoing Coronary Artery Bypass Graft
Surgery. Life Science Journal 2012; 9(3): 1432-1437.

Salome CM, King GG, Berend N. Physiology of obesity
and effects on lung function. Journal of Applied Physiology
2010;108(1):206-211.

Satoh K, Chikuda M, Ohashi A & Evaluation of
Partial Pressure of Arterial Oxygen in Obese Patients in Supine Position during
General Anesthesia. Open Journal of Anesthesiology 2015; 5(05): 85-92.

Sebastian JC. Respiratory physiology and pulmonary
complications in obesity. Best Practice & Research Clinical Endocrinology
& Metabolism 2013; 27(2): 157-161.

Verbraecken J, McNicholas WT. Respiratory mechanics
and ventilatory control in overlap syndrome and obesity hypoventilation.
Respiratory research 2013; 14(1): 1.

World Health Organization  Available: 05.08.2017
http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf

Yap JC, Moore DM, Cleland JG & et al.  Effect of supine posture on respiratory
mechanics in chronic left ventricular failure. American journal of respiratory
and critical care medicine 2000; 162(4): 1285-1291.

Yıldırım GÖ, Yavuz M. Yoğun Bakımlarda Hastalara Verilen Sırtüstü
Pozisyonların Hemodinamik ve Fizyolojik Ölçümlere Olan Etkileri 2009; 2(2).

Anahtar Kelimeler

Vücut Pozisyonları, Obezite, Oksijenlenme, Pulse Oksimetre

Kaynakça

• Benedik PS, Baun MM, Keus L & et al. Effects of body position on resting lung volume in overweight and mildly to moderately obese subjects. Respiratory care 2009; 54(3): 334-339.
• Breiburg AN, Aitken L, Reaby L & et al. Efficacy and safety of prone positioning for patients with acute respiratory distress syndrome. Journal of advanced nursing 2000; 32(4): 922-929.
• Ceylan B, Khorshid L, Güneş ÜY & et al. Evaluation of oxygen saturation values in different body positions in healthy individuals. Journal of clinical nursing 2016; 25: 1095-1100.
• Dean E. Effect of body position on pulmonary function. Physical Therapy 1985; 65(5): 613-618.
• Fahy BG, Barnas GM, Nagle SE & et al. Effects of Trendelenburg and reverse Trendelenburg postures on lung and chest wall mechanics. Journal of clinical anesthesia 1996; 8(3): 236-244.
• Fischer AJ, Kaese S, Lebiedz P. Management of obese patients with respiratory failure–A practical approach to a healthcare issue of increasing significance. Respiratory Medicine. 2016; 117: 174-178.
• Fredheim JM. Obstructive sleep apnea in severely obese subjects. Diagnosis, association with glucose intolerance and the effect of surgical and non-surgical weight loss. Doctorate Dissertation Oslo 2013.
• Gordon S, Jones A, Sealey R & et al. Body position and cardio-respiratory variables in older people. Archives of gerontology and geriatrics 2011; 2(1): 23-27.
• Göker M, İlkhan GD. Obezite Hipoventilasyon Sendromu. Okmeydanı Tıp Dergisi 2014; 30 (Ek sayı 1) : 15-18.
• Hakala K. Pulmonary Mechanics and Gas Exchange in Obesity: Effects of weight reduction and body position. Academic Dissertation Helsinki 2000.
• Hakverdi G. Oksijen Saturasyonunun Değerlendirilmesinde Pulseoksimetre Kullanımı. Cumhuriyet Üniversitesi Hemşirelik Yüksekokulu Dergisi 2007; 11(3); 45-48.
• Hardie JA, Mørkve O, Ellingsen I. Effect of body position on arterial oxygen tension in the elderly. Respiration 2002; 69(2): 123-128.
• Jones AY, Dean E. Body position change and its effect on hemodynamic and metabolic status. Heart & Lung: The Journal of Acute and Critical Care, 2004; 33(5): 281-290.
• Jones RL, Nzekwu MMU. The effects of body mass index on lung volumes. Chest journal 2006; 130(3): 827-833.
• Littleton SW. Impact of obesity on respiratory function. Respirology 2012; 17(1): 43-49.
• Manning F, Dean E, Ross J & et al. Effects of side lying on lung function in older individuals. Physical therapy 1999; 79(5): 456-466.
• Marklew A. Body positioning and its effect on oxygenation–a literature review. Nursing in critical care 2006; 11(1): 16-22.
• Mathew R, Castriotta RJ. High hypopnea / apnearatio (HAR) in extreme obesity. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 2014; 10(4): 391-396.
• Mokdad AH, Ford ES, Bowman BA & et. al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Jama 2003; 289(1): 76-79.
• Petrofsky J, Laymon M, Khowailed IA & et al. The Effect of BMI on Oxygen Saturation at Rest and during Mild Walking. Journal of Applied Medical Sciences 2015; 4(2): 1-8.
• Sabeti F, Soltanzadeh M, Mali S & et al. The Effect of Semi Sitting, Supine and Lateral Positions on Results of Arterial Blood Gases and Vital Signs in Patients undergoing Coronary Artery Bypass Graft Surgery. Life Science Journal 2012; 9(3): 1432-1437.
• Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. Journal of Applied Physiology 2010;108(1):206-211.
• Satoh K, Chikuda M, Ohashi A & Evaluation of Partial Pressure of Arterial Oxygen in Obese Patients in Supine Position during General Anesthesia. Open Journal of Anesthesiology 2015; 5(05): 85-92.
• Sebastian JC. Respiratory physiology and pulmonary complications in obesity. Best Practice & Research Clinical Endocrinology & Metabolism 2013; 27(2): 157-161.
• Verbraecken J, McNicholas WT. Respiratory mechanics and ventilatory control in overlap syndrome and obesity hypoventilation. Respiratory research 2013; 14(1): 1.
• World Health Organization Available: 05.08.2017 http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf
• Yap JC, Moore DM, Cleland JG & et al. Effect of supine posture on respiratory mechanics in chronic left ventricular failure.
• American journal of respiratory and critical care medicine 2000; 162(4): 1285-1291.
• Yıldırım GÖ, Yavuz M. Yoğun Bakımlarda Hastalara Verilen Sırtüstü Pozisyonların Hemodinamik ve Fizyolojik Ölçümlere Olan Etkileri 2009; 2(2).