Çocuk onkoloji hastalarında ağrı deneyiminin değerlendirilmesi
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Date
2012
Authors
Özdemir, Ramazan
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmanın amacı, kemoterapi alan çocuk onkoloji hastalarının ağrı deneyimlerini tanımlamaktır.Eylül 2011-Haziran2012 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Çocuk Onkoloji Bilim Dalı'nda yeni kanser tanısı alan ve tedavi verilen 1-18 yaş arası 102 hasta ve aileleri davet edildi. Bu değerlendirmeye kemoterapisinin bitiminden en fazla 3 ay geçmiş olan hastalar alındı. Çalışmaya dahil olan hastalarda, tanı anında, kemoterapi tedavisi sırasında, yapılan girişimsel işlemlere ve komplikasyonlara bağlı gelişen ağrı deneyimleri anketlerle sorgulandı. Katılımcıların anne-babalarına ve 7 yaşın üstündeki çocuklarda hem kendilerine hem ebeveynlerine ağrı deneyimleri sayısal ağrı ölçeği ve yüzlü ağrı ölçeği kullanılarak soruldu.Çalışmamıza 39'u (%38) kız, 63'ü erkek (%62) olmak üzere toplam 102 hasta ve ebeveyni katıldı. Hastaların ortalama yaşı 8,7±5.8 yıl idi. Çalışmaya katılanlardan %17'si lenfoma, %14'ü merkezi sinir sistemi (MSS) tümörü ve %69'u solid tümör tanısı aldı. Hastaların % 48'sine majör cerrahi girişim uygulandığı, %37'sinde radyoterapi yapıldığı ve %100'ünün kemoterapi aldığı gözlendi.Ağrı; tanı anında hastaların %65'inde, kan alımı sırasında %91'inde, damar yolu açımı sırasında %94'ünde, cerrahi müdahaleler sonucunda %80'inde, kemik iliği aspirasyonunda %76'sında, lomber ponksiyonda %91'inde, ilaç ektravazasyonunda %96, mukozitte % 98 oranında tanımlandı. Sık tekrarlanan girişimlerde ağrı hissinin, kan alımında %64, damar yolu açımında % 60,9 oranında arttığı belirlendi.Hastalarda en yüksek ağrı skorları tümör basısına, cerrahi işlemlere ve ilaç ekstravazasyonuna ve anal fissür/abselere bağlı gözlenmiş olup ortalama ağrı skoru sırasıyla 8,16-7,6-7,6-7,5 bulundu.Ortalama ağrı skoru değerleri 6 ve üstünde ise ağrı şiddetli kabul edildi. Tanı anında tümör basısına bağlı ağrısı olan olguların %95'inde, cerrahiye bağlı ağrıların %70'inde ve oral mukozitlerin %88'inde opioid kullanımı gerektirecek şiddette ağrı tanımlandı. Ancak bu olguların sırası ile %5'inde, %32'sinde, ve %3,1'inde opioid kullanılmıştı.Çalışmamızda çocuk onkoloji pratiğinde ağrı yakınmasının yüksek oranlarda görüldüğü saptanmıştır. Merkezimizde daha etkin ağrı protokolleri gereklidir.Sonuç olarak kanserli çocukların yaşam kalitesi ve tedavi uyumu bir çok faktörden etkilenmekle beraber bunun büyük kısmını ağrı yakınması oluşturmaktadır. Bu nedenle ağrı kavramının çok iyi bilinmesi ve etkin tedavi edilmesi ve sürekli gündemde tutularak, hekimlerin ve bakım sağlayıcıların farkındalığını sağlamak önemlidir.
Evaluation of pain experiences of pediatric oncology patientsIn this study we aimed to determine pain experiences of pediatric oncology patients.102 patiens who were diagnosed with different types of pediatric cancer in Uludag University pediatric in or outpatient clinic between September 2011 and June 2012 and their families were enrolled to this study. Patients whose chemoterapy ended minimum 3 months earlier were excluded. We have questioned the patient at the time of diagnosis, during chemoterapy, during painfull procedures and treatment complications with questionnaires. Both visual and numerical pain scales were given to parents and patients older than 7 years of age.39 girls(38%) and 63 boys(62%) cumulative 102 patients whose age were between 1 and 18 years and their families were enrolled in this study. Mean age was 8.7 ±5.8 years. 17% of patients were diagnosed with lymphomas, 14 % were CNS tumor patients and the remainder(69%) were other solid pediatric cancers. 48 percent of all patients received major surgical procedures, 37 percent received radiotherapy and all of them received chemotherapy.65% of our patients declared they had tumor related pain, %91 during blood puncture, %94 had pain during iv cathaterization, 80% had pain after surgical procedures, 76% had pain during bone marrow sampling, 91% had pain durin lombar punction, 96% had pain after drug extravasation, and 98% had pain during oral mucositis. Pain was 64% higher after repeated blood sampling and 60.9% higher after repeated iv cathaterisation.According to pain scores tumor related pain was the highest mean score surgical procedures and respectively drug extravasation, anal fissure, tumor pain. Pain mean score dicovered in turn 8,16-7,6-7,6-7,5.Mean pain score 6 and above were regarded as severe pain. In our study, 95% of tumor related pain were severe, 70% of surgical procedures, 88,4 % of mucositis. Severe pain was detected respecvtively only 5%, 32%, 3.1% received opioids.Our study showed that although pain is common during pediatric oncology practice, pain can not receive deserved attention it deserves. However, treatment is not sufficient for the control of pain for patients. Our center has required more effective pain protocols.The life quality of pediatric cancer patients were affected by many factors. But pain is one of the main problems during treatment. All healthcare professionals should be familiar with the issue of pain and its treatment. Pain management strategies should be regularly revised and kept up to date.
Evaluation of pain experiences of pediatric oncology patientsIn this study we aimed to determine pain experiences of pediatric oncology patients.102 patiens who were diagnosed with different types of pediatric cancer in Uludag University pediatric in or outpatient clinic between September 2011 and June 2012 and their families were enrolled to this study. Patients whose chemoterapy ended minimum 3 months earlier were excluded. We have questioned the patient at the time of diagnosis, during chemoterapy, during painfull procedures and treatment complications with questionnaires. Both visual and numerical pain scales were given to parents and patients older than 7 years of age.39 girls(38%) and 63 boys(62%) cumulative 102 patients whose age were between 1 and 18 years and their families were enrolled in this study. Mean age was 8.7 ±5.8 years. 17% of patients were diagnosed with lymphomas, 14 % were CNS tumor patients and the remainder(69%) were other solid pediatric cancers. 48 percent of all patients received major surgical procedures, 37 percent received radiotherapy and all of them received chemotherapy.65% of our patients declared they had tumor related pain, %91 during blood puncture, %94 had pain during iv cathaterization, 80% had pain after surgical procedures, 76% had pain during bone marrow sampling, 91% had pain durin lombar punction, 96% had pain after drug extravasation, and 98% had pain during oral mucositis. Pain was 64% higher after repeated blood sampling and 60.9% higher after repeated iv cathaterisation.According to pain scores tumor related pain was the highest mean score surgical procedures and respectively drug extravasation, anal fissure, tumor pain. Pain mean score dicovered in turn 8,16-7,6-7,6-7,5.Mean pain score 6 and above were regarded as severe pain. In our study, 95% of tumor related pain were severe, 70% of surgical procedures, 88,4 % of mucositis. Severe pain was detected respecvtively only 5%, 32%, 3.1% received opioids.Our study showed that although pain is common during pediatric oncology practice, pain can not receive deserved attention it deserves. However, treatment is not sufficient for the control of pain for patients. Our center has required more effective pain protocols.The life quality of pediatric cancer patients were affected by many factors. But pain is one of the main problems during treatment. All healthcare professionals should be familiar with the issue of pain and its treatment. Pain management strategies should be regularly revised and kept up to date.
Description
Keywords
Çocuk, Onkoloji, Ağrı, Ağrı kontrolü, Analjezi, Child, Oncology, Pain, Pain control, Analgesia
Citation
Özdemir, R. (2012). Çocuk onkoloji hastalarında ağrı deneyiminin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.