Acil servise asemptomatik tansiyon yüksekliği ile başvuran hastalarda nefes egzersizinin tansiyon yüksekliği tedavisine etkisinin araştırılması
Investigation of the effect of breathing exercise on the treatment of high blood pressure in patients presenting to the emergency department with asymptomatic high blood pressure
- Tez No: 893261
- Danışmanlar: PROF. DR. GÜÇLÜ SELAHATTİN KIYAN
- Tez Türü: Tıpta Uzmanlık
- Konular: Acil Tıp, Emergency Medicine
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2023
- Dil: Türkçe
- Üniversite: Ege Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Acil Tıp Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 98
Özet
Amaç: Hipertansiyon tedavisinin başarılı kabul edilmesinde en önemli belirleyici, uç organ hasarı oluşmadan ve çoklu ilaç tedavisinden önce risk faktörleri konusunda farkındalık sağlanması ve koruyucu yaşam tarzı değişikliklerinin kazandırılması ile aynı zamanda maliyet etkin hastalık yönetim seçeneklerinin oluşturulmasıdır. Nefes Egzersizi yaşam tarzı değişikliklerinin davranışa dönüştürülmesini amaçlayan çözümlerden biridir. Yavaş ve derin nefes egzersizinin baroreseptörlerde artışa ve bunun sonucunda sempatik tonüsde azalmaya neden olarak kan basıncını düşürdüğü belirtilmektedir. Bu çalışma, acil servis başvurularında uç organ hasarı olmaksızın yüksek kan basıncı saptanan hastalarda Sama Vritti Pranayama nefes egzersizinin kan basıncının düşürülmesindeki etkinliğini incelemek amacıyla planlanmış ve Sama Vritti Pranayama nefes egzersizi tekniğinin kullanıldığı ilk çalışmadır. Gereç ve Yöntem: Araştırma, 01/12/2022-31/05/2023 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Tıp Fakültesi Tıbbi Araştırmalar Etik Kurulu onayı ile üçüncü basamak bir üniversite hastanesinin acil servisinde tek merkezli, prospektif, tek kör, randomize kontrollü deneysel araştırma tasarımı ile yapılmış bir çalışmadır. Uç organ hasarı olmaksızın yüksek kan basıncı ile acil service başvuran hastaların oluşturduğu evrende, örneklem büyüklüğü G-Power 3.1 programı ile en az 158 hasta ile yeterli kabul edilmiş ancak 6 aylık izlemde çalışma kriterlerini karşılayan 432 hastanın dahil edilmiş, hastane protokol numarası ile randomizasyonu yapılarak son harfi tek olan girişim gurubunda 216 ve çift olan kontrol grubunda 216 hasta çalışma örneklemini oluşturmuştur. Çalışmaya onam vermeyen 12 hasta ve primer acil hekimi tarafından hipertansif kriz kabul edilen 6 hastanın çalışma dışı bırakılması ile her grupta 207 hasta ile çalışma tamamlanmuştır. Girişim grubunda 15, 45 ve 75. dakikada yaptırılan Sama Vritti nefes egzersizinin kan basıncını düşürmedeki etkisi, rutin acil servis hipertansif hasta izlemi ile tedavi edilen kontrol grubundaki hastaların kan basıncı değişimleri ile karşılaştırılmıştır. Hastaların başvurularından 90.dakikaya kadar 15 dk arayla kan basıncı ve nabız değerleri ölçülmüştür. Hastalardan toplanan verilerin istatistiksel analizlerinde IBM SPSS Statistics V25.0 analiz programından yararlanılmıştır. İstatiksel olarak, p
Özet (Çeviri)
Objective: The most crucial determinant for the successful management of hypertension is raising awareness about risk factors before the occurrence of end-organ damage and initiating multiple drug therapy. Simultaneously, it is essential to instill awareness about lifestyle modifications and establish cost-effective disease management options. One of the solutions aimed at translating lifestyle changes into behavior is the practice of breathing exercises. It is stated that slow and deep breathing exercises increase baroreceptor sensitivity and subsequently reduce sympathetic tone, leading to a decrease in blood pressure. This study was designed to examine the effectiveness of Sama Vritti Pranayama breathing exercise in lowering blood pressure in patients presenting to the emergency department with high blood pressure and no evidence of end-organ damage. This study is the first to use the Sama Vritti Pranayama breathing exercise technique for this purpose. Materials and Methods: The research was conducted between December 1, 2022, and May 31, 2023, in a tertiary university hospital's emergency department with a single-center, prospective, single-blind, randomized controlled experimental design approved by the Ege University School of Medicine Medical Research Ethics Committee. The sample size, determined using the G-Power 3.1 program, was initially set at a minimum of 158 patients. However, 432 patients meeting the study criteria and followed up for 6 months were included. Randomization was performed using hospital protocol numbers, resulting in 216 patients in the intervention group and 216 patients in the control group. Twelve patients who did not provide consent and six patients considered to have hypertensive crisis by the primary emergency physician were excluded from the study. The study was completed with 207 patients in each group. The effect of Sama Vritti breathing exercises performed at 15, 45, and 75 minutes on blood pressure was compared with the blood pressure changes in hypertensive patients treated with routine emergency department protocols in the control group. Blood pressure and pulse values were measured every 15 minutes from patients' admission until the 90th minute. IBM SPSS Statistics V25.0 was used for statistical analysis, considering p < 0.05 as significant. Independent sample t-tests were used for comparing groups showing normal distribution, and the Mann-Whitney U test was used for groups not showing normal distribution. Continuous variables were presented as mean and standard deviation. Chi-square tests were used for comparing categorical variables, and One Way ANOVA test was used for the analysis of more than two groups. Descriptive data were presented as number (n) and percentage (%). Results: The mean age in the intervention group was 63.93 ± 12.22, and in the control group, it was 66.59 ± 12.42. The majority of patients in both groups were female and classified as“overweight”in terms of body mass index. The rate of patients using antihypertensive drugs was 70.5% in the intervention group and 69.1% in the control group. Diabetes Mellitus was the most common comorbid condition in both groups. Seventy-one percent of patients visited the emergency department outside working hours, with cardiovascular complaints being the most common reason for admission. There was no significant difference in systolic and diastolic blood pressure values at the initial presentation (p = 0.31), indicating no bias in the randomization of groups. A significant reduction in systolic and diastolic blood pressure values was observed at the 90th minute after breathing exercises at 15, 45, and 75 minutes, with a more significant decrease in the group subjected to breathing exercises compared to the control group (p < 0.001). Although a decrease in systolic and diastolic blood pressure values was observed from the 15th minute onwards in both groups, no statistical significance was found. The rate of patients not receiving antihypertensive treatment was 85.4% in the intervention group and 77.8% in the control group. The mean waiting time in triage was 45.29 ± 34.55 minutes in the intervention group and 42.39 ± 33.61 minutes in the control group. The total length of stay in the emergency department was 388.12 ± 494.92 minutes in the intervention group and 546.51 ± 783.74 minutes in the control group. Patients subjected to breathing exercises had a shorter stay in the emergency department by two and a half hours compared to patients receiving antihypertensive treatment. The discharge rates from the emergency department were 90.4% in the intervention group, 85.5% in the control group, and the discharge rate with breathing exercises alone in total admissions was 32.9%. Conclusion: The study findings indicate that breathing exercises effectively reduce systolic and diastolic blood pressure in patients presenting to the emergency department with high blood pressure and no end-organ damage. One-third of the patients were discharged with breathing exercises alone, without the need for antihypertensive treatment. There was no superiority of antihypertensive treatment over breathing exercises or rest in lowering blood pressure. Therefore, we recommend implementing rest and breathing exercises before initiating antihypertensive treatments in patients without end-organ damage in the emergency department, considering both the health burden and rational drug use.
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