LAPAROTOMA EXPLORATORIA PDF
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Exploratory laparotomy and cholecystectomy: To evaluate and compare the respiratory rate and oxygen saturation of patients in the immediate postoperative period of exploratory laparotomy and cholecystectomy.
This is a cross-sectional and quantitative study with 63 patients seen between November and April Data were collected through a structured questionnaire applied to exploratorix admitted to the Surgical Clinic of the Municipal Hospital of Imperatriz City.
Patients of both sexes, aged from 18 to 59 years, in the immediate postoperative period of exploratory laparotomy Group I and cholecystectomy Group II participated in the study.
Data related to respiratory rate RR and oxygen saturation SpO 2 were extracted from the questionnaire. Data were analyzed statistically using the BioEstat 5. The cases in which the values of both analyzed variables were altered, evidencing conditions of tachypnoea or bradypnea explotatoria hypoxemia, were isolated cases, not statistically significant.
Regardless of the surgical procedures performed, the respiratory pattern remained normal to minimally altered and, in these individuals, there was no direct interference of these surgeries on the respiratory function that caused a significant clinical alteration of respiration. The presence of pain in the postoperative period of abdominal surgeries limits the movement of the abdominal region, limiting also the stimulation of coughing and altering the respiratory cycle.
In some cases, it may lead to atelectasis, hypoxemia and pneumonia 2 3. In the first 24 hours that comprise the immediate postoperative period, which is considered a critical phase of the surgical recovery, it is of fundamental importance the monitoring and assistance to the patient through verification of the vital signs until their stabilization, as well as careful evaluation of the functional patterns, mainly respiratory, hemodynamic, thermoregulator, recovery of consciousness and protective reflexes, thus ensuring return to organic homeostasis 4.
The balance of the systems from the 1st postoperative day reflects positively on the other post-surgical recovery days 4 5. In this sense, this study aimed to evaluate and compare the respiratory rate and oxygen saturation of patients in the postoperative period of exploratory laparotomy and cholecystectomy in the first 24 hours after the surgical procedure. The present study is a quantitative and cross-sectional research carried out from November to April at the Surgical Clinic of the Municipal Hospital of Imperatriz City, a place aimed at patients who are in the pre and postoperative period.
Patients of both sexes, aged from 18 to 59 years, who were in the immediate postoperative period of high abdominal surgeries of the exploratory laparotomy or cholecystectomy types were included in the study. Patients with pre-existing pneumopathies, patients with a postoperative period of more than 24 hours, patients in clinical situations that were unable to answer to the questionnaire, such as a severe clinical condition, cognitive alteration or mental disorder, were excluded from the study.
All the 63 patients treated during the study period were divided into two groups according to the type of surgical procedure to which they were submitted.
Initially, an invitation was made verbally to the patients present at the study site and submitted to exploratory laparotomy Group I and cholecystectomy Group II surgeries. A structured questionnaire containing socioeconomic, clinical and surgical data was used to collect the data.
Measurement of the respiratory rate RR was performed with the patient in the position where they felt most comfortable, giving priority to the verification in the seated position. However, if the patient refused to be in this position, it was performed with the patient in the supine position, and the respiratory incursions per minute irpm performed by the patient were counted from the verification of the movement of the thoracic cavity, with exploraroria 14 to 20 irpm as parameter 6 7.
As the number of exxploratoria was different in both groups, initially, the normality test Shapiro Wilk test k samples was applied; ecploratoria the variables did not present normal distribution, the Mann-Whitney inferential analytical test was used. Subsequently, the correlation between the two variables in the two groups was analyzed using the Spearman test.
In Group I, the mean age of the patients was Laparoto,a Group II, the mean age was The majority of patients in this study submitted to high abdominal surgeries are female, in both groups. The results obtained from exploratoira analyzed clinical variables RR and SpO 2 in both groups are shown in tables and figures below.
Regardless of the type of surgery that the patients in each group underwent, they did not cause significant respiratory impairment, both clinically and statistically Table 1.
Laparotomia exploratoria em equinos 
Regarding the minimum and maximum values of RR, Group I had a minimum value of 14 irpm normal lapraotoma and a maximum value of 40 irpm intense tachypnea ; Group II presented a minimum value of 13 irpm mild bradycardia and a maximum value of 26 irpm discrete tachypnea.
The Box-Plot graph shows an lapaortoma difference in the maximum value of both groups, where Group I presented a peak of 40 irpm and presented intense tachypnea, while Group II presented mild tachypnoea Figure 1. The values found were within normal limits and there was no statistically significant result of clinical change in SpO 2 in both groups. The median values obtained are within that recommended by the literature, and therefore indicate that there was no negative clinical change in this parameter Table 1.
The most lwparotoma change occurred in Group I, with a minimum value of SpO 2 with marked hypoxemia. In Group II, the minimum value was also below the reference value, but with no significant clinical repercussion as in Group I, both of which were not statistically significant Figure 2.
The linear correlation between the RR and the SpO 2 in Group I and Group II it allowed identifying that their values have an inverse proportionality, since as the RR increases evidencing values that characterize tachypnea, the SpO 2, in turn, decreases evidencing values that characterized hypoxemia. Increased RR promotes shorter, faster, and shallower respiratory cycles and, according to explotatoria intensity, can significantly alter breath quality 8.
Although the RR was altered, the SpO 2 remained with values in agreement with what is recommended in the literature. This may have occurred because the tachypnea present in both groups was mild, and since it was only minimally increased in relation to the physiological value, it did not negatively influence the SpO 2because, in this case, despite the respiratory cycle had been slightly faster than normal, it did not happened markedly accelerated and superficially.
Thus, it did not reduce exponentially the tidal volume and consequently did not impair gas exchange and perfusion. Nunes et al 5when evaluating the complications in the postoperative period of anesthetic recovery, identified an average of Studies have shown that some level of limitation in pulmonary ventilation is common in laparotomy and cholecystectomy surgeries, considering factors inherent to the surgical procedure, such as pain, diaphragmatic dysfunction, incision extension and proximity to the respiratory system, surgery time and type of anesthesia, which can result in restrictive respiratory disorders 9 However, if it does not occur significantly and the RR remains normal, stable or without significant changes, it means that there was effective control and organic adaptation of the pulmonary ventilation.
Associated with these variables, the therapy adopted in the postoperative period, the drug therapy and the general care have shown to be effective in the stability, control and return of homeostasis.
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Regarding SpO 2the results of medians of Group I and Group II evidenced values in agreement with that set as normal by the literature. RR and SpO 2 present a correlation, in which adequate pulmonary ventilation promotes the supply of alveolar O 2 required for gas exchange and to guarantee satisfactory levels of SpO 2 8. The more laoarotoma the RR is from the eupnea condition, as in isolated cases in which it has been markedly increased and characterizing intense tachypnea, the lower the SpO 2 values, showing hypoxemic values Table 2.
Except for the isolated values of extremes above or below the la;arotoma value, in both groups there was a significant normality of these two parameters. In general, RR close to the eupnea condition may have influenced the outcome of normoxemic SpO 2.
The influence of respiratory rate on blood gases in individuals esploratoria the 1st, 2nd and 3rd postoperative days of emergency exploratory laparotomy shows little expressive variations of RR in the first 3 postoperative days with averages that remain above 20 irpm, but do not exceed 30 irpm, being considered mild tachypnea.
The partial pressure of carbon dioxide pCO 2 changes but it is minimally reduced, and the oxygen partial pressure pCO 2 is maintained It was not the purpose of the study to evaluate the patient on the 1st, 2nd and 3rd days of post-surgical recovery and to measure blood gas levels by arterial blood gas analysis; however, based on the results of the aforementioned study, it is highlighted that the respiratory rate has an influence on the concentration of CO 2 and O 2 in the blood, and the more it is altered and closer to the physiological value, the lower the changes in the saturation of these gases.
Thus, the findings of this research showed that in the first 24 postoperative hours, the respiratory rate of the individuals of both Group I and Laparotona II occurred a priori without significant impairment, making up a respiratory pattern considered normal to discretely altered. There was a significant normality in the parameters of laparotma analyzed variables in both groups, thus allowing an adequate pulmonary ventilation and gas exchange.
And, therefore, the surgical procedures exploratory laparotomy and cholecystectomy did not promote significant functional alteration of the breathing of these individuals. As a limitation of this study, it was not possible to evaluate all parameters referring to the respiratory pattern due to the lack of spirometry devices that would allow measuring pulmonary capacities and volumes. Also, patients were not monitored throughout the postoperative period, as data collection occurred only in the first 24 hours after surgery; however, the patient may develop respiratory changes during the rest of the recovery days.
Ramos GC, et al. Rev Col Bras Cir.
Originales Exploratory laparotomy and explorayoria ABSTRACT Objective To evaluate and compare exploratooria respiratory rate and oxygen saturation of patients in the immediate postoperative period of exploratory laparotomy and cholecystectomy. Material and Method This is a cross-sectional and quantitative study with 63 patients seen between November and April Conclusion Regardless of the surgical procedures performed, the respiratory pattern remained normal to minimally altered and, in these individuals, there was no direct interference of these surgeries on the respiratory function that caused a significant clinical alteration of respiration.
January 21, ; Accepted: Como citar este artigo.