Över 160 000 människor i Sverige väntade på en operation 2021. 40 % av dessa har väntat längre än vårdgarantins 90 dagar. Patienter väntar dagligen på operationer, både på vårdavdelningar och i hemmet. Operationer som kan bidra till ökad hälsa och lindrat lidande. Utan kunskap och förståelse för patienter i den preoperativa väntan riskerar patienten ett ökat lidande och ohälsa. Sjuksköterskans kännedom om patienternas upplevelser i väntan på en operation behöver synliggöras för att öka möjligheten till en individanpassad och säkrare vård.  Syftet med examensarbetet var att belysa patienters upplevelser av att vänta på en operation. Metoden som användes var en litteraturöversikt över kvalitativ forskning då författarna ville belysa upplevelser kring ämnet. Nio vårdvetenskapliga artiklar söktes fram, granskades och sammanställdes. Resultatet presenteras i tre huvudteman: Upplevelse av ohälsa, En känsla av hopp och Kontakten med vården med fem tillhörande subteman som svarade på examensarbetets syfte. Resultatet påvisar patienters känsla av oro, ångest och rädsla inför operation och hur väntan kan öka de negativa upplevelserna. Men det framkommer även att med individanpassad information och en god kontakt med vården kan tillit och hopp bidra till en positivare upplevelse för patienten. Diskussionen stärker resultatet med tidigare forskning som visar att goda vårdrelationer och ett tydligt patientperspektiv kan förebygga oro och skapa bättre förutsättningar för patienten i väntan på en operation. Slutsatsen är att med ett vårdvetenskapligt förhållningssätt kan sjuksköterskan synliggöra patientperspektivet och skapa en individanpassad vård som kan vara ett stöd för patienten i den påfrestande tid som väntan inför en operation kan innebära. / Over 160,000 people in Sweden were waiting for an operation in 2021. 40% of these have waited longer than the care guarantee's 90 days. Patients wait daily for operations that can contribute to increased health, alleviate suffering or be crucial to survival. Without knowledge and understanding of patients in the preoperative waiting period, the patient risks increased suffering and ill health. The nurse's knowledge of the experiences while waiting for an operation needs to be made visible in order to increase the possibility of better and safer care. The aim of the study was to shed light on patients' experiences of waiting for an operation. The method used was a literature review of qualitative research as the authors wanted to highlight experiences around the subject. Nine health science articles were searched for, reviewed and compiled. The results are presented in three main themes: Experience of ill-health, A feeling of hope and Contact with care with 6 associated sub-themes that responded to the purpose of the study. The results demonstrate patients' feelings of worry, anxiety and fear before surgery and how waiting can increase these negative experiences. But it also appears that with individually tailored information and a good contact with care, trust and hope can contribute to a more positive experience for the patient. The discussion strengthens the results with previous research that shows that good care relationships and a clear patient perspective can prevent anxiety and create better conditions for the patient while waiting for an operation. The conclusion is that with a nursing scientific approach, the nurse can make the patient's perspective visible and create an individually tailored care that can be a support for the patient in the stressful time that waiting before an operation can entail.

Bien que la spirométrie incitative (SI) face partie intégrante des soins périopératoires, son utilisation et impact chez les patients demeurent incertaines, particulièrement lorsqu’elle est initiée en préopératoire. Dans cette étude clinique randomisée prospective à simple insu, l'objectif primaire était de déterminer si un programme préopératoire d'exercice inspiratoire basé sur la SI avait un impact sur les complications pulmonaires après une chirurgie thoracique. Un total de 141 patients à risque de complications pulmonaires a été analysé, soit 72 dans le groupe SI + soins usuels et 69 dans le groupe soins usuels. L'incidence de complications pulmonaires était de 38,3%. Une diminution significative de l’atélectasie pulmonaire avec impact clinique a été observée chez le groupe SI + soins usuels en comparaison au groupe soins usuels (SI + soins usuels 9,7% vs soins usuels 23,2%, p = 0,031). L'impact semblait bénéficier davantage aux patients ayant eu une VATS ou lobectomie pulmonaire. Dans une analyse multivariée tenant compte des facteurs confondants, le groupe soins usuels développait plus d’atélectasie pulmonaire avec impact clinique que le groupe SI + soins usuels (OR 3,046, IC95% :1,108 - 8,372). L'incidence des autres complications pulmonaires était similaire entre les deux groupes. Le séjour hospitalier était de < 3 jours dans 34,7% du groupe SI + soins usuels et dans 20,3% du groupe soins usuels (p = 0,062). Donc, l'initiation de la spirométrie incitative en préopératoire chez les patients à risque de complications pulmonaires pourrait faire partie des stratégies de prévention utilisées en préhabilitation. / Although incentive spirometry (IS) is an integral part of perioperative care, its impact on pulmonary complications remains unclear, particularly when initiated preoperatively. In this randomized, single-blind prospective clinical study, the primary objective was to determine if a preoperative inspiratory exercise program based on IS had an impact on pulmonary complications after a thoracic surgery. A total of 141 patients at risk of pulmonary complications were analyzed, 72 in the IS + usual care group and 69 in the usual care group. In our study, the incidence of pulmonary complications was 38.3%. A significant decrease in pulmonary atelectasis with clinical impact was observed in the IS + usual care group compared to the usual care group (IS + usual care 9.7% vs usual care 23.2%, p = 0.031). The impact seemed to benefit patients who had a VATS or pulmonary lobectomy. In a multivariable analysis considering confounding factors, the usual care group developed more pulmonary atelectasis with clinical impact than the IS + usual care group (OR 3.046, 95%CI:1.108 - 8.372). The incidence of other pulmonary complications was similar between the two groups. The hospital stay was < 3 days in 34.7% of the IS + usual care group and in 20.3% of the usual care group (p = 0,062). In conclusion, the initiation of IS preoperatively in patients at risk of pulmonary complications could be part of the prevention strategies used in prehabilitation.

Bakgrund: Operationssjuksköterskan ansvarar för infektionsprevention samt att säkerställa att patienten inte drabbas av skada eller komplikation i samband med operation. Det krävs tekniska färdigheter i det praktiska arbetet likaväl som stor kunskap om de olika ingreppen och medicinteknisk utrustning för att upprätthålla patientsäkerheten. Ett patientsäkert arbete i operationsteamet innebär att alla arbetar mot samma mål med patienten i fokus. Kommunikation i operationsteamet är grundläggande för att teamet ska kunna arbeta säkert och effektivt. Bristande kommunikation är den vanligaste orsaken till vårdskada. Operationssjuksköterskan ska ha en situationsmedvetenhet och ett helhetsperspektiv för att kunna ligga steget före och därmed bidra till ett optimalt genomförande av operationen. Enligt Benners teori ställs den novisa sjuksköterskan inför en stor utmaning som ny operationssjuksköterska när hen förväntas kunna arbeta i komplexa situationer som hen saknar erfarenhet av.  Motiv: Operationssjuksköterskan har ett stort ansvar där kommunikation utgör en viktig del. Under aspiranttjänst och verksamhetsförlagd utbildning har författarna till föreliggande studie observerat att preoperativ kommunikation i operationsteamet varierar, det kan påverka operationssjuksköterskan i sitt arbete vilket kan äventyra patientsäkerheten. Syfte: Syftet var att belysa operationssjuksköterskans upplevelse av preoperativ kommunikation i operationsteamet. Metod: Individuella semistrukturerade intervjuer genomfördes med nio operationssjuksköterskor. Insamlad data analyserades med kvalitativ innehållsanalys. Resultat: Resultatet redovisas i följande tre kategorier med tillhörande subkategorier: Nödvändig information inför förberedelser, Teamarbete - ett gemensamt ansvar och Konsekvenser av bristande kommunikation. Konklusion: Det framkom vad ett önskvärt förhållningssätt till kommunikation och information innebär samt att det är nödvändigt att ha tillgång till korrekt och utförlig information för att kunna vara väl förberedd inför kommande operation. Tydlig kommunikation är grundläggande för att teamet ska kunna arbeta mot samma mål. Information, kommunikation och agerande i operationsteamet påverkar arbetsmiljön och patienten. / Background: Two main responsibilities of a theatre nurse are to ensure the patient does not suffer from injury or complications during surgery and to prevent infection. To maintain patient safety, technical skills are required as well as an extensive knowledge of procedures and equipment. Patient safety demands that each member of the surgical team works together towards a common goal where the patient is the primary focus. Communication is fundamental for the surgical team to be able to work safely and efficiently. Lack of communication is the most common cause of adverse events. To be able to be one step ahead and contribute to an optimal performed surgery, the theatre nurse must have situational awareness and be able to see the situation as a whole. According to Benner’s theory, the novice nurse faces major challenges in her new role as a theatre nurse due to expectations that she will be able to perform in situations that she has not yet experienced. Motive: Communication plays an important role in a theatre nurse’s responsibilities. During trainee placement and clinical training, the authors of this study have observed that preoperative communication within the surgical team varies. This can affect the theatre nurse in her work and therefore compromise patient safety. Aim: The aim of this study was to explore theatre nurses’ experience of preoperative communication within the surgical team. Methods: Individual semi-structured interviews were conducted with nine theatre nurses. Data analysis was conducted with qualitative content analysis. Result: The result are presented in the following three categories with associated subcategories: Necessary information prior to preparation, Teamwork - a shared responsibility and Consequences due to lack of communication. Conclusion: It was found that there is a desirable approach to communication and information, and that it is necessary to have access to correct and detailed information in order to be well prepared for an upcoming surgery. Distinct communication is essential for the team to be able to work towards a mutual goal. Information, communication and behavior in the surgical team affect the work environment and the patient.

Bakgrund: Preoperativ oro är vanligt förekommande för patienter som ska genomgå en operation. I Europa beräknas mellan 27% till 80% av patienterna som ska genomgå en operation lida av preoperativ oro. Den preoperativa oron kan orsaka fysiologiska reaktioner, vilket kan leda till postoperativa komplikationer samt lidande. Anestesisjuksköterskan är den som möter patienten i den preoperativa fasen och har därmed en betydande roll för att försöka stödja patienten att lindra sin preoperativa oro. Syfte: Syftet är att beskriva hur patienter upplever att preoperativ oro lindras. Metod: Den strukturerade litteraturöversikten genomfördes genom systematiska litteratursökningar i databaserna Science Direct och Cinahl. Det insamlade materialet analyserades med hjälp av en integrativ analys enligt Whittemore och Knafl, (2005). 12 vetenskapliga artiklar inkluderades till studien.   Resultat: Patienterna upplevde tre framträdande faktorer som kunde lindra deras preoperativa oro. Dessa tre faktorer var behov av information, behov av kommunikation samt behov av en relation. Patienterna upplevde det som betydande när anestesisjuksköterskan tog sig tid till att ge individuell och kontinuerlig information genom samtal där en relation byggd på tillit skapades och där  patienterna sågs som personer med unika behov. Det var betydande att både verbal och icke verbal kommunikation användes för att lindra preoperativ oro. Slutsats: Genom skapande av en relation där patienten sågs som unik med egna behov samt där en kommunikation fördes och information utbyttes så lindrade detta patientens preoperativa oro. Detta förutsätter att anestesisjuksköterskan var närvarande för patienten. / Background: Preoperative anxiety is common among patients that is about to undergo a surgery. In Europe it is estimated that between 27% to 80% of the patients that is about to undergo a surgery experience preoperative anxiety. (The preoperative anxiety can cause physiological reactions, which can cause postoperative complications and suffering. It is the nurse anesthetist who meets the patient in the preoperative phase and due to this has an important role to try to help the patient to reduce their preoperative anxiety. Aim: The aim is to describe how patients experience how preoperative anxiety is reduced.  Method: A structured literature review was performed by systematic literature searches in the databases Science Direct and Cinahl. The gathered material was analyzed according to an integrative analysis according to Whittemore and Knafl, (2005). 12 scientific articles were included in the study.  Result: The patients experienced three prominent factors that could reduce their preoperative anxiety. These three factors were the need of information, the need of communication and establishing of a relationship. Patients experienced it as important when the nurse anesthetist took time to give individual and continuous information by conversations where a relationship built on trust is created and where the patients was seen as a person with unique needs. It was important that both verbal and non-verbal communication was used to reduce preoperative anxiety.  Conclusion: When creating a relationship where the patient is seen as unique with their own needs where communication is preformed and information exchanged, preoperative anxiety was reduced for the patient. This requires that the nurse anesthetist is present for the patient.

Introduktion: Preoperativ fasta är sedan många år tillbaka vedertaget inför kirurgi. Bakgrunden är bland annat att förhindra aspiration hos sövd patient som inte kan försvara sin luftväg. Fastan medför emellertid negativa konsekvenser för patienten. För att minska de negativa konsekvenserna har tidigare forskning kunnat påvisa positiva effekter av preoperativ kolhydratladdning i form av exempelvis minskad opioidanvändning och minskat antal vårddygn. Forskning beträffande patientens upplevelse av preoperativ kolhydratladdning är dock begränsad. Syfte: Att belysa upplevelsen av preoperativ kolhydratladdning hos patienter som genomgår elektiv höft- och knäledsplastik. Metod: Semistrukturerade telefonintervjuer med 12 patienter som analyserades med manifest kvalitativ innehållsanalys. Resultat: Hur information gavs från vårdpersonal hade en avgörande betydelse för patienters motivation att dricka preoperativ kolhydratdryck. Även viljan att må så bra som möjligt efter operationen var en stor motivator. Patienter beskrev känslan av att bli pigga och få en kick efter att ha druckit dryckerna, samt att de skulle rekommendera dryckerna till anhöriga. Diskussion: Resultatet visade att informationens utformning var av avgörande betydelse för patientens uppfattning av preoperativ kolhydratladdning och att intaget av dryckerna i många fall gav positiva känslor och förbättrat mående. Slutsats: Informationens ursprung har stor betydelse och preoperativ kolhydratdryck bidrar till känslan av förbättrat mående hos patienter som genomgår elektiv ortopedkirurgi.

Bakgrund: Preoperativ oro förekommer hos över hälften av alla barn som ska genomgå kirurgiska ingrepp. Oron inför den kommande operationen orsakar ett stort lidande för barnet. Detta kan orsaka både fysiologiska och psykologiska symtom till följd av oron. Dessutom får dessa barn en ökad risk för postoperativa komplikationer, vilket innebär fortsatt lidande för barnen men även en ökad belastning för sjukvården. Lekterapi har visat ha en lindrande effekt på känslor hos barn och därför syftar denna studie på att undersöka om lekterapin även kan lindra den preoperativa oron.  Syfte: Detta arbetets syfte var att undersöka om lekterapi har effekt på preoperativ oro hos barn i åldrarna 0-18 som ska genomgå kirurgiska ingrepp.  Metod: En litteraturstudie gjordes med en deskriptiv design med en kvantitativ ansats. Denna studie baserades på 11 experimentella kvantitativa studier som undersökte lekterapins effekt på preoperativ oro. Artiklarna kvalitetsgranskades utifrån Fribergs granskningsmall.  Resultat: Studien använde Popenoe et al.s guide för dataanalys och resultatet delades in i tre kategorier: terapeutisk lek, teknologisk lek och strukturerad lek. Gemensamt för alla tre kategorier var att de visade på en reducerande effekt på preoperativ oro hos barn.  Slutsats: Lekterapi verkar ha en reducerande effekt på den preoperativa oron hos barn. Vilken typ av lek som lekterapin baseras på tycks inte påverka effekten av interventionen. Lekterapi bör därmed kunna användas som preoperativ förberedelse av barn i kombination med den rutinmässiga förberedelsen. / Background: Preoperative anxiety is prevalent in over half of all children undergoing invasive procedures. This may cause great suffering for the child which can lead to both physiological and psychological symptoms. Additionally these children face an increased risk of postoperative complications, which only leads to more suffering for the children but also an additional burden on the healthcare system. Studies have shown that play therapy has an alleviating effect on emotions in children, therefore this study aims to explore if play therapy also could have an alleviating effect on preoperative anxiety. Aim: To examine play therapy’s effect on preoperative anxiety in children undergoing invasive procedures.  Method: A literature review using a descriptive design with a quantitative approach. This study was based on 11 experimental quantitative studies examining the effect of play therapy on preoperative anxiety. The articles were reviewed based on Friberg’s quality review template. Results: This study used Popenoe et al.’s guide for data analysis and the results were categorized into three groups: therapeutic play, technological play and structured play. Common across all three categories was that they showed a reduction in preoperative anxiety in children.  Conclusion: Play therapy appears to have an alleviating effect on preoperative anxiety in children. What type of play that was carried out in play therapy does not seem to matter. Therefore, play therapy should be considered as part of the preoperative preparation for children, in conjunction with general surgery preparation.

Introduktion: Det ställs höga krav på anestesisjuksköterskan i mötet med ett barn inför anestesi. Många barn är rädda och anestesisjuksköterskan måste ha genomtänkta strategier att ta till för att minska risken för att anestesin ska bli en obehaglig upplevelse. Föräldrarna ska vara barnets trygghet och stöd och anestesisjuksköterskan måste kunna kommunicera även med dem. Syfte: Att belysa anestesisjuksköterskans erfarenheter av det preoperativa omhändertagandet av barn. Metod: En kvalitativ intervjustudie där intervjuernas innehåll analyserades enligt kvalitativ innehållsanalys. Intervjuerna utfördes på tre sjukhus i södra Sverige under vintern 2017. Sammanlagt intervjuades 12 anestesisjuksköterskor med varierande yrkeserfarenhet. Resultat: Fem kategorier framkom i resultatet: Miljö, som beskriver teamarbetet och arbetsklimatet på operationssalen. Anestesisjuksköterskans förhållningssätt, hur anestesisjuksköterskan bemöter barnen och de utmaningar som finns inom barnanestesin. Barnets delaktighet, vilket beskriver barnets samarbete eller avsaknad av samarbete med anestesisjuksköterskan. Förberedelser där  både medicinska förberedelser, information och förberedelser av barnet innan operationsdagen ingår. Föräldrarnas roll, som beskriver hur föräldrarnas beteende påverkar barnen och föräldrarnas förmåga att hantera obehagliga situationer. Slutsats: De intervjuade anestesisjuksköterskorna upplevde sina arbetsuppgifter under barnanestesi som en stor utmaning, men även en källa till glädje och tillfredsställelse. De såg vinsten av en bra förberedelse och en god kommunikation med både barn och föräldrar som ett sätt att minska deras oro. Anestesisjuksköterskan har en central roll i samarbetet med övrig personal på salen och höga krav ställs på sociala färdigheter och ödmjukhet. Nyckelord: anestesisjuksköterska, anestesi, barn, föräldrar, preoperativt omhändertagande, oro, omvårdnad, erfarenhet / Introduction: High demands meet the nurse Anaesthetist (NA) when seeing a child before anaesthesia. Many children are afraid, and the NA must have thought through strategies to reduce the risk of making the anaesthesia a frightful experience for the child. Parents are a great source of security for the children, and the NA must be able to communicate with them too. Aim: To illuminate the NA:s experience of the preoperative care of children. Method: A qualitative interview study where the interviews content was analysed by qualitative content analysis. The interviews were performed on three different hospitals in the southern of Sweden in the winter of 2017. Altogether 12 NA were interviewed, with a variation of professional experience. Result: There were five categories that emerged from the result: Environment, that describes the teamwork and the work climate in the operating room. The NA:s approach, how the NA meets the child and the challenges in children´s anaesthesia. Children´s participation which describes the cooperation or lack of cooperation between the child and the NA. Preparation there both the medical preparations, information and the preparation of the child before the day of the operation are included. The parent´s role, that describes how the parent´s behavior affects the children and the parent´s ability to handle unpleasant situations. Conclusion: The NA:s that were interviewed experienced their tasks during children´s anaesthesia as very challenging, but also as a source of joy and satisfaction. They appreciated the importance of an open communication with both children and parents as a way of decreasing their anxiety. The NA has a prominent role in the interaction with the operating room personnel, and great demands are put on social skills and humility.

Introdução: O jejum prolongado pré-operatório aumenta a resistência periférica à insulina. Foi investigado se a abreviação do jejum pré-operatório com uma bebida contendo carboidrato e glutamina melhora a resposta orgânica ao trauma cirúrgico. Métodos: Quarenta e oito pacientes adultas, do sexo feminino (19-62 anos) candidatas a colecistectomia videolaparoscópica eletiva. As pacientes foram aleatoriamente divididas em quatro grupos: grupo jejum convencional (grupo Jejum), ou em três grupos para receber três tipos diferentes bebidas oito horas (400 mL) e duas horas antes da indução anestésica (200ml): água pura (grupo Placebo), água mais dextrinomaltose (grupo carboidrato; 12,5% de dextrinomaltose) e grupo glutamina (grupo glutamina; 12,5% de dextrinomaltose e respectivamente 40 e 10g de glutamina). As amostras de sangue foram coletadas no período pré e pós-operatório. Resultados: não houve nenhum evento de aspiração ou regurgitação do conteúdo gástrico manifesto por sinais e sintomas clínicos, durante a indução anestésica, ou em qualquer outro momento do estudo. Também não houve nenhum óbito ou complicação pós-operatória. A média e o erro padrão médio da resistência à insulina determinada pelo HOMA-IR realizada no pós-operatório foi maior (p<0,05) no grupo que permaneceu em jejum (4,3±1,3) quando comparado com os outros três grupos de pacientes (Placebo, 1,6±0,3); carboidrato, (2,3±0,4) e glutamina, (1,5±0,1). A medida da glutationa peroxidase sérica, medida nos dois períodos foi maior no grupo glutamina (40±3,0) que nos grupos carboidrato (32±2,0) e jejum (32±2,0) (p<0,01). Ao se comparar o comportamento da IL-6 sérica em cada grupo estudado no período pré e pós-operatório, observou-se que o grupo glutamina foi o único sem diferença, enquanto nos demais a IL-6 aumentou no pós-operatório (p<0,01). No período pós-operatório a razão proteína-C-reativa/albumina foi maior no grupo jejum quando comparado com os grupos carboidrato (p=0,04) e glutamina (p=0,01). O balanço nitrogenado acumulativo foi menos negativo no grupo glutamina (-2,5±0,8 gN) que nos grupos placebo (-9,0±2,0 gN; p=0,001) e jejum (-6,6±0,4 gN; p=0,04). Conclusão: A abreviação do jejum pré-operatório com uma bebida contendo carboidrato e glutamina melhora a resistência periférica a insulina, a resposta anti-oxidativa e diminui a resposta inflamatória de pacientes submetidas à colecistectomia videolaparoscópica eletiva / Introduction: Prolonged preoperative fasting increases insulin resistance. We investigated whether an abbreviated preoperative fast with glutamine plus a carbohydrate based beverage would improve the organic response after surgery. Methods: Forty-eight female patients (19-62 years) candidates for video-cholecystectomy were randomized to either standard fasting (fasting group) or to fasting with one of three different beverages. Beverages were consumed 8 hours (400 mL; placebo group: water; glutamine group: water with 50 g maltodextrine plus 40 g glutamine; and carbohydrate group: water with 50 g maltodextrine) and 2 hours (200 mL; placebo group: water; glutamine group: water with 25 g maltodextrine plus 10 g glutamine; and carbohydrate group: water with 25 g maltodextrine) before anesthesia. Blood samples were collected pre- and postoperatively. Results: There were no cases of regurgitation during anesthesia. The mean [SEM] postoperative HOMA-IR was greater (p<0,05) in fasted patients (4,3±1,3) than in the other groups (placebo, 1,6±0,3); carbohydrate, (2.3±0,4); and glutamine, (1,5±0,1). Glutathione peroxidase (U/g hemoglobin) was significantly higher (40±3,0) in glutamine group than both carbohydrate (32±2,0) and fasting (32±2,0) groups (p< 0,01). Interleukin-6 increased in all groups except the glutamine group. The C-reactive protein/albumin ratio was higher in fasting subjects than carbohydrate (p=0,04) and glutamine (p=0,01) groups. The nitrogen balance was less negative in glutamine (-2,5±0,8 gN) than both placebo (-9,0±2,0 gN; p=0,001) and fasting (-6,6±0,4 gN; p=0,04) groups. Conclusions: Preoperative intake of a glutamine-enriched carbohydrate beverage improves insulin resistance and antioxidant defenses, and decreases the inflammatory response after videolaparoscopic cholecystectomy

INTRODUÇÃO: Os rins são alvos de diversas patologias que comprometem o seu funcionamento em graus variáveis, e em muitos casos, a nefrectomia é o melhor tratamento disponível. Atualmente existe um grande interesse na literatura no intuito de tentar prever como será a evolução da função renal do paciente após uma nefrectomia. Alguns estudos retrospectivos propuseram métodos para esta estimativa, no entanto, suas metodologias possuem falhas e seus resultados são contraditórios. OBJETIVOS: Avaliar de maneira prospectiva os fatores prognósticos préoperatórios associados a evolução da função renal seis meses após nefrectomias unilaterais utilizando para esta análise, um método radioisotópico de referência (51Cr- EDTA). Em seguida, elaborar um modelo matemático com o objetivo de predizer o ritmo de filtração glomerular (RFG) pós-operatório. Além disso, avaliar qual das equações mais usadas para estimativa do RFG por meio da creatinina sérica (Cockcroft-Gault, MDRD e CKD-EPI) tem melhor concordância com o 51Cr-EDTA. MÉTODOS: Este é um estudo prospectivo onde foram coletados dados demográficos, clínicos, laboratoriais e radiológicos pré-operatórios e seis meses após a nefrectomia, incluindo variáveis pouco ou nunca antes estudadas como a função renal diferencial na cintilografia com DMSA e o RFG mensurado por meio de estudo radioisotópico (51Cr-EDTA). Análises univariadas e multivariadas foram realizadas para identificar possíveis fatores de risco independentes para a piora da função renal. Essas variáveis foram então utilizadas na elaboração de um modelo matemático cujo objetivo foi estimar a função renal pós-operatória dos pacientes, utilizando para isso, apenas variáveis pré-operatórias. Por meio de estudos de correlação, os valores do RFG estimados pelas equações que utilizam a creatinina sérica foram comparados aos valores mensurados por meio do 51Cr-EDTA para avaliar qual tinha melhor concordância com o método padrão-ouro. RESULTADOS: De Abril de 2014 a Janeiro de 2018, 107 pacientes foram incluídos e completaram o protocolo de pesquisa. Doenças benignas foram responsáveis pela indicação da nefrectomia em 63,6% dos casos. Na análise univariada, diversas variáveis foram identificadas como possíveis fatores associados à evolução da função renal: idade, HAS, DM, DLP, DMSA e 51Cr-EDTA pré-operatórios. Entretanto, a análise multivariada demonstrou que a idade avançada (p=0,008), uma função relativa alta no DMSA do rim retirado (p < 0,001) e um valor de 51Cr-EDTA pré-operatório reduzido (p < 0,001) foram as variáveis que mantiveram significância e portanto foram consideradas fatores de risco independentes. A partir destas variáveis, elaborou-se um modelo matemático para estimativa do RFG pós-operatório (51Cr-EDTA pós-operatório = 37,9 - (0,29 x Idade) - (0,42 x DMSA RA) + (0,67 x 51Cr-EDTA pré-operatório). Por meio de análises de correlações, demonstrou-se que os valores do RFG obtidos por meio da equação CKD-EPI apresentavam melhor concordância com os valores mensurados com o 51Cr-EDTA. CONCLUSÕES: O presente protocolo de pesquisa demonstrou que a idade, o DMSA e o 51Cr-EDTA pré-operatórios estão significativamente associados à evolução da função renal após nefrectomias unilaterais e possibilitou a construção de um modelo para predizer o RFG pós-operatório. Também demonstrou que a equação CKD-EPI apresenta melhor concordância com o método considerado padrão-ouro para medida do RFG nesta população de pacientes / INTRODUCTION: The kidneys can be affected by pathologies that compromise their function in several degrees and unilateral nephrectomy is the best treatment option in many cases. However, there are still controversies about the renal function outcomes after nephrectomies and there are few retrospective studies that proposed models to estimate the postoperative glomerular filtration rate (GFR) after surgery. Moreover, they have methodological flaws and contradictory results. OBJECTIVES: To prospectively evaluate preoperative prognostic factors associated to renal function outcomes six months after unilateral nephrectomies with a gold-standard isotopic technique (51Cr-EDTA). To formulate a model for estimate the postoperative GFR. And to evaluate which equation for GFR estimation using serum creatinine has the best concordance to the 51Cr-EDTA. METHODS: Preoperative variables were prospectively collected and included: demographics, clinical, laboratorial and imaging studies. Univariate and multivariate analyses were done to identify the independent risk factors associated to renal function outcomes. These variables were used to create a model in order to predict the postoperative GFR. Correlation analyses were performed to evaluate which equation for GFR estimation using serum creatinine has the best concordance to the gold-standard isotope technique. RESULTS: One hundred and seven patients were enrolled and completed the study protocol from April 2014 to January 2018. Nephrectomy was performed for a benign disease in 63,2% of patients. After univariate and multivariate analyses, older age (p=0,008), higher split function of the affected kidney in DMSA scintigraphy (p < 0,001) and lower values of preoperative 51Cr-EDTA (p < 0,001) were identify as independent risk factors for postoperative GFR worsening. Using these variables, a mathematical model was elaborated to predict the postoperative GFR (postoperative 51Cr-EDTA = 37.9 - (0.29 x Age) - (0.42 x DMSA) + (0.67 x preoperative 51Cr-EDTA). Correlation analyses showed that GFR estimated by CKD-EPI equation has the best concordance to GFR measured by 51Cr-EDTA. CONCLUSIONS: The present study protocol demonstrated that age, DMSA and preoperative 51Cr-EDTA are significantly associated to postoperative renal function outcomes after unilateral nephrectomies and permitted the elaboration of a model to predict the postoperative GFR. Also demonstrated that CKD-EPI equation has the best concordance to the gold-standard technique for GFR measurement

Orientador: Maria Salete Costa Gurgel / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-09-11T21:11:07Z (GMT). No. of bitstreams: 1 Zorlini_Renata_M.pdf: 756123 bytes, checksum: b912b10737e099427e96e5d68482c9eb (MD5) Previous issue date: 2007 / Resumo: Introdução: As mulheres com câncer ginecológico ou de mama apresentam, freqüentemente, alterações do estado nutricional como a desnutrição e a obesidade, devido à própria doença como também ao tratamento a que são submetidas: cirurgia, quimioterapia e/ou radioterapia. Tais alterações podem trazer complicações no pós-operatório como aumento do período de hospitalização, dos custos hospitalares e piora do prognóstico. Para identificar este problema, a avaliação nutricional pode ser o melhor método para tratar os distúrbios nutricionais, como a desnutrição e/ou a obesidade, melhorar a resposta terapêutica e o prognóstico das pacientes. Objetivo: Identificar o perfil nutricional pré-operatório de mulheres com câncer ginecológico ou mamário e correlacioná-lo à localização e estádio da doença e tratamentos oncológicos (quimioterapia e/ou radioterapia) prévios. Sujeitos e Métodos: Trata-se de um estudo de corte transversal com 250 mulheres avaliadas no pré-operatório de cirurgias oncologicas no CAISM/Unicamp, pelo Índice de Massa Corpórea e pela Avaliação Nutricional Subjetiva Global, no período de agosto de 2003 a abril de 2005. Para análise dos dados foram aplicados os testes Qui-Quadrado e Índice de Concordância entre os dois métodos, assumindo-se o nível de significância de 5%. Resultados: O câncer da mama foi o mais freqüente, predominando em 56,2%. A mediana da idade foi de 52 anos; em cerca de 57% dos casos a neoplasia se restringia aos estádios clínicos 0, I e II, e 77% das mulheres não realizaram outro tratamento oncológico pré-cirurgico. A Avaliação Nutricional Subjetiva Global detectou 76% de mulheres eutróficas e 24% desnutridas, enquanto o Índice de Massa Corpórea identificou 34% de mulheres eutróficas, 3,6% desnutridas e 62,4% com sobrepeso/obesidade. A concordância do diagnóstico de eutrofia e desnutrição pelos dois métodos foi baixa [63,8%; kappa (IC 95%) = 0,0884 (-0,07 ¿ 0,24)]. Não foram observadas correlações entre as avaliações nutricionais e os tratamentos prévios e estádios da doença. Quanto à localização anatômica, segundo a Avaliação Nutricional Subjetiva Global, as mulheres com câncer do corpo do útero eram mais desnutridas que as demais (p=0,02). Conclusões: Os achados sugerem que uma avaliação mais criteriosa deva ser empregada para identificação do estado nutricional pré-operatório em mulheres com câncer ginecológico ou mamário. Palavras-chave: perfil nutricional; avaliação nutricional; desnutrição; obesidade; câncer ginecológico; câncer de mama; pré-operatório / Abstract: Introduction: The oncologic patient often undergoes several surgical procedures and nutritional status is usually altered during hospitalization, resulting in a worse prognosis. The association between cancer and malnutrition or obesity has many consequences, including increased risk of infection, increased length of hospitalization, poor wound healing, reduction in muscle function and its consequences, thus affecting response to therapy. Objective: To identify the preoperative nutritional profile of women with gynecologic or breast cancer, in correlation with disease site and staging as well as previous treatments. Subjects and Methods: A cross-sectional study of 250 women evaluated by Body Mass Index and Subjective Global Assessment from August 2003 to April 2005. For data analysis, the chi-square test was applied and the agreement between the diagnoses of normal nutrition and malnutrition was calculated by both methods using kappa coefficient and its 95% confidence interval. Results: Breast cancer was the most frequent cancer, predominating in 56.2%. The median age of the patients was 52 years. In about 57% of these women, the tumor was restricted to clinical stages 0, I and II and 77% of the women had not undergone any other oncologic treatment prior to surgery. Subjective Global Assessment detected 76% of nourished women and 24% undernourished women, while Body Mass Index identified 34% of nourished women, 3.6% undernourished women and 62.4% overweight/obese women. A low level of diagnostic agreement between normal nutrition and malnutrition by both methods was observed (63.8%; kappa (95% CI) = 0.0884 (-0.07 ¿ 0.24). No correlation between nutritional evaluation and previous treatment and disease staging was observed. Concerning anatomic site, it was subjectively observed that women with cancer of the uterine corpus were more malnourished than the rest (p=0.02). Conclusions: The findings suggest that a more careful evaluation should be employed to identify preoperative nutritional status in women with gynecologic or breast cancer. Keywords: nutritional profile; assessment; malnutrition; obesity; gynecologic cancer; breast cancer; preoperative / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia