ICHAK TUTILISHI BOR BOLALARDA PERIOPERATSION OQIBATLARNING ANESTEZIOLOGIK DЕТERMINANTLARI
Abstrakt
Chaqaloqlar va yosh bolalarda ichak tutilishi yuqori perioperatsion asoratlar va o‘lim ko‘rsatkichlari bilan bog‘liq bo‘lib, klinik natijalarga nafaqat xirurgik omillar, balki anesteziologik ta’minot va perioperatsion intensiv terapiya ham sezilarli ta’sir ko‘rsatadi. Maqsad. Ichak tutilishi bor bolalarda salbiy klinik natijalarning perioperatsion prediktorlarini aniqlash hamda anesteziologik boshqaruv strategiyalarini baholashdan iborat. Usullar. Retrospektiv kuzatuv tadqiqoti Andijon viloyat ko‘p tarmoqli tibbiyot markazi bazasida o‘tkazildi. 0–3 yoshli, ichak tutilishi sababli shoshilinch jarrohlik amaliyoti o‘tkazilgan 99 nafar bolaning tibbiy hujjatlari tahlil qilindi. Demografik, klinik, anesteziologik va perioperatsion ko‘rsatkichlar baholandi. Salbiy klinik natijalarning mustaqil prediktorlarini aniqlash maqsadida binar logistik regressiya hamda ROC-tahlil qo‘llanildi. Natijalar. Salbiy klinik natijalar (og‘ir asoratlar va/yoki o‘lim) 34,3% bemorlarda kuzatildi. Operatsiya davomiyligi salbiy klinik natijaning mustaqil prediktori sifatida aniqlandi (OR=1,064 har bir daqiqa uchun; 95% ishonch oralig‘i 1,023–1,107; p=0,002). Kasalxonaga kech murojaat qilish (>24 soat) salbiy natija bilan chegaraviy bog‘liqlikni ko‘rsatdi (p=0,057). Regressiya modeli qoniqarli diskriminatsion qobiliyatga ega bo‘lib, ROC egri chizig‘i ostidagi maydon (AUC) 0,722 ni tashkil etdi. Tahlil natijalariga ko‘ra, operatsiya davomiyligi salbiy klinik natijalarning mustaqil va ishonchli prediktori sifatida aniqlandi (OR=1,078; 95% CI: 1,028-1,131; p=0,002). Bu har bir qo‘shimcha operatsiya daqiqasi salbiy klinik natija rivojlanish ehtimolini o‘rtacha 7-8% ga oshirishini ko‘rsatadi. Bu esa operatsiya vaqtining uzayishi bilan bog‘liq metabolik buzilishlar va operatsiya stressining kuchayishi klinik natijalarga salbiy ta’sir ko‘rsatishini anglatadi. Shuningdek, kasalxonaga kech murojaat qilish (>24 soat) salbiy klinik natijalar xavfini sezilarli darajada oshiruvchi muhim omil sifatida qayd etildi (OR=9,20; 95% CI: 1,62-52,38; p=0,012). Bu natija kasallikning kech bosqichida tashxis qo‘yilishi, ichak ishemiyasi va infeksion-septik asoratlar xavfining ortishi bilan izohlanishi mumkin. Anesteziya turi, xususan multimodal anesteziya, ko‘p omilli model doirasida mustaqil statistik ahamiyatga ega bo‘lmadi (p=0,301). Xulosa. Perioperatsion omillar, ayniqsa operatsiya davomiyligi, bolalarda ichak tutilishida klinik natijalarni belgilashda muhim ahamiyatga ega. Kasalxonaga erta murojaat qilish va anesteziologik ta’minotni optimallashtirish klinik natijalarni yaxshilashga xizmat qilishi mumkin.
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