Sağlık profesyonellerinin bitkisel ilaç kullanan hastalara yaklaşımı

Abstract

bjective: Patients commonly take a combination of prescription drugs and herbal medicines. Often these alternative products have known pharmacological effects which may interact with drugs given perioperatively, resulting in adverse effects (1, 2). These herbal mixtures, which are known as natural herbal products, have been reported in cases as increasing morbidity and mortality. These herbal products must have effect on anesthetic and surgical method since they have that much side effects in daily usage. The purpose of this study is to raise awareness of medical specialists of herbal product usage in preoperative stage. Method: The study was performed on voluntary residents and specialists practicing in the Ankara Numune Education and Research Hospital following the approval received from the Ethics Committee. Apart from personal information such as age, gender, department and academic status, it was also investigated whether they use herbal medicine and recommend herbal medicines to their patients. The perioperative management strategies of patients who use herbal medicine were examined. The data obtained were analyzed using SPSS for Windows, version 20.0. The level of significance was set as p<0.05. Results: 150 medical doctors aged 24-60 participated in the study on voluntary basis. The maximum herbal medicine was observed in 40-49 age group attendants. The ratio of recommending herbal medicine was higher among attendants over 50, and among doctors who used herbal medicine. 4% of the participants stated that they had protocols for herbal medicines, 57% of the participants claimed that usage of herbal medicine should be avoided in preoperative stage but only 8.6% of doctors managed to answer the question regarding the period of stopping the use of medicine accurately. Conclusion: Anesthesiologists should obtain a history of herbal medicine use from patients and work out the adverse perioperative herb-drug interactions before the actual operation.

Objective: Patients commonly take a combination of prescription drugs and herbal medicines. Often these alternative products have known pharmacological effects which may interact with drugs given perioperatively, resulting in adverse effects (1, 2). These herbal mixtures, which are known as natural herbal products, have been reported in cases as increasing morbidity and mortality. These herbal products must have effect on anesthetic and surgical method since they have that much side effects in daily usage. The purpose of this study is to raise awareness of medical specialists of herbal product usage in preoperative stage. Method: The study was performed on voluntary residents and specialists practicing in the Ankara Numune Education and Research Hospital following the approval received from the Ethics Committee. Apart from personal information such as age, gender, department and academic status, it was also investigated whether they use herbal medicine and recommend herbal medicines to their patients. The perioperative management strategies of patients who use herbal medicine were examined. The data obtained were analyzed using SPSS for Windows, version 20.0. The level of significance was set as p<0.05. Results: 150 medical doctors aged 24-60 participated in the study on voluntary basis. The maximum herbal medicine was observed in 40-49 age group attendants. The ratio of recommending herbal medicine was higher among attendants over 50, and among doctors who used herbal medicine. 4% of the participants stated that they had protocols for herbal medicines, 57% of the participants claimed that usage of herbal medicine should be avoided in preoperative stage but only 8.6% of doctors managed to answer the question regarding the period of stopping the use of medicine accurately. Conclusion: Anesthesiologists should obtain a history of herbal medicine use from patients and work out the adverse perioperative herb-drug interactions before the actual operation.

Amaç: Operasyona hazırlanan hastaların çoğunun reçeteli ilaçlar yanında reçetesiz ulaşılabilen bitkisel karışımlar kullandığı ve bu bitkisel ürünlerin de reçeteli ilaçlar gibi farmakolojik etkileri, dolayısı ile yan etkileri olduğu bilinmektedir (1, 2). Doğal bitkisel ürünler olarak bilinen bu bitkisel karışımların morbidite ve mortaliteyi arttırdığına ilişkin olgu sunuları rapor edilmektedir. Günlük kullanım sırasında böylesi yan etkiler gösterebilen bu bitkisel ürünlerin anestezi ve cerrahi sürecinde de etkisi olacağı açıktır. Çalışmamızın amacı; hastanemizdeki doktorların bitkisel ürün kullanımının preoperatif hazırlık sürecindeki önemine karşı farkındalığını araştırmaktır. Yöntem: Çalışmaya etik kurul izni alındıktan sonra, Ankara Numune Eğitim ve Araştırma Hastanesi’nde çalışan asistan ve uzman doktorlar gönüllülük esası ile dahil edildi. Yaş, cinsiyet, çalıştıkları bölüm ve görev ünvanları gibi kişisel bilgileri yanında, bitkisel ilaç kullanıp kullanmadıkları, hastalarına bitkisel ilaç tavsiye edip etmedikleri irdelendi. Bitkisel ilaç kullanan hastalardaki perioperatif yönetim stratejileri araştırıldı. Verilerin istatistiksel analizi SPSS 20.0 paket programı ile yapıldı. Anlamlılık düzeyi p<0.05 olarak belirlendi. Bulgular: Ankete gönüllü olarak 24-60 yaşları arasında 150 doktor katıldı. Bu doktorların 40-49 yaş arası bitkisel ilaç kullanım oranı en yüksekti. 50 yaş ve üstü katılımcıların bitkisel ilaç tavsiye etme oranı ile kendisi de bitkisel ilaç kullanan hekimlerin hastalarına bitkisel ilaç tavsiye etme oranı daha yüksek bulundu. Katılımcıların %4’ü bitkisel ilaçlara yönelik klinik protokollerinin olduğunu, %57’si preoperatif dönemde bitkisel ilaçların kesilmesi gerektiğini belirtti, ancak %8.6’sı ilaç kesilme süresini doğru cevapladı. Sonuç: Sağlık profesyonelleri hastalarının bitkisel ilaç kullanım öyküsünü almalı, özellikle operasyon öncesinde olumsuz perioperatif bitki-ilaç etkileşimlerini bilmeli ve güncel değişiklikleri takip etmelidirler.