Katarakt ameliyatı esnasında ağrı ve anksiyete: Birinci göz ve ikinci göz cerrahisi arasında karşılaştırma
Pain and anxiety during cataract surgery: Comparison between first eye and second eye surgery
Yazar: CANER ALİ AKOĞLU
Danışman: DR. ÖĞR. ÜYESİ GÜLDEN KÜÇÜKAKÇA ÇELİK
Nevşehir Hacı Bektaş Veli Üniversitesi / Fen Bilimleri Enstitüsü / Hemşirelik Ana Bilim Dalı
Derece: Yüksek Lisans, 2020
Konu: Hemşirelik = Nursing
Dizin: Anksiyete = Anxiety ; Ağrı = Pain ; Cerrahi-göz = Surgery-eye ; Göz hastalıkları = Eye diseases ; Katarakt = Cataract ; Katarakt çıkartılması = Cataract extraction ; Perioperatif dönem = Perioperative period

Özet:
Bu aratrma; her iki göze katarakt cerrahisi uygulanan hastalarn, ameliyat esnasnda
deneyimledikleri ar ve anksiyete düzeylerinin belirlenmesi ve karlatrlmas
amacyla yapld. Tanmlayc nitelikte olan aratrmann evrenini; Ekim 2018- Temmuz
2019 tarihleri arasnda, bir devlet hastanesinin Göz Hastalklar- Cerrahisi Polikliniine
bavuran ve katarakt nedeniyle fakoemülsifikasyon ameliyat uygulanan 128 hasta
oluturdu. Aratrmann örneklem büyüklüü, yaplan güç analizi ile belirlendi ve
aratrma kriterlerine uyan 60 hasta aratrmann örneklemini oluturdu. Veri
toplamada; Tantc Özellikler Formu, Durumluluk- Sürekli Anksiyete Ölçei, Vizüel
Analog Skala, Sözel Ar Skalas ve Fizyolojik Parametreleri Deerlendirme Formu
kullanld. Veriler hastalardan; ameliyathaneye gitmeden önce, ameliyata alnmadan
önce, ameliyat srasnda, ameliyat bittikten hemen sonra ve klinie alndktan sonra
olmak üzere, be aamal bir süreçte topland. Verilerin deerlendirilmesinde; kategorik
deikenler için frekans dalm, saysal deikenler için tanmlayc istatistikler
(ortalama, standart sapma); I. ve II. göz cerrahi giriim sonuçlar için eletirimi t testi,
Bonferroni testi ve ANOVA analizi kullanld. Bütün istatistiksel analizlerde önemlilik
seviyesi p<0.05 olarak kabul edildi. Aratrma bulgularnda; gruplar aras ar ve
anksiyete puan ortalamalar karlatrldnda; hastalarn I. göz ameliyat öncesi
durumluluk anksiyetelerinin ve II. göz cerrahisi ameliyat bittikten hemen sonra VASar puan ortalamalarnn daha yüksek olduu belirlendi (p<0.05). Grup içi
deerlendirmede; II. göz cerrahisinde ameliyata alnmadan ve ameliyat esnasnda
ölçülen VAS-anksiyete puanlar ve klinie alndktan sonra ölçülen durumluluk
anksiyete puanlar daha yüksekti (p<0.05). Ameliyat esnasnda hastalarn çounlukla
hafif ar deneyimledii ve II. göz cerrahisinde klinie alndktan sonra ar
iddetlerinin artt saptand (p<0.05). Hastalarn fizyolojik parametreleri 
v
karlatrldnda; her iki göz cerrahisinde de gruplar aras ve grup içi sistolik kan
basnc ve oksijen saturasyonu ortalamalar arasnda istatistiksel olarak anlaml bir fark
yoktu. Hastalarn I. göz cerrahisinde, II. göz cerrahisine göre ameliyata alnmadan önce
ölçülen diastolik kan basnc deerlerinin daha yüksek olduu belirlendi (p<0.05). Grup
içi deerlendirmede; hastalarn I. göz cerrahisi ameliyat esnasnda ölçülen diastolik kan
basnc deerleri, dier tüm ölçümlerden daha yüksekdi. II. göz cerrahisinde ise
hastalarn nabz ve solunum says daha düük olarak saptand (p<0.05). Hastalarn
%38.3'ü her iki göz ameliyatnda benzer düzeyde anksiyete yaadklarn ifade ederken,
%51.7'si ikinci göz ameliyatnda daha fazla ar hissettiini belirtti. Çalma sonuçlar
dorultusunda; katarakt ameliyatnn tüm aamalarnda ar ve anksiyetenin
deerlendirilip kontrol altna alnmasnda, gerekli hemirelik giriimlerinin planlanmas
önerilir.
Anahtar kelimele : Katarakt Cerrahisi, Ameliyat Esnas, Ar, Anksiyete

Abstract:
This study was conducted to determine and compare the levels of intraoperative pain
and anxiety experienced by patients undergoing cataract operation on both eyes in
different times. The population of the descriptive study consisted of 128 patients who
applied to the Ophthalmology Outpatient Clinic of a public hospital and underwent
phacoemulsification operation due to cataract, between October 2018 and July 2019.
Sample size of the study was determined via the power analysis and the sample of the
study consisted of 60 patients meeting the inclusion criteria. The data were collected
using; Descriptive Characteristics Form, State-Trait Anxiety Scale, Visual Analogue
Scale, Verbal Pain Scale, and Evaluation Form for Physiological Parameters. The data
were collected from patients in a five-stage process; before going into the operating
room, before being taken into the operation, during the operation, immediately after the
operation and after being taken into the clinic. The data were evaluated using frequency
distribution for categorical variables, descriptive statistics (mean, standard deviation)
for numeric variables, paired t-test for intervention outcomes of the first and second eye
surgeries, Bonferroni test and ANOVA analysis. In all statistical analyses, the
significance level was accepted as p<0.05. In the study findings, upon comparison of
intergroup pain and anxiety mean scores, it was determined that patients' state anxiety
mean scores were higher before the first eye surgery and VAS– pain mean scores were
higher immediately after the second eye surgery (p<0.05). In the intragroup evaluation;
VAS– anxiety scores were higher before being taken into the operation and during the
operation and state anxiety scores were also higher after being taken into the clinic in
the second eye surgery (p<0.05). It was determined that the patients experienced mostly
mild pain during the operation and the severity of their pain increased after being taken 
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into the clinic in the second eye surgery (p<0.05). When comparing patients'
physiological parameters, it was determined that there was no statistically significant
difference between intergroup and intragroup systolic blood pressure and mean oxygen
saturation values in both eye surgeries. It was found that patients' diastolic blood
pressure values were higher before being taken into the operation in the first eye
surgery, compared to the second eye surgery (p<0.05). In the intragroup evaluation, it
was determined that patients' diastolic blood pressure values were higher during the
first eye surgery, compared to all other measurements. In the second eye surgery, on the
other hand, patients' pulse and respiratory rates were lower (p<0.05). While 38.3% of
the patients stated that they experienced similar levels of anxiety in both eye surgeries,
51.7% stated that they felt more pain in the second eye surgery. In line with the study
results, it is recommended that necessary nursing interventions are planned to evaluate
and control pain and anxiety in all stages of cataract operation.
Keywords : Cataract Operation, Intraoperative, Pain, Anxiety