تأثیر روش بیهوشی بر میزان خونریزی (میزان هموگلوبین و هماتوکریت) بعد از عمل هیسترکتومی شکمی: یک کارآزمایی بالینی تصادفی شده

نوع مقاله: اصیل پژوهشی

نویسندگان

1 دانشیار گروه بیهوشی، دانشکده پزشکی، دانشگاه بابل، بابل، ایران.

2 متخصص بیهوشی، دانشکده پزشکی، دانشگاه بابل، بابل، ایران.

3 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه بابل، بابل، ایران.

چکیده

مقدمه: خونریزی، کاهش هموگلوبین و هماتوکریت، از عوارض اصلی هیسترکتومی می­باشند. با توجه به تناقض مطالعات مختلف در مورد انتخاب روش بیهوشی در جراحی‌های قسمت تحتانی شکم، مطالعه حاضر با هدف بررسی تأثیر روش بیهوشی بر میزان خونریزی (میزان هموگلوبین و هماتوکریت) بعد از عمل هیسترکتومی شکمی انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی تصادفی در سال 93-1392 بر روی 100 زن 70-35 ساله با II و class I ASA (انجمن بیهوشی آمریکا) کاندیدای هیسترکتومی شکمی با علل خوش‌خیم صورت گرفت. بیماران به دو گروه مساوی بی‌حسی نخاعی و بیهوشی عمومی تقسیم شدند. میزان هموگلوبین و هماتوکریت، قبل و 24 ساعت بعد از عمل و فشارخون سیستول و دیاستول حین عمل در دقایق 5، 10، 15، 20، 25، 30، 40، 50 و 60 بعد از شروع بیهوشی عمومی و بی‌حسی نخاعی ثبت شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 22) و آزمون‌های تی تست، من ویتنی و کای اسکوئر انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: دو گروه از نظر سن، مدت بیهوشی و جراحی، میزان هموگلوبین و هماتوکریت قبل از عمل تفاوتی نداشتند (05/0p>). میانگین میزان هموگلوبین بعد از عمل در گروه بیهوشی عمومی 12/1±64/9 و بی‌حسی نخاعی‌ 11/1±24/10 میلی‌گرم در دسی‌لیتر و هماتوکریت بعد از عمل در گروه بی‌حسی نخاعی 21/3±83/29 و بیهوشی عمومی 05/3±45/32 درصد بود که بین دو گروه اختلاف آماری معنی‌داری وجود داشت (009/0=p، 001/0>p). میانگین فشار‌خون سیستولیک و دیاستولیک در حین عمل در گروه بیهوشی عمومی به طور معنی‌داری بیشتر از گروه بیهوشی نخاعی بود.
نتیجه‌گیری: میزان کاهش هموگلوبین و هماتوکریت بعد از عمل هیسترکتومی شکمی در بیمارانی که تحت بیهوشی عمومی قرار گرفتند، بیشتر از بی‌حسی نخاعی است.

کلیدواژه‌ها


عنوان مقاله [English]

Effect of Different Anesthetic Techniques on Post-operative Hemoglobin and Hematocrit Levels Following Abdominal Hysterectomy; a Randomized Clinical Trial

نویسندگان [English]

  • Hakimeh Alereza 1
  • Nadia Banihashem 1
  • Iman Akhlaghi 2
  • Parviz Amri 1
  • Mahtab Zinalzadeh 3
  • Shahnaz Barat 3
1 Associate Professor, Department of Anesthesiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
2 Anesthesiologist, Department of Anesthesiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
3 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
چکیده [English]

Introduction: Hemorrhage and drop in hemoglobin (Hb) and hematocrit (Hct) levels are the major complications of hysterectomy. This study was conducted to compare the effect of different anesthetic techniques on post-operative Hb and Hct levels following abdominal hysterectomy.
Materials and Methods: This randomized clinical trial was performed on 100 women aged between 35 and 70 years old in 2013. They were classified as classes I and II according to the American Society of Anesthesiology physical status classification and were candidates for abdominal hysterectomy due to benign causes. The patients were assigned into two groups of spinal and general anesthesia (50 patients per group). The pre- and 24 h post-operative levels of Hb and Hct and systolic and diastolic blood pressure during surgery were recorded 5, 10, 15, 20, 25, 30, 40, 50, and 60 min after the onset of general and spinal anesthesia. Data analysis was performed using t-test, Mann-Whitney U and Chi-squared tests by SPSS software, version 22. P-value less than 0.05 was considered statistically significant.
Results: There was no significant different regarding age, the duration of anesthesia and surgery, mean pre-operative levels of Hb and Hct (P>0.05). The mean post-operative levels of Hb were 9.64±1.12 mg/dl and 10.24±1.11 mg/dl with general and spinal anesthesia, respectively. Moreover, the post-operative levels of Hct were 29.83±3.21% and 32.45±3.05% with the spinal and general anesthesia, respectively (P=0.009 and P<0.001). The mean systolic and diastolic blood pressure was significantly higher in the patients in the general anesthesia group than those in the spinal anesthesia group.
Conclusion: The decrease in the post-operative levels of Hb and Hct in the patients who underwent general anesthesia was greater than those who underwent spinal anesthesia.

کلیدواژه‌ها [English]

  • Abdominal hysterectomy
  • General anesthesia
  • Hematocrit
  • Hemorrhage
  • Hemoglobin
  • Spinal anesthesia
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