مقایسه پیامدهای مادر و نوزاد حین زایمان واژینال و سزارین با بیهوشی عمومی و نخاعی- مطالعه گذشته‌نگر

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه بیهوشی، مرکز تحقیقات بیهوشی و مراقبت‌های ویژه، دانشکده پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران.

2 پزشک، مرکز تحقیقات بیهوشی و مراقبت‌های ویژه، دانشکده پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران.

3 کارشناس ارشد علوم تغذیه، مرکز تحقیقات بیهوشی و مراقبت‌های ویژه، دانشکده پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران.

4 استادیار گروه فارماکولوژی، مرکز تحقیقات بیهوشی و مراقبت‌های ویژه، دانشکده پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران.

چکیده

مقدمه: بر اساس گزارش سازمان جهانی بهداشت، اثرات دقیق سزارین بر سطح سلامت مادر و نوزاد نامشخص است. مطالعه حاضر با هدف مقایسه پیامد مادر و نوزاد پس از زایمان واژینال، سزارین با بیهوشی عمومی و بی‌حسی نخاعی انجام شد.
روش‌کار: در این مطالعه گذشته‌نگر، 122 پرونده پزشکی از زنانی که تحت عمل زایمان طبیعی و سزارین غیراورژانس در بیمارستان مادر و کودک غدیر وابسته به دانشگاه علوم پزشکی شیراز طی سال 95-1394 قرار گرفته بودند، در سه گروه 36 نفره (زایمان واژینال، سزارین با بیهوشی عمومی و بی حسی نخاعی) مورد بررسی قرار گرفتند. ضربان قلب، فشارخون مادر و همچنین نمره آپگار و گازهای خون بندناف بررسی شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 19) و آزمون آنالیز واریانس یک‌طرفه برای داده‌های پارامتری بین گروه‌ها و اندازه‌گیری مکرر برای ارزیابی تأثیر زمان در گروه‌ها استفاده شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: نمره آپگار دقایق 1 و 5 بین گروه­ها اختلاف معنی‌داری نداشت (به‌ترتیب 39/0=p و 91/0=p). PH جنین در گروه سزارین با بی‌حسی نخاعی (05/0=p) و PO2 و HCo3 در گروه سزارین با بیهوشی عمومی بیشتر بود (04/0=p). فشارخون سیستولیک پس از زایمان در زنان تحت بیهوشی نخاعی و فشارخون دیاستولیک در زنان تحت بیهوشی عمومی تفاوت معنی‌داری با دو گروه دیگر داشتند (05/0>p).
نتیجه‌گیری: فشارخون سیستولیک پس از زایمان در زنان تحت بیهوشی نخاعی و فشارخون دیاستولیک در زنان تحت بیهوشی عمومی نسبت به سایر گروه­ها بالاتر بود. PH خون نوزاد در گروه سزارین با بی‌حسی نخاعی و فشار اکسیژن و بی‌کربنات در خون بندناف نوزادان گروه تحت عمل سزارین با بیهوشی عمومی، بیشتر بود، اما نمره آپگار و فشار دی‌اکسیدکربن بین گروه­ها تفاوتی نداشت.

کلیدواژه‌ها

عنوان مقاله [English]

Comparison of Maternal and Neonatal Outcomes between Vaginal Delivery and Cesarean Section under General or spinal anesthesia- retrospective study

نویسندگان [English]

  • Ali Karami 1
  • Sara Khademi 2
  • Zeinabsadat Fattahi Saravi 1
  • Reza Jouybar 1
  • Zahra Esmaeilinezhad 3
  • Elham Asadpour 4
1 Assistant professor, Department of Anesthesia, Anesthesiology and Critical Care Research Center, Faculty of Medicine, Shiraz University of Medical Science, Shiraz, Iran.
2 Physician, Anesthesiology and Critical Care Research Center, Faculty of Medicine, Shiraz University of Medical Science, Shiraz, Iran.
3 M.Sc. in Nutrition Sciences, Anesthesiology and Critical Care Research Center, Faculty of Medicine, Shiraz University of Medical Science, Shiraz, Iran.
4 Assistant professor of pharmacology, Anesthesiology and Critical Care Research Center, Faculty of Medicine, Shiraz University of Medical Science, Shiraz, Iran.
چکیده [English]

Introduction: World Health Organization (WHO) has reported that the exact impacts of cesarean section on maternal and neonatal health are uncertain. This study was performed with aim to compare maternal and neonatal outcomes after vaginal delivery, cesarean section with general anesthesia or spinal anesthesia.
Methods: In this retrospective study, 122 medical records of women who underwent vaginal delivery and non-emergency cesarean section at Ghadir Mother and Child Hospital affiliated to Shiraz University of Medical Sciences in 2015-2016 were divided into three groups of 36 subjects (vaginal delivery, cesarean section with general anesthesia and spinal anesthesia) were evaluated. Maternal heart rate and blood pressure, Apgar score, and fetal blood gas of umbilical cord were assessed. Data were analyzed by SPSS software (version 19) and One-way ANOVA test was used for parametric data between groups and repeated measure for evaluating the effect of time in the groups. P Results: Exact Apgar scores at 1 and 5 min showed no significant difference between the groups (P = 0.39 and P = 0.91, respectively). Fetal pH was higher in cesarean group with spinal anesthesia (P = 0.05) while PO2 and HCo3 were higher in cesarean group with general anesthesia (P = 0.04). Postpartum systolic blood pressure in women under spinal anesthesia and diastolic blood pressure in women under general anesthesia were significantly different with other two groups (P <0.05).
Conclusion: Postpartum systolic blood pressure was higher in women under spinal anesthesia and diastolic blood pressure was higher in women under general anesthesia than other groups. pH of the infant's blood was higher in the cesarean group with spinal anesthesia, and the oxygen and bicarbonate pressure in the umbilical cord blood of the infants was higher in the cesarean group with general anesthesia, but the Apgar score and carbon dioxide pressure did not differ between the groups.

کلیدواژه‌ها [English]

  • Apgar
  • Cesarean section
  • General anesthesia
  • Spinal anesthesia
  • Vaginal delivery

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مجله زنان، مامایی و نازایی ایران
دوره 23، شماره 4
تیر 1399
صفحه 15-23

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