مقایسه بروز علائم بالینی ترومبوز ورید عمقی در بیهوشی عمومی و بیحسی نخاعی بعد از عمل جراحی هیسترکتومی شکمی

نوع مقاله : اصیل پژوهشی

نویسندگان

1 متخصص بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران.

2 دانشجوی کارشناسی هوشبری، دانشکده پیراپزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران.

3 استادیار گروه جراحی عمومی و عروق، مرکز تحقیقات تنفس و خواب راحت، دانشگاه علوم پزشکی تبریز، تبریز ایران.

چکیده

مقدمه: با توجه به اینکه روش بیهوشی در بروز علائم بالینی ترومبوز ورید عمقی (DVT) پس از هیسترکتومی شکمی دخیل است و این موضوع می­تواند در ابتلاء به ترمبوز ورید عمقی مؤثر باشد و عدم اطلاع دقیق از بروز و یا عدم بروز آن منجر به شروع درمان می­شود، مطالعه حاضر با هدف مقایسه بروز علائم بالینی DVT در بیهوشی عمومی و بی­حسی نخاعی بعد از عمل جراحی هیسترکتومی شکمی انجام شد.
روشکار: این مطالعه توصیفی- تحلیلی طی سال‌های 99-1398 با مشارکت 70 زن بعد از عمل هیسترکتومی شکمی که به یکی از دو روش بیهوشی عمومی و بی‌حسی نخاعی تحت عمل جراحی قرار گرفته بودند، در بیمارستان الزهراء تبریز انجام شد. تشخیص DVT به‌وسیله چک‌لیست علائم بالینی و سونوگرافی داپلر انجام شد. تجزیه و تحلیل داده­ها با استفاده از نرم‌افزار آماری SPSS (نسخه 22) و آزمون­های آماری تی تست و کای اسکوئر انجام شد. میزانp  کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: بروز علائم بالینی DVT در بیماران دریافت کننده بیهوشی عمومی 14/17% و در بیماران دریافت‌کننده بی­حسی نخاعی 85/22% بود که بروز این علائم در گروه بیماران دریافت‌کننده بی­حسی نخاعی به‌طور غیرمعناداری بالاتر از گروه دریافت‌کنندگان بیهوشی عمومی بود (103/0=p)؛ با این حال بروز این عارضه پس از انجام سونوگرافی داپلر در هر دو گروه برابر صفر بود.
نتیجهگیری: بروز علائم بالینی DVT در زنان کاندید هیسترکتومی شکمی که به یکی از دو روش بیهوشی عمومی و بی­حسی نخاعی تحت جراحی قرار گرفته بودند، تفاوت معنادار نداشت؛ به این معنا که نوع روش بیهوشی در بروز ترومبوز ورید عمقی سهمی ندارد.

کلیدواژه‌ها


عنوان مقاله [English]

The incidence of the symptoms of deep vein thrombosis in general anesthesia and spinal anesthesia after abdominal hysterectomy

نویسندگان [English]

  • Mansour Rezaee 1
  • Nafiseh Sheghaghi Ilkhchi 2
  • Mina Zeinalzadeh 2
  • Dara Alvandfar 3
1 Anesthesiologist, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
2 B.Sc. Student of Anesthesia, School of Paramedical, Tabriz University of Medical Sciences, Tabriz, Iran.
3 Assistant Professor, Department of General and Vascular Surgery, Comfortable Breathing and Sleep Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
چکیده [English]

Introduction: Considering that anesthesia method is involved in the incidence of the symptoms of deep vein thrombosis (DVT) after abdominal hysterectomy, and this can be effective on the development of DVT, and lack of accurate information about the occurrence or non-occurrence of it leads to the start of treatment; this study was performed with aim to compare the incidence of the symptoms of DVT in general anesthesia and spinal anesthesia after abdominal hysterectomy.
Methods: This descriptive-analytical study was performed in 2019-2020 with participation of 70 women after abdominal hysterectomy that underwent the surgery under one of the two methods of general anesthesia and spinal anesthesia in Al-Zahra Hospital, Tabriz. DVT was diagnosed by the checklist of clinical symptoms and Doppler ultrasound. Data were analyzed by SPSS statistical software (version 22) and t-test and Chi-square test. P<0.05 was considered statistically significant.
Results: The incidence of DVT symptoms in patients receiving general anesthesia was 17.14% and in those receiving spinal anesthesia was 22.85%; the incidence of these symptoms in the group receiving spinal anesthesia was non-significantly higher than the group receiving general anesthesia (P = 0.103). However, the incidence of this complication after Doppler ultrasound was zero in both groups.
Conclusion: The incidence of DVT was not significantly different in women candidates for abdominal hysterectomy that underwent surgery under one of the two methods of general anesthesia and spinal anesthesia; however, the method of anesthesia has no role in the incidence of DVT.

کلیدواژه‌ها [English]

  • Abdominal hysterectomy
  • Deep vein thrombosis
  • General anesthesia
  • Spinal anesthesia
  1. Khanbabaei Gol M, Aghamohammadi D. Effect of intravenous infusion of magnesium sulfate on opioid use and hemodynamic status after hysterectomy: double-blind clinical trial. Iran J Obstet Gynecol Infertil 2019; 22(7):32-8.
  2. Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstetrics & Gynecology 2013; 121(3):654-73.
  3. Ackenbom MF, Giugale LE, Wang Y, Shepherd JP. Incidence of occult uterine pathology in women undergoing hysterectomy with pelvic organ prolapse repair. Female pelvic medicine & reconstructive surgery 2016; 22(5):332-5.
  4. Zhang Y, Yan J, Han Q, Yang T, Cai L, Fu Y, et al. Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage: a 12-year review. Medicine 2017; 96(45).
  5. Cusimano MC, Simpson AN, Dossa F, Liani V, Kaur Y, Acuna SA, et al. Laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity: a systematic review and meta-analysis of conversions and complications. American journal of obstetrics and gynecology 2019; 221(5):410-28.
  6. Kraaijpoel N, van Es N, Porreca E, Büller HR, Di Nisio M. The diagnostic management of upper extremity deep vein thrombosis: a review of the literature. Thrombosis research 2017; 156:54-9.
  7. Di Minno MN, Ambrosino P, Ambrosini F, Tremoli E, Di Minno G, Dentali F. Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta‐ Journal of thrombosis and haemostasis 2016; 14(5):964-72.
  8. Feng JP, Xiong YT, Fan ZQ, Yan LJ, Wang JY, Gu ZJ. Efficacy of intermittent pneumatic compression for venous thromboembolism prophylaxis in patients undergoing gynecologic surgery: A systematic review and meta-analysis. Oncotarget 2017; 8(12):20371.
  9. Li Q, Xue Y, Peng Y, Li L. Analysis of risk factors for deep venous thrombosis in patients with gynecological malignant tumor: A clinical study. Pakistan journal of medical sciences 2019; 35(1):195.
  10. Alvandfar D, Alizadeh M, Khanbabayi Gol M. Prevalence of pregnancy varicose and its effective factors in women referred to gynecology hospitals in Tabriz. Iran J Obstet Gynecol Infertil 2019; 22(9):1-7.
  11. Soltanizadeh S, Degett TH, Gögenur I. Outcomes of cancer surgery after inhalational and intravenous anesthesia: A systematic review. Journal of clinical anesthesia 2017; 42:19-25.
  12. Nemirovsky A, Herbert AS, Gorman EF, Malik RD. A systematic review of best practices for the perioperative management of abdominal sacrocolpopexy. Neurourology and Urodynamics 2020; 39(5):1264-75.
  13. Gol MK, Aghamohamadi D. Effect of massage therapy with and without elastic bandaging on pain, edema, and shoulder dysfunction after modified radical mastectomy: a clinical trial. International Journal of Women’s Health and Reproduction Sciences 2020; 8(1):73-8.
  14. Fakhari S, Bile Jani I, Atashkhouei S, Khanbabayi Gol M, Soliemanzadeh S. Comparing the effect of hypotension treatment due to spinal anesthesia with ephedrine or phenylephrine on arterial blood gases and neonatal Apgar score during cesarean delivery in obese mothers: randomized clinical trial. Iran J Obstet Gynecol Infertil 2019; 22(10):12-20.
  15. Ackroyd SA, Hernandez E, Roberts ME, Chu C, Rubin S, Mantia-Smaldone G, et al. Postoperative complications of epidural analgesia at hysterectomy for gynecologic malignancies: an analysis of the National Surgical Quality Improvement Program. International Journal of Gynecologic Cancer 2020; 30(8).
  16. Bhavani V, Raajesh IJ. Comparison of intrathecal isobaric levobupivacaine, levobupivacaine-clonidine, with hyperbaric bupivacaine as a control for quality of anaesthesia intraoperative hemodynamics and duration of post-operative pain relief in patients undergoing vaginal hysterectomy. Indian Journal of Clinical Anaesthesia 2016; 3(2):148-54.
  17. Zdravkovic M, Podbregar M, Kamenik M. Near-infrared spectroscopy for assessing microcirculation during laparoscopic gynaecological surgery under combined spinal-general anaesthesia or general anaesthesia alone: a randomised controlled trial. Journal of clinical monitoring and computing 2020; 34(5):943-53.
  18. Bilir AY, Akay MO, Ceyhan Dİ, Mutlu FS. Potential antithrombotic effects of bupivacaine in malignancies: An in vitro assesment using thromboelastography. Indian Journal of Pharmaceutical Sciences 2016; 78(4):552-6.
  19. Liu H, Brown M, Sun L, Patel SP, Li J, Cornett EM, et al. Complications and liability related to regional and neuraxial anesthesia. Best Practice & Research Clinical Anaesthesiology 2019; 33(4):487-97.
  20. Petca A, Borislavschi A, Dumitrascu MC, Sandru F, Geoarsa M, Petca RC. Postoperative ileus complicated with incomplete evisceration after hysterectomy for benign pathology. Chirurgia 2020; 115(1):112-9.
  21. Monsour MA, Wiley W, Le CH, Lee J, Brown KP, Robinson M, et al. Infectious Causes of 30-Day Unplanned Hospital Encounters and Readmissions After Hysterectomies: A Single Institutional Study. Journal of Gynecologic Surgery 2019; 35(2):89-93.