بررسی بالا آوردن اندام تحتانی در پیشگیری از هیپوتنشن مادری بعد از بی‌حسی نخاعی در سزارین الکتیو؛ یک مطالعه کارآزمایی بالینی تصادفی شده دوسویه‌کور

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه بیهوشی و مراقبت‌های ویژه، دانشکده پزشکی، دانشگاه علوم پزشکی همدان، همدان، ایران.

2 دانشیار گروه پزشکی اجتماعی، دانشکده پزشکی، دانشگاه علوم پزشکی همدان، همدان، ایران.

3 متخصص بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی همدان، همدان، ایران.

10.22038/ijogi.2022.20093

چکیده

مقدمه: افت فشارخون، یک عارضه شایع در بی‌حسی نخاعی حین سزارین است که درمان‌های موجود این عارضه را کاملاً برطرف نمی‌سازد. با توجه به سهولت و کم‌عارضه بودن این روش، مطالعه حاضر با هدف بررسی اثر بالا آوردن اندام تحتانی بر کاهش انسیدانس هیپوتانسیون انجام شد.
روشکار: این مطالعه کارآزمایی بالینی دوسوکور در سال ۹۹-1398 بر روی 101 زن باردار کاندید سزارین تحت بی‌حسی نخاعی در بیمارستان فاطمیه دانشگاه علوم پزشکی همدان انجام شد. افراد به‌طور تصادفی در دو گروه مداخله (بالا آوردن پاها پس از بی‌حسی) و شاهد (بدون بالا آوردن پا) تخصیص داده شدند. پس از شروع بی‌حسی و در زمان‌های مختلف، فشارخون سیستولیک و دیاستولیک، بروز هیپوتانسیون، وقوع تهوع و استفراغ و برادیکاردی و مقدار مصرف آتروپین و افدرین در دو گروه ثبت و مقایسه شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 22) و آزمون‌های آماری تی مستقل و آزمون مربع کای صورت گرفت. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: اختلاف معنی‌داری از نظر میانگین فشار سیستولیک و دیاستولیک و تعداد ضربان قلب در زمان‌های مختلف بین دو گروه مشاهده نشد (05/0<p) و فقط میانگین فشار دیاستولیک در دقیقه 25 در گروه مداخله پایین‌تر از گروه کنترل بود (05/0≥p). وقوع تهوع و استفراغ در گروه مداخله همواره کمتر از گروه کنترل بود، ولی تفاوت دو گروه معنی‌دار نبود (05/0<p). میزان وقوع هیپوتانسیون در گروه مداخله 54% و در گروه کنترل 8/60% بود، ولی تفاوت دو گروه معنی‌دار نبود (5/0=p).
نتیجه‌گیری: بالا آوردن پا پس از بی‌حسی نخاعی، تأثیر چشم‌گیری در اندکس‌های همودینامیک از جمله وقوع هیپوتانسیون ندارد.

کلیدواژه‌ها


عنوان مقاله [English]

Lower limb elevation in prevention of spinal anesthesia (SA)- induced maternal hypotension in elective Cesarean section (C/S): a randomized double blind clinical trial

نویسندگان [English]

  • Mahshid Nikooseresht 1
  • Pooran Hajian 1
  • Mohammad Ali Seifrabiee 2
  • Nazanin Fallah 3
1 Associate Professor, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
2 Associate Professor, Department of Community Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
3 Anesthesiologist, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
چکیده [English]

Introduction: Hypotension is a common complication of spinal anesthesia during cesarean section that available treatments do not completely eliminate this complication. Due to the low cost and ease of legs elevation, this study was performed with aim to evaluate the effect of leg's raising on reducing the incidence of maternal hypotension.
Methods: This double-blind randomized clinical trial study was performed in 2019-2020 on 101 pregnant women who were candidates for c/s under spinal anesthesia in Fatemiyeh Hospital of Hamadan University of Medical Sciences. The subjects were randomly assigned to the intervention group (raising legs after anesthesia) and control group (without raising legs). After the onset of anesthesia and at different times, systolic and diastolic blood pressure, the incidence of hypotension, bradicardia, nausea, vomiting and used atropin or ephedrin were recorded and compared in the two study groups. Data were analyzed by SPSS software (version 22) and Independent t-test and Chi square test. P<0.05 was considered statistically significant.
Results: No significant difference was observed between the two groups in terms of mean systolic and diastolic blood pressure and heart rate at different times (P>0.05) and only the mean diastolic BP at 25 minutes was lower in the intervention group than the control group (P≤0.05). The incidence of nausea and vomiting was always lower in the intervention group than the control group, but the difference was not significant (P>0.05). The incidence of hypotension was 54% in the intervention and 60.8% in the control group, but the difference was not significant (P = 0.5).
Conclusion: The leg's raising after spinal anesthesia has no significant effect on hemodynamics indices including the occurrence of hypotension.

کلیدواژه‌ها [English]

  • Cesarean section
  • Ephedrine
  • Hypotension
  • Spinal anesthesia
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