نوع بیهوشی و تأثیر بی‌دردی زایمان اپیدورال بر سطح گلوکز در سزارین و پیامدهای نوزادی: مروری سیستماتیک و متاآنالیز

نوع مقاله : مروری

نویسندگان

1 فوق تخصص غدد، استادیار گروه داخلی، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

2 استادیار گروه داخلی، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

3 دانشیار گروه بیهوشی، مرکز تحقیقات بیهوشی و کنترل درد، دانشکده پزشکی، دانشگاه علوم پزشکی هرمزگان، بندرعباس، ایران.

4 استادیار گروه بیهوشی، مرکز تحقیقات بیهوشی و کنترل درد، دانشکده پزشکی، دانشگاه علوم پزشکی هرمزگان، بندرعباس، ایران.

5 متخصص بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی تهران، تهران، ایران.

6 استادیار بیهوشی، گروه بیهوشی و مراقبت‌های ویژه، دانشکده پزشکی، دانشگاه علوم پزشکی گلستان، گلستان، ایران.

7 دانشیار گروه بیهوشی، مرکز تحقیقات بیهوشی و کنترل درد، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

10.22038/ijogi.2024.74605.5838

چکیده

مقدمه: با توجه به حساس بودن سطح گلوکز خون مادر و نوزاد در زمان تولد، مطالعه حاضر با هدف بررسی تأثیر نوع بیهوشی (عمومی، نخاعی، اپیدورال) بر سطح گلوکز خون پس از عمل جراحی زنان باردار با دیابت بارداری و پیامدهای نوزادی انجام شد.
روش‌کار: در این مطالعه مرور سیستماتیک و متاآنالیز، پایگاه داده­های PubMed، Scopus، Web of Science، SID و مگیران با استفاده از ترکیبی از کلمات کلیدی سزارین، نوع بیهوشی، سطح گلوکز خون و دیابت بارداری بدون محدودیت زمانی مورد جستجو قرار گرفتند. مطالعاتی وارد شدند که تأثیر انواع بیهوشی مانند بیهوشی عمومی، بی‌حسی نخاعی و بی‌حسی اپیدورال را بر روی سطوح گلوکز خون، پاسخ استرس مادر، مصرف مواد افیونی و پیامدهای نوزادی بررسی کردند.
یافته ­ها: سطوح گلوکز خون بعد از عمل در بی­حسی نخاعی به‌‌طور معنی‌داری کمتر از بیهوشی عمومی بود (مدل اثر تصادفی؛ 99%=I2). با حذف سوگیری انتشار با استفاده از روش Trim and Fill به نتایج تعدیلی منجر شد که تفاوت آماری یا بالینی را در سطح گلوکز خون نشان نداد. هیچ تفاوتی در پذیرش ‏NICU و هیپوگلیسمی نوزاد وجود نداشت. کیفیت شواهد در اکثر مطالعات بسیار پایین بود. ‏
نتیجه­ گیری: هیچ تفاوتی در پیامد کنترل قند خون بین بیهوشی عمومی و اسپاینال وجود ندارد. این نتایج بر اهمیت انتخاب نوع بیهوشی و نظارت در حین جراحی در سناریوهای بالینی خاص تأکید می‌کند.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Type of Anesthesia and the Impact of Labor Epidural Analgesia on Glucose Levels in Cesarean Section and Neonatal Outcomes: A Systematic Review and Meta-Analysis

نویسندگان [English]

  • Fatemeh Eftekharian 1
  • Zhila Rahmanian 2
  • Majid Vatankhah 3
  • Tayyebeh Zarei 4
  • Pourya Adibi 4
  • Kaveh Hedayati Emami 5
  • Mansour Deylami 6
  • Reza Sahraei 7
1 Endocrinologist, Assistant Professor, Department of Internal Medicine, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
2 Assistant Professor, Department of Internal Medicine, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
3 Associate Professor, Department of Anesthesiology, Anesthesiology and Pain Management Research Center, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
4 Assistant Professor, Department of Anesthesiology, Anesthesiology and Pain Management Research Center, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
5 Anesthesiologist, Department of Anesthesiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
6 Assistant Professor, Department of Anesthesiology and Critical Care, Faculty of Medicine, Golestan University of Medical Sciences, Golestan, Iran.Golestan University of Medical Sciences
7 Associate Professor, Department of Anesthesiology, Anesthesiology and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
چکیده [English]

Introduction: Considering the sensitivity of blood glucose level of mother and baby at the time of birth, the present study was conducted with aim to investigate the effect of the type of anesthesia (general, spinal, epidural) on blood glucose level after surgery and neonatal outcomes in pregnant women with gestational diabetes.
Methods: In this systematic review and meta-analysis study, databases of PubMed, Scopus, Web of Science, SID, and Megiran were searched using a combination of keywords of cesarean section, type of anesthesia, blood glucose level, and gestational diabetes without time limit. Studies were included that examined the effects of types of anesthesia such as general anesthesia, spinal anesthesia, and epidural anesthesia on blood glucose levels, maternal stress response, opioid use, and neonatal outcomes.
Results: Postoperative blood glucose levels in spinal anesthesia were significantly lower than general anesthesia (random effect model; I2=99%). Removing publication bias using the Trim and Fill method led to adjusted results that did not show statistical or clinical differences in blood glucose levels. There was no difference in NICU admission and neonatal hypoglycemia. The quality of evidence in most studies was very low.
Conclusion: There was no difference between general and spinal anesthesia in glycemic control outcome. These results emphasize the importance of choosing the type of anesthesia and monitoring during surgery in specific clinical scenarios.

کلیدواژه‌ها [English]

  • Cesarean Section
  • Epidural
  • General Anesthesia
  • Gestational Diabetes
  • Hyperglycemia

مراجع

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مجله زنان، مامایی و نازایی ایران
دوره 27، شماره 8
آبان 1403
صفحه 51-63

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