Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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1683-1764
1735-7322
10.18869/acadpub.tumj
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fa
jalali
1390
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gregorian
2011
10
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69
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online
1
fulltext
fa
مقایسه دو روش بیحسی نخاعی در حالتهای خوابیده به پهلو و نشسته در جراحی عروق اندام تحتانی
The comparison between lateral spinal anesthesia and sitting positions in lower limb vascular surgery
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<p dir="rtl" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">زمینه و
هدف:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">بیماران </span><span style="font-size: 10pt">تحت عمل جراحی</span><span style="font-size: 10pt"> عروقی اندام تحتانی که توسط جراحان متبحر عروق تحت عمل جراحی قرار میگیرند
از لحاظ تمهیدات بیهوشی بسیار پرخطر تلقی میگردند. در این مطالعه مقایسه دو روش بیحسی
نخاعی در حالتهای خوابیده به پهلو و نشسته از نظر همودینامیک و مدت بیدردی در
بیماران تحت جراحی عروق اندام تحتانی توسط داروی بوپیواکایین (5/0%) هیپربار صورت
پذیرفته است.</span><span style="font-size: 9pt"> </span><strong><span style="font-size: 10pt">روش بررسی:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">برای<span> </span>40 بیمار که به دو گروه 20 نفره تقسیمبندی شدند
در دو حالت نشسته </span><span style="font-size: 8pt">(Sitting position)</span><span style="font-size: 10pt"> و حالت خوابیده به پهلو </span><span style="font-size: 8pt">(Lateral position)</span><span style="font-size: 10pt"> داروی بوپیواکایین هیپربار 5/0% بهمیزان </span><span style="font-size: 8pt">ml</span><span style="font-size: 8pt">3</span><span lang="AR-SA"> </span><span style="font-size: 10pt">در
فضای ساب آراکنویید تزریق گردید. سطح بیحسی بیماران </span><span style="font-size: 7pt">T10</span><span style="font-size: 10pt"> در نظر گرفته شد و نتایج از نظر همودینامیک
و مدت بیدردی در دو گروه مقایسه شد.</span><strong><span style="font-size: 10pt"> <br></span></strong></p><p dir="rtl" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt"></span></strong><strong><span style="font-size: 10pt">یافتهها:</span></strong><span style="font-size: 10pt"> اختلاف آماری معنیداری بین
تغییرات فشار خون متوسط شریانی، فشار خون سیستولیک و فشار خون دیاستولیک دو گروه
وجود داشت (05/0</span><span style="font-size: 7pt">P<</span><span style="font-size: 10pt">). اختلاف آماری معنیداری بین تغییرات ضربان قلب در کلیه زمانهای
مورد بررسی در دو گروه وجود داشت (05/0</span><span style="font-size: 7pt">P<</span><span style="font-size: 10pt">)؛ اما در مورد ضربان قلب در دقایق نخست و سیام
اختلاف آماری معنیداری را بین دو گروه نشان نمیداد (05/0</span><span style="font-size: 7pt">P></span><span style="font-size: 10pt">). طول بیحسی
در گروه خوابیده به پهلو بهمیزان معنیداری طولانیتر و میزان مایع مصرفی در گروه
نشسته بهمیزان معنیداری بیشتر بود (05/0</span><span style="font-size: 7pt">P<</span><span style="font-size: 10pt">).</span><strong><em><span style="font-size: 10pt"> <br></span></em></strong></p><p dir="rtl" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">نتیجهگیری:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">در مجموع بر اساس نتایج حاصل از این مطالعه چنین استنباط میشود که
میزان تغییرات همودینامیک در بیهوشی اسپاینال با بوپیواکایین در پوزیشن خوابیده به
پهلو کمتر از نشسته میباشد.</span></p>
<p style="text-align: justify"><strong>Background:</strong> Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009.<br><strong></strong></p>
<p style="text-align: justify"><strong>Methods:</strong> In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups.<br><strong></strong></p>
<p style="text-align: justify"><strong>Results:</strong> The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups (P<0.05). Except in the first and thirtieth minutes, the changes in heart rate (HR) were significantly different throughout the study between the two groups (P<0.04) and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position (P<0.04) and the use of fluid was significantly larger in the sitting group (P<0.05).<br><strong></strong></p>
<p style="text-align: justify"><strong>Conclusion: </strong>According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb.</p>
بوپیواکایین،بیهوشی،اسپاینال،پوزیشن،جراحیهای اندام تحتانی
Bupivacaine,position,spinal anesthesia,vascular surgery
420
425
http://tumj.tums.ac.ir/browse.php?a_code=A-10-25-212&slc_lang=fa&sid=1
Mohajer
MR
محمدرضا
مهاجر