مقايسة پيامدهاي بعد از عمل بيماران در جراحي واريكوسلكتومي به دو روش بيهوشي عمومي و نخاعي در بيمارستان امام رضا تهران

Comparison of Outcomes of Patients after Varicocelectomy with General Anesthesia vs Spinal Anesthesia in Emam Reza Hospital (Tehran)

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺍﻓﺰﺍﻳﺶ ﺭﻭﺯﺍﻓﺰﻭﻥ ﻋﻤﻞ ﻭﺍﺭﻳﮑﻮﺳﻠﻜﺘﻮﻣﻲ ﺍﻧﺘﺨﺎﺏ ﺗﮑﻨﻴﮏ ﺑﻴﻬﻮﺷﻲ ﺑﺮﺍﺳﺎﺱ ﻧﻮﻉ ﺟﺮﺍﺣﻲ، ﺍﻧﺠﺎﻡ ﺳﺮﻳﻊ ﺑﻴﻬﻮﺷﻲ، ﺑﻬﺒﻮﺩ ﺳﺮﻳﻊ ﺑﻴﻤﺎﺭ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﻭ ﮐﺎﻫﺶ ﻋﻮﺍﺭﺽ ﺟﺎﻧﺒﻲ ﺍﺯ ﺍﻫﻤﻴﺖ ﺑﺎﻻﻳﻲ ﺑﺮﺧﻮﺭﺩﺍﺭ ﺍﺳﺖ. ﺍﻳﻦ ﻃﺮﺡ ﺑﺎ ﻫﺪﻑ ﻣﻘﺎﻳﺴﻪ ﻭﺿﻌﻴﺖ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺩﺭ ﺟﺮﺍﺣﻲ ﻭﺍﺭﻳﮑﻮﺳﻠﻜﺘﻮﻣﻲ ﺑﻪ ﺩﻭ ﺭﻭﺵ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﻭ ﺑﻲ ﺣﺴﻲ ﻧﺨﺎﻋﻲ )ﺍﺳﭙﺎﻳﻨﺎﻝ( ﺍﻧﺠﺎﻡ ﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﻳﮏ ﻣﻄﺎﻟﻌﻪ ﻣـﺪﺍﺧﻠﻪ ﺍﻱ ﺍﺯ ﻧـﻮﻉ ﻧﻴﻤﻪ ﺗﺠـﺮﺑﻲ (Quasi-experimental) ﮐﻪ ﺩﺭ ﺳﺎﻝ1387 -86 ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺍﻣﺎﻡ ﺭﺿﺎ ﻉ( ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﺁﺟﺎ ﺩﺭ ﺷﻬﺮ ﺗﻬﺮﺍﻥ ﺍﻧﺠﺎﻡ ﺷﺪ، 78 ﺑﻴﻤﺎﺭ ﺑﺮﺍﻱ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻭﺍﺭﻳﮑﻮﺳﻠﻜﺘﻮﻣﻲ ﺑﺮ ﺣﺴﺐ ﺭﻭﺵ ﺑﻴﻬﻮﺷﻲ ﺑﻪ ﺩﻭ ﮔﺮﻭﻩ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﻭ ﺑﻲ ﺣﺴﻲ ﻧﺨﺎﻋﻲ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ. ﺟﻬﺖ ﺍﺭﺯﻳﺎﺑﻲ ﻳﮑﻨﻮﺍﺧﺘﻲ ﻭﺿﻌﻴﺖ ﺩﻭ ﮔـﺮﻭﻩ ﻗﺒﻞ ﺍﺯ ﺷﺮﻭﻉ ﺩﺭﻣﺎﻥ، ﻣﺘﻐﻴﺮﻫﺎﻱ ﺩﻣﻮﮔﺮﺍﻓﻴﮏ ﻣﻮﺭﺩ ﻣﻘﺎﻳﺴﻪ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ ﻭ ﺟﻬﺖ ﺍﺭﺯﻳﺎﺑﻲ ﺗﺄﺛﻴﺮ ﺩﻭ ﺭﻭﺵ ﻣﺘﻐﻴﺮﻫﺎﻱ ﻣﺪﺕ ﺯﻣﺎﻥ ﺷﺮﻭﻉ ﺑﻴﻬـﻮﺷﻲ ﺗﺎ ﺁﻏﺎﺯ ﺟﺮﺍﺣﻲ، ﺩﺭﺩ ﻣﺤﻞ ﻋﻤﻞ، ﻣﺪﺕ ﺯﻣﺎﻥ ﺍﻭﻟﻴﻦ ﺭﺍﻩ ﺭﻓﺘﻦ ﭘﺲ ﺍﺯ ﺟﺮﺍﺣﻲ، ﺗﻬﻮﻉ ﻭ ﺍﺳﺘﻔﺮﺍﻍ ﺑﻌﺪ ﺟﺮﺍﺣﻲ، ﺗﻐﺬﻳﻪ ﺑﻌﺪ ﺍﺯ ﺟﺮﺍﺣﻲ، ﻧﻌﻮﻅ ﺣﻴﻦ ﻋﻤﻞ، ﺳﺮﺩﺭﺩ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﻭ ﻣﻮﻓﻘﻴﺖ ﺍﻧﺠﺎﻡ ﺑﻴﻬﻮﺷﻲ ﺩﺭ ﺩﻭ ﮔﺮﻭﻩ ﺛﺒﺖ ﺷﺪﻧﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻧﺮﻡ ﺍﻓـﺰﺍﺭ SPSS 13 ﻭ ﺁﺯﻣـﻮﻥ ﻫﺎﻱ ﺁﻣﺎﺭﻱ T- student ﻭ Chi-square ﻭ Kolmogorov-Smirnov ﻣـﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗـﺮﺍﺭ ﮔـﺮﻓﺘﻨﺪ ﻭ ﺑﻪ ﺻﻮﺭﺕ ﻣﻴـﺎﻧﮕﻴﻦ ﺧﻄﺎﻱ ﺍﺳﺘـﺎﻧﺪﺍﺭﺩ ﺑﻴﺎﻥ ﮔـﺮﺩﻳﺪﻩ ﺍﻧﺪ ﻭ -P value <0.05 ﻣﻌﻨﻲ ﺩﺍﺭ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺯﻣـﺎﻥ ﺑﻴﻦ ﺷـﺮﻭﻉ ﺑﻴﻬـﻮﺷﻲ ﺗﺎ ﺷـﺮﻭﻉ ﺟـﺮﺍﺣﻲ، ﻣـﺪﺕ ﺯﻣـﺎﻥ ﺟـﺮﺍﺣﻲ، ﺍﻭﻟﻴـﻦ ﺯﻣـﺎﻥ ﺭﺍﻩ ﺭﻓﺘـﻦ ﭘﺲ ﺍﺯ ﺟـﺮﺍﺣﻲ، ﺯﻣﺎﻥ ﺷـﺮﻭﻉ ﺗﻐـﺬﻳﻪ ﭘﺲ ﺍﺯ ﺟـﺮﺍﺣﻲ، ﺩﻭﺭﺓ ﺑـﺪﻭﻥ ﺩﺭﺩ ﻭ ﺷـﺪﺕ ﺩﺭﺩ ﻣﺤـﻞ ﺟـﺮﺍﺣﻲ ﺩﺭ ﺯﻣـﺎﻥ ﻫﺎﻱ 6، 12 ﻭ 24 ﺳﺎﻋـﺖ ﭘﺲ ﺍﺯ ﻋﻤـﻞ، ﺗﻬـﻮﻉ ﻭ ﺍﺳﺘﻔـﺮﺍﻍ ﺩﺭ ﺩﻭ ﮔـﺮﻭﻩ ﺑﻴﻬـﻮﺷﻲ ﺗﻔـﺎﻭﺕ ﻣﻌﻨﻲ ﺩﺍﺭﻱ ﺭﺍ ﻧﺸـﺎﻥ ﻧﺪﺍﺩ. ﻣﻴـﺰﺍﻥ ﺑـﺮﻭﺯ ﺳﺮ ﺩﺭﺩ ﺩﺭ ﮔـﺮﻭﻩ ﺍﺳﭙـﺎﻳﻨﺎﻝ ﺑﻄﻮﺭ ﻣﻌﻨـﻲ ﺩﺍﺭﻱ ﺑﻴـﺶ ﺍﺯ ﮔـﺮﻭﻩ ﺑﻴﻬـﻮﺷﻲ ﻋﻤـﻮﻣﻲ ﺑﻮﺩ )0/03

Introduction & Objective: Considering the increasing rate of varicocele disease, the choice of anesthesia for suitable surgical condition and rapid recovery and minimal side effects is very important. This study was conducted to evaluate of patient’s condition after varicocelectomy with general anesthesia Vs spinal anesthesia. Materials & Methods: In a Quasi-experimental study, 78 patients who were candidated for varicocele surgery at Emam Reza Hospital were selected sequentially. The study population was divided into two equal general and spinal anesthesia groups. All relevant data, such as demographics and clinical parameters, were registrated. Results: In this study, duration of operation, time in the operating room, first walking and feeding after operation, duration of free-pain period, pain of surgical site at 6, 12 and 24 hours after the operation, nausea and vomiting, did not show any significant difference between the two groups. In spinal anesthesia group the occurrence of headache was significantly more than general anesthesia group (P<0.03). Intraoperative erection was lower in spinal anesthesia than in the general anesthesia group (P<0.04). Conclusions: In this study, it seems that general anesthesia is useful for the decrease of postoperative complications such as headache and spinal anesthesia is useful for the decrease of intraoperative complications such as erection.