پديد آورندگان :
فرنوش، فرضي دانشگاه علوم پزشكي گيلان - مركز تحقيقات بيهوشي - بيمارستان الزهرا (س) - گروه بيهوشي , بي آزار، گلاره دانشگاه علوم پزشكي گيلان - مركز تحقيقات بيهوشي - بيمارستان الزهرا (س) - گروه بيهوشي , اميدي، صمد دانشگاه علوم پزشكي گيلان - مركز تحقيقات بيهوشي - بيمارستان الزهرا (س) - گروه بيهوشي , حبيبي، محمدرضا دانشگاه علوم پزشكي گيلان - مركز تحقيقات بيهوشي - بيمارستان الزهرا (س) - گروه بيهوشي , ظهري نوبيجاري، طاهره دانشگاه علوم پزشكي گيلان - مركز تحقيقات بيهوشي - بيمارستان الزهرا (س) - گروه بيهوشي , خصوصي ثاني، مهسا دانشگاه علوم پزشكي گيلان - مركز تحقيقات بهداشتو باروري - گروه جراحي زنان و زايمان , نعمت اللهي، گودرز دانشگاه علوم پزشكي گيلان - مركز تحقيقات بيهوشي
چكيده فارسي :
زﻣﯿﻨﻪ و ﻫﺪف: از آﻧﺠﺎ ﮐﻪ ﻋﻤﻞ ﺳﺰارﯾﻦ ﺷﺎﯾﻌﺘﺮﯾﻦ روش ”ﻣﺪاﺧﻠﻪﮔﺮ“ ﺧﺘﻢ ﺑﺎرداري اﺳﺖ، در اﯾﻦ ﻣﻮرد اﻧﺘﺨﺎب ﺗﮑﻨﯿﮏ ﺑﯿﻬﻮﺷﯽ ﮐﻢ ﺧﻄﺮ، ﻣﻄﻠﻮب و ﻣﻘﺮون ﺑﻪ ﺻﺮﻓﻪ ﺑﺮاي ﻣﺎدر و ﻧﻮزاد اﻫﻤﯿﺖ زﯾﺎدي دارد. ﺑﺮ اﺳﺎس ﻣﻄﺎﻟﻌﺎت ﻣﻌﺘﺒﺮ روش ارﺟﺢ ﺑﺮاي ﺳﺰارﯾﻦ، ﺑﯿﻬﻮﺷﯽ ﻧﺨﺎﻋﯽ اﺳﺖ. ﺑﺎ اﯾﻦ ﺣﺎل ﻧﺘﺎﯾﺞ ﻣﻄﺎﻟﻌﺎت اﻧﺠﺎم ﺷﺪه در اﯾﺮان ﻣﺆﯾﺪ اﺳﺘﻔﺎده زﯾﺎد از روش ﺑﯿﻬﻮﺷﯽ ﻋﻤﻮﻣﯽ ﺑﺮاي اﻧﺠﺎم ﻋﻤﻞ ﺳﺰارﯾﻦ ﺑﻮده اﺳﺖ. ﻟﺬا ﻫﺪف از ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ، ﺑﺮرﺳﯽ ﻋﻠﻞ ﻋﺪم ﭘﺬﯾﺮش ﺑﯽﺣﺴﯽ ﻧﺨﺎﻋﯽ در ﻋﻤﻞ ﺳﺰارﯾﻦ ﺗﻮﺳﻂ زﻧﺎن ﺑﺎردار اﺳﺖ. ﻣﻮاد و روش ﻫﺎ: اﯾﻦ ﭘﮋوﻫﺶ ﻣﻘﻄﻌﯽ - ﺗﺤﻠﯿﻠﯽ ﺑﺮ روي زﻧﺎن ﺑﺎردار ﻣﺮاﺟﻌﻪ ﮐﻨﻨﺪه ﺟﻬﺖ اﻧﺠﺎم ﻋﻤﻞ ﺟﺮاﺣﯽ ﺳﺰارﯾﻦ اﻟﮑﺘﯿﻮ ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎن اﻟﺰﻫﺮا رﺷﺖ در ﺳﺎل 1396 ﺻﻮرت ﭘﺬﯾﺮﻓﺖ. ﭘﺲ از اﺧﺬ رﺿﺎﯾﺖ ﻧﺎﻣﻪ آﮔﺎﻫﺎﻧﻪ از اﻓﺮاد، ﭘﺮﺳﺸﻨﺎﻣﻪاي ﮐﻪ رواﯾﯽ آن ﺗﻮﺳﻂ ده ﻧﻔﺮ از اﻋﻀﺎي ﻫﯿﺎت ﻋﻠﻤﯽ ﮔﺮوه ﺑﯿﻬﻮﺷﯽ ﺗﺄﯾﯿﺪ ﺷﺪه ﺑﻮد، ﻃﯽ ﯾﮏ ﻣﺼﺎﺣﺒﻪ ﺣﻀﻮري ﺗﻮﺳﻂ ﯾﮏ ﺗﮑﻨﺴﯿﻦ آﻣﻮزش دﯾﺪه ﭘﺮ ﺷﺪ. اﯾﻦ ﭘﺮﺳﺸﻨـﺎﻣﻪ ﺷﺎﻣﻞ ﻣﺸﺨﺼﺎت دﻣﻮﮔﺮاﻓﯿﮏ و ﺳﻮاﻻﺗﯽ ﭘﯿﺮاﻣﻮن ﻋﻠﻞ ﻋـﺪم اﻧﺘﺨﺎب روش ﺑﯿﻬـﻮﺷﯽ ﻧﺨـﺎﻋﯽ ﺑﻮد. ﺟﻬـﺖ ﺗﺤﻠﯿﻞ آﻣﺎري از
ﻧﺮم اﻓﺰار 21 SPSS و آزﻣﻮن ﮐﺎي اﺳﮑﻮار و ﻓﯿﺸﺮ اﺳﺘﻔﺎده ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: در ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿـﺮ در ﻣﺠﻤـﻮع 386 زن ﺑﺎردار ﺑﺎ ﻣﯿﺎﻧﮕﯿـﻦ ﺳﻨﯽ 6/31 ± 30/09 ﺳﺎل و ﻣﯿﺎﻧﮕﯿﻦ ﺗﻌﺪاد ﺑﺎرداري 0/7± 2 ﺑﺎر ﻣﻮرد ﺑﺮرﺳﯽ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. "ﺗﺮس و ﻧﮕﺮاﻧﯽ از ﮐﻤﺮ درد"، "ﺗﺮس و ﻧﮕﺮاﻧﯽ دﯾﺪن و ﺷﻨﯿﺪن در اﺗﺎق ﻋﻤﻞ" و "ﺗﺮس و ﻧﮕﺮاﻧﯽ از درد ورود ﺳﻮزن" ﺷﺎﯾﻊﺗﺮﯾﻦ ﻋﻠﻞ ﻋﺪم ﭘﺬﯾﺮش ﺑﯽﺣﺴﯽ ﻧﺨﺎﻋﯽ در زﻧﺎن ﺑﺎردار ﺑﺮاي ﺳﺰارﯾﻦ ﻋﻨﻮان ﺷﺪ. ﻫﻤﭽﻨﯿﻦ، ارﺗﺒﺎط آﻣﺎري ﻣﻌﻨﯽداري ﺑﯿﻦ ﻣﯿﺰان ﺗﺤﺼﯿﻼت زﻧﺎن ﺑﺎردار و " ﻧﮕﺮاﻧﯽ از ﮐﻤﺮ درد" )0/0001 ˂ P(، " دﯾﺪن و ﺷﻨﯿﺪن در اﺗﺎق ﻋﻤﻞ" )0/014 = P( و ﺳﺮدرد" )0/009 = P( دﯾﺪه ﺷﺪ. ارﺗﺒﺎط آﻣﺎري ﻣﻌﻨﯽداري ﺑﯿﻦ ﺗﻌـﺪاد دﻓﻌﺎت ﺑﺎرداري زﻧﺎن ﺑﺎردار ﻋﻨـﻮان ﮐﺮدن " ﻧﮕـﺮاﻧﯽ از ﮐﻤﺮ درد"، " ﻧﮕﺮاﻧﯽ از ﻓﻠﺞ ﺷﺪن"، " ﻧﮕﺮاﻧﯽ دﯾﺪن و ﺷﻨﯿﺪن در اﺗﺎق ﻋﻤﻞ"، " ﻧﮕﺮاﻧﯽ از ﺳﺮ درد"، " ﻧﮕﺮاﻧﯽ از درد ورود ﺳﻮزن" و " ﻧﮕﺮاﻧﯽ از درد ﺣﯿﻦ ﻋﻤﻞ" دﯾﺪه ﺷﺪ )0/0001 ˂ P(، در ﺗﻤﺎﻣﯽ ﻣﻮارد(. ﻫﻤﭽﻨﯿﻦ، ارﺗﺒﺎط آﻣﺎري ﻣﻌﻨﯽداري ﺑﯿﻦ وﺟﻮد ﺳﺎﺑﻘﻪ ﺑﯽﺣﺴﯽ ﻧﺨﺎﻋﯽ زﻧﺎن ﺑﺎردار، " ﻧﮕﺮاﻧﯽ از ﮐﻤﺮ درد "، " ﻧﮕﺮاﻧﯽ از ﻓﻠﺞ ﺷﺪن" و " ﻧﮕﺮاﻧﯽ از ﺳﺮ درد" دﯾﺪه ﺷﺪ )0/042= P و
0/027 = P و 0/031 = P، ﺑﻪ ﺗﺮﺗﯿﺐ(.
ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﻧﮕﺮاﻧﯽ از ﮐﻤﺮ درد، دﯾﺪن و ﺷﻨﯿﺪن در اﺗﺎق ﻋﻤﻞ و درد ورود ﺳﻮزن ﺑﻪ ﻋﻨﻮان ﻋﻠﻞ اﺻﻠﯽ ﻋﺪم ﭘﺬﯾﺮش ﺑﯿﻬﻮﺷﯽ
ﻧﺨﺎﻋﯽ ﮔﺰارش ﺷﺪ. ﺑﺮ اﺳﺎس ﻧﺘﺎﯾﺞ ﻣﻄﺎﻟﻌﻪ، ﺗﻮﺻﯿﻪ ﺑﻪ ﺗﻮﺟﻪ و ﺗﻼش در ﺟﻬﺖ رﻓﻊ ﻧﮕﺮاﻧﯽ زﻧﺎن ﺑﺎردار در ﻣﻮرد ﻋﻠﻞ اﺻﻠﯽ ﻋﺪم ﭘﺬﯾﺮش ﺑﯿﻬﻮﺷﯽ ﻧﺨﺎﻋﯽ در وﯾﺰﯾﺖﻫﺎي ﻗﺒﻞ ﻋﻤﻞ ﻣﯽﺷﻮد. ﻫﻤﭽﻨﯿﻦ ﻻزم اﺳﺖ در ﺗﺤﻘﯿﻘﺎت ﺑﻌﺪي ﺑﻪ ﺻﻮرت ﭼﻨﺪ ﻣﺮﮐﺰي و درﺑﺮﮔﯿﺮﻧﺪه ﺑﺨﺶﻫﺎي ﺧﺼﻮﺻﯽ ﺑﺎﺷﺪ.
چكيده لاتين :
Introduction & Objective: Caesarean section is the most common method of termination of pregnancy. In this case, the choice of a low-risk, desirable, and affordable anesthetic technique for mother and baby is important. Based on valid studies, the preferred method for cesarean section is spinal anesthesia. However, the results of studies conducted in Iran have confirmed the high use of general anesthetic technique for performing cesarean section. Therefore, the aim of this study was to investigate the causes of non-acceptance of spinal episode in cesarean section by pregnant women.
Materials & Methods: This descriptive cross-sectional study was performed on all pregnant women referred to al-Zahra hospital in Rasht, Iran, in 2017, for elective cesarean section. After obtaining informed consent from the subjects, a questionnaire consisting of demographic characteristics and questions about the reasons for not choosing the method of spinal anesthesia was conducted as a face-to-face interview with a trained technician. Finally, the data were analyzed using SPSS 21 software and appropriate statistical methods.
Results: In this study, 386 pregnant women with a mean age of 30.09 ± 6.31 years and mean pregnancy rate of 2 ± 0.7 years were studied. Anxiety from back pain, seeing and hearing in the operating room needle stick pain" were the most common causes of non-acceptance of spinal anesthesia. Also, statistical significance was found between the education level of pregnant women and anxiety of the back pain" (P ˂ 0.0001), “seeing and hearing in the operating room" (P = 0.014), headache "(P = 0.009). A statistical relationship between anxiety about back pain", " anxiety for paralysis", " anxiety to see and hear in the operating room", ", headache, needle insertion pain" and pain during surgery"(P = 0.0001 in all cases). Also, there was a statistically significant correlation between the history of spinal anesthesia in
pregnant women and "anxiety of back pain, paralysis and headache" was observed (P = 0.42, 0.027 and 0.03, respectively).
Conclusions: Anxiety from back pain, seeing and hearing in the operating room and needle stick pain" were the most common causes of spinal anesthesia refusal. Enough attention and attempt to relief pregnant women in preoperative visits are recommended. In addition future multicenter studies involving private wards should be planned.
