fa بررسی تأثیر استفاده از دو پروتکل بیهوشی در میزان بروز استفراغ بعد از بیهوشی بیماران تحت عمل جراحی عمومی پرستاری Nursing پژوهشي اصیل Original Research <p class="MsoTitle" dir="rtl" style="margin: 0cm 0cm 0pt direction: rtl unicode-bidi: embed text-align: justify"><strong><span lang="AR-SA" style="font-size: 9pt font-family: "B Traffic"">مقدمه</span><span lang="AR-SA" dir="ltr" style="font-size: 9pt mso-bidi-font-family: 'B Traffic'"> </span><span lang="FA" style="font-size: 9pt font-family: "B Traffic" mso-bidi-language: FA">و هدف </span><span lang="AR-SA" style="font-size: 9pt font-family: "B Traffic"">:</span></strong><span lang="AR-SA" style="font-weight: normal font-size: 9pt font-family: "B Traffic""> </span><span lang="AR-SA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">تهوع و استفراغ بعد ازعمل</span><span lang="AR-SA" dir="ltr" style="font-weight: normal font-size: 10pt font-family: "Arial Narrow" mso-bidi-font-family: 'B Traffic'"> </span><span lang="AR-SA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">شایع ترین عارضه بیهوشی است که شیوع کلی آن 30-20 درصد می باشد و سبب بروز مشکلاتی چون : طولانی­تر شدن مدت اقامت بیمار در اتاق بهبودی و افزایش هزینه و ناراحتی بیمار می­گردد. هدف از این مطالعه مقایسه شیوع استفراغ به دنبال عمل­های آپاندکتومی، لاپاراتومی، هرنیورافی و هموروئید با دو پروتکل بیهوشی در بیمارستانهای امام خمینی (ره) و اکباتان همدان می­باشد.</span><span dir="ltr" style="font-weight: normal font-size: 10pt font-family: "Arial Narrow" mso-bidi-font-family: 'B Traffic'"><!--stripped--><!--stripped--></span></p> <p class="MsoTitle" dir="rtl" style="margin: 0cm 0cm 0pt direction: rtl unicode-bidi: embed text-align: justify"><strong><span lang="AR-SA" style="font-size: 9pt font-family: "B Traffic"">روش</span><span lang="AR-SA" style="font-size: 7pt font-family: "B Traffic""> </span><span lang="AR-SA" style="font-size: 9pt font-family: "B Traffic"">کار:</span></strong><span lang="AR-SA" dir="ltr" style="font-weight: normal font-size: 9pt mso-bidi-font-family: 'B Traffic'"> </span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">این کارآزمایی بالینی برروی 250 زن تحت اعمال جراحی آپاندکتومی </span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA">،</span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'"> لا پاراتومی </span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA">،</span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'"> هرنیورافی و هموروئید مراجعه کننده به بیمارستان های امام خمینی (ره) واکباتان صورت گرفت و با روش نمونه گیری تصادفی<span style="mso-spacerun: yes">  </span>به عنوان نمونه پژوهش انتخاب شدند و سؤال هایی که در قالب یک پرسشنامه طراحی شده بود<span style="mso-spacerun: yes">  </span>از بیماران پرسیده می شد و شیوع استفراغ بعد از بیهوشی بیماران تحت عمل جراحی عمومی بستری در بیمارستان های امام خمینی و اکباتان مقایسه گردید.<!--stripped--><!--stripped--></span></p> <p class="MsoTitle" dir="rtl" style="margin: 0cm 0cm 0pt direction: rtl unicode-bidi: embed text-align: justify"><span lang="AR-SA" style="font-size: 9pt font-family: "B Traffic""><strong>نتایج :</strong></span><span lang="AR-SA" style="font-weight: normal font-size: 9pt font-family: "B Traffic""> </span><span lang="AR-SA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">زنانی که درمحدوده سنی 60-10 سال قرار داشتند و تحت اعمال جراحی </span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">آپاندکتومی </span><span lang="AR-SA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">،</span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">هرنیورافی</span><span lang="AR-SA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">،</span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">هموروئید و لاپاراتومی قرار گرفتند</span><span lang="AR-SA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">، به عنوان نمونه های مورد پژوهش انتخاب شدند. از نظر تحصیلات 7% بیسواد، 2/29% ابتدایی ، 20% راهنمایی ،36% دبیرستان و 8/7% تحصیلات دانشگاهی داشتند. 5/72% واحدهای پژوهش خانه دار و 5/27% شاغل بودند. شیوع استفراغ در بیمارستان امام خمینی (ره) با توجه به پروتکل آن</span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">،</span><span lang="AR-SA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'"> 4/14 درصد و در بیمارستان اکباتان با توجه به پروتکل بیهوشی آن ، 8/0 درصد است</span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">. در تحلیل نتایج از آزمون کای اسکویر استفاده شد که اختلاف مشاهده شده در سطح کمتر از 5% معنی دار گردید<span style="mso-spacerun: yes">  </span>05 /0</span><span lang="FA" style="font-weight: normal font-size: 11pt font-family: "B Traffic" mso-bidi-language: FA">></span><span dir="ltr" style="font-weight: normal font-size: 11pt font-family: "Arial Narrow" mso-bidi-language: FA mso-bidi-font-family: 'B Traffic'">P </span><span style="font-weight: normal font-size: 11pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'"><span style="mso-spacerun: yes"> </span></span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">.<!--stripped--><!--stripped--></span></p> <p class="MsoTitle" dir="rtl" style="text-justify: kashida margin: 0cm 0cm 0pt direction: rtl unicode-bidi: embed text-align: justify text-kashida: 0%"><strong><span lang="AR-SA" style="font-size: 9pt font-family: "B Traffic"">نتیجه نهائی</span><span lang="AR-SA" dir="ltr" style="font-size: 9pt mso-bidi-font-family: 'B Traffic'"> </span><span lang="AR-SA" style="font-size: 9pt font-family: "B Traffic"">:</span><span lang="AR-SA" dir="ltr" style="font-size: 9pt mso-bidi-font-family: 'B Traffic'"> </span></strong><span lang="AR-SA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">نتایج مطالعه حاضر نشان داد که افزودن 10 میلی­گرم متوکلوپرامید و 8 میلی­گرم دگزامتازون به پروتکل بیهوشی در اعمال جراحی­: لاپاراتومی، آپاندکتومی، هموروئید، هرنیورافی به دنبال بیهوشی عمومی تأثیری در کاهش شیوع استفراغ در پایان بیهوشی و اتاق بهبودی نداشته است و آزمونهای آماری اختلاف معنی داری را بین نتایج حاصل از دو بیمارستــان نشـــان می دهد</span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">05 /0</span><span lang="FA" style="font-weight: normal font-size: 11pt font-family: "B Traffic" mso-bidi-language: FA">></span><span dir="ltr" style="font-weight: normal font-size: 11pt font-family: "Arial Narrow" mso-bidi-language: FA mso-bidi-font-family: 'B Traffic'">P</span><span lang="FA" style="font-weight: normal font-size: 10pt font-family: "B Traffic" mso-bidi-language: FA mso-ascii-font-family: 'Arial Narrow' mso-hansi-font-family: 'Arial Narrow'">.<span style="mso-spacerun: yes">   </span><!--stripped--><!--stripped--> <p class="MsoNormal" style="text-justify: kashida margin: 0cm 0cm 0pt text-align: justify text-kashida: 0%"><span style="mso-bidi-language: FA mso-bidi-font-family: Nazanin"><!--stripped--> <!--stripped--></span></p> <p class="MsoNormal" style="text-justify: kashida margin: 0cm 0cm 0pt text-align: justify text-kashida: 0%"><strong><span style="mso-bidi-language: FA">Introduction& Objective : </span></strong><span style="mso-bidi-font-family: 'B Nazanin'">Nausea and vomiting is the most common postoperative problem. The incidence of nausea and vomiting is Likely to affect %20-30 of postoperative patients. Postoperative nausea and vomiting (PONV) can delay post Anesthetic Care unit (PACU), cause patient discomfortability<span style="mso-spacerun: yes">  </span>and more epensive. This research is a comparative study about incidence of vomiting after appendectomy, laparatomy, herniorraphy and hemorhoidectomy with two different anesthetic protocol between Imam khomeiny and Ekbatan hospitals in Hamedan city.<!--stripped--><!--stripped--></span></p> <p class="MsoNormal" style="text-justify: kashida margin: 0cm 0cm 0pt text-align: justify text-kashida: 0%"><strong>Materials & Methods:</strong> <span style="mso-bidi-font-family: 'B Nazanin'">This clinical trial experience was performed on 250 women in surgeries like appendectomy, laparatomy , herniorraphy and hemorhoidectomy referrad to Imam khomeiny and ekbatan hospitals and<span style="mso-spacerun: yes">  </span>was selected to study with randomized sampling . And the questions were designed in<span style="mso-spacerun: yes">  </span>a<span style="mso-spacerun: yes">  </span>questionna ire , was asked from patients. The characteristics of selected samples was : 1)They have<span style="mso-spacerun: yes">  </span>no othery diseases<span style="mso-spacerun: yes">  </span>2) They were elective patients which were NPO (not per oral)<span style="mso-spacerun: yes">  </span>with appendectomy, laparatomy , herniorraphy and hemorhoidectomy surgeries . 3) Were between 10-60 years old . 4) Physical status one ( normal patients) and<span style="mso-spacerun: yes">  </span>two (patients with low infectious disease that has no limited<span style="mso-spacerun: yes">  </span>function ) and has<span style="mso-spacerun: yes">  </span>mallampati one and two . 5)During surgery or in Ricovery Room<span style="mso-spacerun: yes">  </span>has no blood infusion , and has no NGT .The comparative of vomiting incidence was between<span style="mso-spacerun: yes">  </span>Imam<span style="mso-spacerun: yes">  </span>khomeing hospital protocol on 125 patients.Vomiting was evaluated in recovery room. The gathered datas in (SPSS) statistical program the version of 13 , was given to<span style="mso-spacerun: yes">    </span>computer , and was survey by descriptive and analytic<!--stripped--><!--stripped--></span></p> <p class="MsoNormal" style="text-justify: kashida margin: 0cm 0cm 0pt text-align: justify text-kashida: 0%"><strong>Results:</strong> <span style="mso-bidi-font-family: 'B Nazanin'">The women in 10-60 years old , has surgeries like appendectomy, laparatomy , herniorraphy and hemorhoidectomy , were the selected samples in this study . Their education were %7 illitered , %29.2 primery school , %20 guidan school , %36 high school<span style="mso-spacerun: yes">  </span>and %7.71 has university education . %72.5 of samples were housekeeper and %27.5 were employed . <!--stripped--><!--stripped--></span></p> <p class="MsoNormal" style="text-justify: kashida margin: 0cm 0cm 0pt text-align: justify text-kashida: 0%"><span style="mso-bidi-font-family: 'B Nazanin'">The incidence of vomiting was %14.4 and %0.8 in Imam khomeiny and Ekbatan hospitals respectively. Stastical<span style="mso-spacerun: yes">  </span>methods kay skover experience was used in analyzing results.Wich was significant at P<0.05 level.<!--stripped--><!--stripped--></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0pt text-align: justify"><strong>Conclusion: </strong><span style="mso-bidi-font-family: 'B Nazanin'">Addition of metoclopramide 10 mg/ Iv and dexamethasone 8 mg to anesthetic protocol at appendectomy , Laparatomy , herniorraphy and hemorrhoidectomy surgery were not more effective to reduce postoperative and recovery incidence<span style="mso-spacerun: yes">  </span>of vomiting and statistical<span style="mso-spacerun: yes">  </span>tests relioves meanisful differences between results from two hospital.<!--stripped--><!--stripped--> استفراغ ، بیهوشی عمومی ، دگزامتازون ، متوکلوپرامید Dexamethasone /General Anesthesia / Metoclopramide / Vomiting 16 26 http://nmj.umsha.ac.ir/browse.php?a_code=A-10-1-1027&slc_lang=fa&sid=1 N. Ali pour , B.Sc. نسیم علی پور 10031947532846001073 10031947532846001073 No S.A. Alvi Moghadam , M.D. دکتر سید عباس علوی مقدم 10031947532846001074 10031947532846001074 No Kh. Mani Kahani, M.Sc مهندس خسرو مانی کاشانی 10031947532846001075 10031947532846001075 No