Sezaryen Hastalarında Post Spinal Baş Ağrısı ile Serebral Oksijen Saturasyonu Arasındaki İlişkinin Değerlendirilmesi

Öz

Amaç: Bu çalışmada amacımız spinal anestezi ile elektif şartlarda sezaryen olan hastalarda NIRS ile PSBA arasındaki ilişkiyi araştırmaktır. Materyal ve metot: Bu çalışmaya, elektif şartlarda spinal anestezi ile sezaryen uygulanan 205 hasta dahil edildi. İntraoperatif genel anesteziye geçildiği için 5 hasta çalışma dışı bırakıldı. Çalışma sonunda Preoperatif dönemde hastalara Beck anksiyete testi doldurtuldu. Hastaların preoperatif, intraoperatif ve postoperatif sol ve sağ alın bölgesinden 5 dk. serebral somatik saturasyon değerleri (NIRS değerleri) kayıt edildi. Tüm hastalar postoperatif 15 gün PSBA gelişme açısından takip edildi. PSBA (-) gelişmeyenler Grup A (n:126), PSBA (+) gelişenler ise Grup B (n:74) olarak iki gruba ayrılarak istatistiksel olarak veriler karşılaştırıldı. Çalışma sonunda PSBA gelişen ve gelişmeyen hastaların NIRS değerleri ortalamaları, NIRS değişim oranları, demografik verileri ( yaş, boy, kilo, beden kitle indeksi, ek hastalık, migren, kronik ağrı, kronik sinüzit, alerji, sigara, spinal anestezi öyküsü ), sosyokültürel durumları (öğrenim durumları, çocuk sayıları, çalışma durumu, kimlerle yaşadıkları ), BAÖ verileri karşılaştırıldı. Bulgular: Hastalar gruplara ayrılmış haliyle, demografik veriler, ek hastalıklar ve alışkanlıklarına göre değerlendirildiğinde gruplar arasında anlamlı fark olmadığı görüldü (p > 0,05). Hastaların öğrenim durumları, çocuk sayıları, çalışma durumları (çalışıyor -çalışmıyor), yaşadıkları yer (kırsal - kent), kimlerle yaşadıkları (çekirdek aile - aile büyükleriyle) gibi sosyokültürel durumları ile preopreratif anksiyete seviyeleri gruplara göre anlamlı fark olmadığı görüldü (p > 0,05;) Gruplar kendi içinde preoperatif sol ve sağ NIRS değerlerine göre; intraoperatif spinal anestezi sonrası 1.dk., 4.dk., 7.dk., 10.dk., 15.dk., 30.dk., ve postoperatif 24. saatteki NIRS değişim yüzdeleri arasında anlamlı fark bulunmadı. (p > 0,05). Hastaların preoperatif, intraoperatif spinal anestezi sonrası 1.dk, 4.dk, 7.dk, 10.dk, 15.dk, 30.dk ve postoperatif Ortalama arteryal basınç (OAB) ve NIRS değerleri arasındaki korelasyon analizinde; intraoperatif 4. dk ve 7. dk sol ve sağ NIRS değerlerindeki azalma ile OAB değerlerindeki azalma arasında istatistiksel olarak pozitif korelasyon olduğu görüldü ( p < 0,05; r < 0,4 ). Sonuç: Bu çalışmada, spinal anestezi sonrası görülebilen PSBA olan ve olmayan hastaların preoperatif, imntraoperatif ve postoperatif NIRS değerleri ve değişimleri arasında istatiksel olarak anlamlı bir fark olmadığını bulduk.

Anahtar Kelimeler

• Spinal anestezi
• sezaryen
• post spinal baş ağrısı
• Near infrared spektroskopi

Evaluation of the Relationship Between Post Spinal Headache and Cerebral Oxygen Saturation in Cesarean Section Patients

Öz

Objective: Our purpose in this study is to examine the relationship between NIRS and PSH in patients who had cesarean section under elective conditions with spinal anesthesia. Materials and Methods: 200 patients who underwent cesarean section with spinal anesthesia in elective conditions were included in this study. Perioperative, intraoperative, and postoperative NIRS values of patients were recorded for 5 min from the left and right forehead areas. All patients were monitored for 15 days postoperatively in terms of PSH development. The patients were divided into two groups as Group A (n:126) with patients who did not develop PSH (-), and Group B (n:74) with patients who developed PSH (+). At the end of the study, NIRS mean values, NIRS change ratios, demographic data, and the scores of Beck Anxiety Scale (BAS) completed by patients during the pre-operative period were compared between the patients who developed PSH and who did not. Resuts: When the groups were compared among themselves according to the preoperative left and right NIRS values, no significant difference was found between the NIRS percentage changes at minutes 1, 4, 7, 10, 15, 30, and postoperative hour 24 after intraoperative spinal anesthesia (p>0/05). In the correlation analysis between the patients’ preoperative, intraoperative post spinal anesthesia at minutes 1, 4, 7, 10, 15, 30 mean arterial pressure (MAP) and NIRS values, there was a statistically positive correlation between the decrease in the left and right NIRS values at intraoperative minutes 4 and 7 and the decrease in the MAP values (p<0.05; r<0.4) Conclusion: In the study, it was found that there was no statistically significant difference between preoperative, intraoperative, and postoperative NIRS values and changes in patients with and without PSH, which can occur after spinal anesthesia.

Anahtar Kelimeler

• Spinal anesthesia
• cesarean section
• post spinal headache
• Near infrared spectroscopy

Kaynakça

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