Razi Journal of Medical Sciences
مجله علوم پزشکی رازی
RJMS
Medical Sciences
http://rjms.iums.ac.ir
39
journal39
2228-7043
2228-7051
en
jalali
1398
9
1
gregorian
2019
12
1
26
9
online
1
fulltext
fa
بررسی عوامل مرتبط با بروز عوارض جراحی و پزشکی بعد از عمل در اعمال جراحی تومورهای مغزی در بیمارستان رسول اکرم (ص) تهران طی سال 1395
Postoperative complications after brain tumor surgery at Rasoul Akram hospital in 1395
جراحی مغز و اعصاب
Neurosurgery
پژوهشي
Research
<strong><span style="color:#0070c0;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">زمینه و هدف: </span></span></span></strong><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">هرچند که تومورهای مغزی در بالغین ناشایع هستند، اما جزو علل اساسی مورتالیتی و موربیدیتی به شمار میروند.</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;"> روش درمانی ارجح برای رزکسیون تودههای مغزی استفاده از تکنیکهای مختلف جراحی میباشد که میتواند عوارض مختلفی مانند مشکلات عفونی، عصبی، و یا عروقی برای بیماران ایجاد کند و سبب کاهش کیفیت و حتی بقای آنها و افزایش هزینههای درمانی و مراقبتی شود.</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;"> این</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">مطالعه</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">به بررسی عوامل مرتبط با بروز عوارض</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">پس از انجام</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">جراحیهای</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">رزکسیون تومورهای</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">مغزی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">می پردازد.</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;"></span></span></span></span><br>
<strong><span style="color:#0070c0;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">روش</span></span></span></strong> <strong><span style="color:#0070c0;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">کار</span></span></span></strong><strong><span dir="LTR"><span style="color:#0070c0;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">:</span></span></span></span></strong><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;"> این</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">مطالعه</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">به</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">صورت</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">توصیفی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">گذشتهنگر</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بر روی بیمارانی که در سال ۱۳۹۵ در بیمارستان رسول اکرم (ص) تحت رزکسیون جراحی تومورهای مغزی قرار گرفته بودند، انجام شد</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">.</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;"> سن،</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">جنس،</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">میزان رزکسیون،</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">نوع</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">تومور،</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">علائم</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عوارض</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بعد</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عمل</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">جراحی و عوامل مرتبط با بروز آنها،</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">همچنین</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">طول</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عمل</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">جراحی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">میزان خونریزی حین عمل و مدت</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بستری</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بیماران از پرونده های بایگانی استخراج</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">نهایتا داده</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">ها</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">در</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">نرم</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">افزار</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;"> SPSS </span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">وارد</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">آنالیز شدند.</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;"></span></span></span></span><br>
<strong><span style="color:#0070c0;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">یافتهها:</span></span></span></strong><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;"> این مطالعه بر روی ۱۷۹ بیمار صورت گرفت که ۸۵ نفر (5/47%) مرد و ۹۴ نفر (5/52%) زن بودند. میانگین</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">سن</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بیماران</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">8/45 (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">σ</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">=42/17) سال،</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">میانگین</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">زمان</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بستری</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">قبل</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عمل</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">6/4</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">روز (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">σ</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">=97/3)</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بعد</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عمل </span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">7/9 روز (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">σ</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">=48/9)</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بود</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">. </span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">شایع</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;"></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">ترین</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عوارض</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">جراحی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">شامل</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">هیدروسفالی (4/13%) و خونریزی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">داخل</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">مغزی (5/9%)</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بودند</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">.</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">شایع</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;"></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">ترین</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عارضه پزشکی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">(مدیکال) بروز اختلالات الکترولیتی (4/13%) بود</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">.</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;"> میانگین</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">زمان</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عمل</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">جراحی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">1</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">ساعت</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">40</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">دقیقه (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">σ</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">=5/5)</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">و خونریزی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">حین</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عمل</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">542</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">میلی لیتر (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">σ</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">=474)</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">محاسبه شد. </span></span></span><br>
<strong><span style="color:#0070c0;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">نتیجهگیری</span></span></span></strong><strong><span dir="LTR"><span style="color:#0070c0;"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">:</span></span></span></span></strong> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بر اساس مطالعه ما، میزان</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">وسعت رزکسیون</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">با</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بروز</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عوارض پس از جراحی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">سن</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بالاتر</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">مدت</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">زمان بستری</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">قبل و بعد</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">جراحی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">زمان</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">طولانی</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;"></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">تر</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">جراحی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">با</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عوارض</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">پزشکی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">ارتباط معنادار داشت. همچنین</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">در مطالعه ما سن</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بالا</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">با</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">مورتالیته</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بالاتری</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">در</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">ارتباط</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بود اما خونریزی</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">حین</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">عمل</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">با</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">بروز عوارض</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">ارتباط معناداری</span></span></span> <span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">نداشت</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">.</span></span></span>
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<strong>Background:</strong> Brain tumors are rare and yet a significant cause of mortality and morbidity in adults. Surgical resection has been treatment of choice for brain tumors. Despite its effectiveness, surgical resection may cause various post-operatives complications such as infections, neurological deficits, and vascular damages that can lead to decrease in quality of life and survival rate and can impose great medical expenses. This study was aimed to assess related factors of medical and surgical complications after surgical brain tumors resection.<br>
<strong>Methods: </strong>This was a descriptive and retrospective study performed on patients that underwent brain surgical tumor resection at Rasoul Akram Hospital of Iran University of medical science in Tehran, 2016. Age, sex, extent of resection, pathology of tumor, post-operative symptoms and complications, duration of surgery, blood loss volume during surgery, and duration of admission were collected, and analyzed with SPSS.<br>
<strong>Results:</strong> Of 179 patients, 47.5% (85) were male, and 52.5% (94) were female. Mean patient age was 45.8 years old, and mean admission duration was 4.6 day before and 9.7 day after surgery. The most common surgical complications were hydrocephalus (13.4%) and ICH (9.5%). The most common medical complication was electrolyte disorder (13.4%). Mean surgery duration was 1 hour 40 min and mean blood loss during surgery was 542 ml.<br>
<strong>Conclusion:</strong> Based on our study, extent of brain resection was correlated with surgical and medical complications. Older age, longer duration of admission, and longer duration of surgery were correlated with medical complications, but it was not correlated with surgical complications. Older age was correlated with higher mortality rate. Blood loss volume during surgery had no correlation with surgical or medical complications.<br>
کلمات کلیدی : تومور مغز, عوارض بعد از عمل, عوارض جراحی, عوارض مدیکال
brain tumor , post-operative complication, medical complication, surgical complication
142
150
http://rjms.iums.ac.ir/browse.php?a_code=A-10-4597-1&slc_lang=fa&sid=1
Alireza
Tabibkhooei
علیرضا
طبیب خوئی
3900319475328460088819
3900319475328460088819
No
دانشگاه علوم پزشکی ایران، تهران، ایران
Farid
Kazemi Gazik
فرید
کاظمی گزیک
3900319475328460088820
0009-0004-8493-8932
No
دانشگاه علوم پزشکی ایران، تهران، ایران
Sadra
Rohani
صدرا
روحانی
3900319475328460088821
0009-0002-5131-4248
No
دانشگاه علوم پزشکی ایران، تهران، ایران
Arash
Fattahi
آرش
فتاحی
3900319475328460088822
3900319475328460088822
No
دانشگاه علوم پزشکی ایران، تهران، ایران
Mahdi
Rezaei
مهدی
رضائی
3900319475328460088823
3900319475328460088823
No
دانشگاه علوم پزشکی ایران، تهران، ایران
Kiana
Anousha
کیانا
انوشا
kiana.anousha@gmail.com
3900319475328460088824
3900319475328460088824
Yes
دانشگاه علوم پزشکی ایران، تهران، ایران