تأثیر کرم Myrtus communis (گیاه مورد) بر ترمیم زخم و شدت درد اپی‌زیاتومی: کارآزمایی بالینی دو‌سو‌کور

نوع مقاله: اصیل پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد مامایی، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

2 مربی گروه مامایی، مرکز تحقیقات مامایی و بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

3 استادیار گروه مامایی، مرکز تحقیقات مامایی و بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

4 استاد گروه فارماکوگنوزی، دانشکده داروسازی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

5 استادیار گروه آمار زیستی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

چکیده

مقدمه: اپی­زیاتومی، از متداول‌ترین اعمال جراحی در مامایی است و عوارض پس از آن شامل التهاب، ادم، باز شدگی زخم و درد پرینه می‌باشد. در گذشته گیاه مورد، برای درمان زخم‌ها و تسکین درد استفاده می‌شده است. مطالعه حاضر با هدف تعیین تأثیر کرم گیاه مورد بر ترمیم زخم و شدت درد اپی‌زیاتومی انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی دو‌سو‌کور از تیر تا آبان ۱۳۹۷ بر روی ۱۰۰ زن نخست‌زا در بیمارستان امیرالمومنین علی (ع) شهر زابل انجام شد. مشارکت‌کنندگان به‌طور تصادفی کرم مورد یا دارونما را دریافت و از کرم‌های کد‌گذاری شده، ۲ بار در روز به‌مدت ۱۰ روز استفاده کردند. برای ارزیابی افراد از پرسشنامه‌های اطلاعات فردی و مامایی، ارزیابی وضعیت بهداشتی، مسکن مصرفی، مقیاس عددی درد، ارزیابی بهبود پرینه و جدول عوارض دارویی استفاده شد. سپس در 2 ساعت اول، روز پنجم و دهم بعد از زایمان، شدت درد و میزان بهبودی مورد بررسی قرار گرفت. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه ۲۳) و آزمون‌های من‌ویتنی، تی مستقل و کای دو انجام شد.میزان p‌ کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: دو گروه از نظر مشخصات دموگرافیک، مامایی و شدت درد در 2 ساعت اول پس از زایمان اختلاف آماری معنی‌داری نداشتند (۰۵/۰p>). اختلاف میانگین شدت درد در روز پنجم (۰۰۹/۰=p) و دهم (۰۱۲/۰=p)پس از زایمان در گروه گیاه مورد و دارونما معنی‌دار بود و در گروه کرم گیاه مورد میزان درد کمتر بود. میانگین امتیاز ریدا در گروه کرم گیاه مورد در روز پنجم پس از زایمان ۰۹/۱±۷۰/۱ و در گروه دارونما ۵۱/۱±۹۴/۲ (۰۰۱/۰p<) و در روز دهم در گروه کرم گیاه مورد ۸۵۴/۰±۰۴/۱ و در گروه دارونما ۶۲۰/۰±۰۶/۲ بود (۰۰۱/۰p<) که از نظر آماری معنی‌دار بود.
نتیجه‌گیری: کرم گیاه مورد به‌علت خواص التیام‌بخشی خود، بهبود زخم اپی‌زیاتومی را تسریع می‌نماید و شدت درد را کاهش می‌دهد.

کلیدواژه‌ها


عنوان مقاله [English]

The effect of Myrtus communis cream on wound healing and severity of episiotomy pain: Double-blind clinical trial

نویسندگان [English]

  • Fatemeh Mirzaee 1
  • Sharareh Jannesari 2
  • Nourossadat Kariman 3
  • Faraz Mojab 4
  • Malihe Nasiri 5
1 M.Sc. student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Instructor, Department of Midwifery, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Assistant Professor, Department of Midwifery, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 Professor, Department of Pharmacognosy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
5 Assistant Professor, Department of Biostatistics, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Episiotomy is of common surgical procedures in midwifery and is followed by complications including inflammation, edema, approximation of the wound and perineal pain. In past, Myrtus communis plant has been used to treat wounds and relieve pain. This study was performed with aim to investigate the effect of M. communis cream on wound healing and episiotomy pain severity.
Methods: This double-blind clinical trial was conducted on 100 nulliparous women in Zabol Amiralmomenin Ali Hospital from July to November 2018. The participants randomly received Myrtus Communis cream or placebo and used the encoded creams 2 times a day for 10 days. Demographic and obstetrics questionnaire, health status form, analgesic used, Numeric pain rating scale, Reeda scale and drug side effects table were used to assess the individuals. Then, the pain severity and recovery rate were examined on the first 2 hours, fifth and tenth day after delivery. Data were analyzed by SPSS software (version 23) and Mann-Whitney, independent-t, and Chi-square tests. P<0.05 was considered statistically significant.
Results: There was no significant difference between two groups in terms of demographic and obstetric variables and pain severity in first 2 hours after delivery (p>0.05). The mean difference of pain severity on the fifth (p=0.009) and tenth day (p=0.012) after delivery was significant in M. communis cream and placebo cream groups, and the severity of pain was less pain in M. communis cream group. The mean of Reeda score group on the 5th day after delivery was 1.70 ± 1.09 in the M. communis cream group and 2.94 ± 1.51 in the placebo cream group (p<0.001), and on the tenth day after delivery was 1.04 ± 0.854 in the M. communis cream group and 2.06 ± 0.620 in the placebo cream group that was statistically significant (p<0.001).
Conclusion: M. communis cream due to its healing properties accelerates the healing of episiotomy wound and reduces the severity of pain.

کلیدواژه‌ها [English]

  • Episiotomy
  • Myrtus Communis
  • Myrtaceae
  • Nulliparous
  • Pain
  • Wound healing
  1. Cleary-Goldman J, Robinson JN. The role of episiotomy in current obstetric practice. Semin Perinatol 2003; 27(1):3-12.
  2. Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams obstetrics. 24th ed. New York: McGraw-Hill; 2014.
  3. Robinson JN, Lockwood CJ, Barss VA. Approach to episiotomy. Waltham, MA: UpToDate; 2016.
  4. Dutta DC. Safe motherhood, epidemiology of obstetrics. Textbook of obstetrics. London: New Central Book Agency; 2010. P. 600-7.
  5. Robinson JN, Lockwood CJ, Barss VA. Approach to episiotomy. Waltham, MA: UpToDate; 2013.
  6. Frankman E, Wang L, Bunker CH, Lowder JL. Episiotomy in the United States: has anything changed? Obstet Anesth Digest 2010; 30(1):27-8.
  7. Lam K, Wong H, Pun T. The practice of episiotomy in public hospitals in Hong Kong. Hong Kong Med J 2006; 12(2):94-8.
  8. Kajoye Shirazie C, Davaty A, Zayere F. Episiotomy rates and its complication. J Qom Univ Med Sci 2009; 3(2):1-4. (Persian).
  9. Bick DE, Ismail KM, Macdonald S, Thomas P, Tohill S, Kettle C. How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice. BMC Pregnancy Childbirth 2012; 12(1):57.
  10. Andrews V, Thakar R, Sultan AH, Jones PW. Evaluation of postpartum perineal pain and dyspareunia--a prospective study. Eur J Obstet Gynecol Reprod Biol 2008; 137(2):152-6.
  11. Boyle M. Wound healing in midwifery. London: Radcliffe Publishing; 2006.
  12. Watanatitan J, Armarttasn S, Manusirivithaya S. Incidence and factors associated with postpartum perineal pain in primipara. Thai J Obstet Gynaecol 2009; 17(3):139-44.
  13. Azhari S, Aradmehr M, Rakhshandeh H, Tara F, Shakeri MT. The effects of chamomile cream on wound healing of episiotomy in primiparous women. Iran J Obstet Gynecol Infertil 2014; 17(93):16-26. (Persian).
  14. Albers LL, Borders N. Minimizing genital tract trauma and related pain following spontaneous vaginal birth. J Midwifery Womens Health 2007; 52(3):246-53.
  15. Karaçam Z, Ekmen H, Çalişır H, Şeker S. Prevalence of episiotomy in primiparas, related conditions, and effects of episiotomy on suture materials used, perineal pain, wound healing 3 weeks postpartum, in Turkey: a prospective follow-up study. Iran J Nurs Midwifery Res 2013; 18(3):237-45.
  16. Golezar S. Ananas comosus effect on perineal pain and wound healing after episiotomy: a randomized doubleblind placebo-controlled clinical trial. Iran Red Crescent Med J 2016; 18(3):e21019.
  17. Malekpour P, Sehatie F. The effect of turmeric solution on pain intensity on episiotomy in primiparous women. J Nurs Midwifery Facul Tehran Univ Med Sci 2009; 2(4):279-86. (Persian).
  18. Cooper ML, Laxer JA, Hansbrough JF. The cytotoxic effects of commonly used topical antimicrobial agents on human fibroblasts and keratinocytes. J Trauma 1991; 31(6):775-82.
  19. Mahdavian M, Golmakani N, Mansoori A, Hoseinzadeh H, Afzalaghaee M. An investigation of effectiveness of oral Dill extracts on postpartum hemorrhage. J Women Midwifery Infertil Iran 2001; 78(4):19-26.
  20. Shahrahmani H, Kariman N, Jannesari S, Rafieian‐Kopaei M, Mirzaei M, Ghalandari S, et al. The effect of green tea ointment on episiotomy pain and wound healing in primiparous women: a randomized, double‐blind, placebo‐controlled clinical trial. Phytother Res 2018; 32(3):522-30.
  21. Shahrahmani H, Kariman N, Jannesari S, Ghalandari S, Asadi N. A systematic review on the type of treatment  methods toreduce pain and improve wound healing in Iran. Iran J Obstet Gynecol Infertil 2016; 19(9):17-31. (Persian).
  22. Laki E, Turk Zahrani S, Mojtaba F, Heidari A, Soltani Kermanshahi M. The effect frankincense ointment on pain intensity and episiotomy wound healing in primiparous women. Iran J Obstet Gynecol Infertil 2019; 22(2):42-51. (Persian).
  23. Sohrabi-Haghdost RV, Safarmashaei S. Comparison of in-vivo wound healing activity of Verbascum thapsus flower extract with zinc oxide on experimental wound model in rabbits. Adv Environ Biol 2011; 5(7):1501-9.
  24. Zargari A. Medicinal plants. 6th ed. Tehran: Tehran University Press; 1985. P. 519-21. (Persian).
  25. Hashemipour MA, Lotfi S, Torabi M, Sharifi F, Ansari M, Ghassemi A, et al. Evaluation of the effects of three plant species (Myrtus Communis L., Camellia Sinensis L., Zataria Multiflora Boiss.) on the healing process of intraoral ulcers in rats. J Dent 2017; 18(2):127-35.
  26. Evans W. Trease and evans pharmacognosy. 15th ed. New York: Elsevier Health Sciences; 2002.
  27. Christenhusz MJ, Byng JW. The number of known plants species in the world and its annual increase. Phytotaxa 2016; 261(3):201-17.
  28. Nicoletti R, Salvatore M, Ferranti P, Andolfi A. Structures and bioactive properties of myrtucommulones and related acylphloroglucinols from myrtaceae. Molecules 2018; 23(12):E3370.
  29. Mohammad N, Mousavi R, Ramezani T. The effect of Myrtus Communism leave extract cream on wound healing process in Wistar rats. Complementary Med J Facul Nurs Midwifery 2014; 4(3):854-64. (Persian).
  30. Taleb S, Ozgoli G, Mojab F, Nsiri M, Ahvazi M. Effect of Verbascum Thapsus cream on intensity of episiotomy pain in primiparous women. Iran J Obstet Gynecol Infertil 2016; 19(7):9-17. (Persian).
  31. Pazandeh F, Savadzadeh S. Effect chamomile essential oil on healing episiotomy in nulliparous women. J Ardebil Univ Med Sci 2010; 8(4):364-70. (Persian).
  32. Pore Y. Effectiveness of moist heat and dry heat application on healing of episiotomy wound. Asian J Multidiscipl Stud 2014; 2(7):225-36.
  33. Brunicardi F, Brandt M, Andersen D, Billiar T, Dunn D, Hunter JG, et al. Schwartz's principles of surgery ABSITE and board review. New York: McGraw Hill Professional; 2010.
  34. Rossi A, Di Paola R, Mazzon E, Genovese T, Caminiti R, Bramanti P, et al. Myrtucommulone from Myrtus communis exhibits potent anti-inflammatory effectiveness in vivo. J Pharmacol Exper Ther 2009; 329(1):76-86.
  35. Raeiszadeh M, Esmaeili-Tarzi M, Bahrampour-Juybari K, Nematollahi-mahani S, Pardakhty A, Nematollahi M, et al. Evaluation the effect of Myrtus communis L. extract on several underlying mechanisms involved in wound healing: an in vitro study. South Afr J Botany 2018; 118:144-50.
  36. Davis SC, Ricotti C, Cazzaniga A, Welsh E, Eaglstein WH, Mertz PM. Microscopic and physiologic evidence for biofilm‐associated wound colonization in vivo. Wound Repair Regen 2008; 16(1):23-9.
  37. Owlia P, Saderi H, Rasooli I, Sefidkon F. Antimicrobial characteristics of some herbal Oils on Pseudomonas aeruginosa with special reference to their chemical compositions. Iran J Pharm Res 2010; 8(2):107-14.
  38. Hosseininejad Z, Moghadam SD, Ebrahimi F, Abdollahi M, Zahedi M, Nazari M, et al. In vitro screening of selected Iranian medicinal plants against Helicobacter pylori. Int J Green Pharmacy 2011; 5(4):282.
  39. Jahdi F, Sheikhan F, Haghani H. The effect of cooling gel pad on the intensity of perineal pain following episiotomy. Arak Med Univ J 2010; 13(3):76-83. 
  40. Asif H, Akram M, Uddin S, Hasan ZU, Sami A, Iqbal A, et al. Myrtus communis Linn. (Pharmacological activity). J Med Plants Res 2011; 5:26.
  41. SadeghiAvalshahr H, Davami B, Amini L, Kashanian M. Investigating the effect of chamomile-marigold ointment on episiotomy pain in nulliparous women. Complementary Med J Facul Nurs Midwifery 2018; 8(2):2254-64. (Persian).
  42. Lopes LS, Pereira SS, Silva LL, Figueiredo KA, Moura BA, Almeida FC, et al. Antinociceptive effect of topiramate in models of acute pain and diabetic neuropathy in rodents. Life Sci 2009; 84(3-4):105-10.
  43. Sheikhan F, Jahdi F, Khoei EM, Shamsalizadeh N, Sheikhan M, Haghani H. Episiotomy pain relief: use of lavender oil essence in primiparous Iranian women. Complementary Ther Clin Pract 2012; 18(1):66-70.