بررسی اثر پماد زردچوبه بر بهبود زخم ناشی از اپی زیاتومی در زنان نخست زا

نوع مقاله: اصیل پژوهشی

نویسندگان

1 - کارشناس ارشد مامائی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد

2 - استادیار زنان و زایمان، بیمارستان ام البنین(س)، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد

3 - استادیار فارماکوگنوزی، دانشکده داروسازی، دانشگاه علوم پزشکی مشهد

4 - استادیار آمار زیستی، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد

چکیده

مقدمه: یکی از مداخلات پزشکی در زایمان، اپی زیاتومی می باشد که برای وسیع ترکردن میاندوراه بهکارمیرود.
زردچوبه یکی از قدیمی ترین گیاهان دارویی است که بدلیل دارا بودن کورکومینوئیدها، دارای خاصیت بهبود زخم
می باشد. این مطالعه با هدف تعیین اثر پماد زردچوبه بر بهبود زخم ناشی از اپی زیاتومی در خانم های نخست زا
انجام گردید.
روش کار: این مطالعه کارآزمایی بالینی دو سو کور که بر 84 زن نخست زای 17 تا35 ساله واجد شرایط پژوهش
که جهت زایمان طبیعی به بیمارستان زنان ام البنین(س) مشهد مراجعه کرده بودند، انجام گردید. پس از زایمان،
مادران گروه کنترل پماد زردچوبه و گروه شاهد پماد دارونما را روزی دوبار (12±2 ساعت) به مدت ده روز
استفاده کرده و ارزیابی میزان بهبود اپی زیاتومی در روزهای هفتم، دهم و چهاردهم پس از زایمان با استفاده از
ابزار ریدا (قرمزی، ادم، کبودی، ترشح از زخم، فاصله دو لبه زخم) انجام شد. داده ها با استفاده از آزمون تی، کای
دو و من ویتنی تجزیه و تحلیل گردید.
نتایج: از 63 نفر، 32 نفر در گروه مطالعه و 31 نفر در گروه کنترل مورد مطالعه قرار گرفتند. دو گروه از نظر
مشخصات دموگرافیک و سایر متغیر های مداخله گر اختلاف آماری معنی داری نداشتند. مقایسه نمره ریدا در روز
هفتم پس از زایمان نشان دادکه میانگین نمره در گروه مطالعه(2/84 ± 1/68) و در گروه کنترل (4/35 ± 1/45)
می باشد وتفاوت آماری معنی دار بین دوگروه وجود دارد (p<0/001). بطور مشابه در بررسی روز دهم پس از
زایمان میانگین نمره ریدا در گروه مطالعه(2/09 ± 1/59) تقریبا نصف نمره میانگین بهبود زخم در گروه کنترل
(4/10 ± 1/77) بود و دو گروه اختلاف آماری معنی داری با یکدیگر داشتند (p<0/001). بررسی زخم اپی زیاتومی
در روز 14 پس از زایمان نیز نشان داد که هم چنان نمره ریدا در گروه مطالعه کمتر از یک دوم نمره گروه کنترل
است و دو گروه از نظر بهبود زخم تفاوت آماری معنی داری را نشان می دهند (p=0/012).
نتیجه گیری: استفاده از پماد زردچوبه سرعت بهبود زخم اپی زیاتومی را افزایش می دهد به عبارت دیگر بهبود
برش اپی زیاتومی در گروه مطالعه را تا روز 14 به میزان 4 روز ارتقا میدهد و میتواند بهعنوان ارتقا دهنده بهبود
اپی زیاتومی در خانمهای نخست زا پیشنهاد گردد.

کلیدواژه‌ها


عنوان مقاله [English]

The Effects of Turmeric (Curcuma Longa L) Ointment on Healing of Episiotomy Site in Primiparous Women

نویسندگان [English]

  • Nahid Golmakani 1
  • Elhameh Rabiei Motlagh 1
  • Fatemeh Tara 2
  • Javad Assili 3
  • Mohamad Taghi Shakeri 4
1 M.Sc. of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences , Mashhad, Iran
2 Assistant Professor of Obstetrics & Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Professor of Pharmacology, Faculty of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
4 Assistant Professor of Public Health & Epidemiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
چکیده [English]

Introduction: Episiotomy is a surgical incision of the perineum, which is done during delivery to facilitate and expedite delivery and to prevent perineal tears. Within the midwifery practice, perineal care both during and after the labor has changed during the past 20 years, however, there is little research on the care of this most frequently performed wound. Curcuma longa or turmeric is a tropical plant, which has the capability of healing wounds because of its containing curcuminoids. The aim of this study was to determine the effect of turmeric ointment on healing of episiotomy site in primiparous women.
 
Material and Methods: This study was a double blind clinical trial, which was accomplished in Omul Banin hospital affiliated to Mashhad University of Medical Sciences. Eighty four qualified primiparous women aged 17-35 years who were scheduled for normal vaginal delivery were recruited. Inclusion criteria were: Primiparity, gestational age 37-42 weeks, live and singleton pregnancy, and lack of chronic systemic diseases such as diabetes mellitus that can affect the healing process. The included women were alternately divided to the study and control groups. The turmeric ointment contained 5% ethanolic extract of turmeric rhizomes powder in Vaseline basement and placebo contained a few drops of in concentrated hydro alcoholic extract of turmeric rhizomes powder in Vaseline basement. Both the turmeric and placebo ointments were prepared, packed and coded in similar tubes by a pharmacologist who was blind to the study protocol. After delivery, in case of performing episiotomy, the women were advised to apply either the drug or the placebo every 12±2 hours for 10 days. The healing process was assessed at days 7th, 10th, and 14th after the delivery using the REEDA (Redness, Edema, Ecchymosis, Discharge, and Adhesive) scale. The data were analyzed using Student's t, c2, and Mann-Whitney tests.
 
Results: There was not a significant difference in demographic characteristics and other distracted variables between the two groups. Of the 84 recruited women, 17 were excluded. The remaining 63 women consisted of 32 cases and 31 controls. At the 7th day postpartum, the mean REEDA score was 2.84±1.68 for the study group and 4.35±1.45 for the control group (P<0.001). At the 10th day, the mean REEDA score for the women in the study group was about half of their counterparts in the control group (2.09±1.594 v 4.10±1.777, P<0.001). At the 14th day, 4 days after discontinuing the treatment, the mean REEDA score for the study group was still lower than that of the control group (P=0.012). No side effect was seen or reported during the study.
 
Conclusion: The mean REEDA score for the study group at the 10th day was likely the control group at the 14th day. In fact, the turmeric ointment enhances the healing at the episiotomy site and decreases the duration of healing from 14 days to10 days. Therefore, it seems that this ointment can be prescribed for primiparous women with episiotomy incisions.
 
 

کلیدواژه‌ها [English]

  • Episiotomy
  • Curcuma longa
  • Wound healing
  • Prim parity
1. Moshkbid Haghighi M, Hoseini Z, Ebrahimi A, Haghani H.A study of effect of diclofenac
supp. on perineal pain after delivery.Iranian J Nurs Midwifery 2000;13(26):21-5.
2. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap III L, Wenstrom KD.Williams
obstetrics.22th ed.New York:McGrow-Hill;2005:409-41.
3. Drife J, Magowon B.Clinical obstetrics and gynecology.New York:Saunders;2004:403.
4. Klossner NJ.Introductory maternity nursing.Philadelphia:Lippincott Williams &
Wilkins;2006:252-8.
5. Navabi Rigi SH, Abedian Z, Poorjavad M, Smaeli H.Comparing the effect of cooling jell
pads and ice pack, after episiotomy on the intensity of perineal pain.Tabibe_Shargh J
2007;9(1):27-36.
6. Golmakani N, Refaie Saeidi SH, Mazlum R, Soltani B.Evaluation of the perineal trauma
level in primiparous women with routine and selective episiotomy.The Iranian J Obstet
Gynecol Infert 2008;11(1):39-46.
7. Scott JR, Gibbs HS, Karlan BI, Haney AF.Danforth`s Obstetric and gynecology.9th
ed.Philadelphia: Lippincott Williams&Wilkin;2003:21-43.
8. Olds SB, London ML, Wielandladewig P, Pavidson RM.Maternal- newborn nursing
women’s health care.7 th ed.Upper Saddle River, N.J.:Pearson Prentic Hall;2004:733. 
 
9. Upton A, Roberts CL, Ryan M, Faulkner M, Reynolds M, Raynes-Greenow C.A
randomized trial, conducted by midwives, of perineal repairs comparing a polyglycolic
suture material and chromic catgut.Midwifery 2002;18:223-9.
10. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap III L, Wenstrom KD.Williams
obstetrics.22th ed.New York:McGrow-Hill;2005:711-24.
11. Karacam Z, Eroglu K.Effect of episiotomy on bonding and mother`s health.J Adv Nurs
2003;43(4):384-94.
12. Cardozo L, Drife J, Kean L, Kilby M, Kitchener H, Ledger W.Obstetrics and gynecology:
an evidence based text for MRCOG.London:Arnold;2004:427.
13. Murray S., McKinney E., Gorrie T.Foundation of maternal -new born nursing. 3rd ed.
Philadelphia:Saunders;2002:408.
14. Decherney AH, Nathan L.Current obstetric and gynecology: diagnosis & tretment.9th
ed.New york:McGrow-Hill;2002:213-22.
15. Varney H, Kriebs JM, Geogor CL.Varney`s midwifery.4th ed.Boston:Jones and Bartlett
Publishers;2004:1060-280.
16. Fraser DM, Coope MA.Myles text book for midwives.14th ed.Philadelphia:Churchill
Livingstone;2003:632.
17. Adele P.Maternal & child health nursing: care of the child-bearing & child bearing
family.4th ed.Philadelphia:Lippincott Williams & Wilkins;2003:612.
18. Tay SK, Soong SL, Choo BM.Is routin procaine spirit application necessary in the care of
episiotomy wound?.Singapore Med J 1999;40(9).
19. Ziai A, Mesgarpoor B.Medicinal plant, evidence-based-contraindication and drug
intraction.Tehran:Teimourzadeh Medical Publication;2005;92.
20. Naseri M.Development of traditional medicin and WHO Guideline.Daneshvar Pezeshki J
2004;11(52):53-68.
21. Zargari A.Medicinal plant.5th ed.Tehran:Tehran Univercity;1995:163..
22. Evans WC.Trease and evans, pharmacogenosy.15th ed.New York:W.B. Saunders;202:418.
23. Kohli K, Ali J, Ansari M, Raheman Z.Curcumin: a natural antiinflammatory agent.Indian J
Pharmacolo 2005;37 (3):141-7.
24. Kundu S, Biswas TK, Das P, Kumar S.Turmeric (curcuma longa) rhizome paste and honey
show similar wound healing potential: a preclinical study in rabbits.Lower Extremity
Wounds 2005;4(4):205-13.
25. 25.Houghton G P, Raman A.Laboratory handbook for the fractionation of natural
extracts.London:Chapman & Hall;1998:27-8.
26. Maheshwari RK, Singh AK, Gaddipati J, Srimal R.C.Multiple biological activities of
curcumin: short review.Life Sci 2006;78:2081.
27. Fleming VEM, Hagen S, Niven C.Does perineal suturing make: a difference?.Suns Trial
Biol 2003 July;110:684-9.
28. Sidhu GS, Mani H, Gaddipati JP, Singh AK.Curcumin enhances wound healing in
streptozotocin induced diabetic rats and genetically diabetic mice.Wound Rep Reg
1999;7:362-374
29. Mani H, Sidhu GS, Kumari R, Gaddipati JP.Curcumin differentially regulates TGF –beta1,
its receptors and nitric oxide synthase during impaired wound healing.Biofactors
2002;16(1-2):29-43.
30. Thanqazh RL, Sharma A, Maheshwari Rk.Beneficial role of curcumin in skin deasese.Adv
Exp Med Bio 2007;595:343–57.
31. Gopinath D, Rafiuddin Ahmad M, Gomathi K, Chitra K, Sehgal PK, Jayakumar R.Dermal
wound healing processes with curcumin incorporated collagen films.Biomaterials
2004;25:1911-17. Available at: www.sciencedirect.com. 
 
32. Hong J, Bose M, Ju J, Ryu H, Chen X, Sang SH.Modulation of arachidonic acid aetabolism
by curcumin and related β-diketone derivatives: effects on cytosolic phospholipase A2;
cyclo oxygenase And 5-lipoxygenase.Carcinogenesis 2004;25(9):1671-9.