مقایسه اثر فنیل‌افرین و افدرین بر نوزاد در درمان هیپوتانسیون ناشی از بی‌حسی نخاعی در زنان باردار کاندید سزارین

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه بیهوشی، دانشکده پزشکی ، دانشگاه علوم پزشکی ایران، تهران، ایران.

2 استادیار گروه بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران

3 دستیار گروه بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران.

چکیده

مقدمه: یکی از روش‌های مورد استفاده در سزارین، بی‌حسی نخاعی است که این بیهوشی نقش عمده‌ای در عمل سزارین دارد. یکی از عوارض بی‌حسی نخاعی، افت فشارخون می‌باشد. مطالعه حاضر با هدف بررسی مقایسه اثر فنیل‌افرین و افدرین در درمان هایپوتنشن ناشی از بی‌حسی نخاعی در زنان باردار کاندید سزارین انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی تصادفی دو‌سو‌کور در سال 97-1396 بر روی 74 زن باردار سالم کاندید عمل جراحی سزارین انتخابی تحت بی‌حسی نخاعی مراجعه‌کننده به بیمارستان فیروزگر تهران انجام شد. بیماران به‌طور تصادفی در دو گروه فنیل‌افرین یا افدرین قرار گرفتند. بیماران فنیل‌افرین یا افدرین را بلافاصله پس از افت فشارخون به‌دنبال بی‌حسی نخاعی دریافت کردند. طی جراحی متغیرهای همودینامیک شامل فشارخون سیستولیک، دیاستولیک و ضربان قلب هر 5 دقیقه اندازه‌گیری شد و بعد از خروج نوزاد، گازهای خون شریانی بندناف نوزاد تحت آنالیز قرار گرفت و همچنین آپگار نوزاد در دقایق 1 و 5 ثبت شدند. تجزیه و تحلیل داده‌ها با استفاده از نرم افزار آماریSPSS (نسخه 21) و آزمون تحلیل اندازه‌های تکراری انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته­ها: بین فشارخون سیستولیک بیماران در دو گروه طی جراحی تفاوت معناداری وجود نداشت (05/0<p). فشار‌خون دیاستولیک بیماران طی جراحی در دقایق 5، 10، 15، 20، 25 و 30 بعد از خروج نوزاد، در گروه فنیل‌افرین به‌طور معناداری کمتر از گروه افدرین بود (05/0>p). ضربان قلب بیماران طی جراحی به استثنای دقایق قبل از بی‌حسی نخاعی، 6 دقیقه بعد از بی‌حسی نخاعی، 40 و 45 بعد از خروج نوزاد در گروه فنیل‌افرین به‌طور معناداری کمتر از گروه افدرین بود (05/0>p). آپگار نوزادان در دقیقه 1 در گروه فنیل‌افرین به‌طور معناداری بیشتر از گروه افدرین بود (05/0>p). بین نمره آپگار نوزادان در دو گروه در دقیقه 5 تفاوت معناداری وجود نداشت (05/0<p). بین میزان pH نوزادان در بیماران دو گروه تفاوت معناداری وجود نداشت.
نتیجه­گیری: هر دو داروی افدرین و فنیل‌افرین جهت درمان هیپوتانسیون ناشی از بی‌حسی نخاعی در زنان باردار کاندید سزارین،  بدون اختلاف مشخصی در کنترل فشارخون سیستمیک و با کمترین تأثیر بر آپگار نوزاد، قابل استفاده می‌باشند.

کلیدواژه‌ها

عنوان مقاله [English]

Comparison of the effect of phenylephrine and ephedrine on the neonate in treatment of hypotension due to spinal anesthesia in pregnant women candidate for cesarean section

نویسندگان [English]

  • Alireza Pournajafian 1
  • Faranak Rokhtabnak 1
  • Mohamadreza Ghodrati 1
  • Alireza Kholdebarin 2
  • Ali Hassani 3
  • Abdolreza Dayani 3
1 Associate professor, Department of Anesthesia, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
2 Assistant professor, Department of Anesthesia, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
3 Resident, Department of Anesthesia, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: One of the methods used in cesarean section is spinal anesthesia that have major role in cesarean section. One complication of spinal anesthesia is hypotension. This study was performed with aim to compare the effects of phenylephrine and ephedrine in the treatment of hypotension due to spinal anesthesia in pregnant women who are candidates for cesarean section.
Methods: This randomized, double-blind, clinical trial study was performed on 74 healthy pregnant women candidate for ceasarian section under spinal anesthesia who referred to Firoozgar hospital in Tehran in 2017-2018. Patients were randomly assigned to two groups: phenylephrine or ephedrine. Patients received phenylephrine or ephedrine immediately after hypotension due to spinal anesthesia. During the surgery, hemodynamic variables including systolic, diastolic blood pressure and heart rate were measured every 5 minutes. After the removal of the baby, the umbilical cord blood gases were analyzed; first and fifth minutes Apgar score were recorded. Data were analyzed by SPSS software (version 21) and Repeated measures ANOVA. P<0.05 was considered statistically significant.
Results: There was no significant difference between systolic blood pressure in two groups during surgery (P>0.05). The diastolic blood pressure during surgery at 5, 10, 15, 20, 25 and 30 minutes after the removal of the baby was significantly less in the phenylephrine group than Ephedrine group (P<0.05). Heart rate of patients during surgery except minutes before spinal anesthesia, 6 min after spinal anesthesia, 40 and 45 after the removal of the newborn was significantly less in the phenylephrine group than ephedrine group (P<0.05). First minute Apgar score was significantly higher in phenylephrine group than the ephedrine group (P<0.05). Fifth minute Apgar score was not significantly different between the two groups (P >0.05). There was no significant difference in the PH of newborns in two groups (P>0.05).
Conclusion: Both ephedrin and phenylephrine can be used in treatment of hypotension due to spinal anesthesia in pregnant women candidate for caesarean section, without any significant differences in control of systemic blood pressure and minimum effect on Apgar score.           

کلیدواژه‌ها [English]

  • Apgar
  • Ephedrine
  • Hypotension
  • Phenylephrine
  • Spinal Anesthesia

مراجع

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مجله زنان، مامایی و نازایی ایران
دوره 23، شماره 1
فروردین 1399
صفحه 7-18

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