مقایسه دوز کم پروپوفول با میدازولام بر روی علائم همودینامیک مادر و آپگار نوزادان در زنان تحت بی‌حسی اسپاینال در عمل جراحی سزارین: یک مطالعه کارآزمایی بالینی تصادفی شده دوسویه‌کور

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه بیهوشی، مرکز تحقیقات بیهوشی، مراقبت‌های ویژه و کنترل درد، دانشکده پزشکی، دانشگاه علوم پزشکی هرمزگان، بندرعباس، ایران

2 استادیار گروه بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران.

3 دکترای تخصصی ژنتیک پزشکی، پزشک قانونی، مرکز تحقیقات سازمان پزشکی قانونی کشور، تهران، ایران.

4 استادیار گروه زنان و مامایی، مرکز تحقیقات سلامت و بیماری‌های زنان، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

5 مربی گروه بیهوشی، مرکز تحقیقات بیهوشی و کنترل درد، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

6 دانشجوی پزشکی، کمیته تحقیقات دانشجویی، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

7 دانشیار گروه بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

چکیده

مقدمه: بی‌حسی ناحیه‌ای، روش انتخابی در جراحی سزارین می‌باشد. داروهای خواب‌آور داخل وریدی که در القاء بیهوشی استفاده می‌شوند، به‌سرعت از جفت عبور کرده و ممکن است باعث دپرسیون تنفسی جنین شوند. مطالعه حاضر با هدف مقایسه دوز کم پروپوفول با میدازولام بر روی علائم همودینامیک مادران و آپگار نوزادان در زنان تحت بی‌حسی اسپاینال در عمل جراحی سزارین انجام شد.
روش‌کار: در این مطالعه کارآزمایی بالینی تصادفی شده دو‌سویه‌کور که در سال 1392 در شهرستان جهرم انجام شد، 42 بیمار با کلاس بیهوشی I و II تحت بی‌حسی اسپاینال به دو گروه مساوی تزریق 20 میلی‌گرم پروپوفول و 5/1 میلی‌گرم میدازولام همزمان با انجام بی‌حسی اسپاینال قرار گرفتند. علائم همودینامیک مادر در دقایق 1، 3، 5، 10، 15، 30 و 60 دقیقه بعد از بی‌حسی اسپاینال و آپگار نوزادان در دقایق 1 و 5 بعد از به‌دنیا آمدن سنجیده شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 21) و آزمون‌ من‌ویتنی انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: بین گروه‌های میدازولام و پروپوفول از لحاظ فشارخون سیستول و دیاستول، اشباع اکسیژن و ضربان قلب در زمان‌های مختلف و از لحاظ آپگار نوزادان تفاوت آماری معنی‌داری وجود نداشت (05/0p>).
نتیجه‌گیری: با توجه به نتایج مطالعه و عدم تفاوت دو گروه از نظر آپگار نوزادان و نوسانات متغیرهای همودینامیک مادر، می‌توان نتیجه گرفت در شرایط معمولی دوزهای کم پروپوفول و میدازولام برای جراحی سزارین، از نظر بالینی تفاوت بارزی بر آپگار نوزاد و متغیرهای همودینامیک مادر ندارند و می‌توان بسته به شرایط و تجربه متخصص بیهوشی از داروهای مورد نظر استفاده کرد.

کلیدواژه‌ها

عنوان مقاله [English]

Low doses of propofol and midazolam on maternal hemodynamic symptoms and neonatal Apgar in women undergoing spinal anesthesia in cesarean section: A double-blind randomized clinical trial study

نویسندگان [English]

  • Majid Vatankhah 1
  • Seyed Ebrahim Sadeghi 2
  • Mohammad Zarenezhad 3
  • Athar Rasekh Jahromi 4
  • Navid Kalani 5
  • Naser Hatami 6
  • Farshid Javdani 6
  • Hasan Zabetian 7
1 Assistant Professor, Department of Anesthesiology, Anesthesiology & Critical Care and Pain Management Research Center, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
2 Assistant Professor, Department of Anesthesiology, Faculty of Medicine, Shiraz University of Medical sciences, Shiraz, Iran.
3 PhD in Medical Genetic, Department of Forensic Sciences, Iranian Legal Medicine Research Center, Tehran, Iran.
4 Assistant Professor, Department of Obstetrics and Gynecology, Women’s Health and Disease Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
5 Instructor, Department of Anesthesiology, Anesthesiology and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
6 Medical student, Student Research Committee, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
7 Associate Professor, Department of Anesthesiology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
چکیده [English]

Introduction: Regional anesthesia is the method of choice in cesarean section. Intravenous sleeping pills used to induce anesthesia quickly cross the placenta and cause fetal respiration depression. This study was performed with aim to compare the low dose of propofol with midazolam on the maternal hemodynamics symptoms and neonatal Apgar in women undergoing spinal anesthesia in cesarean section.
Methods: In this double-blind randomized clinical trial study which was performed in Jahrom in 2013, 42 patients with anesthesia classes I and II underwent spinal anesthesia and were placed in two equal groups of injection of propofol 20 mg and midazolam 1.5 mg along with spinal anesthesia. Symptoms of maternal hemodynamics were measured at 1, 3, 5, 10, 15, 30, and 60 minutes after spinal anesthesia and neonatal apgar at 1 and 5 minutes after birth. Data were analyzed by SPSS software (version 21) and Mann-Whitney test. p < 0.05 was considered statistically significant.
Results: There was no significant difference between midazolam and propofol groups in terms of systolic and diastolic blood pressure, Blood O2 saturation, and hear rate at different times and neonatal Apgar (P> 0.05).
Conclusion: Considering the results of the study and no difference between the two groups in terms of neonatal Apgar and fluctuations of maternal hemodynamic variables, it can be concluded that under normal conditions, low doses of propofol and midazolam for cesarean section clinically have no significant difference on neonatal Apgar and hemodynamic variables; both drugs can be used depending on the condition and experience of the anesthesiologist.

کلیدواژه‌ها [English]

  • Cesarean section
  • Hemodynamic Symptoms
  • Midazolam
  • Neonatal Apgar
  • Propofol

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مجله زنان، مامایی و نازایی ایران
دوره 24، شماره 2
اردیبهشت 1400
صفحه 41-49

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