بررسی تأثیر رمی‌فنتانیل بر تغییرات همودینامیک و اسپاستیسیتی عضلانی بیماران تحت هیسترکتومی کامل از طریق شکم: یک مطالعه کارآزمایی بالینی تصادفی شده دو سویه‌کور

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه بیهوشی، مرکز تحقیقات بیماری‌های غیرواگیر، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

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

3 مربی بیهوشی، مرکز تحقیقات مؤلفه‌های اجتماعی نظام سلامت، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

4 استادیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

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

چکیده

مقدمه: هیسترکتومی به‌معنای خارج نمودن رحم از بدن می‌باشد که نیازمند کاهش اسپاسیتی و تون عضلانی شکم حین این جراحی طولانی‌مدت است. مطالعه حاضر با هدف بررسی تأثیر رمی‌فنتانیل بر تغییرات همودینامیک و اسپاستیسیتی عضلانی بیماران تحت هیسترکتومی کامل از طریق شکم انجام گرفت.
روش‌کار: این مطالعه کارآزمایی بالینی تصادفی شده دوسویه‌کور در سال 1401 بر روی 24 نفر از بیماران مراجعه کننده به اتاق عمل بیمارستان مطهری شهرستان جهرم که تحت عمل جراحی هیسترکتومی قرار گرفتند، انجام شد. بیماران به دو گروه رمی‌فنتانیل و کنترل تقسیم شدند. علائم هودینامیک، میزان خونریزی، رضایت جراح از اسپاستیسیتی عضلانی شکم  و زمان تزریق مجدد شل کننده عضلانی بیماران مورد ارزیابی قرار گرفت. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار SPSS (نسخه 21) و آزمون‌های آنالیز واریانس با اندازه‌های تکراری، من‌ویتنی و کای دو انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته­ ها: میانگین فشارخون سیستولیک، دیاستولیک، متوسط شریانی و ضربان قلب در اکثر زمان‌های بررسی شده بین دو گروه تفاوت معنی‌داری نداشت (05/0<p). میانه میزان خونریزی در زمان‌های مختلف (05/0<p) و میزان رضایت جراح از اسپاستیسیتی عضلانی شکم در زمان‌های مختلف، بین دو گروه رمی فنتانیل و کنترل تفاوت معنی‌داری نداشت (05/0<p). زمان نیاز به تزریق مجدد شل کننده عضلانی در تزریق اول و دوم در گروه رمی‌فنتانیل به‌طور معنی‌داری بیشتر از گروه کنترل بود (05/0>p)؛ اما در تزریق سوم بین دو گروه رمی‌فنتانیل و کنترل تفاوت معنی‌داری وجود نداشت (05/0<p).
نتیجه ­گیری: استفاده از رمی­ فنتانیل در حین بیهوشی تأثیر قابل ملاحظه ­ای در بهبود تغییرات همودینامیک، میزان خونریزی و رضایت جراح نداشت، اما نیاز به دوز­های اضافی شل کننده ­های عضلانی را به تأخیر انداخت. با این‌حال لزوم بررسی بیشتر این دارو در ترکیب با گازهای استنشاقی در جوامع بزرگ‌تر احساس می‌شود.

کلیدواژه‌ها

عنوان مقاله [English]

The effect of remifentanil on hemodynamic changes and muscle spasticity in patients undergoing total abdominal hysterectomy: A double-blind randomized clinical trial study

نویسندگان [English]

  • Hasan Zabetian 1
  • Sarina Malekzadeh 2
  • Navid Kalani 3
  • Farideh Mogharab 4
  • Mohammad Rahmanian 5
1 Associate Professor, Department of Anesthesiology, Research Center for Non-Communicable Diseases, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
2 Medical Student, Student Research committee, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
3 Instructor, Department of Anesthesiology, Research Center for Social Determinants of Health, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
4 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
5 Assistant Professor, Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
چکیده [English]

Introduction: Hysterectomy means removing the uterus from the body, which requires reducing spasticity and abdominal muscle tone during this long-term surgery. The present study was conducted with aim to investigate the effect of remifentanil on hemodynamic changes and muscle spasticity in patients undergoing total abdominal hysterectomy.
Methods: This double-blind randomized clinical trial study was conducted in 2022 on 24 patients referred to the operating room of Motahari Hospital in Jahrom city who underwent hysterectomy surgery. Patients were divided into two groups of remifentanil and control. Hemodynamic symptoms, bleeding rate, surgeon's satisfaction with abdominal muscle spasticity and the time of re-injection of muscle relaxant were evaluated. Data analysis was done using SPSS software (version 21) and ANOVA with repeated measures, Mann-Whitney and chi-square tests. P<0.05 was considered statistically significant.
Results: The mean systolic, diastolic, mean arterial blood pressure and heart rate were not significantly different between the two groups during most of the examined times (P>0.05). There was no significant difference between the two remifentanil and control groups in the mean amount of bleeding at different times (P>0.05), surgeon's satisfaction with abdominal muscle spasticity at different times (P>0.05). The time needed to re-inject the muscle relaxant in the first and second injections was significantly longer in the remifentanil group than the control group (P<0.05); However, there was no significant difference between the two remifentanil and control groups in the third injection (P>0.05).
Conclusion: The use of remifentanil during anesthesia did not have a significant effect on improving hemodynamic changes, bleeding rate and surgeon satisfaction, but delayed the need for additional doses of muscle relaxants. However, it is necessary to further investigate this drug in combination with inhalation gases in larger communities.

کلیدواژه‌ها [English]

  • Hemodynamics
  • Hysterectomy
  • Muscular spasticity
  • Remifentanil

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مجله زنان، مامایی و نازایی ایران
دوره 26، شماره 2
اردیبهشت 1402
صفحه 1-13

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