fa مقایسه دوزهای مختلف سولفات منیزیم در پیشگیری از لرز بعد از عمل در بیماران تحت بی حسی اسپاینال بيهوشی Anesthesiology پژوهشی Original <strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">اهداف: </span></span></span></strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">لرز یک فعالیت ماهیچه ای نوسانی و غیر ارادی است که گرمای متابولیکی را افزایش می دهد و یک عارضه در بیحسی&nbsp; نورآگزیال</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">است. لرز باعث افزایش مصرف اکسیژن بافتی و فعالیت قلبی و ریوی می شود که می تواند ایجاد عوارض&nbsp; قلبی و عروقی، خونریزی و عفونی نماید. در این طرح تحقیقاتی دوزهای مختلف منیزیم سولفات را در پیشگیری از لرز بعد از عمل در بیماران تحت بیحسی نخاعی بررسی کردیم.</span></span></span><br> <strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">مواد و روش</span></span></span></strong> <strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">ها:</span></span></span></strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> در این کارآزمایی بالینی دوسوکور، 99 بیمار با </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">ASA</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> کلاس یک یا دو و در محدوده سنی بین 80-20 سال کاندید جراحی عمومی، ارتوپدی یا اورولوژی تحت بی</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">حسی اسپاینال که به اتاق عمل بیمارستان</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">های 15 خرداد و علامه بهلول گنابادی مراجعه کرده بودند، به روش نمونه</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">گیری تصادفی انتخاب شده و به صورت تصادفی ساده به سه گروه تقسیم شدند. به هر سه گروه منیزیم سولفات 20</span></span></span><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">%</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">&nbsp; که در گروه </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">A</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> با دوز<br> &nbsp;</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">&nbsp;30 </span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">mg</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:9.0pt;">/</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">kg</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">، گروه </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">B</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> با دوز </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">50 </span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">mg</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:9.0pt;">/</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">kg</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> و گروه </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">C</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> با دوز </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">80 </span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">mg</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:9.0pt;">/</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">kg</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> بعد از اسپاینال و طی 15 دقیقه انفوزیون شد. طی جراحی و پس از اتمام جراحی به مدت یک ساعت بیماران توسط پژوهشگر از نظر لرز قابل دیدن کنترل شد. داده</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">ها توسط نرم افزار </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">SPSS</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> نسخه </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">22</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> تجزیه و تحلیل شد.</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">برای مطمئن شدن از توزیع نرمال داده</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">ها از تست کولموگروف اسمیرنوف استفاده شده وسطح معنی داری </span></span></span><em><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">p-</span></span></span></span></em><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">value</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> کمتر از 05/0 در نظر گرفته شده است.</span></span></span><br> <strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">یافته</span></span></span></strong> <strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">ها</span></span></span></strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">: در گروه</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-size:10.0pt;">A</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">، </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">29 </span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">نفر ( 89</span></span></span><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">%</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">) بدون لرز و 4 نفر ( 11</span></span></span><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">%</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">) لرز داشتند که شدت لرز&nbsp; همه گرید1 بود. در گروه</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-size:10.0pt;">B</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">، </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">28 </span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">نفر ( 84</span></span></span><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">%</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> ) لرز نداشتند ولی 5نفر (16</span></span></span><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">%</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">) لرز داشتند که شدت لرز در 4 نفر (11</span></span></span><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">%</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">) گرید1 و در یک نفر (5</span></span></span><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">%</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">) گرید 3 بود. در گروه</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-size:10.0pt;">C</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">، </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">29</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> نفر (89</span></span></span><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">%</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> ) بدون لرز و 4 نفر (11</span></span></span><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">%</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">) لرز داشتند که شدت لرز گرید3 بود. فراوانی و شدت لرز بین گروه </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">A</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> و </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">B</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> (</span></span></span><em><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">P</span></span></span></span></em><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">=0/374</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">)، بین گروه </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">A</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> و </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">C</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> (</span></span></span><em><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">P</span></span></span></span></em><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">=0/631</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">) و بین گروه </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">B</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> و </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">C</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> (</span></span></span><em><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">P</span></span></span></span></em><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">=0/676</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">) اختلاف معنی داری وجود نداشت. </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"></span></span></span></span><br> <strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">نتیجه گیری</span></span></span></strong><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">: دوز پایین سولفات منیزیوم 20</span></span></span><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">%</span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;"> (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">30 </span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">mg</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:9.0pt;">/</span></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:9.0pt;">kg</span></span></span></span><span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">) به اندازه دوزهای بالاتر آن در پیشگیری از بروز لرز بعد از عمل در بیماران بی</span></span></span> <span style="color:black;"><span style="font-family:b nazanin;"><span style="font-size:10.0pt;">حسی اسپاینال موثر است.</span></span></span> <strong>Aims: </strong>Shivering is an oscillating and involuntary activity of the muscles which increases the metabolic hyperthermia and is considered as a complication in neuraxial anesthesia. Shivering also increases the cardiopulmonary activity and oxygen consumption of the tissue. In this research project, different doses of magnesium sulfate in prevention of postoperative shivering in patients undergoing spinal anesthesia were investigated<span dir="RTL">.</span><strong>Materials and Methods<span dir="RTL">:</span></strong> In this double-blind randomized study, 99 patients with ASA classes 1 or 2 aged between 20<span dir="RTL"> -80 </span>years old who were under spinal anesthesia were selected. The patients were divided into 3 groups of 33 each with simple sampling method<span dir="RTL">. </span>During the operation and upon completion of surgery, the patients were controlled regarding the observable shivering for one hour by the researcher. The data were analyzed using SPSS software version<span dir="RTL"> 22. </span>To ensure of the normal distribution of the data<span dir="RTL">, </span>the normality test of Kolmogorov Smirnov was used. The <em>p</em><span dir="RTL">-</span>value was considered significant at < 0.05 level<span dir="RTL">.</span><br> <strong>Results<span dir="RTL">:</span></strong> The results showed that there was no significant difference between groups A and B regarding the frequency and intensity of occurrence of shivering<span dir="RTL"> (</span><em>p</em><span dir="RTL"> = 0.374). </span>Also, no significant difference was observed between group A and group C considering the frequency and intensity of occurrence of shivering<span dir="RTL"> (</span><em>p</em><span dir="RTL"> = 0.631). </span>Further<span dir="RTL">, </span>the frequency and intensity of occurrence of shivering between group B and group C was not significantly different<span dir="RTL"> (</span><em>P</em><span dir="RTL">=0.676).</span><br> <strong>Conclusion<span dir="RTL">:</span></strong> The results indicated that a low dose of magnesium sulfate<span dir="RTL"> 20% </span>(30mg/kg) is effective in the prevention of postoperative shivering in patients undergoing spinal anesthesia to the same degree that higher doses are<span dir="RTL">.</span> بی حسی نخاعی, لرز بعد از عمل, منیزیوم سولفات Spinal anesthesia: [https://www.ncbi.nlm.nih.gov/mesh/?term=Spinal+anesthesia], Postoperative shivering: [https://www.ncbi.nlm.nih.gov/mesh/?term=shivering], Magnesium sulfate: [https://www.ncbi.nlm.nih.gov/mesh/68008278], 127 133 http://imtj.gmu.ac.ir/browse.php?a_code=A-10-2841-1&slc_lang=fa&sid=1 M. Sahebanmaleki محسن صاحبان ملکی dr.saheban@gmu.ac.ir 8000319475328460028984 8000319475328460028984 Yes Department of Anesthesia, Clinical Research Developmental Unit Bohlool Hospital,Gonabad University of Medical Science,Gonabad,Iran. گروه بیهوشی، مرکز تحقیات بالینی بیمارستان علامه بهلول، دانشگاه علوم پزشکی گناباد، گناباد، ایران. B. Ebrahimi بهاره ابراهیمی ebrahimi.72@gmail.com 8000319475328460028985 8000319475328460028985 No Student Research Committee, Gonabad University of Medical Science, Gonabad, Iran. کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی گناباد، گناباد، ایران. S. Eshaghi سمیرا اسحقی 8000319475328460028986 8000319475328460028986 No Student Research Committee, Gonabad University of Medical Science, Gonabad, Iran. کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی گناباد، گناباد، ایران. M. Amiri مصطفی امیری Mu1amiry@yahoo.com 8000319475328460028987 8000319475328460028987 No Department of Bascic Sciences, School of Medicine, Gonabad University of Medical Science, Gonabad, Iran. گروه علوم پایه، دانشکده پزشکی، دانشگاه علوم پزشکی گناباد، گناباد، ایران. M. Moavensaiedi مریم معاون سعیدی mmoavensaidi@yahoo.com 8000319475328460028988 8000319475328460028988 No Department of Occupational Medicine, Clinical Research Developmental Unit Bohlool Hospital, Gonabad University of Medical Science, Gonabad, Iran. گروه طب کار، دانشکده پزشکی، دانشگاه علوم پزشکی گناباد، گناباد، ایران.