Journal of Babol University of Medical Sciences
مجله علمی دانشگاه علوم پزشکی بابل
J Babol Univ Med Sci
Medical Sciences
http://jbums.org
1
admin
1561-4107
2251-7170
10.22088/jbums
fa
jalali
1393
6
1
gregorian
2014
9
1
16
9
online
1
fulltext
fa
مقایسه اثر فنتانیل جلدی با مورفین وریدی بر درد بعد از عمل جراحی کانسرمری به روش ترانس هیاتال
Comparison of Efficacy of Transdermal Fentanyl Patch and Intravenous Morphine on Postoperative Pain of Esophageal Cancer Surgery with Trans-Hiatal Approach
بافت شناسی
Histology
تحقیقی
Research
<p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 16pt text-justify: kashida text-kashida: 0% mso-line-height-rule: exactly" dir="rtl"><font size="2"><b><span lang="FA" style="color: blue font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">سابقه و هدف:</span></b><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"> کنترل موثر درد پس از اعمال جراحی برای کاهش عوارض آن اهمیت بالایی دارد. در این مطالعه اثر فنتانیل جلدی با مورفین وریدی بر درد بعد از عمل جراحی کانسر مری به روش ترانس هیاتال مقایسه شده است.<b><span style="color: blue"><o:p /></span></b></span></font></p><font face="Times New Roman" size="3"></font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 16pt text-justify: kashida text-kashida: 0% mso-line-height-rule: exactly" dir="rtl"><font size="2"><b><span lang="FA" style="color: blue font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">مواد و روشها:</span></b><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"> این مطالعه کارآزمایی بالینی یک سوکور بر روی 57 بیمار کلاس </span><font face="Times New Roman"><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">I</span><span dir="rtl"></span><span dir="rtl"></span><span style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA">و </span></span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">II</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span> انجمن بیهوشی آمریکا کاندید جراحی الکتیو کانسرمری به روش ترانس هیاتال که بصورت تصادفی به دو گروه (فنتانیل جلدی = </span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">F</span><span dir="rtl"></span><span dir="rtl"></span><span style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA">و مورفین </span></span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">M =</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span>)</span><span dir="ltr"></span><span dir="ltr"></span><span class="hps"><span lang="FA" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra" mso-ansi-language: EN" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span></span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">تقسیم شدند، انجام گردید. در گروه</span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">F</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span>، یک چسب جلدی فنتانیل (</span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">μg/h</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span>50) یک ساعت قبل از شروع القای بیهوشی به پوست قفسه سینه چسبانده شد. در گروه </span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">M</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span> در پایان جراحی4 میلی گرم مورفین وریدی تجویز شد. وضعیت درد، میزان فشار خون، تعداد ضربان قلب و تعداد تنفس بیماران در طول 72 ساعت بعد از عمل در ساعات 0-2-4-6 و بعد از آن هر 6 ساعت اندازه گیری شد.در هر دو گروه در صورتی که نمره درد بیمار (براساس </span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">Visual Analogue Scale</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span>) بیش</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">از 3 شد، 4 میلی گرم مورفین وریدی<span style="mso-spacerun: yes"> </span>تزریق شد. در پایان میانگین میزان دریافت مورفین و نمره درد، میزان شیوع دپرسیون تنفسی، تغییرات فشار خون و ضربان قلب<span style="mso-spacerun: yes"> </span>در دو گروه مقایسه شد. (</span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">IRCT:201110107752N1</span><span dir="rtl"></span><span dir="rtl"></span></font><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span>)<b><span style="color: blue"><o:p /></span></b></span></font></p><font face="Times New Roman" size="3"></font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 16pt mso-line-height-rule: exactly" dir="rtl"><font size="2"><b><span lang="FA" style="color: blue font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">یافته ها:</span></b><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"> تعداد بیماران گروه فنتانیل و مورفین بترتیب ۲۹ و ۲۸ بیمار بود</span><span dir="ltr"></span><span dir="ltr"></span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span><font face="Times New Roman">.</font></span><span dir="rtl"></span><span dir="rtl"></span><span style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font face="Times New Roman">دو گروه از نظر سن، جنس و وزن مشابه بودند. اثر بخشی فنتانیل جلدی در کاهش نمره درد پس از جراحی کانسر مری بروش ترانس هیاتال بهتر از گروه مورفین وریدی بود (001/0</font></span></span><font face="Times New Roman"><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">p<</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span>). میانگین میزان مورفین تجویز شده در هر بیمار در گروه </span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">M</span><span dir="rtl"></span><span dir="rtl"></span><span style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA">(</span></span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">mg</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span>82/3</span><span lang="FA" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">±</span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">64) و در گروه فنتانیل جلدی (</span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">mg</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span>63/5</span><span lang="FA" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">±</span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">20) بوده است (05/0</span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">p<</span><span dir="rtl"></span><span dir="rtl"></span></font><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span>).میزان شیوع دپرسیون تنفسی، تغییرات فشار خون و ضربان قلب در دو گروه تفاوت بارزی نداشت.<b><span style="color: blue"><o:p /></span></b></span></font></p><font face="Times New Roman"><font size="3"></font><b><span lang="FA" style="color: blue font-family: "2 Mitra" font-size: 10pt mso-fareast-font-family: "Times New Roman" mso-bidi-language: FA mso-no-proof: yes mso-ansi-language: EN-US mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-fareast-language: EN-US" dir="rtl">نتیجه گیری:</span></b><span lang="FA" style="font-family: "2 Mitra" font-size: 10pt mso-fareast-font-family: "Times New Roman" mso-bidi-language: FA mso-no-proof: yes mso-ansi-language: EN-US mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-fareast-language: EN-US" dir="rtl"> این مطالعه نشان می دهد که فنتانیل جلدی(</span><span style="font-family: "Times New Roman","serif" font-size: 10pt mso-fareast-font-family: "Times New Roman" mso-bidi-font-family: "2 Mitra" mso-bidi-language: FA mso-no-proof: yes mso-ansi-language: EN-US mso-fareast-language: EN-US">TFP</span><span dir="rtl"></span><span dir="rtl"></span><span lang="FA" style="font-family: "2 Mitra" font-size: 10pt mso-fareast-font-family: "Times New Roman" mso-bidi-language: FA mso-no-proof: yes mso-ansi-language: EN-US mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-fareast-language: EN-US" dir="rtl"><span dir="rtl"></span><span dir="rtl"></span>) یک روش موثر و مناسب در کاهش درد پس از عمل کانسرمری به روش ترانس هیاتال</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: "Times New Roman","serif" font-size: 10pt mso-fareast-font-family: "Times New Roman" mso-bidi-font-family: "2 Mitra" mso-bidi-language: FA mso-no-proof: yes mso-ansi-language: EN-US mso-fareast-language: EN-US"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" font-size: 10pt mso-fareast-font-family: "Times New Roman" mso-bidi-language: FA mso-no-proof: yes mso-ansi-language: EN-US mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-fareast-language: EN-US" dir="rtl">می باشد.</span></font>
<p><font face="Times New Roman" size="3"> </font></p><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 15pt unicode-bidi: embed direction: ltr mso-line-height-rule: exactly"><font size="2"><font face="Times New Roman"><b><span style="color: blue mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">BACKGROUND AND
OBJECTIVE</span></b><span style="color: blue mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">:</span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman""> Effective control of postoperative
pain is very important to reduce its complications.<b> </b>This study was
performed to compare the efficacy of trans-dermal fentanyl patch and
intravenous morphine on postoperative pain of esophageal cancer surgery with
trans-hiatal approach.<o:p /></span></font></font></p><p><font face="Times New Roman" size="3"> </font></p><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 15pt unicode-bidi: embed direction: ltr mso-line-height-rule: exactly"><font size="2"><font face="Times New Roman"><b><span style="color: blue mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">METHODS:</span></b><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman""> In
this double blind clinical trial study, 57 ASA class I-II patients who
scheduled for elective esophageal cancer surgery with trans-hiatal approach </span><span lang="EN" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman" mso-ansi-language: EN">were randomly divided into two groups (M=Morphine,
F=Fentanyl patch).</span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman""> In a fentanyl group (F), a TFP (50 µg/h) was placed on
chest wall skin one hour before the induction of anesthesia. In M group,
morphine 4 mg was administrated at the end of surgery. </span><span lang="EN" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman" mso-ansi-language: EN">Pain score, blood pressure, heart rate and respiratory
rate in 0-2-4-6 and then every 6 hours for 72 hours after surgery were
measured.</span><b><span lang="EN" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman""> </span></b><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">In both groups 4mg intravenous morphine
was administered to the patient if they had pain score (base of visual analogue
scale) more than three.<b> </b>Finally, the mean amount of morphine, pain
score, the</span><span lang="EN" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman" mso-ansi-language: EN"> incidence of respiratory depression,
changes in blood pressure and heart rate </span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">in two groups was compared.
(IRCT:201110107752N1)<o:p /></span></font></font></p><p><font face="Times New Roman" size="3"> </font></p><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 15pt unicode-bidi: embed direction: ltr mso-line-height-rule: exactly"><font size="2"><font face="Times New Roman"><b><span style="color: blue mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">FINDINGS:</span></b><span style="mso-bidi-font-size: 10.0pt mso-fareast-font-family: Calibri mso-bidi-font-family: "Times New Roman" mso-ansi-language: EN"> </span><span lang="EN" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman" mso-ansi-language: EN">The</span><span dir="rtl"></span><span dir="rtl"></span><span lang="EN" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"" dir="rtl"><span dir="rtl"></span><span dir="rtl"></span> </span><span lang="EN" style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman" mso-ansi-language: EN">numbers of
patients in fentanyl and morphine groups were 29 and 28</span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">,
respectively. The two groups were similar for age, gender and weight. The
efficacy of TFP to reduce pain score after operation was better than the
Morphine group (p<0.001). The mean amount of prescribed morphine in M group
was (64<span dir="rtl"></span><span dir="rtl"></span><span lang="FA" dir="rtl"><span dir="rtl"></span><span dir="rtl"></span>±</span><span dir="ltr"></span><span dir="ltr"></span><span dir="ltr"></span><span dir="ltr"></span>3.82mg) and in F group (20±5.63mg)
(p<0.05). The incidence of respiratory depression, blood pressure and heart
rate variation was not significant in two groups. <span style="color: black"><o:p /></span></span></font></font></p><p><font face="Times New Roman" size="3"> </font></p><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 15pt unicode-bidi: embed direction: ltr mso-line-height-rule: exactly"><font size="2"><font face="Times New Roman"><b><span style="color: blue mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">CONCLUSION</span></b><b><span style="color: blue mso-bidi-font-size: 10.0pt mso-fareast-font-family: Calibri mso-bidi-font-family: "Times New Roman"">:</span></b><span style="mso-bidi-font-size: 10.0pt mso-fareast-font-family: Calibri mso-bidi-font-family: "B Mitra""> </span><span style="color: black mso-bidi-font-size: 10.0pt mso-fareast-font-family: Calibri mso-bidi-font-family: "Times New Roman"">This study showed that the transdermal fentanyl
patch (TFP) could be an appropriate and effective method to reduce postoperative
pain of esophageal cancer surgery with trans-hiatal approach. </span><span style="mso-bidi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: "Times New Roman" mso-fareast-language: ZH-CN"><o:p /></span></font></font></p><p><font face="Times New Roman" size="3"> </font></p>
فنتانیل جلدی, مورفین, سرطان مری, مقیاس دیداری درد.
Transdermal fentanyl patch, Morphine, Esophagus cancer, Visual analogue scale.
7
13
http://jbums.org/browse.php?a_code=A-10-1370-1006&slc_lang=fa&sid=1
P.
Amri Maleh (MD)
پرویز
امری مله
10031947532846006447
10031947532846006447
No
گروه بیهوشی، دانشگاه علوم پزشکی بابل
E.
Alijanpour (MD)
ابراهیم
علیجانپور
10031947532846006448
10031947532846006448
No
گروه بیهوشی، دانشگاه علوم پزشکی بابل
N.
Nikbakhsh (MD)
نوین
نیک بخش
10031947532846006449
10031947532846006449
Yes
گروه جراحی، دانشگاه علوم پزشکی بابل
N.
Samarghandi (MD)
نسیبه
ثمرقندی
10031947532846006450
10031947532846006450
No
دانشگاه علوم پزشکی بابل
M.
Esmaeilnia (MD)
مصطفی
اسماعیل نیا
10031947532846006451
10031947532846006451
No
دانشگاه علوم پزشکی بابل
S.
Khafri (PhD)
ثریا
خفری
10031947532846006452
10031947532846006452
No
گروه آمار زیستی و پزشکی اجتماعی، دانشگاه علوم پزشکی بابل