بررسي اثر تركيبي متيل پردنيزولون و كلماستين در جلوگيري از چسبندگي پريتوئن در موش

Effect of Methyl Prednisolone - Clemastine Combination on the Peritoneal Adhesions in Rats

ﺯﻣﻴﻨﻪ ﻭ ﻫـﺪﻑ: ﺍﺳﺘﻔـﺎﺩﻩ ﺍﺯ ﮐﻮﺭﺗﻴﮑـﻮﺍﺳﺘﺮﻭﺋﻴﺪ ﻭ ﺁﻧﺘﻲ ﻫﻴﺴﺘـﺎﻣﻴﻦ ﺩﺭﮐﺎﻫﺶ ﭼﺴﺒﻨﺪﮔﻲ ﻣﺆﺛﺮ ﺑـﻮﺩﻩ ﺍﺳـﺖ. ﻫـﺪﻑ ﺍﺯ ﺍﻧﺠـﺎﻡ ﺍﻳـﻦ ﺗﺤﻘﻴﻖ ﺗﻌﻴﻴـﻦ ﺍﺛﺮ ﺗﺮﮐﻴﺒـﻲ ﻣﺘﻴـﻞ ﭘـﺮﺩﻧﻴـﺰﻭﻟﻮﻥ ﻭﮐﻠﻤـﺎﺳﺘﻴـﻦ ﺩﺭ ﺟﻠﻮﮔﻴﺮﻱ ﺍﺯﺗﺸﮑﻴـﻞ ﭼﺴﺒﻨـﺪﮔﻲ ﭘﺮﻳﺘـﻮﺋﻦ ﺩﺭ ﻣـﻮﺵ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ 40 ﻣﻮﺵ ﻣﺬﮐﺮ ﺩﺭ ﺩﻭ ﮔﺮﻭﻩ ﺑﻴﺴﺖ ﺗﺎﻳﻲ ﺑﻪ ﺻﻮﺭﺕ ﺗﺼﺎﺩﻓﻲ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ. ﭘﺲ ﺍﺯ ﺑﻲ ﻫﻮﺵ ﮐﺮﺩﻥ ﺍﻳﻦ ﻣﻮﺵ ﻫﺎ ﺟﺪﺍﺭ ﺷﮑﻢ ﺑﺎﺯ ﺷﺪﻩ ﻭ 10 ﺑﺮﺵ ﻃﻮﻟﻲ ﺗﻘﺮﻳﺒﺎﹰ 1 ﺳﺎﻧﺘﻴﻤﺘﺮ ﺑﺮ ﺭﻭﻱ ﺳﻄﺢ ﭘﺮﻳﺘﻮﺋﻦ ﺩﺭ ﺳﻤﺖ ﺭﺍﺳﺖ ﺩﺭ ﺩﻳﻮﺍﺭﺓ ﻗﺪﺍﻣﻲ ﺩﺍﺩﻩ ﺷﺪﻩ ﻭ ﺳﭙﺲ ﻗﻄﻌﻪ ﺍﻱ ﺍﺯ ﭘﺮﻳﺘﻮﺋﻦ ﻧﻴﺰ ﺑﻪ ﺍﺑﻌﺎﺩ 2×2 ﺳﺎﻧﺘﻴﻤﺘﺮ ﻣﺮﺑﻊ ﺍﺯ ﺳﻄﺢ ﻗﺪﺍﻣﻲ ﺩﻳﻮﺍﺭﻩ ﭼﭗ ﺷﮑﻢ ﺑﺮﺩﺍﺷﺘﻪ ﺷﺪ. ﺩﺭ ﮔﺮﻭﻩ ﻣﻮﺭﺩ ﮐﻠﻤﺎﺳﺘﻴﻦ ﺑﺎ ﺩﻭﺯ 50µg/kg ﻭ ﻣﺘﻴﻞ ﭘﺮﺩﻧﻴﺰﻭﻟـﻮﻥ ﺑﺎ ﺩﻭﺯ mg/kg 40 ﺩﺍﺧﻞ ﭘﺮﻳﺘﻮﺋﻦ ﺗﺰﺭﻳﻖ ﺷﺪ ﻭ ﺩﺭ ﮔﺮﻭﻩ ﺷﺎﻫﺪ ﺑﻪ ﻫﻤﻴﻦ ﻣﻴﺰﺍﻥ ﻧﺮﻣﺎﻝ ﺳﺎﻟﻴﻦ ﺗﺰﺭﻳﻖ ﺷﺪ. ﭘﺲ ﺍﺯ 20 ﺭﻭﺯ ﻣـﻮﺵ ﻫﺎ ﺗﺤﺖ ﻻﭘﺎﺭﺍﺗﻮﻣﻲ ﻣﺠﺪﺩ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ ﻭ ﻭﺟﻮﺩ ﭼﺴﺒﻨﺪﮔﻲ، ﺗﻌﺪﺍﺩ ﺑﺎﻧﺪﻫﺎﻱ ﭼﺴﺒﻨﺪﻩ ﻭ ﺩﺭﺟﻪ ﭼﺴﺒﻨﺪﮔﻲ ﺑﺮ ﺍﺳﺎﺱ ﻣﺸﺎﻫـﺪﻩ ﻣﺴﺘﻘﻴﻢ، ﺩﺭ ﻫﺮ ﮔﺮﻭﻩ ﻣﺸﺨﺺ ﺷﺪ. ﻧﺘﺎﻳﺞ ﺑﺎ ﺁﺯﻣﻮﻥ ﻣﺎﻥ ـ ﻭﻳﺘﻨﻲ ﻭ ﺁﺯﻣﻮﻥ ﺩﻗﻴﻖ ﻓﻴﺸﺮ ﺁﻧﺎﻟﻴﺰ ﺷﺪ. ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ P<0.05 ﻣﻌﻨﻲ ﺩﺍﺭ ﺗﻠﻘﻲ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻧﺘﺎﻳﺞ ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ﺗﻌﺪﺍﺩ ﺑﺎﻧﺪﻫﺎﻱ ﭼﺴﺒﻨﺪﻩ ﻭ ﺩﺭﺟﻪ ﺁﻧﻬﺎ ﺩﺭ ﮔﺮﻭﻩ ﻣﻮﺭﺩ ﻛﻤﺘﺮ ﺑﻮﺩ. ﺗﻔﺎﻭﺕ ﻫﺎ ﺩﺭ ﺩﺭﺟﻪ ﻭ ﺗﻌﺪﺍﺩ ﺑﺎﻧﺪﻫﺎﻱ ﭼﺴﺒﻨﺪﻩ ﺑﻴﻦ ﺩﻭ ﮔﺮﻭﻩ ﻭ ﺷﺎﻫﺪ ﻗﺎﺑﻞ ﺗﻮﺟﻪ ﺑﻮﺩ )P<0.0001(. ﻣﻴﺎﻧﮕﻴﻦ ﺗﻌﺪﺍﺩ ﺑﺎﻧﺪﻫﺎﻱ ﭼﺴﺒﻨﺪﻩ ﺩﺍﺧﻞ ﺷﻜﻤﻲ ﺩﺭ ﮔﺮﻭﻩ ﻣﻮﺭﺩ 0/222 ± 0/6 ﻭ ﺩﺭ ﮔﺮﻭﻩ ﺷﺎﻫﺪ 3/8±0/439 ﺑﻮﺩ. ﻳﻚ ﻫﻤﺒﺴﺘﮕﻲ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﺑﻴﻦ ﺗﻌﺪﺍﺩ ﻭ ﺩﺭﺟﻪ ﭼﺴﺒﻨﺪﮔﻲ ﻭﺟﻮﺩ ﺩﺍﺷﺖ. ﻛﻠﻤﺎﺳﺘﻴﻦ ﻭ ﭘﺮﺩﻧﻴﺰﻭﻟﻮﻥ، ﺗﻌﺪﺍﺩ ﻭ ﺩﺭﺟﻪ ﺑﺎﻧﺪﻫﺎﻱ ﭼﺴﺒﻨﺪﻩ ﺭﺍ ﻛﻢ ﻛﺮﺩ )P<0.0001(. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻣﺘﻴﻞ ﭘﺮﺩﻧﻴﺰﻭﻟﻮﻥ ﺑﺎ ﺩﻭﺯ mg/kg 40 ﻭ ﮐﻠﻤﺎﺳﺘﻴﻦ ﺑﺎ ﺩﻭﺯ µg/kg 50 ﺑﻪ ﻃﻮﺭ ﺗﺮﮐﻴﺒﻲ ﻭ ﺑﻪ ﺻﻮﺭﺕ ﺗﺰﺭﻳﻖ ﺩﺍﺧﻞ ﺻﻔﺎﻗﻲ ﺑﺎﻋﺚ ﮐﺎﻫﺶ ﻣﻌﻨﻲ ﺩﺍﺭ ﺩﺭ ﺗﻌﺪﺍﺩ ﭼﺴﺒﻨﺪﮔﻲ ﻭ ﺷﺪﺕ ﺩﺭﺟﻪ ﭼﺴﺒﻨﺪﮔﻲ ﻣﻲ ﺷﻮﺩ. ﻣﻲ ﺗﻮﺍﻥ ﺑﻪ ﻣﻨﻈﻮﺭ ﺟﻠﻮﮔﻴﺮﻱ ﺍﺯ ﭼﺴﺒﻨﺪﮔﻲ ﭘﺮﻳﺘﻮﺋﻦ ﺩﺭ ﺟﺮﺍﺣﻲ ﻫﺎﻱ ﺷﻜﻢ ﺍﺯ ﺗﺮﻛﻴﺐ ﺍﻳﻦ ﺩﻭ ﺩﺍﺭﻭ استفاده كرد

Introduction & Objective: Corticosteroids and Antihistamines have been effective in reducing adhesion formation. This study was performed to examine the effect of clemastin - methyl prednisolone combination in the prevention of intra-abdominal adhesions after lapartomy in rats. Materials & Methods: The samples included 40 healthy, male rats that were randomly assigned to the case and control groups. The rats, used in the experiment, were from the same generation and the same age, weighting about 230±20g. Each rat was anesthetized with ketamine-hydrochloride (5mg/kg). Using sterile technique, the abdominal cavity was entered via a 4cm vertical midline incision. Ten longitudinal incision, each of them 1cm in length, were incised in the internal port of their right abdominal wall and a 2×2 (cm)2 piece of peritoneum was excised from the left side. Concurrently, clemastin (50 μg/kg) and methyl-prednisolone (40 mg/kg) was injected intra peritonealy in case group. Then, 20 days later, they had a second laparatomy for assessing the grade of adhesions. At last, the findings were analyzed by Mann-Whitney and fisher exact tests (P<0.05 was significant). Results: The results showed that the number of adhesions bands and their grading were less in the case group. Both differences in the grade and number of adhesion bands, between case and control groups were significant (P<0.0001).The average number of intra-abdominal adhesion bands in case group was 0.6±0.222 (control group: 3.8±0.439). There was a positive and significant correlation between the number and the grade of adhesions. Clemastin and methyl-predinsolone decreased the number and the degree of adhesion bands, effectively (P<0.0001). Conclusions: The use of methyl-predinsolone (40 mg/kg) and clemastin (50 μg/kg) in a combinational and intra peritoneal manner results in significant reduction in the number and the degree of adhesion bands.