ﻣﻘﺎﯾﺴﻪ اﺛﺮ ﺳﻮﻟﻔﺎت ﻣﻨﯿﺰﯾﻮم و دﮐﺴﻤﺪﺗﻮﻣﯿﺪﯾﻦ ﺑﺮ ﮐﯿﻔﯿﺖ ﻓﯿﻠﺪ ﺟﺮاﺣﯽ در ﺑﯿﻤﺎران ﮐﺎﻧﺪﯾﺪ ﻋﻤﻞ ﺟﺮاﺣﯽ اﻧﺪوﺳﮑﻮﭘﯿﮏ ﺳﯿﻨﻮس

Comparison of the Effects of Magnesium Sulfate and Dexmedetomidine on Operation Field of Candidates for Endoscopic Sinus Surgery

سابقه و هدف: يكي از درمانهاي اصلي رينوسينوزيت مزمن عمل جراحي به وسيله اندوسكوپي مي باشد. خونريزي حين عمل جراحي به علت كاهش ديد جراح باعث افزايش عوارض عمل خواهد شد. ﺑﺮاي داﺷﺘﻦ فيلد ﻣﻨﺎﺳﺐ ﺟﺮاﺣﯽ اﻧﺪوﺳﮑﻮﭘﯽ ﺳﯿﻨﻮس، ﮐﻨﺘﺮل ﺧﻮﻧﺮيزي ﺿﺮورت دارد. ﻫﺪف از اﻧﺠﺎم ايﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﺎيسه اﺛﺮ ﺳﻮﻟﻔﺎت ﻣﻨﯿﺰيم ﻧﺴﺒﺖ ﺑﻪ دﮐﺴﻤﺪﺗﻮﻣﯿﺪين ﺑﺮ ﮐﯿﻔﯿﺖ ﻓﯿﻠﺪ ﺟﺮاﺣﯽ در ﺑﯿﻤﺎران ﮐﺎﻧﺪيد ﻋﻤﻞ اﻧﺪوﺳﮑﻮﭘﯿﮏ ﺳﯿﻨﻮس ﻣﯽ ﺑﺎﺷﺪ. مواد و روش‌‌ها: در اين ﻣﻄﺎﻟﻌﻪ ﮐﺎرآزﻣﺎيي ﺑﺎﻟﯿﻨﯽ سه سوكور 60 ﺑﯿﻤﺎر ﮐﺎﻧﺪيد ﺟﺮاﺣﯽ اﻧﺪوﺳﮑﻮﭘﯽ ﺳﯿﻨﻮس ﺑﻪ ﻃﻮر ﺗﺼﺎدﻓﯽ ﺑﻪ دو ﮔﺮوه دﮐﺴﻤﺪﺗﻮﻣﯿﺪين و ﺳﻮﻟﻔﺎت ﻣﻨﯿﺰيم ﺗﻘﺴﯿﻢ ﺷﺪﻧﺪ. در ﮔﺮوه دريافت ﮐﻨﻨﺪه ﺳﻮﻟﻔﺎت ﻣﻨﯿﺰيم ﻗﺒﻞ از ﺷﺮوع ﺑﯿﻬﻮﺷﯽ ﺑﺎ دوز mg/kg 50 ﺑﻤﺪت ده دﻗﯿﻘﻪ و ﺑﺎ دوز mg / kg /h 15 اداﻣﻪ ﭘﯿﺪا ﮐﺮد .در ﮔﺮوه دﮐﺴﻤﺪﺗﻮﻣﯿﺪين ﻗﺒﻞ از ﺑﯿﻬﻮﺷﯽ ﺑﺎ دوز mic/kg 1 ﺑﻤﺪت ده دﻗﯿﻘﻪ و ﺑﺎ دوز mic/kg /h 0/6 اداﻣﻪ ﭘﯿﺪا ﮐﺮد. وﺿﻌﯿﺖ ﻫﻤﻮديناﻣﯿﮏ ﻫﺮ دو ﮔﺮوه در دﻗﺎيق 1، 5 ،15 ، 30 ،60، ﭘﺲ از ﻟﻮﻟﻪ ﮔﺬاري ﺗﺮاﺷﻪ ﺛﺒﺖ ﺷﺪ. ﻧﺘﺎيج ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮم اﻓﺰار SPSS ويرايش 16 ﻣﻮرد ﺗﺠﺰيه و ﺗﺤﻠﯿﻞ ﻗﺮار ﮔﺮﻓﺖ. يافته‌ها: 20 ﻧﻔﺮ 66/7% در ﮔﺮوه دﮐﺴﻤﺪتوميدين و 18 ﻧﻔﺮ 60% در ﮔﺮوه ﺳﻮﻟﻔﺎت ﻣﻨﯿﺰيم ﻣﺮد ﺑﻮدﻧﺪ (0/592=p). ﻣﯿﺎﻧﮕﯿﻦ ﺳﻨﯽ اﻓﺮاد ﮔﺮوه دﮐﺴﻤﺪﺗﻮميدين 37/93ﺳﺎل و در ﮔﺮوه ﺳﻮﻟﻔﺎت ﻣﻨﯿﺰيم 39/56 ﺳﺎل ﺑﻮد (0/250=p). ﻣﯿﺎﻧﮕﯿﻦ زﻣﺎن ﺟﺮاﺣﯽ در ﮔﺮوه دﮐﺴﻤﺪﺗﻮﻣﯿﺪين 41/8± 79/03 دﻗﯿﻘﻪ در ﺣﺎﻟﯽ ﮐﻪ ﮔﺮوه ﺳﻮﻟﻔﺎت ﻣﻨﯿﺰيم 15/09± 87/30 دﻗﯿﻘﻪ ﺑﻮد (0/003=p). ﻣﯿﺎﻧﮕﯿﻦ فشار شرياني Mean arterial pressure (MAP) در ﺗﻤﺎم زﻣﺎن ﻫﺎي ﺳﻨﺠﯿﺪه ﺷﺪه ﺑﺠﺰ زﻣﺎن اول در ﮔﺮوه دﮐﺴﻤﺪﺗﻮﻣﯿﺪين ﮐﻤﺘﺮ از ﮔﺮوه ﺳﻮﻟﻔﺎت ﻣﻨﯿﺰيوم ﺑﻮد ﮐﻪ اﺧﺘﻼف ﻓﻘﻂ در زﻣﺎن اول ﺑﯿﻦ دو ﮔﺮوه ﻣﻌﻨﯽ دار ﻧﺒﻮد. ﻣﯿﺎﻧﮕﯿﻦ اشباع اكسيژن خون محيطي peripheral oxygen saturation (SpO2) در ﺗﻤﺎﻣﯽ زﻣﺎن ﻫﺎ ي ﺛﺒﺖ ﺷﺪه ﺑﯿﻦ دو ﮔﺮوه ﺗﻔﺎوﺗﯽ از ﻧﻄﺮ آﻣﺎري ﻧداشت. ﻣﯿﺎﻧﮕﯿﻦ ﺿﺮﺑﺎن ﻗﻠﺐ درﻃﻮل ﺟﺮاﺣﯽ و ﻣﯿﺎﻧﮕﯿﻦ ﺷﺪت درد در ﮔﺮوه دﮐﺴﻤﺪﺗﻮﻣﯿﺪين ﮐﻤﺘﺮ از گروه ﺳﻮﻟﻔﺎت ﻣﻨﯿﺰيم ﺑﻮد. در ﮔﺮوه ﺳﻮﻟﻔﺎت ﻣﻨﯿﺰيم ﻧﺴﺒﺖ ﺷﺎﻧﺲ ﺧﻮﻧﺮيزي درﺟﻪ ﺳﻪ ﺑﻪ درﺟﻪ دو 6 ﺑﺮاﺑﺮ اﻓﺮادي ﺑﻮد ﮐﻪ داروي دﮐﺴﻤﺪﺗﻮﻣﯿﺪين درياﻓﺖ ﻣﯽﮐﺮدﻧﺪ (19/1، 1/89:OR 6/66 ،%15 CI). نتيجه‌گيري: ﺑﺮ اﺳﺎس ﻧﺘﺎيج اين ﻣﻄﺎﻟﻌﻪ داروي دﮐﺴﻤﺪﺗﻮﻣﯿﺪين در ﮐﻨﺘﺮل وﺿﻌﯿﺖ ﻫﻤﻮديناﻣﯿﮏ ﺑﯿﻤﺎران ﺟﺮاﺣﯽ اﻧﺪوﺳﮑﻮﭘﯽ ﺳﯿﻨﻮس ﮐﺎرايي ﻣﻨﺎﺳﺒﯽ دارد و ﻣﯽ ﺗﻮاﻧﺪ ﻓيلد ﺟﺮاﺣﯽ ﺑﻬﺘﺮي ﻓﺮاﻫﻢ ﮐﻨﺪ.

Background and Objective: One of the main treatments for chronic rhinosinusitis is endoscopic surgery. In this procedure, intraoperative bleeding due to limited view of the surgeon can bring about surgical complications. To have a clear operation field for endoscopic sinus surgery, bleeding management is necessary. We aimed to compare the effects of magnesium sulfate and dexmedetomidine on operation field of candidates for endoscopic sinus surgery. Materials and Methods: In this triple-blind clinical trial, 60 candidates for endoscopic sinus surgery were randomly divided into two groups of Dexmedetomidine and Magnesium sulfate. Before anesthesia, magnesium sulfate was administered for 10 min at a dose of 50 mg/kg and at a dose 15 mg/kg/h afterwards. In the other group, dexmedetomidine was given for 10 min before anesthesia at a dose of 1 mic/kg and at a dose of 0.6 mic/kg/h thereupon. The hemodynamic status of both groups was recorded 1, 5, 15, 30, and 60 min post-tracheal intubation. The results were analyzed using SPSS, version 16. Results: In general, 20 (66.7%) patients in the Dexmedetomidine group and 18 (60.0%) patients in the Magnesium sulfate group were male (P=0.592). The mean ages of the Dexmedetomidine and Magnesium sulfate groups were 37.93 and 39.56 years, respectively (P=0.250). The mean surgical durations in the Dexmedetomidine and Magnesium sulfate groups were 79.03±41.8 min and 87.30± 15.09 min, respectively (P=0.003). Mean arterial pressure (MAP) in the Dexmedetomidine group was less than in the Magnesium Sulfate group at all the assessed times, except for the first time. The difference between the two groups was not significant only at first time. There was no statistical difference between the two groups in terms of mean saturation oxygen peripheral (SpO2) at all the recorded times. The mean intraoperative heart rate and mean pain intensity were lower in the Dexmedetomidine group than the Magnesium sulfate group. In the Magnesium sulfate group, odds ratio of bleeding in grade 3 to grade 2 was six times higher than the Dexmedetomidine group (OR= 6.00; 95% CI: 1.89, 19.1). Conclusion: Dexmedetomidine is more beneficial for controlling hemodynamic status of sinus endoscopic surgery patients as it can provide a better operation field.