تأثير آغشته كردن كاف لوله ي تراشه با ژل ديلتيازم بر روي تغييرات قلبي عروقي در بيماران تحت جراحي - كله سيستكتومي به روش لاپاراسكوپي: يك كارآزمايي باليني

The Effect of Smearing Tracheal Tube Cuff with Diltiazem Gel on Cardiovascular Changes in Patients Underwent Laparoscopic Cholecystectomy Surgery: A Clinical Trial Study

ﻣﻘﺪﻣﻪ: ﻣﻘﺪﻣﻪ: ﻫﺪف از اﻧﺠﺎم اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﺑﺮرﺳﯽ ﺗﺄﺛﯿﺮ آﻏﺸﺘﻪ ﮐﺮدن ﮐﺎف ﻟﻮﻟﻪ ي ﺗﺮاﺷﻪ ﺑﺎ ژل دﯾﻠﺘﯿﺎزم ﺑﺮ روي ﺗﻐﯿﯿﺮات ﻗﻠﺒﯽ- ﻋﺮوﻗﯽ در ﺑﯿﻤﺎران ﺗﺤﺖ ﺟﺮاﺣﯽ ﮐﻠﻪ ﺳﯿﺴﺘﮑﺘﻮﻣﯽ ﺑﻪ روش ﻻﭘﺎراﺳﮑﻮﭘﯽ ﺑﻮد. روش ﻫﺎ: اﯾﻦ ﻣﻄﺎﻟﻌﻪ ي ﮐﺎرآزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ، ﺑﺮ روي 80 ﻧﻔﺮ از ﺑﯿﻤﺎران ﮐﺎﻧﺪﯾﺪاي ﻋﻤﻞ ﺟﺮاﺣﯽ ﮐﻠﻪ ﺳﯿﺴﺘﮑﺘﻮﻣﯽ ﺑﻪ روش ﻻﭘﺎراﺳﮑﻮﭘﯽ در ﺑﯿﻤﺎرﺳﺘﺎن اﻣﺎم رﺿﺎ )ع( ﮐﺮﻣﺎﻧﺸﺎه اﻧﺠﺎم ﺷﺪ. ﺑﯿﻤﺎران ﺑﻪ ﺻﻮرت ﺗﺼﺎدﻓﯽ در 2 ﮔﺮوه ﻣﻮرد )ﮐﺎف ﻟﻮﻟﻪ ي ﺗﺮاﺷﻪ ي آﻏﺸﺘﻪ ﺑﺎ ژل 2 درﺻﺪ دﯾﻠﺘﯿﺎزم( و ﮔﺮوه ﺷﺎﻫﺪ )ﮐﺎف ﻟﻮﻟﻪ ي ﺗﺮاﺷﻪ ي آﻏﺸﺘﻪ ﺑﺎ ژل ﻟﻮﺑﺮﯾﮑﺎﻧﺖ اﺳﺘﺮﯾﻞ ﻣﺤﻠﻮل در آب( ﺗﻘﺴﯿﻢ ﺷﺪﻧﺪ. ﺗﻐﯿﯿﺮات ﻗﻠﺒﯽ- ﻋﺮوﻗﯽ )ﺿﺮﺑﺎن ﻗﻠﺐ، ﻓﺸﺎر ﺧﻮن ﺳﯿﺴﺘﻮل و دﯾﺎﺳﺘﻮل( ﻗﺒﻞ، ﺑﻼﻓﺎﺻﻠﻪ و 5 دﻗﯿﻘﻪ ﺑﻌﺪ از ﻟﻮﻟﻪ ﮔﺬاري و ﺣﯿﻦ ﻋﻤﻞ ﻫﺮ 15 دﻗﯿﻘﻪ و در ﺑﺪو ورود ﺑﻪ رﯾﮑﺎوري و 15 و 30 دﻗﯿﻘﻪ ﺑﻌﺪ از ورود ﺑﻪ رﯾﮑﺎوري اﻧﺪازه ﮔﯿﺮي ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ ﻓﺸﺎر ﺧﻮن ﺳﯿﺴﺘﻮل، دﯾﺎﺳﺘﻮل و ﺿﺮﺑﺎن ﻗﻠﺐ در ﮔﺮوه درﯾﺎﻓﺖ ﮐﻨﻨﺪه ي ژل دﯾﻠﺘﯿﺎزم در ﻣﻘﺎﯾﺴﻪ ﺑﺎ ﮔﺮوه ﺷﺎﻫﺪ، ﮐﺎﻫﺶ ﻣﻌﻨﯽ داري را ﻧﺸﺎن داد )0/050 < P(. ﻫﻤﭽﻨﯿﻦ، در ﮔﺮوه درﯾﺎﻓﺖ ﮐﻨﻨﺪه ي ژل دﯾﻠﺘﯿﺎزم، ﻃﺒﻖ ﻧﺘﺎﯾﺞ آزﻣﻮن Repeated measures ANOVA، ﻣﯿﺎﻧﮕﯿﻦ ﻣﺘﻐﯿﺮﻫﺎي اﻧﺪازه ﮔﯿﺮي ﺷﺪه، ﺗﻔﺎوت ﻣﻌﻨﯽ داري را در زﻣﺎن ﻫﺎي ﻣﺨﺘﻠﻒ ﻧﺸﺎن داد )0/050 < P(. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: از آن ﺟﺎﯾﯽ ﮐﻪ ﻟﻮﻟﻪ ﮔﺬاري داﺧﻞ ﺗﺮاﺷﻪ ﻣﯽ ﺗﻮاﻧﺪ ﻣﻨﺠﺮ ﺑﻪ ﺗﻐﯿﯿﺮات وﺳﯿﻌﯽ در ﺗﻌﺪاد ﺿﺮﺑﺎن ﻗﻠﺐ و ﻓﺸﺎر ﺧﻮن ﮔﺮدد و ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﺛﺮ آﻏﺸﺘﻪ ﮐﺮدن ﮐﺎف ﻟﻮﻟﻪ ي ﺗﺮاﺷﻪ ﺑﺎ ژل دﯾﻠﺘﯿﺎزم در ﮐﺎﻫﺶ ﺗﻐﯿﯿﺮات ﻗﻠﺒﯽ- ﻋﺮوﻗﯽ، ﺑﺮاي ﺟﻠﻮﮔﯿﺮي از اﯾﻦ ﭘﺎﺳﺦ ﻫﺎ ﯾﺎ ﺳﺮﮐﻮب آن ﻫﺎ، از دﯾﻠﺘﯿﺎزم ﻣﯽ ﺗﻮان اﺳﺘﻔﺎده ﻧﻤﻮد

Background: Tracheal intubation can result in extensive changes in heart rate and blood pressure. The aim of this study was to investigate the effect of smearing tracheal tube cuff with diltiazem gel on cardiovascular changes in patients who underwent laparoscopic cholecystectomy surgery. Methods: This clinical trial study was conducted on 80 patients who underwent laparoscopic cholecystectomy surgery in Imam Reza hospital, Kermanshah, Iran. Patients were randomly divided in two groups of intervention (tracheal tube cuff smeared with 2% diltiazem gel) and control (tracheal tube cuff smeared with sterile water-soluble lubricant gel) using permuted block technique. Cardiovascular changes (heart rate, systolic blood pressure, diastolic blood pressure, and dysrhythmia) was measured before the surgery, and immediately and 5 minutes after intubation, every 15 minutes during the surgery, at the beginning of the recovery, and 15 and 30 minutes after entering the recovery. Findings: The mean heart rate, systolic blood pressure, and diastolic blood pressure in patients receiving diltiazem gel was significantly decreased compared to control group (P < 0.050). Moreover, according to the results of repeated measures ANOVA, in the group receiving diltiazem gel, the mean of measured variables showed a significant difference in various times (P < 0.050). Conclusion: Regarding the effect of smearing tracheal tube cuff with diltiazem gel on decreasing cardiovascular changes, diltiazem gel can be used to prevent mentioned responses or to suppress them.