بررسي تاثير 12 هفته تمرينات استقامتي بر CRP سرمي و فيبرينوژن پلاسمايي به عنوان عوامل التهابي پيشگويي كننده بيماريهاي قلبي و عروقي

Effect of remifentanil on hemodynamic parameters of parturients and APGAR of the neonate in elective cesarean section under general anesthesia

سابقه و هدف: با توجه به شيوع و روند رو به رشد بيماريهاي قلبي عروقي و اهميت شاخصهاي التهابي پيشگويي كننده اين بيماريها و همچنين وجود بعضي گزارشات مبني بر تاثير تمرينات استقامتي بر وضعيت آنها، اين پژوهش به منظور تعيين تاثير 12 هفته تمرين استقامتي بر CRP سرمي و فيبرينوژن پلاسمايي (به عنوان شاخصهاي التهابي پيشگويي كننده بيماريهاي قلبي و عروقي) و مقايسه آن با گروه كنترل، روي دانشجويان مرد جوان غير ورزشكار در سال 1389 انجام گرفت. مواد و روشها: اين تحقيق به روش كارآزمايي باليني بر روي 24 دانشجوي داوطلب پسر غير ورزشكار دانشگاه آزاد اسلامي واحد علوم و تحقيقات تهران انجام گرفت. افراد دو گروه به لحاظ سن، جنس، قد، وزن، درصد چربي و حداكثر اكسيژن مصرفي مشابه‌سازي شدند. در ابتداي مطالعه با اخذ 5 ميلي‌ليتر خون، ميزان CRP سرمي و فيبرينوژن پلاسمايي آنها تعيين و ثبت شد. به گروه تجربي 12 هفته تمرينات استقامتي شامل سه دوره چهارهفته‌اي و هر هفته سه جلسه تمرين، داده شد. گروه شاهد اين تمرينات را نداشتند. در خاتمه تحقيق، مجدداً اين شاخصها در هر دو گروه بررسي و تغييرات آنها مورد قضاوت آماري قرار گرفت. يافته‌ها: در پايان مطالعه، ميزان فيبرينوژن گروه شاهد از 03/0± 45/0 به 02/0± 45/0 رسيد (5/0 P < ) و در گروه تجربي از 03/0±45/0 به 04/0±40/0 كاهش پيدا كرد (0002/0 P < ) كه اختلاف بين دو گروه از نظر آماري معني‌دار بود. در مورد شاخص CRP، در گروه شاهد تغييري مشاهده نشد، اما در گروه تجربي از 233 به 213 كاهش پيدا كرد ( 002/0 P < ). نتيجه‌گيري: به نظر مي‌رسد كه 12 هفته تمرينات استقامتي موجب بهبود شاخصهاي التهابي پيشگويي كننده بيماريهاي قلبي عروقي در افراد جوان غير ورزشكار مي‌شود، بنابراين انجام اين‌گونه تمرينات را توصيه مي‌نماييم.

Background and Aim: Neonatal respiratory depression due to narcotics usage during cesarean section under general anesthesia is an important challenge for anesthesiologists. Remifentanil, due to its pharmacokinetic properties, may be a solution for this challenge. This study was designed to evaluate the effect of this drug on maternal hemodynamics and Apgar scores of their neonates during cesarean section under general anesthesia. Materials and Methods: In this double blind randomized controlled clinical trial, 84 women who were candidates for elective cesarean section under general anesthesia were randomly allocated into three groups. In the first group remifentanil was infused at a rate of 0.5?g/kg/min and the second group received an IV bolus of 0.7 ?g/kg of the drug. Control group received an equivalent volume of normal saline. Maternal heart rate and blood pressure were measured and recorded before induction of anesthesia and one minute after tracheal intubation. Neonatal Apgar scores in the first and fifth minutes postnatal were also recorded and compared. Results: Mean maternal HR changes before and after tracheal intubation were not significant between groups (P= 0.33). Mean arterial pressure (MAP) changes between groups were significantly different (P= 0.001). MAP changes were smallest in the bolus group and largest in the control group. These changes were not significantly different between infusion and control groups (P= 0.994). This difference was significant between the bolus group with the infusion and control groups (P=0.001 and 0.002 respectively). The mean first minute Apgar scores in neonates were significantly different in three groups (p=0.006). This parameter was not significantly different between bolus and infusion groups (p=0.603). Mean first minute Apgar scores in the bolus (8.46) and infusion (8.31) groups were significantly less than the control (8.93) group (p= 0.005 and 0.002 respectively). The mean fifth minute Apgar scores were not significantly different between three groups. None of the neonates in the remifentanil groups needed resuscitation. Conclusion: The results indicated that bolus administration of remifentanil (compared with infusion and control groups) produces more stability in maternal blood pressure during cesarean section under general anesthesia. The decrease in first minute Apgar score in remifentanil groups were clinically negligible (none of these neonates needed resuscitation). Despite these results, multicenter studies more samples are needed to confirm using remifentanil in elective cesarean section.