Razi Journal of Medical Sciences
مجله علوم پزشکی رازی
RJMS
Medical Sciences
http://rjms.iums.ac.ir
39
journal39
2228-7043
2228-7051
en
jalali
1387
10
1
gregorian
2009
1
1
15
Autumn,Winter
online
1
fulltext
fa
مقایسه اثر تحریک الکتریکی از راه پوست با ترکیب دارویی پتیدین- پرومتازین بر کاهش درهای زایمانی در مرحله فعال زایمان
A Comparative Study of Transcutaneous Electrical Nerve Stimulation and Pethidine - Promethazine For Pain Relief in Active Phase of Labor
زنان و زایمان
Gynecology
پژوهشي
Research
<h2 style="MARGIN: 0cm 0cm 0pt" dir="rtl"><span style="FONT-FAMILY: " lang="FA"><h2 style="MARGIN: 0cm 0cm 0pt DIRECTION: rtl" dir="rtl"><span lang="AR-SA"><p><font size="2"> </font></p><p style="DIRECTION: rtl"><font size="2"> ز</font></p></span><font face="tahoma,arial,helvetica,sans-serif"><font size="2"><span>مینه و هدف: برای کنترل درد زایمان از عوامل متعدد استفاده شده است که یکی از انواع موثر آنها در کارآزماییهای بالینی، ترکیب دارویی پتیدین- پرومتازین میباشد. تحریک الکتریکی از راه پوست<br></span><span dir="ltr"></span><span dir="ltr"><span dir="ltr"></span>(TENS-</span><span dir="ltr">Transcutaneous Electrical Nerve Stimulation</span><span dir="ltr">)</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span> نیز روشی جدید است که در آن تحریکات الکتریکی خفیفی از راه پوست باعث سرکوب درد از طریق بلوک سیگنال درد قبل از رسیدن به عصب میگردد. این روش در مورد دردهای مزمن مثل درد پایین کمر، دردهای رماتیسمی و در مورد دردهای حاد جراحی و تروما نیز موثر نشان داده است. در این مطالعه این دو روش با یکدیگر مقایسه شدهاند. </span><span style="FONT-FAMILY: " lang="AR-SA">هدف از این مطالع</span><span style="FONT-FAMILY: " lang="FA">ه مقایسه اثر </span><span style="mso-bidi-language: FA" dir="ltr">TENS</span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span><font size="2" face="tahoma,arial,helvetica,sans-serif"> با ترکیب دارویی پتیدین- پرومتازین در کاهش دردهای زایمانی در مرحله فعال زایمان میباشد.</font></span><h4 style="MARGIN: 0cm 0cm 0pt" dir="rtl"><font face="tahoma,arial,helvetica,sans-serif"><font size="2"><span>روش بررسی: در این مطالعه کارآزمایی بالینی، 100 خانم باردار که جهت زایمان به بیمارستان شهید اکبریآبادی تهران مراجعه کرده بودند، به صورت یک در میان تحت درمان ضد درد پتیدین (50 میلیگرم عضلانی) و پرومتازین (25 میلیگرم عضلانی) توأم (گروه </span><span dir="ltr">B</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>) یا </span><span dir="ltr">TENS</span><span dir="rtl"></span><span style="FONT-FAMILY: "><span dir="rtl"></span> <span lang="FA">(گروه </span></span><span dir="ltr">A</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>) قرار گرفتند. سپس، شدت درد در حداکثر انقباضات رحمی از فرد پرسیده میشد. چهارده ساعت پس از انجام زایمان نیز میزان تخفیف درد و میزان رضایت از روش به کار رفته از بیمار پرسیده میشد. شدت درد براساس </span><span dir="ltr">Visual Analogue Scale (VAS)</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span> سنجیده میشد. دادههای دموگرافیک نیز در هر مورد ثبت شد. سپس دادهها وارد رایانه شد و با استفاده از نرمافزار </span><span dir="ltr">SPSS- 15</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span> مورد آنالیز تحلیلی قرار گرفت. دادهها توسط </span><span dir="ltr">Chi2, regression,t-test</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>. آنالیز شدند. </span><span dir="ltr">P Value</span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span><font size="2" face="tahoma,arial,helvetica,sans-serif"> کمتر از 05/0 معنیدار در نظر گرفته شد.</font><p></p></span></h4><h4 style="MARGIN: 0cm 0cm 0pt" dir="rtl"><font face="tahoma,arial,helvetica,sans-serif"><font size="2"><span>یافتهها: متوسط شدت درد در دیلاتاسیون 3 تا 4 سانتیمتر در گروه </span><span style="mso-bidi-language: FA" dir="ltr">A</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span> 05/1</span><span dir="ltr"></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-char-type: symbol mso-symbol-font-family: Symbol" dir="ltr"><span dir="ltr"></span><span style="mso-char-type: symbol mso-symbol-font-family: Symbol">±</span></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>65/7 و گروه </span><span style="mso-bidi-language: FA" dir="ltr">B</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span> 14/1</span><span dir="ltr"></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-char-type: symbol mso-symbol-font-family: Symbol" dir="ltr"><span dir="ltr"></span><span style="mso-char-type: symbol mso-symbol-font-family: Symbol">±</span></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>16/8 بود که اختلاف بین دو گروه معنیدار بود (003/0</span><span style="mso-bidi-language: FA" dir="ltr">P=</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>). متوسط شدت در دیلاتاسیون 6 تا 7 سانتیمتر در گروه </span><span style="mso-bidi-language: FA" dir="ltr">A</span><span dir="rtl"></span><span style="FONT-FAMILY: "><span dir="rtl"></span> <span lang="FA">76/0</span></span><span dir="ltr"></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-char-type: symbol mso-symbol-font-family: Symbol" dir="ltr"><span dir="ltr"></span><span style="mso-char-type: symbol mso-symbol-font-family: Symbol">±</span></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>55/8 و در گروه </span><span style="mso-bidi-language: FA" dir="ltr">B</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span> 87/0</span><span dir="ltr"></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-char-type: symbol mso-symbol-font-family: Symbol" dir="ltr"><span dir="ltr"></span><span style="mso-char-type: symbol mso-symbol-font-family: Symbol">±</span></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>38/8 بود و اختلاف بین دو گروه معنیدار نبود (05/0</span><span style="mso-bidi-language: FA" dir="ltr">P></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>). متوسط شدت درد در دیلاتاسیون فول در گروه </span><span style="mso-bidi-language: FA" dir="ltr">A</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span> 84/0</span><span dir="ltr"></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-char-type: symbol mso-symbol-font-family: Symbol" dir="ltr"><span dir="ltr"></span><span style="mso-char-type: symbol mso-symbol-font-family: Symbol">±</span></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>73/8 و در گروه </span><span style="mso-bidi-language: FA" dir="ltr">B</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span> 69/0</span><span dir="ltr"></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-char-type: symbol mso-symbol-font-family: Symbol" dir="ltr"><span dir="ltr"></span><span style="mso-char-type: symbol mso-symbol-font-family: Symbol">±</span></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>54/8 بود که این اختلاف نیز معنیدار نبود (05/0</span><span style="mso-bidi-language: FA" dir="ltr">P></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>). متوسط تعداد انقباض در 10 دقیقه در دیلاتاسیون فول در گروه </span><span style="mso-bidi-language: FA" dir="ltr">A</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span> به طور معنیداری بیشتر از گروه </span><span style="mso-bidi-language: FA" dir="ltr">B</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span> بود (22/7</span><span dir="ltr"></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-char-type: symbol mso-symbol-font-family: Symbol" dir="ltr"><span dir="ltr"></span><span style="mso-char-type: symbol mso-symbol-font-family: Symbol">±</span></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>18/6 در برابر 66/0</span><span dir="ltr"></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-char-type: symbol mso-symbol-font-family: Symbol" dir="ltr"><span dir="ltr"></span><span style="mso-char-type: symbol mso-symbol-font-family: Symbol">±</span></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>87/3؛ 02/0</span><span style="mso-bidi-language: FA" dir="ltr">P=</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>). متوسط زمان زایمان در گروه </span><span style="mso-bidi-language: FA" dir="ltr">A</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>، 64/2</span><span dir="ltr"></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-char-type: symbol mso-symbol-font-family: Symbol" dir="ltr"><span dir="ltr"></span><span style="mso-char-type: symbol mso-symbol-font-family: Symbol">±</span></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>49/3 ساعت و در گروه </span><span style="mso-bidi-language: FA" dir="ltr">B</span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>، 5/1</span><span dir="ltr"></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-char-type: symbol mso-symbol-font-family: Symbol" dir="ltr"><span dir="ltr"></span><span style="mso-char-type: symbol mso-symbol-font-family: Symbol">±</span></span><span dir="rtl"></span><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span>31/3 ساعت بود که اختلاف بین دو گروه معنیدار نبود</span><span style="FONT-FAMILY: " lang="FA"> </span><span style="FONT-FAMILY: " lang="FA">(05/0</span><span style="mso-bidi-language: FA" dir="ltr">P></span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span><font size="2" face="tahoma,arial,helvetica,sans-serif">).</font><p></p></span></h4><h4 style="MARGIN: 0cm 0cm 0pt" dir="rtl"><font face="tahoma,arial,helvetica,sans-serif"><font size="2"><span>نتیجهگیری: آنچه از نتایج این مطالعه و مقایسه آن با مطالعات قبلی در این زمینه به دست میآید این است که روش </span><span style="mso-bidi-language: FA" dir="ltr">TENS</span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: " lang="FA"><span dir="rtl"></span><font size="2" face="tahoma,arial,helvetica,sans-serif"> روش بیعارضه، ارزان و مناسب برای کنترل دردهای زایمانی میباشد که البته میتوان آن را به صورت درمان مکمل نیز به کار برد تا از تجویز زیاد داروهای ضد درد جلوگیری شود.</font><p></p></span></h4></h2><p></p></span></h2>
<span style="mso-bidi-language: FA"><strong><font size="5"><font face="Monotype Corsiva"><p></p></font></font></strong></span><p></p><p style="MARGIN: 0cm 0cm 0pt" class="Style2"><span><font face="Verdana"><strong></strong></font></span></p><p style="MARGIN: 0cm 0cm 0pt" class="Style2"><span><font face="Verdana"><strong><font size="5" face="Monotype Corsiva"> </font>Background and Aim:</strong> Several agents have been used for labor pain relief. Clinical trials have shown pethidine – promethazine combination as an effective mean. Transcutaneous electrical nerve stimulation (TENS) is a new method for pain relief which uses mild electrical stimulation for inhibition of pain signals in nerves. This method has been used successfully for chronic pains such as low back pain, rheumatic pains, acute surgical and traumatic pains. In this study we compared these two methods for reducing labor pain.</font></span><p></p><p style="MARGIN: 0cm 0cm 0pt" class="Style2"><span style="mso-bidi-language: FA"><font face="Verdana">The aim of this study was to compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) and pethidine-promethazine in reducing labor pain in the active phase of labor</font></span><p></p><p style="MARGIN: 0cm 0cm 0pt" class="Style2"><font face="Verdana"><b><span style="mso-bidi-language: FA">Patients and Methods:</span></b><span style="mso-bidi-language: FA"> In this clinical trial study, 100 pregnant women admitted in Shaheed Akbarabadi hospital for labor were included in the study and alternatively were allocated into one of two the groups: TENS group (A) or combined pethidine (50mg, IM) and promethazine (25mg, IM) group (B). Pain intensity during maximum uterus contractions was evaluated with Visual Analogue Scale (VAS) in all of the cases. Four hours after delivery, pain relief and efficacy of the method was asked from the mothers. Demographic data were recorded in all cases. Data analysis was accomplished with SPSS V. 15 software. <span style="mso-spacerun: yes"> </span>For statistical analysis t-test, regression and Chi<sup>2</sup> were used. P value under 0.05 was assumed as significant.</span></font><p></p><p style="MARGIN: 0cm 0cm 0pt" class="Style2"><font face="Verdana"><b><span style="mso-bidi-language: FA">Results:</span></b><span style="mso-bidi-language: FA"> Mean pain intensity in 3-4cm dilatation in group A was 7.65</span></font><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: Verdana mso-hansi-font-family: Verdana mso-char-type: symbol mso-symbol-font-family: Symbol"><span style="mso-char-type: symbol mso-symbol-font-family: Symbol"><font face="Symbol">±</font></span></span><span style="mso-bidi-language: FA"><font face="Verdana">1.05 and in group B was 8.16</font></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: Verdana mso-hansi-font-family: Verdana mso-char-type: symbol mso-symbol-font-family: Symbol"><span style="mso-char-type: symbol mso-symbol-font-family: Symbol"><font face="Symbol">±</font></span></span><span style="mso-bidi-language: FA"><font face="Verdana">1.14 and difference was significant (P=0.003). Mean pain intensity in 6-7cm dilatation was 8.55</font></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: Verdana mso-hansi-font-family: Verdana mso-char-type: symbol mso-symbol-font-family: Symbol"><span style="mso-char-type: symbol mso-symbol-font-family: Symbol"><font face="Symbol">±</font></span></span><span style="mso-bidi-language: FA"><font face="Verdana">0.76 and 8.38</font></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: Verdana mso-hansi-font-family: Verdana mso-char-type: symbol mso-symbol-font-family: Symbol"><span style="mso-char-type: symbol mso-symbol-font-family: Symbol"><font face="Symbol">±</font></span></span><span style="mso-bidi-language: FA"><font face="Verdana">0.87, respectively which was not statistically significant (P>0.05). In full dilatation this measure was 8.73</font></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: Verdana mso-hansi-font-family: Verdana mso-char-type: symbol mso-symbol-font-family: Symbol"><span style="mso-char-type: symbol mso-symbol-font-family: Symbol"><font face="Symbol">±</font></span></span><span style="mso-bidi-language: FA"><font face="Verdana">0.84 and 8.54</font></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: Verdana mso-hansi-font-family: Verdana mso-char-type: symbol mso-symbol-font-family: Symbol"><span style="mso-char-type: symbol mso-symbol-font-family: Symbol"><font face="Symbol">±</font></span></span><span style="mso-bidi-language: FA"><font face="Verdana">0.69, respectively which was not statistically significant (P>0.05). Mean number of contractions in full dilatation in group A was significantly higher than group B (6.18</font></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: Verdana mso-hansi-font-family: Verdana mso-char-type: symbol mso-symbol-font-family: Symbol"><span style="mso-char-type: symbol mso-symbol-font-family: Symbol"><font face="Symbol">±</font></span></span><span style="mso-bidi-language: FA"><font face="Verdana">7.22 vs 3.87</font></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: Verdana mso-hansi-font-family: Verdana mso-char-type: symbol mso-symbol-font-family: Symbol"><span style="mso-char-type: symbol mso-symbol-font-family: Symbol"><font face="Symbol">±</font></span></span><span style="mso-bidi-language: FA"><font face="Verdana">66 P=0.02). Mean duration of labor in group A was 3.49</font></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: Verdana mso-hansi-font-family: Verdana mso-char-type: symbol mso-symbol-font-family: Symbol"><span style="mso-char-type: symbol mso-symbol-font-family: Symbol"><font face="Symbol">±</font></span></span><span style="mso-bidi-language: FA"><font face="Verdana">2.64 hrs and in group B was 3.31</font></span><span style="FONT-FAMILY: Symbol mso-bidi-language: FA mso-ascii-font-family: Verdana mso-hansi-font-family: Verdana mso-char-type: symbol mso-symbol-font-family: Symbol"><span style="mso-char-type: symbol mso-symbol-font-family: Symbol"><font face="Symbol">±</font></span></span><span style="mso-bidi-language: FA"><font face="Verdana">1.5hrs which was not statistically significant (P>0.05).</font></span><p></p><p style="MARGIN: 0cm 0cm 0pt" class="Style2"><font face="Verdana"><b><span style="mso-bidi-language: FA">Conclusion:</span></b><span style="mso-bidi-language: FA"> With respect to the results of this research and the previous studies, TENS is a side-effect free, cheap and suitable method for controlling labor pain and can be used solely and as adjuvant therapy for this purpose.</span></font><p></p></p><p></p></p><p></p></p><p></p></p><p></p></p><p></p>
زایمان کمدرد، تحریک الکتریکی از راه پوست (TENS)، پتدین- پرومتازین
Pain free labor,Transcutaneous Electrical Nerve Stimulation (TENS),Pethidine-Promethazine
87
93
http://rjms.iums.ac.ir/browse.php?a_code=A-10-312-11&slc_lang=fa&sid=1
F.
Zonoozy
فتانه
زنوزی
3900319475328460017692
3900319475328460017692
No
M.
Hashemijam
منیژه
سیمیندخت هاشمی جم
3900319475328460017693
3900319475328460017693
Yes