Razi Journal of Medical Sciences

fa تاثیر هایپوترمی بر تغییرات الکترولیتی در بیماران بزرگسال تحت عمل جراحی CABG: کارآزمایی بالینی The Effect of Hypothermia on Electrolyte Changes in Adult Patients Undergoing CABG: A Clinical Trial قلب و عروق Cardio Muscular Disease پژوهشي Research <div style="text-align: justify;">زمینه و هدف: بیماری‌های قلبی-عروقی از جمله بیماری‌های شایع غیرواگیر می‌باشند و متداولترین شیوه‌ه‌ی درمانی برای این بیماران، جراحی قلب باز می‌باشد. هدف از انجام تحقیق حاضر تعیین تاثیر هایپوترمی بر تغییرات الکترولیتی در بیماران بزرگسال تحت عمل جراحی پیوند بای پس عروق کرونرCoronary artery bypass grafting - (CABG) بود. روشکار: مطالعه حاضر از نوع کارآزمایی بالینی بود که بر روی 60  بیمار کاندید عمل جراحی CABG  در بیمارستان حضرت فاطمه زهرا ساری انجام شد. بیماران به صورت تصادفی در دو گروه 30 نفری هایپوترم و نرموترم گروه بندی شدند. گردآوری اطلاعات با استفاده ازچک‌لیست محقق ساخته انجام شد. نهایتاً از آزمونهای تی مستقل و تحلیل واریانس یک طرفه  و از نرم افزار SPSS 20  جهت تجزیه و تحلیل دادهها استفاده شد. یافته‌ها: مشخصات دموگرافیکی دو گروه تفاوت معنی‌داری نداشتند (05/0P>). اختلاف معنی داری بین سطح سدیم و پتاسیم یک روز بعد از جراحی در دو گروه هایپوترم و نرموترم مشاهده شد (05/0P<).  به‌گونه‌ای که درگروه هایپوترم بالاتر از گروه نرموترم بوده است. مقایسه سطح کلسیم در دوگروه نشان داد که سطح کلسیم در زمان‌های مختلف در دو گروه تفاوت معنی‌داری نداشت (05/0P>). نتیجهگیری: نتایج نشان داد سطح الکترولیتها تنها در روز بعد از جراحی بین دو گروه هایپوترم و نرموترم تفاوت دارد و این سطوح در قبل و زمان ترخیص برای دو گروه تفاوتی ندارد. لذا، می‌توان چنین استنباط نمود که قرارگیری بیماران در گروه هایپوترمیک یا نرموترمیک نمی تواند بصورت  معنی داری بر اختلالات الکترولیتی تاثیر گذار باشد و اختلاف مشاهده شده می‌تواند مرتبط با شرایط مراقبتی و درمانی باشد.</div> <div style="text-align: justify;">Bakcground & Aims: Electrolyte imbalance is one of the important factors in the occurrence of cardiac arrhythmias (9) and in order to prevent the occurrence of these arrhythmias, it is necessary to measure serum electrolytes regularly after the operation and examine the patient for signs of decrease or increase in potassium, sodium and calcium. take (10). In connection with achieving the above goal, the amount of liquid absorption and excretion should be accurately measured and recorded. In order to determine the adequacy of hydration and cardiac output, the central venous pressure, blood pressure, serum electrolytes and, if possible, the patient's weight should be monitored regularly, and the patient should be carefully monitored for signs of hypokalemia, hyperkalemia, hyponatremia (sodium depletion) and hypocalcemia (calcium depletion). be taken care of Any signs or symptoms of dehydration, excess fluid accumulation or electrolyte imbalance should be reported to the doctor immediately (11). Considering the high prevalence of cardiovascular diseases and considering that hypothermia is a therapeutic intervention in these patients and also considering the diversity and dispersion of complications and the difference in the percentage of their occurrence in patients undergoing heart surgery in studies, and from there After reviewing the research conducted inside and outside the country, no research was found on the subject, the researcher is trying to answer the question whether hypothermia has an effect on electrolyte changes in patients undergoing )CABG- Coronary artery bypass grafting( surgery at Hazrat Fatemeh Zahra Sari Hospital in 2018. No? Methods: The present study, which received the ethics code IR.MAZUMS.REC1398.575, was conducted as a single-blind randomized clinical trial on 60 adult patients who were candidates for coronary artery bypass surgery, who were randomly divided into two groups of 30 people. The objectives and method of the study were explained to the patients and written informed consent was obtained. At the beginning of the study, the amount of sodium, potassium and calcium electrolytes of patients who were to undergo open heart surgery were recorded. All patients were operated on by a cardiac surgeon in Hazrat Fatima Zahra Sari Hospital. Arterial pressure of all patients was controlled through the radial artery, and they underwent general anesthesia with the same drugs. And each of them performed their own operation, after the completion of the operation and transfer to the ICU, special checklists containing demographic information and electrolyte changes were completed. The desired electrolytes were measured and noted on the day after surgery and the day of discharge from ICU. Finally, after data collection, the information was analyzed using SPSS 21 statistical software and descriptive statistics (mean and standard deviation) and inferential statistics (independent t test and one-way analysis of variance). Results: The comparison of the sodium level shows that in the comparison of the two groups, the sodium level is different in the two groups only one day after surgery (P=0.008) and there is a statistically significant difference in such a way that the sodium level in the hypothermic group is higher than in the northermic group. Is. Comparison of sodium level by groups and by time was significant only in the hypothermic group (P=0.006) and in the normothermic group, this difference was not significant by time. The comparison of potassium level shows that in the comparison of the two groups, only one day after the surgery, the potassium level in the two groups is different (P=0.017) and there is a statistically significant difference such that the potassium level in the hypothermic group is higher than the northermic group. Is. The comparison of potassium level by groups and by time was significant only in the hypothermic group (P=0.018) and in the normothermic group, this difference was not significant by time. The comparison of calcium level shows that the calcium level was not different in the two groups at any time (P<0.05) and there was no statistically significant difference. The comparison of calcium levels by groups and by time showed that there is a significant difference in calcium levels by time in both groups (P<0.05) so that the calcium level one day before surgery was higher than the other two times. Conclusion: Based on the results of the present study, the level of sodium and potassium in the two groups is different only one day after surgery, and there is a statistically significant difference; Sodium and potassium levels were higher in the hypothermic group than in the northermic group one day after surgery. These values are not significantly different on the day of discharge from ICU and before surgery. The comparison of sodium and potassium levels by groups and by time was significant only in the hypothermic group, which increased and then decreased on the day after the operation. There was no significant difference in the level of calcium in the two groups; However, the comparison of calcium level by groups and by time showed that this value has a significant difference in both groups, in such a way that the calcium level was higher one day before surgery than the other two times. In this regard, Haddadzadeh et al. (2012) conducted a study titled comparing complications after normothermic and hypothermic heart surgery. The sodium level in the hypothermic group was higher than the normothermic group, and the potassium level was higher in the normothermic group than the hypothermic group, but this difference was not significant. These results were inconsistent with the results of the present study; In such a way that there was no significant difference between sodium and potassium levels after the operation in the two groups (5). The reason for the difference in the results of the present study and the study of Haddadzadeh et al. can be attributed to the difference in the background variables of the patients, the time of measuring the levels of electrolytes, and the procedures performed before and after heart surgery. Shahidi et al. (2019) conducted a study under the title of hypomagnesemia and imbalance of other electrolytes in children's open and closed heart surgery. The calcium level in each group decreased significantly on the second and third day after surgery compared to before surgery, but the calcium level of the two groups did not differ significantly, which was consistent with the present study. The level of sodium and potassium in both groups decreased significantly on the second and third day compared to before the operation, which was inconsistent with the present study. A decrease in these factors was observed during the second and third days after surgery, but there was no significant difference between them in the two groups. The difference in the results of this study with the current study can be due to the difference in the age of the participants and the different measures taken for them (19).</div> جراحی قلب باز, هایپرتروم, نرموترم, الکترولیت, CABG Open Heart Surgery, Hypothermia, Normothermia, Electrolyte, CABG 1 10 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7014-1&slc_lang=fa&sid=1 Hodeise Asadpour Sorkhkolaee حدیثه اسدپور سرخکلائی hodeiseasadpour1995@gmail.com 3900319475328460089554 3900319475328460089554 Yes Instructor and faculty, Department of Operating Room, School of Allied Medical Sciences, Mazandaran Faculty of Medical Sciences, Sari, Iran مربی و عضو هیئت علمی، گروه اتاق عمل، دانشکده پیراپزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران Hooshang Akbari هوشنگ اکبری 3900319475328460089555 3900319475328460089555 No Assistant Professor, Department of Anesthesiology and Operating Room, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran استادیار بیهوشی،گروه هوشبری و اتاق عمل، دانشکده پیراپزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران Ebrahim Nasiri Formi ابراهیم نصیری فرمی 3900319475328460089556 3900319475328460089556 No PhD, Assistant Professor, Department of Anesthesiology and Operating Room, School of Allied Medical Sciences, Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran استادیار طب سنتی،گروه هوشبری و اتاق عمل، دانشکده پیرا پزشکی، مرکز تحقیقات طب سنتی و مکمل با گرایش اعتیاد، پژوهشکده اعتیاد، دانشگاه علوم پزشکی مازندران، ساری، ایران Rahman Ghaffari رحمان غفاری 3900319475328460089557 3900319475328460089557 No Assistant Professor, Department of Cardiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran استادیار جراحی قلب و عروق، گروه قلب و عروق، دانشکده پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران