Mahikhan, Farzaneh

Simorgh Research Repository

  ١                                                                                                                                 ﭼﻜﻴﺪه اﻧﮕﻠﻴﺴﻲ       دا஺ه ﻋ࢖ﻮم ﭘﺰﺷਔﯽ ໊ඟﻣﺎن  داﻧﺸﻜﺪه داروﺳﺎزي  ﭘﺎﻳﺎن ﻧﺎﻣﻪ ﻣﻘﻄﻊ ﻛﺎرﺷﻨﺎﺳﻲ ارﺷﺪ  ﻋﻨﻮان:  ﺑﺮرﺳﻲ اﺛﺮ داروي اﻧﺪاﻧﺴﺘﺮون ﺑﺮ ﻋﻼﻳﻢ ﺳﻨﺪرم ﻣﺤﺮوﻣﻴﺖ ﻣﻮاد ﻣﺨﺪر  و ﻧﻴﺎز ﺑﻪ داروي ﻓﻨﺘﺎﻧﻴﻞ و ﺳﻄﺢ ﺳﺮﻣﻲ ﻧﻴﺘﺮﻳﻚ اﻛﺴﺎﻳﺪ در    ﻣﻌﺘﺎدﻳﻦ ﺗﺤﺖ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ  ﻓﺮزاﻧﻪ ﻣﺎﻫﻲ ﺧﺎنﺗﻮﺳﻂ:   اﺳﺎﺗﻴﺪ راﻫﻨﻤﺎ:  دﻛﺘﺮ ﺣﻤﻴﺪرﺿﺎ رﺣﻴﻤﻲ ﻣﺮﺗﻀﻲ ﻫﺎﺷﻤﻴﺎندﻛﺘﺮ    ﺗﺎﻧﻴﺎ دﻫﺶدﻛﺘﺮ  اﺳﺘﺎد ﻣﺸﺎور:    7931- 8931ﺳﺎل ﺗﺤﺼﻴﻠﻲ:   ٢                                                                                                                                 ﭼﻜﻴﺪه اﻧﮕﻠﻴﺴﻲ     ﭼﻜﻴﺪهﺑﺎ ﻓﺮاﮔﻴﺮ ﺷﺪن اﻋﺘﻴﺎد در ﺟﻮاﻣﻊ اﻧﺴﺎﻧﻲ، ﺗﻮﺟﻪ ﺑﻪ ﻋﻼﻳﻢ و ﺣﺎﻻت اﻓﺮاد ﻣﻌﺘﺎد و ﭘﻴﺸﮕﻴﺮي و درﻣﺎن اﻳﻦ  : زﻣﻴﻨﻪ و ﻫﺪفاز اﻳﻦ رو ﺑﺮاي ﻛﺎﻫﺶ ﻋﻼﻳﻢ ﻗﻄﻊ ﻣﺼﺮف دارو در ﻫﻨﮕﺎم ﻋﻤﻞ  .ﻋﻼﻳﻢ در ﻣﺮاﻛﺰ درﻣﺎﻧﻲ از اﻫﻤﻴﺖ ﺧﺎﺻﻲ ﺑﺮﺧﻮردار ﺷﺪه اﺳﺖﻄﺎﻟﻌﺎت ﺣﻴﻮاﻧﻲ ﻧﺸﺎن داده اﻧﺪ ﻣ .اﺳﺖﺗﺰرﻳﻖ داروﻫﺎي ﺿﺪ درد از ﺟﻤﻠﻪ داروﻫﺎي ﻣﺨﺪر ﺑﻪ ﻛﻨﺘﺮل درد ﭘﺲ از آن ﻧﻴﺎز  ﺟﺮاﺣﻲ ودرﻛﺎﻫﺶ ﻋﻼﻳﻢ ﻗﻄﻊ ﻣﺼﺮف ﻧﺴﺒﺖ ﺑﻪ ﻣﻮاد ﻣﺨﺪر ﻣﻮﺛﺮ ﺑﻮده اﻧﺪ. از ﻃﺮف دﻳﮕﺮ اﻳﻦ دارو در دﺳﺘﺮس  3TH5 ﻛﻪ ﮔﻴﺮﻧﺪه ﻫﺎيﻧﻴﺰ  اﭘﻴﻮﺋﻴﺪي و ﺑﺎ ﻋﻮارض ﻛﻢ ﻣﻲ ﺑﺎﺷﺪ ﻛﻪ ﻣﻲ ﺗﻮاﻧﺪ ﻋﻼوه ﺑﺮ اﺛﺮ ﺿﺪ ﺣﺎﻟﺖ ﺗﻬﻮع از ﻃﺮﻳﻖ ﮔﻴﺮﻧﺪه ﻫﺎي ﻓﻮق ﺑﺮ ﮔﻴﺮﻧﺪه ﻫﺎي  واﻗﻊ ﺷﻮد. ﻣﻮﺛﺮ ﺑﻮده و در ﻛﺎﻫﺶ ﻋﻼﺋﻢ واﺑﺴﺘﮕﻲ ﻳﺎ ﻗﻄﻊ ﻣﺼﺮف ﻣﻮاد ﻣﺨﺪر ﻣﻮﺛﺮاﻧﺘﺨﺎب  داﺷﺘﻨﺪ ﺑﺼﻮرت ﺗﺼﺎدﻓﻲﺷﺮاﻳﻂ ورود ﺑﻪ ﻣﻄﺎﻟﻌﻪ را ﻛﻪ ﺑﻴﻤﺎر  69 ﺗﻌﺪاد ﺳﻮﻳﻪ ﻛﻮر، 2در اﻳﻦ ﻛﺎرآزﻣﺎﻳﻲ  روش ﻣﻄﺎﻟﻌﻪ: ﺪﻧﮔﻴﺮ ﻫﺎي ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻗﺮار ﻣﻲ و ﭘﺲ از دادن ﺗﻮﺿﻴﺤﺎت ﻛﺎﻣﻞ و دﻗﻴﻖ ﺑﻪ ﺑﻴﻤﺎر و ﮔﺮﻓﺘﻦ ﺷﺮح ﺣﺎل در ﻳﻜﻲ از ﮔﺮوهﻧﺪ ﺷﺪ ﻣﻴﻠﻲ ﮔﺮم 8 : B وﮔﺮوه ﻣﻴﻠﻲ ﮔﺮم 4 :Aاﻧﺪاﺳﺘﺮون ﻛﻪ ﺷﺎﻣﻞ:ﮔﺮوه داروي و ﺑﻪ ﻫﺮ ﮔﺮوه از اﻳﻦ ﺑﻴﻤﺎران دوزﻫﺎي ﻣﺨﺘﻠﻒ ﺷﻮد. ﭘﺲ از ورود ﺑﻴﻤﺎر ﺑﻪ اﺗﺎق  دﻗﻴﻘﻪ ﻗﺒﻞ از ﺑﻴﻬﻮﺷﻲ ﺗﺰرﻳﻖ ﻣﻲ 51: ﭘﻼﺳﺒﻮ ﻣﻲ ﺑﺎﺷﺪ و ﺑﺼﻮرت داﺧﻞ ورﻳﺪي Cوﮔﺮوه  ﻋﻼﻳﻢ ﺣﻴﺎﺗﻲ ﺛﺒﺖ ﻣﻲ ﮔﺮدد.ﻫﻢ و ﻗﺒﻞ از ﺑﻴﻬﻮﺷﻲ  ﻛﻨﺘﺮلﺑﺮاي او ﺳﻨﺪرم ﻣﺤﺮوﻣﻴﺖ از ﻣﻮاد ﻣﺨﺪر ﻋﻤﻞ، ﻓﺮم ﻛﻨﺘﺮل ﻋﻼﻳﻢ ﺟﻬﺖ ﺗﻤﺎﻣﻲ ﺑﻴﻤﺎران از ، ﺑﻴﻬﻮﺷﻲ دﺳﺘﻮراﻟﻌﻤﻞﺑﻴﻤﺎران ﻣﻌﺘﺎدي ﻛﻪ ﻧﻴﺎز ﺑﻪ ﻋﻤﻞ ﺟﺮاﺣﻲ دارﻧﺪ، ﺑﺮاﺳﺎس در ﻣﺮﺣﻠﻪ اﻟﻘﺎ ﺑﻴﻬﻮﺷﻲ ﺷﻮد  اﺳﺘﻔﺎده ﻣﻲ آور دوزﻫﺎﻳﻲ از داروﻫﺎي ﺧﻮابﻛﻪ  ﮔﺮدﻳﺪﺑﺴﺘﻪ ﺑﻪ وزن ﺑﻴﻤﺎر اﺳﺘﻔﺎده ﺿﺪ درد ﻳﻚ ﺗﻜﻨﻴﻚ ﺑﻴﻬﻮﺷﻲ و داروي و درﺣﻴﻦ ﻋﻤﻞ ﺟﺮاﺣﻲ ﻣﻴﺰان ﻧﻴﺎز ﺑﻪ ﺗﻜﺮار دوز ﻓﻨﺘﺎﻧﻴﻞ ﻧﻴﺰ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻋﻼﻳﻢ ﺣﻴﺎﺗﻲ ﺑﻴﻤﺎر ﻛﻨﺘﺮل و در ﻓﺮم ﭘﺎﻳﺶ ﺑﻴﻤﺎر ﺛﺒﺖ   ﻧﻴﺘﺮﻳﻚ اﻛﺴﺎﻳﺪ در اﻳﻦ ﺑﻴﻤﺎران ﻳﻚ ﺳﺎﻋﺖ ﺑﻌﺪ از ﻣﺮﺣﻠﻪ اﻟﻘﺎ اﻧﺪازه ﮔﻴﺮي ﻣﻲ ﺷﻮد. ﺳﺮﻣﻲﺧﻮاﻫﺪ ﺷﺪ. در ﻧﻬﺎﻳﺖ ﺳﻄﺢ ﺷﻮد ﻛﻪ داروي اﻧﺪاﻧﺴﺘﺮون ﺗﻮاﻧﺴﺘﻪ اﺳﺖ ﺗﺎﺛﻴﺮ ﻛﻤﻲ ﺑﺮ روي ﻋﻼﻳﻢ  ﺗﺤﻠﻴﻞ داده ﻫﺎ ﻣﺸﺎﻫﺪه ﻣﻲ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﺘﺎﻳﺞ و :ﻳﺎﻓﺘﻪ ﻫﺎﻫﻤﭽﻨﻴﻦ ﻣﻴﺰان  ﺑﮕﺬارد. و داروﺑﻌﺪ از ﺗﺰرﻳﻖ دﻗﻴﻘﻪ  05دﻗﻴﻘﻪ و 02ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ در ﺑﺎزه زﻣﺎﻧﻲ  ﺣﻴﺎﺗﻲ ﺣﻴﻦ ﻋﻤﻞ ﺟﺮاﺣﻲ وﻫﻤﻴﻨﻄﻮر ﻛﺎﻫﺶ ﻧﻴﺎز  دﻗﻴﻘﻪ ﺑﻌﺪ از ﺗﺰرﻳﻖ اﻧﺪاﻧﺴﺘﺮون در ﺣﻴﻦ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﻫﻢ ﻛﺎﻫﺶ داده اﺳﺖ. 02ﺗﻜﺮار دوز ﻓﻨﺘﺎﻧﻴﻞ در در ﻣﺸﺎﻫﺪه ﻣﻘﻴﺎس  ،ﺷﻮد رﻳﻜﺎوري در ﮔﺮوﻫﺎي درﻳﺎﻓﺖ ﻛﻨﻨﺪه اﻧﺪاﻧﺴﺘﺮون دﻳﺪه ﻣﻲﺑﺨﺶ ﺑﻪ داروﻫﺎي ﻣﺨﺪر ازﺟﻤﻠﻪ ﭘﺘﻴﺪﻳﻦ در ﺳﺮدي  ﮔﺮﻣﻲ و ﻛﻠﻴﻨﻴﻜﻲ از ﺟﻤﻠﻪ: ﻟﺮزش دﺳﺖ، ﻋﻼﻳﻢﺗﺎﺛﻴﺮ داروي اﻧﺪاﻧﺴﺘﺮون ﺑﺮ روي ﺑﺮﺧﻲ از 1ﻣﺤﺮوﻣﻴﺖ از ﻣﻮاد ﻣﺨﺪر   اﺳﺖ. دﻳﺪناﺿﻄﺮاب ﻫﻢ ﻗﺎﺑﻞ  ﭘﻮﺳﺖ وﺎران در ﺑﻴﻤ د ﻣﺨﺪراﻣﻮ از اﻳﻦ ﻣﻄﺎﻟﻌﻪ اﺛﺮات درﻣﺎﻧﻲ ﻣﻔﻴﺪ داروي اﻧﺪاﻧﺴﺘﺮون را در ﻛﻨﺘﺮل ﻋﻼﻳﻢ ﻣﺤﺮوﻣﻴﺖ ﻧﺘﻴﺠﻪ ﮔﻴﺮي:    ﻣﻄﺎﻟﻌﺎت ﺑﺎﻟﻴﻨﻲ ﺑﻴﺸﺘﺮي در اﻳﻦ زﻣﻴﻨﻪ ﻧﻴﺎز اﺳﺖ. دﻫﺪ ﻛﻪ ﺗﺤﻘﻴﻘﺎت و ﻣﻌﺘﺎد ﻧﺸﺎن ﻣﻲ  ﻧﻴﺘﺮﻳﻚ اﻛﺴﺎﻳﺪ ،ﻋﻼﻳﻢ ﺗﺮك ﻣﺼﺮف دارو ، ﻓﻨﺘﺎﻧﻴﻞ، درد، ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ اﻧﺪاﻧﺴﺘﺮون، : ﻛﻠﻤﺎت ﻛﻠﻴﺪي                                                             )SWOO( elacs lawardhtiw dioipo evitcejbO 1ﻲﺴﻴﻠﮕﻧا هﺪﻴﻜﭼ                                                                                                                                 ٣     Abstract Purpose Serotonin 5-HT3 receptor antagonists such as ondansetron have been investigated to attenuate opioid withdrawal signs in studies. Therefore, we designed a randomized doubleblinded placebo-controlled trial to evaluate this effect in opioid-addicted patients who were admitted to orthopedic department for surgery due to bone fractures. Methods Male adults who were addicted to opioids, aged 18 to 79 years were enrolled (n=96) and randomized into two oral doses (4 & 8 mg) of ondansetron (n=32) and placebo (n=32). The vital signs and withdrawal symptoms and the frequency requirement of fentanyl were recorded during anesthesia, and opioid (pethidine) analgesic were received the period of recovery. Outcome parameters were analyzed for reduction of withdrawal symptoms in adult addicted patients. Results We indicated that ondansetron demonstrated significant differences with few vital outcomes including systolic blood pressure (SBP) 20 (SBP3) and 50 min (SBP 4) after injection of ondansetron during the period of the surgery. Ondansetron could also significantly reduce the frequency requirement of fentanyl at 20 min (Dose 3) in general anesthesia. Furthermore, requirement for further administration of opioid analgesic drugs such as pethidine were significantly reduced in the ondansetron groups. Objective opioid withdrawal scale (OOWS) results indicated that few clinical parameters including tremor, hot and cold flushes and anxiety were significantly attenuated in addicted patients who received ondansetron. Conclusions This study demonstrated a few evidence for beneficial treatment of ondansetron for control of withdrawal symptoms and pain in addicted patients, and more clinical studies are suggested in this regard. Key words: 5-HT3 receptor antagonists, Clinical trial, Pethidine, Withdrawal symptoms, Pain       ﻲﺴﻴﻠﮕﻧا هﺪﻴﻜﭼ                                                                                                                                 ٤         Kerman University of Medical Sciences  School of Pharmacy  In Prtial Fulfillment of the Requirements for the Degree Master of Science  Title: Impact of ondansetron on withdrawal signs, fentanyl  requirement and pain relief in opioid addicted patients  under general anesthesia  By: Farzaneh Mahikhan Supervisors: Dr. Hamid Reza Rahimi  Dr. Morteza Hashemian   Adviser: Dr. Tania Dehesh   Year: 2018   ٥                                                                                                                                 ﭼﻜﻴﺪه اﻧﮕﻠﻴﺴﻲ    

بررسی اثر داروی اندانسترون بر علایم سندرم محرومیت مواد مخدر  و نیاز به داروی فنتانیل و سطح سرمی نیتریک اکساید در  معتادین تحت بیهوشی عمومی

http://eprints.kmu.ac.ir/30957/1/7101.pdf

بررسی اثر داروی اندانسترون بر علایم سندرم محرومیت مواد مخدر و نیاز به داروی فنتانیل و سطح سرمی نیتریک اکساید در معتادین تحت بیهوشی عمومی

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