نوع مقاله : مقاله پژوهشی
نویسندگان
1 کمیته تحقیقات دانشجویی، دانشجوی کارشناسی ارشد پرستاری مراقبت های ویژه، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران
2 دانشکده پرستاری، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران
3 مربی، کارشناسی ارشد آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران
4 استادیار، دکتری پرستاری، مرکز تحقیقات سلامت سالمندان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران
چکیده
سابقه و هدف: بیماری ایسکمیک قلبی در اکثر مناطق جهان اولین علت مرگ زودرس به شمار می‌رود. یکی از درمانهای اصلی بیماران با سندرم کرونری حاد استفاده از داروهای ضد انعقاد می باشد. هدف این مطالعه مقایسه تاثیر دو روش تزریق وریدی متناوب و انفوزیون مداوم بر APTT بیماران سندرم کرونری حاد می‌باشد.
مواد و روش‌ها: کارآزمایی بالینی روی 60 نفر از بیماران انتخاب شده به روش تصادفی در بیمارستان نیشابور سال 1396 انجام شد. به منظور جمع اوری داده ها پرسشنامه اطلاعات دموگرافیک، چک لیست ثبت APTT استفاده شد. گروه تزریق وریدی متناوب، هر 3 ساعت هپارین به میزان 2500 واحد و گروه انفوزیون، 1000 واحد بر ساعت انفوزیون مداوم هپارین دریافت کردند و APTT کنترل شد. تحلیل داده های پژوهش با استفاده از نرم افزار SPSS -16 انجام شد و سطح معنی-داری کمتر از پنج صدم در نظر گرفته شد.
یافته‌ها: میانگین APTT در مرحله اول گروه تزریق وریدی متناوب 17/11±8/40 و در گروه انفوزیون مداوم 86/8±87/38 بود. در مرحله هشتم گروه تزریق وریدی متناوب 14/8±03/55 و در گروه انفوزیون مداوم 09/14±7/55 بود. آزمون t مستقل اختلاف معنی داری را بین دو گروه نشان نداد (P> 0.05)
نتیجه‌گیری: با توجه به همسانی نتایج در دو روش، می‌توان از روش تزریق متناوب به جای انفوزیون مداوم وریدی استفاده کرد. این روش محدودیت کمتری برای بیمار ایجاد کرده و بارکاری پرستاران بدلیل عدم نیاز به ست کردن پمپ سرنگ، آماده کردن سرم هپارینه و خاموش کردن آلارم ها کمتر می‌شود.
کلیدواژه‌ها
موضوعات
عنوان مقاله [English]
A comparative study on the effect of heparin on of intermittent intravenous injection and continuous infusion with syringe pump on APTT results and possible complications in patients with acute coronary syndrome
نویسندگان [English]
- Ali Saneipour 1
- mojtaba rad 2
- Yaser Tabaraei 3
- Mostafa Rad 4
1 Student Research Committee, Student of MSc Critical Care Nursing , Sabzevar University of Medical Scinces, Sabzevar,Iran.
2 sabzevar
3 MSc of Biostatistics, School of public health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
4 Assistant Professor, Iranian Research Center on Healthy Aging, Department of nursing, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
چکیده [English]
Background: Ischemic heart disease is the first cause of early death in the world. One of the main treatments for patients with acute coronary syndrome is the use of anticoagulants. The aim of this study, The aim of this study was to compare effect of two methods of intermittent intravenous injection and continuous infusion on APTT in patients with ACS.
Materials and Methods: clinical trial was performed on 60 patients selected by random sampling in Neishabour Hospital in 2018. To data gathering were used the demographic information questionnaire, and APTT checklist. The intravenous injection group received 2500 units heparin every 3 hours and infusion group was given 1000 units per hour and APTT was controlled. Data analysis was done using SPSS-16 software and sinifiant level was considered to be less than 0.05.
Results: Mean APTT level in first stage was 40.8 ± 11.17 and 38.87 ± 8.86 in intermittent intravenous injection and continuous infusion groups respectively. In the 8th stage, mean APTT level in intravenous injection group was 55.03 ± 8.41 and in continuous infusion group was 55.7 ± 14.09. Independent t-test did not show a significant difference between the two groups (P> 0.05).
Conclusion: Regarding to approximation of the results in two methods, alternate injection method can be used instead of continuous intravenous infusion. This method creates less constraints for the patient and reduces the burden on nurses due to don’t need setting pump syringe, serum heparin preparation, and alleviation of alarms.
کلیدواژه‌ها [English]
- Heparin
- Intravenous
- Infusion
- Acute Coronary Syndrome
heart. 11th ed. USA: Mc Grow-Hill Companies 2004; 1215-49.
[2]. Haldong w,Amanuel A, Kalkim H, Cristiana A, Kaja MA, Foad Abd A,et al. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 2017; 390: 1084-1150.
[3]. Schoenenberger AW, Radovanovic D, Windecker S, Iglesias JF, Pedrazzini G, Stuck AE, Erne P, AMIS Plus Investigators, Lessing P, Hess F, Simon R. Temporal trends in the treatment and outcomes of elderly patients with acute coronary syndrome. European heart journal 2016; 12; 37(16): 1304-11.
[4]. Tofighiyan T, Rad M, Taghizadeh A, Rakhshani MH; Prevalence of Cardiac Arrhythmia Disorders in Patients with Myocardial Infarction Admitted to CCU Ward in the Vasei Hospital of Sabzevar. Jundishapur. J Chronic Dis Care 2012; 1(2): 38-44. (persian)
[5]. Cayla G, Cuisset T, Silvain J, Leclercq F, Manzo-Silberman S, Saint-Etienne C, Delarche N, Bellemain-Appaix A, Range G, El Mahmoud R, Carrié D. Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome (ANTARCTIC): an open-label, blinded-endpoint, randomised controlled superiority trial. The Lancet. 2016 Oct 22; 388(10055):2015-22.
[6]. Smythe MA, Priziola J, Dobesh PP, Wirth D, Cuker A, Wittkowsky AK. Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism. Journal of thrombosis and
thrombolysi2016 Jan 1; 41(1): 165-86.
[7]. Gavura S, Bayliff CD, Kovacs MJ. Evaluation of a Heparin Nomogram in the Treatment of Deep Vein Thrombosis and Pulmonary Embolism. The Canadian Journal of Hospital Pharmacy 2018 May 15; 50(3).
[8]. Adib A, Fatorchi B. Comparative Study of Continuous and Intermittent Administration of Heparin on APTT
(Activated Partial Thromboplastin Time). Journal of Iran University of Medical Sciences 2005; 46(12): 243-48. (Persian)
[9]. Yadolahi E,Beigi A. Comparison of the efficacy of heparin injection in two continuous infusion methods and multiple intravenous infusion, on coagulation status after vascular surgery. Journal of Isfahan Medical School 2010;
150(29): 1046-51. (Persian)
[10]. Poortaghi S, Baghernia A, Golzari SE, Safayian A, Atri SB. The effect of home-based cardiac rehabilitation program
on self efficacy of patients referred to cardiac rehabilitation center. BMC research notes 2013; 6(1): 287.
[11]. Valgimigli M, Frigoli E, Leonardi S, Rothenbühler M, Gagnor A, Calabrò P, Garducci S, Rubartelli P, Briguori C,
Andò G, Repetto A. Bivalirudin or unfractionated heparin in acute coronary syndromes. New England Journal of Medicine 2015; 373(11): 997-1009.
[12]. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN. 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology 2014; 64(24): e139-228.
[13]. Savonitto S, Cavallini C, Petronio AS, Murena E, Antonicelli R, Sacco A, Steffenino G, Bonechi F, Mossuti E, Manari A, Tolaro S. Early aggressive versus initially conservative treatment in elderly patients with non–STsegment elevation acute coronary syndrome: a randomized controlled trial. JACC: Cardiovascular Interventions 2012; 5(9): 906-16.
[14]. Hansen KW, Sorensen R, Madsen M, Jensen JS, Mortensen PE, Lange T, Gislason GH, Galatius S. P1230
Association between early invasive management, secondary preventive medical therapy and long-term outcomes after acute coronary syndromes. European Heart Journal 2018; 39 (suppl-1): ehy565-P1230.
[15]. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). European heart journal 2016; 37(3): 267-315.
[16]. Puymirat E, Aissaoui N, Cayla G, Lafont A, Riant E, Mennuni M, Saint-Jean O, Blanchard D, Jourdain P, Elbaz
M, Henry P. Changes in one-year mortality in elderly patients admitted with acute myocardial infarction in relation with early management. The American journal of medicine 2017; 130(5): 555-63.
[17]. Oh YS, Kim SH, Kim TS, Shin WS, Kim JH, Jang SW, Lee MY, Rho TH. randomized comparison of continuous and
intermittent heparin infusion during catheter ablation of atrial fibrillation. JACC: CLINICAL ELECTROPHYSIOLOGY 2016; 2 (3): 319-26.
[18]. Hamam I, Daoud EG, Zhang J, et al. Impact of international normalized ratio and activated clot- ting time on unfractionated heparin dosing during ablation of atrial fibrillation. Circ Arrhythm Elec-trophysiol 2013; 6:491-96.
[19]. Izadpanah M, Khalili H, Mohammadi M. Comparingsafety of heparin as continuous intravenous infusion andmultiple subcutaneous injections. Journal of comparative effectiveness research 2016; 5(1): 31-38.
[20]. Haines DE. Heparin Bolus or Infusion: Can We Draw aConclusion?. JACC: CLINICAL ELECTROPHYSIOLOGY2016; 2 (3): 327-29.
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