Background Traumatic brain injury is the second leading cause of death in Iran. Having knowledge of the factors affecting the clinical outcomes of these patients can improve the therapeutic outcomes. Objective The aim of this study was to determine the relationship of phosphorus (P) and magnesium (Mg) serum levels during admission with clinical outcomes of patients with head trauma. Methods This descriptive-analytic study was conducted in the intensive care unit of Shahid Rajaei Hospital in Qazvin, Iran from March to August 2018. Participants were 70 patients with head trauma under mechanical ventilation who had inclusion criteria. They were selected using a convenience sampling technique. Based on admission P level, patients were divided into two groups of hypophosphatemia (P> 3 mg/dL) and normophosphatemia (P≥3 mg/dL); and based on admission Mg level, they were assigned into two groups of hypomagnesemia (Mg <1.5 mg/dL) and normomagnesemia (Mg ≥1.5 mg/dL). Hypomagnesemia group was compared with normomagnesemia group, and hypophosphatemia group with normophosphatemia group in terms of clinical outcomes. Findings There was a significant difference between two Mg groups in terms of successful weaning (P=0.03), mechanical ventilation duration (P=0.01), and death rate (P=0.03), but not in terms of endotracheal extubation and length of hospital stay (P>0.5). The difference between two P groups was significant only in terms of successful weaning (P=0.006). Conclusion Serum levels of phosphorus and magnesium affect the clinical outcomes of patients with head trauma.
Objective:postoperative pain increases the activity of the sympathetic system, causes hypermetabolic conditions, retains salt and water, increases glucose, fatty acid lactate and oxygen consumption, weakens the immunity system which delays wound healing.Our object was comparison of the analgesic effect of morphine and paracetamol in the patients undergoing laparotomy, using PCA method.Method:Seventy patients who had undergone laparotomy were studied using double blind randomized clinical trial (35 patients received morphine and 35 paracetamol) in the Shahid Rajaee Center and Velayat Hospital (Qazvin, Iran). People using opioids, painkillers and sedatives regularly and in large doses and patients with a history of lung or liver problems did not participate in this project. The parameters of the severity of pain and nausea (VAS), hemodynamic changes (BP and HR), pruritus, arterial oxygen desaturation and patient satisfaction (VAS) of both groups were measured by a third party (trained colleague). The data was analyzed using SPSS 16 statistical software then descriptive results were extracted and ultimately the groups were compared using the following statistical tests: student’s T-test, chi 2 and Fisher’s exact test (P<0.05).Findings:The mean age of the participants was 45±12.5 years. Women constituted 24.3% of the patients and men 75.7%. The average pain severity for morphine and paracetamol groups (VAS) was 5.3±2.2and 6.37±1.7 after2 hours and reached 1.91±1.3 and 2.49±1.3 after 8 hours (after the operation) respectively. There was a significant difference between the groups after 2 and 4 hours in terms of pain severity (after 2 hours P=0.007 and after 4 hours P=0.047). However there was no significant difference between the average pain severity of the studied groups (after 6 hours P=0.4 and 8 hours P=0.08).After 8 hours, the average nausea severity was the minimum in both groups being 1.71±1.6 and 1.43±1.1 in morphine and paracetamol groups respectively. Nausea severity was higher after 2 hours in paracetamol group. In morphine group, it was higher after 4, 6 and 8 hours. Difference between the groups was not significant. The average satisfaction level (VAS) for morphine and paracetamol groups reached from 5.29±2.3 and 4.2±2.4 after 2 hours, to 7.94±1.8 and 7.69±2.1 after 8 hours (after the operation), respectively. The average satisfaction level of patients was higher in morphine group in 2,4,6 and 8 hours and except for, after 4 hours (P=0.01), the satisfaction difference between both groups was not significant in other hours (P=0.06 after 2 hours, P=0.6 after 6 hours and P=0.5 after 8 hours)Conclusion:Morphine seems to be more effective at 2 and 4 hours, but after 4 hours they have similar effects, the satisfaction difference between both groups was not significant in the patients.
Background: Physiological responses to pain and trauma have negative and dangerous effects on all organs. Objectives: This study aimed to compare intravenous patient-controlled analgesia (PCA) and intrathecal morphine in patients undergoing tibial fracture surgery under spinal anesthesia. Patients and Methods: This double-blind clinical trial was conducted on 80 patients undergoing tibial fracture surgery, aged 20-50 years and under class I and II of American Society of Anesthesiologists (ASA). They were randomly divided into two equal groups. Patients in the first group received spinal anesthesia with 3 mL marcaine 0.5% and 2 µg/kg (1 mL) morphine. Patients in the second group received the same, but instead of morphine we used 1 mL of distilled water. In the second group, immediately after the spinal anesthesia, 1 mg/hour morphine PCA pump was connected to the patients. In both groups, the following variables were assessed every hour for 12 hours by a third party (a trained anesthesiologist assistant): pain through visual analog scale, nausea, vomiting, pruritus, respiratory complications, mean arterial pressure, and heart rate. Data were collected using a questionnaire and then analyzed by Student's t-test, repeated measures analysis of variance (ANOVA) and chi-squared tests in SPSS software. Results: The ANOVA test showed that there was no meaningful difference in pain between the two groups within the 12 hours after the surgery, based on visual analogue scale (VAS) (despite a slightly higher VAS in group one) (P = 0.17). There was no meaningful difference between the patients in pruritus, nausea, vomiting and respiratory complications in the two groups. Conclusions: Given the similar level of pain, complications, and the hemodynamic signs postoperatively in both groups, we concluded that it is better to use a single dose of intrathecal morphine instead of morphine PCA pump.
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