اثر مكمل سلنيم بر كيفيت زندگي بيماران همودياليزي

Effect of selenium supplement on quality of life in hemodialysis patients

ﺳﺎﺑﻘﻪ و ﻫﺪف: ﻧﺎرﺳﺎﯾﯽ ﻣﺰﻣﻦ ﮐﻠﯿﻪ ﺿﻤﻦ ﮐﺎﻫﺶ اﺳﺘﺎﻧﺪاردﻫﺎي زﻧﺪﮔﯽ ﺑﺮ اﻓﺰاﯾﺶ مشكلات ﺟﺴـﻤﯽ و رواﻧـﯽ اﺛـﺮ ﮔﺬاﺷﺘﻪ و ﺑﻪ ﮐﺎﻫﺶ ﮐﯿﻔﯿﺖ زﻧﺪﮔﯽ ﺑﯿﻤﺎران ﻫﻤﻮدﯾﺎﻟﯿﺰي ﻣﯽ اﻧﺠﺎﻣﺪ. ﺑﻪ ﺟﻬﺖ ﮐﻤﺒﻮد ﺳﻠﻨﯿﻢ در ﺑﯿﻤﺎران ﻫﻤﻮدﯾﺎﻟﯿﺰي، اﯾﻦ ﻣﺎده ﻣﻐﺬي ﺿﻤﻦ اﺛﺮات آﻧﺘﯽ اﮐﺴﯿﺪاﻧﯽ و ﻣﺤﺎﻓﻈﺖ ﮐﻨﻨﺪه ي ﻗﻠﺒﯽ-ﻋﺮوﻗﯽ ﻣﯽ ﺗﻮاﻧﺪ ﺑﺮ ﺑﻬﺒـﻮد ﮐﯿﻔﯿـﺖ زﻧـﺪﮔﯽ ﺑﯿﻤـﺎران ﻫﻤﻮدﯾﺎﻟﯿﺰي ﻣﺆﺛﺮ ﺑﺎﺷﺪ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺑﺮرﺳﯽ اﺛﺮ ﻣﮑﻤﻞ ﺳﻠﻨﯿﻢ ﺑﺮ ﮐﯿﻔﯿـﺖ زﻧـﺪﮔﯽ در ﺑﯿﻤـﺎران ﻫﻤﻮدﯾـﺎﻟﯿﺰي ﺻﻮرت ﮔﺮﻓﺘﻪ اﺳﺖ. ﻣﻮاد و روش ﻫﺎ: در اﯾﻦ ﮐﺎرآزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ ﯾﮏ ﺳﻮﮐﻮر، 80 ﺑﯿﻤﺎر ﻫﻤﻮدﯾﺎﻟﯿﺰي ﺑﻪ روش ﺗﺼﺎدﻓﯽ ﺳﯿﺴﺘﻤﺎﺗﯿﮏ اﻧﺘﺨـﺎب ﺷﺪه و ﺳﭙﺲ ﻃﯽ ﺗﺨﺼﯿﺺ ﺗﺼﺎدﻓﯽ ﺑﻪ دو ﮔﺮوه آزﻣﺎﯾﺸﯽ و ﮐﻨﺘﺮل ﺗﻘﺴﯿﻢ ﺷﺪﻧﺪ. ﺑﯿﻤﺎران در ﮔﺮوه آزﻣﺎﯾﺸﯽ ﻣﯿﺰان 200 ﻣﯿﮑﺮوﮔﺮم ﻣﮑﻤﻞ ﺳﻠﻨﯿﻢ ﺑﻪ ﻓﺮم ﻣﺨﻤﺮ ﺳﻠﻨﯿﻢ و ﺑﯿﻤﺎران ﮔﺮوه ﮐﻨﺘﺮل ﯾﮏ ﻋﺪد ﮐﭙﺴﻮل داروﻧﻤﺎ ﻫﺮ روز ﺑـﻪ ﻣـﺪت 3 ﻣـﺎه درﯾﺎﻓﺖ ﻣﯽ ﮐﺮدﻧﺪ. ﭘﺮﺳﺶ ﻧﺎﻣﻪ ﮐﯿﻔﯿﺖ زﻧﺪﮔﯽ (36-SF) وﯾﮋه ﺑﯿﻤﺎران ﻫﻤﻮدﯾﺎﻟﯿﺰي در اﺑﺘﺪا و اﻧﺘﻬﺎي ﻣﺪاﺧﻠـﻪ ﺑـﺮاي ﻫـﺮ ﺑﯿﻤﺎر تكميل گرديد. ﯾﺎﻓﺘﻪ ﻫﺎ: ﮐﯿﻔﯿﺖ زﻧﺪﮔﯽ در ﮔﺮوه ﻣﺼﺮف ﮐﻨﻨﺪه ﻣﮑﻤﻞ ﺳﻠﻨﯿﻢ ﻫﻢ از ﻧﻈﺮ ﻓﯿﺰﯾﮑﯽ و ﻫﻢ روﺣﯽ-رواﻧـﯽ ﺑﻬﺒـﻮد ﯾﺎﻓﺘـﻪ اﺳﺖ (P0/05). در ﺣﺎﻟﯽ ﮐﻪ در ﮔﺮوه ﮐﻨﺘﺮل ﺗﻐﯿﯿﺮ ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪ اي ﻣﺸﺎﻫﺪه ﻧﮕﺮدﯾﺪه اﺳﺖ. در ﻣﻘﺎﯾﺴﻪ دو ﮔﺮوه ﺑﻌـﺪ از 3 ﻣﺎه، ﺗﻔﺎوت ﻣﻌﻨﯽ داري در اﺑﻌﺎد ﺳﻼﻣﺖ ﻋﻤﻮﻣﯽ، ﻋﻤﻞ ﮐﺮد اﺟﺘﻤﺎﻋﯽ، ﻣﺤﺪودﯾﺖ ﻧﻘﺶ ﺑـﻪ ﻋﻠـﺖ ﻣﺸـﮑﻼت اﺣﺴﺎﺳـﯽ و ﺳﻼﻣﺖ روﺣﯽ-رواﻧﯽ ﻣﺸﺎﻫﺪه ﮔﺮدﯾﺪ. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: ﺳﻠﻨﯿﻢ ﺑﺮ ﺑﻬﺒﻮد ﮐﯿﻔﯿﺖ زﻧﺪﮔﯽ ﺑﯿﻤﺎران ﻫﻤﻮدﯾﺎﻟﯿﺰي اﺛﺮ ﺑﺎﻟﻘﻮه اي دارد و از اﯾﻦ ﻃﺮﯾﻖ ﺑﺮ ﺳﻼﻣﺖ ﻋﻤﻮﻣﯽ اﯾﻦ ﺑﯿﻤﺎران ﻣﺆﺛﺮ ﻣﯽ ﺑﺎﺷﺪ. اﯾﻦ ﻣﻄﺎﻟﻌﻪ از ﺣﯿﺚ اﺛﺮات ﺑﺎﻟﻘﻮه ﻣﮑﻤﻞ ﺳﻠﻨﯿﻢ در راﺳﺘﺎي ﺑﻬﺒـﻮد ﮐﯿﻔﯿـﺖ زﻧـﺪﮔﯽ ﺑﯿﻤـﺎران ﻫﻤﻮدﯾﺎﻟﯿﺰي ﻣﻨﺤﺼﺮ ﺑﻪ ﻓﺮد ﻣﯽ ﺑﺎﺷﺪ.

Introduction: Chronic renal failure produces physical and psychological problems in patients who are receiving hemodialysis, because of reducing the life standards. Selenium deficiency is common in hemodialysis patients. Selenium has antioxidant and cardio-protective effects, which can raise the quality of life in hemodialysis patients. The aim of the current study was to evaluate the effect of selenium supplement on quality of life in hemodialysis patients. Materials and Methods: In this one-blinded clinical trial, 80 hemodialysis patients were selected by random systematic sampling and divided into experimental and control groups. Experimental group received 200 micrograms of selenium supplement in the form of selenium yeast and control group received a placebo capsule every day for three months. Quality of life questionnaire (SF-36) specific to hemodialysis patients was completed for every patient at the beginning and at the end of the intervention. Results: quality of life improved in the group receiving selenium supplements, both in the physical and mental aspects (P<0.05), while no significant changes were seen in the control group. In comparing two groups after three months, significant differences were seen in the aspects of general health, social functioning and degree of limitations due to emotional problems and mental health. Conclusion: Selenium has a significant effect on improving quality of life in hemodialysis patients and in this way it can affect general health in these patients. This study, for the first time, has taken into consideration the potential effects of selenium supplement on improving the quality of life in hemodialysis patients.