ﺑﺮرﺳﻲ ﺗﺄﺛﻴﺮ ﺗﺰرﻳﻖ اﭘﻲ ﻧﻔﺮﻳﻦ در اﻳﺠﺎد ﻧﻜﺮوز ﻋﻀﻮ اﻧﺘﻬﺎﻳﻲ در ﻣﺪل ﺷﺒﻴﻪ ﺳﺎزي ﺷﺪه 54 ﻧﻤﻮﻧﻪ ﮔﻮش ﺧﺮﮔﻮش ﺑﻪ روش ﺗﺠﺮﺑﻲ در آزﻣﺎﻳﺸﮕﺎه ﺣﻴﻮاﻧﺎت ﺑﻴﻤﺎرﺳﺘﺎن 15ﺧﺮداد داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺷﻬﻴﺪ ﺑﻬﺸﺘﻲ از ﺗﺎرﻳﺦ 85/05/01 ﻟﻐﺎﻳﺖ 86/07/01

A Study of Epinephrine Effect on End Organ Necrosis in 54 Simulated Samples of Rabbits’ Ears by Pure Experimental Method in the Animal Laboratory of 15 Khordad Hospital of Shahid Beheshty University from 2006 till 2007

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺍﺯ ﺍﺻﻮﻝ ﺍﺑﺘﺪﺍﺋﻲ ﮐﻪ ﻫﺮ ﺩﺍﻧﺸﺠﻮ ﭘﺰﺷﮑﻲ ﻣﻲ ﺁﻣﻮﺯﺩ ﺍﻳﻦ ﺍﺳﺖ ﻛﻪ ﺗﺰﺭﻳﻖ ﻟﻴﺪﻭﮐﺎﺋﻴﻦ ﺍﭘﻲ ﻧﻔﺮﻳﻨﻪ ﺩﺭ ﺍﻧﺪﺍﻡ ﻫﺎﻱ ﺍﻧﺘﻬﺎﻳﻲ ﺧﻄﺮﻧﺎﮎ ﺍﺳﺖ ﻫﺪﻑ ﺍﺯ ﺍﻳﻦ ﺗﺤﻘﻴﻖ، ﺑﺮﺭﺳﻲ ﺍﺛﺮ ﺍﭘﻲ ﻧﻔﺮﻳﻦ ﺗﺰﺭﻳﻘﻲ ﺩﺭ ﺍﻳﺠﺎﺩ ﻧﮑﺮﻭﺯ ﺍﻋﻀﺎﺀ ﺍﻧﺘﻬﺎﻳﻲ ﺩﺭ ﻏﻠﻈﺖ ﻫﺎﻱ ﻣﺨﺘﻠﻒ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺑﻪ ﺷﮑﻞ ﻳﮏ ﻣﻄﺎﻟﻌﺔ ﺗﺠﺮﺑﻲ ﺭﻭﻱ54 ﻧﻤﻮﻧﻪ ﮔﻮﺵ 9 ﺧﺮﮔﻮﺵ ﺍﻧﺠﺎﻡ ﺷﺪ. ﺑﻪ ﻋﻠﺖ ﺧﻮﻧﺮﺳﺎﻧﻲ ﺧﻮﺏ ﮔﻮﺵ ﻫﺎﻱ ﺧﺮﮔﻮﺵ، ﮔﻮﺵ ﺧﺮﮔﻮﺵ ﺟﻬﺖ ﺑﺮﺧﻮﺭﺩﺍﺭﻱ ﺍﺯ ﻓﻘﻂ ﻳﮏ ﺷﺮﻳﺎﻥ ﺍﻧﺘﻬﺎﻳﻲ ﺷﺒﻴﻪ ﺳﺎﺯﻱ ﺷﺪ. ﺑﻪ ﻧﺤﻮﻱ ﮐﻪ ﻫﺮ ﻗﺴﻤﺖ ﺟﺪﺍ ﺷﺪﻩ ﺍﺯ ﻫﺮ ﮔﻮﺵ ﻓﻘﻂ ﺍﺯ ﻳﮏ ﺷﺮﻳﺎﻥ ﺧﻮﻧﺮﺳﺎﻧﻲ ﺩﺍﺷﺘﻪ ﺑﺎﺷﺪ ﺳﭙﺲ ﻟﻴﺪﻭﮐﺎﺋﻴﻦ 1 ﺧﺎﻟﺺ ﻭ ﻟﻴﺪﻭﮐﺎﺋﻴﻦ 1 ﺑﺎ ﺍﭘﻲ ﻧﻔﺮﻳﻦ ﺩﺭ ﻏﻠﻈﺖ ﻫﺎﻱ ﻣﺨﺘﻠﻒ1/50000 ﻭ 1/100000 ﻭ 1/200000 ﺑﻪ ﻗﺴﻤﺖ ﻫﺎﻱ ﺟﺪﺍ ﺷﺪﻩ ﮔﻮﺵ ﺗﺰﺭﻳﻖ ﮔﺮﺩﻳﺪ ﻭ ﻧﮑـﺮﻭﺯ ﻋﻀﻮ ﺍﻧﺘﻬﺎﻳﻲ ﺑﺮﺭﺳﻲ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺩﺭ ﮔـﺮﻭﻩ ﺍﻭﻝ ﻭ ﺩﻭﻡ ﮐﻪ ﻏﻠﻈﺖ ﺍﭘﻲ ﻧﻔﺮﻳﻦ ﺑﻪ ﺗﺮﺗﻴﺐ1/100000 ﻭ 1/200000 ﺑﻮﺩ ﻭ ﺑﺎ ﻟﻴﺪﻭﮐﺎﻳﻴﻦ 1 ﺧﺎﻟﺺ ﻣﻘﺎﻳﺴﻪ ﮔﺮﺩﻳﺪ، ﻧﮑﺮﻭﺯ ﻣﺸﺎﻫـﺪﻩ ﻧﺸﺪ. ﺩﺭ ﮔﺮﻭﻩ ﺳﻮﻡ، ﺍﭘﻲ ﻧﻔـﺮﻳﻦ ﺑﺎ ﻏﻠﻈﺖ 1/50000 ﺑﺎ ﻟﻴـﺪﻭﮐﺎﻳﻴﻦ 1 ﺧﺎﻟﺺ ﻣﻘﺎﻳﺴﻪ ﺷـﺪ ﻭ ﺍﺯ ﻧﻪ ﻣﻮﺭﺩ ﺩﺭ ﭼﻬـﺎﺭ ﻣﻮﺭﺩ ﻧﮑﺮﻭﺯ ﻣﺸﺎﻫﺪﻩ ﮔﺮﺩﻳﺪ36% - P = 0.08 (. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺎﺗﻮﺟﻪ ﺑﻪ ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﻪ ﻭ ﺍﻧﺠﺎﻡ ﺁﺯﻣﻮﻥ ﺩﻗﻴﻖ ﻓﻴﺸﺮ، ﺗﺰﺭﻳﻖ ﻟﻴﺪﻭﮐﺎﺋﻴﻦ ﺍﭘﻲ ﻧﻔﺮﻳﻨﻪ ﺑﺎ ﻏﻠﻈﺖ 1/100000 ﻭ 1/200000 ﺩﺭ ﺍﻧﺪﺍﻡ ﻫﺎﻱ ﺍﻧﺘﻬﺎﺋﻲ ﮐﺎﻣ ﺑﻲ ﺧﻄﺮ ﺍﺳﺖ. ﺍﮔﺮ ﭼﻪ ﺩﺭ ﻏﻠﻈﺖ 1/50000 ﻧﻴﺰ ﻧﺴﺒﺖ ﻧﻜﺮﻭﺯ ﺍﺯ ﻧﻈﺮ ﺁﻣﺎﺭﻱ ﺩﺭ ﺩﻭ ﮔﺮﻭﻩ ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲ ﺩﺍﺭﻱ ﻧﺸﺎﻥ ﻧﺪﺍﺩ، ﻭﻟﻲ ﺍﺯ ﻧﻈﺮ ﺑﺎﻟﻴﻨﻲ ﺍﻳﻦ ﺍﺧﺘﻼﻑ ﻣﻌﻨﻲ ﺩﺍﺭ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﻭ ﺗﻮﺻﻴﻪ ﻣﻲ ﺷﻮﺩ ﺍﺯ ﺍﭘﻲ ﻧﻔﺮﻳﻦ ﺑﺎ ﻏﻠﻈﺖ ﺑﻴﺸﺘﺮ ﺍﺳﺘﻔﺎﺩﻩ ﻧﺸﻮﺩ. ﺗﻮﺻﻴﻪ ﻣﻲ ﺷﻮﺩ ﺩﺭ ﺁﻥ ﺩﺳﺘﻪ ﺍﺯ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﺭﻭﻱ ﺍﻧﺪﺍﻡ ﻫﺎﻱ ﺍﻧﺘﻬﺎﺋﻲ ﮐﻪ ﺍﺣﺘﻴﺎﺝ ﺑﻪ ﻣﺤﻴﻂ ﺑﺪﻭﻥ ﺧﻮﻥ ﺩﺍﺭﻧﺪ ﺍﺯ ﻟﻴﺪﻭﮐﺎﺋﻴﻦ ﺍﭘﻲ ﻧﻔﺮﻳﻨﻪ ﺑﺎ ﻏﻠﻈﺖ 1/200000 ﻳﺎ 1/100000 ﺑﻪ ﻋﻨﻮﺍﻥ ﺗﻮﺭﻧﻴﮑﻪ ﺷﻴﻤﻴﺎﻳﻲ ﺍﺳﺘﻔﺎﺩﻩ ﮔﺮﺩﺩ.

Introduction & Objective: One of the basic rules that all physician know is the danger of epinephrine injection in end organs. This article investigates the necroses of end organs following epinephrine injection in various concentrations. Materials & Methods: This double blind pure experimental study has been done on 54 simulated samples of 9 rabbits’ ears. Under general anesthesia, the surgeons divided rabbits’ ears into 3 lobs, each lobe being nourished only by one end artery. Pure lidocaine of 1% and lidocaine of 1% concentrations with epinephrine in 3 concentrations (1:200000, 1:100000, 1:50000) was injected, andnecrosis or viability of end organs was evaluated by physical examination after 48 hours. Results: In the first and second group for which epinephrine concentration were 1:200000 and 1:100000, necrosis was not seen. In third group for which epinephrine concentration was 1:50000, 4 necrosis were seen among 9 cases (36%- P=0.08). Conclusions: Epinephrine injection with 1:100000 and 1:200000 concentrations in end organs is absolutely safe, but with 1:50000 concentrations is clinically unsafe. Xylocain-epinephrine solution lower than 1:50000 can be used safely as a chemical tourniquet