بررسی اثرات تجویز خوراکی فراورده گیاهی (ماءالعسل مرکب) بر پیشگیری و درمان پنومونی ناشی از دستگاه تهویه مکانیکی: یک مطالعه کارآزمایی بالینی تصادفی
محورهای موضوعی : گیاهان دارویی
رسول چوپانی
1
(گروه طب سنتی، دانشکده طب سنتی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران)
زهرا شعاعی
2
(کمیته تحقیقات دانشجویی و گروه داروسازی بالینی، دانشکده داروسازی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران)
مینوش شعبانی
3
(گروه بیماریهای عفونی و گرمسیری، دانشکده پزشکی، بیمارستان لقمان حکیم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران)
محمدرضا حاجی اسماعیلی
4
(مرکز تحقیقات قاعده جمجمه، بیمارستان لقمان حکیم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران)
علی صفائی
5
(گروه داروسازی بالینی، دانشکده داروسازی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران)
زهرا صحرایی
6
(گروه داروسازی بالینی، دانشکده داروسازی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.)
کلید واژه: آنتی بیوتیک, تهویه مکانیکی, شربت ماءالعسل مرکب, عفونت تنفسی ,
چکیده مقاله :
پنومونی ناشی از تهویه مکانیکی(VAP)، یک بیماری شایع بیمارستانی است که طبق تعریف 48 ساعت بعد از شروع تهویه مکانیکی رخ می دهد. در مطالعه حاضر، تاثیر مصرف خوراکی فراورده طب سنتی ماءالعسل مرکب (فراورده ای شامل عسل، زنجبیل، هل، خولنجان، زعفران، مصطکی و دارچین) و نتایج آن بر پیش گیری و درمان VAP مورد بررسی قرار گرفته است. این مطالعه یک کارآزمایی بالینی تصادفی شده می باشد که بر روی 41 بیمار اینتوبه بستری در بیمارستان های لقمان حکیم و شهدای تجریش شهر تهران در طی سال های 1398 الی 1399 انجام شده است. بیماران در دو گروه کنترل شامل 19 نفر و مداخله شامل 22 نفر تقسیم شدند. در گروه مداخله، بیماران 10 میلی لیتر شربت ماءالعسل مرکب (ساخت کارخانه داروسازی نیاک گرگان) را سه بار در روز به صورت گاواژ دریافت کردند. در تمام بیماران متغیر هایی چون اطلاعات دموگرافیک، بیماری های زمینه ای، داروهای مصرفی، مدت زمان اینتوبیشن، میزان ابتلا به VAP ، اطلاعات بالینی و آزمایشگاهی ثبت و مورد ارزیابی قرار گرفته است. میزان ابتلا به VAP بر اساس امتیاز CPIS در گروه مداخله 50 درصد و در گروه کنترل 47/36 درصد می باشد که میان این دو مقدار اختلاف معنی داری وجود ندارد (0/558= P). هم چنین بر اساس آنالیزها مشخص شد که روز شروع درمان آنتی بیوتیکی در بیماران مبتلا به پنومونی نیز تفاوت معنی داری با هم نداشتند. بر اساس نتایجی که از ماءالعسل مرکب دیده شده است این دارو اثری بر میزان ابتلای بیماران به پنومونی ناشی از دستگاه تهویه مکانیکی نداشت اما اثرات مثبت آن در قطع سریع تر تب در بیماران گروه مداخله مشهود بود.
Mechanical ventilation-associated pneumonia (VAP) is a common nosocomial disease defined as occurring 48 hours after initiation of mechanical ventilation. In the present study, the effect of oral consumption of the traditional medicinal product (a product containing honey, ginger, cardamom, alpinia, saffron, mastic, and cinnamon) on the prevention and treatment of VAP was investigated. The study was a randomized clinical trial, conducted on 41 intubated patients admitted to Loghman Hakim and Shohadaye Tajrish hospitals in Tehran during 2019-2020. Patients were divided into two groups including 19 cases (control) and 22 cases (intervention). In the intervention group, patients received 10 ml of mixed honey syrup (manufactured by Niyak Gorgan Pharmaceutical Factory) three times a day by gavage. In all patients, variables such as demographic information, underlying diseases, medications, duration of intubation, rate of VAP, and clinical and laboratory information were recorded and evaluated. The incidence of VAP based on the CPIS score was 50% and 47.36% in the intervention and control group, respectively, showing no significant difference (P≤0.558). Also, based on the analysis of the obtained data, no significant difference was found between the days of antibiotic treatment in patients with pneumonia. Based on the findings, this product had no effect on the rate of pneumonia caused by mechanical ventilation devices, but its positive effects were evident in stopping fever faster in the patients of the intervention group.
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Banupriya, B., Biswal, N., Srinivasaraghavan, R., Narayanan, P. & Mandal, J. 2015. Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Intensive Care Med, 41(4), 677-685.
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Chai, C., Liu, X. & Zhao, Y. 2022. The effect of different solutions in tracheal suctioning on the incidence of pneumonia in patients on the ventilator. Cell Mol Biol (Noisy-le-grand), 68(2), 197-202.
Çifci, A., Tayman, C., Yakut, H., Halil, H., Çakır, E., Çakır, U. & Aydemir, S. 2018. Ginger ( Zingiber officinale ) prevents severe damage to the lungs due to hyperoxia and inflammation. Turk J Med Sci, 48(4), 892-900.
Dadfar, F., Hosseini, S. E. & Bahaoddini, A. 2014. A review of phytochemical, pharmacological and physiological properties of ginger (zingiber officinale). Clinical Excellence, 3(1), 72-86.
Dou, H., Hu, F., Wang, W., Ling, L., Wang, D. & Liu, F. 2020. Assessment of the sedative effects of dexmedetomidine and propofol treatment in patients undergoing mechanical ventilation in the ICU and relationship between treatment and occurrence of ventilator-associated pneumonia and detection of pathogenic bacteria. Exp Ther Med, 20(1), 599-606.
Halimeh, A., Farhad, R. B., Naseh, S. & Karim, N. 2020. Comparative efficacy of honey 12.5% and chlorhexidine 0.2% mouthwashes on the oropharyngeal bacterial colonization in mechanically-ventilated patients: a randomized controlled trial. J Tradit Chin Med, 40(3), 440-446.
Heimesaat, M. M., Mousavi, S., Weschka, D. & Bereswill, S. 2021. Anti-Pathogenic and Immune-Modulatory Effects of Peroral Treatment with Cardamom Essential Oil in Acute Murine Campylobacteriosis. Microorganisms, 9(1), 111-118.
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_||_Abubakar, I. B., Malami, I., Yahaya, Y. & Sule, S. M. 2018. A review on the ethnomedicinal uses, phytochemistry and pharmacology of Alpinia officinarum Hance. Journal of Ethnopharmacology, 224(45-62.
Adini, S., Santoso, B., Sarkum, S. & Sudirman, S. 2018. The comparison of the effect of honey and chlorhexidine in preventing ventilator associated pneumonia in patients on mechanical ventilaton. Intensive, Emergency and Critical Care Nursing, 4(2), 161-167.
Akhondzadeh, S., Mohammadi, M., Khani, M., Jamshidi, A., Daliri, A. & Bastani, S. 2003. Comparison of dried ethanolic extract of Crocus sativus L. and imipramine in the treatment of mild to moderate depression: a double-blind, randomised trial. Journal of Medicinal Plants, 2(8), 55-62.
Alam, A. & Rehman, N. U. 2021. Effects of Essential Oils of Elettaria cardamomum Grown in India and Guatemala on Gram-Negative Bacteria and Gastrointestinal Disorders. Molecules, 26(9), 141-152.
Álvarez-Lerma, F., Palomar-Martínez, M., Sánchez-García, M., Martínez-Alonso, M., Álvarez-Rodríguez, J., Lorente, L., Arias-Rivera, S., García, R., Gordo, F., Añón, J. M., Jam-Gatell, R., Vázquez-Calatayud, M. & Agra, Y. 2018. Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU "Pneumonia Zero" Program. Crit Care Med, 46(2), 181-188.
Ashokkumar, K., Murugan, M., Dhanya, M. K. & Warkentin, T. D. 2020. Botany, traditional uses, phytochemistry and biological activities of cardamom [Elettaria cardamomum (L.) Maton] - A critical review. J Ethnopharmacol, 246(112244.
Banupriya, B., Biswal, N., Srinivasaraghavan, R., Narayanan, P. & Mandal, J. 2015. Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Intensive Care Med, 41(4), 677-685.
Batra, P., Soni, K. D. & Mathur, P. 2020. Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials. J Intensive Care, 8(2), 81.
Cárdenas Garza, G. R. & Elizondo Luévano, J. H. 2021. Benefits of Cardamom (Elettaria cardamomum (L.) Maton) and Turmeric (Curcuma longa L.) Extracts for Their Applications as Natural Anti-Inflammatory Adjuvants. Plants (Basel), 10(9), 224-228.
Chai, C., Liu, X. & Zhao, Y. 2022. The effect of different solutions in tracheal suctioning on the incidence of pneumonia in patients on the ventilator. Cell Mol Biol (Noisy-le-grand), 68(2), 197-202.
Çifci, A., Tayman, C., Yakut, H., Halil, H., Çakır, E., Çakır, U. & Aydemir, S. 2018. Ginger ( Zingiber officinale ) prevents severe damage to the lungs due to hyperoxia and inflammation. Turk J Med Sci, 48(4), 892-900.
Dadfar, F., Hosseini, S. E. & Bahaoddini, A. 2014. A review of phytochemical, pharmacological and physiological properties of ginger (zingiber officinale). Clinical Excellence, 3(1), 72-86.
Dou, H., Hu, F., Wang, W., Ling, L., Wang, D. & Liu, F. 2020. Assessment of the sedative effects of dexmedetomidine and propofol treatment in patients undergoing mechanical ventilation in the ICU and relationship between treatment and occurrence of ventilator-associated pneumonia and detection of pathogenic bacteria. Exp Ther Med, 20(1), 599-606.
Halimeh, A., Farhad, R. B., Naseh, S. & Karim, N. 2020. Comparative efficacy of honey 12.5% and chlorhexidine 0.2% mouthwashes on the oropharyngeal bacterial colonization in mechanically-ventilated patients: a randomized controlled trial. J Tradit Chin Med, 40(3), 440-446.
Heimesaat, M. M., Mousavi, S., Weschka, D. & Bereswill, S. 2021. Anti-Pathogenic and Immune-Modulatory Effects of Peroral Treatment with Cardamom Essential Oil in Acute Murine Campylobacteriosis. Microorganisms, 9(1), 111-118.
Husaini, A. M., Jan, K. N. & Wani, G. A. 2021. Saffron: A potential drug-supplement for severe acute respiratory syndrome coronavirus (COVID) management. Heliyon, 7(5), e07068.
Jalayer Naderi, N., Niakan, M. & Mohamadi Motlagh, M. 2015. Determination of Antibacterial Activity of Pistacia lentiscus Methanolic Extract on Staphylococcus aureus, Streptococcus mutans, Streptococcus sanguis , Pseudomonas aeruginosa. journal of ilam university of medical sciences, 22(7), 67-74.
Johnstone, J., Meade, M., Lauzier, F., Marshall, J., Duan, E., Dionne, J., Arabi, Y. M., Heels-Ansdell, D., Thabane, L., Lamarche, D., Surette, M., Zytaruk, N., Mehta, S., Dodek, P., Mcintyre, L., English, S., Rochwerg, B., Karachi, T., Henderson, W., Wood, G., Ovakim, D., Herridge, M., Granton, J., Wilcox, M. E., Goffi, A., Stelfox, H. T., Niven, D., Muscedere, J., Lamontagne, F., D'aragon, F., St-Arnaud, C., Ball, I., Nagpal, D., Girard, M., Aslanian, P., Charbonney, E., Williamson, D., Sligl, W., Friedrich, J., Adhikari, N. K., Marquis, F., Archambault, P., Khwaja, K., Kristof, A., Kutsogiannis, J., Zarychanski, R., Paunovic, B., Reeve, B., Lellouche, F., Hosek, P., Tsang, J., Binnie, A., Trop, S., Loubani, O., Hall, R., Cirone, R., Reynolds, S., Lysecki, P., Golan, E., Cartin-Ceba, R., Taylor, R. & Cook, D. 2021. Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients: A Randomized Clinical Trial. Jama, 326(11), 1024-1033.
Kaushik, D., Yadav, J., Kaushik, P., Sacher, D. & Rani, R. 2011. Current pharmacological and phytochemical studies of the plant Alpinia galanga. Zhong Xi Yi Jie He Xue Bao, 9(10), 1061-1065.
Kianmehr, M. & Khazdair, M. R. 2020. Possible therapeutic effects of Crocus sativus stigma and its petal flavonoid, kaempferol, on respiratory disorders. Pharmaceutical Biology, 58(1), 1140-1149.
Konno, K., Sawamura, R., Sun, Y., Yasukawa, K., Shimizu, T., Watanabe, W., Kato, M., Yamamoto, R. & Kurokawa, M. 2011. Antiviral activities of diarylheptanoids isolated from Alpinia officinarum against respiratory syncytial virus, poliovirus, measles virus, and herpes simplex virus type 1 in vitro. Nat Prod Commun, 6(12), 1881-1884.
Mentis, A. A., Dalamaga, M., Lu, C. & Polissiou, M. G. 2021. Saffron for "toning down" COVID-19-related cytokine storm: Hype or hope? A mini-review of current evidence. Metabol Open, 11(3), 100111.
Mesri, M., Esmaeili Saber, S. S., Godazi, M., Roustaei Shirdel, A., Montazer, R., Koohestani, H. R., Baghcheghi, N., Karimy, M. & Azizi, N. 2021. The effects of combination of Zingiber officinale and Echinacea on alleviation of clinical symptoms and hospitalization rate of suspected COVID-19 outpatients: a randomized controlled trial. J Complement Integr Med, 18(4), 775-781.
Mirtalaei, N., Farazi, A., Ebrahimi Monfared, M. & Jokar, A. 2019. Efficacy of antibiotic prophylaxis against ventilator-associated pneumonia. J Hosp Infect, 101(3), 272-275.
Modaresi, M. 2011. The Effect of Cinnamon Extract on Serum Proteins Levels of Male Balb/c Mice. Armaghane Danesh, 16(5), 444-452.
Modi, A. R. & Kovacs, C. S. 2020. Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention. Cleve Clin J Med, 87(10), 633-639.
Mokhtari, M. & Shariatpanahi, Z. 2009. Ginger extract dietary supplementation effects on delayed gastric emptying and ventilator-associated pneumonia in adult respiratory distress syndrome patients. Critical Care, 13(1), P134.
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