،ﻪﯿﻠﮐ ﻦﻣﺰﻣ ﯽﯾﺎﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ رد یﺮﺘﻣﻮﯾدا تﻻﻼﺘﺧا و ﯽﯾاﻮﻨﺷ ﺶﻫﺎﮐ ﯽﺳرﺮﺑ لﺎﺳ زا ﺮﻐﺻاﯽﻠﻋ نﺎﮐدﻮﮐ نﺎﺘﺳرﺎﻤﯿﺑ ﻪﺑ هﺪﻨﻨﮐ ﻪﻌﺟاﺮﻣ ﻪﯿﻠﮐ ﺪﻧﻮﯿﭘ و ﻦﻣﺰﻣ ﺰﯿﻟﺎﯾدﻮﻤﻫ
1382 ﺎﺗ 1381
I ﺶﮐﻮﺗا ﻦﺴﺣ ﺮﺘﮐد*
II یﻮﺳﻮﻣ …اﺪﺒﻋ ﺮﺘﮐد
III ﯽﻨﯿﺴﺣ ﺎﺘﯾزر ﺮﺘﮐد
IV یزردﻮﮔ ﻪﻧﺎﺸﺧر ﺮﺘﮐد
V ﯽﻧﺎﻬﺑزور ﻪﻣﻮﺼﻌﻣ
هﺪﯿﮑﭼ
ﺮـﮐذ نارﺎــﻤﯿﺑ ﻦﯾا رد نآ یاﺮﺑ ﯽﻔﻠﺘﺨﻣ ﻞﻠﻋ ﻪﮐ ﺖﺳا ﻪﯿﻠﮐ ﻦﻣﺰﻣ ﯽﯾﺎﺳرﺎﻧ ﻢﻬﻣ ضراﻮﻋ زا ﯽﮑﯾ ﯽﯾاﻮﻨﺷ ﺶﻫﺎﮐ تﻻﻼـﺘﺧا ﻪـﺑ ناﻮـﺗ ﯽـﻣ ﻞـﻠﻋ ﺮﯾﺎـﺳ زا و ﺪـﺷﺎﺑﯽﻣ (ﮏـﯿﻣروا ﯽﺗﺎـﭘورﻮـﻧ)ﯽــﻣروا ﺮﺛا ﻞﻣﺎﻋ ﻦﯾﺮﺗﻢﻬﻣ .ﺖﺳا هﺪﺷ رد ﺎـﻫﺖﻧﻮﻔﻋ ﺮــﺗﺶﯿﺑ زوﺮﺑ ،ﻻﺎﺑ نﻮﺧ رﺎﺸﻓ زا ﯽﺷﺎﻧ ﯽﻗوﺮﻋ تﻻﻼﺘﺧا ،یﺮﺗﺎﻧﻮﭙﯿﻫ و ﯽﻤﻟﺎﮐﺮﭙﯿﻫ ﺪﻨﻧﺎﻣ ﯽﺘﯿﻟوﺮﺘﮑﻟا یﺎـﻫوراد فﺮـﺼﻣ و ﺎــﻫﺪﯾزﻮﮑﯿﻠﮔﻮﻨﯿﻣآ ﻪﻠﻤﺟ زا ﺎﻫﮏﯿﺗﻮﯿﺑﯽﺘﻧآ ﺮﺗﺶﯿﺑ فﺮﺼﻣ ﻪﺠﯿﺘﻧ رد و ﻪﯿﻠﮐ ﯽﯾﺎﺳرﺎﻧ نﺎﯾﺮﺟ تﺪـﺷ ﺮـﺑ ﻪــﯿﻠﮐ ﻦﻣﺰﻣ ﯽﯾﺎﺳرﺎﻧ یﺎﻫنﺎﻣرد عاﻮﻧا ﺮﺛا درﻮﻣ رد ﯽﻧﻮﮔﺎﻧﻮﮔ تﺎﻌﻟﺎﻄﻣ .دﺮﮐ هرﺎﺷا نﻮﺧ رﺎﺸﻓ هﺪﻨﻫﺎﮐ ﻪﮐ ﯽﻧارﺎﻤﯿﺑ رد تﺎﻌﻟﺎﻄﻣ ﺐﻠﻏا رد .ﺖﺳا هدﻮﺑ دﺎﻀﺘﻣ ﯽﻫﺎﮔ و توﺎﻔﺘﻣ ﺎﻫنآ ﺞﯾﺎﺘﻧ ﻪﮐ هﺪﺷ مﺎﺠﻧا ﯽﯾاﻮﻨﺷ تﻻﻼﺘﺧا ﯽﯾاﻮﻨـﺷﺎﻧ یدﻮﺒﻬـﺑ رد ﯽـﺳﻮﺴﺤﻣ ﺮﯿـﯿﻐﺗ ﯽــﻣروا ناﺰﯿﻣ ﺶﻫﺎﮐ دﻮﺟو ﺎﺑ ،ﺪﻧدﻮﺑ ﻦﻣﺰﻣ ﺰﯿﻟﺎﯾدﻮﻤﻫ ﺎﺑ نﺎﻣرد ﺖﺤﺗ تﻻﻼـﺘﺧا یدﻮﺒﻬـﺑ رد ﻪـﯿﻠﮐ ﺪـﻧﻮﯿﭘ ﺮـﺛا ،ﺲـﮑﻋ ﺮـﺑ .دﻮــﺑ هﺪﺷ ﺮﺗﺶﯿﺑ نآ تﺪﺷ ﯽﺘﺣ ﯽﻫﺎﮔ و دﻮﺑ هداﺪﻧ خر ﺎﻫنآ هﺪـﯾد ﺪــﻧﻮﯿﭘ نارود ﻞﯾاوا رد ،ﺐﺳﺎﻨﻣ ﺮﺛا ﻦﯾا تﺎﻘﯿﻘﺤﺗ ﺐﻠﻏا ﺞﯾﺎﺘﻧ ﻖﺒﻃ ﺎﻣا ﺖﺳا هدﻮﺑ ﺮﺗﺮﯿﮔﻢﺸﭼ و ﺮﺘﻬﺑ ﯽﯾاﻮﻨﺷ هﺪـﺷ ﺰﯿـﻧ ﺮـﺗﺪﺑ ﯽـﺘﺣ ﺎــﯾ ﻪﺘﺸﮔ ﺮﻫﺎﻇ دﺪﺠﻣ رﻮﻃ ﻪﺑ نارﺎﻤﯿﺑ ﻦﯾا رد ﯽﯾاﻮﻨﺷ تﻻﻼﺘﺧا نﺎﻣز ﺖﺷﺬﮔ ﺎﺑ و دﻮﺷﯽﻣ رد ﻪــﻄﺑار ﻦﯾا رد هﺪﺷ مﺎﺠﻧا تﺎﻌﻟﺎﻄﻣ داﺪﻌﺗ ندﻮﺑ ﻢﮐ و نﺎﮐدﻮﮐ ﯽﻨﺳ هوﺮﮔ رد ﯽﯾاﻮﻨﺷ ﺖﯿﻤﻫا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ .ﺖﺳا رد هﺪـﺷ مﺎـﺠﻧا یﺎﻫﯽـﺳرﺮﺑ رد دﺎـﯾز تﺎـﻀﻗﺎﻨﺗ دﻮـﺟو ﻪـﺑ ﻪـﺟﻮﺗ ﺎـﺑ و ﻪـﯿﻠﮐ ﻦــﻣﺰﻣ ﯽﯾﺎﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ نﺎﮐدﻮﮐ تﻻﻼـﺘﺧا ﺶﻫﺎـﮐ رد ار ﻪـﯿﻠﮐ ﺪــﻧﻮﯿﭘ و ﺰﯿﻟﺎﯾد ﺮﺛا نﺎﮐدﻮﮐ رد یاﻪﻌﻟﺎﻄﻣ نداد مﺎﺠﻧا ﺎﺑ ﺎﺗ ﻢﯾﺪﺷ نآ ﺮﺑ ،نﻻﺎﺴﮔرﺰﺑ یاﺮـﺑ ار ﯽﺒـﺳﺎﻨﻣ ﯽﻧﺎــﻣرد شور ناﻮﺘﺑ ﺐﯿﺗﺮﺗ ﻦﯾﺪﺑ ﺎﺗ ،ﻢﯿﯾﺎﻤﻧ ﻪﺴﯾﺎﻘﻣ ﻢﻫ ﺎﺑ و هدﺮﮐ ﯽﺳرﺮﺑ نارﺎﻤﯿﺑ ﻦﯾا ﯽﯾاﻮﻨﺷ ﺮـﺛا ﯽــﺳرﺮﺑ ﻦﯾا رد .دﺮﮐ ﻦﯾﺰﮔیﺎﺟ و ﯽﯾﺎﺳﺎﻨﺷ ﯽﯾاﻮﻨﺷ ﺶﻫﺎﮐ ﻪﺑ ﻼﺘﺒﻣ نﺎﮐدﻮﮐ رد ﯽﯾاﻮﻨﺷ تﻻﻼﺘﺧا ندﺮﮐ ﻢﮐ ﻦــﻣﺰﻣ ﯽﯾﺎﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ کدﻮﮐ 35 رد ﯽﯾاﻮﻨﺷ لﻼﺘﺧا ﺶﻫﺎﮐ ﺮﺑ (ﺪﻧﻮﯿﭘ و ﺰﯿﻟﺎﯾدﻮﻤﻫ ،ﯽﺘﯾﺎﻤﺣ)ﻒﻠﺘﺨﻣ یﺎﻫنﺎﻣرد .ﺖـﻓﺮﮔ راﺮـﻗ ﯽﺑﺎـﯾزرا درﻮــﻣ ﺪﻧدﻮﺑ هدﺮﮐ ﻪﻌﺟاﺮﻣ ﺮﻐﺻاﯽﻠﻋ نﺎﺘﺳرﺎﻤﯿﺑ ﻪﺑ 1382 ﺎﺗ 1381 یﺎﻫلﺎﺳ ﻦﯿﺑ ﻪﮐ ﻪﯿﻠﮐ ﯽﻨــﺳ ﻦﯿﮕﻧﺎﯿﻣ .ﺪﺷ مﺎﺠﻧا ﺮﻔﻧ 1 ﻂﺳﻮﺗ ﻻﺎﺑ و ﻂﺳﻮﺘﻣ ،ﻦﯿﯾﺎﭘ ﺲﻧﺎﮐﺮﻓ 3 رد نارﺎﻤﯿﺑ ﻦﯾا رد یﺮﺘﻣﻮﯾدا رﻮﻈﻨﻣ ﻦﯾﺪﺑ .ﺪﻧﺪﺷﯽﻣ ﺰﯿﻟﺎﯾدﻮﻤﻫ %46 و هﺪﺷ ﻪﯿﻠﮐ ﺪﻧﻮﯿﭘ %34 و ﺪﻧدﻮﺑ ﯽﺘﯾﺎﻤﺣ نﺎﻣرد ﺖﺤﺗ ﺎﻫنآ %20 و دﻮﺑ لﺎﺳ 12 نارﺎﻤﯿﺑ هوﺮــﮔ 3 ﻦﯿﺑ یاﻪﻈﺣﻼﻣ ﻞﺑﺎﻗ فﻼﺘﺧا ﭻﯿﻫ و دﻮﺑ ﻻﺎﺑ ﺲﻧﺎﮐﺮﻓ رد نارﺎﻤﯿﺑ ﻦﯾا رد ﯽﯾاﻮﻨﺷ ﺶﻫﺎﮐ ﻪﺟرد ﻦﯾﺮﺗﺶﯿﺑ .ﺪﻣﺎﯿﻧ ﺖﺳد ﻪﺑ ﯽﯾاﻮﻨﺷ لﻼﺘﺧا ﺮﻈﻧ زا رﺎﻤﯿﺑ ﯽﯾاﻮﻨﺷ – 5 ﻪﯿﻠﮐ ﻦﻣﺰﻣ ﯽﯾﺎﺳرﺎﻧ – 4 ﺰﯿﻟﺎﯾدﻮﻤﻫ – 3 یﺮﺘﻣﻮﯾدا – 2 ﺪﻧﻮﯿﭘ – 1 :ﺎﻫهژاوﺪﯿﻠﮐ
.1382 لﺎﺳ ﺶﮐﻮﺗا ﻦﺴﺣ ﺮﺘﮐد ﯽﯾﺎﻤﻨﻫار ﻪﺑ نﺎﮐدﻮﮐ یﺎﻫیرﺎﻤﯿﺑ ﯽﺼﺼﺨﺗ یاﺮﺘﮐد ﺖﻓﺎﯾرد ﺖﻬﺟ یزردﻮﮔ ﻪﻧﺎﺸﺧر ﺮﺘﮐد ﻪﻣﺎﻧ نﺎﯾﺎﭘ زا ﺖﺳا یاﻪﺻﻼﺧ ﻪﻟﺎﻘﻣ ﻦﯾا
(لﻮﺌﺴﻣ ﻒﻟﻮﻣ*).ناﺮﯾا ﯽﻧﺎﻣرد ـ ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﺮﻔﻇ نﺎﺑﺎﯿﺧ ،ﺮﻐﺻاﯽﻠﻋ تﺮﻀﺣ نﺎﺘﺳرﺎﻤﯿﺑ ،نﺎﮐدﻮﮐ ﻪﯿﻠﮐ یﺎﻫیرﺎﻤﯿﺑ ﺺﺼﺨﺗقﻮﻓ و رﺎﯾدﺎﺘﺳا (I
.ناﺮﯾا ﯽﻧﺎﻣرد ـ ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﯽﺸﺨﺑناﻮﺗ هﺪﮑﺸﻧاد ،ﯽﻨﯿﺑ و ﻖﻠﺣ و شﻮﮔ ﯽﺣاﺮﺟ رﺎﯾدﺎﺘﺳا (II
.ناﺮﯾا ﯽﻧﺎﻣرد ـ ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،نﺎﮐدﻮﮐ یﺎﻫیرﺎﻤﯿﺑ رﺎﯾدﺎﺘﺳا (III .نﺎﮐدﻮﮐ یﺎﻫیرﺎﻤﯿﺑ ﺺﺼﺨﺘﻣ (IV
.یﺮﺘﻣﻮﯾدا ﺪﺷرا سﺎﻨﺷرﺎﮐ (V
ﻪﻣﺪﻘﻣ ﻦــﯿﻟوا ﻪﯿﻠﮐ ﯽﯾﺎﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ رد ﯽﯾاﻮﻨﺷ تﻻﻼﺘﺧا
تﺎــﻌﻟﺎﻄﻣ رد .ﺪﺷ شراﺰﮔ 1924 لﺎﺳ رد Graphe ﻂﺳﻮﺗ رﺎﺑ
ﯽﻨــﺳ هوﺮــﮔ رد ﯽﯾاﻮﻨــﺷﺎﻧ ﻒـــﻠﺘﺨﻣ تﺎـﺟرد ،هﺪـﺷ مﺎـﺠﻧا (2 و1).ﺖﺳا هﺪﺷ نﺎﯿﺑ %20-87 نﻻﺎﺴﮔرﺰﺑ و (3)ﻪــﺘﻓﺮﮔ ترﻮـﺻ ﺮـﺗﻢﮐ نﺎـﮐدﻮﮐ رد ﯽـﺳرﺮﺑ عﻮـﻧ ﻦـﯾا رد ﻪـﮐ یرﻮــﻃ ﻪﺑ دراد دﻮﺟو ﻪﻨﯿﻣز ﻦﯾا رد ﯽﺗوﺎﻔﺘﻣ یﺎﻫرﺎﻣآ
ﺖـﺤﺗ نﺎـﮐدﻮﮐ زا %8/6 ،EDTA ﻂـﺳﻮﺗ هﺪــﺷ مﺎﺠﻧا ﯽﺳرﺮﺑ
ﻞﮑــــﺸﻣ (Renal replacement therapy)RRT نﺎــﻣرد
ناﺰﯿـﻣ ﻦـﯾا ﺮـﮕﯾد تﺎـﻌﻟﺎﻄﻣ رد ﻪـﮐ ﯽﻟﺎــﺣ رد ﺪﻨﺘﺷاد ﯽﯾاﻮﻨﺷ ﻪــﻄﺑار رد ﯽﻧﻮﮔﺎﻧﻮﮔ ﻞﻠﻋ .ﺖﺳا هﺪﺷ ﺮﮐذ (5)%38/2 و (4)%14/7 هﺪــﺷ نﺎﯿﺑ ﻪﯿﻠﮐ ﯽﯾﺎﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ ﯽﯾاﻮﻨﺷ تﻼﮑﺸﻣ ﺎﺑ ﻢﯿﺳﺎﺘﭘ و ﻢﯾﺪﺳ لدﺎﻌﺗ تﻻﻼﺘﺧا ،(6)ﯽﻣروا :زا ﺪﻨﺗرﺎﺒﻋ ﻪﮐ ﺖﺳا زا هدﺎﻔﺘـﺳا ،(10 و9)ﯽـﻧﻮﺧﻢﮐ ،(8 و7)ﯽﺘﯿﻟوﺮﺘﮑﻟا ﯽﮕﺘﺨﯾر ﻢﻫ ﻪﺑ و زوﺮـــﺑ ،ﺎـﻫﮏﯿﺗرﻮﯾد ﻪـﻠﻤﺟ زا نﻮـﺧ رﺎـﺸﻓ هﺪﻨﻫﺎـﮐ یﺎـﻫوراد نارﺎـﻤﯿﺑ ﻦـﯾا رد ﻪـﯿﻠﮐ ﯽﯾﺎـﺳرﺎﻧ نﺎــﯾﺮﺟ رد ﺎﻫﺖﻧﻮﻔﻋ ﺮﺗﺶﯿﺑ ﺮــﺗﺶﯿﺑ فﺮــﺼﻣ ﻪــﺠﯿﺘﻧ رد و یدﺎــﻋ ﺖـــﯿﻌﻤﺟ ﻪـﺑ ﺖﺒـﺴﻧ ﯽﺷﺎﻧ ﯽﻗوﺮﻋ تﺎﻌﯾﺎﺿ ،ﺎﻫﺪﯾزﻮﮑﯿﻠﮔﻮﻨﯿﻣآ ﺪﻨﻨﻧﺎﻣ ﺎﻫﮏﯿﺗﻮﯿﺑﯽﺘﻧآ ،(12 و11)ﯽﻤﻟﺎــﮐﺮﭙﯿﻫ ،(11)داﺮــﻓا ﻦــﯾا رد ﻻﺎـــﺑ نﻮـﺧ رﺎـﺸﻓ زا ﯽـﻧﻮﮔﺎـﻧﻮﮔ ﺞﯾﺎــﺘﻧ .(14)ﯽﻤﯿﭙﯿﻟﺮﭙﯿﻫ ،(13)ﺎﻤﺳﻼﭘ ﻪﺘﯾزﻮﮑﺴﯾوﺮﭙﯿﻫ ﯽﯾﺎــﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ ﯽﯾاﻮﻨﺷ ﺮﺑ ﺰﯿﻟﺎﯾدﻮﻤﻫ ﺮﺛا درﻮﻣ رد ﺎﻫﯽـــﺳرﺮﺑ ﻦـﯾا زا ﯽـﺧﺮﺑ .ﺖـﺳا هﺪـﺷ شراﺰـﮔ ﻪـﯿﻠﮐ ﻦـﻣﺰﻣ تﻻﻼـﺘﺧا یاﺮـﺑ ﺮـﻀﻣ ﺎـﯾ ﺮﯿﺛﺎـﺗ نوﺪــﺑ ﯽﻧﺎﻣرد ار ﺰﯿﻟﺎﯾدﻮﻤﻫ ﺰﯿــﻧ یﺮـﮕﯾد تﺎـﻌﻟﺎﻄﻣ (14-19).ﺪـﻨﻧادﯽﻣ نارﺎـﻤﯿﺑ ﻦـﯾا ﯽﯾاﻮﻨـﺷ ﯽﯾاﻮﻨﺷﺎﻧ دﻮﺒﻬﺑ رد ﺮﺛﻮﻣ ﯽﺷور ار ﺰﯿﻟﺎﯾدﻮﻤﻫ ﻪﮐ ﺪﻧراد دﻮﺟو یﺎﻫنﺎﻣرد زا ﻪﯿﻠﮐ ﺪﻧﻮﯿﭘ (21 و20 ،13)
.ﺪﻧاهدﺮﮐ ﯽﻓﺮﻌﻣ نارﺎﻤﯿﺑ ﻦﯾا .ﺪﺷﺎﺑﯽﻣ ﻪﯿﻠﮐ ﯽﯾﺎﺳرﺎﻧ رد ﺮﺛﻮﻣ و ﺪﯾﺪﺟ ﯽﻧﺎـﻣرد شور ﻦـﯾا ﺮــﺛا درﻮﻣ رد ﻪﮐ ﯽﯾﺎﻫﯽﺳرﺮﺑ ﺐﻠﻏا رد عﻮــﻧ ﻦﯾا ﺖﺳا هﺪﺷ مﺎﺠﻧا نﻻﺎﺴﮔرﺰﺑ رد ﯽﯾاﻮﻨﺷ تﻼﮑﺸﻣ ﺮﺑ ﯽﯾاﻮﻨـﺷ تﻻﻼــﺘﺧا ﺮﺑ نﺎﻣرد ﯽﯾاﺪﺘﺑا ﻞﺣاﺮﻣ رد ﻞﻗاﺪﺣ نﺎﻣرد ،سرﺮـــﯾد ﻞـﺣاﺮﻣ رد ﺎـﻣا (23 و22 ،5)
ﺖـﺳا هدﻮـﺑ ﺮـﺛﻮﻣ رﺎﯿـﺴﺑ تاﺮﯿــﯿﻐﺗ نآ ﺖـﻠﻋ ﻪـﮐ دﻮـﺑ ﻪﺘـﺸﮔزﺎـﺑ نارﺎـﻤﯿﺑ رد ﯽﯾاﻮﻨـﺷﺎﻧ ،(ﺎﻫﺪﯿﯾوﺮﺘــﺳا فﺮﺼﻣ لﺎﺒﻧد ﻪﺑ)ﯽﻣﺪﯿﭙﯿﻟﺮﭙﯿﻫ زا ﯽﺷﺎﻧ ﯽﻗوﺮﻋ هﺪـﺷ ﺮـﮐذ ﻪـﯿﻠﮐ ﻪــﯿﻟوا یرﺎﻤﯿﺑ دﻮﻋ و ﺎﻫﮏﯿﺴﮐﻮﺗﻮﺗا فﺮﺼﻣ رد و هدﻮـﺑ ﻢﻬـﻣ رﺎﯿـﺴﺑ نﺎـﮐدﻮﮐ رد ﯽــﻌﯿﺒﻃ ﯽﯾاﻮﻨﺷ (5).ﺖﺳا
ﻒـﻠﺘﺨﻣ تﺎــﻋﻮﺿﻮﻣ شزﻮﻣآ و ﯽﻃﺎﺒﺗرا یﺎﻫترﺎﻬﻣ یﺮﯿﮔدﺎﯾ رد ﺮـﮕﯾد یﻮـﺳ زا .دراد یدﺎﯾز ﺖﯿﻤﻫا ﯽﻨﺳ هوﺮﮔ ﻦﯾا رد یﻮـﯿﻠﮐ ﻦـﯾﺰﮔیﺎـﺟ یﺎـﻫنﺎﻣرد ﯽــﮐدﻮﮐ نارود رد ﻪﮐ یداﺮﻓا ﻪــﮐ ﻒﻠﺘﺨﻣ ﯽﻧاﻮﺗﺎﻧ درﻮﻣ ﺪﻨﭼ ﺎﯾ 1 دﻮﺷﯽﻣ عوﺮﺷ ﺎﻫنآ یاﺮﺑ ،ﺪﻨﺘـﺴﻫ ﯽﯾاﻮﻨـﺷ و ﯽـﻨﻫذ ،رﻮـﺗﻮﻣ تﻻﻼــﺘﺧا ﺎﻫنآ ﻦﯾﺮﺗﻊﯾﺎﺷ ﺮـﺛا درﻮـﻣ رد ﻪـﮐ ﯽـﻧﻮﮔﺎـﻧﻮﮔ تﺎــﻌﻟﺎﻄﻣ ﻦﯿﺑ زا .دﻮﺷﯽﻣ هﺪﯾد ،هﺪـﺷ مﺎـﺠﻧا ﯽﯾاﻮﻨـﺷ ﺮـﺑ ﻪـﯿﻠﮐ ﻦـــﻣﺰﻣ ﯽـﯾﺎﺳرﺎﻧ یﺎﻫنﺎﻣرد .ﺖــﺳا هدﻮـﺑ نﺎـﮐدﻮﮐ ﯽــﻨﺳ هوﺮـﮔ ﻪـﺑ طﻮـﺑﺮﻣ ﯽـﻤﮐ داﺪـﻌﺗ صﻮــﺼﺧ ﻪﺑ نﻻﺎﺴﮔرﺰﺑ رد هﺪﺷ مﺎﺠﻧا یﺎﻫﯽﺳرﺮﺑ ﻦﯿﻨﭼﻢﻫ نﺎـﺸﻧ ﻪـﮐ ﺪــﺷﺎﺑﯽﻣ یدﺎﯾز ﺾﻗﺎﻨﺗ یاراد ﺰﯿﻟﺎﯾد ﺮﺛا درﻮﻣ رد ﯽﻨــﺳ هوﺮﮔ ﻦﯾا رد ﺮﺗﺶﯿﺑ تﺎﻌﻟﺎﻄﻣ نﺪﺷ مﺎﺠﻧا ﻪﺑ زﺎﯿﻧ هﺪﻨﻫد .ﺪﺷﺎﺑﯽﻣ رد ﯽـﺳرﺮﺑ ﺎـﺗ ﺪـﺷ ﻪـﺘﻓﺮﮔ ﻢـﯿﻤﺼﺗ ﺐــﻠﻄﻣ ﻦﯾا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﺶﻫﺎﮐ ناﺰﯿﻣ ﺮﺑ ﻪﯿﻠﮐ ﻦﯾﺰﮔیﺎﺟ یﺎﻫنﺎﻣرد و ﯽﻣروا ﺮﺛا درﻮﻣ ﺮــﺛا نﺎﮐدﻮﮐ ﯽﻨﺳ هوﺮﮔ رد ﺐﯿﺗﺮﺗ ﻦﯾﺪﺑ ﺎﺗ دﻮﺷ مﺎﺠﻧا ﯽﯾاﻮﻨﺷ و هﺪــﺷ ﯽﺑﺎﯾزرا ﯽﯾاﻮﻨﺷ لﻼﺘﺧا نﺎﻣرد رد ﺰﯿﻟﺎﯾدﻮﻤﻫ و ﺪﻧﻮﯿﭘ .ددﺮﮔ ﻪﺴﯾﺎﻘﻣ ﻢﻫ ﺎﺑ
ﯽﺳرﺮﺑ شور ﻪـﮐ ﻪﯿﻠﮐ ﻦﻣﺰﻣ ﯽﯾﺎﺳرﺎﻧ ﻪﺑ ﻼﺘﺒﻣ رﺎﻤﯿﺑ 35 یور ﻪﻌﻟﺎﻄﻣ ﻦﯾا تﺮــﻀﺣ نﺎـــﮐدﻮﮐ نﺎﺘـﺳرﺎﻤﯿﺑ ﻪـﺑ 1382 ﺎـﺗ 1381 لﺎـﺳ زا ﻪﺑ نارﺎﻤﯿﺑ ﻦﯾا .ﺖﻓﺮﮔ ترﻮﺻ ،ﺪﻧدﻮﺑ هدﺮﮐ ﻪﻌﺟاﺮﻣ ﺮﻐﺻاﯽﻠﻋ ﺎـﺑ ﯽﺘﯾﺎـﻤﺣ نﺎـﻣرد ﺖـﺤﺗ لوا هوﺮــﮔ ﻪﮐ ﺪﻧﺪﺷ ﻢﯿﺴﻘﺗ هوﺮﮔ 3 ﺎـﺑ نﺎـﻣرد ﺖـﺤﺗ مود هوﺮـﮔ ،ﺪﻨﺘـﺷاد راﺮــﻗ یﻮﯿﻠﮐ یﺎﻫﻞﻤﮑﻣ ﻪﺑ ﻞﻗاﺪﺣ و ﺖﻋﺎﺳ 3 رﺎﺑ ﺮﻫ و ﻪﺘﻔﻫ رد رﺎﺑ 3)ﺪﻧدﻮﺑ ﺰﯿﻟﺎﯾدﻮﻤﻫ ﺎـﻫنآ ﻪـﯿﻠﮐ ﺪـﻧﻮﯿﭘ زا هﺎــﻣ 6 ﻞﻗاﺪﺣ مﻮﺳ هوﺮﮔ و (هﺎﻣ 6 تﺪﻣ ﻪـﮐ یداﺮـﻓا ،ترﻮـﭙﻟآ مرﺪﻨـﺳ ﻪـﺑ ﻼـﺘﺒﻣ نارﺎــﻤﯿﺑ .دﻮﺑ ﻪﺘﺷﺬﮔ یﺮـﮐ رﺎـﭼد ﻪــﮐ یداﺮﻓا و ﺪﻧدﻮﺑ ﻪﺘﻓﺮﮔ ﮏﯿﺴﮐﻮﺗﻮﺗا یﺎﻫوراد .ﺪﻧﺪﺷ جرﺎﺧ ﻪﻌﻟﺎﻄﻣ زا ،ﺪﻧدﻮﺑ ﯽﺘﯾاﺪﻫ دﺮﻓ ﮏﯾ ﻂﺳﻮﺗ یﺮﺘﻣﻮﯾدا ،ﻪﻌﻟﺎﻄﻣ ﻪﺑ هﺪﺷ دراو نارﺎﻤﯿﺑ رد 250 هدوﺪـﺤﻣ رد)ﻻﺎــﺑ و ﻂﺳﻮﺘﻣ ،ﻦﯿﯾﺎﭘ ﺲﻧﺎﮐﺮﻓ 3 رد و ﺮﻫﺎﻣ ﻪــﺑ نارﺎـــﻤﯿﺑ ،ﺲﻧﺎـﮐﺮﻓ ﺮـﻫ رد .ﺪـﺷ مﺎـﺠﻧا (ﺰـﺗﺮﻫ 8000 ﺎـﺗ و ﻂـﺳﻮﺘﻣ ﯽﯾاﻮﻨـﺷﻢﮐ ،ﻒـﯿﻔﺧ ﯽﯾاﻮﻨــﺷﻢﮐ ،ﯽﻌﯿﺒﻃ یﺎﻫهوﺮﮔ
1 3
یاهﺪﻫﺎــﺸﻣ عﻮﻧ زا ﻪﻌﻟﺎﻄﻣ ﻦﯾا .ﺪﻧﺪﺷ ﻢﯿﺴﻘﺗ ﺪﯾﺪﺷ ﯽﯾاﻮﻨﺷﻢﮐ نﻮــﺳﺮﯿﭘ ﻪﻄﺑار ﮏﻤﮐ ﺎﺑ SPSS ﻂﺳﻮﺗ ﺎﻫهداد و دﻮﺑ ﯽﻌﻄﻘﻣ و .ﺪﻧﺪﯾدﺮﮔ ﻞﯿﻠﺤﺗ و ﻪﯾﺰﺠﺗ
ﺞﯾﺎﺘﻧ زا ﻪـﮐ ﺪــﻨﺘﻓﺮﮔ راﺮﻗ ﯽﺳرﺮﺑ درﻮﻣ رﺎﻤﯿﺑ 35 ﻪﻌﻟﺎﻄﻣ ﻦﯾا رد ﺮــﺴﭘ (%45/7)رﺎـﻤﯿﺑ 16 و ﺮﺘـﺧد (%54/3)ﺮـﻔﻧ 19 داﺪـﻌﺗ ﻦـﯾا ﺎﻫنآ ﯽﻨﺳ ﻦﯿﮕﻧﺎﯿﻣ و لﺎﺳ 18 ﺎﺗ 5 ﺎﻫنآ ﯽﻨﺳ هدوﺪﺤﻣ .ﺪﻧدﻮﺑ ﺖـﺤﺗ (%20)رﺎـﻤﯿﺑ ﺖــﻔﻫ .دﻮﺑ 3/67 رﺎﯿﻌﻣ فاﺮﺤﻧا ﺎﺑ لﺎﺳ 12 ﺰﯿﻟﺎــﯾدﻮﻤﻫ (%45/7)ﺮـــﻔﻧ 16 ،ﺪﻨﺘـﺷاد راﺮـﻗ ﯽﺘﯾﺎـﻤﺣ نﺎـﻣرد رد .ﺪــﻧدﻮﺑ هﺪـــﺷ ﻪـﯿﻠﮐ ﺪـﻧﻮﯿﭘ (%34/4)رﺎـﻤﯿﺑ 12 و ﺪﻧﺪـﺷﯽﻣ ﺮـﻔﻧ 1 و ﺰﯿﻟﺎـﯾد هوﺮــﮔ رد ﺮـﻔﻧ 1 ﻦـﯿﯾﺎﭘ ﺲﻧﺎﮐﺮﻓ ﺎﺑ یﺮﺘﻣﻮﯾدا ﻦـﯿﻤﻫ رد .ﺪﻨﺘـﺷاد ﻪــﻓﺮﻃ 2 ﻒﯿﻔﺧ ﯽﯾاﻮﻨﺷﻢﮐ ،ﺪﻧﻮﯿﭘ هوﺮﮔ رد ﺮـﻔﻧ 1 ﺪــﻧدﻮﺑ ﯽـﺘﯾﺎﻤﺣ نﺎﻣرد ﺖـﺤﺗ ﻪـﮐ ﯽـﻫوﺮﮔ رد ،ﺲﻧﺎﮐﺮﻓ رد .ﺖــﺷاد (ﭗــﭼ شﻮــﮔ رد)ﻪـــﻓﺮﻃ 1 ﻂـﺳﻮﺘﻣ ﯽﯾاﻮﻨـﺷﻢﮐ درﻮﻣ 2 ﺰﯿﻟﺎﯾد ﺖﺤﺗ نارﺎﻤﯿﺑ رد ،ﻂﺳﻮﺘﻣ ﺲﻧﺎﮐﺮﻓ ﺎﺑ یﺮﺘﻣﻮﯾدا 2 ﻒـﯿﻔﺧ ﯽﯾاﻮﻨـﺷﻢﮐ نآ درﻮــﻣ 1 ﻪﮐ ﺪﺷ شراﺰﮔ ﯽﯾاﻮﻨﺷ ﻢﮐ رد .دﻮـﺑ ﻪـﻓﺮﻃ 1 و ﻂـﺳﻮﺘﻣ ﯽﯾاﻮﻨـﺷﻢﮐ ﺮــﮕﯾد درﻮﻣ و ﻪﻓﺮﻃ لﻼـﺘﺧا و رﺎـﻤﯿﺑ 1 رد ﻪــﻓﺮﻃ 1 ﻒﯿﻔﺧ ﯽﯾاﻮﻨﺷﻢﮐ ،ﺪﻧﻮﯿﭘ هوﺮﮔ هﺪﻫﺎـﺸﻣ ﺮـﮕﯾد رﺎــﻤﯿﺑ 1 رد ﻪﻓﺮﻃ 1 و ﻂﺳﻮﺘﻣ عﻮﻧ زا ﯽﯾاﻮﻨﺷ ﺰﯿﻟﺎـﯾد هوﺮـﮔ رﺎــﻤﯿﺑ 5 رد ﻻﺎﺑ ﺲﻧﺎﮐﺮﻓ ﺎﺑ یﺮﺘﻣﻮﯾدارد .ﺪﯾدﺮﮔ 2 ﻒﯿﻔﺧ ﯽﯾاﻮﻨﺷﻢﮐ ﺎﻫنآ زا ﺮﻔﻧ 2 ﻪﮐ ﺖﺷاد دﻮﺟو ﯽﯾاﻮﻨﺷﻢﮐ ﺮــﻔﻧ 1 ،ﻪــﻓﺮﻃ 1 ﻒــﯿﻔﺧ ﯽﯾاﻮﻨـــﺷﻢﮐ ﺮـﮕﯾد ﺮـﻔﻧ 1 و ﻪـﻓﺮﻃ و ﻪــﻓﺮﻃ 1 ﯽﯾاﻮﻨـﺷﻢﮐ ﺮـﻔﻧ 1 و ﻪـﻓﺮﻃ 1 ﻂـﺳﻮﺘﻣ ﯽﯾاﻮﻨـﺷﻢﮐ .ﺪﻨﺘﺷاد ﺪﯾﺪﺷ ،یﺰـــﯿﻟﺎﯾد رﺎـﻤﯿﺑ 16 زا درﻮـﻣ 2 رد ،ﻦــﯿﯾﺎﭘ ﺲــﻧﺎﮐﺮﻓ رد ﺖـﺤﺗ رﺎـﻤﯿﺑ 7 زا درﻮـﻣ 1 و هﺪــﺷ ﺪﻧﻮﯿﭘ رﺎﻤﯿﺑ 12 زا درﻮﻣ 2 یرﺎـﻣآ ﺮـﻈﻧ زا ﻪـﮐ ﺖـﺷاد دﻮـﺟو ﯽﯾاﻮﻨﺷﻢﮐ ،ﯽﺘﯾﺎﻤﺣ نﺎﻣرد .(Pv>0/05)ﺪـﯾدﺮﮕﻧ هﺪﻫﺎـﺸﻣ ﺎــﻫنآ ﻦﯿﺑ ﯽﻬﺟﻮﺗ ﻞﺑﺎﻗ فﻼﺘﺧا درﻮـﻣ 2 و یﺰﯿﻟﺎــﯾد رﺎﻤﯿﺑ 16 زا درﻮﻣ 2 ﻂﺳﻮﺘﻣ ﺲﻧﺎﮐﺮﻓ رد زا ﮏـﯾ ﭻـﯿﻫ ﺎـﻣا ﺪﻨﺘـﺷاد ﯽﯾاﻮﻨـﺷﻢﮐ هﺪــﺷ ﺪﻧﻮﯿﭘ رﺎﻤﯿﺑ 12 زا ﺎـﻫنآ رد ﯽﯾاﻮﻨـﺷﻢﮐ ،ﺪﻧﺪـﺷﯽﻣ ﯽﺘﯾﺎـﻤﺣ نﺎــﻣرد ﻪﮐ ﯽﻧارﺎﻤﯿﺑ ﻞﺑﺎـﻗ توﺎـﻔﺗ یرﺎــﻣآ ﺮﻈﻧ زا ﺰﯿﻧ هوﺮﮔ ﻦﯾا رد ﻪﮐ ﺪﺸﻧ شراﺰﮔ رﺎـﻤﯿﺑ 16 زا درﻮـﻣ 5 ﻻﺎــﺑ ﺲﻧﺎﮐﺮﻓ رد .ﺖﺷاﺪﻧ دﻮﺟو ﯽﻬﺟﻮﺗ 7 زا درﻮـﻣ 1 و هﺪـﺷ ﺪـﻧﻮﯿﭘ رﺎـﻤﯿﺑ 12 زا درﻮــﻣ 4 و یﺰﯿﻟﺎﯾد
ﺮـﻈﻧ زا ﻪـﮐ ﺪﻨﺘـﺷاد ﯽﯾاﻮﻨـﺷﻢﮐ ،ﯽـــﺘﯾﺎﻤﺣ نﺎﻣرد ﺖﺤﺗ رﺎﻤﯿﺑ ﺖـﺳد ﻪــﺑ ﺎﻫنآ ﻦﯿﺑ یرادﯽﻨﻌﻣ فﻼﺘﺧا ﯽﯾاﻮﻨﺷ لﻼﺘﺧا عﻮﯿﺷ هﺪﺷ ﺪﻧﻮﯿﭘ رﺎﻤﯿﺑ 4 ،یﺰﯿﻟﺎﯾد رﺎﻤﯿﺑ 5 ﺎﻫﺲﻧﺎﮐﺮﻓ مﺎﻤﺗ رد .ﺪﻣﺎﯿﻧ فﻼﺘﺧا ﻪﮐ ﺪﻨﺘﺷاد ﯽﯾاﻮﻨﺷﻢﮐ ،ﯽﺘﯾﺎﻤﺣ نﺎﻣرد ﺖﺤﺗ رﺎﻤﯿﺑ 1 و ﻪـﻌﻟﺎﻄﻣ ﻦـﯾا رد .ﺖـﺷاﺪﻧ دﻮـﺟو ﺎــﻫنآ ﻦﯿﺑ یرادﯽﻨﻌﻣ یرﺎﻣآ (شﻮــﮔ 70)ﺎـﻫشﻮﮔ مﺎـﻤﺗ رد ﻪـﻧﺎﮔاﺪـﺟ رﻮـﻃ ﻪـﺑ ﯽﯾاﻮﻨـﺷﻢﮐ عﻮﯿﺷ ﺮﻈﻧ زا ﯽﺗوﺎﻔﺗ هوﺮﮔ 3 رد ﻪﻄﺑار ﻦﯾا رد ﻪﮐ ﺪﺷ ﯽﺑﺎﯾزرا .ﺪﯾدﺮﮕﻧ هﺪﻫﺎﺸﻣ ﯽﯾاﻮﻨﺷﻢﮐ
ﺚﺤﺑ ﻪﯾﺎﭘ ﺢﻄﺳ ندروآ ﺖﺳد ﻪﺑ رﻮﻈﻨﻣ ﻪﺑ ﻪﮐ ﯽﻌﻄﻘﻣ ﻪﻌﻟﺎﻄﻣ ﻦﯾا ﻊـﯾزﻮﺗ ،ﺪـﺷ مﺎــﺠﻧا ﻪﯿﻠﮐ ﻦﻣﺰﻣ ﯽﯾﺎﺳرﺎﻧ رد ﯽﯾاﻮﻨﺷﻢﮐ ناﺰﯿﻣ ﺮـــﻈﻧ زا ار ﺞﯾﺎـﺘﻧ ﺖـﺤﺻ ﺐـﻠﻄﻣ ﻦـﯾا ﻪـﮐ دﻮـﺑ ﯽـﻌﯿﺒﻃ ﯽﻨـﺳ رد هﺪــﺷ مﺎﺠﻧا ﯽﺳرﺮﺑ رد .ﺪﻨﮐﯽﻣ ﺮﺗﺶﯿﺑ ﻪﻌﻣﺎﺟ ﺎﺑ ﯽﻧاﻮﺧﻢﻫ ﻪـــﮐ ﯽﻧارﺎـﻤﯿﺑ رد ﯽﯾاﻮﻨـﺷﻢﮐ ناﺰﯿـﻣ ،ﺮـﻐﺻاﯽﻠﻋ نﺎﺘـﺳرﺎﻤﯿﺑ ﺪـﻧدﻮﺑ ﯽﺘﯾﺎــﻤﺣ نﺎﻣرد ﺖﺤﺗ ﻪﮐ ﯽﻫوﺮﮔ ﺎﺑ ﺪﻧﺪﺷﯽﻣ ﺰﯿﻟﺎﯾدﻮﻤﻫ ﻪـﮐ ﯽﺗﺎـﻌﻟﺎﻄﻣ ﺮﯾﺎـﺳ ﺎـﺑ ﺐـﻠﻄﻣ ﻦــﯾا ﻪﮐ ﺖﺷاﺪﻧ یزرﺎﺑ توﺎﻔﺗ نارﺎـﻤﯿﺑ ﻦـﯾا رد ﯽﯾاﻮﻨــﺷ تﻻﻼﺘﺧا ﺮﺑ ﺮﺛﻮﻣ ﯽﻧﺎﻣرد ار ﺰﯿﻟﺎﯾد
(23-25 ،19 ،5)
.دراد ﺖﻘﺑﺎﻄﻣ ،ﺪﻨﻧادﯽﻤﻧ ﻪـﺑ ﻼـﺘﺒﻣ نارﺎــﻤﯿﺑ ﯽﯾاﻮﻨﺷ ﺮﺑ ﺰﯿﻟﺎﯾد ﺮﺛا تﺎﻌﻟﺎﻄﻣ زا ﯽﺧﺮﺑ ار ﯽﻧﺎـﻣرد شور ﻦـﯾا ﻪـﮑﻠﺑ ﺪـﻨﻧادﯽﻤﻧ ﺖــﺒﺜﻣ ﺎﻬﻨﺗ ﻪﻧ ار ﯽﻣروا ﯽـﺧﺮﺑ رد (26 و15-18)
.ﺪــﻨﻨﮐﯽﻣ ﺮﮐذ ﺰﯿﻧ ﯽﯾاﻮﻨﺷﻢﮐ ﺪﯾﺪﺸﺗ ﻞﻣﺎﻋ ﻦـﯿﺑ زا و ﯽــﻗوﺮﻋ تاﺮﯿﯿﻐﺗ ار ﺐﻠﻄﻣ ﻦﯾا ﺖﻠﻋ ﺎﻫﯽﺳرﺮﺑ ﻦﯾا زا ،ﺰـــﯿﻟﺎﯾدﻮﻤﻫ نﺎـــﯾﺮﺟ رد ﯽــﺗﺮﮐ ﻮــﻀﻋ رد ﺎﻫلﻮﻠـﺳ ﻦـﺘﻓر ﻪـﺑ ﺰﯿﻟﺎـﯾد ﯽـﻃ ﯽﯾﺎﯿﻤﯿــﺷﻮﯿﺑ و ﯽﺘﯿﻟوﺮﺘﮑﻟا ،ﮏﯿﺗﻮﻤﺳا تاﺮﯿﯿﻐﺗ تﺎﻧﺎـﺳﻮﻧ (18 و16).ﺪـﻨﻧادﯽﻣ تﺪــﻣ ﯽﻧﻻﻮﻃ یﺎﻫﺰﯿﻟﺎﯾد صﻮﺼﺧ دﺎﺠﯾا ﺰـﯿﻟﺎﯾد نﺎـﯾﺮﺟ رد ﻪــﮐ ﮏــﯿﺗﻮﻤﺳا رﺎﺸﻓ و ﯽﺘﯿﻟﻻﻮﻤﺳا رد ﯽﯾاﻮﻨـﺷ ﻢـﮐ هﺪﻨﻨﮐ ﺪﯾﺪﺸﺗ ﻞﻣاﻮﻋ ﻦﯾﺮﺗﻢﻬﻣ زا ﯽﮑﯾ دﻮﺷﯽﻣ ﯽﺗﺎـﭘﻮﻟﺎﻔـﺴﻧا ﺪـﻧور ﺎـﺑ ﻪﺑﺎــﺸﻣ ﻪﺿرﺎﻋ ﻦﯾا .ﺖﺳا نارﺎﻤﯿﺑ ﻦﯾا
هﺪﯿﻣﺎـــﻧ reverse ureas syndrome و هدﻮــﺑ ﮏــﯿﻣروا
ﯽﯾاﻮﻨـﺷﻢﮐ ﻦﺘﻓﺎـﯾ تﺪــــﺷ ﺮــﮕﯾد ﻢﻬﻣ ﻞﻠﻋ زا (28 و27).دﻮﺷﯽﻣ رﺎـﺸﻓ ﻪـﺠﯿﺘﻧ رد و ﻢـﺠﺣ تاﺮﯿـﯿﻐﺗ ﻪــﺑ ناﻮﺗﯽﻣ ﺰﯿﻟﺎﯾد ﯽﻃ رد نآ دﺮـﮐﻞﻤﻋ و نوﺰـﻠﺣ ﻪﺑ ﯽــﻧﺎﺳرنﻮﺧ ﻪـﮐ دﺮﮐ هرﺎﺷا نﻮﺧ
و (hairy cell) ﯽــﯾﻮﻣ یﺎﻫلﻮﻠــﺳ مدا .ﺪــﻨﮐﯽﻣ ﻞــﺘﺨﻣ ار نﺎـــﯾﺮﺟ رد ﻪــﮐ (Supportive cells)ﻆﻓﺎــﺤﻣ یﺎﻫلﻮﻠــﺳ
و ﻢــﺠﺣ ﺶﻫﺎـﮐ و ﺪـﻫدﯽﻣ خر reverse ureas syndrome
زا (28).ﺖﺳا ﺮﺗﻊﯾﺎﺷ نﺎﮐدﻮﮐ رد ﺰﯿﻟﺎﯾدﻮﻤﻫ ﯽﻃ رد نﻮﺧ رﺎﺸﻓ ﻪـﮐ تﺎـﻌﻟﺎﻄﻣ زا ﯽـﻀﻌﺑ ﺎـﺑ ﺮﺿﺎــﺣ ﻪﻌﻟﺎﻄﻣ ﺞﯾﺎﺘﻧ ﺮﮕﯾد یﻮﺳ نارﺎـﻤﯿﺑ ﻦـﯾا ﯽﯾاﻮﻨـﺷ تﻻﻼـﺘﺧا ﺮـﺑ ﺮـﺛﻮﻣ ﯽﻧﺎــﻣرد ار ﺰﯿﻟﺎﯾد تﻻﻼـﺘﺧا ﺶﻫﺎـﮐ ﺖـﻠﻋ تﺎـﻌﻟﺎﻄﻣ ﻦــﯾا .دراد تﺮﯾﺎﻐﻣ ،ﺪﻨﻧادﯽﻣ ،ﯽــﻣروا ناﺰﯿـﻣ ﺶﻫﺎـﮐ ار ﺰﯿﻟﺎـﯾد ﺖـﺤﺗ نارﺎـﻤﯿﺑ رد ﯽﯾاﻮﻨـﺷ و Markowski J(29).ﺪﻨﻨﮐﯽﻣ ﺮﮐذ نﻮﺧ ﻢﯿﺳﺎﺘﭘ و ﺎﻫﻦﯿﺴﮐﻮﺗ ﯽـﻧﻮﺧﻢﮐ حﻼــﺻا ﻪﮐ ﺪﻧداد نﺎﺸﻧ 2002 لﺎﺳ رد یو نارﺎﮐﻢﻫ ﺮـﺑ ﯽﺒـﺳﺎﻨﻣ ﺮـﺛا ﺰﯿﻟﺎـﯾدﻮﻤﻫ رﺎــﻨﮐ رد ﻦﯿﺘﯾﻮﭘوﺮﺘﯾرا ﺰﯾﻮﺠﺗ ﺎﺑ ﺎﺑ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد ﺐﻠﻄﻣ ﻦﯾا ﻪﮐ دراد نارﺎﻤﯿﺑ ﻦﯾا ﯽﯾاﻮﻨﺷﻢﮐ هﺪـــﯾد ﺰﯿﻟﺎـﯾد ﺖـﺤﺗ نارﺎـﻤﯿﺑ رد ﯽـﻧﻮﺧﻢﮐ حﻼـﺻا ﻪـﺑ ﻪـﺟﻮﺗ ﺎـــﻫﯽﺳرﺮﺑ ﺐﻠﻏا رد ﯽﯾاﻮﻨﺷ ناﺰﯿﻣ ﺮﺑ ﻪﯿﻠﮐ ﺪﻧﻮﯿﭘ ﺮﺛا (30).ﺪﺸﻧ ﺮـﮐذ ﺮﯿـﮔﻢـﺸﭼ ﺪــﻧﻮﯿﭘ زا ﺪﻌﺑ ﻪﯿﻟوا ﻞﺣاﺮﻣ رد ﻞﻗاﺪﺣ و ﺖـﺒﺜﻣ زا ﺪــﻌﺑ ﯽـﻧﻻﻮﻃ تﺪـﻣ رد ﺎﻫﯽـﺳرﺮﺑ ﻦــﯾا ﻖﺒﻃ ﺎﻣا ﺖﺳا هﺪﺷ ﻪـﮐ ﺖـﺸﮔ ﺪـﻫاﻮﺧ زﺎـﺑ دﺪــﺠﻣ رﻮﻃ ﻪﺑ ﯽﯾاﻮﻨﺷ لﻼﺘﺧا ،ﺪـﻧﻮﯿﭘ لﺎـﺒﻧد ﻪـﺑ ﯽـﻣﺪﯿﭙﯿﻟﺮﭙﯿﻫ زا ﯽـﺷﺎﻧ ﯽـﻗوﺮﻋ تﻻﻼــﺘﺧا ،نآ ﺖﻠﻋ دﻮـﻋ و ﮏﯿـﺴﮐﻮﺗﻮﺗا یﺎــﻫوراد فﺮﺼﻣ ،ﺎﻫﺪﯿﯾوﺮﺘﺳا فﺮﺼﻣ (24 و5).ﺪﺷﺎﺑﯽﻣ یﻮﯿﻠﮐ یاﻪﻨﯿﻣز یرﺎﻤﯿﺑ ﺮـﺑ یﺮــﺛا تﺪﻣ زارد رد ﻪﯿﻠﮐ ﺪﻧﻮﯿﭘ ﺎﻫﯽﺳرﺮﺑ ﻦﯾا سﺎﺳاﺮﺑ رد صﻮـﺼﺧ ﻪـﺑ تﺎـﻌﻟﺎﻄﻣ زا ﯽــﺧﺮﺑ رد (24).دراﺪﻧ ﯽﯾاﻮﻨﺷﻢﮐ هﺪـﺷ ﺪﻧﻮﯿﭘ نﺎﮐدﻮﮐ رد ﯽﯾاﻮﻨﺷﻢﮐ ﻪﭼ ﺮﮔا نﺎﮐدﻮﮐ ﯽﻨﺳ هوﺮﮔ ﺎـﺑ یرادﯽـﻨﻌﻣ توﺎـﻔﺗ یرﺎـﻣآ ﺮـﻈﻧ زا ﺎــﻣا ﺖﺳا هدﻮﺑ ﺮﺗﺶﯿﺑ ﻦﯾا رد ﻪﮐ (5)ﺖﺷاﺪﻧ دﻮﺟو ﯽﺘﯾﺎﻤﺣ نﺎﻣرد ﺖﺤﺗ ﺎﯾ ﺰﯿﻟﺎﯾد هوﺮﮔ .دراد دﻮﺟو ﯽﻧاﻮﺧﻢﻫ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ ﺎﺑ ﻪﻨﯿﻣز
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The Evaluation of Hearing Loss and Audiometric Disorders in Patients with Chronic Renal Failure, Chronic Hemodialysis and Transplantation
Referred to Ali Asghar Pediatric Hospital from 2002 to 2003
I II III IV
*H. Otukesh, MD A. Moosavi, MD R. Hosseini, MD R. Goodarzi, MD
V
M. Roozbahani, MSc
Abstract
Hearing loss is an important complication in chronic renal failure. The etiology of hearing loss is various in these patients, but uremia is the most important cause(uremic neuropathy). Other etiologies include electrolyte disorders (hyperkalemia-hyponatremia), vascular disorders, susceptibility to infections, antibiotics (e.g. aminoglycosides) and antihypertensive drugs. Studies on the effects of renal replacement therapy on hearing disorders are various and occasionally contradictory. Most studies have demonstrated that hemodialysis reduces uremia, but it is an ineffective or even intensifying treatment for hearing loss.
On the contrary, renal transplantation is more remarkable in treatment of hearing disorders especially in early phase in most assessments However, it was also seen that hearing loss rebounds in later phases ( as much as previous degree or even more). Although hearing is an important sense in pediatric group, a few number of studies have been conducted on it in this group and the assessments in adults have also had various results. Therefore, it was decided to assess and compare hearing loss and its treatment in children with chronic renal failure undergoing dialysis or transplantation in order to be able to recognize the proper treatment for hearing loss in these children. 35 patients with chronic renal failure and hearing disorder who were treated by conservative hemodialysis or transplantation were assessed from 2002 to 2003 in Ali Asghar Hospital. Audiometry was performed in low, moderate and high frequency by an experienced person. The mean age was 12 years old. 20% of patients were treated by conservative therapy, 34% by hemodialysis and 46% of patients by transplantation. Hearing loss was prominent with high frequency and no significant difference was found between these groups regarding hearing disorder.
Key Words: 1) Transplantation 2) Audiometry 3) Hemodialysis 4) Chronic Renal Failure 5) Hearing
This article is a summary of the thesis by R. Goodarzi, MD for the degree of specialty in Pediatrics under supervision of H. Otukesh, MD(2003). It was also presented in the Annual Congress of Organ Transplantation held in Tehran(2004).
I) Assistant Professor of Pediatric Nephrology. Hazrat Ali Asghar Hospital, Zafar Ave. Iran University of Medical Sciences and Health Services.Tehran, Iran.(*Corresponding Author)
II) Assistant Professor of ENT. School of Rehabilitation. Iran University of Medical Sciences and Health Services.Tehran, Iran.
III) Assistant Professor of Pediatrics. Akbar Abadi Hospital. Iran University of Medical Sciences and Health Services.Tehran, Iran.
IV) Pediatrician.
V) MSc in Audiometry.
