ﻪﻣﺎﻨﻠﺼﻓ ﻲﺸﻫوﮋﭘ ﻲﻤﻠﻋ
هرود ،درد و ﻲﺷﻮﻬﻴﺑ 2
هرﺎﻤﺷ ، 5
ﺰﻴﻳﺎﭘ ، 1390
ﻲﻧﺎﻣرد كﻮﺷوﺮﺘﻜﻟا زا ﺲﭘ و ﻞﺒﻗ مﺮﺳ يﺎﻫ ﺖﻴﻟوﺮﺘﻜﻟا و نﻮﺧ ﺪﻨﻗ تاﺮﻴﻴﻐﺗ ﻲﺳرﺮﺑ
ﻲﻠﻋ ﻢﻴﻫاﺮﺑا ﺎﺿر ﻲﻧﺎﻄﻠﺳ
ﻲﻜﻠﻣ ﺪﻴﻫﺎﻧآ ،1
يزردﻮﮔ دادﺮﻬﻣ ،2
*
ﻢﺨﻓا وﺮﺴﺧ ،2
ﺪﻧﻮﺧآ ﻦﻴﻫﺎﺷ ،3
هداز ﻲﻤﻇﺎﻛ يدﺎﻫ ،4
،5
ﻲﺑﺎﺑرا رﺎﻳﺮﻬﺷ وﺮﻴﭘ ﷲاﺪﺒﻋ ،2
6
1 . نﺎﻛدﻮﻛ ﻲﺒﻃ ﺰﻛﺮﻣ ،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻲﺷﻮﻬﻴﺑ هوﺮﮔ رﺎﻴﺸﻧاد
2 . نﺎﻛدﻮﻛ ﻲﺒﻃ ﺰﻛﺮﻣ ،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻲﺷﻮﻬﻴﺑ هوﺮﮔ رﺎﻳدﺎﺘﺳا
3 . ﻪﺑزور نﺎﺘﺳرﺎﻤﻴﺑ ،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻲﺷﻮﻬﻴﺑ هوﺮﮔ رﺎﻳدﺎﺘﺳا
4 . ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد يژﻮﻟﻮﻛﺎﻣرﺎﻓ دﺎﺘﺳا
5 . هوﺮﮔ رﺎﻳدﺎﺘﺳا نﺎﻛدﻮﻛ
ﺄﻴﺒﻧﻻا ﻢﺗﺎﺧ نﺎﺘﺳرﺎﻤﻴﺑ ،ﺪﻫﺎﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
6 . ﻲﻣﻮﻤﻋ ﻚﺷﺰﭘ ___________________________________________________________________
__________________________
هﺪﻴﻜﭼ فﺪﻫ و ﻪﻨﻴﻣز :
كﻮﺷوﺮﺘﻜﻟا زا هدﺎﻔﺘﺳا يرﺎﻤﻴﺑ رد ﻲﻧﺎﻣرد
وراد ﻪﺑ رﺎﻤﻴﺑ ﻪﻛ دراد دﺮﺑرﺎﻛ يدراﻮﻣ رد هﮋﻳﻮﺑ ﺪﻳﺪﺷ ﻲﮔدﺮﺴﻓا ﺮﻴﻈﻧ ﻲﻳﺎﻫ
ﻲﻤﻧ ﺐﺳﺎﻨﻣ ﺦﺳﺎﭘ وراد ﻪﻛ ﻲﮕﻠﻣﺎﺣ رد ﺎﻳ ﺪﻫد
نﺎﻳز ﻦﻴﻨﺟ ياﺮﺑ ﺖﺳا روآ
. كﻮﺷوﺮﺘﻜﻟا ﻪﻛ ﻲﻳﺎﺠﻧآ زا ﺖﺤﺗ ﻲﻧﺎﻣرد
ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ
ﻲﻣ مﺎﺠﻧا يﺮﮕﻳد ﻲﺷﻮﻬﻴﺑ ﺮﻫ ﺪﻨﻧﺎﻣ نآ زا ﻞﺒﻗ ﻦﻳاﺮﺑﺎﻨﺑ ،دﻮﺷ تﺎﻨﻳﺎﻌﻣ
دﻮﺷ مﺎﺠﻧا ﺪﻳﺎﺑ رﺎﻤﻴﺑ ياﺮﺑ مزﻻ تﺎﺸﻳﺎﻣزآ و مزﻻ .
ﻦﻴﺑ رد
كﻮﺷوﺮﺘﻜﻟا ﺖﺤﺗ نارﺎﻤﻴﺑ كﻮﺷوﺮﺘﻜﻟا ﺮﻴﺛﺎﺗ ﻦﻳاﺮﺑﺎﻨﺑ دراد دﻮﺟو ﺰﻴﻧ ﺖﺑﺎﻳد ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ ﻲﻧﺎﻣرد
ﺮﻳﺎﺳ و ﺪﻨﻗ يور ﻲﻧﺎﻣرد
ﺖﻴﻟوﺮﺘﻜﻟا دراد ﺖﻴﻤﻫا ﺎﻫ
.
ﻲﺳرﺮﺑ شور :
كﻮﺷوﺮﺘﻜﻟا دﺰﻣﺎﻧ نارﺎﻤﻴﺑ ﻦﻴﺑ زا كﻮﺷوﺮﺘﻜﻟا زا ﻞﺒﻗ نﻮﺧ ﻪﻧﻮﻤﻧ ﻚﻳ ﺪﻨﺘﺷاد ار ﻪﻌﻟﺎﻄﻣ ﻪﺑ دورو يﺎﻫرﺎﻴﻌﻣ ﻪﻛ ﻲﻧﺎﻣرد
ﺖﺷﺬﮔ زا ﺲﭘ ،ﺪﺷ ﻪﺘﻓﺮﮔ ﻲﻧﺎﻣرد 30
نﮋﻴﺴﻛا ﺰﻳﻮﺠﺗ زا ﻪﻴﻧﺎﺛ
، ﻞﻴﻨﺴﻛﺎﺳ و ﻢﻳﺪﺳ لﺎﺘﻨﭘﻮﻴﺗ ﺎﺑ ﻲﺷﻮﻬﻴﺑ ءﺎﻘﻟا ﺪﺷ مﺎﺠﻧا ﻦﻴﻟﻮﻛ
. ﻲﻃ
ﻴﺑ ﻲﺷﻮﻬﻴﺑ ﺪﻨﺘﻓﺮﮔ راﺮﻗ كﻮﺷوﺮﺘﻜﻟا ﺎﺑ نﺎﻣرد ﺖﺤﺗ نارﺎﻤ
. 20 كﻮﺷوﺮﺘﻜﻟا مﺎﺠﻧا زا ﺲﭘ ﻪﻘﻴﻗد و ﺪﺷ ﻪﺘﻓﺮﮔ نﻮﺧ ﻪﻧﻮﻤﻧ ًادﺪﺠﻣ ﻲﻧﺎﻣرد
ﻪﻧﻮﻤﻧ ﺖﻴﻟوﺮﺘﻜﻟا و ﺪﻨﻗ ﺮﻈﻧ زا نﻮﺧ يﺎﻫ ﺪﻧﺪﺷ ﻲﺳرﺮﺑ ﺎﻫ
.
،تﺎﻋﻼﻃا ﻊﻤﺟ
ﺖﻓﺮﮔ راﺮﻗ يرﺎﻣآ ﺰﻴﻟﺎﻧآ ﺖﺤﺗ و هﺪﺷ يروآ .
ﺎﻫ ﻪﺘﻓﺎﻳ : كﻮﺷوﺮﺘﻜﻟا دﺰﻣﺎﻧ رﺎﻤﻴﺑ دﺎﺘﻔﻫ ﺖﻴﻟوﺮﺘﻜﻟا ﺮﻳﺎﺳ و ﺪﻨﻗ و ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻪﻌﻟﺎﻄﻣ ﺖﺤﺗ ﻲﻧﺎﻣرد
كﻮﺷوﺮﺘﻜﻟا زا ﺪﻌﺑ و ﻞﺒﻗ ﺎﻫ
هزاﺪﻧا ﺪﺷ يﺮﻴﮔ .
ﻲﻨﻌﻣ توﺎﻔﺗ ﻞﺒﻗ نادﺮﻣ رد ﻢﻴﺳﺎﺘﭘ ﺮﻈﻧ زا و نادﺮﻣ و نﺎﻧز رد ﻢﻳﺪﺳ ﺮﻈﻧ زا و نادﺮﻣ و نﺎﻧز رد نﻮﺧ ﺪﻨﻗ ﺮﻈﻧ زا يراد
ﺖﺷاد دﻮﺟو كﻮﺷوﺮﺘﻜﻟا زا ﺲﭘ و .
زا ﺲﭘ و ﻞﺒﻗ ﻢﻴﺴﻠﻛ ﺢﻄﺳ ﺎﻣا ﻲﻨﻌﻣ توﺎﻔﺗ هوﺮﮔ ود ﺮﻫ رد كﻮﺷوﺮﺘﻜﻟا
ﺖﺷاﺪﻧ يراد .
ﺢﻄﺳ
ﻲﻨﻌﻣ توﺎﻔﺗ كﻮﺷوﺮﺘﻜﻟا زا ﺲﭘ و ﻞﺒﻗ نﺎﻧز رد ﻢﻴﺳﺎﺘﭘ ﺖﺷاﺪﻧ يراد
.
ﻪﺠﻴﺘﻧ يﺮﻴﮔ : كﻮﺷوﺮﺘﻜﻟا نﻮﭼ ﻲﻣ مﺎﺠﻧا ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺮﻳز ﻲﻧﺎﻣرد
مزﻻ تﺎﺸﻳﺎﻣزآ و ﻞﻣﺎﻛ ﻲﻜﻳﺰﻴﻓ ﻪﻨﻳﺎﻌﻣ ﻪﻛ ﺖﺳا يروﺮﺿ دﻮﺷ
كﻮﺷوﺮﺘﻜﻟا مﺎﺠﻧا زا ﻞﺒﻗ ﺠﻧا ﻲﻧﺎﻣرد
دﻮﺷ مﺎ كﻮﺷوﺮﺘﻜﻟا ﺮﺛا رد ﻪﻜﻨﻳا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ. ﺖﻴﻟوﺮﺘﻜﻟا ﺮﻳدﺎﻘﻣ رد ﻲﺗاﺮﻴﻴﻐﺗ ﻲﻧﺎﻣرد
خر مﺮﺳ يﺎﻫ
ﻲﻣ ﺖﻴﻟوﺮﺘﻜﻟا ﻦﻳا ﻪﺑ ﻪﺟﻮﺗ ،ﺪﻫد ﺖﺳا ﺖﻴﻤﻫا ﺰﺋﺎﺣ ﻢﻴﺳﺎﺘﭘ و ﻢﻳﺪﺳ ًﺎﺻﻮﺼﺨﻣ ﺎﻫ
.
نﺎﮔژاو يﺪﻴﻠﻛ : ﺖﻴﻟوﺮﺘﻜﻟا ،نﻮﺧ ﺪﻨﻗ تاﺮﻴﻴﻐﺗ كﻮﺷوﺮﺘﻜﻟا ،مﺮﺳ يﺎﻫ
ﻲﻧﺎﻣرد
___________________________
__________________________________________________
* سردآ هﺪﻨﺴﻳﻮﻧ لﻮﺌﺴﻣ : نﺎﻛدﻮﻛ ﻲﺒﻃ ﺰﻛﺮﻣ نﺎﺘﺳرﺎﻤﻴﺑ، ﺐﻳﺮﻗ ﺮﺘﻛد نﺎﺑﺎﻴﺧ ،زروﺎﺸﻛ راﻮﻠﺑ، ناﺮﻬﺗ
ﻚﻴﻧوﺮﺘﻜﻟا ﺖﺴﭘ Drgoudarzi@tums.ac.ir:
__________________________________________________________________
ناﺮﻳا درد و يﺰﺘﺴﻧآ لﺎﻧﻮﻳژر ﻦﻤﺠﻧا
39
نارﺎﻜﻤﻫ وﻲﻧﺎﻄﻠﺳﻢﻴﻫاﺮﺑا ﺎﺿرﻲﻠﻋ
ﻪﻣﺪﻘﻣ كﻮﺷوﺮﺘﻜﻟا زا هدﺎﻔﺘﺳا ﻲﻧﺎﻣرد
(ECT) ﻲﺧﺮﺑ رد
يرﺎﻤﻴﺑ
ًﺎﺻﻮﺼﺨﻣ ﺪﻳﺪﺷ ﻲﮔدﺮﺴﻓا ﺪﻨﻧﺎﻣ ﻲﻧاور يﺎﻫ رﺎﻤﻴﺑ ﻪﻛ يدراﻮﻣ رد ﺦﺳﺎﭘ ﻲﻳوراد نﺎﻣرد ﻪﺑ
ﻲﻤﻧ ﻲﺒﺳﺎﻨﻣ
)ﺪﻫد
5 - 1
رادرﺎﺑ نز دراﻮﻣ رد ﺎﻳ( )
13،14 (
ﻪﻛ يدراﻮﻣ رد ﺎﻳ دراد يدﺎﻳز ضراﻮﻋ وراد ﻪﻛ و دراد دﻮﺟو دﻮﺧ ﻪﺑ و ناﺮﮕﻳد ﻪﺑ ﺐﻴﺳآ لﺎﻤﺘﺣا دﻮﺷ جرﺎﺧ ﻊﺿو نآ زا ﻊﻳﺮﺳ رﺎﻤﻴﺑ ﻪﻛ ﺖﺳا مزﻻ
) 4
، 6
، 9
، 11
ﻲﻳوراد ﺖﻣوﺎﻘﻣ دراﻮﻣ رد ﺎﻳ ( )
12 - 10 (
دراد دﺮﺑرﺎﻛ .
كﻮﺷوﺮﺘﻜﻟا ﻪﻛ ﻲﻳﺎﺠﻧا زا ﻲﻧﺎﻣرد
ﺎﺠﻧا ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺖﺤﺗ ﻲﻣ م
ﺳا مزﻻ دﻮﺷ ﻪﻛ ﺖ
سﺎﺳا ﺮﺑ مزﻻ تﺎﺸﻳﺎﻣزآ و ﻲﻜﻳﺰﻴﻓ تﺎﻨﻳﺎﻌﻣ دﻮﺷ مﺎﺠﻧا رﺎﻤﻴﺑ ﺖﻴﻌﺿو .
نارﺎﻤﻴﺑ ﻦﻴﺑ رد
ﻢﻫ ﺖﺑﺎﻳد ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ ﻲﻧﺎﻣرد كﻮﺷوﺮﺘﻜﻟا نارﺎﻤﻴﺑ ﻪﻛ ﻪﻠﺌﺴﻣ ﻦﻳا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ و دراد دﻮﺟو ﺐﺷ لﻮﻃ رد و ﺪﻧراد ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﻪﺑ زﺎﻴﻧ ﺪﻧا هدﻮﺑ ﺎﺘﺷﺎﻧ )
ﻞﻗاﺪﺣ 8 ﺖﻋﺎﺳ ( ﻲﻣ سﺮﺘﺳا و -
ﺑ ﺪﻧاﻮﺗ ندﻮﺑ ﺎﺘﺷﺎﻧ و دﻮﺷ نﻮﺧ ﺪﻨﻗ رد ﺮﻴﻴﻐﺗ ﺚﻋﺎ
ﺖﺳا ﻦﻜﻤﻣ ﻲﺗاﺮﻴﻴﻐﺗ
دﺎﺠﻳا ﻲﺘﻴﻟوﺮﺘﻜﻟا ﺢﻄﺳ رد
ﺪﻨﻛ
، ا ﺖﻴﻟوﺮﺘﻜﻟا و ﺪﻨﻗ ﻲﺑﺎﻳزر ﺎﻫ
دراد ﺖﻴﻤﻫا .
ﻪﻌﻟﺎﻄﻣ شور
هوﺮﮔ ﻲﻜﺷﺰﭘ قﻼﺧا ﻪﺘﻴﻤﻛ ﺐﻳﻮﺼﺗ زا ﺲﭘ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻲﺷﻮﻬﻴﺑ ناﺮﻬﺗ
ﻪﻌﻟﺎﻄﻣ ﻦﻳا
ﻲﻔﻴﺻﻮﺗ عﻮﻧ زا ﻪﻛ -
يور ﺮﺑ ﺖﺳا ﻲﻌﻄﻘﻣ 70
ﺮﻔﻧ
رﺎﻤﻴﺑ 18 ﺎﺗ 70 سﻼﻛ ﺎﺑ ﻪﻟﺎﺳ ود و ﻚﻳ ASA
ﺪﻨﺘﺷاد ار ﻪﻌﻟﺎﻄﻣ ﻪﺑ دورو يﺎﻫرﺎﻴﻌﻣ ﻪﻛ ﻪﺑ زﺎﻴﻧ و
كﻮﺷوﺮﺘﻜﻟا ﺪﻨﺘﺷاد ﻲﻧﺎﻣرد
، ﺖﻓﺮﮔ مﺎﺠﻧا .
ﻲﻧارﺎﻤﻴﺑ
ﻪﻛ ﺗرﻮﻛ ﺪﻴﻳوﺮﺘﺳاﻮﻜﻴ ﻲﻣ فﺮﺼﻣ
ﻪﻌﻟﺎﻄﻣ زا ﺪﻧدﺮﻛ
ﺪﻧﺪﺷ فﺬﺣ .
نارﺎﻤﻴﺑ ياﺮﺑ ﻪﻌﻟﺎﻄﻣ ﻒﻠﺘﺨﻣ ﻞﺣاﺮﻣ
ﺪﺷ هداد ﺢﻴﺿﻮﺗ .
ﻪﻧﻮﻤﻧ شور
يﺮﻴﮔ
زا كﻮﺷوﺮﺘﻜﻟا دﺰﻣﺎﻧ نارﺎﻤﻴﺑ دورو زا ﺲﭘ ﻲﻧﺎﻣرد
ﺬﺧا ﺖﻬﺟ ﻲﺒﺘﻛ ﺖﻳﺎﺿر ﺶﺨﺑ ﻪﺑ و نﻮﺧ ﻪﻧﻮﻤﻧ
ﻪﺘﻓﺮﮔ ﺶﻳﺎﻣزآ مﺎﺠﻧا ﺪﺷ
. زا ﻞﺒﻗ نﻮﺧ ﻪﻧﻮﻤﻧ ﻚﻳ
ﺎﻘﻟا ﺖﻬﺟ ﻲﺷﻮﻬﻴﺑ ﺮﻳﺎﺳ و نﻮﺧ ﺪﻨﻗ ﻲﺳرﺮﺑ
ﺖﻴﻟوﺮﺘﻜﻟا ﺎﻫ
ﻢﻳﺪﺳ ﻞﻣﺎﺷ
، ﻪﺘﻓﺮﮔ ﻢﻴﺴﻠﻛ و ﻢﻴﺳﺎﺘﭘ
ﺪﺷ . ﺶﻳﺎﭘ يﺎﻫ مزﻻ كﻮﺷوﺮﺘﻜﻟا ﺖﻬﺟ ﻲﻧﺎﻣرد
ﺪﻨﻧﺎﻣ ﺷا نﮋﻴﺴﻛا عﺎﺒ ﻲﻧﺎﻳﺮﺷ نﻮﺧ
و هزاﺪﻧا يﺮﻴﮔ
نﻮﺧرﺎﺸﻓ شور ﻪﺑ ﻲﻟﻮﺘﺳﺎﻳد و ﻲﻟﻮﺘﺴﻴﺳ
زا ﻞﺒﻗ ﻲﻓاﺮﮔﻮﻳدرﺎﻛوﺮﺘﻜﻟا و ﻲﻤﺟﺎﻬﺗﺮﻴﻏ كﻮﺷوﺮﺘﻜﻟا زا ﺲﭘ و ﻦﻴﺣ ﻲﻧﺎﻣرد
نآ ﺪﻣآ ﻞﻤﻌﺑ .
زا ﺲﭘ 30 ﻪﻴﻧﺎﺛ
،نﮋﻴﺴﻛا ﺰﻳﻮﺠﺗ ﺎﻘﻟا
ء ﻲﺷﻮﻬﻴﺑ ﺎﺑ
ﻢﻳﺪﺳ لﺎﺘﻨﭘﻮﻴﺗ 5
- 3 ﻲﻠﻴﻣ مﺮﮔ و مﺮﮔﻮﻠﻴﻛ يازا ﻪﺑ
ﻞﻴﻨﺴﻛﺎﺳ ﻦﻴﻟﻮﻛ
5 / 0 ﻲﻠﻴﻣ مﺮﮔ ﻮﻠﻴﻛ يازا ﻪﺑ مﺮﮔ
نﺪﺑ نزو ﺪﺷ مﺎﺠﻧا
. زا ﺲﭘ 20 رﺎﻛ نﺎﻳﺎﭘ زا ﻪﻘﻴﻗد
ًادﺪﺠﻣ ﻧﻮﻤﻧ ﻪﺘﻓﺮﮔ يﺪﻳرو نﻮﺧ ﻪ ﺪﺷ
ﻪﺑ و
هدﺎﺘﺳﺮﻓ هﺎﮕﺸﻳﺎﻣزآ ﺪﺷ
.
ﻊﻤﺟ شور هداد يروآ
ﻢﻴﻘﺘﺴﻣ هﺪﻫﺎﺸﻣ ﻖﻳﺮﻃ زا ﺎﻫ
ﺑ ﻪﻣﺎﻨﺸﺳﺮﭘ رد ﺖﺒﺛ و رﺎﻤﻴﺑ تﺎﺸﻳﺎﻣزآ ﻪ
ﺪﻣآ ﻞﻤﻋ .
ﻊﻤﺟ زا ﺲﭘ ﺮﻳدﺎﻘﻣ ﻦﻳا رد يروآ
ﻊﻤﺟ مﺮﻓ يروآ
راﺰﻓا مﺮﻧ ﺎﺑ يرﺎﻣآ ﺰﻴﻟﺎﻧآ ﺖﺤﺗ تﺎﻋﻼﻃا 13
SPSS
ﺪﺷ ﻪﻴﻬﺗ ﻲﻳﺎﻬﻧ شراﺰﮔ و ﺖﻓﺮﮔ راﺮﻗ و
ﺞﻳﺎﺘﻧ
ﺖﺳا هﺪﺷ ﻪﺋارا .
ﻪﺘﻓﺎﻳ ﺎﻫ
ﻪﻧﻮﻤﻧ ﺎﻫ 70 ﻪﻛ ﺪﻧدﻮﺑ درﻮﻣ داﺪﻌﺗ ﻦﻳا زا
49 ﺮﻔﻧ
دﺮﻣ ) 70 (%
و 21 ﺮﻔﻧ نز ) 30 (%
راﺮﻗ ﻪﻌﻟﺎﻄﻣدرﻮﻣ
ﺪﻨﺘﻓﺮﮔ . زا ﻞﺒﻗ رد نﻮﺧ ﺪﻨﻗ ﻦﻴﮕﻧﺎﻴﻣ كﻮﺷوﺮﺘﻜﻟا
ﻲﻧﺎﻣرد 2 / 29 8 ± / 86 زا ﺲﭘ و نآ
9 / 29
±
8 / 92 ﻪﻛدﻮﺑ ﻲﻨﻌﻣ توﺎﻔﺗ ﺖﺳا ﻪﺘﺷاد يراد
) راﺪﻘﻣ
ﺮﺑاﺮﺑ P 016 / 0 .(
تاﺮﻴﻴﻐﺗ نادﺮﻣ رد ﻢﻴﺳﺎﺘﭘ ﺢﻄﺳ
زا ﺲﭘ و ﻞﺒﻗ كﻮﺷوﺮﺘﻜﻟا
ﻲﻧﺎﻣرد ) راﺪﻘﻣ ﺮﺑاﺮﺑ P
005 / 0 ( و تاﺮﻴﻴﻐﺗ ﻢﻳﺪﺳ ﺢﻄﺳ
رد نادﺮﻣ و ﻞﺒﻗ
__________________________________________________________________
ناﺮﻳا درد و يﺰﺘﺴﻧآ لﺎﻧﻮﻳژر ﻦﻤﺠﻧا
40
نارﺎﻜﻤﻫ وﻲﻧﺎﻄﻠﺳﻢﻴﻫاﺮﺑا ﺎﺿرﻲﻠﻋ
زا ﺲﭘ كﻮﺷوﺮﺘﻜﻟا ﻲﻧﺎﻣرد
) راﺪﻘﻣ ﺮﺑاﺮﺑP
001 / 0 (
و تاﺮﻴﻴﻐﺗ نﺎﻧز رد ﻢﻳﺪﺳ ﺢﻄﺳ
زا ﺲﭘ و ﻞﺒﻗ
كﻮﺷوﺮﺘﻜﻟا ﻲﻧﺎﻣرد
) راﺪﻘﻣ ﺮﺑاﺮﺑ P
001 / 0 ( توﺎﻔﺗ
ﻲﻨﻌﻣ راد ي ﺖﺳا ﻪﺘﺷاد .
تاﺮﻴﻴﻐﺗ ﻪﻛ ﻲﻟﺎﺣ رد
نﺎﻧز رد ﻢﻴﺳﺎﺘﭘ ﺢﻄﺳ كﻮﺷوﺮﺘﻜﻟا زا ﺲﭘو ﻞﺒﻗ
ﻲﻨﻌﻣ توﺎﻔﺗ ﻲﻤﻧ نﺎﺸﻧ يراد
ﺪﻫد ) شزرا ﺮﺑاﺮﺑ P
655 / 0 ( و مﺎﻤﺗ رد ﻢﻴﺴﻠﻛ ﺢﻄﺳ نارﺎﻤﻴﺑ
) دﺮﻣ
نزو ( كﻮﺷوﺮﺘﻜﻟا زا ﺲﭘ و ﻞﺒﻗ توﺎﻔﺗ ﻲﻧﺎﻣرد
ﻲﻨﻌﻣ يراد ﻲﻤﻧ نﺎﺸﻧ ار ﺪﻫد
) دﺮﻣ رد ﺎﺑ ﺮﺑاﺮﺑ P
574 / 0 نز رد و ﺎﺑ ﺮﺑاﺮﺑ P
114 / 0 (.
ﺢﻄﺳ تاﺮﻴﻴﻐﺗ
ﻢﻳﺪﺳ ،ﺪﻨﻗ ﻴﺳﺎﺘﭘ ،
زا ﺲﭘ و ﻞﺒﻗ ﻢﻴﺴﻠﻛ و ﻢ
كﻮﺷوﺮﺘﻜﻟا ﻲﻧﺎﻣرد
و راﺪﻘﻣ ﻚﻴﻜﻔﺗ ﻪﺑ ﻪﻃﻮﺑﺮﻣ P
ﺖﺳا هﺪﻣآ ﻚﻳ هرﺎﻤﺷ لوﺪﺟ رد ﻲﺘﻴﺴﻨﺟ .
لوﺪﺟ 1 : و ﻢﻴﺳﺎﺘﭘ ،ﻢﻳﺪﺳ ،ﺪﻨﻗ تاﺮﻴﻴﻐﺗ كﻮﺷوﺮﺘﻜﻟا زا ﺲﭘ و ﻞﺒﻗ ﻢﻴﺴﻠﻛ
ﻲﺘﻴﺴﻨﺟ ﻚﻴﻜﻔﺗ ﻪﺑ ﻲﭘاﺮﺗ
ﺪﻨﻗ ﻢﻳﺪﺳ
ﻢﻴﺳﺎﺘﭘ
ﻢﻴﺴﻠﻛ
زا ﻞﺒﻗ دﺮﻣ)ECT
( 45 /
±33 63 / 90 0 /
±6 1 / 136 5 /
±0 7 / 3 6 /
±0 8 / 9
زا ﺲﭘ دﺮﻣ)ECT ( 1 / 34 10± / 97 8 / 4 6± / 139 5 / 0 9± / 3 5 / 0 7± / 9
راﺪﻘﻣ P 001
/ 0 001
/ 0 005
/ 0 574
/ 0
زا ﻞﺒﻗ نز)ECT (
1
/ 12 8± / 77 3 / 9 6± / 134 3 / 0 6± / 3 7 / 0 1± / 10
زا ﺲﭘ نز)ECT (
3
/
±12 9 / 82 9
/
±4 9 / 136 4
/
±0 6 / 3 8 /
±0 9 / 9
راﺪﻘﻣ P 001
/ 0 001
/ 0 655
/ 0 114
/ 0
ﺚﺤﺑ كﻮﺷوﺮﺘﻜﻟا ﺪﻨﻣزﺎﻴﻧ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺖﺤﺗ ﻲﻧﺎﻣرد
و ﻲﻜﻳﺰﻴﻓ ﻪﻨﻳﺎﻌﻣ مﺎﺠﻧا
آ تﺎﺸﻳﺎﻣز ﺖﺳا مزﻻ
. رد
ﺎﻌﻟﺎﻄﻣ ﻲﺧﺮﺑ ت
كﻮﺷوﺮﺘﻜﻟا ﺮﮕﻳد يﺎﻫرﻮﺸﻛ -
ﻲﻧﺎﻣرد ﺖﻴﻟوﺮﺘﻜﻟا يور يدﺎﻳز ﺮﺛا ﺖﺳا ﻪﺘﺷاﺪﻧ ﺎﻫ
.
ﻲﺳرﺮﺑ ﻲﻓاﺮﮔﻮﻳدرﺎﻛوﺮﺘﻜﻟا
يﺮﻴﮔ هزاﺪﻧا و و ﻢﻳﺪﺳ
كﻮﺷوﺮﺘﻜﻟا زا ﻞﺒﻗ ﻢﻴﺳﺎﺘﭘ شور ﻲﻧﺎﻣرد
ﺖﺳا يﺮﺛﻮﻣ يﺮﮕﻟﺎﺑﺮﻏ
).
15
ﭻﻴﻫ ﻪﻨﻴﺳ ﻲﻓاﺮﮔ مﺎﺠﻧا(
ﺖﺳا ﻪﺘﺷاﺪﻧ ﻲﺘﻳﺰﻣ
).
2
و مﺮﺳ ﻢﻳﺪﺳ ﻦﻴﺑ ﻲﻃﺎﺒﺗرا (
آ دﻮﺟو ﺞﻨﺸﺗ ﻪﻧﺎﺘﺳ دراﺪﻧ
).
16
نارﺎﻤﻴﺑ ﻲﺧﺮﺑ رد (
ﻪﻠﺻﺎﻓ ﻲﻣ ﺶﻳاﺰﻓا Q-T
ﺪﺑﺎﻳ ﺪﻌﺘﺴﻣ ار رﺎﻤﻴﺑ ﻪﻛ
و كﻮﻠﺑ آ ﻲﻣ ﻲﻤﺘﻳر ﺪﻨﻛ
).
17
ﻪﻌﻟﺎﻄﻣ رد (
يا 21 رﺎﻤﻴﺑ ﻲﺒﻠﻗ ضراﻮﻋ ﻦﻳا ﺮﺘﺸﻴﺑ ﻪﻛ ﺪﻧﺪﺷ ضراﻮﻋ رﺎﭼد
ﺖﺳا هدﻮﺑ
).
6
هﺪﺷ شراﺰﮔ ﺰﻴﻧ ﻲﻨﻄﺑ يدرﺎﻜﻴﻛﺎﺗ (
ﺖﺳا
).
18
ﻪﻌﻟﺎﻄﻣرد (
ﻦﺳﻮﻤﺳار لﺎﺳ رد
2006
، رد
ﻲﺘﺑﺎﻳد نارﺎﻤﻴﺑ ود عﻮﻧ
ﺑ ﻪﻛ ﻪ ﻪﺑ زﺎﻴﻧ ﻲﮔدﺮﺴﻓا ﺖﻠﻋ
و ﻞﺒﻗ ﺪﻨﺘﺷاد كﻮﺷوﺮﺘﻜﻟا 20
ﺲﭘ ﻪﻘﻴﻗد زا
هﺪﻴﺠﻨﺳ ار نﻮﺧ ﺪﻨﻗ كﻮﺷوﺮﺘﻜﻟا هﺪﻫﺎﺸﻣ و ﺪﻧا
ناﺰﻴﻣ ﻪﺑ نﻮﺧ ﺪﻨﻗ ﻪﻛ ﺪﺷ 9
/ 0 ﺪﺑﺎﻳ ﻲﻣ ﺶﻳاﺰﻓا
) 7
. (
ﻪﻌﻟﺎﻄﻣ رد ﻦﺳﻮﻤﺳار
لﺎﺳ رد 2005
نارﺎﻤﻴﺑ رد
ﺖﺤﺗ ﻪﻛ ﻲﺘﺑﺎﻳد ﺮﻴﻏ كﻮﺷوﺮﺘﻜﻟا
راﺮﻗ ﻲﻧﺎﻣرد
ﻧدﻮﺑ ﻪﺘﻓﺮﮔ ﺧ ﺪﻨﻗ ﺪ
كﻮﺷوﺮﺘﻜﻟا زا ﺲﭘ و ﻞﺒﻗ نﻮ -
و ﺪﺷ يﺮﻴﮔ هزاﺪﻧا ﻲﻧﺎﻣرد هزاﺪﻧا ﻪﺑ نﻮﺧ ﺪﻨﻗ
9l
ﻲﻠﻴﻣ ﻲﺳد رد مﺮﮔ ﺮﺘﻴﻟ
ﺖﻓﺎﻳ ﺶﻳاﺰﻓا
).
8
ﻪﻌﻟﺎﻄﻣ رد (
__________________________________________________________________
ناﺮﻳا درد و يﺰﺘﺴﻧآ لﺎﻧﻮﻳژر ﻦﻤﺠﻧا
41
نارﺎﻜﻤﻫ و يزردﻮﮔ دادﺮﻬﻣ
يﺮﺨﻓ لﺎﺳ رد 1980
، 15 ﺖﺤﺗ ﻲﺘﺑﺎﻳد رﺎﻤﻴﺑ
ﺎﺑ نﺎﻣرد كﻮﺷوﺮﺘﻜﻟا
ﺪﺷ ﺺﺨﺸﻣ و ﺪﻨﺘﻓﺮﮔ راﺮﻗ
ﺘﻜﻟا ﻪﻛ دراﺪﻧ رﺮﺿ ﻲﺘﺑﺎﻳد نارﺎﻤﻴﺑرد كﻮﺷوﺮ
) 9
رد.(
ﺪﻳد ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﻲﻣ كﻮﺷوﺮﺘﻜﻟا ﻪﻛ ﺪﺷ ه
ﺪﻧاﻮﺗ
ﻴﺳﺎﺘﭘ و ﻢﻳﺪﺳ ﺢﻄﺳ رﻮﻄﺑ ار نﻮﺧ ﺪﻨﻗو ﻢ
ﻲﻨﻌﻣ و سﻮﺴﺤﻣ دﺮﺒﺑ ﻻﺎﺑ يراد
) لوﺪﺟ 1 (
، ﻲﻟو
ﺖﺳا ﻪﺘﺷاﺪﻧ ﺮﺛا ﻢﻴﺴﻠﻛ ﺢﻄﺳ يور .
ﺪﻨﻗ ﻦﺘﻓر ﻻﺎﺑ
ﺖﻴﻟوﺮﺘﻜﻟا و ﻪﻠﻤﺟ زا ﻢﻴﺳﺎﺘﭘ و ﻢﻳﺪﺳ ﺪﻨﻧﺎﻣ ﻲﻳﺎﻫ
نارﺎﻤﻴﺑ مﺎﻤﺗ رد ﻢﻫ زﺎﺑ ﺎﻣا ﺖﺳا شور ﻦﻳا ضراﻮﻋ هدوﺪﺤﻣ رد ﻲﻌﻴﺒﻃ
زا يدﺎﻳز ﻲﻧاﺮﮕﻧ و دراد راﺮﻗ ﻻﺎﺑ ﺖﻬﺟ
ﺖﻴﻟوﺮﺘﻜﻟا و ﺪﻨﻗ دﺎﻳز ﻲﻠﻴﺧ ﻦﺘﻓر ﺎﻫ
هدوﺪﺤﻣ يﺎﻬﺘﻧا رد ﻪﻛ ﻲﻧارﺎﻤﻴﺑ ﻲﻟو دراﺪﻧ دﻮﺟو ﻲﻌﻴﺒﻃ ﺪﻧراد يﺮﺘﺸﻴﺑ ﻪﺟﻮﺗ ﻪﺑ زﺎﻴﻧ ﺪﻧراد راﺮﻗ .
ﺎﺑ
يدﺪﻌﺘﻣ يﺎﻫوراد نارﺎﻤﻴﺑ ﻦﻳا ﻪﻜﻨﻳا ﻪﺑ ﻪﺟﻮﺗ ﻛ ﻲﻣ فﺮﺼﻣ ﺖﻴﻟوﺮﺘﻜﻟا رد ﺮﻴﻴﻐﺗ لﺎﻤﺘﺣا و ﺪﻨﻨ
ﺎﻫ
راد دﻮﺟو مزﻻ د
ﻲﺷﻮﻬﻴﺑ زا ﻞﺒﻗ ﻪﻛ ﺖﺳا
ﺖﻴﻟوﺮﺘﻜﻟا دﻮﺷ ﻚﭼ ﺎﻫ
. اﺪﻗا ﻪﻛ ﻲﺗرﻮﺻ رد تﺎﻣ
كﻮﺷوﺮﺘﻜﻟا دﺮﻳﺬﭘ مﺎﺠﻧا يروﺮﺿ ءﺰﺟ ﻲﻧﺎﻣرد
نﺎﻣرد ﻢﻛ يﺎﻫ ﺮﻄﺧ دﻮﺸﻴﻣ بﻮﺴﺤﻣ .
عبانم
1. Muller PS, Albin SM, Barnes RD-Rasmussen KG. jr. Safety of Electroconvulsive therapy in patients with unrepaired abdominal aortic aneurism: report of 8 patients. Divition of General internal medicine, Mayo clinic.J ECT 2009 sep:25(3):165-9
2. Abarmczuic A, Rose NM. Pre anaesthetic assessment &the prevention of post-ECT morbidity. Bar j Psychiatry 1979 jun:134:582- 7
3. Van Hercke, Sienaert P, Hagon A.
Electroconvulsive therapy for patients with intracranial aneurism:A case study and literature review. Psychiatr 2009,51:43-51 4. Lunde ME, Lee EK.Rasmussen KG. Electro-
convulsion therapy in patients with epilepcy Mayo clinic. Epilepcy Behave 2006 ,sep 9(2):355-9 EPub 2006 jul 28
5. Masachetts KL, Fiore La, Peluso MA, Rigonatti SP. Safety and efficacy of ECT in mental disorders associated with epilepcy:
report of 3 cases. J ECT 2003 sep 19(3),175-6 6. Ferrill MJ, Kehoe WA, Jacisin jj. ECT during
pregnancy:physiologic and pharmacologic consideration. Convuls ther,1992:8(3):186-200 7. Anderson EI, Refi IM. ECT in pregnancy: a
review of the literature from 1941-2007.
Psychosom med 2009 FEB :335-42
8. Nuttall GA, Bouwersox, Dnglass SB.
Morbidity and Mortality in the use of ECT 2004 dec (4):237-41
9. Fakhri O, Fadhi AA, Elrawi RM. Effect of electroconvulsive therapy therapy on diabetics mellitus. Lancet 1980 oct 11:2(8198):775-5 10. Teh S.p.c, Helmes E, Drake,D. A western
Australian Surtvey on Public Attitudes Toward and Knowledge of Electroconvulsive therapy.
International journal of social psychiatry2007, Vol 53, No3, 247-271.
11. E.B. SOLOMONT. Shock Therapy Emerges As detail in therapist killng- February 21,2008- the New York Sun Chiristofer Faherty :2008,04-13
12. Abrams, Richard, coelho, Paulo. Electro- convulsivetherapy, Oxford University of press, 2002. Harpercollins publisher.978 -12
13. Ramussen K G.Rayan DA,Muller PS. Blood Glucose before &after ECT treatments in type 2 diabetic patients. J ECT .2006 June 22;2:124-6
14. Ramussen K G.Rayan Da. The effect of electroconvulsive therapy treatment on blood glucose in non diabetic patients. J ECT 2005 Des:21(4):23-4
15. Lafferty je,North cs,spitznag. Laboratory screening prior to ECT. J ECT, 2001 sep 17(3):158-65
16. Rasmussen KG. Serum Sodium does not correlate with Seizure Length or seizure there- shold in ECT.2007 sep 23(3):175-6
17. Rasmusen KG,Mohan A, Steven SR . Assessment of QT interval and QT displace- ment during electroconvulsivetherapy using computerized Measurment:J ect 2010 Mar 26(1):41-6
18. Satoy, Takashi H, Miaybe M. Case of pre- mature ventricular contraction immediately after ECT in a depressive patient: Masui.2005 Jan,54(1):46-8.
__________________________________________________________________
و يﺰﺘﺴﻧآ لﺎﻧﻮﻳژر ﻦﻤﺠﻧا ناﺮﻳا درد
__________________________________________________________________
و يﺰﺘﺴﻧآ لﺎﻧﻮﻳژر ﻦﻤﺠﻧا ناﺮﻳا درد
The Evaluation of Blood Glucose and Serum Electrolyte changes before and after Electroconvulsive Therapy under General
Anesthesia
Ali‐reza Ebrahim‐soltani1, Anahid Maleki2, Mehrdad Goodarzi2٭, Khosro Afkham3, Shahin Akhoondzadeh4, Hadi Kazemi5, Shahriar Arbabi2, Abdollah Peyro6
1- Associate Professor of Anesthesiology, Koodakan Medical Center 2- Assistant Professor of Anesthesiology, Koodakan Medical Center 3- Assistant Professor of Anesthesiology, Roozbeh Hospital
4- Professor of Pharmacology, Tehran University of Medical Sciences 5- Assistant Professor of Pediatrics, Khatamol-anbia Hospital 6- General Practitioner
______________________________________________
Abstract
Background: Electroconvulsive therapy (ECT) is used in the treatment of various medical conditions such as severe depression, mainly in situations where the patient does not respond effectively to drug treatment and during pregnancy where drug intake can result in severe
complication for fetus. ECT carried out under general anesthesia, therefore before ECT some physical exam and some lab data is necessary. Patients who are ECT candidates also include diabetic patients which renders the study of the effect of ECT on blood glucose and serum electrolyte level significantly important.
Methods: Blood sample were taken from patients before induction of anesthesia. After 30 seconds preoxygenation anesthesia was induced by making use of sodium thiopental and succiniylcholine .20 minutes after ECT, the second blood samples were taken. The resulting data was gathered and then subjected to statistical analysis.
Results: To investigate changes in blood sugar and serum electrolytes level in 70 patients who were subjected to ECT, significant changes were noted in pre and post ECT in glucose between men and women and sodium in men and women and potassium in men. But no significant changes were noted in pre and post ECT calcium level and in potassium level in women.
Conclusion: ECT carried out under general anesthesia; therefore pre ECT physical exam and blood samples are required. Electrolytes change under ECT, therefore attention to these electrolytes specially sodium and potassium are important
Keywords: Blood glucose change, serum electrolytes, electroconvulsion therapy
*Corresponding Author: Dr Mehrdad Goudarzi, Department of anesthesiology, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
E mail: [email protected]
Anesthesiology and Pain
Official Journal of ISRAPM Autumn 2011, Vol2, No 5
