دﺮﻔﻣﺎﻳرﻮﭘ ﻢﻴﻫاﺮﺑا نارﺎﻜﻤﻫ و
١٥٨
ﻲﺸﻫوﮋﭘ:ﻪﻟﺎﻘﻣ عﻮﻧهرود ،درد و ﻲﺷﻮﻬﻴﺑ ﻲﺸﻫوﮋﭘ ﻲﻤﻠﻋ ﻪﻣﺎﻨﻠﺼﻓ 2
هرﺎﻤﺷ ، 8
، نﺎﺘﺴﺑﺎﺗ 1391
و ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺮﻴﺛﺎﺗ ﻪﺴﻳﺎﻘﻣ ﻲﺴﺤﻴﺑ
ﺎﭙﺳا ﻨﻳ نﻮﺧ ﺪﻨﻗ تاﺮﻴﻴﻐﺗ ﺮﺑ لﺎ ﻦﻴﺣ
ﻲﺣاﺮﺟ
دﺮﻔﻣﺎﻳرﻮﭘ ﻢﻴﻫاﺮﺑا ﻲﻳﺎﺟر ﺪﻤﺤﻣ ،1
ﻪﻨﻳﺪﻣ ﻦﻴﺴﺣ ،2
ﻲﻗدﺎﺻ ﻦﻤﻬﺑ ،1 3
1 - ﺮﺟﺎﻫ نﺎﺘﺳرﺎﻤﻴﺑ ،دﺮﻛﺮﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﺷﻮﻬﻴﺑ رﺎﻳدﺎﺘﺳا )
س (
2 - ﻮﻟورا رﺎﻳدﺎﺘﺳا دﺮﻛﺮﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،يﮋ
3 - كارا ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻋﺎﻤﺘﺟا ﻲﻜﺷﺰﭘ رﺎﻳدﺎﺘﺳا
ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ :
30 / 2 / 1391 ﻲﻨﻴﺑزﺎﺑ ﺦﻳرﺎﺗ
: 30 / 3 / 1391 شﺮﻳﺬﭘ ﺦﻳرﺎﺗ
: : 19 / 4 / 1391
هﺪﻴﻜﭼ فﺪﻫ و ﻪﻨﻴﻣز :
مﺎﻴﭘ يﺮﺳ ﻚﻳ لﺎﻘﺘﻧا ﺐﺟﻮﻣ ﻲﺣاﺮﺟ سﺮﺘﺳا ا ﻲﻧﻮﻣرﻮﻫ و ﻲﺒﺼﻋ يﺎﻫ
هﺪﻨﻨﻛ لﺮﺘﻨﻛ ﺰﻛاﺮﻣ ﻪﺑ ﺐﻴﺳآ ﻞﺤﻣ ز هﺪﺷ
ﺐﺟﻮﻣ ﻪﻛ
ﺶﻨﻛاو ﻜﻳژﻮﻟﻮﻳﺰﻴﻓ يﺎﻫ ﻲ
ﻲﻣ زا ﺪﻨﺗرﺎﺒﻋ نآ ﻢﻫا ﻪﻛ دﻮﺷ :
،لوﺰﻴﺗرﻮﻛ ،ﻦﻴﻟﺎﻧردآرﻮﻧ ﺶﻳاﺰﻓا ﺪﻨﻧﺎﻣ ﻲﻧﻮﻣرﻮﻫ تاﺮﻴﻴﻐﺗ ﻪﺠﻴﺘﻧ رد و ﻚﻳژﺮﻧردآ ﻚﻳﺮﺤﺗ
ﻢﻫ و ﻦﻴﻟﻮﺴﻧا ﺶﻫﺎﻛ و ﺪﺷر نﻮﻣرﻮﻫ ﺪﻨﻗ ﻢﻴﻈﻨﺗ رد لﻼﺘﺧا و ﻦﻴﻟﻮﺴﻧا ﻪﺑ ﺖﻣوﺎﻘﻣ ﺶﻳاﺰﻓا ﻦﻴﻨﭼ
ﺶﻳاﺰﻓا ﻪﻄﺳاو ﻪﺑ ﻲﻤﺴﻴﻠﮔﺮﭙﻳﺎﻫ ترﻮﺻ ﻪﺑ نﻮﺧ
ﺰﻛﻮﻠﮔ فﺮﺼﻣ ﺶﻫﺎﻛ و ﺰﻧژﻮﺌﻧﻮﻛﻮﻠﮔ .
ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ
ﻪﻛ لﺎﻨﮕﻴﺳ كﻮﻠﺑ ﻖﻳﺮﻃ زا ﻲﻣ يﺰﻐﻣ يﺎﻫ
ﺐﺟﻮﻣ ﺪﻧاﻮﺗ ﺶﻨﻛاو ﺶﻫﺎﻛ
ﻪﺑ
ﻲﻤﺴﻴﻠﮔﺮﭙﻳﺎﻫ و ﻲﺣاﺮﺟ سﺮﺘﺳا دﻮﺷ
ﺶﻨﻛاو كﻮﻠﺑ رد ﻪﻛ ﻦﻴﻳﺎﭘ ﺢﻄﺳ رد لﺎﻨﻳﺎﭙﺳا ﻲﺴﺤﻴﺑ شور ﺎﺑ ، لﺎﻧﻮﻣرﻮﻫ يﺎﻫ
ﻲﻄﻴﺤﻣ ﻖﻳﺮﻃ زا ﻚﻳژﺮﻧردآ و
ﺖﺳا هﺪﺷ ﻪﺴﻳﺎﻘﻣ ،دراد ﺮﻴﺛﺎﺗ .
شور و داﻮﻣ ﺎﻫ
: هوﺮﮔ ود يورﺮﺑ هﺪﺷ ﻲﻓدﺎﺼﺗ ﻲﻨﻴﻟﺎﺑ ﻲﻳﺎﻣزآرﺎﻛ عﻮﻧ زا ﻪﻌﻟﺎﻄﻣ ﻦﻳا 30
رد لﺎﻨﻳﺎﭙﺳا ﺎﺑ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﻪﺴﻳﺎﻘﻣ فﺪﻫ ﺎﺑ نارﺎﻤﻴﺑ هﺮﻔﻧ
ﺶﻨﻛاو لﺮﺘﻨﻛ هزاﺪﻧا ﻖﻳﺮﻃ زا ﻚﻳژﺮﻧردآﻮﺗﺎﭙﻤﺳ يﺎﻫ
ا هﺪﺷ مﺎﺠﻧا نﻮﺧ ﺪﻨﻗ يﺮﻴﮔ ﺖﺳ
. ﺢﻄﺳ ﺎﺗ نارﺎﻤﻴﺑ لﺎﻨﻳﺎﭙﺳا هوﺮﮔ رد T12
هوﺮﮔ رد و ﺪﻧﺪﺷ كﻮﻠﺑ
ﺪﻨﺘﻓﺮﮔ راﺮﻗ لﺎﻨﻴﻳﻮﮕﻨﻳا ﻖﺘﻓ ﻲﺣاﺮﺟ ﻞﻤﻋ ﺖﺤﺗ ﻪﺑﺎﺸﻣ يﺎﻫوراد و نﺎﺴﻜﻳ شور ﺎﺑ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ .
ﻲﻜﻳﺰﻴﻓ يﺪﻨﺑ ﻪﺒﺗر ياراد نارﺎﻤﻴﺑ (ASA)
1 و 2
ﻪﻛ ﻲﻟﺎﺣرد و هدﻮﺑ نﻮﺧﺪﻨﻗ ﺮﺑ ﺮﺛﻮﻣ يﺎﻫوراد فﺮﺼﻣ ﺎﻳ يرﺎﻤﻴﺑ ﻪﻘﺑﺎﺳ ﺪﻗﺎﻓ و ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻲﺣاﺮﺟ ﻞﻤﻋ ﺖﺤﺗ ﺪﻧدﻮﺑ ﺎﺘﺷﺎﻧ
. ﺖﻋﺎﺳ ﻚﻳ نارﺎﻤﻴﺑ نﻮﺧ ﺪﻨﻗ
ﻞﺻاﻮﻓ ﻪﺑ و ﻞﻤﻋ زا ﻞﺒﻗ 1
و 6 ﺪﺷ يﺮﻴﮔ هزاﺪﻧا ﺮﺘﻣﻮﻛﻮﻠﮔ ﻪﻠﻴﺳﻮﺑ ﺪﻨﺘﺷاد نﺎﺴﻜﻳ يﺪﻳرو ﻖﻳرﺰﺗ ﻪﻛ ﻲﻟﺎﺣ رد ﻞﻤﻋ زا ﺲﭘ ﺖﻋﺎﺳ .
ﻪﺘﻓﺎﻳ ﺎﻫ :: ﻞﻤﻋ زا ﻞﺒﻗ نﻮﺧ ﺪﻨﻗ ﻲﻨﻌﻣ توﺎﻔﺗ
ﺪﻫﺎﺷ هوﺮﮔ ود رد يراد )
ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ (
و درﻮﻣ ) لﺎﻨﻳﺎﭙﺳا ( ﻲﻟو ،ﺖﺳا ﻪﺘﺷاﺪﻧ ﻚﻳ
ﺶﺷ و ﺖﻋﺎﺳ
هوﺮﮔ رد ﻞﻤﻋ زا ﺪﻌﺑ ﺖﺳا ﻪﺘﻓﺎﻳ ﺶﻫﺎﻛ لﺎﻨﻳﺎﭙﺳا
.
ﻪﺠﻴﺘﻧ يﺮﻴﮔ ﻲﺴﺣ ﻲﺑ: لﺮﺘﻨﻛ رد يﺮﺘﻬﺑ ﻲﻳﺎﻧاﻮﺗ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺎﺑ ﻪﺴﻳﺎﻘﻣ رد لﺎﻨﻳﺎﭙﺳا
ﺪﻳﺎﺷ و نﻮﺧ ﺪﻨﻗ ﺶﻨﻛاو
يﺎﻫ ﻚﻴﻟﻮﺑﺎﺘﻣ و ﻚﻳژﺮﻧردآ
د سﺮﺘﺳا ﻪﺑ ﺖﺒﺴﻧ درا
ﻲﻣ و ﻨﻤﻣ مﺪﻋ ترﻮﺻ رد ﺪﻧاﻮﺗ ﻲﺑﻮﺧ ﻦﻳﺰﮕﻳﺎﺟ ﺖﻴﻋﻮ
ياﺮﺑ
ًﺎﺻﻮﺼﺧ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ رد
ﻴﻟﻮﺑﺎﺘﻣ تﻼﻜﺸﻣ ﺎﺑ نارﺎﻤﻴﺑ ﻚ
ﺪﺷﺎﺑ .
هژاو يﺪﻴﻠﻛ يﺎﻫ :
نﻮﺧ ﺪﻨﻗ ،لﺎﻨﻳﺎﭙﺳا ﻲﺴﺣ ﻲﺑ ،ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ،سﺮﺘﺳا .
ﻪﻣﺪﻘﻣ ﺖﺳا ﻚﻳژﻮﻟﻮﻳﺰﻴﻓ تاﺮﻴﻴﻐﺗ ﻪﻠﺴﻠﺳ ﻚﻳ سﺮﺘﺳا ﻪﺑ ﺶﻨﻛاو
ﻪﻛ ﺖﻴﻫﺎﻣ و هدﻮﺑ لﺎﻧردآﻮﺗﺎﭙﻤﺳ ﻚﻳﺮﺤﺗ ﻪﻄﺳاﻮﺑ ﺎﺗﺪﻤﻋ
د ﻚﻴﻟﻮﺑﺎﺗﺎﻛ
) درا
1
.(
ﺲﻟﺎﭙﻤﻳا ﻚﻳﺮﺤﺗ ﻞﺤﻣ زا ناروآ يﺎﻫ
هﺪﻴﺳر ﺰﻴﻓﻮﭙﻴﻫ و سﻮﻣﻻﺎﺗﻮﭙﻴﻫ رﻮﺤﻣ ﻪﺑ
) 1
ﺐﺟﻮﻣ و (
،ﺪﺷر نﻮﻣرﻮﻫ ﺶﻳاﺰﻓا ﻪﻠﻤﺟ زا ﻲﻧﻮﻣرﻮﻫ تاﺮﻴﻴﻐﺗ و لﺎﻧردآﻮﺗﺎﭙﻤﺳ ناﺮﺑاو نﺎﻳﺮﺟ ﻚﻳﺮﺤﺗ و لوﺰﻴﺗرﻮﻛ لﻮﻜﺗﺎﻛ ﺶﻳاﺰﻓا ﻦﻴﻣآ
ﻲﺗاﺮﻴﻴﻐﺗ و ﻦﮔﺎﻛﻮﻠﮔ نوﺮﺘﺳوﺪﻟا ،ﺎﻫ
ﻦﻴﺌﺗوﺮﭘ رد ﺎﺒﺘﺣا ،ﺎﻤﺳﻼﭘ يﺎﻫ
و ﻢﻴﺳﺎﺘﭘ ﺶﻫﺎﻛ ،ﻢﻳﺪﺳ س
دﻮﺸﻴﻣ نﻮﺧ ﺪﻨﻗ ﺶﻳاﺰﻓا
) 2
. (
و ﻚﻴﺗﺎﭙﻤﺳ ﺖﻴﻟﺎﻌﻓ ﺶﻳاﺰﻓا
دﺮﻔﻣﺎﻳرﻮﭘ ﻢﻴﻫاﺮﺑا نارﺎﻜﻤﻫ و
١٥٩
ﺰﻴﻧ ﻦﻴﻟﻮﺴﻧا ﺢﺷﺮﺗ ﺶﻫﺎﻛ ﺐﺟﻮﻣ ﻦﻴﻟﺎﻧردآرﻮﻧ ﺢﻄﺳ دﻮﺸﻴﻣ
) 6 - 3
ﻢﻫ .(
ﺶﻫﺎﻛ و ﺰﻧژﻮﺌﻧﻮﻛﻮﻠﮔ ﺶﻳاﺰﻓا ﺎﺑ ﻦﻴﻨﭼ
ﻲﻣ ﻲﻤﺴﻴﻠﮔﺮﭙﻳﺎﻫ ﺚﻋﺎﺑ ﺰﻛﻮﻠﮔ فﺮﺼﻣ
)دﻮﺷ
7
. (
ﻦﻴﻨﭽﻤﻫ
ﺰﻴﻧ ﻦﻴﻟﻮﺴﻧا ﻪﺑ ﺖﺒﺴﻧ ﺖﻣوﺎﻘﻣ ﺮﺑ ﻲﻨﺒﻣ يﺪﻫاﻮﺷ دﻮﺟو
) دراد
8
. (
سﺮﺘﺳا ﻚﻳ ناﻮﻨﻋ ﻪﺑ ﻲﺣاﺮﺟ ﻖﻳﺮﻃ زا
ﺶﻨﻛاو ﺶﻳاﺰﻓا ﺐﺟﻮﻣ قﻮﻓ يﺎﻫ زا ﺲﭘ و ﻦﻴﺣ ضراﻮﻋ
دﻮﺒﻬﺑ رد ﺮﻴﺧﺄﺗ ﻪﻠﻤﺟ زا ﻞﻤﻋ ﺮﻴﻣ و گﺮﻣ ﻲﺘﺣ و ﻢﺧز
ﻲﻣ
)دﻮﺷ
9
.(
ﺰﻛﻮﻠﮔ ﺪﻗﺎﻓ تﺎﻌﻳﺎﻣ ﻪﻛ يدراﻮﻣ رد نﻮﺧ ﺪﻨﻗ ﺶﻳاﺰﻓا
دراد دﻮﺟو دﻮﺷ فﺮﺼﻣ ﻢﻫ
) ,10 11
. (
ﻦﻳا ﺶﻳاﺰﻓا داﺮﻓا رد
ﻳد ﻲﻣ هﺪﻳد ﻚﻴﺘﺑﺎﻳد ﺮﻴﻏ و ﻚﻴﺘﺑﺎ
) دﻮﺷ
12
.(
ﻲﻤﺴﻴﻠﮔﺮﭙﻳﺎﻫ
ﺶﻫﺎﻛ ﻪﺑ ﺮﺠﻨﻣ ﻲﺻﺎﺼﺘﺧا ترﻮﺻ ﻪﺑ ﻲﺴﻛﺎﺗﻮﻤﻛ
هﺪﺷ ﺎﻫ ﻞﻴﻓوﺮﺗﻮﻧ
) 13
ﺖﻧﻮﻔﻋ ﺶﻳاﺰﻓا ﺐﺟﻮﻣ ﺮﻣا ﻦﻳا و (
،نﺪﺑ ﻲﺗاذ ﻲﻨﻤﻳا ﺶﻫﺎﻛ ﺖﻠﻌﺑ ﺮﻴﻣ و گﺮﻣ و ﻞﻤﻋ زا ﺪﻌﺑ ﻢﺧز دﻮﺒﻬﺑ رد ﺮﻴﺧﺄﺗ
،ﺎﻫ ﺐﻴﺳآ و نژﻼﻛ ﺢﺷﺮﺗ ﺶﻫﺎﻛ يﺎﻫ
ﻲﺒﻠﻗ و يﻮﻴﻠﻛ ،ﻲﺒﺼﻋ ﻲﻣ ﻲﻗوﺮﻋ
ﻮﺷ
) د
12
.(
ﻦﻴﻘﻘﺤﻣ ﺮﺜﻛا
ﻲﻤﻜﺴﻳا ترﻮﺻ رد ﻞﻤﻋ ﻦﻴﺣ نﻮﺧ ﺪﻨﻗ ﺶﻳاﺰﻓا ﺪﻧﺪﻘﺘﻌﻣ ناﺮﺒﺟ تﺎﻌﻳﺎﺿ ﺚﻋﺎﺑ ﻲﻣ يﺰﻐﻣ ﺮﻳﺬﭘﺎﻧ
) ددﺮﮔ
16 - 14
.(
ﻢﻫ سﺮﺘﺳا ﻲﻣ ﻦﻴﻨﭼ
ﻞﺜﻣ ﻲﻧاور ضراﻮﻋ ﺐﺟﻮﻣ ﺪﻧاﻮﺗ
ﻲﺑ ﺎﻣوﺮﺗ زا ﺲﭘ ﻲﻧاور لﻼﺘﺧا ﻲﺘﺣ و باﺮﻄﺿا ،ﻲﺑاﻮﺧ
) دﻮﺷ
17
.(
ﻲﺳرﺮﺑ رد ﺮﻃ زا هﺪﻣآ ﻞﻤﻌﺑ يﺎﻫ
هزاﺪﻧا ﻖﻳ يﺮﻴﮔ
ﻲﻃ نﻮﺧ ﺰﻛﻮﻠﮔ ﺢﻄﺳ 48
ﺺﺨﺸﻣ ﻞﻤﻋ زا ﺲﭘ ﺖﻋﺎﺳ
هﺪﻳدﺮﮔ ﺎﺑ ﺐﺟﻮﻣ يدﺎﻳز ﺪﺣ ﺎﺗ ﻞﻤﻋ ﻦﻴﺣ سﺮﺘﺳا ﺶﻫﺎﻛ
ددﺮﮔ ﻲﻣ ﻞﻤﻋ زا ﺲﭘ ضراﻮﻋ ﺶﻫﺎﻛ
) ,12 18
. (
ﺶﻨﻛاو كﻮﻠﺑ ﻪﻛ دراد دﻮﺟو ﺖﻴﻌﻗاو ﻦﻳا يﺎﻫ
سﺮﺘﺳا رد ﻲﻤﻬﻣ ﺶﻘﻧ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﻖﻳﺮﻃ زا از
ﺶﻨﻛاو ﻦﻳا لﺮﺘﻨﻛ راد ﻚﻳژﺮﻧردآ يﺎﻫ
) د
19
ﻢﻫ و (
ﻦﻴﻨﭼ
ﻲﭘا ﻖﻳﺮﻃ زا ﻲﻄﻴﺤﻣ كﻮﻠﺑ ﺢﻄﺳ رد لﺎﻨﻳﺎﭙﺳا و لارود
ﺶﻨﻛاو رﺎﻬﻣ ﺎﺑ ﻦﻴﻳﺎﭘ سﺮﺘﺳا ﻪﺑ ﺖﺒﺴﻧ ﻚﻳژﺮﻧردآ يﺎﻫ
دراد تاﺮﻴﻴﻐﺗ ﻦﻳا لﺮﺘﻨﻛ رد يﺮﺛﻮﻣ ﺶﻘﻧ ﻲﺣاﺮﺟ
) 20 21,
. (
ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﻊﻳﺎﺷ شور ود ﻲﺳرﺮﺑ ﻦﻳا رد
) ﻲﺑ ،يﺰﻨﻣآ تﻼﻀﻋ ﻲﻠﺷ و يدرد
( لﺎﻴﻧﺎﭙﺳا ﻲﺴﺤﻴﺑ و
) ﻮﻠﺑ ﺎﭙﻤﻳا ك ﻟ ﺲ عﺎﺨﻧ ﺢﻄﺳ رد ﺎﻫ (
رد ﻲﻧارﺎﻤﻴﺑ ﺖﺤﺗ ﻪﻛ
ﻲﻣ راﺮﻗ ﻲﺣاﺮﺟ ﻞﻤﻋ ﻦﻴﻴﻌﺗ ﺖﻬﺟ و ﺪﺷ ﻪﺴﻳﺎﻘﻣ ﺪﻨﺘﻓﺮﮔ
هزاﺪﻧا زا شور ود ﻦﻳا ﺮﻴﺛﺄﺗ يﺮﻴﮔ
ناﻮﻨﻋ ﻪﺑ نﻮﺧ ﺪﻨﻗ
ﻦﻳﺮﻛوﺪﻧا تاﺮﻴﻴﻐﺗ ﻪﺠﻴﺘﻧ ﺮﺘﻣﻮﻛﻮﻠﮔ ﺖﻗد ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ و
ﺖﺴﺗ ﺎﺑ ﺐﺳﺎﻨﺘﻣ ﻲﻫﺎﮕﺸﻳﺎﻣزآ يﺎﻫ
) 24 - 22
ﻪﻠﻴﺳو ﻪﺑ (
و هﺮﺒﻴﻟﺎﻛ ﺮﺘﻣﻮﻛﻮﻠﮔ ﻪﻨﻴﻣز ﻞﻣاﻮﻋ ﻦﺘﻓﺮﮔ ﺮﻈﻧ رد ﺎﺑ
ﺮﺛﻮﻣ يا
ﺮﺘﻣﻮﻛﻮﻠﮔ دﺮﻜﻠﻤﻋ ﺮﺑ
) 25 26,
ﺪﺷ هدﺎﻔﺘﺳا (
. ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد
ود رد ﻞﻤﻋ زا ﺪﻌﺑ و ﻞﺒﻗ نﻮﺧ ﺪﻨﻗ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ شور
ﺎﭙﺳا و ﻨﻳ هزاﺪﻧا لﺎ ﺑ نﻮﺧ ﺪﻨﻗ ﺢﻄﺳ توﺎﻔﺗ ﻪﺴﻳﺎﻘﻣ و يﺮﻴﮔ ﻪ
ﻪﺑ ﺶﻨﻛاو ﺶﻫﺎﻛ رد شور ود ﻦﻳا ﺮﻴﺛﺄﺗ ناﺰﻴﻣ ناﻮﻨﻋ ﻲﺳرﺮﺑ درﻮﻣ سﺮﺘﺳا راﺮﻗ
ﺖﻓﺮﮔ .
شور و داﻮﻣ ﺎﻫ
هﺪﺷ ﻲﻓدﺎﺼﺗ ﻲﻨﻴﻟﺎﺑ ﻲﻳﺎﻣزآرﺎﻛ عﻮﻧ زا ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ ﻲﺣاﺮﺟ ﻞﻤﻋ ﺪﻳﺪﻧﺎﻛ نارﺎﻤﻴﺑ يور ﺮﺑ ﻪﻛ هدﻮﺑ رﻮﻛ ﻪﻳﻮﺴﻜﻳ ﺪﺷ مﺎﺠﻧا لﺎﻨﻴﻳﻮﮕﻨﻳا ﻖﺘﻓ .
ﻪﺘﻴﻤﻛ ﺖﻘﻓاﻮﻣ ﺬﺧا زا ﺲﭘ
قﻼﺧا 60 ﻲﻨﺳ هدوﺪﺤﻣ رد رﺎﻤﻴﺑ 55
- 35 سﻼﻛ ﺎﺑ لﺎﺳ
ﻲﻜﻳﺰﻴﻓ ASA(I & II) ﺟ ﻞﻤﻋ مﺎﺠﻧا ﺖﻬﺟ ﻪﻛ
ﻲﺣاﺮ
ﺖﻳآ نﺎﺘﺳرﺎﻤﻴﺑ ﻪﺑ لﺎﻨﻴﻳﻮﮕﻨﻳا ﻖﺘﻓ ﷲا
دﺮﻛﺮﻬﺷ ﻲﻧﺎﺷﺎﻛ
ﺬﺧا و مزﻻ تﺎﺤﻴﺿﻮﺗ زا ﺲﭘ ،ﺪﻧدﻮﺑ هدﻮﻤﻧ ﻪﻌﺟاﺮﻣ هوﺮﮔ ود رد ﻪﻣﺎﻨﺸﺳﺮﭘ ﻞﻴﻤﻜﺗ و ﻪﻣﺎﻧ ﺖﻳﺎﺿر 30
هﺮﻔﻧ
) ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ هوﺮﮔ و لﺎﻨﻳﺎﭙﺳا هوﺮﮔ (
ﺪﻨﺘﻓﺮﮔ راﺮﻗ .
ﻚﻳ ﺎﺗ ﻢﻴﻧ ﻞﻤﻋ لﻮﻃ و ﺪﺣاو حاﺮﺟ ﻂﺳﻮﺗ ﻲﺣاﺮﺟ لﺎﻤﻋا دﻮﺑ ﺖﻋﺎﺳ .
ﺮﻫ ﻚﻳ ﻂﺳﻮﺗ لﺎﻨﻳﺎﭙﺳا و ﻲﺷﻮﻬﻴﺑ شور ود
ﻦﻴﺴﻨﻜﺗ ﻚﻤﻛ ﺎﺑ و ﻲﺷﻮﻬﻴﺑ ﺺﺼﺨﺘﻣ مﺎﺠﻧا توﺎﻔﺘﻣ يﺎﻫ
ﻲﻣ دﺮﻴﮔ . ﺲﻟﺎﭘ ﻞﻣﺎﺷ ﻞﻤﻋ ﻦﻴﺣ ﺶﻳﺎﭘ نﺎﺑﺮﺿ ،يﺮﺘﻤﻴﺴﻛا
دﻮﺑ نﻮﺧرﺎﺸﻓ و ﺐﻠﻗ .
ﺮﻫ ﻞﻣﺎﺷ ﻪﻌﻟﺎﻄﻣ زا جوﺮﺧ يﺎﻫرﺎﻴﻌﻣ
ﻲﻫدﺮﻴﺷ و يرادرﺎﺑ ،ﺖﺑﺎﻳد ،ﻲﻗوﺮﻋ ﻲﺒﻠﻗ يرﺎﻤﻴﺑ ﻪﻧﻮﮔ )
رد
نز نارﺎﻤﻴﺑ (
ﻴﻠﻜﻟا ،يژﺮﻟآ ، ،يﺪﺒﻛ ،يدﺪﻏ تﻼﻜﺸﻣ ،ﻢﺴ
و ﻦﻴﻟﻮﺴﻧا ﺮﺑ ﺮﺛﻮﻣ يﺎﻫوراد ﺎﻳ رﺪﺨﻣ داﻮﻣ فﺮﺼﻣ ،يﻮﻴﻠﻛ
ﻴﻫاﺮﺑا دﺮﻔﻣﺎﻳرﻮﭘ ﻢ نارﺎﻜﻤﻫ و
١٦٠
دﻮﺑ لﺎﻨﻳﺎﭙﺳا ﺎﻳ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺖﻬﺟ ﻊﻨﻣ ﻪﻧﻮﮔﺮﻫ .
رد
درﻮﻣ هوﺮﮔ )
ﻲﻋﺎﺨﻧ ﻲﺴﺤﻴﺑ ﺎﺑ نارﺎﻤﻴﺑ (
2 ﻲﻠﻴﻣ ﺮﺘﻴﻟ
ﻚﻳرﺎﺑﺮﭙﻴﻫ ﻦﻴﺋﺎﻛﻮﻠﻳﺰﮔ 5
% هرﺎﻤﺷ نزﻮﺳ زا هدﺎﻔﺘﺳا ﺎﺑ و
24 - 22 ﭙﺳا ﺎ هﺮﻬﻣ ﻦﻴﺑ يﺎﻀﻓ رد لﺎﻨﻳ يا
L3-L5 ﻖﻳرﺰﺗ
ﺪﺷ ﺢﻄﺳ ﺎﺗ ﻲﺴﺤﻴﺑ و (T12 –L1)
ﺪﻳدﺮﮔ ﻆﻔﺣ .
ﺲﭙﺳ
رﺎﻤﻴﺑ ﻲﻣ راﺮﻗ ﻦﻳﺎﭘﻮﺳ ﺖﻟﺎﺣ رد ﺖﻓﺮﮔ
. ﺪﻫﺎﺷ هوﺮﮔ رد
يوراد ﺎﺑ نارﺎﻤﻴﺑ ﻦﻴﭘوﺮﺗآ
5 / 0 ﻲﻠﻴﻣ ﻢﻳﺪﺳ لﺎﺘﻨﭘﻮﻴﺗ ،مﺮﮔ
5 ﻠﻴﻣ ﻲ مﻮﻳرﻮﻛاﺮﺗآ و نﺪﺑ نزو مﺮﮔﻮﻠﻴﻛ يازا ﻪﺑ مﺮﮔ
5 / 0 ﻲﻠﻴﻣ مﺮﮔﻮﻠﻴﻛ يازا ﻪﺑ مﺮﮔ ﻞﻴﻧﺎﺘﻨﻓ زا و هﺪﺷ ﻦﺸﻛاﺪﻨﻳا
2 مﺮﮔﻮﻠﻴﻛ ﺮﻫ يازا ﻪﺑ مﺮﮔوﺮﻜﻴﻣ و درد ﻦﻴﻜﺴﺗ ﺖﻬﺟ
لﻮﻓﻮﭘوﺮﭘ نﻮﻳزﻮﻔﻧا ترﻮﺻ ﻪﺑ
ﻲﺷﻮﻬﻴﺑ ﻪﻣادا ﺖﻬﺟ يﺪﻳرو
ﻲﻣ هدﺎﻔﺘﺳا ﺪﺷ
. ﺮﻫ رد ود ﺪﻨﻗ هوﺮﮔ نﻮﺧ
ﻞﺒﻗ ﺖﻋﺎﺳ ﻚﻳ
ﻞﺻاﻮﻓ ﻪﺑ و ﻞﻤﻋ زا 1
و 6 ﻞﻤﻋ زا ﺲﭘ ﺖﻋﺎﺳ ﻪﻛ ﻲﻟﺎﺣ رد
،ﺪﻨﺘﺷاد نﺎﺴﻜﻳ يﺪﻳرو ي ﻪﻳﺬﻐﺗ و هدﻮﺑ ﺎﺘﺷﺎﻧ ﻪﻠﻴﺳﻮﺑ
ﻟﺎﻛ ﺮﺘﻣﻮﻛﻮﻠﮔ ﺒﻴ
هﺮ كرﺎﻣ Accu-Check )
لﺪﻣ sensor
ﻪﻧﺎﺧرﺎﻛ ﺖﺧﺎﺳ Rochs
(
، ) ﺮﺘﻣﻮﻛﻮﻠﮔ ﻪﻜﻨﻳا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ
دراد ﻲﻫﺎﮕﺸﻳﺎﻣزآ شور ﻪﺑﺎﺸﻣ نﺎﻨﻴﻤﻃا (
ﺖﺸﮕﻧا ﻖﻳﺮﻃزا
ﻪﻧﻮﻤﻧ ﻂﻳاﺮﺷ ﺖﻳﺎﻋر ﺎﺑ و ﺖﺳار ﺖﺳد مود هرﺎﻤﺷ و يﺮﻴﮔ
ﺪﻳﺮﻴﺴﻴﻠﮔ يﺮﺗ ﺪﻨﻧﺎﻣ راﺬﮔﺮﻴﺛﺎﺗ ﻞﻣاﻮﻋ فﺬﺣ 500<
ﻲﻠﻴﻣ ﻲﺳد رد مﺮﮔ
،نﻮﻴﺳﺎﺗارﺪﻴﻫد ،ﺮﺘﻴﻟ زا ﺮﺘﻤﻛ ﺖﻳﺮﻛﻮﺗﺎﻤﻫ
20 زا ﺮﺘﺸﻴﺑ ﺎﻳ 65
زا ﺶﻴﺑ ﻚﻳروا ﺪﻴﺳا ،ﺪﺻرد 10
ﻲﻠﻴﻣ ﻲﺳد رد مﺮﮔ
،ﻚﻴﺑرﻮﻜﺳا ﺪﻴﺳا فﺮﺼﻣ ﺎﻳ و ﺮﺘﻴﻟ
هزاﺪﻧا بﺮﺠﻣ ﻲﺷﻮﻬﻴﺑ ﻦﻴﺴﻨﻜﺗ ﻂﺳﻮﺗ ﻲﻣ يﺮﻴﮔ
و ﺪﺷ
نﺮﺘﻨﻳا ﻂﺳﻮﺗ تﺪﻣ ﻦﻳا ﻲﻃ ﻪﺿرﺎﻋ ﻪﻧﻮﮔ ﺮﻫ عﻮﻗو ﻲﺑ نارﺎﻤﻴﺑ هوﺮﮔ زا ﻪﻛ ﻪﻃﻮﺑﺮﻣ ﺪﻳدﺮﮔ ﻲﺳرﺮﺑ دﻮﺑ عﻼﻃا
.
تﺎﻋﻼﻃا ﻞﻤﻋ تﺪﻣ و ﻲﺷﻮﻬﻴﺑ عﻮﻧ ،ﻦﺳ ﻪﺑ طﻮﺑﺮﻣ
ﻲﺣاﺮﺟ
، فﺮﺼﻣ درﻮﻣ تﺎﻌﻳﺎﻣ راﺪﻘﻣ )
هوﺮﮔ ود ﺮﻫ رد ﻪﻛ
ﻲﻣ هدﺎﻔﺘﺳا ﺮﮕﻨﻳر مﺮﺳ زا نﺎﺴﻜﻳ رﻮﻃ ﻪﺑ ﺪﺷ
( ، ﺪﻨﻗ ناﺰﻴﻣ
ﻚﻳ رﺎﻤﻴﺑ نﻮﺧ ﺖﻋﺎﺳ
و ﻞﻤﻋ زا ﻞﺒﻗ 1
ﺖﻋﺎﺳ ﺶﺷ و
ﻞﻤﻋ زا ﺲﭘ ﺖﻋﺎﺳ
، ﺪﺷ ﺖﺒﺛ .
ﻊﻤﺟ زا ﺲﭘ يروآ
،
راﺰﻓا مﺮﻧ ﻂﺳﻮﺗ تﺎﻋﻼﻃا ﻪﺨﺴﻧ SPSS
10 و زا هدﺎﻔﺘﺳا و ﻦﻴﮕﻧﺎﻴﻣ
نﻮﻣزآ زا هدﺎﻔﺘﺳا ﺎﺑ ﻪﻠﺻﺎﺣ ﺞﻳﺎﺘﻧ ،ﺖﺴﺗ T
هوﺮﮔ ﺪﻧﺪﺷ ﺰﻴﻟﺎﻧآ رﻮﻜﺳا يﺎﻛ و ﻞﻘﺘﺴﻣ ﻲﺟوز يﺎﻫ ﺞﻳﺎﺘﻧ و
ﻦﻴﮕﻧﺎﻴﻣ ترﻮﺻ ﻪﺑ /+
- و نﺎﻴﺑ ﺪﺻرد و رﺎﻴﻌﻣ فاﺮﺤﻧا
ﻲﻨﻌﻣ ﺢﻄﺳ ترﻮﺻ ﻪﺑ يراد
) 05 / 0 p<
( ﺪﺷ ﻒﻳﺮﻌﺗ .
ﻪﺘﻓﺎﻳ ﺎﻫ ﻪﻧﻮﻤﻧ ﻢﺠﺣ ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا 60
ﺎﻘﻣ رﻮﻈﻨﻣ ﻪﺑ ﺮﻔﻧ ود ﺮﺛا ﻪﺴﻳ
نﻮﺧ ﺪﻨﻗ تاﺮﻴﻴﻐﺗ ﺮﺑ لﺎﻨﻳﺎﭙﺳا و ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ شور ﻖﺘﻓ ﻮﻴﺘﻜﻟا ﻲﺣاﺮﺟ ﻞﻤﻋ زا ﻲﺷﺎﻧ ﻲﺣاﺮﺟ يﺎﻣوﺮﺗ زا ﻲﺷﺎﻧ ﺖﻓﺮﮔ مﺎﺠﻧا لﺎﻨﻴﻳﻮﮕﻨﻳا .
ﻞﻣﺎﺷ ﺎﻫ هوﺮﮔ زا ماﺪﻛ ﺮﻫ 30
لﺎﺴﻧﺎﻴﻣ دﺮﻣ ﺮﻔﻧ ASA (I , II)
ﻦﺳ ﻦﻴﮕﻧﺎﻴﻣ ﺎﺑ 43
لﺎﺳ
ﺪﻫﺎﺷ هوﺮﮔ رد ﻪﻛ 1
/ 42 ) رﺎﻴﻌﻣ فاﺮﺤﻧا 53
/ 4 ( ﮔ رد و هوﺮ
لﺎﻨﻳﺎﭙﺳا درﻮﻣ 1
/ 43 ) رﺎﻴﻌﻣ فاﺮﺤﻧا 05
/ 5 ( دﻮﺑ . ﺞﻳﺎﺘﻧ
ﺖﻋﺎﺳ ﻚﻳ رد نﻮﺧ ﺪﻨﻗ ﻦﻴﮕﻧﺎﻴﻣ ﺪﻫد ﻲﻣ نﺎﺸﻧ ﻲﺳرﺮﺑ ﺪﻫﺎﺷ هوﺮﮔ رد ﻞﻤﻋ زا ﻞﺒﻗ 5
/ 109 ﻲﻠﻴﻣ ﻲﺳد رد مﺮﮔ ﺮﺘﻴﻟ
رﺎﻴﻌﻣ فاﺮﺤﻧا ﺎﺑ 3
/ 5 درﻮﻣ هوﺮﮔ رد و ، 4
/ 109 ﻲﻠﻴﻣ رد مﺮﮔ
ﻲﺳد رﺎﻴﻌﻣ فاﺮﺤﻧا ﺎﺑ ﺮﺘﻴﻟ 5
/ 5 توﺎﻔﺗ ﻪﻛ ﺖﺳا هدﻮﺑ
ﻲﻨﻌﻣ اد دراﺪﻧ ير )
05 / 0 p>
.(
زا ﺪﻌﺑ ﺖﻋﺎﺳ ﻚﻳ نﻮﺧ ﺪﻨﻗ
ﺪﻫﺎﺷ هوﺮﮔ رد ﻞﻤﻋ 2
/ 114 ﻲﻠﻴﻣ ﻲﺳد رد مﺮﮔ ﺎﺑ ﺮﺘﻴﻟ
رﺎﻴﻌﻣ فاﺮﺤﻧا 6
/ 5 درﻮﻣ هوﺮﮔ رد و 3
/ 101 ﻲﻠﻴﻣ رد مﺮﮔ
ﻲﺳد رﺎﻴﻌﻣ فاﺮﺤﻧا ﺎﺑ ﺮﺘﻴﻟ 1
/ 5 نﻮﺧ ﺪﻨﻗ و 6
ﺲﭘ ﺖﻋﺎﺳ
ﺪﻫﺎﺷ هوﺮﮔ رد ﻞﻤﻋ زا 06
/ 111 ﻲﻠﻴﻣ ﻲﺳد رد مﺮﮔ ﺎﺑ ﺮﺘﻴﻟ
رﺎﻴﻌﻣ فاﺮﺤﻧا 8
/ 5 درﻮﻣ هوﺮﮔ رد و 88
ﻲﻠﻴﻣ رد مﺮﮔ
ﻲﺳد رﺎﻴﻌﻣ فاﺮﺤﻧا ﺎﺑ ﺮﺘﻴﻟ 5
/ 4 ﻲﻣ نﺎﺸﻧ ﻪﻛ دﻮﺑ ﺪﻨﻗ ﺪﻫد
نﻮﺧ 1 ﻪﺑ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ هوﺮﮔ رد ﻞﻤﻋ زا ﺲﭘ ﺖﻋﺎﺳ
ﺖﺳا ﻪﺘﺷاد ﺶﻳاﺰﻓا ﺢﺿاو رﻮﻃ .
ﻪﻛ ﺖﺳا ﻲﺗرﻮﺻ رد ﻦﻳا
ﺪﻫد ﻲﻣ نﺎﺸﻧ ﺶﻫﺎﻛ لﺎﻨﻳﺎﭙﺳا ﻲﺴﺤﻴﺑ هوﺮﮔ رد ) 05 / p<0 ( . رد ﻦﻴﻨﭽﻤﻫ 6
ﮔ رد ﻞﻤﻋ زا ﺲﭘ ﺖﻋﺎﺳ هوﺮ
ﻪﺑ ﺖﺒﺴﻧ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ 1
ﺶﻳاﺰﻓا ﻞﻤﻋ زا ﻞﺒﻗ ﺖﻋﺎﺳ
ﻢﻫ ﻲﻟو هداد نﺎﺸﻧ يﺮﺘﻤﻛ لﺎﻨﻳﺎﭙﺳا هوﺮﮔ ﻪﺑ ﺖﺒﺴﻧ نﺎﻨﭼ
ﺖﺳا ﺮﺘﺸﻴﺑ ﺢﺿاو رﻮﻃ ﻪﺑ ) .
05 / p<0 (.
دﺮﻔﻣﺎﻳرﻮﭘ ﻢﻴﻫاﺮﺑا نارﺎﻜﻤﻫ و
١٦١
ﺚﺤﺑ ﺖﻗد ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ نارﺎﻤﻴﺑ نﻮﺧ ﺪﻨﻗ تاﺮﻴﻴﻐﺗ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد
شور ﺎﺑ ﺐﺳﺎﻨﺘﻣ ﺮﺘﻣﻮﻛﻮﻠﮔ ﻲﻫﺎﮕﺸﻳﺎﻣزآ يﺎﻫ
) 25 - 23 (
ﻟﺎﻛ ﺮﺘﻣﻮﻛﻮﻠﮔ ﻪﻠﻴﺳﻮﺑ ﻲﻟﺎﻤﺘﺣا ﻞﻣاﻮﻋ فﺬﺣ ﺎﺑ و هﺮﺒﻴ
ﺮﺘﻣﻮﻛﻮﻠﮔ ﺖﻗد رد هﺪﻨﻨﻛ ﻪﻠﺧاﺪﻣ
) 25
، 26
زا ﺪﻌﺑ و ﻞﺒﻗ (
هزاﺪﻧا ﻲﺣاﺮﺟ ﻞﻤﻋ ﺪﺷ يﺮﻴﮔ
. ﻦﻴﻳﺎﭘ رد نﻮﺧ ﺪﻨﻗ ندﻮﺑ ﺮﺗ
ﻻﺎﻤﺘﺣا ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﻪﺑ ﺖﺒﺴﻧ لﺎﻨﻴﭙﺳا هوﺮﮔ نﺎﺸﻧ لﺮﺘﻨﻛ رد لﺎﻨﻳﺎﭙﺳا شور ﺮﺘﻬﺑ ﺮﻴﺛﺎﺗ هﺪﻨﻫد
ﺶﻨﻛاو ﺣ ﻚﻳژﺮﻧردآﻮﺗﺎﭙﻤﺳ و لﺎﻧﻮﻣرﻮﻫ يﺎﻫ زا ﺲﭘ و ﻦﻴ
ﻲﻣ ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﻪﺑ ﺖﺒﺴﻧ ﻞﻤﻋ ﺪﺷﺎﺑ
.
"
ﺰﻨﻴﻟﺎﻛ و رﻮﻤﻠﻳو
"
ﺪﻧداد نﺎﺸﻧ سﺮﺘﺳا ﻪﺑ ﺶﻨﻛاو
ﻖﻳﺮﻃ زا ﺐﻴﺳآ ﻞﺤﻣ زا ﻪﻛ ﺖﺳا تاﺮﻴﻴﻐﺗ ﻪﻠﺴﻠﺳ ﻚﻳ هار لﺮﺘﻨﻛ ﺰﻛﺮﻣ ﻪﺑ ﻲﻧﻮﻣرﻮﻫ و ﻲﺒﺼﻋ يﺎﻫ و ﻞﻘﺘﻨﻣ هﺪﻨﻨﻛ
ﺶﻨﻛاو تاﺮﻴﻴﻐﺗ ﺮﻴﻈﻧ يدﺪﻌﺘﻣ يﺎﻫ ،بآ ﻢﺠﺣ ،ﻲﺑﺮﭼ
ﻦﻴﺌﺗوﺮﭘ و ﻢﻴﺳﺎﺘﭘ ،ﻢﻳﺪﺳ ﺎﻫ
دﻮﺷ ﻲﻣ نﻮﺧ ﺢﻄﺳ ي
) 1
، 2
.(
و ﻚﻳژﺮﻧردآ ﻚﻳﺮﺤﺗ ﺪﻧﺪﻘﺘﻌﻣ ﺮﺘﻟﺎﻫ و اﻮﻨﻳرآ،نﻮﺴﻴﻟآ ﻲﻣ ﻦﻴﻟﻮﺴﻧا ﺢﺷﺮﺗ ﻪﻔﻗو ﺐﺟﻮﻣ ﻦﻴﻟﺎﻧردآرﻮﻧ ﺶﻳاﺰﻓا دﻮﺷ
) 6 - 3
.(
"
رﻮﺘﻠﻳد
"
ﻲﺷﺎﻧ ﻲﻤﺴﻴﻠﮔﺮﭙﻳﺎﻫ ﻪﻛ ﺪﻴﺳر ﻪﺠﻴﺘﻧ ﻦﻳا ﻪﺑ
ﺶﻳاﺰﻓا ﺐﺟﻮﻣ ﻚﻳژﺮﻧردآ ﻚﻳﺮﺤﺗ و سﺮﺘﺳا زا ﻮﻠﺳ ﻪﺑ ﺰﻛﻮﻠﮔ دورو ﺶﻫﺎﻛ ﻦﻴﻨﭽﻤﻫ و ﺰﻧژﻮﺌﻧﻮﻛﻮﻠﮔ و ل
ﻲﻣ ﻲﻤﺴﻴﻠﮔﺮﭙﻳﺎﻫ ﺎﺘﻳﺎﻬﻧ
) دﻮﺷ
7
ﻦﻴﻨﭽﻤﻫ (
"
"ﻚﻠﺑ ﻲﻋﺪﻣ
ﻪﺑ ﺖﺒﺴﻧ ﺖﻣوﺎﻘﻣ دﺎﺠﻳا ﺐﺟﻮﻣ ﻲﺣاﺮﺟ سﺮﺘﺳا ﺖﺳا ددﺮﮕﻴﻣ ﻦﻴﻟﻮﺴﻧا
) 8
" .(
ﻦﻨﻴﺗﻮﻧ و نﻮﺴﻠﻴﻧ
"
ﻲﺘﺣ ﺪﻧﺪﻘﺘﻌﻣ
ﻲﺣاﺮﺟ ﻞﻤﻋ ﻦﻴﺣ رد ﺰﻛﻮﻠﮔ ﺪﻗﺎﻓ تﺎﻌﻳﺎﻣ ﻪﻛ يدراﻮﻣ رد ﻲﻣ هﺪﻫﺎﺸﻣ نﻮﺧ ﺪﻨﻗ ﺶﻳاﺰﻓا ﻢﻫ زﺎﺑ ،دﻮﺷ فﺮﺼﻣ دﻮﺷ
) , 10 11
ﺰﭘ .(
ﻲﺣاﺮﺟ ﺰﻛﺮﻣ نﺎﻜﺷ ﺪﻧداد نﺎﺸﻧ ﺰﻨﻴﺑار
ﻦﻳا
ﻲﺘﺑﺎﻳدﺮﻴﻏ نارﺎﻤﻴﺑ رد ﻢﻫ و ﻲﺘﺑﺎﻳد نارﺎﻤﻴﺑ رد ﻢﻫ ﺮﻴﻴﻐﺗ ﺖﺳا هﺪﻫﺎﺸﻣ ﻞﺑﺎﻗ
) 12
.(
ﻢﻫ ﺰﻨﻴﺑار ﻲﺣاﺮﺟ ﺰﻛﺮﻣ نﺎﻜﺷﺰﭘ -
رد نﻮﺧ ﺪﻨﻗ يراﺪﻬﮕﻧ ﻪﻛ ﺪﻧدﺮﺑ ﻲﭘ ﻪﺘﻜﻧ ﻦﻳا ﻪﺑ ﻦﻴﻨﭼ ﺢﻄﺳ 120 - 80 ﻲﻠﻴﻣ ﻲﺳد رد مﺮﮔ ﺶﻫﺎﻛ ﺐﺟﻮﻣ ﺮﺘﻴﻟ
ﻤﻋ زا ﺲﭘ بﻮﻠﻄﻣﺎﻧ ضراﻮﻋ ﻲﻣ ﻞ
)دﻮﺷ
12
. (
"
پارﺪﻨﺴﻳرو
"
و
ﻞﻤﻋ ﻊﻗﻮﻣ سﺮﺘﺳا لﺮﺘﻨﻛ ﻪﻛ ﺪﻧداد نﺎﺸﻧ ﺶﻧارﺎﻜﻤﻫ ﺎﺗ ﺪﺣ ﻲﻣ ﺶﻫﺎﻛ ار ﻞﻤﻋ زا ﺪﻌﺑ ﺖﻧﻮﻔﻋ يدﺎﻳز
) ﺪﻫد
18
. (
"
ﻲﺴﻴﻧﺎﺷوآ
"
ﻲﺴﺤﻴﺑ و ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺖﺳا ﺪﻘﺘﻌﻣ
ﻲﻣ سﺮﺘﺳا ﻪﺑ ﺶﻨﻛاو زا لﺎﻨﻳﺎﭙﺳا
)ﺪﻫﺎﻛ
19
.(
"
"مﻮﻴﻫ ﻪﺑ
ﻲﻣ لﺎﻨﻳﺎﭙﺳا ﻲﺴﺤﻴﺑ ﻪﻛ ﺪﻴﺳر ﻪﺠﻴﺘﻧ ﻦﻳا ﻲﺑﻮﺧ ﻪﺑ ﺪﻧاﻮﺗ
ﺪﻨﻛ ﻞﻤﻋ يﻮﻗ ﻦﻜﺴﻣ زا هدﺎﻔﺘﺳا و ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ
) 27
. (
"
ﺮﺘﻟﺎﻫ
"
ود زا ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺎﺑ ﻲﺣاﺮﺟ ﺖﺳا ﺪﻘﺘﻌﻣ
ﻲﻣ نﻮﺧ ﺪﻨﻗ ﺶﻳاﺰﻓا ﺐﺟﻮﻣ ﻖﻳﺮﻃ ﺶﻘﻧ ﻲﻜﻳ ،دﻮﺷ
يﺎﻫوراد ﻚﻳژﻮﻟﻮﻛﺎﻣرﺎﻓ تاﺮﺛا يﺮﮕﻳد و ﻲﺣاﺮﺟ سﺮﺘﺳا ﻲﺷﻮﻬﻴﺑ
) 28
. (
ﻦﻴﻨﭽﻤﻫ
"
"گﻼﻓ ﻪﻛ ﺪﻴﺳر ﻪﺠﻴﺘﻧ ﻦﻳا ﻪﺑ
ﺶﻳاﺰﻓا ﺮﺑ يﺮﺘﻤﻛ تاﺮﺛا لﺎﻨﻳﺎﭙﺳا ﻲﺴﺤﻴﺑ ﺖﺤﺗ ﻲﺣاﺮﺟ دراد نﻮﺧ ﺪﻨﻗ
) 29
. (
"
ﺖﻠﻴﻛ و ﺮﺘﻟﺎﻫ
"
ﻲﻣ هرﺎﺷا ﻪﻛ ﺪﻨﻨﻛ
ﺢﺷﺮﺗ ﻂﻔﺣ ﺐﺟﻮﻣ ﻦﻴﻳﺎﭘ ﺢﻄﺳ رد لﺎﻨﻳﺎﭙﺳا و لارود ﻲﭘا ﻚﻳژﺮﻧردآ ﻪﻔﻗو ﻖﻳﺮﻃ زا نﻮﺧ ﺰﻛﻮﻠﮔ ﻞﻤﺤﺗ و ﻦﻴﻟﻮﺴﻧا دﻮﺸﻴﻣ ﻲﺣاﺮﺟ سﺮﺘﺳا ﻪﺑ ﺖﺒﺴﻧ
) 20
، 21
. (
ﻻ ﻦﻣﺮﺗ
ماﻮﺗ لاروﺪﻴﭘا ﻲﺴﺤﻴﺑ مﺎﺠﻧا ﺪﻧدﺮﻛ ﻪﺑﺮﺠﺗ ﺰﻴﻧ ﺶﻧارﺎﻜﻤﻫو و ﻦﻴﺣ نﻮﺧ ﺪﻨﻗ ﺖﻈﻠﻏ ﺶﻳاﺰﻓا زا ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺎﺑ ﻲﻣ يﺮﻴﮔﻮﻠﺟ يﺮﻴﮕﻤﺸﭼ رﻮﻃ ﻪﺑ ﻲﺣاﺮﺟ ﻞﻤﻋ زا ﺲﭘ ﺪﻨﻛ
) 30
. (
نارﺎﻤﻴﺑ نﻮﺧ ﺪﻨﻗ ﻪﻛ داد نﺎﺸﻧ ﺰﻴﻧ ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﺞﻳﺎﺘﻧ 1 و ﻪﺘﺷاد ﺶﻫﺎﻛ لﺎﻨﻳﺎﭙﺳا هوﺮﮔ رد ﻞﻤﻋ زا ﺲﭘ ﺖﻋﺎﺳ
ﻦﻳا ﺶﻳاﺰﻓا ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ هوﺮﮔ رد ﻪﻛ ﺖﺴﻴﻟﺎﺣ رد
نﻮﺧ ﺪﻨﻗ و ﻪﺘﻓﺎﻳ 6
ود ﺮﻫ رد ﺪﻨﭼﺮﻫ ﻞﻤﻋ زا ﺲﭘ ﺖﻋﺎﺳ
نﻮﺧ ﺪﻨﻗ ﻪﺑ ﺖﺒﺴﻧ هوﺮﮔ 1
ﺶﻫﺎﻛ ﻞﻤﻋ زا ﺲﭘ ﺖﻋﺎﺳ
ﻲﻣ نﺎﺸﻧ رﻮﻃ ﻪﺑ لﺎﻨﻳﺎﭙﺳا هوﺮﮔ رد ﺶﻫﺎﻛ ﻦﻳا ﻲﻟو ﺪﻫد
ﻲﻨﻌﻣ ﺮﻈﻧ ﺪﻳﻮﻣ ﻦﻳا ﻪﻛ ،ﺖﺳا ﺮﺘﺸﻴﺑ يراد
"
گﻼﻓ
"
ﻲﻣ ﺪﺷﺎﺑ . ﺪﻨﭼﺮﻫ
"
ﺮﺘﻟﺎﻫ
"
تاﺮﺛا ﻪﺑ ﻚﻳژﻮﻟﻮﻛﺎﻣرﺎﻓ
ﺮﺛا ﻦﻳا ﻪﻛ ﺖﺳا هدﻮﻤﻧ هرﺎﺷا ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ يﺎﻫوراد ﻲﻣ توﺎﻔﺘﻣ هدﺎﻔﺘﺳا درﻮﻣ يوراد عﻮﻧ ﻪﺑ ﻪﺘﺴﺑ ﺎﺑ ﻲﻟو ﺪﺷﺎﺑ
ﺮﻈﻧ ﻪﺑ ﻪﺟﻮﺗ
"
ﻦﻣﺮﺗﻻ
"
ﻲﻣ ﺮﻈﻧ ﻪﺑ ،ﺎﻣ هﺪﺷ مﺎﺠﻧا حﺮﻃ و -
لﺎﻘﺘﻧا رﺎﻬﻣ رد يﺮﺘﺸﻴﺑ ترﺪﻗ لﺎﻨﻳﺎﭙﺳا شور ﻻﻮﺻا ﺪﺳر ﺶﻨﻛاو سﺮﺘﺳا يﺎﻫ ﺮﻴﮔﻮﻠﺟ و ﺰﻛﺮﻣ ﻪﺑ درد و از
زا ي
ﻴﻫاﺮﺑا دﺮﻔﻣﺎﻳرﻮﭘ ﻢ نارﺎﻜﻤﻫ و
١٦٢
ﺶﻨﻛاو بﻮﻠﻄﻣﺎﻧ ضراﻮﻋ ًﺎﺘﺠﻴﺘﻧ و ﻲﺒﺼﻋ و ﻲﻧﻮﻣرﻮﻫ يﺎﻫ
ﻲﻣ نآ زا ﻲﺷﺎﻧ ﺪﺷﺎﺑ
. يﺎﻫوراد ﻚﻳژﻮﻟﻮﻛﺎﻣرﺎﻓ ﺮﻴﺛﺎﺗ ﺪﻨﭼﺮﻫ
رود ﺮﻈﻧ زا ﺪﻳﺎﺒﻧ ار نﻮﺧ ﺪﻨﻗ ﺶﻳاﺰﻓا رد ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺖﺷاد . ﻲﻣ لﺎﻨﻳﺎﭙﺳا شور ﺪﻧاﻮﺗ
رد ﻲﺑﺎﺨﺘﻧا و ﺮﺛﻮﻣ شور
ﮔﺮﻫ ﺎﻳ ﺖﺑﺎﻳد ًﺎﺻﻮﺼﺧ ﻚﻴﻟﻮﺑﺎﺘﻣ تﻻﻼﺘﺧا ﺎﺑ نارﺎﻤﻴﺑ ﻪﻧﻮ
ﻞﻴﺒﻗ زا ﺮﮕﻳد لﻼﺘﺧا يرﺎﻤﻴﺑ ﺎﻳ ﮓﻨﻴﺷﻮﻛ
ﺎﺑ هاﺮﻤﻫ يﺎﻫ
ﭙﻴﻫ ﺮ يﺮﺗﺮﭙﻴﻫ ،ﻲﻤﺴﻴﻠﮔ ﮔ
ﺮﺴﻴﻠ ﺪﻳ ﻲﻣﺮﺗﺎﻧﺮﭙﻴﻫ ،ي و
ﺪﺷﺎﺑ نﻮﻴﺳﺎﺗﺮﭙﻴﻫ .
ﻲﻣ ﺮﻈﻧ ﻪﺑ ﻦﻴﻨﭽﻤﻫ ﺪﻴﺋﺎﺗ رد ﺪﺳر
ﺮﻈﻧ
"
ﮓﻧاﻮﻫ
"
هزاﺪﻧا لﺎﻤﻋا ﻦﻴﺣ نﻮﺧ ﺪﻨﻗ رﺮﻜﻣ يﺮﻴﮔ
ﻲﻣ ﻲﺣاﺮﺟ و شور ﻦﻴﻴﻌﺗ ﺖﻬﺟ ﻲﺑﻮﺧ يﺎﻤﻨﻫار ﺪﻧاﻮﺗ
ﺑ يﺎﻫوراد ناﺰﻴﻣ ﻢﻴﻈﻨﺗ ﺪﺷﺎﺑ ﻲﺷﻮﻬﻴ
. ﺶﻫﺎﻛ ،ندﻮﺑ ﻦﻤﻳا ،ﻲﻳوراد ﺮﺘﻤﻛ تﻼﺧاﺪﺗ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ
لﺎﻨﻳﺎﭙﺳا شور ﺮﺘﻤﻛ سرﺮﻳد ضراﻮﻋ ،ﻚﻴﻟﻮﺑﺎﺘﻣ ضراﻮﻋ رد شور ﻦﻳا ﺐﺳﺎﻨﻣ ﻲﻳﺎﻧاﻮﺗ و ،ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﻪﺑ ﺖﺒﺴﻧ ﺲﻟﺎﭙﻤﻳا لﺮﺘﻨﻛ ﺰﻐﻣ ﻪﺑ از سﺮﺘﺳا يﺎﻫ
ﻲﻣ شور ﻦﻳا, ﺪﻧاﻮﺗ
رد ﺖﻴﻋﻮﻨﻤﻣ مﺪﻋ ترﻮﺻ رد هﺮﻣزور شور ﻚﻳ ناﻮﻨﻋ ﻪﺑ ﻤﻋا دﺮﻴﮔ راﺮﻗ ﻲﺣاﺮﺟ لﺎ .
ﻢﻫ ضراﻮﻋ ﺶﻫﺎﻛ ناﻮﺘﻴﻣ ﻦﻴﻨﭼ
و لﺎﻨﻳﺎﭙﺳا ﻲﺴﺤﻴﺑ زا ﻪﻛ ﻲﻧارﺎﻤﻴﺑ رد ار سﺮﺘﺳا زا ﻲﺷﺎﻧ هدﺮﻛ هدﺎﻔﺘﺳا ﻞﻤﻋ مﺎﮕﻨﻫ رد هﺪﻨﻫد يﺰﻨﻣآ يﺎﻫوراد ﺎﺑ ﺪﻧا
هدﺮﻜﻧ هدﺎﻔﺘﺳا قﻮﻓ يﺎﻫوراد زا ﻪﻛ ﻲﻳﺎﻬﻧآ رﺎﻴﺷﻮﻫ و
هدﻮﺑ داد راﺮﻗ ﺶﻫوﮋﭘ و ﻪﺴﻳﺎﻘﻣ درﻮﻣ ،ﺪﻧا .
References
1. Collins Vj. Principles of anesthesiology general and regional anesthesia . 3rd ed pennsilvania :Lea and Febiger :1993 p :1507 -9
2. Wilmore D W. Alteration in protein carbohydrates and fat metabolism in injured and septic patients.
J Am Coll Nutr 1983; 2(1):3-13.
3. Allison S P, TomLin PG, Chamberlain M G.
Some effects of anesthesia and surgery on carbohydrate and fat metabolism. Br J Anesth 1969; 41:588-93,
4. Halter Ge , Pflug Ae , Port Dg R. Mechanism of plasma catecholamine increase during surgical stress in man. J Clin Endocrinol Methab 1977;
45:936-44,
5. Halter Gb, Pflug Ae. Relationship of impaired insulin secretion during surgical stress to anesthesia and catecholamine release. J Clin Endocrinol Methab 1980; 51:1093-8
6. Aarimaa M , Syvalahti E , Viikari J, Ovaska J.
Insulin, grow hormone and catecholamine as regulator of energy metabolism in the course of surgery. Acta Chir Scand 1978;144:411-22 7. Diltoer M, Camu F. Glucose hoemostasi and
insulin secretion during isoflurane anesthesia in humans. Anesthesiology 1988; 68:880-6
8. Black Pr , Brooks Dc , Bessey Pq, Wolf Rr, Wilmore D. Mechanisms of insulin resistance following injury. ANN Surgery 1982; 196:420-35.
9. Kehlet H. The stress response to surgery: release mechanisms and the modifying effect of pain relief. Acta Chir Scand Suppl. 1989;550:22-8.
10. Nilsson K, Larsson L, Andreasson S, EkstromJodal B. Blood glucose concentration during anesthesia in children, effect of starvation and pre operative fluid therapy. Br J Anaesth 1984, 56:375-9
11. Nuutinen L, Hollmen I. Blood sugar level during routine fluid therapy of surgical patients.
Ann.Chir Gynaecol Femn1975:64:108_11
12. Vriesendorp TM, Morélis QJ, Devries JH, Legemate DA, Hoekstra JB. Post _operative glucose levels are an independent risk factor for infection after peripheral surgery. Eur J Vasc Endovassc Surg 2004;28(5):520-5
13. Turina M ,Miller FN, Turker CF, Polk HC .Short- term hyperglycemia in surgical patient and study of related cellular mechanisms. Ann Surg 2006;
243(6):845-51
14. Swamy Mn. Murthy Hs, Rao Gs. Intra operative blood glucose levels in neurosurgical patients: and evaluation of two fluid regimens. Neurol India 2001; 49:371-4
15. Ittichaikulthol W, Lekprasert V, Pausawasdi S, Suchartwantnachai P. Effect of intra operative fluid on blood glucose level in neurosurgery. G Med Assocthai 1997:80(7):461-5
16. Roizen Mf, Michael F, Lee A, Fleisher. 2010 Anesthetic implication of concurrent disease. In:
Miller Rd (ed) chapter 35. Miller’s anesthesia 7th edition Churchill Livingstone: Elsevier, P1067-999 17. Peck C. psychological factors in acute pain
management. In: cousins MJ. Philips GD (ed)
دﺮﻔﻣﺎﻳرﻮﭘ ﻢﻴﻫاﺮﺑا نارﺎﻜﻤﻫ و
١٦٣
acute pain management. Churchil Livington:
Edinburgh 1986, 251_74
18. Vriensendorp TM, Morelis QJ, Devries JH, Legemate DA, Hoekstra JB, Early Post operative glucose level are an independent risk factor for infection after peripheral surgery. Eur J Vasc Endovassc surg 2004; 28:5,520-5
19. O’shaghnessy L, Stome A. Etiology of traumatic shock. Br J surg1934; 22:589
20. Halter GB, Pflug Ae. Effect of sympathetic blockage by spinal anesthesia on pancreatic islet function in man. Am J Physiol 1980; 239: 150-5 21. Kehlet H, Brandt Mr, Prange Hansen A, Alberti
MM. effects of epidural analgesia on metabolic profiles during and after surgery. Br J Surg. 1979;
66:543-6,
22. Wing Rr, Epstein Lh, Lamparski D, Hagg Sa, Nowalk Mp, Scoot N. Accurasive in estimating fasting blood glucose level by patient with diabetes. Diabetes Care 1984,7:476-8
23. Joseph Rg, Allyson K, Graves Tk, Rondeaumg, Peterson Me. Evaluation of to reagent strips and three reflectance meters for rapid determination of blood glucose concentration. J Vet Intern Med 1987: 1:170_4
24. Zahedi H, Akhyani V, Hussainkhan Z, Younesian M. Evaluation of FBS changes before, during and after elective eye surgery under general anesthesia, with glucometer and lab tests. Tehran
University Medical Journal 1385, 64 (3),44-51 25. Brickell J,Freeman V, Arneson W. Diabetes and
other carbohydrate disorders : In: Clinical chemistry a laboratory perspective .chapter -4, Philadelphia 2007; p- 175.
26. Mukhtar I, Weinstok RS. Carbohydrates. In:
McPherson RA, Pincus MR. Henry’s clinical diagnosis and management by laboratory methods 21st edition. Philadelphia: Elsevier/Saunders 2007, chapter 16; p-188.
27. Hume D.M Eghdahi R H . The importance of the brain in the endocrine response to injury. Ann Surg1959; 150:697-712
28. Halter J b, Pflug Ae. Relationship of impaired insulin secretion during surgical stress to anaesthesia and catecholamine release .J Clin Endocrinol Metab. 1980; 51(5):1093-8.
29. Halter Jb, Pflug Ae, Effects of anesthesia and surgical stress on insulin secretion in man.
Anesthesiology 1981 55 (2):120-6
30. Lattermann R, Belohlavek G, Wittmann S, Fchtmeir B, Gruber M. The anticatabolic effect of neuraxial blockade after hip surgery. Anesth Analg 2005 ;101(4):1202-8
31. Huang Yc, Lui Pw, Chu Cc, Lur Gy, Lee Ty.
Effect of glucose free maintenance solution on plasma glucose during anesthesia in patients undergoing line neurologic surgery. Zhonghua Yixue Zazhi (Taipei) 2000:63:467-74.
Anesthesiology and Pain
Official Journal of ISRAPM Summer 2012, Vol. 2, No. 8
The effect of general versus spinal anesthesia on blood sugar changes during surgery
Ebrahim Pouriamofrad1, Mohammad Rajaee2, Hossein Madineh1, Bahman Sadeghi3
1- Assistant Professor of Anesthesiology, Shahrekord University of Medical Sciences, Hajar Hospital 2- Assistant Professor of Uroology, Shahrekord University of Medical Sciences
3- Assistant Professor of Social Medicine,Arak University of Medical Sciences
Abstract
Aim and Background: Stress of surgery transfers some neurological and hormonal signals which triggers some physiological responses like adrenergic stimulation, increase in nor- adrenalin, cortisol, growth factor, decrease in insulin and increase in insulin resistance resulting in hyperglycemia during surgery. In this study a comparison is done between general anesthesia which by blocking brain's signals decreases reactions to the stress of surgery and hyperglycemia, and spinal analgesia which blocks hormonal and adrenergic reactions by peripheral effect.
Methods and Materials: This randomized control clinical trial study was performed on 60 ASA I, II patients candidate of inguinal hernioraphy. The patients were randomly allocated to general anesthesia or spinal anesthesia with T12 level. Blood sugar of the patients was measured by glucometer 1 hour before the surgery and 1 hour and 6 hours postoperatively.
Findings: There was no significant difference in blood sugar levels before the surgery between two groups but it was lower 1and 6 hours postoperatively in spinal anesthesia group.
Conclusions: Spinal analgesia more effectively controls rises in blood sugar during the surgery and may be a suitable alternative for general anesthesia in patients with metabolic disorders.
Keywords: stress, general anesthesia, spinal analgesia, blood sugar
Corresponding Author: Ebrahim Pouriamofrad, department of anesthesiology, Hajar Hospital, Shahre- kord, Iran
Email: [email protected]
