ﺝ
رﺎﻴﺸﻧاد*
وﺮﮔ ﻲﺘﻌﻳﺮﺷ ﺮﺘﻛد نﺎﺘﺳرﺎﻤﻴﺑ ،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻣﻮﻤﻋ ﻲﺣاﺮﺟ ه ﻮﮕﺨﺳﺎﭘ ةﺪﻨﺴﻳﻮﻧ
: ﻲﻣﺎﮔرﻮﺧ ﻚﻣاژ ﺮﺘﻛد
دﺎﺘﺳا**
ﻲﺘﻌﻳﺮﺷ ﺮﺘﻛد نﺎﺘﺳرﺎﻤﻴﺑ ،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻣﻮﻤﻋ ﻲﺣاﺮﺟ هوﺮﮔ رﺎﻳ ﻦﻔﻠﺗ
: 84902450
رﺎﻤﻴﺑ ،ناﺮـﻬﺗ ﻲﻜﺷﺰﭘ مﻮـﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻣﻮﻤﻋ ﻲﺣاﺮﺟ هوﺮﮔ رﺎﻴﺘﺳد***
ﻲﺘﻌﻳﺮﺷ ﺮﺘﻛد نﺎﺘﺳ E-mail: [email protected]
ﻲﺘﻌﻳﺮﺷ ﺮﺘﻛد نﺎﺘﺳرﺎﻤﻴﺑ ،ناﺮـﻬﺗ ﻲﻜﺷﺰﭘ مﻮـﻠﻋ هﺎﮕﺸﻧاد ،ﻖﻘﺤﻣ ،ﻲﻣﻮﻤﻋ ﻚﺷﺰﭘ****
لﻮﺻو ﺦﻳرﺎﺗ : 22 / 06 / 1389
شﺮﻳﺬﭘ ﺦﻳرﺎﺗ :
18 / 09 / 1389
ﺗ ﻲﺳرﺮﺑ ﺄ
ﺮﻴﺛ ﻴﭘﻮﻜﺳارﺎﭘﻻ ﻲﺣاﺮﺟ ﻞﻤﻋ زا ﺪﻌﺑ و ﻞﺒﻗ ﺐﻴﺴﻛﻮﻜﻠﺳ ﻚ
ﻪﻠﻛ ﺮﺑ ﻲﻣﻮﺘﻜﺘﺴﻴﺳ
نارﺎﻤﻴﺑ رﺪﺨﻣ فﺮﺼﻣ ناﺰﻴﻣ و درد
ﺮﺘﻛد شوﺮﺳ ﺎﺿرﺪﻤﺣا ،
*ﺮﺘﻛد ﻲﻣﺎﮔرﻮﺧ ﻚﻣاژ ﺮﺘﻛد ،
**ﻦﻴﺒﻣ ﺎﺿرﺪﻤﺤﻣ
***ﺪﻴﻔﻣ ازر ﺮﺘﻛد
،
****يﺮﻴﺼﻧ دازﺮﻴﺷ ﺮﺘﻛد
**
ﻭ ﻩﮊﺍ ﻱﺪﻴﻠﻛ ﻱﺎﻫ :
ﻪﻠﮐ ﺳ ﻴ ﯽﻣﻮﺘﮑﺘﺴ
، ﻭﺭﺎﭘﻻ ﯽﭘﻮﮑﺳ
، ﺴﻛﻮﮑﻠﺳ ﻴ ﺩﺭﺩ ،ﺐ
ﻩﺪﻴﻜﭼ :
ﺯ ﻣ ﻨﻴ ﻪ ﻑﺪﻫ ﻭ : ﻠﻄﻣ ﺖﺒﻗﺍﺮﻣ ﻡﺎﺠﻧﺍ ﺖﻬﺟ ـ
ﺑ ﺭﺩ ﺏﻮ ﻴ ﻤ ـ ﻧﺍﺭﺎ ﻲ ﺣﺍﺮﺟ ﻞﻤﻋ ﺖﺤﺗ ﻪﮐ ﻲ
ﻜﺳﺍﺭﺎﭘﻻ ﭘﻮ ﻴ ﮏ ﻪﻠﻛ ﺳ ﺴﻴ ﻜﺘ ﻗ ﻲﻣﻮﺘ ـ ﻣ ﺭﺍﺮ ﻲ ﮔ ﻴ ﺪﻧﺮ
، ﺘﻨﮐ ـ ﺩﺭﺩ ﻝﺮ ﻳ ﻞﺻﺍ ﮏ
ﺵﻭﺭ ﻪﺑ ﻪﮐ ﺖﺳﺍ ﺎﻫ
ﻱ ﻠﺘﺨﻣ ـ ﺠﻧﺍ ﻒ ـ ﻣ ﻡﺎ ﻲ ﺩﻮﺷ . ﮑﺴﻣ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ـ
ﻦ ﺎﻫ ﻱ ﻬﺘﻟﺍﺪﺿ ـ ﺑﺎ ﻲ ﻏ ﻴـ ﻭﺮﺘﺳﺍﺮ ﻴﻳ ﺪ ﻱ ﻣ ﻲ ﺪﻧﺍﻮﺗ ﻳ ﺎﺟ ﮏ ﻳ ﮕ ـ ﺰ ﻳ ﺮﺑ ﻩﻭﻼﻋ ﻪﮐ ﺪﺷﺎﺑ ﺎﻫﺭﺪﺨﻣ ﺐﺳﺎﻨﻣ ﻦ
ﺨﻣ ﺽﺭﺍﻮﻋ ﺩﺭﺩ ﺪﺿ ﺹﺍﻮﺧ ـ
ﻧ ﺍﺭ ﺎﻫﺭﺪ ﻴ ﺩﺭﺍﺪﻧ ﺰ . ﺐﻴﺴﮐﻮﮑﻠﺳ ﻳ
ﺼﺘﺧﺍ ﻩﺪﻨﻨﮐﺭﺎﻬﻣ ﮏ ﺻﺎ
ﻲ ۲ COX - ﺍ ﺭﺩ ﻪﮐ ﺖﺳﺍ ﻳ
ﻟﻮﺗ ﻥﺍﺮ ﻴ ﻣ ﺪ ﻲ ﺷ ـ ﻣ ﻭ ﺩﻮ ﻨ ﻌ ﻲ ﺣﺍﺮﺟ ﺭﺩ ﻲ ﺩﺭﺍﺪﻧ ﺎﻫ .
ﺍ ﻡﺎﺠﻧﺍ ﺯﺍ ﻑﺪﻫ ﻳ
ﺳﺭﺮﺑ ﻪﻌﻟﺎﻄﻣ ﻦ ﻲ
ﺛﺎﺗ ﻴ ﺍ ﺮ ﻳ ﺑ ﺭﺩ ﺩﺭﺩ ﺶﻫﺎﮐ ﺭﺩ ﻭﺭﺍﺩ ﻦ ﻴ
ﮑﺳﺍﺭﺎﭘﻻ ﻞﻤﻋ ﺯﺍ ﺲﭘ ﻥﺍﺭﺎﻤ ﻮ
ﭘﻴ ﻠﮐ ﮏ ﻪ ﺳ ﻴ ﻣﻮﺘﮑﺘﺴ ﻲ ﺖﺳﺍ .
ﺵﻭﺭ ﻭ ﺩﺍﻮﻣ ﺎﻫ
: ﺍﻳ ﻦ ﻪﻌﻟﺎﻄﻣ ﻳ ﮏ ﺋﺎﻣﺯﺁﺭﺎﮐ ﻲ ﻟﺎﺑ ﻴﻨ ﻲ ﻓﺩﺎﺼﺗ Randomized Clinical Trial)ﻲ ﺮﺑ ﻪﮐ ﻩﺩﻮﺑ(
ﻭﺭ ﻱ ﺑﻴ ﻧﺍﺭﺎﻤ ﻲ ﻪﮐ ﺭﺩ ﺑﻴ ﻥﺎﺘﺳﺭﺎﻤ ﺮﺘﮐﺩ
ﺮﺷ ﻳ ﺘﻌ ﻲ ﺭﻮﻳﺮﻬﺷ ﺯﺍ ۱۳۸۶ ﻦﻳﺩﺭﻭﺮﻓ ﺎﺗ ۱۳۸۷
ﺖﺤﺗ ﻞﻤﻋ ﻪﻠﻛ ﻚﻴﭘﻮﻜﺳﻭﺭﺎﭘﻻ ﻲﻣﻮﺘﻜﺘﺴﻴﺳ ﺭﺍﺮﻗ
ﻪﺘﻓﺮﮔ ﺪﻧﺍ ، ﻡﺎﺠﻧﺍ ﺖﺳﺍ ﻩﺪﺷ . ۷۵ ﻩﻭﺮﮔ ﻭﺩ ﻪﺑ ﻲﻓﺩﺎﺼﺗ ﻞﻜﺷ ﻪﺑ ﺭﺎﻤﻴﺑ
ﺪﻧﺪﺷ ﻢﻴﺴﻘﺗ ﻮﺒﺳﻼﭘ ﻭ ﺐﻴﺴﻛﻮﻜﻠﺳ .
ﻥﺎﻣﺭﺩ ﻩﻭﺮﮔ ﺭﺩ ﻥﺍﺭﺎﻤﻴﺑ ۲۰۰
ﻲﻠﻴﻣ ﺴﻛﻮﻜﻠﺳ ﻡﺮﮔ ﻞﻤﻋ ﺯﺍ ﺲﭘ ﻭ ﻞﻤﻋ ﺯﺍ ﻞﺒﻗ ﺖﻋﺎﺴﻜﻳ ﺐﻴ
۲۰۰ ﻲﻠﻴﻣ ﮔ ـ ﺮﻫ ﻡﺮ ۱۲ ﻪﺑ ﺖﻋﺎﺳ
ﺕﺪﻣ ۲ ﮔ ﺭﺩ ﻭ ﺪﻧﺩﺮﻛ ﺖﻓﺎﻳﺭﺩ ﺯﻭﺭ ـ
ﺪﺷ ﺰﻳﻮﺠﺗ ﻮﺒﺳﻼﭘ ﺪﻫﺎﺷ ﻩﻭﺮ .
ﻟﺎﻧﺁ ﻪﻠﻴﺳﻭ ﻪﺑ ﻞﻤﻋ ﺯﺍ ﺲﭘ ﺩﺭﺩ ﻥﺍﺰﻴﻣ ﺲﭙﺳ ـ
ﻱﺮﺼﺑ ﺩﺭﺩ ﮒﻮ (VAS)
ﺮﻫ ۶ ﺪﺷ ﻩﺪﻴﺠﻨﺳ ﺖﻋﺎﺳ .
ﺺﻴﺧﺮﺗ ﻥﺎﻣﺯ ﺎﺗ ﻲﺘﻓﺎﻳﺭﺩ ﻦﻳﺪﺘﭘ ﻥﺍﺰﻴﻣ
، ﻍﺍﺮﻔﺘﺳﺍ ،ﻉﻮﻬﺗ
، ﺖﺸﮔﺯﺎﺑ ﻥﺎﻣﺯ ﻭ ﻩﺩﻭﺭ ﻱﺍﺪﺻ
ﻣ ﻭ ﺯﺎﮔ ﻊﻓﺩ ـ
ﺘﺴﺑ ﻥﺎﻣﺯ ﺕﺪﻣ ﻭ ﻉﻮﻓﺪ ـ
ﻲﺳﺭﺮﺑ ﺰﻴﻧ ﻥﺎﺘﺳﺭﺎﻤﻴﺑ ﺭﺩ ﻱﺮ ﺪﺷ
. ﺲﭙﺳ
ﻩﺩﺍﺩ ﺎﻫ ﺎﺑ ﻩﺩﺎﻔﺘﺳﺍ ﺯﺍ ﻡﺮﻧ ﺭﺍﺰﻓﺍ SPSS 16 ﺩﺭﻮﻣ
ﻞﻴﻠﺤﺗ ﻱﺭﺎﻣﺁ ﺭﺍﺮـﻗ ﺪﻨﺘﻓﺮﮔ . ﻲﻔﻴﻛ ﻱﺎﻫﺮﻴﻐﺘﻣ ﺎﺑ
chi-squareﺖـﺴﺗ ﻲﻤﻛ ﻱﺎﻫﺮﻴﻐﺘﻣ ﻭ
ﻂﺳﻮﺗ ﻝﺎﻣﺮﻧ ﻊﻳﺯﻮﺗ ﺎﺑ
-Test ،T ﺳ ﺭﺩ ﺩﺭﺩ ﻥﺍﺰﻴﻣ ﻦﻴﮕﻧﺎﻴﻣ ﻦﻴﻨﭼ ﻢﻫ ﻩﺯﺍﺪﻧﺍ ﻞﻴﻠﺤﺗ ﻂﺳﻮﺗ ﻒﻠﺘﺨﻣ ﺕﺎﻋﺎ
ﻭ ﻱﺭﺍﺮﻜﺗ ﻱﺎﻫ T- test
ﺩﺭﻮﻣ ﻞﻴﻠﺤﺗ ﺭﺍﺮﻗ ﺪﻨﺘﻓﺮﮔ . ﻝﺎﻤﺘﺣﺍ ۹۵ P<0.05) % ( ﻪﺑ
ﻥﺍﻮﻨﻋ ﺺﺧﺎﺷ ﻲﻨﻌﻣ ﻥﺩﻮﺑ ﺭﺍﺩ ﺭﺩ ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ .
ﻪﺘﻓﺎﻳ ﺎﻫ : ﻲﻠﻛ ﺭﻮﻃ ﻪﺑ ۳۷
ﻭ ﻥﺎﻣﺭﺩ ﻩﻭﺮﮔ ﺭﺩ ﺭﺎﻤﻴﺑ ۳۸
ﺮﻔﻧ ﺠﻧﺍ ﺯﺍ ﺲﭘ ﺕﺎﻋﻼﻃﺍ ﺖﺒﺛ ﻡﺮﻓ ﻭ ﺪﻨﺘﻓﺮﮔ ﺭﺍﺮﻗ ﻪﻌﻟﺎﻄﻣ ﺩﺭﻮﻣ ﺪﻫﺎﺷ ﻩﻭﺮﮔ ﺭﺩ ﺩﺮﻓ ﻂﺳﻮﺗ ﻪﻠﺧﺍﺪﻣ ﻡﺎ
ﻱ ﻪﮐ
ﺖﺷﺍﺪﻧ ﻉﻼﻃﺍ ﻪﻠﺧﺍﺪﻣ ﻉﻮﻧ ﺯﺍ
، ﻤﮑﺗ ﻴ ﺩﺮﮔ ﻞ ﻳ ﺪ . ﺎﺘﻧ ﻖﺒﻃ ﻳ ﻩﺪﻣﺁ ﺖﺳﺩ ﻪﺑ ﺞ ﺯﺍ
ﻩﻭﺮﮔ ﻭﺩ ) ﺭﺩ ﻳ ﺴﻛﻮﮑﻠﺳ ﺖﻓﺎ ﻴ
ﺣﺍﺮﺟ ﻞﻤﻋ ﺯﺍ ﺪﻌﺑ ﻭ ﻞﺒﻗ ﺐ ﻲ
ﺭﺩ ﻡﺪﻋ ﻭ ﻳ ﺖﻓﺎ
ﺴﻛﻮﮑﻠﺳ ﻴ ﺐ ( ﺨﺸﺗ ﻭ ﺲﻨﺟ ﻭ ﻦﺳ ﺮﻈﻧ ﺯﺍ ﻴ
ﺣﺍﺮﺟ ﺯﺍ ﻞﺒﻗ ﺺ ﻲ
ﺗﻭﺎﻔﺗ ﻲ ﺪﻨﺘﺷﺍﺪﻧ . ﺎﺘﻧ ﺱﺎﺳﺍ ﺮﺑ ﻳ
ﺍ ﺞ ﻳ ﺳﺭﺮﺑ ﻦ ﻲ ﻣ ﺶﻫﺎﮐ ﻥﺎﻣﺭﺩ ﻩﻭﺮﮔ ﺭﺩ ﺪﺘﭘ ﻑﺮﺼ
ﻳ ﻨﻌﻣ ﻦ ﻲ ﺩﻮﺑ ﺭﺍﺩ .
ﻣ ﻴ ﺪﺘﭘ ﻥﺍﺰ ﻳ ﻓﺮﺼﻣ ﻦ ﻲ ﻥﺎﻣﺭﺩ ﻩﻭﺮﮔ ﺭﺩ ۲
/ ۱۵
± ۱ / ۳۶ ﻲﻠﻴﻣ ﮔ ـ ﮔ ﺭﺩ ﻭ ﻡﺮ ـ ﻫﺎﺷ ﻩﻭﺮ ـ ﺪ ۷ / ۱۸
± ۲ / ۶۳ ﻲﻠﻴﻣ ﺩﻮﺑ ﻡﺮﮔ P<0.001) .(
ﻨﭽﻤﻫ ﻴـ ﻦ ﻴﮕﻧﺎﻴﻣ ـ ﻭﺩ ﻦﻴﺑ ﺩﺭﺩ ﻩﺮﻤﻧ ﻦ
ﻨﻌﻣ ﻑﻼﺘﺧﺍ ﻩﻭﺮﮔ ﻲ
ﺖﺷﺍﺩ ﺭﺍﺩ ) ۰۰۱ / ۰ <
.(P ﺍﻳ ﺎﺘﻧ ﻦ ﻳ ﺍﺮﺑ ﺞ ﻱ ﻞﻤﻋ ﺯﺍ ﺪﻌﺑ ﻍﺍﺮﻔﺘﺳﺍ ﻭ ﻉﻮﻬﺗ
، ﺑ ﺖﻣﺎﻗﺍ ﺕﺪﻣ ﻴ
ﺳﺭﺎﻤ ﻧﺎﺘ ﻲ ﻨﭽﻤﻫ ﻭ ﻴ ﻦ ﺩﺮﻜﻠﻤﻋ ﻧ ﻩﺩﻭﺭ ﻴ ﻨﻌﻣ ﺰ ﻲ ﺩﻮﺑ ﺭﺍﺩ .
ﻪﺠﻴﺘﻧ ﻴﮔ ـ ﻱﺮ : ﺴﻛﻮﮑﻠﺳ ﺯﺍ ﻩﺩﺎﻔﺘﺳﺍ ﻴ
ﺐ ) ﺻﺎﺼﺘﺧﺍ ﻩﺪﻨﻨﮐ ﺭﺎﻬﻣ ﻲ
۲ COX- ( ﺣﺍﺮﺟ ﻞﻤﻋ ﺯﺍ ﺪﻌﺑ ﻭ ﻞﺒﻗ ﻲ
ﻧ ﻭ ﺩﺭﺩ ﺶﻫﺎﮐ ﺭﺩ ﻴ
ﻭ ﺭﺪﺨﻣ ﻪﺑ ﺯﺎ ﻥﺁ ﺽﺭﺍﻮﻋ ﺶﻫﺎﻛ
،
ﺑ ﺖﻣﺎﻗﺍ ﺕﺪﻣ ﻭ ﻍﺍﺮﻔﺘﺳﺍ ﻭ ﻉﻮﻬﺗ ﺶﻫﺎﮐ ﻴ
ﻧﺎﺘﺳﺭﺎﻤ ﻲ ﻣ ﺆ ﺖﺳﺍ ﻩﺩﻮﺑ ﺮﺛ .
ﻨﻴﻣز ﻪ فﺪﻫ و
هدﻮـﺑ ﻲﺣاﺮﺟ هوﺮﮔ ﻪﻏﺪﻏد ﻪﺸﻴﻤﻫ ﻪﻛ ﻲﺗﺎﻋﻮﺿﻮﻣ ﻪﻠﻤﺟ زا ﺖﺳا
، ﻞـﻤﻋ زا ﺲـﭘ يﺎـﻫدرد ﺮـﺘﻬﺑ لﺮـﺘﻨﻛ ﺖﻬﺟ ﻲﻫار ﻦﺘﻓﺎﻳ
ﻲﻣ ﺪﺷﺎﺑ . ﺑ ﺶﻘﻧ درد ﻪﻛ اﺮﻳز ﻪ
اﺰـﺳ ﻳ يﺮﺘـﺴﺑ نﺎـﻣز تﺪـﻣ رد ﻲ
نﺎﺘﺳرﺎﻤﻴﺑ رد نارﺎﻤﻴﺑ
، رﺎﻤﻴﺑ يدﻮﻨﺸﺧ ناﺰﻴﻣ
، و ﺖـﻫﺎﻘﻧ تﺪـﻣ
ﻟﺎﻌﻓ ﻪﺑ رﺎﻤﻴﺑ ﺖﺸﮔزﺎﺑ ﺖﻴ
دراد ار ﻲﮔﺪﻧز لﻮﻤﻌﻣ يﺎﻫ
1. درد ناﺰﻴﻣ
ﻲﺣاﺮﺟ رد ﻲﻣ توﺎﻔﺘﻣ ﻒﻠﺘﺨﻣ يﺎﻫ
ﺪﺷﺎﺑ
، ناﻮـﻨﻋ ﻪﺑ ﻪﻛ يرﻮﻃ ﻪﺑ
ﻪﻠﻛ ﺖﺤﺗ ﻪﻛ ﻲﻧارﺎﻤﻴﺑ لﺎﺜﻣ راﺮـﻗ ﻚﻴﭘﻮﻜـﺳورﺎﭘﻻ ﻲﻣﻮﺘﻜﺘﺴﻴﺳ
ﻲﻣ ﺪﻧﺮﻴﮔ
، ﻲﻣ ﻪﺑﺮﺠﺗ ار يﺮﺘﻤﻛ درد زﺎﺑ ﻲﺣاﺮﺟ ﻪﺑ ﺖﺒﺴﻧ ﺪـﻨﻨﻛ
2.
ﻪﻠﻛ زا ﺲﭘ يﺎﻫدرد ﻦﻴﻜﺴﺗ ﺖﻬﺟ ﻚﻴﭘﻮﻜـﺳورﺎﭘﻻ ﻲﻣﻮﺘﻜﺘﺴﻴﺳ
زا ﻦﻜﺴﻣ ﻲـﻣ هدﺎﻔﺘﺳا ﻲﻔﻠﺘﺨﻣ يﺎﻫ ﺎـﻬﻧآ ﻦﻳﺮـﺘﻤﻬﻣ ﻪـﻛ دﻮـﺷ
ﻲﻣ ﺎﻫﺪﻴﺋﻮﻴﭘا ﺪﺷﺎﺑ
. ﻞـﻤﻋ زا ﺲﭘ درد لﺮﺘﻨﻛ رد ﺎﻫرﺪﺨﻣ ﻪﭼ ﺮﮔا
ًﺎﻳﻮﻗ ﺪﻨﺘﺴﻫ ﺮﺛﺆﻣ
، دﻮـﺟو ﻪـﺑ ﻪـﻛ ﻲﺒﻧﺎـﺟ ضراﻮـﻋ ﻞﻴﻟد ﻪﺑ ﺎﻣا
ﻲﻣ باﻮﺧ ﻪﻠﻤﺟ زا ﺪﻧروآ ﻲﮔدﻮـﻟآ
،
غاﺮﻔﺘـﺳا و عﻮـﻬﺗ
، سﻮـﺌﻠﻳا
،
ﺖﺳﻮﺒﻳ
، ﻲﺴﻔﻨﺗ ﻢﺘﺴﻴﺳ رﺎﻬﻣ
،
ـﻛﺮﻣ بﺎـﺼﻋا ﻢﺘﺴﻴﺳ رﺎﻬﻣ و يﺰ
دﺎﻴﺘﻋا
، يﺮـﮕﻳد ﻦﻜـﺴﻣ يﺎﻫوراد زا هدﺎﻔﺘﺳا لﺎﺒﻧد ﻪﺑ نﺎﻜﺷﺰﭘ
ﻲﻣ ﺪﻨـﺷﺎﺑ
3. NSAID
ﻲـﺻﺎﺼﺘﺧاﺮﻴﻏ يﺎـﻫ
، ﻪﺘـﺳد زا ﺮـﮕﻳد يا
ﻲﻣ ﻲﺋﺎﻫوراد درد لﺮﺘﻨﻛ ﺖﻬﺟ هدﺮﺘﺴﮔ ترﻮﺻ ﻪﺑ ﻪﻛ ﺪﻨﺷﺎﺑ
يﺎﻫ
ﻲﻣ رﺎﻛ ﻪﺑ ﻞﻤﻋ زا ﺲﭘ ﺪﻧور
4. رﺎﻬﻣ ﺖﻠﻋ ﻪﺑ ﺎﻫوراد ﻦﻳا -I
وCOX
-II رﺎﻨﻛ ردCOX
د ﺪـﺿ و بﺎـﻬﺘﻟا ﺪﺿ تاﺮﺛا دﺎـﺠﻳا ﻪـﻛ يدر
ﻲﻣ ﺪﻨﻛ
، ﻋ ـ ﺒﻧد ﻪﺑ ﺰﻴﻧ يﺪﺟ ضراﻮ ـ
ﺪﻧراد لﺎ
، ﺑ ﻪ ﻪـﺑ ﺮـﮔا صﻮﺼﺧ
ﻣ دﺎﺣ ترﻮﺻ ـ
ﻗ هدﺎﻔﺘﺳا درﻮ ـ
ﺪﻧﺮﻴﮔ راﺮ .
زا ﺪﻨﺗرﺎﺒﻋ ضراﻮﻋ ﻦﻳا :
ﻓا ـ يﺰﻳﺮﻧﻮـﺧ ﻚﺴﻳر ﺶﻳاﺰ
ـﮔ هﺎﮕﺘـﺳد يﺎـﻫ ـ
ﻲﻧﺎـﻗﻮﻓ شراﻮ
،
ﻴﻠﻛ دﺎﺣ ﻲﺋﺎﺳرﺎﻧ ـ
يﻮ
، ـﻜﻠﻤﻋ رد لﻼﺘﺧا دﺎﺠﻳا ـ
ﻪـﺑ و ﺖـﻛﻼﭘ دﺮ
ﺧ دﺎﺠﻳا نآ لﺎﺒﻧد ـ
يﺰﻳﺮﻧﻮ يﺎﻫ ﻲﺣاﺮﺟ زا ﺲﭘ ﺎﻳ و ﻦﻴﺣ ﺪﻳﺪﺷ
5.
ًاﺮﻴﺧا ﻪﺠﻴﺘﻧ رد ﺎـﻬﻨﺗ ﻲﺻﺎﺼﺘﺧا رﻮﻃ ﻪﺑ ﻪﻛ ﻲﺋﺎﻫوراد زا هدﺎﻔﺘﺳا
ﻢﻳﺰﻧآ -II ﻲﻣ رﺎﻬﻣ ارCOX ﺪﻨﻛ
،
ﺖـﺳا ﻪـﺘﻓﺮﮔ راﺮﻗ ﻪﺟﻮﺗ درﻮﻣ .
درد ﺪـﺿ و ﻲﺑﺎـﻬﺘﻟا ﺪـﺿ تاﺮـﺛا دﺎـﺠﻳا رﺎﻨﻛ رد اﺮﻳز
، ضراﻮـﻋ
هﺪـــﻨﻫد يﺰﻳﺮﻧﻮـــﺧ NSAID
يﺎـــﻫ اراد ار ﻲـــﺻﺎﺼﺘﺧاﺮﻴﻏ
ﻲﻤﻧ ﺪﻨـﺷﺎﺑ
6 و
ﻴﺑ رد و7
هﺎﮕﺘـﺳد يﺰﻳﺮﻧﻮـﺧ ﺪﻌﺘـﺴﻣ ﻪـﻛ ﻲﻧارﺎـﻤ
ﺪﻨﺘﺴﻫ ﻲﻧﺎﻗﻮﻓ ﻲﺷراﻮﮔ
، ﻲﻣ ﻲﺘﺣار ﻪﺑ راﺮﻗ هدﺎﻔﺘﺳا درﻮﻣ ﺪﻨﻧاﻮﺗ
ﺪﻧﺮﻴﮕﺑ
6. رﺎـﻬﻣ يﺎـﻫ وراد ﻲـﺸﺨﺑﺮﺛا ﻪـﻛ ﺪﻧراد دﻮﺟو ﻲﺗﺎﻌﻟﺎﻄﻣ
هﺪــﻨﻨﻛ -II
نﺎــﺸﻧ ﻲــﺣاﺮﺟ زا ﺲــﭘ درد لﺮــﺘﻨﻛ رد ارCOX
هداد ﺪﻧا
6.
و 8 -
ﻲﺒﻠﻗ تﻼﻜﺸﻣ12
ﻪـﻛ ﺖﺳا ﻲﺿراﻮﻋ ﻪﻠﻤﺟ زا ﻲﻗوﺮﻋ
هدﺎﻔﺘﺳا رد هﺪﻨﻨﻛ رﺎﻬﻣ يﺎﻫوراد زا
-II ﻲـﻣ هﺪﻳدCOX دﻮـﺷ
13.
هﺪﻨﻨﻛرﺎﻬﻣ ﻪﺘﺳد رد دﻮﺟﻮﻣ يﺎﻫوراد ﻪﻠﻤﺟ زا ﺐﻴﺴﻛﻮﻜﻠﺳ يﺎـﻫ
-II ﻲﻣCOX ﺐـﺟﻮﻣ هوﺮـﮔ ﻦﻳا يﺎﻫوراد ﺮﻳﺎﺳ زا ﺮﺘﻤﻛ ﻪﻛ ﺪﺷﺎﺑ
ﻲﻣ ﻲﻗوﺮﻋ ﻲﺒﻠﻗ ضراﻮﻋ دﻮﺷ
14. ﻲـﺸﺨﺑ ﺮﺛا ﻲﺗﺎﻌﻟﺎﻄﻣ ﻦﻴﻨﭼ ﻢﻫ
ﻲـﺣاﺮﺟ زا ﺲـﭘ درد ﺶﻫﺎﻛ رد ار ﺐﻴﺴﻛﻮﻜﻠﺳ و ﻒـﻠﺘﺨﻣ يﺎـﻫ
ﺶﻫﺎﻛ هداد نﺎﺸﻧ ﺎﻫرﺪﺨﻣ فﺮﺼﻣ ﻪﺑ زﺎﻴﻧ ﺪﻧا
15.
-
ﻪـﻌﻟﺎﻄﻣ ﻦﻳا رد18
ﺮﺛا ﺖﺳا ﻦﻳا ﺮﺑ ﻲﻌﺳ ﻞـﻤﻋزا ﺪـﻌﺑ و ﻞـﺒﻗ ﺐﻴـﺴﻛﻮﻜﻠﺳ ﺰﻳﻮﺠﺗ
ﻪﻠﻛ ﻚﻴﭘﻮﻜﺳورﺎﭘﻻ ﻲﻣﻮﺘﻜﺘﺴﻴﺳ
، فﺮﺼﻣ ناﺰﻴﻣ و درد لﺮﺘﻨﻛ ﺮﺑ
رﺪﺨﻣ دﻮﺷ هﺪﻴﺠﻨﺳ .
ﻣ ـ شور و داﻮ ﺎﻫ
ﻦــﻳا ــﻌﻟﺎﻄﻣ ـ ﻪ ــﻳ ـ ﻚ ﻲﺋﺎــﻣزآرﺎﻛ ﻲﻨﻴﻟﺎــﺑ
ﻲﻓدﺎــﺼﺗ
) Randomized Controlled Trial (
ﻲــﻣ ﺪــﺷﺎﺑ ﺮــﺑ ﻪــﻛ يور
ﻤﻴﺑ ـ ﻲﻧارﺎ ﻪﻛ رد ﻤﻴﺑ ـ نﺎﺘﺳرﺎ ﺘﻛد ـ ﺮ ﺘﻌﻳﺮﺷ ـ
لﺎـﺳ ﻲـﻃ ﻲ يﺎـﻫ
87 - 1386 ﺤﺗ ـ ﺖ ﻤﻋ ـ ﻞ ﻪـﻠﻛ ﻲﻣﻮﺘﻜﺘـﺴﻴﺳ ـﻴﭘﻮﻜﺳورﺎﭘﻻ
ـ ﻚ
راﺮﻗ ﻪﺘﻓﺮﮔ ﺪﻧا ، مﺎﺠﻧا ﺖﺳا هﺪﺷ .
ﻪـﺘﻴﻤﻛ ﻂـﺳﻮﺗ ﻪﻌﻟﺎﻄﻣ ﻞﻜﺗوﺮﭘ
ﻲﺸﻫوﮋﭘ نارﺎﻤﻴﺑ زا و هﺪﻴﺳر ﺐﻳﻮﺼﺗ ﻪﺑ هﺎﮕﺸﻧاد
ﺖﻳﺎﺿر ﻪﻧﺎﻫﺎﮔآ
ﺖﻛﺮﺷ ﺖﻬﺟ ﻲﺒﺘﻛ رد
ﺶﻫوﮋﭘ ﺪﺷ ﻪﺘﻓﺮﮔ .
رﺎـﻴﻌﻣ
،دورو ﻞﻣﺎـﺷ
ﺖﺳا ﻲﻧارﺎﻤﻴﺑ ﻪﻛ
رد نﺎﺘﺳرﺎﻤﻴﺑ ﻲﺘﻌﻳﺮﺷ
زا رﻮﻳﺮﻬـﺷ 1386
ﺎـﺗ
ﻦﻳدروﺮﻓ 1387
ﺖﺤﺗ ﻞﻤﻋ ﻪﻠﻛ ﻚﻴﭘﻮﻜﺳورﺎﭘﻻ ﻲﻣﻮﺘﻜﺘﺴﻴﺳ ﻪـﺑ
ترﻮﺻ ﻮﻴﺘﻜﻟا ﻳ ﺎ ﺲﻧاژروا راﺮﻗ ﻪـﺘﻓﺮﮔ ﺪـﻧا . رﺎـﻴﻌﻣ يﺎـﻫ جوﺮـﺧ
ﺪﻨﺗرﺎﺒﻋ زا : ﻲﻧارﺎﻤﻴﺑ ﻪﻛ دﺎﻴﺘﻋا ﻪﺑ داﻮﻣ رﺪﺨﻣ ﺪﻨﺘـﺷاد
، نارﺎـﻤﻴﺑ
ﻪﺑ ﻼﺘﺒﻣ ﻪﻠﻛ ﺿراﻮﻋ رﺎﭼد ﻪﻛ دﺎﺣ ﺖﻴﺘﺴﻴﺳ نﺮﮕﻧﺎﮔ ﺪﻨﻧﺎﻣ ﻲ
هﺪﺷ
ﺪﻧدﻮﺑ
، ﻲﻧارﺎـﻤﻴﺑ هوﺮـﮔ يﺎـﻫوراد ﻪـﺑ ﻪـﻛ
NSAID ﺖﻴـﺳﺎﺴﺣ
ﺪﻨﺘﺷاد
، ﻲﻧارﺎﻤﻴﺑ يرﺎﻤﻴﺑ ياراد ﻪﻛ و ﺪﻧدﻮﺑ يﻮﻴﻠﻛ ﺎﻳ يﺪﺒﻛ يﺎﻫ
اﺪﻴﭘ ﺮﻴﻴﻐﺗ زﺎﺑ ﻲﺣاﺮﺟ عﻮﻧ ﻪﺑ نﺎﻧآ ﻲﺣاﺮﺟ ﻪﻛ ﻲﻧارﺎﻤﻴﺑ ﻲﻣ
دﺮـﻛ .
ﻠﺧاﺪﻣ عوﺮﺷ زا ﺲﭘ نارﺎﻤﻴﺑ جوﺮﺧ رﺎﻴﻌﻣ ﻦﻴﻨﭼ ﻢﻫ راﺮﻗ ﻦﻳا ﻪﺑ ﻪ
ﺪﺷﺎﺑ ﻲﻣ
، تاﺮﻴﻴﻐﺗ رﺎﭼد ﻪﻛ ﻲﻧارﺎﻤﻴﺑ ﻲﻣEKG
ﺪﻧﻮﺷ
، ﻲﻧارﺎـﻤﻴﺑ
ﻲﻛارﻮﺧ ﻞﻤﺤﺗ مﺪﻋ و ﺪﻳﺪﺷ غاﺮﻔﺘﺳا و عﻮﻬﺗ ﻞﻴﻟد ﻪﺑ ﻪﻛ
، ردﺎـﻗ
ﺪﻨﺷﺎﺒﻧ وراد فﺮﺼﻣ ﻪﺑ .
ﻧﻮﻤﻧ ﺔ زﺎﻴﻧ درﻮﻣ يرﺎﻣآ ﻪﻌﻟﺎﻄﻣ ﺖﻬﺟ
، 74
ﺪﺷ دروآﺮﺑ رﺎﻤﻴﺑ .
ترﻮﺻ ﻪﺑ نارﺎﻤﻴﺑ ﻲﻓدﺎـﺼﺗ
داﺪـﻋا ﻚـﻤﻛ ﺎـﺑ
ﻠﺳ هوﺮﮔ ود ﻪﺑ ﻲﻓدﺎﺼﺗ ﺪﻧﺪﺷ ﻢﻴﺴﻘﺗ ﻮﺒﺳﻼﭘ و ﺐﻴﺴﻜ
. ﻚـﻴﻨﻜﺗ
ﻲﺣاﺮﺟ ﻞﻤﻋ دﻮﺑ ﻪﺑﺎﺸﻣ نارﺎﻤﻴﺑ ﻪﻴﻠﻛ رد
، رد ﻪـﻛ ﺐـﻴﺗﺮﺗ ﻦﻳا ﻪﺑ
ﺪـﺷ هدﺎﻔﺘـﺳا ﻲﭘﻮﻜـﺳورﺎﭘﻻ ترﻮﭘ رﺎﻬﭼ زا نارﺎﻤﻴﺑ مﺎﻤﺗ .
ﻚـﻳ
ﺞﻨـﭘ ترﻮـﭘ ﻪـﺳ و ﺰـﻨﻟ ﺖـﻬﺟ فﺎـﻧ زا يﺮـﺘﻣ ﻲﻠﻴﻣ هد ترﻮﭘ ﻲﻠﻴﻣ ﺮﺘﺳﺎﮕﻴﭘا ﻲﺣاﻮﻧ رد يﺮﺘﻣ
، ﺮـﻳز ﺖﺳار رﻻﻮﻜﻳوﻼﻛﺪﻴﻣ ﻂﺧ
هﺪﻧد ﻪﺒﻟ و يا ﻂﺧ رد ﻲﻣاﺪﻗ يرﻼﻳﺰﮔآ ﻪـﻴﺒﻌﺗ ﺖـﺳار ﺖﻤـﺳ رد
ﺪﺷ . نﺎﻣرد هوﺮﮔ رد نارﺎﻤﻴﺑ
، 200 ﻲﻠﻴﻣ
ﻚـﻳ ﺐﻴـﺴﻛﻮﻜﻠﺳ مﺮـﮔ
ﺰﻴﻧ و ﻞﻤﻋ زا ﻞﺒﻗ ﺖﻋﺎﺳ 200
ﻲﻠﻴﻣ ﺮـﻫ ﻞﻤﻋ زا ﺲﭘ وراد مﺮﮔ 12
تﺪﻣ ﻪﺑ ﺖﻋﺎﺳ 2
ﺪﻧدﺮﻛ ﺖﻓﺎﻳرد زور .
ﻮﺒﺳﻼﭘ ﺰﻴﻧ لﺮﺘﻨﻛ هوﺮﮔ ﻪﺑ
ﺪﺷ ﺰﻳﻮﺠﺗ ﺐﻴﺴﻛﻮﻜﻠﺳ ﻪﺑﺎﺸﻣ ﺰﻳﺎﺳ و ﻞﻜﺷ ﺎﺑ .
رد لﺮﺘﻨﻛ ﺖﻬﺟ د
ﺪﻳﺪﺷ زﺎﻴﻧ ترﻮﺻ رد 50
ﻖـﻳرﺰﺗ نارﺎـﻤﻴﺑ ﻪـﺑ ﻦﻳﺪﺘﭘ مﺮﮔ ﻲﻠﻴﻣ
ﻲﻣ ﺪﺷ . ﺮﻫ ﻞﻤﻋ زا ﺲﭘ درد ناﺰﻴﻣ نآ زا ﺲﭘ 6
ﻪﻠﻴﺳو ﻪﺑ ﺖﻋﺎﺳ
Visual Analog Score (VAS) ﺪﺷ هﺪﻴﺠﻨﺳ
. ﻦﻳﺪـﺘﭘ ناﺰـﻴﻣ
ﮔ ﺖﺒﺛ ﺺﻴﺧﺮﺗ نﺎﻣز ﺎﺗ ﺰﻴﻧ ﻲﺘﻓﺎﻳرد ﺪﻳدﺮ
. عﻮـﻬﺗ ناﺰﻴﻣ ﻦﻴﻨﭽﻤﻫ
ﺪﻴﻣاﺮﭘﻮﻠﻛﻮﺘﻣ فﺮﺼﻣ ناﺰﻴﻣ سﺎﺳا ﺮﺑ غاﺮﻔﺘﺳا و
، نﺎﻣز ﺖـﺸﮔﺮﺑ
يﺎﻫاﺪﺻ هدور يا
، عﻮﻓﺪﻣ و زﺎﮔ ﻊﻓد عوﺮﺷ نﺎﻣز
، ـﺘﺴﺑ تﺪﻣ ـ
يﺮ
و ﻲــﺳرﺮﺑ ﺰــﻴﻧ نﺎﺘــﺳرﺎﻤﻴﺑ رد ﺪــﺷ ﺖــﺒﺛ
. و نﺎــﺣاﺮﺟ ﻲﻣﺎــﻤﺗ
ﺷﺰﭘ ـ ﻊﻤﺟ رد ﻪﻛ ﻲﻧﺎﻜ ﺪﻨﺘﺷاد ﺶﻘﻧ تﺎﻋﻼﻃا يروآ
، ﺖﺒـﺴﻧ ﻪـﺑ
عﻮﻧ ﻪﻠﺧاﺪﻣ ﻤﻴﺑ ـ نارﺎ رﻮﻛ ﺪﻧدﻮﺑ . هداد ﺎﻫ ﺎﺑ هدﺎﻔﺘﺳا زا مﺮـﻧ راﺰـﻓا
SPSS16 درﻮﻣ
ﻞﻴﻠﺤﺗ يرﺎﻣآ ﻗ راﺮـ ﺪﻨﺘﻓﺮﮔ . ﻲﻔﻴﻛ يﺎﻫﺮﻴﻐﺘﻣ ﺎـﺑ
ﺖـﺴﺗ Chi-square ﻲﻤﻛ يﺎﻫﺮﻴﻐﺘﻣ و
ﻂـﺳﻮﺗ لﺎـﻣﺮﻧ ﻊـﻳزﻮﺗ ﺎﺑ
-Test وT ﻒـﻠﺘﺨﻣ تﺎﻋﺎـﺳ رد درد ناﺰـﻴﻣ ﻦﻴﮕﻧﺎﻴﻣ ﻦﻴﻨﭼ ﻢﻫ
هزاﺪﻧا ﻞﻴﻠﺤﺗ ﻂﺳﻮﺗ و يراﺮﻜﺗ يﺎﻫ
T- test درﻮـﻣ ﻞـﻴﻠﺤﺗ راﺮـﻗ
ﺪﻨﺘﻓﺮﮔ . لﺎﻤﺘﺣا 95 ) % P<0.05 ( ﻪﺑ ناﻮﻨﻋ ﺺﺧﺎﺷ ﻲﻨﻌﻣ راد ندﻮﺑ
رد ﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ ﺪ
.
ﻪﺘﻓﺎﻳ ﺎﻫ
ﻞﻛ رد 75 ﺪﻧﺪﺷ ﻪﻌﻟﺎﻄﻣ دراو رﺎﻤﻴﺑ
، ﻪﻛ 37 رﺎـﻤﻴﺑ ) 3 / 49 (%
و نﺎﻣرد هوﺮﮔ رد 38
ﺮﻔﻧ ) 7 / 50 (%
ﺪـﻨﺘﻓﺮﮔ راﺮﻗ ﺪﻫﺎﺷ هوﺮﮔ رد .
ﻲـﻠﻛ رﻮﻃ ﻪﺑ 51
رﺎـﻤﻴﺑ ) 5 / 69 (%
و نز 24 رﺎـﻤﻴﺑ ) 5 / 30 (%
دﺮـﻣ
ﺪﻧدﻮﺑ . توﺎﻔﺗ ﻲﻨﻌﻣ يراد هوﺮﮔ ﻦﻴﺑ دﻮـﺟو ﺖﻴـﺴﻨﺟ ﺮـﻈﻧ زا ﺎـﻫ
ﺖﺷاﺪﻧ . رد نارﺎﻤﻴﺑ ﻂﺳﻮﺘﻣ ﻦﺳ نﺎـﻣرد هوﺮﮔ
3 / 18 50± و لﺎـﺳ
ﺪﻫﺎﺷ هوﺮﮔ رد 8
/ 21 2± / 48
ﻣ توﺎـﻔﺗ ﻪـﻛ دﻮﺑ ﻲـﻨﻌ
ﻦﻴـﺑ يراد
هوﺮﮔ ﺖﺷاﺪﻧ دﻮﺟو ﺎﻫ .
نﺎﻣرد هوﺮﮔ رد 5
رﺎﻤﻴﺑ ) 5 / 13 (%
ﺖـﻠﻋ ﻪﺑ
ﻪﻟﻮﻛ ﺖﻴﺘﺴﻴﺳ
، 6 رﺎﻤﻴﺑ ) 2 / 16 (%
و ﺖﻴﺗاﺮﻜﻧﺎﭘ ﺖﻠﻋ ﻪﺑ 26
رﺎـﻤﻴﺑ
) 2 / 70 (%
ﺪـﻧدﻮﺑ هﺪـﺷ ﻞﻤﻋ ﺪﻳﺪﻧﺎﻛ يواﺮﻔﺻ ﻚﻴﻟﻮﻛ ﺖﻠﻋ ﻪﺑ .
رد
ﻧ لﺮﺘﻨﻛ هوﺮﮔ ﺰﻴ
8 رﺎﻤﻴﺑ ) 21 (%
ﻪﻟﻮﻛ ﺖﻠﻋ ﻪﺑ ﺖﻠﻋ ﻪﺑ ﺖﻴﺘﺴﻴﺳ
، 4
رﺎﻤﻴﺑ ) 10 (%
و ﺖﻴﺗاﺮﻜﻧﺎﭘ ﺖﻠﻋ ﻪﺑ 26
رﺎـﻤﻴﺑ ) 4 / 68 (%
ﺖـﻠﻋ ﻪـﺑ
ﺪﻧدﻮﺑ هﺪﺷ يﺮﺘﺴﺑ يواﺮﻔﺻ ﻚﻴﻟﻮﻛ (P=0.583)
.
نﺎــﻣرد هوﺮــﮔ رد ﻲﻓﺮــﺼﻣ ﻦﻳﺪــﺘﭘ ناﺰــﻴﻣ 2
/ 15 1± / 36
ﻲــﻠﻴﻣ ــﮔ ـ هوﺮــﮔ رد و مﺮ ﺪﻫﺎــﺷ
7 / 18 2± / 63 ﻲــﻠﻴﻣ مﺮــﮔ
دﻮﺑ P<0.001) .(
ﻣزآ مﺎﺠﻧا ﺎﺑ هزاﺪﻧا ﻞﻴﻠﺤﺗ نﻮ
يﺮﻴﮔ يراﺮـﻜﺗ يﺎﻫ
هﺮﻤﻧ ﻦﻴﮕﻧﺎﻴﻣ ﻪﻛ ﺪﺷ هداد نﺎﺸﻧ درد
ﻂﺳﻮﺗ ﻪﻛ هﺪﻴﺠﻨـﺳVAS
ﺪﺷ
،ﺖﺳا ه ﻲﻨﻌﻣ رﻮﻃ ﻪﺑ دﻮﺑ ﺮﺘﻤﻛ نﺎﻣرد هوﺮﮔ رد يراد
ﺖـﺳا ه .
(Tests of Between-Subjects Effects, P<0.001) )
رادﻮﻤﻧ 1 ( .
هدور يﺎﻫاﺪـﺻ ﺖﺸﮔزﺎﺑ نﺎﻣز ﻦﻴﮕﻧﺎﻴﻣ نﺎـﻣرد هوﺮـﮔ رد يا
1 / 3 9± / 10 ﺳ زا ﺲﭘ ﺖﻋﺎ ﻲﺣاﺮﺟ
ﺪﻫﺎـﺷ هوﺮـﮔ رد و 3
/ 4 7± / 13
ﺖﻋﺎﺳ دﻮﺑ (P=0.001) .
رد عﻮﻓﺪﻣ ﺎﻳ زﺎﮔ ﻊﻓد زﺎﻏآ نﺎﻣز ﻦﻴﮕﻧﺎﻴﻣ
نﺎﻣرد هوﺮﮔ 1
/ 3 9± / 16 هوﺮـﮔ رد و ﻞـﻤﻋ زا ﺲﭘ ﺖﻋﺎﺳ ﺪﻫﺎـﺷ
4 / 4 6± / 18 ﺖﻋﺎﺳ دﻮﺑ (P=0.016) .
نﺎﻣرد هوﺮﮔ رد ﻲﻠﻛ رﻮﻃ ﻪﺑ 5
ﺮﻔﻧ ) 5 / 13 (%
ﺪﻫﺎﺷ هوﺮﮔ رد و 13
ﺮﻔﻧ ) 2 / 34 (%
ﺗ ﻊﻓر ﺖﻬﺟ عﻮـﻬ
ﺘﺳا و ﻔ
ﺪـﻧدﺮﻛ فﺮـﺼﻣ ﺪﻴﻣاﺮﭘﻮﻠﻛﻮﺘﻣ غاﺮ (P=0.033)
. ﻦﻴﮕﻧﺎـﻴﻣ
ﺖﻣﺎﻗا تﺪﻣ رد
د هوﺮـﮔ رد نﺎﺘـﺳرﺎﻤﻴﺑ نﺎـﻣر
2 /
±1 5 / 1 رد و زور
هوﺮﮔ ﺪﻫﺎﺷ 3 / 1 2± / 2 ﻲﻣ زور ﺪﺷﺎﺑ ﻲﻨﻌﻣ رﻮﻃ ﻪﺑ ﻪﻛ هوﺮﮔ رد يراد
هﺎﺗﻮﻛ نﺎﻣرد ﻲﻣ ﺮﺗ
ﺪﺷﺎﺑ (P<0.001) .
ﺖـﺳا ﺮﻛذ ﻪﺑ مزﻻ رد
ﻦـﻳا
ﺎﺸﻣ يﻮﻴﻠﻛ ﺎﻳ ﻲﺒﻠﻗ ضراﻮﻋ ﻪﻌﻟﺎﻄﻣ ﺪﺸﻧ هﺪﻫ
.
ﺭﺍﺩﻮﻤﻧ ۱ ـ ﻩﺯﺍﺪﻧﺍ ﺕﺎﻋﺎﺳ ﺭﺩ ﺩﺭﺩ ﻦﻴﮕﻧﺎﻴﻣ ﻪﺴﻳﺎﻘﻣ ﻩﻭﺮﮔ ﻭﺩ ﻦﻴﺑ ﻩﺪﺷ ﻱﺮﻴﮔ
ﺚﺤﺑ ﻪﺠﻴﺘﻧ و يﺮـﻴﮔ
ﻲـﺣاﺮﺟ رد ﻲﻠـﺻا تﻼﻜﺸﻣ زا هراﻮﻤﻫ نارﺎﻤﻴﺑ درد لﺮﺘﻨﻛ ﺖﺳا هدﻮﺑ .
دﻮـﺒﻬﺑ ﻪـﺑ تﺎـﻌﻟﺎﻄﻣ زا يرﺎﻴـﺴﺑ نﺎـﻨﭽﻤﻫ هزوﺮـﻣا
شور ﻲﻣ درد لﺮﺘﻨﻛ يﺎﻫ ﺪﻧزادﺮﭘ
، ،درد ﺐـﺳﺎﻨﻣ لﺮﺘﻨﻛ ﺎﺑ ﻪﻛ اﺮﭼ
ﺎﻴﺴﺑ ﺶﻫﺎﻛ يﻮﻳر و ﻲﺒﻠﻗ ضراﻮﻋ ﻪﻠﻤﺟ زا ﻲﺣاﺮﺟ ضراﻮﻋ زا ير
ﻪﻨﻳﺰﻫ ،رﺎﻤﻴﺑ يدﻮﺒﻬﺑ ﻊﻳﺮﺴﺗ ﺎﺑ و ﻪﺘﻓﺎﻳ يﺪﻨﻤﺘﻳﺎـﺿر و ﺶﻫﺎﻛ ﺎﻫ
ﻲﻣ ﺶﻳاﺰﻓا ﻳ
ﺪﺑﺎ .
هار زا ﻲﻜﻳ
ﻞـﻤﻋ زا ﺲـﭘ درد لﺮـﺘﻨﻛ ﺖـﻬﺟ ﺐﺳﺎﻨﻣ يﺎﻫ
،
هﺪﻨﻨﻛ رﺎﻬﻣ يﺎﻫوراد زا هدﺎﻔﺘﺳا ﻲـﻣCOX2
ﺪـﺷﺎﺑ . زا هدﺎﻔﺘـﺳا
هوﺮـﮔ ﻦـﻳا رد دﻮﺟﻮﻣ يﺎﻫوراد زا ﻲﺧﺮﺑ ﻪـﻠﻤﺟ زا
Rofecoxib و
Valdecoxib ﻪﺑ
ﻲﻣ دﺎﺠﻳا ﻪﻛ ﻲﻗوﺮﻋ ﻲﺒﻠﻗ ضراﻮﻋ ﺖﻠﻋ ﺪﻨﻨﻛ
، ﻪﺑ
ﻲﻧارﺎﻤﻴﺑ رد صﻮﺼﺧ ﻪﻛ
ﺖـﺤﺗ و ﺪـﻧراد ﻲـﻗوﺮﻋ ﻲﺒﻠﻗ تﻼﻜﺸﻣ
ﻲﻣ راﺮﻗ ﻲﺒﻠﻗ ﻞﻤﻋ ﺪﻧﺮﻴﮔ
، ﺖـﺳا ﺮﻈﻧ فﻼﺘﺧا درﻮﻣ تﺪﺷ ﻪﺑ
19. زا
تﺎﻌﻟﺎﻄﻣ ﻲﻓﺮﻃ ﺪـﻨﻫد ﻲﻣ نﺎﺸﻧ ﻪﻛ ﺪﻧراد دﻮﺟو يﺮﮕﻳد
، ﻲﻧﺎـﻣز
ﺑ ﻲﺣاﺮﺟ لﺎﻤﻋا رد ﻪﻛ ﻲﺣاﺮﺟ زا ﺮﻴﻏ ﻪ
زا ﻪﺘﺳد ﻦﻳا زا ﻲﺒﻠﻗ يﺎﻫ
وراد ﻲﻣ هدﺎﻔﺘﺳا ﺎﻫ دﻮﺷ
،
يﺪـﺟ ضراﻮـﻋ ﻦﺘـﺷاد نوﺪﺑ
، ـﺗ ﺄ ﺮﻴﺛ
يرﺎﻴﺴﺑ ﻲﺣاﺮﺟ زا ﺪﻌﺑ درد لﺮﺘﻨﻛ رد
، ﻪﺘﺷاد ﺪﻧا
8.
- 12 و
ﻚـﻳ رد20
يوراد زا هدﺎﻔﺘــﺳا ﻪــﻛ هﺪــﺷ هداد نﺎــﺸﻧ ﺰﻴﻟﺎــﻧآﺎﺘﻣ ﻪــﻌﻟﺎﻄﻣ
Rofecoxib
، ﺶﻳاﺰـﻓا ار يﻮـﻴﻠﻛ و ﻲـﺒﻠﻗ ضراﻮﻋ دﺎﺠﻳا لﺎﻤﺘﺣا
ﻲﻣ ﺪﻫد . دﺎـﺠﻳا ﻚـﺴﻳر ﺐﻴـﺴﻛﻮﻜﻠﺳ زا هدﺎﻔﺘـﺳا ﻪﻛ ﻲﻟﺎﺣرد
ﺖـﺳا هداد ﺶﻫﺎـﻛ ار يﻮـﻴﻠﻛ و ﻲﺒﻠﻗ ضراﻮﻋ
21. ﻦـﻳا رﺎـﻨﻛ رد
عﻮــﺿﻮﻣ
، ﻪﺑﺎــﺸﻣ تﺎــﻌﻟﺎﻄﻣ ﺪــﻧا هداد نﺎــﺸﻧ
زا هدﺎﻔﺘــﺳا ﻪــﻛ
ﺰـﻴﻧ و ﻲﺣاﺮﺟ زا ﺪﻌﺑ درد ﺶﻫﺎﻛ رد ﻲﺣاﺮﺟ زا ﺲﭘ ﺐﻴﺴﻛﻮﻜﻠﺳ رﺪﺨﻣ فﺮﺼﻣ ناﺰﻴﻣ ﺶﻫﺎﻛ رﺎﻴﺴﺑ
ﻲﻣ ﺮﺛﺆﻣ ﺪﺷﺎﺑ
15.
- 18 و
سﺎﺳا ﺮﺑ22
ﻧ ﻪـﺿرﺎﻋ دﺎﺠﻳا نوﺪﺑ ﺐﻴﺴﻛﻮﻜﻠﺳ ﺰﻴﻧ ﻪﻌﻟﺎﻄﻣ ﻦﻳا زا ﻞﺻﺎﺣ ﺞﻳﺎﺘ
دﻮﺧ ﻪﻛ ﺖﺳا هﺪﺷ ﻞﻤﻋ زا ﺲﭘ درد ﺶﻫﺎﻛ ﺐﺒﺳ يﺪﺟ
، ﺐـﻟﺎﻄﻣ
ﺗ ار ﻪﺘﺷﺬﮔ تﺎﻘﻴﻘﺤﺗ ﺄ
ﻲﻣ ﺪﻴﻳ ﺪﻨﻛ . ﻪﺘﻓﺎﻳ ﻦﻳا ﻲﻠﻛ رﻮﻃ ﻪﺑ ﺲﭘ ﺎـﻫ
ﻲﻣ نﺎﺸﻧ ﻪـﺿرﺎﻋ ﻢﻛ و ﺐﺳﺎﻨﻣ يوراد ﻚﻳ ﺐﻴﺴﻛﻮﻜﻠﺳ ﻪﻛ ﺪﻫد
ﻲﻣ ﻲﺣاﺮﺟ زا ﺪﻌﺑ درد لﺮﺘﻨﻛ ﺖﻬﺟ ﺪﺷﺎﺑ
.
ﻪﺘﻜﻧ يا ﻪـﻛ ﺖﺳا ﻦﻳا دراد دﻮﺟو ﻪﻛ هدﺎﻔﺘـﺳا ﻲـﺋوراد زود
تﺎﻘﻴﻘﺤﺗ رد هﺪﺷ ﻪﺘﺷﺬﮔ
400 ﻲﻠﻴﻣ مﺮﮔ ﺲـﭘ وراد عوﺮﺷ و هدﻮﺑ
ﻲﺣاﺮﺟ ﻞﻤﻋ زا ﺖﺳا هدﻮﺑ
15،
- 18 و
ﻌﻟﺎﻄﻣ رد ﻪﻛ ﻲﻟﺎﺣ رد22
ﺔ ﺮـﺿﺎﺣ
زود هﺪﺷ ﺰﻳﻮﺠﺗ يﺎﻫ 200
ﻲﻠﻴﻣ زا ﺶﻴـﭘ وراد عوﺮﺷ و ﺪﻧدﻮﺑ مﺮﮔ
دﻮﺑ هﺪﺷ زﺎﻏآ ﻲﺣاﺮﺟ مﺎﺠﻧا .
تﺎـﻌﻟﺎﻄﻣ ﻪﺠﻴﺘﻧ رد زﺎـﻴﻧ يﺮﺘـﺸﻴﺑ
ﺮﺛﺆـﻣ زود ﺪـﺣ ﻦﻳﺮﺘﻤﻛ ﺎﺗ ﺖﺳا
دﻮـﺷ ﻪﺘﺧﺎﻨـﺷ وراد .
ﻪـﺘﺒﻟا رد
ﻪﻌﻟﺎﻄﻣ ﻧارﺎﻜﻤﻫ و ﺖﻳاو زا يا ﺶ
،
ﻪـﻛ هﺪـﺷ هداد نﺎـﺸﻧ ﺰﻳﻮـﺠﺗ
ﻲﺣاﺮﺟ عوﺮﺷ زا ﺶﻴﭘ ﺐﻴﺴﻛﻮﻜﻠﺳ
، زا ﺪـﻌﺑ درد لﺮـﺘﻨﻛ ﺖﻬﺟ
ﻲﺣاﺮﺟ
، ﺗ ﺄ مﺎـﻤﺗا زا ﺲـﭘ نﺎـﻣرد ﻪﻛ ﻦﻳا ﻪﺑ ﺖﺒﺴﻧ يﺮﺘﺸﻴﺑ ﺮﻴﺛ
دﻮﺷ زﺎﻏآ ﻲﺣاﺮﺟ
، اﺪﻧ در
23.
ﺑ ﻲﻠﻛ رﻮﻃ ﻪﺑ ﻲﻣ راﺮﻗ ﻲﺣاﺮﺟ لﺎﻤﻋا ﺖﺤﺗ ﻪﻛ ﻲﻧارﺎﻤﻴ
ﺪﻧﺮﻴﮔ
ﺎﻫرﺪـﺨﻣ دﺎﻳز فﺮﺼﻣ زا ﻲﺷﺎﻧ ضراﻮﻋ رﺎﭼد ﻊﻳﺎﺷ رﻮﻃ ﻪﺑ
نﻮـﭼ
سﻮﺌﻠﻳا
، عﻮﻬﺗ
، غاﺮﻔﺘﺳا
، ﺖﺳﻮﺒﻳ ﻲﻣ ﺪﻧﻮﺷ . ضراﻮـﻋ ﺎـﺑ سﻮﺌﻠﻳا
ﺪﺑﺎﻳ ﻪﻣادا يﺮﺘﺸﻴﺑ تﺪﻣ ﻪﭼ ﺮﻫ و ﺖﺳا هاﺮﻤﻫ ﻲﻛﺎﻧﺮﻄﺧ
، لﺎﻤﺘﺣا
ﻲﻣ ﺮﺘﺸﻴﺑ ﺰﻴﻧ نآ زا ﻲﺷﺎﻧ ضراﻮﻋ عﻮﻗو دﻮﺷ
. ﻲﺑ ﺘﻨﻣ ﻲﺘﻛﺮﺣ ﺮـﺸ
هدور رﺎـﺸﻓ ﺶﻳاﺰـﻓا و هدور عﺎﺴﺗا ﻪﺑ ﺮﺠﻨﻣ سﻮﺌﻠﻳا ﺖﻟﺎﺣ رد ﺎﻫ
ﻲﻣ هدور ﻦﻣﻮﻟ ﻞﺧاد ﻲﻤﻜـﺴﻳا دﺎﺠﻳا ﺚﻋﺎﺑ عﻮﺿﻮﻣ ﻦﻳا ﻪﻛ دﻮﺷ
ﻲﻣ هدور هراﻮﻳد رد ﻲﻣ ﻪﻛ ددﺮﮔ
هدور نﻮﻴﺳارﻮﻓﺮﭘ ﻪﺑ ﺮﺠﻨﻣ ﺪﻧاﻮﺗ
مرﺪﻨـﺳ دﺎـﺠﻳا ﺎـﺑ ﻪـﻛ دﻮـﺷ ﻲﻤﻜـﺷ ﻞﺧاد رﺎﺸﻓ ﺶﻳاﺰﻓا ﺎﻳ و د ﻪﺑ ار يرﺎﺒﮔﺮﻣ ضراﻮﻋ ﻲﻤﻜﺷ نﺎﻤﺗرﺎﭙﻤﻛ دراد لﺎﺒﻧ
. ﻦﻴـﻨﭼ ﻢﻫ
يﺮﺘﻛﺎﺑ ﺪﺣ زا ﺶﻴﺑ ﺪﺷر هدور ﻞﺧاد يﺎﻫ
ﻪـﻠﻤﺟ زا ﻲﺗﻼﻜـﺸﻣ يا
ﻲﻣ دﻮﺟو ﻪﺑ ار ﺲﻴﺴﭙﺳ ﺎﻳ و ﺖﻴﻧﻮﺘﻳﺮﭘ دروآ
24. نﺪﺷ فﺮﻃ ﺮﺑ اﺬﻟ
ﻊﻳﺮﺳ ﻪﭼ ﺮﻫ ﺖـﻴﻤﻫا رﺎﻴـﺴﺑ ﻲـﺣاﺮﺟ لﺎﻤﻋا زا ﺲﭘ سﻮﺌﻠﻳا ﺮﺗ
دراد . اﺪﺻ زﺎﻏآ نﺎﻣز ﺐﻴﺴﻛﻮﻜﻠﺳ فﺮﺼﻣ ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد يﺎـﻫ
ﻓﺪﻣ و زﺎﮔ ﻊﻓد و هدور ﻲـﻨﻌﻣ رﻮﻃ ﻪﺑ عﻮ
هوﺮـﮔ ﻪـﺑ ﺖﺒـﺴﻧ يراد
ﻊﻳﺮﺳ ﺪﻫﺎﺷ ﺖﺳا هدﻮﺑ ﺮﺗ
، ﻪـﻛ
ﻲـﻣ نﺎـﻤﮔ
ـﺗ ﺖـﻠﻋ ﻪـﺑ دور ﺄ
ﺮﻴﺛ
رﺪﺨﻣ فﺮﺼﻣ ﺶﻫﺎﻛ رد ﺐﻴﺴﻛﻮﻜﻠﺳ هدور دﺮﻜﻠﻤﻋ
هﺪﺷ ﺮﺘﻬﺑ يا
ﺖﺳا .
ﻲـﻨﻌﻣ رﻮـﻃ ﻪﺑ ﺰﻴﻧ غاﺮﻔﺘﺳا و عﻮﻬﺗ ناﺰﻴﻣ ﻦﻴﻨﭼ ﻢﻫ يراد
ﺖﺳا ﻪﺘﺷاد ﺶﻫﺎﻛ نﺎﻣرد هوﺮﮔ رد .
و ﺖﻳاو ﻪﻌﻟﺎﻄﻣ رد ﻪﻜﻴﻟﺎﺣ رد
ﻧارﺎﻜﻤﻫ ﺶ ﻪﻛ 400 ﻲﻠﻴﻣ ﻪـﺑ ﻲـﺣاﺮﺟ زا ﺲﭘ ار ﺐﻴﺴﻛﻮﻜﻠﺳ مﺮﮔ
هدﺮﻛ ﺰﻳﻮﺠﺗ نارﺎﻤﻴﺑ ﺪﻧا
، و ﻲـﺣاﺮﺟ زا ﺪـﻌﺑ درد ناﺰـﻴﻣ ﻪـﭼ ﺮﮔا
ﻲﻨﻌﻣ رﻮﻃ ﻪﺑ رﺪﺨﻣ فﺮﺼﻣ ناﺰﻴﻣ ﺖﺳا ﻪﺘﻓﺎﻳ ﺶﻫﺎﻛ يراد
، ﻲـﻟو
ﻪﺘـﺷاﺪﻧ ﻲﺗوﺎـﻔﺗ لﺮﺘﻨﻛ هوﺮﮔ ﻪﺑ ﺖﺒﺴﻧ غاﺮﻔﺘﺳا و عﻮﻬﺗ ناﺰﻴﻣ ﺖﺳا
22. دراد دﻮـﺟو ﻪﻌﻟﺎﻄﻣ ود ﻦﻳا نﺎﻴﻣ ﻪﻛ ﻲﺗوﺎﻔﺗ
، ـﻔﺗ رد توﺎ
ﺐﻴـﺴﻛﻮﻜﻠﺳ ﺰﻳﻮـﺠﺗ عوﺮـﺷ نﺎـﻣز و هﺪـﺷ هدﺎﻔﺘـﺳا يﺎﻫزود ﻲﻣ ﺪﺷﺎﺑ . نﺎـﻳﺎﭘ زا ﺲـﭘ ﺖﻳاو يﺎﻗآ ﻪﻌﻟﺎﻄﻣ رد ﻪﻛ ترﻮﺻ ﻦﻳا ﻪﺑ
ـﻌﻟﺎﻄﻣ رد ﻪﻛ ﻲﻟﺎﺣ رد هﺪﺷ ﺰﻳﻮﺠﺗ وراد زود ﻦﻴﻟوا ﻲﺣاﺮﺟ ﺔ
ﺎـﻣ
،
دﻮﺑ هﺪﺷ ﺰﻳﻮﺠﺗ ﻞﻤﻋ عوﺮﺷ زا ﺶﻴﭘ ﺐﻴﺴﻛﻮﻜﻠﺳ زود ﻚﻳ .
عﻮﻬﺗ
ﻲﺷﺎﻧ ضراﻮﻋ زا ﻪﻛ ﻦﻳا ﺮﺑ هوﻼﻋ غاﺮﻔﺘﺳا و ﻪﺑ ﺎﻫرﺪﺨﻣ فﺮﺼﻣ زا
ﻲﻣ بﺎﺴﺣ ﺪﻳآ
، ﺰﻴﻧ ﻲﺣاﺮﺟ ﻞﻤﻋ و ﻲﺷﻮﻬﻴﺑ زا ﻲﺷﺎﻧ ضراﻮﻋ ءﺰﺟ
ﻲﻣ رﺎﻤﺷ ﻪﺑ ﺪﻳآ
25. ﺖـﺳا ﻦـﻜﻤﻣ ﻦﻳاﺮﺑﺎﻨﺑ ﺰﻳﻮـﺠﺗ
زا ﺶﻴـﭘ وراد
ﻲﺣاﺮﺟ عوﺮﺷ ﺗ ﺎﺑ
ﺄ هﺪﺷ ﺮﻛذ ﻞﻣاﻮﻋ يور ﺮﺑ ﺮﻴﺛ
، ناﺰﻴﻣ ﺶﻫﺎﻛ رد
ﻪﺘﺷاد ﺶﻘﻧ غاﺮﻔﺘﺳا و عﻮﻬﺗ ﺪﺷﺎﺑ
. مﺎـﺠﻧا ﻪﺑ عﻮﺿﻮﻣ ﻦﻳا تﺎﺒﺛا
ﻴﻧ يﺮﺘﺸﻴﺑ تﺎﻌﻟﺎﻄﻣ دراد زﺎ
.
ﻛذ ﻪﺑ مزﻻ ـ
ﻪﻛ ﺖﺳا ﺮ ﮔ ود
ـ ﻣ هوﺮ ـ ﻲﺳرﺮﺑ درﻮ )
نﺎﻣرد هوﺮﮔ
ﮔ و ـ ﺘﻨﻛ هوﺮ ـ لﺮ ( ـﻈﻧ زا ـ ـﻠﻣاﻮﻋ ﺮ ـ و ﺲﻨـﺟ و ﻦـﺳ ،ﺪـﻨﻧﺎﻣ ﻲ
ﺟ ﻞﻤﻋ ﻚﻴﻨﻜﺗ ـ
ﻔﺗ ﻲﺣاﺮ ـ ﺪﻨﺘـﺷاﺪﻧ توﺎ .
ـﻟ ـ ﺎـﻫﺮﻴﻐﺘﻣ ﻦـﻳا اﺬ
رﻮﺘﻛﺎﻓ ﻨﻌﻣ رد هﺪﻨﻨﻛ شوﺪﺨﻣ يﺎﻫ ـ
ﻲ هﺪـﺷ ﺮﻛذ ﺞﻳﺎﺘﻧ نﺪﺷ راد
ﻲﻤﻧ رﺎﻤﺷ ﻪﺑ ﺪﻧور
.
ﻲﻠﻛ رﻮﻃ ﻪﺑ ﺎﻄﻣ ﻦﻳا رد
ﺪـﺷ هداد نﺎـﺸﻧ ﻪـﻌﻟ فﺮـﺼﻣ ﻪـﻛ
ﻜﻠﺳ ﻲﻛارﻮﺧ ﻛﻮ
ﺐﻴﺴ زود ﺎﺑ 200 ﻲﻠﻴﻣ مﺮﮔ ﻞﺒﻗ زا ﻲـﺣاﺮﺟ ﻞﻤﻋ
ﻪﻠﻛ ﺳ ﺴﻴ ﻲﭘﻮﻜﺳارﺎﭘﻻ ﻲﻣﻮﺘﻜﺘ و
ﺰﻴﻧ 200 مﺮﮔ ﻲﻠﻴﻣ ﺮﻫ
12 ﺖﻋﺎﺳ
ﻞﻤﻋ زا ﺲﭘ ﻲﻣ
ﺪﻧاﻮﺗ ﻲﻨﻌﻣ رﻮﻃ ﻪﺑ يراد
ﺶﻫﺎﻛ ﺐﺒﺳ تﺪـﺷ
درد
و عﻮـﻬﺗ ﻞـﺜﻣ ﻲـﺣاﺮﺟ ﺪـﻌﺑ ضراﻮـﻋ ﺶﻫﺎﻛ و رﺪﺨﻣ فﺮﺼﻣ و دﻮﺒﻬﺑ ﻦﻴﻨﭽﻤﻫ و غاﺮﻔﺘﺳا هدور دﺮﻜﻠﻤﻋ
يا ) ـﺑ ﻪ ترﻮـﺻ عوﺮـﺷ
اﺪﺻ و هدور يﺎﻫ عﻮﻓﺪـﻣ و زﺎﮔ ﻊﻓد
( ﺖـﻣﺎﻗا تﺪـﻣ ﻦﻴـﻨﭽﻤﻫ و
ددﺮﮔ نارﺎﻤﻴﺑ ﻦﻳا نﺎﺘﺳرﺎﻤﻴﺑ .
Abstract:
Evaluation of the Effects of Perioperative Administration of Celecoxib on Pain Management and the use of narcotic after
Laparoscopic Cholecystectomy
Soroush A. R. MD*, Khorgami Zh. MD**, Mobayen M. R. MD***, Mofid R. MD****
(Received: 13 Sep 2010 Accepted: 9 Dec 2010)
Introduction & Objective: Pain control is one of the main issues in laparoscopic surgeries. Although opioid and non-steroidal anti-inflammatory drugs (NSAIDS) are used for pain control but there are severe side effects, but it is thought that, new generation of NSAIDS are able to control pain without any significant side effects of narcotics. We compared postoperative pain, analgesic administration, duration of hospital stay, and side effect of surgeries such as vomiting.
Materials & Methods: From September 2008 to March 2009, we enrolled 75 laparoscopic cholecystectomy patients in a randomized clinical trial study. The patients were randomly divided into two groups. In intervention group, 200 mg for celecoxib administered one hour before surgery and then 200 mg each 12 hours, for two days after surgery. Placebo was administered in the control group. Then severity of pain was measured by visual analogue score (VAS) every six hours during 48 hours. Opioid consumption, duration of hospital stay, antiemetic usage, and other complications of surgery (such as nausea and vomiting) were recorded. Statistical analysis was performed with SPSS version 16.0. Data were reported as means and SD. Data with normal distribution was tested with independent t-test. Qualitative data was analyzed with chi- square. Means of pain intensity were analyzed with repeated measures anova. P<0.05 was considered statistically significant.
Results: From the 75 patients, who enrolled in our study, 37 patients took celecoxib and 38 patients took placebo. The two groups were identical in; age, gender, and type of gallbladder disease. The amounts of pethidine administered in celecoxib and placebo groups were 36.1±15.2 mg and 63.2±18.7 mg respectively (P-Value < 0.001). Pain scores according to VAS were lower significantly in celecoxib group (P<0,001).
Postoperative hospital stay in celecoxib group was 1.5±1.2 day in compare to 2.2±1.3 days in placebo group (P-Value < 0.001). These results were significant for the case of post-operating, vomiting, duration of hospitalization and intestinal function.
Conclusions: Perioperative oral celecoxib can reduce postoperative pain after LC. It can also decrease the usage of analgesic and antiemetic drugs and their complications. This practice lead to faster recovery and lower hospital stay after LC and probably after other minor laparoscopic surgeries.
Key Words: Cholecystectomy, Laparoscopy, Celecoxib, Pain
*Associate Professor of General Surgery, Tehran University of Medical Sciences and Health Services, Tehran, Iran
**Assistant Professor of General Surgery, Tehran University of Medical Sciences and Health Services, Tehran, Iran
***Resident of General Surgery, Tehran University of Medical Sciences and Health Services, Tehran, Iran
****General Practitioner, Tehran University of Medical Sciences and Health Services, Tehran, Iran
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