ژﺎﺗرﻮﮐ ﯽﻃ نارﺎﻤﯿﺑ درد تﺪﺷ ﺮﺑ ﺲﮑﯾوﺮﺳ ﯽﺴﺣﯽﺑ رد ﻦﯿﻟﺎﺳ و ﻦﯿﯾﺎﮐوﺪﯿﻟ ﺮﺛا ﻪﺴﯾﺎﻘﻣ
I هدازیﺪﻬﻣ ﻞﻀﻔﻟاﻮﺑا ﺮﺘﮐد*
II نﺎﯾﺮﺒﮐا لﻮﺳﺮﻟاﺪﺒﻋ ﺮﺘﮐد
III ﯽﻤﺳﺎﻗ ﻪﻧﺎﺴﻓا ﺮﺘﮐد
IV یرﻮﻤﯿﺗ ﺪﻨﻤﺟرا ﻪﻤﻃﺎﻓ ﺮﺘﮐد
ﻪﻣﺪﻘﻣ ﻦﯾﺮﺗﻊﯾﺎــﺷ ﻪـﻠﻤﺟ زا ﯽﻧﺎـﻣرد و ﯽﺼﯿﺨـﺸﺗ یﺎـﻫژﺎـﺗرﻮﮐ ﺎـﻫﯽﺣاﺮﺟ ﻪـﻧﻮﮔ ﻦـﯾا رد .ﺪﻨﺘــﺴﻫ ناﺮﯾا رد ﯽﺣاﺮﺟ یﺎﻫﻞﻤﻋ ﺪﻧورﯽﻣ رﺎﮐﻪﺑ ﯽﻌﺿﻮﻣ ﯽﺴﺣﯽﺑ ﺖﻬﺟ ﯽﻧﻮﮔﺎﻧﻮﮔ یﺎﻫﺐﯿﮐﺮﺗ زا .ﺪﻨـﺷﺎﺑﯽﻣ دﻮــﺧ صﺎﺧ ﯽﺒﻧﺎﺟ ضراﻮﻋ یاراد ماﺪﮐ ﺮﻫ ﻪﮐ ﺪـﺷﺎﺑ هﺪــﺷ ﺰﯾﻮﺠﺗ ﺢﯿﺤﺻ ﻪﮐ ﯽﻌﺿﻮﻣ ﯽﺴﺣﯽﺑ ﺮﮕﯾد یﻮﺳ ﻦﯿﻨﭼ رد ﯽﻣﻮﻤﻋ ﯽﺷﻮﻬﯿﺑ ﻪﺑ ﺖﺒﺴﻧ یﺮﺘﻤﮐ ﺮﯿﻣ و گﺮﻣ ﺮﻄﺧ ناﻮﻨﻌﺑ فﺮﺑ زا طاﺮﻘﺑ نﺎﻣز رد .(1)دراد لﺎﺒﻧد ﻪﺑ ار ﯽﯾﺎﻫﻞﻤﻋ ﻪﺑ ور ﺪﻧور ﻦﯾا و ﺪــﺷﯽﻣ هدﺎﻔﺘﺳا ﯽــﻌﺿﻮﻣ ﯽﺴﺣﯽﺑ هدﺎﻣ ﻦـﯿﻟوا یاﺮــﺑ ـ ﻦﯿﯾﺎﮐوﺪﯿﻟ زا هدﺎﻔﺘﺳا و ﺪﯿﻟﻮﺗ ﻪﺑ ﺮﺠﻨﻣ ﻞﻣﺎﮑﺗ
ﻦﯾﺮﺗﻊﯾﺎـﺷ ﻦﯿﯾﺎـﮐوﺪﯿﻟ هزوﺮـﻣا .(2)ﺪــﺷ ـ 1943 لﺎﺳ رد رﺎﺑ .ﺖﺳا ﯽﻌﺿﻮﻣ ﯽﺴﺣﯽﺑ رد هدﺎﻔﺘﺳا درﻮﻣ لﻮﻠﺤﻣ ﻂــﺳﻮﺗ هﺪﺷ شراﺰﮔ درد تﺪﺷ ﻪﺴﯾﺎﻘﻣ ﻪﻌﻟﺎﻄﻣ ﻦﯾا فﺪﻫ ﻦﯿﯾﺎــﮐوﺪﯿﻟ لﻮﻠﺤﻣ ود ﻂﺳﻮﺗ ﺲﮑﯾوﺮﺳ ﯽﺴﺣﯽﺑ رد نارﺎﻤﯿﺑ یدردﯽـﺑ ﻪـﮐﯽﺗرﻮﺻ رد .ﺖـﺳا هدﺎـﺳ ﻦﯿﻟﺎـﺳ و هﺪــﺷ ﺮﻓﺎﺑ ﻦﯿﯾﺎـﮐوﺪﯿﻟ زا ﻪـﮐ ﺪـﺷﺎﺑ یاهزاﺪـﻧا ﻪــﺑ هدﺎﺳ ﻦﯿﻟﺎﺳ زا ﯽﺷﺎﻧ ﯽﺒﻧﺎـﺟ ضراﻮـﻋ ۀﻮﻘﻟﺎـﺑ تاﺮــﻄﺧ زا نارﺎﻤﯿﺑ ،ﺪﯾآﯽﻣ ﺖﺳدﻪﺑ
هﺪﯿﮑﭼ
ﯽـﺴﺣﯽﺑ زا هدﺎﻔﺘـﺳا ﺎـﺑ ژﺎـﺗرﻮﮐ ﯽــﻃ نارﺎﻤﯿﺑ ﻂﺳﻮﺗ هﺪﺷ شراﺰﮔ درد تﺪﺷ ﻪﺴﯾﺎﻘﻣ ﺶﻫوﮋﭘ ﻦﯾا زا فﺪﻫ ﯽﯾﺎـﻣزآرﺎﮐ شور ﻪـﺑ یاﻪـﻌﻟﺎﻄﻣ رﻮــﻈﻨﻣ ﻦـــــﯿﻤﻫ ﻪﺑ .دﻮﺑ هﺪﺷ ﺮــﻓﺎﺑ ﻦـــﯿﯾﺎﮐوﺪﯿﻟ و هدﺎﺳ ﻦـــــﯿﻟﺎﺳ ﻂﺳﻮﺗ ﯽﻧﺎـﻣرد ﺎـﯾ ﺺﯿﺨـﺸﺗ ژﺎــﺗرﻮﮐ ﺪﯾﺪﻧﺎﮐ رﺎﻤﯿﺑ 85 یور ﺮﺑ (Double blind clinical trial ) رﻮﮐﻮﺳ ود ﯽــﻨﯿﻟﺎﺑ (n=41) ﻦﯿﻟﺎﺳ ﺎﺑ (CervicoVaginal) لﺎﻨﯾژاوﻮﮑﯾوﺮﺳ ﯽﻃﺎﺨﻣ ﺮﯾز ﻖﯾرﺰﺗ هوﺮﮔ ود ﻪﺑ نارﺎﻤﯿﺑ .ﺖﻓﺮﮔ ترﻮﺻ زا هدﺎﻔﺘـﺳا ﺎـﺑ هوﺮـﮔ ود نارﺎـﻤﯿﺑ ﯽﻣﺎـﻤﺗ باﺮـﻄﺿا ﺢﻄـﺳ .ﺪﻧﺪــﺷ ﻢﯿﺴﻘﺗ (n=44) هﺪﺷ ﺮـــﻓﺎﺑ ﻦـــﯿﺋﺎﮐوﺪﯿﻟ و رد نارﺎـﻤﯿﺑ ﻂـﺳﻮﺗ هﺪـﺷ شراﺰــﮔ درد تﺪﺷ .ﺪﺷ یﺮﯿﮔهزاﺪﻧا Anxiety Self-evaluation Questionnaire .ﺖﻓﺮﮔ راﺮﻗ ﻪﺴﯾﺎﻘﻣ درﻮﻣ هوﺮﮔ ود رد و ﺪﺷ ﺖﺒﺛ ﻞﻤﻋ زا ﺪﻌﺑ ﻪﻘﯿﻗد 30 و نﻮﯿﺳﺎﺗﻼﯾد مﺎﮕﻨﻫ توﺎـﻔﺗ ﻦﯿﻟﺎـﺳ و ﻦﯿﯾﺎـﮐوﺪﯿﻟ ﺎـﺑ ﯽــﻌﺿﻮﻣ ﯽﺴﺣﯽﺑ رد (ﻞﻤﻋ زا ﺲﭘ ﻪﻘﯿﻗد 30 و نﻮﯿﺳﺎﺗﻼﯾد ﯽﻃ) درد تﺪﺷ ﺎـﺑ ﺖﯿﻣﻮﻤـﺴﻣ زا ﯽـﻤﯾﻼﻋ ﻦﯿﯾﺎـﮐوﺪﯿﻟ هﺪـﻨﻨﮐ ﺖﻓﺎــﯾرد نارﺎﻤﯿﺑ هوﺮﮔ رد .(P>0/05) ﺖﺷاﺪﻧ ﯽﻬﺟﻮﺗ ﻞﺑﺎﻗ یرﺎﻣآ ﯽـﻃ ﻦﯿﯾﺎـﮐوﺪﯿﻟ ﺎـﺑ ﺖﯿﻣﻮﻤـﺴﻣ و ﯽﺒﻧﺎـﺟ ضراﻮــﻋ نﺪﻧﺎﺳر ﻞﻗاﺪﺣ ﻪﺑ ﺖﻬﺟ ﻪﮐ ﻦﯾا ﻪﺠﯿﺘﻧ .ﺪﺸﻧ ﺖﻓﺎﯾ ﻦﯿﯾﺎﮐوﺪﯿﻟ راﺮـﻗ ﻪـﺟﻮﺗ درﻮﻣ (alternative) ﻦﯾﺰﮕﯾﺎــﺟ ﯽﻘﯾرﺰﺗ هﺪﻨﻨﮐ ﺲﺣﯽﺑ هدﺎﻣ ﮏﯾ ناﻮﻨﻋ ﻪﺑ ار ﻦﯿﻟﺎﺳ ناﻮﺗﯽﻣ ژﺎﺗرﻮﮐ کﻮـﻠﺑ ﺎـﺗ ﺪـﺷﺎﺑ ﺲﮑﯾوﺮـﺳ ﻪــﻧﺎﻫد رد مﻮﻧﻮﺗا بﺎﺼﻋا عﺎﺴﺗا ﺮﺘﺸﯿﺑ ﻦﯿﻟﺎﺳ ﺮﺛا ﻢﺴﯿﻧﺎﮑﻣ ﻪﮐ ﺪﺳرﯽﻣ ﺮﻈﻧ ﻪﺑ .داد .ﺖﺴﯿﻧ زﺎﯿﻧ درﻮﻣ ﻦﯿﻟﺎﺳ ﺮﺛا عوﺮﺷ یاﺮﺑ رﺎﻈﺘﻧا نﺎﻣز اﺬﻟ و ﯽﺒﺼﻋ یﺎﻫﻪﻧﺎﯾﺎﭘ
ﻦﯿﻟﺎﺳ – 3 ﻦﯿﺋﺎﮐوﺪﯿﻟ – 2 ﺲﮑﯾوﺮﺳ ﯽﺴﺣﯽﺑ – 1 :ﺎﻫ هژاو ﺪﯿﻠﮐ ژﺎﺗرﻮﮐ - 5 درد تﺪﺷ – 4
،ناﺮـﯾا ﯽﻧﺎـﻣرد ـ ﯽﺘــﺷاﺪﻬﺑ تﺎﻣﺪﺧوﯽﮑﺷﺰﭘ مﻮﻠﻋهﺎﮕﺸﻧاد ،ﺶﯾﺎﯿﻧ نﺎﺑﺎﯿﺧ ،نﺎﺧرﺎﺘﺳ نﺎﺑﺎﯿﺧ ،(ص)مﺮﮐا لﻮﺳر تﺮﻀﺣ نﺎﺘﺳرﺎﻤﯿﺑ ،ﯽﯾﺎﻣﺎﻣ و نﺎﻧز یﺎﻫیرﺎﻤﯿﺑ رﺎﯿﺸﻧاد (I (لوﺆﺴﻣ ﻒﻟﻮﻣ*) .ناﺮﻬﺗ ناﺮﯾا ﯽﻧﺎﻣرﺪـﯽﺘﺷاﺪﻬﺑتﺎﻣﺪﺧوﯽﮑﺷﺰﭘمﻮﻠﻋهﺎﮕﺸﻧاد ،ﺶﯾﺎﯿﻧ نﺎﺑﺎﯿﺧ،نﺎﺧرﺎﺘﺳ نﺎﺑﺎﯿﺧ،(ص)مﺮﮐالﻮﺳر تﺮﻀﺣ نﺎﺘﺳرﺎﻤﯿﺑ،ﯽﯾﺎﻣﺎﻣونﺎﻧز یﺎﻫیرﺎﻤﯿﺑهوﺮﮔﺮﯾﺪﻣورﺎﯿﺸﻧاد (II ناﺮﯾا ﯽﻧﺎﻣرد ـ ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،یرﺮﻬﺷ ،یدﺎﺑآزوﺮﯿﻓ نﺎﺘﺳرﺎﻤﯿﺑ ،ﯽﯾﺎﻣﺎﻣ و نﺎﻧز یﺎﻫیرﺎﻤﯿﺑ رﺎﯾدﺎﺘﺳا (III ناﺮﯾا ﯽﻧﺎﻣرد ـ ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﯽﯾﺎﻣﺎﻣ و نﺎﻧز یﺎﻫیرﺎﻤﯿﺑ رﺎﯿﺘﺳد (IV
نارﺎﮑﻤﻫ و هدازیﺪﻬﻣ ﻞﻀﻔﻟاﻮﺑا ﺮﺘﮐد ﺲﮑﯾوﺮﺳ ﯽﺴﺣﯽﺑ رد ﻦﯿﻟﺎﺳ و ﻦﯿﺋﺎﮐوﺪﯿﻟ ﺮﺛا ﻪﺴﯾﺎﻘﻣ
ناﺮﯾا ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻪﻠﺠﻣ 1379ﺰﯿﯾﺎﭘ / 21 هرﺎﻤﺷ / ﻢﺘﻔﻫ لﺎﺳ221 ﻦﯿﯾﺎــﮐوﺪﯿﻟ ﯽﻟﺎـــﻤﺘﺣا ﯽﺒﻧﺎـﺟ ضراﻮـﻋ و ﯽـﻣﻮﻤﻋ ﯽـﺷﻮﻬﯿﺑ
.ﺪﻧﺎﻣ ﺪﻨﻫاﻮﺧ نﻮﺼﻣ ﯽﻌﺿﻮﻣ
ﯽﺳرﺮﺑ شور رﻮﮐﻮـﺳ ود ﯽﻨﯿﻟﺎـﺑ ﯽﯾﺎــﻣزآرﺎﮐ شور ﻪﺑ ﺮﺿﺎﺣ ﺶﻫوﮋﭘ ترﻮﺻ رﺎﻤﯿﺑ 85 یور ﺮﺑ (Double blind Clinical trial) ﯽﮕﻠﻣﺎـﺣ ﻢــﺘﺧ ﺎﯾ و ﯽﺼﯿﺨﺸﺗ ژﺎﺗرﻮﮐ ﺪﯾﺪﻧﺎﮐ نارﺎﻤﯿﺑ .ﺖﻓﺮﮔ شﻮـﻣاﺮﻓ ﯽﮕﻠﻣﺎـﺣ ،ﺮــﯾﺬﭘﺎﻧبﺎﻨﺘﺟا ﻂﻘﺳ ،ﺺﻗﺎﻧ ﻂﻘﺳ ﺖﻠﻋﻪﺑ نارﺎــﻤﯿﺑ .ﺪﻧﺪﺷ ﻪﻌﻟﺎﻄﻣ دراو نﺎﯾور نوﺪﺑ یرادرﺎﺑ ﺎﯾ و هﺪﺷ ﺎــــﺑ ﻖــﯾرﺰﺗ)ﯽــﺑﺮﺠﺗ هوﺮــﮔ ود رد ﯽﻓدﺎــﺼﺗ ترﻮﺻﻪــﺑ ﺮﻓﺎــــﺑ ﻦﯿﯾﺎــﮐوﺪﯿﻟ ﺎــﺑ ﻖــﯾرﺰﺗ) ﺪﻫﺎــﺷ و (n=41)(ﻦﯿﻟﺎــﺳ 14 زا ﺶـﯿﺑ ﯽﮕﻠﻣﺎـﺣ ﻦـﺳ دراﻮــﻣ .ﺪﻨﺘﻓﺮﮔ راﺮﻗ (n=44)(هﺪﺷ ﻪـﻌﻟﺎﻄﻣ زا ﯽﻨﯿﻟﺎـﺑ ﻪـﻨﯾﺎﻌﻣ ﺎـﯾ و ﯽـﻓاﺮﮔﻮﻧﻮــﺳ سﺎﺳاﺮﺑ ﻪﺘﻔﻫ ﻦـﺳ ،رﺎـﻤﯿﺑ ﻦـﺳ ﻪـﺑ طﻮـﺑﺮﻣ تﺎــﻋﻼﻃا اﺪﺘﺑا .ﺪﻧﺪﯾدﺮﮔ فﺬﺣ درﻮـﻣ ﯽـﻠﺒﻗ یﺎﻫﻂﻘـﺳ و ﯽـﺒﻠﻗ یﺎــﻫیرادرﺎﺑ داﺪﻌﺗ ،ﯽﮕﻠﻣﺎﺣ ﻪـﺑ ﻪــﮐ صﻮﺼﺨﻣ یﺎﻫﻪﻣﺎﻧﺶﺳﺮﭘ رد و ﻪﺘﻓﺮﮔ راﺮﻗ ﯽﺳرﺮﺑ ﻦـــــﯿﻨﭽﻤﻫ .ﺪـــــﯾدﺮﮔ جرد دﻮــﺑ هﺪﺷ ﻪــﯿﻬﺗ رﻮﻈﻨﻣ ﻦـــﯾا (Bias) یﺮﯿـﮔهزاﺪـﻧا یﺎـﻄﺧ نﺪﻧﺎـﺳر ﻞــــﻗاﺪﺣ ﻪﺑ ﺖــــﻬﺟ سﺎــﺳاﺮﺑ نارﺎــﻤﯿﺑ ﻪــــــﯿﻠﮐ باﺮـــﻄﺿا ﺢـــﻄﺳ ﯽﻟﺎـﻤﺘﺣا Anxiety Self-evaluation Questionnaire ﻪـﻣﺎﻧﺶﺳﺮﭘ ﻖــﯾرﺰﺗ ﻪـﮑﻨﯾا ﻪـﺑ ﻪـﺟﻮﺗ ﺎـﺑ .(3)ﺖـﻓﺮﮔ راﺮـﻗ ﯽـﺳرﺮﺑ درﻮـﻣ ﻊﻗﻮﻣ رد شزﻮﺳ سﺎﺴﺣا ﺐﺒﺳ ًﻻﻮﻤﻌﻣ هﺪﺸﻧ ﺮﻓﺎﺑ ﻦﯿﯾﺎﮐوﺪﯿﻟ رد هﺪﺷ ﺮﻓﺎﺑ ﻦﯿﯾﺎﮐوﺪﯿﻟ زا ﻪﻌﻟﺎﻄﻣ ﻦﯾا رد اﺬﻟ ددﺮﮔﯽﻣ ﻖﯾرﺰﺗ ﺮﻓﺎـﺑ ﻦﯿﯾﺎـﮐوﺪﯿﻟ ﻪـﯿﻬﺗ ﺖﻬـﺟ .(5و4)ﺪــﺷ هدﺎﻔﺘﺳا ﺪﻫﺎﺷ هوﺮﮔ ﮏـﯾ ﻪـﺑ %7/4 ﻢﯾﺪــﺳ تﺎﻨﺑﺮﮐﯽﺑ لﻮﻠﺤﻣ زا ﯽﺳﯽﺳ ﺞﻨﭘ هﺪﺷ ﺎـﺑ ﻖـﯾرﺰﺗ .ﺪـﺷ ﻪـﻓﺎﺿا %1 ﻦﯿﯾﺎـﮐوﺪﯿﻟ ﯽــﺳﯽﺳ هﺎﺠﻨﭘ لﺎﯾو زا 4cc اﺪـﺘﺑا .ﺪـﯾدﺮﮔ مﺎـﺠﻧا 18 هرﺎﻤــﺷ ﺖﮐﻮﯾﮋﻧآ زا هدﺎﻔﺘﺳا رد ﻪﺘـﺴﺑ ﺲﮑﯾوﺮـﺳ ﯽـﻔﻠﺧ ﺎـﯾ ﯽـﻣاﺪﻗ “lip” رد لﻮــﻠﺤﻣ ﻦﯾا .ﺪــﺷ ﻖﯾرﺰﺗ لﺎﻨﯾژاوﻮﮑﯾوﺮﺳ طﺎﺨﻣ ﻞﺤﻣ رد و ﻢﺣر یﺎﺘﺳار رد لﻮـﻠﺤﻣ زا 8cc و ﺪـﯾدﺮﮔ ﺖﺑﺎــﺛ ﺲﮑﯾوﺮﺳ یور مﻮﻟﻮﮐﺎﻨﺗ
ﺖـﺸﻫ ﺖﻋﺎـﺳ ﺖــﯿﻌﻗﻮﻣ رد ﺰﯿﻧ 8cc و رﺎﻬﭼ ﺖﻋﺎﺳ ﺖﯿﻌﻗﻮﻣ
تﺎـﻘﯾرﺰﺗ .ﺪـﯾدﺮﮔ ﻖـﯾرﺰﺗ لﺎـﻨﯾژاوﻮﮑﯾوﺮـﺳ طﺎــﺨﻣ ﻞﺤﻣ رد
مرﻮــﺗ ﻪﮐیرﻮﻃﻪﺑ (1cm زا ﺮﺘﻤﮐ ﻖﯾرﺰﺗ ﻖﻤﻋ) ﺪﻧدﻮﺑ ﯽﺤﻄﺳ
درد تﺪـﺷ .دﻮـﺑ ﺖــﯾور ﻞﺑﺎﻗ ﺮﮔﺶﻫوﮋﭘ ﻂﺳﻮﺗ ﻖﯾرﺰﺗ ﻞﺤﻣ ﻪـﻘﯿﻗد 30 و نﻮﯿـﺳﺎﺗﻼﯾد مﺎــﮕﻨﻫ ﯽﻧﺎﻣز ﻊﻄﻘﻣ ود رد نارﺎﻤﯿﺑ و ﻂﺳﻮﺘﻣ درد ،ﻢﮐدرد ،یدردﯽﺑ ﺢﻄﺳ رﺎﻬﭼ رد ﻞﻤﻋ زا ﺲﭘ
ناﺰﯿــﻣ ﯽــﺳرﺮﺑ ﺎــﺑ درد ناﺰﯿــﻣ .ﺪـــﺷ لاﻮـﺳ ﺪﯾﺪـﺷ درد و ﯽـﻨﮕﻟ تﻼـﻀﻋ ﻢـﺳﺎﭙﺳا ،ﻖـﯾﺮﻌﺗ ،ﺾــﺒﻧ داﺪﻌﺗ ،نﻮﺧرﺎﺸﻓ ﻦﯿﻨﭼﻢﻫ و ﺖﻓﺮﮔ راﺮﻗ ﯽﺳرﺮﺑ درﻮﻣ رﺎﻤﯿﺑ ﻂﺳﻮﺘﻣ درد نﺎﯿﺑ Self Evaluation Questionnaire (stat anxity) مﺮﻓ زا ﻪـﻠﺻﺎﻓﻼﺑ نارﺎـﻤﯿﺑ ﺪــــﯾﺪﺷ درد ترﻮـﺻ رد .ﺪــﺷ هدﺎﻔﺘﺳا توﺎﻀﻗ ﺖــﻬﺟ .ﺪﻨﺘﻓﺮﮔﯽﻣ راﺮﻗ ﯽــــﻣﻮﻤﻋ ﯽـــﺷﻮﻬﯿﺑ ﺖﺤﺗ و Chi-Square و t-test یﺎــــﻫنﻮﻣزآ زا ﺎــﻫهداد یرﺎــﻣآ .ﺪﺷ هدﺎﻔﺘﺳا Fisher exact test
ﺞﯾﺎﺘﻧ رد ﺖﮐﺮـﺷ ﻖـﻓاﻮﻣ ﺮـﻔﻧ 85 نﺎـﮔﺪﻨﻨﮐﻪــﻌﺟاﺮﻣ ﻞﮐ نﺎﯿﻣ زا
ود رد (Random) ﯽﻓدﺎــﺼﺗ ترﻮﺻﻪـﺑ ﻪـﮐ ﺪـﻧدﻮﺑ ﻪـﻌﻟﺎﻄﻣ
ﺎــﺑ ﯽﺴﺣﯽﺑ و (n=44) هﺪﺷ ﺮﻓﺎﺑ ﻦﯿﯾﺎﮐوﺪﯿﻟ ﺎﺑ ﯽﺴﺣﯽﺑ هوﺮﮔ
تﺎـﯿﺻﻮﺼﺧ .ﺪـﻨﺘﻓﺮﮔ ﯽـﺳرﺮﺑ درﻮـﻣ (n=41) هدﺎــﺳ ﻦﯿﻟﺎﺳ
ﻪــﯾارا ﮏﯾ هرﺎﻤﺷ لوﺪﺟ رد هوﺮﮔ ود ﺮﻫ نارﺎﻤﯿﺑ ﮏﯿﻓاﺮﮔﻮﻣد داﺪـﻌﺗ رد یرادﯽـﻨﻌﻣ فﻼـﺘﺧا یرﺎــﻣآ ﺮﻈﻧ زا .ﺖﺳا هﺪﯾدﺮﮔ باﺮــﻄﺿا ﺢﻄﺳ ﻦﯿﻨﭼﻢﻫ و ﯽﻠﺒﻗ یﺎﻫﻂﻘﺳ ،ﯽﻠﺒﻗ یﺎﻫﯽﮕﻠﻣﺎﺣ .(P>0/05) ﺖﺷاﺪﻧ دﻮﺟو هوﺮﮔ ود نﺎﯿﻣ رد ﻞﻤﻋ زا ﻞﺒﻗ
نارﺎﻤﯿﺑ ﮏﯿﻓاﺮﮔﻮﻣد تﺎﻋﻼﻃا -1 هرﺎﻤﺷ لوﺪﺟ
ﻦﯿﻟﺎﺳ هوﺮﮔ (ﺮﻔﻧ 41 =داﺪﻌﺗ) ﻦـﯿﯾﺎﮐوﺪﯿﻟهوﺮﮔ
(ﺮﻔﻧ 44 =داﺪﻌﺗ) Pvalue
27/90± 2/94 ﻦﺳ 33/18 ±3/04
0/02
>1ﯽﻠﺒﻗیﺎﻬﻧﺎﻤﯾاز %75/6
%84/09
نﺎﻤﯾاز نوﺪﺑ %24/3
%15/9 0/30
>1ﯽﻠﺒﻗ یﺎﻬﻄﻘﺳ %21/9
%31/8 0/67
ﻂﻘﺳ نوﺪﺑ %78/04
%68/1
ﻂﺳﻮﺘﻣ ﻦﺳ (زور ﻪﺑ)ﯽﮕﻠﻣﺎﺣ 58/7±8/19
43/27 ±10/90 0/03
ﻦﯿﯾﺎـﮐوﺪﯿﻟ هوﺮـﮔ زا ﺮـﻔﻧ ﮏـﯾ و ﻦﯿﻟﺎــﺳ هوﺮﮔ زا ﺮﻔﻧ ﺖﻔﻫ .ﺪـﻧدﻮﻤﻧ اﺪـﯿﭘ ﯽـﻣﻮﻤﻋ ﯽـﺷﻮﻬﯿﺑ ﻪـﺑ زﺎـﯿﻧ ﺪﯾﺪــﺷ درد ﺖﻠﻋﻪﺑ هوﺮـﮔ زا رﺎـﻤﯿﺑ 5 و ﻦﯿﯾﺎـﮐوﺪﯿﻟ هوﺮـﮔ زا رﺎــﻤﯿﺑ 16 ﻦﯿﻨﭽﻤﻫ رادﯽﻨﻌﻣ فﻼﺘﺧا لﺎﺣ ﻦﯾا ﺎﺑ .ﺪﻧدﺮﮐ اﺪﯿﭘ زﺎﯿﻧ یژﻮﺑ ﻪﺑ ﻦﯿﻟﺎﺳ زا هﺪﻨﻨﮐ هدﺎﻔﺘﺳا هوﺮﮔ رد درد تﺪﺷ ﻪــــــﺴﯾﺎﻘﻣ رد یرﺎﻣآ
.(P>0/05) ﺖﺷاﺪﻧ دﻮﺟو یژﻮﺑ مﺎـــﮕﻨﻫ نارﺎـــﻤﯿﺑ ﻂــــﺳﻮﺗ هﺪــﺷ شراﺰــﮔ درد تﺪﺷ توﺎـﻔﺗ یرﺎـﻣآ ﺮـﻈﻧ زا ﻞــﻤﻋ زا ﺪﻌﺑ ﻪﻘﯿﻗد 30 و نﻮﯿﺳﺎﺗﻼﯾد هوﺮـﮔ رد ﺰﯿـﻧ .(P=0/09) ﺖــﺷاﺪﻧ هوﺮﮔ ود نﺎﯿﻣ یرادﯽﻨﻌﻣ ﯽﺷﺎﻧ ﺖﯿﻣﻮﻤﺴﻣ زا ﯽﻤﺋﻼﻋ ﻦﯿﯾﺎﮐوﺪﯿﻟ هﺪﻨﻨﮐ ﺖﻓﺎﯾرد نارﺎﻤﯿﺑ .ﺪﺸﻧ ﺖﻓﺎﯾ وراد ﻦﯾا فﺮﺼﻣ زا هوﺮﮔ زا %61 ﺎــــﺑ ﻪﺴﯾﺎﻘﻣ رد ﻦﯿﻟﺎﺳلﺎﻣﺮﻧ هوﺮﮔ زا %44
مﺎﮕﻨﻫ نارﺎﻤﯿﺑ ﻂﺳﻮﺗ هﺪﺷ شراﺰﮔ درد تﺪﺷ -1 هرﺎﻤﺷ رادﻮﻤﻧ
(ﻦﯿﯾﺎﮐوﺪﯿﻟ هوﺮﮔ) نﻮﯿﺳﺎﺗﻼﯾد
ﻪــﻘﯿﻗد 30 نارﺎﻤﯿﺑ ﻂﺳﻮﺗ هﺪﺷ شراﺰﮔ درد تﺪﺷ -3 هرﺎﻤﺷ رادﻮﻤﻧ
(ﻦﯿﯾﺎﮐوﺪﯿﻟ هوﺮﮔ)ﻞﻤﻋ زا ﺲﭘ
زا %17 و ﺪــﻧدﻮﺑ درد نوﺪﺑ Procedure مﺎﮕﻨﻫ رد ﻦﯿﯾﺎﮐوﺪﯿﻟ %2 ﻪـﺴﯾﺎﻘﻣ رد .ﺪﻨﺘــﺷاد ﺪﯾﺪﺷ ًﺎﺘﺒﺴﻧ درد ﻦﯿﻟﺎﺳلﺎﻣﺮﻧ هوﺮﮔ ﻪــﺑ ﻪﺟﻮﺗ ﺎﺑ ﻪﮐ ﺪﻨﺘﺷاد یﺪﯾﺪﺷ ًﺎﺘﺒﺴﻧ درد ﻦﯿﯾﺎﮐوﺪﯿﻟ هوﺮﮔ زا رد درد ناﺰﯿﻣ .ﺪﺷﺎﺑﯽﻤﻧ یرادﯽﻨﻌﻣ فﻼﺘﺧا یرﺎﻣآ یﺎﻫهداد رد نآ زا ﺲــﭘ ﻪﻘﯿﻗد 30 و Procedure ﻦﯿﺣ رد هوﺮﮔ ود ﺮﻫ .ﺪﺷﺎﺑﯽﻣ ﺺﺨﺸﻣ 1-4 یﺎﻫرادﻮﻤﻧ
مﺎﮕﻨﻫ نارﺎﻤﯿﺑ ﻂﺳﻮﺗ هﺪﺷ شراﺰﮔ درد تﺪﺷ -2 هرﺎﻤﺷ رادﻮﻤﻧ
(ﻦﯿﻟﺎﺳ هوﺮﮔ) نﻮﯿﺳﺎﺗﻼﯾد
ﻪﻘﯿﻗد 30 نارﺎﻤﯿﺑ ﻂﺳﻮﺗ هﺪﺷ شراﺰﮔ درد تﺪﺷ -4 هرﺎﻤﺷ رادﻮﻤﻧ
(ﻦﯿﻟﺎﺳ هوﺮﮔ)ﻞﻤﻋ زا ﺲﭘ
نارﺎﮑﻤﻫ و هدازیﺪﻬﻣ ﻞﻀﻔﻟاﻮﺑا ﺮﺘﮐد ﺲﮑﯾوﺮﺳ ﯽﺴﺣﯽﺑ رد ﻦﯿﻟﺎﺳ و ﻦﯿﺋﺎﮐوﺪﯿﻟ ﺮﺛا ﻪﺴﯾﺎﻘﻣ
ناﺮﯾا ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻪﻠﺠﻣ 1379ﺰﯿﯾﺎﭘ / 21 هرﺎﻤﺷ / ﻢﺘﻔﻫ لﺎﺳ223 ﺚﺤﺑ ﻪﺑ ﻞﯾﺎﻤﺗﺰﯿﻧ ﯽﮑﺷﺰﭘ یﺎﻫﻪﺘﺷرﺮﯾﺎﺳ ،نﺎﻧز ﻪﺘﺷر ﺮﺑ هوﻼﻋ .ﺪـﻧراد (ﯽـﻌﺿﻮﻣ) ﯽـﺴﺣﯽﺑ رد ﻦﯿﯾﺎــﮐوﺪﯿﻟ زا ﺮﺘﻤﮐ هدﺎﻔﺘﺳا ﮏـﯿﻨﮑﺗ زا ﺖـﺳﻮﭘ یﺎـﻫﯽﺣاﺮﺟ ﺮﺜـﮐا رد هزوﺮــﻣا لﺎﺜﻣ یاﺮﺑ .(7و6)دﻮﺷﯽﻣ هدﺎﻔﺘﺳا “Ice-Saline” رد درد تﺪـﺷ ﻪـﮐ ﺖــﺳا ﻪﺘﮑﻧ ﻦﯾا ﺪﯾﻮﻣ ﺶﻫوﮋﭘ ﻦﯾا ﺞﯾﺎﺘﻧ زا هدﺎﻔﺘـــﺳا ﺎـﺑ (Para Cervical) لﺎﮑﯾوﺮـﺳارﺎﭘ ﯽـﺴﺣﯽﺑ یاراد هدﺎـــﺳ ﻦﯿﻟﺎـﺳ ﺎـﺑ ﻪـﺴﯾﺎﻘﻣ رد هﺪـﺷ ﺮﻓﺎـﺑ ﻦﯿﯾﺎـﮐوﺪﯿﻟ یﺮﯿـﮔﻪــﺠﯿﺘﻧ ﻪﺑﺎﺸﻣ ﻪﺠﯿﺘﻧ ﻦﯾا .ﺪﺷﺎﺑﯽﻤﻧ یرادﯽﻨﻌﻣ فﻼﺘﺧا ﺎﻬـﻧآ ﻪــﻌﻟﺎﻄﻣ رد ﻪﮐ ﺖﺳا 1996 لﺎﺳ رد نارﺎﮑﻤﻫ و Miller 25 و ( ﻦﯿﯾﺎـــﮐوﺪﯿﻟ هوﺮـﮔ ) یﺮـﻔﻧ 27 هوﺮـﮔ ود رد نارﺎـﻤﯿﺑ راﺮـﻗ لﺎﮑﯾوﺮـﺳارﺎﭘ ﯽـﺴﺣﯽﺑ ﺖـﺤﺗ ( ﻦﯿﻟﺎـﺳ هوﺮــﮔ ) یﺮﻔﻧ .(8)ﺪﻨﺘﻓﺮﮔ عﺎﺴﺗا ﻪﺑ ﻪﯿﺒﺷ ﯽﺣﺎﺸﺗرا ﯽﺴﺣﯽﺑ ﮏﯾ لﺎﮑﯾوﺮﺳ ﯽﺴﺣﯽﺑ
ﺖﻓﺎـﺑ Disruption ﺐـﺟﻮﻣ ﻪــﮐ ﺪﺷﺎﺑﯽﻣ ﺖﺳﻮﭘ رد مرد ﻪﯾﻻ
ﯽﻧﺎـﻣز تﺪـﻣ .ﯽـﻄﯿﺤﻣ بﺎـﺼﻋا کﻮــﻠﺑ ﻪﻧ دﻮﺷﯽﻣ لﺎﮑﯾوﺮﺳ ﻦـﯾا رد .ﺖـﺳا زﺎـﯿﻧ ﻦﯿﯾﺎـﮐوﺪﯿﻟ ﺮـﺛا ﺖﻬــﺟ ﻪﻘﯿﻗد 1-5 دوﺪﺣ ﻦﯾاﺮﺑﺎﻨﺑ و ﺪﺷ عوﺮﺷ هوﺮﮔ ود ﺮﻫ رد ﻞﻤﻋ ﻪﻠﺻﺎﻓﻼﺑ ﻪﻌﻟﺎﻄﻣ .ﺪـﺷﺎﺑﯽﻣ حﺮـﻄﻣ ﯽـﺴﺣﯽﺑ ﺮﺛا ﻢﺴﯿﻧﺎﮑﻣ رد Infiltrative ﺮﺛا ﺖﯿﻣﻮﻤﺴﻣ ﺮﺑ لاد ﯽﻤﯾﻼﻋ نارﺎﻤﯿﺑ زا ﮏﯾ ﭻﯿﻫ ﻪﻌﻟﺎﻄﻣ ﻦﯾا رد Miller ﻪـﻌﻟﺎﻄﻣ رد ﻪــﮐﯽﻟﺎﺣ رد .ﺪﻧداﺪﻧ زوﺮﺑ ار ﻦﯿﯾﺎﮐوﺪﯿﻟ ﺎﺑ ﻒــﯿﻔﺧ ﺖﯿﻣﻮﻤﺴﻣ ﻢﯾﻼﻋ یاراد نارﺎﻤﯿﺑ زا %11 ﺶﻧارﺎﮑﻤﻫ و ﻖــﯾرﺰﺗ ﻪــﻌﻟﺎﻄﻣ نآ رد ﺪـــﻨﭼ ﺮـﻫ .(8)ﺪـﻧدﻮﺑ ﻦﯿﯾﺎـﮐوﺪﯿﻟ ﺎـﺑ ﻦـﮑﯿﻟ ،دﻮـﺑ ﻪـﺘﻓﺮﮔ مﺎــﺠﻧا (1cm زا ﺮﺘﻤﮐ) ﯽﺤﻄﺳ ترﻮﺻﻪﺑ .ﺪﺷﺎﺑ هﺪﺷ نﻮﺧ بﺬﺟ وراد زا یراﺪﻘﻣ ﻪﮐ ﺪﺳرﯽﻣ ﺮﻈﻧﻪﺑ ﻪـﺠﯿﺘﻧ ناﻮـﺗﯽﻣ ﺶــﻫوﮋﭘ ﻦﯾا رد ﻞﺻﺎﺣ ﺞﯾﺎﺘﻧ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﻪـﺑ ﻦﯿﯾﺎـﮐوﺪﯿﻟ یﺎـﺟ ﻪـﺑ هدﺎـﺳ ﻦﯿﻟﺎــﺳ زا ناﻮﺗﯽﻣ ﻪﮐ ﺖﻓﺮﮔ .دﻮﻤﻧ هدﺎﻔﺘﺳا ژﺎﺗرﻮﮐ رد ﯽﻌﺿﻮﻣ هﺪﻨﻨﮐ ﺲﺣﯽﺑ هدﺎﻣ ناﻮﻨﻋ ﺎــﺑ ﯽﻟﺎـــﻤﺘﺣا ﺖﯿﻣﻮﻤـﺴﻣ زا یﺮﯿﮕـﺸﯿﭘ رد ﯽﻤﻬـﻣ مﺪـﻗ ﻦـﯾا .ﺪﺷﺎﺑﯽﻣ نآ ﯽﺒﻧﺎﺟ ضراﻮﻋ ﺮﯾﺎﺳ ﺎﯾ و ﻦﯿﺋﺎﮐوﺪﯿﻟ ﻊﺑﺎﻨﻣ
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Vol 7 . No 21 . Autumn 2000 JIUMS٢٤٠ I II III IV
*A. Mehdizadeh, MD A. Akbarian, MD A. Ghasemi, MD F. Ardjomand, MD
ABSTRACT
Legal surgical pregnancy terminations are commonly performed in Iran. Lidocaine is used widely for cervical anesthesia during suction curettage . Lidocaine carries the potential risk of side effects and toxicity if over – dosed. The aim of this study was to compare lidocaine and saline for cervical anesthesia to blunt the reported pain during curettage.
For this purpose a double – blind randomized clinical trial was conducted on 85 women presenting for legal pregnancy termination procedure.Participants received either paracervical submucosal injections of 1% lidocaine (n=44) or saline (n=41) just before cervical dilation. Anxiety level or all subjects about the procedure was assessed by using of Anxiety Self – evaluation Questionnaire. Self – roported pain intensity was assessed after dilation and 30 minutes after procedure.
Eighty–five eligible women presenting for legal pregnancy termination procedure participated in the study. No statistically significant differences were found between lidocaine and saline subjects on prior pregnancies, abortions, and level of anxiety about the procedures.
Pain intensity ratings in lidocaine and saline treatment subjects did not differ significantly at any point.
Furthermore, of those women receiving lidocaine, toxicity symptoms were not reported.
To minimize lidocaine side effects and toxicity for a curettage procedure, saline could be considered for the paracervical injection solution. The local anesthesia mechanism of saline may be distention rather than blockage of specific autonomic nerves when there is no waiting period.
Key Words: 1) Cervical Anesthesia 2) Lidocaine 3) Saline
4) Pain Severity 5) Curettage
I) Associate professor of obstetrics and Gynecology,Hazrat Rasule-Akram Hospital, Niayesh st., Sattarkhan Aveneu, Iran University of Medical Sciences and Health Services, Tehran, Iran. (*Corresponding author)
II) Associate professor and Head of department of obstetrics and Gynecology, Hazrat Rasule-Akram Hospital, Niayesh st., Sattarkhan Aveneu, Iran University of Medical Sciences and Health Services, Tehran, Iran.
III) Assistant professor of obstetrics and Gynecology, Firooz-Abadi Hospital, Shahr–e–Ray, Iran University of Medical Sciences and Health Services, Tehran, Iran.
IV) Resident of obstetrics and Gynecology, Hazrat Rasule-Akram Hospital, Niayesh st., Sattarkhan Aveneu, Iran University of Medical Sciences and Health Services, Tehran, Iran.
