ﺶﻴﭘ رد رﺎﻤﻴﺑ ﻦﻴﻟﺎﺑ ﺮﺑ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا ﺶﻘﻧ ﻲﺳرﺮﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ ﻪﻫﺎﻤﻜﻳ مﺎﺠﻧاﺮﺳ ﻲﻨﻴﺑ
ﻦﻴﻳﺎﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻪﺑ
ﻲﺳرﺎﻓ دوواد ﺮﺘﻛد I
ﺮﺘﻛد* ﻣ يﺪﻴﻔﻣ ﻲﻧﺎ II
ﺮﻬﻤﻧﺎﻴﻛ ﺪﻴﻫﺎﻧ ﺮﺘﻛد III
ﻲﺳﺎﺒﻋ ﺪﻴﻌﺳ ﺮﺘﻛد I
عراز ﻦﻴﻣا ﺪﻤﺤﻣ ﺮﺘﻛد I
ﺮﻛﺎﺷ ﻦﻴﺴﺣ ﺮﺘﻛد III
ﻲﺋﺎﺿر يﺪﻬﻣ IV
يﺮﻳﺎﺸﻋ اﺪﻧ IV
ﻪﻣﺪﻘﻣ
دوﺪﺣ 5 % ﻞﻴﻟد ﻪﺑ ﺎﻜﻳﺮﻣا رد ﺲﻧاژروا ﺶﺨﺑ ﻪﺑ تﺎﻌﺟاﺮﻣ زا
ﻲﻣ ﻪﻨﻴﺳ ﻪﺴﻔﻗ درد
لدﺎﻌﻣ ﻪﻛ ﺪﺷﺎﺑ 5
لﺎـﺳ رد ﺖﻳﺰﻳو نﻮﻴﻠﻴﻣ
ﻲﻣ و دﻮﺷ 6 دراد ﻲﭘ رد ﻪﻨﻳﺰﻫ رﻻد درﺎﻴﻠﻴﻣ .
دوﺪﺣ 500 راﺰـﻫ
ﺮﻴﻣ و گﺮﻣ رﺎﭼد ،ﺖﻴﻌﻤﺟ ﻦﻳا زا ﺮﻔﻧ
ﻲﻣ نآ زا ﻲﺷﺎﻧ
ﺪﻧﻮﺷ
).
4 - 1 (
30 %
ﺶــﺨﺑ ﻪــﺑ هﺪــﻨﻨﻛ ﻪــﻌﺟاﺮﻣ ﻲــﻗوﺮﻋ ـ ﻲــﺒﻠﻗ نارﺎــﻤﻴﺑ
ار ﺲــﻧاژروا ﻞﻜﺸــﺗ راﺪــﻳﺎﭘﺎﻧ ﻲــﺒﻠﻗ ﻦﻳﮋــﻧآ ﻪــﺑ ﻼﺘــﺒﻣ نارﺎــﻤﻴﺑ
ﻲﻣ ﻲـﺒﻠﻗ ﻪﺘﻜـﺳ ﺎﻳ تﺪﻣ هﺎﺗﻮﻛ گﺮﻣ لﺎﻤﺘﺣا سﺎﺳا ﺮﺑ ﻪﻛ ﺪﻨﻫد ﻢﻴﺴﻘﺗ ﻦﻴﻳﺎﭘ و ﻂﺳﻮﺘﻣ ،ﻻﺎﺑ ﻚﺴﻳر ﺎﺑ هوﺮﮔ ﻪﺳ ﻪﺑ هﺪﻨﺸﻛ ﺮﻴﻏ
ﻲﻣ ﺪﻧدﺮﮔ . ﻴﻣ زا
ﻲـﻣ ﺎـﻬﻨﺗ هوﺮـﮔ ﻪـﺳ ﻦﻳا نﺎ
ﺎـﺑ نارﺎـﻤﻴﺑ ناﻮـﺗ
ﻲﺳرﺮﺑ ندﻮﺑ لﺎﻣﺮﻧ ترﻮﺻ رد ار ﻦﻴﻳﺎﭘ ﻚﺴﻳر
ﻲـﻜﻴﻨﻴﻠﻛ يﺎﻫ
هﺪﻴﻜﭼ
فﺪﻫ و ﻪﻨﻴﻣز :
30 %
ﺸـﺗ راﺪـﻳﺎﭘﺎﻧ ﻲـﺒﻠﻗ ﻦﻳﮋـﻧآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ ار ﺲﻧاژروا ﺶﺨﺑ ﻪﺑ هﺪﻨﻨﻛ ﻪﻌﺟاﺮﻣ ﻲﻗوﺮﻋ ـ ﻲﺒﻠﻗ نارﺎﻤﻴﺑ ﻞﻴﻜ
ﻲﻣ ﺪﻨﻫد .
ﻲﻣ ار ﻦﻴﻳﺎﭘ ﻚﺴﻳر ﺎﺑ نارﺎﻤﻴﺑ
ﻲـﺳرﺮﺑ ندﻮـﺑ لﺎﻣﺮﻧ ترﻮﺻ رد ناﻮﺗ ،ﺲـﻧاژروا ﺶـﺨﺑ زا ،ﻲﻜﻴﻨﻴﻠﻛارﺎـﭘ و ﻲـﻜﻴﻨﻴﻠﻛ يﺎـﻫ
دﻮﻤﻧ يﺮﻴﮕﻴﭘ ﻲﻳﺎﭘﺮﺳ ترﻮﺼﺑ و ﺺﻴﺧﺮﺗ .
ﻞﻜﺗوﺮﭘ نارﺎﻤﻴﺑ ﻦﻳا ﺺﻴﺧﺮﺗ ﺖﻬﺟ ﻲﻣ دﺎﻬﻨﺸﻴﭘ يدﺎﻳز يﺎﻫ
دﻮـﺷ . نﺎـﻜﻣا ﻪـﺑ ﻪـﺟﻮﺗ ﺎـﺑ
ﻫﺎﮕﺘﺳد ناﻮﻨﻋ ﻪﺑ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا مﺎﺠﻧا ﻲ
نازرا
، ﺎـﺗ ﺪـﺷ ﻲﻌـﺳ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد ،ﺲﻧاژروا ﺶﺨﺑ نارﺎﻤﻴﺑ ياﺮﺑ ﻦﻤﻳا و مﺎﺠﻧا ﻞﺑﺎﻗ
ﺶﻴﭘ رد رﺎﻤﻴﺑ ﻦﻴﻟﺎﺑ ﺮﺑ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا ﺶﻘﻧ
ﻲـﺳرﺮﺑ ﻦﻴﻳﺎـﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ ﻪﻫﺎﻤﻜﻳ مﺎﺠﻧاﺮﺳ ﻲﻨﻴﺑ
دﻮﺷ . ﺑ شور ﺮ ﻲﺳر :
ﻲﻫوﺮﮕﻤﻫ شور ﻪﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا Cohort)
( ﺑ رد
مﺮـﻛا لﻮـﺳر تﺮﻀـﺣ نﺎﺘﺳرﺎﻤﻴﺑ ﺲﻧاژروا ﺶﺨ )
ص ( يور ﺮـﺑ
140
ﺖـﻓﺮﮔ ترﻮـﺻ ﻦﻴﻳﺎـﭘ ﻚﺴـﻳر ﺎـﺑ راﺪـﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﺺﻴﺨﺸﺗ ﺎﺑ ﻪﻨﻴﺳ ﻪﺴﻔﻗ درد رﺎﭼد رﺎﻤﻴﺑ .
،ﺺﻴﺧﺮـﺗ زا ﻞـﺒﻗ نارﺎـﻤﻴﺑ
ﺪـﻳدﺮﮔ ﺖـﺒﺛ ﺺﻴﺧﺮﺗ زا ﺲﭘ هﺎﻤﻜﻳ لﻮﻃ رد هدﺎﺘﻓا قﺎﻔﺗا ضراﻮﻋ ،ﻲﻨﻔﻠﺗ يﺮﻴﮕﻴﭘ زا هدﺎﻔﺘﺳا ﺎﺑ و هﺪﺷ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا .
ﻳ ﻪـﺘﻓﺎ يﺎـﻫ
ﺖﻓﺮﮔ راﺮﻗ ﻪﺴﻳﺎﻘﻣ درﻮﻣ نﺎﺸﻳا ﻪﻫﺎﻤﻜﻳ ﺖﺷﻮﻧﺮﺳ ﺎﺑ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا .
مﺮﻧ ﻂﺳﻮﺗ تﺎﻋﻼﻃا ﻪﻴﻠﻛ
راﺰـﻓا راﺮـﻗ ﺰﻴﻟﺎـﻧآ درﻮـﻣ SPSS
ﺖﻓﺮﮔ . نﻮﻣزآ زا يرﺎﻣآ ﺰﻴﻟﺎﻧآ رد و يﺎﻛ روﺬﺠﻣ ،ﺮﺸﻴﻓ يﺎﻫ
t-Test ﺪﻳدﺮﮔ هدﺎﻔﺘﺳا .
ﻪﺘﻓﺎﻳ ﺎـﻫ : 1 / 42 )%
59 ﺮـﻔﻧ ( و نز ،نارﺎـﻤﻴﺑ زا 9
/ 57 )%
81 ﺮـﻔﻧ (
،
ﺪـﻧدﻮﺑ دﺮـﻣ .
حﺮـﻃ ﻪـﺑ هﺪـﺷ دراو داﺮـﻓا ﻲﻨـﺳ ﻦﻴﮕﻧﺎـﻴﻣ 39
/ 51
لﺎﺳ ) 13 / 10 SD= ( دﻮﺑ ، .
ﺪـﺷ هﺪـﻳد ﺎﻬﻧآ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا رد ﻲﻌﻴﺒﻃﺮﻴﻏ ﻪﺘﻓﺎﻳ ﻪﻛ يداﺮﻓا )
نوﺮـﺑ زا ﺮـﺘﻤﻛ ﻲـﺒﻠﻗ هد 20
% تﺎـﻛﺮﺣ ﺎـﻳ
ﺐﻠﻗ هراﻮﻳد ﻲﻌﻴﺒﻃﺮﻴﻏ (
ﻲﻨﻌﻣ رﻮﻄﺑ ﺺﻴﺧﺮﺗ زا ﺲﭘ هﺎﻤﻜﻳ لﻮﻃ رد ﺶﻴﺑ يراد
ﺠﻣ ﻪﻌﺟاﺮﻣ ،نارﺎﻤﻴﺑ ﺮﻳﺎﺳ زا ﺮﺗ ﻪـﺑ دﺪ
ﺑ ﻚـﺷﺰﭘ ﺖـﻠﻌ
ﺪﻨﺘﺷاد ﻲﺒﻠﻗ درد )
000 / 0 p= .(
ﻪﺠﻴﺘﻧ يﺮﻴﮔ :
ﺶﻴﭘ رد ﻦﺌﻤﻄﻣ ﻲﺷور ،ﺺﻴﺧﺮﺗ زا ﻞﺒﻗ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا ﻪﻛ داد نﺎﺸﻧ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ
ﻲـﻗوﺮﻋ ﻲـﺒﻠﻗ ثداﻮـﺣ ﻲﻨﻴﺑ
ﻲﻣ ﻦﻴﻳﺎﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ رد ﺪﺷﺎﺑ
.
هژاوﺪﻴﻠﻛ ﺎﻫ : –1 ﻪﺴﻔﻗ درد ﻪﻨﻴﺳ –2 ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا
–3 ﻦﻴﻳﺎﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ
ﻪﺻﻼﺧ ﻪﻟﺎﻘﻣ ﻦﻳا ﻲﻳﺎﻤﻨﻫار ﻪﺑ ﺲﻧاژروا ﺐﻃ ﺺﺼﺨﺗ ﻊﻄﻘﻣ رد يﺪﻴﻔﻣ ﻲﻧﺎﻣ ﺮﺘﻛد يﺎﻗآ ﻪﻣﺎﻧ نﺎﻳﺎﭘ زا يا
يﺎﻗآ اد ﺮﺘﻛد و ﻲﻣ ﻲﺳرﺎﻓ دو ﺪﺷﺎﺑ
.
(I ﺺﺼﺨﺘﻣ و رﺎﻳدﺎﺘﺳا مﺮﻛا لﻮﺳر تﺮﻀﺣ نﺎﺘﺳرﺎﻤﻴﺑ ،ﺲﻧاژروا ﺐﻃ
) ص ( ،ناﺮـﻳا ﻲﻧﺎـﻣرد ـ ﻲﺘـﺷاﺪﻬﺑ تﺎﻣﺪـﺧ و ﻲﻜـﺷﺰﭘ مﻮـﻠﻋ هﺎﮕﺸﻧاد ،ﺶﻳﺎﻴﻧ نﺎﺑﺎﻴﺧ ،نﺎﺧرﺎﺘﺳ نﺎﺑﺎﻴﺧ ،
ناﺮﻳا ،ناﺮﻬﺗ .
(II مﺮﻛا لﻮﺳر تﺮﻀﺣ نﺎﺘﺳرﺎﻤﻴﺑ ،ﺲﻧاژروا ﺐﻃ ﺺﺼﺨﺘﻣ و رﺎﻳدﺎﺘﺳا )
ص ( ﺑ تﺎﻣﺪـﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﺶﻳﺎﻴﻧ نﺎﺑﺎﻴﺧ ،نﺎﺧرﺎﺘﺳ نﺎﺑﺎﻴﺧ ،
،ناﺮـﻳا ﻲﻧﺎـﻣرد ـ ﻲﺘـﺷاﺪﻬ
ناﺮﻳا ،ناﺮﻬﺗ
*) لوﺆﺴﻣ ﻒﻟﺆﻣ .(
(III
،ﺲﻧاژروا ﺐﻃ ﭗﻴﺷﻮﻠﻓ و ﻲﻠﺧاد ﺺﺼﺨﺘﻣ و رﺎﻳدﺎﺘﺳا مﺮﻛا لﻮﺳر تﺮﻀﺣ نﺎﺘﺳرﺎﻤﻴﺑ
) ص ( ـ ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﺶﻳﺎﻴﻧ نﺎﺑﺎﻴﺧ ،نﺎﺧرﺎﺘﺳ نﺎﺑﺎﻴﺧ ،
ناﺮﻳا ،ناﺮﻬﺗ ،ناﺮﻳا ﻲﻧﺎﻣرد .
(IV ،ﺮﮕﺸﻫوﮋﭘ ،ﻲﻜﺷﺰﭘ يﻮﺠﺸﻧاد ﺸﻧاد
ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕ ناﺮﻳا ،ناﺮﻬﺗ ،ناﺮﻳا ﻲﻧﺎﻣرد –
.
دﻮﻤﻧ ﺺﻴﺧﺮﺗ ﺲﻧاژروا ﺶﺨﺑ زا ﻲﻜﻴﻨﻴﻠﻛارﺎﭘ و
).
1 ، 2 ، 5 و 6
ﺖﻬﺟ (
ﻞﻜﺗوﺮﭘ نارﺎﻤﻴﺑ ﻦﻳا ﺺﻴﺧﺮﺗ
ﻲﻣ دﺎﻬﻨﺸﻴﭘ يدﺎﻳز يﺎﻫ
زا ،دﻮـﺷ
هزاﺪﻧا ﻪﻠﻤﺟ
ﻢﻳﺰﻧآ لﺎﻳﺮﺳ يﺮﻴﮔ
راﻮـﻧ ﻦﺘﻓﺮـﮔ ،ﻲـﺒﻠﻗ يﺎـﻫ ﺐـﻠﻗ
ﺐـﻠﻗ ﻦﻜـﺳا و شزرو ﺖﺴـﺗ ،لﺎﻳﺮـﺳ ترﻮﺼﺑ
).
13 - 7
لﺎـﺣ رد (
ﻞـﻜﺗوﺮﭘ رد ﻲﻓاﺮﮔﻮﻳدرﺎـﻛﻮﻛا ﺮﺿﺎﺣ
نارﺎـﻤﻴﺑ ﺺﻴﺧﺮـﺗ يﺎـﻫ
دراﺪـﻧ ﻲﻳﺎﺟ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻪﺑ ﻼﺘﺒﻣ .
مﺎـﺠﻧا تﺎـﻌﻟﺎﻄﻣ رد
سﺎـﺳاﺮﺑ ﻪـﻛ نارﺎـﻤﻴﺑ زا ﻪﺘﺳد نآ ﺖﺳا هﺪﺷ هﺪﻫﺎﺸﻣ ،ﻪﺘﻓﺮﮔ
ﻢﻳﺰـﻧآ و ﺐـﻠﻗ ﻦﻜـﺳا ،شزرو ﺖﺴـﺗ ندﻮـﺑ ﻲﻌﻴﺒﻃ
ﻲـﺒﻠﻗ يﺎـﻫ
ﻦﻴﻧﻮﭘوﺮﺗ و I
،هﺪـﺷ مﺎﺠﻧا يﺮﻴﮕﻴﭘ لﻮﻃ رد ،ﺪﻧﺪﺷ ﺺﺧﺮﻣ T
ﺪﻧﺪﺸﻧ ﻲﺒﻠﻗ ﺪﻣﺎﻴﭘ ﭻﻴﻫ رﺎﭼد
).
23 - 14
(
،ﻲـﺒﻠﻗ سﻮﺘﻛرﺎﻔﻧا نﺎﻣز رد ﻪﻛ ﺖﺳا هﺪﺷ هﺪﻳد ﻪﻌﻟﺎﻄﻣ ﺪﻨﭼ رد ناﺰﻴﻣ نآ ﺐﻗﺎﻌﺘﻣ و هدﺮﻛ اﺪﻴﭘ ﻲﻌﻴﺒﻃ ﺮﻴﻏ تﺎﻛﺮﺣ ﺐﻠﻗ هراﻮﻳد نوﺮــﺑ ﻲــﻣ ﺶﻫﺎــﻛ ﻲــﺒﻠﻗ هد ﺪــﺑﺎﻳ
. ﺮــﻴﻏ نﺎــﻣز رد ﻪــﺘﻓﺎﻳ ﻦــﻳا
ندﻮـﺑ ﻲﺼﻴﺨﺸﺗ
)ECG
Electrocardiogram (
ﻚـﻤﻛ رﺎﻴﺴـﺑ ،
ﺖﺳا هﺪﻨﻨﻛ
).
15 - 13
(
ﺴـﺗ دﻮـﺟو مﺪﻋ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ــ
ﻪﺘﺴـﻫ ﻦﻜـﺳا و شزرو ﺖ
يا
نﺎﺘﺳرﺎﻤﻴﺑ ﺲﻧاژروا ﺶﺨﺑ رد ﺐﻠﻗ ﺮـﻈﻧ رد ﺎـﺑ و رﻮﺸـﻛ يﺎـﻫ
ﻦـﻳا رد ،ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا ندﻮﺑ ﻦﻤﻳا و ﻲﻧازرا ،ﺖﻟﻮﻬﺳ ﻦﺘﻓﺮﮔ
ﻘﻧ ﺎﺗ ﺪﺷ ﻲﻌﺳ ﻪﻌﻟﺎﻄﻣ ــ
ﺑ ﻦﻴﻟﺎـﺑ ﺮـﺑ ﻲﻓاﺮﮔﻮﻳدرﺎـﻛﻮﻛا ﺶ رﺎـﻤﻴ
bed side echocardiography) (
ﺶﻴﭘ رد ﻪﻫﺎﻤﻜﻳ مﺎﺠﻧاﺮﺳ ﻲﻨﻴﺑ
ﻪـﻌﺟاﺮﻣ ﻦﻴﻳﺎـﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ
دﻮﺷ ﻲﺳرﺮﺑ ﺲﻧاژروا ﺶﺨﺑ ﻪﺑ هﺪﻨﻨﻛ .
عﻮـﺿﻮﻣ ﻦـﻳا ﺖـﻴﻤﻫا
تاﺮـﻄﺧ ضﺮـﻌﻣ رد هﺪﻨﻳآ رد نارﺎﻤﻴﺑ ﻦﻳا ﻪﻛ ﺖﺳا ﻦﻳا ﺮﻃﺎﺨﺑ ﺪـــﻧراد راﺮـــﻗ يدﺎـــﻳز .
4 % ﺖﻤـــﺳ ﻪـــﺑ ﺎـــﻬﻧآ ﻪﺘﻜـــﺳ
ﻲـــﺒﻠﻗ
MI) Myocardial infarction= (
ﻲــﻣ ﺖﻓﺮﺸــﻴﭘ ناﺰــﻴﻣ و ﺪــﻨﻨﻛ
ﻪﺑ لﺎﺳ ﻚﻳ ضﺮﻋ رد ﺎﻬﻧآ ﺮﻴﻣ و گﺮﻣ 2
% ﻲﻣ ﺪﺳر
).
1 و 3
(
رﺎـﻛﻮﻛا ﺶـﻘﻧ ﻲـﺳرﺮﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا مﺎﺠﻧا زا فﺪﻫ ﻲﻓاﺮﮔﻮﻳد
ﺶﻴﭘ رد ﻦﻴﻟﺎﺑ ﺮﺑ
ﻦﻳﮋﻧآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ ﻪﻫﺎﻤﻜﻳ مﺎﺠﻧاﺮﺳ ﻲﻨﻴﺑ
دﻮﺑ ﻦﻴﻳﺎﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ .
ﺑ شور ﻲﺳرﺮ
ﻲـﻫوﺮﮕﻤﻫ شور ﻪﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا Cohort)
(
ﺪـﺷ مﺎـﺠﻧا .
140
ﺲــﻧاژروا ﻪــﺑ هﺪــﻨﻨﻛ ﻪــﻌﺟاﺮﻣ ﻲــﺒﻠﻗ درد ﺖﻳﺎﻜــﺷ ﺎــﺑ رﺎــﻤﻴﺑ
مﺮﻛا لﻮﺳر تﺮﻀﺣ نﺎﺘﺳرﺎﻤﻴﺑ )
ص ( يد زا هﺎﻣ 84 هﺎـﻣﺮﻴﺗ ﺎﺗ
85
ﻲﺳرﺮﺑ زا ﺲﭘ ﻪﻛ
ﺺﻴﺨﺸﺗ ﺎﻬﻧآ ياﺮﺑ ،ﻪﺘﻓﺮﮔ ترﻮﺻ يﺎﻫ
ترﻮـﺻ ﻪـﺑ ،ﺪـﺷ حﺮـﻄﻣ ﻦﻴﻳﺎـﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻪﻧﻮﻤﻧ
ﺪﻧﺪـﺷ ﻪـﻌﻟﺎﻄﻣ دراو نﺎـﺳآ يﺮﻴﮔ .
ﻪـﺑ دورو يﺎـﻫرﺎﻴﻌﻣ
ﻪﻌﻟﺎﻄﻣ Inclusion Criteria) (
دﻮﺑ ﻦﻴﻨﭼ :
1 - ﻦﺳ 18 ﺎﺗ 65 لﺎﺳ
2 - ﻲﺒﻠﻗ ﺄﺸﻨﻣ ﺎﺑ درد
3 - ﻲﺒﻠﻗ راﻮﻧ ﺪﻳﺪﺟ ﺮﻴﻴﻐﺗ مﺪﻋ
4 - ﻢﻳﺰﻧآ ﺶﻳاﺰﻓا مﺪﻋ ﻲﺒﻠﻗ يﺎﻫ
ﻲــﺒﻠﻗ ﺮــﻴﻏ درد ،ﻪــﻌﻟﺎﻄﻣ ﻪــﺑ هﺪــﺷ دراو نارﺎــﻤﻴﺑ )
،يﻮــﻳر
و ﻲـــﺷراﻮﮔ ،ﻲﻧﻼﻀـــﻋ (...
ﻢﻳﺰـــﻧآ ﺶﻳاﺰـــﻓا و ﻲـــﺒﻠﻗ يﺎـــﻫ
CPK/CPK-MB
ﺪﻨﺘـﺷاﺪﻧ ﻦﻴﻧﻮﭘوﺮﺗ و .
ترﻮـﺻ رد ﻦﻴـﻨﭽﻤﻫ
رﺎـﻤﻴﺑ ﻲـﻠﺒﻗ يﺎـﻫراﻮﻧ ،ﻲـﺒﻠﻗ راﻮـﻧ رد ﻚﻴﻤﻜﺴـﻳا ﻢﻳﻼﻋ دﻮﺟو ددﺮﮔ در ﺎﻬﻧآ ندﻮﺑ ﺪﻳﺪﺟ ﺎﺗ ﺪﺷ ﺖﺳاﻮﺧرد .
ﻲـﺒﻠﻗ ﻦﻳﮋﻧآ ﺺﻴﺨﺸﺗ ﺎﺑ ،ﻻﺎﺑ يﺎﻫرﺎﻴﻌﻣ ﺎﺑ نﺎﮔﺪﻨﻨﻛ ﻪﻌﺟاﺮﻣ ــﻌﻟﺎﻄﻣ دراو ﻦﻴﻳﺎــﭘ ﻚﺴــﻳر ﺎــﺑ راﺪــﻳﺎﭘﺎﻧ ﺎــﻬﻧآ ياﺮــﺑ ،هﺪــﺷ ﻪ
ﻪــﺘﻓﺮﮔ مﺎــﺠﻧا ﻦﻴﻟﺎــﺑ ﺮــﺑ ﻲﻓاﺮﮔﻮﻳدرﺎــﻛﻮﻛا ﺪــﺷ
ﻪــﺘﻓﺎﻳ و يﺎــﻫ
ﺖﺴـﻴﻟ ﻚـﭼ دراو تﺎﺼـﺨﺸﻣ ﺮﻳﺎـﺳ هاﺮـﻤﻫ ﻪﺑ هﺪﺷ هﺪﻫﺎﺸﻣ ﺪﻧﺪﻳدﺮﮔ . ﻪﺘﻓﺎﻳ تﺎـﻛﺮﺣ ﻞﻣﺎﺷ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا ﻲﻌﻴﺒﻃﺮﻴﻏ يﺎﻫ
ﺐﻠﻗ هراﻮﻳد ﻲﻌﻴﺒﻃﺮﻴﻏ Wall Motion Abnormality)
( دﻮـﺟو ،
ﺐـﻠﻗ فاﺮـﻃا ﻊﻳﺎﻣ Pericardial Effusion)
( و هد نوﺮـﺑ ناﺰـﻴﻣ
ﺐﻠﻗ Ejection Fraction) (
زا ﺮﺘﻤﻛ 40 % دﻮﺑ .
رد ،ﺮــﺿﺎﺣ ﻪــﻌﻟﺎﻄﻣ مﺎــﺠﻧا نﺎــﻣز رد ﻪــﻜﻨﻳا ﻪــﺑ ﻪــﺟﻮﺗ ﺎــﺑ مﺮــــﻛا لﻮــــﺳر تﺮﻀــــﺣ نﺎﺘــــﺳرﺎﻤﻴﺑ ﺲــــﻧاژروا )
ص ( ،
نارﺎـﻤﻴﺑ ﻦـﻳا ﺺﻴﺧﺮـﺗ ﻞـﻜﺗوﺮﭘ رد ﻦﻴﻟﺎﺑ ﺮﺑ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا نارﺎﻤﻴﺑ ﻪﻤﻫ اﺬﻟ ؛ﺖﺷاﺪﻧ ﻲﻳﺎﺟ )
ﻪﺘﻓﺎﻳ ﺎﺑ ﻢﻫ و ﻲﻌﻴﺒﻃ ﻪﺘﻓﺎﻳ ﺎﺑ ﻢﻫ
ﻏ ﻲﻌﻴﺒﻃﺮﻴ (
ﺠﻧا زا ﺲﭘ ــ
ﺲﻧاژروا ﺶﺨﺑ زا ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا مﺎ
ﻧﺪﻳدﺮﮔ ﺺﻴﺧﺮﺗ ــ
ﺪ . ﻣ ﻚﻳ ــ ﺖﻴﻌﺿو ،ﻲﻨﻔﻠﺗ يﺮﻴﮕﻴﭘ ﺎﺑ ﺪﻌﺑ هﺎ
ﻲـﻌﻴﺒﻃﺮﻴﻏ ﺪـﻣﺎﻴﭘ ﻪـﻛ ﺪـﻳدﺮﮔ لاﻮﺳ هﺎﻣ ﻚﻳ لﻮﻃ رد نارﺎﻤﻴﺑ دﻮﺑ ﺮﻳز دراﻮﻣ زا ﻲﻜﻳ ﻞﻣﺎﺷ :
ﻪــﺑ دﺪــﺠﻣ ﻪــﻌﺟاﺮﻣ ﻪــﺑ ﺮــﺠﻨﻣ ﻪــﻛ ﻲــﺒﻠﻗ درد ﻪــﺑ ﻼﺘــﺑا ـــ ﺪﺷﺎﺑ هﺪﺷ نﺎﺘﺳرﺎﻤﻴﺑ )
ﺑ نﺪﺷ يﺮﺘﺴﺑ نوﺪ .(
ـــ ﻪــﺑ دﺪــﺠﻣ ﻪــﻌﺟاﺮﻣ ﻪــﺑ ﺮــﺠﻨﻣ ﻪــﻛ ﻲــﺒﻠﻗ درد ﻪــﺑ ﻼﺘــﺑا
ﺖـــﺒﻗاﺮﻣ ﺶـــﺨﺑ رد يﺮﺘﺴـــﺑ و نﺎﺘـــﺳرﺎﻤﻴﺑ هﮋـــﻳو يﺎـــﻫ
CCU) cardiac care unite= (
ﻴﺨﺸــﺗ ﺎــﺑ ــ
ﻲــﺒﻠﻗ ﻦﻳﮋــﻧآ ﺺ
ﻳﺎﭘﺎﻧ ـــــــ راﺪ unstable angina) (
ﺘﻜﺳ ﺎـــــﻳ ـــــــ
ﻲـــــﺒﻠﻗ ﻪ
MI) Myocardial infarction= (
ﺪﺷﺎﺑ هﺪﺷ .
ـ ﺛدﺎﺣ ـ ﺒﻠﻗ ﻪ ـــ ﻛ ﻲ ـــ
ـﺠﻨﻣ ﻪ ـ ﺑ ﺮ ـــ ﻓ ﻪ ــــ
ـﻤﻴﺑ تﻮ ـ ـﺷ رﺎ ـ هﺪ
ﺷﺎﺑ ـ ﺪ .
ﻪــﺘﻓﺎﻳ ،ﺖــﻳﺎﻬﻧ رد ﺺﻴﺧﺮــﺗ زا ﻞــﺒﻗ ﻲﻓاﺮﮔﻮﻳدرﺎــﻛﻮﻛا يﺎــﻫ
ﺖﻓﺮﮔ راﺮﻗ ﻪﺴﻳﺎﻘﻣ درﻮﻣ نﺎﺸﻳا ﻪﻫﺎﻤﻜﻳ ﺖﺷﻮﻧﺮﺳ ﺎﺑ نارﺎﻤﻴﺑ .
مﺮﻧ ﻂﺳﻮﺗ تﺎﻋﻼﻃا ﻪﻴﻠﻛ
راﺰﻓا ﺰﻴﻟﺎﻧآ SPSS
ﺪـﻳدﺮﮔ . ﺰﻴﻟﺎـﻧآ رد
نﻮﻣزآ زا يرﺎﻣآ
و يﺎـﻛ روﺬـﺠﻣ ،ﺮﺸـﻴﻓ يﺎﻫ t-Test
هدﺎﻔﺘـﺳا
ﺪﺷ . 05 / P value<0 ﻲﻨﻌﻣ ،
ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد راد .
ﻪﺘﻓﺎﻳ ﺎﻫ
1 / 42
% ) 59 ﺮــﻔﻧ ( و نز ،نارﺎــﻤﻴﺑ زا 9
/ 57 )%
81 ﺮــﻔﻧ ( دﺮــﻣ ،
ﺪﻧدﻮﺑ .
حﺮـﻃ ﻪـﺑ هﺪـﺷ دراو داﺮـﻓا ﻲﻨـﺳ ﻦﻴﮕﻧﺎﻴﻣ )
13 / 10 SD= (
39 / 51 دﻮــﺑ لﺎــﺳ .
ﺮــﻄﺧ ﻞــﻣاﻮﻋ ﻲــﻧاواﺮﻓ Risk Factors)
( رد
ﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ لوﺪﺟ رد ﻦﻴﻳﺎ
هرﺎﻤﺷ 1 ﺖﺳا هﺪﻣآ .
هرﺎﻤﺷ لوﺪﺟ 1
-
يرﺎﻤﻴﺑ ﺮﻄﺧ ﻞﻣاﻮﻋ ﻲﻧاواﺮﻓ ﺪﺻرد ـ ﻲﺒﻠﻗ يﺎﻫ
ﻲﻗوﺮﻋ
ﺮﻄﺧ ﻞﻣﺎﻋ
ﻲﻧاواﺮﻓ ﻲﻧاواﺮﻓ ﺪﺻرد
ﻦﻳﺮﻴﺷ ﺖﺑﺎﻳد
29 7
/ 20
نﻮﺧ يرﺎﺸﻓﺮﭘ
36 7
/ 25
ﻻﺎﺑ ﻲﺑﺮﭼ 23
4
/ 16
رﺎﮕﻴﺳ 31
1
/ 22
ﺖﺒﺜﻣ ﻲﮔداﻮﻧﺎﺧ ﻪﻘﺑﺎﺳ
25 9
/ 17
ﻲﺒﻠﻗ ﻞﻜﺸﻣ ﻪﻘﺑﺎﺳ
20 3
/ 14
9 / 7 )%
11 ﺮــــﻔﻧ ( ،نارﺎــــﻤﻴﺑ زا Ejection Fraction
EF) (
ﻲﻌﻴﺒﻃﺮﻴﻏ )
زا ﺮﺘﻤﻛ 40 (%
و 9 / 12 )%
18 ﺮﻔﻧ ( ،ﺰﻴﻧ Wall Motion
Abnormality ﺪﻨﺘﺷاد
.
،ﺲﻧاژروا زا ﺺﻴﺧﺮﺗ زا ﺲﭘ هﺎﻤﻜﻳ لﻮﻃ رد 7
/ 0 )%
1 ﺮﻔﻧ ( زا
ﻲـﺒﻠﻗ درد ﺮﻃﺎـﺧ ﻪـﺑ ﺰـﻴﻧ نارﺎـﻤﻴﺑ Cardiac Chest pain)
( ﻪـﺑ
ﺪﻧدﻮﺑ هدﺮﻛ ﻪﻌﺟاﺮﻣ ﻚﺷﺰﭘ .
ﻪــﺘﻓﺎﻳ ﻦﻴــﺑ رد درﺎــﻜﻳﺮﭘ نﻮــﻴﻓا ﻪــﻜﻨﻳا ﻪــﺑ ﻪــﺟﻮﺗ ﺎــﺑ يﺎــﻫ
ﻲـﺒﻠﻗ ﻪﺘﻜﺳ و ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا MI)
( ﻪـﺿرﺎﻋ ﺮـﺛا رد گﺮـﻣ و
مﺎـﺠﻧا ،ﺪﺸـﻧ هﺪﻳد نارﺎﻤﻴﺑ زا ﻚﻳ ﭻﻴﻫ رد ﺎﻫﺪﻣﺎﻴﭘ ﻦﻴﺑ رد ﻲﺒﻠﻗ ﻲﺳرﺮﺑ ﺖﻓﺮﮕﻧ ترﻮﺻ ﺮﻴﻐﺘﻣ ﻪﺳ ﻦﻳا درﻮﻣ رد ﻲﻠﻴﻠﺤﺗ يﺎﻫ .
ﻪـﺘﻓﺎﻳ زا ﻚـﻳ ﺮـﻫ دﻮـﺟو يﺎـﻫ
40 EF<% ﺎـﻳ Wall motion
abnormality رد ﻲـﻌﻴﺒﻃﺮﻴﻏ ﻲﻓاﺮﮔﻮﻳدرﺎـﻛﻮﻛا ﻪﺘﻓﺎﻳ ناﻮﻨﻋ ﻪﺑ
ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ .
ﺎـﻳ ﻲـﺒﻠﻗ راﺪـﻳﺎﭘﺎﻧ ﻦﻳﮋﻧآ دﻮﺟو ،ﺮﮕﻳد فﺮﻃ زا
هﺎـﻤﻜﻳ لﻮـﻃ رد نآ ﻞﻴﻟد ﻪﺑ نﺎﺘﺳرﺎﻤﻴﺑ ﻪﺑ ﻪﻌﺟاﺮﻣ و ﻲﺒﻠﻗ درد ناﻮـﻨﻋ ﻪـﺑ ،ﺲـﻧاژروا زا نارﺎـﻤﻴﺑ ﺺﻴﺧﺮـﺗ زا ﺲﭘ outcome
ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد ﻲﻌﻴﺒﻃﺮﻴﻏ .
زا 122
ـﺑ رﺎـﻤﻴﺑ ﻲـﻌﻴﺒﻃ ﻪـﺘﻓﺎﻳ ﺎ
،ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا 6
ﺮﻔﻧ ) 4 (%
زا و 18 ﻲـﻌﻴﺒﻃﺮﻴﻏ ﻪﺘﻓﺎﻳ ﺎﺑ رﺎﻤﻴﺑ
،ﻲﻓاﺮﮔﻮﻳدرﺎــﻛﻮﻛا 7
ﺮــﻔﻧ ) 39 (%
رﺎــﭼد outcome ﻲــﻌﻴﺒﻃﺮﻴﻏ
ﺪﻧﺪﺷ .
يﺎــﻛ روﺬــﺠﻣ نﻮــﻣزآ زا هدﺎﻔﺘــﺳا ﺎــﺑ chi2)
( ﻦﻴــﺑ طﺎــﺒﺗرا ،
ﻪــﺘﻓﺎﻳ بﻮﻠﻄﻣﺎــﻧ ﺪــﻣﺎﻴﭘ ﺎــﺑ ﻲﻓاﺮﮔﻮﻳدرﺎــﻛﻮﻛا ﻲــﻌﻴﺒﻃﺮﻴﻏ يﺎــﻫ
ﺎﺒﺗرا ﻪﻛ ﺪﺷ هﺪﻴﺠﻨﺳ ﻪﻫﺎﻤﻜﻳ ﻲﻨﻌﻣ ،ط
دﻮﺑ راد . ،ﺮﮕﻳد ترﺎﺒﻋ ﻪﺑ
ﻪـﺑ ﻼﺘـﺒﻣ نارﺎﻤﻴﺑ رد ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا ﻲﻌﻴﺒﻃﺮﻴﻏ ﻪﺘﻓﺎﻳ دﻮﺟو
رﻮﻃ ﻪﺑ ،ﺺﻴﺧﺮﺗ نﺎﻣز رد ﻦﻴﻳﺎﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻲﻨﻌﻣ دﻮﺑ هﺪﺷ ﺎﻬﻧآ رد بﻮﻠﻄﻣﺎﻧ ﺪﻣﺎﻴﭘ ﺚﻋﺎﺑ يراد )
000 / 0 p= .(
و ﺮﺸـﻴﻓ نﻮـﻣزآ زا هدﺎﻔﺘﺳا ﺎﺑ t-Test
يﺎـﻫﺮﻴﻐﺘﻣ طﺎـﺒﺗرا ،
،ﻦﺳ رد راﺪـﻳﺎﭘﺎﻧ ﻲـﺒﻠﻗ ﻦﻳﮋـﻧآ ﺶﻳاﺪﻴﭘ ﺎﺑ ﺮﻄﺧ ﻞﻣاﻮﻋ و ﺲﻨﺟ ،قﻮـﻓ يﺎـﻫﺮﻴﻐﺘﻣ زا ماﺪـﻛ ﭻﻴـﻫ ﻪـﻛ ﺪـﺷ ﻲـﺳرﺮﺑ هﺎﻤﻜﻳ لﻮﻃ
ﻲﻨﻌﻣ يرﺎﻣآ طﺎﺒﺗرا
ـﻧآ ﺶﻳاﺪﻴﭘ ﺎﺑ يراد رد راﺪـﻳﺎﭘﺎﻧ ﻲـﺒﻠﻗ ﻦﻳﮋ
ﺪﻨﺘﺷاﺪﻧ ﺺﻴﺧﺮﺗ زا ﺲﭘ هﺎﻤﻜﻳ لﻮﻃ )
05 / p>0 .(
ﻲـﻨﻌﻣ رﻮﻄﺑ ﻦﺳ ﺶﻳاﺰﻓا
و ﻲـﺒﻠﻗ درد ﺶﻳاﺪـﻴﭘ ﺚـﻋﺎﺑ يراد
دﺪﺠﻣ ﻪﻌﺟاﺮﻣ ؛ﺪـﺷ ﻲـﺳرﺮﺑ ﺖـﺤﺗ نارﺎـﻤﻴﺑ رد نﺎﺘﺳرﺎﻤﻴﺑ ﻪﺑ
ﻲـﺒﻠﻗ درد رﺎـﭼد ﻪـﻛ ﻲﻧارﺎـﻤﻴﺑ رد ﻦـﺳ ﻦﻴﮕﻧﺎـﻴﻣ ﻪـﻛ يرﻮﻄﺑ
،ﺪﻧﺪــﺷ ) 89 / 4 SD= ( 17 / 58 ﻧارﺎــﻤﻴﺑ رد و لﺎــﺳ ﻲ
لﻮــﻃ رد ﻪــﻛ
ﺪﻧﺪﺸـﻧ ﻲـﺒﻠﻗ درد رﺎـﭼد ﺺﻴﺧﺮـﺗ زا ﺲﭘ هﺎﻤﻜﻳ
، ) 27 / 10 SD= (
75 / 50
ﺪﻣآ ﺖﺳﺪﺑ لﺎﺳ .
ﻲـﻨﻌﻣ يرﺎـﻣآ ﺮﻈﻧ زا فﻼﺘﺧا ﻦﻳا
راد
دﻮﺑ ) 05 / p<0 t-Test و .(
و ﺖﺒﺜﻣ ﻲﻠﻴﻣﺎﻓ ﻪﻘﺑﺎﺳ ،ﻦﻳﺮﻴﺷ ﺖﺑﺎﻳد ،ﺮﻄﺧ ﻞﻣاﻮﻋ نﺎﻴﻣ رد ﻪـﺑ دﺪـﺠﻣ ﻪـﻌﺟاﺮﻣ و ﻲـﺒﻠﻗ درد ﺶﻳاﺪﻴﭘ ﺎﺑ ،ﻲﺒﻠﻗ ﻞﻜﺸﻣ ﻪﻘﺑﺎﺳ
ﻲـﻨﻌﻣ طﺎﺒﺗرا نﺎﺘﺳرﺎﻤﻴﺑ
ﺪﻨﺘـﺷاد يراد .
ﻪـﻛ يداﺮـﻓا ﻊـﻗاو رد
ﺪﺟاو
زا ﻲـﻜﻳ ﻞﻗاﺪﺣ رﻮـﻃ ﻪـﺑ ،ﺪـﻧدﻮﺑ قﻮـﻓ ﺮـﻄﺧ ﻞـﻣﺎﻋ ﻪـﺳ
ﻲﻨﻌﻣ
نارﺎـﻤﻴﺑ ﺮﻳﺎﺳ زا ﺶﻴﺑ يراد
،
ﺺﻴﺧﺮـﺗ زا ﺲـﭘ لﻮـﻃ رد
هدﺮــﻛ ﻪــﻌﺟاﺮﻣ نﺎﺘــﺳرﺎﻤﻴﺑ ﻪــﺑ ﻲــﺒﻠﻗ درد ﺮﻃﺎــﺨﺑ هﺎــﻤﻜﻳ ﺪﻧدﻮﺑ ) 05 / p<0 chi2 و .(
ﺮﻄﺧ ﻞﻣاﻮﻋ ﺮﻳﺎﺳ )
نﺪﻴﺸـﻛ و ﻲﻣﺪﻴﭙﻴﻟﺮﭙﻴﻫ ،نﻮﺧ يرﺎﺸﻓﺮﭘ
رﺎﮕﻴــﺳ ( ﻲــﻨﻌﻣ طﺎــﺒﺗرا ، زا ﺲــﭘ ﻲــﺒﻠﻗ درد ﺶﻳاﺪــﻴﭘ ﺎــﺑ يراد
ﺪﻨﺘﺷاﺪﻧ ﺺﻴﺧﺮﺗ )
05 / p>0 chi2 و .(
ﺚﺤﺑ
ﻊﻳﺎﺷ ﺮﺑ لاد تﺎﻌﻟﺎﻄﻣ ﺮﻳﺎﺳ ﺎﺑ ﻖﺑﺎﻄﻣ
ﻮـﺑ ﺮﺗ يرﺎـﻤﻴﺑ ﻦـﻳا ند
ﺶﻴـﺑ ﺰﻴﻧ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد ،نادﺮﻣ هوﺮﮔ رد
ﺖﻛﺮـﺷ داﺮـﻓا ﺮـﺗ
نادﺮﻣ ار هﺪﻨﻨﻛ )
9 / 57 (%
ﺪﻧداد ﻞﻴﻜﺸﺗ .
رد نارﺎـﻤﻴﺑ ﻲﻨﺳ ﻦﻴﮕﻧﺎﻴﻣ
ﺮﺒﺘﻌﻣ ﻊﺑﺎﻨﻣ سﺎﺳاﺮﺑ ﺎﻣا ،دﻮﺑ ﻲﮔﺪﻧز ﻢﺠﻨﭘ ﻪﻫد ،ﻪﻌﻟﺎﻄﻣ ﻦﻳا
، ﻦﻳا
يرﺎﻤﻴﺑ ﺶﻴﺑ ﻲﻣ زوﺮﺑ ﻲﮔﺪﻧز ﻢﺸﺷ ﻪﻫد رد ﺮﺗ ﺪﻨﻛ
).
1 و 2
(
دﻮـﺟﻮﻣ ﻊﺑﺎـﻨﻣ سﺎﺳاﺮﺑ
ﻊﻳﺎـﺷ ، ﻦـﻳا رد ﺮـﻄﺧ ﻞـﻣاﻮﻋ ﻦﻳﺮـﺗ
ﺖـﺒﺜﻣ ﻲﻠﻴﻣﺎـﻓ ﻪﻘﺑﺎـﺳ و ﺖﺑﺎﻳد ،نارﺎﻤﻴﺑ ﺖـﺳا
ﻪـﻌﻟﺎﻄﻣ رد ﻲـﻟو
رﺎﮕﻴﺳ فﺮﺼﻣ و ﻻﺎﺑ نﻮﺧرﺎﺸﻓ ،ﺮﺿﺎﺣ ﺪﻣآ ﺖﺳﺪﺑ
) 1 و 4
ﺪﻳﺎـﺷ ،(
توﺎﻔﺗ ﻦﻳا ﺪﺷﺎﺑ داﺮﻓا ﻲﻜﻴﺘﻧژ و ﻲﻳﺎﻴﻓاﺮﻐﺟ تﺎﻓﻼﺘﺧا ﺖﻠﻋ ﻪﺑ
.
ﻊﻳﺎـــﺷ ،ﺮـــﺿﺎﺣ ﻪـــﻌﻟﺎﻄﻣ رد ﻲـــﻌﻴﺒﻃﺮﻴﻏ ﻪـــﺘﻓﺎﻳ ﻦﻳﺮـــﺗ
،ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا Wall Motion Abnormality
ﻪﺑﺎﺸﻣ ﻪﻛ دﻮﺑ
ﺖﺳا ﺮﮕﻳد ﺮﺒﺘﻌﻣ تﺎﻌﻟﺎﻄﻣ ﺎﺑ
).
2 ، 13 و 14
(
ﻦﻴﻟﺎـﺑ ﺮـﺑ ﻲﻓاﺮﮔﻮﻳدرﺎـﻛﻮﻛا ﺶـﻘﻧ ﻦﻴﻴﻌﺗ ،ﻪﻌﻟﺎﻄﻣ ﻦﻳا فﺪﻫ
ﺶﻴﭘ رد رﺎﻤﻴﺑ
ﻦﻳﮋـﻧآ ﻪـﺑ ﻼﺘـﺒﻣ نارﺎﻤﻴﺑ ﻪﻫﺎﻤﻜﻳ مﺎﺠﻧاﺮﺳ ﻲﻨﻴﺑ
دﻮـﺑ ﺲـﻧاژروا ﻪﺑ هﺪﻨﻨﻛ ﻪﻌﺟاﺮﻣ ﻦﻴﻳﺎﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ .
ﺖﻤﺴــﻗ رد ﻪــﻛ نﺎــﻨﭽﻤﻫ ﻪــﻛ يداﺮــﻓا ،ﺪــﺷ هرﺎــﺷا ﻞــﺒﻗ
دﻮﺑ ﻲﻌﻴﺒﻃﺮﻴﻏ ﺎﻬﻧآ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا )
زا ﺮـﺘﻤﻛ ﻲـﺒﻠﻗ هد نوﺮـﺑ
40 %
ﺐـﻠﻗ هراﻮﻳد ﻲﻌﻴﺒﻃﺮﻴﻏ تﺎﻛﺮﺣ ﺎﻳ (
ﻲـﻨﻌﻣ رﻮـﻃ ﻪـﺑ
يراد
ﺶﻴﺑ ﻪـﺑ دﺪـﺠﻣ ﻪـﻌﺟاﺮﻣ و ﻲﺒﻗ درد رﺎﭼد ،نارﺎﻤﻴﺑ ﺮﻳﺎﺳ زا ﺮﺗ
ﺪﻧدﻮﺑ هﺪﺷ نﺎﺘﺳرﺎﻤﻴﺑ .
ﺒﻣ نارﺎﻤﻴﺑ هﺪﻨﻳآ ﻲﺳرﺮﺑ ﻪﻨﻴﻣز رد يدﺪﻌﺘﻣ تﺎﻌﻟﺎﻄﻣ ﻪـﺑ ﻼﺘ
ﺖﺳا ﻪﺘﻓﺮﮔ ترﻮﺻ ﻦﻴﻳﺎﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻦﻳﮋﻧآ .
ﻪﻌﻟﺎﻄﻣ رد
Weston لﺎﺳ رد ﻪﻛ نارﺎﻜﻤﻫ و 2004
،ﺖـﺳا ﻪـﺘﻓﺮﮔ ترﻮـﺻ
1500 ﻪـﺑ ﻼﺘـﺒﻣ رﺎﻤﻴﺑ Low Risk Chest Pain
مﺎـﺠﻧا زا ﺲـﭘ
هﺪﺷ يﺮﻴﮕﻴﭘ هﺎﻤﻜﻳ تﺪﻣ ﻪﺑ ﺺﻴﺧﺮﺗ و ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا
ﺪﻧا . رد
5 / 2 % ﺎــﻬﻧآ ﻲﻓاﺮﮔﻮﻳدرﺎــﻛﻮﻛا رد ﻪــﻛ يداﺮــﻓا Wall Motion
Abnormality
ﺪﻧ دﻮﺟو
دﺎـﺘﻓا قﺎﻔﺗا ﻲﺒﻠﻗ سﻮﺘﻛرﺎﻔﻧا ،ﺖﺷا رد ،
ﺎــﻬﻧآ ﻲﻓاﺮﮔﻮﻳدرﺎــﻛﻮﻛا ﻪــﻛ ﻲﻧﺎﺴــﻛ رد ناﺰــﻴﻣ ﻦــﻳا ﻪــﻛ ﻲﻟﺎــﺣ ،دﻮﺑ ﻲﻌﻴﺒﻃﺮﻴﻏ 20
% ﺪﺷ شراﺰﮔ .
ًﺎـﺘﻳﺎﻬﻧ ﻪﻟﺎﻘﻣ ﻦﻳا نﺎﮔﺪﻨﺴﻳﻮﻧ
ﻨﺸﻴﭘ ﻬ هدﺮﻛ دﺎ
ﻲﻣ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا زا ﻪﻛ ﺪﻧا
ﺶﻴﭘ رد ناﻮﺗ ﻲـﻨﻴﺑ
نارﺎـﻤﻴﺑ هﺪـﻨﻳآ ﻲـﺒﻠﻗ ﻊﻳﺎـﻗو Low Risk Chest Pain
هدﺎﻔﺘـﺳا
دﺮـﻛ
).
14
ﺶـﻘﻧ ،ﺮـﮕﻳد ﻪـﻌﻟﺎﻄﻣ ود رد (
)ESE
Exercise Stress
Echocardiography (
ﺶﻴﭘ رد ﻲﺳرﺮﺑ هﺪﻨﻳآ ﻲﺒﻠﻗ ثداﻮﺣ ﻲﻨﻴﺑ
مﺎﺠﻧا ناﺮﮕﺸﻫوﮋﭘ ﻪﻛ ﺪﺷ يﮋﺗاﺮﺘـﺳا ﻚـﻳ ناﻮـﻨﻋ ﻪـﺑ ار ESE
ﺶﻴﭘ و ﻲﺼﻴﺨﺸﺗ ﻼﺘـﺒﻣ نارﺎﻤﻴﺑ رد ﻲﺒﻠﻗ ﻲﺗآ ﻊﻳﺎﻗو هﺪﻨﻨﻛ ﻲﻨﻴﺑ
ﻳﺎﭘﺎﻧ ﻲﺒﻗ ﻦﻳﮋﻧآ ﻪﺑ ﺪﻧداد دﺎﻬﻨﺸﻴﭘ ﻦﻴﻳﺎﭘ ﺮﻄﺧ ﺎﺑ راﺪ
).
17 و 18
(
ﺶـﻘﻧ ﺰـﻴﻧ ﺮـﮕﻳد ﻪـﻌﻟﺎﻄﻣ ود رد
)DSE
Dubutamine Stress
Echocardiography (
ﺶﻴــﭘ رد رد ﻲــﺒﻠﻗ هﺪــﻨﻳآ ثداﻮــﺣ ﻲــﻨﻴﺑ
ﺪﻴﻳﺎﺗ ﻦﻴﻳﺎﭘ ﺮﻄﺧ ﺎﺑ نارﺎﻤﻴﺑ ﺪﻳدﺮﮔ
).
19 و 20
ﻪﻌﻟﺎﻄﻣ رد (
Moreno و
ـﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ يور ﺮﺑ نارﺎﻜﻤﻫ ﺮـﻄﺧ ﺎ
نﻮــﻣزآ ،ﻦﻴﻳﺎــﭘ Dipyridamol Stress Echocardiography
،
ﺎـﻬﻧآ نﻮـﻣزآ ﻪـﻛ يداﺮﻓا ؛ﺖﻓﺮﮔ ترﻮﺻ يﺮﻴﮕﻴﭘ ﺲﭙﺳ و مﺎﺠﻧا
ﻲـﻨﻌﻣ رﻮـﻃ ﻪـﺑ دﻮﺑ ﻲﻌﻴﺒﻃ
ﻲـﺒﻠﻗ ﻪـﺿرﺎﻋ رﺎـﭼد يراد يﺮـﺘﻤﻛ
ﺪﻧﺪﺷ
).
21
(
ﻞــﻜﺗوﺮﭘ رد ﻲﻓاﺮﮔﻮﻳدرﺎــﻛﻮﻛا زا ،ﺮــﺿﺎﺣ لﺎــﺣ رد يﺎــﻫ
ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ نارﺎﻤﻴﺑ ﺺﻴﺧﺮﺗ هدﺎﻔﺘـﺳا ﻦﻴﻳﺎﭘ
ﻲﻤﻧ دﻮﺷ .
ـﻧﻮﮔ ﭻﻴـﻫ ﻪﻛ ﻲﻳﺎﺠﻧآ زا ﻦـﻳا رد ﻲﻬﺑﺎﺸـﻣ ﻪـﻌﻟﺎﻄﻣ ﻪ
ز ﻨﻴﻣ ﺎـﺑ ﻪـﻌﻟﺎﻄﻣ ﻦـﻳا ﻪﺴـﻳﺎﻘﻣ ،ﺖـﺳا ﻪـﺘﻓﺮﮕﻧ مﺎـﺠﻧا نﻮﻨﻛ ﺎﺗ ﻪ
ﻲﻤﻧ روﺪﻘﻣ ﺮﮕﻳد تﺎﻌﻟﺎﻄﻣ
ﺪﺷﺎﺑ
، ﺖـﺳﺪﺑ ﺞﻳﺎﺘﻧ ﻪﺑ ﺖﻳﺎﻨﻋ ﺎﺑ ﻲﻟو
ﻲﻣ ،ﺶﻫوﮋﭘ ﻦﻳا رد هﺪﻣآ
ﻦﻴﻟﺎـﺑ ﺮﺑ ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا ﺖﻔﮔ ناﻮﺗ
ﺑ ﻲﺷزرا ﺎﺑ تﺎﻋﻼﻃا ،رﺎﻤﻴﺑ
ﻲﻣ ﺎﻣ ﻪ
ﻲﻣ ﺎﻬﻧآ زا ﻪﻛ ﺪﻫد
رد ناﻮﺗ
ﺶﻴﭘ
دﻮـﻤﻧ هدﺎﻔﺘﺳا نارﺎﻤﻴﺑ ﻦﻳا هﺪﻨﻳآ ﻲﺒﻠﻗ ﻊﻳﺎﻗو ﻲﻨﻴﺑ .
ﻦـﻳا رد
مﺪـﻋ ﻪﺠﻴﺘﻧ رد و نارﺎﻤﻴﺑ زا ﻲﺧﺮﺑ ﺖﻧﻮﻜﺳ ﻞﺤﻣ ﺮﻴﻴﻐﺗ ﻪﻌﻟﺎﻄﻣ ﺎـﻬﻧآ ﺐﺳﺎﻨﻣﺎﻧ يرﺎﻜﻤﻫ ﺮﮕﻳد يﻮﺳ زا و ﻲﻨﻔﻠﺗ سﺎﻤﺗ يراﺮﻗﺮﺑ
ﺖﻳدوﺪﺤﻣ زا ،تﻻاﺆﺳ ﻪﺑ ﺦﺳﺎﭘ رد
دﻮﺑ ﺶﻫوﮋﭘ يﺎﻫ .
ﻦﻴـﻨﭽﻤﻫ
ﺗ ﺎﺑ ﻢـﺠﺣ ﺎـﺑ و ﻪﺑﺎﺸﻣ تﺎﻌﻟﺎﻄﻣ مﺎﺠﻧا ،عﻮﺿﻮﻣ ﺖﻴﻤﻫا ﻪﺑ ﻪﺟﻮ
ﻲﻣ ﻪﻴﺻﻮﺗ ﺮﺗﻻﺎﺑ ﻪﻧﻮﻤﻧ ددﺮﮔ
.
ﻪﺠﻴﺘﻧ يﺮﻴﮔ
نﻮـﻣزآ عﻮـﻤﺠﻣ ﺞﻳﺎﺘﻧ ﻦﺘﻓﺮﮔ ﺮﻈﻧ رد ﺪﻳﺎﺷ ﻪﭼ ﺮﮔا ﺎـﻫ
) ﺖﺴـﺗ
و ﺐﻠﻗ ﻦﻜﺳا ،شزرو (...
ﻖـﻴﻗد نارﺎﻤﻴﺑ ﻦﻳا ﺺﻴﺧﺮﺗ ياﺮﺑ
و ﺮـﺗ
ﻞﻣﺎﻛ
ﻲـﻣ ﺮـﻈﻧ ﻪـﺑ ﺮﺗ
رد يدﺎـﻳز ﻊـﻧاﻮﻣ و تﻼﻜﺸـﻣ ﻲـﻟو ﺪـﺳر
ﺘﺳرﺎﻤﻴﺑ نﺎ
ﻦـﻳا ﻪﻴﻠﻛ مﺎﺠﻧا ياﺮﺑ ـ ﻲﺷزﻮﻣآ و ﻲﺘﻟود هﮋﻳﻮﺑ ـ ﺎﻫ
نﻮﻣزآ
دراد دﻮـﺟو ﺎﻫ .
سﺮﺘـﺳد رد يﺎـﻫراﺰﺑا يﺮﻴﮔرﺎـﻜﺑ و ﺮـﺗ
هدﺎﺳ
ﻢﻴﻤﺼﺗ رﻮﻈﻨﻣ ﻪﺑ ﺮﺗ
ﻦﻴﺋﺎـﭘ ﺮﻄﺧ ﺎﺑ نارﺎﻤﻴﺑ درﻮﻣ رد يﺮﻴﮔ
ﻪﻨﻳﺰﻫ زا ﻪﻜﻨﻳا ﻦﻤﺿ
ﻲـﻣ ﻲﻧﺎﺘﺳرﺎﻤﻴﺑ يﺎﻫ
ﻢﻴﻤﺼـﺗ ،ﺪـﻫﺎﻛ
يﺮـﻴﮔ
ﻊﻳﺮﺳ ﺗ ـ ﻲﻣ ﻲﻠﻤﻋ نارﺎﻤﻴﺑ ﻦﻳا درﻮﻣ رد ار ﺮ ﺎﺳ
دز .
و ﻦﻴـﻘﻘﺤﻣ ﻪـﻜﻨﻳا ﻪـﺑ ﺖـﻳﺎﻨﻋ ﺎﺑ و ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﺞﻳﺎﺘﻧ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﻲﺑﺎﻳزرا رد ار دﻮﺧ شور ،ماﺪﻛ ﭻﻴﻫ ،ﻒﻠﺘﺨﻣ تﻻﺎﻘﻣ نﺎﮔﺪﻨﺴﻳﻮﻧ ﻚﺴـﻳر ﺎـﺑ راﺪـﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ ﺺﻴﺧﺮﺗ زا ﻞﺒﻗ
ﻪﺘﺴﻧاﺪﻧ ﻦﻳﺮﺘﻬﺑ ﻦﻴﻳﺎﭘ
ندﻮـﺑ سﺮﺘﺳد رد و ﻦﻤﻳا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ و ﺪﻧا
ﻣ ،ﻲﻓاﺮﮔﻮﻳدرﺎﻛﻮﻛا ﻲ
نارﺎـﻤﻴﺑ ﺺﻴﺧﺮﺗ ﺖﻬﺟ هﺎﮕﺘﺳد ﻦﻳا زا ناﻮﺗ
دﻮﻤﻧ هدﺎﻔﺘﺳا ﻦﻴﻳﺎﭘ ﻚﺴﻳر ﺎﺑ راﺪﻳﺎﭘﺎﻧ ﻲﺒﻠﻗ ﻦﻳﮋﻧآ ﻪﺑ ﻼﺘﺒﻣ .
ﺮﻜﺸﺗ و ﺮﻳﺪﻘﺗ
مﺮــﺘﺤﻣ ﺖــﻧوﺎﻌﻣ ﻲﻟﺎــﻣ ﺖــﻳﺎﻤﺣ زا هدﺎﻔﺘــﺳا ﺎــﺑ ﻖــﻴﻘﺤﺗ ﻦــﻳا
ﻧﺎـﻣرد ـ ﻲﺘـﺷاﺪﻬﺑ تﺎﻣﺪـﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻲﺸﻫوﮋﭘ ﻲ
ﺴﻳﻮﻧ ﻪﻠﻴﺳو ﻦﻳﺪﺑ ﻪﻛ ،ﺖﺳا هﺪﻳدﺮﮔ مﺎﺠﻧا ناﺮﻳا ﺐﺗاﺮﻣ ﻪﻟﺎﻘﻣ هﺎﮔﺪﻨ
ﻣ زا ار دﻮﺧ ﺮﻜﺸﺗ و ﺮﻳﺪﻘﺗ ﺴ
ﻲﻣ زاﺮﺑا ﺰﻛﺮﻣ نآ ﻦﻴﻟوﺆ ﺪﻧراد
.
ﻊﺑﺎﻨﻣ ﺖﺳﺮﻬﻓ
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Assessment of the Role of Bedside Echocardiography in Predicting One- Month Outcome of the Patients with Low Risk Unstable Angina
I II III I D. Farsi, MD *M. Mofidi, MD N. Kianmehr, MD S. Abbasi, MD
I III IV IV M.A. Zare, MD H. Shaker, MD M. Rezaee N. Ashayeri
Abstract
Background & Aim: Unstable angina accounts for about 30% of cardiovascular patients referred to emergency departments. Low risk patients can be discharged and receive outpatient treatment if clinical and paraclinical assays are normal. The recommended pre-discharge evaluations are controversial. However, because of the availability and safety of bedside echocardiography in emergency departments, we decided to conduct this study.
Patients and Method: This cohort study was done on 140 patients with chest pain who were diagnosed with low risk unstable angina and admitted to the Emergency Department of Hazrat Rasoul-e-Akram Hospital. All of the cases underwent bedside echocardiography before their discharge. Calling the patients one month after their discharge, their outcomes were recorded. Then we made a comparison between echocardiographic findings and their one-month outcomes. The data were analyzed via SPSS software using statistical tests such as Fisher, Chi-square and t-test.
Results: The mean age of the patients was 51.39(SD=10.13) years. 42.1%(59 cases) were female and 57.9%(81 cases) were male. The patients with abnormal echocardiographic findings, i.e. EF(Ejection Fraction)<40% and wall motion abnormality, had a significantly higher rate of re-hospitalization because of chest pain(p=0.000).
Conclusion: The study shows that bedside echocardiography before discharge is a reliable method for predicting cardiovascular events in low risk unstable angina patients.
Key Words: 1) Chest Pain 2) Echocardiography 3) Low Risk Unstable Angina
This article is an abstract of Mr. Mofidi's thesis advised by Dr. Farsi in partial fulfillment of a medical doctor's degree in emergency medicine.
I) Assistant Professor of Emergency Medicine. Hazrat Rasool-e-Akram Hospital. Niayesh St., Sattarkhan Ave., Iran University of Medical Sciences and Health Services. Tehran, Iran.
II) Assistant Professor of Emergency Medicine. Hazrat Rasool-e-Akram Hospital. Niayesh St., Sattarkhan Ave., Iran University of Medical Sciences and Health Services. Tehran, Iran.(*Corresponding Author)
III) Assistant Professor of Internal Medicine and Fellowship of Emergency Medicine. Hazrat Rasool-e-Akram Hospital. Niayesh St., Sattarkhan Ave., Iran University of Medical Sciences and Health Services. Tehran, Iran.
IV) Medical Student. Researcher.Iran University of Medical Sciences and Health Services. Tehran, Iran.