Downloaded from http://journals.tums.ac.ir/ at 9:31 IRDT on Saturday August 6th 2016

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Downloaded from http://journals.tums.ac.ir/ on Tuesday, July 23, 2013

surgery inpatients in hospitals affiliated With Tehran University of Medical Sciences

Azar Tol¹, Abolghasem Pourreza*²

Submitted: 12.4.2010 Accepted: 23.5.2010

Abstract

Background: Multiple environmental factors have roles in producing anxiety. Individualized differences and environmental conditions can affect the anxiety level. So, hospital environment and especially cardiac surgery ward have a great importance because they can save the patient's life.

Material & Methods: The present study is a descriptive- analytical one which has been conducted upon studying the level of anxiety pre and post coronary artery bypass graft surgery in the hospitals of Tehran University of Medical Sciences and preparing an educational program for such patients, was the other goal of the study.

Study population consists of 150 patients under examination that at the time of the study have been voluntaries to coronary artery bypass graft surgery. The sample was studied 24 hours before and weeks after surgery. The sample was selected randomly and data collected through a questionnaire with two separate parts.

For the purpose of data analysis, SPSS software was employed.

Results: The result of the study shows that the level of anxiety before coronary artery bypass graft have been more than the level of anxiety after the operation. The difference between of the levels of anxiety have had significant relations with some of independent variables of the study such as sex, age, number of children and marital status, but there were not significant relations between occupation, educational level, non cardiac disease background, background of MI, non cardiac surgery background, the period of suffering from coronary disease background of hospitalization.

Conclusion: It seems that the men's ability to return to pre-operation socio-economic condition reduces their post operation anxiety. When people become older, they will be more fearful regarding the future's events but people older than 46 years old will obtain more life expectancy after surgery due to more extended familial relationship.

Married people experience less anxiety due to post operation, familial responsibilities and relief of cardiac symptoms. It can be concluded that anxiety reduction in these patients can result from cultural, socio-economic and demographic variables. Believes as cultural factors in the life have a great role in appearance and the level of anxiety.

Keywords: Anxiety, Coronary Artery Bypass Graft, hospitals affiliated to TUMS

1 - Phd student, Department Of health services, School of Public Health, Isfahan University of medical Sciences.

2 - Associate professor , Department of Management healtn Economic School of public health , Tehran university of medical Sciences.

(*corresponding Author) Email: [email protected]

Downloaded from http://journals.tums.ac.ir/ at 9:31 IRDT on Saturday August 6th 2016

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ﺮﻧوﺮﻛ قوﺮﻋ ﺪﻧﻮﻴﭘ ﻲﺣاﺮﺟ ﻞﻤﻋ زا ﺪﻌﺑ و ﻞﺒﻗ باﺮﻄﺿا ناﺰﻴﻣ ﻲﺳرﺮﺑ رد

يﺎﻬﻧﺎﺘﺳرﺎﻤﻴﺑ ﻪﻌﺑﺎﺗ

ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد لﺎﺳ ـ

1367

ﻞﻃ رذآ ،1

ﺎﺿررﻮﭘ ﻢﺳﺎﻘﻟاﻮﺑا ﺮﺘﻛد

2

*

ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ :

23 / 1 / 89 شﺮﻳﺬﭘ ﺦﻳرﺎﺗ

: 2 / 3 / 89

-1

نﺎﻬﻔﺻا ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ هوﺮﮔ ،ﺖﺷاﺪﻬﺑ هﺪﻜﺸﻧاد ،ﺖﻣﻼﺳ ءﺎﻘﺗرا و ﺖﺷاﺪﻬﺑ شزﻮﻣآ ﻲﺼﺼﺨﺗ ياﺮﺘﻛد يﻮﺠﺸﻧاد

-2

ناﺮـﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﺖﺷاﺪﻬﺑ هﺪﻜﺸﻧاد ،ﺖﺷاﺪﻬﺑ دﺎﺼﺘﻗا و ﺖﻳﺮﻳﺪﻣ مﻮﻠﻋ هوﺮﮔ رﺎﻴﺸﻧاد )

لﻮﺌـﺴﻣ هﺪﻨـﺴﻳﻮﻧ* .(

سردآ : مﻮـﻠﻋ هﺎﮕـﺸﻧاد ،ﺎﻨﻴـﺳرﻮﭘ نﺎـﺑﺎﻴﺧ ،ناﺮـﻬﺗ

ﺖﺷاﺪﻬﺑ دﺎﺼﺘﻗا و ﺖﻳﺮﻳﺪﻣ مﻮﻠﻋ هوﺮﮔ ،ﺖﺷاﺪﻬﺑ هﺪﻜﺸﻧاد ،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ .

Email: [email protected]

فﺪﻫ و ﻪﻨﻴﻣز دﺮـﻓ يﺎـﻬﺗوﺎﻔﺗ و ﺪـﻨﻨﻛ ﻲﻣ ﺶﻘﻧ يﺎﻔﻳا باﺮﻄﺿا زوﺮﺑ رد يدﺪﻌﺘﻣ ﻲﻄﻴﺤﻣ ﻞﻣاﻮﻋ و ﻞﻠﻋ:

و ي

ﺪﻧﺮﺛﻮﻣ باﺮﻄﺿا ناﺰﻴﻣ و تﺪﺷ رد ﻲﻄﻴﺤﻣ ﻂﻳاﺮﺷ .

ﺶـﺨﺑ و ﻲﻧﺎﺘـﺳرﺎﻤﻴﺑ ﻂﻴـﺤﻣ ، ﻂﻳاﺮـﺷ ﻦﻳا بﻮﭼرﺎﭼ رد

دراد رﺎﻛ و ﺮﺳ نﺎﺴﻧا تﺎﻴﺣ ﺎﺑ ﻪﻛ ﺐﻠﻗ ﻲﺣاﺮﺟ

، هﮋﻳو ﺖﻴﻤﻫا زا ﺖـﺳا رادرﻮـﺧﺮﺑ يا

. و ﻦﻴـﻴﻌﺗ ﻪـﻌﻟﺎﻄﻣ ﻦـﻳا

ﻴﭘ ﻲﺣاﺮﺟ زا ﺪﻌﺑ و ﻞﺒﻗ باﺮﻄﺿا ناﺰﻴﻣ ﻪﺴﻳﺎﻘﻣ ﺑﺎﺗ يﺎﻬﻧﺎﺘﺳرﺎﻤﻴﺑ رد ﺮﻧوﺮﻛ قوﺮﻋ ﺪﻧﻮ

هﺎﮕﺸﻧاد ﻪﻌ ﻲﻜﺷﺰﭘ مﻮﻠﻋ

ناﺮﻬﺗ ﺖﺳا هﺪﻳﺰﮔﺮﺑ دﻮﺧ ﻲﻠﺻا فاﺪﻫا ناﻮﻨﻋ ﻪﺑ ار .

و داﻮﻣ ﺎﻬﺷور ﻲﻔﻴﺻﻮﺗ عﻮﻧ زا ﻪﻌﻟﺎﻄﻣ ﻦﻳا: -

ﺖﺳا ﻲﻠﻴﻠﺤﺗ .

ار ﻲـﺳرﺮﺑ ﻦـﻳا ﻪـﻌﻟﺎﻄﻣ ﺖـﺤﺗ داﺮﻓا 150

زا ﺮـﻔﻧ

ﺐﺨﺘﻨﻣ يﺎﻬﻧﺎﺘﺳرﺎﻤﻴﺑ رد يﺮﺘﺴﺑ نارﺎﻤﻴﺑ هﺎﮕﺸﻧاد

ﺪﻨﻫﺪﻴﻣ ﻞﻴﻜﺸﺗ ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ .

ﻦﻳا باﺮﻄﺿا ناﺰﻴﻣ

رد داﺮﻓا 24 ﻞﻤﻋ زا ﺪﻌﺑ مود ﻪﺘﻔﻫ رد ﺲﭙﺳ و ﻞﻤﻋ زا ﻞﺒﻗ ﺖﻋﺎﺳ ﻪﻣﺎﻨﺸﺳﺮﭘ ﻂﺳﻮﺗ

نﻮـﻣزآ زا هدﺎﻔﺘـﺳا ﺎـﺑ

ﺮﮔﺮﺑ ﻞﻴﭙﺳا دراﺪﻧﺎﺘﺳا )

(Spielberger

ﺪﺷ هﺪﻴﺠﻨﺳ .

ﺞﻳﺎﺘﻧ ناﺰـﻴﻣ زا ﺮﺘﺸﻴﺑ ﺮﻧوﺮﻛ قوﺮﻋ ﺪﻧﻮﻴﭘ ﻞﻤﻋ زا ﻞﺒﻗ باﺮﻄﺿا ناﺰﻴﻣ ﻪﻛ ﺪﻫد ﻲﻣ نﺎﺸﻧ ﺶﻫوﮋﭘ يﺎﻫ ﻪﺘﻓﺎﻳ:

هدﻮﺑ ﻞﻤﻋ زا ﺪﻌﺑ باﺮﻄﺿا ﺲﻨﺟ ﻞﺜﻣ ﻲﻳﺎﻫﺮﻴﻐﺘﻣ ﺎﺑ باﺮﻄﺿا تاﺮﻴﻴﻐﺗ و ﺖﺳا

5 /.

0

P<

( ﻦﺳ،

) 5 /.

0

P<

( داﺪﻌﺗ ،

ناﺪﻧزﺮﻓ ) 5 /.

0

P<

( ﻞﻫﺎﺗ ﺖﻴﻌﺿو و )

5 /.

0

P<

( ﺪـﻨﻧﺎﻣ ﺮﮕﻳد يﺎﻫﺮﻴﻐﺘﻣ ﺎﺑ ﺎﻣا ﺖﺳا ﻪﺘﺷاد يراد ﻲﻨﻌﻣ طﺎﺒﺗرا

ﻪﻘﺑﺎـﺳ ،ﻲﺒﻠﻗ ﺮﻴﻏ ﻲﺣاﺮﺟ ﻪﻘﺑﺎﺳ،ﻲﺒﻠﻗ ﺮﻴﻏ يرﺎﻤﻴﺑ ﻪﻘﺑﺎﺳ ،تﻼﻴﺼﺤﺗ ﺢﻄﺳ ،ﻲﻠﻐﺷ ﺖﻴﻌﺿو MI

ﻲـﻨﻌﻣ طﺎـﺒﺗرا

د ﺖﺷاﺪﻧ يرا .

يﺮﻴﮔ ﻪﺠﻴﺘﻧ ﺪﺳر ﻲﻣ ﺮﻈﻧ ﻪﺑ:

ﻦﻳارد باﺮﻄﺿا ﺶﻫﺎﻛ يدﺎـﺼﺘﻗا، ﻚـﻴﻓاﺮﮔﻮﻣد يﺎـﻫﺮﻴﻐﺘﻣ زا ﺮﺛﺎﺘﻣ نارﺎﻤﻴﺑ

-

ﺖﺳا ﻲﮕﻨﻫﺮﻓ و ﻲﻋﺎﻤﺘﺟا .

ﺪـﻧاﻮﺗ ﻲﻣ ﻲﮔﺪﻧز ﻪﺑﺮﺠﺗ ﻲﮕﻨﻫﺮﻓ ﺞﻳﺎﺘﻧ و دﺎﻌﺑا ناﻮﻨﻋ ﻪﺑ ﺎﻫروﺎﺑ و ﺎﻬﺷزرا ، تادﺎﻘﺘﻋا

ﺪﻳﺎﻤﻧ ﺎﻔﻳا ﻲﺳﺎﺳا ﺶﻘﻧ نآ ﻒﻌﺿ و تﺪﺷ و باﺮﻄﺿا زوﺮﺑ رد .

ﻤﻠﻛ يﺪﻴﻠﻛ تﺎ

،باﺮﻄﺿا:

،ﺮﻧوﺮﻛ قوﺮﻋ ﺪﻧﻮﻴﭘ ﻲﺣاﺮﺟ هﺎﮕﺸﻧاد ﻪﻌﺑﺎﺗ يﺎﻬﻧﺎﺘﺳرﺎﻤﻴﺑ

ﻜﭼ ﻜﭼ ﻜﭼ ﻴﻴﻴﻴ ﻜﭼ هﺪ هﺪ هﺪ :::: هﺪ

(3)

ﻪﻣﺪﻘﻣ : ﻜﻣ هﮋــﻳو ﻪــﺑ ناﺪﻨﻤــﺸﻳﺪﻧا زا ﻲــﻀﻌﺑ دﺎــﻘﺘﻋا ﻪــﺑ باﺮﻄــﺿا ﺐــﺘ

ﻪـﺑ ﻲﻧﺎـﺴﻧا تﺎـﻴﺣ و ﻲﮔﺪﻧز ﻲﺗاذ ﺮﺻﺎﻨﻋ زا ﻲﻜﻳ ،ﻢﺴﻴﻟﺎﻴﺴﻧﺎﺘﺴﻳﺰﮔا دور ﻲﻣ رﺎﻤﺷ .

لﺎـﺳرد يرﺎـﻤﻴﺑ ﻚـﻳ ناﻮـﻨﻋ ﻪـﺑ هﺪﻳﺪﭘ ﻦﻳا 1895

ﻲﻓﺮﻌﻣ ﻲﻜﺷﺰﭙﻧاور و ﻲﺳﺎﻨﺷ ناور ﻢﻟﺎﻋ ﻪﺑ و ﻲﻳﺎﺳﺎﻨﺷ ﺪﻳوﺮﻓ ﻂﺳﻮﺗ يﺮـﻄﺧ رﺎﻈﺘﻧا و ﻲﻧﺎﺸﻳﺮﭘ سﺎﺴﺣا ﺎﺑ نآ ﻲﻠﺻا تﺎﻴﻠﺠﺗ ﻪﻛ ،ﺪﻳدﺮﮔ ﺖﺳا هاﺮﻤﻫ عﻮﻗﻮﻟا ﺐﻳﺮﻗ .

ﺒﻋ ﻪﺑ زا ﻲـﻜﻳ دراﻮـﻣ ﺮﺘﺸﻴﺑ رد ،ﺮﺘﻘﻴﻗد ترﺎ

و فاﺪـﻫا نآ رد ﻪـﻛ ﻲﻄﻳاﺮـﺷ ﺎـﻳ ﻲﮔﺪـﻧز كﺎـﻧدرد يﺎـﻫ ﺖﻴﻘﻓﻮﻣ ﻲﺛداﻮـﺣ مﺎﺠﻧاﺮـﺳ و دﻮﺷ ﻲﻣ ﻊﻗاو ﺪﻳﺪﻬﺗ درﻮﻣ ﻲﺼﺨﺷ يﺎﻬﺘﻴﻌﻗﻮﻣ ﻲـﻣ ﻲﻋﺎـﻓد يﺎـﻫ ﻢـﺴﻴﻧﺎﻜﻣ ﻲﮕﺘـﺴﻜﺷ ﻢﻫ رد زا سﺮﺗ ﺐﺟﻮﻣ ﻪﻛ دﻮﺷ ﻲﻣ ﻲﻘﻠﺗ باﺮﻄﺿا هﺪﻧزﺎﺳرﺎﻜﺷآ ﺖﻠﻋ ناﻮﻨﻋ ﻪﺑ ،ددﺮﮔ )

1 .(

رﻮﺻ ﻪﺑ باﺮﻄﺿا ﺎﺒﻳﺮﻘﺗ ، دﺎﺣ ت

"

مﺎـﻤﺗ ءاﺰـﺟا زا ﻲـﻜﻳ

ﺖﺳا ﻲﻧاور يﺎﻬﻳرﺎﻤﻴﺑ .

نﺎﻧز زا نادﺮـﻣ زا ﺮﺘـﺸﻴﺑ ﺮـﺑاﺮﺑ ود

ﺪـﻧﺮﺑ ﻲـﻣ ﺞﻧر لﻼﺘﺧا ﻦﻳا .

، ﺪـﻫد ﻲـﻣ نﺎـﺸﻧ ﺎﻬﻴـﺳرﺮﺑ

دراد ﻲﮔداﻮﻧﺎﺧ و ﻲﺛرا ﻪﻨﻴﻣز و عﻮﻴﺷ باﺮﻄﺿا )

2 .(

ﺎـﻳ و ﻲﺘﺣارﺎﻧ و ﺶﻣارآ مﺪﻋ سﺎﺴﺣا ﻚﻳ ﻪﺑ ﻲﺨﺳﺎﭘ باﺮﻄﺿا ﻢـﻳﻼﻋ ﻂﺳﻮﺗ ﻪﻛ ﺖﺳا يﺪﻳﺪﻬﺗ ﻚﻳ ﻪﺑ ﺺﺨـﺸﻣ ﻲﻜﻳژﻮـﻟﻮﻳﺰﻴﻓ

دﻮﺷ ﻲﻣ . ﺮﺑ هزرﺎﺒﻣ و ﮓﻨﺟ رد نﺪﺷ دراو ﺖﺳا ﻦﻜﻤﻣ ﺦﺳﺎﭘ ﻦﻳا

ﺪﻳﺪﻬﺗ ﻞﻣﺎﻋ ﻪﻴﻠﻋ ﻚـﻳ و ﺰـﻳﺮﮔ ﻞﻜﺷ ﻪﺑ ﺎﻳ ،ﺪﺷﺎﺑ ﺮﻄﺧ ﺎﻳ هﺪﻨﻨﻛ

ﻢﺴﻴﻧﺎﻜﻣ عﻮﻧ ﺪﻳﺎﻤﻧ زوﺮﺑ ﻲﻋﺎﻓد

) 3 .(

ﺎـﻳ رﺎﻜـﺷآ ﻲﻔﻃﺎـﻋ ﺶﻨﻛاو ﻲﻋﻮﻧ ﺎﺑ ﻪﺸﻴﻤﻫ ﻲﺣاﺮﺟ ﻞﻤﻋ ﺮﻫ ﺖـﺳا هاﺮـﻤﻫ ﻲﻌﻴﺒﻃ ﺮﻴﻏ و ﻲﻌﻴﺒﻃ،ﻲﻔﺨﻣ .

ﺖـﺳا ﻦـﻜﻤﻣ رﺎـﻤﻴﺑ

ا ﺶﻴـﭘ ﻞـﺑﺎﻗ ﺶﻨﻛاو ناﻮﻨﻋ ﻪﺑ ار ﻲﺣاﺮﺟ ﻞﻤﻋ زا ﻲﺷﺎﻧ باﺮﻄﺿ ﻪـﻴﻠﻋ ﺮﺑ يﺪﻳﺪﻬﺗ ناﻮﻨﻋ ﻪﺑ ار ﻲﺣاﺮﺟ ﻪﺑﺮﺠﺗ و يرﺎﻤﻴﺑ رد ﻲﻨﻴﺑ دﻮـﺧ ﻲـﺘﺣ و نﺪـﺑ نﺎﻤﺘﺧﺎـﺳ ﺖـﻴﻣﺎﻤﺗ ،ﻲﮔﺪـﻧز ﻲﻌﻴﺒﻃ ﺪﻧور ﺪﻳﺎﻤﻧ ﻲﻘﻠﺗ ﻲﮔﺪﻧز )

4 .(

باﺮﻄـﺿا ﻪـﻌﻟﺎﻄﻣ ﻦـﻳا رد ﻪـﻛ دراد ﻲﺗوﺎـﻔﺘﻣ عاﻮﻧا باﺮﻄﺿا ﻲﺘﻔﺻ )

Trait Anxiety

( ﺎﺣ باﺮﻄﺿاو ﻲﺘﻟ

)

State Anxiety

( درﻮـﻣ

دﺮﻴﮕﻴﻣ راﺮﻗ ﻲﺳرﺮﺑ .

ﻧﺎﺸﻧ ﻲﺘﻔﺻ باﺮﻄﺿا ﻲﺘﻴﻌﻗﻮـﻣ باﺮﻄﺿاﺮﮕ

ﺪﺷﺎﺑ ﻲﻣ دﺮﻓ .

داﺮـﻓا ﻲـﻀﻌﺑ،ﺖﻴﺼﺨﺷ ﺪـﺷر رد لﻮﺤﺗ ﻪﻄﺳاو ﻪﺑ

ﺪﻨﺘـﺴﻫ يﺮﺘـﺸﻴﺑ باﺮﻄـﺿا ﺪﻌﺘﺴﻣ ناﺮﮕﻳد ﻪﺑ ﺖﺒﺴﻧ .

باﺮﻄـﺿا

ﺖـﻴﻌﻗﻮﻣ ﻦـﻳا ﺎﻣا ﺪﻫد ﻲﻣ خر يﺎﻫﮋﻳو يﺎﻫ ﺖﻴﻌﻗﻮﻣ رد ﻲﺘﻟﺎﺣ ﻲﻳﺎﺳﺎﻨﺷ ﻞﺑﺎﻗ باﺮﻄﺿا هﺪﻧﺰﻴﮕﻧاﺮﺑ ﺖﺳا

) 2 .(

درﻮﻣ هزوﺮﻣا ،ﻲﻧﺎﻣرد يﺎﻬﻫار زا ﻲﻜﻳ ناﻮﻨﻋ ﻪﺑ ﻲﺣاﺮﺟ ﻪﭼﺮﮔا گﺮـﻣ ﺮـﻄﺧ زا ار نارﺎـﻤﻴﺑ زا يرﺎﻴـﺴﺑ و دﺮﻴﮔ ﻲﻣ راﺮﻗ هدﺎﻔﺘﺳا

دراد ﺰﻴﻧ ﻲﺿراﻮﻋ ﺎﻣا ﺪﻫد ﻲﻣ تﺎﺠﻧ ﻲﻤﺘﺣ .

ﻲﺛداﻮـﺣ زا رﺎـﻤﻴﺑ

باﺮﻄـﺿا و ﻲﺘﺣارﺎـﻧ ، ﻲـﻧاﺮﮕﻧ ،هﺮﻬﻟد رﺎﭼد ﺖﺳوا رﺎﻄﺘﻧا رد ﻪﻛ ددﺮﮔ ﻲﻣ . رﺎﻤﻴﺑ رد نﺪﺷ يﺮﺘﺴﺑ ﻪـﺑ ﻲﺣاﺮﺟ ﻞﻤﻋ مﺎﺠﻧا و نﺎﺘﺳ

دﻮﺷ ﻲﻣ بﻮﺴﺤﻣ از ﺶﻨﺗ ﻞﻣاﻮﻋ زا ﻲﻜﻳ ناﻮﻨﻋ )

5 .(

ﻞﻤﻋ مﺎﺠﻧا و نﺪﺷ يﺮﺘﺴﺑ ، ﻚﺷﺰﭘ ﻪﺑ ﻪﻌﺟاﺮﻣ ،ﻲﺒﻠﻗ يرﺎﻤﻴﺑ دﺮﻓ ياﺮﺑ ﻲﺗﻼﻜﺸﻣ ءﺎﺸﻨﻣ ﺪﻧاﻮﺗ ﻲﻣ ﻲﻳﺎﻬﻨﺗ ﻪﺑ ﻚﻳ ﺮﻫ ، ﻲﺣاﺮﺟ

ﺪﺷﺎﺑ . ﻲﻋﻮـﻨﺘﻣ تاﺮـﺛا ﺪـﻧاﻮﺗ ﻲـﻣ نﺎﺘـﺳرﺎﻤﻴﺑ رد نﺪـﺷ يﺮﺘﺴﺑ ﺪﺷﺎﺑ ﻪﺘﺷاد

) 6 .(

ﻳﺮﮔ ، ﺖﻴﻧﺎﺒﺼﻋ ياﺪـﺘﺑا رد ضاﺮـﺘﻋا ﺎـﺑ هاﺮﻤﻫ ﻪ

، ﻲﮔﺪـﻧﺎﻣاو سﺎـﺴﺣا ﻪـﺑ ﺞﻳرﺪﺗ ﻪﺑ ار دﻮﺧ يﺎﺟ ، نﺪﺷ يﺮﺘﺴﺑ ﺎﺘﻳﺎﻬﻧ و تﺮﺴﺣ

"

ﺪـﻫد ﻲـﻣ ﻢﻴﻠـﺴﺗ )

5 .(

ﻞـﻤﻋ ﺖـﺤﺗ نارﺎـﻤﻴﺑ

نﺎﻣز زا ار ﻲﻧاﺮﮕﻧ و باﺮﻄﺿا ،سﺮﺗ ﻪﻴﺒﺷ ﻲﻤﺋﻼﻋ ، ﺐﻠﻗ ﻲﺣاﺮﺟ ﺪـﻨﻳﺎﻤﻧ ﻲـﻣ ﻪﺑﺮﺠﺗ ار ﻲﻧﺎﻣرد ماﺪﻗا ﻪﺑ زﺎﻴﻧ نﺪﻴﻨﺷ .

ﻦـﻳا ﺶﻫﺎـﻛ

ﻋﺎﺑ ﻢﺋﻼﻋ سﺎﺴﺣا ﺚ هرود رد ﻪـﻛ هﺪـﻳدﺮﮔ يراوﺪـﻴﻣا و ﻲـﺘﺣار

ﻲﻣ خر ﻞﻤﻋ زا ﺲﭘ ﺪﻫد

) 7 .(

رﺎﻤﻴﺑ ، زﺎﺑ ﺐﻠﻗ ﻲﺣاﺮﺟ ﻞﻤﻋ ﺖﺤﺗ

ﻲـﻧاور و ﻲـﺣور ناﺮﺤﺑ ﻚﻳ ضﺮﻌﻣ رد ،مزﻻ يﺎﻬﺘﺒﻗاﺮﻣ ﺮﺑ هوﻼﻋ دﺮﻴﮔ ﻲﻣ راﺮﻗ .

ﺰـﻴﻧ وا هداﻮﻧﺎـﺧ قﺎـﻤﻋا ﺎﺗ ﻲﻫﺎﮔ ناﺮﺤﺑ ﻦﻳا ﻪﻨﻣاد

ﺪﻨﻛ ﻲﻣ ذﻮﻔﻧ .

ﺮـﺛا تﺪـﺷ و عﻮﻧ هﺪﻨﻨﻛ ﻦﻴﻴﻌﺗ يدﺪﻌﺘﻣ ﻞﻣاﻮﻋ

ر ﻲـﻣ دﺎـﺠﻳا نﺎﺘـﺳرﺎﻤﻴﺑ ردرﺎﻤﻴﺑ نﺪﺷ يﺮﺘﺴﺑ ﻪﻛ ﺪﻨﺘﺴﻫ ﻲﻧاو

ﺪﻨﻛ . ﻪﭼ و يدﺎﺼﺘﻗا ﺮﻈﻧ زا ﻪﭼ ﻲﻠﻴﻣﺎﻓ و ﻲﮔداﻮﻧﺎﺧ ﻂﻳاﺮﺷ ،ﻦﺳ ياﺮـﺑ ﻲـﻠﺒﻗ ﻲﮔدﺎـﻣآ ﻪـﺟرد ،ﻲﮔداﻮﻧﺎـﺧ ﻂﺑاور ﻂﺑاور ظﺎﺤﻟ ﻪﺑ رد نﺪــﺷ يﺮﺘــﺴﺑ نﺎــﻣز رد يرﺎــﻤﻴﺑ ﻂﻳاﺮــﺷ ،نﺪــﺷ يﺮﺘــﺴﺑ ،ﻲﺼﻴﺨﺸﺗ لﺎﻤﻋا مﺎﺠﻧا ﻪﺑ زﺎﻴﻧ ،نﺎﺘﺳرﺎﻤﻴﺑ ﺮﻓا رﻮﻀﺣ نﺎﻜﻣا

ﺎﻧ دا

،نﺪــﺷ يﺮﺘــﺴﺑ زا ﻲــﻠﺒﻗ تﺎــﻴﺑﺮﺠﺗ ، رﺎــﻤﻴﺑ راﻮــﺟ رد ﺎﻨــﺷآ هﻮﺤﻧ و ﻲﻧﺎﺘﺳرﺎﻤﻴﺑ تﺎﻧﺎﻜﻣا دﻮﺟو ،رﺎﻤﻴﺑ ﻲﺘﻴﺼﺨﺷ تﺎﻴﺻﻮﺼﺧ ﺖﺳا ﻞﻣاﻮﻋ ﻦﻳا ﻪﻠﻤﺟ زا رﺎﻤﻴﺑ ﺎﺑ نﺎﻣرد ردﺎﻛ درﻮﺧﺮﺑ )

5 .(

ﺲﻜﻋ،گﺮـﻣ و ﻲﮔﺪـﻧز ﺎـﺑ ﺐـﻠﻗ ﻢﻴﻘﺘـﺴﻣ ﻲﮕﺘﺴﺑاو ﻞﻴﻟد ﻪﺑ ﻗ ﻲـﺣاﺮﺟ ﻪـﺑ ﺪﻨﻣزﺎﻴﻧ نارﺎﻤﻴﺑ ﻲﻧاور و ﻲﻔﻃﺎﻋ يﺎﻫ ﻞﻤﻌﻟا ،ﺐـﻠ

ﻪـﺒﻧﺎﺟ ﻪـﻤﻫ شزﻮـﻣآ و ﻲﻔﻃﺎـﻋ ﺖـﻳﺎﻤﺣ ﻪﺑ وا هداﻮﻧﺎﺧ و رﺎﻤﻴﺑ ﺪﻧﺪﻨﻣزﺎﻴﻧ ) 8 .(

زا ﻲﺷﺎﻧ باﺮﻄﺿا و سﺮﺗ ﺪﻳﺪﺸﺗ ﺖﻠﻋ ﻪﺑ ﺐﻠﻗ ﻲﺣاﺮﺟ زا ﺲﭘ و رﺎـﻤﻴﺑ ياﺮـﺑ ﻪـﺒﻧﺎﺟ ﻪﻤﻫ ﺶﻣارآ ﻦﻴﻣﺎﺗ و ﻲﻔﻃﺎﻋ ﺖﻳﺎﻤﺣ ،نآ

ﺖﺳا هﺪﺷ ﻪﻴﺻﻮﺗ يو هداﻮﻧﺎﺧ )

5 و 9 .(

رزﻮـﻣ و پﺎﻛارد )

Dracup & Moser

( نارﺎـﻤﻴﺑ ﻪـﻛ ﺪـﻧﺪﻘﺘﻌﻣ

ﺟ ﺎـﺑ يﺮﺘـﺸﻴﺑ ﻲﮔدﺎـﻣآ ﺎﺑ ﺎﺗ ﺪﻧﻮﺷ هداد شزﻮﻣآ ﺪﻳﺎﺑ ﺐﻠﻗ ﻲﺣاﺮ

يﺎﻬﺳﺮﺘﺳا و باﺮﻄﺿا ﺪﻨﻳﺎﻤﻧ ﻪﻠﺑﺎﻘﻣ ﻲﺣاﺮﺟ ﻞﻤﻋ

. ﺶﻫﺎﻛ ﺖﻬﺟ

رﺎﻤﻴﺑ ﺎﺑ ﺐﺳﺎﻨﺘﻣ نوﺪﻣ ﻲﺷزﻮﻣآ ﻪﻣﺎﻧﺮﺑ نﻮﭼ ﻲﻳﺎﻬﺷور باﺮﻄﺿا ﺎــﺑ ﻪــﻄﺑار رد ﻲﻫﺎﻔــﺷ و ﻲــﺒﺘﻛ يﺎــﻫ ﻪﻴــﺻﻮﺗ ،شا هداﻮﻧﺎــﺧ و رد شا هدﻮﻧﺎـﺧ و رﺎـﻤﻴﺑ ﺖﻛﺮـﺷ ، ﻲﻟﺎـﻤﺘﺣا تﻼﻜﺸﻣ تﺎـﺴﻠﺟ

ردﺎﻛ ﺎﺑ طﺎﺒﺗرا ﻪﻣادا و يﺮﻴﮕﻴﭘ درﻮﻣ رد رﺎﻤﻴﺑ ﻪﺑ ﻪﻴﺻﻮﺗ،ﻲﺷزﻮﻣآ ﺪﺷﺎﺑ ﻲﻣ ﺪﻨﻣدﻮﺳ ،نﺎﻣرد )

5 و 6 و 10 .(

نارﺎﻜﻤﻫ و ﺮﻤﻧ اﺮﺗ )

Tranmer, et al

( ﺪـﻧداد نﺎـﺸﻧ دﻮﺧ ﻪﻌﻟﺎﻄﻣ رد

نارﺎـﻤﻴﺑ ياﺮﺑ ﻪﻛ زﺎﺑ ﺐﻠﻗ ﻲﺣاﺮﺟ نارﺎﻤﻴﺑ باﺮﻄﺿا ﺮﺑ شزﻮﻣآ ﻪﻛ دراد ﻲﻳاﺰﺳ ﻪﺑ ﺮﻴﺛﺎﺗ ،ﺖﺳا روآ باﺮﻄﺿا رﺎﻴﺴﺑ )

11 .(

دﻮـﺟو و زﺎـﺑ ﺐـﻠﻗ ﻲﺣاﺮﺟ ﺪﻳﺪﻧﺎﻛ نارﺎﻤﻴﺑ تﺮﺜﻛ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ناﺰـﻴﻣ ﺎـﺗ ﺪـﺷ نآ ﺮـﺑ ﻖـﻘﺤﻣ ﻲـﺣاﺮﺟ ﻞﻤﻋ زا ﻲﺷﺎﻧ باﺮﻄﺿا درﻮـﻣ نآ ﺮـﺑ ﺮﺛﻮﻣ ﻞﻣاﻮﻋ و ﻲﺣاﺮﺟ ﻞﻤﻋ زا ﺪﻌﺑ و ﻞﺒﻗ باﺮﻄﺿا و باﺮﻄـﺿا ﻢـﺋﻼﻋ ﻊـﻗﻮﻣ ﻪـﺑ ﻲﻳﺎـﺳﺎﻨﺷ ﺎـﺑ ﺎﺗ دﺮﻴﮔ راﺮﻗ ﻲﺳرﺮﺑ آ ﺎـﺑ ﺢﻴﺤﺻ ﻪﻠﺑﺎﻘﻣ ﻣ زا ناﻮـﺘﺑ نﺎـﻣرد ردﺎـﻛ ﻂـﺳﻮﺗ ن

تﻼﻜـﺸ

دﻮﻤﻧ يﺮﻴﮕﺸﻴﭘ ﻲﻟﺎﻤﺘﺣا .

(4)

ﺎﻬﺷور و داﻮﻣ :

فﺪـﻫ ﺎﺑ ﻪﻛ ﺖﺳا ﻲﻠﻴﻠﺤﺗ ﻲﻔﻴﺻﻮﺗ ﻲﺳرﺮﺑ ﻚﻳ ،ﻪﻌﻟﺎﻄﻣ ﻦﻳا قوﺮـﻋ ﺪـﻧﻮﻴﭘ ﻲﺣاﺮﺟ ﻞﻤﻋ زا ﺪﻌﺑ و ﻞﺒﻗ باﺮﻄﺿا ناﺰﻴﻣ ﻦﻴﻴﻌﺗ رد ناﺮـﻬﺗ ﻲﻜـﺷﺰﭘ مﻮـﻠﻋ هﺎﮕﺸﻧاد ﻪﻌﺑﺎﺗ يﺎﻬﻧﺎﺘﺳرﺎﻤﻴﺑ رد ﺮﻧوﺮﻛ لﺎﺳ 1387 ﺖﺳا ﻪﺘﻓﺮﮔ مﺎﺠﻧا .

ترﺎـﺒﻋ ، ﻪـﻌﻟﺎﻄﻣ ﺖـﺤﺗ ﻪـﻌﻣﺎﺟ

ﺖﺳا ياﺮﺑ ﻪﻛ ﻲﻧاور صﺎﺧ ﻞﻜﺸﻣ نوﺪﺑ ،داﻮﺳﺎﺑ نارﺎﻤﻴﺑ ﻪﻴﻠﻛ زا ﻞـﻤﻋ و ﺪـﻧدﻮﻤﻧ ﻪـﻌﺟاﺮﻣ ﻪـﻌﻟﺎﻄﻣ ﺖـﺤﺗ ﺰﻛاﺮﻣ ﻪﺑ رﺎﺑ ﻦﻴﺘﺴﺨﻧ

ﺪﺷﺎﺑ هﺪﺷ مﻮﻠﻌﻣ ،ﺎﻬﻧآ ﻲﺣاﺮﺟ .

ﻲﻓدﺎـﺼﺗ ، ﻪـﻧﻮﻤﻧ بﺎـﺨﺘﻧا شور

ﺖﺳا هدﻮﺑ هدﺎﺳ .

ﻪـﺑ ﻪـﺟﻮﺗ ﺎـﺑ ﻪـﻌﻟﺎﻄﻣ ﻦـﻳا رد

pilot Study

ﻪـﻛ

باﺮﻄــﺿا ناﺰــﻴﻣ رﺎــﻴﻌﻣ فاﺮــﺤﻧا 2

/ 12 و ﺪــﻳدﺮﮔ ﻪﺒــﺳﺎﺤﻣ ﺎــﺑ

نﺎﻨﻴﻤﻃا 95 ﺖـﻗد و ﺪـﺻرد 2

ﻢـﺠﺣ ،ﺪـﺣاو ﻪـﻧﻮﻤﻧ

150 ﺮـﻔﻧ

ﺪﻳدﺮﮔ دروآﺮﺑ .

ود رد و ﻲﻧﺎـﻣز ﻊـﻄﻘﻣ ود رد زﺎـﻴﻧ درﻮﻣ تﺎﻋﻼﻃا

ﺶﺨﺑ ﻲﺣاﺮﺟ ) ﻞﻤﻋ زا ﻞﺒﻗ (

و

post Icu

) ﻞـﻤﻋ زا ﺪـﻌﺑ (

ﻊـﻤﺟ

ﺪﻳدﺮﮔ يروآ .

ﻪﺑ دورو ﺎﺑ ﻖﻘﺤﻣ هﺎﮕـﺸﻧاد ﻪـﻌﺑﺎﺗ يﺎﻬﻧﺎﺘـﺳرﺎﻤﻴﺑ

و

ﻪﺑ دﻮﺧ ﻲﻓﺮﻌﻣ ﻂﻳاﺮﺷ ﺪﺟاو نارﺎﻤﻴﺑ

ﻴﺟﻮﺗ و رد نﺎﺸﻳا ندﻮﻤﻧ ﻪ

رد ﺖﻛﺮـﺷ ياﺮـﺑ ﺎـﻬﻧآ ﻞـﻳﺎﻤﺗ ترﻮﺻ رد ،ﺶﻫوﮋﭘ فاﺪﻫا درﻮﻣ ﻦﻳزاﻮـﻣ ﺖـﻳﺎﻋر ﺎـﺑ هاﺮـﻤﻫ ﻪﻣﺎﻨﺸﺳﺮﭘ ﻞﻴﻤﻜﺗ ﻪﺑ ﺖﺒﺴﻧ ،ﻲﺳرﺮﺑ ﻪــﺑ ﻪﻣﺎﻨـﺸﺳﺮﭘ ﻞــﻴﻤﻜﺗ ندﻮـﺒﻧ ﻲــﻠﻴﻤﺤﺗ و ﻲـﻗﻼﺧا نارﺎــﻤﻴﺑ

و

تﺎﻋﻼﻃا ندﻮﺑ ﻪﻧﺎﻣﺮﺤﻣ دﻮﻤﻧ ماﺪﻗا

.

ﺶـﺨﺑ ود زا ﻪـﻛ ﺖﺳا يا ﻪﻣﺎﻨﺸﺳﺮﭘ ،ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﻲﻠﺻا راﺰﺑا ﻃا و ﻚﻴﻓاﺮﮔﻮﻣد تﺎﻋﻼ نﻮـﻣزآ

ﻞﻴﻜـﺸﺗ ﺮـﮔﺮﺑ ﻞﻴﭙـﺳادراﺪﻧﺎﺘﺳا

ﺖﺳا هﺪﺷ .

ﻪﻛ نﻮﻣزآ ﻦﻳا )

(STAI

ﻞﻣﺎـﺷ ،دﻮﺸﻴﻣ هﺪﻴﻣﺎﻧ ﺰﻴﻧ 40

ﻪــﻛ ﺖــﺳا لاﻮــﺳ تﻻاﻮــﺳ

20 - 1 ﻲﺘﻴﻌﻗﻮــﻣ باﺮﻄــﺿا ار دﺮــﻓ

دراد ﻲـﺳرﺮﺑ نﺎـﻣز رد و ﻪـﻈﺤﻟ رد دﺮـﻓ ﻪﻛ دزﺎﺳ ﻲﻣ ﺺﺨﺸﻣ .

تﻻاﻮﺳ 40 - 21 و سﺎـﺴﺣا هﺪـﻨﻨﻛ نﺎﻴﺑ ﻪﻛ ار ﻲﺘﻟﺎﺣ باﺮﻄﺿا

ﻓ شﺮﮕﻧ

، ﺖﺳا دﺮ ﺪﻫد ﻲﻣ نﺎﺸﻧ

. نﻮﻣزآ ﺮـﮔﺮﺑ ﻞﻴﭙﺳادراﺪﻧﺎﺘﺳا

ءﺎـﻀﻋا ﻂـﺳﻮﺗ نآ ﻲﻳاﻮﺘﺤﻣ رﺎﺒﺘﻋا و ﺖﺳا دراﺪﻧﺎﺘﺳا يﺎﻬﺘﺴﺗ زا ﺪﻴﺗﺎـﺳا و ﻲﺘـﺸﻬﺑ ﺪﻴﻬـﺷ ﻲﻜـﺷﺰﭘ مﻮـﻠﻋ هﺎﮕﺸﻧاد ﻲﻤﻠﻋ ﺖﺌﻴﻫ ﺖـﺳا ﻪـﺘﻓﺮﮔ راﺮﻗ ﺪﻴﺋﺎﺗ و ﻲﺳرﺮﺑ درﻮﻣ ﻲﻜﺷﺰﭙﻧاور ﻮﺘﻴﺘﺴﻴﻧا .

رد

،نﻮﻣزآ ﻦﻳا يراﺬﮔ هﺮﻤﻧ شور درﻮﻣ مزﻻ يﺎﻬﻴﺋﺎﻤﻨﻫار

ﺪﻴﺗﺎﺳا زا

ﺪــﻳدﺮﮔ ﺖــﻓﺎﻳرد ناﺮــﻬﺗ ﻲﻜــﺷﺰﭙﻧاور ﻮﺘﻴﺘــﺴﻴﻧا ﻪﺘــﺴﺟﺮﺑ .

هﺮــﻤﻧ

زا ،ﻪﻣﺎﻨـﺸﺳﺮﭘ زا ﺖﻤﺴﻗ ﺮﻫ باﺮﻄﺿا 60

- 0 ﻪـﺳ ﻪـﺑ ﻪـﻛ ﺖـﺳا

ﻒــــﻴﻔﺧ هوﺮــــﮔ )

20 - 0 ( ﻂــــﺳﻮﺘﻣ ، )

40 - 21 ( ﺪﻳﺪــــﺷ و

) 60 - 41 ( ﺪﻳدﺮﮔ ﻢﻴﺴﻘﺗ .

تازﺎـﻴﺘﻣا عﻮـﻤﺠﻣ زا باﺮﻄﺿا ﻞﻛ ناﺰﻴﻣ و ﻲﺘﻟﺎـﺣ باﺮﻄـﺿا

ﻲﺘﻴﻌﻗﻮﻣ باﺮﻄﺿا ﻪﺒﺳﺎﺤﻣ

ﺪﻳدﺮﮔ .

راﺰــﻓا مﺮــﻧ زا ﺎــﻫ هداد ﻞــﻴﻠﺤﺗ ﻲــﺳرﺮﺑ رد رﺎــﻣآ زا وSPSS

ﺪﻳدﺮﮔ هدﺎﻔﺘﺳا ﻲﻃﺎﺒﻨﺘﺳا و ﻲﻔﻴﺻﻮﺗ .

ﺢﻄﺳ ﺶﺠﻨﺳ ﺖﻬﺟ لﺰﻨﻫ ﻞﺘﻨﻣ و ﺮﺸﻴﻓ ، ود يﺎﻛ يﺎﻬﻧﻮﻣزآ تﺎﻴﺿﺮﻓ ن ﻮﻣزآ ﻦﻴﻨﭽﻤﻫ و ﺎﻫﺮﻴﻐﺘﻣ ﻦﻴﺑ ﻂﺑاور رد يراد ﻲﻨﻌﻣ

ﺪﻧﺪﺷ ﻪﺘﻓﺮﮔ رﺎﻛ ﻪﺑ .

ﺎﻫ ﻪﺘﻓﺎﻳ

: ﻧﻮﻴﭘ ﻲﺣاﺮﺟ ﺐﻠﻃواد نارﺎﻤﻴﺑ ﺖﻳﺮﺜﻛا درﻮـﻣ ﺮـﻧوﺮﻛ قوﺮﻋ ﺪ

ﻲﺳرﺮﺑ ) 3 / 81 (%

ﺎﻬﻨﺗ نﺎﻧز و ﺪﻧداد ﻞﻴﻜﺸﺗ نادﺮﻣ ار 7

/ 18 %

ﺪﻧا هداد صﺎﺼﺘﺧا دﻮﺧ ﻪﺑ ار ﻪﻌﻟﺎﻄﻣ درﻮﻣ داﺮﻓا .

ﻲﻨﺳ ﻦﻴﮕﻧﺎﻴﻣ

ﻲﺳرﺮﺑ ﺖﺤﺗ داﺮﻓا 13

/ 49 رﺎﻴﻌﻣ فاﺮﺤﻧا ﺎﺑ 12

/ 11 هدﻮـﺑ لﺎﺳ

ﺖﺳا . ﻲﻨﺳ هوﺮﮔ رد ﻲﻧاواﺮﻓ ﻦﻳﺮﺘﺸﻴﺑ 44

- 35 ﻪﻟﺎـﺳ ) 3 / 31

(%

ﻨـﺳ هوﺮﮔ نآ زا ﺲﭘ و ﻲ

54 - 45 ﻪﻟﺎـﺳ ) 7 / 28 (%

هﺪﻫﺎـﺸﻣ

ﺪﺷ . ﺪـﺣ رد ﻲـﺳرﺮﺑ ﺖـﺤﺗ نارﺎـﻤﻴﺑ ﺖـﻳﺮﺜﻛا ﻲﻠﻴﺼﺤﺗ ﺢﻄﺳ

دﻮﺑ ﻢﻠﭙﻳد )

3 / 41 .(%

ﻞـﻤﻋ ﺐـﻠﻃواد نارﺎـﻤﻴﺑ ناﺰﻴﻣ ﻦﻳﺮﺘﺸﻴﺑ

داﺪـﻌﺗ ﺎـﺑ ﺖـﻴﻌﻤﺟﺮﭘ يﺎﻫراﻮﻧﺎﺧ ياراد ،ﻲﺳرﺮﺑ درﻮﻣ ﻲﺣاﺮﺟ ناﺪﻧزﺮﻓ 4 هدﻮﺑ ﺮﺘﺸﻴﺑ ﺎﻳ و )

4 / 49 (%

ﺖـﺤﺗ داﺮـﻓا ﺖـﻳﺮﺜﻛا و

ﻪﻌﻟﺎﻄﻣ ) 7 / 88 (%

هدﻮـﺑ ﻞـﻫﺎﺘﻣ ﻦﻳﺮﺘـﺸﻴﺑ ﻞﻏﺎـﺷ داﺮـﻓا و ﺪـﻧا

ﺪﺻرد ) 7 / 84 (%

ﺪﻧداد ﻞﻴﻜﺸﺗ ار نارﺎﻤﻴﺑ .

ﺖـﺤﺗ داﺮـﻓا ﺮﺘﺸﻴﺑ

ﻪﻌﻟﺎﻄﻣ ) 62 (%

ود رد ار نﺎﺘـﺳرﺎﻤﻴﺑ رد نﺪـﺷ يﺮﺘـﺴﺑ ﻪﻘﺑﺎـﺳ

ﻲﺳرﺮﺑ ﺖﺤﺗ داﺮﻓا ﺮﺘﺸﻴﺑ و ﻪﺘﺷاد ﺮﻴﺧا لﺎﺳ )

3 / 75 (%

ﻪﻘﺑﺎـﺳ

ﺪﻧدﻮﻤﻧ ﺮﻛذ ارMI

. نارﺎﻤﻴﺑ ﻦﻳا رد ﻞﻤﻋ زا ﻞﺒﻗ باﺮﻄﺿا ناﺰﻴﻣ

ﺑ ﻂﺳﻮﺘﻣ هﺮﻤﻧ ياراد ﺖﺳا هدﻮ

) 7 / 64 (%

زاﺪﻌﺑ باﺮﻄﺿا ناﺰﻴﻣ و

ﺖـﺳا هدﻮـﺑ ﻢـﻛ هﺮﻤﻧ ياراد نارﺎﻤﻴﺑ ﻦﻳا رد ﻞﻤﻋ )

3 / 97 (%

و

ﻂـﺳﻮﺘﻣ و ﻢـﻛ باﺮﻄـﺿا ﺶﻫﺎـﻛ ،ﻪـﻌﻟﺎﻄﻣ ﺖﺤﺗ داﺮﻓا ﺮﺘﺸﻴﺑ ﺪﻧا ﻪﺘﺷاد ) 3 / 87 .(%

ﻳ يﺎﻫ ﻪﺘﻓﺎ زا ﻞﺒﻗ باﺮﻄﺿا ناﺰﻴﻣ ﻪﻛ ﺪﻫد ﻲﻣ نﺎﺸﻧ ﺶﻫوﮋﭘ

ﻋ زا ﺪـﻌﺑ باﺮﻄـﺿا ناﺰﻴﻣ زا ﺮﺘﺸﻴﺑ ﺮﻧوﺮﻛ قوﺮﻋ ﺪﻧﻮﻴﭘ ﻞﻤﻋ ﻞـﻤ

ﺖﺳا هدﻮﺑ )

لواﺪﺟ 1 و 2 .(

لوﺪﺟ ) 1 :(

ﻪﻌﻟﺎﻄﻣ ﺖﺤﺗ نارﺎﻤﻴﺑ ﻲﺒﺴﻧ و ﻖﻠﻄﻣ ﻲﻧاواﺮﻓ ﻊﻳزﻮﺗ ﻞﻤﻋ زا ﻞﺒﻗ باﺮﻄﺿا ناﺰﻴﻣ ﺐﺴﺣ ﺮﺑ

باﺮﻄﺿا ناﺰﻴﻣ

ﻞﻤﻋ زا ﻞﺒﻗ ﻖﻠﻄﻣ ﻲﻧاواﺮﻓ

ﻲﺒﺴﻧ ﻲﻧاواﺮﻓ

ﻢﻛ 37

7

/ 24

ﻂﺳﻮﺘﻣ 97

7

/ 64

دﺎﻳز 16

6

/ 10

ﻊﻤﺟ 150

100

لوﺪﺟ ) 2 :(

ارﺎﻤﻴﺑ ﻲﺒﺴﻧ و ﻖﻠﻄﻣ ﻲﻧاواﺮﻓ ﻊﻳزﻮﺗ ﻪﻌﻟﺎﻄﻣ ﺖﺤﺗ ن

ﻞﻤﻋ زا ﺪﻌﺑ باﺮﻄﺿا ناﺰﻴﻣ ﺐﺴﺣ ﺮﺑ

باﺮﻄﺿا ناﺰﻴﻣ

ﻞﻤﻋ زا ﺪﻌﺑ ﻖﻠﻄﻣ ﻲﻧاواﺮﻓ

ﻲﺒﺴﻧ ﻲﻧاواﺮﻓ

ﻢﻛ

146

3

/ 97

ﻂﺳﻮﺘﻣ

4

7

/ 2

ﻊﻤﺟ

150

100

(5)

ﺲﻨﺟ نﻮﭼ ﻲﻳﺎﻫﺮﻴﻐﺘﻣ ﺎﺑ باﺮﻄﺿا تاﺮﻴﻴﻐﺗ ﻪﻛ ﺪﻫد ﻲﻣ نﺎﺸﻧ ﺶﻫوﮋﭘ يﺎﻫ ﻪﺘﻓﺎﻳ )

هرﺎﻤﺷ لوﺪﺟ 3

( ﻦـﺳ ، ) هرﺎﻤـﺷ لوﺪـﺟ 4

( ،

ناﺪﻧزﺮﻓ داﺪﻌﺗ )

ﺪﺟ هرﺎﻤﺷ لو 5

( ﻞﻫﺎﺗ ﺖﻴﻌﺿو و )

هرﺎﻤﺷ لوﺪﺟ 6

( ﺖﺳا ﻪﺘﺷاد يراد ﻲﻨﻌﻣ طﺎﺒﺗرا .

لوﺪﺟ ) 3 :(

ﺐﺴﺣ ﺮﺑ ﻪﻌﻟﺎﻄﻣ ﺖﺤﺗ نارﺎﻤﻴﺑ ﻲﺒﺴﻧ و ﻖﻠﻄﻣ ﻲﻧاواﺮﻓ ﻊﻳزﻮﺗ تاﺮﻴﻴﻐﺗ

باﺮﻄﺿا ﺲﻨﺟ و

باﺮﻄﺿا تاﺮﻴﻴﻐﺗ

ﺲﻨﺟ ﺶﻫﺎﻛ

ﺶﻳاﺰﻓا

ﻊﻤﺟ

نز 25

) 3 / 89 (%

3

) 7 / 10 (%

28

) 100 (%

دﺮﻣ 120

) 4 / 98 (%

2

) 6 / 1 (%

122

) 100 (%

ﻊﻤﺟ 125

) 7 / 96 (%

5

) 3 / 3 (%

150

) 100 (%

Fisher exact test P- value=0.045

لوﺪﺟ ) 4 :(

باﺮﻄﺿا ﻦﺳو

ﻦﺳ ﺶﻫﺎﻛ

ﺶﻳاﺰﻓا

ﻊﻤﺟ

45 ﺮﺘﻤﻛ و لﺎﺳ 59

) 2 / 92 (%

5

) 8 / 7 (%

64

) 100 (%

46 ﺳ ﺮﺘﺸﻴﺑ و لﺎ

86 ) 100 (%

0

) 0 (%

86

) 100 (%

ﻊﻤﺟ 145

) 7 / 96 ( 5

) 4 / 3 (%

150 ) 100 (%

لوﺪﺟ ) 5 :(

باﺮﻄﺿا ناﺪﻧزﺮﻓ داﺪﻌﺗو

ناﺪﻧزﺮﻓ داﺪﻌﺗ ﺶﻫﺎﻛ

ﺶﻳاﺰﻓا

ﻊﻤﺟ

ﺳ ﺮﺘﻤﻛ و ﺪﻧزﺮﻓ ﻪ

71 ) 4 / 93 (%

5

) 6 / 6 (%

76

) 100 (%

ﺮﺘﺸﻴﺑ و ﺪﻧزﺮﻓ رﺎﻬﭼ

74 ) 100 (%

0

) 0 (%

74

) 100 (%

ﻊﻤﺟ 145

) 7 / 96 ( 5

) 3 / 3 (%

150 ) 100 (%

لوﺪﺟ ) 6 :(

باﺮﻄﺿا و

ﻞﻫﺎﺗ ﺖﻴﻌﺿو

ﻞﻫﺄﺗ ﺖﻴﻌﺿو ﺶﻫﺎﻛ

ﺶﻳاﺰﻓا

ﻊﻤﺟ

ﻞﻫﺎﺘﻣ ﺮﻴﻏ 71

) 4 / 82 (%

3

) 6 / 17 (%

17

) 100 (%

ﻞﻫﺎﺘﻣ 131

) 5 / 98 (%

2 ) 5 / 1 (%

133 ) 100 (%

ﻊﻤﺟ 145

) 5 / 96 ( 5

) 3 / 3 (%

150 ) 100 (%

ﺮﮕﻳد يﺎﻫﺮﻴﻐﺘﻣ ﺎﺑ باﺮﻄﺿا تاﺮﻴﻴﻐﺗ ي

ﻨﻧﺎﻣ ،ﻲـﺒﻠﻗ ﺮـﻴﻏ ﻲـﺣاﺮﺟ ﻪﻘﺑﺎـﺳ،ﻲﺒﻠﻗ ﺮﻴﻏ يرﺎﻤﻴﺑ ﻪﻘﺑﺎﺳ ،تﻼﻴﺼﺤﺗ ﺢﻄﺳ ،ﻲﻠﻐﺷ ﺖﻴﻌﺿو ﺪ

ﻪﻘﺑﺎﺳ ﺖﺷاﺪﻧ يراد ﻲﻨﻌﻣ طﺎﺒﺗراMI

.

(6)

يﺮﻴﮔ ﻪﺠﻴﺘﻧ و ﺚﺤﺑ :

ﺖـﺤﺗ نارﺎـﻤﻴﺑ ﻪـﻛ ﺪـﻫد ﻲـﻣ نﺎـﺸﻧ ﻚﻴﻓاﺮﮔﻮﻣد يﺎﻫ هداد ﺎﺗﺪــﻤﻋ ﻪــﻌﻟﺎﻄﻣ

"

ﻖــﻠﻌﺘﻣ ﻪــﺑ ﻦﻴﻳﺎــﭘ رﺎــﺸﻗا

ﻲــﻣ ﻪــﻌﻣﺎﺟ

ﺪﻨﺷﺎﺑ . ﺮﺑ ﺖﺤﺗ نارﺎﻤﻴﺑ قﺎﻔﺗا ﻪﺑ ﺐﻳﺮﻗ ﺖﻳﺮﺜﻛا ﺎـﺑ داﺮـﻓا ار ﻲـﺳر

ﺮﺗ ﻦﻴﻳﺎﭘ و ﻢﻠﭙﻳد تﻼﻴﺼﺤﺗ )

1 / 86

% ( ﺪـﻨﻫد ﻲـﻣ ﻞﻴﻜﺸﺗ .

ﺎـﺑ

ﻦـﻳا ﻪـﻛ ﺖﻔﮔ ناﻮﺗ ﻲﻣ داﺮﻓا ﻦﻳا ﻲﻨﺳ هوﺮﮔ ﻪﺑ ﻪﺟﻮﺗ رد هوﺮـﮔ

و هدﺮﻛ جاودزا ﻦﻴﻳﺎﭘ ﻦﻴﻨﺳ هدﻮﺑ رادرﻮﺧﺮﺑ ﻲﻳﻻﺎﺑ يرورﺎﺑ زا

ﺪـﻧا .

ﻖﺑﺎــﻄﻣ هداد ﺎــﻳ ﺪــﻧزﺮﻓ رﺎــﻬﭼ ﺎــﺑ نارﺎــﻤﻴﺑ ، ﻖــﻴﻘﺤﺗ يﺎــﻫ

ردﺮﺘﺸﻴﺑ ﺖﺤﺗ داﺮﻓا ﻊﻤﺟ ﻄﻣ

دﻮـﺧ ﻪـﺑ ار ناﺰـﻴﻣ ﻦﻳﺮﺘـﺸﻴﺑ ﻪﻌﻟﺎ

ا هداد صﺎﺼﺘﺧا ﺪـﻧ

) 4 / 49 (%

. ﻞـﻫﺎﺗ يﻻﺎـﺑ ناﺰـﻴﻣ )

7 / 88 (%

رد

و ﻮـﺳ ﻚـﻳ زا جاودزا ﺖـﻴﻣﻮﻤﻋ زا ﻲﻛﺎﺣ ﺰﻴﻧ نﺎﻳﻮﮕﺨﺳﺎﭘ ﻊﻤﺟ يرورﺎﺑ زا ﻲﻛﺎﺣ يﻮﺤﻧ ﻪﺑ ﻪﻛ ﺖﺳا ﺮﮕﻳد يﻮﺳ زا سر دوز ﻞﻫﺎﺗ ﻪـﺑ ﻪـﻌﻣﺎﺟ ﻦﻴﻳﺎـﭘ رﺎـﺸﻗا ياﺮـﺑ ﻲﮔﮋﻳو ﻚﻳ لﺎﺣ ﻦﻴﻋ رد و ﻻﺎﺑ يدﺎــﺼﺘﻗا ظﺎــﺤﻟ -

ا ددﺮــﮔ ﻲــﻣ بﻮــﺴﺤﻣ ﻲﻋﺎــﻤﺘﺟ .

ﺢﻄــﺳ

ﺎﺘﺒﺴﻧ

"

رﺎﺸﻗا ﻪﺑ ﻖﻠﻌﺗ رد يﺮﮕﻳد ﺺﺧﺎﺷ ﺰﻴﻧ داﻮﺳ ﻦﻴﻳﺎﭘ ﻦﻴﻳﺎـﭘ

دﻮﺷ ﻲﻣ بﻮﺴﺤﻣ ﻲﻋﺎﻤﺘﺟا .

رد ﺮـﻧوﺮﻛ قوﺮـﻋ يرﺎﻤﻴﺑ ﻪﺑ ءﻼﺘﺑا

نارﺎـﻤﻴﺑ ندﻮـﺑ ناﻮـﺟ زا ﺖـﻳﺎﻜﺣ ، ﺶﻫوﮋـﭘ ﻦﻳا يرﺎﻣآ ﻪﻌﻣﺎﺟ دراد .

"ﻻﻮﺻا

قوﺮـﻋ يرﺎـﻤﻴﺑ ﻪـﺑ نﺎـﻧز زا ﺮﺘـﺸﻴﺑ مﻮﺳ ود نادﺮﻣ

ﺪﻧﻮـﺷ ﻲﻣ رﺎﭼد ﺮﻧوﺮﻛ )

12 و 10 .(

ﻲﻳﺎـﻧاﻮﺗ ﺪـﺳر ﻲـﻣ ﺮـﻈﻧ ﻪـﺑ

ﻲﻋﺎﻤﺘﺟا ﺖﻴﻌﻗﻮﻣ ﻪﺑ ﺖﺸﮔزﺎﺑ رد نادﺮﻣ -

زا ﻞـﺒﻗ رد يدﺎﺼﺘﻗا

ﺪﻫﺎﻛ ﻲﻣ ﺎﻬﻧآ ﻞﻤﻋ زا ﺪﻌﺑ باﺮﻄﺿا زا ،ﻞﻤﻋ )

10 .(

ﻪﺑ ﻞﻤﻋ زا ﻞﺒﻗ

زا ﻲﺷﺎﻧ و ﻲﻨﻳﮋﻧآ يﺎﻫدرد ﺖﻠﻋ ار يدﺎـﻳز باﺮﻄﺿا نارﺎﻤﻴﺑMI

ناﺰـﻴﻣ زا ﺎـﻬﻧآ ﻒـﻴﻔﺨﺗ ﺎـﻳ و ﻢﺋﻼﻋ ﻊﻓر ﺎﺑ ﻲﻟو ﺪﻨﻨﻛ ﻲﻣ ﻪﺑﺮﺠﺗ ا دﻮﺷ ﻲﻣ ﻪﺘﺳﺎﻛ داﺮﻓا باﺮﻄﺿ )

13 و 14 .(

زا سﺮـﺗ ﻦﺳ ﺶﻳاﺰﻓا ﺎﺑ

يﻻﺎﺑ داﺮﻓا ﺎﻣا دﻮﺸﻴﻣ ﺮﺘﺸﻴﺑ هﺪﻨﻳآ ﻲﻟﺎﻤﺘﺣا تﺎﻗﺎﻔﺗا 46

ﺎـﺑ لﺎﺳ

ﺪـﻴﻣا، ﻲﮔداﻮﻧﺎـﺧ يﺎﻫ ﻲﮕﺘﺴﺑاو شﺮﺘﺴﮔ ﻞﻴﻟد ﻪﺑ و ﻞﻤﻋ مﺎﺠﻧا ﺪـﻨﻨﻛ ﻲـﻣ اﺪـﻴﭘ يﺮﺘـﺸﻴﺑ ﻲﮔﺪـﻧز ﻪﺑ .

ﻞـﻴﻟد ﻪـﺑ ﻞـﻫﺎﺘﻣ داﺮـﻓا

ﻔﺨﺗ ﻞﻴﻟد ﻪﺑ ﻞﻤﻋ زا ﺪﻌﺑ ﻲﮔداﻮﻧﺎﺧ يﺎﻬﺘﻴﻟﻮﺌﺴﻣ ﻲﺒﻠﻗ ﻢﻳﻼﻋ ﻒﻴ

ﻲــﻣ ﻪــﺑﺮﺠﺗ ار يﺮــﺘﻤﻛ باﺮﻄــﺿا ناﺰــﻴﻣ، ﻲــﻧاور ﺶــﻣارآ و ﺪﻨﻳﺎﻤﻧ ) 15 .(

ﺪـﻫد ﻲـﻣ نﺎﺸﻧ ﺶﻫوﮋﭘ ﻦﻳا يﺎﻫ ﻪﺘﻓﺎﻳ زا يا هرﺎﭘ

ﻪﺑ ﻲﻧﺎﻣرد تﺎﻣﺪﺧ ﻪﺻﺮﻋ ﺎﺑ ﻲﻳﺎﻨﺷآﺎﻧ ، باﺮﻄﺿا هﺪﻤﻋ ﻞﻣﺎﻋ ﻪﻛ ﻲﮕﺘـﺳﻮﻴﭘ و ﻮﺳ ﻚﻳ زا نآ ﻲﻜﻳژﻮﻟﻮﻨﻜﺗ و ﻲﻜﻴﻨﻜﺗ دﺎﻌﺑا رد هﮋﻳو ﻮﺳ زا ﻲﻋﺎﻤﺘﺟا يﺎﻫ ﻲﮕﺘﺴﺒﻤﻫ و ﺎﻫ ﺪـﺷﺎﺑ ﻲـﻣ ﺮـﮕﻳد ي

) 16 .(

زا سﺮﺗ ﺮﻄﺧ، ﻲﺣاﺮﺟ و يرﺎﻤﻴﺑ ﻪﺑﺮﺠﺗ نارﺎﻤﻴﺑ زا يرﺎﻴﺴﺑ ياﺮﺑ ﻲـﻣ ﻲﻋاﺪﺗ ار ﻲﮔﺪﻧز زا ﻦﺘﺴﺴﮔ و گﺮﻣ و ﻲﮕﺘﺴﺑاو ، ﺖﻴﻟﻮﻠﻌﻣ ﺖـﺳا باﺮﻄﺿا ﺐﺟﻮﻣ ﺰﻴﻧ دﻮﺧ ﻪﻛ ﺪﻨﻛ )

16 .(

و بﻮـﻛ ﻪـﻌﻟﺎﻄﻣ نارﺎــﻜﻤﻫ

)

Coob, et al

( ﻪــﻌﻟﺎﻄﻣ ﺎــﺑ 60

رد يﺮﺘــﺴﺑ رﺎــﻤﻴﺑ

، ﺐـﻠﻗ ﻲﺣاﺮﺟ يﺎﻬﺸﺨﺑ ـﻳا ﻪـﺑ

ﺮﺘـﺸﻴﺑ ﻪـﻛ ﺪﻧﺪﻴـﺳر ﻪـﺠﻴﺘﻧ ﻦ

و ﺪﻨﺘـﺴﻫ ﺪﻳﺪـﺷ ﺎﺗ ﻂﺳﻮﺘﻣ باﺮﻄﺿا زا ﻲﺗﺎﺟرد رﺎﭼد نارﺎﻤﻴﺑ اﺮﺜﻛا

"

ﺪـﻣﺎﻴﭘ و ﻂﻴﺤﻣ ﺎﺑ ﻲﻳﺎﻨﺷآ مﺪﻋ و ﻲﺣاﺮﺟ ﻪﺠﻴﺘﻧ درﻮﻣ رد و ﺪﻨﺘـﺴﻫ ﻲﻫﺎـﮔآ ﺐـﺴﻛ ﺪﻨﻣزﺎﻴﻧ دراﻮﻣ ﻦﻳا رد و هدﻮﺑ نآ يﺎﻫ ﻲـﻣ ﺶﻫﺎـﻛ يراد ﻲـﻨﻌﻣ ناﺰـﻴﻣ ﻪـﺑ ﻲـﺣاﺮﺟ زا ﺲﭘ باﺮﻄﺿا ﺪﺑﺎﻳ ) 17 .(

ﻜﻤﻫ و يﺮﻓاﺰﭙﺳا نارﺎ

)

Spezzaferri,et al

( ﻪـﻌﻟﺎﻄﻣ رد

ﻲـﺣاﺮﺟ ﻞﻤﻋ زا ﻲﺷﺎﻧ ﻲﻧاور تﻻﻼﺘﺧا ﻲﺳرﺮﺑ فﺪﻫ ﺎﺑ ﻪﻛ دﻮﺧ ﺪﺷ مﺎﺠﻧا ﺎﻴﻟﺎﺘﻳا رد زﺎﺑ ﺐﻠﻗ ،

ﻲﺘﻟﺎـﺣ باﺮﻄـﺿا ﻪـﻛ ﺪﻧداد نﺎﺸﻧ

ناﺰـﻴﻣ ﻪـﺑ ﺮـﻧوﺮﻛ قوﺮﻋﺪـﻧﻮﻴﭘ ﻲـﺣاﺮﺟ ﻞـﻤﻋ زا ﻲﺷﺎﻧ 5

/ 23 %

ﻲﻣ ﺶﻫﺎﻛ ﺞﻳرﺪﺗ ﻪﺑ ﻞﻤﻋزا ﺲﭘ لﺎﺴﻜﻳ ﺎﺗ ﻪﻛ ﺪﺑﺎﻳ ﻲﻣ ﺶﻳاﺰﻓا ﺪﺑﺎﻳ ) 18 .(

و ﻲﮕﺘﺳﻮﻴﭘ ، ﺮﺘـﺸﻴﺑ ﻲـﻧاواﺮﻓ ﺎـﺑ ﻲﻋﺎـﻤﺘﺟا تﺎﻃﺎﺒﺗرا

ﺶﻫوﮋـﭘ درﻮـﻣ نارﺎـﻤﻴﺑ ﻪﻌﻣﺎﺟ رد ار يﺮﺘﺸﻴﺑ باﺮﻄﺿا ﺶﻫﺎﻛ ﺖﺳا هدﻮﻤﻧ ﺲﻜﻌﻨﻣ .

ناﺪـﻧزﺮﻓ داﺪـﻌﺗ ﺎـﺑ داﺮـﻓا لﺎـﺜﻣ ناﻮـﻨﻋ ﻪﺑ

باﺮﻄﺿا ﺶﻫﺎﻛ ﻞﻤﻋ زا ﺲﭘ ، ﺮﺘﺸﻴﺑ 100

% ﺪﻧداد نﺎﺸﻧ دﻮﺧ زا

. اﺪـﻧزﺮﻓ داﺪﻌﺗ ﺎﺑ داﺮﻓا ﻊﻤﺟ رد ناﺰﻴﻣ ﻦﻳا ﻪﻜﻴﺗرﻮﺻ رد ﺮـﺘﻤﻛ ن

ﺖﺳا هدﻮﺑ رﻮﻛﺬﻣ ﺪﺣ زا ﺮﺗ ﻦﻴﻳﺎﭘ .

ﺪـﻴﺋﺎﺗ يﻮـﺤﻧ ﻪﺑ ﺪﻳﺎﺷ ﺮﻣا ﻦﻳا

ﻪﻜﺒـﺷ ﺎـﺑ داﺮﻓا نآ ﻖﺑﺎﻄﻣ ﻪﻛ ﺪﺷﺎﺑ ﻢﻴﻛرود ﻞﻴﻣا يرﻮﺌﺗ هﺪﻨﻨﻛ ﻪـﺑ يﺮـﺘﻤﻛ ﻞـﻴﻣ و ﻲﮔﺪـﻧز ﻪـﺑ ﻲﮕﺘـﺴﺑاو ، ﺮﺘﻌﻴﺳو تﺎﻃﺎﺒﺗرا ﺪﻧراد ﻲﺸﻛ دﻮﺧ ﻪﺑ ماﺪﻗا ﺎﺑ نآ زا ﻦﺘﺴﺴﮔ .

عﻮﺿﻮﻣ ﻦﻳا ﺪﻴﺋﺎﺗ رد

ﻫﺎـﺘﻣ ﻪـﻛ ﺪـﻫد ﻲﻣ نﺎﺸﻧ ﺮﺿﺎﺣ ﺶﻫوﮋﭘ ﻪـﻛ ناﺪﻨﻤﻟﺎـﺳ و ﻦﻴﻠ

ﻻﻮﻤﻌﻣ

"

را ﻪﻜﺒﺷ ياراد ﺗ

ﻪـﺴﻳﺎﻘﻣ رد يﺮﺘﻌﻴﺳو ﻲﻋﺎﻤﺘﺟا تﺎﻃﺎﺒ

ﺪﻨﺘﺴﻫ ﻦﻳدﺮﺠﻣ ﺎﺑ ﺪﻧا ﻪﺘﺷاد يﺮﻴﮕﻤﺸﭼ باﺮﻄﺿا ﺶﻫﺎﻛ ،

. رد

نارﺎﻜﻤﻫ و ﺖﻨﺑوﺮﺘﺳا ﺶﻫوﮋﭘ ، ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﺪﻴﺋﺎﺗ )

Stroobant,

et al

( ﺪﻧﻮﻴﭘ ﻞﻤﻋ زا ﺲﭘ نارﺎﻤﻴﺑ ﻲﻧاور دﺮﻜﻠﻤﻋ ﻲﺳرﺮﺑ فﺪﻫ ﺎﺑ

نﺎﺸﻧ ﺮﻧوﺮﻛ قوﺮﻋ ﻮﺤﻧ ﻪﺑ باﺮﻄﺿا ﻪﻛ داد

رﺎﻴـﺴﺑ يﺮﻴﮕﻤـﺸﭼ

ﺪﺑﺎﻳ ﻲﻣ ﺶﻫﺎﻛ ﻞﻤﻋ زا ﺲﭘ )

19 .(

ﻦﻴـﻨﭼ ناﻮـﺗ ﻲﻣ عﻮﻤﺠﻣ رد

زا ﺮﺛﺎـﺘﻣ نارﺎـﻤﻴﺑ ﻦـﻳا رد باﺮﻄـﺿا ﺶﻫﺎـﻛ ﻪـﻛ دﺮﻛ طﺎﺒﻨﺘﺳا يدﺎﺼﺘﻗا، ﻚﻴﻓاﺮﮔﻮﻣد يﺎﻫﺮﻴﻐﺘﻣ -

ﺖـﺳا ﻲـﮕﻨﻫﺮﻓ و ﻲﻋﺎﻤﺘﺟا .

ﺎـﺑ ﻲﻳﺎﻨـﺷآﺎﻧ و ﻲﻳﺎﻨـﺷآ ،دﺮـﺠﺗ و ﻞﻫﺎﺗ ،داﻮﺳ ﺢﻄﺳ ، ﺖﻴﺴﻨﺟ و نﺎﻣرد ﻪﺻﺮﻋ ...

ماﺪﻛ ﺮﻫ راﺬـﮔ ﺮﻴﺛﺎـﺗ ﺪﻨﻳآﺮﻓ ﻦﻳا رد يﻮﺤﻧ ﻪﺑ

ﺪﻧا هدﻮﺑ . دﺎـﺠﻳا يﺎﺘـﺳار رد يﺰﻳر ﻪﻣﺎﻧﺮﺑ ﻪﻧﻮﮔ ﺮﻫ ياﺮﺑ رﺎﭼﺎﻧ ﻪﺑ ﻦـﻳا زا ﻲﺧﺮﺑ يا ﻪﻧﻮﮔ ﻪﺑ ﺪﻳﺎﺑ باﺮﻄﺿا ناﺰﻴﻣ و ﺢﻄﺳ رد ﺮﻴﻴﻐﺗ

دﻮﻤﻧ ﻞﻳﺪﻌﺗ ار ﺎﻫﺮﻴﻐﺘﻣ .

ناﻮـﻨﻋ ﻪـﺑ ﺎـﻫروﺎﺑ و ﺎﻬﺷزرا ، تادﺎﻘﺘﻋا

اﻮﺗ ﻲﻣ ﻲﮔﺪﻧز ﻪﺑﺮﺠﺗ ﻲﮕﻨﻫﺮﻓ ﺞﻳﺎﺘﻧ و دﺎﻌﺑا باﺮﻄـﺿا زوﺮﺑ رد ﺪﻧ

ﺎﻔﻳا ﻲﺳﺎﺳا ﺶﻘﻧ نآ ﻒﻌﺿ و تﺪﺷ و

ﺪﻳﺎﻤﻧ ) 20 و 8 .(

(7)

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