Research Paper
Copyright © 2021 Sabzevar University of Medical Sciences. This work is licensed under a Creative Commons Attribution- Non Commercial 4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited .
Published by Sabzevar University of Medical Sciences.
The Effect of Mindfulness-based Intervention on Postpartum Depression in Mothers with Infants in NICU
Ashraf Khoramirad1, Mojtaba Ansari Shahidi2*, Hasan Rezaei Jamaloei3, Parvaneh Sadeghimoghaddam4
1. PhD candidate, Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran 2. Assistant Professor, Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran 3. Assistant Professor, Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran 4. Associate Professor, Pediatrics Clinical Research Development Center, Qom University of Medical Sciences, Qom,
Iran
Received: 2019/09/16 Accepted: 2019/10/03
Abstract
Introduction: Having an infant in the Neonatal Intensive Care Unit (NICU) is very stressful and increases the risk of postpartum depression. The aim of this study was to investigate the effect of mindfulness intervention on the prevention of postpartum depression in mothers with preterm infants admitted to NICU.
Materials and Methods: : In an interventional study, postpartum depression was compared in three groups under mindfulness-based developmental care (group 34 = 1), developmental care (group 39 = 2) and control (group 3 = 50). Sampling was purposive and group assignment was random. Data were collected using the Edinburgh Postpartum Depression Inventory and the Demographic Information Questionnaire.
Results: The results of covariance analysis showed that the mean score of postpartum depression in the two months postpartum in the mindfulness-based developmental care group was significantly lower than the other two groups (pvalue
<.01) While 78% of postpartum depression changes could be explained by the intervention R2 = 78%..
Conclusion: Mindfulness based interventions are effective in reducing postpartum depression scores and it is recommended that these interventions be considered at the NICUs for better effectiveness of developmental care programs and reduction of psychological complications in mothers.
*Corresponding Author: Mojtaba Ansari Shahidi
Address: Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran
Tel: 09124377330
E-mail: [email protected]
Keywords: Mindfulness, Postpartum Depression, NICU
How to cite this article: Khoramirad A., Ansari Shahidi M., Rezaei Jamaloei H., Sadeghimoghaddam P. The Effect of Mindfulness-based Intervention on Postpartum Depression in Mothers with Infants in NICU, Journal of Sabzevar University of Medical Sciences, 2021; 28(4):509- 520.
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Introduction
Postpartum depression (PPD) is a serious mental disorder and the most common complication in the postpartum period with a prevalence of 10 to 15% and in different societies, more than 12.5%
of women's admissions for psychiatric disorders are related to it. PPD is higher in mothers with infants in the neonatal intensive care unit, and approximately 28 to 70% of mothers of preterm infants in the NICU report significant degrees of psychological distress. Babies who stay in the NICU for long periods of time were often born prematurely, and prematurity is a major contributor to infants' neurodevelopment.
Maternal depression also has long-term consequences for children's cognitive, emotional and developmental grow. Thus, hospitalization in the NICU exacerbate the negative effects of postpartum depression on the growth and development of preterm infants.
Previous research has shown that maternal depression in the postpartum period interferes with mother-infant attachment and adversely affects breastfeeding and the mother's ability to care of the baby. It may also lead to anger or irritability, hostility and aggression of the mother towards NICU staff and the newborn.
Mindfulness is one of the psychological interventions that is considered to have significant positive effects in texts today.
Mindfulness is a person's clear awareness of what is happening inside and in interaction with the external environment, in successive moments of perception that can help free people from automatic thoughts, habits and unhealthy behavioral patterns and therefore play an important role in regulating behavior In addition, by adding clarity and life to experiences, it can bring health and freshness.
In a study conducted in this field, a significant decrease in postpartum depression scores was reported in the group undergoing intermittent metacognitive therapy intervention, although the above study was performed on mothers with healthy and full-term infants and therefore cannot be generalized to mothers with premature and hospitalized infants. In some other studies, supportive interventions for mothers have improved the short-term and long-term development of NICU infant.
Recent meta-analysis studies on effective and applicable interventions in the NICU point to a
gap in studies examining the effectiveness of mindfulness-based interventions on postpartum anxiety and depression in the NICU. Therefore, the present study was designed and performed to determine the effect of mindfulness intervention on the prevention of postpartum depression in mothers with preterm infants admitted to the NICU.
The present study was limited to mothers who, although at risk for depression, were not definitively diagnosed with depression, so it is suggested that longitudinal studies examine the impact of mindfulness based intervention on mothers who meet the criteria for depression during pregnancy.
Methodology
This study was a three-group interventional study consisting of two intervention groups:
mindfulness-based developmental care group (group 1), developmental care group (grop2) and a control group (group3). The neonatal wards of the two hospitals were considered as the research environment. Mothers of premature infants admitted to the neonatal wards of the above hospitals who meet the inclusion criteria include:
gestational age 25-35 weeks, minimum birth weight 800 grams, predicting the duration of infant hospitalization in the NICU for at least 14 days, no more than From 5 days of delivery at the time of admission, no history of psychiatric disorders before and at the time of admission, no use of psychiatric drugs, the ability to receive training, agree to participate in research and sign written consent , And lack of exclusion criteria including: need for surgery in the infant, language barrier, stay of the infant in NICU less than 14 days, maternal dissatisfaction to continue participation in the study, receiving psychological treatment during the study, diagnosis of congenital anomalies in The neonates had cerebral hemorrhage in grade 3 and 4 in the neonates. They were studied by easy and consecutive sampling until the sample size was completed and were randomly selected using a random number table in the evolutionary care groups based on mindfulness, evolutionary care and were controlled. According to the statistical power of 0.8, the number of sample sizes for each group was considered 34. However, in order to control the cases of sample loss, sampling
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continued until the sample size reached 50 mothers in each group. After the loss (18% loss) in the intervention and data collection stages, finally the information about 123 mothers (34 in the mindfulness group, 39 in the developmental care group and 50 in the control group) were analyzed.
Mothers of group1 and group 2 participated in individual training sessions in the hospital training room during the first 10 days after delivery. Four sessions of 30-60 minutes of developmental care training for each mother in group 2 and four sessions of 30-60 minutes of mindfulness training in addition to developmental care sessions were held for each mother in the mindfulness-based evolutionary care group. For the control group, no intervention was performed except for routine ward care. Developmental care training included training in environmental stress management and skin care, sleep, pain, kangaroo care, and infant nutrition. Mindfulness training included the principles and techniques of mindfulness based developmental care of the infant. The instruments used in the study included the Demographic Questionnaire and the Edinburgh Postpartum Depression Questionnaire.
Demographic questionnaire including maternal age, maternal occupation, history of depression or other psychiatric disorders in the mother, spouse support and age and birth weight of the baby, sex of the baby, number of fetuses, level of education, having another child, type of delivery and Apgar score. The Edinburgh Postnatal Depression Scale EPDS (10 items) was used to determine the rate of postpartum depression. The Edinburgh Scale is between zero and 30, and a score of 12 or higher is considered postpartum depression (19). In the present study, Cronbach's alpha coefficient for the Edinburgh questionnaire was 0.70.
Result
The mean age of mothers was 29.8 ±6.60 years, 52 mothers (74.8%) had a bachelor's or master's degree, and 108 mothers (88.5%) had no history of depression or other psychiatric disorders. Most neonates were single (74.8%) and 84 (68.3%) cesarean deliveries and the mean fetal age was 31.7
± 2.74. Based on univariate analysis and at a significant level of 30%, neonatal singleton, history of depression or other psychiatric disorders
in the mother, maternal age, birth weight, Apgar score and postpartum depression before the intervention, considered as potential variables can be heterogeneous between groups and using the analysis of covariance to adjust the effect of these variables. Postpartum depression and multiple birth were determined as the final variables whose distribution was significant among the three groups. The effect of the above two variables was controlled using covariance test.
The results of covariance analysis showed that the mean score of postpartum depression in the two months after birth in the mindfulness-based developmental care group was significantly lower than the other two groups (p-value< 0.01). Further results showed that R2= 78%. Due to the high value of this index, it can be considered that 78%
of postpartum depression changes can be justified by behavioral intervention (mindfulness based intervention).
Discussion
The results showed that mindfulness-based intervention is effective on postpartum depression in mothers with infants admitted to the NICU.
Depression scores 2 months after delivery were significantly lower in the mindfulness-based developmental care group compared to the control group and the developmental care group. Since there was no significant difference between the scores of depression in the developmental care group and control group it can be concluded that adding psychological interventions such as mindfulness to infant care training programs can be more effective on mothers' psychological symptoms such as postpartum depression. There is little research on the effect of mindfulness interventions in preventing the onset and exacerbation of postpartum depression in mothers with infants admitted to the NICU. In a study aimed at investigating the effects of metacognitive therapy based on disconnected mindfulness pattern on postpartum depression it was concluded that this method improves depression in women with postpartum depression. Although this study was performed on women with postpartum depression, their infants were not premature and were not admitted to the intensive care unit. The present study added to previous findings and showed that mindfulness-based intervention has a preventive effect in mothers whose diagnosis of depression is not yet known but who are at risk due to preterm
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delivery and hospitalization of the infant in the NICU.
Explaining the above findings, mindfulness training as a mechanism by which parents learn not to judge their own and their child's behavior makes them distance themselves from negative emotions and so pursue parental goals in the first days after birth with more motivation. It has already been suggested that mindfulness-based parenting interventions target six areas: 1. Parental stress. 2.
Parents 'concerns about their own or the child's psychological problems. 3. Parents' executive performance. 4. Repetition of dysfunctional habits and plans. 5- Self-centered attention 6- Marital performance and joint parental performance.
Learning the concept and techniques of mindfulness helps mothers to accept that although the negative emotions of being admitted to a NICU are stressful and painful, but they are temporary and not a fixed part of life.
Previous research has shown that higher rates of depression in mothers of preterm infants during the first year are associated with factors such as more stress during hospitalization and greater concerns about the baby's health. In this regard, mothers of the mindfulness group, with the help of five mindfulness skills, act with awareness, observation, and description, non-reaction to internal experience and non-judgment, while attending the NICU and on their baby's bedside to observe events far from any judgment. On the other hand, mindfulness exercises improve the mother's performance and optimal relationship with her husband, and with better empathy, facilitate accepting the situation and overcoming this
situation with less vulnerability. Depression is exacerbated by rumination activation and maladaptive response patterns. During the mindfulness exercises, the mothers in the intervention group learned how to get rid of rumination and did not fall into the trap of the vicious circle by performing exercises such as daily activities and caring for the baby with a focus on the five senses, practicing conscious deep breathing and maintaining the present.
Conclusions
Because mothers of infants in the NICU are at high risk for postpartum depression and infants often stay in the NICU for a long time, designing and evaluating the effectiveness of psychological interventions such as mindfulness-based interventions is essential to advance the care goals of neonates admitted to the NICU and to prevent the onset and exacerbation of postpartum depression.
The present study provided new information on the feasibility and effectiveness of mindfulness-based interventions on postpartum depression in mothers of NICU infants. It is suggested that along with other defined elements of developmental care, an element called mindfulness intervention be provided for mothers in NICUs.
Conflict of Interest
Conflict of interest statement must be placed at the manuscript as below: “the authors declare that there are no conflict of interest regarding the publication of this manuscript”.
ﯽﺷھوژﭘ ﮫﻟﺎﻘﻣ
Copyright © 2021 Sabzevar University of Medical Sciences. This work is licensed under a Creative Commons Attribution- Non Commercial 4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited.
Published by Sabzevar University of Medical Sciences.
ﮥﻠﺠﻣ ﯽﻤﻠﻋ ـ ،راوﺰﺒﺳ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﯽﺸﻫوﮋﭘ ةرود
28 ةرﺎﻤﺷ ، 4 ، ﺮﻬﻣ و نﺎﺑآ 1400 ص ، 520 - 509
[email protected] :ﻪﻣﺎﻧﺎﯾار http://jsums.medsab.ac.ir :ﺖﯾﺎﺳ سردآ :ﯽﭘﺎﭼ يﺎﭘﺎﺷ 7487
- 1606
ﻦﻫذ ﺮﺑ ﯽﻨﺘﺒﻣ ﻪﻠﺧاﺪﻣ ﺮﯿﺛﺄﺗ رد يﺮﺘﺴﺑ دازﻮﻧ ياراد ناردﺎﻣ رد نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا ﺮﺑ ﯽﻫﺎﮔآ
ﺖﺒﻗاﺮﻣ ﺶﺨﺑ نادازﻮﻧ هﮋﯾو يﺎﻫ
فﺮﺷا ﯽﻣﺮﺧ دار ،1
ﯽﺒﺘﺠﻣ يرﺎﺼﻧا يﺪﯿﻬﺷ
*
،2
ﻦﺴﺣ ﯽﯾﺎﺿر ﯽﯾﻮﻟﺎﻤﺟ ،3
مﺪﻘﻣ ﯽﻗدﺎﺻ ﻪﻧاوﺮﭘ
4
1 . هوﺮﮔ ناور
،ﯽﺳﺎﻨﺷ ﺪﺣاو ﻒﺠﻧ
،دﺎﺑآ هﺎﮕﺸﻧاد دازآ
،ﯽﻣﻼﺳا ﻒﺠﻧ
،دﺎﺑآ ناﺮﯾا
2.
،ﯽﻧﺎﻗﺮﻓ نﺎﺘﺳرﺎﻤﯿﺑ ﯽﻨﯿﻟﺎﺑ تﺎﻘﯿﻘﺤﺗ ﻪﻌﺳﻮﺗ ﺰﮐﺮﻣ هﺎﮕﺸﻧاد
مﻮﻠﻋ ﯽﮑﺷﺰﭘ
،ﻢﻗ
،ﻢﻗ ناﺮﯾا
:ﺖﻓﺎﯾرد ﺦﯾرﺎﺗ 26
/ 06 / 1399 :شﺮﯾﺬﭘ ﺦﯾرﺎﺗ
12 / 07 / 1399
1 . ﻪﻣﺪﻘﻣ
ﯽﮔدﺮﺴﻓا ﺲﭘ
زا نﺎﻤﯾاز ) ﮏﯾ (PPD
لﻼﺘﺧا ﯽﻧاور يﺪﺟ
و 15ﺎﺗ10عﻮﯿﺷﺎﺑهرودﻦﯾاردﻊﯾﺎﺷ ﻪﺿرﺎﻋﻦﯾﺮﺗناواﺮﻓ ﺪﺻرد 125/ زا ﺶﯿﺑ ،ﻒﻠﺘﺨﻣ ﻊﻣاﻮﺟ رد ﻪﮐ يرﻮﻃ ﻪﺑ( 1) ﺖﺳا ﺪﺻرد
شﺮﯾﺬﭘ يﺎﻫ نﺎﻧز ﻪﺑ ﻞﯿﻟد تﻼﮑﺸﻣ ﯽﻧاور
ار ﻪﺑ صﺎﺼﺘﺧا دﻮﺧ
ﯽﻣ ﺪﻫد ) 2 ( زوﺮﺑ خﺮﻧ .
PPD
رد ﯽﻧاردﺎﻣ ﻪﮐ دازﻮﻧ رد يﺮﺘﺴﺑ
ﺶﺨﺑ ﺖﺒﻗاﺮﻣ يﺎﻫ هﮋﯾو نادازﻮﻧ ﺪﻧراد ﺮﺗﻻﺎﺑ
ًﺎﺒﯾﺮﻘﺗ و ﺖﺳا 28
ﺎﺗ تﺎﺟردNICU ردسرﺎﻧنادازﻮﻧ ناردﺎﻣﺪﺻرد70 زا يرادﺎﻨﻌﻣ
ﯽﻧﺎﺸﯾﺮﭘ هدﺮﮐ شراﺰﮔ ار ﯽﻧاور نﺎﺸﻧ تﺎﻌﻟﺎﻄﻣ ﻦﯿﻨﭽﻤﻫ ،ﺪﻧا
هداد رد دازﻮﻧ ﺖﻣﺎﻗا نﺪﺷ ﯽﻧﻻﻮﻃ ﺎﺑ ﺪﻧا
NICU
تﺪﺷ و ﮏﺴﯾر
ﻪﺑ ﻼﺘﺑا ﯽﻣ ﺶﯾاﺰﻓاPPD
ﺪﺑﺎﯾ ) 3 (
. ﻦﯿﻤﺠﻨﭘ يﺎﻫرﺎﯿﻌﻣ ﻖﺑﺎﻄﻣ ﺖﺳاﺮﯾو
يﺎﻤﻨﻫار شور
يﺎﻫ زا ﺲﭘ ﯽﮔدﺮﺴﻓا ،ﯽﻧاور تﻻﻼﺘﺧا يرﺎﻣآ و ﯽﺼﯿﺨﺸﺗ نﺎﻤﯾاز
ترﺎﺒﻋ ﺖﺳا ﯽﮔدﺮﺴﻓا زا هﺪﻤﻋ
و دﻮﺟو ﻢﻫ نﺎﻣز ﺞﻨﭘ درﻮﻣ
زا ﯽﮔدﺮﺴﻓا ﻪﺼﺨﺸﻣ و ﯽﻧﺎﻤﺴﺟ ﻢﻈﻧ ندرﻮﺧ ﻢﻫﺮﺑ ﻢﺋﻼﻋ ﻪﮐتﺬﻟ و ﻪﻗﻼﻋ ﺶﻫﺎﮐ ﺎﯾ هدﺮﺴﻓا ﻖﻠﺧ ﺎﻬﻧآ زا ﯽﮑﯾ ﻞﻗاﺪﺣ رد نﺎﻤﯾاز زا ﺲﭘ ﻪﺘﻔﻫ 4 فﺮﻇ ﺮﺜﮐاﺪﺣ و ﺪﺷﺎﺑ ﺎﻫﺖﯿﻟﺎﻌﻓ زﺎﻏآﺳ لﻮﻃ رد نﺎﻣز ﺮﻫ رد ﺖﺳا ﻦﮑﻤﻣ PPD ﻢﺋﻼﻋ .(4) ددﺮﮔ لﺎ
* ﺪﻨﺴﯾﻮﻧ ة لﻮﺌﺴﻣ : ﯽﺒﺘﺠﻣ
يرﺎﺼﻧا يﺪﯿﻬﺷ
:ﯽﻧﺎﺸﻧ : ﻦﻔﻠﺗ 09124377330
:ﻪﻣﺎﻧﺎﯾار [email protected]
ﻪﺳﺎﻨﺷ ORCID 0000-0003-3213-5164:
ﻪﺳﺎﻨﺷ ORCID :لوا هﺪﻨﺴﯾﻮﻧ
-9797 -0475 -0003 0000
هژاوﺪﯿﻠﮐ
،نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا:ﺎﻫ
ﻦﻫذ ،ﯽﻫﺎﮔآ
NICU
هدﯾﮑﭼ
فﺪﻫ و ﻪﻨﯿﻣز :
ﻦﺘﺷاد دازﻮﻧ رد ﺶـﺨﺑ ﺖﺒﻗاﺮﻣ يﺎـﻫ هﮋـﯾو نادازﻮـﻧ ) NICU
رﺎﯿـﺴﺑ ( سﺮﺘـﺳا از ﺖـﺳا و زوﺮـﺑ ﺮـﻄﺧ
ﯽﻣ ﺶﯾاﺰﻓا ار نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا فﺪﻫ .ﺪﻫد
ﻦﯾا
،ﻪﻌﻟﺎﻄﻣ ﯽﺳرﺮﺑ زا يﺮﯿﮕـﺸﯿﭘ ﺮـﺑ ﯽﻫﺎـﮔآ ﻦـﻫذ ﻪـﻠﺧاﺪﻣ ﺮﯿﺛﺄـﺗ
رد يﺮﺘﺴﺑ سرﺎﻧ دازﻮﻧ ياراد ناردﺎﻣ رد نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا ﯽﻣNICU
.ﺪﺷﺎﺑ
شور و داﻮﻣ ﻫﺎ
: ﻪﻠﺧاﺪﻣ ﻪﻌﻟﺎﻄﻣ ﮏﯾ رد نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا ،يا
ﻦﻫذ ﺮﺑ ﯽﻨﺘﺒﻣ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ﺖﺤﺗ هوﺮﮔ ﻪﺳ رد
هوﺮﮔ) ﯽﻫﺎﮔآ 1
= 34 هوﺮﮔ) ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ،(
2
= 39 هوﺮﮔ) لﺮﺘﻨﮐ و ( 3
= 50 ﻪﻧﻮﻤﻧ .ﺪﺷ ﻪﺴﯾﺎﻘﻣ ( ﻞﮑﺷ ﻪﺑ يﺮﯿﮔ
ﯽﻨﺘﺒﻣ هوﺮﮔ ﺺﯿﺼﺨﺗ و فﺪﻫ ﺮﺑ ﻊﻤﺟ .دﻮﺑ ﯽﻓدﺎﺼﺗ ﻞﮑﺷ ﻪﺑ ﺎﻫ
هداد يروآ ﺎﺑ ﺎﻫ ﺶﺳﺮﭘ زا هدﺎﻔﺘﺳا زا ﺲﭘ ﯽﮔدﺮﺴﻓا ﻪﻣﺎﻧ
ﺶﺳﺮﭘ و گرﻮﺒﻨﯾدا نﺎﻤﯾاز .ﺪﺷ مﺎﺠﻧا ﮏﯿﻓاﺮﮔﻮﻣد تﺎﻋﻼﻃا ﻪﻣﺎﻧ
ﻪﺘﻓﺎﯾ ﺎﻫ :
رد نﺎﻤﯾاز زا ﺪﻌﺑ هﺎﻣ ود رد نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا هﺮﻤﻧ ﻦﯿﮕﻧﺎﯿﻣ ﻪﮐ داد نﺎﺸﻧ ﺲﻧﺎﯾراوﻮﮐ ﻞﯿﻠﺤﺗ ﺞﯾﺎﺘﻧ
ﯽﻨﺘﺒﻣ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ هوﺮﮔ ﻦﻫذ ﺮﺑ
ﻪﺑ ﯽﻫﺎﮔآ ا ﺮﺘﻤﮐ يرادﺎﻨﻌﻣ رﻮﻃ ) ﺮﮕﯾد هوﺮﮔ ود ز
p-value<.01
ﯽﻣ ( رد ﻦﯾا و ﺪﺷﺎﺑ
ﻪﮐ دﻮﺑ ﯽﻟﺎﺣ 78
دﻮﺑ ﻦﯿﯿﺒﺗ ﻞﺑﺎﻗ ﻪﻠﺧاﺪﻣ ﻂﺳﻮﺗ نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا تاﺮﯿﯿﻐﺗ زا ﺪﺻرد
R2 =78%
. ﻦﻫذ ﺮﺑﯽﻨﺘﺒﻣ تﻼﺧاﺪﻣ :يﺮﯿﮔﻪﺠﯿﺘﻧ
ﯽﻣ ﻪﯿﺻﻮﺗ .ﺖﺳا ﺮﺛﺆﻣ نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا تاﺮﻤﻧ ﺶﻫﺎﮐ رد ﯽﻫﺎﮔآ ددﺮﮔ
ﻪﺑ تﻼﺧاﺪﻣ ﻦﯾا ﻪﻣﺎﻧﺮﺑ ﺮﺘﻬﺑ ﯽﺸﺨﺑﺮﺛا رﻮﻈﻨﻣ
رد نادازﻮﻧ زا ﯽﺘﺒﻗاﺮﻣ يﺎﻫ NICU
ناور ضراﻮﻋ ﺶﻫﺎﮐ و ناردﺎﻣ ﯽﺘﺧﺎﻨﺷ
.دﻮﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد
فﺮﺷا ﯽﻣﺮﺧ دار نارﺎﮑﻤﻫ و
514
،راوﺰﺒﺳ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﺮﻬﻣ
و نﺎﺑآ 1400 ، ةرود 28 ةرﺎﻤﺷ ، 4
لﻮﻤﻌﻣ ﻪﭼﺮﮔا ،دﻮﺷ زﺎﻏآ نﺎﻤﯾاز زا ﺲﭘ لوا ياﺮﺑ نﺎﻣز ﻦﯾﺮﺗ
نآ زوﺮﺑ 2 ﺎﺗ 3 هﺎﻣ ﺲﭘ زا نﺎﻤﯾاز ﺖﺳا ) 5
( . نﺎﻣزتﺪﻣ ﻪﮐ ﯽﻧادازﻮﻧ ﺮﺘﺸﯿﺑ رد ﯽﻧﻻﻮﻃ
NICU
ﯽﻣ ،ﺪﻨﻧﺎﻣ
هﺪﺷ ﺪﻟﻮﺘﻣ سرﺎﻧ ﯽﮑﯾ ،ندﻮﺑ سرﺎﻧ و ﺪﻧا
ﻞﻣاﻮﻋ زا ﯽﻠﺻا
ﺐﯿﺳآ ﻞﻣﺎﮑﺗ ﻪﺑ نﺎﺳر
ﯽﮔدﺮﺴﻓا .ﺖﺳا ناراﻮﺧﺮﯿﺷ ﯽﺒﺼﻋ
ردﺎﻣ وﯽﺘﺧﺎﻨﺷ ﺪﺷر ﺮﺑ تﺪﻣ ﯽﻧﻻﻮﻃ ﺐﻗاﻮﻋ ياراد ﺰﯿﻧ و ﯽﻔﻃﺎﻋ
ﯽﻣ نﺎﮐدﻮﮐ ﯽﻠﻣﺎﮑﺗ ندﻮﺑ سرﺎﻧ ﻦﯾاﺮﺑﺎﻨﺑ .ﺪﺷﺎﺑ
و دازﻮﻧ يﺮﺘﺴﺑ
نﺪﺷ رد NICU
ﯽﻔﻨﻣ تاﺮﺛا
رد ار نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا
ﯽﻣ ﺪﯾﺪﺸﺗ سرﺎﻧ نادازﻮﻧ ﻞﻣﺎﮑﺗ و ﺪﺷر ﺮﯿﺴﻣ ﺪﻨﻨﮐ
)6 , 7
( . ﻪﻠﺣﺮﻣ رد ردﺎﻣ ﯽﮔدﺮﺴﻓا ﻪﮐ ﺪﻧاهداد نﺎﺸﻧ ﯽﻠﺒﻗ تﺎﻘﯿﻘﺤﺗ ﺲﭘو ﺪﻨﮐﯽﻣ ﻞﺧاﺪﺗ دازﻮﻧ وردﺎﻣ ﯽﮕﺘﺴﺒﻟد رد سردوز نﺎﻤﯾاز زا ﺮﯿﺛﺄﺗ ﺖﺤﺗ ار دازﻮﻧ زا ﺖﺒﻗاﺮﻣ رد يو ﯽﯾﺎﻧاﻮﺗ و ردﺎﻣ ﯽﻫدﺮﯿﺷ ﺎﯾ ﺖﯿﻧﺎﺒﺼﻋ ﻪﺑ ﺖﺳا ﻦﮑﻤﻣ ﻦﯿﻨﭽﻤﻫ .ﺪﻫد ﯽﻣ راﺮﻗ ﯽﻔﻨﻣ ﮏﯾﺮﺤﺗ ﺖﻣﻮﺼﺧ ،يﺮﯾﺬﭘ
و رﺎﺘﻓر ﻪﻧاﺮﮕﺷﺎﺧﺮﭘ
ﺖﺒﺴﻧ ردﺎﻣ
ﻪﺑ
( .2)( 8) دﻮﺷﺮﺠﻨﻣ هﺪﺷ ﺪﻟﻮﺘﻣ هزﺎﺗ دازﻮﻧﻪﺑو NICU ﻞﻨﺳﺮﭘ بﻮﭼرﺎﭼ يﻮﮕﻟا
،ﯽﺘﺧﺎﻨﺷ لﺪﻣ
يﺎﻫ يﺮﻈﻧ و ﻪﺑ ﻊﺒﺗ
نآ ﻪﺑ ﯽﮔدﺮﺴﻓا نﺎﻣرد ياﺮﺑ يدﺪﻌﺘﻣ ياﻪﻠﺧاﺪﻣ يﺎﻫرﺎﮑﻫار ناﻮﻨﻋ
ﻊﯾﺎﺷ
،ﯽﻧاور لﻼﺘﺧا ﻦﯾﺮﺗ ﻪﻌﺳﻮﺗ
ﻪﺘﻓﺎﯾ تﻼﺧاﺪﻣ زا ﯽﮑﯾ .ﺖﺳا
ناور ﻪﺑ هزوﺮﻣا ﻪﮐ ﯽﺘﺧﺎﻨﺷ ﻞﺑﺎﻗ رﻮﻃ
تاﺮﯿﺛﺄﺗ ﻪﺑ نﻮﺘﻣ رد ﯽﻬﺟﻮﺗ
هزﻮﺣ رد نآ ﺖﺒﺜﻣ ﻪﺘﺧادﺮﭘ ﯽﮔدﺮﺴﻓا ﻪﻠﻤﺟزا ﻒﻠﺘﺨﻣ يﺎﻫ
ﯽﻣ ﻦﻫذ دﻮﺷ ﻦﻫذ .ﺖﺳا ﯽﻫﺎﮔآ
ﺺﺨﺷ ﻦﺷور ﯽﻫﺎﮔآ ،ﯽﻫﺎﮔآ
تﺎﻈﺤﻟ رد ،نوﺮﯿﺑ ﻂﯿﺤﻣ ﺎﺑ ﻞﻣﺎﻌﺗ رد و نورد رد ﻪﭽﻧآ ﻪﺑ ﺖﺳا ﯽﻣ خر كاردا ﯽﻟاﻮﺘﻣ ﯽﻣ ﻪﮐ ﺪﻫد
يزﺎﺳﺎﻫر رد ﺪﻧاﻮﺗ
زا داﺮﻓا
زا و ﺪﻨﮐ ﮏﻤﮐ ﻢﻟﺎﺳﺎﻧ يرﺎﺘﻓر يﺎﻫﻮﮕﻟا و تادﺎﻋ ،رﺎﮐدﻮﺧ رﺎﮑﻓا ﯽﻣ ﺎﻔﯾا يرﺎﺘﻓر ﻢﯿﻈﻨﺗ رد ﯽﻤﻬﻣ ﺶﻘﻧ ور ﻦﯾا ﻪﺑ ﺪﻨﮐ
ﺎﺑ هوﻼﻋ
ﯽﻣ تﺎﯿﺑﺮﺠﺗ ﻪﺑ تﺎﯿﺣ و حﻮﺿو ندوﺰﻓا ﯽﺑادﺎﺷ و ﯽﺘﻣﻼﺳ ﺪﻧاﻮﺗ
ﺪﺷﺎﺑ ﻪﺘﺷاد هاﺮﻤﻫ ﻪﺑ ار )
9 - 11 ( .
ﮏﯿﻨﮑﺗ يﺎﻫ ﻦﻫذ ﯽﻫﺎﮔآ ﻪﺑ رﻮﻃ هﺪﻨﯾاﺰﻓ يا رد تﻼﺧاﺪﻣ
ﯽﻨﯿﻟﺎﺑ و ﯽﻧﺎﻣرد ﯽﻨﺘﺒﻣ ﺮﺑ ﺶﻫﺎﮐ سﺮﺘﺳا هﺪﺷ ﯽﺳرﺮﺑ ﺪﻧا
و ﻦﯿﻨﭽﻤﻫ و ﻪﻧازور يﺎﻫ ﺖﯿﻟﺎﻌﻓ رد نآ ندﻮﺑ ﺪﯿﻔﻣ ﻂﯾاﺮﺷ
يﺎﻫ يرﺎﻤﯿﺑ ﺎﯾ ازسﺮﺘﺳا ﻞﻣاﻮﻋ ﺎﺑ ﻪﻬﺟاﻮﻣ ﺮﯿﻈﻧ لﻮﻤﻌﻣﺮﯿﻏ يﺪﺟ ﯽﺘﺣ رد نارود يرادرﺎﺑ ﺖﺑﺎﺛ هﺪﺷ ﺖﺳا ) 12 - 14 (
رد رد يرادﺎﻨﻌﻣ ﺶﻫﺎﮐ ،ﻪﻨﯿﻣز ﻦﯾا رد هﺪﺷ مﺎﺠﻧا ﻪﻌﻟﺎﻄﻣ ﮏﯾ نﺎﻣرد ﻪﻠﺧاﺪﻣ ﺖﺤﺗ هوﺮﮔ رد نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا تاﺮﻤﻧ ﻦﻫذ ﯽﺘﺧﺎﻨﺷاﺮﻓ شراﺰﮔ لﺮﺘﻨﮐ هوﺮﮔ ﻪﺑ ﺖﺒﺴﻧ ﯽﻟﺎﺼﻔﻧا ﯽﻫﺎﮔآ
ﺎﻣ ﺮﺑ ﻪﻌﻟﺎﻄﻣ ﻦﯾا ﻦﮑﯿﻟو ﺪﺷ مﺎﺠﻧا ﻢﻟﺎﺳ و مﺮﺗ دازﻮﻧ ياراد نارد
يﺮﺘﺴﺑ و سرﺎﻧ دازﻮﻧ ياراد ناردﺎﻣ ﻪﺑ ﻢﯿﻤﻌﺗ ﻞﺑﺎﻗ و ﺖﺳا هﺪﺷ رد
NICU
ﯽﻤﻧ ﺪﺷﺎﺑ ) 15 ( تﻼﺧاﺪﻣ ،ﺮﮕﯾد تﺎﻌﻟﺎﻄﻣ ﯽﺧﺮﺑ رد .
ﯽﺘﯾﺎﻤﺣ ناردﺎﻣ ﺎﮑﺗ و ﺪﺷر ﻞﻣ
هﺎﺗﻮﮐ تﺪﻣ و تﺪﻣﺪﻨﻠﺑ نادازﻮﻧ
NICU
دﻮﺒﻬﺑ ار ﺖﺳا هﺪﯿﺸﺨﺑ )
16 ( ﻪﻨﯿﻣز ﻦﯿﻤﻫ رد ﯽﻟو ﯽﻣ ﺖﻓﺎﯾ ﯽﺗﺎﻌﻟﺎﻄﻣ
ﯽﻨﯿﻟﺎﺑ ﻢﯾﻼﻋ رد يرادﺎﻨﻌﻣ توﺎﻔﺗ ﻪﮐ دﻮﺷ
ﻦﯾﺪﻟاو ﻦﯿﺑ ﯽﮔدﺮﺴﻓا
NICU
ﺪﻧدﺮﮑﻧ شراﺰﮔ لﺮﺘﻨﮐ ﻦﯾﺪﻟاو و
) 17 ( و ﺮﺛﺆﻣ تﻼﺧاﺪﻣ ﻪﻨﯿﻣز رد ﺮﯿﺧا ﺰﯿﻟﺎﻧآﺎﺘﻣ تﺎﻌﻟﺎﻄﻣ رد .
رد اﺮﺟا ﻞﺑﺎﻗ
NICU
ﯽﺳرﺮﺑ ﻪﻨﯿﻣز رد تﺎﻌﻟﺎﻄﻣ ﻸﺧ ﻪﺑ
ﯽﻨﺘﺒﻣ تﻼﺧاﺪﻣ ﯽﺸﺨﺑﺮﺛا ﻦﻫذ ﺮﺑ
و باﺮﻄﺿا ﺮﺑ ﯽﻫﺎﮔآ
رد نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا
NICU
ﺖﺳا هﺪﺷ هرﺎﺷا )
18 ( زا .
ﻦﻫذ ﻪﻠﺧاﺪﻣ ﺮﯿﺛﺄﺗ ﻦﯿﯿﻌﺗ فﺪﻫ ﺎﺑ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ ور ﻦﯾا ﯽﻫﺎﮔآ
دازﻮﻧ ياراد ناردﺎﻣ رد نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا زا يﺮﯿﮕﺸﯿﭘ ﺮﺑ رد يﺮﺘﺴﺑ سرﺎﻧ ﺮﮔ اﺮﺟا و ﯽﺣاﺮﻃNICU
.ﺪﯾد
2 . شور و داﻮﻣ ﺎﻫ
ﻪﻠﺧاﺪﻣ عﻮﻧ زا ﻪﻌﻟﺎﻄﻣ ﻦﯾا هوﺮﮔ ود ﻞﻣﺎﺷ ﯽﻫوﺮﮔ ﻪﺳ يا
ﯽﻨﺘﺒﻣ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ هوﺮﮔ) ﻪﻠﺧاﺪﻣ ﻦﻫذ ﺮﺑ
هوﺮﮔ ،ﯽﻫﺎﮔآ
ﺶﺨﺑ .دﻮﺑ لﺮﺘﻨﮐ هوﺮﮔ ﮏﯾ و (ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ هﮋﯾو يﺎﻫ
نﺎﺘﺳرﺎﻤﯿﺑ و ﯽﻧﺎﻗﺮﻓ نﺎﺘﺳرﺎﻤﯿﺑ) ﻢﻗ ﺮﻬﺷ نﺎﺘﺳرﺎﻤﯿﺑ ود نادازﻮﻧ ﻪﺑ (اﺪﻬﺷ ﺶﻫوﮋﭘ ﻂﯿﺤﻣ ناﻮﻨﻋ
ياﺮﺑ و ﺪﻧﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد
زا يﺮﯿﮔﻮﻠﺟ ﻦﯿﻨﭽﻤﻫ و حﺮﻃ ﯽﯾاﺮﺟا ﺖﯿﻠﺑﺎﻗ ﺶﯾاﺰﻓا ﻪﺑ ﮏﻤﮐ يﮋﺗاﺮﺘﺳا و تﺎﯿﻤﺼﺗ ﺮﺛا شرﻮﺗ و ﻪﻠﺧاﺪﻣ ﺮﺛا يﺎﻄﺧ يﺎﻫ
نﺎﺘﺳرﺎﻤﯿﺑ ﯽﺘﯾﺮﯾﺪﻣ و يرﺎﺘﺳﺮﭘ ،ﯽﮑﺷﺰﭘ ﻪﻧﻮﻤﻧ ،ﺎﻫ
يﺎﻫ هوﺮﮔ
.ﺪﺷ ﻪﺘﻓﺮﮔ نﺎﺘﺳرﺎﻤﯿﺑ ود ﺮﻫ زا لﺮﺘﻨﮐ و ﻪﻠﺧاﺪﻣ يﺎﻫ د يﺮﺘﺴﺑ سرﺎﻧ نادازﻮﻧ ناردﺎﻣ ﺶﺨﺑ ر
نادازﻮﻧ يﺎﻫ
نﺎﺘﺳرﺎﻤﯿﺑ كﻼﻣ ﺪﺟاو ﻪﮐ قﻮﻓ يﺎﻫ
:ﻞﻣﺎﺷ ﻪﻌﻟﺎﻄﻣ ﻪﺑ دورو يﺎﻫ
يرادرﺎﺑ ﻦﺳ 25
- 35 دازﻮﻧ ﺪﻟﻮﺗ نﺎﻣز نزو ﻞﻗاﺪﺣ ،ﻪﺘﻔﻫ 800
NICU رد دازﻮﻧ يﺮﺘﺴﺑ تﺪﻣ ﯽﻨﯿﺑ ﺶﯿﭘ ،مﺮﮔ تﺪﻣ ﻪﺑ ﻞﻗاﺪﺣ
14 زا ﺶﯿﺑ ﻦﺘﺷﺬﮕﻧ ،زور 5
ردﺎﻣ دورو نﺎﻣز رد نﺎﻤﯾاز زا زور
ﻘﺑﺎﺳ ﻦﺘﺷاﺪﻧ ،ﻪﻌﻟﺎﻄﻣ ﻪﺑ ناور لﻼﺘﺧا ﻪ
رد و ﻞﺒﻗ رد ﯽﮑﺷﺰﭘ
يﺎﻫوراد ندﺮﮑﻧ فﺮﺼﻣ ،ردﺎﻣ رﺎﻬﻇا ﻖﺒﻃ ﻪﻌﻟﺎﻄﻣ ﻪﺑ دورو نﺎﻣز ناور شزﻮﻣآ ﺖﻓﺎﯾرد ﯽﯾﺎﻧاﻮﺗ ،ردﺎﻣ رﺎﻬﻇا ﻖﺒﻃ ﯽﮑﺷﺰﭘ ،ﺎﻫ
ﺖﻘﻓاﻮﻣ ياﺮﺑ ﺖﮐﺮﺷ رد و ﺶﻫوﮋﭘ يﺎﻀﻣا
ﺖﯾﺎﺿر ﻪﻣﺎﻧ ﯽﺒﺘﮐ .دﻮﺑ
،دازﻮﻧ رد ﯽﺣاﺮﺟ ﻞﻤﻋ ﻪﺑ زﺎﯿﻧ :ﻞﻣﺎﺷ ﺰﯿﻧ جوﺮﺧ يﺎﻫرﺎﯿﻌﻣ دﻮﺟو
،نﺎﺑز ﻊﻧﺎﻣ
زا ﺮﺘﻤﮐ ﺖﻣﺎﻗا 14
رد دازﻮﻧ زور ،NICU
ﺖﻓﺎﯾرد ،ﻪﻌﻟﺎﻄﻣ رد ﺖﮐرﺎﺸﻣ ﻪﻣادا ياﺮﺑ ردﺎﻣ ﻦﺘﺷاﺪﻧ ﺖﯾﺎﺿر نﺎﻣرد ناور يﺎﻫ ﯽﺘﺧﺎﻨﺷ
يرﺎﺠﻨﻫﺎﻧ ﺺﯿﺨﺸﺗ ،ﻪﻌﻟﺎﻄﻣ لﻮﻃ رد
ﺪﯾﺮﮔ رد يﺰﻐﻣ يﺰﯾﺮﻧﻮﺧ داﺪﺧر ،دازﻮﻧ رد يدازردﺎﻣ 3
و 4
رد ﻟاﻮﺘﻣ و نﺎﺳآ يﺮﯿﮔﻪﻧﻮﻤﻧ ﻞﮑﺷ ﻪﺑ دراﻮﻣ .ﺪﻧدﻮﺑ دازﻮﻧ ﺎﺗ ﯽ
هدﺎﺳ ﯽﻓدﺎﺼﺗ ﻞﮑﺷ ﻪﺑ و ﺪﻧﺪﺷ ﻪﻌﻟﺎﻄﻣ دراو ﻪﻧﻮﻤﻧ ﻢﺠﺣ ﻞﯿﻤﮑﺗ هوﺮﮔ رد ﯽﻓدﺎﺼﺗ داﺪﻋا لوﺪﺟ زا هدﺎﻔﺘﺳا ﺎﺑ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ يﺎﻫ
ﯽﻨﺘﺒﻣ ﻦﻫذ ﺮﺑ ﺎﺑ .ﺪﻨﺘﻓﺮﮔ راﺮﻗ لﺮﺘﻨﮐ و ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ،ﯽﻫﺎﮔآ
يرﺎﻣآ ناﻮﺗ ﻪﺑ ﻪﺟﻮﺗ 8/
0 هوﺮﮔ ﺮﻫ ياﺮﺑ ﻪﻧﻮﻤﻧ ﻢﺠﺣ داﺪﻌﺗ 34
شﺰﯾر دراﻮﻣ لﺮﺘﻨﮐ رﻮﻈﻨﻣﻪﺑ دﻮﺟو ﻦﯾا ﺎﺑ .ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد
ﻦﻫذ ﺮﺑ ﯽﻨﺘﺒﻣ ﻪﻠﺧاﺪﻣ ﺮﯿﺛﺄﺗ نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا ﺮﺑ ﯽﻫﺎﮔآ
...
515 نﺎﺑآ و ﺮﻬﻣ ،راوﺰﺒﺳ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد 1400
، ةرود 28 ةرﺎﻤﺷ ، 4
،ﻪﻧﻮﻤﻧ ﻪﻧﻮﻤﻧ ﻪﺑ هوﺮﮔ ﺮﻫ رد ﻪﻧﻮﻤﻧ ﻢﺠﺣ نﺪﯿﺳر ﺎﺗ يﺮﯿﮔ
شﺰﯾر ناﺰﯿﻣ) هدﺎﺘﻓا قﺎﻔﺗا شﺰﯾر زا ﺲﭘ .دﺮﮐ اﺪﯿﭘ ﻪﻣادا ردﺎﻣ50 18 ﻊﻤﺟ و ﻪﻠﺧاﺪﻣ ﻞﺣاﺮﻣ رد (ﺪﺻرد هداد يروآ
ﺖﯾﺎﻬﻧ رد ،ﺎﻫ
ﻪﺑ طﻮﺑﺮﻣ تﺎﻋﻼﻃا 123
) ردﺎﻣ 34 ﻦﻫذ هوﺮﮔ رد ﺮﻔﻧ ،ﯽﻫﺎﮔآ
39 وﺮﮔ رد و ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ه 50
و ﻪﯾﺰﺠﺗ (لﺮﺘﻨﮐ هوﺮﮔ رد
.ﺪﻧﺪﺷ ﻞﯿﻠﺤﺗ هوﺮﮔ ناردﺎﻣ ﯽﻨﺘﺒﻣ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ يﺎﻫ
ﻦﻫذ ﺮﺑ و ﯽﻫﺎﮔآ
لﻮﻃ رد ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ 10
تﺎﺴﻠﺟ رد نﺎﻤﯾاز زا ﺲﭘ لوا زور
ﯽﻣ ﺖﮐﺮﺷ نﺎﺘﺳرﺎﻤﯿﺑ ﯽﺷزﻮﻣآ قﺎﺗا رد يدﺮﻓ ﯽﺷزﻮﻣآ .ﺪﻧدﺮﮐ
ﻪﺴﻠﺟ رﺎﻬﭼ داﺪﻌﺗ ،ﻞﮐ رد 30
- 60 ﻪﻘﯿﻗد شزﻮﻣآ يا
ﺖﺒﻗاﺮﻣ
ﻪﺴﻠﺟ رﺎﻬﭼ و ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ هوﺮﮔ رد ردﺎﻣ ﺮﻫ ياﺮﺑ ﯽﻠﻣﺎﮑﺗ 30 - 60 ﻪﻘﯿﻗد ﻦﻫذ شزﻮﻣآ يا ﺖﺒﻗاﺮﻣ تﺎﺴﻠﺟ ﺮﺑ هوﻼﻋ ﯽﻫﺎﮔآ
ﺮﺑ ﯽﻨﺘﺒﻣ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ هوﺮﮔ رد ردﺎﻣ ﺮﻫ ياﺮﺑ ﯽﻠﻣﺎﮑﺗ ﻦﻫذ ﻪﻠﺧاﺪﻣ ﭻﯿﻫ لﺮﺘﻨﮐ هوﺮﮔ ياﺮﺑ .ﺪﺷ راﺰﮔﺮﺑ ﯽﻫﺎﮔآ ﻪﺑ يا
ﺰﺟ .ﺖﻓﺮﮕﻧ ترﻮﺻ ﺶﺨﺑ ﻦﯿﺗور يﺎﻫ ﺖﺒﻗاﺮﻣ ﺖﺒﻗاﺮﻣ شزﻮﻣآ
شزﻮﻣآ ﻞﻣﺎﺷ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ و ﯽﻄﯿﺤﻣ سﺮﺘﺳا لﺮﺘﻨﮐ يﺎﻫ
ﻪﮐ دﻮﺑ دازﻮﻧ ﻪﯾﺬﻐﺗ و ﯽﯾورﻮﮕﻧﺎﮐ ﺖﺒﻗاﺮﻣ ،درد ،باﻮﺧ ،ﺖﺳﻮﭘ ﻪﺑ ﯽﮑﺷﺰﭘ شزﻮﻣآ و نﺎﻣرد ،ﺖﺷاﺪﻬﺑ ترازو ﻊﺒﻨﻣ سﺎﺳاﺮﺑ لوﺪﺟ حﺮﺷ 1
ﻦﻫذ شزﻮﻣآ .ﺪﯾدﺮﮔ اﺮﺟا شزﻮﻣآ ﻞﻣﺎﺷ ﯽﻫﺎﮔآ
ﮏﯿﻨﮑﺗ و لﻮﺻا ﯽﻨﺘﺒﻣ ﯽﻫﺎﮔآ ﻦﻫذ يﺎﻫ
اﺮﻣ ﺮﺑ ﺖﺒﻗ ﯽﻠﻣﺎﮑﺗ يﺎﻫ
لوﺪﺟ ﺎﺑ ﻖﺑﺎﻄﻣ ﻪﮐ دﻮﺑ دازﻮﻧ زا 2
هوﺮﮔ ود ﺮﻫ ﻪﺑ .ﺪﺷ راﺰﮔﺮﺑ
ﻪﻠﺧاﺪﻣ ﻪﯿﻬﺗ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ﯽﺷزﻮﻣآ ﻢﻠﯿﻓ يوﺎﺣ ﯽﺷزﻮﻣآCD
.ﺪﯾدﺮﮔ ﻪﺋارا ﯽﮑﺷﺰﭘ شزﻮﻣآ و نﺎﻣرد ﺖﺷاﺪﻬﺑ ترازو رد هﺪﺷ ،ﻪﺘﻔﻫ ﺮﻫ نﺎﯾﺎﭘ رد دازﻮﻧ يﺮﺘﺴﺑ تﺪﻣ لﻮﻃ رد ًﺎﻨﻤﺿ ﺑ و ﺪﻧدﻮﺑ ﺮﺿﺎﺣ ﺶﺨﺑ رد ناﺮﮕﺸﻫوﮋﭘ ﯽﻟﺎﻤﺘﺣا تﻻاﺆﺳ ﻪ
ﯽﻣ ﺦﺳﺎﭘ ناردﺎﻣ هوﺮﮔ ناردﺎﻣ ﻪﺑ ﺖﺳا ﺮﮐذ نﺎﯾﺎﺷ .ﺪﻧداد
يﺎﻫ
ناردﺎﻣ ﺎﺑ ﯽﺷزﻮﻣآ ياﻮﺘﺤﻣ صﻮﺼﺧ رد ﺪﯾدﺮﮔ ﺪﯿﮐﺄﺗ ﻪﻠﺧاﺪﻣ ﺶﺳﺮﭘ .ﺪﻨﻨﮑﻧ ﺖﺒﺤﺻ ﺮﮕﯾد ﻪﻣﺎﻧ
ﺮﻫ ناردﺎﻣ ياﺮﺑ ﻖﯿﻘﺤﺗ يﺎﻫ
ﮏﯾ ،هوﺮﮔ ﻪﺳ
رﺎﺑ و نﺎﻤﯾاز زا ﺲﭘ ﻢﺠﻨﭘ ﺎﺗ مود يﺎﻫزور رد رﺎﺑ
مود 60 نﺎﻤﯾاز زا ﺲﭘ زور )
5 ( ﻞﯿﻤﮑﺗ ياﺮﺑ .ﺪﯾدﺮﮔ ﻞﯿﻤﮑﺗ
ﺶﺳﺮﭘ ﻪﻣﺎﻧ ﺶﺨﺑ ﺮﻫ زا ﺮﮕﯾد رﺎﮑﻤﻫ ﮏﯾ و ﺶﺨﺑ ﯽﺸﻨﻣ زا ﺎﻫ
.ﺪﺷ ﻪﺘﻓﺮﮔ ﮏﻤﮐ
لوﺪﺟ 1 ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ﯽﺷزﻮﻣآ تﺎﺴﻠﺟ ياﻮﺘﺤﻣ .
اﻮﺘﺤﻣ
لوا ﻪﺴﻠﺟ ﻪﻣﺪﻘﻣ ،ﯽﯾﺎﻨﺷآ و مﺪﻘﻣ ﺮﯿﺧ
ﺖﯿﻟﺎﻌﻓ حﺮﺷ و ﯽﺸﻫوﮋﭘ حﺮﻃ درﻮﻣ رد يا ﺖﺒﻗاﺮﻣ ،رﺎﻈﺘﻧادرﻮﻣ يﺎﻫ
ﺮﯿﺳ ،نادازﻮﻧ هﮋﯾو يﺎﻫ
ﺖﮐرﺎﺸﻣ ﺖﯿﻤﻫا و ﻦﯾﺪﻟاو ﺶﻘﻧ ،ﯽﺒﺼﻋ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ﺖﯿﻤﻫا و لﻮﺻا ،دازﻮﻧ ﺖﯿﻌﺿو ﺖﻓﺮﺸﯿﭘ و دﻮﺒﻬﺑ ﺪﻧور و ﯽﻠﻣﺎﮑﺗ ﻊﻤﺟ ،ﻦﯾﺪﻟاو ﺦﺳﺎﭘ و ﺶﺳﺮﭘ و يﺪﻨﺑ
مود ﻪﺴﻠﺟ سﺮﺘﺳا و تﺎﮑﯾﺮﺤﺗ ،ﯽﯾورﻮﮕﻧﺎﮐ ﺖﺒﻗاﺮﻣ
شور و ﯽﻄﯿﺤﻣ يﺎﻫ ﻪﺑ يﺎﻫ
ﻞﻗاﺪﺣ يﺎﻫدﺮﮑﻠﻤﻋ و دازﻮﻧ ﺖﺳﻮﭘ زا ﺖﻇﺎﻔﺣ ،نﺪﻧﺎﺳر
مﺎﯿﺘﻟا رد باﻮﺧ ﺖﯿﻤﻫا ﺺﯿﺨﺸﺗ و دازﻮﻧ باﻮﺧ زا ﺖﻇﺎﻔﺣ ،دازﻮﻧ ﺲﻤﻟ و نآ دﺪﻌﺘﻣ ﻊﻤﺟ ،ﺰﻐﻣ ﻞﻣﺎﮑﺗ و ﺪﺷر و ﯽﺸﺨﺑ
و يﺪﻨﺑ
ﺦﺳﺎﭘ و ﺶﺳﺮﭘ
مﻮﺳ ﻪﺴﻠﺟ ﻪﺑ
ﻦﺸﯾزﻮﭘ ،ﻦﮑﻤﻣ نﺎﮑﻣ و نﺎﻣز ﺮﻫ رد ﻪﻨﯿﺳ زا ﻪﯾﺬﻐﺗ و ردﺎﻣ ﺮﯿﺷ ﺎﺑ دازﻮﻧ ﻪﯾﺬﻐﺗ نﺪﻧﺎﺳر ﺮﺜﮐاﺪﺣ كرد ،ﺖﯿﻨﻣا ﻦﯿﻣﺄﺗ و ﯽﻫد
ﺶﻨﮐاو ﻪﺑ ﺦﺳﺎﭘ و رﺎﺘﻓر ﺮﯿﺴﻔﺗ و يرﺎﺘﻓر طﺎﺒﺗرا دازﻮﻧ يﺎﻫ
مرﺎﻬﭼ ﻪﺴﻠﺟ ﺦﺳﺎﭘ و ﺶﺳﺮﭘ ،ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ درﻮﻣ رد ﯽﺷزﻮﻣآ ﻢﻠﯿﻓ ﺶﯾﺎﻤﻧ
لوﺪﺟ 2 ياﻮﺘﺤﻣ . ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ﯽﺷزﻮﻣآ تﺎﺴﻠﺟ ﯽﻫﺎﮔآ ﻦﻫذ ﺮﺑ ﯽﻨﺘﺒﻣ
اﻮﺘﺤﻣ
لوا ﻪﺴﻠﺟ ﻪﻣﺪﻘﻣ
ﻦﻫذ صﻮﺼﺧ رد يا ﻦﻫذ ياﺰﺟا و لﻮﺻا ،ﯽﻫﺎﮔآ
ﻦﻫذ ﺪﯾاﻮﻓ و ﺖﯿﻤﻫا ،ﯽﻫﺎﮔآ رد نآ تاﺮﯿﺛﺄﺗ ﯽﮕﻧﻮﮕﭼ و ﻦﯾﺪﻟاو رد ﯽﻫﺎﮔآ
،نﺪﺑ ﯽﺳرﺮﺑ ﻦﯾﺮﻤﺗ ،ﯽﺸﺸﮐ ﻦﯾﺮﻤﺗ ،ﻂﺒﺗﺮﻣ تﻻﺎﻘﻣ زا يﺮﺼﺘﺨﻣ شراﺰﮔ ،دازﻮﻧ زا ﺖﺒﻗاﺮﻣ ﻊﻤﺟ
ﺦﺳﺎﭘ و ﺶﺳﺮﭘ و يﺪﻨﺑ
مود ﻪﺴﻠﺟ ﻦﻫذ ،ﻦﺘﻓر هار ﻪﺒﻗاﺮﻣ ﻦﯾﺮﻤﺗ ،ﻦﺘﺴﺸﻧ ﻪﺒﻗاﺮﻣ ﻦﯾﺮﻤﺗ
ﻊﻤﺟ ،ﻪﻧازور ﯽﮔﺪﻧز رد ﯽﻫﺎﮔآ ﺦﺳﺎﭘ و ﺶﺳﺮﭘ و يﺪﻨﺑ
مﻮﺳ ﻪﺴﻠﺟ ﻪﺑ ﺖﺒﺴﻧ ﺮﺘﺸﯿﺑ نﺪﺷ ﺮﺗ هﺎﮔآ ،دازﻮﻧ ﺎﺑ ﻞﻣﺎﻌﺗ و ﺖﺒﻗاﺮﻣ ،نﺎﻣز ﻪﻈﺤﻟ ﻪﺑ ﻪﻈﺤﻟ رد دازﻮﻧ هﺪﻫﺎﺸﻣ و ﻞﻣﺎﮐ ﻪﺟﻮﺗ ﻦﺘﺷاد
ﺖﻟﺎﺣ ﺖﻟﺎﺣ و دﻮﺧ ﯽﻔﻃﺎﻋ يﺎﻫ ﻪﺑ كدﻮﮐ شﺮﯾﺬﭘ و لﻮﺒﻗ لﺎﻤﺘﺣا ندﺮﺑ ﻻﺎﺑ ،دازﻮﻧ يﺎﻫ
اﺮﯾﺬﭘ و ﯽﺗوﺎﻀﻗﺮﯿﻏ هﺎﮕﻧ ﻦﺘﺷاد ﻪﻄﺳاو
ﺶﻨﮐاو ﻞﯾﺪﻌﺗ ،وا زا ﺖﺒﻗاﺮﻣ ﻦﯿﺣ و دازﻮﻧ ﺎﺑ تﻼﻣﺎﻌﺗ لﻮﻃ رد ،دازﻮﻧ زا ﺖﺒﻗاﺮﻣ ﻦﯿﺣ و ﻞﻣﺎﻌﺗ لﻮﻃ رد ﯽﻧﺎﺠﯿﻫ و ﯽﻔﻃﺎﻋ يﺎﻫ
ﺧ ﻪﺑ ﺖﺒﺴﻧ ﯽﻟﺪﻤﻫ و يزﻮﺴﻟد ﻊﺿﻮﻣ ﻦﺘﺷاد ﺦﺳﺎﭘ و ﺶﺳﺮﭘ ،دازﻮﻧ و دﻮ
مرﺎﻬﭼ ﻪﺴﻠﺟ ﻦﻫذ ﻂﺑاور ﻪﻣادا و نﺪﺑ ﻦﮑﺳا ﻦﯾﺮﻤﺗ ،ﻪﻧﺎﻫﺎﮔآ ﺰﮐﺮﻤﺘﻣ ﺲﻔﻨﺗ
ﺦﺳﺎﭘ و ﺶﺳﺮﭘ و دازﻮﻧ ﺎﺑ ﻪﻧﺎﻫﺎﮔآ
فﺮﺷا ﯽﻣﺮﺧ دار نارﺎﮑﻤﻫ و
516
،راوﺰﺒﺳ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﺮﻬﻣ
و نﺎﺑآ 1400 ، ةرود 28 ةرﺎﻤﺷ ، 4
ﺶﺳﺮﭘ ﻞﻣﺎﺷ ﺶﻫوﮋﭘ رد هدﺎﻔﺘﺳا درﻮﻣ راﺰﺑا ﻪﻣﺎﻧ
ﺶﺳﺮﭘ و ﮏﯿﻓاﺮﮔﻮﻣد نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا ﻪﻣﺎﻧ
ﺶﺳﺮﭘ تﻻاﺆﺳ .دﻮﺑ گرﻮﺒﻨﯾدا ﻞﻣﺎﺷ ﮏﯿﻓاﺮﮔﻮﻣد ﻪﻣﺎﻧ
ﻦﺳ ردﺎﻣ ﻞﻐﺷ ،ردﺎﻣ
تﻻﻼﺘﺧا ﺮﯾﺎﺳ ﺎﯾ ﯽﮔدﺮﺴﻓا ﻪﻘﺑﺎﺳ ،
ناور و ﻦﺳ و ﺮﺴﻤﻫ ﺖﯾﺎﻤﺣ ،ردﺎﻣ رد ﯽﮑﺷﺰﭘ مﺎﮕﻨﻫ نزو
دازﻮﻧ ﺪﻟﻮﺗ ،ﻞﻗ داﺪﻌﺗ ،دازﻮﻧ ﺲﻨﺟ ،
ﯿﺼﺤﺗ ﺢﻄﺳ تﻼ
ﻦﺘﺷاد ،
،نﺎﻤﯾاز عﻮﻧ ،ﺮﮕﯾد ﺪﻧزﺮﻓ هﺮﻤﻧ ،دازﻮﻧ ﻦﯿﻟﺎﺑ ﺮﺑ رﻮﻀﺣ ناﺰﯿﻣ
ﺎﮕﭘآ ر دﻮﺑ زا نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا ناﺰﯿﻣ ﻦﯿﯿﻌﺗ ياﺮﺑ .
گﺮﺒﻨﯾدا نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا ﺶﺠﻨﺳ سﺎﯿﻘﻣ
Depression Postnatal Edinburgh EPDS Scale
) 10
ﻪﻧﻮﮔ ﻪ ﺑ ﻪﻣﺎﻧ ﺶﺳﺮﭘ ﻦﯾا . ﺪﺷ هدﺎﻔ ﺘﺳا ( ﻢﺘﯾا هﺪﺷ ﻪﺘﺧﺎﺳ يا
زا ار ﯽﮔدﺮﺴﻓا ﺺﯿﺨﺸﺗ نﺎﮑﻣا ﻪﮐ 6
ﻪﺘﻔﻫ ﺲﭘ نﺎﻤﯾاز زا
ﯽﻣ ﻢﻫاﺮﻓ ﻣ هﺮﻤﻧ .ﺪﻨﮐ
ﺎﺗ ﺮﻔﺻ ﻦﯿﺑ گﺮﺒﻨﯾدا سﺎﯿﻘ 30
ﻪﺑ ﺮﺘﺸﯿﺑ و 12 هﺮﻤﻧ ﺐﺴﮐ و ﺪﺷﺎﺑ ﯽﻣ ﺲﭘ ﯽﮔدﺮﺴﻓا ناﻮﻨﻋ
ﯽﻣ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد نﺎﻤﯾاز زا دﻮﺷ
. لاﺆﺳ يﺎﻫ 1 ، 2 ، 4 زا 0
ﺎﺗ يراﺬﮔ هﺮﻤﻧ 0 ﺎﺗ 3 زا 10 9 ، 8 ، ، 7 ،6 5 ، 3 ، يﺎﻫ لاﺆﺳ و 3 خﺎﺒﻧوﺮﮐ ﺎﻔﻟآ ﺐﯾﺮﺿ ﺮﺿﺎﺣ ﺶﻫوﮋﭘ رد . (19 ) دﻮﺷ ﯽﻣ ياﺮﺑ
ﺶﺳﺮﭘ ﺮﺑاﺮﺑ گﺮﺒﻨﯾدا ﻪﻣﺎﻧ 70
/ 0 دﻮﺑ .
ﯽﯾﺎﺳﺎﻨﺷ ياﺮﺑ
نﻮﻣزآ زا ﺮﮕﺷوﺪﺨﻣ هﻮﻘﻟﺎﺑ يﺎﻫﺮﯿﻐﺘﻣ ﮏﺗ يﺎﻫ
ياﺮﺑ و هﺮﯿﻐﺘﻣ
هدﺎﻔﺘﺳا ﺲﻧﺎﯾراﻮﮐ ﻞﯿﻠﺤﺗ زا ﺮﮕﺷوﺪﺨﻣ يﺎﻫﺮﯿﻐﺘﻣ ﺮﺛا ﻞﯾﺪﻌﺗ :ﯽﻗﻼﺧا تﺎﻈﺣﻼﻣ .ﺪﺷ مﺎﺠﻧا ياﺮﺑ ﯽﺘﺒﻗاﺮﻣ يﺎﻫدراﺪﻧﺎﺘﺳا ﻪﯿﻠﮐ
ﺮﻈﻧ ﺮﯾز تﻼﺧاﺪﻣ ﻪﯿﻠﮐ و ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد تﻼﺧاﺪﻣ ا ﺶﺨﺑ نارﺎﺘﺳﺮﭘ ﺎﯾ ﮏﺷﺰﭘ ﻪﻧﻮﻤﻧ ياﺮﺑ .ﺪﺷ مﺎﺠﻧ
هوﺮﮔ يﺎﻫ
ﺖﺒﻗاﺮﻣ ﻪﯿﻠﮐ ،لﺮﺘﻨﮐ ﺶﺨﺑ دراﺪﻧﺎﺘﺳا و ﻦﯿﺗور يﺎﻫ
يﺎﻫ
هوﺮﮔ ياﺮﺑ .ﺪﯾدﺮﮔ اﺮﺟا هﮋﯾو ﺖﺒﻗاﺮﻣ ،تﻼﺧاﺪﻣ ،ﻪﻠﺧاﺪﻣ يﺎﻫ
ﺖﺒﻗاﺮﻣ ﺮﺑ دازﺎﻣ ﺶﺨﺑ دراﺪﻧﺎﺘﺳا و ﻦﯿﺗور يﺎﻫ
ﺖﺒﻗاﺮﻣ يﺎﻫ
هوﺮﮔ ﻦﯾا ور ﻦﯾا زا ؛ﺪﺷ اﺮﺟا هﮋﯾو ﺖﺒﻗاﺮﻣ ﻪﯿﻠﮐ زا ﺎﻫ
يﺎﻫ
هﺮﻬﺑ ﺶﺨﺑ لﻮﻤﻌﻣ حﺮﻃ زا جﺮﺨﺘﺴﻣ ﻪﻟﺎﻘﻣ ﻦﯾا .ﺪﻧﺪﯾدﺮﮔ ﺪﻨﻣ
قﻼﺧا ﺪﮐ ﺎﺑ ﻢﻗ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد رد بﻮﺼﻣ ﯽﺗﺎﻘﯿﻘﺤﺗ )
IR.MUQ.REC.1398.006
.دﻮﺑ (
3 . ﻪﺘﻓﺎﯾ ﺎﻫ
يور ﺮﺑ ﻪﻌﻟﺎﻄﻣ ﻦﯾا 123
رد يﺮﺘﺴﺑ دازﻮﻧ ياراد ﻪﮐ ردﺎﻣ
NICU
ناردﺎﻣ ﻦﺳ ﻦﯿﮕﻧﺎﯿﻣ .ﺖﻓﺮﯾﺬﭘ مﺎﺠﻧا ﺪﻧدﻮﺑ 60
/6 ±
8 / 29 ،لﺎﺳ 52 ) ردﺎﻣ 74.8 ﺎﯾ ﻢﻠﭙﯾد تﻼﯿﺼﺤﺗ (ﺪﺻرد
،ﺪﻨﺘﺷاد ﻢﻠﭙﯾدﺮﯾز 108
) ردﺎﻣ 88.5 ﻪﻘﺑﺎﺳ نوﺪﺑ (ﺪﺻرد
نادازﻮﻧ ﺮﺘﺸﯿﺑ .ﺪﻧدﻮﺑ ﯽﮑﺷﺰﭙﻧاور تﻻﻼﺘﺧا ﺮﯾﺎﺳ ﺎﯾ ﯽﮔدﺮﺴﻓا ﮏﺗ ) ﻮﻠﻗ 74.8 و ( ﺪﺻرد 84
نﺎﻤﯾاز زا درﻮﻣ ) ﺎﻫ
68.3 ﻪﺑ (ﺪﺻرد
ﯽﻨﯿﻨﺟ ﻦﺳ ﻦﯿﮕﻧﺎﯿﻣ و ﻦﯾراﺰﺳ هﻮﯿﺷ 74
/ 2 ±
7 / 31 ﻪﮐ دﻮﺑ 26 ) دازﻮﻧ 62.6 ﻪﺘﻔﻫ رد (ﺪﺻرد 31
ﺪﻟﻮﺘﻣ
ﺖﺒﻗاﺮﻣ هوﺮﮔ ﻪﺳ رد ناردﺎﻣ ،ﻪﻌﻟﺎﻄﻣ ﻦﯾا رد .ﺪﻧدﻮﺑ هﺪﺷ ) ﯽﻫﺎﮔآ ﻦﻫذ ﺮﺑ ﯽﻨﺘﺒﻣ ﯽﻠﻣﺎﮑﺗ 34
ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ،(ﺮﻔﻧ
) 39 ) لﺮﺘﻨﮐ هوﺮﮔ و (ﺮﻔﻧ 50
لوﺪﺟ رد .ﺪﻧﺪﺷ ﯽﺑﺎﯾزرا (ﺮﻔﻧ
3 و ﯽﻧاواﺮﻓ ، لوﺪﺟ رد و ﯽﻔﯿﮐ يﺎﻫﺮﯿﻐﺘﻣ ﺪﺻرد
4 ﻦﯿﮕﻧﺎﯿﻣ ،
رﺎﯿﻌﻣ فاﺮﺤﻧا و
ﻪﺑ ،ﻪﻌﻟﺎﻄﻣ رد ﯽﺳرﺮﺑ درﻮﻣ ﯽﻤﮐ يﺎﻫﺮﯿﻐﺘﻣ
.ﺖﺳا هﺪﺷ هداد ﺶﯾﺎﻤﻧ ﯽﺳرﺮﺑ درﻮﻣ هوﺮﮔ ﻪﺳ ﮏﯿﮑﻔﺗ ﮏﺗ ﻞﯿﻠﺤﺗ سﺎﺳاﺮﺑ ﯽﻨﻌﻣ ﺢﻄﺳ رد و هﺮﯿﻐﺘﻣ
يراد 30
ﮏﺗ يﺎﻫﺮﯿﻐﺘﻣ ﺪﺻرد
ﺮﯾﺎﺳ ﺎﯾ ﯽﮔدﺮﺴﻓا ﻪﻘﺑﺎﺳ ،دازﻮﻧ ﯽﯾﻮﻠﻗ
د ﯽﮑﺷﺰﭙﻧاور تﻻﻼﺘﺧا ﺪﻟﻮﺗ مﺎﮕﻨﻫ نزو ،ردﺎﻣ ﻦﺳ ،ردﺎﻣ ر
و رﺎﮕﭘآ هﺮﻤﻧ ،دازﻮﻧ نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا
ﻪﻠﺧاﺪﻣ زا ﻞﺒﻗ
ﻪﺑ ﯽﻣ هﻮﻘﻟﺎﺑ ﻪﮐ ﯽﯾﺎﻫﺮﯿﻐﺘﻣ ناﻮﻨﻋ هوﺮﮔ ﻦﯿﺑ ﻦﮕﻤﻫﺎﻧ ﺪﻨﻧاﻮﺗ
ﺎﻫ زا هدﺎﻔﺘﺳا ﺎﺑ ﺲﭙﺳ و ﺪﻧﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد ﺪﻨﺷﺎﺑ هﺪﺷ ﻊﯾزﻮﺗ .ﺪﯾدﺮﮔ ﻞﯾﺪﻌﺗ ﺎﻫﺮﯿﻐﺘﻣ ﻦﯾا ﺮﺛا ﺲﻧﺎﯾراﻮﮐ ﻞﯿﻠﺤﺗ يﺎﻫﺮﯿﻐﺘﻣ ،سﺎﺳا ﻦﯾا ﺮﺑ نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا
زا ﻞﺒﻗ
ﻪﺑ ﯽﯾﻮﻠﻗﺪﻨﭼ و ﻪﻠﺧاﺪﻣ ﺮﻈﻧ رد ﯽﯾﺎﻬﻧ يﺎﻫﺮﯿﻐﺘﻣ ناﻮﻨﻋ
نآ ﻊﯾزﻮﺗ ﻪﮐ ﺪﻧﺪﺷ ﻪﺘﻓﺮﮔ ﯽﻨﻌﻣ هوﺮﮔ ﻪﺳ ﻦﯿﺑ ﺎﻫ
هﺪﺷ راد
ﺮﺑ ﯽﻨﺘﺒﻣ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ) ﻪﻠﺧاﺪﻣ ﻪﻄﺑار ﯽﺳرﺮﺑ ياﺮﺑ .ﺖﺳا ﻦﻫذ ﻦﯿﮕﻧﺎﯿﻣ ﺮﺑ (لﺮﺘﻨﮐ هوﺮﮔ و ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ،ﯽﻫﺎﮔآ
ز زا ﺲﭘ ﯽﮔدﺮﺴﻓا ﻦﯾا ﺮﯿﺛﺄﺗ ،نﺎﻤﯾاز زا ﺪﻌﺑ هﺎﻣ ود نﺎﻤﯾا
.ﺪﯾدﺮﮔ لﺮﺘﻨﮐ ﺲﻧﺎﯾراﻮﮐ ﻞﯿﻠﺤﺗ شور زا هدﺎﻔﺘﺳا ﺎﺑ ﺎﻫﺮﯿﻐﺘﻣ نﺎﺸﻧ ﺞﯾﺎﺘﻧ ﯽﻨﻌﻣ ﺮﯿﺛﺄﺗ هﺪﻨﻫد
ﺮﯿﻐﺘﻣ ﺮﺑ ﻪﻠﺧاﺪﻣ ﺮﯿﻐﺘﻣ راد
) دﻮﺑ ﻪﺘﺴﺑاو
P<0.01
نﺎﺸﻧ ﺮﺘﺸﯿﺑ ﺞﯾﺎﺘﻧ .(
راﺪﻘﻣ هﺪﻨﻫد
R2=
78%
راﺪﻘﻣ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ .دﻮﺑ
R2
زا يﺪﺻرد نﺎﺸﻧ ﻪﮐ
يﺮﯾﺬﭘﺮﯿﯿﻐﺗ ﯽﮑﻤﮐ يﺎﻫﺮﯿﻐﺘﻣ ﻂﺳﻮﺗ ﻪﮐ ﺖﺳا ﻪﺘﺴﺑاو ﺮﯿﻐﺘﻣ
ﯽﻣ ﻦﯿﯿﺒﺗ ﺺﺧﺎﺷ ﻦﯾا يﻻﺎﺑ راﺪﻘﻣ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ و دﻮﺷ
ﯽﻣ ﻪﮐ ﺖﻔﮔ ناﻮﺗ 78
زا ﺲﭘ ﯽﮔدﺮﺴﻓا تاﺮﯿﯿﻐﺗ زا ﺪﺻرد
ﻞﺑﺎﻗ يرﺎﺘﻓر ﻪﻠﺧاﺪﻣ ﺎﺑ نﺎﻤﯾاز ﯽﻣ ﻪﯿﺟﻮﺗ
لوﺪﺟ رد .ﺪﻨﺷﺎﺑ 5
2 نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا دراﺪﻧﺎﺘﺳا يﺎﻄﺧ و ﻦﯿﮕﻧﺎﯿﻣ هﺎﻣ
ﺎﺑ ﻪﻠﺧاﺪﻣ زا ﺲﭘ
ﺮﯿﻐﺘﻣ لﺮﺘﻨﮐ نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا
ﻞﺒﻗ
ﻪﺑ ﯽﯾﻮﻠﻗﺪﻨﭼ و ﻪﻠﺧاﺪﻣ زا
ﻪﺑ ﯽﺳرﺮﺑ درﻮﻣ هوﺮﮔ ﻪﺳ ﮏﯿﮑﻔﺗ
ﻪﺑود ﻪﺴﯾﺎﻘﻣ ﺮﯾدﺎﻘﻣ هاﺮﻤﻫ ﻪﺳ ﮏﯿﮑﻔﺗ ﻪﺑ ﺮﯿﻐﺘﻣ ﻦﯾا يود
شراﺰﮔ ﺞﯾﺎﺘﻧ سﺎﺳاﺮﺑ .ﺖﺳا هﺪﺷ شراﺰﮔ ﯽﺳرﺮﺑ درﻮﻣ هوﺮﮔ ﺮﺑ ﯽﻨﺘﺒﻣ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ هوﺮﮔ ﺎﻬﻨﺗ لوﺪﺟ ﻦﯾا رد هﺪﺷ ﻦﻫذ وﺮﮔ ﺎﺑ ﯽﻫﺎﮔآ زا ﺲﭘ ﯽﮔدﺮﺴﻓا ﻦﯿﮕﻧﺎﯿﻣ ﺮﻈﻧ زا لﺮﺘﻨﮐ ه
ﯽﻨﻌﻣ توﺎﻔﺗ ،نﺎﻤﯾاز ﺖﺒﻗاﺮﻣ هوﺮﮔ ﺎﻣا دﺮﮐ شراﺰﮔ ار يراد
ﯽﻨﻌﻣ توﺎﻔﺗ ،يرﺎﻣآ ﺮﻈﻧ زا ﯽﻠﻣﺎﮑﺗ زا لﺮﺘﻨﮐ هوﺮﮔ ﺎﺑ ار يراد
ﻦﯿﮕﻧﺎﯿﻣ ﺮﻈﻧ نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا
.داﺪﻧ ﺶﯾﺎﻤﻧ
ﻦﻫذ ﺮﺑ ﯽﻨﺘﺒﻣ ﻪﻠﺧاﺪﻣ ﺮﯿﺛﺄﺗ نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا ﺮﺑ ﯽﻫﺎﮔآ
...
517 نﺎﺑآ و ﺮﻬﻣ ،راوﺰﺒﺳ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد 1400
، ةرود 28 ةرﺎﻤﺷ ، 4
لوﺪﺟ 3 ﻣ ﺪﺻرد و ﯽﻧاواﺮﻓ . ﯽﺳرﺮﺑدرﻮﻣ هوﺮﮔ ﮏﯿﮑﻔﺗ ﻪﺑ ﻪﻌﻟﺎﻄﻣ رد ﯽﺳرﺮﺑدرﻮﻣ ﯽﻔﯿﮐ يﺎﻫﺮﯿﻐﺘ
ﺮﯿﻐﺘﻣ هدر
ﻪﻌﻟﺎﻄﻣدرﻮﻣ هوﺮﮔ
ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ ﺮﺑ ﯽﻨﺘﺒﻣ
ﻦﻫذ ﯽﻫﺎﮔآ
n=34 ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ
n=39 لﺮﺘﻨﮐ
n=50 P-value
ﻞﯾﺪﻌﺗ P-value هﺪﺸﻧ
ﻞﯾﺪﻌﺗ هﺪﺷ
ﯽﻧاواﺮﻓ (ﺪﺻرد) ﯽﻧاواﺮﻓ (ﺪﺻرد)
ﯽﻧاواﺮﻓ (ﺪﺻرد)
ﮏﺗ دازﻮﻧ ﯽﯾﻮﻠﻗ ﻪﻠﺑ
) 2 / 85 ( 29 )
7 / 71 ( 28 )
70 ( 35 249
/0 0.014
ﺮﯿﺧ )
7 / 14 ( 5 )
2 / 28 ( 11 )
30 (
15 ﺮﯾﺎﺳ ﺎﯾ ﯽﮔدﺮﺴﻓا ﻪﻘﺑﺎﺳ
رد ﯽﮑﺷﺰﭙﻧاور تﻻﻼﺘﺧا ردﺎﻣ ﻪﻠﺑ
) 5 / 20 ( 7 )
5 / 2 ( 1 )
12 (6 056
/0 44(88) 38(974 /) 27(794 /) ﺮﯿﺧ
0.35
ردﺎﻣ تﻼﯿﺼﺤﺗ ﯽﺑ
داﻮﺳ )
7 / 11 ( 4 )
3 / 15 (6 )
10 ( 5
735 /0
ﯽﯾﺎﻤﻨﻫار )
5 / 23 ( 8 )
9 / 17 ( 7 )
10 (
20(19) 20(512 /) 13(382 /) ﻢﻠﭙﯾد
38(13) 5 (128 /) (617 / )6 ﺲﻧﺎﺴﯿﻟ
26
- و ﺲﻧﺎﺴﯿﻟقﻮﻓ
ﺮﺗﻻﺎﺑ )
8 / 8 ( 3 )
5 / 2 ( 1 )6
( 3
ﺮﺴﻤﻫ ﺖﯾﺎﻤﺣ ناﺰﯿﻣ بﻮﺧ ﯽﻠﯿﺧ
) 3 / 82 ( 28 )
7 / 64 ( 22 )
68 ( 34 930
/0 15(30) 15(441 /) 4 (117 /) بﻮﺧ
بﻮﺧ ًﺎﺘﺒﺴﻧ )
9 / 5 ( 2 )
0 ( 0 )
2 ( 1
- 0 (0) 1 (29 /) 0 (0) ﺪﺑ
ﺪﺑ ﯽﻠﯿﺧ )
0 ( 0 )
9 / 2 ( 1 )
0 ( 0
نﺎﻤﯾاز عﻮﻧ ﯽﻌﯿﺒﻃ
) 3 / 32 ( 11 )
9 / 35 ( 14 )
0 / 28 ( 624 14
- /0
ﻦﯾراﺰﺳ )
7 / 67 ( 23 )
1 / 64 ( 23 )
0 / 72 ( 36
لوﺪﺟ 4 ﯽﻤﮐ يﺎﻫﺮﯿﻐﺘﻣ رﺎﯿﻌﻣ فاﺮﺤﻧا و ﻦﯿﮕﻧﺎﯿﻣ . ﯽﺳرﺮﺑدرﻮﻣ هوﺮﮔ ﮏﯿﮑﻔﺗ ﻪﺑ ﻪﻌﻟﺎﻄﻣ رد ﯽﺳرﺮﺑدرﻮﻣ
ﺮﯿﻐﺘﻣ ﻪﻌﻟﺎﻄﻣدرﻮﻣ هوﺮﮔ
P-value هﺪﺸﻧ ﻞﯾﺪﻌﺗ P-value
هﺪﺷ ﻞﯾﺪﻌﺗ ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ
ﯽﻨﺘﺒﻣ ﻦﻫذ ﺮﺑ ﯽﻫﺎﮔآ
n=34 ﯽﻠﻣﺎﮑﺗ ﺖﺒﻗاﺮﻣ
n=39 لﺮﺘﻨﮐ
n=50
رﺎﯿﻌﻣ فاﺮﺤﻧا) (±
ﻦﯿﮕﻧﺎﯿﻣ رﺎﯿﻌﻣ فاﺮﺤﻧا)
(±
ﻦﯿﮕﻧﺎﯿﻣ رﺎﯿﻌﻣ فاﺮﺤﻧا)
(±
ﻦﯿﮕﻧﺎﯿﻣ
ردﺎﻣ ﻦﺳ )6
/6 ( 8/
29 )
5/
8 ( 9/
28 )
9/
6 ( 1/
30 289
/0
0.45 مﺎﮕﻨﻫ دازﻮﻧ ﯽﻨﯿﻨﺟ ﻦﺳ
ﺪﻟﻮﺗ )6
/2 ( 7/
30 )
1/
2 ( 5/
31 07
/2 ( 31 525
- /0
دازﻮﻧ ﺪﻟﻮﺗ مﺎﮕﻨﻫ نزو )
34 ( 51 )
37 ( 4/
71 )
48 ( 5/
57 057
/0 0.37
رﺎﮕﭘآ هﺮﻤﻧ )
33 ( 4/
62 )
39 ( 3/
70 )
50 ( 54 086
/0 0.56
يﺮﺘﺴﺑ تﺪﻣ )
88 / 19 ( 5/
28 )
45 / 14 ( 18 / 19 )
75 / 25 ( 47 / 29 834
/0
- نﺎﻤﯾاز زا ﺲﭘ ﯽﮔدﺮﺴﻓا
ﻪﻠﺧاﺪﻣ زا ﻞﺒﻗ 11.06±6.79
10.10±7.20 10.80±7.45
001 /0 001 <
/0
<
