(ع)ﺮﻐﺻاﯽﻠﻋ تﺮﻀﺣ نﺎﺘﺳرﺎﻤﯿﺑ رد ﯽﻧﻮﻣﻮﻨﭘ ﺖﻠﻋ ﻪﺑ یﺮﺘﺴﺑ نارﺎﻤﯿﺑ ﯽﺳرﺮﺑ لﺎﺳ 3 تﺪﻣ رد
I ﯽﺟﻮﻠﺤﻣ ﻪﺠﯾﺪﺧ ﺮﺘﮐد
هﺪﯿﮑﭼ
زا ﺮﺘـﺸﯿﺑ ARI ﺎﻫرﻮـﺸﮐ ﺐـﻠﻏا رد .ﺪـﺷﺎﺑﯽﻣ نﺎـﮐدﻮﮐ رد ﺮﯿـﻣ و گﺮـﻣ ﻢﻬـﻣ ﻞـﻠﻋ زا (ARI) ﯽـﺴﻔﻨﺗ دﺎــﺣ یﺎﻫﺖﻧﻮﻔﻋ رد ﯽﻧﺎﻬـﺟ ﺖـﺷاﺪﻬﺑ نﺎﻣزﺎــﺳ ﻦﯿﻤﺨﺗ سﺎﺳا ﺮﺑ .ﺪﺘﻓاﯽﻣ قﺎﻔﺗا یﺮﯿﺴﻣﺮﮔ یﺎﻬﯾرﺎﻤﯿﺑ و لﺎﻬﺳا ﻪﻠﻤﺟ زا ،ﺮﮕﯾد دﺎﺣ یﺎﻬﯾرﺎﻤﯿﺑ و عﻮﻧ .ﺖﺳا هداد خر ﯽﻧﻮﻣﻮﻨﭘ ﺎﺑ طﺎﺒﺗرا رد هﺪﻤﻋ رﻮﻄﺑ ﻪﮐ ﺖﺳا هدﻮﺑ نﺎﮐدﻮﮐ رد گﺮﻣ نﻮﯿﻠﯿﻣ 4/3 ﻞﻣﺎﻋ ARI ،1990 لﺎﺳ ﺐـﻠﻏا رد ﯽـﻧﻮﻣﻮﻨﭘ .دراد ﯽﮕﺘـﺴﺑ ﯽـﻄﯿﺤﻣ ﻞـﻣاﻮﻋ و ﯽــﻨﻤﯾا ﺖﯿﻌﺿو ،ﻞﺼﻓ ،ﻦﺳ ﻪﻠﻤﺟ زا ﯽﻔﻠﺘﺨﻣ ﻞﻣاﻮﻋ ﻪﺑ ﯽﻧﻮﻣﻮﻨﭘ تﺪﺷ :زا ﺪﻨﺗرﺎـﺒﻋ ﻪـﮐ ﺪﻨـﺷﺎﺑ ﻞـﯿﺧد نآ رد ﺪـﻨﻧاﻮﺗﯽﻣ ﺰﯿـﻧ ﯽﻧﻮﻔﻋﺮﯿـﻏ ﻞــﻣاﻮﻋ ﺎﻣا دﻮﺷﯽﻣ دﺎﺠﯾا ﺎﻬﻤﺴﯿﻧﺎﮔراوﺮﮑﯿﻣ ﻂﺳﻮﺗ دراﻮﻣ هﺪـﻧوﺮﭘ ،ﺮﮕﻧﻪﺘـﺷﺬﮔ ﻪــﻌﻟﺎﻄﻣ ﮏﯾ رد .ﺎﻫوراد زا ﯽﺷﺎﻧ ﯽﻧﻮﻣﻮﻨﭘ و ﺖﯿﺳﺎﺴﺣ ،ﯽﺟرﺎﺧ ﻢﺴﺟ ،هﺪﻌﻣ ﺪﯿﺳا ﺎﯾ اﺬﻏ نﻮﯿﺳاﺮﯿﭙﺳآ ﺎـﺑ درﻮـﻣ 457 .ﺪـﺷ ﯽـﺳرﺮﺑ ،ﺪـﻧدﻮﺑ هﺪـﺷ یﺮﺘـﺴﺑ 1372 ﺎـﺗ 1369 یﺎﻬﻟﺎــﺳ ﯽﻃ ،ﯽﻧﻮﻣﻮﻨﭘ ﻪﯿﻟوا ﺺﯿﺨﺸﺗ ﺎﺑ ﻪﮐ ﯽﻧارﺎﻤﯿﺑ هﺪـﺷ هداد ﯽـﻓاﺮﮔﻮــﯾدار ﻪﺠﯿﺘﻧ و ﯽﻨﯿﻟﺎﺑ ﻪﻨﯾﺎﻌﻣ سﺎﺳاﺮﺑ ﯽﻧﻮﻣﻮﻨﭘ ﺺﯿﺨﺸﺗ ﻪﮐ ﺪﻧدﻮﺑ هﺪﺷ یﺮﺘﺴﺑ ﯽﻧﻮﻣﻮﻨﭘ ﻪﯿﻟوا ﺺﯿﺨﺸﺗ زا نارﺎـﻤﯿﺑ ﻦـﯾا .دﻮـﺑ هدﺮــﮐ ﮏﻤﮐ ﺺﯿﺨﺸﺗ ﻪﺑ ﯽﺴﻔﻨﺗ یﺎﻬﻫار تﺎﺤﺷﺮﺗ و راردا ،نﻮﺧ ﺖﺒﺜﻣ ﺖﺸﮐ دراﻮﻣ ﯽﻀﻌﺑ رد و دﻮﺑ درﻮـﻣ 266 ،لوا هوﺮــﮔ رد درﻮﻣ 147 ﻪﮐ ﺪﻧﺪﺷ ﻢﯿﺴﻘﺗ لﺎﺳ 16 ﺎﺗ 6 و لﺎﺳ 5 ﺎﺗ هﺎﻣ 4 ،هﺎﻣ 3 ﺎﺗ ﺮﻔﺻ ،هوﺮﮔ 3 ﻪﺑ ﯽﻨﺳ ﺮﻈﻧ .ﺪﻨﺘﻓﺮﮔ راﺮﻗ مﻮﺳ هوﺮﮔ رد درﻮﻣ 44 و مود هوﺮﮔ رد ﺖـﻠﻋ درﻮـﻣ 14 رد ﻪــﮐ دﻮﺑ هﺪﺷ هﺪﯾد درﻮﻣ 30 رد رﺮﮑﻣ ﯽﻧﻮﻣﻮﻨﭘ .ﺪﻧدﻮﺑ نز درﻮﻣ 184 ودﺮﻣ درﻮﻣ 273 ،ﺲﻨﺟ ﺮﻈﻧ زا ﯽﻤـﺳﻮﻟ ،یﺮـﻣ یزﺮـﺗآ ،ﯽﺟرﺎـﺧ ﻢــﺴﺟ ،لﺎﯾژﺎﻓوزا وﺮﺘﺳﺎﮔ ﺲﮐﻼﻔﯾر ،یﺰﻐﻣ ﺞﻠﻓ ،ﻢﺳآ دراﻮﻣ ﺮﯾﺎﺳ رد و ﺪﺸﻧ ﻪﺘﺧﺎﻨﺷ نآ .ﺪﻧﺪﺷ ﻪﺘﺧﺎﻨﺷ رﺮﮑﻣ ﯽﻧﻮﻣﻮﻨﭘ ﺖﻠﻋ ﺞﻨﺸﺗ و دﺎﺣ ﮏﯿﺘﺳﻼﺑﻮﻔﻨﻟ و ﯽﻟﺎـﺣﯽﺑ ،غاﺮﻔﺘـﺳا ،ندرﻮﺨﻧﺮﯿـﺷ ،ﺲـﻔﻨﺗ داﺪـﻌﺗ ﺶـﯾاﺰﻓا ،ﺐـﺗ ،ﻪﻓﺮـﺳ :زا ﺪــﻧدﻮﺑ ترﺎﺒﻋ عﻮﯿﺷ ﺐﯿﺗﺮﺗ ﻪﺑ ﯽﻨﯿﻟﺎﺑ ﻢﺋﻼﻋ
%58/8 .ﺪﻨﺘـﺷاد FTT زا ﯽﺗﺎـﺟرد ،نارﺎـﻤﯿﺑ %75 ﻪـﮐ دﻮـﺑ هﺪــﺷ یﺮﯿﮔهزاﺪﻧا ﺪﺷر رادﻮﻤﻧ ﺐﺴﺣﺮﺑ ﺪﺷر ناﺰﯿﻣ .زﻮﻧﺎﯿﺳ .ﺪﻨﺘﺷاد ﻪﻨﭘﯽﮐﺎﺗ %80/1 و ﯽﻌﯿﺒﻃ زا ﺮﺗﻻﺎﺑ تراﺮﺣ ﻪﺟرد ﺪﺷ هﺪﯾد درﻮﻣ 78 رد ﺖﺒﺜﻣ ﺖﺸﮐ و درﻮﻣ 147 رد ﯽﻣﺪﻧﺎﺑ .دﻮﺑ ﻪﺘﻓﺎﯾ ﺶﯾاﺰﻓا %66 رد ESR ،ﯽﻫﺎﮕﺸﯾﺎﻣزآ ﻢﺋﻼﻋ ﺮﻈﻧ زا
،ﯽـﺴﻔﻨﺗ یﺎﻬــﻫار تﺎﺤﺷﺮﺗ ﺖﺸﮐ و درﻮﻣ 9 ﯽﻋﺎﺨﻧ ـ یﺰﻐﻣ ﻊﯾﺎﻣ ﺖﺸﮐ ،درﻮﻣ 24 راردا ﺖﺸﮐ ،درﻮﻣ 24 رد نﻮﺧ ﺖﺸﮐ ﻪﮐ زوﺪﯿـﺳا و ﯽـﺴﮐﻮﭙﯿﻫ ،ﯽﻧﺎﯾﺮـﺷ نﻮـﺧ یﺎـﻫزﺎﮔ ﺰﯿﻟﺎـﻧآ رد.دﻮــﺑ ﺖﺒﺜﻣ ،درﻮﻣ 21 ًﻼﮐ ،عﻮﻓﺪﻣ ﺖﺸﮐ و لﻮﺘﺳﻮﭘ ،شﻮﮔ ،ﻢﺸﭼ نﺎـﻣرد .دﻮـﺑ هداد نﺎـﺸﻧ ار ﺮـﺸﺘﻨﻣ نﻮﯿـﺳاﺮﺘﻠﯿﻔﻧا ﯽﻨـﺳ هوﺮــﮔ ﻪﺳ ﺮﻫ رد ،ﻪﻨﯿﺳ ﻪﺴﻔﻗ ﯽﻓاﺮﮔﻮﯾدار .ﺪﺷ هﺪﻫﺎﺸﻣ ﮏﯿﻟﻮﺑﺎﺘﻣ 14 زا ﺮﺘﺸﯿﺑ دراﻮﻣ %4/3 رد و زور 14 یوﺎﺴﻣ ﺎﯾ ﺮﺘﻤﮐ دراﻮﻣ %95/7 رد ﻪﮐ دﻮﺑ هﺪﺷ مﺎﺠﻧا درﻮﻣ 373 رد ﯽﮑﯿﺗﻮﯿﺑﯽﺘﻧآ زا .دﻮـﺑ هدﺎـﺘﻓا قﺎـﻔﺗا FTT ﻪــﺑ نﺎﯾﻼﺘﺒﻣ و هﺎﻣ 3 زا ﺮﺘﻤﮐ ﻦﯿﻨﺳ رد و (%7) درﻮﻣ 31 رد ﯽﻧﻮﻣﻮﻨﭘ زا ﯽﺷﺎﻧ گﺮﻣ .دﻮﺑ زور قﺎـﻔﺗا ﺮﺘـﺸﯿﺑ FTT و ﻪﯾﺬﻐﺗءﻮـﺳ ﻪـﺑ ﻼـﺘﺒﻣ داﺮــﻓا و هﺎﻣ 3 زا ﺮﺘﮑﭼﻮﮐ ناﻮﺟ ناراﻮﺧﺮﯿﺷ رد ﺪﯾﺪﺷ ﯽﺴﻔﻨﺗ ﺖﻧﻮﻔﻋ ﻪﮑﯿﺋﺎﺠﻧآ یﺮﯿـﮔﻮـﻠﺟ ،ﯽــﻧﻮﻣﻮﻨﭘ ﺮﯿﻣو گﺮﻣ زا قﻮﻓ دراﻮﻣ رد ﺎﺗ دﻮﺷ عوﺮﺷ ﺐﺳﺎﻨﻣ ﮏﯿﺗﻮﯿﺑﯽﺘﻧآ ﺮﺗدوز ﻪﭼ ﺮﻫ ﺖﺳا ﺮﺘﻬﺑ اﺬﻟ ،ﺪﺘﻓاﯽﻣ .ددﺮﮔ
ﯽﻧﻮﻣﻮﻨﭘ زا ﯽﺷﺎﻧ گﺮﻣ – 3 ﯽﺴﻔﻨﺗ دﺎﺣ ﺖﻧﻮﻔﻋ – 2 ﯽﻧﻮﻣﻮﻨﭘ – 1 :ﺎﻫهژاوﺪﯿﻠﮐ
.ناﺮﻬﺗ ،ناﺮﯾا ﯽﻧﺎﻣرد ـ ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﺮﻔﻇ نﺎﺑﺎﯿﺧ ،(ع)ﺮﻐﺻا ﯽﻠﻋ تﺮﻀﺣ نﺎﺘﺳرﺎﻤﯿﺑ ،نﺎﮐدﻮﮐ یﺎﻬﯾرﺎﻤﯿﺑ رﺎﯿﺸﻧاد (I
ﻪﻣﺪﻘﻣ ﺮﯿـﻣ و گﺮـﻣ ﻢﻬــﻣ ﻞﻠﻋ زا ،(ARI) ﯽﺴﻔﻨﺗ دﺎﺣ یﺎﻫﺖﻧﻮﻔﻋ ﺮﯾﺎـﺳ زا ﺮﺘـﺸﯿﺑ ARI،ﺎﻫرﻮـﺸﮐ ﺐــﻠﻏا رد .ﺪﺷﺎﺑﯽﻣ نﺎﮐدﻮﮐ قﺎﻔﺗا یﺮﯿﺴﻣﺮﮔ یﺎﻬﯾرﺎﻤﯿﺑ و لﺎﻬﺳا ﻪﻠﻤﺟ زا ،دﺎﺣ یﺎﻬﯾرﺎﻤﯿﺑ (WHO) ﯽﻧﺎﻬـﺟ ﺖــﺷاﺪﻬﺑ نﺎﻣزﺎﺳ ﻦﯿﻤﺨﺗ سﺎﺳاﺮﺑ .ﺪﺘﻓاﯽﻣ نﺎﮐدﻮـﮐ رد گﺮـﻣ نﻮـﯿﻠﯿﻣ4/3ﻞـﻣﺎﻋ ARI ،1990 لﺎﺳ رد ﯽـﻧﻮﻣﻮﻨﭘ ﺎـﺑ طﺎــﺒﺗرا رد ﺎﻬﮔﺮﻣ ﻦﯾا هﺪﻤﻋرﻮﻄﺑ ﻪﮐ ﺖﺳا هدﻮﺑ رد ﺮﺘﺸﯿﺑ ﺪﻨﻨﮐﯽﻣ تﻮﻓ ﯽﻧﻮﻣﻮﻨﭘ ﺮﺛا رد ﻪﮐ ﯽﻧﺎﮐدﻮﮐ .ﺪﻧاهدﻮﺑ ﻪـﺑ ﻼـﺘﺑا زا ﺪـﻌﺑ ﯽــﻫﺎﺗﻮﮐ نﺎـﻣز رد و ﺪﻨﺘـﺴﻫ ﻦﯿﯾﺎــﭘ ﻦﯿﻨﺳ .ﺪﻧﺮﯿﻣﯽﻣ ،ﯽﻧﻮﻣﻮﻨﭘ ﺮﯿـﺷ هرود رد یرﺎــﻤﯿﺑ ﻦﯾﺮﺘﻌﯾﺎﺷ ﯽﺴﻔﻨﺗ هﺎﮕﺘﺳد ﺖﻧﻮﻔﻋ رﺎﺑ 4 ﺎﺗ 2 ﻂﺳﻮﺘﻣ رﻮﻄﺑ کدﻮﮐ ﺮﻫ .ﺖﺳا ﯽﮐدﻮﮐ و ﯽﮔراﻮﺧ ﻪـﺑ ﻪـﻌﺟاﺮﻣ %7 و دﻮـﺷﯽﻣ ﻼــﺘﺒﻣ ﯽﺴﻔﻨﺗ ﺖﻧﻮﻔﻋ ﻪﺑ لﺎﺳ رد عﻮﻧ .ﺪﺷﺎﺑﯽﻣ ﯽﺴﻔﻨﺗ ﺖﻧﻮﻔﻋ ﺎﺑ طﺎﺒﺗرا رد ،لﺎﻔﻃا ﻦﯿﺼﺼﺨﺘﻣ ﻞﻣﺎـﺷ ﻪـﮐ دراد ﯽﮕﺘــﺴﺑ ﯽﻔﻠﺘﺨﻣ ﻞﻣاﻮﻋ ﻪﺑ ﯽﻧﻮﻣﻮﻨﭘ تﺪﺷ و .ﺪﺷﺎﺑﯽﻣ نﺎﺑﺰﯿﻣ ﯽﻨﻤﯾا ﺖﯿﻌﺿو و ﻞﺼﻓ ،ﻦﺳ ﺮﺘـﺸﯿﺑ ار ﯽـﻧﻮﻣﻮﻨﭘ ﻪـﺑ ﻼـﺘﺑا لﺎـﻤﺘﺣا ﻪــﮐ ﯽﻄﯿﺤﻣ ﻞﻣاﻮﻋ ؛نﺪﯿـﺸﮐ رﺎﮕﯿــﺳ ؛ﺎﻬﮐدﻮﮐ ﺪﻬﻣ رد ﯽﮔﺪﻧز :زا ﺪﻨﺗرﺎﺒﻋ ،ﺪﻨﻨﮐﯽﻣ یدﺎــﺼﺘﻗا -ﯽﻋﺎﻤﺘﺟا ﺖﯿﻌﺿو ؛ ندﻮﺑ رﺎﮕﯿﺳ دود ضﺮﻌﻣ رد .(1-13).هداﻮﻧﺎﺧ ﺖﯿﻌﻤﺟ یدﺎﯾز و ،ﻦﯿﯾﺎﭘ دراﻮـﻣ ﺮﺘــﺸﯿﺑ رد ﻪﮐ ﺖﺳا ﻪﯾر ﻢﯿﺸﻧارﺎﭘ بﺎﻬﺘﻟا ،ﯽﻧﻮﻣﻮﻨﭘ ﺮﯿـﻏ ﻞـﻣاﻮﻋ ﺎـﻣا دﻮـﺷﯽﻣ دﺎـﺠﯾا ﺎﻬﻤــﺴﯿﻧﺎﮔراوﺮﮑﯿﻣ ﻪﻠﯿﺳﻮﺑ ﻞـﻣاﻮﻋ ﻦـﯾا .ﺪﻨـﺷﺎﺑ ﻞـﯿﺧد نآ زوﺮــﺑ ردﺪﻨﻧاﻮﺗﯽﻣ ﺰﯿﻧ ﯽﻧﻮﻔﻋ ؛ﯽﺟرﺎــﺧ ﻢـﺴﺟ ؛هﺪـﻌﻣ ﺪﯿـﺳا ﺎـﯾ اﺬـﻏ نﻮﯿـﺳاﺮﯿﭙﺳآ ،ﻞﻣﺎـﺷ .(13-22)(7 و5،2)ﺪﻨﺘﺴﻫ ﺎﻫوراد زا ﯽﺷﺎﻧ ﯽﻧﻮﻣﻮﻨﭘ و ﺖﯿﺳﺎﺴﺣ و ﺺﯿﺨــﺸﺗ ﺮﻣا رد ﮏﺷﺰﭘ یاﺮﺑ ﻦﯾﺮﻓآ ﻞﮑﺸﻣ دراﻮﻣ زا ﯽﮑﯾ .ﺪﺷﺎﺑﯽﻣ ﻪﻌﺟار ﯽﻧﻮﻣﻮﻨﭘ ،ﯽﺴﻔﻨﺗ یﺎﻬﺘﻧﻮﻔﻋ نﺎﻣرد نوﺪـﺑ ﻞـﺻاﻮﻓ لﺎــﺒﻧﺪﺑ مﻮﺳ ﺎﯾ مود رﺎﺑرد ﯽﻧﻮﻣﻮﻨﭘ زوﺮﺑ هﺪـﺷ ﺪﯿﯾﺄـﺗ یژﻮـﻟﻮﯾدار ﺎــﯾ و ﯽﻨﯿﻟﺎﺑ ﻢﺋﻼﻋ ﻂﺳﻮﺗ ﻪﮐ ﺖﻣﻼﻋ ﺰﯿــﻧ یﺮﮕﯾد حﻼﻄﺻا .دﻮﺷﯽﻣ هﺪﻧاﻮﺧ ﻪﻌﺟار ﯽﻧﻮﻣﻮﻨﭘ ،ﺪﺷﺎﺑ ﺮﯿﺧﺄــﺗ زا ﺖﺳا ترﺎﺒﻋ نآ و دراد دﻮﺟو مواﺪﻣ ﯽﻧﻮﻣﻮﻨﭘ مﺎﻨﺑ ندﻮــﺑ ﯽﻓﺎﮐ ﻢﻏﺮﯿﻠﻋ ﻪﮐ ﯽﻧﻮﻣﻮﻨﭘ یدﻮﺒﻬﺑ رد رﺎﻈﺘﻧا ﻞﺑﺎﻗ ﺮﯿﻏ رﺎﻤﯿﺑ شﺮﯾﺬﭘ ﺎﯾ عﺎﺟرا نﺎـﻣز رد زﻮﻨﻫ ،ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ نﺎﻣرد ﻢـــﺋﻼﻋ ﺎــــﯾ ﯽـــﻨﯿﻟﺎﺑ تﺎــــﻨﯾﺎﻌﻣ ﻪـﯾﺎﭘ ﺮــﺑ و دراد دﻮــﺟو حﻼـــﻄﺻا 2 ﻦـﯾا ًﻻﻮــﻤﻌﻣ .ددﺮـﮔﯽـﻣ تﺎـﺒﺛا یژﻮــﻟﻮــﯾدار
Persistent or recurrent.دﻮـﺷﯽﻣ هدﺮﺑرﺎـﮑﺑ نﺎﻣﺰــﻤﻫ
(23-27)(21 و11)pneumonia (prp)
ﯽﺳرﺮﺑ شور رﺎــﻤﯿﺑ 457 هﺪﻧوﺮﭘ ،1372 ﺎﺗ 1369 لﺎﺳ زا ﻖﯿﻘﺤﺗ ﻦﯾا رد (ع)ﺮـﻐﺻا ﯽـﻠﻋ تﺮـﻀﺣ نﺎﺘﺳرﺎﻤﯿﺑ رد ﻪﮐ ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺒﻣ رﺎـﻤﯿﺑ 30 .ﺖـﻓﺮﮔ راﺮـﻗ ﯽـﺳرﺮﺑ درﻮــﻣ ،ﺪﻧدﻮﺑ هﺪﺷ یﺮﺘﺴﺑ ﺮـﮐذ ﯽــﻧﻮﻣﻮﻨﭘ ﺖﻠﻌﺑ ار (ﺮﺘﺸﯿﺑ ﺎﯾ رﺎﺑ 2)رﺮﮑﻣ یﺮﺘﺴﺑ ﻪﻘﺑﺎﺳ .ﺪﻧدﺮﮐﯽﻣ :زا ﺪــﻧدﻮﺑ ترﺎـﺒﻋ ﯽــﺳرﺮﺑ ﻦﯾا رد ﯽﺼﯿﺨﺸﺗ یﺎﻫرﺎﯿﻌﻣ ًﺎــﺗﺪﻤﻋ ،نارﺎﻤﯿﺑ رد ﯽﻧﺎﺘﺤﺗ ﯽﺴﻔﻨﺗ ﺖﻧﻮﻔﻋ ﻪﯿﻟوا ﺺﯿﺨﺸﺗ -1 ﻪﻨﯿــﺳ ﻪﺴﻔﻗ ﯽﻓاﺮﮔﻮﯾدار زا هدﺎﻔﺘﺳا و ﯽﻨﯿﻟﺎﺑ ﻢﺋﻼﻋ یﺎﻨﺒﻣ ﺮﺑ .ﯽﯾﺎﻬـﻧ ﺺــــﯿﺨﺸﺗ یاﺮــﺑ ،ﺲــﮑﻧرﺎﻓوزﺎﻧ و نﻮﺧ ﺖــﺸﮐ و ﻼــﺘﺑا ﻦﺳ ﻪﯾﺎﭘ ﺮﺑ داﺮﻓا ﻦﯾا رد ﮏﯾژﻮﻟﻮﯿﺗا ﻞﻣاﻮﻋ ﯽﺳرﺮﺑ -2 26 رد ﻪـﮐ دﺮـﮐ هرﺎــﺷا ﻪﺘﮑﻧ ﻦﯾا ﻪﺑ ﺪﯾﺎﺑ) .یاﻪﻨﯿﻣز یرﺎﻤﯿﺑ و ﺶـــﻧﺮﺑ تﺎﺤـﺷﺮﺗ ﺖــــﺸﮐ درﻮﻣ 1 رد و نﻮﺧ ﺖﺸﮐ درﻮﻣ سﺎﺳاﺮﺑ نارﺎﻤﯿﺑ ﺪﺷر ﺖﯿﻌﺿو ﯽﺳرﺮﺑ -3 .(دﻮﺑ هﺪﺷ ﺖﺒﺜﻣ .ﺮـﺳ رود و نزو و ﺪـﻗ ﯽﺒــﺴﻧ ﺮﯾدﺎﻘﻣ ﻪﺑ طﻮﺑﺮﻣ یﺎﻫرادﻮﻤﻧ زا یرﺎﯿـــﺴﺑ یﺎـﻫهﺪﻧوﺮﭘ ندﻮـﺒﻧ ﻞﻣﺎـﮐ ﻪـﺑ ﻪـﺟﻮﺗ ﺎـﺑ :ﺮـﮐﺬﺗ رد نﺎـﯾﻼﺘﺒﻣ ﻪــﺑ طﻮﺑﺮﻣ یﺎﻫﺮﯿﻐﺘﻣ زا یدﺎﯾز دراﻮﻣ ،نارﺎﻤﯿﺑ ﺪـﺸﻧ دراو ﺎـﻫهداد ﺖـﺴﯿﻟ رد رﺎـﭼﺎـﻧ ﻪـﺑ ﻪـﮐ دﻮــﺒﻧ سﺮﺘﺳد ،ﺖــﺳا هﺪـﺷ جرد ﻖـﯿﻘﺤﺗ ﻦـﯾا رد ﻪـﮐ ﯽﯾﺎـﻫﺪﺻرد ﻦﯾاﺮﺑﺎـﻨﺑ .ﺪﺷﺎﺑﯽﻣ سﺮﺘﺳد رد یﺎﻫﺮﯿﻐﺘﻣ ﻪﺑ طﻮﺑﺮﻣ
ﺞﯾﺎﺘﻧ ترﻮــﺼﺑ ،هﺪــﺷ ﯽـــﺳرﺮﺑ (%6/56) نارﺎـﻤﯿﺑ زا ﺮـﻔﻧ 30 ﯽـﻧﻮﻣﻮﻨﭘ ﺺﯿﺨـﺸﺗ ﺎـﺑ رﺎـﺑ 2/6 ،ﻂـﺳﻮﺘﻣ رﻮــﻄﺑ و یراﺮﮑﺗ .ﺪﻧدﻮﺑ هﺪﺷ یﺮﺘﺴﺑ 4 ،هﺎـﻣ 3 ﺎـﺗ ﺮــﻔﺻ ﯽﻨﺳ هوﺮﮔ 3 رد ،نارﺎﻤﯿﺑ ﯽﻨﺳ عﻮﯿﺷ رد رﺎـﻤﯿﺑ 147 .ﺪـﺷ ﯽـﺳرﺮﺑ لﺎـﺳ 16 ﺎــﺗ 6 و لﺎﺳ 5 ﺎﺗ هﺎﻣ مود ﯽﻨـﺳ هوﺮـﮔ رد رﺎـﻤﯿﺑ 266 ،(%32/16) لوا ﯽﻨــﺳ هوﺮﮔ زا .ﺪــﻨﺘﻓﺮﮔ راﺮﻗ (%9/62) مﻮﺳ هوﺮﮔ رد رﺎﻤﯿﺑ 44 و (%58/2) ﺖﺒـﺴﻧ ﻪــﮐ ﺪﻧدﻮﺑ نز درﻮﻣ 184 و دﺮﻣ درﻮﻣ273 ﺲﻨﺟ ﺮﻈﻧ
ﺮﺘـﺸﯿﺑ ﺎـﯾ رﺎـﺑ 2 ﻪـﮐ رﺎــﻤﯿﺑ ﺮﻔﻧ 30 زا ﺖﺳا هدﻮﺑ 1/48 ﺎﻬﻧآ رﺎـﻤﯿﺑ 14 رد ،ﺪﻧﺪـﺷ یﺮﺘـﺴﺑ ﺰـﮐﺮﻣ ﻦـﯾا رد ﯽــﻧﻮﻣﻮﻨﭘ ﺖﻠﻌﺑ رﻮـﻄﺑ نارﺎـﻤﯿﺑ ﻦـﯾا) ﺖــﺷاﺪﻧ دﻮﺟو یاﻪﻨﯿﻣز ﻞﻣﺎﻋ (%46/6) .(ﺪﻧدﻮﺑ هﺪﺷ یﺮﺘﺴﺑ رﺎﺑ 2 ﻂﺳﻮﺘﻣ (%23/3) ﺪــﺷﯽﻣ بﻮﺴﺤﻣ یاﻪﻨﯿﻣز ﻞﻣﺎﻋ ﻢﺳآ رﺎﻤﯿﺑ 7 رد رﺎـﻤﯿﺑ 3 .دﻮـﺑ رﺎــﺑ 3 هوﺮﮔ ﻦﯾا رد یﺮﺘﺴﺑ ﻂﺳﻮﺘﻣ داﺪﻌﺗ ﻪﮐ نﻮﯿـﺳاﺮﯿﭙﺳآ ﯽـﻧﻮﻣﻮﻨﭘ رﺎـﭼد رﺮــﮑﻣ رﻮﻄﺑ یﺰﻐﻣ ﺞﻠﻓ ﺖﻠﻌﺑ 5 ،یﺮﺘــﺴﺑ ﻂﺳﻮﺘﻣ داﺪﻌﺗ هوﺮﮔ ﻦﯾا رد ﻪﮐ (%10) ﺪﻧدﻮﺑ هﺪﺷ .ﺖﺳا هدﻮﺑ رﺎﺑ (%6/7) ﺖـﺷاد دﻮــﺟو یﺮﻣ ﻪﺑ هﺪﻌﻣ ﺲﮐﻼﻔﯾر رﺎﻤﯿﺑ 2 رد 4 رد و ﺪـﻧدﻮﺑ هﺪــﺷ یﺮﺘﺴﺑ رﺎﺑ 4 ،رﺎﻤﯿﺑ 2 ﻦﯾا زا ﮏﯾ ﺮﻫ ﻪﮐ و یﺮـﻣ یزﺮـﺗآ ،ﻞﻣﺎـﺷ یاﻪـﻨﯿﻣز یرﺎـﻤﯿﺑ ،هﺪﻧﺎــﻤﯿﻗﺎﺑ رﺎﻤﯿﺑ دﺎـــﺣ ﯽﻤـﺳﻮﻟ ،ﯽﺟرﺎـﺧ ﻢـﺴﺟ ،نآ ﻢـﯿﻣﺮﺗ زا ﺪـﻌﺑ ﻪـﺿرﺎﻋ رﺎـﺑ 2 ﮏـﯾ ﺮـﻫ ﻪـﮐ %3/3 ماﺪــﮐ ﺮﻫ) دﻮﺑ ﺞﻨﺸﺗ و ﮏﯿﺘﯿﺳﻮﻔﻨﻟ .(ﺪﻧدﻮﺑ هﺪﺷ یﺮﺘﺴﺑ هوﺮـﮔ 5 ﻪـﺑ یﺮﺘــﺴﺑ تﺪﻣ ﺮﻈﻧ زا نارﺎﻤﯿﺑ ﯽﺳرﺮﺑ ﻦﯾا رد .ﺪﻧﺪﺷ ﻢﯿﺴﻘﺗ 213 ،زور 8-14 ،(%38/3) درﻮــــﻣ 175 ،زور 7 زا ﺮﺘــﻤﮐ 22-30 ،(%10/72) درﻮـــﻣ 49 ،زور15-21 ،(%46/6) درﻮــﻣ .(%1/09) درﻮــﻣ 5 ،زور 30 زا ﺶﯿﺑ و (%3/7) درﻮﻣ 17 ،زور ،ﻦـــﺳ ﺮـﻈﻧ زا نارﺎـﻤﯿﺑ ﯽـــﻠﯿﻣﺎﻓ ﻪـﭽﺨﯾرﺎﺗ ﻖـﯿﻘﺤﺗ ﻦـﯾا رد ﯽـــﮔداﻮﻧﺎـﺧ یرﺎـﻤﯿﺑ ﻪﻘﺑﺎـﺳ و ﻦـﯾﺪﻟاو یرﺎـﻤﯿﺑ عﻮـﻧ ،ﻞﻐـﺷ .ﺪﺷ ﯽﺳرﺮﺑ ﻦـﯾﺪﻟاو %31/8 ،ﺎـﻫهﺪﻧوﺮﭘ رد دﻮـﺟﻮﻣ تﺎــﻋﻼﻃا سﺎﺳاﺮﺑ .ﺪﻨﺘــﺷاد رود ﯽﻠﯿﻣﺎــﻓ ﺖﺒــﺴﻧ %12/3 رد و ﮏـــﯾدﺰﻧ ﻞﯿﻣﺎـﻓ ﺪـﻧزﺮﻓ 2 ﺎﺑ یﺎﻫهداﻮﻧﺎﺧ رد ،ﯽﺴﻔﻨﺗ ﺖﻧﻮﻔﻋ ناﺰﯿﻣ ﻦــﯾﺮﺘﺸﯿﺑ 30 ﯽﻠﯿﻣﺎـﻓ ﻪـــﻘﺑﺎﺳ رد .(%72/3) ﺪـﺷ هﺪﻫﺎـﺸﻣ ﺮــــﺘﺸﯿﺑ ﺎﯾ ،(%26/6) درﻮـﻣ 8 ﻢـــﺳآ ﻪﻘﺑﺎـﺳ ،رﺮـﮑﻣ ﯽـﻧﻮﻣﻮﻨﭘ ﺎــﺑ رﺎﻤﯿﺑ رد یژﺮﻟآ ،(%33/3) درﻮﻣ 10 هداﻮﻧﺎﺧ رد کدﻮﮐ گﺮﻣ ﻪﻘﺑﺎﺳ و (%10) درﻮـــﻣ 3 رد ﺞﻨـﺸﺗ و ﯽﻤـﺳﻻﺎﺗ ،(%13/3) درﻮـﻣ 4 .دﻮﺑ هﺪﺷ شراﺰﮔ (%6/6) درﻮﻣ 2 رد یﻮﯾر تﻼﮑﺸﻣ نارﺎﻤﯿﺑ زا (%3/5) ﺮﻔﻧ 16 ،هﺪﻧوﺮﭘ رد دﻮﺟﻮﻣرﺎﻣآ ﻖﺒﻃ ﺮﺑ ﺪـﻟﻮﺗ یﻮﻠﺑﺎــﺗ ﺎﺑ (%0/2) درﻮﻣ 1 و سردوز نﺎﻤﯾاز یﻮﻠﺑﺎﺗ ﺎﺑ ﻞﺼﻓ ﻦﯾﺮﺘﺸﯿﺑ ﻖﯿﻘﺤﺗ ﻦﯾا رد .ﺪﻧدﻮﺑ هﺪﺷ ﺪﻟﻮﺘﻣ ﺪﻋﻮﻣ زا ﺲﭘ و رﺎﻬـﺑ و نﺎﺘـﺴﻣز ﻞـﺼﻓ ،ﯽﻧﺎـﺘﺤﺗ ﯽـﺴﻔﻨﺗ ﺖـﻧﻮﻔﻋ ﻪــﺑ ﻼﺘﺑا
ﺎﻣﺮـﺳ ﻪﻘﺑﺎـﺳ .دﻮـﺑ نﺎﺘـﺴﺑﺎﺗ ،عﻮﯿـﺷ ﺮــﻈﻧ زا ﻞﺼﻓ ﻦﯾﺮﺘﻤﮐ درﻮــﻣ 99رد ﯽﻧﺎـﻗﻮﻓ ﯽـﺴﻔﻨﺗ هﺎﮕﺘـﺳد ﺖـﻧﻮﻔﻋ و ﯽـﮔدرﻮـﺧ رﺎــﻤﯿﺑ 68 و ﺖﺷاد دﻮﺟو ﯽﻧﻮﻣﻮﻨﭘ ﻪﺑ ﻼﺘﺑا زا ﻞﺒﻗ ،(%21/66) رد ار ﯽﻧﺎــﻗﻮﻓ ﯽــﺴﻔﻨﺗ هﺎﮕﺘــﺳد رﺮـــﮑﻣ یﺎﻬـﺘﻧﻮﻔﻋ ﻪﻘﺑﺎـﺳ .ﺪﻧدﺮﮐﯽﻣ ﺮﮐذ ﻪﭽﺨﯾرﺎﺗ ،ﻪـﻨﭘ ﯽﮐﺎـﺗ ،ﺐـﺗ ،ﻪﻓﺮــﺳ ،عﻮﯿﺷ ﺐﯿﺗﺮﺗ ﻪﺑ نارﺎﻤﯿﺑ ﺖﯾﺎﮑﺷ ﯽﻟﺎﺣﯽﺑ ،ﯽﻨﯿﺑ زا شﺰﯾﺮﺑآ ،غاﺮﻔﺘﺳا ،ندرﻮﺨﻧﺮﯿﺷ ،ﺲﻔﻧ ﯽﮕﻨﺗ ﺐــﺴﺣ ﺮﺑ ﻪﺘﺷاد ﺖﻣﻼﻋ رﺎﻤﯿﺑ ﻪﮐ ﯽﻧﺎﻣز تﺪﻣ .دﻮﺑ زﻮﻧﺎﯿﺳ و ﺮﺘــﻤﮐ .ﺪﺷ ﻢﯿﺴﻘﺗ هوﺮﮔ 6 ﻪﺑ ،هﺪﻧوﺮﭘ رد جرﺪﻨﻣ عوﺮﺷ نﺎﻣز ،(%39/6) ﺮــــﻔﻧ 181 ،زور 3-7 ،(%13/8) ﺮــﻔﻧ 63 ،زور 2 زا ،(%3/3) ﺮـــﻔﻧ 15 ،زور 15-21 ،(%10/5) ﺮـﻔﻧ 48 ،زور 8-14 (%3/3) ﺮــﻔﻧ 15 ،زور 30 زا ﺶﯿﺑ (%3/9) ﺮﻔﻧ 18 زور 22-30 نارﺎﻤﯿﺑ ،ﺪﺷر رادﻮﻤﻧ ﺐﺴﺣﺮﺑ .(%25/6) ﺮﻔﻧ 117 ،مﻮﻠﻌﻣﺎﻧ و ﯽـﻌﯿﺒﻃ زا ﺮﺘـﻤﮐ ﺪــﺷر ﺎﺑ لوا هوﺮﮔ .ﺪﻧﺪﺷ ﻢﯿﺴﻘﺗ هوﺮﮔ 3 ﻪﺑ درﻮــﻣ 105 ،ﯽـــﻌﯿﺒﻃ ﺪـﺷر ﺎـﺑ مود هوﺮـﮔ ،(%75) ﺮـﻔﻧ 343 درﻮــﻣ 9 ﯽـﻌﯿﺒﻃ زا ﺮﺘـﺸﯿﺑ ﺪـﺷرﺎﺑ مﻮـﺳ هوﺮـﮔ و ،(%23/1) .(%1/9) هﺪـــﻧوﺮﭘ 352 رد تراﺮـﺣ ﻪـﺟرد ،ﯽــــﻨﯿﻟﺎﺑ ﻢﺋﻼﻋ ﺮﻈﻧ زا ﻪـﺟرد (%36/9) ﺮـﻔﻧ 130 داﺪـﻌﺗ ﻦـﯾا زا ﻪـﮐ دﻮـﺑ هﺪــﺷ ﺖـﺒﺛ ﺪـﺣ زاﺮﺘـﻤﮐ تراﺮـﺣ ﻪـﺟرد (%4/5) ﺮــﻔﻧ 16 ،ﯽﻌﯿﺒﻃ تراﺮﺣ ﺪــﺣ زا ﺮﺗﻻﺎـﺑ تراﺮـﺣ ﻪـﺟرد (%58/52) ﺮـﻔﻧ 206 و ﯽـﻌﯿﺒﻃ .ﺪﻨﺘﺷاد ﯽﻌﯿﺒﻃ ﻪـﮐ دﻮــﺑ هﺪﺷ ﺖﺒﺛ هﺪﻧوﺮﭘ رد ﺲﻔﻨﺗ داﺪﻌﺗ ،کدﻮﮐ 333 رد کدﻮــﮐ 4 و ﯽﻌﯿﺒﻃ ﺲﻔﻨﺗ داﺪﻌﺗ ،(%18/6) ﺮﻔﻧ 62 داﺪﻌﺗ ﻦﯾا زا .ﺪﻨﺘـﺷاد ﺪـﻨﺗ ﺲـﻔﻨﺗ ،(%80/1) ﺮــﻔﻧ 267 و ﺪﻨﮐ ﺲﻔﻨﺗ ،(%1/2) ،هﺎﻣ2 زا ﺮﺘﮑﭼﻮﮐ ناراﻮﺧﺮﯿﺷ رد ﺪﻨﺗ ﺲﻔﻨﺗ ،ﻒﯾﺮﻌﺗ ﺐﺴﺣﺮﺑ) ﺎــﺗ 2 ناراﻮﺧﺮﯿﺷ رد ،ﻪﻘﯿﻗد رد ﺲﻔﻨﺗ 60 زاﺮﺘﺸﯿﺑ ﺎﯾ یوﺎﺴﻣ نﺎــﮐدﻮﮐ رد و ﻪﻘﯿﻗد رد ﺲﻔﻨﺗ 50 زاﺮﺘﺸﯿﺑ ﺎﯾ یوﺎﺴﻣ هﺎﻣ 11 ﻪـﻘﯿﻗدر د ﺲـﻔﻨﺗ 40 زاﺮﺘـﺸﯿﺑ ﺎـﯾ یوﺎـﺴﻣ لﺎــﺳ 5 ﺎﺗ هﺎﻣ12 .(ﺪﺷﺎﺑﯽﻣ درﻮﻣ 18 رد ﯽﻄﯿﺤﻣ زﻮﻧﺎﯿﺳ ،ﻪﻌﻟﺎﻄﻣ درﻮﻣ رﺎﻤﯿﺑ 457 رد 30 ﯽﻟﺎـﺣﯽﺑ ،(%4/8) درﻮـﻣ 22 رد یﺰــﮐﺮﻣ زﻮﻧﺎﯿﺳ ،(%3/9) 17 ﻖــﻠﺣ ﺖﺸﭘ ﺢﺷﺮﺗ ،(%3/5) درﻮﻣ 16 یدرز ،(%6/1) درﻮﻣ
نﺎــﻘﺘﺣا و (%2/4) درﻮـﻣ 11 ﻖـﻠﺣ رد ادوﺰـﮔا ،(%3/7) درﻮـﻣ ،یﻮـﯾر ﻢــﺋﻼﻋ ﯽﺳرﺮﺑ رد .ﺪﺷ هﺪﯾد (%10/5) درﻮﻣ 48 ﯽﻨﯿﺑ ،(%12/7) یﺎــــﮑﻧور درﻮـــﻣ 58 ،(%63/2) لار درﻮـــﻣ 289 74 ﺰـــﯾو ،(%39/4) درﻮـﻣ 180 رد ﯽـﺴﻔﻨﺗ یاﺪـﺻ ﺖﻧﻮـﺸﺧ ﺶﻫﺎــﮐ ،(%49/9) درﻮـــﻣ 228 نﻮﯿـﺴﮐاﺮﺗر ،(%16/2) درﻮـﻣ درﻮـﻣ 25 ﯽـﻨﯿﺑ هﺮــﭘ نﺎﻤﺗﺎﺑ ،(%6/8) درﻮﻣ 31 ﯽﺴﻔﻨﺗ یاﺪﺻ و (%2/8) درﻮــﻣ 13 ﻪﻨﭘآ ،(%2/4) درﻮﻣ 11 ﮓﻨﯿﺘﻧاﺮﮔ ،(%5/5) .ﺖﺷاد دﻮﺟو (%1/5) درﻮﻣ 7 قدرد ﻪﺘﯿﺗﺎﻣ ﺲــﻤﻟ ﻞﺑﺎﻗ ﺪﺒﮐ (%24/2) درﻮﻣ 116 ،ﻞﻣﺎﺷ ﺮﮕﯾد یﺎﻫﻪﺘﻓﺎﯾ و گرﺰـــﺑ ﺎـﯾ ﺲـﻤﻟ ﻞﺑﺎـﻗ لﺎـﺤﻃ (%5) درﻮـﻣ 23 ،گرﺰـﺑ ﺎـﯾ .دﻮﺑ ﯽﺗﺎﭘﻮﻧدآ (%4/8) درﻮﻣ22 457 زا ،ﮏـﯾژﻮـﻟﻮﯾدار و ﯽﻫﺎﮕــﺸﯾﺎﻣزآ ﻢﺋﻼﻋ ﯽﺳرﺮﺑ رد 147 رد و (%17) ﺪــﻧدﻮﺑ ﮏﯿﻤﻧآ رﺎﻤﯿﺑ 78 ،ﻪﻌﻟﺎﻄﻣ درﻮﻣ رﺎﻤﯿﺑ نﻮﯿـﺳﺎﺘﻧﺎﻤﯾﺪﺳ ناﺰﯿــﻣ ،ﺖﺷاد دﻮﺟو ﯽﻣﺪﻧﺎﺑ (%32/1) درﻮﻣ رد ﻪـﮐ دﻮــﺑ هﺪﺷ یﺮﯿﮔ هزاﺪﻧا رﺎﻤﯿﺑ 165 رد ﺰﻣﺮﻗ یﺎﻬﻟﻮﺒﻠﮔ .دﻮﺑ ﻪﺘﻓﺎﯾ ﺶﯾاﺰﻓا (%66) درﻮﻣ 109 ﺖﺒﺜﻣ ﺖﺸﮐ درﻮﻣ 78 رد ،هﺪﺷ مﺎﺠﻧا یﺎﻬﺘﺸﮐ ﯽﺳرﺮﺑ رد درﻮﻣ 24 نﻮﺧ ،(%5/2) درﻮﻣ 24 راردا :ﻞﻣﺎﺷ ﻪﮐ ﺪﻣآ ﺖﺳﺪﺑ 21 ﺮﮕﯾد ﯽﺣاﻮﻧ و (%2) درﻮﻣ 9 ﯽﻋﺎﺨﻧ ـ یﺰﻐﻣ ﻊﯾﺎﻣ ،(%5/2) ﯽﻧﺎﯾﺮــﺷ نﻮـﺧ یﺎـﻫزﺎﮔ رﺎـﻤﯿﺑ 152 رد .دﻮـﺑ (%4/4) درﻮـﻣ ،(%24/4) درﻮــﻣ 37 رد ﯽــﺴﮐﻮﭙﯿﻫ ﻪــﮐ ﺪـﺷ یﺮﯿـﮔ هزاﺪـﻧا 39 رد ﮏﯿﻟﻮﺑﺎــﺘﻣ زوﺪﯿﺳا ،(%1/9) درﻮﻣ3 رد ﯽﺴﻔﻨﺗ زوﺪﯿﺳا هﺪـﯾد (%7/2) درﻮـﻣ 11 رد ﯽــﺴﻔﻨﺗ زﻮﻟﺎﮑﻟآ و (%25/6) درﻮﻣ .ﺪﺷ شراﺰـﮔ درﻮـﻣ 197 ،ﻪﻨﯿــﺳ ﻪﺴﻔﻗ ﯽﻓاﺮﮔﻮﯾدار ﯽﺳرﺮﺑ رد 3 ﻪـﺑ ﻦـﺳ ﺐـﺴﺣﺮﺑ ﻪـﮐ دﻮــﺑ دﻮﺟﻮﻣ هﺪﻧوﺮﭘ رد یژﻮﻟﻮﯾدار .ﺪﻧﺪﺷ ﻢﯿﺴﻘﺗ هوﺮﮔ 74 هوﺮﮔ ﻦـﯾا رد ﻪـﮐ ،درﻮﻣ 66 ،هﺎﻣ 3 ﺎﺗﺮﻔﺻ ﯽﻨﺳ هوﺮﮔ هرﺎـﺷا ﻪـﺘﮑﻧ ﻦــﯾا ﻪﺑ ﺪﯾﺎﺑ ) ﺖـﺷاد دﻮـﺟو ﯽﻌﯿﺒﻃ ﺮـﯿﻏ ﻪـﺘﻓﺎﯾ ﯽﻌﯿﺒﻃﺮﯿـﻏ ﻪــﺘﻓﺎﯾ ﮏﯾ زا ﺶﯿﺑ نارﺎﻤﯿﺑ زا ﯽﻀﻌﺑ رد ﻪﮐ دﻮﺷ .(دﻮﺑ هﺪﺷ شراﺰﮔ ﻪـﺘﻓﺎﯾ 135 ﻪـﮐ ،رﺎـﻤﯿﺑ 114 ،لﺎـﺳ 5 ﺎـﺗ هﺎــﻣ4 ﯽﻨﺳ هوﺮﮔ ﯽﻌﯿﺒﻃﺮﯿـﻏ ﻪـﺘﻓﺎﯾ 21 ﻪـﮐ رﺎــﻤﯿﺑ 17 مﻮﺳ هوﺮﮔ و ﯽﻌﯿﺒﻃﺮﯿﻏ .(1هرﺎﻤﺷ لوﺪﺟ) دﻮﺑ هﺪﺷ شراﺰﮔ ﺎﻬﻧآ یاﺮﺑ
ﻪﻨﯿﺳ ﻪﺴﻔﻗ ﯽﻓاﺮﮔﻮﯾدار رد ﮏﯾژﻮﻟﻮﯾدار یﺎﻫﻪﺘﻓﺎﯾ -1 هرﺎﻤﺷ لوﺪﺟ
نارﺎﻤﯿﺑ
ﮏﯾژﻮﻟﻮﯾدار یﺎﻤﻧ هﺎﻣ 3 ﺎﺗ ﺮﻔﺻ
لﺎﺳ 5 ﺎﺗ هﺎﻣ 4 لﺎﺳ 16 ﺎﺗ 6
ﯽﻌﯿﺒﻃ (%4)3
(%4/4)6
(%4/8)1
ﯽﯾاﻮﻫﺮﭘ (%4)3
(%8/11)16
(%4/8)1
کﺎﯾدرﺎﮐارﺎﭘ حﺎﺸﺗرا (17/6)13
(%26/7)36 (%4/8)1
ﺮﺑﻮﻟ ﯽﻧﻮﻣﻮﻨﭘ یﺎﻤﻧ (%9/5)7
(%5/2)7
(%19)4
هﺪﻨﮐاﺮﭘ حﺎﺸﺗرا (%44/6)33
(%28/9)39
(%42/8)9
ﯽﻨﯿﺑﺎﻨﯿﺑ حﺎﺸﺗرا (%6/8)5
(%10/4)14 (%4/8)1
ﻪﺘﺴﺟﺮﺑ یﻮﯾرقوﺮﻋ (%2/7)2
(%1/5)2
(%4/8)1
ﯽﻟﺎﮕﻣﻮﯾدرﺎﮐ (%4)3
(%3/7)5
(%4/8)1
ماﺮﮔﻮﮑﻧوﺮﺑ ﺮﯾا (%2/7)2
(%0/8)1 -
ﺮﮕﯾد دراﻮﻣ* (%4)3
(%6/6)9
(%9/4)2
ﭗﭼ رﻮﻠﭘ نژﻮﯿﻓا ﻪﯾر فﺎﻧ ﯽﺗﺎﭘﻮﻧدآ ،گرﺰﺑ سﻮﻤﯿﺗ درﻮﻣ1* ﺖﺳاررﻮﻠﭘنژﻮﯿﻓا رﻮﻠﭘ نژﻮﯿﻓا،زﻮﻠﯿﮑﺳا ﮏﯿﺗﺎﻤﮔاﺮﻓﺎﯾدﻖﺘﻓدرﻮﻣ1
هﺮﯿﻏ و ﻦﻬﭘ ﻦﺘﺳﺎﯾﺪﻣ یزﺎﺘﮑﻠﺗآ درﻮﻣ 1
ﯽـــﮑﯿﺗﻮﯿﺑ ﯽـﺘﻧآ نﺎـﻣرد درﻮـﻣ 373 رد ،ﯽﻧﺎـﻣرد ﺮـﻈﻧ زا نﺎـﻣرد تﺪـﻣ (%95/7) درﻮــﻣ 357 رد ﻪﮐ دﻮﺑ ﻪﺘﻓﺮﮔ ترﻮﺻ 14 زا ﺶــﯿﺑ ،(%4/3) درﻮﻣ 17 رد و زور 14 یوﺎﺴﻣ ﺎﯾ ﺮﺘﻤﮐ رد ﺪﻧﺪﺷ هدﺮﺑرﺎﮑﺑ نﺎﻣرد یاﺮﺑ ﻪﮐ ﯽﯾﺎﻬﮑﯿﺗﻮﯿﺑﯽﺘﻧآ .دﻮﺑ زور 31 ﻪــﮐ ﺖﺳا ﺮﮐذ ﻪﺑ مزﻻ .ﺖﺳا هﺪﺷ هدروآ 2 هرﺎﻤﺷ لوﺪﺟ تﻮـــﻓ یرﺎـﻤﯿﺑ ﺮـﺛا رد ﯽـﻧﻮﻣﻮﻨﭘ ﻪـﺑ ﻼـﺘﺒﻣ نارﺎـﻤﯿﺑ زا ﺮـﻔﻧ .(%7)ﺪﻧدﺮﮐ
ﺚﺤﺑ و ﻊﯾﺎـﺷ نﺎـﮐدﻮﮐ رد ﻪـﮐ ﺖــﺳا ﻪﯾر ﺖﻓﺎﺑ بﺎﻬﺘﻟا ﯽﻧﻮﻣﻮﻨﭘ ،لاﺮـﯾو ﻞـﻣاﻮﻋ ﺮـﺛا رد یرﺎـﻤﯿﺑ ﻦـﯾا .ﺪــﺷﺎﺑﯽﻣ ﺪﯾﺪﺷ هﻮﻘﻟﺎﺑ ﺮﯿـﻣوگﺮـﻣ ﻢﻬــﻣ ﻞﻠﻋ زا و دﻮﺷﯽﻣ دﺎﺠﯾا ﯽﭼرﺎﻗ و لﺎﯾﺮﺘﮐﺎﺑ یﺎـــﻫﺮﯿﻣوگﺮـﻣ ﻞـﮐ %80 ًﺎـﺒﯾﺮﻘﺗ .دورﯽـﻣ رﺎﻤـﺸﺑ نﺎـﮐدﻮﮐ
و3 ،2)ﺪــﺘﻓاﯽﻣ قﺎـــﻔﺗا ﯽــــﮔراﻮﺧﺮﯿـﺷ هرود رد ﯽـــﻧﻮﻣﻮﻨﭘ رﺎــﺸﺘﻧا ﺐـــﺴﺣﺮﺑ ،ﯽـﻧﻮﻣﻮﻨﭘ ﯽﻨﯿﻟﺎـﺑ یﺎـﻬﻣﺮﻓ .(24)(6-13)(4
و ،ﯽـﻧﻮﻣﻮﻨﭘ ﻮـﮑﻧوﺮﺑ و ﯽﻨﯿﺑﺎـﻨﯿﺑ ،رﺎـﺑﻮﻟ عاﻮــﻧا ﻪﺑ ،ﮏﯿﻣﻮﺗﺎﻧآ و ﯽـــﺳوﺮﯾو عاﻮـــﻧا ﻪـﺑ هﺪـــﻨﻨﮐ دﺎـﺠﯾا ﻞـﻣاﻮﻋ ﺐـــﺴﺣﺮﺑ ﻞﻣﺎـﻋ ﺮـﻫ .(13-22)(6 و4) ﺪﻧﻮـﺷﯽﻣ ﻢﯿــﺴﻘﺗ هﺮﯿﻏ و لﺎﯾﺮﺘﮐﺎﺑ
کﻮـﮐﻮﻣﻮﻨﭘ ًﻼـﺜﻣ .ﺪــﻨﮐﯽﻣ دﺎﺠﯾا ار ﯽﺻﺎﺧ تﺎﻌﯾﺎﺿ اﺰﯾرﺎﻤﯿﺑ ًﻻﻮـﻤﻌﻣ ﻪﮐ ﺪـﻨﮐﯽﻣ دﺎﺠﯾا رﻻﻮﺋﻮﻟآ یادوﺰﮔا و ﯽﻃﺎﺨﻣ بﺎﻬﺘﻟا
هدﺎﻔﺘﺳا ﺎﻬﻧآ زا نﺎﻣرد یاﺮﺑ ﻪﮐ ﯽﯾﺎﻬﮑﯿﺗﻮﯿﺑﯽﺘﻧآ -2 هرﺎﻤﺷ لوﺪﺟ
.ﺖﺳا هﺪﺷ
هﺪﺷ فﺮﺼﻣ ﮏﯿﺗﻮﯿﺑﯽﺘﻧآ عﻮﻧ دراﻮﻣ داﺪﻌﺗ
ﺪﺻرد
ﻦﯿﻠﯿﺳﯽﭙﻣآ 126
33/7
ﻦﯿﺗﻮﻟﺎﻔﺳ 3
0/8
ﻦﯿﻠﯿﺳﯽﻨﭘ 8
2/1
ﻦﯿﺗﻮﻟﺎﻔﺳ + ﻦﯿﻠﯿﺳﯽﭙﻣآ 103
27/6
ﻦﯿﺴﯾﺎﻣﺎﺘﻨﺟ + ﻦﯿﻠﯿﺳﯽﭙﻣآ 37
9/9
ﻦﯿﺳﺎﮑﯿﻣآ + ﻦﯿﻠﯿﺳﯽﭙﻣآ 18
4/8
ﻦﯿﺳﺎﮑﯿﻣآ + ﻦﯿﺗﻮﻟﺎﻔﺳ 12
3/21
ﻦﯿﺴﯾﺎﻣﺎﺘﻨﺟ + ﻦﯿﺗﻮﻟﺎﻔﺳ 15
4/02
ﻦﯿﻠﯿﺳﯽﻨﭘ + ﻦﯿﺗﻮﻟﺎﻔﺳ 4
1
ﻢﯿﺴﮐوزﯽﺘﻔﺳ + ﻦﯿﺗﻮﻟﺎﻔﺳ 2
0/53
ﻦﯿﻠﯿﺳﯽﻨﭘ + ﻦﯿﻠﯿﺳﯽﭙﻣآ 2
0/53
ﻢﯿﺴﮐوزﯽﺘﻔﺳ+ ﻦﯿﻠﯿﺳﯽﭙﻣآ 3
0/8
ﻞﮑﯿﻨﻔﻣاﺮﻠﮐ + ﻦﯿﻠﯿﺳﯽﭙﻣآ 2
0/53
ﻦﯿﺴﯾﺎﻣﺎﺘﻨﺟ +ﻦﯿﺗﻮﻟﺎﻔﺳ +ﻦﯿﻠﯿﺳﯽﭙﻣآ 26
6/97
ﻦﯿﺳﺎﮑﯿﻣآ +ﻦﯿﺗﻮﻟﺎﻔﺳ + ﻦﯿﻠﯿﺳﯽﭙﻣآ 30
8/04
ﯽﮑﯿﺗﻮﯿﺑﯽﺘﻧآ یﺎﻫنﺎﻣرد ﺮﯾﺎﺳ 17
4/55
ﺖـــﻓﺎﺑ ﻊﯿـﺳو یرﺎـﺘﻓﺮﮔ ﺎــﯾ ﯽﻃﺎﺨﻣ یﺎﻬﻟﻮﻠﺳ ﺐﯾﺮﺨﺗ نوﺪﺑ ﺖﺨـﺳ ترﻮـﺼﺑ رﺎﺑﻮﻟ عﻮﻧ رد ﯽـــﻧﻮﻣﻮﻨﭘ .ﺖــﺳا ﯽــﻨﯿﺑﺎﻨﯿﺑ عﻮــﻧ رد و ﺪــﺷﺎﺑﯽﻣ بﻮـــﻟ ﮏـﯾ یﺎﻬﺘـــﻤﺴﻗ مﺎـﻤﺗ نﺪـــﺷ هﺪـﯾد هﺪــــﻨﮐاﺮﭘ یﺎـــﻬﻟﻮﺑﻮﻟ ترﻮــﺼﺑ ،ﮏــﯿﻧﻮﻣﻮﻨﭘﻮﮑﻧوﺮﺑ .دﻮﺷﯽﻣ و ﺮـــﺘﮔرﺰــﺑ یﺎﻫﻪﭽﺑ رد ﯽﮐﻮﮐﻮﻣﻮﻨﭘ ﯽﻧﻮﻣﻮﻨﭘ ﻪـﺼﺨﺸﻣ
،ﺮﺘﮑﭼﻮﮐ یﺎﻫﻪﭽﺑ رد ﯽﻟو ﺪﺷﺎﺑﯽﻣ رﺎﺑﻮﻟ عﻮﻧ ،ناﻮﺟ ﻦــﯿﻐﻟﺎﺑ سﻮـﻠﯿﻓﻮﻤﻫ ،ﯽــﺳوﺮﯾو ﻞﻣاﻮﻋ .دﻮﺷﯽﻣ هﺪﯾد ﺮﺘﻤﮐ رﺎﺑﻮﻟ عﻮﻧ کﻮــﮐﻮﺘﭘﺮﺘــﺳا هوﺮــﮔ زا ﯽﺻﺎـــﺧ یﺎﻬـﺷﻮﺳ و اﺰـﻧاﻮﻠﻔﻧآ ﺚﻋﺎـﺑ و ﺪـﻨﻨﮐﯽﻣ ﻢﺟﺎﻬـﺗ ﯽﻃﺎـﺨﻣ یﺎـﺸﻏ ﻪـﺑ ﻪــﮐ ﺲﻧاﺪﯾﺮﯾو و ﺖﯿﻟﻮﯿــﺸﻧوﺮﺑ ﺖـﺳا ﻦـﮑﻤﻣ ًﺎـﺳﺎﺳا ،ﺪﻧﻮـﺷﯽﻣ نآ ﺐـﯾﺮﺨﺗ .(13-22)(6 و4)ﺪﻨﯾﺎﻤﻧ دﺎﺠﯾا ﯽﻨﯿﺑﺎﻨﯿﺑ تﺎﻌﯾﺎﺿ دﺎـﺠﯾا و ﺐــﯾﺮﺨﺗ ﻪﺑ ﻞﯾﺎﻤﺗ ود ﺮﻫ ﻼﯿﺴﺒﻠﮐ و کﻮﮐﻮﻠﯿﻓﺎﺘﺳا دراﻮـﻣ زا ﯽـﮑﯾ .(2)ﺪـﻧراد ﻪــﯾر رد دﺪﻌﺘﻣ و ﮏﭼﻮﮐ یﺎﻫﻪﺴﺑآ نﺎــﻣرد و ﺺﯿﺨـــﺸﺗ ﺮـﻣا رد ﮏـﺷﺰﭘ یاﺮـﺑ ﻦـﯾﺮﻓآ ﻞﮑـﺸﻣ ﻞـــﻣاﻮﻋ ﻪـﮐ ﺪـﺷﺎﺑﯽﻣ ﻪـﻌﺟار ﯽـﻧﻮﻣﻮﻨﭘ ،ﯽـﺴﻔﻨﺗ یﺎﻬـﺘﻧﻮﻔﻋ
ﻞــﻣاﻮﻋ ﻦـﯾا .ﺪﻨﺘـﺴﻫ ﻞـﯿﺧد نآ ندروآ دﻮـﺟﻮﺑ رد یدﺪـﻌﺘﻣ ،ﺮـﻧﻮﻤﻟﻮﭘﻮـﮑﻧوﺮﺑ یزﻼﭙــﺴﯾد ،ﻢﺳآ ،نﻮﯿﺳاﺮﯿﭙﺳآ :زاﺪﻨﺗرﺎﺒﻋ و یدازردﺎــﻣ یﺎﻬـﯾرﺎﺠﻨﻫﺎﻧ ،ﺎﻬـﮐﮋﻣ ﺖـﮐﺮﺣ لﻼـﺘﺧا مرﺪﻨـﺳ .(21-27)(11)ﯽﻨﻤﯾا تﻻﻼﺘﺧا ﺎـﯾ رﺎـﺑ 2) رﺮـﮑﻣ ﯽـﻧﻮﻣﻮﻨﭘ ﺖــﻠﻌﺑ رﺎﻤﯿﺑ 30 ﺎﻣ ﻪﻌﻟﺎﻄﻣ رد .دﻮـﺑ ﺺﺨــﺸﻣﺎﻧ ﺖﻠﻋ رﺎﻤﯿﺑ 14 رد ﻪﮐ ﺪﻧﺪﺷ یﺮﺘﺴﺑ (ﺮﺘﺸﯿﺑ ﻦـﺘﻓﺮﮔ ،ﺪـﺸﻧ ﺖﻓﺎــﯾ ﯽﺼﺨﺸﻣ ﺖﻠﻋ ﻪﮐ دراﻮﻣ زا یرﺎﯿﺴﺑ رد ،ﯽﻠﯿﻣﺎـــﻓ ﻪﻘﺑﺎـﺳ ﻦﺘـﺴﻧاد ﻞـﺜﻣ رﺎـﻤﯿﺑ زا ﺮﺘـﻘﯿﻗد لﺎـﺣ حﺮـﺷ ﻞـﺜﻣ ﯽـﻠﯿﻤﮑﺗ یﺎﻬــﺸﯾﺎﻣزآ مﺎﺠﻧا ﺰﯿﻧ و ﻦﯾﺪﻟاو نﺪﯿﺸﮐرﺎﮕﯿﺳ ،(ﺮﺘــﮔرﺰﺑ نﺎﮐدﻮﮐ رد) ﻦﯿﻟﻮﮐﺎﺘﻣ ﺖﺴﺗ و یﻮﯾر دﺮﮑﻠﻤﻋ ﺖﺴﺗ ﺖﯿــﺳﺎﺴﺣ ﺶـﯾاﺰﻓا زا یدراﻮـﻣ ﻪـﺑ ندﺮـﺑﯽﭘ ﺐـﺟﻮﻣ ﺪﯾﺎـﺷ (Bronchial Hyperreactivity) ﯽــــــﯾاﻮﻫ یﺎﻬــــﻫار .(25)ﺪﯾدﺮﮔﯽﻣ یﺎﻬـﺘﻧﻮﻔﻋ ﺖـﻠﻋ ﻦﯾﺮﺘﻌﯾﺎــﺷ ار ﻢﺳآ ،ﻒﻠﺘﺨﻣ تﺎﻌﻟﺎﻄﻣ رد و ﻦﮕـــﯾا ﻪــــﻌﻟﺎﻄﻣ رد .(25 و24)ﺪﻧاﻪﺘــﺴﻧاد ﯽــﺴﻔﻨﺗ رﺮــﮑﻣ 8 ﻪــﻌﺟار ﯽﻧﻮﻣﻮﻨﭘ ﺎﺑ رﺎﻤﯿﺑ 81 زا ،1982 لﺎﺳ رد ﺶﻧارﺎﮑﻤﻫ ﻪـﺑ ﻪﯿﺒـﺷ ناﺰﯿـﻣ ﻦـﯾا ﻪـﮐ (%9/8) ﺪﻨﺘــﺷاد یﺰﻐﻣ ﺞﻠﻓ کدﻮﮐ .ﺖﺳا هﺪﻣآ ﺖﺳﺪﺑ ﯽﺳرﺮﺑ ﻦﯾا رد ﻪﮐ ﺖﺳا یاﻪﺠﯿﺘﻧ ﺎﺗ ﯽﮕﻫﺎﻣ 4 ،ﻪﻌﻟﺎﻄﻣ درﻮﻣ نﺎﮐدﻮﮐ رد ﻼﺘﺑا ﻦﺳ ﻦﯾﺮﺘﻌﯾﺎﺷ ﻞﻣﺎﺷ ار ﻼﺘﺑا دراﻮﻣ زا ﯽﻤﯿﻧ زا ﺶﯿﺑ ﻪﮐ ﺖﺳا هدﻮﺑ ﯽﮕﻟﺎﺳ 5 ﻞــﺼﻓ رد ﺰﯿـــﻧ ﯽـﺴﻔﻨﺗ ﺖـﻧﻮﻔﻋ دراﻮـﻣ ﻦﯾﺮﺘـﺸﯿﺑ .دﻮـﺷﯽﻣ عﻮﯿــﺷ ،دﻮﺟﻮﻣ یﺎﻫﻪﺘﻓﺎﯾ سﺎﺳاﺮﺑ .ﺪﺷ هﺪﯾد رﺎﻬﺑ و نﺎﺘﺴﻣز و لﺎـﯾﺮﺘﮐﺎﺑﺮﯿﻏ ﻞـﻣاﻮﻋ ،ﮏـﯾژﻮــﻟﻮﯾدار ﻢﯾﻼﻋ و ﯽﻠﺼﻓ ،ﯽﻨﺳ
،1)ﺪﻧراد ﺖﻧﻮﻔﻋ دﺎﺠﯾا رد ار ﺶﻘﻧ ﻦـﯾﺮﺘﺸﯿﺑ ﺎﻬﺳوﺮﯾو ًﺎﺳﺎﺳا .(20و 18 ،8 ،7
ﺖـﺳﺪﺑ ﻪـﮐ ﯽﯾﺎﻬﻤــﺴﯿﻧﺎﮔرا ،نﻮﺧ ﺖﺒﺜﻣ ﺖﺸﮐ درﻮﻣ 26 زا زﻻﻮــﮔآﻮﮐ کﻮﮐﻮﻠﯿﻓﺎﺘﺳا درﻮﻣ 4 :زا ﺪــﻧدﻮﺑ ترﺎﺒﻋ ،ﺪــﻧﺪﻣآ درﻮــﻣ 3 ،ﯽـــﻔﻨﻣ زﻻﻮـﮔاﻮـﮐ کﻮﮐﻮﻠﯿﻓﺎﺘـﺳا درﻮـﻣ 9 ،ﺖـﺒﺜﻣ ﻼﻧﻮﻤﻟﺎــﺳ درﻮــﻣ 2 ،ﯽﻠﮐﺎﯿـــﺷﺮﺷا درﻮـﻣ ﮏـﯾ ،ﺮﺘﮐﺎـﺑوﺮﺘﻧآ کﻮــﮐﻮﺘﭘﺮﺘــﺳا درﻮــﻣ 1 و ﻼﯿـــﺴﺒﻠﮐ درﻮـﻣ 1 ،ﯽـــﻔﯿﺗﺮﯿﻏ .ﻪﯿﻧﻮﻣﻮﻨﭘ رد یﺮﺘـﺴﺑ تﺪـﻣ ،ﯽــﻧﻮﻣﻮﻨﭘ ﺺﯿﺨﺸﺗ ﺎﺑ نارﺎﻤﯿﺑ ﺮﺜﮐا رد ﺎـــﺑ نﺎـﻣرد ﺖـﺤﺗ ًﺎـﺒﻟﺎﻏ ﻪـﮐ دﻮـﺑ زور 14 ﺎـﺗ 8 نﺎﺘـﺳرﺎﻤﯿﺑ
دراﻮـﻣ ﯽـﻀﻌﺑ رد ﯽـﻟو ﺪـــﻨﺘﻓﺮﮔ راﺮـﻗ یﺪــﯾرو ﻦﯿﻠﯿﺳﯽﭙﻣآ ﻢــﺋﻼﻋ ﺖـﻓﺮﺸﯿﭘ و ﻦــﺘﻓﺎﯾ تﺪﺷ و ﯽــﻣﻮﻤﻋ لﺎﺣ یﺪﺑ ﺖﻠﻌﺑ زا ﺮﺘـﺸﯿﺑ دراﻮـﻣ ﻦــﯾا رد ﻪﮐ ،ﺪﺷ هدﺎﻔﺘﺳا وراد 2 زا ،ﯽﺴﻔﻨﺗ (ﻦــﯿﻠﻔﮐ) لوا ﻞــﺴﻧ ﻦﯾرﻮﭙـــﺳﻮﻟﺎﻔﺳ + ﻦﯿﻠﯿـﺳﯽﭙﻣآ ﺐـﯿﮐﺮﺗ و ﯽـﯾوراد ﮏــﺗ ﻢﯾژر زا دراﻮﻣ %32/8 رد ﻞﮐرد .ﺪﺷ هدﺎﻔﺘﺳا ﻢــﯾژر زا %27/3 ردو ﯽـﯾوراد 2 ﻢـﯾژر زا ،دراﻮـﻣ %40/5 رد .ﺪﯾدﺮﮔ هدﺎﻔﺘﺳا ﯽﯾوراد ﺪﻨﭼ زا ﺮــﻔﻧ 31 ﯽﺳرﺮﺑ ﻦﯾا رد هﺪﻣآ ﺖــﺳﺪﺑ ﺞــﯾﺎﺘﻧ سﺎﺳاﺮﺑ هﺎــﻣ 3 ﺎﺗ ﺮﻔﺻ ﯽﻨﺳ هوﺮﮔ رد ﻪﮐ (%7) ﺪــﻧدﺮﮐ تﻮﻓ نارﺎﻤﯿﺑ ﺰــــﯾﻮﺠﺗ ﻪﮐ ﺖﺳا هﺪــﺷ هﺪﯾد (10)ﯽــﺳرﺮﺑ ﮏﯾ رد .ﺪــﻧدﻮﺑ ترﻮــــﺼﺑ RSV ﺪــﺿ ﻦــــﯿﻟﻮﺑﻮﻠﮔﻮــﻧﻮﻤﯾا ﻪــــﻧاﺮﯿﮕﺸﯿﭘ ﺖـﺳا ﻊﯾﺎـﺷ سوﺮـﯾو ﻦـﯾا ﻪــﮐ ﯽﻟﻮﺼﻓ رد ،ﻪﻧﺎﻫﺎﻣ نﻮﯾزﻮﻔﻧا زوﺮـﺑ یﻮـﻠﺟ یﺮـﺛﻮﻣ رﻮـﻄﺑ ،(رﺎﻬــﺑ ﻞـﯾاوا و ﺰــﯿﯾﺎﭘ ﺮﺧاوا) ار سوﺮـــﯾو ﻦــــﯾا ﻂـــــﺳﻮﺗ ﯽﻧﺎـﺘﺤﺗ ﯽـــﺴﻔﻨﺗ ﺖـــﻧﻮﻔﻋ .دﺮﯿﮔﯽﻣ
ﻪﺠﯿﺘﻧ و ﯽـﺴﻔﻨﺗ یﺎﻬـﺘﻧﻮﻔﻋ ﻪـﺑ ﻪـﺟﻮﺗﺎﺑ ﺖــﻔﮔ ناﻮﺗﯽﻣ نﺎﯾﺎﭘ رد عﻮﯿـﺷ ﻦـﯿﻨﭽﻤﻫ و هﺎــﻣ 3ﺮﯾز ﻦﯿﻨﺳ رد نآ یﻻﺎﺑ ﺮﯿﻣ و گﺮﻣ ﻪﮑﻨﯾا و (ﻪﻌﻟﺎﻄﻣ درﻮﻣ هوﺮﮔ) FTTو ﻪﯾﺬﻐﺗءﻮﺳ دراﻮﻣ رد نآ 2 رد ﯽـﺴﻔﻨﺗ یﺎﻬـﺘﻧﻮﻔﻋ ﻊــﻗﻮﻤﺑ نﺎﻣرد و سردوز ﺺﯿﺨﺸﺗ نﺎﮑﺷﺰﭘ ﻪﺟﻮﺗ ،ﺪﻫﺎﮑﺑ ﺎﻬﻧآ ﺮﯿﻣ و گﺮﻣ زا ﺪﻧاﻮﺗﯽﻣ قﻮﻓ هوﺮﮔ ﺎـﺑ ناﻮـﺘﺑ ﻪـﮐ ﺖـﺳا ﺪـﯿﻣا .ﻢـﯾرادﯽﻣ فﻮــﻄﻌﻣ ﻢﻬﻣ ﻦﯾا ﻪﺑ ار ﻦــﯾا ﺮﯿـــﻣ و گﺮـﻣ زا سردوز نﺎـﻣرد و ﻊـﻗﻮﻤﺑ ﺺﯿﺨـﺸﺗ .دﺮﮐ یﺮﯿﮔﻮﻠﺟ نﺎﮐدﻮﮐ
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RESULTS OF 3 YEARS STUDY OF PNEUMONIA IN CHILDREN ADMITTING IN HOSPITAL MEDICAL CENTER OF ALI ASGHAR
I
Kh. Mahlooji, MD
ABSTRACT
Acute respiratory infections (ARI) are a leading cause of childhood illness and death. In most countries, ARI occurs more frequently than other acute illnesses, including diarrhea and tropical disease. WHO estimates that in 1990, ARI caused 4.3 million death in this age group. Pneumonia is responsible for the majority of these deaths. The type and severity of the illness are influenced by several factors including age, season of the year, immune status of the host and Enviromental factors. Most cases of pneumonia are caused by microorganisms but a number of noninfectious causes sometimes, need to be considered, these non infectious causes include but are not limited to aspiration of food or gastric acid, foreign bodies, hypersensitivity reactions, and drug induced pneumonitis. This study was done retrospectively by the study of case records during 1990-1993. 457 cases were hospitalized with primary diagnosis of pneumonia. Diagnosis was made by physical examination, result of chest radiography and culture of blood, urine, and respiratory tract secretions. Description of cases: Of 457 cases that met the criteria for inclusion, age distribution: 0-3 month 147 cases, 4 month-5years 266 cases and 6-16 years 44 cases. Sex distribution male 273 cases, female 184 cases.
30 cases were hospitalized with recrrent pneumonia, in 14 cases there were no definitive cause and in others, asthma, cerebral palsy, gastroesophageal reflux, foreign body, lymphoblastic leukemia; esophageal atresia and convulsion were found. the symptoms of the disease by their prevalence were as follows:
cough, increased respiratory rate per minute, respiratory distress, poor feeding, vomiting, lethargy and cyanosis. Growth & development. 75% of patients had some degrees of FTT. Temperature. 58.5% of patients had high temperature. Respiratory Rate per minute was increased in 80.1%. Lab test: ESR was elevated in 66%., Bandemia were seen in 147 cases, and cultures were positive in 78 cases asfollow: blood culture in 24 cases, urine in 24 cases, CSF in 9 cases, eye, ear, pustules, respiratory secretions and stool culture in 21 cases were positive. ABG was done and 37 cases had hypoxia and 39 cases had metabolic acidosis. The results of chest radiography finding was diffuse infiltration in all three age groups.
Antibiotic treatment was done in 373 cases, and duration of treatment was equal or less than 14 days in (95.7%), and more than 14 days in (4.3%). Mortality rate of pneumonia in this study was 31 cases (7%) because of young age and FTT. As life threatening lower respiratory tract infections do occur especially among infants younger than three months and those with underling conditions such as FTT (that were seen in this study), With appropriate antibiotic therapy instituted early in the course of the illness the mortality rate during infancy and childhood can be reduced.
Key Words: 1) ARI(Acute Respiratory Infection) 2) Pneumonia 3) Mortality Rate of Pneumonia
I) Associate professor of pediatrics, Hazrat Ali asghar hospital, Zafar St., Iran University of Medical Sciences and Health Services, Tehran, Iran.
