ﻦﻣﺰﻣ ﻢﺳآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ رد ﯽﺘﯿﻟوﺮﺘﮑﻟا تﻻﻼﺘﺧا عﻮﯿﺷ ﯽﺳرﺮﺑ
I یﻮﺳﻮﻣ داﻮﺟ ﯽﻠﻋﺪﯿﺳ ﺮﺘﮐد*
II ﻞﺻا هداﺰﯿﻠﻋ ﻦﯾذآ ﺮﺘﮐد
III ﺮﻓﯽﺗﺎﺠﻧ ﻪﻤﻃﺎﻓ ﺮﺘﮐد
ﻪﻣﺪﻘﻣ ﺖــﺧرد ﯽـــــﻫد ﺦـﺳﺎﭘ ﺶـــﯾاﺰﻓا ﺎـﺑ ﻪـﮐ ﻢـﺳآ یرﺎـﻤﯿﺑ ﺺﺨــﺸﻣ ﺎــﻫکﺮﺤﻣ زا یداﺪـــﻌﺗ ﻪـﺑ ﯽـﺸﻧوﺮﺑ ـ یاﻪـﺷاﺮﺗ یﻻﺎـﺑ یﺎﻫﻪـﻨﯾﺰﻫ ،ﯽﻧاﻮﺗﺎـﻧ ﻞـﻠﻋ ﻦﯾﺮﺗﻢﻬـﻣ زا ﯽــﮑﯾ ،دﻮﺷﯽﻣ %4-5 ﻪﮐ یرﻮﻃ ﻪﺑ ﺖﺳا ﺎﻫیرﺎﻤﯿﺑ ﻦﯾﺮﺗﻊﯾﺎﺷ زا و یدﺎﺼﺘﻗا .(1)ﺪﻨﺘﺴﻫ ﻼﺘﺒﻣ نآ ﻪﺑ ﺎﮑﯾﺮﻣآ ﺖﯿﻌﻤﺟ ﻪــﻧﻮﮔ ﺮـﻫ نآ زا ﯽـﺷﺎﻧ ﯽﻧاﻮﺗﺎـﻧ و یرﺎـﻤﯿﺑ یﻻﺎـﺑ عﻮـﯿﺷ
رد صﻮـﺼﺧ ﻪـﺑ ،یرﺎـﻤﯿﺑ ﻦـﯾا ﺎـﺑ ﻪــــﻄﺑار رد ار یاﻪﻌﻟﺎﻄﻣ یاهﮋــﯾو ﺖــﯿﻤﻫا زا نآ نﺎــﻣرد یﺎـــﻫشور دﻮﺒﻬـﺑ ﻪـﻨﯿﻣز یﺎـــﻫشور ﺖـﻓرﺶﯿﭘ ﺎـﺑ هزوﺮـــﻣا .دزﺎـﺳﯽﻣ رادرﻮـــﺧﺮﺑ ﻦﯾا رد دﻮــﺟﻮﻣ ﯽـــﺘﯿﻟوﺮﺘﮑﻟا تﻻﻼﺘﺧا ،نﺎــﻣرد و ﻖــﯿﻘﺤﺗ
هﺪﯿﮑﭼ
ﺎـﺑ .ﺖـﺳا یدﺎﺼﺘﻗا یﻻﺎﺑ یﺎﻫﻪﻨﯾﺰﻫ فﺮﺻ و ﯽﻧاﻮﺗﺎﻧ ﻢﻬﻣ ﻞﻠﻋ زا و ﺎﻫیرﺎﻤﯿﺑ ﻦﯾﺮﺗﻊﯾﺎﺷ زا ﯽﮑﯾ ﻢﺳآ یرﺎﻤﯿﺑ ﻪـﺟﻮﺗ درﻮـﻣ نارﺎـﻤﯿﺑ ﻦــﯾا رد دﻮﺟﻮﻣ ﯽﺘﯿﻟوﺮﺘﮑﻟا تﻻﻼﺘﺧا ﺮﺿﺎﺣ لﺎﺣ رد ،نﺎﻣرد و ﻖﯿﻘﺤﺗ یﺎﻫشور ﺖﻓرﺶﯿﭘ ﻪـﺑ ﻦـﯿﻨﭼ ﻢــﻫ .ﺪﺷﺎﺑﯽﻣ گﺮﻣ ﯽﺘﺣ و یﺪﺟ ضراﻮﻋ دﺎﺠﯾا ،یرﺎﻤﯿﺑ دﻮﺧ ﺪﯾﺪﺸﺗ ﻢﻬﻣ ﻞﻠﻋ زا اﺮﯾز ﺖﺳا ﻪﺘﻓﺮﮔ راﺮﻗ زا ﯽـﺸﺨﺑ نآ زا ﯽﺘﻤـﺴﻗ ﺪﯾﺎـﺷ و ﺪـﺷﺎﺑ ﯽـﻓﺮﺼﻣ یﺎــﻫوراد زا ﯽﺷﺎﻧ ضراﻮﻋ ،تﻻﻼﺘﺧا ﻦﯾا مﺎﻤﺗ ﺪﺳرﯽﻤﻧ ﺮﻈﻧ ﺶـﯾاﺪﯿﭘ ،نارﺎـﻤﯿﺑ ﻦـﯾا نﺎـﻣرد رد تﺎـﻋﻼﻃا ﻦـﯾا ﻪـﺑ ﯽﺑﺎﯾﺖـﺳد ﻦﯾاﺮﺑﺎـﻨﺑ .ﺪــﺷﺎﺑ یرﺎﻤﯿﺑ دﻮﺧ ﺰﻧژﻮﺗﺎﭘ ﺎﯾ ﺖﻌﯿﺒﻃ ﻦـﯿﻤﻫ ﺰﯿـﻧ ﻪـﻌﻟﺎﻄﻣ ﻦـﯾا فﺪـﻫ ﻪـﮐ دﻮﺑ ﺪﻫاﻮﺧ ﺮﺛﺆﻣ ﯽﻬﮔآﺶﯿﭘ دﻮﺒﻬﺑ و ضراﻮﻋ ﺶﻫﺎﮐ ،ﯽﻧﺎﻣرد ﺪﯾﺪﺟ یﺎﻫشور ﺎـﻫنآ زا ﮏـﯾ ﭻـﯿﻫ ﻪــﮐ ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻪﻌﻟﺎﻄﻣ درﻮﻣ ﻦﻣﺰﻣ ﻢﺳآ ﻪﺑ ﻼﺘﺒﻣ رﺎﻤﯿﺑ 96 ﻪﻌﻟﺎﻄﻣ ﻦﯾا رد .ﺖﺳا هدﻮﺑ ﻪﻠﺌﺴﻣ و (یﺪﯾرو ،رﺰﯾﻻﻮﺒﻧ ،ﯽﮐارﻮﺧ)ﺖﺴﯿﻧﻮﮔآﺎﺘﺑ ،یﺪﯾرو ﻦﯿﻠﯿﻓﻮﻨﯿﻣآ ﺖﻓﺎﯾرد ﻪﻘﺑﺎﺳ ،نﺎﺘﺳرﺎﻤﯿﺑ رد ﺮﯿﺧا یﺮﺘﺴﺑ ﻪﻘﺑﺎﺳ یﺮـﮕﯾد یرﺎــﻤﯿﺑ نﺎﻣز ﻢﻫ رﻮﻃ ﻪﺑ و ﺪﻧدﺮﮐﯽﻤﻧ فﺮﺼﻣ ﺰﯿﻧ ﮏﯿﺗرﻮﯾد و رﺎﮕﯿﺳ ،ﻞﮑﻟا ،ﺪﻨﺘﺷاﺪﻧ ار یﺪﯾرو نﻮﺗرﻮﮐ مﺎﻤﺗ یاﺮﺑ ﺮﺒﺘﻌﻣ هﺎﮕﺸﯾﺎﻣزآ ﮏﯾ رد مﻮﯾﺰﯿﻨﻣ و ﺮﻔﺴﻓ ،ﻢﯿﺴﻠﮐ ،ﻢﯿﺳﺎﺘﭘ ،ﻢﯾﺪﺳ ﻞﻣﺎﺷ مﺮﺳ یﺎﻫ ﺖﯿﻟوﺮﺘﮑﻟا .ﺪﻨﺘﺷاﺪﻧ نادﺮـﻣ ﻦـﺳ ﻦﯿﮕﻧﺎـﯿﻣ و ﺪـﻧدﻮﺑ نز %54/2 و دﺮـﻣ %45/8 ﻪــﻌﻟﺎﻄﻣ درﻮﻣ رﺎﻤﯿﺑ 96 زا .ﺪﯾدﺮﮔ یﺮﯿﮔهزاﺪﻧا نارﺎﻤﯿﺑ رد دﻮـﺟﻮﻣ ﯽﺘﯿﻟوﺮﺘـﮑﻟا لﻼــﺘﺧا ﺎﻬﻨﺗ .(P<0/05)دﻮﺑ (41/2±3/1)نﺎﻧز زا ﺶﯿﺑ یرادﯽﻨﻌﻣ ترﻮﺻ ﻪﺑ (49/8±3/5) ﻦﯿﮕﻧﺎـﯿﻣ .دﻮـﺒﻧ رادﯽـﻨﻌﻣ مﻮﯾﺰﯿـﻨﻣ لﻼـﺘﺧا و ﺎـﻫوراد فﺮــﺼﻣ ﻦﯿﺑ طﺎﺒﺗرا ﺎﻣا (%10/4)دﻮﺑ ﯽﻤﯾﺰﯿﻨﻣﻮﭙﯿﻫ نارﺎﻤﯿﺑ دﻮــﺑ ﯽﻧارﺎﻤﯿﺑ زا ﺮﺗﻢﮐ یرادﯽﻨﻌﻣ رﻮﻃ ﻪﺑ ﺪﻧدﺮﮐﯽﻣ هدﺎﻔﺘﺳا ﯽﻗﺎﺸﻨﺘﺳا ﺖﺴﯿﻧﻮﮔآﺎﺘﺑ ﻪﮐ ﯽﻧارﺎﻤﯿﺑ رد مﺮﺳ ﻢﯿﺳﺎﺘﭘ نارﺎـﻤﯿﺑ رد (ﺮﺘﯿﻟﯽـﺳد رد مﺮـﮔﯽـﻠﯿﻣ 10/4)مﺮــﺳ ﻢﯿﺴﻠﮐ ﻦﯿﻨﭼ ﻢﻫ .(P<0/05)ﺪﻧدﺮﮐﯽﻤﻧ هدﺎﻔﺘﺳا وراد ﻦﯾا زا ﻪﮐ ار وراد ﻦـــﯾا ﻪــﮐ دﻮــﺑ ﯽﻧارﺎــﻤﯿﺑ زا ﺮﺗﻻﺎــﺑ یرادﯽــﻨﻌﻣ رﻮــﻃ ﻪــﺑ ﯽــﮐارﻮﺧ نﻮــﺗرﻮﮐ ﺎــﺑ نﺎــﻣرد ﺖــﺤﺗ ﻪــﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ رد ﯽﺘﯿﻟوﺮﺘﮑﻟا لﻼﺘﺧا ﻦﯾﺮﺗﻊﯾﺎﺷ ﯽﻤﯾﺰﯿﻨﻣﻮﭙﯿﻫ .(P<0/05)(ﺮﺘﯿﻟﯽﺳد رد مﺮﮔﯽﻠﯿﻣ8/8)ﺪﻨﺘﻓﺮﮔﯽﻤﻧ زا ﯽـﺸﺨﺑ ﻪـﮐ ﺪـﺳرﯽﻣ ﺮـﻈﻧ ﻪـﺑ و دراﺪـﻧ رﺎـﻤﯿﺑ ﯽـﻓﺮﺼﻣ یﺎــﻫوراد ﺎﺑ ﯽﻃﺎﺒﺗرا ﻪﮐ (%10/4)ﺪﺷﺎﺑﯽﻣ ﻦﻣﺰﻣ ﻢﺳآ ﺶﻫﺎﮐ و ﻢﺳآ ﺮﺘﻬﺑ لﺮﺘﻨﮐ یاﺮﺑ ﻪﻨﯿﻣز ﻦﯾا رد زﺎﯿﻧ درﻮﻣ یﺎﻫنﺎﻣرد رد ﺪﯾﺎﺷ ﻦﯾاﺮﺑﺎﻨﺑ ﺪﺷﺎﺑ یرﺎﻤﯿﺑ دﻮﺧ ﺰﻧژﻮﺗﺎﭘ .ﺪﺷﺎﺑ ﺮﺛﺆﻣ نآ ضراﻮﻋ ﯽﯾوراد نﺎﻣرد – 4 ﯽﻤﯾﺰﯿﻨﻣﻮﭙﯿﻫ – 3 ﯽﺘﯿﻟوﺮﺘﮑﻟا تﻻﻼﺘﺧا – 2 ﻦﻣﺰﻣ ﻢﺳآ – 1 :ﺎﻫهژاوﺪﯿﻠﮐ
.1381-82 لﺎﺳ ،یﻮﺳﻮﻣ داﻮﺟﯽﻠﻋﺪﯿﺳ ﺮﺘﮐد ﯽﯾﺎﻤﻨﻫار ﻪﺑ ﯽﻣﻮﻤﻋ یاﺮﺘﮐد ﻪﺟرد ﺖﻓﺎﯾرد ﺖﻬﺟ ﺮﻓﯽﺗﺎﺠﻧ ﻪﻤﻃﺎﻓ ﺮﺘﮐد ﻪﻣﺎﻧ نﺎﯾﺎﭘ زا ﺖﺳا یاﻪﺻﻼﺧ ﻪﻟﺎﻘﻣ ﻦﯾا
،ناﺮـﯾا ﯽﻧﺎـﻣرد ـ ﯽﺘــﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﺶﯾﺎﯿﻧ ،نﺎﺧرﺎﺘﺳ نﺎﺑﺎﯿﺧ ،(ص)مﺮﮐا لﻮﺳر تﺮﻀﺣ نﺎﺘﺳرﺎﻤﯿﺑ ،ﻪﯾر یﺎﻫیرﺎﻤﯿﺑ ﺺﺼﺨﺗ قﻮﻓ و رﺎﯾدﺎﺘﺳا (I .(لﻮﺌﺴﻣ ﻒﻟﻮﻣ*)ناﺮﻬﺗ .ناﺮﻬﺗ ،ناﺮﯾا ﯽﻧﺎﻣرد ـ ﯽﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،قوﺮﻋ و ﺐﻠﻗ یﺎﻫیرﺎﻤﯿﺑ رﺎﯿﺘﺳد (II ﯽﻣﻮﻤﻋ ﮏﺷﺰﭘ (III
ﺪﯾﺪـﺸﺗ ﻢﻬـﻣ ﻞــﻠﻋ زا اﺮﯾز ﺪﻧاﻪﺘﻓﺮﮔ راﺮﻗ ﻪﺟﻮﺗ درﻮﻣ نارﺎﻤﯿﺑ یﺎـﻫﯽﻤﺘﯾرآ ﺪﻨﻧﺎـﻣ یﺪـﺟ ضراﻮــﻋ دﺎﺠﯾا ،(2-6)یرﺎﻤﯿﺑ دﻮﺧ ﺮـــﻈﻧ ﻪـﺑ ﺮـﮕﯾد یﻮـﺳ زا .(3)ﺪﻨـﺷﺎﺑﯽﻣ گﺮـﻣ ﯽـﺘﺣ و ﯽـﺒﻠﻗ یﺎـﻫوراد زا ﯽــﺷﺎﻧ ضراﻮﻋ ،تﻻﻼﺘﺧا ﻦﯾا مﺎﻤﺗ ﻪﮐ ﺪﺳرﯽﻤﻧ ﺎـﯾ ﺖـﻌﯿﺒﻃ ﻪـﺑ ار نآ زا ﯽـﺸﺨﺑ ناﻮﺘﺑ ﺪﯾﺎﺷ و ﺪﺷﺎﺑ ﯽﻓﺮﺼﻣ ﻪـﺑ ﯽﺑﺎﯾﺖــﺳد ،ﻪﺠﯿﺘﻧ رد (6 و3)داد ﺖﺒﺴﻧ رﺎﻤﯿﺑ دﻮﺧ ﺰﻧژﻮﺗﺎﭘ ﺪﯾﺪﺟ یﺎﻫشور ﺶﯾاﺪﯿﭘ ،نارﺎﻤﯿﺑ ﻦﯾا نﺎﻣرد رد تﺎﻋﻼﻃا ﻦﯾا نارﺎـﻤﯿﺑ ﻦـﯾا ﯽﻬـﮔآﺶـﯿﭘ دﻮﺒﻬــﺑ و ضراﻮﻋ ﺶﻫﺎﮐ ،ﯽﻧﺎﻣرد .دﻮﺑ ﺪﻫاﻮﺧ ﺮﺛﺆﻣ ﺶـﯿﭘ ﺎﻫلﺎــﺳ ﻪﮐ دﻮﺑ ﯽﺘﯿﻟوﺮﺘﮑﻟا لﻼﺘﺧا ﻦﯿﻟوا ﯽﻤﻟﺎﮐﻮﭙﯿﻫ ﺪـﺷ ﺖﺑﺎﺛ ﺪﻌﺑ و ﺪﯾدﺮﮔ شراﺰﮔ دﺎﺣ ﻢﺳآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ رد ﻦــﯿﻠﯿﻓﻮﻨﯿﻣآ و ﺎﻫﺖـــﺴﯿﻧﻮﮔآﺎـﺘﺑ فﺮـﺼﻣ ﺎـﺑ طﺎـﺒﺗرا رد ﻪـﮐ ﻦــﯾا رد ﺰﯿـﻧ ﯽﻤـﺴﻠﮐﻮﭙﯿﻫ و ﯽﻤﺗﺎﻔـﺴﻓﻮﭙﯿﻫ ًاﺮﯿـﺧا .ﺪـﺷﺎﺑﯽﻣ .ﺖﺳا هﺪﺷ شراﺰﮔ نارﺎﻤﯿﺑ
لﻼــﺘﺧا ﻦﯾﺮﺗﻊﯾﺎـــﺷ ﻦـﻣﺰﻣ ﻢـﺳآ ﻪـﺑ ﻼـﺘﺒﻣ نارﺎـﻤﯿﺑ رد .(3)ﺪﺷﺎﺑﯽﻣ ﯽﻤﯾﺰﯿﻨﻣﻮﭙﯿﻫ هﺪﺷ شراﺰﮔ ﯽﺘﯿﻟوﺮﺘﮑﻟا لﺎـﺳ رد Alamodi OS یﺎـﻗآ ﻂــﺳﻮﺗ ﻪﮐ یاﻪﻌﻟﺎﻄﻣ رد ﺮـﺑ هوﻼـﻋ ﻪــﮐ ﺪﺷ هداد نﺎﺸﻧ ،ﺖﻓﺮﮔ ترﻮﺻ یدﻼﯿﻣ 2001 یﺮـﺗﺶﯿﺑ تﺪــﻣ نآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ ،لﻼﺘﺧا ﻦﯾا یﻻﺎﺑ عﻮﯿﺷ .(3 و2)ﺪﻧﻮﺷﯽﻣ یﺮﺘﺴﺑ نﺎﺘﺳرﺎﻤﯿﺑ رد و ﻢـــﺳآ تﺪـﺷ ﻦـﯿﺑ یاﻪـﻄﺑار ﻪـﻌﻟﺎﻄﻣ ﻦـﯾا رد ﻦـﯿﻨﭼﻢﻫ .(3)ﺖﺳا هﺪﺷ شراﺰﮔ ﯽﻤﯾﺰﯿﻨﻣﻮﭙﯿﻫ ﯽﻟﺎـﺧ ﺎــﻣ رﻮﺸﮐ رد ﯽﺗﺎﻌﻟﺎﻄﻣ ﻦﯿﻨﭼ هﺎﮔیﺎﺟ ﻪﮐ ﺎﺟ نآ زا عﻮﯿـﺷ ناﺰﯿــﻣ ﻦﯿﯿﻌﺗ یاﺮﺑ ار یاﻪﻌﻟﺎﻄﻣ ﺎﺗ ﻢﯾﺪﺷ نآ ﺮﺑ ،ﺖﺳا ،ﻢﯾﺰﯿـﻨﻣ ،ﻢﯿـﺳﺎﺘﭘ ،ﻢﯾﺪـﺳ ﻞﻣﺎــﺷ مﺮﺳ یﺎﻫﺖﯿﻟوﺮﺘﮑﻟا لﻼﺘﺧا و هداد مﺎــﺠﻧا ﻦﻣﺰﻣ ﻢﺳآ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﯿﺑ رد ﺮﻔﺴﻓ و ﻢﯿﺴﻠﮐ ﯽــﺳرﺮﺑ تﻻﻼﺘﺧا ﻦﯾا ﺮﺑ ار ﻢﺳآ رد ﯽﻓﺮﺼﻣ یﺎﻫوراد ﺮﯿﺛﺄﺗ .ﻢﯿﯾﺎﻤﻧ ﯽﺳرﺮﺑ شور
ﻪـﺑ ﻪـﮐ ﻦـﻣﺰﻣ ﻢـﺳآ ﻪـﺑ ﻼـﺘﺒﻣ رﺎـﻤﯿﺑ 96 ﻪــﻌﻟﺎﻄﻣ ﻦﯾا رد هدﺮـﮐ ﻪـﻌﺟاﺮﻣ ناﺮﻬـﺗ ﺮـﮔزوﺮﯿـﻓ نﺎﺘـﺳرﺎﻤﯿﺑ ﻪــﯾر هﺎﮕﻧﺎﻣرد ﺖـﺤﺗ و هﺪـﺷ بﺎـﺨﺘﻧا نﺎــﺳآ و ﯽﻟﺎﻤﺘﺣاﺮﯿﻏ شور ﻪﺑ ،ﺪﻧدﻮﺑ .ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻪﻌﻟﺎﻄﻣ رد ﺮﯿــﺧا یﺮﺘﺴﺑ ﻪﻘﺑﺎﺳ ﻪﮐ ﺪﻧﺪﺷ ﻪﻌﻟﺎﻄﻣ ﻦﯾا دراو یداﺮﻓا و یﺪــــﯾرو ﻦـــﯿﻠﯿﻓﻮﻨﯿﻣآ ﺖﻓﺎـــﯾرد ﻪﻘﺑﺎـــﺳ ،نﺎﺘـــﺳرﺎﻤﯿﺑ یرﺎـﻤﯿﺑ ﻪﻘﺑﺎـﺳ ،(یﺪـﯾرو و رﺰــﯾﻻﻮﺒﻧ ،ﯽﮐارﻮﺧ)ﺖﺴﯿﻧﻮﮔآﺎﺘﺑ و یرﺎـــﮐﺮﭘ ،لﺎﻬـﺳا ،ﯽـﻤﯿﺧﺪﺑ ،ﻻﺎـﺑ نﻮــــﺧ رﺎـﺸﻓ ،ﺖﺑﺎـﯾد .ﺪﻨﺘـﺷاﺪﻧ یﻮـﯿﻠﮐ و ﯽــﺒﻠﻗ یﺮــــﯿﮔرد ،ﺪـــــﯿﺋوﺮﯿﺗ یرﺎﮐﻢﮐ ﺰﯿـﻧ ﻪـﻠﻣﺎﺣ و ﺪـﻧدﺮﮐﯽﻤﻧ فﺮـﺼﻣ ﮏــﯿﺗرﻮﯾد و رﺎﮕﯿﺳ ،ﻞﮑﻟا .ﺪﻧدﻮﺒﻧ ،ﻒـﯿﻔﺧ هوﺮـﮔ 3 رد 1 هرﺎﻤـﺷ لوﺪـﺟ سﺎــﺳا ﺮﺑ نارﺎﻤﯿﺑ .ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﺪﯾﺪﺷ و ﻂﺳﻮﺘﻣ
ﻞﻣﺎــﺷ ﻪـﻌﻟﺎﻄﻣ ﻦــــﯾا رد هﺪـﺷ ﯽـﺳرﺮﺑ یﺎـﻫﺖﯿﻟوﺮﺘﮑﻟا ﻪــﮐ دﻮـﺑ ﻢــــﯾﺰﯿﻨﻣ و ﺮـــﻔﺴﻓ ،ﻢــــﯿﺴﻠﮐ ،ﻢـــﯿﺳﺎﺘﭘ ،ﻢﯾﺪـﺳ یﻮـــــﺳ زا هﺪـــﺷ شراﺰــﮔ ﯽــﻌﯿﺒﻃ هدوﺪــﺤﻣ سﺎــﺳاﺮﺑ 134-148 ﻢﯾﺪــــﺳ)یﺰـــﮐﺮﻣ یژﻮﻟﻮﯿﺑﻮﺗﺎـــﭘ هﺎﮕـــﺸﯾﺎﻣزآ رد نﻻاوﯽـﮐاﯽﻠﯿﻣ 3/5-5/5 ﻢﯿـﺳﺎﺘﭘ ،ﺮﺘــﯿﻟ رد نﻻاوﯽﮐاﯽﻠﯿﻣ ﺮــﻔﺴﻓ ،ﺮـــﺘﯿﻟﯽﺳد رد مﺮـــﮔﯽـﻠﯿﻣ 8/5-10 ﻢــــﯿﺴﻠﮐ ،ﺮﺘﯿﻟ 1/5-2/5 ﻢﯾﺰﯿــــﻨﻣ و ﺮﺘﯿﻟﯽــﺳد رد مﺮــــﮔﯽــﻠﯿﻣ 2/5-4/5 راﺮــﻗ ﯽـــــﻌﯿﺒﻃ هدوﺪـــﺤﻣ رد ،(ﺮـــﺘﯿﻟﯽﺳد رد مﺮـﮔﯽـﻠﯿﻣ .ﺪﻨﺘﺷاد یرﺎــﻣآ راﺰــــﻓامﺮﻧ زا ﺎــﻫهداد ﻞـــﯿﻠﺤﺗ و ﻪـﯾﺰﺠﺗ ﺖـﻬﺟ Chi-squre و t-test یرﺎــــــﻣآ یﺎﻫنﻮﻣزآ زا و SPSS10 .ﺪﯾدﺮﮔ هدﺎﻔﺘﺳا ﻪــﺘﻓﺮﮔ ﺮﻈﻧ رد 0/05 زا ﺮﺗﻢﮐ ﺎﯾ یوﺎﺴﻣ ،یرادﯽﻨﻌﻣ ﺢﻄﺳ .ﺪﺷ
ﯽﻨﯿﻟﺎﺑ ﻢﺋﻼﻋ و رﻮﺗﻼﯾدﻮﮑﻧوﺮﺑ ﻪﺑ زﺎﯿﻧ سﺎﺳاﺮﺑ ﯽﻤﺳآ نارﺎﻤﯿﺑ یﺪﻨﺑﻪﻘﺒﻃ -1 هرﺎﻤﺷ لوﺪﺟ
رﻮﺗﻼﯾدﻮﮑﻧوﺮﺑ ﻪﺑ زﺎﯿﻧ ﻢﺋﻼﻋ
یرﺎﻤﯿﺑ تﺪﺷ
ترﺪﻨﺑ ﻪﺘﻔﻫ 1 زا ﺮﺗﺶﯿﺑ نﺪﺷ رادﺖﻣﻼﻋ ﻞﺻاﻮﻓ
ﻒﯿﻔﺧ
زور 1 زا ﺶﯿﺑ ﯽﻠﺻاﻮﻓ رد زور 1 زا ﺮﺗﺶﯿﺑ نﺪﺷ رادﺖﻣﻼﻋ ﻞﺻاﻮﻓ
ﻂﺳﻮﺘﻣ
ﻪﻧازور دﻮﺷﯽﻣ راﺪﯿﺑ ﻪﻓﺮﺳ و ﺲﻔﻧ ﯽﮕﻨﺗ ﺖﻠﻋ ﻪﺑ رﺎﻤﯿﺑ ﺎﻫﺐﺷ
ﺪﯾﺪﺷ
ﺞﯾﺎﺘﻧ 52 و دﺮــﻣ (%45/8)ﺮـــﻔﻧ 44 ﻪـﻌﻟﺎﻄﻣ درﻮـﻣ رﺎـﻤﯿﺑ 96 زا لﺎــﺳ 45/8 ﺎـﻫنآ ﯽﻨـﺳ ﻦﯿﮕﻧﺎـﯿﻣ و ﺪـﻧدﻮﺑ نز (%54/2)ﺮـﻔﻧ .(لﺎﺳ 77 ﺮﺜﮐاﺪﺣ و لﺎﺳ 12 ﻞﻗاﺪﺣ)دﻮﺑ ﻦﯿﮕﻧﺎﯿﻣ زا ﺮﺗ ﺶﯿﺑ (لﺎﺳ 49/8±3/1)نادﺮﻣ ﯽﻨﺳ ﻦﯿﮕﻧﺎﯿﻣ .(P=0/0001)ﺪـــﻣآ ﺖـﺳد ﻪـﺑ (لﺎـﺳ 41/2±3/5)نﺎـﻧز ﯽﻨـﺳ و هﺎـﻣ 1 ﻞـﻗاﺪﺣ)دﻮـﺑ هﺎـﻣ 60 یرﺎـﻤﯿﺑ تﺪــﻣ لﻮــﻃ ﻦﯿﮕﻧﺎﯿﻣ .(لﺎﺳ 20 ﺮﺜﮐاﺪﺣ و ﻂــﺳﻮﺘﻣ ﻢـــﺳآ %18/8 ،ﻒـﯿﻔﺧ ﻢـﺳآ نارﺎـﻤﯿﺑ %42/7 .ﺪﻨﺘﺷاد ﺪﯾﺪﺷ ﻢﺳآ %38/5 طﺎــﺒﺗرا یرﺎــﻣآ ﺮـــﻈﻧ زا یرﺎـﻤﯿﺑ تﺪـﺷ و ﻦـــﺳ ﻦـﯿﺑ ﺶـﯾاﺰﻓا ﺎـﺑ ﻪـﮐ یرﻮـــﻃ ﻪـﺑ ﺖـــــﺷاد دﻮـــﺟو یرادﯽﻨﻌﻣ ﺖﻓﺎـــــﯾﯽﻣ ﺶـــﯾاﺰﻓا ﻦـــﺳ ﻦﯿﮕﻧﺎـــﯿﻣ ،یرﺎـــﻤﯿﺑ تﺪـــﺷ .(1 هرﺎﻤﺷ رادﻮﻤﻧ)(P=0/001) تﺪــﻣ لﻮﻃ رد ﺶﯾاﺰﻓا ،یرﺎﻤﯿﺑ تﺪﺷ ﺶﯾاﺰﻓا ﺎﺑ ﻦﯿﻨﭼ ﻢﻫ .(P=0/0001)ﺪﯾدﺮﮔ هﺪﻫﺎﺸﻣ یرﺎﻤﯿﺑ یرادﯽـﻨﻌﻣ یرﺎـﻣآ طﺎـﺒﺗرا ﺲـﻨﺟ و یرﺎـﻤﯿﺑ تﺪــﺷ ﻦﯿﺑ ﻢـﺳآ و ﺎـﻫﻢﻧﺎﺧ رد ﻒـﯿﻔﺧ ﻢــﺳآ ﻪﮐ یرﻮﻃ ﻪﺑ ﺖﺷاد دﻮﺟو .(2 هرﺎﻤﺷ رادﻮﻤﻧ)(P<0/05)دﻮﺑ ﺮﺗﻊﯾﺎﺷ نﺎﯾﺎﻗآ رد ﺪﯾﺪﺷ
رد ﻢﺳآ یرﺎﻤﯿﺑ تﺪﺷ و ﯽﻨﺳ ﻦﯿﮕﻧﺎﯿﻣ ﻦﯿﺑ طﺎﺒﺗرا -1 هرﺎﻤﺷ رادﻮﻤﻧ
ﻪﻌﻟﺎﻄﻣ درﻮﻣ نارﺎﻤﯿﺑ نارﺎﻤﯿﺑ رد یرﺎﻤﯿﺑ تﺪﺷ و ﺖﯿﺴﻨﺟ ﻦﯿﺑ طﺎﺒﺗرا -2 هرﺎﻤﺷ رادﻮﻤﻧ
ﻪﻌﻟﺎﻄﻣ درﻮﻣ
ﯽﻤﯾﺰﯿـﻨﻣﻮﭙﯿﻫ نارﺎــﻤﯿﺑ رد دﻮﺟﻮﻣ ﯽﺘﯿﻟوﺮﺘﮑﻟا لﻼﺘﺧا ﺎﻬﻨﺗ .(%10/4)دﻮﺑ رد مﻮﯾﺰﯿـﻨﻣ نارﺎــﻤﯿﺑ %26 رد ﻪﮐ ﺖﺳا مزﻻ ﻪﺘﮑﻧ ﻦﯾا ﺮﮐذ رد مﺮــﮔﯽــﻠﯿﻣ 1/5)ﺖــﺷاد راﺮـــﻗ ﯽـﻌﯿﺒﻃ ﺪـﺣ ﻦﯾﺮﺗﻦﯿﯾﺎـﭘ رد ًﺎـﺒﯾﺮﻘﺗ ﻢﯿـﺳﺎﺘﭘ و ﻢﯾﺪــﺳ ،ﺮﻔﺴﻓ ،ﻢﯿﺴﻠﮐ ناﺰﯿﻣ .(ﺮﺘﯿﻟﯽﺳد .دﻮﺑ ﯽﻌﯿﺒﻃ هدوﺪﺤﻣ رد نارﺎﻤﯿﺑ مﺎﻤﺗ ﻦـﯾا رد مﻮﯾﺰﯿـﻨﻣ لﻼـﺘﺧا و ﺎـﻫوراد فﺮــﺼﻣ ﻦﯿﺑ طﺎﺒﺗرا .(2 هرﺎﻤﺷ لوﺪﺟ)ﺪﻣﺎﯿﻧ ﺖﺳد ﻪﺑ راد ﯽﻨﻌﻣ ﻪﻌﻟﺎﻄﻣ
ﯽﻓﺮﺼﻣ یﺎﻫوراد سﺎﺳاﺮﺑ مﺮﺳ مﻮﯾﺰﯿﻨﻣ ﻦﯿﮕﻧﺎﯿﻣ -2 هرﺎﻤﺷ لوﺪﺟ
ﻦﻣﺰﻣ ﻢﺳآ رد
مﻮﯾﺰﯿﻨﻣ ﻦﯿﮕﻧﺎﯿﻣ فﺮﺼﻣ وراد
فﺮﺼﻣ وراد
ﺎﻫوراد ﺪﻧدﺮﮐﯽﻣ
ﺪﻧدﺮﮐﯽﻤﻧ Pvalue
ﯽﻗﺎﺸﻨﺘﺳا ﺖﺴﯿﻧﻮﮔآﺎﺘﺑ 1/74
1/90
>0/05
ﯽﻗﺎﺸﻨﺘﺳا نﻮﺗرﻮﮐ 1/9
2/01
>0/05
ﯽﮐارﻮﺧ نﻮﺗرﻮﮐ 2/04
1/89
>0/05
ﻦﯿﻠﯿﻓﻮﺌﺗ 1/95
1/92
>0/05
یﺎــﻫوراد سﺎـــﺳا ﺮـﺑ ﻒـﻠﺘﺨﻣ یﺎـﻫﺖﯿﻟوﺮﺘﮑﻟا ﻦﯿﮕﻧﺎـﯿﻣ ﻦﯿﮕﻧﺎـﯿﻣ .ﺖـﺳا هﺪﺷ هداد نﺎﺸﻧ 3 هرﺎﻤﺷ لوﺪﺟ رد ﯽﻓﺮﺼﻣ 2 و ﯽﻨـﺳ یﺎﻫهوﺮﮔ ،ﻢﺳآ ﻒﻠﺘﺨﻣ یﺎﻫتﺪﺷ رد ﺎﻫﺖﯿﻟوﺮﺘﮑﻟا .دﻮﺒﻧ توﺎﻔﺘﻣ ﯽﺴﻨﺟ هوﺮﮔ
ﺚﺤﺑ ﻪــﺑ طﻮﺑﺮﻣ ﯽﺘﯿﻟوﺮﺘﮑﻟا لﻼﺘﺧا ﺎﻬﻨﺗ ،هﺪﺷ مﺎﺠﻧا ﯽﺳرﺮﺑ رد مﻮﯾﺰﯿـﻨﻣ %10/4 ﻪـﻌﻟﺎﻄﻣ درﻮــﻣ داﺮﻓا ﻦﯿﺑ زا ﻪﮐ دﻮﺑ مﻮﯾﺰﯿﻨﻣ ﯽـﻌﯿﺒﻃ ناﺰﯿـﻣ ﻞـﻗاﺪﺣ مﻮﯾﺰﯿــﻨﻣ ﺰﯿﻧ %26 رد و ﺪﻨﺘﺷاد ﻦﯿﯾﺎﭘ ﻪــﻌﻟﺎﻄﻣ رد ﺐﻠﻄﻣ ﻦﯾا ﻪﮐ (ﺮــﺘﯿﻟﯽﺳد رد مﺮــﮔﯽﻠﯿﻣ 1/5)دﻮﺑ ﺰﯿـﻧ (2)نﺎﺘـﺴﺑﺮﻋ رد 2001 لﺎــﺳ رد Alamodi OS یرﺎﻣآ عﻮﯿـﺷ ﻪــﻌﻟﺎﻄﻣ نآ رد ﻪـﮐ توﺎـﻔﺗ ﻦـﯾا ﺎــﺑ ،ﺖﺳا هﺪﺷ ﺪﯿﯾﺄﺗ .دﻮﺑ هﺪﺷ شراﺰـﮔ %26/9 ﯽﻤﯾﺰﯿﻨﻣﻮﭙﯿﻫ و ﺖﺴﯿﻧ ﺺﺨﺸﻣ ﯽﺑﻮﺧ ﻪﺑ نارﺎﻤﯿﺑ رد ﯽﻤﯾﺰﯿﻨﻣﻮﭙﯿﻫ ﺖﻠﻋ .(6 و3)ﺪﺷﺎﺑ یرﺎﻤﯿﺑ ﺰﻧژﻮﺗﺎﭘ زا ﯽﺸﺨﺑ ﺪﺳرﯽﻣ ﺮﻈﻧ ﻪﺑ Kakishs و (7)2001 لﺎـــﺳ رد ﺶﻧارﺎـﮑﻤﻫ و Picodo C ﺶــﯾاﺰﻓا و ﻦﯿﯾﺎـــﭘ مﻮﯾﺰﯿـﻨﻣ ﻦـﯿﺑ طﺎـﺒﺗرا (8)2001 لﺎـﺳ رد و یﻮـﯾر قوﺮــﻋ ﺖﻣﺎﺨﺿ ﺶﯾاﺰﻓا ،ﯽﯾاﻮﻫ یﺎﻫهار ﺖﯿﺳﺎﺴﺣ Alamodi OS ﺮﮕﯾد ﻪﻌﻟﺎﻄﻣ .ﺪﻧدﺮﮐ شراﺰﮔ ار ﯽﻨﻄﺑ ﯽﻤﺘﯾرآ ﺎــﺑ ﻢﺳآ ﻪﺑ ﻼﺘﺒﻣ داﺮﻓا رد ﻪﮐ داد نﺎﺸﻧ ﺰﯿﻧ (3)2000 لﺎﺳ رد ﻢــﺳآ تﻼﻤﺣ ﺪﯾﺪﺸﺗ و نﺪﺷ یﺮﺘﺴﺑ ﻪﺑ ﻞﯾﺎﻤﺗ ﻦﯿﯾﺎﭘ مﻮﯾﺰﯿﻨﻣ .ﺖﺳا ﺮﺗﺶﯿﺑ ﯽﻌﯿﺒﻃ مﻮﯾﺰﯿﻨﻣ ﺎﺑ ﻢﺳآ ﻪﺑ ﻼﺘﺒﻣ داﺮﻓا ﻪﺑ ﺖﺒﺴﻧ ﻪــﮐ دﺮـﮐ شراﺰـﮔ (7)2001 لﺎـﺳ رد ﺰﯿـﻧ Picodo C یﺎـﻗآ ﺶﻫﺎـﮐ ،ﻪﯾر دﺮﮐ ﻞﻤﻋ دﻮﺒﻬﺑ رد ﯽﯾاﺬﻏ ﻢﯾژر مﻮﯾﺰﯿﻨﻣ ﺶﯾاﺰﻓا یﺎـﻫوراد ﻦـﯿﺑ ﻪــﻌﻟﺎﻄﻣ ﻦﯾا رد .ﺖﺳا ﺮﺛﺆﻣ ﺰﯾو و ﺲﻔﻧ ﯽﮕﻨﺗ ﺖــﺳد ﻪﺑ یراد ﯽﻨﻌﻣ طﺎﺒﺗرا ﯽﺘﯿﻟوﺮﺘﮑﻟا تﻻﻼﺘﺧا و ﯽﻓﺮﺼﻣ ﻪـﮐ دﺎـﺣ ﻢـﺳآ نﺎــﻣرد رد ﻢﯾراد رﺎﻈﺘﻧا ﻪﮐ رﻮﻃ نﺎﻤﻫ .ﺪﻣﺎﯿﻧ هدﺎـﻔﺘﺳا یﺪـﯾرو و رﺰـﯾﻻﻮﺒﻧ ترﻮــﺻ ﻪـﺑ ﺖـﺴﯿﻧﻮﮔآﺎﺘﺑ ﻪـﺑ و ﻪــﺘﻓر ﻻﺎﺑ ﻦﯿﻟﻮﺴﻧا و ﻦﯿﻟﺎﻧردآ ﺢﻄﺳ ﻦﺘﻓر ﻻﺎﺑ دﻮﺷﯽﻣ
ﻪــﺠﯿﺘﻧ رد و لﻮﻠﺳ جرﺎﺧ زا ﺮﻔﺴﻓ و ﻢﯿﺳﺎﺘﭘ ﺖﻔﯿﺷ نآ لﺎﺒﻧد یﺪـﯾرو ﻦـﯿﻠﯿﻓﻮﻨﯿﻣآ .ﺪــﻫدﯽﻣ خر ﯽﻤﺗﺎﻔﺴﻓﻮﭙﯿﻫ و ﯽﻤﻟﺎﮐﻮﭙﯿﻫ نآ ﺖﻔﯿﺷ و ﺮﻔﺴﻓ یراردا ﺢﺷﺮﺗ ﺶﯾاﺰﻓا ﺐﺟﻮﻣ ﺪﻧاﻮﺗﯽﻣ ﺰﯿﻧ ﯽﻤﺗﺎﻔـﺴﻓﻮﭙﯿﻫ یاﺮـﺑ یﺮــﮕﯾد ﻪﯿﺟﻮﺗ ﻪﮐ دﻮﺷ لﻮﻠﺳ ﻞﺧاد ﻪﺑ Ritak نﺎــﯾﺎﻗآ ﻪﻌﻟﺎﻄﻣ سﺎﺳاﺮﺑ ﻦﯿﻨﭼ ﻢﻫ .ﺖﺳا دﺎﺣ ﻢﺳآ رد نارﺎــﮑﻤﻫ و Haffier GA و (9)2000 لﺎﺳ رد وا نارﺎﮑﻤﻫ و ﻢـﺴﯿﻧﺎﮑﻣ ﺎـﺑ ود ﺎــﺘﺑ یﺪﯾرو ﺖﺴﯿﻧﻮﮔآ (10)1992 لﺎﺳ رد وا زا مﻮﯾﺰﯿـﻨﻣ ﻊـﻓد ﺶـﯾاﺰﻓا و لﻮﻠـﺳ ﻞــﺧاد ﻪﺑ مﻮﯾﺰﯿﻨﻣ ﺖﻔﯿﺷ مﺪـﻋ دﻮـﺟو ﺎـﺑ ﻪـﮐ ﺪـﺷﺎﺑ ﯽـﻣ ﯽﻤﯾﺰﯿــﻨﻣﻮﭙﯿﻫ لﻮﺌﺴﻣ ،راردا ﻪـﻌﻟﺎﻄﻣ رد نارﺎـﻤﯿﺑ ﻂـﺳﻮﺗ یﺪـﯾرو ﺖـﺴﯿﻧﻮﮔآﺎــﺘﺑ فﺮﺼﻣ یﺎـﻫحﺮﻃ زا یرﺎﯿــﺴﺑ ﻪﺑﺎﺸﻣ)ﺎﻫنآ رد ﯽﻤﯾﺰﯿﻨﻣﻮﭙﯿﻫ ،ﺮﺿﺎﺣ نارﺎﻤﯿﺑ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد .دورﯽﻣ لاﻮﺳ ﺮﯾز ﺖﻠﻋ ﻦﯾا (ﺮﮕﯾد سﺎـﺳاﺮﺑ و ﺪـﻧدﺮﮐﯽﻣ هدﺎﻔﺘــﺳا ﯽﻗﺎﺸﻨﺘﺳا ﺖﺴﯿﻧﻮﮔآﺎﺘﺑ ﺎﻬﻨﺗ ﺖـﺴﯿﻧﻮﮔآﺎـﺘﺑ ﻪـﮐ ﯽﻧارﺎــﻤﯿﺑ رد مﻮﯾﺰﯿﻨﻣ یاﺮﺑ 1/74 ﻦﯿﮕﻧﺎﯿﻣ رد 1/90 ﻦﯿﮕﻧﺎـــﯿﻣ ﺮـﺑاﺮﺑ رد ﺪـﻧدﺮﮐﯽﻣ ﺖﻓﺎـﯾرد ﯽﻗﺎـﺸﻨﺘﺳا دﻮــﺟو یرادﯽﻨﻌﻣ توﺎﻔﺗ ﺪﻨﺘﻓﺮﮔﯽﻤﻧ ار وراد ﻦﯾا ﻪﮐ ﯽﻧارﺎﻤﯿﺑ 14 ﻪـﻌﻟﺎﻄﻣ درﻮـﻣ داﺮــﻓا زا .(1 هرﺎﻤﺷ لوﺪﺟ)(P<0/05)ﺖﺷاﺪﻧ ﻦﯿﮕﻧﺎـﯿﻣ ﻪـﮐ ﺪـﻧدﺮﮐﯽﻣ هدﺎﻔﺘـﺳا ﯽـﮐارﻮﺧ ﺪﯿﯾوﺮﺘــﺳا زا ﺮﻔﻧ ﺪﯿﯾوﺮﺘـﺳا ﻪﮐ ﯽﻧارﺎﻤﯿﺑ زا یرادﯽﻨﻌﻣ رﻮﻃ ﻪﺑ ﺎﻫنآ رد ﻢﯿﺴﻠﮐ ﻪﻠﺌــﺴﻣ ﻦﯾا ﻪﯿﺟﻮﺗ رد .دﻮﺑ ﺮﺗﻻﺎﺑ ﺪﻧدﺮﮐﯽﻤﻧ فﺮﺼﻣ ﯽﮐارﻮﺧ ﻦﯿﮕﻧﺎــﯿﻣ .دﺮﮐ هرﺎﺷا ﯽﮐارﻮﺧ ﺪﯿﯾوﺮﺘﺳا ضراﻮﻋ ﻪﺑ ناﻮﺗﯽﻣ
ﻦﻣﺰﻣ ﻢﺳآ رد ﯽﻓﺮﺼﻣ یﺎﻫوراد سﺎﺳاﺮﺑ ﺮﻔﺴﻓ و ﻢﯿﺴﻠﮐ ،ﻢﯿﺳﺎﺘﭘ ،ﻢﯾﺪﺳ یﺎﻫﺖﯿﻟوﺮﺘﮑﻟا ﻦﯿﮕﻧﺎﯿﻣ -3 هرﺎﻤﺷ لوﺪﺟ
ﻢﯾﺪﺳ ﻢﯿﺳﺎﺘﭘ
ﻢﯿﺴﻠﮐ ﺮﻔﺴﻓ
139* 3/6
9/9
3/8 ﯽﻗﺎﺸﻨﺘﺳا ﺖﺴﯿﻧﻮﮔآﺎﺘﺑ
141/8 4/42
10/1 4
142/3 4/18
9/5
3/6 ﯽﻗﺎﺸﻨﺘﺳا نﻮﺗرﻮﮐ
140/4 4
9/3 3/7
139/3 3/94
10/4
3/8 ﯽﮐارﻮﺧ نﻮﺗرﻮﮐ
138/2 3/83
8/8 3/7
137/4 3/4
8/9
3/6 ﻦﯿﻠﯿﻓﻮﺌﺗ
141/3 4/05
9/2 3/7
ﻢﯾﺪـﺳ درﻮــﻣ رد لﺎﺜﻣ ناﻮﻨﻋ ﻪﺑ ﻪﮐ ﺪﺷﺎﺑﯽﻣ فﺮﺼﻣ مﺪﻋ ﻪﺑ طﻮﺑﺮﻣ ﯽﻨﯿﯾﺎﭘ دﺪﻋ و وراد فﺮﺼﻣ ﻪﺑ طﻮﺑﺮﻣ ﺖﯿﻟوﺮﺘﮑﻟا ﺮﻫ درﻮﻣ رد * ﯽﯾﻻﺎﺑ دﺪﻋ :ﺢﯿﺿﻮﺗ p.v<0/05 .ﺖﺳا هﺪﺷ هداد نﺎﺸﻧ و * یﺎﻫﺖﻟﺎﺣ ﺎﺑ ﯽﻗﺎﺸﻨﺘﺳا ﺖﺴﯿﻧﻮﮔآﺎﺘﺑ ﺎﺑ طﺎﺒﺗرا رد
هدﺎﻔﺘـﺳا ﯽﻗﺎﺸﻨﺘﺳا ﺖﺴﯿﻧﻮﮔآﺎﺘﺑ زا ﻪﮐ یداﺮﻓا رد ﺰﯿﻧ ﻢﯿﺳﺎﺘﭘ ﻦﯾا ﻪﮐ دﻮﺑ ﯽﻧارﺎﻤﯿﺑ زا ﺮﺗﻢﮐ یرادﯽﻨﻌﻣ ترﻮﺻ ﻪﺑ ﺪﻧدﺮﮐﯽﻣ فﺮـﺼﻣ ﺎـﺑ طﺎـﺒﺗرا رد ﺮــﺛا ﻦﯾا .ﺪﻧدﺮﮐﯽﻤﻧ فﺮﺼﻣ ار وراد ﯽﻗﺎـــﺸﻨﺘﺳا یﺎﻫﺖـﺴﯿﻧﻮﮔآﺎـﺘﺑ تﺪـﻣ ﯽـﻧﻻﻮﻃ و ﮏﯿﻤﺘـﺴﯿﺳ ﻖـــﯿﻗد ﻞـﻠﻋ زﻮـﻨﻫ هﺪـﺷ ﻪـﺘﻔﮔ ﺐﻟﺎـﻄﻣ دﻮـﺟو ﺎـﺑ .ﺪـﺷﺎﺑﯽﻣ ﺺﺨــﺸﻣ ﻦـﻣﺰﻣ ﻢـﺳآ ﻪـﺑ ﻼـﺘﺒﻣ نارﺎـﻤﯿﺑ رد ﯽﻤﯾﺰﯿـﻨﻣﻮﭙﯿﻫ ﯽﺗﻻﺎـﻘﻣ مﺎـﻤﺗ رد ﻪـﮐ ﺖﺳا ﻦﯾا ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﺐﻠﻄﻣ .(2-6)ﺖﺴﯿﻧ ﻪـﻌﻟﺎﻄﻣ رد ﻦـﯿﻨﭼ ﻢـﻫ و ﺪﻧاهﺪـﺷ ﺮـﺸﺘﻨﻣ ﻪـﻨﯿﻣز ﻦــﯾا رد ﻪﮐ رد ﯽﺘﯿﻟوﺮﺘــﮑﻟا لﻼـــﺘﺧا ﻦﯾﺮﺗﻊﯾﺎـﺷ ﯽﻤﯾﺰﯿـﻨﻣﻮﭙﯿﻫ ،ﺮﺿﺎـﺣ ﺎــﯾآ .(11-13 ،8 ،4)ﺖــﺳا هدﻮــﺑ ﻦــﻣﺰﻣ ﻢــﺳآ ﺎـــﺑ نارﺎـﻤﯿﺑ ﺮﯿـﺳ یور ﺮـﺛا ﺎـﯾ ﻢـﺳآ تﻼــﻤﺣ ﺪﯾﺪﺸﺗ ﺚﻋﺎﺑ ﯽﻤﯾﺰﯿﻨﻣﻮﭙﯿﻫ و 2001 ﻞﯿـــﺴﯿﺳ بﺎــــﺘﮐ رد ؟ﻪــﻧ ﺎــﯾ دﻮــﺷﯽﻣ نﺎــﻣرد زا یﺪﯾرو مﻮﯾﺰﯿﻨﻣ Good man & Gil man یژﻮﻟﻮﮐﺎﻣرﺎﻓ
(15 و14)ﺖﺳا هﺪﺷ ﯽﻓﺮﻌﻣ ﻢﺳآ موﺎﻘﻣ ﻪﻠﻤﺣ یﺎﻫنﺎﻣرد ﻪﻠﻤﺟ ﺎـﺑ .ﺖـﺳا هﺪـﯾدﺮﮔ هﺪـــﻫﺎﺸﻣ ﺰـــﯿﻧ ﻞـﻤﻋ رد ﻪﻠﺌــﺴﻣ ﻦﯾا ﻪﮐ ﺎﺑ ﯽﺗﺎﻌﻟﺎﻄﻣ نداد مﺎﺠﻧا ﻪﺑ زﺎﯿﻧ عﻮﺿﻮﻣ ﻦﯾا تﺎﺒﺛا ﻦﯾا دﻮﺟو لﺮﺘـﻨﮐ داﺮـﻓا ﺎـﺑ هاﺮــﻤﻫ ﺮﺗﺶﯿﺑ تﺎﻧﺎﮑﻣا ،ﺮﺗﺶﯿﺑ ﻪﻧﻮﻤﻧ ﻢﺠﺣ .دراد
ﻊﺑﺎﻨﻣ 1- Goerge RB., Light RW., Matthay MA. Chest medicine, Essentials of pulmonary and critical care medicine, 4th edition, Philadelphia, Lippincott Williams&Wilkins,2000,PP:132-163.
2- Alamodi OS. Electrolytes disturbances in patients with chronic stable asthma, Chest, 2001, 2:
431-436.
3- Alamodi OS. Hypomagnesemia in chronic stable asthmatics: prevalence, correlation with severity and hospitalization, Eur Respir J., 2000 Sep, 16(3): 427-31.
4- Falker D., Glauser J., Allen M. Serum Mg levels in asthmatics patients during acute exacerbation of asthma, Am J Emerg Med, 1992, 10: 1-3.
5- Fedoseev GB., Emelianov AV., Neskoromnyi AG. The role of disorders in the homeostasis of divalent cations in the pathogenesis and clinical
picture of bronchial asthma, Ter Arkh, 1994, 66(3):
8-12.
6- Zervas E., Papatheodorou G., Psathakis K., Panayou P., Georgatou N., Loukides S. Reduced intracellular Mg concentrations in patients with acute asthma, Chest, 2003 Jan, 123(1): 113-8.
7- Picodo C., Deulofeu R. Diatary micronutrients antioxidants and their relationship with bronchial asthma severity, Alletgy, 2001, 56(1): 43-9.
8- Baker JC., Ayres JC. Diet and asthma, Respir Med, 2000, 94(10): 925-934.
9- Rita K., Haward E. New medication for asthma, Emerg Med Clin North Am, 2000, 18(4):
789-801.
10- Haffiner GA., Kendall MJ. Metabolic effects of B2agonist, Clin Pharm Ther, 1992, 17: 155-164.
11- Murry A., Nadel GL., Mason B. Textbook of respiratory medicine, 3rd edition, Philadelphia, W.B.Saunders Company, 2000, Volume 2, PP:
1247-1278.
12- Knutsen R., Bohmer T. Intravenous theophylin induced excretion of calcium, magnesium and sodium in patients with recurrent asthma, N Engl Med J, 1994, 54: 119-125.
13- Fitz Gerald J., Ernest P., Boulet M.
Evidence-bases asthma management. 2nd ed., London, Hamilton B.C. Deker Inc, 2001, PP: 202.
14- Hardman JG., Limbard L. Goodman &
Gilmans The pharmacological basis of therapeutics, 10 th edition, NewYork, McGraw- Hill, 2001, PP: 733-750.
15- Andreoli TE., Carpenter CJ., Griggs RC., Loscalzo J. Cecil essential of medicine, 5th edition, Philadelphia, W.B.Saunders Company, 2001, PP:
187.
The Prevalence of Electrolyte Disorders in Patients with Chronic Asthma
I II III
*S.A.J. Mousavi, MD A. Alizadeh Asl, MD F. Nejatifar, MD
Abstract
Asthma is one of the most common diseases and one of the major causes of morbidities which demands high cost. With improvement in research and management methods, electrolyte disorders have been considered in patients with asthma because these disorders may cause exacerbation of asthma and lead to severe complications and even death. However, it does not seem these disorders are side effects of drugs used by these patients and they may be a part of natural history or pathogenesis of the disease. Thus, due to the importance of these disorders in effective management of the patients, creating new treatment methods, decreasing complications and improving outcome of these patients, this study was carried out on 96 patients with chronic asthma to explore the above-mentioned subjects. Patients neither had hospitalization nor received intravenous aminophyline; oral inhaler and intravenous beta-agonist and intravenous corticosteroid. None of the patients used alcohol or diuretics, was smoker and had co-existing disease. Sodium, potassium, calcium, phosphore and magnesium were measured in all of the patients. 45.8% of the patients were males and 54.2% were females. Mean age of males(49.8±3.5) was significantly more than that of females(41.2±3.1; P<0.05). The only electrolyte abnormality in this study was hypomagnesemia(10.4%). Mean plasma potassium level in patients that received inhalational beta- agonists(3.6 meq/dl) was significantly less than those who did not receive them (4.21 meq/dl, P<0.05). Also, mean plasma calcium concentration(10.4 mg/dl) in patients who took oral steroids was significantly more than those who did not receive them(8.8mg/dl, P<0.05). In conclusion, hypomagnesemia is the most common electrolyte disorder in patients with chronic asthma, which is not related to drugs used in these patients and may be a part of pathogenesis of this disease. Thus, treatment of hypomagnesemia may be effective in better control of asthma and decreasing its complications.
Key Words: 1) Chronic Asthma 2) Electrolyte Disorders 3) Hypomagnesemia 4) Medical therapy
This article is a summary of the thesis by F. Nejatifar, MD under supervision of S.A.J. Mousavi, MD, 2002-2003.
I) Assistant Professor of Pulmonary Diseases. Hazrat Rasoul-e-Akram Hospital. Sattarkhan Ave., Niayesh St., Iran University of Medical Sciences and Health Services. Tehran, Iran.(*Corresponding Author)
II) Resident of Cardiovascular Diseases. Iran University of Medical Sciences and Health Services.
Tehran, Iran.
III) General Practitioner.
