ﻲﻳاﻮﻫ هار ﻲﺟرﺎﺧ ﻢﺴﺟ نﻮﻴﺳاﺮﻴﭙﺳآ رﺎﭼد نارﺎﻤﻴﺑ ﻲﺼﻴﺨﺸﺗ ﺮﻴﺧﺄﺗ ﻞﻠﻋ ﻲﺳرﺮﺑ
ﻢﻴﺨﻓ ﻲﻬﻟاﺪﺒﻋ ﻦﻴﻬﺷ ﺮﺘﻛد* I
ﺮﺘﻛد ﻦﻳﺮﺑدﺎﺑ دوواد II
يﺰﻳﺮﺒﺗ نﺎﻴﻧﺎﺠﻠﮔ ﻲﻠﻋ ﺮﺘﻛد III
ﻣ ﻪﻣﺪﻘ
ﻲﺟرﺎــﺧ ﻢﺴــﺟ نﻮﻴــﺳاﺮﻴﭙﺳآ ﻢــﻬﻣ ﺚــﺣﺎﺒﻣ زا ﻲــﻜﻳ ﻢــﻫ زﻮــﻨﻫ
ﻲﻧﺎﻣرد و ﻲﺼﻴﺨﺸﺗ
ﻲـﻣ بﻮﺴﺤﻣ نﺎﻜﺷﺰﭘ ياﺮﺑ
دﻮـﺷ . ﺶﻴـﺑ ﻦﻳﺮـﺗ
نﺎﻛدﻮﻛ رد ﻲﺟرﺎﺧ ﻢﺴﺟ نﻮﻴﺳاﺮﻴﭙﺳآ عﻮﻴﺷ 1
ﺎﺗ 3 ﻲﻣ ﻪﻟﺎﺳ ﺪﺷﺎﺑ .
يرﺎﻤﻴﺑ ﻦﻴﻨﭽﻤﻫ و ﺮﻴﻣ و گﺮﻣ ناﺰﻴﻣ
مﺎﺴـﺟا زا ﻲﺷﺎﻧ يﺎﻫ
ﺟرﺎﺧ ـ ﻳاﻮﻫ هار ﻲ ــ
ﺑ ﻲ ـ ﻳاﻮﻫ هار ندﻮﺑ ﻚﻳرﺎﺑ ﻞﻴﻟد ﻪ ـ
مﺪﻋ و ،ﻲ
ــﻣﺎﻜﺗ ـ ﻢﺴــﻴﻧﺎﻜﻣ ﻲﻓﺎــﻛ ﻞ ﺶﻴــﺑ نﺎــﻛدﻮﻛ رد ،ﻲﺘﻇﺎــﻔﺣ يﺎــﻫ
ﺮــﺗ
ﺳا ــــ ﺖ
).
1
ﻓﺮﺳ (
ــــ ﻳﺮﭘ ،ﻪ ــــ ﺴــﺟ نﺪ ــــﺟرﺎﺧ ﻢـ
،ﻖــﻠﺣ ﻪــﺑ ﻲ
ﺲــﺧ دﺎــﺣ عوﺮــﺷ و دﺎــﺣ ﻲﺴــﻔﻨﺗ سﺮﺘﺴــﻳد ،ﻪﻨﻴــﺳ ﺲــﺧ
ﻊﻳﺎﺷ ﻲﻣ ﻲﺟرﺎﺧ ﻢﺴﺟ نﻮﻴﺳاﺮﻴﭙﺳآ ﻢﻳﻼﻋ ﻦﻳﺮﺗ ﻲﻗﺎـﺑ ﺎﺑ ﻪﻛ ﺪﻨﺷﺎﺑ
ﻲﻣ ﻒﻴﻔﺨﺗ ﺖﻋﺮﺳ ﻪﺑ ﻢﻳﻼﻋ ﻦﻳا ،ﻲﺟرﺎﺧ ﻢﺴﺟ نﺪﻧﺎﻣ ﺪﻨﺑﺎﻳ
).
2
(
ﺷﺎﻧ گﺮﻣ ﻪﺑ ﺮﺠﻨﻣ ﺖﺳا ﻦﻜﻤﻣ ﻲﺟرﺎﺧ ﻢﺴﺟ نﻮﻴﺳاﺮﻴﭙﺳآ ﻲ
يﺪـﺟ ضراﻮـﻋ ﺎـﻳ و ﻲﮕﻔﺧ زا
ﻲﻧﻮـﻣﻮﻨﭘ نﻮـﭽﻤﻫ
،رﺮـﻜﻣ يﺎـﻫ
،يزﺎﺘﻜﻠﺗآ
ﺸﻧوﺮﺑ و نﻮﻴﺳﻻﻮﻧاﺮﮔ ﺖﻓﺎﺑ ﻞﻴﻜﺸﺗ ﻪـﻛ دﻮـﺷ يزﺎﺘﻜ
ﻴﺨﺸـﺗ ،ضراﻮﻋ ﻦﻳا زا يﺮﻴﮕﺸﻴﭘ ياﺮﺑ ــ
ـﻠﺧاﺪﻣ و ﺺ ـ
ﻊـﻗﻮﻤﺑ ﻪ
ﺖﺳا ﻲﺗﺎﻴﺣ
).
5 - 3
ﺎﺗ ﻲﺟرﺎﺧ ﻢﺴﺟ ﻪﻛ ﻲﺗرﻮﺻ رد (
24 رد ﺖﻋﺎـﺳ
ﺪﺷ ﺪﻫاﻮﺧ ﻲﺘﻳﺪﻴﺑرﻮﻣ ﻪﺑ ﺮﺠﻨﻣ ،دﻮﺸﻧ هدروآ
).
6
(
هﺪﻴﻜﭼ
فﺪﻫ و ﻪﻨﻴﻣز :
ﻪﭽﺑ ﻲﻌﻳﺎﺷ ﻲﻠﻴﺧ ترﻮﺼﺑ ﻲﺟرﺎﺧ مﺎﺴﺟا نﻮﻴﺳاﺮﻴﭙﺳآ
ﻲـﻣ ﺮﻴﮔرد ار ﻚﭼﻮﻛ يﺎﻫ
ﺪـﻨﻛ . و لﺎـﺣ حﺮـﺷ
ﻲﻣ ﻖﻴﻗد ﻪﻨﻳﺎﻌﻣ
ﻮﺗ
دﻮﺷ ﺺﻴﺨﺸﺗ ﻪﺑ ﺮﺠﻨﻣ ﺪﻧا .
ﺎـﺗ ﻲﺟرﺎـﺧ ﻢﺴـﺟ ﻪﻛ ﻲﺗرﻮﺻ رد 24
ﻪـﺑ ﺮـﺠﻨﻣ ،دﻮﺸـﻧ هدروآرد ﺖﻋﺎـﺳ
ﺪﺷ ﺪﻫاﻮﺧ يزﺎﺘﻜﻠﺗآ و ﻪﺴﺑآ ،ﻲﻧﻮﻣﻮﻨﭘ نﻮﭽﻤﻫ ﻲﺿراﻮﻋ .
نارﺎﻤﻴﺑ ﺺﻴﺨﺸﺗ ﺮﻴﺧﺄﺗ ﻞﻠﻋ ﺎﺗ ﺖﺳا هﺪﺷ شﻼﺗ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد
دﻮﺷ ﻲﺳرﺮﺑ ﺰﻳﺮﺒﺗ نﺎﻛدﻮﻛ نﺎﺘﺳرﺎﻤﻴﺑ رد ﻲﻳاﻮﻫ هار ﻲﺟرﺎﺧ ﻢﺴﺟ نﻮﻴﺳاﺮﻴﭙﺳآ رﺎﭼد .
ﺑ شور ﺮ ﻲﺳر : يور ﺮﺑ و ﻲﻌﻄﻘﻣ ـ ﻲﻔﻴﺻﻮﺗ شور ﻪﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا 155
يﺎﻬﻟﺎﺳ رد ﻪﻛ رﺎﻤﻴﺑ 83
- 1380 نﺎﺘـﺳرﺎﻤﻴﺑ رد
ﻲﺟرﺎـﺧ ﻢﺴـﺟ يزﺎـﺳ جرﺎـﺧ و ﺪـﻳﮋﻳر ﻲﭘﻮﻜﺳﻮﻜﻧوﺮﺑ ﺖﺤﺗ و هﺪﺷ يﺮﺘﺴﺑ ،ﻪﻳر ﻲﺟرﺎﺧ ﻢﺴﺟ لﺎﻤﺘﺣا ﺎﺑ ﺰﻳﺮﺒﺗ نﺎﻛدﻮﻛ
ﺖﺳا هﺪﺷ مﺎﺠﻧا ،ﺪﻧدﻮﺑ ﻪﺘﻓﺮﮔ راﺮﻗ .
ﻪﺑ طﻮﺑﺮﻣ تﺎﻋﻼﻃا ،نارﺎﻤﻴﺑ ياﺮﺑ ﻲﻧﺎﻣز ﻪﻠﺻﺎﻓ ،ﻖﻠﺣ ﻪﺑ ﻲﺟرﺎﺧ ﻢﺴﺟ نﺪﻳﺮﭘ ﻪﻘﺑﺎﺳ
نﺪﺷ يﺮﺘﺴﺑ ﺎﺗ ﻢﺋﻼﻋ عوﺮﺷ زا )
ﺺﻴﺨﺸﺗ رد ﺮﻴﺧﺎﺗ نﺎﻣز تﺪﻣ (
رﺎـﻤﻴﺑ ﻪﻴﻟوا ﺺﻴﺨﺸﺗ ،يﺮﺘﺴﺑ زا ﻞﺒﻗ ﻚﺷﺰﭘ ﻪﺑ ﻪﻌﺟاﺮﻣ ،
ﺪـﺷ ﺖـﺒﺛ ،دﻮـﺑ هﺪـﺷ ﻪﻴﻬﺗ ﻞﺒﻗ زا ﻪﻛ ﻲﺘﺴﻴﻟ ﻚﭼ رد ﻲﭘﻮﻜﺳﻮﻜﻧوﺮﺑ ﺞﻳﺎﺘﻧ و .
هداد ﻪﻠﻴـﺳﻮﺑ ﻪـﻌﻟﺎﻄﻣ زا هﺪـﻣآ ﺖـﺳﺪﺑ يﺎـﻫ
يرﺎﻣآ يﺎﻬﺷور مﺮﻧ زا هدﺎﻔﺘﺳا ﺎﺑ و ﻲﻔﻴﺻﻮﺗ
يرﺎﻣآ راﺰﻓا version 11.0)
Excel( ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣ .
ﻪﺘﻓﺎﻳ ﺎﻫ : ،نارﺎﻤﻴﺑ ﻲﻨﺳ ﻦﻴﮕﻧﺎﻴﻣ 90
/
±12 58 / 21 دﻮﺑ هﺎﻣ . 3 / 81 % ﺮﻳز ﻲﻨﺳ هوﺮﮔ رد نارﺎﻤﻴﺑ 3
ﺪﻧدﻮﺑ لﺎﺳ .
ﻦﻣﺰﻣ ﻪﻓﺮﺳ
ﺶﻴﺑ زا ﺮﺗ 3
ﻊﻳﺎﺷ ،ﻪﺘﻔﻫ رد ﻪﻛ دﻮﺑ ﺖﻣﻼﻋ ﻦﻳﺮﺗ 5
/ 73 %
ﺷاد دﻮﺟو دراﻮﻣ ﺖ
. ﺎـﺗ نﻮﻴـﺳاﺮﻴﭙﺳآ زا ﻲﻧﺎـﻣز ﻪﻠـﺻﺎﻓ ﻂـﺳﻮﺘﻣ
،نﺎﺘﺳرﺎﻤﻴﺑ ﻪﺑ ﻪﻌﺟاﺮﻣ 96
/ 8 71± / 24 ﺎﻬﻨﺗ ،دﻮﺑ زور 5
/ 24 % رد نارﺎﻤﻴﺑ زا 24
ﺪﻧدﻮﺑ هدﻮﻤﻧ ﻪﻌﺟاﺮﻣ لوا ﺖﻋﺎﺳ .
ﺮﻴﺧﺎﺗ ﻞﻠﻋ
ﺪﻧدﻮﺑ ﻚﺷﺰﭘ ﻂﺳﻮﺗ ﺢﻴﺤﺻ ﺺﻴﺨﺸﺗ مﺪﻋ و ﻦﻳﺪﻟاو ﻪﺟﻮﺗ مﺪﻋ ،ﺺﻴﺨﺸﺗ .
ﻪﺠﻴﺘﻧ يﺮﻴﮔ : ،نﺎﻛدﻮﻛ ﻲﻜﺷﺰﭘ ﺰﻛﺮﻣ رد 5
/ 75 % ﻣ نﺎﻛدﻮﻛ زا ﺪﻌﺑ ﻲﺟرﺎﺧ ﻢﺴﺟ نﻮﻴﺳاﺮﻴﭙﺳآ ﻪﺑ ﻼﺘﺒ 24
ﻪﻌﺟاﺮﻣ ﺖﻋﺎﺳ
ﻲﻣ
ﺶﻴﺑ ﻲﻠﻴﺧ ،ﻲﺼﻴﺨﺸﺗ ﺮﻴﺧﺄﺗ نﺎﻣز تﺪﻣ و ﺪﻨﻨﻛ
ﻲﻣ ﺰﻛاﺮﻣ ﺮﻳﺎﺳ ﻪﺑ طﻮﺑﺮﻣ تﺎﻌﻟﺎﻄﻣ زا ﺮﺗ
ﺪﺷﺎﺑ . و ﻦﻳﺪـﻟاو ﻲﻫﺎـﮔآ مﺪﻋ
ﻲﻣ نﺎﻜﺷﺰﭘ ﻲﻓﺎﻛ شزﻮﻣآ مﺪﻋ دﻮﺷ يﺪﺟ ضراﻮﻋ زوﺮﺑ و ﻲﻳاﻮﻫ هار ﻲﺟرﺎﺧ مﺎﺴﺟا ﺺﻴﺨﺸﺗ رد ﺮﻴﺧﺎﺗ ﻪﺑ ﺮﺠﻨﻣ ﺪﻧاﻮﺗ
.
هژاوﺪﻴﻠﻛ ﺎﻫ : –1 ﻲﺟرﺎﺧ ﻢﺴﺟ نﻮﻴﺳاﺮﻴﭙﺳآ
–2 ﻲﺋاﻮﻫ هار
–3 ﻲﺼﻴﺨﺸﺗ ﺮﻴﺧﺎﺗ
ﻪﺻﻼﺧ ﻪﻟﺎﻘﻣ ﻦﻳا ﻴﻬﺷ ﺮﺘﻛد ﻢﻧﺎﺧ ﻲﻳﺎﻤﻨﻫار ﻪﺑ ﻲﻣﻮﻤﻋ ﻲﻜﺷﺰﭘ ﻊﻄﻘﻣ رد ﻦﻳﺮﺑدﺎﺑ دوواد ﺮﺘﻛد يﺎﻗآ ﻪﻣﺎﻧ نﺎﻳﺎﭘ زا يا
ﻦ ﻲﻣ ﻢﻴﺨﻓ ﻲﻬﻟاﺪﺒﻋ ﺷﺎﺑ
ﺪ .
(I
ناﺮـﻳا ،ﺰـﻳﺮﺒﺗ ،ﺰﻳﺮﺒﺗ ﻲﻧﺎﻣرد ـ ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،نﺎﻛدﻮﻛ نﺎﺘﺳرﺎﻤﻴﺑ ،ندﺮﮔ و ﺮﺳ ﻲﺣاﺮﺟ و ﻲﻨﻴﺑ و ﻖﻠﺣ و شﻮﮔ ﺺﺼﺨﺘﻣ و رﺎﻳدﺎﺘﺳا
*) ﻒـﻟﺆﻣ
لوﺆﺴﻣ .(
(II
،ﻲﻣﻮﻤﻋ ﻲﺣاﺮﺟ رﺎﻴﺘﺳد ناﺮﻳا ،ﺰﻳﺮﺒﺗ ،ﺰﻳﺮﺒﺗ ﻲﻧﺎﻣرد ـ ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
.
(III رﺎﻴﺘﺳد ناﺮﻳا ،ﺰﻳﺮﺒﺗ ،ﺰﻳﺮﺒﺗ ﻲﻧﺎﻣرد ـ ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ندﺮﮔ و ﺮﺳ ﻲﺣاﺮﺟ و ﻲﻨﻴﺑ و ﻖﻠﺣ و شﻮﮔ .
ﺖـﺳا ﻦـﻜﻤﻣ ﻲﺟرﺎـﺧ ﻢﺴـﺟ نﻮﻴـﺳاﺮﻴﭙﺳآ ﻪـﻛ ﻲﻳﺎﺠﻧآ زا
يرﺎﻤﻴﺑ
ﻲﻣ ﻪﻟﺄﺴﻣ ﻦﻳا ،ﺪﻳﺎﻤﻧ ﺪﻴﻠﻘﺗ ار ﺮﮕﻳد يﺎﻫ
ﻪـﺑ ﺮـﺠﻨﻣ ﺪﻧاﻮﺗ
دﻮــﺷ نآ زا ﻲــﺷﺎﻧ ضراﻮــﻋ زوﺮــﺑ و ﺺﻴﺨﺸــﺗ مﺪــﻋ .
مﺪــﻋ
زا ﺢﻴﺤـﺻ ﻪـﭽﺨﻳرﺎﺗ ﻪﺋارا مﺪﻋ زا ﻲﺷﺎﻧ ﺖﺳا ﻦﻜﻤﻣ ﺺﻴﺨﺸﺗ ﻪــﺘﻓﺎﻳ ﺎــﻳ و ﻦﻳﺪــﻟاو فﺮــﻃ ﻢﻬﺒــﻣ ﻲــﺳﺎﻨﺷﻮﺗﺮﭘ و ﻲﻨﻴﻟﺎــﺑ يﺎــﻫ
ﺪﺷﺎﺑ
).
7
(
ﻜﻤﻣ ــ ﺳا ﻦ ــ
ﺘﺒﻣ نارﺎـﻤﻴﺑ ﺖ ـــ
لﻮـﻃ ﻲﺟرﺎـﺧ ﻢﺴـﺟ ﻪـﺑ ﻼ
ﻓﺎﺑ و بﺎــﻬﺘﻟا دﻮــﺟو ﺖــﻠﻋ ﻪــﺑ هﺪﻴﺸــﻛ ــــ
رد نﻮﻴــﺳﻻﻮﻧاﺮﮔ ﺖ
ﻴﺨﺸﺗ ﺎﺑ ،ﻲﻧﻻﻮﻃ تﺪﻣ ﻪﺑ ﻲﺟرﺎﺧ ﻢﺴﺟ فاﺮﻃا ــ
ﻲﻧﻮﻣﻮﻨﭘ ﺺ
ﺪﻧﻮــﺷ نﺎــﻣرد ﻢــﺳآ ﺎــﻳ و
).
8
و ﺺﻴﺨﺸــﺗ يدراﻮــﻣ ﻦﻴــﻨﭼ رد (
ﺪـﻫاﻮﺧ ﺮﺗراﻮـﺷد رﺎﻴﺴـﺑ ﻲﻳاﻮـﻫ هار ﻲﺟرﺎـﺧ مﺎﺴﺟا نﺎﻣرد
دﻮﺑ
).
9
(
د ﺨﺑ ر ـ ﻪـﻛ نﺎـﻛدﻮﻛ نﺎﺘـﺳرﺎﻤﻴﺑ ﻲـﻨﻴﺑ و ﻖـﻠﺣ و شﻮﮔ ﺶ
ﻘﻄﻨﻣ ﻲﻋﺎﺟرا ﺰﻛﺮﻣ ــ
ﻏ لﺎﻤـﺷ ﻪ ـــ
نارﺎـﻤﻴﺑ ياﺮـﺑ رﻮﺸـﻛ بﺮ
ﻲـﻣ ﻲﺟرﺎـﺧ مﺎﺴـﺟا ﻪﺑ ﻼﺘﺒﻣ ﺑ ،ﺪـﺷﺎﺑ
ـــ
ﻲـﻣ ﺮـﻈﻧ ﻪ ﻪـﻛ ﺪـﺳر
عﺎـﺟرا ﺮﻴﺧﺎـﺗ ﺎـﺑ ﻲﺟرﺎـﺧ ﻢﺴـﺟ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ زا يرﺎﻴﺴﺑ ﻲﻣ ﻪـﻌﺟاﺮﻣ ﻞﻠﻋ ﻪﻛ ﺖﺳا هﺪﺷ شﻼﺗ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد اﺬﻟ ،ﺪﻧﻮﺷ
ﻴﺑ سرﺮﻳد ﻲـﺳرﺮﺑ ﻲﻳاﻮـﻫ هار ﻲﺟرﺎـﺧ مﺎﺴﺟا ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤ
ﺪﻧﻮﺷ .
ﻲﺳرﺮﺑ شور
يور ﺮـﺑ و ﻲﻌﻄﻘﻣ ـ ﻲﻔﻴﺻﻮﺗ شور ﻪﺑ ﻪﻛ ﻪﻌﻟﺎﻄﻣ ﻦﻳا
155
تﺪـﻣ لﻮـﻃ رد ﻪﻛ رﺎﻤﻴﺑ 3
لﺎـﺳ ﻦﻳدروﺮـﻓ زا لﺎـﺳ 1380
ﺎـﺗ
لﺎــﺳ ﻦﻳدروﺮــﻓ 1383
ﻲــﻨﻴﺑ و ﻖــﻠﺣ و شﻮــﮔ ﺶــﺨﺑ رد ،
ﺖـــﺤﺗ و هﺪـــﺷ يﺮﺘﺴـــﺑ ،ﺰـــﻳﺮﺒﺗ نﺎـــﻛدﻮﻛ نﺎﺘـــﺳرﺎﻤﻴﺑ ﻲﭘﻮﻜﺳﻮﻜﻧوﺮﺑ
جرﺎﺧ و ﺪﻳﮋﻳر
ﻲﻳاﻮﻫ هار ﻲﺟرﺎﺧ ﻢﺴﺟ يزﺎﺳ
ﺖــﺳا هﺪــﺷ مﺎــﺠﻧا ،ﺪــﻧدﻮﺑ ﻪــﺘﻓﺮﮔ راﺮــﻗ .
ﺖــﺤﺗ نارﺎــﻤﻴﺑ ﻪــﻴﻠﻛ
ﺎـﺑ ﻲﺟرﺎـﺧ ﻢﺴﺟ يزﺎﺳ جرﺎﺧ و ﻲﻗﺎﺸﻨﺘﺳا ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ ﺪﻳﮋﻳر پﻮﻜﺴﻧوﺮﺑ Storz
ﺪﻨﺘﻓﺮﮔ راﺮﻗ .
ﻪﻧﺎﺸﻧ و ﻢﺋﻼﻋ ،نارﺎﻤﻴﺑ تﺎﺼﺨﺸﻣ
ﻢﺴـﺟ نﺪـﻳﺮﭘ ﻪﻘﺑﺎﺳ ،ﺎﻫ
ﻖﻠﺣ ﻪﺑ ﻲﺟرﺎﺧ )
chocking (
ﺎـﻣز ﻪﻠـﺻﺎﻓ ، ﻢـﺋﻼﻋ عوﺮـﺷ زا ﻲﻧ
ﻲﭘﻮﻜـﺳﻮﻜﻧوﺮﺑ ﺖـﻬﺟ يﺮﺘﺴﺑ نﺎﻣز ﺎﺗ ﻲﺴﻔﻨﺗ )
ﺮﻴﺧﺎـﺗ تﺪـﻣ (
،
ﻪـــﺘﻓﺎﻳ ،ﻪـــﻴﻟوا ﺺﻴﺨﺸـــﺗ ﺞﻳﺎـــﺘﻧ ،ﻪﻨﻴـــﺳ ﻲﻓاﺮﮔﻮـــﻳدار يﺎـــﻫ
راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣ ،ﺺﻴﺨﺸﺗ رد ﺮﻴﺧﺎﺗ ﻞﻠﻋ و ﻲﭘﻮﻜﺳﻮﻜﻧوﺮﺑ ﺪﻨﺘﻓﺮﮔ . زا ﺪﻌﺑ ﻲﭘﻮﻜﺳﻮﻜﻧوﺮﺑ و ﺺﻴﺨﺸﺗ 24
ﻪـﺑ لوا ﺖﻋﺎـﺳ
ﻲـﻣ ﻪـﺘﻓﺮﮔ ﺮﻈﻧ رد سرﺮﻳد ﺺﻴﺨﺸﺗ ،ناﻮﻨﻋ
دﻮـﺷ . هداد يﺎـﻫ ﻪﻠﻴـﺳﻮﺑ ﻪـﻌﻟﺎﻄﻣ زا هﺪـﻣآ ﺖﺳﺪﺑ
ﻲﻔﻴـﺻﻮﺗ يرﺎـﻣآ يﺎﻬـﺷور
)
ﻦﻴﮕﻧﺎﻴﻣ و ﺪﺻرد ـ ﻲﻧاواﺮﻓ
رﺎﻴﻌﻣ فاﺮﺤﻧا ± (
زا هدﺎﻔﺘﺳا ﺎﺑ و
مﺮﻧ
يرﺎـﻣآ راﺰـﻓا )
version 11.0 (
Excel راﺮـﻗ ﻲـﺳرﺮﺑ درﻮـﻣ
ﺪﻨﺘﻓﺮﮔ .
ﻪﺘﻓﺎﻳ ﺎﻫ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد 155
هاﺮـﻤﻫ ﻪـﻛ ﺪﻳﮋﻳر ﻲﭘﻮﻜﺳﻮﻜﻧوﺮﺑ درﻮﻣ
جرﺎـﺧ ﺎﺑ
ﺑ ﻲﺟرﺎـﺧ ﻢﺴـﺟ يزﺎـﺳ راﺮـﻗ ﻲـﺳرﺮﺑ درﻮـﻣ ﺪـﻧدﻮ
ﺪــﻨﺘﻓﺮﮔ . ،نارﺎــﻤﻴﺑ ﻲﻨــﺳ ﻦﻴﮕﻧﺎــﻴﻣ 90
/ 12 58± / 21 و دﻮــﺑ هﺎــﻣ
ﺎـﺗ هﺎـﻣ ﻚـﻳ ﻲﻨـﺳ هدوﺪـﺤﻣ رد نارﺎـﻤﻴﺑ 6
ﺪــﻧدﻮﺑ لﺎـﺳ .
126
رﺎﻤﻴﺑ ) 3 / 81 (%
ﺮﻳز ﻲﻨﺳ هوﺮﮔ رد 3
و لﺎﺳ 29
رﺎـﻤﻴﺑ ) 7 / 18 (%
زا ﺮﺗﻻﺎﺑ ﻲﻨﺳ هوﺮﮔ رد 3
ﺪﻧدﻮﺑ لﺎﺳ .
81 رﺎﻤﻴﺑ ) 2 / 52 (%
ﺮﺴـﭘ
و 74 رﺎﻤﻴﺑ ) 7 / 47 (%
ﻧدﻮﺑ ﺮﺘﺧد ﺪ
.
ﺶﻴﺑ ﻪﻛ ﻦﻣﺰﻣ ﻪﻓﺮﺳ
زا ﺮـﺗ 3 ،دﻮـﺑ هﺪﻴﺸـﻛ لﻮـﻃ ﻪـﺘﻔﻫ
ﻊﻳﺎﺷ
رد ﻪـﻛ دﻮـﺑ ﺖﻣﻼﻋ ﻦﻳﺮﺗ
114
رﺎـﻤﻴﺑ ) 5 / 73 (%
دﻮـﺟو
ﺖﺷاد .
ﻲﻧﺎـﻬﮔﺎﻧ عوﺮﺷ ﻞﻣﺎﺷ عﻮﻴﺷ ﺐﻴﺗﺮﺗ ﻪﺑ ﻢﻳﻼﻋ ﺮﻳﺎﺳ
رد ﻪﻓﺮــﺳ 108
رﺎــﻤﻴﺑ ) 7 / 69 (%
ﺲــﺧ ، رد ﻪﻨﻴــﺳ ﺲــﺧ 90
رﺎــﻤﻴﺑ ) 1 / 58 (%
رد ﻲﺴــﻔﻨﺗ سﺮﺘﺴــﻳد و 21
رﺎــﻤﻴﺑ ) 6 / 13 (%
دﻮﺑ . رد ﻂﻘﻓ 31
رﺎﻤﻴﺑ ) 9 / 21 (%
ﻢﺴﺟ نﺪﻳﺮﭘ ﺖﺒﺜﻣ ﻪﻘﺑﺎﺳ ﻦﻳﺪﻟاو ،
ﻮﻠﮔ ﻪﺑ ﻲﺟرﺎﺧ
ﺶﺳﺮﭘ ﺎﺑ ﻲﻟو ﺪﻧدﻮﺑ هدﺮﻛ ﺮﻛذ ار ﺶﻴﺑ يﺎﻫ
ﺮـﺗ
رد ﻦﻳﺪـﻟاو ﻪـﺑ ﺢﻴﺿﻮﺗ و 136
رﺎـﻤﻴﺑ ) 8 / 85 (%
عوﺮـﺷ ﻦﻳﺪـﻟاو ،
ﺲﺧ ﺎﻳ و ﻲﺴﻔﻨﺗ سﺮﺘﺴﻳد ،ﻪﻓﺮﺳ ﻲﻧﺎﻬﮔﺎﻧ
دﺎﻳ ﻪﺑ ار ﻪﻨﻴﺳ ﺲﺧ
ﺪﻧدروآ . ،ﻪـــﻌﺟاﺮﻣ نﺎـــﻣز ﻂـــﺳﻮﺘﻣ 96
/ 8 71± / 24 دﻮـــﺑ زور .
38
رﺎﻤﻴﺑ ) 5 / 24 (%
ﻲﻃ رد 24 و لوا ﺖﻋﺎﺳ 117
رﺎﻤﻴﺑ ) 5 / 75 (%
ﺲﭘ
زا 24
ﺪـﻧدﻮﺑ هدﻮﻤﻧ ﻪﻌﺟاﺮﻣ لوا ﺖﻋﺎﺳ .
58
رﺎـﻤﻴﺑ ) 4 / 37 (%
رد
،ﻪﺘﻔﻫ ﻚﻳ ﺎﺗ زور ﻚﻳ ﻪﻠﺻﺎﻓ 42
رﺎﻤﻴﺑ ) 1 / 37 (%
ﻚـﻳ ﻪﻠـﺻﺎﻓ رد
و هﺎﻣ ﻚﻳ ﺎﺗ ﻪﺘﻔﻫ 17
رﺎﻤﻴﺑ ) 9 / 10 (%
ﺶﻴﺑ ﺮﻴﺧﺎﺗ ﺎﺑ
هﺎﻣ ﻚﻳ زا ﺮﺗ
ﺪﻧدﻮﺑ هدﻮﻤﻧ ﻪﻌﺟاﺮﻣ
) هرﺎﻤﺷ رادﻮﻤﻧ 1
.(
38
58
42
17
0 10 20 30 40 50 60 70
لوا ﺖﻋﺎﺳ24
ﻪﺘﻔﻫ ﻚﻳ ﺎﺗ زور ﻚﻳ
هﺎﻣ ﻚﻳ ﺎﺗ ﻪﺘﻔﻫ ﻚﻳ
هﺎﻣﻚﻳ زا ﺮﺘﺸﻴﺑ
نارﺎﻤﻴﺑ ﻪﻌﺟاﺮﻣ نﺎﻣز-1 هرﺎﻤﺷ رادﻮﻤﻧ
زا 38 رد ﻪﻛ يرﺎﻤﻴﺑ 24
،ﺪـﻧدﻮﺑ هدﻮﻤﻧ ﻪﻌﺟاﺮﻣ لوا ﺖﻋﺎﺳ
20 رﺎﻤﻴﺑ ) 9 / 12 (%
و ﻚﺷﺰﭘ عﺎﺟرا ﻖﻳﺮﻃ زا 18
رﺎـﻤﻴﺑ ) 6 / 11 (%
ﺪﻧدﻮﺑ هدﻮﻤﻧ ﻪﻌﺟاﺮﻣ ﻚﺷﺰﭘ ﻪﺑ ﻲﻠﺒﻗ ﻪﻌﺟاﺮﻣ نوﺪﺑ و ًﺎﻤﻴﻘﺘﺴﻣ
ﻤﻫ رد دﺎﺣ ﻲﺴﻔﻨﺗ سﺮﺘﺴﻳد ﻪﻛ ﻦﻳا ﻪ
18
ﺖـﺷاد دﻮـﺟو رﺎﻤﻴﺑ .
68 رﺎﻤﻴﺑ ) 8 / 43 (%
رد 24 ﺪﻨﺘﺷاد ﻚﺷﺰﭘ ﻪﺑ ﻪﻌﺟاﺮﻣ لوا ﺖﻋﺎﺳ
رد ﺎﻬﻨﺗ ﻪﻛ 20
رﺎﻤﻴﺑ ) 9 / 12 (%
ﻴﺨﺸﺗ ـ ـﻴﺤﺻ ﺺ ـ
هﺪـﺷ حﺮـﻄﻣ ﺢ
دﻮﺑ .
نﺎﻴﻣ رد 117
ﻤﻴﺑ ــ ﻛ يرﺎ ــ ﭘ ﻪ ــ زا ﺲ 24 ﻪﻌﺟاﺮﻣ لوا ﺖﻋﺎﺳ
ـﻧدﻮﺑ هدﻮﻤﻧ ـ
رد ،ﺪ 69
رﺎـﻤﻴﺑ ) 59 (%
مﺪـﻋ و ﻦﻳﺪـﻟاو ﻪـﺟﻮﺗ مﺪـﻋ
ﺰﭘ ﻪﺑ ﻪﻌﺟاﺮﻣ ﻢﻬﻣ ،ﻚﺷ
رد و دﻮﺑ ﻊﻗﻮﻤﺑ ﻪﻌﺟاﺮﻣ مﺪﻋ ﻞﻣﺎﻋ ﻦﻳﺮﺗ
48
هﺪﻧﺎﻤﻴﻗﺎﺑ رﺎﻤﻴﺑ )
41 (%
ﻲﻠﻋ ، رد ﻚـﺷﺰﭘ ﻪـﺑ ﻪـﻌﺟاﺮﻣ ﻢـﻏر 24
ﻴﺤﺻ ﺺﻴﺨﺸﺗ ،لوا ﺖﻋﺎﺳ ــ
دﻮﺑ هﺪﺸﻧ حﺮﻄﻣ ﺢ .
رد ﻞﻛ رد 88
رﺎﻤﻴﺑ ) 7 / 56 (%
ﻢﺴـﺟ ﻚـﺷﺰﭘ ﻪـﺑ ﻪـﻌﺟاﺮﻣ رد
دﻮـــﺑ هﺪﺸـــﻧ هداد ﺺﻴﺨﺸـــﺗ ﻲﻳاﻮـــﻫ هار ﻲﺟرﺎـــﺧ .
رد 45
رﺎﻤﻴﺑ ) 1 / 29 (%
ﻪﻌﺟاﺮﻣ رﺎﺒﻜﻳ رد ،ﻚـﺷﺰﭘ ﻪﺑ
24
رﺎـﻤﻴﺑ ) 4 / 15 (%
رد ،ﻚـﺷﺰﭘ ﻪـﺑ ﻪـﻌﺟاﺮﻣ ﻪﺒﺗﺮﻣ ود 14
رﺎـﻤﻴﺑ ) 9 (%
ﻪـﺒﺗﺮﻣ ﻪـﺳ
رد و ﻚﺷﺰﭘ ﻪﺑ ﻪﻌﺟاﺮﻣ 5
رﺎﻤﻴﺑ ) 2 / 3 (%
ﻪﺑ ﻪﻌﺟاﺮﻣ ﻪﺒﺗﺮﻣ رﺎﻬﭼ
ﺪــﻳدﺮﮔ ﺮــﻛذ ﺢﻴﺤــﺻ ﺺﻴﺨﺸــﺗ نوﺪــﺑ ﻚــﺷﺰﭘ .
ﻞــﻛ رد 137
رﺎﻤﻴﺑ ) 4 / 88 (%
ﻪـﺒﺗﺮﻣ ﻦﻴـﻟوا رد ﻪـﻛ ﺪﻨﺘﺷاد ﻚﺷﺰﭘ ﻪﺑ ﻪﻌﺟاﺮﻣ
رد ﻂﻘﻓ ،ﻪﻌﺟاﺮﻣ 41
رﺎـﻤﻴﺑ ) 4 / 26 (%
حﺮـﻄﻣ ﺢﻴﺤـﺻ ﺺﻴﺨﺸـﺗ
دﻮﺑ هﺪﺷ هداد .
رد 84 ــﻤﻴﺑ ـ رﺎ ) 2 / 54 (%
ــﻧﻮﻣﻮﻨﭘ ـ رد و ﻲ 22 رﺎــﻤﻴﺑ ) 2 / 14 (%
ﻴﺨﺸﺗ ناﻮﻨﻋ ﻪﺑ ﻢﺳا ــ
ﻴﻟوا ﺺ ـــ
ـﺷ حﺮـﻄﻣ ﻪ ـ
ﺑ هﺪ ـــ دﻮ
) رادﻮـﻤﻧ
هرﺎﻤﺷ 2
.(
41
84
22
0 20 40 60 80 100
نﻮﻴﺳاﺮﻴﭙﺳآ ﻲﻧﻮﻣﻮﻨﭘ ﻢﺳآ
هرﺎﻤﺷ رادﻮﻤﻧ 2
-
ﺺﻴﺨﺸﺗ ﻪﻌﺟاﺮﻣ ﻦﻴﻟوا رد نﺎﻜﺷﺰﭘ ﻪﻴﻟوا يﺎﻫ
ﻴﺳاﺮﻴﭙﺳآ رﺎﭼد نارﺎﻤﻴﺑ ﻲﺟرﺎﺧ ﻢﺴﺟ نﻮ
رد ﻲﻧﻮـــﻣﻮﻨﭘ ،ﻪﻨﻴـــﺳ ﻪﺴـــﻔﻗ ﻲـــﻓاﺮﮔ ﻲـــﺳرﺮﺑ رد 75
رﺎـــﻤﻴﺑ ) 4 / 48 (%
رد ﻪـــﻓﺮﻄﻜﻳ مﺰـــﻴﻔﻣآ و 49
رﺎـــﻤﻴﺑ ) 6 / 31 (%
،
ﻊﻳﺎﺷ ﻪﺘﻓﺎﻳ ﻦﻳﺮﺗ ﺪﻧدﻮﺑ ﺎﻫ
. رد يزﺎﺘﻜﻠﺗآ 26
رﺎﻤﻴﺑ ) 8 / 16 (%
ﺖﻳور
زا ﺪـﻌﺑ سرﺮﻳد ﻪﻌﺟاﺮﻣ نارﺎﻤﻴﺑ ﻦﻳا ﻲﮕﻤﻫ ﻪﻛ ﺪﺷ 24
ﺖﻋﺎـﺳ
ﺪﻨﺘﺷاد . رد ﻂﻘﻓ كﺎﭘا ﻞﻜﺷ ﻪﺑ ﻲﺟرﺎﺧ ﻢﺴﺟ 22
رﺎﻤﻴﺑ ) 2 / 14 (%
دﻮـﺑ ﺖـﻳور ﻞﺑﺎﻗ .
ﺎـﺑ ﺖـﺳار ﺶﻧوﺮـﺑ ،ﻲﭘﻮﻜـﺳﻮﻜﻧوﺮﺑ رد 85
درﻮــﻣ ) 8 / 54 (%
هار ﻲﺟرﺎــﺧ ﻢﺴــﺟ دﻮــﺟو ﻞــﺤﻣ ﻦﻳﺮﺘﻌﻳﺎــﺷ ،
ﺎـﺑ ﭗـﭼ ﺶﻧوﺮـﺑ نآ زا ﺲـﭘ و دﻮﺑ ﻲﻳاﻮﻫ 61
درﻮـﻣ ) 3 / 39 (%
،
ﺎﺑ ﻪﺷاﺮﺗ 7
درﻮﻣ ) 5 / 4 (%
ﺎﺑ تﻮﻠﮔاﺮﭘﻮﺳ و 2
درﻮﻣ ) 3 / 1 (%
ﺮﻳﺎﺳ
ﻲﻣ ﻞﻴﻜﺸﺗ ار دراﻮﻣ ﺪﻧداد
.
رد ﻪﻛ يرﻮﻄﻧﺎﻤﻫ هرﺎﻤﺷ رادﻮﻤﻧ
3
ﻊﻳﺎـﺷ ،ﺖﺳا هﺪﻣآ
ﻦﻳﺮـﺗ
ﻞﻴﺟآ و ﻪﻤﺨﺗ عاﻮﻧا و تﺎﺑﻮﺒﺣ ﻪﻧاد ،هﺪﻣآ ﺖﺳﺪﺑ ﻲﺟرﺎﺧ ﻢﺴﺟ ﺪﻧدﻮﺑ .
48
40
12
0 10 20 30 40 50 60
( تﺎﺑﻮﺒﺣ) ﻲﻫﺎﻴﮔ يﺎﻫ ﻪﻧاد ﻞﻴﺟآ و ﻪﻤﺨﺗ ﻲﻜﻴﺘﺳﻼﭘ و يﺰﻠﻓ مﺎﺴﺟا
هرﺎﻤﺷ رادﻮﻤﻧ 3
-
ﻲﭘﻮﻜﺳﻮﻜﻧوﺮﺑ زا هﺪﻣآ ﺖﺳﺪﺑ ﻲﺟرﺎﺧ مﺎﺴﺟا عاﻮﻧا نارﺎﻤﻴﺑ
ﺚﺤﺑ ﺎﻬﻨﺗ ﺮﺿﺎﺣ ﻲﺳرﺮﺑ رد 5
/ 24 % رد نارﺎـﻤﻴﺑ 24
لوا ﺖﻋﺎـﺳ
ﻪﻌﺟاﺮﻣ
ﻲﺼـﻴﺨﺸﺗ ﺮﻴﺧﺎـﺗ نﺎـﻣز تﺪـﻣ و ﺪﻨﺘﺷاد )
7 / 24 زور (
ﺶﻴﺑ ﻲﻠﻴﺧ
ﻲﻣ ﺰﻛاﺮﻣ ﺮﻳﺎﺳ ﻪﺑ طﻮﺑﺮﻣ تﺎﻌﻟﺎﻄﻣ زا ﺮﺗ
ﺪـﺷﺎﺑ . رد
ﻲﺳرﺮﺑ رﻮﺸﻛ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﻪﻌﺟاﺮﻣ نﺎﻣز ﻂﺳﻮﺘﻣ ،ﻒﻠﺘﺨﻣ يﺎﻫ
ﺖـــﺳا توﺎـــﻔﺘﻣ ،ﮓـــﻨﻫﺮﻓ ﺢﻄـــﺳ و .
ﻖـــﻴﻘﺤﺗ رد Schmidt
و
،ﺶﻧارﺎﻜﻤﻫ 42
% رد نارﺎـﻤﻴﺑ 24
هدﻮـﻤﻧ ﻪـﻌﺟاﺮﻣ لوا ﺖﻋﺎـﺳ
ز ﻂﺳﻮﺘﻣ و ﺪﻧدﻮﺑ ،ﻪﻌﺟاﺮﻣ نﺎﻣ
4 / 5
دﻮـﺑ زور
).
10
د (
ﻲـﻘﻴﻘﺤﺗ ر
ﻂــﺳﻮﺗ نﺎﺘﺴــﺑﺮﻋ رد ﻪــﻛ Khalid
هﺪــﺷ مﺎــﺠﻧا ﺶﻧارﺎــﻜﻤﻫ و
،ﺖﺳا 30 % رد نارﺎﻤﻴﺑ 24
ﺪﻧدﻮﺑ هدﺮﻛ ﻪﻌﺟاﺮﻣ لوا ﺖﻋﺎﺳ
).
11 (
ﻪﻌﻟﺎﻄﻣ رد ،chiu
43 % رد نارﺎﻤﻴﺑ زا 24
ﺺﻴﺨﺸـﺗ لوا ﺖﻋﺎﺳ
ﺺﻴﺨﺸﺗ رد ﺮﻴﺧﺎﺗ ﻂﺳﻮﺘﻣ و ﺪﻧﺪﺷ هداد 4
/ 10 دﻮﺑ زور
).
12
(
آ ﺺﻴﺨﺸﺗ ﺎـﺑ ﻪـﻛ ﻲﻧارﺎـﻤﻴﺑ رد ﻲﺟرﺎﺧ ﻢﺴﺟ نﻮﻴﺳاﺮﻴﭙﺳ
ﻲﻣ ﻪﻌﺟاﺮﻣ ﺮﻴﺧﺎﺗ
ﺬـﺧا ﺪـﻨﻣزﺎﻴﻧ ﻪـﻛ ﺖـﺳا راﻮـﺷد يﺮﻣا ،ﺪﻨﻨﻛ
ﺖـﺳا يﻮﻗ ﻲﻨﻴﻟﺎﺑ ﻚﺷ و ﻦﻳﺪﻟاو زا ﻖﻴﻗد ﻪﭽﺨﻳرﺎﺗ
).
9
نﺎـﻛدﻮﻛ (
ﻦﻳﺪﻟاو ﻂﺳﻮﺗ نﻮﻴﺳاﺮﻴﭙﺳآ ﻪﭽﺨﻳرﺎﺗ ﻪﺋارا مﺪﻋ ﺎﺑ ﺖﺳا ﻦﻜﻤﻣ ﺪــﻨﻨﻛ ﻪــﻌﺟاﺮﻣ ﻲﺻﺎﺼــﺘﺧاﺮﻴﻏ ﻢــﻳﻼﻋ ﺎــﻳ و
).
15 - 13
دراﻮــﻣ رد (
ﻮﺗ كﻮﻜﺸﻣ
ﻢـﻬﻣ زا ﻲـﻜﻳ رﺎـﻤﻴﺑ ﻦـﺳ ﻪـﺑ ﻪـﺟ
ﺎـﻫرﻮﺘﻛﺎﻓ ﻦﻳﺮـﺗ
ﻲﻣ بﻮﺴﺤﻣ
ﺮـﻳز ﻲﻨﺳ هوﺮﮔ رد نارﺎﻤﻴﺑ ﺮﺜﻛا ﻪﻛ اﺮﭼ ،دﻮﺷ 3
ﺪﻧراد راﺮﻗ لﺎﺳ
).
5 و 16
هوﺮـﮔ ندﻮـﺑ ﺐـﻟﺎﻏ ﺮـﺿﺎﺣ ﻲﺳرﺮﺑ رد (
ﺮﻳز ﻲﻨﺳ 3
دﻮـﺑ دﻮﻬﺸـﻣ لﺎﺳ )
3 / 81 .(%
ﻊﻳﺎـﺷ و ﻢـﻳﻼﻋ ﻦﻳﺮـﺗ
ﻪﻧﺎﺸﻧ نﺪـﻳﺮﭘ ،ﻪﻓﺮـﺳ ﻞﻣﺎـﺷ ﻲﺟرﺎﺧ ﻢﺴﺟ نﻮﻴﺳاﺮﻴﭙﺳآ يﺎﻫ
ﮔ ﻪﺑ ﻲﺟرﺎﺧ ﻢﺴﺟ
ﺲـﺧ ،ﻮـﻠ
يﺎﻫاﺪـﺻ ﺶﻫﺎـﻛ و ﻪﻨﻴـﺳ ﺲـﺧ
ﻲﻣ ﻲﺴﻔﻨﺗ
نﺪـﻳﺮﭘ هﺪﻫﺎﺸـﻣ ،درﻮـﻣ ﻦﻳﺮﺗدﺎﻤﺘﻋا ﻞﺑﺎﻗ ﻪﻛ ﺪﻨﺷﺎﺑ
ﺖـﺳا ﺮﮕﻳد داﺮﻓا ﺎﻳ ﻦﻳﺪﻟاو ﻂﺳﻮﺗ ﻮﻠﮔ ﻪﺑ ﻲﺟرﺎﺧ ﻢﺴﺟ
).
17 و 18 (
ﻪﻧاد و تﺎﺑﻮﺒﺣ هﮋﻳﻮﺑ هﺪﻴﺸﻛ لﻮﻃ ﻲﺟرﺎﺧ مﺎﺴﺟا
ﻲﻨﻏور يﺎﻫ
ﻲــﻣ دراﻮــﻣ ﻦــﻳا رد ﻪــﻛ ﺪﻧﻮــﺷ ﺪﻳﺪــﺷ بﺎــﻬﺘﻟا ﺐــﺟﻮﻣ ﺪــﻨﻧاﻮﺗ
د ﻪﺑ موﺎﻘﻣ ﻲﻧﻮﻣﻮﻨﭘ ﺮـﺑ ﻦﻣﺰـﻣ ﻪﻓﺮـﺳ ﺰﻴﻧ و ﻪﻌﺟار ﺎﻳ و نﺎﻣر
ﺪﺷ ﺪﻫاﻮﺧ هدوﺰﻓا يرﺎﻤﻴﺑ يﻮﻠﺑﺎﺗ
).
5 و 15
ناواﺮـﻓ ﻪـﺑ ﻪـﺟﻮﺗ ﺎـﺑ (
ﻲﻓاﺮﮔ رد بذﺎﻛ ﻲﻔﻨﻣ ﺞﻳﺎﺘﻧ ندﻮﺑ ﻲﻤﻧ ،ﻪﻨﻴﺳ ﻪﺴﻔﻗ يﺎﻫ
ﺮﺑ ناﻮﺗ
در ار ﻲﻳاﻮﻫ هار ﻲﺟرﺎﺧ ﻢﺴﺟ ،ﻲﻌﻴﺒﻃ ﻪﻨﻴﺳ ﻪﺴﻔﻗ ﻲﻓاﺮﮔ ﻪﻳﺎﭘ دﺮﻛ
).
5
رد ﻂـﻘﻓ ﻲﺟرﺎـﺧ ﻢﺴـﺟ ﺰﻴﻧ ﺮﺿﺎﺣ ﻲﺳرﺮﺑ رد (
2 / 14 %
دراﻮﻣ
دﻮﺑ ﺖﻳور ﻞﺑﺎﻗ ﻪﻨﻴﺳ ﻪﺴﻔﻗ ﻲﻓاﺮﮔ رد .
Hyperinflation
ﺖﻠﻋ ﻪﺑ air trapping ﻪﺼﺨﺸﻣ ﺖﻣﻼﻋ ﻲﺟرﺎﺧ ﻢﺴﺟ زا ﻲﺷﺎﻧ
ﻲﻣ ﻪﻛ ﺖﺳا ﻪﻳر رد ﻲﺟرﺎﺧ ﻢﺴﺟ دﻮﺟو ﻢﻴﻘﺘﺴﻣﺮﻴﻏ ﻢـﻫ ﺪﻧاﻮﺗ
دﻮــﺷ ﺖــﻳور ﻦﻣﺰــﻣ دراﻮــﻣ رد ﻢــﻫ و دﺎــﺣ دراﻮــﻣ رد
).
1
رد (
ﺎﺑ ﻲﻧﻮﻣﻮﻨﭘ ﺮﺿﺎﺣ ﻲﺳرﺮﺑ
4 / 48 % و Hyperinflation ﺖﻠﻋ ﻪﺑ
air trapping ﻲﺟرﺎــﺧ ﻢﺴــﺟ زا ﻲــﺷﺎﻧ
) ﻪــﻓﺮﻄﻜﻳ مﺰــﻴﻔﻣآ (
ﺎــﺑ
6 / 31
% ﻊﻳﺎﺷ ، ﺪﻧدﻮﺑ ﻲﺳﺎﻨﺷﻮﺗﺮﭘ ﻢﻳﻼﻋ ﻦﻳﺮﺗ .
Tokar ار يﺮﻴﺧﺎـﺗ ﻲﻧﻮﻣﻮﻨﭘ زوﺮﺑ ناﺰﻴﻣ ﺶﻧارﺎﻜﻤﻫ و 37
%
هدﺮﻛ ﺮﻛذ
ﺪﻧا
).
9
Sersar(
ار ناﺰﻴﻣ ﻦﻳا ﺶﻧارﺎﻜﻤﻫ و 6
/ 27 % نﺎﻴﺑ
هدﺮـﻛ ﺪــﻧا
).
2
ﻦـﻳا ﺮــﺿﺎﺣ ﻲـﺳرﺮﺑ رد (
ناﺰــﻴﻣ 4 / 48 % ﻪــﻛ دﻮـﺑ
ﺶﻴﺑ زا ﺮﺗ
ﺖﺳا قﻮﻓ ﺞﻳﺎﺘﻧ .
دراﻮـﻣ رد يزﺎـﺘﻜﻠﺗآ عﻮﻴـﺷ ناﺰﻴﻣ
زا يﺮﻴﺧﺎﺗ 25
% ﺎﺗ 7 / 32 %
ﺖﺳا هﺪﻳدﺮﮔ ﺮﻛذ
).
2 و 9
ﻲـﺳرﺮﺑ رد (
رد يزﺎـﺘﻜﻠﺗآ ﺮﺿﺎﺣ 21
% ﺖـﻳور سرﺮـﻳد ﻪـﻌﺟاﺮﻣ دراﻮـﻣ زا
دﻮﺑ هﺪﺷ .
رد ﺮﻴﺧﺎــﺗ ﻞــﻠﻋ ﻲــﺳرﺮﺑ رد 117
ﻪــﻌﺟاﺮﻣ ﻪــﻛ يرﺎــﻤﻴﺑ
رد ﻦﻳﺪــﻟاو ﻪــﺟﻮﺗ مﺪــﻋ ،ﺪﻨﺘــﺷاد سرﺮــﻳد 9
/ 58 % مﺪــﻋ و
ﺤﺻ ﺺﻴﺨﺸﺗ
رد ﻚﺷﺰﭘ ﺢﻴ
1 / 41 %
ﺮﻴﺧﺎـﺗ ﻪﺑ ﺮﺠﻨﻣ دراﻮﻣ
دﻮﺑ هﺪﺷ ﺺﻴﺨﺸﺗ رد .
ﻚـﺷﺰﭘ ﻪـﺑ نارﺎـﻤﻴﺑ تﺎـﻌﺟاﺮﻣ رد
رد ﺎــﻬﻨﺗ 4
/ 26 % ،ﻚــﺷﺰﭘ ﻪــﺑ ﻪــﻌﺟاﺮﻣ ﻪــﺒﺗﺮﻣ ﻦﻴــﻟوا رد
رد و دﻮـــــﺑ هﺪـــــﺷ هداد ﺢﻴﺤـــــﺻ ﺺﻴﺨﺸـــــﺗ 6
/ 73
% ،
ﺺﻴﺨﺸﺗ ﺪﻧدﻮﺑ هﺪﺷ حﺮﻄﻣ ﺮﮕﻳد يﺎﻫ
.
راﺮﻗ ﻪﻨﻳﺎﻌﻣ درﻮﻣ ار نارﺎﻤﻴﺑ ﻪﻛ ﻲﻧﺎﻜﺷﺰﭘ ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد د سﺎـﺳاﺮﺑ و دﻮـﺑ هﺪﺸـﻧ راﺮـﻗﺮﺑ ﻢﻴﻘﺘﺴـﻣ ﻲﻃﺎﺒﺗرا ،ﺪﻧدﻮﺑ هدا
ﻪﺨﺴﻧ هﺪﻫﺎﺸﻣ
زا هﺪـﺷ ﺬـﺧا لﺎـﺣ حﺮـﺷ و رﺎﻤﻴﺑ كراﺪﻣ و ﺎﻫ
ﺪــﺷ هدﺮــﺑ ﻲــﭘ ﻚــﺷﺰﭘ ﺺﻴﺨﺸــﺗ ﻪــﺑ رﺎــﻤﻴﺑ ﻦﻳﺪــﻟاو .
زا
ﺖﻳدوﺪﺤﻣ
ﻲﺳﺮﺘﺳد مﺪﻋ و نارﺎﻤﻴﺑ داﺪﻌﺗ ندﻮﺑ ﻢﻛ ،ﺮﮕﻳد يﺎﻫ
ﺖـﺒﺛ مﺪـﻋ ﺖـﻠﻋ ﻪـﺑ ﺮﻴﻣ و گﺮﻣ دراﻮﻣ ﻪﺑ طﻮﺑﺮﻣ تﺎﻋﻼﻃا ﻪﺑ ﻞﻠﻋ ﺢﻴﺤﺻ ﻲﻣ گﺮﻣ
ﺪﺷﺎﺑ .
ﻪﺠﻴﺘﻧ يﺮﻴﮔ
فﺮـﻃ زا ﺢﻴﺤـﺻ ﺺﻴﺨﺸـﺗ مﺪﻋ ﺰﻴﻧ و ﻦﻳﺪﻟاو ﻲﻫﺎﮔآ مﺪﻋ ﻢﺴــﺟ نﻮﻴــﺳاﺮﻴﭙﺳآ سرﺮــﻳد ﺺﻴﺨﺸــﺗ ﻪــﺑ ﺮــﺠﻨﻣ نﺎﻜــﺷﺰﭘ هار ﻲﺟرﺎﺧ
ﻲﻣ ﻲﻳاﻮﻫ دﻮﺷ
. زا ﺖﺳردﺎﻧ ﺺﻴﺨﺸﺗ يﻻﺎﺑ ﺪﺻرد
و نﺎﻜﺷﺰﭘ فﺮﻃ ﻢﺴـﺟ نﻮﻴـﺳاﺮﻴﭙﺳآ ﻢـﻳﻼﻋ ﻪـﺑ ﺖـﻗد مﺪـﻋ
ﺘﺣا ﻦﺘﻓﺮــﮕﻧ ﺮــﻈﻧ رد ﺰــﻴﻧ و دﺎــﺣ ﻞــﺣاﺮﻣ رد ﻲﺟرﺎــﺧ لﺎــﻤ
ﻢﺴﺟ نﻮﻴﺳاﺮﻴﭙﺳآ ﺎﺧ
ﻲﻧﻮﻣﻮﻨﭘ دراﻮﻣ رد ﻲﺟر
و موﺎـﻘﻣ يﺎـﻫ
زا ﺶﻴـﺑ ﻪـﻴﻜﺗ ﻦﻴـﻨﭽﻤﻫ و نﺎﻣرد ﻪﺑ موﺎﻘﻣ ﻢﺳآ ﺎﻳ و ﻪﻌﺟار ﺎﻳ ﻪﺑ ﺪﺣ ﻮﻳدار ﻲﻓاﺮﮔ ﻪﺴﻔﻗ نﻮﻴـﺳاﺮﻴﭙﺳآ ﺺﻴﺨﺸـﺗ ياﺮـﺑ ﻪﻨﻴﺳ
ﺶﻴـﺑ شزﻮـﻣآ تروﺮـﺿ ،نﺎﻜـﺷﺰﭘ ﻂـﺳﻮﺗ ﻲﺟرﺎﺧ ﻢﺴﺟ
ﺮـﺗ
ﺶﻴﺑ ار ﻲﻳاﻮﻫ هار ﻲﺟرﺎﺧ مﺎﺴﺟا ﻪﻨﻴﻣز رد ﻲﻜﺷﺰﭘ ﻪﻌﻣﺎﺟ
ﺮﺗ
حﺮﻄﻣ ﻲﻣ ﺪﻨﻛ .
ﺮﻜﺸﺗ و ﺮﻳﺪﻘﺗ
ار دﻮـﺧ ﺮﻜﺸﺗ و ﺮﻳﺪﻘﺗ ﺐﺗاﺮﻣ ،ﻪﻟﺎﻘﻣ نﺎﮔﺪﻨﺴﻳﻮﻧ ﻪﻠﻴﺳﻮﻨﻳﺪﺑ ﻲـﻨﻴﺑ و ﻖـﻠﺣ و شﻮﮔ ﺶﺨﺑ يرﺎﺘﺳﺮﭘ و ﻲﻜﺷﺰﭘ ردﺎﻛ ﻪﻴﻠﻛ زا ﻲﻣ زاﺮﺑا نﺎﻛدﻮﻛ نﺎﺘﺳرﺎﻤﻴﺑ ﻞﻤﻋ قﺎﺗا و ﺪﻧراد
.
ﻊﺑﺎﻨﻣ ﺖﺳﺮﻬﻓ
1- Johnson DG, Condon VR. Foreign bodies in pediatric patients. Curr Probl Surg 1998; 35: 273-9.
2- Sersar S, Rizk WH, Bilal M, EIDiasty MM, Eltantawy TA, Abdelhakam BB< et al. Inhaled foreign bodies:
presentation, management and value of history and plain chest radiography in delayed presentation. Otolaryngol Head Neck Surg 2006; 134: 92-9.
3- Mittleman RE. Fatal choking in infants and children.
Am J Forensic Med Pathol 1984; 5: 201-10.
4- Black RE, Johnson DG, Matlak ME. Bronchoscopic removal of aspiration foreign bodies in children. J Pediatr Surg 1994; 29: 682-4.
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Study of the Causes of Delayed Diagnosis in Patients with Foreign Body Aspiration
I II III
*Sh. Abdollahi Fakhim, MD D. Badbarin, MD A.Goljanian Tabrizi, MD
Abstract
Background & Aim:Foreign body aspiration commonly involves very young children and taking a precise history and doing a careful physical examination can lead to diagnosis. If the extraction of the object is delayed beyond 24 hours, it will lead to complications such as pneumonia, abscess, and atelectasis. Therefore, the present study tries to investigate the duration and reasons of delayed diagnosis of airway foreign body aspiration in children admitted to pediatric Hospital in Tabriz.
Patients and Method: This cross-sectional descriptive study was done over a period of 36 months, from 2001 to 2004, in the ENT Department of Children’s Hospital in Tabriz. 155 cases who had been admitted for foreign body aspiration and had undergone successful bronchoscopic removal were studied. The information such as the history of choking, the gap between initiation of symptoms and admission (duration of delayed diagnosis), outpatient visits, the first diagnosis, and the results of bronchoscopy was all recorded in the checklists. To analyze the data, descriptive statistics, and Excell 11.0 were used.
Results: The mean age of the patients was 21.58 (±12.90) months. 81.3% were under 3 years of age and 18.7% were above 3. Protracted cough lasting beyond 3 weeks was the most common symptom found in 73.5%
of the cases. The average interval between aspiration and admission was 24.71 (± 8.96) days. Only 24.5%
arrived in the first 24 hours. The main causes of delayed diagnosis were lack of notice on the part of parents and incorrect diagnoses made by physicians.
Conclusion: 75.5% of the cases with foreign body aspiration were referred after 24 hours and the duration of delayed diagnosis in the present study was longer than that mentioned in the reports of other centers. Parents' unawareness and physicians' insufficient training can delay the diagnosis of airway foreign body aspiration and cause serious complications. Thus, providing proper education is necessary to prevent them.
Key Words: 1) Foreign Body Aspiration 2)Airway 3)Delayed Diagnosis
This article is an abstract of Mr.Badbarin's thesis advised by Dr.Abdollahi Fakhim in partial fulfillment of a medical doctor's degree.
I) Assistant Professor of Otolaryngology. ENT Department. Pediatric Hospital. Tabriz University of Medical Sciences and Health Services.
Tabriz, Iran. (* Corresponding Author)
II) Resident of General Surgery. Tabriz University of Medical Sciences and Health Services. Tabriz, Iran.
III)Resident of ENT. Tabriz University of Medical Sciences and Health Services. Tabriz, Iran.
