Tehran University Medical Journal (TUMJ), Vol.69, No.7, October 2011

‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬ ‫دوره ‪69‬‬

‫ﺷﻤﺎره ‪7‬‬

‫ﻣﻬﺮ ‪1390‬‬

‫ﺻﺎﺣﺐ اﻣﺘﻴﺎز‪ :‬داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬ ‫ﻣﺪﻳﺮ ﻣﺴﺆول‪ :‬دﻛﺘﺮ ﺳﻴﺪ ﺣﺴﻦ اﻣﺎﻣﻲرﺿﻮي‬ ‫ﺳﺮدﺑﻴﺮ‪ :‬دﻛﺘﺮ ﻧﺎدره ﺑﻬﺘﺎش‬ ‫ﻣﺪﻳﺮ اﺟﺮاﻳﻲ‪ :‬دﻛﺘﺮ ﻣﺤﻤﺪ ﻋﻠﻲ ﻧﻮﻳﺎن اﺷﺮف‬ ‫ﺷﻮراي دﺑﻴﺮان‬

‫دﻛﺘﺮ ﺷﺎﻫﻴﻦ آﺧﻮﻧﺪزاده‪ ،‬دﻛﺘﺮ ﺻﺪﻳﻘﻪ ﺑﺮﻧﺎ‪ ،‬دﻛﺘﺮ ﺟﻤﺸﻴﺪ ﺣﺎﺟﺘﻲ‪ ،‬دﻛﺘﺮ ﻧﻴﻤﺎ رﺿﺎﻳﻲ‪ ،‬دﻛﺘﺮ ﻧﮕﺎر ﺳﺠﺎدﻳﺎن‪ ،‬دﻛﺘﺮ ﻋﻠﻲ ﻋﺮبﺧﺮدﻣﻨﺪ‪،‬‬ ‫دﻛﺘﺮ ﻧﻌﻤﺖاﷲ ﻋﻄﺎﻳﻲ‪ ،‬دﻛﺘﺮ راﻣﺶ ﻋﻤﺮاﻧﻲﭘﻮر‪ ،‬دﻛﺘﺮ ﻣﺤﻤﻮد ﻗﺎﺿﻲ ﺧﻮاﻧﺴﺎري‪ ،‬دﻛﺘﺮ ﺳﻴﺪﺟﻮاد ﻗﺎﺿﻲ ﻣﻴﺮ ﺳﻌﻴﺪ‪ ،‬دﻛﺘﺮ ﻣﻬﺮي ﻛﺪﺧﺪاﻳﻲ‪،‬‬ ‫دﻛﺘﺮ ﺳﻴﻨﺎ ﻣﺮادﻣﻨﺪ‪ ،‬دﻛﺘﺮ زﻳﻨﺖ ﻧﺎدﻳﺎﺣﺘﻤﻲ‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪ ﻋﻠﻲ ﻧﻮﻳﺎن اﺷﺮف‬ ‫ﻫﻴﺄت ﺗﺤﺮﻳﺮﻳﻪ‬

‫دﻛﺘﺮ ﻧﺎﺻﺮ اﺑﺮاﻫﻴﻤﻲ درﻳﺎﻧﻲ‪ ،‬دﻛﺘﺮ ﻣﺤﻤﻮد اﻛﺒﺮﻳﺎن‪ ،‬دﻛﺘﺮ ﻓﺮﻧﺎز آﻣﻮزﮔﺎر ﻫﺎﺷﻤﻲ‪ ،‬دﻛﺘﺮ ﺑﺎﺑﻚ ﺑﻬﺎر‪ ،‬دﻛﺘﺮ ﭘﺮوﻳﻦ ﭘﺎﺳﺎﻻر‪ ،‬دﻛﺘﺮ ﭘﺮﻳﭽﻬﺮ ﭘﺎﺳﺒﺨﺶ‪،‬‬ ‫دﻛﺘﺮ زاﻫﺪ ﺣﺴﻴﻦ ﺧﺎن‪ ،‬دﻛﺘﺮ زﻫﺮا ﺣﻼﺟﻲ‪ ،‬دﻛﺘﺮ ﻓﺎﻃﻤﻪ داوري ﺗﻨﻬﺎ‪ ،‬دﻛﺘﺮ ﻣﻬﺮﻧﺎز رﺳﻮﻟﻲﻧﮋاد‪ ،‬دﻛﺘﺮ ﻣﺴﻌﻮد ﺳﺘﻮده‪ ،‬دﻛﺘﺮ ﻋﻠﻴﺮﺿﺎ ﺷﻌﺒﺎﻧﻲ‪،‬‬ ‫دﻛﺘﺮ اﺣﻤﺪرﺿﺎ ﻃﻼﺋﻲﭘﻮر‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪرﺿﺎ ﻇﻔﺮﻗﻨﺪي‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪ ﻛﺠﺒﺎفزاده‪ ،‬دﻛﺘﺮ ﺳﻴﺪ ﻣﺤﻤﺪﺟﻮاد ﻣﺮﺗﻀﻮي‪ ،‬دﻛﺘﺮ اﻋﻈﻢاﻟﺴﺎدات ﻣﻮﺳﻮي‪،‬‬ ‫دﻛﺘﺮ ﻣﺤﻤﺪﺟﻮاد ﻣﻴﻜﺎﺋﻴﻠﻲ‪ ،‬دﻛﺘﺮ ﺑﻬﺮوز ﻧﺒﺌﻲ‪ ،‬دﻛﺘﺮ ﻣﺮﺿﻴﻪ وﺣﻴﺪ دﺳﺘﺠﺮدي‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪرﺿﺎ ﻫﺎدﻳﺎن‬ ‫ﻫﻴﺄت ﺗﺤﺮﻳﺮﻳﻪ ﺑﻴﻦ اﻟﻤﻠﻠﻲ‬

‫دﻛﺘﺮ ﻓﺮﻫﻨﺎك اﺳﺪي )ﺷﻴﻜﺎﮔﻮ(‪ ،‬دﻛﺘﺮ ﺟﻮاد ﭘﺮوﻳﺰي )ﻓﻴﻼدﻟﻔﻴﺎ(‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪرﺿﺎ ﻛﺸﺘﮕﺮ )ﻟﻨﺪن(‪ ،‬دﻛﺘﺮ اﻓﺸﻴﻦ ﮔﻨﺠﻲ )اﺳﺘﺮاﺳﺒﻮرگ(‪،‬‬ ‫دﻛﺘﺮ ﺷﻬﻼ ﻣﺴﻌﻮد )ﻓﻠﻮرﻳﺪا(‪ ،‬دﻛﺘﺮ ﭘﺮوﻳﺰ ﻫﻨﺠﻨﻲ )ﭘﻨﺴﻴﻠﻮاﻧﻴﺎ(‬ ‫وﻳﺮاﺳﺘﺎران‬

‫دﻛﺘﺮ ﻧﺎدره ﺑﻬﺘﺎش‪ ،‬دﻛﺘﺮ ﻣﺤﻤﺪ ﻋﻠﻲ ﻧﻮﻳﺎن اﺷﺮف‪ ،‬دﻛﺘﺮ وﺣﻴﺪ ﻧﻴﻜﻮﻳﻲ‪ ،‬دﻛﺘﺮ ﺳﻴﺪ ﺑﻬﻨﺎم ﻫﺎﺷﻤﻲ‬ ‫ﻫﻤﻜﺎران دﻓﺘﺮ ﻣﺠﻠﻪ‬

‫ﺣﺴﻴﻦ ﭼﺎﻳﭽﻲ‪ ،‬راﺣﻠﻪ رﻣﻀﺎﻧﻲ‪ ،‬ﺳﺤﺮ ﺻﺪﻳﻖ‪ ،‬ﻣﻌﺼﻮﻣﻪ ﻋﺴﮕﺮي‪ ،‬آرزو ﻛﻤﻴﺰاﻧﻲ‬ ‫ﻧﺸﺎﻧﻲ‪ :‬ﺗﻬﺮان‪ ،‬ﺧﻴﺎﺑﺎن ﻗﺪس‪ ،‬ﺧﻴﺎﺑﺎن ﭘﻮرﺳﻴﻨﺎ‪ ،‬داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬ﺳﺎﺧﺘﻤﺎن آﻣﻮزش‪ ،‬ﻃﺒﻘﻪ اول‪ ،‬ﺷﻤﺎره ‪ ،202‬دﻓﺘﺮ ﻣﺠﻠﻪ‬ ‫آدرس اﻟﻜﺘﺮوﻧﻴﻚ‪ http://tumj.tums.ac.ir :‬ﭘﺴﺖ اﻟﻜﺘﺮوﻧﻴﻚ‪medjournal@tums.ac.ir :‬‬ ‫ﺻﻨﺪوق ﭘﺴﺘﻲ ‪ ،14155/6447‬ﺗﻠﻔﻜﺲ‪Online submission: http://journals.tums.ac.ir/login ، 88962510 :‬‬ ‫ﺑﺮاﺳﺎس ﻣﺼﻮﺑﻪ ﻛﻤﻴﺴﻴﻮن ﻧﺸﺮﻳﺎت ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻛﺸﻮر‪ ،‬ﺑﻪ ﻧﻮﻳﺴﻨﺪﮔﺎن ﻣﻘﺎﻻت اﻳﻦ ﻣﺠﻠﻪ اﻣﺘﻴﺎز ارﺗﻘﺎي ﻋﻠﻤﻲ ﭘﮋوﻫﺸﻲ ﺗﻌﻠﻖ ﻣﻲﮔﻴﺮد‪.‬‬ ‫ﺗﻴﺮاژ‪ 1000 :‬ﻧﺴﺨﻪ‬

‫ﻟﻴﺘﻮﮔﺮاﻓﻲ‪ ،‬ﭼﺎپ و ﺻﺤﺎﻓﻲ‪ :‬ﺑﻬﺮﻧﮓ‬

‫)راﻳﮕﺎن(‬

‫ﻧﻤﺎﻳﻪ ﺷﺪه در‪:‬‬

‫‪SCOPUS, EMBASE, Cambridge Scientific Abstracts (CSA), CAB Abstracts (CABI), Chemical Abstract Service (CAS),‬‬ ‫‪DOAJ, Psych Info, ULRICH΄S, Index Copernicus, IMEMR, EMR Beta, SID, Magiran, Iran Medex‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬ ‫دوره ‪69‬‬

‫ﺷﻤﺎره ‪7‬‬

‫ﻣﻬﺮ ‪1390‬‬

‫ﻓﻬﺮﺳﺖ‬ ‫اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ زﻋﻔﺮان در ﻣﻘﺎﺑﻞ آﺳﻴﺐﻫﺎي اﻛﺴﻴﺪاﺗﻴﻮ در اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ‪ -‬ﻣﻮﻗﺘﻲ در ﻣﻮش ﺻﺤﺮاﻳﻲ‪405.................................................................... ..‬‬ ‫ﻋﺎﺑﺪﻳﻦ وﻛﻴﻠﻲ‪ ،‬ﻣﺤﻤﺪ رﺿﺎ ﻋﻴﻨﻌﻠﻲ‪ ،‬اﺣﻤﺪ رﺿﺎ ﺑﻨﺪﮔﻲ‬

‫ﻣﻘﺎﻳﺴﻪ اﺛﺮ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﺑﺎ اﻛﺴﻲﺗﻮﺳﻴﻦ در اﻟﻘﺎي زاﻳﻤﺎن در زﻧﺎن ﺑﺎ ﺳﺮوﻳﻜﺲ ﻧﺎﻣﻨﺎﺳﺐ‪413...........................................................................‬‬ ‫ﺷﻴﺮﻳﻦ ﻧﻴﺮوﻣﻨﺶ‪ ،‬ﻣﻌﺼﻮﻣﻪ داداش ﻋﻠﻴﻬﺎ‪ ،‬ﻣﻴﻨﺎ اﻛﺮﻣﻲ‬

‫ﻣﻘﺎﻳﺴﻪ دو روش ﺑﻲﺣﺴﻲ ﻧﺨﺎﻋﻲ در ﺣﺎﻟﺖﻫﺎي ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و ﻧﺸﺴﺘﻪ در ﺟﺮاﺣﻲ ﻋﺮوق اﻧﺪام ﺗﺤﺘﺎﻧﻲ‪420..................................................................... .....‬‬ ‫ﻣﺤﻤﺪرﺿﺎ ﻣﻬﺎﺟﺮ‪ ،‬ﻛﺴﺮي ﻛﺮوﻧﺪﻳﺎن‪ ،‬زاﻫﺪ ﺣﺴﻴﻦﺧﺎن‪ ،‬اﻓﺸﻴﻦ ﺟﻌﻔﺮزاده‪ ،‬ﺳﻬﻴﻼ دﺑﻴﺮان‬

‫ﺗﺄﺛﻴﺮ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻫﻮازي ﺑﺮ ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖ در زﻧﺎن ﺗﻤﺮﻳﻦ ﻛﺮده‪426.........................................................................................................‬‬ ‫اﻣﻴﺮ رﺷﻴﺪﻟﻤﻴﺮ‪ ،‬ﻣﻬﺪﻳﻪ اﺑﺮاﻫﻴﻢﻧﻴﺎ‪ ،‬ﻋﻠﻲ اﻛﺒﺮ ﻫﺎﺷﻤﻲ ﺟﻮاﻫﺮي‬

‫ﻣﻘﺎﻳﺴﻪ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل در ﻧﻮزادان ﻣﺒﺘﻼ ﺑﻪ زردي ﻗﺒﻞ و ﺑﻌﺪ از ﻓﺘﻮﺗﺮاﭘﻲ‪432.......................................................................................................‬‬ ‫ﻧﺴﺘﺮن ﺧﺴﺮوي‪ ،‬ﻋﻠﻴﺮﺿﺎ اﻣﻴﻨﻴﺎن‪ ،‬رﺿﺎ ﺗﻘﻲﭘﻮر‬

‫ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺮي و ﻣﻌﺪه‪ :‬ﺑﺮرﺳﻲ ‪ 24‬ﺑﻴﻤﺎر‪438..............................................................................................................................................‬‬ ‫رﺿﺎ ﺑﺎﻗﺮي‪ ،‬ﻗﺪرت اﷲ ﻣﺪاح‪ ،‬ﻋﻠﻴﺮﺿﺎ ﺗﻮﺳﻠﻲ‪ ،‬ﻓﺎﻃﻤﻪ ﻧﻘﻮي رﻳﺎﺑﻲ‬

‫ﺑﺮرﺳﻲ ﻋﻮاﻣﻞ ﻣﺮﺗﺒﻂ ﺑﺎ ﺑﺮوز ﻋﻮارض ﻋﺮوﻗﻲ ﭘﺲ از ﻣﺪاﺧﻼت ﻛﺮوﻧﺮ در ﻣﺮﻛﺰ ﻗﻠﺐ و ﻋﺮوق ﺷﻬﻴﺪ رﺟﺎﻳﻲ ﺗﻬﺮان‪445.................................................................‬‬ ‫اﺣﻤﺪﻋﻠﻲ ﻳﻮﺳﻔﻲ‪ ،‬ﻣﺤﺴﻦ ﻣﻌﺪﻧﻲ‪ ،‬ﺣﻤﻴﺪرﺿﺎ ﻋﻈﻴﻤﻲ‪ ،‬ﺣﺴﻴﻦ ﻓﺮﺷﻴﺪي‬

‫آﺗﺮزي ﻛﻮآن‪ :‬ﺗﺠﺮﺑﻪ ‪ 13‬ﺳﺎﻟﻪ و ﺑﺮرﺳﻲ ﻣﺘﻮن‪ :‬ﮔﺰارش ﻛﻮﺗﺎه‪451........................................................................................................................................‬‬ ‫ﻣﺤﺴﻦ ﻧﺮاﻗﻲ‪ ،‬ﻧﺎزﻧﻴﻦ ﺣﺠﺮاﻻﺳﻮدي‬

‫اﻧﺴﻴﺪاﻧﺲ ﺳﻨﺪروم ﻧﻮروﻟﻮژﻳﻚ ﻣﻮﻗﺖ ﺑﻌﺪ از ﺑﻲﺣﺴﻲ اﺳﭙﺎﻳﻨﺎل ﺑﺎ ﻟﻴﺪوﻛﺎﻳﻴﻦ و ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ‪ :‬ﺗﺎﺛﻴﺮ ﻧﻮع ﺳﻮزن و ﭘﻮزﻳﺸﻦ ﺟﺮاﺣﻲ‪ :‬ﮔﺰارش ﻛﻮﺗﺎه‪453.............................‬‬ ‫ﻓﺮﻫﺎد اﻋﺘﻀﺎدي‪ ،‬آﻳﻼر آﻫﻨﮕﺮي‪ ،‬ﻫﺎﺟﺮ ﺷﻜﺮي‪ ،‬ﻣﺤﻤﺪرﺿﺎ ﺧﺎﺟﻮي‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫راﻫﻨﻤﺎي ﻧﻮﻳﺴﻨﺪﮔﺎن‬ ‫‪ -1‬اﺻﻮل ﻛﻠﻲ‪ -1-1 :‬آﻳﻴﻦ ﻧﮕﺎرش زﺑﺎن ﻓﺎرﺳﻲ ﺑﻪﻃﻮر ﻛﺎﻣﻞ رﻋﺎﻳﺖ ﺷـﺪه و از‬

‫ﺳﻴﺎه و ﺳﻔﻴﺪ و دوﺑﻌﺪي ﺑﺎﺷﺪ و ﻋﻨﻮان ﺟﺪول ﺑﺎﻻي آن و در ﻧﻤـﻮدار زﻳـﺮ آن ﻗـﺮار‬

‫ﺑﻪﻛﺎر ﺑﺮدن ﻛﻠﻤﺎت ﺧﺎرﺟﻲ ﻛﻪ ﻣﻌﺎدلﻫﺎي دﻗﻴﻖ و رﺳﺎﻳﻲ در زﺑﺎن ﻓﺎرﺳﻲ دارﻧﺪ‪،‬‬

‫ﮔﻴﺮد )ﺑﺎ ذﻛﺮ ﺷﻤﺎره(‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﺤﺪودﻳﺖ ﺻﻔﺤﺎت ﻣﺠﻠﻪ‪ ،‬ﺑﺪﻳﻬﻲ اﺳـﺖ از ﺗﻜـﺮار‬

‫ﺧﻮدداري ﺷﻮد‪ -1-2 .‬ﻣﻘﺎﻻت ارﺳﺎﻟﻲ در ﭼﻬﺎر ﻧـﺴﺨﻪ )ﻳـﻚ ﻧـﺴﺨﻪ اﺻـﻞ و ﺳـﻪ‬

‫اراﻳﻪ ﻣﻄﺎﻟﺒﻲ ﻛﻪ در ﻣﺘﻦ آورده ﺷﺪهاﻧﺪ در ﺟـﺪاول و ﺑـﺎﻟﻌﻜﺲ ﺑﺎﻳـﺪ اﺟﺘﻨـﺎب ﻧﻤـﻮد‪،‬‬

‫ﻧﺴﺨﻪ ﻛﭙﻲ( ﺗﻬﻴﻪ و ﺗﺤﻮﻳﻞ دﻓﺘﺮ ﻣﺠﻠﻪ ﮔﺮدﻧـﺪ‪ -1-3 .‬ﻣﻄﺎﻟـﺐ ﻣﻘﺎﻟـﻪ ﻓﻘـﻂ ﺑـﺮ روي‬

‫ﺟﺪاول و ﻧﻤﻮدارﻫﺎ ﻓﺎرﺳﻲ ﺑﺎﺷﻨﺪ‪ .‬ﺑﺤﺚ‪ -1 :‬آﺛﺎر و اﻫﻤﻴﺖ ﻳﺎﻓﺘﻪﻫﺎي ﺑﻪدﺳﺖ آﻣﺪه‬

‫ﻳﻚﻃﺮف ﻛﺎﻏﺬ ‪ A4‬و ﺑﻪﺻﻮرت ﻳﻚ ﺳﺘﻮﻧﻲ و ﻳﻚ ﺧﻂ درﻣﻴـﺎن ﺑـﺎ رﻋﺎﻳـﺖ ﺣﺎﺷـﻴﻪ‬

‫و ﻣﺤﺪودﻳﺖ آنﻫﺎ ‪ -2‬ذﻛﺮ ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻖ ﻣـﺸﺎﺑﻪ دﻳﮕـﺮان و ذﻛـﺮ ﻣﻐـﺎﻳﺮات و ﻣـﻮارد‬

‫ﻻزم )ﺣﺪاﻗﻞ دو ﺳﺎﻧﺘﻲﻣﺘﺮ( ﺗﺎﻳﭗ ﮔﺮدﻧﺪ و ﻫﻤﻪ ﺻﻔﺤﺎت ﺷﻤﺎرهﮔﺬاري ﺷﻮﻧﺪ‪-1-4 .‬‬

‫ﻧﻘﺾﻛﻨﻨﺪه ‪ -3‬ﺗﻮﺿﻴﺢ ﻋﻠﺖ ﺗﻔﺎوت ﺑﻴﻦ ﻧﺘﺎﻳﺞ اﻳﻦ ﺗﺤﻘﻴﻖ ﺑﺎ ﺑﻘﻴﻪ ‪ -4‬ﺗﻮﺿـﻴﺢ ﻣـﻮارد‬

‫ﻣﻘﺎﻟﻪ ارﺳﺎﻟﻲ ﺑﻪﻃﻮر ﻫﻤﺰﻣﺎن ﺑﺮاي ﺳﺎﻳﺮ ﻣﺠﻼت ارﺳﺎل ﻧﮕﺮدد و در ﺳﺎﻳﺮ ﻣﺠﻼت‬

‫ﻛﺎرﺑﺮد ﻋﻤﻠﻲ و ﻗﺎﺑﻠﻴﺖ ﺗﻌﻤﻴﻢﭘﺬﻳﺮي ﻧﺘﺎﻳﺞ ﺑﻪدﺳﺖ آﻣـﺪه ‪ -5‬راﻫﻨﻤـﺎﻳﻲ ﺑـﺮاي اداﻣـﻪ‬

‫)ﺣﺘﻲ ﺑﻪ زﺑﺎن اﻧﮕﻠﻴﺴﻲ و ﻏﻴﺮه( ﺑﻪ ﭼﺎپ ﻧﺮﺳﻴﺪه ﺑﺎﺷﺪ‪ -1-5 .‬ﻟـﻮح ﻓـﺸﺮده ﻣﻘﺎﻟـﻪ‬

‫ﺗﺤﻘﻴﻖ ﺧﻮد ﻳﺎ دﻳﮕﺮان‪ ،‬در ﻣﺠﻤﻮع اراﻳﻪ آﻧﭽﻪ ﻛﻪ از اﻳﻦ ﺗﺤﻘﻴﻖ ﺑﻪ ﻋﻠﻢ اﺿـﺎﻓﻪ ﺷـﺪه‬

‫)ﺗﺮﺟﻴﺤﺎً ﺑﺎ ﺑﺮﻧﺎﻣﻪ ‪ Word 2003‬ﻳﺎ ﺑﺎﻻﺗﺮ( ﺑﺎ اﻋﻤﺎل آﺧﺮﻳﻦ اﺻﻼﺣﺎت ﻣﻮرد ﻧﻈﺮ‪ ،‬ﭘﺲ‬

‫اﺳﺖ‪ .‬ﻣﻨﺎﺑﻊ‪ :‬ﺷﻤﺎره ﻣﻨﺎﺑﻊ ﺑﻪﻛﺎر ﮔﺮﻓﺘﻪ ﺷﺪه در ﻣﺘﻦ ﺑﺎﻳﺴﺘﻲ ﻗﻴﺪ ﺷﻮد و ﺑﻪﻃﻮر ﻗﻄﻌـﻲ‬

‫از درﻳﺎﻓﺖ ﻧﺎﻣﻪ ﭘﺬﻳﺮش ﻣﻘﺎﻟﻪ‪ ،‬ﺑﻪ دﻓﺘﺮ ﻣﺠﻠﻪ اراﻳﻪ ﮔﺮدد‪ -1-6 .‬ﻧﻮع ﻣﻘﺎﻻت ﭘﺬﻳﺮﻓﺘـﻪ‬

‫ﺑﺎﻳـﺪ از ﻋﺪد ﻳﻚ ﺷﺮوع و ﺑﻪﺗﺮﺗﻴـﺐ اﺿـﺎﻓﻪ ﮔـﺮدد‪ .‬ﺿـﻤﻦ اﻧﻄﺒـﺎق ﻛﺎﻣـﻞ ﺗﻌـﺪاد‬

‫ﺷﺪه ﺷﺎﻣﻞ ﻣﻘﺎﻻت ﺗﺤﻘﻴﻘـﻲ‪ ،‬ﻣﻘـﺎﻻت ﻣـﺮوري )از ﻧﻮﻳـﺴﻨﺪﮔﺎن ﺑـﺎ ﺗﺠﺮﺑـﻪ ﻛـﺎﻓﻲ و‬

‫رﻓﺮاﻧﺲﻫﺎي ﻣﺤﺘﻮاي ﻣﻘﺎﻟﻪ و ﻟﻴﺴﺖ اﻧﺘﻬﺎﻳﻲ آن‪ ،‬ﻣﺘﻦ دﻗﻴﻖ رﻓﺮاﻧﺲﻫﺎ ﺑﻪﺗﺮﺗﻴﺐ ﻇﻬﻮر‪،‬‬

‫ﺻﺎﺣﺐ ﺗﺄﻟﻴﻔﺎت در ﻣﻮﺿﻮع ﻣﻘﺎﻟﻪ( و ﮔـﺰارش ﻣـﻮردي ﻣـﻲﺑﺎﺷـﺪ‪ -1-7 .‬در اﻧﺠـﺎم‬

‫در ﻓﻬﺮﺳﺖ ﻣﻨﺎﺑﻊ آورده ﺷﻮﻧﺪ‪ .‬ﻧﺤﻮه ﺗﻨﻈﻴﻢ ﻣﻨـﺎﺑﻊ ﺑـﻪ ﺷـﺮح ذﻳـﻞ ﻣـﻲﺑﺎﺷـﺪ‪ .‬ﻣﻨـﺎﺑﻊ‬

‫ﭘﮋوﻫﺶ‪ ،‬اﺻﻮل اﻋﻼﻣﻴﻪ ﻫﻠﺴﻴﻨﻜﻲ و ﺿﻮاﺑﻂ اﺧﻼق ﭘﺰﺷﻜﻲ رﻋﺎﻳﺖ ﮔﺮدد‪ -2 .‬ﻧﺤﻮه‬

‫ﺑﻪﺻﻮرت ﻛﺘﺎب‪) :‬ﻧﺎمﺧﺎﻧﻮادﮔﻲ‪ /‬ﻧﺎم ﻧﻮﻳﺴﻨﺪه‪ /‬ﻓﺼﻞ‪ /‬ﻋﻨﻮان‪ /‬ﻓﺼﻞ‪ /‬ﻋﻨﻮان ﻛﺘﺎب‪ /‬ﻧـﺎم‬

‫ﺗﻨﻈﻴﻢ ﻣﻘﺎﻻت ﺗﺤﻘﻴﻘﻲ‪ -2-1 :‬ﺻﻔﺤﻪ اول )ﺻﻔﺤﻪ ﻋﻨـﻮان( ﺑﺎﻳـﺴﺘﻲ ﺷـﺎﻣﻞ‪ :‬ﻋﻨـﻮان‬

‫ﻧﻮﻳﺴﻨﺪﮔﺎن ﻛﺘﺎب‪ /‬ﻧﺎم ﻧﺎﺷﺮ‪ /‬ﻣﺤﻞ اﻧﺘﺸﺎر‪ /‬ﺳﺎل‪ /‬ﺻﻔﺤﺎت‪:‬‬

‫ﻣﻘﺎﻟﻪ‪ ،‬ﻧﺎم و ﻧﺎمﺧﺎﻧﻮادﮔﻲ ﻧﻮﻳﺴﻨﺪﮔﺎن‪ ،‬درﺟﻪ ﻋﻠﻤﻲ و آدرس دﻗﻴﻖ ﻛﻠﻴـﻪ ﻧﻮﻳـﺴﻨﺪﮔﺎن‬ ‫)از ﺟﻤﻠﻪ ﻛﺪ ﭘﺴﺘﻲ‪ ،‬ﺗﻠﻔﻦ‪ ،‬دورﻧﮕﺎر و ‪ (E-mail‬ﻣﺤﻞ اﻧﺠﺎم ﭘﮋوﻫﺶ‪ ،‬ﻣﺴﺌﻮل ﻣﻘﺎﻟﻪ و‬ ‫ﺗﺎرﻳﺦ ارﺳﺎل ﻣﻘﺎﻟﻪ ﺑﺎﺷﺪ‪ -2-2 .‬ﺻﻔﺤﻪ دوم و ﺳﻮم ﺷﺎﻣﻞ ﺧﻼﺻﺔ ﻓﺎرﺳﻲ و اﻧﮕﻠﻴﺴﻲ‬ ‫و ﻛﻠﻤﺎت ﻛﻠﻴﺪي اﻧﮕﻠﻴﺴﻲ ﻣﻲﺑﺎﺷـﺪ‪ .‬ﭼﻜﻴﺪه ﻣﻘﺎﻟﻪ ﻧﻤﻲﺑﺎﻳﺴﺖ از ‪ 250‬ﻛﻠﻤﻪ ﺑﻴـﺸﺘﺮ‬ ‫ﺑﺎﺷﺪ و در ﭼﻬﺎر ﭘﺎراﮔﺮاف ﺑﺎ ﻋﻨﺎوﻳﻦ زﻣﻴﻨـﻪ و ﻫـﺪف‪ ،‬روش ﺑﺮرﺳـﻲ‪ ،‬ﻳﺎﻓﺘـﻪﻫـﺎ‪،‬‬

‫‪Nochols DH, Randall CL. Massive eversion of the vagina. In:‬‬ ‫‪Nichols DH, Randall CL, editors. Vaginal Surgery. 3rd ed. Baltimore:‬‬ ‫‪Williams Wilkins; 1989. p. 328-57.‬‬

‫ﻣﻨﺎﺑﻊ ﺑﻪﺻﻮرت ﻣﻘﺎﻟﻪ‪) :‬ﻧﺎمﺧﺎﻧﻮادﮔﻲ(‪ /‬ﻧﺎم‪ /‬ﻋﻨﻮان ﻣﻘﺎﻟﻪ‪ /‬ﻋﻨﻮان ﻛﺎﻣـﻞ ژورﻧـﺎل‪ /‬ﺳـﺎل‬ ‫اﻧﺘﺸﺎر‪ /‬ﺷﻤﺎره ﻣﺠﻠﻪ‪ /‬ﺻﻔﺤﺎت‪ .‬ﻣﺜﺎل‪ .1 :‬ﻛﺎوﻳــﺎﻧﻲ ﺣــﺴﻴﻦ‪ ،‬ﭘﻮرﻧﺎﺻــﺢ ﻣﻬﺮاﻧﮕﻴــﺰ‪.‬‬ ‫اﻋﺘﺒﺎرﻳﺎﺑﻲ و ﻫﻨﺠﺎرﺳﺎزي ﭘﺮﺳﺸﻨﺎﻣﻪ ﺳﺮﺷـﺖ و ﻣـﻨﺶ ﻛﻠـﻮﻧﻴﻨﺠﺮ ‪ TCI‬در ﺟﻤﻌﻴـﺖ‬ ‫اﻳﺮاﻧﻲ‪ .‬ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪1384 ،‬؛ ﺳﺎل ‪ ،63‬ﺷﻤﺎره ‪ :2‬ﺻﻔﺤﺎت ‪ 89‬ﺗﺎ ‪.98‬‬

‫ﻧﺘﻴﺠﻪﮔﻴﺮي و ﻛﻠﻤﺎت ﻛﻠﻴﺪي )ﺣـﺪاﻗﻞ ‪ 3‬و ﺣـﺪاﻛﺜﺮ ‪ 7‬واژه( ﺳـﺎزﻣﺎﻧﺪﻫﻲ ﺷـﻮد‪.‬‬

‫ﻣﻘﺎﻟﻪ ﻧﺸﺮﻳﻪ در ﻧﺴﺨﻪ اﻟﻜﺘﺮوﻧﻴﻚ‪:‬‬

‫ﺗﻮﺻﻴﻪ ﻣﻲﺷﻮد ﻧﺴﺒﺖ ‪ 1-2-2-1‬در ﺗﻬﻴﻪ ﭼﻜﻴﺪه ﺑﺎ ﭼﻬﺎر ﻋﻨﻮان ﻓـﻮق ﻣـﻮرد ﻟﺤـﺎظ‬

‫‪CDI, Clinical Dermatology Illustrated [monograph on CD-ROM].‬‬ ‫‪Reeves JRT, Maibach H. CMEA Multimedia Group, Producers. 2nd‬‬ ‫‪ed. Version 2.0 Scan Diego: CMEA; 1995.‬‬

‫ﻗﺮار ﮔﻴﺮد‪ .‬ﭼﻜﻴﺪه اﻧﮕﻠﻴﺴﻲ ﺑﺎﻳﺪ ﻛـﺎﻣﻼ ﻣﻨﻄﺒـﻖ ﺑـﺎ ﭼﻜﻴـﺪه ﻓﺎرﺳـﻲ ﺑﺎﺷـﺪ و در‬ ‫ﺑﺨﺶﻫﺎي ‪ Conclusion ،Results ،Methods ،Background‬و ‪Keywords‬‬

‫‪ -‬ﻋﻜﺲﻫﺎ‪ ،‬ﻧﻤﻮدارﻫﺎ و ﺟﺪاول ﻣﺮﺑﻮط ﺑﻪ ﻣﻘﺎﻟﻪ ﺑﻪﻫﻤـﺮاه ﺗﻮﺿـﻴﺤﺎت آنﻫـﺎ ﺑﺎﻳـﺴﺘﻲ‬

‫ﺗﻬﻴﻪ ﮔﺮدد و در ﺣﺪود ‪ 230-250‬ﻛﻠﻤﻪ ﺑﺎﺷﺪ‪ -2-3 .‬اﺻـﻞ ﻣﻘﺎﻟـﻪ ﺑﺎﻳـﺴﺘﻲ ﺷـﺎﻣﻞ‬

‫ﺟﺪاﮔﺎﻧﻪ و در دﻧﺒﺎﻟﻪ ﻣﺘﻦ اﺻﻠﻲ ﻣﻘﺎﻟـﻪ )‪ (text‬آورده ﺷـﻮد و ﺷـﻤﺎرهﮔـﺬاري ﮔـﺮدد‪.‬‬

‫ﻣﻮارد زﻳﺮ ﺑﺎﺷﺪ‪ :‬ﻣﻘﺪﻣﻪ‪ :‬ﻳﻚ ﺻﻔﺤﻪ ﺷﺎﻣﻞ‪ -1 :‬اﻃﻼﻋﺎت ﻗﺒﻠﻲ و زﻣﻴﻨﻪاي اﻧﺠﺎم ﺷﺪه‬

‫ﻛﻴﻔﻴﺖ ﺗﺼﺎوﻳﺮ ارﺳﺎﻟﻲ ﺑﺎﻳﺪ ﻣﻄﻠﻮب ﺑﺎﺷﺪ‪ .‬در اراﻳﻪ ﻋﻜﺲﻫﺎي اﺳﻜﻦ ﺷﺪه اﺳﺘﻔﺎده از‬

‫و ﺳﺎﺑﻘﻪ ﺑﺎ ذﻛﺮ رﻓﺮاﻧﺲ ‪ -2‬ﺿﺮورت اﻧﺠﺎم ﺗﺤﻘﻴﻖ ‪ -3‬ﺳﺆاﻻت ﺑﺪون ﭘﺎﺳﺨﻲ ﻛﻪ اﻳﻦ‬

‫رزوﻟﻮﺷﻦ ﺣﺪاﻗﻞ ‪ 600dpi‬ﺿﺮوري اﺳﺖ‪ .‬ﻋﻜﺲ ﻫﺎي ارﺳـﺎﻟﻲ ﺑﺎﻳـﺴﺘﻲ ﺑـﻪﺻـﻮرت‬

‫ﺗﺤﻘﻴﻖ ﺑﻪ آنﻫﺎ ﭘﺎﺳﺦ ﻣﻲﮔﻮﻳﺪ و ﺑﻴﺎن اﻳﻦ ﻣﻮﺿـﻮع ﻛـﻪ ﭼﮕﻮﻧـﻪ ﻧﺘـﺎﻳﺞ اﻳـﻦ ﺗﺤﻘﻴـﻖ‬

‫اﺻﻞ ﺑﺎﺷﺪ‪ ،‬ﺑﻪ اﻧﻀﻤﺎم ﺳﻪ ﻧـﺴﺨﻪ ﻛﭙـﻲ رﻧﮕـﻲ و در ﭘـﺸﺖ ﻋﻜـﺲ ﺷـﻤﺎره آن‪ ،‬ﻧـﺎم‬

‫ﻣﻲﺗﻮاﻧﺪ ﺑﻪ رﻓﻊ اﺑﻬﺎﻣﺎت ﻛﻤﻚ ﻛﻨﺪ‪ -4 .‬ﺗﻌﺮﻳﻒ اﺻﻄﻼﺣﺎت ﺗﺨﺼﺼﻲ ﻳﺎ اﺧﺘﺼﺎرات‬

‫ﻧﻮﻳﺴﻨﺪه و ﺟﻬﺖ ﻧﺼﺐ ﺗﺼﻮﻳﺮ ﺛﺒﺖ ﮔﺮدد‪.‬‬

‫ﻋﻠﻤﻲ ‪ -6‬ﻫﺪف ﺗﺤﻘﻴﻖ ﺑﻪ ﻧﺤﻮ روﺷﻦ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬ﺑﻪ ﻧﺤﻮي ﺑﺎﻳﺪ ﻧﻮﺷﺘﻪ ﺷﻮد ﻛﻪ‬

‫‪ -3‬ﻧﺤﻮة ﺗﻨﻈﻴﻢ ﻣﻘﺎﻻت ﮔﺰارش ﻣﻮارد ‪ -3-‬ﺻﻔﺤﻪ اول ﺗﻮﺿﻴﺤﺎت اراﻳﻪ ﺷـﺪه در‬

‫ﻫﺮ ﺧﻮاﻧﻨﺪهاي ﺑﺘﻮاﻧﺪ ﺑﺎ آن‪ ،‬ﺗﺠﺮﺑﻪ ﻧﻮﻳـﺴﻨﺪه ﻣﻘﺎﻟـﻪ را ﺗﻜـﺮار ﻛﻨـﺪ‪ ،‬ﺷـﺎﻣﻞ‪ :‬ﻃﺮاﺣـﻲ‬

‫ﻗﺴﻤﺖ ‪ -3-1 ،2-1‬ﺻﻔﺤﻪ دوم و ﺳﻮم ﺷﺎﻣﻞ ﺧﻼﺻﻪ ﻓﺎرﺳﻲ و اﻧﮕﻠﻴﺴﻲ و ﻛﻠﻤـﺎت‬

‫ﺗﺤﻘﻴﻖ‪ :‬ﺟﺰﺋﻴﺎت روش ﻣﻄﺎﻟﻌﻪ و ﻋﻠﺖ اﻧﺘﺨﺎب آن )ﻣـﺜﻼ ﻛﻮﻫـﻮرت(‪ -‬ﻣـﺪت زﻣـﺎن‬

‫ﻛﻠﻴﺪي اﻧﮕﻠﻴﺴﻲ ﻣﻲﺑﺎﺷﺪ‪ .‬ﺧﻼﺻﻪ ﮔﺰارش ﻣﻮردي ﻧﺒﺎﻳـﺴﺘﻲ از ‪ 100‬ﻛﻠﻤـﻪ ﺑﻴـﺸﺘﺮ‬

‫اﺟﺮاي ﻃﺮح و ﭘﻲﮔﻴﺮي‪ -1 .‬زﻣﺎن و ﻣﻜﺎن اﺟﺮاي ﭘﮋوﻫﺶ ‪ -2‬ﺳﻮژهﻫﺎ و ﻧﻤﻮﻧﻪﻫـﺎي‬

‫ﺑﺎﺷﺪ‪ -3-3 .‬اﺻﻞ ﻣﻘﺎﻟﻪ ﺑﺎﻳﺴﺘﻲ ﺷﺎﻣﻞ ﻣﻮارد زﻳﺮ ﺑﺎﺷﺪ‪ :‬ﻣﻘﺪﻣﻪ‪ ،‬ﺷﺮح ﺣـﺎل ﺑﻴﻤـﺎر ﻳـﺎ‬

‫ﻣﻮرد آزﻣﻮن و ﻣﻼك اﻧﺘﺨﺎب‪ .‬روش ﻧﻤﻮﻧﻪﮔﻴﺮي و ﻣﻨﻄﻖ ﺗﻌﺪاد ﻧﻤﻮﻧﻪ )اﻳـﻦ ﻗـﺴﻤﺖ‬

‫ﻣﻮرد‪ ،‬ﺑﺤﺚ‪ :‬ﮔﺰارش ﻣﻮرد و ﺑﺤﺚ ﻣﺠﻤﻮﻋﺎً از ‪ 1500‬ﻛﻠﻤﻪ ﺑﻴﺸﺘﺮ ﻧﺒﻮده و ﺣﺪاﻛﺜﺮ‬

‫ﺑﺴﻴﺎر ﻣﻬﻢ اﺳﺖ و در اﺑﺘﺪاي اﻣﺮ ﻣﻮرد ﻛﺎرﺷﻨﺎﺳﻲ ﻗﺮار ﻣﻲﮔﻴﺮد(‪ -‬ﻣﻼكﻫﺎي ورود و‬

‫دو ﺟﺪول ﻳﺎ ﺗﺼﻮﻳﺮ اراﻳﻪ ﺷﻮد‪ -3-4 .‬ﻣﻨﺎﺑﻊ ﻣﺸﺎﺑﻪ ﻣﻘﺎﻻت ﺗﺤﻘﻴﻘﻲ اﺳﺖ‪.‬‬

‫ﺧﺮوج ﺑﻪ ﻣﻄﺎﻟﻌﻪ‪ -3 .‬ﻧﺤﻮه ﺟﻤﻊ آوري اﻃﻼﻋﺎت‪ -4 .‬رﻋﺎﻳﺖ ﻣـﻮازﻳﻦ اﺧـﻼق در‬

‫‪ -4‬ﻧﺤﻮه ﺗﻨﻈﻴﻢ ﻣﻘﺎﻻت ﻣـﺮوري‪ -4-1 :‬اﻳـﻦ ﮔﻮﻧـﻪ ﻣﻘـﺎﻻت ﺑـﺮاي اراﻳـﻪ آﺧـﺮﻳﻦ‬

‫ﭘﮋوﻫﺶ ‪ -5‬اﺑﺰارﻫﺎي اﻧﺪازهﮔﻴﺮي ‪ -6‬آزﻣﻮنﻫﺎي آﻣﺎري ‪ -7‬ﻧﺎم ﻛـﺸﻮر و ﺷـﺮﻛﺖ‬

‫ﻳﺎﻓﺘﻪﻫﺎي ﻋﻠﻤﻲ درﺑﺎره ﻳﻚ ﻣﻮﺿﻮع ﺧﺎص ﺑﺎﺷﺪ‪ -4-2 .‬ﻧﻮﻳﺴﻨﺪه در زﻣﻴﻨـﻪ ﻣﻮﺿـﻮع‬

‫ﺳﺎزﻧﺪه ﻣﻮاد و دﺳﺘﮕﺎهﻫﺎ‪ .‬ﻳﺎﻓﺘﻪ ﻫﺎ‪ :‬اراﻳـﻪ ﻧﺘـﺎﻳﺞ دﻗﻴـﻖ‪ -1 :‬رﻋﺎﻳـﺖ اﺻـﻮل ﻋﻠﻤـﻲ‬

‫ﻣﻘﺎﻟﻪ ﻣﻲﺑﺎﻳﺴﺖ ﺻﺎﺣﺐ ﻧﻈﺮ و داراي ﻣﻘﺎﻟﻪ ﺑﺎﺷـﻨﺪ‪ -5 .‬ﻫﻴـﺄت ﺗﺤﺮﻳﺮﻳـﻪ ﻣﺠﻠـﻪ در‬

‫)ﮔﺰارش ﻋﺪد ﺑﺎ درﺻﺪ‪ -‬ﮔﺰارش ﻣﻴﺎﻧﮕﻴﻦ ﺑﺎ ﺣﺪود اﻃﻤﻴﻨـﺎن‪ -‬ﻣﻴﺎﻧـﻪ ﺑـﺎ ‪-2 (Range‬‬

‫ﻗﺒﻮل ﻳﺎ ﻋﺪم ﻗﺒﻮل و ﻳﺎ اﺻﻼح ﻣﻘﺎﻟﻪ )ﺑﺎ ﺗﺄﻳﻴﺪ ﻣﺆﻟﻒ( آزاد اﺳـﺖ و از ﭘـﺲ دادن‬

‫ﭘﺮﻫﻴﺰ از ﻧﺸﺎن دادن ﻫﻤﻪ ﻳﺎﻓﺘﻪﻫﺎي ﺑﻪدﺳﺖ آﻣﺪه ﺑﻪﺟﺰ ﻳﺎﻓﺘﻪﻫﺎي ﻣﻬﻢ و ﺗﻌﻴـﻴﻦﻛﻨﻨـﺪه‬

‫ﻣﻘﺎﻟﻪ و ﻣﻠﺤﻘﺎت آن ﻣﻌﺬور ﻣﻲﺑﺎﺷﺪ‪ -6 .‬ﻧﻮﻳـﺴﻨﺪﮔﺎن ﻣﻘـﺎﻻت ﻣـﺴﺌﻮل ﻧﻮﺷـﺘﻪﻫـﺎ و‬

‫‪ -3‬اﺳﺘﻔﺎده ﻣﻨﺎﺳﺐ از ﺟﺪول و ﻧﻤﻮدار ﺑﺎ ﺣﺪاﻗﻞ ﺗﻌﺪاد ﻣﻤﻜﻦ ﺑﻪﻃﻮريﻛﻪ ﺑـﻪ ازاي‬

‫ﻣﺪاﻓﻊ ﻣﻄﺎﻟﺐ ﭼـﺎپ ﺷـﺪه از ﻣﻘﺎﻟـﻪ ﺧـﻮد در ﻣﺠﻠـﻪ ﺧﻮاﻫﻨـﺪ ﺑـﻮد‪ -7 .‬اﺳـﺘﻔﺎده از‬

‫ﻫﺮ ﺳﻪ ﺻﻔﺤﻪ ﺗﺎﻳﭙﻲ ﻳﻚ ﺟﺪول ﻳﺎ ﻧﻤﻮدار اﺳﺘﻔﺎده ﺷﻮد‪ ،‬ﺿﻤﻦ اﻳﻦﻛﻪ ﻧﻤﻮدار ﺑﺎﻳـﺪ‬

‫ﻣﻨﺪرﺟﺎت ﻣﺠﻠﻪ ﺑﺎ ذﻛﺮ ﻛﺎﻣﻞ ﻣﺄﺧﺬ آزاد اﺳﺖ‪.‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪405-412 ،1390‬‬ ‫ﺷﻤﺎره ‪7‬‬ ‫دوره ‪، 69‬‬ ‫ﻫﺎيﺗﻬﺮان‪،‬‬ ‫آﺳﻴﺐﻜﻲ‬ ‫ﻋﻠﻮم ﭘﺰﺷ‬ ‫ﻣﺤﺎﻓﻈﺘﻲداﻧﺸﮕﺎه‬ ‫اﺛﺮﭘﺰﺷﻜﻲ‪،‬‬ ‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه‬ ‫ﻣﻬﺮﻣﻮش‬ ‫ﻣﻐﺰي‪ ،‬در‬ ‫اﻳﺴﻜﻤﻲ‬ ‫اﻛﺴﻴﺪاﺗﻴﻮ‬ ‫زﻋﻔﺮان در‬

‫اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ زﻋﻔﺮان در ﻣﻘﺎﺑﻞ آﺳﻴﺐﻫﺎي اﻛﺴﻴﺪاﺗﻴﻮ در اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ‪ -‬ﻣﻮﻗﺘﻲ‬ ‫در ﻣﻮش ﺻﺤﺮاﻳﻲ‬

‫ﭼﻜﻴﺪه‬

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‫ﻋﺎﺑﺪﻳﻦ وﻛﻴﻠﻲ‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/04/21 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/05/03 :‬‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﻣﻄﺎﻟﻌﺎت ﻣﺘﻌﺪد ﻧﺸﺎن دادهاﻧﺪ زﻋﻔﺮان اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ در ﻣﻘﺎﺑﻞ آﺳﻴﺐ اﻛﺴﻴﺪاﺗﻴﻮ در اﻳﺴﻜﻤﻲ ﮔﻠﻮﺑﺎل‬

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‫ﻣﺤﻤﺪ رﺿﺎ ﻋﻴﻨﻌﻠﻲ‬

‫ﻣﻐﺰي دارد‪ ،‬اﻣﺎ اﺛﺮ آن ﺑﺮ ادم ﻣﻐﺰي و آﺳﻴﺐ اﻛﺴﻴﺪاﺗﻴﻮ در اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ ﻛﺎﻣﻼ ﻣﺸﺨﺺ ﻧﻴﺴﺖ‪ .‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ‬

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‫اﺣﻤﺪ رﺿﺎ ﺑﻨﺪﮔﻲ‬

‫ﺑﺎ ﻫﺪف ﺑﺮرﺳﻲ اﺛﺮ زﻋﻔﺮان ﺑﺮ ادم ﻣﻐﺰي‪ ،‬ﺣﺠﻢ ﺿﺎﻳﻌﺎت ﻣﻐﺰي و ﻣﻴﺰان ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢﻫﺎي آﻧﺘﻲ اﻛﺴﻴﺪاﻧﺖ )آﻧﺰﻳﻢ‬ ‫‪ -1‬ﮔﺮوه ﻓﻴﺰﻳﻮﻟﻮژي‪ ،‬ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت و ﺑﺨﺶ‬

‫ﺳﻮﭘﺮ اﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز و ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪ( و ﻏﻠﻈﺖ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ در ﺑﺎﻓﺖ اﻳﺴﻜﻤﻴﻚ ﻣﻐﺰ در ﻣﺪل ﺗﺠﺮﺑﻲ‬

‫ﻓﻴﺰﻳﻮﻟﻮژي‬

‫ﺳﻜﺘﻪ ﻣﻐﺰي ﻃﺮاﺣﻲ ﺷﺪ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬اﻳﺴﻜﻤﻲ ﻣﻮﺿﻌﻲ ﺑﺎ ﻣﺴﺪود ﻛﺮدن ﻣﻮﻗﺘﻲ ﺷﺮﻳﺎن ﻣﻴﺎﻧﻲ ﻣﻐﺰ ﺑﺮاي ﻣﺪت ﻳﻚ‬

‫‪ -2‬ﮔﺮوه ﺑﻴﻮﺷﻴﻤﻲ‬

‫ﺳﺎﻋﺖ در ﻣﻮش ﺻﺤﺮاﻳﻲ اﻳﺠﺎد ﺷﺪ‪ .‬زﻋﻔﺮان ﺑﺎ دوز ‪ 100mg/kg ip‬در ﺷﺮوع اﻳﺴﻜﻤﻲ ﺑﻪﺻﻮرت داﺧﻞ ﺻﻔﺎﻗﻲ ﺗﺰرﻳﻖ‬

‫داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺳﻤﻨﺎن‪،‬‬

‫و ‪ 24‬ﺳﺎﻋﺖ ﺑﻌﺪ ادم و ﺣﺠﻢ آﺳﻴﺐ ﻣﻐﺰي اﻧﺪازهﮔﻴﺮي ﺷﺪ‪ .‬ﻏﻠﻈﺖ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ و ﻣﻴﺰان ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢ ﺳﻮﭘﺮ‬

‫ﺳﻤﻨﺎن‪ ،‬اﻳﺮان‪.‬‬

‫اﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز و ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪ در ﺑﺎﻓﺖ اﻳﺴﻜﻤﻴﻚ ﻣﻐﺰ ﺑﺎ اﺳﺘﻔﺎده از ﻛﻴﺖ ﻣﺨﺼﻮص اﻧﺪازهﮔﻴﺮي ﺷﺪ‪.‬‬ ‫ﻳﺎﻓﺘﻪﻫﺎ‪ :‬زﻋﻔﺮان ﺣﺠﻢ ﺿﺎﻳﻌﺎت ﻣﻐﺰي را ‪ (P<0/001) %77‬و ادم ﻣﻐﺰي را ‪ (P<0/001) %60‬در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه ﺷﺎﻫﺪ‬ ‫ﻛﺎﻫﺶ داد‪ .‬ﻫﻤﻴﻦﻃﻮر زﻋﻔﺮان ﺑﻪﻃﻮر ﻣﻌﻨﻲداري ﻏﻠﻈﺖ ﺑﺎﻓﺘﻲ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ را ﻛﺎﻫﺶ داده )‪ (P<0/001‬و ﻣﻴﺰان‬ ‫ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢ ﺳﻮﭘﺮ اﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز )‪ (P<0/001‬و ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪ )‪ (P<0/001‬در ﺑﺎﻓﺖ اﻳﺴﻜﻤﻴﻚ ﻛﻮرﺗﻜﺲ‬ ‫ﻣﻐﺰ ﺑﻪﻃﻮر ﻣﻌﻨﻲداري اﻓﺰاﻳﺶ داد‪ .‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬زﻋﻔﺮان اﺛﺮات ﻣﺤﺎﻓﻈﺘﻲ در ﻣﻘﺎﺑﻞ آﺳﻴﺐ اﻛﺴﻴﺪاﺗﻴﻮ اﻳﺴﻜﻤﻴﻚ و ادم‬

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‫ﻣﻐﺰي در ﻣﺪل اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ‪ -‬ﻣﻮﻗﺘﻲ در ﻣﻮش ﺻﺤﺮاﻳﻲ دارد‪ .‬اﻳﻦ اﺛﺮ اﺣﺘﻤﺎﻻ از ﻃﺮﻳﻖ اﻓﺰاﻳﺶ ﻇﺮﻓﻴﺖ‬ ‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺳﻤﻨﺎن‪ ،‬ﻛﻴﻠﻮﻣﺘﺮ ‪ 5‬ﺟﺎده داﻣﻐﺎن‪،‬‬

‫آﻧﺰﻳﻢﻫﺎي آﻧﺘﻲاﻛﺴﻴﺪان و ﻛﺎﻫﺶ ﺗﻮﻟﻴﺪ رادﻳﻜﺎلﻫﺎي آزاد اﻋﻤﺎل ﻣﻲﺷﻮد‪.‬‬

‫داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت و ﺑﺨﺶ ﻓﻴﺰﻳﻮﻟﻮژي‬ ‫ﺗﻠﻔﻦ‪0231-3354161 :‬‬ ‫‪E-mail: Abvakili@yahoo.com‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬زﻋﻔﺮان‪ ،‬آﺳﻴﺐ اﻛﺴﻴﺪاﺗﻴﻮ‪ ،‬اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ‪ ،‬ادم ﻣﻐﺰي‪ ،‬ﻣﻮش ﺻﺤﺮاﻳﻲ‪.‬‬

‫ﻣﻴﺘﻮﻛﻨﺪريﻫﺎ و آزاد ﺷﺪن ﻣﺤﺘﻮﻳﺎت آنﻫﺎ و ﺗﺴﺮﻳﻊ ﺗﻮﻟﻴﺪ رادﻳﻜﺎلﻫﺎي‬

‫ﻣﻘﺪﻣﻪ‬

‫آزاد ﻣﻲﺷﻮد‪ 1.‬ﻛﺎﻫﺶ ﻓﻌﺎﻟﻴﺖ و ﻇﺮﻓﻴﺖ آﻧﺰﻳﻢﻫﺎي آﻧﺘﻲاﻛﺴﻴﺪاﻧﺘﻲ و‬

‫اﻣﺮوزه ﻣﺸﺨﺺ ﺷﺪه اﺳﺖ اﺳﺘﺮسﻫﺎي اﻛﺴﻴﺪاﺗﻴﻮ ﻧﻘﺶ ﻣﺤﻮري در‬

‫اﻓﺰاﻳﺶ رادﻳﻜﺎلﻫﺎي آزاد ﻣﻨﺠﺮ ﺑﻪ وارد ﺷﺪن آﺳﻴﺐ ﺟﺪي ﺑﻪ اﺟﺰاي‬

‫ﭘﺎﺗﻮژﻧﺰ ﺑﻴﻤﺎريﻫﺎي ﻧﻮرودژﻧﺮاﺗﻴﻮ و ﻧﻮروﻟﻮژﻳﻚ ﻧﻈﻴﺮ‪ ،‬آﻟﺰاﻳﻤﺮ‪،‬‬

‫ﺗﺸﻜﻴﻞدﻫﻨﺪه ﺳﻠﻮل ﻧﻈﻴﺮ ﻟﻴﭙﻴﺪﻫﺎ‪ ،‬ﭘﺮوﺗﻴﻴﻦﻫﺎ و اﺳﻴﺪﻫﺎي ﻧﻮﻛﻠﻴﻴﻚ ﺷﺪه‬

‫ﺑﻪدﻧﺒﺎل ﺳﻜﺘﻪ ﻣﻐﺰي و ﻳﺎ‬

‫و در ﻧﻬﺎﻳﺖ ﺑﺎﻋﺚ ﻣﺮگ ﺳﻠﻮﻟﻲ ﻣﻲﮔﺮدد‪ 1.‬ﺷﻮاﻫﺪ ﭘﮋوﻫﺸﻲ ﻧﺸﺎن‬

‫ﻗﻄﻊ ﺟﺮﻳﺎن ﺧﻮن ﺑﻪ ﻗﺴﻤﺘﻲ از ﻣﻐﺰ‪ ،‬ﻏﻠﻈﺖ اﻛﺴﻴﮋن و ﻣﻮاد ﻣﺘﺎﺑﻮﻟﻴﻜﻲ‬

‫ﻣﻲدﻫﻨﺪ‪ ،‬رادﻳﻜﺎلﻫﺎي آزاد ﻧﻘﺶ اﻧﻜﺎرﻧﺎﭘﺬﻳﺮي در ﺗﺸﻜﻴﻞ‪ ،‬ﮔﺴﺘﺮش‬

‫‪2‬و‪1‬‬

‫ﭘﺎرﻛﻴﻨﺴﻮن‪ ،‬ﺗﺮوﻣﺎ و ﺳﻜﺘﻪ ﻣﻐﺰي دارﻧﺪ‪.‬‬

‫‪5-7‬‬

‫ﺑﻪﺳﺮﻋﺖ در ﻧﻮاﺣﻲ اﻳﺴﻜﻤﻴﻚ ﻣﻐﺰ ﻛﺎﻫﺶ ﻳﺎﻓﺘﻪ و در ﻋﺮض ﭼﻨﺪ‬

‫ادم و ﺿﺎﻳﻌﺎت ﺛﺎﻧﻮﻳﻪ ﻣﻐﺰي ﭘﺲ از ﺳﻜﺘﻪ ﻣﻐﺰي دارﻧﺪ‪.‬‬

‫دﻗﻴﻘﻪ ﺑﻪ ﺳﻄﻮح ﻏﻴﺮ ﻗﺎﺑﻞ ﺗﺸﺨﻴﺺ ﻣﻲرﺳﻨﺪ‪ 3.‬ﻛﺎﻫﺶ اﻛﺴﻴﮋن ﺑﺎﻓﺘﻲ در‬

‫اﺳﺘﻔﺎده از ﻣﻮاد و ﻳﺎ داروﻫﺎي ﮔﻴﺎﻫﻲ ﻛﻪ ﺧﺎﺻﻴﺖ آﻧﺘﻲاﻛﺴﻴﺪان ﻗﻮي‬

‫ﻧﺎﺣﻴﻪ اﻳﺴﻜﻤﻴﻚ ﻣﻐﺰ‪ ،‬ﺳﺒﺐ اﺧﺘﻼل در ﻋﻤﻠﻜﺮد ﻣﻴﺘﻮﻛﻨﺪريﻫﺎ و ﺗﻮﻟﻴﺪ‬

‫داﺷﺘﻪ ﺑﺎﺷﺪ‪ ،‬ﻣﻤﻜﻦ اﺳﺖ ﺑﺘﻮاﻧﺪ ﻣﻐﺰ را در ﻣﻘﺎﺑﻞ آﺳﻴﺐﻫﺎي ﻧﺎﺷﻲ از‬

‫رادﻳﻜﺎلﻫﺎي آزاد ﻣﻲﺷﻮد‪ 4.‬از ﻃﺮﻓﻲ ﺑﺮﻗﺮاري ﻣﺠﺪد ﺟﺮﻳﺎن ﺧﻮن ﺑﻌﺪ‬

‫اﻛﺴﻴﺪاﻧﺖﻫﺎ در ﺳﻜﺘﻪ ﻣﻐﺰي ﺗﺎ ﺣﺪودي ﻣﺤﺎﻓﻈﺖ ﻧﻤﻮده و ﺑﺎﻋﺚ‬

‫از وﻗـﻮع ﺳﻜﺘﻪ ﻣﻐﺰي ﺳﺒﺐ اﻓﺰاﻳـﺶ ﺗﻮﻟﻴـﺪ ﭘﺮواﻛﺴﻴـﺪاﻧﺖﻫﺎ‪ ،‬آﺳﻴـﺐ‬

‫ﻛﺎﻫﺶ ﻣﺮگ و ﻣﻴﺮ ﻧﺮوﻧﻲ ﺷﻮد‪ .‬زﻋﻔﺮان ﺑﺎ ﻧﺎم ﻋﻤﻮﻣﻲ ‪ Saffron‬و ﻧﺎم‬

‫ﺑﻨﺎﺑﺮاﻳﻦ‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﻋﺎﺑﺪﻳﻦ وﻛﻴﻠﻲ و ﻫﻤﻜﺎران‬

‫‪406‬‬

‫ﻋﻠﻤﻲ ‪ Crocus Sativus L.‬از ﺧﺎﻧﻮاده زﻧﺒﻘﻴﺎن )‪ (Iridaceae‬ﮔﻴﺎﻫﻲ‬

‫وﻳﺴﺘﺎر )‪ 280-320‬ﮔﺮم( اﺳﺘﻔﺎده ﮔﺮدﻳﺪ‪ .‬ﺣﻴﻮاﻧﺎت در ﺷﺮاﻳﻂ اﺳﺘﺎﻧﺪارد‬

‫ﻋﻠﻔﻲ‪ ،‬ﭼﻨﺪ ﺳﺎﻟﻪ‪ ،‬ﺑﺪون ﺳﺎﻗﻪ و ﭘﻴﺎزدار اﺳﺖ و ﺑﻪﻣﻴﺰان زﻳﺎد در ﻣﻨﺎﻃﻘﻲ‬

‫و دﺳﺘﺮﺳﻲ آزاد ﺑﻪ آب و ﻏﺬا ﻧﮕﻪداري ﺷﺪه و ﻛﻠﻴﻪ آزﻣﺎﻳﺸﺎت ﻣﻄﺎﺑﻖ‬

‫‪8‬‬

‫آﻳﻴﻦﻧﺎﻣﻪ ﻛﻤﻴﺘﻪ اﺧﻼق ﭘﮋوﻫﺸﻲ در ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻓﻴﺰﻳﻮﻟﻮژي داﻧﺸﮕﺎه‬

‫ﻧﻈﻴﺮ ﺳﻮاﺣﻞ ﻣﺪﻳﺘﺮاﻧﻪ‪ ،‬اﻳﺮان‪ ،‬ﻫﻨﺪ‪ ،‬ﺗﺒﺖ‪ ،‬ﭼﻴﻦ‪ ،‬و ﻏﻴﺮه ﻛﺸﺖ ﻣﻲﺷﻮد‪.‬‬

‫زﻋﻔﺮان ﻋﻼوه ﺑﺮ اﻳﻦﻛﻪ ﻳﻚ ﭼﺎﺷﻨﻲ ﻏﺬاﻳﻲ ﭘﺮﻣﺼﺮف اﺳﺖ‪ ،‬اﺛﺮات‬

‫ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺳﻤﻨﺎن در ﺳﺎل ‪ 1389‬اﻧﺠﺎم ﮔﺮدﻳﺪ‪.‬‬

‫ﻓﺎرﻣﺎﻛﻮﻟﻮژﻳﻜﻲ ﻣﺘﻌﺪدي ﻧﻴﺰ دارد‪ 9.‬ﭘﮋوﻫﺶﻫﺎي ﺟﺪﻳﺪ ﻧﺸﺎن ﻣﻲدﻫﻨﺪ‪،‬‬

‫ﭘﺮوﺗﻜﻞ و ﻃﺮح آزﻣﺎﻳﺶ‪ :‬آزﻣﺎﻳﺸﺎت ﻣﺮﺣﻠﻪ اول‪ :‬ﺟﻬﺖ ارزﻳﺎﺑﻲ اﺛﺮ‬

‫زﻋﻔﺮان و ﻣﻮاد ﻣﻮﺛﺮه آن‪ ،‬اﺛﺮات ﺿﺪ ﺗﻮﻣﻮري‪ ،‬آﻧﺘﻲاﻛﺴﻴﺪان‪،‬‬

‫زﻋﻔﺮان )‪ (Sigma-Germany‬ﺑﺮ ﺿﺎﻳﻌﺎت ﻣﻐﺰي‪ 21 ،‬ﺳﺮ ﻣﻮش‬

‫آﻧﺘﻲژﻧﻮﺗﻮﻛﺴﻴﻚ‪ ،‬ﺗﻘﻮﻳﺖﻛﻨﻨﺪه ﺣﺎﻓﻈﻪ و ﻳﺎدﮔﻴﺮي‪ ،‬ﺿﺪ درد و ﺿﺪ‬

‫ﺻﺤﺮاﻳﻲ ﺑﻪ ﺳﻪ ﮔﺮوه ﻫﻔﺖﺗﺎﻳﻲ ﺑﻪﺗﺮﺗﻴﺐ زﻳﺮ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ‪ .‬ﮔﺮوه‬

‫اﻟﺘﻬﺎب‪ ،‬ﺿﺪ ﺗﺸﻨﺞ‪ ،‬ﺿﺪ اﻓﺴﺮدﮔﻲ‪ ،‬ﭘﺎﻳﻴﻦآورﻧﺪه ﻓﺸﺎر ﺧﻮن‪،‬‬

‫ﻛﻨﺘﺮل ﻛﺎذب )‪ :(Sham‬در اﻳﻦ ﮔﺮوه ﻓﻘﻂ ﻋﻤﻞ ﺟﺮاﺣﻲ ﺻﻮرت ﮔﺮﻓﺘﻪ‬

‫اﻓﺰاﻳﺶدﻫﻨﺪه اﻛﺴﻴﮋنرﺳﺎﻧﻲ ﺑﺎﻓﺖﻫﺎ‪ ،‬ﮔﺸﺎد ﻛﻨﻨﺪه ﺑﺮوﻧﺶ‪ ،‬ﺿﺪ ﺳﺮﻓﻪ و‬

‫وﻟﻲ ﺷﺮﻳﺎن ﻣﻴﺎﻧﻲ ﻣﻐﺰ ﺑﺴﺘﻪ ﻧﻤﻲﺷﺪ‪ .‬ﮔﺮوه ﻛﻨﺘﺮل اﻳﺴﻜﻤﻴﻚ‪ :‬در اﻳﻦ‬

‫ﻏﻴﺮه دارد‪ 9-11.‬ﻋﻼوه ﺑﺮ اﻳﻦ‪ ،‬ﻳﺎﻓﺘﻪ آزﻣﺎﻳﺸﮕﺎﻫﻲ ﺟﺪﻳﺪ ﻧﺸﺎن داده اﺳﺖ‪،‬‬

‫ﮔﺮوه ﺳﺎﻟﻴﻦ ﺑﻪﻋﻨﻮان ﺣﻼل دارو ﺑﻼﻓﺎﺻﻠﻪ ﺑﻌﺪ از اﻟﻘﺎي اﻳﺴﻜﻤﻲ‬

‫زﻋﻔﺮان و ﻳﺎ ﻣﻮاد ﻣﻮﺛﺮه آن ﻣﻲﺗﻮاﻧﺪ ﺑﺎﻋﺚ ﻛﺎﻫﺶ ﻗﺎﺑﻞ ﺗﻮﺟﻪ‬

‫ﺑﻪﺻﻮرت داﺧﻞ ﺻﻔﺎﻗﻲ ﺗﺰرﻳﻖ ﺷﺪ‪ .‬ﮔﺮوه درﻣﺎن‪ :‬زﻋﻔﺮان ﺑﺎ دوز‬

‫‪13‬‬

‫‪ 100mg/kg‬ﺑﻪﺻﻮرت داﺧﻞ ﺻﻔﺎﻗﻲ در ﺷﺮوع اﻳﺴﻜﻤﻲ ﺗﺰرﻳﻖ ﺷﺪ‪ .‬در‬

‫ﻣﻲﺷﻮد‪ .‬ﻣﻄﺎﻟﻌﺎﺗﻲ ﻛﻪ در راﺑﻄﻪ ﺑﺎ اﺛﺮ ﻋﺼﺎره ﺗﺎم‬

‫ﻫﻤﻪ اﻳﻦ ﮔﺮوهﻫﺎ ‪ 24‬ﺳﺎﻋﺖ ﺑﻌﺪ اﻳﺴﻜﻤﻲ ﻣﻴﺰان آﺳﻴﺐ ﻣﻐﺰي ﺑﺮرﺳﻲ و‬

‫‪12‬‬

‫آﺳﻴﺐﻫﺎي اﻛﺴﻴﺪاﺗﻴﻮ در ﺑﺎﻓﺖ اﻳﺴﻜﻤﻴﻚ ﻛﻠﻴﻪ‪،‬‬ ‫‪14‬‬

‫ﻗﻠﺐ‬

‫‪15‬‬

‫و ﻣﻐﺰ‬

‫ﻋﻀﻠﻪ اﺳﻜﻠﺘﻲ‪،‬‬

‫زﻋﻔﺮان در اﻳﺴﻜﻤﻲ ﻣﻐﺰي اﻧﺠﺎم ﺷﺪه ﻣﺤﺪود ﺑﻮده و ﻋﻤﺪﺗﺎ ﺗﺎﺛﻴﺮ‬

‫اﻧﺪازهﮔﻴﺮي ﻣﻲﺷﺪ‪.‬‬

‫ﺗﺮﻛﻴﺒﺎت ﻓﻌﺎل آن در اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻗﺮار ﮔﺮﻓﺘﻪ اﺳﺖ‪.‬‬

‫آزﻣﺎﻳﺸﺎت ﻣﺮﺣﻠﻪ دوم‪ :‬ﺟﻬﺖ ارزﻳﺎﺑﻲ اﺛﺮ زﻋﻔﺮان ﺑﺮ ادم ﻣﻐﺰي ‪21‬‬

‫ﻳﺎﻓﺘﻪﻫﺎي ﺟﺪﻳﺪ ﻧﺸﺎن ﻣﻲدﻫﻨﺪ‪ ،‬ﻣﻮاد ﻣﻮﺛﺮه زﻋﻔﺮان ﻣﺜﻞ ﺳﺎﻓﺮﻧﺎل‪،‬‬

‫ﺳﺮ ﻣﻮش ﺻﺤﺮاﻳﻲ ﺑﻪ ﺳﻪ ﮔﺮوه ﻫﻔﺖﺗﺎﻳﻲ ﺗﻘﺴﻴﻢ ﻣﻲﺷﺪﻧﺪ ﻛﻪ ﺷﺎﻣﻞ‬

‫ﻛﺮوﺳﻴﻦ‪ ،‬ﭘﻴﻜﺮوﺗﻮﻛﺴﻴﻦ و ﺗﺮيﻛﺮوﺳﻴﻦ اﺛﺮات ﻣﺤﺎﻓﻈﺘﻲ در ﻣﻘﺎﺑﻞ‬

‫ﮔﺮوه ﻛﻨﺘﺮل ﻛﺎذب )‪ ،(Sham‬ﮔﺮوه ﻛﻨﺘﺮل اﻳﺴﻜﻤﻴﻚ و ﮔﺮوه درﻣﺎن ﺑﺎ‬

‫آﺳﻴﺐ ﻧﺎﺷﻲ اﺳﺘﺮس اﻛﺴﻴﺪاﺗﻴﻮ در ﻣﺪل ﺗﺠﺮﺑﻲ اﻳﺴﻜﻤﻲ ﮔﻠﻮﺑﺎل‪ 16‬و‬

‫زﻋﻔﺮان ﺑﻮد‪ .‬اﻳﻦ ﻣﺮﺣﻠﻪ از آزﻣﺎﻳﺶ ﺷﺒﻴﻪ ﻣﺮﺣﻠﻪ ﻳﻚ ﺑﻮد ﺑﺎ اﻳﻦ ﺗﻔﺎوت‬

‫ﻣﻮﺿﻌﻲ و اﻳﺴﻜﻤﻲ در ﺷﺮاﻳﻂ ‪ 15In vitro‬دارد‪ .‬ﺗﻨﻬﺎ ﻳﻚ ﭘﮋوﻫﺶ ﻧﺸﺎن‬

‫ﻛﻪ ﺑﻪﺟﺎي ﺿﺎﻳﻌﺎت ﻣﻐﺰي‪ ،‬درﺻﺪ ﻣﺤﺘﻮاي آب ﻣﻐﺰ‬

‫‪(%water‬‬

‫داد‪ ،‬ﺗﺠﻮﻳﺰ ﺧﻮراﻛﻲ زﻋﻔﺮان ﻫﻔﺖ روز ﻗﺒﻞ از اﻳﺠﺎد اﻳﺴﻜﻤﻲ ﻣﻐﺰي‬

‫)‪ content‬ﻛﻪ ﺷﺎﺧﺼﻲ از ادم ﻣﻐﺰي اﺳﺖ‪ ،‬ﻣﺤﺎﺳﺒﻪ و اﻧﺪازهﮔﻴﺮي ﺷﺪ‪.‬‬

‫ﻣﻮﺿﻌﻲ ﺑﺎﻋﺚ ﻛﺎﻫﺶ ﻣﺮگ ﻧﺮوﻧﻲ و اﻓﺰاﻳﺶ ﻇﺮﻓﻴﺖ آﻧﺘﻲاﻛﺴﻴﺪاﻧﺘﻲ‬ ‫ﻣﻐﺰ در ﻣﻮش ﺻﺤﺮاﻳﻲ ﻣﻲﺷﻮد‪.‬‬

‫‪11‬‬

‫آزﻣﺎﻳﺸﺎت ﻣﺮﺣﻠﻪ ﺳﻮم‪ :‬ﺟﻬﺖ ﺑﺮرﺳﻲ اﺛﺮ آﻧﺘﻲاﻛﺴﻴﺪاﻧﺘﻲ زﻋﻔﺮان ‪21‬‬ ‫ﺳﺮ ﻣﻮش ﺻﺤﺮاﻳﻲ ﺑﻪ ﺳﻪ ﮔﺮوه ﻫﻔﺖﺗﺎﻳﻲ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ ﻛﻪ ﺷﺎﻣﻞ ﮔﺮوه‬

‫ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ ﻋﺼﺎره زﻋﻔﺮان ﻣﺤﺘﻮي ﻫﻤﻪ ﺗﺮﻛﻴﺒﺎت ﻓﻌﺎل و ﻣﻮاد‬

‫ﻛﻨﺘﺮل ﻛﺎذب )‪ ،(Sham‬ﮔﺮوه ﻛﻨﺘﺮل اﻳﺴﻜﻤﻴﻚ و ﮔﺮوه درﻣﺎن ﺑﺎ زﻋﻔﺮان‬

‫ﻣﻮﺛﺮ اﺳﺖ‪ ،‬اﺣﺘﻤﺎﻻ اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ و آﻧﺘﻲاﻛﺴﻴﺪاﻧﺘﻲ آن ﺑﻴﺸﺘﺮ از ﻛﺎرﺑﺮد‬

‫ﺑﻮد‪ .‬اﻳﻦ ﻣﺮﺣﻠﻪ از آزﻣﺎﻳﺶ ﺷﺒﻴﻪ ﻣﺮﺣﻠﻪ ﻳﻚ ﺑﻮد ﺑﺎ اﻳﻦ ﺗﻔﺎوت ﻛﻪ‬

‫ﻣﺠﺰاي ﺗﺮﻛﻴﺒﺎت ﻣﻮﺛﺮ آن در اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﺧﻮاﻫﺪ ﺑﻮد‪ .‬از ﻃﺮﻓﻲ‬

‫ﻏﻠﻈﺖ ﺑﺎﻓﺘﻲ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ )‪ Malondialdehyde (MDA‬ﺑﺎ اﺳﺘﻔﺎده‬

‫ﺗﺎﻛﻨﻮن ﺗﺎﺛﻴﺮ زﻋﻔﺮان و ﻣﻮاد ﻣﻮﺛﺮ آن ﺑﺮ ادم ﻣﻐﺰي ﻣﻮرد ﺗﺤﻘﻴﻖ و‬

‫از روش ﺗﻴﻮﺑﺎرﺑﻴﺘﻮرﻳﻚ اﺳﻴﺪ و ﺳﻄﺢ ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢﻫﺎي ﺳﻮﭘﺮ اﻛﺴﻴﺪ‬ ‫)‪(SOD‬‬

‫ﭘﮋوﻫﺶ ﻗﺮار ﻧﮕﺮﻓﺘﻪ اﺳﺖ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ‪ ،‬ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺑﺮرﺳﻲ اﺛﺮ‬

‫دﻳﺲﻣﻮﺗﺎز‬

‫زﻋﻔﺮان ﺑﺮ ادم‪ ،‬ﻣﻴﺰان آﺳﻴﺐ ﻣﻐﺰي و ﻫﻤﻴﻦﻃﻮر ﺳﻄﺢ ﻓﻌﺎﻟﻴﺖ‬

‫ﻛﻮرﺗﻜﺲ ﻣﻐﺰ ﺑﺎ اﺳﺘﻔﺎده از ﻛﻴﺖ ﻣﺨﺼﻮص‬

‫آﻧﺰﻳﻢﻫﺎي اﻛﺴﻴﺪاﺗﻴﻮ )آﻧﺰﻳﻢ ﺳﻮﭘﺮ اﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز و ﮔﻠﻮﺗﺎﺗﻴﻮن‬

‫)‪ Crumlin, UK‬اﻧﺪازهﮔﻴﺮي ﺷﺪ‪.‬‬

‫ﭘﺮاﻛﺴﻴﺪ( و ﻏﻠﻈﺖ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ در ﺑﺎﻓﺖ اﻳﺴﻜﻤﻴﻚ ﻛﻮرﺗﻜﺲ‬ ‫ﻣﻐﺰي در ﻣﺪل ﺗﺠﺮﺑﻲ ﺳﻜﺘﻪ ﻣﻐﺰي ﻃﺮاﺣﻲ ﺷﺪ‪.‬‬

‫و ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪ‬

‫)‪(GPX‬‬

‫و در ﺑﺎﻓﺖ اﻳﺴﻜﻤﻴﻚ‬

‫‪(Randox Laboratories,‬‬

‫اﻳﺠﺎد اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ‪ :‬ﺟﻬﺖ اﻳﺠﺎد اﻳﺴﻜﻤﻲ ﻣﻐﺰي‬ ‫ﻣﻮﺿﻌﻲ‪ -‬ﻣﻮﻗﺘﻲ‪ ،‬اﺑﺘﺪا ﻣﻮشﻫﺎي ﺻﺤﺮاﻳﻲ ﺑﺎ ﺗﺰرﻳﻖ ﻛﻠﺮال ﻫﻴﺪرات‬ ‫)‪ (Fluka-Germany‬ﺑﺎ دوز )‪ (400mg/kg ip‬ﺑﻴﻬﻮش ﻣﻲﺷﺪﻧﺪ‪ .‬ﺑﻌﺪ از‬

‫روش ﺑﺮرﺳﻲ‬

‫اﻃﻤﻴﻨﺎن از ﻋﻤﻴﻖ ﺑﻮدن ﺑﻴﻬﻮﺷﻲ‪ ،‬ﺟﻬﺖ ﺛﺒﺖ ﺟﺮﻳﺎن ﺧﻮن ﻣﻮﺿﻌﻲ ﻣﻐﺰ‪،‬‬

‫در اﻳـﻦ ﻣﻄﺎﻟﻌﻪ ﺗﺠﺮﺑﻲ از ﺗﻌﺪاد ‪ 63‬ﺳﺮ ﻣﻮشﻫﺎي ﺻﺤﺮاﻳـﻲ ﻧﺮ ﻧﮋاد‬

‫اﺑﺘﺪا ﭘﻮﺳﺖ ﻧﺎﺣﻴﻪ ﮔﻴﺠﮕﺎﻫﻲ زاوﻳﻪ ﺑﻴﻦ ﭼﺸﻢ و ﮔﻮش ﺣﻴﻮان ﺑﺮش‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪407‬‬

‫اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ زﻋﻔﺮان در آﺳﻴﺐﻫﺎي اﻛﺴﻴﺪاﺗﻴﻮ اﻳﺴﻜﻤﻲ ﻣﻐﺰي در ﻣﻮش‬

‫‪NIH Image analyzer‬‬

‫داده و ﻋﻀﻠﻪ ﮔﻴﺠﮕﺎﻫﻲ در ﻣﺤﻞ ﭼﺴﺒﻨﺪﮔﻲ ﺑﻪ اﺳﺘﺨﻮان ﺟﺪا ﻧﻤﻮده و‬

‫اﺳﺘﻔﺎده از ﻧﺮماﻓﺰار‬

‫ﺳﭙﺲ ﺑﺎ ﻛﻤﻚ ﻣﻴﻜﺮودرﻳﻞ ﺣﻔﺮهاي ﻛﻮﭼﻚ در ﺳﻄﺢ اﺳﺘﺨﻮان‬

‫ﻣﺤﺎﺳﺒﻪ ﺣﺠﻢ‪ ،‬ﺳﻄﺢ ﺿﺎﻳﻌﻪ ﻣﻘﺎﻃﻊ در ﺿﺨﺎﻣﺖ ﺑﺮش ﺿﺮب ﺷﺪ‪.‬‬

‫ﮔﻴﺠﮕﺎﻫﻲ اﻳﺠﺎد ﺷﺪ‪ .‬ﺳﭙﺲ ﺑﺮاي اﻳﺠﺎد اﻳﺴﻜﻤﻲ ﻣﻮﺿﻌﻲ ﻣﻐﺰ‪ ،‬در زﻳﺮ‬

‫ﺣﺠﻢ ﻛﻞ ﺿﺎﻳﻌﻪ ﻣﻐﺰي ﻧﻴﺰ از ﺣﺎﺻﻞ ﺟﻤﻊ ﺿﺎﻳﻌﺎت در ﻫﻔﺖ ﺑﺮش‬

‫ﻣﻴﻜﺮوﺳﻜﻮپ ﺑﺮﺷﻲ ﺑﻪﻃﻮل دو ﺳﺎﻧﺘﻲﻣﺘﺮ در ﺟﻠﻮ ﮔﺮدن ﺣﻴﻮان اﻳﺠﺎد‬

‫ﻣﻐﺰي ﺑﻪدﺳﺖ ﻣﻲآﻣﺪ‪.‬‬

‫اﻧﺪازهﮔﻴﺮي ﺷﺪ‪ .‬ﺑﺮاي‬

‫‪18‬‬

‫و ﻋﻀﻼت اﻳﻦ ﻧﺎﺣﻴﻪ ﻛﻨﺎر زده ﺷﺪه و ﺷﺮﻳﺎنﻫﺎي ﻛﺎروﺗﻴﺪ ﻣﺸﺘﺮك و‬

‫ارزﻳﺎﺑﻲ ادم ﻣﻐﺰي‪ :‬ﺣﺪود ‪ 24‬ﺳﺎﻋﺖ ﺑﻌﺪ از اﻳﺴﻜﻤﻲ ﺣﻴﻮان ﻛﺸﺘﻪ‬

‫ﺷﺎﺧﻪﻫﺎي آن ﻛﺎروﺗﻴﺪ ﺧﺎرﺟﻲ و داﺧﻠﻲ را از ﺑﺎﻓﺖ ﻫﻢﺑﻨﺪ و ﻋﺼﺐ‬

‫ﺷﺪه و ﻣﻐﺰ ﺑﻪدﻗﺖ ﺧﺎرج ﻣﻲﮔﺮدد‪ .‬ﺳﭙﺲ ﭘﻴﺎز ﺑﻮﻳﺎي و ﭘﻞ ﻣﻐﺰي را‬

‫ﺟﺪا و اﻳﺰوﻟﻪ ﺷﺪ‪ .‬ﺷﺎﺧﻪﻫﺎي ﺷﺮﻳﺎن ﻛﺎروﺗﻴﺪ ﺧﺎرﺟﻲ ﺑﺎ اﺳﺘﻔﺎده از‬

‫ﺟﺪا ﻧﻤﻮده و ﻧﻴﻢﻛﺮه اﻳﺴﻜﻤﻴﻚ و ﺳﺎﻟﻢ ﻣﻐﺰ را ﺑﺎ ﻛﻤﻚ‬

‫‪Brain matrix‬‬

‫دﺳﺘﮕﺎه ﻛﻮﺗﺮي ﺟﻬﺖ ﺟﻠﻮﮔﻴﺮي از ﺧﻮنرﻳﺰي ﺳﻮزاﻧﺪه و ﻣﺴﺪود ﺷﺪ‪.‬‬

‫و ﺑﺎ دﻗﺖ ﺑﺴﻴﺎر زﻳﺎد ﺟﺪا ﻧﻤﻮده و وزن ﻣﺮﻃﻮب دو ﻧﻴﻢﻛﺮه ﺑﻪوﺳﻴﻠﻪ‬

‫در اداﻣﻪ ﺷﺮﻳﺎن ﻛﺎروﺗﻴﺪ ﺧﺎرﺟﻲ و ﺷﺮﻳﺎن ﻛﺎروﺗﻴﺪ ﻣﺸﺘﺮك ﺑﻪﺻﻮرت‬

‫ﺗﺮازوي دﻗﻴﻖ ﺑﻪدﺳﺖ ﻣﻲآﻳﺪ‪ .‬در اداﻣﻪ ﺟﻬﺖ ﺑﻪدﺳﺖ آوردن وزن‬

‫داﻳﻤﻲ و ﺷﺮﻳﺎن ﻛﺎروﺗﻴﺪ داﺧﻠﻲ ﺑﻪوﺳﻴﻠﻪ ﻣﻴﻜﺮوﻛﻼﻣﭗ ﺑﻪﻃﻮر ﻣﻮﻗﺖ‬

‫ﺧﺸﻚ ﻫﺮ ﻧﻴﻢﻛﺮه آنﻫﺎ را در داﺧﻞ ‪ Oven‬ﺑﺎ درﺟﻪ ﺣﺮارت ‪110 C‬‬

‫ﻣﺴﺪود ﻣﻲﺷﺪ‪ .‬ﺳﭙﺲ ﻧﺦ ﻧﺎﻳﻠﻮن ﺑﺎ ﺷﻤﺎره ‪ 3/0‬ﻛﻪ ﻧﻮك آن ﺟﻠﻮ ﺷﻌﻠﻪ‬

‫ﺑﺮاي ﻣﺪت ‪ 24‬ﺳﺎﻋﺖ ﻗﺮار داده ﺷﺪ‪ .‬در ﻧﻬﺎﻳﺖ در ﺻﺪ ﻣﺤﺘﻮاي آب‬

‫ﮔﺮده ﺷﺪه ﺑﻮد را از ﻃﺮﻳﻖ ﺑﺮﺷﻲ ﻛﻮﭼﻚ ﻛﻪ در ﺷﺮﻳﺎن ﻛﺎروﺗﻴﺪ‬ ‫ﺧﺎرﺟﻲ اﻳﺠﺎد ﮔﺮدﻳﺪه وارد ﺷﺮﻳﺎن ﻛﺎروﺗﻴﺪ داﺧﻠﻲ ﻣﻲﺷﺪ‪ .‬ﺑﻌﺪ از اﻳﻦ‬

‫ﻣﻐﺰ ﻛﻪ ﺷﺎﺧﺺ ﻣﻴﺰان ادم ﻣﻐﺰي اﺳﺖ ﺑﺎ ﻓﺮﻣﻮل زﻳﺮ ﺑﻪدﺳﺖ آﻣﺪ‪.‬‬ ‫‪× 100‬‬

‫اﺧﺘﻼف وزن ﻣﺮﻃﻮب و ﺧﺸﻚ ﻧﻴﻢﻛﺮه‬

‫‪19‬‬

‫= ‪ %‬ﻣﺤﺘﻮاي آب ﻣﻐﺰ‬

‫وزن ﻣﺮﻃﻮب ﻧﻴﻢﻛﺮه‬

‫ﻣﺮﺣﻠﻪ ﭘﺮوب ﺟﺮﻳﺎنﺳﻨﺞ ﻟﻴﺰري در ﻣﺤﻞ ﺧﻮد در اﺳﺘﺨﻮان ﮔﻴﺠﮕﺎﻫﻲ‬ ‫ﺛﺎﺑﺖ ﺷﺪه و ﺟﺮﻳﺎن ﺧﻮن ﭘﺎﻳﻪ ﻣﻐﺰ ﺑﺮاي ‪ 15‬دﻗﻴﻘﻪ ﺛﺒﺖ ﻣﻲﺷﺪ‪ ،‬ﺑﻌﺪ از‬

‫اﻧﺪازهﮔﻴﺮي ﺳﻄﺢ ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢ ﺳﻮﭘﺮ اﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز و ﮔﻠﻮﺗﺎﺗﻴﻮن‬

‫ﺗﺜﺒﻴﺖ ﺟﺮﻳﺎن ﺧﻮن‪ ،‬ﻧﺦ ﻧﺎﻳﻠﻮن داﺧﻞ ﺷﺮﻳﺎن ﻛﺎروﺗﻴﺪ داﺧﻠﻲ ﺑﻪآراﻣﻲ‬

‫ﭘﺮاﻛﺴﻴﺪ و ﺗﻌﻴﻴﻦ ﻏﻠﻈﺖ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ در ﺑﺎﻓﺖ اﻳﺴﻜﻤﻴﻚ ﻣﻐﺰي‪:‬‬

‫ﺑﻪداﺧﻞ ﻣﻐﺰ ﻫﺪاﻳﺖ ﻣﻲﺷﺪ ﺗﺎ ﺟﺮﻳﺎن ﺧﻮن ﻣﻮﺿﻌﻲ ﺑﻪ ﻛﻤﺘﺮ از ‪ %15‬ﺗﺎ‬

‫ﺑﻴﺴﺖ و ﭼﻬﺎر ﺳﺎﻋﺖ ﺑﻌﺪ از اﻳﺴﻜﻤﻲ ﻣﻐﺰي‪ ،‬ﺣﻴﻮان ﺗﺤﺖ ﺑﻴﻬﻮﺷﻲ‬

‫‪ %20‬ﻣﻴﺰان ﭘﺎﻳﻪ ﻛﺎﻫﺶ ﻳﺎﺑﺪ‪ 17.‬ﻳﻚ ﺳﺎﻋﺖ ﺑﻌﺪ از اﻳﺴﻜﻤﻲ ﻧﺦ ﻧﺎﻳﻠﻮن‬

‫ﻋﻤﻴﻖ ﻛﺸﺘﻪ و ﻣﻐﺰ ﺧﺎرج ﺷﺪه و ﻛﻮرﺗﻜﺲ از ﺑﻘﻴﻪ ﻗﺴﻤﺖﻫﺎي ﻣﻐﺰ ﺑﺎ‬

‫ﺑﻪآراﻣﻲ ﺧﺎرج و ﺟﺮﻳﺎن ﺧﻮن ﻣﺠﺪد ﺑﺮاي ‪ 23‬ﺳﺎﻋﺖ در ﺷﺮﻳﺎن ﻣﻴﺎﻧﻲ‬

‫دﻗﺖ ﺟﺪا ﺷﺪه و در ﻇﺮف ﻣﺨﺼﻮص در دﻣﺎي ‪ -70 C‬ﺗﺎ زﻣﺎن اﻧﺠﺎم‬

‫ﻣﻐﺰ ﺑﺮﻗﺮار ﻣﻲﺷﺪ‪ .‬در ﻃﻮل ﻳﻚ ﺳﺎﻋﺖ اﻳﺴﻜﻤﻲ و ﺗﺎ ‪ 15‬دﻗﻴﻘﻪ ﺑﻌﺪ از‬

‫آزﻣﺎﻳﺶ ﻧﮕﻪداري ﻣﻲﺷﺪ‪ .‬ﻧﻤﻮﻧﻪﻫﺎ در ﻫﻨﮕﺎم آزﻣﺎﻳﺶ در ﺑﺎﻓﺮ‬ ‫‪G‬‬

‫ﺧﺎرج ﻛﺮدن ﻧﺦ و ﺑﺮﻗﺮاري ﻣﺠﺪد ﺟﺮﻳﺎن ﺧﻮن‪ ،‬ﺟﺮﻳﺎن ﺧﻮن ﻣﻮﺿﻌﻲ‬

‫ﻣﺨﺼﻮص ﻫﻤﻮژﻧﻴﺰه و در‬

‫ﺗﻮﺳﻂ دﺳﺘﮕﺎه ﺟﺮﻳﺎنﺳﻨﺞ ﻟﻴﺰري ﻫﺮ ﭘﻨﺞ دﻗﻴﻘﻪ ﺛﺒﺖ و ﻳﺎدداﺷﺖ‬

‫ﻣﺤﻠﻮل روﻳﻲ )‪ (Supernatant‬ﻧﻤﻮﻧﻪ ﺟﻬﺖ اﻧﺪازهﮔﻴﺮي ﻓﻌﺎﻟﻴﺖ‬

‫ﻣﻲﺷﺪ‪ 17.‬در ﺿﻤﻦ درﺟﻪ ﺣﺮارت ﺣﻴﻮان از ﻃﺮﻳﻖ رﻛﺘﺎل ﻛﻨﺘﺮل و در‬

‫آﻧﺰﻳﻢﻫﺎي ‪ SOD‬و ‪ ،GPX‬ﺗﻌﻴﻴﻦ ﻏﻠﻈﺖ ‪ MDA‬و ﭘﺮوﺗﻴﻴﻦ اﺳﺘﻔﺎده ﺷﺪ‪.‬‬

‫ﺗﻤﺎم ﻃﻮل ﻣﺪت ﺟﺮاﺣﻲ ﺗﺎ ﺑﻪﻫﻮش آﻣﺪن ﻛﺎﻣﻞ ﺣﻴﻮان در ﻣﺤﺪوده‬ ‫ﻓﻴﺰﻳﻮﻟﻮژﻳﻚ ﻧﮕﻪ داﺷﺘﻪ ﻣﻲﺷﺪ‪.‬‬ ‫ﺗﻌﻴﻴﻦ ﺣﺠﻢ ﺿﺎﻳﻌﻪ ﻣﻐﺰي‪ :‬ﺗﺤﺖ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻴﻖ ﺣﻴﻮان ﻛﺸﺘﻪ و‬

‫‪ 20000‬ﺳﺎﻧﺘﺮﻳﻔﻮژ ﺷﺪﻧﺪ‪ .‬ﺳﭙﺲ از‬

‫ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢﻫﺎي ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪاز و ﺳﻮﭘﺮاﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز و‬ ‫ﺑﺎ اﺳﺘﻔﺎده از ﻛﻴﺖﻫﺎي ﺷﺮﻛﺖ راﻧﺪوﻛﺲ‬ ‫)‪UK‬‬

‫‪(Randox Laboratories,‬‬

‫‪ Crumlin,‬و ﺑﺮ اﺳﺎس دﺳﺘﻮراﻟﻌﻤﻞ ﺷﺮﻛﺖ ﺳﺎزﻧﺪه و ﺑﺎ ﻛﻤﻚ‬

‫ﺳﺮش ﺟﺪا و ﻣﻐﺰ ﺧﺎرج ﺷﺪ‪ .‬ﺑﺮاي ﺑﺮش ﮔﻴﺮي‪ ،‬ﻣﻐﺰ را ﺑﻪﻣﺪت ﭘﻨﺞ‬

‫دﺳﺘﮕﺎه ﻓﺘﻮﻣﺘﺮ )‪ (Stat fax 3300-USA‬اﻧﺪازهﮔﻴﺮي ﮔﺮدﻳﺪ‪ 20.‬ﺑﺮاي ﺗﻌﻴﻴﻦ‬

‫دﻗﻴﻘﻪ در ﻣﺤﻠﻮل ﺳﺮم ﻓﻴﺰﻳﻮﻟﻮژي ﭼﻬﺎر درﺟﻪ ﻗﺮار داده‪ ،‬ﺳﭙﺲ ﺑﻪﻛﻤﻚ‬

‫ﻏﻠﻈﺖ ﭘﺮوﺗﻴﻴﻦ از روش ﺑﺮادﻓﻮرد اﺳﺘﻔﺎده ﺷﺪ‪ 20 .‬ﺑﺮاي اﻳﻦ ﻣﻨﻈﻮر دو‬

‫‪ Brain matrix‬ﻫﻔﺖ ﺑﺮش ﺑﻪﻗﻄﺮ دو ﻣﻴﻠﻲﻣﺘﺮ از ﻣﻐﺰ ﺗﻬﻴﻪ ﻣﻲﮔﺮدﻳﺪ‪.‬‬

‫ﻣﻴﻠﻲﻟﻴﺘﺮ از ﻣﺤﻠﻮل ﺑﺮادﻓﻮرد ﺑﻪ ‪ 40‬ﻣﻴﻜﺮوﻟﻴﺘﺮ از ﻣﺤﻠﻮل ﻫﻤﻮژﻧﻴﺰه‬

‫ﺟﻬﺖ رﻧﮓآﻣﻴﺰي‪ ،‬ﺑﺮشﻫﺎ را ﺑﻪﻣﺪت ‪ 15‬دﻗﻴﻘﻪ در ﻣﺤﻠﻮل دو درﺻﺪ‬

‫ﻧﻤﻮﻧﻪ ﺑﺎﻓﺘﻲ اﺿﺎﻓﻪ ﺷﺪه و ﺑﻪﻣﺪت ﭘﻨﺞ دﻗﻴﻘﻪ در دﻣﺎي آزﻣﺎﻳﺸﮕﺎه اﻧﻜﻮﺑﻪ‬

‫ﺗﺮيﻓﻨﻴﻞ ﺗﺘﺮازوﻟﻴﻮم ﻛﻠﺮاﻳﺪ )‪ (Sigma-Germany‬ﻗﺮار داده ﺷﺪ‪ .‬در اﻳﻦ‬

‫ﺷﺪ‪ .‬ﺳﭙﺲ در ﻃﻮل ﻣﻮج ‪ 595‬ﻧﺎﻧﻮﻣﺘﺮ و در ﺑﺮاﺑﺮ ﺑﻼﻧﻚ ﻣﻌﺮف ﺟﺬب‬

‫روش رﻧﮓآﻣﻴﺰي ﻣﻨﻄﻘﻪ ﺿﺎﻳﻌﻪ دﻳﺪه ﺑﻪ رﻧﮓ ﺳﻔﻴﺪ و ﻣﻨﻄﻘﻪ ﻧﺮﻣﺎل ﻣﻐﺰ‬

‫آن ﻗﺮاﺋﺖ ﺷﺪ‪ .‬ﻣﻨﺤﻨﻲ اﺳﺘﺎﻧﺪارد ﺑﺎ اﺳﺘﻔﺎده از ﺳﺮم آﻟﺒﻮﻣﻴﻦ ﮔﺎوي رﺳﻢ‬

‫ﺑﻪ رﻧﮓ ﻗﺮﻣﺰ آﺟﺮي در ﻣﻲآﻳﺪ‪ 18.‬در ﭘﺎﻳﺎن ﺑﺎ دورﺑﻴﻦ دﻳﺠﻴﺘﺎﻟﻲ از‬

‫و ﻏﻠﻈﺖ ﭘﺮوﺗﻴﻴﻦ ﺑﺎﻓﺖ ﺑﺮ اﺳﺎس آن اﻧﺪازهﮔﻴﺮي ﮔﺮدﻳﺪ‪ .‬از روش‬

‫ﺑﺮشﻫﺎ ﻋﻜﺲ ﮔﺮﻓﺘﻪ و ﺑﻪ ﻛﺎﻣﭙﻴﻮﺗﺮ ﻣﻨﺘﻘﻞ و ﺳﻄﺢ ﻧﺎﺣﻴﻪ ﺿﺎﻳﻌﻪ دﻳﺪه ﺑﺎ‬

‫ﺗﻴﻮﺑﺎرﺑﻴﺘﻮرﻳﻚ اﺳﻴﺪ ﺑﺮاي اﻧﺪازه ﻏﻠﻈﺖ ﺑﺎﻓﺘﻲ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ اﺳﺘﻔﺎده‬

‫‪20‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﻋﺎﺑﺪﻳﻦ وﻛﻴﻠﻲ و ﻫﻤﻜﺎران‬

‫‪408‬‬

‫ﺷﺪ‪ 21.‬ﺑﺮاي اﻧﺪازهﮔﻴﺮي ﻏﻠﻈﺖ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ در ﺑﺎﻓﺖ اﻳﺴﻜﻤﻴﻚ‬

‫ﺧﻠﻔﻲ ﻣﻐﺰ را ﺑﻪﻃﻮر ﻣﻌﻨﻲداري در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه ﺳﺎﻟﻴﻦ ﻛﺎﻫﺶ داد‬

‫ﻣﻐﺰ‪ 250 ،‬ﻣﻴﻜﺮوﻟﻴﺘﺮ از ﻣﺤﻠﻮل روﻳﻲ ﻧﻤﻮﻧﻪ اوﻟﻴﻪ را ﺑﺎ ‪ 1/5‬ﻣﻴﻠﻲﻟﻴﺘﺮ‬

‫)‪ ،P<0/001‬ﻧﻤﻮدار ‪ .(3‬درﺻﺪ ﻣﺤﺘﻮاي آب ﻣﻐﺰ ﺑﻴﺴﺖ و ﭼﻬﺎر ﺳﺎﻋﺖ‬

‫اﺳﻴﺪ ﻓﺴﻔﺮﻳﻚ ‪ %1‬و ﻧﻴﻢ ﻣﻴﻠﻲﻟﻴﺘﺮ ﻣﺤﻠﻮل آﺑﻲ ﺗﻴﻮﺑﺎرﺑﻴﺘﻮرﻳﻚ اﺳﻴﺪ ‪0/6‬‬

‫ﺑﻌﺪ از ﺟﺮاﺣﻲ در ﻧﻴﻢﻛﺮهﻫﺎي ﭼﭗ )ﻏﻴﺮ اﻳﺴﻜﻤﻴﻚ( در ﮔﺮوه ﻛﻨﺘﺮل‬

‫درﺻﺪ ﻣﺨﻠﻮط ﻛﺮده و ﺑﻪﻣﺪت ‪ 45‬دﻗﻴﻘﻪ در دﺳﺘﮕﺎه ﺑﻦ ﻣﺎري ﻗﺮار داد‬

‫ﻛﺎذب ‪ ،78/2±0/3‬ﮔﺮوه ﻛﻨﺘﺮل ﺳﺎﻟﻴﻦ ‪ 78/4±0/3‬و در ﮔﺮوه زﻋﻔﺮان‬

‫ﻣﻲﺷﺪ‪ .‬ﭘﺲ از ﺧﻨﻚ ﺷﺪن دو ﻣﻴﻠﻲﻟﻴﺘﺮ ﻣﺤﻠﻮل ‪ n-butanol‬ﺑﻪ ﻣﺤﻠﻮل‬

‫‪ 78/5±0/32‬ﺑﻮد ﻛﻪ اﺧﺘﻼف ﻣﻌﻨﻲداري وﺟﻮد ﻧﺪاﺷﺖ )‪،P>0/05‬‬

‫ﻓﻮق اﻓﺰوده ﺷﺪه و ﺑﻪﻣﺪت ‪ 10‬دﻗﻴﻘﻪ در ‪ 3000G‬ﺳﺎﻧﺘﺮﻳﻔﻴﻮژ ﮔﺮدﻳﺪ‪.‬‬

‫ﻧﻤﻮدار ‪ .(3‬اﻳﺠﺎد ﺳﻜﺘﻪ ﻣﻐﺰي ﻣﻮﺿﻌﻲ ﺑﻪﻃﻮر ﻣﻌﻨﻲداري ﺑﺎﻋﺚ اﻓﺰاﻳﺶ‬

‫ﻣﺤﻠﻮل روﻳﻲ ﻧﻤﻮﻧﻪ ﺑﻪ ﻳﻚ ﻟﻮﻟﻪ ﺗﺎزه ﻣﻨﺘﻘﻞ ﮔﺸﺘﻪ و ﺟﺬب ﻧﻮري آن در‬

‫درﺻﺪ ﻣﺤﺘﻮاي آب ﻣﻐﺰ در ﻧﻴﻢﻛﺮه اﻳﺴﻜﻤﻴﻚ )‪ (82/4±0/78‬و ﭼﻬﺎر‬

‫ﻃﻮل ﻣﻮج ‪ 535‬ﻧﺎﻧﻮﻣﺘﺮ اﻧﺪازهﮔﻴﺮي ﮔﺮدﻳﺪ و ﺑﺎ ﻣﻨﺤﻨﻲ اﺳﺘﺎﻧﺪارد ﻛﻪ از‬

‫درﺻﺪي ادم ﻣﻐﺰي ﺷﺪ )‪ ،P<0/001‬ﻧﻤﻮدار ‪ .(4‬ﺗﺠﻮﻳﺰ زﻋﻔﺮان ﺑﺎ دوز‬

‫ﻣﺤﻠﻮلﻫﺎي اﺳﺘﺎﻧﺪارد ﺗﻬﻴﻪ ﺷﺪه از ‪ -3 ،3 ،1 ،1‬ﺗﺘﺮاﻣﺘﻴﻞ ﭘﺮوﭘﺎن‬

‫‪ 100mg/kg‬در ﺷﺮوع اﻳﺴﻜﻤﻲ ﺑﺎﻋﺚ ﻛﺎﻫﺶ ﻣﻌﻨﻲدار درﺻﺪ ﻣﺤﺘﻮاي‬

‫ﺑﻪدﺳﺖ آﻣﺪه ﺑﻮد‪ ،‬ﺧﻮاﻧﺪه ﺷﺪ‪ .‬ﻏﻠﻈﺖ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ ﺑﺮ ﺣﺴﺐ‬

‫آب ﻣﻐﺰ )‪ (80/1±0/43‬ﺷﺪه و ادم ﻣﻐﺰي را ﺑﻪﻣﻴﺰان ‪ %60‬در ﻣﻘﺎﻳﺴﻪ‬

‫ﻧﺎﻧﻮﻣﻮل ﺑﺮ ﻣﻴﻠﻲﮔﺮم ﭘﺮوﺗﻴﻴﻦ ﺑﻴﺎن ﺷﺪ‪ 21.‬ﻧﺘﺎﻳﺞ ﺑﻪﺻﻮرت‬

‫ﻣﻴﺎﻧﮕﻴﻦ‪±‬‬

‫ﺑﺎ ﮔﺮوه ﻛﻨﺘﺮل ﻳﺎ ﺳﺎﻟﻴﻦ ﻛﺎﻫﺶ داد )‪ ،P<0/001‬ﻧﻤﻮدار ‪.(4‬‬

‫اﻧﺤﺮاف ﻣﻌﻴﺎر )‪ (MeanSD‬ﺑﻴﺎن ﺷﺪه اﺳﺖ‪ .‬آزﻣﻮن آﻣﺎري ﻧﺸﺎن داد‬

‫‪ -3‬ﺗﺎﺛﻴﺮ زﻋﻔﺮان ﺑﺮ ﻏﻠﻈﺖ ﺑﺎﻓﺘﻲ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ در ﻛﻮرﺗﻜﺲ ﻣﻐﺰ‪:‬‬

‫ﺗﻮزﻳﻊ داده در ﻣﻮرد درﺻﺪ آب ﻣﻐﺰ و آﻧﺰﻳﻢﻫﺎي آﻧﺘﻲاﻛﺴﻴﺪانﻫﺎ ﻧﺮﻣﺎل‬

‫ﻏﻠﻈﺖ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ در ﻛﻮرﺗﻜﺲ ﺑﻴﺴﺖ و ﭼﻬﺎر ﺳﺎﻋﺖ ﺑﻌﺪ از‬

‫‪One Way‬‬

‫ﺟﺮاﺣﻲ در ﮔﺮوه ﻛﻨﺘﺮل ﻛﺎذب ‪ 2/2±0/38nmol/mg Protein‬ﺑﻮد‪،‬‬

‫و روش ‪ Dennett's‬ﺑﻪﻋﻨﻮان ‪ Post-hoc analysis‬ﺑﺮاي آﻧﺎﻟﻴﺰ‬

‫اﻳﺠﺎد ﺳﻜﺘﻪ ﻣﻐﺰي ﻣﻮﺟﺐ اﻓﺰاﻳﺶ ﻏﻠﻈﺖ ﺑﺎﻓﺘﻲ ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ‬

‫آﻣﺎري اﺳﺘﻔﺎده ﮔﺮدﻳﺪ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ آزﻣﻮن آﻣﺎري ﻧﺸﺎن داد ﺗﻮزﻳﻊ‬

‫)‪ (3/6±0/27nmol/mg Protein‬ﺑﻪﻣﻴﺰان ﻣﻌﻨﻲدار ﮔﺮدﻳﺪ )‪.(P≤0/001‬‬

‫داده در ﻣﻮرد ﺣﺠﻢ ﺿﺎﻳﻌﺎت ﻣﻐﺰي ﻧﺮﻣﺎل ﻧﺒﻮد‪ ،‬ﺑﺮاي ﻣﻘﺎﻳﺴﻪ ﺑﻴﻦ دو‬

‫ﺗﺠﻮﻳﺰ زﻋﻔﺮان در ﺷﺮوع اﻳﺴﻜﻤﻲ ﺑﺎﻋﺚ ﻛﺎﻫﺶ ﻣﻌﻨﻲدار ﻏﻠﻈﺖ ﺑﺎﻓﺘﻲ‬

‫ﮔﺮوه از آزﻣﻮن ‪ Mann-Whitney U-test‬ﺑﺮاي آﻧﺎﻟﻴﺰ آﻣﺎري اﺳﺘﻔﺎده‬

‫ﻣﺎﻟﻮن دي آﻟﺪﻳﻴﺪ )‪ (3/1±0/26nmol/mg Protein‬ﺷﺪ )‪.(P≤0/001‬‬

‫ﺑﻮد‪ ،‬ﺑﻨﺎﺑﺮاﻳﻦ ﺑﺮاي ﻣﻘﺎﻳﺴﻪ ﺑﻴﻦ ﮔﺮوهﻫﺎ از آزﻣﻮن ﭘﺎرﻣﺘﺮﻳﻚ‬ ‫‪ANOVA‬‬

‫ﺷﺪ‪ .‬در ﺻﻮرﺗﻲﻛﻪ‬

‫‪P<0/05‬‬

‫ﻣﻲﮔﺮدﻳﺪ‪ .‬از ﻧﺮماﻓﺰار‬

‫ﺑﻮد اﺧﺘﻼف ﺑﻴﻦ ﮔﺮوه ﻣﻌﻨﻲدار ﺗﻠﻘﻲ‬

‫‪ -4‬ﺗﺎﺛﻴﺮ زﻋﻔﺮان ﺑﺮ ﻓﻌﺎﻟﻴﺖ ﺑﺎﻓﺘﻲ آﻧﺰﻳﻢ ﺳﻮﭘﺮ اﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز و‬

‫‪(SigmaStat 3.0, Jandel Scientific, Erkrath‬‬

‫ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪ در ﻛﻮرﺗﻜﺲ ﻣﻐﺰ‪ :‬ﻓﻌﺎﻟﻴﺖ ﺑﺎﻓﺘﻲ آﻧﺰﻳﻢ ﺳﻮﭘﺮ اﻛﺴﻴﺪ‬

‫)‪ Germany‬ﺑﺮاي آﻧﺎﻟﻴﺰ ﻧﺘﺎﻳﺞ اﺳﺘﻔﺎده ﺷﺪ‪.‬‬

‫دﻳﺲﻣﻮﺗﺎز در ﻛﻮرﺗﻜﺲ ﻣﻐﺰ‪ ،‬ﺑﻴﺴﺖ و ﭼﻬﺎر ﺳﺎﻋﺖ ﺑﻌﺪ از ﺟﺮاﺣﻲ در‬ ‫ﮔﺮوه ﻛﻨﺘﺮل ﻛﺎذب ‪ 22±0/33U/mg Protein‬ﺑﻮد‪ ،‬اﻳﺠﺎد ﺳﻜﺘﻪ ﻣﻐﺰي‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫ﺑﺎﻋﺚ ﻛﺎﻫﺶ ﻣﻌﻨﻲداري ﻓﻌﺎﻟﻴﺖ ﺑﺎﻓﺘﻲ آﻧﺰﻳﻢ ﺳﻮﭘﺮ اﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز‬

‫‪ -1‬ﺟﺮﻳﺎن ﺧﻮن ﻣﻮﺿﻌﻲ‪ :‬ﻣﺴﺪود ﻛﺮدن ﺷﺮﻳﺎن ﻣﻴﺎﻧﻲ ﻣﻐﺰ ﺑﺎﻋﺚ‬

‫)‪ (15/3±0/28U/mg Protein‬در ﻛﻮرﺗﻜﺲ ﺷﺪ )‪ ،P≤0/001‬ﻧﻤﻮدار ‪.(5‬‬

‫ﺷﺪه اﺳﺖ ﺗﺎ ﺟﺮﻳﺎن ﺧﻮن ﻣﻮﺿﻌﻲ ﺑﻪ ﻛﻤﺘﺮ از ‪ 15‬درﺻﺪ ﺳﻄﺢ ﭘﺎﻳﻪ در‬

‫در ﺣﺎﻟﻲﻛﻪ ﺗﺰرﻳﻖ زﻋﻔﺮان در ﺷﺮوع اﻳﺴﻜﻤﻲ ﺑﺎﻋﺚ اﻓﺰاﻳﺶ ﻣﻌﻨﻲدار‬

‫ﻫﺮ دو ﮔﺮوه ﺳﺎﻟﻴﻦ )ﻛﻨﺘﺮل اﻳﺴﻜﻤﻴﻚ( و زﻋﻔﺮان ﻛﺎﻫﺶ ﺑﻴﺎﺑﺪ‪ .‬اﮔﺮﭼﻪ‬

‫ﻓﻌﺎﻟﻴﺖ‬

‫)‪Protein‬‬

‫ﺟﺮﻳﺎن ﺧﻮن ﻣﻮﺿﻌﻲ در ﻃﻮل ‪ 60‬دﻗﻴﻘﻪ اﻳﺴﻜﻤﻲ در ﮔﺮوه زﻋﻔﺮان‬

‫‪ (16/2±0/37U/mg‬در ﻛﻮرﺗﻜﺲ ﻣﻐﺰ ﺷﺪ )‪ .(P<0/001‬ﻓﻌﺎﻟﻴﺖ ﺑﺎﻓﺘﻲ‬

‫ﻛﻤﺘﺮ از ﮔﺮوه ﺳﺎﻟﻴﻦ ﺑﻮده اﺳﺖ وﻟﻲ اﻳﻦ اﺧﺘﻼف ﺑﻴﻦ دو ﮔﺮوه‬

‫آﻧﺰﻳﻢ ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪ در ﻛﻮرﺗﻜﺲ ﻣﻐﺰ ﺑﻴﺴﺖ و ﭼﻬﺎر ﺳﺎﻋﺖ ﺑﻌﺪ‬

‫ﻣﻌﻨﻲدار ﻧﺒﻮد )‪ ،P>0/05‬ﻧﻤﻮدار ‪.(1‬‬

‫از ﺟﺮاﺣﻲ در ﮔﺮوه ﻛﻨﺘﺮل ﻛﺎذب ‪ 0/32±0/02 U/mg Protein‬ﺑﻮد‪،‬‬

‫ﺑﺎﻓﺘﻲ‬

‫آﻧﺰﻳﻢ‬

‫ﺳﻮﭘﺮ‬

‫اﻛﺴﻴﺪ‬

‫دﻳﺲﻣﻮﺗﺎز‬

‫‪ -2‬ﺗﺎﺛﻴﺮ زﻋﻔﺮان ﺑﺮ ﻣﻴﺰان آﺳﻴﺐ و ادم ﻣﻐﺰي‪ :‬ﺗﺠﻮﻳﺰ زﻋﻔﺮان در‬

‫اﻳﺠﺎد ﺳﻜﺘﻪ ﻣﻐﺰي ﺑﺎﻋﺚ ﻛﺎﻫﺶ ﻣﻌﻨﻲداري ﻓﻌﺎﻟﻴﺖ ﺑﺎﻓﺘﻲ آﻧﺰﻳﻢ‬

‫ﺷﺮوع ﺳﻜﺘﻪ ﻣﻐﺰي ﺑﺎﻋﺚ ﻛﺎﻫﺶ ‪ 77‬درﺻﺪي ﺣﺠﻢ آﺳﻴﺐ ﻣﻐﺰي‬

‫ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪ )‪ (0/26±0/02U/mg Protein‬در ﻛﻮرﺗﻜﺲ ﺷﺪ‬

‫)‪ 45±11‬ﻣﻴﻠﻲﻣﺘﺮ ﻣﻜﻌﺐ( در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه ﻛﻨﺘﺮل اﻳﺴﻜﻤﻴﻚ ﻳﺎ‬

‫)‪ ،P≤0/001‬ﻧﻤﻮدار ‪ .(6‬در ﺣﺎﻟﻲﻛﻪ ﺗﺰرﻳﻖ زﻋﻔﺮان در ﺷﺮوع اﻳﺴﻜﻤﻲ‬

‫ﺳﺎﻟﻴﻦ )‪ (201±25mm3‬ﺷﺪ )‪ ،P<0/001‬ﻧﻤﻮدار ‪ .(2‬ﻋﻼوه ﺑﺮ اﻳﻦ‬

‫ﺑﺎﻋﺚ اﻓﺰاﻳﺶ ﻣﻌﻨﻲدار ﻓﻌﺎﻟﻴﺖ ﺑﺎﻓﺘﻲ آﻧﺰﻳﻢ ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪ‬

‫زﻋﻔﺮان ﺳﻄﺢ آﺳﻴﺐ ﻣﻐﺰي را از ﺑﺮش دو ﺗﺎ ﭘﻨﺞ ﺳﻄﺢ ﻗﺪاﻣﻲ ﺑﻪﺳﻤﺖ‬

‫)‪ (0/29±0/01U/mg Protein‬در ﻛﻮرﺗﻜﺲ ﻣﻐﺰ ﺷﺪ )‪.(P<0/001‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪409‬‬

‫اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ زﻋﻔﺮان در آﺳﻴﺐﻫﺎي اﻛﺴﻴﺪاﺗﻴﻮ اﻳﺴﻜﻤﻲ ﻣﻐﺰي در ﻣﻮش‬

‫ﻧﻤﻮدار‪ :1-‬ﺟﺮﻳﺎن ﺧﻮن ﻣﻮﺿﻌﻲ ﻣﻐﺰ ﻗﺒﻞ و در ﻃﻮل ‪ 60‬دﻗﻴﻘﻪ اﻧﺴﺪاد ﺷﺮﻳﺎن ﻣﻴﺎﻧﻲ‬ ‫ﻣﻐﺰ و ‪ 15‬دﻗﻴﻘﻪ ﺑﻌﺪ از ﺑﺮﻗﺮاري ﺟﺮﻳﺎن ﺧﻮن در ﮔﺮوه ﺳﺎﻟﻴﻦ )ﺷﺎﻫﺪ( و زﻋﻔﺮان‬

‫‪2‬‬

‫ﻧﻤﻮدار‪ :3-‬ﺳﻄﺢ آﺳﻴﺐ ﻣﻐﺰي ) ‪ (mm‬در ﻫﻔﺖ ﺑﺮش ﻣﻐﺰي از ﻗﺴﻤﺖ ﻗـﺪاﻣﻲ ﺑـﻪ‬ ‫ﺑﺨﺶ ﺧﻠﻔﻲ ﻣﻐﺰ در ﮔﺮوهﻫﺎي ﺳﺎﻟﻴﻦ )ﺷﺎﻫﺪ( و زﻋﻔﺮان ﺑﻴﺴﺖ و ﭼﻬﺎر ﺳﺎﻋﺖ ﺑﻌﺪ‬ ‫از اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ در ﻣﻮش ﺻﺤﺮاﻳﻲ‬

‫ﻧﻤﻮدار‪ :2-‬ﺣﺠﻢ آﺳﻴﺐ ﻣﻐﺰي )‪ (mm3‬در ﮔﺮوهﻫـﺎي ﺳـﺎﻟﻴﻦ )ﺷـﺎﻫﺪ( و زﻋﻔـﺮان‬ ‫ﺑﻴﺴﺖ و ﭼﻬﺎر ﺳﺎﻋﺖ ﺑﻌﺪ از اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ در ﻣﻮش ﺻﺤﺮاﻳﻲ‬ ‫ﻧﻤﻮدار‪ :4-‬درﺻﺪ ﻣﺤﺘﻮاي آب ﻣﻐﺰ در ﻧﻴﻢﻛﺮه اﻳﺴﻜﻤﻴﻚ )راﺳﺖ( و ﻧﻴﻢﻛـﺮه ﻏﻴـﺮ‬

‫ﺑﺤﺚ‬

‫اﻳﺴﻜﻤﻴﻚ )ﭼﭗ( در ﮔﺮوهﻫﺎي ﺷﻢ )ﻛﻨﺘﺮل ﻛﺎذب( و ﺳـﺎﻟﻴﻦ )ﺷـﺎﻫﺪ( و زﻋﻔـﺮان‬

‫ﻧﺘﺎﻳﺞ ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﻧﺸﺎن داد‪ ،‬زﻋﻔﺮان آﺳﻴﺐ ﻧﺎﺷﻲ از اﻳﺴﻜﻤﻲ‬

‫ﺑﻴﺴﺖ و ﭼﻬﺎر ﺳﺎﻋﺖ ﺑﻌﺪ از ﺟﺮاﺣﻲ ﻳﺎ اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ در ﻣﻮش‬

‫ﻣﻐﺰي ﻣﻮﺿﻌﻲ را ﺑﻪﻣﻴﺰان زﻳﺎدي در ﻣﻮش ﺻﺤﺮاﻳﻲ ﻛﺎﻫﺶ ﻣﻲدﻫﺪ‪.‬‬ ‫اﻳﻦ ﻳﺎﻓﺘﻪ ﺗﺎ ﺣﺪودي ﻣﺸﺎﺑﻪ ﻣﻄﺎﻟﻌﻪ ‪ Saleem‬اﺳﺖ ﻛﻪ ﻧﺸﺎن داد ﻣﺼﺮف‬ ‫‪14‬‬

‫ﺧﻮراﻛﻲ زﻋﻔﺮان ﻫﻔﺖ روز ﻗﺒﻞ از اﻳﺠﺎد اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ‬

‫اﻳﻦ ﻳﺎﻓﺘﻪ ﻧﻴﺰ ﻣﻲﺗﻮاﻧﺪ ﺗﺎﻳﻴﺪي ﺑﺮ ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﺑﺎﺷﺪ‪ .‬ﺑﻪدﻧﺒﺎل‬

‫ﻣﻲﺗﻮاﻧﺪ از آﺳﻴﺐ اﻛﺴﻴﺪاﺗﻴﻮ و ﻣﺮگ ﻧﺮوﻧﻲ در ﻣﻮش ﺻﺤﺮاﻳﻲ‬

‫ﻛﺎﻫﺶ ﻳﺎ ﻗﻄﻊ ﺟﺮﻳﺎن ﺧﻮن ﻣﻮﺿﻌﻲ ﻣﻐﺰ‪ ،‬ﺳﻠﻮلﻫﺎي ﻋﺼﺒﻲ در ﻣﺮﻛﺰ‬

‫ﭘﻴﺶﮔﻴﺮي ﻧﻤﺎﻳﺪ‪ 11.‬ﻫﻤﻴﻦﻃﻮر ﻳﺎﻓﺘﻪ ﻣﺎ ﺗﺎ ﺣﺪودي ﺑﺎ ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﺎت‬

‫ﻗﻄﻊ ﺟﺮﻳﺎن ﺳﻠﻮل ﻋﺼﺒﻲ در ﻫﻤﺎن دﻗﺎﻳﻖ اوﻟﻴﻪ ﺳﻜﺘﻪ ﻣﻐﺰي از ﺑﻴﻦ‬

‫دﻳﮕﺮان ﻫﻢﺧﻮاﻧﻲ دارد‪ ،‬ﻛﻪ در آن ﻧﺸﺎن داده ﺷﺪ‪ ،‬زﻋﻔﺮان اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ‬

‫رﻓﺘﻪ و آﺳﻴﺐﻫﺎي اوﻟﻴﻪ را اﻳﺠﺎد ﻣﻲﻛﻨﻨﺪ‪ .‬وﻟﻲ ﺳﻠﻮلﻫﺎي ﻋﺼﺒﻲ ﻛﻪ‬

‫ﻧﺎﺷﻲ از‬

‫ﺣﺎﺷﻴﻪ ﻣﺮﻛﺰ ﻗﻄﻊ ﺟﺮﻳﺎن ﺧﻮن )ﻧﺎﺣﻴﻪ ‪ (Penumbra‬ﻗﺮار دارﻧﺪ‪ ،‬زﻧﺪهاﻧﺪ‬

‫اﻳﺴﻜﻤﻲ را در ﻣﻮش ﺻﺤﺮاﻳﻲ دارد‪ Joukar .‬ﻧﺸﺎن داد‪ ،‬ﻣﺼﺮف‬

‫وﻟﻲ ﻓﺎﻗﺪ ﻋﻤﻠﻜﺮد ﻃﺒﻴﻌﻲ ﻫﺴﺘﻨﺪ و ﺑﻪﺗﺪرﻳﺞ ﻣﻤﻜﻦ اﺳﺖ از ﺑﻴﻦ رﻓﺘﻪ و‬

‫‪12‬‬

‫در ﻣﻘﺎﺑﻞ آﺳﻴﺐ اﻛﺴﻴﺪاﺗﻴﻮ در ﻛﻠﻴﻪ‬

‫‪13‬‬

‫و ﻋﻀﻠﻪ اﺳﻜﻠﺘﻲ‬

‫‪22‬‬

‫ﺧﻮراﻛﻲ زﻋﻔﺮان از ﻃﺮﻳﻖ ﺗﻘﻮﻳﺖ ﺳﻴﺴﺘﻢ آﻧﺘﻲاﻛﺴﻴﺪاﻧﺘﻲ اﺛﺮ‬

‫آﺳﻴﺐ ﺛﺎﻧﻮﻳﻪ ﭘﺲ از ﺳﻜﺘﻪ ﻣﻐﺰي را ﺑﻪوﺟﻮد آورﻧﺪ‪.‬‬

‫ﭘﻴﺶﮔﻴﺮيﻛﻨﻨﺪﮔﻲ در ﻣﻘﺎﺑﻞ آﺳﻴﺐ ﻗﻠﺒﻲ اﻟﻘﺎ ﺷﺪه ﺑﺎ اﻳﺰوﭘﺮﺗﺮاﻧﻮل دارد‪،‬‬

‫ﻋﺼﺒﻲ ﻣﺴﺘﻘﺮ در ﻧﺎﺣﻴﻪ ‪ Penumbra‬ﻗﺎﺑﻠﻴﺖ ﺑﺎزﻳﺎﺑﻲ ﺑﻪوﺳﻴﻠﻪ داروﻫﺎي‬

‫ﺳﻠﻮلﻫﺎي‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﻋﺎﺑﺪﻳﻦ وﻛﻴﻠﻲ و ﻫﻤﻜﺎران‬

‫‪410‬‬

‫ﻧﺮوﭘﺮوﺗﻜﺘﻴﻮ ﺑﺮاي آنﻫﺎ ﻣﺘﺼﻮر اﺳﺖ‪ 23.‬ﻛﻮرﺗﻜﺲ ﻣﻐﺰ ﺑﻪدﻟﻴﻞ وﺟﻮد‬

‫رادﻳﻜﺎلﻫﺎي آزاد و ﺷﺮوع ﻣﺮگ ﺑﺮﻧﺎﻣﻪرﻳﺰي ﺷﺪه ﺳﻠﻮﻟﻲ اﻓﺰاﻳﺶ‬

‫ﺟﺮﻳﺎن ﺧﻮن ﺟﺎﻧﺒﻲ زﻳﺎد ﺑﺨﺶ اﺻﻠﻲ ‪ Penumbra‬ﺑﻪ ﺧﻮد اﺧﺘﺼﺎص‬

‫ﻣﻲﻳﺎﺑﺪ‪ ،‬ﻟﺬا ﺑﺮﮔﺮداﻧﺪن و ﻳﺎ ﺣﻔﻆ ﻓﻌﺎﻟﻴﺖ ﺳﻄﺢ داﺧﻞ ﺳﻠﻮﻟﻲ اﻳﻦ‬

‫در ﻫﻤﻴﻦ راﺳﺘﺎ‪ ،‬ﻧﺘﺎﻳﺞ دﻳﮕﺮ اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داد‪ ،‬اﺛﺮ‬

‫آﻧﺰﻳﻢﻫﺎ ﺑﻪوﺳﻴﻠﻪ ﺗﺤﺮﻳﻚ اﻓﺰاﻳﺶ ﺳﻨﺘﺰ آن ﻣﻤﻜﻦ اﺳﺖ ﺳﻠﻮلﻫﺎ را در‬

‫ﻣﺤﺎﻓﻈﺘﻲ زﻋﻔﺮان ﻋﻤﺪﺗﺎ را در ﺑﺮش دو ﺗﺎ ﭘﻨﺞ ﻣﻐﺰي ﻛﻪ ﺑﺨﺶ اﻋﻈﻢ‬

‫ﻣﻘﺎﺑﻞ آﺳﻴﺐ و ﻣﺮگ ﻣﺤﺎﻓﻈﺖ ﻧﻤﺎﻳﺪ‪ .‬ﺷﻮاﻫﺪ ﭘﮋوﻫﺸﻲ ﻧﺸﺎن ﻣﻲدﻫﻨﺪ‪،‬‬

‫ﻛﻮرﺗﻜﺲ ﻣﻐﺰ و ﻧﺎﺣﻴﻪ ‪ Penumbra‬را ﺗﺸﻜﻴﻞ ﻣﻲدﻫﺪ‪ ،‬ﻣﺸﺎﻫﺪه ﺷﺪه‬

‫زﻋﻔﺮان و ﻣﻮاد ﻣﻮﺛﺮه آن ﺳﻴﺴﺘﻢ آﻧﺘﻲاﻛﺴﻴﺪاﻧﺘﻲ را ﺗﻘﻮﻳﺖ ﻧﻤﻮده و‬

‫‪23‬و‪22‬‬

‫ﻣﻲدﻫﺪ‪.‬‬

‫‪15‬و‪11‬‬

‫ﻧﺘﺎﻳﺞ ﭘﮋوﻫﺶ ﺣﺎﺿﺮ‬

‫اﺳﺖ‪ .‬ﻫﻢﭼﻨﻴﻦ در اﻳﻦ ﺗﺤﻘﻴﻖ ﺑﺮاي اوﻟﻴﻦﺑﺎر ﻣﺎ ﻧﺸﺎن دادﻳﻢ‪ ،‬زﻋﻔﺮان‬

‫ﺗﻮﻟﻴﺪ رادﻳﻜﺎلﻫﺎي آزاد را ﻛﺎﻫﺶ ﻣﻲدﻫﺪ‪.‬‬

‫ﻣﻲﺗﻮاﻧﺪ ادم ﻣﻐﺰي را ﻛﻪ ﻳﻜﻲ از ﻋﻠﺖ اﺻﻠﻲ اﻳﺠﺎد و ﮔﺴﺘﺮش آﺳﻴﺐ‬

‫ﻫﻢ ﻧﺸﺎن داد‪ ،‬زﻋﻔﺮان در ﺑﺎﻓﺖ اﻳﺴﻜﻤﻴﻚ ﻛﻮرﺗﻜﺲ ﻣﻐﺰ‬

‫ﺛﺎﻧﻮﻳﻪ ﭘﺲ از ﺳﻜﺘﻪ ﻣﻐﺰي اﺳﺖ را ﺑﻪﻣﻴﺰان ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪاي در ﻣﺪل‬

‫ﭘﺮاﻛﺴﻴﺪاﺳﻴﻮن ﭼﺮﺑﻲﻫﺎي ﻏﺸﺎي ﺳﻠﻮلﻫﺎي ﻋﺼﺒﻲ را ﻛﺎﻫﺶ داده و‬

‫ﺗﺠﺮﺑﻲ اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ‪ -‬ﻣﻮﻗﺘﻲ ﻛﺎﻫﺶ دﻫﺪ‪ .‬اﮔﺮﭼﻪ ﺗﺎﻛﻨﻮن‬

‫ﻫﻤﻴﻦﻃﻮر ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢ آﻧﺘﻲاﻛﺴﻴﺪانﻫﺎ از ﻗﺒﻴﻞ ﺳﻮﭘﺮاﻛﺴﻴﺪ‬

‫ﻣﻄﺎﻟﻌﻪ ﻣﺸﺎﺑﻪاي در اﻳﻦ زﻣﻴﻨﻪ اﻧﺠﺎم ﻧﺸﺪه اﺳﺖ وﻟﻲ ﺑﺮﺧﻲ ﺷﻮاﻫﺪ ﻏﻴﺮ‬

‫دﻳﺲﻣﻮﺗﺎز‪ ،‬ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪاز را ﺗﻘﻮﻳﺖ ﻣﻲﻧﻤﺎﻳﺪ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ ﺑﻪﻧﻈﺮ‬

‫ﻣﺴﺘﻘﻴﻢ ﻧﺸﺎن دادهاﻧﺪ ﻛﺮوﺳﻴﻦ از اﺟﺰاي ﻣﻮﺛﺮ زﻋﻔﺮان اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ در‬

‫ﻣﻲآﻳﺪ در ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ زﻋﻔﺮان از ﻃﺮﻳﻖ ﻛﺎﻫﺶ ﺗﻮﻟﻴﺪ رادﻳﻜﺎلﻫﺎي‬

‫ﻣﻘﺎﺑﻞ ﺗﺨﺮﻳﺐ ﺳﺪ ﺧﻮﻧﻲ ﻣﻐﺰي ﺑﻌﺪ از اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﮔﻠﻮﺑﺎل در‬

‫آزاد و اﻓﺰاﻳﺶ ﺳﻄﺢ ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢ آﻧﺘﻲاﻛﺴﻴﺪاﻧﺘﻲ ﻣﺮگ ﻧﺮوﻧﻲ و ادم‬

‫ﻛﺎﻫﺶ ﻧﻔﻮذﭘﺬﻳﺮي ﻋﺮوق ﻣﻐﺰي در ﻃﻮل‬

‫ﻣﻐﺰي را در ﻣﺪل ﺗﺠﺮﺑﻲ اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ ﻛﺎﻫﺶ داده ﺑﺎﺷﺪ‪.‬‬

‫‪16‬‬

‫ﻣﻮش ﺳﻮري دارد‪.‬‬

‫‪TNF-α‬‬

‫)ﻓﺎﻛﺘﻮر‬

‫اﻳﺴﻜﻤﻲ ﻣﻲﺗﻮاﻧﺪ ﺷﺎﻫﺪي ﺑﺮ ﻛﺎﻫﺶ ادم ﻣﻐﺰي ﺑﺎﺷﺪ ﻛﻪ ﺗﺎ ﺣﺪودي‬

‫ﻫﻤﻴﻦﻃﻮر ﭘﮋوﻫﺶﻫﺎي اﺧﻴﺮ ﻧﺸﺎن دادهاﻧﺪ‪،‬‬

‫ﻣﻲﺗﻮاﻧﺪ ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ را ﺗﺎﻳﻴﺪ ﻧﻤﺎﻳﺪ‪ 17.‬ﭘﮋوﻫﺶﻫﺎي اﺧﻴﺮ ﻧﺸﺎن‬

‫ﻧﻜﺮوزدﻫﻨﺪه ﺗﻮﻣﻮري‪ -‬آﻟﻔﺎ( ﺑﻪﻋﻨﻮان ﻳﻚ ﻓﺎﻛﺘﻮر ﭘﻴﺶاﻟﺘﻬﺎﺑﻲ ﻧﻘﺶ‬

‫دادهاﻧﺪ اﺳﺘﺮسﻫﺎي اﻛﺴﻴﺪاﺗﻴﻮ در ﭘﺎﺗﻮژﻧﺰ ﻣﺮﺣﻠﻪ ﺣﺎد ﺳﻜﺘﻪ ﻣﻐﺰي‬

‫ﻣﻬﻤﻲ در ﭘﺎﺗﻮﻓﻴﺰﻳﻮﻟﻮژي ادم و آﺳﻴﺐ ﻣﻐﺰي ﭘﺲ از ﺗﺮوﻣﺎ و ﺳﻜﺘﻪ‬ ‫‪29‬و‪28‬و‪17‬‬

‫ﻧﻘﺶ ﻣﺤﻮري دارﻧﺪ‪22.‬و‪ 16‬اﻳﺠﺎد اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ‪ -‬ﻣﻮﻗﺘﻲ ﺑﺎﻋﺚ‬

‫ﻣﻐﺰي دارد‪.‬‬

‫اﻓﺰاﻳﺶ ﺗﻮﻟﻴﺪ رادﻳﻜﺎلﻫﺎي آزاد‪ ،‬ﻧﻴﺘﺮﻳﻚ اﻛﺴﺎﻳﺪ و ﻛﺎﻫﺶ ﺳﻄﺢ‬

‫زﻋﻔﺮان ﺳﻨﺘﺰ‬

‫ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢﻫﺎي آﻧﺘﻲاﻛﺴﻴﺪاﻧﺖ ﻣﺜﻞ ﺳﻮﭘﺮاﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز‪،‬‬

‫ﺷﻮاﻫﺪي وﺟﻮد دارد ﻛﻪ ﻧﺸﺎن ﻣﻲدﻫﺪ‪ ،‬ﻛﺮوﺳﻴﻦ از ﺗﺮﻛﻴﺒﺎت ﻣﻮﺛﺮ‬

‫اﮔﺮﭼﻪ ﻣﻄﺎﻟﻌﻪاي وﺟﻮد ﻧﺪارد ﻛﻪ ﻧﺸﺎن دﻫﺪ‪،‬‬

‫‪TNF-α‬‬

‫در ﻃﻮل اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻬﺎر ﻣﻲﻧﻤﺎﻳﺪ‪ ،‬اﻣﺎ‬

‫ﮔﻠﻮﺗﺎﺗﻴﻮن و ﻛﺎﺗﺎﻻز ﻣﻲﺷﻮد‪ 11.‬رادﻳﻜﺎلﻫﺎي آزاد ﺑﻪوﺳﻴﻠﻪ آﻧﺰﻳﻢﻫﺎي‬

‫زﻋﻔﺮان ﻣﻲﺗﻮاﻧﺪ در ﻣﺤﻴﻂ ‪ In vitro‬ﻣﺮگ ﻧﺮوﻧﻲ ﻧﺎﺷﻲ از‬

‫آﻧﺘﻲاﻛﺴﻴﺪان داﺧﻞ ﺳﻠﻮﻟﻲ از ﻗﺒﻴﻞ آﻧﺰﻳﻢﻫﺎي ﺳﻮﭘﺮاﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز‪،‬‬

‫ﻣﻬﺎر ﻧﻤﺎﻳﺪ‪ 30.‬ﺑﻨﺎﺑﺮاﻳﻦ ﻣﻤﻜﻦ اﺳﺖ ﺑﺨﺸﻲ از اﺛﺮات ﻣﻔﻴﺪ زﻋﻔﺮان از‬

‫‪TNF-α‬‬

‫را‬

‫ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪاز و ﻛﺎﺗﺎﻻزﻫﺎ ﺑﺮداﺷﺘﻪ و ﺣﺬف ﻣﻲﺷﻮﻧﺪ‪ 24.‬ﻛﺎﻫﺶ‬

‫ﻃﺮﻳﻖ ﻣﻬﺎر ﺳﻨﺘﺰ‬

‫ﺳﻄﺢ ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢﻫﺎي آﻧﺘﻲاﻛﺴﻴﺪانﻫﺎ در ﻃﻮل اﻳﺴﻜﻤﻲ ﻣﻐﺰي و‬

‫روﺷﻦ ﺷﺪن اﻳﻦ ادﻋﺎ و ﮔﻤﺎن در ﺳﻄﺢ ﺳﻠﻮﻟﻲ و ﻣﺪلﻫﺎي ﺣﻴﻮاﻧﻲ‬

‫اﻓﺰاﻳﺶ ﺗﻮﻟﻴﺪ رادﻳﻜﺎلﻫﺎي آزاد و اﻛﺴﻴﺪانﻫﺎ ﻣﺴﻴﺮﻫﺎي ﺳﻴﮕﻨﺎﻟﻴﻨﮓ‬

‫ﺳﻜﺘﻪ ﻣﻐﺰي ﻧﻴﺎز اﺳﺖ‪ .‬ﺑﻪﻃﻮر ﺧﻼﺻﻪ ﻧﺘﺎﻳﺞ اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داد‪،‬‬

‫آﺳﻴﺐرﺳﺎن ﻣﺨﺘﻠﻔﻲ از ﺟﻤﻠﻪ ﻣﺴﻴﺮ ﻣﺮگ ﺑﺮﻧﺎﻣﻪرﻳﺰي ﺷﺪه ﺳﻠﻮﻟﻲ را‬

‫زﻋﻔﺮان اﺛﺮ آﻧﺘﻲاﻛﺴﻴﺪاﻧﺘﻲ ﻗﻮي دارد و ﻣﻲﺗﻮاﻧﺪ از ﻃﺮﻳﻖ ﻛﺎﻫﺶ ﺗﻮﻟﻴﺪ‬

‫ﻓﻌﺎل ﻛﺮده و ﺑﺎﻋﺚ اﻓﺰاﻳﺶ آﺳﻴﺐ و در ﻧﻬﺎﻳﺖ ﻣﺮگ ﺳﻠﻮﻟﻲ‬

‫رادﻳﻜﺎلﻫﺎي آزاد و ﺗﻘﻮﻳﺖ ﺳﻴﺴﺘﻢ آﻧﺘﻲاﻛﺴﻴﺪاﻧﺘﻲ ﺳﻠﻮﻟﻲ ﻣﺮگ ﻧﺮوﻧﻲ‬

‫ﭘﮋوﻫﺶ ﻗﺒﻠﻲ ﮔﺰارش ﻛﺮدهاﻧﺪ‪ ،‬ﻣﻬﺎرﻛﻨﻨﺪه ﭘﺮاﻛﺴﻴﺪاﺳﻴﻮن‬

‫و ادم ﻣﻐﺰي را در ﻣﺪل ﺗﺠﺮﺑﻲ اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ ﻛﺎﻫﺶ دﻫﺪ‪.‬‬

‫ﭼﺮﺑﻲ ﻏﺸﺎ و ﻳﺎ از ﺑﻴﻦ ﺑﺮﻧﺪهﻫﺎي رادﻳﻜﺎل آزاد اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ در ﻣﻘﺎﺑﻞ‬

‫ﺳﭙﺎﺳﮕﺰاري‪ :‬اﻳﻦ ﺗﺤﻘﻴﻖ ﺑﺎ ﺣﻤﺎﻳﺖ ﻣﺎﻟﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺳﻤﻨﺎن‬

‫ﻫﻤﻴﻦﻃﻮر ﺗﺤﺮﻳﻚ اﻓﺰاﻳﺶ ﺑﻴﺎن آﻧﺰﻳﻢ‬

‫)ﻃﺮح ﺗﺤﻘﻴﻘﺎﺗﻲ ﺷﻤﺎره ‪ (312‬اﻧﺠﺎم ﺷﺪ‪ .‬اﻳﻦ ﻣﻘﺎﻟﻪ ﺑﺨﺸﻲ از ﭘﺎﻳﺎنﻧﺎﻣﻪ‬

‫ﺳﻮﭘﺮاﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز ﺑﺎﻋﺚ ﻣﻘﺎوﻣﺖ ﺑﻴﺸﺘﺮ در ﺑﺮاﺑﺮ اﻳﺴﻜﻤﻲ و‬

‫آﻗﺎي ﻣﺤﻤﺪ رﺿﺎ ﻋﻴﻨﻌﻠﻲ داﻧﺸﺠﻮي ﻛﺎرﺷﻨﺎﺳﻲ ارﺷﺪ ﻓﻴﺰﻳﻮﻟﻮژي اﺳﺖ‪.‬‬

‫ﺑﺮﻋﻜﺲ ﺣﺬف آن ﺑﺎﻋﺚ اﻓﺰاﻳﺶ ﺣﺠﻢ ﺳﻜﺘﻪ ﻣﻐﺰي در ﻣﻮش ﺳﻮري‬

‫ﻧﻮﻳﺴﻨﺪﮔﺎن ﻣﻘﺎﻟﻪ از ﻫﻤﻜﺎري و ﻣﺴﺎﻋﺪت آﻗﺎي دﻛﺘﺮ ﻋﺒﺎﺳﻌﻠﻲ وﻓﺎﻳﻲ‬

‫ﻛﺎﻫﺶ ﺳﻄﺢ ﻓﻌﺎﻟﻴﺖ آﻧﺰﻳﻢﻫﺎي ﺳﻮﭘﺮاﻛﺴﻴﺪ دﻳﺲﻣﻮﺗﺎز‪،‬‬

‫اﺳﺘﺎد ﺗﻤﺎم ﮔﺮوه ﻓﻴﺰﻳﻮﻟﻮژي و دﻛﺘﺮ ﻋﻠﻲ رﺷﻴﺪي ﭘﻮر رﻳﺎﺳﺖ ﻣﺤﺘﺮم‬

‫ﮔﻠﻮﺗﺎﺗﻴﻮن ﭘﺮاﻛﺴﻴﺪاز در ﻃﻮل اﻳﺴﻜﻤﻲ ﻣﻐﺰي ﻣﻮﺿﻌﻲ‪ ،‬اﺣﺘﻤﺎﻻ‬

‫ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻓﻴﺰﻳﻮﻟﻮژي داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺳﻤﻨﺎن ﻗﺪرداﻧﻲ و‬

‫ﺣﺴﺎﺳﻴﺖ ﺳﻠﻮلﻫﺎي ﻋﺼﺒﻲ را ﺑﻪﻋﻮاﻣﻞ آﺳﻴﺐرﺳﺎن از ﻗﺒﻴﻞ‬

‫ﺗﺸﻜﺮ ﻣﻲﻧﻤﺎﻳﻨﺪ‪.‬‬

‫‪16‬و‪11‬‬

‫ﻣﻲﺷﻮد‪.‬‬

‫‪25‬و‪7‬و‪1‬‬

‫ﺳﻜﺘﻪ ﻣﻐﺰي دارﻧﺪ‪.‬‬

‫‪27‬و‪26‬‬

‫ﻣﻲﺷﻮد‪.‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪TNF-α‬‬

‫اﻋﻤﺎل ﺷﺪه ﺑﺎﺷﺪ‪ .‬ﻣﻄﺎﻟﻌﺎت ﺑﻴﺸﺘﺮي ﺑﺮاي‬

411

‫اﻛﺴﻴﺪاﺗﻴﻮ اﻳﺴﻜﻤﻲ ﻣﻐﺰي در ﻣﻮش‬ Vakili ‫ﻫﺎي‬ A. et‫آﺳﻴﺐ‬ al. ‫اﺛﺮ ﻣﺤﺎﻓﻈﺘﻲ زﻋﻔﺮان در‬

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13. Hosseinzadeh H, Modaghegh MH, Saffari Z. Crocus sativus L. (Saffron) extract and its active constituents (crocin and safranal) on ischemia-reperfusion in rat skeletal muscle. Evid Based Complement Alternat Med 2009;6(3):343-50.

14. Joukar S, Najafipour H, Khaksari M, Sepehri G, Shahrokhi N, Dabiri S, Gholamhoseinian A, Hasanzadeh S. The effect of saffron consumption on biochemical and histopathological heart indices of rats with myocardial infarction. Cardiovasc Toxicol 2010;10(1):6671.

15. Ochiai T, Shimeno H, Mishima K, Iwasaki K, Fujiwara M, Tanaka H, Shoyama Y, Toda A, Eyanagi R, Soeda S. Protective effects of carotenoids from saffron on neuronal injury in vitro and in vivo.

Biochim Biophys Acta 2007;1770(4):578-84.

16. Zheng YQ, Liu JX, Wang JN, Xu L. Effects of crocin on reperfusion-induced oxidative/nitrative injury to cerebral

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microvessels after global cerebral ischemia. Brain Res 2007;1138:86-94.

17. Vakili A, Mojarrad S, Akhavan MM, Rashidy-Pour A. Pentoxifylline attenuates TNF-α protein levels and brain edema following temporary focal cerebral ischemia in rats. Brain Res 2011;1377:119-25.

18. Vakili A, Zahedi khorasani M. Post-ischemic treatment of pentoxifylline reduces cortical not striatal infarct volume in transient model of focal cerebral ischemia in rat. Brain Res 2007;1144:186-91.

19. Vakili A, Kataoka H, Plesnila N. Role of arginine vasopressin V1 and V2 receptors for brain damage after transient focal cerebral ischemia. J Cereb Blood Flow Metab 2005;25(8):1012-9.

20. Bradford MM. A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of proteindye binding. Anal Biochem 1976;72:248-54.

21. Mihara M, Uchiyama M. Determination of malonaldehyde precursor in tissues by thiobarbituric acid test. Anal Biochem 1978;86(1):271-8.

22. Doyle KP, Simon RP, Stenzel-Poore MP. Mechanisms of ischemic brain damage. Neuropharmacology 2008;55(3):310-8.

23. Segura T, Calleja S, Jordan J. Recommendations and treatment strategies for the management of acute ischemic stroke. Expert Opin Pharmacother 2008;9(7):1071-85.

24. Kakita T, Suzuki M, Takeuchi H, Unno M, Matsuno S. Significance of xanthine oxidase in the production of intracellular oxygen radicals in an in-vitro hypoxia-reoxygenation model. J Hepatobiliary Pancreat Surg 2002;9(2):249-55.

25. Kontos HA. Oxygen radicals in cerebral ischemia: the 2001 Willis lecture. Stroke 2001;32:2712-6.

26. Kim GW, Kondo T, Noshita N, Chan PH. Manganese superoxide dismutase deficiency exacerbates cerebral infarction after focal cerebral ischemia/reperfusion in mice: implications for the production and role of superoxide radicals. Stroke 2002;33(3):80915.

27. Kondo T, Reaume AG, Huang TT, Murakami K, Carlson E, Chen S, et al. Edema formation exacerbates neurological and histological outcomes after focal cerebral ischemia in CuZn-superoxide dismutase gene knockout mutant mice. Acta Neurochir Suppl 1997;70:62-4.

28. Hosomi N, Ban CR, Naya T, Takahashi T, Guo P, Song XY, et al.

Tumor necrosis factor-alpha neutralization reduced cerebral edema through inhibition of matrix metalloproteinase production after transient focal cerebral ischemia. J Cereb Blood Flow Metab 2005;25(8):959-67.

29. Sriram K, O'Callaghan JP. Divergent roles for tumor necrosis factor-alpha in the brain. J Neuroimmune Pharmacol 2007;2(2):140-53.

30. Soeda S, Ochiai T, Paopong L, Tanaka H, Shoyama Y, Shimeno H. Crocin suppresses tumor necrosis factor-alpha-induced cell death of neuronally differentiated PC-12 cells. Life Sci 2001;69(24):2887-98.

Tehran University Medical Journal;‫ﻫﻤﻜﺎران‬ Vol. 69, ‫ و‬No. 7, October 2011: 405-412

102

The protective effects of Saffron against the oxidative damage in a transient model of focal cerebral ischemia in rats

Abedin Vakili Ph.D.1* Mohammad Reza Eianali M.Sc.1 Ahmad Reza Bandegi Ph.D.2 1- Department and Research Center of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.

2- Department of Biochemistry, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.

Received: July 12, 2011 Accepted: July 25, 2011

Abstract

Background: Numerous studies have shown the protective effects of saffron against oxidative damage in a global model of cerebral ischemia, but its effects on brain edema and oxidative ischemic injury in focal ischemic stroke are not completely understood.

Therefore, this study was designed to investigate the effects of saffron on brain edema, infarct volume, antioxidant enzyme activity (glutathione peroxidase and superoxide dismutase) and concentration of malondialdehyde (MDA) in ischemic brain tissue in an experimental model of stroke.

Methods: Focal brain ischemia was established with the temporary occlusion of the middle cerebral artery for one hour in rats. Saffron (100 mg/kg) was given intraperitoneally at the onset of ischemia. 24 hours later, brain edema and infarct volume were evaluated and glutathione peroxidase and superoxide dismutase activities and MDA concentration were measured in the ischemic brain tissue using a specific kit.

Results: The results showed that saffron reduced infarct volume by 77% (P<0.001) and brain edema by 60% (P<0.001) compared with the control group in 24 hours following ischemia. Moreover, saffron significantly reduced the content of MDA (P<0.001) and increased the activity of superoxide dismutase (P<0.001) and glutathione peroxidase (P<0.001) in the cortex of the ischemic brain tissue.

Conclusion: Saffron has protective effects against oxidative ischemic damage and brain edema in a transient model of focal cerebral ischemia in rats. This protective effect is probably induced by increasing the capacity of antioxidant enzymes and decreasing the production of free radicals.

Keywords: Brain edema, focal cerebral ischemia, oxidative damage, rat, saffron. *

Corresponding author: Km 5 Road Damghan, Faculty of Medicine, Dept. and Research Center of Physiology, Semnan, Iran.

Tel: +98-231-3354161 E-mail: Abvakili@yahoo.com

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

‫ﺳﺮوﻳﻜﺲ‪413-‬‬ ‫ﻣﻬﺮ ﺑﺎ‪419 ،1390‬‬ ‫اﻛﺴﻲ ﺗﻬﺮان‪،‬‬ ‫ﻋﻠﻮم ﺑﺎﭘﺰﺷﻜﻲ‬ ‫داﻧﺸﮕﺎه‬ ‫ﻣﺤﻠﻮلﺪه ﭘﺰﺷﻜﻲ‪،‬‬ ‫اﺛﺮ داﻧﺸﻜ‬ ‫ﻣﻘﺎﻳﺴﻪﻣﺠﻠﻪ‬ ‫ﻧﺎﻣﻨﺎﺳﺐ‬ ‫ﺷﻤﺎرهدر‪،7‬زﻧﺎن‬ ‫‪، 69‬زاﻳﻤﺎن‬ ‫دورهاﻟﻘﺎي‬ ‫ﺗﻮﺳﻴﻦ در‬ ‫ﺧﻮراﻛﻲ‬ ‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﻣﻘﺎﻳﺴﻪ اﺛﺮ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﺑﺎ اﻛﺴﻲﺗﻮﺳﻴﻦ در اﻟﻘﺎي زاﻳﻤﺎن در زﻧﺎن ﺑﺎ ﺳﺮوﻳﻜﺲ ﻧﺎﻣﻨﺎﺳﺐ‬

‫ﭼﻜﻴﺪه‬

‫‪1‬‬

‫ﺷﻴﺮﻳﻦ ﻧﻴﺮوﻣﻨﺶ‬

‫ﻣﻌﺼﻮﻣﻪ داداش ﻋﻠﻴﻬﺎ‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/03/11 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/04/06 :‬‬

‫‪*2‬‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﺳﺮوﻳﻜﺲ ﻣﻄﻠﻮب و اﻧﻘﺒﺎﺿﺎت رﺣﻤﻲ دو ﻋﺎﻣﻞ اﺳﺎﺳﻲ در زاﻳﻤﺎن ﻫﺴﺘﻨﺪ و ﺑﺮاي ﻣﻮﻓﻘﻴﺖ اﻟﻘﺎي‬ ‫زاﻳﻤﺎن ﺣﺎﻳﺰ اﻫﻤﻴﺖ ﻫﺴﺘﻨﺪ‪ .‬روشﻫﺎي ﻣﺨﺘﻠﻔﻲ ﺑﺮاي اﻟﻘﺎي زاﻳﻤﺎن وﺟﻮد دارد ﻛﻪ ﻣﻲﺗﻮان ﺑﻪ ﻣﻴﺰوﭘﺮوﺳﺘﻮل و‬

‫‪2‬‬

‫ﻣﻴﻨﺎ اﻛﺮﻣﻲ‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ اﺷﺎره ﻛﺮد‪ .‬ﻫﺪف اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﺎﻳﺴﻪ ﻛﺎراﻳﻲ و اﻳﻤﻨﻲ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺑﺎ اﻛﺴﻲﺗﻮﺳﻴﻦ ﺟﻬﺖ اﻟﻘﺎي‬ ‫‪ -1‬ﮔﺮوه ﭘﺮي ﻧﺎﺗﺎل‬

‫زاﻳﻤﺎن در اﻓﺮاد ﺑﺎ ﻣﻌﺎﻳﻨﻪ ﻧﺎﻣﻨﺎﺳﺐ ﺳﺮوﻳﻜﺲ ﻣﻲﺑﺎﺷﺪ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬اﻳﻦ ﭘﮋوﻫﺶ ﻳﻚ ﻛﺎرآزﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ دوﺳﻮﻛﻮر‬

‫‪ -2‬ﮔﺮوه زﻧﺎن و زاﻳﻤﺎن‬

‫اﺳﺖ‪ 140 .‬ﺧﺎﻧﻢ ﺑﺎردار ‪ 34-42‬ﻫﻔﺘﻪ ﻣﺮاﺟﻌﻪﻛﻨﻨﺪه ﺑﻪ ﺑﻴﻤﺎرﺳﺘﺎن زﻧﺎن در ﻃﻲ ﺳﺎلﻫﺎي ‪ 1388-89‬ﻛﻪ ﻛﺎﻧﺪﻳﺪاي ﺧﺘﻢ‬

‫ﺑﻴﻤﺎرﺳﺘﺎن زﻧﺎن )ﻣﻴﺮزاﻛﻮﭼﻚ ﺧﺎن(‪ ،‬داﻧﺸﮕﺎه‬ ‫ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫ﺣﺎﻣﻠﮕﻲ ﺑﻮده و ﺳﺮوﻳﻜﺲ ﻧﺎﻣﻨﺎﺳﺐ داﺷﺘﻨﺪ ﺑﺎ اﺳﺘﻔﺎده از ﺟﺪول اﻋﺪاد ﺗﺼﺎدﻓﻲ ﺑﻪ دو ﮔﺮوه ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ‪ .‬ﻳﻚ ﮔﺮوه‬ ‫ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﺑﺎ دوز اوﻟﻴﻪ ‪ 20‬ﻣﻴﻜﺮوﮔﺮم در ﺳﺎﻋﺖ ﻫﻤﺮاه ﺑﺎ ﭘﻼﺳﺒﻮي ورﻳﺪي و ﻳﻚ ﮔﺮوه‬ ‫اﻛﺴﻲﺗﻮﺳﻴﻦ ﺑﺎ دوز اوﻟﻴﻪ ﺷﺶ ﻣﻴﻠﻲﻳﻮﻧﻴﺖ در دﻗﻴﻘﻪ ﻫﻤﺮاه ﺑﺎ ﭘﻼﺳﺒﻮ ﺧﻮراﻛﻲ درﻳﺎﻓﺖ ﻧﻤﻮدﻧﺪ و در ﻫﺮ دو ﮔﺮوه در‬ ‫ﺻﻮرت ﻧﺎﻣﻨﺎﺳﺐ ﺑﻮدن اﻧﻘﺒﺎﺿﺎت دوز دارو اﻓﺰوده ﺷﺪ‪ .‬در اداﻣﻪ زﻣﺎن ﺑﺴﺘﺮي ﺗﺎ زاﻳﻤﺎن‪ ،‬ﻧﻮع زاﻳﻤﺎن و ﻋﻮارض‬ ‫داروﻳﻲ در ﻫﺮ دو ﮔﺮوه ﺑﺮرﺳﻲ ﺷﺪﻧﺪ‪ .‬ﻳﺎﻓﺘﻪﻫﺎ‪ :‬در ﮔﺮوه ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﻓﺎﺻﻠﻪ زﻣﺎﻧﻲ درﻳﺎﻓﺖ اوﻟﻴﻦ دوز ﺗﺎ زاﻳﻤﺎن‬ ‫ﻃﺒﻴﻌﻲ ‪ 11/07±3/62‬ﺳﺎﻋﺖ و در ﮔﺮوه اﻛﺴﻲﺗﻮﺳﻴﻦ ‪ 14/87±3/11‬ﺳﺎﻋﺖ ﺑﻮد ﻛﻪ ﺑﻪﻣﻴﺰان ﻣﻌﻨﻲداري در ﮔﺮوه‬ ‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﻛﻢﺗﺮ ﺑﻮد )‪ .(P=0/001‬ﻧﻮع زاﻳﻤﺎن و ﻫﻢﭼﻨﻴﻦ ﻣﻴﺰان ﻓﺮاواﻧﻲ ﻋﻮارض داروﻳﻲ در دو ﮔﺮوه اﺧﺘﻼف‬ ‫آﻣﺎري ﻣﻌﻨﻲداري ﻧﺪاﺷﺖ )‪ .(P>0/05‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﻧﻪﺗﻨﻬﺎ داروﻳﻲ اﻳﻤﻦ و ﻛﺎرا در اﻟﻘﺎي‬

‫*‬

‫زاﻳﻤﺎن در اﻓﺮاد ﺑﺎ ﺳﺮوﻳﻜﺲ ﻧﺎﻣﻨﺎﺳﺐ ﻣﻲﺑﺎﺷﺪ ﺑﻠﻜﻪ ﻧﺴﺒﺖ ﺑﻪ اﻛﺴﻲﺗﻮﺳﻴﻦ ﻓﺎﺻﻠﻪ ﺑﻴﻦ ﺷﺮوع اﻳﻨﺪاﻛﺸﻦ ﺗﺎ زاﻳﻤﺎن‬ ‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﻬﺮان‪ ،‬ﺧﻴﺎﺑﺎن ﻛﺮﻳﻢﺧﺎن‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن‬

‫زﻧﺎن )ﻣﻴﺮزاﻛﻮﭼﻚ ﺧﺎن(‪ ،‬ﮔﺮوه زﻧﺎن زاﻳﻤﺎن‬

‫واژﻳﻨﺎل را ﻛﻮﺗﺎهﺗﺮ ﻣﻲﻛﻨﺪ‪.‬‬

‫ﺗﻠﻔﻦ‪021-88900002 :‬‬ ‫‪E-mail: dadashaliha@razi.tums.ac.ir‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﻣﻴﺰوﭘﺮوﺳﺘﻮل‪ ،‬اﻛﺴﻲﺗﻮﺳﻴﻦ‪ ،‬اﻟﻘﺎي زاﻳﻤﺎن‪ ،‬ﺳﺮوﻳﻜﺲ ﻧﺎﻣﻨﺎﺳﺐ‪.‬‬

‫واژﻳﻨﺎل و ﺧﻮراﻛﻲ ﺟﻬﺖ آﻣﺎدهﺳﺎزي ﺳﺮوﻳﻜﺲ و ﺑﻬﺒﻮد اﻧﻘﺒﺎﺿﺎت‬

‫ﻣﻘﺪﻣﻪ‬

‫رﺣﻤﻲ اﺳﺘﻔﺎده ﻣﻲﺷﻮد‪ .‬ﺗﻜﻨﻴﻚﻫﺎي ﻣﻜﺎﻧﻴﻜﻲ ﺷﺎﻣﻞ ﻛﺎﺗﺘﺮ ﺗﺮاﻧﺲ‬

‫اﻧﺪﻳﻜﺎﺳﻴﻮنﻫﺎي ﻣﺘﻌﺪدي ﺑﺮاي اﻟﻘﺎي زاﻳﻤﺎن )‪ (Labor‬وﺟﻮد دارد ﻛﻪ‬

‫ﺳﺮوﻳﻜﺎل‪ ،‬اﻧﻔﻮزﻳﻮن ﺧﺎرج آﻣﻨﻴﻮﻧﻲ ﺳﺎﻟﻴﻦ )‪ ،(EASI‬ﻣﺘﺴﻊﻛﻨﻨﺪهﻫﺎي‬

‫از آن ﺟﻤﻠﻪ ﻣﻲﺗﻮان ﺑﻪ ﺣﺎﻣﻠﮕﻲ ﭘﺴﺖﺗﺮم‪ ،‬ﭘﺮهاﻛﻼﻣﭙﺴﻲ‪ ،‬دﻳﺎﺑﺖ‪،‬‬

‫ﻫﻴﮕﺮوﺳﻜﻮﭘﻴﻚ ﻛﻪ ﺟﻬﺖ ﻣﺘﺴﻊ ﻛﺮدن ﺳﺮوﻳﻜﺲ ﻗﺒﻞ از اﻟﻘﺎي ﻟﻴﺒﺮ‬

‫اﻟﻴﮕﻮﻫﻴﺪراﻣﻨﻴﻮس‪ ،‬ﭘﺎرﮔﻲ ﭘﺮدهﻫﺎ‪ ،IUGR ،‬وﺿﻌﻴﺖ ﻏﻴﺮ اﻃﻤﻴﻨﺎنﺑﺨﺶ‬

‫اﺳﺘﻔﺎده ﻣﻲﺷﻮد‪ .‬ﺳﺮوﻳﻜﺲ ﻣﻄﻠﻮب و اﻧﻘﺒﺎﺿﺎت رﺣﻤﻲ دو ﻋﺎﻣﻞ‬ ‫‪2‬‬

‫ﺟﻨﻴﻦ و ﻏﻴﺮه اﺷﺎره ﻛﺮد‪ 1.‬روشﻫﺎي ﻣﺨﺘﻠﻔﻲ ﻧﻴﺰ ﺑﺮاي اﻟﻘﺎي زاﻳﻤﺎن‬

‫اﺳﺎﺳﻲ در زاﻳﻤﺎن ﻫﺴﺘﻨﺪ‪ .‬وﺿﻌﻴﺖ ﺳﺮوﻳﻜﺲ ﻳﺎ ﻣﻄﻠﻮب ﺑﻮدن آن‬

‫وﺟﻮد دارد ﻛﻪ ﺷﺎﻣﻞ ﺗﻜﻨﻴﻚﻫﺎي ﻓﺎرﻣﺎﻛﻮﻟﻮژﻳﻚ ﻣﺜﻞ اﻛﺴﻲﺗﻮﺳﻴﻦ ﻛﻪ‬

‫ﺑﺮاي ﻣﻮﻓﻘﻴﺖ اﻟﻘﺎي زاﻳﻤﺎن ﺣﺎﻳﺰ اﻫﻤﻴﺖ اﺳﺖ‪ 3.‬ﺳﺮوﻳﻜﺲ ﻣﻄﻠﻮب ﻳﺎ‬

‫ﺑﻪﺻﻮرت داﺧﻞ ورﻳﺪي و ﺑﺎ اﺳﺘﻔﺎده از ﭘﻤﭗ اﻧﻔﻮزﻳﻮن ﺗﺠﻮﻳﺰ‬

‫ﻧﺮم ﻛﺮدن ﺳﺮوﻳﻜﺲ اﺷﺎره ﺑﻪ ﻛﻮﺗﺎﻫﻲ‪ ،‬اﻓﺎﺳﻤﺎن و دﻳﻼﺗﺎﺳﻴﻮن‬

‫ﻛﻪ ﺑﻪﺻﻮرت‬

‫ﺳﺮوﻳﻜﺲ دارد ﻛﻪ ﺑﻪﻃﻮر ﻃﺒﻴﻌﻲ در ﭘﺎﻳﺎن ﺳﻪ ﻣﺎﻫﻪ ﺳﻮم ﻗﺒﻞ از زاﻳﻤﺎن‬

‫ﻣﻲﮔﺮدد‪ ،‬ﭘﺮوﺳﺘﺎﮔﻼﻧﺪﻳﻦﻫﺎ ﻣﺎﻧﻨﺪ دﻳﻨﻮﭘﺮوﺳﺘﻮن‬

‫)‪(PGE2‬‬

‫واژﻳﻨﺎل اﺳﺘـﻔﺎده ﻣﻲﺷـﻮد و ﻣﻴـﺰوﭘﺮوﺳـﺘﻮل )‪ (PGE1‬ﻛـﻪ ﺑـﻪ دو روش‬

‫‪4‬‬

‫ﺧﻮد ﺑﻪﺧﻮد آﻏﺎز ﻣﻲﺷﻮد‪ .‬ﻣﺘﺎﺳﻔﺎﻧﻪ در ﺑﺴﻴﺎري از ﻣﻮارد اﻧﺪﻳﻜﺎﺳﻴﻮن‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﺷﻴﺮﻳﻦ ﻧﻴﺮوﻣﻨﺶ و ﻫﻤﻜﺎران‬

‫‪414‬‬

‫اﻟﻘﺎ‪ ،‬ﺳﺮوﻳﻜﺲ ﻓﺎﻗﺪ ﺣﺎﻟﺖ ﻣﻄﻠﻮب اﺳﺖ و ﻫﺮ ﭼﻪ ﺣﺎﻟﺖ ﻣﻄﻠﻮب ﻳﺎ‬

‫ﻣﺮاﺟﻌﻪﻛﻨﻨﺪه ﺑﻪ ﺑﻴﻤﺎرﺳﺘﺎن زﻧﺎن از ﺗﺎرﻳﺦ ‪ 1388/10/1‬ﻟﻐﺎﻳﺖ‬

‫اﻣﺘﻴﺎز ﺑﻴﺸﺎب ﻛﺎﻫﺶ ﻳﺎﺑﺪ‪ ،‬ﻣﻴﺰان ﻣﻮﻓﻘﻴﺖ اﻟﻘﺎي زاﻳﻤﺎن ﺑﻪﻃﻮر‬

‫‪ 1389/10/1‬ﺑﻮدﻧﺪ ﭘﺮداﺧﺘﻴﻢ‪.‬‬

‫ﭘﻴﺶروﻧﺪه ﻛﺎﻫﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬ﺑﻪﻫﻤﻴﻦ دﻟﻴﻞ ﻧﻴﺎز ﺑﻪ ﻳﻚ روش ﻛﺎرا و اﻳﻤﻦ‬ ‫ﺟﻬﺖ آﻣﺎدهﺳﺎزي ﺳﺮوﻳﻜﺲ دارﻳﻢ‪ .‬اﻛﺴﻲﺗﻮﺳﻴﻦ ﺑﺮ اﻧﻘﺒﺎﺿﺎت رﺣﻤﻲ‬

‫روش ﺑﺮرﺳﻲ‬

‫ﻣﻮﺛﺮ اﺳﺖ و ﺑﻪﺻﻮرت ﻣﺴﺘﻘﻴﻢ ﺗﺎﺛﻴﺮي ﺑﺮ اﻓﺎﺳﻤﺎن و دﻳﻼﺗﺎﺳﻴﻮن‬

‫ﭘﺲ از ﺗﺎﻳﻴﺪ ﻃﺮح ﺗﻮﺳﻂ ﻛﻤﻴﺘﻪ اﺧﻼق ﭘﺰﺷﻜﻲ‪ ،‬ﺧﺎﻧﻢﻫﺎي ﺑﺎرداري‬

‫ﺳﺮوﻳﻜﺲ ﻧﺪارد‪ .‬ﻛﺎرﺑﺮد آن ﻧﻴﺎز ﺑﻪ ﻛﺎﺗﺘﺮ ورﻳﺪي و ﭘﻤﭗ اﻧﻔﻮزﻳﻮن و‬

‫ﻛﻪ ﻛﺎﻧﺪﻳﺪ ﺧﺘﻢ ﺣﺎﻣﻠﮕﻲ و اﻟﻘﺎي زاﻳﻤﺎن ﺑﻮدﻧﺪ و از ﺗﺎرﻳﺦ ‪1388/10/1‬‬

‫ﭘﺎﻳﺶ ﻣﺴﺘﻘﻴﻢ دارد‪ .‬ﻳﻜﻲ از روشﻫﺎي داروﻳﻲ ﺟﻬﺖ آﻣﺎدهﺳﺎزي‬

‫ﻟﻐﺎﻳﺖ ‪ 1389/10/1‬ﺑﻪ ﺑﻴﻤﺎرﺳﺘﺎن زﻧﺎن )ﻣﻴﺮزا ﻛﻮﭼﻚﺧﺎن( ﻣﺮاﺟﻌﻪ‬

‫ﺳﺮوﻳﻜﺲ اﺳﺘﻔﺎده از ﭘﺮوﺳﺘﺎﮔﻼﻧﺪﻳﻦﻫﺎ ﻣﻲﺑﺎﺷﺪ ﻛﻪ ﺑﻴﺶ از ﻫﻤﻪ‬

‫ﻛﺮده و داراي ﻣﻌﻴﺎر ورود‪ :‬ﺧﺎﻧﻢﻫﺎي ﺑﺎردار ‪ 18-40‬ﺳﺎﻟﻪ ﻛﻪ ﺑﻴﻦ‬

‫)دﻳﻨﻮﭘﺮوﺳﺘﻮن( ﺑﻪﺷﻜﻞ ژل ﻳﺎ ﺷﻴﺎف و ﻳﺎ‬

‫‪ 34-42‬ﻫﻔﺘﻪ ﺑﺎرداري ﺑﻮده‪ .‬ﺣﺎﻣﻠﮕﻲ ﺗﻚﻗﻠﻮ‪ ،‬ﭘﺮزاﻧﺘﺎﺳﻴﻮن ﺳﻔﺎﻟﻴﻚ‪،‬‬

‫ﭘﺮوﺳﺘﺎﮔﻼﻧﺪﻳﻦ ‪) E1‬ﻣﻴﺰوﭘﺮوﺳﺘﻮل( ﺑﻪﺷﻜﻞ ﻗﺮص از ﻃﺮﻳﻖ ﺧﻮراﻛﻲ ﻳﺎ‬

‫ﻣﻌﻴﺎر ﻧﻤﺮهدﻫﻲ ﺑﻴﺸﺎب ﻛﻢﺗﺮ از ﺷﺶ‪ ،‬اﻧﻘﺒﺎﺿﺎت ﻧﺎﻛﺎﻓﻲ رﺣﻤﻲ )ﻛﻢﺗﺮ‬

‫واژﻳﻨﺎل ﺑﻪﻛﺎر ﻣﻲروﻧﺪ‪ .‬ﭘﺮوﺳﺘﺎﮔﻼﻧﺪﻳﻦﻫﺎ ﺑﺎﻋﺚ اﻓﺰاﻳﺶ ﺗﺠﺰﻳﻪ‬

‫ﻳﺎ ﻣﺴﺎوي دو اﻧﻘﺒﺎض در ‪ 10‬دﻗﻴﻘﻪ( و ‪ Nst: normal‬و ﻧﺪاﺷﺘﻦ ﻣﻌﻴﺎر‬

‫ﭘﺮوﺳﺘﺎﮔﻼﻧﺪﻳﻦ‬

‫‪E2‬‬

‫ﻣﺎﺗﺮﻳﻜﺲ ﻛﻼژن ﺳﺮوﻳﻜﺲ ﻣﻲﺷﻮد و ﺑﺎ اﻳﻦ ﻛﺎر ﻣﻨﺠﺮ ﺑﻪ اﻓﺎﺳﻤﺎن و‬ ‫آﻣﺎدهﺷﺪن ﺳﺮوﻳﻜﺲ ﻣﻲﺷﻮد‪ 5.‬ﭘﺮوﺳﺘﺎﮔﻼﻧﺪﻳﻦ‬

‫‪E2‬‬

‫ﺧﺮوج )ﭘﺎرﻳﺘﻲ≤‪،2‬‬

‫‪NST: abnormal‬‬

‫ﺳﺎﺑﻘﻪ اﺳﻜﺎر رﺣﻤﻲ‪ ،‬ﺟﻔﺖ‬

‫)دﻳﻨﻮﭘﺮوﺳﺘﻮن(‬

‫ﺳﺮراﻫﻲ‪ ،‬ﺧﻮنرﻳﺰي واژﻳﻨﺎل ﺑﻴﺶﺗﺮ از ﻧﻤﺎﻳﺶ ﺧﻮﻧﻲ زاﻳﻤﺎﻧﻲ‪ ،‬ﺑﻴﻤﺎري‬

‫اوﻟﻴﻦ ﭘﺮوﺳﺘﺎﮔﻼﻧﺪﻳﻦ ﺷﻨﺎﺧﺘﻪ ﺷﺪه در اﻣﺮﻳﻜﺎ در دﻫﻪﻫﺎي ﮔﺬﺷﺘﻪ اﺳﺖ‬

‫ﻗﻠﺒﻲ‪ .‬ﻛﻠﻴﻮي و ﻳﺎ ﻛﺒﺪي ﻣﺎدر‪ ،‬اﻓﺰاﻳﺶ ﺣﺴﺎﺳﻴﺖ ﺑﻪ اﻛﺴﻲﺗﻮﺳﻴﻦ‪،‬‬

‫ﻛﻪ ﺑﺮاي آﻣﺎدهﺳﺎزي ﺳﺮوﻳﻜﺲ اﺳﺘﻔﺎده ﻣﻲﺷﻮد‪ 6.‬دو اﺷﻜﺎل ﻋﻤﺪه دارد‪:‬‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﻳﺎ آﻧﺎﻟﻮگﻫﺎي ﭘﺮوﺳﺘﺎﮔﻼﻧﺪﻳﻦ( ﺑﻮدﻧﺪ ﭘﺲ از اﺧﺬ‬

‫ﻗﻴﻤﺖ آن ﮔﺮان اﺳﺖ و ﺑﺮاي ﻧﮕﻪداري از آن ﻧﻴﺎز ﺑﻪ ﻳﺨﭽﺎل دارﻳﻢ‪.‬‬

‫رﺿﺎﻳﺖﻧﺎﻣﻪ ﺗﻔﻬﻴﻤﻲ ﺟﻬﺖ ورود ﺑﻪ ﻃﺮح‪ ،‬ﺑﻪﺻﻮرت ﺗﺼﺎدﻓﻲ ﺳﺎده ﺑﺎ‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل آﻧﺎﻟﻮگ ‪ PGE1‬و ﺳﻴﻨﺘﺘﻴﻚ اﺳﺖ ﻛﻪ ﻗﻴﻤﺖ آن ارزان اﺳﺖ‬

‫اﺳﺘﻔﺎده از ﺟﺪول اﻋﺪاد ﺗﺼﺎدﻓﻲ در ﻳﻜﻲ از دو ﮔﺮوه زﻳﺮ )‪ (A, B‬ﻗﺮار‬

‫و ﺑﺮاي ﻧﮕﻪداري آن ﻧﻴﺎز ﺑﻪ ﻳﺨﭽﺎل ﻧﻴﺴﺖ و در دﻣﺎي اﺗﺎق ﻗﺎﺑﻞ‬

‫ﮔﺮﻓﺘﻨﺪ و وارد ﻳﻚ ﻛﺎرآزﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ ﺗﺼﺎدﻓﻲ دوﺳﻮﻛﻮر ﺷﺪﻧﺪ‪ .‬ﺗﻌﺪاد‬

‫ﻧﮕﻪداري اﺳﺖ و ﻋﻮارض ﺟﺎﻧﺒﻲ آن در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﭘﺮوﺳﺘﺎﮔﻼﻧﺪﻳﻦﻫﺎي‬

‫ﻧﻤﻮﻧﻪ ‪ 140‬ﻧﻔﺮ ﺑﻮد‪ .‬در ﮔﺮوه ‪ 70 ،A‬ﻧﻔﺮ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ‬

‫ﻃﺒﻴﻌﻲ ﻛﻢﺗﺮ اﺳﺖ و ﺑﺎﻋﺚ ﺷﺪه اﻳﻦ روش راﻫﻲ اﺳﺘﺎﻧﺪارد ﺟﻬﺖ‬

‫)‪ (Highwycomble, England‬ﺑﻪﻫﻤﺮاه ﭘﻼﺳﺒﻮي ورﻳﺪي و در ﮔﺮوه ‪،B‬‬

‫‪7‬‬

‫‪ 70‬ﻧﻔﺮ اﻛﺴﻲﺗﻮﺳﻴﻦ ورﻳﺪي )ﻛﺎﺳﭙﻴﻦ‪ ،‬اﻳﺮان( ﺑﻪﻫﻤﺮاه ﭘﻼﺳﺒﻮي‬

‫آﻣﺎدهﺳﺎزي ﺳﺮوﻳﻜﺲ و اﻟﻘﺎي زاﻳﻤﺎن در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﻮد‪.‬‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﻫﻢ ﺑﺮ اﻧﻘﺒﺎﺿﺎت ﻣﻴﻮﻣﺘﺮ رﺣﻤﻲ ﻣﻮﺛﺮ اﺳﺖ و ﺑﺎ اﺛﺮ روي‬

‫ﺧﻮراﻛﻲ درﻳﺎﻓﺖ ﻛﺮدﻧﺪ‪ .‬ﺑﻪ اﻳﻦ ﺻﻮرت ﻛﻪ در ﮔﺮوه‬

‫ﺳﺮوﻳﻜﺲ ﺑﺎﻋﺚ اﻓﺎﺳﻤﺎن و دﻳﻼﺗﺎﺳﻴﻮن آن ﻣﻲﺷﻮد و ﺑﺎ اﻳﻦ دو‬

‫‪ 200g‬ﻣﻴﺰوﭘﺮوﺳﺘﻮل در ‪ 200ml‬آب ﺣﻞ ﺷﺪه و در ﭼﻬﺎر ﺳﺎﻋﺖ اول‬

‫ﻣﻜﺎﻧﻴﺴﻢ اﺣﺘﻤﺎل ﻣﻮﻓﻘﻴﺖ زاﻳﻤﺎن اﻓﺰاﻳﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬روشﻫﺎي ﻣﺨﺘﻠﻒ‬

‫ﻫﺮ ﺳﺎﻋﺖ ‪ 20ml= 20g‬و در ﺻﻮرت ﻧﺎﻛﺎﻓﻲ ﺑﻮدن اﻧﻘﺒﺎﺿﺎت ﭼﻬﺎر‬

‫ﺗﺠﻮﻳﺰ ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺷﺎﻣﻞ ﺧﻮراﻛﻲ‪ ،‬زﻳﺮزﺑﺎﻧﻲ و واژﻳﻨﺎل اﺳﺖ‪.‬‬

‫ﺳﺎﻋﺖ دوم ﻫﺮ ﺳﺎﻋﺖ ‪ 40g= 40ml‬و در ﭼﻬﺎر ﺳﺎﻋﺖ ﺳﻮم ﻫﺮ‬

‫ﭘﻴﻚ ﺳﺮﻣﻲ ﻧﻮع ﺧﻮراﻛﻲ ‪ 34‬دﻗﻴﻘﻪ و ﻧﻴﻤﻪﻋﻤﺮ آن ‪ 20-40‬دﻗﻴﻘﻪ‬

‫ﺳﺎﻋﺖ ‪ 60g= 60ml‬از ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل داده ﻣﻲﺷﺪ و در اﻳﻦ‬

‫اﺳﺖ وﻟﻲ ﭘﻴﻚ ﺳﺮﻣﻲ ﻣﻴﺰوﭘﺮوﺳﺘﻮل واژﻳﻨﺎل ‪ 60-80‬دﻗﻴﻘﻪ و ﺳﻄﺢ‬

‫ﻣﺪت اﻧﻘﺒﺎﺿﺎت رﺣﻤﻲ ﭼﻚ ﻣﻲﺷﺪ‪ .‬در ﺻﻮرﺗﻲﻛﻪ اﻧﻘﺒﺎﺿﺎت ﻣﻨﺎﺳﺐ‬

‫ﺧﻮﻧﻲ آن ﺗﺎ ﭼﻬﺎر ﺳﺎﻋﺖ ﺑﺎﻗﻲ ﻣﻲﻣﺎﻧﺪ‪ 8.‬اﺳﺘﻔﺎده از ﺷﻜﻞ ﺧﻮراﻛﻲ‬

‫)ﻓﻮاﺻﻞ اﻧﻘﺒﺎﺿﺎت ‪ 2-3‬دﻗﻴﻘﻪ و ﻫﺮ اﻧﻘﺒﺎض ‪ 60-90‬ﺛﺎﻧﻴﻪ ﻃﻮل‬

‫آﺳﺎنﺗﺮ‪ ،‬ﻧﻴﻤﻪﻋﻤﺮ آن ﻛﻮﺗﺎهﺗﺮ و ﺷﺎﻧﺲ ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ آن ﻛﻢﺗﺮ‬

‫ﻣﻲﻛﺸﻴﺪ و ﻓﺸﺎر داﺧﻞ رﺣﻤﻲ ‪ 50-60‬ﻣﻴﻠﻲﻣﺘﺮ ﺟﻴﻮه( ﺑﻮد دوز ﺑﻌﺪي‬

‫اﺳﺖ‪ 9.‬ﻫﻢاﻛﻨﻮن در ﺑﻴﻤﺎرﺳﺘﺎن زﻧﺎن )ﻣﻴﺮزاﻛﻮﭼﻚﺧﺎن( از اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫داده ﻧﻤﻲﺷﺪ‪ .‬اﮔﺮ ﻣﺠﺪدا اﻧﻘﺒﺎﺿﺎت ﻧﺎﻛﺎﻓﻲ ﻣﻲﺷﺪ از ‪ 10g‬در ﺳﺎﻋﺖ‬

‫ﺟﻬﺖ اﻟﻘﺎي زاﻳﻤﺎن اﺳﺘﻔﺎده ﻣﻲﺷﻮد‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻫﻤﻴﺖ ﻣﻮﺿﻮع و ﻧﻴﺰ‬

‫ﺷﺮوع و ﺑﻪ ‪ 20g‬و ﺣﺘﻲ ﺑﻪ ‪ 40g‬در ﺳﺎﻋﺖ دوز را اﻓﺰاﻳﺶ داده ﺗﺎ‬

‫‪A‬‬

‫ﻳﻚ ﻗﺮص‬

‫ﻋﺪم وﺟﻮد ﻣﻄﺎﻟﻌﻪ ﻣﺸﺎﺑﻬﻲ در اﻳﺮان‪ ،‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪﻣﻘﺎﻳﺴﻪ اﺛﺮ‬

‫زﻣﺎﻧﻲﻛﻪ اﻧﻘﺒﺎﺿﺎت ﻣﻨﺎﺳﺐ اﻳﺠﺎد ﮔﺮدد‪ .‬در ﮔﺮوه‬

‫ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ و اﻛﺴﻲﺗﻮﺳﻴﻦ در اﻟﻘﺎي زاﻳﻤﺎن در‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ ورﻳﺪي اﺳﺘﻔﺎده ﺷﺪ ﻛﻪ ‪ 10‬واﺣﺪ در ﻳﻚ ﻟﻴﺘﺮ ﺳﺮم رﻳﻨﮕﺮ‬

‫ﺧﺎﻧﻢﻫﺎي ﺑﺎردار ﺑﺎ ﺳﻦ ﺣﺎﻣﻠﮕﻲ ‪ 34-42‬ﻛﻪ ﻛﺎﻧﺪﻳﺪ ﺧﺘﻢ ﺣﺎﻣﻠﮕﻲ و‬

‫رﻳﺨﺘﻪ و از ‪ 6mu/min‬ﺷﺮوع و در ﻓﻮاﺻﻞ ‪ 20‬دﻗﻴﻘﻪ‪ ،‬ﺷﺶ ﻣﻴﻠﻲﻳﻮﻧﻴﺖ‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪B‬‬

‫از ﻣﺤﻠﻮل‬

‫‪415‬‬

‫ﻣﻘﺎﻳﺴﻪ اﺛﺮ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﺑﺎ اﻛﺴﻲﺗﻮﺳﻴﻦ در اﻟﻘﺎي زاﻳﻤﺎن در زﻧﺎن ﺑﺎ ﺳﺮوﻳﻜﺲ ﻧﺎﻣﻨﺎﺳﺐ‬

‫اﻓﺰوده ﻣﻲﺷﺪ ﺗﺎ اﻧﻘﺒﺎﺿﺎت ﻛﺎﻓﻲ اﻳﺠﺎد ﺷﻮد و در ﺻﻮرت اﻳﺠﺎد ﺗﺎﻛﻲ‬

‫ﺟﻤﻊآوري اﻃﻼﻋﺎت ﻣﻮرد ﻧﻴﺎز‪ ،‬اﻗﺪام ﺑﻪ ﺗﺠﺰﻳﻪ و ﺗﺤﻠﻴﻞ دادهﻫﺎي‬ ‫‪SPSS‬‬

‫ﺳﻴﺴﺘﻮل ﻳﺎ ﻫﻴﭙﺮﺗﻮﻧﻮس ﺗﺠﻮﻳﺰ اﻛﺴﻲﺗﻮﺳﻴﻦ ﻣﺘﻮﻗﻒ ﻣﻲﺷﺪ‪ .‬در‬

‫ﺣﺎﺻﻠﻪ ﺷﺪ ﻛﻪ در اﻳﻦ زﻣﻴﻨﻪ از ﻧﺮماﻓﺰار آﻣﺎري‬

‫ﺻﻮرت اﻧﻘﺒﺎﺿﺎت ﻧﺎﻛﺎﻓﻲ رﺣﻤﻲ ﻣﺠﺪدا از دوز ﻛﻢ ﺷﺮوع و در‬

‫اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺑﺮاي ﻣﻘﺎﻳﺴﻪ داده ﻛﻤ‪‬ﻲ در دو ﮔﺮوه ﻏﻴﺮواﺑﺴﺘﻪ از آزﻣﻮن‬

‫ﺻﻮرت ﻧﻴﺎز در ﻓﻮاﺻﻞ ‪ 20‬دﻗﻴﻘﻪاي دوز آن را اﻓﺰاﻳﺶ ﻣﻲدادﻳﻢ‪.‬‬

‫‪ Independent sample t-test‬اﺳﺘﻔﺎده ﺷﺪ و ﺑﺮاي ﻣﻘﺎﻳﺴﻪ دادهﻫﺎي‬

‫وﻳﺮاﺳﺖ ‪17‬‬

‫‪2‬‬

‫ﺑﻴﻤﺎران در ﺗﻤﺎم ﻣﺪت ﺗﺤﺖ ﻣﺎﻧﻴﺘﻮرﻳﻨﮓ ﺿﺮﺑﺎن ﻗﻠﺐ ﺟﻨﻴﻦ ﺑﻮدﻧﺪ‪.‬‬

‫ﻛﻴﻔﻲ از آزﻣﻮن ‪ ‬ﺑﻪﺗﻨﺎﺳﺐ اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺳﻄﺢ ﻣﻌﻨﻲداري ﺑﺮاي ﺗﻔﺴﻴﺮ‬

‫ﻋﻼﻳﻢ ﺣﻴﺎﺗﻲ و ﮔﻮارﺷﻲ ﻣﺎ در ﻧﻴﺰ ﻫﺮ ﻳﻚ ﺳﺎﻋﺖ ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار‬

‫ﻧﺘﺎﻳﺞ ‪ 0/05‬ﻟﺤﺎظ ﮔﺮدﻳﺪ‪.‬‬

‫ﻣﻲﮔﺮﻓﺖ‪ .‬ﻋﻮارض ﺟﺎﻧﺒﻲ دارو ﺷﺎﻣﻞ ﺗﺎﻛﻲ ﺳﻴﺴﺘﻮل )ﺷﺶ اﻧﻘﺒﺎض در‬ ‫‪ 10‬دﻗﻴﻘﻪ ﻛﻪ ﺑﺮاي ﺣﺪاﻗﻞ ‪ 20‬دﻗﻴﻘﻪ ﻃﻮل ﺑﻜﺸﺪ(‪ ،‬ﻫﻴﭙﺮﺗﻮﻧﻮس )ﺑﻪ ﻳﻚ‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫اﻧﻘﺒﺎض ﻛﻪ ﺑﻪﺗﻨﻬﺎﻳﻲ ﺑﺮاي ﺑﻴﺶﺗﺮ از دو دﻗﻴﻘﻪ ﻃﻮل ﺑﻜﺸﺪ( و‬

‫‪ 140‬ﺑﻴﻤﺎر ﻣﻮرد ﺑﺮرﺳﻲ ﻧﻬﺎﻳﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﻫﻴﭻ ﺑﻴﻤﺎري از ﻣﻄﺎﻟﻌﻪ‬

‫‪NST‬‬

‫ﺧﺎرج ﻧﺸﺪ و در ﻫﺮ دو ﮔﺮوه ﺗﺎ زﻣﺎن زاﻳﻤﺎن در ﺻﻮرت ﻧﻴﺎز ﺑﻪ‬

‫ﻏﻴﺮﻃﺒﻴﻌﻲ ﻣﺜﻞ اﻓﺖ دﻳﺮرس‪ ،‬اﻓﺖ ﻣﺘﻐﻴﺮ ﺷﺪﻳﺪ‪ ،‬اﻓﺖ ﻃﻮﻻﻧﻲﻣﺪت و ﻳﺎ‬

‫اﻳﻨﺪاﻛﺸﻦ‪ ،‬ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﻳﺎ اﻛﺴﻲﺗﻮﺳﻴﻦ اداﻣﻪ داده ﺷﺪ و در ﻫﻴﭻﻛﺪام‬

‫ﺗﺎﻛﻴﻜﺎردي ﻣﻨﺠﺮ ﺷﻮد ﮔﻔﺘﻪ ﻣﻲﺷﻮد ﻛﻪ اﺣﺘﻴﺎج ﺑﻪ ﻳﻚ ﻣﺪاﺧﻠﻪ ﺗﻮﻛﻮﻟﻴﺰ‬

‫ﺑﻪﻋﻠﺖ ﻋﻮارض داروﻳﻲ ﻣﺠﺒﻮر ﺑﻪ ﻗﻄﻊ دارو ﻧﺸﺪﻳﻢ‪ .‬ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ‪،‬‬

‫ﻳﺎ زاﻳﻤﺎن داﺷﺘﻪ ﺑﺎﺷﻨﺪ[ و ﻋﻮارض ﮔﻮارﺷﻲ ﺷﺎﻣﻞ ﺗﻬﻮع‪ ،‬اﺳﺘﻔﺮاغ‪،‬‬

‫ﮔﺮاوﻳﺪ‪ ،‬ﭘﺎرﻳﺘﻲ و ﺳﻦ ﺑﺎرداري در دو ﮔﺮوه ﻫﻤﺴﺎن ﺑﻮد )‪.(P>0/05‬‬

‫اﺳﻬﺎل‪ ،‬ﺗﺐ و ﺳﺮدرد ﻧﻴﺰ در دو ﮔﺮوه ﺑﺮرﺳﻲ ﺷﺪ‪ .‬ﻣﺘﻮﺳﻂ ﻓﺎﺻﻠﻪ‬

‫ﻣﻴﺎﻧﮕﻴﻦ ﺑﻴﺸﺎب اﺳﻜﻮر ﺳﺮوﻳﻜﺲ در ﺣﻴﻦ ﺑﺴﺘﺮي در دو ﮔﺮوه ﻫﻤﺴﺎن‬

‫زﻣﺎﻧﻲ زاﻳﻤﺎن واژﻳﻨﺎل از ﺷﺮوع اﻟﻘﺎ‪ ،‬ﻣﻴﺰان ﺳﺰارﻳﻦ‪ ،‬ﻣﻴﺰان رﺿﺎﻳﺖﻣﻨﺪي‬

‫ﺑﻮد )‪) (P>0/05‬ﺟﺪول ‪ .(1‬ﻧﻮع زاﻳﻤﺎن )ﻃﺒﻴﻌﻲ و ﺳﺰارﻳﻦ(‪ ،‬ﻋﻮارض‬

‫ﺑﻴﻤﺎران و آﭘﮕﺎر ﻧﻮزادان در ﻫﺮ دو ﮔﺮوه ﺑﺮرﺳﻲ و ﻣﻘﺎﻳﺴﻪ ﺷﺪ‪ .‬ﭘﺲ از‬

‫داروﻳـﻲ )ﺳﺮدرد‪ ،‬ﺗﻬﻮع‪ ،‬اﺳﺘﻔﺮاغ‪ ،‬اﺳﻬﺎل‪ ،‬ﺧﻮنرﻳﺰي‪ ،‬ﺗﺎﻛﻲ ﺳﻴﺴﺘﻮل و‬

‫ﺟﺪول‪ :1-‬ﺗﻮزﻳﻊ ﻓﺮاواﻧﻲ ﻣﺘﻐﻴﺮﻫﺎي دﻣﻮﮔﺮاﻓﻴﻚ در دو ﮔﺮوه ﻣﻮرد ﻣﻄﺎﻟﻌﻪ‬

‫ﺟﺪول‪ :2-‬ﺗﻮزﻳﻊ ﻓﺮاواﻧﻲ ﻋﻮارض داروﻳﻲ در دو ﮔﺮوه ﻣﻮرد ﻣﻄﺎﻟﻌﻪ‬

‫ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ ]ﺗﺎﻛﻲ ﺳﻴﺴﺘﻮل ﻳﺎ ﻫﻴﭙﺮﺗﻮﻧﻮس ﻛﻪ ﻣﻨﺠﺮ ﺑﻪ‬

‫ﻣﺘﻐﻴﺮ و ﮔﺮوه ﻣﺮﺑﻮﻃﻪ‬

‫ﻣﻴﺎﻧﮕﻴﻦ‬

‫اﻧﺤﺮافﻣﻌﻴﺎر‬

‫*‪P‬‬

‫ﻣﻴﺎﻧﮕﻴﻦ‬

‫اﻧﺤﺮافﻣﻌﻴﺎر‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫‪11/07‬‬

‫‪3/62‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫‪14/87‬‬

‫‪3/11‬‬

‫ﻣﺘﻐﻴﺮ و ﮔﺮوه ﻣﺮﺑﻮﻃﻪ‬

‫‪P‬‬

‫ﻓﺎﺻﻠﻪ اﻟﻘﺎ ﺗﺎ زاﻳﻤﺎن )ﺳﺎﻋﺖ(‬

‫ﺳﻦ )ﺳﺎل(‬ ‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫‪26/27‬‬

‫‪3/59‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫‪27/00‬‬

‫‪3/9‬‬

‫‪0/025‬‬

‫ﻧﻮع زاﻳﻤﺎن‬

‫ﮔﺮاوﻳﺪ )ﺗﻌﺪاد ﺣﺎﻣﻠﮕﻲ(‬ ‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫‪1/34‬‬

‫‪0/50‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫‪1/44‬‬

‫‪0/62‬‬

‫‪0/3‬‬

‫ﭘﺎرﻳﺘﻲ )ﺗﻌﺪاد زاﻳﻤﺎن(‬ ‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫‪0/21‬‬

‫‪0/41‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫‪0/25‬‬

‫‪0/44‬‬

‫‪0/69‬‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﻃﺒﻴﻌﻲ‬

‫‪%84/28‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫ﻃﺒﻴﻌﻲ‬

‫‪%74/28‬‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﺗﻬﻮع‪ -‬اﺳﺘﻔﺮاغ‬

‫‪%21/42‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫ﺗﻬﻮع‪ -‬اﺳﺘﻔﺮاغ‬

‫‪%15/71‬‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫‪38/94‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫‪38/48‬‬

‫‪1/7‬‬

‫‪1/07‬‬

‫ﺑﻴﺸﺎب اﺳﻜﻮر )اﺑﺘﺪاي ﺑﺴﺘﺮي(‬

‫**‪0/55‬‬

‫ﺗﺎﻛﻲ ﺳﻴﺴﺘﻮل‬ ‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﺳﻦ ﺑﺎرداري )ﻫﻔﺘﻪ(‬

‫**‪0/107‬‬

‫ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﺎرﺿﻪ‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫‪2/62‬‬

‫*‪0/001‬‬

‫ﺻﻔﺮ‬

‫‪--‬‬

‫ﺻﻔﺮ‬

‫‪--‬‬

‫‪--‬‬

‫ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ‬ ‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﺻﻔﺮ‬

‫‪--‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫ﺻﻔﺮ‬

‫‪--‬‬

‫‪--‬‬

‫رﺿﺎﻳﺖﻣﻨﺪي‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫‪3/45‬‬

‫‪1/25‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫‪3/32‬‬

‫‪1/16‬‬

‫* آزﻣﻮن آﻣﺎري ﻣﻮرد اﺳﺘﻔﺎده ‪ Student’s t-test‬و ‪ P<0/05‬ﻣﻌﻨﻲدار ﻣﻲﺑﺎﺷﺪ‬

‫‪0/34‬‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫‪88/57‬‬

‫‪--‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ‬

‫‪78/57‬‬

‫‪--‬‬

‫**‪0/17‬‬

‫* آزﻣﻮن ‪ P<0/05 ،Student’s t-test‬ﻣﻌﻨﻲدار ﻣﻲﺑﺎﺷﺪ ** آزﻣﻮن ‪ 2‬و ‪ P<0/05‬ﻣﻌﻨﻲدار ﻣﻲﺑﺎﺷﺪ‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪416‬‬

‫ﺷﻴﺮﻳﻦ ﻧﻴﺮوﻣﻨﺶ و ﻫﻤﻜﺎران‬

‫ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ( و ﻣﻴﺰان رﺿﺎﻳﺖﻣﻨﺪي ﺑﻴﻤﺎران از ﻧﺤﻮه اﻟﻘﺎ در ﺑﻴﻦ دو‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل واژﻳﻨﺎل در ‪ 106‬ﺧﺎﻧﻢ ﺑﺎردار ‪ 34-42‬ﻫﻔﺘﻪ ﺑﺎرداري‬

‫ﮔﺮوه ﺗﻔﺎوت آﻣﺎري ﻣﻌﻨﻲداري ﻧﺪاﺷﺖ )‪ .(P>0/05‬ﺷﺎﻳﻊﺗـﺮﻳﻦ ﻋﺎرﺿـﻪ‬

‫ﻛﺎﻧﺪﻳﺪ اﻟﻘﺎي زاﻳﻤﺎن ﺑﺎ ﻣﻌﻴﺎر ﻧﻤﺮهدﻫﻲ ﺑﻴﺸﺎب ﻛﻢﺗﺮ از ﺷﺶ ﻣﻘﺎﻳﺴﻪ‬

‫داروﻳﻲ در دو ﮔﺮوه ﺗﻬﻮع اﺳﺘﻔﺮاغ ﺑﻮد‪ .‬در دو ﮔﺮوه ﺗـﺎﻛﻲ ﺳﻴـﺴﺘﻮل و‬

‫ﺷﺪه ﺑﻪاﻳﻦ ﺻﻮرت ﻛﻪ در ﻧﻮع ﺧﻮراﻛﻲ ﻳﻚ ﻗﺮص ‪ 200‬ﻣﻴﻜﺮوﮔﺮﻣﻲ‬

‫ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ دﻳﺪه ﻧﺸﺪ‪ .‬ﻣﻴﺎﻧﮕﻴﻦ ﻣﺪت زﻣﺎن اﻟﻘﺎ ﺗﺎ زاﻳﻤﺎن در ﮔﺮوه‬

‫در ‪ 200ml‬آب ﺣﻞ ﺷﺪه و در ﭼﻬﺎر ﺳﺎﻋﺖ اول ﻫﺮ ﺳﺎﻋﺖ ‪ 20ml‬و‬

‫ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه اﻛﺴﻲﺗﻮﺳـﻴﻦ ﺑـﻪﻣﻴـﺰان‬

‫در ﭼﻬﺎر ﺳﺎﻋﺖ دوم ﻫﺮ ﺳﺎﻋﺖ ‪ 40ml‬و در ﭼﻬﺎر ﺳﺎﻋﺖ ﺳﻮم ﻫﺮ‬

‫ﻣﻌﻨﻲداري ﻛﻢ ﺗـﺮ ﺑـﻮد )‪ 11/07±3/62‬در ﺑﺮاﺑـﺮ ‪ 14/87±3/11‬ﺳـﺎﻋﺖ‬

‫ﺳﺎﻋﺖ ‪ 60ml‬داده ﻣﻲﺷﺪ ﺗﺎ ﻫﺮ زﻣﺎن ﻛﻪ اﻧﻘﺒﺎﺿﺎت ﻣﻨﺎﺳﺐ ﭘﻴﺪا ﻛﻨﺪ‬

‫‪ .(P=0/001‬ﻣﻴﺎﻧﮕﻴﻦ آﭘﮕﺎر دﻗﻴﻘﻪ ﭘﻨﺠﻢ ﻧﻮزادان ﺑـﻴﻦ دو ﮔـﺮوه ﻣﺤﻠـﻮل‬

‫دوز ﺑﻌﺪي داده ﻧﻤﻲﺷﺪ و در ﮔﺮوه دﻳﮕﺮ ‪ 25‬ﻣﻴﻜﺮوﮔﺮم ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ و اﻛﺴﻲﺗﻮﺳﻴﻦ )ﺑﻪﺗﺮﺗﻴﺐ ‪ 9/45±0/82‬در ﺑﺮاﺑـﺮ‬

‫واژﻳﻨﺎل ﻫﺮ ﭼﻬﺎر ﺳﺎﻋﺖ ﮔﺬاﺷﺘﻪ ﺷﺪ‪ .‬ﻧﺘﻴﺠﻪ اﻳﻦ ﻣﻄﺎﻟﻌﻪ زاﻳﻤﺎن واژﻳﻨﺎل‬

‫‪ (P>0/05 ،9/61±0/78‬اﺧﺘﻼف ﻣﻌﻨﻲداري ﻧﺪاﺷﺖ )ﺟـﺪول ‪ .(2‬ﻫـﻴﭻ‬

‫در ﻋﺮض ‪ 12‬ﺳﺎﻋﺖ در ‪ 75‬زن )‪ (%74/3‬در ﮔﺮوه ﻣﺤﻠﻮل‬

‫ﻣﻮردي از ﻣﺮگ و ﻣﻴﺮ ﻣﺎدري و ﻧﻮزادي وﺟﻮد ﻧﺪاﺷﺖ و ﻣﻴـﺎﻧﮕﻴﻦ دوز‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ و ‪ (%25/5) 27‬زن در ﮔﺮوه واژﻳﻨﺎل رخ داده‬

‫ﻣﺼﺮﻓﻲ ﻣﻴﺰوﭘﺮوﺳﺘﻮل ‪ 169/7±65/7‬ﻣﻴﻜﺮوﮔـﺮم ﺑـﻮد‪ .‬ﺣـﺪاﻛﺜﺮ زﻣـﺎن‬

‫ﺑﻮد ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ ﺻﻔﺮ در ﮔﺮوه ﺧﻮراﻛﻲ در ﻣﻘﺎﺑﻞ ‪ %11/3‬در ﮔﺮوه‬

‫اﻳﻨﺪاﻛﺸﻦ ‪ 24‬ﺳﺎﻋﺖ ﺑﻮده و در ﺻﻮرت ﻋﺪم ﭘﺎﺳﺦ در ‪ 24‬ﺳﺎﻋﺖ ﭘﺲ‬

‫واژﻳﻨﺎل‪ .‬ﺗﻬﻮع در ﮔﺮوه ﺧﻮراﻛﻲ ﺑﻴﺶﺗﺮ ﺑﻮد‪ .‬آﭘﮕﺎر ﻛﻢﺗﺮ از ﻫﻔﺖ در‬

‫از ﺷﺮوع اﻳﻨﺪاﻛﺸﻦ‪ ،‬ﺑﺎ ﺗﺸﺨﻴﺺ ﻋﺪم ﭘﺎﺳﺦ زاﻳﻤﺎن ﺳﺰارﻳﻦ اﻧﺠﺎم ﺷﺪ‪.‬‬

‫دﻗﻴﻘﻪ اول در ﮔﺮوه ﺧﻮراﻛﻲ ﻛﻢﺗﺮ از واژﻳﻨﺎل ﺑﻮد و ﻧﺘﻴﺠﻪ اﻳﻦﻛﻪ ﻣﻴﺰان‬ ‫ﺳﺰارﻳﻦ و ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ در ﮔﺮوه ﻣﺤﻠﻮل ﺧﻮراﻛﻲ ﻛﻪ ﻳﻚ‬

‫ﺑﺤﺚ‬

‫ﺳﺮوﻳﻜﺲ ﻧﺎﻣﻨﺎﺳﺐ داﺷﺘﻨﺪ ﻛﻢﺗﺮ از ﮔﺮوه واژﻳﻨﺎل ﺑﻮد و ﻣﺤﻠﻮل‬

‫ﺑﺮ اﺳﺎس ﺟﺴﺘﺠﻮي ﻣﺎ ﺗﺎﻛﻨﻮن در ﻛﺸﻮرﻣﺎن اﻳﺮان از ﻣﺤﻠﻮل‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ روﺷﻲ اﻳﻤﻦ و ﻛﺎرا ﺟﻬﺖ اﻟﻘﺎي زاﻳﻤﺎن‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﺑﻪﻋﻨﻮان اﻟﻘﺎي زاﻳﻤﺎن در ﺧﺎﻧﻢﻫﺎي ﺑﺎردار‬

‫ﻣﻲﺑﺎﺷﺪ‪ .‬در ﻣﻄﺎﻟﻌﻪ ‪11 ،Hofmeyr‬ﺗﺎﺛﻴﺮ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ‬

‫اﺳﺘﻔﺎده ﻧﺸﺪه اﺳﺖ‪ .‬ﻣﻄﺎﻟﻌﺎﺗﻲ در راﺑﻄﻪ ﺑﺎ ﻣﻘﺎﻳﺴﻪ ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﺑﺎ دﻳﻨﻮﭘﺮوﺳﺘﻮن واژﻳﻨﺎل ﻣﻘﺎﻳﺴﻪ ﺷﺪ ‪ 695‬ﺧﺎﻧﻢ ﺑﺎردار ﻛﻪ ﻛﺎﻧﺪﻳﺪ اﻟﻘﺎي‬

‫ﺧﻮراﻛﻲ ﺑﺎ واژﻳﻨﺎل ﻳﺎ زﻳﺮ زﺑﺎﻧﻲ در اﻟﻘﺎي زاﻳﻤﺎن در ﺣﺎﻣﻠﮕﻲ ﺗﺮم اﻧﺠﺎم‬

‫زاﻳﻤﺎن ﺑﻌﺪ از ‪ 34‬ﻫﻔﺘﮕﻲ ﺷﺪه ﺑﻮدﻧﺪ ‪ 346‬ﻧﻔﺮ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﺷﺪه وﻟﻲ در ﻣﻮرد ﻛﺎراﻳﻲ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ در اﻳﻨﺪاﻛﺸﻦ‬

‫ﺧﻮراﻛﻲ )ﻫﺮ دو ﺳﺎﻋﺖ ‪ 20g‬ﺗﺎ ﺳﻪ دوز و در ﺻﻮرت ﻧﺎﻣﻨﺎﺳﺐ ﺑﻮدن‬

‫ﻛﻪ دوز آن در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺳﺎﻳﺮ اﺷﻜﺎل آن ﺑﺴﻴﺎر ﻛﻢﺗﺮ اﺳﺖ ﺑﻪﻃﻮري ﻛﻪ‬

‫اﻧﻘﺒﺎﺿﺎت ﺑﻪ ‪ 40g‬ﻫﺮ دو ﺳﺎﻋﺖ اﻓﺰاﻳﺶ داده ﻣﻲﺷﺪ( و ‪ 349‬ﻧﻔﺮ‬

‫از دوز ‪ 20‬ﻣﻴﻜﺮوﮔﺮم در ﺳﺎﻋﺖ در ﭼﻬﺎر ﺳﺎﻋﺖ اول ﺷﺮوع و ﺑﺮ‬

‫دﻳﻨﻮﭘﺮوﺳﺘﻮﻧﻮاژﻳﻨﺎل ‪ 2mg‬در دو دوز ﺑﻪﻓﺎﺻﻠﻪ ﺷﺶ ﺳﺎﻋﺖ درﻳﺎﻓﺖ‬

‫اﺳﺎس ﻧﻴﺎز دوز آن ﻗﺎﺑﻞ اﻓﺰاﻳﺶ ﻳﺎ ﻛﺎﻫﺶ اﺳﺖ ﻣﻄﺎﻟﻌﻪاي ﻧﻴﺎﻓﺘﻴﻢ‪ .‬ﺑﺎ‬

‫ﻛﺮدﻧﺪ‪ .‬ﻫﺪف اﻳﻦ ﻣﻄﺎﻟﻌﻪ زاﻳﻤﺎن واژﻳﻨﺎل در ‪ 24‬ﺳﺎﻋﺖ ﺑﻮد‪ .‬در ﮔﺮوه‬

‫ﺗﻮﺟﻪ ﺑﻪ اﻫﻤﻴﺖ ﻣﻮﺿﻮع ﺑﺮرﺳﻲ ﻣﺎ ﺑﺮ روي ﻣﺎدران ﺑﺎردار ﺑﺎ ﺳﻦ‬

‫اول ‪ %38‬و در ﮔﺮوه دوم ‪ %36‬ﺑﻪاﻳﻦ ﻫﺪف دﺳﺖ ﻧﻴﺎﻓﺘﻨﺪ‪.‬‬

‫ﺑﺎرداري ﺑﻴﺶﺗﺮ از ‪ 34‬ﻫﻔﺘﻪ ﻛﻪ ﻛﺎﻧﺪﻳﺪ ﺧﺘﻢ ﺣﺎﻣﻠﮕﻲ و ﻧﻴﺎز ﺑﻪ اﻟﻘﺎي‬

‫ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ ﻛﻪ ﺑﺎﻋﺚ ﺗﻐﻴﻴﺮ‬

‫زاﻳﻤﺎن در ﺑﻴﻤﺎرﺳﺘﺎن زﻧﺎن ﺗﻬﺮان از ﺗﺎرﻳﺦ ‪ 1388/10/1‬ﻟﻐﺎﻳﺖ‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل و در ‪ %3‬ﮔﺮوه دﻳﻨﻮﭘﺮوﺳﺘﻮن رخ داده ﺑﻮد‪ .‬رﻳﺴﻚ‬

‫‪ 1389/10/1‬داﺷﺘﻨﺪ اﻧﺠﺎم ﺷﺪ‪ .‬در ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻧﺸﺎن داده ﺷﺪ ﻛﻪ ﻧﻪ‬

‫ﺳﺰارﻳﻦ ‪ %16‬در ﻣﻘﺎﺑﻞ ‪ %20‬ﺑﻮد‪ Outcome .‬ﺟﻨﻴﻨﻲ در ﻫﺮ دو ﮔﺮوه‬

‫ﺗﻨﻬﺎ اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﻲداري ﺑﻴﻦ دو ﮔﺮوه از ﻧﻈﺮ ﻋﻮارض داروﻳﻲ‪،‬‬

‫ﻳﻜﺴﺎن ﺑﻮد‪ .‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داد ﻛﻪ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ‬

‫آﭘﮕﺎر ﻧﻮزادان‪ ،‬ﻧﻮع زاﻳﻤﺎن و رﺿﺎﻳﺖﻣﻨﺪي ﻣﺎدران از داروي ﻣﻮرد‬

‫ﺟﻬﺖ اﻟﻘﺎي زاﻳﻤﺎن ﻣﻮﺛﺮ اﺳﺖ و رﻳﺴﻚ ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ آن ﻛﻢ اﺳﺖ‪.‬‬

‫اﺳﺘﻔﺎده در اﻟﻘﺎي زاﻳﻤﺎن )‪ (P>0/05‬وﺟﻮد ﻧﺪاﺷﺖ ﺑﻠﻜﻪ در ﮔﺮوه‬

‫اﻟﺒﺘﻪ در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﻛﻪ ﺗﻤﺎم ﻣﺎدران ﺗﺤﺖ ﻣﺎﻧﻴﺘﻮرﻳﻨﮓ ﻗﻠﺒﻲ و اﻧﻘﺒﺎﺿﺎت‬

‫ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﻣﺪت زﻣﺎن ﺷﺮوع اﻟﻘﺎ ﺗﺎ زاﻳﻤﺎن واژﻳﻨﺎل‬

‫ﺑﻮدﻧﺪ ﻣﻮردي از ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ دﻳﺪه ﻧﺸﺪ ﻛﻪ دﻟﻴﻞ اﺣﺘﻤﺎﻟﻲ آن ﻫﻤﻴﻦ‬

‫ﺑﻪﻃﻮر ﻣﻌﻨﻲداري ﻛﻢﺗﺮ ﺷﺪه ﺑﻮد )‪ .(P=0/001‬ﻫﻴﭻ ﻣﻮردي از ﻣﺮگ‬

‫ﻣﺎﻧﻴﺘﻮرﻳﻨﮓ داﻳﻤﻲ ﺑﻮده ﻛﻪ در ﺻﻮرت اﻓﺰاﻳﺶ اﻧﻘﺒﺎﺿﺎت دوز ﺑﻌﺪي‬

‫‪Cheng‬‬

‫داده ﻧﻤﻲﺷﺪ و در ﺻﻮرت ﺷﺮوع ﻣﺠﺪد اﻟﻘﺎ‪ ،‬دوز دارو ﺑﻪﻧﺼﻒ ﻛﺎﻫﺶ‬

‫‪ 10 ،SY‬ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ در ‪ 101‬زن ﺑﺎردار ﺑﺎ‬

‫ﻣﻲﻳﺎﻓﺖ‪ .‬رﻳﺴﻚ ﺳﺰارﻳﻦ در ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ‪ %16‬در‬

‫ﻣﺎدري و ﻣﺮگ ﻧﻮزادي در دو ﮔﺮوه وﺟﻮد ﻧﺪاﺷﺖ‪ .‬در ﻣﻄﺎﻟﻌﻪ‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪FHR‬‬

‫ﺷﺪه ﺑﻮد در ‪ %4‬ﮔﺮوه‬

‫ﻣﻘﺎﻳﺴﻪ اﺛﺮ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﺑﺎ اﻛﺴﻲﺗﻮﺳﻴﻦ در اﻟﻘﺎي زاﻳﻤﺎن در زﻧﺎن ﺑﺎ ﺳﺮوﻳﻜﺲ ﻧﺎﻣﻨﺎﺳﺐ‬

‫‪417‬‬

‫ﻣﻘﺎﺑﻞ ‪ %26‬در ﮔﺮوه اﻛﺴﻲﺗﻮﺳﻴﻦ در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﺑﻮد‪ .‬در ﻣﻄﺎﻟﻌﻪ‬

‫ﺳﺎﻋﺖ اول و ﻣﺘﻮﺳﻂ ﻓﺎﺻﻠﻪ زﻣﺎﻧﻲ ﺑﻴﻦ ﺷﺮوع اﻟﻘﺎ ﺗﺎ زاﻳﻤﺎن واژﻳﻨﺎل‬

‫‪ 12 Matonhodze BB‬ﻣﻘﺎﻳﺴﻪ ﺳﻪ ﻣﺘﺪ ﺟﻬﺖ اﻟﻘﺎ در ﺧﺎﻧﻢﻫﺎي ﺑﺎردار‬

‫ﺑﻮد‪ .‬ﻫﺪف ﺛﺎﻧﻮﻳﻪ ﺷﺎﻣﻞ ﻧﻴﺎز ﺑﻪﺗﻘﻮﻳﺖ اﻟﻘﺎ ﺑﺎ اﻛﺴﻲﺗﻮﺳﻴﻦ‪ ،‬دوز ﺗﻮﺗﺎل‬

‫ﺑﺎ ﻣﺎﻣﺒﺮان ﺳﺎﻟﻢ ﺷﺪه ﺑﻮد ‪ -1‬اﻛﺴﺘﺮاآﻣﻨﻴﻮﺗﻴﻚ ﻓﻮﻟﻲ ﻛﺎﺗﺘﺮ ﺑﻪﻫﻤﺮاه‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل‪ ،‬ﺗﻌﺪاد زاﻳﻤﺎن ﺳﺰارﻳﻦ‪ ،‬ﺷﻜﺴﺖ اﻟﻘﺎ‪ ،‬ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ‬

‫ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل در ‪ 174‬زن‪ -2 ،‬ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ‬

‫رﺣﻤﻲ و اوتﻛﺎم ﺟﻨﻴﻨﻲ ﺑﻮد‪ .‬ﻧﺘﻴﺠﻪ اﻳﻦ ﻣﻄﺎﻟﻌﻪ ‪ %97/4‬در ‪ 24‬ﺳﺎﻋﺖ‬

‫ﺑﻪﺗﻨﻬﺎﻳﻲ در ‪ 176‬زن‪ -3 ،‬دﻳﻨﻮﭘﺮوﺳﺘﻮن واژﻳﻨﺎل در ‪ 176‬زن‪ .‬ﻫﺪف‬

‫اول وارد اﻛﺘﻴﻮ ﻓﺎز ﺷﺪﻧﺪ و ‪ %93/5‬در ‪ 24‬ﺳﺎﻋﺖ اول زاﻳﻤﺎن واژﻳﻨﺎل‬

‫اوﻟﻴﻪ در اﻳﻦ ﺳﻪ ﻣﺘﺪ زاﻳﻤﺎن واژﻳﻨﺎل در ‪ 24‬ﺳﺎﻋﺖ اول ﺑﻮد ﻛﻪ در ﻫﺮ‬

‫داﺷﺘﻨﺪ‪ .‬ﻣﺘﻮﺳﻂ ﻓﺎﺻﻠﻪ زﻣﺎﻧﻲ ‪ 7/9‬ﺳﺎﻋﺖ ﺑﻮد‪ .‬ﻣﺘﻮﺳﻂ و ﻣﻴﺎﻧﮕﻴﻦ دوز‬

‫ﺳﻪ ﮔﺮوه ﻣﺸﺎﺑﻪ ﺑﻮد‪ .‬زاﻳﻤﺎن ﺳﺰارﻳﻦ‪ ،‬اﺳﺘﻔﺎده از وﻛﻴﻮم و ﻧﻴﺎز ﺑﻪ‬

‫ﻣﺼﺮﻓﻲ ﻣﻴﺰوﭘﺮوﺳﺘﻮل ‪ 206‬ﻣﻴﻜﺮوﮔﺮم ﺑﻮد‪ .‬ﻫﺸﺖ ﻧﻔﺮ ﻧﻴﺎز ﺑﻪ‬

‫ﺗﻘﻮﻳﺖ اﻟﻘﺎ در ﮔﺮوه اول ﺑﻴﺶﺗﺮ ﺑﻮد وﻟﻲ اﻳﻦ اﺧﺘﻼف ﻣﻌﻨﻲدار ﻧﺒﻮد‪.‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ ﭘﻴﺪا ﻛﺮدﻧﺪ و ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ دﻳﺪه ﻧﺸﺪ‪ .‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ‬

‫ﻋﻮارض ﺟﺎﻧﺒﻲ و ﻋﻮارض ﺟﻨﻴﻨﻲ در ﻫﺮ ﺳﻪ ﮔﺮوه ﻣﺸﺎﺑﻪ ﺑﻮد و اﺿﺎﻓﻪ‬

‫ﻧﺸﺎن داد ﻛﻪ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﻳﻚ روش اﻳﻤﻦ و ﻣﻮﺛﺮ‬

‫ﻛﺮدن ﻓﻮﻟﻲ ﻛﺎﺗﺘﺮ اﺛﺮ ﻣﻔﻴﺪي در ﺑﺮاﺑﺮ ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺗﻨﻬﺎ ﻳﺎ‬

‫در اﻟﻘﺎي زاﻳﻤﺎن ﻣﻲﺑﺎﺷﺪ و دوز آن ﻗﺎﺑﻞ ﺗﻨﻈﻴﻢ اﺳﺖ‪ .‬در ﺑﺮرﺳﻲ ﻣﺎ‬

‫دﻳﻨﻮﭘﺮوﺳﺘﻮن ﻧﺪارد‪ .‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻫﻢ ﻧﺸﺎن داد ﻛﻪ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﻣﺘﻮﺳﻂ ﻓﺎﺻﻠﻪ زﻣﺎﻧﻲ ‪ 11/07‬ﺳﺎﻋﺖ و ﻣﻴﺎﻧﮕﻴﻦ دوز ﻣﺼﺮﻓﻲ‬

‫ﺧﻮراﻛﻲ ﺟﻬﺖ اﻟﻘﺎي زاﻳﻤﺎن ﻣﻮﺛﺮ اﺳﺖ و اﺿﺎﻓﻪ ﻛﺮدن ﻓﻮﻟﻲ ﻛﺎﺗﺘﺮ در‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ‪ 170‬ﻣﻴﻜﺮوﮔﺮم ﺑﻮد و ‪ %84‬در ‪ 24‬ﺳﺎﻋﺖ زاﻳﻤﺎن‬

‫آﻣﺎده ﻛﺮدن ﺳﺮﻳﻜﺲ ﻛﻤﻚ ﭼﻨﺪاﻧﻲ ﻧﻜﺮده و ﻣﻲﺗﻮان از ﻣﺤﻠﻮل‬

‫واژﻳﻨﺎل داﺷﺘﻨﺪ و ﺑﻌﺪ از ‪ 24‬ﺳﺎﻋﺖ ﺑﺎ ﺗﺸﺨﻴﺺ ﻋﺪم ﭘﺎﺳﺦ ﺑﻪ‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﺑﻪﺗﻨﻬﺎﻳﻲ‪ ،‬ﻫﻤﺎﻧﻨﺪ آنﭼﻪ در ﻣﻄﺎﻟﻌﻪ ﻣﺎ اﻧﺠﺎم‬

‫اﻳﻨﺪاﻛﺸﻦ‪ ،‬ﺳﺰارﻳﻦ ﻣﻲﺷﺪﻧﺪ‪ .‬در ﻣﻄﺎﻟﻌﻪاي در ﺑﻴﻤﺎرﺳﺘﺎن‬

‫‪13‬‬

‫‪ Jahannesburg‬در آﻓﺮﻳﻘﺎي ﺟﻨﻮﺑﻲ ‪ 16‬در ‪ 25‬زن از ﻣﺤﻠﻮل‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ )‪ 100g‬ﻫﺮ ﭼﻬﺎر ﺳﺎﻋﺖ ﺗﺎ ﺷﺶ دوز( ﺑﺎ‬

‫ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﻫﺮ دو ﺳﺎﻋﺖ ‪ 20g‬ﺗﺎ ﺳﻪ دوز و ﺑﻌﺪ ﺑﻪ ‪40g‬‬

‫اﻛﺴﻲﺗﻮﺳﻴﻦ ورﻳﺪي ﺟﻬﺖ اﻟﻘﺎي زاﻳﻤﺎن در زﻧﺎن ﺑﺎ ﺳﺮوﻳﻜﺲ ﻣﻨﺎﺳﺐ‬

‫اﻓﺰاﻳﺶ داده ﻣﻲﺷﺪ اﺳﺘﻔﺎده ﺷﺪ‪ 18 .‬ﻧﻔﺮ در ﻋﺮض ‪ 32‬ﺳﺎﻋﺖ زاﻳﻤﺎن‬

‫)ﻣﻌﻴﺎر ﻧﻤﺮهدﻫﻲ ﺑﻴﺸﺎب <‪ (6‬ﻣﻘﺎﻳﺴﻪ ﺷﺪ‪ .‬ﻧﺘﻴﺠﻪ اﻳﻦ ﻣﻄﺎﻟﻌﻪ اﻳﻦ ﺑﻮد ﻛﻪ‬

‫واژﻳﻨﺎل ﻛﺮد و دو ﻧﻔﺮ دﭼﺎر ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ ﺷﺪ و ﺳﺰارﻳﻦ در ‪%20‬‬

‫در ﻣﻮارديﻛﻪ ﺳﺮوﻳﻜﺲ ﻣﻨﺎﺳﺐ اﺳﺖ ﻣﻴﺰوﭘﺮوﺳﺘﻮل ارﺟﺤﻴﺘﻲ ﻧﺪارد و‬

‫رخ داد‪ .‬در ﻣﻄﺎﻟﻌﻪ ‪ Dällenbach P‬دوز ﻛﻢ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﻋﻮارض ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ آن ﺑﻴﺶﺗﺮ اﺳﺖ و اﺣﺘﻤﺎل ﭘﺎرﮔﻲ رﺣﻤﻲ‬

‫ﺧﻮراﻛﻲ ﺑﺎ دﻳﻨﻮﭘﺮوﺳﺘﻮن واژﻳﻨﺎل ﺟﻬﺖ ‪ Ripening‬ﺳﺮوﻳﻜﺲ و اﻟﻘﺎي‬

‫دارد‪ .‬اﻟﺒﺘﻪ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ از دوز ﺑﺎﻻي ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ اﺳﺘﻔﺎده‬

‫زاﻳﻤﺎن در ﺧﺎﻧﻢﻫﺎي ﺑﺎ ﻣﻌﻴﺎر ﻧﻤﺮهدﻫﻲ ﺑﻴﺸﺎب >‪ 6‬ﻣﻘﺎﻳﺴﻪ ﺷﺪ‪.‬‬

‫‪17‬‬

‫ﺷﺪه وﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ ﻣﻌﻴﺎر ﻧﻤﺮهدﻫﻲ ﺑﻴﺸﺎب <‪ 6‬ﻣﻲﺑﺎﻳﺴﺖ از دوز‬

‫ﺳﺰارﻳﻦ در دو ﮔﺮوه ﺑﻪﺗﺮﺗﻴﺐ ‪ %18‬و ‪ %19‬ﺑﻮد‪ .‬ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ ‪ %9‬در‬

‫ﻛﻢﺗﺮ اﺳﺘﻔﺎده ﻣﻲﺷﺪ ﺗﺎ ﺧﻄﺮ ﭘﺎرﮔﻲ رﺣﻤﻲ از ﺑﻴﻦ ﺑﺮود‪ .‬در ﻣﻄﺎﻟﻌﻪ ﻣﺎ‬

‫ﺑﺮاﺑﺮ ‪ %14‬و ‪ Outcome‬ﺟﻨﻴﻨﻲ ﺗﻔﺎوﺗﻲ ﻧﺪاﺷﺖ‪ .‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ اﺧﺘﻼﻓﻲ‬

‫ﺑﺮ ﺧﻼف ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻣﻌﻴﺎر ﻧﻤﺮهدﻫﻲ ﺑﻴﺸﺎب >‪ 6‬ﺑﻮد و ﺑﺎ اﻳﻦ‬

‫ﺑﻴﻦ دو روش دوز ﻛﻢﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل ﺧﻮراﻛﻲ ﺑﺎ دﻳﻨﻮﭘﺮوﺳﺘﻮن‬

‫ﺷﺮاﻳﻂ از دوز ﺑﺴﻴﺎر ﻛﻢﺗﺮ ‪ 20g‬اﺳﺘﻔﺎده ﺷﺪ و ﻫﻴﭻ ﻣﻮردي از‬

‫واژﻳﻨﺎل ﺟﻬﺖ ‪ Ripening‬ﺳﺮوﻳﻜﺲ وﺟﻮد ﻧﺪاﺷﺖ‪ .‬ﺑﺎ ﺑﺮرﺳﻲ و‬

‫‪Zateroglu‬‬

‫ﻣﻘﺎﻳﺴﻪ اﻳﻦ ﻣﻄﺎﻟﻌﺎت و ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻣﻲﺗﻮان ﭼﻨﻴﻦ اﺳﺘﻨﺒﺎط ﻛﺮد ﻛﻪ‬

‫اﻳﻤﻨﻲ و ﻛﺎراﻳﻲ ﻣﻴﺰوﭘﺮوﺳﺘﻮل واژﻳﻨﺎل ﺑﺎ اﻛﺴﻲﺗﻮﺳﻴﻦ ﺟﻬﺖ رﻳﭗ‬

‫درﺻﻮرت وﺟﻮد داﺷﺘﻦ ﻣﻌﻴﺎرﻫﺎي ورود و ﻧﺪاﺷﺘﻦ ﻣﻌﻴﺎرﻫﺎي ﺧﺮوﺟﻲ‬

‫ﺷﺪن )‪ (Ripening‬ﺳﺮوﻳﻜﺲ در زﻧﺎن دﭼﺎر ﭘﺎرﮔﻲ زودرس ﻏﺸﺎﻫﺎي‬

‫)ﻫﻤﺎنﻃﻮر ﻛﻪ در ﻣﺘﻦ ذﻛﺮ ﺷﺪ(‪ ،‬ﻣﻲﺗﻮان ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫‪14‬‬

‫ﺧﻮراﻛﻲ را ﺟﺎﻳﮕﺰﻳﻦ ﺳﺎﻳﺮ روشﻫﺎي ﻓﺎرﻣﺎﻛﻮﻟﻮژﻳﻚ ﻣﺜﻞ‬

‫ﻧﺘﺎﻳﺞ زاﻳﻤﺎن واژﻳﻨﺎل و ﺳﺰارﻳﻦ و آﭘﮕﺎر در ﻫﺮ دو ﮔﺮوه ﻣﺸﺎﺑﻪ ﺑﻮد‪ .‬در‬

‫دﻳﻨﻮﭘﺮوﺳﺘﻮن‪ ،‬اﻛﺴﻲﺗﻮﺳﻴﻦ و ﺳﺎﻳﺮ روشﻫﺎي ﻣﺼﺮﻓﻲ ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫ﻣﻄﺎﻟﻌﻪ ‪ 77 ،Cheng SY‬ﺧﺎﻧﻢ ﺑﺎردار )‪ 37‬ﻧﻮﻟﻲﭘﺎر و ‪ 40‬ﻣﻮﻟﺘﻲﭘﺎر( ﻛﻪ‬

‫اﻋﻢ از ﺧﻮراﻛﻲ‪ ،‬زﻳﺮ زﺑﺎﻧﻲ و واژﻳﻨﺎل ﻛﺮد ﭼﻮن ﻫﻢ دوز آن ﻛﻢﺗﺮ اﺳﺖ‬

‫ﻛﺎﻧﺪﻳﺪ اﻟﻘﺎي زاﻳﻤﺎن ﺑﻌﺪ از ﻫﻔﺘﻪ ‪ 37‬ﺑﺎرداري ﺑﺎ ﺳﺮوﻳﻜﺲ ﻧﺎﻣﻨﺎﺳﺐ‬

‫وﻫﻢ روش اﺳﺘﻔﺎده آن آﺳﺎنﺗﺮ اﺳﺖ و ﻛﺎراﻳﻲ و اﻳﻤﻨﻲ آن در اﻟﻘﺎي‬

‫ﻣﻌﻴﺎر ﻧﻤﺮهدﻫﻲ ﺑﻴﺸﺎب >‪ 7‬ﺑﻮدﻧﺪ ﺗﺤﺖ اﻟﻘﺎ ﺑﺎ ﻣﺤﻠﻮل ﻣﻴﺰوﭘﺮوﺳﺘﻮل‬

‫زاﻳﻤﺎن ﻣﺸﺎﺑﻪ و ﺣﺘﻲ در ﺑﻌﻀﻲ ﻣﻄﺎﻟﻌﺎت ﺑﻬﺘﺮ از ﺳﺎﻳﺮ روشﻫﺎي‬

‫ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ 15.‬ﻫﺪف اوﻟﻴﻪ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻌﺪاد زاﻳﻤﺎن واژﻳﻨﺎل در ‪24‬‬

‫ﻓﺎرﻣﺎﻛﻮﻟﻮژﻳﻚ ﻣﺜﻞ دﻳﻨﻮﭘﺮوﺳﺘﻮن و اﻛﺴﻲﺗﻮﺳﻴﻦ ﺑﻮده اﺳﺖ‪.‬‬

‫ﺷﺪه ﺟﻬﺖ اﻳﻨﺪاﻛﺸﻦ اﺳﺘﻔﺎده ﻛﺮد‪ .‬در ﻣﻄﺎﻟﻌﻪ‬

‫‪Wing DA‬‬

‫ﻫﻴﭙﺮاﺳﺘﻴﻤﻮﻟﻴﺸﻦ و ﭘﺎرﮔﻲ رﺣﻤﻲ دﻳﺪه ﻧﺸﺪ‪ .‬در ﻣﻄﺎﻟﻌﻪ‬

‫ﺟﻨﻴﻨﻲ‬

‫)‪(PROM‬‬

‫ﻛﻪ در زﻣﺎن ﺗﺮم ﻣﺮاﺟﻌﻪ ﻛﺮده ﺑﻮدﻧﺪ ﻣﻘﺎﻳﺴﻪ ﺷﺪ‪.‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﻫﻤﻜﺎران‬ ‫ﻧﻴﺮوﻣﻨﺶ و‬ Niroomanesh Sh.‫ﺷﻴﺮﻳﻦ‬ et al.

418

References 1. American College of Obstetricians Gynecologists. ACOG technical bulletin. Induction of labor. Int J Gynaecol Obstet 1996;53(1):6572.

2. Tromans PM, Beazley J, Shenouda PI. Comparative study of oestradiol and prostaglandin E2 vaginal gel for ripening the unfavourable cervix before induction of labour. Br Med J (Clin Res Ed) 1981;282(6265):679-81.

3. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC III, Wenstrom KD, editors. Williams Obstetrics. 22nd ed. New York: McGraw-Hill; 2005.

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7. Hofmeyr GJ, Gülmezoglu AM. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2003;(1):CD000941.

8. Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol 1997;90(1):88-92.

9. Danielsson KG, Marions L, Rodriguez A, Spur BW, Wong PY, Bygdeman M. Comparison between oral and vaginal administration of misoprostol on uterine contractility. Obstet Gynecol 1999;93(2):275-80.

10. Cheng SY, Ming H, Lee JC. Titrated oral compared with vaginal misoprostol for labor induction: a randomized controlled trial.

Obstet Gynecol 2008;111(1):119-25.

11. Hofmeyr GJ, Alfirevic Z, Matonhodze B, Brocklehurst P, Campbell E, Nikodem VC. Titrated oral misoprostol solution for induction of labour: a multi-centre, randomised trial. BJOG 2001;108(9):952-9.

12. Matonhodze BB, Hofmeyr GJ, Levin J. Labour induction at term: a randomised trial comparing Foley catheter plus titrated oral misoprostol solution, titrated oral misoprostol solution alone, and dinoprostone. S Afr Med J 2003;93(5):375-9.

13. Wing DA, Fassett MJ, Guberman C, Tran S, Parrish A, Guinn D. A comparison of orally administered misoprostol to intravenous oxytocin for labor induction in women with favorable cervical examinations. Am J Obstet Gynecol 2004;190(6):1689-94; discussion 1694-6.

14. Zeteroğlu S, Engin-Ustün Y, Ustün Y, Güvercinçi M, Sahin G, Kamaci M. A prospective randomized study comparing misoprostol and oxytocin for premature rupture of membranes at term. J Matern Fetal Neonatal Med 2006;19(5):283-7.

15. Cheng SY, Chen TC. Pilot study of labor induction with titrated oral misoprostol. Taiwan J Obstet Gynecol 2006;45(3):225-9.

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17. Dällenbach P, Boulvain M, Viardot C, Irion O. Oral misoprostol or vaginal dinoprostone for labor induction: a randomized controlled trial. Am J Obstet Gynecol 2003;188(1):162-7.

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

Tehran University Medical Journal; Vol. 69, No. 7, October 2011: 413-419

Titrated oral misoprostol solution compared with oxytocin for induction of labor in women with unfavorable cervix

Shirin Niroomanesh M.D.1 Masoumeh Dadashaliha M.D.2* Mina Akrami M.D.2 1- Department of Perinatology, Tehran University of Medical Sciences, Tehran, Iran.

2- Department of Obstetrics and Gynecology, Women Hospital (Mirza Koochackkhan), Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Received: June 01, 2011 Accepted: June 27, 2011

Background: Uterine contractions and an appropriate cervix are two important factors in labor contributing to good pregnancy outcomes. Oxytocin and prostaglandins, such as misoprostol, are used for the induction of labor. Misoprostol is used for cervical ripening and labor induction. The aim of this trial was to compare the efficacy and safety of titrated oral misoprostol solution with oxytocin for labor induction in pregnant women with an unfavorable cervix.

Methods: In this randomized double-blind clinical trial, 140 women with a gestational age of 34−42 weeks and an unfavorable cervix were recruited. The participants had an indication for labor induction and had been referred to the Women’s Hospital in Tehran, Iran between January 2010 and January 2011. The participants were randomly assigned to receive 20 µg/hour titrated oral misoprostol plus intravenous placebo or 6 mU/min oxytocin plus oral placebo. In case contractions were inadequate, the drug doses were gradually increased. Pharmacological complications, the mean interval from the start of induction till vaginal delivery and delivery type were monitored and analyzed in both groups.

Results: The mean interval from the start of induction till vaginal delivery in misoprostol group was shorter than the oxytocin group (11.07±3.42 vs. 14.87±3.21 hours, P=0.001). The frequency of pharmacological complications and vaginal or cesarean

deliveries were similar between the two groups (P>0.05).

Conclusion: Use of titrated oral misoprostol is a safe and effective method for labor induction in pregnant women with unfavorable cervix. Misoprostol is associated with a shorter interval from induction to vaginal delivery than oxytocin. *

Corresponding author: Dept. of Obstetrics and Gynecology, Women Hospital (Mirza Koochackkhan), Karimkhan Ave., Tehran, Iran.

Tel: +98-21-88900002 E-mail: dadashaliha@razi.tums.ac.ir

Keywords: Cervix, induction, labor, misoprostol, oxytocin.

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

‫‪420-425‬‬ ‫‪،1390‬‬ ‫ﻋﺮوقﻣﻬﺮ‬ ‫ﺷﻤﺎره ‪،7‬‬ ‫ﺗﺤﺖ‪، 69‬‬ ‫دوره‬ ‫درديﻲدرﺗﻬﺮان‪،‬‬ ‫ﺑﻲﭘﺰﺷﻜ‬ ‫ﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ‫ﺪه ﭘﺰﺷﻜﻲ‪،‬‬ ‫ﻣﺠﻠﻪ داﻧﺸﻜ‬ ‫ﺗﺤﺘﺎﻧﻲ‬ ‫اﻧﺪام‬ ‫ﺟﺮاﺣﻲ‬ ‫ﺑﻴﻤﺎران‬ ‫ﻣﺪت‬ ‫ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ و‬ ‫ﺗﻐﻴﻴﺮات‬

‫ﻣﻘﺎﻳﺴﻪ دو روش ﺑﻲﺣﺴﻲ ﻧﺨﺎﻋﻲ در ﺣﺎﻟﺖﻫﺎي ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و ﻧﺸﺴﺘﻪ در ﺟﺮاﺣﻲ ﻋﺮوق اﻧﺪام ﺗﺤﺘﺎﻧﻲ‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/02/14 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/04/13 :‬‬

‫ﭼﻜﻴﺪه‬

‫‪1‬‬

‫ﻣﺤﻤﺪرﺿﺎ ﻣﻬﺎﺟﺮ‬

‫‪*1‬‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﺑﻴﻤﺎران ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﻲ ﻋﺮوﻗﻲ اﻧﺪام ﺗﺤﺘﺎﻧﻲ ﻛﻪ ﺗﻮﺳﻂ ﺟﺮاﺣﺎن ﻣﺘﺒﺤﺮ ﻋﺮوق ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﻲ‬

‫‪1‬‬

‫ﻗﺮار ﻣﻲﮔﻴﺮﻧﺪ از ﻟﺤﺎظ ﺗﻤﻬﻴﺪات ﺑﻴﻬﻮﺷﻲ ﺑﺴﻴﺎر ﭘﺮﺧﻄﺮ ﺗﻠﻘﻲ ﻣﻲﮔﺮدﻧﺪ‪ .‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﺎﻳﺴﻪ دو روش ﺑﻲﺣﺴﻲ‬

‫‪1‬‬

‫ﻧﺨﺎﻋﻲ در ﺣﺎﻟﺖﻫﺎي ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و ﻧﺸﺴﺘﻪ از ﻧﻈﺮ ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ و ﻣﺪت ﺑﻲدردي در ﺑﻴﻤﺎران ﺗﺤﺖ ﺟﺮاﺣﻲ‬

‫ﻛﺴﺮي ﻛﺮوﻧﺪﻳﺎن‬ ‫زاﻫﺪ ﺣﺴﻴﻦﺧﺎن‬ ‫اﻓﺸﻴﻦ ﺟﻌﻔﺮزاده‬

‫ﻋﺮوق اﻧﺪام ﺗﺤﺘﺎﻧﻲ ﺗﻮﺳﻂ داروي ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ )‪ (%0/5‬ﻫﻴﭙﺮﺑﺎر ﺻﻮرت ﭘﺬﻳﺮﻓﺘﻪ اﺳﺖ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬ﺑﺮاي‬

‫‪2‬‬

‫ﺳﻬﻴﻼ دﺑﻴﺮان‬

‫‪ 40‬ﺑﻴﻤﺎر ﻛﻪ ﺑﻪ دو ﮔﺮوه ‪ 20‬ﻧﻔﺮه ﺗﻘﺴﻴﻢﺑﻨﺪي ﺷﺪﻧﺪ در دو ﺣﺎﻟﺖ ﻧﺸﺴﺘﻪ )‪ (Sitting position‬و ﺣﺎﻟﺖ ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ‬ ‫‪ -1‬ﮔﺮوه ﺑﻴﻬﻮﺷﻲ و ﻣﺮاﻗﺒﺖﻫﺎي وﻳﮋه‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن‬ ‫اﻣﺎمﺧﻤﻴﻨﻲ )ره(‬

‫)‪(Lateral position‬‬

‫ﺑﻲﺣﺴﻲ ﺑﻴﻤﺎران‬

‫‪ -2‬ﮔﺮوه ﭘﺰﺷﻜﻲ اﺟﺘﻤﺎﻋﻲ‬

‫داروي ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ ﻫﻴﭙﺮﺑﺎر ‪ %0/5‬ﺑﻪﻣﻴﺰان‬

‫‪T10‬‬

‫‪3ml‬‬

‫در ﻓﻀﺎي ﺳﺎب آراﻛﻨﻮﻳﻴﺪ ﺗﺰرﻳﻖ ﮔﺮدﻳﺪ‪ .‬ﺳﻄﺢ‬

‫در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ و ﻧﺘﺎﻳﺞ از ﻧﻈﺮ ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ و ﻣﺪت ﺑﻲدردي در دو ﮔﺮوه ﻣﻘﺎﻳﺴﻪ ﺷﺪ‪.‬‬

‫ﻳﺎﻓﺘﻪﻫﺎ‪ :‬اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﻲداري ﺑﻴﻦ ﺗﻐﻴﻴﺮات ﻓﺸﺎر ﺧﻮن ﻣﺘﻮﺳﻂ ﺷﺮﻳﺎﻧﻲ‪ ،‬ﻓﺸﺎر ﺧﻮن ﺳﻴﺴﺘﻮﻟﻴﻚ و ﻓﺸﺎر ﺧﻮن‬

‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫دﻳﺎﺳﺘﻮﻟﻴﻚ دو ﮔﺮوه وﺟﻮد داﺷﺖ )‪ .(P<0/05‬اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﻲداري ﺑﻴﻦ ﺗﻐﻴﻴﺮات ﺿﺮﺑﺎن ﻗﻠﺐ در ﻛﻠﻴﻪ زﻣﺎنﻫﺎي‬ ‫ﻣﻮرد ﺑﺮرﺳﻲ در دو ﮔﺮوه وﺟﻮد داﺷﺖ )‪(P<0/05‬؛ اﻣﺎ در ﻣﻮرد ﺿﺮﺑﺎن ﻗﻠﺐ در دﻗﺎﻳﻖ ﻧﺨﺴﺖ و ﺳﻲام اﺧﺘﻼف آﻣﺎري‬ ‫ﻣﻌﻨﻲداري را ﺑﻴﻦ دو ﮔﺮوه ﻧﺸﺎن ﻧﻤﻲداد )‪ .(P>0/05‬ﻃﻮل ﺑﻲﺣﺴﻲ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ ﺑﻪﻣﻴﺰان ﻣﻌﻨﻲداري‬ ‫ﻃﻮﻻﻧﻲﺗﺮ و ﻣﻴﺰان ﻣﺎﻳﻊ ﻣﺼﺮﻓﻲ در ﮔﺮوه ﻧﺸﺴﺘﻪ ﺑﻪﻣﻴﺰان ﻣﻌﻨﻲداري ﺑﻴﺸﺘﺮ ﺑﻮد )‪ .(P<0/05‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬در ﻣﺠﻤﻮع ﺑﺮ‬

‫*‬

‫اﺳﺎس ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ از اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﭼﻨﻴﻦ اﺳﺘﻨﺒﺎط ﻣﻲﺷﻮد ﻛﻪ ﻣﻴﺰان ﺗﻐﻴﻴﺮات ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ در ﺑﻴﻬﻮﺷﻲ اﺳﭙﺎﻳﻨﺎل ﺑﺎ‬ ‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﻬﺮان‪ ،‬ﺑﻠﻮار ﻛﺸﺎورز‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن‬

‫اﻣﺎمﺧﻤﻴﻨﻲ)ره(‪ ،‬ﮔﺮوه ﺑﻴﻬﻮﺷﻲ و ﻣﺮاﻗﺒﺖﻫﺎي وﻳﮋه‬

‫ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ در ﭘﻮزﻳﺸﻦ ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ ﻛﻢﺗﺮ از ﻧﺸﺴﺘﻪ ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫ﺗﻠﻔﻦ‪021-88249920 :‬‬ ‫‪E-mail: kassramail@yahoo.com‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ‪ ،‬ﺑﻴﻬﻮﺷﻲ‪ ،‬اﺳﭙﺎﻳﻨﺎل‪ ،‬ﭘﻮزﻳﺸﻦ‪ ،‬ﺟﺮاﺣﻲﻫﺎي اﻧﺪام ﺗﺤﺘﺎﻧﻲ‪.‬‬

‫ﻣﻘﺪﻣﻪ‬

‫ﻋﻤﻞ ﺟﺮاﺣﻲ ﻗﺮار ﺧﻮاﻫﻨﺪ ﮔﺮﻓﺖ و ﺑﻪﻃﻮر ﻋﻤﺪه از ﻋﺮوق ﻟﮕﻨﻲ‬ ‫اﺻﻠﻲ ﺑﻪ ﻋﺮوق اﻧﺪام ﺗﺤﺘﺎﻧﻲ ﺑﺎيﭘﺲ ﻣﻲﮔﺮدد‪ ،‬ﺑﺎﻳﺪ ﺑﺎ ﻛﻢﺗﺮﻳﻦ ﺧﻄﺮ و‬

‫ﺑﻴﻤﺎران ﻧﻴﺎزﻣﻨﺪ ﺑﻪ ﺗﺮﻣﻴﻢ و اﺻﻼح ﺑﻴﻤﺎريﻫﺎي ﻋﺮوﻗﻲ اﻧﺪام ﺗﺤﺘﺎﻧﻲ‬

‫ﻋﺎرﺿﻪاي ﻫﻤﺮاه ﺑﺎﺷﺪ‪ 3.‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺑﻴﻤﺎريﻫﺎي ﻫﻤﺮاه در اﻳﻦ ﺑﻴﻤﺎران‬

‫ﻛﻪ ﻋﻤﻮﻣﺎً ﺗﻮﺳﻂ ﺟﺮاﺣﺎن ﻣﺘﺒﺤﺮ ﻋﺮوق و ﺑﺎ ﻛﻤﻚ از ﭘﺮوﺗﺰﻫﺎي‬

‫ﻛﻪ ﻋﻼوه ﺑﺮ ﺳﻴﺴﺘﻢ ﻗﻠﺐ و ﻋﺮوق و ﮔﺎﻫﻲ ﺳﻴﺴﺘﻢ ﺗﻨﻔﺴﻲ‪ ،‬ﻛﻠﻴﻪﻫﺎ و‬

‫ﻋﺮوﻗﻲ ﺧﻮنرﺳﺎﻧﻲ اﻧﺪام ﺗﺤﺘﺎﻧﻲ اﻳﺸﺎن ﺗﺎﻣﻴﻦ ﻣﻲﮔﺮدد از ﻟﺤﺎظ‬

‫ﺳﺎﻳﺮ ارﮔﺎنﻫﺎ را ﻧﻴﺰ درﮔﻴﺮ ﻧﻤﻮده اﺳﺖ‪ ،‬ﻛﻢ ﻛﺮدن ﺗﻐﻴﻴﺮات‬

‫ﺗﻤﻬﻴﺪات ﺑﻴﻬﻮﺷﻲ ﺑﺴﻴﺎر ﭘﺮﺧﻄﺮ ﺗﻠﻘﻲ ﻣﻲﮔﺮدﻧﺪ‪ 1.‬ﺑﺪﻳﻬﻲ اﺳﺖ ﻛﻪ‬

‫ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ در ﻃﻲ ﺑﻴﻬﻮﺷﻲ از ﺣﺴﺎﺳﻴﺖ ﺑﺴﻴﺎر ﺑﺎﻻﻳﻲ ﺑﺮﺧﻮردار‬

‫ﺑﻴﻤﺎريﻫﺎي ﺳﻴﺴﺘﻤﻴﻚ ﭘﻴﺸﺮﻓﺘﻪاي ﻛﻪ ﺳﻴﺴﺘﻢ ﻗﻠﺐ و ﻋﺮوق اﻳﻦ‬

‫اﺳﺖ‪ 4.‬ﻣﺤﺪودﻳﺖ در ﻣﺼﺮف دارو و ﻫﻢﭼﻨﻴﻦ ﻛﺎﻫﺶ ﻋﻮارض‬

‫ﺑﻴﻤﺎران را ﻃﻲ ﺳﺎلﻫﺎ ﺑﻴﻤﺎري درﮔﻴﺮ ﻧﻤﻮده اﺳﺖ ﻧﺸﺎﻧﮕﺎن ﺧﻮد را‬

‫ﺗﺮوﻣﺒﻮآﻣﺒﻮﻟﻴﻚ ﭘﺲ از ﺟﺮاﺣﻲ از ﻣﺰاﻳﺎي ﺑﻴﻬﻮﺷﻲ ﻧﺎﺣﻴﻪاي ﺑﺮاي‬

‫ﺑﻪﺻﻮرت ﻧﺎرﺳﺎﻳﻲ در ﺧﻮنرﺳﺎﻧﻲ‪ ،‬ﺳﻴﺎه ﺷﺪن اﻧﺪامﻫﺎ و ﺗﻮرم و درد و‬

‫ﺟﺮاﺣﻲ اﻳﻦ ﺑﻴﻤﺎران ﻣﻲﺑﺎﺷﺪ‪ 5.‬اﻳﻦ روش ﺑﻪﻋﻠﺖ ﺑﻠﻮك ﻧﺎﺣﻴﻪاي در‬

‫اﻳﺠﺎد ﺧﻄﺮات ﻣﻬﻤﻲ ﻣﺎﻧﻨﺪ ﺗﺮﻣﺒﻮز ﻋﺮوﻗﻲ ﻧﺸﺎن ﻣﻲدﻫﺪ‪ 2.‬اﻧﺘﺨﺎب‬

‫اﻧﺪام ﺗﺤﺘﺎﻧﻲ ﺗﻨﻬﺎ ﺳﻴﺴﺘﻢ ﻋﺼﺒﻲ ﺣﺴﻲ ﺣﺮﻛﺘﻲ را ﺑﻠﻮك ﻧﻤﻮده و ﺑﺎ‬

‫روش ﺑﻴﻬﻮﺷﻲ ﻣﻨﺎﺳﺐ ﺑﺮاي اﻳﻦ ﺑﻴﻤﺎران ﻛﻪ ﺑﻪﻣﺪت ‪ 2-3‬ﺳﺎﻋﺖ ﺗﺤﺖ‬

‫ﻛﺎﻫﺶ واﺿﺢ در ﺗﻮﻧﻴﺴﻴﺘﻪ ﻋﺮوﻗﻲ ﻣﻲﺗﻮاﻧﺪ ﺧﻮنرﺳﺎﻧﻲ اﻧﺪام ﺗﺤﺘﺎﻧﻲ را‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﻣﺤﻤﺪرﺿﺎ ﻣﻬﺎﺟﺮ و ﻫﻤﻜﺎران‬

‫ﺑﻪﻃﻮر ﻣﻮﺛﺮي ﺑﻬﺒﻮد ﺑﺨﺸﺪ‪ ،‬از ﻃﺮف دﻳﮕﺮ ﻛﻢﺗﺮﻳﻦ اﺛﺮ ﻣﺴﺘﻘﻴﻢ را ﺑﺮ‬

‫‪421‬‬

‫)‪ %0/5 (Merck, Germany‬ﺑﻪﻣﻴﺰان ‪ 3ml‬ﺗﺰرﻳﻖ ﮔﺮدﻳﺪ و ﺳﻄﺢ‬ ‫‪T10‬‬

‫در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ‪ .‬در ﮔﺮوه ﻧﺸﺴﺘﻪ ﺑﻴﻤﺎران‬

‫روي ﻗﻠﺐ رﻳﻪ و ﻣﻐﺰ داﺷﺘﻪ و ﺑﺎ ﻛﺎﻫﺶ ﻣﻘﺎوﻣﺖ ﺑﺮ ﺳﺮ راه ﺑﺮونده‬

‫ﺑﻲﺣﺴﻲ ﺑﻴﻤﺎران در‬

‫ﻗﻠﺒﻲ ﻗﺪرت ﭘﻤﭗ و اﻧﺪﻛﺲ ﻗﻠﺒﻲ را ﻧﻴﺰ ﺑﻬﺒﻮد ﻣﻲﺑﺨﺸﺪ‪ 6.‬اﻳﻦ ﺑﻴﻤﺎران‬

‫ﭘﺲ از اﻧﺠﺎم ﺗﻜﻨﻴﻚ ﺑﺎ ﺳﻮزن اﺳﭙﺎﻳﻨﺎل ‪ 25‬ﺑﻪ ﭘﺸﺖ ﺧﻮاﺑﺎﻧﺪه ﺷﺪه و‬

‫ﻋﻤﺪﺗﺎ در ﺳﻨﻴﻦ ﻣﻴﺎنﺳﺎل و ﻣﺴﻦ ﺑﻮده و ﻣﺸﻜﻼﺗﻲ ﻣﺎﻧﻨﺪ ﺑﺮوﻧﺸﻴﺖ‪،‬‬

‫ﭘﺲ از اﺳﺘﻘﺮار ﺑﻠﻮك اﺟﺎزه آﻏﺎز ﻋﻤﻞ ﺟﺮاﺣﻲ داده ﺷﺪ‪ .‬در ﺑﻴﻤﺎران‬

‫ﺑﻴﻤﺎريﻫﺎي اﻧﺴﺪادي رﻳﻮي‪ ،‬دﻳﺎﺑﺖ‪ ،‬ﺑﻴﻤﺎريﻫﺎي ﻋﺮوﻗﻲ ﻣﺎﻧﻨﺪ ﺑﻮرﮔﺮ‬

‫ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ ﻧﻴﺰ ﭘﺲ از ﺧﻮاﺑﺎﻧﻴﺪن ﺑﻴﻤﺎران ﺑﻪﺳﻤﺖ اﻧﺪام ﻣﻮرد ﻋﻤﻞ‬

‫را ﺑﻪﻫﻤﺮاه ﺧﻮد دارﻧﺪ‪ 7.‬از ﻃﺮف دﻳﮕﺮ اﻳﻦ ﺟﺮاﺣﻲ ﺑﻪﻋﻠﺖ ﻇﺮاﻓﺖ و‬

‫)ﭼﭗ ﻳﺎ راﺳﺖ( دارو ﺗﺰرﻳﻖ ﮔﺮدﻳﺪ و ﭘﺲ از اﻃﻤﻴﻨﺎن از اﺳﺘﻘﺮار ﺑﻠﻮك‬

‫ﺣﺴﺎﺳﻴﺖ ﺧﺎص ﺧﻮد ﻣﺪت زﻳﺎدﺗﺮي را ﺑﻪ ﺧﻮد اﺧﺘﺼﺎص ﺧﻮاﻫﺪ داد‬

‫ﺣﺴﻲ و ﺣﺮﻛﺘﻲ در اﻧﺪام ﺑﻌﺪ از ﭘﻨﺞ دﻗﻴﻘﻪ ﺑﻴﻤﺎر ﺑﻪﺣﺎﻟﺖ ﺧﻮاﺑﻴﺪه ﺑﻪ‬

‫و در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺑﺴﻴﺎري از اﻋﻤﺎل ﺟﺮاﺣﻲ ﻣﺸﺎﺑﻪ ﻧﻴﺎز ﺑﻪ ﺑﻲدردي و‬

‫ﭘﺸﺖ در ﻣﻲآﻣﺪ‪ .‬ﭘﺲ از ﺑﺎز ﮔﺮداﻧﻴﺪن ﺑﻴﻤﺎر ﺑﻪﺣﺎﻟﺖ ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﺸﺖ‬

‫ﻣﺪت ﺑﻠﻮك ﺑﻴﺸﺘﺮي اﺳﺖ‪ 8.‬ﻫﻴﭙﺮﺑﺎر ﺑﻮدن داروي ﺑﻲﺣﺴﻲ ﻣﻮﺿﻌﻲ ﺑﻪ‬

‫ﭘﺎي ﺳﻤﺖ ﻋﻤﻞ داراي ﺑﻠﻮك ﺣﺴﻲ و ﺣﺮﻛﺘﻲ ﺑﻴﺸﺘﺮي ﺑﻮد و ﺑﻪﻋﺒﺎرت‬

‫ﻣﺘﺨﺼﺺ ﺑﻴﻬﻮﺷﻲ اﺟﺎزه ﻣﻲدﻫﺪ ﻛﻪ ﻛﻨﺘﺮل ﺑﻴﺸﺘﺮي در ﻣﺤﻞ ﺗﻮزﻳﻊ‬

‫دﻳﮕﺮ ﭘﺎي ﻣﺤﻞ ﻋﻤﻞ ﺑﻪﻃﻮر ﻛﺎﻣﻞ ﺑﻠﻮك ﻣﻲﮔﺮدﻳﺪ و اﻳﻦ در ﺣﺎﻟﻲ ﺑﻮد‬

‫دارو داﺷﺘﻪ ﺑﺎﺷﺪ‪ ،‬اﮔﺮ ﺑﻴﻤﺎران ﭘﺲ از اﻧﺠﺎم ﺑﻴﻬﻮﺷﻲ اﺳﭙﺎﻳﻨﺎل در‬

‫ﻛﻪ در زﻣﺎن آﻏﺎز ﻋﻤﻞ ﺟﺮاﺣﻲ ﭘﺎي دﻳﮕﺮ ﺑﻴﻤﺎران ﺗﻔﺎوت ﻓﺎﺣﺸﻲ از‬

‫وﺿﻌﻴﺖ ﺳﺮ ﺑﺎﻻ ﻗﺮار ﺑﮕﻴﺮﻧﺪ در ﺳﻄﺢ ﭘﺎﻳﻴﻦﺗﺮي از ﻧﺨﺎع ﺳﻄﺢ‬

‫ﻧﻈﺮ ﺑﻠﻮك ﺣﺴﻲ و ﺣﺮﻛﺘﻲ ﻧﺴﺒﺖ ﺑﻪ ﭘﺎي ﻣﻘﺎﺑﻞ داﺷﺖ‪ .‬اﻃﻼﻋﺎت در‬

‫ﺑﻲﺣﺴﻲ ﻣﺴﺘﻘﺮ ﺷﺪه و ﻣﻴﺰان اﺛﺮ و ﻃﻮل ﻣﺪت ﺑﻲﺣﺴﻲ ﻧﻴﺰ ﺑﻴﺸﺘﺮ‬

‫ﻣﻮرد ﺳﻦ‪ ،‬ﺟﻨﺴﻴﺖ‪ ،‬ﻣﺪت ﻋﻤﻞ ﺟﺮاﺣﻲ‪ ،‬ﻣﺪت ﺑﻠﻮك ﻋﺼﺒﻲ‪،‬‬

‫ﻣﻲﺷﻮد‪ .‬اﮔﺮ ﺑﻴﻤﺎران ﭘﺲ از اﻧﺠﺎم ﺑﻴﻬﻮﺷﻲ اﺳﭙﺎﻳﻨﺎل ﺑﺎ ﻣﺤﻠﻮل ﻫﻴﭙﺮﺑﺎر‬

‫ﺑﻴﻤﺎريﻫﺎي ﻫﻤﺮاه‪ ،‬ﻋﻠﺖ ﻋﻤﻞ ﺟﺮاﺣﻲ‪ ،‬درﺻﺪ ﺗﻐﻴﻴﺮات ﻓﺸﺎر ﺧﻮن‪،‬‬

‫در وﺿﻌﻴﺖ ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ ﻗﺮار ﺑﮕﻴﺮﻧﺪ ﺳﻄﺢ ﺑﻲﺣﺴﻲ ﻣﻨﺎﺳﺐ در‬

‫ﺿﺮﺑﺎن ﻗﻠﺐ و ﺳﻄﺢ ﺑﻠﻮك ﻋﺼﺒﻲ ﺑﺮاي ﻛﻠﻴﻪ ﺑﻴﻤﺎران ﺛﺒﺖ ﮔﺮدﻳﺪ‪ .‬در‬

‫ﺳﻤﺖ ﺟﺮاﺣﻲ ﺣﺎﺻﻞ ﺷﺪه‪ ،‬ﺗﻐﻴﻴﺮات ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ ﻛﻢﺗﺮ ﺷﺪه و ﻃﻮل‬

‫ﻫﺮ دو ﮔﺮوه ﻗﺒﻞ از اﻗﺪام ﺑﻪ ﺑﻲﺣﺴﻲ ﻧﺨﺎﻋﻲ ﻓﺸﺎر ﺧﻮن و ﺿﺮﺑﺎن ﻗﻠﺐ‬

‫ﻣﺪت ﺑﻲﺣﺴﻲ ﻧﻴﺰ ﺑﻴﺸﺘﺮ ﻣﻲﺷﻮد‪ .‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺑﺮرﺳﻲ ﺗﻐﻴﻴﺮات‬

‫ﺑﻴﻤﺎران ﭘﺲ از ﭘﻨﺞ دﻗﻴﻘﻪ از ﺧﻮاﺑﻴﺪن روي ﺗﺨﺖ اﺗﺎق ﻋﻤﻞ ﺛﺒﺖ و‬

‫ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ و ﻣﺪت ﺑﻲدردي در ﺑﻴﻤﺎران ﺗﺤﺖ ﺟﺮاﺣﻲ ﻋﺮوق اﻧﺪام‬

‫ﺑﻪﻋﻨﻮان ﻣﻴﺰان ﭘﺎﻳﻪ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ‪ .‬ﺗﻤﺎﻣﻲ ﺑﻴﻤﺎران ﻳﻚ ﻣﻴﻠﻲﮔﺮم‬

‫ﺗﺤﺘﺎﻧﻲ ﺑﺎ دو روش ﺑﻲﺣﺴﻲ ﻧﺨﺎﻋﻲ در ﺣﺎﻟﺖﻫﺎي ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و‬

‫ﻣﻴﺪازوﻻم ورﻳﺪي ﺑﺮاي ﻛﺎﻫﺶ اﺿﻄﺮاب ﻣﻲﮔﺮﻓﺘﻨﺪ و ﺳﭙﺲ ‪5ml‬‬

‫ﻧﺸﺴﺘﻪ از ﺑﺎ اﺳﺘﻔﺎده از ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ ‪ %0/5‬ﻫﻴﭙﺮﺑﺎر ﭘﺮداﺧﺘﻴﻢ‪.‬‬

‫ﺑﻪازاي ﻫﺮ ﻛﻴﻠﻮﮔﺮم وزن ﺑﺪن‪ ،‬از ﻣﺤﻠﻮل رﻳﻨﮕﺮ درﻳﺎﻓﺖ ﻣﻲﻧﻤﻮدﻧﺪ‪.‬‬ ‫ﻋﻼﻳﻢ ﺣﻴﺎﺗﻲ ﺑﻴﻤﺎران ﺷﺎﻣﻞ ﻓﺸﺎر ﺧﻮن ﺳﻴﺴﺘﻮﻟﻲ و دﻳﺎﺳﺘﻮﻟﻲ‪ ،‬ﻓﺸﺎر‬

‫روش ﺑﺮرﺳﻲ‬

‫ﻣﺘﻮﺳﻂ ﺷﺮﻳﺎﻧﻲ و ﺿﺮﺑﺎن ﻗﻠﺐ ﺑﺎ دﺳﺘﮕﺎه ﻣﺎﻧﻴﺘﻮر اﻃﺎق ﻋﻤﻞ آرم‬

‫اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﻛﺎرآزﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ ﻣﻘﺎﻳﺴﻪاي ﺗﺼﺎدﻓﻲ‬

‫ﺳﻌﺎدت )‪ (Saadat‬ﺳﺎﺧﺖ ﻛﺸﻮر اﻳﺮان ﺛﺒﺖ ﺷﺪ و در اداﻣﻪ اﻗﺪام ﺑﻪ‬

‫دوﺳﻮﻛﻮر ﻣﻲﺑﺎﺷﺪ ﻛﻪ در ‪ 40‬ﺑﻴﻤﺎر از ﻫﺮ دو ﮔﺮوه زن و ﻣﺮد و در‬

‫اﻧﺠﺎم ﺑﻲﺣﺴﻲ اﺳﭙﺎﻳﻨﺎل ﺑﺎ ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ ‪ %0/5‬ﻫﻴﭙﺮﺑﺎر ﺷﺮﻛﺖ‬

‫‪(Merck,‬‬

‫ﺳﻨﻴﻦ ‪ 35-75‬ﺳﺎل ﻃﻲ ﻣﺪت ﻳﻚﺳﺎل ﺻﻮرت ﭘﺬﻳﺮﻓﺖ‪ .‬ﻛﻠﻴﻪ ﺑﻴﻤﺎران‬

‫)‪ Germany‬ﺑﻪﻣﻴﺰان ‪ 15‬ﻣﻴﻠﻲﮔﺮم ﮔﺮدﻳﺪ‪ .‬ﭘﺲ از ﺗﺰرﻳﻖ داروي‬

‫ﻣﺒﺘﻼ ﺑﻪ ﻧﺎرﺳﺎﻳﻲ ﺧﻮنرﺳﺎﻧﻲ در اﻧﺪام ﺗﺤﺘﺎﻧﻲ ﺑﻮدﻧﺪ‪ .‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ‬

‫ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ در دﻗﺎﻳﻖ ﻳﻚ‪ ،‬ﺳﻪ‪ ،‬ﭘﻨﺞ‪ 25 ،20 ،15 ،10 ،‬و ‪ 30‬ﻓﺸﺎر ﺧﻮن‬

‫داروي اﻧﺘﺨﺎﺑﻲ ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ ‪ %0/5‬ﻫﻴﭙﺮﺑﺎر ﻛﻪ ﺑﻪﻋﻨﻮان ﻳﻚ داروي‬

‫ﺳﻴﺴﺘﻮﻟﻴﻚ‪ ،‬دﻳﺎﺳﺘﻮﻟﻴﻚ‪ ،‬ﻣﻴﺎﻧﮕﻴﻦ و ﺿﺮﺑﺎن ﻗﻠﺐ اﻧﺪازهﮔﻴﺮي و ﺛﺒﺖ‬

‫ﺑﻲﺣﺴﻲ ﻣﻮﺿﻌﻲ ﻃﻮﻻﻧﻲ اﺛﺮ ﺷﻨﺎﺧﺘﻪ ﺷﺪه اﺳﺖ و ﺑﻪﺻﻮرت ﻣﻌﻤﻮل‬

‫ﻣﻲﺷﺪ‪ .‬ﺟﻬﺖ ﺗﺼﺎدﻓﻲ ﻧﻤﻮدن ﻣﻄﺎﻟﻌﻪ از ﺟﻤﻊ دو ﻋﺪد ﺳﻤﺖ راﺳﺖ‬

‫ﻣﻲﺗﻮاﻧﺪ ﺑﻠﻮك ﻣﻮﺛﺮي را ﺑﻪﻣﺪت دو ﺳﺎﻋﺖ در ﻧﻮاﺣﻲ ﻣﻮرد ﻧﻴﺎز اﻳﻦ‬

‫ﺷﻤﺎره ﭘﺮوﻧﺪه ﺑﻴﻤﺎر اﺳﺘﻔﺎده ﻣﻲﺷﺪ‪ .‬ﻋﺪد زوج در ﮔﺮوه ﻧﺸﺴﺘﻪ و ﻋﺪد‬

‫اﻋﻤﺎل ﺟﺮاﺣﻲ اﻳﺠﺎد ﻧﻤﺎﻳﺪ ﻣﻮرد اﺳﺘﻔﺎده ﻗﺮار ﮔﺮﻓﺖ‪ .‬از ﻛﻠﻴﻪ ﺑﻴﻤﺎران‬

‫ﻓﺮد در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ ﻗﺮار ﻣﻲﮔﺮﻓﺘﻨﺪ‪ .‬ﻳﻚ ﻧﻔﺮ از ﻫﻤﻜﺎران‬

‫ﻣﻮرد ﺑﺮرﺳﻲ رﺿﺎﻳﺖﻧﺎﻣﻪ ﻛﺘﺒﻲ اﺧﺬ ﺷﺪ و ﻃﺮح در ﻛﻤﻴﺘﻪ اﺧﻼق‬

‫ﻣﻄﺎﻟﻌﻪ ﺟﻬﺖ ﺛﺒﺖ ﻧﺘﺎﻳﺞ وارد اﻃﺎق ﻋﻤﻞ ﺷﺪه و ﭘﺮﺳﺶﻧﺎﻣﻪ ﺑﺮ اﺳﺎس‬

‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان ﺑﻪ ﺗﺼﻮﻳﺐ رﺳﻴﺪ‪ .‬در ‪ 40‬ﺑﻴﻤﺎر ﻛﻪ ﺑﻪ دو‬

‫ﻳﺎﻓﺘﻪﻫﺎي ﺑﺎﻟﻴﻨﻲ ﺛﺒﺖ ﻣﻲﮔﺮدﻳﺪ‪ .‬ﺑﺮاي ﻳﻜﺴﺎنﺳﺎزي اﺟﺮاي ﻃﺮح ﺑﺴﺘﻪ‬

‫ﮔﺮوه ‪ 20‬ﻧﻔﺮه ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ در دو ﺣﺎﻟﺖ ﻧﺸﺴﺘﻪ و ﺣﺎﻟﺖ ﺧﻮاﺑﻴﺪه ﺑﻪ‬

‫ﺑﻪ وﻇﺎﻳﻒ اﻓﺮاد ﻗﺒﻞ از اﺟﺮاي ﻃﺮح آﻣﻮزشﻫﺎي ﻻزم داده ﺷﺪ‪ .‬ﺗﻤﺎﻣﻲ‬

‫ﭘﻬﻠﻮ داروي ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ ﻫﻴﭙﺮﺑﺎرﻳﻚ ﺑﺎ ﻧﺎم ﺗﺠﺎري ﻣﺎرﻛﺎﻳﻴﻦ ﺷﺮﻛﺖ‬

‫ﺑﻴﻤﺎران ﺗﻮﺳﻂ ﻳﻚ ﻣﺘﺨﺼﺺ ﺑﻴﻬﻮﺷﻲ ﺗﺤﺖ ﺑﻲﺣﺴﻲ اﺳﭙﺎﻳﻨﺎل ﻗﺮار‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪422‬‬

‫ﺗﻐﻴﻴﺮات ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ و ﻣﺪت ﺑﻲدردي در ﺑﻴﻤﺎران ﺗﺤﺖ ﺟﺮاﺣﻲ ﻋﺮوق اﻧﺪام ﺗﺤﺘﺎﻧﻲ‬

‫ﻣﻲﮔﺮﻓﺘﻨﺪ‪ .‬ﺣﺠﻢ ﻣﺎﻳﻌﺎت ﻣﻮرد اﺳﺘﻔﺎده‪ ،‬ﻃﻮل ﻣﺪت ﺑﻲﺣﺴﻲ در اﺗﺎق‬

‫داﺷﺘﻨﺪ ﻛﻪ در دو ﮔﺮوه ﻫﻤﺴﺎن ﺑﻮد )‪ .(P>0/05‬ﻣﺸﺨﺼﺎت دﻣﻮﮔﺮاﻓﻴﻚ‬

‫ﻋﻤﻞ و در زﻣﺎن اﻧﺘﻘﺎل ﺑﻪ رﻳﻜﺎوري و ﻣﺪت اﺳﺘﻘﺮار ﺑﻴﻤﺎران در‬

‫ﻛﻞ اﻓﺮاد در ﺟﺪول ‪ 1‬آﻣﺪه اﺳﺖ‪ .‬اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﻲداري ﺑﻴﻦ‬

‫رﻳﻜﺎوري ﺗﺎ ﻗﺒﻞ از اﻧﺘﻘﺎل ﺑﻪ ﺑﺨﺶ ﺟﺮاﺣﻲ‪ ،‬ﻧﻴﺎز ﺑﻪ اﺳﺘﻔﺎده از‬

‫ﺗﻐﻴﻴﺮات ﻓﺸﺎر ﺧﻮن ﻣﺘﻮﺳﻂ ﺷﺮﻳﺎﻧﻲ‪ ،‬ﻓﺸﺎر ﺧﻮن دﻳﺎﺳﺘﻮﻟﻲ و ﻓﺸﺎر‬

‫وازوﭘﺮﺳﻮر‪ ،‬ﺗﻮاﻧﺎﻳﻲ ﺣﺮﻛﺖ دادن اﻧﺪام ﺗﺤﺘﺎﻧﻲ و ﻋﻼﻳﻢ ﺣﻴﺎﺗﻲ ﺛﺒﺖ‬

‫ﺧﻮن ﺳﻴﺴﺘﻮﻟﻲ در ﻛﻠﻴﻪ زﻣﺎنﻫﺎي ﻣﻮرد ﺑﺮرﺳﻲ در دو ﮔﺮوه وﺟﻮد‬

‫ﻣﻲﮔﺮدﻳﺪ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺟﻬﺖ ﭘﮋوﻫﺶ ﺑﺮ روي‬

‫داﺷﺖ )‪ .(P=0/0001‬اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﻲداري ﺑﻴﻦ ﺗﻐﻴﻴﺮات ﺿﺮﺑﺎن‬

‫ﺑﻴﻤﺎران ﭘﺮﺧﻄﺮ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪه ﺑﻮد‪ ،‬ﻣﺤﺪودﻳﺖﻫﺎي ﻧﺴﺒﻲ و ﻣﻄﻠﻖ‬

‫ﻗﻠﺐ در ﻛﻠﻴﻪ زﻣﺎنﻫﺎي ﻣﻮرد ﺑﺮرﺳﻲ در دو ﮔﺮوه وﺟﻮد داﺷﺖ‬

‫و ﺑﻴﻤﺎراﻧﻲ ﻛﻪ‬

‫)‪(P=0/0001‬؛ اﻣﺎ در ﻣﻮرد ﺿﺮﺑﺎن ﻗﻠﺐ در دﻗﺎﻳﻖ ﻧﺨﺴﺖ و ﺳﻲام‬

‫ﺣﻴﻦ ﻋﻤﻞ ﺟﺮاﺣﻲ ﺗﻐﻴﻴﺮ روش ﺑﻴﻬﻮﺷﻲ از اﺳﭙﺎﻳﻨﺎل ﺑﻪ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ‬

‫اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﻲداري را ﺑﻴﻦ دو ﮔﺮوه ﻧﺸﺎن ﻧﻤﻲداد )‪.(P>0/05‬‬

‫داﺷﺘﻨﺪ از ﻣﻄﺎﻟﻌﻪ ﺣﺬف ﮔﺮدﻳﺪﻧﺪ‪ .‬ﻛﻨﺘﺮااﻧﺪﻳﻜﺎﺳﻴﻮنﻫﺎي اﺳﭙﺎﻳﻨﺎل ﺷﺎﻣﻞ‬

‫ﻣﻴﺰان ﻣﺎﻳﻊ ﻣﺼﺮﻓﻲ در ﮔﺮوه ﻧﺸﺴﺘﻪ ﺑﻪﻣﻴﺰان ﻣﻌﻨﻲداري ﺑﻴﺸﺘﺮ ﺑﻮد‬

‫ﻋﺪم رﺿﺎﻳﺖ ﺑﻴﻤﺎر ﺑﺮاي ﻫﻤﻜﺎري‪ ،‬ﻋﻔﻮﻧﺖ ﭘﻮﺳﺘﻲ و زﻳﺮﺟﻠﺪي در‬

‫)‪ 55 .(P=0/037‬درﺻﺪ از ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و ‪ 10‬درﺻﺪ از ﮔﺮوه‬

‫ﻣﺤﻞ ورود ﺳﻮزن‪ ،‬ﺳﺎﺑﻘﻪ ﺟﺮاﺣﻲ ﻧﺨﺎع و ﺳﺘﻮن ﻓﻘﺮات در ﻣﺤﻞ ورود‬

‫ﻧﺸﺴﺘﻪ ﺗﻮاﻧﺎﻳﻲ ﺣﺮﻛﺖ ﻳﻚ ﭘﺎيﺷﺎن را ﭘﺲ از ﭘﻨﺞ دﻗﻴﻘﻪ از ﺷﺮوع‬

‫ﺳﻮزن و دﻓﻮرﻣﻴﺘﻲ ﺳﺘﻮن ﻓﻘﺮات ﺑﻮدﻧﺪ‪ .‬در ﻧﻬﺎﻳﺖ آﻧﺎﻟﻴﺰ آﻣﺎري ﺑﺎ ﻛﻤﻚ‬

‫ﺑﻲﺣﺴﻲ داﺷﺘﻨﺪ ﻛﻪ اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﻲداري را ﻧﺸﺎن ﻣﻲداد‬

‫ﻧﺮماﻓﺰار ‪ SPSS‬وﻳﺮاﺳﺖ ‪ 16‬اﻧﺠﺎم ﺷﺪ و آزﻣﻮن ﻣﻮرد اﺳﺘﻔﺎده در ﻣﻮرد‬

‫)‪ .(P<0/05‬ﺻﻔﺮ درﺻﺪ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و ‪ 20‬درﺻﺪ در‬

‫‪Kolmogorov-‬‬

‫ﮔﺮوه ﻧﺸﺴﺘﻪ ﻣﺼﺮف وازوﭘﺮﺳﻮر داﺷﺘﻨﺪ ﻛﻪ اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﻲداري‬

‫‪ Student’s t-test ،Smirnov test‬ﺑﻮد و در ﻣﻮرد ﻣﺘﻐﻴﺮﻫﺎي ﻛﻴﻔﻲ ﻧﻴﺰ از‬

‫را ﻧﺸﺎن ﻣﻲداد )‪ .(P=0/034‬ﺷﺮوع ﺑﻲﺣﺴﻲ در دو ﮔﺮوه اﺧﺘﻼف‬

‫و ‪ Fisher’s exact test‬اﺳﺘﻔﺎده ﮔﺮدﻳﺪ‪ .‬ﺳﻄﺢ ﻣﻌﻨﻲدار‬

‫آﻣﺎري ﻣﻌﻨﻲداري ﻧﺪاﺷﺖ )‪ ،(P>0/05‬اﻣﺎ ﻃﻮل ﻣﺪت ﺑﻲﺣﺴﻲ در ﮔﺮوه‬

‫ﺑﻲﺣﺴﻲ اﺳﭙﺎﻳﻨﺎل‪ ،‬ﺑﺎﻻﺗﺮ رﻓﺘﻦ ﺳﻄﺢ ﺑﻲﺣﺴﻲ از‬

‫‪T10‬‬

‫ﻣﻘﺎﻳﺴﻪ ﻣﺘﻐﻴﺮﻫﺎي ﻛﻤ‪‬ﻲ در دو ﮔﺮوه ﺑﺮ اﺳﺎس ﻧﺘﺎﻳﺞ‬ ‫آزﻣﻮنﻫﺎي‬

‫‪2‬‬

‫‪‬‬

‫ﺑﺎ اﻧﺤﺮافﻣﻌﻴﺎر ‪ %0/05‬در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ‪.‬‬

‫ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ ﺑﻪﻣﻴﺰان ﻣﻌﻨﻲداري ﻃﻮﻻﻧﻲﺗﺮ ﺑﻮده و ﺗﺎ زﻣﺎن اﻧﺘﻘﺎل‬ ‫ﺑﻴﻤﺎران ﺑﻪ رﻳﻜﺎوري اﻧﺪازهﮔﻴﺮي ﮔﺮدﻳﺪ در ﺑﻴﻤﺎران ﻧﺸﺴﺘﻪ درد در‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫رﻳﻜﺎوري ﺑﻪﻋﻠﺖ ﺑﺎزﮔﺸﺖ ﺣﺲ ﻣﺤﻞ ﻋﻤﻞ ﺟﺮاﺣﻲ زودﺗﺮ آﻏﺎز‬

‫ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ ‪ 52‬ﺳﺎل و در ﮔﺮوه ﻧﺸﺴﺘﻪ‬

‫ﮔﺮدﻳﺪ‪ ،‬در ﻳﻚ ﺳﺎﻋﺖ اول ﭘﺲ از ورود ﺑﻪ رﻳﻜﺎوري ﻣﺼﺮف ﻣﺴﻜﻦ‬

‫‪ 56/1‬ﺳﺎل ﺑﻮد ﻛﻪ در دو ﮔﺮوه ﻫﻤﺴﺎن ﺑﻮد )‪ 90 .(P>0/05‬درﺻﺪ در‬

‫دﻳﺪه ﺷﺪ ﻛﻪ اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﻲداري را ﻧﺸﺎن ﻣﻲداد‪ .‬اﻳﻦ اﺧﺘﻼف‬

‫ﻫﺮ دو ﮔﺮوه ﻣﺬﻛﺮ ﺑﻮدﻧﺪ )‪ 95 .(P>0/05‬درﺻﺪ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ‬

‫‪ 75‬درﺻﺪ در ﮔﺮوه ﻧﺸﺴﺘﻪ در ‪ 10‬درﺻﺪ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ‬

‫ﭘﻬﻠﻮ و ‪ 85‬درﺻﺪ در ﮔﺮوه ﻧﺸﺴﺘﻪ ﺳﻴﮕﺎر ﻣﻲﻛﺸﻴﺪﻧﺪ ﻛﻪ در دو ﮔﺮوه‬

‫اﻧﺪازهﮔﻴﺮي و ﺛﺒﺖ ﮔﺮدﻳـﺪ )‪ .(P=0/0001‬در ﭘﻨﺞ درﺻﺪ ﮔﺮوه ﺧﻮاﺑﻴﺪه‬

‫ﻫﻤﺴﺎن ﺑﻮد )‪ 60 .(P>0/05‬درﺻﺪ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و ‪55‬‬ ‫درﺻﺪ در ﮔﺮوه ﻧﺸﺴﺘﻪ ﻣﻮاد ﻣﺨﺪر ﻣﺼﺮف ﻣﻲﻧﻤﻮدﻧﺪ )‪15 ،(P>0/05‬‬ ‫درﺻﺪ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و ‪ 15‬درﺻﺪ در ﮔﺮوه ﻧﺸﺴﺘﻪ اﻟﻜﻞ‬

‫ﺟﺪول‪ :1-‬ﻣﺸﺨﺼﺎت دﻣﻮﮔﺮاﻓﻴﻚ ﻛﻞ اﻓﺮاد ﻣﻮرد ﺑﺮرﺳﻲ‬ ‫ﻓﺮاواﻧﻲ‬

‫درﺻﺪ ﻓﺮاواﻧﻲ‬

‫ﺟﻨﺲ ﻣﺬﻛﺮ‬

‫‪36‬‬

‫‪90‬‬

‫اﺳﺘﻌﻤﺎل ﺳﻴﮕﺎر‬

‫‪36‬‬

‫‪90‬‬

‫درﺻﺪ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و ‪ 25‬درﺻﺪ در ﮔﺮوه ﻧﺸﺴﺘﻪ ﺳﺎﺑﻘﻪ‬

‫ﻣﺼﺮف ﻣﻮاد ﻣﺨﺪر‬

‫‪23‬‬

‫‪57/5‬‬

‫اﻧﻔﺎرﻛﺘﻮس ﻣﻴﻮﻛﺎرد داﺷﺘﻨﺪ )‪ 45 ،(P>0/05‬درﺻﺪ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ‬

‫ﻣﺼﺮف اﻟﻜﻞ‬

‫‪6‬‬

‫‪15‬‬

‫ﭘﻬﻠﻮ و ‪ 65‬درﺻﺪ در ﮔﺮوه ﻧﺸﺴﺘﻪ ﺳﺎﺑﻘﻪ دﻳﺎﺑﺖ داﺷﺘﻨﺪ )‪30 ،(P>0/05‬‬

‫ﺳﺎﺑﻘﻪ اﻧﻔﺎرﻛﺘﻮس ﻣﻴﻮﻛﺎرد‬

‫‪8‬‬

‫‪20‬‬

‫درﺻﺪ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و ‪ 65‬درﺻﺪ در ﮔﺮوه ﻧﺸﺴﺘﻪ ﺳﺎﺑﻘﻪ‬

‫ﺳﺎﺑﻘﻪ دﻳﺎﺑﺖ‬

‫‪22‬‬

‫‪55‬‬

‫ﺑﻴﻤﺎري اﻳﺴﻜﻤﻴﻚ ﻗﻠﺒﻲ داﺷﺘﻨﺪ )‪ (P>0/05‬و ﺑﺎﻻﺧﺮه ‪ 40‬درﺻﺪ در‬

‫ﺳﺎﺑﻘﻪ ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮن‬

‫‪20‬‬

‫‪50‬‬

‫ﺳﺎﺑﻘﻪ ﺑﻴﻤﺎري اﻳﺴﻜﻤﻴﻚ ﻗﻠﺒﻲ‬

‫‪19‬‬

‫‪47/5‬‬

‫ﻣﺼﺮف ﻣﻲﻛﺮدﻧﺪ )‪ 40 ،(P>0/05‬درﺻﺪ در ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و‬ ‫‪ 60‬درﺻﺪ در ﮔﺮوه ﻧﺸﺴﺘﻪ ﺳﺎﺑﻘﻪ ﺑﻴﻬﻮﺷﻲ ﻧﺪاﺷﺘﻨﺪ )‪15 ،(P>0/05‬‬

‫ﮔﺮوه ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ و ‪ 60‬درﺻﺪ در ﮔﺮوه ﻧﺸﺴﺘﻪ ﺳﺎﺑﻘﻪ ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮن‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﻣﺸﺨﺼﻪ‬

‫ﻣﺤﻤﺪرﺿﺎ ﻣﻬﺎﺟﺮ و ﻫﻤﻜﺎران‬

‫ﺟﺪول‪ :2-‬ﻛﻠﻴﻪ ﻧﺘﺎﻳﺞ ﺑﻪدﺳﺖ آﻣﺪه در دو ﮔﺮوه ﻣﻮرد ﺑﺮرﺳﻲ‬ ‫ﮔﺮوه‬ ‫‪ MAPC1‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ MAPC2‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ MAPC3‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ MAPC4‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ MAPC5‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ MAPC6‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ MAPC7‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ MAPC8‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ SBPC1‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ SBPC2‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ SBPC3‬ﭘﻮرﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ SBPC4‬ﭘﻮرﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ SBPC5‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ SBPC6‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ SBPC7‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ SBPC8‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬

‫ﻣﻴﺎﻧﮕﻴﻦ‬ ‫‪0/8500‬‬ ‫‪-6/6000‬‬ ‫‪-5/7600‬‬ ‫‪-12/2000‬‬ ‫‪-8/3000‬‬ ‫‪-14/7000‬‬ ‫‪-8/0500‬‬ ‫‪-12/4500‬‬ ‫‪-7/9500‬‬ ‫‪-12/4500‬‬ ‫‪-7/3500‬‬ ‫‪-11/6000‬‬ ‫‪-6/8000‬‬ ‫‪-11/35000‬‬ ‫‪-6/5000‬‬ ‫‪-11/3500‬‬ ‫‪-0/5000‬‬ ‫‪-6/4000‬‬ ‫‪-6/2000‬‬ ‫‪-10/9000‬‬ ‫‪-8/9500‬‬ ‫‪-12/6500‬‬ ‫‪-8/7000‬‬ ‫‪-11/9000‬‬ ‫‪-8/5500‬‬ ‫‪-11/1500‬‬ ‫‪-7/9500‬‬ ‫‪-11/0500‬‬ ‫‪-7/9000‬‬ ‫‪-11/0500‬‬ ‫‪-7/5500‬‬ ‫‪-10/6500‬‬

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‫اداﻣﻪ ﺟﺪول‪ :2-‬ﻛﻠﻴﻪ ﻧﺘﺎﻳﺞ ﺑﻪدﺳﺖ آﻣﺪه در دو ﮔﺮوه ﻣﻮرد ﺑﺮرﺳﻲ‬ ‫اﻧﺤﺮافﻣﻌﻴﺎر‬ ‫‪0/1273‬‬ ‫‪3/10178‬‬ ‫‪2/19749‬‬ ‫‪4/40813‬‬ ‫‪2/67739‬‬ ‫‪6/44999‬‬ ‫‪2/51850‬‬ ‫‪5/18576‬‬ ‫‪3/51650‬‬ ‫‪4/43045‬‬ ‫‪2/60111‬‬ ‫‪4/04449‬‬ ‫‪2/14231‬‬ ‫‪3/50188‬‬ ‫‪1/87785‬‬ ‫‪2/72223‬‬ ‫‪1/46898‬‬ ‫‪2/72223‬‬ ‫‪2/26181‬‬ ‫‪4/14094‬‬ ‫‪3/10305‬‬ ‫‪4/53379‬‬ ‫‪3/24605‬‬ ‫‪3/52286‬‬ ‫‪2/87411‬‬ ‫‪3/34467‬‬ ‫‪2/64525‬‬ ‫‪3/70313‬‬ ‫‪2/78908‬‬ ‫‪3/03445‬‬ ‫‪2/45867‬‬ ‫‪3/01357‬‬

‫ﮔﺮوه‬ ‫‪ DBPC1‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ DBPC2‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ DBPC3‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ DBPC4‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ DBPC5‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ DBPC6‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ DBPC7‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ DBPC8‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ HRC1‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ SHRC2‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ HRC3‬ﭘﻮرﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ HRC4‬ﭘﻮرﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ HRC5‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ HRC6‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ HRC7‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬ ‫‪ HRC8‬ﭘﻮزﻳﺸﻦ ﻟﺘﺮال‬ ‫ﻧﺸﺴﺘﻪ‬

‫ﻣﻴﺎﻧﮕﻴﻦ‬ ‫‪-0/9500‬‬ ‫‪-6/1000‬‬ ‫‪-5/5500‬‬ ‫‪-9/3000‬‬ ‫‪-7/4000‬‬ ‫‪-9/5500‬‬ ‫‪-7/6600‬‬ ‫‪-9/7500‬‬ ‫‪-7/2500‬‬ ‫‪-9/0500‬‬ ‫‪-6/7000‬‬ ‫‪-9/2000‬‬ ‫‪-6/3000‬‬ ‫‪-9/0500‬‬ ‫‪-6/3000‬‬ ‫‪-8/6500‬‬ ‫‪4/1500‬‬ ‫‪4/5000‬‬ ‫‪3/7500‬‬ ‫‪7/3000‬‬ ‫‪3/7000‬‬ ‫‪10/2500‬‬ ‫‪3/4000‬‬ ‫‪9/7500‬‬ ‫‪3/0500‬‬ ‫‪9/1500‬‬ ‫‪3/4500‬‬ ‫‪7/4500‬‬ ‫‪2/8500‬‬ ‫‪6/3000‬‬ ‫‪2/7500‬‬ ‫‪4/8500‬‬

‫اﻧﺤﺮافﻣﻌﻴﺎر‬ ‫‪0/94451‬‬ ‫‪2/67346‬‬ ‫‪2/41650‬‬ ‫‪3/19704‬‬ ‫‪2/77963‬‬ ‫‪4/08431‬‬ ‫‪2/68475‬‬ ‫‪2/53138‬‬ ‫‪2/67296‬‬ ‫‪2/48088‬‬ ‫‪2/40832‬‬ ‫‪2/50473‬‬ ‫‪2/67739‬‬ ‫‪2/54383‬‬ ‫‪2/40822‬‬ ‫‪2/47673‬‬ ‫‪1/08942‬‬ ‫‪4/01989‬‬ ‫‪1/25132‬‬ ‫‪3/62883‬‬ ‫‪0/97672‬‬ ‫‪6/80997‬‬ ‫‪1/78885‬‬ ‫‪6/7704‬‬ ‫‪1/43179‬‬ ‫‪6/20400‬‬ ‫‪1/70062‬‬ ‫‪6/79905‬‬ ‫‪2/10950‬‬ ‫‪6/36166‬‬ ‫‪1/88833‬‬ ‫‪5/49946‬‬

‫ﺑﻪ ﭘﻬﻠﻮ و ‪ 30‬درﺻﺪ ﮔـﺮوه ﻧﺸـﺴﺘﻪ‪ ،‬ﺗﻬـﻮع و اﺳـﺘﻔﺮاغ دﻳـﺪه ﺷـﺪ ﻛـﻪ‬

‫ﺑﻬﺒﻮد ﻣﻲﺑﺨﺸﺪ‪ 6.‬اﻳﻦ ﺑﻴﻤﺎران ﺑﻪﻃﻮر ﻋﻤﺪه در ﺳﻨﻴﻦ ﻣﻴﺎنﺳـﺎل و ﻣـﺴﻦ‬

‫اﺧﺘﻼف آﻣﺎري ﻣﻌﻨﻲداري را ﻧﺸﺎن ﻧﻤﻲداد )‪) (P>0/05‬ﺟﺪول ‪.(2‬‬

‫ﺑﻮده و ﻣﺸﻜﻼﺗﻲ ﻣﺎﻧﻨﺪ ﺑﺮوﻧﺸﻴﺖ‪ ،‬ﺑﻴﻤﺎريﻫﺎي اﻧﺴﺪادي رﻳﻮي‪ ،‬دﻳﺎﺑﺖ‪،‬‬ ‫ﺑﻴﻤﺎريﻫﺎي ﻋﺮوﻗﻲ ﻣﺎﻧﻨﺪ ﺑﻮرﮔﺮ را ﺑﻪﻫﻤﺮاه ﺧﻮد دارﻧﺪ‪ 7.‬از ﻃﺮف دﻳﮕﺮ‬

‫ﺑﺤﺚ‬ ‫ﺑﻪﻋﻠﺖ ﺑﻠﻮك ﻧﺎﺣﻴﻪاي در اﻧـﺪام ﺗﺤﺘـﺎﻧﻲ ﺗﻨﻬـﺎ ﺳﻴـﺴﺘﻢ ﻋـﺼﺒﻲ ﺣـﺴﻲ‬

‫اﻳﻦ ﺟﺮاﺣﻲ ﺑﻪﻋﻠﺖ ﻇﺮاﻓﺖ و ﺣﺴﺎﺳﻴﺖ ﺧﺎص ﺧﻮد ﻣﺪت زﻳﺎدﺗﺮي را‬ ‫ﺑﻪ ﺧـﻮد اﺧﺘـﺼﺎص ﺧﻮاﻫـﺪ داد و در ﻣﻘﺎﻳـﺴﻪ ﺑـﺎ ﺑـﺴﻴﺎري از اﻋﻤـﺎل‬ ‫‪8‬‬

‫ﺣﺮﻛﺘﻲ را ﺑﻠﻮك ﻧﻤﻮده و ﺑﺎ ﻛﺎﻫﺶ واﺿﺢ در ﺗﻮﻧﻴﺴﻴﺘﻪ ﻋﺮوﻗﻲ ﻣﻲﺗﻮاﻧﺪ‬

‫ﺟﺮاﺣﻲ ﻣﺸﺎﺑﻪ ﻧﻴﺎز ﺑﻪ ﺑﻲدردي و ﻣﺪت ﺑﻠﻮك ﺑﻴﺸﺘﺮي اﺳـﺖ‪ .‬در اﻳـﻦ‬

‫ﺧﻮنرﺳﺎﻧﻲ اﻧﺪام ﺗﺤﺘﺎﻧﻲ را ﺑﻪﻃﻮر ﻣﻮﺛﺮي ﺑﻬﺒﻮد ﺑﺨﺸﺪ‪ ،‬از ﻃﺮف دﻳﮕﺮ‬

‫ﻣﻄﺎﻟﻌﻪ داروي اﻧﺘﺨﺎﺑﻲ ﺑﻮﭘﻴﻮاﻛـﺎﻳﻴﻦ ‪ %0/5‬ﻫﻴﭙﺮﺑـﺎر ﻛـﻪ ﺑـﻪﻋﻨـﻮان ﻳـﻚ‬

‫ﻛﻢﺗﺮﻳﻦ اﺛﺮ ﻣﺴﺘﻘﻴﻢ را ﺑﺮ روي ﻗﻠـﺐ رﻳـﻪ و ﻣﻐـﺰ داﺷـﺘﻪ و ﺑـﺎ ﻛـﺎﻫﺶ‬

‫داروي ﻃﻮﻻﻧﻲ اﺛﺮ ﺷﻨﺎﺧﺘﻪ ﺷﺪه اﺳﺖ و ﺑﻪﺻـﻮرت ﻣﻌﻤـﻮل ﻣـﻲﺗﻮاﻧـﺪ‬

‫ﻣﻘﺎوﻣﺖ ﺑﺮ ﺳﺮ راه ﺑﺮونده ﻗـﻠﺒﻲ ﻗﺪرت ﭘﻤـﭗ و اﻧـﺪﻛﺲ ﻗﻠﺒﻲ را ﻧﻴـﺰ‬

‫ﺑﻠﻮك ﻣﻮﺛﺮي را ﺑﻪﻣﺪت دو ﺳﺎﻋﺖ در ﻧﻮاﺣﻲ ﻣـﻮرد ﻧﻴـﺎز اﻳـﻦ اﻋﻤـﺎل‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﺗﺤﺖ ﺟﺮاﺣﻲ ﻋﺮوق اﻧﺪام ﺗﺤﺘﺎﻧﻲ‬ ‫ ﺑﻴﻤﺎران‬M.R. ‫دردي در‬ Mohajer et ‫ﺑﻲ‬ al.‫ﺗﻐﻴﻴﺮات ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ و ﻣﺪت‬

424

‫ در اﻧﮕﻠـﻴﺲ اﻧﺠـﺎم ﺷـﺪ ﺑـﺮ‬Chadwick ‫ در ﻣﻄﺎﻟﻌﻪاي ﻛﻪ ﺗﻮﺳﻂ‬.‫ﮔﺮدد‬

‫ ﺑﻴﻤﺎر ﻛﻪ ﺑـﻪ دو‬40 ‫ در‬9.‫ﺟﺮاﺣﻲ اﻳﺠﺎد ﻧﻤﺎﻳﺪ ﻣﻮرد اﺳﺘﻔﺎده ﻗﺮار ﮔﺮﻓﺖ‬

‫ﺧﻼف ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﺑﻪ اﻳﻦ ﻧﺘﻴﺠﻪ رﺳﻴﺪ ﻛﻪ ﺑﻴﻦ وﺿﻌﻴﺖ ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠـﻮ‬

‫ ﻧﻔﺮه ﺗﻘﺴﻴﻢﺑﻨﺪي ﺷﺪﻧﺪ در دو ﺣﺎﻟﺖ ﻧﺸﺴﺘﻪ و ﺣﺎﻟﺖ ﺧﻮاﺑﻴﺪه‬20 ‫ﮔﺮوه‬

‫ اﺧﺘﻼﻓﻲ از ﻧﻈﺮ ﻧﺘﺎﻳﺞ ﺑﻪدﺳﺖ آﻣﺪه از ﻧﻈﺮ وﺿﻌﻴﺖ‬،‫و وﺿﻌﻴﺖ ﻧﺸﺴﺘﻪ‬

‫ ﺗﺰرﻳـﻖ‬3ml ‫ ﺑـﻪﻣﻴـﺰان‬%0/5 ‫ﺑﻪ ﭘﻬﻠـﻮ داروي ﺑﻮﭘﻴﻮاﻛـﺎﻳﻴﻦ ﻫﻴﭙﺮﺑﺎرﻳـﻚ‬

‫ ﻫﻤﺎﻧﻨـﺪ‬،‫ در آﻣﺮﻳﻜـﺎ‬Emerson ‫ ﻣﻄﺎﻟﻌـﻪ‬16.‫ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ وﺟـﻮد ﻧـﺪارد‬

‫ در ﮔـﺮوه‬.‫ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ‬T10 ‫ﮔﺮدﻳﺪه و ﺳﻄﺢ ﺑﻲﺣﺴﻲ ﺑﻴﻤﺎران در‬

‫ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﺑﻪ اﻳﻦ ﻧﺘﻴﺠﻪ رﺳﻴﺪ ﻛـﻪ ﺑـﻴﻦ وﺿـﻌﻴﺖ ﺧﻮاﺑﻴـﺪه ﺑـﻪ ﭘﻬﻠـﻮ و‬

‫ ﺧﻮاﺑﺎﻧـﺪه‬25 ‫ﻧﺸﺴﺘﻪ ﺑﻴﻤﺎران ﭘﺲ از اﻧﺠﺎم ﺗﻜﻨﻴﻚ ﺑـﺎ ﺳـﻮزن اﺳـﭙﺎﻳﻨﺎل‬

‫وﺿــﻌﻴﺖ ﻧﺸــﺴﺘﻪ اﺧــﺘﻼف آﻣــﺎري ﻣﻌﻨ ـﻲداري وﺟــﻮد دارد و ﻣﻴــﺰان‬

‫ در‬.‫ﺷﺪه و ﭘﺲ از اﺳﺘﻘﺮار ﺑﻠﻮك اﺟﺎزه آﻏـﺎز ﻋﻤـﻞ ﺟﺮاﺣـﻲ داده ﺷـﺪ‬

De

17

‫ در ﻣﻄﺎﻟﻌﻪ‬.‫ﺗﻐﻴﻴﺮات در ﭘﻮزﻳﺸﻦ ﺧﻮاﺑﻴﺪه ﻛﻢﺗﺮ از ﻧﺸﺴﺘﻪ ﻣﻲﺑﺎﺷﺪ‬

‫ﺑﻴﻤﺎران ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﻬﻠﻮ ﻧﻴﺰ ﭘﺲ از ﺧﻮاﺑﺎﻧﻴﺪن ﺑﻴﻤﺎران ﺑـﻪﺳـﻤﺖ ﻣـﻮرد‬

‫ در ﻫﻠﻨﺪ ﻧﻴﺰ اﺧﺘﻼﻓﻲ ﺑﻴﻦ ﺗﻐﻴﻴﺮات ﻫﻤﻮدﻳﻨﺎﻣﻴﻚ ﺑﻴﻦ دو ﭘﻮزﻳـﺸﻦ‬Laat

‫ﻋﻤﻞ )ﭼﭗ ﻳﺎ راﺳﺖ( داروي ﻣﺬﻛﻮر ﺗﺰرﻳـﻖ ﮔﺮدﻳـﺪ و ﺑـﻪﻣـﺪت ﭘـﻨﺞ‬

‫ در ﻣﺠﻤﻮع ﺑﺮ اﺳـﺎس ﻧﺘـﺎﻳﺞ ﺣﺎﺻـﻞ از‬18.‫ﺧﻮاﺑﻴﺪه و ﻧﺸﺴﺘﻪ ﭘﻴﺪا ﻧﺸﺪ‬

‫ ﮔﺮوه دوم ﭘﺲ از ﺑـﺎز‬.‫دﻗﻴﻘﻪ ﺑﻴﻤﺎران در اﻳﻦ ﻣﻮﻗﻌﻴﺖ ﺣﻔﻆ ﻣﻲﮔﺮدﻳﺪﻧﺪ‬

‫اﻳﻦ ﻣﻄﺎﻟﻌﻪ و ﻣﻘﺎﻳﺴﻪ آنﻫﺎ ﺑﺎ ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎت اﻧﺠﺎم ﺷﺪه در اﻳـﻦ زﻣﻴﻨـﻪ‬

‫ﮔﺮداﻧﻴﺪن ﺑﻪﺣﺎﻟﺖ ﺧﻮاﺑﻴﺪه ﺑﻪ ﭘﺸﺖ در ﭘﺎي ﻣﺬﻛﻮر در ﺳﻤﺖ ﺧﻮاﺑﻴـﺪن‬

‫ﭼﻨﻴﻦ اﺳﺘﻨﺒﺎط ﻣﻲﺷـﻮد ﻛـﻪ ﻣﻴـﺰان ﺗﻐﻴﻴـﺮات در ﺑﻴﻬﻮﺷـﻲ اﺳـﭙﺎﻳﻨﺎل در‬

‫ﺑﻴﻤﺎر داراي ﺑﻠﻮك ﻋﻤﻴﻖﺗﺮي ﺑﻮده و ﺑﻪﻋﺒﺎرت دﻳﮕﺮ ﭘـﺎي ﻣﺤـﻞ ﻋﻤـﻞ‬

‫ﭘﻮزﻳﺸﻦ ﺧﻮاﺑﻴﺪه ﻛﻢﺗﺮ از ﻧﺸﺴﺘﻪ ﻣﻲﺑﺎﺷـﺪ و ﻟـﺬا اﺳـﺘﻔﺎده از ﭘﻮزﻳـﺸﻦ‬

‫ اﻳﻦ در ﺣـﺎﻟﻲ اﺳـﺖ ﻛـﻪ در زﻣـﺎن آﻏـﺎز‬.‫ﺑﻪﻃﻮر ﻛﺎﻣﻞ ﺑﻠﻮك ﻣﻲﮔﺮدﻳﺪ‬

‫ﺧﻮاﺑﻴﺪه ﺑﺮاي ﺑﻴﻬﻮﺷﻲﻫﺎي اﺳﭙﺎﻳﻨﺎل در اﻓﺮاد ﺗﺤﺖ ﺟﺮاﺣﻲﻫﺎي ﻋـﺮوق‬

‫ﻋﻤﻞ ﺟﺮاﺣﻲ ﭘﺎي دﻳﮕﺮ ﺑﻴﻤﺎران ﺗﻔﺎوت ﻓﺎﺣﺶ و ﻛﻢﺗﺮي از ﻧﻈﺮ ﺑﻠﻮك‬

‫اﻧﺪام ﺗﺤﺘﺎﻧﻲ و ﺳﺎﻳﺮ ﺟﺮاﺣﻲﻫﺎﻳﻲ ﻛﻪ ﺗﻐﻴﻴـﺮات ﻫﻤﻮدﻳﻨﺎﻣﻴـﻚ زﻳـﺎد در‬

‫ اﻳﻦ ﺑﻠﻮك ﻋﺼﺒﻲ ﻣﻨﺠﺮ ﺑﻪ‬.‫ﺣﺴﻲ و ﺣﺮﻛﺘﻲ ﻧﺴﺒﺖ ﺑﻪ ﭘﺎي ﻣﻘﺎﺑﻞ داﺷﺖ‬

‫ در اﻧﺘﻬـﺎ ﭘﻴـﺸﻨﻬﺎد ﻣـﻲﺷـﻮد‬.‫ ﺗﻮﺻـﻴﻪ ﻣـﻲﺷـﻮد‬،‫آنﻫﺎ ﺧﻄﺮﻧﺎك اﺳـﺖ‬

‫اﻳﻦ ﺷﺪ ﻛـﻪ ﻣﺰاﻳـﺎ و ﻣﻌﺎﻳـﺐ اﻳـﻦ دو روش ﺑﺮرﺳـﻲ و ﻃـﻲ ﺟـﺪوﻟﻲ‬

.‫ﻣﻄﺎﻟﻌﺎت ﺑﻴﺸﺘﺮي ﺑﻪﻣﻨﻈﻮر ﺗﺄﻳﻴﺪ ﻳﺎﻓﺘﻪﻫﺎي اﻳﻦ ﻣﻄﺎﻟﻌﻪ اﻧﺠﺎم ﺷﻮد‬

‫ﺑﻪﺻﻮرت ﻣﺘﻐﻴﺮﻫﺎي اﻧﺪازهﮔﻴﺮي ﺷﺪه ﺑﻪﺻﻮرت ﻧﺘﺎﻳﺞ اﻳﻦ ﻣﻄﺎﻟﻌﻪ اﻋﻼم‬

References 1. Norris EJ. Anesthesia for vascular surgery. In: Miller RD, editor.

Miller's Anesthesia. 5th ed. Philadelphia: Churchill Livingston; Vol. 2. 2005. p. 2051-125.

2. Singh N, Sidawy AN, Dezee K, Neville RF, Weiswasser J, Arora S, et al. The effects of the type of anesthesia on outcomes of lower extremity infrainguinal bypass. J Vasc Surg 2006;44(5):964-8; discussion 968-70.

3. Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990;72(1):153-84.

4. Hertzer NR. Cardiac risk factors in peripheral vascular surgery. In: Estafanous FG, editor. Anesthesia and the Heart Patient. Oxford: Buterworth Heineman; 1989. p. 173-95.

5. Tisi GM. Preoperative evaluation of pulmonary function. Validity, indications, and benefits. Am Rev Respir Dis 1979;119(2):293-310.

6. Christopherson R, Beattie C, Frank SM, Norris EJ, Meinert CL, Gottlieb SO, et al. Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery.

Perioperative Ischemia Randomized Anesthesia Trial Study Group.

Anesthesiology 1993;79(3):422-34.

7. Mackay CA, Razik W, Simms MH. Local anaesthetic for lowerlimb revascularization in high-risk patients. Br J Surg 1997;84(8):1096-8.

8. Slogoff S, Keats AS. Does perioperative myocardial ischemia lead to postoperative myocardial infarction?

Anesthesiology 1985;62(2):107-14.

9. Rosenfeld BA, Beattie C, Christopherson R, Norris EJ, Frank SM, Breslow MJ, et al. The effects of different anesthetic regimens on fibrinolysis and the development of postoperative arterial thrombosis. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology 1993;79(3):435-43.

10. Norris EJ, Beattie C, Perler BA, Martinez EA, Meinert CL, Anderson GF, et al. Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery. Anesthesiology 2001;95(5):1054-67.

11. Horlocker TT, Heit JA. Low molecular weight heparin: biochemistry, pharmacology, perioperative prophylaxis regimens, and guidelines for regional anesthetic management. Anesth Analg 1997;85(4):874-85.

12. Urmey WF, Rowlingson J. Do antiplatelet agents contribute to the development of perioperative spinal hematoma? Reg Anesth Pain Med 1998;23(6 Suppl 2):146-51.

13. Guinard JP, Mulroy MF, Carpenter RL. Aging reduces the reliability of epidural epinephrine test doses. Reg Anesth 1995;20(3):193-8.

14. Kooger Infante NE, Van Gessel E, Forster A, Gamulin Z. Extent of hyperbaric spinal anesthesia influences the duration of spinal block.

Anesthesiology 2000;92(5):1319-23.

15. Chohan U, Afshan G, Hoda MQ, Mahmud S. Haemodynamic effects of unilateral spinal anesthesia in high risk patients. J Pak Med Assoc 2002;52(2):66-9.

16. Chadwick IS, Eddleston JM, Chandelier CK, Pollard BJ. Haemodynamic effects of the position chosen for the insertion of an epidural catheter. Int J Obstet Anesth 1993;2(4):197-201.

17. Emerson RJ, Banasik JL. Effect of position on selected hemodynamic parameters in postoperative cardiac surgery patients.

Am J Crit Care 1994;3(4):289-99.

18. de Laat E, Schoonhoven L, Grypdonck M, Verbeek A, de Graaf R, Pickkers P, van Achterberg T. Early postoperative 30 degrees lateral positioning after coronary artery surgery: influence on cardiac output. J Clin Nurs 2007;16(4):654-61.

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

Tehran University Medical Journal;‫ﻫﻤﻜﺎران‬ Vol. 69, ‫ و‬No. 7, October 2011: 420-425

100

The comparison between lateral spinal anesthesia and sitting positions in lower limb vascular surgery

Abstract Mohammad Reza Mohajer M.D.1 Kasra Karvandian M.D.1* Zahid Hussain Khan M.D.1 Afshin Jafarzadeh M.D.1 Soheila Dabiran M.D.2 1- Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran.

2- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Received: May 04, 2011 Accepted: July 04, 2011

Background: Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of

the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009.

Methods: In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups.

Results: The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups (P<0.05). Except in the first and thirtieth minutes, the changes in heart rate (HR) were significantly different throughout the study between the two groups (P<0.04) and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position (P<0.04) and the use of fluid was significantly larger in the sitting group (P<0.05).

Conclusion: According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb.

Keywords: Bupivacaine, position, spinal anesthesia, vascular surgery.

*

Corresponding author: Keshavarz Blvd., Imam Khomeini Hospital, Tehran, Iran.

Tel: +98-21-88249920 E-mail: kassramail@yahoo.com

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

‫ﻛﺮده‪426-431‬‬ ‫‪،1390‬‬ ‫زﻧﺎنﻣﻬﺮ‬ ‫ﺷﻤﺎره ‪،7‬‬ ‫دوره ‪، 69‬‬ ‫ﺗﻬﺮان‪،‬‬ ‫ﻋﻠﻮمﺑﺮﭘﺰﺷﻜ‬ ‫داﻧﺸﮕﺎه‬ ‫ﻳﻚﭘﺰﺷﻜ‬ ‫ﺗﺄﺛﻴﺮﻜﺪه‬ ‫ﻣﺠﻠﻪ داﻧﺸ‬ ‫ﺗﻤﺮﻳﻦ‬ ‫ﻟﻨﻔﻮﺳﻴﺖ در‬ ‫اﺑﺴﺘﺎﺗﻴﻦ‬ ‫ﺑﻴﺎنﻲژن‬ ‫ﻫﻮازي‬ ‫ﺟﻠﺴﻪﻲ‪،‬ﺗﻤﺮﻳﻦ‬

‫ﺗﺄﺛﻴﺮ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻫﻮازي ﺑﺮ ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖ در زﻧﺎن ﺗﻤﺮﻳﻦ ﻛﺮده‬

‫ﭼﻜﻴﺪه‬

‫‪*1‬‬

‫اﻣﻴﺮ رﺷﻴﺪﻟﻤﻴﺮ‬

‫ﻣﻬﺪﻳﻪ اﺑﺮاﻫﻴﻢﻧﻴﺎ‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/02/14 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/05/24 :‬‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬اﺑﺴﺘﺎﺗﻴﻦ‪ ،‬ﻳﻚ ﭘﭙﺘﻴﺪ ﺿﺪ اﺷﺘﻬﺎ اﺳﺖ‪ .‬ﻣﻄﺎﻟﻌﺎت ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛﻪ اﺑﺴﺘﺎﺗﻴﻦ در ﺗﻌﺎدل اﻧﺮژي‪ ،‬ﺗﺮﺷﺢ‬

‫‪1‬‬ ‫‪2‬‬

‫ﻋﻠﻲ اﻛﺒﺮ ﻫﺎﺷﻤﻲ ﺟﻮاﻫﺮي‬

‫ﻫﻮرﻣﻮن رﺷﺪ‬

‫)‪(GH‬‬

‫و ﺗﻐﻴﻴﺮات وزن ﺑﺪن ﻧﻘﺶ دارد و ﻣﺸﺨﺺ ﺷﺪه ﻛﻪ از ﻧﻈﺮ ﻓﻴﺰﻳﻮﻟﻮژﻳﻜﻲ ﻋﻤﻠﻜﺮد ﻣﺘﻀﺎدي ﺑﺎ‬

‫ﮔﺮﻟﻴﻦ دارد‪ .‬ﻫﺪف از ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﺑﺮرﺳﻲ اﺛﺮ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻫﻮازي )‪ 1/5‬ﻣﺎﻳﻞ دوﻳﺪن( ﺑﺮ ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ‬ ‫‪ -1‬ﮔﺮوه ﻓﻴﺰﻳﻮﻟﻮژي ورزﺷﻲ‬

‫ﻟﻨﻔﻮﺳﻴﺖﻫﺎي زﻧﺎن ﺗﻤﺮﻳﻦﻛﺮده ﻣﻲﺑﺎﺷﺪ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬ﺗﻌﺪاد ‪ 16‬زن ﺗﻤﺮﻳﻦﻛﺮده ﺧﺮاﺳﺎﻧﻲ ﭘﺲ از ﻓﺮاﺧﻮان اﻧﺘﺨﺎب و‬

‫‪ -2‬ﮔﺮوه درﻣﺎﻧﮕﺮي ورزﺷﻲ‬

‫ﺑﻪﻃﻮر ﺗﺼﺎدﻓﻲ ﺑﻪ دو ﮔﺮوه ﻛﻨﺘﺮل و ﺗﺠﺮﺑﻲ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ‪ .‬ﮔﺮوه ﺗﺠﺮﺑﻲ ﻣﺴﺎﻓﺖ ‪ 1/5‬ﻣﺎﻳﻞ را ﺑﺎ ﺳﺮﻋﺖ ﺛﺎﺑﺖ‬

‫داﻧﺸﻜﺪه ﺗﺮﺑﻴﺖ ﺑﺪﻧﻲ و ﻋﻠﻮم ورزﺷﻲ‪ ،‬داﻧﺸﮕﺎه‬ ‫ﻓﺮدوﺳﻲ ﻣﺸﻬﺪ‪ ،‬ﻣﺸﻬﺪ‪ ،‬اﻳﺮان‪.‬‬

‫)‪VO2max‬‬

‫‪ (%70‬دوﻳﺪﻧﺪ و ﮔﺮوه ﻛﻨﺘﺮل ﻧﻴﺰ در اﻳﻦ ﻣﺪت ﺑﺪون ﺗﻤﺮﻳﻦ )ﺣﺎﺿﺮ در ﺷﺮاﻳﻂ ﺗﻤﺮﻳﻦ( ﺑﻮدﻧﺪ‪ .‬ﻧﻤﻮﻧﻪﻫﺎي‬

‫ﺧﻮﻧﻲ ﻗﺒﻞ از ﭘﺮوﺗﻜﻞ ﺗﻤﺮﻳﻨﻲ ﺑﻪﺻﻮرت ﻧﺎﺷﺘﺎ و ﺑﻼﻓﺎﺻﻠﻪ ﭘﺲ از ﺗﻤﺮﻳﻦ‪ ،‬ﺑﻪﻣﻴﺰان ‪ 10ml‬از ورﻳﺪ ﺑﺎزوﻳﻲ ﺟﻤﻊآوري‬ ‫ﺷﺪ‪ .‬ﭘﺲ از ﺟﺪاﺳﺎزي ﻟﻨﻔﻮﺳﻴﺖﻫﺎ ﺑﻪروش ﺳﺎﻧﺘﺮﻳﻔﻴﻮژ‪ ،‬ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ در ﻟﻨﻔﻮﺳﻴﺖﻫﺎي آزﻣﻮدﻧﻲﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از‬ ‫روش‬

‫‪Semi-quantitative-RT-PCR‬‬

‫اﻧﺠﺎم ﺷﺪ‪ .‬ﻳﺎﻓﺘﻪﻫﺎ‪ :‬اﻳﻦ ﭘﮋوﻫﺶ ﻧﺸﺎن داد ﻛﻪ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻫﻮازي ﻣﻮﺟﺐ‬

‫اﻓﺰاﻳﺶ اﻧﺪك ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖﻫﺎي آزﻣﻮدﻧﻲﻫﺎي ﮔﺮوه ﺗﺠﺮﺑﻲ ﻣﻲﺷﻮد ﻛﻪ اﻳﻦ اﻓﺰاﻳﺶ ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه‬ ‫ﻛﻨﺘﺮل‪ ،‬ﺗﻐﻴﻴﺮات ﻣﻌﻨﻲداري را ﻧﺸﺎن ﻧﻤﻲدﻫﺪ‪ .‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﻧﺘﺎﻳﺞ اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﺸﺨﺺ ﻣﻲﻛﻨﺪ ﻛﻪ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ‬ ‫ﻫﻮازي اﻓﺰاﻳﺶ ﻣﻌﻨﻲداري در ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖ اﻳﺠﺎد ﻧﻤﻲﻛﻨﺪ‪ .‬ﻣﻤﻜﻦ اﺳﺖ ﺷﺪت‪ ،‬ﻧﻮع و ﻣﺪت ﭘﺮوﺗﻜﻞ‬ ‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﻣﺸﻬﺪ‪ ،‬ﻣﻴﺪان آزادي‪ ،‬داﻧﺸﮕﺎه‬

‫ﻓﺮدوﺳﻲ ﻣﺸﻬﺪ‪ ،‬داﻧﺸﻜﺪه ﺗﺮﺑﻴﺖ ﺑﺪﻧﻲ و ﻋﻠﻮم ورزﺷﻲ‪،‬‬ ‫ﮔﺮوه ﻓﻴﺰﻳﻮﻟﻮژي ورزﺷﻲ‪ .‬ﻛﺪ ﭘﺴﺘﻲ‪9177948979 :‬‬

‫ﺗﻤﺮﻳﻨﻲ ﺑﻪﻛﺎر رﻓﺘﻪ در اﻳﻦ ﺗﺤﻘﻴﻖ‪ ،‬ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖ را ﺗﺤﺖ ﺗﺄﺛﻴﺮ ﻗﺮار ﻧﺪاده ﻛﻪ اﻳﻦ ﻧﺘﻴﺠﻪ‪ ،‬ﻫﻢراﺳﺘﺎ ﺑﺎ ﻧﺘﺎﻳﺞ‬ ‫ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎت اﻧﺠﺎم ﺷﺪه در زﻣﻴﻨﻪ ﺗﻐﻴﻴﺮات ﭘﻼﺳﻤﺎﻳﻲ اﺑﺴﺘﺎﺗﻴﻦ ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫ﺗﻠﻔﻦ‪0511-8829580 :‬‬ ‫‪E-mail: rashidlamir@ferdowsi.um.ac.ir‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬اﺑﺴﺘﺎﺗﻴﻦ‪ ،‬ﺑﻴﺎن ژن‪ ،‬ﻟﻨﻔﻮﺳﻴﺖ‪ ،‬ﺗﻤﺮﻳﻦ ﻫﻮازي‪.‬‬

‫ﻏﺬا را ﻛﺎﻫﺶ ﻣﻲدﻫﺪ‪ ،‬از ﺗﺨﻠﻴﻪ ﻣﻌﺪه و ﻓﻌﺎﻟﻴﺖ اﻧﻘﺒﺎﺿﻲ ژژﻧﻮم‬

‫ﻣﻘﺪﻣﻪ‬

‫ﺟﻠﻮﮔﻴﺮي ﻣﻲﻧﻤﺎﻳﺪ و در ﻛﺎﻫﺶ وزن ﺑﺪن ﻣﻮﺛﺮ ﻣﻲﺑﺎﺷﺪ‪ .‬ﻧﺸﺎن داده‬

‫ﮔﺮﻟﻴﻦ )‪ ،(Ghrelin‬ﻳﻚ ﭘﭙﺘﻴﺪ ‪ 28‬اﺳﻴﺪ آﻣﻴﻨﻪاي اﺳﺖ ﻛﻪ از ﻣﺨﺎط‬ ‫‪2‬و‪1‬‬

‫و ﺑﻪﻋﻨﻮان ﻳﻚ ﻋﺎﻣﻞ‬

‫ﻣﻮﺛﺮ در ﺗﻨﻈﻴﻢ ﻣﻐﺰي‪ -‬رودهاي ﻫﻮرﻣﻮن رﺷﺪ‬

‫‪Growth Hormone‬‬

‫ﻣﻌﺪه و روده اﻧﺴﺎن و ﻣﻮش ﺗﺮﺷﺢ ﻣﻲﮔﺮدد‬ ‫)‪(GH‬‬

‫و ﺗﻌﺎدل اﻧﺮژي ﺷﻨﺎﺧﺘﻪ ﺷﺪه اﺳﺖ‪4.‬و‪ 3‬ﻋﻼوه ﺑﺮ ﮔﺮﻟﻴﻦ‪ ،‬اﺑﺴﺘﺎﺗﻴﻦ‬

‫)‪ (Obestatin‬ﻳﻚ ﭘﭙﺘﻴﺪ ‪ 23‬اﺳﻴﺪ آﻣﻴﻨﻪاي اﺳﺖ ﻛﻪ از ﻓﻮﻧﺪوس ﻣﻌﺪه و‬ ‫ﻣﺨﺎط روده ﺗﺮﺷﺢ و ﺗﻮﺳﻂ ژن ﮔﺮﻟﻴﻦ‪ ،‬ﻛﺪﮔﺬاري ﻣﻲﺷﻮد‪.‬‬

‫‪5-7‬‬

‫اﻛﺜﺮ‬

‫ﺷﺪه ﻛﻪ اﺑﺴﺘﺎﺗﻴﻦ ﺗﺮﺷﺢ ﻫﻮرﻣﻮن رﺷﺪ ﺗﻮﺳﻂ ﺳﻠﻮلﻫﺎي ﻫﻴﭙﻮﻓﻴﺰي را‬ ‫‪8‬و‪7‬‬

‫ﻓﻌﺎﻟﻴﺖ ﺑﻴﻮﻟﻮژﻳﻜﻲ و ﺗﻮزﻳﻊ اﺑﺴﺘﺎﺗﻴﻦ و‬

‫در ﻣﻮشﻫﺎ‪ ،‬ﺗﻐﻴﻴﺮ ﻧﺪاد‪.‬‬

‫ﻫﻢﭼﻨﻴﻦ ﻧﻘﺶ آن در ﺗﻌﺎدل اﻧﺮژي‪ ،‬ﺗﺮﺷﺢ‬ ‫‪10‬و‪9‬‬

‫ﺟﻮﻧﺪﮔﺎن ﻣﻄﺎﻟﻌﻪ ﺷﺪه اﺳﺖ‪.‬‬

‫‪GH‬‬

‫و وزن ﺑﺪن‪ ،‬در‬

‫در اﻳﻦ ﺑﺎره‪ ،‬اﻃﻼﻋﺎت ﻣﺘﻨﺎﻗﻀﻲ وﺟﻮد‬

‫دارد‪ ،‬ﺑﺮﺧﻲ از ﻣﻄﺎﻟﻌﺎت ﮔﺰارش ﻛﺮدهاﻧﺪ ﻛﻪ اﺑﺴﺘﺎﺗﻴﻦ ﺟﺬب ﻏﺬا را‬ ‫ﻛﺎﻫﺶ ﻣﻲدﻫﺪ‬

‫‪4-7‬‬

‫و ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎت‪ ،‬اﻋﻼم ﻛﺮدهاﻧﺪ ﻛﻪ اﺑﺴﺘﺎﺗﻴﻦ ﻫﻴﭻ‬ ‫‪8-11‬‬

‫ﺗﺤﻘﻴﻘﺎت ﭘﻴﺸﻨﻬﺎد ﻣﻲﻛﻨﻨﺪ ﻛﻪ اﮔﺮ ﭼﻪ ﮔﺮﻟﻴﻦ و اﺑﺴﺘﺎﺗﻴﻦ از ﭘﻴﺶ‬

‫اﺛﺮي ﺑﺮ ﺟﺬب ﻏﺬا ﻧﺪارد‪.‬‬

‫ﺳﺎﺧﺖ ﭘﺮوﭘﭙﺘﻴﺪي ﻳﻜﺴﺎﻧﻲ ﻣﻨﺸﺎ ﻣﻲﮔﻴﺮﻧﺪ‪ ،‬اﻳﻦ دو ﻫﻮرﻣﻮن ﻧﻘﺶﻫﺎي‬

‫ﻣﻴﺰان ﺣﺮﻛﺎت ﻣﻌﺪي‪ -‬رودهاي‪ ،‬ﻫﻤﻮﺳﺘﺎز ﮔﻠﻮﻛﺰ‪ ،‬ﺗﻜﺜﻴﺮ ﺳﻠﻮﻟﻲ‪ ،‬ﺗﺮﺷﺢ‬

‫ﻓﻴﺰﻳـﻮﻟﻮژﻳﻜﻲ ﻣﺘﻀﺎدي دارﻧﺪ‪8.‬و‪ 7‬در ﻣﻘﺎﻳـﺴﻪ ﺑﺎ ﮔﺮﻟﻴﻦ‪ ،‬اﺑﺴﺘﺎﺗﻴﻦ ﺟﺬب‬

‫ﻫﻮرﻣﻮن‪ ،‬ﺗﺸﻨﮕﻲ‪ ،‬ﺧﻮاب‪ ،‬ﺣﺎﻓﻈﻪ‪ ،‬اﺿﻄﺮاب‪ ،‬ﺟﺬب آب‪ ،‬وزن ﺑﺪن و‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﻣﻄﺎﻟﻌﺎت ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛﻪ اﺑﺴﺘﺎﺗﻴﻦ ﺑﺮ‬

‫اﻣﻴﺮ رﺷﻴﺪﻟﻤﻴﺮ و ﻫﻤﻜﺎران‬

‫‪8-12‬‬

‫ﻫﺰﻳﻨﻪ اﻧﺮژي ﺗﺄﺛﻴﺮ دارد‪.‬‬

‫ﺑﺮ ﻃﺒﻖ ﺷﻮاﻫﺪ‪ ،‬اﺑﺴﺘﺎﺗﻴﻦ در وﺿﻌﻴﺖ‬ ‫‪13‬‬

‫ﻣﻘﺎوﻣﺖ ﺑﻪ اﻧﺴﻮﻟﻴﻦ‪ ،‬ﻛﺎﻫﺶ ﻣﻲﻳﺎﺑﺪ و ﻋﻤﻠﻜﺮد ﮔﺮﻟﻴﻦ را در ﺑﺪن‬ ‫‪10‬‬

‫ﺗﻌﺪﻳﻞ ﻣﻲﻧﻤﺎﻳﺪ‪.‬‬

‫ﻏﻠﻈﺖ اﺑﺴﺘﺎﺗﻴﻦ ﭘﻼﺳﻤﺎ ﺑﻪوﺳﻴﻠﻪ ﮔﺮﺳﻨﮕﻲ و‬

‫ﺳﻴﺮي‪ 14،‬وﻋﺪه ﻏﺬاﻳﻲ ﭘ‪‬ﺮ ﻛﺮﺑﻮﻫﻴﺪرات‪ 15،‬ﻛﺎﻫﺶ وزن‪ 16‬و ﭼﺎﻗﻲ‬

‫‪427‬‬

‫وزن آزﻣﻮدﻧﻲﻫﺎ از ﺗﺮازوي دﻳﺠﻴﺘﺎﻟﻲ ﺑﺎ ﺣﺴﺎﺳﻴﺖ ‪ 0/1‬ﻛﻴﻠﻮﮔﺮم اﺳﺘﻔﺎده‬ ‫ﺷﺪ و آزﻣﻮدﻧﻲﻫﺎ ﻗﺒﻞ از ﻧﻤﻮﻧﻪﮔﻴﺮي اوﻟﻴﻪ وزنﻛﺸﻲ ﺷﺪﻧﺪ‪ .‬ﺿﺮﺑﺎن‬ ‫ﻗﻠﺐ آزﻣﻮدﻧﻲﻫﺎ ﺗﻮﺳﻂ دﺳﺘﮕﺎه ﺿﺮﺑﺎن ﺳﻨﺞ ﭘﻮﻻر ﻣﺪل‬

‫‪F1tm‬‬

‫ﺳﺎﺧﺖ‬

‫‪18‬و‪17‬‬

‫ﻛﺸﻮر ﻓﻨﻼﻧﺪ اﻧﺪازهﮔﻴﺮي ﺷﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ زﻣﺎن ﺗﻤﺮﻳﻦ ﺗﻮﺳﻂ ﻛﺮﻧﻮﻣﺘﺮ‬

‫ﺗﻨﻈﻴﻢ ﻣﻲﮔﺮدد‪ .‬از آﻧﺠﺎﻳﻲﻛﻪ ﮔﺮﻟﻴﻦ و اﺑﺴﺘﺎﺗﻴﻦ ﺑﺮ ﺗﻌﺎدل اﻧﺮژي ﻣﺆﺛﺮ‬

‫دﻳﺠﻴﺘﺎل ﺑﺎ دﻗﺖ ‪ 0/01‬ﺛﺎﻧﻴﻪ اﻧﺪازهﮔﻴﺮي ﺷﺪ‪ .‬درﺻﺪ ﭼﺮﺑﻲ آزﻣﻮدﻧﻲﻫﺎ‬

‫ﻫﺴﺘﻨﺪ‪ ،‬ﻣﺸﺨﺺ ﻧﻤﻮدن اﺛﺮات ﺗﻤﺮﻳﻦ ﺑﺪﻧﻲ ﺑﺮ اﻳﻦ ﻫﻮرﻣﻮنﻫﺎ ﺿﺮوري‬

‫ﺑﺎ اﺳﺘﻔﺎده از ﻛﺎﻟﻴﭙﺮ و ﺑﺎ اﺳﺘﻔﺎده از ﻓﺮﻣﻮل ﺳﻪ ﻧﻘﻄﻪاي‬

‫‪Dale Wagner‬‬

‫ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ‪ .‬ﻣﻄﺎﻟﻌﺎت درﺑﺎره اﺛﺮ ﺑﺮﻧﺎﻣﻪ ﺗﻤﺮﻳﻨﻲ ﺑﺮ اﺑﺴﺘﺎﺗﻴﻦ‪ ،‬ﺑﻪوﻳﮋه‬

‫اﻧﺪازهﮔﻴﺮي ﺷﺪ‪ .‬وﻳﮋﮔﻲﻫﺎي آزﻣﻮدﻧﻲﻫﺎي ﺗﺤﻘﻴﻖ در ﺟﺪول ‪ 1‬آورده‬

‫در اﻧﺴﺎنﻫﺎ‪ ،‬ﺑﺴﻴﺎر اﻧﺪك و ﻣﺤﺪود اﺳﺖ‪ .‬در ﻳﻚ ﻣﻄﺎﻟﻌﻪ اﺛﺮ ﻳﻚ ﺟﻠﺴﻪ‬

‫ﺷﺪه اﺳﺖ‪ .‬از ﺗﻤﺎﻣﻲ آزﻣﻮدﻧﻲﻫﺎ ﻗﺒﻞ از اﻧﺠﺎم ﭘﺮوﺗﻜﻞ ﺗﻤﺮﻳﻨﻲ و ﭘﺲ‬

‫ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ داﻳﺮهاي ﺑﺎ ﺷﺪتﻫﺎي ﻣﺨﺘﻠﻒ ﺑﺮ ﺳﻄﻮح ﭘﻼﺳﻤﺎﻳﻲ‬

‫از ﻧﺎﺷﺘﺎﻳﻲ ‪ 12‬ﺳﺎﻋﺘﻪ در ﺳﺎﻋﺖ ﻫﺸﺖ ﺻﺒﺢ و ﻫﻢﭼﻨﻴﻦ ﺑﻼﻓﺎﺻﻠﻪ ﺑﻌﺪ‬

‫ﮔﺰارش ﺷﺪه اﺳﺖ‪ 19.‬در ﻣﻄﺎﻟﻌﻪاي دﻳﮕﺮ اﺛﺮ ﺷﺶ ﻫﻔﺘﻪ ﺗﻤﺮﻳﻦ ﺗﺮدﻣﻴﻞ‬

‫از اﺗﻤﺎم ﭘﺮوﺗﻜﻞ ﺗﻤﺮﻳﻨﻲ‪ ،‬ﻫﺮ ﺑﺎر ﺑﻪﻣﻴﺰان ‪ 10ml‬از ورﻳﺪ ﺑﺎزوﻳﻲ ﺧﻮن‪-‬‬

‫ﺑﺮ ﻏﻠﻈﺖ ﻛﻞ اﺑﺴﺘﺎﺗﻴﻦ ﻓﻮﻧﺪوس و روده ﻛﻮﭼﻚ در ﻣﻮشﻫﺎ ﺑﺮرﺳﻲ‬

‫ﮔﻴﺮي ﺑﻪﻋﻤﻞ آﻣﺪ‪ .‬ﻧﻤﻮﻧﻪﻫﺎي ﺧﻮﻧﻲ در ﻟﻮﻟﻪﻫﺎي آزﻣﺎﻳﺸﻲ ﺑﺎ ﻣﺎده ﺿﺪ‬

‫ﺷﺪه اﺳﺖ‪ 20.‬اﻣﺎ ﺑﺎ ﺑﺮرﺳﻲﻫﺎي ﺑﻪﻋﻤﻞ آﻣﺪه ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ ﺗﺎ اﻳﻦ زﻣﺎن‬

‫اﻧﻌﻘﺎد‬

‫ﺗﺤﻘﻴﻘﻲ ﻣﺒﻨﻲ ﺑﺮ ﺗﺄﺛﻴﺮ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻫﻮازي ﺑﺮ ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ در‬

‫ﻟﻨﻔﻮﺳﻴﺖﻫﺎ ﺑﻪروش ﺳﺎﻧﺘﺮﻳﻔﻴﻮژ در اﻳﻦ ﻣﺮﺣﻠﻪ اﻧﺠﺎم ﺷﺪ‪ .‬ﺑﺮاي‬

‫ﻟﻨﻔﻮﺳﻴﺖ آزﻣﻮدﻧﻲﻫﺎي اﻧﺴﺎﻧﻲ‪ ،‬ﻣﻨﺘﺸﺮ ﻧﺸﺪه اﺳﺖ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ‪ ،‬در اﻳﻦ‬

‫اﻧﺪازهﮔﻴﺮي ﻣﻴﺰان ﺑﻴﺎن ‪ mRNA‬از روش‬

‫‪Semi quantitative RT-PCR‬‬

‫ﺗﺤﻘﻴﻖ ﺑﺮرﺳﻲ ﻛﺮدهاﻳﻢ ﻛﻪ آﻳﺎ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻫﻮازي ﺳﺒﺐ اﻓﺰاﻳﺶ‬

‫اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺑﺪﻳﻦﺻﻮرت ﻛﻪ ﻟﻨﻔﻮﺳﻴﺖﻫﺎ را در ﻧﻴﺘﺮوژن ﻣﺎﻳﻊ ﻗﺮار داده‬

‫ﻣﻌﻨﻲداري در ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖ اﻧﺴﺎﻧﻲ ﻣﻲﮔﺮدد‪.‬‬

‫و ﺑﻪﺻﻮرت ﻛﺎﻣﻞ ﺗﻮﺳﻂ ‪ Mortal & Pestle‬ﺧﺮد ﻛﺮدﻳﻢ‪ .‬ﺑﺎﻓﺖ ﺗﺨﺮﻳﺐ‬

‫‪EDTA‬‬

‫ﺟﻤﻊآوري و ﺑﻪ آزﻣﺎﻳﺸﮕﺎه اﻧﺘﻘﺎل داده ﺷﺪ‪ ،‬ﺟﺪاﺳﺎزي‬

‫ﺷﺪه در ﺑﺎﻓﺮ ‪ RLT‬ﻫﻤﻮژﻧﻴﺰه ﺷﺪ‪ ،‬اﺳﺘﻔﺎده از ﻫﻤﻮژنﻛﻨﻨﺪه‬

‫‪Rotor-stator‬‬

‫روش ﺑﺮرﺳﻲ‬

‫ﻣﻮﺟﺐ ﻓﺮاﻫﻢ ﺷﺪن ﻣﻘﺎدﻳﺮ ﺑﻴﺸﺘﺮي از‬

‫ﻃﺮح ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ دو ﮔﺮوﻫﻲ ﺑﺎ ﭘﻴﺶآزﻣﻮن و ﭘﺲآزﻣﻮن ﺑﻮده و از‬

‫ﻧﻴﺘﺮوژن ﻣﺎﻳﻊ‪ ،‬در ﺗﻴﻮب ﻣﻴﻜﺮوﺳﺎﻧﺘﺮﻳﻔﻴﻮژ ‪ 2ml ،RNase free‬رﻳﺨﺘﻪ ﺷﺪ‬

‫ﻧﻮع ﺗﺤﻘﻴﻘﺎت ﻧﻴﻤﻪﺗﺠﺮﺑﻲ ﻣﻲﺑﺎﺷﺪ‪ .‬آزﻣﻮدﻧﻲﻫﺎي اﻳﻦ ﺗﺤﻘﻴﻖ ﺷﺎﻣﻞ ‪16‬‬

‫و اﺟﺎزه داده ﺷﺪ ﺗﺎ ﻧﻴﺘﺮوژن ﻣﺎﻳﻊ ﺗﺒﺨﻴﺮ ﺷﻮد وﻟﻲ ﻟﻨﻔﻮﺳﻴﺖﻫﺎ از ﺣﺎﻟﺖ‬

‫زن ﺳﺎﻟﻢ ﺑﻮدﻧﺪ ﻛﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻓﺮاﺧﻮان ﻣﺤﻘﻘﻴﻦ از ﺟﺎﻣﻌﻪ ورزشﻛﺎران‬

‫ﻳﺦزدﮔﻲ ﺧﺎرج ﻧﺸﻮد‪ .‬ﺑﻪﻣﻴﺰان ﻛﺎﻓﻲ ﺑﺎﻓﺮ‬

‫اﺿﺎﻓﻪ ﺷﺪ‪ Lysate .‬را‬

‫اﺳﺘﺎن ﺧﺮاﺳﺎن رﺿﻮي )ﺗﺎﺑﺴﺘﺎن ﺳﺎل ‪ (1389‬اﻧﺘﺨﺎب و ﭘﺲ از اﻧﺠﺎم‬

‫ﻣﺴﺘﻘﻴﻢ ﺑﻪﺳﺘﻮن ‪ QIAshredder‬ﻛﻪ در ﺗﻴﻮب ﻗﺮار داﺷﺖ‪ ،‬ﻣﻨﺘﻘﻞ ﻛﺮده و‬

‫ﻣﻌﺎﻳﻨﺎت ﭘﺰﺷﻜﻲ و ﺗﻌﻴﻴﻦ ﺳﻼﻣﺖ ﻛﺎﻣﻞ ﺟﺴﻤﺎﻧﻲ ﺗﻮﺳﻂ ﭘﺰﺷﻚ و‬

‫ﺑﻪﻣﺪت دو دﻗﻴﻘﻪ و ﺑﺎ ﺳﺮﻋﺖ ﺑﺎﻻ ﺳﺎﻧﺘﺮﻳﻔﻴﻮژ ﻛﺮدﻳﻢ‪ ،‬ﺳﭙﺲ ﻣﻮاد وارد‬

‫ﻛﺴﺐ رﺿﺎﻳﺖﻧﺎﻣﻪ ﺟﻬﺖ ﺷﺮﻛﺖ در ﭘﮋوﻫﺶ و ﻧﻤﻮﻧﻪﮔﻴﺮي ﺧﻮﻧﻲ‪ ،‬ﺑﻪ‬

‫دﺳﺘﮕﺎه ‪ PCR‬ﺷﺪه و در اﻧﺘﻬﺎ روي ژل آﮔﺎرز ﻗﺮار ﮔﺮﻓﺘﻨﺪ ﺗﺎ ﻋﻜﺲﻫﺎي‬

‫ﻃﻮر ﺗﺼﺎدﻓﻲ ﺑﻪ دو ﮔﺮوه ﻛﻨﺘﺮل و ﺗﺠﺮﺑﻲ )ﻫﺮ ﮔﺮوه ﻫﺸﺖ ﻧﻔﺮ( ﺗﻘﺴﻴﻢ‬

‫ﻻزم از آنﻫﺎ ﺗﻬﻴﻪ ﺷﻮد‪ .‬در اﻧﺘﻬﺎ ﭘﺲ از ﺑﻪدﺳﺖ آﻣﺪن ﻧﺘﺎﻳﺞ ﺑﺎ اﺳﺘﻔﺎده‬

‫ﺷﺪﻧﺪ‪ .‬ﺗﻤﺎﻣﻲ آزﻣﻮدﻧﻲﻫﺎ ﺑﻪﻃﻮر ﻛﺎﻣﻞ ﺑﺎ ﭘﺮوﺗﻜﻞ ﺗﻤﺮﻳﻨﻲ آﺷﻨﺎ ﺷﺪﻧﺪ‪.‬‬

‫از دﺳﺘﮕﺎه‬

‫ﻣﺪل ‪ Gel Doc-It Ts310‬ﺳﺎﺧﺖ ﻛﺸﻮر آﻣﺮﻳﻜﺎ و‬

‫ﺗﻤﺎﻣﻲ آزﻣﻮدﻧﻲﻫﺎ در زﻣﺎن اﻧﺠﺎم ﭘﺮوﺗﻜﻞ در دوره ﻟﻮﺗﺌﺎل ﻗﺮار داﺷﺘﻨﺪ‪.‬‬

‫ﺑﻪدﺳﺖ آوردن ﻣﻘﺎدﻳﺮ ﺑﺘﺎ اﻛﺘﻴﻦ ﺑﺮاي ﻫﺮ ﻧﻤﻮﻧﻪ‪ ،‬ﻋﺪدﻫﺎي ﺑﻪدﺳﺖ آﻣﺪه‬

‫ﻣﻴﺎﻧﮕﻴﻦ ﻛﺎﻟﺮي ﻣﺼﺮﻓﻲ آزﻣﻮدﻧﻲﻫﺎ از ﻃﺮﻳﻖ ﭘﺮﺳﺶﻧﺎﻣﻪ ﺳﻪ روزه رژﻳﻢ‬

‫را ﺑﺮ ﻣﻘﺎدﻳﺮ ﺑﺘﺎاﻛﺘﻴﻦ ﺑﺮاي ﻫﺮ ﻳﻚ‪ ،‬ﺗﻘﺴﻴﻢ ﻧﻤﻮدﻳﻢ و ﺣﺎﺻﻞ را در ‪100‬‬

‫‪UVP‬‬

‫‪RNA‬‬

‫‪RLT‬‬

‫ﻣﻲﺷﻮد‪ .‬ﭘﻮدر ﺑﺎﻓﺖ و‬

‫ﻏﺬاﻳﻲ و ﺑﺎ اﺳﺘﻔﺎده از ﺟﺪولﻫﺎي ﻣﺮﺑﻮﻃﻪ ﻣﺤﺎﺳﺒﻪ ﮔﺮدﻳﺪ و ﺑﺮ ﻃﺒﻖ آن‬ ‫وﻋﺪه ﻏﺬاﻳﻲ ﺷﺐ ﭘﻴﺶ از ﺧﻮنﮔﻴﺮي ﺗﻬﻴﻪ و ﺑﻪ ﺗﻤﺎم آزﻣﻮدﻧﻲﻫﺎ‬ ‫ﺗﺤﻮﻳﻞ داده ﺷﺪ‪ .‬ﺑﺮاي ﻛﻨﺘﺮل رژﻳﻢ ﻏﺬاﻳﻲ آزﻣﻮدﻧﻲﻫﺎ و ﺟﻠﻮﮔﻴﺮي از‬ ‫ﺗﺪاﺧﻞ رژﻳﻢ ﻏﺬاﻳﻲ ﺑﺮ ﻣﻘﺎدﻳﺮ ﻣﻮرد اﻧﺪازهﮔﻴﺮي ﻗﺒﻞ از ﺧﻮنﮔﻴﺮي ﺑﻪ‬ ‫آزﻣﻮدﻧﻲﻫﺎ ﺗﻮﺻﻴﻪ ﺷﺪه ﺑﻮد ﺗﺎ ﺑﻪﻣﺪت ‪ 12‬ﺳﺎﻋﺖ از ﺧﻮردن ﭘﺮﻫﻴﺰ‬ ‫ﻛﻨﻨﺪ‪ ،‬اﻟﺒﺘﻪ آزﻣﻮدﻧﻲﻫﺎ ﻣﺠﺎز ﺑﻪ ﻧﻮﺷﻴﺪن آب ﺑﻮدﻧﺪ‪ .‬ﺑﺮاي اﻧﺪازهﮔﻴﺮي‬

‫ﺟﺪول‪ :1-‬وﻳﮋﮔﻲﻫﺎي آﻧﺘﺮوﭘﻮﻣﺘﺮﻳﻚ آزﻣﻮدﻧﻲﻫﺎ‬ ‫ﮔﺮوه‬

‫ﻣﻴﺎﻧﮕﻴﻦ ﻗﺪ‬

‫ﻣﻴﺎﻧﮕﻴﻦ وزن‬

‫‪BMI‬‬

‫‪FB%‬‬

‫ﻛﻨﺘﺮل‬

‫‪161±2/29‬‬

‫‪61/65±10/05‬‬

‫‪23/88±4/66‬‬

‫‪22/156‬‬

‫ﻫﻮازي‬

‫‪158±3/6‬‬

‫‪49/88±4/7‬‬

‫‪19/98±1/955‬‬

‫‪22/750‬‬

‫‪) FB%: Body Fat percent‬درﺻﺪ ﭼﺮﺑﻲ ﺑﺪن(‪) BMI: Body Mass Index ،‬ﺷﺎﺧﺺ ﺗﻮده ﺑﺪن(‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪428‬‬

‫ﺗﺄﺛﻴﺮ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻫﻮازي ﺑﺮ ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖ در زﻧﺎن ﺗﻤﺮﻳﻦ ﻛﺮده‬

‫ﺿﺮب ﻧﻤﻮدﻳﻢ ﺗﺎ ﻣﻘﺎدﻳﺮ ‪mRNA‬ي اﺑﺴﺘﺎﺗﻴﻦ ﺑﺮاي ﻫﺮ ﻧﻤﻮﻧﻪ ﺑﺮاﺳﺎس‬ ‫درﺻﺪ ﺑﻪدﺳﺖ آﻳﺪ‪ .‬ﺗﻐﻴﻴﺮات ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﺑﻪروش‬

‫‪RT-PCR‬‬

‫ﻧﻴﻤﻪ ﻛﻤﻲ اﻧﺪازهﮔﻴﺮي ﺷﺪ‪ .‬اﻳﻦ روش ﺑﻪﻛﻤﻚ ﭘﺮاﻳﻤﺮﻫﺎي وﻳﮋه‬ ‫اﺑﺴﺘﺎﺗﻴﻦ ﺷﺎﻣﻞ‬

‫‪AGCCCTGAACACCAGAGAGTC‬‬

‫‪،OBESTATIN-f‬‬

‫‪OBESTATIN-r CCAGAGGATGTCCTGAAGAAAC‬‬

‫ﺟﺪول‪ :2-‬ﺗﻐﻴﻴﺮات ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ در ﮔﺮوهﻫﺎ‬ ‫ﮔﺮوه‬

‫ﭘﻴﺶآزﻣﻮن‬

‫ﭘﺲآزﻣﻮن‬

‫*‪P‬‬

‫ﻫﻮازي‬

‫‪35/57±22/56‬‬

‫‪46/72±17/31‬‬

‫‪0/473‬‬

‫ﻛﻨﺘﺮل‬

‫‪59/85±16/50‬‬

‫‪66/18±14/62‬‬

‫‪0/860‬‬

‫* ‪Paired sample t-test‬‬

‫**‪P‬‬

‫‪0/792‬‬

‫** ‪Independent sample t-test‬‬

‫ﻛﻪ ﻳﻚ ﻗﻄﻌﻪ‬

‫‪ 237‬ﺑﺎزي را در اﻳﻦ ژن ﺗﻜﺜﻴﺮ ﻣﻲﻛﻨﻨﺪ‪ ،‬اﻧﺠﺎم ﺷﺪ‪.‬‬ ‫از آزﻣﻮدﻧﻲﻫﺎي ﮔﺮوه ﺗﺠﺮﺑﻲ ﺧﻮاﺳﺘﻪ ﺷﺪ ﺗﺎ ﻣﺴﺎﻓﺖ ‪ 1/5‬ﻣﺎﻳﻞ را ﺑﺎ‬ ‫ﺳﺮﻋﺖ ﺛﺎﺑﺖ‬

‫)‪VO2max‬‬

‫‪21-23‬‬

‫‪ (%70‬ﺑﺪوﻧﺪ‪.‬‬

‫ﭘﻴﺶ از ﭘﺮوﺗﻜﻞ ‪5-10‬‬

‫دﻗﻴﻘﻪ زﻣﺎن ﺑﻪ ﮔﺮم ﻛﺮدن و ﺣﺪود ‪ 10‬دﻗﻴﻘﻪ ﺑﻪ ﺳﺮد ﻛﺮدن ﭘﺲ از‬ ‫ﭘﺮوﺗﻜﻞ اﺧﺘﺼﺎص ﻳﺎﻓﺖ‪ .‬ﻛﻞ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ و ﻧﻤﻮﻧﻪﮔﻴﺮي از ﺳﺎﻋﺖ ‪9‬‬ ‫ﺗﺎ ‪ 11/5‬ﻇﻬﺮ ﺑﻪﻃﻮل اﻧﺠﺎﻣﻴﺪ‪ .‬ﺗﻤﺎم ﺷﺮﻛﺖﻛﻨﻨﺪﮔﺎن ﭘﺲ از ﻧﺎﺷﺘﺎﻳﻲ‬ ‫ﺷﺐ ﻗﺒﻞ )ﺣﺪاﻗﻞ ‪ 12‬ﺳﺎﻋﺖ‪ ،‬ﻓﻘﻂ اﺟﺎزه ﻧﻮﺷﻴﺪن آب داﺷﺘﻨﺪ( ﺑﻪ‬

‫ﺷﻜﻞ‪ :1-‬اﻟﻜﺘﺮوﻓﻮرز از ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ در ﮔﺮوه ﻛﻨﺘﺮل‬

‫آزﻣﺎﻳﺸﮕﺎه ﻣﻨﺘﻘﻞ ﺷﺪﻧﺪ‪ .‬از آزﻣﻮدﻧﻲﻫﺎ ﺧﻮاﺳﺘﻪ ﺷﺪ ﺿﻤﻦ رﻋﺎﻳﺖ رژﻳﻢ‬ ‫ﻏﺬاﻳﻲ‪ ،‬از ﺗﻤﺮﻳﻦ ﻛﺮدن در ﺑﺎزه زﻣﺎﻧﻲ ﺳﻪ روز ﭘﻴﺶ از ﺗﻤﺮﻳﻦ ﭘﺮﻫﻴﺰ‬ ‫ﻛﻨﻨﺪ‪ ،‬ﻫﻢﭼﻨﻴﻦ در اﻳﻦ ﻣﺪت ﻫﻴﭻ داروﻳﻲ ﻣﺼﺮف ﻧﻜﻨﻨﺪ‪ .‬ﻣﺤﺎﺳﺒﻪﻫﺎي‬ ‫آﻣﺎري ﺑﺎ ﻧﺮماﻓﺰار ‪ SPSS‬وﻳﺮاﺳﺖ ‪ 16‬اﻧﺠﺎم ﺷﺪ‪ .‬از آﻣﺎر ﺗﻮﺻﻴﻔﻲ ﺑﺮاي‬ ‫دﺳﺘﻪﺑﻨﺪي دادهﻫﺎ و ﺑﺮاي ﺗﺠﺰﻳﻪ و ﺗﺤﻠﻴﻞ دادهﻫﺎ از آزﻣﻮن‬ ‫‪ Independent sample t-test‬اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺳﻄﺢ ﻣﻌﻨﻲداري آﻣﺎري‬ ‫‪ P<0/01‬در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ‪.‬‬

‫ﺷﻜﻞ‪ :2-‬اﻟﻜﺘﺮوﻓﻮرز از ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ در ﮔﺮوه ﺗﺠﺮﺑﻲ‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬ ‫ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﻧﺸﺎن داد ﻛﻪ ﺑﻼﻓﺎﺻﻠﻪ ﭘﺲ از ﭘﺮوﺗﻜﻞ ﺗﻤﺮﻳﻨﻲ‪،‬‬ ‫ﻋﻠﻲرﻏﻢ اﻓﺰاﻳﺶ اﻧﺪك اﺑﺴﺘﺎﺗﻴﻦ در ﮔﺮوه ﻫﻮازي )ﻧﻤﻮدار ‪ 1‬و ﺟﺪول‬

‫ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ در ﻟﻨﻔﻮﺳﻴﺖﻫﺎ ﻣﺸﺎﻫﺪه ﻧﮕﺮدﻳﺪ )ﺑﻪﺗﺮﺗﻴﺐ‬

‫‪P<0/473‬‬

‫و ‪.(P<0/860‬‬

‫‪ ،(2‬در ﻫﻴﭻﻳـﻚ از ﮔـﺮوهﻫﺎي ﻫـﻮازي و ﻛﻨﺘﺮل اﻓﺰاﻳﺶ ﻣﻌﻨﻲداري در‬

‫ﺑﺤﺚ‬ ‫ﻫﺪف از ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﺑﺮرﺳﻲ اﺛﺮ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻫﻮازي ﺑﺮ‬ ‫ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖ زﻧﺎن ﺗﻤﺮﻳﻦ ﻛﺮده ﺑﻮد‪ .‬ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ‬ ‫ﻧﺸﺎن داد ﻛﻪ ﻳﻚ وﻫﻠﻪ ﺗﻤﺮﻳﻦ ﻫﻮازي ﺳﺒﺐ اﻓﺰاﻳﺶ ﻣﻌﻨﻲداري در ﺑﻴﺎن‬ ‫ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖﻫﺎ ﻧﻤﻲﮔﺮدد‪ .‬در اﻳﻦ زﻣﻴﻨﻪ‪ Ghanbari-Niaki ،‬ﺑﻪ‬ ‫ﺑﺮرﺳﻲ اﺛﺮ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﺑﺎ ﺷﺪتﻫﺎي ﻣﺨﺘﻠﻒ ﺑﺮ ﺳﻄﻮح‬ ‫ﭘﻼﺳﻤﺎﻳﻲ اﺑﺴﺘﺎﺗﻴﻦ ﭘﺮداﺧﺖ‪ ،‬ﻧﺘﺎﻳﺞ اﻳﻦ ﭘﮋوﻫﺶ ﺣﺎﻛﻲ از آن ﺑﻮد ﻛﻪ‬ ‫ﺳﻄﻮح اﺑﺴﺘﺎﺗﻴﻦ ﭘﻼﺳﻤﺎ در ﭘﺎﺳﺦ ﺑﻪ ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ در‬ ‫ﻫﻴﭻﻳﻚ از ﺷﺪتﻫﺎي ﻣﺨﺘﻠﻒ ﺗﻤﺮﻳﻦ‪ ،‬ﺗﻐﻴﻴﺮ ﻣﻌﻨﻲداري ﻧﻴﺎﻓﺖ‪.‬‬ ‫ﻧﻤﻮدار‪ :1-‬ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ در دو ﮔﺮوه ﻗﺒﻞ و ﺑﻌﺪ اﺟﺮاي ﭘﺮوﺗﻜﻞ ﺗﻤﺮﻳﻨﻲ‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪19‬‬

‫‪ Manshouri‬ﺑﻪ ﺑﺮرﺳﻲ اﺛﺮ ﻳﻚ ﺑﺮﻧﺎﻣﻪ ﺗﻤﺮﻳﻦ ﺑﻲﻫﻮازي ﻛﻮﺗﺎهﻣﺪت ﺑﺮ‬

‫ﻫﻤﻜﺎران‬ ‫رﺷﻴﺪﻟﻤﻴﺮ و‬ Rashidlamir A. et‫اﻣﻴﺮ‬ al.

429

‫ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ‬.‫ﻟﻨﻔﻮﺳﻴﺖ در ﻫﻴﭻﻳﻚ از دو ﮔﺮوه ﻣﻌﻨﻲدار ﻧﺒﻮد‬

‫ ﻧﺘﺎﻳﺞ اﻳﻦ ﭘﮋوﻫﺶ ﻧﺸﺎن داد‬،‫ﺳﻄﻮح ﭘﻼﺳﻤﺎﻳﻲ اﺑﺴﺘﺎﺗﻴﻦ ﭘﺮداﺧﺘﻪ اﺳﺖ‬

‫ ﻳﻚ ﺗﻜﺮار ﺑﻴﺸﻴﻨﻪ ﺑﻪﻃﻮر‬%80 ‫ﻧﺴﺒﺖ ﺳﻄﺢ ﮔﺮﻟﻴﻦ ﺑﻪ اﺑﺴﺘﺎﺗﻴﻦ در ﮔﺮوه‬

‫ﻛﻪ ﺳﻄﻮح اﺑﺴﺘﺎﺗﻴﻦ ﭘﻼﺳﻤﺎ در آزﻣﻮدﻧﻲﻫﺎ ﺗﻐﻴﻴﺮ ﻧﻴﺎﻓﺖ و ﭘﮋوﻫﺶﮔﺮان‬

‫ ﺑﻪﻧﻈﺮ ﭘﮋوﻫﺶﮔﺮان اﻳﻦ اﻓﺮاﻳﺶ ﺑﻪﻃﻮر‬،‫ﻣﻌﻨﻲداري اﻓﺰاﻳﺶ ﻳﺎﻓﺘﻪ ﺑﻮد‬

‫ﻧﺘﻴﺠﻪﮔﻴﺮي ﻛﺮدﻧﺪ ﻛﻪ ﺳﻄﺢ اﺑﺴﺘﺎﺗﻴﻦ ﺗﺤﺖ ﺗﺎﺛﻴﺮ ﻓﻌﺎﻟﻴﺖﻫﺎي ورزﺷﻲ‬

‫اﺣﺘﻤﺎﻟﻲ ﺑﺮاي ﺗﺤﺮﻳﻚ درﻳﺎﻓﺖ ﻏﺬا و ﺟﺒﺮان ﻣﻨﺎﺑﻊ از دﺳﺖ رﻓﺘﻪ اﻧﺮژي‬

‫ ﻫﻢﭼﻨﻴﻦ ﻳﻚ ﺑﺮﻧﺎﻣﻪ ﺗﻤﺮﻳﻦ ﺗﺮدﻣﻴﻞ ﺑﻪﻣﺪت‬24.‫ﻛﻮﺗﺎهﻣﺪت ﻗﺮار ﻧﻤﻲﮔﻴﺮد‬

‫ ﮔﺮ ﭼﻪ ﺗﺤﻘﻴﻘﺎت اﻧﺪﻛﻲ درﺑﺎره ﺗﺄﺛﻴﺮ ﺗﻤﺮﻳﻦ‬26.‫ﺻﻮرت ﮔﺮﻓﺘﻪ اﺳﺖ‬

‫ در ﺳﻄﻮح اﺑﺴﺘﺎﺗﻴﻦ ﭘﻼﺳﻤﺎي ﻣﻮشﻫﺎ‬22m/min ‫ﻫﺸﺖ ﻫﻔﺘﻪ ﺑﺎ ﺷﺪت‬

‫ ﻫﻴﭻ ﭘﮋوﻫﺸﻲ در‬،‫ﺑﺪﻧﻲ ﺑﺮ ﺳﻄﻮح ﭘﻼﺳﻤﺎﻳﻲ اﺑﺴﺘﺎﺗﻴﻦ اﻧﺠﺎم ﺷﺪه اﺳﺖ‬

‫ در ﻳﻚ ﺗﺤﻘﻴﻖ ﺑﺮاي ﻛﺎﻫﺶ وزن‬،‫ از ﻃﺮﻓﻲ‬25.‫ﺗﻐﻴﻴﺮي اﻳﺠﺎد ﻧﻜﺮد‬

‫راﺑﻄﻪ ﺑﺎ ﺗﺄﺛﻴﺮ ﻓﻌﺎﻟﻴﺖ ﺑﺪﻧﻲ ﺑﺮ ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖ اﻧﺠﺎم ﻧﺸﺪه‬

‫ رژﻳﻢ ﻏﺬاﻳﻲ ﺑﻪ اﺿﺎﻓﻪ ﻓﻌﺎﻟﻴﺖ ﺑﺪﻧﻲ ﺑﻪﻛﺎر‬،‫ﻛﻮدﻛﺎن داراي اﺿﺎﻓﻪ وزن‬

‫ ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﻧﻘﺶ ﺗﻤﺮﻳﻦ ﺑﺮ ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﺑﻪروش‬.‫اﺳﺖ‬

‫ ﻧﺘﺎﻳﺞ اﻳﻦ ﭘﮋوﻫﺶ ﻧﺸﺎن داد ﻛﻪ ﺗﺮﻛﻴﺐ رژﻳﻢ ﻏﺬاﻳﻲ‬،‫رﻓﺖ‬

‫ﻧﻴﻤﻪﺗﺠﺮﺑﻲ و ﺑﺎ اﺟﺮاي ﭘﺮوﺗﻜﻞ ﺗﻤﺮﻳﻨﻲ ﺑﺮاي اوﻟﻴﻦﺑﺎر روي اﻧﺴﺎن‬

‫ ﻛﻢﭼﺮﺑﻲ و ﻓﻌﺎﻟﻴﺖ ﺑﺪﻧﻲ ﻣﻨﺠﺮ ﺑﻪ ﻛﺎﻫﺶ وزن ﺷﺪ و‬،‫ﭘﺮﻛﺮﺑﻮﻫﻴﺪرات‬

‫ ﺳﺎز و ﻛﺎرﻫﺎي ﺗﺄﺛﻴﺮ ورزش ﺑﺮ ﺑﻴﺎن ژن ﻟﻨﻔﻮﺳﻴﺖ‬.‫اﻧﺠﺎم ﺷﺪه اﺳﺖ‬

‫ در ﺣﺎﻟﻲ ﻛﻪ ﺳﻄﺢ ﮔﺮﻟﻴﻦ ﺗﻐﻴﻴﺮ‬،‫در ﻧﺘﻴﺠﻪ ﺳﻄﺢ اﺑﺴﺘﺎﺗﻴﻦ اﻓﺰاﻳﺶ ﻳﺎﻓﺖ‬

‫ ﻫﻢراﺳﺘﺎ ﺑﺎ ﺳﺎﻳﺮ‬،‫ ﻧﺘﺎﻳﺞ ﻣﺸﺎﻫﺪه ﺷﺪه در اﻳﻦ ﻣﻄﺎﻟﻌﻪ‬.‫ﻧﺎﺷﻨﺎﺧﺘﻪ اﺳﺖ‬

‫ﻣﻌﻨﻲداري ﻧﺪاﺷﺖ و ﭘﮋوﻫﺶﮔﺮان ﭼﻨﻴﻦ ﭘﻴﺸﻨﻬﺎد ﻛﺮدﻧﺪ ﻛﻪ ﻣﻤﻜﻦ‬

.‫ﻣﻄﺎﻟﻌﺎت اﻧﺠﺎمﺷﺪه در زﻣﻴﻨﻪ ﺗﻐﻴﻴﺮات ﭘﻼﺳﻤﺎﻳﻲ اﺑﺴﺘﺎﺗﻴﻦ ﻣﻲﺑﺎﺷﺪ‬

‫ ﺳﺎز و ﻛﺎري ﺿﺮوري‬،‫اﺳﺖ اﻓﺰاﻳﺶ اﺑﺴﺘﺎﺗﻴﻦ ﺑﻪدﻧﺒﺎل ﻛﺎﻫﺶ وزن‬

‫ ﻧﻮع و ﻣﺪت ﭘﺮوﺗﻜﻞ‬،‫ﭘﻴﺸﻨﻬﺎد داده ﻣﻲﺷﻮد ﻛﻪ ﻣﻤﻜﻦ اﺳﺖ ﺷﺪت‬

‫ اﺛﺮ ﭼﻬﺎر‬Saghebjoo ‫ در ﭘﮋوﻫﺶ‬16.‫ﺑﺮاي ﺣﻔﻆ ﻛﺎﻫﺶ وزن ﺑﺎﺷﺪ‬

‫ ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖ را ﺗﺤﺖ ﺗﺄﺛﻴﺮ‬،‫ﻣﻮرد اﺳﺘﻔﺎده در اﻳﻦ ﺗﺤﻘﻴﻖ‬

‫ ﻳﻚ ﺗﻜﺮار ﺑﻴﺸﻴﻨﻪ‬%80 ‫ و‬40 ‫ﻫﻔﺘﻪ ﺗﻤﺮﻳﻦ ﻣﻘﺎوﻣﺘﻲ داﻳﺮهاي ﺑﺎ دو ﺷﺪت‬

‫ اﻃﻼﻋﺎت ﻧﺸﺎن ﻣﻲدﻫﺪ ﻛﻪ ﺑﻴﺎن ژن‬،‫ ﺑﻪﻃﻮر ﺧﻼﺻﻪ‬.‫ﻗﺮار ﻧﺪاده ﺑﺎﺷﺪ‬

‫ﺑﺮ ﺳﻄﺢ اﺑﺴﺘﺎﺗﻴﻦ ﭘﻼﺳﻤﺎ و ﻟﻨﻔﻮﺳﻴﺖ زﻧﺎن ﺟﻮان ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار‬

‫اﺑﺴﺘﺎﺗﻴﻦ ﻟﻨﻔﻮﺳﻴﺖ ﭘﺲ از ﻳﻚ ﺟﻠﺴﻪ ﺗﻤﺮﻳﻦ ﻫﻮازي اﻓﺰاﻳﺶ ﻣﻌﻨﻲداري‬

‫ ﻳﻚ ﺗﻜﺮار‬%80 ‫ در اﻳﻦ ﺗﺤﻘﻴﻖ ﻣﻴﺰان اﺑﺴﺘﺎﺗﻴﻦ ﭘﻼﺳﻤﺎ ﺑﺎ ﺷﺪت‬.‫ﮔﺮﻓﺖ‬

‫ در ﻧﻬﺎﻳﺖ ﺳﺎز و ﻛﺎر ﺗﺎﺛﻴﺮ ﺗﻤﺮﻳﻦ ﻫﻮازي ﺑﺮ ﺑﻴﺎن ژن اﺑﺴﺘﺎﺗﻴﻦ‬.‫ﻧﻤﻲﻳﺎﺑﺪ‬

‫ در ﺣﺎﻟﻲ ﻛﻪ اﻳﻦ ﺗﻐﻴﻴﺮ در ﮔﺮوه‬،‫ﺑﻴﺸﻴﻨﻪ ﺑﻪﻃﻮر ﻣﻌﻨﻲداري ﻛﺎﻫﺶ ﻳﺎﻓﺖ‬

.‫ﻟﻨﻔﻮﺳﻴﺖ ﻧﻴﺎز ﺑﻪ ﺑﺮرﺳﻲﻫﺎي ﺑﻴﺸﺘﺮي دارد‬

‫ ﻫﻢﭼﻨﻴﻦ ﺗﻐﻴﻴﺮات ﺳﻄﺢ اﺑﺴﺘﺎﺗﻴﻦ‬.‫ ﻳﻚ ﺗﻜﺮار ﺑﻴﺸﻴﻨﻪ ﻣﻌﻨﻲدار ﻧﺒﻮد‬%40

1. Date Y, Nakazato M, Hashiguchi S, Dezaki K, Mondal MS, Hosoda H, et al. Ghrelin is present in pancreatic alpha-cells of humans and rats and stimulates insulin secretion. Diabetes 2002;51(1):124-9.

2. Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 1999;402(6762):656-60.

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1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

Tehran University Medical Journal;‫ﻫﻤﻜﺎران‬ Vol. 69, ‫ و‬No. 7, October 2011: 426-431

100

The effects of a single session aerobic exercise on obestatin gene expression in trained women

Amir Rashidlamir Ph.D.1* Mahdieh Ebrahimnia M.Sc.1 Aliakbar Hashemi Javaheri Ph.D.2 1- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.

2- Department of Sports Medicine, Faculty of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.

Abstract

Received: May 04, 2011 Accepted: August 15, 2011

Background: Studies indicate that obestatin, an anti-hunger peptide, plays an important role in energy balance, GH secretion, and body weight. It has been physiologically shown that obestatin apposes the function of Ghrelin. The purpose of the present study was to investigate the effects of a single session of aerobic exercise in trained women (a 1.5-mile run) on the expression of obestatin gene found in lymphocytes.

Methods: 16 trained female participants (4±1 years of training experience) were voluntarily selected from Khorasan province in Iran and were randomly divided into two groups: the control and aerobic exercise groups. The participants in the aerobic group were asked to run for 1.5 miles with a fixed speed (70 VO2 max) while the controls were passively present in the exercise environment. Following an overnight fast, blood samples (10 ml from the antecubital vein) were collected before and immediately after the exercise from all the participants. Obestatin expression was investigated after separating the lymphocytes by centrifuge and using semi-quantitative RT-PCR.

Results: There was a rise in obestatin gene expression in the case group after one session of aerobic training versus the control group but the changes were not statistically significant.

Conclusion: The results indicated that a single aerobic exercise could not significantly increase the expression of obestatin. Perhaps the type, duration and intensity of the applied protocol in this study did not have a cumulative effect on this gene although these results are in harmony with the results of other studies in this regard. *

Corresponding author: Dept. of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Azadi Sq., Mashhad, Iran, Postal code: 9177948979 Tel: +98-511-8829580 E-mail: rashidlamir@ferdowsi.um.ac.ir

Keywords: Aerobic exercise, gene expression, lymphocyte, obestatin.

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

‫‪432-437‬‬ ‫ﻣﻬﺮاز‪،1390‬‬ ‫ﺷﻤﺎره‬ ‫دورهﺑﻪ‪، 69‬‬ ‫ﭘﺰﺷ‬ ‫داﻧﺸﮕﺎهﻳﻢﻋﻠﻮم‬ ‫ﭘﺰﺷﻜﻲ‪،‬‬ ‫داﻧﺸﻜ‬ ‫ﻓﺘﻮﺗﺮاﭘﻲ‬ ‫ﻗﺒﻞ ‪7‬و‪ ،‬ﺑﻌﺪ‬ ‫زردي‬ ‫ﺗﻬﺮان‪،‬ﻣﺒﺘﻼ‬ ‫درﻜﻲﻧﻮزادان‬ ‫ﺗﻮﺗﺎل‬ ‫ﺳﺮﻣﻲ ﻣﻨﻴﺰ‬ ‫ﺴﻪﺪهﺳﻄﺢ‬ ‫ﻣﺠﻠﻪ ﻣﻘﺎﻳ‬

‫ﻣﻘﺎﻳﺴﻪ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل در ﻧﻮزادان ﻣﺒﺘﻼ ﺑﻪ زردي ﻗﺒﻞ و ﺑﻌﺪ از ﻓﺘﻮﺗﺮاﭘﻲ‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/02/14 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/04/13 :‬‬

‫ﭼﻜﻴﺪه‬

‫ﻧﺴﺘﺮن ﺧﺴﺮوي‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﺑﻴﻠﻲروﺑﻴﻦ ﺗﻤﺎﻳﻞ ﺑﻪ ﻓﺴﻔﻮﻟﻴﭙﻴﺪﻫﺎي ﻏﺸﺎي ﺳﻠﻮﻟﻲ دارد‪ ،‬از ﻣﻬﻢﺗﺮﻳﻦ آنﻫﺎ رﺳﭙﺘﻮر‬

‫*‬

‫ﻋﻠﻴﺮﺿﺎ اﻣﻴﻨﻴﺎن‬

‫‪Aspartate‬‬

‫رﺿﺎ ﺗﻘﻲﭘﻮر‬

‫‪N-Methyl-D-‬‬

‫ﻣﻲﺑﺎﺷﺪ ﻣﻨﻴﺰﻳﻢ از ﻣﻬﻢﺗﺮﻳﻦ ﻣﻬﺎرﻛﻨﻨﺪﮔﺎن اﻳﻦ رﺳﭙﺘﻮر ﻣﻲﺑﺎﺷﺪ‪ .‬ﻫﺪف از اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﺎﻳﺴﻪ ﻣﻴﺰان ﻣﻨﻴﺰﻳﻢ‬

‫ﻗﺒﻞ و ﺑﻌﺪ از ﻓﺘﻮﺗﺮاﭘﻲ و ارزﻳﺎﺑﻲ روشﻫﺎي ﻧﻮﻳﻦ درﻣﺎن )ﺗﺠﻮﻳﺰ ﻣﻨﻴﺰﻳﻢ( ﻣﻲﺑﺎﺷﺪ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬ﻣﻄﺎﻟﻌﻪ ﻧﻴﻤﻪﺗﺠﺮﺑﻲ‬ ‫ﮔﺮوه ﺑﻴﻤﺎريﻫﺎي ﻧﻮزادان‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن ﺣﻀﺮت‬

‫)‪(Semi-experimental‬‬

‫ﻋﻠﻲ اﺻﻐﺮ )ع(‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪،‬‬

‫ﻋﻠﻲاﺻﻐﺮ از ﻓﺮوردﻳﻦ اﻟﻲ اﺳﻔﻨﺪ ‪ 1389‬ﺑﻮدﻧﺪ‪ .‬ﻣﻌﻴﺎرﻫﺎي ورود ﺑﻪ ﻣﻄﺎﻟﻌﻪ ﺷﺎﻣﻞ ﺳﻦ ﻛﻢﺗﺮ از ‪ 28‬روز‪ ،‬ﻋﺪم ﻣﺎﻟﻔﻮر‪-‬‬

‫ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫و آﻳﻨﺪهﻧﮕﺮ ﻣﻲﺑﺎﺷﺪ و ﺟﻤﻌﻴﺖ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ‪ ،‬ﻧﻮزادان ﻣﺒﺘﻼ ﺑﻪ زردي ﺑﺴﺘﺮي در ﺑﻴﻤﺎرﺳﺘﺎن‬

‫ﻣﺎﺳﻴﻮن‪ ،‬اﺧﺘﻼل ﻣﺘﺎﺑﻮﻟﻴﺴﻢ و ﺳﭙﺴﻴﺲ‪ ،‬ﻋﺪم درﻳﺎﻓﺖ ﻣﻨﻴﺰﻳﻢ ﺳﻮﻟﻔﺎت در ﻣﺎدر ﺑﻮد‪ .‬ﻳﺎﻓﺘﻪﻫﺎ‪ :‬در ﻣﻄﺎﻟﻌﻪ ‪ 106‬ﻧﻮزاد زرد‪،‬‬ ‫‪ 50/9‬درﺻﺪ ﭘﺴﺮ و ‪ 49/1‬درﺻﺪ دﺧﺘﺮ ﺑﻮدﻧﺪ‪ .‬ﻓﺮاواﻧﻲ ﻋﻠﺖ زردي در ﺑﻴﻤﺎران ﺷﺎﻣﻞ ‪ 37‬ﻧﻮزاد ﺑﺎ ﻧﺎﺳﺎزﮔﺎري )‪(%9/34‬‬ ‫‪ ،ABO‬ﭘﻨﺞ ﻧﻮزاد ﺑﺎ ﻧﺎﺳﺎزﮔﺎري )‪ 17 ،Rh(%7/4‬ﻧﻮزاد ﺑﺎ ﻣﺼﺮف ﻛﻢ ﺷﻴﺮ ﻣﺎدر )‪ Breast feeding (%16‬و ‪ 47‬ﻧﻮزاد ﻧﺎﺷﻲ‬ ‫از ﺷﻴﺮ ﻣﺎدر )‪ (%44/3‬ﺑﻮد‪ .‬ﻣﻴﺎﻧﮕﻴﻦ ﻣﻨﻴﺰﻳﻢ ﻗﺒﻞ )‪ (2/24‬و ﺑﻌﺪ )‪ (2/12‬از ﻓﺘﻮﺗﺮاﭘﻲ در ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ زردي ﺑﺎ اﺧﺘﻼف‬ ‫ﻣﻌﻨﻲدار ﻛﺎﻫﺶ ﻣﻲﻳﺎﺑﺪ )‪ (P<0/001‬و ﺑﻴﻦ دو ﺟﻨﺲ و ﺑﻴﻦ ﮔﺮوهﻫﺎي ﺳﻦ ﺑﺎرداري از ﻧﻈﺮ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ‬ ‫در زﻣﺎن ﺑﺴﺘﺮي )ﻛﻢﺗﺮ از ‪ 34‬ﻫﻔﺘﻪ= ‪ ،2/35‬ﺑﻴﻦ ‪ 35‬ﺗﺎ ‪ 37‬ﻫﻔﺘﻪ= ‪ ،2/27‬ﺑﻴﺶ از ‪ 38‬ﻫﻔﺘﻪ= ‪ (2/17‬و ﺑﻴﻦ ﮔﺮوهﻫﺎي‬ ‫وزﻧﻲ از ﻧﻈﺮ ﻣﻴﺎﻧﮕﻴﻦ ﻣﻨﻴﺰﻳﻢ در زﻣﺎن ﺑﺴﺘﺮي )‪ 1500‬ﺗﺎ‪ 2500‬ﮔﺮم= ‪ ،2/4‬ﺑﻴﺶ از ‪ 2500‬ﮔﺮم= ‪ (2/23‬و ﺑﻴﻦ ﮔﺮوهﻫﺎي‬ ‫ﺷﺪت ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ از ﻧﻈﺮ ﻣﻨﻴﺰﻳﻢ ﺳﺮﻣﻲ در زﻣﺎن ﺑﺴﺘﺮي )ﺧﻔﻴﻒ= ‪ ،23/2‬ﻣﺘﻮﺳﻂ= ‪ ،2/21‬ﺷﺪﻳﺪ= ‪(2/29‬‬

‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﻬﺮان‪ ،‬ﺧﻴﺎﺑﺎن ﺷﺮﻳﻌﺘﻲ‪ ،‬ﺧﻴﺎﺑﺎن ﻛﺎج‪،‬‬

‫ﺑﻴﻤﺎرﺳﺘﺎن ﺧﺎﻧﻮاده ارﺗﺶ‬

‫اﺧﺘﻼف ﻣﻌﻨﻲدار وﺟﻮد ﻧﺪارد‪ .‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﻓﺘﻮﺗﺮاﭘﻲ ﻣﻲﺗﻮاﻧﺪ ﻣﻨﺠﺮ ﺑﻪ ﻛﺎﻫﺶ ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل ﺳﺮﻣﻲ ﺷﻮد‪.‬‬

‫ﺗﻠﻔﻦ‪021-77603100 :‬‬

‫‪E-mail: dr.aminian@gmail.com‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ‪ ،‬ﻓﺘﻮﺗﺮاﭘﻲ‪ ،‬ﻣﻨﻴﺰﻳﻢ‪.‬‬

‫ﺳﻴﺴﺘﻢ ﻋﺼﺒﻲ ﺑﺎﻋﺚ اﺧﺘﻼل در رﺷﺪ ﻋﺼﺒﻲ‪ ،‬اﺧﺘﻼل ﺳﻴﻨﺎﭘﺘﻮژﻧﺰو‬

‫ﻣﻘﺪﻣﻪ‬

‫ﺗﻜﺎﻣﻞ ﻳﺎدﮔﻴﺮي‪ -‬ﺧﺎﻃﺮه و ﺑﻴﻨﺎﻳﻲ ﻣﻲﮔﺮدد‪ .‬ﺑﻴﻠﻲروﺑﻴﻦ ﻣﻲﺗﻮاﻧﺪ ﺑﺎﻋﺚ‬

‫رﺳﻮب ﺑﻴﻠﻲروﺑﻴﻦ ﻏﻴﺮﻛﻮﻧﮋوﮔﻪ )‪ (Unconjugated bilirubin‬ﻳﺎ ﻓﺮم‬

‫ﻓﻌﺎل ﺷﺪن اﻳﻦ رﺳﭙﺘﻮر ﮔﺮدد و از اﻳﻦ ﻃﺮﻳﻖ ﺑﺎﻋﺚ آﺳﻴﺐ ﻋﺼﺒﻲ‬ ‫‪3‬‬

‫اﺳﻴﺪي آن در دﻳﻮاره ﺳﻠﻮلﻫﺎي ﻋﺼﺒﻲ ﻣﻨﺠﺮ ﺑﻪ آﺳﻴﺐ داﻳﻤﻲ آنﻫﺎ‬

‫ﮔﺮدد‪ .‬ﻳﻜﻲ از ﻣﻬﻢﺗﺮﻳﻦ ﻣﻬﺎرﻛﻨﻨﺪﮔﺎن رﺳﭙﺘﻮر ‪ NMDA‬در اﻧﺴﺎن ﻣﻨﻴﺰﻳﻢ‬

‫ﻣﻲﮔﺮدد‪ .‬ﺑﺎ در ﻧﻈﺮ ﮔﺮﻓﺘﻦ اﻳﻦ ﻣﻄﻠﺐ ﻛﻪ ﻣﻮﻟﻜﻮل ﺑﻴﻠﻲروﺑﻴﻦ ﺗﻤﺎﻳﻞ‬

‫ﻣﻲﺑﺎﺷﺪ‪ .‬ﻣﻨﻴﺰﻳﻢ ﺳﻴﺴﺘﻢ ﻋﺼﺒﻲ را در ﻣﻘﺎﺑﻞ ﻫﻴﭙﻮﻛﺴﻲ ﻣﺤﺎﻓﻈﺖ ﻣﻲﻛﻨﺪ‬

‫ﺑﺎﻻﻳﻲ ﺑﺮاي اﺗﺼﺎل ﺑﻪ ﻓﺴﻔﻮﻟﻴﭙﻴﺪﻫﺎي ﻏﺸﺎ ﺳﻠﻮﻟﻲ ﭘﻼﺳﻤﺎﻳﻲ دارد‪،‬‬

‫و اﺛﺮات ﻣﺤﺎﻓﻈﺖ ﻋﺼﺒﻲ ﺧﻮد را از ﻃﺮﻳﻖ ﺑﻠﻮك ﻛﺮدن ﻣﻜﺎﻧﻴﺴﻢ‬ ‫‪NMDA‬‬

‫‪4‬‬

‫اﻋﻤﺎل ﻣﻲﻛﻨﺪ‪.‬‬

‫ﺑﺴﻴﺎري از اﺛﺮات‬

‫ﻣﺠﻤﻮﻋﻪ آﺳﻴﺐﻫﺎي ﻧﺎﺷﻲ از ﺑﻴﻠﻲروﺑﻴﻦ روي ﺗﻤﺎﻣﻲ آﻧﺰﻳﻢﻫﺎ و‬

‫ﺗﺤﺮﻳﻜﻲ رﺳﭙﺘﻮر‬

‫ﮔﻴﺮﻧﺪهﻫﺎي ﻋﺼﺒﻲ ﺗﺨﺮﻳﺐ اﻳﺠﺎد ﺧﻮاﻫﺪ ﻧﻤﻮد ﻛﻪ ﻳﻜﻲ از ﻣﻬﻢﺗﺮﻳﻦ‬

‫ﻓﻴﺰﻳﻮﻟﻮژﻳﻚ ﻣﻨﻴﺰﻳﻢ ﺑﺎ اﺛﺮات ﻧﻮروﺗﻮﻛﺴﻴﻚ ﺑﻴﻠﻲروﺑﻴﻦ در ﺗﻀﺎد‬

‫آنﻫﺎ رﺳﭙﺘﻮر‬

‫)‪(NMDA‬‬

‫ﻃﻮﻻﻧﻲﻣﺪت رﺳﭙﺘﻮر‬

‫‪2‬و‪1‬‬

‫‪ N-Methyl D- Aspartate‬ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫‪NMDA‬‬

‫ﺗﺤﺮﻳﻚ‬

‫ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫‪NMDAR‬‬

‫ﻛﻪ در آﺳﻔﻴﻜﺴﻲ ﭘﺮيﻧﺎﺗﺎل ﻫﻢ دﻳﺪه‬

‫ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫‪NMDA‬‬

‫ﻣﻲﺷﻮد ﻣﻨﺠﺮ ﺑﻪ آﺳﻴـﺐ ﺳﻠﻮلﻫﺎي ﻣﻐﺰي ﺷﺪه و ﻋﻼوه ﺑـﺮ ﺗﻐﻴـﻴـﺮات‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﻳﻚ ﻧﻮع اﺧﺘﺼﺎﺻﻲ رﺳﭙﺘﻮر ﻳﻮﻧﻴﻚ ﮔﻠﻮﺗﺎﻣﺎت‬

‫ﻧﺎم اﮔﻮﻧﻴﺴﺖ اﻧﺘﺨﺎﺑﻲ اﺳﺖ ﻛﻪ ﺑﻪ رﺳﭙﺘﻮر‬

‫‪NMDA‬‬

‫ﮔﻠﻮﺗﺎﻣﺎت ﺑﺎﻧﺪ ﻣﻲﺷﻮد وﻟﻲ ﺑﻪ دﻳﮕﺮ رﺳﭙﺘﻮرﻫﺎي ﮔﻠﻮﺗﺎﻣﺎت ﺑﺎﻧﺪ‬

‫ﻧﺴﺘﺮن ﺧﺴﺮوي و ﻫﻤﻜﺎران‬

‫‪NMDA‬‬

‫‪433‬‬

‫ﻣﻨﺠﺮ ﺑﻪ ﺑﺎز ﺷﺪن ﻛﺎﻧﺎل ﻳﻮﻧﻲ‬

‫ﻛﻪ ﺑﻪﺻﻮرت آﻳﻨﺪهﻧﮕﺮ ﺑﻮده و ﺟﻤﻌﻴﺖ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ اﻳﻦ ﭘﮋوﻫﺶ ﺷﺎﻣﻞ‬

‫ﻣﻲﺷﻮد ﻛﻪ ﺑﺮاي ﻛﺎﺗﻴﻮنﻫﺎ ﻏﻴﺮ اﺧﺘﺼﺎﺻﻲ اﺳﺖ‪ .‬ﻳﻚ ﺧﺎﺻﻴﺖ ﺑﻲﻧﻈﻴﺮ‬

‫ﻧﻮزادان ﻣﺒﺘﻼ ﺑﻪ زردي ﺑﻮد ﻛﻪ در ﺑﺨﺶ ﻧﻮزادان ﺑﻴﻤﺎرﺳﺘﺎن ﺣﻀﺮت‬

‫رﺳﭙﺘﻮر ‪ ،NMDA‬ﻓﻌﺎﻟﻴﺖ واﺑﺴﺘﻪ ﺑﻪ وﻟﺘﺎژان ﻣﻲﺑﺎﺷﺪ ﻛﻪ ﺳﺒﺐ ﺑﻠﻮك‬

‫ﻋﻠﻲاﺻﻐﺮ )ع( ﺗﻬﺮان از ﻓﺮوردﻳﻦﻣﺎه ﺳﺎل ‪ 1389‬اﻟﻲ ﭘﺎﻳﺎن اﺳﻔﻨﺪ ﺳﺎل‬

‫ﻛﺎﻧﺎل ﻳﻮﻧﻲ ﺗﻮﺳﻂ ﻣﻨﻴﺰﻳﻢ ﺧﺎرج ﺳﻠﻮﻟﻲ ﻣﻲﺷﻮد‪ .‬اﻳﻦ اﻣﺮ اﺟﺎزه ﺟﺮﻳﺎن‬

‫‪ 1389‬ﺑﺴﺘﺮي و ﺗﺤﺖ درﻣﺎن ﻗﺮار ﮔﺮﻓﺘﻪ ﺑﻮدﻧﺪ‪ .‬اﻳﻦ ﺑﻴﻤﺎران ﺑﺮ اﺳﺎس‬

‫ﺳﺪﻳﻢ و ﻣﻘﺎدﻳﺮ ﻛﻢ ﻛﻠﺴﻴﻢ ﺑﻪ داﺧﻞ ﺳﻠﻮل و ﭘﺘﺎﺳﻴﻢ ﺑﻪ ﺧﺎرج ﺳﻠﻮل‪-‬‬

‫ﻣﻨﺤﻨﻲ ﺑﻴﻠﻲروﺑﻴﻦ ﺑﺮ ﺣﺴﺐ ﺳﻦ ﺑﻪ ﺳﺎﻋﺖ ﺗﺸﺨﻴﺺ داده ﻣﻲﺷﺪﻧﺪ و‬

‫واﺑﺴﺘﻪ ﺑﻪ وﻟﺘﺎژ را ﻣﻲدﻫﺪ‪ .‬ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ ﻧﻔﻮذ ﻛﻠﺴﻴﻢ از ﻃﺮﻳﻖ‬

‫ﻫﻴﭻﻛﺪام ﻋﻼﻣﺖ دﻳﮕﺮي ﻏﻴﺮ از زردي ﻧﺪاﺷﺘﻨﺪ‪ .‬ﻣﻌﻴﺎرﻫﺎي ورود ﺑﻪ‬

‫ﻳﻚ ﻧﻘﺶ ﺣﻴﺎﺗﻲ در ﭘﻼﺳﺘﻴﺴﻴﺘﻪ ﺳﻴﻨﺎﭘﺴﻲ‪ ،‬ﻣﻜﺎﻧﻴﺴﻢ‬

‫ﻣﻄﺎﻟﻌﻪ ﻋﺒﺎرت ﺑﻮد از ﺳﻦ ﻛﻤﺘﺮ از ﭼﻬﺎر ﻫﻔﺘﻪ‪ ،‬ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﺑﺮ‬

‫ﻳﺎدﮔﻴﺮي و ﺣﺎﻓﻈﻪ دارد‪ .‬رﺳﭙﺘﻮر ‪ NMDA‬از دو ﻧﻈﺮ ﻣﺘﻔﺎوت اﺳﺖ‪ :‬اول‪،‬‬

‫اﺳﺎس ﻧﺘﻴﺠﻪ ﺑﻴﻠﻲروﺑﻴﻦ و ﺑﺮ اﺳﺎس ﻣﻨﺤﻨﻲ ﺑﻴﻠﻲروﺑﻴﻦ ﺑﺮ ﺣﺴﺐ ﺳﻦ‬

‫ﻧﻤﻲﺷﻮد‪ .‬ﻓﻌﺎﻟﻴﺖ رﺳﭙﺘﻮرﻫﺎي‬

‫‪NMDARs‬‬

‫ﻫﻢ دروازه ﻟﻴﮕﺎﻧﺪي ‪ Ligand-gate‬و ﻫﻢ واﺑﺴﺘﻪ ﺑﻪ وﻟﺘﺎژ اﺳﺖ دوم‬

‫ﺑﻪ ﺳﺎﻋﺖ ﻛﻪ ﺑﺎﻻﺗﺮ از ﺣﺪ ﻣﺠﺎز ﺑﺮاي آن ﻧﻮزاد ﺑﺎﺷﺪ‪ ،‬ﻋﺪم وﺟﻮد‬

‫‪5‬‬

‫اﺧﺘﻼﻻت ﻣﺘﺎﺑﻮﻟﻴﺴﻢ ﻣﺎدرزادي‪ ،‬ﻋﺪم ﺷﻮاﻫﺪ ﺳﭙﺴﻴﺲ ﻧﻮزادي در ﻣﻌﺎﻳﻨﻪ‬

‫ﻳﻚ ﻛﺎﻧﺎل ﻳﻮﻧﻲ ﻏﻴﺮ اﺧﺘﺼﺎﺻﻲ ﻛﺎﺗﻴﻮﻧﻲ اﺳﺖ ﻛﻪ‬

‫ﺷﺎﻣﻞ ﺗﺐ‪ ،‬اﺧﺘﻼل ﺗﻐﺬﻳﻪ‪ ،‬ﻛﺎﻫﺶ رﻓﻠﻜﺲﻫﺎي ﻧﻮزادي‪ ،‬ﻋﺪم درﻳﺎﻓﺖ‬

‫اﺟﺎزه ﻋﺒﻮر ﻛﻠﺴﻴﻢ‪ ،‬ﺳﺪﻳﻢ و ﭘﺘﺎﺳﻴﻢ ﺑﻪ داﺧﻞ ﺳﻠﻮل را ﻣﻲدﻫﺪ‪ .‬ﭘﺘﺎﻧﺴﻴﻞ‬

‫ﺳﻮﻟﻔﺎت ﻣﻨﻴﺰﻳﻢ در ﻣﺎدر‪ .‬ﻧﻮزادان ﺑﺴﺘﺮي داراي ﻣﻌﻴﺎرﻫﺎي ورود ﺑﻪ‬

‫)‪Excitatory Postsynaptic Potential (EPSP‬‬

‫ﻣﻄﺎﻟﻌﻪ ﺑﻪﺻﻮرت ﻧﻤﻮﻧﻪﮔﻴﺮي ﭘﻲدرﭘﻲ ‪ Consecutive‬وارد ﻣﻄﺎﻟﻌﻪ‬

‫ﻏﻠﻈﺖ ﻛﻠﺴﻴﻢ داﺧﻞ ﺳﻠﻮﻟﻲ را اﻓﺰاﻳﺶ‬

‫ﺷﺪﻧﺪ‪ .‬اﻃﻼﻋﺎت دﻣﻮﮔﺮاﻓﻴﻚ ﺷﺎﻣﻞ ﺟﻨﺲ‪ ،‬ﺳﻦ ﺣﺎﻣﻠﮕﻲ‪ ،‬ﺳﻦ ﻧﻮزاد در‬

‫ﻣﻲدﻫﺪ‪ .‬ﻛﻠﺴﻴﻢ ﺑﻪﻋﻨﻮان ﭘﻴﺎﻣﺒﺮ ﺛﺎﻧﻮﻳﻪ در راهﻫﺎي ﺳﻴﮕﻨﺎلدﻫﻨﺪه ﻣﺨﺘﻠﻔﻲ‬

‫ﺷﺮوع زردي‪ ،‬ﻃﻮل ﻣﺪت زردي‪ ،‬وزن ﻧﻮزاد در زﻣﺎن ﺑﺴﺘﺮي از واﻟﺪﻳﻦ‬

‫ﺗﻮﺳﻂ ﻣﻨﻴﺰﻳﻢ در‬

‫ﺑﻴﻤﺎر ﻛﺴﺐ و در ﭘﺮﺳﺶﻧﺎﻣﻪ ﺛﺒﺖ ﺷﺪ‪ .‬ﻣﻴﺰان ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﺑﺮ‬

‫ﺳﻄﻮح ﻓﻴﺰﻳﻮﻟﻮژﻳﻚ ﺑﻠﻮك ﻣﻲﺷﻮد‪ .‬ﺑﺮاي ﻛﺎﻧﺎل ﺑﻠﻮكﻧﺸﺪه‪ ،‬ﺳﻠﻮل‬

‫اﺳﺎس اوﻟﻴﻦ آزﻣﺎﻳﺶ ﺑﻴﻠﻲروﺑﻴﻦ اﺧﺬ ﺷﺪه از ﻧﻮزاد و ﺳﺎﻳﺮ آزﻣﺎﻳﺸﺎت‬

‫ﭘﺴﺖ ﺳﻴﻨﺎﭘﺴﻲ ﺑﺎﻳﺪ دﭘﻼرﻳﺰه ﺑﺎﺷﺪ‪ 5.‬ﺑﺪون در ﻧﻈﺮ ﮔﺮﻓﺘﻦ ﻋﻠﺖ‪ ،‬ﻫﺪف‬

‫ﻏﺮﺑﺎلﮔﺮي ﺷﺎﻣﻞ ‪ ،CBC‬اﺳﻤﻴﺮ ﺧﻮن ﻣﺤﻴﻄﻲ‪ ،‬ﮔﺮوه ﺧﻮﻧﻲ و ‪،Rh‬‬

‫از درﻣﺎن ﺟﻠﻮﮔﻴﺮي از رﺳﻴﺪن ﺑﻴﻠﻲروﺑﻴﻦ ﻏﻴﺮ ﻣﺴﺘﻘﻴﻢ ﺑﻪﻣﻘﺎدﻳﺮ‬

‫‪G6PD ،D-Coombs‬‬

‫و ‪ Retic‬ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺖ‪ .‬ﺷﺪت زردي‬

‫ﻧﻮروﺗﻮﻛﺴﻴﻚ ﻣﻲﺑﺎﺷﺪ‪ .‬ﺑﺎ ﻓﺘﻮﺗﺮاﭘﻲ و در ﺻﻮرت ﻋﺪم ﭘﺎﺳﺦ ﺑﺎ ﺗﻌﻮﻳﺾ‬

‫ﺑﺮ اﺳﺎس ﻣﻴﺰان ﺑﻴﻠﻲروﺑﻴﻦ ﺗﻮﺗﺎل در ﻧﻮزادان ﺗﺮم ﺗﻘﺴﻴﻢﺑﻨﺪي ﺷﺪ‬

‫ﺧﻮن ﻣﻴﺰان ﺑﻴﻠﻲروﺑﻴﻦ را ﺑﻪ ﻣﻘﺎدﻳﺮ ﭘﺎﻳﻴﻦﺗﺮ از ﺣﺪ ﺗﻌﻴﻴﻦﺷﺪه‬

‫)ﺧﻔﻴﻒ‪ :‬ﺑﻴﻦ ‪ 15‬ﺗﺎ ‪ ،18‬ﻣﺘﻮﺳﻂ‪ :‬ﺑﻴﻦ ‪ 18‬ﺗﺎ ‪ ،20‬ﺷﺪﻳﺪ‪ 20 :‬ﺑﻪ ﺑﺎﻻ(‪ .‬از‬

‫ﻣﻲرﺳﺎﻧﻴﻢ ﺗﺎ از اﺛﺮات ﻧﻮروﺗﻮﻛﺴﻴﻚ ﺑﻴﻠﻲروﺑﻴﻦ ﺟﻠﻮﮔﻴﺮي ﻧﻤﺎﻳﻴﻢ‪.‬‬

‫ﺗﻤﺎﻣﻲ ﺷﺮﻛﺖﻛﻨﻨﺪﮔﺎن در ﻣﻄﺎﻟﻌﻪ ﻳﻚ ﻧﻤﻮﻧﻪ ﻣﻨﻴﺰﻳﻢ ﻗﺒﻞ از ﻓﺘﻮﺗﺮاﭘﻲ و‬

‫اﻳﻦﻛﻪ ﻧﻴﺎزﻣﻨﺪ ﻓﻌﺎل ﺷﺪن ﺑﺎ دو ﻟﻴﮕﺎﻧﺪ ﮔﻠﻮﺗﺎﻣﺎت و ﮔﻠﻴﺴﻴﻦ اﺳﺖ‪.‬‬ ‫رﺳﭙﺘﻮر‬

‫‪NMDA‬‬

‫ﺗﺤﺮﻳﻜﻲ ﭘﺴﺖ ﺳﻴﻨﺎﭘﺴﻲ‬ ‫ﺑﺎ ﻓﻌﺎﻟﻴﺖ رﺳﭙﺘﻮر‬

‫‪NMDA‬‬

‫ﻋﻤﻞ ﻣﻲﻛﻨﺪ‪ .‬اﮔﺮﭼﻪ ﻛﺎﻧﺎل ﻛﺎﺗﻴﻮﻧﻲ رﺳﭙﺘﻮر‬

‫‪NMDA‬‬

‫از آﻧﺠﺎﻳﻲﻛﻪ ﻣﻴﺰان ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل در ﺑﺪن ﻧﻮزادان و ارﺗﺒﺎط آن ﺑﺎ‬

‫ﻳﻚ ﻧﻤﻮﻧﻪ ﭘﺲ از ﻓﺘﻮﺗﺮاﭘﻲ اﺧﺬ ﺷﺪ‪ .‬ﻧﻤﻮﻧﻪﮔﻴﺮي ﻣﻨﻴﺰﻳﻢ ﻫﻢزﻣﺎن ﺑﺎ‬

‫ﺳﻄﺢ ﺑﻴﻠﻲروﺑﻴﻦ‪ ،‬در ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ دوران ﻧﻮزادي ﺑﺮرﺳﻲ ﻛﺎﻓﻲ‬

‫اﻧﺠﺎم ﺗﺴﺖﻫﺎي ﻻزم در ﻣﻮرد زردي ﻧﻮزادي اﻧﺠﺎم و ﺑﺎﺑﺖ اﻳﻦ ﻣﺴﺎﻟﻪ‬

‫ﻧﺸﺪه‪ ،‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل در ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﻧﻮزادي‬

‫ﺧﻮنﮔﻴﺮي اﺿﺎﻓﻪ اﻧﺠﺎم ﻧﺸﺪ‪ .‬ﻣﺠﺪدا ﭘﺲ از ‪ 24‬ﺳﺎﻋﺖ از ﺷﺮوع‬

‫ﺗﻌﻴﻴﻦ ﻣﻲﺷﻮد‪ .‬ﺑﺎ ﻓﺮض اﺛﺮات ﻣﺤﺎﻓﻈﺘﻲ ﻣﻨﻴﺰﻳﻢ در ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ‬

‫ﻓﺘﻮﺗﺮاﭘﻲ ﺑﻴﻠﻲروﺑﻴﻦ و ﻣﻨﻴﺰﻳﻢ ﺑﺮرﺳﻲ ﺷﺪ‪ .‬زﻣﺎن ﺗﺮﺧﻴﺺ ﻧﻮزادان ﺑﺮ‬

‫ﻧﻮزادي‪ ،‬ﻣﻴﺰان ﻣﻨﻴﺰﻳﻢ را در ﻗﺒﻞ و ﺑﻌﺪ از ﻓﺘﻮﺗﺮاﭘﻲ ﻣﻘﺎﻳﺴﻪ و ﺗﺎﺛﻴﺮ‬

‫اﺳﺎس آزﻣﺎﻳﺶ ﺳﻄﺢ ﺑﻴﻠﻲروﺑﻴﻦ ﺳﺮم و رﺳﻴﺪن ﺑﻪ ﻣﻨﻄﻘﻪ ﺑﺎ ﺧﻄﺮ ﭘﺎﻳﻴﻦ‬

‫درﻣﺎﻧﻲ آن ﺑﺮرﺳﻲ ﻣﻲﺷﻮد‪ .‬ﻫﻢﭼﻨﻴﻦ ارﺗﺒﺎط ﺑﻴﻦ ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل و‬

‫ﻣﻨﺤﻨﻲ ﺳﻄﺢ ﺑﻴﻠﻲروﺑﻴﻦ ﺳﺮم ﺑﺮ ﺣﺴﺐ ﺳﺎﻋﺖ ﭘﺲ از ﺗﻮﻟﺪ ﺑﻮده اﺳﺖ‪.‬‬

‫ﺷﺪت ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﺑﺮرﺳﻲ ﻣﻲﺷﻮد ﺑﺪﻳﻦﺗﺮﺗﻴﺐ ﻧﻮزادان در‬

‫ﺑﻌﺪ از ﺟﻤﻊآوري اﻃﻼﻋﺎت در ﭘﺮﺳﺶﻧﺎﻣﻪ و ورود ﺑﻪ ﻧﺮماﻓﺰار آﻣﺎري‬ ‫‪2‬‬

‫ﻣﻌﺮض ﺧﻄﺮ ﺷﻨﺎﺳﺎﻳﻲ و زﻣﺎن ﺗﺮﺧﻴﺺ ﻣﻨﺎﺳﺐ و روشﻫﺎي ﻧﻮﻳﻦ‬

‫‪ SPSS‬وﻳﺮاﺳﺖ ‪ 17‬ﺑﺎ روشﻫﺎي ‪  ،Student’s t-test‬و ﺳﺎﻳﺮ روشﻫﺎ‬

‫درﻣﺎن )ﺗﺠﻮﻳﺰ ﻣﻨﻴﺰﻳﻢ( ارزﻳﺎﺑﻲ ﻣﻲﺷﻮد‪.‬‬

‫ﺑﺮ ﺣﺴﺐ ﻧﻴﺎز اﻃﻼﻋﺎت ﺗﺤﻠﻴﻞ ﺷﺪ‪ .‬ﺳﻄﺢ ﻣﻌﻨﻲدار در اﻳﻦ ﻣﻄﺎﻟﻌﻪ‬ ‫ﻛﻢﺗﺮ از ‪ 0/05‬ﺑﻮد‪ .‬ﻣﺮاﺣﻞ ﺗﺤﻘﻴﻖ ﺑﺮ اﺳﺎس ﺣﻔﻆ اﺳﺮار ﺑﻴﻤﺎران و ﺑﺮ‬

‫روش ﺑﺮرﺳﻲ‬

‫اﺳﺎس ﻗﻄﻊﻧﺎﻣﻪ ﻫﻠﺴﻴﻨﻜﻲ اﻧﺠﺎم و در ﻛﻤﻴﺘﻪ اﺧﻼق ﺑﻴﻤﺎرﺳﺘﺎن ﺑﻪ ﺗﺎﻳﻴﺪ‬

‫ﻣﻄﺎﻟﻌﻪ اﻧﺠﺎمﺷﺪه از ﻧﻮع ﻧﻴﻤﻪﺗﺠﺮﺑﻲ )‪ (Semi experimental‬ﻣﻲﺑﺎﺷﺪ‬

‫رﺳﻴﺪه اﺳﺖ‪.‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪434‬‬

‫ﻣﻘﺎﻳﺴﻪ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل در ﻧﻮزادان ﻣﺒﺘﻼ ﺑﻪ زردي ﻗﺒﻞ و ﺑﻌﺪ از ﻓﺘﻮﺗﺮاﭘﻲ‬

‫ﺟﺪول‪ :1-‬وﻳﮋﮔﻲﻫﺎي ﻣﺮﺗﺒﻂ ﺑﺎ زردي در ﺑﻴﻤﺎران‬ ‫ﻣﻴﺎﻧﮕﻴﻦ )ﻣﻴﺎﻧﻪ(‬

‫اﻧﺤﺮافﻣﻌﻴﺎر‬

‫وﻳﮋﮔﻲ‬

‫ﻓﺮاواﻧﻲ‬

‫درﺻﺪ در ﮔﺮوه‬

‫وﻳﮋﮔﻲ‬ ‫ﺳﻦ ﺷﺮوع زردي )روز(‬

‫‪(3) 3/16‬‬

‫‪1/736‬‬

‫اﺳﻤﻴﺮ ﺧﻮن ﻣﺤﻴﻄﻲ ﻏﻴﺮ ﻃﺒﻴﻌﻲ‬

‫‪0‬‬

‫‪0‬‬

‫ﺳﻦ ﭘﺎﻳﺎن زردي )روز(‬

‫‪(7) 7/55‬‬

‫‪2/948‬‬

‫‪9‬‬

‫‪8/5‬‬

‫دوره زﻣﺎﻧﻲ ﻓﺘﻮﺗﺮاﭘﻲ )روز(‬

‫‪(4) 4/36‬‬

‫‪2/627‬‬

‫‪2‬‬

‫‪1/9‬‬

‫‪18/29‬‬

‫‪3/619‬‬

‫‪ABO‬‬

‫‪37‬‬

‫‪34/9‬‬

‫‪14/83‬‬

‫‪2/534‬‬

‫‪Rh‬‬

‫‪5‬‬

‫‪4/7‬‬

‫ﻫﻤﺎﺗﻮﻛﺮﻳﺖ )‪(%‬‬

‫‪44/34‬‬

‫‪6/869‬‬

‫ﻣﺼﺮف ﻛﻢ ﺷﻴﺮ ﻣﺎدر ‪Breast feeding‬‬

‫‪17‬‬

‫‪16‬‬

‫رﺗﻴﻜﻮﻟﻮﺳﻴﺖ )‪(%‬‬

‫‪2/29‬‬

‫‪2/297‬‬

‫ﺷﻴﺮ ﻣﺎدر ‪Breast milk‬‬

‫‪47‬‬

‫‪44/3‬‬

‫ﺑﻴﻠﻲروﺑﻴﻦ ﺗﻮﺗﺎل‬ ‫ﻫﻤﻮﮔﻠﻮﺑﻴﻦ‬

‫)‪(mg/dl‬‬

‫)‪(gr/dl‬‬

‫ﻛﻤﺒﻮد‬

‫ﻛﻮﻣﺒﺲ ﻣﺴﺘﻘﻴﻢ ﻣﺜﺒﺖ‬ ‫ﻧﺎﺳﺎزﮔﺎري‬

‫ﻧﺎﺳﺎزﮔﺎري‬

‫ﺟﺪول‪ :2-‬ﻣﻨﻴﺰﻳﻢ و ﺑﻴﻠﻲروﺑﻴﻦ ﻗﺒﻞ و ﺑﻌﺪ از ﻓﺘﻮﺗﺮاﭘﻲ در ﻧﻮزادان ﻣﺒﺘﻼ ﺑﻪ زردي‬ ‫وﻳﮋﮔﻲ‬

‫ﻗﺒﻞ از ﻓﺘﻮﺗﺮاﭘﻲ‬

‫ﭘﺲ از ﻓﺘﻮﺗﺮاﭘﻲ‬

‫‪t-test‬‬

‫‪P‬‬

‫ﻣﻴﺎﻧﮕﻴﻦ ﻣﻨﻴﺰﻳﻢ‬

‫‪(0/270) 2/24‬‬

‫‪(0/231) 2/12‬‬

‫‪6/332‬‬

‫*‪0/001‬‬

‫)اﻧﺤﺮافﻣﻌﻴﺎر(‬ ‫ﻣﻴﺎﻧﮕﻴﻦ ﺑﻴﻠﻲروﺑﻴﻦ‬

‫‪(3/619) 18/29‬‬

‫‪(3/622) 9/15‬‬

‫‪25/984‬‬

‫ﺟﺪول‪ :3-‬ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ در زﻣﺎن ﺑﺴﺘﺮي ﺑﻪدﻟﻴﻞ زردي )ﺳﻦ ﺑﺎرداري و وزن ﺗﻮﻟﺪ(‬

‫ﻣﺘﻐﻴﺮ‬

‫ﺗﻘﺴﻴﻢﺑﻨﺪي‬

‫ﺟﻨﺲ‬

‫ﭘﺴﺮ‬

‫ﻣﻴﺎﻧﮕﻴﻦ‬ ‫ﻣﻨﻴﺰﻳﻢ‬ ‫‪2/28‬‬

‫‪0/275‬‬

‫دﺧﺘﺮ‬

‫‪2/19‬‬

‫‪0/259‬‬

‫ﻛﻢﺗﺮ از ‪ 34‬ﻫﻔﺘﻪ‬

‫‪2/35‬‬

‫‪0/264‬‬

‫‪ 35‬ﺗﺎ ‪ 37‬ﻫﻔﺘﻪ‬

‫‪2/27‬‬

‫‪0/284‬‬

‫ﺑﻴﺶ از ‪ 38‬ﻫﻔﺘﻪ‬

‫‪2/17‬‬

‫‪0/236‬‬

‫ﻛﻢﺗﺮ از ‪1500gr‬‬

‫‪0‬‬

‫‪0‬‬

‫‪1500-2500 gr‬‬

‫‪2/4‬‬

‫‪0/200‬‬

‫ﺑﻴﺶ از ‪2500gr‬‬

‫‪2/23‬‬

‫‪0/272‬‬

‫ﺧﻔﻴﻒ )‪(15-18‬‬

‫‪2/23‬‬

‫‪0/290‬‬

‫ﻣﺘﻮﺳﻂ )‪(18-20‬‬

‫‪2/21‬‬

‫‪0/250‬‬

‫ﺷﺪﻳﺪ )ﺑﻴﺶ از ‪(20‬‬

‫‪2/29‬‬

‫‪0/238‬‬

‫**‪0/001‬‬ ‫ﺳﻦ ﺑﺎرداري‬

‫)اﻧﺤﺮافﻣﻌﻴﺎر(‬ ‫* ‪ P<0/001‬و ‪t-test=6/332‬‬

‫‪G6PD‬‬

‫** ‪ P<0/001‬و ‪t-test=25/984‬‬

‫وزن ﺗﻮﻟﺪ‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬ ‫در ﻣﻄﺎﻟﻌﻪ اﻧﺠﺎمﺷﺪه ﺑﺮ روي ‪ 106‬ﺑﻴﻤﺎر ﺑﺎ ﺗﺸﺨﻴﺺ زردي‪ ،‬ﻣﻴﺎﻧﮕﻴﻦ‬ ‫ﺳﻦ ﺑﺎرداري ‪ 37/34±1/286‬ﻫﻔﺘﻪ )ﺣﺪاﻗﻞ= ‪ ،33‬ﺣﺪاﻛﺜﺮ= ‪ (41‬و‬ ‫ﻣﻴﺎﻧﮕﻴﻦ وزن زﻣﺎن ﺗﻮﻟﺪ ‪ 3172/12±436/936‬ﮔﺮم )ﺣﺪاﻗﻞ= ‪،2022‬‬

‫ﺷﺪت زردي‬

‫* ‪ P=0/078‬و ‪t-test=1/783‬‬

‫اﻧﺤﺮافﻣﻌﻴﺎر‬

‫** ‪ P=0/122‬و ‪F=2/147‬‬

‫*‪P‬‬

‫*‪0/078‬‬

‫**‪0/122‬‬

‫***‪0/113‬‬

‫‪0/558‬‬

‫*** ‪ P=0/113‬و ‪t-test=1/1597‬‬

‫ﺣﺪاﻛﺜﺮ= ‪ (4300‬ﺑﻮد‪ 50/9 .‬درﺻﺪ ﭘﺴﺮ و ‪ 49/1‬درﺻﺪ دﺧﺘﺮ ﺑﻮدﻧﺪ‪.‬‬ ‫وﻳﮋﮔﻲﻫﺎي ﻣﺮﺗﺒﻂ ﺑﺎ زردي ﻧﻮزادان در ﺟﺪول ‪ 1‬ﺧﻼﺻﻪ ﺷﺪهاﻧﺪ‪ .‬در‬ ‫ﺿﻤﻦ در ‪ 93/4‬ﻧﻮزادان ﻓﻘﻂ ﻓﺘﻮﺗﺮاﭘﻲ و در ‪ 6/6‬درﺻﺪ ﻋﻼوه ﺑﺮ‬

‫زﻣﺎن ﺑﺴﺘﺮي اﺧﺘﻼف ﻣﻌﻨﻲدار وﺟﻮد ﻧﺪارد )‪ F=2/147‬و ‪ .(P=0/122‬ﺑﺎ‬

‫ﻓﺘﻮﺗﺮاﭘﻲ‪ ،‬ﺗﻌﻮﻳﺾ ﺧﻮن ﻧﻴﺰ اﻧﺠﺎم ﺷﺪه ﺑﻮد‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺟﺪول ‪ 2‬و ﺑﺮ‬

‫ﺗﻮﺟﻪ ﺑﻪ ﺟﺪول ‪ 2‬و ﺑﺎ ﻋﻨﺎﻳﺖ ﺑﻪ اﻳﻦﻛﻪ ﻳﻜﻲ از ﮔﺮوهﻫﺎي وزﻧﻲ )ﻛﻢﺗﺮ‬

‫اﺳﺎس ﻧﺘﺎﻳﺞ ﺗﺴﺖ ‪ Paired samples t-test‬ﻣﻴﺎﻧﮕﻴﻦ ﻣﻨﻴﺰﻳﻢ ﻗﺒﻞ و ﺑﻌﺪ‬

‫از ‪ 1500‬ﮔﺮم( ﻣﻘﺪار ﻋﺪدي ﺻﻔﺮ دارد ﺑﻪﺟﺎي ﺗﺴﺖ‬

‫‪ANOVA‬‬

‫از‬

‫‪Student’s t-test‬‬

‫از ﻓﺘﻮﺗﺮاﭘﻲ در ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ زردي ﺑﺎ اﺧﺘﻼف ﻣﻌﻨﻲدار ﻛﺎﻫﺶ‬

‫‪ Student’s t-test‬اﺳﺘﻔﺎده ﻛﺮدﻳﻢ و ﺑﺮ اﺳﺎس ﻧﺘﺎﻳﺞ‬

‫ﻣﻲﻳﺎﺑﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ ﺑﺮ اﺳﺎس ﻧﺘﺎﻳﺞ ‪ Paired samples t-test‬ﻣﻴﺎﻧﮕﻴﻦ‬

‫ﺑﻴﻦ ﮔﺮوهﻫﺎي وزﻧﻲ زﻣﺎن ﺗﻮﻟﺪ از ﻧﻈﺮ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ در‬

‫ﺑﻴﻠﻲروﺑﻴﻦ ﻗﺒﻞ و ﺑﻌﺪ از ﻓﺘﻮﺗﺮاﭘﻲ ﻧﻴﺰ در ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ زردي ﺑﺎ‬

‫زﻣﺎن ﺑﺴﺘﺮي اﺧﺘﻼف ﻣﻌﻨﻲدار وﺟﻮد ﻧﺪارد )‪ T=1/1597‬و ‪.(P=0/113‬‬

‫اﺧﺘﻼف ﻣﻌﻨﻲدار ﻛﺎﻫﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬ﺑﺮ اﺳﺎس ﻧﺘﺎﻳﺞ ‪ Student’s t-test‬ﺑﻴﻦ‬

‫ﺑﻪﻋﻼوه ﺑﺮ اﺳﺎس ﻧﺘﺎﻳﺞ ﺗﺴﺖ‬

‫دو ﺟﻨﺲ )ﭘﺴﺮ= ‪ ،2/28±0/275‬دﺧﺘﺮ= ‪ (2/19±0/259‬از ﻧﻈﺮ ﻣﻴﺎﻧﮕﻴﻦ‬

‫ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ از ﻧﻈﺮ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ در زﻣﺎن ﺑﺴﺘﺮي‬

‫ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ در زﻣﺎن ﺑﺴﺘﺮي اﺧﺘﻼف ﻣﻌﻨﻲدار وﺟﻮد ﻧﺪارد‬

‫و ‪ .(P=0/558‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ‬

‫)‪ t-test=1/783‬و ‪ .(P=0/078‬ﻫﻢﭼﻨﻴﻦ ﺑﺮ اﺳﺎس ﻧﺘﺎﻳﺞ ﺗﺴﺖ‬

‫اﺧﺘﻼف ﻣﻌﻨﻲدار وﺟﻮد ﻧﺪارد‬

‫‪ANOVA‬‬

‫)‪F=0/586‬‬

‫ﺑﻴﻦ ﮔﺮوهﻫﺎي ﺷﺪت‬

‫‪ANOVA‬‬

‫ﻧﺘﺎﻳﺞ ‪ Student’s t-test‬ﺑﻴﻦ دو ﮔﺮوه داراي ﻟﻴﺰ )رﺗﻴﻜﻮﻟﻮﺳﻴﺖ ﺑﻴﺶ از‬

‫ﺑﻴـﻦ ﮔﺮوهﻫﺎي ﺳﻦ ﺑﺎرداري از ﻧﻈﺮ ﻣﻴـﺎﻧﮕﻴـﻦ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴـﺰﻳﻢ در‬

‫ﭘﻨﺞ( و ﻓﺎﻗﺪ ﻟﻴﺰ )داراي ﻟﻴﺰ= ‪ ،2/19±0/253‬ﻓﺎﻗﺪ ﻟﻴﺰ= ‪(2/25±0/273‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ﻧﺴﺘﺮن ﺧﺴﺮوي و ﻫﻤﻜﺎران‬

‫‪435‬‬

‫از ﻧﻈﺮ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ در زﻣﺎن ﺑﺴﺘﺮي اﺧﺘﻼف ﻣﻌﻨﻲدار‬

‫داد ﻛﻪ ﻏﻠﻈﺖ ﭘﺎﻳﻴﻦﺗﺮ ﺳﺮﻣﻲ و ﺑﻨﺪ ﻧﺎف روي و ﻣﻨﻴﺰﻳﻢ ﻫﻢ در ﻧﻮزادان‬

‫وﺟﻮد ﻧﺪارد )‪ T= -0/702‬و ‪.(P=0/484‬‬

‫ﺑﺎ ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﻣﺘﻮﺳﻂ و ﻫﻢ در ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﺷﺪﻳﺪ ﻛﻪ ﺗﺤﺖ‬ ‫درﻣﺎن ﺗﻌﻮﻳﺾ ﺧﻮن ﻗﺮار ﮔﺮﻓﺘﻨﺪ در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﻧﻮزادان ﺑﺪون‬

‫ﺑﺤﺚ‬

‫ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ وﺟﻮد دارد‪ ،‬آنﻫﺎ ﻧﺘﻴﺠﻪ ﮔﺮﻓﺘﻨﺪ ﻛﻪ ﺳﻮءﺗﻐﺬﻳﻪ ﻣﺎدر‬

‫ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﺑﺮاي ﺗﻌﻴﻴﻦ ارﺗﺒﺎط ﺑﻴﻦ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل در‬

‫در زﻣﺎن ﺑﺎرداري ﻣﻨﺠﺮ ﺑﻪ ﻫﻴﭙﻮﻣﻨﻴﺰﻳﻤﻲ ﻧﻮزادي و ﻣﺎدري ﻣﻲﮔﺮدد ﻛﻪ ﺑﺎ‬

‫ﻧﻮزادان ﻣﺒﺘﻼ ﺑﻪ زردي ﻗﺒﻞ و ﺑﻌﺪ از ﻓﺘﻮﺗﺮاﭘﻲ ﺑﻮد ﻛﻪ ﻣﺸﺨﺺ ﺷﺪ در‬

‫اﺛﺮ ﻣﻌﻜﻮس ﻧﺎﺷﻲ از آﻧﺰﻳﻢﻫﺎ ﺑﺮ ﻣﺘﺎﺑﻮﻟﻴﺴﻢ ﺑﻴﻠﻲروﺑﻴﻦ و آﻧﺰﻳﻢﻫﺎي‬

‫ﺑﻴﻤﺎران ﺑﺎ ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ‪ ،‬اﻓﺰاﻳﺶ ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﻧﻴﺰ دارﻳﻢ و ﺳﻄﺢ‬

‫آﻧﺘﻲاﻛﺴﻴﺪاﻧﺖ ﺑﺮ ارﻳﺘﺮوﺳﻴﺖﻫﺎ ﺑﺎﻋﺚ ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﻏﻴﺮ ﻣﺴﺘﻘﻴﻢ‬ ‫‪6‬‬

‫ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل ﺳﺮﻣﻲ ﭘﺲ از ﻓﺘﻮﺗﺮاﭘﻲ ﻛﺎﻫﺶ ﻣﻌﻨﻲدار ﭘﻴﺪا ﻣﻲﻛﻨﺪ‬

‫ﻣﻲﮔﺮدد‪ .‬در ﻣﻄﺎﻟﻌﻪ دﻳﮕﺮ ‪ ،Misra‬ارﺗﺒﺎط ﺑﻴﻦ ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ و ﻣﻮاد‬

‫)‪ (t-test=6/332‬و )‪ .(P<0/001‬ﺳﻌﻲ ﺑﺮ اﻳﻦ ﺑﻮد ﻛﻪ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ‬

‫ﻣﻌﺪﻧﻲ ﻣﺨﺘﻠﻒ ﻣﻮرد ارزﻳﺎﺑﻲ ﻗﺮار ﮔﺮﻓﺖ و ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل‬

‫ارﺗﺒﺎط ﺑﻴﻦ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ در زﻣﺎن ﺑﺴﺘﺮي ﺑﺎ ﺟﻨﺲ‪ ،‬ﺳﻦ ﺑﺎرداري‬

‫ﻣﺸﺨﺼﺎ در ‪ 30‬ﻧﻮزاد ﺑﺎ ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﻫﻤﻮﻟﻴﺘﻴﻚ در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه‬ ‫‪7‬‬

‫)ﻛﻢﺗﺮ از ‪ 34‬ﻫﻔﺘﻪ‪ 35 ،‬ﺗﺎ ‪ 37‬ﻫﻔﺘﻪ‪ ،‬ﺑﻴﺶﺗﺮ از ‪ 38‬ﻫﻔﺘﻪ(‪ ،‬وزن ﺗﻮﻟﺪ‬

‫ﻛﻨﺘﺮل ﭘﺎﻳﻴﻦﺗﺮ ﺑﻮد‪ Pintov .‬ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل‪ ،‬ﻣﺲ و روي ﺑﻨﺪ ﻧﺎف‬

‫)ﻛﻢﺗﺮ از ‪ 1500‬ﮔﺮم‪ 1500 ،‬ﺗﺎ ‪ 2500‬ﮔﺮم‪ ،‬ﺑﻴﺶﺗﺮ از ‪ 2500‬ﮔﺮم(‬

‫را ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار داد ﺗﺎ اﺣﺘﻤﺎل ﺑﺮوز ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ را در ﻃﻲ‬

‫ﺗﻌﻴﻴﻦ ﮔﺮدﻳﺪ ﻛﻪ در ﻫﻴﭻﻛﺪام از ﻣﻮارد ﻓﻮق ارﺗﺒﺎط ﻣﻌﻨﻲداري ﺑﻪدﺳﺖ‬

‫‪ 48‬ﺳﺎﻋﺖ آﻳﻨﺪه ﭘﻴﺶﺑﻴﻨﻲ ﻛﻨﺪ ﻛﻪ ﻫﻴﭻﮔﻮﻧﻪ ﺗﻔﺎوت ﻣﻌﻨﻲداري در ﻣﻮرد‬

‫ﻧﻴﺎﻣﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﺑﻴﻦ ﺷﺪت ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ و ﺳﻄﺢ‬

‫اﻳﻦ ﻣﻮاد ﻣﻌﺪﻧﻲ در ﺑﻴﻦ ﻧﻮزاداﻧﻲ ﺑﺎ و ﺑﺪون ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﭘﻴﺪا‬ ‫‪8‬‬

‫ﻣﻨﻴﺰﻳﻢ ﭘﻼﺳﻤﺎ ارﺗﺒﺎط ﻣﻌﻨﻲداري ﺑﻪدﺳﺖ ﻧﻴﺎﻣﺪ اﻟﺒﺘﻪ ﺷﺎﻳﺪ ﻋﻠﺖ اﻳﻦ اﻣﺮ‬

‫ﻧﻜﺮد‪ .‬از ﻃﺮف دﻳﮕﺮ در ﻣﻄﺎﻟﻌﻪ ‪ Sarici‬ارﺗﺒﺎط ﻣﺜﺒﺘﻲ ﺑﻴﻦ ﺳﻄﺢ‬

‫ﺗﺎﺧﻴﺮ در ﺧﻮنﮔﻴﺮي ﺑﺎﺑﺖ ﻣﻨﻴﺰﻳﻢ ﺑﻪدﻟﻴﻞ رﻋﺎﻳﺖ ﻣﺴﺎﻳﻞ اﺧﻼﻗﻲ ﺑﺎﺷﺪ‪.‬‬

‫ﺑﻴﻠﻲروﺑﻴﻦ ﺳﺮم و ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﻳﻮﻧﻴﺰه ﭘﻼﺳﻤﺎ وﺟﻮد داﺷﺖ؛ در ﮔﺮوه‬

‫)در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻫﻴﭻ ﺧﻮنﮔﻴﺮي از ﻧﻮزاد ﺻﺮﻓﺎ ﺑﺮاي اﻧﺠﺎم ﺗﺤﻘﻴﻖ‬

‫ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﺷﺪﻳﺪ ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﻳﻮﻧﻴﺰه ﺳﺮم ﺑﻪﻃﻮر ﻣﻌﻨﻲداري در‬

‫ﺑﻪﻋﻤﻞ ﻧﻴﺎﻣﺪ و ﺗﻤﺎﻣﻲ ﻣﻮارد ارزﻳﺎﺑﻲﻫﺎي آزﻣﺎﻳﺸﮕﺎﻫﻲ ﻫﻤﺮاه‬

‫ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮوه ﻣﺘﻮﺳﻂ ﺑﺎﻻﺗﺮ ﺑﻮد‪ .‬ﻫﻢﭼﻨﻴﻦ در ﮔﺮوه ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ‬

‫ﺧﻮنﮔﻴﺮيﻫﺎي ﻻزم دﻳﮕﺮ ﺟﻬﺖ ﺗﺸﺨﻴﺺ و درﻣﺎن زردي ﻧﻮزاد اﻧﺠﺎم‬

‫ﺷﺪﻳﺪ‪ ،‬ارﺗﺒﺎط آﻣﺎري ﻣﺜﺒﺖ ﺑﻴﻦ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ ﻳﻮﻧﻴﺰه و ﺷﺪت‬

‫ﺷﺪ ﺑﻪﻫﻤﻴﻦ دﻟﻴﻞ ﻧﻮزاداﻧﻲ ﻛﻪ ﺑﺎ ﺑﺮﮔﻪ آزﻣﺎﻳﺶ از ﺳﺎﻳﺮ ﻣﺮاﻛﺰ ﻳﺎ‬

‫ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ وﺟﻮد داﺷﺖ و ﻧﺘﻴﺠﻪ ﮔﺮﻓﺖ ﻛﻪ ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﻳﻮﻧﻴﺰه‬ ‫‪9‬‬

‫ﻣﻄﺐﻫﺎ ارﺟﺎع ﻣﻲﺷﺪﻧﺪ‪ ،‬ﭘﺲ از ﮔﺬﺷﺖ ﺷﺶ ﺳﺎﻋﺖ از ﻓﺘﻮﺗﺮاﭘﻲ ﺑﺎ‬

‫ﭘﻼﺳﻤﺎ ﺑﺎ اﻓﺰاﻳﺶ ﺳﻄﺢ ﺑﻴﻠﻲروﺑﻴﻦ ﺳﺮم اﻓﺰاﻳﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬در ﻣﻄﺎﻟﻌﻪ ﻣﺎ‬

‫ﺳﺎﻳﺮ آزﻣﺎﻳﺸﺎﺗﺸﺎن ﺑﺮرﺳﻲ ﻣﻨﻴﺰﻳﻢ ﻧﻴﺰ ﺻﻮرت ﮔﺮﻓﺖ‪ .‬ﻫﺮﭼﻨﺪ اﺛﺮات‬

‫ﻧﻴﺰ ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﺳﺮﻣﻲ در ﻣﻮارد ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﺑﺎ درﻣﺎن ﻛﺎﻫﺶ‬

‫ﺑﻪﺧﻮﺑﻲ‬

‫ﻳﺎﻓﺖ ﻛﻪ ﺷﺎﻳﺪ ﺑﻪﻋﻠﺖ اﻓﺰاﻳﺶ ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﭘﻼﺳﻤﺎ ﻫﻢزﻣﺎن ﺑﺎ‬

‫ﺗﻮﺻﻴﻒ و ﺑﺮرﺳﻲ ﺷﺪه اﺳﺖ و ﻧﻘﺶ آن و اﺛﺮات ﻧﻮروﭘﺮوﺗﻜﺘﻴﻮ آن در‬

‫ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﺑﺎﺷﺪ ﻛﻪ ﭘﺲ از ﻛﺎﻫﺶ ﺳﻄﺢ ﺑﻴﻠﻲروﺑﻴﻦ‪ ،‬ﺳﻄﺢ‬

‫ﭘﺎﺗﻮﻓﻴﺰﻳﻮﻟﻮژي آﻧﺴﻔﺎﻟﻮﭘﺎﺗﻲ ﻫﻴﭙﻮﻛﺴﻴﻚ اﻳﺴﻜﻤﻴﻚ ﻣﺸﺨﺺ ﺷﺪه اﺳﺖ‬

‫ﻣﻨﻴﺰﻳﻢ ﻧﻴﺰ ﻛﺎﻫﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ ﺗﻨﻬﺎ ‪ %1‬ﻣﻨﻴﺰﻳﻢ ﺑﺪن ﺧﺎرج‬

‫وﻟﻲ ارﺗﺒﺎط ﺑﻴﻦ ﻣﻨﻴﺰﻳﻢ و ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﻧﻮزادي ﻫﻨﻮز ﺑﻪﻃﻮر ﻛﺎﻣﻞ‬

‫ﺳﻠﻮﻟﻲ ﻗﺮار دارد ﺑﻴﺸﺘﺮ اﻳﻦ ﺗﻐﻴﻴﺮات ﻛﻪ ﻋﻤﺪﺗﺎ ﺳﺮﻳﻊ و ﻃﻲ ‪ 24‬ﺳﺎﻋﺖ‬

‫ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار ﻧﮕﺮﻓﺘﻪ اﺳﺖ‪ .‬در ﻣﻄﺎﻟﻌﻪ ‪ ،Tuncer‬ﻏﻠﻈﺖ ﻣﻨﻴﺰﻳﻢ‬

‫)ﻓﻮاﺻﻞ ﻧﻤﻮﻧﻪﮔﻴﺮي در اﻳﻦ ﻣﻄﺎﻟﻌﻪ( ﻣﻲﺑﺎﺷﺪ در اﺛﺮ ﺟﺎﺑﻪﺟﺎﻳﻲ ﺑﻴﻦ‬

‫ﺗﻮﺗﺎل ﭘﺎﻳﻴﻦﺗﺮي در ﺧﻮن ﺑﻨﺪ ﻧﺎف و ﺧﻮن ﻣﺎدر در ﻧﻮزاداﻧﻲ ﺑﺎ‬

‫داﺧﻞ و ﺧﺎرج ﺳﻠﻮل ﻣﻲﺑﺎﺷﺪ‪ .‬ﺑﻨﺎﺑﺮاﻳﻦ ﺑﺎ اﻓﺰاﻳﺶ ﺑﻴﻠﻲروﺑﻴﻦ ﻳﺎ در اﺛﺮ‬

‫ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﻧﻮزادان ﺳﺎﻟﻢ ﮔﺰارش ﻛﺮد و ﻧﺘﻴﺠﻪ‬

‫ﺗﺨﺮﻳﺐ ﺳﻠﻮلﻫﺎ ﻳﺎ ﺑﻪﻋﻨﻮان ﻣﻜﺎﻧﻴﺴﻢ دﻓﺎﻋﻲ‪ ،‬اﻓﺰاﻳﺶ ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ‬

‫ﮔﺮﻓﺖ ﻛﻪ ﻫﻴﭙﻮﻣﻨﻴﺰﻳﻤﻲ ﻧﺎﺷﻲ از ﺷﻴﻔﺖ داﺧﻞ ﺳﻠﻮﻟﻲ ﻳﻮن ﻣﻨﻴﺰﻳﻢ‬

‫ﭘﻼﺳﻤﺎ دارﻳﻢ‪ .‬ﭼﻮن در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ارﺗﺒﺎﻃﻲ ﺑﻴﻦ ﺷﺪت ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ‬

‫ﻣﻲﺑﺎﺷﺪ‪ .‬در ﻣﻄﺎﻟﻌﻪ ﺑﻌﺪي ‪ Tuncer‬ﺳﻄﻮح ﻣﻨﻴﺰﻳﻢ‪ ،‬روي و ﻣﺲ ﻳﻮﻧﻴﺰه‬

‫و ﻫﻴﭙﺮﻣﻨﻴﺰﻣﻲ ﻳﺎﻓﺖ ﻧﺸﺪ و ﺣﺘﻲ ﺑﺎ ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﻣﺘﻮﺳﻂ ﻧﻴﺰ‬

‫در ﺧﻮن ﺑﻨﺪ ﻧﺎف و ﺧﻮن ﻣﺤﻴﻄﻲ ﻧﻮزاداﻧﻲ ﺑﺎ ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﻣﺘﻮﺳﻂ‬

‫اﻓﺰاﻳﺶ ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﭘﻼﺳﻤﺎ ﻣﺸﺎﻫﺪه ﺷﺪ و ﺑﺮ ﻃﺒﻖ ﻧﺘﺎﻳﺞ ﺟﺪﻳﺪ‬

‫و ﻧﻮزاداﻧﻲ ﺑﺎ ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﺷﺪﻳﺪ ﻛﻪ ﻧﻴﺎزﻣﻨﺪ ﺗﻌﻮﻳﺾ ﺧﻮن ﺷﺪﻧﺪ‬

‫ﺗﺤﻘﻴﻘﺎت روي ﻧﻘﺶ رﺳﭙﺘﻮر ‪ NMDA‬و ﻧﻘﺶ اﺛﺮ ﺗﺤﺮﻳﻜﻲ آن در ﺑﺮوز‬

‫در ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﻧﻮزاداﻧﻲ ﺑﺪون ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ اﻧﺪازهﮔﻴﺮي ﺷﺪ و ﻧﺸﺎن‬

‫ﻧﻮروﺗﻮﻛﺴﻴﺴﻴﺘﻪ در ﻣﻮارد ﻫﻴﭙﻮﻛﺴﻲ و ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ و ﻧﻘﺶ ﻣﻨﻴﺰﻳﻢ‬

‫ﺑﻠﻮكﻛﻨﻨﺪه و ﺗﻨﻈﻴﻢﻛﻨﻨﺪه ﻳﻮن ﻣﻨﻴﺰﻳﻢ ﺑﺮ رﺳﭙﺘﻮر‬

‫‪NMDA‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫ ﺑﻪ زردي ﻗﺒﻞ و ﺑﻌﺪ از ﻓﺘﻮﺗﺮاﭘﻲ‬Khosravi ‫ﻧﻮزادان ﻣﺒﺘﻼ‬N.‫در‬et‫ﺗﻮﺗﺎل‬ al. ‫ﻣﻘﺎﻳﺴﻪ ﺳﻄﺢ ﺳﺮﻣﻲ ﻣﻨﻴﺰﻳﻢ‬

436

‫ ﺑﻨﺎﺑﺮاﻳﻦ ﻓﺘﻮﺗﺮاﭘﻲ ﻣﻲﺗﻮاﻧﺪ ﻣﻨﺠﺮ‬.‫ﻧﻮروﺗﻮﻛﺴﻴﻚ ﺑﻴﻠﻲروﺑﻴﻦ اﺳﺘﻔﺎده ﻛﺮد‬

-‫ از اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺘﻴﺠﻪ ﮔﺮﻓﺘﻴﻢ ﻛﻪ در ﻫﻴﭙﺮﺑﻴﻠﻲ‬،‫در ﻣﻬﺎر اﻳﻦ رﺳﭙﺘﻮر‬

‫ﺑﻪ ﻛﺎﻫﺶ ﻣﻨﻴﺰﻳﻢ ﺗﻮﺗﺎل ﺳﺮﻣﻲ ﺷﻮد ﻛﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺷﻮاﻫﺪ اﺳﺘﻔﺎده از‬

‫ ﺑﺪن ﺑﻪﻋﻨﻮان ﻣﻜﺎﻧﻴﺴﻢ دﻓﺎﻋﻲ ﺑﺎ اﻓﺰاﻳﺶ ﺳﻄﺢ ﻣﻨﻴﺰﻳﻢ ﺧﺎرج‬،‫روﺑﻴﻨﻤﻲ‬

‫ﻣﻨﻴﺰﻳﻢ در درﻣﺎن ﺑﻴﻤﺎران ﺑﺎ زردي ﺑﺎﻻ ﺑﺎﻋﺚ ﻛﺎﻫﺶ ﺧﻄﺮ آﺳﻴﺐ ﻋﺼﺒﻲ‬

‫ﺳﻠﻮﻟﻲ ﺳﻌﻲ در ﻛﺎﻫﺶ اﺛﺮات ﻧﻮروﺗﻮﻛﺴﻴﻚ ﺑﻴﻠﻲروﺑﻴﻦ ﺑﺎ ﻣﻬﺎر رﺳﭙﺘﻮر‬

.‫ﻧﺎﺷﻲ از ﺑﻴﻠﻲروﺑﻴﻦ ﺧﻮاﻫﺪ ﺷﺪ‬

‫دارد و ﺷﺎﻳﺪ در ﺻﻮرت ﺗﺎﻳﻴﺪ ﻧﺘﺎﻳﺞ اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﺳﺎﻳﺮ‬

NMDA

‫ ﺑﺪﻳﻦوﺳﻴﻠﻪ از ﺳﺮﻛﺎر ﺧﺎﻧﻢ دﻛﺘﺮ ﻧﺴﺮﻳﻦ ﺧﺎﻟﺼﻲ ﻓﻮق‬:‫ﺳﭙﺎﺳﮕﺰاري‬

،‫ﻣﻄﺎﻟﻌﺎت ﺑﺘﻮان در ﻣﻮارد ﻫﻴﭙﺮﺑﻴﻠﻲروﺑﻴﻨﻤﻲ ﺷﺪﻳﺪ و ﺧﻄﺮ ﻛﺮﻧﻴﻜﺘﺮوس‬

‫ﺗﺨﺼﺺ ﻧﻮزادان ﻛﻪ اﻧﺠﺎم اﻳﻦ ﭘﮋوﻫﺶ ﺑﺪون ﻫﻤﻜﺎري اﻳﺸﺎن ﻣﻴﺴﺮ‬

‫ ﻫﻤﺮاه ﺳﺎﻳﺮ درﻣﺎنﻫﺎي ﻛﺎﻫﺶ ﺳﻄﺢ‬،‫از ﻣﻨﻴﺰﻳﻢ ﺑﻪﻋﻨﻮان درﻣﺎن ﻛﻤﻜﻲ‬

.‫ ﺻﻤﻴﻤﺎﻧﻪ ﺗﺸﻜﺮ ﻣﻲﻧﻤﺎﻳﻢ‬،‫ﻧﺒﻮد‬

‫ﺑﻴﻠﻲروﺑﻴﻦ از ﺟﻤﻠﻪ ﻓﺘﻮﺗﺮاﭘﻲ و ﻳﺎ ﺗﻌﻮﻳﺾ ﺧﻮن ﺑﺮاي ﻛﺎﻫﺶ اﺛﺮات‬

1. Volpe JJ. Bilirubin and brain injury. In: Volpe JJ, editor. Neurology of Newborn. Philadelphia, PA: WB Saunders; 1995. p. 490-514.

2. Cashore WJ. Bilirubin metabolism and toxicity in the newborn. In: Polin RA, Fox WW, editors. Fetaland Neonatal Physiology.

Philadelphia, PA: WB Saunders; 1998. p. 1493-8.

3. Hoffman DJ, Zanelli SA, Kubin J, Mishra OP, DelivoriaPapadopoulos M. The in vivo effect of bilirubin on the N-methyl-Daspartate receptor/ion channel complex in the brains of newborn piglets. Pediatr Res 1996;40(6):804-8.

4. Johnston M, McDonald M, Chen C, Trescher W. Role of excitatory amino acid receptors in perinatal hypoxic-ischemic brain injury. In: Meldrum BS, Moroni F, Simon RP, Woods JH, editors. Excitatory Amino Acids. New York: Raven Press; 1991. p. 711-6.

5. Sarici SU, Serdar MA, Erdem G, Alpay F. Evaluation of plasma ionized magnesium levels in neonatal hyperbilirubinemia. Pediatr Res 2004;55(2):243-7.

6. Tunçer M, Yenice A, Ozand P. Serum Mg, Ca, total protein levels in maternal and cord blood and its clinical significance. Turk J Pediatr 1972;14(1):13-22.

7. Misra PK, Kapoor RK, Dixit S, Seth TD. Trace metals in neonatal hyperbilirubinemia. Indian Pediatr 1988;25(8):761-4.

8. Pintov S, Kohelet D, Arbel E, Goldberg M. Predictive inability of cord zinc, magnesium and copper levels on the development of benign hyperbilirubinemia in the newborn. Acta Paediatr 1992;81(11):868-9.

9. Sarici SU, Kul M, Alpay F. Neonatal jaundice coinciding with or resulting from urinary tract infections?

Pediatrics 2003;112(5):1212-3; author reply 1212-3.

References

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

Tehran University Medical Journal;‫ﻫﻤﻜﺎران‬ Vol. 69, ‫ و‬No. 7, October 2011: 432-437

100

Total serum magnesium level in icteric neonates before and after phototherapy

Abstract Nastaran Khosravi M.D. Alireza Aminian M.D.* Reza Taghipour M.D. Department of Neonatology, Aliasgar Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Received: May 04, 2011 Accepted: July 04, 2011

Background: Deposition of bilirubin in neurons causes permanent neuronal injury.

Bilirubin exhibits an affinity for the phospholipids of plasma membrane like N-methylD-aspartate (NMDA) receptors. Magnesium is an NMDA antagonist and it acts against the neurotoxic effects of bilirubin. We compared pre- and post-phototherapy serum magnesium level of neonates with hyperbilirubinemia to find the best time of discharge and evaluate new management techniques such as magnesium supplementation.

Methods: In this semi-experimental study, we evaluated neonates admitted in Ali Asghar Children’s Hospital in Tehran, Iran with signs of icter from 2009 to 2010. The inclusion criteria included age less than four weeks, no history of magnesium sulfate administration in the mother and absence of sepsis.

Results: From 106 patients with icter, 50.9% were male and 49.1% were female neonates. Their mean gestational age was 37.341.286 (33-41) weeks and the mean birth weight was 3172.12436.936 (2022-4300) grams. The frequency of underlying causes of hyperbillirubinemia included: ABO mismatch 9.34%, Rh incompatibility 4.7%, breastfeeding 16% and breast milk 44.3%. There was a significant difference (P≤0.001) between serum magnesium levels before (2.24mg/dl) and after phototherapy (2.12mg/dl). There were no significant differences between serum magnesium values in the two sexes (male=2.28, female=2.19), among different gestational age groups (<34 wks=2.35, 35-37 wks=2.27, >38 wks=2.17), between different birth weight groups (15002500 g=2.4 and >2500 g=2.23) or severity of hyperbilirubinemia (mild=2.23,

moderate=2.21 and severe=2.29).

Conclusion: Phototherapy decreases the total magnesium concentration and magnesium administration will prevent bilirubin neurotoxicity in icteric neonates. *

Corresponding author: Aliasghar Hospital, Khanevade’s Army Hospital, Kaj St., Shariati Ave., Tehran, Iran.

Tel: +98-21-77603100 E-mail: dr.aminian@gmail.com

Keywords: Hyperbillirubinemia, magnesium, phototherapy.

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

‫ﺑﻴﻤﺎر ﻣﻬﺮ ‪438-444 ،1390‬‬ ‫ﺷﻤﺎره ‪،7‬‬ ‫دوره ‪، 69‬‬ ‫ﻣﺰاﻧﺸﻴﻤﺎلﻜﻲ‬ ‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷ‬ ‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪،‬‬ ‫ﺑﺮرﺳﻲ ‪24‬‬ ‫ﺗﻬﺮان‪،‬ﻣﻌﺪه‪:‬‬ ‫ﻣﺮي و‬ ‫ﺗﻮﻣﻮرﻫﺎي‬

‫ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺮي و ﻣﻌﺪه‪ :‬ﺑﺮرﺳﻲ ‪ 24‬ﺑﻴﻤﺎر‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1389/11/11 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/04/06 :‬‬

‫ﭼﻜﻴﺪه‬

‫‪*1‬‬

‫رﺿﺎ ﺑﺎﻗﺮي‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﮔﻮارﺷﻲ ﺟﺰو ﺗﻮﻣﻮرﻫﺎي ﺑﺎ ﻣﻨﺸﺎء ﻋﻀﻼت ﺻﺎف ﻃﺒﻘﻪﺑﻨﺪي ﻣﻲﺷﺪﻧﺪ‪.‬‬

‫‪2‬‬

‫ﻗﺪرت اﷲ ﻣﺪاح‬

‫)‪ Gastrointestinal Stromal Tumors (GIST‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻧﻮع ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﮔﻮارﺷﻲ ﻫﺴﺘﻨﺪ ﻛﻪ در ﺳﺮﺗﺎﺳﺮ ﻟﻮﻟﻪ‬

‫‪2‬‬

‫ﻋﻠﻴﺮﺿﺎ ﺗﻮﺳﻠﻲ‬

‫ﮔﻮارش از ﻣﺮي ﺗﺎ آﻧﻮس دﻳﺪه ﻣﻲﺷﻮد و اﻛﺜﺮ ﻣﻮارد آن در ﻣﻌﺪه اﺗﻔﺎق ﻣﻲاﻓﺘﺪ‪ .‬ﺑﻴﺸﺘﺮ ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ‬

‫‪3‬‬

‫ﻓﺎﻃﻤﻪ ﻧﻘﻮي رﻳﺎﺑﻲ‬

‫ﻋﻼﻣﺖ ﻫﺴﺘﻨﺪ و درﻣﺎن آن در اﻛﺜﺮ ﻣﻮارد ﺟﺮاﺣﻲ اﺳﺖ‪ .‬ﻫﺪف ﻣﺎ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮرﺳﻲ‬

‫‪GIST‬‬

‫‪GIST‬‬

‫ﺑﺪون‬

‫ﺗﻮﻣﻮرﻫﺎي ﻣﺮي و‬

‫‪ -1‬ﮔﺮوه ﺟﺮاﺣﻲ ﺗﻮراﻛﺲ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن ﻗﺎﺋﻢ‬

‫ﻣﻌﺪه ﺑﻮده اﺳﺖ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬در ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﮔﺬﺷﺘﻪﻧﮕﺮ ﺑﻴﻤﺎراﻧﻲ ﻛﻪ ﺑﻴﻦ ﺳﺎلﻫﺎي ‪ 1370‬ﺗﺎ ‪ 1388‬ﺑﺎ ﺗﺸﺨﻴﺺ‬

‫‪ -2‬ﮔﺮوه ﺟﺮاﺣﻲ ﻋﻤﻮﻣﻲ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن ﻗﺎﺋﻢ‬

‫ﺗﻮﻣﻮر ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺮي و ﻣﻌﺪه در ﺑﻴﻤﺎرﺳﺘﺎن ﻗﺎﺋﻢ )ﻋﺞ( و اﻣﻴﺪ ﻣﺸﻬﺪ ﺑﺴﺘﺮي و ﺗﺤﺖ درﻣﺎن ﻗﺮار ﮔﺮﻓﺘﻪ ﺑﻮدﻧﺪ ﻣﻮرد‬

‫‪ -3‬ﮔﺮوه ﺟﺮاﺣﻲ ﻋﻤﻮﻣﻲ‬

‫ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﻳﺎﻓﺘﻪﻫﺎ‪ 24 :‬ﺑﻴﻤﺎر وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ )‪ 16‬ﻧﻔﺮ ﻣﺮد و ﻫﺸﺖ ﻧﻔﺮ زن( ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ‪ 50‬ﺳﺎل‬

‫داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺸﻬﺪ‪،‬‬

‫ﺑﻮد‪ ،‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻣﺤﻞ ﺗﻮﻣﻮر در ﻓﻮﻧﺪوس ﻣﻌﺪه ﺑﻮد‪ .‬ﺗﻤﺎم ﺑﻴﻤﺎران در ﺣﻴﻦ ﺗﺸﺨﻴﺺ ﻋﻼﻣﺖدار ﺑﻮده و ﺷﺎﻳﻊﺗﺮﻳﻦ‬

‫ﻣﺸﻬﺪ‪ ،‬اﻳﺮان‪.‬‬

‫ﻋﻼﻣﺖ در ﺑﻴﻤﺎران اﺣﺴﺎس ﭘﺮي ﺑﻮد ﻛﻪ در ‪ %50‬از ﺑﻴﻤﺎران وﺟﻮد داﺷﺖ‪ .‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻤﻞ ﺟﺮاﺣﻲ اﻧﺠﺎمﺷﺪه در‬ ‫اﻳﻦ ﺑﻴﻤﺎران ﮔﺎﺳﺘﺮﻛﺘﻮﻣﻲ ﺳﺎبﺗﻮﺗﺎل ﺑﻮد‪ .‬ﻣﺮگ و ﻣﻴﺮ ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ ﺛﺒﺖ ﻧﺸﺪه ﺑﻮد‪ .‬ﻋﻮارض در ﭘﻨﺞ ﺑﻴﻤﺎر )‪(%20/5‬‬ ‫ﺑﻌﺪ از ﻋﻤﻞ دﻳﺪه ﺷﺪ ﻛﻪ ﺷﺎﻳﻊﺗﺮﻳﻦ آن اﻳﻠﺌﻮس ﺑﻌﺪ از ﻋﻤﻞ ﺑﻮده اﺳﺖ‪ ،‬درﻣﺎن ﻛﻤﻜﻲ ﺑﻌﺪ از ﻋﻤﻞ ﻛﻪ در ﻫﺸﺖ‬ ‫ﺑﻴﻤﺎر )‪ (%33/1‬اﺳﺘﻔﺎده ﮔﺮدﻳﺪ‪ ،‬در ﭘﻲﮔﻴﺮي ﺳﻪ ﺳﺎﻟﻪ ﺗﻨﻬﺎ ﺳﻪ ﺑﻴﻤﺎر ﻓﻮت ﻧﻤﻮدﻧﺪ )‪ .(%12/45‬ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ‬

‫*‬

‫ﻧﺘﺎﻳﺞ ﻣﻨﺎﺳﺐ ﺟﺮاﺣﻲ در اﻳﻦ ﺑﻴﻤﺎران ﺑﺎ ﻋﻮارض ﻣﺮگ و ﻣﻴﺮ اﻧﺪك‪ ،‬ﺟﺮاﺣﻲ ﺑﻪﻋﻨﻮان درﻣﺎن اﻧﺘﺨﺎﺑﻲ در ﺑﻴﻤﺎراﻧﻲ‬ ‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﻣﺸﻬﺪ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن ﻗﺎﺋﻢ )ﻋﺞ(‪ ،‬ﻣﺮﻛﺰ‬

‫ﺗﺤﻘﻴﻘﺎت ﺟﺮاﺣﻲ آﻧﺪوﺳﻜﻮﭘﻴﻚ و روشﻫﺎي ﻛﻢﺗﻬﺎﺟﻤﻲ‬ ‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺸﻬﺪ‬

‫ﻛﻪ ﺗﻮاﻧﺎﻳﻲ ﺟﺮاﺣﻲ را دارﻧﺪ ﺗﻮﺻﻴﻪ ﻣﻲﮔﺮدد‪.‬‬

‫ﺗﻠﻔﻦ‪0511-8012806 :‬‬

‫‪E-mail: Bagherir@mums.ac.ir‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﺗﻮﻣﻮر ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺮي و ﻣﻌﺪه‪ ،‬ﺗﺸﺨﻴﺺ‪ ،‬درﻣﺎن‪ ،‬ﻋﻮارض‪ ،‬ﻣﺮگ و ﻣﻴﺮ‪.‬‬

‫اﻳﻦ ﺗﻮﻣﻮرﻫﺎ‪ ،‬واﺑﺴﺘﮕﻲ ﻧﺰدﻳﻜﻲ ﺑﺎ ﻳﻜﻲ از ﺳﻠﻮلﻫﺎي ﺑﺎﻓﺖ ﺑﻴﻨﺎﺑﻴﻨﻲ‬

‫ﻣﻘﺪﻣﻪ‬

‫ﺑﻪﻧﺎم ‪ Cajal‬دارﻧﺪ‪ .‬اﻳﻦ ﺳﻠﻮلﻫﺎ ﺣﺎوي‬

‫ﺗﺎ ﺣﺪود ‪ 20‬ﺳﺎل ﻗﺒﻞ اﻛﺜﺮ ﻣﻮارد ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﮔﻮارﺷﻲ‬

‫‪C-Kit‬‬

‫و‬

‫و از ﻧﻈﺮ اﻳﻤﻮﻧﻮﻫﻴﺴﺘﻮﺷﻴﻤﻲ از ﻧﻈﺮ دﺳﻤﻴﻦ و‬ ‫‪GIST‬‬

‫‪CD117‬‬ ‫‪S100‬‬

‫و‬

‫‪CD34‬‬

‫ﻫﺴﺘﻨﺪ‬ ‫‪5‬و‪4‬‬

‫ﻣﻨﻔﻲ ﻫﺴﺘﻨﺪ‪.‬‬

‫ﺟﺰء ﺗﻮﻣﻮرﻫﺎي ﺑﺎ ﻣﻨﺸﺎ ﻋﻀﻼت ﺻﺎف ﻃﺒﻘﻪﺑﻨﺪي ﻣﻲﺷﺪﻧﺪ‪ .‬در ﺳﺎل‬

‫ﺷﻴﻮع‬

‫‪ Mazur ،1984‬و ‪ Clark‬ﮔﺰارش ﻛﺮدﻧﺪ ﻛﻪ ﺗﻌﺪاد زﻳﺎدي از ﺗﻮﻣﻮرﻫﺎﻳﻲ‬

‫و ﭘﻨﺞ درﺻﺪ از ﺗﻤﺎم ﻣﻮارد ﺳﺎرﻛﻮمﻫﺎي ﮔﺰارش ﺷﺪه را ﺷﺎﻣﻞ‬ ‫‪7‬و‪6‬‬

‫زﻳﺎد ﻧﻴﺴﺖ و ﺣﺪود ‪ %0/1-3‬ﻛﻞ ﻧﺌﻮﭘﻼﺳﻢﻫﺎي ﮔﻮارﺷﻲ‬

‫و اﻛﺜﺮ ﻣﻮارد آن در ﻣﺤﺪوده ﺳﻨﻲ ‪ 40-60‬ﺳﺎل اﺗﻔﺎق‬

‫ﻛﻪ ﺟﺰ ﺗﻮﻣﻮرﻫﺎي ﻋﻀﻼت ﺻﺎف ﻣﺤﺴﻮب ﻣﻲﺷﻮﻧﺪ‪ ،‬داراي ﺷﻮاﻫﺪ‬

‫ﻣﻲﺷﻮد‬

‫اﻳﻤﻮﻧﻮﻫﻴﺴﺘﻮﺷﻴﻤﻴﺎﻳﻲ و ﻣﻴﻜﺮوﺳﻜﻮپ اﻟﻜﺘﺮوﻧﻲ ﻋﻀﻼت ﺻﺎف و‬

‫ﻣﻲاﻓﺘﺪ‪ ،‬اﻣﺎ ﺗﻔﺎوت ﺟﻨﺴﻲ واﺿﺤﻲ در آن ﻣﺸﺎﻫﺪه ﻧﻤﻲﺷﻮد‪ .‬اﻟﺒﺘﻪ در‬

‫ﻏﻼف ﻋﺼﺒﻲ ﻧﻴﺴﺘﻨﺪ و اﺻﻄﻼح ﺗﻮﻣﻮرﻫﺎي اﺳﺘﺮوﻣﺎﻳﻲ ﻣﻌﺪه‬

‫ﺑﻌﻀﻲ ﻣﻄﺎﻟﻌﺎت ﺑﻴﺸﺘﺮﻳﻦ ﺷﻴﻮع ﺳﻨﻲ را در ﺑﺎزده زﻣﺎﻧﻲ ‪ 55-65‬ﺳﺎل‬

‫‪2‬و‪1‬‬

‫)‪ Gastrointestinal Stromal Tumor (GIST‬را ﭘﻴﺸﻨﻬﺎد ﻛﺮدﻧﺪ‪.‬‬

‫‪1‬‬

‫‪4‬‬

‫‪GIST‬‬

‫ذﻛﺮ ﻛﺮدهاﻧﺪ‪ .‬ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ ﻛﻪ اﻛﺜﺮ ﻣﻮارد آن در ﻣﻌﺪه )‪(%40-70‬‬

‫ﺷﺎﻳﻊﺗﺮﻳﻦ ﻧﻮع ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﮔﻮارﺷﻲ ﻫﺴﺘﻨﺪ ﻛﻪ از ﻣﺮي ﺗﺎ‬

‫اﺗﻔﺎق ﻣﻲاﻓﺘﺪ اﻣﺎ ﺑﺮوز آن در روده ﺑﺎرﻳﻚ و ﻣﺰاﻧﺘﺮ ﻧﻴﺰ ﺷﺎﻳﻊ اﺳﺖ‬

‫آﻧﻮس دﻳﺪه ﻣﻲﺷﻮﻧﺪ‪ 3.‬در ﺣﺎل ﺣﺎﺿﺮ روﺷﻦ ﺷﺪه اﺳﺖ ﻛﻪ ﺳﻠﻮلﻫﺎي‬

‫)‪ %5 .(%20-40‬ﻣﻮارد آن در ﻣﺮي و ‪ %5-15‬آن در ﻛﻮﻟﻮن و رﻛﺘﻮم‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫رﺿﺎ ﺑﺎﻗﺮي و ﻫﻤﻜﺎران‬

‫‪9‬و‪8‬‬

‫ﮔﺰارش ﺷﺪه اﺳﺖ‪.‬‬

‫ﺑﻴﺶﺗﺮ ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ‬

‫‪GIST‬‬

‫ﺑﺪون ﻋﻼﻣﺖ‬

‫‪439‬‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫ﻫﺴﺘﻨﺪ اﻣﺎ در ﻣﻮارد ﭘﻴﺶرﻓﺘﻪ ﻋﻼﻳﻢ ﺗﻮده ﺷﻜﻤﻲ‪ ،‬درد ﺷﻜﻢ ﻳﺎ‬ ‫‪10‬و‪3‬‬

‫ﺣﺪاﻗﻞ ‪ %10-30‬ﻣﻮارد ﺑﻪﺻﻮرت اﺗﻔﺎﻗﻲ‬

‫ﺑﻪﻃﻮر ﻛﻠﻲ ‪ 24‬ﺑﻴﻤﺎر در ﻓﺎﺻﻠﻪ زﻣﺎﻧﻲ ‪ 1370-88‬در اﻳﻦ ﺑﻴﻤﺎرﺳﺘﺎن‬

‫در ﺣﻴﻦ ﻻﭘﺎراﺗﻮﻣﻲ ﻳﺎ آﻧﺪوﺳﻜﻮﭘﻲ ﻳﺎ ﺑﺮرﺳﻲﻫﺎي ﺗﺼﻮﻳﺮﺑﺮداري ﻛﺸﻒ‬

‫ﺑﺎ ﺗﺸﺨﻴﺺ ﺗﻮﻣﻮر ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺮي و ﻣﻌﺪه ﺑﺴﺘﺮي ﺷﺪه ﺑﻮدﻧﺪ ﻛﻪ از‬

‫ﺧﻮد را ﺑﺎ ﻣﺘﺎﺳﺘﺎز ﻧﺸﺎن‬

‫ﺑﻴﻦ اﻳﻦ ﺑﻴﻤﺎران ‪ 16‬ﻧﻔﺮ ﻣﺮد )‪ (%66‬و ﻫﺸﺖ ﻧﻔﺮ زن )‪ (%34‬ﺑﻮدﻧﺪ‪.‬‬

‫ﺣﺬف ﺟﺮاﺣﻲ اﺳﺖ‪ .‬ﺑﺎﻳﺪ ﺗﻼش‬

‫ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ﺑﻴﻤﺎران ‪ 50‬ﺳﺎل ﺑﻮد )ﺟﻮانﺗﺮﻳﻦ ﺑﻴﻤﺎر ‪ 14‬ﺳﺎﻟﻪ و‬

‫ﺷﻮد ﻛﻪ در ﺣﺪ اﻣﻜﺎن ﺗﻤﺎم ﺗﻮﻣﻮر ﺑﻪﺻﻮرت ﻛﺎﻣﻞ ﺧﺎرج ﺷﻮد و ﻫﻤﺮاه‬

‫ﻣﺴﻦﺗﺮﻳﻦ آنﻫﺎ ‪ 76‬ﺳﺎﻟﻪ ﺑﻮده اﺳﺖ(‪ .‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻣﺤﻞ ﺗﻮﻣﻮر در‬

‫ﺑﺎ آن ﻗﺴﻤﺘﻲ از ﺑﺎﻓﺖ ﺳﺎﻟﻢ و ﻧﻴﺰ ارﮔﺎنﻫﺎي ﻣﺠﺎور در ﺻﻮرت‬

‫ﻓﻮﻧﺪوس ﻣﻌﺪه ﺑﻮد ﻛﻪ ﺷﺎﻣﻞ ﻫﺸﺖ ﺑﻴﻤﺎر )‪ (%34‬ﻣﻲﺷﺪ‪ .‬ﺳﺎﻳﺮ ﻣﻨﺎﻃﻖ‬

‫‪GIST‬‬

‫درﮔﻴﺮ ﺑﻪﺗﺮﺗﻴﺐ ﺷﻴﻮع ﻋﺒﺎرت ﺑﻮدﻧﺪ از‪ :‬ﺟﺴﻢ ﻣﻌﺪه )ﭘﻨﺞ ﺑﻴﻤﺎر(‬

‫ﺑﻪﻧﺪرت ﺑﻪ ﮔﺮهﻫﺎي ﻟﻨﻔﺎوي ﻣﺘﺎﺳﺘﺎز ﻣﻲدﻫﺪ و ﺑﻪﻫﻤﻴﻦ ﺟﻬﺖ‬

‫‪ ،%20/5‬ﺛﻠﺚ ﻣﻴﺎﻧﻲ ﻣﺮي )ﭼﻬﺎر ﺑﻴﻤﺎر( ‪ ،%16/6‬اﻧﺘﺮوم )دو ﺑﻴﻤﺎر( ‪،%8/3‬‬

‫ﻟﻨﻔﺎدﻧﻜﺘﻮﻣﻲ در ﻣﻮرد اﻳﻦ ﺗﻮﻣﻮرﻫﺎ ﻣﻌﻤﻮل ﻧﻴﺴﺖ‪ 1.‬ﺑﺮداﺷﺖ ﮔﻮهاي در‬

‫ﺟﺴﻢ ﻣﻌﺪه و اﻧﺘﺮوم )دو ﺑﻴﻤﺎر( ‪ ،%8/3‬ﻳﻚﺳﻮم ﺗﺤﺘﺎﻧﻲ و ﻳﻚﺳﻮم‬

‫ﻣﻌﺪه ﻳﺎ ﺣﺬف ﻳﻚ ﻗﺴﻤﺖ از روده ﺑﺎرﻳﻚ ﺑﺮاي درﻣﺎن ﺟﺮاﺣﻲ ﻛﻔﺎﻳﺖ‬

‫ﻣﻴﺎﻧﻲ ﻣﺮي )دو ﺑﻴﻤﺎر( ‪ %8/3‬و ﻳﻚﺳﻮم ﭘﺮوﮔﺰﻳﻤﺎل ﻣﺮي )ﻳﻚ ﺑﻴﻤﺎر(‬

‫ﻣﻲﻛﻨﺪ و ﺟﺮاﺣﻲﻫﺎي ﺑﺰرگﺗﺮ ﻧﺘﺎﻳﺞ و ﭘﻴﺶآﮔﻬﻲ ﺑﻬﺘﺮي در ﺑﺮ ﻧﺨﻮاﻫﺪ‬

‫‪ .%4/15‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻼﻳﻢ ﺑﻴﻤﺎران ﻫﻨﮕﺎم ﻣﺮاﺟﻌﻪ اﺣﺴﺎس ﭘﺮي ﺑﻮد ﻛﻪ‬

‫ﻛﺮد‪ 1.‬رادﻳﻮﺗﺮاﭘﻲ در اﻳﻦ ﺑﻴﻤﺎران اﺛﺮ زﻳﺎدي ﻧﺪارد‪ .‬ﻗﺒﻞ از اﻳﻦﻛﻪ‬

‫در ‪ %50‬از ﺑﻴﻤﺎران وﺟﻮد داﺷﺖ‪ .‬ﺳﺎﻳﺮ ﻋﻼﻳﻢ ﺑﻪﺗﺮﺗﻴﺐ ﺷﻴﻮع در‬

‫ﺧﻮنرﻳﺰي دﻳﺪه ﻣﻲﺷﻮد‪.‬‬

‫ﻣﻲﺷﻮﻧﺪ و ﺣﺪود ‪ %15-50‬ﻣﻮارد‬ ‫ﻣﻲدﻫﻨﺪ‪ 10.‬اﺻﻠﻲﺗﺮﻳﻦ درﻣﺎن‬

‫‪GIST‬‬

‫‪GIST‬‬

‫درﮔﻴﺮي ﺧﺎرج ﺷﻮﻧﺪ‪ 8.‬ﺑﺮﺧﻼف آدﻧﻮﻛﺎرﺳﻴﻨﻮمﻫﺎي ﮔﻮارﺷﻲ‪،‬‬

‫ﻣﻬﺎرﻛﻨﻨﺪهﻫﺎي‬ ‫ﺗﻮﻣﻮرﻫﺎي‬

‫‪KIT‬‬

‫‪GIST‬‬

‫ﺑﻪﻧﺎم ‪ Imatinib‬ﺗﻮﻟﻴﺪ ﺷﻮﻧﺪ ﺑﻪﻧﻈﺮ ﻣﻲرﺳﻴﺪ ﻛﻪ‬ ‫‪12‬و‪11‬‬

‫ﺑﻪ ﺷﻴﻤﻲدرﻣﺎﻧﻲ ﭘﺎﺳﺦ ﻗﺎﺑﻞ ﻗﺒﻮﻟﻲ ﻧﻤﻲدادﻧﺪ‪،‬‬

‫ﺟﺪول ‪ 1‬آورده ﺷﺪه اﺳﺖ‪ .‬ﺑﺮاي ﺗﺸﺨﻴﺺ ﻗﺒﻞ از ﻋﻤﻞ در ﺑﻴﻤﺎران‬ ‫روشﻫﺎي ﻣﺨﺘﻠﻔﻲ از ﺟﻤﻠﻪ آﻧﺪوﺳﻜﻮﭘﻲ‪ ،‬ﺑﻠﻊ ﺑﺎرﻳﻢ و‬

‫‪CT Scan‬‬

‫و‬

‫وﻟﻲ اﻣﺮوزه ‪ Imatinib‬درﻣﺎن اﻧﺘﺨﺎﺑﻲ اﻧﻮاع ﻏﻴﺮﻗﺎﺑﻞ ﺑﺮداﺷﺖ ﻳﺎ‬

‫ﺳﻮﻧﻮﮔﺮاﻓﻲ اﻧﺠﺎم ﺷﺪه ﺑﻮد‪ .‬در ‪ 18‬ﻣﻮرد از ﺑﻴﻤﺎران )‪ (%75‬آﻧﺪوﺳﻜﻮﭘﻲ‬

‫ﻣﺘﺎﺳﺘﺎﺗﻴﻚ ‪ GIST‬ﺷﺪه اﺳﺖ‪ 4.‬ﺣﺬف ﻛﺎﻣﻞ ﺟﺮاﺣﻲ در ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ‬

‫ﺑﻪﺗﺸﺨﻴﺺ ﻛﻤﻚ ﻛﺮده ﺑﻮد و در ﻫﺸﺖ ﻣﻮرد )‪ (%33‬ﻧﻴﺰ ﺑﻠﻊ ﺑﺎرﻳﻮم‬

‫ﺑﻘﺎي ﭘﻨﺞ ﺳﺎﻟﻪ ‪ %48-65‬اﻳﺠﺎد ﺧﻮاﻫﺪ ﻛﺮد‪ 1.‬ﻣﺎ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ‬

‫ﻧﺸﺎندﻫﻨﺪه ﺿﺎﻳﻌﻪ ﺑﻮد‪ CT Scan .‬در ﺗﻤﺎﻣﻲ ﺑﻴﻤﺎران ﻗﺒﻞ از ﻋﻤﻞ اﻧﺠﺎم‬

‫ﻣﺮي ﻣﻌﺪه در ﺑﻴﻤﺎران ﻣﺮاﺟﻌﻪﻛﻨﻨﺪه‬

‫ﺷﺪ‪ .‬ﺷﻜﻞ ‪ 1‬ﻧﻤﺎي ﺑﻠﻊ ﺑﺎرﻳﻢ ﺑﻴﻤﺎر ﺑﺎ ﻟﻴﻮﻣﻴﻮﻣﺎي ﻣﺮي را ﻧﺸﺎن ﻣﻲدﻫﺪ‬

‫‪GIST‬‬

‫ﺑﻪ ﺑﺮرﺳﻲ ﻣﻮارد ﺗﻮﻣﻮرﻫﺎي‬

‫‪GIST‬‬

‫ﺑﻪ دو ﻣﺮﻛﺰ ﻗﺎﺋﻢ و اﻣﻴﺪ ﻣﺸﻬﺪ ﻃﻲ ﺳﺎلﻫﺎي ‪ 1370-88‬ﭘﺮداﺧﺘﻴﻢ‪.‬‬

‫و ﺷﻜﻞ ‪ 2‬ﺳﻲﺗﻲاﺳﻜﻦ ﺑﻴﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ‪ GIST‬ﻣﻌﺪه را ﻧﺸﺎن ﻣﻲدﻫﺪ‪ .‬از‬ ‫ﺑﻴﻦ اﻳﻦ ‪ 24‬ﺑﻴﻤﺎر در زﻣﺎن ﻣﺮاﺟﻌﻪ ﺳﻪ ﻣﻮرد ﺿﺎﻳﻌﻪ وﺳﻴﻊ ﺑﺎ درﮔﻴﺮي‬

‫روش ﺑﺮرﺳﻲ‬

‫اﺣﺸﺎي ﻣﺠـﺎور )ﻃﺤﺎل( و دو ﻣـﻮرد ﻣﺘﺎﺳﺘﺎز ﻛﺒـﺪي ﻫﻢزﻣـﺎن ﻣﺸﺎﻫﺪه‬

‫در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﮔﺬﺷﺘﻪﻧﮕﺮ و ‪ Case-series‬ﺑﻴﻤﺎران ﺑﺴﺘﺮي ﺷﺪه در‬ ‫ﺑﻴﻤﺎرﺳﺘﺎنﻫﺎي ﻗﺎﺋﻢ و اﻣﻴﺪ ﻣﺸﻬﺪ ﻃﻲ ﺳﺎلﻫﺎي ‪ 1370-88‬ﻛﻪ ﺑﺎ‬ ‫ﺗﺸﺨﻴﺺ ﻧﻬﺎﻳﻲ ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺮي و ﻣﻌﺪه ﺑﻮد ﺗﺤﺖ درﻣﺎن‬

‫ﺟﺪول‪ :1-‬ﻋﻼﻳﻢ ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺮي و ﻣﻌﺪه ﻫﻨﮕﺎم ﻣﺮاﺟﻌﻪ‬ ‫)در ﺑﻌﻀﻲ از ﺑﻴﻤﺎران ﺑﻴﺶ از ﻳﻚ ﻋﻼﻣﺖ وﺟﻮد داﺷﺘﻪ اﺳﺖ(‬

‫ﻗﺮار ﮔﺮﻓﺘﻪ ﺑﻮدﻧﺪ‪ ،‬ﺑﺮرﺳﻲ ﺷﺪﻧﺪ‪ .‬در اﻳﻦ ﺑﻴﻤﺎران درﻣﺎن ﺟﺮاﺣﻲ و‬

‫ﻋﻼﻳﻢ‬

‫ﻓﺮاواﻧﻲ‬

‫درﺻﺪ‬

‫ﻛﻤﻮرادﻳﻮﺗﺮاﭘﻲ ﺑﺮاﺳﺎس ﺷﺮاﻳﻂ ﺑﻴﻤﺎر اﻧﺠﺎم ﺷﺪه اﺳﺖ‪ .‬اﻃﻼﻋﺎت‬

‫اﺣﺴﺎس ﭘﺮي‬

‫‪12‬‬

‫‪%50‬‬

‫ﺑﻴﻤﺎران ﺷﺎﻣﻞ ﺳﻦ و ﺟﻨﺲ و ﻋﻼﻳﻢ ﺑﺎﻟﻴﻨﻲ ﻫﻨﮕﺎم ﻣﺮاﺟﻌﻪ‪ ،‬روش‬

‫ﺑﻲاﺷﺘﻬﺎﻳﻲ‬

‫‪10‬‬

‫‪%42‬‬

‫ﻛﺎﻫﺶ وزن‬

‫‪8‬‬

‫‪%33‬‬

‫دﻳﺴﻔﺎژي‬

‫‪7‬‬

‫‪%29‬‬

‫ﺗﻮده ﺷﻜﻤﻲ‬

‫‪5‬‬

‫‪%21‬‬

‫درﻣﺎن ﻗﺮار ﮔﺮﻓﺘﻪ و اﻃﻼﻋﺎت از ﭘﺮوﻧﺪهﻫﺎي ﻣﻮﺟﻮد ﮔﺮدآوري ﺷﺪﻧﺪ‪.‬‬

‫درد ﺷﻜﻢ‬

‫‪4‬‬

‫‪%17‬‬

‫ﭘﺲ از ﺟﻤﻊآوري اﻃﻼﻋﺎت و رﺳﻢ ﺟﺪاول ﻓﺮاواﻧﻲ و ﻧﻤﻮدارﻫﺎ‪ ،‬آﻧﺎﻟﻴﺰ‬

‫ﺗﻬﻮع و اﺳﺘﻔﺮاغ‬

‫‪1‬‬

‫‪%4‬‬

‫ﺗﻮﺳﻂ ﻧﺮماﻓﺰار ‪ SPSS‬وﻳﺮاﺳﺖ ‪ 11/5‬اﻧﺠﺎم ﺷﺪ‪.‬‬

‫ﻫﻤﺎﺗﻤﺰ‬

‫‪1‬‬

‫‪%4‬‬

‫ﺗﺸﺨﻴﺼﻲ‪ ،‬ﻧﻮع ﺑﺎﻓﺖﺷﻨﺎﺳﻲ ﺗﻮﻣﻮر‪ ،‬ﻧﻮع درﻣﺎن اﻧﺠﺎمﺷﺪه و ﻋﻮارض‬ ‫ﻣﺮﺑﻮط ﺑﻪ درﻣﺎن ﻣﺮگ و ﻣﻴﺮ ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ و ﻃﻮل ﻋﻤﺮ ﺳﻪ ﺳﺎل ﺑﻌﺪ از‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪440‬‬

‫ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺮي و ﻣﻌﺪه‪ :‬ﺑﺮرﺳﻲ ‪ 24‬ﺑﻴﻤﺎر‬

‫ﺷﻜﻞ‪ :3-‬ﻣﺘﺎﺳﺘﺎز ﻛﺒﺪي ‪ GIST‬ﺗﻮﻣﻮر ﻣﻌﺪه‬

‫ﺷﻜﻞ‪ :1-‬ﺑﻠﻊ ﺑﺎرﻳﻢ ﺿﺎﻳﻌﻪ ﻟﻴﻮﻣﻴﻮم ﻣﺮي‬

‫ﺟﺪول‪ :2-‬اﻋﻤﺎل ﺟﺮاﺣﻲ در ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺮي و ﻣﻌﺪه‬ ‫ﻓﺮاواﻧﻲ‬

‫درﺻﺪ‬

‫ﻧﻮع ﻋﻤﻞ‬ ‫ﮔﺎﺳﺘﺮﻛﺘﻮﻣﻲ ﺳﺎب ﺗﻮﺗﺎل‬

‫‪7‬‬

‫‪%29‬‬

‫ﮔﺎﺳﺘﺮﻛﺘﻮﻣﻲ ﺗﻮﺗﺎل‬

‫‪6‬‬

‫‪%25‬‬

‫اﻧﻮﻛﻠﺌﺎﺳﻴﻮن ﺗﻮﻣﻮر از ﻣﺮي‬

‫‪4‬‬

‫‪%16‬‬

‫رزﻛﺴﻴﻮن ﮔﻮه اي ﻣﻌﺪه‬

‫‪5‬‬

‫‪%20‬‬

‫ازوﻓﺎژﻛﺘﻮﻣﻲ ﺗﺮاﻧﺲ ﺗﻮراﺳﻴﻚ‬

‫‪1‬‬

‫‪%5‬‬

‫ازوﻓﺎژﻛﺘﻮﻣﻲ ﺗﺮاﻧﺲ ﻫﻴﺎﺗﺎل‬

‫‪1‬‬

‫‪%5‬‬

‫ﻣﺠﻤﻮع‬

‫‪24‬‬

‫‪%100‬‬

‫ﻟﻴﻮﻣﻴﻮﺳﺎرﻛﻮم و ﻳﻚ ﺑﻴﻤﺎر )‪ (%4/1‬ﻟﻴﻮﻣﻴﻮﺑﻼﺳﺘﻮﻣﺎ ﮔﺰارش ﺷﺪه ﺑﻮد‪.‬‬ ‫ﺷﻜﻞ‪ :2-‬در ﺳﻲﺗﻲاﺳﻜﻦ ﮔﺴﺘﺮش ‪ GIST‬ﺗﻮﻣﻮر از ﺟﺪار ﻣﻌﺪه‬

‫ﻋﻮارض ﺑﻌﺪ از ﻋﻤﻞ ﻧﻴﺰ در ﭘﻨﺞ ﺑﻴﻤﺎر )‪ (%20/5‬ﺑﻴﻤﺎران ﻣﺸﺎﻫﺪه ﺷﺪه‬ ‫ﺑﻮد ﻛﻪ ﺑﻪﺗﺮﺗﻴﺐ ﺷﺎﻣﻞ اﻳﻠﺌﻮس ﺳﻪ ﺑﻴﻤﺎر )‪ (%13/3‬ﻋﻔﻮﻧﺖ زﺧﻢ‪ ،‬ﻳﻚ‬ ‫ﺑﻴﻤﺎر )‪ (%4/1‬و آﺗﻠﻜﺘﺎزي ﻳﻚ ﺑﻴﻤﺎر )‪ (%4/1‬ﺑﻮدﻧﺪ ﻛﻪ ﻫﻤﻪ ﺑﻬﺒﻮد ﻛﺎﻣﻞ‬

‫ﺷﺪه ﺑﻮد‪ .‬ﺷﻜﻞ ‪ 3‬ﻣﺘﺎﺳﺘﺎز ﻛﺒﺪي در ﺑﻴﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ‪ GIST‬ﻣﻌﺪه را ﻧﺸﺎن‬

‫ﭘﻴﺪا ﻛﺮدﻧﺪ‪ ،‬ﻓﻴﺴﺘﻮل ﺑﻌﺪ از ﻋﻤﻞ دﻳﺪه ﻧﺸﺪ‪ .‬در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﻫﺸﺖ ﺑﻴﻤﺎر‬

‫ﻣﻲدﻫﺪ‪ .‬ﺟﻬﺖ اﻳﻦ ﺑﻴﻤﺎران روشﻫﺎي ﺟﺮاﺣﻲ ﻣﺨﺘﻠﻔﻲ ﺑﻪﻛﺎر رﻓﺘﻪ ﺑﻮد‬

‫ﺑﻌﺪ از ﺟﺮاﺣﻲ ﻧﻴﺎز ﺑﻪ درﻣﺎن ﻛﻤﻜﻲ داﺷﺘﻨﺪ )‪ ،(%33/1‬ﻛﻪ در ﭘﻨﺞ ﺑﻴﻤﺎر‬

‫ﻛﻪ ﺷﺎﻳﻊﺗﺮﻳﻦ آنﻫﺎ ﮔﺎﺳﺘﺮﻛﺘﻮﻣﻲ ﺳﺎبﺗﻮﺗﺎل در ‪ %29‬از ﺑﻴﻤﺎران ﺑﻮد‪.‬‬

‫)‪ (%20/5‬از ‪ Imatinib‬ﺳﻮد ﺑﺮده ﻛﻪ از اﻳﻦ ﺑﻴﻤﺎران دو ﺑﻴﻤﺎر ﺑﺎ ﻣﺘﺎﺳﺘﺎز‬

‫روشﻫﺎي درﻣﺎﻧﻲ دﻳﮕﺮ ﺑﻪﺗﺮﺗﻴﺐ ﺷﻴﻮع در ﺟﺪول ‪ 2‬ﻧﺸﺎن داده‬

‫ﻛﺒﺪي در زﻣﺎن ﺗﺸﺨﻴﺺ ﺑﺎ دوز ‪ 600mg‬ﺗﺤﺖ درﻣﺎن ﻗﺮار ﮔﺮﻓﺘﻪ و ﺗﺎ‬

‫ﺷﺪهاﻧﺪ‪ .‬در ﺳﻪ ﻣﻮرد )‪ (%11/5‬از ﺑﻴﻤﺎران ﺿﻤﻦ اﻧﺠﺎم ﮔﺎﺳﺘﺮﻛﺘﻮﻣﻲ‬

‫زﻣﺎن ﺣﻴﺎت )‪ 1/5‬و دو ﺳﺎل ﺑﻌﺪ از ﺟﺮاﺣﻲ اوﻟﻴﻪ( اﻳﻦ دارو را ﺑﺎ ﻛﻨﺘﺮل‬

‫ﺑﻪﻋﻠﺖ درﮔﻴﺮي ﻣﺠﺎورﺗﻲ اﺳﭙﻠﻨﻜﺘﻮﻣﻲ ﻧﻴﺰ اﻧﺠﺎم ﺷﺪه اﺳﺖ و در دو‬

‫آﻧﺰﻳﻢﻫﺎي ﻛﺒﺪي درﻳﺎﻓﺖ ﻛﺮدﻧﺪ و ﺳﻪ ﺑﻴﻤﺎر دﻳﮕﺮ ﺑﻪﻋﻨﻮان درﻣﺎن‬

‫ﺑﻴﻤﺎر ﻛﻪ ﻣﺘﺎﺳﺘﺎز ﻛﺒﺪي داﺷﺘﻨﺪ ﻧﻴﺰ ﺗﻮﻣﻮر ﺑﺎ ﺗﻮﺗﺎل ﮔﺎﺳﺘﺮﻛﺘﻮﻣﻲ‬

‫ﻛﻤﻜﻲ در ﻓﺮمﻫﺎي ﮔﺴﺘﺮش ﻣﻮﺿﻌﻲ و ﺑﺪون ﻣﺘﺎﺳﺘﺎز دوردﺳﺖ ﺑﻪﻣﻴﺰان‬

‫ﺑﻪﺻﻮرت ﻛﺎﻣﻞ ﻗﺎﺑﻞ اﻧﺠﺎم ﺑﻮد و ﺗﻨﻬﺎ ﻧﻤﻮﻧﻪﺑﺮداري از ﻛﺒﺪ اﻧﺠﺎم‬

‫‪ 400mg‬ﺗﺎ ﻳﻚﺳﺎل ﺑﻌﺪ از ﻋﻤﻞ دارو را درﻳﺎﻓﺖ ﻧﻤﻮدﻧﺪ‪ .‬دو ﺑﻴﻤﺎر‬

‫ﺷﺪ‪ .‬ﺷﻜﻞ ‪ 4‬ﻧﻤﺎي اﻧﻮﻛﻠﺌﺎﺳﻴﻮن را ﺣﻴﻦ ﺟﺮاﺣﻲ ﻟﻴﻮﻣﻴﻮﻣﺎي ﻣﺮي‬

‫ﺑﻪﻋﻠﺖ ﻟﻴﻮﻣﻴﻮﺳﺎرﻛﻮﻣﺎي ﻣﺮي ﺗﺤﺖ ﻛﻤﻮﺗﺮاﭘﻲ و رادﻳﻮﺗﺮاﭘﻲ ﺑﻌﺪ از‬

‫دﻳﺴﺘﺎل ﻧﺸﺎن ﻣﻲدﻫﺪ‪ .‬ﻧﺘﻴﺠﻪ ﭘﺎﺗﻮﻟﻮژي در اﻳﻦ ﺑﻴﻤﺎران ‪ 12‬ﺑﻴﻤﺎر )‪(%50‬‬

‫ﻋﻤﻞ و ﻳﻚ ﺑﻴﻤﺎر ﻧﻴﺰ ﺑﻪﻋﻠﺖ ﻟﻴﻮﻣﻴﻮﺑﻼﺳﺘﻮﻣﺎي ﻣﺮي ﺗﺤﺖ ﻛﻤﻮﺗﺮاﭘﻲ‬

‫ﻣﻮارد ‪ ،GIST‬ﻫﺸﺖ ﺑﻴـﻤﺎر )‪ (%33/1‬ﻣﻮارد ﻟﻴﻮﻣﻴﻮم‪ ،‬ﺳﻪ ﺑﻴﻤﺎر )‪(%12/5‬‬

‫ﺑﻌـﺪ از ﻋﻤﻞ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬در ﭘﻲﮔﻴـﺮي ﺳﻪ ﺳﺎل ﺑﻌـﺪ از درﻣـﺎن در دو‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫رﺿﺎ ﺑﺎﻗﺮي و ﻫﻤﻜﺎران‬

‫‪441‬‬

‫اﻳﻦ ﺑﻴﻤﺎران ﺛﺒﺖ ﺷﺪه اﺳﺖ‪ 14.‬ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ﺑﻴﻤﺎران ﺑﻴﻦ ‪ 53‬ﺗﺎ ‪ 49‬ﺳﺎل‬

‫اﻟﻒ‬

‫ﮔﺰارش ﮔﺮدﻳﺪه ﺑﻮد‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ ﺗﻔﺎوت زﻳﺎدي ﺑﻴﻦ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ‬ ‫در ﻣﻄﺎﻟﻌﺎت وﺟﻮد ﻧﺪارد ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ ﻛﻪ ﭘﺮاﻛﻨﺪﮔﻲ ﺳﻨﻲ آن ﺗﺤﺖ‬ ‫ﺗﺄﺛﻴﺮ ﻋﻮاﻣﻞ ﻣﺤﻴﻄﻲ ﻧﻴﺴﺖ‪ 15.‬در ﺑﺮﺧﻲ ﻣﻄﺎﻟﻌﺎت ذﻛﺮ ﺷﺪه ﻛﻪ ﺑﺮﺗﺮي‬ ‫واﺿﺢ ﺟﻨﺴﻲ در اﻳﻦ ﺑﻴﻤﺎران وﺟﻮد ﻧﺪارد‪ 1.‬در ﻣﻄﺎﻟﻌﻪ ‪ Rabin‬ﻛﻪ ﺑﻪ‬ ‫ﻣﺪت ‪ 19‬ﺳﺎل اﻳﻦ ﮔﺮوه ﺑﻴﻤﺎران را ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار داده ﺑﻮد‪ ،‬ﻧﺴﺒﺖ‬ ‫ﺟﻨﺴﻲ ﻣﺮد ﺑﻪ زن ‪ 1/3‬ﺑﻪ ﻳﻚ ﺑﻪدﺳﺖ آﻣﺪه ﺑﻮد‪ 16.‬در ﻣﻄﺎﻟﻌﻪ ‪ Hiki‬در‬ ‫ﺳﺎل ‪ ،2008‬ﺗﻤﺎم ﺑﻴﻤﺎران ﻣﻮﻧﺚ ﺑﻮدﻧﺪ ﻛﻪ ﺑﺎ ﻫﻴﭻﻳﻚ از ﻣﻄﺎﻟﻌﺎت ﻗﺒﻠﻲ‬ ‫و اﻋﺪاد و ارﻗﺎم ﺛﺒﺖ ﺷﺪه در رﻓﺮﻧﺲﻫﺎي ﻗﺒﻠﻲ ﺗﺸﺎﺑﻪ و ﻫﻢﺧﻮاﻧﻲ‬ ‫ﻧﺪارد‪ 15.‬در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﻣﺘﻮﺳﻂ ﺳﻨﻲ ﺑﻴﻤﺎران ‪ 50‬ﺳﺎل ﺑﻮده و ﺑﻴﻤﺎري در‬ ‫ﻣﺮدان ﺷﺎﻳﻊﺗﺮ ﺑﻮده اﺳﺖ‪ .‬ﺑﺮرﺳﻲﻫﺎ ﻧﺸﺎن داده اﺳﺖ ﻛﻪ ﺑﺮوز‬

‫ب‬

‫ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﮔﻮارﺷﻲ ﺑﻪﺧﺼﻮص ‪ GIST‬در ﺳﺮﺗﺎﺳﺮ ﻃﻮل ﻟﻮﻟﻪ‬ ‫ﮔﻮارش ﻳﻜﺴﺎن ﻧﻴﺴﺖ و در ﺑﻌﻀﻲ ﻗﺴﻤﺖﻫﺎ اﻳﻦ ﺗﻮﻣﻮرﻫﺎ ﺷﺎﻳﻊﺗﺮﻧﺪ‪.‬‬ ‫ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ ﻛﻪ ﺷﺎﻳﻊﺗﺮﻳﻦ ﻣﺤﻞ ﺑﺮاي اﻳﺠﺎد و ﺑﺮوز اﻳﻦ ﺗﻮﻣﻮرﻫﺎ‬ ‫‪8‬و‪1‬‬

‫ﻣﻌﺪه ﺑﺎﺷﺪ‬

‫ﻛﻪ در ﻣﻮرد ﺑﻴﻤﺎران ﻣﺎ ﻧﻴﺰ اﻳﻦ ﻣﺴﺄﻟﻪ ﺻﺪق ﻣﻲﻛﺮد‬

‫ﺑﻪﻃﻮري ﻛﻪ در ‪ %71/5‬ﺑﻴﻤﺎران ﺗﻮﻣﻮر در ﻣﻌﺪه اﻳﺠﺎد ﺷﺪه ﺑﻮد و ﻓﻘﻂ‬ ‫ﺷﻜﻞ‪ :4-‬اﻟﻒ( ﻧﻤﺎي اﻧﻮﻛﻠﺌﺎﺳﻴﻮن ﺣـﻴﻦ ﺟﺮاﺣـﻲ ﻟﻴﻮﻣﻴﻮﻣـﺎي ﻣـﺮي‪ ،‬ب( ﻧﻤﻮﻧـﻪ‬

‫در ‪ %28/5‬ﺑﺎﻗﻲﻣﺎﻧﺪه ﺗﻮﻣﻮر در ﻣﺮي ﻣﺸﺎﻫﺪه ﻣﻲﺷﺪ‪ .‬اﻳﻦ اﻓﺰاﻳﺶ ﺑﺮوز‬ ‫ﺗﻮﻣﻮر در ﻣﻌﺪه در ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎت ﻧﻴﺰ ذﻛﺮ ﺷﺪه ﺑﻮد از ﺟﻤﻠﻪ در ﻣﻄﺎﻟﻌﻪ‬

‫رزﻛﺴﻴﻮن ﺗﻮﻣﻮر ﻟﻴﻮﻣﻴﻮم ﻣﺮي‬

‫‪ Rabin‬ﻧﻴﺰ در ‪ %66/2‬از ﺑﻴﻤﺎران ﺗﻮﻣﻮر در ﻣﻌﺪه داﺷﺘﻨﺪ‪ 16‬و ﻳﺎ در‬ ‫ﻣﻄﺎﻟﻌﻪاي ﻛﻪ ‪ Aydia A‬در ﺗﺮﻛﻴﻪ اﻧﺠﺎم داد ﻧﻴﺰ ‪ %68‬ﺗﻮﻣﻮرﻫﺎ در ﻣﻌﺪه‬ ‫ﺑﻴﻤﺎر ﻛﻪ ﻣﺘﺎﺳﺘﺎز ﻛﺒﺪي ﺑﺎ ‪ GIST‬ﻣﻌﺪه در ﻫﻨﮕﺎم ﻣﺮاﺟﻌﻪ داﺷﺘﻪاﻧﺪ ﻓﻮت‬

‫ﮔﺰارش ﺷﺪه ﺑﻮد‪ 2.‬در ﻣﻄﺎﻟﻌﻪ ‪ El-zohairy‬ذﻛﺮ ﺷﺪه ﻛﻪ ‪ %39/4‬از‬

‫ﻧﻤﻮده و ﻳﻚ ﺑﻴﻤﺎر ﻣﺒﺘﻼ ﺑـﻪ ﻟﻴﻮﻣﻴﻮﺑﻼﺳـﺘﻮﻣﺎي ﻣـﺮي دو ﺳـﺎل ﺑﻌـﺪ از‬

‫ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺗﻮﻣﻮر ﻣﻌﺪه ﺑﻮدﻧﺪ اﻣﺎ ﺑﺎز ﻫﻢ ﻣﻌﺪه ﺷﺎﻳﻊﺗﺮﻳﻦ ﻣﺤﻞ‬ ‫‪1‬‬

‫ﺟﺮاﺣﻲ ﺑﻪﻋﻠﺖ ﻣﺘﺎﺳﺘﺎز دوردﺳﺖ ﻓﻮت ﻧﻤﻮدﻧﺪ و ﺑﻘﻴـﻪ ﺑﻴﻤـﺎران زﻧـﺪه‬

‫اﺑﺘﻼ ﺑﻮده اﺳﺖ‪ .‬ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﮔﻮارﺷﻲ ﻣﻌﻤﻮﻻً ﺑﺪون ﻋﻼﻣﺖ‬

‫ﻣﺎﻧﺪﻧﺪ‪ %87/55 .‬ﺑﻴﻤﺎران ﻇﺮف ﺳﻪ ﺳﺎل ﺑﻌﺪ از درﻣﺎن زﻧﺪه ﻣﺎﻧﺪﻧﺪ‪.‬‬

‫ﻫﺴﺘﻨﺪ ﻳﺎ ﻋﻼﻳﻢ ﻏﻴﺮاﺧﺘﺼﺎﺻﻲ اﻳﺠﺎد ﻣﻲﻛﻨﻨﺪ‪ .‬ﻫﺮﭼﻨﺪ ﻛﻪ در ﺑﺮﺧﻲ‬ ‫ﻣﻮارد ﺑﻪﺧﺼﻮص در ﻣﻮارد ﭘﻴﺸﺮﻓﺘﻪ ﺑﻴﻤﺎري ﻣﻤﻜﻦ اﺳﺖ ﻋﻼﻳﻤﻲ ﭼﻮن‬

‫ﺑﺤﺚ‬

‫ﺗﻮده ﺷﻜﻤﻲ‪ ،‬درد ﺷﻜﻤﻲ ﻳﺎ ﺧﻮنرﻳﺰي ﺑﺮوز ﻛﻨﺪ‪ 10،‬ﺗﻤﺎم ﺑﻴﻤﺎران در‬

‫ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل دﺳﺘﮕﺎه ﮔﻮارش از ﺑﻴﻤﺎريﻫﺎي ﻧﺎﺷﺎﻳﻊ ﻫﺴﺘﻨﺪ‬

‫زﻣﺎن ﺗﺸﺨﻴﺺ ﻋﻼﻣﺖدار ﺑﻮده‪ ،‬اﻣﺎ ﺷﻜﺎﻳﺎت دﻳﮕﺮي ﭼﻮن ﻛﺎﻫﺶ‬

‫ﻛﻪ ﺑﺮوز آنﻫﺎ در ﻧﻘﺎط ﻣﺨﺘﻠﻒ دﻧﻴﺎ اﺧﺘﻼف ﭼﻨﺪاﻧﻲ ﻧﺪارد‪ 13‬و ﺑﻪ‬

‫وزن‪ ،‬دﻳﺴﻔﺎژي‪ ،‬ﺗﻮده ﺷﻜﻤﻲ‪ ،‬درد ﺷﻜﻢ و ﺗﻬﻮع و اﺳﺘﻔﺮاغ ﻧﻴﺰ در‬

‫ﮔﺮوهﻫﺎي ﻣﺨﺘﻠﻔﻲ ﺗﻘﺴﻴﻢ ﻣﻲﺷﻮﻧﺪ ﻛﻪ ﺷﺎﻣﻞ ﻟﻴﻮﻣﻴﻮم‪ ،‬ﻟﻴﻮﻣﻴﻮﺳﺎرﻛﻮم‪،‬‬

‫ﺑﻴﻤﺎران ﮔﺰارش ﺷﺪه ﺑﻮد‪ .‬در ﺑﻴﻦ ﺑﻴﻤﺎران ﻣﺼﺮي ﺧﻮنرﻳﺰي ﮔﻮارﺷﻲ‬

‫ﻟﻴﻮﻣﻴﻮﺑﻼﺳﺘﻮﻣﺎ و ﺷﻮاﻧﻮﻣﺎ ﻣﻲﺑﺎﺷﻨﺪ وﻟﻲ ﺷﺎﻳﻊﺗﺮﻳﻦ ﻧﻮع آنﻫﺎ ﺑﻪﻋﻨﻮان‬

‫ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻼﻣﺖ ﺑﻮد و ﻧﻴﺰ ﻓﻘﻂ ‪ %33/3‬از ﺑﻴﻤﺎران از ﺗﻮده ﺷﻜﻤﻲ‬

‫ﮔﺮوه‬

‫‪GIST‬‬

‫ﻃﺒﻘﻪﺑﻨﺪي ﻣﻲﺷﻮﻧﺪ‪ .‬ﺗﻮﻣﻮرﻫﺎي ﮔﺮوه‬

‫‪GIST‬‬

‫ﻣﺎرﻛﺮﻫﺎي اﻳﻤﻮﻧﻮﻫﻴﺴﺘﻮﺷﻴﻤﻴﺎﻳﻲ ﺗﺸﺨﻴﺺ داده ﻣﻲﺷﻮﻧﺪ‬ ‫‪CD117‬‬

‫و‬

‫‪CD34‬‬

‫ﺑﺮاﺳﺎس‬ ‫‪C-Kit‬‬

‫و‬

‫ﺷﻜﺎﻳﺖ داﺷﺘﻨﺪ‪.‬‬

‫‪16‬‬

‫در ﮔﺰارش ‪ Berindoague R‬از ﻛﺸﻮر اﺳﭙﺎﻧﻴﺎ‪،‬‬

‫ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻼﻳﻢ آﻧﻤﻲ )‪ (%77‬و ﺧﻮنرﻳﺰي ﮔﻮارﺷﻲ )‪ (%68‬ﺑﻮده‬ ‫‪17‬‬

‫در اﻳﻦ ﺗﻮﻣﻮرﻫﺎ ﻣﺜﺒﺖ اﺳﺖ‪ .‬اﻳﻦ ﺑﻴﻤﺎران ﺑﻪ رژﻳﻢﻫﺎي‬

‫اﺳﺖ‪ .‬در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﺗﻤﺎم ﺑﻴﻤﺎران در زﻣﺎن ﺗﺸﺨﻴﺺ ﻋﻼﻣﺖدار ﺑﻮده و‬

‫ﻣﻌﻤﻮﻟﻲ ﻛﻤﻮﺗﺮاﭘﻲ ﻣﻘﺎوم ﻫﺴﺘﻨﺪ وﻟﻲ ﭘﺎﺳﺦ ﻣﻨﺎﺳﺐ ﺑﻪ ‪ Imatinib‬در‬

‫ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻼﻣﺖ ﻧﻴﺰ اﺣﺴﺎس ﭘﺮي و ﺑﻲاﺷﺘﻬﺎﻳﻲ ﺑﻮده و ﻫﻤﺎﺗﻤﺰ ﺗﻨﻬﺎ‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫‪ :Bagheri‬ﺑﺮرﺳﻲ ‪ 24‬ﺑﻴﻤﺎر‬ ‫ﻣﺮي و ﻣﻌﺪه‬ ‫ﺗﻮﻣﻮرﻫﺎي‬ ‫ﻣﺰاﻧﺸﻴﻤﺎل ‪R.‬‬ ‫‪et al.‬‬

‫‪442‬‬

‫در ﻳﻚ ﺑﻴﻤﺎر ﻣﺎ ﺑﻪﻋﻨﻮان ﻋﻼﻣﺖ ﻣﻬﻢ وﺟﻮد داﺷﺘﻪ اﺳﺖ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ‬

‫ﻧﺪاﺷﺖ و ﻋﻮارض در ﭘﻨﺞ ﺑﻴﻤﺎر )‪ (%20/5‬ﺑﻌﺪ از ﻋﻤﻞ دﻳﺪه ﺷﺪ ﻛﻪ‬

‫ﻣﺤﻞ آﻧﺎﺗﻮﻣﻴﻚ ﺿﺎﻳﻌﻪ و ﻧﻴﺰ وﺳﻌﺖ ﺿﺎﻳﻌﻪ اﻋﻤﺎل ﺟﺮاﺣﻲ ﻣﺨﺘﻠﻔﻲ در‬

‫ﺷﺎﻳﻊﺗﺮﻳﻦ آن اﻳﻠﺌﻮس ﺑﻌﺪ از ﻋﻤﻞ ﺑﻮده اﺳﺖ‪ .‬در ﻣﻮرد ﻧﻘﺶ‬

‫ﺑﻴﻤﺎران اﻧﺠﺎم ﺷﺪه اﺳﺖ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺟﺎﻳﮕﺎه اﺻﻠﻲ اﻳﻦ ﺗﻮﻣﻮرﻫﺎ در‬

‫رادﻳﻮﺗﺮاﭘﻲ در اﻳﻦ ﺗﻮﻣﻮرﻫﺎ ﻧﺘﺎﻳﺞ ﻣﻮﺛﻘﻲ وﺟﻮد ﻧﺪاﺷﺘﻪ و اﻏﻠﺐ ﺑﻪ‬

‫ﻣﻌﺪه اﺳﺖ‪ ،‬ﻣﻌﻤﻮﻻ ﺷﺎﻳﻊﺗﺮﻳﻦ اﻋﻤﺎل ﮔﺎﺳﺘﺮﻛﺘﻮﻣﻲ ﺗﻮﺗﺎل ﻳﺎ ﺳﺎبﺗﻮﺗﺎل‬

‫رادﻳﻮﺗﺮاﭘﻲ ﻣﻘﺎوم ﻫﺴﺘﻨﺪ‪ .‬ﺑﻌﺪ از ﻛﺸﻒ ﻣﻬﺎرﻛﻨﻨﺪه ‪ KIT‬ﺑﻪﻧﺎم‬

‫‪Imatinib‬‬

‫اﺳﺖ ﻛﻪ ﻧﺘﺎﻳﺞ ﻣﺘﻐﻴﺮي در ﻣﻄﺎﻟﻌﺎت ﻣﺘﻌﺪد ﺑﻴﻦ ‪ 30‬ﺗﺎ ‪ %35‬ﻛﻞ ﺑﻴﻤﺎران‬

‫ﻧﺘﺎﻳﺞ ﻣﻨﺎﺳﺒﻲ از درﻣﺎن ﺷﻴﻤﻲدرﻣﺎﻧﻲ در ﻓﺮمﻫﺎي ﻣﺘﺎﺳﺘﺎﺗﻴﻚ‬

‫‪18‬و‪16‬و‪2‬‬

‫‪GIST‬‬

‫و‬

‫در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﻧﻴﺰ ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻤﻞ ﺟﺮاﺣﻲ ﻧﻴﺰ‬

‫ﻓﺮمﻫﺎي ﻏﻴﺮﻗﺎﺑﻞ ﺑﺮداﺷﺖ آن ﮔﺰارش ﺷﺪه اﺳﺖ‪ ،‬ﺑﺎ اﻳﻦ ﺣﺎل در ﺳﺎﻳﺮ‬

‫ﺳﺎبﺗﻮﺗﺎل ﮔﺎﺳﺘﺮﻛﺘﻮﻣﻲ ﺑﻮده ﻛﻪ در ‪ %29‬ﺑﻴﻤﺎران اﻧﺠﺎم ﺷﺪه اﺳﺖ‪ .‬از‬

‫ﻓﺮمﻫﺎي ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺜﻞ ﻟﻴﻮﻣﻴﻮﺳﺎرﻛﻮﻣﺎ و ﻟﻴﻮﻣﻴﻮﺑﻼﺳﺘﻮﻣﺎ‬

‫ﻧﻈﺮ ﺷﻴﻮع اﻧﻮاع ﭘﺎﺗﻮﻟﻮژﻳﻚ اﻳﻦ ﺗﻮﻣﻮرﻫﺎ ﻧﻴﺰ ﻣﻄﺎﻟﻌﺎت ﻣﺘﻌﺪدي اﻧﺠﺎم‬

‫اﻧﺠﺎم ﺷﻴﻤﻲدرﻣﺎﻧﻲ ﺑﺎ رژﻳﻢ ﻣﻨﺎﺳﺐ ﺑﺎ ﻳﺎ ﺑﺪون رادﻳﻮﺗﺮاﭘﻲ ﺗﻮﺻﻴﻪ‬

‫ﺷﺪه اﺳﺖ در ﻣﻄﺎﻟﻌﻪاي ﻛﻪ ‪ Yafa Wu‬ﮔﺰارش ﻛﺮد‪ ،‬ﺷﺎﻳﻊﺗﺮ ﻧﻮع‬

‫ﻣﻲﺷﻮد‪ 20.‬ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ ﻛﻪ ﺑﻪدﻟﻴﻞ ﺷﻴﻮع ﻛﻢ ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل‬

‫داﻧﺴﺘﻪ ﻛﻪ اﻛﺜﺮا ﻓﺮم‬

‫ﮔﻮارﺷﻲ ﻧﺴﺒﺖ ﺑﻪﺳﺎﻳﺮ ﺗﻮﻣﻮرﻫﺎي ﮔﻮارﺷﻲ ﻧﻴﺎز ﺑﻪ ﻣﻄﺎﻟﻌﺎت ﺑﻴﺸﺘﺮ در‬

‫ﺧﻮشﺧﻴﻢ ﺑﻮدﻧﺪ )‪ (%57‬و در ﻓﺮمﻫﺎي ﺧﻮشﺧﻴﻢ ﻣﻌﻤﻮﻻ ﻋﻮد و ﺑﺮوز‬

‫اﻳﻦ زﻣﻴﻨﻪ وﺟﻮد داﺷﺘﻪ ﺑﺎﺷﺪ‪ .‬ﻫﻢﭼﻨﻴﻦ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ در ﺳﺎلﻫﺎي‬

‫ﻣﺘﺎﺳﺘﺎز ﺑﻌﺪ از درﻣﺎن وﺟﻮد ﻧﺪاﺷﺖ وﻟﻲ در ﻓﺮمﻫﺎي ﺑﺪﺧﻴﻢ )‪(%36‬‬

‫اﺧﻴﺮ ﺗﺄﻛﻴﺪ روي ﭘﺎﺳﺦ درﻣﺎﻧﻲ ﺑﻪ ‪ Imatinib‬ﺷﺪه اﺳﺖ‪ .‬ﺑﺮرﺳﻲ‬

‫ﻣﻴﺰان ﻋﻮد و ﻣﺘﺎﺳﺘﺎز دوردﺳﺖ اﺳﺖ ﺑﺎﻻﺗﺮ ﺑﻮده و ﻋﻠﺖ ﻣﺮگ ﺑﻴﻤﺎران‬

‫ﻣﺎرﻛﺮﻫﺎي اﻳﻤﻮﻧﻮﻫﻴﺴﺘﻮﺷﻴﻤﻴﺎﻳﻲ ﺟﻬﺖ اﻓﺘﺮاق ‪ GIST‬از ﺳﺎﻳﺮ اﻧﻮاع اﻳﻦ‬

‫ﻧﻴﺰ ﻣﺘﺎﺳﺘﺎز دوردﺳﺖ ﺑﻮده اﺳﺖ‪ .‬در آن ﻣﻄﺎﻟﻌﻪ ﻧﺘﺎﻳﺞ ﭘﻴﺶآﮔﻬﻲ ﺗﻮﻣﻮر‬

‫ﺗﻮﻣﻮرﻫﺎ ﺿﺮوري ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ اﻛﺜﺮ اﻳﻦ ﺑﻴﻤﺎران‬

‫را ﺑﻪ ﺣﺠﻢ ﺗﻮﻣﻮر و ﻣﻴﺰان ﺑﺪﺧﻴﻤﻲ آن در ﺑﺮرﺳﻲ ﭘﺎﺗﻮﻟﻮژي ﻣﺮﺗﺒﻂ‬

‫ﺑﺪون ﻋﻼﻣﺖ ﻫﺴﺘﻨﺪ و ﻳﺎ ﻋﻼﻳﻢ ﻏﻴﺮاﺧﺘﺼﺎﺻﻲ ﺑﺮوز ﻣﻲدﻫﻨﺪ و‬

‫داﻧﺴﺘﻨﺪ‪ 18.‬ﻧﺘﺎﻳﺞ ﻣﺸﺎﺑﻬﻲ ﻧﻴﺰ در ﻣﻄﺎﻟﻌﻪ ‪ El- Zohairy‬ﮔﺰارش ﺷﺪه و‬

‫ﻫﻢﭼﻨﻴﻦ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻣﻜﺎن اﻧﺠﺎم اﻧﻮاع ﻣﺨﺘﻠﻒ ﺟﺮاﺣﻲﻫﺎ و درﻣﺎنﻫﺎي‬

‫وي ﻋﻮاﻣﻞ ﻣﺴﺎﻋﺪ ﭘﻴﺶآﮔﻬﻲ را رزﻛﺴﻴﻮن ﻧﺎﻛﺎﻣﻞ و درﺟﻪﺑﻨﺪي‬

‫ﺗﻜﻤﻴﻠﻲ ﺗﻮﺻﻴﻪ ﻣﻲﺷﻮد ﻛﻪ در ﻣﻮارد ﻣﺸﻜﻮك ﺑﺮرﺳﻲﻫﺎي ﺗﺸﺨﻴﺼﻲ‬

‫)‪ (Grading‬ﭘﺎﺗﻮﻟﻮژي ﺗﻮﻣﻮر ذﻛﺮ ﻛﺮده اﺳﺖ‪ 1.‬ﻣﻴﺰان ﻋﻮد ﻣﻮﺿﻌﻲ ﻳﺎ‬

‫دﻗﻴﻖﺗﺮ اﻧﺠﺎم ﺷﻮد‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ ﺟﺮاﺣﻲ در اﻳﻦ ﺑﻴﻤﺎران ﺑﺎ ﺣﺪاﻗﻞ‬

‫ﻣﺘﺎﺳﺘﺎز دوردﺳﺖ ﺑﻌﺪ از ﺟﺮاﺣﻲ و ﻣﺮگ در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﻧﻴﺰ در ﺳﻪ ﺑﻴﻤﺎر‬

‫ﻣﻮرﺑﻴﺪﻳﺘﻲ و ﻣﻮرﺗﺎﻟﻴﺘﻲ ﻫﻤﺮاه اﺳﺖ ﺑﻪﻋﻨﻮان اﺻﻠﻲﺗﺮﻳﻦ ﺑﺨﺶ درﻣﺎن‬

‫وﺟﻮد داﺷﺖ ﻛﻪ دو ﺑﻴﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ﻓﺮم ﺗﻬﺎﺟﻤﻲ ‪ GIST‬و ﻣﺘﺎﺳﺘﺎز ﻛﺒﺪي‬

‫اﻳﻦ ﺑﻴﻤﺎران ﺗﻮﺻﻴﻪ ﻣﻲﮔﺮدد‪.‬‬

‫داﺷﺘﻪاﻧﺪ‪.‬‬

‫ﭘﺎﺗﻮﻟﻮژﻳﻚ اﻳﻦ ﺗﻮﻣﻮرﻫﺎ را در ﻣﻌﺪه‬

‫‪GIST‬‬

‫ﻫﻢزﻣﺎن ﺑﻮده و دﻳﮕﺮي ﻣﺒﺘﻼ ﺑﻪ ﻟﻴﻮﻣﻴﻮﺑﻼﺳﺘﻮﻣﺎي ﻣﺮي ﺑﻮد‪ .‬در ﻣﻮرد‬

‫ﺳﭙﺎﺳﮕﺰاري‪ :‬اﻳﻦ ﻣﻘﺎﻟﻪ از ﭘﺎﻳﺎنﻧﺎﻣﻪ آﻗﺎي ﻣﺤﻤﺪ ﺻﺎدق ﻓﺘﻮﻧﻲ ﺑﺎ‬

‫ﻋﻮارض و ﻣﺮگ و ﻣﻴﺮ ﺑﻌﺪ از ﺟﺮاﺣﻲ ﻧﺘﺎﻳﺞ ﻣﺘﻐﻴﺮي اﺷﺎره ﺷﺪه اﺳﺖ‪،‬‬

‫ﻣﻮﺿﻮع ﺑﺮرﺳﻲ ﺗﻮﻣﻮرﻫﺎي ﻣﺰاﻧﺸﻴﻤﺎل ﻣﺮي و ﻣﻌﺪه در ﺑﻴﻤﺎران‬

‫‪ Braghetto‬ﮔﺰارش ﻧﻤﻮد ﻛﻪ ﻫﻴﭻ ﻣﻮرد ﻋﺎرﺿﻪ و ﻣﺮگ و ﻣﻴﺮ ﺑﻌﺪ از‬

‫ﻣﺮاﺟﻌﻪﻛﻨﻨﺪه ﺑﻪ ﺑﻴﻤﺎرﺳﺘﺎن ﻗﺎﺋﻢ )ﻋﺞ( و اﻣﻴﺪ ﻣﺸﻬﺪ در ﻓﺎﺻﻠﻪ ﺳﺎلﻫﺎي‬

‫ﻋﻤﻞ ﻧﺪاﺷﺖ‪ 19.‬در ﻣﻄﺎﻟﻌﻪ ‪ ،Eisenberg‬ﻣﺮگ و ﻣﻴﺮ ﺑﻴﻤﺎرﺳﺘﺎﻧﻲ ﮔﺰارش‬

‫‪ 1370-86‬اﺳﺘﺨﺮاج ﮔﺮدﻳﺪه اﺳﺖ‪ .‬ﺑﺪﻳﻦوﺳﻴﻠﻪ از ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺸﻲ‬

‫ﻧﺸﺪ‪ ،‬وﻟﻲ ﻋﻮارﺿﻲ ﻣﺜﻞ ﻋﻔﻮﻧﺖ زﺧﻢ و ﺧﻮنرﻳﺰي ﮔﻮارﺷﻲ ﺑﻌﺪ از‬

‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺸﻬﺪ ﻛﻪ در اﻳﻦ ﭘﮋوﻫﺶ ﻧﻮﻳﺴﻨﺪﮔﺎن ﻣﻘﺎﻟﻪ را‬

‫ﻋﻤﻞ را ذﻛﺮ ﻧﻤﻮد‪ 20.‬در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﻣﺮگ و ﻣﻴﺮ ﺑﻌﺪ از ﻋﻤﻞ وﺟﻮد‬

‫ﻳﺎري ﻧﻤﻮدهاﻧﺪ‪ ،‬ﺻﻤﻴﻤﺎﻧﻪ ﺗﺸﻜﺮ ﻣﻲﺷﻮد‪.‬‬

‫‪and prognostic classification based on tumor size and MIB-1 grade.‬‬ ‫‪Hum Pathol 2002;33(6):669-76.‬‬ ‫‪5. Staiger WI, Ronellenfitsch U, Kaehler G, Schildhaus HU,‬‬ ‫‪Dimitrakopoulou-Strauss A, Schwarzbach MH, et al. The‬‬ ‫‪Merendino procedure following preoperative imatinib mesylate for‬‬ ‫‪locally advanced gastrointestinal stromal tumor of the‬‬ ‫‪esophagogastric junction. World J Surg Oncol 2008;6:37.‬‬ ‫‪6. Huang H, Liu YX, Zhan ZL, Liang H, Wang P, Ren XB. Different‬‬ ‫‪sites and prognoses of gastrointestinal stromal tumors of the‬‬ ‫‪stomach: report of 187 cases. World J Surg 2010;34(7):1523-33.‬‬ ‫‪7. Burkill GJ, Badran M, Al-Muderis O, Meirion Thomas J, Judson‬‬ ‫‪IR, Fisher C, et al. Malignant gastrointestinal stromal tumor:‬‬

‫‪1. El-Zohairy M, Khalil el-SA, Fakhr I, El-Shahawy M, Gouda I.‬‬ ‫‪Gastrointestinal stromal tumor (GIST)'s surgical treatment, NCI‬‬ ‫‪experience. J Egypt Natl Canc Inst 2005;17(2):56-66.‬‬ ‫‪2. Aydin A, Tekin F, Günşar F, Güler A, Tunçyürek M, Ilter T. Value‬‬ ‫‪of endoscopic ultrasonography for upper gastrointestinal stromal‬‬ ‫‪tumors: a single center experience. Turk J Gastroenterol‬‬ ‫‪2004;15(4):233-7.‬‬ ‫‪3. Divis P, Veverkova L, Capov I, Wechsler J, Zak J, Rovn I.‬‬ ‫‪Gastrointestinal stromal tumors- clinical experience. Scripta Med‬‬ ‫‪2006;2:99-104.‬‬ ‫‪4. Hasegawa T, Matsuno Y, Shimoda T, Hirohashi S. Gastrointestinal‬‬ ‫‪stromal tumor: consistent CD117 immunostaining for diagnosis,‬‬

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Esophagogastric mesenchymal tumors: ‫ﻫﻤﻜﺎران‬ ‫ و‬analysis of 24 patients

distribution, imaging features, and pattern of metastatic spread.

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8. Reichardt P, Pink D, Mrozek A, Lindner T, Hohenberger P. Gastrointestinal stromal tumors (GIST). Z Gastroenterol 2004;42(4):327-31.

9. Bauer S, Corless CL, Heinrich MC, Dirsch O, Antoch G, Kanja J, et al. Response to imatinib mesylate of a gastrointestinal stromal tumor with very low expression of KIT. Cancer Chemother Pharmacol 2003;51(3):261-5.

10. Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G. Management of malignant gastrointestinal stromal tumours. Lancet Oncol 2002;3(11):655-64.

11. Savage DG, Antman KH. Imatinib mesylate: a new oral targeted therapy. N Engl J Med 2002;346(9):683-93.

12. Demetri GD, von Mehren M, Blanke CD, Van den Abbeele AD, Eisenberg B, Roberts PJ, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 2002;347(7):472-80.

13. Gupta M, Sheppard BC, Corless CL, MacDonell KR, Blanke CD, Billingsley KG. Outcome following surgical therapy for gastrointestinal stromal tumors.

J Gastrointest Surg 2006;10(8):1099-105.

14. Dagher R, Cohen M, Williams G, Rothmann M, Gobburu J, Robbie G, et al. Approval summary: imatinib mesylate in the treatment of

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100

metastatic and/or unresectable malignant gastrointestinal stromal tumors. Clin Cancer Res 2002;8(10):3034-8.

15. Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 2008;22(7):1729-35.

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20. Eisenberg BL, Harris J, Blanke CD, Demetri GD, Heinrich MC, Watson JC, et al. Phase II trial of neoadjuvant/adjuvant imatinib mesylate (IM) for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumor (GIST): early results of RTOG 0132/ACRIN 6665. J Surg Oncol 2009;99(1):42-7.

Tehran University Medical Journal; Vol. 69, No. 7, October 2011: 438-444

Esophagogastric mesenchymal tumors: analysis of 24 patients

Reza Bagheri M.D.1* Ghodratolah Maddah M.D.2 Alireza Tavasoli M.D.2 Fateme Naghavi Riyabi M.D.3 1- Department of Thoracic Surgery, Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2- Department of General Surgery, Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3- Department of General Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Received: January 31, 2011 Accepted: June 27, 2011

Background: Gastrointestinal mesenchymal tumors are classified as tumors that originate from smooth muscles. Gastrointestinal stromal tumors (GIST) are the most common types of the proposed tumors and can be seen in the GI tract from the esophagus to the anus, but they are mostly seen in the stomach. Mostly from the stomach and asymptomatic, the majority of patients would benefit from surgery as the best method of treatment.

Methods: In this retrospective study we evaluated the data of patients with the diagnosis of esophageal or gastric mesenchymal tumors admitted in Ghaem and Omid Hospitals affiliated to Mashhad University of Medical Sciences in Iran, from 1992 to 2010. We analyzed factors such as age, sex, presenting symptoms and signs, diagnostic

methods, types of pathology, types of treatment, morbidity, mortality and 3-year survival rates.

Results: Twenty four patients (16 male, 8 female) with a mean age of 50 were included in the study. The common site of tumor was gastric fundus. The most common symptom at the time of diagnosis was epigastric fullness which was observed in almost 50% of the patients. The most common type of surgery in the patients was subtotal

gastrectomy and no hospital mortality was recorded. Paralytic ileus was the commonest complication seen in five patients (20.5%). Adjuvant therapy had been performed in eight patients (33.1%). Following the patients three years postoperatively, there were only three deaths (12.45%).

Conclusion: Regarding to the low mortality and morbidity of the surgeries, surgical treatment, if tolerated, is recommended for all Esophagogastric mesenchymal tumors *

Corresponding author: Endoscopic & Minimally Invasive Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Tel: +98-511-8012806 E-mail: Bagherir@mums.ac.ir

patients.

Keywords: Complication, diagnosis, gastroesophageal, mesenchymal tumor, mortality, treatment.

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

‫ﻛﺮوﻧﺮ ‪445-450 ،1390‬‬ ‫ﻣﺪاﺧﻼت ‪ ،7‬ﻣﻬﺮ‬ ‫‪ ، 69‬ﺷﻤﺎره‬ ‫ﻋﺮوﻗﻲدوره‬ ‫ﻋﻮارضﺗﻬﺮان‪،‬‬ ‫ﺑﺮوزﭘﺰﺷﻜﻲ‬ ‫داﻧﺸﮕﺎهﺑﺎﻋﻠﻮم‬ ‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜ‬ ‫ﭘﺲ از‬ ‫ﻲ‪ ،‬ﻣﺮﺗﺒﻂ‬ ‫ﻋﻮاﻣﻞ‬

‫ﺑﺮرﺳﻲ ﻋﻮاﻣﻞ ﻣﺮﺗﺒﻂ ﺑﺎ ﺑﺮوز ﻋﻮارض ﻋﺮوﻗﻲ ﭘﺲ از ﻣﺪاﺧﻼت ﻛﺮوﻧﺮ‬ ‫در ﻣﺮﻛﺰ ﻗﻠﺐ و ﻋﺮوق ﺷﻬﻴﺪ رﺟﺎﻳﻲ ﺗﻬﺮان‬

‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪ 1390/03/08 :‬ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1390/06/20 :‬‬

‫ﭼﻜﻴﺪه‬

‫‪1‬‬

‫اﺣﻤﺪﻋﻠﻲ ﻳﻮﺳﻔﻲ‬

‫زﻣﻴﻨﻪ و ﻫﺪف‪ :‬ﻋﻮارض ﻋﺮوﻗﻲ ﺑﻪﻋﻨﻮان ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﺎرﺿﻪ آﻧﮋﻳﻮﮔﺮاﻓﻲ ﺗﺸﺨﻴﺼﻲ و آﻧﮋﻳﻮﭘﻼﺳﺘﻲ ﻋﺮوق ﻛﺮوﻧﺮ‪،‬‬

‫‪1‬‬

‫ﻣﺤﺴﻦ ﻣﻌﺪﻧﻲ‬

‫ﺑﻪﻋﻨﻮان ﻳﻚ ﻋﺎﻣﻞ ﻣﻬﻢ در ﻣﻮرﺑﻴﺪﻳﺘﻲ ﺑﻴﻤﺎران ﻣﻄﺮح ﻣﻲﺑﺎﺷﺪ و ﻟﺬا ﻣﻄﺎﻟﻌﻪ روي ﺷﻴﻮع اﻳﻦ ﻋﺎرﺿﻪ و ﻋﻮاﻣﻞ ﻣﺮﺗﺒﻂ ﺑﺎ‬

‫‪*1‬‬

‫ﺣﻤﻴﺪرﺿﺎ ﻋﻈﻴﻤﻲ‬

‫آن در ﺑﻴﻤﺎران ﺿﺮوري ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ‪ .‬روش ﺑﺮرﺳﻲ‪ :‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ‪ ،‬ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ ﺑﻮده‪ 2097 ،‬ﻣﻮرد‬

‫‪2‬‬

‫ﺣﺴﻴﻦ ﻓﺮﺷﻴﺪي‬

‫آﻧﮋﻳﻮﭘﻼﺳﺘﻲ ﻋﺮوق ﻛﺮوﻧﺮ در ﻣﺪت ﻳﻚﺳﺎل از ديﻣﺎه ‪ 87‬ﺗﺎ ديﻣﺎه ‪ 88‬در ﺑﻴﻤﺎرﺳﺘﺎن ﻗﻠﺐ ﺷﻬﻴﺪ رﺟﺎﻳﻲ ﺗﻬﺮان اﻧﺠﺎم‬ ‫‪ -1‬ﮔﺮوه ﻗﻠﺐ و ﻋﺮوق‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن ﻗﻠﺐ و ﻋﺮوق‬ ‫ﺷﻬﻴﺪ رﺟﺎﻳﻲ‬

‫ﮔﺮﻓﺖ و اﻳﻦ ﺑﻴﻤﺎران از ﻧﻈﺮ ﭘﻴﺪاﻳﺶ ﻋﻮارض ﻋﺮوﻗﻲ در ﻃﻮل ﻣﺪت ﺑﺴﺘﺮي و ﻧﻴﺰ ﻋﻮاﻣﻞ ﻣﺮﺗﺒﻂ ﺑﻪ آن ﻣﻮرد ﻣﻄﺎﻟﻌﻪ‬ ‫ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﻳﺎﻓﺘﻪﻫﺎ‪ :‬از ﻛﻞ ‪ 2097‬ﺑﻴﻤﺎر‪ 1544 ،‬ﺑﻴﻤﺎر ﻣﺬﻛﺮ )‪ (%73/6‬و ‪ 553‬ﺑﻴﻤﺎر ﻣﻮﻧﺚ )‪ (%26/4‬ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ‬

‫‪ -2‬ﻓﻠﻮﺷﻴﭗ ﺑﺎﻟﻮن آﻧﮋﻳﻮﭘﻼﺳﺘﻲ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن ﻗﻠﺐ‬ ‫و ﻋﺮوق ﺷﻬﻴﺪ رﺟﺎﻳﻲ‬

‫‪ 57±10‬ﺑﻮدﻧﺪ‪ .‬ﻣﻴﺰان ﺑﺮوز ﻋﻮارض ﻋﺮوﻗﻲ از زﻣﺎن آﻧﮋﻳﻮﭘﻼﺳﺘﻲ ﺗﺎ زﻣﺎن ﺗﺮﺧﻴﺺ ﺑﻴﻤﺎر از ﺑﻴﻤﺎرﺳﺘﺎن‪ ،‬در ‪ 19‬ﻣﻮرد‬ ‫)‪ (%0/9‬ﻣﺸﺎﻫﺪه ﺷﺪ ﻛﻪ از اﻳﻦ ﺗﻌﺪاد ‪ 10‬ﻣﻮرد ﻫﻤﺎﺗﻮم )‪ %52/6‬ﻋﻮارض(‪ ،‬آﻧﻮرﻳﺴﻢ ﻛﺎذب در ﭘﻨﺞ ﻣﻮرد )‪%26/3‬‬

‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫ﻋﻮارض(‪ ،‬ﺧﻮنرﻳﺰي ﺧﻠﻒ ﺻﻔﺎﻗﻲ و ﻓﻴﺴﺘﻮل ﺷﺮﻳﺎﻧﻲ ورﻳﺪي ﻫﺮ ﻛﺪام دو ﻣﻮرد )‪ %10/5‬ﻋﻮارض در ﻫﺮ ﻣﻮرد( را‬ ‫ﺗﺸﻜﻴﻞ دادﻧﺪ‪ .‬ﻋﻮارض در ﺟﻨﺲ ﻣﻮﻧﺚ )‪ ،(P=0/003‬در ﺑﻴﻤﺎران ﺑﺎ ﺳﺎﺑﻘﻪ‬

‫‪HTN‬‬

‫)‪ ،(P=0/02‬در ﺑﻴﻤﺎران ﺑﺎ ﻗﺪ ﻛﻮﺗﺎهﺗﺮ‬

‫)‪ ،(P=0/004‬در ﺑﻴﻤﺎراﻧﻲ ﻛﻪ از ﻣﻬﺎرﻛﻨﻨﺪه ‪ gp IIIa/IIb‬اﺳﺘﻔﺎده ﻛﺮده ﺑﻮدﻧﺪ )‪ ،(P=0/003‬ﺑﻪﻃﻮر ﻗﺎﺑﻞﺗﻮﺟﻬﻲ ﺷﺎﻳﻊﺗﺮ ﺑﻮد‪.‬‬ ‫ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﻣﻴﺰان ﺑﺮوز ﻋﻮارض ﻋﺮوﻗﻲ در ﺑﻴﻤﺎران ﺑﻌﺪ از آﻧﮋﻳﻮﭘﻼﺳﺘﻲ ﻛﺮوﻧﺮ ﭘﺎﻳﻴﻦ اﺳﺖ و ﻳﻚ روش ﻣﻨﺎﺳﺐ‬ ‫درﻣﺎﻧﻲ ﺑﺮاي ﺑﻴﻤﺎران ﺑﺎ ﺗﻨﮕﻲ ﻛﺮوﻧﺮ ﻣﺤﺴﻮب ﻣﻲﺷﻮد و در ﺻﻮرﺗﻲﻛﻪ ﺑﻌﺪ از ﺑﺮداﺷﺘﻦ ﺷﻴﺖ ﺷﺮﻳﺎﻧﻲ‪ ،‬در ﻣﺪت زﻣﺎن‬ ‫*‬

‫ﻣﻨﺎﺳﺐ‪ ،‬ﻓﺸﺎر روي ﻣﺤﻞ دﺳﺘﻴﺎﺑﻲ‬ ‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﺗﻬﺮان‪ ،‬ﺧﻴﺎﺑﺎن وﻟﻴﻌﺼﺮ‪ ،‬اﺑﺘﺪاي ﻧﻴﺎﻳﺶ‪،‬‬

‫ﺑﻴﻤﺎرﺳﺘﺎن ﻗﻠﺐ و ﻋﺮوق ﺷﻬﻴﺪ رﺟﺎﻳﻲ‬

‫)‪(Access‬‬

‫ﻋﺮوﻗﻲ داده ﺷﻮد‪ ،‬ﺑﻪﺧﺼﻮص در ﻣﻮرد ﺑﻴﻤﺎران زن‪ ،‬ﺳﺎﺑﻘﻪ ‪ ،HTN‬ﺳﻄﺢ‬

‫آﻧﺘﻲﻛﻮآﮔﻮﻻﻧﺖ ﺑﺎﻻﺗﺮ‪ ،‬اﺣﺘﻤﺎل ﭘﻴﺪاﻳﺶ ﻋﻮارض ﻋﺮوق ﭘﺎﻳﻴﻦ ﻣﻲﺑﺎﺷﺪ‪.‬‬

‫ﺗﻠﻔﻦ‪021-23921 :‬‬ ‫‪E-mail: azimihamidreza66@yahoo.com‬‬

‫ﻛﻠﻤﺎت ﻛﻠﻴﺪي‪ :‬ﻋﻮارض ﻋﺮوﻗﻲ‪ ،‬ﻫﻤﺎﺗﻮم‪ ،‬ﻓﻴﺴﺘﻮل ﺷﺮﻳﺎﻧﻲ ورﻳﺪي‪ ،‬ﺧﻮنرﻳﺰي ﺧﻠﻒ ﺻﻔﺎﻗﻲ‪.‬‬

‫اﺳﺘﻔﺎده از ﺷﻴﺖﻫﺎي ﺷﺮﻳﺎﻧﻲ ﻛﻮﭼﻚ و وﺳﺎﻳﻞ ﻣﻜﺎﻧﻴﻜﺎل ﺑﺴﺘﻦ ﻋﺮوﻗﻲ‬

‫ﻣﻘﺪﻣﻪ‬

‫)‪ ،(Vascular closer devise‬ﺳﻌﻲ در ﺟﻬﺖ ﻛﺎﻫﺶ ﻋﺎرﺿﻪ ﻋﺮوﻗﻲ‬

‫ﻣﻄﺎﻟﻌﺎت اﺧﻴﺮ ﻣﺸﺨﺺ ﻧﻤﻮده ﻛﻪ ﺧﻮنرﻳﺰي ﺑﻌﺪ از ﻛﺎﺗﺘﺮﻳﺰاﺳﻴﻮن‬

‫داﺷﺖ‪ ،‬وﻟﻲ ﻫﻢﭼﻨﻴﻦ اﻳﻦ ﻋﻮارض ﺑﻪﻋﻨﻮان ﻋﺎﻣﻞ ﻣﻬﻢ در ﻣﻮرﺑﻴﺪﻳﺘﻲ‬

‫‪Percutaneous‬‬

‫ﺑﻴﻤﺎران ﻣﻄﺮح اﺳﺖ‪ .‬ﺷﺮﻳﺎن ﻓﻤﻮرال ﻣﺸﺘﺮك‪ ،‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻣﺤﻞ دﺳﺘﻴﺎﺑﻲ‬

‫‪ ،Coronary Intervention‬ﺑﻪوﻳﮋه ﺧﻮنرﻳﺰي ﺧﻠﻒ ﺻﻔﺎﻗﻲ‬

‫)‪ (Access‬ﻋﺮوﻗﻲ اﺳﺖ ﻛﻪ ﺑﺮاي آﻧﮋﻳﻮﮔﺮاﻓﻲ ﻛﺮوﻧﺮ ﺗﺸﺨﻴﺼﻲ و ﻧﻴﺰ‬

‫ﺑﻪﻋﻨﻮان ﻳﻚ ﻋﻠﺖ ﻗﺎﺑﻞ ﺗﻮﺟﻪ ﻣﻮرﺑﻴﺪﻳﺘﻲ و ﻣﻮرﺗﺎﻟﻴﺘﻲ ﺑﻌﺪ از اﻳﻦ‬

‫ﻣﺪاﺧﻠﻪاي ﻣﻮرد اﺳﺘﻔﺎده ﻗﺮار ﻣﻲﮔﻴﺮد‪ .‬روشﻫﺎي ﺑﺮاﻛﻴﺎل و رادﻳﺎل‬

‫روشﻫﺎ ﻣﺤﺴﻮب ﻣﻲﺷﻮد‪ .‬ﮔﺮﭼﻪ ﺗﻤﺎﻣﻲ ﺧﻮنرﻳﺰي ﻧﻤﻲﺗﻮاﻧﺪ ﺑﻪﻃﻮر‬

‫ﺑﻪﻋﻨﻮان روشﻫﺎي ﺟﺎﻳﮕﺰﻳﻦ ﻣﻲﺑﺎﺷﻨﺪ‪ .‬ﻋﻮارض ﻣﻮﺿﻌﻲ از‬

‫‪1‬‬

‫ﻫﻤﺎﺗﻮمﻫﺎي دردﻧﺎﻛﻲ ﻛﻪ ﺧﻮدﺑﻪﺧﻮد ﺑﻬﺒﻮد ﻣﻲﻳﺎﺑﻨﺪ ﺗﺎ ﺧﻮنرﻳﺰي ﺧﻠﻒ‬

‫ﻋﻮارض ﻣﺮﺑﻮط ﺑﻪ آن ﺑﻪﻋﻨﻮان ﻳﻚ ﻋﺎﻣﻞ ﻣﻬﻢ در ﺧﻮنرﻳﺰي ﺑﻌﺪ از‬

‫ﺻﻔﺎﻗﻲ ﺗﻬﺪﻳﺪﻛﻨﻨﺪه ﺣﻴﺎت ﻣﻲﺗﻮاﻧﺪ ﻣﺘﻐﻴﺮ ﺑﺎﺷﺪ‪ .‬ﺧﻮنرﻳﺰي ﺧﻠﻒ‬

‫اﻳﻦ روشﻫﺎ ﻣﻄﺮح ﻣﻲﺑﺎﺷﺪ‪ .‬ﮔﺮﭼﻪ در ﺳﺎﻟﻴﺎن اﺧﻴﺮ‪ ،‬ﺑﻬﺒﻮد ﺗﻜﻨﻴﻚ ‪،PCI‬‬

‫ﺻﻔﺎﻗﻲ‪ ،‬اﮔﺮ ‪ Access‬ﺧﻴﻠﻲ ﭘﺮوﮔﺰﻳﻤﺎل ﺑﺎﺷﺪ و ﻫﻤﺎﺗﻮم‪ ،‬آﻧﻮرﻳﺴﻢ‬

‫ﻗﻠﺒﻲ ﺗﺸﺨﻴﺼﻲ و ﻣﺪاﺧﻼت ﻛﺮوﻧﺮي از ﻃﺮﻳﻖ ﭘﻮﺳﺖ‬ ‫)‪(PCI‬‬

‫ﻣﺴﺘﻘﻴﻢ ﺑﻪﻋﻮارض در ﻣﺤﻞ دﺳﺖﻳﺎﺑﻲ ﻋﺮوﻗﻲ ﻧﺴﺒﺖ داده ﺷﻮد‪،‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫اﺣﻤﺪﻋﻠﻲ ﻳﻮﺳﻔﻲ و ﻫﻤﻜﺎران‬

‫‪446‬‬

‫ﻛﺎذب و ﻓﻴﺴﺘﻮل ﺷﺮﻳﺎﻧﻲ ورﻳﺪي اﮔﺮ دﺳﺘﻴﺎﺑﻲ ﺧﻴﻠﻲ دﻳﺴﺘﺎل ﺑﺎﺷﺪ‬

‫ﻣﺮگ ﺑﻪﻋﻠﺖ ﻋﻮارض ﻋﺮوﻗﻲ‪ ،‬ﺧﻮنرﻳﺰي ﻋﺮوﻗﻲ ﻣﻬﻢ )‪ >3gr‬اﻓﺖ‬

‫)ﻧﺴﺒﺖ ﺑﻪ ﭼﻴﻦ اﻳﻨﮕﻮﻳﻨﺎل(‪ ،‬ﻣﻲﺗﻮاﻧﻨﺪ اﻳﺠﺎد ﺷﻮﻧﺪ‪ 1-3.‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ در‬

‫ﺑﻪﻋﻠﺖ ﺧﻮنرﻳﺰي از ﻣﺤﻞ ‪ Access‬ﻳﺎ ﺧﻮنرﻳﺰي ﺧﻠﻒ ﺻﻔﺎﻗﻲ(‪ ،‬ﻳﺎ از‬

‫ﻣﺪت ﻳﻚﺳﺎل‪ ،‬ﻣﻴﺰان ﺑﺮوز ﻋﻮارض در ﻣﺪت ﺑﺴﺘﺮي ﺑﻴﻤﺎران ﭘﺲ از‬

‫دﺳﺖ دادن ﻧﺒﺾ ﺗﻌﺮﻳﻒ ﻣﻲﺷﺪ‪ 2.‬در ﻣﻮارد ﺷﻚ ﺑﻪ ﻓﻴﺴﺘﻮل ﺷﺮﻳﺎﻧﻲ‬

‫اﻧﺠﺎم ‪ PCI‬و ﻋﻮاﻣﻞ ﻣﺮﺗﺒﻂ ﺑﺎ آن ﺑﺮرﺳﻲ ﺷﺪ‪ .‬ﻋﻮارض ﺧﻮﻧﺮﻳﺰيدﻫﻨﺪه‪،‬‬

‫ورﻳﺪي ﻳﺎ آﻧﻮرﻳﺴﻢ ﻛﺎذب در ﻣﻌﺎﻳﻨﻪ‪ ،‬ﺗﺸﺨﻴﺼﻲ ﺑﺎ ﺳﻮﻧﻮﮔﺮاﻓﻲ از ﻣﺤﻞ‬

‫‪4-7‬‬

‫ﺑﺎ ﺷﻴﻮع ‪ 2-6‬درﺻﺪ در ﻣﻄﺎﻟﻌﺎت ﻗﺒﻠﻲ ﮔﺰارش ﺷﺪه اﺳﺖ‪.‬‬

‫‪Hb‬‬

‫ﻛﺎﺗﺘﺮﻳﺴﻢ ﺗﺄﻳﻴﺪ ﻣﻲﺷﺪ و ﻧﻴﺰ در ﻣﻮارد ﺷﻚ ﺑﻪ ﺧﻮنرﻳﺰي ﺧﻠﻒ‬ ‫ﺻﻔﺎﻗﻲ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻋﻼﻳﻢ ﺑﺎﻟﻴﻨﻲ و ﻣﻌﺎﻳﻨﻪ‪ ،‬از‬

‫‪CT‬‬

‫اﺳﻜﻦ ﻛﻤﻚ ﮔﺮﻓﺘﻪ‬

‫روش ﺑﺮرﺳﻲ‬

‫ﻣﻲﺷﺪ‪ .‬در ﻧﻬﺎﻳﺖ‪ ،‬اﻃﻼﻋﺎت ﻣﺮﺑﻮط ﺑﻪ ﺑﻴﻤﺎران و ﻋﺎرﺿﻪ اﻳﺠﺎد ﺷﺪه در‬

‫در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻛﻪ از ديﻣﺎه ‪ 87‬ﺗﺎ ديﻣﺎه ‪ 88‬در ﻣﺮﻛﺰ ﻗﻠﺐ و ﻋﺮوق‬

‫ﭘﺮﺳﺶﻧﺎﻣﻪ ﻣﺮﺑﻮﻃﻪ‪ ،‬ﺛﺒﺖ ﮔﺮدﻳﺪ و اﻳﻦ اﻃﻼﻋﺎت ﺗﺤﻠﻴﻞ آﻣﺎري ﺷﺪ‪.‬‬

‫ﺷﻬﻴﺪ رﺟﺎﻳﻲ اﻧﺠﺎم ﺷﺪه‪ ،‬ﺗﻌﺪاد ‪ 2097‬ﺑﻴﻤﺎر ﻛﻪ ﺗﺤﺖ ‪ PCI‬ﻗﺮار ﮔﺮﻓﺘﻪ‬ ‫در ﻣﺪت ﺑﺴﺘﺮي از ﻧﻈﺮ ﭘﻴﺪاﻳﺶ ﻋﻮارض ﻋﺮوﻗﻲ ﻣﺤﻞ ﻛﺎﺗﺘﺮﻳﺰاﺳﻴﻮن‪،‬‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﻫﻴﭻ ﻣﻌﻴﺎري ﺟﻬﺖ ﺧﺮوج ﺑﻴﻤﺎر از ﻣﻄﺎﻟﻌﻪ‬

‫در اﻳﻦ ﻣﻄﺎﻟﻌﻪ‪ 2097 ،‬ﺑﻴﻤﺎر ﺑﺮرﺳﻲ ﺷﺪﻧﺪ‪ 1544 ،‬ﻧﻔﺮ )‪ (%73/6‬ﻣﺬﻛﺮ‬

‫وﺟﻮد ﻧﺪاﺷﺖ و ﻛﻠﻴﻪ ﺑﻴﻤﺎران ﻣﻮرد آﻧﮋﻳﻮﭘﻼﺳﺘﻲ ﻗﺮار ﮔﺮﻓﺘﻪ در ﻓﺎﺻﻠﻪ‬

‫و ‪ 553‬ﻧﻔﺮ )‪ (%26/4‬ﻣﻮﻧﺚ ﺑﻮدﻧﺪ‪ .‬ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ﺑﻴﻤﺎران ‪ 57±10‬ﺳﺎل‬

‫زﻣﺎﻧﻲ ﻣﺬﻛﻮر‪ ،‬در ﻣﻄﺎﻟﻌﻪ وارد ﺷﺪهاﻧﺪ‪ .‬اﻃﻼﻋﺎت ﻣﻮرد ﻧﻴﺎز ﻃﻲ ﺗﺤﻘﻴﻖ‬

‫ﺑﻮد‪ .‬در ‪ 2035‬ﻣﻮرد )‪ Access ،(%97‬ﻓﻤﻮرال و در ‪ 56‬ﻣﻮرد )‪،(%2/7‬‬

‫ﺷﺎﻣﻞ ﻳﺎﻓﺘﻪﻫﺎي دﻣﻮﮔﺮاﻓﻴﻚ و ﻣﺘﻐﻴﺮﻫﺎي ﺑﺎﻟﻴﻨﻲ‪ ،‬در ﭘﺮﺳﺶﻧﺎﻣﻪ ﻣﺮﺑﻮﻃﻪ‬

‫‪ Access‬رادﻳﺎل اﺳﺘﻔﺎده ﺷﺪ‪ .‬در ‪ 1359‬ﻣﻮرد )‪،(%64/8‬‬

‫‪Vascular‬‬

‫ﻗﺮار ﮔﺮﻓﺘﻪ و در ﻃﻲ ﻣﺪت ﺑﺴﺘﺮي‪ ،‬ﺑﻴﻤﺎران از ﻧﻈﺮ ﭘﻴﺪاﻳﺶ ﻋﻮارض‬

‫‪ Access‬ﺗﻮﺳﻂ ﻓﻠﻮﺷﻴﭗ آﻧﮋﻳﻮﭘﻼﺳﺘﻲ و در ‪ 732‬ﻣﻮرد )‪،(%35/2‬‬

‫ﻋﺮوﻗﻲ ﻣﻮرد ﻣﻌﺎﻳﻨﻪ ﻗﺮار ﻣﻲﮔﺮﻓﺘﻨﺪ‪ .‬اﻧﺘﺨﺎب ﻣﺤﻞ دﺳﺖﻳﺎﺑﻲ اوﻟﻴﻪ‬

‫ﺗﻮﺳﻂ دﺳﺘﻴﺎر ﻗﻠﺐ و ﻋﺮوق ﮔﺮﻓﺘﻪ ﺷﺪه اﺳﺖ‪ .‬از ﻧﻈﺮ ﻓﺮاواﻧﻲ ﻧﻮع‬

‫ﺷﺮﻳﺎن )‪ (Access site‬ﺑﻪﺗﺸﺨﻴﺺ ﭘﺰﺷﻚ ارﺷﺪ اﻧﺠﺎمدﻫﻨﺪه آﻧﮋﻳﻮﮔﺮاﻓﻲ‬

‫ﻋﺮوق ﻛﺮوﻧﺮ ﻣﻮرد آﻧﮋﻳﻮﭘﻼﺳﺘﻲ‪ 1326 ،‬ﻣﻮرد )‪ (%63/2‬ﻣﺮﺑﻮط ﺑﻪ‬

‫ﺻﻮرت ﻣﻲﮔﺮﻓﺖ‪ .‬روش ارﺟﺢ دﺳﺘﻴﺎﺑﻲ ﻓﻤﻮرال ﺑﻮد و دﺳﺘﻴﺎﺑﻲ رادﻳﺎل‬

‫‪ 576 ،LAD‬ﻣﻮرد )‪ ،(%27/5‬ﻣﺮﺑﻮط ﺑﻪ ﺷﺮﻳﺎن ﺳﻴﺮﻛﻤﻔﻠﻜﺲ ﭼﭗ‬

‫در ﻣﻮاردي ﻛﻪ دﺳﺘﻴﺎﺑﻲ ﻓﻤﻮرال ﻗﺎﺑﻞ دﺳﺘﺮﺳﻲ ﻧﺒﻮد‪ ،‬ﺑﻪﻋﻨﻮان روش‬

‫)‪ (LCX‬و ‪ 689‬ﻣﻮرد )‪ (%32/9‬ﻣﺮﺑﻮط ﺑﻪ ﺷﺮﻳﺎن ﻛﺮوﻧﺮي راﺳﺖ‬

‫‪Right‬‬

‫ﺟﺎﻳﮕﺰﻳﻦ اﻧﺠﺎم ﻣﻲﺷﺪ‪ .‬ﻛﻠﻴﻪ ﺑﻴﻤﺎران ﻗﺒﻞ از ورود ﺑﻪﺑﺨﺶ آﻧﮋﻳﻮﮔﺮاﻓﻲ‬

‫)‪ Coronary Artery (RCA‬ﺑﻮده اﺳﺖ‪ .‬ﻻزم ﺑﻪذﻛﺮ اﺳﺖ ﻛﻪ در ﺗﻌﺪادي‬

‫‪ASA‬‬

‫)‪ 80-325‬ﻣﻴﻠﻲﮔﺮم روزاﻧﻪ( و ﭘﻼوﻳﻜﺲ )‪ 300-600‬ﮔﺮم‬

‫از ﺑﻴﻤﺎران دو ﻳﺎ ﺳﻪ رگ ﺑﻪﻃﻮر ﻫﻢزﻣﺎن ﻣﻮرد‬

‫‪PCI‬‬

‫ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪.‬‬

‫ﺑﻪﺻﻮرت دوز اﺑﺘﺪاﻳﻲ و ‪ 75‬ﻣﻴﻠﻲﮔﺮم روزاﻧﻪ( درﻳﺎﻓﺖ ﻛﺮده ﺑﻮدﻧﺪ‪.‬‬

‫ﻫﻤﺎنﮔﻮﻧﻪ ﻛﻪ در ﺟﺪول ‪ 1‬ﻣﻼﺣﻈﻪ ﻣﻲﺷﻮد‪ ،‬اﻛﺜﺮ ﺑﻴﻤﺎران )‪،(%81‬‬

‫وﻳﺮاﺳﺖ ﭘﺎﻧﺰدﻫﻢ‬

‫‪ LVEF‬ﻧﺮﻣﺎل ﻳﺎ اﺧﺘﻼل ﻋﻤﻠﻜﺮدي ﺧﻔﻴﻒ )‪ (Mild dysfunction‬داﺷﺘﻨﺪ‬

‫ﻣﻮرد ﺗﺠﺰﻳﻪ و ﺗﺤﻠﻴﻞ آﻣﺎري ﻗﺮار ﮔﺮﻓﺘﻪ و ارﺗﺒﺎط ﻣﺘﻐﻴﺮﻫﺎي ﻣﺨﺘﻠﻒ و‬

‫و ﻧﺎرﺳﺎﻳﻲ ﻣﺘﻮﺳﻂ ﺗﺎ ﺷﺪﻳﺪ ﺑﻄﻦ ﭼﭗ در ﻛﻢﺗﺮ از ‪ %20‬ﺑﻴﻤﺎران وﺟﻮد‬

‫ﻣﻴﺰان ﺗﺄﺛﻴﺮ آن ﺑﺮ ﺷﻴﻮع ﻋﻮارض ﻋﺮوﻗﻲ ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺖ‪.‬‬

‫داﺷﺖ‪ .‬از ﻧﻈﺮ ﻧﻮع ﺷﻴﺖ )‪ (Sheat‬ﺑﻪﻛﺎر رﻓﺘﻪ‪ ،‬در ‪ 863‬ﻣﻮرد )‪،(%41/2‬‬

‫‪Fisher’s exact‬‬

‫‪ ،6F‬در ‪ 1225‬ﻣﻮرد )‪ 7F ،(%58/5‬و در ﭘﻨﺞ ﻣﻮرد )‪(%0/2‬؛ ‪ 8F‬در‬

‫‪ test‬و ‪ Student’s t-test‬اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺑﺮ اﺳﺎس اﻳﻦ ﻣﻄﺎﻟﻌﻪ‪ ،‬ﻫﻴﭻ‬

‫ﺑﻴﻤﺎران اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﺟﺪول ‪ ،2‬وﺿﻌﻴﺖ ﻛﺎرﻛﺮد ﻛﻠﻴﻪ ﺑﻴﻤﺎران را ﺑﺮ‬

‫داروﻳﻲ ﺧﺎرج از ﺑﺮﻧﺎﻣﻪ ﻣﻌﻤﻮل آﻧﮋﻳﻮﭘﻼﺳﺘﻲ ﺑﻪ ﺑﻴﻤﺎر ﺗﺠﻮﻳﺰ ﻧﺸﺪه و‬

‫اﺳﺎس ﻋﺪد ﻛﺮاﺗﻲﻧﻴﻦ ﺳﺮم در روز اﻧﺠﺎم آﻧﮋﻳﻮﭘﻼﺳﺘﻲ ﻛﺮوﻧﺮ ﻧﺸﺎن‬

‫ﻫﺰﻳﻨﻪ ﻣﺎﻟﻲ اﺿﺎﻓﻲ ﺑﻪ ﺑﻴﻤﺎر ﺗﺤﻤﻴﻞ ﻧﮕﺮدﻳﺪه‪ ،‬ﺗﻤﺎم ﺑﻴﻤﺎران از روال‬

‫ﻣﻲدﻫﺪ‪ .‬اﻟﺒﺘﻪ ﻻزم ﺑﻪذﻛﺮ اﺳﺖ ﻛﻪ ﻋﺪد ﻛﺮاﺗﻲﻧﻴﻦ ﺳﺮم ﺷﺎﺧﺺ ﻗﺎﺑﻞ‬

‫اﻧﺠﺎم ﻓﻌﺎﻟﻴﺖ ﻣﻌﻤﻮل ﺑﺨﺶ ﺧﺎرج ﻧﺸﺪﻧﺪ‪ .‬ﻋﻮارض اﻳﺠﺎد ﺷﺪه در‬

‫اﻃﻤﻴﻨﺎﻧﻲ ﺑﺮاي ﺑﺮرﺳﻲ وﺿﻌﻴﺖ ﻛﻠﻴﻪ ﺑﻴﻤﺎران ﻧﺒﻮده و ﺑﻬﺘﺮ اﺳﺖ ﻛﻪ از‬

‫ﻳﺎﻓﺘﻪﻫﺎي ﭘﺮﺳﺶﻧﺎﻣﻪ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮماﻓﺰار‬

‫‪SPSS‬‬

‫ﺑﺮاي ﺗﺠﺰﻳﻪ و ﺗﺤﻠﻴﻞ اﻃﻼﻋﺎت از آزﻣﻮنﻫﺎي‬

‫‪2‬‬

‫‪‬‬

‫و‬

‫ﺑﻴﻤﺎران‪ ،‬ﺑﺮ اﺳﺎس ﺗﻌﺎرﻳﻒ ‪ American college of cardiology‬ﺑﺮاي‬

‫ﻣﺤﺎﺳﺒﻪ ﻣﻴﺰان ﻓﻴﻠﺘﺮاﺳﻴﻮن ﮔﻠﻮﻣﺮوﻟﻲ‬

‫ﻋﻮارض ﻋﺮوﻗﻲ ﺗﻌﺮﻳﻒ ﻣﻲﺷﺪ‪ 2.‬ﻋﻮارض ﻋﺮوﻗﻲ ﺧﻔﻴﻒ ﺑﻪﻋﻨﻮان ﻫﺮ‬

‫ﺷﻮد‪ ،‬وﻟﻲ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺣﺠﻢ ﻧﻤﻮﻧﻪ زﻳﺎد‪ ،‬اﻣﻜﺎن اﻳﻦ ﻣﺤﺎﺳﺒﻪ ﻣﻴﺴﺮ ﻧﺸﺪ‬

‫ﻛﺪام از ﻣﻮارد زﻳﺮ ﺗﻌﺮﻳﻒ ﻣﻲﺷﺪﻧﺪ‪ :‬ﻫﻤﺎﺗﻮم< ‪ 10‬ﺳﺎﻧﺘﻲﻣﺘﺮ‪ ،‬ﻓﻴﺴﺘﻮل‬

‫و ﻣﺎ ﺑﻪ اﻧﺪازهﮔﻴﺮي ‪ Cr‬ﺳﺮم ﺑﻪﻋﻨﻮان ﺗﺨﻤﻴﻨﻲ از وﺿﻌﻴﺖ ﻛﻠﻴﻪ ﺑﻴﻤﺎران‬

‫ﺷﺮﻳﺎﻧﻲ ورﻳﺪي‪ ،‬ﻳﺎ آﻧﻮرﻳﺴﻢ ﻛﺎذب‪ ،‬ﻋﻮارض ﻋﺮوﻗﻲ ﻋﻤﺪه ﺑﻪﺻﻮرت‬

‫ﺑﺴﻨﺪه ﻛﺮدﻳﻢ‪ .‬در ﻋﻴﻦ ﺣﺎل ﻫﻤﺎنﮔﻮﻧﻪ ﻛﻪ ﻣﻼﺣﻈﻪ ﻣﻲﮔﺮدد‪ ،‬ﻧﺰدﻳﻚ ﺑﻪ‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫)‪(GFR‬‬

‫ﺑﺮاي اﻳﻦ ﻣﻨﻈﻮر اﺳﺘﻔﺎده‬

‫‪447‬‬

‫ﻋﻮاﻣﻞ ﻣﺮﺗﺒﻂ ﺑﺎ ﺑﺮوز ﻋﻮارض ﻋﺮوﻗﻲ ﭘﺲ از ﻣﺪاﺧﻼت ﻛﺮوﻧﺮ‬

‫ﺟﺪول‪ :1-‬ﻓﺮاواﻧﻲ ﺑﻴﻤﺎران ﺑﺮ اﺳﺎس ﻣﻴﺰان ﻛﺎرﻛﺮد ﻋﻀﻠﻪ ﺑﻄﻦ ﭼﭗ‬

‫)‪(LVEF‬‬

‫ﺟﺪول‪ :2-‬ﻓﺮاواﻧﻲ ﺑﻴﻤﺎران ﺑﺮ اﺳﺎس ﻣﻴﺰان ﻛﺮاﺗﻲﻧﻴﻦ ﺳﺮم‬

‫‪LVEF‬‬

‫ﺗﻌﺪاد‬

‫درﺻﺪ‬

‫‪ Cr‬ﺳﺮم )‪(mg/dl‬‬

‫ﺗﻌﺪاد‬

‫درﺻﺪ‬

‫‪<%30‬‬

‫‪121‬‬

‫‪%5/8‬‬

‫‪<1‬‬

‫‪488‬‬

‫‪%23/4‬‬

‫‪%30-%39‬‬

‫‪273‬‬

‫‪%13/1‬‬

‫‪1-1/5‬‬

‫‪1373‬‬

‫‪%65/8‬‬

‫‪%40-%49‬‬

‫‪821‬‬

‫‪%39/5‬‬

‫‪1/5-2‬‬

‫‪179‬‬

‫‪%8/6‬‬

‫‪≥%50‬‬

‫‪866‬‬

‫‪%41/6‬‬

‫‪>2‬‬

‫‪47‬‬

‫‪%2/3‬‬

‫ﻧﻤﻮدار‪ :1-‬ﻓﺮاواﻧﻲ ﻋﻮارض ﻣﺨﺘﻠﻒ ﻋﺮوﻗﻲ‬

‫ﻧﻤﻮدار‪ :3-‬ﺑﺮرﺳﻲ ﺳﺎﺑﻘﻪ ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮن ﺑﺮ ﭘﻴﺪاﻳﺶ ﻋﻮارض ﻋﺮوﻗﻲ‬

‫ﻧﻤﻮدار‪ :2-‬ﻣﻘﺎﻳﺴﻪ ﺟﻨﺴﻲ ﭘﻴﺪاﻳﺶ ﻋﻮارض ﻋﺮوﻗﻲ‬

‫ﻧﻤﻮدار‪ :4-‬ﺑﺮرﺳﻲ اﺛﺮ ‪ gp IIIa/IIb inh.‬ﺑﺮ ﭘﻴﺪاﻳﺶ ﻋﻮارض ﻋﺮوﻗﻲ‬

‫‪ %90‬ﺑﻴﻤﺎران‪ Cr ،‬ﻛﻢﺗﺮ از ‪ 1/5‬دارﻧﺪ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻋﺎرﺿﻪ ﻣﺴﻤﻮﻣﻴﺖ‬

‫ﻋﻮارض(‪ ،‬آﻧﻮرﻳﺴﻢ ﻛﺎذب در ﭘﻨﺞ ﻣﻮرد )‪ %26/3‬ﻋﻮارض(‪ ،‬ﺧﻮنرﻳﺰي‬

‫ﻛﻠﻴﻮي ﺷﻨﺎﺧﺘﻪ ﺷﺪه ﻣﻮاد ﺣﺎﺟﺐ در آﻧﮋﻳﻮﮔﺮاﻓﻲ و آﻧﮋﻳﻮﭘﻼﺳﺘﻲ‬

‫ﺧﻠﻒ ﺻﻔﺎﻗﻲ و ﻓﻴﺴﺘﻮل ﺷﺮﻳﺎﻧﻲ ورﻳﺪي ﻫﺮ ﻛﺪام در دو ﻣﻮرد )در ﻫﺮ‬

‫ﻛﺮوﻧﺮ‪ ،‬ﺑﻪﻃﻮر ﻣﻌﻤﻮل‪ ،‬در ﺑﻴﻤﺎراﻧﻲ ﻛﻪ ‪ Cr‬ﺑﺎﻻ دارﻧﺪ‪ ،‬ﻓﻘﻂ در ﺷﺮاﻳﻂ‬

‫ﻣﻮرد ‪ %10/5‬ﻋﻮارض( وﺟﻮد داﺷﺖ )ﻧﻤﻮدار ‪ .(1‬ﻓﻘﻂ ﻫﻤﺎﺗﻮم ﻗﺎﺑﻞ‬

‫ﺧﺎص ﻛﻪ ﻣﻴﺰان ﻓﺎﻳﺪه ﺑﻪﺧﻄﺮ اﻧﺠﺎم آﻧﮋﻳﻮﮔﺮاﻓﻲ ﻗﺎﺑﻞ ﻗﺒﻮل ﺑﺎﺷﺪ‪ ،‬اﻳﻦ‬

‫ﺗﻮﺟﻪ‪ ،‬ﻳﻌﻨﻲ ﻫﻤﺎﺗﻮﻣﻲ ﻛﻪ ﺑﻴﺶ از ﺷﺶ ﺳﺎﻧﺘﻲﻣﺘﺮ ﻗﻄﺮ داﺷﺘﻪ و ﻳﺎ ﺑﺎ‬

‫ﻛﺎر ﺑﺎ اﺣﺘﻴﺎط ﺧﺎص ﺻﻮرت ﻣﻲﮔﻴﺮد‪ .‬ﻣﻴﺰان ﻋﻮارض ﻋﺮوﻗﻲ از زﻣﺎن‬

‫اﻓﺖ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﺑﻴﺶ ﻳﺎ ﻣﺴﺎوي ‪ 3g/dl‬ﻫﻤﺮاه ﺑﻮد در ﻣﻄﺎﻟﻌﻪ ﻣﻨﻈﻮر‬

‫اﻧﺠﺎم آﻧﮋﻳﻮﭘﻼﺳﺘﻲ ﺗﺎ زﻣﺎن ﺗﺮﺧﻴﺺ ﺑﻴﻤﺎر از ﺑﻴﻤﺎرﺳﺘﺎن‪ ،‬در ‪ 19‬ﻣﻮرد‬

‫ﺷﺪ و ﻫﻤﺎﺗﻮمﻫﺎي ﻛﻮﭼﻚ ﺑﻪﻋﻨﻮان ﻋﺎرﺿﻪ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﻧﺸﺪه اﺳﺖ‪.‬‬

‫)‪ (%0/9‬ﻣﺸـﺎﻫﺪه ﺷـﺪ ﻛـﻪ از اﻳـﻦ ﺗﻌـﺪاد ‪ 10‬ﻣـﻮرد ﻫﻤـﺎﺗﻮم )‪%52/6‬‬

‫ارﺗﺒﺎط ﻋﻮارض ﺑﺎ ﻣﺘﻐﻴـﺮﻫﺎي ﻣﺨﺘﻠﻒ‪ :‬ﻋﻮارض ﻋﺮوﻗﻲ‪ ،‬ﺑﻪﻃﻮر ﻗﺎﺑﻞ‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫اﺣﻤﺪﻋﻠﻲ ﻳﻮﺳﻔﻲ و ﻫﻤﻜﺎران‬

‫‪448‬‬

‫ﻛﺎﺗﺘﺮ ‪ 7F‬ﻛﻢﺗﺮ ﺑﻮد وﻟـﻲ اﺧـﺘﻼف ﻣﻌﻨـﻲداري ﻧﺪاﺷـﺖ )‪ .(P=0/82‬در‬

‫ﺟﺪول‪ :3-‬ﻣﻘﺎﻳﺴﻪ ﺑﻴﻤﺎران داراي ﻋﺎرﺿﻪ ﻋﺮوﻗﻲ و ﺑﺪون آن‬ ‫ﻋﺎرﺿﻪ ﻋﺮوﻗﻲ‬

‫ﺑﺪون ﻋﺎرﺿﻪ ﻋﺮوﻗﻲ‬

‫ﺧﺼﻮﺻﻴﺎت‬

‫)‪(n=19‬‬

‫)‪(n=2078‬‬

‫ﺳﻦ )ﺳﺎل(‬

‫‪57/812‬‬

‫‪57/410‬‬

‫*‪0/87‬‬

‫ﺟﻨﺲ زن‬

‫‪%57/9‬‬

‫‪%26/1‬‬

‫**‪0/003‬‬

‫دﻳﺎﺑﺖ‬

‫‪%42/1‬‬

‫‪%27/9‬‬

‫**‪0/19‬‬

‫ﺳﻴﮕﺎر‬

‫‪%26/3‬‬

‫‪%40/4‬‬

‫**‪0/24‬‬

‫ﻫﻴﭙﺮﻟﻴﭙﻴﺪﻣﻲ‬

‫‪%47/4‬‬

‫‪%40/2‬‬

‫**‪0/63‬‬

‫ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮن‬

‫‪%68/4‬‬

‫‪%43/7‬‬

‫**‪0/03‬‬

‫ﻧﺎرﺳﺎﻳﻲ ﻛﻠﻴﻪ‬

‫‪%15/8‬‬

‫‪%10/7‬‬

‫**‪0/17‬‬

‫‪27/044‬‬

‫‪28/63/9‬‬

‫**‪0/07‬‬

‫‪BMI‬‬

‫‪P‬‬

‫ﻣﻘﺎﻳﺴﻪ اﺧﺘﻼف ﺷﻴﻮع ﻋﻮارض ﻋﺮوﻗـﻲ در ﺑﻴﻤـﺎراﻧﻲ ﻛـﻪ دﺳـﺖﻳـﺎﺑﻲ‬ ‫ﻋﺮوﻗﻲ ﺗﻮﺳـﻂ رزﻳـﺪﻧﺖ ﻳـﺎ ﻓﻠـﻮي ‪ Intervention‬ﮔﺮﻓﺘـﻪ ﺷـﺪه ﺑـﻮد‪،‬‬ ‫اﺧﺘﻼف ﻣﻌﻨﻲداري ﻣﺸﺎﻫﺪه ﻧﺸﺪ )‪ .(P=0/13‬در ﻣﻮرد ﻋﺎرﺿـﻪ ﻋﺮوﻗـﻲ‬ ‫ﺧﺎص در ﻃﻮل اﻧﺠﺎم ‪ PCI‬ﻫﻤﺎﺗﻮم در ﺑﻴﻤﺎران ﺟﻨﺲ ﻣﺆﻧﺚ )‪(P=0/005‬‬ ‫و ﻗﺪ ﻛﻮﺗﺎه ﺗﺮ )‪ (P=0/009‬ﺷﺎﻳﻊ ﺗﺮ ﺑـﻮد‪ .‬ﻓﻴـﺴﺘﻮل ﺷـﺮﻳﺎﻧﻲ ورﻳـﺪي در‬ ‫‪ BMI‬ﺑﺎﻻﺗﺮ )‪ (P=0/02‬و در ﺑﻴﻤﺎران ﺑﺎ وزن ﺑﻴﺶﺗﺮ )‪ (P=0/05‬ﺷـﺎﻳﻊﺗـﺮ‬ ‫ﺑﻮد‪ .‬ﺧﻮنرﻳﺰي ﺧﻠـﻒ ﺻـﻔﺎﻗﻲ در ﺑﻴﻤـﺎران ﺑـﺎ ﺳـﻦ ﭘـﺎﻳﻴﻦﺗـﺮ ﺷـﻴﻮع‬ ‫ﺑﻴﺶﺗﺮي داﺷﺖ )‪ .(P=0/02‬آﻧﻮرﻳﺴﻢ ﻛﺎذب ﺷـﺮﻳﺎﻧﻲ در ﺑﻴﻤـﺎراﻧﻲ ﻛـﻪ‬ ‫ﻣﻬﺎرﻛﻨﻨﺪه ‪ gp IIIa/IIb‬اﺳﺘﻔﺎده ﺷﺪه ﺑﻮد‪ ،‬ﺷﺎﻳﻊﺗﺮ ﺑﻮد )‪.(P=0/01‬‬

‫اﻧﺪﻳﻜﺎﺳﻴﻮن آﻧﮋﻳﻮﭘﻼﺳﺘﻲ‬ ‫‪) STEMI‬ﻃﻲ ‪ 7‬روز(‬

‫‪%26/3‬‬

‫‪%28/9‬‬

‫**‪0/51‬‬

‫ﺑﺤﺚ‬

‫‪Chronic CAO‬‬

‫‪%31/6‬‬

‫‪%43/5‬‬

‫**‪0/35‬‬

‫در اﻳﻦ ﻣﻄﺎﻟﻌﻪ‪ ،‬ﻋﻮارض ﻋﺮوﻗﻲ در ‪ 0/9‬درﺻﺪ ﺑﻴﻤﺎران ﻣﺸﺎﻫﺪه ﺷﺪ‪.‬‬

‫‪UA/NSTEMI‬‬

‫‪%10/5‬‬

‫‪%8/1‬‬

‫**‪0/66‬‬

‫ﻫﻤﺎﺗﻮم ﻣﻮﺿﻌﻲ در ﻣﺤﻞ ﻛﺸﺎﻟﻪ ران‪ ،‬ﺑﻪﻋﻨﻮان ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﺎرﺿﻪ‬

‫‪<%40‬‬

‫‪%26/4‬‬

‫‪%18/9‬‬

‫‪%40-49‬‬

‫‪%26/3‬‬

‫‪%39/6‬‬

‫‪>%50‬‬

‫‪%47/4‬‬

‫‪%41/5‬‬

‫**‪0/47‬‬

‫‪%21/1‬‬

‫‪%3/1‬‬

‫**‪0/003‬‬

‫‪162/19/1‬‬

‫‪167/78/3‬‬

‫*‪0/004‬‬

‫ﻋﺮوﻗﻲ ﻣﺤﺴﻮب ﻣﻲﺷﻮد‪ .‬ﻣﺎ ﻋﻮاﻣﻞ ﻣﺮﺑﻮط ﺑﻪ ﺑﻴﻤﺎر و ﻧﻮع ﻣﺪاﺧﻠﻪ‬

‫‪LVEF‬‬

‫ﻣﻬﺎرﻛﻨﻨﺪه‬ ‫ﻗﺪ‬

‫‪gp IIIa/IIb‬‬

‫‪ P<0/05‬ﻣﻌﻨﻲدار * آزﻣﻮن آﻣﺎري ‪ ** ،t-test‬آزﻣﻮن آﻣﺎري‬

‫)‪ (Procedure‬را ﻛﻪ روي ﻣﻴﺰان ﺑﺮوز ﻋﻮارض ﻋﺮوﻗﻲ ﻣﺆﺛﺮﻧﺪ‪ ،‬ﺑﺮرﺳﻲ‬ ‫ﻧﻤﻮدﻳﻢ‪ .‬ﻋﻮاﻣﻞ ﻣﺮﺑﻮط ﺑﻪ ﺑﻴﻤﺎر ﺷﺎﻣﻞ ﺟﻨﺲ زن‪ ،‬ﺳﺎﺑﻘﻪ ‪ ،HTN‬ﻗﺪ‬

‫‪Fisher’s exact test‬‬

‫‪BMI: Body Mass Index, STEMI: ST Elevation MI, CAD: Coronary Artery Disease,‬‬ ‫‪UA/NSTEMI: Unstable Angina/ Non ST Elevation MI, LVEF: LV Ejection Fraction‬‬

‫ﻛﻮﺗﺎهﺗﺮ و ‪ BMI‬ﺑﺎﻻﺗﺮ ﺑﻮد‪ ،‬در اﺳﺘﻔﺎده از داروي ﻣﻬﺎر ﻛﻨﻨﺪه‬

‫‪gp IIIa/IIb‬‬

‫ﻫﻨﮕﺎم ‪ ،PCI‬ﻣﻴﺰان ﺑﺮوز ﻋﻮارض ﻋﺮوﻗﻲ ﺑﻪﻃﻮر ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﺷﺎﻳﻊﺗﺮ‬ ‫ﺑﻮد‪ .‬ﻣﻄﺎﻟﻌﺎت ﻣﺘﻌﺪدي‪ ،‬ﻋﻮاﻣﻞ ﻫﻤﺮاه ﺑﺎ اﻓﺰاﻳﺶ ﺧﻄﺮ اﻳﺠﺎد ﻋﻮارض‬ ‫ﻋﺮوﻗﻲ ﻫﻨﮕﺎم آﻧﮋﻳﻮﮔﺮاﻓﻲ ﻛﺮوﻧﺮ و‬

‫‪PCI‬‬

‫را ﻣﺸﺨﺺ ﻧﻤﻮدهاﻧﺪ‪ .‬ﺟﻨﺲ‬

‫زن‪ ،‬ﻋﻤﻞ اورژاﻧﺲ‪ ،‬ﺳﺎﻳﺰ ‪ Sheat‬و ﻧﺎرﺳﺎﻳﻲ ﻛﻠﻴﻪ‪ ،‬ﭘﻴﺶﮔﻮﻳﻲﻛﻨﻨﺪهﻫﺎي‬ ‫ﻣﺴﺘﻘﻞ اﻓﺰاﻳﺶ ﻋﻮارض ﻋﺮوﻗﻲ ﺑﻮدهاﻧﺪ‪ 8.‬ﺟﻨﺲ زن‪ ،‬ﻋﻤﻞ اورژاﻧﺲ و‬

‫ﺗﻮﺟﻬﻲ در ﺟﻨﺲ ﻣﺆﻧﺚ )‪) (P=0/003‬ﻧﻤﻮدار ‪ ،(2‬در ﺑﻴﻤﺎران ﺑـﺎ ﺳـﺎﺑﻘﻪ‬

‫‪ Access site‬ﺷﺮﻳﺎن ﻓﻤﻮرال در ﻣﺤﻞ ﺷﺮﻳﺎن اﭘﻲﮔﺎﺳﺘﺮﻳﻚ ﺗﺤﺘﺎﻧﻲ ﻳﺎ‬ ‫‪9‬‬

‫‪) (P=0/027) HTN‬ﻧﻤﻮدار ‪ ،(3‬در ﺑﻴﻤﺎران ﺑﺎ ﻗﺪ ﻛﻮﺗـﺎه ﺗـﺮ )‪،(P=0/004‬‬

‫ﺑﺎﻻي آن‪ ،‬ﻫﻤﺮاه ﺑﺎ اﻓﺰاﻳﺶ ﺧﻮنرﻳﺰي ﺧﻠﻒ ﺻﻔﺎﻗﻲ ﻣﻲﺑﺎﺷﺪ‪ .‬ﻣﺎ‬

‫‪gp IIIa/IIb‬‬

‫ﻫﻢﭼﻨﻴﻦ ﻣﻴﺰان اﻳﺠﺎد ﻋﻮارض ﻋﺮوﻗﻲ را ﻧﺴﺒﺖ ﺑﻪ ﺳﺎﻳﺰ ‪ Sheat‬ﻣﻮرد‬

‫اﺳﺘﻔﺎده ﺷﺪه ﺑﻮد )‪) (P=0/003‬ﻧﻤﻮدار ‪ (4‬ﺷﺎﻳﻊﺗﺮ ﺑﻮد‪ .‬وﺿـﻌﻴﺖ ﺑـﺎﻟﻴﻨﻲ‬

‫اﺳﺘﻔﺎده‪ ،‬ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار دادﻳﻢ‪ .‬ﮔﺮﭼﻪ ﻋﻮارض ﻋﺮوﻗﻲ در ﺳﺎﻳﺰ ‪7F‬‬

‫‪ NSTEMI ،UA ،Chronic‬و ‪(STEMI‬‬

‫ﺷﺎﻳﻊﺗﺮ از ﺳﺎﻳﺰ ‪ 6F‬ﺑﻮد‪ ،‬وﻟﻲ ارﺗﺒﺎط ﻗﺎﺑﻞ ﺗﻮﺟﻪ و آﻣﺎري ﻣﻌﻨﻲداري‬

‫در ﺑﻴﻤــﺎراﻧﻲ ﻛــﻪ در ﻃــﻮل اﻧﺠــﺎم ‪ ،PCI‬داروي ﻣﻬﺎرﻛﻨﻨــﺪه‬ ‫ﺑﻴﻤﺎران در زﻣـﺎن ﻣﺮاﺟﻌـﻪ‬

‫)‪CAD‬‬

‫‪PCI‬‬

‫از ﻃﺮﻳﻖ ﺷﺮﻳﺎن رادﻳﺎل در اﻳﻦ ﻣﻄﺎﻟﻌﻪ‪،‬‬

‫ﺗﺎﺛﻴﺮي روي ﺷﻴﻮع ﻋﻮارض ﻧﺪاﺷﺖ‪ .‬ﺷﻴﻮع ﻋﻮارض ﻋﺮوﻗﻲ‪ ،‬ﺑـﺎ ﻣﻴـﺰان‬

‫دﻳﺪه ﻧﺸﺪ‪ .‬ﺗﻌﺪاد ﻣﻮارد‬

‫ﻛﺎرﻛﺮد ﻋﻀﻠﻪ ﻗﻠﺒﻲ ﺑﻴﻤﺎران )‪ ،(P=0/47) ،(LVEF‬ﺑﺎ ﻣﻴﺰان ﻛﺎرﻛﺮد ﻛﻠﻴـﻪ‬

‫ﺧﻴﻠﻲ ﻛﻢ ﺑﻮد و ﻋﻠﻲرﻏﻢ اﻳﻦﻛﻪ ﻣﺎ ﻫﻴﭻ ﻋﺎرﺿﻪ ﻋﺮوﻗﻲ ﺑﺎ روش رادﻳﺎل‬

‫ﺑﻴﻤﺎران )‪ ،(P=0/17‬ﺷﺎﺧﺺ ﺗﻮده ﺑﺪﻧﻲ )‪ ،(P=0/07) (BMI‬ﺳﻦ ﺑﻴﻤـﺎران‬

‫ﻧﺪاﺷﺘﻴﻢ‪ ،‬وﻟﻲ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺗﻌﺪاد ﺧﻴﻠﻲ ﻛﻢ ﻣﻮارد ﻧﺴﺒﺖ ﺑﻪ ﺷﺮﻳﺎن‬

‫)‪ ،(P=0/87‬ﻓــﺸﺎر ﺧــﻮن ﺳﻴــﺴﺘﻮﻟﻴﻚ و دﻳﺎﺳــﺘﻮﻟﻴﻚ در روز اﻧﺠــﺎم‬

‫ﻓﻤﻮرال‪ ،‬ﻣﻘﺎﻳﺴﻪ ارزﺷﻤﻨﺪي ﻣﺤﺴﻮب ﻧﻤﻲﺷﻮد‪ .‬ﺷﻴﻮع ﻋﺎرﺿﻪ ﻋﺮوﻗﻲ‬

‫آﻧﮋﻳﻮﭘﻼﺳــﺘﻲ و وزن ﺑﻴﻤــﺎران ارﺗﺒــﺎط ﻣﻌﻨــﻲداري ﻧﺪاﺷــﺖ‪ .‬ﻋــﻮارض‬

‫ﺑﻌﺪ از ‪ ،PCI‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﭘﺎﻳﻴﻦ ﺑﻮد )‪ 0/9‬درﺻﺪ(‪ ،‬اﻳﻦ ﺷﻴﻮع ﭘﺎﻳﻴﻦﺗﺮ‬

‫ﻋﺮوﻗﻲ در ﺑﻴﻤﺎراﻧﻲ ﻛﻪ ﻛﺎﺗﺘﺮ ‪ 6F‬اﺳﺘﻔﺎده ﺷﺪه ﺑﻮد‪ ،‬ﻧﺴﺒﺖ ﺑﻪ ﺑﻴﻤﺎران ﺑـﺎ‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ، 69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

‫از ﺷﻴﻮع ﮔﺰارشﺷﺪه در ﻣﻄﺎﻟﻌﺎت ﻗﺒﻠﻲ ﻣﻲﺑﺎﺷﺪ )ﺣﺪود ‪ 1/5‬درﺻﺪ(‪،‬‬

‫‪10‬‬

‫ﭘﺲ از ﻣﺪاﺧﻼت ﻛﺮوﻧﺮ‬ ‫ ﻋﺮوﻗﻲ‬A.A. ‫ﻋﻮارض‬ ‫ﻋﻮاﻣﻞ ﻣﺮﺗﺒﻂ ﺑﺎ ﺑﺮوز‬ Yousefi et al.

449

‫ روي ﺷﺮﻳﺎن در ﻣﺪت زﻣﺎن ﻣﻨﺎﺳﺐ ﻓﺸﺎر ﻻزم ﺑﺎ دﺳﺖ اﻋﻤﺎل‬،‫ﺷﺮﻳﺎﻧﻲ‬

‫ﺷﺎﻳﺪ اﻳﻦ ﺗﻔﺎوت ﺑﻪﻋﻠﺖ ﻃﻴﻒ ﺗﻌﺮﻳﻒ ﺑﺎرﻳﻚﺗﺮ ﻋﻮارض ﻋﺮوﻗﻲ اﺳﺖ‬

‫ اﻳﻦ‬.‫ اﺣﺘﻤﺎل ﭘﻴﺪاﻳﺶ ﻋﻮارض در اﻳﻦ ﻣﺤﻞ ﺑﺴﻴﺎر ﻛﻢ ﺧﻮاﻫﺪ ﺑﻮد‬،‫ﺷﻮد‬

‫ ﻣﺎ ﻋﻮارض ﻋﺮوﻗﻲ را ﺑﻌﺪ‬،‫ اﻟﺒﺘﻪ‬.‫ﻛﻪ در اﻳﻦ ﻣﻄﺎﻟﻌﻪ اﺳﺘﻔﺎده ﺷﺪه اﺳﺖ‬

‫ ﻣﻄﺎﻟﻌﻪ‬،‫ ﻳﻚ ﺑﺮرﺳﻲ ﺗﻚ ﻣﺮﻛﺰي ﺑﻮده و ﺑﺮاي ارزﻳﺎﺑﻲ ﺟﺎﻣﻊﺗﺮ‬،‫ﻣﻄﺎﻟﻌﻪ‬

‫ ﭼﺮا ﻛﻪ ﺑﻌﻀﻲ از ﻋﻮارض‬،‫از ﺗﺮﺧﻴﺺ از ﺑﻴﻤﺎرﺳﺘﺎن ارزﻳﺎﺑﻲ ﻧﻜﺮدﻳﻢ‬

‫ﭼﻨﺪ ﻣﺮﻛﺰي در ﺑﻴﻤﺎرﺳﺘﺎنﻫﺎي ﻣﺨﺘﻠﻒ ﺑﺎ ﺗﻌﺪاد ﻣﻮارد ﺑﻴﺶﺗﺮ ﺗﻮﺻﻴﻪ‬

‫ﻣﺜﻞ ﻓﻴﺴﺘﻮل ﺷﺮﻳﺎﻧﻲ ورﻳﺪي ﻳﺎ آﻧﻮرﻳﺴﻢ ﻛﺎذب ﻣﻤﻜﻦ اﺳﺖ ﺑﻪﺻﻮرت‬

‫ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪاﺣﺘﻤﺎل ﭘﻴﺪاﻳﺶ ﺑﻌﻀﻲ ﻋﻮارض ﻋﺮوﻗﻲ ﺑﻪﺻﻮرت‬.‫ﻣﻲﺷﻮد‬

‫ ﻳﺎﻓﺘﻪﻫﺎي اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﺸﺨﺺ ﻣﻲﻛﻨﺪ ﻛﻪ اﻧﺠﺎم‬.‫ﺗﺄﺧﻴﺮي ﻇﺎﻫﺮ ﺷﻮﻧﺪ‬

‫ ﭘﺎﻳﺶ ﺑﻴﻤﺎران در روزﻫﺎي ﺑﻌﺪ آﻧﮋﻳﻮﮔﺮاﻓﻲ ﻧﻴﺰ ﺟﻬﺖ‬،‫ﺗﺄﺧﻴﺮي‬

‫از ﻃﺮﻳﻖ ﺷﺮﻳﺎن ﻓﻤﻮرال ﻳﻚ روش ﻛﻢﻋﺎرﺿﻪ از ﻧﻈﺮ ﭘﻴﺪاﻳﺶ‬

.‫ﻣﺸﺨﺺ ﻧﻤﻮدن دﻗﻴﻖﺗﺮ ﺗﻌﺪاد ﻋﻮارض ﻋﺮوﻗﻲ ﭘﻴﺸﻨﻬﺎد ﻣﻲﺷﻮد‬

PCI

‫ﻋﻮارض ﻋﺮوﻗﻲ ﻣﻲﺑﺎﺷﺪ و در ﺻﻮرﺗﻲﻛﻪ در ﻣﺤﻞ ﺧﺎرج ﻛﺮدن وﺳﻴﻠﻪ‬

References 1. Topol EJ, editor. Textbook of Interventional Cardiology. 5th ed.

Philadelphia, PA: WB Saunders; 2008. p. 513-28.

2. Eeckhout E, Carlier S, Lerman A, Kern M, editors. Handbook of Complications During Percutaneous Coronary Interventions.

London: Taylor and Francis: Informa Healthcare; 2007. p. 53-62.

3. Libby P, Bonow R, Mann D, Zipes D, editors. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed.

Philadelphia, PA: WB Saunders; 2008. p. 1423-4.

4. Applegate RJ, Sacrinty MT, Kutcher MA, Kahl FR, Gandhi SK, Santos RM, et al. Trends in vascular complications after diagnostic cardiac catheterization and percutaneous coronary intervention via the femoral artery, 1998 to 2007. JACC Cardiovasc Interv 2008;1(3):317-26.

5. Piper WD, Malenka DJ, Ryan TJ Jr, Shubrooks SJ Jr, O'Connor GT, Robb JF, et al. Predicting vascular complications in percutaneous coronary interventions.

Am Heart J 2003;145(6):1022-9.

6. Dumont CJ, Keeling AW, Bourguignon C, Sarembock IJ, Turner M. Predictors of vascular complications post diagnostic cardiac

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

catheterization and percutaneous coronary interventions. Dimens Crit Care Nurs 2006;25(3):137-42.

7. Kelm M, Perings SM, Jax T, Lauer T, Schoebel FC, Heintzen MP, et al. Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: implications for risk stratification and treatment. J Am Coll Cardiol 2002;40(2):291-7.

8. Tavris DR, Dey S, Albrecht-Gallauresi B, Brindis RG, Shaw R, Weintraub W, et al. Risk of local adverse events following cardiac catheterization by hemostasis device use - phase II. J Invasive Cardiol 2005;17(12):644-50.

9. Farouque HM, Tremmel JA, Raissi Shabari F, Aggarwal M, Fearon WF, Ng MK, et al. Risk factors for the development of retroperitoneal hematoma after percutaneous coronary intervention in the era of glycoprotein IIb/IIIa inhibitors and vascular closure devices. J Am Coll Cardiol 2005;45(3):363-8.

10. Koreny M, Riedmüller E, Nikfardjam M, Siostrzonek P, Müllner M. Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis. JAMA 2004;291(3):350-7.

Tehran University Medical Journal;‫ﻫﻤﻜﺎران‬ Vol. 69, ‫ و‬No. 7, October 2011: 445-450

100

The factors relevant to the onset of vascular complications after coronary intervention in Shahid Rajaei Cardiovascular Center in Tehran, Iran

1

Ahmad Ali Yousefi M.D. Mohsen Madani M.D.1 Hamid Reza Azimi M.D.1* Hossein Farshidi M.D.2 1- Department of Cardiovascular, Shahid Rajaei Hospital, Tehran University of Medical Sciences, Tehran, Iran.

2- Fellowship of Angioplasty, Department of Cardiovascular, Shahid Rajaei Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Received: May 29, 2011 Accepted: September 11, 2011

Background: Vascular complications, as the most common complications of diagnostic catheterization and percutaneous coronary intervention (PCI), are important factors in the morbidity of patients undergoing such procedures; thus, this study was done to evaluate the prevalence of these complications and their related factors.

Methods: This is a descriptive study composed of 2097 consecutive patients who underwent percutaneous coronary intervention in Shahid Rajaei Cardiovascular Center in Tehran, Iran from January 2008 to January 2009. Occurrence of vascular complications in course of hospitalization and the related factors leading to the complications were investigated.

Results: Out of 2097 patients, 1544 (73.6%) were male and 553 (26.4%) were female, and the mean age of the participants was 5710 years. Vascular complications from the time of PCI to the time discharge were observed in 19 (0.9%) patients. The other complications included: hematoma in 10 cases (52.6%), pseudoaneurysm in five cases (26.3%), retroperitoneal hemorrhage and arteriovenous fistula in 2 (10.5%) patients each.

The complications were significantly more common in female patients (P=0.003), in patients with a history of hypertension (P=0.02), people of shorter stature (P=0.004), and being on gp IIIa/IIb inhibitors (P=0.003).

Conclusion: The rate of vascular complications post-percutaneous coronary interventions is low and it is considered to be a good treatment option for patients with coronary stenosis; provided that sufficient compression is applied on the vascular access point in the right time after removal of the arterial sheath. PCI is of fewer vascular complications, especially in female patients, history of hypertension, and higher anticoagulant concentrations. *

Corresponding author: Shahid Rajaei Hospital, Next to Mellat Park, Valiasr St., Tehran, Iran.

Tel: +98-21-23921 E-mail: azimihamidreza66@yahoo.com

Keywords: Arteriovenous fistula, hematoma, hemorrhage, retroperitoneal, vascular complication.

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬، 69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

‫ﻣﻮش‬ ‫ﺳﺮم‪ ،‬در‬ ‫ﻟﻴﭙﻴﺪﻫﺎي‬ ‫ﺷﻤﺎرهو‬ ‫ﻛﻮرﺗﻴﺰول‬ ‫ﺗﻴﺮوﻳﻴﺪ‪،‬‬ ‫ﻫﻮرﻣﻮن‬ ‫ﻣﺎﻳﻜﺮووﻳﻮ‬ ‫اﺟﺎق‬ ‫‪451‬‬ ‫‪1390‬‬ ‫ﺷﻤﺎره‪،7،4‬ﺗﻴﺮﻣﻬﺮ‬ ‫‪،69‬‬ ‫ﺗﻬﺮان‪،‬‬ ‫ﭘﺰﺷﻲﻜﻲ‬ ‫ﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ‫ﻲ‪،‬ﻲ‪،‬‬ ‫ﭘﺰﺷﻜ‬ ‫ﺪهﺪه‬ ‫ﻧﺸﺘﻲﻜ‬ ‫داﻧﺸ‬ ‫ﻣﺠﻠﻪ‬ ‫‪312‬‬ ‫‪،1390‬‬ ‫دوره‪، 69‬‬ ‫دوره‬ ‫ﺗﻬﺮان‪،‬‬ ‫وزن‪،‬ﭘﺰﺷﻜ‬ ‫ﺑﺮﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ‫ﭘﺰﺷﻜ‬ ‫اﻣﻮاجداﻧﺸﻜ‬ ‫ﺗﺎﺛﻴﺮﻣﺠﻠﻪ‬

‫آﺗﺮزي ﻛﻮآن‪ :‬ﺗﺠﺮﺑﻪ ‪ 13‬ﺳﺎﻟﻪ و ﺑﺮرﺳﻲ ﻣﺘﻮن‪ :‬ﮔﺰارش ﻛﻮﺗﺎه‬

‫آﺗﺮزي ﻛﻮآن )‪ (Choanal atresia‬ﻛﻪ اﺑﺘﺪا ﺗﻮﺳﻂ دﻛﺘﺮ ‪ Roeder‬در‬

‫ﻋﻼﻳﻤﻲ از اﻧﺴﺪاد ﺑﻴﻨﻲ ﻣﺮاﺟﻌﻪ ﻛﺮده ﻛﻪ در ﺑﻴﻦ آنﻫﺎ ‪ %18‬ﻣﻮارد‬

‫ﺳﺎل ‪ 1755‬ﻣﻌﺮﻓﻲ ﺷﺪ‪ 1،‬ﺑﺎرﻳﻚ ﺷﺪن ﻳﺎ اﻧﺴﺪاد دﻫﺎﻧﻪ ﺧﻠﻔﻲ ﺣﻔﺮه ﺑﻴﻨﻲ‬

‫دوﻃﺮﻓﻪ و ﺑﺎ ﺳﻴﺎﻧﻮز ﻫﻤﺮاه ﺑﻮده اﺳﺖ و ‪ %64‬ﻣﻮارد ﻧﻴﺰ رﻳﻨﻮره داﺷﺘﻨﺪ‪.‬‬

‫اﺳﺖ‪ .‬اﻳﻦ ﺑﻴﻤﺎري ﻣﻲﺗﻮاﻧﺪ ﻣﺎدرزادي ﻳﺎ اﻛﺘﺴﺎﺑﻲ رخ دﻫﺪ‪ .‬اﻏﻠﺐ‬

‫ﻣﻴﺎﻧﮕﻴﻦ ﺑﻴﻤﺎران ﻣﺎ ‪ 12/4‬ﺳﺎل ﻣﺤﺎﺳﺒﻪ ﺷﺪ ﻛﻪ ﻧﺴﺒﺖ ﺑﻪ ﻣﻄﺎﻟﻌﺎت دﻳﮕﺮ‬

‫ﻣﺒﺘﻼﻳﺎن ﺑﻪ اﻳﻦ ﺑﻴﻤﺎري ﻣﻮﻧﺚ ﻫﺴﺘﻨﺪ‪ 2.‬ﻣﻮارد ﻣﺎدرزادي ﻣﻤﻜﻦ اﺳﺖ‬

‫ﻛﻤﻲ ﺑﺎﻻﺗﺮ اﺳﺖ و اﻳﻦ ﻣﺴﺌﻠﻪ ﻣﻲﺗﻮاﻧﺪ ﻧﺎﺷﻲ از ﻣﺮاﺟﻌﻪ دﻳﺮﻫﻨﮕﺎم و‬

‫اﻳﺰوﻟﻪ ﺑﻮده ﻳﺎ ﻫﻤﺮاه ﺑﺎ ﻧﺎﻫﻨﺠﺎريﻫﺎي دﻳﮕﺮي ﻧﻈﻴﺮ ﻫﻤﺮاﻫﻲ ﺳﻨﺪرم‬

‫ﻋﺪم آﮔﺎﻫﻲ ﺑﻴﻤﺎران از ﻋﻼﻳﻢ و ﻛﻤﺒﻮد ﻣﺮاﻛﺰ ﺑﻬﺪاﺷﺘﻲ در ﺳﻄﺢ ﻛﺸﻮر‬

‫ﺑﺎﺷﻨﺪ ﻛﻪ اﻳﻦ ﻣﻮارد ﺣﺪود ‪ %20-50‬از ﻣﻮارد ﻣﺎدرزادي را‬

‫ﺑﺎﺷﺪ‪ .‬روش ﺗﺮاﻧﺲ ﭘﺎﻻﺗﺎل ﺑﻴﺶﺗﺮﻳﻦ روش ﻣﻮرد اﺳﺘﻔﺎده ﺗﺎ اواﺧﺮ دﻫﻪ‬

‫‪CHARGE‬‬

‫‪3‬‬

‫ﺗﺸﻜﻴﻞ ﻣﻲدﻫﻨﺪ‪ .‬آﺗﺮزي ﻛﻮان ﻣﻲﺗﻮاﻧﺪ ﻳﻚﻃﺮﻓﻪ ﻳﺎ دوﻃﺮﻓﻪ ﺑﺎﺷﺪ؛ ﺑﺎ‬

‫‪ 80‬ﺑﻮده اﺳﺖ‪ .‬اﻳﻦ روش ﺑﻪﻋﻠﺖ ﺗﻮاﻧﺎﻳﻲ اﻳﺠﺎد ورودي اﺑﺘﺪاﻳﻲ‬

‫وﺟﻮد اﻳﻦﻛﻪ ﻣﻮارد دوﻃﺮﻓﻪ ﺟﺪيﺗﺮ ﺑﻮده و ﻧﻴﺎزﻣﻨﺪ درﻣﺎن اورژاﻧﺲ‬

‫ﺑﺰرگﺗﺮ دﺳﺘﺮﺳﻲ ﻣﻨﺎﺳﺐﺗﺮي را ﻓﺮاﻫﻢ ﻣﻲﻛﻨﺪ‪ .‬اﻣﺎ در دو دﻫﻪ اﺧﻴﺮ‬

‫ﻫﺴﺘﻨﺪ‪ ،‬ﻣﻮارد ﻳﻚﻃﺮﻓﻪ ﺷﺎﻳﻊﺗﺮ ﺑﻮده و اﻛﺜﺮا ﺳﻤﺖ راﺳﺖ را درﮔﻴﺮ‬

‫روش ﺗﺮاﻧﺲ ﻧﺎزال ارﺟﺢ ﺑﻮده اﺳﺖ‪ .‬در اﻳﻦ روش ﺑﺎ اﺳﺘﻔﺎده از‬

‫ﻣﻲﻧﻤﺎﻳﻨﺪ‪ .‬آﺗﺮزي ﻛﻮان ﻣﻲﺗﻮاﻧﺪ ﻣﻨﺸﺎ اﺳﺘﺨﻮاﻧﻲ‪ ،‬ﻏﺸﺎﻳﻲ ﻳﺎ ﻣﺨﺘﻠﻂ‬

‫آﻧﺪوﺳﻜﻮپ ﻣﻲﺗﻮان ﻣﻜﺎن دﻗﻴﻖ رزﻛﺴﻴﻮن را ﺗﻌﻴﻴﻦ و اﻣﻨﻴﺖ ﺟﺮاﺣﻲ‬

‫داﺷﺘﻪ ﺑﺎﺷﺪ‪ 2.‬در ﺣﺎل ﺣﺎﺿﺮ درﻣﺎن ﻗﻄﻌﻲ آﺗﺮزي ﻛﻮان‪ ،‬درﻣﺎن ﺟﺮاﺣﻲ‬

‫را اﻓﺰاﻳﺶ داد‪ 4.‬اﺳﺘﻔﺎده از اﺳﺘﻨﺖ در ﺟﺮاﺣﻲ آﺗﺮزي ﻛﻮان ﻫﻨﻮز ﻣﻮرد‬

‫اﺳﺖ‪ .‬در ﺣﺎل ﺣﺎﺿﺮ‪ ،‬ﺳﻪ روش ﺟﺮاﺣﻲ ﺗﺮاﻧﺲ ﭘﺎﻻﺗﺎل‪ ،‬ﺗﺮاﻧﺲ ﺳﭙﺘﺎل‬

‫ﺑﺤﺚ اﺳﺖ‪ .‬ﺑﻌﻀﻲ ﻧﻮﻳﺴﻨﺪﮔﺎن ﻋﻘﻴﺪه دارﻧﺪ اﺳﺘﻨﺖ ﻣﺎﻧﻊ ﺗﻨﮕﻲ ﻣﺠﺪد‬

‫و ﺗﺮاﻧﺲ ﻧﺎزال )ﺑﻪوﺳﻴﻠﻪ آﻧﺪوﺳﻜﻮپ( ارﺟﺢ ﻫﺴﺘﻨﺪ‪ 3.‬در اﻳﻦ ﭘﮋوﻫﺶ‬

‫ﻣﻲﺷﻮد در ﺣﺎﻟﻲﻛﻪ ﺑﻌﻀﻲ دﻳﮕﺮ ﺑﻪ اﻓﺰاﻳﺶ رﻳﺴﻚ ﻋﻔﻮﻧﺖ و اﺳﻜﺎر ﺑﺎ‬

‫ﭘﺮوﻧﺪه ﺗﻤﺎﻣﻲ ﺑﻴﻤﺎراﻧﻲ ﻛﻪ از ﺳﺎل ‪ 1376‬ﺗﺎ ﺳﺎل ‪ 1388‬ﺑﻪ ﺑﻴﻤﺎرﺳﺘﺎن‬

‫اﺳﺘﻔﺎده از اﺳﺘﻨﺖ ﻣﻌﺘﻘﺪﻧﺪ‪ 5.‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﻮارد ذﻛﺮ ﺷﺪه ﺑﺮرﺳﻲﻫﺎي‬

‫اﻣﻴﺮاﻋﻠﻢ ﻣﺮاﺟﻌﻪ ﻧﻤﻮدهاﻧﺪ ﻣﻄﺎﻟﻌﻪ ﺷﺪ‪ .‬ﺑﺎ ﺟﺴﺘﺠﻮ در ﺑﺨﺶ ﺑﺎﻳﮕﺎﻧﻲ‬

‫ﺑﻴﺸﺘﺮ در زﻣﻴﻨﻪ آﺗﺮزي ﻛﻮان‪ ،‬ﺑﻬﺘﺮﻳﻦ روشﻫﺎي ﺟﺮاﺣﻲ و ﺗﻜﻨﻴﻚﻫﺎﻳﻲ‬

‫ﺑﻴﻤﺎرﺳﺘﺎن اﻣﻴﺮاﻋﻠﻢ ‪ 54‬ﺑﻴﻤﺎر ﻣﻮرد آﺗﺮزي ﻛﻮان ﻛﻪ در اﻳﻦ ﺑﻴﻤﺎرﺳﺘﺎن‬

‫ﺟﻬﺖ ﺗﺸﺨﻴﺺ زودرس آن ﺿﺮوري ﺑﻪﻧﻈﺮ ﻣﻲرﺳﺪ‪.‬‬

‫ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ ﻳﺎﻓﺖ ﺷﺪ‪ .‬ﺳﻦ اﻳﻦ ﺑﻴﻤﺎران از دو ﺗﺎ‬ ‫‪ 29‬ﺳﺎل ﻣﺘﻐﻴﺮ و ﻣﻴﺎﻧﮕﻴﻦ و ﻣﻴﺎﻧﻪ ﺳﻦ ﺑﻴﻤﺎران ﺑﻪﺗﺮﺗﻴﺐ ‪ 12/4‬و ‪12‬‬ ‫ﺳﺎل ﺑﻮد‪ .‬ﻧﺴﺒﺖ دﺧﺘﺮ ﺑﻪ ﭘﺴﺮ دو ﺑﻪ ﻳﻚ ﺑﻮده و ﻧﺴﺒﺖ ﻣﻮارد ﻳﻚﻃﺮﻓﻪ‬ ‫ﺑﻪ دوﻃﺮﻓﻪ ‪ 1/9: 1‬ﻣﺤﺎﺳﺒﻪ ﺷﺪ‪ .‬از ﺑﻴﻦ ﻣﻮارد ﻳﻚﻃﺮﻓﻪ ‪ 19‬ﻣﻮرد ﺳﻤﺖ‬

‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﻣﺤﺴﻦ ﻧﺮاﻗﻲ‪ ،‬ﮔﺮوه ﮔﻮش‪ ،‬ﮔﻠﻮ‪ ،‬ﺑﻴﻨﻲ و ﺟﺮاﺣﻲ‬

‫ﺳﺮ و ﮔﺮدن‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬ ‫ﻧﺎزﻧﻴﻦ ﺣﺠﺮاﻻﺳﻮدي‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫راﺳﺖ ﺑﻮدﻧﺪ‪ 40 .‬ﻣﻮرد ﻣﺨﺘﻠﻂ‪ 13 ،‬ﻣﻮرد اﺳﺘﺨﻮاﻧﻲ ﺑﻮدﻧﺪ و ﻳﻚ ﻣﻮرد‬

‫* ﺷﻤﺎره ﺗﻠﻔﻦ‪021-66703037 :‬‬

‫ﻧﻴﺰ ﻏﺸﺎﻳﻲ ﻣﺸﺎﻫﺪه ﺷﺪ‪ .‬ﭘﻨﺞ ﺑﻴﻤﺎر از ﻃﺮﻳﻖ ﺗﺮاﻧﺲ ﭘﺎﻻﺗﺎل و ﺑﻘﻴﻪ ﻣﻮارد‬

‫آدرس‪ :‬ﺗﻬﺮان‪ ،‬ﺧﻴﺎﺑﺎن ﺳﻌﺪي‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن اﻣﻴﺮاﻋﻠﻢ‪ ،‬ﮔﺮوه ﮔﻮش‪ ،‬ﮔﻠﻮ‪ ،‬ﺑﻴﻨﻲ و ﺟﺮاﺣﻲ‬

‫ﺗﺤﺖ روش آﻧﺪوﺳﻜﻮﭘﻴﻚ ﺑﺪون اﺳﺘﻨﺖ ﺟﺮاﺣﻲ ﺷﺪﻧﺪ‪ %80 .‬ﻣﻮارد ﺑﺎ‬

‫ﺳﺮ و ﮔﺮدن‬

‫‪E-mail: naraghim@sina.tums.ac.ir‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ،69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

452 ،1390 ‫ ﻣﻬﺮ‬،7 ‫ﻫﻤﻜﺎرانﺷﻤﺎره‬ ،69 ‫ ودوره‬،‫ﺗﻬﺮان‬ ‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜ‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬ ‫ﻏﻼﻣﻌﻠﻲﻲﺟﻠﻮدار‬

The choanal atresia: 13- year experience and a review of the literature: brief report

Choanal atresia was first described by Roeder in 1755.1 Choanal atresia is the narrowing or obstruction of the posterior nasal fossa. This anomaly could be congenital or acquired. Most patients are female.2 Choanal atresia might be isolated or associated with other anomalies like CHARGE syndrome and 20-50% of congenital cases have this company.3 Choanal atresia could be unilateral or bilateral; while bilateral cases are emergent surgical conditions, unilateral cases are more frequent and mostly right-sided. Choanal atresia may be osseous, membranous or mixed.2 The definite treatment for choanal atresia is surgery and transpalatal, transseptal and transnasal (with endoscope) are the three preferable approaches.3 The medical records of fifty-four patients diagnosed with choanal atresia and admitted in Amiralam university hospital during the years 1998 to 2010 were evaluated. The patients were 2 to 29 years old with a mean and median age of 12.4 and 12, respectively. Female to male ratio was 2:1 and unilateral to bilateral involvement ratio was 1.9:1. Among unilateral cases, 19 cases had right-sided involvement. Forty cases had mixed, 13 had osseous, and one of them had membranous choanal atresia. Five patients had undergone transplatal surgery and the rest had their choanal atresia repaired by endoscopic approach. 80% of the cases had revisited for symptoms of nasal obstruction among which 18% had bilateral obstruction and presented with cyanosis and 64% had rhinorrhea.

In comparison to similar studies, our patients had a higher mean age. This could be due to late referral, the patients’ unfamiliarity with the symptoms and inadequacy of specialized treatment centers.

Transpalatal approach was the most common surgical approach till late 80s as it provided better access due to the provision of a wider opening. Providing direct access to the surgical field and causing the least trauma to the site, endoscopic approach has been the most preferable option during the last two decades. In this approach, the exact site of resection can be determined and surgical safety will be increased.4 Use of stents in the surgery of choanal atresia is still controversial. Some authors believe in the prevention of recurrence with stents while some think about higher probability of infection and scar.5 Regarding the mentioned issues above, more research is needed to find the best surgical approaches and techniques for the early detection and treatment of choanal atresia. *

Corresponding author: Mohsen Naraghi M.D.

Department of Otorhinolaryngology, Head and Neck Surgery, Tehran University of Medical

Sciences, Tehran, Iran.

Nazanin HajarolAsvadi M.D. Tehran University of Medical Sciences, Tehran, Iran. * Address: Amiralam Hospital, Sa’di St., Enghelab Ave., Tehran, Iran.

Tel: +98-21-66703037 E-mail: naraghim@sina.tums.ac.ir

References 1. Ramsden JD, Campisi P, Forte V. Choanal atresia and choanal stenosis. Otolaryngol Clin North Am 2009;42(2):339-52, x.

2. da Fontoura Rey Bergonse G, Carneiro AF, Vassoler TM. Choanal atresia: analysis of 16 cases: the experience of HRAC-USP from 2000 to 2004. Braz J Otorhinolaryngol 2005;71(6):730-3.

3. Hengerer AS, Brickman TM, Jeyakumar A. Choanal atresia: embryologic analysis and evolution of treatment, a 30-year experience. Laryngoscope 2008;118(5):862-6.

4. Assanasen P, Metheetrairut C. Choanal atresia. J Med Assoc Thai 2009;92(5):699-706.

5. Mantovani M, Mosca F, Laguardia M, Di Cicco M, Pignataro L. A new dynamic endonasal stent for bilateral congenital choanal atresia. Acta Otorhinolaryngol Ital 2009;29(4):209-12

1390 ‫ ﻣﻬﺮ‬،7 ‫ ﺷﻤﺎره‬،69 ‫ دوره‬،‫ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬،‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‬

‫ﻣﻮش‬ ‫ﺳﺮم‪ ،‬در‬ ‫ﻛﻮرﺗﻴﺰول و‬ ‫ﺗﻴﺮوﻳﻴﺪ‪،‬‬ ‫ﻣﺎﻳﻜﺮووﻳﻮ‬ ‫اﺟﺎق‬ ‫‪453‬‬ ‫ﻟﻴﭙﻴﺪﻫﺎي‪1390‬‬ ‫ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ‬ ‫دوره ‪،69‬‬ ‫ﻫﻮرﻣﻮنﺗﻬﺮان‪،‬‬ ‫وزن‪ ،‬ﭘﺰﺷﻜﻲ‬ ‫ﺑﺮ ﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ‫ﭘﺰﺷﻜﻲ‪،‬‬ ‫ﻧﺸﺘﻲﻜﺪه‬ ‫اﻣﻮاج داﻧﺸ‬ ‫ﺗﺎﺛﻴﺮ ﻣﺠﻠﻪ‬

‫اﻧﺴﻴﺪاﻧﺲ ﺳﻨﺪروم ﻧﻮروﻟﻮژﻳﻚ ﻣﻮﻗﺖ ﺑﻌﺪ از ﺑﻲﺣﺴﻲ اﺳﭙﺎﻳﻨﺎل ﺑﺎ ﻟﻴﺪوﻛﺎﻳﻴﻦ و ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ‪ :‬ﺗﺎﺛﻴﺮ ﻧﻮع‬ ‫ﺳﻮزن و ﭘﻮزﻳﺸﻦ ﺟﺮاﺣﻲ‪ :‬ﮔﺰارش ﻛﻮﺗﺎه‬

‫ﺳﻨﺪرم ﻧﻮروﻟﻮژﻳﻚ ﻣﻮﻗﺖ‬

‫)‪(TNS‬‬

‫ﺑﻪﺻﻮرت ﻛﻤﺮ درد ﻳﺎ درد در‬

‫ﺑﻴﻤﺎر درد در ﻧﺎﺣﻴﻪ ﻟﻮﻣﺒﻮﺳﺎﻛﺮال ﺑﺎ اﻧﺘﺸﺎر ﺑﻪ اﻧﺪام ﺗﺤﺘﺎﻧﻲ ﺑﻮد ﻛﻪ ﺑﺎ‬

‫ﻧﺎﺣﻴﻪ ﺑﺎﺳﻦ و اﻧﺪام ﺗﺤﺘﺎﻧﻲ ﺑﻮده و ﻣﻌﻤﻮﻻ ﻣﻮﻗﺘﻲ ﻣﻲﺑﺎﺷﺪ‪ .‬اﻳﻦ ﺳﻨﺪرم‬

‫ﻧﺸﺴﺘﻦ ﺗﺸﺪﻳﺪ ﻣﻲﻳﺎﻓﺖ و در ‪ 22‬ﻣﻮرد درد در ﻧﺎﺣﻴﻪ ران ﺑﻮد‪ .‬دردﻫﺎ‬

‫اوﻟﻴﻦﺑﺎر ﺗﻮﺳﻂ ‪ Schneider‬در ﺳﺎل ‪ 1993‬ﮔﺰارش ﮔﺮدﻳﺪه و ﺑﻪﻧﺎم‬

‫ﺑﻪﻃﻮر ﻋﻤﺪه ‪ 6-8‬ﺳﺎﻋﺖ ﺑﻌﺪ از اﺳﭙﺎﻳﻨﺎل ﺷﺮوع ﻣﻲﺷﺪ‪ .‬ﻣﺘﻮﺳﻂ درد‬

‫اﻧﺴﻴﺪاﻧﺲ ﺳﻨﺪروم‬

‫ﺑﻴﻤﺎران ﺑﺮﺣﺴﺐ )‪ Visual Analog Scale (VAS‬ﺷﺶ ﺑﻮد ﻛﻪ ﺑﺎ داروي‬

‫ﻧﻮروﻟﻮژﻳﻚ ﻣﻮﻗﺖ ﺑﻌﺪ از ﺑﻲﺣﺴﻲ اﺳﭙﺎﻳﻨﺎل ﺑﺎ ﻟﻴﺪوﻛﺎﻳﻴﻦ‪ %10 ،‬ﺗﺎ ‪%40‬‬

‫ﭘﺘﺪﻳﻦ ﻛﺎﻫﺶ ﻣﻲﻳﺎﻓﺖ‪ .‬از ﻧﻈﺮ ﻧﻮع ﺳﻮزن اﺳﭙﺎﻳﻨﺎل اﺧﺘﻼف واﺿﺤﻲ‬

‫ﻫﺪف اوﻟﻴﻪ اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻌﻴﻴﻦ درﺻﺪ ﺑﺮوز‬

‫ﺑﻴﻦ دو ﻧﻮع ﺳﻮزن‪ ،‬در ﺑﺮوز ﺳﻨﺪرم ﻧﻮروﻟﻮژﻳﻚ ﻣﻮﻗﺖ وﺟﻮد ﻧﺪاﺷﺖ‬

‫‪2‬و‪1‬‬

‫ﺳﻨﺪرم ﻧﻮروﻟﻮژﻳﻚ ﻣﻮﻗﺖ ﻧﺎﻣﻴﺪه ﺷﺪ‪.‬‬ ‫‪4‬و‪3‬‬

‫ﮔﺰارش ﺷﺪه اﺳﺖ‪.‬‬

‫ﺳﻨﺪرم ﻧﻮروﻟﻮژﻳﻚ ﻣﻮﻗﺖ در اﻳﻦ ﺑﻴﻤﺎران و ﻫﺪف ﺛﺎﻧﻮﻳﻪ ﺗﻌﻴﻴﻦ ارﺗﺒﺎط‬

‫)‪.(P=0/7‬‬

‫ﺑﺮوز ﺳﻨﺪرم ﻧﻮروﻟﻮژﻳﻚ ﻣﻮﻗﺖ ﺑﺎ ﻧﻮع ﺳﻮزن ﻳﺎ ﻧﻮع ﭘﻮزﻳﺸﻦ ﺟﺮاﺣﻲ‬

‫در اﻳﻦ ﻣﻄﺎﻟﻌﻪ‪ ،‬اﻧﺴﻴﺪاﻧﺲ ﻋﻮارض ﻧﻮروﻟﻮژﻳﻚ ﺑﺎ ﻟﻴﺪوﻛﺎﻳﻴﻦ ﺑﻴﺸﺘﺮ از‬

‫ﺑﻮده اﺳﺖ‪ .‬اﻳﻦ ﻣﻄﺎﻟﻌﻪ آﻳﻨﺪهﻧﮕﺮ ﺑﺮ روي ‪ 250‬ﺑﻴﻤﺎر‬

‫)‪(ASA I-II‬‬

‫در‬

‫‪5‬‬

‫ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ ﺑﻮد ﻛﻪ اﻳﻦ ﻳﺎﻓﺘﻪ ﺑﺎ ﻣﻄﺎﻟﻌﻪ ‪ Keld‬ﻫﻢﺧﻮاﻧﻲ دارد‪.‬‬

‫ﻣﺤﺪوده ﺳﻨﻲ ‪ 18‬ﺗﺎ ‪ 60‬ﺳﺎل ﻛﻪ ﻛﺎﻧﺪﻳﺪاي ﺟﺮاﺣﻲ در دو ﭘﻮزﻳﺸﻦ‬

‫در ﭘﻮزﻳﺸﻦ ‪ Supine‬ﺑﺮوز ﻛﻤﺮدرد ﺑﺴﻴﺎر ﻛﻤﺘﺮ ﺑﻮد‪ ،‬ﺷﺎﻳﺪ ﻋﻠﺖ آن اﻳﻦ‬

‫ﻟﻴﺘﻮﺗﻮﻣﻲ و ﺳﻮﭘﺎﻳﻦ ﺑﻮدﻧﺪ ﻃﺮاﺣﻲ ﮔﺮدﻳﺪ‪ .‬ﺑﻴﻤﺎران ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﻮع‬

‫ﺑﺎﺷﺪ ﻛﻪ در وﺿﻌﻴﺖ ﺳﻮﭘﺎﻳﻦ ﺳﺘﻮن ﻓﻘﺮات ﻛﻤﺮي ﺣﺎﻟﺖ ﻟﻮردوز‬

‫ﺳﻮزن اﺳﭙﺎﻳﻨﺎل )‪ (Sprotte or Quincke‬و ﻧﻮع داروي ﺑﻲﺣﺴﻲ‬

‫ﻃﺒﻴﻌﻲ ﺧﻮد را ﺣﻔﻆ ﻣﻲﻛﻨﺪ وﻟﻲ در وﺿﻌﻴﺖ ﻟﻴﺘﻮﺗﻮﻣﻲ ﻟﻮردوز ﻛﻤﺮي‬

‫)‪ (Lidocaine or bupivacaine‬ﺑﻪﻃﻮر ﺗﺼﺎدﻓﻲ ﺑﻪ ﭼﻬﺎر ﮔﺮوه ﺗﻘﺴﻴﻢ‬

‫ﻛﺎﻫﺶ ﻳﺎﻓﺘﻪ و ﺣﺎﻟﺖ ﺻﺎف ﭘﻴﺪا ﻣﻲﻛﻨﺪ‪ .‬در اﻳﻦ وﺿﻌﻴﺖ ﻋﻀﻼت‪،‬‬

‫ﺷﺪﻧﺪ‪ .‬ﻫﻤﻪ ﺑﻴﻤﺎران ﺑﻌﺪ از اﻧﺠﺎم ﻣﺎﻧﻴﺘﻮرﻳﻨﮓ اﺳﺘﺎﻧﺪارد ﺗﻮﺳﻂ‬

‫ﺗﺎﻧﺪونﻫﺎ‪ ،‬ﻣﻔﺎﺻﻞ و اﻋﺼﺎب دماﺳﺒﻲ ﻛﺸﻴﺪﮔﻲ ﻳﺎﻓﺘﻪ و اﺣﺘﻤﺎل ﺑﺮوز‬

‫ﻣﺘﺨﺼﺺ ﺑﻴﻬﻮﺷﻲ در ﺳﻄﺢ ‪ L2- L3‬ﻳﺎ ‪ L3- L4‬ﺗﺤﺖ ﺑﻲﺣﺴﻲ اﺳﭙﺎﻳﻨﺎل‬

‫ﻛﻤﺮدرد اﻓﺰاﻳﺶ ﻣﻲﻳﺎﺑﺪ‪ .‬ﻧﻮروﺗﻮﻛﺴﻴﺴﻴﺘﻪ ﻟﻴﺪوﻛﺎﻳﻴﻦ در ﻣﻘﺎﻳﺴﻪ ﺑﺎ‬

‫ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬ﺑﻌﺪ از ﺑﻲﺣﺴﻲ اﺳﭙﺎﻳﻨﺎل ﺑﻴﻤﺎران ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﻮع ﺟﺮاﺣﻲ‪،‬‬

‫ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ ﺑﻴﺸﺘﺮ اﺳﺖ ﻛﻪ ﺷﺎﻳﺪ ﻳﻜﻲ از ﻋﻠﻞ اﻓﺰاﻳﺶ ﺑﺮوز‬

‫در وﺿﻌﻴﺖ ﺳﻮﭘﺎﻳﻦ ﻳﺎ ﻟﻴﺘﻮﺗﻮﻣﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪ .‬در ﻃﻲ ﺳﻪ روز ﺑﻌﺪ از‬

‫ﮔﺮوه ﻟﻴﺪوﻛﺎﻳﻴﻦ ﺑﺎﺷﺪ‪.‬‬

‫ﻋﻤﻞ ﺟﺮاﺣﻲ ﺑﻴﻤﺎران از ﻧﻈﺮ ﺑﺮوز‬

‫)‪(TNS‬‬

‫)‪(TNS‬‬

‫در‬

‫ﻣﻮرد ﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪.‬‬

‫ﻫﺮﮔﻮﻧﻪ درد و ﻛﺮﺧﺘﻲ ﻳﺎ ﻫﻴﭙﺮآﻟﮋزي در ﻧﺎﺣﻴﻪ ﻛﻤﺮ‪ ،‬ﺑﺎﺳﻦ‪ ،‬ﻗﺴﻤﺖ‬ ‫ﻗﺪاﻣﻲ ﻳﺎ ﺧﻠﻔﻲ ران‪ ،‬زاﻧﻮ‪ ،‬ﺳﺎق و ﭘﺎﻫﺎ ﺑﻪﺻﻮرت ﻳﻚﻃﺮﻓﻪ ﻳﺎ دوﻃﺮﻓﻪ‬ ‫ﺛﺒﺖ ﮔﺮدﻳﺪ‪ .‬ﻫﻤﻴﻦﻃﻮر ﺧﺼﻮﺻﻴﺎت درد ﻣﺎﻧﻨﺪ اﺣﺴﺎس ﺳﻮزش‪ ،‬اﻧﺘﺸﺎر‬ ‫درد‪ ،‬ارﺗﺒﺎط درد ﺑﺎ ﺧﻮاب و ﭘﻮزﻳﺸﻦ ﺑﻴﻤﺎر‪ ،‬ﻣﺪت درد و ﻧﻴﺎز ﺑﻪ‬ ‫آﻧﺎﻟﮋزﻳﻚ ﻧﻴﺰ ﺑﺮرﺳﻲ ﺷﺪ‪ .‬اﻧﺴﻴﺪاﻧﺲ ﺳﻨﺪرم ﻧﻮروﻟﻮژﻳﻚ ﻣﻮﻗﺖ در‬ ‫ﺑﻴﻤﺎراﻧﻲﻛﻪ ﺑﺎ ﻟﻴﺪوﻛﺎﻳﻴﻦ اﺳﭙﺎﻳﻨﺎل ﺷﺪه ﺑﻮدﻧﺪ ﺑﻴﺸﺘﺮ ﺑﻮد )‪%22 P=0/003‬‬ ‫‪ (%68 Vs.‬ﺳﻨﺪرم ﻧﻮروﻟﻮژﻳﻚ ﻣﻮﻗﺖ در ‪ %85‬از ﺑﻴﻤﺎران ﮔﺮوه‬ ‫ﻟﻴﺪوﻛﺎﻳﻴﻦ و ‪ %58‬از ﺑﻴﻤﺎران ﮔﺮوه ﺑﻮﭘﻴﻮاﻛﺎﻳﻴﻦ ﻛﻪ در ﭘﻮزﻳﺸﻦ ﻟﻴﺘﻮﺗﻮﻣﻲ‬

‫ﻓﺮﻫﺎد اﻋﺘﻀﺎدي‪ ،‬ﮔﺮوه ﺑﻴﻬﻮﺷﻲ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن ﺳﻴﻨﺎ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم‬ ‫ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬ ‫آﻳﻼر آﻫﻨﮕﺮي‪ ،‬داﻧﺸﺠﻮي ﺑﻴﻬﻮﺷﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪،‬‬ ‫ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬ ‫ﻫﺎﺟﺮ ﺷﻜﺮي‪ ،‬داﻧﺸﺠﻮي ﺑﻴﻬﻮﺷﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪،‬‬ ‫ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬ ‫*‬

‫ﻧﻮﻳﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬ﻣﺤﻤﺪرﺿﺎ ﺧﺎﺟﻮي‪ ،‬ﮔﺮوه ﺑﻴﻬﻮﺷﻲ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن‬

‫ﺳﻴﻨﺎ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬

‫ﺟﺮاﺣﻲ ﺷﺪه ﺑﻮدﻧﺪ ﺑﺮوز ﻧﻤﻮد‪ .‬ﺑﻴﻤﺎراﻧﻲﻛﻪ ﻋﻼﻳﻢ داﺷﺘﻨﺪ ﺑﻪﻃﻮر ﻋﻤﺪه‬

‫* ﺷﻤﺎره ﺗﻠﻔﻦ‪0912-3837096 :‬‬

‫در ﮔﺮوه ﻟﻴﺪوﻛﺎﻳﻴﻦ و ﭘﻮزﻳﺸﻦ ﻟﻴﺘﻮﺗﻮﻣﻲ ﺑﻮدﻧﺪ )‪ .(P=0/002‬در ‪77‬‬

‫آدرس‪ :‬ﺗﻬﺮان‪ ،‬ﻣﻴﺪان ﺣﺴﻦآﺑﺎد‪ ،‬ﺧﻴﺎﺑﺎن اﻣﺎمﺧﻤﻴﻨﻲ‪ ،‬ﻧﺒﺶ ﺳﻲ ﺗﻴﺮ‪ ،‬ﺑﻴﻤﺎرﺳﺘﺎن ﺳﻴﻨﺎ‬

‫‪E-mail: khajavim@tums.ac.ir‬‬

‫ﻣﺠﻠﻪ داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‪ ،‬دوره ‪ ،69‬ﺷﻤﺎره ‪ ،7‬ﻣﻬﺮ ‪1390‬‬

،1390 ،7 ‫ﺷﻤﺎره‬ ،69 ‫دوره‬ ‫ﻏﻼﻣﻌﻠﻲﻲ‬ ‫ﭘﺰﺷﻜ‬ ‫داﻧﺸﮕﺎه‬ ،‫ﭘﺰﺷﻜﻲ‬ ‫داﻧﺸﻜﺪه‬ ‫ و‬،‫ﺗﻬﺮان‬ ‫ﺟﻠﻮدار‬ 312 454 ،1390 ‫ ﺗﻴﺮ‬،4‫ﻣﻬﺮ‬ ‫ﺷﻤﺎره‬ ، 69 ‫ﻫﻤﻜﺎران‬ ‫دوره‬ ،‫ﺗﻬﺮان‬ ‫ﭘﺰﺷﻜﻲ‬ ‫ﻋﻠﻮمﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ،‫ﭘﺰﺷﻜﻲ‬ ‫داﻧﺸﻜﺪه‬ ‫ﻣﺠﻠﻪﻣﺠﻠﻪ‬

The incidence of transient neurologic syndrome after spinal anesthesia with lidocaine or bupivacaine: The effects of needle type and surgical position: brief report Burning Transient Neurologic Syndrome (TNS) which was first described by Schneider et al in 1993, is defined as a transient pain and dysesthesia in waist, buttocks and the lower limbs after spinal anesthesia.1,2 The incidence of TNS after spinal anesthesia with lidocaine is reported to be as high as 10−40%.3,4 This prospective study was designed to determine the incidence of TNS with two different types of drugs, lidocaine and bupivacaine, in lithotomy or supine positions as the primary outcomes and to determine the association between two different types of needles and surgical positions with the occurrence of TNS as the secondary outcome.

The present study was conducted on 250 patients (ASA I-II), aged 18−60 years old, who were candidates for surgery in supine or lithotomy positions. According to the needle type (Sprotte or Quincke) and the local anesthetic (lidocaine or bupivacaine) all patients were randomly divided into four groups. After establishing standard monitoring, spinal anesthesia was performed in all sitting patients by attending anesthesiologists at L2-L3 or L3-L4 levels. The patients were placed in supine or lithotomy position, in regards to the surgical procedure. During the first three postoperative days, patients were observed for post spinal anesthesia complications, especially TNS. Any sensation of pain, dysesthesia, paresthesia or hyperalgesia in the low back area, buttocks, the anterior or posterior thigh, knees, either foot or both feet were recorded. Moreover, duration of pain, its radiation and its relation to sleep and the patients’ position were all carefully considered. Ultimately, the patients’ response to opioid (pethidine) for analgesia was determined.

The incidence of TNS was higher when spinal anesthesia was induced with lidocaine (68% vs. 22%, P=0.003). TNS developed in 85% of the patients in lidocaine group and 58% in bupivacaine group after surgery in lithotomy position (P=0.002). In 77 patients pain was in lumbosacral area that radiated to lower limbs and was aggravated in sitting position but in 22 patients pain was in thighs with no radiation. The mean visual analogue scale (VAS) for the determination of pain severity was six in all patients. Pain was alleviated by the administration of pethidine. With regard to the needle type, there were no significant differences between the two types of needles (P=0.7).

According to the results of this prospective study, it seems that induction of spinal anesthesia by lidocaine combined with surgical lithotomy position increases the risk of TNS. Our study is in concordance with Keld's study.5 Higher neurotoxicity of lidocaine in comparison with bopivacaine may justify the higher incidence of TNS in the lidocaine group. Moreover, natural lumbar lordosis is maintained better in supine position while it is lost in lithothomy position which may lay traction forces on cauda equina or other nerve roots in the lumbar area leading to neuropraxia.

Farhad Etezadi M.D. Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Aylar Ahangary B.Sc. Student of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.

Hajar Shokri B.Sc. Student of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Corresponding author: Mohammad Reza Khajavi M.D. Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Address: Hassan Abad Sq., Imam khomini St., Sina Hospital, Tehran, Iran.

Tel: +98-912-3837096 E-mail: khajavim@tums.ac.ir

References 1. Schneider M, Ettlin T, Kaufmann M, Schumacher P, Urwyler A, Hampl K, et al. Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg 1993;76(5):1154-7.

2. Hampl KF, Schneider MC, Ummenhofer W, Drewe J. Transient neurologic symptoms after spinal anesthesia. Anesth Analg 1995;81(6):1148-53.

3. Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S, et al. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg 2002;94(1):194-8, table of contents.

4. Salazar F, Bogdanovich A, Adalia R, Chabás E, Gomar C. Transient neurologic symptoms after spinal anaesthesia using isobaric 2% mepivacaine and isobaric 2% lidocaine. Acta Anaesthesiol Scand 2001;45(2):240-5. Erratum in: Acta Anaesthesiol Scand 2003;28(3):257.

5. Keld DB, Hein L, Dalgaard M, Krogh L, Rodt SA. The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5%. Acta Anaesthesiol Scand 2000;44(3):285-90.

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14-21 Tehran University Medical Journal; Vol.Journal 64, No. 8, Nov 2006: Tehran University Medical

Tehran UniversityMedical Medical Journal Tehran University Journal Volume 69 Number 7 October 2011 Volume 68 Number 7 October 2010 Volume 64, Number 8, November 2006

Contents The protective effects of Saffron against the oxidative damage in a transient model of focal cerebral ischemia in rats.........................................................................................................................................405 Vakili A, Eianali M.R, Bandegi A.R.

Titrated oral misoprostol solution compared with oxytocin for induction of labor in women with unfavorable cervix....................................................................................................................................413 Niroomanesh Sh, Dadashaliha M, Akrami M.

The comparison between lateral spinal anesthesia and sitting positions in lower limb vascular surgery...420 Mohajer M.R, Karvandian K, Hussain Khan Z, Jafarzadeh A, Dabiran S.

The effects of a single session aerobic exercise on obestatin gene expression in trained women................426 Rashidlamir A, Ebrahimnia M, Hashemi Javaheri A.A.

Total serum magnesium level in icteric neonates before and after phototherapy......................................432 Khosravi N, Aminian A, Taghipour R.

Esophagogastric mesenchymal tumors: analysis of 24 patients.................................................................438 Bagheri R, Maddah Gh, Tavasoli A, Naghavi Riyabi F.

The factors relevant to the onset of vascular complications after coronary intervention in Shahid Rajaei Cardiovascular Center in Tehran, Iran....................................................................................................445 Yousefi A.A, Madani M, Azimi H.R, Farshidi H.

The choanal atresia: 13- year experience and a review of the literature: brief report....................................451 Naraghi M, HajarolAsvadi N.

The incidence of transient neurologic syndrome after spinal anesthesia with lidocaine or bupivacaine: The effects of needle type and surgical position: brief report........................................................................453 Etezadi F, Ahangary A, Shokri H, Khajavi M.R.

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TUMJ

TEHRAN UNIVERSITY MEDICAL JOURNAL The Official Publication of Medical School, Tehran University of Medical Sciences Volume 69

Number 7

October 2011

Chairman: S.H. Emami Razavi Editor in Chief: N. Behtash Executive Editor: M.A. Noyan Ashraf Associate Editors: SH. Akhondzadeh, A. Arab Kheradmand, N. Ataei, S. Borna, M. Ghazi Khansari, S.J. Ghazi Mirsaeed, J. Hajati, M. Kadkhodaei, S. Moradmand, Z. Nadiya Hatmi, M.A. Noyan Ashraf, R. Omranipoor, N. Rezaei, N. Sajjadian Editorial Board: M. Akbarian, F. AmoozegarHashemi, B. Bahar, F. Davari Tanha, N. Ebrahimi Daryani, M.R. Hadiyan, Z. Hallaji, Z. Hussain Khan, M. Kajbaf Zadeh, M.J Mikaeli, A. Mousavi, S.M.J. Mortazavi, B. Nabaei, P. Pasalar , P. Pasbakhsh, M. Rasooli Negad, A. Shaabani, M. Sotoodeh, A.R. Talaeipoor, M. Vahid Dasjerdi, M.R. Zafarghandi International Board: F. Assadi (Chicago), J. Parvizi (Philadelphia), A. Gangi (Strasbourg), M.R. Keshtgar (London), Sh. Masood (Florida), P. Hanjani (Pennsylvania) Editors: N. Behtash, S.B. Hashemi, V. Nikoui, M.A. Noyan Ashraf Office staff: M. Asgari, H. Chaychi, A. Kamizani, R. Ramezani, S. Sadigh Publisher: Tehran University of Medical Sciences Office: Tehran University Medical Journal, Medical School, 202 Amouzesh building, Poursina Ave., Ghods St., Keshavarz Blvd., Tehran, Iran, P.o. Box: 14155-6447, Tel: +98(21)88962510, Fax: +98(21)88962510, Online submission: http://journals.tums.ac.ir/login, and http://tumj.tums.ac.ir, Email: medjournal@tums.ac.ir

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