‫ﺍﻷﻗﺴﺎﻡ ﺍﻟﺴﻨﻮﺍﺕ ﺍﻟﺜﺎﻧﺔ ﻋﻠﻮﻡ ﺗﺠﺔ‬ ‫ﺛﺎﻧﺔ ﺷﻌﺎﻥ ﺍﻋﻤﺮ ﺍﻭﻗﺎﺱ –ﺠﺎﺔ‬

‫*‬ ‫‪-‬‬
‫ﺍﻟﺜﻼ‪ .‬ﺍﻷﻭﻝ )‪ +‬ﻣﺎﺩﺓ ﺍﻟﻌﻠﻮﻡ ﺍﻟﻄﺒﻌﺔ‬
‫)‬ ‫ﺇﺧﺘﺎﺭ‬
‫= *‬
‫ﺳﺎﻋﺘ>‬ ‫ﺍﻟﻤﺪﺓ‬ ‫ﺍﻟﺴﻨﺔ ﺍﻟﺪﺭﺍﺳﺔ ‪2019/2018 :‬ﻡ‬
‫ﺍﻟﺘﻤﻦ ﺍﻷﻭﻝ ‪:‬‬
‫‪ K‬ﺩﻋﺎﻣﺔ ﺍﻧ‪J‬ﺸﺎﺭ ﺍﻟﺴﺎﻟﺔ ﺍﻟﻌﺼﺔ ﺣﺚ ﺗﺪﻱ ﺍﺗﺼﺎﻻﺕ ﻓﻤﺎ ﺑ‪A‬ﻨﻬﺎ ﺍﻭ‬ ‫ﺇﻥ ﺍﻟﻌﺼﺒﻮﻧﺎﺕ‪ ،‬ﺧﻼﺎ = *‬
‫ﻣﻤ‪P‬ﺓ ﻟﻠﺠﻬﺎﺯ‬
‫ﺍﻟﻌﺼ‪ ،N‬ﻭ )‬
‫‪)M‬‬
‫ﺧﻼﺎ ﺃﺧﺮﻯ ‪W‬ﺎﻟﺨﻼﺎ ﺍﻟﻌﻀﻠﺔ ﺗﺪ‪ T‬ﻫﺬﻩ ﺍﻹﺗﺼﺎﻻﺕ ﺎﻟﻤﺸﺎﻚ‪.‬‬
‫ﻊ ﺧﻼ‬
‫ﻣﻊ‬
‫_‬
‫ﻟﻔﻬﻢ ﻛﻒ ﺗ‪c‬ﺘﻘﻞ ﺍﻟﺴﺎﻟﺔ ﺍﻟﻌﺼﺔ ﻋ‪ a‬ﻣﺴﺘﻮﻯ ﺍﻟﻤﺸﺎﻚ ﺍﻟﻤﻨﺒﻬﺔ ﻧﻘ‪P‬ﺡ ﻋﻠﻚ ﺍﻟﺪﺭﺍﺳﺔ ﺍﻟﺘﺎﻟﺔ‪:‬‬

‫‪s‬‬
‫ﺗﻤﺜﻞ ﺍﻟﻮﺛﻘﺔ ‪ -1-‬ﺻﻮﺭ ﻣﺠﻬﺔ ﻟﻠﻮﺣﺔ ﺍﻟﻤﺤﺮﻛﺔ‪.‬‬

‫‪am‬‬
‫‪io‬‬

‫‪ -1‬ﺍ‪k‬ﻤﻞ ﺑﺎﻧﺎﺕ ﺍﻟﻮﺛﻘﺔ ‪ -1-‬ﻭ ﻗﺪﻡ ﻋﻨﻮﺍﻧﺎ ﻣﻨﺎﺳﺎ ﻟ‪m‬ﻞ ﺷ‪l‬ﻞ‬

‫ﺷ‪l‬ﻞ‬
‫ﺍﻟﻌﺼﺔ ﻋ‪ a‬ﻣﺴﺘﻮﻯ ﺍﻟﻤﺸﻚ ‪.‬‬ ‫*‬
‫ﺳﺎﻟﺔ ﺍﻟﻌ‬ ‫ﻋﻠ‪ q‬ﺁﻟﺔ ﺇ ﻝ‬
‫ﻧﺘﻘﺎﻝ ﻭ ﺗﺮﺟﻤﺔ ﺍﻟﺮﺮﺳﺎ‬ ‫‪ -2‬ﺎﺳﺘﻐﻼﻟﻚ ﻟﻠﻮﺛﻘﺔ ‪ -1-‬ﻟﺨﺺ )‪ +‬ﻧﺺ‬
‫‪at‬‬

‫)‬
‫*‬
‫ﺍﻟﺜﺎ‪:.‬‬
‫)‬ ‫ﺍﻟﺘﻤﻦ‬
‫*‬ ‫*‬ ‫*‬
‫ﺃﺣﺎﻧﺎ ﻭ )‪ +‬ﺣﺎﻻﺕ =‬
‫ﺗﻐ‪ P‬ﺍﻟ‪c‬ﺸﺎﻁ‬ ‫ﺗﺤﺎﻓﻆ ﺍﻟﻌﻀﺔ )‪ +‬ﺍﻟﺤﺎﻟﺔ ﺍﻟﻌﺎﺩﺔ ﻋ‪ a‬ﺛﺎﺕ ‪v‬ﺴﺔ ﺍﻟﺴﻜﺮ )‪ +‬ﺍﻟﺪﻡ ﺭﻏﻢ ﻧﻘﺺ ﺍﻷﻏﺬ‬
‫ﺍﻷﻏﺬﺔ ﺃﺣ‬
‫‪uc‬‬

‫ﻮﻟﻮ‪.x‬‬
‫‪M‬‬ ‫=*‬
‫ﺍﻟﻔ‪P‬‬
‫*‬ ‫)‬
‫ﻣﺮ‪ z‬ﺩﺍﺀ ﺍﻟﺴﻜﺮﻱ ﻌﺎﻧﻮﻥ ﻣﻦ ﻋﺪﻡ ﻗﺪﺭﺓ ﻋﻀﺘﻬﻢ ﻋ‪ a‬ﺛﺎﺕ ‪v‬ﺴﺔ ﺍﻟﺴﻜﺮﺮ )‪ +‬ﺍﻟﺪﻡ‪ ،‬ﺍﻟﻤﺼ‬
‫ﺍﻟﻤﺼﺎﺑﻮﻥ ﺎﺎﻟﺪﺍﺀ ﺍﻟﺴﻜﺮﻱ ﻣﻦ‬ ‫*‬
‫‪d‬‬

‫ﺍﻻ‪v‬ﺴﻮﻟ> ‪. l’insulinothérapie‬‬ ‫= *‬ ‫ﺍﻟﻨﻤﻂ ‪ 1‬ﻋﻼﺟﻬﻢ ﻫﻮ ﺣﻘﻦ ﺩﻭﺭﻱ ﻟﺠﺮﻋﺎﺕ‬

‫*‬
‫>‪.‬‬
‫ﺍﻷ‪v‬ﺴﻮﻟ>‬
‫ﺍﻷ‪v‬ﺴﻮﻟ =‬
‫ﺨﺎﺕ ﺍﻷ‪v‬ﺴ‬
‫ﻣﻨﺬ ‪ 1980‬ﺪﺃ ﺗﻌﺾ ﻫﺬﻩ ﺍﻟﺤﻘﻦ ﺍﻟﺪﻭﺭﺔ ﺍﻭ ﻫﺬﺍ ﺍﻟﻌﻼﺝ ﻌﻼﺝ ﺁﺧﺮ ﻫﻮ ﺇﺳﺘﻌﻤﺎﻝ ﻣﻀﺨﺎﺕ‬
‫‪-e‬‬

‫ﺍﻷ‪v‬ﺴﻮﻟ> ﺎﺳﺘﻤﺮﺍﺭ * )‪ +‬ﺍﻟﺪﻡ‪.‬‬

‫= *‬ ‫_‬
‫‪) pompe à insuline‬‬
‫ﺍﻟ‪ N‬ﺗﻘﻮﻡ ﺑŒﻓﺮﺍﺯ‬
‫‪cy‬‬
‫‪en‬‬

‫= *‬
‫ﺍﻟﻌﻼﺟ>‬ ‫ﻟﻔﻬﻢ ‪-‬‬
‫ﺍ‪ P‬ﻫﺬﻳﻦ‬
‫ﻣﺎ‪:a‬‬ ‫_‬
‫ﻧﻘ‪P‬ﺡ ﻋﻠﻚ‬
‫)‬

‫‪2as.ency-education.com‬‬
 ‫*‬ ‫= *‬ ‫= *‬
‫ﺍﻷﺳﻮﻟ> ﻭ ﺍﻟﺘﺤﻠﻮﻥ )‪+‬‬ ‫ﺍﻷ‪v‬ﺴﻮﻟ> ﺗﺤﺖ ﺍﻟﺠﻠﺪ ) ‪( sous-cutanée‬ﻋ‪ a‬ﺗﻄﻮﺭ ‪W‬ﻤﺔ‬ ‫ﺗﺄﺛ‪ P‬ﺣﻘﻦ‬
‫‪ -1-‬ﺗﻤﺜﻞ ﺍﻟﻮﺛﻘﺔ ‪= -1-‬‬
‫ﻼﺯﻣﺎ ﺩﻡ ﺷﺨﺺ ﻣﺼﺎﺏ ﺪﺍﺀ ﺳﻜﺮﻱ ﻣﻦ ﺍﻟﻨﻤﻂ ‪-1-‬‬

‫‪s‬‬
‫‪m‬‬
‫‪D’après Baden et coll., Diabetes, 2003, 52:133-137‬‬
‫‪ a‬ﺍﻟﺘﺤﻠﻮﻥ‪.‬‬ ‫ﻟ= *‬
‫> ﻋ‪a‬‬
‫ﺍﻻ‪v‬ﺴﻮﻟ>‬ ‫ﺗﺎﺛ‪ P‬ﺣﻘﻦ‬‫‪-‬ﺃ‪ -‬ﻭﺿﺢ =‬
‫ﻭﺣﺔ ﻣﻦ ﻫﺬﻩ ﺍﻟﺪﺭﺍﺍﺳﺔ‪.‬‬
‫‪ 11‬ﻳﻮﻡ ﻟﺸﺨﺺ ﻣﺼﺎﺏ ﺪﺍﺀ ﺍﻟﺴﻜﺮﻱ ﻣﻦ ﺍﻟﻨﻤﻂ ‪ -1-‬ﻣﺴﺘﺨﺪﻣﺎ ﻋﻼﺝ ﺣﻘﻦ‬
‫‪co‬‬
‫ﻤﻄﺮﻭﺣﺔ‬
‫‪-‬ﺏ‪ -‬ﺇﺳﺘﺨﺝ ﺬﻟﻚ ﺍﻟﻤﺸ‪l‬ﻠﺔ ﺍﻟﻤﻄﺮﻭﺣﺔ‬
‫ﻼﻝ ‪1‬‬
‫‪ -2-‬ﺗﻢ ﺗﺘﺎﺑﻊ ﺗﻄﻮﺭ ‪v‬ﺴﺔ ﺍﻟﺘﺤﻠﻮﻥ ﺧﻼﻝ‬
‫*‬ ‫= *‬
‫ﻗﺎﺳﻬﺎ ‪ 8‬ﻣﺮﺍﺕ )‪ +‬ﺍﻟﻴﻮﻡ ‪ ،‬ﺍﻟﻨﺘﺎﺋﺞ ﺍﻟﻤﺤﺼﻞ ﻋﻠﻴﻬﺎ ﻣﻮﺿﺤﺔ‬
‫ﻗﺎﺳﻬ‬
‫‪ ، L’insulinothérapie‬ﻭﺗﻢ ﻗ‬
‫‪L’insulin‬‬
‫‪’in‬‬ ‫ﺍﻷ‪v‬ﺴﻮﻟ>‬ ‫ﺩﻭﺭﻱ ﻟﺠﺮﻋﺎﺕ‬
‫‪n.‬‬
‫*‬
‫ﺷﺨﺺ ﻣﺼﺎﺏ ﺪﺍﺀ ﺍﻟﺴﻜﺮﻱ ﺗﻢ ﻋﻼﺟﻪ ﻤﻀﺨﺎﺕ‬ ‫ﻋﻨﺪ ﺷ‬ ‫)‪ +‬ﺍﻟﻮﺛﻘﺔ ‪ -2-‬ﺃ‪ ، -‬ﺑ‪A‬ﻨﻤﺎ ﺗﻤﺜﻞ ﺍﻟﻮﺛﻘﺔ ‪-2-‬ﺏ‪ -‬ﺗﻄﻮﺭ‬
‫ﻮﺭ ﺍﻟﺘﺤﻠﻮﻥ ﻋﻨ‬
‫= *‬
‫ﺍﻻ‪v‬ﺴﻮﻟ> ﻭ ﻫﺬﺍ ﺧﻼﻝ ﻳﻮﻡ ﻭﺍﺣﺪ‬
‫‪tio‬‬
‫‪c‬‬
‫‪en‬‬

‫‪Lauritzen et coll., Oiabetologia, 1979, 17:291-295‬‬

‫‪D’après Laurit‬‬
‫‪D’après‬‬ ‫‪Couper et Prins, Recent Advances in Therapy of Diabetes, MJA, 2003, vol. 179‬‬
‫‪’’après C‬‬
‫= *‬
‫ﺍﻷ‪v‬ﺴﻮﻟ>‬ ‫= *‬
‫ﻟﻸ‪v‬ﺴﻮﻟ> ﺇ ﻋﻼﺝ ﻤﻀﺨﺔ‬ ‫‪-‬ﺃ‪ -‬ﺎﺳﺘﻐﻼﻟﻚ ﻟﻠﻮﺛﻘﺔ ‪ -2-‬ﺑﺮﺭ ﺗﺪﻞ ﺍﻭ ﺗﻌﺾ ﻋﻼﺝ ﺍﻟﺤﻘﻦ ﺍﻟﺪﻭﺭﻱ‬
‫= *‬
‫ﻟﻠﻤﺼﺎﺑ> ﺪﺍﺀ ﺍﻟﺴﻜﺮﻱ ﻣﻦ ﺍﻟﻨﻤﻂ ‪ -1-‬ﻭ ﻫﺬﺍ ﻣﻨﺬ ‪1980‬ﻡ‪.‬‬
‫= *‬
‫ﺍﻻ‪v‬ﺴﻮﻟ> ‪.‬‬ ‫ﺗﻔﺴ‪P‬ﻱ ﺗﻈﻬﺮ ﻓﺔ ﺁﻟﺔ ﻋﻤﻞ‬
‫=‬ ‫‪-‬ﺏ‪ -‬ﺍﻧﺠﺮ ﺭﺳﻢ‬

‫ﺎﻟﺘﻮﻓﻴﻖ ﻭ ﺍﻟﺴﺪﺍﺩ – ﻋﻦ ﺃﺳﺎﺗﺬﺓ ﺍﻟﻤﺎﺩﺓ ‪-‬‬

‫‪2as.ency-education.com‬‬
 ‫_‬
‫ﺍﻟﻤﻘ‪P‬ﺡ‪:‬‬ ‫ﺍﻟﺤﻞ‬
‫ﺍﻟﺘﻤﻦ ﺍﻻﻭﻝ ‪:‬‬
‫‪ -1‬ﺗ‪l‬ﻤﻠﺔ ﺍﻟﺒﺎﻧﺎﺕ‪:‬‬
‫ﺍﻟﻤﺸ‪ - 4 ، ¢‬ﻫﻴﻮ ﺧﻠﺔ ﻌﺪ‬ ‫)‬ ‫‪ - 1‬ﻫﻴﻮ ﺧﻠﺔ ) ﻋﺼﺒﻮﻥ( ﻗﻞ ﺍﻟﻤﺸﻜﺔ‪ -2 ،‬ﺣﺼﻼﺕ ﻣﺸﻜﺔ ‪ -3 ،‬ﺍﻟﺸﻖ‬
‫ﻛﻮﻟ>( ‪.‬‬ ‫ﻣﺸﻜﺔ ‪ - 5 ،‬ﺗﺤﺮ ﻣﺤﺘﻮﻯ ﺍﻟﺤﺼﻼﺕ *‪ +‬ﺍﻟﺸﻖ ﺍﻟﻤﺸ‪ ) ¢‬ﺍﻷﺳ‪J‬ﻞ = *‬
‫)‬ ‫)‬
‫ﻋﻨﻮﺍﻥ ﻣﻨﺎﺳﺐ ‪:‬‬
‫*‬ ‫_‬
‫ﺍﻟﻌﻀ‪ a‬ﺃﺛﻨﺎﺀ ﺍﻟﺮﺍﺣﺔ‬ ‫)‬ ‫ﺍﻟﻌﺼ‪N‬‬
‫‪)M‬‬ ‫ﻭ‪ (.‬ﻟﻤﻨﻄﻘﺔ ﺇﺗﺼﺎﻝ‬ ‫ﺍﻟﺸ‪l‬ﻞ –ﺃ‪ -‬ﺻﻮﺭﺓ ﻣﺠﻬﺔ ) ﻣﺠﻬﺮ ﺇﻟﻜ‪) P‬‬ ‫ﺍﻟﺸ‪l‬‬
‫*‬ ‫*‬ ‫_‬

‫‪s‬‬
‫ﺍﻟﻌﻀ‪ a‬ﺃﺛﻨﺎﺀ ﺗﻮﻟﺪ ‪W‬ﻤﻮﻥ ﻋﻤﻞ )‪ +‬ﺍﻟﺨﻠﺔ ﻗﻞ‬ ‫)‬ ‫ﺍﻟﻌﺼ‪N‬‬
‫‪)M‬‬ ‫ﻭ‪ (.‬ﻟﻤﻨﻄﻘﺔ ﺇﺗﺼﺎﻝ‬ ‫ﺻﻮﺭﺓ ﻣﺠﻬﺔ ) ﻣﺠﻬﺮ ﺇﻟﻜ‪) P‬‬ ‫ﺍﻟﺸ‪l‬ﻞ –ﺏ‪ -‬ﺻ‬
‫¦ﺴﻤﺢ ﺑŒﻧﺘﻘﺎﻝ ﺍﻟﺮﺳﺎﻟﺔ ﺍﻟﻌﺼﺔ ﻋ‪ a‬ﻣﺴﺘﻮﻯ ﺍﻟﻤﺸﻚ‬ ‫ﻣﺸﻜﺔ ﺍﻟﺬﻱ ¦ﺴﻤ‬ ‫ﺸﻜﺔ‬

‫‪m‬‬
‫‪:q‬‬
‫ﺍﻟﻌﻠ‪q‬‬
‫ﺍﻟﻨﺺ ﺍﻟﻌﻠ )‬ ‫‪ -2‬ﺺ‬
‫*‬ ‫_‬
‫ﺍﻟ‪ N‬ﺗﺘﻤﺜﻞ )‪ +‬ﻣﻮﺍﺩ ﻛﻤﺎﺋﺔ ﺗﻔﺮﺯﻫﺎ‬ ‫ﺍﻟﻌﺼﺔ ﻋ‪ a‬ﻣﺴﺘﻮﻯ ﺍﻟﻤﺸﻚ ﺎﺳﺘﻌﻤﺎﻝ ﺍﻟﻮﺳﺎﺋﻂ ﺍﻟﻌﺼﺔ‪ ،‬ﻭ )‬ ‫ﻝ ﺍﻟﺮﺳﺎﻟﺔ ﺍﻟﻌ‬ ‫ﻧﺘﻘﺎﻝ‬
‫ﻳﺘﻢ ﺇﻧﺘﻘﺎﻝ‬

‫‪xa‬‬
‫ﺍﻟﻤﺸ‪¢‬‬
‫)‬ ‫ﺍﻟﻤﺸﻜﺔ ﻭ ﺗﺆﺩﻱ ﺇ ﺯﻭﺍﻝ ﺍﺳﺘﻘﻄﺎﺏ ﻏﺸﺎﺀ ﺍﻟﻌﺪ‬ ‫ﺍﻟﻤﺸﻜ‬‫ﺼﺔ ﺍﻟﻘﻞ ﺍﻟﻤ‬ ‫ﺍﻟﻨﻬﺎﺎﺕ ﺍﻟﻌﺼﺔ‬
‫ﻋ‪ P‬ﺍﻟﻤﺸﻚ ؟‬ ‫ﻓﻤﺎ ﺁﻟﺔ ﺇﻧﺘﻘﺎﻝ ﻭ ﺗﺮﺟﻤﺔ ﺍﻟﺴﺎﻟﺔ ﺍﻟﻌﺼﺔ ‪M‬‬ ‫ﻓﻤ‬

‫‪/e‬‬
‫ﺍﻟ‪J‬ﺸﻔ‪ P‬ﻋ‪a‬‬ ‫=‬ ‫ﻝ ﺗﺼﻞ ﻣﻮﺟﺔ ﺯﻭﺍﻝ ﺍﻻﺳﺘﻘﻄﺎﺏ ﺇ ﺍﻟﻨﻬﺎﺔ ﺍﻟﻌﺼﺔ ﻗﻞ ﻣﺸﻜﺔ‪ ،‬ﺣﺚ ﻜﻮﻥ‬ ‫ﺇﺛﺮ ﺇﺣﺪﺍﺙ ﺗ‪c‬ﺒﻪ ﻓﻌﺎﻝ‬
‫ﺑﺘﻮﺗﺮﺮﺍﺕ ‪W‬ﻤﻮﻧﺎﺕ ﻋﻤﻞ ‪ ،‬ﻭﻫﺬﺍ ﻣﺎ ¦ﺴ‪ª‬ﺐ ﺍﻧﺘﻘﺎﻝ ﺍﻟﺤﺼﻼﺕ ﺍﻟﻤﺸﻜﺔ ﻭﺍﻟﺘﺤﺎﻣﻬﺎ‬ ‫ﺍﻟﻤﺸ‪ ¢‬ﻣﺸﻔﺮﺓ ﺑﺑﺘﻮﺗ‬ ‫ﻣﺴﺘﻮﻯ ﺍﻟﻐﺸﺎﺀ ﻗﻞ ﺍﻟﻤﺸ )‪¢‬‬
‫‪¢‬‬

‫‪m‬‬
‫ﺍﻟﻤﺸ‪ ¢‬ﻭ ﻳﺘﺤﻮﻝ ﺬﻟﻚ‬ ‫ﻛﻮﻟ> ﺇ ﺍﻟﺸﻖ‬ ‫ﻣﺤﺘﻮﻯ ﺍﻟﺤﺼﻼﺕ ﻫﻮ ﺍﻻﺳ‪J‬ﻞ = *‬ ‫ﺍﻟﻤﺸ‪ ،¢‬ﻳﺘﻢ ﺬﻟﻚ ﻃﺡ ﻣﺤﺘﻮ‬ ‫ﻣﻊ ﺍﻟﻐﺸﺎﺀ ﻗﻞ‬
‫)‬ ‫*‬ ‫­‬ ‫)‬
‫ﻛﻮﻟ> ﺍﻟﻤﻔﺮﺯ )‪ +‬ﺍﻟﺸﻖ ( ‪.‬‬ ‫*‬ ‫*‬ ‫_‬ ‫*‬
‫ﻛ‪ P‬ﺍﻷﺳ‪J‬ﻞ =‬ ‫ﺍﻟ®ﻤﺎ‪ ) .‬ﺑ‪= P‬‬‫ﻂ ﺍﻟ®ﻤﺎ )‪.‬‬ ‫ﻛ‪ P‬ﺍﻟﻮﺳﻂ‬ ‫¬ﺸﻔ‪ P‬ﺗﻠﻚ ﺍﻟﺮﺳﺎﻟﺔ ﺇ ﺗﺮ =‬ ‫=‬
‫ﺍﻟﻤﺸ‪،¢‬‬ ‫ﻛﻮﻟ> ( ﻋ‪ a‬ﺍﻟﻤﺴﺘﻘﻼﺕ ﺍﻟﺨﺎﺻﺔ ﻪ ﻋ‪ a‬ﺍﻟﻐﺸﺎﺀ ﻌﺪ‬ ‫*‬ ‫‪co‬‬
‫ﺍﻻﺳ‪J‬ﻞ ﻛﻛﻮﻟ =>‬ ‫ﻄﺮﻭﺡ ) ﺍﻻﺳ‪JJ‬ﻞ‬ ‫ﻳ‪J‬ﺜﺖ ﻣﺤﺘﻮﻯ ﺍﻟﺤﺼﻼﺕ ﺍﻟﻤﻄﺮﻭﺡ‬
‫)‬
‫ﻣﺸ‪ ¢‬ﻣﻨﻪ ﻣﺸﻔﺮ ﺑﺘﻮﺗﺮﺍﺕ ‪W‬ﻤﻮﻥ ﻋﻤﻞ) ﺗﻘﻠﺺ ﺍﻟﻌﻀﻠﺔ(‪.‬‬ ‫)‬ ‫ﻣﺸﻜﺔ ‪،‬ﺃﻱ ‪WW‬ﻤﻮﻥ ﻌﺪ‬ ‫ﺔ‬ ‫ﻣﻤﺎ¦ﺴ‪ª‬ﺐ ﺗﻮﻟﺪ ﺳﺎﻟﺔ ﻋﺼﺔ ﻌﺪ‬
‫_‬
‫ﺍﻟﻤﺸ‪ ¢‬ﻣﺸﻔﺮﺓ ﺑﺘﻮﺗﺮﺍﺕ ‪W‬ﻤﻮﻧﺎﺕ ﻋﻤﻞ ﺗ‪P‬ﺟﻢ ﺇ ﻧﺄ‬ ‫ﻟﻠﻌﺼﺒﻮﻥ ﻗ‬
‫ﻗﻞ‬ ‫ﺔ ﻟﻠﻌﺼﺒﻮ‬ ‫ﺇﺫﻥ‪ :‬ﻋ‪ a‬ﻣﺴﺘﻮﻯ ﺍﻟﻤﺸﻚ ﺗﻜﻮﻥ ﺍﻟﺴﺎﻟﺔ ﺍﻟﻌﺼﺔ‬
‫)‬
‫‪n.‬‬
‫ﺟﺪﺪ ﺇ ‪W‬ﻤﻮﻧﺎﺕ ﻌﺪ ﻣﺸﻜﺔ‪.‬‬ ‫_‬ ‫­‬ ‫ﻛﻤﺎ‪ .‬ﻣﺸﻔﺮ _ﺑ‪* = P‬‬ ‫­‬
‫ﺟﻢ ﻣﻦ ﺟﺪ‬ ‫ﻳ‪P‬ﺟ‬‫ﻋﺼ‪ N‬ﺛﻢ ﻳ‪P‬‬ ‫‪)M‬‬ ‫ﺍﻟ®ﻤﺎ‪.‬‬
‫)‬ ‫ﻛ‪ P‬ﺍﻟﻮﺳﻂ‬ ‫)‬
‫ﺍﻟﺜﺎ‪:.‬‬‫*‬
‫‪io‬‬

‫)‬ ‫ﺍﻟﺘﻤﻦ‬
‫ﺍﻷ‪v‬ﺴﻮﻟ> ﻋ‪ a‬ﺍﻟﺘﺤﻠﻮﻥ‬ ‫= *‬ ‫ﺗﺄﺛ‪ P‬ﺣﻘﻦ‬ ‫‪ -1‬ﺃ‪ -‬ﺗﻮﺿﻴﺢ =‬
‫*‬ ‫*‬ ‫= *‬
‫‪at‬‬

‫‪ ،( pmol/l ) 150‬ﺛﻢ ‪°‬ﻋﺎﻥ ﻣﺎ‬ ‫ﺍﻻﻭ ‪50‬‬ ‫ﻒ ﺍﻟﺴﺎﻋﺔ ﺍﻻ‬ ‫ﺍﻷ‪v‬ﺴﻮﻟ> ﻳﺆﺩﻱ ﺇ ﺯﺎﺩﺓ ‪W‬ﻤﻴﺘﻪ )‪ +‬ﺍﻟﺪﻡ ﻟﻴﺘﻌﺪﻯ )‪ +‬ﻧﺼﻒ‬
‫ﺼﻒ‬ ‫ﺣﻘﻦ‬
‫ﺍﻟﺘﺤﻠﻮﻥ ﺇﻧﺨﻔﺎﺽ ﺍﻟﺘﺤﻠﻮﻥ ﻤﺠﺮﺩ‬ ‫‪ N‬ﺍﻟﺘﺤ‬ ‫*‬
‫ﻣﻨﺤ‪N‬‬ ‫ﻳ‪J‬ﻨﺎﻗﺺ ﻟﻌﻮﺩ ﺇ ﻗﻤﺘﻪ ﺍﻹﺑﺘﺪﺍﺋﺔ ﻌﺪ ‪ 5‬ﺳﺎﻋﺎﺕ ﻣﻦ ﺣﻘﻨﻪ‪ ،‬ﺑ‪A‬ﻨﻤﺎ ﻈﻬﺮ ﻣﻨﺤ‬
‫ﻳ‪P‬ﺍﺪ ﻣﻦ ﺟﺪﺪ ﻌﺪ ‪ 3‬ﺳﺎﻋﺎﺕ ﻣﻦ ﺣﻘﻦ ﺴﻮﻟ = *‬ ‫ﺍﻻ‪v‬ﺴﻮﻟ> ‪ ،‬ﺛﻢ _ *‬
‫= *‬
‫‪uc‬‬

‫>‬
‫ﺍﻷ‪v‬ﺴﻮﻟ>‬ ‫ﺣﻘﻦ‬
‫*‬ ‫*‬
‫‪P‬ﻩﻩ ﻣﺆﻗﺖ ) ﻻ ﺪﻭﻡ‪ ،‬ﺯﺍﺋﻞ‪(...‬‬ ‫‪P‬‬
‫ﺗﺄﺛ‪P‬‬
‫ﻟ®ﻦ ﺗﺄﺛ =‬ ‫ﺍﻟﺘﺤﻠﻮﻥ( ﻦ‬
‫ﻥ(‬ ‫ﺍﻷ‪v‬ﺴﻮﻟ> ﻌﻤﻞ ﻋ‪ a‬ﺧﻔﺾ ‪v‬ﺴﺔ ﺍﻟﺴﻜﺮ )‪ +‬ﺍﻟﺪﻡ ) ﺧﻔﺾ‬ ‫=‬ ‫ﺇﺫﻥ‪:‬‬
‫‪-1‬ﺏ‪ -‬ﺍﻟﻤﺸ‪l‬ﻠﺔ ﺍﻟﻤﻄﺮﻭﺣﺔ‪:‬‬
‫‪d‬‬

‫ﺍﻟﺴﻜﺮﻱ ﻣﻦ ﺍﻟﻨﻤﻂ ‪-1-‬‬ ‫‪ z‬ﺍﻟﺪﺍﺀ ﺍﻟﺴ‬ ‫ﻟﻤﺮ‪z‬‬ ‫*‬ ‫ﺍﻷ‪v‬ﺴﻮﻟ> ﻣﺆﻗﺖ ﻭ ﻳﺰﻭﻝ ‪´µ‬ﻋﺔ ) ﻟ‪³‬ﺲ ﺩﺍﺋﻢ( ﻓﻤﺎ ﻫﻮ ﺍﻟﻌﻼﺝ ﺍﻷ‪v‬ﺴﺐ ﻟﻤﺮ‬ ‫= *‬ ‫ﺗﺄﺛ‪ P‬ﺣﻘﻦ‬ ‫=‬
‫*‬ ‫*‬
‫‪-e‬‬

‫ﺍﻷ‪v‬ﺴﻮﻟ> ﻟﻤﺮ‪ z‬ﺍﻟﺪﺍﺀ ﺍﻟﺴﻜﺮﻱ ﻣﻦ ﺍﻟﻨﻤﻂ ‪:-1-‬‬ ‫=‬ ‫‪ -2‬ﺃ‪M -‬ﺗ‪P‬ﺮ ﺍﻟﻌﻼﺝ ﻤﻀﺨﺔ‬
‫ﺧﻼﻝ ‪W‬ﻞ‬ ‫ﺍﻟﺘﺤﻠﻮﻥ ﻟﺪﻪ ﻣﺘﺬﺬﺔ ﺧ‬
‫ﻥ‬ ‫ﻟﻸ‪v‬ﺴﻮﻟ> ﻧﻼﺣﻆ ﺍﻥ ﻗﻤﺔ‬ ‫= *‬ ‫ﻣﻦ ﺍﻟﻮﺛﻘﺔ ‪ -2-‬ﺃ‪ -‬ﻋﻨﺪ ﺍﻟﻤﺾ ﺍﻟﻤﻌﺎﻟﺞ ﺤﻘﻦ ﺩﻭﺭﺔ‬
‫ﺑ> ) ‪ 2.7 - 0.7‬ﻍ¸ﻝ( ‪W ،‬ﻤﺎ ﻧﻬﺎ‬ ‫ﺍﻟ‪ N‬ﺗﻢ ﻣﺮﺍﻗﺔ ﻓﻴﻬﺎ ‪v‬ﺴﺔ ﺍﻟﺘﺤﻠﻮﻥ ﻭ ﻏﺎﻟﺎ ﻣﺎ ﺗﻜﻮﻥ ﻣﺤﺼﻮﺭﺓ = *‬ ‫_‬
‫‪cy‬‬

‫ﺍﻧﻬﺎ ﻤﻜﻦ ﺍﻥ ﺗﺘﻌﺪ‬

‫ﺗﺘﻌﺪﻯ‬ ‫ﺍﻷﺎﻡ )‬
‫ﻟﻤﺮ‪ z‬ﺍﻟﺪﺍﺀ ﺍﻟﺴﻜﺮﻱ ‪،‬‬ ‫*‬ ‫ﺗ‪ º‬ﻫﺬﻩ ﺍﻟﻘﻢ ﻣﺮﺗﻔﻌﺔ ﺎﻟﻨ‪³‬ﺴﺔ‬ ‫‪2.7‬ﻍ¸ﻝ ﻭ _‬
‫*‬ ‫= *‬
‫ﺍﻟﻮﺍﺣﺪ ﺗﻜﻮﻥ‬ ‫ﺪ‬ ‫ﺗﻐ‪P‬ﺍﺕ ﺍﻟﺘﺤﻠﻮﻥ ﻋﻨﺪﻩ )‪ +‬ﺍﻟﻴﻮﻡ‬ ‫ﺍﻷ‪v‬ﺴﻮﻟ> =‬ ‫ﺑ‪A‬ﻨﻤﺎ ﺗﻈﻬﺮ ﺍﻟﻮﺛﻘﺔ ‪-2-‬ﺏ‪ -‬ﻋﻨﺪ ﺍﻟﻤﺾ ﺍﻟﻤﻌﺎﻟﺞ ﻤﻀﺨﺔ‬
‫‪en‬‬

‫*‬
‫ﻭﺗﻌﺘ‪ P‬ﻫﺬﻩ ﺍﻟﻘﻢ ﻣﻘﺒﻮﻟﺔ ﻓﺎﻹﺭﺗﻔﺎﻉ ﻫﻨﺎ ﻃﻔﻒ ﺎﻟ‪c‬ﺴﺔ ﻟﻤﺮ‪z‬‬
‫ﻟﻤﺮ‪ z‬ﺍﻟﺪﺍﺀ‬ ‫ﺑ> ) ‪ 1.8 – 0.6‬ﻍ¸ﻝ( ﻛﺤﺪ ﺍﻗ¼ ‪،‬‬ ‫ﻣﺤﺼﻮﺭﺓ = *‬
‫‪M‬‬
‫ﺍﻟﺴﻜﺮﻱ ‪.‬‬
‫ﺍﻟﻤﺼﺎﺑ> ﺪﺍﺀ ﺍﻟﺴﻜﺮﻱ ﻣﻦ‬ ‫= *‬ ‫*‬
‫‪v‬ﺴﻮﻟ> ﺃ‪ P‬ﻧﺠﺎﻋﺔ ﻟﻠﻤﺮ‪z‬‬ ‫‪-‬‬ ‫= *‬ ‫ﺗﺒ> ﻟﻨﺎ ﺍﻥ ﺍﻟﻌﻼﺝ ﻤﻀﺨﺔ ﺍﻷ‬ ‫ﺇﺫﻥ ﻣﻦ ﺗﺤﻠﻞ ﺍﻟﻮﺛﻘﺔ ‪* = : -2-‬‬
‫* *‬ ‫*‬
‫ﺍﻻ‪v‬ﺴﻮﻟ> )‪ +‬ﺍﻟﺪﻡ ﻭ ﺬﻟﻚ ﺗﻜﻮﻥ ﻫﻨﺎﻙ ﻣﺮﺍﻗﺔ ﻣﺴﺘﻤﺮﺓ ﻭ ﺩﺍﺋﻤﺔ‬ ‫=‬ ‫ﺍﻟﻨﻤﻂ ‪ -1-‬ﻷﻧﻪ ¦ﺴﻤﺢ ﺎﻟﺘﺤ‪l‬ﻢ )‪v +‬ﺴﺔ ﻫﺮﻣﻮﻥ‬
‫*‬ ‫* *‬
‫ﻟﻸ‪v‬ﺴﻮﻟ> )‪ +‬ﺍﻟﺪﻡ ﻳ‪J‬ﻌﻪ ﺗﻨﺎﻗﺼﻪ ﺗﺪﺭﺠﺎ ‪ ،‬ﻭ )‪ +‬ﻣﻌﻈﻢ ﺍﻟﺤﺎﻻﺕ ﺗﻜﻮﻥ ‪v‬ﺴﺘﻪ‬ ‫=‬ ‫ﻟ‪c‬ﺴﺔ ﺍﻟﺘﺤﻠﻮﻥ ‪ ،‬ﺑ‪A‬ﻨﻤﺎ ﺍﻟﺤﻘﻦ ﺍﻟﺪﻭﺭﻱ‬
‫*‬
‫ﺿﻌﻔﺔ ﻭ ﻣﻨﺨﻔﻀﺔ ﻭ ﻫﺬﺍ ﻣﺎ ﻳﺆﺩﻱ ﻋ‪ a‬ﺍﺭﺗﻔﺎﻉ ‪v‬ﺴﺔ ﺍﻟﺘﺤﻠﻮﻥ )‪ +‬ﺍﻟﺪﻡ ﻣﻦ ﺟﺪﺪ ﺃﻱ ﺍﻟﻤﺮﺍﻗﺔ ﻻ ﺗﻜﻮﻥ ﻣﺴﺘﻤﺮﺓ ﻭ ﺩﺍﺋﻤﺔ‬
‫* )‪ +‬ﻫﺬﻩ ﺍﻟﺤﺎﻟﺔ ﻭ ﺇﻧﻤﺎ ﺗﻜﻮﻥ ﺩﻭﺭﺔ ﻓﻘﻂ ‪ ،‬ﻓﺎﻟﻌﻼﺝ ﺎﻟﻤﻀﺨﺔ ﺍﻧﺠﻊ ﻣﻦ ﺍﻟﺤﻘﻦ ﺍﻟﺪﻭﺭﻱ ‪.‬‬

‫‪2as.ency-education.com‬‬
 * =
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= ‫ ﺍﻟﺮﺳﻢ‬-‫ﺏ‬-2

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