‫ﻟﯿﻨﮏ ﻫﺎى ﻣﻔﯿﺪ‬

‫ﻋﻀﻮﯾﺖ‬ ‫ﮐﺎرﮔﺎه ﻫﺎى‬ ‫ﺳﺮوﯾﺲ‬ ‫ﻓﯿﻠﻢ ﻫﺎى‬ ‫ﺑﻼگ‬ ‫ﺳﺮوﯾﺲ ﻫﺎى‬

‫درﺧﺒﺮﻧﺎﻣﻪ‬ ‫آﻣﻮزﺷﻰ‬ ‫ﺗﺮﺟﻤﻪ ﺗﺨﺼﺼﻰ‬ ‫آﻣﻮزﺷﻰ‬ ‫ﻣﺮﮐﺰ اﻃﻼﻋﺎت ﻋﻠﻤﻰ‬ ‫وﯾﮋه‬
‫‪STRS‬‬

‫‪ %40‬ﺗﺨﻔﯿﻒ‬
‫ﺑﻪ ﻣﻨﺎﺳﺒﺖ ﺳﺎﻟﺮوز ﺗﺎﺳﯿﺲ‬
‫ﻣﺮﮐﺰ اﻃﻼﻋﺎت ﻋﻠﻤﻰ‬
 ‫ﺑﺮﺭﺳﻲ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﺩﺭ ﻭﺍﺣﺪ ﺭﻳﻜﺎﻭﺭﻱ‬
‫‪۴‬‬
‫ﻣﺠﻴﺪ ﭘﻮﺭﺷﻴﺨﻴﺎﻥ)‪* ‐۱(M.Sc‬ﻋﺒﺪﺍﻟﺤﺴﻴﻦ ﺍﻣﺎﻣﻲ ﺳﻴﮕﺎﺭﻭﺩﻱ)‪ ‐۲(M.Sc‬ﺩﮐﺘﺮ ﺍﺣﺴﺎﻥ ﻛﺎﻇﻢﻧﮋﺍﺩ)‪ ‐۳(Ph.D‬ﻣﻴﻨﺎ ﺭﺋﻮﻑ)‪(M.Sc‬‬
‫ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﻜﺪﻩ ﭘﺮﺳﺘﺎﺭﻱ ﻭ ﻣﺎﻣﺎﻳﻲ‬ ‫*ﻧﻮﻳﺴﻨﺪﻩ ﻣﺴﺌﻮﻝ‪:‬‬
‫ﭘﺴﺖ ﺍﻟﮑﺘﺮﻭﻧﻴﮏ‪kasraema2004@yahoo.com :‬‬
‫ﺗﺎﺭﻳﺦ ﭘﺬﻳﺮﺵ‪۹۰/۱۰/۲۶:‬‬ ‫ﺗﺎﺭﻳﺦ ﺩﺭﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪۹۰/۷/۹:‬‬

‫ﭼﮑﻴﺪﻩ‬
‫ﺟﺮﺍﺣﻲ ﻭ ﺑﻴﻬﻮﺷﻲ ﻣﻮﺟﺐ ﺑﺮﻭﺯ ﺗﻌﺪﺍﺩﻱ ﺍﺧﺘﻼﻝ ﻓﻴﺰﻳﻮﻟﻮﮊﻱ ﻣﻲﺷﻮﻧﺪ ﮐﻪ ﺑﺮ ﺍﻋﻀﺎﻱ ﺑﺪﻥ ﻣﺆﺛﺮﻧﺪ ﻭ ﻣﻤﮑﻦ ﺍﺳﺖ ﺩﺭ ﺣﻴﻦ ﺭﻳﮑﺎﻭﺭﻱ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﺑﻪﺻﻮﺭﺕ ﻋﻮﺍﺭﺿﻲ‬ ‫ﻣﻘﺪﻣﻪ‪:‬‬
‫ﻇﺎﻫﺮ ﺷﻮﻧﺪ‪ .‬ﭘﺲ‪ ،‬ﺍﻳﻦ ﻣﻮﺍﺭﺩ ﺑﺎﻳﺴﺘﻲ ﺍﺭﺯﻳﺎﺑﻲ ﻭ ﺷﻨﺎﺳﺎﻳﻲ ﺷﻮﻧﺪ‪.‬‬
‫ﻫﺪﻑ‪ :‬ﺑﺮﺭﺳﻲ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﺩﺭ ﻭﺍﺣﺪ ﻣﺮﺍﻗﺒﺖ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻭ ﻫﻤﭽﻨﻴﻦ ﺷﻨﺎﺧﺖ ﺑﻌﻀﻲ ﺍﺯ ﻋﻮﺍﻣﻞ ﺧﻄﺮ ﻣﻮﺛﺮ ﺩﺭ ﺍﻳﺠﺎﺩ ﺍﻳﻦ ﻋﻮﺍﺭﺽ‬
‫ﺑﺎ ﻣﺤﺪﻭﺩﻩ ﺳﻨﻲ ‪ ۱۰ ‐۷۵‬ﺳﺎﻝ ﺩﺭ ﻣﺮﮐﺰ ﺁﻣﻮﺯﺷﻲ ﺩﺭﻣﺎﻧﻲ ﺭﺍﺯﻱ ﺭﺷﺖ ﺍﻧﺠﺎﻡ ﺷﺪ‪ .‬ﻧﻤﻮﻧﻪﻫﺎ‬

‫‪I‬‬ ‫‪D‬‬
‫ﻣﻮﺍﺩ ﻭ ﺭﻭﺵﻫﺎ‪ :‬ﻣﻄﺎﻟﻌﻪ ﺍﺯ ﻧﻮﻉ ﻣﻘﻄﻌﻲ‐ ﺗﻮﺻﻴﻔﻲ ﺑﺮ ‪ ۱۵۵‬ﺑﻴﻤﺎﺭ ﮐﻼﺱ ‪ ۱‬ﻭ ‪ASA ۲‬‬
‫ﺑﻴﻤﺎﺭﺍﻧﻲ ﺑﻮﺩ ﮐﻪ ﺩﺭ ﺳﺎﻝ ‪ ۸۹‬ﺑﺎ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﺑﻪ ﺭﻭﺵ ﺗﻘﺮﻳﺒﺎ ﻣﺸﺎﺑﻪ ﺗﺤﺖ ﺟﺮﺍﺣﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﻭ ﺑﻪ ﻭﺍﺣﺪ ﻣﺮﺍﻗﺒﺖ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻣﻨﺘﻘﻞ ﺷﺪﻩﺑﻮﺩﻧﺪ‪ .‬ﺍﺑﺰﺍﺭ ﺟﻤﻊﺁﻭﺭﻱ ﺍﻃﻼﻋﺎﺕ‬
‫ﭘﺮﺳﺸﻨﺎﻣﻪ ﺷﺎﻣﻞ ‪ ۲‬ﺑﺨﺶ‪ ،‬ﺑﺨﺶ ﺍﻭﻝ ﺍﻃﻼﻋﺎﺕ ﭘﺎﻳﻪ ﻭ ﺑﺨﺶ ﺩﻭﻡ‪ ،‬ﺣﺎﻭﻱ‪ :‬ﻋﻮﺍﺭﺽ ﺗﻨﻔﺴﻲ‪ ،‬ﻗﻠﺒﻲ ﻋﺮﻭﻗﻲ‪ ،‬ﻋﺼﺒﻲ ﻭ ﮔﻮﺍﺭﺷﻲ ﺑﻮﺩ‪ .‬ﺍﻃﻼﻋﺎﺕ ﮔﺮﺩﺁﻭﺭﻱ ﺷﺪﻩ ﺑﺎ ﻧﺮﻡﺍﻓﺰﺍﺭ ‪ SPSS‬ﻭ‬

‫‪S‬‬
‫ﺁﺯﻣﻮﻥ ﮐﺎﻱ‪ -‬ﺩﻭ ﻭ ﺁﺯﻣﻮﻥ ﺯﻭﺝﻫﺎ ﺗﺠﺰﻳﻪ ﺗﺤﻠﻴﻞ ﻭ ‪ P<0/05‬ﻣﻌﻨﻲﺩﺍﺭ ﺗﻠﻘﻲ ﺷﺪ‪.‬‬
‫ﺑﺮﻭﺯ ﺗﻐﻴﻴﺮ)ﺍﻓﺰﺍﻳﺶ ﻳﺎ ﮐﺎﻫﺶ( ﻗﺎﺑﻞ ﺗﻮﺟﻪ ﻓﺸﺎﺭﺧﻮﻥ‪ ،‬ﺗﻌﺪﺍﺩ ﺿﺮﺑﺎﻥ ﻗﻠﺐ ﻭ ﺗﻨﻔﺲ ﺑﻪﺗﺮﺗﻴﺐ ﺩﺭ ‪ %۳۶ ،%۴۲‬ﻭ ‪ ،%۴۹‬ﻫﻴﭙﻮﮐﺴﻤﻲ ‪ ،%۸/۴‬ﺩﺭﺩ ‪ ،%۷۶‬ﻟﺮﺯ ‪ ،%۲۲‬ﺑﻴﻘﺮﺍﺭﻱ ﭘﺲ ﺍﺯ‬ ‫ﻧﺘﺎﻳﺞ‪:‬‬

‫‪f‬‬
‫ﺟﺮﺍﺣﻲ ‪ %۲۶‬ﻭ ﺗﻬﻮﻉ ﻭ ﺍﺳﺘﻔﺮﺍﻍ ‪ %۱۲‬ﺩﻳﺪﻩﺷﺪ‪ .‬ﺩﺭ ﻣﻮﺭﺩ ﺗﺎﺛﻴﺮ ﺑﻌﻀﻲ ﺍﺯ ﻋﻮﺍﻣﻞ ﺩﺭ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ‪ ،‬ﻧﺘﺎﻳﺞ ﺣﺎﮐﻲ ﺍﺯ ﺁﻥ ﺑﻮﺩ ﮐﻪ ﺑﻴﻦ ﺳﻦ ﺑﻴﻤﺎﺭ ﻭ ﺑﺮﻭﺯ ﺗﻐﻴﻴﺮ ﻗﺎﺑﻞ ﺗﻮﺟﻪ‬
‫ﺗﻌﺪﺍﺩ ﺿﺮﺑﺎﻥ ﻗﻠﺐ ﻭ ﻟﺮﺯ ﭘﺲﺍﺯ ﺟﺮﺍﺣﻲ ﻭ ﻫﻤﭽﻨﻴﻦ ﺑﻴﻦ ﺟﻨﺲ ﻭ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﺩﺭﺩ‪ ،‬ﻟﺮﺯ‪ ،‬ﺑﻲﻗﺮﺍﺭﻱ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻭ ﺗ ٴﺎﺧﻴﺮ ﺩﺭ ﺑﻴﺪﺍﺭﻱ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﺍﺭﺗﺒﺎﻁ ﻣﻌﻨﻲﺩﺍﺭ ﺁﻣﺎﺭﻱ ﻭﺟﻮﺩ ﺩﺍﺭﺩ‪.‬‬

‫‪o‬‬
‫ﺑﻪﻋﻼﻭﻩ ﺑﻴﻦ ﻣﺪﺕ ﺟﺮﺍﺣﻲ ﺑﺎ ﻟﺮﺯ‪ ،‬ﺷﺪﺕ ﺩﺭﺩ ﻭ ﺗﺎﺧﻴﺮ ﺩﺭ ﺑﻴﺪﺍﺭﻱ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﺍﺭﺗﺒﺎﻁ ﻣﻌﻨﻲﺩﺍﺭﻱ ﻭﺟﻮﺩ ﺩﺍﺷﺖ‪.‬‬
‫ﺷﻴﻮﻉ ﻧﺴﺒﺘﺎ ﺑﺎﻻﻱ ﻋﻮﺍﺭﺽ ﺩﺭ ﺭﻳﮑﺎﻭﺭﻱ‪ ،‬ﺍﻫﻤﻴﺖ ﺑﮑﺎﺭﮔﻴﺮﻱ ﮐﺎﺭﮐﻨﺎﻥ ﻫﻮﺷﻴﺎﺭ ﻭ ﺗﺠﻬﻴﺰﺍﺕ ﻣﺎﻧﻴﺘﻮﺭﻳﻨﮓ)ﻭﺳﺎﻳﻞ( ﮐﺎﻓﻲ ﺩﺭ ﻭﺍﺣﺪ ﻣﺮﺍﻗﺒﺖﻫﺎﻱ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﺑﺮﺍﻱ‬ ‫ﻧﺘﻴﺠﻪﮔﻴﺮﻱ‪:‬‬
‫ﮐﺎﻫﺶ ﻣﺮﮒﻭﻣﻴﺮ ﻭ ﺑﻴﻤﺎﺭﻳﺰﺍﻳﻲ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﺗﺤﻤﻴﻞ ﻫﺰﻳﻨﻪﻫﺎﻱ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ ﻧﺸﺎﻥ ﻣﻲ ﺩﻫﺪ‪.‬‬

‫‪v‬‬ ‫‪e‬‬ ‫ﺍﺗﺎﻕ ﺑﻬﺒﻮﺩﻱ‪ /‬ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ‪ /‬ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﻲ‬ ‫ﮐﻠﻴﺪ ﻭﺍﮊﻩﻫﺎ‪:‬‬

‫‪h‬‬ ‫‪i‬‬
‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ﻣﺠﻠﻪ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﮔﻴﻼﻥ‪ ،‬ﺩﻭﺭﻩ ﺑﻴﺴﺖ ﻭﻳﮑﻢ ﺷﻤﺎﺭﻩ ‪ ،۸۲‬ﺻﻔﺤﺎﺕ‪۸‐۱۴:‬‬

‫ﻣﻘﺪﻣﻪ‬

‫‪r‬‬
‫‪ PACU‬ﺩﭼﺎﺭ ﻋﺎﺭﺿﻪ ﻣﻲﺷﻮﻧﺪ)‪ Tarrac .(۲‐۵‬ﺩﺭ ﻣﻄﺎﻟﻌﻪﺍﻱ ﺩﺭ‬
‫ﺳﺎﻝ ‪ ۲۰۰۶‬ﺍﻋﻼﻡ ﻛﺮﺩ ﮐﻪ ﻳﮏ ﭼﻬﺎﺭﻡ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺴﺘﺮﻱ ﺩﺭ‬
‫‪c‬‬
‫ﻣﻄﺎﻟﻌﺎﺕ ﻣﺨﺘﻠﻒ ﺩﺭﺻﺪ ﻧﺴﺒﺘﺎﹰ ﺯﻳﺎﺩﻱ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺴﺘﺮﻱ ﺩﺭ‬ ‫ﭘﺎﺳﺦ ﺑﺪﻥ ﺑﻪ ﺍﺳﺘﺮﺱ ﻭ ﺁﺳﻴﺐ ﺟﺮﺍﺣﻲ ﺷﺎﻣﻞ ﺗﺮﺷﺢ ﮐﻮﺭﺗﻴﺰﻭﻝ‪،‬‬
‫ﮐﺎﺗﮑﻮﻝ ﺁﻣﻴﻦﻫﺎ‪ ،‬ﺳﻴﺘﻮﮐﻴﻨﺎﺯ‪ ADH ،‬ﻭ ﮔﻠﻮﮐﺎﮔﻦ ﺍﺳﺖ‪ .‬ﺑﻌﻀﻲ ﺍﺯ‬
‫ﭘﺎﺳﺦﻫﺎﻱ ﻣﺘﺎﺑﻮﻟﻴﮏ ﻭ ﭘﺎﺳﺦﻫﺎﻱ ﺑﺪﻥ ﺑﻪ ﺟﺮﺍﺣﻲ ﺑﺎﻋﺚ ﻋﺪﻡ‬

‫‪PACU‬‬ ‫‪A‬‬
‫ﺭﻳﮑﺎﻭﺭﻱ ﺩﭼﺎﺭ ﻋﺎﺭﺿﻪ ﺷﺪﻩ ﻭ ﻧﻴﺎﺯ ﺑﻪ ﻣﺪﺍﺧﻠﻪ ﺩﺭﻣﺎﻧﻲ ﭘﻴﺪﺍ‬
‫ﻣﻲﮐﻨﻨﺪ‪ Hines .‬ﻃﻲ ﻣﻄﺎﻟﻌﻪ ﺩﻳﮕﺮﻱ ﺑﺮ ‪ ۱۸۰۰۰‬ﻧﻔﺮ ﺩﺭ‬
‫ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ‪ %۲۴‬ﺑﻴﻤﺎﺭﺍﻥ ﻋﺎﺭﺿﻪ ﻳﺎﻓﺘﻨﺪ ﮐﻪ ﺗﻬﻮﻉ ﻭ ﺍﺳﺘﻔﺮﺍﻍ‬
‫ﺗﻌﺎﺩﻝ ﻋﻤﻠﮑﺮﺩﻫﺎﻱ ﻓﻴﺰﻳﻮﻟﻮﮊﻱ ﻣﻬﻢ ﻣﻲﺷﻮﺩ‪ .‬ﻫﻤﺰﻣﺎﻥ‪ ،‬ﺍﺛﺮ‬
‫ﺗﺎﺧﻴﺮﻱ ﺩﺍﺭﻭﻫﺎﻱ ﺑﻴﻬﻮﺷﻲ ﻭ ﺷﻞ ﮐﻨﻨﺪﻩﻫﺎﻱ ﻋﻀﻼﻧﻲ ﺗﻮﺍﻧﺎﻳﻲ‬
‫ﻃﺒﻴﻌﻲ ﺑﺪﻥ ﺑﻪ ﺗﺜﺒﻴﺖ ﻣﺠﺪﺩ ﺗﻌﺎﺩﻝ ﻓﻴﺰﻳﻮﻟﻮﮊﻱ ﻭ ﺣﻔﻆ ﺳﻼﻣﺖ‬
‫‪ ،%۲۴‬ﻋﻮﺍﺭﺽ ﺗﻨﻔﺴﻲ ‪ %۹/۸‬ﻭ ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ‪ %۲/۷‬ﻣﻮﺍﺭﺩ ﺭﺍ‬ ‫ﺭﺍ ﺗﻀﻌﻴﻒ ﻣﻲﮐﻨﺪ)‪ (۱‬ﮐﻪ ﺩﺭ ﻧﺘﻴﺠﻪ ﻣﻨﺠﺮ ﺑﻪ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﭘﺲ‬
‫ﺗﺸﮑﻴﻞ ﻣﻲ ﺩﺍﺩ)‪ Magni .(۴‬ﻃﻲ ﻣﻄﺎﻟﻌﻪﺍﻱ ﺩﺭ ﺳﺎﻝ ‪ ۲۰۰۷‬ﻧﺸﺎﻥ‬ ‫ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻭ ﺟﺮﺍﺣﻲ ﺩﺭ ﻭﺍﺣﺪ ﻣﺮﺍﻗﺒﺖﻫﺎﻱ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ‬
‫ﺩﺍﺩ ﮐﻪ ‪ %۳۱‬ﺑﻴﻤﺎﺭﺍﻥ ﺗﺤﺖ ﺟﺮﺍﺣﻲ ﻣﻐﺰ ﺩﺭ ﺭﻳﮑﺎﻭﺭﻱ ﺣﺪﺍﻗﻞ‬ ‫ﻣﺮﺍﻗﺒﺘﻲ)‪(Post Anesthesia Care Unit‬‬ ‫ﻣﻲﺷﻮﺩ‪ .‬ﻫﺪﻑ ﺗﻴﻢ‬
‫ﻳﮏ ﻋﺎﺭﺿﻪ ﭘﻴﺪﺍ ﮐﺮﺩﻧﺪ ﮐﻪ ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﺎﺭﺿﻪ ﺁﻧﻬﺎ ﺍﺧﺘﻼﻝ‬ ‫‪ PACU‬ﻫﻮﺵﺁﻭﺭﻱ ﺗﺪﺭﻳﺠﻲ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﺗﺨﻔﻴﻒ ﺗﻐﻴﻴﺮ ﻧﺎﮔﻬﺎﻧﻲ‬
‫ﺗﻨﻔﺴﻲ ﺑﻮﺩ)‪ .(۴‬ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺩﻳﮕﺮﻱ ﺩﺭ ﺳﺎﻝ ‪ ۲۰۰۲‬ﺩﺭ ﻧﻴﻮﺯﻳﻠﻨﺪ‪،‬‬ ‫ﻓﻴﺰﻳﻮﻟﻮﮊﻱ‪ ،‬ﺷﻨﺎﺧﺖ ﻭ ﺗﺼﺤﻴﺢ ﺳﺮﻳﻊ ﺍﻧﺴﺪﺍﺩ ﺭﺍﻩ ﻫﻮﺍﻳﻲ‪،‬‬
‫‪ %۲۹‬ﻋﺎﺭﺿﻪ ﻣﻨﺠﺮ ﺑﻪ ﺍﺧﺘﻼﻝ ﻓﻴﺰﻳﻮﻟﻮﻱ ﻣﻬﻢ ﺩﻳﺪﻩ ﺷﺪ ﮐﻪ ﻧﻴﺎﺯ‬ ‫ﺍﻓﺰﺍﻳﺶ‪ /‬ﮐﺎﻫﺶ ﺷﺪﻳﺪ ﻓﺸﺎﺭ ﺧﻮﻥ‪ ،‬ﮐﺎﻫﺶ ﺍﮐﺴﻴﮋﻥ ﺧﻮﻥ‪،‬‬
‫ﺑﻪ ﻣﺮﺍﻗﺒﺖ ﻃﻮﻻﻧﻲ ﺩﺭ ﻭﺍﺣﺪ ﻳﺎ ﺑﺨﺶ ﻣﺮﺍﻗﺒﺖ ﻭﻳﮋﻩ ﺩﺍﺷﺘﻨﺪ)‪.(۵‬‬ ‫ﮐﺎﻫﺶ ﻣﻴﺰﺍﻥ ﻋﻮﺍﺭﺿﻲ ﻣﺜﻞ ﺩﺭﺩ‪ ،‬ﺗﻐﻴﻴﺮ ﺩﺭﺟﻪ ﺣﺮﺍﺭﺕ‪،‬‬
‫ﺍﻫﻤﻴﺖ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪﺩﻟﻴﻞ ﻟﺰﻭﻡ ﺷﻨﺎﺳﺎﻳﻲ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﺗﻐﻴﻴﺮ‬ ‫ﺑﻲﻗﺮﺍﺭﻱ‪ ،‬ﻫﺬﻳﺎﻥ‪ ،‬ﺗﻬﻮﻉ ﻭ ﺍﺳﺘﻔﺮﺍﻍ ﺍﺳﺖ)‪ .(۱‬ﺑﺮ ﺍﺳﺎﺱ ﻧﺘﺎﻳﺞ‬
‫‪۸‬‬ ‫‪ .۲‬ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﻜﺪﻩ ﭘﺮﺳﺘﺎﺭﻱ ﻭ ﻣﺎﻣﺎﻳﻲ‬ ‫‪ .۱‬ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﻜﺪﻩ ﻣﺪﻳﺮﻳﺖ ﻭ ﺍﻃﻼﻉﺭﺳﺎﻧﻲ ﭘﺰﺷﮑﻲ‬
‫‪www.SID.ir‬‬
‫‪ .۴‬ﺭﺷﺖ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﮔﻴﻼﻥ‪ ،‬ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺭﺍﺯﻱ‬ ‫‪ .۳‬ﺭﺷﺖ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﮔﻴﻼﻥ‪ ،‬ﺩﺍﻧﺸﻜﺪﻩ ﭘﺮﺳﺘﺎﺭﻱ ﻭ ﻣﺎﻣﺎﻳﻲ ﺷﻬﻴﺪ ﺑﻬﺸﺘﻲ‬
 ‫ﻣﺠﻴﺪ ﭘﻮﺭﺷﻴﺨﻴﺎﻥ‐ ﻋﺒﺪﺍﻟﺤﺴﻴﻦ ﺍﻣﺎﻣﻲ ﺳﻴﮕﺎﺭﻭﺩﻱ‐ ﺩﮐﺘﺮ ﺍﺣﺴﺎﻥ ﻛﺎﻇﻢ ﻧﮋﺍﺩ‐ ﻣﻴﻨﺎ ﺭﺋﻮﻑ‬

‫ﺷﺪﺕ ﺩﺭﺩ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﺗﺒﻪﺑﻨﺪﻱ ﻣﻘﻴﺎﺱ ‪) VAS‬ﻧﻤﺮﻩ ‪۳‐۵‬‬
‫ﺩﺭﺩ ﺿﻌﻴﻒ‪ ۶‐۸ ،‬ﺩﺭﺩ ﻣﺘﻮﺳﻂ ﻭ ‪ ۹‐۱۰‬ﺑﻪ ﻋﻨﻮﺍﻥ ﺩﺭﺩ ﺷﺪﻳﺪ(‪،‬‬
‫ﻟﺮﺯ )ﺩﺍﺭﺩ‪/‬ﻧﺪﺍﺭﺩ(‪ ،‬ﺑﻲﻗﺮﺍﺭﻱ )ﺩﺍﺭﺩ‪/‬ﻧﺪﺍﺭﺩ( ﻭ ﺯﻣﺎﻥ ﺑﻴﺪﺍﺭﻱ ﺍﺯ‬
‫ﺑﻴﻬﻮﺷﻲ)≤‪۶۰‬ﺩﻗﻴﻘﻪ ﺑﻪﻋﻨﻮﺍﻥ ﺗﺎﺧﻴﺮ ﺩﺭ ﺑﻴﺪﺍﺭﻱ( ﺑﻮﺩ‪ .‬ﺗﻬﻮﻉ ﻭ‬
‫ﺍﺳﺘﻔﺮﺍﻍ)ﺩﺍﺭﺩ‪/‬ﻧﺪﺍﺭﺩ( ﺑﻪﻋﻨﻮﺍﻥ ﻋﺎﺭﺿﻪﮔﻮﺍﺭﺷﻲ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪﺷﺪ‪.‬‬
‫ﺭﻭﺍﻳﻲ ﭘﺮﺳﺸﻨﺎﻣﻪ ﭘﺲ ﺍﺯ ﻣﻄﺎﻟﻌﻪ ﭼﻨﺪ ﻧﻔﺮ ﺍﺯ ﺍﻋﻀﺎﻱ ﻫﻴﺎﺕ‬
‫ﻋﻠﻤﻲ ﮔﺮﻭﻩ ﻫﻮﺷﺒﺮﻱ ﻭ ﺍﺗﺎﻕ ﻋﻤﻞ ﺩﺍﻧﺸﮕﺎﻩ ﺣﺎﺻﻞ ﺷﺪ‪ .‬ﺣﺠﻢ‬
‫ﻧﻤﻮﻧﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﻄﺎﻟﻌﻪ ﺍﻧﺘﻈﺎﺭﻱ ﻭ ﻫﻤﻜﺎﺭﺍﻥ ﺑﺎ ﺣﺪﻭﺩ ﺍﻃﻤﻴﻨﺎﻥ‬
‫‪ ۹۵%‬ﻭ ﺑﺎ ﻓﺮﻣﻮﻝ ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ‪ ۱۵۵ ،‬ﻧﻔﺮ ﺍﻧﺘﺨﺎﺏ ﮔﺮﺩﻳﺪ )‪.(۸‬‬
‫ﻭ‪Paired T test‬‬ ‫ﺍﻃﻼﻋﺎﺕ ﺑﺎ ﻧﺮﻡﺍﻓﺮﺍﺯ ‪ SPSS‬ﻭ ﺁﺯﻣﻮﻥ ﮐﺎﻱ ﺩﻭ‬
‫ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﻭ ‪ P<0.05‬ﻣﻌﻨﻲﺩﺍﺭ ﺗﻠﻘﻲ ﺷﺪ‪.‬‬
‫ﻓﻴﺰﻳﻮﻟﻮﮊﻱ ﻭ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﺩﺭ ‪ PACU‬ﺑﻪﻣﻨﻈﻮﺭ‬
‫ﺍﻳﻤﻨﻲ ﺑﻴﺸﺘﺮ‪ ،‬ﮐﺎﻫﺶ ﻣﺮﮒﻭﻣﻴﺮ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﻫﻤﭽﻨﻴﻦ ﺑﺪﻟﻴﻞ ﻧﺒﻮﺩﻥ‬
‫ﻣﻄﺎﻟﻌﻪ ﮐﺎﻓﻲ ﺩﺭ ﺍﻳﻦ ﺯﻣﻴﻨﻪ ﺩﺭ ﺍﻳﺮﺍﻥ )ﺑﻮﻳﮋﻩ ﮔﻴﻼﻥ( ﺍﺳﺖ‪.‬‬
‫ﺑﻨﺎﺑﺮﺍﻳﻦ‪ ،‬ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺍﻫﻤﻴﺖ ﺷﻨﺎﺳﺎﻳﻲ ﻋﻮﺍﺭﺽ‬
‫ﻳﺎﺩﺷﺪﻩ ﻭ ﺗﺎﺛﻴﺮ ﺑﻌﻀﻲ ﺍﺯ ﻋﻮﺍﻣﻞ ﺧﻄﺮ ﺍﺯ ﺟﻤﻠﻪ ﺳﻦ‪ ،‬ﺟﻨﺲ‪،‬‬
‫ﻣﺪﺕ ﻭ ﻧﻮﻉ ﺟﺮﺍﺣﻲ ﺩﺭ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﺁﻥ ﻃﺮﺍﺣﻲ ﻭ ﺩﺭ ﺳﺎﻝ‬
‫‪ ۱۳۸۹‬ﺩﺭ ﻣﺮﮐﺰ ﺁﻣﻮﺯﺷﻲ‐ ﺩﺭﻣﺎﻧﻲ ﺭﺍﺯﻱ ﺭﺷﺖ ﺍﺟﺮﺍ ﺷﺪ‪.‬‬
‫ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ‬
‫ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺍﺯ ﻧﻮﻉ ﻣﻘﻄﻌﻲ‐ ﺗﻮﺻﻴﻔﻲ ﺍﺳﺖ ﮐﻪ ﺑﺮ ‪ ۱۵۵‬ﺑﻴﻤﺎﺭ ﺩﺭ‬

‫ﻧﺘﺎﻳﺞ‬
‫‪I‬‬ ‫‪D‬‬
‫ﻣﺤﺪﻭﺩﻩ ﺳﻨﻲ‪ ۱۰‐۷۵‬ﺳﺎﻟﻪ ﺩﺭ ﻣﺮﮐﺰ ﺁﻣﻮﺯﺷﻲ ﺩﺭﻣﺎﻧﻲ ﺭﺍﺯﻱ‬
‫ﺭﺷﺖ ﺍﻧﺠﺎﻡ ﺷﺪ‪ .‬ﻧﻤﻮﻧﻪﻫﺎ ﺷﺎﻣﻞ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﻭﺿﻌﻴﺖ ﻓﻴﺰﻳﮑﻲ ‪۱‬‬
‫ﻭ ‪ ۲‬ﺍﻧﺠﻤﻦ ﻣﺘﺨﺼﺼﺎﻥ ﺑﻴﻬﻮﺷﻲ ﺁﻣﺮﻳﮑﺎ )‪ (ASA‬ﺑﻮﺩﻧﺪ ﮐﻪ ﺩﺭ‬
‫‪ ۶۶/۵%‬ﻧﻤﻮﻧﻪﻫﺎ ﻣﺮﺩ ﻭ ‪ ۳۳/۵%‬ﺯﻥ‪ ۵۰/۳% ،‬ﺩﺭ ﮔﺮﻭﻩ ﺳﻨﻲ‬
‫‪ ۱۰‐۳۵‬ﺳﺎﻟﻪ‪ ۳۵‐۶۵ ۳۴/۲% ،‬ﺳﺎﻟﻪ ﻭ ‪ ۱۵/۵%‬ﺳﻦ ﺑﻴﺶ ﺍﺯ ‪۶۵‬‬

‫‪f‬‬ ‫‪S‬‬
‫ﺳﺎﻝ ‪) ۱۳۸۹‬ﺑﻬﻤﻦ ‪ ۸۸‬ﺗﺎ ﺧﺮﺩﺍﺩ ‪ (۸۹‬ﺑﺎ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﺑﻪ‬
‫ﺭﻭﺵ ﺗﻘﺮﻳﺒﺎﹰ ﻣﺸﺎﺑﻪ )ﭘﻴﺶﺩﺭﻣﺎﻧﻲ‪ :‬ﻣﻴﺪﺍﺯﻭﻻﻡ ‪۲٪mg/kg‬‬
‫ﺳﺎﻝ ﺩﺍﺷﺘﻨﺪ‪ .‬ﻣﺪﺕ ﺟﺮﺍﺣﻲ ﺩﺭ ‪ ۵۰/۳%‬ﮐﻤﺘﺮﺍﺯ‪ ۱‬ﺳﺎﻋﺖ‪۴۳/۹% ،‬‬
‫ﺑﻴﻦ ‪ ۱‐۲‬ﺳﺎﻋﺖ ﻭ ‪ ۴۹/۷%‬ﺑﻴﺶﺍﺯ ‪۲‬ﺳﺎﻋﺖ ﺑﻮﺩ‪ .‬ﻧﻮﻉ ﻋﻤﻞ‬
‫ﺟﺮﺍﺣﻲ ﻧﻴﺰ ‪ ۲۱/۹%‬ﻧﻔﺮﮐﺘﻮﻣﻲ‪ ۱۱% ،‬ﮔﻴﺮﻧﺪﻩ ﮐﻠﻴﻪ‪۴۰% ،‬‬

‫‪e‬‬ ‫‪o‬‬ ‫ﻓﻨﺘﺎﻧﻴﻞ ‪ ،۲mic/kg‬ﺍﻟﻘﺎﻱ ﺑﻴﻬﻮﺷﻲ‪ :‬ﺗﻴﻮﭘﻨﺘﺎﻝ ‪ ،۵ mg/kg‬ﺁﺗﺮﺍ ﻛﻮﺭﻳﻮﻡ‬

‫‪ ۰/۵mg/kg‬ﻭ ﺍﺩﺍﻣﻪ ﺑﻴﻬﻮﺷﻲ ﺑﺎ ﻫﻮﺷﺒﺮﻫﺎﻱ ﺍﺳﺘﻨﺸﺎﻗﻲ ﻭ ﺍﻛﺴﻴﮋﻥ(‬
‫ﺟﺮﺍﺣﻲ ﺍﻧﺘﺨﺎﺑﻲ ﺍﺭﻭﻟﻮﮊﻱ ﺷﺪﻩ ﻭ ﺑﻪ ‪ PACU‬ﻣﻨﺘﻘﻞ ﺷﺪﻩﺑﻮﺩﻧﺪ‪.‬‬

‫‪iv‬‬
‫ﺳﻨﮓﻫﺎﻱ ﮐﻠﻴﻪ ﻭ ﻣﺠﺎﺭﻱ ﺍﺩﺭﺍﻱ ﻭ ‪ ۲۷/۱%‬ﺳﺎﻳﺮ ﻣﻮﺍﺭﺩ ﺟﺮﺍﺣﻲ‬ ‫ﺩﺍﺭﻭﻫﺎﻱ ﻣﺼﺮﻓﻲ ﺑﺎ ﺩﻭﺯ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ ﻋﻮﺍﺭﺽ ﺟﺎﻧﺒﻲ ﻣﻬﻤﻲ‬
‫ﺍﺭﻭﻟﻮﮊﻱ ﺑﻮﺩ‪ .‬ﻓﺮﺍﻭﺍﻧﻲ ﻋﻮﺍﺭﺽ ﻗﻠﺒﻲ ﻋﺮﻭﻗﻲ )ﻓﺸﺎﺭ ﺧﻮﻥ ﻭ‬ ‫ﻧﺪﺍﺷﺘﻨﺪ ﻭ ﺗﺰﺭﻳﻖ ﺁﻧﻬﺎ ﺑﺎ ﻧﻈﺮ ﻭ ﻣﻮﺍﻓﻘﺖ ﻣﺘﺨﺼﺺ ﺑﻴﻬﻮﺷﻲ‬

‫‪c‬‬ ‫‪h‬‬
‫ﺗﻌﺪﺍﺩ ﺿﺮﺑﺎﻥ ﻗﻠﺐ(‪ ،‬ﺗﻨﻔﺴﻲ )ﺗﻌﺪﺍﺩ ﺗﻨﻔﺲ ﻭ ‪ ،(Sao2‬ﻋﺼﺒﻲ‬
‫)ﺩﺭﺩ ﻭ ﺷﺪﺕ ﺁﻥ‪ ،‬ﻟﺮﺯ‪ ،‬ﺑﻲﻗﺮﺍﺭﻱ ﻭ ﺗﺎﺧﻴﺮ ﺩﺭ ﺑﻴﺪﺍﺭﻱ ﭘﺲ ﺍﺯ‬
‫ﺍﻧﺠﺎﻡ ﺷﺪ‪ .‬ﺩﺭ ﺻﻮﺭﺕ ﭘﺎﻳﻴﻦ ﺑﻮﺩﻥ ﺩﺭﺟﻪ ﺣﺮﺍﺭﺕ ﺍﺗﺎﻕ ﻋﻤﻞ ﻭ‬
‫ﺭﻳﻜﺎﻭﺭﻱ‪ ،‬ﻭﺟﻮﺩ ﺑﻴﻤﺎﺭﻱﻫﺎﻱ ﺷﻨﺎﺧﺘﻪ ﺷﺪﻩ ﺩﺭ ﺩﺳﺘﮕﺎﻩ ﻗﻠﺒﻲ‐‬

‫‪A‬‬ ‫‪r‬‬
‫ﺑﻴﻬﻮﺷﻲ( ﻭ ﺗﻬﻮﻉ ﺍﺳﺘﻔﺮﺍﻍ ﺩﺭ ﻧﻤﻮﺩﺍﺭ ‪ ۱‬ﻧﺸﺎﻥ ﺩﺍﺩﻩ ﺷﺪﻩ ﺍﺳﺖ‪.‬‬
‫ﺟﺪﻭﻝ ‪ ۱‬ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﺳﻦ ﻭ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﻗﻠﺒﻲ ﻋﺮﻭﻗﻲ‪ ،‬ﺗﻨﻔﺴﻲ‬
‫ﻭ ﻋﺼﺒﻲ ﺭﺍ ﻧﺸﺎﻥ ﻣﻲﺩﻫﺪ‪ .‬ﺁﺯﻣﻮﻥ ﺁﻣﺎﺭﻱ ﺑﻴﻦ ﺳﻦ ﻭ ﺗﻐﻴﻴﺮﺍﺕ‬
‫ﺿﺮﺑﺎﻥ ﻗﻠﺐ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭ ﻧﺸﺎﻥ ﺩﺍﺩ‪ .‬ﺍﺯ ﻧﻈﺮ ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﺳﻦ‬
‫ﻋﺮﻭﻗﻲ ﻭ ﺭﻳﻮﻱ‪ ،‬ﺍﺧﺘﻼﻝ ﻫﻮﺷﻴﺎﺭﻱ ﻭ ﻣﺸﻜﻼﺕ ﻣﺮﺗﺒﻂ ﺑﺎ ﺗﻬﻮﻉ‬
‫ﻭ ﺍﺳﺘﻔﺮﺍﻍ‪ ،‬ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ ﻣﻄﺎﻟﻌﻪ ﺧﺎﺭﺝ ﻣﻲﺷﺪﻧﺪ‪.‬‬
‫ﺍﺑﺰﺍﺭ ﺟﻤﻊﺁﻭﺭﻱ ﺍﻃﻼﻋﺎﺕ‪ ،‬ﭘﺮﺳﺸﻨﺎﻣﻪ ﺣﺎﻭﻱ ﺩﻭ ﺑﺨﺶ ﺑﻮﺩ‪.‬‬
‫ﺑﺨﺶ ﺍﻭﻝ‪ :‬ﺍﻃﻼﻋﺎﺕ ﭘﺎﻳﻪ ﺍﺯ ﺟﻤﻠﻪ ﺍﻃﻼﻋﺎﺕ ﻓﺮﺩﻱ‪ ،‬ﻣﺪﺕ ﻭ‬
‫ﻭ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﻋﺼﺒﻲ ﻧﺸﺎﻥ ﺩﺍﺩﻩ ﺷﺪ ﮐﻪ ﺍﺯ ‪۳۴‬ﻣﻮﺭﺩ ﺑﺮﻭﺯ ﻟﺮﺯ‪،‬‬ ‫ﻧﻮﻉ ﺟﺮﺍﺣﻲ ﻭ ﻋﻼﻳﻢ ﺣﻴﺎﺗﻲ ﺍﻭﻟﻴﻪ ﻭ ﺑﺨﺶ ﺩﻭﻡ‪ ،‬ﻋﻮﺍﺭﺽ ﭘﺲ‬
‫ﺑﻴﺸﺘﺮ ﺍﻓﺮﺍﺩ)‪ (۷۱%‬ﺩﺭ ﮔﺮﻭﻩ ﺑﻴﺶﺍﺯ ‪۶۵‬ﺳﺎﻟﮕﻲ‪۳۵‐۶۵ %۱۷/۵ ،‬‬ ‫ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﺷﺎﻣﻞ‪ :‬ﻋﻮﺍﺭﺽ ﻗﻠﺒﻲ ﻋﺮﻭﻗﻲ‪ ،‬ﺗﻨﻔﺴﻲ‪ ،‬ﻋﺼﺒﻲ ﻭ‬
‫ﺳﺎﻟﻪ ﻭ ‪ ۱۲%‬ﺩﺭ ﮔﺮﻭﻩ ﮐﻤﺘﺮﺍﺯ ‪ ۳۵‬ﺳﺎﻟﮕﻲ ﻗﺮﺍﺭ ﺩﺍﺷﺘﻨﺪ‪ .‬ﺁﺯﻣﻮﻥ‬ ‫ﮔﻮﺍﺭﺷﻲ ﻣﻲﺷﺪ‪ .‬ﻋﻮﺍﺭﺽ ﻗﻠﺒﻲ‐ ﻋﺮﻭﻗﻲ ﺷﺎﻣﻞ ﺗﻐﻴﻴﺮ ﻓﺸﺎﺭﺧﻮﻥ‬
‫ﺁﻣﺎﺭﻱ ﺑﻴﻦ ﺳﻦ ﻭ ﻟﺮﺯ ﭘﺲﺍﺯ ﺟﺮﺍﺣﻲ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭ ﻧﺸﺎﻥ ﺩﺍﺩ‪.‬‬ ‫)≤‪ ۲۰%‬ﺍﻓﺰﺍﻳﺶ ﻳﺎ ﮐﺎﻫﺶ ﺑﻪﺗﺮﺗﻴﺐ ﺑﻪﻋﻨﻮﺍﻥ ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮﻥ ﻭ‬
‫ﺗﻐﻴﻴﺮ ﻓﺸﺎﺭﺧﻮﻥ ﺩﺭ‪۷۰%‬ﻣﺮﺩﺍﻥ ﻭ ‪ ۳۰%‬ﺯﻧﺎﻥ ﺑﺮﻭﺯ ﮐﺮﺩ‪ .‬ﻫﻤﭽﻨﻴﻦ‪،‬‬ ‫ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ( ﻭ ﺗﻐﻴﻴﺮ ﻗﺎﺑﻞ ﺗﻮﺟﻪ ﺗﻌﺪﺍﺩ ﺿﺮﺑﺎﻥ ﻗﻠﺐ )≤‪۲۰%‬‬
‫ﺗﺎﮐﻲﮐﺎﺭﺩﻱ ﻭ ﺑﺮﺍﺩﻱﻛﺎﺭﺩﻱ ﺑﻪﺗﺮﺗﻴﺐ ﺩﺭ ‪ ۷۱‬ﻭ‪ ۶۰%‬ﻣﺮﺩﺍﻥ ﺩﻳﺪﻩ‬ ‫ﺍﻓﺰﺍﻳﺶ ﻳﺎ ﮐﺎﻫﺶ(‪ ،‬ﻋﻮﺍﺭﺽ ﺗﻨﻔﺴﻲ ﺷﺎﻣﻞ ﺗﻐﻴﻴﺮ ﺗﻌﺪﺍﺩ ﺗﻨﻔﺲ‬
‫ﺷﺪ‪ ،‬ﺍﻣﺎ ﺁﺯﻣﻮﻥﻫﺎﻱ ﺁﻣﺎﺭﻱ ﺑﻴﻦ ﺟﻨﺲ ﻭ ﺗﻐﻴﻴﺮ ﻓﺸﺎﺭﺧﻮﻥ ﻭ‬ ‫)ﺑﻴﺶﺍﺯ ‪۱۸‬ﺑﺎﺭ ﺑﻪﻋﻨﻮﺍﻥ ﺗﺎﮐﻲﭘﻨﻪ ﻭ ﮐﻤﺘﺮ ﺍﺯ ‪ ۱۲‬ﺑﺎﺭ ﺑﺮﺍﺩﻱﭘﻨﻪ( ﻭ‬
‫ﺿﺮﺑﺎﻥ ﻗﻠﺐ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭ ﻧﺸﺎﻥ ﻧﺪﺍﺩ‪ .‬ﻫﻤﭽﻨﻴﻦ ﺁﺯﻣﻮﻥ ﺁﻣﺎﺭﻱ‬ ‫ﻭﺿﻌﻴﺖ ﺍﮐﺴﻴﮋﻧﺎﺳﻴﻮﻥ ﺷﺮﻳﺎﻧﻲ)‪ Sao2‬ﮐﻤﻨﺮ ﻭ ﻣﺴﺎﻭﻱ‪۹۰‬‬
‫ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭ ﺑﻴﻦ ﺟﻨﺲ ﻭ ﺗﻐﻴﻴﺮ ﺗﻨﻔﺴﻲ ﻧﺸﺎﻥ ﻧﺪﺍﺩ‪ .‬ﻧﺘﺎﻳﺞ ﺍﺯ‬ ‫ﺑﻪﻋﻨﻮﺍﻥ ﻫﻴﭙﻮﮐﺴﻤﻲ(‪ ،‬ﻋﻮﺍﺭﺽ ﻋﺼﺒﻲ ﺷﺎﻣﻞ ﺩﺭﺩ )ﺩﺍﺭﺩ‪ /‬ﻧﺪﺍﺭﺩ(‪،‬‬

‫‪www.SID.ir‬‬
‫‪       ۹‬ﻣﺠﻠﻪ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﮔﻴﻼﻥ‪ /‬ﺩﻭﺭﻩ ﺑﻴﺴﺖﻭﻳﮑﻢ‪ /‬ﺷﻤﺎﺭﻩ‪ /۸۲‬ﺗﺎﺑﺴﺘﺎﻥ ‪۱۳۹۱‬‬
 ‫ﺑﺮﺭﺳﻲ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﺩﺭ ﻭﺍﺣﺪ ﺭﻳﻜﺎﻭﺭﻱ‬

‫ﻋﻮﺍﺭﺽ ﻋﺼﺒﻲ ﺩﺭ ﺟﺪﻭﻝ ‪ ۳‬ﻧﺸﺎﻥ ﺩﺍﺩﻩﺷﺪﻩﺍﺳﺖ ﻛﻪ ﺑﻴﻦ ﻣﺪﺕ‬ ‫ﻧﻈﺮ ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﺟﻨﺲ ﻭ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﻋﺼﺒﻲ ﺩﺭ ﺟﺪﻭﻝ ‪۲‬‬
‫ﺟﺮﺍﺣﻲ ﻭ ﺑﺮﻭﺯ ﺩﺭﺩ‪ ،‬ﻟﺮﺯ ﻭ ﺗﺎﺧﻴﺮ ﺩﺭ ﺑﻴﺪﺍﺭﻱ ﺭﺍﺑﻄﻪ ﻣﻌﻨﻲﺩﺍﺭ‬ ‫ﻧﺸﺎﻥ ﺩﺍﺩﻩ ﺷﺪﻩﺍﺳﺖ ﻛﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺁﻥ ﺑﻴﻦ ﺟﻨﺲ ﻭ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ‬
‫ﻭﺟﻮﺩ ﺩﺍﺷﺖ)‪ (P<۰/۰۵‬ﺍﻣﺎ ﺑﻴﻦ ﺷﺪﺕ ﺩﺭﺩ ﻭ ﻣﺪﺕ ﺟﺮﺍﺣﻲ‬ ‫ﺩﺭﺩ‪ ،‬ﻟﺮﺯ‪ ،‬ﺑﻲﻗﺮﺍﺭﻱ ﻭ ﺗﺎﺧﻴﺮ ﺩﺭ ﺑﻴﺪﺍﺭﻱ ﺍﺭﺗﺒﺎﻁ ﻣﻌﻨﻲﺩﺍﺭ ﻭﺟﻮﺩ‬
‫ﺍﻳﻦ ﺭﺍﺑﻄﻪ ﺩﻳﺪﻩ ﻧﺸﺪ‪ .‬ﺍﺯ ﻧﻈﺮ ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﻣﺪﺕ ﺟﺮﺍﺣﻲ ﻭ ﺑﺮﻭﺯ‬ ‫ﺩﺍﺷﺖ)‪ ،(P<۰/۰۵‬ﺍﻣﺎ ﺑﻴﻦ ﺷﺪﺕ ﺩﺭﺩ ﻭ ﺟﻨﺲ ﺍﻳﻦ ﺭﺍﺑﻄﻪ‬
‫ﺗﻬﻮﻉ ﺍﺳﺘﻔﺮﺍﻍ ﻧﺸﺎﻥ ﺩﺍﺩﻩﺷﺪ ﮐﻪ ﺩﺭ ‪ ۶۱٪‬ﻣﻮﺍﺭﺩ ﺑﺮﻭﺯ ﺍﻳﻦ‬ ‫ﺩﻳﺪﻩﻧﺸﺪ‪.‬‬
‫ﻋﺎﺭﺿﻪ‪ ،‬ﻣﺪﺕ ﻋﻤﻞ ﺑﻴﺸﺘﺮ ﺍﺯ ‪۲‬ﺳﺎﻋﺖ ﺑﻮﺩ‪ ،‬ﺍﻣﺎ ﺗﻔﺎﻭﺕ‬ ‫ﺑﺮﻭﺯ ﺗﻬﻮﻉ ﺍﺳﺘﻔﺮﺍﻍ ﺩﺭ ﺯﻧﺎﻥ ﺷﺎﻳﻊﺗﺮ ﺍﺯ ﻣﺮﺩﺍﻥ ﺑﻮﺩ)‪ ۱۹%‬ﺩﺭ‬
‫ﻣﻌﻨﻲﺩﺍﺭﻱ ﺑﻴﻦ ﺁﻥ ﺩﻭ ﺩﻳﺪﻩ ﻧﺸﺪ‪ .‬ﻳﺎﻓﺘﻪﻫﺎﻱ ﭘﮋﻭﻫﺶ ﻫﻤﭽﻨﻴﻦ‬ ‫ﻣﻘﺎﺑﻞ ‪ ،(۸%‬ﺍﻣﺎ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭ ﺑﻴﻦ ﺟﻨﺲ ﻭ ﺗﻬﻮﻉ ﺍﺳﺘﻔﺮﺍﻍ‬
‫ﻧﺸﺎﻥﺩﺍﺩ ﻛﻪ ﺑﻴﻦ ﺍﻧﻮﺍﻉ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﻭ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ‬ ‫ﺩﻳﺪﻩ ﻧﺸﺪ‪ .‬ﺑﻪﻋﻼﻭﻩ ﻧﺘﺎﻳﺞ ﺣﺎﻛﻲ ﺍﺯ ﺁﻥ ﺑﻮﺩ ﻛﻪ ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﻣﺪﺕ‬
‫ﻗﻠﺒﻲ‐ ﻋﺮﻭﻗﻲ‪ ،‬ﺗﻨﻔﺴﻲ‪ ،‬ﻋﺼﺒﻲ ﻭ ﮔﻮﺍﺭﺷﻲ ﺍﺭﺗﺒﺎﻁ ﻣﻌﻨﻲﺩﺍﺭ‬ ‫ﺟﺮﺍﺣﻲ ﻭ ﺩﻭ ﻋﺎﻣﻞ ﻋﺎﺭﺿﻪ ﻗﻠﺒﻲ‐ ﻋﺮﻭﻗﻲ ﻭ ﺗﻨﻔﺴﻲ ﻣﻌﻨﻲﺩﺍﺭ‬
‫ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ‪.‬‬ ‫ﻧﻴﺴﺖ‪ .‬ﻫﻤﭽﻨﻴﻦ‪ ،‬ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﻋﺎﻣﻞ ﻣﺪﺕ ﺟﺮﺍﺣﻲ ﻭ ﺑﺮﻭﺯ‬
‫ﺩﺭﺻﺪ‬
‫‪60‬‬

‫‪50‬‬
‫‪49‬‬

‫‪I‬‬ ‫‪D‬‬
‫‪40‬‬

‫‪30‬‬

‫‪20‬‬
‫‪35.5‬‬

‫‪18‬‬ ‫‪18‬‬
‫‪21.3‬‬

‫‪f‬‬ ‫‪S‬‬‫‪21.9‬‬
‫‪26.5‬‬

‫‪o‬‬
‫‪11.6‬‬
‫‪8.4‬‬
‫‪10‬‬ ‫‪6.5‬‬ ‫‪6.5‬‬
‫‪1.3‬‬

‫‪e‬‬
‫‪0‬‬
‫ﺗ‬

‫ﻟ‬
‫ﻫﻴﭙ‬

‫ﺑﻴ‬
‫ﺑﺮ‬

‫ﻫﻴ‬
‫ﺑ‬
‫ﻫ‬

‫ﺗﺎ‬

‫ﺮﺯ‬

‫ﺗﺎ‬
‫ﺩﺭ‬
‫ﺎﮐﻴ‬

‫ﺗ‬
‫ﺮﺍﺩ‬

‫ﻬ‬
‫ﻴﭙﺮ‬

‫ﻘﺮﺍ‬
‫ﮐ‬

‫ﺧﻴ‬
‫ﺍﺩﻳ‬

‫ﭙﻮ‬

‫ﺩﻣﺘ‬
‫ﻮ‬

‫ﮑﺎﺭ‬

‫ﻮﻉ‪ ‬‬
‫ﻲ‪ ‬‬

‫ﻱ‪ ‬‬

‫ﺮ‪ ‬ﺩ‬
‫ﺗﺎﻧ‬

‫ﺗﺎﻧ‬

‫ﺭﻱ‬
‫ﮑﺎﺭ‬

‫ﮐﺴ‬
‫ﭘﻨﻪ‬

‫ﻮ‬
‫ﭘﻨﻪ‬
‫ﺴﻴ‬

‫ﺴﻴ‬

‫ﻭ‪ ‬‬
‫ﺩﻱ‬

‫ﺭ‪ ‬ﺑ‬

‫‪v‬‬
‫ﺳﻂ‬
‫ﻤﻲ‬
‫ﺩﻱ‬

‫ﺍ‬
‫ﻴﺪﺍ‬

‫ﺳﺘ‬
‫ﻮﻥ‬

‫ﻮﻥ‬

‫‪ ‬ﻭ‬

‫ﺭﻱ‬

‫ﻔﺮ‬
‫‪ ‬ﺷ‬

‫ﺍﻍ‬
‫ﺪﻳﺪ‬

‫‪h‬‬ ‫‪i‬‬
‫ﻧﻤﻮﺩﺍﺭ ‪ :۱‬ﺗﻮﺯ ﻳﻊ ﻓﺮﺍﻭﺍﻧﻲ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ‬

‫ﺟﺪﻭﻝ ‪ :۱‬ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﺳﻦ ﺑﻴﻤﺎﺭﺍ ﻥ ﻭ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ‬

‫‪P value‬‬
‫ﺟﻤﻊ‬
‫ﺗﻌﺪﺍﺩ)ﺩﺭﺻﺪ(‬
‫‪(۳۵/۵)۵۵‬‬
‫‪r‬‬ ‫‪c‬‬ ‫‪>۶۵‬‬
‫ﺗﻌﺪﺍﺩ)‪(٪‬‬
‫‪(۲۹/۲)۷‬‬
‫‪۳۵‐۶۵‬‬
‫ﺗﻌﺪﺍﺩ)‪(٪‬‬
‫‪(۳۷/۷)۲۰‬‬
‫‪<۳۵‬‬
‫ﺗﻌﺪﺍﺩ)‪(٪‬‬
‫‪(۳۵/۹)۲۸‬‬
‫ﺳﻦ ﺑﻴﻤﺎﺭ)ﺳﺎﻝ(‬

‫ﺍﻓﺰﺍﻳﺶ‬ ‫ﻓﺸﺎﺭ ﺧﻮﻥ‬

‫ﻣﺘﻐﻴﺮ‬

‫‪A‬‬
‫‪P<0.05‬‬
‫‪(۶/۵)۱۰‬‬ ‫‪(۵۴/۲)۱۳‬‬ ‫‪(۵/۷)۳‬‬ ‫‪(۳/۸)۳‬‬ ‫ﮐﺎﻫﺶ‬
‫‪(۲۸/۱)۲۸‬‬ ‫‪(۴/۲)۱‬‬ ‫‪(۱۸/۹)۱۰‬‬ ‫‪(۲۱/۸)۱۷‬‬ ‫ﺍﻓﺰﺍﻳﺶ‬ ‫ﺿﺮﺑﺎﻥ ﻗﻠﺐ‬
‫‪P<0.05‬‬
‫‪(۱۸/۱)۲۸‬‬ ‫‪(۴۱/۷)۱۰‬‬ ‫‪(۲۰/۸)۱۱‬‬ ‫‪(۹)۷‬‬ ‫ﮐﺎﻫﺶ‬
‫‪(۴۹)۷۶‬‬ ‫‪(۳۷/۵)۹‬‬ ‫‪(۴۷/۲)۲۵‬‬ ‫‪(۵۳/۸)۴۲‬‬ ‫ﺍﻓﺰﺍﻳﺶ‬ ‫ﺗﻌﺪﺍﺩ ﺗﻨﻔﺲ‬
‫‪P<0.05‬‬
‫‪(۰/۶)۱‬‬ ‫‐‬ ‫‐‬ ‫‪(۱/۳)۱‬‬ ‫ﮐﺎﻫﺶ‬
‫‪(۸/۴)۱۳‬‬ ‫‪(۱۲/۵)۳‬‬ ‫‪(۷/۵)۴‬‬ ‫‪(۷/۷)۶‬‬ ‫ﺩﺍﺭﺩ‬ ‫ﻫﻴﭙﻮﮐﺴﻤﻲ‬
‫‪P<0.05‬‬
‫‪(۹۱/۶)۱۴۲‬‬ ‫‪(۸۷/۵) ۲۱‬‬ ‫‪(۹۲/۵)۴۹‬‬ ‫‪(۹۳/۲) ۷۲‬‬ ‫ﻧﺪﺍﺭﺩ‬
‫)‪(۷۶/۱)۱۱۸‬‬ ‫‪(۷۵)۱۸‬‬ ‫‪(۶۹/۸)۳۷‬‬ ‫‪(۸۰/۸)۶۳‬‬ ‫ﺩﺍﺭﺩ‬ ‫ﺩﺭﺩ‬
‫‪P<0.05‬‬
‫‪(۲۳/۹)۳۷‬‬ ‫‪(۲۵)۶‬‬ ‫‪(۳۰/۲)۱۶‬‬ ‫‪(۱۹/۲)۱۵‬‬ ‫ﻧﺪﺍﺭﺩ‬
‫‪(۲۱/۹)۳۴‬‬ ‫‪(۱۶/۷)۴‬‬ ‫‪(۱۱/۳)۶‬‬ ‫‪(۳۰/۸)۲۴‬‬ ‫ﺩﺍﺭﺩ‬ ‫ﻟﺮﺯ‬
‫‪P<0.05‬‬
‫‪(۲۸/۷)۱۲۱‬‬ ‫‪(۸۳/۳)۲۰‬‬ ‫‪(۸۸/۷)۴۷‬‬ ‫‪(۶۹/۲)۵۴‬‬ ‫ﻧﺪﺍﺭﺩ‬
‫‪(۶/۵)۱۰‬‬ ‫‪(۴/۲)۱‬‬ ‫‪(۵/۷)۳‬‬ ‫‪(۷/۷)۶‬‬ ‫ﺩﺍﺭﺩ‬ ‫ﺗﺎﺧﻴﺮ ﺑﻴﺪﺍﺭﻱ‬
‫‪P<0.05‬‬ ‫‪(۹۳/۵)۱۴۵‬‬ ‫‪(۹۵/۸)۲۳‬‬ ‫‪(۹۴/۳)۵۰‬‬ ‫‪(۹۲/۳)۷۲‬‬ ‫ﻧﺪﺍﺭﺩ‬

‫‪www.SID.ir‬‬
‫‪       ۱۰‬‬ ‫ﻣﺠﻠﻪ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﮔﻴﻼﻥ‪ /‬ﺩﻭﺭﻩ ﺑﻴﺴﺖﻭﻳﮑﻢ‪ /‬ﺷﻤﺎﺭﻩ‪ /۸۲‬ﺗﺎﺑﺴﺘﺎﻥ ‪۱۳۹۱‬‬
 ‫ﻣﺠﻴﺪ ﭘﻮﺭﺷﻴﺨﻴﺎﻥ‐ ﻋﺒﺪﺍﻟﺤﺴﻴﻦ ﺍﻣﺎﻣﻲ ﺳﻴﮕﺎﺭﻭﺩﻱ‐ ﺩﮐﺘﺮ ﺍﺣﺴﺎﻥ ﻛﺎﻇﻢ ﻧﮋﺍﺩ‐ ﻣﻴﻨﺎ ﺭﺋﻮﻑ‬

‫ﺟﺪﻭﻝ ‪ :۲‬ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﺟﻨﺲ ﺑﻴﻤﺎﺭﺍ ﻥ ﻭ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﻋﺼﺒﻲ ﭘﺲ ﺍﺯ ﻋﻤﻞ‬
‫ﺯﻥ‬ ‫ﻣﺮﺩ‬ ‫ﺟﻨﺲ ﺑﻴﻤﺎﺭ‬
‫‪P value‬‬ ‫ﺟﻤﻊ‬
‫)‪ (٪‬ﺗﻌﺪﺍﺩ‬ ‫)‪ (٪‬ﺗﻌﺪﺍﺩ‬ ‫ﻣﺘﻐﻴﺮ‬
‫)‪۱۱۸(۷۶/۱‬‬ ‫)‪۴۴(۸۴/۶‬‬ ‫)‪۷۴(۷۱/۸‬‬ ‫ﺩﺍﺭﺩ‬ ‫ﺩﺭﺩ‬
‫‪P<0.05‬‬
‫)‪۳۷(۲۳/۹‬‬ ‫)‪۸(۱۵/۴‬‬ ‫)‪۲۹(۲۸/۲‬‬ ‫ﻧﺪﺍﺭﺩ‬
‫)‪۸۵(۵۴/۸‬‬ ‫)‪۳۱(۵۹/۶‬‬ ‫)‪۵۴(۵۲/۴‬‬ ‫ﺧﻔﻴﻒ‬ ‫ﺷﺪﺕ ﺩﺭﺩ‬
‫‪P<0.05‬‬ ‫)‪۳۰(۱۹/۴‬‬ ‫)‪۱۳(۲۵‬‬ ‫)‪۱۷(۱۶/۵‬‬ ‫ﻣﺘﻮﺳﻂ‬
‫)‪۳(۱/۹‬‬ ‫‪-‬‬ ‫)‪۳(۲/۹‬‬ ‫ﺷﺪﻳﺪ‬
‫)‪۳۴(۲۱/۹‬‬ ‫)‪۵(۹/۶‬‬ ‫)‪۲۹(۲۸/۲‬‬ ‫ﺩﺍﺭﺩ‬ ‫ﻟﺮﺯ‬
‫‪P<0.05‬‬
‫)‪۱۲۱(۷۸/۱‬‬ ‫‪۴۷(۹۰/۴‬‬ ‫)‪۷۴(۷۱/۸‬‬ ‫ﻧﺪﺍﺭﺩ‬
‫)‪۴۱(۲۶/۵‬‬ ‫)‪۷(۱۳/۵‬‬ ‫)‪۳۴(۳۳‬‬ ‫ﺩﺍﺭﺩ‬ ‫ﺑﻲﻗﺮﺍﺭﻱ‬
‫‪P<0.05‬‬
‫)‪۱۱۴(۳۷/۵‬‬ ‫)‪۴۵(۸۶/۵‬‬ ‫)‪۶۹(۶۷‬‬ ‫ﻧﺪﺍﺭﺩ‬
‫)‪۱۰(۶/۵‬‬ ‫)‪۳(۵/۸‬‬ ‫)‪۷(۶/۸‬‬ ‫ﺩﺍﺭﺩ‬ ‫ﺗﺎﺧﻴﺮ ﺩﺭ ﺑﻴﺪﺍﺭﻱ‬
‫‪P<0.05‬‬
‫)‪۱۴۵(۹۳/۵‬‬ ‫)‪۴۹(۹۴/۲‬‬ ‫)‪۹۶(۹۳/۲‬‬ ‫ﻧﺪﺍﺭﺩ‬

‫‪I‬‬ ‫‪D‬‬
‫‪P value‬‬
‫ﺟﺪﻭﻝ ‪ :۳‬ﺍﺭﺗﺒﺎﻁ ﺑﻴﻦ ﻃﻮﻝ ﻣﺪﺕ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻭ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﻋﺼﺒﻲ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ‬

‫ﺟﻤﻊ‬
‫‪>١٢٠‬‬
‫ﻣﺪﺕ ﻋﻤﻞ ﺟﺮﺍﺣﻲ)ﺩﻗﻴﻘﻪ(‬
‫‪٦٠ ‐١٢٠‬‬ ‫‪>٦٠‬‬

‫‪f‬‬ ‫‪S‬‬ ‫ﻓﺮﺍﻭﺍﻧﻲ‬

‫ﻣﺘﻐﻴﺮ‬

‫‪P<0.05‬‬
‫)‪ (%‬ﺗﻌﺪﺍﺩ‬
‫)‪١١٨(٧٦/١‬‬
‫)‪٣٧(٢٣/٩‬‬
‫)‪ (%‬ﺗﻌﺪﺍﺩ‬
‫)‪٦٠(٧٧/٩‬‬
‫)‪١٧(٢٢/١‬‬
‫)‪ (%‬ﺗﻌﺪﺍﺩ‬
‫)‪٥١(٧٥‬‬
‫)‪١٧(٢٥‬‬

‫‪e‬‬ ‫‪o‬‬ ‫)‪ (%‬ﺗﻌﺪﺍﺩ‬

‫)‪٧(٧٠‬‬
‫)‪٣(٣٠‬‬
‫ﺩﺍﺭﺩ‬
‫ﻧﺪﺍﺭﺩ‬
‫ﺩﺭﺩ‬

‫‪P<0.05‬‬
‫)‪٨٥(٥٤/٨‬‬
‫)‪٣٠(١٩/٤‬‬
‫)‪٣(١/٩‬‬
‫)‪٤٠(٥١/٩‬‬
‫)‪١٧(٢٢/١‬‬
‫)‪٣(٣/٩‬‬
‫‪i‬‬ ‫‪v‬‬ ‫)‪٣٨(٥٥/٩‬‬
‫)‪١٣(١٩/١‬‬
‫)‪٧(٧٠‬‬
‫‪-‬‬
‫ﺧﻔﻴﻒ‬
‫ﻣﺘﻮﺳﻂ‬
‫ﺷﺪﻳﺪ‬
‫ﺷﺪﺕ ﺩﺭﺩ‬

‫‪h‬‬
‫‪-‬‬ ‫‪-‬‬
‫)‪٣٤(٢١/٩‬‬ ‫)‪٢٥(٧٣‬‬ ‫)‪٩(٢٧‬‬ ‫‪-‬‬ ‫ﺩﺍﺭﺩ‬ ‫ﻟﺮﺯ‬
‫‪P<0.05‬‬

‫‪P<0.05‬‬
‫)‪١٢١(٧٨/١‬‬
‫)‪٤١(٢٦/٥‬‬
‫)‪١١٤(٧٣/٥‬‬
‫‪r‬‬ ‫‪c‬‬ ‫)‪٥٢(٥٦/٥‬‬
‫)‪٢٢(٢٨/٦‬‬
‫)‪٥٥(٧١/٤‬‬
‫)‪٥٩(٨٦/٧‬‬
‫)‪١٨(٢٦/٥‬‬
‫)‪٥٠(٧٣/٥‬‬
‫)‪١٠(١٠٠‬‬
‫)‪١(١٠‬‬
‫)‪٩(٩٠‬‬
‫ﻧﺪﺍﺭﺩ‬
‫ﺩﺍﺭﺩ‬
‫ﻧﺪﺍﺭﺩ‬
‫ﺑﻴﻘﺮﺍﺭﻱ‬

‫‪P<0.05‬‬
‫‪A‬‬
‫)‪١٠(٦/٥‬‬
‫)‪١٤٥(٩٣/٥‬‬
‫)‪٧(٩/١‬‬
‫)‪٧٠(٩١‬‬
‫)‪٣(٤/٤‬‬
‫)‪(٩٥/٦‬‬
‫‪-‬‬
‫)‪١٠(١٠٠‬‬
‫ﺩﺍﺭﺩ‬
‫ﻧﺪﺍﺭﺩ‬
‫ﺗﺎﺧﻴﺮ ﺩﺭ ﺑﻴﺪﺍﺭﻱ‬

‫ﻗﻠﺒﻲ ﻋﺮﻭﻗﻲ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮﻥ ﺍﺳﺖ ﮐﻪ ﺧﻄﺮﻧﺎﮎﺗﺮ ﺍﺯ‬
‫ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ﺑﻮﺩﻩ ﻭ ﻣﻲﺗﻮﺍﻧﺪ ﻋﻮﺍﺭﺽ ﺩﻳﮕﺮﻱ ﺍﺯ ﺟﻤﻠﻪ‬
‫ﺩﻳﺲﺭﻳﺘﻤﻲ ﻭ ﺍﻧﻔﺎﺭﮐﺘﻮﺱ ﻳﺎ ﻧﺎﺭﺳﺎﻳﻲ ﻗﻠﺒﻲ ﻭ ‪ ...‬ﺍﻳﺠﺎﺩ ﮐﻨﺪ ﮐﻪ‬
‫ﻧﻴﺎﺯﻣﻨﺪ ﻣﺪﺍﺧﻠﻪ ﺍﺳﺖ)‪ .(۱‬ﺩﺭ ﻣﻄﺎﻟﻌﻪ ‪ Hines‬ﻭ ﻫﻤﮑﺎﺭﺍﻥ ﺩﺭ‬
‫ﺁﻣﺮﻳﮑﺎ ﺍﻓﺰﺍﻳﺶ ﻭ ﮐﺎﻫﺶ ﻓﺸﺎﺭ ﺧﻮﻥ ﻧﻴﺎﺯﻣﻨﺪ ﺩﺭﻣﺎﻥ ﺑﻪﺗﺮﺗﻴﺐ‬
‫ﺣﺪﻭﺩ ‪ ۲‬ﻭ ‪ (۳) ۱/۱%‬ﻭ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺍﻧﺘﻈﺎﺭﻱ ﺩﺭ ﺍﺭﺩﺑﻴﻞ ﻫﻢ ﺑﺮﻭﺯ‬
‫ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ‪ ۱/۳%‬ﮔﺰﺍﺭﺵ ﺷﺪ)‪ .(۷‬ﺩﺭﺻﺪ ﺑﺎﻻﺗﺮ ﺑﺮﻭﺯ‬
‫ﺑﺤﺚ ﻭ ﻧﺘﻴﺠﻪﮔﻴﺮﻱ‬
‫ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻋﻤﺪﺗﺎﹰ ﺑﺎ ﻫﺪﻑ ﺑﺮﺭﺳﻲ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻭ‬
‫ﺗﺎﺛﻴﺮ ﺑﻌﻀﻲ ﺍﺯ ﻋﻮﺍﻣﻞ ﻣﺜﻞ ﺳﻦ‪ ،‬ﺟﻨﺲ‪ ،‬ﻣﺪﺕ ﻭ ﻧﻮﻉ ﺟﺮﺍﺣﻲ ﺩﺭ‬
‫ﺑﺮﻭﺯ ﻋﻮﺍﻣﻞ ﻳﺎﺩﺷﺪﻩ ﺍﻧﺠﺎﻡ ﺷﺪ‪ .‬ﺍﺯ ﻋﻮﺍﺭﺽ ﺷﺎﻳﻊ ‪ PACU‬ﮐﻪ ﺩﺭ‬
‫ﻣﻨﺎﺑﻊ ﺍﺷﺎﺭﻩ ﺷﺪﻩ‪ ،‬ﻣﺴﺎﻳﻞ ﻗﻠﺒﻲ ﻋﺮﻭﻗﻲ ﻋﻤﺪﺗﺎﹰ ﺑﻪﺻﻮﺭﺕ ﺗﻐﻴﻴﺮ‬
‫ﻓﺸﺎﺭﺧﻮﻥ ﻭ ﺿﺮﺑﺎﻥ ﻗﻠﺐ ﺍﺳﺖ )‪ .(۱‬ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﻣﺎ ‪ ۴۲%‬ﺑﻴﻤﺎﺭﺍﻥ‬
‫ﺩﭼﺎﺭ ﺗﻐﻴﻴﺮﺍﺕ ﻗﺎﺑﻞ ﺗﻮﺟﻪ ﻓﺸﺎﺭ ﺧﻮﻥ ﺷﺪﻧﺪ ﮐﻪ ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮﻥ ﺩﺭ‬
‫‪ ۳۵/۵%‬ﻭ ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ﺩﺭ ‪ ۶/۵%‬ﻣﺸﺎﻫﺪﻩﺷﺪ‪ .‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﺎﺭﺿﻪ‬

‫‪www.SID.ir‬‬
‫‪       ۱۱‬ﻣﺠﻠﻪ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠ ﻮﻡ ﭘﺰﺷﻜﻲ ﮔﻴﻼﻥ‪ /‬ﺩﻭﺭﻩ ﺑﻴﺴﺖﻭﻳﮑﻢ‪ /‬ﺷﻤﺎﺭﻩ‪ /۸۲‬ﺗﺎﺑﺴﺘﺎﻥ ‪۱۳۹۱‬‬
 ‫ﺑﺮﺭﺳﻲ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﺩﺭ ﻭﺍﺣﺪ ﺭﻳﻜﺎﻭﺭﻱ‬

‫ﺗﻮﻥ ﺳﻤﭙﺎﺗﻴﮏ ﺑﺎﻋﺚ ﺍﻓﺰﺍﻳﺶ ﻣﺼﺮﻑ ﺍﮐﺴﻴﮋﻥ ﻣﻲ ﺷﻮﺩ‪ .‬ﺍﻧﺠﻤﻦ‬
‫ﺩﺭﺩ ﺁﻣﺮﻳﮑﺎ ﺍﺭﺯﻳﺎﺑﻲ ﺩﺭﺩ ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻼﻣﺖ ﺣﻴﺎﺗﻲ ﭘﻨﺠﻢ‬
‫ﺗﻮﺻﻴﻪ ﻣﻲﮐﻨﺪ‪ .‬ﺍﺯ ﻧﻈﺮ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭﺩ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺍﺯ ﺑﺪﺗﺮﻳﻦ‬
‫ﺗﺠﺎﺭﺏ ﺯﻧﺪﮔﻲ ﺁﻧﻬﺎﺳﺖ)‪ (۱‬ﮐﻪ ﺑﺎﻋﺚ ﺗﺪﺍﺧﻞ ﺩﺭ ﻋﻤﻠﮑﺮﺩ‬
‫ﺗﻨﻔﺴﻲ‪ ،‬ﮔﺮﺩﺵ ﺧﻮﻥ ﻭ ﮔﻮﺍﺭﺵ ﻣﻲ ﺷﻮﺩ‪.‬‬
‫ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻟﺮﺯ ﺣﺪﻭﺩ ‪ ۲۲%‬ﺑﻮﺩ‪ ،‬ﺑﻪﻃﻮﺭﻱﮐﻪ ﺑﻴﻦ‬
‫ﺑﺮﻭﺯ ﻟﺮﺯ ﺑﺎ ﺳﻦ ﺑﺎﻻ‪ ،‬ﺟﻨﺲ ﻣﺬﻛﺮ ﻭ ﻣﺪﺕ ﺟﺮﺍﺣﻲ ﺍﺭﺗﺒﺎﻁ‬
‫ﻣﻌﻨﻲ ﺩﺍﺭ ﻭﺟﻮﺩ ﺩﺍﺷﺖ‪ .‬ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﺍﻧﺘﻈﺎﺭﻱ ﻟﺮﺯ ﺩﺭ ‪۳۶%‬‬
‫ﻣﻮﺍﺭﺩ ﮔﺰﺍﺭﺵ ﺷﺪ)‪ .(۷‬ﺩﺭ ﻣﻄﺎﻟﻌﺎﺕ ﺩﻳﮕﺮ ﺑﺮﻭﺯ ﻟﺮﺯ ﺩﺭ ‪۵‐۶۵%‬‬
‫ﻣﻮﺍﺭﺩ ﮔﺰﺍﺭﺵ ﮔﺮﺩﻳﺪ ﮐﻪ ﺑﻴﺸﺘﺮ ﺩﺭ ﻣﺮﺩﺍﻥ ﻭ ﺟﺮﺍﺣﻲ ﻃﻮﻻﻧﻲ‬
‫ﺑﻮﺩ)‪ .(۱۴‬ﻟﺮﺯ ﺑﺎﻋﺚ ﺍﻓﺰﺍﻳﺶ ﻣﺼﺮﻑ ﺍﮐﺴﻴﮋﻥ ﺑﺪﻥ ﻣﻲﺷﻮﺩ‪،‬‬
‫ﺑﻨﺎﺑﺮﺍﻳﻦ ﺑﺎﻳﺴﺘﻲ ﺑﺮﺍﻱ ﺩﺭﻣﺎﻥ ﺁﻥ ﺍﻗﺪﺍﻡ ﮐﺮﺩ‪ .‬ﺑﻲﻗﺮﺍﺭﻱ ﭘﺲ ﺍﺯ‬
‫ﻋﻤﻞ ﺩﺭ ‪ ۲۶%‬ﻣﻮﺍﺭﺩ ﻣﺸﺎﻫﺪﻩ ﺷﺪﻩﺑﻮﺩ ﻛﻪ ﺑﺎ ﺟﻨﺲ ﺭﺍﺑﻄﻪﻱ‬
‫ﻣﻌﺼﻮﻡ ﻗﻨﻮﺗﻲ ﻫﻢ ﺗﺎﮐﻲﭘﻨﻪ ﺩﺭ ‪ %۵۱/۸‬ﻣﻮﺍﺭﺩ ﮔﺰﺍﺭﺵ ﺷﺪ)‪ .(۶‬ﺍﺯ‬
‫ﻫﻴﭙﺮﺗﺎﻧﺴﻴﻮﻥ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﻣﻲﺗﻮﺍﻧﺪ ﺑﺪﻟﻴﻞ ﺷﻴﻮﻉ ﺑﺎﻻﺗﺮ ﻣﻴﺰﺍﻥ‬
‫ﺩﺭﺩ‪ ،‬ﻟﺮﺯ‪ ،‬ﺑﻴﻘﺮﺍﺭﻱ ﻳﺎ ﺍﺣﺘﺒﺎﺱ ﺍﺩﺭﺍﺭ ﺑﺎﺷﺪ‪ .‬ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ﻗﺎﺑﻞ‬
‫ﺗﻮﺟﻪ‪ ،‬ﮐﻤﺘﺮ ﺷﺎﻳﻊ ﺍﺳﺖ ﻭ ﻣﻌﻤﻮﻻﹰ ﺑﺪﻟﻴﻞ ﻫﻴﭙﻮﻭﻟﻤﻲ ﺍﺳﺖ ﮐﻪ‬
‫ﻧﻴﺎﺯ ﺑﻪ ﺩﺭﻣﺎﻥ )ﻣﺎﻳﻊ‪ /‬ﻭﺍﺯﻭﭘﺮﺳﻮﺭ( ﺩﺍﺭﺩ‪ .‬ﺩﺭ ﺑﺮﺭﺳﻲ ﻣﺎ ﺗﻐﻴﻴﺮﺍﺕ‬
‫ﺗﻌﺪﺍﺩ ﺿﺮﺑﺎﻥ ﻗﻠﺐ ﺑﻄﻮﺭ ﻣﺴﺎﻭﻱ ﺩﺭ ‪ ۲۸%‬ﻣﻮﺍﺭﺩ ﺩﻳﺪﻩ ﺷﺪ ﻭ ﺑﻴﻦ‬
‫ﺳﻦ ﻭ ﺗﻐﻴﻴﺮﺍﺕ ﺿﺮﺑﺎﻥ ﻗﻠﺐ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭ ﺑﻮﺩ‪ .‬ﺩﺭ ﻣﻄﺎﻟﻌﻪ‬
‫‪ Babin‬ﻫﻢ ﻓﺮﻭﺍﻧﻲ ﺗﺎﮐﻴﮑﺎﺭﺩﻱ ﺑﻪﻣﻴﺰﺍﻥ ‪ %۳۰‬ﮔﺰﺍﺭﺵ ﺷﺪ)‪.(۸‬‬
‫ﻋﻠﻞ ﻋﻤﺪﻩ ﺗﺎﮐﻲﮐﺎﺭﺩﻱ‪ ،‬ﺩﺭﺩ‪ ،‬ﺑﻲﻗﺮﺍﺭﻱ‪ ،‬ﻟﺮﺯ ﻭ ﺍﻳﺎﺗﺮﻭﮊﻧﻲ ﺍﺳﺖ‪.‬‬
‫ﺩﺭ ﺑﺮﺭﺳﻲ ﻣﺎ ﺣﺪﻭﺩ ‪ %۵۰‬ﺑﻴﻤﺎﺭﺍﻥ ﺩﭼﺎﺭ ﺗﻐﻴﻴﺮﺍﺕ ﻗﺎﺑﻞ ﺗﻮﺟﻪ‬
‫ﺗﻌﺪﺍﺩ ﺗﻨﻔﺲ ﺷﺪﻧﺪ ﮐﻪ ﺍﮐﺜﺮ ﺁﻧﻬﺎ ﺗﺎﻛﻲﭘﻨﻪ ﻧﺸﺎﻥ ﺩﺍﺩﻧﺪ‪ .‬ﺩﺭ ﻣﻄﺎﻟﻌﻪ‬
‫‪D‬‬

‫‪I‬‬
‫ﻧﻈﺮ ﻭﺿﻌﻴﺖ ‪ PaO2‬ﮐﻪ ﻋﻤﺪﺗﺎﹰ ﻣﻲﺗﻮﺍﻧﺪ ﺑﺪﻟﻴﻞ ﻫﻴﭙﻮﻭﻧﺘﻴﻼﺳﻴﻮﻥ‬
‫ﺍﺗﻔﺎﻕ ﺍﻓﺘﺪ‪ ،‬ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪﺭﻏﻢ ﺍﮐﺴﻴﮋﻥ ﺩﺭﻣﺎﻧﻲ ﻣﻌﻤﻮﻝ‪ ،‬ﺩﺭ‬
‫ﻣﻌﻨﻲﺩﺍﺭ ﺩﺍﺷﺖ‪ ،‬ﺑﺪﻳﻦ ﺗﺮﺗﻴﺐ ﮐﻪ ﺑﻲﻗﺮﺍﺭﻱ ﺑﻴﺸﺘﺮ ﺩﺭ ﻣﺮﺩﺍﻥ‬
‫ﺩﻳﺪﻩﺷﺪ‪ .‬ﺩﺭ ﺑﺮﺭﺳﻲ ﺍﻧﺘﻈﺎﺭﻱ‪ ،‬ﺑﻲﻗﺮﺍﺭﻱ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺩﺭ ‪۲۱%‬‬

‫‪f‬‬ ‫‪S‬‬
‫‪ %۱۳‬ﻣﻮﺍﺭﺩ ﻫﻴﭙﻮﮐﺴﻤﻲ ﺩﻳﺪﻩ ﺷﺪ ﮐﻪ ﺩﺭ ﻣﺮﺩﺍﻥ ﺑﺎ ﺳﻦ ﮐﻤﺘﺮ ﺍﺯ‬
‫‪ ۶۵‬ﺳﺎﻝ ﺑﻴﺸﺘﺮ ﺍﺯ ﺳﺎﻳﺮﻳﻦ ﺑﺮﻭﺯ ﮐﺮﺩﻩﺑﻮﺩ ﺍﻣﺎ ﺑﻪﻃﻮﺭ ﮐﻠﻲ ﺍﺭﺗﺒﺎﻁ‬
‫ﻣﻮﺍﺭﺩ ﻣﺸﺎﻫﺪﻩ ﺷﺪ ﮐﻪ ﺑﻪ ﻧﺘﺎﻳﺞ ﺑﺮﺭﺳﻲ ﻣﺎ ﻧﺰﺩﻳﮏ ﺍﺳﺖ ﺩﺭ‬
‫ﻣﻄﺎﻟﻌﻪ ‪ Mayer‬ﮔﺰﺍﺭﺵ ﺷﺪ ﮐﻪ ﺩﺭﺩ‪ ،‬ﻧﻮﻉ ﺟﺮﺍﺣﻲ‪ ،‬ﺳﻦ ﻭ‬
‫ﺍﺿﻄﺮﺍﺏ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﺩﺭ ﺑﺮﻭﺯ ﺑﻲﻗﺮﺍﺭﻱ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﻣﻮﺛﺮ‬

‫‪e‬‬ ‫‪o‬‬
‫ﺁﻣﺎﺭﻱ ﻣﻌﻨﻲﺩﺍﺭ ﺑﻴﻦ ﻋﻮﺍﺭﺽ ﺗﻨﻔﺴﻲ ﺑﺎ ﺳﻦ‪ ،‬ﺟﻨﺲ‪ ،‬ﻣﺪﺕ ﻭ‬
‫ﻧﻮﻉ ﺟﺮﺍﺣﻲ ﺑﺪﺳﺖ ﻧﻴﺎﻣﺪ‪ .‬ﺩﺭ ﻣﻄﺎﻟﻌﻪ ‪ Richard‬ﻭ ﻫﻤﮑﺎﺭﺍﻥ ﺑﺎ‬
‫ﻋﻨﻮﺍﻥ ﻫﻴﭙﻮﮐﺴﻤﻲ ﺩﺭ ﺭﻳﮑﺎﻭﺭﻱ‪ ،‬ﻫﻴﭙﻮﮐﺴﻤﻲ ﺩﺭ ‪ ۱۴٪‬ﻣﻮﺍﺭﺩ‬

‫‪iv‬‬
‫ﺍﺳﺖ)‪ .(۱۵‬ﺑﻲﻗﺮﺍﺭﻱ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﮐﺎﻣﻼ ﺑﻴﺪﺍﺭ ﻧﺸﺪﻩﺍﻧﺪ‬ ‫ﻭﺟﻮﺩ ﺩﺍﺷﺖ)‪ (۹‬ﮐﻪ ﺑﺎ ﻧﺘﺎﻳﺞ ﻣﺎ ﻣﻄﺎﺑﻘﺖ ﺩﺍﺭﺩ‪ .‬ﺑﻨﺎﺑﺮﺍﻳﻦ‪ ،‬ﺑﺮﺍﻱ‬
‫ﻣﻲﺗﻮﺍﻧﺪ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻼﻣﺘﻲ ﺍﺯ ﺍﺧﺘﻼﻝ ﻓﻴﺰﻳﻮﻟﻮﮊﻱ ﺑﺎﺷﺪ‪ ،‬ﺑﻨﺎﺑﺮﺍﻳﻦ‪،‬‬ ‫ﭘﻴﺸﮕﻴﺮﻱ ﺍﺯ ﺧﻄﺮ ﻫﻴﭙﻮﮐﺴﻲ ﮐﻪ ﻣﻲﺗﻮﺍﻧﺪ ﺗﻬﺪﻳﺪﮐﻨﻨﺪﻩ ﺣﻴﺎﺕ‬

‫‪c‬‬ ‫‪h‬‬
‫ﺑﺎﻳﺴﺘﻲ ﺑﻴﻤﺎﺭ ﺭﺍ ﺍﺯ ﻧﻈﺮ ﺩﺭﺩ‪ ،‬ﻫﻴﭙﻮﮐﺴﻤﻲ ﻭ ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ﺑﺮﺭﺳﻲ‬
‫ﮐﺮﺩ‪.‬‬
‫ﺑﺎﺷﺪ‪ ،‬ﻣﺎﻧﻴﺘﻮﺭ ﺍﮐﺴﻴﮋﻧﺎﺳﻴﻮﻥ ﺑﻪﻫﻤﺮﺍﻩ ﻭﺿﻌﻴﺖ ﺗﻬﻮﻳﻪ ﺿﺮﻭﺭﻱ‬
‫ﺍﺳﺖ ﺯﻳﺮﺍ ﮐﻪ ﺩﺭ ﺑﺮﺭﺳﻲ ‪ Down‬ﺗﺎﻳﻴﺪ ﺷﺪ ﮐﻪ ﺍﮐﺴﻲﻣﺘﺮﻱ ﺩﺭ‬

‫‪A‬‬ ‫‪r‬‬
‫ﺩﺭ ﺍﺭﺗﺒﺎﻁ ﺑﺎ ﻫﻨﮕﺎﻡ ﺑﻴﺪﺍﺭﻱ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻧﺘﺎﻳﺞ ﻣﺎ ﻧﺸﺎﻥ ﺩﺍﺩ ﮐﻪ‬
‫‪ ۶/۵%‬ﺑﻴﻤﺎﺭﺍﻥ ﺯﻣﺎﻥ ﺑﻴﺪﺍﺭﻱ ﺑﻴﺸﺘﺮ ﺍﺯ ‪ ۱‬ﺳﺎﻋﺖ )ﺗﺎﺧﻴﺮ ﺩﺭ‬
‫ﺑﻴﺪﺍﺭﻱ( ﺩﺍﺷﺘﻨﺪ ﮐﻪ ﺑﺎ ﺟﻨﺲ ﻭ ﻣﺪﺕ ﺟﺮﺍﺣﻲ ﺭﺍﺑﻄﻪ ﻣﻌﻨﻲﺩﺍﺭ‬
‫ﻭﺟﻮﺩ ﺩﺍﺷﺖ‪ .‬ﺩﺭ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﻣﻌﻤﻮﻟﻲ ﭘﺎﺳﺦ ﺑﻪ ﺗﺤﺮﻳﮏ‬
‫ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﺍﺯ ﺍﮐﺴﻴﮋﻥ ﮐﻤﮑﻲ ﺍﺳﺘﻔﺎﺩﻩ ﻣﻲﮐﻨﻨﺪ ﻣﻲﺗﻮﺍﻧﺪ‬
‫ﺗﺸﺨﻴﺺ ﺑﻤﻮﻗﻊ ﻫﻴﭙﻮﻭﻧﺘﻴﻼﺳﻴﻮﻥ ﺭﺍ ﺑﺎ ﻣﺸﮑﻞ ﻣﻮﺍﺟﻪ ﺳﺎﺯﺩ)‪.(۱۱‬‬
‫ﺍﺯ ﻧﻈﺮ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﻋﺼﺒﻲ‪ ،‬ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﻣﺬﮐﻮﺭ ﺁﺯﻣﻮﻥﻫﺎﻱ‬
‫ﺁﻣﺎﺭﻱ ﻧﺸﺎﻥ ﺩﺍﺩ ﮐﻪ ﺑﻴﻦ ﺩﺭﺩ ﻭ ﺟﻨﺲ)ﻣﺮﺩﺍﻥ( ﻭ ﻫﻤﭽﻨﻴﻦ ﺑﻴﻦ‬
‫ﺑﺎﻳﺴﺘﻲ ﺩﺭ ﻣﺪﺕ‪ ۱‬ﺳﺎﻋﺖ ﭘﺲ ﺍﺯ ﺟﺮﺍﺣﻲ ﻭﺟﻮﺩ ﺩﺍﺷﺘﻪ ﺑﺎﺷﺪ ﺩﺭ‬ ‫ﺷﺪﺕ ﺩﺭﺩ ﻭ ﻣﺪﺕ ﺟﺮﺍﺣﻲ)ﻃﻮﻻﻧﻲ ﻣﺪﺕ( ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭ‬
‫ﻏﻴﺮ ﺍﻳﻦ ﺻﻮﺭﺕ ﺑﻪ ﺍﺭﺯﻳﺎﺑﻲ ﻣﺠﺪﺩ ﻧﻴﺎﺯ ﺩﺍﺭﺩ)‪ .(۱۶‬ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﻪ‬ ‫ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻛﻪ ﺑﺎ ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﻪ ‪ Zeev‬ﺩﺭ ﺩﺍﻧﺸﮕﺎﻩ ‪ Yale‬ﻣﺒﻨﻲ ﺑﺮ‬
‫‪ Fedok‬ﺑﺮ ‪ ۱۷۷‬ﺑﻴﻤﺎﺭ‪ ،‬ﻋﻠﻞ ﻋﻤﺪﻩ ﺗﺎﺧﻴﺮ‪ ،‬ﺍﺛﺮ ﺑﺎﻗﻴﻤﺎﻧﺪﻩ ﻫﻮﺷﺒﺮﻫﺎ‬ ‫ﺍﺭﺗﺒﺎﻁ ﺍﺿﻄﺮﺍﺏ ﻗﺒﻞ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﺑﺎ ﺩﺭﺩ‪ ،‬ﻫﻤﺎﻫﻨﮓ ﺍﺳﺖ)‪.(۱۱‬‬
‫ﻭ ﻫﻴﭙﻮﺗﺮﻣﻲ ﺑﻪﻋﻨﻮﺍﻥ ﻋﻠﻞ ﺍﺻﻠﻲ ﺗﺎﺧﻴﺮ ﺑﻴﺪﺍﺭﻱ ﺍﻋﻼﻡ ﺷﺪ)‪.(۱۷‬‬ ‫ﻓﺮﺍﻭﺍﻧﻲ ﺩﺭﺩ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ‪ Farsi‬ﺩﺭ ﻋﺮﺑﺴﺘﺎﻥ )‪ (۲۰۰۹‬ﺣﺪﻭﺩ ‪%۴۸‬‬
‫ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﺗﻬﻮﻉ ﻭ ﺍﺳﺘﻔﺮﺍﻍ ‪ ۱۲%‬ﺑﻮﺩ ﮐﻪ ﺩﺭ ﺯﻧﺎﻥ ﻭ ﺍﻋﻤﺎﻝ‬ ‫)‪ ،(۱۲‬ﻣﻄﺎﻟﻌﻪ ‪ Popping‬ﺩﺭ ﺁﻟﻤﺎﻥ‪ (۱۳) %۳۰‐۸۰‬ﻭ ﺩﺭ ﻣﻄﺎﻟﻌﻪ‬
‫ﺟﺮﺍﺣﻲ ﻃﻮﻻﻧﻲ ﺷﺎﻳﻊﺗﺮ ﺑﻮﺩ ﺍﻣﺎ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺑﻴﻦ ﺟﻨﺲ ﻭ‬ ‫ﺍﻧﺘﻈﺎﺭﻱ ‪ %۲۷‬ﮔﺰﺍﺭﺵ ﺷﺪ)‪ .(۷‬ﺍﮔﺮ ﺍﺯ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﺩﺭﺩ ﺧﻔﻴﻒ‬
‫ﻣﺪﺕ ﺟﺮﺍﺣﻲ ﺩﻳﺪﻩ ﻧﺸﺪ‪ .‬ﺍﺯ ﻧﻈﺮ ‪ Miller‬ﺗﻬﻮﻉ ﻭ ﺍﺳﺘﻔﺮﺍﻍ ﺩﺭ‬ ‫ﺑﮕﺬﺭﻳﻢ‪ ،‬ﻓﺮﺍﻭﺍﻧﻲ ﺑﺮﻭﺯ ﺩﺭﺩ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﻣﺎ ‪ ۲۱%‬ﺍﺳﺖ ﮐﻪ ﻧﺴﺒﺖ‬
‫ﺑﻴﻬﻮﺷﻲ ﺍﺳﺘﻨﺸﺎﻗﻲ ﺑﻴﺸﺘﺮ ﺩﻳﺪﻩ ﻣﻲﺷﻮﺩ ﺑﻪﻃﻮﺭﻱ ﮐﻪ ﻣﻤﮑﻦ‬ ‫ﺑﻪ ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎﺕ ﮐﻤﺘﺮ ﺑﻮﺩ ﮐﻪ ﺷﺎﻳﺪ ﻋﻠﹼﺖ ﺁﻥ ﻣﺤﻞ ﺍﻋﻤﺎﻝ‬
‫ﺍﺳﺖ ﺩﺭ ‪ %۱۰ ‐۳۰‬ﻣﻮﺍﺭﺩ ﺁﻥ ﺑﺎﺷﺪ)‪ .(۱‬ﺑﺮﻭﺯ ﺗﻬﻮﻉ ﺍﺳﺘﻔﺮﺍﻍ ﺩﺭ‬ ‫ﺟﺮﺍﺣﻲ ﺍﺭﻭﻟﻮﮊﻱ )ﻗﺴﻤﺖ ﭘﺎﻳﻴﻦ ﺷﮑﻢ( ﺑﺎﺷﺪ‪ .‬ﺩﺭﺩ ﺑﺎ ﺍﻓﺰﺍﻳﺶ‬

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‫‪       ۱۲‬‬ ‫ﻣﺠﻠﻪ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﮔﻴﻼﻥ‪ /‬ﺩﻭﺭﻩ ﺑﻴﺴﺖﻭﻳﮑﻢ‪ /‬ﺷﻤﺎﺭﻩ‪ /۸۲‬ﺗﺎﺑﺴﺘﺎﻥ ‪۱۳۹۱‬‬
 ‫ﻣﺠﻴﺪ ﭘﻮﺭﺷﻴﺨﻴﺎﻥ‐ ﻋﺒﺪﺍﻟﺤﺴﻴﻦ ﺍﻣﺎﻣﻲ ﺳﻴﮕﺎﺭﻭﺩﻱ‐ ﺩﮐﺘﺮ ﺍﺣﺴﺎﻥ ﻛﺎﻇﻢ ﻧﮋﺍﺩ‐ ﻣﻴﻨﺎ ﺭﺋﻮﻑ‬
‫ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺷﻴﻮﻉ ﻧﺴﺒﺘﺎﹰ ﺑﺎﻻﻱ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﺍﺯ ﺟﻤﻠﻪ‬
‫ ﺑﻲﻗﺮﺍﺭﻱ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﻭ ﺗﺎﺧﻴﺮ ﺩﺭ‬،‫ ﻟﺮﺯ‬،‫ ﺩﺭﺩ‬،‫ﺗﻐﻴﻴﺮ ﺿﺮﺑﺎﻥ ﻗﻠﺐ‬
‫ ﻭ ﻗﺎﺑﻠﻴﺖ‬،‫ﺑﻴﺪﺍﺭﻱ ﺩﺭ ﻭﺍﺣﺪ ﻣﺮﺍﻗﺒﺖﻫﺎﻱ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ‬
‫ﭘﻴﺶﺑﻴﻨﻲ ﺁﻧﻬﺎ ﺩﺭ ﮔﺮﻭﻩﻫﺎﻱ ﺧﺎﺹ ﻛﻪ ﻣﻤﮑﻦ ﺍﺳﺖ ﺑﺎﻋﺚ‬
‫ ﻣﺮﮒﻭﻣﻴﺮ ﻭ ﺗﺤﻤﻴﻞ ﻫﺰﻳﻨﻪ ﺑﻴﺸﺘﺮ ﺑﺮ ﺑﻴﻤﺎﺭ ﻭ ﻣﺮﮐﺰ‬،‫ﺑﻴﻤﺎﺭﻱﺯﺍﻳﻲ‬
‫ ﻫﻮﺷﻴﺎﺭ‬،‫ ﻻﺯﻡ ﺍﺳﺖ ﺑﺎ ﺑﮑﺎﺭﮔﻴﺮﻱ ﮐﺎﺭﮐﻨﺎﻥ ﻣﺎﻫﺮ‬،‫ﺩﺭﻣﺎﻧﻲ ﺷﻮﺩ‬
‫ ﺷﻨﺎﺳﺎﻳﻲ ﻭ‬،‫ﺗﺠﻬﻴﺰﺍﺕ ﭘﻴﺸﺮﻓﺘﻪ ﻣﺎﻧﻴﺘﻮﺭ ﺩﺭ ﺟﻬﺖ ﭘﻴﺸﮕﻴﺮﻱ‬
.‫ﮐﻨﺘﺮﻝ ﺑﻤﻮﻗﻊ ﻋﻮﺍﺭﺽ ﺍﺣﺘﻤﺎﻟﻲ ﺗﺪﺍﺑﻴﺮ ﻣﻨﺎﺳﺐ ﺍﺗﺨﺎﺫ ﺷﻮﺩ‬
1. Dorre N. The Post Anesthesia Care Unit, In: Miller's
Anesthesia. Miller R D. 7th Edition. Philadelphia;
Churchill Livingstone, 2010.
2 Trarrac SE. A Description Of Intraoperative And
Post Anesthesia Complication Rates. Journal Of
Perianesth Nursing, 2006; 21(2): 88–96.
3 Hines R, Barash P, Watrous, O'Connor T.
Complications Occurring In The Post Anesthesia Care
Unit. A & A 1992; 74(4): 503-9.
4. Magni G, Rosa I, Gimignani S, Melillo G, et al .
e
Early Postoperative Complications after Intracranial
Surgery: Comparison between Total Intravenous and
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Balanced Anesthesia. Neurosurg Anesthesioly 2007;
19(4):229-34.
5. Kluger MT, Bullock MF. Recovery Room Incidents:
57(11):1060-66.
c h
A Review of 419 Reports from The Anaesthetic
Incident Monitoring Study (AIMS). Anesthesia 2002;
& Midwife Faculty 2004; 22:
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6. Masoom Gh F, Heidari A, Zandieh M, Sajedi Zh, et
al. Incidence of Post General Anesthesia
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(Text in Persian).
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Incidence pf Post Anesthesia Complications at Ardabil
Fatemi & Alavi Hospitals in 2000. Journal of Ardabil
Med 2002; 2(2):12-18(Text in Persian).
8. Babin EJ, Keith PR. Efficacy and Safety of Low
Dose Propranolol Versus Diltiazem In Prophylaxis
Tachycardia after CABG. Eur J Cardiothorac Surg
2003; 5(3):312-22.
9. Morris R W, Buschman A , Warren D L, Philip
J H, Reamer D B. Prevalence of Hypoxemia Detected
by POM During Recovery from Anesthesia. J Clinical
Monitoring 1987; 4: 16-20.
۱۳۹۱ ‫ ﺗﺎﺑﺴﺘﺎﻥ‬/۸۲‫ ﺷﻤﺎﺭﻩ‬/‫ ﺩﻭﺭﻩ ﺑﻴﺴﺖﻭﻳﮑﻢ‬/‫ﻣﺠﻠﻪ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠ ﻮﻡ ﭘﺰﺷﻜﻲ ﮔﻴﻼﻥ‬       ۱۳
‫ ﺩﺭ ﺍﻳﺮﺍﻥ ﻭ ﻋﺮﺑﺴﺘﺎﻥ‬Farsi ‫( ﻭ‬۷)‫ﻣﻄﺎﻟﻌﺎﺕ ﺟﺪﺍﮔﺎﻧﻪ ﺍﻧﺘﻈﺎﺭﻱ‬
(۳) ۹/۸% ‫ ﺩﺭ ﺁﻣﺮﻳﮑﺎ‬Hines ‫( ﻭ ﺩﺭ ﻣﻄﺎﻟﻌﻪ‬۱۲‫ﻭ‬۷) ۸/۸% ‫ﺣﺪﻭﺩ‬
‫ ﺩﺭ‬.‫ﻭﺟﻮﺩ ﺩﺍﺷﺖ ﮐﻪ ﻫﻤﮕﻲ ﺑﻪ ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﻧﺰﺩﻳﮏ ﺑﻮﺩ‬
‫( ﮐﻪ ﺷﺎﻳﺪ‬۶)‫ ﺍﻋﻼﻡ ﺷﺪ‬۳۳% ‫ﻣﻄﺎﻟﻌﻪ ﻗﻨﻮﺗﻲ ﻧﻴﺰ ﺑﺮﻭﺯ ﺍﺳﺘﻔﺮﺍﻍ‬
‫ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﻴﺰﺍﻥ‬.‫ﻧﻮﻉ ﺟﺮﺍﺣﻲ ﺩﺭ ﺷﻴﻮﻉ ﺑﺎﻻﻱ ﺁﻥ ﻣﻮﺛﺮ ﺑﻮﺩ‬
‫ﺷﻴﻮﻉ ﺗﻬﻮﻉ ﺍﺳﺘﻔﺮﺍﻍ ﻭ ﺍﺣﺘﻤﺎﻝ ﺑﺮﻭﺯ ﭘﻨﻮﻣﻮﻧﻲ ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﮐﻪ‬
‫ ﺑﺎﻳﺪ ﻧﺴﺒﺖ ﺑﻪ ﭘﻴﺸﮕﻴﺮﻱ ﻭ‬،‫ﻣﻲﺗﻮﺍﻧﺪ ﺗﻬﺪﻳﺪﮐﻨﻨﺪﻩ ﺣﻴﺎﺕ ﺑﺎﺷﺪ‬
.‫ﺩﺭﻣﺎﻥ ﺑﻤﻮﻗﻊ ﺁﻥ ﺍﻗﺪﺍﻡ ﻛﺮﺩ‬
‫ﻣﻨﺎﺑﻊ‬
D
10. Down Preoperative Anxiety, Postoperative Pain,
I
And Behavioral Recovery in Young Children
Undergoing Surgery. Chest 2004; 126:1552-58.
S
11. Zeev N, Mayes L, Caldwell A, Karas D, et al.
Preoperative Anxiety, Postoperative Pain, and
Behavioral Recovery In Young Children Undergoing
o f
Surgery. Pediatric 2006; 118:651-58.
12. Farsi N, Ba'akdah R, Boker A, Almushayt A.
Postoperative Complications of Pediatric Dental
General Anesthesia Provided in Jeddah Hospitals,
Saudi Arabia BMC Oral Health 2009; 9(6):10.
13. Pöpping D, Zahn P, Vanaken H, Dasch R, Boche E.
Effectiveness And Safety of Postoperative Pain
Management. Br J Anaesth 2008; 101(6):832-40.
14. Buggy DJ, Crossley AW. Thermoregulation, Mild
Perioperative Hypothermia and Postanaesthetic
Shivering. Br J Anaesth 2000; 84:615-628.
15. Mayer J, Boldt J, Rohm KD, et al. Desflurane
Anesthesia after Sevoflurane Inhaled Induction
Reduces Severity of Emergence Agitation in Children
Undergoing Minor Ear-Nose-Throat Surgery
Compared With Sevoflurane Induction and
Maintenance. A & A 2006; 102: 400- 04.
16. Pavlin D J , Rapp S E , Polissar N L , Malmgren J
A , Malmgren. Factors Affecting Discharge Time in
Adult Outpatients. A & A 1998; 87: 816-826.
17. Fedoc G, Ferraro F, Kingsley P, Fornadley J.
Operative Times, Post Anesthesia Recovery Times,
And Complications During Sinonasal Surgery Using
General Anesthesia And Local Anesthesia With
Sedation. Otolaryngology - Head and Neck Surgery
2000; 122: 560-566.
www.SID.ir
 ‫ﺑﺮﺭﺳﻲ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﭘﺲ ﺍﺯ ﺑﻴﻬﻮﺷﻲ ﻋﻤﻮﻣﻲ ﺩﺭ ﻭﺍﺣﺪ ﺭﻳﻜﺎﻭﺭﻱ‬

Incidence of Post General Anesthesia Complications in Recovery

Room

Poorsheykhian M.(M.Sc)1-*Emami Sigaroodi A.H.(M.Sc)2-Kazamnejad E.(Ph.D)3-Raoof M.(M.Sc)4

*Corresponding Address: Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IRAN
Email: kasraema2004@yahoo.com
Received: 1/Oct/2011 Accepted: 16/Jan/2012

Abstract
Introduction: General anesthesia and surgery cause several physiological disorders in different organs of the respective
patients that may appear as several complications during recovery, which need to be identified and evaluated.
1
Objective: Survey of the incidence of such complications at Post Anesthesia Care Unit (PACU) and some of the
effective risk factors in Rasht Razi Hospital.

I D
Materials and Methods: In this cross-sectional and descriptive study, 155 patients 10-75 years old, in ASA 1 and 2

S
classes were selected in the hospital. Cases included those who underwent general anesthesia with the same techniques
for elective urology surgery and transferred to PACU, in 2010. Questionnaires consisted of two parts, part one included

o f
basic information and part two included: respiratory, cardiovascular, neural and digestive complications. Collected data
were analyzed using chi-square, paired tests by SPSS 16 and P≤0/05 was considered significant.
Results: Findings indicated that the incidence of considerable changes (increase or decrease) in BP, PR and respiration

e
were 42%, 36% and 49%, hypoxemia(SaO2< 90%) 8/4%, pain 76%, shivering 22%, postoperative restlessness 26%,
and nausea and vomiting 12% cases, as observed. We found a significant correlation between age and the incidence of

i v
considerable changes of PR and postoperative shivering and also between sex and the incidence of pain, shivering,
postoperative restlessness and delay in recovery. In addition, the data showed a significant relationship between

c h
duration of surgery and shivering, postoperative pain severity and delay in recovery.
Conclusion: The relatively high incidence of complications in recovery indicates the importance of employing skilled

r
personnel and also using enough monitoring equipment at PACU in order to decrease mortality and morbidity of the
patients and also save on hospital charges.

A
Key words: Anesthesia General/ Postoperative Complications/ Recovery Room
_______________________________________Journal of Guilan University of Medical Sciences, No: 82, Pages: 8-14

1. Faculty of Management and Medical Information, Tehran University of Medical Sciences, Tehran, IRAN
2. Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IRAN
3. Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IRAN www.SID.ir
       ۱۴ ۱۳۹۱ ‫ ﺗﺎﺑﺴﺘﺎﻥ‬/۸۲‫ ﺷﻤﺎﺭﻩ‬/‫ ﺩﻭﺭﻩ ﺑﻴﺴﺖﻭﻳﮑﻢ‬/‫ﻣﺠﻠﻪ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﮔﻴﻼﻥ‬
4. Razi Hospital, Guilan University of Medical Sciences, Rasht, IRAN
 ‫ﻟﯿﻨﮏ ﻫﺎى ﻣﻔﯿﺪ‬

‫ﻋﻀﻮﯾﺖ‬ ‫ﮐﺎرﮔﺎه ﻫﺎى‬ ‫ﺳﺮوﯾﺲ‬ ‫ﻓﯿﻠﻢ ﻫﺎى‬ ‫ﺑﻼگ‬ ‫ﺳﺮوﯾﺲ ﻫﺎى‬

‫درﺧﺒﺮﻧﺎﻣﻪ‬ ‫آﻣﻮزﺷﻰ‬ ‫ﺗﺮﺟﻤﻪ ﺗﺨﺼﺼﻰ‬ ‫آﻣﻮزﺷﻰ‬ ‫ﻣﺮﮐﺰ اﻃﻼﻋﺎت ﻋﻠﻤﻰ‬ ‫وﯾﮋه‬
‫‪STRS‬‬

‫‪ %40‬ﺗﺨﻔﯿﻒ‬
‫ﺑﻪ ﻣﻨﺎﺳﺒﺖ ﺳﺎﻟﺮوز ﺗﺎﺳﯿﺲ‬
‫ﻣﺮﮐﺰ اﻃﻼﻋﺎت ﻋﻠﻤﻰ‬