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ﺍﻟﺘﺨﺪﻳﺮﻭﺍﻟﺘﻨﻮﻳﻢ
.1ﺍﻟﺨﻠﻔﻴﺔ
ﺍﻟﺠﺪﻭﻝ.1ﺩﻭﺭﺍﺕ ﺍﻟﻨﻮﻡ
ﻣﺮﺣﻠﺔﺣﺮﻛﺔ ﺍﻟﻌﻴﻦ ﺍﻟﺴﺮﻳﻌﺔ )(REM ﻣﺮﺍﺣﻞﺣﺮﻛﺔ ﺍﻟﻌﻴﻦ ﻏﻴﺮ ﺍﻟﺴﺮﻳﻌﺔ )(Non-REM
ﺍﻟﻨﻮﻡﺍﻟﻨﺸﻂ ﺍﻟﻨﻮﻡﺍﻟﻬﺎﺩﺉ:
.1ﺍﻧﺨﻔﺎﺽ ﻣﻌﺪﻝ ﺍﻷﻳﺾ
.2ﺍﻧﺨﻔﺎﺽ ﻧﺸﺎﻁ ﺍﻟﺨﻼﻳﺎ ﺍﻟﻌﺼﺒﻴﺔ
.3ﺍﻧﺨﻔﺎﺽ ﻣﻌﺪﻝ ﺿﺮﺑﺎﺕ ﺍﻟﻘﻠﺐ ) (HRﻭﺿﻐﻂ ﺍﻟﺪﻡ ) (BPﺑﺴﺒﺐ ↑ ﺍﻟﺴﻤﺒﺘﺎﻭﻱ ﻭ
↓ ﺍﻟﻨﺸﺎﻁ ﺍﻟﻮﺩﻱ ← ﺍﻧﻘﺒﺎﺽ ﺍﻟﺤﺪﻗﺔ
ﺍﻟﻨﻮﻡﺍﻟﻨﺸﻂ ﺍﻟﻨﻮﻡﺍﻟﻌﻤﻴﻖ )ﺍﻟﻤﻮﺟﺔ ﺍﻟﺒﻄﻴﺉﺔ( ﻧﻮﻡﺧﻔﻴﻒ
ﺍﻟﻤﺮﺣﻠﺔﺍﻟﺨﺎﻣﺴﺔ ﺍﻟﻤﺮﺣﻠﺔﺍﻟﺮﺍﺑﻌﺔ ﺍﻟﻤﺮﺣﻠﺔ3 ﺍﻟﻤﺮﺣﻠﺔﺍﻟﺜﺎﻧﻴﺔ ﺍﻟﻤﺮﺣﻠﺔ1
↑ ﺣﺮﻛﺔ ﺍﻟﻌﻴﻦ • ﻣﻮﺟﺎﺕﺩﻟﺘﺎ 4-0.5ﻫﺮﺗﺰ ) • 20 -15ﺩﻗﻴﻘﺔ • 5-15ﺩﻗﻴﻘﺔ
↑ ﻣﻌﺪﻝ ﺍﻟﺘﻨﻔﺲ ﻏﺎﻟﺒﺎًﻓﻲ ﺍﻟﻤﺮﺣﻠﺔ (4 • ↓ ﻧﺸﺎﻁ ﺍﻟﻌﻀﻼﺕ • ﺍﻻﻧﺘﻘﺎﻝﺑﻴﻦ
↑ ﻧﺸﺎﻁ ﺍﻟﺪﻣﺎﻍ ← ﺍﻟﺤﻠﻢ ﻭﻣﻌﺪﻝ ﺍﻷﻳﺾ ) • ﺍﻻﺳﺘﻴﻘﺎﻅﻓﻲ ﻫﺬﻩ ﺍﻟﻤﺮﺣﻠﺔ ﻭﺍﻟﻬﻴﻜﻞﺍﻟﻌﻈﻤﻲ ﺍﻟﻴﻘﻈﺔ)25-15
ﺍﻟﻨﻮﻡﺍﻟﻨﺸﻂ( ﺣﺮﻛﺎﺕ ﺍﻟﻬﻴﻜﻞ ﺍﻟﻌﻈﻤﻲ ← ﺍﻻﺭﺗﺒﺎﻙ ﻭ • ﺛﻴﺘﺎﻣﻮﺟﺎﺕ ﻣﻊ ﻫﺮﺗﺰ( /ﻧﻮﻡ
ﺍﻟﻤﺸﻠﻮﻟﺔﻳﺘﻢ ﻋﺮﺽ ﺣﺮﻛﺔ ﺍﻟﻌﻴﻦ ﺍﻟﺴﺮﻳﻌﺔ ﺍﻻﺭﺗﺒﺎﻙ ﺩﻭﺭﻱ • 4-10ﻫﺮﺗﺰ
ﺑﻮﺍﺳﻄﺔﻃﻔﺮﺍﺕ ﺇﻃﻼﻕ ﺍﻟﺠﻬﺪ ﺍﻟﻌﺎﻟﻲ ﻓﻲ ﺍﻧﻘﻄﺎﻉ ﺍﻟﺘﻮﺍﻓﻴﺲ
ﻣﺨﻄﻂﻛﻬﺮﺑﻴﺔ ﺍﻟﺪﻣﺎﻍ ﺍﻟﻨﻮﻡﻣﻊ ﻣﻐﺎﺯﻝ
12-15ﻫﺮﺗﺰ
20-25٪ﻣﻦ ﻭﻗﺖ ﺍﻟﻨﻮﻡ 20٪ﻣﻦ ﻭﻗﺖ ﺍﻟﻨﻮﻡ 55-60٪ﻣﻦ ﻭﻗﺖ ﺍﻟﻨﻮﻡ
ﺩﻭﺭﺍﺕﺍﻟﻨﻮﻡ:
• ﻋﺎﺩﺓﻣﺎ ﻳﺘﻢ ﺗﺪﻭﻳﺮ ﻣﺮﺍﺣﻞ ﺍﻟﻨﻮﻡ ﻛﻞ 100-90ﺩﻗﻴﻘﺔ
• ﻳﺒﺪﺃﺍﻟﻨﻮﻡ ﻓﻲ ﺍﻟﻤﺮﺣﻠﺔ 1ﻭﻳﺘﻘﺪﻡ ﺇﻟﻰ ﺍﻟﻤﺮﺣﻠﺔ .5ﺗﺒﺪﺃ ﺍﻟﺪﻭﺭﺍﺕ ﺍﻟﺘﺎﻟﻴﺔ ﻓﻲ ﺍﻟﻤﺮﺣﻠﺔ 2ﺃﻭ .3ﻳﺰﺩﺍﺩ ﻭﻗﺖ ﺣﺮﻛﺔ ﺍﻟﻌﻴﻦ
ﺍﻟﺴﺮﻳﻌﺔﻣﻊ ﺗﻘﺪﻡ ﺍﻟﻨﻮﻡ ﻋﻠﻰ ﻣﺪﺍﺭ ﺍﻟﻠﻴﻞ.
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ﺑﻴﺮﺍﺯﻭﻟﻮﺑﻴﺮﻳﻤﻴﺪﻳﻦﻋﻠﻰ ﺳﺒﻴﻞ ﺍﻟﻤﺜﺎﻝ ،ﺯﺍﻟﻴﺒﻠﻮﻥ ﺳﻴﻜﻠﻮﺑﻴﺮﻭﻟﻮﻥ
ﺍﻟﺒﺎﺭﺑﻴﺘﻮﺭﺍﺕ C.
ﺃﻣﻮﺑﺎﺭﺑﻴﺘﺎﻝ ،ﺃﺑﺮﻭﺑﺎﺭﺑﻴﺘﺎﻝ ،ﺑﻮﺗﺎﺑﺎﺭﺑﻴﺘﺎﻝ ،ﺑﻨﺘﻮﺑﺎﺭﺑﻴﺘﺎﻝ ،ﻓﻴﻨﻮﺑﺎﺭﺑﻴﺘﺎﻝ ،ﻭﺳﻴﻜﻮﺑﺎﺭﺑﻴﺘﺎﻝ .ﻟﻘﺪ ﻋﻔﺎ
ﻋﻠﻴﻬﺎﺍﻟﺰﻣﻦ ﺇﻟﻰ ﺣﺪ ﻛﺒﻴﺮ ﻭﺣﻞ ﻣﺤﻠﻪ ﺍﻟﺒﻨﺰﻭﺩﻳﺎﺯﻳﺒﻴﻨﺎﺕ.
ﺩ •.ﺍﻟﺘﺨﺪﻳﺮ ﺍﻟﻌﺎﻡ ﻭﺍﻹﻳﺜﺎﻧﻮﻝ.
.2ﻧﺎﻫﻀﺎﺕ ﻣﺴﺘﻘﺒﻼﺕ ﺍﻟﻤﻴﻼﺗﻮﻧﻴﻦ ، (MT1) 1ﻣﺜﻞ ﺭﺍﻣﻴﻠﺘﻴﻮﻥ )ﺭﻭﺯﻳﺮﻡ(
ﺟﺰﺉﻲ-HTﻏﻴﺮ ﺍﻟﻨﻤﻄﻴﺔ ﻣﺜﻞ ﺑﻮﺳﺒﻴﺮﻭﻥ ) 13. azaspirodecanediones 5ﺃﻧﺎﻫﺾ ﺍﻟﻤﺴﺘﻘﺒﻞ(
.4ﻟﻢ ﻳﻌﺪ ﻳﻮﺻﻰ ﺑﻤﺨﺘﻠﻒ ﺃﻧﻮﺍﻉ ﻫﻴﺪﺭﺍﺕ ﺍﻟﻜﻠﻮﺭﺍﻝ ﻭﺍﻟﻤﻴﺒﺮﻭﺑﺎﻣﺎﺕ ﻭﺍﻟﻐﻠﻮﺗﻴﺜﻴﻤﻴﺪ ،ﻭﻟﻜﻦ ﻳﺘﻢ ﺍﺳﺘﺨﺪﺍﻣﻬﺎ ﺃﺣﻴﺎﻧﺎً.
.2ﺑﻨﺰﻭﺩﻳﺎﺯﻳﺒﻴﻨﺎﺕ
.2.1ﺍﻟﺘﻮﻟﻴﻒ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ
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.2.2ﺍﻟﻌﻼﻗﺔ ﺑﻴﻦ ﺍﻟﻨﺸﺎﻁ ﻭﺍﻟﺒﻨﻴﺔ )(SAR
ﺍﻟﺤﻠﻘﺔﺍﻟﻌﻄﺮﻳﺔ ﺃﻭ ﻏﻴﺮ ﺍﻟﻤﺘﺠﺎﻧﺴﺔ Aﻣﻄﻠﻮﺑﺔ ﻟﻠﻨﺸﺎﻁ ﺍﻟﺬﻱ ﻗﺪ ﻳﺸﺎﺭﻙ ﻓﻲ ﺗﻜﺪﻳﺲ π-πﻣﻊ ﺑﻘﺎﻳﺎ •
ﺍﻟﺤﻤﺾﺍﻟﻌﻄﺮﻱ ﻟﻠﻤﺴﺘﻘﺒﻞ.
ﻣﻄﻠﻮﺏﺑﺪﻳﻞ ﻛﻬﺮﺑﻲ ﻓﻲ ﺍﻟﻤﻮﺿﻊ 7ﻟﻠﻨﺸﺎﻁ ،ﻭﻛﻠﻤﺎ ﻛﺎﻥ ﺃﻛﺜﺮ ﻛﻬﺮﺑﻴﺎً ،ﺯﺍﺩ ﺍﻟﻨﺸﺎﻁ. •
ﺍﻟﻤﺮﻛﺒﺎﺕﺍﻟﺘﻲ ﺗﺤﺘﻮﻱ ﻋﻠﻰ OH-3ﻫﻲ ﻗﻄﺒﻴﺔ ← ﺗﺘﺤﻮﻝ ﺑﺴﺮﻋﺔ ﺇﻟﻰ 3ﻏﻠﻮﻛﻮﺭﻭﻧﻴﺪﺍﺕ ﻏﻴﺮ ﻧﺸﻄﺔ ﺍ
ﻭﺗﻔﺮﺯﻓﻲ ﺍﻟﺒﻮﻝ ← ﻓﺘﺮﺍﺕ ﻧﺼﻒ ﻋﻤﺮ ﻗﺼﻴﺮﺓ.
.ﻣﻬﻢﻟﻠﻨﺸﺎﻁ 2-carbonyl •
ﺫﺭﺓﺍﻟﻨﻴﺘﺮﻭﺟﻴﻦ ﻓﻲ ﺍﻟﻤﻮﺿﻊ 1ﻣﻬﻤﺔ ﻟﻠﻨﺸﺎﻁ. •
ﻣﻄﻠﻮﺏﻣﺠﻤﻮﻋﺔ ﺗﻘﺒﻞ Hﻓﻲ C2ﻭﻗﺪ ﺗﺘﻔﺎﻋﻞ ﻣﻊ ﺍﻟﻬﻴﺴﺘﻴﺪﻳﻦ ﻓﻲ ﻣﻮﻗﻊ ﺍﺭﺗﺒﺎﻁ ﺍﻟﺒﻨﺰﻭﺩﻳﺎﺯﻳﺒﻴﻦ ﻟـ GABAﺃ. •
ﻳﻤﻜﻦﺃﻥ ﺗﻨﺪﻣﺞ ﺣﻠﻘﺎﺕ ﺍﻟﺘﺮﻳﺎﺯﻭﻝ ﺃﻭ ﺍﻹﻳﻤﻴﺪﺍﺯﻭﻝ ﺍﻷﺧﺮﻯ ﺍﻟﻘﺎﺩﺭﺓ ﻋﻠﻰ ﺍﻟﺘﺮﺍﺑﻂ Hﻓﻲ ﺍﻟﻤﻮﺿﻌﻴﻦ 1ﻭ 2
ﻭﺗﺰﻳﺪﻣﻦ ﺍﻟﻨﺸﺎﻁ.
2.3ﺍﻟﺪﻭﺍﺉﻴﺔ
.2.3.1ﺍﺳﺘﻴﻌﺎﺏ
3
.2.3.2ﺗﻮﺯﻳﻊ
.2.3.3ﺍﻟﺘﻤﺜﻴﻞ ﺍﻟﻐﺬﺍﺉﻲ
.2.4.1ﺩﻳﺎﺯﻳﺒﺎﻡ
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• -7ﻛﻠﻮﺭﻭ-1،3-ﺛﻨﺎﺉﻲ ﻫﻴﺪﺭﻭ -1-ﻣﻴﺜﻴﻞ-5-ﻓﻴﻨﻴﻞ-2H-1،4-ﺑﻨﺰﻭﺩﻳﺎﺯﻳﺒﻴﻦ-2-ﻭﺍﻥ
)ﺍﻟﻔﺎﻟﻴﻮﻡ(
ﻣﺤﺒﺔﻟﻠﺪﻫﻮﻥ ← ﺍﻣﺘﺼﺎﺹ ﺳﺮﻳﻊ ﻭﻛﺎﻣﻞ ﻟﻠﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ ) 46 ~ =1/2tﺳﺎﻋﺔ( •
• ﻃﻮﻳﻞﺍﻟﻤﻔﻌﻮﻝ ،ﺍﺭﺗﺒﺎﻁ ﺑﺎﻟﺒﺮﻭﺗﻴﻦ = ٪99
• ﻳﺘﻢﺍﺳﺘﻘﻼﺑﻪ ﺑﻮﺍﺳﻄﺔ N-demethylationﺇﻟﻰ nordazepamﺍﻟﻨﺸﻂ ،ﻭﻫﻮ -3
ﻫﻴﺪﺭﻭﻛﺴﻴﻞﺇﻟﻰ ﺃﻭﻛﺴﺎﺯﻳﺒﺎﻡ ﺍﻟﻨﺸﻂ )ﺑﺎﻟﻔﻴﺪﻳﻮ ﺑﺎﻷﺷﻌﺔ ﺗﺤﺖ ﺍﻟﺤﻤﺮﺍء( ﺛﻢ ﻳﺘﻢ ﺍﺳﺘﻘﻼﺑﻪ ﻭﻓﻘﺎً ﻟﻠﻤﺨﻄﻂ ﺍﻟﻌﺎﻡ
ﻳﺴﺘﺨﺪﻡﻓﻲ ﺣﺎﻻﺕ ﺍﻟﻘﻠﻖ ﻭﺍﻟﺼﺮﻉ ﻭﺍﻟﺘﺨﺪﻳﺮ ﺍﻟﻤﺴﺒﻖ ﻭﺍﺿﻄﺮﺍﺑﺎﺕ ﺍﻟﺘﺸﻨﺞ ﺍﻟﻤﺨﺘﻠﻔﺔ. •
.2.4.2ﻛﻠﻮﺭﺩﻳﺎﺯﻳﺒﻮﻛﺴﻴﺪ
.2.4.3ﻓﻠﻮﺭﺍﺯﻳﺒﺎﻡ
ﺍﻟﺒﻨﺰﻭﺩﻳﺎﺯﻳﺒﻴﻦ 2-ﻭﺍﺣﺪ
• ﻳﺴﺘﺨﺪﻡﻟﻸﺭﻕ
• ﻳﺘﻢﺍﺳﺘﻘﻼﺑﻪ ﺇﻟﻰ ← N-dealkyl flurazepamﻃﻮﻳﻞ ﺟﺪﺍً ﻣﺪﻯ ﺍﻟﺤﻴﺎﺓ )ﻋﺪﺓ ﺃﻳﺎﻡ(
• ﺗﺮﺍﻛﻢ← ﺁﺛﺎﺭ ﺟﺎﻧﺒﻴﺔ ﻣﺜﻞ ﺍﻟﺘﺨﺪﻳﺮ ﺍﻟﻤﻔﺮﻁ
.2.4.4ﺃﻟﺒﺮﺍﺯﻭﻻﻡ
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