1 ،رﺎﻴﺸﻧاد هوﺮﮔ ﻲﺣاﺮﺟ ،ﻲﻣﻮﻤﻋ ﻧاد هﺪﻜﺸ ،ﻲﻜﺷﺰﭘ ي هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜﺷﺰﭘ ،نﺎﻬﻔﺻا ،نﺎﻬﻔﺻا ناﺮﻳا . 2 ،رﺎﻳدﺎﺘﺳا هوﺮﮔ ﻲﺣاﺮﺟ ،ﻲﻣﻮﻤﻋ هﺪﻜﺸﻧاد ،ﻲﻜﺷﺰﭘ ي هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜﺷﺰﭘ ،نﺎﻬﻔﺻا ،نﺎﻬﻔﺻا ناﺮﻳا . 3 ،رﺎﻳدﺎﺘﺳا هوﺮﮔ ﻲﺣاﺮﺟ ،ﻲﻣﻮﻤﻋ هﺪﻜﺸﻧاد ،ﻲﻜﺷﺰﭘ ي هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜﺷﺰﭘ ،نﺎﺘﺳﺮﻟ ،نﺎﺘﺳﺮﻟ ناﺮﻳا . 4 ا ،رﺎﻳدﺎﺘﺳ هوﺮﮔ اﺮﺟ ﻲﺣ ،ﻲﻣﻮﻤﻋ هﺪﻜﺸﻧاد ،ﻲﻜﺷﺰﭘ ي هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜﺷﺰﭘ دﺮﻛﺮﻬﺷ ، ،دﺮﻛﺮﻬﺷ ناﺮﻳا . 5 ،رﺎﻳدﺎﺘﺳا هوﺮﮔ ﺐﻃ ﺲﻧاژروا ، هﺪﻜﺸﻧاد ،ﻲﻜﺷﺰﭘ ي هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜﺷﺰﭘ ،نﺎﻬﻔﺻا ،نﺎﻬﻔﺻا ناﺮﻳا . 6 ،رﺎﻳدﺎﺘﺳا هوﺮﮔ ﻲﺷﻮﻬﻴﺑ و ﺖﺒﻗاﺮﻣ يﺎﻫ هﮋﻳو ، هﺪﻜﺸﻧاد ،ﻲﻜﺷﺰﭘ ي هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜﺷﺰﭘ ،نﺎﻬﻔﺻا ،نﺎﻬﻔﺻا اﺮﻳا ن . 7 ،رﺎﻴﺘﺳد هوﺮﮔ نﺎﻧز و نﺎﻤﻳاز ، هﺪﻜﺸﻧاد ،ﻲﻜﺷﺰﭘ ي هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜﺷﺰﭘ ،نﺎﻬﻔﺻا ،نﺎﻬﻔﺻا ناﺮﻳا . 8 ،رﺎﻴﺘﺳد ﺰﻛﺮﻣ تﺎﻘﻴﻘﺤﺗ شزﻮﻣآ ﻲﻜﺷﺰﭘ ، هوﺮﮔ ﻲﺣاﺮﺟ ﻲﻣﻮﻤﻋ ، هﺪﻜﺸﻧاد ﻲﻜﺷﺰﭘ ي ، هﺎﮕﺸﻧاد مﻮﻠﻋ ﻲﻜﺷﺰﭘ ،نﺎﻬﻔﺻا ،نﺎﻬﻔﺻا ناﺮﻳا . 9 ،رﺎﻳدﺎﺘﺳا هوﺮﮔ ﻲﺣاﺮﺟ ،ﻲﻣﻮﻤﻋ هﺪﻜﺸﻧاد ،ﻲﻜﺷﺰﭘ ي ﺸﻧاد هﺎﮕ مﻮﻠﻋ ﻲﻜﺷﺰﭘ نﺎﺷﺎﻛ ، ﺷﺎﻛ ،نﺎ ناﺮﻳا . ﻢﻬﻧ و ﺖﺴﻴﺑ لﺎﺳ / هرﺎﻤﺷ 125 / هﺎﻣ ﻦﻳدروﺮﻓ لوا ﻪﺘﻔﻫ 1390 ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ : 19 / 5 / 89 شﺮﻳﺬﭘ ﺦﻳرﺎﺗ : 23 / 12 / 89
ﻦﻴﮕﻧﺎﻴﻣ
لﻮﻃ
تﺪﻣ
ﻪﻳﻮﻬﺗ
ي
ﻲﻜﻴﻧﺎﻜﻣ
و
ﻞﻣاﻮﻋ
ﺮﺛﺆﻣ
ﺮﺑ
نآ
رد
نارﺎﻤﻴﺑ
ﺖﺤﺗ
ﻞﻤﻋ
ﻲﻣﻮﺘﻛژﺎﻓوزا
ﺲﻧاﺮﺗ
لﺎﺗﺎﻴﻫ
ﻪﺑ
ﻞﻴﻟد
نﺎﻃﺮﺳ
يﺮﻣ
ﺮﺘﻛد ﺪﻴﺳ سﺎﺒﻋ ﻲﻳﺎﺒﻃﺎﺒﻃ 1 ، ﺮﺘﻛد ﺪﻴﺳ ﺮﻔﻈﻣ ﻲﻤﺷﺎﻫ 1 ، ﺮﺘﻛد ﺎﺿﺮﻣﻼﻏ يﺮﺟﺎﻬﻣ 2 ، ﺮﺘﻛد ﻲﺒﺘﺠﻣ يﺪﻤﺣا داﮋﻧ 3 ، ﺮﺘﻛد ﺪﻴﺣو نﺎﻳﺮﻫﻮﮔ 4 ، ﺮﺘﻛد ﻦﺴﺤﻣ نازوﺪﻫﻼﻛ 5 ، ﺮﺘﻛد ﺪﻴﻌﺳ ﻲﺳﺎﺒﻋ 6 ، ﺮﺘﻛد اﺪﻧ هرﺎﻘﻣ ﺪﺑﺎﻋ 7 ، ﺮﺘﻛد ﺮﻴﻣا ﻦﻴﺴﺣ هﺎﻨﭘرواد يﺰﺟ 8 ، ﺮﺘﻛد ﺪﻤﺤﻣ يﺪﻴﻋ 9 ﻪﺻﻼﺧ ﻪﻣﺪﻘﻣ : ﻲﻣﻮﺘﻛژﺎﻓوزا نﺎﻣرد ﻲﻠﺻا ياﺮﺑ ﻲﻤﻴﺧﺪﺑ يﺎﻫ يﺮﻣ و ﻞﺤﻣ لﺎﺼﺗا يﺮﻣ ﻪﺑ هﺪﻌﻣ ﺖﺳا . ﻲﻳﺎﺳرﺎﻧ ﻲﺴﻔﻨﺗ ﺲﭘ زا ﻞﻤﻋ و ﺮﻳﺎﺳ تﻼﻜﺸﻣ ﻲﺴﻔﻨﺗ ﻞﺜﻣ يزﺎﺘﻜﻠﺗآ و ﻲﺴﻛﻮﭙﻴﻫ ﺪﻳﺪﺷ ﻪﺑ تﺎﻌﻓد دﺪﻌﺘﻣ ﺲﭘ زا ﻲﺣاﺮﺟ نﺎﻃﺮﺳ يﺎﻫ يﺮﻣ خر ﻲﻣ ﺪﻫد . ﻦﻴﻨﭼ ﻲﻧارﺎﻤﻴﺑ رد ﺐﻠﻏا دراﻮﻣ زﺎﻴﻧ ﻪﺑ ﺖﺒﻗاﺮﻣ رد ICU و ﻪﻳﻮﻬﺗ ي ﻲﻜﻴﻧﺎﻜﻣ ﺪﻧراد . فﺪﻫ زا ﻦﻳا ﻪﻌﻟﺎﻄﻣ ، ﻲﺳرﺮﺑ ﻦﻴﮕﻧﺎﻴﻣ لﻮﻃ تﺪﻣ ﻪﻳﻮﻬﺗ ي ﻲﻜﻴﻧﺎﻜﻣ و ﻞﻣاﻮﻋ ﺮﺛﺆﻣ ﺮﺑ نآ ﻦﻴﺣ ﻦﺘﺷادﺮﺑ يﺮﻣ ﻪﺑ شور ﺲﻧاﺮﺗ لﺎﺗﺎﻴﻫ رد نﺎﻃﺮﺳ يﺎﻫ يﺮﻣ ﻲﻧﺎﻴﻣ و ﻲﻧﺎﺘﺤﺗ دﻮﺑ . شور ﺎﻫ : ﻦﻳا ﻪﻌﻟﺎﻄﻣ ﻚﻳ ﻪﻌﻟﺎﻄﻣ ي Cross sectional ﻲﻠﻴﻠﺤﺗ دﻮﺑ و رد نﺎﺘﺳرﺎﻤﻴﺑ اﺮﻫﺰﻟا ي ) س ( نﺎﻬﻔﺻا يور تﺎﻋﻼﻃا هﺪﻧوﺮﭘ يا طﻮﺑﺮﻣ ﻪﺑ 70 رﺎﻤﻴﺑ ﻼﺘﺒﻣ ﻪﺑ نﺎﻃﺮﺳ ﺖﻤﺴﻗ ﻲﻧﺎﻴﻣ و لﺎﺘﺴﻳد يﺮﻣ ﻪﻛ رد ﺶﺨﺑ ﻲﺣاﺮﺟ ﺲﻛارﻮﺗ ﻦﻳا نﺎﺘﺳرﺎﻤﻴﺑ رد ﻪﻠﺻﺎﻓ ي لﺎﺳ يﺎﻫ 1385 ﺎﺗ 1386 ﺖﺤﺗ ﻞﻤﻋ اﺮﺟ ﻲﺣ ﻲﻣﻮﺘﻛژﺎﻓوزا ﻪﺑ شور ﺲﻧاﺮﺗ لﺎﺗﺎﻴﻫ راﺮﻗ ﻪﺘﻓﺮﮔ ،ﺪﻧدﻮﺑ مﺎﺠﻧا ﺪﺷ . تﺎﻋﻼﻃا طﻮﺑﺮﻣ ﻪﺑ ،ﻦﺳ ،ﺲﻨﺟ ﻞﺤﻣ ،ﻪﻌﻳﺎﺿ لﻮﻃ تﺪﻣ ﻪﻳﻮﻬﺗ ي ،ﻲﻜﻴﻧﺎﻜﻣ لﻮﻃ تﺪﻣ ،ﻲﺣاﺮﺟ ﻪﺘﻓﺎﻳ يﺎﻫ يﺮﺘﻣوﺮﻴﭙﺳا ) FEV1 (، ﺶﻫﺎﻛ ،نزو دﻮﺟو ﺎﻳ مﺪﻋ دﻮﺟو نژﻮﻴﻔﺴﻧاﺮﺗ و ناﺰﻴﻣ ﻦﻴﻣﻮﺒﻟآ مﺮﺳ مﺎﮕﻨﻫ يﺮﺘﺴﺑ نﺪﺷ زا هﺪﻧوﺮﭘ ي ﺑ نارﺎﻤﻴ جاﺮﺨﺘﺳا ﺪﻳدﺮﮔ . رد ﺖﻳﺎﻬﻧ ﻲﻣﺎﻤﺗ هداد ﺎﻫ ﺎﺑ هدﺎﻔﺘﺳا نﻮﻣزآزا يﺎﻫ t و 2 χ ﻂﺳﻮﺗ مﺮﻧ راﺰﻓا 16 SPSS ﻞﻴﻠﺤﺗ ﺪﻳدﺮﮔ . ﻪﺘﻓﺎﻳ ﺎﻫ : ﻦﻴﮕﻧﺎﻴﻣ ﻲﻨﺳ نارﺎﻤﻴﺑ 81 / 11 ± 71 / 60 لﺎﺳ و 3 / 64 ﺪﺻرد نارﺎﻤﻴﺑ ار نادﺮﻣ ﻞﻴﻜﺸﺗ ﻲﻣ ﺪﻧداد . زا ﺮﻈﻧ يژﻮﻟﻮﺗﺎﭘ 43 ﺮﻔﻧ ) 4 / 61 ﺪﺻرد ( SCC و 26 ﺮﻔﻧ ) 1 / 37 ﺪﺻرد ( مﻮﻨﻴﺳرﺎﻛﻮﻧدآ ﺪﻨﺘﺷاد . رد ﻞﻛ 4 / 41 ﺪﺻرد نارﺎﻤﻴﺑ رﺎﭼد ﻪﺿرﺎﻋ و 1 / 7 ﺪﺻرد زا نارﺎﻤﻴﺑ رﺎﭼد گﺮﻣ رد 30 زور لوا ﺪﻧﺪﺷ . 15 رﺎﻤﻴﺑ ) 4 / 21 ﺪﺻرد ( ﺲﭘ زا ﻞﻤﻋ زﺎﻴﻧ ﻪﺑ نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ ﺎﺑ ﻦﻴﮕﻧﺎﻴﻣ 34 / 1 زور اﺪﻴﭘ ﺪﻧدﺮﻛ . ﻦﻴﮕﻧﺎﻴﻣ نﺎﻣز نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ ﺎﺑ ﻲﮔرﺎﭘ رﻮﻠﭘ ﻦﻴﺣ ﻤﻋ ،ﻞ زﺎﻴﻧ ﻪﺑ نژﻮﻴﻔﺴﻧاﺮﺗ ﻦﻴﺣ ،ﻞﻤﻋ ﻚﻴﻟ ،زﻮﻣﻮﺘﺳﺎﻧآ عﻮﻧ دﺎﺠﻳا،يژﻮﻟﻮﺗﺎﭘ ﻲﮕﻨﺗ ﺲﭘ زا ﻞﻤﻋ و دﺎﺠﻳا ﻢﻴﭙﻣا ﻪﻄﺑار ي ﻲﻨﻌﻣ يراد ﻪﺘﺷاﺪﻧ ﺖﺳا . رد ﻲﻟﺎﺣ ﻪﻛ ﻦﻳا ﻦﻴﮕﻧﺎﻴﻣ رد ﻲﻧارﺎﻤﻴﺑ ﻪﻛ ﻲﻃ 30 زور ﺲﭘ زا ﻞﻤﻋ تﻮﻓ هدﺮﻛ ،ﺪﻧدﻮﺑ ﻲﻧارﺎﻤﻴﺑ ﻪﻛ ﺲﭘ زا ﻞﻤﻋ زﺎﻴﻧ ﻪﺑ ﻪﻟﻮﻟ يراﺬﮔ ﻞﺧاد ﻪﺷاﺮﺗ ﺘﺷاد ﻪ ، ﻲﻧارﺎﻤﻴﺑ ﻪﻛ ﻞﺒﻗ زا ﻞﻤﻋ ﻦﻴﻣﻮﺒﻟآ ﺮﺘﻤﻛ زا gr/dl 5 / 3 ﻪﺘﺷاد ﺪﻧا و ﻲﻧارﺎﻤﻴﺑ ﻪﻛ FEV1 ﺮﺘﻤﻛ زا 2 ﺮﺘﻴﻟ ﻪﺘﺷاد ﺪﻧا ، ﻪﺑ رﻮﻃ ﻲﻨﻌﻣ يراد ﺮﺘﺸﻴﺑ زا ﻪﻴﻘﺑ دﻮﺑ . زا ﻦﻴﺑ يﺎﻫﺮﻴﻐﺘﻣ ﻲﻤﻛ ﻦﻳا ﻪﻌﻟﺎﻄﻣ ، ﺎﻬﻨﺗ ناﺰﻴﻣ FEV1 ﻞﺒﻗ زا ﻞﻤﻋ ﺎﺑ ﻦﻴﮕﻧﺎﻴﻣ نﺎﻣز نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ ﻪﻄﺑار ي ﻲﻨﻌﻣ يراد اد ﻪﺘﺷ ﺖﺳا . ﻪﺠﻴﺘﻧ يﺮﻴﮔ : ﺎﺑ ﻪﺟﻮﺗ ﻪﺑ ﻦﻳا ﻪﻛ رد ﻦﻳا ﻪﻌﻟﺎﻄﻣ ﺺﺨﺸﻣ ﺪﺷ ، ﻦﻴﻣﻮﺒﻟآ ﻦﻴﻳﺎﭘ مﺮﺳ ) ﻪﻛ ﺮﮕﻧﺎﻳﺎﻤﻧ ءﻮﺳ ﻪﻳﺬﻐﺗ ي ﻪﻨﻴﻣز يا ﺖﺳا ( و FEV1 ﺮﺘﻤﻛ زا 2 ﺮﺘﻴﻟ ﺎﺑ نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ ﻲﻧﻻﻮﻃ تﺪﻣ ) و رد ﻲﭘ نآ گﺮﻣ و ﺮﻴﻣ ﺮﺗﻻﺎﺑ ( ﻪﻄﺑار ي ﻲﻨﻌﻣ راد دراد ، ﻪﺑ ﺮﻈﻧ ﻲﻣ ﺪﺳر حﻼﺻا ﺖﻴﻌﺿو ﻐﺗ ﻪﻳﺬ يا رﺎﻤﻴﺑ و دﻮﺒﻬﺑ نﺪﻴﺸﺨﺑ ﻪﺑ دﺮﻜﻠﻤﻋ يﻮﻳر ﻲﻣ ﺪﻧاﻮﺗ لﻮﻃ تﺪﻣ ﻪﻳﻮﻬﺗ ي ﻲﻜﻴﻧﺎﻜﻣ ار هﺎﺗﻮﻛ ﺮﺗ ﺪﻨﻛ و ﺪﻳﺎﺷ زا ناﺰﻴﻣ گﺮﻣ و ﺮﻴﻣ ﺐﻗﺎﻌﺘﻣ ﻲﻣﻮﺘﻛژﺎﻓوزا ﺪﻫﺎﻜﺑ . نﺎﮔژاو يﺪﻴﻠﻛ : نﺎﻃﺮﺳ ،يﺮﻣ ﻲﻣﻮﺘﻛژﺎﻓوزا ﺲﻧاﺮﺗ ،لﺎﺗﺎﻴﻫ نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ .
ﻪﻣﺪﻘﻣ ﻲﻣﻮﺘﻛژﺎﻓوزا نﺎﻣرد ﻲﻠﺻا ﻲﻤﻴﺧﺪﺑ يﺎﻫ يﺮـﻣ و ﻞـﺤﻣ لﺎﺼﺗا يﺮﻣ ﻪﺑ هﺪـﻌﻣ ) Esophagogastric junction ( و ﻦﻴﻨﭽﻤﻫ يرﺎـﻤﻴﺑ يﺎـﻫ شﻮـﺧ ﻢﻴـﺧ يﺮـﻣ ﺖـﺳا ) 1 .( شور يﺎﻫ ﻲﻔﻠﺘﺨﻣ ياﺮﺑ نﺎﻣرد ﻲـﺣاﺮﺟ نﺎﻃﺮـﺳ يﺮـﻣ ﺢﻴﺿﻮﺗ هداد هﺪﺷ ﺖﺳا ﻪﻛ ﻞﻣﺎﺷ شﺮـﺑ زا هار ـﺴﻔﻗ ﻪ ي ،يرﺪﺻ شور ﺲﻧاﺮـﺗ لﺎـﺗﺎﻴﻫ و دازآ يزﺎـﺳ يﺮـﻣ ﺎـﺑ پﻮﻜﺳﻮﻛارﻮﺗ هاﺮﻤﻫ ﺎﺑ دازآ يزﺎﺳ هﺪﻌﻣ زا ﻖﻳﺮﻃ شﺮﺑ ﻲﻤﻜﺷ ﺪﻨﺘﺴﻫ ) 2 ( ﻪﻛ ود شور ﺮﺧآ ﻞﻣﺎﺷ زﻮﻣﻮﺘـﺳﺎﻧآ ﻲــﻧدﺮﮔ هدﻮــﺑ ، ﺖﺒــﺴﻧ ﻪــﺑ شور شﺮــﺑ زا هار ﻪــﺴﻔﻗ ي يرﺪﺻ ﺐﻴﺳآ يﺮﺘﻤﻛ دراو ﻲﻣ ﺪﻧروآ ) 5 -3 .( شور ﺲﻧاﺮــﺗ لﺎــﺗﺎﻴﻫ ياﺮــﺑ ﻦﻴــﺼﺼﺨﺘﻣ ﺑ ﻴ ﻲــﺷﻮﻬ ﻦﻜﻤﻣ ﺖﺳا ﻲﺗﻼﻜﺸﻣ ﻪﺑ رﺎﺑ دروآ ؛ اﺮﭼ ﻪﻛ دازآ يزﺎـﺳ يﺮﻣ زا ﻦﺘﺳﺎﻳﺪﻣ ﻲﻔﻠﺧ ﻪﻛ ﺎﺑ ﺖـﺳد ا مﺎـﺠﻧ ﻲـﻣ دﻮـﺷ ، ﻲﻣ ﺪﻧاﻮﺗ ﺚﻋﺎﺑ تاﺮﻴﻴﻐﺗ رد رﺎﺸﻓ نﻮﺧ و داﺪﻌﺗ نﺎﺑﺮـﺿ ﺐﻠﻗ دﻮﺷ ) 6 .( ﻲﻳﺎﺳرﺎﻧ ﻲﺴﻔﻨﺗ ﺲـﭘ زا ﻞـﻤﻋ و ﺮﻳﺎـﺳ تﻼﻜﺸﻣ ﻲﺴﻔﻨﺗ ﻞﺜﻣ يزﺎﺘﻜﻠﺗآ و ﻲﺴﻛﻮﭙﻴﻫ ﺪﻳﺪـﺷ ﻪـﺑ تﺎﻌﻓد دﺪﻌﺘﻣ ﺲﭘ زا ﻲـﺣاﺮﺟ نﺎﻃﺮـﺳ يﺎـﻫ يﺮـﻣ خر ﻲﻣ ﺪﻫد . ﻦﻴﻨﭼ ﻲﻧارﺎﻤﻴﺑ رد ﺐﻠﻏا دراﻮﻣ زﺎﻴﻧ ﻪﺑ ﺖـﺒﻗاﺮﻣ رد ICU و ﻪﻳﻮﻬﺗ ي ﻲﻜﻴﻧﺎﻜﻣ ﺪﻧراد . ﺎــﺗ نﻮــﻨﻛ تﺎــﻌﻟﺎﻄﻣ يدوﺪــﺤﻣ تاﺮــﺛا ﻞــﻤﻋ ﻲﻣﻮﺘﻛژﺎﻓوزا ار ﺮﺑ يور ﻢﺘﺴﻴﺳ ﻲـﺴﻔﻨﺗ درﻮـﻣ ﻪـﻌﻟﺎﻄﻣ راﺮﻗ هداد ﺪﻧا . رد تﻻﺎﻳا هﺪﺤﺘﻣ ، Patti و نارﺎﻜﻤﻫ تاﺮﺛا ﻲﺒﻠﻗ يﻮﻳر ﻲﻣﻮﺘﻛژﺎﻓوزا ﺲﻧاﺮﺗ لﺎـﺗﺎﻴﻫ ار ﺮـﺑ يور 44 رﺎﻤﻴﺑ درﻮﻣ ﻪﻌﻟﺎﻄﻣ راﺮـﻗ ﺪـﻧداد . ﻦﻴﮕﻧﺎـﻴﻣ لﻮـﻃ تﺪـﻣ ﻪﻳﻮﻬﺗ ي ﺎﻜﻣ ﻲﻜﻴﻧ رد ﻦﻳا نارﺎﻤﻴﺑ 49 ﺖﻋﺎﺳ ﻪـﺑ ﺖـﺳد ﺪﻣآ ، ﻲﻟو ﻞﻠﻋ زﺎﻴﻧ رﺎﻤﻴﺑ ﻪﺑ ﻪـﻳﻮﻬﺗ ي ﻲﻜﻴﻧﺎـﻜﻣ رد ﻦـﻳا ﻪﻌﻟﺎﻄﻣ ﻲﺳرﺮﺑ هﺪﺸﻧ دﻮـﺑ ) 7 .( Gillinov و رﺎـﻜﻤﻫ ﻪـﺑ ﻲﺳرﺮﺑ ضراﻮﻋ يﻮﻳر ﻲﻣﻮﺘﻛژﺎﻓوزا ﺲﻧاﺮـﺗ لﺎـﺗﺎﻴﻫ رد 101 رﺎــﻤﻴﺑ ﺪــﻨﺘﺧادﺮﭘ . 10 ﺪــﺻرد زا نارﺎــﻤﻴﺑ رﺎــﭼد ضراﻮﻋ روژﺎﻣ يﻮﻳر ) ﻞﻣﺎﺷ ،ﻲﻧﻮﻣﻮﻨﭘ ـﻴﻓا نژﻮ ﺪـﻨﻣزﺎﻴﻧ ،ژﺎــﻧرد ﺪﻳﺪــﺸﺗ COPD و سﻮــﻛﻮﻣ گﻼــﭘ ﺪــﻨﻣزﺎﻴﻧ ﻲﭘﻮﻜﺳﻮﻜﻧوﺮﺑ ﺎـﻳ نﻮﻴـﺳﺎﺑﻮﺘﻧا ( و ًﺎـﺒﻳﺮﻘﺗ ﻲﻣﺎـﻤﺗ نآ ﺎـﻫ رﺎﭼد ضراﻮﻋ زارﻮﻨﻴﻣ ﻞﻴﺒﻗ ،ﺲﻛارﻮﺗﻮﻣﻮﻨﭘ نژﻮﻴﻓا رﻮﻠﭘ و يزﺎـﺘﻜﻠﺗآ دﻮﺑ ﺪــﻧ . رد ﻦــﻳا ﻪـﻌﻟﺎﻄﻣ زﺎــﻴﻧ نارﺎــﻤﻴﺑ ﻪــﺑ ﻪﻳﻮﻬﺗ ي ﻲﻜﻴﻧﺎﻜﻣ ﻲﺳرﺮﺑ هﺪﺸﻧ دﻮﺑ ) 8 .( ﻦﻳﺮﺧآ ﻪﻌﻟﺎﻄﻣ رد ﻦﻳا ﻴﻣز ﻪـﻨ رد نﺎﺘـﺴﻠﮕﻧا ﺮـﺑ يور 98 رﺎـﻤﻴﺑ مﺎـﺠﻧا ﺖﻓﺮﻳﺬﭘ . 15 ﺪﺻرد زا نارﺎﻤﻴﺑ زﺎﻴﻧ ﻪﺑ ﻪﻳﻮﻬﺗ ي ﻲﻜﻴﻧﺎﻜﻣ اﺪﻴﭘ ﺪﻧدﺮﻛ ) 9 .( فﺪﻫ زا ﻦﻳا ﻪﻌﻟﺎﻄﻣ ، ﻲﺳرﺮﺑ ﻦﻴﮕﻧﺎـﻴﻣ لﻮـﻃ تﺪـﻣ ﻪﻳﻮﻬﺗ ي ﻲﻜﻴﻧﺎﻜﻣ و ﻞﻣاﻮﻋ ﺮﺛﺆﻣ ﺮـﺑ نآ ﻦﻴـﺣ ﻦﺘـﺷادﺮﺑ يﺮﻣ ﻪﺑ شور ﺲﻧاﺮﺗ لﺎﺗﺎﻴﻫ رد نﺎﻃﺮﺳ يﺎﻫ يﺮﻣ ﻲﻧﺎﻴﻣ و ﻲﻧﺎﺘﺤﺗ دﻮﺑ . ر شو ﺎﻫ ﻦﻳا ﻪﻌﻟﺎﻄﻣ ﻚﻳ ﻪـﻌﻟﺎﻄﻣ ي ﻲـﻌﻄﻘﻣ ) Cross sectional ( ﻲﻠﻴﻠﺤﺗ دﻮـﺑ و رد نﺎﺘـﺳرﺎﻤﻴﺑ اﺮـﻫﺰﻟا ي ) س ( نﺎﻬﻔـﺻا يور تﺎﻋﻼﻃا هﺪﻧوﺮﭘ يا طﻮﺑﺮﻣ ﻪﺑ 70 رﺎﻤﻴﺑ ﻼﺘـﺒﻣ ﻪـﺑ نﺎﻃﺮﺳ ﺖﻤﺴﻗ ﻲﻧﺎـﻴﻣ و لﺎﺘـﺴﻳد يﺮـﻣ ﻪـﻛ رد ﺶـﺨﺑ ﻲﺣاﺮﺟ ﺲﻛارﻮﺗ ﻦﻳا نﺎﺘﺳرﺎﻤﻴﺑ ﺖـﺤﺗ ﻞـﻤﻋ ﻲـﺣاﺮﺟ ﻲﻣﻮﺘﻛژﺎﻓوزا ﻪﺑ شور ﺲﻧاﺮﺗ ﺎﻴﻫ لﺎﺗ راﺮﻗ ﻪﺘﻓﺮﮔ دﻮﺑ ،ﺪـﻧ مﺎــﺠﻧا ــﺷ ﺪ . رد شور ﻲــﺣاﺮﺟ ﻲﻣﻮﺘﻛژﺎــﻓوزا ﺲﻧاﺮــﺗ لﺎﺗﺎﻴﻫ ﺲﭘ زا دازآ يزﺎﺳ هﺪﻌﻣ و زﺎـﺑ ندﺮـﻛ ،سﻮﺗﺎـﻴﻫ رﻮﻣﻮﺗ يﺮﻣ زا ﺮﻈﻧ ﻞﺑﺎﻗ ﻞﻤﻋ ندﻮﺑ ﻲﺳرﺮﺑ ﺪﺷ . ﺲﭙـﺳ يﺮﻣ ﻲﻧدﺮﮔ ﺎﺑ ﺖﺒﻗاﺮﻣ زا ﺐﺼﻋ هﺮﺠﻨﺣ يا ﻪﻌﺟار زﺎﺑ و ﺲﭘ زا نآ يﺮﻣ رد ندﺮﮔ ﺎﺑ ﺖﺳد دازآ ﺪﺷ و رد ﻞـﺤﻣ ﺐﺳﺎﻨﻣ ﻪﻛ ﻦﻴﻳﺎﭘ ﺮﺗ زا ﻞﺤﻣ شﺮﺑ دﻮﺑ ﺎﺑ ﺦـﻧ ﻚﻠﻴـﺳ ﻪـﺑ ﻪﻟﻮﻟ ي هﺪﻌﻣ ﻢﻜﺤﻣ ﻳدﺮﮔ ﺪ و رد ﺖﻳﺎﻬﻧ ﺎﺑ شﺮﺑ ﺮﺑ يور ﺖﻤﺴﻗ ﻲﻳﺎﻬﺘﻧا يﺮﻣ ﻪﻟﻮﻟ ي هﺪﻌﻣ ﻪـﺑ ﻲـﻣارآ ﻪـﺑ ﻦﻴﻳﺎـﭘ هﺪﻴﺸﻛ و يﺮﻣ ﻪﺑ رﻮﻃ ﻞﻣﺎﻛ زا ﻞﺧاد ﻦﺘـﺳﺎﻳﺪﻣ جرﺎـﺧ ﺪﺷ ) Method of stripping .( رد ﺶﺨﺑ ﻲﺣاﺮﺟ ﺲﻛارﻮﺗ ﻪﺑ رﻮﻃ لﻮﻤﻌﻣ ياﺮﺑ ﺮـﻫ
رﺎﻤﻴﺑ ﺒﻣ ﻼﺘ ﻪـﺑ نﺎﻃﺮـﺳ يﺮـﻣ ﻚـﻳ ﺶـﺳﺮﭘ ﻪـﻣﺎﻧ يوﺎـﺣ تﺎﻋﻼﻃا ﻣ ﺰ رﻮﺑ ﺖﻬﺟ هدﺎﻔﺘـﺳا ياﺮـﺑ فاﺪـﻫا ﻲـﺸﻫوﮋﭘ ﻲﺗآ ﻞﻴﻤﻜﺗ ﺪﺷ . ﻦﻳاﺮﺑﺎﻨﺑ مﺎﻤﺗ تﺎﻋﻼﻃا درﻮﻣ ﺮﻈﻧ زا ﻦـﻳا ﻖﻳﺮﻃ ﻞﺑﺎﻗ ﻲﺳﺮﺘﺳد دﻮﺑ . زا ﻦﻳا ﺶﺳﺮﭘ ﻪﻣﺎﻧ ﺎﻫ تﺎـﻋﻼﻃا طﻮﺑﺮﻣ ﻪﺑ ،ﻦﺳ ،ﺲﻨﺟ ﻞﺤﻣ ،ﻪﻌﻳﺎﺿ لﻮﻃ تﺪﻣ ﻪـﻳﻮﻬﺗ ي ،ﻲﻜﻴﻧﺎﻜﻣ لﻮﻃ تﺪﻣ ،ﻲـﺣاﺮﺟ ﻪـﺘﻓﺎﻳ يﺎـﻫ يﺮﺘﻣوﺮﻴﭙـﺳا ) FEV1 ( ﺶﻫﺎﻛ ،نزو دﻮﺟو ﺎﻳ مﺪﻋ دﻮﺟو نژﻮﻴﻔـﺴﻧاﺮﺗ و ناﺰﻴﻣ ﻦﻴﻣﻮﺒﻟآ مﺮﺳ مﺎﮕﻨﻫ يﺮﺘﺴﺑ نﺪﺷ ﺑ ﻪ ﺖﺳد ﺪﻣآ و رد مﺮﻓ ﻪﻧﺎﮔاﺪﺟ يا ﻂﺳﻮﺗ ﺮﮕـﺸﻫوﮋﭘ دراو ﺪـﻳدﺮﮔ . زا نآ ﺎﺟ ﻪﻛ رد ﻦﻳا ﻪﻌﻟﺎﻄﻣ ، ﻪﻳﺬﻐﺗ رد ﻲﻣﺎـﻤﺗ نارﺎـﻤﻴﺑ ﻞـﺒﻗ زا ﻞـﻤﻋ ﻪـﺑ ترﻮـﺻ
Partial parenteral nutritioning
و ﺑ ﺪﻌ زا ﻞﻤﻋ زا ﻖﻳﺮﻃ ﻪﻟﻮﻟ ي ﻲﻣﻮﺘﺳﻮﻧژژ ،دﻮﺑ » ﻪﻳﺬﻐﺗ « ﻪـﺑ ناﻮﻨﻋ ﻚﻳ ﺮﻴﻐﺘﻣ رد ﺮﻈﻧ ﻪﺘﻓﺮﮔ ﺪﺸﻧ . ﻧارﺎـﻤﻴﺑ ﻲ ﻪـﻛ ﺪـﻗﺎﻓ تﺎﻋﻼﻃا هﺪﻧوﺮﭘ يا درﻮـﻣ زﺎـﻴﻧ رد ﻦـﻳا ﻪـﻌﻟﺎﻄﻣ ﺪـﻧدﻮﺑ ، ﻲﻧارﺎﻤﻴﺑ ﻪﻛ ﻦﻴـﺣ ﻲـﺣاﺮﺟ عﻮـﻧ نﺎـﺸﻠﻤﻋ ﺮـﻴﻴﻐﺗ ،دﺮـﻛ ﻲﻧارﺎﻤﻴﺑ ﻪﻛ ﺲﭘ زا ﻞـﻤﻋ ﺺﺨـﺸﻣ ﺪـﺷ نﺎﻃﺮـﺳ يﺮـﻣ ﺪﻨﺘﺷاﺪﻧ و ﻲﻧارﺎﻤﻴﺑ ﻪﻛ ﺲﭘ زا ﻲﻣﻮﺗارﺎﭘﻻ ﺺﺨـﺸﻣ ﺪـﺷ ﺮﻴﻏ ﻞﺑﺎﻗ ﻲﺣاﺮﺟ ﺪﻨﺘﺴﻫ زا ﻪﻌﻟﺎﻄﻣ رﺎﻨﻛ ﻪﺘـﺷاﺬﮔ ﺪﻧﺪـﺷ . رد ﺖﻳﺎﻬﻧ ﻲﻣﺎﻤﺗ هداد ﺎﻫ ﻂﺳﻮﺗ مﺮﻧ راﺰـﻓا SPSS ﻪﺨـﺴﻧ ي 16 )
version 16, SPSS Inc., Chicago, IL
( ﺎﺑ هدﺎﻔﺘﺳا زا نﻮﻣزآ يﺎﻫ t و 2 χ ﺗ ﻞﻴﻠﺤ دﺮﮔ ﻳ ﺪ . ﻪﺘﻓﺎﻳ ﺎﻫ زا 85 ﺮﻔﻧ ﺑ ،رﺎﻤﻴ 15 ﺮـﻔﻧ ﻪـﺑ ﻞـﻴﻟد ﻞـﻣاﻮﻋ زﺎـﺳﺮﻄﺧ و ﺮﻴﻴﻐﺗ رد ﻪﻣﺎﻧﺮﺑ ي ﻞﻤﻋ و ﺮﻴﻏ ﻞﺑﺎﻗ ﻞﻤﻋ ندﻮﺑ زا ﻪﻌﻟﺎﻄﻣ فﺬﺣ و رد ﺖﻳﺎﻬﻧ 70 ﺮـﻔﻧ رﺎـﻤﻴﺑ دراو ﻪـﻌﻟﺎﻄﻣ ﺪﻧﺪـﺷ . ﻦﻴﮕﻧﺎــﻴﻣ ﻲﻨــﺳ نارﺎــﻤﻴﺑ 81 / 11 ± 71 / 60 لﺎــﺳ دﻮــﺑ و 3 / 64 ﺪﺻرد نارﺎﻤﻴﺑ ار نادﺮﻣ ﻞﻴﻜﺸﺗ ﻲﻣ ﺪﻧداد . ﻦﻴﮕﻧﺎﻴﻣ نزو ارﺎـﻤﻴﺑ ن 2 / 7 ± 41 / 62 مﺮﮔﻮـﻠﻴﻛ دﻮـﺑ ﻪــﻛ 5 / 26 ﺪــﺻرد رﺎــﻤﻴﺑ نا رﺎــﭼد ﺶﻴــﺑ زا 20 ﺪــﺻرد ﺶﻫﺎﻛ نزو ﺪﻧدﻮﺑ . ﻪﺑ رﻮﻃ ﻂﺳﻮﺘﻣ ﺶﻫﺎﻛ نزو نارﺎﻤﻴﺑ 96 / 4 ± 46 / 10 مﺮﮔﻮـﻠﻴﻛ و ﻦﻴﮕﻧﺎــﻴﻣ آ ﻦﻴﻣﻮــﺒﻟ نارﺎــﻤﻴﺑ ﻞﺒﻗ زا ﻞﻤﻋ dl / gr 7 / 0 ± 2 / 3 دﻮﺑ . ﻂـــﺳﻮﺘﻣ FEV1 نارﺎـــﻤﻴﺑ 41 / 0 ± 06 / 2 ﺮـــﺘﻴﻟ و ﻦﻴﮕﻧﺎﻴﻣ نﺎﻣز ﻞﻤﻋ 92 / 17 ± 93 / 105 ﻪﻘﻴﻗد دﻮﺑ . ﻂﺳﻮﺘﻣ نﻮﺧ يﺰﻳر رد ارﺎـﻤﻴﺑ ن 33 / 123 ± 43 / 486 ﺮﺘﻴﻟ ﻪﺑ ﺖﺳد ﺪﻣآ . زا ﺮﻈﻧ يژﻮﻟﻮﺗﺎﭘ 43 ﺮﻔﻧ ) 4 / 61 ﺪﺻرد ( SCC و 26 ﺮﻔﻧ ) 1 / 37 ﺪﺻرد ( مﻮﻨﻴﺳرﺎﻛﻮﻧدآ ﺪﻨﺘﺷاد . نارﺎﻤﻴﺑ ﻪﺑ رﻮـﻃ ﻂـﺳﻮﺘﻣ 5 ± 28 / 11 زور يﺮﺘـﺴﺑ ﺪﻧﺪﺷ . ﻦﻴﮕﻧﺎﻴﻣ ﻊﻳﺎـﻣ ﻲﺘﻓﺎـﻳرد 3 / 0 ± 54 / 1 ﺮـﺘﻴﻟ رد ﻦﻴـﺣ ﻞﻤﻋ دﻮﺑ . 50 ﺪــﺻرد ﺎــﻫرﻮﻣﻮﺗ ) 35 = n ( رد ﺖﻤــﺴﻗ ﻣ ﻲﻧﺎــﻴ يﺮﻣ ﺪﻧدﻮﺑ . 6 / 28 ﺪﺻرد ) 20 ﺮـﻔﻧ ( نارﺎـﻤﻴﺑ يرﺎﮕﻴـﺳ ﺪﻧدﻮﺑ . 8 / 58 ﺪﺻرد نارﺎﻤﻴﺑ مﺎﮕﻨﻫ ﻪﻌﺟاﺮﻣ ﻦﻴﻣﻮﺒﻟآ ﺮﺘﻤﻛ زا gr/dl 5 / 3 ﺪﻨﺘﺷاد ﻪﻛ ﻞـﺒﻗ زا ﻞـﻤﻋ ﻲـﮕﻤﻫ ﺎـﺑ ﻖـﻳرﺰﺗ ﻦﻴﻣﻮﺒﻟآ و ﻪﻳﺬﻐﺗ ي يﺪﻳرو حﻼﺻا ﺪﻧﺪﺷ . 3 / 54 ﺪﺻرد نارﺎﻤﻴﺑ ﻲﮔرﺎﭘ رﻮـﻠﭘ اﺪـﻴﭘ ﺪـﻧدﺮﻛ و رد ﻞﻛ 4 / 41 ﺪﺻرد نارﺎﻤﻴﺑ ﺎﭼد ر ﻪـﺿرﺎﻋ و 1 / 7 ﺪـﺻرد زا نارﺎــﻤﻴﺑ رﺎــﭼد گﺮــﻣ رد 30 زور لوا ﺪﻧﺪــﺷ . 18 ﺮــﻔﻧ ) 5 / 29 ﺪﺻرد ( رﺎﭼد ضراﻮﻋ ﻲﺴﻔﻨﺗ ﺲﭘ زا ﻞﻤﻋ ﺪﻧﺪﺷ ﻪﻛ 10 ﺮﻔﻧ ) 4 / 16 ﺪﺻرد ( رﺎﭼد لارﻮﻠﭘ نژﻮﻴﻓا ) ﻢﻴـﭙﻣآ ( و ﻪﻴﻘﺑ ي دراﻮﻣ ﻞﻣﺎﺷ ﻲﻧﻮﻣﻮﻨﭘ ) 5 ﺮﻔﻧ لدﺎﻌﻣ 2 / 8 ﺪﺻرد ( و ﺲﭘﻼﻛ ﻪﻳر ) 3 ﺮﻔﻧ لدﺎﻌﻣ 9 / 4 ﺪﺻرد ( ﺪـﻧدﻮﺑ و رﻮـﻣ يد زا ﻲﻟﻮﺒﻣآ ﻪﻳر ﺎﻳ ﺲﻛارﻮﺗﻮﻠﻴﺷ هﺪﻳد ﺪﺸﻧ . 15 رﺎــﻤﻴﺑ ) 4 / 21 ﺪــﺻرد ( ﺲــﭘ زا ﻞــﻤﻋ زﺎــﻴﻧ ﻪــﺑ نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ ﺎﺑ ﻦﻴﮕﻧﺎـﻴﻣ 34 / 1 زور اﺪـﻴﭘ ﺪـﻧدﺮﻛ . ﻦﻴﮕﻧﺎـــﻴﻣ نﺎـــﻣز نﻮﻴـــﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎـــﻜﻣ رد نﺎـــﻧز 83 / 3 ± 96 / 1 زور و رد نادﺮﻣ 39 / 2 ± 1 زور ﻪﺑ ﺖـﺳد
ﺪﻣآ ) 29 / 0 = P .( ﻦﻴﮕﻧﺎﻴﻣ نﺎﻣز ﺳﻼﻴﺘﻧو نﻮﻴ ﻲﻜﻴﻧﺎـﻜﻣ رد يﺎﻫرﻮﻣﻮﺗ لﺎﺘﺴﻳد و ﻲﻧﺎﻴﻣ يﺮﻣ ﻪﺑ ﺐﻴﺗﺮﺗ 61 / 2 ± 09 / 1 و 36 / 3 ± 6 / 1 زور ﻪﺒــــﺳﺎﺤﻣ ﺪــــﻳدﺮﮔ ) 42 / 0 = P .( ﻦﻴﮕﻧﺎﻴﻣ نﺎﻣز نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ رد يداﺮﻓا ﻪﻛ ﻞـﺒﻗ زا ﻞﻤﻋ رﺎﭼد ﺶﻫﺎﻛ نزو ﺶﻴﺑ زا 20 ﺪﺻرد ،ﺪـﻧدﻮﺑ 15 / 4 ± 78 / 2 زور دﻮﺑ ﻪﻛ ﻦﻳا ناﺰﻴﻣ ﻪﺑ رﻮﻃ ﻲـﻨﻌﻣ يراد ﺶﻴـﺑ زا ا يداﺮﻓ دﻮﺑ ﻪـﻛ ﺶﻫﺎـﻛ نزو ﺪﻨﺘـﺷاﺪﻧ ) 37 / 2 ± 88 / 0 زور .( ﺮﻫ ﺪﻨﭼ ﻦﻴﮕﻧﺎﻴﻣ نﺎـﻣز نﻮﻴـﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎـﻜﻣ رد نارﺎﻤﻴﺑ يرﺎﮕﻴـﺳ ﺮﺘـﺸﻴﺑ زا نارﺎـﻤﻴﺑ ﺮـﻴﻏ يرﺎﮕﻴـﺳ دﻮـﺑ ) 22 / 3 ± 05 / 2 زور رد ﻞــﺑﺎﻘﻣ 89 / 2 ± 06 / 1 زور (، ﺎــﻣا ﻦﻳا فﻼﺘﺧا زا ﺮﻈﻧ يرﺎﻣآ ﻲﻨﻌﻣ راد دﻮﺒﻧ . نﺎــﻤﻫ رﻮــﻃ ﻪــﻛ رد لوﺪــﺟ هرﺎﻤــﺷ ي 1 ﺺﺨــﺸﻣ ﺖﺳا ، ﻦﻴﮕﻧﺎﻴﻣ نﺎﻣز نﻮﻴـﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎـﻜﻣ ﺎـﺑ ﻲﮔرﺎـﭘ رﻮﻠﭘ ﻦﻴﺣ ،ﻞﻤﻋ زﺎﻴﻧ ﻪﺑ نژﻮﻴﻔﺴﻧاﺮﺗ ﻦﻴـﺣ ،ﻞـﻤﻋ ﻚـﻴﻟ لوﺪﺟ 1 . طﺎﺒﺗرا يﺎﻫﺮﻴﻐﺘﻣ ﻲﻔﻴﻛ ﺎﺑ ﻦﻴﮕﻧﺎﻴﻣ نﺎﻣز نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ ﺎﻫﺮﻴﻐﺘﻣ ﻦﻴﮕﻧﺎﻴﻣ نﺎﻣز نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ P value ﺲﻨﺟ نز 83 / 3 ± 96 / 1 29 / 0 دﺮﻣ 39 / 2 ± 1 ﻴﺳ رﺎﮕ ﻲﻠﺑ 22 / 3 ± 05 / 2 09 / 0 ﺮﻴﺧ 89 / 2 ± 06 / 1 ﻞﺤﻣ رﻮﻣﻮﺗ لﺎﺘﺴﻳد 61 / 2 ± 09 / 1 42 / 0 ﻲﻧﺎﻴﻣ 36 / 3 ± 6 / 1 ﺶﻫﺎﻛ نزو ﺶﻴﺑ زا 20 ﺪﺻرد ﻲﻠﺑ 15 / 4 ± 78 / 2 01 / 0 ﺮﻴﺧ 37 / 2 ± 88 / 0 ﻔﺴﻧاﺮﺗ ﻴ ﻮ ژ ن ﻲﻠﺑ 26 / 4 ± 83 / 2 26 / 0 ﺮﻴﺧ 86 / 2 ± 2 / 1 گﺮﻣ و ﺮﻴﻣ ﻲﻠﺑ 5 / 4 ± 4 / 6 006 / 0 ﺮﻴﺧ 49 / 2 ± 9 / 0 ﻚﻴﻟ زﻮﻣﻮﺘﺳﺎﻧآ ﻲﻠﺑ 98 / 4 ± 92 / 2 2 / 0 ﺮﻴﺧ 34 / 2 ± 02 / 1 يژﻮﻟﻮﺗﺎﭘ SCC 11 / 3 ± 39 / 1 1 / 0 ﺎﻣﻮﻨﻴﺳرﺎﻛﻮﻧدآ 68 / 2 ± 04 / 1 زﺎﻴﻧ ﻪﺑ ﻪﻟﻮﻟ يراﺬﮔ دﺪﺠﻣ ﻲﻠﺑ 66 / 4 ± 38 / 5 001 / 0 ﺮﻴﺧ 32 / 1 ± 42 / 0 ﻢﻴﭙﻣآ ﻲﻠﺑ 3 / 5 ± 5 / 3 081 / 0 ﺮﻴﺧ 3 / 2 ± 98 / 0 ﻲﮕﻨﺗ زﻮﻣﻮﺘﺳﺎﻧآ ﺲﭘ زا ﻋ ﻞﻤ ﻲﻠﺑ 56 / 2 ± 62 / 1 37 / 0 ﺮﻴﺧ 09 / 3 ± 33 / 1 ﻲﮔرﺎﭘ رﻮﻠﭘ ﻦﻴﺣ ﻞﻤﻋ ﻲﻠﺑ 66 / 2 ± 21 / 1 89 / 0 ﺮﻴﺧ 39 / 3 ± 5 / 1 ﻦﻴﻣﻮﺒﻟآ > 5 / 3 g/dl 55 / 3 ± 92 / 1 05 / 0 < 5 / 3 g/dl 89 / 1 ± 6 / 0 FEV1 > 2 ﺮﺘﻴﻟ 87 / 3 ± 68 / 2 001 / 0 < 2 ﺮﺘﻴﻟ 08 / 2 ± 6 / 0
لوﺪﺟ 2 . طﺎﺒﺗرا يﺎﻫﺮﻴﻐﺘﻣ ﻛ ﻤ ﻲ ﺎﺑ ﻴﻣ ﻦﻴﮕﻧﺎ نﺎﻣز نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ ﺎﻫﺮﻴﻐﺘﻣ P value ﻪﻠﺻﺎﻓ نﺎﻨﻴﻤﻃا ي 95 ياﺮﺑ ﺪﺻرد B ﺮﺜﻛاﺪﺣ ﻞﻗاﺪﺣ ﻦﺳ 33 / 0 081 / 0 27 / 0 -FEV1 03 / 0 212 / 0 -57 / 3 -ناﺰﻴﻣ ﻦﻴﻣﻮﺒﻟآ ﻞﺒﻗ زا ﻞﻤﻋ 13 / 0 214 / 0 598 / 1 -تﺪﻣ نﺎﻣز ﻞﻤﻋ ﻲﺣاﺮﺟ 36 / 0 049 / 0 18 / 0 ـﮕﻨﺗ دﺎﺠﻳا ،يژﻮﻟﻮﺗﺎﭘ عﻮﻧ ،زﻮﻣﻮﺘﺳﺎﻧآ و ﻞـﻤﻋ زا ﺲـﭘ ﻲ ﻪﻄﺑار ﻢﻴﭙﻣا دﺎﺠﻳا ي ﻲﻨﻌﻣ ﺖﺳا ﻪﺘﺷاﺪﻧ يراد . ﻪﻛ ﻲﻟﺎﺣ رد ﻲﻜﻴﻧﺎﻜﻣ نﻮﻴﺳﻼﻴﺘﻧو نﺎﻣز ﻦﻴﮕﻧﺎﻴﻣ ﻲـﻃ ﻪـﻛ ﻲﻧارﺎﻤﻴﺑ رد 30 ﺲـﭘ ﻪﻛ ﻲﻧارﺎﻤﻴﺑ ،ﺪﻧدﻮﺑ هدﺮﻛ تﻮﻓ ﻞﻤﻋ زا ﺲﭘ زور ﻲﻧارﺎﻤﻴﺑ ،ﺪﻨﺘﺷاد ﻪﺷاﺮﺗ ﻞﺧاد يراﺬﮔ ﻪﻟﻮﻟ ﻪﺑ زﺎﻴﻧ ﻞﻤﻋ زا زا ﺮـﺘﻤﻛ ﻦﻴﻣﻮـﺒﻟآ ﻞﻤﻋ زا ﻞﺒﻗ ﻪﻛ gr/dl 5 / 3 ﻲﻧارﺎـﻤﻴﺑ و ﻪﻛ FEV1 زا ﺮﺘﻤﻛ 2 ﻲـﻨﻌﻣ رﻮـﻃ ﻪـﺑ ﺪﻨﺘـﺷاد ﺮـﺘﻴﻟ يراد دﻮﺑ ﻪﻴﻘﺑ زا ﺮﺘﺸﻴﺑ . نﺎﻤﻫ ﻪﻧﻮﮔ ﻪﻛ لوﺪﺟ هرﺎﻤـﺷ ي 2 نﺎـﺸﻧ ﻲـﻣ ﺪـﻫد هدﺎﻔﺘــﺳا زا ﺰﻴﻟﺎــﻧآ نﻮﻴــﺳﺮﮔر ﻲــﻄﺧ نﺎــﺸﻧ داد زا ﻦﻴــﺑ يﺎﻫﺮﻴﻐﺘﻣ ﻲﻤﻛ ﻦﻳا ،ﻪﻌﻟﺎﻄﻣ ﺎﻬﻨﺗ ناﺰـﻴﻣ FEV1 ﻞـﺒﻗ زا ﻞﻤﻋ ﺎﺑ ﻦﻴﮕﻧﺎﻴﻣ نﺎـﻣز نﻮﻴـﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎـﻜﻣ ﺑار ﻪـﻄ ي ﻲﻨﻌﻣ يراد دراد و يﺎـﻫﺮﻴﻐﺘﻣ ﺮـﮕﻳد ﺮـﻴﻈﻧ ،ﻦـﺳ ناﺰـﻴﻣ ﻦﻴﻣﻮــﺒﻟآ ﻞــﺒﻗ زا ﻞــﻤﻋ و تﺪــﻣ نﺎــﻣز ﻞــﻤﻋ ﻲــﺣاﺮﺟ ﻪﻄﺑار يا ﺪﻧراﺪﻧ . ﺚﺤﺑ فﺪــﻫ زا ﻦــﻳا ،ﻪــﻌﻟﺎﻄﻣ ﻦﻴــﻴﻌﺗ ﻦﻴﮕﻧﺎــﻴﻣ نﻮﻴــﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ و ﻪﻄﺑار ي نآ ﺎﺑ ﻞﻣاﻮﻋ زﺎﺳﺮﻄﺧ ﻒﻠﺘﺨﻣ ﻞـﺒﻗ و ﺪﻌﺑ زا ﻞـﻤﻋ ﻲـﺣاﺮﺟ رد ﻲﻧارﺎـﻤﻴﺑ دﻮـﺑ ﻪـﻛ ﺖـﺤﺗ ﻣﻮﺘﻛژﺎﻓوزا ﻲ ﺲﻧاﺮﺗ لﺎﺗﺎﻴﻫ راﺮﻗ ﻪﺘﻓﺮﮔ ﺪﻧدﻮﺑ . ﺞﻳﺎﺘﻧ ﻦﻳا ﻪــﻌﻟﺎﻄﻣ نﺎــﺸﻧ داد ﻦﻴﮕﻧﺎــﻴﻣ نﻮﻴــﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎــﻜﻣ رد ﻲﻧارﺎﻤﻴﺑ ﻪﻛ FEV1 ﺮﺘﻤﻛ زا 2 ﺮﺘﻴﻟ ﻞﺒﻗ زا ﻞﻤﻋ ،ﻪﺘـﺷاد ﻲﻧارﺎﻤﻴﺑ ﻪﻛ تﻮﻓ ،هﺪﺷ ﻲﻧارﺎﻤﻴﺑ ﻪـﻛ ﻦﻴﻣﻮـﺒﻟآ ﺮـﺘﻤﻛ زا gr/dl 5 / 3 ،ﻪﺘﺷاد ﻲﻧارﺎﻤﻴﺑ ﻪﻛ زﺎﻴﻧ ﻪﺑ ﻪﻟﻮﻟ يراﺬﮔ دﺪﺠﻣ اﺪﻴﭘ هدﺮﻛ و ﻤﻴﺑ ﻲﻧارﺎ ﻪﻛ ﺶﻫﺎﻛ نزو ﻪﺘﺷاد ﺪﻧا ﻪـﺑ رﻮـﻃ ﻲﻨﻌﻣ يراد ﺮﺘﺸﻴﺑ زا ﻪﻴﻘﺑ ﺖﺳا . ود ﻪﺿرﺎﻋ ي ﻊﻳﺎﺷ و ﻢﻬﻣ ﺲـﭘ زا نﻮﻴـﺴﻛزر يﺮـﻣ ﻚﻴﻟ زﻮﻣﻮﺘﺳﺎﻧآ و ضراﻮﻋ يﻮـﻳر ﺖـﺳا ) 11 -10 .( ﺎـﻣ رد ﻪﻌﻟﺎﻄﻣ ي ﻲﻠﺒﻗ ﻞـﻣاﻮﻋ ﻂﺒﺗﺮـﻣ ﺎـﺑ ﻚـﻴﻟ زﻮﻣﻮﺘـﺳﺎﻧآ ﺐﻗﺎﻌﺘﻣ ﻲﻣﻮﺘﻛژﺎﻓوزا ار درﻮﻣ ﻲﺳرﺮﺑ راﺮﻗ ﻢـﻳداد ) 12 ( و رد ﻪــﻌﻟﺎﻄﻣ ي ﺮــﺿﺎﺣ ﻪــﺑ ﻲــﺳرﺮﺑ ضراﻮــﻋ يﻮــﻳر ﻢﻴﺘﺧادﺮﭘ . ضراﻮﻋ ﻲﺴﻔﻨﺗ ﺐﻗﺎﻌﺘﻣ ﻲﻣﻮﺘﻛژﺎﻓوزا نﺎـﻤﻫ ﻪﻧﻮﮔ ﻪﻛ رد ﻦﻳا ﻪﻌﻟﺎﻄﻣ ﺰﻴﻧ هﺪﻫﺎﺸﻣ ﺪﻳدﺮﮔ نﺎﻨﭽﻤﻫ ﻚﻳ ﻪﺿرﺎﻋ ي ﻢﻬﻣ ﺲـﭘ زا ﻞـﻤﻋ بﻮـﺴﺤﻣ ﻲـﻣ ،دﻮـﺷ ﺎـﻣا نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ ﻪﺑ ﻊﻗﻮﻣ ﻲﻣ ﺪﻧاﻮﺗ ﻦﻳا ضراﻮـﻋ ار ﺮﺗدوﺪﺤﻣ و دﻮﺒﻬﺑ نآ ار ﻊﻳﺮﺴﺗ ﺪﻳﺎﻤﻧ ) 9 .( رد ﺎﻄﻣ ﻪﻌﻟ ي Atkins و ،نارﺎـﻜﻤﻫ عﻮﻴـﺷ ضراﻮـﻋ ﻲﺴﻔﻨﺗ ﺲﭘ زا ﻲﻣﻮﺘﻛژﺎﻓوزا 5 / 28 ﺪﺻرد شراﺰـﮔ ﺪـﺷ ﻪﻛ ًﺎﺒﻳﺮﻘﺗ ﻪﺑﺎﺸﻣ ﻪﻌﻟﺎﻄﻣ ي ﺎـﻣ دﻮـﺑ . ﻦﻳﺮﺘـﺸﻴﺑ ﻪـﺿرﺎﻋ ي ﻲﺴﻔﻨﺗ رد ﻪﻌﻟﺎﻄﻣ ي نآ ﺎﻫ ار ﻲﻧﻮﻣﻮﻨﭘ ﻞﻴﻜﺸﺗ ﻲـﻣ داد رد ﻲﻟﺎــﺣ ﻪــﻛ رد ﻪــﻌﻟﺎﻄﻣ ي ﺎــﻣ ﻢﻴــﭙﻣا زا ﻪــﻴﻘﺑ ي ضراﻮــﻋ ﻊﻳﺎﺷ ﺮﺗ دﻮﺑ ) 13 .( تﺎﻌﻟﺎﻄﻣ ﻲﻠﺒﻗ ـﺳ ﻦ ﻻﺎـﺑ و ﺖﻴﻌـﺿو ﻪﻳﺬﻐﺗ يا ﻞـﺒﻗ زا ﻞـﻤﻋ ﻲـﺣاﺮﺟ ار رد زوﺮـﺑ ضراﻮـﻋ ﻲﺴﻔﻨﺗ ﺲﭘ زا ﻲﻣﻮﺘﻛژﺎﻓوزا ار ﺮﺛﺆﻣ ﻪﺘﺴﻧاد ﺪﻧا ) 14 (؛ ﻪـﺑ يرﻮﻃ ﻪﻛ ﻲﻧﻮﻣﻮﻨﭘ ﻲﺷﺎﻧ زا ،نﻮﻴﺳاﺮﻴﭙﺳآ گﺮﻣ و ﺮـﻴﻣ و ﻲﺷﻮﺧﺎﻧ ﻻﺎﺑ ﺎﺑ ﻦﺳ يﻻﺎﺑ 60 لﺎﺳ رد طﺎﺒﺗرا هدﻮﺑ ﺖﺳا ) 15 -14 .( ﺎﺑ ﻦﻳا لﺎﺣ ﺞﻳﺎﺘﻧ ﻪـﻌﻟﺎﻄﻣ ي ﺮـﺿﺎﺣ ﻪـﻄﺑار ي
ﻲﻨﻌﻣ د يرا ار ﻦﻴﺑ ﻦﺳ و ضراﻮﻋ ﻲﺴﻔﻨﺗ ﺎﻳ نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ نﺎﺸﻧ داﺪﻧ . ﻪـﺘﺒﻟا ﻪــﺑ ﺮــﻈﻧ ﻲــﻣ ﺪـﺳر ضراﻮــﻋ يﻮــﻳر ﺐــﻗﺎﻌﺘﻣ ﻲﻣﻮﺘﻛژﺎــﻓوزا ﻪــﺑ شور ﺲﻧاﺮــﺗ ﻚﻴــﺳارﻮﺗ ﺮﺘــﺸﻴﺑ زا ﻲﻣﻮﺘﻛژﺎــﻓوزا ﺲﻧاﺮــﺗ لﺎــﺗﺎﻴﻫ خر ﻲــﻣ ﺪــﻫد . Hsu و نارﺎــﻜﻤﻫ رد ﻪــﻌﻟﺎﻄﻣ يا عﻮﻴــﺷ زﺎــﻴﻧ ﻪــﺑ نﻮﻴــﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎــﻜﻣ ﺐــﻗﺎﻌﺘﻣ ﺎــﻓوزا ﻲﻣﻮﺘﻛژ ) ﻢــﻋا زا ﺲﻧاﺮــﺗ ﻚﻴﺳارﻮﺗ و ﺲﻧاﺮﺗ لﺎﺗﺎﻴﻫ ( ار 3 / 16 ﺪﺻرد ) رد ﻪﺴﻳﺎﻘﻣ ﺎﺑ 4 / 21 ﺪﺻرد رد ﻪﻌﻟﺎﻄﻣ ي ﺎﻣ ( و ﻦﻴﮕﻧﺎﻴﻣ لﻮـﻃ تﺪـﻣ ﺖﻣﺎﻗا رد ICU ار رد ﻲﻧارﺎﻤﻴﺑ ﻪﻛ ﺖـﺤﺗ ﻲﻣﻮﺘﻛژﺎـﻓوزا ﺲﻧاﺮﺗ ﻚﻴﺳارﻮﺗ و ﺲﻧاﺮﺗ لﺎﺗﺎﻴﻫ راﺮﻗ ﻪﺘﻓﺮﮔ ﺪـﻧدﻮﺑ ﻪـﺑ ﺐﻴﺗﺮﺗ 6 و 2 زور شراﺰﮔ ﺪﻧدﺮﻛ . ﻦﻴﮕﻧﺎﻴﻣ تﺪﻣ ﺎـﻣز ن زﺎﻴﻧ ﻪﺑ نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎـﻜﻣ ﺰـﻴﻧ رد ﻲﻣﻮﺘﻛژﺎـﻓوزا ﻪـﺑ شور ﺲﻧاﺮﺗ ﻚﻴﺳارﻮﺗ و ﺲﻧاﺮﺗ لﺎﺗﺎﻴﻫ ﻪﺑ ﺐـﻴﺗﺮﺗ 2 و 1 زور ﻪﺑ ﺖﺳد ﺪﻣآ ) 16 .( رد ﻪﻌﻟﺎﻄﻣ ي ﺎﻣ ﻪﻤﻫ نارﺎـﻤﻴﺑ ﻪﺑ شور ﺲﻧاﺮﺗ لﺎـﺗﺎﻴﻫ ﻞـﻤﻋ هﺪـﺷ ﺪـﻧدﻮﺑ و ﻦﻴﮕﻧﺎـﻴﻣ نﺎﻣز زﺎﻴﻧ ﻪﺑ نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ 34 / 1 زور ﻪـﺑ ﺖـﺳد ﺪﻣآ ﻪﻛ ﻲﻛﺪـﻧا ﺶﻴـﺑ زا راﺪـﻘﻣ شراﺰـﮔ هﺪـﺷ ﻂـﺳﻮﺗ ﻪﻌﻟﺎﻄﻣ ي ﻲﻠﺒﻗ ﺖﺳا . رد ﻪﻌﻟﺎﻄﻣ ي ﺎﻣ FEV1 ﻪﭼ ﻪـﺑ ترﻮـﺻ ﻚـﻳ ﺮـﻴﻐﺘﻣ ﻲﻔﻴﻛ ) ﺮﺘﻤﻛ زا 2 و يﻻﺎﺑ 2 ﺮﺘﻴﻟ ( و ﻪﭼ ﻪﺑ ترﻮـﺻ ﻚـﻳ ﻦﻴﮕﻧﺎﻴﻣ يدﺪﻋ ﺎﺑ نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎﻜﻣ ﻲﻧﻻﻮﻃ ﺮﺗ طﺎـﺒﺗرا ﻲﻨﻌﻣ راد ﺖـﺷاد ﻪـﻛ ﻦـﻳا ﻪـﺘﻓﺎﻳ رد يﺎﺘـﺳار ﻪـﺘﻓﺎﻳ يﺎـﻫ ﻪــﻌﻟﺎﻄﻣ ي Hsu و نارﺎــﻜﻤﻫ ﻲــﻣ ﺪــﺷﺎﺑ ) 16 .( زا ،ﻲــﻓﺮﻃ ﻦﻴﻣﻮﺒﻟآ ﺮﺘﻤﻛ زا gr/dl 5 / 3 رد تﺎﻌﻟﺎﻄﻣ ﻲﻠﺒﻗ ﺰﻴﻧ ﺎﺑ گﺮﻣ و ﺮﻴﻣ ﺮﺗﻻﺎﺑ رد طﺎﺒﺗرا هدﻮﺑ ﺖﺳا ) 15 ( و رد ﻦﻳا ﻪـﻌﻟﺎﻄﻣ ﻢﻫ ﺎﺑ نﻮﻴﺳﻼﻴﺘﻧو ﻲﻧﻻﻮﻃ ﺮﺗ ﻪﻄﺑار ﻪﺘﺷاد ﺖﺳا . زا ﺖﻳدوﺪﺤﻣ يﺎﻫ ﻦﻳا ﻪﻌﻟﺎﻄﻣ ﺪﻳﺎﺑ ﻪﺑ مﺪـﻋ ﻪـﻌﺟاﺮﻣ ﻪـﺑ ﻊﻗﻮﻣ نارﺎﻤﻴﺑ ياﺮﺑ ﻲﭘ يﺮﻴﮔ هرﺎﺷا دﻮﻤﻧ ﻪﻛ ﺎﺑ ﻲﭘ يﺮـﻴﮔ ﻲﻨﻔﻠﺗ رﺮﻜﻣ ﻲﻌﺳ ﺪﺷ ﻦﻳا ﺖﻳدوﺪﺤﻣ ﻪﺑ ﻞﻗاﺪﺣ ﺪـﺳﺮﺑ . ﺎﺑ ﻪﺟﻮﺗ ﻪﺑ ﻦﻳا ﻪﻛ رد ﻦﻳا ﻪﻌﻟﺎﻄﻣ ﺺﺨﺸﻣ ﺪﺷ ﻦﻴﻣﻮـﺒﻟآ ﻦﻴﻳﺎﭘ مﺮﺳ ) ﻪﻛ ﺮﮕﻧﺎﻳﺎﻤﻧ ءﻮﺳ ﻪﻳﺬﻐﺗ ي ﻪﻨﻴﻣز يا ﺖﺳا ( و FEV1 ﺮﺘﻤﻛ زا 2 ﺮﺘﻴﻟ ﺎﺑ نﻮﻴﺳﻼﻴﺘﻧو ﻲﻜﻴﻧﺎـﻜﻣ ﻲﻧﻻﻮـﻃ تﺪﻣ ) و رد ﻲﭘ نآ گﺮﻣ و ﺮﻴﻣ ﺮﺗﻻﺎﺑ ( ﻪﻄﺑار ي ﻲﻨﻌﻣ د ار ،دراد ﻪﺑ ﺮﻈﻧ ﻲﻣ ﺪﺳر حﻼﺻا ﺖﻴﻌﺿو ﻪﻳﺬﻐﺗ يا رﺎـﻤﻴﺑ و دﻮﺒﻬﺑ نﺪﻴﺸﺨﺑ ﻪﺑ دﺮﻜﻠﻤﻋ يﻮﻳر ﻲﻣ ﺪﻧاﻮﺗ لﻮـﻃ تﺪـﻣ ﻪﻳﻮﻬﺗ ي ﻲﻜﻴﻧﺎﻜﻣ ار هﺎﺗﻮﻛ ﺮﺗ ﺪﻨﻛ و ﺪﻳﺎﺷ زا ناﺰﻴﻣ گﺮـﻣ و ﺮــﻴﻣ ﺐــﻗﺎﻌﺘﻣ ﻲﻣﻮﺘﻛژﺎــﻓوزا ﺪــﻫﺎﻜﺑ . ﺎــﺑ ﻦــﻳا ،لﺎــﺣ ﻲﻣﻮﺘﻛژﺎﻓوزا ﻪﺑ ترﺪﻧ ﻚﻳ ﻞﻤﻋ ﻲـﺣاﺮﺟ ﺎـﺑ ﻲـﺷﻮﺧﺎﻧ ﻻﺎﺑ و گﺮﻣ و ﺮﻴﻣ ﻞﺑﺎﻗ ﻪﺟﻮﺗ ﻲﻘﻠﺗ ﻲﻣ دﻮﺷ . References
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Vol 29, No 125, 1 week, April 2011 Received: 8.10.2010 Accepted: 14.3.2011
Evaluation of Mechanical Ventilation Mean Duration and its Predicting Factors during Transhiatal Esophagectomy
in Patients with Esophageal Cancer
Sayed Abbas Tabatabai MD1, Sayed Mozafar Hashemi MD1, Gholam Reza Mohajeri MD2, Mojtaba Ahmadinejad MD3, Vahid Goharian MD4, Mohsen Kolahdouzan MD5, Saeed Abbasi MD6, Neda Mogharehabed MD7, Amir Hossein Davarpanah Jazi MD8,
Mohammad Eidi MD9
Abstract
Background:Esophagenctomy is the principle treatment for esophageal and gastroesophageal junction
malignancies. Postoperative respiratory failure and other respiratory problems like athelectasis and se-vere hypoxia occur frequently after esophageal cancer surgeries. Such patients mostly need ICU care and mechanical ventilation. The aim of present study was to evaluate mean duration of mechanical ventila-tion and its predictor factors during esophageal resecventila-tion in middle and distal esophageal cancers.
Methods: This cross sectional analytic study performed in Al Zahra hospital, Isfahan on medical
records of 70 patients with middle and distal esophageal cancer operated by transhiatal method in De-partment of Thoracic Surgery. Patient’s age, sex, tumor location, duration of mechanical ventilation, duration of operation, spirometry findings (FEV1), weight loss, need for transfusion, and serum
albu-min level on admission extracted from medical charts. Finally all data were analyzed by SPSS16 using
chi-square and t tests.
Findings: Patient’s mean age was 60.71 ± 11.81 years and 64.3% of them were men. Pathologically,
43 patients (61.4%) and 26 patients (37.1%) were diagnosed by SCC and adenocarcinoma respective-ly. Totally frequency of complications were 41.4%, and 7.1% of subjects were died within first 30 days. 15 patients (21.4%) were mechanically ventilated after surgery with mean duration of 1.34 day. Mean duration of mechanical ventilation showed no association with intraoperative pleural rapture, intraoperative blood transfusion, anastomosis leakage, type of pathology, postoperative anastomotic stricture, and empyema. However mean duration of mechanical ventilation were significantly higher in died patients within 30 days after surgery, reintubated subjects, patients with serum albumin level of less than 3.5 g/dl, and patients with less than 2 liter FEV1. Among quantitative variables, only FEV1 were associated with mean duration of mechanical ventilation.
Conclusion: As our data showed hypoalbuminemia (which reflects subsequent malnutrition) and less
than 2 liter FEV1 is correlates with prolonged mechanical ventilation (and probably more mortality) it is recommended to improve nutritional condition as well as pulmonary function preoperatively to shortened duration of mechanical ventilation and prohibit mortality rate.
Keywords: Esophageal cancer, Transhiatal esophagectomy, Mechanical ventilation.
1
Associate Professor, Department of Thoracic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2
Assistant Professor, Department of Thoracic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 3 Assistant Professor, Department of Thoracic Surgery, School of Medicine, Lorestan University of Medical Sciences, Lorestan, Iran. 4
Assistant Professor, Department of Thoracic Surgery, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran.
5
Assistant Professor, Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 6
Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 7 Resident, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 8
Resident, Medicine Education Research Center, Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
9
