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Sh Y G U f Sh G c IFe Y H j MQ fe..dhDG g G QfCG Gfc GNCGh INEG e a ,,, adG h Gh 11. dG dhO j eSEG dGh bhCG IQGRhwww.islam.gov.kw 5736 .U 02 5601332 ca h Jg : eG e21511 IL 40987 .U 2750565 Jg : IL ewww.nooran.org 12. dG RYEG H KCGdG jdG H G G Y .OhdG OGG Y .O jG 13. 14L QKCG IN MCG Y Hh Mh LCG H J iha IY M Ic DhJ QK d LCG AH RGH idGh ,TCG HQCG b LCG SEG RGH idG gh dG ShCG SGhhSh .gG g e Gc a dG dG RYEG H G e K ,GS Id MQCGIe bCGh , hdG fh G QGWCG :gh VG GH J e jb KK be dG Gg eG ICGG CGh ,dhdG fh G QGWCG :hCG dG,dGh dG :hCG G QGWCG eR CG Y jUGh HdG G AY e c H a T;Zh QdG eEG GhQ dG G L jM e a Y AH ;ej hYh Fe Je ,Gh:b ` hG OdG gh Sh Y G U G SQ KM : b Y G VQ Oe H G Y YG j K ,dP e e j K dP e Y j K k ej HQCG eCG H N j cMCG EGb jG CG h (1) hdG a j K ,S hCG Th ,bRQh Y cG :d jh c HQCH eDj k eM ddG HQCG jH j dG G QW eR AfG H j G hdG f CG EG QTCGhCG H QCG QdG N WSEGh G VLEG RGH ALCG FY H aCG a , dG GgffEG hdG a J ,Jf IM a M IdG g JM C ,e IQhV H ,Y eQGWCG ed G Gg d .e YT M fCc UCG M dG Y dG g SJ bh ,HY IG dG FG e VQj fCG dG j K b ;HQCG KK J fCGh hCG G,U jh jOMCG g e hOj G e dG SGdG Z L .jG LCGG U dG S H Gj CG jjCH GN j VG Gg CG SEd HQG H gJ c. 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H VQJ jM GhQ dG jG gXh VQj ej jYh Fe H J CGjH dh ,ITe SOdG SCG H CGj dG J CG e jG LCG Y FM KCG e e(10) . jM j gdG VGdG G jDj Y HdG SCGHdG ALCG fDhY G QGWC bGdG dG FG e VGdG VQdG Gg Y f bha QdG jGhQ J dGh MCG eEG jGhH Oe HG jM OQhCG eH : G LQ HG a Z Ggh ,ej Sh Fe H EG j G CG Y J MG eEG jGhQh :b M Sh e(13) .H j YL HG g jR HG Yh ,a jQ jG 24. 25dG dG h Lh Hh S Nh G jJ CG Y j Oe HG jM gXh :NBG Ve bh(26).Yh fdG HQCG hCG j CG dP e a ,fdG HQCG hCG j eYh ;UG QdG e BGdG Ud dG j M G QGWC BGdG UdG e VQdG -3 Mh T jh AG Ic Uh KdGh SdG hCG KdG hCG jdG dG a . dG Lh Y Y AedG h dG J dG IOhdG T Y fCH Uh dG hCG G dG Gh L N h QJh J b IdG g G j M IeL O b T Y j fCG hCG fCH H Uh jdGh FG dG EGh fdG dG H Gh .( ) T h ( ) T .FYCG ,H eR e J b G ILCG J M Zh fCG hCG J h a T e( 10) T fG . JfGh JcM L SQh dGh jG e f Gh MGh EG aU d -dP e - db IQTEG SG c fEG :G e eEG jGhQ-4 j d a ;ej HQCGh , CG Hh , G L :gh ,jG b cP ATCG KK e fCG fe dG jM jM dP d j dGh ,db IQTEG SG e Od G dG YjG 25. 26YGb M G dG Y j G dG C (ej HQCG) edG IdG Y IQTEG SG OjSh GjL e j jG QGJ C (CG H) Y IQTEG SG Oj CG j h dUCEG JOYEG j jG IQTEG SG c GPEGh . rG SQ Ma e VQj GM dGY (dP e) db IQTEG SG Oj CG dP Y AH a ,CG H EG h ,hCG ej HQCGe SGh . dG HdG dG edG HG Mh dEG UJ e gh ,HQCG Y ,G L (10) . hCG ej HQCG N J Gh dGh dG CG dPeh ,jh j CG ,eCG H j e PEG ,dP Y a QdG jM eCGh ) :edG HG b e j fEG K ,UN MEGh JEG e jhe a . G CG L LQdP e a ej HQCG H fEG IQU CG e G ,HQCG e jCG MJ J K. Y Ie fdG j fEG EG :db dG fh. dG Y QG YdPh .dP H G aj K eg K T K c K HT K aj K a K VQ j fEG K : a.fdG FH Ie a j dG QGWCG Y QNEG JJ H eGPEG EG ,gH G Hh b G H NGdGh JdG J (K) CG HdG dG YGb e ehdG Se JBG K J d H cUh dP ) :J db e , dP J fCG Y J jb ALY G JJ J g (K)`a ,Se c H AL BGdG d G Uh CG G eh . (dP j K ej HQCG eCG H N j cMCG EG : Oe HG jM j Gg Yh .jBG K ( HQCG N LG e CG ) dP e ( N ) Y (jCG e OdG dP CG)LG e CG dP e ( d QG G e ) e ej HQCG f CG ) dP j`g G(14) .ej HQCG Ne HQCG e j CG Oe HG G Y jM (dP e) e CG j Gg YhG iNCG jOMCG eh e jGhQ e j QdG jGhH Oe HG jM a a .jCGG QGWC WG G Y QdG jGhQ LQOCG c g CG Y dG jh .VHf ej HQCG eCG H N j cMCG EG) :jG e hCG G f c :gh.U jGhQ CG gOLh Y Y a QdG jGhQ IOLe Z f a (jGjG 26. 27dG dG ?HQCG KK H CG IMGh HQCG HCG ?G hdG J e :HGQ a Lj h .YdG UdG a J dh jG dG a j b c dG g EG Oe H G Y Y gZh e QdG GhQ dG G L jM EG Uh jU f YCG ej HQCG H N d cMCG CG hG OdG gh Sh Y G U G SQ KM b HQCH eDjh hdG a a G Sj K dP e e dP j K dP e Y dP j Ke GhQ *S hCG Th Yh LCGh bRQ H c dG dG Gg Y AH ,G QW cG H hdG a J G CG G AY JG bh L j e eEG jGhQ H ,hCG ej HQCG j G eR CG K b fCG h . jdG LCG Y FM aGJh (jG...ej HQCGh K dH e GPEG ) SCG H jM jMh ,G .H G Y e hCG HQCG H J hda GPEG ; G QGWC YdG UhCG g e jG CG j GMCG CG XCG ?cCG hCG bCG hCG HQCG CG KK CG jT HCG ? dH dP j e d YCG a Lj M !hCG ej HQCG H H j dGh G Lh Y hdG f Ye Oj fh GS K ) :J G H SSG jdG YG j j CG d .dP U f JCJ jdG CG h , jdG H G J hdG CG e j CG M 9 IdG ( MhQ e a J hdG CH dG a . 7 QfEG .(da Ga N dG ) :J dd ITe G H e SG gh ;NBG N ICdG Me CG Y e edG SCG H CG G Me H G H EG j dGh hdG a J dG G QdG g NBG N ICdG QW EG Gdb jdG jG hM NGdG j dG (K) M dP jh .dG jBG f c dH Fch dG QW Sj K hCG QdG c hdG a j K ) OQh M G L jM hdG f e cP M dG (e c hdG a a G HQCG G QW fGh J b FdG ILCG Lh EG edG SCG j fCG Mh ;H gH hCG IdG g N fEG N iSh ffEG IQdG h G Y e hCG ej AYCG H hCG TdG hCG SdG SCG G Y AfG H G J CG hd a .YCG Gh !dP H hCG Y dG SCG SdG Y eY G f j CG f ?hdG a f b G CG Y J eY LJ g d G b e GNCG .bDe e b b hdG CG ZQ IH j dG FdG Y Sb a hdG f iNCG Sjh G Y b dG a ee dGh Je M fCG aj G ) : J 42edG (hj d jB dP EG e LCG EG jG 27. 28b G Uh dG HG dd QTCG bh .hdG OLh Y dO jOGQEG cG J CG ca ,IOGQEH AGZGh cM J h ,dc AGZGh dG cM a fc :a hdG f Hh(15).FGZGh cM EG JOGQEGh M cM fG hdG a fSCG Y QJ CG M ;e bh G L cM jDhQ jG ILCG KCG bhG cG iJ CG c . 15 GM G W j hCG S3 G c j eY hCG edGdG SY cMh dG HVh dG GWCG cMh dG cM e G jM Y J dGdG e fetal activity G `f Y J dG cG UQ c .jOhdG AeCG cMh dGhY iJ CG dGh ;HUCG e h LdG EG dG cM h dG cMh Gh dG EG dG cMh(11)T! eCa ej jYh Fe b CG;Y SOdG SCGIOLe cG g fc a ;cG dG RG d Te Z SfG cG g Jh .Sh f dG RG dM fc c ,fRGehhCG G QGWCG CG cDJ dG FG g bdG ILCG H LCG AY KCG GghG AYCG N e c jh ,hCG ej HQCG N c , Gh dGh dG eY AHh jOGQEG G cM CGh ,Y e hCG ej HQCG N FGHG JQU JLCGh jG 28. 29dG dG.Y e fdG ej HQCG FdG G AYCG FXh U Z b ;ej jYh Fe Gh dGh dG e d hCG QGWCG Ie CH da Yh . Vh H dG Fd be b dO Y d b TCG HQCG H EG hdG f H G CH dG S e c Y AHh Oe HG j QdG eEG jGhQ :g ddG X j a Y e H ,YdG UdG e fh jG d iNCG jGhd IjDeh jGhdG g VQe jG LCG Y FM AL K jGhH MG j Ggh a d VH dG H G H IOjH e eEG gGhQ hGdG b G hdG f H H MG j dHh .hCG G QGWCG eR j QdG.TCG HQCG hCG ,HdG SCG jf ;hCG ej HQCG H bh CG Fb LCG hdG f feEa Yh e edG SCG H J hdG CG UdG e LGdG c EGh TCG HQCG H M hCG ,SdG hCG,edG j , M hCG U MGh jM OLh dh .dP Y dGh jdG UdG dd dG eh LCG Y HdG dG FG dP cDj h .TCG HQCG H EG G J hdG CH FXH JLCG e bh jJh N cGh ,fJ jGH e G G MGe jDhQ gCG .dG Lh Y TCG HQCG b fdG fCG h JGdG cM UQh fh ,hdG f H AdG QL Y VLEG C ; HQCG H VLEG eM dP Y jh Lj a ;H hCG ej HQCG N jh jh CGj G QWh ,G QW H j hdG eG Jh .eCG dG Jh dG J jGH e hCG ej HQCG H VLEG eH dGYCG Gh .HGdG hCG ddG dG H TCG gh ,HSCG fK H CG ,dG Me H?d Ie bCG g e :fdG dG AdGh S h c e AT j Oj a G eCG cCG eCG) : G MQ dG b : d Ie bCG AdG GbCG VSG K .(..AdG GMCG e d X e H j ch ,a ,G eCG cC M fCG dO GbCG XCG :b CG EG ..,S hCG N hCG HQCG hCG S fCG Fb a ) dGh ,WS j U e H eR jh ,Y dO h d UCG e eH j c C . ( 85/3 dG AGVCG ) ( J G YjG 29. 30:adG Hh f eG g He cCJh M dG ICGa ,AdG e ege QNCG Y e AGQBG fc EG AdG gcP dG AGQBG c EGIe a ,M Y JCG M CG J Q jdG JQhO NCJ H IQGH Qh ,O Y j.M ,M,02) IdG g AedG Sh IOG dH ij M ,e GKCG dG iJ fCG UNh ,eM fCGa ,hCG IG M e d jh ,cCG hCG KG hCG T H iNCG Ie K ,(hCG dG jf LCG c .dG hCG H QJ CG Z e ,GQGe SCG K M fCG Gh ,hCG G e NCG M YM j M :gdG Gd SSCG j b ,(Molar Pregnancy) PdG H Y j .ICGG HUEGGQT J CG dG,VGYCG g hJ b K ,dM eh g eM fCH eRL Jh ICGG H jh MdGh .PdG M AH e G M Y a ,M M dP H K W M JCjh ,IjYjh ,OY Id fMCGh GS Id hCG TCG Id jT IQhO ICGd JCJ h dG j ;G VLEG M H38 I jdG IQhd fG jd KM GdG H id M T iCGQ fCG : dG LG MU QcdG.(Charles R. Whiteld (1995) Dewhursts Textbook Of Obestetrics & Gynecology. P31) .GTGg fh ,H Gh AdG Y Gh jdG CG j CG ;MG g Y AHh,TCG J e cCG eCG H G NCJ RGH ALCG fDhY aCa ,jW Y AdG EG CG .eCa.dP Zh S S hCG H Fb eh ,HQCG hCG ,H Fb eh,H Fb aY dO fC ,eR M H Lh eCG Gg WCG M ,YVe - G MQ - dG CGQ c bh.dEG Lj U e Lj M ,jdG AY Y G Gg,Wb IQH BG OLe - G MQ - dG cP dG dG G CG dCG g Gh .! dgEGhCG fGd h ,G dG dG LGG G CG Y O dG AMEGh :(120 / 13 G dG) J jUG AdG MCG IOT ghjb S G IY CG dG gG CGQ gh ,ej 308 hCG 305 Y eCG H .DhH jj b SdGh ,SdG QNCGh AGSG a G-Ie bC gGG cj e eCGh ,ej (354).HK YT f dP dh ,e eR Ia G OLh gj hCG jMGh Y jJ G Ie CG cDJ LGeh KHCGh ,VG Gg cdG gCG g BG AWCaG IAc Qgd dPh ;G Ve a dP Y OGR EGh ,dG AH e YSCG HQCGhE. Albert Reece & Others (1994)) jh G H a ;RdG AGdH OGeEG MdGh .(Fundamental Of Obstetric & Gynecology Ultrasound p203jG 30. 31dG dG cj h ,J HK S ah J IOdGh G C ,YSCG N G j CG e a g H GPEGh ,dP e cCG Y a ,e ec S I G a S IMGh dM W Le CG H G AHh ,eG ICGG e dG hf H HJ AGQBG e OQh e a - b WH gh - dCG.U Z AGQBG ;WCG IaeG ICGG M Y :ddG dG eG ICGa .dG h YdG MdG e ,dG e d SSCG eG ICGG M b EG e b e b LJh dG LGG dG FdH eh ,a T Y M g . J YdG dOCGh ,M O Oa O g e j dG dG CGh , eG ICGG CH ,AdG: ddG dG - (93,94 / 3 dG AGVCG) G MQ - dG gcP bh ,dG Gg Sh Y G U dG CG G JCGeG bW Y HG jM jGhQ H AL e (1) dG UCGh eh MCG LNCG jGhdG gh (eM hCG GgW d K LGa e) :d b .dd eY dG L c ,G G Y eY rdG L b :Gdb ,HQCG jM e cGh OhGO HCGh MCG GhQ (H CGJ M FM h ,J M eM CWJ ) jM (2) ,MdG IAGH Y eY G rdG a :Gdb ,gGT dh cG Uh ,Y G VQ S HCG .G e j fCG Y dP a eH ,FdG GJ e Y Sb ,M Z a ,dZ G a Oj eR O fCG eh (3).dG fH G AdG j EG :G MQ MCG eEG b bh ,e c G Y Z ,M Z fCG Y dP O Y fG a ,G RGd Y fG e M O c d fCG :eh (4) jd ,bW eG Oh ,dG eM G R a ,hG AfG Lj RdG AfG C eG Oh ,H IdG AfG jCG G R eh ,gdGh eG W MHEG Y GdG fBG QcG (M j CG LCG MCG hCGh) :J dd M VH J fC JY AfG d KCG .(4) dG. eG CG Y dG dOCG g hCG ,G AKCG G bJh hM c Y ,LCG Y SG b FM IY g .MEGh bdGh HGdG jZ ,feg GKCd j bJh G hM CG : FG edG dG a QhO d MdGh G H IWh bY g CG : FG g Kh jG 31. 32 .G MG G Y Y G G hM H MdG L Xh Jh GJ g CG : FG g dK .G hM .jh Vj FG d J Y jS dWEG AdEGh.G S (MdG IQhdG) MdG jQhdG dG -G :MGe HQCG e MdG IQhdG dCJ,MdG fd XdG dG J M G O jDhd hCG dG e CGJ :* G Me - CG.jCG 5 - 3 e Jh jJ ej 28 c JhM ,LhSCG eg a Y Jh ,HdG MG Jh :KdG QW hCG HGG MG- .d G HLCGh ,AdG EG MdG fH OJRG ,hLhdG eg a Y Jh HS J gh :UCG QdG hCG jRGaEG MG- .fhM jGT Jh ,gOZ GRe Jh MdG fH (J) QJ ah ,UCG G ea (fsh&lh) ,edG fedG RGaEG j ah :eG QW hCG G b e MG -OdG Jh ,MdG OdG jfh fhG jGdG Jh ,Hf EG G UCG Ge HGe H MdG IQhdG J .ddG dG IQhdG AH Jh ,MT Jh XdGIdG Y KDJ feg RJ a (hypothalamus) ,OG e e edG CGJ ,fedGH gh (FSH) HGG KG :g gCGh ,gRGaG J hCG feg e a e a ,edGGG gh L H AGdG KGh ,IQhdG jGH e dG Y ,ICGG e IOLG HLCG(12)T fCG .HGG KG IY VHEG Y VdGJ hCG jJ b PEG;IdG AfGh IdG AGOCc ;YT M Y j fCG EG W e c EGh , IdG J Y G b * .KdG QW e bh NCJ b gh , IQdGh IdG e QKBGh dG fG d j PEG .AdG GOY NG HjG 32. 33dG dG dG ijh .Gh MdG JQhOh ,edG Id edG dG H bdG j :12) T dG MdG fH iJh ,dG e hC dG ,jOdG dG IQhO MdG fH GJ Jg N fedG GdGh G GdG MJh ,a eCG dG SGf CJ bh NBG .JQhdG jG 33. 34:MdGh G H IWdG bdG -2Rj M ,UCG H G dG FH N e ,eg RGaEH dG IQhdG N G jK ,VHEG H SdGh HdG edG H JhQP d jQJ H ,VHEG H hLhdG eg.LhSCG eg e b c UCG G Rj c ,eH dG b dG Ge EG jRGh MdG fH jh ,(L. H) AGdG KG jQJ hLhdG j.(12) T fCGYj dd ,(dG) G M dM ,(Blastocyst) QCG dG d fCG SdGH SdG dG GM QJ IhQP UCG G j dG J GPEa .d AG edGedG Gg e RG bj dd ,HCG H j e EG jh G LGj K ,VHEG UCG G a dG J GPEG eCG .(12) T fG .dG dG Y Cj ,jSN j dG ,(S.C.G.T) ffEG HZdG SdG G :g dK eg a f RGaEGh M OGOjh ,M UCG L EG UCG G j gh ,G dG J e KK hCG ejd jdG LhSEGh hLhdG e edG RGaEG OGOj c ,ddG dG jf Gc GOjORGG g ddGh AdG dG LGG cDJh .Md XdG cdG J e M KCJdG g MdG EG :(Steven G. Gobbe & others Obstetrics (1991) 2nd Ed P34) gMCG a dG dG J SM QhO d fedG Ggh ,hLhdGh LhSEG ed dGY i ,Y jNh Ae Y e SSCG MdG j M ,ICGG IM G MGG AKCGS jdG FXhh MdG cJ CG if CG a ,hLhdGh LhSEd e.ICGd fedG dG Y GOYG (64 U dW jdG .O G QJ) SdGeR MdG L -3hCG MJh ,UCG G Y LdG fhLhdG RGaEG QW dG eR MdG fH Jh Jh MdG OZ J M ,VHEG e KK hCG ej N ,hLhdG KCJ eYjGT Jh ,bdG jG Jh (stroma cells) Md G jG J c ,GRGaEH .(12) T fCG .(e) ePe fh fhM MdG fH :NGd QG e g W K EG MdG fH jJ dG d fh.G e J h ,UG YhCG dh ,J a hCG PJ a ij :bQ jYb W - 1dG eh ,G fhG jGdG eh ,ePG OdG bCG e J :K SEG W - 2.OdG H PG,dGh ePG MdG fH jN e J :ee S W -3 jG 34. 35dG dG ?dG H j GPe a Je Jh ,jRGaEG da GOjORG WG MdG AZ OZ iJ dG J GPEG ,G jG g jd eRdGh ,dG g S Y IjdG Ja e ,LGh G Vj ,c FYh TGa Jh ,je SEGh dG dG hJ dG jdG Jh QCG dG S Geh ,PdG jT WG MdG AZ j dd ,ITe MdG IH dG J cG H WG MdG AZ e SGh dG dG YJh .(blastocyst) edG Kd edG KCdG AdG Gg j M ,(decidua) bdG AdG SH QCG gh ,G dG J H G Y CJ fegh UCG G fegh ,(F.S.H & L.H).JOh e hCG G S e j dG Ic EG jCG (4 - 3) H Jh ,VHEG e YS (36 - 24) N d dG j,JGRe Jh MdG L EG J (blastocyst) QCG c EG J K ,JdH TCG jH fedG YJ H UN feg RGaEH CGJ K eh ,SOdG dG MdG fH Jh J K UCG G Y a gh ,(H.C.G.T) ffEG HZdG SdG G :Y jh G ,(LhSEGh hLhdG) G feg RGaEG d fG j dd ;RGaEG QW Jh ,MdG fH RGaEGh QGSG EG iODJ fedG gh .G IQH d U Ie MdG fH Jh G hM j dHh Y eg GRGaEG OGOJ dHh ,M UCG L EG UCG G EG iODJ G fedG CG c VHEG dd ;IjL HLCG QJ a ;(FSH&LH) edG IdG feg a Jfeg.eG ICGG Y G bj GHh G N eG ICGG Y J dG AedG Uh dG AGQBG a Y h , eG ICGG CG j GHh.U Z AGQBG ,M AeO fCHSGh UG hM Y eY hCG ee j CG eEG ,G AH He ICGG GJ dG dG Ea J e Y AH ,LQG MdG Y VG FGhdG f e j hCG ,QG VLEG M c FdG SEG CGdG eR hCG ,PdG H HG Y J dG AedG Gch ,L hCG eH HUE f hCG ICGG H J Ia jdG Gg j bh ,eCGdG MCG g f ICGd jf j M ;TG jG 35. 36Y KCJ CG d dh ,M O J CG AedG a .NBG d eG M Y M fCGe IOY j dG a ,fRh hCG G Y dH KDJ Q H ,MdG WCG Ia ,G AHEG MG g j a K eh .dG RdG hO j hCG ,TCG dG hO j b QG VLEG .d WG JGjJ e JGge AdG EG f FdG IdG ADg M CNIG e cCG G Ie OjORGh ,AedG g hH bQh ddG V H HQ dG AGQBG a Yh .Y dO CG Y dh ,U Z AGQBG IOGLGGh eGdG363/6h . 32 0 8 jG bQ .FG cP H , G AH c,G .303/6 QdG U T QdG a-1G,G dGh dG BGdG J G hQ (O djdG T dG HCG)SdCG-2.hH -dG QGO ,1994 /`g1414 ,172U,TdG.hH -aG QGO 483U HGdG G .dG BGdG J ( c H YSEG AGdG HCG) c HG-3.262/16 SdCGh 483/4 c HG-4.125/4 dG je ,529/4 gG , 268~267 /10 dG d-4 .hH ,dG QGO442U3 G 1983 jdG a( Y H ) cdG-5.d fdG QGdG.(1984) jdGh jdG .QTY H gdG--6.eG e-RdG QGO 9/12 .dG dG ,(dG) RGdG--721/10SdCGh 9/18ZGGh 483/3cdGh 251/3c HG .528h 588U SdG G- 9e H ,Gh dG QW dG dG Uh ,MCG eh GfdG G Yh Qe c-10AV LCG Y c e ,1987-`g1408),dGh BGdG dG RYEd hCG dG Dd .eG e ,eSEG dG HGQ He ,hCG ,dGh BGdG53/8 Qe H dG d-11jG 36. 37dG dG .hH ,aG QGO.488/11 QdG U T QdG a ,( M HG Y H MCG)dG-12 ,Gh dG e`L( MCG H jdG T H MdG Y dG HCG jdG jR)G LQ HG-13 .hH ,jdG G 1(1995) YdG Sj QcdG 55U 275 U edG H BGdG RYEG Y TdG gdG-14 351 h339U dG H dG -15 .OQCG ,jRdGh d bdG QGO ,hCG ,(1990) ,G hdG J e ,IdG T-16 G QGO ,hCG ,(1990) ,jdGh UdG LCG Y EG NG ,c jdG Y dU-17.IL ,jRdGh d AMEG QGO ,bdG Y OGDa ,e U(dG G H G HCG )e-18 .HdG GdGLCG LGG19-E Albert reece & others (1994) Fundamental OfObstetric & Gynecology Ultrasound International ED.Printice-Hall International Inc.U.S.A.20-F.gary Cunnigham , Pc.MacDonald & Others (1993)Williams obstetrics.19th ED.Prentice-hall International Inc.21-J.P. 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Y Y SCGQ fG b FdH G,MCG Ge IUG dG dEG QTCG b JgX Y j ,dG gX Y hdG b EG .3Wb dO eCG Gg h ,dG AKCG hCG ,G Z dG e fQH jdG dG AJQG :(hCG)AJQG j Gd ,adG H jd eCG Gg Qjh .G dG Me SM J OLh YMe baEG Y JQG (fdG)h .FdG H Y G gaJ b dG C ,JLQO bCG dGQdG Y j H QdGh ,MG g j c MhQ aJ e j ch ,G dG.baEG Y MG OHCG P MhQ Y dhh QGH dG Y bJ H ,YdG Z J FdG aJ EG .4 Ggh ,dG Ia Y g Y dG Aj d YdG a MG VdG ah Yh ,! jbCGZedG cG e ,dG AKCG ZedG cG QJ f VH TDJ dGh jG jdG cDJaGWC jf NRH U TJ Y MhQ SGh SGM ZCG b dG C G dG Ia .IG:``e`N Xe .6QYH dG Y OLh Va b fCGh dH NG b ,gGdG fY ,HdG fEG c GPEG.a MU HdG CfCG dG dG gMG b dG aG ee CG j Ga ,hCG k J k ffEG kAV Y Va ZU jW Y dEG dG FbdG J e dGb EG dG daJh ,G VG OhM EG J CG jdGh VdG g EGh ,IgG FbdG.MhdGh jdG HdG OhM Qe Ve jd Lh e GPEG k e ILYjG 48. 49dG dG OG dG f " dG Hc jdG jH fc FfY CG dG U CG e dGh jaG HdG OSG e f dG dG OhM g UN Ge EG J IGOCG UCG (22)".JegG OhM QN j dG JGH AdG IFGH bEGh JFGO Y ( MUG M )q UG JGOCG dh ,NBG e f Lj fCG g : g G Gg f Vj dG GDdG qCG EG HdG CG iMCH dG j g hCG ?dG G IgdG IFGO J dGh IgG FbdG jJk .? UG dG GOe H IOLe Z a IGOCG C JVH HDj W VCG b jdG dh ,jdG HdG OLh j UG dG CH cQOCG,jf M jdG aG jQCJ qJ GPEGh ,OYG ie gh ,W Fj dG iG dGR fe CG H jdG Q de dCG HdG eCG ,a OhMh de LQG ATCd j d ,jh j dG dG JGOCG dG C dG Y f dh M d Hb Z c G dEG dH eDj dG GLdG JGOCa jdG j H JFGO Y dG AbEG j Gg CG EG .Gh dG dGe EG LG hOh UdG dG dG e dG HJ C dP .MdG ggX AGQh j eh Fbd a J dG hdG H dG NGO Fbd a f GjEH b b fC ,f GH j j JVd k ah U dG dG a ,bGdH dG OGG L AGMG Y J dG HQ AV Y UG dG OhG.fh ,O j gh ,dH SMEG jd dd ,VGh GdG HH f dG MdG dG gh HdG Y j UG dG OQe CH k FGO YCG f f CG j PEG LGQOEG hCG H d AdG J N jCG j gOhM Y N e c Ea Gd ,FM e j ,GhQd QGhOCG b c ,(23)IOG Jh J f g EG dG fGb a HH .JegG Fb dH G dG cJ e fCG j H ,ATCG e e Y fCG j CG Dhj fb c CGh.EG d f Ld G dG j e JW H j e c OYGh G BGdG G QSG f Yf fEG Gd jdG dGh dG BGdG e N e ,ITe IQH ,FbdG H d IjL aBH UG ,dGh dG IQcG FbdG dN e Y dG G N e ,ITe Z IQH hCG .jdG hf dG FbdG H a e Y YCG Y VdG jj jL Q aQe ZCG b dH fh .dG HdG OhM Y f h ,a fGe G eCG j ,QG dG Me Mj e jJ UH fcP e Ea ,Gg Yh MGe e Me c a jdG jdG dGh dG BGdG H M e AV Y SGQd IjL k baBG g CG gh G i MG gGdG H dG G a ,adG UG M e AV YjG 49. 50dG iDhdG Y J fCG CG ,dG Ife OhM k S G j dG G e eGJ gGdGIjL g dc .?dG SMCGh dG jM Y Gk Hh Gk S cCG GY G hdG a bJMe Hh ,H Ldja Igc dG H UdG G OjE ZedG cG f SGQO eCG ...c gZh ,adG QdG d MGbG CG g ,gCG e Ic LQO Y M f fG f CG Of fCG HY S e Hh ,YdG UdG M e Y HG dG JGOYG H gL JQG OLh j,bQCGh QdG YOh ,gG Yh ,JGQY bO e dG d C ,k fBG MbG dG QdG qjdG fCG EG ,J hCG JGOe H a ,dG dCG H Y dG jJ b fEa .FdEG hCG be G J d:`MEGh `eG`dG . 7. 144:dG Gh AGSEG / 184:dGh dG ` (1). 72:dG G jL Ne ` (2). `LG f ` (3). 47:dG Gh AGSEG / 285:dG dG geh G ` (4). 18:dG dG ICf ` (5). 326:MCG Hh dG H ` (6) . 133:LG f ` (7) . 88 ` 88:LG f ` (8). 103 ` 102:LG f ` (9). 82:d jL Ne ` (10) . 60: fCG IQS ` (11) . 42:edG IQS ` (12). 2:478 e U / :12 QdG a ` (13). 31 `27 : gJh jDhdG G NG ` (14) . 11:IdG IQS / 28:dG IQS / 87:AdG IQS ` (15). 28 : gJh jDhdG G NG ` (16) . LG f ` (17)jG 50. 51dG dG. 117:IFG IQS / 55:GY BG IQS ` (18). 60: fCG IQS ` (19) . 30 : gJh jDhdG G NG ` (20). 134:MCG Hh dG H ` (21) . 44:dG JGSG ` (22). 83:dG G jL Ne ` (23):```LGG .8.hH ,edG AEG ce ,1986 ,U ` ,aG fCG f dG JGSG . (1) Yd eG T SDe ,1980 ,HGdG dG ,GjR O Qcd ,dG Gh AGSG . (2).IgdG,dGh.OGH ,d SGh QGO ,1990,fdG dG ,c Y Qcd ,MCG Hh dG H . (3) .hH ,dG QGO ,jQJ hH ,QHdG e eEd ,dG . (4).hH ,dG QGO ,dG M HG ad ,QdG U T QdG a . ( 5) .hH ,dGh Yd WdG SDG ,1964 ,jT eCG QcdG LJ ,c ,dGh dG . (6).``UG ,UG H cT ,1990 ,hRdG e ,gJh jDhdG G NG . (7) .jdG ,YG dch , 1974,hH MdG Y Qcd ,dG G jL Ne . (8) .IgdG ,jG eG QGO ,1976 , G Y Y Qcd ,dG dG geh G . (9) jG 51. 25 jG 52. dH gEG dG RYEGiQdG O .O eG e - dG AGM e - IGh PCGh fCG QSGjG 53. 54:dG IaIc aUhCG fBGdG jBG cPh dH eGbCG gCG b Lh Y G CG dG Ia JGUCd IQdG QKBG e c EG GNCG jG dG UJ bh ,HG Y gQKBh gEG Sd.gQKBGh d dG BGdG UhCG e j dG GQfdh JGgEG cP RYEG LhCG e CG EG IHY IQTEG TCGh dG BGdG dG Ve H b c h .dHjBG Lh eH VG dG YCG ddh IHY IQTEG H CG e cCG eCG CG J K!!!Y La eCG Gg K dGIQcG cfCG gCGh T b jeh dU b OK g dH GgCG jdG GbCG CG hCG cdh.jdG UCH ahGh j IQS Lh K ?H GHY dG GdG f Hh GgCG b c Y H Se g g fCG GDS bh b chS EG dG b f e:H N ):b fCG Sh Y G U dG Y jT jM GG,G a a EG MdG a X h ,dG a a EG G fCG e H GM eh ,ghY YGhQ (.dH GhNCGh dG Y M EG IcdG Geh ,dH GhNCGh dG Ge EG G GW h .WdG Uh Y G VQ SY HG Y dG GdGh Le HGG b dP dG WCGh G MQ c HG Lhh njr n e Gfo chn p sdG rY ogsa dn YCGn or sdG dn nsjRhn ppce re dn sn Jn bhn OKn hn Gk OYhn )p p r o n p n r n n ro nr nro n r p n n p ro n rn n on(39) Hp S Gn p n ofc ehn VQCn G Ghn Sa n un dr Hp Se ogAL dn hn ne ngnh nr Yap hn nhQbhn (38)n n p r p on r r n pn o r n n rn nnr o nor sdG Jr NCGn re r ehn r sdG Jr NCGn re r ehn k UM p r n Y n r SQCGn re r pa p p fr Hp fn NCGn var ehn nro p o n n n ro pono n n n ro p p n n nr n ro n n r n onIQS ((40) np jn fr CGn Gfo c rdn hn p n dp o G nc ehn n bZCGn re r ehn VQCn G p Hp n N reo r ronon p ron rn n rnr n ro p n rrn n n dGfH gNCGh ,HGY Jh gOHCG c Sd HG CG ADg Y J j :G MQ adPh OY gh( k UM p r n Y n r SQCGn re r pa ) Sj HY fc CG ( p fr Hp fn NCGn va ) e p n n nr n ro n n r n onY ,dG IjT JY ,OdG IjT IOQH UU jQ JAa Ib e TCG e Gdb fCGJ K AdG Y EG VQCG e e LdG aa ,VQCG e Jh ,Y a VQCG AM jG 54. 55dG dG ,OK gh ( r sdG Jr NCGn re r ehn ).e f RYCG fCc SCGQ H fH a Na SCGQ CG Yono n n n ro p ,AGH AGS GdCS e e IdG Y fG dG bdG J Y ddG d Xh G Y eb CH ghYJh ,e eBG eh k U G f GhOJh gch fW Y GhSG H GeBG e Gg eh gh ( VQCn G p Hp n N re r ehn ),cGh e GUCG NCG U JAa gLjh gLj n rrn n n ro p NGh ,Z e aCG fCG YGh k Me VQCG eh ,YCG dG Yh Yh Hh W dG hQb Ya gh ( n bZCGn re r ehn ) ,edG j EG a j a VQCG QGHh H G a ,e rnr n ro pron rn n CG p n dp G nc ehn ) , e j a IMGh U GbZCG gNBG Y gOLh eg jRhh.`gG.jjCG c k bah AGL H dP a EG CG ( np jn fr CGn Gfo c rdn hn ,H a ao r rono n p Gn X njsdG NCGn hn se m MHp e Go eBG njsdGhn k r T n r fn eCGn AL shn ) J db dc bh o n p r n np n r n onn n p no sn or n n n H GJ fCG - YCG Gh - g SGh , Og IQS ((94) ppKL gpQjn O Gn UCn a r sdG n n r p p p o r n on p G nfr Cn sfEGp Afn e n dp Gn eCGn fn rCGn hr CGn fn DhHn BG o jn e fn rCGn eCr Jn oJUCGn r T jn Gdo b ) db o rn n o n nr p nnr o o r n n or n oo n n o non o Ho sa ) AGdG IQS Y Gk QNEG J bh ,SCa dG Aa , Og IQS ((87) TsdG nn o p d Gdb fC EG GP eh , AGdG IQS ((189) Y r jn GY nc sfEGp p stdG r jn GY ogNCn a m p n m n nn n op o nn r n n n fCG NCa , (AGdG IQS) ( (187) bp OsdG re nr c rEGp Ap sdG re k c n r n Y SCn a ) :dG Sn pp on p n p n r pr n T a ,XCG HS gh ,dG j GY HUCG c dP Y LG bh ,dG j GY HUCG ga ,e SCG e IjT VQCG e LQh AdG e U JAL K ,Y ghh dh Qf e GUCG ADa , Og IQS ((67) ppKL gpQjn O Gn UCn a ) LCG Nh ,SdG Vah ,GhQCGn n r p p p o r n L e GH G gNCG dGDS EG GLCG CG H GQSG GhSG GhUCGh G S Y YSCG.d YPEGh d YS d SG dG YCG SGM e Y e :AVd IQdG QKBG .UGdG h ,jdG h ,fG L GUCG Jh .H Y UGd jb Sh g dG .QfG U e Jj gh IQdG dG dBG d Yj fEa ,G d AG Jj Hh. Xh HSG Y Jj GUCG e U ch Jh AGdG Jh ZJ Y IQY a bdG TCG e T EG g e dG CG c e ie h (fdG HHP 20000 EG 20 e) GOOdG e e ie c W d dG PCG cQJ b fEa PCd dG iG Y dG N GPEa (jO 110 M 10-e) dG IT e c hCG JdG - hCG - a LH ahG gh jdG PCG cQJ dG GOOdG Z c GPEG.GL dY c GPEG e QJ hCG GL aN jG 55. 56M IdG hCG IG VdG OGR GPEG K (Adaptation) OdG EG ODj AVd VdG CG hGhdG e V EG iOCG cCG OGR Ea (Temporary threshold shifts) dG bDe V .(Permanent threshold shifts) Diseases of the ear, Ludman,H and Wright,T Oxford university press, 1998 p.487:J b M NdH edG j J G S bho rn n n nY hCG :e HQCG Y J HQCG hG GP dG gh Y IQS ( (33) sNsdG AL GPEp a )ddGh H CGj edG j c dGh .edG j ASCG e NdG :b SY HG Y edG jh :WdG b H gj fCGh j e PCG dG Gg KCG g NCGh Je dG Gg ce EG J a J CG :SCG J ,fdG dG gh ,edG Y J dG dG :NdG dG UCG h .bh IH J CG U GPBG J U :NdG :G b .AMCd H Yj.jdG dG :dG .fEG H gdG AVdG KCG Y fEG aY e hCG jBG g fc Qh dG Y dG jdG jG H a EG ODj AVd VdG Ea jdG MdG eh .NGdG PCH bd edG OGeEG GJh NGdG PCGOGOj ddh ,AVdH jCG KCJ G AYCG H EG H PCG Y JG dG QV bj hh ,dG e OGOj ,jedG YhCG J ,dG j ,dG V Jjh ,dG HV edG dG e GOTQE ahh.JG dG H G ehe OGOJh ,G Fc GJb ,YLG bYEG EG ODJ CG ,gQhH ,dG QKBG g" Ea dG AVdG Y"OGGh ,jhOCG SG IOjR ,SQGh dG Y dG ,SGQdG dG b ,LfEG OK b .dG BGdG e Ic bGe e b cP M dH gCG e OK NCdhGUh M jH IQMh Jh Y f Gfch KhCG hj Gfch Og b OY H Gfc dGk Qb dp S re nhsJn VQCn G cCGn sHn hn OY Hn re An N n L PEGp GhcPGhn ) :J dH BGdG ao o n o o p o p p r p ro m n pr p n n o ro nn r oorg d HCG CG GYCG IQS ( (74) njre VQCn G Gr n Jn hn G ABG GhcPa k Jo Ho n G nor Jn hn p p o p r p rn oor n n rp p.eMEGh fJEG h U bPM CG gQa JH G e Jh QdG dS J VQCG jG 56. 57dG dGre nor Jn hn (148) ng r W rfn hn hQRhn (147) moYhn sL (146) p eBG n og ng e ncoJCGn )p pl p no n m m ooo m n pn p n p o rn n p r or n r nhorjo njsdG (151) ap G e o pp ppnCG GoJ hn (150) WCGn hn G GsJa (149) gpQa k Jo Ho n G p o p o n n p np rpAGdG IQS ( (152) np jo hn VQCn Go rp r GHo oJ sKo o hn Sa ap cn SGhn VQCn G re cCn fCGn n og o Z m dn EGp re dn e G Ghoo YG r b jn b ) opr r n n ronnr r p r p ro nor n p ro nr p n n n CG gQY Lh VQCG e cCfCa N dG g CG (Og IQS) ((61) jb uHQ sEGp p r dn EGp l op l p n n fc d , dG IQS ( (9) OGn dr Hp rsdG GHo L njsdG OKn n ).QdGh hQdG e a gcYCGp nn p n o SCG Y ,G QU dG f EG GUJ d M , GQG e gQ HV OK IQM HdG IjG e Jh jG H G dG EG Fb dGRe dGh dG Sg e bO gNCG c Gdh ,d eT jh .IdG ec SfG c AdG dSQ Y YLEG dh EG gH OJ edG e IO Id Y a dG UCG FXh Jh SCG SfG jW Y. W ,e MGdG e b a QG e dG j Gfa ,jW gQYCG fc dU b CG cP bhJ b c GdGh QGdG e eCH FGR SMEG j dP ch G JH d Ga GTCG H dEG MG h N Z e CG , G IQS ((82) p eBG k Jo Ho n G re nor jn Gfo chn )n p p rp p pn.G e fj Gfc dG dG H gJCG eCG j CG h Yh GHhdG Sh Uh Y gKCG Uhh gEG Sh Uh IOe GQeCG Mj cgEG cP dG jBG eCG d:G:e Ic UhCH Uh a gEG Sh eCG : dG AT c Uh ,YU c U a AdG e U : bh jL U : b jdG dG gh .GJeh Hb a ,VQCG :ZdG .dG e dG CG ,d IRhG hCG ,ZdG dH CG : IOb bh . ZdG dH CGjG 57. 58: eh ,G IRh : dGh rn p r o n n o rn n n n .G RhL CG , bG( (11) p jn Qp G cn r M AG W s sfEGp )HPdc Qe a ,dH . G bh . fdH .g bh . YdH ZdH .dG bh GgCG CG jR HG db : bdG bY ZdG EG . bh . gch fH GgCG CG . adGh bdGhZW d bh .hDdeh H GVQ fC G g EGh ,GMGh ch ,bdG Y e ZW Y bCG.Hfh eYh gGOh ,dG jhGQ a :j c :dG j GYHUCG SY HG b , AGdG IQS ((189) Y r jn GY nc sfEGp p stdG r jn GY ogNCn a o Ho sa )m p n m n nn n op o nn r n n n nn .Ga H U GhQU a .H Gd dEG GHa HS fS G SQCa jT M:LdGgYO CG T j a , GYCG IQS ( (37) ppKL gpQGnO Gn UCn a LsdG Jr NCn a o Ho sa ) n n r p p o r n onr ro n n nnnG e LQ U a ,Y ba f jL CG dPh LsdG Jr NCn dG Y GY a z nr ro n n n nr ro n ndG GS M fCG dPh ( LsdG Jr N n nCa ) db da ,fGHCG e MGhQCG La VQCGhm p n m n nn( Y r jn GY ).e ea VQCG H La ,d GYa eb Geb :YdG((17) no jn Gfo c dr G Gdr G YU Jr NCn a i nodr G n Y dr G GtnSa ogn jr nna OKn seCGn hn ) pr n np p o p n n o n p n r o n n n n nnn r n rn o o . a IQS :eedG nn .dG IQS((14) ngGsa pp fr Hp tHQ pr n Y ne na ngha o Ho sa ) n n r n ro n r n n r n onnn:dG GQfG Y JG QKBGSh e OG CJ dGh ZdG e Fg Le Y IQY fCH GQfG JY Lj G c O dP Y a Fa YH jRdG dG EG U Sh dZ hCG FS . LQO 400 EG J b dY IQGM g Y bdG g e AL Oj .QfG e LG g gjG 58. 59dG dG G e dG H e j e gh dG Ac jeg g CG , eDG IQS( An Z ogn r a )k o r nnnp p r or p p n n n n .dG IQS( (31) nG c Gfo a ) Jh j dGh:JBG QKBG Y Jj G dG e e H EG dG jj NBG AGh FG HUEG .G Y ITG dG Le S - CG LQd (dGh G) G eCG LG Jh Yh d FM OLH eG gKCG jj - OLe Gh f g M d Jb j CG AGdG M d N HUEG EG ODj dG QfG g J b ,eCG IOjd G e JH GH bh OK CG g bQGh .U Fc cY S eCG M dG CG cCG dG BGdGh gJh Y H d G KCG jGJ S f G.ba dG OLh EG aVEH Gg ( gpQjn O )r p p p I fCG Gh ( mGn a re dn e ) d edG IG Yh ( p n ZsdHp ) dG Ib Y gQV j - n p n n p.dG Le J dG dG Le Y dG dG Ib Y j c ,a J .(dG RG,FdG ,PCG) j Y dG AYCG SSCG QdG j - jG dc KCJh ,SdG PCG Y J hCG J CG h PCG W a PCG eCG-o KCJ IjdG G h ( sNsdG ) dG Xh Y c Gg KDjh NGdG PCG G dG.Og IQS ( (67) ppKL gpQjn O Gn UCn a ) {jh fRGJ fEG a RGdG Xhn n r p p p o r n ODJ dG IOjR CG dPh GQfG H IadG SCG TCGh NCG e a FdG HUEG eCGh- Hh PSI 75 Y cCJh PSI 30 Y CGJ a FGdG jG GQ h jFQ ec EG Ib (dG - FdH e c) jedG YhCGh (AGdH e c) FdG H fhG NG j jQh UM JG j h jQU af J Shearing and tearing force j b e S g FGdG UGh jedG YhCG H QSdG Ggh Air embolism FGg L Y AGdG GH J CG LdG fjdG IQhdGh dG RG e LG WG C IG adG dG (GJeh Hb a) Y G VQ SY HG b dh .IadG Y Jj NGdG.GNh GQV bCG a dG RG HUEG eCG .bH dBG g j OjjG 59. 60LdG :FG HUEG HJLQ EG ODJ G dG e GG e EG dG IOjR Y JG dhCG edG Le EG - .IdG Rd He VQCG.KhM cCj PSI 200 Yh IadG hM j PSI 100 Yh fSG j PSI 40 Y -e MGhQCG La VQCGh G e LQ U a ,Y ba f jL CG dPh - (LsdG Jr NCn a ) :db da ,fGHCG nr ro n n njG 60. 61dG dGjfdG HUEG dG HUEG EG ODj b QfG ce Y GH abh AT c KJ EG ODJ dG Le EG -.bQN Z hCG bQN HUEH.T HUEG g Ea QfG Yd Gfh - KdG HUEG.ce Y GH QfG H j M jb EG f dG j gh -.jW dG aOJ e Y g HUEG Jh - HG Y dG QKBG :j a HG Y dG QKBG EG Gg e fh.LQCG e LQ hM .KL Ybhh fRGJ NG.Jeh Hb Jh U e j e gh ,dG Ac jeg g CG ( An Z ogn r a ) dGh Adc gOLCG Sjk o r nnn .Jh j dGh G e dG H p p r or dH IM d j LdG g ( nG ) SY HG b G c f H gKJ .IOb b gh ,bG IdG dc jCG Yh .dG a dG SGOh dP e S a ,dGh IG e KJ e g :QdG S bR .jQ j G e KG GdG g :L H S bhq Gfc fCG SY HG Yh .g a WQ c AT c J dG :jR HG bh ,dH HV GPEG .dGh dG a dGh,YQR Y IM j dG Gg Y a ,gh jO dG dG eadG e j CGh MCG a dG j jdG e j CG Lh Y G CfJcHh G MQh Y dGh jG 61. 26 jG 62. dG jG dG RYEG Lh odG H nY jdGl o, J G EG Hbh ,b dG rCGO fEa , dG H nY )l l(G Y AGd IOeh d Jh, KEG Y IehSh Y G U G SQ U( 3549 ) bQ S edG GhQ ) dG a Y .OjG 63. 64 eeQS eh Uh dBG Yh , G IL dG MCG e Y dG h IdGh , dG Q GfGe h fCGo e JGN Lh , f SdGh jG jCG e a . jdG j EG f YZCG , G H aCGh , MGdG H ZCG NCG j a , f BGdG IhJh , fHh gf cPh ,. dG H aCGh dG HFH d G Ea k ehDfp Jh d jdG NhJMh JGOY SQ LG EG , AUCG g h dG H J bh k SfCG La fe dG b Yh j YdG Gfc gLCG H GPEa HT Y dCa , W e mM EG Im QH . dc G a , HT G GM ADg ,, G a . aGpHG / Gh dG eL) . dG d G a ,dG gM QGL g :b e Uh ( 225 U dSdG SDe - G LQ: ( Sh Y G U ) dG dG b a Uhll l o nd Jh , KEG Y Ieh , J G EG Hbh , b dG CGO fEa , dG H Y))- re -dG M H S O `g1420 edG dG - dG gQ (1)((G Y AGd IOehl e L H PeS ihQ M Y G VQ Y H G Y gh Sh Y G U G SQ CG H PEGh .j c d G Y LdG f )) HC b Sh Y G U dG CG HCG Y Y H G Y H oHdG Fa " eh " 1122 bQ dG b a " } 2 H{ dG QdG GhQ ((dG eG HS S dG dG a ( 6370) bQ Y G VQ Y H G Y Fa e (31) H "`g1422 hH jdG G 222U 221U hCGMdG e Y AdG AdE dh EG e dG G Gg eh d Gd QNG c g ehG a k HGU c a jdG jG RYEG Lh cP dh K , dG MdG e K , YdGGe dP j CG Lh Y G GYOCG dP Y G SCGh dG eh f a CN c ehj CGh . (AGdG 89-88)(3)"S H G JCG e EG -H h e j j" ,dCG j JM S e c Qj CGh , e c G H G . dG Q G CG fGYO NBGh.dG jW Ghj jdGh dG jG 64. 65 dG dG dG N:a IY Y dG TG .a AdG GbCGh Jh MTh jG d N bh : hCG dG:Me K EG bh dG dG a dhJ bh : dG dGYGfCG h dG Y/ hCG G-dG Lda Y / dG G-dG HGVG Y/ ddG G-. GdGh IQdGh AVdG Y TG bh : ddG dG:EG bh, eY H IdG FGa Y : HGdG dG hdG fGh IdG/ hCG G- : AGLCG KK EG bh / dG G-.Fd jMh IdG : hCG AG. dG IAch IdG : dG AG .dGh dG VGeCG Y gKCGh Idc dG : ddG AG .OdG FGa :eG dG . AZEG OdG / hCG G- . dG Ve Ye e dGh OdG / dG G-. d JFah OdG / ddG G-: Me K Y TG bh dG : SOdG dG . YG RL jJh dG / hCG G-. dG IU IFa / dG G- . AT BGdG h / ddG G- jG 65. 66 . AYdGh cd SG IFah LddG YdH bYh dG : HdG dG. jG dG RYEG Ld N bh : edG dG .UdGh GhCG dG dG H YdG d fYj k BGdG79 jBG AGSEG . " GO k ee HQ j CG Y d af H a dG eh " : J bG EG ODG jdG g Gg . H dGh BGdG GHh H BGdG X b S PSCG b . OG ( 62U 15 ) BGdG X . Gk O k ee d BGdGh dGh IdH eDj SdG c EGhf J a , j gbRQ h k Wh k aN HQ Yj LG Y HL aJ " : J jh17- 16 IdG " j Gfc AGL YCG Ib e d NCG ek G MQ jRG dG H b . f J d NCG dG AGH dG b e NCG e Hb c eCJ. G YCG IH dG IU EG ej M Le Y HGVGh aNh b Hb ch ( G e 278 ` U jRG dG HE GaCG OH EG GhQCG OM)H ... BGdG X " b S dG bhMGdGh ObdG EG G YJ dG LG IQU Sj ".. LG Y HL aJ .... " k kT , jdG ObdGh , dG LG Y NBG T d C , J G g dh H PdGhkG GY e G .. ALdGh G YRj N dEG LdHh JM bdH T HHVQ dGh Z e Gh MQ ALdGh : dH BGdG Y Y aJ dGh e e Gh jG 66. 67dG dG" k Wh k aN HQ Yj " h " IcRh YW G Yd LGh hODj QG AYdGh SG g fL EG gh" j gbRQ" ... YCG Ib e d NCG e f J a " MCG Y j dG QNG OGYEG dG JGH dJh dH fS G IhM Y j Y J Vh IQd fEGh , d Y Fd j Y HUC j M Gk Qe UN Y j dGh , GS.. G IM dG G AdG Gd JOY fc e ADg g eh a e gj GP ch , ec e OY Y G j GP c... G j. G dG G a fCG d jYQh jY AGL e d Nj e OGYEG dL L G j M 107 - 106 U dG(17) jQGdG " j e dG e b Gfc " : k jCG jhkk kk JJ BGdG JQh Y OR hCG - b e fG hCG f - b EG dG b - eG jCG j " : NBG AGfh cPGh jW k S QdG d EG - b bCGh k Wh TCG g dG Tf EG - K b Y S fEG - kk k kk ( 8-1) eG " . J dEG Jh HQ SG : JFa a eG jCG j : WdG b WG : gGMEG 682 `U 10) WdG) . a J G cPh dG b EG d d bGQ ee d dG : k fK( 6825- GPEG HdG Cf e JJh J CG IOdG EG e e CJ dG g dH TdG dGh (( 176 U 5) dG dG) . f GPEG fe e Cfh , JQG , b Sh Y G U G Sd b 177 168 U" H " dG b S dG bh. G IYO Y k Fb X j k eY jY e cCG k Fb gH X .. a e a b dG AdGh dG eCd b , G dG Uh AdG IYO fEG ".. b eG jCG j " . MGdGh dG Y AdG j dG dG eCa .. Gk U h Gk U j dh k je j b d j dG EG jG 67. 68G VQ j a Gg Sh Y G U dG Y d ? MGdGh d eh ? dGh d a dG: Y( H 177 -168 U BGdG X ) . " jN j dG Y e " . dG b fEG fe OGYEG FSH idG d OGYEG EG " dG b"k k" K b Y S fEG "H eCG Gg Y eSG EGh jW OGSG EG j d HSGh QdG e dG Gg J EG . jW OGSG EG j d g hCG g GG hO , OOJJJh . " e IMdH fCGh H JGh edG IG Y Y fGh f SdGh dG b EGhjh Sh Y G U dG dG j dG dG dG M OGdG d cS dGh BGdGdG dG eh dG SSh e j h dG jdG jh L c IYdG H Yj e . G jdG GH aG" b bCGh k Wh TCG g dG Tf EG "kfCGh G eC HSGh, hdG Id YEG dh k Wh TCG d TGdG HPLh dG JGg de EG k . YN a Idh JhM a cd C b bCG a K eh H " jW k S QdG d EG " k . dEG j G EG g a dG Hd jh QdG aGe b e jdG e FWh fCG ... BGQ fEG " ..... e jdG e FWh ... j HQ EG .... " . G AGf Sh LG Y HL a gh fCG j HQ EG , GjG : k fKdG d fYj e k jCG jG OQhh, J G EG Hbh , b dG CGO fEa , dG H Y Sh Y G U : SQ bl l ro n l. G Y AGd IOeh d Jh , KEG Y IehlUh , ( 205 / 2) idG dG dGh ( 308/1) cG LNCG U jM : jG jJ jG 68. 69dG dG ( dG ) GdG GhQ : AMEG jJ bGdG aG bh gdG aGhh QdG T Y fdG HCG HGh 18 U dG b f HGh( 3549 ) bQ S edG Gha , M H dGh ( 1 / 61/5 ) eO jQJ cY HGh ( 1 / 30 / 1 ) dG jG T " b : Sh Y G U db. HdG dG Y XGh b IOY g CG : hG b d dG CGO Y (Hb) j h H JCGh k fCT d CH fGjEG HdG f , G EG Hbh" jdG j c fdG j fCG FGdG e dG h : G HG b . jJ je Y dSH FG iJh , dG jh dG gjh , LdG jh QdG Qj h , IdG e G QdG UdG( hd jdG a - ). AdG e d QdG cdG iAGj c AdG Ve J G EG Hbh G EG CG Y G VQ Oe H G Y b bh ch , HdG YCG e g dG EG k M Y G a IdG EG b K CVa , QKOh ah TGa e IOQH d b MQ : LQ EG j . Y Th Y e ALQ HQ : da ? U e Y Gg Y M e : F Lh ( dG G GdG GhQ, M OSEG ) .. j eCGh , LQ e YCG b Ea : a e MCG GhQ ) .. Y M a dG e G V GPEG : Sh Y G U G SQ bh (K dLQh MhQh j Y EG GhfG : j , FG H G gH Gk LS dG f GPEG : dG G jh .( M H MC gdG) " LS gh Y gCG g BGdG gCG: b Sh Y G U G NCG c , G gCG g BGdGh dG gCGh{ ( . UNh G Y " ... Ie MV - Ie ej Lh " Qf e dCa VQ f e e dG bG ch( 39 38 ) e Ga e c Y j Gk Qf Lh G a , dH d LdG EG G H S bhjG 69. 70 ( GN H dG IdG c) . LdG Gg MC EG a b je S HCG j : d LQ b :b da H QG Y } ( 122 121) U{ dG c ALhaCG G EG HG H j k T YCG e : b ? YCG e J G EG dG H j e aCG . IdG EG dG L dG b eb dG CGO dG bRGMEG GhLGh , HdG sdG Y XGh b IOY g ( 351 /4 ) jdG a hG b. aj bh eb U dG cQOCG jCG dG Y e H Y c" Y G VQ SY HG b. " ( 16 / 2 ) jdGh jGdG " . dG M, dG f j c OhhGO U G EG dG MCGh OhhGO IU G EG IdG MCG ) jG ( GN H dG IdG c) . "( . k ej jh k ej jh SS jh K jh d J dG b? G GHCG Y dOCG CG .... " : L H Pe jM haJ " CGb K , dG L LdG IUh , QdG AG j c G J bdGh , L dGjBG " ... LG Y HLKEG Y Ie dG bGPEa dH j k fa EG : a Sh Y G U dG EG LQ AL : b Y G VQ Ijg HCG YEG T dGh G MCG GhQ, U OSEG . " J e S fEG " a , S UCGU OSEG dCG bh (1237) bQ jM "IG" G Y AGd IOe dGe G QdG UdG jdG j c fdG j fCG FGdG e dG b h : G H bc AdG Ve FG iJh , dG jh dG gjh , LdG jh QdG Qj h , IdG( ( 351/4 ) hd jdG a ) . AdG e d QdG cdG iAGj jG 70. 71dG dGf g GPEG cMCG SCGQ ab Y dG j ): Sh Y G U G SQ b: b t Ijg HCG Yhro CVJ Ea , IrY fG G ca SG Ea , bQa jW d Y: I nY c Y j Y K o rno( c dG N UCG EGh , dG W k f UCa c o Y fG U Ea , IrY fGono odG GK HGdG G ( cH dh dG Y Ga ) NBG OGRh N HGh eh QdG GhQ 71 `U / WedG jdG T aG eEd ddG dG dGjd dG dG ( YGfCGh dG ) hCG G -1( dG Lda ) dG G -2 ( dG HGVG) ddG G-3( YGfCGh dG ) hCG G NHh dG GQhO Y Wf LQO hJh cS dh f W dM g : dG jJJLQO hG dHh QGdH J , dG dH fQe LQG GKDd HSG VfG e dM gh. a NdGh e : dG dG e g e k. YS hCG YH ( j hCG jj ) d YS 8- 7 e hGjh NC T e hJ16 . YS 5 NBG dG Yh YS 10 EG j b dG Y dG dGk: e fGG YS 16 e cCG GWdG H , YS 3 e bCG j G jG 71. 72 Shapiro C .M dCJ BMJ puplishing group fh ,( ABC sleep disorders ) c e. H dfG IdG g Jh dG dM EG edG dG dM e k jQJ fEG j dG jGH Ic QaCG SdG Ia Jh dGh dG SJ dG SdG IHdG GfCGG dG G Z dG k G Z dG " hCG"dh dGh IG H Y Jh LQO HQCG Y IQY gh c dG e %85 80 GM j... . c dG e %3 - S gcCGh Ie gbCG : hCG LQdG . G J e T e gh hCG e k Y cCG hCG H fdGh4 + 3 { %15 LQdG YCGh ddG H " HGdG " %7 k Y cCGh fdG H " ddG" %50 Jh(1) }dG dG = : G dG " k fK"gOY hGj GQhO Y IQY eY IQH dGh . MCG dN h c dG e % 20 15 jh } G dG j G Z dG e IQhO c Jh . b hCG dG W M GQhO 6 -4{ e jG 72. 73dG dG GQhO J e k jQJ bJ JLQO h G Z dG Ga W CG M , bO 100 90 dW LQdG J dG bh dG Qhe e dh . c LQO HQCG J fdGh hCG JQhda. dG. dda HGdG G dG Ga eCG k.. G Z dG Ga Ie bJ dG YS e e CG dG bG c W OGOJk - hCG dH fQe NCG dG MCG Wh Ic j Ggh W G dG Ga OGOJ 22-21 U h Y GS /O dG HGVEG: dG UNh k Y bCGh hCG dG k Y cCG j dG dG CGh G Z dG e g dG e CG Gk L f e hP fEG fCch jh d dG e NCG dG JCj G dG e CGh . NCG dGk 2nd ed- Kryger and Dement Principles and Practices of sleep medicine . e H1994. .p p Y J dG dG GQhO Hh dG dGh JdG H bY K g g : gh CG DhJ f gh? k HS. f : g HLEGh eG k fMCG H , dG GQhO fG Y EG jODj ( Stress and Anxiety ) dG dGh JdG EGjJdG ie fG EG ODj dG( hJQdG ) f e jj JdG C dPh . dG e HdG QG - QCG EG ODJ dHh ( Leukotriens )(dG Lda) dG G .(cS) dh,(f) W dM g dG CG EG IQTEG S. FdG Y CGJ dG LddG GdG g e :Gk PEG .(CNS) H bYh dG Lda.1 .(Pulmonay) FdH bYh dG Lda.2.(Heart) dH bYh dG Lda.3 jG 73. 74.(G I T) dG RH bYh dG Lda.4(CNS) H bYh dG Lda :hCG kcCG LQH dG jL OGOj (REM) G dG H ,k eY dG AKCG G EG dG jL OGOjIOjR ( NCG dG CG ) G dG Me ddh , G Z dG Me CG (NREM)e. G Le W : QG(-Carskadon, MA, Dement, WC. Normal Human Sleep .An Overview in PrinciplesAnd Practices Of Sleep Medicine,2nd ed Kryger Roth and Dement,PP.16-25Sounderies 1994 k.(Pulmonay) FdH bYh dG Lda :fK . bdG dG Ge OY j (NREM) G Z dG ( CG ) .(REM) G dG ( ) . dG Ge OY OGOJ . dG fG Y .(Mucocilliary Clearance) f . dH FGdG jH cCG e f : QG(-Carskadon, MA, Dement, WC. Normal Human Sleep .An Overview in PrinciplesAnd Practices Of Sleep Medicine,2nd ed Kryger Roth and Dement,PP.16-25Sounderies 1994.)k.(Heart) dH bYh dG Lda :dK (NREM) G Z dG Me( CG) dG V j jG 74. 75dG dG dG f J dG HV fG .(REM) G dG ( ) dG OGOj dG f OGOJ . dG dG e Vf Zh e Z f hN CG (PVCS) :QG (Carskadon, MA, Dement, WC. Normal Human Sleep .An Overview in Principles And Practices Of Sleep Medicine,2nd ed Kryger Roth and Dement,PP.16-25 Sounderies 1994.).(GIT) dG RH bYh dG Lda :HGQ k k FG dG KCJ (Gastrin and Pepsin) dGh jSG RGaEG OGOj d dG AKCG jG bJ b BGh IjdG VG EG ODj , IG VM OGOJ dd fh , (Vagus) d M bCG EG jh d d M bC j M edG jEG jH G eG Rjh dG e John del Valle,peptic ulcer disease and related disorders. . dG e hCG YdG Jh 2001-1650 page 15th. Ed. Volume2 Harrisons Principles of Internal Medicine Y dch . dG e NCG dG CG ) G dG Me ( H C L) G eG RGaEG IhQP Carskadon, MA, Dement, WC. Normal Human Sleep .An) AG cMh dG j dG 2nd ed Kryger Roth and,Overview in Principles And Practices Of Sleep Medicine (.1994 Sounderies 25-16.Dement,PP( dG HGVG) ddG G( Parasomnia) G dG Me dG HGVG H g - Je Fe Y jdG MCG Conventional Sleep dream (1) . G dG M. dG HGdG Night mares (2) jG 75. 76YSh dG N e fG h G eY Y Jh gH jG j : MCG . dG. Sleep Paralysis dG T (3)jh dG GY a cG Y IQdG Yh dG dH fEG j ah G e baEG H . dG. SCG H k fMCG Gg jhMG cdG HGVG ( Rapid eye movement sleep behaviour disorder) (4). G dSdG H dh G dG Me AKCG dG dH " dG Y GY" G Y c JiPCG J bh Y GMCG J k fMCG M H j e e OdG ec Z dG j .d M e cj CG jG jh . e j e hCG HPeduncular Hallucinations : jdG SdG (5)Me H NGJ e J gh G jY VGeCH Je jdGh dG SdG e IQU g . dGh G dG : dG GdG (6) ( Cluster Headache )ef jh JM U Fd j fEa , G dH dG GdG JjdG HdG (7) UNh HdG Hf EG ODj jFdG GRGaEG cGJh dG Gk f d HdG VGYCG OGOJk ( H 66-58 U h Y GS / O dG VGeCG) . dG e hCG YdG jeh je eSGQH (8) : jG G LSG -CGbh . NGh c e dG UNh ICa jG jh c e QdG VH SMEG.VGeCG) . AG EG IG j LSGh IG VM IOjd Gk f .. dG Ia Y QG j ( H 66-58 U h Y GS / O dG k(Parasympathetic) Oh dG RG IS f d IG VM OGOJh : IG Mb - jG 76. 77dG dG dGh ( pepsin , gastrin ) RGaEG IOjR EG ODj dGh ( Vagus ) FG dG IQKEG jW Y John del Valle,peptic ulcer disease and related disorders. Harrisons - MdG EG ODJ 2001-1650 page 15th. Ed. Volume2 Principles of Internal Medicine: dGh dG H bdG (9) dG bCj . dG fEG .. dG f IOjR g j ( R.E. M) G dG Ia AKCG Carskadon, MA, . dG jhJ f EG Gg ODj LdG QdG Ve dh .. IOjdG g e Dement, WC. Normal Human Sleep .An Overview in Principles And Practices Of(.Sleep Medicine,2nd ed Kryger Roth and Dement,PP.16-25 Sounderies.1994 Obstructive Sleep apnea dG AKCG OGfG dG fG eRe (10)syndrome QJh dG c e IQe Ga Y IQY gh ) cCa GK Y I AGdG fG bj ah dG Ga b EG ODj IMGdG dG Ie 500 hCG 400 ) EG Jh YdG Ge N GM , dG Gg Y d dG HV IOjR EG ODj dG cCG e j dG AKCG h IOjRh dG M ch , JRdG J : e S C OGfG hCG fGH jd jdG UTCG jh. NdG G W ( dG AKCG dG fG j c ) dG AKCG edG gJJ Jh fhe OGOJ M SSCG dG Y L JJ dG AKCG . ( dG Yh LG G Y ASH ) G Y JJh , j cCG fe gY G Y CG VG ADg dG AKCG Lh dh dG EG ODa FGdG iG S EG ODj IdGh dG IYb e jdG NdG Gh dG . dG fGh: VGYCG. jQhe OGM JQG J bh Gk Qf SdG Ic-1 dG Ga d Gk f d dG e eG-2 k jG 77. 78 dGh dG YS h cdG Y-3dG V JQG-4 jQdG HdG-5 ZedG dG-6 . dG HV N-7jd dG V JQG Ve e % 40 , dG V JQG jd ADg e % 96 50 : CG LhEliota phillipson- sleep Apnea .Harrison principles fnternal , dG AKCG J OGfG. medicine 15 th edition, volume 2- 1520 - 1523: eg XedG ICa G j WCG Y UN dG Y dG j dG AKCG dG OGfG GgY dG aCG EG dG jG dEG QTCG c CG dG Y VG M Gg e jh , hCG H 126 `U h GS /O dG HGVG . CG dGdG AKCG dG OGfG Ye : dG dG -1( ce bQRG dG V g) EG ODj cCG f -( HZ cdG b jdH YQ dG IOjR GU ) EG ODj HdG cCG K IOjR - ( FdG jGT dG JQG )pulmonary (H T N)-2. FdG jGT VfG EG ODj QG cCG f C - . FdG jGT dG V JQG K ehK bdG QJ e CG AG Xh a K , dG e CG AG J EG ODj bdG Qhh(cor pulmonale)V j e VGYCG gh dG FGS h dG JCardiac Arrhythmias-3 Hypoxaemia SH j e EG ODj dG G Y cCG f jG 78. 79dG dG Hypercapnia ( dG HdG cCG K IOjR ) h M , dG HV IOjR h dG HV fG Y):e dG HV NG EG ODj QhH Ggh( dG bJ CG ( cardiac arrest) SH j e EG J k fMCG(cEG LddGgG h dG AKCG OGfG dG fG eRe hM c Vj VJ SQ)Eliota phillipson- sleep Apnea .Harrison principles fnternal medicine 15 thedition, volume 2- 1520 - 1523. Central Sleep Apnea Syndrome (CAS) :dG AKCG cG dG fG (11) . NCG dG IOY j dG h ( R E M) G dG Ga AKCG HdG cCG K IOjR a jh , UTCG HQCG c e k T Lj M G Y k YT cCGhHypercapnia (CO2) . -:e Ye EG ODj dGh ( Hypoxaemia) chCG fh ,dG b e jG j e IOYh , dG e CG fG gh FdG dG IOjRh dG a jG 79. 80. dG Gd I U dG j h ,k MU jT GU h, AYEG IOjRhGk c OGOJ YG Ea , dG e j j ( C S A) M GPEG fCG KCG jM SGQO ghdGh (ecJdG) IOjR EG ODJ dGh ( Sympathatic) OdG dG RG f IOjR H d . dG je EG aVEG iNCG Ye EG QhH ODj. dG Y Qb Hh , dG AKCG chCH djhEliota phillipson- sleep Apnea .Harrison principles fnternal medicine 15 th edition,volume 2- 1520 - 1523dG h dH bYh fCG G (12)H J dGh fCG jd GOGeG f fJ dG h LdG Y FGg ZGa Y IQY g K EGh bdG Y SCGdG Rh J G g Xh eh . jJ a H a jW Y.dG h hG Q a KCG d j bh RdG : GfCG HQCG ghIOdG e CJ ( Lh ) - Maxillary ( HZ ) - Ethmoid ( dG e ) fdG ( L )- Frontal ( dG e ) HdG ( Jh) - Sphenoid fCG G RJ dG jG h HdG jG gh fCG jN e jH G g JhProducing Goblet cells and Ciliated Cells Mucous . fCG G a EG J ( Mucous) GRGaEG gh . (Cilia ) g H bdG S/1 YH ( Ostia ) jG 80. 81dG dG: fCG G dG SCG ge: g hCG dG d fCG G e GRGaEG f e ( Mucociliary transport Time) IOjR - . ( Ostia) fCG EG. GRGaEG SMG EG ODj dG h ( Ostia) V -j FKCGh OdG H HUEG H MCG dZ FdG dG gh ShdG -h GRGaEG IOjR h ( (Mucosal Oedema & Ostial Obstruction . ( Mucous Trans part Time) NCJ CG ( Cilia)jH jfK HUEG ShdG HUEG j be NBG eY fCG SMh idG SCG dG S G H gh k ) WG AdG QJ OGOa (Mucociliary Clearance ) j d dG AKCGh a ( Mnucosal Oedema k Mucocillary transport ) NCJ e fCG jH fCG G jJ a CG ( Ostia )( time VG Gg VGYCG eh , fCG d jdG VdG M LdG GUMGG NdG k fMCGh , G h , SG GOe h jG GOH djh Marlene Durcinol , Michach joseph, infection ot the upper respiratory tract Harrisons Principles Of Internal Medicine,15 TH Edition - Volume 1.2001- Sinusits -188 jG 81. 82(Me IY jh ) ddG dG( AVdG h IQdG :) hCG G (11) jBG fCG " H cd Ae AdG e Y jh "fEa , aa IQW Y GJ CG SG EG H j " de H fCG Sh Y G U dG UhCG bh/ O OQhCG bh 26066 jM 29319 dG c edG GhQ " IOdG YCG AVh Y gh G JCG egEG WdG GMCG Y IYG eGdG e CG K d " db e eSEG dG f VdG MCG . SdG AYCGh dG ah dG JkSQa /O " jbhh U IdG " c Y f IdH ASG Hc eGb gR /O OQhCG dh . H 58/, 57U GYjG OcCH AGhdGh dG H AYCG e ) jQSEG eL AWCG e ja iLCG: FdG fch dG MdG e AVdH dG bd k H " LddGh dG dHJCG H Ne Y Sj G gO Vj e dZ Y dG MT j " fCG WH ". Qb Y Ue dGh e dG bJ j dG cGO Ld " fCG a " , QdGh. HJCGh QdG e k dN k e dG a VG Y eCG : eKG QGd jG UdG XCGhG j eNG CG d e dG dG Y EG KGL Lj jYh jOY eKL GedG SG J HLhOe jFQ GQehj c , fCG JG L e WG GRGaEG jj Ge K QSGh SG CG cQdG e VG j QSHh dG AGg Wd HWdGh IhGdG d aLh jGAVdG CG c FdGh fCG Gh fCG SM j e IOY dG WG fCG AZ Y UdGdG RYEG g `g 1417 hCG dG ( eGb gR / O IdH ASG ) . G Fd af H 21 -17`U dGh BGdG jG 82. 83dG dG jedG IQhdGh AVdG. dG b G H j dG YCG MCG g IQdGh AVdG k dG LCGh , dG Jh EG IOjR : e , iNCG dG QKBG Y a dG QKCG AVdh . HdG dGa . QG Y AVdG SEG e H OQdG AH AVdG j dH dG UN AVdG AYCG hYh jGT dG jL OGOjjJ.dG Y G QN Uh dG jdGh KG AVdG jjh .. d. AVdG Y e k jCG jh VfH G EG dG QJ a .. jdG AdG dM eCG Oj Gd , dG jL OGOjh dH IQe Z a dch jGdGh hdH e AVdG AYCGh . AfCG FS cCG AVdG AYCG Y AG G IdG j AH dG CG dG dG a Hc f fg QcdG CG g IQTEG Qjh human culture) . dGh fEG aK Hc dH O EG QcdG cP c d WG ( and cure j dG dG f K ( calvanometer) efdc dBG Vh gH jLCG dG SGQdG dOh bWh U cCG IOQdG WG j jdG CG HdG ch G e L CG AG MIQG WG j jdG e Vj jdG e U FGa j AVdG GhOYG jdG CG Yf CG QNG Gg AV Yh dG Y QdG Y / O H e) KGG e dGh jG VGeCG BG J Y Yj c . H (1429 S -11 U hCG G HH dGh BGdG dG RYEd HdG dG DG ( GdG) dG G GhQ .. d IVe d Ie GdG : b Sh Y G U dG CG Y G VQ FY Yh adGh ( 34 /1 ) dG dGh IQdG (10/1 ) FdG h ( 124 /6 ) e MCG N HGh ( 200 , 199 ) bQ dG T dGh ( 159 / 7 ) G f HCGh ( 27/1 ) G. L S jGh ( 1067 ) bQ U M HGh ( 135) UjG 83. 84dG Y GdG j : ( Oe GRdG Y GY ) Qcd SCH jdGh GdG c ALhfCG c , dG jf V IQe SG dh Gk e dG j c d Oe KCJ IOG dh e dG jf h IdG MhL jh SCGh dG jOG e fe jRL Y IQY ghSinnigrin) ) OH bY d GdG IOe g CG c jRS EG ( Myrosin) IG IG SGH a h OGh dG S e "dCG " OG , dG`g 1417 hCG dG ( eGb gR / O IdH ASG ) . 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CG G Y dG j hCG dG Y G IOSdG VH Sh Y G U dG M dM ah , AGdG Y jCG h CG fG EG dG j dG e SG H dG f eY hdG h FdGh edG C MGSG EG jdG d h SCGdG EG dG V Y dG j OdGk Id J Gd, AYCG g EG dP dG ij OdG dM h ,dG ie dH JG . fEd U OHCG dG. dG hd Qj gh g, dG e dG G EG IaH k W dG e Gk c ij , WQhCG jQh Y dG ij eYh . idG d dH FQ QhH J edG e dG G CG M ic gCG d IgdG Y dG CG Y cG Gg jh ,( HQd eH PSCG fe L) QcdG cG G gh QGe EG dG ed dG G EG AedG S j U Zh ,W Z jCG dG iL b j h). fEd e a idG G hCG, dG Y dG GW dG eCG, dG e aGh . dG IUh dG b EG G AfCG EG RdG dG QdG Y / O HO dG h BGdG a dG RYEd HdG dG DG dG IU Ie. H / 8 -4 `U hCG G dG Y jG 93. 94 HdG dG LddG YdH bYh dG dG bh AYdGh cd SG e IFdGh96)(( dG jdG jJ dGP fM dGh dG h S dG Lh UEG da )) J bcCG dh SdG Y a hd G EG Ge QdG h a Gd dG d L dG G )),,,, ( fCG m(aZ 61) (( hj SdGm: LddG YdG Y KDJ dG GKDG dGh AVdG dGh dG - dGh AdGkGQf AVdG,,. OdG dG RG f OGOjh IQcdG egh hJQdG RGaE G eg RGaEG OGOj c ( hJQdG IOjR d jedG IQhdG dG V dG HV ) IOjR EG iODj Gg c11) ((Te QdG Lh )) Gk Qf TG Y dG e j cdG h dG IOjR EG iODj Gg.(CdGAdG Mea j , Gk Ahgh k S dG CG CG . aZ ( 61) jBG ((.. a Gd dG d L dG G ))YG J h d e g a OdG Z dG RG j h dG bO J h hJQdGbh IY Mf CG jh ,,, fJG eg OGOjh (jfLShdG) ANSG eg OGOjh jRYEG LddG YdG jW Y dG feg IhQP e aGj Rd dG h dG Id SG.1hJQdGeLdGJdGhjddHh,(QdG 58),,((IdGeHK J Mh)):ddG.2Gk Y HGdG CG M , (Gk Y 4 EG 2 )YdG e dH ie YCG EG j dGh , djQOCGhJ dhj dG OH fG M , G IQGMh dG fh dG JQG YCG g jj , k fh Og gH G d bO 40 EG10 e j ddG Ia CH dG e , ddG CGe k jG 94. 95dG dG GdG Y GaM ))fdG djQOCG b IQN e f j M dG Id SCG d GM . dG b Y ddH jh (238 IdG),,(( fb Gebh SdG IdGh dG RG Oj h ( djQOCGh hJQdG ) dG eg j h ANSG eg OGOj : dG.3. YG RL jh OdG Z LdH dL Ad AdG S G OGSGh gdG AU M dG IU b : dG b.4 jh Gk a HGdG b JQH CGj dG , hJQdG jW Y JdG IOjd VdG Y dG h IjL k jOe ILGh , IdG h AYdGh cdG M NCG dG G b GPEG dHh HGdG b EG G EG H dP JCG d GM jh fEG jh AhdG M , G jdG OGMh dG eRCG g KM GPEG H dP e M GPEG dG AYS jG j dG g AKCGh , dG Id dG HGVG h dG HGVG e G j NCG dG SHh , dG AKCG cG . LddG YdG GVGh dG Ga dWEG Y LdG dG RYEd HdG dG DG - ec S e /O LddG YdG jEGh SEG ig HO dG h BGdG edG dG dG b dG RYEG Lh. jgL QeCG IY dG Ldd dG VdG e jCGQG Z dG- bCG jh , MCG e Nh , dG h MGdG e c QH fEG a jh , hCG dG K JCjhm. NCG dG k Y( R E M) G dG- Lda GJ IY h . MCG e c ah dG e NCG dG JCjh . : gh MG g jG 95. 96k( Heart and C.V.S ) QhdG RG h dG :hGCarskadon, MA, dG HV fG jh , dG OGOj ( R E M ) G dG Me Dement, WC. Normal Human Sleep .An Overview in Principles And Practices Of(.1994 Sounderies 25-16.2nd ed Kryger Roth and Dement,PP,Sleep Medicine. LG G h dG G h dG V JQG e j G Ea d G b GPEG dHh.Ua j fEa d SG K f GPEG fEa dG jhJ f hCG dG V e fj jG c GPEGh dG b CG CG ---- . dG dGh dG jhJ fh dG IOjR Y VdG JYeh dGh dG VGeC ATh jbh : dG RH bYh dG b k fK , NCG dG G dG Me fcP c . dG fG jh , dG Ge OY OGOj. QdG h ShdG h HhG NO e fEG PfE J dG GgCG cM J (-Carskadon, MA, Dement, WC. Normal Human Sleep .An Overview in PrinciplesAnd Practices Of Sleep Medicine,2nd ed Kryger Roth and Dement,PP.16-25Sounderies 1994.)AKCG g a dHh , jZ NGO CG e d IQdG H Y j dG SQG H ghSGM Y SQG Z d c , dG RG Y LQN d VYId Gk f (Bronchiospasm) FGdG dG Vh , FdG GRGaEG IOjR j dcG SG GPEa. HdG eRC VY cCG AKCG g HdG je Ea dHh , OdG Z RGU dG UhCG c , a dG h SG AVdG eh , AVdG h GdG h IQdH CGj fEa Id, G SQ j b: b,, IU H d HCG Y IU H d H UY Y )) dH Sh Y G(( ,,,, k FU J CG EG SG dHh HUCG H Nh AVdG SEG, b ,,, AVdG Y NCG . 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HGVG g Y Gk H UC dG d G SG GPEa ,( H dG AKCG OGfEG dG fEG eRe e jG h dG b :k eN cCG fe G Y J VG ADg ah SSCG dG Y L NJ dG AKCG U h GS /O - dG HGVG ) dG fGh dG h FGdG iG S EG iODj j YG h G Y Gk H d dG e NCG dG UN jG SG a ,H 66-58 jG 97. 98h dG a h dG e dG G J , e dG h dG dG AKCG k HS cP dG IdG LG G h jQdG HdG h ZedG dG h dG ah dG HGVGh dG V JQG, (Cardiac Arrest) k . GG Jh dG YSh G GdGh dG e eG Y aeh ( R E M) G dG AKCG j dG (C S A) dG AKCG cG dG fG Ve dcOxford Handbook of dG je Ye e jJ dG eJc IOjR H Ye e H.2002-190-178 Clinical Medicine -(OSA) and Respiratory Failure page dG d SG f QSGh IQW Y dG IFa :k SOSjJdG IOjRh hJQdG ie VfG EG ODj QdG e ,dG Og G j GghU G SQ b: b t Ijg HCG Y :jG AL c f FOg jh dG GQhO arornoY: I nY c Y j Y K f g GPEG cMCG SCGQ ab Y dG j ): Sh Y Gonoc o Y fG U Ea , IrY fG CVJ Ea , IrY fG G ca SG Ea , bQa jW do o) NBG OGRh N HGh eh QdG GhQ ( c dG N UCG EGh , dG W k f UCa. ( cH dh dG Y Ga dG RYEd HdG dG DG ec S e /O-LddG YdG JQGh SEG ig `g1426 - HO dGh BGdGVfGh OdG Z RG IS h AhdGh dG M HQ Lfh BGdG CGbh IdG NO GPEaVGeCGh dG V JQG e eJdGh hJQdG IOjR Ye e jMh hJQdG iee eY Id dG FGdG EG aVEH Gg . dG GQhO fG Yh jQdG Hdc dGY Mj Mh EG g EG ) ?...GH G NCG a ....dG AGOCG h hdG fG e jG(5-4 :dG) (idG jT G Y AGd IOe dG b k MjG 98. 99dG dG dG UJ : EG LhCG FSQ Y IQY gk . e dG G EG K G AY EG K G EG K hCG f: f EG dSQdG QO g Ga dG e Gk OQh j CGh , dG gCG jW dCG CG :G EG dSQ.jdG GH jh fEG OGOj CG . a jQ G g BGdG e H AL eh Sh Y G U f H AL e CGh b e EG JCJ jdG Gg If Ea , dG jW a , dG gCG jW G j CG . jG K dG Id j K dG H j K dG IU H e ej G CGj CG Gfhj CG cdGh SDG UCG Yh..dG b d j M AdG IU H ej ..LCG G e dh dP d He e. G AY JJSCG EG dSQ . dGh BGdG dG RYEG egG OGOj CG . G Z h G H j M dG Gg LJh f . G Z EG dSQ AGd IOe dG b CG jdG jG AL e e J ch LGe CG c jCGQ , G Y GJ CG EG e f h ,G d jfh ffEG fGNEG fCa , , G YHb G j CG Y j h k T H f h G EG f CG Hh H AGS c EG GdJ dG gCG j b BG) dG G U " e fCH GhTG Gda GdJ Ea G hO e k HHQCG k H H.(64- GY GN G cGL jG 99. 100HdG LGG dG BGdG- d dG- odG c WdG eEd - WdG J- JYd QdG GHCG Y dG M H MG eEG JJ HdG dG- Gd dG G-eSEG G dCG d dG dG- eSEG G dCG d dG eG U- hdG QGO b S dG -BGdG X - d EG T - o . QG QGO W cT MCG dG M H MCG eEG e- G e dG H GaCG OH EG GhQCG OM-M H MG eEd gdG-dG `g1417 eSEG dG HGQ dGh BGdG dG RYEG g - eGb HGQ gR /O IdH ASG- . hCGLddG YdG `g1421 SOdG OdG dG RYEG- ihd jdG a- .GN H dG h IdG c-e L H Pe e -dG M H S O `g1420 edG dG - dG gQ-QZ TCG / O h VdG MG / O fhdEG bGG ILCG SGH Sbh , idG G AYCG Y BGdG KCJ-d eSEG G eSEG dG Y ddG dG DG YCGh HCG ddG OdG eSEG dG If .`g1405 jdG dG 1985 IgdG dG h BGdG dG RYEd hCG DG - N Sj IdH dG dG-`g1407 Y d HGW CG QGO hCG dG HdG MG / G dG dG VGeCG- S 60`dG a G id d XdG IAdG aQ Y IdG KCJ- 1985 IgdG dGh BGdG dG RYEd hCG DG GTQ iS /O.`g1418 jOdG - IL WdG a G e hCG dG - h Y GS /O dG HGVG -HO dGh BGdG dG RYEd HdG DG ec S e /O - LddG YdG jEGh SEG ig-`g1426 Y jG 100. 101dG dGHO dG h BGdG dG RYEd HdG dG DG - dG Y QdG Y /O IdG dG QGSCG- `g1426 Y . 1985 Y d jOdG QGdG - dG Oe GRdG Y G Y /O SCH jdGh GdG- 2005 d RdG e QGf e WedG jdG T aG eEd ddG dG GK HGdG G- `g1422 hH jdG G hCG G HS S dG dG a - dSdG SDe G LQ H Gh dG eL-.LCG LGG1- Carskadon, MA, Dement, WC. Normal Human Sleep .An Overviewin Principles And Practices Of Sleep Medicine,2nd ed Kryger Roth andDement,PP.16-25 Sounderies 1994.2-Eliota phillipson- sleep Apnea .Harrison principles fnternal medicine 15 thedition, volume 2- 1520 - 15233-John del Valle,peptic ulcer disease and related disorders. Harrisons Principles ofInternal Medicine 15th. Ed. Volume2 page 1650-20014- Kryger and Dement PPPrinciples and Practices of Sleep Medicine2 nd edition 1994.5- Oxford , Hand Book Of Clinical Medicine, Fifth Edition ,2002. jG 101. 201 jG 102. Sh Y GU dG d dG RYEGFGdG AGh cGdG AG OGYEGdG gGHEG .OjG 103. 104 k: eG hCGeh , Uh dBG Yh , jNBGh dhCG S fS Y dGh IdGh , dG Q G : Hh , jdG j EG MEH JH f K , jQh QOe e AG SG , SEG dJ e d Vf , dG Gg fEG. e dG EG H d d dG , ddG J AGQh , OTQh M e Gf e , dGh dGGhYh , dhO ea , jO dH G j , e CG e , G Y SEG dd c d . CG L G Yh , fCT JQGhY IQG CG iS , CG N cQ Gh , SEG dJ fG CG Hh , dGh. CG c Y b fEG H , GjbdG eSEG G bQh Sh j id , AdG jT c e U d g VSf ZdG Y iSGh , dG H VG Gg T c iS , HG h ; SQdG Ve e . aeh Jh Y e H f eh , dfhCG , QGh dG OCG e jh , BGh Y c SdG Sj , k jJ SEG iS . dG Y JCJ hCG H fh dEG f e Xfh , aG OGVGh QJ EG f , fOH fCG , HG iShdh , b e d e EG - aY - SdG j dG , QGh dG Y H fEGh , JM .? G fc GPe fCG , k jCG Gh . dG , OY dEG f e CGh , L dEG J aG CG iSfEG K . dM IG e CG , dG fCH Yf CG d e EG , k ej f CG nr joo nYGj , sa H Y o fn M , eRh e c jeh SdG GMCH f CG , H no r . dG IM IGh , dG dGh FdG e CG e VQj h , QGh dG cY d k Me d d , bGdG VQCG Y , eSEG jdG W , dG Gg W H eCd. Ysfn Y fn nHo h , a f e N idp h ; WdH G Jh , GQdGh jdG Y Gk H , Gpr n n n nYh VGeCG e Ve e , fEG GU U e U f , dG Gg , G H fEaBG ZdG Y , H Gh , DhG jQdG YCG dUCH HQdG , dG dG e. dhCG HdG J fCG if , FShh Jh Yh Qe ejG 104. 105dG dG. cQ dEG UJ e NBG g , V OhM d J a , bGdG ATCG M Y f CG jfY f h , ddG QdG J SdG TY c a fh fh , VG EG f CG jf H. fH , VG U e U , k jCG , S fCG , dc dh ; VG VGnp, Y J h , bdG FdG g TY c , fh Ha , aeh Y c Y f CG jfhe d eh ; CGh IfG Jh C , H iOCG dG eh , a dG dG EG gGg dG ehk af p L ch , af g a d nnj fCG , Gh . d af j b fCG hCG , Y Gk H j b FdG n o . Gk QV UCG ch , QV g e h , : J j , IG d Cgh , JM d LhCGh , Qb dG a 50-49 : W (i n ng sKo r N mAT sc YCGn sdG n tHQ b (49) Se jn tHQ ra b )on n r n o n r pn n nn o no n nn n nU iS c EGh . dGh jbd dG CG Y , dG H a fh , dY CG jf f CG jf dh . Geh Ff e , Y bh e iSh , IfGh VG Y Ad YQe e ,. Qch AH c e dGh dG , a , d x ng cCG j h , QeCG j AGQh IdG Y Gk j. gGP f jCG EGh , H OGj AT CG EGh , dM e M EG aG IOGQEH j dG , dG Gg fEG IM U e U , G H dG Gg iS o nrkSdG j e , Td jGgh , d G IOGQEG e Jo dG , dEG MdG dd e iSh . . e c dG e GHh , L c GhL EGh , fC dh , dG gGJ dG jG hCG bdG FdG J , VG SCG if b fEa , dch. G e HCG g e , fEG HUEG e dLCG J ch , jW J ch , J ch , fT Hj e , FdG J IM aYCG Y YCG a , e dGh jbdG H EG , FdG J Y aG e f b fEG . MGh G gAGQh f h , gOLh e Gh dG, eeCG bd j e EG aG e Uh fCG , M c f , FdG J e d S hif , YdGh QG bQCG jJ , Jh FSh e Qf e H fCG , bGdGh . OLdG e KLGh.Y AdG Y IQdG EG H f ?Hhd k FGO , G , dG J ddG fCGFb , VQCG G Sh , H EG Ib h M h , j Cj eh , c G AT e CG , a. Ich IU c Y FGOhjG 105. 106 . QG Y AT ch , AGdGh dG Nh , SCG Nh , ATCG G N aEG j k T CG , Gh bGdG g dP EGh , f CG j dh , dH feCGo h f fCG ia rph j dG , G IOGQE h Oe g EGh , Ggh fEG IOGQEG LJ dG Gg CGh , G IOGQEH Gk c Gk Y Jh fS , AdG h VQCG IQP e Y j , fh N c Y b , jdH , jG dG YGU K ; dG J e FW e , fEG IM e dG g Eao. AdG Mh tN nJn c c id , b eh ; VQCG Y H Qf fCG f dG , dGh: VdG / k fK: cGdG AG ZGh AVdG MCG / hCG GH MdG Y CG OfdG HCG NCG b dG HCG KM , FGdG AG dG H , QdG U OQhHdG hNBG f : j Sh Y G U G SQ S fCG Ijg HCG S fCG KM YCG eg. a j K j dG FGdG AG cMCG dj : b OSEHh ,k: cGdG AG ZG Y dG HH , G MQ e OaCG cgh HG KM hQg b gh Y k L Y H MCGh gW HCGh jCG S H hQg KM -b j Ijg HCG S fCG IgR H g e FdG HCG CG TCG H H Y QG H hY NCGb Ijg HCG j j c a L gh FGdG AG cMCG j : Sh Y G U G SQ. hJ dhjG U dG Y Ijg HCG Y jS H Y g Y jL KM M H gR KM , jGhQ h -. e j K FGdG AG cMCG dj b Sh YH KM e Gg b e H g Y e KM RGdG Y KM aGQ H KM , jGhQ h -Sh Y G U G SQ bh e jOMCG ca Sh Y G U G SQ Y Ijg HCG. e J K j dG FGdG AG J , M HG U hH hY NCG b gh H KM b j H eM KM b S H H G Y fNCG - jG 106. 107dG dGG SQ b j Ijg HCG S fG KM IgR H g e FdG HCG CG TCG H H Y QGkhJ dhj b Ijg HCG j f c Gda L gh FGdG AG cMCG j Sh Y G UK j dG FGdG AG cMCG dj Sh Y G U G SQ b b Ijg HCG Yh -HCG H S j S S j j H eM S j eCG HCG S M HCG b e j . jOMCG HQCG j Gk MGh fh HQCG Y HCG H Se Y OfdGHCG Y HCG Y Y HG Y dG j KM b N HCG KM b j HCG fNG , jGhQ h - . HG e a j h FGdG AG cMCG dj b Sh Y G U dG Y IjgVY H fCG KM b YCG Y H fj KM b N H SEG H fNCG , jGhQ h -Sh Y G U G SQ CG Ijg HCG Y Ae H AY Y HP HCG H MdG Y Y QG Y . j hCG e CVj K FGdG AG cMCG