Studies in Medical Sciences
مجله مطالعات علوم پزشکی
Studies in Medical Sciences
Medical Sciences
http://umj.umsu.ac.ir
37
journal37
2717-008X
2717-008X
10.61186/umj
fa
jalali
1393
9
1
gregorian
2014
12
1
25
10
online
1
fulltext
fa
مقایسه نسبت Spo2/Fio2 با نسبت Pao2/Fio2 در بیماران مبتلا به آسیب حاد ریه و سندرم دیسترس حاد تنفسی
COMPARISON OF THE SPO2/FIO2 RATIO AND THE PAO2/FIO2 RATIO IN PATIENTS WITH ACUTE LUNG INJURY AND ACUTE RESPIRATORY DISTRESS SYNDROM
آناتومی
آناتومی
پژوهشي(توصیفی- تحلیلی)
Research
<p class="Chekide" style="TEXT-JUSTIFY: kashida TEXT-ALIGN: justify TEXT-KASHIDA: 0% MARGIN: 0cm 0cm 0pt unicode-bidi: embed DIRECTION: rtl" dir="rtl"><b><span lang="AR-SA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt">پیشزمینه و هدف:</span></b><span lang="AR-SA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt"> </span><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt">کرایتریاهای تشخیصی </span><font size="2"><font face="Times New Roman"><span dir="ltr">ALI</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> و </span><font size="2"><font face="Times New Roman"><span dir="ltr">ARDS</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> شامل شروع حاد بیماری، یافتههای رادیوگرافی سینه مطابق با انفیلتراسیون دوطرفه ریه و نبود اختلال عملکرد بطن چپ و نسبت (</span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span>) </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">Pao<sub>2</sub>/Fio<sub>2</sub></span><span dir="rtl"></span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">کمتر یا مساوی 200 برای </font></span></span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">ARDS</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> و کمتر یا مساوی 300 برای </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">ALI</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span>؛ که مورد اخیر نیازمند نمونهگیری تهاجمی خون شریانی هست. </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">Spo2</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> که توسط دستگاه پالس اکسیمتری اندازهگیری میشود و محاسبه نسبت </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-font-family: 'Times New Roman'" dir="ltr">Spo<sub>2</sub>/Fio<sub>2</sub></span><span dir="rtl"></span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">(</font></span></span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">SF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span>) را شاید بتوان یک آلترناتیو غیرتهاجمی جایگزین برای نسبت </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> در نظر گرفت.<p></p></span></p><p class="Chekide" style="TEXT-JUSTIFY: kashida TEXT-ALIGN: justify TEXT-KASHIDA: 0% MARGIN: 0cm 0cm 0pt unicode-bidi: embed DIRECTION: rtl" dir="rtl"><b><span lang="AR-SA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt">مواد و روش کار:</span></b><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"> در یک مطالعه تحلیلی مقطعی، 70 بیمار مبتلا به </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">ALI</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> و </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">ARDS</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> بستری در </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">PICU</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> بیمارستان کودکان تبریز وارد مطالعه شدند. </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">Spo<sub>2</sub></span><span dir="rtl"></span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">و </font></span></span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">Pao<sub>2</sub></span><span dir="rtl"></span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">و </font></span></span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">Fio<sub>2</sub></span><span dir="rtl"></span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">در حداکثر بازه زمانی 5 دقیقه اندازهگیری شد و نسبت </font></span></span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">SF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> و </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> محاسبه شد و نسبت </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">SF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> با نسبت </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> مقایسه و ارتباط میان آنها و حد آستانه نسبت </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">SF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> برای جایگزینی با نسبت </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> برای تشخیص </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">ARDS</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> و </span><font size="2"><font face="Times New Roman"><span style="mso-bidi-language: FA" dir="ltr">ALI</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> تعیین شد.<p></p></span></p><p class="Chekide" style="TEXT-JUSTIFY: kashida TEXT-ALIGN: justify TEXT-KASHIDA: 0% MARGIN: 0cm 0cm 0pt unicode-bidi: embed DIRECTION: rtl" dir="rtl"><b><span lang="AR-SA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt">یافتهها</span></b><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt">: در مطالعه انجامشده رابطه نسبت </span><font size="2"><font face="Times New Roman"><span dir="ltr">SF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> با نسبت </span><font size="2"><font face="Times New Roman"><span dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> با معادله رگرسیون </span><font size="2"><font face="Times New Roman"><span dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> 61/0+57=</span><font size="2"><font face="Times New Roman"><span dir="ltr">SF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> محاسبه شد؛ و نسبت </span><font size="2"><font face="Times New Roman"><span dir="ltr">SF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> 181 و 235 مطابق با نسبت </span><font size="2"><font face="Times New Roman"><span dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span>200 و 300 بود. آستانه </span><font size="2"><font face="Times New Roman"><span dir="ltr">SF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> برای </span><font size="2"><font face="Times New Roman"><span dir="ltr">ALI</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> 235 بود که دارای 57 درصد حساسیت و 100 درصد اختصاصیت و آستانه</span><span lang="FA" style="FONT-FAMILY: "Tahoma","sans-serif" FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"> </span><font size="2"><font face="Times New Roman"><span dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> برای </span><font size="2"><font face="Times New Roman"><span dir="ltr">ARDS</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> 181 بود که دارای 71 درصد حساسیت و 82 درصد اختصاصیت بود؛ و جهت جایگزینی </span><font size="2"><font face="Times New Roman"><span dir="ltr">SF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> با </span><font size="2"><font face="Times New Roman"><span dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> 001/0</span><span dir="ltr"></span><span dir="ltr"></span><span dir="ltr"><span dir="ltr"></span><span dir="ltr"></span><font face="Times New Roman" size="2"><</font></span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> </span><font size="2"><font face="Times New Roman"><span dir="ltr">P</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font size="2"><font face="Nazanin">هست.<p></p></font></font></span></span></p><p class="Chekide" style="TEXT-JUSTIFY: kashida TEXT-ALIGN: justify TEXT-KASHIDA: 0% MARGIN: 0cm 0cm 0pt unicode-bidi: embed DIRECTION: rtl" dir="rtl"><b><span lang="AR-SA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-ansi-font-size: 8.5pt">نتیجهگیری</span></b><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt">: نسبت </span><font size="2"><font face="Times New Roman"><span dir="ltr">SF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font face="Nazanin" size="2">که مارکر غیرتهاجمی قابلاعتماد جهت جایگزینی با نسبت </font></span></span><font size="2"><font face="Times New Roman"><span dir="ltr">PF</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> جهت تشخیص </span><font size="2"><font face="Times New Roman"><span dir="ltr">ALI</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span lang="FA" style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> و </span><font size="2"><font face="Times New Roman"><span dir="ltr">ARDS</span><span dir="rtl"></span><span dir="rtl"></span></font></font><span style="FONT-FAMILY: Nazanin FONT-SIZE: 9.5pt mso-bidi-language: FA mso-ansi-font-size: 8.5pt"><span dir="rtl"></span><span dir="rtl"></span> <span lang="FA"><font size="2"><font face="Nazanin">هست و میتوان پالس اکسی متری را جایگزین خونگیری شریانی نمود.<p></p></font></font></span></span></p>
<p style="DIRECTION: ltr"> <strong><i> Background & Aims: </i></strong>Diagnostic criteria for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) requires acute onset of disease, chest radiograph demonstrating bilateral pulmonary infiltrates, lack of significant left ventricular dysfunction and Pao<sub>2</sub>/Fio<sub>2</sub> (PF) ratio 300 for ALI or 200 for ARDS. And the latter one requires invasive arterial sampling. Measurement spo<sub>2</sub> by pulse oxi metry and calculation spo<sub>2</sub>/Fio<sub>2</sub> (SF) ratio may be a reliable non invasive alternative to the PF ratio. </p><p> <strong><i> Materials & Methods: </i></strong>In this cross sectional study, 70 patient diagnosed for ALI or ARDS admitted in Tabriz children’s hospital PICU were enrolled. Then spo2, Fio2, Pao2 charted within 5 minutes were measured and the ratio of SF and PF were calculated and compared. SF threshold the values were determined to replacement PF ratio for diagnose ARDS and ALI. </p><p> <strong><i> Results: </i></strong>The relationship between SF and PF ratio was described by the following regression equation SF=57+0/61PF (P<0/001). SF ratios of 181 and 235 corresponded of PF ratio 300 and 200. The ALI SF cutoff of 235 had 57% sensitivity and 100% specificity, and ARDS, SF cutoff of 181 had 71% sensitivity and 82% specificity. </p><p> <strong><i> Conclusion: </i></strong>SF ratio is a reliable noninvasive marker for PF ratio to identify children with ALI or ARDS. <strong>A </strong>nd can be replaced pulse oximetry by arterial blood sampling. </p><p> </p><p> SOURCE: URMIA MED J 2014: 25(10): 909 ISSN: 1027-3727 </p><p> </p>
ARDS, ALI, Pao2/Fio2, پالس اکسی متری
ARDS, ALI, Pao2/Fio2 , Pulse oximetry
0
0
http://umj.umsu.ac.ir/browse.php?a_code=A-10-582-544&slc_lang=fa&sid=1
Nemat
Bilan
نعمت
بیلان
dastranji61@gmail.com
3700319475328460010832
3700319475328460010832
Yes
Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz
بیمارستان کودکان تبریز مرکز تحقیقات سلامت کودکان، دانشگاه علوم پزشکی تبریز،
Afshin
Ghale Golab Behbahani
افشین
قلعه گلاب بهبهانی
3700319475328460010833
3700319475328460010833
No
Children’s Hospital, Tabriz University of Medical Sciences
بیمارستان کودکان تبریز، دانشگاه علوم پزشکی تبریز،
Azar
Dastranji
آذر
دسترنجی
3700319475328460010834
3700319475328460010834
No
, Children’s Hospital, Tabriz University of Medical Sciences
بیمارستان کودکان تبریز، دانشگاه علوم پزشکی تبریز،