Abstract:
ﻣﻘﺪﻣﻪ : ﻫﻤﺎﯾﻨﺪی اﺧﺘﻼﻻت اﺿﻄﺮاﺑﯽ و ﻣﺎﻫﯿﺖ ﭘﯿﭽﯿﺪه اﺧﺘﻼل اﺳﺘﺮس ﭘﺲ از ﺳﺎﻧـﺤـﻪ، ﺑـﺮرﺳـﯽ و ﺑﻪ ﮐﺎر ﮔﯿﺮی درﻣﺎن ﻫﺎی ﺟﺪﯾﺪ را اﯾﺠﺎب ﻣﯽ ﮐﻨﺪ . ﻫﺪف ﭘﮋوﻫﺶ ﺣﺎﺿﺮ، ﺗﻌـﯿـﯿـﻦ »اﺛـﺮﺑـﺨـﺸـﯽ آﻣـﻮزش ﻣﻮﻟﻔﻪ ﻫﺎی ﻓﺮاﺷﻨﺎﺧﺘﯽ ﺑﺮﮐﺎﻫﺶ ﻧﺸﺎﻧﮕﺎن« اﯾﻦ اﺧﺘﻼل ﺑﻮده اﺳﺖ . ﻣﻮاد و روش ﻫﺎ : ﭘﮋوﻫﺶ ﺣﺎﺿﺮ، از ﻧﻮع ﺷﺒﻪ آزﻣﺎﯾﺸﯽ ﺑﻮد ﮐﻪ ﺑﺎ ﻃﺮح ﭘﯿﺶ آزﻣﻮن-ﭘﺲآزﻣﻮن و ﺑـﺎ ﮔﺮوه ﮐﻨﺘﺮل اﺟﺮا ﺷﺪ. ﺑﺪﯾﻦ ﻣﻨﻈﻮر از ﺑﯿﻦ ﮐﻠﯿﻪ ﺟﺎﻧﺒﺎزان اﻋﺼﺎب و روان )25% ﺗﺎ 40% ( آذرﺑﺎﯾﺠﺎن ﻏﺮﺑـﯽ ﺗﻌﺪاد40 ﻧﻔﺮ ﺑﺎ ﺗﺸﺨﯿﺺ PTSD ﺑﻪ ﺻﻮرت ﺗﺼﺎدﻓﯽ اﻧﺘﺨﺎب ﺷﺪه و ﺑﻪ ﺻﻮرت ﺗﺼﺎدﻓﯽ در دو ﮔـﺮوه آزﻣﺎﯾﺶ و ﮐﻨﺘﺮل ﻗﺮار ﮔﺮﻓﺘﻨﺪ . ﮔﺮوه آزﻣﻮن 8 ﺟﻠﺴﻪ درﻣﺎن ﻓﺮاﺷﻨﺎﺧﺘﯽ »وﻟﺰ« را ﺗﺠﺮﺑﻪ ﮐﺮدﻧﺪ و ﮔـﺮوه ﮐﻨﺘﺮل ﺗﻨﻬﺎ ﭘﯽ ﮔﯿﺮی ﺷﺪﻧﺪ . آزﻣﻮن ﻣﯽ ﺳﯽ ﺳﯽ ﭘﯽ ﺑﻪ ﻋﻨﻮان اﺑﺰار ﺗﺸﺨﯿﺺ، آزﻣﻮن ﭼﮏ ﻟﯿﺴﺖ PCL و آزﻣﻮن ﻓﺮاﺷﻨﺎﺧﺖ وﻟﺰ، ﺑﻪ ﻋﻨﻮان اﺑﺰارﻫﺎی ارزﺷﯿﺎﺑﯽ در ﭘﯿﺶ آزﻣﻮن، ﭘﺲ آزﻣﻮن و ﭘﯿﮕﯿﺮی ﺑﻪ ﮐﺎر ﮔﺮﻓﺘـﻪ ﺷﺪ و ﻧﺘﺎﯾﺞ ﺛﺒﺖ ﮔﺮدﯾﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ : داده ﻫﺎی ﺟﻤﻊ آوری ﺷﺪه ﺑﺎ آزﻣﻮن ﺗﺤﻠﯿﻞ ﮐﻮوارﯾﺎﻧﺲ ﭼﻨﺪ ﻣﺘﻐﯿﺮه و آزﻣﻮن t ﻣﻮرد ﺗﺠـﺰﯾـﻪ و ﺗﺤﻠﯿﻞ ﻗﺮار ﮔﺮﻓﺘﻨﺪ ﮐﻪ ﻧﺘﺎﯾﺞ آن ﻧﺸﺎن داد ﺑﯿﻦ ﻣﯿﺎﻧﮕﯿﻦ ﻧﻤﺮات ﻣﻮﻟﻔﻪ ﻫﺎی ﻓﺮاﺷﻨﺎﺧﺘﯽ ﮔﺮوه آزﻣـﺎﯾـﺶ و ﮐﻨﺘﺮل در ﭘﺲ آزﻣﻮن و ﭘﯿﮕﯿﺮی ﺗﻔﺎوت ﻣﻌﻨﯽ داری وﺟﻮد دارد )P<0/001 ( ﻫﻤﭽﻨﯿﻦ ﮔﺮوه آزﻣـﺎﯾـﺶ در ﻧﻤﺮه ﮐﻞ ﻧﺸﺎ ﻧﮕﺎن اﺳﺘﺮس ﭘﺲ از ﺳﺎﻧﺤﻪ ﮐﺎﻫﺶ ﻣﻌﻨﯽ داری ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﮐﻨﺘﺮل در ﭘـﺲ آزﻣـﻮن و ﭘﯿﮕﯿﺮی ﻧﺸﺎن دادﻧﺪ )P<0/05(. ﻧﺘﯿﺠﻪ ﮔﯿﺮی : ﻧﺘﺎﯾﺞ اﯾﻦ ﭘﮋوﻫﺶ ﺣﺎﮐﯽ از آن اﺳﺖ ﮐﻪ ﻣﻮﻟﻔﻪ ﻫﺎی ﻓﺮاﺷﻨﺎﺧﺘﯽ درﺟﺎﻧﺒﺎزان ﻣـﺒـﺘـﻼ ﺑـﻪ PTSD ﻣﺨﺘﻞ اﺳﺖ . و ﺑﻪ ﮐﺎرﮔﯿﺮی اﻟﮕﻮی ﻓﺮاﺷﻨﺎﺧﺘﯽ »وﻟﺰ« در ﮐﺎﻫﺶ ﻧﺸﺎﻧﮕﺎن ﻋﻤﻮﻣﯽ آن ﻫﺎ ﻣـﻮﺛـﺮ ﻣﯽ ﺑﺎﺷﺪ.
Background: Perineal trauma is a common problem during operational
conflicts that is a surgical emergency.
Case report: In this case report, a 25-year-old man was referred to
our hospital because of penetrating trauma caused by gunshot. The
patient had severe pain, decline of hemoglobin and decreased blood
pressure. An emergency surgery was performed immediately. During
surgery, a complete destruction of the right testis, cutting the root of
the penis and urethra, bladder large rupture, the rupture of the ileum
and approximately two liters of blood in the peritoneal space was observed.
Resection and the anastomosis of bowel were done, and abdominal
vascular and bladder rupture were also repaired. His penis
and urinary tract were repaired, as well. Right testis was removed
and the cystostomy drain was fixed and the wall was repaired. The
patient did not have urinary problems and his erection was normal
during follow-up period.
Conclusion: This report showed that the multidisciplinary emergency
surgery during the least possible time can lead to complete repair
of extensive injury to the pelvis and genitalia following gunshot
trauma, and the patient had normal and stable condition without any
urinary and sexual disorder in seven months follow-up.