آسیب‌های ناشی از موشک و انفجار در جمعیت غیرنظامی: سازوکارها، الگوهای پیشگیرانه و بالینی

نوع مقاله : مروری

نویسندگان

گروه آموزشی طب اورژانس، دانشکده پزشکی، دانشگاه علوم پزشکی بقیه الله (عج)، تهران، ایران

چکیده

زمینه و هدف: آسیب‌های ناشی از انفجار در جمعیت غیرنظامی، از مهم‌ترین علل مرگ‌ومیر قابل پیشگیری، ناتوانی طولانی‌مدت و اختلال در عملکرد نظام سلامت هستند. این آسیب‌ها ممکن است در زمینه‌های مختلفی از جمله جنگ، حملات تروریستی، انفجارهای صنعتی، مواد منفجره دست‌ساز و حملات پهپادی رخ دهند.
روش‌ها: این مطالعه یک مرور روایتی بر مطالعات مرتبط از سال 2000 تا 2026 است که با استفاده از کلیدواژه‌های"blast injury civilian"، "explosive trauma" و "missile injury" در پایگاه‌های PubMed ،Google Scholar  ،Scopus و Science Direct انجام شد. پس از غربالگری بر اساس معیارهای ورود و خروج، در نهایت 53 مقاله کاملاً مرتبط استخراج و به‌طور کامل بررسی شد.
یافته‌ها: ویژگی اصلی این تروماها چندمکانیسمی بودن آن‌هاست؛ به‌گونه‌ای که موج انفجار، ترکش، جابه‌جایی بدن، سوختگی، له شدگی­ های اندام­ ها و آلودگی بافتی ممکن است به‌صورت هم‌زمان یا متوالی رخ دهند. در نتیجه، طیف آسیب‌ها از زخم‌های سطحی و پارگی پرده تمپان تا آسیب مغزی تروماتیک، خونریزی‌های وسیع، قطع عضو، آسیب‌های عروقی و آسیب احشای داخلی گسترده است. شواهد اخیر نشان می‌دهد که در غیرنظامیان، علاوه بر پیامدهای حاد جراحی و مراقبت ویژه، عوارض درازمدت مانند درد مزمن، اختلال شنوایی، ناتوانی عملکردی، دفورمیتی کرانیوفاسیال و اختلالات نوروپسیکیاتریک نیز بار قابل‌توجهی بر نظام سلامت تحمیل می‌کنند.
نتیجه‌گیری: مدیریت این بیماران نیازمند رویکردی چندرشته‌ای شامل تریاژ سریع، تثبیت همودینامیک، تصویربرداری هدفمند، جراحی کنترل آسیب، ترمیم عروقی، بازسازی مرحله‌ای و توانبخشی طولانی‌مدت است. در سطح پیشگیری نیز کاهش استفاده از سلاح‌های انفجاری در مناطق پرجمعیت، تقویت آمادگی بیمارستانی و ارتقای آموزش عمومی و پناه‌گیری از مهم‌ترین راهبردها هستند.

کلیدواژه‌ها

مراجع

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طب نظامی
دوره 28، ویژه نامه شماره 1 - شماره پیاپی 141
جنگ تحمیلی 40 روزه
مرداد و شهریور 1405
صفحه 29-41

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