stresis neirofsiqologiuri gamovlinebebi travmis Semdgom mdgomareobebisas

 

z.anTaZe, m. kukava

nervul sneulebaTa kaTedra, mediko-biologiur kvleviTi centri

 

      stresuli reaqcia, romelic warmoiqmneba organizmze eqstremaluri faqtorebis moqmedebis Sedegad, aucilebelia garemoSi efeqturi adaptaciisaTvis, magram, calkeul SemTxvevebSi, travmis Semdeg individualuri adaptacia SesaZloa ver ganxorcieldes da ganviTardes myari posttravmuli stresuli darRvevebi [3,4,5].

      Sromis mizans warmoadgens afxazeTis omis dros (1993 wlis seqtember-oqtomberi) afxazeTidan iZulebiT gadaadgilebul pirebSi gadatanili fsiqosocialuri stresis Soreuli Sedegebis klinikur-epidemiologiuri gamokvleva da posttravmuli stresuli darRvevebis ganviTarebis Taviseburebebis dazusteba.

      masalebi da kvlevis meTodebi. Cveni dakvirvebis qveS imyofeboda afxazeTidan iZulebiT gadaadgilebuli 110 piri, romlebic amJamad cxovroben TbilisSi. maTi asaki meryeobda 20-dan 70 wlamde. epidemiologiuri kvleva Catarebuli iyo anketuri gamokvlevis meTodikis gamoyenebiT. posttravmuli stresuli darRvevebi Seswavlili iqna DSM-IV sqemaSi [6] mocemuli diagnostikuri kriteriumebis mixedviT. kerZod, dazustebuli iyo: 1. travmuli zemoqmedebis gamudmebuli ganmeorebiTi gancdis arseboba; 2. mudmivi qceviTi Tavidan acileba stimulebisa, romlebic asocirdebian travmasTan; 3. momatebuli agznebadobis myari niSnebis ganviTareba travmis Semdeg. posttravmul periodSi individualuri adaptaciuri reaqciebis formirebaSi socialuri da ekonomikuri faqtorebis rolis dazustebis mizniT, Catarebul iqna fsiqosocialuri sferos gamokvleva taqsonormirebuli test-anketebis saSualebiT, romlebic Sedgenili iyo nervul sneulebaTa kaTedraze fsiqolog r. sayvareliZesTan erTad. vegetaturi nervuli sistemis (vns) funqciuri mdgomareoba Seiswavleboda specialuri kiTxvariT, sadac vegetatur darRvevaTa Sefaseba swarmoebs qulebiT; vsazRvravdiT kerdos indeqssa da hildebrantis koeficients [1]. stresis Semdgom periodSi ganviTarebuli klinikuri gamovlinebebis dazustebis mizniT, dakvirvebis qveS myof yvela pirs Cautarda somaturi da nevrologiuri statusebis dawvrilebiTi gamokvleva.

      sakontrolo jgufi warmodgenili iyo imave asakis TbilisSi mudmivad mcxovrebi 20 adamianiT.

      kvlevis Sedegebi da maTi ganxilva. miRebuli monacemebis mixedviT, gamokvleul pirTa umetesobas (78 adamiani 70,9%) aReniSneboda posttravmuli stresuli darRvevebi (ptsd). travmuli zemoqmedebis ganmeorebiT gancdis arsebobaze miuTiTebdnen Semdegi maCveneblebi: ganmeorebiTi an akviatebuli mZime mogonebebi gancdilisa (71,8%); xSiri, mZime sizmrebi gancdilis Sesaxeb (76,9%); gadatanili travmuli situaciis xSiri warmosaxva (66,6%); Zlieri fsiqologiuri gancda, romelic vlindeba gadatanili travmis msgavsi situaciis dros (57,65). dadebiTi iyo agreTve ptsd-s meore niSani _ mudmivi qceviTi Tavidan acileba yovelivesi, rac asocirdeba travmasTan. kerZod: gadatanili travmis Sesaxeb fiqrebis, saubris daJinebiTi Tavis arideba gamovlinda am jgufebSi Semaval pirTa 74,7%-Si; Tavidan acileba adamianebis, adgilebis, moqmedebebis, romlebic iwveven travmuli situaciis gaxsenebas _ 51,3%-Si; umomavlobis SegrZneba _ 52,5%-Si. yuradRebas ipyrobda am jgufSi Semaval pirebSi gamoxatuli momatebuli zogadi agznebadoba, razedac miuTiTebdnen Semdegi diagnostikuri kriteriumebi: daZinebis gaZneleba da zedmetad fxizeli Zili (78,2%), advilad gaRizianeba da sibrazis afeTqeba (67,9%), yuradRebis koncentraciis gaZneleba (64,1%), uZiloba _ gaZlierebuli sifxizle (58,9%).

      Zilis gamokvlevam gamokiTxul pirTa subieqturi Sefasebis mixedviT gamoavlina Zilis darRvevebis arseboba: daZinebis gaZneleba (64,1%); zerele, araRrma Zili xSiri gamoRviZebebiT (43,5%); Zilis xangrZlivobis Semcireba (58,9%). gansakuTrebiT xSirad ki _ mZime sizmrebi gadatanili travmis Sesaxeb (76,9%). vegetaturi nervuli sistemis funqciuri mdgomareobis Seswavla specialuri kiTxvaris saSualebiT miuTiTebda vegetaturi mogonebebis arsebobaze ptsd sindromis mqone jgufSi. ZiriTadad adgili hqonda simpaTikotoniis arsebobas, rac xSirad gamoixateboda simpaTo-adrenaluri krizebiT, e.w. “panikis SetevebiT”.

      poststresul periodSi, individualuri adaptaciuri reaqciebis formirebaSi socialuri da ekonomikuri faqtorebis mniSvnelobis dazustebis mizniT, Catarebul iqna fsiqosocialuri sferos gamokvleva. umuSevaria, Tumca aqvs profesia an muSaobs arakvalificiur samuSaoze ptsd mqone pirTa 65,4%; diasaxlisia _ 23,1%; profesiis mixedviT muSaobs mxolod 11,5%. aradamakmayofilebeli aris cxovrebis pirobebi (cxovroben sastumroebSi an saerTo sacxovreblebSi). kveba atarebs arasrulyofil da araregularul xasiaTs.

      mZime fsiqosocialuri stresis Semdeg xangrZlivi periodis ganmavlobaSi afxazeTidan devnilebis didi nawilis cxovrebis wesi ar Seesabameba maT moTxovnilebebs. isini imyofebian uCveulo pirobebSi, iZulebulni arian daikavon sazogadoebaSi maTTvis Seusabamo adgili.

      amrigad, zemoTmoyvanili monacemebi naTel warmodgenas iZleva afxazeTidan devnil pirebSi stresis Soreuli Sedegebis Sesaxeb. gamokvleul pirTa umetesobas (70,9%) aReniSneboda gamoxatuli da gaxangrZlivebuli posttravmuli stresuli darRvevebis (ptsd) arseboba. gamovlenili iyo vns disfunqcia ZiriTadad simpaTikotoniis saxiT, insomnia. stresis Semdgom periodSi gamokvleul kontingentSi xSiri iyo daZabulobis Tavis tkivilisa da hipertonuli daavadebis ganviTareba. gansakuTrebiT aRsaniSnavia fsiqosocialuri sferos mkveTri moSla. ptsd sindromisa da fsiqosocialuri sferos moSlis drouli gamovlena da koreqcia xels Seuwyobs poststresul periodSi fsiqosomaturi daavadebebis ganviTarebis racionalur profilaqtikas.

 

literatura:

1.        Âåéí À.Ì. (ðåä) Çàáîëåâàíèÿ âåãåòàòèâíîé íåðâíîé ñèñòåìû. Ìîñêâà, Ìåäèöèíà, 1991.

2.       ×õèêâèøâèëè Ö.Ø. Îá èíôîðìàöèîííîì íåâðîçå. Æóðí. âûñø. íåðâí. äåÿò., 1984, 34, 1, 175-180.

3.       Ýâåðëè Äæ.,  Ðîçåíôåëüä Ð. Ñòðåññ: ïðèðîäà è ëå÷åíèå. Ìîñêâà, Ìåäèöèíà, 1985.

4.       Fridman M.J., Charney D.S., Deutch A.Y. (eds) Neurobiological and Clinical Consequences of Stress. From Normal Adaptation to PRSD. Philadelphia, Lippincott-Raven, 1995.

5.       Hiley-Young B. (ed). Posttraumatic Stress. An Information Packet. Palo Alto Ca. National Center for PTSD, 1995.

6.       Sonnenberg S.M., Blank A. Sl., Talbott J. A. The Trauma of War: Stress and Recovery in Vietnam Veterans. Washington DC, American Psychiatric Press, 1985.

 

 

SEVERAL SPECIFICATIONS OF POSTTRAUMATIC STRESS DISORDERS

Z. Antadze, M. Kukava

Chair of Neurology, Center for Medical-Biological Studies

 

SUMMARY

            The study purposed investigation of 110 war refugees from Abkhazia. In the most cases (70,9%) pronounced and prolonged PRSD had been revealed, which were conditioned by marked disfunction of psychosocial sphere. As a rule, PRSD was accompanied by sympathicotonia, insomnia and psychosomatic manifestations, expressed in a form of arterial hypertension and the chronic headache attacks.