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$8 $3 ÓÀØÀÒÈÅÄËÏÓ ÁÀÅÛÅÈÀ ÊÀÒÃÉÏËÏÂÈÀ ÀÓÏÝÉÀÝÉÉÓ ÑÖÒÍÀËÉ JOURNAL OF THE GEORGIAN PEDIATRIC CARDIOLOGY ASSOCIATION clb ÁÀÅÛÅÈÀ ÊÀÒÃÉÏËÏÂÉÀ Pediatric Cardiology Ucjmjtj 33124 119 TBILISI ISSN 1987-9857 clb ÓÀØÀÒÈÅÄËÏÓ ÁÀÅÛÅÈÀ ÊÀÒÃÉÏËÏÂÈÀ ÀÓÏÝÉÀÝÉÀ Ó.Á.Ê.À. ÜÀÌÏÚÀËÉÁÃÀ ÈÓÓÖ-Ó ÐÄà ÊËÉÍÉÊÉÓ ÁÀÆÀÆÄ 1992 ßÄËÓ, ÒÄÂÉÓÔÒÉÒÄÁÖË ÉØÍÀ 1999 ßËÉÓÈÅÉÓ. ÀÙÍÉÛÍÖËÉ ÀÓÏÝÉÀÝÉÀ ßÀÒÌÏÀÃÂÄÍÓ ÊÀÅÛÉÒÓ, áÖÈÉ ×ÉÆÉÊÖÒÉ ÐÉÒÉÓ ÌÉÄÒ ÜÀÌÏÚÀËÉÁÄÁÖËÓ, ÒÏÌÄËÉÝ ÃÀÀÒÓÃÀ ÓÀØÀÒÈÅÄËÏÓ 1997 ßËÉÓ ÓÀÌÏØÀËÀØÏ ÊÏÃÄØÓÉÓ ÃÄÁÖËÄÁÄÁÉÓ ÛÄÓÀÁÀÌÉÓÀÃ. mTavari redaqtori medicinis mecnierebaTa doqtori, profesori, akademikosi-mdivani hjpshj!DbyvobTwjmj „ÀÓÏÝÉÀÝÉÉÓ“ ÓÀØÌÉÀÍÏÁÉÓ ÅÀÃÀ ÂÀÍÖÓÀÆÙÅÒÄËÉÀ, ÀØÅÓ ÃÀÌÏÖÊÉÃÄÁÄËÉ ÁÀËÀÍÓÉ ÓÀØÀÒÈÅÄËÏÓÀ ÃÀ ÖÝáÏÄÈÉÓ ÓÀÁÀÍÊÏ ÃÀßÄÓÄÁÖËÄÁÄÁÛÉ. ÀÌ ÊÀÅÛÉÒÉÓ ÌÉÆÍÄÁÓ ßÀÒÌÏÀÃÂÄÍÓ – ×ÏÒÌÖËÉÒÄÁÉÓ ÌÏÞÄÁÍÀ ÂÖË-ÓÉÓáËÞÀÒÙÅÈÀ ÓÉÓÔÄÌÉÓ ÒÄÅÌÀÔÉÔÖËÉ, ÒÄÅÌÀÔÖËÉ, ÀÒÀÒÄÅÌÀÔÖËÉ ÃÀÆÉÀÍÄÁÄÁÉÓ, ÂÖËÉÓ ÉÛÄÌÖÒÉ ÃÀÀÅÀÃÄÁÀÈÀ, ÌÉÏÊÀÒÃÉÖÌÉÓ ÉÍ×ÀÒØÔÉÈ, ÊÀÒÃÉÏÐÀÈÏÄÁÉÓ ÓáÅÀÃÀÓáÅÀ ×ÏÒÌÄÁÉÓ, ÁÀÅÛÅÈÀ äÉÐÏÔÄÍÆÉÄÁÉÓ, ÓÐÏÒÔÖËÉ ÂÖËÉÓ ÃÀ ÓáÅÀ ÐÀÈÏËÏÂÉÖÒÉ ÐÒÏÝÄÓÄÁÉÓ ÍÀÀÃÒÄÅÉ ÃÉÀÂÍÏÓÔÉÒÄÁÀÛÉ, ÊÀÒÃÉÏËÏÂÉÉÓ ÂÀÍÅÉÈÀÒÄÁÀ, ÀÂÒÄÈÅÄ ÁÀÅÛÅÈÀ ÊÀÒÃÉËÏÂÉÉÈ ÃÀÉÍÔÄÒÄÓÄÁÖË ÓÔÖÃÄÍÔÀáÀËÂÀÆÒÃÏÁÉÓÀÃÌÉ ÚÏÅÄËÂÅÀÒÉ ÃÀáÌÀÒÄÁÉÓ ÂÀßÄÅÀ. ÓÀØÌÉÀÍÏÁÉÓ ÓÀÂÀÍÓ ßÀÒÌÏÀÃÂÄÍÓ ÂÖËÓÉÓáËÞÀÒÙÅÈÀ ÖÓÉÓáËÏ ÉÍÓÔÒÖÌÄÍÔÖËÉ ÊÅËÄÅÀ. Ä.ÊÂ. 15 ÂÀÍáÒÛÉ, ×À – ÃÀÔÅÉÒÈÅÉÓÀÓ, ÄËÄØÔÒÏÂÀÌÏÈÅËÉÈ ÅÄËÏÌÄÔÒÉÀ, ÐÖËÓÖÒÉ ÌÒÖÃÄÁÉ, ÊÀÐÉÃÀÒÉÓÊÏÐÀ, ÒÄÏÂÒÀ×ÉÀ, ÄØÏÊÀÒÃÉÏÂÒÀ×ÉÀ ÃÀ ÓáÅÀ. ÀÂÒÄÈÅÄ, ÉÌÖÍÏËÏÂÉÖÒÉ ÃÀ ÂÄÍÄÔÉÊÖÒÉ ÌÀÒÊÄÒÄÁÉÓ ÊÅËÄÅÀ. ÀÙÓÀÍÉÛÍÀÅÉÀ, ÒÏÌ „ÀÓÏÝÉÀÝÉÉÓ“ ßÄÅÒÄÁÉ ÛÄÉÞËÄÁÀ ÉÚÅÍÄÍ ÒÏÂÏÒÝ ÉÖÒÉÃÉÖËÉ ÀÓÄÅÄ ×ÉÆÉÊÖÒÉ ÐÉÒÄÁÉ, ÒÏÌËÄÁÉÝ ÉÆÉÀÒÄÁÄÍ ÌÉÓ ÌÉÆÍÄÁÓÀ ÃÀ ÓÀØÌÉÀÍÏÁÉÓ ÐÒÉÍÝÉÐÄÁÓ ßÄÒÉËÏÁÉÈÉ ÂÀÍÝáÀÃÄÁÉÓ ÓÀ×ÖÞÅÄËÆÄ. „ÀÓÏÝÉÀÝÉÉÓ“ ßÄÅÒÄÁÓ ÀÊÉÓÒÉÀÈ ÂÀÒÊÅÄÖËÉ Ö×ËÄÁÀ-ÌÏÅÀËÄÏÁÄÁÉ. ÌÏÍÀßÉËÄÏÁÉÓ ÌÉÙÄÁÀ ßÄÓÃÄÁÉÈ ÂÀÈÅÀËÉÓßÉÍÄÁÖËÉ ßÄÓÉÈ. „ÀÓÏÝÉÀÝÉÉÓ“ ÌÀÒÈÅÀÛÉ, ÉÓÀÒÂÄÁËÏÍ ÀÓÏÝÉÀÝÉÉÓ ÊÏÍÓÖËÔÀÝÉÄÁÉÈ ÃÀ ÒÄÊÏÌÄÍÃÀÝÉÄÁÉÈ, ÌÏÍÀßÉËÄÏÁÀ ÌÉÉÙÏÍ ÂÀÍÆÒÀáÖË ÐÒÏÄØÔÄÁÆÄ, ÌÉÉÙÏÍ ×ÉÍÀÍÓÖÒÉ ÌáÀÒÃÀàÄÒÀ „ÀÓÏÝÉÀÝÉÉÓ“ ×ÏÍÃÄÁÉÃÀÍ, ÀÂÒÄÈÅÄ – ÂÀÅÉÃÍÄÍ „ÀÓÏÝÉÀÝÉÉÃÀÍ“. „ÀÓÏÝÉÀÝÉÉÓ“ ÌÀÒÈÅÉÓ ÏÒÂÀÍÏÓ ßÀÒÌÏÀÃÂÄÍÓ „ÀÓÏÝÉÀÝÉÉÓ“ ßÄÅÒÈÀ „ÓÀÄÒÈÏ ÊÒÄÁÀ“, ÒÏÌÄËÉÝ ÌÏÉßÅÄÅÀ 1 ãÄÒ ßÄËÉßÀÃÛÉ, ÀÍ ÓÀàÉÒÏÄÁÉÓÀÌÄÁÒ. ÈÉÈÏ ßÄËÓ ÌÉÄÊÖÈÅÍÄÁÀ ÈÉÈÏ áÌÀ. ßÉÍÀÌÃÄÁÀÒÄ ßÄÓÃÄÁÀ ÞÀËÀÛÉÀ ÌÉÓÉ ÒÄÂÉÓÔÒÀÝÉÉÓ ÈÀÒÉÙÉÃÀÍ. ÀÌÒÉÂÀÃ, ÀÙÍÉÛÍÖË ÀÓÏÝÉÀÝÉÓ ÊÀÒÃÉÏËÏÂÉÉÓ ÃÀÒÂÛÉ ÀÊÉÓÒÉÀ ÌÍÉÛÅÍÄËÏÅÀÍÉ ×ÖÍØÝÉÀ-ÌÏÅÀËÄÏÁÄÁÉ, ÒÏÌÄËÉÝ ÃÀ×ÖÞÍÄÁÖËÉÀ ÄØÉÌÈÀ ÂÖËÉÓáÌÉÄÒÄÁÀÓÀ ÃÀ ÛÄÌÏØÌÄÃÄÁÉÈ ÃÀÌÏÊÉÃÄÁÖËÄÁÀÆÄ ÀÌ ÃÀÒÂÉÓ ÌÉÌÀÒÈ. UDC (uak) 616.12-053.2(051.2) misamarTi: Tbilisi, Lublianas q. #21; Tel: 47-04-01; njtbnbsUj; E-mail: [email protected], [email protected] www.sppf.info www.esgns.org b 169 7ELOLVLOXEOLDQDVTWHOHOIRVWDLQIR#VSSILQIRVSSI#KRWPDLOFRPZZZVSSILQIR #3 $8 Tbilisi 2013 Tbilisi redaqtori: giorgi CaxunaSvili med.mec.doqtori, profesori Editor in chief: GEORGE CHAKHUNASHVILI MD.PHD.S.D.Professor saredaqcio kolegia: Editorial Board: mamanti rogava manana RuduSauri konstantine CaxunaSvili nino jobava (redaqtoris moadgile) dito tabucaZe vladimer zardaliSvili neli TofuriZe (kolegiis mdivani) neli badriaSvili Temur miqelaZe manana SvangiraZe maia inasariZe mixeil mWedliSvili merab maTiaSvili maka ioseliani TamTa metreveli nino Wanturaia lali kvezereli mamuka CxaiZe TinaTin kutubiZe zurab SaqaraSvili giorgi didava vaxtang xelaSvili d. kilaZe marine xecuriani Tamaz surmaniZe k. a. r. d. CaxunaSvili bliaZe svanaZe CaxunaSvili MAMANTI ROGAVA MD. MANANA GUDUSAURI MD. KONSTANTINE CHAKHUNASVILI MD.PHD. PROF. NINO JOBAVA (CoEditor) MD. DITO TABUCAZE MD, PROF. VLADIMER ZARDALISVILI MD. NELI TOFURIZE (Secretary of Board) MD. NELI BADRIASHVILI MD. TEMUR MIKELADZE MD. MANANA SHVANGIRADZE MD. MAIA INASARIDZE MD. MIKHEIL MCHEDLISHVILI MD. MERAB MATIASHVILI MD. MAKA IOSELIANI MD. TAMTA METREVELI MD. NINO CHANTURAIA MD. LALI KVEZERELI MD. MAMUKA CXAIDZE MD. TINATIN KUTUBIDZE MD. PROF. ZURAB SHAQARASHVILI MD. GIORGI DIDAVA MD. PROF. VAXTANG XELASHVILI D. KILADZE MD. MARINE XECURIANI TAMAZ SURMANIDZE ILYA M. YEMETS PROF. /ukr/ FABIO PIGOZZI PROF. /Italia/ DIRK-ANDRE CLEVENT MD. /Germany/ K. CHAKHUNASVILI A. BLIADZE R. SVANADZE D. CHAKHUNASVILI ,fdidsf rfhlbjkjubf sarCevi 3 CONTENTS saqarTvelos bavSvTa kardiologTa asociacia ............................................................................................................................................................ 6 Georgian Pediatric Cardiology Association .............................................................................................................................................................................. 9 kardiologia ST segmentisa da T kbilis cvlilebani janmrTel bavSvTa sxvadasxva asakobriv jgufebSi ST and T wave changes in children of different ages ......................................................................................................................................................... 11 sportsmenTa fizikuri da funqciuri mdgomareobis Sefaseba api pulmosa da apikoris fonze Estimation of sportsmen physical and functional condition under the treatment of Apipulmo and Apicori .................................... 19 e.k.g.-is (ST da T kbili) da kapilaroskopiuli parametrebi bavSvebSi diabetis pirveli ti pis dros. EKG Parameters ( ST and T wave ) and Capillaroscopic Parameters during Diabetes Mellitus Type I in Children ..................................... 23 e.k.g. parametrebi (ST segmenti da T kbili) Saqriani diabetis ti pi I - sa, zogierTi anTebadi da sxva araanTebadi daavadebebis dros bavSvTa asakSi EKG Parameters (ST and T wave) during Diabetes Mellitus Type I in Children during some inflammatory and non-inflammatory diseases ............................................................................................................................................................................................................... 26 mitraluri sarqvlis prolapsis sixSire, etiopa Togenezi, daavadebaTa paTogenur procesSi Cabmis xarisxis gansazRvra da ariaTmiebTan konteqsSi misi ganxilva The frequency of mitral valve prolapse, ethiology and pathology, determination of pathological process involvement degree and discussion in context with Arrhythmia .............................................................................................................................................................................................. 32 ST segmentisa da T kbilis cvlilebebaTa Rrma klinikuri analizis aucilebloba, parkuWTa repolarizaciis, naadrevi agznebis parcialuri sindromTa da P-Q intervalis Semcirebis arsebobisas bavSvTa da mozardTa asakSi Clinical value of ST segment and T wave, during ventricle repolarization, early discharge partial syndrome and narrowed P-Q interval in children and adolescents ........................................................................................................................................................... 38 arteriuli hi pertenzia bavSvTa da mozardTa asakSi Arterial hypertension in children and adult ...................................................................................................................................................................... 41 gulis riTmisa da gamtarobis darRveva bavSvTa asakSi (maTi marTvis Tanamedrove princi pebi) Heart rhythm and conducting disorder in children (Modern governing principles) .............................................................................. 48 revmatologia kidev erTxel mwvave revmatiuli cxelebis Sesaxeb Once again about acute rheumatic fever ............................................................................................................................................................................. 57 revmatologiisa da arTrologiis sakiTxebi Questions of rheumatology and arthrology ............................................................................................................................................................................. 64 kodebi revmatologiaSi ........................................................................................................................................................................................................ 69 sxvadasxva pediatriul kardiologiaSi – infeqciur paTologiaTa dros mkurnalobaSi imunoTerapiuli preparat “GA-40”-is CarTvis SesaZleblobani In pediatric cardiology - possible usage of Immune therapeutic medicine “GA-40” in treatment during infectious pathology ... 77 sportuli valeologiis ganviTarebis perspeqtivebi Перспективы развития спортивной валеологии The prospects of sporting valeology ........................................................................... 79 saintereso SromaTa kaleidoskopi Факторы риска поражения сердечно-сосудистой системы при ревматоидном артрите и системной красной волчанке у детей; клинико-инструментальный (эхокардиографический) анализ ранних морфофункциональных проявлений заболевания, вопросы профилактики и реабилитации автореферат диссертации для написания диплома, курсовой работы, тема для доклада и реферата ............................................................................................................................................................................ 82 zogierTi Tandayolili, anTebadi da SeZenili araanTebadi daavadebis dros gul-sisxlZarRvTa sistemis klinikur-instrumentuli daxasiaTeba bavSvTa asakSi da mkurnalobaSi preparat GA-40-is CarTvis SesaZleblobani ............................................................................................................................................................................................................ 85 Clinical-instrumental characterizations of Cardiovascular System during Some Congenital, inflammatory and acquired noninflammatory diseases in Childhood and possibilities of The involvement of preparation GA-40 in The TReatment.............................. 87 aTerosklerozis risk-faqtorebi msuqan bavSvebSi ..................................................................................................................................................................................... 88 Atherosclerosis Risk-Factors in Obese Children ................................................................................................................................................................. 89 praqtikosi eqimebisaTvis daavadebaTa marTvis erovnuli protokoli ................................................................................................................................................... 90 Teoriuli safuZvlebi .......................................................................................................................................................................................................... 102 2013 weli ,fdidsf rfhlbjkjubf 4 teqinformis qarTul referatul JurnalSi asaxuli gamocemaTa CamonaTvali 1. bavSvTa kardiologia 2. gaenaTis macne 3. eqsperimentuli da klinikuri medicina 4. Tbilisis saxelmwifo samedicino universitetis samecniero SromaTa krebuli 5. kavkasiis saerTaSoriso universitetis macne 6. kardiologia da Sinagani medicina 7. kritikul mdgomareobaTa da katastrofaTa medicina 8. mecniereba da teqnologiebi 9. rentgenologiis da radiologiis macne www.tech.caucasus.net mTavari dagvikavSirdiT teqinformi saitis ruka qarTuli bmulebi 10. saqarTvelos mecnierebaTa erovnuli akademiis macne, biomedicinis seria 11. saqarTvelos mecnierebaTa erovnuli akademiis moambe 12. saqarTvelos pediatri • • • • • • • • • Cvens Sesaxeb saqmianoba struqtura TanamSromlebi resursebi momsaxureba gamocemebi RonisZiebebi partniorebi vakansiebi qarTuli referatuli Jurnali 8 (20), 2012 nomerSi asaxul gamocemaTa CamonaTvali Tematuri rubrikebi avtorTa saZiebeli sagnobrivi saZiebeli 13. saqarTvelos respiraciuli Jurnali 14. saqarTvelos samedicino siaxleni 15. saqarTvelos samecniero siaxleebi, saerTaSoriso samecniero Jurnali 16. saqarTvelos teqnikuri universitetis Sromebi 17. socialuri, ekologiuri da klinikuri pediatria 18. suxiSvilis universitetis saerTaSoriso sa mecniero konferenciis „Tanamedrove aqtualuri samecniero sakiTxebi“ masalebi 19. suxiSvilis universitetis samecniero SromaTa krebuli 2013 weli ,fdidsf rfhlbjkjubf 2013 weli 5 6 ,fdidsf rfhlbjkjubf saqarTvelos bavSvTa kardiologTa asociacia s.b.k.a. Camoyalibda Tssu-s pedklinikis bazaze 1992 wels, registrirebul iqna 1999 wlisTvis. aRniSnuli asociacia warmoadgens kavSirs,xuTi fizikuri piris mier Camoyalibebuls, romelic daarsda saqarTvelos 1997 wlis samoqalaqo kodeqsis debulebebis Sesabamisad. `asociaciis~ saqmianobis vada ganusazRvrelia, aqvs damoukidebeli balansi saqarTvelosa da ucxoeTis sabanko dawesebulebebSi. am kavSiris miznebs warmoadgens _ formulirebismoZeb nagul-sisxlZarRvTa sistemis revmatituli, revmatuli, ararevmatuli dazianebebis, gulis iSemuri daavadebaTa, miokardiumis infarqtiT, kardiopaToebis sxvadasxva formebis, bavSvTa hi potenziebis, sportuli gulis da sxva paTologiuri procesebis naadrevi diagnostirebaSi,kardiologiis ganviTareba,agreTve bavSvTa kardilogiiT dainteresebul student-axalgazrdobisadmi yovelgvari daxmarebis gaweva. saqmianobis sagans warmoadgens gulsisxlZarRvTa usisxlo instrumentuli kvleva. e. kg. 15 ganxrSi, fag _ datvirTvisas, eleqtrogamoTvliT velometria, pulsuri mrudebi, kapidari skopa, reografia, eqokardiografia da sxva. agreTve, imunologiuri da genetikuri markerebis kvleva. aRsaniSnavia, rom `asociaciis~ wevrebi SeiZleba iyvnen rogorc iuridiuli aseve fizikuri pirebi, romlebic iziareben mis miznebsa da saqmianobis princi pebs werilobiTi gancxadebis safuZvelze. `asociaciis~ wevrebs akisriaT garkveuli ufleba-movaleobebi. monawileobis miReba wesdebiT gaTvaliswinebuli wesiT. `asociaciis~ marTvaSi, isargeblon asociaciis konsultaciebiT da rekomendaciebiT, monawileoba miiRon ganzraxul proeqtebze, miiRon finansuri mxardaWera `asociaciis~ fondebidan, agreTve _ gavidnen `asociaciidan~. `asociaciis~ marTvis organos warmoadgens `asociaciis~ wevrTa `saerTo kreba~, romelicmoiwveva 1 jer weliwadSi, an saWiroebisamebr. TiTo wels miekuTvneba TiTo xma. winamdebare wesdeba ZalaSia misi registraciis TariRidan. amrigad, aRniSnul asociacis kardiologiis dargSi akisria mniSvnelovanifunqcia-movaleobebi, romelic dafuZnebulia eqimTa gulisxmierebasa da SemoqmedebiT damokidebulebaze am dargis mimarT. saqarTvelos bavSvTa kardiologTa asociacia saqvelmoqmedo aqciebi 1992wlidan 1998 wlamde mimdinareobda periodulad mosaxleobis humanitaruli gasinjvebi. sul 1998 wlidan socialuri pediatriis fond- Tan erTad daiwyo saqvelmoqmedo aqciebi. aqciebSi monawileoben: gamoCenili qarTveli pediatrebi. mimdinareobs avadmyofTa labora toriuli da instrumentuli kvleva da sxva. urigdebaT medikamentebi. CautardaT ramdenime aTeuli saswrafo operacia. aTobiT avadmyofs Cautarda ufaso gamokvleva da mkurnaloba sxvadasxva wamyvan klinikebSi. 07.01.98-07. 02. 99ww. Tbilisi, gaisinja 9200 bav Svi. 23.24.01.99w. aRmosavleT saqarTvelo. centri q. Telavi. gaisinja 3500-ze meti bavSvi. 12-13-14. 02. 99 Tbilisi televiziis muSakTa Tvis Ria karis dRe; gaisinja 100-mde bavSvi da daurigdaT medikamentebi. dedaTa da bavSvTa sadiagnostiko centrSi da agreTve qalaqis sxvadasxva poliklinikebSi Camoyalibda maRalkvalificiur profesor-maswavlebelTa ufaso konsultaciebi kviraSi erTjer. qalaqis wamyvan pediatriul klinikebSi tardeba maRalkvalificiur profesor-maswavlebel Taufaso konsultaciebi TveSi erTjer. aqciebSi sxvadasxva profiliT monawileobdnen: 1. kanisa da venseneulebaTa instituti 2. parazitologiis samecniero-kvleviTi instituti da sxv. dawyebulia munisa da tilis sawinaaRmdego profilaqtikuri RonisZiebebi damkurnalobis etapi. aseve darigdeba Sesabamisi medikamentebi. daibeWda da gavrcelda munisa da tilis sawinaaRmdego Sesabamisi ufaso samaxsovroebi. 12-13-14.03.99w. eqspedicia foTsa da abaSaSi. 13. 03. 99w. q. foTi,gaisinja 950 bavSvi. daurigdaT metikamentebi. 13-14.03.99w. q. abaSa da abaSis raioni (s. qedisi, s. marani da sxv.) 29-30. 01-07. 08. 99w. gaisinja 4400 bavSvi,daurigdaT medikamentebi. 23-24-25. 08. 99 w. Catarda ufaso laboratoriuli da instrumentuli kvleva. q. xobi da q. zugdi daurigdaT munisa da tilis sawinaaRmdego wamlebi. 04.04.99w. eqspedicia fasanaurSi kompleqsur ad gaisinja 400-ze meti bavSvi. 07.05.99w. eqspedicia guriis regionSi. q. lan CxuTi CautardaT ufaso laboratoriuli da instrumentuli kvleva, daurigdaT medikamentebi. 18.05.99w. Catarda gasinjvebi q. rusTavSi (gaisinja 250-ze meti bavSvi, darigda medikamentebi). 22. 06. 99w. Catarda gasinjvebi sagarejoSi (gaisinjda 250-ze meti bavSvi,darigda medikamentebi). 13-14.08.99 w Camoxatauri (gaisinja 1500-mde bavSvi). 15.08.99 w. baxmaro (gaisinja 2000-ze meti bavSvidamsvenebeli) zRvis donidan 2050m. 16.08.99w. eqspediciagadavidabaxmarodan aWaris maRalmTian raionebSi (sul gaisinja 750-ze meti bavSvi) zRvis donidan 2300-2400m. 17.09.99 w. Catardakompleqsuri gamokvlevebi Tbilisis upatrono bavSvTa saxlSi. 16.10.99w. Catarda gasinjvebi duSeTSi (gaisinja 200-mde bavSvi, darigda medikamentebi). 2000 weli 26.02.2000 w. q. gori gaisinja 500-ze meti bavSvi, darigda medikamentebi 23.03.200 w. axalgori, gaisinja 30 bavSvi. 2013 weli ,fdidsf rfhlbjkjubf 01.04.2000 w. marneulis r-ni sof. weraqvi gakeTda sisxlis saerTo analizi, instrumentuli gamokvlevebi - eqoskopia, encefalograma da sxva. sul gaisinja 1500 bavSvi da momvleli. 15.04.2000. w. gurjaani kompleqsuri gasinjvebi, gaisinja 1200-mde bavSvi darigda medikamentebi. 29.04.2000 w. q. rusTavi (kostavas #6) gaisinja 300-mde bavSvi. 05-06-07. 2000 w. gasinjulia avWalis koloni is bavSvebi. 20.07-28.07. 2000 w. wyneTis bavSvTa saxlSi gasinjulia 60 bavSvi. 21-22-23.-7. 2000w. abaSis r-ni sof. sakieTisa da samtrediis r-nis aRsazrdelTa skolis bavSvTa gasinjvebi. 7-8.08. 2000 w. baxmaro-buSumi gaisinja 1925 bavSvi. 2001 w. 15.03. 2001 w. gaisinja da kompleqsuri gamokvleva Cautarda rusTavis azotis qarxnis TanamSromelTa bavSvebs. 23.06.2001w. gaisinja da kompleqsuri gamokv levaCautarda rusTavis azotis qarxnis TanamSromelTa bavSvebs. 14-15-16. 09. 2001w. baRdadis r-ni sof. sairme, wiTelxevi, roxi, II obCa, xani, zegani, saqraula. gaisinja 2500 bavSvi. 2002 weli 10.03. 2002 w. axalgori gaisinja 250 bavSvi. 20-04. 2002wl. siRnaRis r-ni gaisinja 450 bavSvi 23-24-25-26. 2002w. xulo (aWara) sapatriarqos- Tan erTad gaisinja 600 bavSvi da 100 mozrdili. 27-28-29. 06. 2002w. q. Tbilisi 20 mozrdilTa poliklinika, 10 bavSvTa poliklinika, 121 bavSv Tapoliklinika gaisinja 400 bavSvi. 16-17-18-19. 07. 2002w. kodoris xeoba (afxazeTi) gaisinja 250 bavSvi. 3-4-5-6. 2002w. mTa-TuSeTi,diklo,omalo,Senaqo, gaisinja 200 bavSvi. 2003 weli 5. 03. 2003w. samcxe-javaxeTi gaisinja 1250 bavSvi. 17.04. 2003w. werovani gaisinja 450 bavSvi. 20.05. 2003w. borjomi gaisinja 870 bavSvi. 25.06. 2003w. mTa-TuSeTi gaisinja 320 bavSvi. 30.07. 2003w. baxmaro gaisinja 630 bavSvi. 20.08. 2003 w. zestafoni gaisinja 210 bavSvi. 7.09. 2003 w. zugdidi gaisinja 290 bavSvi. 15.10. 2003 w. raWa gaisinja 170 bavSvi. 18. 10. 2003 w. dmanisi gaisinja 180 bavSvi. 2004 weli marti-aprili-maisi: kaspi, gurjaani, Telavi, axmeta, lagodexi, siRnaRi, bodbe, aspinZa, axalcixe, borjomi,Tbilisi,zestafoni,xaragauli,WiaTura gaisinja 1728 bavSvi. socialuri pediatriis dacvis fondis mier saqarTvelos sapatriarqos TanadgomiT saqarTvelos sxvadasxva regionebSi: zugdidi,xulo,xelvaCauri,qeda, lanCxuTi, ozurgeTi, ingiri _ Catarda saqvelmoqmedo aqciebi, sadac gaisinja, Sesabamisi kvalificiuri samedicino konsultacia gaewia da medikamentebi daurigda 2400 bavSvs. 2013 weli 7 2005weli mrneulis regionSi,gaisinja 700 bavSvi da 800 mozrdili. 18 ivlisi kaspi 450 bavSvi. 8 oqtomberi mcxeTis raioni 300 bavSvi. 14-15-16 oqtomberi lentexi 850 bavSvi da 200 mozardi. 2006 weli 2006 wlis 18 Tebervals klinikaSi Catarda Ria karis dRe. gaisinja mxatvarTa kavSiris 20 ojaxi. martSi Ria karis dRe. gaisinja ltolvilTa 100-ze meti bavSvi. aprilSi saguramoSi elCebis monawileobiT Catarda aqcia. 31 maiss q. rusTavSi gaisinja 450 bavSvi. 1-2 ivniss Tssu-Si Catarda Ria karis dRe. gaisinja 400 bavSvi. maT CautardaT konsultacia da kliniko laboratoriuli gamokvlevebi. 9-10 ivniss kaspis raionSi Catarda gasvliTi gasinjvebi. (gaisinja 300 bavSvi. 1 ivliss cxinvalis raionSi omSi monawileTa 500 bavSvi gaisinja. seqtember-oqtomberSi gaisinja 120 bavSvi. noemberSi gaisinja JurnalistTa 100-200 ojaxi. 2007 weli marneuli. ufaso konsultacia Cautarda 110 bavSvs. gamovlindnen sqolioziT daavadebuli bavSvebi. gadaecaT espanderebi da meToduri rekomendaciebi samkurnalo fizkulturis Sesaxeb. duSeTi. kansultacia Cautarda 280 bavSvs. axaSeni. kansultacia Cautarda 85 bavSvs. _ bavSvTa kardiologia gaisinja 400 bavSvi. maT CautardaT konsultacia da klinikolaboratoriuli gamokvlevebi. 9-10 ivniss kaspis raionSi Catarda gasvliTi gasinjvebi. (gaisinja 300 bavSvi. 1 ivliss cxinvalis raionSi omSi monawileTa 500 bavSvi gaisinja. seqtember-oqtomberSi gaisinja 120 bavSvi. noemberSi gaisinja JurnalistTa 100-200 ojaxi. 2008 weli 1 ivnisi – Ria karis DdRe (gaisinja 200 bavSvi) 2 ivnisi Teddy bear (gaisinja 300 bavSvi) 14 ivnis axmeta (qaqucoba - gaisinja 450 bavSvi, romelTac CautardaT Semdegi gamokvlevebi muclis Rrus eqoskopia,ekg da sxva. darigda Sesabamis medikametebi 27 ivnisi – saqarTvelos seqciis aRdgena 20 agvisto – Stop Russia/ igoeTis aqcia 1 seqtemberi – Stop Russia/ Tbilisi jaWvis aqcia 4 oqtomberi Ria karis DdRe konsultacia, gamokvlevebi: muclis Rrus eqoskopia, ekg da sxva. Sedga mxatvrebis da xelvnebis moRvaweebis master-klasi bavSvebisTvis 6 dekemberi bergmanis klinikaSi ufasod gaisinja 110 bavSvi, romelTac CautardaT Semdegi gamokvlevebi muclis Rrus eqoskopia,ekg da sxva. darigda Sesabamis medikametebi 13.06.2009 xaSuri gaisinja 750 bavSvi 26.12.2009 barisaxo gaisinja 80 bavSvi 8 2010 weli 4 ivlisi – Ria karis omSi daRupulTa ojaxis wevrebi (gaisinja 50 bavSvi) 10 ivlisi – karaleTi. gaisinja 200 bavSvi da daurigdaT medikamentebi. 4 noemberi – wminda keTilmsaxuri mefe Tamaris skola pansionis bavSvebi. gaisinja 50 bavSvi. 3-4 dekemberi – gaisinja sporcmeni 400 bavSvi. 2011 weli 1 ivnisi _ gaisinja 200 bavSvi. 24 dekemberi – gaisinja 200 bavSvi. 2012 weli 1 ivnisi – gaisinja 250 bavSvi 27.07 _ Telavi, 11.08 _ karaleTi 22 dekemberi – gaisinja 250 bavSvi dRemde aqciebSi sul gaisinja 93 727 bavSvi da aTasobiT xanSiSesuli. saqvelmoqmedo aqciebi grZeldeba. bavSvTa kardiologiuri asociaciis mier Catarebulia konferenciebi da simpoziumebi: 1992 w. I bavSvTa kardiologTa konferencia. I konferencia `CvenTan erTad irwmune ukeTesi momavlis realoba~ 01.VI. 99 II konferencia `janmrTeli bavSvi mSvidobiani kavkasia~ 25.XII. 99 III konferencia `dRevandeli ekonomikuri mimarTulebani pediatriaSi da misi perspeqtiva~ XXI saukunis pediatria _ invalidobis profilaqtikis medicinad unda iqces. 01. VI. 2000 IVkonferencia `Canasaxidan bavSvis ufleba unda iyos daculi~ 27.III. 2001 Sexvedra saxalxo damcvelis ofisSi `arasrulwlovani damnaSaveebi, maTi uflebebi da realoba~ 01. 06. 2001 V (XIX) konferencia `miZRvnili bavSvTa dacvissaerTaSorisodRisadmi~ 30.03. 99, 01.06. 2000, 01.06. 2001 `bavSvTa mkurnaloba XXI saukuneSi~ simpoziumi 1, #2, #5 23.04.99.01. 06. 2000 `bavSvTa kveba XXI saukuneSi~ simpoziumi #1, #2. 20. 05. 99. 01. 06. 2000 `orTopediuli skola~ simpoziumi #1, #2 17. 12. 99 `mukovis cidozis diagnostikisa da mkurnalobis sakiTxebi~ 01. 06. 2000 axalgazrda pediatrTa XVIII konferencia 28. 02. 2001 erToblivi samecniero konferencia `respiratorul daavadebaTa Terapiis aqtualuri sakiTxebi pediatriaSi~. 01. 06. 2001 `Canasaxidan bavSvs ufleba aqvs iyos daculi~ simpoziumi #1 01. 06. 2001 `bavSvi, mozardi da ojaxuri Zaladoba~ simpoziumi #1 01. 06. 2001 `Canasaxidan bavSvs ufleba aqvs iyos daculi~ ,fdidsf rfhlbjkjubf simpoziumi #1 13. 02. 2002 `adamianis genomis proeqti~ 10. 03. 2002 axalgori,matonizirebuli sasmeli `lomisis~ prezentacia. 6. 11. 2002 saerTaSoriso konferencia Temaze: `mukovis cidoziT da nivTierebaTa cvlis konstituciuri moSlilobiT daavadebulTa samedicino da socialuri problemebi~. 7. 11. 2002 saerTaSorisoko nferencia Temaze: `Tandayolili infeqciebis Tanamedrove apeqtebi~. 4. 04. 2003 pediatriis aqtualuri sakiTxebi. IX konferencia. 1. 06. 2003 I internet-konferencia (X samecniero-praqtikuli konferencia) socialuri pediatriis dacvis fondi ufasod uSvebs da arigebs gazeTs `socialuri pediatria~ da Jurnals `socialuri pediatria~ (Suqdeba socialuri, samedicino, pedagogiuri, fsiqologiuri, fsiqiatriuli, religiuri da sxva aqtualuri da problemuri sakiTxebi) 19. 12. 2003 saqarTvelos bavSvTa kardiologTa II kongresi. 1. 06. 2004. II saerTaSoriso internet-konferencia. pediatriis aqtualuri sakiTxebi 22. 10. 2004. konferencia Temaze: `pediatriis aqtualuri sakiTxebi~, romelic eZRvneboda socialuri pediatriis prezidentis, genetikosis viqtor moroSkinis naTel xsovnas. 1. 06. 2005 pediatriis aqtualuri sakiTxebi XIV konferencia. 9. 09. 2005 Tbilisi, merioti II saerTaSoriso konferencia `janmrTeli bavSvi mSvidobiani kavkasia~. 2006w. 1 ivnisi socialuri pediatris dacvis fondis konferencia. dekemberSi axalgazrda pediatrTa ligis eqim specialistTa XXIII kongresi. 31.05. 2007 bavSvTa kardiologiis III kongresi. 7.12. 2007 spdf me-17 konferencia. 07.10.08. konferencia `bavSvis da mozardis~ kardiologiuri seqcia (Tbilisi). 20.12.08 socialuri pediatriis dacvis fondis da ESMNS erToblivi meore konferencia (Tbilisi). 12.06.2009 socialuri pediatriis dacvis fondis XX konferencia 18.12.2009 socialuri pediatriis dacvis fondis XXI konferencia 01.06.10 walkis XXII da saqarTvelos eqTanTa II konferencia. 03.12.10 profesor i. kvaWaZis 85 wlisadmi saiubileo konferencia. 01.06.2011 socialuri pediatriis dacvis fondis XXVI konferencia 23.12.2011 socialuri pediatriis dacvis fondis XXVII konferencia 01.06.2012 bavSvTa kardiologTa IV kongresi 21-22.12.2012 socialuri pediatriis dacvis fondis XXIX konferencia 2013 weli ,fdidsf rfhlbjkjubf 9 Georgian Pediatric Cardiology Association GPCA was founded on the base of TSMU pediatric clinics in 1992 and was registered in 1999. Association was founded by five persons according to Georgian Civil Codex Regulation in 1997. Association work is not limited, has independent balance in Georgian and foreign banks. Main goals of this association is early diagnostics of diseases like – Rheumatic and None-Rheumatic Cardiovascular diseases, heart ischemic diseases, myocardial infarction, different cardiomyopathy diseases, children hypertensions, Athlete’s Heart and etc. Also, one of the main goals of GPCA is to help all young people who are interested in Pediatric Cardiology. Association works include bloodless instrumental research like – ECG in 15 inclinations, PCG– during load, electric velometry, capillaroscopy, rheography, echocardiography and others, research ofimmunological and genetic markers. Members of Association can be lawyers who share the goals and main principles of work. Members of GPCA have determined rights and duties: to participate in governing of Association and various projects, use the consultations and recommendations of Association, get financial support from Association funds and leave Association. The governing system of Association is represented by general meeting of the members which is held once in a year. Each member has one vote. These charters are in action after registration. So, this association has important duties and function, which is stimulated by doctor’s sensitiveness and creative work in this field. GEORGIAN PEDIATRIC CARDIOLOGY ASSOCIATION CHARITY ACTIVITIES From 1992 to 1998 GPCA was periodically holding humanitarian examinations. From 1998 with the help of Social Pediatrics Protection Fund started charity activities, in which Georgian pediatrists were participating. Activities included: Instrumental and laboratory research of patients in different regions of Georgia, Medical gifts, several funded emergency operations. 07.01.98 – 07.02.99 Tbilisi, - over 9200 children were examined. 23-24.01.99 East Georgia, - over 3500 children were examined. 12-13-14.02.99 Tbilisi, - over 100 children were examined and gifted medicines. Free consultations by professors were held by Mother and Child Diagnostic Centre and other hospitals once a week, consultations in leading pediatric clinics of the city once in a month. In these activities were also participating: 1. Institute of skin and vein 2.Scientific Institute of Parasitology and others. 12-13-14.03.99 expedition in Poti and Abasha (Qedisi, Marani and other), - 950 children were examined and gifted medicines. 29-30. 01-07.08.99 – 4400 children were examined and gifted medicines. 23-24-25.08.99 Khobiand Zugdidi, - Free instrumental and laboratory examinations were funded. Also medicines against louse and itch were given. 04.04.99 - Expedition in Pasanauri – over 400 children were examined. 07.05.99 – Expedition in Lanchkhuti – Free instrumental and laboratory examinations were held and medicines were gifted. 18.05.99 Rustavi, - 250 children were examined and gifted medicines. 22.06.99 Sagarejo, - 250 children were examined and gifted medicines. 2013 weli 13-14.08.99 Chokhatauri, - over 1500 children were examined. 15.08.99 Bakhmaro, - over 2000 children were examined. 16.08.99 Adjara high-mountain regions, - over 750 children were examined. 17.08.99 Tbilisi, – Examinations in Homeless children house. 16.10.99 Dusheti region, - over 200 children were examined and gifted medicines. 2000. 26.02.2000 Gori, - over 500 children were examined. Different medicines were given out. 23.03.2000 Axalgori, - 30 children were examined. 01.04.2000 Marneuli region (Werakvi), - General blood analysis, instrumental examinations – echoscopy, encephalography were done. Over 1500 children were examined. 15.04.2000 Gurjaani, - 1200 children were examined, medicines were given out. 29.04.2000 Rustavi, - 300 children were examined. 05.06.2000 – Children from Avchala colony were examined. 20-28.07.2000 – Children in Tskhneti Orphanage were examined. 21-22-23.07.2000 – Examinations in Abasha and Samtredia region. 7-8.08. 2000, Bakhmaro-Beshumi – 1925 children were examined. 2001. 15.03.2001. Children of employees of Rustavi Nitrogen Factory were examined. 23.06.2001. Children of employees of Rustavi Nitrogen Factory were examined. 14-15-16.09.2001 Baghdati region (Sairme, Witelkhevi, Rokhi, Ochba, Xani, Zegani,Saqraula) – over 2500 children were examined. 2002. 10.03.2002 Axalgori, - 250 children were examined. 20-04.2002 Sighnaghi, - 450 children examined. 23-24-25-26.05.2002 Khulo, - 600 children and 100 adults were examined with the help of Patriarchy. 27-28-29.06.2002 Tbilisi, - 400 children were examined in different Hospitals. 16-17-18-19.07.2002 KodorisKheoba, - 250 children were treated. 3-4-5-6.08.2000 Tusheti (Dikolo,Omalo,Shenaqo) – 200 children were treated. 2003. 05.03.2003 Samtskhe-Javakheti, - 1250 children were examined. 17.04.2003 Werovani, - 450 children were examined. 20.05.2003 Borjomi, - 870 children were examined. 25.06.2003 Mta-Tusheti, - 320 children were examined. 30.07.2003 Bakhmaro, - 630 children were examined. 20.08.2003 Zestaponi, - 210 children were examined. 07.09.2003 Racha, - 170 children were examined. 18.102003 Dmanisi, - 180 children were examined. 2004. March, April, May – Kaspi, Gurjaani, Telavi, Akhmeta, Lagodekhi, Sighnaghi, Bodbe, Aspindza, Axaltsikhe, Borjomi, Tbilisi, Zestaponi, Kharagauli, Chiatura – over 1728 children were examined. In different regions (Zugdidi, Khulo, Khelvacharui, Qeda, Lanchkhuti, OzurgetiIngiri), SPPF 10 held charity activities with the help of Patriarchy – over 2400 children were examined and medicines were given out. 2005. Marneuli region – 700 children and 80 adults were examined. 18th of July, Kaspi – 450 children were examined. 8th of October, Mtskheta – 300 children were examined. 14-15-16th of October, Lentekhi – 850 children and 250 adults were examined. 2006. 18th of February –20 Painter Union families were examined. March – over 100 refugee children were examined. April – Charity activities were held by ambassadors in Guria. 31th of May – 450 children were examined in Rustavi. 1-2th of June - Open door day in TSMU, 400 children were examined. They were held free consultations and laboratory examinations. 9-10th of June, Kaspi - 300 children were examined. 1th of July, Ckhinvali region – 500 children of war participants were examined. In September-October – 120 children. In November – over 200 of Journalist’s families were examined. 2007. Marneuli – Free consultations for 100 children. Childrens with Scoliosis were shown. They got espander gifts and were recommended how to treat scoliosis. Dusheti – 250 children were examined. Akhalsheni–85 children were held consultations. 9-10th of June, Kaspi – 300 children were examined. 1th of July, Ckhinvali region – 500 children of war participants were examined. In September-October – 120 children. In November – over 200 of Journalist’s families were examined. 2008. 1st of June – Open door day (200 children were examined). 2nd of June – Teddy bear (300 children examined). 14th of June, Akhmeta (QaQucoba) - 450 children were examined and gifted medicines. Also examinations like echoscopy of abdominal cavity and ECG were held. 27th of June – restoration of Georgian Section. 20th of August - STOP RUSSIA (meeting at Igoeti) 1st of September, Tbilisi – STOP RUSSIA (meeting of chain) 4th of October – free consultations and examinations. Painters and artists master classes were held. 6th of December – 110 children were examined in Bergman Clinics with echoscopy of abdominal cavity, ECG and other. 2009. 13.06.2009, Khashuri – 750 children were examined. 26.12.2009, Barisakho – 80 children were examined. 2010. 4th of July – Open door day for family members of war victims (50 children were examined). 10th of July, Karaleti – 200 children were examined and medicines were given out. 4th of November – St. King Tamar orphanage children were examined. 3-4th of December, Tbilisi– 400 sportsmen children were examined. 2011. 1st of June, Tbilisi – 200 children were examined. 24th of December, Tbilisi – 200 children were examined. ,fdidsf rfhlbjkjubf 2012. 1st of June ,Tbilisi – 350 children were examined. 22th of December, Tbilisi – 250 children were examined. Till today over 93 727 children were examined and thousands of old people. Charity activities continue. SIMPOSIUMS AND CONFERENCES HELD BY GEORGIAN PEDIATRIC CARDIOLOGY ASSOCIATION: 1992. First pediatric cardiology conference – “believe the reality of better future”. 01.06.1999. II conference – “Healthy child & peaceful Caucasus”. 25.12.1999. III conference – “Today’s economic directions in pediatric and its perspective”. XXI century Pediatrics should be the start of invalid prophylaxis. 01.06.2000. IV conference – “Child must have right to be protected since embryo”. 27.03.2001. Meeting in ombudsman’s office – “Under aged criminals, their rights and reality”. 01.06.2001. V conference dedicated to Children Protection National Day. 32.03.1999. 01.06.2000. 01.06.2001 “Child treatment in XXI century” 23.04.1999. 01.06.2000 “Child treatment in XXI century” “Orthopedic school” 17.12.1999. Mucoviszidose treatment and diagnostics. 01.06.2000. Young Pediatrists XVIII conference. 28.02.2001. Urgent questions of Therapy of respiratory diseases in pediatrics. 01.06.2001. “Child has right to be protected since embryo”. 01.06.2001. “Child, adult and family violence”. 13.02.2002. “Human genome project”. 10.03.2002. Akhalgori, - Presentationof toner drink “Lomisi”. 06.11.2002. National Conference: Medical and social problems of people who suffer from mucoviszidose and metabolism disorder. 07.11.2002. “Contemporary aspects of inborn diseases”. 04.04.2003. “Urgent pediatric questions” (IX conference). 01.06.2003. Internet conference (X conference) – Social Pediatrics Protection Fund gave out journals and magazines called “Social Pediatrics” (In which is written about social, medical, pedagogic, psychological, religious and other urgent problems). 19.12.2003. Second Georgian Cardiology Congress. 22.10.2004. “Urgent Pediatric questions” dedicated to SPPF president, Victor Moroshkin. 01.06.2004. Second National Internet Conference. 01.06.2005. Urgent Pediatric questions. 09.09.2005. Tbilisi Marriot, - Second National Conference “Healthy child & Peaceful Caucasus”. 1st of June, 2006. – SPPF conference. XXIII Congress of Young Pediatrists League. 31.05.2007. III congress of Pediatric Cardiology. 07.12.2007. SPDF XVII conference. 07.10.2008. Conference – “Section of child and adult”. 20.12.2008. SPPF and ESMNS second conference. 12.06.2009. SPPF XX conference. 01.06.10. Second conference of Georgian surgeons and XXII conference of Tsalka. 03.12.2010. Conference dedicated to I. Kvachadze 85th anniversary. 01.06.2011. SPPF XXVI conference. 23-24.12.2011. SPPF XXVII conference. 01.06.2012. IV congress of Pediatric Cardiology. SPPF XXVIII conference. 21-22.12.2012. SPPF XXIX conference 2013 weli ,fdidsf rfhlbjkjubf 11 originaluri statiebi kardiologia ST segmentisa da T kbilis cvlilebani janmrTel bavSvTa sxvadasxva asakobriv jgufebSi g.CaxunaSvili, n.jobava (saqarTvelos bavSvTa kardiologTa asociacia) umniSvnelovanesia, rom periferiul ganxrebSi ST intervalis 1 mm-iT cdoma Seesabameba 400 000 miokardiuli boWkos dazianebas (gulmkerdis ganxrebSi ki 4000-s). am monacemebis (Schaeffer H., Haas H., 1962) gaTvaliswinebiT saWiroa da aucilebelia ufro meti yuradReba daeTmos ST-T umniSvnelo darRvevebsac, romlebic aRiniSneba standartul da monopolarul ganxrebSi, radgan es cvlilebebi SeiZleba iyos ufro mniSvnelovani, vidre iSemiis ufro intensiuri gamovlinebebi gulmkerdis ganxrebSi. mravali statistikuri monacemebis Tanaxmad msubuqi eleqtrokardiografiuli darRvevebi warmoadgenen koronaluri riskis aSkara faqtorebs (Ross S.R., 1970). swored amitom, vTvliT saWirod danxiluli iqnqs skupulozurad ST segmentisa da T kbilis cvlilebani janmrTel sxvadasxva asakobriv bavSvTa jgufebSi. Cvens mier gaanalizebulia 1981-2013ww-is 5 000 janmrTeli bavSvi sxvadasxva asakobriv jgufebSi. 2013 weli T kbilis farTobi ganisazRvreba Semdegi formuliT: S = 2/3. a. h, sadac a aris sigane, xolo h simaRle. Sesabamisad diagramebi ## 115 asaxaven T kbilois maqsimalur da minimalur farTs mm2, ekg-s 15 ganxraSi – 12 Cveulebrivi da 3 NeHb-is janmrTel bavSvTa sxvadasxva asakobriv jgufebSi. diagrama ## 1(a)-15(a) asaxavs dadebiTi da uaryofiTi T kbilis SemTxvevaTa raodenobebs procentebSi,xolo diagrama ## 1-15 ganxrebSi T kbilis maqsimaluri dadebiTi, maqsimaluri da minimaluri simaRleebi, aseve uaryofiTi minimaluri da maqsimaluri siRrmeebi. T kbilis farTobi ganisazRvreba Semdegi formuliT: S = 2/3. a. h, sadac a aris sigane, xolo h simaRle. Sesabamisad diagramebi ## 115 asaxaven T kbilois maqsimalur da minimalur farTs mm2, ekg-s 15 ganxraSi – 12 Cveulebrivi da 3 NeHb-is janmrTel bavSvTa sxvadasxva asakobriv jgufebSi. diagrama ## 1(a)-15(a) asaxavs dadebiTi da uaryofiTi T kbilis SemTxvevaTa raodenobebs procentebSi,xolo diagrama ## 1-15 ganxrebSi T kbilis maqsimaluri dadebiTi, maqsimaluri da minimaluri simaRleebi, aseve 12 ,fdidsf rfhlbjkjubf uaryofiTi minimaluri da maqsimaluri siRrmeebi. 2013 weli ,fdidsf rfhlbjkjubf 2013 weli 13 14 ,fdidsf rfhlbjkjubf # 1 cxrilSi kargad Cans TiToeul ganxraSi T kbilis maqsimaluri dadebiTi, maqsimaluri da minimaluri simaRleebi, aseve uaryofiTi minimaluri da maqsimaluri siRrmeebi. amdenad, rac Seexeba naxazebsa da diagramebs, isini saSualebas iZlevian bavSvebSi (asakis miuxedavad) ganisazRvros depresiuli T kbilis arseboba: - I standartul ganxraSi – pirveli askobrivi jgufis garda (cxrili # 1, diagrama # 1). - II standartul ganxraSi – yvela asakobriv jgufSi (cxrili # 1, diagrama # 2). - AVF-Si pirvel or asakobriv jgufSi (cxrili # 1, diagrama # 6). - V4-Si – bolo or asakobriv jgufSi (cxrili # 1, diagrama # 10). - V5 da V6-Si – yvela asakobriv jgufSi (cxrili # 1, diagrama # 11-12). ukanaskneli warmoadgens rogorc dRenaklul, ise droul axalSobilTa kardiologiaSi wamyvan sadiagnostiko kriteriumebs, romelic mniSvnelovania rogorc dasawyisSi daavadebaTa mkurnalobisaTvis, ise misi dinamikis Sefaseba-prognozirebisaTvis da rac mTavaria, reabilita2013 weli ,fdidsf rfhlbjkjubf 15 cxrili # 1 T kbilis maqsimaluri da minimaluri simaRle ekg-s 15 ganxraSi (12 Cveulebrivi da 3 NeHb-is) janmrTel bavSvTa sxvadasxva asakobriv jgufebSi cxrili # 5 ST segmentis maqsimaluri cdoma izoeleqtruli xazis zemoT (mm-iT da mm 2-Si) ciis periodSi, ukve mozrdilTa gulsisxlZarRvTa sistemis daavadebaTa prevenciisaTvis. amJamad ganvixiloT ST segmentis cvlilebani. # 5 da # 6 cxrilSi mocemulia ST segmentis maqsimaluri cdoma izoeleqtruli xa2013 weli zis zemoT da qvemoT (mm-iT da mm2-iT). ST segmentis farTobi ganisazRvreboda Semdegi formuliT: ST = QT1 – QRS SST = ST > XST diagramebi ## 16-30 asaxaven ST segmentis farTobs aRniSnul ganxrebSi. unda aRiniSnos, rom ST segmentisa da T kbilis morfologiuri cvlilebani unda ganixilebodes erTian konteqstSi: ST segmentis izoeleqtruli xazidan zemoT an qvemoT cdoma misi formis gaTvaliswinebiT rkalisebri, naxevarmTvarisebri, gadatriale bu li, gad mot ri a le bu li da a.S.). Tu rogor T kbilSi gadadis da piriqiT, dadebiTi an uaryofiTi T kbili misi sxvadasxva formiT (orkuziani, gafarToebuli, wvetiani, orfaziani + - an - +), rogor ST segments mosdevs da risi gagrZelebaa. amitom migvaCnia T kbilis cvlilebisa da ST intervalis cdomis orientirad unda ganvixiloT ara TP intervali, aramed P-Q segmenti, radgan praqtikulad is ufro stabiluria da TiTqmis arasdros ar ganicdis cdomas. ST intervalis cdomis xarisxi unda gaizomos izoeleqtruli xazidan, romelic P-Q seg men tis gag r Ze le bas warmoadgens. imasTan dakavSirebiT, rom S-T intervalis forma SeiZleba sxvadasxvagvari iyos, izoeleqtruli fazi dan in ter va lis cdo mis donis gansazRvrisaTvis, Cveni azriT, unda gamoviyenoT S-T intervalis QRS kompleqsTan SeerTebis wertili da ara ST intervalis Suawertili. ekg-ze is wertili, rogorc wesi SesamCnevia, igi repolarizaciis procesis dawyebas Seesabameba (nax) es wertili ucxour literaturaSi aRiniSneba asi J-Ti (Junetion – SeerTeba). qvemoT moyvanili diagramebi asaxaven ST segmentis farTs aRniSnul ganxrebSi. rogorc diagramebidan Cans ST-segmentis farTebi mniSvne- 16 ,fdidsf rfhlbjkjubf cxrili # 6 ST segmentis maqsimaluri cdoma izoeleqtruli xazis qvemoT (mm-iT da mm2-Si) lovan klinikur Rirebulebebs ar gvaZleven da ST segmentisa da T kbilis morfologiuri cvlilebani unda ganixilebodes erTian konteqstSi: ST segmentis izoeleqtruli xazidan zemoT an qvemoT cdoma, misi formis gaTvaliswinebiT (rkalisebri, naxevarmTvarisebri, gadatrialebuli, gadmotrialebuli da a.S.), Tu rogor T kbilSi gadadis (dadebiTi an uaryofiTi T kbili, misi sxvadasxva formiT (orkuziani, gafarToebuli, wvetiani, orfaziani + - an - +), an piriqiT T kbili rogor ST segments mosdevs da risi gagrZelebaa is. yovelive aqedan gamomdinare Cvens mier SemuSavebulia ST segmentisa da T kbilis morfologiuri cvlilebebis 8 ti pi(sur.2) amdenad, warmodgenil suraTSi # 2 (ST–segmentisa da T kbilis morfologia) naCvenebia ST segmentisa da T kbilis morfologiur cvlilebaTa 8 ti pi, saidanac aRsani Snavia, rom janmrTel babSvTa kontigentSi: - cdoma zemoT ST segmentisa da T kbilis cvlilebasTan erTad, ti pi 2-3 ar dagviregistrirebia, garda ti pi 1-sa (vagotonuri ti pi) da isic 10 wlis zemoT, sxva asakSi iSviaTad. - cdoma qvemoT ST segmentisa taqikardiuli ti pis (ti piV) gvxvdeboda 0-dan 3 wlamde asakSi, xolo hi pertonuli ti pis( ti pi–VII) iSviaTad, da mainc 5 wlis zemoT. amgvarad, ST segmentisa da T kbilis morfologiuri cvlelebebi erTian konteqsSi, princi pSi janmrTel bavSvebSi ar gvxvdeba, Tu ar gaviTvaliswinebT gardamaval asaks da riTmis mkveTr cvlilebebs, bradikardiisa da taqikardiis saxiT. A aqedan gamomdinare ST segmentisa da T kbilis morfologiuri cvlelebebis gamoyofili 8 ti pi, rogorc dRenaklul, ise droul axalSobilTa kardiologiaSi,aseve bavSvTa da mozardTa yvela asasakobrivi jgufebisaTvis,warmoadgens wamyvan sadiagnostiko kriteriumebs daavadebaTa mimdinareobis simZimis SefasebaSi, romelic TavisTavad umniSv ne lo va ne sia, ro gorc da sawyisSi daavadebaTa mkurnalobisaTvis, ise misi dinamikis Sefaseba-prognozirebisaTvis da rac mTavaria, reabilitaciis periodSi, ukve mozrdilTaT vis gul-sis x l Zar R v Ta sistemis daavadebaTa prevenciisaTvis. 2013 weli ,fdidsf rfhlbjkjubf 2013 weli 17 18 ,fdidsf rfhlbjkjubf reziume ST segmentisa da T kbilis cvlilebani janmrTel bavSvTa sxvadasxva asakobriv jgufebSi g.CaxunaSvili, n.jobava (saqarTvelos bavSvTa kardiologTa asociacia) vTvliT saWirod danxiluli iqnqs skupulozurad ST segmentisa da T kbilis cvlilebani janmrTel sxvadasxva asakobriv bavSvTa jgufebSi. Cvens mier gaanalizebulia 1981-2013ww-is 5 000 janmrTeli bavSvi sxvadasxva asakobriv jgufebSi. bavSvebSi (asakis miuxedavad) ganisazRvra depresiuli T kbilis arseboba: - I standartul ganxraSi – pirveli askobrivi jgufis garda - II standartul ganxraSi – yvela asakobriv jgufSi - AVF-Si pirvel or asakobriv - V4-Si – bolo or asakobriv jgufSi - V5 da V6-Si – yvela asakobriv jgufSi ukanaskneli warmoadgens rogorc dRenaklul, ise droul axalSobilTa kardiologiaSi wamyvan sadiagnostiko kriteriumebs, romelic mniSvnelovania rogorc dasawyisSi daavadebaTa mkurnalobisaTvis, ise misi dinamikis Sefaseba-prognozirebisaTvis da rac mTavaria, reabilitaciis periodSi, ukve mozrdilTa gulsisxlZarRvTa sistemis daavadebaTa prevenciisaTvis. ST segmentisa da T kbilis morfologiuri cvlelebebis gamoyofili 8 ti pi, rogorc dRenaklul, ise droul axalSobilTa kardiologiaSi,aseve bavSvTa da mozardTa yvela asasakobrivi jgufebisaTvis,warmoadgens wamyvan sadiagnostiko kriteriumebs daavadebaTa mimdinareobis simZimis SefasebaSi, romelic TavisTavad umniSvnelovanesia, rogorc dasawyisSi daavadebaTa mkurnalobisaTvis, ise misi dinamikis Sefaseba-prognozirebisaTvis da rac mTavaria, reabilitaciis periodSi, ukve mozrdilTaTvis gul-sisxlZarRvTa sistemis daavadebaTa prevenciisaTvis. SUMMARY ST AND T WAVE CHANGES IN CHILDREN OF DIFFERENT AGES (G.CHAKHUNASHVILI, N.JOBAVA) (Georgian Pediatric Cardiology Association) We think that ST and T wave changes in children of different ages must be discussed. We analyzed over 5000 child of different ages from 1981-2013. Despite the age, children appeared to have depressed T wave: - I standard lead – besides first age group. - II standard lead – in all age group. - AVF – in two age groups. - V4 – in last two age groups. - V5-V6 – in all age groups these leads shows as short-lived and also timely born children diagnostic criteria. This is important for disease treatment and also for estimation-prediction of dynamics, for prevention of cardiovascular diseases during rehabilitation in adults. 8 types of ST and T wave morphological changes is the leading estimation criteria during disease progression, as in short-lived, also in timely born children, also for all age groups of children and adult. This is important for disease treatment and also for estimation-prediction of dynamics, for prevention of cardiovascular diseases during rehabilitation in adults. 2013 weli ,fdidsf rfhlbjkjubf 19 sportsmenTa fizikuri da funqciuri mdgomareobis Sefaseba api pulmosa da apikoris fonze m.m.d. g. CaxunaSvili, n. badriaSvili, m.d. n. TofuriZe, m.d. n. jobava, m.d. z. SaqaraSvili,m.d. z.fxalaZe, m.m.d. k. CaxunaSvili, socialuri pediatriis dacvis fondi, ir.ciciSvilis sax. pediatriuli klinika, Tbilisis sax.samedicino universiteti organizmis fizikuri ganviTareba ganisazRvreba, rogorc adamianis organizmis morfofunqciuri Taviseburebebis cvlilebaTa rTuli procesi. is emorCileba biologiur kanonebs da asaxavs zrdisa da ganviTarebis zogad kanonzomierebebs. varjiSis procesis intensifikacia(2,3) da organizmis sistematiuri gadatvirTva iwvevs struqturuli, fiziologiuri da sxa rezervebis Semcirebas(1,5). didi fizikuri datvirTva gazrdil moTxovnebs uyenebs organizms, spotsmenebSi deficituri mdgomareoba iCens Tavs, rasac SeiZleba Tan axldes funqciuri rezervebis amowurva, adaptaciis uaryofiTi efeqtebi da janmrTelobis darRveva(4,7,9,11). Aamdenad, sportuli medicinis umniSvnelovanes problemas mwvave da qronikuli gadaZabva da misi profilaqtika warmoadgens. Aam mxriv gansakuTrebul yuradRebas ipyrobs sportsmen bavSvTa kvebis racionSi api pulmosa da apikoris gamoyeneba. apikori ori biologiurad aqtiuri kompinentebiT mdidari produqtis futkris nawarmisa da yurZnis wipwis nazavia. yvavilis mtveri mdidaria organizmis Senebis, ganviTarebisa da sicocxlisaTvis aucilebeli nivTierebebiT: cilebiT(Seicavs aminomJavebis 22 saxeobas, maTgan 8 Seucvlels), najeri da ujeri cximovani mJavebiT, glikozidebiT, vitaminebiT(A,B,C,D,PP,E,K,folis mJava), fosfoterinebiT, sisxlZarRvis kedlis gamamagrebeli bioflavinoidebiT, mikro da makroelementebiT(Fe,Zn,Cu,F). Aamave dros yurZnis wipwa SesaniSnavi imunomodulatoria. api pulmo warmoadgns ori biologiurad aqtiuri kompinentebiT mdidari produqtis qarTuli futkris nawarmisa da wiwvovanis eqstraqtis nazavs, romelic mdidaria organizmis Senebis, ganviTarebisa da sicocxlisaTvis aucilebeli nivTierebebiT. is awesrigebs vitaminebis, aminomJavebis da mikroelementebis cvlas, Jangva-aRdgeniT procesebs; aZlierebs qsovilis mier Jangbadis utilizacias da Sedegad zrdis gonebriv da fizikur Sromisunarianobas; uzrunvelyofs organizmis zrdisa da ganviTarebis procesebs; aumjobesebs reproduqciuli sistemis funqcionirebas; aZlierebs eqstremaluri da stresuli faqtorebisadmi organizmis adaptaciis unars da mis dacviT meqanizmebs. gaaCnia imunomodulaciuri, imunomastimulirebeli da antimikrobuli Tvisebebi; preparatSi Semavali aminomJavebi advilad aTvisebadia, rac xels uwyobs azotovani balansis SenarCunebasa da organizmis zrda-ganviTarebas; swored aminomJavebiTa da vitaminebiT mdidarma preparatebma: api pulmom da apikorma, SeiZleba Seasrulos mniSvnelovani roli sportsmenTa reabilitaciaSi energiis aRsadgenad, polideficituri mdgomareobebis, fizikuri da gonebrivi gadaRlis dros. (6,8,10). mizani: maRali fizikuri datvirTvis pirobebSi kalaTburTelTa fizikuri da funqciuri mdgomareobis Sefaseba api pulmosa da api2013 weli koris fonze. masala da meTodebi: samuSaos safuZvlad daedo 12-dan 18 wlamde asakis 50kalaTburTelis fizikuri ganviTarebis maCveneblebis da datvirTvaze adaptaciis gamokvlevis Sedegebi api pulmosa da apikoris miRebis fonze(TiTo abi samjer dreSi erTi Tve). CarTvis kriteriumebi: damakmayofilebeli socialur-ekonomiuri pirobebi, damakmayofilebeli da kargi sportuli Sedegebi. sakontrolod aRebuli iyo igive monacemebis 25 kalaTburTeli, romelTac ar eZleodaT api pulmo da apikori. Seswavlil iqna Semdegi maxasiaTeblebi: ramden dRes varjiSobs kviraSi, ramden saaTs varjiSobs dReSi, ganwyoba varjiSis Semdeg, aqvs Tu ara gadaRla da gadaZabva,gulis SekumSvaTa sixSire,sunTqvis Sekvris dro, zogadi mdgomareoba, simaRle mjdomare da fexze dgomisas; welis, gulmkerdis, mxrebis, kidurebis garSemoweriloba, pulsi, arteriuli wneva sistoluri da diastoluri, datvirTvamde da datvirTvis Semdeg, am maCveneblebis mixedviT gamoTvlil iqna Semdegi sportuli indeqsebi: rufies indeqsi(fizikuri Sromis unarianoba), amtanobis koeficienti (kvasis formula), Stanges sinji(sunTqvis Sekaveba CasunTqvisas), genCis sinji(sunTqvis Sekaveba amosunTqvisas), saSualo arteriuli wneva, sisxlis mimoqcevis sistoluri da wuTobrivi moculobebi (lilienistradisa da canderis formulebi), sisxlis mimoqcevis efeqturobis koeficienti, ketles indeqsi(simaRlisa da wonis Tanafardoba), minuvries indeqsi (sxeulisa da fexebis sigrZeTa Tanafardoba), pinies indeqsi. raodenobrivi maCveneblebis sarwmunobis Sefasebas vaxdendiT stiudentis kriteriumiT (t), xarisxovanis χ2 kriteriumiT, jgufebs Soris Sedarebas Pearson-iT. gansxvaveba iTvleboda sarwmunod, Tu t>1,96 p<0,05 da χ>3,84, p<0,05 (10,11). maTematikuri uzrunvelyofa ganxorcielda programebis paketis SPSS –is gamoyenebiT. kvlevis Sedegebi da maTi ganxilva: kvlevis pirvel etapze SeviswavleT kalaTburTelTa anTropometruli, fizikuri da funqciuri maxasiaTeblebi apipulmosa da apikoris miRebamde da miRebidan 3 Tvis Semdeg(cxr#1) sarwmunod gaumjobesda fizikuri da funqciuri maCveneblebi apipulmosa da apikoris miRebis fonze. gaumjobesda iseTi funqciuri monacemebi rogoricaa sunTqviTi indeqsebi (Stanges sinji; genCis sinji) rufies indeqsi, amtanobis koeficienti, sisxlis mimoqcevis sistoluri da wuTobrivi moculobebi (lilienistradisa da canderis formulebi), gauaresda sisxlis mimoqcevis efeqturobis koeficienti. igive maCveneblebis Sedarebam sakontrolo jgufSi 3 Tvis Semdeg arsebiTi gansxvaveba ar mogvca(cxrili#2) 20 ,fdidsf rfhlbjkjubf cxrili #1 kalaTburTelTa anTropometruli, fizikuri da funqciuri maCveneblebis SedarebiTi analizi api pulmosa da apikoris miRebis fonze 2013 weli ,fdidsf rfhlbjkjubf 21 cxrili #2 kalaTburTelTa anTropometruli, fizikuri da funqciuri maCveneblebis SedarebiTi analizi sakontrolo jgufSi 2013 weli ,fdidsf rfhlbjkjubf 22 daskvnebi: 1. api pulmosa da apikoris miRebis Semdeg adgili aqvs kalaTburTelTa anTropometruli maCveneblebis gaumjobesebas; 3. umjobesdeba kalaTburTelTa fizikuri da funqcionaluri indeqsebi: sunTqvis Sekavebis maCveneblebi, saSualo arteriuli wneva, sisxlis mimoqcevis sistoluri da wuTobrivi moculobebi, amtanobis koeficienti. 4. apipulmosa da apikoris gamoyeneba aumjobesebs sportsmenTa Sromisunarianobas, afarTovebs adaptaciuri meqanizmebs savarjiSo da saSejibro pirobebisadmi; aCqarebs aRdgeniT procesebs intensiuri fizikuri datvirTvis Semdeg; literatura: 1.. М. 1998; 2. , , М-Л. - 2009. 3. и , К. 2008; 4. - В кн.. М. 2010. 5.. К. 2007. 6. // Международный конгресс ФКС в Польше, 2012. 7. , Алма-Ата, 2010. 8.. т.48.-№2.-2010. 9. Флетчер Р., Флетчер С. Вагнер Э. Клиническая эпидемиология(основы доказательной медицины). Москва: Медиасфера – 2008. - 345c 10. Гайятт Г., Ренни Д. Путеводитель читателя медицинской литературы – Принципы клинической практики, основанной на доказанном. Издательство.Медия Сфера. –М. 2012 reziume sportsmenTa fizikuri da funqciuri mdgomareobis Sefaseba apipulmosa da apikoris fonze m.m.d. g. CaxunaSvili, n. badriaSvili, m.d. n. TofuriZe, m.d. n. jobava, m.d. z. SaqaraSvili,m.d. z.fxalaZe, m.m.d. k. CaxunaSvili, socialuri pediatriis dacvis fondi, ir.ciciSvilis sax. pediatriuli klinika,Tbilisis sax.samedicino universiteti api pulmo warmoadgns ori biologiurad aqtiuri kompinentebiT mdidari produqtis qarTuli futkris nawarmisa da wiwvovanis eqstraqtis nazavs, romelic mdidaria organizmis Senebis, ganviTarebisa da sicocxlisaTvis aucilebeli nivTierebebiT. is awesrigebs vitaminebis, aminomJavebis da mikroelementebis cvlas, Jangva-aRdgeniT procesebs; aZlierebs qsovilis mier Jangbadis utilizacias da Sedegad zrdis gonebriv da fizikur Sromisunarianobas; uzrunvelyofs organizmis zrdisa da ganviTarebis procesebs; aumjobesebs reproduqciuli sistemis funqcionirebas; aZlierebs eqstremaluri da stresuli faqtorebisadmi organizmis adaptaciis unars da mis dacviT meqanizmebs. gaaCnia imunomodulaciuri, imunomastimulirebeli da antimikrobuli Tvisebebi; preparatSi Semavali aminomJavebi advilad aTvisebadia, rac xels uwyobs azotovani balansis SenarCunebasa da organizmis zrda-ganviTarebas; mizani: maRali fizikuri datvirTvis pirobebSi kalaTburTelTa fizikuri da funqciuri mdgomareobis Sefaseba api pulmosa da apikoris fonze. masala da meTodebi: samuSaos safuZvlad daedo 12-dan 18 wlamde asakis 50kalaTburTelis fizikuri ganviTarebis maCveneblebis da datvirTvaze adaptaciis gamokvlevis Sedegebi apipulmosa da apikoris miRebis fonze(TiTo abi samjer dreSi erTi Tve). kvlevis Sedegebi da maTi ganxilva: kvlevis pirvel etapze SeviswavleT kalaTburTelTa anTropometruli, fizikuri da funqciuri maxasiaTeblebi api pulmosa da apikoris miRebamde da miRebidan 3 Tvis Semdeg daskvna: api pulmosa da apikoris gamoyeneba aumjobesebs sportsmenTa Sromisunarianobas, afarTovebs adaptaciuri meqanizmebs savarjiSo da saSejibro pirobebisadmi; aCqarebs aRdgeniT procesebs intensiuri fizikuri datvirTvis Semdeg; SUMMARY ESTIMATION OF SPORTSMEN PHYSICAL AND FUNCTIONAL CONDITION UNDER THE TREATMENT OF APIPULMO AND APICORI MD. G.CHAKHUANSHVILI, N.BADRIASHVILI, MD. NELI TOPURIDZE, MD. N.JOBAVA, MD.Z.SHAQARASHVILI, MD. Z.PKHALADZE, MD.K.CHAKHUNASHVILI Social Pediatric Protection Fund, Pediatric Clinic named after I.Cicishvili, TSMU. Apipulmo is a mix of two biologically active components - bee and coniferous extract products, which are full of essential substances. It regulates metabolism of vitamins, amino acids and micro elements, rust and restoration reactions, improves utilization of tissues with oxygen, and increases physical and mental capacity of work, improves reproductive system functions, increases the ability of adaptation to stress reactions and defensive mechanisms. It has immune stimulating, immune modulating and anti-microbe effects. Apipulmo Amino acids are easy to assimilate, which assists to preserve nitrogen balance and organism growth. Aim: Estimation of basketballers physical and functional condition under the treatment of Apipulmo and Apicori. Stuff and methods: This work was based on 50 sportsmen (12-18 years old) physical development index and adaptation to load while getting Apipulmo and Apicori (three tablets once a day over a month). Results of research and their discussion: On the first step of research studied sportmen anthropometric, physical and functional features before using Apipulmo/Apicori and after 3 months of using these products. Conclusion: Usage of Apicori and Apipulmo increases capacity of work, widens training and competition adaptation mechanisms conditions, fastens restoration processes after intensive physical load. 2013 weli ,fdidsf rfhlbjkjubf 23 EKG PARAMETERS (ST AND T WAVE ) AND CAPILLAROSCOPIC PARAMETERS DURING DIABETES MELLITUS TYPE I IN CHILDREN G. CHAKHUNASHVILI, N. JOBAVA, K. CHAKHUNASHVILI, M. SHVANGIRADZE, K.PAGAVA, D.CHAKHUNASHVILI Association of Georgian Pediatric Cardiology, New Children’s Hospital, Health Center (Tbilisi,Georgia) All subjects in modern pediatric cardiology, which is about diagnosis, treatment and preventions are of great importance.(13,14.15.16.17,18,19,20,21). 2-5% of population has diabetes type I and in recent years the disease rate is increasing, especially in children, 612 years old, all over the world. Disease rate of diabetes type I increases by 3.5% annually. In 2003 we had 63 new cases, in 2006 – 72. By 2020 diseased population is expected to be significantly increased. At the same times chronic or acute complications of diabetes remain one of the main reasons of lethality or disablement. Prevention of those complications are professional as well as social issue. (1,2,3,7) Diabetes is associated with high risk of cardiovascular diseases. The disease increases the chance of developing cardiovascular pathologies by 2-4 times, compared to healthy population. Development of cardiovascular diseases in children during diabetes is not well studiedproblem(4,9,11). The disease causes endocrine dysfunction that leads to metabolic changes in myocardium, which effects electric conduction. Arterial hypertension, dyslipidemia and hyperglycemia increases the speed of developing diabetic cardiomyopathy. (5,6) Aim of the research: Evaluate EKG parameters during diabetic cardiomyopathies; Detecting changes in Capillaroscopic parameters. Methods: Cases of 32 children(6-15 years old, 17 boys,15 girls) diseased with diabetes type I were studied, who were hospitalized In TSMU pediatric clinic’s endocrine department. 13 of them were diagnosed and their cases were studied at once, 10 of them had been diagnosed 2-5 years before, 9 0f them – 5-10 years before. We did capillarosopic examinations. we determined carpillarospopic background (pink, pale, cyanosis), transparency (transparent, dimmed), number of capillaries (6-7 in sight, more or less), diameter of capillaries ( dilated, contracted), shape of capillaries (hair like, anastomosis, loop like), Order/Disposition of capillaries (shows some order, does not show any order), 2013 weli blood flow type (homogenous, fast, slow), capillaries( homogenous, nonhomogenous). 8 types of ST and T wave changes were determined (G. Chakhunashvili, N jobava 2005-2012) I group – 12 patients with no complications of Diabetes type I. II group – 20 patients with diagnosed complications of Diabetes type I (Diabetic cardiomyopathy, angiopathy). 6 of them with diabetic encephalopathy , 4 of them with diabetic encephalopathy and peripherial diastolic neuropathy, 3 of them encephalopathy, 4 of them nephropathy and retinal angiopathy. Studies and examinations were held after decompensation of diabetes type I (without keto-acidosis). Level of glycolised hemoglobin was 8-11%, level of glucose 4 to 15 mmole/L, level of glucose in Urine from 0 to 4%. Control group included 20 healthy children of the same age. EKGs were recorded in 12 standard leads and additional heart leads. Differences between groups were determined based on coefficient (t>1,96; P<0,05). SPSS 11-5 was used to provide mathematic service. Analysis:50% of patients had various subjective complaints – 13 patients complained about tiring easily, 8 – shortness of breath after physical load, 4 – dizziness, 3 – syncope. Majority of these complaints were from patients who had Diabetes type I with complications. Only 4 children who did not have complications complained about tiring easily. Changes in EKG were shown in 29 patients ( 90,6%) and these changes were quite diverse (Table #1). ½ of patients had hypertrophied left ventricle, in rare cases right ventricle or both ventricles were hypertrophied. Most patients with hypertrophy of both ventricles were part of Group II, however, Hypertrophy of left ventricle was at the same rate in both groups. Atrial hypertrophies occurred only in group II. As seen from the table, in 1/3 cases we had left atrial hypertrophy, 50 % of them were combined with right atrial hypertrophy. Only 1 patient had right atrial hypertrophy alone. Typical EKG parameter was pathologic Q wave, which was mostly met in group II and in some patients it’s depth reached 10-17mm. Electric systole of ventricles also were prolonged. Parameters of diabetic cardiomyopathy were damaged repolarization, which was shown by ST deviation from the isoline, decreased amplitude, two-phased or inversion of T wave in I, aVL and V4-6 leads. In 13,5% of group II patients in V46 leads tall, narrow-based, sharpened T wave was registered; Changes in QRS complex were also more frequent than group I. EKG recorded damages of rhythm and conduction in 64% of patients (table #2). Sinus tachycardia was in 45%, sinus bradycardia – 40%, slowed Table #1 ,fdidsf rfhlbjkjubf 24 Table #2 heart rhythm was significant in group II patients and in 1/3 of them heart rate was 47-53. Sinus, atrial and ventricular extrasystoles were found rarely and equally in both groups. However, only in group II we had interatrial, atrioventricular and interventricular damages of conduction. Supraventricular paroxysmal tachycardia was found only in 2 patients who had pulse rate of 133-155. We had not met paroxysmal ventricular tachycardia, what consents with literature data.(7,10) In both groups we studied changes of ST and T wave. The changes were more often in group II. However, alterations in group I were case which were also significant ( See detailed information in Table #3). Analyzing all above said we can say, that discussing ST and T wave changes in Children with Diabetes type I is quite important. Table #3 numbers of capillaries were vastly decreased(3-4). cyanosis was detected in the background, transparency was decreased, capillaries tended to contraction and dilation of venous part. Shape changes were also significant (loop like and bended). Disposition was also out of order, blood flow was slow. detailed information is shown in table #4. capillaroscopic data in children gives us important additional information even for differencial diagnosis. Also it is cheap, non-invasive method, which can be used not only for diagnosis but the prognosis of disease development. CONCLUSIONS: 1. In group I EKG is less informative. 2. Hypertrophies of left ventricle and atrium and disorders of repolarizations were mainly found in group II 3. In 64% of cases EKG showed rhythm and conduction disorders, which were more often in group II 4. To achieve early diagnosis of cardiomyopathy and start early therapy, EKG must be recorded in every diabetes type I. 5. Determining types of changes in ST and T wave is important in children with type I diabetes. 6. Capillaroscopic data are quite important to get the right prognosis of disease progression. Nowadays there are several medications for treating cardiomyopathy, which can improve the quality of life the data from group I were following (Table #4): Group II (table #5) LITERATURE: 1. L. Kacharava, K. Koplatadze, D. Varsaladze “”Methods of treating Diabetes Type I in Georgian Diabetics” - Journal “Cardiology and Medicine” 2005,#2 page 59-61 2. Dedoev I.I. – Endocrinology – Moscow 2000 Publication “Medicine” 3. Kasatkina E.P. – Prophylactic of complication of Diabetes Type I in Children and Youth – Sugar diabetes 2003 p. 9-12 4. Kuznetsova I.G., Philartova O.V. –Problems of Endocrinology – 2003 T.491 p12-15 5. Sobolev A.V. – Problems of Cardiac Rhythm Assessment During EKG monitoring – Vestnik of Arhythmology 2002, 26 p21-26 6. Ch. Dimitar. R. – Clinical Cardiology – 1993 vol. 15 p784-790 7. Fang ZY Diabetic Cardiomyopathy – Endocrine Reviewers, 2004 V25 N4 P543-567 8. Schmaltz A.A. Aptiz I. Hort W. – Europ. Heart. – J – 1987 N8 P100-105 9. Sovers JR. – Insulin and Insulinlike growth factor in normal and pathological cardiovascular Hypertension 29:681-699. 1997 2013 weli ,fdidsf rfhlbjkjubf 10. Riggers T.W.; Transue D – Amer. J. Cardiology. 1990ap.ivol65 #13 p899-902 11. Juhas M; Silier Bauer K; Oherberge G; Winhofer G; - Wien. Klin. Wschr. 1990-vol.102#3S70-74 12Alterations of ECG in Children with Diabetes Mellitus – type I – M. Shvangiradze; Prof. G. Chakhunashvili; T. Ghonghadze; Prof. M. Gordeladze(lurnal of the pediatric cardiolojy assotiation-“Pediatric Cardiolojy”2007.N 18-20. 13.Damage of Cardiovascular System During Systemic Lupus Erythematosus G. Chakhunashvili, N. Jobava,K. Chakhunashvili, A. Bliadze (lurnal of the pediatric cardiolojy assotiation“Pediatric Cardiolojy”2012.N 6. 8-15p. 14. Early discovery of morphologic (adaptive, pathologic) changes in cardiovascular system and modern governance of training process in young sportsmen G. Chakhunashvili, I. Dolidze, N. Jobava, K. Chakhunashvili, Z. Pkhaladze, T. Gogatishvili (lurnal of the pediatric cardiolojy assotiation“Pediatric Cardiolojy”2012.N 6. 15-20p. 15.Status of cardiovascular system, during clandestine vegetative dysfunction and vascular reactivity , in sportsmen children and teenagers (subjects of diagnostic, treatment and prevention) (review of Literature) (lurnal of the pediatric cardiolojy assotiation“Pediatric Cardiolojy”2012.N 6. 20-25p. 16.Value of Dysrhythmias and Mitral Prolapse Diagnosis in Modern Pediatric Cardiology G. Chakhunashvili, N. Jobava, M. Shvangiradze, M. Inasaridze, T.Gogatishvili, A. Bliadze(lurnal of the pediatric cardiolojy assotiation“Pediatric Cardiolojy”2012.N 6. 25-28p. 17 `kapilaroskopiisa da kardiointervalografiiT miRebuli monacemebis daxasiaTeba” - n.jobava, g.CaxunaSvili; saqarTvelos bavSvTa kardiologTa asociaciis Jurnali “bavSvTa kardiologTa” #5, gv:1624; 2011w. 18 “ST segmentis, T kbilis, da Q-T intervalis Tanamedrove problemebi bavSvTa da mozardTa kardiologiaSi” – g.CaxunaSvili, n.jobava, k.CaxunaSvili - saqarTvelos bavSvTa kardiologTa asociaciis Jurnali“ bavSvTa kardiologTa” #4 gv:9-28 2010w 19. `gul-sisxlZarRvTa sistemis funqciuri mdgomareoba 25 faruli vegetatiuri disfunqciisa da sisxlZarRvovani hi perreaqtiulobis dros sportsmen bavSvebsa da mozardebSi (diagnostikis, mkurnalobisa da prevenciis sakiTxebi)” – g.CaxunaSvili, i.doliZe, T.gogatiSvili; saqarTvelos bavSvTa kardiologTa asociaciis Jur nali “bavSvTa kardio logTa” #4 gv:39-41 2010w. 20. “ST segmentis daT kbilis morfologiuri”– g.CaxunaSvili, n.jobava, k.CaxunaSvili saqarTvelos bavSvTa kardiologTa asociaciis Jurnali `bavSvTa kardiologTa” #6 gv: 63 2012w 21 `sportsmenTa anTropometruli da funqciuri maxasiaTeblebi da gul-sisxlZarRvTa sistemis funqciuri mdgomareoba aminomJavebiT gamdidrebuli energetikuli sasmeli “iveriuli-fito”-s moqmedebis fonze” _ g.CaxunaSvili da sxv. saqarTvelos bavSvTa kardiologTa asociaciis Jurnali `bavSvTa kardiologTa” #5, gv:24-33; 2011w reziume e.k.g. -is (ST da T kbili) da kapilaroskopiuli parametrebi bavSvebSi diabetis pirveli tipis dros. g. CaxunaSvili, n. jobava, d. CaxunaSvili, k. CaxunaSvili saqarTvelos bavSvTa kardiologTa asociacia, janmrTelobaTa centri (Tbilisi, saqarTvelo). diabeti dakavSirebulia gul-sisxlZarRvTa daavadebis ganviTarebis maRal riskTan. janmrTel adamianTan SedarebiT,diabetiT daavadebulis SemTxvevaSi gul-sisxlZarRvTa daavadebebi 2-4 jer imatebs. kvlevis mizani: gamovsaxoT ekg parametrebi diabeturi kardiomiofaTiebis dros, aRmovaCinoT cvlilebebi kapilaroskopiul parametrebSi. meTodebi: Seswavlili iqna 32 diabetiT daavadebul bavSvTa (6-15 wlamde; 17 gogo da 15 biWi) SemTxveva. es bavSvebi mkurnalobdnen Tssu-s pediatriuli klinikis endokrinologiur ganyofilebaSi. 13 maTgani gaisinja da maTi SemTxvevebi maSinve Seswavlili iqna, 10 – gaisinjuli iyo 2-5 wlis win, 9 – 5-10 wlis win. gamovikvlieT isini kapilaroskopiulad, davadgineT kapilaroskpiuli foni (vardisferi, mkrTali, cianozi), gamWirvaloba (naTeli, mbzinavi), kapilarebis raodenoba (6-7 daaxloebiT), kapilarebis diametric (gafarToebuli, Seviwrovebuli), kapilarebis forma (anastomozi, maryuJisebri, Tmisebri), kapilarebis ganlageba (aranairi ganlageba, garkveuli ganlagebis), sisxlis mimoqceva (swrafi, neli, homogenuri), kapilarebi (homogenuri, arahomogenuri). ST da T kbilis 8 ti pis cvlileba gamovlinda (g. CaxunaSvili, n.jobava 2005-2012). daskvna: 1. pirvel jgufSi ekg naklebad informatiulia. 2. meore jgufSi gamovlinda marcxena parkuWis da winagulis hi pertrofia da repolarizaciis darRvevebi. 3. 64%-Si gamovlinda gulis riTmis da gamtareblobis darRvevebi (ufro meore jgufSi). 4. adreuli diagnozis dasasmelad da adreuli Terapiis dasawyebad, ekg aucilebelia yovel diabetian pacientSi (pirveli ti pi). 5. pirveli tipis diabetian bavSvebSi ST da T kbilis cvlilebebis aRmoCenas didi mniSvneloba aqvs. 6. kapilaroskopiuli monacemebi aucilebelia daavadebis ganviTarebis zusti prognozisaTvis. dReisTvis aris kardiomiopaTiis mkurnalobis ramodenime gza, romelic cxovrebis xarisxs aumjobesebs 2013 weli ,fdidsf rfhlbjkjubf 26 SUMMARY EKG PARAMETERS( ST AND T WAVE ) AND CAPILLAROSCOPIC PARAMETERS DURING DIABETES MELLITUS TYPE I IN CHILDREN G. CHAKHUNASHVILI, N. JOBAVA, K. CHAKHUNASHVILI, D.CHAKHUNASHVILI Association of Georgian Pediatric Cardiology, New Children’s Hospital, Health Center (Tbilisi,Georgia) Diabetes is associated with high risk of cardiovascular diseases. The disease increases the chance of developing cardiovascular pathologies by 2-4 times, compared to healthy population. Aim of the research: Evaluate EKG parameters during diabetic cardiomyopathies; Detecting changes in Capillaroscopic parameters. Methods: Cases of 32 children(6-15 years old, 17 boys,15 girls) diseased with diabetes type I were studied, who were hospitalized In TSMU pediatric clinic’s endocrine department. 13 of them were diagnosed and their cases were studied at once, 10 of them had been diagnosed 2-5 years before, 9 0f them – 5-10 years before. We did capillarosopic examinations. we determined carpillarospopic background (pink, pale, cyanosis), transparency (transparent, dimmed), number of capillaries (6-7 in sight, more or less), diameter of capillaries ( dilated, contracted), shape of capillaries (hair like, anastomosis, loop like), Order/Disposition of capillaries (shows some order, does not show any order), blood flow type (homogenous, fast, slow), capillaries( homogenous, non-homogenous). 8 types of ST and T wave changes were determined (G. Chakhunashvili, N jobava 2005-2012) conclusions: 1. In group I EKG is less informative. 2. Hypertrophies of left ventricle and atrium and disorders of repolarizations were mainly found in group II 3. In 64% of cases EKG showed rhythm and conduction disorders, which were more often in group II 4. To achieve early diagnosis of cardiomyopathy and start early therapy, EKG must be recorded in every diabetes type I. 5. Determining types of changes in ST and T wave is important in children with type I diabetes. 6. Capillaroscopic data are quite important to get the right prognosis of disease progression. Nowadays there are several medications for treating cardiomyopathy, which can improve the quality of life e.k.g. parametrebi (ST segmenti da T kbili) Saqriani diabetis ti pi I - sa, zogierTi anTebadi da sxva araanTebadi daavadebebis dros bavSvTa asakSi g.CaxunaSvili,n.jobava,k.CaxunaSvili,d.CaxunaSvili saqarTvelos bavSvTa kardiologTa asociacia, ir.ciciSvilis sax. pediatriuli klinika,janmrTelobis centri parkuWovani kompleqsis terminaluri nawilis eleqtrokardio-grafiuli cvlilebebis sixSire da daxasiaTeba bavSvebSi,erTerTi umniSvnelovanesia. Cveni monacemebis saboloo interpretaciamde aucileblad migvaCnia ST segmentisa da T kbilis cvlilebaTa mimoxilviTi analizi normisa da paTologiis zRvarze. unda aRiniSnos, rom dadgenilia periferiul ganxrebSi ST intervalis 1 mm-iT cdoma Seesabameba 400 000 miokardiuli boWkos dazianebas (gulmkerdis ganxrebSi ki 4000-s). am monacemebis (Schaeffer H., Haas H., 1962) gaTvaliswinebiT saWiroa da aucilebelia ufro meti yuradReba daeTmos ST‐T umniSvnelo darRvevebsac, romlebic aRiniSneba standartul da monopolarul ganxrebSi, radgan es cvlilebebi SeiZleba iyos ufro mniSvnelovani, vidre iSemiis ufro intensiuri gamovlinebebi gulmkerdis ganxrebSi. mravali statistikuri monacemebis Tanaxmad msubuqi eleqtrokardiografi- uli darRvevebi warmoadgenen koronaluri riskis aSkara faqtorebs (Ross S.R., 1970). zogierTi gamokvlevis Tanaxmad mamakacebs sikvdilianoba dabali, dakbiluli mcired uaryofiTi T kbiliT 2-jer metia, vidre sakontrolo jgufSi (Friegberg H.D., 1969), rac miuTiTebs, rom msgavsi darRvevebis SemTxvevaSi aucilebelia vawarmooT damatebiTi gamokvlevebi am cvlilebebis mniSvnelobis dasadgenad. ST intervalis da T kbilis patara cvlilebebi eleqtrokardio-grafiaSi interpretaciisaTvis yvelaze rTuli sferoa. amitom ioli ar aris ST‐T darRvevebis mniSvnelobis gansazRvra iSemiuri kardiopaTiis adreuli diagnostirebis mizniT. am TvalsazrisiT, ST‐T cvlilebebis interpretaciis mniSvnelovan kriteriums warmoadgens am darRvevaTa “lokalizacia” da maTi SeuTanxmebeli evolucia sxvadasxva ganxrebSi. repolarizaciis “meoradi” aSliloba (daRmavali, Senelebuli, progresirebadi ST intervaliT da arasimetriuli uaryo2013 weli ,fdidsf rfhlbjkjubf fiTi T kbiliT) SeiZleba gamoCndes I, II da marcxena gulmkerdismier ganxrebSi (maqsimaluri I da V6 ganxraSi) an III, II da wina gulmkerdismier ganxrebSi (maqsimaluri III da V1 ganxraSi) da romelic warmoadgens sxvadasxva ganxrebSi TandaTanobiT evolucias V1-Si maqsimaluri uaryofiTidan meoradi T kbilis amplituda marcxena gulmkerdis ganxraSi an Sesabamisi tranziciis zonaSi progresulad unda mcirdebodes. Tumca aseT pirobebSi, agreTve “iuveniluri” T kbilis SemTxvevaSi, aranormaluria, rom TII ufro uaryofiTi iyos, vidre T1 an T3; TVs an V4 ufro uaryofiTi, vidre TV6 da sxv. radgan aseTi darRvevebi mxolod maSin dgeba, roca adgilobrivi “pirveladi” ganapirobebs T kbilis uaryofiTobis cdomas. agreTve ST‐T umnniSvnelo cvlilebebis dros gaumarTlebelia momdevno gulmkerdis ganxrebSi dadebiTi T kbilis amplitudis mkveTri Semcireba, im SemTxvevaSic ki, roca Sesabamisi T kbilebi QRS kompleqsis maqsimaluri kbilis 1/20-s ver aRweven. aseTi mdgomareobebis dros aucilebelia yuradReba mivaqcioT iseT SemTxvevebs, roca T kbilebis amplituda V5 da V6 ganxraSi naklebia TV3-is da TV4‐is jamis naxevarze an TV5<TV4/2 uaryofiTi ganrTxmuli TV3-is SemTxvevaSi. gamokvlevebis Tanaxmad, msgavsi aspeqtebiYxSirad aRiniSneba organuli kardiopaTiebis dros. T kbilis da ST intervalis sxva morfologiuri Taviseburebebis analizi agreTve SesaZleblobas iZleva moxdes organuli dazianebebis diferencireba ST‐T umniSvnelo cvlilebebisagan. migvaCnia, rom T kbilis aSkara simetriuloba da mzardi uaryofiToba V1 da V4 ganxrebSi warmoadgens niSans, romelic met yuradRebas saWiroebs, vidre 12 mm-ze meti amplitudis minesotis kodSi aRniSnuli T kbili. simetriuli wvetiani T kbilebi xSirad warmoadgenen subendokardialuri iSemiis gamovlinebas (Lepeschkin E., 1957), romelic uxSiresad iSemiuri kardiopaTiis dasawyisia. miTumetes, rom normalur pirobebSic ki endokardiumi warmoadgens zonas, sadac sisxlis nakadi da O2-is wneva SedarebiT (epikardiumTan) dabalia. umtkivneulo iSemuri kardiopaTiis dros ST‐ T zogierTi mcire darRvevebis mniSvnelobis dadgena rTulia paTologiuri cvlilebebis difuzuri xasiaTis gamo. aseve gvxvdeba ST‐T difuzuri darRvevebi, romlebic upirates lokalizacias gansazRvrul arxebSi ar gvaZleven. maTi arsebobisas da sxva sarwmuno asocirebuli niSnebis ararsebobisas umtkivneulo iSemiuri kardiopaTiis diagnozis dadgena did sifrTxiles moiTxovs, gansakuTrebiT xandazmulebSi da Zalian axalgazrda asakSi, romelSic dabalia riskis faqtoris da iSemiuri kardiopaTiis arsebobis sarwmunoeba. 2013 weli 27 aqve unda gvaxsovdes mravali eqstrakardiuli mizezi, romlebic iwveven ekg-ze sxvadasxva darRvevebs da romlebic arTuleben diagnostirebas, kerZod: ST‐T cvlilebebi qalebSi menstrualuri ciklis da saSvilosnos fibrozis dros, dabalvoltaJiani T kbili hi persimpaTikotonur mdgomareobaSi, taqikardiiT mimdinare mousvenrobis dros, maRalvoltaJiani T kbili da ST intervali cdomiT zemoT (“aRmavali ti pis”) adreuli repolarizaciis dros, dakbiluli, gaormagebuli T kbili cnsis dazianebis da vegetatiuri labilobis dros da sxv. amasTan ST intervalTan SedarebiT T kbilis didi cvalebadobis gamo vegetatiurad aramdgrad avadmyofebSi orTostatiuli sinjis da fizikuri datvirTvis dros darRvevebi ST nawilSi SeiZleba ufro mniSvnelovani iyos, vidre T kbilis amplitudis da mimarTulebis cvlileba. amdenad, ST segmentisa da T kbilis morfologiuri parametrebi gulis zogierTi zemoT ganxiluli anTebiTi da araanTebiTi daavadebebis dros mkveTrad gamoxatuli cvlilebebiT xasiaTdeba da aucilebel pirobas warmoadgens maTi ti paJebis gansazRvris Semdgom damatebiTi informaciis miReba koronaluri sisxlis mimoqcevaze ekg-s sxvadasxva maCvenebelTa gansazRvriT (TV6 +TV5 . . . da a.S.). Cvens mier, rogorc aRvniSneT SromebSi(G. Chakhunashvili, N jobava 2005‐2012), warmoebuli iyo ekg-li gamokvcleva 12 Cveulebriv da damatebiT 3 NeHb‐is (D, A. I) ganxrebSi, sadac vvaraudobdiT rom NeHb‐is ganxrebSi unda migveRo mniSvnelovani korelaciuri informaciebi. Cveni masalis analizisas aRmoCnda Semdegi saintereso Sedegebi, romlebic mniSvnelovan adgils daiWers bavSvTa kardiologiaSi. korelaciuri indeqsebi maRalia (saSualod > 10-ze), gansakuTrebiT V5 -V6 da Sesabamisad NeHb‐s D-ur ganxrebSi (>14-ze), V4 -Si SedarebiT maRali iyo korelaciis indeqsi NaHb‐s A-sTan (11, 491), xolo NaHb‐s I-sTan korelaciis indeqsi SedarebiT maRali iyo AVF-ganxraSi (10,492). yovelive zemo aRniSnulis garda aRsaniSnavia,rom saintereso SromebSi: ,,ST segmentis, T kbilis,da Q-T intervalis Tanamedrove problemebi bavSvTa da mozardTa kardiologiaSi”-g.CaxunaSvili, n.jobava, k.CaxunaSvili - saqarTvelos bavSvTa kardiologTa asociaciis Jurnali“bavSvTa kardiologTa” #4 gv: 9-28 2010w. ,,ST segmentis daT kbilis morfologiuri”– g.CaxunaSvili, n.jobava, k.CaxunaSvili - saqarTvelos bavSvTa kardiologTa asociaciis Jurnali“bavSvTa kardiologTa” #6 gv: 63 2012w, aRniSnulia ST segmentisa da T kbilis morfologiuri cvlilebaTa SesaZleblobani, kerZod : 28 # 1 cxrilSi mocemulia T kbilis maqsimaluri da minimaluri simaRle ekg-s 15 ganxraSi (12 Cveulebrivi da 3 NeHbis) janmrTel bavSvTa sxvadasxva asakobriv jgufebSi. T kbilis farTobi ganisazRvreba Semdegi formuliT: S = 2/3 . a . h, sadac a aris sigane, xolo h simaRle. Sesabamisad diagramebi ## 1-15 asaxaven T kbilois maqsimalur da minimalur farTs mm2, ekg-s 15 ganxraSi – 12 Cveulebrivi da 3 NeHb-is janmrTel bavSvTa sxvadasxva asakobriv jgufebSi. SromaSi arsebuli diagramebi asaxavs dadebiTi da uaryofiTi T kbilis SemTxvevaTa raodenobebs procentebSi. # 2 da # 3 cxrilSi mocemulia ST segmentis maqsimaluri cdoma izoeleqtruli xazis zemoT da qvemoT (mm-iT da mm2-iT). ST segmentis farTobi ganisazRvreboda Semdegi formuliT: ST = QT1 – QRS SST = ST > XST diagramebi aseve asaxaven ST segmentis farTobs aRniSnul ganxrebSi. # 1 cxrilSi kargad Cans TiToeul ganxraSi T kbilis maqsimaluri dadebiTi, maqsimaluri da minimaluri simaRleebi, aseve uaryofiTi minimaluri da maqsimaluri siRrmeebi. rac Seexeba naxazebsa da diagramebs, isini saSualebas iZlevian bavSvebSi (asakis miuxedavad) ganisazRvros depresiuli T kbilis arseboba: - I standartul ganxraSi – pirveli askobrivi jgufis garda - II standartul ganxraSi – yvela asakobriv jgufSi - AVF-Si pirvel or asakobriv jgufSi - V4-Si – bolo or asakobriv jgufSi - V5 da V6-Si – yvela asakobriv jgufSi ukanaskneli warmoadgens rogorc dRenaklul, ise droul axalSobilTa kardiologiaSi wamyvan sadiagnostiko kriteriumebs, romelic mniSv- ,fdidsf rfhlbjkjubf nelovania rogorc dasawyisSi daavadebaTa mkurnalobisaTvis, ise misi dinamikis Sefaseba-prognozirebisaTvis da rac mTavaria, reabilitaciis periodSi, ukve mozrdilTa gulsisxlZarRvTa sistemis daavadebaTa prevenciisaTvis. rac Seexeba ST segmentis cdomas izoeleqtruli xazis zemoT, igi bavSvTa asakis yvela periodSi gvxvdeba, magram uxSiresad ar cdeba 1 mm-s (cxrili # 2), xolo izoeleqtrul xazs qvemoT V5 da V6 ganxrebs garda, maqsimaluri siRrme aqac umetes wilad 1 mm-mdea (cxrili # 3). unda aRiniSnos, rom ST segmentisa da T kbilis morfologiuri cvlilebani unda ganixilebodes erTian konteqstSi: ST segmentis izoeleqtruli xazidan zemoT an qvemoT cdoma misi formis gaTvaliswinebiT rkalisebri, naxevarmTvarisebri, gadatrialebuli, gadmotrialebuli da a.S.). Tu rogor T kbilSi gadadis da piriqiT, dadebiTi an uaryofiTi T kbili misi sxvadasxva formiT (orkuziani, gafarToebuli, wvetiani, orfaziani + - an - +), rogor ST segments mosdevs da risi gagrZelebaa. amitom migvaCnia T kbilis cvlilebisa da ST intervalis cdomis orientirad un- da ganvixiloT ara T‐P intervali, aramed P‐Q segmenti, radgan praqtikulad is ufro stabiluria da TiTqmis arasdros ar ganicdis cdomas. garda imisa, misi ST intervalTan siaxlovis gamo, am ukanasknelis umniSvnelo cdomac ki SesamCnevia. arcTu iSviaTad T‐P intervalis cdoma izoeleqtruli xazidan zemoT SeiZleba gamowveuli iyos T kbilis daRmavali muxlis da momdevno P kbilis SerwymiT taqikardiis an mkveTrad gamoxatuli U kbilis dros. ST intervalis cdomis xarisxi unda gaizomos izoeleqtruli xazidan, romelic P‐Q segmentis gagrZelebas warmoadgens. imasTan dakavSirebiT, rom S-T intervalis forma SeiZleba sxvadasxvagvari iyos, izoeleqtruli fazidan intervalis cdomis donis gansazRvrisaTvis, Cveni azriT, unda gamoviyenoT S‐T intervalis QRS kompleqsTan SeerTebis wertili da ara S‐T intervalis Suawertili. ekg-ze is wertili, rogorc wesi SesamCnevia, igi repolarizaciis procesis dawyebas Seesabameba (nax) es wertili ucxour literaturaSi aRiniSneba asi JTi (Junetion – SeerTeba). amdenad, warmodgenil suraTSi # 1 (ST segmentisa da T cxrili # 1 T kbilis maqsimaluri da minimaluri simaRle ekg-s 15 ganxraSi (12 Cveulebrivi da 3 NeHb-is) janmrTel bavSvTa sxvadasxva asakobriv jgufebSi 2013 weli ,fdidsf rfhlbjkjubf kbilis morfologia) naCvenebia ST segmentisa da T kbilis morfologiur cvlilebaTa 8 ti pi, saidanac aRsaniSnavia, rom: - cdoma zemoT ST segmentisa da T kbilis cvlilebaTa erTad ti pi 2-3 ar dagviregistrirebia, garda ti pi 1-sa (vagotonuri ti pi) da isic 10 wlis zemoT, sxva asakSi iSviaTad. - cdoma qvemoT ST segmentisa taqikardiuli ti pis (V ti pi) gvxvdeboda 0-dan 3 wlamde asakSi, xolo hi pertonuli ti pis iSviaTad da mainc 5 wlis zemoT. amgvarad, ST segmentisa da T kbilis morfologiuri cvlelebebi princi pSi janmrTel bavSvebSi ar gvxvdeba, Tu ar gaviTvaliswinebT gardamaval asaks da riTmis mkveTr cvlilebebs bradikardiisa da taqikardiis saxiT. zemo aRniSnuli mniSvnelovani literaturuli monacemebis Semdeg aucilebelia Cveni sakuTari masalis analizi: Cvens mier gaanalizebuli avadmyofTa raodenoba mocemulia qvemo cxrilSi N4: sakontrolo jgufs Seadgenda igive asakis 120 praqtikulad janmrTeli bavSvi (gogona, biWi). maTi SerCevis kriteriumi iyo somaturi, arainfeqciuri da mwvave infeqciuri daavadebebis ararseboba gamokvlevamde 3 kviris ganmavlobaSi, Civilebis arqona, biologiuri asakis Sesabamisoba sapasporto monacemebTan. parkuWovani kompleqsis terminaluri nawilis eleqtrokardiografiuli cvlilebebis sixSire da daxasiaTeba Saqriani diabetis ti pi I sa, zogierTi anTebadi da sxva araanTebadi daavadebebis dros bavSvTa asakSi mocemulia qvemo cxrilSi #5,xolo ST segmentisa da T kbilis 8 ti pis cvlilebaTa ganawilebaTa raodenoba mocemmulia crilSi #6: amdenad, 2013 weli 29 cxrili # 2 ST segmentis maqsimaluri cdoma izoeleqtruli xazis zemoT (mm-iT da mm 2-Si) cxrili # 3 ST segmentis maqsimaluri cdoma izoeleqtruli xazis qvemoT (mm-iT da mm2-Si) sur. 1 ,fdidsf rfhlbjkjubf 30 8 types of ST and T wave changes were determined (G. Chakhunashvili, N jobava 2005-2012) cxrili # 4 – e.k.g. parametrebi (ST segmenti da T kbili) Saqriani diabetis ti pi I - sa, zogierTi anTebadi da sxva araanTebadi daavadebebis dros bav S v Ta asak Si ga nic dis cvlilebebs,romelic mkurnalobis strategias gansazRvravs. – parkuWovani kompleqsis terminaluri nawilis eleqtrokardio-grafiuli cvlilebebis sixSire da daxasiaTeba Saqriani diabetis ti pi I - is dros umniSvnelovanesia, bavSvTa asakSi daavadebis mimdinareobis prognozirebasa da reabilitaciaSi amasTan erTad, paTologiur procesSi gul–sisxlZarRvTa sistemis Cabmis xarisxis gansazRvrisaTvis. – gul-sisxlZarRvTa sistemis dazianebis prognozirebas Saqriani diabetis ti pi I - sa, zogierTi anTebadi da sxva ara an Te ba di da a va de be bis dros bavSvTa asakSi, ST segmentisa da T kbilis cvlilemaTa drouli Sefaseba ganapirobebs. lit.: L. Kacharava, K. Koplatadze, D. Varsaladze “”Methods of treating Diabetes Type I in Georgian Diabetics” - Jour nal “Car di o logy and Medicine” 2005,#2 page 59-61 Dedoev I.I. – Endocrinology – Moscow 2000 Publication “Medicine” Kasatkina E.P. – Prophylactic of complication of Diabetes Type I in Children and Youth – Sugar diabetes 2003 p. 9-12 Kuznetsova I.G., Philartova O.V. –Problems of Endocrinology – 2003 T.491 p12-15 Sobolev A.V. – Problems of Cardiac Rhythm Assessment During EKG monitoring – Vestnik of Arhythmology 2002, 26 p21-26 Ch. Dimitar. R. – Clinical Cardiology – 1993 vol. 15 p784-790 Fang ZY Diabetic Cardiomyopathy – Endocrine Reviewers, 2004 V25 N4 P543-567 Schmaltz A.A. Aptiz I. Hort W. – Europ. Heart. – J – 1987 N8 P100-105 Sovers JR. – Insulin and Insulin-like growth factor in normal and pathological cardiovascular Hypertension 29:681-699. 1997 Riggers T.W.; Transue D – Amer. J. Cardiology. 1990ap.ivol65 #13 p899-902 Juhas M; Silier Bauer K; Oherberge G; Winhofer G; - Wien. Klin. Wschr. 1990-vol.102#3S70-74 12. Alterations of ECG in Children with Diabetes Mellitus – type I – M. Shvangiradze; Prof. G. Chakhunashvili; T. Ghonghadze; Prof. M. Gordeladze(lurnal of the pediatric cardiolojy assotiation-“Pediatric Cardiolojy”2007 .N 18-20. 13.Damage of Cardiovascular System During Systemic Lupus Erythematosus 2013 weli ,fdidsf rfhlbjkjubf G. Chakhunashvili, N. Jobava,K. Chakhunashvili, A. Bliadze (lurnal of the pe di at ric car di o lojy as so ti a ti on“Pediatric Cardiolojy”2012 .N 6. 8-15p. 14. Early discovery of morphologic (adaptive, pathologic) changes in cardiovascular system and modern governance of training process in young sportsmen G. Chakhunashvili, I. Dolidze, N. Jobava, K. Chakhunashvili, Z. Pkhaladze, T. Gogatishvili (lurnal of the pediatric cardiolojy assotiation-“Pediatric Cardiolojy”2012 .N 6. 15-20p. 15. Status of cardiovascular system, during clandestine vegetative dysfunction and vascular reactivity , in sportsmen children and teenagers (subjects of diagnostic, treatment and prevention) (review of Literature) (lurnal of the pediatric cardiolojy assotiation-“Pediatric Cardiolojy”2012 .N 6. 20-25p. 16.Value of Dysrhythmias and Mitral Prolapse Diagnosis in Modern Pediatric Cardiology G. Chakhunashvili, N. Jobava, M. Shvan gi rad ze, M. Inasaridze, T.Gogatishvili, A. Bliadze(lurnal of the pediatric cardiolojy assotiation-“Pediatric Cardiolojy”2012 .N 6. 25-28p. 17. ,,kapilaroskopiisa da kardiointervalografiiT miRebuli monacemebis daxasiaTeba”- n. jobava, g.CaxunaSvili; saqarTvelos bavSvTa kardiologTa asociaciis Jurnali `bavSvTa kardiologTa” #5, gv:16-24; 2011w. 18. ,,ST segmentis, T kbilis, da Q-T intervalis Tanamedrove problemebi bavSvTa da mozardTa kardiologiaSi” – g.CaxunaSvili, n.jobava, k.CaxunaSvili - saqarTvelos bavSvTa kardiologTa asociaciis Jurnali `bavSvTa kardiologTa” #4 gv:9-28 2010w 19. ,,gul-sisxlZarRvTa sistemis funqciuri mdgomareoba faruli vegetatiuri disfunqciisa da sisxlZarRvovani hi perreaqtiulobis dros sportsmen bavSvebsa da mozardebSi (diagnostikis, mkurnalobisa da prevenciis sakiTxebi)” – g.CaxunaSvili, i.doliZe, T.gogatiSvili; saqarTvelos bavSvTa kardiologTa asociaciis Jurnali `bavSvTa kardiologTa” #4 gv:39-41 2010w. 20. ,,ST segmentis da T kbilis morfologiuri” – g.CaxunaSvili, n.jobava, k.CaxunaSvi2013 weli 31 cxrili # 5 parkuWovani kompleqsis terminaluri nawilis eleqtrokardiografiuli cvlilebebis sixSire da daxasiaTeba bavSvebSi cxrili # 6 ST segmentisa da T kbilis 8 ti pis cvlilebaTa ganawileba (monacemebi % -ia) li - saqarTvelos bavSvTa kardiologTa asociaciis Jurnali `bavSvTa kardiologTa” #6 gv: 63 2012w 21. ,,sportsmenTa anTropometruli da funqciuri maxasiaTeblebi da gul-sisxlZarRvTa sistemis funqciuri mdgo- mareoba aminomJavebiT gamdidrebuli energetikuli sasmeli ,,iveriuli-fito”-s moqmedebis fonze” - g. CaxunaSvili da sxv. saqarTvelos bavSvTa kardiologTa asociaciis Jurnali `bavSvTa kardiologTa” #5, gv:24-33; 2011w. ,fdidsf rfhlbjkjubf 32 reziume E e.k.g. parametrebi (ST segmenti da T kbili) Saqriani diabetis ti pi I - sa, zogierTi anTebadi da sxva araanTebadi daavadebebis dros bavSvTa asakSi g.CaxunaSvili,n.jobava,k.CaxunaSvili,d.CaxunaSvili saqarTvelos bavSvTa kardiologTa asociacia, ir.ciciSvilis sax.pediatriuli klinika,janmrTelobis centri parkuWovani kompleqsis terminaluri nawilis eleqtrokardio-grafiuli cvlilebebis sixSire da daxasiaTeba bavSvebSi,erTerTi umniSvnelovanesia. SromaSi detaluradaa ganxiluliEe.k.g. parametrebi (ST segmenti da T kbili) Saqriani diabetis ti pi I - sa, zogierTi anTebadi da sxva araanTebadi daavadebebis dros bavSvTa asakSi. daskvnebSi aRniSnulia: –e.k.g. parametrebi (ST segmenti da T kbili) Saqriani diabetis ti pi I - sa, zogierTi anTebadi da sxva araanTebadi daavadebebis dros bavSvTa asakSi ganicdis cvlilebebs,romelic mkurnalobis strategias gansazRvravs. – parkuWovani kompleqsis terminaluri nawilis eleqtrokardiografiuli cvlilebebis sixSire da daxasiaTeba Saqriani diabetis ti pi I - is dros umniSvnelovanesia, bavSvTa asakSi daavadebis mimdinareobis prognozirebasa da reabilitaciaSi, amasTan erTad, paTologiur procesSi gul–sisxlZarRvTa sistemis Cabmis xarisxis gansazRvrisaTvis. – gul–sisxlZarRvTa sistemis dazianebis prognozirebas Saqriani diabetis ti pi I - sa, zogierTi anTebadi da sxva araanTebadi daavadebebis dros bavSvTa asakSi, ST segmentisa da T kbilis cvlilemaTa drouli Sefaseba ganapirobebs. SUMMARY EKG PARAMETERS (ST AND T WAVE) DURING DIABETES MELLITUS TYPE I IN CHILDREN DURING SOME INFLAMMATORY AND NON-INFLAMMATORY DISEASES G.CHAKHUNASHVILI, N.JOBAVA, K.CHAKHUNASHVILI, D.CHAKHUNASHVILI. Georgian Pediatric Cardiology Association, Pediatric Clinic named after I.Cicishvili, Health Centre. The frequency and description of ECG changes of ventricle complex terminal part in children is one of the important things. ECG parameters during (ST and T wave) Diabetes Mellitus type 1 is described in details during some inflammatory and non-inflammatory diseases. Conclusion: ECG parameters during (ST and T wave) Diabetes Mellitus type 1 is described in details during some inflammatory and non-inflammatory diseases has some changes during childhood, which determines the strategy of treatment. The frequency and description of ECG changes of ventricle complex terminal part in children is one of the important things in disease progression, diagnosis and rehabilitation in child age. Also for the involvement of cardiovascular system in pathological process. Timely estimation of ST and T wave changes conditions prognosis of the cardiovascular damage during Diabetes Mellitus Type I, some inflammatory and non-inflammatory diseases in child age. mitraluri sarqvlis prolapsis sixSire, etiopa Togenezi, daavadebaTa paTogenurprocesSi Cabmis xarisxis gansazRvra da ariaTmiebTan konteqsSi misi ganxilva g.CaxunaSvili, n.jobava, k.CaxunaSvili, m.SvangiraZe, m.inasariZe, d.CaxunaSvili (saqarTvelos bavSvTa kardiologTa asociacia, axali pediatriuli klinika,janmrTelobis centri) pirvelad mitraluri sarqvlis prolafsis Sesaxeb alaparakdnen gasuli saukunis 60-iani wlebidan. misi warmoSobis da diagnostirebis sakiTxebs mravali mecnieris Sromebi mieZRvna (White, 1931; Reid, 1961; Barloid, 1963; Hancock, Cohu, 1966; Jeresaty, 1979 da sxva). kvlevisa da diagnostirebis meTodebis daxvewam aCvena, rom mitraluri sarqvlis prolafsi sakmarisad gavrcelebuli paTologiaa. populaciuri kvlevisas, mitraluri sarqvlis prolafsi aRmoCnda bavSvTa 2,2 dan 14%-s (Perloff J.K. et al., 1987). stacionarebSi mitraluri sarqvlis prolafsi kardiologiur avadmyofebSi diagnostirdeba 10-30%-Si (Белоконь Н.А. и др., 1989). eqokardiogrfiis danergvam SesaZlebeli gaxada mitraluri sarqvlis prolafsis gamovlena iseT avadmyofebSic, romelTac ar hqondaT damaxasiaTebeli auskultaciuri cvlilebebi. mitraluri sarqvlis prolafss (msp) sxvagvarad ganixilaven rogorc: mogvianebiTi sistoluri Suilisa da anomaluri T talRis sindroms, tkacuna sarqvlis sindroms da sxva. TandaTan naTeli gaxda, rom mitraluri sarqvlis prolafsi ar aris “uwyinari samedicino kuri2013 weli ,fdidsf rfhlbjkjubf ozi” da igi mitraluri sarqvlis erT-erTi gavrcelebuli dazianebaa. Nagulic u cobr (1982) mspis diagnostireba moaxdines gss-iT daavadebulTa 5%-Si. Bromn da Tanaavtorebma (1970) eqokardiografiis saSualebiT msp daudgines qalTa 6%-s da mamakacTa 0,5%-s. Henri da Ibrahim (1980) ultrabgeriTi kvlevis daxmarebiT msp gamouvlines pacientTa 8%-s (maT Soris qalebi 2-jer Warbobdnen mamakacebs), Rizzon da Tanaavtorebma studentTa Soris, qalTa 3%-s da mamakacTa 0,9%-s aRmouCines msp. Markiewic da Tanaavtorebi miuTiTeben (1976), rom msp savaraudod janmrTel qalebSi 21%-s Seadgenda. Д.Н. Бочкова da Tanaavtorebi aRniSnaven, rom sistoluri Suili da sistoluri tkacuni aRiniSneboda gamokvleulTa 2,6%-s. Greenwood (1984) monacemebis mixedviT msp aRmoCnda gamokvleul bavSvTa 4,6%-s. gamomdinare iqedan, rom zemoaRniSnuli monacemebi kvlevis sxvadasxva meTods eyrdnoba da rom arsebobs msp-is “munji” formebic, SeiZleba iTqvas, rom arcerTi maTgani ar asaxavs realur suraTs. msp-is yvela varianti SeiZleba davyoT Tandayolil da SeZenil, pirvelad (izolirebuli, idiopaTiuri) da meorad (karditi, gulis Tandayolili manki, kardiomiopaTia, marfanis daavadeba da sxva) formebad. izolirebuli msp-is mqone bavSvebSi gamoyofen or formas: auskultaciurs (sistoluri tkacuni an mogvianebiTi sistoluri Suili) da “munji” (roca msp vlindeba mxolod eqokardiografiis dros, “fsevdo – msp”). mitraluri sarqvlis prolabireba SeiZleba gamoiwvios Semdegma mizezebma: a) miokardiumis struqturis darRvevam (marfinis sindromi da sxva) an umniSvnelo anomaliis arsebobam (rgolis gafarToeba, qordis dagrZeleba da sxva); b) sarqvlovani da qvesarqvlovani apartatis anomaliam (araswori mimagreba, qorduli Zafebis dagrZeleba, TiTistarisebri kunTebis struqturis darRveva); g) marcxena parkuWis miokardiumis kumSvadobisa da relaqsaciis darRvevam (qvebazaluri hi pokinezia, naadrevi relaqsacia da sxva) anTebiTi procesis an vegetatiuuri inervaciis darRvevis gamo; d) sarqvlovan-parkuWovanma disproporciam (mitraluri sarqveli didia parkuWisaTvis an sarqvelia SedarebiT patara parkuWisaTvis); e) afeqturi gamovlinebebis somaturma realizaciam – vegetosisxlZarRvovani distoniis da fsiqoemociuri gadaxrebis fonze. izolirebul msp-is (idiopaTiuri) ganviTarebaSi mniSvnelovania erTdroulad ramodenime zemoaRniSnuli faqtori, magram ZiriTadi mainc SemaerTebelqsovilovani struqturebis arasrulfasovneba da sarqvlovani aparatis mcire anomaliebia. izolirebuli msp Cveulebriv 7-15 wlis asakSi diagnostirdeba, Tumca SeiZleba 1 wlamdec gamovlindes. auskultaciuri forma 5-6-jer metad aReniSnebodaT gogonebs. ufro xSirad aRniSnul kontingentSi yuradRebas iqcevs displaziuri fizikuri ganviTarebis niSnebi: asTeniuri agebuleba brtyeli gulmkerdiT, simaRleSi zrda, kunTovani sistemis susti ganviTareba, wvril saxsrebSi momatebuli moZra2013 weli 33 oba, bevri gogona cisferTvaleba da qeraTmiania, SeiniSneba agreTve goTuri sasa, brtyelterfianoba, miopia da sxva. izolirebuli msp-is mqone bavSvTa 2/3-ze mets aqvT garkveuli Civilebi: tkivili gulmkerdis areSi, qoSini, Tavbrusxveva, sisuste, Tavis tkivili. gulis wasvla. tkivili gulis areSi aris xanmokle, gaivlis TavisTavad an valerianis miRebisas (da ara validolis) da ar axasiaTebs iradiacia. guliswasvlis da sxva simptomTa ZiriTadi mizezi vegetatiuri disfunqciaa. gulis sazRvrebi perkutorulad gadidebuli ar aris. gadamwyveti mniSvneloba aqvs auskultaciur fenomens, romelic unda moxdes sxvadasxva pozaSi: gulaRma wolisas, marcxena mxarze wolisas, mjdomared, fexze dgomisas da mcire fizikuri datvirTvis Semdeg. damaxasiaTebeli niSania tkacunis xma, romelic moismineba sistolis SuaSi an bolos, zogjer Serwymulia mogvianebiT sistolur SuilTan, zogjer ara. auskultaciuri fenomeni ukeTesad moismineba vertikalur poziciaSi da fizikuri datvirTvis dros V wertilze an mwvervalze. mitraluri sarqvlis prolabirebisas sistoluri eqstratonis warmoqmna ganpirobebulia sistolis SuaSi myesovani qordis ucabedi da mkveTri daWimviT sarqvlis karis marcxena winagulis sivrceSi Sedrekisas an amobrunebisas. bavSvTa naxevars aReniSneba Suasistoluri tkacunis Serwyma mogvianebiT sistolur SuilTan, romelic dakavSirebulia mitraluri sarqvlis ukmarisobasTan da Cveulebriv mudmiv xasiaTs atarebs. SesaZlebelia ramdenime tkacunis arseboba mitraluri sarqvlis sxvadasxva ubnis araerTdrouli amoburculobis gamo. iSviaT SemTxvevaSi, mps-is aseT SemTxvevaSi aucileblad unda gamoiricxos mitraluri sarqvlis ukmarisobis sxvagvari warmoSoba. gulmkerdis marcxena V neknTaSua areSi tkacunis arseboba damaxasia-Tebelia samkariani sarqvlis prolafsiisaTvis. asakTan erTad SesaZlebelia xmovani simptomatikis progresireba: izolirebuli tkacuni icvleba mogvianebiTi an polisistoluri SuiliT. msp-is mqone bavSvTa umravlesobas aReniSneba fsiqikuri aSlilobebi subdepresiuli mdgomareobiT, i poqondruli SiSebiT, asTeniuri gamovlinebebiT da sxva. aseTi fsiqovegetatiuri gadaxrebi ganapirobeben hemodinamikur disregulacias da karedis polabirebas. msp-is dros eleqtrokardiografiul registracias akeTeben pacientis vertikalur da horizontalur mdgomareobaSi. avadmyofTa umravlesobas aReniSneba gulis eleqtruli RerZis vertikaluri mdebareoba, SemTxvevaTa 1/3-Si fiqsirdeba hisis konis marjvena fexis arasruli blokada, damaxasiaTebelia repolarizaciis procesis darRveva sinusuri taqikardiis fonze (T kbilis amplitudis daqveiTeba I, II, III, aVF, V5-6 ganxrebSi). msp-is auskultaciuri formis dros, ekg-is orTostatiul mdgomareobaSi registraciisas, aseTi darRvevebis sixSire 2jer metia. SemTxvevaTa 1/5, marcxena gulmkerdismier ganxrebSi, aRiniSneba T kbilis inversia. organuli ST-T darRvevebisagan gansxvavebiT, msp- 34 is dros, cvlilebebi tranzitoruli xasiaTisaa da SeiZleba ramodenime dReSi an kviraSi gaqres. zogjer ekg-ze adgili aqvs parkuWTa miokardiumis adreuli repolarizaciis sindroms. msp-is dros QT intervalis gadideba ganapirobebs ariTmiis (maT Soris parkuWovanis) ganviTarebas, amitom aseTi bavSvebi saWiroeben kardiorevmatologis ufro xSir kontrols. repolarizaciis procesis darRvevis genezis dazustebisaTvis atareben obzidanis (0,5 mg/kgze) farmakologiur sinjs. adgili aqvs T kbilis mxriv dadebiT dinamikas, rac adasturebs bavSvebSi msp-is dros repolarizaciis procesis darRvevis simpatikodamokidebul xasiaTs. eleqtrokardiogramis klinomdebareobaSi registraciisas zogjer aRiniSneba eqstrakardialuri warmoSobis supraventrikuluri eqstrasistoliebi. yovelive es dakavSirebulia vegetatiur disregulaciasTan. msp-is mqone bavSvebSi ariTmiis SemTxvevaTa registraciis sixSire izrdeba xangrZlivi ekg registraciis (monitoringis) dros. dadginda, rom guliswasvlis dros xdeba QT-intervalis gaxangrZliveba. mitraluri prolafsis dros arcTu iSviaTi gamovlinebaa repolarizaciis procesis darRveva. sxvadasxva avtorebis (Appeldlatt da Tanaavt., 1975; Babow u Pocock, 1975; Г.В. Мыслицкая, 1982) monacemebiT, msp-is dros II-III standartul da AVF ganxrebSi aRiniSneba T kbilis negatiuri transformacia (inversia) da ST segmentis eleqtruli xazis qvemoT cdoma. zemoT CamoTvlil da agreTve gulmkerdis marcxena ganxrebSi. isini aRniSnavdnen, rom T kbilis inversia aReniSnebodaT msp-is mqone avadmyofTa 1/3-s. Н.М. Мухарлямов da А.М. Норузбаева TanaavtorebTan erTad miuTiTeben, rom msp-is dros T kbilis inversia, gabrtyeleba an orfzianoba zemoaRniSnul ganxrebSi aRwevs 44,6%-s. isinive mitraluri prolafsis mqone avadmyofebis 24,5%-Si aRniSnaven maRali, wvetiani, zogjer giganturi T kbilis arsebobas gulmkerdis ganxrebSi (upiratesad V2 da V5). literaturuli monacemebis mixedviT ST segmentis izoeleqtruli xazis qvemoT cdoma mosvenebis mdgomareobaSi iSviaTia, xolo fizikuri datvirTvisas xSiri. mitraluri prolafsis mqone avadmyofebis eleqtrokardiogramebis Seswavlisas 33,2%-Si aRiniSneba esa Tu is gadaxrebi, maT Sors uxSiresi iyo T kbilis inversia, gadasworeba an orfazianoba, SedarebiT iSviaTi iyo ST segmentis cdoma (0,5-1 mm) izoeleqtruli xazis qvemoT. rac Seexeba mozrdilebs aRniSnuli darRvevebi msp-is dros gamovlenilia 49%-Si. magram aseTi cvlilebebi SeiZleba gamovlindes sxva daavadebebis droac (mag.: miokarditi, parkuWTa hi pertrofia, hi pokalemia, gulis iSemiuri daavadeba da sxva). rac msp-is diagnostirebas arTulebs. sirTule gansakuTrebiT reliefuria maSin, roca saqme gvaqvs tkivilis sindromTan. eqoangio da fonokardiografiul kvlevas yovelTvis ar SeuZlia gagvarkvios pirveladia (idopaTuri) prolafsi Tu meoradi (gid-iT gamowveuli). ismeba kiTxva – arsebobs Tu ara iseTi ekg cvlileba (inversiuli T kbi- ,fdidsf rfhlbjkjubf li, ST segmentis cdoma da a.S.), romelic msp-is diferencirebis saSualebas iZleva? samwuxarod, aseTi saimedo ekg kriteriumebi ar arsebobs. Tumca msp-is dros T kbilis inversia da ST segmentis cdomac ufro naklebadaa gamoxatuli, vidre gid-is dros. amasTan gid-is dros es cvlilebebi stabiluria, xolo msp-is dros cvlilebebi tranzitoruli xasiaTisaa. mitraluri prolafsis sxvadasxva aspeqtebis SeswavlaSi didi roli Seasrula eqokardiografiam. msp-is eqokardiografiuli niSnebi pirvelad aRwera Shan da Gramiac-ma (1970). aRmoCnda, rom msp-is ZiriTadi niSania sarqvelis karedis anomaluri moZraoba marcxena winagulisken, marcxena parkuWis sistolis dros, rac SeiZleba Tavisuflad davafiqsitoT eqokardiografiulad. eqo- da fonokardiografiis erTdrouli registraciis dros SeiZleba davakvirdeT marcxena winagulis Rrusaken karedebis maqsimaluri Sezneqis dros rogor warmoiqmneba damaxasiaTebeli gviani sistoluri Suili fkg-ze auskultaciur da maRali sixSiris diapazonebSi gviani sistoluri tkacuni registrirdeba mcire raodenobis oscilaciiT, romelic amplitudiT II tons ar aRemateba. aRniSnuli tkacuni ar unda aurioT I tonis gaxleCasTan, aortis gandevnis (aortaluri mankebi) an filtvis arteriis sistolur tonTan (filtvismieri hi pertenzia). mogvianebiTi sistoluri Suili fiqsirdeba tkacunis Semdeg da uxSiresad kreSendos forma aqvs. rentgenogramaze msp-is auskultaciuri formis mqone bavSvebis 2/3-s aReniSnebodaT gulis zomis gaswvrivi Semcireba da filtvis arteriis rkalis gamozneqa, rac sisxlZarRvis kedlis SemaerTebeli qsovilis arasrulfasovnebaze miuTiTebs. angiokardiografiiT iolad xdeba msp-is gamovlena, rogorc gulis Tandayolili mankis kontingentSi, ise mis gareSe. magram igi invaziuri kvlevis meTods da arasasurvel sadiagnostiko saSualebas warmoadgens. msp-s Taviseburi da mravalmxrivi klinikuri simptomatika aqvs, romelic bevradaa damokidebuli etiologiur faqtorze. Tandayolili (sistemuri daavadebebi, gulis Tandayolili mankebi) da SeZenili (revmatizmi, gid, kardiomiopaTia) msp-is dros klinikas gansazRvravs ZiriTadi daavadeba da am SemTxvevaSi mitraluri prolafsis niSnebi meoradi an meorexarisxovani xasiaTisaa. magram roca idiopaTiur prola-birebazea saubari, am dros wina planze swored msp-is simptomatika gamodis. msp-is Seswavlas mravali naSromi mieZRvna (Devereux da Tanaavtori, 1976; Wooley, 1976; Cтороников Г.И., 1978; Артамонова И.П., 1979; Yeresaty, 1979; King, 1980; g. baxtaZe, 1981). literaturis gacnobisas yuradRebas iqcevs Civilebis mravasaxeoba: tkivili an diskomfortis SegrZneba mkerdis areSi, guliscemis Setevebi, Tavbrusxveva, guliswasvla, qoSini, zogadi sisuste. Tumca zogierTi avtori (Brown da Tanaavt., 1975; Г.И. Сторожаков da Tanaavt., 1983) miiCnevs, rom msp-s ar aqvs raime mniSvnelovani damaxasiaTebeli Civilebi da 60%-Si usimptomod midis. sxva av2013 weli ,fdidsf rfhlbjkjubf torebi (Hancock u Cohu, 1966, Yeresaty, 1979; Malcolm da Tanaavt., 1976) aRniSnaven, rom msp-is mqone avadmyofebs 75%-87%-Si aReniSnebaT esa Tu is Civilebi. yvelaze uxSires Civils warmoadgens tkivili gulmkerdis areSi, romelic Cveulebriv ar aris dakavSirebuli fizikur datvirTvasTan da ar ixsneba nitrogliceriniT. tkivilis sindromi bavSvebSi SedarebiT ufro iSviaTia, vidre mozrdilebSi. Semdeg modis Civilebi guliscemis SeteviT gaZlierebaze (Yeresaty, 1973; Мухарлямов и соавт., 1981) da ariTmiaze (Bharati et all., 1979; Lichtein, 1980; Burch, 1980), romelsac SesaZlebelia sxvadasxva genezi hqondes – gamtareblobiTi sistemis Tandayolili paTologiiT dawyebuli, sarqvlis karedebis kunTovan boWkoebSi impulsaciis eqtopiuri keris warmoqmniT damTavrebuli. umravles SemTxvevaSi msp-is mqone bavSvebs mkurnaloba ar sWirdebaT. avadmyofebi, romelTac aqvT: mitraluri regurgitacia, parkuWovani ariTmia, QT intervalis gadideba, repolarizaciis procesis darRveva, guliswasvla, Tavisufldebian fizkulkturidan da sportidan, aramedikamenturi (fsiqo da fizioTerapia, masaJi, refleqsoTerapia) da medikamenturi mkurnaloba iniSneba diferencirebulad. mkurnaloba mimarTulia miokardiumSi cvliTi procesebis gaumjobesebisaken, vegetatiuri disfunqciis koreqciisaken, garTulebebisa da Tanmxlebi daavadebebis winaaRmdeg. fsiqoemociuri labilobis SemTxvevaSi gamoiyeneba sedaciuri saSualebebic. bavSvTa da mozardTa asakSi da Tu sakiTxi exeba sportsmenebsac, paTologiis an paTologiis wina mdgomareobis dadgena zogjer Zalze rTulia, vinaidan organizmis maRali fizikuri muSaobis unaris gamo maT daavadebis SemTxvevaSic ki SeuZliaT garkveuli periodis manZilze mainc miiRon monawileoba sportul RonisZiebebSi ise, rom Civilebi arc ki hqondeT. rac SeexebaA ariaTmiebisa da mitraluri sarqvlis prolafss (msp) bavSvTa da mozardTa asakSi yovelTvis saWiroebda da saWiroebs individualur midgomas.( r. svaniSvili-2003-2010-11, G.Chakhunashvili, N, Jobava, K..Chakhunashvili-2008-9-10-11 , D.Corrado-2008, Hill AC, Miyake CY, Grady S, Dubin AM.-2011) gamokvlevis mizani kvlevis mizans warmoadgenda ariaTmiebisa da mitraluri sarqvlis prolafsis diagnostikuri Rirebulebis gamokveTa bavSvTa da mozardTa asakSi. kvlevis masala da meTodika gamokvleuli da gaanalizebuli iqna 0-dan 15 wlamde asakis sxvadasxva diagnoziT 1500 bavSvi da 250 sxvadasxva sportuli skolebis sportsmeni 18 wlamde. yvela piri gamokvleuli iyo klinikur – laboratoriuli da instrumentuli meTodebiT, kerZod: a)eleqtrokardiografia - vinaidan eleqtrokardiografia jer-jerobiT gulis funqciebis – avtomatizmis, agznebadobis da gamtareblobis darRvevaTa saukeTeso aRnusxvlelia, Tu ar davumatebT rTuli riTmis darRvevaTa diagnostirebas, rogoricaa: WPW, CPPJ, CLC da a.S. 2013 weli 35 Zalzed mniSvnelovania misi roli bradikardiebis dros QT – sa da QT 1 – is gaxangrZlivebisas (uecari sikvdilis gasatarebeli prevenciuli RonisZiebebisaTvis).swored amitom gulis riTmis darRvevebis kvlevas mieqca calkeul jgufebSi umniSvnelovanesi yuradReba. b)eqokardiografia- gamokvlevis meTodika – gamokvleva warmoebda pacientis gulaRma an marcxena gverdze wolisas, 3,5 MHz da 5,0 MHz transduseriT, transTorakaluri eqoskopiis meSveobiT, subkostaluri, apikaluri, parasternaluri da suprastenaluri fanjrebis gamoyenebiT. mitraluri sarqvelis ekokardiografiuli daxasiaTeba – mitraluri sarqvelis struqturul cvlilebebs vafasebdT eqvsquliani sistemiT. mitraluri sarqvlis wina sagdulis struqturuli dazianebis klasifikacia mocemulia i.p. marxasinas, m.s. saiCenvskis mixedviT. mitraluri xvrelis sidides vsazRvravdiT v.v. bobkovis meTodikiT (1975) i.p. marxasinas, m.s. saviCenskis (1987) modifikaciiT. mitraluri xvrelis farTobs vsazRvravdiT transmitraluri sisxldinebis maTematikuri modelis safuZvelze W. Seitz-isa da E. Opersrhall-is (1980) meTodis mixedviT. mitraluri sarqvlis prolafsis diagnozis dasasmelad vsargeblobdiT n.a. belokonis da Tanaavt. (1989) mowodebuli diagnostikuri kriteriumebiT..doplereqokardiografiis (marcxena parkuWebis struqturuli, funqciuri da hemodinamikis mdgomareobis Sesafaseblad) asakobrivi normebis gzamkvlevia 1991 wlis damxmare saxelmZRvanelo (,eqokardiografiuli monacemebis niSnebi janmrTel bavSvebSi”. g.CaxunaSvili, n. jobava). v) klinikur-anamneziuri gamokvleva – klinikuri kvlevisas didi yuradReba eTmoboda: anamnezisa da Civilebis zedmiwevniT Seswavlas, gamokvlevis fizikalur da damatebiT meTodebs, organoebis dazianebis xasiaTisa da gamoxatulebis aRweras. .masalis statistikuri damuSaveba – miRebuli cifrobrivi monacemebis damuSaveba umetesad moxdeba variaciuli statistikis meTodiT. ganisazRvreba saSualo ariTmetikul (M) maCvenebelsi, saSualo kvadratl gadaxra. saSualo ariTmetikulis saSualo cdomilebas, sarwmunoebis intervalis sazRvrebi (M+G). maCvenebelTa gansxvavebas miviCnevT sarwmunod roca t>2,07. ganvsazRvravT Secdomis sarwmunoebas (P) da korelaciur analizs (koeficienti r da R-is gamoyenebiT). kvlevis Sedegebi da maTi ganxilva: rogorc avRniSneT gamokvlevis mizani iyo, Segvefasebina ariTmiebi mitraluri sarqvlis prolafsisas,rogorc daavadebul aseve sportsmen bavSvebSi. kvlevisas 250 bavSvs davakvirdiT msp-iT, maTgan 225 daavadebulT da 25-s sportsmens, 0-18 wlebis asakis SualedSi. mspiT yvela bavSvis ekg-ze vakvirdebodiT Semdeg Sedegebs: 36 gulis funqciebis – avtomatizmis, agznebadobis da gamtareblobis darRveva: daavadebul bavSvebSi Sesabamisad – 40% (25%-sin. taqikardia), 5%, da 4%; sportsmenebSi – 60%(45%-sin.bradikardia), 2%, da 1%: orive jgufSi rTuli riTmis darRvevaTagan diagnostirdeboda: WPW -1, CPPJ-3, CLC-2 SemTxveva. Zalzed mniSvnelovani iyo sportsmenebSi bradikardiebis dros QT – sa da QT 1 – is gaxangrZliveba - 3 SemTxveva (uecari sikvdilis gasatarebeli prevenciuli RonisZiebebisaTvis).rogorc aRmoCnda orive jgufSi ariTmia msp-is dros sakmaod maRalia 49 da 63 %. swored , amitom gulis riTmis darRvevebis kvlevas msp-is dros sWirdeba calkeul jgufebSi umniSvnelovanesi yuradReba, rogorc daavadebul bavSvebSi aseve sportsmenebSi. kerZod aucilebelia maTTvis minimum 24 saaTiani holteris ekg-s dakvirveba. Sejameba: 1. msp-ian bavSvebSi ariTmia dadginda 56%-Si. 2. maTi fizikuri aqtivoba orive jgufisaTvis unda iyo umkacresi kontrolis qveS, radganac axali riTmis darRvevebi ar aRmoCndes sicocxlisaTvis saSiSi. daskvnebi: literatutuli monacemebis Rrma analiziTa da SemuSavebuli adaptaciuri kardiomiopaTiis gamovlinebis kompleqsuri kliniko-instrumentuli (doplereqokardiografiuli, ekg, da sxva) kvlevis Sedegebi, sadiferenciacio kriteriumebi, prediqtorebis gansazRvra, unda dainergos saqarTvelos umaRles saswavleblebSi samkurnalo kaTedrebis saswavlo da sportskolebSi iunior sportsmenTa wvrTnaTa procesebSi; samecniero literaturis nusxa: 1. sportuli medicina da kinezoTerapia –r.svaniSvili, z.kaxabriSvili; Tbilisi 2010w. gv:575 2. `marcxena parkuWis sistolur-diatoluri funqcia da parkuWTa repolarizaciis dispersia paTologiuri da adaptaciuri hi pertrofiebis dros”. `samkurnalo fizkultura da sportuli medicina” Mm.m.k. disertacia. -14.00.12 - Tbilisi, 2006 w. T. qiSmaria. 3. `klinikur-morfologiuri maCveneblebis dinamika mozard sportsmenTa wvrTnisa da reabilitaciis procesSi”. 14.00.29 – pediatria. Mm.m.k. disertacia. Tbilisi, 2006 weli. x. lasareiSvili 4. `sportsmenTa eleqtrokardiografia.” Tbilisi, 1989 weli. d. tvilidiani, r. svaniSvili 5. `saeqimo kontroli da samkurnalo fizikuri kultura”. Tbilisi, 2003 weli. 480 gverdi. r. svaniSvili 6. `bavSvTa asakSi zogierTi Tandayolili anTebadi da SeZenili araanTebadi daavadebebis dros gul-sisxlZarRvTa sistemis klinikur-instrumentuli daxasiaTeba, maT mkurnalo- ,fdidsf rfhlbjkjubf baSi preparat GA – 40-is CarTvis SesaZleblobani.” Mm. m. k. disertacia. Tbilisi, 2004 w. n. jobava 7. `kapilaroskopiisa da kardiointervalografiiT miRebuli monacemebis daxasiaTeba”- n.jobava, g.CaxunaSvili; saqarTvelos bavSvTa kardiologTa asociaciis Jurnali #5, gv:16-24; 2011w. 8. `sportsmenTa anTropometruli da funqciuri maxasiaTeblebi da gul-sisxlZarRvTa sistemis funqciuri mdgomareoba aminomJavebiT gamdidrebuli energetikuli sasmeli `iveriuli-fito”-s moqmedebis fonze- saqarTvelos bavSvTa kardiologTa asociaciis Jurnali #5, gv:24-33; 2011w 9. The 26-th International Pediatric association Congress of Pediatrics; South Africa, August 4-9.2010 “the clinical significance of ST – segment deviation and T wavw changes in children” ( abstract). - G.Chakhunashvili, n, jobava, k.Chakhunashvili 10. “USE OF BNP AND NT_PROBNP IN EARLY STAGE DIAGNOSIS OF ATHLETE’S CARDIOVASCULAR PATHOLOGIES : LITERATURE OVERVIEW.” - Ilia NadareiSvili,George Chakhunashvili; journal of the Georgian pediatric cardiology association #4 pages:30-38 2010 11. “ST segmentis, T kbilis,da Q-T intervalis Tanamedrove problemebi bavSvTa da mozardTa kardiologiaSi” – g.CaxunaSvili, n.jobava, k.CaxunaSvili - saqarTvelos bavSvTa kardiologTa asociaciis Jurnali #4 gv:9-28 2010w 12. `gul-sisxlZarRvTa sistemis funqciuri mdgomareoba faruli vegetatiuri disfunqciisa da sisxlZarRvovani hi perreaqtiulobis dros sportsmen bavSvebsa da mozardebSi (diagnostikis, mkurnalobisa da prevenciis sakiTxebi)” – g.CaxunaSvili, i.doliZe, T.gogatiSvili; saqarTvelos bavSvTa kardiologTa asociaciis Jurnali #4 gv:39-41 2010w 13. `bavSvTa kardiologia XXI saukuneSi, koronaruli ukmarisoba da misi pediatriuli aspeqti” – g.CaxunaSvili, n.jobava, k.CaxunaSvili; saqarTvelos bavSvTa kardiologTa asociaciis Jurnali #2 gv:9-12; 2008 14. `gul-sisxlZarRvTa sistemis naadrev morfo-funqciur cvlilebaTa drouli gamovlena dasawvrTo procesebis Tanamedrove marTva mozard sportsmenebSi’’ –m.alTunaSvili, g.CaxunaSvili; saqarTvelos bavSvTa kardiologTa asociaciis Jurnali #2 gv:13-14;2008w 15. “cardiovascular system in the sports-children holding prevention arrangments against week rings”- G.chakhunashvili, N.jobava, D.fruidze, D.tabutsadze,M.chkhaidze; journal of the Georgian pediatric cardiology association # 2; page:15-18;2008 16. Martin A: Apports nutritionnels conseillés pour la population française. (3ème Ed). Paris, Ed Tec & Doc 608p.2001. 17. Rokitzki L, Logemann E, Sagredos AN, Murphy M, Wetzel-Roth W, Keul. J: Lipid peroxidation and antioxidant vitamins under extreme endurance stress. Acta Physiol Scand151 :149– 158,1994 18. Hill AC, Miyake CY, Grady S, Dubin AM. 2011 19.. Effects of a single session of resistance exercise training on specific cardiac and oxidative stress markers 2013 weli ,fdidsf rfhlbjkjubf 20. Tschan Harald , Vidotto Claudia , Atamaniuk Johanna , Kinzelbauer Markus , Wessner Barbara and Bachl Norbert - Center of Sport Sciences and Univversity Sports – Department Sportphysiology, University of Vienna, Austria, BKW Laboratory Medicine, Vienna, Austria, 3 Social Medical Cen ter So uth – Department of Laboratory Diagnostics, Vienna, Austria 21. “Cardiovascular system in the sports – children holding prevention arrangements against week rings”. G. Chakhunashvili, N. Jobava, D. Pruidze, D. Tabutsadze, V. Kandelaki, M. Chichaidze. Pediatric clinic of State Medical University Tbilisi, Georgia. Profilactic Center for Mother and Child Tbilisi, Georgia 22. Функциональные изменения сердца юных спортсменов: профилактика и коррекция. Медицинский научный и учебно-методический журнал. Корнеева И.Т., Поляков С.Д., НЦЗД РАМН, Москва 2005г. 37 23. Детская спортивная медицина. Андреева Т. Г., Феникс, Москва 2007г. 24. Pediatric Cardiology. Walter H. Johnson, James H. Moller. ISBN-13: 9780781728782. 2001 y. 326 pages. Pediatric Cardiology. Victoria Vetter, MD; Professor of Pediatrics; The University of Pennsylvania School of Medicine; Chief; Division of Cardiology; The Children’s Hospital of Philadelphia, Philadelphia, PA., publication date: FEB-2006 y. 384 pages. 26. Hill AC, Miyake CY, Grady S, Dubin AM. Accuracy of interpretation of preparticipation screening electrocardiograms. J Pediatr. 2011, Jul 9. 27.. Мурашко, В.В. Злектрокардиография: Учебн. пособие / В.В. Мурашко, А.В. Струтынский. – 8-е изд. – М.: МЕДпресс-информ, 2007. – 320 с.: ил 28. D.Corrado Publications http://www.labome.org/expert/italy/university/corrado/d-corrado-202830.html reziume mitraluri sarqvlis prolapsis sixSire, etiopa Togenezi, daavadebaTa paTogenur procesSi Cabmis xarisxis gansazRvra da ariaTmiebTan konteqsSi misi ganxilva g.CaxunaSvili, n.jobava, k.CaxunaSvili, m.SvangiraZe, m.inasariZe, d.CaxunaSvili (saqarTvelos bavSvTa kardiologTa asociacia, axali pediatriuli klinika,janmrTelobis centri) pirvelad mitraluri sarqvlis prolafsis Sesaxeb alaparakdnen gasuli saukunis 60-iani wlebidan. misi warmoSobis da diagnostirebis sakiTxebs mravali mecnieris Sromebi mieZRvna (White, 1931; Reid, 1961; Barloid, 1963; Hancock, Cohu, 1966; Jeresaty, 1979 da sxva). gamokvlevis mizani kvlevis mizans warmoadgenda ariaTmiebisa da mitraluri sarqvlis prolafsis diagnostikuri Rirebulebis gamokveTa bavSvTa da mozardTa asakSi. kvlevis masala da meTodika gamokvleuli da gaanalizebuli iqna 0-dan 15 wlamde asakis sxvadasxva diagnoziT 1500 bavSvi da 250 sxvadasxva sportuli skolebis sportsmeni 18 wlamde. yvela piri gamokvleuli iyo klinikur – laboratoriuli da instrumentuli meTodebiT daskvna: 1. msp-ian bavSvebSi ariTmia dadginda 56%-Si. 2. maTi fizikuri aqtivoba yvela jgufisaTvis unda iyo umkacresi kontrolis qveS, radganac axali riTmis darRvevebi ar aRmoCndes sicocxlisaTvis saSiSi. SUMMARY THE FREQUENCY OF MITRAL VALVE PROLAPSE, ETHIOLOGY AND PATHOLOGY, DETERMINATION OF PATHOLOGICAL PROCESS INVOLVEMENT DEGREE AND DISCUSSION IN CONTEXT WITH ARRHYTHMIA G.CHAKHUNASHVILI, N.JOBAVA, K.CHAKHUNASHVILI, D.CHAKHUNASHVILI Georgian Pediatric Cardiology Association, New Child’s Clinic, Health Centre They first talked about mitral valve prolapse in 60’s of XX Century. Many famous scientist works were dedicated to it’s ethiology and diagnosis (White, 1931; Reid, 1961; Barloid, 1963; Hancock, Cohu, 1966; Jeresaty, 1979 and others). Aim of research: The aim of research was to show the diagnostic meaning of mitral valve prolapse and arrhythmia in children and adults. Methods and stuff of the research: 1500 children (0-15 age) and 250 children (max age 18) from sport schools were examined and analyzed. All of them were examined with clinical-laboratory and instrumental methods. Conclusion: 1. In 56% of children who had mitral valve prolapse had arrhythmia. 2. Their physical activities must be under strictest control just in case new rythm disorders can not damage their health. 2013 weli ,fdidsf rfhlbjkjubf 38 ST segmentisa da T kbilis cvlilebebaTa Rrma klinikuri analizis aucilebloba, parkuWTa repolarizaciis, naadrevi agznebis parcialuri sindromTa da P-Q intervalis Semcirebis arsebobisas bavSvTa da mozardTa asakSi n.jobava,g.CaxunaSvili,k.CaxunaSvili,d.CaxunaSvili (saqarTvelos bavSvTa kardiologTa asociacia,bavSvTaaxali klinika,janmrTelobis centri) dadgenilia, rom periferiul ganxrebSi ST intervalis 1 mm-iT cdoma Seesabameba 400 000 miokardiuli boWkos dazianebas (gulmkerdis ganxrebSi ki 4000-s). am monacemebis (Schaeffer H., Haas H., 1962) gaTvaliswinebiT saWiroa da aucilebelia ufro meti yuradReba daeTmos ST-T umniSvnelo darRvevebsac, romlebic aRiniSneba standartul da monopolarul ganxrebSi, radgan es cvlilebebi SeiZleba iyos ufro mniSvnelovani, vidre iSemiis ufro intensiuri gamovlinebebi gulmkerdis ganxrebSi. mravali statistikuri monacemebis Tanaxmad msubuqi eleqtrokardiografiuli darRvevebi warmoadgenen koronaluri riskis aSkara faqtorebs (Ross S.R., 1970). dReisaTvis cnobilia, rom gul-sisxlZarRvTasistemaganicdis paTologiur procesSi Cabmas rogorc sxvadasxva daavadaebaTa dros ase ve s por t s men Ta a ras wo ri w v r T ni sas (1,2,3,4,5,6,7,8,10,12,13). amasTan erTad ziandeba koronaruli sisxliT momarageba, rogorc zogierTi Tandayolili, aseve SeZenili araanTebadi daavadebebis dros. swored amitom mizanSewonilia yvela am daavadebaTa dros da janmrTel kontigentSi (sportsmenebSi) zustad ganisazRvros klinikur-instrumentuli monacemebis cvlilebebi da mieces maT Rirseuli, Rrma analizis meSveobiT, Sesabamisi axsna. mizani: ST segmentisa da T kbilis cvlilebaTa klinikuri RirebulebaTa arsi,Senelebuli repolarizaciis sindromis (Q-T intervalis gaxangrZliveba), parkuWTa adreuli repolarizaciis sindromis (pars),P-Q intervalis Semcirebisa (<0,12c) da parkuWTa naadrevi agznebis parcialuri sinddromis(pnaps) arsebobaTa dros bavSvTa da mozardTa asakSi masala da meTodebi:gamokvleuli da gaanalizebuliiqna 0-dan 15 wlamde asakis sxvadasxva diagnoziT 4 500 bavSvi(I jgufi) da 350 sxvadasxva sportuli skolebis sportsmeni 18 wlamde(II jgufi). Yyvelapiri gamokvleuli iyo klinikur – laboratoriuli da instrumentuli meTodebiT, kerZod: eleqtrokardiografia 15 ganxraSi (12 Cveulebrivi da 3 Nehb-is)-vinaidan e.k.g. jer-jerobiTgulisfunqciebis – avtomatizmis, agznebadobis da gamtareblobis darRvevaTa saukeTeso aRnusxvlelia, Tu ar davumatebT rTuli riTmis darRvevaTa diagnostirebas, rogoricaa: WPW, CPPJ, CLC da a.S. Zalzed mniSvnelovani- a misi roli bradikardiebis dros QT – sa da QT 1 – is gaxangrZlivebisas daST segmentisa da T kbilis cvlilebebaTa(9,11) dros. raodenobrivi maCveneblebis sarwmunobis Sefasebas vaxdendiT stiudentis kriteriumiT (t), xarisxovanis χ2 kriteriumiT, jgufebs Soris Sedarebas Pearson-iT. gansxvaveba iTvleboda sarwmunod, Tu t>1,96 p<0,05 da χ2 >3,84, p<0,05 kvlevis Sedegebi da maTi ganxilva:upriania, rodesac vixilavT ekg-ze ST segmentisa da T kbilis cvlilebebs, aqve ar ganvixiloT QT intervalis gaxangrZliveba da parkuWTa naadrevi repolarizaciis sindromi, miTumetes, rodesac bavSvTa asakzea saubari. SedarebiT damaxasiaTebeli sindromi ekg-ze aris Senelebuli repolarizaciis sindromi (Q-T intervalis gaxangrZliveba), rac eleqtruli sistolis xangrZlivobis matebas asaxavs. es cvlilebebi periodulad emTxveva parkuWovani taqikardiis, parkuWTa TrTolvis da asistoliis Setevebs, rac klinikurad vlindeba sisustiT, TavbrusxveviT, zogjer sinkopeTi an krunCxviT. Q-T intervalis gaxangrZlivebis mizezi ucnobia. autopsiur masalazec ver ipoves calsaxa paTomorfologiuri substrati, rac sikvdilis mizezi gaxda. literaturaSi Q-T intervalis gaxangrZlivebis ori variantia aRwerili: 1) siyruiT – jervel-lange-nelsenis sindromi (Gervell A., Lange-Nielson F., 1957) da 2) siyruis gareSe – romano-uordis sindromi (Romano C Word O., 1963) dRes mas erT sindromad ganixilaven Q-T intervalis gaxangrZlivebis sindromi. Q-T intervalis gaxangrZliveba registrirdeba periodulad – SeiZleba gaqres da isev gamoCndes. misi Semokleba normamde mkurnalobis gareSe iSviaTi da droebiTia. arcTu iSviaTad aRiniSnba repolarizaciis procesis darRvevis sxva niSnebic – T kbilis amplitudis momateba an Semcireba, misi formis (orfazianoba, wvetianoba, gaxleCa, inversia) cvlileba, U kbilis momateba. rogorc Q-T intervalis, ise T da U kbilebis forma da xangrZlivoba SeiZleba varirebdes. am sindromebis damaxasiaTebeli niSnebi memkvidreobiTac gadaecema – pirveli varianti autosomur-recerulia, meore – autosomur dominanturi. Cven vakvirdebodiT bavSvebs, romelTac hqondaT Q-T intervalis gaxangrZliveba siyruis da gonebis dakargvis gareSe (hqondaT 2013 weli ,fdidsf rfhlbjkjubf mxolod Tavbrusxveva). kliniko-instrumentalurma kvlevam ver gamoavlina gulSi mimdinare raime paTologiuri procesi. Q-T intervalis gaxangrZlivebis sindromi SeiZleba iyos agreTve miokardiumis funqciuri dazianebis gamovlineba gulis sxvadasxva paTologiis dros (revmokarditi, infeqciuri miokarditi, gulis manki, mitraluri sarqvlis prolafsi, eleqtrolituri cvlis darRveva da sxva). aseT SemTxvevaSi paTologiuri procesis CaqrobasTan erTad eleqtruli sis to li is xan g r Z li vo ba nor ma liz de ba (p<0,05), yvela bavSvs, romelsac aqvs ati piurad mimdinare epilefsia an sinkopes Setevebi, unda iqnes gamokvleuli Q-T intervalis gaxangrZlivebis sindromis gamosaricxad. ekg-ze parkuWovani kompleqsis damamTavrebeli nawilis Tavisebur cvlilebebs ewodeba parkuWTa adreuli repolarizaciis sindromi (pars). igi gvxvdeba Cvens masalaze 1,5-2% sixSi riT, zo gi er Ti mas nor mad mi iC nevs ( .. ., 1979; .., 1983; .., Phillips J., 1976 da sxva). am sindromisaTvis damaxasiaTebelia izoxazidan ST segmentis amowevis cdoma. dasawyisSi Cavardnis saxes iRebs mimarTuls qvemoT, Semdeg is iRebs iribdaRmaval mimarTulebas da gamokveTili sazRvris gareSe gadadis dadebiT an uaryofiT T kbilSi. izoxazidan ST segmentis awevis xarisxi 0,5-dan 6 mm-mde meryeobs da izomeba 4 g mentis yvelaze dabali wertilidan izoxazamde. aRniSnuli cvlilebebi xSirad aRiniSneba gulmkerdis ganxrebSi (V2-V4) (p<0,05). pars-is damaxasiaTebel Taviseburebad iTvleba ST segmentis amowevis SenarCuneba wlebis manZilze, miuxedavad ekg-suraTis polimorfizmisa da labilobisa, asakTan erTad xdeba ST segmentis Semcireba ( . ., 1976). am sindromis dros xSiria diagnostikis siZneleebi, misi paTologiisagan (gid, mwvave perikarditi, vegetaciuri da endokrinuli moSliloba) diferencirebis TvalsazrisiT. iwyeben fizikuri datvirTvis sinjs, paTologiis ararsebobis SemTxvevaSi xdeba segmentis izoeleqtrul xazze dabruneba da uaryofiTi T kbili xdeba dadebiTi. uaryofiTi T kbilis inversiac qreba kaliumis da inderalis sinjebis dros, rac cvlilebis funqciur xasiaTze miuTiTebs. pars bavSvebSi sakmarisad xSiria, gansakuTrebiT pubertaciul da prepubertatul periodSi vegetodistoniis niSnebis fonze. pars-is niSnebi bavSvebSi ufro xSirad gvxvdeba II, III, aVF, V2, V3, V5, V6 ganxrebSi(p<0,05), iSviaTad I da aVL, V2, V6 ganxrebSi, gamonaklisis saxiT mxolod standartul an mxolod gulmkerdis ganxrebSi. yvelaze ufro gamoxatuli ST segmentis aweva aRiniSneba V2-V3 ganxrebSi(p<0,05), ST segmentis varirebis 0,5-2 mmis farglebSi. rogorc Cvenma dakvirvebebma aCvena, parkuWTa adreuli repolarizaciis sindromi arc Tu 2013 weli 39 iSviaTad emTxveva P-Q intervalis Semcirebas (<0,12c), zogjer parkuWTanaadrevi agznebis parcialur sindroms. sakmarisad xSirad igi registrirdeba bradikardiisa (SemTxvevaTa 1/4) da gamoxatuli sinusuri ariTmiis fonze(p<0,05). yovelive zemoaRniSnulidan gamomdinare, “parkuWTa adreuli repolarizaciis sindromi”-s diagnozi, rogorc normaluri ekg-s varianti, moiTxovs did sifrTxiles da gamarTlebulia sruli kompleqsuri klinikuri kvlevisa da dinamikaSi ekg monacemebis arsebobis SemTxvevaSi. Semdgom Seswavlas moiTxovs agreTve am sindromis klinikuri TavisTavadoba, im SemTxvevaSi roca daavadebis fonze vlindeba sindromis klinikuri niSnebi, Cndeba safuZveli es sindromi ganvixiloT rogorc paTologiis gamovlineba Tu sindromis niSnebi rCeba xangrZlivad, miuxedavad paTologiuri procesis Cacxromisa, maSin igi SeiZleba CaiTvalos janmrTeli organizmis individualur ekg-ul Taviseburebad. udavoa, rom bavSvebSi pars-is genezi Semdgom kvlevas moiTxovs. daskvna: -maSasadame Cvens mier Catarebuli gamokvlevebis Sedegebi adastureben, rom bavSvTa asakSi ST segmentisa da T kbilis cvlilebani sxvadasxva asakobriv jgufebSi moiTxovs individualurad ganxilvis midgomas, rac bavSvTa kardiologiidan siberemde mis Semdgom Rrma klinikuri informaciis matareblad unda darCes. - aucilebeliaST segmentisa da T kbilis cvlilebebaTa Rrma klinikuri analizis, parkuWTa repolarizaciis, naadrevi agznebis parcialuri sindromTa da P-Q intervalis Semcirebis arsebobisas bavSvTa da mozardTa asakSi. literatura: 1. Sobolev A.V. – Problems of Cardiac Rhythm Assessment During EKG monitoring – Vestnik of Arhythmology 2002, 26 p21-26 2. Ch. Dimitar. R. – Clinical Cardiology – 1993 vol. 15 p784-790 3. Schmaltz A.A. Aptiz I. Hort W. – Europ. Heart. – J – 1987 N8 P100-10 4..Damage of Cardiovascular System During Systemic Lupus ErythematosusG. Chakhunashvili, N. Jobava,K. Chakhunashvili, A. Bliadze (lurnal of the pediatric cardiolojyassotiation-“Pediatric Cardiolojy”2012.N 6. 8-15p. 5. Early discovery of morphologic (adaptive, pathologic) changes in cardiovascular system and modern governance of training process in young sportsmenG. Chakhunashvili, I. Dolidze, N. Jobava, K. Chakhunashvili, Z. Pkhaladze, T. Gogatishvili(lurnal of the pediatric cardiolojyassotiation“Pediatric Cardiolojy”2012.N 6. 15-20p. 6..Status of cardiovascular system, during clandestine vegetative dysfunction and vascular reactivity , in sportsmen children and teenagers (subjects of diagnostic, treatment andprevention)(review of Literature) (lurnal of the pediatric cardiolojyassotiation-“Pediatric Cardiolojy”2012.N 6.20-25p. 40 7.Value of Dysrhythmias and Mitral Prolapse Diagnosis in Modern Pediatric Cardiology G. Chakhunashvili, N. Jobava, M. Shvangiradze, M. Inasaridze, T.Gogatishvili, A. Bliadze(lurnal of the pediatric cardiolojyassotiation-“Pediatric Cardiolojy”2012.N 6. 25-28p. 8 `kapilaroskopiisa da kardiointervalografiiTmiRebulimonacemebisdaxasiaTeba”- n.jobava, g.CaxunaSvili; saqarTvelosbavSvTakardiologTaasociaciisJurnali “bavSvTakardiologTa” #5, gv:16-24; 2011w. 9.STsegmentis, Tkbilis,daQ-T intervalisTanamedroveproblemebibavSvTa da mozardTakardiologiaSi” – g.CaxunaSvili, n.jobava, k.CaxunaSvili - saqarTvelosbavSvTakardiologTaasociaciisJurnali“bavSvTakardiologTa” #4 gv:928 2010w 10. `gul-sisxlZarRvTa sistemisfunqciurimdgomareobafarulivegetatiuridisfunqciisa da sisxlZarRvovanihi perreaqtiulobisdros sportsmen bavSvebsa da mozardebSi (diagnostikis, mkurnalobisa da prevenciissakiTxebi)” ,fdidsf rfhlbjkjubf – g.CaxunaSvili, i.doliZe, T.gogatiSvili; saqarTvelosbavSvTakardiologTaasociaciisJurnali “bavSvTakardiologTa” #4 gv: 39-41 2010w. 11. “STsegmentisdaTkbilismorfologiuri”– g.CaxunaSvili, n.jobava, k.CaxunaSvili - saqarTvelosbavSvTakardiologTaasociaciisJurnali“bavSvTakardiologTa” #6 gv: 63 2012w 12. `sportsmenTaanTropometruli da funqciurimaxasiaTeblebi da gul-sisxlZarRvTasistemisfunqciurimdgomareobaaminomJavebiTgamdidrebulienergetikulisasmeli `iveriulifito”-s moqmedebisfonze”-g.CaxunaSvili da sxv. saqarTvelosbavSvTakardiologTaasociaciisJurnali “bavSvTakardiologTa” #5, gv:2433; 2011w 13..”Cardiovascular system in the sports-children and timely holding prevention arrangements-against week rings”G. ChakhunashviliN. KandelakiD. PruidzeM.ChkhaidzeD.Tabutsadze N.Jobava.25 th International Congress of Pediatrics. August 25-30, 2007. Athens-Greece Cardiology PP0070. reziume ST segmentisa da T kbilis cvlilebebaTa Rrma klinikuri analizis aucilebloba, parkuWTa repolarizaciis, naadrevi agznebis parcialuri sindromTa da P-Q intervalis Semcirebis arsebobisas bavSvTa da mozardTa asakSi n.jobava, g.CaxunaSvili, k.CaxunaSvili, d.CaxunaSvili (saqarTvelos bavSvTa kardiologTa asociacia, bavSvTa axali klinika, janmrTelobis centri) dReisaTvis cnobilia, rom gulsisxlZarRvTa sistema ganicdis paTologiur procesSi Cabmas rogorc sxvadasxva daavadaebaTa dros aseve sportsmenTa araswori wvrTnisas. amasTan erTad ziandeba koronaruli sisxliT momarageba, rogorc zogierTi Tandayolili, aseve SeZenili ara anTebadi da avadebebis dros. swored amitom mizanSewonilia yvela am daavadebaTa dros da janmrTel kontigentSi (sportsmenebSi) zustad ganisazRvros klinikur-instrumentuli monacemebis cvlilebebi da miecesmaT Rirseuli, Rrma analizis meSveobiT, Sesabamisi axsna. mizani: ST segmentisa da T kbilis cvlilebaTa klinikuri RirebulebaTa arsi, Senelebuli repolarizaciis sindromis (Q-T intervalis gaxangrZliveba), parkuWTa adreuli repolarizaciis sindromis (pars), P-Qintervalis Semcirebisa (<0,12c) da parkuWTa naadrevi agznebis parcialuri sinddromis (pnaps) arsebobaTa dros bavSvTa da mozardTa asakSi masala da meTodebi: gamokvleuli da gaanalizebuli iqna 0-dan 15 wlamde asakis sxvadasxva diagnoziT 4 500 bavSvi (I jgufi) da 350 sxvadasxva sportuli skolebis sportsmeni 18 wlamde (II jgufi). Yyvela piri gamokvleuli iyo klinikur – laboratoriuli da instrumentuli meTodebiT. raodenobrivi maCveneblebis sarwmunobis Sefasebas vaxdendiT stiudentis kriteriumiT (t), xarisxovanis χ2 kriteriumiT, jgufebs Soris Sedarebas Pearson-iT. gansxvaveba iTvleboda sarwmunod, Tu t>1,96 p<0,05 da χ2 >3,84, p<0,05 kvlevis Sedegebi da maTi ganxilva sindromTa diagnozi, rogorc normaluri ekg-s varianti, moiTxovs did sifrTxiles da gamarTlebulia sruli kompleqsuri klinikuri kvlevisa da dinamikaSi ekg monacemebis arsebobis SemTxvevaSi. Semdgom Seswavlas moiTxovs agreTve am sindromTa klinikuri TavisTavadoba, im SemTxvevaSi roca daavadebis fonze vlindeba sindromTa klinikuri niSnebi, Cndeba safuZveli es sindromebi ganvixiloT rogorc paTologiis gamovlineba Tu sindromebis niSnebi rCeba xangrZlivad, miuxedavad paTologiuri procesis Cacxromisa, maSin igi SeiZleba CaiTvalos janmrTeli organizmis individualur ekg-ul Taviseburebad. Ddaskvna: maSasadame Cvens mier Catarebuli gamokvlevebis Sedegebi adastureben, rom bavSvTa asakSi ST segmentisa da T kbilis cvlilebani sxvadasxva asakobriv jgufebSi moiTxovs individualurad ganxilvis midgomas, rac bavSvTa kardiologiidan siberemde mis Semdgom Rrma klinikuri informaciis matareblad unda darCes. -aucilebeliaST segmentisa da T kbilis cvlilebebaTa Rrma klinikuri analizis, parkuWTa repolarizaciis, naadrevi agznebis parcialuri sindromTa da P-Q intervalis Semcirebis arsebobisas bavSvTa da mozardTa asakSi. 2013 weli ,fdidsf rfhlbjkjubf 41 SUMMARY CLINICAL VALUE OF ST SEGMENT AND T WAVE, DURING VENTRICLE REPOLARIZATION, EARLY DISCHARGE PARTIAL SYNDROME AND NARROWED P-Q INTERVAL IN CHILDREN AND ADOLESCENTS N.JOBAVA, G. CHAKHUNASHVILI, K. CHAKHUNASHVILI, D. CHAKHUNASHVILI (Association of Georgian Pediatric Cardiology, Children’s New Clinic, Health center) Nowadays it is known that, cardiovascular system can be involved in pathological process during either diseases or not right training. Coronary blood flow is also damaged during some congenital or acquired non-inflamatory diseases. That is why we think it would be right to detect all above said changes, analyze them during disease or in healthy contingent (sportsmen). Purpose: Meaning of ST segment and T wave during repolarization syndrome (Prolonged Q-T interval), ventricle repolarization syndrome, Narrowed P-Q interval (0,12) and early discharge of ventricle in children and adolescents. Methods:4500 children of age 0-15 were examined with different diagnosis (Grp I) and 350 sportsmen of age under 18 from different sports schools. All of them were examined with clinical-laboratory and instrumental methods. The numeric index was evaluated with stundet criteria (t), qualitative criteria χ2, comparing between groups by Pearson. Difference was trustworthy if t>1,96 p<0,05 and χ2 >3,84, p<0,05. Results: Diagnosing syndromes, as variety of normal EKG, must take a lot of caution and is justified if we have corresponding data of changing during clinical examination and EKG changes in dynamic. The further study also must be done about clinical syndrome, as we must be aware that if syndromes are symptomes of pathology and they stay after curing the pathology, we might think that the changes in EKG is individual for the healthy organism. Conclusion: The reasearch done by us proves that ST segment and T wave changes in children demand individual discussion, which must stay as a clinical information from childhood thoughout the life. ar te ri u li hi per ten zia bav S v Ta asak Si r.svanaZe, a. bliaZe, g. CaxunaSvili saqarTvelos bavSvTa kardiologTa asociacia arteriuli hi pertenziaSi anu hi pertoniaSi igulisxmeba paTologiuri mdgomareoba mudmivi an perioduli arteriuli wnevis momatebiT. amrigad, arteriuli hi pertenzia sisxlis arteriuli wnevis momatebaa aortidan arteriolebis CaTvliT. is warmoadgens simptoms bevri daavadebisa da paTologiuri mdgomareobisa. gvxvdeba bavSvTa 4-14%-Si, xSiria skolis asakSi. bavSvebSi a. h. ara mxolod samedicino, aramed socialur-ekonomikur problemas warmoadgens, vinaidan swored is aris yvelaze xSiri mizezi gulis iSemiis, infarqtis da Tavis tvinis daavadebebis ganviTarebis. a. h. garTulebebi xSirad letaluradac mTavrdeba. saqarTveloSi Catarebulma gamokvlevebma aCvena, rom bavSvebsa da mozaedebSi dvxvdeba Camoyalibebuli h.d. Tumca, am asakSU is usimptomod mimdinareobs. bavSvTa da mozardTa masobrivma gamokvlevebma gamoavlina tranzitoruli(gardamavali) arteriuli wnevis- hi pertoniis winare 2013 weli mdgomareobis- mqone kontingenti.saWiroa, aseTi bavSvebi da mozardebi ayvanil iqnen aRricxvaze xangrZlivi dakvirvebisa da samkurnalo-profilaqtikur RonisZiebaTa Casatareblad. problema a. h. Sesaxeb yuradRebas i pyrobs ara marto terapevtebis, kardiologebis, aseve pediatrTaTvis. arteriuli wneva mozardebSi 33-42%Sia, aqedan 17-26%-Si iZens progresirebad xasiaTs arteriuli hi pertenziis CamoyalibebiT. ganasxvaveben genezis mixedviT: pirveladi da meoradi. pirveladi arteriuli hi pertenziis farglebSi ganixilaven daavadebas, romelsacewodeba esencialuri hi pertenzia an hi pertonuli daavadeba. meoradi (simptomuri) a.h. dakavSirebulia organoebis an sistemis dazianebasTan, romlebic zemoqmedebas axdenen a. wnevis doneze. arteriuli wnevis momateba warmoadgens am organoebis an sistemebis davadebis erT-erT simptoms. meoradi arteriuli hi pertenziaSi ganasxvaveben: 1. Tir- kmlismieri; a, parenqimuli. b, renovaskuluri. 2. endokrinuli. 3. hemodinamikuri (kardiovaskuluri, meqanikuri). 4. neirogenuli (kerovani) 5. danarCeni. a. h. ganviTarebis risk faqtorebi bavSvTa da mozardTa asakSi: 1. memkvidruli winaswar ganwyobileba. (gamoyofilia geni, romelic gavlenas axdens angiotenzin 1 da angiotenzinwarmomqmneli fermentze.) 2. neonataluri periodis Taviseburebebi. (mcire wona, perinataluri c.n.s.-is dazianebebi, neirovegetatiuri dazianebiT gamowveuli vegetosisxlZarRovani distonia, hi poqsia, mikroorganuli paTologiebi.) 3. fsiqoemociuri darRvevebi (nervul-fsiqikuri gadaRla, stresi, SiSi, mousvenroba, hi podinamia.) 4. c.n.s.–is dazianebebi (simsivne, travma, encefaliti, poliomieliti, pubertuli periodis hormonaluri krizi). 5. endokrinuli darRvevebi(tvinis danamatebis, sasqeso organoebis, farisebri jirkvlis daavadebebi, Saqriani diabeti) 6. metaboluri 42 darRvevebi(hi perkalemia) 7. medikamentebi(d vitaminis zedozireba, hormonaluri da arasteroiduli anTebis sawinaaRmdego preparatebi) 8. tyviis oqsidi, wyalSi xsnadi bromi, qlorofiliT mowamvla. 9. iSviaTi daavadebebi da sindromebi. a. h. paTogenezSi wamyvani mniSvneloba aqvs Tavis tvinis qerqisa da qerqqveSa ubnebis funqciis darRvevas. gamoyofen 3 rgols: 1) centraluri-c.n.sis agznebisa da Sekavebis urTierTmimarTebis darRveva. 2) humoruli- presoruli nivTierebis gamoyofa ( noradrenalini, aldosteroni, renini, angiotenzini) da depresoruli zegavlenis Semcireba. 3) vazomotoruli- arteriebis tonusi SekumSva organoebis spazmisa da iSemiisaken midrekilebiT. sabolood ki gadaZabva T. tvinis qerqisa da gansakuTrebiT limbur-retikuluri kompleqsis centrebSi neiroendokrinuli sistemis zegavleniT arteriuli wnevis momatebaSi gamoixateba. sawyis etapze pirveladi funqciuri darRvevebi, romlebic T. tvinis qerqSi, hi poTalamusSi da limbur-retikulur kompleqsSU warmoiSoba iwvevs simpatoadrenaluri sistemis aqtivobis momatebas, rac xels uwyobs wuTmoculobis gazrdas(hi perdinamiuli stadia), renin-hi pertenzin-aldosteronuli rgolis neirohormonebis sekreciis momateba, organizmSi eleqtrolitebis gadanawilebas da arteriolebis kedlebSi natriumis dagrovebas, ris gamoc sisxlZarRvis kedeli Supdeba da msxvildeba. es cvlilebebi zrdian sisxlZarRvTa kunTovani masis reaqtiulobas, sxvadasxva presoruli faqtorebis (angiotenzinebi, kateqolaminebi da a.S.)mimarT. am dros sisxlZarRvTa kedelSi ganviTarebuli struqturuli cvlilebebi kunTovani garsis hi pertrofia, metad mniSvnelovania maRali arteriuli wnevis ganviTarebisaTvis. bavSvTa asakSi arteriuli ,fdidsf rfhlbjkjubf wnevis maCveneblebis gamoTvla SeiZleba formuliT: sistolu ri- 90+2N, di as to lu ri60+N, N- wlebis cifria. klinikuri daavadebis gamovlena damokidebulia daavadebis simZimeze, mis xangrZlivobaZe da stabilurobaze. Cvil bavSvebSi - sayuradReboa - wonaSi CamorCena, gulyrebi, aRgzneba an daTrgunva, respiratoruli distresi, g. ukmarisoba. moardilebSi-tkivili kefisa da Txemis areSi, daRlilobis SegrZneba mxedvelobis darRveva, cxviridan sisxldena, yurebSi Suili, gulis areSi usiamovno SegrZneba, mousvenroba. aseve wnevis momateba SeiZleba gamoiwvios Tirkmlisa da magistraluri sisxlZarRvebis daavadebebma, aortis koarqtaciam, aortis sarqvlis naklovanebam, winagulTaSua Zgidis defeqtma, srulma atrioventrikulurma blokadam, winagul-parkuWovani gamtarobis darRvevam. Tavis tkivili zogjer intensiuri an SeteviTi xasiaTisaa, grZeldeba ramodenime saaTi da SeiZleba RebinebiT damTavrdes. xSiria Tavbru, xma u ri yu reb Si, Tva leb Si brWyvi a li, gu lis fri a li, swrafi daRla, fizikuri sisuste.h.d. dros aRiniSneba gulis marcxena sazRvrebis gadideba, saZile arteriaze sistoluri Suili, marcxena parkuWis gadideba. h.d. garTulebebidan aRsaniSnavia h. krizi, insulti, mwvave infarqti. krizis dros RiniSneba Semdegi simptomebi: sisxlis miwola saxis areSi, kidurebis tremori, moduneba, gulisreva, pirRebineba, tkivili gulis areSi. krizi SeiZleba ramodenime dRe gagrZeldes, Tumca misi xangrZlivoba erT saaTs ar aRemateba. am dros irRveva mxedveloba da smena, imatebs sxeulis temperatura. krizi SeiZleba garTuldes Tavis tvinSi sisxlis mimoqcevis moSliT, miokardiumis infarqtiT, filtvis SeSupebiT, hi pertonuli encefali paTiiT. mZime SemTxvevaSi aRiniSneba Tirkmlis mxriv cvlilebebi: hematuria, albuminuria, Tirkmlebis koncentraciis unaris daqveiTeba. ramac SeiZleba ganaviTaros azotemiac. zemo analiziT kidev erTxel aRiniSna arteriuli hi pertenziis problema bavSvebsa da mozardebSi. amdenad, saWirod vTvliT sakiTxi kidev ufro dawvrilebiT ganvixiloT. bavSvebsa da mozardebSi arteriuli hi pertenzia ganisazRvreba, rogorc ramodenime ganmeorebiTi gazomviT miRebuli maRali arteriuli wnevis cifrebi-asakis,sqesis da simaRliT gaTvaliswinebulis 95(persintili da meti). saerTaSoriso debatebis ganviTarebam sisxlis wnevis normis maCveneblebze saSualeba miscaT, eRiarebinaT maRali arteriuli wneva bavSvTa da mozardTa asakSi. gavrceleba da procenti pediatriuli hi pertenziis daignozisa xasiTdeba mzardi dinamikiT. epidemiam bavSvTa simsuqnis, riskma marcxena parkuWis hi pertrofiis da mtkicebam adreuli aTrosklerozis ganviTarebisa gamoavlina hi pertenziis mniSvneloba bavSvTa asakSi sicocxlis xangrZlivobis SemcirebasTan. daavadebaTa gavrcelebis sixSire bavSvTa asakSi gulis G ganawileba hipertoniki pacientebis Tandayolili daavadebebi 1% epilefsia 3-5%, ADHD 3-5% asTma 7% hi pertenzia 4-5% simsuqne 18-25% (mowodebulia International Pediatric Hypertension Association mier 2004 wels). The Task Force on Blood Pressure Control in Children, commissioned by the National Heart, 2013 weli ,fdidsf rfhlbjkjubf Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) SeimuSava sisxlis wnevis standartuli maCveneblebis procentuli cxrilebi gamosaxuli persintilebSi. aRniSnuli cxrilebi pirvelad daibeWda 1987wels, sadac aRiwera sistolur-diastoluri wnevis gavrcelebis specifikuroba bavSTa asakSi simaRlis da wonis gaTvaliswinebiT. The Third Report of the Task Force daibeWda1996wels, sadac ganixiles bavSvTa asakis arteriuli wnevis diagnozis da mkurnalobis Taviseburebebi. Sefaseba da rekomendaciebi, mkurnalobis aspeqtebi ganaxl da me oTxe mox se ne ba Si 2004wels. Task Force rekomendaciT bavSvTa asakSi sisxlis wnevis normad ganixileba sidide roca sistoluri da diastoluri maCveneblebi aris naklebi 90persintilze. SemoiRo axali kategoria prehi pertenzia , romelic diagnostirdeba roca saSualo ricxvi arteriuli wnevisa aRemateba 90 persintils magram naklebia 95persintilze. mowodebulia ruseTis kardiologTa kongresis mier cxrili da formulebi arteriuli wnevis maCveneblebisa bavSvTa asakSi sistoluri arteriuli wneva: 2013 weli 1 wlamde asakSi 76 + 2n (sadac n Tveebis ricxvia) >1wlis zemoT asakSi 90 +2n (sadac n wlebis ricxvia) diastoluri ar te ri u li wneva: 1 wlamde 2/3-1/2 maqsimaluri sistoluri wnevis ufros asakSi 60 +n( sadac n wlebis ricxvia). Ggazomvis wesis ramdenime niuansi rac gasaTva lis wi ne be lia bavSvTa asakisTvis da klinikuri rekomendaciebi Kkorotkovis meTodiT arteriuli wnevis gazomvisas gasaTva li wi ne be lia manjetis sigrZe da sigane. amerikis gulis asociaciis (AHA) mier rekomendebulia, rom manJetis gasaberi balonis sigane unda iyos mxris garSemowerilobis aranakleb 40%, xolo 43 sigrZe- aranakleb 80%. specifiuri SemTxvevebi axalgazrda hi pertenziul pacientebSi, agreTve im SemTxvevebSi, roca aRiniSneba barZayis an terfis dorzaluri arteriis pulsaciis Sesusteba, rekomendebulia wnevis gazomva qveda kidurzec da amisTvis SesaZlebelia barZayis specialuri manJetis gamoyeneba. diastoluri wneva qveda kidurebSi, Cveulebriv, zeda kidurebis tolia, xolo sistoluri wneva SesaZloa 20-30 mm.vwy.sv.-iT meti iyos. ufro meti sxvaoba axasiaTebs aortis sarqvlis naklovanebas. amasTanave, sxvaobis sidide, aortis sarqvlis naklovanebis xarisxTan aris dakavSirebuli. arteriuli wnevis etiopaTogenezi rTulia da safuZvlad udevs hemodinamikuri da paTofizologiuri Zvrebi, presorul da depresorul sistemebs Soris Tanafardobis darRveva, rac sabolood iwvevs sisxlis mimoqcevis autoregulaciis darRvevas. Hhiperenzia= gazrdili gulis wuTmoculoba da an/gazrdili peri- 44 feriuli winaaRmdegoba. arCeven pirvelad “Primary” esenciur hi pertenzias da meorad “Secondary” pihertenzias. Eesenciuri hi pertenzia iSviaTad diagnostirdeba bavSveb Si 10wlamde asak Si da gvxdeba ufros asakSi. riskfaqtorebs warmoadgens: simsuqne (sxeulis masis in- ,fdidsf rfhlbjkjubf deqsi >25kg/m) ojaxuri istoria, anamnezSi kardiovaskuluri daavadeba. Saqriani diabeti ti pi 2 disli pidemia meoradi hi pertenzia vlindeba ufro dabal asakSi sicocxlis pirvel wels. aRmocenebis mizezebs warmoadgens Tirkmlis parenqimuli da sisx l Zar R vo va ni da a va de be bi, gul-sisxlZarRvTa paTologia, endokrinuli Zvrebi, Zilis apnoe, fsiqologiuri statusi. mowodebulia cxrili, sadac miTiTebulia bavSvTa asakis hi peretnziis etiologiuri faqtorebi asakobrivi jgufebis mixedviT ruseTis bavSvTa kardiologTa asociaciis rekomendaciiT hi pertenzia 2stadiad iyofa: 2013 weli ,fdidsf rfhlbjkjubf 1stadia ar aRiniSneba organoTa paTologia 2stadia vlindeba oranoTa dazianeba. ziandeba Semdegi organoebi: guli(marcxena parkuWis hi pertrofia), Tavis tvini (sisxlis mimoqcevis darRveva), Tirkmelis ukmarisoba, periferiuli arteriebis daavdeba, retinopaTia. Kklinika efuZvneba nevrologiur simptomatikas. aRiniSneba Tavis tkivili, Tavbrusxveva, mousvenroba, saerTo sisuste, mexsierebis da yuradRebis daqveiTeba, tkivili gulis areSi, taqikardia, Zilis darRveva, rac vlindeba xvrinviT da sunTvis gaukuRmarTebiT. SesaZloa gamovlindes cxviridan sisxldena. mowodebulia simptomuri hi per ten zi is fi zi ka lu ri kvlevis maCveneblebis cxrili laboratoriuli da sxva diagnostikuri procedurebi mkurnalobis dawyebamde rekomendebulia rutinuli laboratoriuli analizebis Catareba, romelic moicavs sisxlis bioqimiur kvlevas, sisxlis saerTo analizs, sisxlSi glukozis, Sratis kaliumis, kreatininis(an Sesabamisi 2013 weli glomerularuli filtraciis sixSiris), kalciumis, lipiduri sqetris gansazRvras; Sardis saerTo analizs, albuminisa da albumin/kreatininis Sefardebis gansazRvras. instrumentuli kvlevebi moicavs ekg, eqokardiografias, Tirk- 45 mlebis ultrasonografiuli kvlevas, SesaZloa dagvWirdes eq s k re to ru li urog ra fia, Tirkmlis angiografia, kompiuteruli tomografia da biofsia. mkurnaloba moicavs: 1. arafarmakolgiuri Terapias cxovrebis wesis Secvla: dRis swori organizeba, Zilis mowesrigeba wonis Semcireba(normaluri wonis SenarCuneba BMI18,5_24,9kg/m) DASH dieta(dieta mdidari xi liT,bos t ne u liT.cxi mi a ni sakbebis koreqcia) sakvebSi sufris marilis SezRudva(4-8wlamde ucilebelia marilis done iyos <1.2mg, ufros asakSi >1.5 mg-ze ar SeiZleba) dozirebuli fizikuri datvirTva mavne Cvevebis uaryofa fitoTerapia (vegeto-sisxlZarRvovani sindromis semTxvevaSi) 2. farmakologiuri Terapia aucilebeli xdeba roca hipertenziis marTva ver xerxdeba mxolod cxovrebis wesis SecvliT. antihipertenziuli medikamentebi igivea rac, rac moz- 46 ,fdidsf rfhlbjkjubf oqromocitoma da sxva mdgomareobebi (vilmsissimsive, hi perTiroidizmi, Tirkmelzeda jirkvlis hi perplazia, terneris simptomi) Llaboratoriuli kvlevebidan: 1. Sardis saerTo analizicila, eriTrocitebi - > Tirkmlis parenqimis dazianebis indikatori 2. Sisxlis bioqimiurikvleva: kreatinini^ - Tirkmlis dazianeba; hi pokalemia – hi peraldosteronizmi 3. sisxlSi hormonebi: rdili asakis pacientebisTvis mxolod doza aris mcire da amavdroulad iniSneba didi sifrTxiliT ganvixiloT Tu rogor ixilavs ucxoeli avtorebi hi pertenziis etiologiis sakiTxs asakis mixedviT: Hypertension can be primary (ie, essential) or secondary. In general, the younger the child and the higher the BP, the greater the likelihood that hypertension is secondary to an identifiable cause (see Table 1 ). A secondary cause of hypertension is most likely to be found before puberty; after puberty, hypertension is likely to be essential. A review of the literature revealed that most of the young patients with secondary hypertension had a renal parenchymal abnormality; in the remaining patients, the causes of hypertension (in order of frequency) were renal artery stenosis, coarctation of the aorta, pheochromocytoma, and a variety of other conditions amJamad ki Cven gvsurs klinicistebs pirvel rigSi movawodoT hi pertenziis uxSiresi mizezebi 7–12 wlis asakSi: amdenad,unda Ggvaxsobdes: hi pertenziis uxSiresimi zezebi 7-12 wlis bavSvebSi 1. Tirkmlis parenqimis daavadebebi 2. Tirkmlis sisxlZarRvebis anomaliebi 3. endokrinuli mizezebi 4. esenciuri hi pertenzia hi pertenzias 78%-Si ganapirobebs Tirkmlis parenqimis anomalia, 22%-Si Tirkmlis arteriis stenozi, aortiskoarqacia, fe- renini^- hi pertenziis mizezi SeiZleba iyos Tirkmlis sisxlZarRvebis anomalia aortis koarqtaciis CaTvliT renini daqveiTebuli – aldosteronizmi, romelic SeiZleba ganikurnos steroidebiT 2013 weli ,fdidsf rfhlbjkjubf aldosteroni plazmaSi^ - hi peraldosteronizmis kateqolaminebi (epinefrini, norepinefrini, dopamin) ^ - feoqromocitoma an neiro blastoma 4. SardSi hormonebi: kateqolaminebi an maTi metabolitebi (metanefrini) ^ - feoqromocitoma an neiroblastoma eqokardiografiidan: marcxena parkuWis hi pertrofia qronikuli hi pertenziis maCvenebelia muclis ultrasonografiidan: 1. gamoiricxos Tirkmlis struqturuli anomalia 2. aucilebelia Tirkmlis sisxZarRvebis Sefaseba 3. simsivnis dadgena 4. Tirkmlis nawiburi (matulobs reninis produqcia) 5. Tirkmlis zomebis asimetria -> Tirkmlis displazia an arteriis stenozi 5. warmonaqmni TirkmelSi an eqstrarenulad -> vilmis simsivne an neiroblastoma radionukleiduri kvleva (kaptopriliT an mis gareSe) asimetria miuTiTebs arteriis stenozze kvleva dopleriT: Tirkmlis arteriis sisxlis nakadis asimetria miuTiTebs Tirkmlis arteriis stenozze arteriografia: Tirkmlis arteriebs Soris asimetria miuTiTebs Tirkmlis arteriis stenozze angiografia: 1. saSualebas iZleva dadgindes gansxvaveba Tirkmlis sisxZarRvTa diametrebs Soris 2. xdeba sisxlis aReba analizisTvis Tirkmlis arteriidan/venidan da aortidan , raTa dadgindes reninis gansxvavebuli sekrecia TirkmlebSi 3. reninis aqtivobis Sefardeba 3:1 TirkmelTa Soris miuTiTebs renovaskulur hi pertenziaze Semdgom cxrilebSi mocemulia misi marTvisaTvis aucilebeli monacemebi amdenad, Cveni mizani iyo farTo literaturuli mimoxilvis bazaze yuradReba gagvemaxvilebina klinikur pediatriaSi erTerT umniSvnelovanes sakiTxisaTvis bavSvTa kardiologiaSi, rogoricaa „arteriuli hi pertenzia bavSvTa da mozardTa asakSi“. lit.: 1. GREGORY B. LUMA, M.D., and ROSEANN T. SPIOTTA, M.D., Jamaica Hospital Medical Center, Family Medicine Residency Program, New York, New York Am Fam Physician. 2006 May 1;73(9):1558-1568. 2. Рекомендации ВНОК и Ассоциации детских кардиологов России по диагностике, лечению и профилактике артериальной гипертенции у детей и подростков.– М.– 2004. 2013 weli 47 3. Мутафьян О.А. Артериальные гипертензии и гипотензии у детей и подростков. Практическое руководство.– М.–2002.– 143 с. 4. Петров В.И., Ледяев М.Я. Артериальная гипертензия у детей и подростков. Руководство для врачей.– Волгоград.–1999.– 145 с. 5. Леонтьева И.В. Лекции по кардиологии детского возраста.– М. – 2005. – С. 399–460. 6. Автандилов А.Г. Артериальная гипертензия у подростков мужского пола.– М.– 286 с. 7. Профилактика, диагностика и лечение артериальной гипертензии. Российские рекомендации (второй пересмотр). Разработаны Комитетом экспертов ВНОК.– М.– 2004. 8. Pickering Th.G. Pathophysiology of exercise hypertension // Herz. – 1987.– Vol.12, №2.– Р. 1348–1350. 9. Чазова И.Е. Применение ингибиторов АПФ в лечении артериальной гипертонии // РМЖ.– Т.8. –№15–16.– 2000.– С.610–613. 10. Кобалава Ж.Д., Моисеев В.С. Систолическое давление – ключевой по–казатель диагностики, контроля и прогнозирования риска артериаль–ной гипертонии. Возможности блокады рецепторов ангиотензина II // Ж. Клиническая фармакология и терапия.– 2000.– №5.– С.1–11. 11. Brooks D., Ohlstein E., Ruffolo R. Pharmacology of eprosartan an angiotensin II receptor agonist: exploring hypotesis from clinical data. Am. Heart. J., 1999, 138, S247–S251. 12. Garsia P., Mateos F. Evaluation of uric acid excretion and blood pressure in patients with essential hypertension treated with eprosartan and iosartan/ J/ Hypertens., 1998, 16 (Suppl. 2), S316. 13. Первичная артериальная гипертензия у детей и подростков. Методи–ческие рекомендации. – Воронеж.– 2006. 14. Задионченко В.С., Адашева Т.В., Сандомирская А.П. Дисфункция эндотелия и артериальная гипертензия: терапевтические возмож–ности.// РМЖ.– Т.10, №1 (145).–2002.– С.11–15. 15. Арабидзе Г.Г., Белоусов Ю.Б., Карпов Ю.А. Артериальная гипертензия.– М.–1999.– С. 8–90. 16. Yiu V., Buka S., Zurakowski D. et al. Relationship between birthweight and blood pressure in childhood // Am. J. Kidney Dis.–1999.–Vol.33, N2.– P.253–260. 17. Александров А.А. Повышенное артериальное давление в детском и подростковом возрасте (ювенильная артериальная гипертония). // РМЖ.– Т.5, №9.–1997.– С.559–561. 18. Бутрова С.А. Метаболический синдром: патогенез, клиника, диагно–стика, подходы к лечению.// РМЖ.–Т.9, №2.– 2001.– С.56–60. 19. Диагностика, лечение и профилактика артериальной гипертензии у детей и подростков. Методические рекомендации.– М.–2003. 20. Заваденко Н.Н. Гиперактивность с детей: диагностика и лечение.// РМЖ.– Т.14, №1.– 2006.– С.51–56. 21. Kaplan N., Gifford R.W. Выбор начальной терапии при гипертензии // Medical Market Journal 1996, N 23(3).– C.24–28. ,fdidsf rfhlbjkjubf 48 reziume arteriuli hipertenzia bavSvTa da mozardTa asakSi g.CaxunaSvili,n.jobava,r.svanaZe, a. bliaZe, k. CaxunaSvili,d.CaxunaSvili saqarTvelos bavSvTa kardiologTa asociacia. SromaSi farTo literaturuli mimoxilvis bazaze yuradReba gamaxvilebulia klinikur pediatriaSi erTerT umniSvnelovanes sakiTxisaTvis bavSvTa kardiologiaSi,rogoricaa „arteriuli hi pertenzia bavSvTa da mozardTa asakSi“. SUMMARY ARTERIAL HYPERTENSION IN CHILDREN AND ADULT G.CHAKHUNASHVILI, N.JOBAVA, R.SVANIDZE, A.BLIADZE, K.CHAKHUNASHVILI, D.CHAKHUNASHVILI Georgian Pediatric Cardiology Association On the base of wide literary discussion this work represents one of the important questions in pediatric cardiology, such as “arterial hypertension in children and adult”. gulis riTmisa da gamtarobis darRveva bavSvTa asakSi (maTi marTvis Tanamedrove princi pebi) g.CaxunaSvili,m.xecuriani,n.jobava (saqarTvelos bavSvTa kardiologTa asociacia,ir.ciciSvilis sax. bavSvTa axali klinika,q.quTaisis dedaTa da bavSvTa samkurnalo diagnostikuri centri,janmrTelobis centri) klinikur pediatriaSi gulis riTmis darRveva da misi marTva bavSvTa asakSi sakmaod rTuli da Zneli Tavi–ganyofilebaa. rTulia diagnostika, misi mkurnaloba ki moiTxovs faqizad midgomas,zust–natif mkurnalobas. gulSi agznebis warmoqmnisa da misi gavrcelebis darRveva iwvevs ariTmiebs. bolo dros gaxSirda ariTmiebiT daavadebul bavSvTa ricxvi. saSiSia taqiariTmia. parkuWebis fibrilacias 80%-Si mivyavarT asistoliamde rac SeiZleba letaluri gamosavliT damTavrdes. sayuradReboa sinusis kvanZis sisustec (midis bavSvi skolaSi, an dgas da uceb waiqca, aucilebloba moiTxovs misi mdgo ma re o bi dan ga moy va nis Semdeg Cautardes mas eleqtrokardiografuli kvleva da Sefasdes igi kompetenturad). aRsaniSnavia,rom praqtikulad, janmrTel bavSvebSi dadasturebuli uecari kolafsis ganviTarebis mizezic Sesazlebelia iyos gulis pirveladi ariTmogenuri gaCereba. ariTmiaTa etiologiis 50% Sesazlebelia dakavSirebuli iyos – Zveli klasifikaciiT – vegetosisxl-ZarRvovan distoniebTan (axal klasifikaciebSi jer–jerobiT misaRwevia daavadebis zusti diagnozi), amitomac atarebs igi funqcionalur xaisaTs,xolo SemTxvevaTa meore 50% ki gulis organuli dazianebebSi unda veZeboT. Cvens mier gaanalizebulia 2001–2011 wwiis, ir.ciciSvilis sax. bavSvTa axali klinikis, q.quTaisis dedaTa da bavSvTa samkurnalo diagnostikuri centrisa da Tbilisis janmrTelobis centris 3500 SemTxveva.maTi detaluri analizisa da literaturuli monacemebis gaTvaliswinebis Sedegad unda aRiniSnos Semdegi: ariTmiebis meqanizmebis klasifikacia moicavs 3 did jgufs. I) im pul se bis for mi re bis darRveva II) agznebis gavrcelebis darRveva III) kombinirebuli formebi I) impulsis warmoqmnis darRveva aris: 1) nomotopuri – ariTmiebi romlebic gamowveulia sinusis kvanZSi avtomatizmis darRveviT a) sinusuri ariTmia b) taxikardia g) bradikardia d)ritmis wamyvanis migracia 2) heterotopuri ti pis (etqopiuri) – agznebis kerebi ar aris dakavSirebuli sinusis kvanZTan a) eqstrasistola b) paroqsizmuli g) araparoqsizmuli taxikardia d) TrTolva da cimcimi winagulebis e) TrTolva da cimcimi parkuWebis. II) gamtarobis darRveva; 1) sinoaurikuluri blokada, 2) winagulSiga, 3)atrioventrikuluri I,II,IIIxarisxis 4) parkuWSiga sruli da arasruli. III) kombinirebuli ariTmiebi; 1) sinusis kvanZis sisustis sindromi 2) atrioventrikuluri disociacia 2013 weli ,fdidsf rfhlbjkjubf 3) parkuWebis naadrevi agznebis sindromi Tu impulsebis warmoqmnis sixSirem eqtopiur keraSi, gadaaWarba sinusis kvanZis sixSires, sinusis kvanZi SeiZleba daiTrgunos da eqtopiuri kera gaxdes gulis ritmis dominanturi wamyvani. aritmiis uxSiresi mizezi aris reentri, romelic SeiZleba gamovlindes sxvadasxva formiT. reeentri warmoadgens gulis gansaZRvruli ubnis mravaljerad ganmeorebiT agznebas, romelic viTardeba fiqsirebuli barieris irgvliv eleqtruli impulsis wriuli moZraobis Sedegad. es meqanizmi udevs safuZvlad reentrul taqikardiebs. gulis moqmedebis normalur riTms ganapirobebs sinusuri kvanZis avtomatizmi da mas sinusuri riTmi ewodeba. sinusuri riTmis sixSire janmrTeli mozrdilebis umravlesobaSi mosvenebul mdgomareobaSi Seadgens 60 – 75 dartymas wuTSi,xolo bavSvebSi igi asa kis Se sa ba mi sia – mag.5 wlisaskSi igi –100-ia. sinusuri ariTmia es aris sinusuri riTmi, romlis drosac ekg – ze R – R intervalebs Soris gansxvaveba aRemateba 0,1 wm -s. sunTqviTi sinusuri ariTmia – fiziologiuri movlenaa; igi gansakuTrebiT xSiria (pulsis an ekg-s mixedviT) axalgazrdebSi neli, magram Rrma sunTqvis dros. faqtorebi, romlebic axSireben sinusur riTms (fizikuri da emociuri datvirTvebi, simpaTomimetikebi), amcireben an xsnian sunTqviT sinusur ariTmias. sinusuri ariTmia, romelic dakavSirebuli ar aris sunTqvasTan, iSviaTia.sinusuri ariTmia mkurna- 2013 weli lobas ar moiTxovs. statistikuri monacemebiT Cvens klinikebSi(ir.ciciSvilis sax. bavSvTa axali klinika,q.quTaisis dedaTa da bavSvTa samkurnalo diagnostikuri centri,janmrTelobis centri)) gatarebul avadmyofTa daaxloebiT 80%-s aReniSneboda sinusuri taxikardia. paroqsizmuli taxikardia 10%-s eqs- 49 toqsinebi, Sxamebi, medikamentebi, tkivili, agzneba iSviaTad tamponada, pnevmoToraqsi, Tromboembolia. sinusuri taqikardiis marTvis ZiriTadi princi pia gamomwvevi mizezis mkurnaloba. mxolod Seusabamo sinusuri taqikardiis SemTxvevaSi beta-blokerebi an verapamili. ixileT sinusuri taqikardiis gamokvlevis da mkurnalobis algoriTmi. cxrili #1 supraventrikuluri taxikardia – yvelaze xSiri taxiariTmiaa romelic CvilebSi gulsisxlZarRvTa sistemis funqcxrili #1 trasistolia 20%-s blokada 10%-s da WPW sindromi 0.5%-s sinusuri taxikardia – ganisaZRvreba rogorc sinusis kvanZidan momdinare impulsebiT. ganpirobebuli riTmi, sixSire aRemateba asakobriv normebs da viTardeba rogorc pasuxi Jangbadis gazrdil moTxovnilebaze. ufro araspecifiuri klinikuri niSania. xSiri mizezebia: hi poqsemia, hi povolemia, hi perTer mia, me ta bo lu ri stre si ciis darRvevebs ganapirobebs. aris swrafi regularuli ritmi, romelic periodulad Cndeba da atarebs paroqsizmebis xasiaTs, romelic SeiZleba warmoiSvas yvela asakSi, maT Soris mucladyofnis drosac. igi viTardeba egreT wodebuli “ri entri” meqanizmiT, damatebiTi gamtari gznebis an AV kvanZis monawileobiT. Cvilobis asakSi pulsi metia 220’-ze, zogjer aRwevs 300’-wTSi. bavSvebSi ramdenadme dabalia 180’-ze meti. supraventrikuluri taxikardiis mqone bavSvebis 90%-Si QRSkompleqsi viwroa (<0.08 wm) mizezi xSirad ucnobia, Tumca Cvil bavSvebSi xSirad viTardeba mwvave respiratoruli daavadebis fonze. mozrdi- 50 ,fdidsf rfhlbjkjubf cxrili #2 lebSi xdeba provocireba emociuri daZabulobis, yavis, fsiqostimulatorebis miRebiT. gulis Tandayolili manki gvxvdeba aseT dros iSviaTad mxolod 5-10%-Si. xSirad e.k.g-ze gamovlindeba WPW sindromi bavSvebis umetesobaSi. garTulebebi adreul etapze xSirad ar viTardeba, Tumca mogvianebiT SeiZleba ganviTardes gulis SegubebiTi ukmarisoba, kardiovaskuluri kolafsi da Soki gansakuTrebiT miokardiumis paTologiis fonze. ufrosi asakis bavSvebi uCivi- an Tavbrusxvevas, diskomforts mkerdis ZvalTan an ubralod amCneven rom gaxSirebuli guliscema aqvT. CvilebSi Zalian swrafi riTmic ki SeiZleba SeumCneveli darCes sanam sagrZnoblad ar Semcirdeba wuTmoculoba gulis. mxolod mSobeli amCnevs gulis areSi pulsacias da bavSvis msubuq gafermkrTalebas. Cvilobis asakSi paroqsizmebis recidivebi xSiria pirveli 6 Tvis manZilze, magram 1 wlis Semdeg xSirad aRar meordeba da meordeba 4-6 wlis asakSi. cxrili #3 Tu ta xi kar dia grZel de ba ramdenime kvira an Tve, magaliTad avtomaturi winagulovani taqikardia, avtomaturi AB kvanZovani taqikardia an mudmivi reciptoruli parkuWzeda taqikardia SeiZleba ganviTardes ariTmogenuri kardiopaTia ixileT cxrili N2 viwrokompeqsiani taxikardiis diagnostikuri algoriTmi. mkurnaloba iTvaliswinebs 2 mizans: a) paroqsizmebis kupireba b) aRmofxvra misi ganmeorebis adenozini kargad axdens taxikardiis kupirebas da warmoadgens aiCevis preparats AB kvanZovani reci ptoruli taxikardiis, taxikardiisa WPW sindromis dros. ge mo di na mi kis dar R ve vis dros SeiZleba swrafad CavataroT ubralo vagusuri manevrebi. magaliTad pacientis saxeze yinulis parkis moTavseba 10-15 wamiT. SeiZleba gameoreba an vcadoT sxva manevri, mozrdilebSi karotiduli sinusis masaJi, an valsavis cda. uefeqtobis SemTxvevaSi mimarTaven ariTmiis farmakologiur Terapias da Semdgom tardeba eleqtruli kardioversia. ixileT cxrili taqikardiis marTvis algoriTmi bavSvebSi swrafi riTmiTa da adekvaturi perfuziiT cxriliN3 da cxrili 4 pediatriuli taqikardiis algoriTmi Cvilebsa da bavSvebisaTvis swrafi ritmisa da cudi perfuziiT. pirvel welze paroqsizmebis profilaqtikis mizniT xSirad ixmareba digoqsini. mxolod ar SeiZleba WPW sindromis dros. misi uefeqtobis SemTxvevaSi propanolili. profilaqtika WPW sindromis drosac.iSviaTad metad mozrdil asakSi amiodaroni miiReba. bavSvebSi skolis asakSi paroqsizmebi SeiZleba ganmeordes weliwadSi ramdenjerme. Tu isini gemodinamikis darRvevis gareSe mimdinareobs unda davarwmunoT bavSvic da mSobelic rom gadaitanos iSviaTi paroqsizmebi msubuqad umjobesia vidre miiRos abebi. zogierT pacients paroqsizmebi xSirad umeordebaT, cudad itanen da medikamentozur 2013 weli ,fdidsf rfhlbjkjubf mkurnalobas ar emorCilebian. am dros utardebaT eleqtrofiziologiuri kvleva da utardebaT paTologiuri gamtari gzebis radiosixSiris keTeteruli destruqcia (ablacia) Cvens kli ni ka Si(q.qu Ta i si) ramdenime wlis win gvqonda 2 SemTxveva daesva WPW diagnozi pacients da damatebiTi gzebis ablacia CautardaT erevanSi. amJamad es SesaZlebelia Tbilisis joenis centrSi. sakmaod warmatebiT da tardeba agreTve q.quTaisis cxakaias saxelobis intervenciul centrSi jer-jerobiT didebSi da momavalSi Catardeba bavSvTa asakSic. ka Te te ru li des t ruq cia efeqturia praqtikulad yvela saxis taqikardiis dros SedarebiT usafrTxoa, magram Cvil bavSvTa asakSi garTulebebis riski metia. parkuWzeda taxikardiisas meTodis efeqturoba 90%-s atarebs, Tumca parkuWovani taxikardiis dros SedarebiT dabalia. parkuWzeda reciprokuli taxikardiis dros SesaZlebelia mudmivi eleqtrokardiostimulatoris dayeneba funqciiT “taxikardiis kupireba” kardiostimulatorebi programirdeba individualurad ariTmiis saxis gaTvaliswinebiT. parkuWovani taxikardia– pediatriul pacientebSi ar aris riTmis darRvevis xSiri mizezi roca saxezea parkuWovani taxikardia pulsiT. pulsi SeiZleba varirebdes normidan 200’w–Si mde. swrafi ventrikuluri ritmi xSirad amcirebs gulis wuTmoculobas da SeiZleba gadaizardos upulso parkuWovan taxikardiaSi an parkuWovan fibrilaciaSi. –par ku Wo va ni ta xi kar di is mqone bavSvebis umravlesobas aReniSnebaT gulis struqturuli dazianebani: gaxangrZlivebuli QT intervalis sindromi, miokarditi an kardiomegalia. sxva gamomwvevi mizezebia hi poqsemia,acidozi, eleqtrolituri disbalansi, toqsini(Sxami), medikamentebiT intoqsikacia. aris algoriTmebi criliN5 brugadas kriteriumebi parkuWovani da supraventrikularuli taxikardiebis sadiferenciaciod. 2013 weli 51 cxrili #4 defibrilacia upulso parkuWovani taxikardiis da parkuWebis fibrilaciis mkurnalobis meTodi. Tu saxezea parkuWovani taxikardia pulsiT da susti sistemuri perfuziiT (gulis SegubebiT, ukmarisoba, daqveiTebuli periferiuli perfuzia, taqi pnoe, cnobierebis dabindva an hi potenzia) dauyovnebliv unda Catardes sinqronizirebuli kardioversia. sicocxlisaTvis sa Si Si ariT mi e bis dros dReisaTvis ufro xSirad ixmareba implantirebadi defibri- latori.Tu parkuWovani taqikardia refraqterulia saWiro xdeba medikamenturi Terapiis dawyeba (amiodaroni, lidokaini) parkuWovani taxikardia adekvaturi perfuziiT ufro iSviaTia da naklebad saSiSi. eqstrasistola – riggareSe SekumSvaa da Tu sad warmoiqmneba aris Sesabamisad winagulovani, supraventrikuluri, atrioventrikuluri, parkuWovani. SeiZleba Segvxvdes praqtiku lad jan m r Tel bav S veb Si, romlebic datvirTvis Semdeg qreba. xSiria miokarditebis da cxrili #5 52 ,fdidsf rfhlbjkjubf cxrili #6 cxrili #7 sagule glikozidebis intoqsikaciis dros. klinikuri mniSvneloba erTeul winagulovan eqstra sistolebs ara aqvs, is xSirad registrirdeba axalSobilobis asakSi da qreba 2–6kviraSi. Tu rCeba saSiSi ar aris. magram xSiri winagulovani eqstrasistolebi igive avadmyofebSi miaTiTebs savaraudod magaliTad faruli gamtari gzebis arsebobaze. amis garda SeiZleba gamoiwvios mocimcime ariTmiis paroqsizmi. monomorfli parkuWovani eqstrasistolebi janmrTel axalgazrdebSi ar aris saSiSi, ma- gram gulis daavadebis dros Zalian sayuradReboa. xSiri parkuWovani eqstrasistolebis dros unda gamoiricxos mitraluri sarqvelis prolafsi, miokarditi, kardiomiopaTia. klinika – bavSvebi zogjer aRnisnaven usiamovno SegrZnebebs, dartymas gulis midamoSi. mkurnaloba saWiroebs pirvel rigSi organuli paTologiis gamoricxvas da Sesabamis Terapias ZiriTadi daavadebis. saWiroa gamovideT ariTmiis genezidan. mimarTulia pirvel rigSi bavSvis mSvidi garemos Seqmnaze. vegetatiuri disfunqciis koregireba, metaboluri procesebis gasaumjobesebeli saSualebebi. anti ariTmuli mkurnaloba iniSneba Tu aris miokardiis dazianeba da mxolod mZime SemTxvevaSi klinikisa da e.k.g gaTvaliswinebiT amorCevis preparatia kordaroni. parkuWzeda eqstrasistoliis dros iniSneba izoptini. didi mniSvneloba aqvs qronikuli kerebis sanacias. blokada – aris gamtar gzebSi agznebis impulsis gatarebis Seferxeba. sinoaurikuluri blokada – xasiaTdeba impulsis gatarebis SeferxebiT sinusis kvanZidan winagulebamde. e.k.g. kriteriumebi ar aris da Zneli gasarCevia sinusuri bradikardiisagan. praqtikuli mniSvneloba aqvs sinoatrialur blokadas.roca sinusuri riTmis fonze TandaTan Cavardeba gulis SekumSvis kompleqsi, es imiTaa gamowveuli rom sinusuri impulsebi ar iwveven winagulebis agznebas. klinika mimdinareobs usimptomod, auskultaciiT aRiniSneba pauzebi normaluri ritmis dros hemodinamikaze ar moqmedebs, mTavaria vimoqmedoT mkurnalobis mxriv mis gamomwvev mizezebze. agreTve vixmaroT preparatebi metabolizmis gasaumjobesebeli. winagulovani blokada – impulsis gatarebis darRveva winagulebSi ZiriTadi mizezi–winagulis miokardis dazianeba. ZiriTadad gvxvdeba ararevmatiuli miokarditis dros SeiZleba sxva ariTmiebis sawyisi iyos nawilobrivad mocimcime ariTmiis. mkurnaloba ZiriTadi daavadebis. sinusuri pauza – klinikurad SeiZleba iyos asimptoruli an gamovlindes sinkopeTi, presinkopeti, uhaerobiT. simptomebis SemTxvevaSi ewodeba sinusis kvanZis sisusitis sindromi romelic agreTve moicavs sinoatrialur blokadebs da mkveTr sinusur bradikardias. SesaZlebelia Serwymuli iyos winagulovan taxikardiasTanac. taxikardia – bradikardiis sindromi. mkurnaloba mxolod simptomur SemTxvevebSia saWiro. mwvave mkurnaloba – asistoliis riskis arsebobis SemTxvevaSi, droebiTi kardiostimu2013 weli ,fdidsf rfhlbjkjubf lacia, atropini, izoproterenoli. grZelvadiani mkurnalba: sim p to mur pa ci en teb Si an 3wm–ze meti xangrZlivobis pauzebis SemTxvevaSi mudmivi peismeikeris implantacia. bradiariTmiebi –klinikurad mniS v ne lo va ni bra di kar dia aris pulsi 60–ze qvemoT asocirebuli cud sistemur perfuziastan. pediatriul praqtikaSi bradiariTmia riTmis sxva darRvevebs Soris yvelaze xSirad uswrebs gulis gaCerebas da xSirad asocirebulia hi poqsisTan, hi potenziasTan, acidozTan. es ukanasknelni aqveiTeben agznebis aRmocenebisa da gavrcelebis siCqaris sinusur da AV kvaZebSi. sinusuri bradikardia, sinusuri kvaZis gaCereba, neli kvanZovani an ventrikuluri ritmiT da AV blokadis sxvadasxca xarisxebi bradiariTmiis gavrcelebuli magaliTebia. simptomuri bradikardiis sxva mizezebia cTomoli nervis Zlieri stimulacia, hi poTermia, toqsinebi da medikamentebi. gulis Tandayolili blokadebi, gulis gadanergva, miokarditi, c.n.s. dazianebani (maRali qalasSiga wneva, tvinis Reros SeSupeba, kompresia) sinusuri bradikardia SeiZleba hqondeT janmrTel drenaklulebs, spocmenebs, revmatizmis dros, atropinrezistentuli cudi bradikardia miuTiTebs struqturul cvlilebebze sinusis kvanZSi da aqvs didi prognozuli niSani. ixileT bradikardiis diagnostikuri algoriTmi. cxrili №6. yvela neli riTmi romelic iwvevs Soks an sicocxlisaT vis sa SiS he mo di na mi kur darRvevebs saWiroebs gadaudebel mkurnalobas. ixilet pediatriuli bradikar di is al go riT mi. cxri li№7. arcTu iSviaTad bradikardiis dros xdeba implantacia mudmivi eleqtrokardiostimulatoris. Tanamedrove kardiostimulatorebs SeuZlia imuSa on yo vel na ir re Jim Si. is adaptirebulia da SeuZlia cvalos stimulaciis sixSire organizmis moTxovnilebis Sesabamisad. kardiostimulatorze saWiroa periodulad dakvir2013 weli veba droulad darRvevebis gamovlena da SesaZlebelia telefoniTac. e.k.g. niSnebisa da klinikurad gamoxatuli paroqsizmuli taqikardiebis erToblioba aris volfparkinson uaitis sindromi. am pacientebis kontrols arTulebs is faqti rom arsebobs uecari sikvdilis riski. riski da kav Si re bu lia wi na gul Ta fibrilaciis aRmocenebasTan ro mel mac da ma te bi Ti gziT swrafi gatarebis gamo SeiZleba gamoiwvios parkuWTa fibri- 53 lacia. mkurnaloba–asimptomuri preegzitacia rekomendebulia kaTeteruli ablacia im pacientebSi romlebic misdeven sports. an iseTi profesia aqvT ramac SeiZleba safrTxe Seuqmnas maTsave an garSemomyofTa sicocxles. warmatebuli ablaciis procentuloba aseT dros metia 90%-ze. ixileT mkurnalobis algoriTmi parkuWTa preegzitaciis dros. cxrili№8. bavSvebSi gulis upulso gaCerebis marTvis algoriTmi mocemulia cxrili #9 cxrili #8 cxrili #9 54 d a s k v n a aritmiis mkurnalobis princi pebidan gamomdinare , manamde sanam ariTmiis mkurnalobas daviwyebT diagnozis dasmis Semdeg oTx SekiTxvas unda vupasuxoT unda ki mkurnaloba am ariTmias? xSirad kerZod ariTmias mkurnaloba ar sWirdeba. bevrma antiariTmiulma saSualebam SeiZleba gamiwvios axali ariTmia an gaauaresos ukve arsebuli. SeiZleba gamoiwvios ucabedi sikvdili. ariTmiebs romlebsac esaWiroeba mkurnaloba miekuTvnebian isini, romlebic iwveven fib ri la ci as par ku We bis da asistolias (magaliTad parkuWovani taqikardia, polimorfuli parkuWovani eqstrasistolebi) an iseTi ariTmiebi romlis drosac an Zalian iSviaTi an Zalian xSiri riTmis gamo vardeba gulis wuTmoculoba. kiTxva - SeiZleba Tu ara aRmovfxvraT mizezi? magaliTad gulis riTmis darRveva „revmatiuli cxelebiT“ gamowveuli miokardis dazianebiT antirevmatuli mkurnalobis Semdeg wesrigdeba. – qronikuli kerebis sanacia xSirad iwvevs ritmis darRvevis likvidacia. ariTmia gamowveuli infeqciuri daavadebis Sedegad xSirad qreba gamojanmrTelebis Semdeg ariTmiebi gamowveuli fsiqoemociuri labilobis Sedgad saWiroeben ara antiariTmiul aramed fsiqotropul saSualebebs. gansakuTrebiT axalSobilebSi ariTmiebi xSirad aris gamowveuli apnoe, hi poqsemiiT, acodoziT, eleqtro lituri disbalansiT. mkurnaloba ariTmiis misi mizezebis gaTvaliswinebis da aRmofx v ris ga re Se auare sebs avadmyofis mdgomareobas. gavwyvitoT ki mankieri wre? – ariT mi e bi rom le bic iw ve ven wuTmoculobis Semcirebas iwvevs arteriul hi potonias da acidozs rac iwvevs kateqolaminebis gadmostyorcnas da ariTmiis SenarCunebas. mkurnaloba konkretul SemTxvevaSi ris mimarT unda iyos mimarTuli? warmovidginoT ori avadmyofi AV blokadiT da 2:1 gatarebiT. romlisganac erT erTis winagulovani riTmi aris 260wT- ,fdidsf rfhlbjkjubf Si. da meoresi 100wT-Si. pirveli avadmyofis parkuWebi ikumSeba 130wT-Si, am SemTxvevaSi mkurnaloba unda iyos mimarTuli winagulebis SekumSvis Semcirebisken. AB blokadis moxsna am SemTxvevaSi ar aris saWiro vinaidan icaven parkuWebs sicocxlisaTvis saSiSi taqikardiisgan. meore avadmyofis parkuWebi ikumSeba 50wm-Si sixSiriT. mkurnaloba am dros mimarTuli unda iyos parkuWebis sixSiris mo ma te bis ken. Se saZ le be lia amis miRweva gamtareblobis gaumjobesebiT, an parkuWebis eleqtrokardiostimulaciiT... ganvixiloT „antiariTmuli preparatebi“ klasebis mixedviT antiariTmuli preparatebi klasi I 1. klasi I A 2. klasi I B 3. klasi I C klasi I A Ia klasi gaxlavT natriumis arxebis blokerebi. am jgufis preparatebidan aRsaniSnavia qinidini, prokainamidi, dizopirami- di, moricizini. am preparatebs umTavresad parkuWovani taqikardiebis, paroqsizmuli taqikardiebis, winagulebis fibrilaciis mosaxsnelad viyenebT. am jgufis medikamentebi xangrZlivad ar iniSneba. isini aneleben depolarizaciasa da gamtarobas. klasi I B Ib klasia adgilobrivi anesTetikebi - iseTebi, rogoric aris lidokaini. igi gamoiyeneba parkuWovani taqikardiebis samkurnalod mwvave fazaSi. difenini efeqturia eqstrasistolebis samkurnalod. es preparatebi amcirebs repolarizaciis dros. 1. lidokaini klasi I C I c klasis medikamentia propafenoni. igi, sazogadod, efeqturia parkuWovani da zogierTi supraventrikuluri taqia- ritmiis, parkuWovani eqstrasistoliebis, paroqsizmuli parkuWovani taqikardiis, supraventrikuluri taqikardiis, mocimcime winagulovani aritmiis dros. es preparatebi Trgunaven repolarizaciis 0 fazas. klasi II. beta-adrenoblokatorebi II klasis medikamentebi - beta-blokerebi - aneleben atrioventrikulur gamtarobas. maT iyeneben AV-kvanZovani reci prokuli taqikardiis, winagulovani taqikardiis (avtomaturi an reentri), winagulebis fibrilaciis dros. beta-blokerebi amcireben uecari sikvdilis risks. am jgufs miekuTvneba propranololi, metoprololi. isini xangrZlivad iniSneba. 1. ateblokori 2. atenoli 3. atenololi klasi III. moqmedebis potencialis gamaxangrZlivebeli preparatebi III klasis preparatebi axangrZliveben moqmedebis potencials. am jgufs miekuTvneba amiodaroni. am klasSi Sedis beta-adrenoblokeri sotaloli, bretiliumi. es preparatebi gamoiyeneba parkuWovani taqikardiebis, supraventrikuluri taqikardiebis samkurnalod. 1. dovini 2 kordaroni samkurnalo saSualeba amiodarone instruqcia tab. 200 mg: 30 c. saineqcio xsnari 150 mg/3 ml: amp. 6 c. antiariTmiuli Tvisebebi: - kordaroni ablokirebs kaliumis arxebs, axangrZlivebs repolarizaciis fazas da aqedan gamomdinare xels uwyobs gulis kunTis moqmedebis potencialis me-3 fazis prolongirebas (antiariTmiuli saSualebebis III jgufi Vaughan Williams-is klasifikaciis mixedviT); moqmedebis potenciuli prolongireba gavlenas ar axdens gulis muSaobis riTmze. - igi amcirebs sinusur avtomatizms bradikardiamde, romelic SedarebiT rezistentulia atropinis mimarT. 2013 weli ,fdidsf rfhlbjkjubf - xasiaTdeba parciuli alfada beta-mablokirebeli TvisebebiT. - anelebs sinoatriul, winagulovan da atrioventrikulur gamtareblobas, romelic ufro mkveTradaa gamoxatuli gulis xSiri riTmis dros. ar cvlis parkuWTaSida gamtareblobas. - zrdis refraqterul periods da amcirebs miokardis agznebas winagulovan, atrioventrikulur da parkuWovan doneze. - aferxebs gamtareblobas da axangrZlivebs refraqterul periods winagulovan-parkuWovan gzebSi. antiiSemiuri Tvisebebi: - iwvevs sisxlZarRvTa periferiuli winaaRmdegobis da gulis riTmis zomierad daqveiTebas, rac amcirebs mis moTxovnilebas Jangbadis mimarT. - xasiaTdeba parciuli alfa- da beta-mablokirebeli moqmedebiT. - koronarul arteriebze pirdapiri zemoqmedebiT aZlierebs koronaruli sisxlmimoqcevis process. - aortaSi wnevis Semcirebis da sisxlZarRvTa periferiuli winaaRmdegobis daqveiTebis gziT xels uwyobs gulis sistoluri moculobis stabilizacias. sxva efeqtebi: - arsebiTi uaryofiTi inotropuli efeqti ar axasiaTebs. kordaroni peroralurad miRebisas nela da sxvadasxva xarisxiT Seiwoveba. igi xasiaTdeba sxvadasxva adgilebSi dagrovebis didi unariT (cximovani qsovili, maRal perfuzirebuli organoebi, iseTebi, rogoricaa: RviZli, filtvebi da elenTa). sxvadasxva avadmyofebSi peroraluri amiodaronis bioSeRwevadoba meryeobs 30-dan 80%-is farglebSi (saSualo maCvenebeli Seadgens daaxloebiT 50%-s). sisxlis plazmaSi amiodaronis maqsimaluri koncentraciebi aRiniSneba 3-7sT-is Semdeg misi erTjeradi doziT miRebisas. samkurnalo efeqti ZiriTadad vlin de ba mkur na lo bis dawyebidan erTi kviris Semdeg (ramodenime dRidan or kviramde). preparati xasiaTdeba naxevargamoyofis xangrZlivi periodiT (20-100 dRe). mkunalobis pirvel dReebSi preparati grovdeba TiTqmis 2013 weli yvela qsovilebSi, gansakuTrebiT-cximovan qsovilSi. eliminacia iwyeba ramodenime dRis Semdeg da avadmyofTa individualuri Taviseburebebis gaTvaliswinebiT sisxlis plazmaSi preparatis stabiluri koncentraciebi aRiniSneba erTidan-ramodenime Tvis ganmavlobaSi. aRniSnulidan gamomdinare, samkurnalo efeqtis misaRwevad, kordaronis qsovilebSi dagrovebis mizniT saWiroa mi Re bul iq nas pre pa ra tis sawyisi (dartymiTi) dozebi. ventrikuluri taqikardiis mkurnaloba: winagulovani ariTmia parkuWovani taqikardiiT, WPW- sindromiT gamowveuli taqikardia, sinusuri taqikardia da eqstrasistoliebi. mozrdilebs preparati eniSnebaT dartymiT dozebSi 600dan 1000 mg-mde 8-10 dRis ganmavlobaSi. minimalur efeqtur Terapiul dozas Seadgens 100 mgdan 400 mg-mde dReSi. radgan kordaroni xasiaTdeba xangrZlivi naxevargamoyofis periodiT, misi miReba SeiZleba yovel meore dRes 200 mg-iani doziT. (xolo yoveldRe 100 mg-iani doziT). agreTve SesaZlebelia kviraSi 2 dRiani Sesveneba. venaSi infuzia sawyisi doza: preparati SehyavT ZiriTadad 5 mg/kg-iani doziT glukozis 250 ml 5% xsnarTan erTad, 20 wT-idan 2 sT-is ganmavlobaSi, SesaZlebelia infuziis ganmeoreba 2-3-jer 24 sT-is ganmavlobaSi. infuziis siswrafis koreqcia xdeba miRebuli Sedegidan gamomdinare. mkurnalobis efeqti aRiniSneba infuziidan ramodenime wTSi da qreba TandaTan. SemanarCunebeli mkurnaloba: 10-20 mg/kg dReSi (saSualod 600800 mg/dReSi da 1200 mg/mde dReSi) glukozis 250 ml 5%-ian xsnarTan erTad ramodenime dRis ganmavlobaSi. infuziis pirveli dRidanve saWiroa preparatis peroralur miRebaze TandaTan gadasvla. venaSi ineqciis dros preparati 5 mg/kg SehyavT 3 wT-is ganmavlobaSi. erT SpricSi kordaronis da sxva preparatebis Sereva nebadarTuli ar aris. - mkurnalobis procesSi adgili aqvs sxvadasxva saxis ara- 55 sasurvel reaqciebs, romlebic damokidebulia preparatis dozaze da mkurnalobis xangrZlivobaze. am movlenebis Tavidan asacileblad, rekomendebulia preparatis gamoyeneba SedarebiT dabal dozebSi; - zogierT avadmyofebSi adgili aqvs bradikardiis ganviTarebas (55 dartyma wT-Si); - kanis mgrZnobelobis momateba da pigmentacia; - iSviaTad-gulisreva, Rebineba, diarea, gemovnebis Sesusteba an dakargva; nevrologiuri daavadebebiT Sepyrobil avadmyofebSi-Zilis darRveva, Tavis tkivili, kunTebSi sisustis SegrZneba. - sinusuri bradikardia da sinoatriuli bloki; - sinusuri ukmarisobis sindromi, riTmis matarebliT koreqciis SemTxvevebis garda (sinusuri kvanZis gaCerebis saSiSroeba); - atrioventrikuluri blokada, II da III xarisxis blokada, romelic ar eqvemdebareba koreqtirebas riTmis matarebliT; - gul-sisxlZarRvovani kolafsi; mZime arteriuli hi potenzia; - im preparatebTan kombinacia, romelTac ZaluZT gamoiwvion paroqsizmuli parkuWovani taqikardia; - farisebri jirkvlis disfunqcia; - iodis an kordaronis mimarT momatebuli mgrZnobeloba. radgan igi gadadis nayofis farisebr jirkvalSi, orsulobis dros misi gamoyeneba winaaRmdegnaCvenebia. preparati mniSvnelovani raodenobiT eqskretirdeba dedis rZeSi, amitom misi gamoyeneba laqtaciis periodSi rekomendebuli ar aris. kor da ro niT mkur na lo bis dawyebamde saWiroa eleqtrokardiografiuli gamokvlevis Catareba, SratSi kaliumis raodenobis gansazRvra. ar arsebobs misi uaryofiTi moqmedebis Sesaxeb monacemebi avtotransportis mZRolebSi da im pirebSi, romelTa muSaoba teqnikasTan moiTxovs momatebul yuradRebas. sinusuri bradikardia, gulis gaCereba, parkuWovani taqi- ,fdidsf rfhlbjkjubf 56 kardiebi, paroqsizmuli taqikardia,”torsade de pointes”, sisxlmimoqcevis moSla da RviZlis dazianeba. mkurnaloba simptomuria. kordaroni da misi metabolitebi dializis gziT ar gamoidevneba organizmidan. kor da ro ni sif r Txi liT eniSnebaT kalciumis antagonistebTan (verapamili da diltiazemi), beta-blokatorebTan (propranololi) da diurezul saSualebebTan kombinaciaSi. igi aZlierebs digoqsinis moqmedebas, agreTve varfarinis da acenokumarolis Sededebis sawinaaRmdego efeqts. kordaronis da I jgufis antiariTmiuli (qinidini, prokainamidi, flekainidi) saSualebebis erTdrouli gamoyenebiT, mniSvnelovnad Zlierdeba maTi moqmedebis efeqti. preparati inaxeba araumetes 25°C temperaturaze, mSral, sinaTlisagan dacul adgilas. vargisianobis vada - 3 weli. 3. amiokordini amiodaroni (amiodarone) klasi IV. kalciumis arxebis blokatorebi IV klasi kalciumis arxebis blokerebi gaxlavT. amaTgan antiaritmiuli moqmedeba aqvT mxolod verapamilsa da diltiazems. es jgufi efeqturia supraventrikuluri winagulovani aritmiebis dros. kalciumis arxebis I klasis seleqtiuri blokatorebi kalciumis arxebis III klasis seleqtiuri blokatorebi Read the rest of this entry» 1.kalciumis arxebis I klasis seleqtiuri blokatorebi verogalidi izoptini finoptini Read the rest of this entry» 2. kalciumis arxebis III klasis seleqtiuri blokatorebi diltiazemi kardili klasi V. V klasi - adenozini (adenokardi). es aris klasikuri AVblokatori, gamoiyeneba AV-kvanZovani reci prokuli da reentri taqikardiebis kupirebisTvis. amdenad, bavSvTa asakSi gulis riT mi sa da gam ta ro bis darRveva da maTi marTvis Tanamedrove princi pebi erTerTi umniSvnelovanesia bavSvTa kardiologiaSi. TiTqmis SeuZlebeli iyo erT naSromSi problema srulyofilad agvesaxa,Tumca vTvliT, rom sakvanZo sakiTxebi wamoweulia da ara erTxel davubrundebiT Cven maT detalur ganxilvas. reziume gulis riTmisa da gamtarobis darRveva bavSvTa asakSi (maTi marTvis Tanamedrove princi pebi) g.CaxunaSvili,m.xecuriani,n.jobava (saqarTvelos bavSvTa kardiologTa asociacia,ir.ciciSvilis sax. bavSvTa axali klinika, q.quTaisis dedaTa da bavSvTa samkurnalo diagnostikuri centri,janmrTelobis centri) klinikur pediatriaSi gulis riTmis darRveva da misi marTva bavSvTa asakSi sakmaod rTuli da Zneli Tavi–ganyofilebaa. rTulia diagnostika , misi mkurnaloba ki moiTxovs faqizad midgomas,zust–natif mkurnalobas. Cvens mier gaanalizebulia 2001–2011ww–is,ir.ciciSvilis sax. bavSvTa axali klinikis,q.quTaisis dedaTa da bavSvTa samkurnalo diagnostikuri centrisa da Tbilisis janmrTelobis centris 3500 SemTxveva. bavSvTa asakSi gulis riTmisa da gamtarobis darRveva da maTi marTvis Tanamedrove princi pebi erTerTi umniSvnelovanesia bavSvTa kardiologiaSi. TiTqmis SeuZlebeli iyo erT naSromSi problema srulyofilad agvesaxa, Tumca vTvliT, rom sakvanZo sakiTxebi wamoweulia da ara erTxel davubrundebiT Cven maT detalur ganxilvas. SUMMARY HEART RHYTHM AND CONDUCTING DISORDER IN CHILDREN (MODERN GOVERNING PRINCIPLES) G.CHAKHUNASHVILI, M.KHETSURIANI, N.JOBAVA (Georgian Pediatric Cardiology Association, New Children’s Clinic named after I.Cicishvili, Mother and Child Medical-diagnostic Centre of Qutaisi, Health Centre). Heart rhythm disorder and it’s governing in children is very hard in clinical pediatrics. It’s hard to diagnose and needs neatly approach and exact subtle treatment. We analyzed 3500 cases from Georgian Pediatric Cardiology Association, New Children’s Clinic named after I.Cicishvili, Mother and Child Medical-diagnostic Centre of Qutaisi and Health Centre. Heart rhythm and conducting disorder in children and their modern governin principles is very essential in pediatric cardiology. It was almost impossible to describe problem perfectly in this case, but we think that key questions are considered and we will often come back to this problem for more detailed discussion. 2013 weli ,fdidsf rfhlbjkjubf 57 revmatologia kidev erTxel mwvave revmatiuli cxelebis Sesaxeb profesori g.CaxunaSvili, r.svanaZe, med. doq. n.jobava /saqarTvelos bavSvTakardiologTa asociacia/ mwvave revmatiuli cxeleba - SemaerTebeli qsovilis anTebiTi daavadebaa, romelic viTardeba A ti pis B hemolizuri streptokokiT gamowveuli infeqciis (faringitis an ton zi li tis) auto i mu nu ri garTu- lebis Semdeg. lokalizaciiT gul-sisxlZarRvTa sistemaSi(revmokarditi), saxsrebSi(poliarTriti), kanze(rgoliseburi eriTema, revmatiuli kvanZebi), tvinSi(qorea). termini revmatizmi, dReisaTvis gamoiyeneba im paTologiuri mdgomareobis aRsaniSnavad, romelic aerTianebs mwvave revmatul cxelebasa da gulis revmatiul avadmyofobas. epidemiologia. revmatiuli cxelebiT avadoba ekonomiurad ganviTarebul qveynebSi bolo aTwleulebis mancilze mniSvnelovnad Semcirda da weliwadSi Seadgens 5 SemTxvevas yovel 100000 macxovrebelze. ganvitarebad qveynebSi ki avadobis maCvenebeli 26-dan 116-mde meryeobs yovel 100000 macxov re bel ze.upi ra te sad avaddebian bavSvebi da mozardebi 5-15 wlis asakSi, SeiZleba ganuviTardes axalSobilebs da zrdasrul asakis pirebs. Crdiloet kavkasiaSi gamovlena 3-jer xSiria samxreTTan SedarebiT. sqesTa Tanafardoba; qali:mamakaci=3:1. dReisaTvis revmatiuli cxelebis evolucia Semdegi Tavisebure-bebiT xasiTdeba: daavadebis sixSiris zrdis tendenciiT ufros asakSi (20-30 weli), dune da latenturi mmimdinareobis SemTxveve-bis mateba, simptomebis mravalferovnebis kleba da monoorganuli dazianeba, gulis sarqvelebis dazianebis sixSiris kleba. etiologia. daavadebis etiologiur faqtors warmoad2013 weli gens A jgufis B hemolizuri streptokoki. Tumca, revmatiuli cxelebis gamowvevis unari mxolod e.w. „revmatogenul“ Stamebs (upiratesad 1, 3, 5,6,14,18,19,24,28) gaaCnia. revmatogenuli Stamebi xasiTdeba: cxvir-xaxis qsovilebisadmi tropulobiT, maRali kontagiozurobiT, maRali hialuronis mJavis Semcveli kafsuliT, ujredis zedapirze c-proteinis msxvili da amaxasiaTebeli agebulebis mqone molekulebis arsebobiT, baqteriuli ujredis antigenebSi iseTi epitopebis arsebobiT, romelTa mimarT gamomuSavebuli antisxeulebi jvaredinad moqmedeben adamianis sxvadasxva qsovilebis struqturebze– miozinze, sarkolemaze, tvinis garsze, sinoviaze. sisxlian agarze mukoiduri kolonebis warmoqmniT, bulionian kulturaze mokle jaWvebis mocemiT. paTogenezi. revmatiuli cxelebis genezSi A ti pis B hemolizuri streptokokis monawileoba, maT mier gamomuSavebuli toqsinebis zemoqmedebasTan da molekuluri mimikriis fenomenTan aris dakavSirebuli. toqsinebi pirdapir zegavlenas axdenen miokardze, rasac moyveba gulis struqtururaSi arsebuli sekvestirebuli autoantigenebis „gaSiSvleba“ da SexebaSi mosvla imunur ujredebTan. paTogenezuri kaskadis CarTvaSi gansakuTrebiT didi roli miuZRvnis streptokokebis molekuluri/antigenuri mimikris fenomens. revmatiuli cxelebis dros upirates dazianebas gulis, saxsrebis, kanqveSa da tvinis qsovilebi ganicdian. es Ajgufis B hemolizuri streptokokebis membranaze aesebuli glikoprotei-nebisa da CamoT- vlili qsovilebis dadgenilia gulis sarqvlebis glikoproteinebisa da streptokokebis membranaSi myof hialuronidazas Soris arsebuli epitopuri msgavseba.mokardiumSi Semavali miozinis saerTo epitopebisa streptokokis McilebTan. A streptokoks SeuZlia imoqmedos organizmze sakuTari cxovelmyofelobis sxvadasxva produqtiT. esenia: streptolizini A da S streptokinaza, antistreptohialuronidaza, anti-dnm-aza. streptolizini O da S azianebs lizosomebis membranebs, uzrunvelyofen mJave hidrolazebis gamonTavisuflebas, riTac iwvevs anTebiT reaqcias. streptolizin O xasiaTdeba, agreTve, kardiotoqsiuri moqedebiT, xolo streptolizini S eqsperimentSi iwvevs arTrits. daavadebis risk-faqtorebi: asaki 5-15 weli, mdederobiTi sqesi(2,6-jer ufro xSirad), memkvidruli winaswarganwyoba, naadrevi mSobiaroba, SemaerTebeli qsovilis Tandayolili anomaliebi, gadatanili mwvave streptokoku li in feq cia da xSi ri cxvir-xaxis infeqciebi, momatebuli tenianobis da dabali temperaturis pirobebSi muSaoba da arseboba. klasifikacia: 1. klinikuri formebi: mwvave revmatiuli cxeleba, ganmeorebiTi revmatiuli cxeleba. 2. klinikuri gamovlinebebi: a. ZiriTadi: karditi, arTriti, qorea, beWdisebri eriTema, revmatiuli kvanZebi. b. damatebiTi: cxeleba, arTralgia, abdominaluri sindromi, seroziti. 3. gamosavali: a. gamojanmrTeleba. b. gulis qronikuli revmatiuli daavadeba. -gulis 58 mankis gareSe -gulis mankiT. 4. gulsisxlZarRovani ukmarisoba. niu-iorkis kardiologTa asociaciis mixedviT; funqciuri klasebi iyofa: 0,1,2,3,4. klinikuri suraTi. daavadebis ganviTarebas yovelTvis win us w rebs cxvir-xa xis streptokokuli infeqcia (tonziliti/angina an faringiti), romelTagan mxolod 3% SemTxvevaSi, mkurnalobis ar arsebobisas viTardeba revmatiuli cxeleba. kanis streptokokul infeqciebs revmatiuli Setevis warmoSobis saSiSroeba ar axlavs. Cveulebriv, daavadebis pirveli niSnebi vlindeba tonzilaruli infeqciis ganviTarebidan 1-4 kviris (saSualod 18 dRis) manZilze.daavadebis mwvave simptomebi SenarCunebulia kvirebisa da Tveebis ganmavlobaSi, romelTac Se iZ le ba Se uq ce va di cvcvlilebebis ganviTareba mohyves. daavadebis mwvave periodSi viTardeba e.w. mfrinavi poliarTriti/ revmariuli poliarTriti(gvxvdeba SemTxvevaTa 60-100%-Si), romlisTvisac damaxasiaTebelia msxvili saxsrebis simetriuli dazianeba da ar T ral gia. da a va de bis mwvave periodis CaTavebis an remisiis dros cvlilebebi saxsrebis mxriv ukvalod qreba. swored amitomac amboben xatovnad-„revmatizmi saxsrebs lokavs, guls ki-kbens.“ zogadi simptomatikidan aRiniSneba: pireqsia, oflianoba, Zlieri sisuste, anoreqsia, sxeulis masis Semcireba. 90-95% Si revmatiuli cxelebis wamyvani sindromia revmatiuli karditi (revmokarditi), SeiZleba ganviTardes mis samive SreSi(pankarditi) an Semoifarglos calkeuli Sreebis anTebiT. anTebiTi da autoagresiuli procesebis Sedegad gulis SreebSi yalibdeba fibrinoiduli nekrozis ubnebi, romlebic garemoculia limfovitebiT, makrofagebiT, poxieri ujredebiT, erTeuli plazmocitiT da gaaqtivebuli histocitebiT. pacients awuxebs qoSini, diskomforti mkerdis areSi, SeSupeba, xveleba an orTopnoe. mitraluri sarqveli ziandeba 85%-Si, aortuli- 44%Si, trikuspidaluri-10-16%-Si. ,fdidsf rfhlbjkjubf eleqtrokardiogramaze damaxasiaTebelia PQ intervalis gaxangrZliveba,QRS kompleqsis voltaJis cvalebadoba, mitraluri regurgitaciiT gamowveuli sistoluri Suili. aortuli regurgitaciiT gamowveuli maRali sixSiris dekreSendos ti pis Suili. kareikumbsis Suili- uxeSi mezisistoluri Suili. arTriti, zogjer poliarTriti. gvxvdeba SemTxvevaTa 7075%-Si. damaxasiTebelia simetriuli, mfrinavi xasiaTჲs. iSviaTad oligoarTritis saxiT. arTriti moicavs msxvil saxsrebs menj-barZayis, muxlis, koW-wvivis, idayvis, sxivmajis saxsars. dazianebuli saxsari mtkivneulia, SeSupebulia, aRiniSneba siwiTle, cxele ba. sax sar Si moZ ra o bis SezRudva. arTriti viTardeba 12-24 saaTSi da grZeldeba 2-6 dRis ganmavlobaSi, zogjer 4 kviraze met xans, erTi da igive adgilas, Semdgom migrirebs, advilad emorCileba aspirinis moqmedebas. karditi Carditis: gvxvdeba SemTxvevaTa 50%-Si axasiaTebs gulis sarqvlebis dazianeba (ZiriTadad ziandeba mitraluri, iSviaTad aortuli sarqvlebi), romelic vlindeba organuli SuilebiT (qsovilis anTeba an axali Suilebi). pacients awuxebs qoSini, diskomforti mkerdis areSi, SeSupeba, xveleba an orTopnoe. revmatiuli valvulitis sadiagnostikod ganixileba axali an Secvlili Suilebi. mwvave revmatiul cxelebas axasiaTebs sarqvlebis regurgitacia, qronikuls – sarqvlebis stenozi. gulis revmatiuli daavadebis eqokardiografia (mjo kriteriumebi-2004w) dopleris kriteriumebi nakadis regurgitacia sigrZiT >1 sm-ze regurgitant jet >1 cm in length nakadis regurgitacia aRiniSneba sul cota or sibrtyeSi A regurgitant jet in at least 2 planes mozaikuri feradi nakadis pikuri siCqare >2,5 m/wm A mosaic colour jet with a peak velocity >2.5 m/s nakadi persistirebs yvela SemTxvevaSo - diastolasa da sistolaSi The jet persists throughout systole or diastole. revmstiuli cxelebis sadiagnostiko laboratoriuli testi – oqros standarti ar arsebobs. doplerografia gamoiyeneba rogorc klinikuri Sedegebis da ma das tu re be li dam x ma re teqnika da kameris zomebis, parkuWebis zomebis, sarqvelebis regurgitaciis xarisxis da morfologiuri Taviseburebebis dasadgenad. igi ar unda iqnas gamoyenebuli revmatiuli karditis didi da mcire kriteriumebis nacvlad kliniku ri su ra Tis ararse bo bi sas(Proceedings of the Jones Criteria Workshop) kombinirebuli kriteriumi dopleris kriteriumebi sarqvlebis regurgitaciis nebismieri xarisxi aRiniSneba sul cota or sibrtyeSi asocirdeba sul cota 2 morfologiur niSanTan ka re de bis moZ ra o bis SezRudva subvalvuluri Sesqeleba sarqvlebis Sesqeleba Any degree of valvular regurgitation seen in at least 2 planes Associated with at least 2 morphological signs Leaflet restriction Subvalvular thickening Valvular thickening eqokardiografia mitraluri sarqvlis valvulitis dros aRiniSneba eqo signalis gasqeleba karedebidan da sarqvlis qordidan, sarqvlis ukana karedis moZraobis SezRudva, mitraluri karedebis sistoluri eqskursis Semcireba, zogjer karedeis mcire prolabireba sistolis bolos. mitraluri sarqvlis endokarditi vlindeba: wina mitraluri karedis SesqelebiT, ukana mitraluri karedis hi pokineziiT, mitraluri regurgitaciiT, wina mitraluri karedis gumbaTiseburi gamrudebiT. aortuli sarqvlis valvulitis dros eqokardiografulad vlindeba mitraluri karedebis mcireamplituduri 2013 weli ,fdidsf rfhlbjkjubf TrTola, aortuli sarqvlis karedebidan eqosignalis gasqeleba doplereograiiT aortuli sarqvlis revmatiuli endokardti vlindeba aortuli sarqvlis SezRuduli kidovani SesqelebiT, karedebis gardamavali prolapsiT, aortuli regurgitaciiT. mjo-s mier SemoTavazebuli karditis maxasiaTebeli Suilebi: Zlieri sistoluri Suili mwvervalze, romelic warmoadgens mitraluri sarqvelis valvulitis gamovlinebas. me zo di as to lu ri Su i li mwvervalze, -is Suili, rac dakavSirebulia winagulidan sisxlis swraf gadasrolaze. bazisuri aortuli sarqvlis valvulitis damaxasiaTebeli bazisuri protodiastoluri Suili, sarqvlebis Sesqeleba jonsis kriteriumebis samuSao jgufi (Proceedings of the Jones Criteria Workshop) iZleva rekomendacias, rom im SemTxvevaSi, rodesac pacients gadatanili aqvs gulis revmatiuli daavadeba da Znelia karditis diagnozis dasma, gaTvaliswinebul iqnas izolirebuli klinikuri niSnebi(arTralgia, cxeleba, monoarTriti, mwvave fazis reagentebis momateba qorea (sidenhamis daavadeba). SedarebiT iSviaTia, Cndeba gvian– pirveladi infeqciidan 6 an meti Tvis Semdeg. miuTiTebs procesSi cns-is CarTulobaze. (hi perkinezi, kunTTa hi potonia, vegetosisxlZarRovani distonia, fsiqoemociuri darRvevebi). umetesad gvxvdeba mdedrobiTi sqesis warmomadgenlebSi e.i. qorea: nerviuli sistemis daavadeba, romelic vlindeba qoreuli hi perkinezebiT, kunTovani hi potoniiT, statikisa da koordinaciis darRveviT, sisxlZarRvovani distoniiT, fsiqopaTologiuri gamovlinebebiT. pacientebi qoreiT zogjer ar xasiaTdebian jonsis sxva kritriumebiT, ufro xSirad aReniSnebaT gogonebs, rgoliseburi eriTema - Erythema marginatum: aReniSnebaT pacientTa 5-13%-s, dasawyisSi 13 sm-is diametric wiTeli feris macula an papula, ZiriTadad lokalizdeba sxeulze 2013 weli da kidurebis proqsimalur nawilebze, ar axasiaTebs qavili, qreba xelis daWerze, gaaCnia tranzitorul migrirebadi xasiati, regresirebs narCeni movlenebis gareSe. SedarebiT gvian simetriuli Setevis pikze kanze viTardeba beWdisebri/anularuliu eriTema, romelic Ria movardisfero 5-7sm diametris laqaa. igi umtkivneuloa, ar axasiaTebs qavili da TiTis daWeriT qreba. eriTemebi TandaTanobiT SemaRlebas ganicdis, ris Semdegac makulad dapapulad gardaiqmneba, romelTac mzardi kideebi aqvT,. upiratesad viTaedeba kanze gul- mkerdis, muclis, zurgis, kidurebis da saxis midamoebSic. kanqveS SeiCleba formireba ganicados revmatulma kvanZebma (SemTxvevaTa 13%-Si), romelTa zomebi xorblis marcvlis odenobidan muxudos marcvlis zomamde meryeobs. isini mkvrivi, umtkivneulo warmonaqmnebia da ganlagebulia msxvili saxsrebis gamSleli (eqstenzoruli) kunTebis myesebSi. isini revmatiuli cxelebis mwvave periodSi viTardeba da 1-2 Tvis manZilze involucias ganicdis. kanqveSa revmatiuli kvanZebi (Subcutaneous nodules): vlindeba 0-8%-Si. lokalizdeba idayvis, muxlis, koW-wvivis saxsrebSi da xerxemlis welisa da mkerdis malata morCebis zedapirebze. zomiT 05-2 sm. saSualod 3-4 raodenobiT. asocirdeba revmatiul karditTan da ukuganviTarebas ganicdis 1 Tvis ganmavlobaSi. gamomricxavi myari simetriuli poliarTriti, romelic arasakmarisad reagirebs NSAID-is moqmedebaze (savaraudoa poststreptokokuli reaqtiuli arTriti, aucilebelia streptokokis ti pireba) –––– karditis klinikur-instrumentuli niSnebis ararseboba. simptomebi da niSnebi a) damadasturebeli simptomebi: gamonayari, temperatura, Tavis tkivili, gaxdoma, wonaSi kleba, cxviridan sisxlis de- 59 na, daRliloba, oflianoba, sifermkrTale, tkivili mkerdis midamoSi da orTopnoe, tkivili muclis areSi da Rebineba. migrirebadi tkivili saxsrebSi, kvanZebi kanqveS, motoruli disfunqcia, gaRizianeba da yuradRebis deficiti, xasiaTis cvlileba, streptokokul infeqciasTan asocirebuli pediatriuli autoimunuri neirofsiqikuri darRvevebi. pacientTa 70%-s 1-5 kviris win gadatanili hqondaT yelis anTebiTi daavadeba. klinikuri niSnebi: muclis tkivili: ZiriTadad gvxvdeba mwvave revmatiul cxelebis dasawyisSi, gavs sxva mikro vaskularul anTebebs, SeiZleba hgavdes mwvave apendicits; ar T ral gia: ar T ral gi is sruli gamovlineba SeiZleba Semcirdes im SemTxvevaSi, rodesac pacienti iRebs aspirins an sxva anTebis sawinaaRmdego preparatebs, amotom arTritis SemTxvevaSi gaTvaliswinebuli unda iyos arTralgiis mcire gamovlinebac; cxviridan sisxldena: asocirdeba seriozul xangrZliv revma-tiul karditTan. temperatura: pacientTa umravlesobaSi Tavidan gvxvdeba 39 gra- dusze meti temperatura. ufro naklebi 38-38-38,5 Seicleba Segvxvdes pacientebSi zomieri karditiT an saerTod ar iyos pacientebSi sufTa qoreiT. temperatura sicxis damwevi Terapiis gareSe mcirdeba daaxloebiT erTi kviris ganmavlobaSi, magram subfebriluri –2-3 kviris ganmavlobaSi. revmatiuli pnevmonia xasiaTdeba iseTive simptomebiT, rogorc infeqciuri genezis. b) gamomricxavi diagnostikur-laboratoriuli testebi da specialistTa konsultaciebi sisxlis saerTo analizi (eds, leikocitebi) C reaqtiuli cila sisxlis mikrobiologiuri gamokvleva yelis nacxis gamokvleva A jgufis β hemolizuri streptookis gamosavlenad. 60 sisxlis serologiuri analizi (antistreptokokuri antisxeulebis titri) ekg eqokardiograma gul-mkerdis rentgenograma klinikurad da eqokardiografiulad dadasturebuli karditis SemTxvevaSi. kardiologis konsultacia e.i. laboratoriuli maCveneblebidan momatebulia C-reaqtiuli cila da eds-i. neitrofiluri leikocitozi. antistreptolizinisa da antidnm-is momateba. antistreptokokuli antisxeulebis titri 4-jer matulobs, Tumca aris SemTxvevebi, rodesac xaxis nacxidan izolirebulia streptokoki. xolo infeqcia serologiurad ar dasturdeba. diagnostika kriteriumebi: a) damadasturebeli revmatiuli cxelebis diagnostirebis gamartivebis mcdelobas warmoadgens jonsis didi da mcire kriteriumebi (Jones criteria, 1956w., ganaxlebuli 1992 da 2002 wlebSi) b) dadasturebuli revmatiuli cxeleba - ori didi an erTi didi da ori mcire kriteriumi da dadasturebuli streptokokuli infeqcia. didi kriteriumebi: poliarTriti karditi qorea anularuli (rgoliseburi) eriTema kanqveSa kvanZebi antineirogenuli antisxeulebi mcire kriteriumebi: cxeleba arTralgia revmatiuli cxeleba an gulis revmatiuli daavadeba anamnezSi. mwvave fazaSi - eds-is da C reaqtiuli cilis momateba eleqtrokardiogramaze – gaxangrZlivebuli PR intervali dadasturebuli streptokokuli infeqcia: yelis pozitiuri baqteriuli kultura dadebiTi rapid testi momatebuli antistreptolizinis titri erTi didi da ori mcire kriteriumi an ori didi kriteriumi streptokokuli infeqciis Sesaxeb informaciasTan erTad amtkicebs mwvave revmatiuli cxelebis diagnozs. ,fdidsf rfhlbjkjubf sayuradReboa aseve karditis dros e.k.g.eqokardiografiisa da doplerografiis monacemebi. gulmkerdis rentgenograma. diferencialuri diagnozi. Tu izolirebulad gvxvdeba erTi didi kriteriumi (karditi, arTriti, qorea), aucilebelia gamoiricxos sxvadasxva daavadebebi. infeqciuri endokarditi– am pa To lo gi is eti o lo gi u ri faqtorebia strep, stafilokoki da gramuaryofiTi flora, mrc-gan gansxvavebiT infeqciur endokarditis dros cxeleba ar eqvemdebareba aass- is gamoyenebas, axasiaTebs progresuli sisuste da anoreqsia, sxeulis masis dakargva, swrafad moprogresire destruqciuli cvlilebebi sarqvelebSi, gulis SegubebiTi ukmarisobis niS ne bi, eqo kar di og ra fi iT vlindeba vegetaciebi, pozitiuri hemokultura. miokarditi– mas uxSiresad aqvs virusuli etiologia, ar axasiaTebs valvuliti, arTriti. sustad aris gamoxatuli arTralgiac. mitraluri sarqvlis prolafsi–am dros paciantTa umravlesoba asTeniuri agebulebisaa, fenoti puri niSnebi, romelic miuTiTebs SemaerTebeli qsovilis Tandayolil displaziaze (xerxemlis svetis sqoliozi gulmkerdis midamoSi, hi permobi- luri saxsrebis sindromi, adreulad ganviTarebuli brtyelterfianoba.) libman-saqsis endokarditi– axasiaTebs sistemur wiTel mgluras. aRniSnuli paTologia gvxvdeba daavadebis maRali aqtivobis fonze, sxva niSnebTan erTad. postreptokokuli reaqtiuli arTriti–gvxvdeba ufro mozrdili asakis mqone pacientebSi gadatanili streptokokuli anginis Semdeg.simptomebi persistirebs xangrZlivi periodis ganmavlobaSi (>2 Tveze). mimdinareobs karditis gareSe, arasaTanadod eqvemdebareba aass-T mkurnalobas. mkur na lo ba. da a va de bis mkurnaloba mimarTuli unda iyos paTogenis drouli eliminaciisken (antistreptokokuli Terapia), organizmSi mimdinare sistemuri anTebiTi da autoimunuri procesebis daTrgunvisken, saWiroebis SemTxvevaSi dazianebuli organoebis funqciebis normalizebisken (gulis mdgradi ukmarisoba). mkurnaloba moicavs: woliTi reJimi, penicilinoTerapia, aspirini - arTrituli tkivilis mosaxsnelad, steroidebi - mZime karditebis samkurnalod. paTogenezuri Terapia tardeba anTebis sawinaaRmdego da imunosupresoruli moqmedebis preparatebiT (kortikos -teroidebi, arasteroiduli preparatebi), romelTa gamoyeneba ramodenime Tvis (25 Tve) manZilze grZeldeba. misi mizania revmatiuli procesebisa da gulis mankis formirebis Sewyveta. avadmyofebs afrTxileben, rom imunosupresuli Terapiis fonze nebismieri qirurgiuli Carevis SemTxvevaSi (kbilis eqstraqcia, operaciebi sxeulis Rruebze) aucilebelia antibiotikebis profilaqtikuri daniSvna. gulis mdgradi ukmarisobis ganviTarebis SemTxvevaSi atareben specifikur mkurnalobas – diuretikebis, kalciumis arxis blokatorebis, sagule glikozidebis gamoyenebiT. gulis sarqvelebis dazianebis SemTxvevaSi mimarTaven qirurgiul Carevasac. profilaqtika. Tu erTxel daisva revmatiuli cxelebis diagnozi, pacienti saWiroebs ganuwyvetel profilaqtikas peniciliniT, imisda miuxedavad, aqvs Tu ara valvuliti. bicilinis (penecilini G). intramuskularuli ineqciebi avad- myofs ukeTdeba 28 dReSi erTxel. bicilinoTerapiis aTwliani kursis Semdeg avadmyofis mdgomareoba umjobesdeba. karditisa da gulis sarqvlebis dazianebisas 10 wlis manZilze ukanaskneli epizodidan da 40 wlis asakamde (potenciurad mTeli sicocxlis manZilze). karditis SemTxvevaSi sarqvelebis dazianebis gareSe – 10 wlis manZilze ukanaskneli epizodidan – minimum 21 wlis asakamde. karditis gareSe - 5 wlis manZilze ukanaskneli epizodidan – minimum 21 wlis asakamde. 2013 weli ,fdidsf rfhlbjkjubf progresis maCvenebeli: temperaturis, laboratoriuli maCveneblebis normalizeba, klinikuri niSnebis Semcireba da gaqroba. amgvarad, mkurnaloba a) I alternativa A jgufis streptokokuli faringitis mkurnalobisaTvis mowodebulia Penicillin VK (Beepen-VK, Pen.Vee K, V-Cillin K, Veetids). bavSvebSi: 250 mg (400,000 U) PO ganawilebuli dReSi orjer 10 dRis ganmavlobaSi mozardebSi: 500 mg (400,000 U) PO ganawilebuli 10 dRis ganmavlobaSi SesaZlebelia ampicilinis da amoqsacilinis gamoyenebac, Tumca maT mikrbiologiuri upiratesoba ar gaaCniaT. amo xi cil lin dRe Si sam jer (dReSi 50 mg/kg, maqsimum 1000 mg) 10 dRis ganmavlobaSi (ar SeiZleba tetraciklinebisa da sulfamidebis gamoyeneba) revmatiuli cxelebi da/an karditis prevenciisaTvis eradikacia(Eradication) <27 kg: 600 000 U benzathine penicillin G (Bicillin L-A; King Pharmaceuticals, Bristol, Tenn) IM 1 doza >27 kg: 1 200 000 U benzathine penicillin G IM 1 doza meoradi prevencia: igive doza 3-4 kviraSi erTxel. benzathine penicillin -is dawyebisas oraluri penicilinis miReba unda Sewydes anTebis sawinaaRmdego saSualebebi: manifestirebuli revmatiuli cxelebis SemTxvevaSi (karditis CaTvliT) naCvenebia aspirini antianTebiTi dozebiT, prednizonis CarTva saWiroa garTulebuli karditisa da gulis dazianebis SemTxvevaSi Aspirin (Anacin, Ascriptin, Bayer Aspirin) 100mg/kg-day ganawilebuli 4-5 dozad sastarto doza - 80-100 mg/kg/d PO 4-6 sT-Si erTxel – ori kviris ganmavlobaSi. gagrZeldes 60-70mg/kg-dReSi 3-6 kviris ganmavlobaSi) gaumjobesebis SemTxvevaSi gagrZeldes 20-25mg/kg dReSi sanam yvela maCvenebeli ar daubrundeba normas. aspirinze alergiis SemTxvevaSi, naproxen (10n20mg/kg-dReSi) 2013 weli 61 Prednisone (Deltasone, Orasone) 2 mg/kg/d PO 2-4 kvira. saSualo da Zlieri karditis dros, rodesac vlindeba kardiomegalia, an mesame xarisxis gulis ukmarisoba, saWiroa 2 mg/kg/dReSi prednizonis CarTva. salicilatebTan erTad prednizoniT Terapia unda gagrZeldes 2-4 kviris ganmavlobaSi,. Terapiis bolo kviris Sedegebis mixdviT. prednizoniT Terapiis gagrZeleba an Canacvleba salicilatebiT 2 kviris Semdeg xels Seuwyobs gverdiTi efeqtebis minimizirebas. gaxangrZlivebis SemTxvevaSi doza unda Semcirdes kviraSi 20-25%-iT b) II alternativa penicilinis mimarT alergiul pacientebSi eriTromicini - Erythromycin (E.E.S., E-Mycin, Eryc, Ery-Tab, Erythrocin) SesaZlebelia klaritromicinis, azitromicinis an viwro speqtris cefalosporinebis(cefaleqsinis) CarTva, Tumca penicilinze alergiul pacientTa 15% alergiulia cefalosporinebze. eriTromicini Base, erythromycin estolate, an ery t h rom y cin ste a ra te salts: 20-40 mg/kg/dRe PO 10 dRis ganmavlobaSi; araumetes 1 g dReSi (ganawilebuli 2-4-jer) Etheylsuccinate salt: 40 mg/kg/dReSi (ganawilebuli 4-jer) 10 dRis ganmavlobaSi Clarithromycin (Biaxin) 7.5 mg/kg/dReSi PO ganawilebuli (2-jer dReSi) 10 dRis ganmavlobaSi Azithromycin (Zithromax) 12 mg/kg/dReSi (araumetes 500 mg) PO ganawilebuli (2-jer dReSi) 5 dRis ganmavlobaSi Cephalexin (Keflex, Biocef, Keftab) 25-50 mg/kg/dReSi ganawilebuli 3-jer dReSi PO 10 dRis ganmavlobaSi. g) gansakuTrebuli SemTxveva (garTulebis mkurnaloba) myari gulis ukmarisobis mkurnaloba gulis ukmarisoba gulis revmatiuli daavadebis dros dakavSirebulia nawilobriv mitraluri da aortuli sarqvlebis naklovanebasTan da nawilobriv pankarditTan, Terapia Sedgeba inotropuli saSualebebisa da Sardmdenebis (furosemide, spironolactone) kombinaciisagan Digoxin (Lanoxin, Lanoxicaps) dRenakl axalSobilebSi: 2030 mkg/kg PO dResrul axalSobilebSi: 25-35 mkg/kg PO 1 Tvidan 2 wlamde: 35-60 mkg/kg PO 2-5 weli: 30-40 mkg/kg PO 5-10 weli: 20-35 mkg/kg PO danarTi 1. eqokardiografiuli algoriTmi 62 danarTi 2. diagnostikis algoriTmebi >10 welze: pirveli 24 sT-is ganmavlobaSi – pirveli doza maqsimaluri dozis naxevari, meore doza 8 sT-is Semdeg - maqsimaluri dozis 1/4 kidev 8 sTis Semdeg. maqsimaluri doza(TDD - Total digitalizing dose): 0.75-1.5 mg PO ,fdidsf rfhlbjkjubf Si PO ganawilebuli 2-3 dozad; araumetes 0.15 mg/kg/dReSi 12 wlis zemoT 0.5-2mg. progresis maCveneblebi temperaturis, laboratoriuli maCveneblebis normalizeba, klinikuri niSnebis Semcireba da gaqroba. regresis maCveneblebi klinikuri niSnebis gaZliereba, axali Suilebis warmoqmna, gulis ukmarisoba, sarqvlebis naklovanebis Camoyalibeba. reabilitacia da dakvirveba aucilebelia rekurentuli faringitis da revmatiuli cxelebis profilaqtika, revmatiuli karditis yoveli epizodi iwvevs sarqvlebis dazianebis gaRrmavebas. aseTi pacientebisTvis, stomatologiuri an qirurgiuli mkurnalobis Catarebis SemTxvevaSi rekomendebulia baqteriuli endokarditis prevencia antibiotikebiT baqteriuli endokarditis profilaqtika. Amoxicillin (Amoxil, Biomox, Trimox) 50 mg/kg 1-jerad PO doza kbilis mkurnalobamde an qirurgiamde 1 sT-iT adre. auci le be lia mit ra lu ri stenozis, pulmonuri hi pertenziis, ariTmiis da gulis ukmarisobis monitoringi monitoringis samizneebi: pacientebi gadatanili revmatiuli cxelebiT. antibiotiko profilaqtika unda gagrZeldes: karditisa da gulis sarqvlebis dazianebisas – 10 wlis man- 1. pirveli niSani qorea SemanarCunebeli dozebia: dRenakl axalSSobilebSi 5-7.5 mkg/kg/d PO ganawilebuli dResrul axalSobilebSi: 6-10 mkg/kg/d PO ganawilebuli 1 Tvidan 2 wlamde: 10-15 mkg/kg/d PO ganawilebuli 2-5 weli: 7.5-10 mkg/kg/d PO ganawilebuli 5-10 weli: 5-10 mkg/kg/dReSi PO ganawilebuli 2-jer dReSi >10 welze::: 0.125-0.5 mg PO 12 sTSi erTxel Captopril (Capoten) sastarto doza: 0.1-0.5 mg/kg/dReSi PO ganawilebuli 2 dozad; ti piuri 1-2 mg/kg/dReSi PO ganawilebuli 2-3 dozad; Furosemide (Lasix) 1-2 mg/kg/dose PO/IV/IM 6-24sTSi erTxel Spironolactone (Aldactone) 2-4 mg/kg/dReSi maqsimum 100200mg dReSi. PO ganawilebuli 2-3 dozad. qoreis SemTxvevaSi Neuroleptic agents haloperidol 3 wlamde ar aris naCvenebi 3-12 weli – sawyisi - 05 mg/kg/dReSi an 0.25-0.5 mg/dReSi PO ganawilebuli, SeiZleba gaizardos 0.25-0.5 mg/dReSi PO 57dRis ganmavlobaSi gagrZeleba: 0.05-0.15 mg/kg/dRe2013 weli ,fdidsf rfhlbjkjubf Zilze ukanaskneli epizodidan da 40 wlis asakamde (potenciurad mTeli sicocxlis manZilze); karditis SemTxvevaSi sarqvlebis dazianebis gareSe – 10 wlis manZilze ukanaskneli epizodidan - minmum 21 wlis asakamde; karditis gareSe – 5 wlis manZilze ukanaskneli epizodidan - minimum 21 wlis asakamde. regresis maCvenebeli: klinikuri niSnebis gaZliereba, axali Suilebis warmoqmna, gulis ukmarisoba, sarqvelebis naklovanebis Camoyalibeba. prognozi: mitraluri regurgitaciis mqone pacientebidan profilaqtikuri mkurnalobis Semdeg Suili rCeba 30%-Si. aortuli regurgitaciis mqone pirebSi Sedegebi ifro dabalia. mitraluri stenozi namkurnaleb pacientTa mcire nawils uvi- Tardeba. es is SemTxvevaSia, roca daavadeba mkurnalobas ar eqvemdebareba.sarqvlovani stenozuri ti pis dazianeba Cveulebriv revmatiuli cxelebis ganmeorebiTi epizodebis Sedegia. amitomac saWiroa meoradi profilaqtikis Catareba aseTi epizodebisagan pacientis dasacavad. reabilitacia da dakvirveba. aucilebelia rekurentuli faringitis da revmatiuli cxelebis profilaqtika, revmatiuli karditis yoveli epizodi iwvevs sarqvlebis dazianebis gaR -rmavebas. aseTi pacientebisaTvis stomatologiuri an qirurgiuli mkurnalobis Catarebis SemTxvevaSi rekomendirebulia baqteriuli endokarditis prevencia antibiotikebiT. aucilebelia mitraluri stenozis, pulmonuri hi pertenziis, ariTmiis da gulis ukmarisobis monitoringi. monitoringis samiznea: pacientebi gadatanili revmatiuli cxelebiT. adamianuri da materialur-teqnikuri resursi: mkurnaloba sasurvelia Catardes specializirebul klinikaSi; eqimi revmatologi, kardiologi, eqimi-eqoskopisti,eqTani, laboratoria, eqoskopi, kardiografi. revmatiuli cxeleba Proceedings of the Jones Criteria Workshop. Patricia Ferrieri and for the Jones Criteria Working Group. Members of the American Heart Association 2013 weli 63 pirveli niSani karditi Com mit tee. Cir cu la ti on November5,2002.p. 106;2521-2523 Rheumatic Heart Disease Screening by Echocardiography. Cir cu la ti on. 2009;120:663-668 Rheumatic Fever: Treatment & Medication Associate Professor of Pediatrics, Chief of Pediatric Cardiology and Medical Director of the Pediatric Heart Institute, University of Tennessee College of Medicine; Director of Cardiology and Endowed Chair for Excellence in Cardiology, St Jude Children’s Research Center Wake Forest University Medical CenterCUpdated: Feb 25, 2010 RHEUMATIC FEVER ANDRHEUMATIC HEART DISEASEReport of a WHO Expert Consultation Geneva, 29 Octobern1 November 2001 AHA Scientific Statement Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis (Circulation. 2009;119:1541-1551.) © 2009 American Heart Association, Inc. A Scientific Statement From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics* New Zealand Cardiovascular Guidelines HandbookCardiovascular risk factor management, Smoking cessation, Atrial ibrillation, Coronary heart disease, Stroke and transient ischaemic attack, Rheumatic fever, Prevention of infective endocarditis, Heart failure -2009 saZiebo sistemebi Medline, www. gu i de li ne.gov, www.cdc.gov. www. Docstoc.com en. Wikipedi. Org. www. Moernpublishing. Ge. Emedicine. Medscape. Com. Детская кардиология и ревматология Л.М. Беляева. Э.К. Хрустфпэва. Э.А. Колупаэва. ,fdidsf rfhlbjkjubf 64 reziume kidev erTxel mwvave revmatiuli cxelebis Sesaxeb profesori g.CaxunaSvili, r.svanaZe, med.doq. n.jobava /saqarTvelos bavSvTakardiologTa asociacia/ kidev erTxel gamaxvilebulia yuradeba, rom revmatiuli cxeleba ekonomiurad ganviTarebul qveynebSi bolo aTwleulebis mancilze mniSvnelovnad Semcirda da weliwadSi Seadgens 5 SemTxvevas yovel 100000 macxovrebelze. ganviTarebad qveynebSi ki avadobis maCvenebeli 26dan 116-mde meryeobs yovel 100000 macxovrebelze.upiratesad avaddebian bavSvebi da mozardebi 5-15 wlis asakSi, SeiZleba ganuviTardes axalSobilebs da zrdasrul asakis pirebs. CrdiloeT kavkasiaSi gamovlena 3-jer xSiria samxreTTan SedarebiT. sqesTa Tanafardoba; qali:mamakaci=3:1. dReisaTvis revmatiuli cxelebis evolucia Semdegi Tavisebure-bebiT xasiTdeba: daavadebis sixSiris zrdis tendenciiT ufros asakSi (20-30 weli), dune da latenturi mmimdinareobis SemTxveve-bis mateba, simptomebis mravalferovnebis kleba da monoorganuli dazianeba, gulis sarqvelebis dazianebis sixSiris kleba. SUMMARY ONCE AGAIN ABOUT ACUTE RHEUMATIC FEVER Proffesor G.CHAKHUNASHVILI, R.SVANADZE, MD. N.JOBAVA Georgian Pediatric Cardiology Association Once again attention should be paid that last few years rheumatic fever number has decreased in economically developed countries and embraces 5 occasions in every 100000 citizens. In less developed countries disease index is 26-116 in every 100000 citizens. Mostly it’s adults and children from 5-15 who get ill, but newborns and old people can also fall ill. Manifest is three times frequent in north Caucasus than in south. Correlation of sex – women : men=3:1. Today’s evolution of rheumatic fever peculiarities: The tendency of increased number of disease in elder ages (20-30), increased number of latent course, decreased number of symptoms and mono organic damage, decreased frequency of heart valves damage. rev ma to lo gi i sa da ar T ro lo gi is sa kiTxe bi g.CaxunaSvili,n.jobava,a.bliaZe,k.CaxunaSvili,d.CaxunaSvili saqarTvelos bavSvTa kardiologTa asociacia,ir.ciciSvilis sax.pediatriuli klinika,janmrTelobis centri reaqtiuli arTriti (reiteris daavadeba),(fisenJe-lerua, ureTro-okulo-sinovialuri sindromi ) warmoadgens infeqciis Semdgom ganviTarebul arTrits, romelic asocirdeba Chlamydia, Yersinia, Salmonella, Shigella da Campylobacter-iT gamowveuli urogenitalur an nawlavur infeqciebTan. aqvs imunokompleqsuri xasiaTi anu warmoiqmneba genetikurad ganwyobil pirebSi (im pacintebSi, romelTa genetikuri markeri HLA B27-ia) imunuri darRvevis Sedegad, makrofaguri sistemis mier antigen-antisxeulis kompleqsebis utilizaciis ukmarisobis gamo. Ddaavadebis klinikuri simpomebis polimorfizmi, mimdinareobis simZime da paTologiuri procesis qronizacia xerxemlis svetis saxsrebis monawileobiT upiratesad B27 antigenis mtarebel avadmyofebs aReniSnebaT. rea Sedis iuveniluri spondiloarTropaTiebis jgufSi, ar moicavs streptokokur da virusul arTritebs, liames daavadebas, romlebic miekuTvnebian infeqciur arTritebs. Cvens mier (saqarTvelos bavSvTa kardiologTa asociaciis, ir.ciciSvilis sax.pediatriuli klinikis da janmrTelobis centris) gaanalizebulia 2001-2013 ww-is 1500 kardio-revma- tologiuri profililis 3-dan 15wlamde bavSvebi.sadac lidev erTxel davrwmundiT,rom aucilebeli iyo gagvenxila arTritiT mimdinare daavadebebis marTvis princi pebi. Kkriteriumebi (berlinis diagnostikuri kriteriumebi (the international workshop on reaqtive artritis.1996, 1999): a) damadasturebeli klasikuri triada- saxsrebis tkivili, koniunqtiviti da urogenitaluri dazianeba. asimetriuli arTriti, oligoarTriti, ZiriTadad qvemo kidurebis. arTriti viTardeba infeqciis (ureTriti/cerviciti an diarea) gamovlinebidan 4 kviris ganmavlobaSi. trigeruli infeqciis laboratoriuli dadastureba. b) gamomricxavi sxva ti pis arTritis dadgenili diagnozi (spondiloarTriti, septiuri arTriti. Streptokokuri arTriti, laimes daavadeba). spondiloarTropaTiebi bavSvebSi qronikuli arTritis yvelaze erT-erTi yvelaze gavrcelebuli formaa. igi gvxvdeba qronikuli arTritiT daavadebuli bavSvebis daaxloebiT 30% SemTx2013 weli ,fdidsf rfhlbjkjubf vevaSi. ufro metad gvxvdeba vaJebSi, daavadebis upiratesad 10-dan 15 wlis asakamde dawyebisas. Ddaavadeba pirvelad aRwera 1916wels hans reiterma, aRwera SemTxveva germaneli oficrisa, romelsac daireis gadatanidan erTi kviris Semdgom gamouvlinda koniunqtiviti, Semdeg poliarTriti Tanmxlebi maRali cxelebiT. reiterisgan damoukideblad, igive movlenebi aRweres fisenJm da leruam enterokolitis epidemiis dros... rigi gamokvlevisas aRmoaCines infeqciuri agentebi aramxolod ureTris epiTelur qsovilSi an cervikalur arxSi, aramed sasaxsre qsovilSi( Shatkin 1973.). dafiqsirebuli iqna qlamidiuri arTriti( Sherbakov 1980). Subinma (1981w.) Seiswavla SemTxveva im pirebSi, romelTac anamnezSi hqondaT gonokokuri arTriti, magram arcerT SemTxvevaSi ar miuRia baqteriologiuri dadastureba gonokokuri infeqciisa arTritis ganviTarebaSi, piriqiT man aRmoaCina qlamidiuri infeqcia. urogenuri an enterogenuri sferos pirveladi infeqcia vrceldeba limfuri da hematogenuri gziT sxvadasxva organosa da qsovilSi, maT Soris sasaxsre qsovilSi da warmoadges organizmis imunuri gardaqmnis mTavar faqtors( Ilin.1975. Mowat 1978.). aRiniSna daavadebis mimdinareobis 2 paTogenezuri faza: infeqciuri (adreuli) da autoimunuri, ufro konkretulad imunopaTologiuri(mogvianebiTi). Kklinika - daavadeba iwyeba uxSiresad ureTritis niSnebiT. 1-4 kviris Semdeg vlindeba klasikuri triada. saxsrovani sindromi - arTriti vlindeba poliarTritiT 65%-Si, oligoarTritiT 29%-Si, monoarTritiT 6% SemTxvevaSi. procesi iwyeba uxSiresad mwvaved, xasiaTdeba periferiuli saxsrebis asimetriuli dazianebiT. ZiriTadad ziandeba sayrdeni saxsrebi(menj-barZayis, muxlis, koW-wvivis). Tumca erTvis mxris. idayvis da sxiv-majis saxsrebic. xSiria terfis ceris arTriti “fsevdopodagruli”, aseve falangTaSua saxsrebis anTeba difuzuri SesivebiT “sosisisebri”. garda periferiuli arTritisa vlindeba sakroileiti, pacientTa 50%-s awuxebs zurgis tkivili, Semcirebulia xerxemlis fleqsia. anu viTardeba xerxemlis svetis zeda nawilebis anTebiTi procesi-spondiloarTriti. Patologiuri procesis gaxangrZlivebisas SeiZleba warmoiqmnas xerxemlis malebs Soris e.w. xidebi(bambukis xerxemali). Tumca es pacientTa mcire ricxvs aReniSneba. bavSvebSi xSiria enTeziti, Cveulebriv dazianebuli anTezi lokalizebulia quslze, Sua terfsa da muxlze-kviristavis garSemo. yvelaze xSiri simptomebia quslis tkivili. Sua terfis Sesieba da tkivili. muxlis Tavebis tkivili. terfis iSviaTad mtevnis calkeuli TiTebis tendovaginiti, TiTis SesiebiT da molurjo-wiTeli SeferilobiT( sosisimgavsi TiTebi). enTezis qronikulma anTebam SeiZleba Zvlis wanazardebis(dezebis) gaCena gamoiwvios gansakuTeriT quslis areSi. damaxasiaTebelia tendinitebi, aqilobursiti, quslqveSa bursitis, quslis borcvis periostiti. Tvalis mxriv ormxrivi koniunqtiviti, siwiT2013 weli 65 le da mtkivneuloba viTardeba erTbaSad, kataruli movlenebi grZeldeba 1-2dRe, ris gamoc araxSirad daignostirdeba. axasiaTebs midrekileba recidivisken. 1/3 avadmyofSi viTardeba mwvave uveiti, romelmac SesaZloa R.D. Gatterall(1974) sibrmavec ki gamoiwvios. xSiria kanisa da lorwovanis Semdegi dazianebani: keratodermia-umtkivneulo fsoriazis msgavsi Keratoderma blennorrhagica xelisgulebze, iSviaTad gvxvdeba kvanZovani eriTema. frCxilebis mxriv viTardeba trofikuli cvlilebebi. frCxilebi sqeldeba da iSleba. gavs sokos an fsoriazul oniqodistrofias. keratodermia imdenad aris damaxasiaTebeli daavadebisTvis rom saubroben reiteris tetradis Sesaxeb. SesaZlebelia ganviTardes rgoliseburi balaniti. umtkivneulo laqebi sasaze, enasa da lorwovanze, zogjer loyebsa da tuCebze. mniSvnelovan daignostikur niSans warmoadgens swrafi ganviTareba kidurebis amiotrofiuli dazianebisa, rac mkurnalobis fonze swrafad lagdeba. Ddetaluri kvlevisas SesaZloa daignostirdes sistemuri gamovlinebebi, rogorc magaliTad riTmis gamtareblobis darRvevebi miokardis dazianebisas. Sidelnikovis (1984) monacemebiT gulis kunTis anTebiTi da distrofiuli cvlilebebi gvxvdeba 43% SemTxvevaSi. aortis sarqvlis naklovaneba imdenad mkveTrad aris gamoxatuli rom SesaZloa sarqvlis proTezirebaze dadges sakiTxi. aRiniSneba agreTve limfadenopaTia. paTologiur procesSi erTveba Tirkmlebi, vlindeba proteinuriiT da mikrohematuriiT. mZime qronikul SemTxvevaSi SeiZleba adgili hqondes amiloidozs an nefropaTias. nawlavuri gamovlinebidan gvaqvs wylulovani kolitis simptomatika. Ddaignostirdeba nevriti, encefalomieliti, nevrozi da fsiqozi…. Qqlamidiur infeqciasTan asocirebuli reiteris daavadeba bavSvebSi mimdinareobs waSlili klinikuri suraTiT, biWebs SeiZleba ganuviTardeT balaniti, inficirebuli sineqiebi. Fimozi. gogonebs vulviti. vulvovaginiti, leikocituria da an mikrohematuria. agreTve cistitis klinika. urogenitaluri traqtis dazianeba SeiZleba ramdenime kviriT win uswrebdes saxsrovan sindroms(uretriti/cerviciti, arTritamde 8 kviris ganmavlobaSi.) tvalebis dazianeba xasiaTdeba naklebad gamoxatuli, magram moricidive koniunqtivitiT, Tvalebis dazianeba aseve SeiZleba ramdenime kviriT win uswrebdes saxsrovan sindroms. Eeqsudaciuri arTriti qlamidiozuri etiologiis dros SeiZleba mimdinareobdes tkivilis da SeboWilobis gareSe, funqciis gamoxatuli darRvevis gareSe. magram didi raodenobiT eqsudaciuri siTxiT da uwyveti recidivebiT. Nnawlavur infeqciasTan asocirebuli reiteris daavadeba iwyeba mwvaved, aRiniSneba febriluri temperature, intoqsikacia, koniunqtiviti mimdinareobs mwvaved, SesaZlebelia skleritis klinikuri niSnebi, zogjer rqovanas wylulebiT. 12-37%-s uviTardeba uveiti. ureT- 66 riti mimdinareobs mwvaved da qvemwvaved(enteritis SeiZleba ganvitardes arTritamde 6kviris ganmavlobaSi). arTriti mimdinareobs gamoxatuli tkivilis sindromiT, saxsris defiguraciiT. Adgilobrivi temperaturis momatebiT da kanis hi peremiiT. Llaboratoriuli maCveneblebi :L Mmwvave stadiaze momatebulia eds-i(30mm/sTis ganmavlobaSi) da C reaqtiuli cila, aRiniSneba normoqromuli anemia da zomieri leikocitozi formulis marcxvniv gadaxriT. revmatoiduli faqtori da antinuklealuri antisxeuli ar dasturdeba, matulobs IgA baqteriuli antigenis mimarT, Sardis analizma SeiZleba aCvenos Cirqis Semcvleli aseptiuri Sardi. iSviaTad mikrohematuria, proteinuria. sinoviuri siTxis analizi aCvenebs polimorful-birTviani leikocitebis maRal Semcvlelobas. Nneitrofilebis Semcvleloba 1-50. 10/3 ml.. xSirad vlindeba fagocituri makrofagebi, aRiniSneba komplementis maRali titri. Sinovialuri qsovilis bioptatSi vlindeba AanTebiTi kerebi, limfocituri infiltracia qsovilis(Kopeva 1986). HLA-B27aRiniSneba pacientTa 60-80%-s. Eetiologiuri faqtoris identifikacia. rentgenologiuri niSnebi procesis adreul stadiaze rentgenologiuri cvlilebebi ar aRiniSneba, mogvianebiT Cans eroziebi da plantaruli dezebi. Ddazianebul saxsrebSi adgili aqvs anTebiT gadagvarebas da osteosklerozs, kidovani eroziebis da enTezebis regionSi adgili aqvs Zvlis proliferacias da peiostitebs. gaxangrZlivebuli arTritis dros Torakolumbalur regionSi aRiniSneba sidesmofitebi. SemTxvevaTa 5%-Si maankilozebeli spondiloarTriti. gansakuTerebiT mniSvnelovania gava-TeZos Sesaxsrebis upiratesad calmxrivi anTebiTi dazianeba(sakroileiti). gamoxatulia uxeSi asimetriuli paravertebraluri osifikaciebiparasindesmofitebi. diferencialuri diagnozi 1. urogenitalur an nawlavur infeqciasTan arTritis an koniunqtivitis qronologiuri kavSiri. 2. axalgazrda asaki( 16wlis asakamde dasawyisi) 3. upiratesad qvemo kidurebis saxsrebis mwvave asimetriuli arTriti. entesopaTia da quslis bursitis. 4. Sard-sasqeso sferos anTebiTi procesis niSnebi da qlamidiis identifikacia. 5. piris Rrus lorwovanis da kanis dazianeba 6. arTritis xangrZlivoba 6kviraze metxans 7.HLA-B27 antigenTan asociacia arTritis diferencialur-daignostikuri niSnebia (dj.Miort -2006w.) 1. pirveladi osteoporozi q:m _6:1 >50w. lokalizacia distalur falangTaSua saxsrebSi, iSviaTad proqsimalur fa- ,fdidsf rfhlbjkjubf langTaSua saxsrebSi. CarTva terfis didi TiTis saxsris, xerxemlis kisris, welis, menj-barZayis segmentebis da muxlis saxsris. saRamoTi tkivilis gaZliereba , mosvenebiT mdgomareobaSi Semcireba. 2. revmatoiduli arTriti q:m _3:1 30-50w. simetriuli arTriti. lokalizacia proqsimalur falangTaSua saxsrebSi. tkivilis gaZliereba mosvenebiT mdgomareobaSi, moZraobisas Semcireba. Ddilis SeboWiloba. Sinagani organoebis dazianeba. 3. sistemuri wiTeli mglura q:m _9:1 15-35w. si met ri u li ar T ri ti. Llokalizacia falangTaSua saxsrebSi. saerTo niSnebi: cxeleba, medikamentebis autanloba, gamonayari(80%), plevriti(67%), reinos sindromi, Sinagani organoebis dazianeba. 4. sistemuri sklerodermia q:m _3:1 20-50w. simetriuli artriti. falangTaSua saxsrebis dazianeba. reinos sindromi(90%), kanis dazianeba, disfagia. 5. virusuli arTritebi(aiv-infeqciis garda) gamovlineba Tanabrad orive sqessa da ZiriTadad bavSvTa asakSi. ziandeba proqsimaluri falangTaSua saxsrebi. axasiaTebs procesis swrafi alageba, cxeleba, gamonayari. 6. maankilozebeli spondiloarTriti q:m _3:1 18-30w. xerxemlis gansakuTrebiT welis segmentis dazianeba, CarTva mkerdis da neknis saxsrebis. iridocikliti, fasciiti, neknebis moZraobis darRveva. 7. fsoriazuli arTriti gamovlineba nebimier asakSi. lokalizacia distalur falangTaSua saxsrebSi. gamonayari, TiTebi “sosisis msgavsi”, frCxilebze “ormoebi”. 8. nawlavur infeqciebTan dakavSirebuli arTritebi gamovlineba nebismier asaksa da orive sqesSi. menj-barZayis muxlis saxsris, koW-wvivis saxsrebis dazianeba. wylulovani kolitis da kronis niSnebi. 9. reqtiuli arTriti q:m _20:1 menj-barZayis, muxlis, koW-wvivis saxsrebSi lokalizacia, CarTva idayvis da sxivmajis saxsrebis. arTrits win uZRvis nawlavuri an saSarde gzebis infeqcia. enTezitebi. 10. Ppodagra Qq:m _20:1 >40w. cera TiTis saxsris dazianeba da sxva fexis saxsris. kristaluri uratebi sinovialur siTxeSi, hi perurikemia, tofusebi. 11. Ffsevdopodagra vlindeba orive sqesis pirebSi, >60w. ziandeba muxlis saxsari. kalciumis pirofosfatis dihidratis kristalebi sinovialu siTxeSi. 12. revmatuli polimialgia q:m -3:1 >60w. dilis SeboWiloba da tkivili mxris da welis areSi. saxsrebi dazianebuli araa an vlindeba osteoarTrozi. Eedsis mniSvnelovani momateba. 2013 weli ,fdidsf rfhlbjkjubf mkurnaloba antibiotikebi trigeruli infeqciis kerebis gamovlenis SemTxvevaSi saWiroa antibiotikoTerapia Sesabamisi baqteriebis mimarT eradikaciamde. mwvave nawlavur infeqciebTan dakavSirebuli rea-s dros antimikrobuli Terapia ar aris efeqturi. aziTromicini - Ziromin 5dRe Wamamde 1saaTiT adre 12mg\kg dReSi X1 doqsiciklini - Unidox Solutab (ureTritis an cervicitis dros) 8-12wlis bavSvebi 50-ze naklebi woniT saSualo dRiuri doza 4mg\kg pirvel dRes,Semdeg 2mg\kg dReSi(1-2 miRebaze), 50kgze meti woniT iniSneba 200mg 1-2 miRebaze pirvel dRes,Semdeg 100mg yoveldRiurad. 5-10dRe Aarasteroiduli antianTebiTi preparatebi Ddiklofenaki - Olfen 50mg tb 0,5-2mg/kg 2-3 jer dReSi 21dRe antihistaminuri preparatebi desloratadini Eslotin 5mg 6-dan 11-Tvemde 1mg dRe-RameSi, 1-dan 5wlamde 1,25mg X1, 6-dan 11-wlamde 2,5mg X1. 12wlis asakze ufros mozardebSi 5mg X1 wylis miyolebiT dauReWavad 1Tvis ganmavlobaSi. naCvenebia adgilobrivi moqmedebis glukokortikoidebi Hidrocortizone 1-2.5% kremi; dazianebul kanze wasma dReSi 3-4-jer. Salicylic acid 10% kremi; gamoiyeneba aplikacia dRSi orjer dazianebul kanze an lorwovanze. aucilebelia mkurnalobis kompleqsSi vitaminebis CarTva. gamoiyeneba fitopreparatebi-naturaluri srulfasovani kompleqsi vitaminebis , mineralebis da aminomJavebis. apiviti, apikori, api pulmo da apihepati. sasurvelia maTi kombinacia L karnitinTan romelic uzrunvelyofs miokardsa da sxva qsovilebs atf-is saWiro raodenobiT. Se- 2013 weli 67 nelebuli moqmedebis antirevmatuli saSualebebi (torpidulad mimdinaremdgradi arTritebis SemTxvevaSi) sulfasalazini 2wlamde bavSvebSi naCvenebi ar aris. 2wlis zemoT asakSi 10-15mg\kg\d sawyisi, 4kviris Semdeg gavzardoT doza 30-50 mg\kg\dReSi PO ganawilebuli; araumetes 2g\d (1kvira araumetes 0.5g\d, 2 kvira 1g\d, 3kvira- 1.5g\d; 4kvira-2g\d) mkurnaloba unda gagrZeldes 3-6Tve dozis TandaTanobiT SemcirebiT. Aaucilebelia Trombocitebis, leikocitebis, eriTrocitebis kontroli. progresis maCveneblebi: laboratoriuli maCveneblebis normalizeba. klinikuri niSnebis Semcireba da gaqroba. reabilitacia naCvenebia samkurnalo varjiSebi. Mmcire datvirTviT siaruli, velosporti, curva. Kkardialuri problemebis dros saWiroa pulsis da ekg-s mudmivi kontroli. Aaucilebelia zogadi profilaqtikuri RonisZiebebi nawlavuri da urogenitaluri infeqciebis Tavidan asacileblad. maSasadame, revmatologiisa da arTrologiis sakiTxebi bavSvTa da mozardTa asakSi Tanamedrove pediatriaSi erTerT umniSvnelovanes sakiTxebad rCeba. teqstsa da algoriTmebSi gamoyenebuli Semoklebebi: ra- revmatoiduli arTriti; rev- revmatiuli arTriti. fa- fsoriazuli arTriti; reareaqtiuli arTriti; ms- maankilozebeli arTriti; naa- nawlavebis daavadebasTan asocirebuli arTriti; ia- infeqciuri arTriti; oaosteoarTrozi; pd- podagra; fpd- fsevdopodagra; bs- bexCetis sindromi; ss- stilis sindromi; swm- sistemuri wiTeli mglura; ssksistemuri sklerodermia; ta-tuberkulozuri arTriti; rf- revmadoiduli faqtori; hm- hemoragiuli vaskuliti. 68 ,fdidsf rfhlbjkjubf 2013 weli ,fdidsf rfhlbjkjubf 69 reziume revmatologiisa da arTrologiis sakiTxebi g.CaxunaSvili,n.jobava,a.bliaZe,k.CaxunaSvili,d.CaxunaSvili saqarTvelos bavSvTa kardiologTa asociacia, ir.ciciSvilis sax.pediatriuli klinika,janmrTelobis centri Cvens mier (saqarTvelos bavSvTa kardiologTa asociaciis, ir.ciciSvilis sax.pediatriuli klinikis da janmrTelobis centris) gaanalizebulia 2001-2013 ww-is 1500 kardio-revmatologiuri profilis 3-dan 15wlamde bavSvebi.sadac kidev erTxel davrwmundiT,rom aucilebeli iyo gagvenxila arTritiT mimdinare daavadebebis marTvis princi pebi. maSasadame, revmatologiisa da arTrologiis sakiTxebi bavSvTa da mozardTa asakSi Tanamedrove pediatriaSi erTerT umniSvnelovanes sakiTxebad rCeba. SUMMARY QUESTIONS OF RHEUMATOLOGY AND ARTHROLOGY G.CHAKHUNASHVILI, N.JOBAVA, A.BLIADZE, K.CHAKHUNASHVILI, D.CHAKHUNASHVILI Georgian Pediatric Cardiology Association, Pediatric Clinic named after I.Cicishvili, Health Centre. We (Georgian Pediatric Cardiology Association, Pediatric Clinic named after I.Cicishvili, Health Centre) analyzed 1500 children (3-15 years old) with cardio-rheumatologic disease from 2001-2013. We can say with confidence that we should have discussed the governing principles of diseases with progression of arthritis. So, rheumatology and arthrology in children and adults remains as one of the main questions of contemporary pediatrics. kodebi revmatologiaSi M45 მაანკილოზებელი სპონდილიტი ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსიახერხემლის რევმატოიდული ართრიტი M46 სხვა ანთებითი სპონდილოპათიები [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] M46.0 ხერხემლის ენთესოპათია ხერხემლის იოგების ან კუნთების მიმაგრების დაზიანებები M46.1 საკროილეიტი, რომელიც არ არის კლასი ფიცირებული სხვა რუბრიკებשი M46.2 ხერხემლის ოსტეომიელიტი M46.3 მალთაשუა დისკების ინფექცია (პიოგენური) M46.4 დისციტი (მალთაשუა დისკის ანთება), დაუზუსტებელი M46.5 სხვა ინფექციური სპონდილოპათიები M46.8 სხვა დაზუსტებული ანთებითი სპონდილოპათიები M46.9 ანთებითი სპონდილოპათია, დაუზუსტებელი M47 სპონდილოზი თუ გსურთ დააზუსტოთ ინფექციური აგენტი გამოიყენეთ დამატებითი კოდი (B95-B97) ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია M47.0 + წინა სპინალური და ხერხემლის არტერიის კომპრესიის სინდრომი (G99.2*) M47.1 სხვა სპონდილოზები მიელოპათიასთან ერთად M47.2 სხვა სპონდილოზები რადიკულოპათიასთან ერთად 2013 weli ზურგის ტვინის სპონდილოგენური კომპრესია+ (G99.2*)† 70 ,fdidsf rfhlbjkjubf M47.8 სხვა სპონდილოზები M47.9 სპონდილოზი, დაუზუსტებელი M48 სხვა სპონდილოპათიები [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] M48.0 სპინალური სტენოზი კაუდალური სტენოზი M48.1 მაანკილოზებელი ჰიპეროსტოზი (ფორესტიეს) ჩონჩხის დიფუზური იდიოპათიური ჰიპეროსტოზი [DISH] M48.2 “მკოცნავი” მალები (მალის ძვლოვანი მორჩების დეფორმაცია, მათი ერთმანეთზე ზეწოლის გამო, მიზეზი - წელის ლორდოზი) M48.3 ტრავმული სპონდილოპათია M48.4 ხერხემლის მოტეხილობა, გამოწვეული გადაღლით მალის სტრესული მოტეხილობა M48.5 მალის რღვევა, რომელიც არ არის კლასიფიცირებული სხვა რუბრიკებשი რღვევა, რომელიც სხვაგვარად არ არის დაზუსტებულიჩაჭედილი მალა, რომელიც სხვაგვარად არ არის დაზუსტებული M48.8 სხვა დაზუსტებული სპონდილოპათიები უკანა გასწვრივი იოგის ოსიფიკაცია M48.9 სპონდილოპათია, დაუზუსტებელი M49.0* ხერხემლის ტუბერკულოზი (A18.0+) M49.1* ბრუცელოზური სპონდილიტი (A23.-+) M49.2* ენტერობაქტერიული სპონდილიტი (A01-A04+) M49.3* სპონდილოპათია სხვა ინფექციური და პარაზიტული ავადმყოფობების დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M49.4* ნეიროპათიური სპონდილოპათია ნეიროპათიკური სპონდილოპათია: . სირინგომიელიისა და სირინგობულბიის დროს (G95.0+) . ზურგის ტვინის ტაბესის დროს (A52.1+) M49.5* ხერხემლის რღვევა იმ ავადმყოფობათა დროს, რომლებიც שეტანილია სხვა რუბრიკებשი მალის მეტასტაზური მოტეხილობა (C79.5+) M49.8* სპონდილოპათია სხვა ავადმყოფობათა დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M50 კისრის სეგმენტის მალთაשუა დისკების დაზიანებები M50.0† კისრის სეგმენტის მალთაשუა დისკების დაზიანება მიელოპათიასთან ერთად (G99.2*) M50.1 კისრის სეგმენტის მალთაשუა დისკების დაზიანება რადიკულოპათიასთან ერთად M50.2 კისრის სეგმენტის მალთაשუა დისკების სხვა ცდომები M50.3 კისრის სეგმენტის მალთაשუა დისკების სხვა დეგენერაცია M50.8 კისრის სეგმენტის მალთაשუა დისკების სხვა დაზიანებები M50.9 კისრის სეგმენტის მალთაשუა დისკების დაზიანება, დაუზუსტებელი M51 სხვა სეგმენტების მალთაשუა დისკების დაზიანებები M51.0 + წელის და სხვა მალთაשუა დისკების დაზიანებანი მიელოპათიასთან ერთად (G99.2*) M51.1 წელის და სხვა მალთაשუა დისკების დაზიანებანი რადიკულოპათიასთან ერთად იשიაზი გამოწვეული მალთაשუა დისკების დაზიანებით M51.2 მალთაשუა დისკების სხვა დაზუსტებული ცდომა ლუმბაგო გამოწვეული მალთაשუა დისკების ცდომით პოტის კუზი 2013 weli ,fdidsf rfhlbjkjubf 71 M51.3 მალთაשუა დისკების სხვა დაზუსტებული დეგენერაცია M51.4 שმორლის კვანძები (თიაქარი) M51.8 მალთაשუა დისკების სხვა დაზუსტებული დაზიანებები M51.9 მალთაשუა დისკების დაზიანებები, დაუზუსტებელი M53 სხვა დორსოპათიები, რომლებიც არ არის שეტანილი სხვა რუბრიკებשი [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] M53.0 ქალა-კისრის სინდრომი უკანა კისრის სიმპატიკური სინდრომი M53.1 მხარ-კისრის სინდრომი M53.2 არამდგრადი ხერხემალი M53.3 გავა-კუდუსუნის დაზიანებანი, რომლებიც არ არის שეტანილი სხვა რუბრიკებשი M53.8 სხვა დაზუსტებული დორსოპათიები M53.9 დორსოპათია, დაუზუსტებელი M54 დორსალგია (ზურგის ტკივილი) M54.0 პანიკულიტი, რომელიც აზიანებს ხერხემლის კისრის და ზურგის სეგმენტებს M54.1 რადიკულოპათია M54.2 ცერვიკალგია (კისრის ტკივილი) M54.3 იשიასი M54.4 ლუმბაგო იשიასთან ერთად M54.5 ზურგის ქვემო ნაწილის ტკივილი M54.6 ტკივილი ხერხემლის გულმკერდის სეგმენტשი M54.8 სხვა დორსალგია M54.9 დორსალგია, დაუზუსტებელი ზურგის ტკივილი, რომელიც სხვაგვარად არ არის დაზუსტებული M60 მიოზიტი [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] M60.0 ინფექციური მიოზიტი თუ გსურთ დააზუსტოთ ინფექციური აგენტი გამოიყენეთ დამატებითი კოდი (B95-B97) M60.1 ინტერსტიციული მიოზიტი M60.2 უცხო სხეულის მოხვედრით გამოწვეული რბილი ქსოვილის გრანულომა, რომელიც არ არის שეტანილი სხვა რუბრიკებשი M60.8 სხვა მიოზიტები M60.9 მიოზიტი, დაუზუსტებელი M61 კუნთის კალციფიკაცია და ოსიფიკაცია M61.0 მაოსიფიცირებელი მიოზიტი, ტრავმული M61.1 მაოსიფიცირებელი მიოზიტი, პროგრესული პროგრესული ფიბროდისპლაზია ოსიფიკაციით M61.2 კუნთის პარალიზური კალციფიკაცია და ოსიფიკაცია ოსიფიკაციური მიოზიტი, שერწყმული ტეტრაპლეგიასთან ან პარაპლეგიასტან 2013 weli კოქციგოდინია (კუდუსუნის ტკივილი) [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] ნევრიტი ან რადიკულიტი . მხრის, რომელიც სხვაგვარად არ არის დაზუსტებული . წელის, რომელიც სხვაგვარად არ არის დაზუსტებული . გავა-წელის, რომელიც სხვაგვარად არ არის დაზუსტებული. გულმკერდის, რომელიც სხვაგვარად არ არის დაზუსტებული რადიკულიტი, რომელიც სხვაგვარად არ არის დაზუსტებული წელის ტკივილიზურგის ქვემო ნაწილის დაჭიმულობალუმბაგო, რომელიც სხვაგვარად არ არის დაზუსტებული [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] ,fdidsf rfhlbjkjubf 72 M61.3 კუნთის კალციფიკაცია და ოსიფიკაცია, დამწვრობასთან დაკავשირებული ოსიფიკაციური მიოზიტი, დამწვრობასთან დაკავשირებული M61.4 კუნთის სხვა კალციფიკაცია M61.5 კუნთის სხვა ოსიფიკაცია M61.9 კუნთის კალციფიკაცია და ოსიფიკაცია, დაუზუსტებელი M62 კუნთების სხვა დაზიანებები M62.0 კუნთის დისოციაცია M62.1 კუნთის სხვა გაგლეჯა (არატრავმული) M62.2 კუნთის იשემიური ინფარქტი M62.3 იმობილიზაციის სინდრომი (პარაპლეგიური) M62.4 კუნთის კონტრაქტურა M62.5 კუნთის გამოფიტვა და ატროფია, რომელიც არ არის שეტანილი სხვა რუბრიკებשი უმოქმედობითი ატროფია, რომელიც არ არის שეტანილი სხვა რუბრიკებשი M62.6 კუნთის დეფორმაცია კუნთის (ფასციური ბუდის) თიაქარი M62.8 კუნთის სხვა დაზუსტებული დაზიანებები M62.9 კუნთის დაზიანება, დაუზუსტებელი M63* კუნთების დაზიანებები იმ ავადმყოფობათა დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M63.0* მიოზიტი იმ ბაქტერიული ავადმყოფობების დროს, რომლებიც שეტანილია სხვა რუბრიკებשი მიოზიტი: . კეთრის დროს (ჰანსენის ავადმყოფობა) (A30.-+) . ათაשანგის დროს (A51.4+, A52.7+) M63.1* მიოზიტი იმ პროტოზოული და პარაზიტული ინფექციების დროს, რომლებიც שეტანილია სხვა რუბრიკებשი მიოზიტი שემდეგი მდგომარეობების დროს: . ცისტიცერკოზი (B69.8+) . שისტოსომოზი [ბილგარციოზი] (B65.-+) . ტოქსოპლაზმოზი (B58.8+). ტრიქინელოზი (B75+) M63.2* მიოზიტი სხვა ინფექციური ავადმყოფობების დროს, რომლებიც שეტანილია სხვა რუბრიკებשი მიოზიტი მიკოზის დროს (B35-B49+) M63.3* მიოზიტი სარკოიდოზის დროს (D86.8+) M63.8* კუნთის სხვა დაზიანებები იმ ავადმყოფობების დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M65 სინოვიტი და ტენოსინოვიტი [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] M65.0 მყესის ბუდის აბსცესი M65.1 სხვა ინფექციური (ტენო) სინოვიტები თუ გსურთ დააზუსტოთ ბაქტერიული აგენტი გამოიყენეთ დამატებითი კოდი (B95-B96) M65.2 ტენდინიტი გაკირვით M65.3 კაუჭისებრი თითი M65.4 სხივის ძვლის სადგისისებრი მორჩის ტენოსინოვიტი [დე კერვენის სინდრომი] M65.8 სხვა სინოვიტი და ტენოსინოვიტი M65.9 სინოვიტი და ტენოსინოვიტი, დაუზუსტებელი M66 სინოვიური გარსებისა და მყესების მთლიანობის სპონტანური დარღვევა M66.0 მუხლქვეשა კისტის მთლიანობის დარღვევა M66.1 სინოვიური გარსის მთლიანობის დარღვევა M66.2 გამשლელი მყესის მთლიანობის სპონტანური დარღვევა M66.3 მომხრელი მყესის მთლიანობის სპონტანური დარღვევა M66.4 სხვა მყესების მთლიანობის სპონტანური დარღვევა [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] მყესის კვანძოვანი ავადმყოფობა [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] სინოვიური კისტის მთლიანობის დარღვევა 2013 weli ,fdidsf rfhlbjkjubf 73 M66.5 მყესის მთლიანობის სპონტანური დარღვევა, დაუზუსტებელი M67 სინოვიური გარსისა და მყესის სხვა დაზიანებები M67.0 მოკლე აქილევსის მყესი (שეძენილი) M67.1 მყესის (ბუდის) სხვა კონტრაქტურა M67.2 სინოვიური გარსის ჰიპერტროფია, რომელიც არ არის שეტანილი სხვა რუბრიკებשი M67.3 მომიგრირე სინოვიტი ტოქსიური სინოვიტი M67.4 განგლიონი სახსრის ან მყესის (ბუდის) განგლიონი M67.8 სინოვიური გარსისა და დაზუსტებული დაზიანებები M67.9 სინოვიური გარსისა და მყესის დაზიანებები, დაუზუსტებელი M68* სინოვიური გარსისა და მყესის დაზიანებანი იმ ავადმყოფობათა დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M68.0* სინოვიტი და ტენოსინოვიტი იმ ბაქტერიული ავადმყოფობების დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M68.8* სინოვიური გარსისა და მყესის სხვა დაზიანებანი იმ ავადმყოფობათა დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M70 რბილი ქსოვილის ავადმყოფობები დაკავשირებული დატვირთვასთან, გადატვირთვასთან და ზეწოლასთან M70.0 მტევნისა და მაჯის ქრონიკული კრეპიტაციული სინოვიტი M70.1 მტევნის ბურსიტი M70.2 იდაყვის მორჩის ბურსიტი M70.3 იდაყვის სახსრის სხვა ბურსიტი M70.4 კვირისთავის წინა ბურსიტი M70.5 მუხლის სახსრის სხვა ბურსიტი M70.6 ბარძაყის ძვლის ციბრუტის ბურსიტი ბარძაყის ძვლის ციბრუტის ტენდინიტი M70.7 მენჯ-ბარძაყის სახსრის სხვა ბურსიტები იשიასური ბურსიტი M70.8 რბილი ქსოვილის სხვა დაზიანებები დაკავשირებული დატვირთვასთან, გადატვირთვასთან და ზეწოლასთან M70.9 რბილი ქსოვილის დაზიანებანი დაკავשირებული დატვირთვასთან, გადატვირთვასთან და ზეწოლასთან, დაუზუსტებელი M71 სხვა ბურსოპათიები M71.0 სინოვიური ჩანთის აბსცესი M71.1 სხვა ინფექციური ბურსიტი M71.2 სინოვიური კისტა, მუხლქვეשა უბნის [ბეიკერის] M71.3 სინოვიური ჩანთის სხვა კისტები M71.4 კალციუმის ჩალაგება სინოვიურ ჩანთაשი M71.5 სხვა ბურსიტი, რომელიც არ არის שეტანილი სხვა რუბრიკებשი M71.8 სხვა დაზუსტებული ბურსოპათიები 2013 weli მყესის მყეს-კუნთოვანი კავשირის მთლიანობის დარღვევა, არატრავმული სხვა სინოვიტი ან ტენოსინოვიტი שემდეგი ავადმყოფობების დროს:. გონორეა (A54.4+) . ათაשანგი (A52.7+) . ტუბერკულოზი (A18.0+) [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] სინოვიური კისტა, რომელიც სხვაგვარად არ არის დაზუტებული 74 ,fdidsf rfhlbjkjubf M71.9 ბურსოპათია, დაუზუსტებელი ბურსიტი, რომელიც სხვაგვარად არ არის დაზუსტებული M72 ფიბრობლასტური დაზიანებები M72.0 ხელის გულის ფასციის ფიბრომატოზი [დიუპიუიტრენის] M72.1 ხელის თითების თანდაყოლილი კვანძოვანება M72.2 ფეხის გულის ფასციის ფიბრომატოზი M72.4 ფსევდოსარკომატოზული ფიბრომატოზი M72.5 ფასციიტი, რომელიც არ არის שეტანილი სხვა რუბრიკებשი M72.8 სხვა ფიბრობლასტური დაზიანებანი M72.9 ფიბრობლასტური დაზიანებები, დაუზუსტებელი M73* რბილი ქსოვილის დაზიანებები იმ ავადმყოფობათა დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M73.0* გონოკოკური ბურსიტი (A54.4+) M73.1* სიფილისური (ათაשანგური) ბურსიტი (A52.7+) M73.8* რბილი ქსოვილის სხვა დაზიანებანი იმ ავადმყოფობათა დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M75 მხრის დაზიანებები M75.0 მხრის ადჰეზიური (שეხორცებითი) კაფსულიტი "გაყინული მხარი" მხრის პერიართრიტი M75.1 მხრის როტაციულ კუნთზე ზეწოლის სინდრომი ზეწოლა როტაციულ კუნთზე ან ძვლის საზრდელას დეფექტი ან მთლიანობის დარღვევა (სრული) (არასრული) დაუზუსტებელი, როგორც ტრავმულიძვლისაზრდელის ქედზედა სინდრომი M75.2 ორთავა კუნთის ტენდინიტი M75.3 მხრის გაკირული ტენდინიტი M75.4 მხრის დარტყმის სინდრომი M75.5 მხრის ბურსიტი M75.8 მხრის სხვა დაზიანებანი M75.9 მხრის დაზიანება, დაუზუსტებელი M76 ქვედა კიდურის ენთესოპათიები, გარდა ტერფისა M76.0 დუნდულოს კუნთის ტენდინიტი M76.1 სუკის კუნთის ტენდინიტი M76.2 თეძოს ქედის წანაზარდი M76.3 თეძო-წვივის დამაკავשირებელი სტრუქტურების დაჭიმულობის სინდრომი M76.4 წვივის კოლატერალური ბურსიტი [პელეგრინიשტიდის] M76.5 კვირისთავის ტენდინიტი M76.6 აქილევსის მყესის ტენდინიტი [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] ფეხის გულის ფასციიტი [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] მხრის გაკირული სინოვიური ჩანთა [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] שენიשვნა: ტერმინები: “ბურსიტი”, “კაფსულიტი” და “ტენდინიტი” გამოიყენება პერიფერიული იოგების და მყესების სხვადასხვა დაზიანებების აღსანიשნავად, მკვეთრი დიფერენციაციის გარეשე; ყველა მდგომარეობა გაერთიანებულია ტერმინשი “ენთესოპათიები”, რაც ამ სახის დაზიანებათა საერთო დასახელებაა. აქილევსის მყესის ბურსიტი 2013 weli ,fdidsf rfhlbjkjubf 75 M76.7 მცირე წვივის ძვლის ტენდინიტი M76.8 ქვედა კიდურის სხვა ენთესოპათიები, გარდა ტერფისა M76.9 ქვედა კიდურის ენთესოპათიები, დაუზუსტებელი M77 სხვა ენთესოპათიები M77.0 მედიალური ეპიკონდილიტი M77.1 ლატერალური ეპიკონდილიტი M77.2 მაჯის პერიარტერიიტი M77.3 ქუსლის ძვლის დეზი M77.4 მეტატარზალგია M77.5 ტერფის სხვა ენთესოპათიები M77.8 სხვა ენთესოპათიები, რომლებიც არ არის שეტანილი სხვა რუბრიკებשი M77.9 ენთესოპათია, დაუზუსტებელი ძვლის წანაზარდი, რომელიც სხვაგვარად არ არის დაზუსტებული კაფსულიტი, რომელიც სხვაგვარად არ არის დაზუსტებული პერიართრიტი, რომელიც სხვაგვარად არ არის დაზუსტებული ტენდი ნიტი, რომელიც სხვაგვარად არ არის დაზუსტებული M79 რბილი ქსოვილის სხვა დაზიანებები, რომლებიც არ არის שეტანილი სხვა რუბრიკებשი [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] M79.0 რევმატიზმი, დაუზუსტებელი ფიბრომიალგიაფიბროზიტი M79.1 მიალგია M79.2 ნევრალგია და ნევრიტი, დაუზუსტებელი M79.3 პანიკულიტი, დაუზუსტებელი M79.4 მუხლქვეשა ცხიმოვანი ბალიשის ჰიპერტროფია M79.5 რბილ ქსოვილებשი დარჩენილი უცხო სხეული M79.6 ტკივილი კიდურებשი M79.8 რბილი ქსოვილის სხვა დაზუსტებული დაზიანება M79.9 რბილი ქსოვილის დაზიანება, დაუზუსტებელი M80 ოსტეოპოროზი პათოლოგიური მოტეხილობით M80.0 მენოპაუზის שემდგომი ოსტეოპოროზი, პათოლოგიური მოტეხილობით M80.1 ოვარიექტომიის שემდგომი ოსტეოპოროზი, პათოლოგიური მოტეხილობით M80.2 უმოქმედობითი ოსტეოპოროზი, პათოლო გიური მოტეხილობით M80.3 ქირურგიული ჩარევის שემდგომი (პოსტქირურგიული), მალაბსორბციის გამო განვითარებული ოსტეოპოროზი, პათოლოგიური მოტეხილობით M80.4 წამლისმიერი ოსტეოპოროზი, პათოლოგიური მოტეხილობით M80.5 იდიოპათური ოსტეოპოროზი, პათოლოგიური მოტეხილობით M80.8 სხვა ოსტეოპოროზი, პათოლოგიური მოტეხილობით 2013 weli წინა დიდი წვივის კუნთის სინდრომიუკანა დიდი წვივის კუნთის ტენდინიტი [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] ჩოგბურთელის იდაყვი [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] თუ გსურთ დააზუსტოთ სამკურნალწამლო საשუალება გამოიყენეთ დამატებითი, გარეგანი მიზეზის აღმნიשვნელი კოდი (კლასი XX) ,fdidsf rfhlbjkjubf 76 M80.9 დაუზუსტებელი ოსტეოპოროზი, პათოლოგიური მოტეხილობით M81 ოსტეოპოროზი პათოლოგიური მოტეხილობის გარეשე M81.0 მენოპაუზის שემდგომი ოსტეოპოროზი M81.1 ოვარექტომიის שემდგომი ოსტეოპოროზი M81.2 უმოქმედობითი ოსტეოპოროზი M81.3 ქირურგიული ჩარევის שემდგომი, მალაბსორბციით გამოწვეული ოსტეოპოროზი M81.4 წამლისმიერი ოსტეოპოროზი M81.5 იდიოპათური ოსტეოპოროზი M81.6 שემოფარგლული (ლოკალიზებული) ოსტეოპოროზი [ლეკენის] M81.8 სხვა ოსტეოპოროზი M81.9 ოსტეოპოროზი, დაუზუსტებელი M82* ოსტეოპოროზი იმ ავადმყოფობათა დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M82.0* ოსტეოპოროზი მრავლობითი მიელომატოზის დროს (მიელომური ავადმყოფობა) (C90.0+) M82.1* ოსტეოპოროზი ენდოკრინული დარღვევების დროს (E00-E34+) M82.8* ოსტეოპოროზი იმ სხვა ავადმყოფობათა დროს, რომლებიც שეტანილია სხვა რუბრიკებשი M83 მოზრდილთა ოსტეომალაცია M83.0 ლოგინობის ხანის ოსტეომალაცია M83.1 სიბერითი (ასაკობრივი) ოსტეომალაცია M83.2 ოსტეომალაცია გამოწვეული მალაბსორბციით M83.3 არასრულფასოვანი კვების გამო განვითარებული მოზრდილთა ოსტეომალაცია M83.4 ძვლის ალუმინური ავადმყოფობა M83.5 სხვა მედიკამენტოზური ოსტეომალაცია, მოზრდილთა M83.8 მოზრდილთა სხვა ოსტეომალაცია M83.9 მოზრდილთა ოსტეომალაცია, დაუზუსტებელი M84 ძვლის მთლიანობის დარღვევები M84.0 მოტეხილი ძვლების არასრული שეხორცება M84.1 მოტეხილი ძვლების [ფსევდოართროზი] M84.2 მოტეხილობის დაყოვნებული שეხორცება M84.3 სტრესული მოტეხილობა, რომელიც არ არის שეტანილი სხვა რუბრიკებשი სტრესული მოტეხილობა, რომელიც სხვაგვარად არ არის დაზუსტებული M84.4 პათოლოგიური მოტეხილობა, რომელიც არ არის שეტანილი სხვა რუბრიკებשი პათოლოგიური მოტეხილობა, რომელიც სხვაგვარად არ არის დაზუსტებული M84.8 ძვლის მთლიანობის სხვა დარღვევები M84.9 ძვლის მთლიანობის დარღვევები, დაუზუსტებელი [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] თუ გსურთ დააზუსტოთ სამკურნალწამლო საשუალება გამოიყენეთ დამატებითი, გარეგანი მიზეზის აღმნიשვნელი კოდი (კლასი XX) ასაკობრივი (მოხუცებულობითი) ოსტეოპოროზი שეუხორცებლობა [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] ქირურგიული ჩარევის שემდგომი მალაბსორბციის გამო განვითარებული ოსტეომალაცია მოზრდილებשი თუ გსურთ დააზუსტოთ სამკურნალწამლო საשუალება გამოიყენეთ დამატებითი, გარეგანი მიზეზის აღმნიשვნელი კოდი (კლასი XX) [ლოკალიზაციის שესაბამისი კოდი იხ. שენიשვნებשი, კლასი XIII დასაწყისשი, ასკ-10 ბეჭდური ვერსია] 2013 weli ,fdidsf rfhlbjkjubf 77 sxvadasxva pediatriul kardiologiaSi –infeqciur paTologiaTa dros mkurnalobaSi imunoTerapiuli preparat “GA-40”-is CarTvis SesaZleblobani g.CaxunaSvili,n.jobava,k.CaxunaSvili,d.CaxunaSvili (saqarTvelos b/kardiologTa asociacia,b/axali klinika, janmrTelobis centri) saqarTvelo. Tbilisi. Tanamedrove etapze droulia daisvas sakiTxi pediatriul kardiologiaSi –infeqciur paTologiaTa dros, imunokoreqtorebis gamoyenebis Sesaxeb, Tu es sakiTxi exeba axali preparatis SesaZleblobebs, romelic SeiZleba gamoyenebul iqnas mxolod arapediatriul asakSi, maSin SromaSi problemaTa aqtualobis areali sagrZnoblad gafarTovdeba (i. malaSxia, 2000; g CaxunaSvili, n. gumbariZe, 2002; n. jobava, g. CaxunaSvili, 2003; n. jobava, g. didava, 2003; m. maTiaSvili, m. Jvania, g. CaxunaSvili, 2003; В.И. Литвинов, И.В. Рубцов, 1990; A. Fontana, 1994; P. Shikant, E. Benveniste, 1996). Sromis mizania ganisazRvros mkurnalobaSi preparat “GA40”-is CarTvis SesaZleblobani. kvlevis amocanebs Seadgenda Seswavlil iqnas g.s.s-ze preparat “GA-40”-is moqmedeba eqsperimentSi, sadac gaanalizebuli iqneba rogorc instrumentuli maCveneblebi, aseve morfologiuri monacemebi. meTodologia da kvlevis Sedegebis analizi :cnobilia, rom gss-is daavadebebis dros infeqciur paTologiaTa dros, procesSi aqtiuradaa CarTuli imunuri sistema. erTi mxriv, am daavadebebis dros adgili aqvs autoantigenebis warmoqmnas, meore mxriv, mkurnalobaSi gamoyenebuli anTebis sawinaaRmdego preparatebi Tavad axdenen gavlenas imunur sistemaze. amitom dReisaTvis imunokoreqtorebis gamoyeneba gss-is daavadebaTa prevenciasa da mkurnalobaSi infeqciur paTologiaTa dros, aqtualuria. magram imunotropuli nivTierebis klinikaSi gamoyenebisaTvis, unda iyos Seswavlili misi aqtivoba, farmakologiuri moqmedeba, optimaluri doza da sxv. amitom, Cvens mier SerCeuli preparati “GA-40”, SeviswavleT eqsperimentSi (bocvrebze). ekg da fkg. kvlevis Sedegebma gviCvena, rom “GA-40”-is 50-jeradi doziT 14 dRiani Seyvanis Semdeg gulis kumSvadobis fazuri struqturis dinamika ar icvleboda da yvela maCvenebeli sawyisi donis farglebSi meryeobda, rac saSualebas gvaZlevs davaskvnaT, rom `GA-40~-is zemoqmedebis Semdeg mocemuli cxovelebis g.s.s. stabilurad funqcionirebs. 2013 weli 78 ,fdidsf rfhlbjkjubf garda zemoaRniSnulisa, eqsperimentis pirobebSi, `GA-40~-is sxvadasxva dozis (1 ml/kg da 5 ml/kg) cxovelis kardiomiocitebze gavlenis Seswavlam gvaCvena, rom mocemul preparats doziT 1 ml/kg-ze eqsperimentSi gaaCnia imunomodulaciuri efeqti. cxovelTa kardiomiocitebSi adgili aqvs cvliTi procesebis aqtivacias rogorc ujredis birTvSi, ise citoplazmaSi. garda amisa, aRiniSna dadebiTi efeqti kapilarebis endoTeliumzec struqturuli organizaciis TvalsazrisiT. amrigad, bocvrebSi Catarebulma eqsperimentma daadastura preparat `GA-40~-is dadebiTi imunomodulaciuri efeqti rogorc kardiomiocitebze, aseve kapilarebis endoTeliumze. daskvna: “GA-40”-is moqmedeba gulsisxlZarRvTa sistemaze eqsperimentSi (e.k.g.; f.k.g.; r.p.g.) da misi morfologiuri daxasiaTeba bocvrebSidadebiTi imunomodulaciuri efeqti, rogorc kardiomiocitebze, aseve kapilarebis endoTeliumze,unda ganixilebodes, rogorc preparatis Semdgomi gamoyenebis SesaZlebloba da maT Soris pediatriul kardiologiaSi – infeqciur paTologiaTa dros gulis paTologiur procesebsi Cabmisas. reziume pediatriul kardiologiaSi – infeqciur paTologiaTa dros mkurnalobaSi imunoTerapiuli preparat “GA-40”-is CarTvis SesaZleblobani g.CaxunaSvili,n.jobava,k.CaxunaSvili,d.CaxunaSvili (saqarTvelos b/kardiologTa asociacia,b/axali klinika, janmrTelobis centri) saqarTvelo. Tbilisi. Tanamedrove etapze droulia daisvas sakiTxi pediatriul kardiologiaSi –infeqciur paTologiaTa dros, imunokoreqtorebis gamoyenebis Sesaxeb. Sromis mizania ganisazRvros mkurnalobaSi preparat “GA-40”-is CarTvis SesaZleblobani. kvlevis amocanebs Seadgenda Seswavlil iqnas g.s.s-ze preparat “GA-40”-is moqmedeba eqsperimentSi, sadac gaanalizebuli iqneba rogorc instrumentuli maCveneblebi, aseve morfologiuri monacemebi. daskvna : “GA-40”-is moqmedeba gul-sisxlZarRvTa sistemaze eqsperimentSi (e.k.g.; f.k.g.; r.p.g.) da misi morfologiuri daxasiaTeba bocvrebSi- dadebiTi imunomodulaciuri efeqti, rogorc kardiomiocitebze, aseve kapilarebis endoTeliumze,unda ganixilebodes, rogorc preparatis Semdgomi gamoyenebis SesaZlebloba da maT Soris pediatriul kardiologiaSi – infeqciur paTologiaTa dros gulis paTologiur procesebsi Cabmisas. SUMMARY IN PEDIATRIC CARDIOLOGY - POSSIBLE USAGE OF IMMUNE THERAPEUTIC MEDICINE “GA-40” IN TREATMENT DURING INFECTIOUS PATHOLOGY G.CHAKHUNASHVILI, N.JOBAVA, K.CHAKHUNASHVILI, D.CHAKHUNASHVILI (Georgian Pediatric Cardiology association, New Child’s Clinic, Health Centre) Tbilisi, Georgia. Aim of work: Determination of usage of “GA-40” usage in treatment. The reason of the research was to investigate how “GA-40” effects on G.S.S. in experiments, where instrumental index and morphological data will be analyzed. Conclusion: “GA-40” effect was positive on cardiovascular system, cardiomyocytes, capillary endothelium (experiments on rabbits). This medicine should be used in pediatric cardiology during infectious diseases. 2013 weli ,fdidsf rfhlbjkjubf 79 sportuli valeologiis ganviTarebis perspeqtivebi med.mecn.doqtori, profesori, akademikosi ig. doliZe med. mecn. doqtori, profesori,akademikosi g. CaxunaSvili evromecnierebis saqarTvelos erovnuli seqciis medicinisa da sportis mecnierebis departamenti,Tbilisis sax.samedicino universiteti dRes, profesiul sportSi moqmedi sportsmenebis janmrTelobis stabiluroba da maTi sportuli muSaobisunarianobis done bevrad aris damokidebuli iseTi mecnierebis Teoriul_praqtikul miRwevebTan, rogoricaa prevenciuli medicina, pedagogika da fsiqologia. ukanasknel wlebSi damsaxurebuli adgili daikava mecnierebis axalma dargma, rogoricaa valeologia _ mecniereba adamianis janmrTelobis, misi praqtikuli SenarCunebisa da gakaJebis Sesaxeb. miuxedavad imisa, rom valeologia iTvleba mecnierebis axal dargad, misi saTaveebi unda veZioT winaistoriul periodSi, xolo fundamentad _ Tanamedrove medicinis mier SemuSavebuli normebisa da profilaqtikis kriteriumebi, xalxuri medicinis, fsiqologiisa da fizikuri aRzrdis pedagogikis koleqtiuri gamocdileba. Tanamedrove mecnieruli xasiaTis samedicino azrovnebiT, janmrTelobisa da avadmyofobis gamyofi zoli pirobiTad unda arsebobdes e.w. “mesame mdgomareobis” sazRvarze, daavadebis wina mdgomareobis periodSi, romlis drosac adamiani formalurad, TiTqosda janmrTelia da organizmi kompensaciis pirobebSi imyofeba, magram amasTan, gamovlenilia daavadebis wina sawyisi klinikuri niSnebi. Tanamedrove saeqimo elitas, gansakuTrebiT es exeba praqtikosebs, azradac ar mouvaT “mesame mdgomareobis’ arsebobis Sesaxeb, ubralod amaze xeli ar miuwvdebaT, profilaqtika ki Tavisi SinaarsiT, mxolod lozungis doneze rCeba. valeologia unda aerTianebdes profesiuli codnis im ZiriTad princi pebs, romlebic damaxasiaTebelia praqtikosi eqimisaTvis, pedagogisaTvis (mwvrTnelisaTvis) da fsiqologisaTvis. aqedan gamomdinare, valeologia aris iseTi mecnieruli integrirebuli codna, sadac janmrTeloba ganixileba ontogenezisa da filogenezis evoluciuri maxasiaTeblebiT da ganTavsebulia fiziologiis, sociologiis, fsiqologiis, fizikuri aRzrdis Teoriisa da pedagogikis sazRvarze. Cven, mravali profilis specialistebma (gansakuTrebiT prevenciuli medicinis muSakebma, pedagogebma da fsiqologebma) unda gaviTavisoT is strategiuli gansxvaveba, romelic arsebobs medicinasa da valeologias Soris. Tu medicina _ mecnierebaa daavadebaTa brZolaSi, maSin valeologia miekuTvneba mecnierebas janmrTelobis Sesaxeb. aqedan gamomdinare, SeiZleba aRvniSnoT seriozuli xarvezebis arseboba eqimTa momzadebis sakiTxSi, kerZod am dar2013 weli gis ganaTlebis sistemas ar gaaCnia janmrTeli adamianis funqcionirebis Sesabamisi fsiqofiziologiuri modeli da bolomde ver gauziarebiaT axali mecnieruli dargis masStabebi. dRes, valeologia axali dargis specialistebis gamoSvebas saWiroebs, magram mecnierebs Soris mZafri kamaTi mimdinareobs imaze, Tu romeli profesiis codnas aqvs meti SesaZleblobebi specialistebis momzadebaSi (mxedvelobaSi aqvT samedicino da pedagogiuri profilis umaRlesi saswavleblebi). Ees meTodologiuri dava mecnierebs Soris araproduqtiulad da subieqturad gveCveneba. Uukve msjeloben imaze, rom valeologi unda momzaddes umaRles samedicino saswavlebelSi farTo fsiqo_pedagogiuri ganaTlebis miRebis fonze, an pedagogiurma umaRlesma saswavlebelma unda gamouSvas specialisti damatebiTi miznobrivi samedicino momzadebiT, axali fiziologiuri normativebis da profilaqtikis kriteriumebis gaTvaliswinebiT. Cven, viTvaliswinebT ra valeolog_specialistis momzadebis efeqturi mimarTulebis perspeqtivas, upiratesobas vaniWebT jansaR fizikur aRzrdaSi sportis umaRlesi saswavleblebis kursdamTavrebulebs, radgan sxva umaRles saswavleblebTan gansxvavebiT isini gadian Rrma Teoriul_praqtikul momzadebas fizikuri aRzrdis Teoriisa da praqtikis meTodikaSi, zogad da sportis fiziologia_pedagogikaSi, sportul medicinaSi, fizikur reabilitaciaSi, kineziologiaSi da a.S. Cven sportul valeologias ganvixilavT axal mecnierul sinTezur dargad, fizikuri aRzrdis Tanamedrove meTodologiad, romlis funqcionirebam sportsmens unda Seuwyos xeli SeinarCunos sakuTari janmrTeloba mzardi fizikuri datvirTvebis pirobebSi da amasTan, miaRwios maRal sportul Sedegebs. Ees ki imas niSnavs, rom Tanamedrove medicinisa, pedagogikisa da fsiqologiis miRwevebis fonze sportsmenma yoveldRiur cxovrebaSi da wvrTnis procesSi unda gamoimuSaos praqtikuli Cvevebi bioenergetikuli rezervebis ekonomiurad gadanawilebisa organizmSi da eqstremalur sportul RonisZiebebSi (sportuli Sejibrebebis gadamwyvet etapze) moaxdinos organizmis saerTo Zalebis maqsimaluri mobilizeba. Tanamedrove epoqaSi mimdinare bunebrivi da socialuri kataklizmebi safrTxes uqmnis kacobriobis arsebobas da moiTxovs civilizaciis TviTmklelobis Tavidan acilebas. Ees ki miiRweva, adamianis mier Tavisi janmrTelobis 80 SenarCunebiT misdami pasiuri damokidebulebis aucilebeli moxsnis xarjze. Aam amocanis gadawyveta damokidebulia sami kardinaluri mimarTulebis warmatemul gadawyvetaze. maTgan pirvelia _ valeologiis Teoriuli safuZvlebis damuSaveba, meore mimarTulebaa _ valeopraqtikis meTodebis mecnieruli dasabuTeba, Mmesame mimarTuleba ki _ valeologiuri ganaTlebaa, sistema, romelic uzrunvelyofs adamianis mravalmxriv ganviTarebas, gonebrivi da fizikuri Sromisunarianobis optimalur zrdasa da aqtiuri dRegrZelobis miRwevas. mxedvelobaSi misaRebia isic, rom valeologia ar warmoadgens mxolod Teoriul disci plinas, is miznobrivad atarebs praqtikul datvirTvasac, radgan adamianis janmrTelobis klinikuri Sefaseba xdeba instrumentul_laboratoruli meTodebis gamoyenebiT. sportul medicinaSi sportsmenis organizmis funqciuri SesaZleblobebis gamovlenisaTvis ZiriTadSi gamoiyeneben biofizikur da eleqtrofiziologiur meTodebs, romlebsac ar gaaCniaT organizmSi mimdinare adaptiuri gadaxrebis eqspres_Sefasebis SesaZleblobebi, e.i. homeostazis darRvevis pirobebSi organizmis zogadi sistemuri da adgilobrivi reaqciebis drouli gamovlena. dRemde, samedicino teqnikis inJiner-gamomgoneblebs jandacvis sistemisaTvis ar mouwodebiaT konkretuli adamianis (sportsmenis) organizmis “susti funqciuri rgolebis” eqspres_diagnostikis saimedo_instrumentuli meTodebi, Tumca isini miiCneven, rom aucileblad saWiroa holistikuri midgomiT Sefasdes “janmrTelobis xarisxi”, radgan gamovlinda farTod reklamirebuli, dinamiuri, sistemuri diagnostikuri meTodebis aradamakmayofilebeli informatuloba. — sportsmenis organizmSi fsiqo_fiziologiuri da funqciuri procesebis sistemuri analizis erT-erT perspeqtiul meTodaT aRiarebulia airganmuxtviTi vizualizaciis meTodis kompiuterizebuli varianti, romelic daamuSava sanqt_peterburgis mecnierTa jgufma (1). Cven, es meTodi gamoviyeneT sportsmenTa janmrTelobis xarisxis Sesafaseblad, kerZod, maTi organizmis emisiuri monacemebis registraciis ori meToduri midgoma: erT SemTxvevaSi gamoviyeneT mxolod “airganmuxtviTi vizualizaciis kamera” (2,3), meoreSi ki _ misi modificirebuli meTodi _ beotomografia (4_8). Cataremuli gamokvlevebis analizma gamoavlina (erTnairi sawvrTno datvirTvebisas) is, rom 70_80 %_SemTvevaSi sportsmenebi ver uZlebda maTdami wayenebul fizikur datvirTvebs, organizmi metwilad ifiteboda bioenergetikulad, romelic iwvevda arasasurvel Sedegs, rogorc sportuli xaziT (dabali SejibrebiTi Sedegi), aseve janmrTelobis mxriv (qronikuli daRlilobis sindromi). Catarebuli kvlevis Sedegad aRmoCnda, rom beotomografia (modi- ,fdidsf rfhlbjkjubf ficirebuli meTodi) ufro metad iZleva sarwmuno da advilad interpretirebul informacias sportsmenis janmrTelobis Sesaxeb, vidre airganmuxtviTi vizualizaciis kamera. sportsmenis organizmis talRuri modelebi, romelic miiReba gamoTvliTi parametrebis grafikuli gamosaxulebiT SesaZleblobas aZlevs eqims an mwvrTnels, TviTonve gamoitanos zogadi msjelobebi sportsmenis organizmis janmrTelobis Sesaxeb da adreulad dasaxos profilaqtikuri RonisZiebebi SesaZlo garTulebebis asacileblad. amasTan, gasaTvaliswinebelia fsiqologis proforientirebuli daskvnac sportuli janmrTelobis SenarCunebisa da organizmis dacviT_kompensatoruli meqanizmebis sruli amoqmedebis mizniT, rac dafuZnebuli unda iyos zogadi valeologiis mecnierul moTxovnebze (9).zemo aRniSnulTan erTad mniSvnelovania ST segmentisa da T kbilis cvlilebebaTa klinikuri Rirebuleba parkuWTa repolarizaciis, naadrevi agznebis parcialur sindromTa da P-Q intervalis Semcirebis arsebobisas bavSvTa da mozardTa asakSi,maTi naadrevi diagnostikuri Riremulebis gansazRvra.maTi Semdgomi fsiqofizikuri mdgomareobis Sesafaseblad da racionaluri Terapiis SerCevisaTvis (10,11,12,13,14-) amgvarad, sportsmenis organizmSi mimdinare fsiqofiziologiuri da funqciuri darRvevebis gamovlenis valeologiuri meTodologia iZleva SesaZleblobas gamovavlinoT dinamiur reJimSi perspeqtiuli sportsmenebi, sworad gavukeToT organizeba maT trenings, drolad avaciloT mosalodneli gadawvrTnisa da qronikuli daRlilobis sindromis ganviTarebis sawyisi movlenebi.H gamoyenebuli literatura: 1. Коротков К.Г., Струков Е.Ю., Широков Д.М._ Метод газоразрядной визуализации (ГРВ) в практике врачаисследователя. ,Санкт-Петербург, 2003 2. i.doliZe, k.xomasuriZe, g.janeliZe, m. tuRuSivaleometriuli bioholografiis meTodologiis gamoyenebis perspeqtivebi sportul medicinaSi \\saqarTvelos ganaTlebis mecnierebaTa akademiis moambe, 2005,# 8, 217–221 3. I.D. Dolidze, Z.G. Kakhabrishvili, G.G.Janelidze – Valeometrik Approach To Determining Psychophysical Fitness of Wrestlers \\ 4 TH International Baltik Congress on Sports Medicine, 2005, Riga, Latvia, p.20 4. Шадури М.И., Чичинадзе Г.К.- Работа с программноаппаратным комплексом ГРВ-камера по методике М.Шадури (БЭО-томография) \\Вестник СевероЗападного отделения медико-технических наук Р.Ф. под ред. К.Г. Короткова – СПб: Агентство “ РДК-принт”, 2001, 119-137 5. Долидзе И.Д., Шадури М.И., Джанелидзе Г.Г., Хомасуридзе К.Г. – Об оценке психофизического состояния спортсменов методом БЭО-томографии \\ Материалы международной конференции “ Медицинская реабилитация и райттерапия “, 2006, Тбилиси ,Грузия, 77-80. 2013 weli ,fdidsf rfhlbjkjubf 6. Долидзе И.Д., Шадури М.И., Джанелидзе Г.Г., Хомасуридзе К.Г.- О перспективах применения БЭОтомографии в спортивной медицине \\ Материалы Международной научной конференции “ Перспективы развития физической культуры в современном обществе “, 2006 , Молдова , Кишинев , 357 – 359 7. Dolidze I.D.- Effectiveness of Beotomography in Psychophysical Training Diagnostics\\ Internacional Conference & Exihibition, 2010, Batumi, p.27 8. i. doliZe – beotomografiis efeqturoba sportsmenebis gawvrTnilobis diagnostikaSi\\ socialuri, ekologiuri da klinikuri pediatria, 2011, # 13_8_7, 66_68 9. igor doliZe_ sportuli valeologia _ zogadi valeologiis ganviTarebis safuZveli \\ saqarTvelos ganaTlebis mecnierebaTa akademiis moambe, 2006, 9, 148_153 10.. ST segmentis, T kbilis,da Q-T intervalis Tanamedrove problemebi bavSvTa da mozardTa kardiologiaSi” – g.CaxunaSvili, n.jobava, k.CaxunaSvili - saqarTvelos bavSvTa kardiologTa asociaciis Jurnali“bavSvTa kardiologTa” #4 gv:9-28 2010w 11. `gul-sisxlZarRvTa sistemis funqciuri mdgomareoba faruli vegetatiuri disfunqci- 81 isa da sisxlZarRvovani hi perreaqtiulobis dros sportsmen bavSvebsa da mozardebSi (diagnostikis, mkurnalobisa da prevenciis sakiTxebi)” – g.CaxunaSvili, i.doliZe, T.gogatiSvili; saqarTvelos bavSvTa kardiologTa asociaciis Jurnali “bavSvTa kardiologTa” #4 gv:39-41 2010w. 12. “ST segmentis daT kbilis morfologiuri”– g.CaxunaSvili, n.jobava, k.CaxunaSvili - saqarTvelos bavSvTa kardiologTa asociaciis Jurnali“bavSvTa kardiologTa” #6 gv: 63 2012w 13. `sportsmenTa anTropometruli da funqciuri maxasiaTeblebi da gul-sisxlZarRvTa sistemis funqciuri mdgomareoba aminomJavebiT gamdidrebuli energetikuli sasmeli `iveriuli-fito”-s moqmedebis fonze”-g.CaxunaSvili da sxv. saqarTvelos bavSvTa kardiologTa asociaciis Jurnali “bavSvTa kardiologTa” #5, gv:24-33; 2011w 14. 13..”Cardiovascular system in the sports-children and timely holding prevention arrangements-against week rings”G. ChakhunashviliN. KandelakiD. PruidzeM.ChkhaidzeD.Tabutsadze N.Jobava.25 th International Congress of Pediatrics. August 25-30, 2007. Athens-Greece Cardiology PP0070 reziume sportuli valeologiis ganviTarebis perspeqtivebi med.mecn.doqtori, profesori,akademikosi ig. doliZe med. mecn. doqtori, profesori,akademikosi g. CaxunaSvili evromecnierebis saqarTvelos erovnuli seqciis medicinisa da sportis mecnierebis departamenti,Tbilisis sax.samedicino universiteti sportsmenis organizmSi mimdinare fsiqofiziologiuri da funqciuri darRvevebis gamovlenis valeologiuri meTodologia iZleva SesaZleblobas gamovavlinoT dinamiur reJimSi perspeqtiuli sportsmenebi, sworad gavukeToT organizeba maT trenings, drolad avaciloT mosalodneli gadawvrTnisa da qronikuli daRlilobis sindromis ganviTarebis sawyisi movlenebi.H РЕЗЮМЕ ПЕРСПЕКТИВЫ РАЗВИТИЯ СПОРТИВНОЙ ВАЛЕОЛОГИИ И.ДОЛИДЗЕ Г.ЧАХУНАШВИЛИ (ТГМУ) Валеология является наукой о путях и способах формирования, сохранения и укрепления здоровья человека. Валеология, как интегративная наука утвердилась в научный мир и решает проблему мотивированного здоровья. Валеолог должен синтезировать в себе основные знания, навыки и умения присущие врачу, педагогу (тренеру) и психологу. Спортивную валеологию надо рассматривать как основу общей валеологии со своими теоретическими и практическими направлениями и требует разработки плана ее перспективного развития в системе спортивной медицины. SUMMARY THE PROSPECTS OF SPORTING VALEOLOGY I.DOLIDZE,G.CHAKHUNASHVILI (TSMU) Sports Valeology is a science on the and means of formation, preservation and strengthenig of humans health. Valeology, as integrative science, gained its place in scientific world and is solving the problems of motivated health. Valeologist should synthesize in himself basic knowledge, typical for medical-prophylactic specialists, teachers and psychologists. The sporting Valeology, alogside with its theoretical and practical trends, should be considered a basis of General Valeology, It is obligatory to outline the plan of its perspective development. 2013 weli 82 ,fdidsf rfhlbjkjubf saintereso SromaTa kaleidoskopi ФАКТОРЫ РИСКА ПОРАЖЕНИЯ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ ПРИ РЕВМАТОИДНОМ АРТРИТЕ И СИСТЕМНОЙ КРАСНОЙ ВОЛЧАНКЕ У ДЕТЕЙ; КЛИНИКО-ИНСТРУМЕНТАЛЬНЫЙ (ЭХОКАРДИОГРАФИЧЕСКИЙ) АНАЛИЗ РАННИХ МОРФОФУНКЦИОНАЛЬНЫХ ПРОЯВЛЕНИЙ ЗАБОЛЕВАНИЯ, ВОПРОСЫ ПРОФИЛАКТИКИ И РЕАБИЛИТАЦИИ АВТОРЕФЕРАТ ДИССЕРТАЦИИ ДЛЯ НАПИСАНИЯ ДИПЛОМА, КУРСОВОЙ РАБОТЫ, ТЕМА ДЛЯ ДОКЛАДА И РЕФЕРАТА ЧАХУНАШВИЛИ ГЕОРГИЙ СЕВЕРЬЯНОВИЧ, 1992 Специальность ВАК РФ: 14.00.06 — Кардиология Ознакомиться с текстом работы • Реферун рекомендует следующие темы дипломов: • Особенности ремоделирования левых камер сердца и внутрисердечной гемодинамики при ревматоидном артрите • Реферун советует написать курсовую работу на тему: • Нарушения сердечного ритма и проводимости при ревматоидном артрите • Реферун советует написать реферат на тему: • Особенности морфофункционального состояния левых отделов сердца при серопозитивном и серонегативном ревматоидном артрите • Реферун предлагает написать доклад на тему: • Анализ показателей диастолической функции у пациентов с серопозитивным и серонегативным ревматоидным артритом • Сопоставление дисритмий с типами вегетативного обеспечения и моделями структурно-геометрической перестройки левого желудочка у пациентов с ревматоидным артритом Выдержки из автореферата диссертации Чахунашвили Георгий Северьянович, 1992, 14.00.06 — Кардиология Актуальность проблем!. Факт поражения сердечно-сосудистой систеш у детей с ревматоидным артритом (РА) я системной красной волчанкой (СКВ) известен (Осколкова ¡.ЦК., Сахарова Ю.Д., 1374; Яковлева A.A., 1984; Кузьмина H.H., 1986; Баженова Л.К., 1986; Чахунашвили Г.С., 1989; Квачадзе U.M., Чахунашвили Г.С., 1991; Pelgenbaun Н., 1934; Chang 3., 1986j Brewer Е., 1967» Ioffe C.D., 1937s Chea I.H., 19S7j Ohakhunashvili 0., Kvaohadze I., Tabutsa-dze D., 1991). Поражение сердца моает протекать от легких функциональных до тяжелых органических изменений (Баженова Л.К., 1986), Степень и распространенность сердечнососудистых нарушений опредоляют тяжесть и прогноз основного заболевания. Однако до настоящего времени не определены факторы раннего вовлечения сердца в патологический процесс, не разработаны критерии ранней диагностики, а также дифференциаино-диагностические клиняко-инструыенгалыше показатели функциональных и органических изменений в сердце. Одной из основных проблем является выявление контингента детой, наиболее угрожаемых по раннему вовлечению сердечнососудистой си-зтеш в патологический процесс, т.е. индивидуумов высокого риска, да которых должны быть сосредоточены, в первую очередь, диагности-гескпе и лечебно-профилактические мероприятия, В выявлении и оценке тяжести поражения сердечнососудистой. ;истеш при РА и СКВ большое значение играет неинваэиншо методы даагностики, позволяющие в клинических условиях определить среди шц с относительно благоприятным течением заболевания, предрасположенных к вовлечении сердца: в патологический процесс. Такие дтагностические критерия до настоящего времени в детской кавдиоло-гической практике не разработаны. В последние годы больше возможности и перспективы в диагностическом процессе возникли благодаря внедрению в широкую педиатрическую практику ультразвуковых методов диагностики. Эхокардно-гр&фия, претерпев быструю технологическую эволюцию, оказывает существенное влияние на усовершенствование диагностического процесса в детской кардиологической практике. Современное эхокавдиогра-фическое оборудование обеспечивает высококачественную визуализацию сердечных структур, позволяет получать пространственное "анатомическое" изображение даже при-очень сложных врожденных пороках сердца, Нараду с этим, оценка размеров полостей, движения клапанов, сердечного выброса, величины шунтов и клапанных градиентов позволяют детально охарактеризовать внутрисердечную гемодинамику, параметрд контрактильноЛ, насосной и релаксационной способностей сердца. Диагностические возможности метода при РА и СКВ в детском возрасте до конца не изучены. Цель работы. Разработать критерии предрасположенности и диагностику ранних стадий функциональных и органических изменений сердечно-сосудистой системы у детей, больных ревматоидным артритом и системной красной волчанкой, подходи к их рациональной терапия. Задачи исследования. 1) Оценить морфофункциовальные показатели сердечнососудистой систеш у здоровых детей с учетом особенностей конституционального развития-в факторов наследственной предрасположенности к сердечно-сосудистым заболеваниям. 2) Выявить влияние стигм соединительно-тканного развития на морфофункциональные показатели сердечнососудистой системы. Разработать экспертные эхокардиографаческкв критерия идеальной диагностикл функциональных я органических изменений сердечно-сосудистой системы при РА н СКВ. 4) Определить особенности горажения севдечио-сосудистой систеш у детей, страдапцшс РА и СКВ в зависимости от возраста, формы заболевания, а также активности патологического процесса. 5) Выявить ранние информативнав критерии дезадаптиваых реакций сердечко-сосудистой систеш у детей, больных РА и СКВ, по данным нагрузочных тестов а анализа сократительной функции левого и правого гелудочкоя. 6) Установить прогностическое значение иаруаеяий центральной и периферической гемодинамика в' прогрессаузкалин органической сердечной патологпл при РА и СКВ. 7) Разработать факторы риска возникновения функциональных и органических изменений севдечно-соскдистой систеш при РА я СКВ, подхода к рациональной терапии и профилактике. Научная новизна есслслогэлия. 2013 weli ,fdidsf rfhlbjkjubf - в педиатрической практике разработаны диагностические ц прогноотцчеслгэ критерии функциональных и органических изменений севдечко-оооудистсй систеш при РА и СКВ, определены фактор! риска раннего вовлечения седгда в патологический прсаесо; - представлэш экспертные эхокарциографяческие критерии дифференциальной диагностики функциональных и патологических изменений в сердце при РА и СКВ, сирэдалены предела адаптищых реакций аппарата кровообращения на нагрузку, даны рекомендация по печению и профилактике. Теоретическое значенао работы. Раскрыта сущность порагеная ;ердечно-сосуднстоЙ систеш у детей, страдающих РА и СКВ в зашсиыосги от возраста, форж заболевания а активности патологического процесса. Разработан комплекс гемодакакических показателей,которое позволяют дать зсесторошгою характеристику йушгци опальному состоянии сердочна-сосудистой системы при РА и СКВ у детей. Выявлены ранние информативные критерия дезадаптиэдех реакций сердоч-но-сосуластой.систем* у детей, больных РА.и СКВ, по данным нагрузочных тостов, кыешие важнее гначоиио для педиатрия. Вперше установлена частота а различные проявления пролапса митрального клапана при 1'Л и СКВ у дето;-,. Епершо в педиатрической практике определены Факторы риска ренкеого вовлечения сердиа в патологаческий процесс при РЛ и С roi у детий.^ Впервыо в педиатрической практике разраоотагш диагностические и прогностические критерии функциональных и органических азкононий сердечно-сосудистой системы при РЛ и СКВ. Практическая ценность. Данные, полученные'm основании клана-ко-инструыенталышх ( эхокапниограТлчсских) исследований, могут быть вне арены в практику детских лечебных учрсзденп£!. для полноты опенки состояния больных с ревматоидным артритом и системной красной волччнкок, назначения адекватней торр.пии к прогнозяроаанил болезни. lia основании полученных данных могут Сыть разработай* Лоле с действенные формы диспанссразоши: а.профилактика сердочно-со-судистых поражений у больных детой с ровултолдным артритом и СКй. Внедрение п тактику. Результаты научных разработок внедрены в практику работы П дотской клинической больницы г.лбнллся, детской яелезнодорожной клинической больший г.Тбилиси, П потеке" шогопрофильной клииичоскоЛ больницы г.Тбилиси я функционирования Республиканского детского кардиологического центра Ггузяи. iats-риады диссертация вклгчены в цл"л лекций а практических кияя'Л на кафедре детских болезней а I Тоилгосмединститута. Апробация работы и публаглиии..материалы научных исследований доложены и обсуадеиы на конференциях молодых медчко» (Бакуриани, 1981, IS82, 1983, 1984, 1989), У-ом съезде детских врачей Грузии (Тбилиси, 1981), заседаниях общества детских врачей г.Тбилиси (1990), Международном симпозиуме "Фактори раска при ревматических болезнях" (Пицунда, 1985), выездном Пленума общества детских врачей Грузии (Кутаиси, 1959), I республиканском съезде ревматологов Грузии (Тбилиси, 1989), ivth. iraeue Rheumatologioal Syapoaiu-n (June 22-24'89, Prague - Czechoslovakia), Pirat European Conference on the Epidaniolosy of Rheumatic Disease 06th-19th September 1990, 1)иЪгоЪа1к, iusoelavia), 4-th Interacieace world Conference on Inflammation antirheumatics, nna^-ealca, Ismunoniodu-lators (Geneva - Switzerland, Palaxpo 15-1 ß April, 1991), XII European Congraee of Rheumatology (Budapest, Hungary, 3th June-6th July, 1991). По теме диссертация опубликовано 29 работ. QcHOBiiiife положения. выносише на защиту; 1. Внутрасерцечаая, центральная и периферическая гемодинамика пра различных формах рэшатоидиого арт2013 weli 83 рита и системной красной волчанка у детей отличается глубиной и степенью поражения. 2. На функциональное состояние сердечно-сосудистой сисгеш оказывает влияние активность общопятологаческого процесса. 3. Электрокардиографические показателя и типы пульсовых кривых в процессе выполнения просЗы с физической нагрузкой у детей, больных РА а СКВ, имеют особенности, обусловленные формой заболевания. 4. Статистически обработанные зхокавдиографаческиа показатели с использованием пакота прикладной программ "Ангара" имеют прогностические значения в гоогрэссярошная органической солнечной патологии при РА и СКВ у детей. 5. Разработанный комплекс диагностических критериев монет слунить для обоснования рациональной терапии и профилактики сор-дечио-сосудистых осложнений при РА и СКВ у детей. Объем я структура гдбота. Диссертации изложена на 419 страницах машинописного текста, включая иллюстрации (ИЗ таблиц, 62 рисунка, 10 шписок из истории болезни). Работа состоит из введения, обзора литературы, описания методов исследования, собственных исследований л их анализа, заключения и выводов. Указатель литературы содеркит 374 наименований, из них 163 отечественных и 186 иност ранних авторов. … ВЫВОДЫ 1. У здоровых дотей морфометрические показатели сердечно-сосудистой системы существенно меняются в онтогенезе. Наиболее интенсивное увеличение размеров левого желудочка как в систолу, так и в диастолу происходит достоверно чаще у девочек в возрасте 9 лет и в периоде от II до 12 лет. У мальчиков такой скачкообразности не отмечено. 2. Увеличение предсердий у мальчиков происходит ^ возрасте 8 лет, а у девочек - в 10 лет. Рост размеров левого п^дсевдия у мальчиков продолжается до конца пубертатного периода. У мальчиков просвет аорты больше, чем у девочек. 3. Масса миокарда левого желудочка интенсивно увеличивается у мальчиков в возрасте 6-8 лет и в пубертатном периоде, а у девочек плавно и равномерно на протяжении 6-15 лот. Масса и то ладна межаелудочкбвой перегородки у мальчиков всегда больше. 4. Эхокардиограммы подтверждают, что развитие основных морфологических структур происходит гетерохронно и согласуется с развитием других систем. 5. Клиническая картина ревматоидного артрита и системной красной волчанки определяется стадийностью процесса, характером и степенью вовлечения в патологический процесс сердечно-сосудистой системы. 6. Наиболее частым и рант, поражением сердца при ревматоидном артрите и системной красной волчанке являются функциональные отклонения митрального клапана в видэ транскитрального кровотока, мылковолнозой диастолической вибрации, пролапса. Редко и при определенных формах заболевания диагностируется недостаточность митрального клапана. При этом при ревматоидном артрите поражается задняя митральная створка, а при системной волчанке - обе створки. 7. Эхокардиографически определяется в 70,8$ наблюдений поражение подклапанних структур сердца, что возможно связано с непосредственным поражением соединительной ткани, а также дилатация атрювентрцкулярного отверстия. 8. Степень и характер структурно-функциональных изменений в сердце тесно коррелирует с активностью патологического процесса -текущим эндокардитом и аортитом - утолщение стенок аорты и их размытость. 9. У одной трети больных определяется дисфункция трикуспвдально-го клапана и у 1/4 - легкий фиброз створок, что 84 следует рассматривать как латентно текущий эндокардит. С такой же частотой определяется экссудативный перикардит. 10. На фоне проводимой терапии структурно-функциональные а органические поражения сердечно-сосудистой системы уменьшается, однако степень реституции (включая выпот в полость перикарда) крайне незначительная, что требует пересмотра парциальной терапии. XI. У всех наблвдавщахся больных имело место нарушение легочной - гемодинамики с повышением давления в системе легочной артерии. 12. Проведенной исследование позволило выделить три степени активности патологического состояния сердечно-сосудистой системы, на основания которых возможно его моделирование с после-дувдам прогнозированием вовлечения аппарата кровообращения в болезненный процесс. Степень вероятности вовлечения в патологический процесс при ревматоидном артрите и системной краснсй волчанке колеблэтея в пределах 65-95$. дракгичшкйе ршшщши Сердечно-сосудистые нарушения при ювенильном ревматоидном артрите и системной кроной волчанке у детей диагностируется в динамике заболевания с помощью доступных методов исследования: электро-фонокардиографический, эхокардаографлческий. В диагностике и дифференциальной диагностике сердечно-сосудистых нарушений имеет значение $акт установления частоты типов реакций сердечного ритма, замедления виутрисердечной и внутра-атриовентрикулярюй проводимости, электрической активности правого я левого желудочков, площадей зубца Ту в процессе физической нагрузки в периоде реституция. Разработанный норматив эхокардиографическях я гемодинашче-ских показателей у здорошх детей, погодешо исследования в возрасте от 6 до 15 лет целесообразно использовать в специализированных детских лечебных учреждениях. Моделирование диагностики с прогнозированием вовлечения сердца в патологический процесс, а также возникновение шокардио-аистрофин, шокардитт и эндокардита с поражением штралького и юртального клапанов, перикардита, а также развития легочной ги-зертензии при РА и СКВ у детей, рекомендуется внедрить в план эбследованая больных детей в детских лечебных учреждениях для юлноты оценки состояния больных, назначения едокватной терапии, грофилактяки и прогнозирования болезни. Список работ, опубликованных ло теме диссертации 1. Некоторые данные инструментального исследования сердечнососудистой системы при коллагенпвых заболеваниях у доте!! /У Сборник научных грудой Тбилгоомедкнститута. - Тбилиси, 1978, - Т. У. - С. 33-43. 2. Динамика комплекса географических и сфигкографлческкх ксслз-дсваний при ревматоидном артрито у детей // У съезд детских врачей Грузии (материалы). - Тбилиси, 198£е - С. 396-397 (в соавт. с К.Кугелия, Т.Дерэтела). 3. Изменения ЭКГ, ФКГ в ЙКГ при ревматоидном артрито у детей // Конференция молодых медиков Грузки (материалы}» - Еакурваас, 1981. - С. 222 (в'соавт. с З.А.Мумладзе). 4. Дннааика деятельности сердоа при • рввматовдиом артрято у детей Л Конференция молодых медиков Грузия (материала) - Баку-рианч, 1982 (в соарт. с М.М.Харатиаш)* 5. Некоторые показатели центральной гемодинамики а тонуса хдошх артериальных сосудов при ревматоидном артрите у детой б возрастном аспекте // Республиканская научная коиферешшя молодых медиков Грузик (материалы докладов). - Бакург&кн е 1983е -С. 171 (в соавт. о Л.И.Лсмтатидзе), 6. Электрокардиографические и пояикардкографичзские изкзнешш у детей, больных решат ошшш артритом и системой красно!! волчанкой // Сборник научных трудов ,fdidsf rfhlbjkjubf Тбилгоскединстятута. - Тбилиси, 198-1. - С. 89-85 (в соавт. с В.А.Ыумладзо, Т.Д.Маринд-швдлв, Л.А.Абуладзе). 7. Характеристика сердечной недостаточности у детей, больных ревматоидным аргрйтсм /7 Республиканская•научная кокфэреишя молодых медиков Грузии (материалы докладов). - Еакуриани, 1984. - С. 225. В, Изучение функции щитовидной яелезы при юшшльном резматеид-ном артрнто я системной красной волчанке у детей //' Пленум правления Всесоюзного научного общества ревматологов (тезы-сы докладов). - Орджоникидзе,IS86. - 0.92 (в соавт. с H.U. Квачадзе, Т.Д.ЫаринашЕиля, Л.Т.Комсиашвили). Э. Особенностя iiia комплекса у дето!!', больных ?А, прсэднзющих в Грузил 11 международный симпозиум "Факторы риска при ревматических болезнях" (тезисы докладов). - Пицунда,198о. -С. 46 (в соавт. с Т.Д.Маринадвила,Э. Д.Онлаамл;:,М.Н.Цулая). 10. Клинико-ии^укологаческие параллели у больных с недостаточностью кровообращения различных этиологии // XI съезд детских врачей Грузии С материалы докладов). - Тбилиси, 1287. - С. 256-257. 11. ¿адовая структура систолы левого желудочка у детей с ревматоидным артрггом Ц ¡Метод рекомендации «13 ГССР. - Тбилиси, 1988. - U.10. 12. Фонокардиогра|лческг.е изменения у детей с ревматоидным артритом /У Метод рекомендации LS3 ГССР. - Тбилиси,ISE8. - С.10. 13. Активность лизосомпых ферментов в к реви п синошальнсЛ яидко-стя при костном лзч1-.--пп гидрокортизоном а шжлофоефемадом больных ювенильным дерлатоидшш артритом Н Всесоюзная конференция рзвматологов с мездунаредшм участием "Локальная то-. ралпя при рев:.птических эаоолеванйях", - Ы. ,1987.-0.55-56. (п соавт. с д.О.Табуглдзо, И.М.Квачадзв и др.). 14. Э*окавдиоГ1иф.ччеоказ показателя при ревматоидном артрита и системной k?acitoU волчанке у детей // Шездная сессия. научного об^етт детсклх втачей Грузия (штораалн дсюодоэ). - Кутаиси, 1989. - С.93-94, 15. Новая форма систолического шума у детей // Там же. - С.20. 16. Диагностическая ценность показателей бескровных инструментальных ыа-ходов исследования сердечно-сосудистой системы при некоторых нерсвматических и ревматических болезнях детей Ц Респ.науч.конф. "Ыедико-социадьнне вопросы охраны материнства и детства" (тезисы докладов). - Тбилиси, 1989. - 0.102. 17. Оценка результатов электрофизиологичоских и гедадинамичеокнх исследований при ювенильном ревматоидном артрите // I Респ. съезд ревматологов Грузии ('/атериалы докладов), - Тбилиси, 1989. - С.105-105, 18. Сердце при ревматоидном артрите у детей // МРИ, У раздел. -Педиатрия. - 1990, й 8. - С,15-18 (в соавг. с И.М.Квачадзе), 19. Сердце при системной красной волчанке у детей }/ МРд, У раздел. - Иедиагрия. - 1990, й 9. - С.11-14. 20. Поражение сосудов й состояние гемодинамики.при ревматоидном артрите и системной красной волчанке у детей }1 Педиатрия. -1391, $ 5. - ОД04-107. 21. Эхокардиографцческяе показатели у здоровых детей // Уч.пособие, Тбилгосмеданститут. - Тбилиси, 1991. - С. 90 (в соавт. с Н.Д.Длсобава). 22. Прогнозирование патологии сердца у больных детей ревматоидным артритом Ц Методические рекомендации. - Тбилиси, 1992. -С.20 (в соавг, с И.М.Квачадзе), 23. Прогнозирование патологии сердца у больных детей системной красной волчанкой // Методические рекомендации. - Тбилиси, 1992. - С. 20 (в соавт. с И.М.Квачадзе). 2013 weli ,fdidsf rfhlbjkjubf 24. Эхокардиографлческая диагностика по радения сердца при ревматоидном артрите и системной красной волчанка // "Охрана материнства и детства" (с печати). 25. Influence of T-aotivine en the specificity of antibodies to DNA and in Georgian children with systemic diseases of the connective tissue // IVth Prague Rheumatological Symposiuti (Abstracts). - Prague, Czechoslovakia, 198?. - P.72. 26. Antigens of HIA-system in children with RA (stills diaeaosc) Biid their faraily »embers // First European Conference on the Epidemiology of Rheomatlc Diseases (Abstracts). - Dubrovnik, Jugoslavia, 1990. 27. Gllnico-inatranental (echocardiography) analysis of early morpho-funcUonal manifestation of cardio-vascular system at RA and SLE in children problem3 of treatment, prevention and rehabilitation // IVth Ititerasience World Con- 85 ference on Inflammr.tioR Antirheamatica, Analgesics, Immunomodulators. - Geneva (Switzerland), PALEXPO. - 1991. - Aba. 74. 28. Tha activity a! lysosomal enzymes antibodies against DNA nnd MIA and their interrelation on the background of complex treatment of patients with Juvenil Rheumatoid Arthritis // Ibid. - Abs. 73. 29. rilagnoatie evaluation of interferone leucocyte reaction (ILR) und i;.tauj»0!»o< 84. Aba. - Ibid. (RA) Arthritis Rheumatoid with patients ir.> За большую консультативную я практическую помощь диссертант шрпяает глубоко признательность и приносит искреннш благодарность засл.деят.науки, доктору мед.наук, профессору И.М.Квачадзе и засл. врачу Грузинской Республики С.К.Чахунашвпли. nino jobava zogierTi Tandayolili, anTebadi da SeZenili araanTebadi daavadebis dros gul-sisxlZarRvTa sistemis klinikur-instrumentuli daxasiaTeba bavSvTa asakSi da mkurnalobaSi preparat GA-40-is CarTvis SesaZleblobani Tbilisis saxelmwifo samedicino universiteti pediatria – 14.00.09 medicinis mecnierebaTa kandidatis samecniero xarisxis mosapoveblad warmodgenili disertaciis a v t o r e f e r a t i Tbilisi – 2005 CvenTvis kargadaa cnobili, rom dReisaTvis iSviaTobas warmoadgens iseTi daavadebebi, rogoricaa aTerosklerozi, kardiosklerozi, gulis iSemiuri daavadeba, miokardiumis infarqti da a.S., magram albaT aucilebeli da droulia, yuradReba mieqces im riskis jgufis bavSvebs (saSiSi aTerosklerozze, gulis iSemiur daavadebaze, miokardiumis infarqtze), romlebic TavisTavad moiTxoven dispanserizacias da saTanado profilaqtikis Catarebas. zemo aRniSnulidan gamomdinare da amasTan erTad avtorTa (g. CaxunaSvili, k. CaxunaSvili, n. uberi, p.xerxeuliZe, n. jobava) monacemebis Rrma analiziT unda daisaxos aTerosklerozisa da gulis iSemiuri daavadebis profilaqtikis V etapi: I etapi – risk-faqtorebis gamovlena: anamnezi, antropometria, arteriuli wneis gazomva, kvebis xasiaTis Sefaseba, emocionaluri tonusis gamokvleva, anamnezSi mniSvnelovania aRiniSnos bavSvTa dRenakloloba (Tu es SesaZlebelia) da misi xasiaTi, bavSvobaSi gadatanili daavadebebiT (ararevmatiuli karditi, revmatiuli arTriti, kardiomiodistrofia, kardiopaTia, vegetosisxlZarRvovani distonia, mitraluri sarqvlis prolafsi, gulis Tandayolili manki (aRiniSnos Tu naoperaciebia da rodis), tonzilogenuri kardiopaTia da a.S.), romelic xorcieldeba ubnis pediatris da skolis eqimis mier. IIOetapi – vegetatiuri nervuli sistemis kompleqsuri Sefaseba – reaqtiuloba moqmedebis vegetatiuri uzrunvelyofa (meTodebi, kardiointervalografia, klinoorTostatikuri sinji), qolesterinisa da trigliceridebis Ronis gansazRvra sisxlis plazmaSi, ST segmentisa da T kbilis 2013 weli sxvadasxva cvlilebaTa gansazRvriT (ra Tqma unda asakobrivi Taviseburebebis gaTvaliswinebiT) – warmoebs ubnis pediatris, kardiorevmatologis an uSualod kardiologis daxmarebiT. III etapi – mimdinareobs stacionaris pirobebSi gul-sisxlZarRvTa sistemis Rrma, kompleqsuri klinikur-instrumentuli gamokvleva, li poproteidebis fraqciebSi qolesterinis ganawilebis analiziT, hemostazisa da fibrinolizis sistemis gamokvleva. Cvenebani am etapis kvlevisaTvis aris qolesterinis Semcveloba 4,4 mmol/l-ze maRla, trigliceridebis 0,79 mmol/l-ze maRla vegetosisxlZarRvovani distonia da klinoorTostatikuri sinjebis sxvadasxva variantebi. ST segmentis formis, misi J cdomisa, T kbilis simaRlisa Tu siRrmis gansazRvriT da gaTvaliswinebiT (sruldeba bavSvTa kardiologebis mier). IV etapi – racionaluri kvebiTi dietologiuri reJimi drouli kurortologiuri sezonuri mkurnaloba, reabilitaciuri RonisZiebebiT (Tu es ukanaskneli saWiroa). riskis jgufis bavSvTa imunoreabilitacia da sxva. V etapi – prevenciuli RonisZiebebis dasaxva da gatareba, samecniero-analitikuri jgufis mier mizandasaxulad Sedgenili daavadebaTa prognozirebis programebis gamoyenebiT awarmoebs wamyvani klinikebi – samTavrobo da arasamTavrobo organizaciebTan (centrebi, asociaciebi da sxv.) erTad. amgvarad, swored mxolod naadrev etapze dawyebul, racionalur, organizebul, individualur, pirvelad profilaqtikur RonisZiebebs SeuZlia aTerosklerozisa da gulis iSe- 86 miuri daavadebis ganviTarebis SedarebiT Soreul asakobriv jgufSi gadaweva. daskvnebi bavSvTa asakSi ararevmatiuli karditis, tonzilogenuri kardiopaTiis, revmatoiduli arTritis saxsrovani da saxsrovan-visceraluri formebis, mitraluri sarqvlis prolafsis, vegetosisxlZarRvovani distoniis, gulis Tandayolili mankebis da miokardiodistrofiis dros miokardiumis SekumSvadobis funqcia, centraluri da periferiuli hemodinamika, kapilaroskopiuli da kardiointervalografiiT miRebul monacemebTan erTad gansxvavdeba dazianebis sixSiriTa da xarisxiT. ST segmentisa da T kbilis monacemebi janmrTel bavSvebSi xasiaTdebian asakobrivi TaviseburebebiT. bavSvTa asakSi SesaZlebelia ganisazRvros T kbilis depresiuloba: I standartul ganxraSi (1 Tvemde asakis garda); II standartul ganxraSi (yvela asakobriv jgufSi); AVF ganxraSi (0-3 wlamde); V4-ganxraSi (6-15 wlamde asakobriv jgufSi); V5-V6 ganxrebSi (yvela asakobriv jgufSi) es ukanaskneli warmoadgens, rogorc dRenakl, ise droul axalSobilTa kardiopaTiaSi wamyvan sadiagnostiko kriteriumebs, romlebic mniSvnelovania, rogorc dasawyisSi daavadebaTa mkurnalobisaTvis, ise misi dinamikis SefasebaprognozirebisaTvis da rac mTavaria, reabilitaciis periodSi, ukve mozrdilTa gul-sisxlZarRvTa sistemis daavadebaTa prevenciisaTvis. janmrTel bavSvebSi ST segmentis cdoma izoeleqtrul xazs zemoT yvela asakobriv jgufebSi gvxvdeba, magram ar cdeba 1 mm-s, xolo izoeleqtrul xazs qvemoT V5-V6 ganxrebs garda maqsimaluri siRrme 1 mm-mdea. ST segmentisa da T kbilis morfologiuri cvlilebani unda ganisazRvrebodes erTian konteqstSi SemuSavebuli 8 ti pidan erTis gansazRvriT, rogorc janmrTel, aseve daavadebul bavSvTa kontingentSi. bavSvTa asakSi ST segmentisa da T kbilis cvlilebani sxvadasxva asakobriv jgufebSi moiTxovs individualurad ganxilviT midgomas, rac bavSvTa kardiologiidan siberemde mis Semdgom Rrma klinikuri informaciis matareblad unda darCes. NeHb-is ganxrebi mniSvnelovan informacias iZlevian rogorc janmrTel, aseve daavadebul bavSvTa kontingentSi da isini aseve mniSvnelovan rols Seasruleben bavSvTa kardiologiis ganviTarebaSi, rogorc samkurnalo, aseve sareabilitacio da daavadebaTa prevenciis etapebze maTi asakisda miuxedavad. vegetosisxlZarRvovani distoniis, tonzilogenuri kardiopaTiisa da revmatiuli arTritis saxsrovani formis dros adgili aqvs gulis muSaobis hi perkompensaciis pirobebSi, romelic sakmarisia qsovilebSi da organoebSi sisxlis nakadis uzrunvelsayofad, xolo revmatoiduli arTritis saxsrovan-visceraluri formis, mio- ,fdidsf rfhlbjkjubf kardiodistrofiisa da ararevmatiuli karditis dros ki adgili aqvs marcxena parkuWis SekumSviTi da tumbis funqciis ukmarisobas. gulis SekumSvadobis Seswavlam sxvadasxva asakobriv jgufebSi gviCvena, rom 0-3 wlamde asakis bavSvebSi SesaZlebelia misi darRvevis mizezi iyos koronaruli ukmarisoba, xolo 6 wlis zemoT swored koronalurma ukmarisobam ganapirobos miokardiumis funqciuri mdgomareobis uaryofiTi fazuri Zvrebi. sakvlevi nozologiebis dros sagrZnoblad mcirdeba normaluri vegetatiuri reaqtiuloba, xolo mkveTrad matulobs hi persimpaTikotonuri reaqtiuloba. es ufro metad gamoxatulia revmatoiduli arTritis, ararevmatiuli karditis da gulis Tandayolili mankis dros, xolo naklebad vegetosisxlZarRvovani distoniis da miokardiodistrofiis SemTxvevaSi. vegetatiuri nervuli sistemis sawyisi tonusis simpaTikotonuroba da vegetatiuri reaqtiulobis hi persimpaTikotonuroba, xolo urTierTkombinaciaSi maTi 22%-mde arseboba vegetosisxlZarRvovani distoniis, gadatanili ararevmatiuli karditisa da revmatiuli arTritis sxvadasxva formis dros SeiZleba warmoadgendes gulis iSemiuri daavadebis risk-faqtors, xolo rac Seexeba miokardiodistrofias, mitraluri sarqvlis prolafss, moiTxoven dinamikaSi mravalmxriv dakvirvebas da Semdgom analizs. eqsperimentSi preparat “GA-40”-is 50-jeradi dozebiT gamoyenebisas ar gaaCnia negatiuri moqmedeba gul-sisxlZarRvTa sistemis mdgomareobasa da funqcionirebaze. preparat “GA-40”-is cxovelis wonaze 1 ml/kg-ze doziT Seyvanisas miiReba imunomodulaciuri efeqti. cvlilebebi aRiniSnba upiratesad kardiomiocitebis birTvuli struqturis mxriv. kardiomiocitebSi nanaxi cvlilebebi aRiniSneba agreTve am jgufis kapilarebis endoTeliumSi, intensivoba igivea, rac kardiomiocitebis SemTxvevaSi. preparat “GA-40”-is moqmedeba gul-sisxlZarRvTa sistemaze eqsperimentSi (ekg, fkg, rpb) da misi morfologiuri daxasiaTeba bocvrebSi iZleva safuZvels persreqtivaSi rogorc preparatis Semdgomi gamoyenebis SesaZleblobas klinikaSi. praqtikuli rekomendaciebi damuSavebuli klinikur-instrumentuli diagnostikuri kriteriumebis kompleqsi, axal samkurnlo saSualebebTan erTad SesaZlebelia gamoyenebul iqnas ararevmatiuli kardiTiT, revmatoiduli arTritiT, vegetosisxlZarRvovani distoniiT, gulis Tandayolili mankebiT, tonzilogenuri kardiopaTiebiT, miokardiodistrofiebiT da mitraluri sarqvlis prolafsiT daavadebul bavSvTa dasabuTebuli, racionaluri Terapiisa da gul-sisxlZarRvTa sistemis garTulebaTa prevenciisaTvis. eqsperimentul monacemebze dayrdnobiT, mizanSewonilia preparat “GA-40”-is moqmedebis Semdgomi kvlevis gagrZeleba klinikaSi, ramdenadac savaraudoa am preparatis gamoyenebis SesaZlebloba gul-sisxlZarRvTa sistemis dazianebiT mimdinare daavadebaTa kompleqsur mkurnalobaSi. 2013 weli ,fdidsf rfhlbjkjubf 87 JOBAVA NINO CLINICAL-INSTRUMENTAL CHARACTERIZATIONS OF CARDIOVASCULAR SYSTEM DURING SOME CONGENITAL, INFLAMMATORY AND ACQUIRED NONINFLAMMATORY DISEASES IN CHILDHOOD AND POSSIBILITIES OF THE INVOLVEMENT OF PREPARATION GA-40 IN THE TREATMENT TBILISI STATE MEDICAL UNINERRSITY 14.00.09 - PAEDIATRICS SYNOPSES OF THE DISSERTATION FOR DEFENDING A DEGREE OF THE CANDIDATE OF MEDICAL SCIENCES TBILISI -2005 CON C LU SI ONS 1. In childhood a function of contractility of the myocardium during nonrhematoid carditis, tonsillogenous cardiopathy, articular and articular-visceral forms of rhematoid arthritis, mitral valve prolapse, vegetative-cardiovascular dystonia, congenital heart diseases and myocardial dystrophy, as well as central and peripheral hemodynamics together with the data of capillaroscopy and cardiointervalography differs by the frequency and degree of disturbance. 2. Data of ST segment and T wave in healthy children are characterized by age peculiarities. 3. In childhood it is possible to determine depression of T wave: - in the I standard recording (except one month age); - in the II standard recording (in all age groups); - in AVF recording (age - 0-3 years); - in V4 recording (in 6-16 years age group); - in V5-V6 recordingas (in all age groups). The latter appears to be leading diagnostic criteria in the cardiology of premature and newborns. They are important both for the treatment of diseases and estimation and prognosis of the dynamics and what is especially significant, in the period of rehabilitation in order to prevent diseases of cardiovascular system. 4. Error of ST segment above isoelectric line in healthy children is observed in all age groups, but it does not exceed 1 mm, while below isoelectric line, except V5-V6 recordings, a maximal depth is about 1 mm. 5. Morphological changes in ST segment and T wave should be considered by determination of one of the 8 types worked out in common context both in healthy and ill children. 6. Changes in ST segment and T wave in different age groups in childhood require an individual approach that should remain as bearing a profound clinical information from childhood up to old age. 7. Recordings of NeHb give an important information both for healthy and ill children and they will play a significant role in the development of children cardiology both at therapeutic and rehabilitation and preventive stages of these diseases in spite of their age. 8. During vegetative-cardiovascular dystony, tonsillogenous cardiopathy and articular form of rheumatoid arthritis there takes place heart activities in the conditions of hypercompensation which is enough for provision of blood flow in tissues and organs, while during articular-visceral form of rheumatoid arthritis, myocardial dystrophy and nonrheumatoid carditis there takes place insufficiency of contractile and pump functions of the left ventricle. 9. Investigation of heart contractile function in different age groups has shown that in 0-3 years old children the reason of disorder of this function may be coronary insufficiency, while in 6 years old children and above just coronary insufficiency may condition negative phasic shifts of functional state of the myocardium. 10. During investigated nosologies normal vegetative reactivity considerably decreases, while hypersympathicotonic reactivity sharply increases. It is more expressed in cases of rheumatoid arthritis, nonrheumatoid carditis and congenital heart disease, while in cases of vegetative-cardiovascular dystonia and myocardial dystrophy it is less pronounced. 11. Sympathicotonia of initial tone of vegetative nervous system and hypersympathicotonia of vegetative reactivity and their existence in intercombination by (22% during vegetative-cardiovascular dystonia, suffered nonrheumatoid carditis and different forms of rheumatoid arthritis may be risk-factors of cardiac ischemic disease. As to 2013 weli myocardial dystrophy and mitral valve prolapse in future they require multiple observation and analysis. 12. Usage of 50-fold doses of GA-40 preparation in the experiment has no negative action on the state and functioning of cardiovascular system. 13. Injection of GA-40 preparation in the dose of 1 ml/kg per animal weight gives an immunomodulating effect. Changes are mainly observed in nuclear structures of cardiomyocytes. Changes in cardiomyocytes are also noted in the endothelium of capillaries of this group. The intensity is the same as in case of cardiomyocytes. 14. Action of GA-40 preparation on cardiovascular system in the experiment (ECG, phonocardiography, rheolography) and its morphological characterization in the rabbits allows us to use the preperation in the clinics in future. PRACTICAL RECOMMENDATIONS 1. A complex of elaborated clinical and instrumental diagnostic criteria together with new therapeutic drugs may be used in treatment of nonrheumatoid carditis, rheumatoid arthritis, vegetative-cardiovascular dystonia, congenital heart disease, tonsillogenous cardiopathies, myocardial dystrophies and mitral valve prolapse in patients in order to carry on a well-grounded rational therapy and prevention of cardiovascular system complications 2. On the basis of experimental data it is expedient to continue the further study of GA-40 preparation in the clinics as it is a presumable possibility of its usage in the complex treatment of cardiovascular system. THE LIST OF PUBLICATIONS ON THE THEME OF DISSERTATION 1. Echocardiographic data in healthy children (manual text-book) (with G. Chakhunashvili), Tbilisi, 1991, p. 94 (in Georgian). 2. Classifications of principal cardiology diseases in childhood. The I part (Methodological recommendation for peadiatrists) (with G. Chakhunashvili, N. Pavliashvili et al.). Publ. “Ana-ki”, Tbilisi, 1994, p. 44 (in Georgian). 3. Prematurity as a risk-factor for the development of the I type diabetes mellitus. Monthly Scientific Bulletin. Medical News of Georgia, 2002, No 2 (83), pp. 154-157 (with G. Chakhunashvili, G. Didava, N. Gumbaridze) (in Russian). 4. Clinical-instrumental characterization of cardiovascular system in the contingent “Program for study of ecological situation state”. Medical News of Georgia, 2003, No 10, pp. 75-79 (with M. Asatiani) (in Georgian). 5. Preparation GA-40 and its influence on cardiac muscle. Proceedings of Georgian Academy of Sciences, ser. biol., 2003, No 5-6, pp. 783-786 (with G. Didava) (in Russian). 6. Urgent problems of children cardiology in Georgia and perspectives of its development in the XXI century. In: “Cardiology and internal medicine”, 2002, No 1, pp. 22-25 (with G. Chakhunashvili, D. Kiladze, K. Chakhunashvili) (in Georgian). 7. A comparative analysis of the effect of different doses of GA40 on rabbit cardiac muscle. Proceedings of the Georgian Academy of Sciences, ser. biol., 2003, No 5-6 pp. 765-757 (with G. Chakhunashvili) (in Russian). 8. The effectiveness of bloodless clinical methods for investigation of cardiovascular system in perinatology. Georgian Medical News, 2004, No 7-8 (112-113), pp. 64-67 (with G. Chakhunashvili, N. Pruidze) (in Russian). 88 ,fdidsf rfhlbjkjubf aTerosklerozis risk-faqtorebi msuqan bavSvebSi m. kakauriZe,* z. sexniaSvili,* n.kakauriZe** Tssu, endokrinologiis kaTedra* Terapiis erovnuli centri** Tanamedrove etapze aTerosklerozis Seswavlas eTmoba gansakuTrebuli yuradReba am daavadebis mizeziT gamowveuli sikvdilianobisa da invalidobis didi procentis gamo. aSS-Si yovelwliurad aRiniSneba aTerosklerozis klinikuri gamovlinebis gid 1,5 mln da sikvdilianobis 520000 SemTxveva (S.Hohnloser, 1988). problemis aqtiulobas ganapirobebs is faqtic, rom, daavadeba iwyeba bavSvobis asakidan da xSirad is genetikurad determinebulia, xangrZlivad mimdinareobs farulad da xSir SemTxvevebSi klinikurad vlindeba ukve Sorswasul SemTxvevebSi [1,2,3]. amdenad avtorTa didi nawilis mier aTerosklerozi ganixileba, rogorc pediatriuli problema [4,5] da misi gamomwvevi risk-faqtorebis koreqcia bavSvobis asakidan iTvleba warmatebuli profilaqtikis ganmapirobeblad (n.yifSiZe 1992, n.xerxeuliZe 1993, n.uberi 1997). aTerosklerozis erT-erT ZiriTad risk-faqtorad miCneulia sxeulis Warbi wona, simsuqne [10]. avtorTa nawili miuTiTebs bavSvTa Soris simsuqnis ricxvis mniSvnelovani matebis Sesaxeb. Tanamedrove etapze dadgenilia kavSiri aTerosklerozis zogierTi risk-faqtorsa da simsuqnes SorisBbavSvebSi. miuxedavad arsebuli gamokvlevebisa, naklebadaa Seswavlili simsuqnis sxvadasxva formebis dros aTerosklerozis zogierTi risk-faqtori. naSromis mizania: aTerosklerozis zogierTi risk-faqtoris dadgena msuqan bavSvebSi. kvlevis masala da meTodebi: gamovikvlieT 5-14 wlamde 9 msuqani da 8 janmrTeli bavSvi (15 mamrobiTi sqesis da 2 mdedrobiTi sqesis). bavSvebis asakobrivi dayofa xdeboda nelsonis mier mowodebuli sqemis mixedviT (pediatrics, 1997). simsuqnisa da misi xarisxebis dadgena xdeboda bavSvebisaTvis mowodebuli percentiluri cxrilebisa da Jukovskis (1997w) mier mowodebuli xarisxobrivi dayofis mixedviT - I xarisxi 2030%, II xarisxi 30-50%, III xarisxi 50-100%, IVxarisxi 100% da zemoT. xdeboda sqesis, asakis da genetikuri datvirTvis gaTvaliswineba (miokardiumis infarqti,Ggid, insulti). yvela pacientisTvis sixlis arteriuli wnevis gazomva (sistoluri da diastoluri) xdeboda 3 jeradad. yvela kriteriumi Sefasda msoflio jandacvis dacvis organizaciis mier miRebuli kriteriumebiT. yvela gamosakvlevi pirisTvis sisxlis aReba xdeboda 12 saaaTiani intervaliT uzmo mdgomareobaSi. li piduri speqtris gamokvleva tardeboda sisxlis SratSi speqtrofotometr “Janway-4500” gamoyenebiT. saerTo qolesterinis (sq) raodenoba ganisazRvreboda enzimuri meTodiT (Cholesterol Chod-Pap Kit. Cotd SFBC, E6. BIOLABO, France), trigliceridebis (tg) - enzimuri meTodiT (CODE GPO Kit, SFBC, KO, BIOLABO, France) gamoyenebiT, xolo maRali simkvrivis li poproteidebis qolesterinis (mslq) Semcveloba ki (dslq) da Zalian dabali simkvrivis li poproteidebis qolesterinis (Zdsl) preci pitaciiis Semdeg (Cholesterol precippitant SFBC, CODE, Mi, BIOLABO, France). gamoiTvleboda aTerogenobis indeqsi. dslq iTvleboda Friedwald formulis mixedviT. sisxlSi fibrinogenis gansazRvra xdeboda Rutberg-is mixedviT, xolo glikemiis fermentuli meTodiT (firma “Humana-“ s reaqtivebiT). miRebuli monacemebi damuSavda statistikurad, gamoiTvala M±SD (saSualo standartuli gadaxra). jgufTa Soris miRebul monecemTa analizisTvis gamoviyeneT stiudent testi Sewyvilebuli monacemTaTvis. sarwmunoebis koeficienti ganisazRvra, rogorc p<0,005. korelaciis testireba Catarda pirsonis korelaciis mixedviT. miRebuli Sedegebi da ganxil- va: literaturuli monacemebis mixedviT, msuqani bavSvebis 60%s mozrdilobaSi uviTardebaT II ti pis Saqriani diabeti. Cvens mier Catarebuli kvlevis Sedegebi mocemulia #1 cxrilSi. msuqani bavSvebis I jgufSi glikemiis cifrebi Seadgenda 82,5±7,52 mg/dl, xolo normaluri wonis bavSvebSi 71,5±3,06 mg/dl, maT Soris sxvaoba statistikurad sarwmunoa (p<0,005). sq maCvenebeli I jgufSi aris 166±18,1 mg/dl, xolo II jgufisaTvis es maCvenebeli Seadgens 143,3±14,7 mg/dl. am or maCvenebels Soris aRiniSneba statistikurad sarwmuno gansxvaveba (p<0,005). tg maCvenebeli I jgufSi aris 142±38,1 mg/dl, rac sarwmunod (p<0,005), gansxvavdeba II jgufis maCveneblisagan 100±15,3 mg/dl. unda aRiniSnos, rom am asakis bavSvebisaTvis sq miRebuli norma aris 170 mg/dl, xolo trigliceridebisTvis > 150mg/dl. sq-s am maCnenebelze maRali mniSvneloba aReniSna Cveni kontigentis (msuqani bavSvebis) 42% bavSvebSi, tg-37%-Si, xolo normaluri wonis kontigentSi, arc erT bavSvs ar aReniSna, arc sq-s da arc, tg-s normisagan gadaxra. rac Seexeba li piduri homeostazis integralur maCvnebels - aTerogenobis indeqss I jgufSi Seadgens 3,4±0,47, xolo sakontrolo jgufSi ki - 2,3±0,4 (p<0,005). aRniSnuli Sedegebidan gamomdinareobs, rom msuqan bavSvTa garkveul nawils aReniSneba hi perqolesterinemia da hi pertrigliceridemia. orive jgufis bavSvebSi aRiniSneba dadebiTi korelaciuri kavSirebis arseboba asaksa da simaRles Soris, Tumca II jgufis bavSvebSi es korelacia ufro gamoxatulia. gansxvavebiT normaluri wonis bavSvebisagan, I jgufSi aRiniSneba dadebiTi koralaciuri kavSiri fibrinogensa da dslq-s Soris (r±0,6). mravali epidemiologiuri da klinikuri monacemebis safuZvelze [2,3,9], dsl miCneulia aTerogenobis yvelaze gamoxatul markerad. akad n. yifSiZis mra2013 weli ,fdidsf rfhlbjkjubf 89 valwliani kvlevebis safuZvel- cifrebi, igive asakis normaluri ris, uaryofiTi korelaciuri kavSiris arseboba mslq-sa da ze [6] bavSvebs, romelTac aReniS- wonis bavSvebTan SedarebiT. 2. msuqan bavSvebSi li piduri asaks Soris, ganapirobebs, rom nebodaT bavSvobaSi dslq-s maRali maCvenebeli, igive aReniSne- cvlis monacemebidan mniSvne- msuqan bavSvTa kontigenti gamobodaT mozdilobis periodSic. lovnad momatebulia qoleste- iyos, rogorc gansakuTrebuli rac, Seexeba fibrinogens, igi mra- rinis, trigliceridebisa da riskis jgufi aTerosklerozis li piduri cvlis homeostazis naadrevi prevenciisaTvis. vali gamokvlevebis mixedviT warmoadgens, rogorc aTeroskliteratura: cxrili #1 lerozis damoukidebel riskanTropometruli, glukozis, 1. NHBI/Fact book, Fiscal Year 1993. faqtors [1,2,3], aseve aTeroskle- lipiduri speqtris da fibrinogenis 2. Prevention in Childhood and youth rozis progresisa da gamwvave- maCveneblebi msuqan da normaluri of adult CVD: time for action. Technical Rewonis bavSvebSi. port series 792& WHO, Geneva&, 1990. bis prediqtorsac. amitom is 3. National Cholesterol Education progkorelaciuri kavSiri, romeram.//Circulation 1994; 89, P. 1329-455. lic gamovlinda msuqan bavSveb4. Lauer RM., Lee J., Clark Si am or parameters Soris, ganWR.//Factors affecting the relationship sakuTrebul mniSvnelobas iZens between childhood and adult CholesaTerosklerozis naadrevi preterol Levels. The Muscatin study. PevenciisaTvis bavSvobis asakidan, diatrics.1988. 82: P. 309-318. uaryofiTi korelaciuri kavSi5. Report on the Second Task Force on ri gamovlinda asaksa da mslqBlood Pressure control in Children, 1987. s Soris, rac miuTiTebs antiaPediatrics 1987. 719, P.1-25. Terogenuli rgolis Sesuste6. N.Kipshidze, N. Shavgulidze. Gebaze msuqan bavSvebSi asakis manetic aspects of atherosclerosis 64th. ContebasTan mimarTebaSi,Aamitogress of EAS, Utrech, the Netherlands. Jumac am maCvenebels SeiZleba mine 10-13, 1995. eniWos aTerosklerozis pre7. Cheercheulidze // Comparative diqtoris mniSvneloba am asastudies of Lp and apo inchildren& j. kobrivi populaciisaTvis.AaGM 1993 p&. seve aRiniSneba uaryofiTi ko8. HDL subclass evalution in childern relaciuri kavSiri mslq-sa da whose parents suffered early CHD Atherosclerozis 104. V7109 N1-2, P. 327. diastolur wnevas Soris, trig9. n. uberi // gid risk-faqtorebi da maTi liceridebs da ai-s Soris. integraluri maCveneblis aTero- koreqciis gzebi am daavadebiT damZimeSeniSvna: P<0,005 genobis indeqsis maCveneblebi. buli memkvidreobis mqone bavSvebSi. avdaskvnebi: 3. msuqan bavSvebSi dadebiTi toreferati, 1997. .. .!. 1. msuqan bavSvebSi aRiniSneba korelaciuri kavSiris arsebo- // " # $ glikemiis SedarebiT maRali baFfibrinogensa da dslq-s So- . %. 1989 - № 8. -' 55-58. CONTENTS ATHEROSCLEROSIS RISK-FACTORS IN OBESE CHILDREN M. KAKAURIDZE*, Z. SEKHNIASHVILI*, N. KAKAURIDZE** TSMU, Endocrynology Department* National Center of Therapy** Objective: Investigation of atherosclerosis risk factors in obese children. Methods and materials: We investigated 17 children (9 obese and 8 with normal body mass, aged of 5-14 years. Among them were 15 boys and 2 girls. They were divided into 2 groups. (I - were obese children, II - healthy chidren). We Determined their lipid metabolizm, fibrinogen. Glucose in the blood , which were taken after 12 hours interval of fasting, systolic and diastolic pressure, genetics, and then statistically calculated gained data. Everything was performed according WHO’s data. 1. In obese children we found high levels of glycemia in comparison with the II group, though, these data are not out of range. 2. From the lipid metabolism: cholesterol, TG, and atherogenic index were increased significantly. 3. In obese children positive correlation between FG and LDLc, also negative correlation between HDLc and age determines, that obese children are risk group for atherosclerosis development and need early prevention. Literature: 1. NHBI/Fact book, Fiscal Year 1993. 2. Prevention in Childhood and youth of adult CVD: time for action. Technical Report series 792& WHO, Geneva&, 1990. 3. National Cholesterol Education program.//Circulation 1994; 89, P. 1329-455. 4. Lauer RM., Lee J., Clark WR.//Factors affecting the relationship between childhood and adult Cholesterol Levels. The Muscatin study. Pediatrics.1988. 82: P. 309-318. 5. Report on the Second Task Force on Blood Pressure control in Children, 1987. Pediatrics 1987. 719, P.1-25. 6. N.Kipshidze, N. Shavgulidze. Genetic aspects of atherosclerosis 64th. Congress of EAS, Utrech, the Netherlands. June 10-13, 1995. 7. Cheercheulidze // Comparative studies of Lp and apo inchildren& j. GM 1993 p&. 8. HDL subclass evalution in childern whose parents suffered early CHD Atherosclerozis 104. V7109 N1-2, P. 327. 9. 9. n. uberi // gid risk-faqtorebi da maTi koreqciis gzebi am daavadebiT damZimebuli memkvidreobis mqone bavSvebSi. avtoreferati, 1997. Кравец Ц.Б. Князев Ю.Я. // Атерогенные факторы при ожирении у детей. Педиатрия. 1989 - № 8. -с 55-58. 2013 weli 90 ,fdidsf rfhlbjkjubf THE CONTENT ON THE UPTODATE WEBSITE IS NOT INTENDED NOR RECOMMENDED AS A SUBSTITUTE FOR MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. ALWAYS SEEK THE ADVICE OF YOUR OWN PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL REGARDING ANY MEDICAL QUESTIONS OR CONDITIONS. THE USE OF THIS WEBSITE IS GOVERNED BY THE UPTODATE TERMS OF USE (CLICK HERE) ©2012 UPTODATE, INC. What's new in pediatrics Authors ALISON G HOPPIN, MD MELANIE S KIM, MD ELIZABETH TEPAS, MD, MS MARY M TORCHIA, MD Disclosures All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jun 2012. | This topic last updated: Jul 12, 2012. The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What’s New entries are at the top of each subsection. CARDIOLOGY Association of cardiovascular risk factors and body mass index — Analysis of 3383 adolescents (ages 12 to 19 years) who participated in the United States National Health and Nutrition Examination Survey from 1999 through 2008 showed the prevalence of any cardiovascular risk factor (eg, hypertension, dyslipidemia, and diabetes) rose with increasing body mass index (BMI): 37, 49, and 61 percent for normal weight, overweight, and obese individuals, respectively [4]. The risk of having three or more risk factors also rose with increasing BMI (1, 2, and 8 percent for normal weight, overweight, and obese adolescents, respectively). These data highlight the high prevalence of CVD risk factors in overweight and obese adolescents. (See "Risk factors and development of atherosclerosis in childhood", section on 'Background'.) Cardiovascular health in children — In December of 2011, an expert panel sponsored by the US National Heart, Lung, and Blood Institute published guidelines to promote a lifestyle for children that reduces the risk of cardiovascular disease (CVD), and to identify and manage the child at-risk for premature atherosclerosis [5]. Key elements of these guidelines included: A comprehensive guide for pediatric health supervision – This includes dietary and activity recommendations based on the child’s age and developmental stage (table 1 and table 2 and table 3), and recommendations for routine screening for CVD risk factors. (See "Pediatric prevention of adult cardiovascular disease: Promoting a healthy lifestyle and identifying at-risk children".) Universal selective screening for lipid disorders in children – This new recommendation is controversial because there is a paucity of data regarding the long-term cost benefit of universal versus selective screening for pediatric dyslipidemia [6,7]. (See "Definition and screening for dyslipidemia in children", section on '2011 NHLBI guidelines on pediatric lipid screening' and "Definition and screening for dyslipidemia in children", section on 'Screening controversies'.) Revision of the risk stratification schema for diseases associated with premature CVD – The panel simplified the management approach to children with diseases associated with early CVD. The decision for therapeutic intervention is based on the degree of risk related to the specific underlying condition and the presence of other risk factors (figure 1). (See "Diseases associated with atherosclerosis in childhood", section on 'Risk stratification based on specific diseases' and "Overview of the management of the child at-risk for atherosclerosis", section on 'High-risk diseases'.) praq ti ko si eqi me bi saT vis daavadebaTa marTvis erovnuli protokoli protokolis dasaxeleba. cxelebis marTva bavSvTa asakSi protokoliT moculi klinikuri mdgomareobebi da Carevebi. daavadebis/sindromis mokle ganmarteba. cxeleba warmoadgens organizmis reqtaluri temperaturis matebas > 380C, xolo aqsilaruli, oraluri da timpanuri >37,50 C. temperaturis gazomvis sxvadasxva meTodi arsebobs: eleqtronuli TermometriT iRliaSi qimiuri wertilovani TermometriT iRliaSi infrawiTeli timpanuri TermometriT 0–36 Tvis bavSvebSi temperaturis gazomvis yvelaze zusti meTodi aris reqtaluri. (2) klinikuri niSnebi da simtomebi cxeleba (febriluri daavadeba) SeiZleba daiyos sam kategoriad: cxeleba Tanmxlebi lokaluri simptomebiT, cxeleba lokaluri niSnebis gareSe, ucnobi etiologiis cxeleba. 2013 weli ,fdidsf rfhlbjkjubf cxeleba lokaluri simptomebiT (4) cxeleba gamonayriT (3. 4) cxelebis mizezebi da marTva 0–3 Tvemde da 3-36 Tvis asakis bavSvebSi princi pulad gansxvavdeba. 2. mwvave cxeleba lokaluri keris gareSe 3 Tvemde asakis CvilebSi lokaluri keris gareSe aRmocenebuli cxelebis mizezebis identificireba, miuxedavad anamnezis srulyofilad Sekrebisa da srulyofili fizikaluri kvlevisa, swrafadve ver xerxdeba. saWiroa virusuli da baqteriuli infeqciebis diferencireba. mZime baqteriuli infeqcia 2013 weli moicavs baqteriul meningits, baqteriemias, filtvis baqteriul anTebas,saSarde gzebis infeqcias (sgi), baqteriul enterits, celulits,Zvlebisa da saxsrebis infeqcias. epidemiologia: sicocxlis pirvel TveebSi febriluri daavadeba SeiZleba Zalian mZimed mimdinareobdes. sicocxlis pirvel sam TveSi baqteriuli infeqcia Seadgens cxelebiT mimdinare daavadebis 12%-s, aqedan- saSarde gzebis infeqcia aris yvelaze xSiri (5.4%), baqteriemia (1.8%), meningiti (0.5%), pnevmonia (3.3%). 91 zeda sasunTqi gzebis infeqcia-25.6%, mwvave otiti- 12.2%, daaxloebiT igive raodenobiT - gastroenteriti. risk-faqtorebi: 1. asaki - baqteriemia orjer ufro xSiria sicocxlis pirvel Tves,vidre meore Tves da ufro iSviaTia mesame Tves (meore TvesTan SedarebiT). 2. temperatura - 4-dan 12 kviramde asakis CvilebSi, romlebic gamoiyurebian kargad an minimalurad avad, baqteriemia an baqteriuli meningiti SeiZleba ganviTardes 1,2%-Si, Tu temperatura aRemateba 38,6C, da -0,4%-Si,Tu temperatura naklebia 38,60 C. 3. dRenakluloba- dRenakl axalSobilebSi bevrad ufro xSiria gvian gamovlenili Bjgufis streptokokuri infeqciebis ganviTarebis albaToba , vidre droul axalSobilebSi. gamomwvevebi: meningitisa da baqteriuli infeqciis gamomwvevi baqteriuli agentebi arian: Streptococcus pneumoniae, Escherichia coli da sxva gramuaryofiTi Cxirebi, Staphylococcus aureus, A jgufis streptokoki, Enterococcus, Listeria monocytogenes, Salmonella da Shigella. pirveli Tvis ganmavlobaSi yvelaze xSiri gamomwvevi aris B jgufis streptokoki, gramuaryofiTi enteraluri mikroorganizmebi, meore Tvidan- S.pneumoniae. gvian gamovlenili B-jgufis streptokokuri infeqcia SeiZleba aRmocendes dabadebidan pirvelive kviraSi an 3 Tvis Semdeg. yvelaze xSiri virusuli agentebia - enterovirusi, respiratorul-sincitialuri virusi,influenca, Herpes Typ 6, adamianis metapnevmovirusi, adenovirusi da Herpes simplex. daavadebis simZimis xarisxi: (2, 4) msubuqi da saSualo simZimis: yvela 4 kvirisa da meti asakis bavSvi temperaturiT < 38,90C,romelTac ara aqvT gulfiltvis mxriv darRvevebi an ar dasWirvebiaT postnatalur periodSi raime ti pis mkurnaloba an samedicino Careva, da romelTac aqvT sando patronaJi. mentaluri statusi- iRimeba da ar aris gaRizianebuli,reagirebs swrafad,sakvebs Rebulobs kargad. 92 ara aqvs gamoxatuli dehidrataciis niSnebi, aqvs kargi periferiuli perfuzia, kani vardisferia, kidurebi-Tbili. ara aqvs gamoxatuli respiratoruli distresis niSnebi, neitrofilebis absoluturi ricxvi <1500/, leikocitebi5000-15000. Tu gamoxatulia diarea, ganavlis mikroskopiuli kvlevisas <5 leikocitze mx/areSi da ganavalSi ar aRiniSneba sisxli. mZime: Cvilebi 4 kviris asakis (4 kviraze naklebi asakis yvela axalSobili unda moTavsdes stacionarSi da Cautardes mkurnaloba kulturis amoTesvis mixedviT, vinaidan ver xerxdeba maTi mdgomareobis srulyofilad Sefaseba) an Cvilebi temperaturiT >38.9C,an Cvile bi kar di o pul mo na lu ri darRvevebiT, an Cvilebi, romelTac aReniSnebodaT garTulebebi postnatalur periodSi, miuxedavad cxelebis xarisxisa da sando patronaJisa. mentaluri statusi _ gaRizianebulia,magram mSviddeba, mzeriTi kontaqti-cudi (leTargia), sakvebs Rebulobs cudad. gamoxatulia dehidrataciis niSnebi an cudi perfuzia-aWrelebuli kani, civi kidurebi. sunTqvis sixSire >60, retraqciebi, grundingi (xrotini), krepitacia. neitrofilebis absoluturi ricxvi metia an tolia 1500/L, leikocitebis saerTo ricxvi <500 da >15000. Tu gamoxatulia diarea, da ganavlis mikroskopiuli kvlevisas >5 leikocitze mx/areSi, an sisxliani ganavali. Zalian mZime mentaluri statusi-gaRizianebulia da agznebulia, ver xerxdeba Cvilis damSvideba, ver Rebulobs sakvebs an aReniSneba krunCxva. gamoxatulia Sokis niSnebi an Zlieri sifermkrTale Zafiseburi pulsiT. gamoxatulia apnoe,cianozi, respiratoruli distresi. mwvave cxeleba 3 Tvemde asakis CvilebSi lokaluri keris gareSe (1) marTvis algoriTmi (sqema 1) A. anamnezSi mniSvnelovania: cxelebis xangrZlivoba,xasia- ,fdidsf rfhlbjkjubf Ti da xarisxi, perinataluri risk-faqtorebi (mag. dRenakluloba, dedis cxeleba, herpes infeqcia, placentis naadrevi aSreveba), Secvlili mentaluri statusi, yovedRiuri garemo (gamaRizianebeli fqtorebi, kveba, Zili,krunCxvebi, reagireba garemo gamRizianeblebze), simptomebi sasunTqi sistemis mxriv (xvela, surdo,swrafi sunTqva an sunTqvis gaZneleba, gulmkerdis retraqciebi) da gastrointestinaluri simptomebi (Rebineba,diarea,muclis tkivili, sisxliani ganavali,meteorizmi, muclis faris daWimuloba, diskomforti). B. fizikaluri kvlevisas: Seafase daavadebis simZime, Seamowme temperatura, guliscemis sixSire, sunTqvis sixSire, kapilaruli avsebis dro, dehidrataciis arseboba da xarisxi.aucilebelia daTvaliereba, mosmena da Semowmeba im niSnebisa, romelic gamoricxavs an adasturebs meningits( daWimuli yiflibandi, susti wova,Znelad gaRviZeba an Zalzed Zlieri agzneba). sakmaod Znelia Sefaseba Cvilebisa,romelTac jer ara aqvT Camoyalibebuli „socialuri“ Rimili (4-6 kvira) an ara aqvT gamomuSavebuli mxedvelobiTi kontaqti. Cvilis Rimili aris sando negatiuri prediqtori meningitisaTvis. miaqcie yuradReba perfuziis niSnebs, rogoricaa kidurebis feri da temperatura,kapilaruli avsebis dro, (>2 wm-ze paTologiuria). gaiTvaliswine, rom Sua yuris anTebis dros daqveiTebulia dafis apkis elastiuroba(mobiloba), SemRvreulia,aqvs reliefuri konturebi. gaiTvaliswine pnevmoniis niSnebi- taqi pnoe, retraqcia,grunTingi ( xrotini), krepitacia. rbili qsovilebis celuliti an abscesi (gansakuTrebiT- omfaliti) vlindeba SeSupebiT,siwiTliT, SemkvrivebiT, mtkivneulobiT da adgilobrivad-temperaturis matebiT. Zvlebisa da saxsrebis infeqcia prezentirdeba moZraobis SezRudviT, zogjer tkiviliTa da SeSupebiT. enterovirusuli infeqcia vlindeba gamonayariT,eriTematozuri laqebiTa da xelis,fexis gulebisa da piris Rrus lorwovanis dazianebiT. Neisseria meningitidis -iT gamowveuli baqteriemia-peteqiebiTa da purpuriT. C. baqteriuli infeqciebi,romlebic vlindeba fizikaluri da laboratoriuli kvlevisas, aris ZiriTadad Sua yuris mwvave anTeba, pnevmonia, impetigo, adeniti, celuliti, omfaliti da baqteriuli enteriti (sisxliani diarea da septiuri arTriti–osteomieliti). baqteriul enteritsa da pnevmoniasTan asocirebuli baqteriemia gvxvdeba 10%-ze nakleb SemTxvevebSi , 10%-Si saSarde gzebis infeqciebis dros, pacientebs mwvave otitiT 5%-ze nakleb SemTvevaSi aReniSnebaT baqteriemia an meningiti. D. 4 kviraze meti asakis Cvilebi,romelTa daavadebis xarisxi Sefasda rogorc msubuqi an saSualo simZimis, SeiZleba davtovoT ambulatoriuli zedamxvedlobis qveS sisxlisa da Sardis kulturebis pasuxis miRebamde. am situaciaSi arsebobs ornairi rekomendacia: 1) intramuskularuli ceftriaqsoniT mkurnalobis dawyeba (1,2) 2) monitoringi da pacientis Sefaseba antibiotikoTerapiis ga re Se. Se a fa se pa ci en tis mdgomareoba yovel dRiurad pasuxis miRebamde. Caatare lumbaluri punqcia antibiotikis dawyebamde.Tu sisxlidan an lumbaluri punqtati-dan moxda raime paTogenis identificireba,gadaiyvane pacienti klinikaSi parenteraluri antibiotikoTerapiis Casatreblad. Cvilebs, romelTac aqvT mxolod Sardis kultura dadebiTi, SeiZleba vumkurnaloT ambulatoriulad peroraluri antibiotikiT,im SemTxvevaSi Tu ukve afebriluria, bavSvi kargad gamoiyureba da SeuZlia peroralurad antibiotikis miReba. winaaRmdeg SemTxvevaSi, pacienti saWiroebs parenteralur antibiotikoTerapias. E.Caatare lumbaluri punqcia meningitis sadiagnostikod CvilTan,romelic avad gamoiyureba. liqvorSi pleocitozi gvaqvs im SemTxvevaSi, Tu ujredebis saerTo raodenoba aRemateba 10/ml-s. umravles SemTxvevaSi meningiti virusuli etiologiis aris. adreuli Cvilobis periodSi meningitis gamomwvevizafxulis TveebSi aris enterovirusi.abnormalur cvlilebebs liqvorSi iwvevs HerpesßSimplex -virusic. Caatare polimerazis jaWvuri reaq2013 weli ,fdidsf rfhlbjkjubf cia (PSR) liqvorSi da umkurnale acikloviriTim pacientebs,romlebsac aqvT mononuklearuli pleocitozi liqvorSi da nevrologiuri simptomatika.CvilebSi, romelTac aReniSnebaT cxeleba > 38.90C, baqteriemiisa da meningitis sixSire Seadgens 3-4 %-s. F. umkurnale hospitalizirebul pacientebs intravenuri antibiotikiT 48 sT –is ganmavlobaSi biologiuri siTxeebis kvlevis Sedegebamde. sisxlisa da Sardis dadebiT kulturebze winaswari pasuxi umravles SemTxvevaSi aris 24 saaTSi. pirveli 4 kviris asakSi optimalur antibiotikad iTvleba ampicilini da gentamicini, 4-8 kvira-ampicilini da cefotaqsimi an ceftriaqsoni. ampicilini rekomendirebulia listeriisa da enterokokis gadasafarad. Secvale nafcilini an sxva naxevradsinTezuri penicilini ampiciliniT,Tu infeqcia gamowveulia oqrosferi stafilokokiT (mag. kanis bulozuri dazianeba). enterokokuri infeqcia xSirad moiTxovs ampicilinisa da gentamicinis intravenur ineqcias 10 dRis ganmavlobaSi. gvian gamovlenili Bjgufis streptokokiTa da S.pneumoniae-Ti gamowveuli baqteriemia moiTxovs intravenur antibiotikoTerapias 7-dan 10 dRemde. ganixile acikloviriT mkurnaloba Herpes-Simplexinfeqciaze eWvis dros(kanis mxriv cvlilebebi, nevrologiuri niSnebi an liqvorSi pleocitozi), aseve im bavSvebTan, romlebic Sefasebulni arian,rogorc Zalian mZime. ceftriaqsoni sifrTxiliT gamoiyene bavSvebSi, romelTac aReniSnebaT hi perbilirubinemia! sqema 1 cxeleba 3-36 Tvis bavSvebSi lokaluri keris gareSe am asakSic mniSvnelovania virusuli da baqteriuli infeqciebis diferencireba. aseve mniSvnelovania lokusis gareSe cxelebisas baqteriemiis gamovlena. baqteriemiis garTulebebi: faruli baqteriemiis garTulebebi moicavs duned mimdinare meningits,periorbitul an bukalur celulits,pnevmonias,septiur arTrits, osteomielits, epiglotitsa da perikardits. Hib da PCV7 da PCV13-vaqcinebis 2013 weli (vaqcina Haemophilus influenyae b ti pisa da Streptococcus pneumoniae-s sawinaaRmdego vaqcinebi) gamoyenebam mniSvnelovnad Seamcira baqteriemiis garTulebebi. epidemiologia: adreuli bavSvobis (3-24 Tve) periodSi pediatrTan vizitis mizezebis saerTo raodenobis 26%-s, xolo hospitalizaciis 55%-s Seadgens febriluri daavadeba. daaxloebiT 25%-Si temperatura aris 39 da meti. pacientTa 15-31%-Si ver xerxdeba baqteriuli da virusuli infeqciebis diferencireba (gamonaklisia zeda sasunTqi gzebis msubuqi infeqciebi). lokaluri keris gareSe mimdinare procesis dros faruli baqteriemiis ganviTarebis albaToba damokidebulia asaksa da cxelebis xarisxze. imunizirebul bavSvebSi cxelebiT >39c-ze faruli baqteriemiis albaToba Seadgens 0,5%-s. ukanaskneli kvlevebis mixedviT, sisxlis baqteriuli kvlevisas xSirad 93 Warbobs kontaminacia (anu kulturebi aris cru dadebiTi), rogorc wesi, pirvel 15 saaTSi gazrdili Stamebi aris WeSmariti, 31saaTis Semdgom kontaminacia (Uptudae). risk-faqtorebi: aRniSnul asakobriv jgufSi baqteriemiis xarisxi dabalia. gamomwvevi faqtorebi : faruli baqteriemia,rogorc wesi, gamowveulia St.pbeumoniae an Neisseria meningitides, sallmonela, Staphylococcus aureus, Escherichia coli, da Streptococcus pyogenes SeuZliaT aseve iyvnen faruli baq te ri e mi is ga mom w ve ve bi.. Haemophilus influenzaetype B iSviaTia imunizirebul pirebSi. baqteriuli enteritis gamomwvevi mizezi aris Salmonella, Campylobacter, Shigella, Yersinia, da invaziuri an toqsiuri Stamebi E.coli-isa. sqema 2(1) cxeleba 3-36 Tvis bavSvebSi lokaluri keris gareSe (1) cxelebis mizezebi risk-faqtorebis arsebobis mixedviT: (4) 94 sqema 2 anamnezSi miaqcie yuradReba cxelebis dawyebis dros,cxelebis ti psa da xarisxiss. daadgine,aqvs Tu ara ojaxs normaluri socialuri statusi (damakmayofilebeli da adeqvaturi patronaJi, transportirebis saSualeba da informaciis gadacemis xelmisawvdomoba). risk-faqtorebi moicavs: imunizaciis statuss, mocemul momentSi miRebul preparatebs, alergias, Tanmxleb paTologiebs (kardiopulmonaluri, gastroenteraluri, renuli darRvevebi, namgliseburi anemia, centraluri venis kaTeterizacia, parenteraluri kveba, mkurnalobis invaziuri meTodebi, yvela is mdgomareoba da mkurnalobis ti pi, romelic auaresebs imunologiur statuss.) Seafase mentaluri statusi (ramdenad xalisiania pacienti, gaRizianebadoba, Zilisa da kvebis ti pi, adeqvaturi re a gi re ba, krun Cx ve bi). yu radReba miaqcie respiratorul simptomebs (xvela, surdo,cxviridan gamonadenis ti pi, faringiti,yuris tkivili, gaxSirebuli an gaZnelebuli sunTqva,retraqciebi).Seamowme gastroenteraluri simptomebi (Rebineba, diarea, muclis tkivili,sisxliani ganavali). Seafase renuli simptomebi (dizuria,mtkivneuli da/an xSiri Sardva, muclis qveda nawilis tkivili, ferdis tkivili). fizikaluri gasinjvisas-Sexede,mousmine,gasinje da Seafase arseboba: meningitis (daWimuli yiflibandi, ver Rebulobs sakvebs,leTrgia, ar reagirebs kontaqtze, ukiduresi an paradoqsuli gaRiazianebadoba, kisris rigidoba, bruZinskisa da kerningis niSnebi). dehidrataciis da cudi perfuziis (kanis turgori, ucremlod ti ri li, ga mom S ra li lorwovani garsebi,kidurebis feri da temperatura, kapilaruli avsebis dro >2wamze) Sua yuris mwvave anTeba (dafis apki-naklebad mobiluri, SemRvreuli,araTanabari konturebis) pnevmonia (taqipnoe, retraqciebi, gruntingi, sveli xixini, krepitacia). adeniti, rbili qsovilebis celuliti,abscesi (SeSupeba,hi peremia,tkivili,ad- ,fdidsf rfhlbjkjubf gilobrivad temperaturis mateba), Zvlebisa da saxsrebis infeqcia (mtkivneuloba, SeSupeba,moZraobis SezRudva), enterovirusuli infeqcia (kanze gamonayari,eriTematozuri egzanTema,xelisa da fexis gulebisa da piris lorwovanis dazianeba), Neisseria meningitidis –baqteriemia (peteqiebi da purpura) fizikaluri gasinjvisas an kvlevisas SesaZlebelia eWvis mitana an identificireba Semdeg baqteriul infeqciebze: Sua yuris mwvave anTeba,pnevmonia,im pe ti go,ade ni ti,si nu si ti,celuliti,baqteriuli enteriti (sisxliani ganavali) da septiuri arTriti an osteomieliti. vinaidan imunizaciis fonze Semcirda baqteriuli infeqciebis sixSre, ufro naklebad rutinuli gaxda sisxlis sruli analizis, Sardisa da kulturebis amoTesvaze laboratoriuli testebis Catareba (a nu aR niS nu li ana li ze bi tardeba seleqtiurad). bavSvis asaki, imunizacia,daavadebis simZime da srulyofili ambulatoriuli patronaJi -aris faqtorebi,romelTa saSualebiTac isazRvreba, vis ra masStabiskvlevebi unda Cautardes. Sardi analizisTvis unda miviRoT kaTeteriT. koleqtoriT miRebuli Sardis daTesvisas erTi pasuxia sando-negatiuri kultura. sisxlis sruli analizi Caatare saSualo simZimis pacientTan faruli baqteriemiis gamosaricxad. sayuradReboa Sedegia, roca neitrofilebis absoluturi ricxvi aRemateba 10 000/micro-ls, da leikocitebisa- naklebia 5000-za an metia 15 000-ze. maRali C-reaqtiuli cila ukeT korelirebs baqteriemiasTan da seriozul infeqciebTan, vidre neitrofilozi da leikocitozi. Caatare lumbaluri punqcia meningitis sadiagnostikod „mZime’ an „Zalian mZime“ Cvilebsa da mcire asakis bavSvebSi,ganixile punqciis saWiroeba saSualo simZimis pacientebTan, romelTanac iwyebT antibiotikoTerapias. liqvoris kvlevisas pleozitozad miiReba leikocitebis saerTo ricxvi meti 10/mm3-ze. baqteri- uli meningitis Zalzed sensitiuri indikatoria liqvoris gramis wesiT SeRebvisas dadebiTi Sedegi. albaToba cerebrospinaluri siTxidan baqteriuli kulturis gamoyofisa Zalian mcirea,roca gramiTSeRebvis Sedegi uaryofiTia da ujredebis ricxvi da bioqimiuri Semadgenloba normis farglebSi. zogadad, ufro xSiria virusuli meningoencefaliti,vidre baqteriuli meningiti. xSirad patara bavSvebis safuZvliani fizikaluri kvleva gaZnelebulia. dakvirvebam aCvena, rom radiologiurad pnevmonia aRmoaCndaT patara bavSvebis (<5 welze) 20-30%-s klinikuri niSnebis gareSe, Tumca maT sisxlSi le i ko ci te bis sa er To ricxvi aRemateboda 20 000-s. sxva dakvirvebebiT aRmoCnda,rom 3-36 Tvis bavSvebis 41%-s ,romelTac leikocitebis ricxvi hqondaT > 25 000-ze, daudgindaT radiologiurad pnevmonia (lobaluri an segmenturi). aRniSnuli asociacia leikocitozsa da pnevmonias Soris Zalzed sando rCeba imunizaciis eraSic. ganavlis kvleva kulturaze Caatare, roca saxezea diarea baqteriuli invaziis niSnebiT,rogoricaa ganavalSi sisxli an 5 da meti leikociti mxedvelobis areSi. bevri eqimi Tavs ikavebs empiriulad antibiotikoTerapiis Catarebaze manam,sanam ar mova ganavlis kulturis pasuxi E.coli 0157 infeqciis garTulebebis Tavidan asacileblad. saSualo simiZimis pacientebs infeqciis keris gareSe umkurnale (seleqciurad) peroraluri amoqsacilinis maRali doziT an intramuskularuli ceftriaqsoniT kulturebis Sedegebis miRebamde. kvlevebma aCvena,rom parenteraluri antibiotikebi ufro efeqturia, vidre oraluri Cvilebsa da mcire asakis bavSvebSi baqteriemiiT duned mimdinare meningitis prevencii saT vis. ara re zis ten tu li Str.pneumoniae-Ti gamowveuli infeqciebis oraluri antibiotikiT mkurnaloba SesaZlebelia. cxelebian ambulatoriul pacientebSi gadaxede klini2013 weli ,fdidsf rfhlbjkjubf kur statuss, Tu sisxlSi amoiTesa baqteriuli agenti. yvela pacientTan, romlebTanac rCeba cxeleba an fasdeba kvlav saSualod an mZimed gaumjobesebis gareSe, ganixile lumbaluri punqcia, gaimeore sisxlis kultura da ganixile intravenuri antibiotikoTe ra pia.bav S ve bi, ro mel Tac sis x lis kul tu ra da de bi Tia,magram cxeleba aRar aqvT da kargad gamoiyurebia n, SeiZleba darCnen ambulatoriul pirobebSi. Tu amoiTesa Str.pneumonie da pacienti aris msubuqi, umkurnale 10 dRis ganmavlobaSi amoqsacilinis maRali dozebiT peroralurad an ceftriaqsoniT parenteralurad. Tu dadebiTia Sardis kultura da pacientis mdgomareoba umjobesdeba,gaagrZele peroraluri antibiotikoTerapia ambulatoriul pirobebSi,Tu pacientis mdgomareoba ar umjobesdeba, ganixile parenteraluri antibiotikoTerapiis sakiTxi. mZime pacientebis mkurnaloba mimdinareobs klinikaSi intravenuri antibiotikebiT pirveli 48saaTis ganmavlobaSi sisxlis kulturis Sedegebis miTebamde.antibiotikebis kombinacia damokidebulia daavadebis simZimeze. Zalzed mZime procesis dros ganixile vankomicini cefalosporinTan( cefotaqsimi),raTa moxdes Staphilococcus aureus-isa da Streptococcus pneumonia-s gadafarva, klindamicini ganixile,roca eWvia anaerobebze an Staphilococcus aureus-ze. ar aris respiratoruli distresis niSnebi saSualo: yvela Cvili da mcire asakis bavSvi qronikuli daavadebiT da yvela pacienti temperaturiT >38.90c-ze an bavSvebi arasrulfasovani patronaJiT mentaluri statusi:xanmokle Rimili,gaRizianebulia,tiris,kontaqtobs mSoblebTan, daavadebamde periodTan SedarebiT naklebad aqtiuria da naklebad TamaSobs msubuqi an saSualo simZimis dehidratacia nor ma lu ri pe ri fe ri u li perfuzia ar aris respiratoruli distresis niSnebi mZime: yvela imunokompromitirebuli Cvili da bavSvi mentaluri statusi: gaRizianebulia, ar iRimeba, cudi mxedvelobiTi kontaqti (leTargia), cudad Rebulobs sakvebs mZime dehidratacia cu di per fu ziaaWrelebuli, civi kidurebi sunTqvis sixSire >60,retraqciebi, gruntingi Zaliam mZime: yvela Cvili da bavSvi peteqiiTa da purpuriT mentaluri statusi: ar aqvs reaqciebi,ar iRviZebs kvebisTvis,krunCxvebi an meningealuri garsis gaRizianebis simptomebi Soki,sifermkrTale,Zafiseburi pulsi apnoe,cianozi,sasunTqi sistemis ukmarisoba lokaluri keris gareSe cxelebis dros 3-36 kviris bavSvebis daavadebis simZimis xarisxebi: (1, 5) msubuqi: yvela Cvili da bavSvi temperaturiT < 38.90c-ze da kargi patronaJiT mentaluri statusi: iRimeba,TamaSobs, ar aris gaRizianebuli, iRviZebs advilad,sakvebs Rebulobs kargad,tiris Zlierad,magram advilad mSviddeba ar aris dehidrataciis niSnebi kargi periferiuli perfuzia: vardisferi, Tbili kidurebi sqema 3(1) ucnobi etiologiis cxeleba definicia: gaxangrZlivebuli, dokumenturad dadasturebuli temperaturis mateba >38.30C minimum 2-jer kviraSi da mizezis dadgena ver xerxdeba 3 kviris ganmavlobaSi ambulatoriul pacientebSi an hospitalizaciidan 1 kviris ganmavlobaSi.(1-18 wlamde populaciaSi)(5) mizezebi: (2, 4) 1.ati piurad mimdinare infeqciuri daavadebebi 30-40% 2.SemaerTebel qsovilovani daavadebebi 20% 3.onkologiuri daavadebebi10% 2013 weli 95 4.sxvadasxva mizezebi (fsevdo an medikamentozuri cxeleba) 10% 5. SemTxvevaTa 10-20% diagnozis verificireba ver xerxdeba diagnostika (safexurebrivi): (3) safexuri- I 1. anamnezi _ cxovrebis anamnezi _ mogzauroba _ cxovelebTan kontaqti _ medikamentozuri anamnezi _ gadatanili travmebi da qirurgiuli Careva, stomatologTan viziti _ wonis kargva - alkoholi da narkotiki (Tineijerebi) _ B-simptomatika (RamiT oflianoba,sisuste...) _ ojaxuri anamnezi _ gadatanili daavadebebi 2. fizikaluri monacemebi _ kani (egzema,abscesi?) _ cxviris danamati Rruebi (tkivili zewolisas?) _ paTologiuri auskultaciuri monacemebi ? _ hi perplaziuri limfuri jirkvlebi? _ hepato- splenomegalia? _ reqtaluri da ginekologiuri kvleva (saWiroebis SemTxvevaSi) _ Tvalebi (iriti?) 3. skriningtestebi sisxlis sarTo analizi (sruli), Sardis analizi ganavlis analizi C-reaqtiuli cila gulmkerdis rentgenologiuri kvleva 2 proeqciaSi transaminazebi revmatoiduli faqtori glukoza SratSi Tavzurgtvinis siTxis analizi baqteriologia -sisxli (3jer), Sardi,naxveli, ganavali paTogenur mikroorganizmebze. muclis sonografia sxeulis temperaturis gazomva -6-jer dReSi safexuri 2 - Semdgomi diagnostika _ anamnezis ganmeorebiT Segroveba _eqokardiografia _tuberkulozis diagnostika 96 _serologiuri skriningi: (antistreptolizini,ebStein baris virusi,vasermanis reaqcia,antinuklearuli antisxeulebi) mononukleozi,hepatiti,Sidsi,citomegalia,toqsoplazmozi,salmonelozi, brucelozi,leptospirozi,fsitakozi _vasermanis reaqcia _cxviris danamatebis rentgenografia safexuri 3 - Semdgomi teqnikuri da invaziuri diagnostika _CT-kvleva gulmkerdisa da muclis: limfoma? abscesi? _Zvlis scintografia: osteomieliti? _gastroduodenoskopia, koloileoskopia, bronqoskopia _Zvlis tvinis punqcia, RviZlis pun q cia, ga di de bu li limfuri jirkvlebisa da sxv. organoebis biofsia (saWiroebisamebr) kvlevebi pirvel 4 saaTSi : sisxlis saerTo analizi Sardis analizi gulmkerdis radiologiuri kvleva SeniSvna: ganavlis kvleva pirveli ulufis miRebisTanave! 24-saaTis ganmavlobaSi: C-reaqtiuli cila eleqtrolitebi da gazebi sisxlis bioqimiuri kvleva_ALT, AST,kreatinini, amilaza,tute fosfataza eqokardiografia muclis Rrus ultrabgeriTi kvleva sistemuri daavadebis dasadgenad an gamosaricxad: ANA,ANCA, revmatoiduli faqtori, O-antistreptolizini sisxlis kultura, Sesabamisi Cvenebis dros-lumbaluri punqtatis kvleva. SeniSvna: Tu SardSi ar aris leikocituria,ar aris saWiro Sardis kulturis kvleva. serologia: mononukleozi, citomegalovirusi,ebSteinbaris virusi, luesi, leiSmaniozi. cxelebis diagnoziT hospitalizaciis Cvenebebi: (5) 1.hospitalizaciisas gaiTvaliswineT bavSvis zogadi ,fdidsf rfhlbjkjubf mdgomareoba (saS.simZimis an mZime) da: -ojaxis socialuri garemo -Tanmxlebi davadebebi -mZime infeqciur daavadebebTan kontaqti -mSoblebis uunaroba saWiroebisas daexmaron bavSvs -anamnezSi mogzauroba tropikul an endemiurad saSiS regionebSi -rodesac pacientis cxelebis etiologia dadgenilia, magram cxeleba gaxangrZlivda 2.Tu gamoxatulia Sokis niSnebi, an arakontaqturia, an meningialuri niSnebi dadebiTia saWiroebs reanimatologis konsultacias da reanimaciis ganyofilebaSi hospitalizacias. 3. Tu saeWvoa meningokokcemiis arseboba, saswrafod unda Seiyvanod parenteralurad antibiotiki da moaxdinoT referali infeqciur klinikaSi. Tu gadawyvitavT, rom pacienti ar saWiroebs hospitalizacias, magram diagnozi ar aris verificirebuli,SesaZloa misi ambulatoriulad marTva, magram dawvrilebiT unda avuxsnaT mSoblebs saSiSroebis niSnebi, rodsac unda mimarTon klinikas. pacienti, romelic Sefasda, rogorc msubuqi ar saWiroebs hospitalizacias. mkurnaloba: (1) baqteriuli genezis diagnozis dadgenisas tardeba Sesabamisi mkurnaloba antibiotikebiT, romelTa SerCeva mocemulia teqstis zeda nawilSi. Acyclovir (Zo vi rax) do za20 mg/kg yovel 8 saaTSi(herpesuli infeqciis dros) Ampicillin so di um do za 50 mg/kg-ze yovel 6 saaTSi intavenurad Cefotaxime (Claforan) 50 mg/kg -ze intravenurad yovel 8saaTSi (baqteriemia) an yovel 6 saaTSi (meningiti) Cef t ri a xo ne (Ro cep hin) 75 mg/kgintravenurad yovel 24 saaTSi(baqteriemia) 50 mg/kg intravenurad yovel 12 saaTSi (meningiti) Gentamicin 2.5mg/kg intravenurad yovel 8saaTSi (axalSobilebSi- yovel 12 saaTSi) Nafcilin 25-50mg\kg yovel 6 saaTSi intravenurad ambulatoriulad-Ceftriaxon(Rocephin) 50-75 mg/kg yovel 24 saaTSi erTxel anti piretuli Careva: (2) 1.grili siTxiT, alkoholiT sxeulis dazelva ar aris rekomendirebuli 2.cxelebiani bavSvis gaSiSvleba ar aris rekomendirebuli 3.anti piretuli saSualebebis micemis Cveneba aris, roca temperatura >38,3-38,5 0C. 4.ganumarteT mSoblebs, rodis esaWiroeba anti piretuli preparatebis micema. 5.rutinulad mu miscemT bavSvs anti piretul saSualebas 6.pirveli rigis preparatad miRebulia paracetamoli erTjeradi doza 10-15 mg/kg, sadReRamiso maqsimaluri doza Seadgens 60mg/kg(4-jerad miRebaze).misi gverdiTi efeqti aris hepatotoqsiuroba. 7.meore rigis anti piretuli saSualebaa ibuprofeni, erTjeradi dozaa 5-10 mg/kg(araumetes 4 jeradi miRebisa), sadRe-Ramiso-doza 40mg/kg. 8. dauSvebelia erTdroulad orive preparatis micema, ganixileT isini rogorc alternatiuli saSualeba im SemTxvevaSi, Tu erT-erTi maTgani ar mogvcems Sedegs. 9. dauSvebelia bavSvTa asakSi acetilsalicilis mJavis da analginis micema. 10. nu daniSnavT anti piretiks mxolod im mizniT, rom movaxdinoT febriluri gulyris prevencia. protokolis gadaxedvis vadebi: protokolis gadaxedva da ganaxleba unda moxdes 3 wlis Semdeg. pro to ko lis war mom d ge ni organizacia. pediatrTa akademia pro to kol ze mo mu Sa ve av torTa jgufi. medicinis doqtori maia CxaiZe (jgufis xelmZRvaneli) medicinis doqtori cicino farulava 2013 weli ,fdidsf rfhlbjkjubf protokolis dasaxeleba. savaraudoT infeqciuri warmoSobis diarea da gastroenteriti bavSvebsa da mozardebSi. protokoliT moculi klinikuri mdgomareobebi da Carevebi. protokolis SemuSavebis meTodologia. protokoli SemuSavebulia Semdegi gaidlainis safuZvelze: European society for paediatric gastroenterology, hepatology, and nutrition/European society for paediatric infectious diseases. (2008). Evidencebased guidelines for the management of acute gastroenteritis in children in Europe. Journal of Pediatric Gastroenterology and Nutrition 46 (2), 81-122. da ma te biT ga mo ye ne bu lia Semdegi wyaroebi: Berman’s Pediatric Decision Making (2011). Acute diarrhea. fifth edition 220-225 Cincinnati children,s hospital medical center. (2011) Evidence-based care guideline for prevention and management of acute gastroenteritis in children aged 2 monthes to 18 years. National Guideline Clearing House 8846 from h t t p : / / w w w. g u i d e l i n e . g o v / c o n 2013 weli tent.aspx?id=35123&search=Breast+Feeding Harris J. (2012). Approach to the child with acute diarrhea in developing countries., UpToDate last literature review version National collaborating centre for Women,s and children,s Health. (2009). Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years. from http://www.nccwch.org.uk/guidelines/guidelines-programme/guidelines-programme-published/diarrhoea-and-vomiting-children/ World Health Organization. (2005 ) Hospital care for children. Guidelines for the management of common illnesses with limited resourses. 109-133 damatebiTi wyaroebis gamoyenebis aucilebloba ganapiroba im faqtma, rom originalur gaidlainSi ar iyo protokolisaTvis aucilebeli yvela informacia. protokolis mizani. bavSvTa samedicino dawesebulebebSi mwvave infeqciuri diareis da gastroenteritis marTvis unificirebuli rekomendaciebis danergva da am gziT mkurnalobis efeqturobis gazrda, garTulebebis prevencia, hospitalizaciis maCveneblebis da 97 hospitalizaciis xangrZliobis Semcireba, xarjTefeqturobis Semcireba. samizne jfufi. 2 Tvidan 18 wlamde asakis diareis dawyebamde praqtikulad janmrTeli Cvilebi, bavSvebi da mozardebi mwvave gastroenteritis klinikuri niSnebiT da RebinebiT da cxelebiT an mis gareSe. protokoli ar iTvaliswinebs marTvas : axalSobilTa diareis persistiuli diareis ( xangrZlioba >14 dReze) arainfeqciuri warmoSobis diareis diareiT gamowveuli hi povolemiuri Sokis hi po da hi pernatriemiuli dehidrataciis Rebinebis, romelic grZeldeba >24 saaTze diareis gareSe diareis fonuri qronikuli daavadebis mqone bavSvebSi (dadasturebuli imunodeficiti, kvebis qronikuli moSla, gulis, Tirkmlis paTologia, diabeti, fenilketonuria da sxva) protokoli gankuTvnilia. ojaxis eqimebis, pediatrebis, kritikuli daxmarebis specialistebis, bavSvTa gastroenterologebisaTvis. samedicino dawesebulebaSi protokolis gamoyenebis pirobebi. protokolis gamoyeneba SesaZlebelia ambulatoriebsa da stacionaris prehospitalur da hospitalur departamentebSi. protokolis gamoyeneba unda ganxorcieldes ambulatoriaSi da stacionarSi pacientis mimarTvis momentidan. rekomendaciebi. daavadebis/sindromis mokle ganmarteba. mwvave gastroenteriti aris ganavlis konsistenciis Secvla da /an evakuaciis ricxvis zrda cxelebiT da RebinebiT an mis gareSe. mwvave gastroenteritis dros ganavlis konsistencia aris ufro Txeli siTxis maRali Semcvelobis gamo, xolo defekaciis ricxvi 3 da meti 24 saaTSi, diarea grZeldeba 7-14 dRe. ganavlis konsistenciis Secvla ufro informatiuli maxasiaTebelia, vidre defekaciis sixSire, gansakuTrebiT sicocxlis pirvel TveebSi. ganavlis moculobis gansazRv- 98 ra SesaZlebelia mxolod zogierT dawesebulebaSi, amitom diareis am komponents rutinulad ar viTvaliswinebT. ganviTarebul qveynebSi mwvave gastroenteritis sixSire bavSvebSi 0,5-1,9 epizodi, pirveli 2-3 wlis asakSi 2,5 epizodi, xolo ganviTarebad qveynebSi 3 epizodia wlis ganmavlobaSi. wamyvani etiologiuri agentebia: virusebi ( rotavirusi da norovirusi) da baqteriebi (kampilobaqteria, salmonela, Sigela). mwvave diareas imunokomprometirebul bavSvebSi uxSiresad parazituli agentebi (kri ptosporidia da lamblia) iwveven. helminTebi da zogierTi parazituli infeqcia ( Isospora Belli, Strongyloides Stercocalis, Trichuris trichiura, Entamoeba Histolytica) diareis mizezi ufro endemiur kerebSi xdeba. nozokomuri diareebis uxSiresi mizezia rotavirusi da Clostridium difficile. damadasturebeli kriteriumebi: defekaciis gaxSireba ( 3 da meti 24 saaTSi) fekaliebis konsistenciis Secvla ( ufro Txeli, vidre Cveulebriv) sisxli, lorwo, Cirqi ganavalSi diareas axlavs Rebineba, cxeleba, muclis tkivili, diareas axlavs gauwyloebis niSnebi diareis xangrZlioba ar aRemateba 14 dRes gamomricxavi kriteriumebi: defekaciis sixSire <3 -ze ar aris Secvlili fekaliebis konsistencia nawlavuri disfunqciis xangrZlioba aRemateba 14 dRes diareas axlavs gangaSis niSnebi: Seupovari Rebineba, naRvlis minarevi pirnaReb masaSi, sisxliani Rebineba, muclis daWimva, gamonayari, siyviTle, dizuria da sxva ,fdidsf rfhlbjkjubf cia, ganavalSi sisxlis arseboba, diareis xangrZlioba. Tanmxlebi simptomebi: Rebineba, cxeleba, muclis Seberva da tkivili, tenezmebi, muclis yuryuri, perianaluri eriTema, swori nawlavis prolafsi. Catarebuli mkurnaloba (antibiotikebiT an sxva preparatebiT) Tanarsebuli infeqcia an sxva daavadeba epid. situacia qveyanaSi (sezoni, afeTqebis kerebi) fizikaluri gasinjva. calke aRebul nebismier klinikur simptoms dabali mgrZnobeloba da specifiuroba aqvs. diareis winmswrebi morecidive Rebineba, wyliseburi ganavali da Tanmxlebi respiraciuli simptomebi ufro virusuli genezis sasargeblod metyvelebs. baqteriul genezze didi albaTobiT miuTuTebs: mwvave dasawyisi + 4 da meti defekacia + Rebineba win ar uswrebs diareas cxeleba + sisxliani ganavali sisxliani ganavali + defekaciis maRali sixSire (>10) zogadi mdgomareobis simZime (intoqsikaciis movlenebi, Seupovari Rebineba, muclis tkivili, oligo/anuria, nevrologiuri simptomebi, Soki) gastroenteritis simZime damokidebulia da ganisazRvreba dehidrataciis xarisxiT, amitom gauwyloebis xarisxis Sefaseba yvela SemTxvevaSi aucilebelia. dehidrataciis xarisxis araakuratuli Sefaseba urgentuli daxmarebis dagvianebis an zedmeti Carevis mizezi SeiZleba gaxdes. dehidrataciis simZimis dadgena xdeba klinikuri niSnebis safuZvelze. wonis danakargis mixedviT dehidrataciis xarisxis gansazRvra ar aris sarwmuno. sami yvelaze informatiuli klinikuri niSania: kapilaruli avsebis drois gaxangrZliveba. kanis elastioba/turgoris daqveiTeba. respiraciuli darRvevebi jan.mo-s rekomendaciiT dehidrataciis xarisxis swrafi Sefaseba SesaZlebelia oTxi klinikuri niSnis safuZvelze: (5) mentaluri statusi wyurvilis SegrZneba Cacvenili Tvalebi kanis naoWi (elastioba) dehidrataciis ganviTarebis riski maRalia bavSvebSi : (4) 1 wlamde asakSi ( gansakuTrebiT 6 Tvemde) dabali woniT dabadebul CvilebSi 5 da meti diareuli epizodiT wina 24 saaTSi 2 da meti Rebinebis epizodiT wina 24 saaTSi diareis dawyebamde ar an ver iRebdnen damatebiT siTxeebs diareis dawyebis dros Sewyvites ZuZuTi kveba malnutriciis niSnebiT cxrili 1 dehidrataciis xarisxis gansazRvra (1) klinikuri niSnebi da simptomebi. anamnezis Sekrebis dros unda Sefasdes: asaki diareis xasiaTi: defekaciis sixSire, ganavlis konsisten2013 weli ,fdidsf rfhlbjkjubf hospitalizaciis Cvenebebi : 3 Tvemde asaki Soki saSualo simZimis da mZime dehidratacia nevrologiuri darRvevebi (leTargia, krunCxva) Seupovari Rebineba maRali cxeleba fonuri daavdebebi (diabeti, Tirkmlis ukmarisoba, gulis manki, malnutricia) dehidrataciis ganviTarebis maRali riski araefeqturi oraluri rehidratacia binaze adeqvaturi movlis, socialuri da lojistikuri problemebi eWvi qirurgiul paTologiaze diagnostikur- laboratoriuli testebi da specialistTa konsultaciebi. ambulatoriuli momsaxurebis dros diagnostika xdeba klinikuri niSnebis safuZvelze. laboratoriuli kvleva aucilebeli ar aris. klinikuri niSnebis da riskfaqtorebis sworad Sefaseba umetes SemTxvevaSi sakmarisia virusuli da baqteriuli diareebis gasamijnad. damatebiT SesaZlebelia ganavlis saerTo analizis Seswavla. ganavalSi leikocitebis deteqciis SemTxvevaSi baqteriuli gastroenteritis albaToba maRalia. hospitaluri momsaxureobis dros (prehospitaluri momsaxureba, hospitalizacia) laboratoruli kvleva rutinulad ar tardeba. pirvel 4 saaTSi. saWiroebis mixedviT: sisxlis saerTo analizi hematokriti ganavlis saerTo analizi sisxlis eleqtrolitebi. gastroenteritis dros dehidratacia uxSiresad izonatriemiulia. eleqtrolitebis gansazRvris Cvenebaa: (1) anamnezi da fizikaluri gasinjvis Sedegebis Seusabamoba defekaciis sixSiresTan mZime diarea hi pernatriemiul dehidrataciaze eWvi infuzuri Terapiis aucilebloba (dawyebis win da dros) 2013 weli mJava-tutovani wonasworoba da sisxlis gazebi (Tu aris an mosalodnelia Soki) pirvel 24 saaTSi. saWiroebis mixedviT: Sardis saerTo analizi sisxlis SratSi kreatinini, Sardovana, glukoza ganavlis mikrobiologiuri kvleva. ganavlis kulturis Seswavlis Cvenebebia: defekacia >5 dRe-RameSi, diarea grZeldeba > 7 dReze 6 Tvemde asaki maRali cxeleba, septicemiis riski antimikrobuli Terapiis saWiroeba ( mag. sisxliani diarea, imunokompromitirebuli pacienti) nawlavuri infeqciis diferencirebis aucilebloba nawlavis anTebiT daavadebebTan araefeqturi sawyisi mkurnaloba mogzauroba qveynebSi baqteriuli da parazituli inficirebis maRali riskiT epid. situacia pirvel 3 dReSi. saWiroebis mixedviT: sisxlis kultura serologiuri kvleva (salmonela, lamblia, ameba da sxva) ganavlis kvleva umartivesebze da helminTebze testi Clostridium difficile-s toqsinze qirurgis, gastroenterologis, infeqcionistis konsultacia mkurnaloba rehidrataciuli Terapia rehidratacia I rigis samkur na lo Ro nis Zi e baa. Tu bavSvs SeuZlia siTxis daleva, intravenuri rehidratacia ar aris rekomendebuli. im SemTxvevaSi Tu oraluri rehidratacia ver xerxdeba, naCvenebia enteraluri rehidratacia nazogastraluri zondiT. bavSvebSi dabali osmolarobis oraluri sarehidratacio marili ( glukoza 111, Na + 50-60, K + 20, qlori 60-70, citrati 30, osmolaroba 251 mmol/l) ufro efeqturia standartul osm-Tan SedarebiT. 99 intravenuri rehidrataciis Cvenebebia: (4) Soki savaraudo an mosalodneli persistiuli Rebineba, rac SeuZlebels xdis oralur an nazogastralur rehidratacias araefeqturi oraluri rehidratacia rehidrataciisaTvis aucilebeli siTxis raodenobis gaTvla: Tu ar aris gauwyloebis niSnebi an msubuqi gauwyloebaa, rekomendebulia oraluri rehidratacia 10 ml/kg osm-iT yoveli diareuli epizodis Semdeg da 2 ml/kg yoveli Rebinebis Semdeg(2,4). osm-is raodenobis gaTvla SesaZlebelia ufro martivadac: 10 kgmde wonis bavSvs unda mieces 60-120 ml, xolo 10kg-ze meti wonis bavSvs 120-240 ml yoveli Rebinebis an diareuli epizodis Semdeg, ylup-ylupiT 23 wT-is SualedebiT manam, sanam ar alagdeba diarea (2). osm-is maqsimaluri raodenobaa 100 ml/kg/ dRe-RameSi. (5) zomieri gauwyloebis dros oraluri rehidratacia tardeba 2-4 saaTis ganmavlobaSi 75100 ml/kg ( saSualod 50ml/kg ) odenobiT. am drois gasvlis Semdeg xelmeored fasdeba zogadi mdgomareoba, hidrataciis xarisxi da miiReba axali gadawyvetileba. Tu bavSvi uars ambobs saWiro raodenobis osm-is miRebaze da ar aris gangaSis niSnebi, SesaZlebelia misTvis Cveuli siTxis damatebiT micema ( rZe, wyali, magram ara xilis damtkbari wvenebi an tkbili sasmelebi). (4) mZime gauwyloebis (savaraudo an mosalodneli Sokis) dros aucilebelia swrafad ganxorcieldes periferiuli venis kaTeterizacia da intravenuri rehidratacia. rehidratacia grZeldeba 24 saaTis ganmavlobaSi: 20ml/kg infuzia ( 1-2 saaTis ganmavlobaSi) ringeris laqtatiT an izotonuri xsnariT mocirkulire siTxis raodenobis swrafi Sevsebis mizniT. glukozis 5 % iani xsnariT rehidratacia ar aris rekomendebuli. (4) Tu guliscemis sixSiris, sisxlis wnevis da mentaluri 100 ,fdidsf rfhlbjkjubf cxrili 2 mwvave baqteriuli diareis etiologiuri mkurnaloba (1) statusis normalizacia ar moxda, rekomendebulia ganmeorebiT 20 ml/kg siTxis infuzia. Semdeg kvlav fasdeba hidrataciis statusi da miiReba axali gadawyvetileba rehidrataciis peroraluri an parenteruli gziT gagrZelebis Sesaxeb. Tu meore infuziis Semdeg mdgomareoba ar umjobesdeba, ganixileba kritikuli medicinis specialistis CarTva an referali Sesabamis dawesebulebaSi. (4) Tu stabilizacia miRweulia, pacientebs inicialurad savaraudo an mosalodneli Sokis niSnebiT ugrZeldebaT infuzia 24 saaTze gaTvlili sadReRamiso moTxovnilebis Sesabamisi da damatebiT siTxis deficitis Sesavsebad 100ml/kg odenobiT. Tu pacients mZime dehidrataciiT ar hqonda savaraudo an mosalodneli Sokis niSnebi, siTxeze sadReRamiso moTxovnilebas emateba 50ml/kg. (4) infuzuri Terapiis dros auci le be lia mo ni to rin gi plazmis eleqtrolitebze, Sardovanaze, kreatininze da glukozaze. (4) kaliumis intravenuri koreqcia dasaSvebia mxolod misi koncentraciis gansazRvris Semdeg. (4) hi pernatremiul dehidrataciaze eWvi Cndeba, Tu aris: uneblie moZraobebi kunTTa tonusis mateba hi perrefleqsia krunCxva, cnobierebis dabindva an koma hi pernatremiuli dehidrataciis SemTxvevaSi ganixileba kritikuli daxmarebis specialistis CarTva an referali Sesabamis dawesebulebaSi. (4) intravenuri rehidrataciis nebismier fazaSi, rogorc ki pacienti SeZlebs oralurad siTxis miRebas, damatebiT eZleva osm 5ml/kg sT-Si. oraluri rehidrataciisadmi toleran- tobis dros, naCvenebia intravenuri rehidrataciis Sewyveta da oraluri rehidrataciaze gadasvla. oraluri an parenteraluri rehidrataciuli Terapiis Catarebis Semdeg, Tu aris dehidrataciis xelaxla ganviTarebis riski, naCvenebia 5 ml/kg osm yoveli diareuli epizodis Semdeg. (4) kvebis rekomendaciebi. rehidrataciuli Terapiis dros eqskluziuri ZuZuTi kveba Seuferxeblad grZeldeba. gamarTlebulia ZuZuTi kveba ufro xSirad da xangrZlivad. yvela sxva SemTxvevaSi rehidrataciuli Terapiis dawyebidan araugvianes 4-6 saaTis Semdeg unda gagrZeldes kveba. xelovnur kvebaze myofi CvilebiTvis formulis ganzaveba da koncentraciis TandaTan mateba ar aris rekomendebuli. ulaqtozo an antidiareuli formuliT Canacvleba ar aris aucilebeli. msubuqi da saSualo simZimis dehidrataciis dros pacientis kveba unda gagrZeldes asakis Sesabamisi sakvebiT. izRudeba ujredisis uxvad Semcveli produqtebi da Znelad mosanelebeli naxSirwylebis Semcveli sasmelebi. rZis mJave produqtebi mniSvnelovnad aumjobesebs klinikur simptomebs. Cvilebsa da bavSvebSi rekomendebulia erTi damatebiTi kveba diareuli daavadebis dros da mis Semdeg sul mcire 2 kviris ganmavlobaSi. farmakologiuri Terapia. etiotropuli mkurnaloba antibiotikebi ar iniSneba rutinulad, radgan paTogenuri agenti uxSiresad cnobili ar aris da Tanac bavSvebSi diarea uxSiresad virusulia. an ti bi o ti ke bi baq te ri u li warmoSobis diareis drosac mxolod specifiuri CvenebiT iniSneba. umjobesia oraluri antibiotikoTerapia. parenteraluri Terapiis Cvenebaa: pacienti ver iRebs oralur Terapias (Rebineba, stupori da sxva) fonuri imunodeficiti mZime toqsemia an baqteriemia 3 Tvemde asakis Cvili maRali cxelebiT 2013 weli ,fdidsf rfhlbjkjubf eqstraintestinuri infeqciuri procesi (baqteriemia, fokaluri infeqcia) sisxliani diarea. kulturis Sedegebis miRebamde. I alternativa. Tu aris eWvi Sigelozze ( epid. situaciis gaTvaliswinebiT) I rigis preparatia aziTromicini I dRes 12 mg/kg ( maqs. 500mg) da Semdeg oTxi dRe 6mg/kg ( maqs.250mg ) erT miRebaze. sxva SemTxvevaSi trimetoprim-sulfametoqsazoli. rekomendebuli doza: trimetoprimi 10mg/kg, sulfametoqsazoli 50mg/kg 2 miRebaze 5 dRe. II alternativa. nalidiqsinis mJava 55 mg/kg 4 miRebaze dReSi 7dRe ( ) sisxliani diarea. kulturis Sedegebis miRebis Semdeg. Sigelozi I alternativa. Tu dadasturda mgrZnobeloba trimetoprim-sulfametoqsazolze, maSin is CaiTvleba I rigis preparatad. kursi 5 dRe. II alternativa. cefiqsimi 8mg/kg er T jer dRe Si (maqs.400mg ) 5 dRe oraluri qvinolonebi <17 welze pacientebSi mxolod im SemTxvevaSi gamoiyeneba, roca sxva alternativa ar aris. rekomendebulia ci profloqsacini 10-15 mg/kg 2 miRebaze 5 dRe. parenteruli TerapiisTvis I rigis preparatia ceftriaqsoni 80 mg/kg 1- jer dReSi. kampilobaqteriuli gastroenteriti I alternativa. aziTromicini 10-12 mg/kg (maqs. 500mg ) erT miRebaze 5 dRe II alternativa eroTromicini 30-40 mg/ kg 2-4 miRebaze 10 dRe nawlavis Cxiri. enterohemoragiuli nawlavis Cxiri. antibiotikoTerapiis efeqturoba dadasturebuli ar aris. aseve ar aris dadgenili amcirebs Tu ara antibiotikiT mkurnaloba hemolizur-uremiuli sindromis ganviTarebis risks. rekomendebulia antibiotikoTerapiis Sewyveta da monitoringi mikroangiopaTiis niSnebis gamosavlenad. enterotoqsiuri, enteroagregaciuli Stamebi. 2013 weli I alternativa. aziTromicini 10 mg/kg /24sT erT miRebaze 3 dRe II alternativa. ceftriaqsoni 50 mg/kg dReSi 3 dRe i/m en te ro in va zi u ri Sta mis mkurnaloba xdeba Sigelozis analogiurad. antibiotikasocirebuli diarea (Clostridium difficile). msubuq da saSualo simZimis SemTxvevaSi rekomendebulia antibiotikis moxsna, mZime SemTxvevebSi: I alternativa. metronidazoli 15-35 mg/kg dReSi 3 miRebaze (maqs. 2 grami) 7-10 dRe II alternativa. vankomicini 40 mg/kg dReSi oralurad 4 miRebaze an parenteralurad 12 saaTSi erTxel 7-10-14 dRe. infuziis xangrZlioba aranakleb 60 wT dadasturebuli amebiazi an giardiazi I alternativa. metronidazoli 15-50 mg/kg 3-jer oralurad 10 dRe II alternativa. Tinidazoli 50mg/kg ( maqs. 2 grami) erTjeradad oralurad 3-5 dRe sisxliani diarea ar aris. virusuli diarea saWiroebs mxolod rehidrataciul Terapias da simptomur daxmarebas. salmonezuri gastroenteritis dros antibiotikoTerapia praqtikulad janmrTel bavSvebSi ar aris gamarTlebuli. antiotikoTerapiis Cvenebebi: baqteriemia eqstraintestinuri kerovani infeqcia gastroenteriti maRali riskis bavSvebSi: 6 Tvemde asakis Cvilebi, imunodeficiti, anatomiuri da funqciuri asplenia, nawlavis anTebiTi daavadebebi, imunosupresiuli Terapia, aqlorhidria. I alternativa. ceftriaqsoni 20-100 mg/kg i/v 1 - jer dReSi 7 dRe II alternativa. aziTromicini 20 mg/kg /24 sT erTjer oralurad 7 dRe simptomuri Terapia. anti piretuli mkurnaloba (paracetamoli, ibupreni) antiemeturi ( Rebinebis sawinaaRmdego) saSualebebi gastrienteritis fonze ganviTa- 101 rebuli Rebinebis dros rutinulad ar gamoiyeneba. metaklopramidi parenterulad gamarTlebulia mxolod Seupovari Rebinebis calkeul SemTxvevebSi. adsorbententebi rutinulad ar gamoiyeneba.dasaSvebia smeqtis gamoyeneba. gaaqtivebuli naxSiri ar aris rekomendebuli bavSvTa asakSi. probioturi saSualebebi amcirebs diareis xangrZliobas, yvelaze efeqturi probiotikebia Lactobacillus GG da Sacharomyces bulardii. probiotikebiT mkurnalobis xangrZlioba 5-7 dRe. fermentuli preparatebi rutinulad ar gamoiyeneba. antidiareuli preparatebi mwvave diareis dros bavSvTa asakSi ar gamoiyeneba. cinkis preparatebi rutinulad ar gamoiyeneba da gamarTlebulia mxolod malnutriciis dros. progresis/regresis maCveneblebi. Cveulebriv klinikuri gaumjobeseba xdeba 1-2 dReSi. diarea grZeldeba 5-7 dRe, Rebineba 1-2 dRe. dadebiT dinamikaze miuTiTebs: damakmayofilebeli hidratacia miRweulia, rac dasturdeba wonis namatiT da/an klinikuri statusiT siTxis oraluri miReba eqvivalenturia da aRemateba danakargebs intravenuri an enteraluri rehidrataciis saWiroeba aRar aris ar aris cxeleba ar aris sisxli ganavalSi (Tu ki aseTi iyo) Tu mesame dRes mkurnalobis dawyebidan saxezea maRali cxeleba, sisxliani ganavali, defekaciis sixSire ar iklebs, savaraudoa mkurnalobis mimarT rezistentuli etiologiuri agenti an sxva daavadeba. (1) uaryofiT dinamikaze miuTiTebs diareis garTulebebi: hi pokaliemia hi povolemia/Soki hemolizur -uremiuli sindromi meoradi baqteriuli infeqciebi (pnevmonia, otiti, sef- 102 ,fdidsf rfhlbjkjubf cxrili 3 si si, sa Sar de gze bis in feq ci a) monitoringis samizneebi. zogadi mdgomareoba, hidrataciis xarisxi, wona, periferiuli sisxlis suraTi, eleqtrolituri balansi. hospitalidan gaweris Cvenebebi: (3) damakmayofilebeli hidratacia (klinikuri mdgomareoba da/an wonis namati) parenteraluri rehidrataciis saWiroeba ar aris oraluri miReba aRemateba danakargs samedicino meTvalyureobis an satelefono kavSiris gagrZelebis SesaZlebloba binaze mSoblebis unari marTon bavSvi binaze ( higiena, oraluri rehidratacia, saSiSroebis niSnebis amocnoba) 9. protokolis gadaxedvis vadebi: protokolis gadaxedva da ganaxleba unda moxdes 3 wlis Semdeg. 10. protokolis warmomdgeni organizacia. pediatrTa akademia 11. protokolze momuSave avtorTa jgufi. medicinis doqtori cicino farulava (jgufis xelmZRvaneli) medicinis doqtori maia CxaiZe, ia xurcilava, naTia cirdava ÊÀÒÃÉÏËÏÂÉÉÓ ÈÄÏÒÉÖËÉ ÓÀ×ÖÞÅËÄÁÉ 122. AV ÊÅÀÍÞÉ: 1). ÀáÏÒÝÉÄËÄÁÓ ÉÌÐÖËÓÉÓ ÂÀÔÀÒÄÁÉÓ ×ÉÆÉÏËÏÂÉÖÒ ÛÄ×ÄÒáÄÁÀÓ, ÒÀÝ ÂÀÍÀÐÉÒÏÁÄÁÓ ßÉÍÀÂÖËÄÁÓÀ ÃÀ ÐÀÒÊÖàÄÁÛÉ ÀÂÆÍÄÁÉÓ ÔÀËÙÉÓ ÈÀÍÌÉÌÃÄÅÒÖË ÂÀÅÒÝÄËÄÁÀÓ; 2). ÀÅÔÏÌÀÔÉÆÌÉÓ II ÒÉÂÉÓ ÝÄÍÔÒÉÀ; 3). ÀÅÔÏÌÀÔÉÆÌÉÓ III ÒÉÂÉÓ ÝÄÍÔÒÉÀ. *À) ÓßÏÒÉÀ 1, 2; Á) ÓßÏÒÉÀ 1, 3. 123. ÛÄ×ÀÒÃÄÁÉÈÉ ÒÄ×ÒÀØÔÄÒÏÁÉÓ ÐÄÒÉÏÃÉ ÛÄÄÓÀÁÀÌÄÁÀ ÌÏØÌÄÃÄÁÉÓ ÔÒÀÍÓÌÄÌÁÒÀÍÖËÉ ÐÏÔÄÍÝÉÀËÉÓ: À) 0, 1, 2, 3 ×ÀÆÄÁÓ; Á) "2" ×ÀÆÀÓ; *Â) "3" ×ÀÆÀÓ; Ã) 2, 3 ×ÀÆÄÁÓ. 124. ØÅÄÌÏÈ ÜÀÌÏÈÅËÉËÉ ÃÄÁÖËÄÁÄÁÉÃÀÍ ÒÏÌÄËÉÀ ÓßÏÒÉ ßÉÍÀÂÖËÄÁÛÉ ÀÂÆÍÄÁÉÓ ÔÀËÙÉÓ ÂÀÅÒÝÄËÄÁÀÓÈÀÍ ÌÉÌÀÒÈÄÁÀÛÉ: 1). ßÉÍÀÂÖËÄÁÛÉ ÀÂÆÍÄÁÉÓ ÔÀËÙÉÓ ÂÀÅÒÝÄËÄÁÉÓ ÌÉÌÀÒÈÖËÄÁÀÀ - ÆÄÅÉÃÀÍ ØÅÄÅÉÈ ÃÀ ÏÃÍÀÅ ÌÀÒÝáÍÉÅ; 2). ßÉÍÀÂÖËÄÁÛÉ ÀÂÆÍÄÁÉÓ ÔÀËÙÉÓ ÂÀÅÒ- ÝÄËÄÁÉÓ áÀÍÂÒÞËÉÅÏÁÀ 0,1ßÌ-Ó ÀÙßÄÅÓ; 3). ßÉÍÂÖËÄÁÛÉ ÀÂÆÍÄÁÉÓ ÔÀËÙÉÓ ÂÀÅÒÝÄËÄÁÉÓ ÓÉÜØÀÒÄ 1000 ÌÌ/ßÌ-ÉÀ; 4). ãÄÒ ÀÙÉÂÆÍÄÁÀ ÌÀÒÝáÄÍÀ ßÉÍÀÂÖËÉ, ÛÄÌÃÄ ÌÀÒãÅÄÍÀ ÃÀ ÁÏËÏÓ ÏÒÉÅÄ ÄÒÈÀÃ. À) ÓßÏÒÉÀ ÌáÏËÏà 1, 2; Á) ÓßÏÒÉÀ 3, 4; *Â) ÓßÏÒÉÀ 1, 2, 3. 125. 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À) ÚÅÄËÀ ÜÀÌÏÈÅËÉËÉ; Á) ÓßÏÒÉÀ À, Á; *Â) ÓßÏÒÉÀ 1; Ã) ÓßÏÒÉÀ 3. 129. ÊÏÏÒÃÉÍÀÔÄÁÉÓ ÄØÅÓ ÙÄÒÞÉÀÍ ÓÉÓÔÄÌÀÛÉ (ÁÄÉËÉÓ ÌÉáÄÃÅÉÈ) I ÂÀÍáÒÀ ÌÏÈÀÅÓÄÁÖËÉÀ: *À) äÏÒÉÆÏÍÔÀËÖÒÀÃ; Á) ÅÄÒÔÉÊÀËÖÒÀÃ; Â) +30 ÂÒÀÃÖÓÉÀÍÉ ÊÖÈáÉÈ; Ã) -30 ÂÒÀÃÖÓÉÀÍÉ ÊÖÈáÉÈ. 130. ÊÏÏÒÃÉÍÀÔÄÁÉÓ ÄØÅÓ ÙÄÒÞÉÀÍ ÓÉÓÔÄÌÀÛÉ (ÁÄÉËÉÓ ÌÉáÄÃÅÉÈ) avF ÂÀÍáÒÀ ÌÏÈÀÅÓÄÁÖËÉÀ: À) äÏÒÉÆÏÍÔÀËÖÒÀÃ; Á) ÅÄÒÔÉÊÀËÖÒÀÃ; *Â) -30 ÂÒÀÃÖÓÉÀÍÉ ÊÖÈáÉÈ; Ã) +60 ÂÒÀÃÖÓÉÀÍÉ ÊÖÈáÉÈ. 131. ÊÏÏÒÃÉÍÀÔÄÁÉÓ ÄØÅÓ ÙÄÒÞÉÀÍ ÓÉÓÔÄÌÀÛÉ (ÁÄÉËÉÓ ÌÉáÄÃÅÉÈ) II ÂÀÍáÒÀ ÌÏÈÀÅÓÄÁÖËÉÀ: À) äÏÒÉÆÏÍÔÀËÖÒÀÃ; Á) ÅÄÒÔÉÊÀËÖÒÀÃ; *Â) +60 ÂÒÀÃÖÓÉÀÍÉ ÊÖÈáÉÈ; Ã) +30 ÂÒÀÃÖÓÉÀÍÉ ÊÖÈáÉÈ. 2013 weli 103 132. ÊÏÏÒÃÉÍÀÔÄÁÉÓ ÄØÅÓ ÙÄÒÞÉÀÍ ÓÉÓÔÄÌÀÛÉ (ÁÄÉËÉÓ ÌÉáÄÃÅÉÈ) III ÂÀÍáÒÀ ÌÏÈÀÅÓÄÁÖËÉÀ: À) äÏÒÉÆÏÍÔÀËÖÒÀÃ; Á) ÅÄÒÔÉÊÀËÖÒÀÃ; *Â) +120 ÂÒÀÃÖÓÉÀÍÉ ÊÖÈáÉÈ; Ã) -60 ÂÒÀÃÖÓÉÀÍÉ ÊÖÈáÉÈ. 133. avF ÂÀÍáÒÉÓ ÙÄÒÞÉ ÐÄÒÐÄÍÃÉÊÖËÖÒÉÀ: *À) I ÂÀÍáÒÉÓ; Á) II ÂÀÍáÒÉÓ; Â) III ÂÀÍáÒÉÓ; Ã) avL ÂÀÍáÒÉÓ. 134. avR ÂÀÍáÒÉÓ ÙÄÒÞÉ ÐÄÒÐÄÍÃÉÊÖËÖÒÉÀ: À) I ÂÀÍáÒÉÓ; Á) II ÂÀÍáÒÉÓ; *Â) III ÂÀÍáÒÉÓ; Ã) avR ÂÀÍáÒÉÓ. 135. ÂÖËÉÓ ÄËÄØÔÒÖËÉ ÙÄÒÞÉ ÍÏÒÌÖËÉÀ, ÈÖ ÀË×À ÊÖÈáÄ: *À) 30-69 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ; Á) 0-29 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ; Â) 70-90 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ; Ã) 0-20 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ. 136. ÂÖËÉÓ ÄËÄØÔÒÖËÉ ÙÄÒÞÉ äÏÒÉÆÏÍÔÀËÖÒÉÀ, ÈÖ ÀË×À ÊÖÈáÄ: À) 30-69 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ; *Á) 0-29 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ; Â) 70-90 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ; Ã) 20-70 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ 137. ÂÖËÉÓ ÄËÄØÔÒÖËÉ ÙÄÒÞÉ ÂÀÃÀáÒÉËÉÀ ÌÀÒãÅÍÉÅ, ÈÖ ÀË×À ÊÖÈáÄ: *À) 91 - '180 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ; Á) 0-29 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ; Â) 70-90 ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ; Ã) 0 - (-90) ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ; Ä) 0 - (-150) ÂÒÀÃÖÓÉÓ ×ÀÒÂËÄÁÛÉÀ. 138. ÂÖËÉÓ ÄËÄØÔÒÖËÉ ÙÄÒÞÉ ÍÏÒÌÖËÉÀ, ÈÖ ÌÀØÓÉÌÀËÖÒÉ ÀÌÐËÉÔÖÃÉÓ R ÊÁÉËÉ ÒÄÂÉÓÔÒÉÒÃÄÁÀ: À) I ÂÀÍáÒÀÛÉ; *Á) II ÂÀÍáÒÀÛÉ; Â) III ÂÀÍáÒÀÛÉ; Ã) avL ÂÀÍáÒÀÛÉ. 139. ÂÖËÉÓ ÄËÄØÔÒÖËÉ ÙÄÒÞÉ ÅÄÒÔÉÊÀËÖÒÉÀ, ÈÖ ÌÀØÓÉÌÀËÖÒÉ ÀÌÐËÉÔÖÃÉÓ R ÊÁÉËÉ ÒÄÂÉÓÔÒÉÒÃÄÁÀ: À) I ÂÀÍáÒÀÛÉ; Á) II ÂÀÍáÒÀÛÉ; Â) III ÂÀÍáÒÀÛÉ; *Ã) avF ÂÀÍáÒÀÛÉ. 140. ÂÖËÉÓ ÄËÄØÔÒÖËÉ ÙÄÒÞÉ äÏÒÉÆÏÍÔÀËÖÒÉÀ, ÈÖ ÌÀØÓÉÌÀËÖÒÉ ÀÌÐËÉÔÖÃÉÓ R ÊÁÉËÉ ÒÄÂÉÓÔÒÉÒÃÄÁÀ: *À) I ÂÀÍáÒÀÛÉ; Á) II ÂÀÍáÒÀÛÉ; Â) III ÂÀÍáÒÀÛÉ; Ã) avF ÂÀÍáÒÀÛÉ. 141. R ÊÁÉËÉÓ ÀÌÐËÉÔÖÃÀ ÌÀØÓÉÌÀËÖÒÉÀ II ÂÀÍáÒÀÛÉ, R=S ÊÏÌÐËÄØÓÉ ÊÉ ÀÙÉÍÉÛÍÄÁÀ avL ÂÀÍáÒÀÛÉ, ÀË×À ÊÖÈáÄ ÖÃÒÉÓ: À) +30 ÂÒÀÃÖÓÓ; *Á) +60 ÂÒÀÃÖÓÓ; Â) +90 ÂÒÀÃÖÓÓ; Ã) 0 ÂÒÀÃÖÓÓ. 104 142. R ÊÁÉËÉÓ ÀÌÐËÉÔÖÃÀ ÌÀØÓÉÌÀËÖÒÉÀ avL ÂÀÍáÒÀÛÉ, R=S ÊÏÌÐËÄØÓÉ ÊÉ ÀÙÉÍÉÛÍÄÁÀ II ÂÀÍáÒÀÛÉ, ÀË×À ÊÖÈáÄ ÖÃÒÉÓ: À) +30 ÂÒÀÃÖÓÓ; *Á) -30 ÂÒÀÃÖÓÓ; Â) 0 ÂÒÀÃÖÓÓ; Ã) +60 ÂÒÀÃÖÓÓ. 143. R ÊÁÉËÉÓ ÀÌÐËÉÔÖÃÀ ÌÀØÓÉÌÀËÖÒÉÀ avF ÂÀÍáÒÀÛÉ, R=S ÊÏÌÐËÄØÓÉ ÊÉ ÀÙÉÍÉÛÍÄÁÀ I ÂÀÍáÒÀÛÉ, ÀË×À ÊÖÈáÄ ÖÃÒÉÓ *À) +90 ÂÒÀÃÖÓÓ; Á) -30 ÂÒÀÃÖÓÓ; Â) 0 ÂÒÀÃÖÓÓ; Ã) +60 ÂÒÀÃÖÓÓ. 144. R ÊÁÉËÉÓ ÀÌÐËÉÔÖÃÀ ÌÀØÓÉÌÀËÖÒÉÀ I ÂÀÍáÒÀÛÉ, R=S ÊÏÌÐËÄØÓÉ ÊÉ ÀÙÉÍÉÛÍÄÁÀ avF ÂÀÍáÒÀÛÉ, ÀË×À ÊÖÈáÄ ÖÃÒÉÓ À) +90 ÂÒÀÃÖÓÓ; Á) -30 ÂÒÀÃÖÓÓ; *Â) 0 ÂÒÀÃÖÓÓ; Ã) +60 ÂÒÀÃÖÓÓ. 145. R ÊÁÉËÉÓ ÀÌÐËÉÔÖÃÀ ÌÀØÓÉÌÀËÖÒÉÀ III ÂÀÍáÒÀÛÉ, R=S ÊÏÌÐËÄØÓÉ ÀÙÉÍÉÛÍÄÁÀ avR ÂÀÍáÒÀÛÉ, ÀË×À ÊÖÈáÄ ÖÃÒÉÓ À) +90 ÂÒÀÃÖÓÓ; Á) -30 ÂÒÀÃÖÓÓ; *Â) +120 ÂÒÀÃÖÓÓ; Ã) +60 ÂÒÀÃÖÓÓ. 146. R ÊÁÉËÉÓ ÀÌÐËÉÔÖÃÀ ÌÀØÓÉÌÀËÖÒÉÀ avR ÂÀÍáÒÀÛÉ, R=S ÊÏÌÐËÄØÓÉ ÀÙÉÍÉÛÍÄÁÀ III ÂÀÍáÒÀÛÉ, ÀË×À ÊÖÈáÄ ÖÃÒÉÓ À) +90 ÂÒÀÃÖÓÓ; *Á) -150 ÂÒÀÃÖÓÓ; Â) +120 ÂÒÀÃÖÓÓ; Ã) +60 ÂÒÀÃÖÓÓ. 147. ÂÖËÉÓ ÌÏÁÒÖÍÄÁÉÓÀÓ ÂÀÍÉÅÉ ÙÄÒÞÉÓ ÂÀÒÛÄÌÏ, ÌßÅÄÒÅÀËÉÈ ßÉÍ, ÓÔÀÍÃÀÒÔÖË ÂÀÍáÒÄÁÛÉ QRS ÊÏÌÐËÄØÓÉ ÉÙÄÁÓ: À) RS(I), RS(II), RS(III) ×ÏÒÌÀÓ; *Á) qR(I), qR(II), qR(III), ×ÏÒÌÀÓ; Â) qRS(I), qRS(II), qRS(III), ×ÏÒÌÀÓ; Ã) QRS(I), QRS(II), QRS(III) ×ÏÒÌÀÓ. 148. ÂÖËÉÓ ÌÏÁÒÖÍÄÁÉÓÀÓ ÂÀÍÉÅÉ ÙÄÒÞÉÓ ÂÀÒÛÄÌÏ, ÌßÅÄÒÅÀËÉÈ ÖÊÀÍ, QRS ÊÏÌÐËÄØÓÉ ÉÙÄÁÓ: *À) RS(I), RS(II), RS(III) ×ÏÒÌÀÓ; Á) qR(I), qR(II), qR(III), ×ÏÒÌÀÓ; Â) qRS(I), qRS(II), qRS(III), ×ÏÒÌÀÓ; Ã) QRS(I), QRS(II), QRS(III) ×ÏÒÌÀÓ. 149. ØÅÄÌÏÈ ÜÀÌÏÈÅËÉËÉ ÃÄÁÖËÄÁÄÁÉÃÀÍ ÓßÏÒÉÀ:1). ÂÖËÌÊÄÒÃÉÓ ÂÀÍáÒÄÁÉ ÄßÏÃÄÁÀÈ ÄÒÈÐÏËÖÓÉÀÍ ×ÒÏÍÔÀËÖÒ ÂÀÍáÒÄÁÓ, ÒÏÌÄËÈÀ ÌÉÓÀÙÄÁÀà ÀØÔÉÖÒ ÄËÄØÔÒÏÃÓ ÀÈÀÅÓÄÁÄÍ ÂÖËÌÊÄÒÃÉÓ ÆÄÃÀÐÉÒÆÄ ÂÀÍÓÀÆÙÅÒÖË ßÄÒÔÉËÄÁÛÉ;2). ÂÖËÌÊÄÒÃÉÓ ÂÀÍáÒÄÁÉ ÄßÏÃÄÁÀÈ ÏÒÐÏËÖÓÉÀÍ ÂÀÍáÒÄÁÓ, ÒÏÃÄÓÀÝ ÏÒÉÅÄ ÄËÄØÔÒÏÃÉ ÌÏÈÀÅÓÄÁÖËÉÀ ÂÖËÌÊÄÒÃÉÓ ÆÄÃÀÐÉÒÆÄ; 3). ÍÄÁÉÓ ÂÀÍáÒÄÁÉ ÄßÏÃÄÁÀÈ ÄÒÈÐÏËÖÓÉÀÍ ×ÒÏÍÔÀËÖÒ ÂÀÍáÒÄÁÓ, ÒÏÌÄËÈÀ ÌÉÓÀÙÄÁÀà ÀØÔÉÖÒ ÄËÄØÔÒÏÃÓ ,fdidsf rfhlbjkjubf ÀÈÀÅÓÄÁÄÍ ÂÖËÌÊÄÒÃÉÓ ÆÄÃÀÐÉÒÆÄ ÂÀÍÓÀÆÙÅÒÖË ßÄÒÔÉËÄÁÛÉ; 4). ÍÄÁÉÓ ÂÀÍáÒÄÁÉ ÄßÏÃÄÁÀÈ ÏÒÐÏËÖÓÉÀÍ ÂÀÍáÒÄÁÓ, ÒÏÃÄÓÀÝ ÏÒÉÅÄ ÄËÄØÔÒÏÃÉ ÌÏÈÀÅÓÄÁÖËÉÀ ÂÖËÌÊÄÒÃÉÓ ÆÄÃÀÐÉÒÆÄ. À) ÓßÏÒÉÀ 1, 3; *Á) ÓßÏÒÉÀ 1, 4; Â) ÓßÏÒÉÀ 2, 3; Ã) ÓßÏÒÉÀ 2, 4. 150. 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V6 ÃÀ I ÓÔÀÍÃÀÒÔÖË ÂÀÍáÒÀÛÉ QRS ÊÏÌÐËÄØÓÓ RS ×ÏÒÌÀ ÀØÅÓ;2). ÂÀÒÃÀÌÀÅÀËÉ ÆÏÍÀ (R=S) V3 ÂÀÍáÒÉÃÀÍ ÂÀÃÀÉÍÀÝÅËÄÁÓ V4_V5 ÂÀÍáÒÉÓÊÄÍ;3). V6 ÃÀ I ÓÔÀÍÃÀÒÔÖË ÂÀÍáÒÀÛÉ QRS ÊÏÌÐËÄØÓÓ avR ×ÏÒÌÀ ÀØÅÓ;4). ÂÀÒÃÀÌÀÅÀËÉ ÆÏÍÀ (R=S) V3 ÂÀÍáÒÉÃÀÍ ÂÀÃÀÉÍÀÝÅËÄÁÓ V2 ÂÀÍáÒÉÓÊÄÍ. À) ÓßÏÒÉÀ 1, 2; *Á) ÓßÏÒÉÀ 3, 4; Â) ÓßÏÒÉÀ 1, 4; Ã) ÓßÏÒÉÀ 2, 4. 153. ØÅÄÌÏÈ ÌÏÚÅÀÍÉËÉ ÃÄÁÖËÄÁÄÁÉÃÀÍ Ä.ß. ÃÀÌÀÔÄÁÉÈ ÂÀÍáÒÄÁÈÀÍ ÌÉÌÀÒÈÄÁÀÛÉ ÓßÏÒÉÀ ÚÅÄËÀ ÜÀÌÏÈÅËÉËÉ, ÂÀÒÃÀ: À) ÃÀÌÀÔÄÁÉÈÉ ÂÀÍáÒÄÁÉ ÂÀÌÏÉÚÄÍÄÁÀ ÉÌ ÛÄÌÈáÅÄÅÄÁÛÉ, ÒÏÃÄÓÀÝ 12 ÂÀÍáÒÉÀÍÉ ÄÊ ÂÀÌÏÊÅËÄÅÀ ÀÒÀÓÀÊÌÀÒÉÓÀà ÉÍ×ÏÒÌÀÔÉÖËÉÀ; Á) V7_V9 ÂÀÍáÒÄÁÉ ÅÉËÓÏÍÉÓ ÂÀÍáÒÄÁÉÓÀÂÀÍ ÌáÏËÏà ÀØÔÉÖÒÉ ÄËÄØÔÒÏ ÃÉÓ ÂÖËÌÊÄ ÒÃÉÓ ÆÄÃÀÐÉ ÒÆÄ ÌÏÈÀÅÓÄÁÉÓ ÀÃÂÉËÄÁÉÓ ÌÉáÄÃÅÉÈ ÂÀÍÓáÅÀÅÃÄÁÉÀÍ; *Â) V7_V9 ÂÀÍáÒÄÁÉ ÂÀÌÏÉÚÄÍÄÁÉÀÍ ÌÀÒÝáÄÍÀ ÐÀÒÊÖàÉÓ ØÅÄÃÀ ÊÄÃËÉÓ ÉÍ×ÀÒØÔÄÁÉÓ ÓÀÃÉÀÂÍÏÓÔÉÊÏÃ; Ã) D, A ÃÀ I ÍÄÁÉÓ ÂÀÍáÒÄÁÉÀ, ÒÏÌËÄÁÉÝ ÂÀÌÏÉÚÄÍÄÁÉÀÍ ÌÉÏÊÀÒÃÉÖÌÉÓ ÊÄÒÏÅÀÍÉ ÃÀÆÉÀÍÄÁÄÁÉÓ ÓÀÃÉÀÂÍÏÓÔÉÊÏÃ, ÛÄÓÀÁÀÌÉÓÀÃ, ÌÀÒÝáÄÍÀ ÐÀÒÊÖàÉÓ ÖÊÀÍÀ, ßÉÍÀ-ÂÅÄÒÃÉÈ ÃÀ ßÉÍÀ-ÆÄÌÏ ÍÀßÉËÄÁÛÉ. 2013 weli erT-erTi pirveli qarTuli preparatebi