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ÀÓÏÝÉÀÝÉÉÓ ÑÖÒÍÀËÉ
JOURNAL OF THE GEORGIAN PEDIATRIC
CARDIOLOGY ASSOCIATION
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ÁÀÅÛÅÈÀ
ÊÀÒÃÉÏËÏÂÉÀ
Pediatric
Cardiology
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33124
119
TBILISI
ISSN 1987-9857
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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
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„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
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#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
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sarCevi
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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
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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
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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
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2013 weli
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6
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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
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uaryofiTi minimaluri da maqsimaluri siRrmeebi.
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# 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
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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-
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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.
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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.
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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)
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cxrili #1
kalaTburTelTa anTropometruli, fizikuri da funqciuri maCveneblebis SedarebiTi analizi api pulmosa da apikoris miRebis fonze
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cxrili #2
kalaTburTelTa anTropometruli, fizikuri da funqciuri maCveneblebis SedarebiTi analizi sakontrolo jgufSi
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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.
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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
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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
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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
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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
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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
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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.
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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.
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- 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
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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
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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
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THE CONTENT ON THE UPTODATE WEBSITE IS NOT INTENDED NOR RECOMMENDED
AS A SUBSTITUTE FOR MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. ALWAYS SEEK THE
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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. ØÅÄÌÏÈ ÜÀÌÏÈÅËÉËÉ ÃÄÁÖËÄÁÄÁÉÃÀÍ ÒÏÌÄËÉÀ
ÓßÏÒÉ AV ÊÅÀÍÞÛÉ ÀÂÆÍÄÁÉÓ ÔÀËÙÉÓ ÂÀÅÒÝÄËÄÁÀÓÈÀÍ
ÌÉÌÀÒÈÄÁÀÛÉ: 1). AV ÊÅÀÍÞÛÉ ÀÂÆÍÄÁÉÓ ÂÀÅÒÝÄËÄÁÉÓ
ÓÉÜØÀÒÄ ÌÉÏÊÀÒÃÉÖÌÉÓ ÓáÅÀ ÍÀßÉËÄÁÈÀÍ ÛÄÃÀÒÄÁÉÈ
ÃÀÁÀËÉÀ ÃÀ 200 ÌÌ/ßÌ-Ó ÛÄÀÃÂÄÍÓ; 2). 180-220 ÛÄÊ/ßÈ-ÆÄ
ÌÄÔÀà ÓÉÍÖÓÖÒÉ ÀÍ ßÉÍÀÂÖËÏÅÀÍÉ ÒÉÔÌÉÓ ÂÀáÛÉÒÄÁÉÓÀÓ
ÛÄÉÞËÄÁÀ ÂÀÍÅÉÈÀÒÃÄÓ ÍÀßÉËÏÁÒÉÅÉ ÀÔÒÉÏÅÄÍ ÔÒÉÊÖËÖÒÉ ÁËÏÊÀÃÀ; 3). AV ÊÅÀÍÞÛÉ ÀÔÒÉÏÅÄÍ ÔÒÉÊÖËÖÒÉ ÁËÏÊÀÃÉÓ ÂÀÍÅÉÈÀÒÄÁÀÓ (ßÉÍÀÂÖËÄÁÉÓ
ÒÉÔÌÉÓ 180-220ÛÄÊ/ßÈ-ÆÄ ÌÄÔÀà ÂÀáÛÉÒÄÁÉÓÀÓ)
ÃÀÌÝÅÄËÏÁÉÈÉ ÌÍÉÛÅÍÄËÏÁÀ ÀØÅÓ; 4). 180-220 ÛÄÊ/ßÈ
ÓÉáÛÉÒÉÓ ßÉÍÀÂÖËÏÅÀÍÉ ÒÉÔÌÉÓ ×ÏÍÆÄ ÍÀßÉËÏÁÒÉÅÉ
ÀÔÒÉÏÅÄÍÔÒÉÊÖËÖÒÉ ÁËÏÊÀÃÀ ÌáÏËÏà ÉÌ ÛÄÌÈáÅÄÅÀÛÉ
2013 weli
,fdidsf rfhlbjkjubf
ÅÉÈÀÒÃÄÁÀ, ÈÖ ÄÒÈÃÒÏÖËÀÃ ÀÙÉÍÉÛÍÄÁÀ AV ÊÅÀÍÞÉÓ
ÃÉÓ×ÖÍØÝÉÀ.
*À) ÓßÏÒÉÀ 1, 2, 3;
Á) ÓßÏÒÉÀ 2, 3, 4;
Â) ÓßÏÒÉÀ 1, 4.
126. ØÅÄÌÏÈ ÜÀÌÏÈÅËÉËÉ ÃÄÁÖËÄÁÄÁÉÃÀÍ ÒÏÌÄËÉÀ
ÓßÏÒÉ ÐÀÒÊÖàÄÁÛÉ ÀÂÆÍÄÁÉÓ ÔÀËÙÉÓ ÂÀÅÒÝÄËÄÁÀÓÈÀÍ
ÌÉÌÀÒÈÄÁÀÛÉ:1). ÀÂÆÍÄÁÉÓ ÔÀËÙÉÓ ÂÀÅÒÝÄËÄÁÉÓ ÓÉÜØÀÒÄ
ÐÀÒÊÖàÄÁÉÓ ÊÖÍÈÛÉ - 400 ÌÌ/ßÌ-Ó, ÐÖÒÊÉÍÄÓ ÓÉÓÔÄÌÀÛÉ ÊÉ
4000 ÌÌ/ßÌ-Ó ÛÄÀÃÂÄÍÓ;2). ÍÏÒÌÀÛÉ ÀÂÆÍÄÁÀ ÏÒÉÅÄ ÐÀÒÊÖàÛÉ
0,08-0,1 ßÌ-ÛÉ ÅÒÝÄËÃÄÁÀ;3). ÐÀÒÊÖàÄÁÉÓ ÌÉÏÊÀÒÃÉÖÌÛÉ
ÃÄÐÏËÀÒÉÆÀÝÉÉÓ ÔÀËÙÀ ÅÒÝÄËÃÄÁÀ ÄÐÉÊÀÒÃÉÖÌÉÃÀÍ
ÄÍÃÏÊÀÒÃÉÖÌÉÓÊÄÍ;4). ãÄÒ ÀÙÉÂÆÍÄÁÀ ÐÀÒÊÖàÈÀÛÖÀ ÞÂÉÃÄ,
ÛÄÌÃÄ ÏÒÉÅÄ ÐÀÒÊÖàÉÓ ÖÌÄÔÄÓÉ ÍÀßÉËÉ (ÌßÅÄÒÅÀËÏ, ÖÊÀÍÀ
ÃÀ ÂÅÄÒÃÉÈÉ ÊÄÃËÄÁÉ), ÁÏËÏÓ ÐÀÒÊÖàÈÀÛÖÀ ÞÂÉÃÉÓ ÃÀ
ÐÀÒÊÖàÄÁÉÓ ÁÀÆÀËÖÒÉ ÍÀßÉËÄÁÉ.
À) ÓßÏÒÉÀ ÚÅÄËÀ ÜÀÌÏÈÅËÉËÉ;
Á) ÓßÏÒÉÀ 1, 2, 3;
*Â) ÓßÏÒÉÀ 1, 2, 4;
Ã) ÓßÏÒÉÀ 2, 3, 4.
127. ØÅÄÌÏÈ ÌÏÚÅÀÍÉËÉ ÃÄÁÖËÄÁÄÁÉÃÀÍ ÓßÏÒÉÀ: 1)
ÃÄÐÏËÀÒÉÆÀÝÉÉÓ ÅÄØÔÏÒÉÓ ÌÉÌÀÒÈÖËÄÁÀ ÄÌÈáÅÄÅÀ
ÃÄÐÏËÀÒÉÆÀÝÉÉÓ ÌÉÌÀÒÈÖËÄÁÀÓ; 2) ÃÄÐÏËÀÒÉÆÀÝÉÉÓ
ÅÄØÔÏÒÉÓ ÌÉÌÀÒÈÖËÄÁÀ ÃÄÐÏËÀÒÉÆÀÝÉÉÓ ÌÉÌÀÒÈÖËÄÁÉÓ
ÓÀßÉÍÀÀÙÌÃÄÂÏÀ; 3) ÒÄÐÏËÀÒÉÆÀÝÉÉÓ ÅÄØÔÏÒÉÓ
ÌÉÌÀÒÈÖËÄÁÀ ÄÌÈáÅÄÅÀ ÒÄÐÏËÀÒÉÆÀÝÉÉÓ ÌÉÌÀÒÈÖËÄÁÀÓ;
4) ÒÄÐÏËÀÒÉÆÀÝÉÉÓ ÅÄØÔÏÒÉÓ ÌÉÌÀÒÈÖËÄÁÀ
ÒÄÐÏËÀÒÉÆÀÝÉÉÓ ÌÉÌÀÒÈÖËÄÁÉÓ ÓÀßÉÍÀÀÙÌÃÄÂÏÀ.
À) ÓßÏÒÉÀ 1, 3;
*Á) ÓßÏÒÉÀ 1, 4;
Â) ÓßÏÒÉÀ 2, 3;
Ã) ÓßÏÒÉÀ 2, 4.
128. ÓÔÀÍÃÀÒÔÖËÉ ÄÊÂ ÂÀÍáÒÄÁÉÀ: 1). ÏÒÐÏËÖÓÉÀÍÉ
ÂÀÍáÒÄÁÉ ÊÉÃÖÒÄÁÉÃÀÍ; 2). ÄÒÈÐÏËÖÓÉÀÍÉ ÂÀÍáÒÄÁÉ
ÊÉÃÖÒÄÁÉÃÀÍ; 3). ÂÖËÌÊÄÒÃÉÓ ÂÀÍáÒÄÁÉ.
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 ÌÉÓÀÙÄÁÀÃ 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 ÌÉÓÀÙÄÁÀÃ 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. ØÅÄÌÏÈ ÌÏÚÅÀÍÉËÉ ÃÄÁÖËÄÁÄÁÉÃÀÍ ÂÖËÌÊÄÒÃÉÓ
ÂÀÍáÒÄÁÈÀÍ ÌÉÌÀÒÈÄÁÀÛÉ ÓßÏÒÉÀ ÚÅÄËÀ ÜÀÌÏÈÅËÉËÉ,
ÂÀÒÃÀ:
*À) ÂÖËÌÊÄÒÃÉÓ ÂÀÍáÒÄÁÉ ÓÀÛÖÀËÄÁÀÓ ÂÅÀÞËÄÅÄÍ
ÂÖËÉÓ ÌÖÛÀÏÁÀ ÛÄÅÀ×ÀÓÏÈ ÓÀÂÉÔÀËÖÒ ÓÉÁÒÔÚÄÛÉ;
Á) ÀÌ ÂÀÍáÒÄÁÉÓ ÖÀÒÚÏ×ÉÈ ÄËÄØÔÒÏÃÓ ÅÉËÓÏÍÉÓ
ÄËÄØÔÒÏÃÉ ÄßÏÃÄÁÀ;
Â) V1_V2 ÂÀÍáÒÄÁÉ ÈÀÅÓÃÄÁÀ ÌÀÒãÅÄÍÀ ÐÀÒÊÖàÉÓ
ÐÒÏÄØÝÉÀÆÄ;
Ã) V3_V4 ÂÀÍáÒÄÁÉ ÈÀÅÓÃÄÁÀ ÐÀÒÊÖàÈÀÛÖÀ ÞÂÉÃÉÓ
ÐÒÏÄØÝÉÀÆÄ;
Ä) V5_V6 ÂÀÍáÒÄÁÉ ÈÀÅÓÃÄÁÀ ÌÀÒÝáÄÍÀ ÐÀÒÊÖàÉÓ
ÐÒÏÄØÝÉÀÆÄ.
151. ÓÀÀÈÉÓ ÉÓÒÉÓ ÌÏÞÒÀÏÁÉÓ ÌÉÌÀÒÈÖËÄÁÉÈ, ÂÀÍÉÅÉ
ÙÄÒÞÉÓ ÂÀÒÛÄÌÏ ÂÖËÉÓ ÌÏÁÒÖÍÄÁÉÓ ÄÊÂ ÍÉÛÍÄÁÉÀ:1). 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 qR ×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, 3.
152. ÓÀÀÈÉÓ ÉÓÒÉÓ ÌÏÞÒÀÏÁÉÓ ÓÀßÉÍÀÀÙÌÃÄÂÏ
ÌÉÌÀÒÈÖËÄÁÉÈ, ÂÀÍÉÅÉ ÙÄÒÞÉÓ ÂÀÒÛÄÌÏ ÂÖËÉÓ ÌÏÁÒÖÍÄÁÉÓ
ÄÊÂ ÍÉÛÍÄÁÉÀ:1). 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 ÄÊÂ ÂÀÌÏÊÅËÄÅÀ ÀÒÀÓÀÊÌÀÒÉÓÀÃ
ÉÍ×ÏÒÌÀÔÉÖËÉÀ;
Á) V7_V9 ÂÀÍáÒÄÁÉ ÅÉËÓÏÍÉÓ ÂÀÍáÒÄÁÉÓÀÂÀÍ ÌáÏËÏÃ
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.
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