avtorebi: T.maRlakeliZe, k.vaWaraZe, i.CxaiZe, p.gvetaZe ...saqarTvelos respiraciuli asociacia...

saqarTvelos

respiraciuli asociacia

mwvave bronqiti

avtorebi: T.maRlakeliZe, k.vaWaraZe, i.CxaiZe,

n.yavlaSvili

eqspertebi: v.qacarava, q.Sarangia, T. lobJani

Tbilisi

2006

saqarTvelos Sromis,

janmrTelobisa da

socialuri dacvis

saministro

p.gvetaZe,

Ze

1

gaidlainis aucilebloba. mwvave bronqiti traqeobronquli xis

anTebiTi procesia, romlis sixSire gansakuTrebiT matulobs zamTris

periodSi, rodesac gansakuTrebiT maRalia mwvave respiraciuli

infeqciebis ricxvi. marto aSS-Si mwvave bronqitis diagnoziT 12

milioni adamiani mimarTavs eqims, ris gamoc yovelwliurad 300.000 mln

dolaris wamali iniSneba.

definicia

mwvave bronqiti bronquli xis lorwovani garsis mwvave anTebaa,

romelic grZeldeba 2-3 kviramde da romlis aucilebel simptoms

warmoadgens xvela naxvelis gamoyofiT an mis gareSe.

epidemiologia

mwvave bronqiti ojaxis eqimis mier erT-erTi yvelaze xSirad

dasmuli diagnozia. is xSiria zamTris periodSi, rodesac Warbobs

respiraciuli virusuli infeqciebi. bronqiti Sedis eqimTan vizitis

uxSires mizezTa xuTeulSi. bronqiti Tanabrad gvxvdeba orive sqesis

pacientebSi. yvelaze xSirad 5 wlamde asakis bavSvebi avaddebian. aseve

maRalia misi sixSire 9-15 wlis bavSvebSi. mwvave bronqitis sixSire

wlis ganmavlobaSi aSS-Si saSualod 87 SemTxvevaa/100.000

mosaxleze/kviraSi, xolo zamTris periodSi misi sixSire 150

SemTxvevaa/100.000 mosaxleze/kviraSi. britaneTSi skolis moswavleebSi

bronqitis gavrceleba 20,7%-mdea.

erT-erTi mizezi imisa, Tu ratom aris mwvave bronqiti ase xSiri,

aris is, rom eqimebi am diagnozis qveS aerTianebian xvelis simptomiT

mimdinare sxvadasxva daavadebebs, rogoricaa zemo sasunTqi gzebis

daavadebebi, virusuli pnevmonia, asTma, sinusiti da sxv.

saqarTvelos Sromis, janmrTelobis da socialuri dacvis

saministros daavadebaTa kontrolis da samedicino statistikis

erovnuli centris 2005 wlis monacemebiT saqarTveloSi mwvave

bronqitis diagnoziT hospitalizebul iqna 3.214 avadmyofi, maT Soris

14 wlamde asakis 2.655 bavSvi. 100.000 mosaxleze maCvenebeli Seadgens

73.5-s. letalobis maCvenebeli 0,1%-ia.

etiologia

mwvave bronqiti uxSiresad dakavSirebulia respiraciul

virusebTan, rogoricaa gaciebis gamomwvevi virusebi (rinovirusi,

2

koronavirusi), gripis virusi, adenovirusi, rs-virusi, paragripis

virusi, martivi herpesis virusi. mwvave bronqitis SedarebiT

umniSvnelo nawili ganpirobebulia sxva mizezebiT (Tumca maT Soris

ufro xSiria baqteriuli gamomwvevebi: mikoplazma da qlamidia):

baqteriebi:

1. Streptococcus Pneumoniae

2. Heamophilus Influenza

3. Moraxella catarrhalis

4. Bordetella pertusis (da parapertusis)

atipuri gamomwvevebi

1. Mycoplasma pneumoniae

2. Chlamydophila pneumoniae

3. Legionella

sokoebi:

1. Blastomyces dermatitidis

2. Candida albicans

3. Coccidiodes immitis

4. Cryptococcus neoformans

5. Histoplasma capsulatum

garemos gamRizianeblebi

1. haeris dabinZureba

2. Tambaqos boli (15 wlamde bavSvebSi bronqitis sixSire

korelirebs pasiur mowevasTan (mtkicebuleba IV)

mwvave bronqitis gamomwvevTa asakobrivi da sezonuri Tavisebureba

bavSvebSi aseTia:

1 wlamde:

1. respiraciul-sincitiuri virusi (zamTari-gazafxuli)

2. paragripis virusi (Semodgoma)

3. koronavirusi (zamTari-gazafxuli)

1-10 weli

1. paragripis virusi (Semodgoma)

2. enterovirusi (Semodgoma)


3

4. rinovirusi (Semodgoma)

10 welze met asakSi

1. gripis virusi (zamTari-gazafxuli)


3. adenovirusi.

cxrilSi moyvanilia mwvave bronqitis uxSires gamomwvevTa

epidemiologiis da klinikuri mimdinareobis Taviseburebani.

gamomwvevi agenti Tavisebureba

Influenza A epidemiis dros avaddeba yvela asakobrivi

jgufis warmomadgeneli

Influenza B avaddeba yvela asakobrivi jgufis

warmomadgeneli

• Parainfluenza 1–3

• Adenovirus

erTeuli SemTxvevebi, epidemia iSviaTia

S.Pneumoniae • saSualo asakSi an moxucebSi

• uecari dasawyisi

• zemo sasunTqi gzebis dazianebis

simptomebi

Mycoplasma pneumonia • epidemia 30 wlamde asakSi gvxvdeba

• daavadebis daswyisSi damaxasiaTebelia

zemo sasunTqi gzebis dazianebis

simptomebi

• mSrali xvela

Bordetella pertussis gaxangrZlivebuli xvela

Haemophilus influenzae mwevelebSi an pirebSi qronikuli bronqitiT

Moraxella catarrhalis qronikuli bronqiti, imunodeficiti

paTogenezi

mwvave bronqitis dros viTardeba bronqis lorwovanis SeSupeba da

lorwos hipersekrecia. xvela SeiZleba, erTi mxriv, gamowveuli iyos

sasunTqi gzebis epiTeliumis destruqciiT, meore mxriv ki anTebis

mediatorebis gamomuSavebiTa da mukociliuri aparatis dazianebiT,

Tumca xvelis ganviTarebis meqanizmi bolomde naTeli ar aris. ufro

4

maRali virulentobis mqone virusebisaTvis, rogoricaa gripi da

adenovirusi, xvelis mizezi SeiZleba iyos lorwovani garsis

epiTeliumis daSla. ufro naklebi virulentobis mqone virusebisaTvis,

rogoricaa rinovirusi, xvelas SesaZloa ganapirobebdes anTebis

mediatorebis aqtivacia da bronqis mukociliaruli funqciis Secvla.

bronqitis ganviTarebasa da simptomebis gamwvavebas xels uwyobs

Tambaqos boli da haeris dabinZureba. mwvave bronqitis dros

ganviTarebuli anTebiTi cvlilebebi gardamavalia, Tumca xvela

SeiZleba gaxangrZlivdes 3 kviramde.

mwvave bronqitis risk-faqtorebia :

• gadacieba;

• cxviriT sunTqvis gaZneleba;

• cxvir-xaxis qronikuli infeqciebi;

• imunodeficituri mdgomareobebi;

• bavSvTa da xandazmuli asaki;

• Tambaqos moweva (pasiuric);

• alkoholizmi;

• refluqs-ezofagiti;

• garemos dabinZureba.

klinikuri niSnebi

mwvave bronqiti uxSiresad gamowveulia respiraciuli virusebiT,

amitom igi iwyeba respiraciuli infeqciis niSnebiT, rogoricaa

Semcivneba, saerTo sisuste, msubuqi cxeleba (araumetes 3 dRis

ganmavlobaSi), cxviridan gamonadeni, yelis tkivili, kunTebis tkivili,

xmis CaxleCa.

ZiriTadi klinikuri niSani xvelaa, romelic daavadebis dawyebidan

2-4 dRis Semdeg iCens Tavs. Tavidan is mSrali, Semawuxebeli

xasiaTisaa, Semdeg produqtiuli xdeba. naxveli Tavidan lorwovania,

mogvianebiT SeiZleba Cirqovani gaxdes. Tumca Cirqovani naxveli

gamowveulia leikocitebis migraciiT da yovelTvis ar miuTiTebs

baqteriuli infeqciis arsebobaze. adreuli asakis bavSvebi naxvels

ylapaven, rasac SeiZleba mohyves Rebineba. dinamikaSi naxveli TandaTan

Txierdeba da 5-10 dReSi xvela gaivlis. bronqitis simptomebi

5

Cveulebriv 2 kviramde grZeldeba, Tumca iSviaTad SeiZleba xvela

gaxangrZlivdes 4-6 kviramde.

obieqturi gamokvleva

obieqturi gamokvlevis Sedegebi damokidebulia pacientis asaksa

da daavadebis stadiaze. temperatura, rogorc wesi, normaluria, Tumca

SesaZlebelia subfebrilur cifrebsac aRwevdes. adreul etapze

SesaZloa gamoxatuli iyos nazofaringiti, koniunqtiviti da riniti.

filtvebis auskultaciuri monacemebi am etapze ar aris Secvlili.

daavadebis progresirebis da xvelis intensivobis matebasTan erTad

filtvebis auskultaciuri monacemebi icvleba, sunTqviTi xmianoba

xdeba mkvrivi, moismineba mSrali da sxadasxva yalibis sveli xixini.

zog pacientSi ismis mstvinavi sunTqva. bronqitisaTvis ar aris

damaxasiaTebeli lokaluri simptomatika: lokaluri krepitacia,

bronquli sunTqva, perkutoruli xmianobis moyrueba. aseT SemTxvevaSi

gamosaricxia pnevmoniis arseboba. mikoplazmuri etiologiis bronqitis

SemTxvevaSi SesaZlebelia kanze gamonayaris gaCenac.

garTulebebi

• pnevmonia (viTardeba pacientTa 5%-Si);

• sunTqvis mwvave ukmarisoba.

simZimis Sefaseba

mwvave bronqiti, rogorc wesi, mimdinareobs msubuqad an saSualo

simZimiT, is ar saWiroebs hospitalizacias

hospitalizaciis Cvenebebi

Cveulebriv mwvave bronqitis mkurnaloba ambulatoriulad

tardeba. hospitalizaciis Cvenebas warmoadgens:

• Tanmxlebi daavadebebi (gulis Tandayolili anomalia, filtvis

qronikuli paTologia, nevrologiuri darRvevebi);

• socialuri problemebi - ojaxSi movlis, meTvalyureobis

deficiti, transportirebis saSualebis ararseboba (sarwmunoeba

IV, rekomendacia D);

• simptomebis 2-3 kviraze metad gaxangrZliveba;

• toqsikozis niSnebi (saeWvoa baqteriuli traqeiti an pnevmonia);

• sicocxlisTvis saSiSi niSnebis arseboba (sarwmunoeba IV,

rekomendacia D,);

6

• sakvebis da siTxis miRebis SeuZlebloba.

diagnozi

daavadebis diagnostika tardeba klinikuri niSnebis safuZvelze.

bronqitze eWvi unda iqnes mitanili im pacientebSi, romelTanac mwvave

respiraciuli infeqciis niSnebi asocirebulia xvelasTan. sruli

anamnezuri gamokvleva unda moicavdes garemo aris da sigaretis

zegavlenis dadgenas, epidemiologiur monacemebs. sruli obieqturi

gamokvleva aucilebelia, raTa gamoiricxos xvelis sxva mizezebi,

rogoricaa kardiovaskuluri daavadebebi da filtvis parenqimis

dazianeba.

s i s xlis s a erTo a n alizi - ar iZleva daavadebis

diagnostikis da misi mkurnalobis gansazRvris saSualebas

(sarwmunoeba IV). amitom ar aris mizanSewonili misi rutinulad

Catareba (rekomendacia C). mwvave bronqitis dros SeiZleba gamovlindes

leikopenia an leikocitozi, limfocitozi, Tumca es ar aris

specifiuri am daavadebisaTvis.

pulsoqs i m etri a , J a n g b adis s aturaci i s g a n s azRvra .

O2 saturaciis gansazRvra mizanSewonilia Cautardes Yyvela bavSvs,

romelic hospitalizebulia sunTqvis mwvave ukmarisobiT (sarwmunoeba

II, rekomendacia C).

re ntg e nologiuri g a mo k vle v a – mwvave bronqitis dros

gulmkerdis rentgenograma normaluria an aRiniSneba bronqogenuri

gaZliereba. gulmkerdis rentgenografia ar tardeba rutinulad.

gulmkerdis rentgenografiis Cvenebebia:

pacients aqvs cxeleba, magram ar aqvs zemo sasunTqi

gzebis dazianebis simptomebi;

pacients aqvs Tanmxlebi davadeba, romelic xels uwyobs

pnevmoniis ganviTarebas – bronqoeqtazia, diabeti, gulis,

RviZlis an Tirkmlis paTologia;

anamnezSi pnevmonia (< 1 weli);

anamnezSi tuberkulozis arseboba;

daavadebis gaxangrZliveba an uCveulo mimdinareoba;

eWvi pnevmoniaze.

7

et iologiuri k vle v a - nazofaringuli sekretidan SeiZleba

virusis gamoyofa, Tumca es ar aris aucilebeli diagnostikis an

mkurnalobisTvis. vinaidan mwvave bronqiti ZiriTadad virusuli

genezisaa, ar aris rekomendebuli naxvelis mikrobiologiuri Tu

mikroskopuli kvlevis Catareba. serologiuri testiT SeiZleba

gamomwvevis (mikoplazmis, qlamidiis) sawinaaRmdego specifiuri

antisxeulebis dadgena. polimerazuli jaWvuri reaqciiT SesaZlebelia

nebismieri etiologiuri faqtoris dadgena, Tumca es meTodi Zviria da

stacionarSic ki rutinulad ar gamoiyeneba.

f iltv is fun qci i s S e sw a vla - mwvave bronqitiT

daavadebul pacientebSi dadgenilia filtvis funqciis daqveiTeba,

magram spirografia ar aris rutinulad rekomendebuli. filtvis

funqciis Seswavla tardeba bronqul asTmaze eWvis dros.

C - r e a qt iuli cila – kvlevebi gviCveneben, rom es testi

xasiaTdeba baqteriuli infeqciis mimarT maRali mgrZnobelobiT (80-

100%), da dabali specifiurobiT (60-70%). C-reaqtiuli cila SeiZleba

gamoyenebul iqnas antibiotikoTerapiis kriteriumad hospitalizebul

bavSvebSi (rekomendacia B). Tumca dabali C-reaqtiuli cila ar

gamoricxavs baqteriuli infeqciis arsebobas.

diferenciuliDdiagnozi

diferencialuri diagnozi tardeba Semdeg daavadebebTan:

pnevmonia;

asTma;

qronikuli bronqitis gamwvaveba;

yivanaxvela;

ucxo sxeulis aspiracia;

mukoviscidozi;

bronqioliti;

zeda sasunTqi gzebis infeqcia;

sinusiti;

nazofaringiti;

refluqs-ezofagiti;

bronqis simsivne;

atipuri mikobaqteriuli infeqcia;

8

baqteriuli traqeiti.

riniti da post-nazaluri wveTi.

prognozi

prognozi pacientTa umravlesobaSi keTilsaimedoa. Tu xvela

gaxangrZlivda, saWiroa damatebiTi gamokvlevebi.

marTva

mwvave bronqitis ZiriTadi gamomwvevia virusi, amitom

antibiotikoTerapia ar aris naCvenebi. placebo-kontrolirebadi,

ormagi brma, randomizebuli kvlevebis meta-analizis Sedegad

naCvenebia, rom ar arsebobs mwvave bronqitis dros antibiotikebis

gamoyenebis efeqturobis damadasturebeli monacemebi. antibiotikebi ar

axdendnen zegavlenas xvelis Semcirebaze, ar icavdnen meoradi

baqteriuli infeqciebis ganviTarebisagan an maTi mZime

mimdinareobisagan.

antibiotiki iniSneba, Tu saeWvoa baqteriuli infeqcia

(sarwmunoebis done I, rekomendacia A). dadgenilia, rom mwvave

bronqitis diagnoscirebisas eqimTa 50-79% niSnavs antibiotiks,

miuxedavad imisa, rom antibiotiks sargebeli ar moaqvs.

antibiotikoTerapiaze unda vifiqroT, Tu:

zogadi mdgomareoba uaresdeba;

cxeleba grZeldeba erT kviraze met xans;

aRiniSneba cxelebis meore talRa;

aRiniSneba profuzuli da Cirqovani naxveli;

epidemiologiuri situaciidan gamomdinare eWvia mikoplazmur,

qlamidiur infeqciaze an yivanaxvelaze;

Tu mwvave bronqitis simptomebTan erTad aRiniSneba sinusiti an

otiti;

Tu daavadeba mimdinareobs im faqtorebis fonze, romelTac

SeuZliaT gazardon pnevmoniis ganviTarebis riski

(imunodeficiti, alkoholizmi, gulis qronikuli ukmarisoba,

filtvis qronikuli paTologia).

mikoplazmur da qlamidiur infeqciaze eWvis dros rekomendebulia

makrolidis gamoyeneba (sarwmunoebis done III, rekomendacia B).

mkurnalobis principebi bavSvebSi

9

1. mSvidi, komfortuli garemo;

2. siTxeebis damatebiTi miwodeba;

3. antipiretuli saSualebebi;

4. amosaxvelebeli saSualebebis efeqturoba da sargeblianoba

bavSvebSi ar aris dadasturebuli;

5. bavSvebSi xvelis damTrgunvelebis gamoyeneba ar amcirebs

daavadebis xangrZlivobas, amasTan naxvelis evakuaciis

daTrgunvam SeiZleba xeli Seuwyos baqteriuli garTulebis

ganviTarebas;

6. bavSvebSi ar arsebobs mwvave bronqitis dros β2-agonistebis

efeqturobis damadasturebeli monacemebi;

7. antihistaminuri preparatebi ar aris rekomendebuli, radgan isini

iwveven naxvelis gamoSrobas da SeiZleba gaaZlieron xvela.

mSobels unda miewodos informacia, rom dauyovnebliv mimarTos

eqims, Tu bavSvs gamoexata Semdegi niSnebi: sunTqva gaxda ufro

gaZnelebuli; daewyo FRebineba yoveli kvebis Semdeg; ver iRebs

siTxeebs; gamoixata zogadi mZime mdgomareoba – daTrgunva, Zilianoba.

mkurnalobis principebi mozrdilebSi

1. siTxeebis damatebiT miwodeba bronquli sekretis gamoSrobis

Tavidan acilebis mizniT;

2. sigaretis mowevisagan Tavis Sekaveba;


4. xvelis damTrgunveli saSualebebi xSirad iniSneba bronqitis,

gansakuTrebiT Semawuxebeli xveliT mimdinare, dros. maT

SeiZleba Seamciron xvela, magram maTi miReba ar amcirebs

daavadebis xangrZlivobas.

5. amosaxvelebeli saSualebebis rutinuli gamoyeneba ar aris

rekomendebuli. naxvelis gamaTxierebeli saSualebebis daniSvna

SesaZlebelia mxolod webovani, Znelad gamosayofi naxvelis

SemTxvevaSi;

6. bronqodilatatorebis gamoyeneba umniSvnelo efeqts iZleva

gaxangrZlivebuli xvelis dros;

10

7. kortikosteroidebis gamoyeneba ar aris rekomendebuli, vinaidan

ar arsebobs kvleva, romelic daadasturebs maT efeqturobas

mwvave bronqitis dros.

prevencia

dty vaqcinacia;

gripis sawinaaRmdego vaqcinacia;

Tambaqos bolisgan Tavis arideba.

meTvalyureoba

Semdgomi meTvalyureoba Cveulebriv ar aris saWiro, garda im

SemTxvevebisa, roca:

mdgomareoba uaresdeba an axali simptomebi Cndeba;

xvela xangrZlivdeba >1 Tveze;

simptomebi meordeba (>3 epizodze weliwadSi).

gaidlainis miRebis wyaro. winamdebare gaidlaini warmoadgens

sxvadasxva gaidlainebis (ix. literatura) Sejerebis da adaptaciis

Sedegs.

literatura:

1. Meza R, Bridges-Webb C, Sayer G, et al. The management of acute bronchitis in

general practice: results from the Australian morbidity and treatment survey.

Australian Family Physician, 1994; 23: 1550-1553.

2. Samuel Ong, MD, Visiting Assistant Professor, Department of Emergency Medicine,

University of California at Los Angeles Medical Center-Olive View Bronchitis Last

Updated: December 29, 2004, WEBMD, eMedicine

3. Guideline for The Management of Acute Bronchitis - developed by an Alberta

Clinical Practice Guideline Working Group, 2006 Update.

4. Family Practice Notebook, 2000

5. Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed

Army Medical Center Bronchitis, Acute and Chronic Last Updated: January 30, 2006,

WEBMD, eMedicine

11

http://www.emedicine.com/cgi-bin/foxweb.exe/screen@d:/em/ga?book=emerg&authorid=2948&topicid=69

http://www.emedicine.com/cgi-bin/foxweb.exe/screen@d:/em/ga?book=ped&authorid=3513&topicid=288

6. DiFranza JR, Lew RA. Morbidity and mortality in children associated with use of

tobacco products by other people. Pediatrics 1996; 97 (4); 560-568

7. Hamm R, Hicks R, Bemben D. Antibiotics and respiratory infections: are patients

more satisfied when expectations are met? J. Family Practice, 1996; 43: 56-62.

8. O’Brien K, Dowell S, Schwartz B, et al. Cough illness/bronchitis – principles of

judicious use of antimicrobial agents.Paediatrics,1998;101: 178-81.

9. Gonzales R, Barrett P, Steiner J. The relationship between purulent manifestations and

antibiotic treatment of upper respiratory tract infections. J. General Internal Medicine,

1999; 14:151-6.

10. Gwaltney J. Acute bronchitis. In: Mandell G, Bennett J, and Dolin R (eds.). Mandell,

Douglas and Bennett’s Principles and Practice of Infectious Diseases. 5th edition,

Churchill and Livingstone, Edinburgh, 2000.

11. Becker L, Glazier R, McIsaac W, et al. Antibiotics for acute bronchitis (Cochrane

Review). In: The Cochrane Library, Issue 3, 1998. Oxford: Update Software.

12. Hueston W. Albuterol delivered by metered dose inhaler to treat acute bronchitis. J.

Family Practice, 1994; 39(5): 437-440.

13. Irwin R, Curley F, Bennett F. Appropriate use of antitussives and protussives: a

practical review. Drugs, 1993; 46: 80-91.

14. Hueston W. Antibiotics: neither cost effective nor ‘cough’ effective. J. Family

Practice, 1997; 44(3): 261-5.

15. Clinical practice guideline for the diagnosis and management of acute bronchitis -

Inland empire health plan, San Bernandino, CA 2001

16. National Guideline Clearinghouse – Bronchitis, 2005

17. Gonzales R, Sande M. What will it take to stop physicians from prescribing antibiotics

in acute bronchitis? Lancet, 1995; 345: 665-666.

18. Mainous A, Zoorob R, Hueston W. Current management of acute bronchitis in

ambulatory care: the use of antibiotics and bronchodilators. Arch Fam Med, 1996; 5:

79-83.

19. National Guideline Clearinghouse – Use of antibiotics in pediatric care, 2002

20. Smuncy J, et al β2 agonists for acute bronchitis (Cochrane review) – The Cochrane

Library, Issue 2, 2006

21. Acute Bronchitis - EBM Guidelines, 2004

22. Nelson - Textbook of pediatrics - 2005

23. Hueston W. J., Mainous A.G. Acute bronchitis. American Academy of Family

Physicians, 1998

12

mwvave bronqitis marTvis

protokoli

(pirveladi jandacvis rgolisaTvis)

daavadebis definicia.




simptomebi da niSnebi



Semcivneba, saerTo sisuste, msubuqi cxeleba (araumetes 3 dRis

ganmavlobaSi), cxviridan gamonadeni, yelis tkivili, kunTebis tkivili,

xmis CaxleCa.




mogvianebiT Cirqovani SeiZleba gaxdes. Tumca Cirqovani naxveli







temperatura normaluria an subfebriluri. adreul etapze



moismineba mSrali da sxadasxva yalibis sveli xixini. zog pacientSi

ismis mstvinavi sunTqva. bronqitisaTvis ar aris damaxasiaTebeli

lokaluri simptomatika: lokaluri krepitacia, bronquli sunTqva,

perkutoruli xmianobis moyrueba. aseT SemTxvevaSi gamosaricxia

pnevmoniis arseboba.

mikoplazmuri etiologiis bronqitis SemTxvevaSi SesaZlebelia

kanze gamonayaris gaCenac.

13

bronqitze eWvi unda iqnes mitanili im pacientebSi, romelTanac

mwvave respiraciuli infeqciis niSnebi asocirebulia xvelasTan.

sruli anamnezuri gamokvleva unda moicavdes garemo aris da

sigaretis zegavlenis dadgenas, epidemiologiur monacemebs. sruli

obieqturi gamokvleva aucilebelia, raTa gamoiricxos xvelis sxva

mizezebi, rogoricaa kardiovaskularuli daavadebebi da filtvis

parenqimis dazianeba.

diagnostikur-laboratoriuli testebi

s i sxlis s a erTo a n alizi - ar iZleva daavadebis

diagnostikis da misi mkurnalobis gansazRvris saSualebas. amitom ar

aris mizanSewonili misi rutinulad Catareba. mwvave bronqitis dros

SeiZleba gamovlindes leikopenia an leikocitozi, limfocitozi,

Tumca es ar aris specifiuri am daavadebisaTvis.

r e ntg e nologiuri g a mo k vle v a – mwvave bronqitis dros


gaZliereba. gulmkerdis rentgenografia ar tardeba rutinulad.

gulmkerdis rentgenogramis Cvenebebia:









eWvi pnevmoniaze.

mkurnaloba


antibiotikoTerapia ar aris naCvenebi. antibiotikoTerapiaze unda

vifiqroT, Tu:



cxeleba Tavidan iwyeba;


14




otiti;






makrolidis gamoyeneba.







daTrgunvam SeiZleba xeli Seuwyos baqteriul garTulebas;



6. antihistaminuri preparatebi ar aris rekomendebuli, radgan

isini iwveven naxvelis gamoSrobas da SeiZleba gaaZlieron

xvela.










4. xvelis damTrgunveli saSualebebi xSirad iniSneba bronqitis

dros. maT SeiZleba Seamciron xvela, magram maTi miReba ar

amcirebs daavadebis xangrZlivobas.

15


rekomendebuli. naxvelis gamaTxierebeli saSualebebis

daniSvna SesaZlebelia mxolod webovani, Znelad gamosayofi

naxvelis SemTxvevaSi;



7. kortikosteroidebis gamoyeneba ar aris rekomendebuli.

reabilitacia da dakvirveba






adamianuri da materialur-teqnikuri resursi

adamianuri resursi: ojaxis eqimi, ubnis Terapevti an pediatri.

materialur-teqnikuri resursi: gamanaTebeli mowyobiloba xaxis

dasaTvaliereblad, enis supresori (Spadeli), fonedoskopi.

protokoli eyrdnoba saqarTvelos respiraciuli asociaciis

“mwvave bronqitis marTvis” gaidlains.

16

mwvave bronqitis marTvis

protokoli

(stacionari)

daavadebis definicia.




simptomebi da niSnebi



Semcivneba, saerTo sisuste, msubuqi cxeleba (araumetes 3 dRe),

cxviridan gamonadeni, yelis tkivili, kunTebis tkivili, xmis CaxleCa.




mogvianebiT Cirqovani SeiZleba gaxdes. Tumca Cirqovani naxveli







temperatura normaluria an subfebriluri. adreul etapze



moismineba mSrali da sxadasxva yalibis sveli xixini. zog pacientSi

SeiZleba moisminebodes mstvinavi sunTqva. bronqitisaTvis ar aris

damaxasiaTebeli lokaluri simptomatika: lokaluri krepitacia,

bronquli sunTqva, perkutoruli xmianobia moyrueba. aseT SemTxvevaSi

gamosaricxia pnevmoniis arseboba.

mikoplazmuri etiologiis pnevmoniis SemTxvevaSi SesaZlebelia

kanze gamonayaris gaCena.

17

bronqitze eWvi unda iqnes mitanili im pacientebSi, romelTanac

mwvave respiraciuli infeqciis niSnebi asocirebulia xvelasTan.

sruli anamnezuri gamokvleva unda moicavdes garemo aris da

sigaretis zegavlenis dadgenas, epidemiologiur monacemebs. sruli

obieqturi gamokvleva aucilebelia, raTa gamoiricxos xvelis sxva

mizezebi, rogoricaa kardiovaskularuli daavadebebi da filtvis

parenqimis dazianeba.

diagnostikur-laboratoriuli testebi da specialistTa

konsultaciebi

a) pirvel 4 saaTSi

• sisxlis saerTo analizi;

• gulmkerdis organoebis rentgenologiuri kvleva;

• Jangbadis saturaciis gansazRvra (Cvenebis mixedviT).

b) pirvel 24 saaTSi


• gulmkerdis rentgenologiuri kvleva;

• Jangbadis saturaciis gansazRvra (Cvenebis mixedviT);

• ekg (Cvenebis mixedviT)

g) pirvel 3 dReSi


• Sardis saerTo analizi;

• gulmkerdis rentgenologiuri kvleva;

• Jangbadis saturaciis gansazRvra (Cvenebis mixedviT).;

• mikrobiologiuri kvleva (Cvenebis mixedviT);

• serologiuri kvleva (Cvenebis mixedviT);

• ekg (Cvenebis mixedviT).

s i s xlis s a erTo a n alizi - ar iZleva daavadebis

diagnostikis da misi mkurnalobis gansazRvris saSualebas. mwvave

bronqitis dros SeiZleba gamovlindes leikopenia an leikocitozi,

limfocitozi, Tumca es ar aris specifiuri am daavadebisaTvis.

18

re ntg e nologiuri g a mo k vle v a – mwvave bronqitis dros


gaZliereba. gulmkerdis rentgenogramis Cvenebebia:









eWvi pnevmoniaze.

et iologiuri k vle v a - nazofaringuli sekretidan SeiZleba

virusis gamoyofa, Tumca es ar aris aucilebeli diagnozis

dasasmelad an mkurnalobisTvis. vinaidan mwvave bronqiti ZiriTadad

virusuli genezisaa, ar aris rekomendebuli naxvelis mikrobiolo-

giuri Tu mikroskopuli kvlevis Catareba.

filtvi s fun qci i s S e sw a vla . filtvis funqciis Seswavla

tardeba bronqul asTmaze eWvis dros.

mkurnaloba


antibiotikoTerapia ar aris naCvenebi. antibiotikoTerapiaze unda

vifiqroT, Tu:



cxeleba Tavidan iwyeba;





otiti;



19




makrolidis gamoyeneba.







daTrgunvam SeiZleba xeli Seuwyos baqteriul garTulebas;



6. antihistaminuri preparatebi ar aris rekomendebuli, radgan

isini iwveven naxvelis gamoSrobas da SeiZleba gaaZlieron

xvela.










4. xvelis damTrgunveli saSualebebi xSirad iniSneba bronqitis

dros. maT SeiZleba Seamciron xvela, magram maTi miReba ar

amcirebs daavadebis xangrZlivobas.


rekomendebuli. naxvelis gamaTxierebeli saSualebebis

daniSvna SesaZlebelia mxolod webovani, Znelad gamosayofi

naxvelis SemTxvevaSi;



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7. kortikosteroidebis gamoyeneba ar aris rekomendebuli.

specialistTa konsultacia:

a. yel-yur-cxviris specialisti;

b. kardiologi, qirurgi, fTiziatri (Cvenebis mixedviT).

reabilitacia da dakvirveba






protokoli eyrdnoba saqarTvelos respiraciuli asociaciis

“mwvave bronqitis marTvis” gaidlains.

adamianuri da materialur-teqnikuri resursi

adamianuri resursi: Terapevti an pediatri.

materialur-teqnikuri resursi: gamanaTebeli mowyobiloba xaxis

dasaTvaliereblad, enis supresori (Spadeli), fonedoskopi,

rentgenografiis aparati, ekg, spirografiis aparati.

21

i

a

ifiqreT

pnevmoniaze (ix.

pnevmoniis marTvis

gaidlaini)

ifiqre

atip

qlam• simptomebis kontroli;

• siTxeebis damatebiT miwodeba

• xvelis sawinaaRmdego

sa

• an ;

• ga

ko

• an

• da• anTa

k

• md

• x

• s

ar

T yivanaxvelasa an

ur (mikoplazma,

idia) infeqciaze

i

•

•

•

•

•

•

diax

mwvave bronqitis marTvis algoritm

pnevmoniis niSnebi saxezea?

• respiraciuli distresi;

• guliscemis sixSire >100/wT –ze;

• sunTqvis sixSire * >24/wT –ze;

• temperatura >380C;

• lokalurad perkutoruli xmis moyrueba,

krepitacia, bronquli sunTqva

gulmkerdis rentgenografia da sxva laboratoriuli

kvleva rutinulad ar aris saWiro

xangrZlivoba < 10-14

dReze, mdgomareoba

damakmayofilebeli

xvelis xangrZlivoba >

10-14 dReze

xvelix xangrZlivoba 4-

8 kvira

fiqreT sxva mizezze:

asTma;

ucxo sxeuli;

tuberkulozi;

mukoviscidozi;

bronqoeqtazia;

fqod da sxva.

Sualebebi**;

tipiretuli saSualebebi

remos gamRizianeblebTan

ntaqtis SezRudva.

pacientTan/mSobelTan

isaubreT:

tibiotikis uefeqtobaze;

avadebaze;

tibiotikis gamoyenebas

n dakavSirebul riskze

Tu dadasturda

laboratoriuli

vleviT, gamoiyeneT

makrolidi

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* bavSvebSi pnevmoniis erT-erT ZiriTad sadiagnostiko niSnad

miCneulia sunTqvis sixSire:

• 2 Tvemde > 60-ze wuTSi,

• 2-dan 12 Tvemde > 50-ze wuTSi,

• 12 Tvidan 5 wlamde > 40-ze wuTSi,

• 5 welze meti asaki > 30 -ze wuTSi.

sunTqvis sixSiris daTvla unda moxdes erTi wuTis ganmavlobaSi,

rodesac bavSvi mSvid mdgomareobaSia da ar tiris.

bavSvebSi gulmkerdis retraqcia (gulmkerdis qveda mesamedis

Cazneqva sunTqvis procesSi) miCneulia mZime pnevmoniis erT-erT

ZiriTad sadiagnostiko niSnad, Tumca gaTvaliswinebuli unda

iyos, rom msubuqi retraqcia damaxasiaTebelia axalSobilebsa da

Cvil bavSvTa asakisTvis da iTvleba normad.

**bavSvebSi xvelis damTr-

gunveli da amosaxveleb-

eli saSualebebis efeqtu-

roba ar aris dadas-

turebuli.

ganmeorebiTi konsultacia da gamokvleva saWiroa, Tu:

gomareoba uaresdeba*** an Cndeba axali simptomebi;

vela xangrZlivdeba 1 Tveze met xans;

imptomebi meordeba (>3 epizodze weliwadSi).
***mSobelma dauyovnebliv unda
mimarTos eqims, Tu bavSvs

gamoexata: Zilianoba;

gaZnelebuli sunTqva; Rebineba

yoveli kvebis Semdeg; ver

iRebs siTxeebs.

avtorebi: T.maRlakeliZe, k.vaWaraZe, i.CxaiZe, p.gvetaZe ...saqarTvelos respiraciuli asociacia...

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Transcript of avtorebi: T.maRlakeliZe, k.vaWaraZe, i.CxaiZe, p.gvetaZe ...saqarTvelos respiraciuli asociacia...