ìïáïîàâåäëì ìïèåæòúòíë...

ìïáïîàâåäëì ìïèåæòúòíë

èëïèþå

ìïèåúíòåîë-ðîïáüòêóäò ýóîíïäò ýóîíïäò æïïîìæï 1922 ùåäì

1

ianvari - marti

2005

öïíãòî èïèïäïûå (èàïâïîò îåæïáüëîò) ìïîåæïáúòë êëäåãòï: â. þïõóüïøâòäò, ë. ãåîçèïâï, ê. ãåäïøâòäò, à. æåêïíëìòûå (èàïâïîò îåæïáüëîòì èëïæãòäå), ô. àëæóï, ã. òëìåäòïíò, ð. êòíüîïòï, â. ìïïêïûå, å. áåèåîüåäòûå, ä. áóîúòêïøâòäò, ç. éóéóíòøâòäò, í. ñòôøòûå, î. øïáïîòøâòäò, ä. øåùòîóäò, ì. õå÷òíïøâòäò, î. õåúóîòïíò

Jurnali `saqarTvelos samedicino moambe~ 80 wlisaa

samedicino Jurnalis daarseba qarTvel eqimTa sanukvari ocneba iyo.

pirveli samedicino Jurnali `qarTuli samkurnalo furceli~ qarTul enaze

gamovida 1908 wels eqim v. RambaSiZis redaqtorobiT. Tavisi SinaarsiT igi

samecniero-popularuli xasiaTisa iyo. meore nomris gamosvlis Semdeg,

usaxsrobis gamo, Jurnalma arseboba Sewyvita.

odesaSi myofma qarTvel mecnierTa da studentTa jgufma mSobliur

enaze gamosca samecniero krebuli `cxovreba da mecniereba~, romlis pirveli

nomeri 1914 wels quTaisSi gamovida, magram Semdegi nomeri aRar gamocemula.

1919 wels qarTvel eqimTa da bunebismetyvelTa sazogadoebam daarsa Jurnali

`eqimi~, romlis mxolod 8 nomeri ixila mkiTxvelma.

pirveli regularuli qarTuli samedicino Jurnali, romelic TbilisSi

1922 wlis aprilSi gamovida `janmrTelobis dacvis saxalxo komisariatis

moambe~ iyo. XX saukunis ociani wlebidan moyolebuli qarTuli perioduli

samedicino presa qveynis janmrTelobis dacvis sistemaSi mimdinare procesebis

Tanaziari da aqtiuri monawilea.

Cveni saukunis ocian wlebSi, saqarTveloSi, erTsa da imave dros

ramdenime perioduli samedicino samecniero Jurnali gamodioda, romelTa

Soris aRsaniSnavia: `samkurnalo moambe~, `Tanamedrove medicina~, `tropikuli

medicinis moambe~, `Tanamedrove farmacia~. 30-ian wlebSi yvela dasaxelebuli

gamocemis roli da daniSnuleba `sabWoTa medicinam~ itvirTa.

1941 wels, omis dawyebis gamo, Jurnalis gamocema droebiT Sewyda. 1957

wlis ianvar-TebervalSi gamovida aRdgenili `sabWoTa medicinis~ pirveli

nomeri, maSindeli jandacvis ministris, profesor daviT mamamTavriSvilis

redaqtorobiT.

Jurnals, 1926-1927 wlebSi erqva `samkurnalo moambe~, 1927-1928 wlebSi _

`jansaxkomis moambe~, 1929 wlis oqtombridan Jurnali gamodis `sabWoTa

medicinis~ saxelwodebiT, xolo 1990 wlidan, saredaqcio kolegiis

gadawyvetilebiT, mas `saqarTvelos samedicino moambe~ ewodeba.

Jurnalis arsebobis periodSi, mis furclebze gamoqveynda medicinis

sxvadasxva dargis 45000-ze meti masala. bolo wlebSi, Jurnalis rubrikaTa

raodenobam 50-s miaRwia.

am xnis manZilze qarTuli samedicino periodis furclebze dastambul

Sromebs Soris gansakuTrebiT unda aRiniSnos is fundamenturi gamokvlevebi,

romlebmac saTave daudo avadmyofTa kvlevis, diagnostikis, mkurnalobis,

reabilitaciis, profilaqtikis axal mecnierul da praqtikul mimarTulebebs,

ramac ganapiroba avadobaTa Semcireba, zogierTi maTganis likvidacia

(malaria), medicinis muSakTa profesiuli momzadeba, sakandidato da

sadoqtoro disertaciebis zrda, qarTvel medikosTa samecniero-kvleviT

miRwevaTa sayovelTao aRiareba, ucxoeTis qveynebTan mecnieruli

TanamSromlobis gafarToeba da sxva.

dRes, saqarTveloSi janmrTelobis dacvis mTeli sistemis radikaluri

gardaqmnebis procesSi, gansakuTrebiT sagulisxmoa Jurnalis samarTliani

principuloba da siaxlisadmi swrafva, roli da daniSnuleba erovnuli

medicinis Semdgomi ganviTarebisa da ganmtkicebisaTvis.

!!!!!!

Tjobhboj!tofvmfcfcj

gul-sisxlZarRvTa sistemis reaqcia fizikur da fsiqomotorul datvirTvaze axalgazrdebSi x. ciciaSvili, prof. g. qavTaraZe, doc. T. maxaraZe, i. JorJoliani, T. cxvaraZe, m. tuRuSi, m. gvalia Tbilisis saxelmwifo samedicino universitetis Sinagan sneulebaTa #1 kaTedra

bolo wlebSi organizmis fiziologiuri da fsiqologiuri adaptaciis

SesaZleblobebis Semcireba aRiarebulia rogorc daavadebaTa ganviTarebis erT-erTi

wamyvani riskis faqtori (2,5).

nebismieri, maT Soris gul-sisxlZarRvTa sistemis daavadebaTa saTave, maTi premorbidi,

axalgazrda asakSia saZebneli. farTo adaptaciuri SesaZlebloba, romelic am asaks

axasiaTebs, xSirad Cqmalavs farulad mimdinare paTologiur process. am asakSi mis gamo-

savlenad submaqsimaluri datvirTvis gamoyeneba xdeba saWiro. amasTan, ama Tu im

saadaptacio modelis mqone pirovnebas fizikur Tu fsiqologiur datvirTvaze sxvadasxva

reaqcia SeiZleba hqondes, anu daavadebis `gamSvebad~ sxvadasxva faqtori mogvevlinos.

kvlevis mizans warmoadgens fizikur da fsiqomotorul datvirTvaze gul-sisxlZarRvTa

sistemis reaqciis TaviseburebaTa Seswavla praqtikulad janmrTel, magram sxvadasxva

fiziologiur da fsiqologiur adaptaciur SesaZleblobaTa mqone axalgazrdebSi.

Mmasala da gamokvlevis meTodebi. gamovikvlieT Tbilisis saxelmwifo samedicino

universitetis 72 praqtikulad janmrTeli studenti (saSualo asaki 23,25±1,32) – 36 (50%)

qali da 36 (50%) kaci. monacemebi davamuSaveT statistikuri analizis meTodebis gamoyene-

biT (programaTa sistema SPSS). gul-sisxlZarRvTa sistemaze, rogorc organizmis adaptaciur SesaZleblobaTa

indikatorze, koncefciis Tanaxmad, misi funqcionirebis done (fd) SeiZleba ganvixiloT

rogorc organizmis garemosTan wonasworobis ZiriTadi maCvenebeli (2). sisxlis

mimoqcevis sistemis fd-isa da misi adaptaciuri potencialis Sesafaseblad `.o. aå!“å…å"=-s

mier 1986-91 wlebSi mowodebulia nozologiamdeli diagnostikis martivi algoriTmi _

funqciuri cvlilebebis indeqsi (FCI), romelic isazRvreba pirobiT erTeulebSi _

balebSi. FCI-s gamoTvlisaTvis saWiroa Semdegi monacemebi: pulsis sixSire (P), sistoluri

da diastoluri arteriuli wneva (TAs, TAd), simaRle (H), sxeulis masa (W) da asaki (A).

FCI=0,011 P + 0,014 TAs + 0,008 TAd + 0,014 A + 0,009 W _ 0,009 H _ 0,27

FCI-is mniSvnelobis mixedviT, gamokvleuli pirebi ganawildnen janmrTelobis donis

Sesatyvis sam jgufad: I. damakmayofilebeli adaptaciiT (FCI≤2,10), II. adaptaciis

meqanizmebis zomieri daZabviT (FCI 2,11-2,59), III. adaptaciis meqanizmebis Zlieri daZabviT

(FCI 2,60≤). I jgufi Seadgina 27 (37,5%), II – 39 (54,17%), III – 6 (8,33%) studentma.

statistikurad sarwmuno gansxvaveba iqna miRebuli gamosakvlev pirTa calkeul

jgufSi FCI-is saSualo mniSvnelobebs Soris (p=0,03). organizmis funqciuri rezervis (fr) gansazRvra erT-erTi aucilebeli pirobaa

funqciuri mdgomareobis Sesafaseblad, vinaidan adaptaciuri SesaZleblobebis Semcireba

dakavSirebulia funqciuri rezervebis gamoxatul klebasTan an sulac amowurvasTan.

mTliani organizmis adaptaciuri SesaZleblobebis gamsazRvrel, wamyvan fiziologiur

sistemad ganixileba sisxlis mimoqcevis sistema, Sesabamisad saubaria am sistemis fr-ze (2).

imisaTvis, rom SegveZlos garemo pirobebis cvlilebebze organizmis SesaZlo

reaqciebis prognozireba, mizanSewonilia fr-is Sefaseba pirdapiri gziT. b.b. o=!,…-isa da t.g. låå!“%…-is (10) mixedviT, organos an sistemis fr SeiZleba raodenobrivad ganisaz-

Rvros rogorc mosvenebisas funqciis dones da am funqciis maqsimalurad misawvdom

dones Soris sxvaoba, vinaidan funqciis maqsimumis gazomva SesaZlebelia mxolod

organizmis zRvruli an zezRvruli datvirTvisas, rac SeuZlebelia Cveulebrivi

momzadebis mqone adamianTa, gansakuTrebiT ki im pirTa kvlevisas, romelTa mdgomareoba

normasa da paTologias Soris zRvarzea.

kardiologiur klinikebSi gamoyenebul mravalricxovan datvirTvis testebs Soris Cven

avirCieT Sefildisa da Tanaavtorebis (Sheffild et al.) mier SemuSavebuli, bolo wlebSi

farTod gavrcelebuli fizikuri datvirTvis funqciuri sinji (1). Fam dros datvirTva

TandaTanobiT (yovel 1_2 wuTSi) matulobs gulis ritmis sasurvel gaxSirebamde.

avtorebi gvirCeven gamokvlevis procesSi fizikuri datvirTva TandaTanobiT gavzardoT

gulis ritmis ara kritikul (maqsimalur) gaxSirebamde, aramed asakisaTvis Sesabamis

submaqsimalur donemde (maqsimaluris 85%-mde). amisaTvis maT SeimuSaves specialuri

cxrili. gamoTvla SeiZleba (3) formuliTac: (220 _ asaki) × 0,85. datvirTva SeiZleba

Sesruldes sxvadasxva meTodiT, mxolod savaldebuloa ekg-s Cawera gamokvlevis

procesSi (1). kvlevas vawarmoebdiT ekg holteriT monitorirebis (hm) fonze (6). hm xdeboda

`NIHON KOHDEN~ (iaponia) firmis 2-arxian cifrul ambulatoriul ekg Camwerze RAC – 1202 K gulmkerdis modificirebul ganxrebSi ANASA (jamuri ganxra) da CM5 ( V5-is analogiuri), imave sistemis deSifratorze Semdgomi damuSavebiT.

gamosakvlev pirs mjdomare da mosvenebul mdgomareobaSi (sakvebis miRebidan 2 saaTis

Semdeg) esinjeboda arteriuli wneva da pulsis sixSire. Semdeg is akeTebda buqnebs,

pulsis individurad, winaswar gansazRvrul submaqsimalur doneze, gaxSirebamde. wneva da

pulsis sixSire izomeboda datvirTvis damTavrebidan 1, 3, 5 da 10 wuTis Semdeg. amave

momentSi xdeboda registratorze arsebuli markeris aqtivaciis Rilakis (event recorder) saSualebiT gamosakvlevi piris mier Canaweris operatiuli aqtivacia analizisas ekg-is

Sesabamisi monakveTis zustad gamoyofis mizniT (6).

pulsisa da arteriuli wnevis dinamika asaxavs sisxlis mimoqcevis aparatis

datvirTvasTan adaptaciis xarisxs. wnevis sagrZnobi mateba da maCveneblebis normamde

Camosvlis Segvianeba gulis funqciis darRvevis niSania.

gul-sisxlZarRvTa sistemis kargi funqciuri mdgomareobisas aRiniSneba e.w.

normotonuli, xolo funqciuri mdgomareobis gauaresebisas _ asTeniuri an distoniuri

reaqciebi (3).

hm-is fonze vaxdendiT fsiqomotorul datvirTvaze (venis fsiqotesti) reaqciis

Seswavlas. am saxis datvirTvaze gamoyofen gul- sisxlZarRvTa sistemis individuri

reaqciis sam tips: 1. inertuls, 2. adekvaturs (tipuri reaqcia), 3. araadekvaturs.

Tavisufali aqtivobis dReRamur ciklTan adaptaciisas gul-sisxlZarRvTa sistemis

funqciur rezervebs asaxavs gulis ritmis parametrTa cirkaduli cvalebadoba.

cirkaduli indeqsi (ci) asaxavs cirkadul profils, romelic SesaZloa iyos normaluri

(ci 1,22-1,44), rigiduli (ci<1,2) an gaZlierebuli (ci>1,47) (7,13). Cven mier gamokvleul

kontingentSi rigiduli cirkaduli profilis mqone pirebi ar aRmoCndnen; aRniSnuli

parametri normaSi hqonda 9 students, gaZlierebuli – 24-s.

gamokvleul studentTa fsiqologiuri adaptaciis unaris gansazRvrisaTvis

gamoyenebul iqna d. uznaZis klasikuri fiqsirebuli ganwyobis meTodi (fgm) (11,12,8,9).

imis gaTvaliswinebiT, rom xasiaTisa da temperamentis aqcentuacia warmoadgens fsiqo-

socialuri dezadaptaciis erT-erT mizezs, gamokvleul pirTa Soris aqcentuantebis

dasadgenad gamoviyeneT qaraqterologiuri kiTxvari k. leonhardis mixedviT (SmiSekis

modifikaciiT) (14,15). fsiqo-socialuri dezadaptaciis mizezTa Soris, agreTve, ganixileba

fsiqopaTologiuri sindromebi, romelTa Seswavlac xdeboda Tbilisis saxelmwifo

samedicino universitetis klinikuri fsiqologiis laboratoriaSi SemuSavebuli

fsiqosocialuri anketis (4) meSveobiT.

miRebuli Sedegebi da maTi ganxilva. FCI-is mniSvnelobis mixedviT gamoyofil

jgufebSi fizikur datvirTvaze iyo Semdegi saxis reaqcia: damakmayofilebeli adaptaciis

(FCI≤2,10) mqone pirTagan 62,96% (17) hqonda normotonuli, 7,41% (2) asTeniuri, 29,63% (8)

distoniuri (aqedan, datvirTvis damTavrebidan 3 wuTis Semdeg diastoluri wneva mxolod

or SemTxvevaSi rCeboda nulis toli). adaptaciis meqanizmebis zomieri daZabviT (FCI 2,11-2,59) gamosakvlev pirTagan normotonuli reaqcia aReniSna 53,8% (21), asTeniuri 20,5% (8),

distoniuri 25,6% (10); adaptaciis meqanizmebis Zlieri daZabvisas (FCI 2,60≤) normotonuli

reaqcia dafiqsirda SemTxvevaTa mxolod 33,3% (2), asTeniuri 16,7% (1), 50% (3) ki reaqcia

distoniuri iyo.

hm dros ekg-s analizma aCvena Semdegi suraTi: adaptaciis meqanizmebis daZabvis

matebasTan erTad, matulobs fizikuri datvirTvisas iseTi cvlilebebis sixSire,

rogoricaa paroqsizmuli taqikardia da ST-segmentis depresia (2mm-ze meti). am

cvlilebebidan statistikurad sarwmunoa jgufebs Soris sxvaoba ST-segmentis depresiis sixSiris mixedviT.

fsiqomotorul datvirTvaze analogiuri niSniT gamoyofil jgufebSi miviReT Semdegi

suraTi: studentebSi damakmayofilebeli adaptaciiTa da adaptaciis meqanizmebis zomieri

daZabviT araadekvaturi reaqcia ar dafiqsirebula. I jgufSi inertuli reaqcia hqonda

62,96% (17), II-Si 74,4% (29); adekvaturi _ Sesabamisad 37,04% (10) da 25,6% (10). III jgufSi

suraTi radikalurad icvleba: adekvaturi reaqcia saerTod ar aRiniSneba, 16,7% -Si

adgili aqvs araadekvatur, 83,3% (5) inertul reaqcias.

adaptaciis meqanizmebis daZabvis matebasTan erTad, fsiqomotoruli datvirTvisas,

matulobs iseTi cvlilebebis sixSire, rogoricaa taqikardia, ST-segmentis depresia (2mm-ze meti), supraventrikuri eqstrasistolia, arasunTqviTi sinusuri ariTmia (rac miu-

TiTebs marTvaSi qerqqveSa struqturebis CarTvaze); paralelurad aRiniSneba sunTqviTi

ariTmiis sixSiris kleba. am cvlilebebidan statistikurad sarwmunoa jgufebs Soris

sxvaoba ST-segmentis depresiisa da sinusuri ariTmiis sixSiris mixedviT.

sarwmuno sxvaoba miviReT normaluri da gaZlierebuli cirkaduli indeqsis mqone pirTa

jgufebis Sedarebisas. I jgufSi fizikur datvirTvaze normotonuli reaqcia hqonda 6

(66,67%), distoniuri 3 (33,33%), II jgufSi _ normotonuli 9 (37,5%), asTeniuri 2 (8,3%), dis-

toniuri 13 (54,2%). fsiqomotorul datvirTvaze inertuli reaqciiT upasuxa I jgufis 4

(44,4%), II jgufis 20 (83,33%) gamosakvlevma pirma, adekvaturi reaqciiT ki _ Sesabamisad 5

(55,6%) da 4 (16,67%).

rogorc vxedavT, orive saxis datvirTvaze gul-sisxlZarRvTa sistemis reaqciis is

tipebi, romlebic miuTiTebs am sistemis (da mTliani organizmis) funqciuri mdgomareobis

(adaptaciuri potencialis) gauaresebaze, sarwmunod xSiria im pirebSi, romelTac

aReniSnebaT adaptaciis meqanizmebis Zlieri daZabva da gaZlierebuli cirkaduli

profili.

fizikur da fsiqomotorul datvirTvaze gamokvleul pirTa reaqciis saxeebi fg-is

tipebisa da sxvadasxva parametris mixedviT gamoyofil jgufebSi mocemulia 1, 2 da 3

cxrilebSi.

fiqsirebuli ganwyobis parametrebis mixedviT, gansxvavebuli jgufebisaTvis, fizikuri

da fsiqomotoruli datvirTva sxvadasxva mniSvnelobas iZens: fizikuri datvirTvisadmi

naklebi tolerantoba aRiniSna variabeluri, maRali simtkicisa da stabiluri ganwyobis

mqone studentebSi, fsiqomotorulze ki _ nulovani da metad susti simtkicis, tlanqi

da labiluri ganwyobis SemTxvevebSi.

fizikur da fsiqomotorul datvirTvaze reaqcia fsiqopaTologiuri sindromebis mqone

pirebs, aRniSnuli sindromebis armqone pirebTan SedarebiT, sarwmunod gansxvavebuli ar

aRmoaCndaT. aseve ver miviReT sarwmuno sxvaoba aqcentuantebisa da araaqcentuirebul

pirTa reaqciebs Soris, rac, albaT, orive SemTxvevaSi gamokvleul pirTa arasakmarisi

raodenobiT unda aixsnas.

nqnaemmnqŠh pe`j0hh qepde)mn-qnqrdhqŠni qhqŠel{ m`

thgh)eqjr~ h oqhunlnŠnpmr~ m`cprgjr lnknd{u kh0 u. x. 0h0h`xbhkh, opnt. c.b. j`bŠ`p`dge,

dn0. Š.c. l`u`p`dge, h.P. fnpfnkh`mh,

Š.n. 0ub`p`dge, l.b. Šrcrxh, l.b. cb`kh�“

j=-åä!= "…32!å……,. K%ëåƒ…åL 1 1 ŠK,ë,““*%ã% ã%“3ä=!“2"å……%ã% ìåä,ö,…“*%ã% 3…,"å!“,2å2=

0åëü !=K%2/ - , ƒ3÷å…, å %“%Kå……%“2åL !å=*ö, , “å!äå÷…%-“%“3ä, “2%L “, “2åì/ …= -, ƒ, ÷å“*3þ

, C“, .%ì%2%!…3þ …=ã!3ƒ*3 C!=*2, ÷å“*, ƒä%!%"/., ì%ë%ä/. ë, ö “ !=ƒ…/ì, =ä=C2=ö, %……/ì, "%ƒ-ì%›…%“2 ì, , äë ä, --å!å…ö, =ëü…%L %öå…*, !, “*= !=ƒ", 2, ƒ=K%ëå"=…, L *=!ä, %"=“*3ë !…%L “, “2åì/.

t, ƒ, ÷å“*3þ , C“, .%ì%2%!…3þ …=ã!3ƒ*3 C!%"%ä, ë, …= -%…å X%ë2å!%"“*%ã% ì%…, 2%!, !%"=…, }jc. `!2å!, =ëü…%å ä="ëå…, å , )qq , ƒ3÷=ë, " ä, …=ì, *å " ã!3CC=., %2ë, ÷=þ?, .“ C% , …äå*“3 -3…*ö, %…=ëü…/. , ƒìå…å…, L “å!äå÷…%-“%“3ä, “2%L “, “2åì/, ö, !*=ä…%ì3 , …äå*“3, 2, C=ì -, *“, !%"=……%L 3“2=…%"*, , …=ë, ÷, þ C“, .%C=2%ë%ã, ÷å“*, . “, …ä!%ì%", =*öå…23=ö, , .=!=*2å!= , 2åìCå!=ìå…2=. nK“ëåä%"=…% 72 “23äå…2= Šclr ›å…?, … #36, ì3›÷, … # 36; “!åä…åL "%ƒ!=“2å 23,251,32 ëå2.

o!, -, ƒ, ÷å“*%L , C“, .%ì%2%!…%L …=ã!3ƒ*å 2, C/ !å=*ö, L “å!äå÷…%-“%“3ä, “2%L “, “2åì/, 3*=ƒ/"=þ?, å …= 3.3äøå…, å -3…*ö, %…=ëü…%ã% “%“2% …, (=ä=C2=ö, %……/. "%ƒì%›…%“2åL) “å!äå÷…%-“%“3ä, “2%L “, “2åì/ , %!ã=…, ƒì= " öåë%ì, ä%“2%"å!…% ÷=?å "“2!å÷=þ2“ “!åä, ë, ö “ “, ëü…/ì …=C! ›å…, åì =ä=C2=ö, %……/. ìå.=…, ƒì%" , 3“, ëå……/ì ö, !*=ä…/ì C!%-, ëåì. dë ã!3CC, %2ë, ÷=þ?, .“ C% C=!=ìå2!=ì -, *“, !%"=……%L 3“2=…%"*, , -, ƒ, ÷å“*= , C“, .%ì%2%!…= …=ã!3ƒ*= "/ "ë å2: ìå…üø3þ 2%ëå!=…2…%“2ü * -, ƒ, ÷å“*%L …=ã!3ƒ*å C!, "=!, =Kåëü…%L, “2=K, ëü…%L , "/“%*%L “2%L*%“2, 3“2=…%"*å, = * C“, .%ì%2%!…%L # C!, …3ëå"%L , %÷å…ü “ë=K%L, ã!3K%L , ë=K, ëü…%L 3“2=…%"*å.

RESPONSE OF CARDIOVASCULAR SYSTEM ON PHYSICAL AND PSYCHOMOTOR LOADS IN HEALTHY YOUNG PEOPLE KH. TSITSIASHVILI, G. KAVTARADZE, T. MAKHARADZE, T. TSKHVARADZE, I. ZHORZHOLIANI, M. TUGUSHI, M. GVALIA

Characteristics of the response of cardiovascular system on physical and psychomotor loads in practically

healthy young people with different physiological and psychological adaptation abilities, with the purpose of evaluation of the risks of development of cardiological diseases was studied.

Physical and psychomotor load against the background of Holter monitoring ECG was provided. Arterial pressure and heart rate in dynamics in different groups, categorized according to index of functional changes of cardiovascular system, circadian index, Fixated Set types, psychopathological syndromes, accentuation of character and temperament was studied. 72 students of TSMU (average age 23,251,32) - 36 (50,0%) females and 36 (50,0%) males were subjected to examination.

Types of cardiovascular system responses on both types of loads, which reveal worsening of functional condition (adaptation potential) of this system (and whole organism), are quite frequent in those persons, who are

characterized with strong strain of adaptation mechanisms and increased circadian profile. For the groups with different Fixated Set parameters physical and psychomotor loads have different values: students with variable, high persistance and stable set revealed lower tolerance to physical loads and in case of zero and weakest persistance, rigid and labile set lower tolerance was characteristic for psychomotor loads.

literatura: khŠep`Šrp`:

1. tvildiani d. _ kardiologia, Tbilisi, 2002, gv. 87.

2. a=å"“*,L p.l., aå!“å…å"= `.o. _ nöå…*= =ä=C2=ö, %……/. "%ƒì%›…%“2åL %!ã=…, ƒì= , !, “* !=ƒ", 2, ƒ=K%ëå"=…, L # l., 1997.

3. b,…%ã!=ä%"= Š.q. _ h…“2!3ìå…2=ëü…/å ìå2%ä/ , ““ëåä%"=…, “å!äå÷…%- “%“3ä, “2%L “, “2åì/ # l., 1987.

4. j="2=!=äƒå c.b. “ “%="2. _ j%ìCëå*“ ìå2%ä%" äë "/ "ëå…, C%ä"å!›å……%“2, .ì%ö, %…=ëü…%ì3 “2!å““3,-=*2%!=ì !, “*=, , ƒ3÷å…, K=ƒ, “…/. C“, .%=ä=C2=ö, %……/. ìå.=…, ƒì%" , .=!=*2å!%ë%ã, ÷å“*, . %“%Kå……%“2åL K%ëü…/. haq , ca (C“, .%“%ö, =ëü…= =…*å2=). lå2%ä, ÷å“*, å !å*%ìå…ä=ö, , . ŠK, ë, “, , 1985, 25“.

5. j%ìCüþ2å!…= .ëå*2!%*=!ä, %ã!=-, …= !3Kå›å “2%ëå2, L. Šåƒ. ä%*ë. lå›ä3…=!%ä…%ã% “, ìC%ƒ, 3ì=, 27-30 =C!åë 1999 ã. l., 1999. c. 320.

6. l=*=!%" k.l. _ u%ë2å!%"“*%å ì%…, 2%!, !%"=…, å # l., 2000. 7. l=*=!%" k.l. _ 8 lå›ä3…=!%ä…/L j%…ã!å““ &u%ë2å!%"“*%å ì%…, 2%!, !%"=…, å , …å, …"=ƒ, "…=

.ëå*2!%*=!ä, %ë%ã, [. j=!ä, %ë%ã, . 1999.3: 79. 8. m%!=*,äƒå b.c. _ Š, C/ .=!=*2å!= , -, *“, !%"=……= 3“2=…%"*=. ŠK, ë, “, : låö…, å!åK=, 1966. 9. m%!=*,äƒå b.c. _ lå2%ä/ , ““ëåä%"=…, .=!=*2å!= ë, ÷…%“2, . ŠK, ë, “, : låö…, å!åK=, 1975. 10. o=!,… b.b., låå!“%… t.g. _ m=C! ›å…, å ì, %*=!ä= , -3…*ö, %…=ëü…/L !åƒå!" “å!äö=. l.

(`lm qqqp), 1977. 11. rƒ…=äƒå d.m. _ nK?= C“, .%ë%ã, . 1964. 12. rƒ…=äƒå d.m. _ }*“Cå!, ìå…2=ëü…/å %“…%"/ C“, .%ë%ã, , 3“2=…%"*, . hƒä. `*=ä. …=3* c!. qqp.

1961. 13. Abstr. VIII International Congress “Holter and Noninvasive Electrocardiology” Ulm, Germany, 22-23

May 1998. Annals of Noninvasive Electrocardiology. 1998; V 13, part 2. 14. Leonhard K. _ Akzentuierte Personlichkeiten, Berlin, 1976. 15. Schmieschek H. _ Fragebogen zur Ermittlung akzentuierter Person-lichkeiten. Psychiat. Neurol. Med.

Psychol. 10 (1970), 378.

Ufsbqjb-!qvmnpopmphjb

adgilobrivi imunitetis roli eqsudaciuri plevritis paTogenezisas

l. otiaSvili

saqarTvelos saxelmwifo samedicino akademiis Terapia-pulmonologiis kaTedra

bolo wlebis samecniero miRwevad iTvleba im imunuri da autoimunuri fenomenis

paTogenezuri rolis dadgena, romelic ganapirobebs filtvebis anTebiTi da simsivnuri

daavadebis ganviTarebas. dadgenilia, rom simsivnis sawinaaRmdego imuniteti upirveles

yovlisa aris adgilobrivi imuniteti, risi mkafio gamoxatulebac aris simsivnuri

qsovilis infiltracia imunokompetenturi ujredebiT. igi cnobilia `limfo-plazmur-

ujreduli infiltraciis” saxelwodebiTY(3). sadReisod eWvs ar iwvevs is faqti, rom sasunTq sistemas aqvs organizebuli

avtonomiuri imunuri sistema, romelic zogadi imunitetis Semadgeneli nawilia, romlis

morfo-funqciuri substratia:

1. pariesuli plevris bazaluri membranis qveS ganlagebuli imunuri limfocitebi,

romlebic antigenuri gaRizianebis Sedegad penetrirebs bazalur membaranaSi,

transformirdeba plazmur ujredebad da producirebs IgG da upiratesad IgA –s (4); 2. plevruli siTxis alveoluri makrofagebi, romelTa garkveuli nawili warmoiqmneba

periferiuli mononuklearuli ujredebidan, zogierTi ki plevris mfaravi mezoTeluri

Sris ujredebisagan da aq transformirdeba e.w. `plevrul makrofagebad~.

3. plevris adgilobrivi imunitetis yvelaze specifikur maxasiaTebels warmoadgens IgA , romelic sinTezirdeba alveolur da lorwqveSa Sris limfocitebSi (7).

m. baroni viscerul plevras ganixilavda rogorc egreT wodebul “serozul –

hemolimfur barierul organos~, romlis funqciaa siTxis transudacia, xolo pariesul

plevras, rogorc `reducirebul serozul – limfur barierul~ organos, romlis

funqciaa plevruli siTxis rezorbcia. starlingis transkapilaruli kanonis Tanaxmad,

siTxis rezorbciis absoluturi gradienti metia pariesuli plevriT gamoyofili siTxis

absolutur gradientze, amitom normalur pirobebSi plevris siTxe moZraobs pariesuli

plevris kapilarebidan plevris Rrusken, Semdeg ki adsorbirdeba visceruli plevriT (1).

plevruli eqsudatis warmoqmnis yvelaze xSiri mizezia simsivnuri metastazebis

gavrceleba Suasayaris limfur kvanZebsa da plevraze.

autofsiuri masalebis gamokvlevis safuZvelze dadginda, rom simsivnuri plevritebis

74%-Si ziandeba Suasayaris limfuri kvanZebi da filtvis kari, xolo 29%-Si pariesuli

plevra.

simsivnuri eqsudatis warmoqmnaSi monawileobs ramdenime meqanizmi, rac ganpirobebulia

simsivnis rogorc pirdapiri, ise iribi moqmedebiT (1). es aris: filtvis arteriis

embolia, pnevmonia, limfur sadinarTa blokireba, hipoproteinemia da sxva (1). plevris

metastazireba iwvevs misi ganvladobis momatebas, ris Sedegadac plevris RruSi Sedis

ufro meti raodenobis cila, vidre gamodis. erTi mxriv, pariesul plevraSi

metastazirebam SeiZleba gamoiwvios limfuri stromis blokireba da cilis rezorbciis

Semcireba. pariesuli plevris limfuri sadinarebiT limfa miemarTeba Suasayaris limfur

kvanZebSi. meore mxriv, avTvisebiani procesis Suasayaris limfur kvanZebze gavrceleba

iwvevs plevris Rrudan limfuri gadinebis Semcirebas da siTxis dagrovebas plevris

RruSi.

plevruli eqsudatis warmoqmnas iwvevs simsivnis mier mTavari an wilovani bronqis

obstruqcia, rasac mosdevs dazianebis distalurad filtvis ateleqtazis ganviTareba,

romlis kompensacia xdeba meore filtvis moculobis zrdis an ipsilateraluri

hemoToraqsis moculobis SemcirebiT, rasac mosdevs plevris RruSi wnevis dacema da

siTxis dagroveba (1).

Meyer (1) ikvlevda ra bronqogenuri kiboTi daavadebul 29 avadmyofs, daadgina, rom am

SemTxvevaSi plevris simsivnuri metastazirebis mizezia ipsilateraluri plevris

midamoSi filtvis arteriis ganStoebebis embolia. 29-dan 26 SemTxvevaSi gamovlinda vis-

ceruli da pariesuli plevris erTdrouli dazianeba. dadginda, rom am dros Suasayris

limfuri kvanZebis metastazuri dazianeba (ris safuZvelzec gamoiTqva mosazreba, rom

plevriti, romelic axlavs gulmkerdis Rrus organoebis simsivnur daavadebebs) viTarde-

ba gulmkerdis limfuri sadinarebis simsivniT obstruqciis Sedegad.

visceruli da pariesuli plevra warmoadgens dacvis araimunur sistemas. filtvebis

anTebiTi Tu simsivnuri daavadebebis dros plevris antigenuri gaRizianeba iwvevs

avtonomiuri imunuri sistemis aqtivacias, rac gamoixateba plevris RruSi sxvadasxva

imunokompetenturi ujredis migraciasa da maT ricxobriv zrdaSi.

am mizniT, saintereso aRmoCnda plevris avtonomiuri imunuri Tvisebis maxasiaTebeli

imunologiuri kriteriumis gamovlena filtvebis simsivnuri daavadebebis dros.

Seswavlili da gamokvleuli iyo 35 avadmyofi. mkurnalobis dawyebidan 10 dRis ganmavlo-

baSi. sxva tradiciul gamokvlevebTan erTad, SeviswavleT periferiul sisxlsa da

plevrul siTxeSi imunoglobulinebis (G,A, M-is) koncentracia, B da T limfocitebis

saerTo raodenoba (B da CD3), maTi subpopulaciebi: supresorebi _ CD8, helperebi CD4 da

bunebrivi kilerebis (CD16) procentuli Semcveloba, agreTve, sisxlsa da punqtatSi - kombinaciebis gamoTvla.

limfocitebis populacias da subpopulaciebs vsazRvravdiT monoklonuri

antisxeulebis gamoyenebiT. gamokvlevis Sedegad miRebulia Semdegi monacemebi:

periferiuli sisxli:

IgG=9,43±0,92. IgM=0,95±0,16. IgA=1,6±0,13. CD3=25,79±1,78. CD4=17,79±1.31. CD8=7,56±0,53. B=6,67±0,41, CD16= 2,11±0,3 plevruli siTxe: IgG=8±0,94. IgM=0,64±0,14. IgA=1,43±0.24. CD3=30,78±1.48. CD4=20,67±1.23. CD8=9,56±0,51. B=5,56±0.24. CD16=0,67±0,29

rogorc miRebuli monacemebidan Cans, simsivnur-plevrul eqsudaciaSi (20%-Si) IgA_s

koncentracia metia sisxlSi IgA_s koncentraciaze. agreTve, plevruli siTxis zogierTi

imunuri ujredis raodenoba metia periferiul sisxlSi maT raodenobaze, anu Se-

fardebiTi koeficienti plevruli siTxe / sisxli >1-ze, rac miuTiTebs, rom CD3, CD4, CD8

ujredebis producireba SeiZleba xdebodes adgilze, rac plevris damcvelobiTi reaqciaa

simsivnuri antigenis mimarT.

amrigad, bolodroindeli literaturis monacemebiT, Cven mier pirvelad aris moZiebuli

da kompleqsurad ganxiluli plevris imunur-paTogenezuri meqanizmebi. aRniSnuli monace-

mebis, periferiuli sisxlisa da plevruli siTxis imunologiuri kriteriumis Sefar-

debiTi maCveneblebis detaluri analizis Sedegad pirvelad gamoiTqva mosazreba plevris

avtonomiuri imunuri sistemis Taobaze.

pnk| `bŠnmnlmni hllrmmni qhqŠel{ oph o`Šncemege }jqqrd`Šhbmncn okebphŠ` k. nŠh`xbhkh j=-åä!= 2å!=C,, , C3ëüì%…%ë%ã,, ã%“3ä=!“2"å……%L ìåä,ö,…“*%L =*=äåì,, c!3ƒ,,

`…2, ãå……%å "%ƒK3›äå…, å Cëå"!/ "/ƒ/"=å2 C%"/øå…, å C!%…, ö=åì%“2, Cëå"!/ C!, !=ƒë, ÷…/.

ƒ=K%ëå"=…, . ëåã*, ., ÷2% " “"%þ %÷å!åäü "ëå÷å2 %!ã=…, ƒ=ö, þ “, “2åì/ Cëå"!/ , !=ƒ", 2, å , ìì3……%-K, %ë%ã, ÷å“*, . !å=*ö, L, …åƒ=", “, ì% %2 “%“2% …, %K?åL , ìì3……%L “, “2åì/.

nK“ëåä%"=…% 35 K%ëü…/. .*““3ä=2, "…/ì Cëå"!, 2%ì %C3.%ëå"%L .2, %ë%ã, , . m=, K%ëåå ƒ=*%…%ìå!…/å , ƒìå…å…, "/ "ëå…/ C!, =…=ë, ƒå “%%2…%øå…, %K?åã% *%ë, ÷å“2"= qd3

ë, ì-%ö, 2%", qd4, qd8 " *!%", , C3…*2=2å C!, .*““3ä=2, "…%ì Cëå"!, 2å %C3.%ëå"%L .2, %ë%ã, , . b ÷=“-2…%“2, , qd3 Cëå"!=ëü…%L ›, ä*%“2, ofqd3/*!%", qd3 # %*=ƒ=ë%“ü !="…/ ì 1.19, qd4 of/qd4 *!%", # 1.20, qd8 of/qd8 *!%", # 1.26, “%äå!›=…, å qd3, qd4, qd8 C!, %C3.%ëå"%ì Cëå"!, 2å " Cëå"!=ëü…%L ›, ä*%“2, %*=ƒ=ë%“ü "/ øå " “!="…å…, , “ Cå!, -å!, ÷å“*%L *!%"üþ.

Š=*, ì %K!=ƒ%ì, ìå“2…= , ìì3……= “, “2åì= Cëå"!/ !å=ã, !3å2 …= %C3.%ëå"/ å =…2, ãå…/ C!%ä3ö, !%"=…, åì , ìì3…%*%ìCå2å…2…/ . *ëå2%*, ÷2% “ëåä3å2 !=“öå…, 2ü *=* ƒ=?, 2…3þ !å=*ö, þ %!ã=…, ƒì= " %2"å2 …= "%ƒäåL“2", å %C3.%ëå"/ . =…2, ãå…%", %2!=›=þ?åL , ìì3……3þ -3…*ö, þ Cëå"!/ .

THE ROLE OF AUTONOMIC IMMUNE SYSTEM IN THE PATHOGENESIS OF TUMORAL EXUDATIVE PLEURISY L. OTIASHVILI

Antigenic stimulation of pleura causes hyperpermeability of pleura in the presence of various diseases of the

lungs that in turn results in (leads to) organization of pleura system and development of immuno-biological reactions independent of the state of common immune system.

35 patients suffering from exudative pleurisy of tumoral etiology have been subjected to examination. The most natural changes were revealed on analysis of relation between common amounts of CD3

lymphocytes, CD4, CD8 in the blood and punctate on exudative pleurisy of tumoral etiology. Local immune system of pleura responds to tumoral antigens by producing immunocompetent cells that can

bee regarded as protective reaction of the organism in response to the action of tumoral antigens, reflecting immune function of the pleura.

literatura: khŠep`Šrp`: 1. k=,2 p.u. _ a%ëåƒ…, Cëå"!/ . 1986 ã. 2. c3“*= m.h., t=,2åëüKå!ã b.t. _ aë=…* &t, ƒ, %ë%ã, , C=2%ë%ã, Cëå"!/ [. 1978. 3. t%““,… `.“ . _ &t, ƒ, %ë%ã, ã=“2%ãåì=2, ÷å“*, . K=!üå!%"[. l.: 1977, “. 129-175. 4. jë, …, ÷å“*= ìåä, ö, …=. f. 1991, I, 71-74.

5. A Light and electron microscopy study. Ist T. Med. Sei. 1976, 12, p. 662-673. 6. Acta Cytology. 1994. 18, 20-22. 7. Allen I., Hogg N. _ Immunology. 1985.

ongdp`bkemhe ~ahk“pr! h“C%ë…, ë%“ü 75 ëå2 “% ä… !%›äå…, ä%*2%!= ìåä, ö, …“*, . …=3*, C!%-å““%!= j%!%2*%"= ̀ …=2%ë,

`ëå*“=…ä!%", ÷=, ", ä…%ã% äå 2åë “%"å2“*%L, !%““, L“*%L , ã!3ƒ, …“*%L ìåä, ö, …/ , "!=÷=, 3÷å…%ã% , Cåä=ã%ã=. që%›å… , "Cå÷=2ë, 2åëå… ›, ƒ…å……/ L C32ü þK, ë !=. r!%›å…åö ã. b%!%…å›=, "“2!å÷=å2 “"%L þK, ëåL " ŠK, ë, “, # " c!3ƒ, , , *%2%!%L %2ä=…= K%ëåå 2!å2, ›, ƒ…, .

`…=2%ë, L `ëå*“=…ä!%", ÷ !%ä, ë“ 11 “å…2 K! 1929 ã%ä= " “åìüå “ë3›=?åã%. o%“ëå %*%…÷=…, " 1954 ã%ä3 b%!%…å›“*%ã% ìåä, ö, …“*%ã% , …“2, 232= 3“Cåø…% !=K%2=å2 ƒ="åä3þ?, ì 3÷=“2*%"%L K%ëü…, ö/ , !=L%……/ ì ., !3!ã%ì, = ƒ=2åì , …=÷=ëü…, *%ì ., !3!ã, ÷å“*%ã% %2äåëå…, ìå›%Kë=“2…%L K%ëü…, ö/ " ã. b%!%…å›å, , ìå " =*2, "å %Cå!=ö, , …= K!þø…%L C%ë%“2, , "*ëþ÷= “Cëå….*2%ì, þ , !åƒå*ö, , ›åë3ä*=. h "“å .2% # ÷å!åƒ 2.5 ã%ä= C%“ëå %*%…÷=…, , …“2, 232=. 1958-1961 ã%ä/ # *ë, …, ÷å“*= %!ä, …=23!= " h…“2, 232å “å!äå÷…%-“%“3ä, “2%L ., !3!ã, , ̀ lm qqqp. 1964 ã%ä3 - "å“üì= 3“Cåø…= ƒ=?, 2= *=…ä, ä=2“*%L ä, ““å!2=ö, , %2 h…“2, 232= qå!äå÷…%-“%“3ä, “2%L ., !3!ã, , `lm qqqp , mhh *ë, …, ÷å“*%L , .*“Cå!, ìå…2=ëü…%L ., !3!ã, , lg pqtqp. n“%K3þ öå……%“2ü " !=K%2å C!åä“2="ë ë= %!, ã, …=ëü…= *ë=““, -, *=ö, “ "/ äåëå…, åì 2 2, C%" "2%!, ÷…%ã% , …-3…ä, K3ë !…%ã% “2å-…%ƒ= # -3…*ö, %…=ëü…%ã% , -, *“, !%"=……%ã%, *=* %“ë%›…å…, *ë=C=……%ã% “2å…%ƒ= ëåã%÷…%L =!2å!, , . jë=““, -, *=ö, C%ƒ"%ë ë= å?å ä% %Cå!=ö, , %C!åäåë 2ü %C2, ì=ëü…3þ ., !3!ã, ÷å“*3þ 2=*2, *3 äë %K ƒ=2åëü…%ã% 3“2!=…å…, -, *“, !%"=……%ã% “2å…%ƒ= , ë, %ã!=…, ÷å…, %KAåì= %Cå!=ö, , "=ëü"3ë%2%ì, åL C!, -3…*ö, %…=ëü…%ì “2å…%ƒå, ÷2% , ìåë% !åø=þ?åå ƒ…=÷å…, å C!, %Cå!=ö, . " 3“ë%", . ã, C%2å!ì, , . m= %“…%"=…, , ä=……/ . *=2å2å!, ƒ=ö, , “å!äö= , =…ã, %*=!ä, %ã%=-, , ̀ .̀ . j%!%2-*%"/ ì "Cå!"/ å K/ ë= ä%*=ƒ=…= …å.--å*2, "…%“2ü 2!=…“"å…2!, *3ë !…%L "=ëü"3ë%2%ì, , a!%*=. n C%ë…%öå……%“2, Cå!"%ã% .2=C= …=3÷…%-C!=*2, ÷å“*%L !=K%2/ þK, ë != ì%›…% “3ä, 2ü C% …å*%2%!/ ì -!=ãìå…2=ì .=!=*2å!, “2, *, , ä=……%L ̀ . ̀ . j%!%2*%"3 " 1966 ã%ä3 h…“2, 232%ì ., !3!ã, , lg pqtqp, !3*%"%ä, ì%ã% "/ ä=þ?, ì“ ., !3!ã%ì , 3÷å…/ ì “%"!åìå……%“2, , =*=äåì, *%ì a.b. oå2!%"“*, ì: &C!% "ë å2 , …, ö, =2, "3 , , ƒ%K!å2=2åëü…%“2ü. ) 3"“2"% …%"%ã% # …å%2Aåìëåì%å *=÷å“2"% `.̀ . j%-!%2*%"=. n… "ë=äåå2 C!=*2, ÷å“*, "“åì, “%"!åìå……/ ì, ìå2%ä=ì, !å…2ãå…%*%…2!=“2…%ã% , ““ëåä%"=…, “å!äö= , “%“3ä%". Š!3ä%ëþK, å , 2?=2åëü…%“2ü "/ C%ë…å…, …=3÷…/ . !=K%2, C%, “* " , ““ëåä%"=…, . # 2=*%" “2, ëü ̀ .̀ . j%!%2*%"=[. }2, *=÷å“2"% ̀ …=2%ë, L ̀ ëå*“=…ä!%", ÷ C!%…å“ ÷å!åƒ "“þ ›, ƒ…ü, 3ãë3K, " , %K%ã=2, " , . “ ã%ä=ì, . b 1970 ã., 3›å " ä%ë›…%“2, “2=!øåã% …=3÷…%ã% “%2!3ä…, *= h…“2, 232= *=!ä, %-ë%ã, , , ì. ̀ .k.l “…, *%"= ̀ lm qqqp ̀ .̀ . j%!%2*%" 3“Cåø…% ƒ=?, ?=å2 ä%*2%!“*3þ ä, ““å!2=ö, þ, " *%2%!%L K/ ë= "/ ä", …32= …%"= *%…öåCö, C=2%ãå…åƒ= ëåã%÷…%L ã, Cå!2å…ƒ, , “ C!åä“2="ëå…, åì %!, ã, …=ëü…%L “.åì/ äå-å*2%" ìå››åë3ä%÷*%"%L Cå!åã%!%ä*, (dlfo), ë%*=ë, ƒ%"=……/ . …= C32, C%2%*= *!%", , ƒ ëå"%ã% ›åë3ä%÷*= , ë, *=“=2åëü…% * C%2%*3. }2% C%ƒ"%ë, ë% C%-…%"%ì3 %öå…, 2ü ., !3!ã, ÷å“*3þ 2=*2, *3 "åäå…, K%ëü…/ . “ 3ã!%›=þ?, ì !=ƒ", 2, åì “, …ä!%ì= }Lƒå…ìå…ãå!= C!, K%ëüø%ì dlfo, !=“C%ë%›å……%ì *=“=2åëü…% * C%2%*3. `"2%! ä%*=ƒ=ë, ÷2% C!åä%2"!=?å…, å *%ìCëå*“= }Lƒå…ìå…ãå!= , “C=“å…, å C%ä%K…/ . C=ö, å…2%" "%ƒì%›…% ë, øü C!, C!%"åäå…, , %Cå!=ö, , Cë=“2, *, äå-å*2= ìå››åë3ä%÷*%"%L Cå!åã%!%ä*, " ã!3ä…%ì "%ƒ!=“2å ä% "%ƒ…, *…%"å…, "å…åƒ…%-=!2å!, =ëü…%ã% “K!%“=.

m= “ëåä3þ?åì .2=Cå …=3÷…/ . , ““ëåä%"=…, L, C!%"%ä, ì/ . `.̀ . j%!%2*%"/ ì “ 1974 ã%ä= " mhh .*“Cå!, ìå…2=ëü…%L , *ë, …, ÷å“*%L 2å!=C, , lg c!3ƒ, , " ã. ŠK, ë, “, " ä%ë›…%“2, !3*%"%ä, 2åë %2äåë= "…32!, “å!äå÷…/ . , -3…*ö, %…=ëü…/ . ìå2%ä%" , ““ëåä%"=…, L, , ƒ3÷=ë, “ü C=2%-, ƒ, %ë%ã, ÷å“*, å ìå.=…, ƒì/ %“2!%L *%!%…=!…%L …åä%“2=2%÷…%“2, . q3?å“2"å……/ ì ä%“2, ›å…, åì K/ ë , C%äK%! %C2, ì=ëü…%L ä%ƒ/ %*“, -åä!, …=, , “C%ëüƒ%"=…, å åã% *%ìK, …=ö, , “ C!%C!=…%ë%ë%ì C!, .!%…, ÷å“*%L , øåì, ÷å“*%L K%ëåƒ…, “å!äö=, ä%C=ì, …= " “%÷å2=…, , “ , …%ƒ, …%ì C!, *=!ä, %ãå……%ì ø%*å. n“%K/ L , …2å!å“ C!åä“2="ë ë, , ““ëåä%"=…, C!, "/ C%ë…å…, , *ë, …, ÷å“*%ã% -!=ãìå…2= 2åì=2, ÷å“*%ã% ƒ=ä=…, cjmŠ qqqp. &t3…*ö, %…=ëü…= =*2, "…%“2ü ä, =“2%ë/ , åå ƒ…=÷å…, å " %Kå“Cå÷å…, , 3ä%"ëå2"%!, 2åëü…%ã% …=C%ë…å…, “å!äö=, “å!äå÷…%ã% "/ K!%“= , “%*!=2, ì%“2, ì, %*=!ä=[, %2*!/ "=þ?, å “å!üåƒ…/ å Cå!“Cå*2, "/ " !=ƒ!=K%2*å %C2, ì=ëü…/ ., C=2%ãå…å2, ÷å“*, …=C!="ëå……/ . “C%“%K%" ëå÷å…, K%ëü…/ . haq “ “%C32“2"3þ?åL =!2å!, =ëü…%L ã, Cå!2å…ƒ, åL. b .2%L !=K%2å å?å " 1976 ã%ä3, C% “3?å“2"3, "Cå!"/ å “2=", ë“ "%C!%“ % ÷!åƒ"/ ÷=L…%L %C=“…%“2, ã, Cå!2!%-, , ì, %*=!ä= , …å%K.%ä, ì%“2, åå !åã!å““, , . }2, K%ëü…/ å “ …, ƒ*, ì ä, =“2%ë, ÷å“*, ì !=““ë=Këå…, åì , ìåë, ìå…üø, L “å!äå÷…/ L "/ K!%“, ÷åì C!, “å!äå÷…%L …åä%“2=2%÷…%“2, . nK 3!%"…å C!%"åäå……/ . , ““ëåä%"=…, L “", äå2åëü“2"3å2 , -=*2 C!, ãë=øå…, `.̀ .j%!%2*%"= b“å“%þƒ…/ ì *=!ä, %ë%ã, ÷å“*, ì …=3÷…/ ì öå…2!%ì `lm qqqp " *=÷å“2"å .*“Cå!2= " !=ƒ!=K%2*å …=ö, %…=ëü…%ã% C!%ã…%ƒ= !=ƒ", 2, *%ìCëå*“…%L C!%Këåì/ &qå!äå÷…%-“%“3ä, “2/ å ƒ=K%ëå"=…, ä% 2000 ã%ä=[. m=*%…åö, …= %!, ã, …=ëü…%L ì%äåë, !åCå!-3ƒ, , %“2!%L , øåì, , ì, %*=!ä= C!åä"=!, 2åëü…/ ì !=……, ì ""åäå…, åì , …ã, K, 2%!=

*, …, …%"%L “, “2åì/ *%…2!, *=ë= , ãåC=!, …= `.̀ . j%!%2*%"/ ì “ “%2!3ä…, *=ì 3ä=ë%“ü ä%*=ƒ=2ü "%ƒì%›…%“2ü ì=*“, ì=ëü…%ã% “%.!=…å…, “2!3*23!/ , -3…*ö, , %“2!%, øåì, ƒ, !%"=……%ã% ì, %*=!ä= , 3ë3÷øå…, !å2!%ã!=ä…%ã% *!%"%“…=K›å…, , …-=!*2…%L ƒ%…/ . o%“ëåä3þ?, å *ë, …, ÷å“*, å , ““ëåä%"=-…, “% “!="…, 2åëü…%L %öå…*%L , ƒ%ë, !%"=……%ã% 2!%ìK%ë, ƒ, “= , 2å!=C, , …= -%…å *%…2!=*=ë= , ãåC=!, …= "/ ", ë, %÷å", ä…/ å C!å, ì3?å“2"= C%“ëåä…åL. }--å*2, "…%“2ü ìå2%ä= C%ä2"å!›äå…= " "åä3?, . *ë, …, *=. ŠK, ë, “, , l%“*"/ , Š=ëë, ……= , h!*32“*= , C!, … 2= c%“*%ì, 2å2%ì qqqp C% äåë=ì , ƒ%K!å2å…, L , %2*!/ 2, L “ "/ ä=÷åL ="2%!“*, . “", äå2åëü“2" C% C%"%ä3 2!%ìK%ë, 2, ÷å“*%L 2å!=C, , (`.̀ .j%!%2*%" “ “%="2., 1983; 1985) , ., !3!ã, ÷å“*%L !å"=“*3ë !, ƒ=ö, , %“2!%ã% , …-=!*2= ì, %*=!ä= (m.m.j, Cø, äƒå, `.̀ j%!%2*%" “ “%="2., 1985). `.̀ .j%!%2*%" "ë å2“ ="2%!%ì , “%="2%!%ì 5 , ƒ%K!å2å…, L, “!åä, *%2%!/ . C%“ëåä…åå, *=“=þ?åå“ ëå÷å…, %“2!%L , øåì, , ì, %*=!ä= “ , “C%ëü-ƒ%"=…, åì =…2, %*“, ä=…2%", ƒ=C=2å…2%"=…= " c!3ƒ, , " 2004 ã%ä3. oå!3 3÷å…%ã% C!, …=äëå›, 2 130 C3Kë, *=ö, L " "åä3?, . %2å÷å“2"å……/ . , ƒ=!3Kå›…/ . , ƒä=…, .. o%ä åã% !3*%"%ä“2"%ì "/ C%ë…å…% 7 *=…ä, ä=2“*, . ä, ““å!2=ö, L. h…2å!å“…/ å …=3÷…/ å , ““ëåä%"=…, , , ìåþ?, å K%ëüø%å C!=*2, ÷å“*%å ƒ…=÷å…, å, %C3Kë, *%"=…/ " ì=2å!, =ë=. b“åì, !…/ . , e"!%CåL“*, . *%…ã!å““%", “%“2% "ø, .“ " l%“*"å (1982), k, %…å (2000), të%!å…ö, , (2003) , c!å…=ä= (2004).

a3ä3÷, …= ƒ=“ë3›å……%ì %2ä/ .å, ̀ .̀ . j%!%2*%" , “åã%ä… C!%ä%ë›=å2 ƒ=…, ì=2ü“ =*2, "…%L …=3÷…%L äå 2åëü…%“2üþ, “%2!3ä…, ÷= “ mhh 2å!=C, , lg c!3ƒ, , , *=-åä!=ì, 2å!=C, , ŠK, ë, ““*%ã% ã%“3ä=!-“2"å……%ã% ìåä, ö, …“*%ã% 3…, "å!“, 2å2=.

d%! %ã%L ̀ …=2%ë, L ̀ ëå*“=…ä! %", ÷! qå! äå÷…% C%ƒä! ="ë åì b=“ “ þK, ëååì, …%"/ . 3“Cå.%", *! åC*%ã% ƒä%! %"ü , ä%“2%L…%ã% b=“ ä%ëã%ëå2, .

lå!=K j", 2=ø", ë, , d,!å*2%! …=ö,%…=ëü…%ã% öå…2!= 2å!=C,,, *=…ä. ìåä. …=3*; b=.2=…ã )3ìK3!, äƒå, g=". ä,!å*2%!= …=3÷…%L ÷=“2, öå…2!=, C!%-å““%!; `ëå*“=…ä! j, “2=3!, , g=". *=-åä!%L ã%“C,2=ëü…%L 2å!=C,,, ŠK,ë,““*%ã% ã%“3ä=!“2"å……%ã% ìåä,÷,…“*%ã% 3…,"å!“,2å2=, C!%-å““%!

j`pdhnknch“

gm`)emhe opedb`phŠek|mncn hqonk|gnb`mh“ hmchahŠnpnb jhmhmnbni qhqŠel{ b qnbepxemqŠbnb`mhh qonqnanb bnqqŠ`mnbkemh“ jpnbnqmàfemh“ nqŠpnhxelhghpnb`mmncn lhnj`pd` opnt. ̀ .̀ .jnpnŠjnb mhh 2å!=C,,, ŠK,ë,““*,L ã%“3ä=!“2"å……/L ìåä,ö,…“*,L 3…,"å!“,2å2

bå…ö%ì ."%ëþö, , “C%“%K%" ëå÷å…, %“2! %, øåì, ƒ, ! %"=……%ã% ì, %*=! ä= (nhl) “ Cå! å.%ä%ì %2 “, ìC2%ì=2, ÷å“*%L ä% C=2%ãå…å2, ÷å“*, %K%“…%"=……%L 2å! =C, , "ë å2“ 2! %ìK%ë, 2, ÷å“*= 2å! =C, (ŠkŠ). n…= C% ä%“2%, …“2"3 ƒ=…, ì=å2 "åä3?, å C%ƒ, ö, , , .%2 , …å ë, øå…= …å*%2%! / . …åä%“2=2*%" , …3›ä=å2“ " 3“%"å! øå…“2"%"=…, , . q%"å! øå…“2"%"=…, å .2%ã% “C%“%K= ëå÷å…, øë% C% C32, “%ƒä=…, C! åC=! =2%", %2ë, ÷=þ?, .“ ì%?…/ ì -, K! , …%ë, 2, ÷å“*, ì .--å*2%ì (“2! åC2%*, …=ƒ=), “%ƒä=…, åì 2! %ìK%ë, 2, *%", %Kë=ä=þ?, . C! %ë%…ã, ! %"=……/ ì -, K! , …%ë, 2, ÷å“*, ì äåL“2", åì, “! %ä“2"%ì * -, K! , …3, …% ë, øü 3ìå! å……%L -, K! , …%ë, 2, ÷å“*%L =*2, "…%“2üþ (“2! åC2%äå*=ƒ=) , , …=*%…åö, “, …2åƒ, -! %"=…, åì 2*=…å"/ . =*2, "=2%! %" Cë=ƒì, …%ãå…= (Šò), %Kå“Cå÷, "=þ?, ., Kë=ã%ä=! -, K! , …%“Cåö, -, ÷…%“2, , %2“32“2", "ë, …, …= “, “2åì…/ L -, K! , …%ãå…%ë, ƒ, …=, K%ëåå .--å*2, "…%å ! =“2"%! å…, å 2! %ìK= , " ƒ…=÷, 2åëü…%L ìå! å C! åä%2"! =?å…, å -, K! , …%ë, 2, ÷å“*, . *! %"%2å÷å…, L. cåì%! ! =ã, ÷å“*, å %“ë%›…å…, , "ë þ?, å“ “å! üåƒ…%L C! %Këåì%L Šò, %K?å, ƒ"å“2…/ , , . ÷=“2%2= “%“2="ë å2 " “! åä…åì 0,7%, , ƒ *%2%! / . 0,4% C! , .%ä 2“ …= ãåì%! ! =ã, ÷å“*, å , …“3ëü2/ . dë %ã! =…, ÷å…, ! %“2= 2! %ìK= , “%ƒä=…, =2! %ìK%ãå……%L C%"å! .…%“2, C%“ëå ! =“2"%! å…, åã% %ä…%"! åìå……% “ 2! %ìK%ë, 2, *=ì, …=÷=ë, C! , ìå… 2ü =…2, 2! %ìK%ö, 2=! …/ å C! åC=! =2/ , , …ã, K, 2%! / 2! %ìK, …=.

nC/ 2 *ë, …, ÷å“*%ã% C! , ìå…å…, 2! %ìK%ë, 2, ÷å“*, . C! åC=! =2%" …%"/ . C%*%ëå…, L (=ëü2åCë=ƒ= /=*2, ë, ƒå/, ! å2, Cë=ƒ=, 2å…å*2åCë=ƒ= , ä! .) C%ƒ"%ë, ë, “ K%ëüø, ì .--å*2%ì , ìå…üø, ì, 2! %ìK%ë, 2, -÷å“*, ì, %“ë%›…å…, ì, "%““2=…="ë, "=2ü *! %"%“…=K›å…, å ƒ%…/ , øåì, ÷å“*%ã% C%"! å›äå…, . nä…=*% “%"å! øå…“2"%"=…, å “C%“%K%" ëå÷å…, , …-=! *2= ì, %*=! ä= (hl), C%-“3?å“2"3, …å *%“…3ë%“ü C! %Këåì/ K%! üK/ “ …å ìå…åå ã! %ƒ…/ ì, %“ë%›…å…, ì, # 2=*, ì, , *=* ! åCå! -3ƒ, %……/ å "…32! , ì, %*=! ä, =ëü…/ å ãåì%! ! =ã, , (pobc) , …å! åä*% -=2=ëü…/ å …=! 3øå…, ! , 2ì= “å! äå÷…/ . “%*! =?å…, L, % *%2%! / . …å%ä…%*! =2…% “%%K?=ë%“ü ! =…åå (3, 18, 24).

q%ƒä=…, þ =ëü2å! …=2, "…%ã% “C%“%K= ŠkŠ , ., ! 3! ã, ÷å“*%L ! å"=“*3ë ! , ƒ=ö, , nhl “C%“%K“2"%"=ë 3“Cåø…% C! %"åäå……/ L , …-%! ì=ö, %……/ L C%, “*, C%ƒ"%ë, "ø, L "/ ", 2ü …åã=2, "…%å "%ƒäåL“2", å C=-2%ë%ã, ÷å“*%L =*2, "=ö, , *=ëë, *! å, …-*, …, …%"%L “, “2åì/ (jjq) …= nhl, C! % "ë þ?åå“ " ", äå 3"åë, ÷å…, C! %…, ö=åì%“2, “%“3ä, “2%L “2å…*, , %2å*= ì, %*=! ä, =ëü…%L “2! %ì/ , = 2=*›å C%ë%›, 2åëü…%å "ë, …, å , …ã, K, 2%! %" C! %2å=ƒ …= 3ìå…üøå…, å K%ëå"%ã% “, …ä! %ì= , C! % "ëå…, L *=! ä, %ãå……%ã% ø%*= /25,26,27,31,35/. o%ë3÷å……= , …-%! ì=ö, ëåãë= " %“…%"3 .*“Cå! , ìå…2=ëü…/ . , ““ëåä%"=…, L …= ì%äåë, ., ! 3! ã, ÷å“*%L ! å"=“*3ë ! , ƒ=ö, , , øåì, ƒ, ! %"=……%ã% ì, %*=! ä= C! , 2-4 ÷=“%"%L %**ëþƒ, , *%! %…=! …%L =! 2å! , , , …= -%…å C! åä"=! , 2åëü…%L (…= 30 ì, …32å) , …-3ƒ, , *%…2! , *=ë= 10 2/ “. `2! eä. , ãåC=! , …= 10 2/ “. eä. (6,7). b *%…2! %ëü…%L ã! 3CCå ›, "%2…/ . C! , ! åCå! -3ƒ, , %2ìå÷=ë%“ü “…, ›å…, å “%*! =2, 2åëü…%L , ãåì%ä, …=ì, ÷å“*%L -3…*ö, “å! äö=. b%““2=…%"ëå…, å *! %"%2%*= " 3“ë%", . C! åä"=! , 2åëü…%ã% ""åäå…, *%…2! , *=ë= , ãåC=! , …= (jc) “%C! %"%›ä=ë%“ü 3"åë, ÷å…, åì “å! äå÷…%ã% "/ K! %“= , “%*! =2, ì%“2, ì, %*=! ä=. o! , ã, “2%ì%! -%ë%ã, ÷å“*%ì , ““ëåä%"=…, , " ! åCå! -3ƒ, ! 3åì%L ƒ%…å " *%…2! %ëü…%L ã! 3CCå ›, "%2…/ . %K…=! 3›å…/ …=K3.=…, å , ! =ƒ%K?å…, å ì, %*=! ä, =ëü…/ . "%ë%*%… “ C% "ëå…, åì .*“2! ="=ƒ=2%", “ëåä/ ãë, *%ãå…=; …= -%…å jc # %2“32“2", å "/ .%›äå…, -%! ìå……/ . .ëåìå…2%" *! %", " ì, %*=! ä “ …åƒ…=÷, 2åëü…/ ì %2å*%ì 2*=…, , 3"åë, ÷å…, åì “%äå! ›=…, ãë, *%ãå…=, ìå…åå "/ ! =›å……/ å (C% “! ="…å…, þ “ *%…2! %ëü…%L ã! 3CC%L) .ëå*2! %……%ì, *! %“*%C, ÷å“*, å , ƒìå…å…, ì, %*=! ä, %ö, 2%", ì, 2%.%…ä! , L , “=! *%Cë=ƒì=2, ÷å“*%ã% ! å2, *3ë3ì=. m=*%…åö, 3ìå…üøå…, å , øåì, , …= }jc ,

.ëå*2! %ã! =ììå “", äå2åëü“2"%"=ë% % C! åä%2"! =?å…, , ! åCå! -3ƒ, %……%ã% ãåì%! ! =ã, ÷å“*%ã% , …-=! *2= ì, %*=! ä=. o! %"åäå……/ å .*“Cå! , ìå…2/ “ , “C%ëüƒ%"=…, åì C! ì/ . “%"! åìå……/ . ìå2%ä%" %öå…*, “%*! =2, 2åëü…%L , ãåì%ä, …=ì, ÷å“*%L -3…*ö, , “å! äö=, ä=……/ å ã, “2%ì%! -%ë%ã, ÷å“*%ã% , .ëå*2! %……%-ì, *! %“*%C, ÷å“*%ã% , ““ëåä%"=…, L, “", äå2åëü“2"3þ?, å % "/ “%*%L .--å*2, "…%“2, , …ã, K, 2%! %" jjq " *=÷å“2"å *=! ä, %C! %2å*2%! %", C%ƒ"%ë, ë, 3“Cåø…% C! , ìå…, 2ü , . " *ë, …, ÷å“*%L C! =*2, *å 3 K%ëü…/ . hl C! , ŠkŠ , ., ! 3! ã, ÷å“*%L ! å"=“*3ë ! , ƒ=ö, , . o! åäë%›å……/ å “C%“%K/ ëå÷å…, K/ ë, =C! %-K, ! %"=…/ " ! äå "åä3?, . *ë, …, * ŠK, ë, “, , l%“*"/ , Š=ëë, ……= , h! *32“*= , ƒ=?, ?å…/ *=* , ƒ%K! å2å…, “ "/ ä=÷åL ="2%! “*, . “", äå2åëü“2" c%“*%ì, 2å2%ì qqqp C% äåë=ì , ƒ%K! å2å…, L , %2*! / 2, L (4,7,8). o! , %C! åäåëå…, , %C2, ì=ëü…/ . “! %*%" , …-3ƒ, , jc ì/ , “.%ä, ë, , ƒ 2%ã%, ÷2% "“å “! åä“2"= ƒ=?, 2/ ì, %*=! ä= %2 , øåì, , %ä, …=*%"% .--å*2, "…/ " Cå! "/ å 2 ÷=“= %2 …=÷=ë= %“2! %ã% =…ã, …%ƒ…%ã% C! , “23C= (nò), *%ãä= å?å “%.! =… å2“ *! %"%“…=K›å…, å , …-=! *2…%L ƒ%…/ , C%“23Cëå…, å " …åå ""%ä, ì/ . C! åC=! =2%". b .2%L “" ƒ, å?å " 1982 ã%ä3 C! , *=ƒ%ì C% l, …, “2å! “2"3 ƒä! ="%%.! =…å…, c ! 3ƒ, , ƒ= 1 362 %2 7 , þë mhh 2å! =C, , K/ ë% C%! 3÷å…% %Kå“Cå÷å…, å "…åä! å…, …= ä%ã%“C, 2=ëü…%ì .2=Cå (dc}) “C%“%K= ëå÷å…, , …-=! *2= ì, %*=! ä= “ , “C%ëüƒ%"=…, åì , …ã, K, 2%! %" jjq. o%“2="ëå……= ƒ=ä=÷= K/ ë= 3“Cåø…% "/ C%ë…å…= …=ì, …= K=ƒå ŠK, ë, ““*%L ã%! %ä“*%L “2=…ö, , “*%! %L ìåä, ö, …“*%L C%ì%?, 5-þ *=! ä, %ë%ã, ÷å“*, ì, K! , ã=ä=ì, . Š=*, 3 156 K%ëü…/ . nhl ""åäå…, åì jc …= dc} …å C%ƒä…åå 2-2,5 ÷=“%" %2 …=÷=ë= nò ä%“2, ã=ë%“ü %2÷å2ë, "%å 3ë3÷øå…, å *ë, …, ÷å“*%ã% 2å÷å…, ƒ=K%ëå"=…, , 3ìå…üøå…, å , øåì, , , %K3“ë%"ëå……/ å 3"åë, ÷å…, åì ! å2! %ã! =ä-…%ã% *! %"%“…=K›å…, , …-=! *2…%L ƒ%…/ (9,11). a%ëåå 2%ã%. " 33% “ë3÷=å" %2ìå÷å…% , “÷åƒ…%"å…, å ƒ3Kö= Q , …, " %ä…%ì “ë3÷=å …å ƒ=! åã, “2! , ! %"=…% C% "ëå…, å *%ìCëå*“= QS. r"åë, ÷å…, å “%äå! ›=…, " *! %", lc ä%“2, ã=ë% C, *= 3›å ÷å! åƒ 2-3 ÷=“=, = lbjtj # ÷å! åƒ 6 ÷=“%" C%“ëå ! =……åL , …-3ƒ, , jc , ÷2% " 3“ë%", . "…%ã% 3ë3÷øå…, C! å*=! ä, =ëü…%L *=! 2%ã! =ìì/ 3*=ƒ/ "=ë% …= ì=*“, ì=ëü…%å “%.! =…å…, å , 3"åë, ÷å…, å " .2, “! %*, *! %"%“…=K›å…, , øåì, ƒ, ! %"=……%ã% ì, %*=! ä=. b K%ëåå C%ƒä…, å “! %*, .--å*2, "…%“2ü jc , = 2=*›å 2! =ä, ö, %……%L 2å! =C, , 3 K%ëü…/ . *%…2! %ëü…%L ã! 3CC/ “…, ›=ë%“ü " “" ƒ, “ …=“23C, "ø, ì, C%"! å›äå…, ì, " “, “2åìå ì, *! %ö, ! *3ë ö, , , ! =ƒ", 2, åì …å*! %2, ÷å“*, . C! %öå““%" " ƒ%…å , øåì, , . }--å*2, "…%å , “C%ëüƒ%"=…, å , …ã, K, 2%! %" jjq C! , ëå÷å…, , K%ëü…/ . , …-=! *2%ì ì, %*=! ä=, %“%Kå……% " ! =……, å “! %*, %“2! %ã% ƒ=K%ëå"=…, , K/ ë% ƒ=! åã, “2! , ! %"=…% , ä! 3-ã, ì, ="2%! =ì, (4,10, 12,13). på=ë, ƒ=ö, C! %ã! =ìì/ “%.! =…å…, -3…*ö, %…=ëü…%L C! %.%ä, ì%“2, “%“3ä, “2%ã% ! 3“ë=, “2! 3*23! / , -3…*ö, , nhl ""åäå…, åì , …ã, K, 2%! %" jjq “2=…%", 2“ %“%Kå……% =*-23=ëü…%L " …=“2% ?åå "! åì " “" ƒ, “ ø, ! %*, ì "…åä! å…, åì " *ë, …, ÷å“*3þ C! =*2, *3 ŠkŠ, “ C! %"å-äå…, åì %Cå! =ö, L =%! 2%*%! %…=! …%ã% ø3…2, ! %"=…, , …å%K.%ä, ì%“2üþ ì, …, ì, ƒ=ö, , ! åCå! -3ƒ, %……/ . C%"! å›äå…, L. 104 K%ëü…/ ì %“2! / ì *! 3C…%-%÷=ã%"/ ì , …-=! *2%ì ì, %*=! ä= C! %"%ä, ë, “ü ŠkŠ “2! åC-2=ƒ%L (1000000 le) " 3“ë%", . C! åä"=! , 2åëü…%L " Cå! "/ å 2 ÷=“= %“2! %L , øåì, , , …-3ƒ, , *%…2! , *=ë= (50 2/ “. `2! eä) , ãåC=! , …= (10 2/ “. eä) (1 ã! 3CC=), ! =……, L (" Cå! "/ å 2-2.5 ÷=“=) , ƒ%ë, ! %"=……/ L 2! %ìK%ë, ƒ, “ (Š) (2 ã! 3CC=) , C%ƒä…, L Š (3-6 ÷=“%") %2 …=÷=ë= nò (3 ã! 3CC=) (11). q! ="…, 2åëü…%L %öå…*%L .--å*2, "…%“2, ŠkŠ 3 K%ëü…/ . 1 , 2 ã! 3CC …=ì " %C! åäåëå……%L ìå! å 3ä=ë%“ü 3“2=…%", 2ü , “2, ……/ å C! , ÷, …/ pobc. Š=* %C2, ì=ëü…= *ë, …, ÷å“*= *=! 2, …= 3 K%ëü…/ . “ C! åä"=! , 2åëü…%L , …--3ƒ, åL jc K/ ë= %K3“ë%"ëå…= ì%?…/ ì =…2, =…ã, …=ëü…/ ì , =…2, =! , 2ì, ÷å“*, ì .--å*2=ì, "“ëåä“2", å C%ä="ëå…, C=2%ë%ã, ÷å“*%L =*2, "=ö, , jjq , “"å! 2/ "=þ?åL “, “2åì/ *! %", , 3ë3÷øå…, åì ! å2! %ã! =ä-…%ã% , "%““2=…%"ëå…, åì =…2åã! =ä…%ã% *! %"%2%*%" (21,23). o! , ! =……åì , ƒ%ë, ! %"=……%ì Š %2ìå÷å…= ìå…åå Kë=ã%C! , 2…= *ë, …, ÷å“*= *=! 2, …= “ C% "ëå…, åì …%"/ . .*“2! =“, “2%ë " ì%ìå…2 ! åCå! -3ƒ, , . }2% “", äå2åëü“2"3å2 % "%““2=…%"ëå…, , *! %"%2%*= " %**ëþƒ, ! %"=……%L *%! %…=! …%L =! 2å! , , , "/ .%›äå…, , Cë=ƒì/ , -%! ìå……/ . .ëåìå…2%" *! %", " ì, %*=! ä, %2å*å “2! %ì/ , C%"! å›äå…, , *=! ä, %ì, %ö, 2%" (22). n“%K%ã% "…, ì=…, ƒ=“ë3›, "=å2 “! ="…, 2åëü…= %öå…*= ä, …=ì, *, ƒ3Kö= Q C! , Š …= -%…å jc (1 %“…%"…= ã! 3CC=) , , ƒ%ë, ! %"=……%ì Š (2 ã! 3CC=). b 1 ã! 3CCå ƒ=! åã, “2! , ! %"=…% %2…%-“, 2åëü…% …åK%ëüø%å (" “! åä…åì 11,5%) 3ãë3Këå…, å ƒ3Kö= Q * 6 ÷=“=ì %2 …=÷=ë= ëå÷å…, “ C%“ëåä3þ?åL C%ƒ, 2, "…%L ä, …=ì, *%L, ÷2% %K3“ë%"ëå…% ì, …, ì=ëü…/ ì, ì, *! %ö, ! *3ë 2%! …/ ì, …=! 3øå…, ì, . bìå“2å “ 2åì, C! , ! =……åì , ƒ%ë, ! %"=……%ì Š ƒ3Kåö Q 3"åë, ÷, "=ë“ …= 30% * 6 ÷=“=ì , å?å " K%ëüøåL “2åCå…, * 7 “32*=ì, ÷2% “", äå2åëü“2"%"=ë% % C! %ã! å““, ! %"=…, , …å*! %2, ÷å“*, . C! %öå““%" " ì, %*=! äå. e?å K%ëåå "/ ! =›å……/ å C! %öå““/ , …-=! ö, ! %"=…, ì, %*=! ä= C! , C%ƒä…åì Š , " *%…2! %ëü…%L (4 ã! 3CC=) 3*=ƒ/ "=ë, “*%! åå …= …åöåëå“%%K! =ƒ…%“2ü C%ƒä…åã% Š. d%"%ëü…% K/ “2! %å C! , Kë, ›å…, å ST “åãìå…2= * , ƒ%ë, …, , " Cå! "/ . 3 ã! 3CC=. “", äå2åëü“2"%"=ë% % ì=ë%L åã% , …-%! ì=2, "…%“2, " %öå…*å 2 ›å“2, C%! =›å…, , 2=* *=* "% 2 , 3 ã! 3CC=. C%“ëå ŠkŠ …=Këþä=ë%“ü ƒ…=÷, 2åëü…%å 3"åë, ÷å…, å ƒ3Kö= Q. b%““2=…%"ëå…, å C! %.%ä, ì%“2, %**ëþƒ, ! %"=……%L *%! %…=! …%L =! 2å-! , , å?å …å "ë å2“ %2! =›å…, åì 3“Cåø…%ã% Š “ *%! ! å*ö, åL ì, *! %ö, ! *3ë 2%! …/ . …=! 3øå…, L. nK .2%ì ì%›…% “3ä, 2ü C% ä=……/ ì `.o.c%ë, *%"= “ “%="2. (1986). Š=*, C! , .--å*2, "…%ì "…32! , *%-! %…=! …%ì Š ì=““= …å*! %ƒ= 3"åë, ÷, "=ë=“ü " 1,8 ! =ƒ=, …å.--å*2, "…%ì - " 1,2 ! =ƒ= , C! , 2! =ä, ö, %……%L 2å! =C, , # " 1,4 ! =ƒ=. o! , ÷åì, ŠkŠ C! %"%ä, ë%“ü " “! åä…åì ÷å! åƒ 6,5 ÷=“%" # %2 …=÷=ë= nò. b “2! åì-ëå…, , ì=*“, ì=ëü…% , ƒKå›=2ü ! åCå! -3ƒ, %……/ . %“ë%›…å…, L , “%*! =?å…, “! %*%" …=÷=ë=

! å"=“*3ë ! , ƒ=ö, , K/ ë, C! åäC! , … 2/ C%C/ 2*, C! %"%ä, 2ü ŠkŠ …= ä%ã%“C, 2=ëü…%ì .2=Cå (dc}) (14,15,19,20,28). h .%2 C! , .2%ì " *=*%L-2% ìå! å K/ ë, C%ë3÷å…/ K%ëåå Kë=ã%C! , 2…/ å ! åƒ3ëü2=2/ , ä%“2%"å! …%ã% ! =ƒë, ÷, C% ÷=“2%2å , .=! =*2å! 3 …=! 3øå…, L ! , 2ì= “å! äå÷…/ . “%*! =?å…, L C! , ŠkŠ …= dc} , " “2=ö, %…=! å ä%“2, ã…32% …å K/ ë% (15). m=“ , …2å! å“%"=ë= …å “2%ëü*% ÷=“2%2= ! åCå! -3ƒ, %……/ . …=! 3øå…, L ! , 2ì=, 3“Cåø…% 3“2! =… åì/ . äå-, K! , ëë ö, åL, “*%ëü*% “! %*, , C! , ÷, …/ , . "%ƒ…, *…%"å…, . Š=*, W.Merx “ “%="2. (ö, 2. C% e .h.) =ƒ%"3 , l.“.p3ä=, 1987) %2ìå÷=þ2, ÷2% &÷åì ! =…üøå …=“23C=å2 ! åCå! -3ƒ, , 2åì "/ øå "å! % 2…%“2ü ! =ƒ", 2, ! åCå! -3ƒ, %……/ . =! , 2ì, L[. }2% %2*! %"å……%å C! , ƒ…=…, å ë, øü C%ä2"å! ›ä=å2 …=ø3 2%÷*3 ƒ! å…, % 2%ì, ÷2% “2! åìëå…, å C! %"å“2, …=, K%ëåå ! =……, L Š ä=›å …= ä%ã%“C, 2=ëü…%ì .2=Cå …å , ƒK="ë å2 %2 ! åCå! -3ƒ, %……/ . =! , 2ì, L “ “%C32“2"3þ?, ì 3"åë, ÷å…, åì , …-=! ö, ! %"=…, ì, %*=! ä=. }2, pobc å“2ü “ëåä“2", å …=ã…å2=…, *! %", C%ä ä="ëå…, åì " ì, %*=! ä, =ëü…3þ “2! %ì3 " 3“ë%", . "%ƒ! =“2=þ?åL C=2%ë%ã, ÷å“*%L =*2, "=ö, , jjq , 3"åë, ÷å…, C! %…, ö=åì%“2, “%“3ä, “2%L “2å…*, C%ä "ë, …, åì "/ “%*%L -, K! , …%ë, 2, ÷å“*%L =*2, "…%“2, "% "! åì ŠkŠ. m=*%…åö, " 3“ë%", . %**ëþƒ, , *%! %…=! …%L =! 2å! , , “ìå?å…, åì =2å! %“-*ëå! %2, ÷å“*%L Kë ø*, C! , …å3ä=÷…%L "…32! , *%! %…=! …%L =…ã, %Cë=“2, *å ìå2%ä%ì "/ K%! = %C 2ü-2=*, K/ ë= , …-3ƒ, jc , C%ƒ"%ë, "ø= C! %-å““%! 3 q. p=K%2…, *%"3 "/ , ã! =2ü "! åì , 3ìå…üø, 2ü , øåì, þ , C! %"å“2, %Cå! =ö, þ ̀ jx (10).

n÷å", ä…%å ! =ƒë, ÷, å " ä, …=ì, *å ƒ3Kö= Q " 1 , 2 ã! 3CC=. " ƒ…=÷, 2åëü…%L ìå! å K%ëåå Kë=ã%C! , 2…%å äë Š …= -%…å jc ì/ “%÷ë, "%ƒì%›…/ ì %KA “…, 2ü ! åƒ3ëü2=2=ì, …=Këþäå…, L c.b.̀ …ä! åå…*% (1976), “%ãë=“…% *%2%! / ì 3"åë, ÷å…, å -, K! , …%ë, 2, ÷å“*%L =*2, "…%“2, C! , Š “%C! %"%›ä=å2“ ä=ëü…åLø, ì "%ƒ! =“2=…, åì C=2%ë%ã, ÷å“*%L =*2, "=ö, , *, …, …%"%L “, “2åì/ , =, “ëåä%"=2åëü…%, , 3"åë, ÷å…, åì C! %-…, ö=åì%“2, “%“3ä, “2%L “2å…*, , pobc. p=……åå C! %"åäå…, å Š , ë, ƒ, ! %"=…, å 2! %ìK= " , …-=! *2-“" ƒ=……%L *%! %…=! …%L =! 2å! , , %K3“ë="ë, "=å2 …=ã…å2=…, å *! %", C%ä ä="ëå…, åì " ì, %*=! ä, =ëü…3þ “2! %ì3 , ! =ƒ", 2, å pobc C! , %2“32“2", , , …ã, K, 2%! %" jjq , , . C%ƒ, 2, "…%ã% "ë, …, . nä…=*% .2, ì ä%“2%, …“2"= ! =……åã% , “C%ëüƒ%"=…, jc …å , “÷å! C/ "=þ2“ . o! , ìå…å…, å , …ã, K, 2%! %" jjq C! , "…32! , K%ëü…, ÷…%ì hl C%ƒ"%ë å2 ä%“2, ÷ü ë3÷ø, . ! åƒ3ëü2=2%" “ C%“ëåä3þ?, ì, " ƒ=", “, ì%“2, %2 C%*=ƒ=…, L, "/ K%! %ì %C2, ì=ëü…%ã% “C%“%K= ìåä, *=ìå…2%ƒ…%ã% , ë, ., ! 3! ã, ÷å“*%ã% ëå÷å…, . o! , ! åö, ä, "å , …-=! *2= ì, %*=! ä= …å2 ä! 3ã%L =ëü2å! …=2, "/ ÷åì , “C%ëüƒ%"=…, å , …ã, K, 2%! %" jjq. ŠkŠ " .2, . 3“ë%", ., ë, ƒ, ! 3 2! %ìK/ %2 C! åäøå“2"3þ?åã% , …-=! *2=, 2%ëü*% 3"åë, ÷, "=å2 C! %öå““/ …å*! %2, ƒ=ö, , , ÷2% %2÷å2ë, "% C! % ", ë%“ü C! , %ä…%ì %ø, K%÷…% C! %"åäå……%ì Š. b %ä…%ì , ƒ 2 ›åë/ . “ë3÷=å" …å“2=K, ëü…%L “2å…%*=! ä, , C! , …, ÷åì …å *3C, ! 3þ?, .“ 24-25 =…ã, …%ƒ…/ . C! , “23C=. " “32*, ä"3*! =2…%å " 2å÷å…, å “32%* , C%"2%! …%å " 2å÷å…, å 3 ä…åL ""åäå…, å 30 2/ “. ̀ Š! e ä. *%…2! , *=ë= , 10 2/ “. e ä. ãåC=! , …= C! , "åë% * ! åƒ*%ì3 3ìå…üøå…, þ n`o, 3ë3÷øå…, þ *ë, …, ÷å“*%ã% 2å÷å…, ƒ=K%ëå"=…, , * "/ C, “*å K%ëü…%ã% ÷å! åƒ …åäåëþ.

b/ "ëå……= " .*“Cå! , ìå…2å “C%“%K…%“2ü , …ã, K, 2%! %" jjq C%"2%! …/ ì ""åäå…, åì jc %2ä=ë 2ü “! %*, ! =ƒ", 2, …å%K! =2, ì/ . , ƒìå…å…, L " , …-=! *2…%L ƒ%…å C%ƒ"%ë, ë= ! å=K, ë, 2, ! %"=2ü , "…32! , -*%! %…=! …/ L 2! %ìK%ë, ƒ, “, *%2%! / L "Cå! "/ å " ì, ! å " 1976 ã%ä3 K/ ë 3“Cåø…% , “C%ëüƒ%"=… e .h.) =ƒ%"/ ì, C%ë%›, "ø, ì …=÷=ë% ø, ! %*%ì3 C! , ìå…å…, þ ŠkŠ " *ë, …, *å. b…32! , *%! %…=! …/ L 2! %ìK%ë, ƒ, “, K/ “2! % ë, ƒ, ! 3þ?, L 2! %ìK “ ƒ=2! =2%L …åK%ëüø, . ä%ƒ 2! %ìK%ë, 2, *= , , ƒK="ëå…, åì %2 ì…%ã, . 2! %ìK%ë, 2, ÷å“*, . %“ë%›…å…, L, * “%›=ëå…, þ, K/ ë " ä=ëü…åLøåì ƒ=ìå…å… “, “2åì…/ ì 2! %ìK%ë, ƒ, “%ì " “" ƒ, “ C%2å! ì, "! åìå…, …= %“3?å“2"ëå…, å *%! %…=! %ã! =-, , , “ 2! 3ä…%“2 ì, %! ã=…, ƒ=ö, %……%ã% , ì=2å! , =ëü…%ã% C%! ä*=. aå“öåL2…%2…= , Kë=ã%ä=! C! åä"=! , 2åëü…%L , …-3ƒ, , jc , *%! %…=! %ã! =-, C%ƒ"%ë å2 %“3?å“2"ë 2ü "…32! , *%! %…=! …/ L 2! %ìK%ë, ƒ, “ , =…ã, %Cë=“2, *3, *%! -! å*ö, þ ! åƒ, ä3=ëü…%ã% “2å…%ƒ=, = C! , …å%K.%ä, ì%“2, , %Cå! =ö, þ =%! 2%*%! %…=! …%ã% ø3…2, ! %"=…, .

b %Kå“Cå÷å…, , .--å*2, "…%ã% C! åä%2"! =?å…, ì, *! %ö, ! *3ë 2%! …/ . …=! 3øå…, L , øåì, ƒ, ! %"=……%ã% ì, %*=! ä= ì/ …å “2=", ë, C%ä “%ì…å…, å ö, 2%C! %2å*2%! …%å äåL“2", å 2! , ìå2=ƒ, ä, …=, ì, ëä! %…=2=, “3ëü-=2= ì=ã…, , ä! . bìå“2å “ 2åì, , ƒ"å“2…/ å ìå.=…, ƒì/ ! åCå! -3-ƒ, %……/ . C%"! å›äå…, L , =! , 2ì, L ì%ã32 K/ 2ü 3“Cåø…% Kë%*, ! %"=…/ ! =……, ì C! åä"=! , 2åëü…/ ì ""åäå…, åì , …ã, K, 2%! %" jjq. Š=*, " .*“Cå! , ìå…2å C! , “%.! =…å…, , *%ëë=2å! =ëü…%ã% *! %"%“…=K›å…, ƒ%…/ , øåì, , , “2, ì3ë ö, , ! å2! %ã! =ä…%ã% *! %"%2%*= C%ä "ë, …, åì jc , C! , "%ä ?, . * 3ìå…üøå…, þ , øåì, , ì, %*=! ä=, %K! =ƒ%"=…, å “"%K%ä…/ . ! =ä, *=ë%" C! , ! åCå! -3ƒ, , C%÷2, “"%ä 2“ …= …å2. hìå……% .2, ì , ì%›…% %KA “…, 2ü Kë=ã%C! , 2…/ å ! åƒ3ëü2=2/ %Cå! =ö, , `jx , ŠkŠ C! , …=ë, ÷, , .%! %ø% ! =ƒ", 2/ . *%ëë=2å! =ëü…/ . “%“3ä%". n2“32“2", å , ë, ƒ…=÷, 2åëü…%å 3ìå…üøå…, å .*“2! ="=ƒ=ö, , -%! ìå……/ . .ëåìå…2%" *! %", …= -%…å jc C! , "%““2=…%"ëå…, , =…2åã! =ä…%ã% *! %"%2%*= “", äå2åëü-“2"3å2 % …åä%“2=2%÷…%L =*23=ëü…%“2, "%ƒì%›…%ã% ìå.=…, ÷å“*%ã% C%"! å›äå…, *=! ä, %ì, %ö, 2%" (jl0 ). m=*%…åö, "/ "ëå……%å " .*“Cå! , ìå…2å C! , , ƒ%ë, ! %"=……%ì Š nhl ƒ=C%ë…å…, å ì, 2%.%…ä! , L *=ëüö, åì “ C%“ëåä3þ?, ì …=! 3øå…, åì , . -3…*ö, , , 3ìå…üøå…, åì “%äå! ›=…, `Št, %K! =ƒ%"=…, åì *%…2! =*23! / jl0 , , . ã, Kåëüþ, …= -%…å jc , “%C! %"%›ä=å2“ ë, øü …å*%2%! / ì …=K3.=…, åì ì, 2%.%…ä! , L C! , “%.! =…å…, , , . “2! 3*23! / , -3…*ö, , .

b ƒ=*ëþ÷å…, å å?‘ ! =ƒ “ëåä3å2 %2ìå2, 2ü, ÷2% 2! %ìK%ë, 2, *, C%“ëåä…, . C%*%ëå…, L, %Kå“Cå÷, "=þ?, å K/ “2! %å ë, ƒ, ! %"=…, å 2! %ìK= , ìå…üø, å -, K! , …%ë, 2, ÷å“*, å ãåì%! ! =ã, , , …å , ƒK="ë þ2 %2 ! åCå! -3-ƒ, %……/ . C%"! å›äå…, L, 2=* *=* , . "/ “%*= -, K! , …%ë, 2, ÷å“*= =*2, "…%“2ü " ì%ìå…2 Š å?‘ K%ëüøå C%"/ ø=å2 C=2%ë%ã, ÷å“*3þ =*2, "=ö, þ jjq , "%ƒ…, *…%"å…, å ƒ…=÷, 2åëü…/ . pobc. b/ .%ä, *=ƒ=ë%“ü K/ , , ƒ Kåƒ/ “.%ä…%ã% C%ë%›å…, , “3?å“2"3þøåã% “ ì%ìå…2= "…åä! å…, " *ë, …, ÷å“*3þ C! =*2, *3 Š, “%“2%, 2 " …=, K%ëåå ! =……åì …= dc} , “C%ëüƒ%"=…, , , …ã, K, 2%! %" jjq, *%2%! / å …å 2%ëü*% C%ä="ë þ2 C=2%ë%ã, ÷å“*3þ =*2, "=ö, þ jjq , "%ƒ…, *…%"å…, å po (, .2% ãë="…%å), …% , ƒ…=÷, 2åëü…% 3ìå…üø=þ2 =*2, "…%“2ü “"å! 2/ "=þ?åL “, “2åì/ , , 2åì “=ì/ ì, C! åC 2“2"3þ2 -%! ì, ! %"=…, þ 2! %ìK= , %Këåã÷=þ2 åã% ë, ƒ, “. }2%ì3 ›å “C%“%K“2"3å2 …å! åä*% %2ìå÷=þ?åå“ " Cå! "/ å 2 ÷=“= %“2! %L , øåì, , ì, %*=! ä=, “%“2% …, å …%! ì%- , ä=›å *%ìCå…“=2%! …%L ã, C%*%=ã3ë ö, , . b%2 C%÷åì3 …=ì, …= -%…å , …ã, K, 2%! %" jjq K/ ë% ƒ=! åã, “2! , ! %"=…% , .--å*2, "…%å , “C%ëüƒ%"=…, å “2! åC2%äå*=ƒ/ .

m=*%…åö, C! åäøå“2"3þ?, å .*“Cå! , ìå…2=ëü…/ å , ““ëåä%"=…, , “%C%“2="ëå…, å ! åƒ3ëü2=2%" ŠkŠ …= -%…å , …ã, K, 2%! %" jjq , C! , ! =……åì , ƒ%ë, ! %"=……%ì Š “", äå2åëü“2"3þ2 % 2%ì, ÷2% "=›…åLø, ì " ä%“2, ›å…, , %C2, ì=ëü…%ã% *ë, …, ÷å“*%ã% .--å*2= ŠkŠ "ë þ2“ …å ì=*“, ì=ëü…% ! =……, å “! %*, C! %"åäå…, Š, = …=, K%ëåå ! =…… …= dc} , …-3ƒ, , …ã, K, 2%! %" jjq, ãë="…/ ì ƒ=?, 2…/ ì “"%L“2"%ì *%2%! / . "ë å2“ 3ìå…üøå…, å , ä=›å C! åä%2"! =?å…, å 3"åë, ÷å…, C! %…, ö=åì%“2, “%“3ä, “2%L “2å…*, , "%ƒ…, *=þ?åL C%ä "ë, …, åì C=2%ë%ã, ÷å“*%L =*2, "=ö, , jjq “ "/ .%›äå…, åì Cë=ƒì/ , -%! ìå……/ . .ëåìå…2%" *! %", " ì, %*=! ä. o! åä"=! , 2åëü…%å …= dc} , “C%ëüƒ%"=…, å , …ã, K, 2%! %" jjq " *=÷å“2"å K=ƒ, “…%L 2å! =C, , “ ì=*“, ì=ëü…/ ì C! åä%2"! =?å…, åì ì, *! %ö, ! *3ë 2%! …/ . …=! 3øå…, L, “2, ì3ë ö, åL ! å2! %ã! =ä…%ã% *! %"%“…=K›å…, , “%.! =…å…, åì -3…*ö, %…=ëü…%L C! %.%ä, ì%“2, “%“3ä, “2%ã% ! 3“ë= " ƒ%…å , øåì, , %Kå“Cå÷, "=þ2 C%“ëåä3þ?3þ .--å*2, "…3þ ŠkŠ C! , C%“23Cëå…, , K%ëü…%ã% " “2=ö, %…=! . b “" ƒ, “ , ƒë%›å……/ ì, 3“Cåø…/ L Š , ƒ…=÷, 2åëü…%å 3ë3÷øå…, å *=÷å“2"= %*=ƒ=…, …å%2ë%›…%L C%ì%?, K%ëü…/ ì %“2! / ì , …-=! *2%ì ì, %*=! ä= …=.%ä 2“ " C! ì%L ƒ=", “, ì%“2, %2 ! å%! ã=…, ƒ=ö, , “ë3›K/ “*%! %L ìåä, ö, …“*%L C%ì%?, , ""åäå…, , …ã, K, 2%! %" jjq …= dc}.

kininuri sistemis inhibitorebis winaswari gamoyenebis mniSvneloba mwvave

iSemiuri miokardis sisxlmomaragebis aRdgenis

meTodebis srulyofisaTvis

prof. a. korotkovi

Terapiis erovnuli centri, Tbilisis saxelmwifo

samedicino universiteti

SromaSi aRwerilia miokardiis infarqtis mkurnalobis meTodebis srulyofis etapebi _

dawyebuli mwvave iSemiuri miokardiumis reperfuziidan _ jer eqsperimentSi, xolo

Semdgom klinikaSi _ Trombolituri Terapiis saxiT. eqsperimentiT damtkicda kontri-

kalisa da heparinis maRali efeqturoba reperfuziuli, Sigamiokardiuli hemoragiis

Tavidan asacileblad, funqciuri kapilarebis raodenobis gazrdiTa da eqstravazatebis

ararsebobiT miokardSi.

inhibitorebis ganmeorebiTi infuziis Sedegad viTardeba Sigakoronaruli

Trombolizisi, romlis drosac saWiroa operaciuli Careva _ angioplastika.

THE IMPORTANCE OF PREVIOUSLY USE OF INHIBITORS IN PERFECTION OF THE WAYS OF RESTORATION OF BLOOD SUPPLY OF ACUTE ISCHEMIC MYOCARDIUM

A. KOROTKOV The stages of perfection of the ways of myocardial infarction treatment beginning from acute ischemic

myocardium reperfusion (AIMR) firstly in experiment and after by thrombolitic therapy in the clinic are descriged.

High efficiency of contrical and heparin (CH) in prevention of reperfusial intercardial hemorrhages ( RICH ) with increase of the number of functioning capillary vessels and absence of extravasals in myocardiumn is proved in the experiment. On the prehospital stage during infusion of KKS inhibitors in 156 patients within first 2 – 2.5 hours from beginning of acute angial attack the improvement of clinical picture and decrease of ischemia caused by improvement of retrograde blood supply in infarcted zone with maximal raising of MG,KFK and MB concentration was noted.

Within first 2 hours after beginning of acute angial attack during the thrombotic therapy in 104 patients on the phone of CH maximal antiangial and antiarythmic effects, caused by suppress of pathologic activation of KKS and blood coagulation system and, as well, the RICH were noted. In conditions of early isolated thrombogenesis ( T) less favorable clinical picture with new extra systoles as a result of extension of KKS pathological activation and increase of vessel walls permeability under influence of increased fibrinolitic activity of infused thrombolitics is followed. Optimal effects on the prehospital stage with the use of KKS inhibitors and following TT in the hospital were achieved. With repeated KKS inhibitors infusion and removal of irreversible changes terms the effective intercoronar thrombolysis, angioplastics and operations on anticoronar shunts are possible.

literatura: khŠep`Šrp`:

1. `…ä!åå…*% c.b., kþ2%"= k.b. $ j=! ä, %ë%ã, , 1977, 1 7, “. 114-118. 2. c%ë,*%" `.o., g,…ãå!ì=… b.~., o%ë3ì,“*%" `.̀ . , “%="2. $ j=! ä, %ë%ã, , 1986, 1 21, “. 12-17. 3. j=2åëü…,ö*= k.h. $ j! %"%%K! =?å…, å, 1983, 1 2, “. 6-10. 4. j,Cø,äƒå m.m., j%!%2*%" `.̀ ., l=!“=ã,ø",ë, k.̀ . , ä!. $ qC%“%K ëå÷å…, %“2! %L , øåì, ,

ì, %*=! ä=. ̀ "2%! “*%å “", äå2åëü“2"% 11186213, c%“*%ì, 2å2 qqqp C% äåë=ì , ƒ%K! å2å…, L , %2*! / 2, L, Kþë. 139, 1985.

5. j,Cø,äƒå m.m., j%!%2*%" ̀ .̀ ., )3ìK3!,äƒå h.Š., Š=".åë,äƒå Š.d. , ä!. $ j=! ä, %ë%ã, , 1986, 1 9, “. 37-41.

6. j%!%2*%" ̀ .̀ ., Š=".åë,äƒå Š.d., a%.3= l.p. , “%="2. $ j=! ä, %ë%ã, , 1984, 3, “. 119-121. 7. j%!%2*%" `.̀ ., l=!“=ã,ø",ë, k.̀ ., a%.3= l.p. , ä!. $ `"2%! “*%å “", äå2åëü“2"% 1 1045250,

aþëëå2å…ü c%“*%ì, 2å2= qqqp C% äåë=ì , ƒ%K! å2å…, L , %2*! / 2, L 1 36, 1983. 8. j%!%2*%" `.̀ ., j,Cø,äƒå m.m., )3ìK3!,äƒå h.Š. , ä!. $ `"2%! “*%å “", äå2åëü“2"% 1 1183112,

aþëëå2å…ü c%“*%ì, 2å2= C% äåë=ì , ƒ%K! å2å…, L , %2*! / 2, L 1 37, 1985. 9. j%!%2*%" ̀ .̀ ., h!åì=äƒå h.h., f%!›%ë,=…, Š.d. , ä!. $ j=! ä, %ë%ã, , 1991, 1 4, “. 59-62. 10. j%!%2*%" `.̀ ., låã!åë=äƒå h.h., jëåìK%"“*,L `.̀ . , ä!. $ b:h…-=! *2 ì, %*=! ä=. l=2å! , =ë/

“, ìC%ƒ, 3ì=. ŠK, ë, “, , 1989, “. 436-438. 11. j%!%2*%" `.̀ ., j,“2=3!, `.c., h!åì=äƒå c.c. $ låäë, …*“, ! =ƒäåë/ *=! ä, %ë%ã, ,

*=! ä, %., ! 3! ã, , 13.11.2004, http://www.medlinks. ru/article.php?sid=18471. 12. k=ƒ32,… b.j., qìå2…å" ̀ .q., g=Cå"=ë%" l.b. , ä!. $ j=! ä, %ë%ã, , 1981, 1 1, “.21-27. 13. kå?,…“*,L k.̀ . b=ëåå"= p.l., }L.ì=… k.k. $ j=! ä, %ë%ã, , 1981, 1 4, “. 53-56. 14. p3ä= l.“ ., ),*"=,ø",ë, d.h., q2=!%"å!%" h.h. , ä!. $ b“åì, ! …/ L *%…ã! å““ *=! ä, %ë%ã%". 11-

L, 1990. 15. q2=!%"å!%" h.h., d3…ä3= d.o., oë%2…,*%" ̀ .m. , ä!. $ j=! ä, %ë%ã, , 1993, 1 3, “. 28-32. 16. )=ƒ%" e.h., p3ä= l.“ . $ j=! ä, %ë%ã, , 1987, 1 2, “. 5-12.

17. Chambles L., Keil U., Dobson A. et al. $ For the WHO MONICA Project. Population versus clinical view of case fatality from acute coronary heart disease: Results from the WHO MONICA Project 1985-1990. Circulation, 1997; 96; 3849-59.

18. Garz W., Ninomuya K., Hishida J. et al. $ Amer.Heart J., 1981, vol. 102, p. 1145-1149. 19. Herve C., Gaillard M., Dubouis-Rande J.L. et al $ Presse med., 1988, vol. 17, p.1143-1146. 20. Koren G., Weiss A.T., Hasin Y. et al. $ New Engl.J.Med, 1985, vol. 313, p. 1384-1389. 21. Korotkov A.A. Tabidze Z.Sh., Kistauri A.G., Chkhaidze M.V. $ In 3RD international congress on

coronary artery disease/Lyon, France, Octomer 2-5, 2000, p.146. 22. Korotkov A., Kistauri A. et al. $ XXIV World Kongress of Internal Medicine. Kioto, 2002. 23. Korotkov A., Kistauri A., Sagaradze D., Zinzadze A. et al. $ J. of Coronary Artery Disease, 2003, vol.

5, N 1, p. 23. 24. Kuebler W., Schwarz F., Schuler G. $ In: World Congress of Cardiology. 9th. Abstracts. Moskow,

1982, vol. 1, N 0069. 25. Palmeri M. $ Minerva cardiologico, 1967, v. 15, p. 481-483. 26. Puddi P. Fontana G., Azzaroli P. $ Arch. clinica med., 1967, v. 43, p. 312-320. 27. Rosa L. $ Trasylol. In: Hypotensive Peptides, Berlin, 1966, 14, p.644-650. 28. Roth A., Brabash G.I., Hold H. et al. $ J. Amer. Coll. Cardiol, 1988, vol. 11, p. 187-191. 29. Schwarz F., Schuler G., Katus H. et al. $ Amer. J. Cardiol., 1982, vol. 50, p. 933-937. 30. Sobel B.F., Bergmann S.R. $ Amer. J. Med., 1982, vol. 72, p. 1-4. 31. Sotgin P., Artuso P. $ Mol. Cardiovaze, 1965, v.6, p. 283-285. 32. Tschirkov F. $ In Neq Aspects of TrasyLoL Therapy, 7, p. 139-150, 1967.

!

!

!

!

!

!

!

!

!

qspgftjvmj!ebbwbefcfcj!

saqarTveloSi eTerzeTebis warmoebis muSaTa Sromis higienis zogierTi sakiTxi

med. mecn. kand. a. kraveiSvili, prof. r. kverenCxilaZe

Tbilisis fizikuri aRzrdisa da sportis saxelmwifo akademia, n. maxvilaZis

saxelobis Sromis medicinisa da ekologiis samecniero-kvleviTi instituti

Sromis medicinis TvalsazrisiT, erovnuli meurneobis metad saintereso dargs

warmoadgens eTerzeTovani kulturis warmoeba, ramdenadac misi sawarmoebi

gavrcelebulia mxolod gansazRvrul klimatur-geografiul pirobebSi. amdenad, misi

gavrcelebis areali SezRudulia, xolo saqarTveloSi misi warmoeba sakmaodaa

ganviTarebuli. 10-15 wlis win es dargi 75 milioni maneTis produqcias awarmoebda, 90

eTerovan da 500 tonamde tungos zeTs amzadebda. eTerovani zeTebi ZviradRirebuli

produqciaa – erTi kilogrami geranis zeTis fasi msoflio bazarze 170-200 dolars aR-

wevs. aqedan gamomdinare, eTerzeTebis warmoeba erT-erTi unikaluri da perspeqtiuli

dargia, romlis bunebrivi da teqnikuri potencialis amoqmedeba mniSvnelovnad Seuwyobs

xels qveynis ekonomikis ganviTarebasa da winsvlas (1,2,3).

miznad davisaxeT saqarTvelos eTerzeTebis warmoebis ZiriTad obieqtebze Sromis

pirobebis formirebis meqanizmebis gamovlena da saTanado profilaqtikuri RonisZiebebis

SemuSaveba.

kompleqsuri gamokvlevebi Catarda saqarTvelos eTerzeTebis warmoebis 5 ZiriTad

meurneoba–qarxnis bazaze (marneuli, lagodexi, yvareli, Telavi, abaSa). Seswavlili iyo

warmoebis teqnologiuri procesis sruli cikli.

eTerzeTebis warmoeba or ZiriTad teqnologiur etaps moicavs – kulturis moyvana da

nedleulis gadamuSaveba. warmoebis pirveli etapi sruldeba saTburisa da plantaciis

pirobebSi da misi teqnologiuri procesi xasiaTdeba arameqanizebuli, xeliT Sromis

mniSvnelovani moculobiT, sxeulis iZulebiTi mdgomareobiT, muSaTa organizmze

araxelsayreli meteorologiuri faqtorebis moqmedebiT da sxv. eTerzeTebis kulturis

gadamuSavebis teqnologiuri procesi mimdinareobs mniSvnelovani fizikuri datvirTviT

garemos araxelsayreli faqtorebis moqmedebis pirobebSi.

Catarebuli gamokvlevebiT dadginda, rom warmoebis yvela etapze aRiniSneba sawarmoo-

profesiul faqtorTa specifikuri kompleqsebis arseboba, romelic ganpirobebulia

sxvadasxva sawarmoo da arasawarmoo faqtoriT. araxelsayrel faqtorTa kompleqsSi gan-

sakuTrebul yuradRebas iqcevs sawarmoo mtveri, romelic sxvadasxva intensiurobiT

gvxvdeba warmoebis yvela etapze.

eTerzeTebis warmoebis mtveri warmoadgens wvrildispersiul unipolarulad damuxtul

nawilakebs, romelSic Tavisufali siliciumis dioqsidis Semcveloba 2,0-6,8%-is

farglebSi meryeobs.

samuSao zonis haeris damtverianebis gansakuTrebiT maRali parametrebi aRiniSneba

gadamamuSavebel qarxnebSi nedleulis meqanikuri gadmotvirTvis procesis dros.

damtverianebis sidideze garkveul gavlenas axdens nedleulis tenianobis xarisxi, ris

Sesabamisadac mtverwarmoqmnis intensiuroba mniSvnelovanad meryeobs.

mtvris koncentraciis maqsimaluri sidide nedleulis gadmotvirTvis dros 31 mg/m3–mde

aRwevs, xolo saSualo maCveneblebi 2,9-5,7-jer aRemateba zRvrulad dasaSveb

koncentracias. samuSao zonis haerSi mtvris warmoqmnis ZiriTadi mizezia sawarmoo

operaciebis arahermetuloba, ris gamoc mtveri garemoSi intensiurad vrceldeba.

vinaidan ar arsebobda eTerzeTebis orTqlis gansazRvris aprobirebuli meTodi, Cven

mier saTanado gamoTvlebis safuZvelze moxda Sesabamisi meTodis SemuSaveba. Catarebuli

gamokvlevebis safuZvelze dadginda, rom samuSao zonis haerSi eTerzeTebis orTqlis

Semcvelobis sidide garkveul kavSirSia teqnologiuri operaciebis xasiaTTan. kerZod,

misi minimaluri sidide aRiniSneba nedleulis damWrel manqanasTan – 2,7 mg/m3, xolo

maqsimaluri – zeTis mimReb kokobatorTan da zeTis mimReb macivarTan – 8,3 mg/m3. Tu

mxedvelobaSi miviRebT eTerzeTebis orTqlis Cven mier dadgenil zRvrulad dasaSveb

koncentracias – 2 mg/m3, romlis koncentracia umetes SemTxvevaSi aRemateba am

maCvenebels.

rogorc aRvniSneT, eTerzeTebis warmoebis teqnologiuri procesis pirveli etapi

ZiriTadad sruldeba Ria atmosferoSi – plantaciis pirobebSi. amis gamo, momuSaveni

ganicdian atmosferos cvladi meteorologiuri pirobebis moqmedebas. kerZod, pirdapiri

radiaciis sidide Seadgens 508-933 vt/m2-s, xolo gafantuli – 77-425 vt/m2-s.

teqnologiuri moTxovnebidan gamomdinare, saTburis pirobebSi muSaoba xasiaTdeba

haeris maRali tenianobiT, rac saSualod 92%-s Seadgens. aRsaniSnavia, rom TiTqmis yvela

SemTxvevaSi, da gansakuTrebiT mzian dReebSi, saTburis haeris tenianobis sidide mniSvne-

lovnad aRemateba gare atmosferuli haeris maCvenebels. aseve unda aRiniSnos, rom

saTburebSi haeris temperatura 3-jer maRalia gare atmosferulTan SedarebiT.

eTerzeTebis kulturis sawarmoo gadamuSavebis etapze (qarxnis pirobebSi), sawarmoo

mikroklimatis mdgomareobis formireba ganpirobebulia rogorc teqnologiuri

procesebis TaviseburebebiT, ise sawarmoo nagebobebis samSeneblo arqiteqturuli

gadawyvetiT.

mikroklimatis kompleqsidan yuradRebas iqcevs haeris SefardebiTi tenianobis

momatebuli sidideebi. misi maqsimaluri maCvenebeli, yvela SemTxvevaSi, aRemateba

dasaSvebs, xolo saSualo maCvenebeli zogierT samuSao adgilze normis farglebSia da

aRemateba optimalurs. haeris tenianobis momateba ZiriTad samuSao adgilebze aixsneba

teqnologiuri operaciebis Sesrulebis Sedegad garemoSi orTqlis intensiuri gamoyofiT.

haeris temperatura dasaSvebi sididis farglebSia. eqstraqciis saaparato ganyofilebaSi

misi maqsimaluri maCvenebelia 26,40C. haeris moZraobis siCqare meryeobs sakmaod did farglebSi da ganpirobebulia sawarmoo

nagebobebis TaviseburebebiT.

sawarmoo danadgarebis muSaobis Sedegad, xmauri umetes SemTxvevaSi aRemateba dasaSveb

dones. kerZod, wisqvilebTan misi done zRvrulad dasaSvebze 12-15 db-iT maRalia.

amrigad, eTerzeTebis warmoebis yvela etapi xasiaTdeba Sromis araxelsayreli

faqtorebis arsebobiT, romelic yovel konkretul SemTxvevaSi xasiaTdeba garkveuli

kompleqsiT. sawarmoo garemosa da SromiTi procesis araxelsayreli faqtorebi gavlenas

axdens muSaTa organizmis funqciur mdgomareobaze. kerZod, gansakuTrebiT mniSvnelovani

Zvrebi gamovlinda fizikuri Termoregulaciis sistemaSi.

Catarebuli higienuri, fiziologiuri, ergonomiuli da profesiografiuli

gamokvlevebis Sedegebis kompleqsuri analizisa da saTanado normatiuli aqtebis

safuZvelze Sefasda Seswavlili warmoebis ZiriTadi profesiis muSaTa Sromis pirobebis

mavneobis, Sromis pirobebis simZimisa da daZabulobis sidide.

Sefasebis umaRlesi saboloo quliT (mavneobis, simZimis da daZabulobis III klasis, III

xarisxi) Sefasda mtvirTav-mWrelis Sromis pirobebi. profesiaTa umetesoba Sefasda,

rogorc III klasis II xarisxi.

Catarebuli kompleqsuri gamokvlevis safuZvelze SemuSavda Sromis pirobebis

gaumjobesebis RonisZiebebi, romelic moicavs teqnologiurs, sanitariul-teqnikurs,

sanitariul-higienursa da samedicino reabilitaciurs. maTi realizacia, samedicino

efeqtTan erTad, garkveul socialur efeqtsac mogvcems.

mejn Šn p{e b n o pn q{ ch ch e m{ Špr d ` p`a n )h u }t h pn l `qk h )mn i o pn l {xk e mmn qŠh cpr gh h j `md . l e d . m`r j ̀ .f. jp`b e h xb h k h , o pn t . p.c. jb e pe m)u h k `d ge c%“3ä=!“2"å……= ̀ *=äåì, -,ƒ,÷å“*%ã% "%“C,2=…, , “C%!2= ŠK,ë,“,, mh h ìåä,ö,…/ , .*%ë%ã,, 2!3ä= ,ì. m.h . l =.",ë=äƒå j %ìCëå*“…%å , ““ëåä%"=…, å 3“ë%", L 2! 3ä= C! %"åäå…% …= K=ƒå 5 %“…%"…/ . .%ƒ L“2"-ƒ="%ä%"

C! %, ƒ"%ä“2"= .-, ! …/ . ì=“åë c ! 3ƒ, , . h ƒ3÷=ë“ C%ë…/ L ö, *ë 2å.…%ë%ã, ÷å“*%ã% C! %öå““= C! %, ƒ"%ä“2"=. m= %“…%"å *%ìCëå*“…%ã% =…=ë, ƒ= ! åƒ3ëü2=2%" ã, ã, å…, ÷å“*, ., -, ƒ, %ë%ã, ÷å“*, .,

.! ã%…%ì, ÷å“*, . , C! %-å““, %ã! =-, ÷å“*, . , ““ëåä%"=…, L "/ "ëå…%, ÷2% …= "“å. .2=C=. 2å.…%ë%ã, ÷å“*%ã% C! %öå““= "“2! å÷=þ2“ "! åä…/ å C! %-å““, %…=ëü…/ å -=*2%! / , “! åä, *%2%! / . ƒ…=÷, 2åëü…%å ìå“2% ƒ=…, ì=å2 C/ ëå"%L. b C! %K=. C/ ë, “%äå! ›=…, å “"%K%ä…%ã% ä, %*“, ä= *! åì…, *%ëåKëå2“ %2 2,0 ä% 6,8 %. j %…öå…2! =ö, C/ ë, " "%ƒä3.å ! =K%÷åL ƒ%…/ " “! åä…åì " 2,9-5,7 ! =ƒ "/ øå o d j . j %…öå…2! =ö, C=! %" .-, ! …/ . ì=“åë " %C! åäåëå……%L “2åCå…, “" ƒ=…= “ .=! =*2å! %ì

2å.…%ë%ã, ÷å“*%ã% C! %öå““=. j %…öå…2! =ö, , C=! %" .-, ! …/ . ì “åë " 1,2 ! =ƒ C! å"/ ø=þ2 ! å*%ìå…ä%"=……3þ …=ì, o d j . j %ìCëå*“ …åKë=ã%C! , 2…/ . -=*2%! %" C! %, ƒ"%ä“2"å……%L “! åä/ %*=ƒ/ "=å2 "ë, …, å …= -3…*ö, %…=ëü…%å “%“2% …, å %! ã=…, ƒì= ! =K%÷, ., %“%Kå……% …= 2å! ì%! åã3ë ö, þ. Š! 3ä ! =K%÷, . %“…%"…/ . C! %-å““, L .=! =*2å! , ƒ3å2“ "! åä…/ ì, , 2 ›åë/ ì, , …=C! ›å……/ ì, 3“ë%", ì, ! =ƒë, ÷…%L “2åCå…, . p=ƒ! =K%2=… *%ìCëå*“ ìå! %C! , 2, L C% 3ë3÷øå…, þ 3“ë%", L 2! 3ä=.

SOME PROBLEMS OF THE WORKING HYGIENE OF VOLATILE OILS PRODUCTION IN GEORGIA A. KRAVEISHVILI, R. KVERENCHKHILADZE

Complex investigation has been carried out on the basis of 5 main volatile ails farms-factories. A complete

technologic cycle of production has been studied. Resulting from the complex hygienic, physiologic, ergonomic and professiographic investigations the availability of

a specific complex of production-professional factors at all production levels has been established. The production dust which contained 2,0-6,8% silicium dioxide is worth noting. The dust concentration in working area was marked 2,9-5,7 times as much as the boundary permissible value.

The volatile oils steam confent has a specific connection with the nature of technologic processes, its concentration being fourfold as much as the boundary permissible concentration established by the authors.

Some unfavourable factors of the production medium and working processes affect on the functional state of the workers’ organism, especially on thermoregulation.

The working conditions for loaders-engravers were estimated by the biggest last point (III group III class of harmness, heaviness and tension) and most of profession was estimated as II degree of III class.

Same actions for improving the working conditions have been developed.

literatura: k h Še p`Šr p`: 1. cqitiSvili T. – sWirdeba Tu ara saqarTvelos eTerzeTebi, Jurnali `ekonomika~, 1999,

#4-5, gv. 158-163.

2. j!="åLø",ë, `.f. $ c , ã, å…, ÷å“*= .=! =*2å! , “2, *= ƒ=C/ ëå……%“2, "%ƒä3ø…%L “! åä/ …= C! åäC! , 2, . .-, ! %ì=“ë, ÷…%L C! %ì/ øëå……%“2, c ! 3ƒ, , . Georgian Medical News, 13 (60), 2000, c. 41-43. 3. l %!=!ü l .h . $ c , ã, å…= 2! 3ä= C! , "%ƒäåë/ "=…, , .-, ! %ì=“ë, ÷…/ . *3ëü23! . `"2%! å-å! =2

ä, ““. *=…ä. ìåä. …=3*., j , å", 1983, 29 “.

natriumis cianidis warmoebis muSaTa Sromis pirobebis sakiTxebi

g. kverenCxilaZe

n. maxvilaZis saxelobis Sromis medicinisa da ekologiis

samecniero-kvleviTi instituti

janmrTeloba sazogadoebrivi progresis integrirebul maCvenebels, sazogadoebis

socialur faseulobas warmoadgens. amdenad, konkretul warmoebaSi arsebuli Sromis

pirobebi da, Sesabamisad, muSaTa janmrTelobis mdgomareoba garkveulad ganpirobebulia

sazogadoebis ganviTarebis doniT. misi yovelmxrivi Seswavla SesaZleblobas mogvcems,

garkveulwilad, vimsjeloT warmoebis teqnikuri ganviTarebis doneze da Sromis

pirobebis garkveuli kompleqsis ganmapirobebel faqtorebze.

konkretuli sawarmos Sromis pirobebis Seswavla muSaTa janmrTelobis pirobebis

gaumjobesebisaken mimarTuli RonisZiebebis SemuSavebis safuZvelia [2], rac ara marto

samedicino, aramed mniSvnelovani socialuri da ekonomikuri problemacaa [3].

sazogadoebis mecnierul-teqnikuri ganviTarebis dones, mis socialur-higienur aspeqtebs

gansakuTrebuli roli eniWeba medicinisaTvis, ramdenadac misi done mniSvnelovnad

ganapirobebs warmoebis konkretuli Sromis pirobebs da, Sesabamisad, muSaTa janmrTe-

lobis mdgomareobis Taviseburebebs.

erovnuli meurneobis dargebs Soris, Sromis medicinis TvalsazrisiT, metad

mniSvnelovania qimiuri mrewveloba [1], romelic xasiaTdeba sawarmoo garemosa da

SromiTi procesis faqtorebis mravalferovnebiT [5].

saqarTvelos qimiuri mrewvelobis obieqtebs Soris mniSvnelovania natriumis cianidis

warmoeba, romelic rusTavis s/g `azotis~ SemadgenlobaSi funqcionirebs. Sromis

medicinis TvalsazrisiT, aRniSnuli warmoeba faqtiurad Seuswavlelia.

Seswavlil warmoebaSi teqnologiuri procesebi, ZiriTadad, daxuruli sqemiT

mimdinareobs, zogierTi operacia _ vakuumis pirobebSi, SesaZleblobis SemTxvevaSi –

vertikaluri sqemiT. amdenad, warmoebis teqnologiuri gadawyveta higienuri

TvalsazrisiT, misaRebia. amasTan, aRiniSneba calkeuli naklovaneba, rac xels uwyobs

Sromis pirobebis araxelsayreli mdgomareobis formirebas.

Seswavlili warmoeba xasiaTdeba sawarmoo garemosa da SromiTi procesis saSiSroebis

maRali klasiT, rac ganpirobebulia teqnologiuri procesis da, saerTod, warmoebis

specifikiT. sawarmoo mowyobilobisa da danadgarebis muSaobis Taviseburebebis gamo,

iqmneba adamianis sicocxlisa da janmrTelobisaTvis saSiSi mTeli rigi pirobebi:

intoqsikaciis, qimiuri da Termuli damwvrobis, meqanikuri travmisa da eleqtruli

dazianebis.

warmoebis teqnologiur procesSi sawarmoo mowyobilobis eqspluataciisas warmoebis

teqnologiuri reglamentiT gaTvaliswinebulia mTeli rigi pirobebis Sesruleba, rac

Tavidan agvacilebs momuSaveTa janmrTelobaze arasasurvel zemoqmedebas.

warmoebis ZiriTadi profesiebia: meaparate, SemfuTveli, laboranti, zeinkali. maT

organizmze moqmedebs sawarmoo garemos araxelsayrel faqtorTa kompleqsi.

kompleqsuri higienuri gamokvlevebis safuZvelze dadginda, rom saqarTvelos qimiuri

mrewvelobis aRniSnuli obieqtis sawarmoo garemo xasiaTdeba araxelsayrel profesiul

faqtorTa kompleqsis arsebobiT, romelTa Soris, higienuri TvalsazrisiT, wamyvania

sawarmoo zonis haeris toqsikuri airebiT dabinZureba.

sawarmoo garemoSi gamoyofili nedleulis, Sualeduri da saboloo produqtebis

(amiakis, cianmJavas, natriumis cianidis) orTqlis koncentracia mniSvnelovnad _ 1,5-5,2-jer

aRemateba zRvrulad dasaSveb sidides. sawarmoo garemoSi maRaltoqsikuri qimiuri

naerTebis orTqlis gamoyofas xels uwyobs sawarmoo aRWurvilobis Hhermetulobisa da

teqnologiuri reJimis darRveva.

wlis Tbil periodSi sawarmoo saTavsebSi aRiniSneba haeris temperaturis momatebuli

parametrebi, rasac ganapirobebs rogorc regionis klimaturi pirobebi (mSrali subtro-

pikuli klimati), ise teqnologiuri procesebis egzoTermuli xasiaTis gamo sawarmoo

garemoSi siTbos gamoyofa da danadgarebis zedapirebis momatebuli temperatura. kerZod,

qimiuri reaqciebis normaluri mimdinareobisTvis, reaqciaSi monawile ingredientebisTvis,

optimaluri temperaturaa 35±5°C, xolo dasaSvebia 40-45°C. naxevarfabrikatis SrobisaTvis

optimaluri temperaturaa 60-65°C. aRniSnuli garemoebis gamo, sawarmoo saTavsebis

umravles samuSao adgilze haeris temperatura 32-34°C-s aRwevs, haeris moZraobis dabali

siCqaris fonze.

sawarmoo danadgarebis muSaobis Sedegad generirdeba farTozoliani mudmivi xasiaTis

xmauri, romlis done umetes SemTxvevaSi aRemateba zRvrulad dasaSvebs. kerZod, samanqano

darbazSi bgeris done 92 dba-mde aRwevs, xolo marTvis pultTan _ meryeobs 70 dba-dan

(saTavsis izolirebis SemTxvevaSi) 81 dba-mde (saTavsSi sxva samuSao zonebidan xmauris

gavrcelebis gamo, Ria karis SemTxvevaSi). saventilacio danadgarebis muSaobis procesSi

da cianmJavas warmoebis samanqano darbazSi generirebuli xmauri 92 dba donezea. sxva

samuSao adgilebze bgeris done 76-80 dba farglebSi meryeobs. mocemuli sawarmoo

saTavsebi xmauris aseTi mdgomareobiT xasiaTdeba mTeli samuSao dRis ganmavlobaSi,

ramac muSaTa organizmze garkveuli arasasurveli zemoqmedeba SeiZleba gamoiwvios.

samuSao adgilis (zogadi) vibracia gvxvdeba samanqano darbazSi da mza produqciis

Camoclisa da SefuTvis ubanze. misi parametrebi zdd-s aRemateba mxolod am ukanasknel

SemTxvevaSi da faqtiuri sidide normas yvela sixSireze 2-5 db-iT aRemateba.

sawarmoo procesebis operatoruli xasiaTis gamo, samuSao adgilTa umetesoba

xasiaTdeba mxedvelobiTi analizatoris intensiuri daZabviT (marTvis pultebi,

xelsawyoTa Cvenebebze dakvirveba da sxva) da, amdenad, racionaluri sawarmoo ganaTebis

Seqmna mniSvnelovani higienuri amocanaa. rogorc Catarebulma gamokvlevebma gviCvena,

zogierT samuSao adgilze sawarmoo ganaTebis done ver akmayofilebs higienur

moTxovnebs. kerZod, marTvis pultTan, samanqano darbazSi bunebrivi ganaTebis

koeficienti normirebulis 68,7-93,4%-s Seadgens.

amrigad, natriumis cianidis warmoebis muSaTa Sromis pirobebi, teqnologiuri

reglamentiT gaTvaliswinebuli mravali RonisZiebis miuxedavad, xasiaTdeba

araxelsayreli faqtoriT, romelic uaryofiT zemoqmedebas axdens muSaTa organizmze. Tu

gaviTvaliswinebT im garemoebas, rom Seswavlil warmoebaSi teqnologiuri operaciebis

umravlesoba operatoruli xasiaTisaa da sawarmoo procesebis Sesrulebaze ZiriTadad

dasaqmebuli arian qalebi, Sromis pirobebis araxelsayreli parametrebi, kerZod, toqsi-

kuri airebis mniSvnelovnad momatebuli koncentracia, samedicino-higienurTan erTad, gar-

kveul socialur problemasac warmoadgens [4], ramdenadac momuSave qalTa Sromisa da

janmrTelobis dacva mWidrodaa dakavSirebuli demografiul problemasTan.

Catarebuli gamokvlevebis safuZvelze SemuSavda Seswavlili warmoebis muSaTa Sromis

pirobebis Semdgomi racionalizaciis RonisZiebebi, romelic etapobrivi realizaciisaTvis

gadaeca warmoebis administracias.

b n o pn q{ r qk n b h i Špr d ` p`a n )h u o pn h gb n d qŠb ` 0 h `mh d ` m`Šph “ c.p. jb e pe m)u h k `d ge mh h ìåä,ö,…/ , .*%ë%ã,, 2!3ä= ,ì. m.h . l =.",ë=äƒå m= %“…%"=…, , *%ìCëå*“…%ã% , ƒ3÷å…, 3“ë%", L 2! 3ä= ! =K%÷, . C! %, ƒ"%ä“2"= ö, =…, ä= …=2! ,

c ! 3ƒ, , 3“2=…%"ëå…%, ÷2% " C! %, ƒ"%ä“2"å , “C%ëüƒ3þ2“ ., ì, ÷å“*, å “%åä, …å…, C%"/ øå……%L %C=“…%“2, . q / ! üå"/ ì, ì=2å! , =ë=ì, "ë þ2“ =ìì, =*, ìå2=…, “, …, ëü…= *, “ë%2=, ÷2% %C! åäåë å2 .=! =*2å! 2! åK%"=…, L * 2å.…%ë%ã, ÷å“*, ì C! %öå““=ì. r “ë%", 2! 3ä= .=! =*2å! , ƒ3þ2“ …åKë=ã%C! , 2…/ ì “%“2% …, åì, "åä3? , ì “! åä, *%2%! / . "ë å2“ ƒ=ã! ƒ…å…, å "%ƒä3ø…%L “! åä/ 2%*“, ÷å“*, ì, ã=ƒ=ì, . måKë=ã%C! , 2…%å “%“2% …, å "%ƒä3ø…%L “! åä/ %K3“ë%"ëå…%, ãë="…/ ì %K! =ƒ%ì, …=! 3øå…, åì ãå! ìå2, ÷…%“2, , %2äåëü…/ ì, …åC%ë=ä*=ì, C! %, ƒ"%ä“2"å……%ã% %K%! 3ä%-"=…, . b 2åCë/ L Cå! , %ä ã%ä= ì, *! %*ë, ì=2 "ë å2“ …åKë=ã%C! , 2…/ ì (C%"/ øå……= 2åìCå! =23! = "%ƒä3.= , …, ƒ*= åå C%ä", ›…%“2ü). x3ì , %K? = ", K! =ö, …= K%ëüø, …“2"å ! =K%÷, . ìå“2 C! å-"/ ø=þ2 o d r . r ! %"å…ü C! %, ƒ"%ä“2"å……%ã% %“"å? å…, …, ›å ã, ã, å…, ÷å“*%L …%! ì/ .

p=ƒ! =K%2=… *%ìCëå*“ %ƒä%! %", 2åëü…/ . ìå! %C! , 2, L C% 3ë3÷øå…, þ 3“ë%", L 2! 3ä= , “%“2% …, ƒä%! %"ü ! =K%÷, . , ƒ3÷å……%ã% C! %, ƒ"%ä“2"=.

THE PROBLEMS OF LABOR CONDITIONS OF KEY PROFESSION OF WORKERS AT ENTERPRISES PRODUCING SODIUM CYANIDE IN GEORGIA G. KVERENCHKHILADZE

A complex study of workers’ labor conditions at enterprises producing sodium cyanide has been performed. It was stated that chemical compounds of high risk used in the industry determine special requirements of technological processes. Labor conditions of investigated industry is characterized by unfavourable state. Among unfavourable factors leading one is air pollution with toxic gazes. The atmosphere at the enterprises producing sodium cyanide is significantly polluted by the ammonia, hydrocyanic acid and sodium cyanide gases. Concentration of toxic substances depends on the character of the technological process. Unfavourable state of air environment is mainly determined by deterioration of hermeticity and specific defects of industrial equipments. Air temperature is rather high in warm periods of the year. It reaches 32-340C at the most working places. Noise factor and general industrial vibration exceed acceptable level in the majority of working area. The level of industrial lighting is lower than the standardized value.

On the basis of carefully performed study a complex of recreation measures has been worked out for improvement of conditions of work, life and health of the workers of the studied industry.

literatura: k h Še p`Šr p`:

1. baqraZe l. _ dariSxanis warmoebis muSaTa Sromis higiena da janmrTelobis

mdgomareoba. avtoref. med.mecn.kand. Tbilisi, 1994, 23 gv.

2. ̀ !.,C%" ̀ .q., l =!÷å…*% e .m. _ må*%2%! / å "%C! %“/ , ƒ=ä=÷, %2! =“ëå"%L ã, ã, å…/ 2! 3ä=.c , ã. 2! 3ä=. 1988, 13 c.4-6 3. j=!=ì%"= k .l . _ m=3÷…%-2å.…, ÷å“*, L C! %ã! å““ " …å-2åCå! å! =K=2/ "=þ? åL

C! %ì/ øëå……%“2, , "ë, …, å åã% …= ƒä%! %"üå ! =K%2=þ? , .: `"2%! å-å! =2 ä, ““. ä%*2. ìåä. …=3*. r -=: 1986, 42“.

4. q,äå…*% `.Š. _ c , ã, å…= 2! 3ä= ›å…? , … " C! %, ƒ"%ä“2"å “2å*ë ……%ã% "%ë%*…=: `"2%! å-å! =2 ä, ““ ä%*2. ìåä. …=3*. k .: 1982. 30 “.

5. Jappinen P., Tenhunen R. _ Hydrogen sulphide poisoning. Blood sulphide concentration and changes in haem metabolism. Brit. J. industr. Med. 1990, V.47, N4, P. 283-285 .

uprtjlpmphjb.frtqfsjnfouvmj!nfejdjob!

spilenZis qlorJangis mwvave toqsikurobis Taviseburebebi eqsperimentSi

med. mecn. kand. i. Rvineria, biol. mecn. doqt. j. oniani, v.saakaZe, x. SiSniaSvili

n. maxvilaZis saxelobis Sromis medicinisa da ekologiis samecniero-kvleviTi

instituti, Tbilisis ivane javaxiSvilis saxelobis saxelmwifo universitetis

hidrobiologiisa da toqsikologiis kaTedra

spilenZis qlorJangi miekuTvneba spilenZis Semcveli fungicidebis jgufs, romelic

farTod gamoiyeneba mcenareTa dacvis mizniT. preparati ZiriTadad Sedgeba spilenZis

qlorJangisagan (90%-mde). igi momwvano, mocisfro, usuno fxvnilia. teqnikuri preparati

minarevebis saxiT SeiZleba Seicavdes tyvias, dariSxansa da kadmiums 250 ppm, 350 ppm, 2ppm

Sesabamisad. spilenZis qlorJangis empiriuli formulaa 3Cu(OH2)xCuCl2, molekuluri masa _ 427,1, IUPAC-is sistemaSi misi saxelwodebaa - 2kuprum qlor trihidroqsidi, sare-

gistracio moxmarebis (CAS) nomeri - 1332-40-7 (1). spilenZis Semcveli fungicidebis moxmareba saqarTveloSi yovelwliurad izrdeba. igi

gamoiyeneba vazis, kartofilis, bostneulis, xilis, samkurnalo mcenareebis, dekoratiuli

kulturebisa da yvavilebis Sesawamlad vegetaciis periodSi (0,3-0,4%samuSao xsnaris sa-

xiT) (2). aseTi intensiuri gamoyeneba iwvevs spilenZis dagrovebas garemos obieqtebSi

(wyali, niadagi, haeri, mcenare), sakveb produqciaSi da, bunebrivia, garkveul gavlenas

axdens adamianis janmrTelobaze.

spilenZisa da misi naerTebis organizmze moqmedebis biologiuri Taviseburebebis

monacemebi araerTgvarovania, radgan spilenZi, rogorc biologiurad aqtiuri

mikroelementi mniSvnelovan gavlenas axdens organizmSi sasicocxlo procesebis

mimdinareobaze. misTvis damaxasiaTebelia kompleqsebis warmoqmna radikalebTan, maT

Soris ujredis komponentebTan, cilasTan, aminomJavebTan. is warmoSobs myar kavSirs

sulfhidrilur jgufebTan, iwvevs zogierTi fermentis inaqtivacias (tute fosfataza,

nerwyvis amilaza, lipaza), urTierTmoqmedebs hormonTan (adrenalini), gavlenas axdens

zogierTi vitaminis (C,A,B) koncentraciaze (3). biologiuri aqtiurobisa da organizmSi

mravalmxrivi funqciis gamo, spilenZis rogorc deficitma, ise didi raodenobiT

dagrovebam SeiZleba gamoiwvios organizmze mavne gavlena. bunebrivia, garkveulwilad

garTulebulia spilenZis zemoqmedebis riskis xarisxis Sefasebac.

Sromis mizans Seadgenda spilenZis qlorJangis ZuZumwovarTa organizmze biologiuri

moqmedebis Taviseburebebis - toqsikurobis parametrebis, zezRurblovani (Limac) da

umoqmedo doneebis (NOEL) dadgena mwvave cdaSi. spilenZis qlorJangis toqsikuri moqmedebis modeli iqmneboda preparatis erTjeradi

SeyvaniT TeTri virTagvebis organizmSi kuW-nawlavis traqtiT, wyliani suspenziis saxiT,

doziT 5000-dan 700 mg/kg.

erTjeradi zemoqmedebis efeqti fasdeboda cxovelis qcevis, gareSe gamRizianebelze

reaqciis, gadarCenisa da dacemis maCveneblebis, periferiuli sisxlis morfologiuri

Semadgenlobis (hemoglobini, meThemoglobini, eriTrocitebi, leikocitebi, sisxlis for-

mula, eds) Saqris Semcvelobis cvlilebebis mixedviT (4,5).

eqsperimentuli gamokvlevebis cifruli monacemebi damuSavebulia statistikurad.

Catarebuli kvlevis Sedegad dadginda, rom spilenZis qlorJangis erTjeradi Seyvana

kuW-nawlavis traqtSi doziT 5000, 4000mg/kg iwvevda mwvave intoqsikaciis ganviTarebas.

zemoqmedebidan ramdenime saaTSi cxovelebs aReniSnebodaT centraluri nervuli sistemis

daTrgunvis simptomebi _ moduneba, kunTebis sisuste, daqveiTebuli reaqcia gareSe

gamRizianeblebze, sunTqvis gaZneleba, diarea. sacdeli cxovelebis nawils, 2-3 dRis

Semdeg, uviTardeboda ukana kidurebis dambla, iRebda gverdiT mdgomareobas da

iRupeboda. danarCenebi, 3-4 dRis Semdeg, gamodiodnen mdgomareobidan da dakvirvebis

bolomde (15 dRe) ar gamoirCeodnen sakontrolo cxovelebisagan.

preparatis dozis SemcirebasTan erTad (3000-2000 mg/kg), intoqsikaciis niSnebi naklebad

iyo gamoxatuli da, Sesabamisad, cxovelebis dacema ar aRniSnula.

miRebuli monacemebis mixedviT, saSualo sasikvdilo doza DL50 aRemateba 5000 mg/kg,

amasTan, preparatis zemoqmedebis me-5 dRes aRiniSneboda (1500 mg/kg) hemoglobinis

Semcvelobisa 187,3 ±4,4 g/l (sakontrolo _ 139,3 ±0,8 g/l) da eriTrocitebis raodenobis

mateba 5.56±0.1·1012l (sakontrolo _ 4.48±0.16·1012l), izrdeboda Trombocitebis ricxvic

229±7.1·109/l (sakontrolo _ 184±0.3·109/l), viTardeboda zomieri leikocitozi 7.75±0.3·109/l

(sakontrolo _ 5.8±0.3·109/l), agreTve, neitrofilebis _ CxirbirTviani _ 5.33±0.6% (sakontrolo 1.16±0.16%), segmentbirTviani _ 66.8±1.1% (sakontrolo _ 46.8±4.1%) momateba da limfocitebis Semcireba 25.1±1.3% (sakontrolo 38.6±1.4%). aRiniSneboda eriTrocitebis

daleqvis siCqaris Semcirebac 2.5±0.3mm/sT (sakontrolo _ 7.16±0.47mm/sT), sagrZnoblad

matulobda Saqris Semcveloba sisxlSi _ 9.26±0.1mmol/l (sakontrolo _ 5.6±0.2mmol/l).

dozis SemcirebasTan erTad, 900-700mg/kg zemoqmedebis efeqti naklebad iyo

warmodgenili.

amrigad, miRebuli eqsperimentuli monacemebis mixedviT, spilenZis qlorJangi

miekuTvneba naklebad toqsikur nivTierebaTa jgufs, saSiSroebis III klasi (WHO/janmo)

(6,7).

mwvave cdaSi intoqsikaciis malimitirebel maCveneblad SeiZleba CaiTvalos

zogadtoqsikuri moqmedeba. mkveTrad aris gamoxatuli damokidebuleba `doza-efeqti~,

xolo spilenZis qlorJangis erTjeradi zemoqmedebis zRurblovan dozad Limac _ 1500mg/kg, umoqmedo doned _ NOEL - 900 mg/kg.

n qn a e mmn qŠh n qŠpn i Šn jqh )mn qŠh u k n pn jh qh l e d h b }jqo e ph l e mŠe j `md . l e d . m`r j h .q cb h meph “ �, d n j Š. a h n k . m`r j d .̀ . n mh `mh , b .u . q``j`d ge , u .h . xh xmh `xb h k h

mh h ìåä,ö,…/ , .*%ë%ã,, 2!3ä= ,ì. m.h . l =.",ë=äƒå, *=-åä!= ã,ä!%K,%ë%ã,, , 2%*“,*%ë%ã,, ŠK,ë,““*%ã% ã%“3ä=!“2"å……%ã% 3…,"å!“,2å2= ,ì. h . ̀ . d ›="=.,ø",ë, o ! , ìå…å…, å ìåäü“%äå! ›=? , . -3…ã, ö, ä%" “ *=›ä/ ì ã%ä%ì "%ƒ! =“2=å2, ÷2% " “"%þ %÷å! åäü,

“%ƒä=å2 ! å=ëü…3þ %C=“…%“2ü ƒ=ã! ƒ…å…, %*! 3›=þ? åL “! åä/ , , å“2å“2"å……%, %*=ƒ/ "=å2 %C! åäåëå……%å "ë, …, å …= %! ã=…, ƒì ëþäåL. 0 åëüþ ! =K%2/ "ë ë=“ü %öå…*= %“2! %L 2%*“, ÷…%“2, , 3“2=…%"ëå…, å C%! %ã%ã%"/ . 3! %"…åL

"%ƒäåL“2", ìåäü“%äå! ›=? åã% -3…ã, ö, ä= .ë%! %*, “, ìåä, C! , åã% Cå! %! =ëü…%ì C%“23Cëå…, , " %! ã=…, ƒì .*“Cå! , ìå…2=ëü…/ . ›, "%2…/ .. b ! åƒ3ëü2=2å C! %"åäå……/ . , ““ëåä%"=…, L 3“2=…%"ëå…%, ÷2% “! åä…å“ìå! 2åëü…= ä%ƒ= DL50

.ë%! %*, “, ìåä, äë Kåë/ . *! / “ >500ìã/*ã , , “ëåä%"=2åëü…%, -3…ã, ö, ä %2…%“, 2“ * ì=ë%2%*“, ÷…/ ì "å? å“2"=ì, III *ë=““3 %C=“…%“2, (C% *ë=““, -, *=ö, , WHO). k , ì, 2, ! 3þ? , ì C%*=ƒ=2åëåì , …2%*“, *=ö, , "ë å2“ %K? å2%*“, ÷å“*%å äåL“2", å.

o ! %“ëå›, "=å2“ ƒ=", “, ì%“2ü “%%2…%øå…, &ä%ƒ/ -.--å*2[, C%! %ã%"= ä%ƒ= %ä…%*! =2…%ã% "%ƒäåL“2", (Limac integr) …=.%ä, 2“ …= 3! %"…å 1500ìã/*ã, …åäåL“2"3þ? = (NOEL) - 900 ìã/*ã.

PECULIARITIES OF COPPER OXYCHLORIDE ACUTE TOXICITY IN EXPERIMENT I. GVINERIA, D. ONIANI, V. SAAKADZE, K. SHISHNIASHVILI

Utilization of Copper-contained Fungicides is increasing annually in Georgia, that in turn presents real threat to environmental pollution and naturally impacts human health.

The aim of this study was to assess acute toxicity of oral copper - containing fungicide - Copper Oxychloride in experimental animals.

As a result of conducted investigations, it was identified that average lethal dose (LD50) of Copper Oxychloride for white mice is over 500 mg/kg and subsequently, the fungicide is a substance with low toxcity, belonging to the III class of hazard (WHO classification).

Limiting marker of intoxication is a general toxic effect. The study of “Dose-effect” relationship identified that threshold dosage of single exposure (Limac integr) is 1500 mg/kg, while 900 mg/kg have no toxic effect (NOEL).


1. q C! ="%÷…, * C% Cå“2, ö, ä=ì. l %“*"=.: u , ì, . 1985, “. 296-297. 2. saqarTveloSi 1999-2003 wlebSi gamosayeneblad nebadarTuli pesticidebis, mcenareTa

dacvis saSualebebisa da zrdis regulatorebis sia, Tbilisi, 1999, gv. 57-59, 61, 149,158. 3. `…2,…%",÷ e .̀ ., o %ä!3ø… * `.e ., x3ö*= Š.̀ . _ Š%*“, ÷…%“2ü ìåä, , å‘ “%åä, …å…, L.

q %%K? å…, å Cå! "%å (%Kƒ%! ë, 2å! =23! / ) , …“2, 232 .*%ã, ã, å…/ , 2%*“, *%ë%ã, , , ì. k .h . l åä"åä , j , å", r *! =, …=. http://www/.medved.kiev.ua/arhiv_mg/stat_99/99_3_ 1.htm (C! %"å! å…% 04.12.2004) r d j 616.6:615.9:621.002.3.669.2

4. Š%*“, *%ìå2! , ., ì, ÷å“*, . "å? å“2", ƒ=ã! ƒ… þ? , . %*! 3›=þ? 3þ “! åä3. l %“*"=: 1986, l po Šu b , “. 65

5. Š%ä%" h . - j ë, …, ÷å“*, å ë=K%! =2%! …/ å , ““ëåä%"=…, " Cåä, =2! , , . q %-, , 1962, “. 239, 500. 6. The who recommended classification of pesticides by hazard and guidelines to classification,

199801999, p. 23. 7. d , ! å*2, "/ b n g C% *ë=““, -, *=ö, , Cå“2, ö, ä%" C% “2åCå…, %C=“…%“2, . b n g, “. 1996.

ifnbupmphjb!

CD95 antigenis eqspresiis xarisxis prognozireba qronikuli limfoiduri leikemiis dros

prof. m. zodelava,

med. mecn. kand. m. vaSaymaZe,

i. daTikaSvili-davidi

saqarTvelos saxelmwifo samedicino akademiis

hematologiisa da transfuziologiis kaTedra

sakiTxis aqtualoba: onkohematologiur daavadebaTa mkurnalobis saqmeSi arsebuli

warmatebebis miuxedavad, dRemde erT-erT umTavres problemad rCeba hemoblastozebis

qimiaTerapiisadmi mgrZnobelobis winaswari gansazRvra, rac mkurnalobis diferenciuli

taqtikis SemuSavebis saSualebas iZleva. cnobilia, rom ujredTa programuli kvdoma,

erTi mxriv, gansazRvravs mravali daavadebis paTogenezs da medikamentebis samkurnalo

efeqtic swored darRveuli apoptozis aRdgenazea damyarebuli, romelic xorcieldeba

rogorc pirdapiri, ise CD95 damokidebuli citotoqsikurobis gziT.

kvlevis mizani: kvleva miznad isaxavda erT-erTi apoptozuri markeris _ CD95/Fas/Apo-1 prognozuli mniSvnelobis dadgenas qronikuli limfoiduri leikemiis mimdinareobasa da

qimiaTerapiisadmi mgrZnobelobis winaswar SefasebaSi.

sakvlevi masala da gamoyenebuli meTodebi: pacientebi 2001-2004 wlebSi mkurnalobdnen

saqarTvelos saxelmwifo samedicino akademiisHhematologiisa da transfuziologiis

kaTedris klinikaSi.

CD95/FAS/APO-1 antigenis gansazRvra xdeboda Tbilisis saxelmwifo samedicino

universitetis imunologiis kaTedris laboratoriaSi.

dakvirvebis qveS imyofeboda 26 pacienti, romelTac CautardaT mkurnaloba leikeraniT,

fludarabiniT da `ACOP~, `CHOP~, `CHOEP~ qimiaTerapiuli sqemebis gamoyenebiT. gamokvleulTa asaki meryeobda 45-dan 80 wlamde.

daavadebis stadia ganisazRvreboda Rai klasifikaciis (1975) mixedviT. avadmyofebis

riskis jgufebad dayofa xdeboba `Rai riskis jgufebis~ Sesabamisad.

sawyis etapze, klinikur-hematologiur monacemebTan erTad, yvela pacients Cautarda

gamdinare fluorometriT (`Becton& Dickinson~) periferiuli limfocitebis CD95/FAS/APO-1 antigenis eqspresiis gansazRvra anti-Fas fluorescin-izocianatTan (FITC)-koniugirebul

Tagvis monoklonur antisxeulebis (mka) (`Dako~) gamoyenebiT.

daavadebulTa saerTo gadrCenadobis gamoTvla warmoebul iqna aqtuarialuri meTodiT

(a å! ‘ƒ*, … d .o . 1982).

miRebuli Sedegebi da maTi gansja: Fas antigenis mixedviT, avadmyofTa gadarCenadobis

Sefasebis Sedegad aRmoCnda, rom CD95 uaryofiT pacientTa (CD95<25%) saerTo

gadarCenadoba iyo 62,5%, xolo antigenis pozitiuri eqspresiisas (CD95>25%) _ 85%

(diagrama 1).

prognozuli jgufebisa da APO-1 antigenis eqspresiis mixedviT, avadmyofTa saerTo

gadarCenadobis analiziT naTeli gaxda, rom saSualo riskis jgufSi CD95 uaryofiT da

dadebiT pacientTa gadarCenadobam orive qvejgufSi Seadgina 100%, maRali riskis mqone

CD95- uaryofiT jgufSi _ 56,5%, xolo dadebiTi eqspresia metad iSviaTi iyo, ris gamoc

statistikuri analizi ver moxerxda (diagrama 2).

amrigad, Catarebuli kvlevis safuZvelze SegviZlia rekomendacia gavuwioT CD95 antigenis raodenobrivi Sefasebis gamoyenebas qronikuli limfoiduri leikemiis

mimdinareobis gansasazRvrad rogorc damoukidebeli prognozuli faqtoris, ise `Rai riskis jgufebis~ damatebiTi kriteriumis saxiT, gansakuTrebiT maRali riskis jgufis

pacientTaTvis.

o pn cmn gh pn b `mh e }jqo peqqh h `mŠh ce m` CD95 o ph upn mh )eqjn i k h l t n 0 h Š`pmn i k e i je l h h o pn t . l .l . gn d e k `b `, j `md .l e d .m`r j l . b `x`jl `d ge , h .c. d `Šh j`xb h k h -d `b h d j=-åä!= ãåì=2%ë%ã,, , 2!=…“-3ƒ,%ë%ã,, ã%“3ä=!“2"å……%L ìåä,ö,…“*%L =*=äåì, c!3ƒ,, `C%C2%“2, ÷å“*, å =…2, ãå…/ , ã! =þ2 "åä3? 3þ ! %ëü *=* " C=2%ãå…åƒå, 2=* , " %öå…*å

÷3"“2", 2åëü…%“2, * ö, 2%“2=2, ÷å“*, ì, C! åC=! =2=ì, K%ëü…/ . u k k . 0 åëüþ ! =K%2/ "ë ë%“ü "/ "ëå…, å "%ƒì%›…%L *%! ! åë ö, , ìå›ä3 .*“C! å““, åL CD95/Fas/Apo-1 =…2, ãå…= , 2å÷å…, åì u k k . l å2%ä%ì C! %2%÷…%L ö, 2%ìå2! , , “Cåö, -, ÷å“*, ì, =…2, - CD95 ì/ ø, …/ ì, =…2, ãå…=ì, C! %"%ä, ë%“ü , ƒìå! å…, å 24-÷=“%"%ã% “C%…2=……%ã% =C%C2%ƒ= Cå! , -å! , ÷å“*, . ë, ì-%ö, 2%" 26 K%ëü…/ . u k k " "%ƒ! =“2å %2 45 ä% 80 ëå2.n K? = "/ ›, "=åì%“2ü (n b ) CD95-…åã=2, "…/ . (25%) K/ ë= ! ="…= 62,5%, = C! , C%ë%›, 2åëü…%L .*“C! å““, , =…2, ãå…= - 85%. o ! , =…=ë, ƒå n b " %2äåëü…/ . Rai C! %ã…%“2, ÷å“*, . ã! 3CC=. %*=ƒ=ë%“ü, ÷2% " ã! 3CCå "/ “%*%ã% ! , “*= C! , CD95(-) n b ! ="… ë=“ü 56,5%, = C! , CD95(+) - 100%, .%2 " ã! 3CCå C! %ìå›32%÷…%ã% ! , “*= 2=*%å ! =ƒë, ÷, å …å …=Këþä=ë%“ü (100% " %Kå, . C%äã! 3CC=.). o %ë3÷å……/ å ä=……/ å “", äå2åëü“2"3þ2 % 2%ì, ÷2% C! , u k k C%ƒ, 2, "…= .*“C! å““, CD95 =…2, ãå…= "ë å2“ Kë=-ã%C! , 2…/ ì C! %ã…%“2, ÷å“*, ì -=*2%! %ì *=* “=ì%“2% 2åëü…%, 2=* , " =““%ö, =ö, , “ Rai *! , 2å! , ì, .

THE PROGNOSTIC SIGNIFICANCE OF APOPTOSIS-RELATED CD95 ANTIGEN EXPRESSION IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA

M. ZODELAVA, M. VASHAKMADZE, I. DATIKASHVILI-DAVID

Apoptosis-related proteins might play an important role in pathogenesis as wel as in estimation of sensibility to the

chemotherapeutical drugs in patients with Chronic Lymphocytic Leukemia. In the study the authors tried to find out the relation between the expression of CD95/Fas/Apo-1 antigen and clinical outcome of CLL. 24hour spontaneous apoptosis of peripherial lymphocytes on flow cytometer using specific monoclonal anti-CD95 mouse antibodies in 26 patients aged 45-80yy was measured. Fas expression proved to be a significant prognostic factor in predicting overall survival (OS) because in CD95 “-“ (<25%) pts. OS was 62,5% vs. CD95”+” _ 85%. After grouping pts. by Rai risk groups in intermediate risk-group there was no difference in Fas negative and positive cases OS (100% both), although in high risk-group the OS values differed according to the CD95 expression 56% vs. 100%. So, Apo-1 positive expression appears to be predictive of good overall survival as an independent prognostic parameter, as in association with Rai risk-groups.


1. Astar Winoto _ Cell death in the regulation of immune responses Current Opinion in Immunology 1997, 9:365-370.

2. S. Stilgenbauer and H. Dohner _ Campath-1H-Induced Complete Remission of Chronic Lymphocytic Leukemia despite p53 Gene Mutation and Resistance to Chemotherapy~ N. Engl. J. Med., August 8, 2002; 347(6): 452 - 453.

3.Lin K., Sherrington P. D., Dennis M. et al. _ Relationship between p53 dysfunction, CD38 expression, and IgVH mutation in chronic lymphocytic leukemia Blood, August 15, 2002; 100(4): 1404 - 1409.

4. Oscier D.G., Gardiner A.C. et al. _ Multivariate analysis of prognostic factors in CLL: clinical stage, IGVH gene mutational status, and loss or mutation of the p53 gene are independent prognostic factors Blood, August 15, 2002; 100(4): 1177 - 1184.

5. Peter H Krammer, Iris Behrmann et al. _ Regulation of apoptosis in the immune system Current Opinion in Immunology 1994, 6:279-289.

!

qspgjmbrujlvsj!nfejdjob

iodizebuli da vitaminizebuli Cais profilaqtikuri moqmedeba ioddeficituri mdgomareobisas

n. Wanturia, med.mecn.kand. n. filia,

biol.mecn.doqt. g.grigoraSvili

g. naTaZis saxelobis sanitariisa da higienis


iodis ukmarisobis koreqciisaTvis ori aRiarebuli meTodi arsebobs: yvelaze

gavrcelebuli kvebis produqtebis iodizeba (marili, puri, rZe da a.S.) da medikamentebis

gamoyeneba (kaliumis iodidi, antistrumini, lugolis xsnari, iodizebuli zeTi).

saqarTveloSi lokaluri ioddeficitis profilaqtikisaTvis mizanSewonilia iodis

Semcveli iodizebuli Cais gamoyeneba. am produqts iodis ukmarisobis dros zogierTi

upiratesoba gaaCnia: Cais moxmareba erT sul mosaxleze SedarebiT stabiluria. Cais

miwodeba SesaZlebelia yvelaze Soreul dasaxlebul punqtebSi. iodizebuli Cais

gamoSveba ar moiTxovs warmoebis gadawyobas da finansur xarjebs. Cven mier SemuSavebuli

iodizebuli da vitaminizebuli Cais `kolxis~ (patenti #442, saqarTvelo, 1997w.)

yoveldRiuri moxmareba adamianis organizmisaTvis iodis sadReRamiso normis miRebas

uzrunvelyofs. moxaliseebze dakvirvebis Catarebis Sedegad dadgenilia iodis

koncentraciis mniSvnelovani zrda SardSi iodizebuli da vitaminizebuli Cais

moxmarebisas (2).

winamdebare samuSaos mizans Seadgenda Cven mier SemuSavebuli iodizebuli da

vitaminizebuli Cais moqmedebis efeqturobis Seswavla studentebSi ioddeficituri

mdgomareobisas.

gamokvlevebi Catarda organizebul koleqtivSi _ universitet `iverias~ samedicino

fakultetis 30 studentis monawileobiT. studentebi, yoveldRiurad, 25 dRis

ganmavlobaSi, diliT da saRamos (2-jer dReSi), moixmardnen iodizebuli Cais _ `kolxs~,

romelic iodis miRebis ZiriTad wyaros warmoadgenda. paralelurad, SeviswavleT

studentebis faqtiuri kveba anketuri gamokiTxvis meTodiT (3,4). kvebis racionis Sefasebas

qimiuri Semadgenlobis maCveneblebis Sesabamisi cxrilebis gamoyenebiT vawarmoebdiT (1).

miRebuli monacemebi SevadareT studentebze ZiriTad nivTierebebsa da energiaze

moTxovnilebebis fiziologiur normebs.

pirveladi informaciis damuSavebasa da analizs vaxorcielebdiT kompiuteruli programis saSualebiT. avtomatur reJimSi warmoebda racionebis raodenobrivi da

Tvisobrivi Semadgenlobis gaangariSeba, aseve kvebis reJimis Sefaseba.

dakvirvebis dasawyissa da dasasrulSi yvela gamokvleuls organizmis iodiT

dakmayofilebis bioqimiuri Sefaseba Cautarda. Sefasebis kriteriums SardSi iodis

eqskreciis done warmoadgenda (5).

studentebis faqtiuri kvebis Seswavlam aCvena, rom maTi energetikuli Rirebuleba

saSualod 2014,0 kkaloriaa, rac fiziologiuri moTxovnilebis 74,6%-s Seadgens.

studentebis racionSi cilebis Semcveloba sadReRamiso normis 81,5%-s Seadgenda. amasTan,

aRiniSneboda rogorc mcenareuli, ise cxoveluri cilebis ukmarisoba. cximebisa da

naxSirwylebis raodenoba aseve daqveiTebuli iyo (Sesabamisad _ 79,8 da 68,9%). kvebis

miTiTebulma Taviseburebam, racionSi ZiriTadi sakvebi nivTierebebis disbalansi

ganapiroba: cilebis, cximebisa da naxSirwylebis Sefardebam Seadgina 1:0,92:3,4, nacvlad

rekomendebuli 1:1:4-isa. aRiniSneboda iodis ukmarisobac (44,7% fiziologiuri normidan).

studentebis racionSi ZiriTadi sakvebi nivTierebebis arabalansebuli Semcveloba,

cxoveluri cilebis ukmarisoba, mikro- da makroelementebis (upirveles yovlisa iodis)

nakleboba xels uwyobs maT organizmSi ioddeficituri mdgomareobis ganviTarebas. aRniS-

nulis sawinaaRmdegod, Cven mier studentTa sakvebad, dakvirvebis periodSi, profilaqti-

kuri saSualebis saxiT gamoyenebul iyo iodizebuli da vitaminizebuli Cai `kolxi~.

dakvirvebis Sedegebi warmodgenilia cxrilSi.

dakvirvebis dasawyisSi, studentebis Sardis gamokvlevis Sedegad, sxvadasxva xarisxiT

iodis deficiti iqna dadgenili. es ukanaskneli 30 studentidan gamovlinebuli iyo 21-Si

(70%), amasTan, 9-Si (30%) saSualo simZimis (iodis eqskreciis doniT 4,0-4,5 mkg%). iodis

normaluri eqskrecia (10,0 mkg %-ze meti) aRniSnulia mxolod 9-studentSi (30%).

rogorc cxrilidan Cans, iodizebuli da vitaminizebuli Cais moqmedebis Sedegad dakvirvebis dasasruls, sawyis monacemebTan SedarebiT, iodis Semcveloba SardSi

mniSvnelovnad (1,5-jer) izrdeboda da Seadgenda 12,0 1,25, nacvlad 7,8 0,85 mkg%-isa. amasTan, am maCveneblis zrda yvela SemTxvevaSi, deficitis simZimis sawyis xasiaTze damoukideblad aRiniSneboda.

amrigad, iodizebuli da vitaminizebuli Cais moqmedebis efeqturobis Seswavlis

Sedegebi studentebSi iodis eqskreciis statistikurad sarwmuno zrdaze miuTiTebs.

aRniSnuli, mocemuli produqtis ioddeficituri mdgomareobis koreqciisaTvis gamoye-

nebis efeqturobaze miuTiTebs. Catarebuli gamokvlevebis safuZvelze rekomendebulia

iodizebuli da vitaminizebuli Cais `kolxis~ gamoyeneba studentTa kvebaSi

ioddeficituri mdgomareobisas.

o pn t h k `jŠh )eqjn e d e i qŠb h e h n d h gh pn b `mmn cn h b h Š`l h mh gh pn b `mmn cn )`“ o ph h n d d e t h 0 h Šm{u qn qŠn �“ mh �“ u m.Š.)`mŠr ph “ , j `md .l e d .m`r j m.l .o h k h “ , d n j Š. a h n k n c. m`r j c.g.cph cn p`xb h k h mh h “=…, 2=! , , , ã, ã, å…/ , ì.c.l .m=2=äƒå r 30 “23äå…2%" , ƒ3÷å…= .--å*2, "…%“2ü , %ä, ! %"=……%ã% , ", 2=ì, …, ƒ, ! %"=……%ã% ÷= `j %ë., œ

C! , , %ääå-, ö, 2…/ . “%“2% …, .. p=“÷‘2…/ å ä=……/ å -=*2, ÷å“*%ã% C, 2=…, C%*=ƒ=ë, , ÷2% .…å! ãå2, ÷å“*= öå……%“2ü 3 “23äå…2%" "

“! åä…åì “%“2="ë å2 2014,0 **=ë, ÷2% “%%2"å2“2"3å2 74,6% -, ƒ, %ë%ã, ÷å“*%L C%2! åK…%“2, . q %äå! -›=…, å Kåë*%" " ! =ö, %…=. “23äå…2%" ä%“2, ã=ë% 81,5% %2 …%! ì/ , C! , .2%ì …=Këþä=ë“ …åä%“2=2%* Kåë*%" *=* ! =“2, 2åëü…%ã%, 2=* , ›, "%2…%ã% C! %, “.%›äå…, . j %ë, ÷å“2"% ›, ! %" , 3ãëå"%ä%" 2=*›å K/ ë% “…, ›å…% (“%%2"å2“2"å……% 79,8% , 68,9%). r *=ƒ=……/ å %“%Kå……%“2, C, 2=…, %C! åäåë ë, ä, “K=ë=…“ %“…%"…/ . C, ? å"/ . "å? å“2" " ! =ö, %…=.. må“K=ë=…“, ! %"=……%å “%äå! ›=…, å %“…%"…/ . C, ? å"/ . "å? å“2" " ! =ö, %…=., …åä%“2=2%* Kåë*=

›, "%2…%ã% C! %, “.%›äå…, , ", 2=ì, …%", ì=*! %- , ì, *! %.ëåìå…2%" (C! å›äå "“åã% , %ä=) “C%“%K“2"3å2 ! =ƒ", 2, þ L%ääå-, ö, 2…/ . “%“2% …, L. b *=÷å“2"å C! %-, ë=*2, ÷å“*%ã% “! åä“2"= K/ ë , “C%ëüƒ%"=… , %ä, ! %"=……/ L , ", 2=ì, …, ƒ, ! %"=……/ L ÷=L ̀ j %ë., œ. b …=÷=ëå …=Këþäå…, 3 “23äå…2%" %2ìå÷=ë“ äå-, ö, 2 , %ä= ! =ƒë, ÷…%L “2åCå…, . o %“ëåä…, L K/ ë

"/ "ëå… 3 21 “23äå…2= (70%), C! , ÷‘ì 3 9 (30%) “! åä…åL 2 ›å“2, “ 3! %"…åì .*“*! åö, , 4,0-4,5 ì*ã%. m%! ì=ëü…= .*“*! åö, (K%ëüøå 10 ì*ã%) %2ìå÷=ë=“ü 3 9 “23äå…2%". b *%…öå …=Këþäå…, L “%äå! ›=…, å , %ä= " ì%÷å ƒ…=÷, 2åëü…% "%ƒ! %“ë%, “%“2=", " 12,0@1,25ì*ã%,

C! %2, " 7,8@0,85 ì*ã%, C! , ÷‘ì ! %“2 …=Këþä=ë“ …åƒ=", “, ì% %2 …=÷=ëü…%L “2åCå…, äå-, ö, 2=. påƒ3ëü2=2/ , ƒ3÷å…, .--å*2, "…%“2, , %ä, ! %"=……%ã% , ", 2=ì, …, ƒ, ! %"=……%ã% ÷= `j %ë., œ

3*=ƒ/ "=þ2 …= ä%“2%"å! …%å 3"åë, ÷å…, å .*“*! åö, , , %ä= 3 “23äå…2%" , “", äå2åëü“2"3å2 %K .--å*2, "…%“2, C! , ìå…å…, ä=……%ã% C! %ä3*2= äë *%! ! å*ö, , , %ääå-, ö, 2…/ . “%“2% …, L, ÷2% C%ƒ"%ë å2 ! å*%ìå…ä%"=2ü .2%2 ÷=L " ! =ö, %…å C, 2=…, “23äå…2%" “ , %ääå-, ö, 2…/ ì “%“2% …, åì.

PROFILACTIC EFFECT OF IODIZED AND VITAMINIZED TEA IN CASE OF IODINE DEFICIENCY N.CHANTURAIA, N.PILIA, G.GRIGORASHVILI

Efficiency of iodized and vitaminized tea “Kolkhi“ in cases of iodine deficiency in 30 students was studied. Observation of actual nutrition shoved, that energetic value among the students makes 2014,0 kkal in averege, that

makes 74,6% of physiological need. Ration of the students contained 81,5% of daily norm proteins, at the same time deficiency of both, vegetable and animal proteins was observed.The levels of fets and carbohydrates were also lowered (79,8 and 68,9% respectively). These peculiarities caused disbalance of basic nutritional substances in rations.

Unbalanced content of basic nutritional substances in rations, deficiency of animal proteins, vitamins, macro- and microelements (first of all iodine) promote the development of iodine deficiency. As a preventive means the iodized and vitaminized tea “Kolkhi“ was used.

In the beginning of the research different levels of iodine deficiency was observed in 21 students (70%), 9(30%) of them had moderete level with 4,0-4,5 mkg% of exretion. Normal exretion (more than 10 mkg%) was observed in 9 students. At the end of observation period iodine level in urine significatly increased and made up 12,0±1,25 mkg%, against 7,8±0,85mkg%, that didn’t depend on the initial level of deficiency.

Thus, the study of efficiency of iodized and vitaminized tea “Kolkhi“ indicate to statistically reliable increase of iodine excretion in students and confirm successful application of the given product for correction of iodine deficiency. All above mentioned makes it possible to recommend iodized and vitaminized tea “Kolkhi“ for application in nutrition of students with iodine deficiency.


1. b %ëã=!‘" M.H., q*3!,.,… h ,l . _ Š=Kë, ö/ ., ì, ÷å“*%ã% “%“2="= C, ? å"/ . C! %ä3*2%" l . 1987, 2. 1,537“.

2. c!,ã%!=ø",ë, c.g., o =ã="= j.h ., o ,ë, m.l ., )=…23!= m.Š. _ h ƒ3÷å…, å K%ë%ã, ÷å“*%L .--å*2, "…%“2, , “C%ëüƒ%"=…, , %ä“%äå! ›=? åã% C! %ä3*2= " C, 2=…, , ÷åë%"å*= Georgian Medical News, 2004 N1(106), c.94-98.

3. qì,!…%" b .l . _ h ƒ3÷å…, å C, 2=…, *%ëëå*2, "%". j =ƒ=…ü, 1994, 123 “. 4. Achenson Ê., Gambel J., Edholm G. _ The measurement of food and energy intake in men evolution of some

techniggues. Emer. J. Clin. Nutr., 1980, v.33,p.H47-l 151. 5. Methods for measuring iodine in urine. International council for control of iodine deficiency disorders. World

Health Organization. 1993, Prented in Netherlands, 71 P.

Ubobnfespwf!ufropmphjfcj!nfejdjobTj

mwvave apendicitis laparoskopiuli diagnostika

o. kviciani, prof. g. fifia, med.mecn.kand. d. abulaZe, T. CarTolani, med.mecn.kand. j. fxalaZe, prof. m. kilaZe

saqarTvelos saxelmwifo samedicino akademiis Torakoabdominuri qirurgiis kaTedra,

Tbilisis meriis akademikos z. cxakaias saxelobis Torakoabdominuri klinika

Sromis mizani. mwvave apendiciti yvelaze gavrcelebuli mwvave muclis Rrus

qirurgiuli paTologiaa. am fonze Zalian xSiria diagnostikuri Secdomebi, ris

Sedegadac matulobs arasaWiro apendeqtomiebis ricxvi, operaciis travmatizmi, intra- da

postoperaciuli garTulebebi. Sromis mizania laparoskopiuli diagnostikis (ld)

teqnikuri aspeqtebis, Cvenebebisa da ukuCvenebebis, efeqturobis ganxilva mwvave

apendicitis mkurnalobis meTodebis optimizaciisTvis.

masala da meTodebi: Sromis masalas warmoadgens sankt-peterburgis (ruseTi)

``ëå*“=…ä! %"“*= K%ëü…, ö=-s~ gadaudebel endovideoqirurgiul ganyofilebaSi mwvave

apendicitis diagnoziT moTavsebuli 332 avadmyofi, romelTagan 311-s (93,67%) Cautarda

laparoskopiuli diagnostika da mkurnaloba, maT Soris qalebs 200-s (64,30%) da kacebs 111

(35,70%). yvela manipulacia Catarebul iqna R.Wolf-is, Karl Storz-is, Stryker-is, Aksioma-s firmebis mier warmoebuli aparaturisa da qirurgiuli instrumentebis gamoyenebiT,

zogadi endotraqeuli, venuri narkozis epiduraluri da adgilobrivi anesTeziis qveS.

pirveli Troakari muclis RruSi idgmeboda Wipis zeda an qveda ganakveTebidan

hassonis gamartivebuli modifikaciiT, rac Tavidan gvacilebda muclis Rrus ormag brma

punqcias. pnevmoperitoneumi myardeboda CO2-iT 12_14 mm (6 mm adgilobrivi anesTeziis

dros) vercxliswylis svetiT. pirvelad tardeba zogadi revizia, muclis RruSi

gamonadenis arsebobis SemTxvevaSi misi maqsimaluri aspiracia, raTa ar moxdes anTebiTi

eqsudatis sxva areebSi gadanacvleba. Semdgom etapze avadmyofis gadayvana trendelburgis

poziciaSi da gadabruneba marcxena gverdze, raTa bunebrivad momxdariyo nawlavTa

maryuJebis gadmonacvleba ileocekaluri aridan da mcire menjis Rrudan. umetes

SemTxvevaSi sasurvelia Caidgas damatebiTi 5 mm-iani Troakari marcxena TeZos fosos

areSi `rbili~ manipulatoris gamosayeneblad. damatebiTi iaraRis moxmareba aadvilebs

`dainteresebuli aris~ ukeTes vizualizacias. pirvel rigSi fasdeba peritoneumis

anTebiTi cvlilebebi, gamonadenis raodenoba da xasiaTi, Sexorcebebis ganviTareba da

gavrceleba. amis Semdeg xdeba marjvena TeZos fosos aris da mcire menjis Rrus

principuli daTvaliereba. zog SemTxvevaSi avadmyofis poziciis Secvla sakmarisia

apendeqsis dasaTvaliereblad (tipuri mdebareobisas), magram sakmaod xSirad saWiro

xdeba misi gamoTavisufleba Sexorcebebidan. Wiisebri nawlavis destruqciuli

cvlilebebisas, misi diagnostireba ar warmoadgens did sirTules da maSinve wydeba

apendeqtomiis sakiTxi laparoskopiuli an tradiciuli meTodis gamoyenebiT.

gaZlierebuli sisxlZarRvovani suraTi da mcire gamonadeni ar SeiZleba CaiTvalos

apendeqtomiis Catarebis kriteriumad. aucilebelia Sefasdes apendiqsis Rrma Sreebis

anTebiT-infiltraciuli cvlilebebi: Wiisebri nawlavis Sua nawilis iaraRiT aweviT

ganisazRvreba misi rigiduloba, apendiqsis `Camokideba~ miuTiTebs mis Rrma SreebSi

anTebiT-infiltraciuli cvlilebebis ararsebobas. Tu es ver xerxdeba SegviZlia

apdaqtiluri palpaciiT SevamowmoT misi elastikuroba. TviTon apendiqsis

rbilkbilebiani iaraRis frTxili palpaciiT SevafasoT kedlis elastikuroba, anTebiTi

cvlilebebisas SevigrZnobT kedlis momatebul simkvrives da naklebelastikurobas,

agreTve, subserozulad Cndeba wvrili sisxlCaqcevebi, rac Cveulebriv ar aRiniSneba.

Wiisebri nawlavis atipuri (retrocekaluri, retroperitoniuli) mdebareobisa da

Sexorcebebis dros. rodesac ver xerxdeba misi vizualizacia mniSvnelovania anTebis

iribi niSnebi: gaZlierebuli sisxlZarRvovani suraTi ileocekalur areSi, gamonadenis

xasiaTi da raodenoba, fibrinis arseboba; brma nawlavis, apendiqsis fuZis cvlilebebi,

klinikur-laboratoriuli monacemebi, muclis Rrus organoTa sxva paTologiis

ararseboba. saeWvo SemTxvevaSi SesaZlebelia cekumis mobilizacia, Sexorcebebis da

infiltraciis daSla diagnozis verifikaciisTvis, magram es manipulaciebi unda

Sesruldes endovideoqirurgiaSi maRalkvalificiuri da sakmao gamocdilebis mqone

qirurgis mier an gatardes tradiciuli apendeqtomia.

mwvave apendicitis diagnozis gamoricxvis Semdgom, ufro dakvirvebiT Tvalierdeboda

muclis Rrus, xolo qalebSi gansakuTrebiT mcire menjis organoebi. sxva paTologiisas

Sesabamisi mkurnaloba tardeboda profilirebul specialistTa CarTviT. sxva

paTologiisas Careva Semoifargleboda muclis Rrus (duglasis fosos) drenirebiT,

simptomaturi mkurnalobiTa da Semdgomi dakvirvebiT erTidan 2 dRemde.

Sedegebi. mwvave apendicitis diagnozi qalebSi daudasturda 93-s (46,5%). danarCen 107

avadmyofze diagnozi gadanawilda Semdegnairad: ginekologiuri paTologia 42 (39,25%),

mezadeniti serozuli gamonadeniT 46 (42,99%), sxva paTologia 10 (9,35%). paTologia ver

iqna nanaxi 8 (7.48%); erT (0.93%) SemTxvevaSi informatiuli ar iyo. mamakacebidan 72-s

(64,86%) daudasturda mwvave apendicitis diagnozi. darCenili 39-dan 15-s (38,46%)

mezadeniti, 14-s (35,90%) sxva paTologia, 8(20,51%) SemTxvevaSi paTologia ver iqna nanaxi, 2

(5,13%) SemTxvevaSi informatiuli ar iyo. `sxva paTologiebSi~ orive sqesis 24

avadmyofisTvis diagnostirebulia Semdegi: mwvave pankreatiti 9 (37,5%), 12-goja nawlavis

wylulis mifarebuli perforacia 2 (8,33%), badeqonis abscedirebuli hematoma 2 (8,33%);

mwvave qolecistiti 4 (16,67%), SexorcebiTi daavadeba erTi (4.17%); urologiuri

paTologia 4 (16,67%): msxvili nawlavis kibo 2 (8,33%).

orive jgufis 165 avadmyofs, romelTac daesvaT mwvave apendicitis diagnozi, histo-

morfologiuri gamokvleviT daudasturda 4 (2,42%) (hiper- da hipodiagnostika) Secdoma.

amaTgan, erT SemTxvevaSi dadginda qr. apendicitis diagnozi. Secdomebs arsebiTi gavlena

ar mouxdenia mkurnalobis taqtikasa da gamosavalze.

Cven mier moyvanil magaliTebSi ld-is xangrZlivoba meryeobda 5-dan 30 wuTamde.

mwvave qirurgiuli paTologiis gamoricxvis SemTxvevaSi avadmyofTa gawera

ganyofilebidan meore-mesame dRes iyo SesaZlebeli.

intraoperaciuli garTuleba diagnostirebis dros aRiniSna 3 SemTxvevaSi, sisxldena

anTebiTi qsovilebidan da gaTiSuli Sexorcebebidan (2 avadmyofi). maTi koregireba

moxda laparoskopiuladve, zedmeti Carevis gareSe. erT SemTxvevaSi aRiniSna sisxldena

damatebiTi Troakaridan _ gaikera videoasistirebiT.

gansja. ld-s CatarebisTvis arsebobs garkveuli kriteriumi da Cveneba: Tu avadmyofs

Semosvlis momentSi ar aReniSneba peritoneumis gaRizianebis simptomebi an sustadaa

gamoxatuli, amasTan dinamikuri dakvirvebis pirvel saaTebSi moexsneba an mniSvnelovnad

Seumcirdeba tkivilze Civilebi, Cveni azriT, SesaZlebelia Tavi SevikavoT ld-s

Catarebisgan. winaswar diagnostirebuli muclis Rrus abscecebis dros ld-is Catareba

aucileblobas ar warmoadgens. gul-sisxlZarRvTa mZime paTologiebis dros sasurvelia

ld gatardes mxolod sasicocxlo Cvenebebis fonze, rodesac sxva gamokvlevebi

mkurnalobis swori taqtikis gansazRvrisTvis ara efeqturia. agreTve, gavrcelebuli

peritonitisa da gadaberil nawlavTa maryuJebis fonze ld mcired informatiulia.

mraval avtorTa monacemebiT, diagnostikuri Secdomebi meryeobs 3,4% dan 6,.3%-mde

[borisovi, levinikrigeri, Surkalini, Heinzelmann-I). Cvens SemTxvevaSi SecdomaTa naklebi

raodenoba qirurgTa kvalifikaciisa da gamocdilebis matebiT unda aixsnas.

Sesadareblad SegviZlia moviyvanoT diagnostikuri Secdomebi tradiciuli

apendeqtomiebisTvis, romelic saSualod Seadgens 34-35%-s (1).

daskvna. Cveni da sxva avtorTa monacemebis SejerebiT naTelia laparoskopiis maRali

diagnostikuri Rirebuleba, rac saSualebas gvaZlevs Tavidan aviciloT arasaWiro

operaciebi, droulad davsvaT da gavataroT diferenciuli diagnozi, ganvsazRvroT paTo-

logiis xasiaTi da davgegmoT mkurnalobis optimaluri meTodi, SevamciroT operaciuli

travmatizmi da avadmyofTa medikur-socialuri reabilitaciis periodi, rac saerTo jamSi

mniSvnelovan ekonomikur efeqts iZleva.

k `o `pn qjn o h )eqj`“ d h `cmn qŠh j` n qŠpn cn ̀ o o e md h 0 h Š`

n .k . jb h 0 h `mh , o pn t . c.b . o h o h “ ,

j `md .l e d .m`r j d .Š. ̀ a r k `d ge , Š.̀ . )`pŠn k `mh , j `md .l e d .m`r j d f.o . o u`k `d ge , o pn t . l .jh k `d ge j=-åä!= 2%!=*%=Kä%ì,…=ëü…%L .,!3!ã,, ã%“3ä=!“2"å……%L ìåä,ö,…“*%L =*=äåì,, c!3ƒ,,, Š%!=*%=Kä%ì,…=ëü…= *ë,…,*= ,ì. g. 0 .=*= ìå!,, ã. ŠK,ë,“, n C, “=…= 2å.…, *= , 2=*2, *= ë=C=! %“*%C, ÷å“*%L ä, =ã…%“2, *, C=ö, å…2%" “ Cå! ", ÷…/ ì

ä, =ã…%ƒ%ì %“2! %ã% =CCå…ä, ö, 2=. o ! , "åäå… ! å2! %“Cå*2, "…/ L =…=ë, ƒ ! åƒ3ëü2=2%" 332 ä, =ã…%“2, ÷å“*, . ë=C=! %“*%C, L C=ö, å…2%" “ Cå! ", ÷…/ ì ä, =ã…%ƒ%ì %“2! %ã% =CCå…ä, ö, 2=. d , =ã…%“2, ÷å“*, å *! , 2å! , , "*ëþ÷=ë, ì=*! %“*%C, ÷å“*, å ä=……/ å "/ äåëå…, L " K! þø…%L C%ë%“2ü, "%“C=ë, 2åëü…/ å , ƒìå…å…, “2å…*, ÷å! "å%K! =ƒ…%ã% %2! %“2*= , ä! . påƒ3ëü2=2/ =…=ë, ƒ= C%*=ƒ=ë, , ÷2% 3 46% C=ö, å…2%" ›å…“*%ã% C%ë=, , ìå"ø, å =…=ë%ã, ÷…3þ “ %“2! / ì =CCå…ä, ö, 2%ì *ë, …, ÷å“*3þ *=! 2, …3 “2! =ä=ë, ä! 3ã, ì, ƒ=K%ëå"=…, ì, K! þø…%L C%ë%“2, , ì=ë%ã% 2=ƒ=. h “.%ä , ƒ .2%ã%, ä, =ã…%“2, ÷å“*= öå……%“2ü ë=C=! %“*%C, , "å“üì= ƒ…=÷, 2åëü…= , , C% ì…å…, þ ="2%! %", ìå2%ä ì%›…% Kåƒ %“%K/ . -, …=…“%"/ . ƒ=2! =2 “"%K%ä…% "…åä! , 2ü " %K? å., ! 3! ã, ÷å“*3þ *ë, …, *3, , ìåþ? åL .ëåìå…2=! …%å 2å.…, ÷å“*%å %“…=? å…, å äë C! %"åäå…, ë=C=! %“*%C, ÷å“*, . C! %öåä3! .

LAPAROSCOPIC DIAGNOSTICS OF ACUTE APPENDICITIS O. KVITSIANI, G. PIPIA, D. ABULADZE, M. CHARTOLANI, J. PKHALADZE, M. KILADZE

Techniques and tactical management of laparoscopic diagnostics for patients having primary diagnosis of acute appendicitis are described. Retrospective analysis of the results of 332 cases of laparoscopic diagnostic procedures on patients with primary diagnosis of acute appendicitis are given. Diagnostic meausremets include macroscopic evaluation of abdoinal effusion, apendix wall inflammatory changes and etc. The results have shown that in 46% of female patients different than appendicitis pathology occurred, with strong resemblance of clinical picture with appendicitis. Therefore, laparoscopic diagnostic method has very high evaluating capability and it can be easily implemented and carried out in any general surgical facility that is equipped with basic logistics for laparoscopy.


1. dixaminjia k., fifia e., maWavariani S. _ Secdomebi da garTulebani qirurgiaSi,

praqtikuli saxelmZRvanelo, 1974w. 2. c=ëë,…ãå! ~.h ., Š,ì%ø,… `.d . _ k =C=! %“*%C, ÷å“*= =CCå…ä.*2%ì, (C! =*2, ÷å“*%å

! 3*%"%ä“2"%). l .: l åä, ö, …=, 1993. “.16 3. j!,ãå! ̀ .c., x3!*=ë,… a .j., x%ãå…%" ̀ .̀ ., p›åK=å" j.e . _ k =C=! %“*%C, = " ä, =ã…%“2, *å %“2! %ã%

=CCå…ä, ö, 2=. u , ! 3! ã, , 18, 2000 “.14 4. a %!,“%" `.e , k å",… k .b . _ b , äå%.å…ä%“*%C, ÷å“*, å "ìåø=2åëü“2"= …= %! ã=…=. ›, "%2= ,

ƒ=K! þø, ……%L C%ë%“2, , p3*%"%ä“2"% äë "! =÷åL, 2002 5. Heinnzelmann M. Simmen H.P. Cummins A.S. _ Laparoscopic appendectomy the new “gold standart”–

Arch.surgery 1995. 6. Yao C.C. Lin C.S. Yang C.C. _ lapar. appendectomy; Surg. Lapar. Endosc. Percut. Tech. 1999.

laparoskopiuli apendeqtomia _ teqnikuri aspeqtebi

prof. g. fifia, o. kviciani, med.mecn.kand. d. abulaZe, prof. m. kilaZe, T. CarTolani, med.mecn.kand. j. fxalaZe

saqarTvelos saxelmwifo samedicino akademiis Torakoabdominuri qirurgiis kaTedra,

Tbilisis meriis akademikos

z. cxakaias saxelobis Torakoabdominuri klinika

Sromis mizani. mwvave apendiciti garTulebebis maRali maCvenebliT Tanamedrove

qirurgiis aqtualur problemad rCeba. Sromis mizania laparoskopiuli apendeqtomiis

teqnikuri aspeqtebis ganxilva operaciis etapebis Sesrulebis taqtikuri da teqnikuri

aspeqtebis optimizaciis, operaciis usafrTxod Catarebis, operaciisSemdgomi uaxlesi da

Soreuli Sedegebis gaumjobesebisa da mkurnalobis TviTRirebulebis Semcirebis mizniT.

masala da meTodebi. sakvlev masalas warmoadgens Tbilisis #1 klinikuri

saavadmyofos akad. z. cxakaias saxelobis Torakoabdominur klinikaSi 1999 wlidan 2004

wlamde da sankt-peterburgis (ruseTi) ``ëå*“=…ä! %"“*= K%ëü…, ö=-s~ gadaudebel

endovideoqirurgiul ganyofilebaSi mwvave apendicitis diagnoziT laparoskopiulad

operirebuli 180 avadmyofi. yvela operacia Sesrulda R.Wolf-is, Karl Storz-is, Stryker-is, Aksioma-s firmebis mier warmoebuli aparaturisa da qirurgiuli instrumentebis

gamoyenebiT, endotraqeuli da spinaluri anesTeziis qveS.

pirveli Troakaris Cadgmis teqnika da pnevmoperitoniumis damyareba xdeboda hassonis

meTodis modifikaciiT 8-dan (epiduruli anesTeziisas) 14 mm vercxliswylis svetiT.

Troakarebis ganlageba pirobiTad warmodgenilia 2 meTodad: 1. Troakarebi (10 mm marjvniv

da 5mm marcxniv) ganlagebulia orive TeZos fosoSi, upiratesad boqvenis mxares, 10 mm-

iani videokamerisTvis Wipis areSi. kosmetikuri efeqtis gasaZliereblad, SesaZlebelia

samuSao Troakarebi Tmis zrdis doneze Caidgas. 2. meTodSi videokameris ganlageba

identuria, marcxena TeZos fosoSi da marjvena mezogastriumSi _ 5 mm-iani Troakarebi.

orive meTodiT uzrunvelyofilia Wiisebri nawlavis sruli vizualizacia da operaciuli

midgoma. jorjlisa da takvis mobilizacia da gadakveTa Cven mier moyvanil

magaliTebidan 3 SemTxvevaSi moxda ENDO-GIA-Ti. es meTodi, mravali avtoris azriT,

yvelaze usafrTxoa, magram instrumentis erTjeradoba da misi maRali Rirebuleba

mniSvnelovnad zrdis apendeqtomiis Rirebulebas. erT SemTxvevaSi moxda takvis

klipireba, 11 SemTxvevaSi ENDO-LOOP-is meSveobiT. Cven mier moyvanil 165 SemTxvevevaSi

gamoyenebulia takvis ligirebis meTodi. yvela am SemTxvevaSi jorjlis damuSaveba

ganxorcielda mono- da bipolaruli koagulaciiT, arteriis damatebiTi klipirebiT.

gadaudebel endovideo qirurgiul ganyofilebaSi moyvanili magaliTebidan yvela SemT-

xvevaSi takvis ligireba xdeboda intrakorporuli kvanZis gamoyenebiT. aseve SesaZlebelia

jorjlis ligireba (40 avadmyofi) an jorjlis bi- da monopolaruli koagulaciiT

damuSaveba. 5 SemTxvevaSi gamoyenebul iqna eqstra- da intrakorporuli kvanZebis SerwymiT

rederis maryuJis modifikacia. orive manipulaciis saSualo xangrZlivoba ar aRemateba

erT wuTs, maTi gamoyeneba damokidebulia qirurgis arCevanze. amave dros, sasurvelia

takvis `Cayursva~ brmanawlavsa da peritoniumis pariesul furcels Soris, rac

uzrunvelyofs lokaluri Sexorcebis ganviTarebas da Tavidan gvacilebs takvTan muclis

Rrus organoebis Sexorcebas. rogorc wesi, apendiqsis gadakveTa (kvanZidan ara uSores 5

mm da ara uaxloes 3 mm) xorcieldeboda makratliT da lorwovani muSavdeboda

koagulaciiT, alternatiulad SesaZlebelia takvis iodiT damuSaveba. takvis koagula-

ciiT damuSavebisas, ar unda moxdes misi hiperkoagulacia (`dawva~), ramac SeiZleba kvanZis

moZroba gamoiwvios (intraoperaciulad, ukeTes SemTxvevaSi, an postoperaciulad), rac

mZime garTulebebis mizezi SeiZleba gaxdes. antegraduli apendeqtomiebis intrakorpo-

ruli kvanZebiT Sesrulebisas, arc erT SemTxvevaSi Wiisebri nawlavis distalur nawilze

meore kvanZi ar iqna dadebuli. igi gadakveTisTanave Tavsdeboda konteinerSi, rasac

saoperacio aris dabinZureba minimumamde dahyavda. meore kvanZis dadeba gamoiyeneboda

retrograduli apendeqtomiebis Sesrulebis dros.

pirvel meTodSi konteineris gamotana xorcieldeboda marjvena TeZos fosos aridan 10

mm-iani Troakaris gamoyenebiT an Wrilobis mcired gafarToebiT. meore meTodisas,

marcxena TeZos fosos aredan 5 mm-iani Troakaris Wrilobis gafarToebiT. sanacia srul-

deboda mxolod destruqciuli apendicitebis dros mniSvnelovani Cirqovani

gamonadenisas. yvela sxva SemTxvevaSi siTxis aspiracia sakmarisad iyo miCneuli, sanaciis

dros inficirebuli gamonadenis muclis Rrus sxva areebSi gauvrceleblobis

TvalsazrisiT. mcire raodenobis siTxis aspiraciisTvis eleqtrosaqaCi ar gamoiyeneboda,

pnevmoperitoniumi uzrunvelyofda drenaJidan siTxis aqtiur TviTdinebas, es manipulacia

xorcieldeboda videokontroliTa da drenaJis mizanmimarTuli gadaadgilebiT.

Sedegebi. laparoskopiuli diagnostikiT (ld) mwvave apendicitis diagnozis

dadasturebis Semdeg, laparoskopiulad gakeTebulia 175 apendeqtomia. maT Soris

kataruli apendicitis diagnoziT 3 (1.71%), flegmonuriT _ adgilobrivi peritonitis

gareSe 78 (44.57%), adgilobrivi peritonitiT 69 (39.42%), gangrenozuliT _ 14 (8%),

gangrenozul-perforaciuli formiT _ 4 (2.29%). destruqciuli formebis garkveul

nawilSi 116 (67.05%) aRiniSnebida rbili infiltracia an Sexorcebebi, romelTa

koregireba SesaZlebeli iyo laparoskopiuli meTodiT. 4 (2,29%) laparoskopiuli apendi-

citis (lap) dros moxda konversia tradiciul meTodze sisxldenis, muclis Rrus

organoebis dazianebis (eleqtrodamwvroba, sxva meqanikuri dazianeba), teqnikuri

sirTuleebis gamo. saerTo jamSi, laparoskopiuli apendeqtomia mwvave apendicitis gamo,

Sesrulebul iqna 164 (93.71%); maT Soris 6 (3,66%) avadmyofs apendeqtomiasTan erTad,

Cautarda ginekologiuri operaciebi.

ld-s Sedegad 7 (4%) avadmyofs Cautarda tradiciuli apendeqtomia, am SemTxvevebSi

sazardulis Tiaqris transabdominaluri plastikis ZiriTad Cvenebebad CaiTvala

ileocekalur areSi mravlobiTi Sexorcebebis da infiltraciis arseboba, apendiqsis

mdebareoba (retroperitoniuli, retrocekaluri, intramuraluri), mkvrivi apendikuluri

infiltratebi, apendikuluri da paraapendikuluri abscesebi, destruqculi apendiciti

perforaciiT, fuZesTan difuzuri Cirqovani peritonitiT. apendeqtomiaTa absolituri

umravlesoba Catarda makburneis ganakveTiT, zog SemTxvevaSi laparoskopiuli asis-

tirebiT, muclis Rrus sanacia-irigaciisa da drenirebis ukeTesi SesaZleblobebis gamo.

5 avadmyofze Catarda laparoskopiuli apendeqtomia (lap) rogorc simultanuri

operacia, damatebiTi Troakarebis gamoyenebis gareSe (qolecisteqtomia 4; TAAP-I 1), yvela

SemTxvevaSi diagnozi iyo qronikuli apendiciti. operacia ganpirobebuli iyo avadmyofis

surviliT da xSiri tkivilebiT ileocekalur areSi. lap-isas intraoperaciuli

garTulebebidan or SemTxvevaSi aRiniSna nawlavTa Termuli dazianeba, erT SemTxvevaSi

_ wvrili nawlavis travmuli uxeSi dazianeba konteineris evakuaciis dros. Wiisebri

nawlavis perforacia misi mobilizaciisas aRiniSna 4 SemTxvevaSi, intraoperaciuli

sisxldena _ 2 SemTxvevaSi. intraoperaciuli garTulebebis saerTo raodenoba Seadgens

5.49%-s.

mosalodnel intraoperaciul garTulebebs SegviZlia mivceT Semdegi klasifikaciis

saxe:

1. nawlavis kedlis dazianeba:

a) Termuli dazianeba,

b) perforacia iaraRis wveriT,

g) kbiliani iaraRiT uxeSi nafleTovani dazianeba.

2. sisxldena:

a) apendiqsis jorjlidan,

b) anTebiTi infiltrirebuli qsovilebidan,

g) peritoniumis kedlidan.

3. Wiisebri nawlavis fragmentacia;

4. Wiisebri nawlavis mowyveta fuZidan;

5. takvis hiperkoagulacia;

6. infeqciis moTesva mTel muclis RruSi.

saerTo fonze sakmaod sainteresoa 15 avadmyofze Catarebuli dakvirveba. yvela maTgans

erTidan 6 wlamde intervalSi Cautarda laparotomia. Cveni dakvirvebis periodSi, imave

ganyofilebaSi, maT gaukeTdaT ganmeorebiTi laparoskopiuli operacia sxva diagnozebis

(qronikuli da mwvave kalkulozuri qolecistiti _ 14, sazardulis Tiaqari _ erTi).

postoperaciul Sexorcebebs pirobiTad SeiZleba mivceT Semdegi klasifikacia:

1. lokaluri _ brmanawlavsa da peritoniumis pariesul furcels Soris (moicavda

mxolod takvis ares).

2. adgilobrivi: I xarisxis _ brmanawlavsa da muclis Rrus erT organos Soris. ar

scildeba marjvena TeZos fosos ares;

II xarisxis _ brmanawlavsa da muclis Rrus erT an or (mcire menjis) organos Soris

peritoniumis pariesul furcelTan erTad.

3. totaluri: I xarisxis _ moicavs mTeli muclis Rrus qveda naxevars,

II xarisxi _ moicavs mTel muclis Rrus.

am klasifikaciis mixedviT, lokalurSi ganTavsda 9 avadmyofi, adgilobrivis I xarisxSi

_ 5, II xarisxSi _ erTi avdmyofi. Tu am pirobiTi klasifikaciiT ganvsjiT, Soreuli

SedegebiT postoperaciul areSi ganviTarebuli Sexorcebebi friad mcirea.

operaciebis saSualo xangrZlivobam laparoskopiuli apendeqtomiisTvis Seadgina 45

wuTi, mkurnalobis saSualo xangrZlivobam 2,5 _ 3 sawoldRe.

mravali ucxoeli avtori gvTavazobs apendicitis eqstraperitoniul meTods, rodesac

apendiqsis da cekumis gamotana muclis Rrudan xdeba 12 mm-iani Troakaris an

minilaparotomiuli Wrilobidan. es meTodi mimarTulia apendeqtomiis gasaiafeblad. zogi

avtori 2 TroakariT operaciis Sesrulebis SesaZleblobasac aRniSnavs, magram es meTodi

gansakuTrebiT SezRudulia fiqsirebuli cekumisa da Sexorcebebis SemTxvevaSi. aseve

videoasistirebiT Sesrulebuli apendeqtomiebisas ikargeba is efeqti, rac zogadad

laparoskopiuli operaciebisTvisaa damaxasiaTebeli.

daskvna. Cveni azriT, mowodebuli taqtikuri da teqnikuri aspeqtebis gaTvaliswinebiT,

meTodi SeiZleba zogadqirurgiul klinikaSi didi finansuri danaxarjebis gareSe

dainergos, sadac ukve arsebobs laparoskopiuli qirurgiis Tundac SedarebiT mcire

gamocdileba da elementaruli materialur-teqnikuri baza.

Še umh )eqjh e ̀ qo ejŠ{ k `o `pn qjn o h )eqjn i d h `cmn qŠh jh n qŠpn cn ̀ o o e md h 0 h Š` o pn t . c.b .o h o h “ , n .k . jb h 0 h `mh , j `md .l e d .m`r j d .Š. ̀ a r k `d ge , o pn t . l .jh k `d ge Š.̀ . )`pŠn k `mh , j `md .l e d .m`r j d f.o . o u`k `d ge j=-åä!= 2%!=*%=Kä%ì,…=ëü…%L .,!3!ã,, ã%“3ä=!“2"å……%L ìåä,ö,…“*%L =*=äåì,, c!3ƒ,,, Š%!=*%=Kä%ì,…=ëü…= *ë,…,*= ,ì. g. 0 .=*= ìå!,, ã. ŠK,ë,“, o ! , "åäå… ! å2! %“Cå*2, "…/ L =…=ë, ƒ ! åƒ3ëü2=2%" ëå÷å…, 332 C=ö, å…2%" “ Cå! ", ÷…/ ì ä, =ã…%ƒ%ì

%“2! %ã% =CCå…ä, ö, 2=, C%ä"å! ãø, .“ ë=C=! %“*%C, ÷å“*%ì3 ìå2%ä3 ä, =ã…%“2, *, , ëå÷å…, " 2%ì ÷, “ëå 180 “ë3÷=å" ë=C=! %“*%C, ÷å“*%L =CCå…ä.*2%ì, , . n C, “=…= 2å.…, *= , 2=*2, *= ë=C=! %“*%C, ÷å“*%L =CCå…ä.*2%ì, , , "*ëþ÷= %“%Kå……%“2, ë, ã, ! %"=…, K! / ›å, *, , *3ëü2, ÷å! "å%K! =ƒ…%ã% %2! %“2*=, “=…=ö, , K! þø…%L C%ë%“2, , ä! . d , =ã…%“2, ÷å“*= 2%÷…%“2ü, %“ë%-›…å…, , äë, 2åëü…%“2ü …=.%›äå…, " “2=ö, %…=! å, %K? , L .*%…%ì, ÷å“*, L .--å*2 C! , ë=C=! %“*%C, ÷å“*%ì ìå2%äå ëå÷å…, , ìåå2 “3? å“2"å……/ å C! å, ì3? å“2"=. o ! , "åäå…= %! , ã, …=ëü…= *ë=““, -, *=ö, %“ë%›…å…, , C! , ë=C=! %“*%C, ÷å“*%L =CCå…ä.*2%ì, , , %C, “=…/ C32, , . C! åä3C! å›äå…, . l å2%ä ì%›…% Kåƒ %“%K/ . -, …=…“%"/ . ƒ=2! =2 ø, ! %*% "…åä! , 2ü " %K? å., ! 3! ã, ÷å“*3þ *ë, …*3 “ .ëåìå…2=! …/ ì 2å.…, ÷å“*, ì %“…=? å…, åì äë ë=C=! %“*%C, ÷å“*%L ., ! 3! ã, , .

LAPAROSCOPIC APPENDECTOMY – TECHNICAL ASPECTS G.PIPIA, O. KVITSIANI, D. ABULADZE, M. KILADZE M. CHARTOLANI, J. PKHALADZE

Retrospective analisis of the results of treatment of 332 patients with primary diagnosis of acute appendicitis submitted to laparoscopic method of diagnosis and treatment including 180 cases of laparoscopic appendectomyare presented. Different techniques and tactics for laparoscopic appendectomy including peculiar techniques for mezoappendix control and apendicular stump ligationa, abdominal cavity washings and etc.are described. Diagnostic accuracy, complications, hospital stay, economic efficiancy in case of laparoscopic method of treatment has real advantage. Unique classifications of complications peculiar to laparoscopic appendectomy and ways for their prevention are presented.

The authors propose that laparoscopy should be considered as the method of choice in the treatment of patients with primary diagnosis of acute appendicitis. The method can be easily installed in any general surgical facility that is equipped with basic logistics for laparoscopy.


1. dixaminjia k., fifia e., maWavariani S. _ Secdomebi da garTulebani qirurgiaSi.

praqtikuli saxelmZRvanelo, 1974w. 2. c=ëë,…ãå! ~.h ., Š,ì%ø,… `.d . _ k =C=! %“*%C, ÷å“*= =CCå…ä.*2%ì, (C! =*2, ÷å“*%å

! 3*%"%ä“2"%). l .: l åä, ö, …=, 1993. “.16 3. j!,ãå! ̀ .c., x3!*=ë,… a .j., x%ãå…%" ̀ .̀ ., p›åK=å" j.e . _ k =C=! %“*%C, = " ä, =ã…%“2, *å %“2! %ã%

=CCå…ä, ö, 2=. u , ! 3! ã, , 18, 2000 “.14 4. a %!,“%" `.e , k å",… k .b . _ b , äå%.å…ä%“*%C, ÷å“*, å "ìåø=2åëü“2"= …= %! ã=…=. ›, "%2= ,

ƒ=K! þø, ……%L C%ë%“2, , p3*%"%ä“2"% äë "! =÷åL, 2002. 5. Heinnzelmann M. Simmen H.P. Cummins A.S. _ Laparoscopic appendectomy the new “gold standart”

– Arch.surgery 1995. 6. Yao C.C. Lin C.S. Yang C.C. _ lapar. appendectomy; Surg. Lapar. Endosc. Percut. Tech. 1999.

bcepnjobmvsj!rjsvshjb

ozonTerapia abdominalur qirurgiaSi

g. lomsaZe, prof. b. arCvaZe, v. lomsaZe, g. saCaleli

goris qirurgiuli klinika ìmedi~, Tbilisis saxelmwifo samedicino universitetis

#1 klinikuri saavadmyofo

ozonTerapia _ Tanamedrove aramedikamenturi mkurnalobis meTodia, romelic efeqturad

gamoiyeneba medicinis sxvadasxva dargSi. mas axasiaTebs gamoyenebis simartive, maRali

efeqturoba, ekonomikuri mizanSewoniloba. amasTan, ozonTerapias praqtikulad ar gaaCnia

gverdiTi movlenebi. misi gamoyeneba SesaZlebelia rogorc damoukideblad, ise

medikamentebTan erTad, romelTan kombinaciaSi axdens am medikamentebis moqmedebis

potencirebas.

ozonis, rogorc Jangbadis izotopis aRmoCena XVIII saukunis bolos moxda. 1785 wels,

holandielma fizikosma, Van Marum, JangbadSi eleqtruli muxtis gatarebis dros,

yuradReba miaqcia uCveulo suns, romelic Tan axlda eleqtrul manqanaSi warmoSobil

naperwklebs da mas èleqtruli nivTierebis suni~ daarqva. 1840 wels, Sveicarielma

mecnierma, Schonbein aRmoaCina, rom wylis eleqtrolizis dros gamoyofili Jangbadi da

Jangbadi, romelSic eleqtrul muxtebs atarebda, icvlida Tvisebebs. Schonbein es movlena

gansakuTrebuli airis gamoyofas daukavSira da mas ozoni daarqva (berZnulidan òzein~ _ `suniani~). mogvianebiT Delarive-m da Mariniak-ma daamtkices, rom ozoni Jangbadis

alotropuli formaa. 1848 wels, Hant-ma gamoTqva mosazreba, rom ozoni samatomian

Jangbads warmoadgenda. 1873 wels, Foke-m SeamCnia mikroorganizmebis daRupva ozonis

zemoqmedebis Sedegad. 1896 wels, gamomgonebelma Tesla-m ozonis pirveli generatori

daapatenta.

1911 wels M. Eberhart iyenebda ozons tuberkulozis, anemiis, pnevmoniis, diabetisa da sxva

daavadebebis samkurnalod. pirveli msoflio omis dros, Wolff iyenebda Jangbad-ozonis

narevs rogorc adgilobriv samkurnalo saSualebas rTuli motexilobebis, Cirqovani

Wrilobebis, nawolebis, abscesebis, flegmonebisa da osteomielitebis dros. meore

msoflio omis Semdeg, ozonis samkurnalo Tvisebebis Seswavla ramdenime aTwleuliT

SeCerda, rac aixsneba antibiotikebis aRmoCeniT, kompaqturi ozonis generatorebisa da

ozongamZle masalebis ararsebobiT.

70-ni wlebis dasawyisSi naTeli gaxda, rom antibiotikebi srulad ver wyveten Cirqovan-

septikuri daavadebebis problemas. am faqtis aRiarebam biZgi misca ozonTerapiis

meTodebis daxvewas axal samecniero-teqnikur doneze.

amJamad, ozonTerapia farTod gamoiyeneba mTel msoflioSi, gansakuTrebiT germaniaSi,

SveicariaSi, safrangeTSi, italiaSi, ruseTsa da kubaSi. 1979 wels daarsda

ozonTerapevtebis saerTaSoriso samedicino sazogadoeba. Catarda 12 saerTaSoriso

kongresi ozonTerapiaSi, gamocemulia praqtikuli saxelmZRvaneloebi [4]. sadReisod, ozonTerapia gamoiyeneba qirurgiaSi, TerapiaSi, ginekologiaSi,

dermatologiaSi, stomatologiaSi, reanimatologiaSi, onkologiaSi, kosmetologiaSi,

infeqciuri da veneruli daavadebebis samkurnalod.

ras warmoadgens ozoni?

ozoni _ O3 Jangbadis alotropuli formaa. is bevrad ufro Zlieri damJangavia, vidre

TviTon Jangbadi da warmoadgens mZafr, damaxasiaTebeli sunis mqone airs. ozonis

gamoyeneba dafuZnebulia mis damJangav, madezinficirebel da baqtericidul Tvisebebze [2]. ozonTerapiis paTogenetikuri efeqti ganpirobebulia ozonis maRali damJangav-aRdgeniTi

potencialiT, rac uzrunvelyofs misi moqmedebis ormag meqanizms:

I. lokaluri: dezinfeqciuri aqtivoba baqteriebis, virusebisa da sokoebis mimarT, rac

dakavSirebulia maTi garsis mTlianobis darRvevasTan fosfolipidebis da

lipoproteidebis daJangvis, polipeptidebis jaWvebisa da proteinebis dazianebis Sedegad.

II. sistemuri: metaboluri moqmedeba plazmis cilovan-lipiduri kompleqsebis mimarT,

rac iwvevs PO2-is momatebas, biologiurad aqtiuri nivTierebebis stimulirebas, imunur-

kompetenturi ujredebis aqtiurobis gaZlierebas, sisxlis reologiuri Tvisebebisa da

Jangbadis transportirebis funqciis gaumjobesebas.

Terapiul dozebSi ozoni moqmedebs rogorc imunomastimulebeli, anTebis

sawinaaRmdego, baqtericiduli, fungiciduri, antivirusuli, citostatikuri,

antistresuli da analgetikuri saSualeba [3,5]. aRniSnuli garemoeba saSualebas gvaZlevs warmatebulad gamoviyenoT ozonTerapia

muclis Rrus infeqciur-Cirqovani procesebis dros.

dReisaTvis arsebobs ozonis gamoyenebis Semdegi meTodebi:

ozonis airis saxiT garegani gamoyeneba.

ozon-Jangbadis narevis airis saxiT reqtaluri insuflacia.

ozonirebuli zeTebis adgilobrivi gamoyeneba.

ozonirebuli wylis enteraluri gamoyeneba.

didi da mcire autohemoTerapia ozon-Jangbadis narevis gamoyenebiT.

muclis Rrus intraoperaciuli sanacia ozonSemcveli xsnarebiT.

peritoneuli lavaJi da dializi ozonSemcveli xsnarebiT.

ozonirebuli fiziologiuri xsnaris intravenuri infuziebi.

ozonis toqsikuroba ZiriTadad ganpirobebulia misi zemoqmedebiT sasunTq gzebze.

amitomac, ozonTerapiis inhalaciuri meTodebi, romlebic 60-70 ww. gamoiyeneboda, amJamad

praqtikidan amoRebulia [1]. ozonTerapiisaTvis ukuCvenebebs warmoadgens: 1) hiperTireozi; 2) sisxlis Sededebis

unaris daqveiTeba; 3) mwvave pankreatiti; 4) miokardiumis mwvave infarqti; 5) hemoragiuli

insulti; 6) sisxldena; 7) mwvave alkoholuri fsiqozi; 8) individuri hiper-mgrZnobeloba

ozonis mimarT.

ozonTerapiaSi ZiriTadad gamoiyeneba ozon-Jangbadis narevi. ozonis koncentraciis

maCveneblebi ozon-Jangbadis narevSi, rogorc wesi, miTiTebulia Semdeg sazom

erTeulebSi: 1 mkg/ml=1 mg/l=1000 mkg/l=1g/m³=1 g (gamma). goris qirurgiuli klinikis `imedis~ bazaze arsebuli rusuli warmoebis ozonator

“j "=ƒ=! B-is meSveobiT ozonTerapia gamoiyeneba Cirqovan-septikuri procesebis

profilaqtikasa da mkurnalobaSi, Semdegi meTodebiT:

1. ozonirebuli fiziologiuri xsnaris intravenuri infuziebi;

2. muclis Rrus intraoperaciuli sanacia furacilinis ozonirebuli xsnariT;

3. operaciisSemdgomi peritoneuli lavaJi da dializi ozonirebuli xsnarebiT;

4. mcire da didi autohemoTerapia ozon-Jangbadis narevis gamoyenebiT.

gavrcelebuli peritonitebis dros gamoiyeneba oTxive meTodis kombinacia. muclis

Rrus sanaciisaTvis Cven viyenebT 5-10 l. furacilinis ozonirebul xsnars (ozonis

koncentracia _ 4000-6000 mkg/l). muclis Rrus gamorecxva xorcieldeba 20-40 wuTis ganmav-

lobaSi, uSualod peritonitis mizezis likvidaciisTanave. intraoperaciuli sanacia

tardeba erTjeradad. laparotomias vasrulebT muclis Rrus drenirebiT,

operaciisSemdgomi peritoneuli lavaJisa da dializis Casatareblad. peritoneuli

lavaJis pirveli seansi tardeba operaciis dasrulebidan 4-6 saaTis Semdeg, risTvisac

viyenebT 500-1000 ml furacilinis ozonirebul Tbil xsnars. peritoneuli lavaJi

sruldeba muclis RruSi 2 l. ozon-Jangbadis narevis SeyvaniT, airis saxiT (ozonis

koncentracia _ 1000-2000 mkg/l). amis Semdeg, 3-5 saaTis ganmavlobaSi, muclis RruSi

wveTovnad Segvyavs ozonirebuli fiziologiuri xsnari. yovel 1000 ml ozonirebul

fiziologiur xsnars vumatebT 5, 6 g. natriumis laqtats, 0, 26 g. kalciumis qlorids da

0, 15 g. magniumis qlorids. mkurnalobis cikls vimeorebT kidev 2-jer, 4-6 saaTis da 10-12

saaTis Semdeg. peritoneuli lavaJi da peritoneuli dializi saSualod 72 saaTs

grZeldeba.

intravenur infuziebs vatarebT 200 ml ozonirebuli fiziologiuri xsnariT, ozonis

koncentraciiT 25 mkg/kg wonaze. ori gadasxma keTdeba zedized, dReSi erTxel, Semdeg ki

_ dRegamoSvebiT, sisxlis Sededebis drois kontrolis qveS (saSualod _ 5-8 infuzia).

ozonTerapiis efeqturobis gamosavlenad, CavatareT klinikuri dakvirveba pacientTa 2

jgufze. pirvel jgufSi CavrTeT pacientebi, operirebulebi sxvadasxva genezis

gavrcelebuli peritonitis gamo, mkurnalobis tradiciuli meTodebiT: infeqciis keris

likvidacia, muclis Rrus sanacia da drenireba, masiuri antibiotikTerapia, wyal-

eleqtrolituri balansis koreqcia, imunomastimulebeli Terapia. meore jgufs

Seadgendnen analogiuri daavadebebisa da simZimis paTologiuri procesebis mqone

pacientebi, romlebsac, tradiciuli mkurnalobis garda, ozonTerapiac utardebodaT.

kerZod: muclis Rrus intraoperaciuli sanacia da peritoneuli lavaJi furacilinis

ozonirebuli xsnariT, peritoneuli dializi ozonirebuli fiziologiuri xsnariT,

autohemoTerapia ozon-Jangbadis narevis gamoyenebiT, ozonirebuli fiziologiuri

xsnaris intravenuri infuziebi.

aRsaniSnavia, rom klinikuri dakvirvebisaTvis orive jgufSi avarCieT is pacientebi,

romlebsac CautardaT laparotomia ukvearsebuli gavrcelebuli peritonotis pirobebSi,

e. i. operaciis Semdgomi Cirqovani garTulebebis maRali albaTobiT.

ozonTerapiis gamoyenebisas ukeTesi Sedegebi miviReT, vidre peritonitis tradiciuli

meTodebiT mkurnalobisas, rogorc calke aRebuli daavadebebis SemTxvevaSi, ise

Semajamebel maCveneblebSi.

106 pacientisagan Semdgar pirvel jgufSi, peritonitis movlenebis gagrZelebisa da

nawlavTaSorisi abscesebis Camoyalibebis gamo, 18 pacients Cautarda 22 relaparotomia

(20, 7%).

meore jgufSi, romelic 119 pacientisagan Sedgeboda, amave garTulebebis gamo,

Catarebulia 9 relaparotomia, Tanac rerelaparotomia arc erT pacients ar dasWirvebia

(ix. cxrili).

amrigad, Cirqovan-septikuri procesebis mkurnalobisas ufro efeqturia ozonTerapiisa

da tradiciuli meTodebis kombinirebuli gamoyeneba. ozonTerapia mniSvnelovnad amcirebs

operaciisSemdgomi Cirqovani garTulebebis ganviTarebis risks, aferxebs paTologiuri

procesis generalizaciasa da xels uwyobs relaparotomiebis ricxvisa da sikvdilianobis

Semcirebas.

n gn mn Še p`o h “ b ̀ a d n l h m`k |mn i u h pr pch h c. k n l q`d ge , o pn t . a . ̀ p)b `d ge , b . k n l q`d ge , c. q`)`k e k h jë,…,*= &h ìåä,[, c%!,; *ë,…,÷å“*= K%ëü…,ö= Šc l r 1 1, ã. ŠK,ë,“, n ƒ%…%2å! =C, "ë å2“ …%"/ ì …åìåä, *=ìå…2%ƒ…/ ì ìå2%ä%ì ëå÷å…, . n …= %2ë, ÷=å2“

C! %“2%2%L C! , ìå…å…, , "/ “%*%L .--å*2, "…%“2üþ, .*%…%ì, ÷å“*%L öåëå“%%K! =ƒ…%“2üþ, C! =*2, ÷å“*, %2“32“2", åì C%K%÷…/ . .--å*2%"; ì%›å2 , “C%ëüƒ%"=2ü“ *=* “=ì%“2% 2åëü…%, 2=* , " *%ìK, …=ö, , “ ìåä, *=ìå…2=ì, , C%2å…ö, ! 3 , . äåL“2", å. b 2å! =Cå"2, ÷å“*, . ä%ƒ=. %ƒ%… äåL“2"3å2

*=* , ìì3…%“2, ì3ë, ! 3þ? åå, C! %2, "%"%“C=ë, 2åëü…%å, K=*2å! , ö, ä…%å, -3…ã, ö, ä…%å, C! %2, "%", ! 3“…%å, ö, 2%“2=2, ÷å“*%å, =…2, “2! å““%"%å , =…=ëüãåƒ, ! 3þ? åå “! åä“2"%. b ., ! 3! ã, ÷å“*%L *ë, …, *å &h ìåä, [ ã. c%! , äë %ƒ%…%2å! =C, , , “C%ëüƒ3å2“ %ƒ%…=2%!

! %““, L“*%ã% C! %, ƒ"%ä“2"= &j "=ƒ=! [. n ƒ%… C! , ìå… ë“ " “ëåä3þ? , . "=! , =…2=.: 1) äë “=…=ö, , K! þø…%L C%ë%“2, ; 2) äë "…32! , "å……/ . , …-3ƒ, L; 3) C! , C! %"åäå…, , =32%ãåì%2å! =C, , . j ë, …, ÷å“*, å …=Këþäå…, …=ä 225 C=ö, å…2=ì, C%*=ƒ=ë, , ÷2% C! , ëå÷å…, , Cå! , 2%…, 2%"

*%ìK, …, ! %"=……%å C! , ìå…å…, å %ƒ%…%2å! =C, , , 2! =ä, ö, %……/ . ìå2%ä%" ƒ…=÷, 2åëü…% 3ìå…üø=å2 ! , “* ! =ƒ", 2, C%“ëå%Cå! =ö, %……/ . ã…%L…/ . %“ë%›…å…, L, C! åä%2"! =? =å2 ãå…å! =ë, ƒ=ö, þ C=2%ë%ã, ÷å“*%ã% C! %öå““= , , “ëåä%"=2åëü…%, “C%“%K“2"3å2 “%*! =? å…, þ ÷, “ë= ! åë=C=! %2%ì, L , “…, ›å…, þ “ìå! 2…%“2, .

OZONTHERAPY IN THE ABDOMINAL SURGERY G. LOMSADZE, B. ARCHVADZE, V. LOMSADZE, G. SACHALELI

Ozontherapy is up-to-date nonmedicamental method of treatments distinguished by simplicity of application,

high efficiency, economic expediency and practically by the absence of side effects. Ozontherapy can be used independently, as well as in combination with medicines, in case of which it stimulates better action of applied medicines.

Ozone, the gas with typical smell, is an alotropic form of oxygen and is much more oxidizer, than oxygen. Application of ozone is based on its oxidizer, disinfectant and bactericide properties.

For the prophylaxis of post-operation purulent complications the authors suggest to use ozone in the following forms: 1) ozonated solution of phuracilinis for the sanation of the abdominal cavity; 2) ozonated physiological solution for the internal infusions; 3) autohemotherapy with the use of ozone.

The clinical research carried out on 225 patients has proved that combined use of ozontherapy with the traditional methods of peritonitis treatment significantly diminishes the risk of post-operation purulent complications and hence assists reduction of the number of relaparotomy.

literatura: k h Še p`Šr p`: 1. e -,ìå…*% m. ̀ . )å!…å.%"“*= m. e . _ n ƒ%…%2å! =C, " ., ! 3! ã, ÷å“*%L *ë, …, *å. l .: p%““, L“*=

ìåä. =*=äåì, C%“ëåä, Cë%ì…%ã% %K! =ƒ%"=…, . 2001. 160 “. 2. j%…2%!?,*%"= j. m. _ a , %., ì, ÷å“*, å %“…%"/ .--å*2, "…%“2, %ƒ%…%2å! =C, , . n ƒ%…%2å! =C, "

*ë, …, ÷å“*%L ìåä, ö, …å. l .: l åä, ö, …=, 1995. 260 “. 3. j%ëå“%"= n . e . b %ë.%"“*= m. a . t !%ë%"= Š. l . _ l å2=K%ë, ÷å“*, å .--å*2/ , …-3ƒ, ,

%ƒ%…, ! %"=……%ã% -, ƒ, %ë%ã, ÷å“*%ã% ! =“2"%! =. n ƒ%… " K, %ë%ã, , , ìåä, ö, …å. Šåƒ, “/ ä%*ë=ä%" I b“å! %“-“, L“*%L …=3÷…%-C! =*2, ÷å“*%L *%…-å! å…ö, , . m. m%"ã%! %ä. 1992. “. 12-13

4. Rilling. S. H. _ 30 years of ozone-oxygen therapy a historical perspective. Ozone in medicine. Proceedings Eleventh Ozone World Congress. San Francisco. 1993. P. 1-14.

5. Smith A. _ Effect of Ozone Concentration on Human Blood Cells. OzoneLab. 2004. ¹ 4. p. 38-43.

u h pr pch “ , ̀ meqŠe gh n k n ch “

Še umh )eqjn e n a eqo e)e mh e , l e Šn d h jh h o ph l e me mh e mh gjn o n Šn )mn i ̀ meqŠe gh h b ̀ a d n l h m`k |mn i u h pr pch h j.~. mr p`k h d ge , a .b . pe b `gh xb h k h 367 ã%“C,2=ëü, l ,…,“2å!“2"% n K%!%…/ p%““,“*%L t åäå!=ö,,, ã. ŠK,ë,“,

b "åäå…,å. o å! "/ å C%C/ 2*, “…, ƒ, 2ü ã=ƒ%2%* " *%…23! å K/ ë, C! åäC! , … 2/ “ …=÷=ë%ì " =…å“2åƒ, %ë%ã, , .! / ö, *ë%C! %C=…= (1933) “ öåëüþ C! åä%2"! =øå…, 32å÷*, .2%ã% "ƒ! / "%%C=“…%ã% ã=ƒ= " C%ìå? å…, å %Cå! =ö, %……%L. l å2%ä …å …=øåë ø, ! %*%ã% ! =“C! %“2! =…å…, , C%“*%ëü*3 Kåƒ …=äå›…/ . *%…2! %ë, ! 3þ? , . 3“2! %L“2" K/ ë% "å“üì= 2! 3ä…% *%…2! %ë, ! %"=2ü *%…öå…2! =ö, þ *, “ë%! %ä= , ëå23÷, . =…å“2å2, *%" " *%…23! å. n ? 32, 2ü ! å=ëü…/ å ä%“2%, …“2"= =…å“2åƒ, , “ …, ƒ*, ì ã=ƒ%2%*%ì 3ä=ë%“ü 2%ëü*% " *%…öå XX "å*=, *%ãä= K/ ë, “, …2åƒ, ! %"=…/ …%"/ å ä%! %ã%“2% ? , å , …ã=ë ö, %……/ å =…å“2å2, *, , C% ", ë, “ü 2å.…, ÷å“*, K%ëåå “%"å! øå……/ å …=! *%ƒ…/ å =CC=! =2/ , ì…%ã%-3…*ö, %…=ëü…/ å “, “2åì/ ì%…, 2%! , …ã=.

n Kå“Cå÷å…, å =…å“2åƒ, , …, ƒ*, ì C%2%*%ì “"å›åã% ã=ƒ= C! åäA "ë å2 %“%K/ å 2! åK%"=…, * =…å“2åƒ, %ë%ã, ÷å“*%L ä/ .=2åëü…%L =CC=! =23! å , ì%…, 2%! , …ã3. n “…%"…/ ì 3“ë%", åì "ë å2“ =K“%ëþ2…% ãå! ìå2, ÷…/ L =…å“2åƒ, %ë%ã, ÷å“*, L *%…23! . n ä…=*% ä%“2, ›å…, å …3›…%L *%…öå…2! =ö, , =…å“2å2, *= , =äå*"=2…%ã% 3! %"… =…å“2åƒ, , ƒ= *%! %2*, L C! %ìå›32%* "! åìå…, C! , …, ƒ*%ì C%2%*å %“2=å2“ “ë%›…%L C! %Këåì%L. b ö, ! *3ë ö, %……/ . “, “2åì=. “"å›, L ã=ƒ “ìåø, "=å2“ “ "/ ä/ .=åì/ ì. b“ëåä“2", å "/ “%*%L ! =“2"%! , ì%“2, ëå23÷, . =…å“2å2, *%" " *! %", …å%K.%ä, ì= C%ä=÷= K%ëüø%ã% %KAåì= =…å“2å2, *=. o ! , , “C%ëüƒ%"=…, , K%ëüø, …“2"= …=! *%ƒ…/ . =CC=! =2%" (Drager, Engstrom-Datex, Ohmeda) "%ƒ…, *=å2 …å%K.%ä, ì%“2ü …=÷, …=2ü =…å“2åƒ, þ "/ “%*, ì C%2%*%ì ã=ƒ%…=! *%2, ÷å“*%L “ìå“, - K%ëüøå 6 ë/ì, … , "/ “2="ë 2ü ƒ…=÷å…, å *%…öå…2! =ö, , =…å“2å2, *= …= , “C=! , 2åëå, " 3-4 ! =ƒ= C! å"/ ø=þ? åå 2! å-K3åì%å * *%…ö3 "/ ä%.=. o ! , ä%“2, ›å…, , …å%K.%ä, ì%L *%…öå…2! =ö, , C%“2åCå……% “…, ›=þ2“ C%*=ƒ=2åë, …= , “C=! , 2åëå , C%2%* “"å›åã% ã=ƒ=. }2% ƒ=…, ì=å2 ƒ…=÷, 2åëü…%å "! åì , 2! åK3å2 %“3? å“-2"ëå…, 2? =2åëü…%ã% *%…2! %ë , ! åã3ë, ! %"*, C=! =ìå2! %" , “C=! , 2åë " “%%2"å2“2", , “ , ƒìå! åì%L *%…öå…2! =ö, åL =…å“2å2, *= [Erdmann W., 1994].

}2, C! %Këåì/ C! =*2, ÷å“*, C%ë…%“2üþ C! å%ä%ëå…/ C%“ëå “%ƒä=…, *%…2! %ë, ! 3þ? , . “, “2åì, ! =K%2=þ? , . C% C! , …ö, C3 %K! =2…%L “" ƒ, . b C%“ëåä…åå "! åì " *ë, …, ÷å“*3þ C! =*2, *3 "…åä! þ2“ "å…2, ë 2%! / (œPhisioFlex Rotterdam VentilatorB) “ C%ë…%“2üþ ƒ=*! / 2/ ì *%…23! %ì, C%“2% ……/ ì %C! åäåëå…, åì C%2! åKëå…, *, “ë%! %ä= , , …ã=ë ö, %……%ã% =…å“2å2, *= , *%…2! %ë, ! 3åì%L *%ìCüþ2å! %ì C%ä=÷åL " *%…23! …å%K.%ä, ì%ã% *%ë, ÷å“2"= *, “ë%! %ä= , =…å“2å2, *= [Hargasser S. et al., 1994; Erdmann W., 1996].

q “å! åä, …/ 70-. ã%ä%", *%ãä= C! , ìå…å…, å …, ƒ*%C%2%÷…%L 2å.…, *, , =…å“2åƒ, , " ƒ=*! / 2%ì *%…23! å C%ë3÷, ë% ø, ! %*%å ! =“C! %“2! =…å…, å "% "“åì ì, ! å, K/ ë, C! åäë%›å…/ ! =ƒë, ÷…/ å "=! , =…2/ .2%L ìå2%ä, *, . m=, K%ëüøåå ! =“C! %“2! =…å…, å C%ë3÷, ë= ìå2%ä, *= “…, ›å…, C%2%*= “"å›åã% ã=ƒ=, " “! åä…åì …= 50 % %2 , “.%ä…%ã%, 2.å. ä% 2,5-3,0 ë/ì, … ("å…2, ë ö, “ ! åö, ! *3ë ö, åL ã=ƒ%…=! *%2, ÷å“*%L “ìå“, ), ÷2% "ë å2“ K%ëåå Kåƒ%C=“…/ ì, …å 2! åK3å2 C%“2% ……%ã% ! =“÷å2= C%2! åKëå…, *, “ë%! %ä=, %Kå“Cå÷, "=å2 ëåã*%“2ü 3C! ="ëå…, *%…öå…2! =ö, åL =…å“2å2, *= , “…, ›å…, å “2%, ì%“2, =…å“2åƒ, , …= 55 % [Cotter S.M. et al., 1991; Virtue R.W., 1981].

l å2%ä *%ë, ÷å“2"å……%ã% 3C! ="ëå…, , …ã=ë ö, %……%L =…å“2åƒ, åL " ƒ=*! / 2%ì *%…23! å, ! =ƒ! =K%2=……/ L Lowe J.H. , Ernst E.A. (1981) , C! åä3“ì=2! , "=þ? , L ""åäå…, å =…å“2å2, *= " ›, ä*%L -%! ìå " *%…23!

ö, ! *3ë ö, , ä/ .=2åëü…%L “ìå“, , %“…%"=… …= ! =“÷å2å Cå! ", ÷…%L ä%ƒ/ ""%ä, ì%L "% "! åì , …ä3*ö, , %ä…%*! =2…% äë ä%“2, ›å…, …å%K.%ä, ì%L =! 2å! , =ëü…%L *%…öå…2! =ö, , "å? å“2"=. d ë ! =“÷å2= , “C%ëü-ƒ3þ2“ : %KAåì ã=ƒ=, , “C=! þ? , L“ , ƒ 1 “ì3 ›, ä*%“2, , %KAåì ä/ .=2åëü…%ã% *%…23! =, *%.--, ö, å…2 ! =“C! åäåëå…, ã=ƒ/*! %"ü , “å! äå÷…/ L "/ K! %“. r ÷, 2/ "= , ÷2% "% "! åìå……%ì =“Cå*2å …=“/ ? å…, å 2*=…åL ã%ë%"…%ã% ì%ƒã= , ìåå2 ë%ã=! , -ì, ÷å“*3þ C! %ã! å““, þ, = ƒ= åä, …, ö3 "! åìå…, C! , …, ì=å2“ 1 ì, …, “%%2"å2“2"å……% %C! åäåëå…/ , …2å! "=ë/ ""åäå…, ! =““÷, 2=……%L ä%ƒ/ =…å“2å2, *=, 2.å. 4, 9, 16 ì, …. , 2.ä. h “.%ä , ƒ .2%ã%, ìå2%ä …=ƒ"=… œ*"=ä! =2…/ L *%! å…ü "! åìå…, B. n ä…=*% %ã! %ì…%å ÷, “ë% %ø, K%* " ! =“÷å2å C! =", ëü…%L ä%ƒ, ! %"*, äë C%"2%! …/ . ""åäå…, L " “%%2"å2“2", , “ åä, …, öåL "! åìå…, ", ë%“ü C! åC 2“2", åì * ø, ! %*%ì3 ! =“C! %“2! =…å…, þ .2%ã% ìå2%ä= [7, Erdmann W., 1994].

b “%%2"å2“2", , “ ìå›ä3…=! %ä…/ ì “2=…ä=! 2%ì Kåƒ%C=“…%“2, , 3÷, 2/ "= ø, ! %*%å ! =“C! %“2! =…å…, å “%"! åìå……/ . “, “2åì ì%…, 2%! , …ã=, “ëåä3å2 C! , … 2ü ƒ= C! =", ë% %Kå“Cå÷å…, å ëþK%ã% =…å“2åƒ, %ë%ã, ÷å“-*%ã% C%“%K, “ C%2%*%ì “"å›åã% ã=ƒ= ìå…åå 3 ë/ì, … C%“2% ……/ ì *%…2! %ëåì *%…öå…2! =ö, , *, “ë%! %ä= "% "ä/ .=åì%L “ìå“, , *%…öå…2! =ö, , 3ãëå*, “ë%ã% ã=ƒ= , ëå23÷åã% =…å“2å2, *= - " "/ ä/ .=åì%L, “ …=ë, ÷, åì Kë%*= 2! å"%ã [8, Cooper J.B ., 1984; London M.J., 1995]. Šåì …å ìå…åå, …å*%2%! / å ="2%! / “÷, 2=þ2, ÷2% =…å“2åƒ, " ƒ=*! / 2%ì *%…23! å ä%“2=2%÷…% Kåƒ%C=“…= äë C=ö, å…2= , %2“32“2", å …å%K.%ä, ì%L “ëåä ? åL =CC=! =23! / …å "ë å2“ C! åC 2“2", åì äë åå C! , ìå…å…, [Couto da Silva J.M., 1996]. q Cåö, =ëü…= 2å.…, *= =…å“2åƒ, , " ƒ=*! / 2%ì *%…23! å “ ÷, “2/ ì *, “ë%! %ä%ì , øC! , öå"/ ì ""åäå…, åì , …ã=ë ö, %……%ã% =…å“2å2, *= C! åäë%›å…= äë “2! =… 2! å2üåã% ì, ! =, ãäå äë %öå…*, ãë3K, …/ =…å“2åƒ, , , …å%K.%ä, ì%“2, ä%C%ë…, 2åëü…/ . , …Aå*ö, L ëå23÷åã% =…å“2å2, *= ! å*%ìå…ä3å2“ ë, øü ì%…, 2%! , …ã “, “2%ë, ÷å“*%ã% =! 2å! , =ëü…%ã% ä="ëå…, [Couto da Silva J.M., 1990, 1996].

j C! å, ì3? å“2"=ì …, ƒ*%C%2%÷…%L =…å“2åƒ, , %2…%“ 2: ƒ…=÷, 2åëü…3þ .*%…%ì, þ ìåä, ö, …“*, . ã=ƒ%" , , …ã=ë ö, %……/ . =…å“2å2, *%"; C! åä%2"! =? å…, å C%2å! ü 2åCë= , "ë=ã, , “%ƒä=þ? åå “…, ›å…, å ! =ƒä! =›å…, ä/ .=2åëü…/ . C32åL ,

"%ƒì%›…%“2, ã, C%2å! ì, , ; %2“32“2", å ƒ=ã! ƒ…å…, "%ƒä3.= %Cå! =ö, %……%L , ƒ=? , 2= Cå! “%…=ë= %2 "! åä…%ã% "%ƒäåL“2",

=…å“2å2, *%"; "%ƒì%›…%“2ü 2? =2åëü…%ã% ì%…, 2%! , …ã= C%2! åKëå…, *, “ë%! %ä= , =…å“2å2, *= 2*=… ì, ; "%ƒì%›…%“2ü 2%÷…%L ä%ƒ, ! %"*, , *%ë, ÷å“2"å……%ã% ! =“÷å2= , …ã=ë ö, %……%L =…å“2åƒ, , ; %2“32“2", å ƒ=ã! ƒ…å…, %*! 3›=þ? åL “! åä/ .

m=! ä3 “ C! å, ì3? å“2"=ì, , “3? å“2"3å2 , ! ä …åä%“2=2*%" ìå2%ä= , C! %2, "%C%*=ƒ=…, L * åã% , “C%ëüƒ%"=…, þ. j ÷, “ë3 …åä%“2=2*%" %2…%“ 2“ C%"/ øå……/ L ! , “* "%ƒ…, *…%"å…, ã, C%*“, , , ã, Cå! *=C…, , , "%ƒì%›…%“2ü …=*%Cëå…, " *%…23! å C%2å…ö, =ëü…% 2%*“, ÷å“*, . “%åä, …å…, L (=öå2%… C! , “=.=! …%ì ä, =Kå2å, =ë*%ã%ëü C! , %“2! %L , …2%*“, *=ö, , ), …å%K.%ä, ì%“2ü …=ë, ÷, ä%! %ã%“2% ? åL “ëåä ? åL =CC=! =23! / .

n K? , ì, C! %2, "%C%*=ƒ=…, ì, "ë þ2“ =…å“2åƒ, äë, 2åëü…%“2üþ ìå…åå 15 ì, …, ì=“%÷…=

=…å“2åƒ, , =…å“2åƒ, C! , K! %….%“*%C, , , C! , ìå…å…, å “å"%-ëþ! =…= (…=*%Cëå…, å 2%*“, ÷…%L

“3K“2=…ö, , `, %K! =ƒ3þ? åL“ C! , äë, 2åëü…%ì *%…2=*2å “ =K“%! Kå…2%ì). j ìåä, ö, …“*, ì

C! %2, "%C%*=ƒ=…, ì %2…%“ 2“ : "/ ! =›å……/ å …=! 3øå…, -3…*ö, , "…åø…åã% ä/ .=…, (%“2! / L

K! %….%“C=ƒì, .! %…, ÷å“*, L %K“2! 3*2, "…/ L K! %…., 2, K! %…., =ëü…= =“2ì=), …=! 3øå…, ä, --3ƒ, %……%L

“C%“%K…%“2, =ëü"å%ë%-*=C, ëë ! …%L ìåìK! =…/ (2%*“, ÷å“*, å C%! =›å…, ëåã*, ., C…å"ì%“*ëå! %ƒ),

äå*%ìCå…“, ! %"=……/ L “=.=! …/ L ä, =Kå2 “ *å2%=ö, ä%ƒ%ì, .! %…, ÷å“*, L =ë*%ã%ë, ƒì, “%“2% …, “ …åC! åä-

“*=ƒ3åì% "/ “%*, ì 3! %"…åì C%2! åKëå…, *, “ë%! %ä= - “åC“, “, ƒë%*=÷å“2"å……= ã, Cå! 2å! ì,

(d=! K, … … Š.l . , “%="2., 1986; k , ."=…öå" b .b ., 1997; Eger E.I., 1996; Grogono A.W., 1996; Rucklidge

M.A., 1996; Bonome C. et al., 1997; Kriesmer T.P., 1997; Moriwaki G. Et al., 1997; Aitkenhead A.R., 1998).

dabalnakadovani anesTeziis gamoyenebis

meTodebi da teqnikuri uzrunvelyofa

abdominalur qirurgiaSi

b. revaziSvili, k. nuraliZe

367-e hospitali, ruseTis federaciis Tavdacvis saministro, q. Tbilisi

dabalnakadovani anesTeziis warmarTvisaTvis aucilebelia maRali klasis

Tanamedrove sanarkoze aparatura da monitoringi. ZiriTadi moTxovnaa absoluturad

hermetuli sasunTqi konturi, Tumca, drois mcire monakveTSi, saanesTezio saSua-

lebebis adekvaturi koncentraciis miReba da anesTeziis saWiro siRrmis miRweva jer

kidev rCeba rTul problemad. usafrTxoebis saerTaSoriso standartebis Sesabamisad

da monitoringis Tanamedrove sistemebis SesaZleblobaTa gaTvaliswinebiT,

nebismieri dabalnakadovani anesTeziis mimdinareobis dros, roca sasunTq airTa

nakadi naklebia 3 l\wT-ze, aucilebelia ganisazRvros CasunTqul airSi Jangbadis,

xolo amosunTqulSi - naxSirorJangisa da sainhalacio saanesTezio saSualebebis

koncentracia.

mocemuli meTodis gamoyenebis ukuCvenebebia: sasunTqi funqciebis gamoxatuli

darRveva, alveolur–kapilarul membranaSi difuziis moSla, Saqriani diabeti

ketoacidoziT, mdgomareobebi, rodesac adgili aqvs Jangbadis didi raodenobiT

moxmarebas.

TECHNICAL PROVISION, METHODICS AND USAGE OF LOW FLOW ANAESTHESIA IN ABDOMINAL SURGERY B. REVAZISHVILI, R. NURALIDZE

Providing anaesthesia by low flow of fresh gas places the special requirements on anaesthesiological

respiratory equipment and monitoring. The basic condition is absolutely hermetic anaesthesiological contour. However, the achievement of the necessary concentration of anaesthetic and adequate level of anaesthesia for a short interval of time at a low flow is still a difficult problem. According to the international standard of safety and taking into account wide circulation of modern systems of monitoring, in the presence of any anaesthesia with low flow when flow of fresh gas is less than 3 l/min by the constant control of concentration of oxygen in an inhaled mixture and concentration of carbonic gas and flying anaesthetic in exhaled with presence of the block of alarms is necessary.

Contraindications of the given method are: expressed deterioration of respiratory function, infringement diffusion of ability of alveolar-capillary membrane, diabetes mellitus with ketoacidosis, conditions with unpredictable high level of consumption of oxygen.


1. Aitkenhead A.R. _ Advatages and disadvantages of low flow techniques. - In: Abstracts 10th European Congress of Anaesthesiology., June 30th - July 4th 1998, Frankfurt, Germany, ECA-432.3.

2. Aldrete J., Cubillos P., Sherrill D. _ Humidity and temperature changes during low flow and closed system anaesthesia. - Acta Anaesth.Scand., 1981, vol. 25, p. 312-314.

3. Baum J.A. _ Clinical applications of low flow and closed circuit anesthesia. - Acta Anaesth. Belg., 1990, vol. 41, p. 239-347.

4. Baum J.A. _ History and Future of the Circle System. - Hospital Supplies, February 1995, p. 18. 5. Baum J., Legat M., Sachs G., Stanke H.G. _ Carbon monoxide accumulation in low flow anaesthesia. -

In: Abstract Book. 11th World Congress of Anaesthesiologists., 14-20 April 1996, Sydney, Australia, F. 162.

6. Boemke W. _ Low flow anaesthesia - the practice. - In: Abstracts 10th European Congress of Anaesthesiology., June 30th - July 4th 1998, Frankfurt, Germany, ECA-432.2.

7. Giunta F. _ Low flow anaesthesia - the theory. - In: Abstracts 10th European Congress of Anaesthesiology., June 30th - July 4th 1998, Frankfurt, Germany, ECA-432.1. Ray D.C.,

8. k ,."=…öå" b .b ., q,2…,*%" `.b ., q3KK%2,… b .b . , ä!. _ q %"! åìå……= %K? = =…å“2åƒ, “ , “C%ëüƒ%"=…, åì C=! %%K! =ƒ3þ? , . =…å“2å2, *%". b å“2…, * , …2å…“, "…%L 2å! =C, , . 1997, 1 1-2, “. 51-57.

9. k ,."=…öå" b .b ., q,2…,*%" ̀ .b ., q3KK%2,… b .b . , ä!. _ b / K%! ìå2%ä= =…å“2åƒ, , C! , äë, 2åëü…/ . , 2! ="ì=2, ÷…/ . %Cå! =ö, .-̀ …å“2. , ! å=…, ì=2%ë. 1997, 1 1, “.53.

u h pr pch “

Šp`mqo e)e mn )mn e d pe mh pn b `mh e o ph l e u`mh )eqjn i fe k Šr u e , n a r qk n b k e mmn i qŠph jŠr p`l h b me o e)e mn )m{u o pn jqh l `k |m{u fe k )m{u o pn Šn jn b

a .b .pe b `gh xb h k h

367 ã%“C,2=ëü, l ,…,“2å!“2"% n K%!%…/ p%““,“*%L t åäå!=ö,,, ã. ŠK,ë,“,

b "åäå…,å. n K23! =ö, %……= ›åë23.= %2ìå÷å2“ " 70-92,5% “ë3÷= . C! , ! 3Kö%"/ . “2! , *23! =. ›åë÷…/ . C! %2%*%". a%ëüø%L C! %öå…2 …å3ä%"ëå2"%! , 2åëü…/ . …åC%“! åä“2"å……/ . (ä% 35 # 40%) , %2ä=ëå……/ . (ä% 50%) ! åƒ3ëü2=2%" ëå÷å…, K%ëü…/ . “% “2! , *23! =ì, ›åë÷…/ . C! %2%*%" “ ! , “*%ì ! åö, ä, "= “2! , *23! (3,5 # 50%) , "/ “%*%L ëå2=ëü…%“2üþ (15-50%) C%ƒ"%ë å2 “äå-ë=2ü "/ "%ä, ÷2% ä=……= C! %Këåì= "“‘ å? å …å ! åøå…= , %“2=å2“ =*23=ëü…%L [1, 2, 3, 4, 5].

l =2å!,=ë , %K“3›äå…,å. r 54 K%ëü…/ ., …=.%ä ? , .“ …= ëå÷å…, , " cb j c , ìå…, m. m. a 3! äå…*% , 367 ã%“C, 2=ëå l n pt ŠK, ë, “, ä, =ã…%“2, ! %"=ë, ! 3Kö%"/ å “2! , *23! / "…åCå÷å…%÷…/ . C! %*“, ì=ëü…/ . ›åë÷…/ . C! %2%*%", %“ë%›…å……/ å ìå.=…, ÷å“*%L ›åë23.%L. b%ƒ! =“2 K%ëü…/ . - %2 20 ä% 80 ëå2. l 3›÷, … - 35, ›å…? , … # 19. 20(37%) K%ëü…/ . K/ ë, “2=! øå 60 ëå2. r "“å. C=ö, å…2%" ! 3Kö%"/ å “2! , *23! / %K! =ƒ%"=ë, “ü "“ëåä“2", å Cå! å…å“å……/ . %Cå! =2, "…/ . "ìåø=2åëü“2" …= ›åë÷å"/ "%ä ? , . C! %2%*=., " 2%ì ÷, “ëå: 3 24(44,4%) - C%“ëå %2*! / 2%L .%ëåö, “2.*2%ì, , , 3 3 (5,6%) - C%“ëå ë=C=! %“*%C, ÷å“*%L .%ëåö, “2.*2%ì, L, 3 27(50%) - C%“ëå %2*! / 2%L .%ëåö, “2.*2%ì, , , ä! å…, ! %"=…, %K? åã% Cå÷å…%÷…%ã% , ë, %K? åã% ›åë÷…%ã% C! %2%*=. r 37 (68,5%) K%ëü…/ . ä, =ã…%“2, ! %"=ë, ! åö, ä, ", ! 3þ? , L .! %…, -÷å“*, L .%ë=…ã, 2.

r gh C! %"åë, "“åì C=ö, å…2=ì: " 100% “ë3÷=å" ä, =ã…%“2, ! %"=ë, "…32! , Cå÷å…%÷…3þ K, ë, =! …3þ ã, Cå! 2å…ƒ, þ, " 14(25,9%) - *=* "…32! , - 2=* "…åCå÷å…%÷…%å ! =“ø, ! å…, å ›åë÷…/ . C! %2%*%". bìå“2å “ 2åì, 3 40 (74,1%) C=ö, å…2%" C! , r gh …å 3ä=ë%“ü ", ƒ3=ë, ƒ, ! %"=2ü "…åCå÷å…%÷…/ å ›åë÷…/ å C! %2%*, (ãåC=2, *%.%ëåä%.). j Š C! %"åäå…% 43 (79,6%) K%ëü…/ ì: "% "“å. “ë3÷= . 3“2=…%"ëå…% ! =“ø, ! å…, å "…32! , Cå÷å…%÷…/ . ›åë÷…/ . C! %2%*%", %ä…=*% ", ƒ3=ë, ƒ, ! %"=2ü ä=……/ ì ìå2%ä%ì “2! , *23! 3 , åå 3! %"å…ü …å 3ä=ë%“ü. b “" ƒ, “ .2, ì

ä=……%ì3 *%…2, …ãå…23 K%ëü…/ . (43 ÷åë%"å*=) C! %"åë, }po u cK " ! åƒ3ëü2=2å 3 36(83,7%) C=ö, å…2%" "/ ", ë, C%ë…3þ %K23! =ö, þ ãåC=2, *%.%ëåä%.=. j %…2! =“2…%å "å? å“2"% ƒ=C%ë… ë% 2%ëü*% =ìC3ë3 K%ëüø%ã% ä3%äå…=ëü…%ã% “%“%÷*= , %K? , L Cå÷å…%÷…%-›åë÷…/ L C! %2%*. r 7 (16,3%) K%ëü…/ . "/ ", ë, …å! ="…%ìå! …/ L “2å…%ƒ ãåC=2, *%.%ëåä%.=: *%…2! =“2…%å "å? å“2"% “ 2! 3ä%ì C%“23C=ë% " "…32! , Cå÷å…%÷…/ å C! %2%*, , ! ="…%ìå! …% ƒ=C%ë… ë% K, ë, =! …%å äå! å"%. o ! åä%Cå! =ö, %……3þ ÷! å“*%›…3þ ÷! å“Cå÷å…%÷…3þ .%ë=…ã, %“2%ì, þ “ C%“ëåä3þ? åL .%ë=…ã, %ã! =-, åL C%ä *%…2! %ëåì r gh C! %"åë, 23 (42,6%) K%ëü…/ ì. o ! , C%ë…%L %K23! =ö, , Cå÷å…%÷…%ã% C! %2%*=, %K3“ë%"ëå……%L “2! , *23! %L, *%…2! =“2…%å "å? å“2"% " ãåC=2, *%.%ëåä%. , ä"å…=äö=2, Cå! “2…3þ *, ø*3 …å C%“23C=ë%, "“ëåä“2", å ÷åã% 3“2=…%", 2ü C! %2 ›å……%“2ü C%! =›å…, ›åë÷…/ . C! %2%*%" …å 3ä=ë%“ü. Šåì …å ìå…åå, “ C%ì%? üþ ) ) u c " 95,5% “ë3÷=å" 3ä=ë%“ü %C! åäåë, 2ü .=! =*2å! C=2%ë%ã, , (“2! , *23! =), 3! %"å…ü %K23! =ö, , , C%“2=", 2ü 2%÷…/ L ä, =ã…%ƒ, = " “%÷å2=…, , “ }po u c - , C! %2 ›å……%“2ü C%! =›å…, C! %2%*%".

b %“…%"…%L ã! 3CCå (28 C=ö, å…2%") K, ë, %ä, ãå“2, "…/ å “%3“2ü K/ ë, …=ë%›å…/ …= 2! =…“Cå÷å…%÷…/ . ä! å…=›=.: 3 14 (50%) K%ëü…/ . - K, ãåC=2, *%åþ…%=…=“2%ì%ƒ, 3 14 (42,9%) # ãåC=2, *%åþ…%=…=“2%ì%ƒ , 3 2 (7,1%) # .%ë=…ã, %åþ…%=…=“2%ì%ƒ C! , “2! , *23! å =2, C, ÷…% ! =“C%ë%›å……%ã% C! ="%ã% Cå÷å…%÷…%ã% C! %2%*=. b *%…2! %ëü…%L ã! 3CCå (26 K%ëü…/ .) 3 19 (73,1%) “-%! ì, ! %"=ë, ãåC=2, *%åþ…%=…=“2%ì%ƒ, = 3 7(26,9%) # K, ãåC=2, *%åþ…%=…=“2%ì%ƒ Kåƒ ä! å…, ! %"=…, .

b ä, …=ì, *å %C! åäåë ë, (Cå! åä %Cå! =ö, åL = 2=*›å " I, III, VII, XIV “32*, C%“ëå%Cå! =ö, %……%ã% Cå! , %ä= , Cå! åä "/ C, “*%L) C%*=ƒ=2åë, ãåì%ãë%K, …=, ãåì=2%*! , 2=, *%ë, ÷å“2"= .! , 2! %ö, 2%", ëåL*%ö, 2%", K, ë, ! 3K, …= , åã% -! =*ö, , , k h h , l q l , ÷2% C%ƒ"%-ë, ë% “! ="…, 2ü .--å*2, "…%“2ü ! =ƒë, ÷…/ . ìå2%ä%" ä! å…, ! %"=…, " ! =ƒ! åøå…, , ›åë23., , ã…%L…%L , …2%*“, *=ö, , , Cå÷å…%÷…%-C%÷å÷…%L …åä%“2=2%÷…%“2, . q 2=2, “2, ÷å“*, %K! =K%2=……/ å ìåä, =…/ C%*=ƒ=2åëåL K, ë, ! 3K, …= %2! =›å…/ " 2=Kë. 1, 2.

o å! åä %Cå! =ö, åL 3 K%ëü…/ . %Kå, . ã! 3CC 3! %"å…ü %K? åã% K, ë, ! 3K, …= K/ ë C%"/ øå…: " %“…%"…%L # " 3,1 ! =ƒ=, " *%…2! %ëü…%L - " 2,8 ! =ƒ=. ) å! åƒ I “32*, C%“ëå %Cå! =2, "…%ã% "ìåø=2åëü“2"= %K…=! 3›, ë, “…, ›å…, å C%*=ƒ=2åë K, ë, ! 3K, …= " %“…%"…%L ã! 3CCå (…= 16,1%), " *%…2! %ëü…%L # C%"/ øå…, å (…= 5,3%). j *%…ö3 III “32%* C%“ëå %Cå! =ö, , 3! %"å…ü K, ë, ! 3K, …= " “! ="…å…, , “ , “.%ä…/ ì 3! %"…åì “…, ƒ, ë“ *=* " %“…%"…%L, 2=* , " *%…2! %ëü…%L ã! 3CC=., “%%2"å2“2"å……% …= 43,5% , 28,5%. q %äå! ›=…, å K, ë, ! 3K, …= * , “.%ä3 Cå! "%L …åäåë, " %“…%"…%L ã! 3CCå K%ëü…/ . C! å"/ “, ë% …%! ì3 " 1,2 ! =ƒ=, = " *%…2! %ëü…%L # " 1,4 ! =ƒ=.

o %"/ øå…, å 3! %"… *%…Aþã, ! %"=……%ã% K, ë, ! 3K, …= %K…=! 3›, ë%“ü ä% %Cå! =2, "…%ã% "ìåø=2åëü“2"= 3 K%ëü…/ . %Kå, . ã! 3CC: " %“…%"…%L - " 6,8 ! =ƒ "/ øå …%! ì/ , " *%…2! %ëü…%L # " 7,2 ! =ƒ=. ) å! åƒ I “32*, C%“ëå äå*%ìC! å““, , ›åë÷…/ . C32åL 3! %"å…ü C! ì%ã% K, ë, ! 3K, …= “…, ƒ, ë“ …= 41,2% " %“…%"…%L ã! 3CCå, 2%ãä= *=* " *%…2! %ëü…%L # …= 16,7%. j *%…ö3 III “32%* “%äå! ›=…, å C! ì%ã% K, ë, ! 3K, …= " %“…%"…%L ã! 3CCå “%“2=", ë% 67,6% %2 , “.%ä…%L "åë, ÷, …/ , " *%…2! %ëü…%L # 44,4%. j *%…ö3 …åäåë, ä%“2%"å! …%ã% ! =ƒë, ÷, " “2åCå…, “…, ›å…, 3! %"… K, ë, ! 3K, …= " %K“ëåä%"=……/ . ã! 3CC=. …å "/ "ëå…%.

b ! =……åì C%“ëå%Cå! =ö, %……%ì Cå! , %äå %“ë%›…å…, ! =ƒ", ë, “ü 3 12(22,2%) K%ëü…/ .: " %“…%"…%L ã! 3CCå # 3 6(21,4%), " *%…2! %ëü…%L # 3 6(23%). b %“…%"…%L ã! 3CCå 3 %ä…%ã% K%ëü…%ã% …=Këþä=ë=“ü ã, C%“2=2, ÷å“*= C…å"ì%…, , 3 2 # K, ë%ì/ 3“2! =…, ë, C3…*ö, åL C%ä *%…2! %ëåì r gh . 2 K%ëü…/ ì C! %"åë, C%"2%! …/ å %Cå! =ö, , : 3 %ä…%ã% # C% C%"%ä3 %“2! %L “C=å÷…%L *, øå÷…%L …åC! %.%ä, ì%“2, , 3 "2%! %ã% # C% C%"%ä3 2%…*%*, øå÷…%ã% “", ? = " %Kë=“2, "/ .%ä= 2! =…“Cå÷å…%÷…%ã% ä! å…=›= …= Cå! åä…þþ K! þø…3þ “2å…*3. b *%…2! %ëü…%L ã! 3CCå " C%“ëå%Cå! =ö, %……%ì Cå! , %äå 3 %ä…%ã% K%ëü…%ã% ä, =ã…%“2, ! %"=ë, C…å"ì%…, þ, 3 2 # K, ë%ì3 3“2! =…, ë, C3…*ö, åL C%ä *%…2! %ëåì r gh . o %"2%! …/ å %Cå! =ö, , C! %"åë, 2 K%ëü…/ ì: 3 %ä…%ã% - “ öåëüþ %“2=…%"*, "…32! , K! þø…%ã% *! %"%2å÷å…, , 3 "2%! %ã% # C% C%"%ä3 “C=å÷-…%L *, øå÷…%L …åC! %.%ä, ì%“2, .

b Kë, ›=Løåì C%“ëå%Cå! =ö, %……%ì Cå! , %äå 3ìå! ë, %ä, … (3,5%) C=ö, å…2 %“…%"…%L ã! 3CC/ , %ä, … (3,8%) - *%…2! %ëü…%L. o ! , ÷, …%L “ìå! 2, K%ëü…%ã% " %“…%"…%L ã! 3CCå K/ ë= ã…%L…= , …2%*“, *=ö, , %K3“ë%"ëå……= =K“öåä, ! 3þ? , ì .%ë=…ã, 2%ì, " *%…2! %ëü…%L # …=! =“2=þ? = Cå÷å…%÷…= …åä%“2=2%÷…%“2ü.

g=*ëþ÷å…,å. o ! , -%! ì, ! %"=…, , K, ë, %ä, ãå“2, "…%ã% =…=“2%ì%ƒ= “ %ä…%"! åìå……/ ì 2! =…“Cå÷å…%÷…/ ì ä! å…, ! %"=…, åì 3“2! =…å…, å ìå.=…, ÷å“*%L ›å23., , "%““2=…%"ëå…, å

-3…*ö, , Cå÷å…, ä%“2, ã=å2“ " K%ëåå *%! %2*, å “! %*, " “! ="…å…, , “ %Cå! =ö, åL …=ë%›å…, ›åë÷…%-*, øå÷…%ã% “%3“2ü Kåƒ äå*%ìC! å““, , K, ë, =! …%ã% äå! å"=.

transhepaturi drenireba RviZlgare

proqsimaluri sanaRvle gzebis striqturiT gamowveuli meqanikuri

siyviTlisas

b. revaziSvili

367-e hospitali, ruseTis federaciis Tavdacvis saministro,

q. Tbilisi

SeviswavleT 54 pacienti meqanikuri siyviTliT, rac RviZlgare proqsimaluri

sanaRvle gzebis striqturiT iyo gamowveuli. ZiriTad jgufSi (28 pacienti)

bilidigestiuri anastomozi formirebul iqna transhepatur drenaJze, sakontrolo

jgufSi (26 pacienti) – drenaJis gareSe. RviZlgare proqsimaluri sanaRvle gzebis

striqturiT gamowveuli meqanikuri siyviTlisas biliaruli hipertenziis likvidacia

SedarebiT mokle vadebSi xdeba transhepatur drenaJze bilidigestiuri anastomozis

formirebisas, vidre drenirebis gareSe.

TRANSHEPATIC DRAINAGE AT MECHANICAL JAUNDICE, CAUSED BY STRICTURES OF EXTRAHEPATIC PROXIMAL BILIARY DUCT B. REVAZISHVILI

54 patients with mechanical jaundice, caused by strictures of extrahepatic proximal biliary duct were subjected to investigation. In the basic group (28 patients) biliodigestive anastomosis was formed with transhepatic drainage, in control one (26 patients) # without drainage. While formation of biliodigestive anastomosis with simultanious transhepatic drainage removal of mechanical jaundice and restoration of the function of liver is achieved in more short space of time than in case of application of choleintestinal anastomosis without drainage.


1. a %!,“%" ̀ .e ., a %!,“%"= m.̀ ., j=!=å" ̀ .b ., p/›*%" b .j., måC%ì… ?= q.d . _ ) ! å“*%›…/ å .…ä%K, ë, =! …/ å "ìåø=2åëü“2"= " ëå÷å…, , ! 3Kö%"/ . “2! , *23! ›åë÷…/ . C! %2%*%" , K, ë, %ä, -ãå“2, "…/ . =…=“2%ì%ƒ%"//`……=ë/ ., ! 3! ã, ÷å“*%L ãåC=2%ë%ã, , . 2003. Š. 8. 1 2. c. 83-84.

2. c=ëüCå!,… }. h ., b %ë*%"= m. b . _ g=K%ëå"=…, ›åë÷…/ . C32åL C%“ëå .%ëåö, “2.*2%ì, , // l . l åä. 1988. c. 245-260.

3. c=ëüCå!,… }.h ., )å"%*,… ̀ .~., d þ›å"= Š.c., c=!ì=å" a .c. _ b / K%! ìå2%ä= " ƒ=", “, ì%“2, %2 2, C= "/ “%*%L ! 3Kö%"%L “2! , *23! / Cå÷å…%÷…/ . C! %2%*%" // `……=ë/ ., ! 3! ã, ÷å“*%L ãåC=2%-ë%ã, , . 2003. Š. 8. 1 2. c. 86-87.

4. l =ë !÷3* b .h ., jë,ì%" `.e ., o =32*,… ~.t ., h "=…%" b .̀ ., a =ƒ,ëå",÷ t .b ., o ë="3…%" m.t . _ d , =ã…%“2, ÷å“*= , ëå÷åK…= 2=*2, *= C! , ä%K! %*=÷å“2"å……/ . “2! , *23! =. ›åë÷…/ . C! %2%*%" // ̀ ……=ë/ ., ! 3! ã, ÷å“*%L ãåC=2%ë%ã, , .

5. qåä%" `.o ., o =!-å…%" h .o ., fä=…%"“*,L n .l ., k 3öå…*% b .d ., l ,ø3“2,… `.l . _ m=ø %C/ 2 ., ! 3! ã, ÷å“*%ã% ëå÷å…, “2! , *23! , C%"! å›äå…, L "…åCå÷å…%÷…/ . ›åë÷…/ . C! %2%*%"//`…-…=ë/ ., ! 3! ã, ÷å“*%L ãåC=2%ë%ã, , . 2003.Š. 8. 1 2. c.113-114.

`meqŠe gh n k n ch “ Še n pe Šh )eqjh e ̀ qo ejŠ{ h Še pl h mn k n ch “ qn b pe l e mmn i mh gjn o n Šn )mn i ̀ meqŠe gh h j. ~. mr p`k h d ge 367 ã%“C,2=ëü, l ,…,“2å!“2"% n K%!%…/ p%““,“*%L t åäå!=ö,, ã. ŠK,ë,“,

b "åäå…,å. n ä…% , ƒ C! å, ì3? å“2" , …ã=ë ö, %……%L =…å“2åƒ, , - "%ƒì%›…%“2ü K/ “2! %ã% 3C! ="ëå…, =ëü"å%ë ! …%L *%…öå…2! =ö, åL =…å“2å2, *= (ãë3K, …%L =…å“2åƒ, , ). Š=*= "%ƒì%›…%“2ü ÷=? å "“åã% ! å=ë, -ƒ3å2“ C32åì C%ä=÷, " *%…23! K%ëüø%ã% *%ë, ÷å“2"= ëå23÷, . =…å“2å2, *%" ƒ= *%! %2*, L C! %ìå›32%* "! åìå…, , 2% å“2ü C! , "/ “%*%ì C%2%*å “"å›åã% ã=ƒ=. bìå“2å “ 2åì, 2! =ä, ö, %……= =…å“2åƒ, “ "/ “%*, ì ã=ƒ%2%*%ì , ìåå2 , “"%, “å! üåƒ…/ å …åä%“2=2*, , *%2%! / å “%“2% 2 " K%ëüø%ì ! =“.%äå =…å“2å2, *=, ƒ…=÷, -2åëü…/ . C%2å! . 2åCë= , "ë=ã, , ƒ ä/ .=2åëü…/ . C32åL ! åKå…*=, ƒ=ã! ƒ…å…, , %*! 3›=þ? åL “! åä/ , "%ƒä3.= " %Cå! =ö, %……%L. q …, ›å…, å ã=ƒ%2%*= " ä/ .=2åëü…%ì *%…23! å C%ƒ"%ë å2 , ƒKå›=2ü "“å. .2, . …åã=2, "…/ . "ëå…, L, ÷2% %C! åäåë å2 ƒ…=÷, 2åëü…/ L , …2å! å“ =…å“2åƒ, %ë%ã%" * ìå2%ä=ì , …ã=ë ö, %……%L =…å“2åƒ, , …= %“…%"å …, ƒ*, . C%2%*%" “"å›åã% ã=ƒ= [1,2].

d ë …, ƒ*%C%2%÷…%L =…å“2åƒ, , , “C%ëüƒ3þ2 ! åö, ! *3ë ö, %……/ L ä/ .=2åëü…/ L *%…23! . o %.2%ì3 C! å›äå "“åã% %“2=…%", ì“ …= *ë=““, -, *=ö, , =…å“2åƒ, %ë%ã, ÷å“*, . “, “2åì. q öåëüþ *ë=““, -, *=ö, , =…å“2åƒ, %ë%ã, ÷å“*, . “, “2åì C! åäë%›å…/ ! =ƒë, ÷…/ å C=! =ìå2! / , 2=*, å *=* “*%! %“2ü C%2%*=, “" ƒü “ =2ì%“-å! %L "% "! åì "ä%.= , "/ ä%.=, C! , “32“2", å , ë, %2“32“2", å =K“%! Kå! = 3ãëå*, “ë%2/ . o ! %“2åLø= *ë=““, -, *=ö, C! åäë%›å…= J.Moyers (1953), *%2%! = %“…%"=…= …= …=ë, ÷, , ã=ƒ%"%ã% ! åƒå! "3=! = , "%ƒ"! =2= "/ ä/ .=åì%ã% ã=ƒ=: %2*! / 2/ å “, “2åì/ …å , ìåþ2 …, ! åƒå! "3=! = …, "%ƒì%›…%“2, "%ƒ"! =2= "/ ä/ .=åì/ . ã=ƒ%"; C%ë3%2*! / 2/ å “, “2åì/ , ìåþ2 ! åƒå! "3=! …/ L ìåø%* , %Kå“Cå÷, "=þ2 ÷=“2, ÷…/ L "%ƒ"! =2; 3 ƒ=*! / 2/ . “, “2åì å“2ü ! åƒå! "3=! , *%2%! / L %Kå“Cå÷, "=å2 C%ë…/ L "%ƒ"! =2.

Kriesmer T.P. (1997) C! åäë%›, ë *ë=““, -, *=ö, þ “, “2åì äë , …ã=ë ö, %……%L =…å“2åƒ, , , %“…%"=……3þ …= %2…%øå…, , ! åö, ! *3ë, ! 3þ? , . , “"å›, . ã=ƒ%": %2*! / 2= - 0/100; "/ “%*%C%2%÷…= (C%ë3ƒ=*! / 2= ) - 20/80; …, ƒ*%C%2%÷…= (C%ë3ƒ=*! / 2= ) - 80/20; ƒ=*! / 2= - 100/0. b “%%2"å2“2", , “ “%"! åìå……%L *ë=““, -, *=ö, åL ä/ .=2åëü…/ . *%…23! %", " ƒ=", “, ì%“2, %2 "åë, ÷, …/ ã=ƒ%2%*= C% ä=……/ ì l å›ä3…=! %ä…%L j %ì, ““, , C% “2=…ä=! 2, ƒ=ö, , (ISO), C! , … 2% ! =ƒë, ÷=2ü “ëåä3þ? , å *%…23! / :

“ %K/ ÷…/ ì C%2%*%ì K%ëåå 3 ë/ì, …

…, ƒ*%C%2%÷…/ L - ìå…åå 3 ë/ ì, … “ ì, …, ì=ëü…/ ì C%2%*%ì - ìå…åå 1 ë/ì, … ƒ=*! / 2/ L *%…23! - C%2%* “"å›åã% ã=ƒ= ! ="å… åã% C%ãë%? å…, þ C=ö, å…2%ì.

Orkin F.K. (1987) %C! åäåë, ë ƒ=*! / 23þ “, “2åì3, *=* “, “2åì3, ãäå C%2%* “"å›åã% ã=ƒ= “…, ›å… ä% 3! %"… , ä%“2=2%÷…%ã% äë 3ä%"ëå2"%! å…, ìå2=K%ë, ÷å“*, . C%2! åK…%“2åL C=ö, å…2= (…=C! , ìå! 4 ìë/*ã/ì, …) , "%ƒäåL“2", =…å“2å2, ÷å“*, . =ãå…2%", " 2% "! åì *=* *ë=C=… , ƒK/ 2%÷…%ã% C%2%*= %“2=å2“ ƒ=*! / 2/ ì. g=*! / 2/ å “, “2åì/ , å“2å“2"å……%, C%ä! =ƒ3ìå"=þ2, ÷2% " …, . C! , ìå… þ2 …, ƒ*, å C%2%*, “"å›, . ìåä, ö, …“*, . ã=ƒ%". n ä…=*% ! =“÷å2 …å%K.%ä, ì%L "åë, ÷, …/ ã=ƒ%2%*= ä% …=“2% ? åã% "! åìå…, "ë å2“ C! åäìå2%ì ä, “*3““, L.

x, ! %*%å ! =“C! %“2! =…å…, å C%ë3÷, ë% 3! ="…å…, å B rody [Lowe J.H. et al., 1981]: V=10 kg3/4 , ãäå V - C%2%* *, “ë%! %ä=, …å%K.%ä, ì/ L äë %Kå“Cå÷å…, C%2! åK…%“2åL %! ã=…, ƒì=. b “%%2"å2“2", , “ .2, ì 3! ="…å…, åì, C=ö, å…2 "å“%ì 70 *ã …3›ä=å2“ " 242 ìë/ì, … n 2, ÷2% ! ="…% 3,4 ìë/*ã/ì, …; ! åKå…%* "å“%ì 10 *ã - " 56 ìë n 2, , ë, 5,6 ìë/*ã. j %ãä= , “C%ëüƒ3å2“ ƒ=*, “ü =ƒ%2= " ƒ=*! / 2%L “, “2åìå, 3“2=…="ë, "=å2“ C%“2% ……/ L C%2%* *, “ë%! %ä=, ! =““÷, 2=……/ L " “%%2"å2“2", , “ 3! ="…å…, åì B rody, …% C%2%* N2O “…, ›=å2“ "", ä3 …=*%Cëå…, =…å“2å2, *= " “, “2åìå =CC=! =2-C=ö, å…2 [Lowe J.H. et al., 1981]. d% …=“2% ? åã% "! åìå…, …å2 , %K? åC! , … 2%ã% ìå2%ä= %C! åäåëå…, "åë, ÷, …/ C%2%*=. Spence `.̀ . , “%="2. (1981) ƒ=ìå2, ë, : œKë=ã%ä=! “%ãë=øå…, þ, ÷2% C%2%* “"å›åã% ã=ƒ= " …, ƒ*%C%2%÷…%L “, “2åìå “%“2="ë å2 %K/ ÷…% 3 ë/ì, … , ë, ìå…ååB, “-%! ì, ! %"=ë%“ü C! åä“2="ëå…, å, ƒ=“2=", "øåå ì…%ã, . =…å“2åƒ, %ë%ã%" C%"å! , 2ü, ÷2% ƒ=*! / 2= “, “2åì= "ë å2“ “, …%…, ì%ì …, ƒ*%ã% C%2%*=. j =* C! =", ë%, …å ä, --å! å…ö, ! 3þ2 C%2! åK…%“2, C! , 2%*= ã=ƒ%" äë "ƒ! %“ë/ . , äå2åL. Aldrete J.A. , Romo-Salas F. (1979) %C! åäåë þ2 “! åä…, L C%2%*, *=* C! , 2%* ã=ƒ= C%! ä*= 2 ë/ì, … , …, ƒ*, L C%2%* - 1 ë/ì, …. Grogono A.W., et al. (1995) %C! åäåë þ2 "/ “%*, L C%2%* (œHigh flowB), *=* ëþK%L C! , 2%* ã=ƒ%", C! å-"/ ø=þ? , L 5 ë/ì, …; …, ƒ*, L C%2%* (œLow flowB), *=* C! , 2%* ã=ƒ%" - 1 ë/ì, …; ì, …, ì=ëü…/ L C%2%* (œMinimal flowB), *=* C! , 2%*, ! ="…/ L 600 ìë/ì, … , ƒ=*! / 2/ L *%…23! (œClosed circuitB), *=* C! , 2%* ã=ƒ%", *%2%! / å ƒ=ìå? =þ2 , “C%ëüƒ%"=……/ å. Kriesmer T.P. (1997) “÷, 2=å2 "/ “%*, ì C%2%* K%ëåå 1 ë/ì, …, …, ƒ*, ì - %2 1 ä% 0,5 ë/ì, … , ì, …, ì=ëü…/ ì - C%2%* 0,5-0,3 ë/ì, …. }2, 2å! ì, …/ - œHigh FlowB, œLow FlowB, œMinimal FlowB , œClosed SystemB %C! åäåëå…/ …å2"å! ä% , …3›ä=þ2“ " ä=ëü…åLøåL äå2=ë, ƒ=ö, , . j “%›=ëå…, þ, C! , 2%* ã=ƒ%" ìå›ä3 1 , 5 ë/ì, … "%"“å …å %C! åäåëå… [B aum J.A., 1993; Couto da Silva J.M., 1996]. r ÷, 2/ "= , ÷2% " “%"! åìå……%L , …ã=ë ö, %……%L =…å“2åƒ, , , “C%ëüƒ3þ2“ …å 2%ëü*% n 2 , N2O, …% , , “C=! þ? , L“ =…å“2å2, *, “, 23=ö, “ %C! åäåëå…, åì "åë, ÷, …/ …å%K.%ä, ì%ã% ã=ƒ%2%*= å? å K%ëåå 3“ë%›… å2“ . Simonescu R. (1986) C! åäë%›, ë ! =““÷, 2/ "=2ü …å%K.%ä, ì/ L C! , 2%* "“å. ã=ƒ%", *=* ! =“.%ä (ìë/*ã) " “%%2"å2“2", , “ 3! ="…å…, åì B rody.

m, ƒ*, L, “! åä…, L , "/ “%*, L C%2%*, ì%›…% 2=*›å %C! åäåë 2ü “ C%ì%? üþ *%ë, ÷å“2"= B rody œkg3/4B. b ƒ " 3! ="…å…, å B rody (V=10 kg3/4), , “C%ëüƒ3þ? åå ! =“÷å2 C%2! åKëå…, *, “ë%! %ä=, , 3ì…%›, " …= C! %-, ƒ"%ëü…/ L -=*2%! &2,5[ , C%ë3÷å……/ L ! åƒ3ëü2=2 K3äå2 25 kg3/4, "å! .…, L C! åäåë ã=ƒ%" (n 2, N2O , , “C=! þ? , L“ =…å“2å2, *) C! , =…å“2åƒ, , C% ƒ=*! / 2%ì3 *%…23! 3 K3äå2 2=*, ì ›å, *=* …, ›…, L C! åäåë C! , …, ƒ*%ì C%2%*å. b å! .…, L C! åäåë …, ƒ*%ã% C%2%*= K3äå2 C%ë3÷å… C% 2%ì3 ›å C32, , *=* 3*=ƒ=…% "/ øå (25 kg3/4. 2,5 ! =ƒ= =62,5), …% äë %Këåã÷å…, ! =“÷å2= .2% ì%›…% C! , … 2ü ƒ= 60 kg3/4, *%2%! / å "ë þ2“ …, ›…, ì C! åäåë%ì “! åä…åã% C%2%*=. b å! .…, L C! åäåë “! åä…åã% C%2%*= ì%›å2 K/ 2ü C%ë3÷å… 3ì…%›å…, åì 60 …= 2,5 ( 60kg3/4. 2,5 ! =ƒ= = 150 kg3/4), ÷2% "ë å2“ …, ›…, ì C! åäåë%ì "/ “%*, . C%2%*%".

n “…%"/ "= “ü …= .2%L *%…öåCö, , , 3 C=ö, å…2= "å“%ì 70 *ã, *%ãä= , “C%ëüƒ3å2“ %K? , L %KAåì ã=ƒ%" 605 ìë. (n 2, N2O , =…å“2å2, *), “, “2åì= ì%›å2 K/ 2ü ! =“öå…å…=, *=* ƒ=*! / 2= . m, ƒ*, L C%2%* K3äå2 C! , ìå…å…, *%ãä= K3äå2 3“2=…%"ëå… %KAåì ìå›ä3 605 , 1452 ìë, “! åä…, L C%2%*, *%ãä= , “C%ëüƒ3þ2“ C%2%*, ìå›ä3 1452 , 3630 ìë , "/ “%*, L C%2%*, *%ãä= C! å"/ ø=þ? , å .2, %KAåì/ …=ƒ…=÷=þ2“ C=ö, å…2=ì. r ! åKå…*= "å“%ì 10 *ã =…å“2åƒ, %ë%ã K3äå2 , “C%ëüƒ%"=2ü "/ “%*, L C%2%* “ C! , 2%*%ì ã=ƒ%", C! å"/ ø=þ? , ì 840 ìë/ì, ….

må“*%ëü*% K%ëåå 2! 3ä…/ L äë ! =“÷å2%" .2%2 C32ü %C! åäåëå…, C! , 2%*= ã=ƒ%" *=›å2“ K%ëåå …=3÷…/ ì [Couto da Silva J.M. et al, 1990], %ä…=*% , %… ä=ëå* %2 “%"å! øå…“2"=.

Tanamedrove dabalnakadovani anesTeziis Teoriuli aspeqtebi da terminologia

k. nuraliZe

376-e hospitali, ruseTis federaciis Tavdacvis saministro, q. Tbilisi

dabalnakadovani anesTeziis principi emyareba airTa recirkulacias sasunTq konturSi.

standartizaciis saerTaSoriso komisiis (ISO) monacemebiT, airTa mowodebuli nakadis

sidididan gamomdinare, arCeven Semdegi saxis konturebs: Cveulebrivi nakadiT – 3 l\wT–ze

meti, dabali nakadiT – 3 l\wT-ze naklebi, minimaluri nakadiT – 1 l\wT-ze naklebi da

daxuruli konturi, rodesac mowodebuli airis moculoba utoldeba pacientis mier mox-

marebul moculobas. terminebi “High Flow”, “Low Flow”, “Minimal Flow” da “Closed System” ar

aris mkafiod gansazRvruli da saWiroebs Semdgom detalizacias. inhalaciuri anesTeziis

dros gamoiyeneba ara marto O2 da N2O, aramed aqroladi saanesTezio saSualebebic, ris

gamoc airTa nakadis saWiro sididis gamoTvla kidev ufro rTuldeba. R. Simonescu (1986) miuTiTebs, rom mowodebuli sasunTqi nakadis aucilebeli sidide da xarjvis maCve-

neblebi (ml\kg) umjobesia gamoTvlil iqnas Brody–is formuliT; aRniSnuli meTodi sad-

Reisod yvelaze mecnierulad iTvleba, Tumca isic saWiroebs Semdgom srulyofas.

THEORETICAL ASPECTS AND TERMINOLOGY OF MODERN LOW FLOW ANAESTHESIA K. NURALIDZE

For low flow anaesthesia recirculatory a respiratory contour is used. Based on the data of the International

Commission on Standartisation (ISO), it is accepted to distinguish the following contours: With a usual flow - more than 3 l/min, low flow - less than 3 l/min, with the minimal flow - less than 1 l/min, the closed contour - flow of fresh gas is equal to its absorption by the patient. These terms - “High Flow”, “Low Flow”, “Minimal Flow” and “Closed System” are not firmly determined and require the further detailed elaboration. That in modern inhalation anaesthesia is used not only O2 and N2O, but evaporating anaesthetic as well, the situation with definition of size necessary flow becomes even more complicated. Simonescu R. (1986) has offered to expect necessary inflow of all gases, as the charge (ml/kg) according to the equation Brody. This way of definition of inflow of gases seems to be the most scientific, however, it needs further perfection.


1. Baum J. _ Low Flow Anesthesia. // Butterworth-Heinemann, 1996. 2. International Organisation for Standards (ISO): ISO 4135: 199X, Revision of ISO 4135:1979. // Anaesthesiology,

Vocabulary. British Standards Institution. 1993. 3. White D. C. _ Closed and Low Flow System Anaesthesia.//Curr. Anaesth. Crit. Care. 1992. V. 3. p. 98-107. 4. Davison J.K.,Eckhardt III W.F., Perese D.A. _ Clinical Anaesthesia Procedures of the Massachusetts General

Hospital. 4-th Edition. 1993. 711 p. 5. Barash PG., Cullen BF., Stoelting RK. _ Handbook of Clinical Anesthesia. J. B. Lippincott Company,

Philadelphia, 1991, pð. 32-39, 40-45. 6. k ,."=…öå" b .b . “ “%="2. _ ̀ ëüì=…=. l mn `p. 2000, “. 57. 7. k ,."=…öå" b .b . “ “%="2. _ ̀ …å“2åƒ, %ë. , ! å=…, ì=2%ë.1996, N 3.- q .68. 8. m,*%ë=å…*% }.l . “ “%="2. _ b å“2…, * , …2å…“, "…%L 2å! =C, , . 1994, 3, “.12-16. 9. m,*%ë=å…*% }.l . “ “%="2. _ b å“2…, * , …2å…“, "…%L 2å! =C, , . 2000, 2, “. 37-40. 10. o å÷å!,ö= b .b . _ `"2%! å-. ä, ““. *=…ä. ìåä. …=3*., l ., 1998, 27 “.

!!

vspmphjb-!qbsb{jupmphjb

Sard-sasqeso organoebis inficireba enterobiozis dros

med.mecn.kand. m.bregvaZe

s. virsalaZis saxelobis samedicino parazitologiisa da tropikuli medicinis


enterobiozi msoflioSi gavrcelebuli helminTozia, rac, ZiriTadad, ganpirobebulia

invaziis gadacemis simartiviT. saqarTveloSi mis masobriv gavrcelebas bolo wlebSi

adasturebs samedicino parazitologiisa da tropikuli medicinis samecniero-kvleviT

institutSi mopovebuli masala (ambulatoriuli gamokvlevebi) _ nawlavTa parazitozebis

70%-i am helminTozze modis. enterobiozi kontaqturi helminTozia, advilad

xorcieldeba rogorc avtoinvazia, ise heteroinvazia. is farTodaa gavrcelebuli

bavSvebSi, gansakuTrebiT bavSvTa organizebul koleqtivebSi, sadac sakmaod Znelia

profilaqtikuri RonisZiebebis gatareba.

parazitis moqmedeba organizmze meqanikuri da toqsikur-alergiuli xasiaTisaa, riTac

ganpirobebulia enterobiozis klinikuri simptomkompleqsi da gamowveuli garTulebebi.

gansakuTrebiT sayuradReboa enterobiozis garTuleba mdedrobiT sqesSi, sadac am

daavadebas gansxvavebuli klinikuri mimdinareoba aqvs. mdedri parazitebi, swori

nawlavidan gamosvlis Semdeg, pirvel rigSi kvercxebs deben anusisa da Sorisis

midamoebSi da Semdeg gadaadgildebian Sard-sasqeso organoebisaken. Tavisi sxeuliT maT

gadaaqvT nawlavis baqteriebi. literaturis monacemebiT, enterobiozi SeiZleba

garTuldes vaginitiTa da vulvovaginitiT (1), zogjer kudmaxvila gvxvdeba SardSic (2),

rac qmnis saSarde gzebis inficirebis saSiSroebas.

urologiasa da nefrologiaSi gamokvlevebis Sedegad cnobilia, rom cistitebisa da

pielonefritebis gamomwvevi yvelaze xSirad nawlavis Cxiria. zogierTi avtoris (3) azriT,

saSarde gzebis inficirebis etiologiaSi nawlavis Cxiris xvedriTi wona 80%-s Seadgens.

sayuradReboa, agreTve, rom rogorc cistiti, ise pielonefriti upiratesad gvxvdeba ara

marto gaTxovil qalebSi, aramed gogonebSic da inficirebis ZiriTadi gza aRmavalia (3,

4).

zemoaRniSnulidan gamomdinare, mozanSewonilad miviCnieT enterobiozis dros Sard-

sasqeso organoebis inficirebis Seswavla gogonebSi, sadac am organoebis inficirebis

sxva gzebi naklebad savaraudoa. Sard-sasqeso gzebis inficirebis sakiTxs vswavlobdiT

baqteriologiuri meTodiT SardSi da gareTa sasqeso organoebze nawlavis Cxiris

amoTesviT. gamokvlevas vawarmoebdiT 3-dan 12 wlamde asakis gogonaTa 2 jgufze. I jgufSi

Sediodnen enterobioziT daavadebulebi (sacdeli jgufi), II jgufSi _ janmrTelebi

(sakontrolo jgufi) TiToeul jgufSi iyo 70 bavSvi. gareTa sasqeso organoebidan

aRebuli nacxis baqteriologiuri gamokvleva CautareT 70 bavSvs, xolo Sardis

gamokvleva mxolod 50-s. Sesabamisad, igive raodenobis gogonebs CautareT nacxisa da

Sardis sakontrolo baqteriologiuri gamokvleva.

gogonebs steriluri tamponiT vuRebdiT nacxs gareTa sasqeso organoebidan da mas

vTesavdiT endos niadagze. Sardis aRebis win gogonebs utardeboda Cabana kalium-

permanganatis xsnariT. Semdeg Sardis pirvel ulufas vRvridiT da meore ulufas

vagrovebdiT sterilur WurWelSi. CaTesvas vawarmoebdiT endos niadagze petris

finjnebSi 0,1 ml-is raodenobiT minis Spadelis saSualebiT. TermostatSi 18-24 saaTis

inkubaciis Semdeg finjnebze vTvlidiT nawlavis CxirisTvis damaxasiaTebel koloniebs,

romlebsac, saxeobis dadgenis mizniT, vswavlobdiT morfologiur-tinqtorialuri,

bioqimiuri da serologiuri niSnis mixedviT (am ukanasknels enteropaTogenuri serotipis

gamosavlenad). nawlavis Cxiris amoTesvis SemTxvevaSi, gamokvlevas vimeorebdiT me-2 an me-3

dRes. aRebul Sardis naleqs vikvlevdiT mikroskopiulad. gamosakvlev kontingentSi

aRvricxavdiT subieqtur monacemebs da detalurad vswavlobdiT avadmyofobis anamnezs.

gamokvlevis Sedegad dadgenil iqna, rom enterobioziT daavadebuli 70 bavSvidan

umetesoba (62) uCioda qavils ukana tanis midamoSi. 17 avadmyofs hqonda vulvo-

vaginitisaTvis damaxasiaTebeli klinikuri suraTi (hiperemia, qavili, wva da gamonadeni

saSodan). isini aRniSnavdnen, rom enterobioziT daavadebis niSnebi daewyoT daaxloebiT

ramdenime Tvis win (gamoricxuli ar aris reinvazia). am avadmyofebs gareTa sasqeso

organodan amoeTesaT nawlavis Cxiri. garda amisa, nawlavis Cxiri damatebiT amoeTesa 6

gogonas. amgvarad, enterobioziT 70 daavadebulebs Soris gareTa sasqeso organodan

nawlavis Cxiri amoeTesa 23-s (32,8%). sakontrolo jgufSi, gareTa sasqeso organodan

nawlavis Cxiri amoeTesa 2 gogonas (2,8%).

Sardis gamokvleva warmoebulia 50 avadmyofze, romelTagan 17 avadmyofs hqonda vulvo-

vaginitisaTvis damaxasiaTebeli klinikuri suraTi da gareTa sasqeso organodan

amoeTesaT nawlavis Cxiri. am 17 avadmyofidan 8-s SardSiac amoeTesa nawlavis Cxiri. ko-

loniebis raodenoba 1 ml-Si iyo 110-dan 320-mde. 6 avadmyofs Sardis naleqSi mcire

raodenobiT aRmoaCnda leikocitebi (2-4-6 mxedvelobis areSi). sakontrolo jgufidan

nawlavis Cxiri SardSi amoeTesa erT bavSvs (160 kolonia erT ml-Si). enteropaTogenuri

nawlavis Cxiris amoTesvas adgili ar hqonia. sacdeli da sakontrolo jgufebis

Sedarebam gviCvena, rom sacdel jgufSi saSarde gzebis inficireba gacilebiT ufro

xSiria (16%), vidre sakontroloSi (2%), xolo im avadmyofebSi, romlebsac enterobiozi

xangrZlivad hqondaT da gaurTuldaT, Sardis inficireba maRalia _ 47%.

amrigad, warmoebuli samuSao gviCvenebs, rom enterobioziT daavadebul gogonebSi

(xangrZlivi invaziis pirobebSi) aRiniSneba Sard-sasqeso organoebis inficireba.

gansakuTrebiT sayuradRebod migvaCnia, rom Cven mier pirvelad iyo Seswavlili Sardis

inficirebis sakiTxi. sakontrolo jgufTan Sedarebam gviCvena, rom enterobiozis dros

gogonebSi adgili aqvs saSarde gzebis inficirebas nawlavis CxiriT. am garemoebis

gaTvaliswinebiT, metad mniSvnelovania enterobiozis drouli gamovlena da mkurnaloba,

vinaidan am helminTozma SesaZloa saSarde gzebis mZime aRmavali infeqciis ganviTareba

gamoiwvios.

h mt h 0 h pn b `mh e l n )e -o n k n b{u n pc`mn b o ph }mŠe pn a h n ge

j `md .l e d .m`r j l .c. ape cb `d ge

mh h ìåä,ö,…“*%L C=!=ƒ,2%ë%ã,, , 2!%C,÷å“*%L ìåä,ö,…/ ,ì. q. b ,!“=ë=äƒå

b ä"3. ã! 3CC=. äå"%÷å*, , …"=ƒ, ! %"=……/ . %“2! , ö=ì, (%C/ 2…= ã! 3CC=) , ƒä%! %"/ .

(*%…2! %ëü…= ) C! %"åäå…% K=*2å! , %ë%ã, ÷å“*%å , ““ëåä%"=…, å ì=ƒ*= , ƒ …=! 3›…/ . C%ë%"/ . %! ã=…%" , ì%÷, …= …=ë, ÷, å *, øå÷…%L C=ë%÷*, . h …-, ö, ! %"=……%“2ü C%ë%"/ . %! ã=…%" "/ "ëå…= 3 32,8%, = ì%÷, 3 16% , …"=ƒ, ! %"=……/ .. b *%…2! %ëü…%L ã! 3CCå , …-, ö, ! %"=…, å C%ë%"/ . %! ã=…%" %2ìå÷=ë%“ü 3 2,8%, ì%÷, 3 2%. q ! åä, , …"=ƒ, ! %"=……/ . %“2! , ö=ì, , %“ë%›…å……/ ì, "3ë"%"=ã, -…, 2=ì, , , …-, ö, ! %"=……%“2ü ì%÷, "/ “%*= # 47%. bCå! "/ å 3“2=…%"ëå…= "%ƒì%›…%“2ü , …-, ö, ! %"=…, ì%÷å"/ . C32åL C! , äë, 2åëü…%

C! %2å*=þ? åL , …"=ƒ, , %“2! , ö=ì, .

CONTAMINATION OF URINOGENITAL ORGANS IN CASE OF ENTEROBIOSIS M. BREGVADZE

Urine and smear from external genital organs were examined on E. coli in two groups of girls – suffering from

Enterobiosis (experimental group) and healthy ones (control group). contamination of genital organs was revealed in 32,8% of patients from experimental group and in 2,8% of

those from control group. Infections of urine were revealed in 16% of experimental group and in 2% of control group. But patients who had been diseased with Enterobiosis for a long time and whose condition became complicated with vulvovaginitis, frequency of urine infections is higher – 47%.


1. miqaZe i., Wkadua l., lomiZe i. _ enterobiozis paTogenuri kavSiri vulvitTan da

vulvovaginatTan. saqarTvelos ssr janmrTelobis dacvis saministros s. virsalaZis sax.

samedicino parazitologiisa da tropikuli medicinis samecniero-kvleviTi institutis

SromaTa krebuli _ parazituli sneulebani da maT winaaRmdeg brZola respublikaSi _

Tbilisi, 1985, gv. 92-95. 2. j!=å"“*,L b .c. $ ̀ 2ë=“ ì, *! %“*%C, , %“=ä*%" ì%÷, . l %“*"=, 1976, “2! .110-112. 3. k %!=… n .a ., g=Löå" ̀ .b ., c%ä3…%" a .m., j=C!,… ̀ .d ., d =",ä …ö ̀ .̀ $ q %"! åìå……/ å =“Cå*2/

ä, =ã…%“2, *, , ëå÷å…, .! %…, ÷å“*%ã% ö, “2, 2= 3 ›å…? , … # ›3! …. r ! %ë%ã, , …å-! %ë%ã, , l .: 1997, “. 7-11.

4. a =!ë/K=å"= m.̀ ., h “ì=,ë%"= `.Š. $ d , =ã…%“2, *= , ëå÷å…, å C, åë%…å-! , 2= 3 äå2åL # q K. 2! 3ä%" ̀ ëì=-̀ 2, …“*%ã% ìåä, …“2, 232= # må-! %ë%ã, äå2“*%ã% "%ƒ! =“2=. ̀ ëì=-̀ 2=, 1975, “. 3-8.

tupnbupmphjb-!njlspcjpmphjb

kbilis eqstraqciis Semdgomi alveolaruli Rrus mikrobuli flora

d. mamamTavriSvili, prof. g. menabde, prof. k. afridoniZe

saqarTvelos saxelmwifo samedicino akademia

kbilis eqstraqciis Semdgom zeda da qveda ybaze rCeba sagrZnoblad didi defeqti

rogorc Tavisi diametriT, ise siRrmiT, romelic mogvianebiT ganicdis reparacias da

regeneracias sxvadasxva xarisxiT. aRniSnuli defeqti problemas qmnis Semdgomi

rekonstruqciis TvalsazrisiT, vinaidan aq Cndeba didi zomis niSa, rac kbilis sayrdenis

- bazisis TvalsazrisiT saWiroebs raRac kompozitiT Sevsebas. sasurvelia, es kompoziti

akmayofilebdes mraval Tanamedrove moTxovnas, ar gaaCndes antigenuri, toqsikuri da

alergiuli Tvisebebi da sxva. amave dros sasurvelia aseTi kompozituri nivTierebebi

iyos myife, kargad emagrebodes zeda da qveda ybis Zvlovan struqturebs, gaaCndes Zlier

adheziuri, antimikrobuli Tvisebebi, iyos advilad gamosayenebeli da iafi sxva arsebul

analogebTan SedarebiT.

zemoaRniSnulTan dakavSirebiT, Cven mier SemuSavebulia axali kompozituri saSualeba

zeda da qveda ybis posteqstraqciuli travmuli, anTebiTi, kistozur-destruqciuli da

sxva etiologiis Zvlovani defeqtebis Sesavsebad.

axali kompoziciuri masalis teqnologiuri Taviseburebebi iqneba asaxuli specialur

publikaciaSi. miznad davisaxeT kompozitis SemadgenlobaSi Segvetana antimikribuli

preparatebi, romelTa seleqciisaTvis diminirebuli etiologiuri agentebis gamovlenisa

da maTi antimikrobuli preparatebisa da baqteriofagebis mimarT mgrZnobeloba

rezistentobis gansazRvris mizniT, gadavwyviteT Segveswavla ybis didi defeqtebis

granulebuli qsovilebis mikrobuli flora, romelic saSualebas mogvcemda Segveswavla

piris Rrus mikroekologia da SegverCia optimaluri antimikrobuli saSualebebi axali

kompozitisaTvis.

masala da meTodebi. masalis Segroveba xdeboda steriluri tamponis saSualebiT.

Seswavlil iqna 20 avadmyofi zeda da qveda ybis defeqtiT. kbilis eqstraqcia xdeboda

saxelmwifo samedicino akademiis qirurgiuli stomatologiis kaTedris bazaze, xolo

mikrobiologiuri gamokvleva amave akademiis mikrobiologiisa da epidemiologiis

kaTedris samecniero analitikur centrSi da qarTul-Sveicarul diagnostikur centrSi

`cito~.

mikrobiologiuri kvlevebi tardeboda standartuli meTodebis gamoyenebiT (1, 2, 3).

masalis CaTesva xdeboda seleqciur sakveb niadagze, xolo inkubacia _ 370 temperaturis

pirobebSi 24-48 saaTis ganmavlobaSi. kulturebis identificirebis Semdeg, vawarmoebdiT

mikrobebis mgrZnobeloba-rezistentobis Seswavlas antibiotikebisa da baqteriofagebis

mimarT. baqteriologiuri kulturebis mgrZnobelobas vsazRvravdiT 52 antimikrobuli

preparatis, xolo fagebis _ stafilo-, streptokokuri, pio- da koli baqteriofagebis

mimarT.

kvlevis Sedegebi. anaerobuli flora arc erT SemTxvevaSi gamovlenili ar iyo.

rogorc moyvanili monacemebi gviCvenebs (cxrili), eqstraqciis Semdeg Rrudan, ZiriTadad,

gamoiyo S. epidermidis. momdevno adgili daikava safuarisebrma soko Candida albicans-ma, S. aureus-ma da iSviaT SemTxvevaSi gamoiyofoda S. saprophiticus, M. Catarralis, E. coli, Ps. aeruginoza.

monokultura izolirebuli iyo 10 SemTxvevaSi da ZiriTadad warmodgenili _ Sp. epidermidis-iT, danarCen 10 SemTxvevaSi identificirebulia Sereuli infeqciebi, romelic,

ZiriTadad, warmodgenilia kokebisa da safuara sokoebis asociaciebiT.

baqteriologiuri kvlevis mimdinareobaSi yvela SemTxvevaSi tardeboda gamoyofili

kulturebis mgrZnobeloba-rezistentobis gansazRvra antimikrobuli preparatebis mimarT.

Cvens SemTxvevaSi dominirebuli baqteria S. epidermidis karg mgrZnobelobas iCenda

penicilin G-s, retarpenis, ampioqsis, doqsiciklinis, tetraciklinis, metaciklinis,

kefzolis, cefaleqsinis, cefazolinis, cefamezinis, klaforanis, rocefinis, rifampicinis,

ciprofloqsalinis, levomicitinis mimarT, xolo rezistentuli iyo norfloqsinis,

sumetrolimis, abaqtalis, uropimidis, sumamedis, rinacefis, kanamicinis, gentamicinis,

linkomitozis mimarT.

stafilokoki S. epidermidis maRal mgrZnobelobas iCenda stafilokokuri fagebisa

(kulturebis 42%) da 32%-Si piofagebis mimarT. S. aureus maRal mgrZnobelobas iCenda

ampicilinis, amikacinis, 5-nokis, klaforanis, zinacefis, rocefinis, levomicetinis,

rifampicinis, oflotazis, xolo rezistentuli iyo penicilinis, penicinil G-s,

oqsacilinis, tetraciklinis, doqsociklinis, gentamicinis, biseptolis, abaqtalis,

sumetrolimis mimarT. S. aureus maRal mgrZnobelobas iCenda homologiuri

baqteriofagebisa da piofagebis mimarT (47% da 34%, Sesabamisad).

Candida albicans maRal mgrZnobelobas iCenda nistatinTan, flunolTan, diflukanTan,

xolo rezistentuli iyo atrikan-250, mikosistisa da amfotericin-B-s mimarT.

daskvna. kvlevis Sedegad aRmoCnda, rom kbilis eqstraqciis Semdeg defeqtebis

mikroflora ZiriTadad warmodgenilia gramdadebiTi kokovani floriT. S. epidermidis, S. aureus, S. saprophiticus-i, Stomatococcus muculgenosis iSviaTad iTeseba. gramuaryofiTi flora,

aseve Moraxella cataralis da Ps. aeruginoza. gansakuTrebul yuradRebas imsaxurebs anaerobuli

floris ararseboba aRniSnuli paTologiis dros, kvlevis Tanamedrove meTodebis

gamoyenebis miuxedavad (safrangeTi, Biomelio, genbak, API da ATI sistemebi). gansakuTrebul

yuradRebas imsaxurebs kokovani floris maRali mgrZnobeloba baqteriofagebis mimarT.

Tu gaviTvaliswinebT im faqts, rom saqarTvelo baqteriofagebis meore samSoblod

iTvleba da TbilisSi arsebobs msoflioSi erTaderTi baqteriofagis instituti,

romelic uSvebs maRali xarisxisa da aqtivobis preparatebs, mizanSewonilad migvaCnia

maTi farTo gamoyeneba stomatologiur praqtikaSi, xolo Cvens konkretul SemTxvevaSi

perspeqtiulia maTi CarTva kompoziciuri preparatis SemadgenlobaSi.

l h jpn t k n p` ̀ k |b e n k “ pmn i o n k n qŠh o n qk e }jqŠp`j0 h h gr a n b d . l `l `l Š`b ph xb h k h , o pn t . c. l e m`a d e , o pn t . j. ̀ o ph d n mh d ge c%“3ä=!“2"å……= ìåä,ö,…“*= =*=äåì, , c!3ƒ,, p=ƒ! =K%2=… …%"/ L *%ìC%ƒ, ö, %……/ L ì=2å! , =ë äë ! åC=! =ö, , =ëü"å%ë ! …/ . äå-å*2%". q öåëüþ

%C! åäåëå…, %C2, ì=ëü…/ . =…2, K, %2, *%" , K=*2å! , %-=ã%" äë "*ëþ÷å…, " “%“2=" *%ìC%ƒ, 2=, C! %"åäå…% ì, *! %K, %ë%ã, ÷å“*%å , ““ëåä%"=…, å ì, *! %-ë%! / =ëü"å%ë ! …/ . C%ë%“2åL C%“ëå .*“2! =*ö, , ƒ3K%". n K…=! 3›å…% ä%ì, …, ! %"=…, å S. epidermidis , C. albicans, 2%ãä= *=* S. saprophiticans , Stomatoccocus mucilagenoza, M. katarralis , Ps. aeruginosa "/ "ëå…/ “! ="…, 2åëü% ! åä*%. må“ì%2! …= C! , ìå…å…, å “%"! åìå……%L 2å.…%ë%ã, , (t ! =…ö, , B iomelio) =…=.! %K…= ì, *! %-ë%! = …å %K…=! 3›å…=. j %**%"a -ë%! = C! % "ë ë= "/ “%*3þ ÷3"“2", 2åëü…%“2ü * Ka*-2å! , %-=ã3 , ! ä3 =…2, K, %2, *%", " ÷=“2…%“2, * öå-=ëå*“, …3, öå-=ƒ%ë, …3, öå-=ìåƒ, …3, *ë=-%! =…3, öå-2! , =*“%…3, ö, C! %-ë%*“=ö, ëë, …3, %-ë%*“=ö, ëë, …3, “3ìå2! %ë, …3 , …%! -ë%*“=ö, …3.

MICROFLORA OF ALVEOLAR CAVITY AFTER TEETH EXTRACTION D. MAMAMTAVRISHVILI, G. MENABDE, K. APRIDONIDZE

A new composition material for the reparation of alveolar defects was developed. For determination of optimal

antibiotics and bacteriophages in order to include them into the composition, microbiological investigation of the microflora of alveolar cavity after teeth extraction was carried out. A prevalence of S. epidermidis and C. albicans was observed, whereas S. saprophiticans and Stomatococcus mucilagenoza, M. katarralis and Ps. aeruginosa were noted relatively rarely. Anaerobic microflora was not revealed in spite of the usage of modern technology (France, Biomelio). Coccal flora showed a high sensitivity to bacteriophage and some antibiotics, particularly to cephalexin, cephazolin, cephamezin, Klaforan, cephtriaxon, Ciprofloxacin, Ofloxacin, sumetrolin, norfloxacin and others.


1. a ,!ãå! l .n . _ q C! ="%÷…, * C% ì, *! %K, %ë%ã, ÷å“*, ì , ", ! 3“%ë%ã, ÷å“*, ì ìå2%ä=ì , ““ëåä%"=…, . l .: 1982, 464 “. 2. o %*!%"“*,L b .̀ . _ l åä, ö, …“*= ì, *! %K, %ë%ã, . l .: 1998, 1000 “. 3. Šåö b .p. _ q C! ="%÷…, * C% *ë, …, ÷å“*%L ì, *! %K, %ë%ã, , . l .: l åä, ö, …=, 1994, 462 “.

!

!

!

!

!

!

!

!

!

!

hbytfofcb!

sityva maswavlebelze

90 weli emsaxura profilaqtikur medicinas Rvawlmosili mecnieri, uxucesi higienisti,

Tbilisis saxelmwifo samedicino universitetis Sromis higienisa da profesiul daavadebaTa

kaTedris damaarsebeli, mecnierebis damsaxurebuli moRvawe, saqarTvelos profilaqtikuri

medicinis mecnierebaTa da samedicino-biologiur mecnierebaTa akademiebis akademikosi, medicinis

mecnierebaTa doqtori, profesori melenti yuraSvili. qveyanas, ers, qarTul samecniero sazogadoebas, inteligencias, profilaqtikuri medicinis

dargs gamoaklda bolomde valmoxdili didi mamuliSvili, SesaniSnavi mecnieri, gulisxmieri

pedagogi da qarTvel eqimTa mravali Taobis aRmzrdeli, yovelmxriv samagaliTo pirovneba.

batoni melenti yuraSvili daibada 1915 wlis 12 Tebervals martvilis raionis sofel

jolevSi, pedagogisa da sasuliero piris ojaxSi. Tbilisis saxelmwifo samedicino institu-

tis damTavrebisTanave (1940 w.), gaiwvies savaldebulo samxedro samsaxurSi, sadac muSaobda

sxvadasxva samxedro SenaerTis ufrosi eqimis Tanamdebobaze. aqve mouswro omma faSistur

germaniasTan. omis dawyebis pirveli dReebidan, mis damTavrebamde, imyofeboda moqmed armiaSi da

ibrZoda yvela frontze _ kavkasiidan baltiispireTamde. gaiara leningradis blokadis

urTulesi periodi. demobilizaciis Semdeg, igi muSaobas iwyebs prof. n. maxvilaZis saxelobis

Sromis higienisa da profesiul daavadebaTa samecniero-kvleviT institutSi, sadac 25 wlis

ganmavlobaSi (1948-1973 w.w.) ucvlelad xelmZRvanelobda institutis wamyvan _ Sromis

higienis samecniero ganyofilebas.

Tbilisis saxelmwifo samedicino institutSi, misi iniciativiT, 1973 wels Camoyalibda

Sromis higienisa da profesiul daavadebaTa kaTedra, romelsac warmatebiT ganagebda 18 wlis

ganmavlobaSi da kaTedris profesoris Tanamdebobaze muSaoda sicocxlis bolomde.

xangrZlivi samecniero-pedagogiuri moRvaweobis manZilze batoni melenti student-

axalgazrdobas da Cven _ mis mowafeebs, pirvel rigSi gvaswavlida _ adamianur urTierTobaTa

mecnierebas da mxolod amis Semdeg specialobas _ Sromis higienas.

mdidari da mravalferovania batoni melentis samecniero moRvaweoba. mas nebismieri

sakiTxisadmi novatoruli midgoma axasiaTebda, erTi SexedviT, banalur sakiTxSic ki SeeZlo

moenaxa siaxle.

batonma melentim, Tavis ukrainel da somex kolegebTan erTad, pirvelad dasva sakiTxi

samrewvelo mikroklimatis normirebisas klimatur-geografiuli zonebis gaTvaliswinebis

aucileblobis Sesaxeb da qveynis (ssr kavSiris) samxreTi regionebisaTvis samuSao dRis

yvelaze cxel periodad, 13-is nacvlad, 16 saaTis dawesebis Sesaxeb.

wlebis ganmavlobaSi Tbilisis saxelmwifo samedicino universitetSi profesiuli

paTologiis swavleba ver idga saTanado doneze, ris erT-erTi mizezi am disciplinis swav-

lebis sxvadasxva kaTedraze danawileba iyo. batonma melentim fundamenturad daasabuTa da

warmatebiT gadaWra es mniSvnelovani sakiTxi _ misi aqtiurobis Sedegad, 1973 wels, Seiqmna

Sromis higienisa da profesiul daavadebaTa kaTedra, riTac Tvisobrivad axal doneze avida

saswavlo-meToduri da samecniero-kvleviTi muSaoba, romlis kompleqsuroba da

urTierTganpirobebuloba cxovrebis Semdgomma ganviTarebam dagvanaxa: dRes es ori disciplina

mTel msoflioSi kompleqsuri samedicino mimarTulebis _ Sromis medicinis saxeliTaa

aRiarebuli.

m. yuraSvilis uSualo xelmZRvanelobiTa da konsultaciiT Sesrulebulia mravali

sakandidato da sadoqtoro disertacia. mas gamoqveynebuli hqonda 140-ze meti samecniero naS-

romi, maT Soris 6 monografia da meToduri saxelmZRvanelo Sromis higienaSi samedicino

institutis studentebisaTvis. gansakuTrebiT didi interesi gamoiwvia misi xelmZRvanelobiT

amierkavkasiis metalurgiuli sawarmoebis bazaze sawarmoo eqsperimentis pirobebSi Catarebuli

gamokvlevebis Sedegad damuSavebulma cxeli saamqroebis muSaTa axalma sasmelma reJimma

(`vitaminizebuli mwvane baixaos Cais nayeni~), romelic 1964 wlidan dainerga saqarTveloSi _

zestafonis feroSenadnob da rusTavis metalurgiul qarxnebSi, sumgaiTis milsaglinav

qarxanaSi, ruseTis 27 metalurgiul warmoebaSi didi ekonomikuri efeqtiT.

usazRvrod keTilSobili, umwikvlo, gansakuTrebuli SromismoyvareobiT dajildovebuli,

axalgazrdebis dauRalavi aRmzrdeli da moamage, mSobliur qveyanasa da tradiciebze Tav-

daviwyebiT Seyvarebuli batoni melenti Tavisi xangrZlivi da patiosani cxovrebiT marad

darCeba WeSmariti erisSvilobisa da adamianurobis saucxoo magaliTad. mis naTel saxels

misi saqmis gamgrZeleblebisa da mowafeebis xsovnaSi daviwyeba ar uweria.

prof. r. kverenCxilaZe

oflspmphj

suliko falavandiSvili

qarTul samedicino sazogadoebas gamoaklda gulmxurvale patrioti, brwyinvale profesio-

nali, keTilSobili adamiani, batoni suliko vasilis Ze falavandiSvili.

batoni suliko Tbilisis saxelmwifo samedicino institutis damTavrebis Semdeg, 1964

wlidan, muSaobda moskovis a.n. bakulevis saxelobis gul-sisxlZarRvTa qirurgiis institutSi,

iqve daicva sakandidato disertacia da Camoyalibda erT-erT wamyvan kardioqirurgad (im

periodSi Ria gulze 500-mde operacia qonda Catarebuli).

1971 wlidan batoni suliko dabrunda TbilisSi da moRvaweoba gaagrZela qirurgiis

institutSi. 80-iani wlebis meore naxevarSi igi muSaobda saqarTvelos janmrTelobis dacvis

saministroSi, Semdeg infeqciuri daavadebebis respublikuri klinikuri saavadmyofos mTavari

eqimis moadgiled.

1991 wels batoni suliko arCeuli iqna Tbilisis sakrebulos Tavmjdomaris pirvel

moadgiled.

batoni suliko Tavis garSemo qmnida im keTilSobilur da patriotul ganwyobas, romliTac

igi yovelTvis gamoirCeoda.

megobrebi da kolegebi

ìïáïîàâåäëì ìïèåæòúòíë...

Documents

Transcript of ìïáïîàâåäëì ìïèåæòúòíë...