mwvave bronqiti

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mwvave bronqiti
sa qa rT ve lo s
res pir ac iu li as oc ia ci a
sa qa rT ve lo s Sro mi s,
jan mr Te lo bi sa d a
soc ia lu ri d ac vi s
sa mi ni st ro
mwva ve br on qit i
avtorebi: T.maRlakeliZe, k. vaWaraZe, i.C xaiZe,
p.g vetaZe,
n.yavlaSvili
eqspertebi: n.uberi, v. qacarava, n. manjaviZe,
q.S arangia
Tb ilisi
200 6
gaidlainis aucilebloba. mwvave bronqiti traqeobronquli xis
anTebiTi procesia, romlis sixSire gansakuTrebiT matulobs zamTris
periodSi, rodesac gansakuTrebiT maRalia mwvave respiraciuli
1
infeqciebis ricxvi. marto aSS-Si mwvave bronqitis diagnoziT 12 milioni
adamiani mimarTavs eqims, ris gamoc yovelwliurad 300.000 mln dolaris
wamali iniSneba.
definicia
mwvave bronqiti bronquli xis lorwovani garsis mwvave anTebaa,
romelic grZeldeba 2-3 kviramde da romlis aucilebel simptoms
warmoadgens xvela naxvelis gamoyofiT an mis gareSe.
epidemiologia
mwvave bronqiti ojaxis eqimis mier erT-erTi yvelaze xSirad
dasmuli diagnozia. is xSiria zamTris periodSi, rodesac Warbobs
respiraciuli virusuli infeqciebi. bronqiti Sedis eqimTan vizitis
uxSires mizezTa xuTeulSi. bronqiti Tanabrad gvxvdeba orive sqesis
pacientebSi. yvelaze xSirad 5 wlamde asakis bavSvebi avaddebian. aseve
maRalia misi sixSire 9-15 wlis bavSvebSi. mwvave bronqitis sixSire wlis
ganmavlobaSi aSS-Si saSualod 87 SemTxvevaa/100.000 mosaxleze/kviraSi,
xolo
zamTris
periodSi
misi
sixSire
150
SemTxvevaa/100.000
mosaxleze/kviraSi. britaneTSi skolis moswavleebSi
bronqitis
gavrceleba
20,7%-mdea.
saqarTvelos
Sromis,
janmrTelobis
da
socialuri dacvis saministros daavadebaTa kontrolis da samedicino
statistikis erovnuli centris 2004 wlis monacemebiT saqarTveloSi
mwvave bronqitis diagnoziT hospitalizebul iqna 3.214 avadmyofi, maT
Soris 14 wlamde asakis 2.655 bavSvi. 100.000 mosaxleze maCvenebeli
Seadgens 73.5-s. letalobis maCvenebeli 0,1%-ia.
etiologia
mwvave bronqiti uxSiresad dakavSirebulia respiraciul virusebTan,
rogoricaa gaciebis gamomwvevi virusebi (rinovirusi, koronavirusi),
gripis virusi, adenovirusi, rs-virusi, paragripis virusi, martivi
herpesis virusi. mwvave bronqitis SedarebiT umniSvnelo nawili
ganpirobebulia sxva mizezebiT:
baqteriebi:
1. Streptococcus Pneumoniae
2. Heamophilus Influenza
3. Moraxella catarrhalis (Branhamellacatarallis)
4. Bordetella pertusis (da parapertusis)
atipuri gamomwvevebi
1. Mycoplasma pneumoniae
2. Chlamidia pneumoniae
3. Legionella
sokoebi:
2
1. Blastomyces dermatitidis
2. Candida albicans
3. Coccidiodes immitis
4. Cryptococcus neoformans
5. Histoplasma capsulatum
garemos gamRizianeblebi
1. haeris dabinZureba
2. Tambaqos
boli
(15
wlamde
bavSvebSi
bronqitis
sixSire
korelirebs pasiur mowevasTan (mtkicebuleba IV)
mwvave
bronqitis
gamomwvevTa
asakobrivi
Tavisebureba
bavSvebSi
aseTia:
1 wlamde:
1. respiraciul-sincitiuri virusi (zamTari-gazafxuli)
2. paragripis virusi (Semodgoma)
3. koronavirusi (zamTari-gazafxuli)
1-10 weli
1. paragripis virusi (Semodgoma)
2. enterovirusi (Semodgoma)
3. respiraciul-sincitiuri virusi (zamTari-gazafxuli)
4. rinovirusi (Semodgoma)
10 welze met asakSi
1. gripis virusi (zamTari-gazafxuli)
2. respiraciul-sincitiuri virusi (zamTari-gazafxuli)
3. adenovirusi.
cxrilSi
moyvanilia
mwvave
bronqitis
uxSires
gamomwvevTa
epidemiologiis da klinikuri mimdinareobis Taviseburebani.
gamomwvevi agenti
Tavisebureba
Influenza A virus
epidemiis dros avaddeba yvela asakobrivi
jgufis warmomadgeneli
Influenza B virus
avaddeba yvela asakobrivi jgufis
warmomadgeneli
•
Parainfluenza 1–3
•
Adenovirus
Pneumococcus
erTeuli SemTxvevebi, epidemia iSviaTia
•
saSualo asakSi an moxucebSi
3
gamomwvevi agenti
Mycoplasma
Tavisebureba
•
uecari dasawyisi
•
zemo sasunTqi gzebis dazianebis
simptomebi
•
epidemia 30 wlamde asakSi gvxvdeba
•
daavadebis daswyisSi damaxasiaTebelia
zemo sasunTqi gzebis dazianebis
simptomebi
•
mSrali xvela
Bordetella pertussis
gaxangrZlivebuli xvela
Haemophilus influenzae
mwevelebSi an pirebSi qronikuli bronqitiT
Moraxella catarrhalis
qronikuli bronqiti, imunodeficiti
paTogenezi
mwvave bronqitis dros viTardeba bronqis lorwovanis SeSupeba da
lorwos hipersekrecia. xvela SeiZleba, erTi mxriv, gamowveuli iyos
sasunTqi gzebis epiTeliumis destruqciiT, meore mxriv ki anTebis
mediatorebis gamomuSavebiTa da mukociliuri aparatis dazianebiT,
Tumca xvelis ganviTarebis meqanizmi bolomde naTeli ar aris. ufro
maRali virulentobis mqone virusebisaTvis, rogoricaa gripi da
adenovirusi, xvelis mizezi SeiZleba iyos lorwovani garsis
epiTeliumis daSla. ufro naklebi virulentobis mqone virusebisaTvis,
rogoricaa rinovirusi, xvelas SesaZloa ganapirobebdes anTebis
mediatorebis aqtivacia da bronqis mukociliaruli funqciis Secvla.
bronqitis ganviTarebasa da simptomebis gamwvavebas xels uwyobs
Tambaqos boli da haeris dabinZureba. mwvave bronqitis dros
ganviTarebuli anTebiTi cvlilebebi gardamavalia, Tumca xvela
SeiZleba gaxangrZlivdes 3 kviramde.
mwvave bronqitis risk-fa qtorebia:
•
gadacieba;
•
cxviriT sunTqvis gaZneleba;
•
cxvir-xaxis qronikuli infeqciebi;
•
imunodeficituri mdgomareobebi;
•
bavSvTa da xandazmuli asaki;
•
Tambaqos moweva (pasiuric);
4
•
alkoholizmi;
•
refluqs-ezofagiti;
•
garemos dabinZureba.
klinikuri ni Snebi
mwvave bronqiti uxSiresad gamowveulia respiraciuli virusebiT,
amitom igi iwyeba respiraciuli infeqciis niSnebiT, rogoricaa
Semcivneba, saerTo sisuste, msubuqi cxeleba (araumetes 3 dRe),
cxviridan gamonadeni, yelis tkivili, kunTebis tkivili, xmis CaxleCa.
ZiriTadi klinikuri niSani xvelaa, romelic daavadebis dawyebidan
2-4 dRis Semdeg iCens Tavs. Tavidan is mSrali, Semawuxebeli xasiaTisaa,
Semdeg produqtiuli xdeba. naxveli Tavidan lorwovania, mogvianebiT
Cirqovani SeiZleba gaxdes. Tumca Cirqovani naxveli gamowveulia
leikocitebis migraciiT da yovelTvis ar miuTiTebs baqteriuli
infeqciis arsebobaze. adreuli asakis bavSvebi naxvels ylapaven, rasac
SeiZleba mohyves Rebineba. dinamikaSi naxveli TandaTan Txierdeba da 510 dReSi xvela gaivlis. bronqitis simptomebi Cveulebriv 2 kviramde
grZeldeba, Tumca iSviaTad SeiZleba xvela gaxangrZlivdes 4-6 kviramde.
obieqturi gamokvleva
obieqturi gamokvlevis Sedegebi damokidebulia pacientis asaksa da
daavadebis stadiaze. temperatura, rogorc wesi, normaluria, Tumca
SesaZlebelia subfebrilur cifrebsac aRwevdes. adreul etapze
SesaZloa gamoxatuli iyos nazofaringiti, koniunqtiviti da riniti.
filtvebis auskultaciuri monacemebi am etapze ar aris Secvlili.
daavadebis progresirebis da xvelis intensivobis matebasTan erTad
filtvebis auskultaciuri monacemebi icvleba, sunTqviTi xmianoba xdeba
mkvrivi, moismineba mSrali da sxadasxva yalibis sveli xixini. zog
pacientSi SeiZleba moisminebodes mstvinavi sunTqva. bronqitisaTvis ar
aris damaxasiaTebeli lokaluri simptomatika: lokaluri krepitacia,
bronquli sunTqva, perkutoruli xmianobis moyrueba. aseT SemTxvevaSi
gamosaricxia pnevmoniis arseboba.
garTulebebi
•
pnevmonia (viTardeba pacientTa 5%-Si);
•
sunTqvis mwvave ukmarisoba.
simZimis Se faseba
mwvave bronqiti, rogorc wesi, mimdinareobs msubuqad an saSualo
simZimiT, is ar saWiroebs hospitalizacias
hospitalizaciis Cvenebebi
5
Cveulebriv mwvave bronqitis mkurnaloba ambulatoriulad tardeba.
hospitalizaciis Cvenebas warmoadgens:
•
Tanmxlebi daavadebebi (gulis Tandayolili anomalia, filtvis
qronikuli paTologia, nevrologiuri darRvevebi);
•
socialuri
problemebi
-
ojaxSi
movlis,
meTvalyureobis
deficiti, transportirebis saSualebis ar arseboba (sarwmunoeba
IV, rekomendacia D);
•
simptomebis 2-3 kviraze metad gaxangrZliveba;
•
toqsikozis niSnebi (saeWvoa baqteriuli traqeiti an pnevmonia);
•
sicocxlisTvis
saSiSi
niSnebis
arseboba
(sarwmunoeba
IV,
rekomendacia D,);
•
sakvebis da siTxis miRebis SeuZlebloba.
diagnozi
daavadebis diagnostika tardeba klinikuri niSnebis safuZvelze.
bronqitze eWvi unda iqnes mitanili im pacientebSi, romelTanac mwvave
respiraciuli infeqciis niSnebi asocirebulia xvelasTan. sruli
anamnezuri gamokvleva unda moicavdes garemo aris da sigaretis
zegavlenis dadgenas, epidemiologiur monacemebs. sruli obieqturi
gamokvleva aucilebelia, raTa gamoiricxos xvelis sxva mizezebi,
rogoricaa kardiovaskuluri daavadebebi da filtvis parenqimis
dazianeba.
sisxlis
saerTo
analizi
ar
iZleva
daavadebis
diagnostikis da misi mkurnalobis gansazRvris saSualebas (sarwmunoeba
IV). amitom ar aris mizanSewonili misi rutinulad Catareba
(rekomendacia C). mwvave bronqitis dros SeiZleba gamovlindes
leikopenia an leikocitozi, limfocitozi, Tumca es ar aris
specifiuri am daavadebisaTvis.
pulsoqsimetria, Jangbadis saturaciis gansazRvra
(mZime
mimdinareobisas).
O2
saturaciis
gansazRvra
mizanSewonilia
Cautardes Yyvela bavSvs, romelic hospitalizebulia sunTqvis mwvave
ukmarisobiT (sarwmunoeba II, rekomendacia C).
rentgenologiuri
gulmkerdis
rentgenograma
gaZliereba.
gulmkerdis
gamokvleva
normaluria
rentgenografia
–
an
mwvave bronqitis dros
aRiniSneba
ar
tardeba
bronqogenuri
rutinulad.
gulmkerdis rentgenografiis Cvenebebia:
pacients aqvs cxeleba, magram ar aqvs zemo sasunTqi gzebis
dazianebis simptomebi;
6
pacients aqvs Tanmxlebi davadeba, romelic xels uwyobs
pnevmoniis ganviTarebas – bronqoeqtazia, diabeti, gulis,
RviZlis an Tirkmlis paTologia;
anamnezSi pnevmonia (< 1 weli);
anamnezSi tuberkulozis arseboba;
daavadebis gaxangrZliveba an uCveulo mimdinareoba;
eWvi pnevmoniaze.
etiologiuri
kvleva
- nazofaringuli sekretidan SeiZleba
virusis gamoyofa, Tumca es ar aris aucilebeli diagnozis dasasmelad
an
mkurnalobisTvis.
genezisaa,
ar
aris
vinaidan
mwvave
rekomendebuli
bronqiti ZiriTadad
naxvelis
virusuli
mikrobiologiuri
Tu
serologiuri testiT SeiZleba
gamomwvevis
(mikoplazmis,
qlamidiis)
sawinaaRmdego
specifiuri
antisxeulebis dadgena. polimerazuli jaWvuri reaqciiT SesaZlebelia
nebismieri etiologiuri faqtoris dadgena, Tumca es meTodi Zviria da
stacionarSic ki rutinulad ar gamoiyeneba.
f i l t v i s f u n q c i i s S e s w a v l a - mwvave bronqitiT daavadebul
pacientebSi
dadgenilia
filtvis
funqciis
daqveiTeba,
magram
spirografia ar aris rutinulad rekomendebuli. filtvis funqciis
Seswavla tardeba bronqul asTmaze eWvis dros.
mikroskopuli
kvlevis
C-reaqtiuli
Catareba.
cila
–
kvlevebi
gviCveneben,
rom
es
testi
xasiaTdeba baqteriuli infeqciis mimarT maRali mgrZnobelobiT (80100%), da dabali specifiurobiT (60-70%). C-reaqtiuli cila SeiZleba
gamoyenebul iqnas antibiotikoTerapiis kriteriumad hospitalizebul
bavSvebSi
(rekomendacia B).
Tumca
dabali
C-reaqtiuli
cila
ar
gamoricxavs baqteriuli infeqciis arsebobas.
diferenciuliDdiagnozi
diferencialuri diagnozi tardeba Semdeg daavadebebTan:
pnevmonia;
asTma;
qronikuli bronqitis gamwvaveba;
yivanaxvela;
ucxo sxeulis aspiracia;
mukoviscidozi;
bronqioliti;
7
zeda sasunTqi gzebis infeqcia;
sinusiti;
nazofaringiti;
refluqs-ezofagiti;
bronqis simsivne;
atipuri mikobaqteriuli infeqcia;
baqteriuli traqeiti.
riniti da post-nazaluri wveTi.
prognozi
prognozi pacientTa umravlesobaSi keTilsaimedoa. Tu xvela
gaxangrZlivda, saWiroa damatebiTi gamokvlevebi.
marTva
mwvave
bronqitis
ZiriTadi
gamomwvevia
virusi,
amitom
antibiotikoTerapia ar aris naCvenebi. rva placebo-kontrolirebadi,
ormagi brma, randomizebuli kvlevis meta-analizis Sedegad naCvenebia,
rom ar arsebobs mwvave bronqitis dros antibiotikebis gamoyenebis
efeqturobis damadasturebeli monacemebi. antibiotikebi ar axdendnen
zegavlenas xvelis Semcirebaze, ar icavdnen meoradi baqteriuli
infeqciebis ganviTarebisagan an maTi mZime mimdinareobisagan.
antibiotiki iniSneba, Tu saeWvoa baqteriuli infeqcia (sarwmunoebis
done
I,
rekomendacia A).
dadgenilia,
rom
mwvave
bronqitis
diagnoscirebisas eqimTa 50-79% niSnavs antibiotiks, miuxedavad imisa,
rom antibiotiks aranairi sargebeli ar moaqvs. antibiotikoTerapiaze
unda vifiqroT, Tu:
zogadi mdgomareoba uaresdeba;
cxeleba grZeldeba erT kviraze met xans;
cxeleba Tavidan iwyeba;
aRiniSneba profuzuli da Cirqovani naxveli;
epidemiologiuri
situaciidan
gamomdinare
eWvia
mikoplazmur,
qlamidiur infeqciaze an yivanaxvelaze;
Tu mwvave bronqitis simptomebTan erTad aRiniSneba sinusiti an
otiti;
Tu
daavadeba
mimdinareobs
im
faqtorebis
fonze,
romelTac
SeuZliaT gazardon pnevmoniis ganviTarebis riski (imunodeficiti,
8
alkoholizmi, gulis qronikuli ukmarisoba, filtvis qronikuli
paTologia).
mikoplazmur da qlamidiur infeqciaze eWvis dros rekomendebulia
makrolidis gamoyeneba (sarwmunoebis done III, rekomendacia B).
mkurnalobis principebi bavSvebSi
1. mSvidi, komfortuli garemo;
2. siTxeebis damatebiTi miwodeba;
3. antipiretuli saSualebebi;
4. amosaxvelebeli
saSualebebis
efeqturoba
da
sargeblianoba
bavSvebSi ar aris dadasturebuli;
5. bavSvebSi
xvelis
damTrgunvelebis
gamoyeneba
ar
amcirebs
daavadebis xangrZlivobas, amasTan naxvelis evakuaciis daTrgunvam
SeiZleba xeli Seuwyos baqteriul garTulebas;
6. bavSvebSi
ar
arsebobs
mwvave
bronqitis
dros
β2-agonistebis
efeqturobis damadasturebeli monacemebi;
7. antihistaminuri preparatebi ar aris rekomendebuli, radgan isini
iwveven naxvelis gamoSrobas da SeiZleba gaaZlieron xvela.
mSobels unda miewodos informacia, rom dauyovnebliv mimarTos
eqims,
Tu
bavSvs
gamoexata
Semdegi
niSnebi:
sunTqva
gaxda
ufro
gaZnelebuli; daewyo FRebineba yoveli kvebis Semdeg; ver iRebs siTxeebs;
gamoixata zogadi mZime mdgomareoba – daTrgunva, Zilianoba.
mkurnalobis principebi mozrdilebSi
1. siTxeebis
damatebiT
miwodeba
bronquli
sekretis
gamoSrobis
Tavidan acilebis mizniT;
2. sigaretis mowevisagan Tavis Sekaveba;
3. antipiretuli saSualebebi;
4. xvelis damTrgunveli saSualebebi xSirad iniSneba bronqitis,
gansakuTrebiT Semawuxebeli xveliT mimdinare, dros. maT SeiZleba
Seamciron
xvela,
magram
maTi
miReba
ar
amcirebs
daavadebis
xangrZlivobas.
5. amosaxvelebeli
saSualebebis
rutinuli
gamoyeneba
ar
aris
rekomendebuli. naxvelis gamaTxierebeli saSualebebis daniSvna
SesaZlebelia
mxolod
webovani,
Znelad
gamosayofi
naxvelis
SemTxvevaSi;
6. bronqodilatatorebis
gamoyeneba
umniSvnelo
efeqts
iZleva
gaxangrZlivebuli xvelis dros;
9
7. kortikosteroidebis gamoyeneba ar aris rekomendebuli, vinaidan
ar arsebobs kvleva,
romelic daadasturebs maT efeqturobas
mwvave bronqitis dros.
prevencia
dty vaqcinacia;
gripis sawinaaRmdego vaqcinacia;
Tambaqos bolisgan Tavis arideba.
meTvalyureoba
Semdgomi meTvalyureoba Cveulebriv ar aris saWiro, garda im
SemTxvevebisa, roca:
mdgomareoba uaresdeba an axali simptomebi Cndeba;
xvela xangrZlivdeba >1 Tveze;
simptomebi meordeba (>3 epizodze weliwadSi).
gaidlainis miRebis wyaro. winamdebare gaidlaini warmoadgenis
sxvadasxva gaidlainebis (ix. literatura) Sejerebis da adaptaciis
Sedegs.
literatura:
1. Meza R, Bridges-Webb C, Sayer G, et al. The management of acute bronchitis in
general practice: results from the Australian morbidity and treatment survey. Australian
Family Physician, 1994; 23: 1550-1553.
2. Samuel Ong, MD, Visiting Assistant Professor, Department of Emergency Medicine,
University of California at Los Angeles Medical Center-Olive View Bronchitis Last
Updated: December 29, 2004, WEBMD, eMedicine
3. Guideline for The Management of Acute Bronchitis - developed by an Alberta Clinical
Practice Guideline Working Group, 2006 Update.
4. Family Practice Notebook, 2000
5. Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army
Medical Center Bronchitis, Acute and Chronic Last Updated: January 30, 2006,
WEBMD, eMedicine
6. DiFranza JR, Lew RA. Morbidity and mortality in children associated with use of
tobacco products by other people. Pediatrics 1996; 97 (4); 560-568
7. Hamm R, Hicks R, Bemben D. Antibiotics and respiratory infections: are patients more
satisfied when expectations are met? J. Family Practice, 1996; 43: 56-62.
10
8. O’Brien K, Dowell S, Schwartz B, et al. Cough illness/bronchitis – principles of
judicious use of antimicrobial agents.Paediatrics,1998;101: 178-81.
9. Gonzales R, Barrett P, Steiner J. The relationship between purulent manifestations and
antibiotic treatment of upper respiratory tract infections. J. General Internal Medicine,
1999; 14:151-6.
10. Gwaltney J. Acute bronchitis. In: Mandell G, Bennett J, and Dolin R (eds.). Mandell,
Douglas and Bennett’s Principles and Practice of Infectious Diseases. 5th edition,
Churchill and Livingstone, Edinburgh, 2000.
11. Becker L, Glazier R, McIsaac W, et al. Antibiotics for acute bronchitis (Cochrane
Review). In: The Cochrane Library, Issue 3, 1998. Oxford: Update Software.
12. Hueston W. Albuterol delivered by metered dose inhaler to treat acute bronchitis. J.
Family Practice, 1994; 39(5): 437-440.
13. Irwin R, Curley F, Bennett F. Appropriate use of antitussives and protussives: a
practical review. Drugs, 1993; 46: 80-91.
14. Hueston W. Antibiotics: neither cost effective nor ‘cough’ effective. J. Family Practice,
1997; 44(3): 261-5.
15. Clinical practice guideline for the diagnosis and management of acute bronchitis Inland empire health plan, San Bernandino, CA 2001
16. National Guideline Clearinghouse – Bronchitis, 2005
17. Gonzales R, Sande M. What will it take to stop physicians from prescribing antibiotics
in acute bronchitis? Lancet, 1995; 345: 665-666.
18. Mainous A, Zoorob R, Hueston W. Current management of acute bronchitis in
ambulatory care: the use of antibiotics and bronchodilators. Arch Fam Med, 1996; 5:
79-83.
19. National Guideline Clearinghouse – Use of antibiotics in pediatric care, 2002
20. Smuncy J, et al β2 agonists for acute bronchitis (Cochrane review) – The Cochrane
Library, Issue 2, 2006
21. Acute Bronchitis - EBM Guidelines, 2004
22. Nelson - Textbook of pediatrics - 2005
23. Hueston W. J.,
Mainous A.G. Acute bronchitis. American Academy of Family
Physicians, 1998
11
mwv av e bro nqi tis ma rTvis
pr otokoli
daavadebis definicia.
mwvave bronqiti bronquli xis lorwovani garsis mwvave anTebaa,
romelic grZeldeba 2-3 kviramde da romlis aucilebel simptoms
warmoadgens xvela naxvelis gamoyofiT an mis gareSe.
simptomebi da niSnebi
mwvave bronqiti uxSiresad gamowveulia respiraciuli virusebiT,
amitom igi iwyeba respiraciuli infeqciis niSnebiT, rogoricaa
Semcivneba, saerTo sisuste, msubuqi cxeleba (araumetes 3 dRe),
cxviridan gamonadeni, yelis tkivili, kunTebis tkivili, xmis CaxleCa.
ZiriTadi klinikuri niSani xvelaa, romelic daavadebis dawyebidan
2-4 dRis Semdeg iCens Tavs. Tavidan is mSrali, Semawuxebeli xasiaTisaa,
Semdeg produqtiuli xdeba. naxveli Tavidan lorwovania, mogvianebiT
Cirqovani SeiZleba gaxdes. Tumca Cirqovani naxveli gamowveulia
leikocitebis migraciiT da yovelTvis ar miuTiTebs baqteriuli
infeqciis arsebobaze. adreuli asakis bavSvebi naxvels ylapaven, rasac
SeiZleba mohyves Rebineba. dinamikaSi naxveli TandaTan Txierdeba da 510 dReSi xvela gaivlis. bronqitis simptomebi Cveulebriv 2 kviramde
grZeldeba, Tumca iSviaTad SeiZleba xvela gaxangrZlivdes 4-6 kviramde.
temperatura normaluria an subfebriluri. adreul etapze
SesaZloa gamoxatuli iyos nazofaringiti, koniunqtiviti da riniti.
daavadebis progresirebis da xvelis intensivobis matebasTan erTad
moismineba mSrali da sxadasxva yalibis sveli xixini. zog pacientSi
SeiZleba moisminebodes mstvinavi sunTqva. bronqitisaTvis ar aris
damaxasiaTebeli
lokaluri
simptomatika:
lokaluri
krepitacia,
bronquli sunTqva, perkutoruli xmianobia moyrueba. aseT SemTxvevaSi
gamosaricxia pnevmoniis arseboba.
bronqitze eWvi unda iqnes mitanili im pacientebSi, romelTanac
mwvave respiraciuli infeqciis niSnebi asocirebulia xvelasTan. sruli
anamnezuri gamokvleva unda moicavdes garemo aris da sigaretis
zegavlenis dadgenas, epidemiologiur monacemebs. sruli obieqturi
gamokvleva aucilebelia, raTa gamoiricxos xvelis sxva mizezebi,
12
rogoricaa
kardiovaskularuli
daavadebebi
da
filtvis
parenqimis
dazianeba.
diagnostikur-laboratoriuli testebi
sisxlis
saerTo
analizi
ar
iZleva
daavadebis
diagnostikis da misi mkurnalobis gansazRvris saSualebas. amitom ar
aris mizanSewonili misi rutinulad Catareba. mwvave bronqitis dros
SeiZleba gamovlindes leikopenia an leikocitozi, limfocitozi, Tumca
es ar aris specifiuri am daavadebisaTvis.
rentgenologiuri
gamokvleva
gulmkerdis
rentgenograma
gaZliereba.
gulmkerdis
normaluria
–
an
rentgenografia
mwvave bronqitis dros
aRiniSneba
ar
tardeba
bronqogenuri
rutinulad.
gulmkerdis rentgenogramis Cvenebebia:
pacients aqvs cxeleba, magram ar aqvs zemo sasunTqi gzebis
dazianebis simptomebi;
pacients aqvs Tanmxlebi davadeba, romelic xels uwyobs
pnevmoniis ganviTarebas – bronqoeqtazia, diabeti, gulis,
RviZlis an Tirkmlis paTologia;
anamnezSi pnevmonia (< 1 weli);
anamnezSi tuberkulozis arseboba;
daavadebis gaxangrZliveba an uCveulo mimdinareoba;
eWvi pnevmoniaze.
etiologiuri
kvleva
- nazofaringuli sekretidan SeiZleba
virusis gamoyofa, Tumca es ar aris aucilebeli diagnozis dasasmelad
an
mkurnalobisTvis.
genezisaa,
ar
aris
vinaidan
mwvave
rekomendebuli
bronqiti ZiriTadad
naxvelis
virusuli
mikrobiolo-giuri
Tu
mikroskopuli kvlevis Catareba.
filtvis
funqciis
S e s w a v l a . filtvis funqciis Seswavla
tardeba bronqul asTmaze eWvis dros.
mkurnaloba
mwvave
bronqitis
antibiotikoTerapia ar
vifiqroT, Tu:
ZiriTadi
aris
gamomwvevia
naCvenebi.
virusi,
antibiotikoTerapiaze
amitom
unda
zogadi mdgomareoba uaresdeba;
cxeleba grZeldeba erT kviraze met xans;
cxeleba Tavidan iwyeba;
aRiniSneba profuzuli da Cirqovani naxveli;
13
epidemiologiuri
situaciidan
gamomdinare
eWvia
mikoplazmur,
qlamidiur infeqciaze an yivanaxvelaze;
Tu mwvave bronqitis simptomebTan erTad aRiniSneba sinusiti an
otiti;
Tu
daavadeba
mimdinareobs
im
faqtorebis
fonze,
romelTac
SeuZliaT gazardon pnevmoniis ganviTarebis riski (imunodeficiti,
alkoholizmi, gulis qronikuli ukmarisoba, filtvis qronikuli
paTologia).
mikoplazmur da qlamidiur infeqciaze eWvis dros rekomendebulia
makrolidis gamoyeneba.
mkurnalobis principebi bavSvebSi
1. mSvidi, komfortuli garemo;
2. siTxeebis damatebiTi miwodeba;
3. antipiretuli saSualebebi;
4. bavSvebSi
xvelis
daavadebis
damTrgunvelebis
xangrZlivobas,
gamoyeneba
amasTan
ar
naxvelis
amcirebs
evakuaciis
daTrgunvam SeiZleba xeli Seuwyos baqteriul garTulebas;
5. bavSvebSi ar arsebobs mwvave bronqitis dros β2-agonistebis
efeqturobis damadasturebeli monacemebi;
6. antihistaminuri preparatebi ar aris rekomendebuli, radgan
isini iwveven naxvelis gamoSrobas da SeiZleba gaaZlieron
xvela.
mSobels unda miewodos informacia, rom dauyovnebliv mimarTos
eqims,
Tu
bavSvs
gamoexata
Semdegi
niSnebi:
sunTqva
gaxda
ufro
gaZnelebuli; daewyo FRebineba yoveli kvebis Semdeg; ver iRebs siTxeebs;
gamoixata zogadi mZime mdgomareoba – daTrgunva, Zilianoba.
mkurnalobis principebi mozrdilebSi
1. siTxeebis damatebiT miwodeba bronquli sekretis gamoSrobis
Tavidan acilebis mizniT;
2. sigaretis mowevisagan Tavis Sekaveba;
3. antipiretuli saSualebebi;
4. xvelis damTrgunveli saSualebebi xSirad iniSneba bronqitis
dros. maT SeiZleba Seamciron xvela, magram maTi miReba ar
amcirebs daavadebis xangrZlivobas.
5. amosaxvelebeli saSualebebis rutinuli gamoyeneba ar aris
rekomendebuli. naxvelis gamaTxierebeli saSualebebis daniSvna
SesaZlebelia mxolod webovani, Znelad gamosayofi naxvelis
SemTxvevaSi;
14
6. bronqodilatatorebis
gamoyeneba
umniSvnelo
efeqts
iZleva
gaxangrZlivebuli xvelis dros;
7. kortikosteroidebis gamoyeneba ar aris rekomendebuli.
reabilitacia da dakvirveba
Semdgomi meTvalyureoba Cveulebriv ar aris saWiro, garda im
SemTxvevebisa, roca:
mdgomareoba uaresdeba an axali simptomebi Cndeba;
xvela xangrZlivdeba >1 Tveze;
simptomebi meordeba (>3 epizodze weliwadSi).
protokoli eyrdnoba saqarTvelos
“mwvave bronqitis marTvis” gaidlains.
respiraciuli
asociaciis
mwvave br onqi tis marTvis
algo ri tmi
pnevmoniis niSnebi saxezea?
•
respiraciuli distresi;
•
guliscemis sixSire >100/wT –ze;
•
* bavSvebSi
pnevmoniis
erT-erT
ZiriTad
sadiagnostiko
niSnad
miCneulia
sunTqvis
sixSire:
sunTqvis sixSire
* >24/wT
–ze;
ifiqreT
ifiqreT sxva mizezze:
• simptomebis kontroli;
• 2 Tvemde > 60-ze wuTSi,
pnevmoniaze
(ix.
di
ax
0
• temperatura >38
C;
pnevmoniis
marTvis
•
asTma;
•
2-dan
12
Tvemde
>
50-ze
wuTSi,
• siTxeebis damatebiT miwodeba
gaidlaini)
• 12 Tvidan 5xmis
wlamde
> 40-ze wuTSi,
• lokalurad perkutoruli
moyrueba,
ucxo sxeuli;
• xvelis sawinaaRmdego
• 5 welze meti asaki > 30 -ze •wuTSi.
krepitacia,sunTqvis
bronquli
sunTqva
sixSiris
daTvla
unda
moxdes
erTi wuTis
ganmavlobaSi,
pacientTan/mSobelTan
ganmeorebiTi
konsultacia da
gamokvleva
saWiroa,
Tu:
ar
a
saSualebebi**;
•
tuberkulozi;
rodesac
bavSvi
mSvid
mdgomareobaSia
da
ar
tiris.
Tu
dadasturda
isaubreT:
***mSobelma dauyovnebliv
unda
bavSvebSi
gulmkerdis
retraqcia
(gulmkerdis
qveda mesamedis
xvelis
damTr• mdgomareoba
uaresdeba***
an Cndeba
axali
simptomebi;
•• **bavSvebSi
antipiretuli
saSualebebi;
mimarTos
eqims,
Tu
bavSvs
laboratoriuli
Cazneqva
sunTqvis
procesSi)
miCneulia
mZime
pnevmoniis
erT-erT
antibiotikis
uefeqtobaze;
xangrZlivoba
<
10-14
• mukoviscidozi;
gunveli da amosaxvelebgulmkerdis
da sxva laboratoriuli
gamoexata:
Zilianoba; rentgenografia
ifiqreT
yivanaxvelasa
an
ZiriTad
sadiagnostiko
niSnad,
Tumca
gaTvaliswinebuli
unda
15
saSualebebis
•• eli
daavadebaze;
kvleviT,
gamoiyeneT
•xvelis
xvela
xangrZlivdeba
met xans;
dReze,
mdgomareoba
> 1 Tveze
xvelix
xangrZlivoba
4gaZnelebuli
sunTqva;efeqtuRebineba
garemos
gamRizianeblebTan
iyos,
romxangrZlivoba
msubuqi
retraqcia
damaxasiaTebelia
axalSobilebsa
da
atipur
(mikoplazma,
kvleva
rutinulad
ar
aris
saWiro
roba
ar
aris
dadas•
bronqoeqtazia;
kvebis gamoyenebas
Semdeg;
ver
Cvil
bavSvTa
asakisTvis
da
iTvleba
normad.
• yoveli
antibiotikis
qlamidia)
infeqciaze
makrolidi
damakmayofilebeli
10-14 dReze
8 kvira
turebuli.
kontaqtis
SezRudva.
iRebs
• simptomebi
meordeba (>3 epizodze weliwadSi).
Tan siTxeebs.
dakavSirebul
• fqod da sxva.

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