simsuqnis marTva pirvelad jandacvaSi
simsuqnis marTva pirvelad jandacvaSi
simsuqnis marTva pirvelad jandacvaSi
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miRebulia “klinikuri praqtikis erovnuli<br />
rekomendaciebis (gaidlainebi) da<br />
daavadebaTa marTvis saxelmwifo<br />
standartebis (protokolebi) SemuSavebis,<br />
Sefasebisa da danergvis erovnuli sabWos"<br />
2009 wlis 30 dekembris #2 sxdomis<br />
gadawyvetilebis Sesabamisad<br />
<strong>simsuqnis</strong> <strong>marTva</strong> <strong>pirvelad</strong><br />
<strong>jandacvaSi</strong><br />
danarTi 2<br />
klinikuri mdgomareobis marTvis saxelmwifo<br />
standarti<br />
(protokoli)<br />
damtkicebulia saqarTvelos Sromis,<br />
janmrTelobisa da socialuri dacvis<br />
ministris 2010 wlis 30 seqtembris<br />
# 315/o brZanebiT<br />
1
1. ganmarteba<br />
<strong>simsuqnis</strong> <strong>marTva</strong> <strong>pirvelad</strong> <strong>jandacvaSi</strong><br />
protokoli<br />
simsuqne warmoadgens qronikul, multifaqtorul daavadebas,<br />
romelsac kompleqsuri fsiqologiuri, socialuri, kulturuli,<br />
genetikuri, metaboluri mizezebi, garemo faqtorebi da cxovrebis<br />
stili ganapirobebs.<br />
simsuqne gulisxmobs organizmSi cximis Warbad Calagebas, ramac<br />
SesaZloa uaryofiTad imoqmedos adamianis janmrTelobaze.<br />
2. sadiagnozo kriteriumebi<br />
<strong>simsuqnis</strong> diagnostireba da xarisxis Sefaseba sxeulis masis indeqsis<br />
safuZvelze xdeba, rac wonis simaRlis kvadratTan SefardebiT<br />
gamoiangariSeba (kg/sm 2 ).<br />
<strong>simsuqnis</strong>a da sxeulis masis indeqsis klasifikacia:<br />
sxeulis masis da <strong>simsuqnis</strong> Sefaseba smi (kg/m 2 )<br />
sxeulis masis deficiti < 18,5<br />
normaluri wona 18,5-24,9<br />
Warbi wona 25,0-29,9<br />
simsuqne (I xarisxis) 30,0-34,9<br />
simsuqne (II xarisxis) 35,0-39,9<br />
morbiduli simsuqne (III xarisxis) > 40<br />
simsuqnesTan dakavSirebuli riskis Sefaseba rekomendebulia, aseve,<br />
welis garSemowerilobis safuZvelze. welis garSemoweriloba 102 smze<br />
meti mamakacebSi da 88 sm-ze meti qalebSi diabetisa da<br />
kardiovaskuluri avadobis gazrdil riskze miuTiTebs.<br />
3. klinikuri simptomatika da rekomendaciebi<br />
simsuqne qronikuli, multifaqtoruli daavadebaa, romelsac<br />
kompleqsuri politikuri, socialuri, fsiqologiuri, garemo,<br />
ekonomikuri da metaboluri mizezebi da Sedegebi gaaCnia.<br />
faqtobrivad simsuqne sxeulis TiTqmis yvela Sinagan organoze<br />
axdens gavlenas;<br />
2
zogad saeqimo praqtikaSi yvela pacients, simsuqnesTan da masTan<br />
dakavSirebuli riskis identificirebis mizniT, unda daudgindes<br />
sxeulis masis indeqsi da welis garSemoweriloba;<br />
gamoTvaleT sxeulis masis maCvenebeli; moaxdineT individebis<br />
klasificireba gamomdinare sxeulis masis maCvenebelTa<br />
kategoriebidan. moaxdineT informireba pacientebis maTi sxeulis<br />
masis maCveneblebis da masTan dakavSirebuli riskebis Sesaxeb;<br />
arsebobs wonis regulirebis efeqturi strategiebi, rac moicavs<br />
kvebas, fizikur aqtiurobas, cxovrebis stilis modificirebas,<br />
medikamentozur mkurnalobas da qirurgiul Carevas;<br />
eqimma unda daicvas xuTi `A~-s principi (ask, advice, assess, assist, arrange)<br />
(kiTxva, rCeva, Sefaseba, daxmareba, mowesrigeba);<br />
wonis regulireba gundur midgomas moiTxovs. gaTviTcnobierebuli<br />
unda gqondeT klinikuri da sazogadoebrivi resursebi. pacients<br />
sWirdeba mudmivi urTierToba ojaxis eqimTan da meTvalyureoba<br />
jandacvis gundis mxridan. wonis kontroli mTeli cxovrebis<br />
savaldebulo saqmea da jandacvis gundma unda moaxerxos<br />
pacientisTvis konkretuli miznebis dasaxvis xelSewyoba;<br />
nebismier pacients, sxeulis masis indeqsis da welis<br />
garSemowerolobis miuxedavad, unda Cautardes konsultireba<br />
jansaRi kvebisa da varjiSis Taobaze.<br />
pacientebs, romelTa smi>25-ze, xolo welis garSemoweriloba<br />
mamakacebSi 94sm-s da qalebSi 80-s aRemateba esaWiroebaT Semdgomi<br />
konsultacia da gamokvlevebi <strong>simsuqnis</strong> dadgenisa da misi marTvis<br />
adeqvaturi gegmis SemuSavebis mizniT.<br />
4. prevencia, diagnozi da marTvis algoriTmi<br />
prioritetuli miznebi:<br />
1. gaacnobiereT sxeulis masis indeqsis mniSvneloba;<br />
2. gaaZliereT im pacientTa konsultireba da informirebuloba,<br />
romelTac aReniSnebaT Warbi sxeulis masis indeqsi da<br />
darwmundiT, rom maT miewodaT saTanado konsultacia wonis<br />
klebasTan dakavSirebiT;<br />
3. gaaumjobeseT <strong>simsuqnis</strong> mkurnalobis Sedegi;<br />
4. gaaumjobeseT <strong>simsuqnis</strong> prevenciasa da mkurnalobaSi<br />
sazogadoebis (mosamsaxureTa, moswavleTa) CarTulobis done.<br />
qvemoT mocemulia <strong>simsuqnis</strong> prevenciis, diagnozisa da marTvis<br />
algoriTmi<br />
3
1<br />
simaRlis da wonis gazomva<br />
da sxeulis masis<br />
indeqsis gamoTvla<br />
7<br />
Tanmxlebi daavadebebis<br />
Sefaseba (komorbiduli<br />
daavadebebi)<br />
8<br />
mzadaa pacienti<br />
wonis daklebisTvis?<br />
6<br />
rCeva wonis kontrolis<br />
da sxva risk-faqtorebis<br />
<strong>marTva</strong> A<br />
3<br />
normaluri masa<br />
smi 18,5-24,9<br />
4<br />
sxeulis masis<br />
deficiti smi 40<br />
riski dabali zomieri maRali ukiduresi<br />
kveba X X X X<br />
fiz. aqtiuroba X X X X<br />
qcevis menejmenti X X X X<br />
medikamentebi *X+ X X X<br />
qirurgiuli Careva ? *X X<br />
* SeiZleba mxedvelobaSi iqnes miRebuli Tu arsebobs Tanmxlebi,<br />
simsuqnesTan dakavSirebuli risk-fatorebi da daavadebebi<br />
+ SeiZleba daiwyos, Tu smi aRwevs 27-s an metia<br />
? operaciuli Careva droebiT kvlevis sagans warmoadgens<br />
diax<br />
<strong>simsuqnis</strong> prevencia da <strong>marTva</strong> (mozardebisa da mozrdilebisTvis)<br />
algoriTmi<br />
2<br />
smi≥25?<br />
diax<br />
diax<br />
11<br />
ganmeorebiTi Sefaseba<br />
12 kviris Semdeg<br />
12<br />
mizani<br />
miRweulia<br />
ara<br />
ara<br />
ara<br />
13<br />
5<br />
gaidlainSi ar<br />
ganixileba<br />
10a<br />
ixileT rekomendaciebi<br />
menejmentis<br />
Sesaxeb,<br />
dafuZnebuli smi/daavadebebis<br />
riskze<br />
ganmeorebiTi Sefaseba miznebisa<br />
da risk-faqtorebis da wonis<br />
ganxilva A<br />
4
algoriTmis anotacia<br />
1. gazomeT simaRle da wona da gamoiangariSeT sxeulis masis<br />
indeqsi<br />
o sakvanZo punqtebi:<br />
sxeulis masis indeqsi sasurvelia gamoiTvalos yovelwliurad<br />
skrininiT (mosaxleobis masiuri gamokvleva) da mkurnalobis<br />
SemTxvevaSi saWiroebisamebr;<br />
sxeulis masis indeqsis gamoTvla yvela asakobriv jgufze<br />
vrceldeba. taneris skaliT me-5 donis mozardebi da bavSvebi<br />
unda Sefasdnen arsebuli zrdis diagramebis mixedviT.<br />
o gamoTvaleT sxeulis masis indeqsi<br />
daaxarisxeT sxeulis masis indeqsi kategoriebis mixedviT. gaanaTleT<br />
pacientebi sxeulis masis indeqsis da masTan dakavSirebuli riskebis<br />
Sesaxeb.<br />
sxeulis masis indeqsis gamoTvla<br />
wona = kg<br />
simaRle kvadratSi kv.m.<br />
mozardebi<br />
mozrdilTa sxeulis masis indeqsis kategoriebi<br />
sxeulis masis indeqsi kategoria<br />
18,5-ze naklebi sxeulis masis deficiti<br />
18,5-24,9 normaluri wona<br />
25-29,9 Warbi wona<br />
30-34,9 simsuqne _ I xarisxi<br />
35-39,9 simsuqne _ II xarisxi<br />
40 an meti morbiduli simsuqne _ III xarisxi<br />
sxeulis masis indeqsi bavSvebsa da mozardebSi gamoiTvleba<br />
centilebSi, sanam bavSvi simaRleSi izrdeba. Warbi wona ganisazRvreba<br />
rogorc 85%-ze meti sxeulis masis indeqsi. simsuqne ganisazRvreba,<br />
rogorc 95%-ze meti sxeulis masis indeqsi, xolo <strong>simsuqnis</strong> ukiduresi<br />
forma ganisazRvreba, rogorc 99%-ze meti sxeulis masis indeqsi<br />
gamomdinare asakidan. (ix. danarTi `A~ `sxeulis masis maCveneblebis da<br />
asakis Sefardeba centilebSi~.)<br />
sxeulis masis indeqsis gaangariSeba xdeba zrdis procesSi myofi<br />
pacientebisTvis, imitom rom is uzrunvelyofs saorientacio<br />
maCvenebels momavali SedarebisaTvis. erTwliani periodisaTvis<br />
5
sxeulis masis indeqsis cvlilebis raime standartebi ar arsebobs,<br />
magram swrafi mateba an dakleba warmoadgens klinikurad sayuradRebo<br />
niSans. gansxvaveba 50 da 75 centilebs Soris igivea, rac sxeulis masis<br />
indeqsis daaxloebiT oridan sam erTeuliT sxvaoba mozardi<br />
gogonebisaTvis. mozard biWebs ki daaxloebiT sxeulis masis indeqsis<br />
ori erTeuli centiliT sxvaoba axasiaTebs. sam erTeulze meti<br />
sxeulis masis indeqsis wliuri mateba gadaWarbebul matebas<br />
gulisxmobs.<br />
mozardebis simsuqnesTan dakavSirebuli klinikuri daavadebebi*<br />
istoria fizikuri daavadeba<br />
Seferxeba<br />
ganviTarebaSi<br />
zrdaSi<br />
CamorCena<br />
RamiT sunTqvis<br />
gaZneleba<br />
varjiSis<br />
gaZneleba<br />
“akantozis nigrikans”<br />
(imigranti)<br />
barZayis/muxlis<br />
tkivili<br />
amenorea<br />
Tavis tkivilebi<br />
muclis<br />
tkivilebi<br />
dismorfuli<br />
Taviseburebebi<br />
Ddabali tanadoba<br />
gadidebuli nuSurebi<br />
genetikuri moSliloba,<br />
magaliTad prader-uilis<br />
sindromi, lourens mun-bidlis<br />
sindromi<br />
hipoTireoidizmi, kuSingi, zrdis<br />
hormonebis deficiti<br />
Zilis apnoe, hipoventilaciuri<br />
sindromi<br />
mstvenavi sunTqva asTma<br />
akantokeratodermia<br />
barZayis areSi<br />
moZraobis SezRudva<br />
hirsutizmi (WarbTmianoba)akantokeratodermia,<br />
insulini-<br />
sadmi rezistentoba<br />
Tvalis optikuri<br />
diskis cvlilebebi<br />
Mmuclis marjvena<br />
zeda<br />
kvadrantis<br />
mgrZnobeloba<br />
insulinisadmi rezistentoba,<br />
Saqriani diabeti tipi2.<br />
barZayis Zvlis mTliani<br />
epifizolizi<br />
polikistozuri sakvercxeebis<br />
sindromi<br />
Tavis tvinis fsevdo simsivne<br />
naRvlis buStis daavadeba<br />
*depresia, SfoTva, kvebis moSliloba da sqesobrivi Zaladoba aseve metad<br />
mniSvnelovani klinikuri niSnebia mozardTa simsuqnesTan dakavSirebuli da unda<br />
Sefasdes ganwyobis disfunqciebis, saskolo warmatebebis, TanatolebSi urTierTobis<br />
da kvebis tipebTan mimarTebaSi.<br />
6
2. rCevebi wonis SenarCunebisa da sxva risk-faqtorebis<br />
menejmentisTvis<br />
metad mniSvnelovania wonis SenarCunebis sakiTxi maTTvis,<br />
visac sxeulis masis indeqsi normaluri aqvs;<br />
wonis SenarCunebis RonisZiebebi moicavs fizikuri aqtiurobis,<br />
kvebis da cxovrebis stilis menejmentis strategias.<br />
mniSvnelovania, wonis SenarCunebis sakiTxis imaTzec mi<strong>marTva</strong>, visac,<br />
sxeulis masis indeqsi normalur diapazonSi (18,5-dan 24,9-mde) aqvT.<br />
wonis normaluri maCvenebeli moiTxovs mTeli cxovrebis manZilze<br />
mudmiv yuradRebas, rac niSnavs: fizikur aqtiurobas, swor kvebas,<br />
cxovrebis stilisa da yuradRebis, fsiqo-socialuri faqtorebis<br />
swor menejments.<br />
pirvel yovlisa, ecadeT regularulad iyoT fizikurad<br />
datvirTulni, TqvenTvis mocemuli rekomendaciis mixedviT.<br />
fizikuri aqtiurobis tipis SerCevisas mniSvnelovania<br />
gaiTvaliswinoT pacientis asaki, Zval-saxsrovani da kunTovani<br />
sistemis mdgomareoba (SezRuduloba) da savarjiSo<br />
mowyobilobebis arseboba. araaqtiuri pacientebisTvis is<br />
SeiZleba moicavdes rogorc minimum 10 wuTian fizikur<br />
aqtiurobas dReSi. idealuria 30-dan 60 wuTamde saSualo<br />
fizikuri aqtiuroba rekomendebuli kviris umetesi dReebis<br />
ganmavlobaSi;<br />
meore, ganixileT sxvadasxva variantebi cxovrebis stilis modificirebasTan<br />
dakavSirebiT. gaamxvileT yuradReba kaloriebze,<br />
gamoiyeneT fizikuri aqtiurobis farglebSi Semcirebuli<br />
kaloriebis moxmarebisa da gazrdili raodenobiT kaloriebis<br />
xarjvis kombinaciebi. yuradReba miaqcieT ulufebis zomas da<br />
sakvebis ingredientebs, sakvebis damzadebas da kaloraJs;<br />
mesame, xeli SeuwyeT cxovrebis stilis marTvis strategias,<br />
romelic moicavs wonis yovelkvireul Semowmebas, kvebis<br />
Jurnalis warmoebas da yoveldRiuri reJimis monitorings, rac<br />
niSnavs dabalansebul cxovrebis stils, balansirebuli kerZebis<br />
miRebas erTi da igive intervalebiT; gasarTob fizikur<br />
aqtiurobas dRis ganmavlobaSi; kviris dagegmvas, rac<br />
samuSaosTan, skolasTan da saojaxo valdebulebebTan erTad<br />
dasvenebas, TamaSs da socialur urTierTobas moicavs.<br />
7
3. mniSvnelovani da naklebad mniSvnelovani (komorbiduli)<br />
Tanmxlebi daavadebebis Sefaseba<br />
sakvanZo punqtebi:<br />
mniSvnelovania sxva daavadebebis Sefaseba, vinaidan maTma<br />
arsebobam SeiZleba gavlena moaxdinos mkurnalobasTan<br />
dakavSirebul gadawyvetilebebsa da Sedegebze;<br />
welis garSemoweriloba, romelic 102 sm toli an metia<br />
mamakacebSi da 88 sm toli an metia qalebSi, warmoadgens<br />
damatebiT risk-faqtors simsuqnesTan dakavSirebuli<br />
garTulebebisaTvis;<br />
depresiebisaTvis da kvebis darRvevebisaTvis, Tu SesaZlebelia,<br />
unda Catardes mokle skriningi;<br />
Sefaseba unda moicavdes srul samedicino anamnezs, raTa moxdes<br />
im medikamentebis identificireba, romlebmac SeiZleba<br />
gamoiwvion wonis momateba an wonis klebis Seferxeba.<br />
Tanmxlebi<br />
daavadebebi<br />
0<br />
1-2<br />
nakleb<br />
mniSvnelovani<br />
Tanxmlebi<br />
daavadeba<br />
mniSvnelovani<br />
Tanmxlebi<br />
daavadebebi an<br />
3 nakleb<br />
mniSvnelovani<br />
Tanmxlebi<br />
daavadeba<br />
Tanxmlebi daavadebebis Sefaseba<br />
sxeulis wonis indeqsi (BMI)<br />
25-30 30-35 35-40 40+<br />
konsultirebaganaTleba:<br />
cxovrebis<br />
wesis Secvla<br />
qcevis<br />
menejmenti<br />
konsultirebaganaTleba:<br />
cxovrebis<br />
wesis Secvla<br />
qcevis<br />
menejmenti<br />
konsultirebaganaTleba:<br />
cxovrebis<br />
wesis Secvla<br />
qcevis<br />
menejmenti<br />
medikamenturi<br />
Terapia<br />
mxolod BMI-s 27ze<br />
meti indeqsis<br />
mqone<br />
pacientTaTvis<br />
konsultirebaganaTleba:<br />
cxovrebis<br />
wesis Secvla<br />
qcevis<br />
menejmenti<br />
medikamenturi<br />
Terapia<br />
konsultirebaganaTleba:<br />
cxovrebis<br />
wesis Secvla<br />
qcevis<br />
menejmenti<br />
*medikamenturi<br />
Terapia<br />
konsultirebaganaTleba:<br />
cxovrebis<br />
wesis Secvla<br />
qcevis<br />
menejmenti<br />
medikamenturi<br />
Terapia<br />
konsultirebaganaTleba:<br />
cxovrebis wesis<br />
Secvla<br />
qcevis menejmenti<br />
medikamenturi<br />
Terapia<br />
konsultirebaganaTleba:<br />
cxovrebis wesis<br />
Secvla<br />
qcevis menejmenti<br />
medikamenturi<br />
Terapia<br />
qirurgiuli Careva<br />
konsultirebaganaTleba:<br />
cxovrebis wesis<br />
Secvla<br />
qccevis menejmenti<br />
medikamenturi<br />
Terapia<br />
qirurgiuli Careva<br />
konsultirebaganaTleba:<br />
cxovrebis wesis<br />
Secvla<br />
qcevis menejmenti<br />
medikamenturi<br />
Terapia<br />
qirurgiuli Careva<br />
konsultirebaganaTleba:<br />
cxovrebis wesis<br />
Secvla<br />
qcevis menejmenti<br />
medikamenturi<br />
Terapia<br />
qirurgiuli Careva<br />
konsultirebaganaTleba:<br />
cxovrebis wesis<br />
Secvla<br />
qcevis menejmenti<br />
medikamenturi<br />
Terapia<br />
qirurgiuli Careva<br />
8
naklebad mniSvnelovani Tanmxlebi daavadebebi<br />
sigaretis moweva<br />
hipertenzia (sisxlis wneva 140/90-ze meti an toli) an<br />
antihipertenziuli saSualebebis mimdinare moxmareba<br />
LDL-qolesterili > 130mg/100ml<br />
HDL-qolesterili
normaluri amosunTqvis bolos. (wyaro: gulis, filtvisa da sisxlis<br />
erovnuli instituti).<br />
4. mzad aris pacienti daiklos wonaSi?<br />
pacients evaleba dasaxos realisturi, miRwevadi miznebi da iyos<br />
pasuxismgebeli axal qcevaze, romlis meSveobiTac xorcieldeba wonis<br />
dakleba da SenarCuneba.<br />
wonis <strong>marTva</strong>/cxovrebis stilis Secvla<br />
wonis warmatebuli marTvisTvis mniSvnelovania konkretuli qcevis<br />
progresis Sesaxeb Canawerebis warmoeba an TviT_monitoringi.<br />
kaloriebis Semcirebis strategia gulisxmobs sakvebSi meti xilisa da<br />
bostneulis gamoyenebas, misaRebi kaloriebis da ulufis Semcirebas.<br />
aucilebelia procesSi yoveldRiurad meti fizikuri aqtiurobis<br />
CarTva.<br />
eqimma unda ixelmZRvanelos 5 A-s principiT (Ask-SeekiTxe, Advise-urCie,<br />
Assist-daexmare, Assess-Seafase, Arrange-monitorireba gauwie).<br />
Ask-SeekiTxe da Seafase wona/simaRle. pacients, umjobesia sawyis<br />
etapze ganesazRvros wona da gamoeTvalos sxeulis masis<br />
indeqsi. pacientebi informirebuli unda iyvnen TavianTi sxeulis<br />
masis indeqsis da riskis statusis Sesaxeb;<br />
Advise-urCieT wonaSi dakleba. mkveTrad, magram delikaturad<br />
aiZuleT yvela Warbi wonis mqone an msuqani pacienti wonaSi<br />
daiklos;<br />
Assess-SeafaseT wonaSi daklebisaTvis mzadyofna. yvela Warbi<br />
wonis mqone an msuqan pacients SeekiTxeT mzad aris Tu ara igi<br />
wonaSi daklebis mcdelobisaTvis;<br />
Assist-daexmare wonaSi daklebis mcdelobaSi. daexmareT pacients<br />
wonaSi daklebis gegmis SemuSavebaSi;<br />
Arrange-monitorireba gauwie. dagegmeT Semdgomi viziti.<br />
4. wonaSi daklebis misaRwevad dasaxeT miznebi da marTvis strategia.<br />
saWiroebisamebr mimarTeT riskis Sesabamis wyaroebs.<br />
kvebiTi rekomendaciebi gulisxmobs kaloriebis Semcirebas ulufis<br />
zomis da raodenobis SefasebiT;<br />
fizikuri aqtiurobis efeqtebi mniSvnelovnad aris damokidebuli<br />
moZraobis sixSireze, xangrZlivobasa da intensiurobaze;<br />
cxovrebis stilis modifikacia (kveba da fizikuri aqtiuroba)<br />
farmakoTerapiasTan (6 Tvidan 1 wlamde) erTad kombinaciaSi<br />
ganapirobebs wonaSi daklebas msuqan pacientebSi;<br />
bariatriuli qirurgia (<strong>simsuqnis</strong> qirurgiuli mkurnaloba:<br />
kuWis, gastroplastika) naCvenebia gansakuTrebuli jgufis<br />
pacientebSi, romelTa sxeulis masis indeqsi 40-ze metia an<br />
10
utoldeba 35-39.9-s, romlebic naadrevi sikvdilis an invalidobis<br />
absoluturi riskis winaSe arian. bariatriuli qirurgia iZleva<br />
mniSvnelovan da xangrZliv Sedegebs, Tumca ar aris cnobili<br />
Soreuli Sedegebi;<br />
mniSvnelovania yoveldRiuri, yovelkvireuli da xanmokle<br />
miznebis dasaxva.<br />
5. kvebis Sefaseba da mkurnaloba<br />
pacientTan SeTanxmebiT xdeba wonis marTvisTvis Sesaferisi kvebiTi<br />
Terapiis SemuSaveba. dietologi afasebs mdgomareobas da iZleva<br />
rCeva-darigebebs aRniSnuli sakiTxis irgvliv.<br />
kvebis Sefaseba<br />
SeafaseT kvebis Cveva. sakvebi da sasmeli, romelsac pacienti irCevs.<br />
Sefaseba gulisxmobs:<br />
sakvebiT da sasmeliT miRebuli kaloriebi da cximi;<br />
ulufis zoma da sakvebis yvela jgufi;<br />
sakvebi nivTierebebis gadaWarbebuli an arasakmarisi moxmareba;<br />
sakvebi danamatebis gamoyeneba;<br />
specifiuri qcevis Secvlis etapi, rogoricaa xilisa da<br />
bostneulis miReba;<br />
kvebis SesaZlo darRvevis simptomebi _ sakvebis gadaWarbebuli<br />
moculobiT miRebis ganmapirobebeli faqtorebi;<br />
sakvebis miRebis dro, jeradoba da racioni.<br />
kvebiTi rekomendaciebi<br />
SearCieT pacientisaTvis sasurveli kvebis ganrigi. dieturi<br />
rekomendaciebi unda iyos individualuri da moqnili kaloraJis<br />
Sesamcireblad.<br />
rekomendebulia:<br />
wonaSi dakleba kaloriebis Semcirebis gziT. kaloriebis<br />
zomieri SemcirebiT (500-1000 kkal dReSi) SesaZlebelia kviraSi<br />
0,5-1kg-iT wonaSi dakleba;<br />
kvebis gegmis SemuSaveba wonaSi dasaklebad, romelic<br />
gulisxmobs 1000-1200 kkal/dReSi qalebisaTvis da 1200-1600<br />
kkal/dReSi mamakacebisaTvis;<br />
dReSi miiReT xilis da bostneulis sul mcire 5 ulufa.<br />
SezRudeT cximis miReba cximidan miRebuli kaloraJis 30%-mde,<br />
najeri cximidan miRebuli kaloraJis 7-10%-mde, ujeri cximi<br />
unda iyos 1%-ze naklebi an ar unda aRematebodes mas.<br />
gansakuTrebuli mniSvneloba eniWeba marcvleulis da ujredisis<br />
miRebas (dReSi 35 grami an meti);<br />
11
miRebuli ujeri cximi unda Seadgendes kaloraJis 1%-ze naklebs.<br />
rac ufro dabalia sakvebiT miRebuli qolesterini, najeri da<br />
ujeri cximis kombinirebuli miReba, miT metia sargebeli<br />
kardiovaskularuli sistemis mxriv.<br />
dabal-kaloriuli kvebis gegma wonaSi dasaklebad<br />
sakvebi nivTiereba rekomendirebuli norma<br />
kaloriebi Cveuli dRiuri kaloraJis Semcireba<br />
dReSi 500-1000 kkal-iT<br />
saerTo cximi saerTo kaloriebis 30% an naklebi<br />
“gansxvavebuli cximi” * saerTo kaloriebis 1% an naklebi<br />
Nnajeri cximi saerTo kaloriebis 7-10%<br />
ujeri cximi saerTo kaloriebis 15%-mde<br />
cila saerTo kaloriebis 15%<br />
naxSirwylebi-rTuli, sxvadasxva<br />
saxis bostneulis, xilis da da<br />
marcvleulisgan miRebuli<br />
saerTo kaloriebis 55%<br />
boWko 25-35 grami an meti<br />
* “ gansxvavebuli cximi” _ mcenareuli warmoSobisaa, magram is qimiurad Secvlilia<br />
xelovnurad, hidrogenizaciis saSualebiT.<br />
naxSirwylebis dasaSvebi norma mozrdilebisa da bavSvebisaTvis<br />
ganisazRvra dReSi minimum 130 grami.<br />
swori kveba gulisxmobs, rom racioni srulfasovani da<br />
mravalferovani iyos. sakvebi unda Seicavdes cilebs, cximebs,<br />
naxSirwylebs, vitaminebs _ garkveuli TanafardobiT.<br />
kvebis gamosavali da miznebi<br />
wonis daklebis da SenarCunebis ukeTesi Sedegis misaRwevad<br />
aucilebelia fizikuri aqtiurobis gazrdis xarjze kaloriebis<br />
gaZlierebuli daxarjva;<br />
xangrZlivi periodis ganmavlobaSi wonaSi daklebis ukeTesi<br />
Sedegi im SemTxvevaSi miiRweva, rodesac kaloraJis Semcireba<br />
kombinirebulia fizikuri aqtiurobis gazrdasTan da qceviT<br />
TerapiasTan;<br />
wonaSi daklebis procesis efeqturobisTvis rekomedebulia<br />
jandacvis muSakis mxridan xSiri meTvalyureoba da<br />
saganmanaTleblo saubrebi;<br />
kaloraJis Semcirebis da fizikuri aqtiurobis gazrdis<br />
erTobliobiT miiRweva wonis SenarCuneba. wonis SenarCunebisTvis<br />
rekomendebulia dReSi saSualod 1400 kkal miReba,<br />
yoveldRiurad 1 saaTi zomieri fizikuri aqtiuroba da diliT<br />
sauzmis miReba.<br />
12
fizikuri aqtiuroba<br />
fizikur aqtiurobas miekuTvneba sxeulis yvela saxis da<br />
intensiurobis moZraoba, yoveldRiuri aqtiurobis CaTvliT. termini<br />
varjiSi galisxmobs datvirTvis intensiurobis gazrdas.<br />
<strong>simsuqnis</strong> prevenciisa da marTvisTvis aucilebelia fizikuri<br />
aqtiurobis xelSewyoba.<br />
fizikuri aqtiurobis specifiuri roli <strong>simsuqnis</strong> <strong>marTva</strong>Si<br />
<strong>simsuqnis</strong> <strong>marTva</strong>Si fizikur aqtiurobas gaaCnia ramodenime specifiuri<br />
roli: prevencia, wonis mkveTri dakleba, wonis dakleba xangrZlivi<br />
periodis ganmavlobaSi, wonis SenarCuneba da normaluri metaboluri<br />
maCveneblebi wonis daklebiT an mis gareSe.<br />
<strong>simsuqnis</strong> prevencia<br />
arsebobs zogadi mosazreba, rom fizikuri aqtiurobis dros<br />
daxarjul energias aqvs unari zemoqmedeba moaxdinos energetikul<br />
balansze da wonis regulaciis procesze. Tumca, mxolod fizikuri<br />
aqtiuroba ver daZlevs arajansaRi kvebis Cvevebs. Warbi wonis<br />
prevenciisTvis orive am faqtoris balansirebaa saWiro. jer kidev ver<br />
dadginda wonaSi matebis prevenciisTvis fizikuri aqtiurobis<br />
optimaluri doza. igi individualuri iqneba asakis, sqesis,<br />
profesiuli energiis xarjvis da Cveuli kaloraJis miRebis mixedviT.<br />
zogadad rekomendebulia kviraSi 5 dRe, 30-dan 60 wuTamde saSualo<br />
intesivobis fizikuri aqtiuroba.<br />
wonaSi mkveTri dakleba<br />
kvlevebiT dadgenilia, rom kaloraJis kontrolis gareSe mxolod<br />
varjiSiT wonaSi dakleba sakmaod rTulia. varjiSiT miRweuli Sedegi<br />
sqesTa Soris gansxvavebulia. wonaSi kleba mamakacebSi ufro mkveTrad<br />
aRiniSneboda, maSin rodesac qalebi mxolod wonis SenarCunebas<br />
aRwevdnen.<br />
wonis SenarCuneba xangrZlivi periodis ganmavlobaSi<br />
xangrZlivi periodis ganmavlobaSi wonis SesanarCuneblad fizikuri<br />
aqtiuroba saWiroa iseTive sixSiriT, rogorc iyo rekomedebuli<br />
daklebis procesSi. wonis SenarCunebisTvis saWiroa yoveldRiurad 1<br />
saaTi an meti zomieri fizikuri aqtiuroba.<br />
normaluri metaboluri maCveneblebi wonis daklebiT an mis gareSe<br />
arsebobs monacemebi, rom 5-dan 10%-mde wonaSi dakleba mniSvnelovan<br />
zegavlenas axdens metabolur sindromze. saSualo <strong>simsuqnis</strong> mqone<br />
qalebSi perioduli varjiSi, dReSi orjer 15 wuTiani Cqari siarulis<br />
saxiT ar iwvevs wonaSi daklebas, magram mkveTrad aumjobesebs maRali<br />
simkvrivis lipoproteidisa da insulinis maCveneblebs. mamakacebSi,<br />
kaloraJis SezRudvis gareSe wonaSi dakleba yoveldRiuri fizikuri<br />
aqtiurobis momatebis xarjze, amcirebs insulinis rezistentobas da<br />
muclis areSi gacximovnebas.<br />
13
arsebobs kvlevebi fizikuri aqtiurobis Sesaxeb, sadac naTlad Cans,<br />
rom wonaSi daklebis gareSe damoukideblad metaboluri efeqtis<br />
miRweva SeuZlebelia.<br />
fizikuri aqtiuroba<br />
fizikuri aqtiuroba SeiZleba gansxvavdebodes moZraobis sixSiris,<br />
xangrZlivobis da intensiurobis mixedviT.<br />
sixSire<br />
fiziologiuri adaptaciis gamomuSavebisTvis fizikuri aqtiurobis<br />
minimaluri sixSire kviraSi sami dRiT ganisazRvreba. yoveldRiuri<br />
varjiSi rekomendebulia arteriuli wnevis da insulinis maCveneblebis<br />
gaumjobesebisTvis. varjiSiT gamowveuli sargeblis misaRwevad<br />
rekomendebulia fizikuri aqtiuroba kviraSi xuTi dRe an meti.<br />
varjiSis dawyeba umjobesia TandanTanobiT, sixSiris Semdgomi<br />
gazrdiT.<br />
xangrZlivoba<br />
vajiSis rekomendirebuli xangrZlivoba cvalebadobs da gulisxmobs<br />
kviraSi samidan xuTi dRis ganmavlobaSi 30 wT varjiSs.<br />
rekomendebulia TiTqmis mTeli kviris ganmavlobaSi 30 wT. saSulo<br />
intensiurobis fizikuri aqtiuroba.<br />
wonis kontrolisTvis rekomendebulia fizikuri aqtiuroba dReSi 60<br />
wT ganmavlobaSi.<br />
intensiuroba<br />
konkretuli pacientisTvis fizikuri aqtiurobis Sesaferisi<br />
intensiurobis SerCeva rTulia. msuqan pacientebs varjiSisTvis<br />
esaWiroebaT didi Zalisxmeva. gadaWarbebuli fizikuri aqtiuroba<br />
zianis momtania. umjobesia fizikuri aqtiurobis mcire intensiurobiT<br />
dawyeba da misi TandaTanobiT gazrda. sunTqvis gaumjobesebisTvis da<br />
varjiSis dasrulebisTvis umjobesia tempis Semcireba.<br />
fizikuri aqtiurobis intensiurobis gansazRvra SesaZlebelia wuTSi<br />
an saaTSi daxarjuli kaloriebis mixedviT. misaRebi kaloraJis<br />
dadgena damokidebulia wonasa da moZraobis intensiurobaze. qvemoT<br />
mocemulia cxrili kaloraJis xarjvis Sesaxeb sxvadasxva datvirTvis<br />
mqone pirebSi.<br />
14
konkretuli fizikuri aqtiurobis dros daxarjuli energia<br />
msubuqi (4 kkal/wT naklebi) saSualo (4-7 kkal/wT) mZime (7 kkal/wT meti)<br />
neli siaruli cocxlad siaruli cocxlad siaruli<br />
aRmarTze an tvirTiT<br />
velosipediT seirnoba velosipediT swrafi<br />
siaruli an rbolaSi<br />
monawileoba<br />
neli curva curva zomieri ZalisxmeviT swrafi curva<br />
zogadi varjiSi, msubuqi zogadi varjiSi, aerobika zogadi varjiSi, kibis<br />
daWimva<br />
ergometria<br />
_ magidis CogburTi CogburTi<br />
golfi _ _<br />
boulingi _ _<br />
Tevzaoba mjdomare Tevzaoba fexze damdgari Tevzaoba mdinareSi<br />
naosnoba neli kanoe swrafi kanoe<br />
diasaxlisoba, xaliCis<br />
diasaxlisoba, zogadi avejis gadaadgileba<br />
dagva<br />
dalageba<br />
balaxis moTibva balaxis moTibva<br />
eleqtrodanadgariT<br />
balaxis moTibva xeliT<br />
saxlSi xeze muSaoba xatva _<br />
mosvenebul mdgomareobaSi yofnis an kiTxvis dros ixarjeba 1<br />
kkal/wuTSi. saSualo wonis adamiani siarulis dros xarjavs<br />
daaxloebiT 5 kkal/wuTSi, 10 wuTis ganmavlobaSi ZunZuliT sirbilis<br />
dros 10 kkal/wuTSi da 7 wuTis ganmavlobaSi sirbiliT 15 kkal/wuTSi.<br />
qcevis <strong>marTva</strong><br />
wonis, kvebis da fizikuri aqtiurobis TviT-monitoringi<br />
wonis daklebisa da SenarCunebisaTvis aucilebel faqtors<br />
warmoadgens energiis miReba-xarjvis da wonis TviT-monitoringi. is<br />
vinc regularulad uwevs TviT-monitorings dietas da fizikur<br />
aqtiurobas, wonaSi daklebis ukeTesi maCveneblebi aReniSnebaT.<br />
pacientebma mudmivad unda akontrolon kaloriebis miReba, fizikuri<br />
aqtiuroba da wona. kaloriebis miRebisa da fizikuri aqtiurobis<br />
aRricxva unda moxdes yoveldRiurad, wonis Sefaseba ki kviraSi<br />
erTxel.<br />
aswavleT cxovrebis unar-Cvevebi<br />
wonis warmatebuli daklebisa da SenarCunebisTvis damatebiTi qceviTi<br />
modifikaciis strategiebi gulisxmobs:<br />
stimulis kontrols: stimulis kontroli gulisxmobs iseTi qcevis<br />
Camoyalibebas, romelic exmareba adamianebs kvebis qcevasa da<br />
inertulobasTan dakavSirebuli garemo impulsebis SemcirebaSi.<br />
pacientebs unda vaswavloT, Seamciron maRali kaloriebis/cximebis<br />
Semcveli, arajansaRi sakvebis SeZena saxlSi, naklebi dro gaataron<br />
dRis manZilze, im adgilas sadac ikvebebian, moeridon kvebis dros<br />
yuradRebis gafantvas (mag, televizoris yureba) da ikvebon SedarebiT<br />
nela.<br />
15
SemecnebiT restruqturizacias: negatiuri fiqrebi (mag. pesimisturi<br />
fiqrebi da eWvi sakuTar TavSi) xSirad arasasurvel gavlenas axdens<br />
qcevis cvlilebis Zalisxmevaze. pirovnebebs unda vaswavloT<br />
negatiuri fiqrebis identificireba da xeli SevuwyoT dadebiTi<br />
muxtis SeZenaSi, rac ganapirobebs jansaRi kvebis da fizikuri<br />
aqtiurobis rekomendaciebis zust Sesrulebas.<br />
miznebis dasaxvas: motivaciis gazrdisTvis pirovnebebs unda vaswavlo<br />
kvebisTvis misaRebi da miRwevadi yoveldRiuri da kvireuli miznebis<br />
dasaxva. fizikuri aqtiuroba da wonaSi dakleba unda iqnes<br />
SenarCunebuli.<br />
problemis gadaWras: wonaSi daklebis komponents warmoadgens kvebisa<br />
da fizikuri aqtiurobis cvlilebebTan dakavSirebuli barierebis<br />
gadalaxva.<br />
socialur mxardaWeras: wonaSi daklebis warmatebaze, rogorc<br />
dadebiTi ise uaryofiTi zegavlenis moxdena SeuZliaT meuRleebs,<br />
ojaxis wevrebs, megobrebs da TanamSromlebs.<br />
Cavardnis (recidivis) prevencias: qcevis cvlilebis dros xSiria<br />
warumatebloba da ganmeorebiT mcdelobis aucilebloba. pacienti,<br />
romelac erTxel ar gaumarTlebs, unda gavamxnevod da vurCioT<br />
scados maSin, rodesac amisTvis mzad iqneba.<br />
medikamenturi mkurnaloba<br />
<strong>simsuqnis</strong> mkurnalobaSi qceviTi Terapia (kvebisa da fizikuri<br />
aqtiurobis CaTvliT) xSirad umniSvnelo gaxanrZlivebul Sedegs<br />
iZleva. iTvleba, rom wonis daklebis da SenarCunebis procesi metad<br />
warmatebuli iqneba, Tu qceviT reJims (kveba da fizikuri aqtiuroba)<br />
davumatebT medikaments.<br />
msuqan pacientebSi wonaSi daklebas ganapirobebs cxovrebis stilis<br />
modifikaciasTan (kveba da fizikuri aqtiuroba) erTad warmoebuli<br />
farmakoTerapia (6 Tvidan 1 wlamde). wonaSi klebis saSualo<br />
maCvenebeli 4-12%-s Seadgens.<br />
wonaSi daklebis medikamenturi mkurnalobisTvis ZiriTadad<br />
gamoiyeneba anoreqsantebi da madis damTrgunveli saSualebebi.<br />
agreTve preparatebi sibutramini (Sibutramine) da orlistati (Orlistat).<br />
sibutramini axdens norepinefrinisa da serotoninis ukuSeboWvis<br />
inhibirebas. orlistati ar miekiTvneba madis damTrgunvel saSualebas<br />
da axdens pankreasis lipazis inhibirebas da cximis Sewovis<br />
daaxloebiT 1/3-is blokirebas.<br />
ixileT agreTve danarTi `C~, `<strong>simsuqnis</strong> samkurnalod FDA 1 _s mier<br />
damtkicebuli medikamentebis nusxa~.<br />
1 sakvebi produqtebisa da medikamentebis sanitaruli kontrolis sammarTvelo<br />
16
mcenareuli medikamentebi ganusazRvreli raodenobiT Seicaven aqtiur<br />
nivTierebebs da potenciurad sazianoa. wonaSi daklebis programaSi<br />
aRniSnuli preparatebis ganxilva dauSvebelia.<br />
farmakoTerapiis dawyebamde aucilebelia TiToeuli pacientis Sesaxeb<br />
sruli medikamenturi anamnezis Sekreba.<br />
usafrTxoeba da gverdiTi efeqtebi<br />
wonaSi daklebis medikamenturi mkurnalobis dros pacientebSi<br />
aRiniSna gverdiTi efeqtebi. mkurnalobis dawyebidan maleve SeiZleba<br />
gamovlindes dozasTan dakavSirebuli mcire efeqtebi, romelic<br />
saSualo simZimisaa da droTa ganmavlobaSi TavisTavad gaqreba.<br />
sawyisi gverdiTi efeqtebis Tavidan acileba an minimumamde Semcireba<br />
SesaZlebelia:<br />
dozirebis da miRebis sqemis SedgeniT,<br />
gverdiTi efeqtebis mimarT maRali riskis jgufebis gamovleniT<br />
da sworad SerCeuli medikamenturi mkurnalobiT,<br />
pacientis ganaTlebiT da gverdiTi efeqtebis monitoringiT<br />
mkurnalobis dasawyisSi an dozis cvlilebis dros.<br />
iSviaTi, magram potenciurad seriozuli gverdiTi efeqtebi SeiZleba<br />
gamovlindes mkurnalobis sakmaod gvian etapze.<br />
ixileT danarTi `D~ `<strong>simsuqnis</strong> samkurnalod FDA-s mier damtkicebuli<br />
medikamentebis uaryofiTi efeqti”.<br />
wamalTSorisi urTierTqmedeba<br />
wonaSi dasaklebi saSualebebiT mkurnalobis dawyebamde unda<br />
Sefasdes preparatTa urTierTqmedebis albaToba.<br />
ixileT danarTi `E~ `<strong>simsuqnis</strong> samkurnalod FDA_s mier damtkicebuli<br />
medikamentebis urTierTqmedeba”.<br />
mkurnaloba<br />
<strong>simsuqnis</strong> medikamenturi mkurnaloba dasaSvebia mxolod wonaSi<br />
daklebis specialuri programis paralelurad, romelic gulisxmobs<br />
dabal-kaloriuli dietis, momatebuli fizikuri aqtiurobis da<br />
qceviTi Terapiis erTobliobas. farmakoTerapiis dawyeba<br />
rekomendebulia im SemTxvevaSi, Tu aRniSnuli specialuri programis<br />
fonze wonaSi kleba kviraSi 0,45kg-iT ar aRiniSneba.<br />
farmakoTerapia eniSnebaT pacientebs, visac sxeulis masis indeqsi (smi)<br />
aqvT 27-30 da meti, agreTve aReniSnebaT simsuqnesTan dakavSirebuli<br />
Tanmxlebi daavadebebi da risk-faqtorebi. 27-29.9 smi-s fonze SesaZlo<br />
daavadebebs da risk-faqtorebs miekuTvneba: hipertenzia, dislipidemia,<br />
gulis koronaruli daavadeba, tipi 2 Saqriani diabeti da Zilis apnoe.<br />
im SemTxvevaSi, Tu mkurnalobis fonze wonaSi klebis sasurveli<br />
maCveneblebi ar fiqsirdeba, saWiroa mkurnalobis procesis xelaxla<br />
gadaxedva da dozis regulireba. preparatis miReba unda Sewydes im<br />
17
SemTxvevaSi, Tu pacienti ar eqvemdebareba mkurnalobas an seriozuli<br />
gverdiTi efeqtebi aRiniSna.<br />
farmakoTerapiis dawyebidan oTxi kviris ganmavlobaSi wonaSi kleba<br />
unda aRiniSnos 2 kilogramiT. Tu aRniSnuli maCvenebeli ar<br />
dafiqsirda samomavlo efeqturoba naklebsavaraudoa. iq sadac<br />
pirveli oTxi kviris ganmavlobaSi sasurveli efeqti ar aRiniSna<br />
rekomendebulia mkurnalobis Sewyveta. medikamenturi mkurnalobis<br />
gagrZeleba mizanSewonilia im SemTxvevaSi, Tu pirveli 6 Tvis<br />
ganmavlobaSi aRiniSneba wonaSi dakleba an klebis sawyisi fazis<br />
Semdeg wonis SenarCuneba. gverdiTi efeqtebis gamovlenisTanave unda<br />
Sewydes preparatis miReba.<br />
pacientebis monitoringi<br />
wonis medikamenturi mkurnalobis dawyebisTanave aucilebelia<br />
pacientTa monitoringi. monitoringis sqema gulisxmobs pacientebis<br />
Sefasebas oridan oTxi kviris SualedSi, TveSi erTxel momdevno 3<br />
Tvis ganmavlobaSi da yovel sam TveSi erTxel mkurnalobis<br />
dawyebidan 1 wlis ganmavlobaSi. aRniSnuli vizitebis dros fasdeba<br />
wona, welis garSemoweriloba, arteriuli wneva, gulis cemis sixSire,<br />
gverdiTi efeqtebis arseboba, warmoebs laboratoriuli testebi da<br />
pacientis SekiTxvebs eZleva pasuxebi.<br />
mkurnaloba warmatebulad iTvleba, Tu preparatis miRebis fonze ar<br />
aRiniSneba gverdiTi efeqtebi da mkurnalobis dawyebidan 6 Tvis<br />
Semdeg wonaSi kleba aRiniSneba 10% an meti. SemdgomSi wonaSi<br />
dasaklebad saWiroa cxovrebis stilis modifikacia, rac kaloraJis<br />
Semcirebas da fizikuri aqtiurobis gazrdas gulisxmobs.<br />
ori wlis ganmavlobaSi welis garSemowerilobis Semcireba sul<br />
mcire 4 sm-iT da namati 3 kg-ze naklebi – wonis warmatebuli<br />
SenarCunebaa.<br />
6. gaidlaini, romelac eyrdnoba aRniSnuli protokoli<br />
- `<strong>simsuqnis</strong> <strong>marTva</strong> <strong>pirvelad</strong> <strong>jandacvaSi</strong>~.<br />
18
7. adamianuri da materialur-teqnikuri resursebi<br />
adamianuri<br />
ojaxis eqimi,<br />
an ubnis<br />
eqimi/Terapevti<br />
resursi funqciebi/mniSvneloba SeniSvna<br />
zogadi praqtikis<br />
eqTani<br />
klinikuri Sefaseba,<br />
prevenciuli<br />
RonisZiebebis SerCeva,<br />
medikamenturi mkurnalobis<br />
Taobaze gadawyvetileba,<br />
mimdinare meTvalyureoba<br />
riskis profilis Sefaseba<br />
pacientis konsultireba<br />
(dietis, fizikuri aqtiurobis<br />
Sesaxeb)<br />
registratori pacientebis gamoZaxebis<br />
uzrunvelyofa mimdinare<br />
menejeri/<br />
administratori<br />
meTvalyureobisaTvis<br />
gaidlainisa da protokolis<br />
danergvis xelSewyoba<br />
danergvaze meTvalyureoba,<br />
auditis Catareba da Sedegebis<br />
analizi<br />
specialisti specialuri Cvenebebis<br />
SemTxvevaSi konsultireba<br />
materialurteqnikuri<br />
simaRlis mzomi riskis profilis Sefaseba<br />
(smi-s gamosaTvlelad)<br />
saswori riskis profilis Sefaseba<br />
(smi-s gamosaTvlelad)<br />
santimetri riskis profilis Sefaseba<br />
(welis garSemowerilobis<br />
pacientis<br />
saganmanaTleblo<br />
masala<br />
mi<strong>marTva</strong><br />
sadiagnostiko<br />
centrSi<br />
(meoreul<br />
doneze)<br />
savaldebulo<br />
savaldebulo<br />
savaldebulo<br />
gamosaTvlelad)<br />
pacientis informireba sasurveli<br />
19
8. danarTebi<br />
danarTi A. smi gamosaxuli centilebSi asakis mixedviT<br />
gogonebi: 2-dan 20 wlamde. saxeli, gvari______<br />
20
iWebi 2-dan 20wlamde saxeli, gvari_________<br />
21
danarTi B. wonis matebasTan dakavSirebuli medikamentebi<br />
medikamentTa klasi<br />
neiroleptikebi (Aronne 2003 [R]):<br />
fenoTiazinebi<br />
atipiuri neiroleptikebi:<br />
klozapini > olanzapini > risperidoni = qetiapini<br />
normoTimikebi:<br />
liTiumi<br />
antidepresantebi:<br />
tricikluri (Masand 2000 [R])<br />
amitriptilini > imipramini<br />
monoaminoqsidazas inhibitorebi (araseleqtiuri)<br />
izokarboqsazidi, fenelzini, tranilcipromini<br />
seleqtiuri serotoninis ukumitacebis<br />
inhibitorebi (Sussman 2001 [M]):<br />
paroqsetini > citaloprami, fluvoqsamini,<br />
sertralini<br />
mirtazapini<br />
epilefsiis sawinaaRmdego saSualebebi:<br />
gabapentini, valproati, karbamazepini, pregabalini<br />
antiepileptikebi/neiroleptikebi gamoyenebuli<br />
bipolaruli aSlilobisas (Nemeroff, 2003 [R])<br />
valproati, karbamazepini, klozapini, olanzapini,<br />
risperidoni<br />
steroiduli hormonebi:<br />
hormonaluri kontraceptivebi<br />
kortikosteroidebi<br />
progestaciuri steroidebi:<br />
megestrolis acetati<br />
diabetis sawinaaRmdego saSualebebi:<br />
insulini<br />
silfonilureazi<br />
Tiazolidindionebi<br />
hipertoniis sawinaaRmdego saSualebebi:<br />
beta da alfa-1 adrenomablokirebeli saSualebebi<br />
antihistaminebi:<br />
ciproheptadini<br />
alternatiuli<br />
varianti<br />
ziprazidoni,<br />
aripiprazoli<br />
nefazodoni, bupropioni,<br />
venlafaqsini<br />
lamotrijini, topiramati<br />
lamotrijini, topiramati,<br />
ziprazidoni<br />
eTinil-estradiolis da<br />
drospirenonis kombinacia<br />
wonis kleba, aromatazas<br />
inhibitorebi<br />
metformini, akarboza,<br />
eqsenatidis ineqcia<br />
agf-inhibitorebi, arb-ebi,<br />
diuretikebi, kalciumis<br />
arxebis blokerebi<br />
difenhidramini,<br />
dekongestantebi (SeSup.<br />
saw.), inhalatorebi<br />
(adaptirebulia Greenway, 2003 [R]; Kushner. 2003b [R]; Weigle, 2003 [R])<br />
22
saxeobis<br />
saxelwodeba<br />
benzfetamini<br />
dieTilpropioni<br />
meTamfetamini<br />
fendimetrazini<br />
fentermini<br />
fentermini<br />
fisis<br />
kompleqsi<br />
sibutramini<br />
orlistati<br />
danarTi C. FDA 2 _s mier damtkicebuli <strong>simsuqnis</strong> samkurnalo<br />
medikamentebis nusxa<br />
moqmedebis<br />
meqanizmi<br />
simpaTomimetiki, iwvevs centraluri nervuli<br />
sistemis stimulacias da moqmedebs rogorc<br />
anoreqtiki (madis damTrgunveli)<br />
simpaTomimetiki, iwvevs centraluri nervuli<br />
sistemis stimulacias da moqmedebs rogorc<br />
anoreqtiki (madis damTrgunveli)<br />
simpaTomimetiki, iwvevs centraluri nervuli<br />
sistemis stimulacias da moqmedebs rogorc<br />
anoreqtiki (madis damTrgunveli)<br />
simpaTomimetiki, iwvevs centraluri nervuli<br />
sistemis stimulacias da moqmedebs rogorc<br />
anoreqtiki (madis damTrgunveli)<br />
simpaTomimetiki, iwvevs centraluri nervuli<br />
sistemis stimulacias da moqmedebs rogorc<br />
anoreqtiki (madis damTrgunveli)<br />
simpaTomimetiki, iwvevs centraluri nervuli<br />
sistemis stimulacias da moqmedebs rogorc<br />
anoreqtiki (madis damTrgunveli)<br />
Terapiuli efeqti miiRweva norefinefrinis,<br />
serotoninisa da dopaminis STanTqmis Sene-<br />
lebiT. sibutramini da misi ZiriTadi<br />
farmakologiurad aqtiuri metabolitebi (M 1<br />
da M 2 ) ar moqmedeben monoaminebis<br />
gamonTavisuflebis gamo; Sedegi gaZRomis<br />
gaumjobesebuli SegrZnebaa<br />
lipazebis Seqcevadad moqmedi inhibitori;<br />
Tavis Terapiul aqtiurobas amJRavnebs mci-<br />
re nawlavSi gastralur da pankreatiul<br />
lipazebTan kovalentuli bmis formirebiT<br />
da trigliceridebis hidrolizis momdevno<br />
SemcirebiT, da maT Soris qolesterinis<br />
STanTqmiT<br />
miTiTeba<br />
gankuTvnilia egzogenuri (gare) <strong>simsuqnis</strong> mkurnalobisaTvis<br />
rogorc moklevadiani xelSemwyobi saSualeba (ramodenime<br />
kvira) kaloriebis SezRudvaze dayrdnobili wonis<br />
daklebis mkurnalobis sqemis dros<br />
gankuTvnilia egzogenuri (gare) <strong>simsuqnis</strong> mkurnalobisaTvis<br />
rogorc moklevadiani xelSemwyobi saSualeba (ramodenime<br />
kvira) kaloriebis SezRudvaze dayrdnobili wonis<br />
daklebis mkurnalobis sqemis dros<br />
gankuTvnilia egzogenuri (gare) <strong>simsuqnis</strong> mkurnalobisaTvis<br />
rogorc moklevadiani xelSemwyobi saSualeba (ramodenime<br />
kvira) kaloriebis SezRudvaze dayrdnobili wonis<br />
daklebis mkurnalobis sqemis dros<br />
gankuTvnilia egzogenuri (gare) <strong>simsuqnis</strong> mkurnalobisaTvis<br />
rogorc moklevadiani xelSemwyobi saSualeba (ramodenime<br />
kvira) kaloriebis SezRudvaze dayrdnobili wonis<br />
daklebis mkurnalobis sqemis dros<br />
gankuTvnilia egzogenuri (gare) <strong>simsuqnis</strong> mkurnalobisaTvis<br />
rogorc moklevadiani xelSemwyobi saSualeba (ramodenime<br />
kvira) kaloriebis SezRudvaze dayrdnobili wonis<br />
daklebis mkurnalobis sqemis dros<br />
gankuTvnilia egzogenuri (gare) <strong>simsuqnis</strong> mkurnalobisaTvis<br />
rogorc moklevadiani xelSemwyobi saSualeba (ramodenime<br />
kvira) kaloriebis SezRudvaze dayrdnobili wonis<br />
daklebis mkurnalobis sqemis dros<br />
gankuTvnilia <strong>simsuqnis</strong> mkurnalobisaTvis, maT Soris wonis<br />
daklebisa da gagrZelebisaTvis; unda gamoyenebul iqnes<br />
kaloriebis Semcirebi dros dietasTan erTad<br />
gankuTvnilia <strong>simsuqnis</strong> mkurnalobisTvis, maT Soris wonis<br />
daklebisa da gagrZelebisaTvis, rodesac gamoiyeneba<br />
kaloriebis Semcireba dietasTan erTad; aseve gankuTvnilia<br />
wonis aRdgenis riskis SemcirebisaTvis, wonis daklebis<br />
Semdeg an manamde<br />
2 sakvebi produqtebisa da medikamentebis saagento (Food and Drug Administration).<br />
23
danarTi D. FDA_s mier <strong>simsuqnis</strong> samkurnalod damtkicebuli<br />
medikamentebis uaryofiTi efeqtebi<br />
saxeobis<br />
saxelwodeba<br />
benzfetamini<br />
dieTilpropioni<br />
meTamfetamini<br />
fendimetrazini<br />
fentermini<br />
fentermini<br />
fisis<br />
kompleqsi<br />
sibutramini<br />
orlistati<br />
uaryofiTi efeqti gafrTxileba da ukuCvenebebi<br />
Tavis tkivilebi, uZiloba, aRznebadoba<br />
(nerviuloba), gaRizianeba, taqikardia,<br />
hipertenzia da aCqarebuli guliscema<br />
cns-is aRznebadoba, Tavbruxvevebi, Tavis<br />
tkivilebi, kuWSi Sekruloba, simSrale pirSi,<br />
Rebineba, uZiloba RebinebiT, SfoTva,<br />
arteriuli wnevis mcire momateba, aCqarebuli<br />
guliscema/msubuqi taqikardia<br />
cns-is aRznebadoba, Tavbruxvevebi, Tavis<br />
tkivilebi, kuWSi Sekruloba, simSrale pirSi,<br />
Rebineba, uZiloba RebinebiT, SfoTva,<br />
arteriuli wnevis mcire momateba, aCqarebuli<br />
guliscema/msubuqi taqikardia<br />
cns-is aRznebadoba, Tavbruxvevebi, Tavis<br />
tkivilebi, kuWSi Sekruloba, simSrale pirSi,<br />
Rebineba, uZiloba RebinebiT, SfoTva,<br />
arteriuli wnevis mcire momateba, aCqarebuli<br />
guliscema/msubuqi taqikardia<br />
filtvebis <strong>pirvelad</strong>i hipertenzia da/an<br />
SeqceviTi kardiovaskularuli daavadeba,<br />
aCqarebuli guliscema, taqikardia, arteriuli<br />
wnevis momateba, gaRizianeba, SfoTva,<br />
Tavbruxvevebi, uZiloba, eiforia, tremori,<br />
Tavis tkivilebi<br />
filtvebis <strong>pirvelad</strong>i hipertenzia da/an Seqce-<br />
vadi kardiovaskularuli daavadeba,<br />
aCqarebuli guliscema, taqikardia, arteriuli<br />
wnevis momateba, gaRizianeba, SfoTva,<br />
Tavbruxvevebi, uZiloba, eiforia, disforia,<br />
tremori, Tavis tkivilebi<br />
normasTan Seusabamo ekg, hipertenzia,<br />
aCqarebuli guliscema, taqikardia, simSrale<br />
pirSi (17%), Tavis tkivilebi (30%), uZiloba<br />
(10%), anoreqsia (madis dakargva) (13%), kuWSi<br />
Sekruloba (11,5%)<br />
muclis tkivilebi/diskomforti, cximiani<br />
ganavali, kuWSi gasvlis xSiri survili,<br />
nawlavTa aSliloba<br />
naadrevi aTeriosklerozi, hipertenzia, hiperTiroidizmi,<br />
glaukoma<br />
naadrevi aTeriosklerozi, aRznebuli mdgomare-<br />
oba,hiperTreoidizmi monoaminoqsidazas inhibitorebis<br />
miRebisas 14 dRis farglebSi, glaukoma, narkotikebis<br />
moxmareba anamnezSi, hiper- an mometebuli mgrZnobeloba<br />
(idiosinkrazia) simpaTomimetikis aminebisadmi,<br />
hiperTiroidizmi, Zlieri hipertenzia<br />
glaukoma, naadrevi aTeriosklerozi, simptomaturi<br />
kardiovaskuluri daavadeba, hipertenzia, hiperTiroidizmi,<br />
monoaminoqsidazas inhibitorebis miRebisas<br />
naadrevi aTriosklerozi, simptomaturi kardiovaskuluri<br />
daavadeba, hipertenzia, hiperTiroidizmi, glaukoma, cns-is sxva<br />
stimulatorebi maT Soris monoaminoqsidazas inhibitorebi,<br />
naadrevi aTeriosklerozi, kardiovaskularuli daavadeba,<br />
hipertenzia, hiperTiroidizmi, glaukoma<br />
naadrevi aTriosklerozi, kardiovaskuluri daavadeba,<br />
hipertenzia, hiperTiroidizmi, glaukoma<br />
nervuli anoreqsia, monoaminoqsidazas inhibitorebis<br />
Tanmxlebi gamoyeneba, gulis koronaruli daavadeba, gulis<br />
mwvave ukmarisoba, insulti , ariTmia, arakontrolirebadi<br />
hipertenzia, narkotikebis moxmareba anamnezSi, orsuloba an<br />
ZuZus woveba, neirogenuri bulimia, medikamentebis Tanmxlebi<br />
miReba, romelic mavned moqmedebs hemostazsa da<br />
trombocitebis funqciaze, qolestazi, RviZlis dazianeba,<br />
glaukoma, filtvebis hipertenzia, Tirkmlebis ukmarisoba da<br />
gulyrebi anamnezSi<br />
qolestazi qronikuli malabsorbciis sindromi, kuW-nawlavis<br />
daavadeba, pacientebi cximSi xsnadi vitaminebis deficitis<br />
riskiT<br />
24
danarTi E. FDA_s mier <strong>simsuqnis</strong> samkurnalod damtkicebuli<br />
medikamentebis urTierTqmedeba<br />
saxeobis<br />
saxelwodeba<br />
benzfetamini<br />
dieTilpropioni<br />
meTamfetamini<br />
fendimetrazini<br />
fentermini<br />
fentermini<br />
fisis<br />
kompleqsi<br />
sibutramini<br />
orlistati<br />
medikamentebis urTierTqmedeba<br />
cns-is stimulatorebi,<br />
monoaminoqsidazas inhibitorebi<br />
tricikluri antidepresantebi<br />
hipertenziis sawinaaRmdego saSualebebi<br />
guaneTidini<br />
monoaminoqsidazas inhibitorebi<br />
sibutramini<br />
Tioridazini<br />
insulini<br />
guaneTidini<br />
monoaminoqsidazas inhibitorebi<br />
fenoTiazinebi<br />
tricikluri antidepresantebi<br />
amfetamini<br />
monoaminoqsidazas inhibitorebi<br />
sibutramini<br />
monoaminoqsidazas inhibitorebi<br />
sibutramini<br />
krazana<br />
pirdapiri qmedebis madis damTrgunvelebi<br />
deqstromeTorfani<br />
dihidroergotamini<br />
droperidoli<br />
ergotamini<br />
fentanili<br />
liTiumi<br />
meperidini<br />
monoaminoqsidazas inhibitorebi<br />
pentazocini<br />
serotoninis SeboWvis seleqtiuri inhibitorebi (SSRIs)<br />
krazana<br />
triptofani<br />
iohimbini<br />
25
danarTi F. fizikuri aqtiurobis recepti (daniSnuleba)<br />
saxeli _____________<br />
TariRi _____________<br />
dakvirvebis intervali _______________<br />
janmrTelobis mdgomareoba fizikuri aqtiurobisaTvis<br />
amJamindeli diagnozi (ix. ukuCvenebebi): amJamindeli mkurnaloba<br />
1. 1.<br />
2. 2.<br />
3. 3.<br />
Sefaseba:<br />
_______ Tanxmoba TviT-monitoringiT aqtiurobis programaze<br />
_______ Tanxmoba mxedvelobis qveS aqtiurobis programaze (mi<strong>marTva</strong> eqimTan)<br />
_______ moiTxovs varjiSisadmi testirebas (mi<strong>marTva</strong> eqimTan)<br />
aqtiurobis mgegmavi: sezoni _________<br />
saSinao pirobebSi – marto saSinao pirobebSi _ sxvebTan erTad<br />
1. aqtiurobis 1. aqtiurobis<br />
resursi resursi<br />
a) a)<br />
b) b)<br />
g) g)<br />
2. aqtiurobis 1. aqtiurobis<br />
resursi resursi<br />
a) a)<br />
b) b)<br />
g) g)<br />
gareT _ marto gareT – sxvebTan erTad<br />
1. aqtiurobis 1. aqtiurobis<br />
resursi resursi<br />
a) a)<br />
b) b)<br />
g) g)<br />
2. aqtiurobis 1. aqtiurobis<br />
resursi resursi<br />
a) a)<br />
b) b)<br />
g) g)<br />
aqtiuroba:<br />
siaruli<br />
curva<br />
velosipedi<br />
mebaReoba<br />
CogburTi<br />
gazonebis<br />
gaTibva<br />
golfi<br />
ioga<br />
eqskursia<br />
gorgolaWebiT<br />
sriali<br />
fexburTi<br />
aerobika<br />
cekva<br />
pacientma unda moaxdinos minimum ori SesaZlo aqtiurobis identificireba TiToeul<br />
garemoebaSi mravalferovnis misaRwevad.<br />
nebismieri arCeuli aqtiurobisaTvis daadgineT is mTavari resursebi, romlebic<br />
saWiroa mis gansaxorcieleblad. resursebi moicavs rogorc fizikur (mag.,<br />
aRWurviloba, mwvrTneli, dro), aseve fsiqologiur aspeqtebs (mag., socialuri<br />
mxardaWera, miznebi).<br />
miznebSi Sedis aqtiurobis gegmis SeTavseba sezonebsa da amindTan, mowyenilobis<br />
minimalizacias, isini ganmartavs socialur mxardaWeras da aqtiurobis<br />
individualur SerCevas.<br />
26
danarTi G. fizikuri aqtiurobis rekomendacia<br />
fizikuri aqtiurobis gaumjobesebis mimarTulebebi:<br />
sixSire – kviraSi dReebis is raodenoba, romelic rekomendirebulia arCeuli<br />
aqtiurobis gansaxorcieleblad.<br />
1. kardiovaskularuli daavadebebi – dasawyisSi 3-jer kviraSi da Semdgom<br />
gavrceleba kviris ufro met dReebze;<br />
2. Zala _ dasawyisSi 2-3 jer kviraSi da Semdgom or dReSi erTxel;<br />
3. plastiuroba – dasawyisSi or dReSi erTxel, xolo SemdgomSi gavrceleba kviris<br />
rac SeiZleba met dReze. gansakuTrebiT moTelva aerobikis dros.<br />
xangrZlivoba _ drois rekomendirebuli xangrZlivoba an aqtiurobisas mTlianad<br />
Sesrulebuli samuSao drois xangrZlivoba. sixSire da xangrZlivoba yvelaze<br />
mniSvnelovania kaloriebis mTliani xarjvisaTvis da wonis regulirebisaTvis. isini<br />
unda gaizardos intensiurad.<br />
intensivoba _ moZraobis siCqare (siarulis siCqare). intensivobis gazrda aris<br />
mudmivi da TandaTobiTi gaumjobesebis sawindari mocemuli sixSirisTvis da<br />
aqtiurobis xangrZlivobisTvis fiziologiuri adaptaciis Semdeg. intensivobis<br />
monitoringi SeiZleba Borg Perceived Exertion Scale-is (specialuri skala, romlis<br />
mixedviT geZlevaT warmodgena miRebul datvirTvaze) meSveobiT. tipiurad samizne<br />
intensivoba borgis 6-20 quliani skalis mixedviT aris Semdegi: 10-12 qulidan _<br />
sakmaod msubuqi; 13-14-mde _ mZime.<br />
aseve `salaparako testi~ gamoxatavs intensivobis Semcirebis moTxovnas, Tu giWirT<br />
laparaki aerobikis Sesrulebis dros.<br />
aqtiurobis recepti: CamowereT receptiT dadgenili aqtiuroba da drois<br />
xangrZlivoba kviris TiToeuli dRis mixedviT.<br />
Sin:<br />
(aqtiuroba)<br />
(aqtiuroba)<br />
gareT<br />
(aqtiuroba)<br />
(aqtiuroba)<br />
Sin:<br />
(aqtiuroba)<br />
(aqtiuroba)<br />
gareT<br />
(aqtiuroba)<br />
(aqtiuroba)<br />
I kvira<br />
kvira orSab. samSab. oTxSab. xuTSab. parask. SabaTi<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
II kvira<br />
kvira orSab. samSab. oTxSab. xuTSab. parask. SabaTi<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
_____<br />
muSaoba ----- wuTamde -------- kviris ganmavlobaSi.<br />
muSaoba -------- kg. daklebamde --------- kviris ganmavlobaSi.<br />
veTanxmebi am danarTi aqtiurobis recepts 8. ,,kvebis da Tanaxma dagegmva var Sevinaxo Cemi da aqtiurobis wonis Jurnali koreqcia’’ Cems kalendarSi<br />
----- dan ----mde.<br />
pacientis xelmowera -------------------------- samedicino muSakis xelmowera ---------------<br />
27
danarTi H. ,,kvebis dagegmva da wonis koreqcia’’<br />
sakvebi produqtebi:<br />
1. puri da pureuli<br />
2. xorci da xorceuli<br />
3. xili<br />
4. bostneuli<br />
5. rZe da rZis produqtebi<br />
6. cximebi<br />
a. nebismieri saWmeli am jgufis produqtebis sxvadasxvagvari kombinaciaa;<br />
b. purisa da pureulis jgufi ZiriTadaT naxSirwylebs Seicavs. aseve<br />
naxSirwylebis wyaroa xili da bostneuli;<br />
c. rZe da rZis produqtebi Seicavs naxSirwylebs, naklebi raodenobiT<br />
cilebs da kidev ufro naklebi raodenobiT cximebs. calke unda<br />
gamoiyos xorceulis jgufi produqtebi - cilis ZiriTadi wyaro.<br />
pureulis siaSi Semavali TiToeuli produqtis erTi erTeuli<br />
(ulufa) Seicavs Tanabari raodenobiT naxSirwyals, cilas, cxims<br />
kvalis saxiT da TiToeuli maTganis erTi erTeuli (ulufa) gvaZlevs<br />
80kkalorias.<br />
purisa da pureulis 1<br />
ulufa<br />
zoma wona grami<br />
TeTri puri 1 naWeri 30<br />
Wvavis puri 1 naWeri 30<br />
Cveulebrivi funTuSa 1 cali 30<br />
mWadi 1 cali 30<br />
hamburgeris funTuSa 1 cali 30<br />
brinji moxarSuli 1/2½ Wiqa 70<br />
Svria herkulesi 1/2½ Wiqa 70<br />
wiwibura 1/2½ Wiqa 70<br />
mananis burRuli 1/2½ Wiqa 70<br />
spageti 1/2½ Wiqa 70<br />
makaroni 1/2½ Wiqa 70<br />
atria 1/2½ Wiqa 70<br />
simindis fqvili 2 1/2 C.k 20<br />
fqvili 2 1/2 C.k 20<br />
simindi 1/2½ Wiqa 100<br />
lobio wiTeli 1/2½ Wiqa 65<br />
ospi 1/2½ Wiqa 75<br />
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ugrexeli 1/2½ Wiqa 75<br />
mwvane barda 1/2½ Wiqa 100<br />
karTofili 1 patara 80<br />
karTofilis piure 1/2½ Wiqa 100<br />
gogra 1 Wiqa 200<br />
yabayi 1/4 Wiqa 200<br />
wabli 12 c.saSualo 200<br />
sistema gaZlevT saSualebas erTmaneTs SeunacvloT TqvenTvis<br />
sasurveli produqtebi, ise rom sakvebis kaloraJi ar Seicvalos.<br />
xili: xilis erTi ulufa Seicavs saSualo 15 gr. naxSirwyals da<br />
60kkal. xili naxSirwylebis erT-erTi wyaroa, cilebsa da cximebs es<br />
jgufi TiTqmis ar Seicavs.<br />
bostneuli: naxSirwylebis didi Semcvelobis gamo bostneulis siidan<br />
amoRebulia da pureulis siaSia Setanili barda, karTofili, gogra,<br />
yabayi, bostneulis siaSi Semavali danarCeni produqtebis 1 ulufa<br />
Seicavs 5gr-naxSirwyals, 2gr. cilas, 25 kkal.<br />
bostneulSi Sedis: Warxali, kombosto, stafilo, yvavilovani<br />
kombosto, badrijani, mwvane lobio, mwvane wiwaka, pomidori, wiTeli<br />
fxali, ispanaxi, soko, xaxvi, mJave kombosto. SezRudviT SeiZleba<br />
miiRoT oxraxuSi, boloki, tarxuna, wiwmati, kama, kitri.<br />
rZe da rZis produqtebi: Seicavs naxSirwylebs, cilebs da cximebs.<br />
rZis da rZis produqtebis cximianoba ganisazRvreba naRebis<br />
procentuli SemcvelobiT. amis mixedviT iyofa 3-jgufad: 1-moxdili; 2dabal<br />
cximiani; 3-mouxdeli. rZis produqtebSi Sedis: rZe, mawoni,<br />
iogurti.<br />
xorci da xorceuli - cilis ZiriTad wyaros warmoadgens.<br />
isini ar Seicaven naxSirwylebs magram Seicaven cximebs sxvadasxva<br />
raodenobiT. maTi kaloriuloba damokidebulia cximis Semcvelobaze.<br />
ulufa<br />
xorceuli<br />
naxSirwylebi<br />
gramebSi<br />
cilebi cximebi kkaloriebi<br />
mWle xorci 0 7 3 55<br />
saSualo cximiani 0 7 5 75<br />
qoniani xorci 0 7 8 100<br />
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ogorc mWle, aseve saSualo da Zalian qoniani xorcis 1 ulufa<br />
udris 30 grams. am jgufs miekuTvneba:<br />
saqonlis, xbos, Rors, kurdRlis, cxvris, Txis, ciknis da<br />
batknis xorci;<br />
indauri, ixvi, wiwila, bati, qaTami, xoxobi;<br />
axali da gayinuli Tevzeuli.<br />
xorceulis erT ulufas agreTve Seesabameba Semdegi: xamanwka – 85 gr.,<br />
kvercxis cila – 100 gr., Tavmoxdili qarTuli yveli – 40 gr., Tevzi –<br />
30gr,. sosisi – 30gr., Zexvi – 30 grami.<br />
sakvebad sjobs uqono, mWle xorcis gamoyeneba. umjobesia frinvelis<br />
xorci miirTvaT kangaclili. xorcs nu SewvavT da nu moxrakavT<br />
cximSi. gamoiyeneT iseTi tafa, romelic ar ikravs. umjobesia<br />
moxarSuli, an Samfurze da quraSi Semwvari xorcis gamoyeneba.<br />
cximi: iyofa najer da ujer cximebad. 1 grami cximi iZleva<br />
daaxloebiT 9 kkalorias. cximis erTi ulufa Seicavs daaxloebiT 5<br />
gr. cxims da 45 kkalorias. yvelanairi cximi maRalkaloriulia.<br />
upiratesoba eniWeba ujer cximebs.<br />
najer cximebs Seicavs: karaqi, kvercxis guli, lori, Roris<br />
qoni, araJani;<br />
ujer cximebs Seicavs: margarini, dieturi margarini, mcenareuli<br />
zeTi, maionezi, nuSi, miwis Txili, nigozi, Txili, zeTisxili,<br />
mzesumzira.<br />
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