saqarTvelos samedicino Jurnali Medical Journal of Georgia
saqarTvelos samedicino Jurnali Medical Journal of Georgia
saqarTvelos samedicino Jurnali Medical Journal of Georgia
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
1<br />
Tbilisis saxelmwifo <strong>samedicino</strong> universiteti<br />
ТБИЛИССКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ<br />
TBILISI STATE MEDICAL UNIVERSITY<br />
<strong>saqarTvelos</strong> <strong>samedicino</strong> <strong>Jurnali</strong><br />
samecniero-praqtikuli, meTodologiuri <strong>Jurnali</strong>.<br />
daarsda 1922 wels<br />
Медицинский журнал Грузии<br />
Научно-практический, методологический журнал. Основан в 1922 году<br />
<strong>Medical</strong> <strong>Journal</strong> <strong>of</strong> <strong>Georgia</strong><br />
Scientific-practical methodological journal. Was established in 1922<br />
3<br />
ivlisi-seqtemberi<br />
2008
2<br />
Sinaarsi<br />
gamosaTxovari<br />
Tamar dekanosiZe<br />
pr<strong>of</strong>ilaqtikuri medicina<br />
k. gelaSvili, r. kverenCxilaZe, n. vefxvaZe, i. mWedliSvili, i. faRava, r. javaxiZe,<br />
l. ziraqiSvili - pr<strong>of</strong>ilaqtikuri medicinis warsuli, awmyo da momavali<br />
kardiologia<br />
g. tabiZe, m. iakobaSvili, d. baRaTuria, T. cibaZe - marcxena parkuWis<br />
remodelirebis Taviseburebebi diastoluri disfuqnciiT mimdinare gulis<br />
qronikuli ukmarisobisas.<br />
pulmonologia, fizioTerapia<br />
n. saakaSvili, m. tabiZe, n. kakulia, m. afxazi, i. kvinikaZe - vanadiumis eleqtr<strong>of</strong>orezis<br />
gavlena gaxangrZlivebuli pnevmoniis mqone avadmy<strong>of</strong>Ta kardiohemodinamikaze<br />
infeqciuri sneulebani, epidemiologia<br />
i. mWedliSvili, T. mWedliSvili, m. eloSvili - saqarTveloSi meningokokuri<br />
infeqciisa da baqteriuli meningitebis epidemiologiuri zedamxedvelobis<br />
gaumjobesebis gzebi.<br />
alergologia, fizioTerapia<br />
n. saakaSvili, i. Tarxan-mouravi, n. jakobia - santimetruli diapazonis<br />
mikrotalRebis eleqtromagnituri velis gavlena bronquli asTmis dros.<br />
pr<strong>of</strong>paTologia<br />
r. kverenCxilaZe, m. cimakuriZe, l. baqraZe, n. xunaSvili - Tbilisis metropolitenis<br />
muSakTa Sromis pirobebis, janmrTelobis mdgomareoba da misi gaujobesebis<br />
RonisZiebebi.<br />
diabetologia, fsiqoTerapia<br />
a. cibaZe, l. cucqiriZe, r. yuraSvili, m. korkelia, d. cibaZe -sensomotoruli da<br />
fsiqoemociuri produqtiuloba araproliferaciuli retinopaTiiT<br />
garTulebuli Saqriani diabetis dros.<br />
pr<strong>of</strong>esiuli ganaTleba, pr<strong>of</strong>paTologia<br />
m. cimakuriZe, vad. saakaZe, r. kverenCxilaZe-mosazrebani umaRles <strong>samedicino</strong><br />
skolaSi pr<strong>of</strong>esiuli paTologiis swavlebis Sesaxeb.<br />
komunaluri farmacia<br />
a. bakuriZe, v. eriaSvili, T. WumburiZe, n. nemsiwveriZe, i. wurwumia - komunaluri<br />
farmaciis problemebi saqarTveloSi.<br />
jandacvis organizacia, nevrologia<br />
m. Savdia, e. darbaiseli, n. Savdia. a. vaCeiSvili -ojaxis eqimis rolo asTeniis<br />
gamovlenasa da mkurnalobaSi.<br />
iubilari<br />
g. CafiZe, j. mamalaZe - sasiqadulo mamuliSvili (simon kapanaZe)<br />
gaxseneba<br />
T. kaWaxiZe, j. mamalaZe - megobris xsovnas (guram baqraZe)<br />
j. mamalaZe, m. kutubiZe - icxovra sikeTiT sxvaTa mimarT (jemal mgalobliSvili)<br />
nekrologi<br />
gulnara gersamia<br />
levan Carkviani
3<br />
gamosaTxovari<br />
Tamar dekanosiZe<br />
<strong>saqarTvelos</strong> sazogadoeba, medikosTa<br />
didi armia, gulistkiviliT gamoeTxova<br />
TvalsaCino mecniers, pedagogs, sazogado<br />
moRvawes, erovnuli paTolog-anatomiuri<br />
skolis erT-erT fuZemdebels, <strong>saqarTvelos</strong><br />
mecnierebaTa akademiis wevr-korespondents,<br />
mecnierebis damsaxurebul<br />
moRvawes, pr<strong>of</strong>esor Tamar dekanosiZes.<br />
qalbatonma Tamarma samecniero-pedagogiuri<br />
moRvaweobis saxelovani gza ganvlo.<br />
pirovnuli da moqalaqeobrivi pozicia,<br />
rogorc WeSmariti mamuliSvilisa,<br />
mudam gamorCeuli da Seuryvneli iyo<br />
qveynis sakeTildReod.<br />
1943 wlidan moyolebuli, 65 wlis man-<br />
Zilze, igi udidesi patriotuli SemarTebiTa<br />
da erTgulebiT emsaxureboda<br />
erovnuli <strong>samedicino</strong> mecnierebis winsvlas,<br />
qarTuli <strong>samedicino</strong> azrovnebis<br />
saerTaSoriso aRiarebas.<br />
axalgazrdobis wlebidan moyolebuli<br />
igi iRvwoda erovnuli cnobierebisa da<br />
sulierebis gansamtkiceblad, wminda<br />
qarTuli Rirebulebebis dasacavad da<br />
dasamkvidreblad.<br />
qalbatoni Tamaris mTeli cxovreba namdvilad<br />
saxalxo moRvawis damaxasiaTebel<br />
Tvisebad SeiZleba miviCnioT. es misgan<br />
udides pasuxismgeblobasa da Tavdadebas<br />
moiTxovda. 9 aprilis erovnuli tragediis<br />
mZime dReebSi, igi Cveuli gambedaobiT<br />
win aRudga sabWoTa imperiis damsjel<br />
Zalas da miuxedavad mis mimarT fizikuri<br />
angariSsworebis saSiSroebisa, mecnierulad<br />
damajerebeli da dasabuTebuli pasuxi<br />
gasca Tavisuflebis moZaladeebs.<br />
qalbaton Tamars did bednierebas hgvrida<br />
demokratiuli qveynis sasikeTo momavalze<br />
fiqri. damoukidebelma saqarTvelom Tavis<br />
pirvel erovnuli parlamentis SemadgenlobaSi<br />
sapatio adgili miuCina mas, rac WeSmariti<br />
aRiareba iyo misi qveynisa da xalxis samsaxurSi<br />
gaweuli didi wvlilis gamo.<br />
ganuzomlad STambeWdavi iyo qalbaton<br />
Tamaris pirovnuli xibli. misi yoveli sityva,<br />
sajaro gamosvla, Tu kerZo saubari,<br />
Rrmad gaazrebuli, maRalpr<strong>of</strong>esiuli,<br />
saxelmwifoebrivi da erovnuli Segnebis<br />
gamomaxatveli iyo.<br />
man Tavisi pirovnuli cxovrebiT magaliTi<br />
mohfina im WeSmaritebas, Tu rogori<br />
unda iyos pirovneba, mecnieri, pedagogi,<br />
sazogado moRvawe da mamuliSvili<br />
`<strong>saqarTvelos</strong> samdicino <strong>Jurnali</strong>sa~ da<br />
gazeT `medicinis~ saredaqcio kolegia<br />
da sabWo, redaqciis TanamSromlebi
4<br />
redaqciisagan<br />
qarTveli sazogadoebrioba, <strong>samedicino</strong> inteligencia mwuxarebiT<br />
gamoeTxova erovnuli medicinis TvalsaCino warmomadgenels,<br />
mkvlevars, pedagogs, sazogado moRvawes, saqarTveloSi paTologanatomiuri<br />
dargis erT-erT fuZemdebelsa da organizators,<br />
qarTvel medikosTa mravali Taobis aRmzrdels, sayvarel maswavlebels,<br />
megobars, damrigebelsa da Tanamdgoms, qalbaton Tamar<br />
dekanosiZes.<br />
mravali wlis manZilze, sicocxlis bolomde, qalbatoni Tamari<br />
gverdSi edga qarTuli perioduli <strong>samedicino</strong> presis SemoqmedebiT<br />
koleqtivs. misi avtorobiTa da moqalaqeobrivi SemarTebiT<br />
mravali mwvave problemuri sakiTxi gaxda sazogadoebriobis<br />
gansjis sagani, rasac farTo mkiTxvelTa mxardaWera xvda. es iyo<br />
erovnuli Tematika Tu qveynis momavali, axalgazrda specialist-<br />
Ta pr<strong>of</strong>esiuli aRzrda Tu maTi Semdgomi saqmianoba, mecnieruli<br />
siaxleni Tu praqtikuli rekomendaciebi da sxva mravali.<br />
qalbaton Tamaris gardacvalebasTan dakavSirebiT gamovxatavT<br />
Rrma mwuxarebas, gulistkivils da qarTuli perioduli <strong>samedicino</strong><br />
presis meSveobiT samZimars vucxadebT yvelas, vinc piradad<br />
icnobda mas da wilad xvda pativi y<strong>of</strong>iliyo misi mowafe, kolega,<br />
Tanamoazre.<br />
didi ivane javaxiSvili brZanebda:<br />
`...gulcivi adamiani ver gaakeTebs verasodes<br />
did saqmes, unda uyvardes yovel maTgans<br />
Tavisi xalxi, unda uyvardes mecniereba,<br />
unda grZnobdes pasuxismgeblobas, rom<br />
Sealios Tavisi Zala mecnierebasac da<br />
xalxsac~. es sityvebi namdvilad miesadageba<br />
Rirsebuli qalbatonis Tamar dekanosiZis<br />
pirovnebas, romelmac didi wvlili<br />
Seitana saqar-TveloSi paTanatomiuri<br />
mecnierebis ganviTarebaSi, Tbilisis saxelmwifo<br />
<strong>samedicino</strong> universitetis aRmavlobisTvis,<br />
qarTveli xalxisa da qarTuli<br />
saxelmwifoebriobis ganmtkicebisaTvis.<br />
qalbatoni Tamari iyo samarTliani,<br />
didsulovani, daxvewili gemovnebis,<br />
gulisxmieri, mimtevebeli, ganaTlebuli,<br />
mzrunveli, erudirebuli, Sromismoyvare,<br />
uerTgulesi, megobrobis etaloni, romelsac<br />
urTules pirobebSic ki arasodes<br />
daukargavs adamianuri Tanadgoma. miuxedavad<br />
imisa, rom sicocxlis bolo period-<br />
Si misi janmrTelobis mdgomareoba<br />
sagrZnoblad Seirya, is mainc didi rudunebiT<br />
eweoda SemoqmedebiT saqmianobas.<br />
amaze metyvelebs Tundac is bolo werili,<br />
romelic man Cveni <strong>Jurnali</strong>s mTavar redaqtors,<br />
baton jangir mamalaZes da redaqciis<br />
TanamSromlebs gamougzavna, sadac isev<br />
qarTuli enis siwmindisaTvis masalis momzadebasa<br />
da paeqrobas apirebda. misTvis<br />
yovlad miuRebeli iyo, roca qarTuli<br />
enisaTvis gaumarTlebel formebs iyenebda<br />
zogierTi mkvlevari. dauRalavad iRvwoda<br />
qarTuli enis axali normebis ZiebisaTvis.<br />
qalbaton Tamars swamda, rom WeSmariti<br />
sityvakazmuloba moiTxovs enobrivi<br />
naklis daZlevas. misi azriT, roca<br />
raime mxatvrul Rirebulebas qmni, amisaTvis<br />
saWiroa daxvewili, xasxasa qarTuli<br />
eniT wera, romelic aZlierebs, avi-<br />
Tarebs da ufro moqnils xdis enobriv<br />
formebs, mkvidr safuZvels uqmnis enis<br />
Semdgom ganviTarebas. mwiri leqsika,<br />
gaumarTavi winadadebebi, orTografiulsintaqsuri<br />
wuni ukan xevs enasa da safuZvels<br />
uryevs mas.<br />
bolo Cvenamde moweril werilSi is sinanuliT<br />
wers: `darwmunebuli var, Cemi<br />
sikvdilis Semdeg `ir~ nawilaks aravin<br />
mixedavs da darCeba is saqarTveloSi. isedac<br />
qarTuli arc poezia da rc proza Zvirad<br />
aRaravis uRirs. `ir~-nawilakiani sityvebis,<br />
vaJasa da akakis da sxva CvenTvis<br />
ZvirfasTa leqsebis JReradobas erTmane-<br />
Tisagan vinRa gaarCevs!~ 25.07.08.<br />
vai, rom bolo survilis Sesruleba ve-<br />
Rar SeZlo.
5<br />
Cveni sulieri CiraRdani<br />
Tbilisis saxelmwifo <strong>samedicino</strong> universitetis gamsvleli<br />
samecniero-praqtikuli konferencia quTaisSi (marjvnidan marcxniv -<br />
Tamar dekanosiZe, vaxtang yifiani, aleqsandre cibaZe, vadim saakaZe).<br />
elvisebri siswrafiT ileva Tbilisis<br />
saxelmwifo <strong>samedicino</strong> institutis sadReisod<br />
jer kidev SemorCenili rva<br />
aTwleulis zRurbls miaxlovebuli<br />
aRzrdilTa ricxvi - ubednieresi Taoba,<br />
romelTa jgufs mec mivekuTvnebi da<br />
romelTa pr<strong>of</strong>esiul CamoyalibebadaostatebaSi<br />
qarTvel medikosTa brwyinvale<br />
Tanavaskvlavedis iSviaTma niWma da<br />
Tavdadebulma mecadineobam gadamwyveti<br />
roli Seasrula.<br />
am SesaniSnav aRmzrdel-pedagogTa<br />
Soris, romlebmac iSviaTi taqtiTa da<br />
dauralavi ZerwviT dagvakvalianes, did<br />
medicinaSi gza dagviloces da sulieradac<br />
gagvanaTles, dRevandelobas, samwuxarod,<br />
mxolod erTeulebma moaRwies.<br />
da, aha, ukanasknel mohikanTaganmac - Cvenma<br />
usayvarlesma maswavlebelma da sulierma<br />
CiraRdanma - qalbatonma Tamar dekanosiZemac<br />
axlaxan migvatova.<br />
eWvic ar mepareba, rom aranairi amaRlebuli<br />
epistoluri niWi da daxvewili<br />
ritorika ver amowuravs am iSviaTad gamor-<br />
Ceuli pirovnebis siRrmiseul sulierebis<br />
asaxvas, uZluria saxovanad ferweros misi<br />
buneba, ar ZaluZs Tundac uamravi nairferovani<br />
epiTetebiT Seavsos misi ganumeorebeli<br />
sidiade.<br />
uamravi Tayvanismcemeli, yvela, vinc<br />
mis iSviaT xibls eziara, ueWvelad unison-<br />
Si amyveba da aRiarebs, rom qalbatoni Tamaris<br />
saxiT am qveynierebas moevlina<br />
sruliad unikaluri pirovneba, romelmac<br />
Tanabarwilad da saocari harmoniulobiT<br />
SeiTavsa uamravi, erTi SexedviT<br />
TiTqosda SeuTavsebeli umniSvnelovanesi<br />
niSanTviseba: boboqari erisSviloba,<br />
rafinirebuli inteligenturoba, umaRlesi<br />
pr<strong>of</strong>esionalizmi, ganuleveli energia,<br />
mCqefare Sromismoyvareoba, daxvewili<br />
metyveleba, SesaSuri ritorikis<br />
unari, sxarti klinikuri azrovneba, saocari<br />
SarmiT Semkobili pedagogiuri xelovneba,<br />
iSviaTi Tavmdabloba da keTil-<br />
Sobileba, usazRvro keTilmosurneoba,<br />
rkinisebri udreki mecnieruli principuloba,<br />
uSiSari patriotizmi, sulieri
6<br />
simtkice da sicocxliT savseoba - swored<br />
am maxasiaTeblebis egzom harmoniuli<br />
urTierTkavSiriT ganisazRvra qalbatoni<br />
Tamaris fenomeni. qalbatonisa, romelic,<br />
miuxedavad Tavisi vaJkacuri SemarTebisa,<br />
ufaqizesi rudunebiT efereboda Ti-<br />
Toeul erovnul ganZeuls da qarTuli<br />
lingvistikis keTil feriad mogvevlina.<br />
auditoriasTan urTierTobisas pirvelsave<br />
wamebidan mTlianad ipyrobda msmenels:<br />
vusmendiT mTeli monologis ganmavlobaSi<br />
zrdadi yuradRebiTa da aRtacebiT<br />
- misi adamianuri xibli auwereli<br />
auriT iyo gajerebuli da sulier aRtacebulobas<br />
gvgvrida.<br />
qalbatoni Tamaris ganumeorebeli inteleqtis<br />
speqtri samamulo kulturis,<br />
istoriis, xelovnebis, sportis, literaturisa<br />
da sxva iSviaTi nairferovani es-<br />
Tetikuri Rirebulebebis siRrmiseuli<br />
aRqmiT iyo gaCiraRdnebuli, Tumca,<br />
amavdroulad, ms<strong>of</strong>lio kulturisa da<br />
mTeli civilizebuli samyaris miRwevebis<br />
uzustesi damokidebulebebiTa da SefasebiTac<br />
gamoirCeoda.<br />
qalbatoni Tamaris gansakuTrebuli mimzidveloba<br />
ki apogeas maSin aRwevda, rodesac,<br />
TiTqosda moulodnelad, is sakuTar iSviaT<br />
adamianur gulubryvilobasa da alalmarTlobas<br />
avlenda, riTac misdami usazRvro<br />
siyvarulisa da pativiscemis grZnobiT<br />
gvavsebda, gvabednierebda da sicocxlisamdi<br />
simxne-sixalisiT gvajildovebda.<br />
qalbatonma Tamar dekanosiZem gaielva<br />
misTvis usazRvrod sayvareli saqar-<br />
Tvelos ciskideze uZvelesi erovnuli<br />
gen<strong>of</strong>ondis gamorCeuli nimuSis saxiT da<br />
dauviwyari niSansveti samaradisod<br />
daamkvidra Cvens kulturaSi. dagvitova<br />
udidesi siyvarulis da siamayis grZnoba<br />
miseuli sayvareli refrenis saxiT - `gaxsovdeT,<br />
visi gorisani brZandebiT!..~<br />
rarig simboluria, rom qalbatoni Tamaris<br />
es epoqaluri niSansveti damkvidrda<br />
da uleveli ZaliT samaradisod akaSkaSda<br />
Rirseul adgilas - <strong>saqarTvelos</strong> sazogado<br />
moRvaweTa didubis panTeonis Suagul-<br />
Si, saamayo erisSvilTa SaravandedSi. aq<br />
misma usayvarlesma qarTulma miwam Cveni<br />
sulieri CiraRdani ki ar Seanela, aramed<br />
camde aRmarTuli samaradiso Zeglad<br />
mogvevlina.<br />
mis auracxel mowafeebs, aRzrdilebs,<br />
kolegebsa da eris danarCen warmomadgenels,<br />
romelnic misi Tanamedroveni da<br />
Tanamoazreni brZandebodnen, samaradisod<br />
dagvrCa madlieri xsovna gulisa qalbaton<br />
Tamar dekanosiZis ganumeorebeli<br />
fenomenis saxiT.<br />
diax! viyaviT ra misi Tanamedroveni - es<br />
WeSmaritad ganuzomeli bednierebac iyo<br />
da RvTismieri jildoc...<br />
vadim saakaZe
7<br />
versiteti, Tamari da saministro, Tamari<br />
da akademia, sxvadasxva sazogadoebebi,<br />
praqtikuli dawesebulebebi da sxva. yvelafers<br />
swvdeboda misi xeli, isaxeboda<br />
axali mimarTulebebi da wamowyebebi, iqmneboda<br />
komisiebi da sabWoebi, krebavda da<br />
aerTianebda yvelaze unarian da Semoqmed<br />
adamianebs. ar maxsovs <strong>samedicino</strong> universitetis<br />
arc erTi reqtori, saministros<br />
arc erTi ministri, akademiis arc erTi<br />
prezidenti, saavadmy<strong>of</strong>oebis mTavari<br />
eqimi, Tu gany<strong>of</strong>ilebis gamge, rom maT<br />
gverdSi ar daeyenebinaT da ar esargeblaT<br />
qalbaton Tamaris maRali avtoritetiT,<br />
erudiciiTa da inteleqtualuri<br />
potencialiT.<br />
swored, Tamariseuli cxovrebis wesi<br />
da aura, misi namoqmedaris da namoRvawaris<br />
gansakuTrebuloba, uSreti energia<br />
da mudmivi swrafva sruly<strong>of</strong>isa da<br />
siaxleebisadmi qmnida im fenomens,<br />
romelic super-egod da zepirovnebad<br />
iwodeba. saukneSi erTeulebi Tu ibadebian<br />
aseTebad. xanSi Sesulobis Jamis drosac<br />
ar daklebia mas es SemoqmedebiTi muxti<br />
da paTosi.<br />
sikvdilamde ori dRiT adre igi pr<strong>of</strong>esor<br />
dimitri korZaias, akademikos Temur<br />
leJavas da am striqonebis avtors aRfr-<br />
TovanebiT gvelaparakeboda im axali mecnieruli<br />
ideis xorcSesxmaze, romelic<br />
exeboda oTxi sxvadasxva saxis kunTovani<br />
substratis - miokardis, gulis gamtari<br />
sistemis, ganivizoliani da gluvi kunTovani<br />
boWkoebis anatomiur-funqciuri gansaxvavebulobis<br />
genetikur da molekulur<br />
axsnis aspeqtebs. am mimarTebiT igi<br />
misTvis Cveuli gulmodginebiT saxavda<br />
gegmebs amerikel da qarTvel axalgazrda<br />
mkvlevarTa erToblivi gundis Camoyalibebaze,<br />
mgznebared saubrobda gamosacemetri,<br />
super-ego<br />
verc erTi zedsarTavi saxeli ise ver<br />
warmoaCens qalbatoni Tamaris, rogorc<br />
mecnierisa da pedagogis, mamuliSvilisa da<br />
sazogado moRvawis saxesa da udidebulesobas,<br />
rogoradac epiTeti - metri, anu gansakuTrebuli<br />
SaravandediT mosili, adamianis<br />
zeaRmatebulobis gamoxatulebis cneba.<br />
marTlac qalbatoni Tamari iseT simaRleze<br />
idga, romlis miRweva saocnebo da<br />
sanukvaria TviT yvelaze maRali rangis<br />
mecnieris, pedagogisa da sazogado moRvawisaTvis.<br />
qalbaton TamarisaTvis dro da sivrce<br />
uwyvet ganzomilebas da usazRvro<br />
masStabs warmoadgenda. igi dilidan gvian<br />
Ramemde muSaobda, mudmivad cdidan<br />
cdamde, eqsperimentidan eqsperimentamde<br />
cxovrobda. leqciebi, mikroskopi,<br />
laboratoria, preparatebis garCeva namdvili<br />
stiqia iyo misTvis. gasaocari iyo<br />
misi mignebebi, analitikuri azrovnebisa<br />
da mecnieruli Sefasebebis siRrme. mis<br />
garemocvaSi y<strong>of</strong>nisas erTnairad maRldebodi,<br />
zemaRal sxva samyaroSi gadadiodi.<br />
axlac Tvawlin midgas rogor aRtacebas<br />
imsaxurebda misi leqciebi da gamosvlebi,<br />
klinikur-paTologanatomiuri<br />
garCevebi da seminarebi, rogor iyo igi<br />
aRtacebuli, rodesac raime sakvanZo sakiTxebs<br />
axsnida da problemis gadaWris<br />
gzebs monaxavda. masTan ar unda wamogvcdenoda<br />
raime wuxili sakuTari<br />
gasaWiris Sesaxeb - aRar mogeSveboda, zed<br />
gadagyveboda, ar mogasvenebda da arc<br />
TviTon moisvenebda, vidre gamarjvebuls<br />
ar gixilavda.<br />
ukidegano iyo Tamaris moRvaweobis asparezi<br />
da sarbieli. ar rCeboda sfero, mas<br />
rom uSualod monawileoba ar mieRo, an<br />
Tanamonawile ar y<strong>of</strong>iliyo. romeli erTi<br />
CamoiTvalos: Tamari da <strong>samedicino</strong> uni-
8<br />
mad gamzadebul or axal wignze, romel-<br />
Sic mTeli misi pr<strong>of</strong>esiuli, pirovnuli<br />
da moqalaqeobrivi fesvebi da filos<strong>of</strong>iuri<br />
kredo iyo gadmocemuli.<br />
qalbatoni Tamaris SemoqmedebiTi Zalis<br />
meoxebiT <strong>samedicino</strong> dargi da pr<strong>of</strong>esia,<br />
uxvad iyo gamdidrebuli qarTuli<br />
pr<strong>of</strong>esionaluri Rirsebis warmoCenis im<br />
maRali suliskveTebiT, razedac Taobebi<br />
unda aRizardon.<br />
qalbatoni Tamaris saxeli, rogorc<br />
epoqaluri pirovnebisa, im gamorCeul<br />
adgils daikavebs <strong>saqarTvelos</strong> medicinis<br />
istoriaSi, rogoric sulmnaT da zeamaRlebul<br />
medikosebs Seefereba.<br />
saTanadod daufasda qalbaton Tamars<br />
Tavisi namoRvawari. saxelmwifosagan mas<br />
maRali pativi miego: igi ganisvenebs<br />
gamoCenil qarTvel moRvaweTa didubis<br />
panTeonSi, arCeul iyo wevr-korespondentad<br />
<strong>saqarTvelos</strong> mecnierebaTa akademiaSi<br />
da dajildoebuli mravali ordeniT,<br />
medliTa da sigeliT. amJamad Seqmnilia<br />
komisia, romelic gamoscems<br />
monografias misi cxovrebisa da Semoqmedebis<br />
Sesaxeb. aranakleb aRsaniSnavia<br />
isic, rom misma aRzrdilma mowafeebma da<br />
kolegebma ZalRone ar daiSures, raTa<br />
ramdenjerme sikvdils gamoetacaT da sicocxle<br />
SeenarCunebinaT misTvis.<br />
vsargeblob SemTxveviT da minda uRrmesi<br />
madloba gadavuxado akademikosebs:<br />
nodar yifSiZes, nikoloz yifSiZes, dimitri<br />
korZaias, guliko CafiZes, soso kapanaZes,<br />
nineli ninuas, ilia TavzaraSvils, reanimatolog<br />
guliko qilifTars da sxvebs,<br />
aseTebi bevri iyvnen - eqimebi da eqTnebi,<br />
qalbatoni Tamaris mimarT avadmy<strong>of</strong>obis<br />
dros gaweuli guliTadi, uangaro da umwikvlo<br />
zrunvisa da daxmarebisaTvis.<br />
didad meamayeba, rom Cemi da uamravi<br />
Cvenganis aRmzrdeli da mrCeveli, didebuli<br />
mecnieri da pirovneba qalbatoni<br />
Tamari iyo.<br />
naTelSi amy<strong>of</strong>os ufalma misi suli!<br />
nodar baqraZe
9<br />
amocanaTa Soris upirvelesia adamianisaTvis<br />
usafrTxo garemos uzrunvely<strong>of</strong>a<br />
da cxovrebis jansaRi wesis damkvidreba,<br />
rac misi normaluri y<strong>of</strong>a-cxovrebisa da<br />
saqmianobis mtkice garantiaa; es ukanaskneli<br />
ki misi janmrTelobis Senar-<br />
Cunebis winapirobaa. am globaluri amocanis<br />
realizaciisaTvis aris mowodebuli<br />
pr<strong>of</strong>ilaqtikuri medicina, romlis prioritetuloba<br />
aRiarebulia mravali saer-<br />
TaSoriso SeTanxmebiTa da konvenciiT.<br />
jandacvis ms<strong>of</strong>lio organizaciis programis<br />
- `janmrTeloba yvelasaTvis 21-e<br />
saukuneSi~ - Tanaxmad, gajansaReba, daavadebaTa<br />
pr<strong>of</strong>ilaqtika, mkurnaloba, reabilitacia<br />
da invalidebis movla mudmivad<br />
ganviTarebadi strategiis ZiriTadi elementebia.<br />
am strategiis mixedviT, janmrTelobis<br />
gaumjobesebis mizania Ti-<br />
Toeul adamians mieces garantia, rom daculi<br />
iqneba misi janmrTelobis, jansaR<br />
garemoSi cxovrebis, avadmy<strong>of</strong>obisa da<br />
travmebisagan efeqtiani dacvis uflebebi.<br />
aRniSnuli programa, pr<strong>of</strong>ilaqtikuri<br />
medicinis mimarTulebiT, iTvaliswinebs<br />
pirveli rigis amocanebs, romelTa realizacia<br />
xels Seuwyobs adamianisaTvis usafrTxo<br />
garemos uzrunvely<strong>of</strong>as. strategiuli<br />
programis 38 amocanidan umetesi<br />
nawili swored garemosa da janmrTelobis<br />
dacvis sakiTxebis gadawyvetas eTmoba.<br />
sayovelTaodaa aRiarebuli, rom mosaxleobis<br />
janmrTelobis dacvis mdgomareoba<br />
realurad mniSvnelovnad aris<br />
damokidebuli garemos pirobebze.<br />
adamianis janmrTelobisaTvis usapr<strong>of</strong>ilaqtikuri<br />
medicina<br />
pr<strong>of</strong>ilaqtikuri medicinis warsuli, awmyo da<br />
momavali<br />
k. gelaSvili, r. kverenCxilaZe, n. vefxvaZe, i. mWedliSvili,<br />
i. faRava, r. javaxaZe, l. ziraqiSvili<br />
<strong>saqarTvelos</strong> pr<strong>of</strong>ilaqtikuri medicinis mecnierebaTa<br />
akademia; Tbilisis saxelmwifo <strong>samedicino</strong> universiteti;<br />
g. naTaZis saxelobis sanitariisa da higienis samecnierokvleviTi<br />
instituti;<br />
n. maxvilaZis saxelobis Sromis medicinisa da ekologiis<br />
samecniero-kvleviTi instituti;<br />
s. virsalaZis saxelobis <strong>samedicino</strong> parazitologiisa da<br />
tropikuli medicinis samecniero-kvleviTi instituti<br />
adamianis janmrTelobaze udides<br />
zemoqmedebas axdens cxovrebis wesi da<br />
pirobebi (48-50%), garemo (20-22%) da genetikuri<br />
faqtorebi (18-20%), maSin roca<br />
janmrTelobis dacvis wili mxolod 7-<br />
12% Seadgens [3]. aqedan gamomdinare, mosaxleobis<br />
janmrTelobis gaumjobesebis<br />
sferoSi erT-erTi mniSvnelovani roli<br />
janmrTelobis xelSemwyob RonisZiebebs<br />
eniWeba, rac gulisxmobs cxovrebis jansaRi<br />
wesis damkvidrebasa da janmrTelobisaTvis<br />
xelsayreli garemos Seqmnas. es<br />
moicavs usafrTxo kvebis produqtebiTa<br />
da sasmeli wyliT uzrunvely<strong>of</strong>as,<br />
gaazrebuli demografiuli politikis<br />
gatarebas, cxovrebis jansaRi wesis<br />
damkvidrebas, pirveladi <strong>samedicino</strong><br />
codnisa da Cvevebis misaRebad mosaxleobis<br />
aRzrdasa da wrTvnas; socialuri<br />
stresebis moxsnas [4].<br />
es sakiTxi metad aqtualuria <strong>saqarTvelos</strong>aTvis,<br />
vinaidan mravali mwvave Tu<br />
qronikuli daavadebis prevencia SesaZlebelia<br />
cxovrebis jansaRi wesis propagandisa<br />
da mosaxleobaSi farTod danergvis<br />
gziT, rac mTlianobaSi Seamcirebs `avadobis<br />
tvirTs~. aRniSnuli mizezis misaRwevad<br />
aucilebelia sazogadoebis sxvadasxva<br />
fenis farTo Zalisxmeva, rac<br />
gulisxmobs janmrTelobis xelSemwyob<br />
RonisZiebebSi janmrTelobis dacvis seqtoris<br />
garda sxva seqtorebis aqtiur<br />
monawileobasac.<br />
aqedan gamomdinare, <strong>samedicino</strong> mecnierebisa<br />
da praqtikis prioritetul
10<br />
frTxo garemos uzrunvely<strong>of</strong>a <strong>saqarTvelos</strong><br />
janmrTelobis dacvis erovnuli<br />
politikis erT-erT prioritetad aris aRiarebuli,<br />
rac ganpirobebulia imiT, rom<br />
garemos dabinZurebis Tavidan acileba da<br />
mosaxleobis janmrTelobasa da cxovrebis<br />
pirobebze misi uary<strong>of</strong>iTi zegavlenis<br />
Semcirebis problema dRes gansakuTrebiT<br />
mwvaved dgas Cvens qveyanaSi [2].<br />
ekonomikuri krizisis pirobebSi ukana<br />
planze moeqca da moiSala sxvadasxva donis<br />
sanitariul-higienuri da garemos<br />
dacviTi RonisZiebaTa sistema, ramac ganapiroba<br />
qveynis mosaxleobis janmrTelobisaTvis<br />
usafrTxo garemos Seqmnis<br />
problemis gamwvaveba. es pirvel rigSi Seexeba<br />
mosaxleobis uzrunvely<strong>of</strong>as<br />
xarisxiani sasmeli wyliTa da kvebis<br />
produqtebiT. amasTan, mosaxleobis mZime<br />
materialurma mdgomareobam ganapiroba<br />
SimSilTan, dabalkaloriul kvebasTan,<br />
sakvebis sxvadasxva komponentis deficitTan<br />
dakavSirebuli problemebis gamwvaveba.<br />
seriozuli mniSvneloba SeiZina<br />
bunebrivi da teqnogenuri katastr<strong>of</strong>ebis,<br />
iseve rogorc saomari konfliqtebis<br />
Sedegebis likvidaciam.<br />
adamianis janmrTelobisaTvis usafrTxo<br />
garemos Seqmna miznad isaxavs adamianis<br />
janmrTelobaze garemos mavne<br />
faqtorebis zegavlenis Semcirebas da<br />
xels uwyobs mosaxleobis gajansaRebas,<br />
riTic uzrunvely<strong>of</strong>s <strong>saqarTvelos</strong> moqalaqeTa<br />
konstituciuri uflebis – janmrTelobisaTvis<br />
uvnebel garemoSi cxovrebis<br />
– dacvas. aRniSnuli miznis misaRwevad,<br />
aucilebelia Semdegi amocanebis<br />
gadawyveta: janmrTelobisaTvis mavne<br />
fizikuri, biologiuri, qimiuri da radioaqtiuri<br />
damabinZureblebis mniSvnelovani<br />
Semcireba – haerSi, wyalSi, niadag-<br />
Si, kvebis produqtebSi, say<strong>of</strong>acxovrebo<br />
da sawarmoo garemoSi da garemoSi arsebuli<br />
dadebiTi faqtorebis adamianis organizmze<br />
keTilsaimedo moqmedebis xelSewyoba.<br />
janmo-s gansazRvrebiT, janmrTelobis<br />
xelSemwyobi garemo – es aris pirobebi,<br />
romelTa Seqmnasac cdiloben qveynebi an<br />
sazogadoebebi janmrTelobis miznis misaRwevad.<br />
mTeli mosaxleobisaTvis janmrTelobis<br />
xelSemwyobi garemos koncefciaSi<br />
mocemulia janmrTelobis determinantebi<br />
da moicavs Semdegs:<br />
adgilobrivi garemo faqtorebis<br />
roli sazogadoebis jansaR ganviTarebaSi;<br />
meTodi, romelic xels uwyobs janmrTelobas<br />
da icavs garemos mavne faqtorebisagan;<br />
janmrTelobis kapitalis Seqmna sazogadoebis<br />
SigniT;<br />
stabiluri ganviTarebis mniSvneloba<br />
janmrTelobis SenarCunebaSi (xelSewyobaSi);<br />
adamianebis mier garemos cnebis far-<br />
To gageba;<br />
adamianebis mier garemos SegrZneba<br />
da jansaRi garemos aRdgenis an Seqmnis<br />
personaluri interesi [4].<br />
ZiriTadi yuradReba eqceva imas, Tu ramdenad<br />
aumjobesebs janmrTelobas kargi<br />
garemo da ara imas, Tu rogor zegavlenas<br />
axdens arasasurveli garemo. es moicavs<br />
iseT sakiTxebs, rogoricaa racionaluri<br />
mSenebloba, cxovrebis jansaRi wesis xelSewyoba,<br />
samrewvelo dabinZurebis aRkve-<br />
Ta an Semcireba, transportis moZraobisas<br />
warmoqmnili saSiSroebebis Semcireba, mwevelobis<br />
Semcireba da kvebis Cvevebis cvlileba.<br />
naklebad ganviTarebul sazogadoebebSi<br />
erT-erTi yvelaze mniSvnelovani<br />
sakiTxi SeiZleba iyos higienuri pirobebi<br />
da wyliT uzrunvely<strong>of</strong>a, dedaTa da bavSv-<br />
Ta janmrTelobis dacvis gaumjobeseba da<br />
gadamdebi daavadebebis kontroli.<br />
sazogadoebis uflebamosilebis koncefcia<br />
– ganaxorcielos kontroli sakuTari<br />
janmrTelobis determinantebze<br />
(ganmsazRvrel faqtorebze), marTlac<br />
warmoadgens janmrTelobis xelSewyobis<br />
kvanZovan sakiTxs. jandacvis ms<strong>of</strong>lio<br />
organizacia, otavis qartiaze dayrdnobiT,<br />
janmrTelobis xelSewyobas gansazRvravs,<br />
rogorc `process, romelic<br />
saSualebas aZlevs adamianebs gaaZlieron<br />
kontroli da gaiumjobeson janmrTeloba~.<br />
rogorc zemoT iyo aRniSnuli, saqar-<br />
Tvelos jandacvis erovnuli politikis<br />
erT-erT prioritetul mimarTulebas<br />
cxovrebis jansaRi wesis damkvidreba warmoadgens,<br />
romelic gansazRvravs am kuTxiT<br />
gamiznuli politikis prioritetul<br />
mimarTulebebs da adgens maTi realizaciis<br />
ZiriTad gzebs qveyanaSi arsebuli<br />
socialuri moTxovnilebebisa da<br />
ekonomikuri mdgomareobis gaTvaliswinebiT.<br />
is miznad isaxavs cxovrebis wesis<br />
cvlilebas, ris Sedegadac Semcirdeba<br />
janmrTelobisaTvis mavne produqtebis<br />
gamoyeneba (Tambaqo, alkoholi, narkotikuli<br />
nivTierebebi da a.S.) da janmrTelobis<br />
saerTo gaumjobesebis mizniT ga-<br />
Zlierdeba mosaxleobis fizikuri aRzr-
11<br />
da. cxovrebis jansaRi wesis damkvidreba<br />
iTvaliswinebs rogorc mZlavr propagandul<br />
zemoqmedebas mosaxleobaze, aseve<br />
saTanado samkurnalo-sareabilitacio da<br />
gamajansaRebeli qselis Seqmnas.<br />
mosaxleobis janmrTelobis dacvis<br />
pr<strong>of</strong>ilaqtikuri mimarTulebis prioritetuloba<br />
xazgasmiTaa aRniSnuli<br />
<strong>saqarTvelos</strong> mraval fundamentur dokumentSi.<br />
am mimarTulebiT, qveynis saxelmwifoebrivi<br />
damoukideblobis aRdgenis<br />
Semdeg, mniSvnelovani sakanonmdeblo<br />
muSaobaa Catarebuli. kerZod, SemuSavebuli<br />
da damtkicebulia mniSvnelovani sakanonmdeblo<br />
dokumenti:<br />
<strong>saqarTvelos</strong> kanoni `janmrTelobis<br />
dacvis Sesaxeb~;<br />
<strong>saqarTvelos</strong> kanoni `<strong>saqarTvelos</strong><br />
sanitariuli kodeqsi~ (amJamad misi moqmedeba<br />
SeCerebulia);<br />
<strong>saqarTvelos</strong> kanoni `sazogadoebrivi<br />
janmrTelobis Sesaxeb~;<br />
<strong>saqarTvelos</strong> kanoni `sursaTis<br />
uvneblobisa da xarisxis Sesaxeb~;<br />
socialur-higienuri monitoringis<br />
debuleba.<br />
aRniSnul dokumentebSi prioritetuladaa<br />
aRiarebuli adamianis janmrTelobisaTvis<br />
usafrTxo garemos uzrunvely<strong>of</strong>is<br />
sakanonmdeblo safuZvlebi.<br />
janmrTelobis dacvis sistemis sakanonmdeblo<br />
bazis safuZvelze SemuSavebulia<br />
saprogramo dokumentebi:<br />
`<strong>saqarTvelos</strong> janmrTelobis dacvis<br />
erovnuli politika~;<br />
`<strong>saqarTvelos</strong> janmrTelobis dacvis<br />
ganviTarebis strategiuli gegma~;<br />
`<strong>saqarTvelos</strong> garemos higienis samoqmedo<br />
erovnuli gegma - `garemo da janmrTeloba~.<br />
maTSi mniSvnelovani adgili eTmoba<br />
pr<strong>of</strong>ilaqtikuri medicinis sakiTxebs, adamianis<br />
janmrTelobisaTvis usafrTxo garemos<br />
uzrunvely<strong>of</strong>is RonisZiebebis damuSavebis<br />
prioritetulobis aRniSvniT [1, 2].<br />
qveynis saxelmwifoebrivi damoukideblobis<br />
aRdgenidan ganvlil TiTqmis 2<br />
aTwleulSi pr<strong>of</strong>iluri samecniero-kvleviTi<br />
da saswavlo dawesebulebebis mier<br />
sakanonmdeblo bazis safuZvelze Catarebulia<br />
mniSvnelovani samuSao pr<strong>of</strong>ilaqtikuri<br />
medicinis mimarTulebiT qveynis<br />
normatiul-meToduri bazis Sesaqmnelad:<br />
SemuSavebulia da damtkicebulia sanitariul-higienuri<br />
da epidemiologiuri normatiuli<br />
aqtebi adamianis janmrTelobisaTvis<br />
usafrTxo garemos uzrunvely<strong>of</strong>is<br />
sferoSi (sanitariuli wesebi da<br />
normebi, higienuri normativebi, meToduri<br />
miTiTebebi da sxv.).<br />
dReisaTvis qveynis pr<strong>of</strong>ilaqtikuri<br />
medicinis sferoSi, dadebiT momentebTan<br />
erTad, aRiniSneba mTeli rigi problemebis<br />
arseboba, rac mniSvnelovani Semaferxebeli<br />
garemoebaa adamianis janmrTelobisaTvis<br />
usafrTxo garemos uzrunvely<strong>of</strong>is<br />
saxelmwifoebrivi mniSvnelobis<br />
problemis realizaciis saqmeSi.<br />
ukanasknel aTwleulSi qveyanaSi Catarda<br />
adamianis janmrTelobisaTvis usafrTxo<br />
garemos uzrunvely<strong>of</strong>is sferoSi<br />
momuSave jandacvis praqtikuli qselis -<br />
sanitariul-epidemiologiuri samsaxuris<br />
instituciuri da funqciuri reforma.<br />
<strong>saqarTvelos</strong> janmrTelobis dacvis<br />
sistemis reorganizaciis periodSi, y<strong>of</strong>ili<br />
sabWoTa sanepidsamsaxuris funqciebi<br />
gadanawilda sazogadoebrivi jandacvisa<br />
da sanitariuli zedamxedvelobisa<br />
da higienuri normirebis departamentebze.<br />
Semdeg moxda sanitariuli zedamxedvelobisa<br />
da higienuri normirebis<br />
departamentis likvidacia da misi funqciebi<br />
gadanawilda sxvadasxva saministroze,<br />
xolo raionuli da saqalaqo<br />
struqturebi gadaeca adgilobrivi TviTmmarTvelobis<br />
organoebs.<br />
2005 wlis 27 dekembris <strong>saqarTvelos</strong><br />
kanonis `sursaTis uvneblobisa da xarisxis<br />
Sesaxeb~ Tanaxmad, s<strong>of</strong>lis meurneobis<br />
saministroSi Seiqmna sursaTis uvneblobis,<br />
veterinariisa da mcenareTa dacvis<br />
erovnuli samsaxuri, romelic uflebamosilia<br />
evropuli standartebis doneze<br />
ganaxorcielos sursaTis sferoSi<br />
zedamxedveloba, monitoringi da saxelmwifo<br />
kontroli sakvebis warmoebisa da<br />
miwodebis yvela rgolze - `fermeridan<br />
Canglamde~.<br />
aRniSnuli reformis realizaciidan<br />
ganvlilma drom da praqtikulma gamocdilebam<br />
gviCvena, rom am mimarTulebiT<br />
qveyanaSi jer kidev bevria gadasaWreli<br />
problema. kerZod, <strong>saqarTvelos</strong> kanonSi<br />
`sazogadoebrivi janmrTelobis Sesaxeb~<br />
(#50.69), romelic moqmedebs 2007 wlis 27<br />
ivnisidan, mocemuli RonisZiebebi ar<br />
sruldeba. magaliTad, 26-e muxli –<br />
produqciis usafrTxoebis Sesaxeb. saqar-<br />
Tvelos parlamentis gadawyvetilebiT,<br />
2010 wlamde SeCerebulia <strong>saqarTvelos</strong><br />
s<strong>of</strong>lis meurneobis saministros struqturaSi<br />
arsebuli sursaTis uvneblobis<br />
samsaxuris funqcionireba saxelmwifo<br />
sanitariuli zedamxedvelobis sferoSi,
12<br />
e.i. kompetentur samsaxurebs akrZaluli<br />
aqvT 2010 wlamde inspeqtireba. amJamad<br />
samsaxuri awarmoebs mxolod monitorings<br />
- Sesabamis obieqtebTan SeTanxmebiT<br />
da mosamzadebel samuSaoebs sanitariuli<br />
zedamxedvelobis ganxorcielebisaTvis.<br />
es garemoeba mniSvnelovani xelSemSleli<br />
faqtoria mosaxleobis xarisxiani da janmrTelobisaTvis<br />
uvnebeli kvebis produqtebiT<br />
uzrunvely<strong>of</strong>is ganxorcielebisaTvis.<br />
analogiuri mdgomareobaa garemos<br />
sxva faqtorebisa da adamianis cxovrebisa<br />
da saqmianobis sxva sferoebSic (garemos<br />
faqtorebi - wyali, atmosferuli<br />
haeri, niadagi da sxv., dasaqmebuli mosaxleobis<br />
Sromis pirobebi da janmrTeloba,<br />
mozardi Taobis janmrTeloba da sxv.).<br />
rac Seexeba 27-e muxls – jansaRi kvebis<br />
politikas aRniSnuli sakiTxis mosagvareblad,<br />
jandacvis saministros ar gaaCnia<br />
Sesabamisi RonisZiebebis gegma.<br />
36-e muxlis Sesabamisad, jandacvis<br />
saministro da <strong>saqarTvelos</strong> ganaTlebisa<br />
da mecnierebis saministro saganmanaTleblo,<br />
saaRmzrdelo da saganmanaTleblosaaRmzrdelo<br />
dawesebulebebisaTvis er-<br />
Toblivad unda adgendnen sanitariul da<br />
higienur normebs. vinaidan umravles<br />
raionsa da qalaqSi faqtobrivad ar arsebobs<br />
adgilobrivi sazogadoebrivi jandacvisa<br />
da sanitariuli zedamxedvelobis<br />
dawesebulebebi, romelTac, 36-e muxlis<br />
Tanaxmad, evalebaT municipalitetis<br />
teritoriaze ganTavsebuli sazogadoebrivi<br />
mniSvnelobis dawesebulebebSi sanitariuli<br />
normebis dacvis zedamxedveloba.<br />
es punqti faqtobrivad ar sruldeba.<br />
aseve ar sruldeba kanonis `sazogadoebrivi<br />
janmrTelobis Sesaxeb~ muxli<br />
45-is me-2 punqti, romlis Sesabamisad<br />
<strong>saqarTvelos</strong> mTavrobas 2008 wlis 1 ianvramde<br />
unda moemzadebina da <strong>saqarTvelos</strong><br />
parlamentisaTvis waredgina kanonproeqti<br />
wylis saauzo marTvis Sesaxeb.<br />
garkveuli xarvezebi aqvs sanitariuli<br />
zedamxedvelobisa da epidemiologiuri<br />
kontrolis samsaxurebis erTmaneTisagan<br />
izolirebulad funqcionirebasac. ufro<br />
metic, reformis Semdgom etapze moxda<br />
erTiani saxelmwifo sanitariuli zedamxedvelobis<br />
samsaxuris decentralizacia<br />
sauwyebo principiT. marTalia, am mimarTulebiT<br />
gadaidga zogierTi nabiji<br />
(moxda sanitariuli zedamxedvelobis<br />
sauwyebo samsaxurebis formireba s<strong>of</strong>lis<br />
meurneobisa da garemos dacvisa da bunebrivi<br />
resuresebis saministroebSi), magram<br />
reforma bolomde jer kidev ar ganxorcielebula<br />
- ar aris Seqmnili analogiuri<br />
samsaxurebi sxva uwyebebSi da ar<br />
aris am samsaxurebis funqcionirebis<br />
koordinirebis struqtura.<br />
Cvenma jandacvam, dafuZnebulma<br />
pr<strong>of</strong>ilaqtikuri da socialuri medicinis<br />
principebze, warsulSi miaRwia did warmatebas<br />
parazitul daavadebebTan brZolis<br />
saqmeSi. saqarTveloSi praqtikulad<br />
likvidirebuli iyo malaria, ankilostomidozebi,<br />
mkveTrad Semcirda sxva parazitozebi,<br />
maT Soris visceruli leiSmaniozi.<br />
dagrovda parazituli daavadebebis<br />
mimarT masobrivi pr<strong>of</strong>ilaqtikuri da<br />
samkurnalo RonisZiebebis dagegmvis,<br />
organizaciisa da ganxorcielebis unikaluri<br />
gamocdileba.<br />
parazituli daavadebebis gavrceleba<br />
upiratesad sanitariuli da ekologiuri<br />
problemaa. amitom maT winaaRmdeg brZolaSi<br />
ZiriTadi mniSvneloba daavadebaTa<br />
pr<strong>of</strong>ilaqtikas eniWeba. es ki warmoudgenelia<br />
garemos dacvis efeqturi<br />
RonisZiebebis warmoebis gareSe. 90-ian<br />
wlebSi ganviTarebulma ekonomikurma da<br />
finansurma depresiam faqtiurad CaSala<br />
qalaqebsa da raionebSi epidemiologiurad<br />
dasabuTebuli pr<strong>of</strong>ilaqtikuri RonisZiebebis<br />
gatareba, rasac Sedegad mohyva<br />
malariis kerebis aRdgena, TbilisSi mniSvnelovnad<br />
imata visceruli leiSmaniozis<br />
SemTxvevebma, rac garkveul epidemiologiur<br />
siaxles warmoadgens. qveynis<br />
mosaxleobaSi aRiniSneba parazitozebis<br />
sarwmuno mateba. saWiroa strategiul<br />
programaSi parazituli daavadebebis mimarT<br />
Camoyalibdes arsebuli situaciis<br />
Secvlis prognozi, romelic gaiTvaliswinebs<br />
bunebis anTropogenur transformacias,<br />
mosaxleobis migraciasa da<br />
pr<strong>of</strong>ilaqtikuri RonisZiebebis mTeli<br />
kompleqsis warmoebas.<br />
sruliad uyuradRebodaa datovebuli<br />
dasaqmebuli mosaxleobis Sromisa da janmrTelobis<br />
dacvis uzrunvely<strong>of</strong>is sfero<br />
- am mimarTulebiT saqmianoba praqtikulad<br />
ar xorcieldeba; ar funqcionirebs<br />
muSaTa winaswari da perioduli<br />
<strong>samedicino</strong> gasinjvebis sistema, rac<br />
dasaqmebuli mosaxleobis Sromisa da janmrTelobis<br />
dacvis mniSvnelovani winapirobaa;<br />
ar warmoebs erovnuli meurneobis<br />
obieqtebis sanitariuli mdgomareobis<br />
zedamxedveloba.<br />
saqarTveloSi dasaqmebulTa Sromisa<br />
da janmrTelobis dacvis, Sromis medicinis<br />
erovnuli konceptualuri safuZvlebisa<br />
da struqturis Camoyalibebis
13<br />
mizniT, sruldeba mxolod erTi saxelmwifo<br />
programa `pr<strong>of</strong>esiul daavadebaTa<br />
prevencia da monitoringi~ (Semsrulebeli<br />
- n. maxvilaZis saxelobis Sromis medicinisa<br />
da ekologiis samecniero-kvleviTi<br />
instituti), problemis aqtualobidan<br />
gamomdinare, rac sruliad arasakmarisia.<br />
ar warmoebs <strong>saqarTvelos</strong> prezidentis<br />
2005 wlis 22 Tebervlis #93 brZanebulebiT<br />
damtkicebuli `socialur-higienuri<br />
monitoringis debulebiT~ gaTvaliswinebuli<br />
samuSaoebis realizacia. aRniSnuli<br />
debulebis Tanaxmad, monitoringis<br />
gaxorcielebis mTavari tvirTi awevs<br />
<strong>saqarTvelos</strong> Sromisa da janmrTelobis<br />
dacvis saministros. am dros ki saministros<br />
struqturaSi ar aris Sesabamisi funqciis<br />
matarebeli erTeuli (rogorc kompetenciis,<br />
ise uflebamosilebis TvalsazrisiT).<br />
monitoringis ganxorcielebis<br />
ZiriTad mizans, sxva momentebTan er-<br />
Tad, warmoadgens adamianis janmrTelobisaTvis<br />
usafrTxo garemos uzrunvely<strong>of</strong>a.<br />
aqedan gamomdinare, aRniSnuli debulebiT<br />
gaTvaliswinebuli samuSaoebis Catareba<br />
uaRresad saSuri saqmea, rac mniSvnelovan<br />
wvlils Seitans garemos da, Sesabamisad,<br />
mosaxleobis gajansaRebis saqmeSi.<br />
ukanasknel periodSi saTanado yuradReba<br />
ar eqceva kanonqvemdebare aqtebis<br />
SemuSavebas adamianis janmrTelobisaTvis<br />
usafrTxo garemos uzrunvely<strong>of</strong>is<br />
sferoSi _ SeCerebulia Sesabamisi<br />
saxelmwifo programis dafinanseba, ris<br />
gamoc ar xdeba axali sanitariul-higienuri<br />
da normatiul-meToduri aqtebis<br />
SemuSaveba. es garemoeba samarTleblivi<br />
TvalsazrisiT mniSvnelovani Semaferxebeli<br />
faqtori iqneba garemos obieqtebisadmi<br />
sanitariuli zedamxedvelobis ganxorcielebis<br />
aRdgenis SemTxvevaSi.<br />
pr<strong>of</strong>ilaqtikuri medicinis mimarTulebiT<br />
qveyanaSi arsebobs mravali<br />
gadauWreli sakiTxi, romelTagan upirvelesad<br />
migvaCnia:<br />
qveyanaSi erTiani saxelmwifo sanitariuli<br />
samsaxuris instituciuri, struqturuli<br />
da funqciuri optimizacia<br />
<strong>saqarTvelos</strong> Sromis, janmrTelobisa da<br />
socialuri dacvis saministros meToduri<br />
xelmZRvanelobiT; am mizniT Sesabamisi<br />
sakanonmdeblo iniciativis ganxorcieleba<br />
saTanado kanonebSi cvlilebebis<br />
SetaniT;<br />
evrokavSiris rekomendaciebis Sesabamisad<br />
Seqmnili dargobrivi sanitariuli<br />
zedamxedvelobis samsaxurebis (saqar-<br />
Tvelos s<strong>of</strong>lis meurneobisa da garemos<br />
dacvisa da bunebrivi resursebis saministroebis<br />
struqturaSi) saqmianobis sruli<br />
ganxorcieleba; analogiuri samsaxurebis<br />
Seqmna Sesabamis uwyebebSi (Sromis<br />
higienis, bavSvTa da mozardTa higienis<br />
sakiTxebze, sacxovrebeli da sazogadoebrivi<br />
Senobebis, kulturul-say<strong>of</strong>acxovrebo,<br />
sportul-gamajansaRebeli,<br />
<strong>samedicino</strong> dawesebulebebis sanitariulhigienuri<br />
mdgomareobis monitoringis<br />
gansaxorcieleblad) da maTi instituciuri<br />
da funqciuri mowyobis optimizacia;<br />
garemos higienis koncefciisa da moqmedebis<br />
gegmebis ganxorcieleba erovnul,<br />
regionul da adgilobriv doneze,<br />
vinaidan, miuxedavad <strong>saqarTvelos</strong> garemos<br />
higienis samoqmedo erovnuli gegmis<br />
arsebobisa, misi praqtikuli realizacia<br />
ar xdeba;<br />
<strong>saqarTvelos</strong> Sromis, janmrTelobisa<br />
da socialuri dacvis saministros<br />
struqturaSi saTanado samsaxuris (struqturuli<br />
erTeulis) Seqmna, romelic<br />
qveynis masStabiT koordinacias gauwevs<br />
saxelmwifo politikis SemuSavebas pr<strong>of</strong>ilaqtikuri<br />
medicinisa da sazogadoebrivi<br />
jandacvis sferoSi;<br />
dawyebuli saxelmwifo sanitariuli<br />
zedamxedvelobis samsaxuris instituciuri<br />
da struqturuli reorganizaciis<br />
procesis dasruleba, rac Zireul koreqcias<br />
saWiroebs qveynis specifikisa da samsaxurisadmi<br />
pirvelxarisxovani moTxovnebis<br />
gaTvaliswinebiT;<br />
sanitariuli zedamxedvelobisa da<br />
epidemiologiuri kontrolis samsaxurebis<br />
instituciuri mowyobisa da urTierT-<br />
TanamSromlobis modelis SemuSaveba da<br />
misi safuZvliani dasabuTeba;<br />
garemosa da mosaxleobis janmrTelobis<br />
dacvis mizniT sauwyebaTaSoriso<br />
sabWoebis Seqmna erovnul da regionul<br />
doneze;<br />
<strong>saqarTvelos</strong> Sromis, janmrTelobisa<br />
da socialuri dacvis ministrTan komisiis<br />
Seqmna pr<strong>of</strong>ilaqtikuri medicinis<br />
TvalsaCino mecnierebisa da praqtikuli<br />
qselis wamyvani specialistebis monawileobiT<br />
jandacvis samsaxuris pr<strong>of</strong>ilaqtikuri<br />
medicinis mimarTulebis instituciuri<br />
da struqturuli organizaciis<br />
winadadebebis SesamuSaveblad;<br />
sakanonmdeblo da kanonqvemdebare<br />
aqtebis SemuSaveba da damtkiceba saqar-<br />
Tvelos prezidentis brZanebulebiT
14<br />
damtkicebuli `socialur-higienuri monitoringis<br />
debulebis~ realizaciisaTvis;<br />
mosaxleobis janmrTelobisaTvis<br />
usafrTxo garemos uzrunvely<strong>of</strong>is<br />
mizniT `socialur-higienuri monitoringis<br />
debulebiT~ gaTvaliswinebuli samuSaoebis<br />
realizaciis dawyeba;<br />
mosaxleobis janmrTelobaze garemos<br />
faqtorebis zemoqmedebis monitoringis<br />
uzrunvely<strong>of</strong>a;<br />
Sromis medicinis samsaxuris instituciuri<br />
mowyoba da saTanado RonisZiebebis<br />
gatareba dasaqmebuli mosaxleobis<br />
Sromisa da janmrTelobis dacvis uzrunvelsay<strong>of</strong>ad;<br />
kvebis produqtebis uvneblobisa da<br />
usafrTxoebis uzrunvely<strong>of</strong>is mizniT<br />
saTanado samuSaoebis drouli dawyeba;<br />
adamianis janmrTelobisaTvis usafrTxo<br />
garemos uzrunvely<strong>of</strong>is (sanitariuli<br />
zedamxedvelobis) samsaxurebis<br />
dawesebulebebSi samuSaod Sesabamisi<br />
pr<strong>of</strong>esiuli ganaTlebisa da kvalifikaciis<br />
specialistebis dasaqmeba (sazogadoebrivi<br />
jandacvis fakultetis kursdamTavrebulebi,<br />
higienuri mimarTulebis<br />
specialistebi);<br />
pr<strong>of</strong>ilaqtikuri medicinis mimarTulebiT<br />
uwyveti pr<strong>of</strong>esiuli ganviTarebis<br />
sistemaSi specialistTa momzadebisa da<br />
gadamzadebis Semdgomi sruly<strong>of</strong>a Tanamedrove<br />
moTxovnaTa gaTvaliswinebiT.<br />
pr<strong>of</strong>ilaqtikuri medicinisa da sazogadoebrivi<br />
jandacvis sferoSi qveynis<br />
winaSe mdgomi amocanebis gadasawyvetad<br />
mniSvnelovani wvlili Seaqvs 1995 wels<br />
dafuZnebul <strong>saqarTvelos</strong> pr<strong>of</strong>ilaqtikuri<br />
medicinis mecnierebaTa akademias.<br />
qveynis jandacvis strategiuli mimarTulebis<br />
- pr<strong>of</strong>ilaqtikis - realizacia-<br />
Si mniSvnelovania sxvadasxva uwyebriv<br />
daqvemdebarebaSi moRvawe pr<strong>of</strong>ilaqtikuri<br />
medicinisa da sazogadoebrivi<br />
jandacvis TvalsaCino specialistTa<br />
Zalisxmevis gaerTianeba. swored aseT<br />
struqturad Camoyalibda <strong>saqarTvelos</strong><br />
pr<strong>of</strong>ilaqtikuri medicinis mecnierebaTa<br />
akademia. Tavisi arsebobis arc Tu xangr-<br />
Zlivi periodis manZilze, qveyanaSi arsebuli<br />
rTuli socialur-ekonomikuri da<br />
politikuri situaciis fonze, akademiaSi<br />
gaerTianebuli specialistebisa da pr<strong>of</strong>iluri<br />
dawesebulebebis ZalisxmeviT<br />
Catarebulia mniSvnelovani samuSaoebi<br />
adamianis janmrTelobisaTvis usafrTxo<br />
garemos uzrunvely<strong>of</strong>is sferoSi. aRiareben<br />
ra pirvelad pr<strong>of</strong>ilaqtikas prioritetul<br />
mimarTulebad, akademiis specialistebi<br />
aqtiurad monawileoben qveynis<br />
sakanonmdeblo-normatiuli bazis Seqmnasa<br />
da sruly<strong>of</strong>aSi, samecniero da<br />
praqtikul saqmianobaSi pr<strong>of</strong>ilaqtikuri<br />
medicinisa da sazogadoebrivi jandacvis<br />
sferoSi. akademiis ZalisxmeviT tardeba<br />
samecniero konferenciebi <strong>saqarTvelos</strong><br />
sxvadasxva qalaqSi (Tbilisi, baTumi, borjomi<br />
da sxv.), gamocemulia akademiis<br />
samecniero SromaTa krebulebi, winamdebare<br />
gamocema am krebulTa V toms warmoadgens.<br />
akademiis egidiT gamocemulia<br />
sxvadasxva monografia, samecniero konferenciebis<br />
masalebi da sxv.<br />
migvaCnia, rom pr<strong>of</strong>ilaqtikuri medicinis<br />
winaSe mdgomi saxelmwifoebrivi<br />
mniSvnelobis problemebis qveynis xelmZRvanelobis<br />
(saTanado struqturebis)<br />
mier prioritetulad aRiareba da Zalisxmevis<br />
gaZliereba maTi realizaciisaTvis<br />
mniSvnelovani momenti iqneba<br />
garemosa da, Sesabamisad, mosaxleobis gajansaRebis<br />
saqmeSi.<br />
literatura<br />
1. <strong>saqarTvelos</strong> garemos higienis samoqmedo erovnuli gegma - `garemo da janmrTeloba~.<br />
Tbilisi: 2003. - 90 gv.<br />
2. <strong>saqarTvelos</strong> janmrTelobis dacvis erovnuli politika. Tbilisi, 1999.<br />
3. Измеров Н.Ф., Каспаров А.А., Медицина труда. Введение в специальность. М.: Медицина. -<br />
2002. - 392 с.<br />
4. Yassi A., Kjellstrom T., de Kok T., Guidotti T.L, Basic Environmental Health, NY: Oxford: University<br />
press, 2001. 441 p.
15<br />
kardiologia<br />
marcxena parkuWis remodelirebis Taviseburebebi<br />
diastoluri disfunqciiT mimdinare gulis<br />
qronikuli ukmarisobisas<br />
g. tabiZe, m. iakobaSvili, d. baRaTuria, T. cibaZe<br />
<strong>saqarTvelos</strong> pr<strong>of</strong>ilaqtikuri medicinis mecnierebaTa<br />
akademia,<br />
iv. javaxiSvilis saxelobis Tbilisis saxelmwifo<br />
universiteti,<br />
akad. m. winamZRvriSvilis saxelobis kardiologiis<br />
instituti<br />
ukanaskneli wlebis informaciuli monacemebi<br />
gulis qronikuli ukmarisobis<br />
(gqu) dros, marcxena parkuWis remodelirebis<br />
procesSi, diastoluri disfunqciis<br />
mniSvnelovan rolze miuTiTebs (1).<br />
kvlevis mizani: diastoluri disfunqciis<br />
Taviseburebebis Seswavla marcxena<br />
parkuWis remodelirebis procesSi gulis<br />
qronikuli ukmarisobis dros (gqu).<br />
masala da meTodebi: gamokvleulia gulis<br />
iSemiuri daavadebis fonze ganviTarebuli<br />
gqu-is II da III funqciuri klasis (NYHAklasifikaciiT)<br />
mqone 45 avadmy<strong>of</strong>i. gulis<br />
ultrabgeriTi gamokvleva warmoebda<br />
aparat “Ausonics-Sonoranger”-ze amerikis<br />
eqokardiografiuli sazogadoebis rekomendaciiT<br />
mowodebuli meTodikiT (2).<br />
Seiswavleboda: marcxena parkuWis saboloo<br />
sistoluri da diastoluri zomebi<br />
da moculobebi, marcxena winagulis zoma,<br />
parkuWTaSua Zgidis sisqe, marcxena parku-<br />
Wis ukana kedlis sisqe, marjvena parkuWis<br />
zoma. marcxena parkuWis miokardiumis masa<br />
gamoiTvleboda R.Devereux-is formuliT.<br />
ganisazRvreboda dartymiTi moculoba,<br />
gandevnis fraqcia da marcxena parkuWis<br />
damoklebis fraqcia sistolaSi.<br />
doplereqokardiografia xorcieldeboda<br />
impulsur reJimSi aparat „Shimad-SDU-<br />
500A”-ze. diastoluri avsebis dopleuri<br />
speqtris analizis dros gamoiTvleboda:<br />
adreuli diastoluri avsebis maqsimaluri<br />
siCqare E, winagulovani diastoluri avsebis<br />
maqsimaluri siCqare - A, Sefardeba E/A.<br />
Seiswavleboda aseve: adreuli avsebis aCqarebisa<br />
da Senelebis dro. restriqciuli<br />
tipis diastolur disfunqciad iTvleboda<br />
dopleruli kriteriumi im SemTxvevaSi<br />
Tu: 1) Sefardeba E/A meti iyo 2-ze<br />
an 2) adreuli avsebis Senelebis dro naklebi<br />
iyo 130 mwm da Sefardeba E/A>1,0 (3).<br />
fizikuri datvirTvisadmi tolerantobis<br />
Sefaseba warmoebda saavadmy<strong>of</strong>os<br />
derefanSi 6-wuTiani siarulis testiT,<br />
rac gamoisaxeboda ganvlili manZiliT<br />
metrebSi (4). avadmy<strong>of</strong>Ta cxovrebis<br />
xarisxis Sefaseba xdeboda minesotas specialuri<br />
kiTxvariT `cxovreba gulis ukmarisobiT”<br />
LWHF (University <strong>of</strong> Minnesota) (5).<br />
statistikuri analizi warmoebda statistikis<br />
standartuli meTodebis gamoyenebiT,<br />
stiudensis t kriteriumis gamoTvliT.<br />
statistikurad sarwmuno gansxvavebis<br />
Sefaseba xdeboda, Tu P
16<br />
rogorc funqciuri klasi (NYHA), aseve<br />
fizikuri datviTvisadmi tolerantoba<br />
mniSvnelovnad uaresdeba restriqciuli<br />
tipis diastoluri disfunqciis mqone<br />
avadmy<strong>of</strong>ebSi, rac miuTiTebs restriqciuli<br />
tipis prediqtorul mniSvnelobaze,<br />
prognozis gauaresebasa da gulis ukmarisobis<br />
mZime mimdinareobaze.<br />
sayuradReboa is faqti, rom diastoluri<br />
disfunqcia restriqciuli tipiT pirdapir<br />
korelaciur kavSirSia marcxena parkuWis<br />
miokardiumis masis momatebasTan da aqedan<br />
gamomdinare, miokardiul stresTanac.<br />
aRsaniSnavia, rom Cvens gamokvlevebSi<br />
marcxena parkuWis diastoluri disfunqcia<br />
Seiswavleboda avadmy<strong>of</strong>ebSi ukve do-<br />
gulis diastoluri disfunqciis sxvadasxva tipis mqone<br />
avadmy<strong>of</strong>ebis klinikuri da eqokardiografiuli maCveneblebi<br />
saboloo diastoluri da sistoluri zoma.<br />
amavdroulad, jgufebis mixedviT, marcxena<br />
winagulisa da marjvena parkuWis zomebi<br />
arsebiTad ar gansxvavdeba.<br />
gulis kumSvadi funqciis maCveneblebi<br />
- gandevnis fraqcia da damoklebis fraqcia,<br />
diastoluri disfunqciis restriqciuli<br />
tipis mqone pacientebSi mniSvnelovnad<br />
dabalia, vidre meore jgufSi.<br />
cxovrebis xarisxis Sefasebisas (LWHF)<br />
sayuradReboa misi dabali done restriqciuli<br />
tipis diastoluri disfunqciis<br />
dros. am jgufSi aseve dabalia fizikuri<br />
datvirTvisadmi tolerantoba.<br />
korelaciuri analizis Catarebisas<br />
klinikur statuss, gulis remodelirebmaCveneblebi<br />
I jgufi<br />
restriqciuli<br />
tipi<br />
II jgufi<br />
restriqciuli<br />
tipi<br />
fk (NYHA) 2,79±0,7 2,0±0,4 P0,05<br />
simaRle (sm) 169±4 171±5 P>0,05<br />
sxeulis masa (kg) 71±7 76±7 P>0,05<br />
sistoluri arteriuli wneva 129±18 136±7 P>0,05<br />
diastoluri arteriuli wneva mm.vwy.sv. 85±1 84±13 P>0,05<br />
gulis SekumSvaTa sixSire (wT) 87±13 79±13 P0,05<br />
mp saboloo diastoluri zoma 6,5±0,7 6,0±0,8 P
17<br />
ОСОБЕННОСТИ ДИАСТОЛИЧЕСКОЙ ДИСФУНКЦИИ В ПРОЦЕССЕ<br />
РЕМОДЕЛИРОВАНИЯ ЛЕВОГО ЖЕЛУДОЧКА СЕРДЦА ПРИ<br />
ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ<br />
Г. Табидзе, М. Якобашвили, Д. Багатурия, Т. Цибадзе.<br />
АКАДЕМИЯ НАУК ПРОФИЛАТКИЧЕСКОЙ МЕДИЦИНЫ ГРУЗИИ, ТБИЛИССКИЙ,<br />
ГОСУДАРСТВЕННЫЙ УНИВЕРСИТЕТ ИВ. ДЖАВАХИШВИЛИ, НИИ<br />
КАРДИОЛОГИИ ИМ. М. ЦИНАМДЗГВРИШВИЛИ<br />
У 45 больных с сердечной недостаточностью, имевших по данным ЭХОКГ признаки систолической и<br />
диастолической дисфункции сердца, исследованы функциональный статус, толерантность к физической<br />
нагрузке и качество жизни. Группа больных с “рестриктивным” типом диастолической дисфункции<br />
характеризовалась более тяжелым течением хронической сердечной недостаточности по всем<br />
рассмотренным критериям. В этой группе выявлены более выраженные корреляционные связи<br />
функционального класса хронической сердечной недостаточности, дистанции, пройденной во время 6-минутной<br />
ходьбы, и суммарного индекса качества жизни с параметрами диастолического наполнения в сравнении с<br />
показателями систолической функции левого желудочка. Таким образом, при развитии рестриктивного типа<br />
диастолического наполнения ремоделирование левого желудочка достигает такой стадии, когда систолическая<br />
дисфункция уже не играет основной роли, а тяжесть состояния больных с хронической сердечной<br />
недостаточностью во многом определяется состоянием диастолической функции сердца.<br />
THE ROLE OF DIASTOLIC DYSFUNCTION IN THE PROCESS OF LEFT<br />
VENTRICULAR REMODELING IN CHRONIC HEART FAILURE<br />
G. Tabidze, M. Iakobashvili, D. Bagaturia, T. Tsibadze<br />
Functional status tolerance <strong>of</strong> exercise and life quality was evaluated in patients with chronic heart failure<br />
and Echocardiographic signs <strong>of</strong> systolic and diastolic heart dysfunction. According to all parameters used in the<br />
study patients with “restrictive” type <strong>of</strong> diastolic dysfunction had more severe course <strong>of</strong> heart failure. In this<br />
group functional class, 6-minute walking distance and total index <strong>of</strong> life quality correlated more closely with<br />
parameters <strong>of</strong> left ventricular diastolic filling, than the parameters <strong>of</strong> systolic function. So, in restrictive type left<br />
ventricular remodeling stage when severity <strong>of</strong> the patients clinical condition is determined mostly by the state <strong>of</strong><br />
diastolic function <strong>of</strong> the heart.<br />
literatura:<br />
1. Xie Y. Y., Berk M. R., Smith M. D. et al. Prognostic valne f Doppler transmitral flow patterns in<br />
patients with congestive heart failure. Amer. Coll. Cardiology 1994, 24: 132-139.<br />
2. John D., De Maria a, Kassio at all. The Commitee on M-mode standartization <strong>of</strong> the American<br />
Society <strong>of</strong> Echocardiography: Recomendations regarding quantitation in M-mode Echocardiography: result <strong>of</strong> a<br />
survey <strong>of</strong> Echocardiographic measurmement Circulation 1978, 58; 1072-1083.<br />
3. Pinamoti B. D., Di Lenarda A. Sinagra I. et al. Restrictive left ventricular filling pattern in dilated<br />
cardiomyopathy assessed by Doppler Echocardiography: clinical, Echocardiographic and hemodinamic correlation<br />
and prognostic implications. Am. Coll. Cardiol. 1993., 22. 808-815.<br />
4. Guyatt G. H., Sullivan M. J., Thompson P. L. et al. The 6-minute walk a new measure <strong>of</strong> exercise<br />
capacity in patients with chronic heart failure can. med. ctss. 1985., 132, 919-923.<br />
5. Rector T. S. Kuba S. H. Cohn J. N. Patients self -assessment <strong>of</strong> their comgestive heart failure part 2:<br />
content, reliability and validity <strong>of</strong> a new measure, the Minnesota Liring with heart failure questionaire. Heart<br />
failure 1987:10:198-209.<br />
6. Thomas J. D. Doppler Echocardiography and Left ventricular diastolic function. In.: Left ventricular<br />
diastolic dysfunction and heart failure. Eds. W. H. Beasch., M.M. LeWinter. Philadelphia, Lea, Febiger, 192-218.<br />
2. <strong>saqarTvelos</strong> <strong>samedicino</strong> <strong>Jurnali</strong>, 3, 2008 w.
18<br />
pulmonologia, fizioTerapia<br />
vanadiumis eleqtr<strong>of</strong>orezis gavlena<br />
gaxangrZlivebuli pnevmoniis mqone avadmy<strong>of</strong>Ta<br />
kardiohemodinamikaze<br />
n.saakaSvili, m.tabiZe, n.kakulia, m.afxazi, i.kvinikaZe<br />
<strong>saqarTvelos</strong> pr<strong>of</strong>ilaqtikuri medicinis mecnierebaTa<br />
akademia, Tbilisis balneologiuri kurorti - <strong>saqarTvelos</strong><br />
kurortologiis, fizioTerapiis, reabilitaciisa da<br />
samkurnalo turizmis samecniero-praqtikuli centri<br />
garegani sunTqvis funqciis darRveva,<br />
gaxangrZlivebuli pnevmoniis dros,<br />
iwvevs hipertenzias sisxlis mimoqcevis<br />
mcire wreSi. es mdgomareoba uary<strong>of</strong>iTad<br />
moqmedebs gul-sisxlZarRvTa sistemis<br />
funqciaze, rac Tavis mxriv sagrZnoblad<br />
auaresebs aRniSnuli paTologiis mqone<br />
avadmy<strong>of</strong>Ta mdgomareobas [6, 4, 2, 1, 3, 7, 5].<br />
Sromis mizani: vanadiumis eleqtr<strong>of</strong>orezis<br />
gavlenis Seswavla gaxangrZlivebuli<br />
pnevmoniis mqone avadmy<strong>of</strong>ebze.<br />
masala da meTodebi: gamokvleul iqna<br />
gaxangrZlivebuli pnevmoniis mqone 25-<br />
dan 63 wlamde asakis 65 avadmy<strong>of</strong>i,<br />
romelTaganac 31-s aReniSneboda pa-<br />
Tologiis kerovani forma, 34-s _ intersticiuli.<br />
avadmy<strong>of</strong>Ta mkurnalobis kursi<br />
moicavda vanadiumis eleqtr<strong>of</strong>orezis<br />
14-15 proceduras. TiToeuli proceduris<br />
xangrZlivoba Seadgenda 12-14<br />
wuTs. eleqtr<strong>of</strong>orezis procedurisaTvis<br />
gamoiyeneboda vanadiumis sulfatis<br />
2%-iani wyliani xsnari.<br />
eleqtr<strong>of</strong>orezis proceduris CatarebisaTvis<br />
gamoiyeneboda sworkuTxa formis<br />
orkapa eleqtrodi, zomiT 4smX8sm.<br />
orkapa eleqtrod-anodis firfita moTavsebuli<br />
vanadium-sulfatis 2%-ian xsnar-<br />
Si dasvelebul hidr<strong>of</strong>ilur safenSi, fiqsirdeboda<br />
paravertebrulad, filtvebis<br />
fesvebis saproeqcio areSi. orkapa<br />
eleqtrod-kaTodis firfita, moTavsebuli<br />
wyalsadenis Tbil wyalSi dasvelebul<br />
hidr<strong>of</strong>ilur safenSi, fiqsirdeboda gulmkerdis<br />
areSi, eleqtrod-anodis simetriulad.<br />
eleqtr<strong>of</strong>orezis proceduris Catarebisas,<br />
denis simkvrive Seadgenda 0,05 ma/<br />
sm 2 -s. procedurebi tardeboda yoveldRe,<br />
kvira dRis garda.<br />
miRebuli Sedegebi. Catarebuli<br />
gamokvlevebiT dadgenil iqna, rom vanadiumis<br />
eleqtr<strong>of</strong>oreziT mkurnaloba<br />
gaxangrZlivebuli pnevmoniis mqone avadmy<strong>of</strong>ebSi<br />
iwvevs gulis indeqsisa da dartymiTi<br />
indeqsis momatebuli sidideebis<br />
Semcirebas, sisxlZarRvTa kuTri periferiuli<br />
winaaRmdegobis zomier zrdas,<br />
`filtv-yuris~ monakveTze sisxlis nakadis<br />
siCqaris matebas, paTologiurad<br />
Secvlili pulsis sixSirisa da arteriuli<br />
wnevis sidideebis normalizacias,<br />
eleqtrokardiografiuli monacemebis<br />
gaumjobesebas.<br />
kardiohemodinamikis maCvenebelTa<br />
aRniSnuli dadebiTi Zvrebi metad iyo<br />
gamoxatuli kerovani pnevmoniis dros<br />
(cxrili 1 da 2).<br />
miRebuli Sedegebis safuZvelze SeiZleba<br />
davaskvnaT, rom vanadiumis eleqtr<strong>of</strong>oreziT<br />
mkurnaloba gaxangrZlivebuli<br />
pnevmoniis mqone avadmy<strong>of</strong>ebSi iwvevs centralur<br />
da periferiul hemodinamikebs<br />
Soris urTierTobis normalizaciasa da miokardiumis<br />
funqciis gaumjobesebas.
19<br />
cxrili 1<br />
vanadiumis eleqtr<strong>of</strong>oreziT mkurnalobis gavlena pnevmoniis<br />
mqone avadmy<strong>of</strong>Ta kardiohemodinamikis maCveneblebze<br />
maCveneblebi<br />
pulsis sixSire wuTSi<br />
(N - 60-80 wT-Si; 72wT-Si<br />
± 1,88 wT-Si)<br />
sisxlis sistoluri<br />
arteriuli wneva, vwys.<br />
mm (N-110-150 vwys.mm;<br />
121,20 vwys.mm ± 1,88vwys.mm)<br />
M±m<br />
M±m<br />
paTologiis formebi<br />
kerovani intersticiuli<br />
n 31 34<br />
mk-mde<br />
mk.Semdeg<br />
72,26 ± 1,769<br />
69,42 ± 0,777<br />
80,71 ± 1,366<br />
77,29 ± 1,117<br />
t 2,384 1,933<br />
p < 0,02 > 0,05<br />
n 31 34<br />
mk-mde 118,10 ± 2,280 125,30 ± 2,488<br />
mk.Semdeg 113,40 ± 1,399 122,20 ± 2,353<br />
t 2,543 0,902<br />
p < 0,02 > 0,2<br />
n 31 34<br />
sisxlis diastoluri<br />
arteriuli wneva, vwys.<br />
mk-mde 77,42 ± 1,369 81,76 ± 1,229<br />
mm (N-70-90vwys.mm; 79,20 M±m<br />
mk.Semdeg 72,10 ± 0,686 78,82 ± 1,157<br />
vwys.mm ± 1,15 vwys.mm)<br />
t 3,503 1,742<br />
p < 0,01 > 0,05<br />
sisxlis saSualo<br />
n 31 34<br />
dinamikuri arteriuli<br />
mk-mde 94,74 ± 1,749 100,40 ± 1,765<br />
wneva, vwys. mm (N-87-112<br />
M±m<br />
mk.Semdeg 89,68 ± 0,969 97,35 ± 1,666<br />
vwys.mm; 97,16 vwys.mm ±<br />
t 3,088 1,236<br />
1,43 vwys.mm) p < 0,01 > 0,2<br />
gulis indeqsi, l/wT/m 2<br />
n 31 34<br />
(N-2,42-3,36 l/wT/m 2 ;<br />
mk-mde 3,958 ± 0,043 4,772 ± 0,034<br />
M±m<br />
2,82 l/wT/m 2 ± 0,09<br />
mk.Semdeg 2,625 ± 0,155 3,806 ± 0,088<br />
l/wT/m 2 )<br />
t 28,596 10,205<br />
p < 0,001 < 0,001<br />
dartymiTi indeqsi,<br />
n 31 34<br />
ml/m 2 (N-30,25-56,00 ml/m 2 ;<br />
mk-mde 55,97 ± 1,775 59,72 ± 1,142<br />
M±m<br />
39,16 ml/m 2 ± 0,42 ml/m 2 )<br />
mk.Semdeg 37,97 ± 0,502 48,98 ± 1,716<br />
t 9,760 6,540<br />
p < 0,001 < 0,001<br />
n 31 34<br />
kuTri periferiuli<br />
sisxlZarRvovani<br />
winaaRmdegoba, p.e (N-<br />
25,88-46,29 p.e; 34,46 p.e ±<br />
0,39 p.e)<br />
sisxlis nakadis<br />
moZraobis dro `filtvyuris"<br />
monakveTze, wm<br />
(N-3,2-4,2 wm; 4,09 wm ± 0,10<br />
wm)<br />
M±m<br />
M±m<br />
mk-mde<br />
mk.Semdeg<br />
22,74 ± 0,369<br />
32,86 ± 0,508<br />
21,05 ± 0,351<br />
26,09 ± 0,518<br />
t 22,533 8,045<br />
p < 0,001 < 0,001<br />
n 31 34<br />
mk-mde 7,377 ± 0,068 9,468 ± 0,073<br />
mk.Semdeg 3,60 ± 0,034 7,65 ± 0,157<br />
t 52,944 10,436<br />
p < 0,001 < 0,001
20<br />
cxrili 2<br />
vanadiumis eleqtr<strong>of</strong>oreziT mkurnalobis gavlena gaxangr-<br />
Zlivebuli pnevmoniis mqone avadmy<strong>of</strong>Ta paTologiureleqtrokardiografiul<br />
maCveneblebze<br />
gulis<br />
eleqtruli<br />
RerZis gadaxra<br />
marjvniv<br />
marjvena<br />
parkuWis<br />
gadaZabvis<br />
niSnebi<br />
hisis konis<br />
marjvena totis<br />
arasruli<br />
niSnebi<br />
atrioventrikuluri<br />
gamtarobis<br />
Seneleba<br />
sinusuri<br />
taqikardia<br />
sinusuri<br />
bradikardia<br />
parkuWovani<br />
eqstrasistolia<br />
paTologiis formebi<br />
intersticiuli<br />
kerovani (n=31)<br />
maCveneblebi<br />
(n=34)<br />
avadmy<strong>of</strong>Ta raodenoba<br />
abs. %% abs. %%<br />
mk-mde 9 29,03 15 44,11<br />
mk. gaqra<br />
_ _ _<br />
Semdeg Semcirda<br />
6 19,35 4<br />
mk.<br />
Semdeg<br />
mk.<br />
Semdeg<br />
mk.<br />
Semdeg<br />
mk.<br />
Semdeg<br />
mk.<br />
Semdeg<br />
mk.<br />
Semdeg<br />
_<br />
11,76<br />
ucvleli darCa 3 9,67 11 32,35<br />
mk-mde 6 19,35 13 38,23<br />
gaqra<br />
Semcirda<br />
ucvleli darCa<br />
4<br />
2<br />
_<br />
12,90<br />
6,45<br />
_<br />
2<br />
8<br />
2<br />
5,88<br />
23,52<br />
5,88<br />
moimata<br />
1 2,94<br />
mk-mde 1 3,22 3 8,82<br />
gaqra<br />
1 3,22 1 2,94<br />
Semcirda<br />
_ _ 2 5,88<br />
ucvleli darCa _ _ _ _<br />
mk-mde 4 12,90 7 20,58<br />
gaqra<br />
Semcirda<br />
ucvleli darCa<br />
4<br />
_<br />
_<br />
12,90<br />
_<br />
_<br />
2<br />
2<br />
2<br />
5,88<br />
5,88<br />
5,88<br />
moimata<br />
_ _<br />
1 2,94<br />
mk-mde 4 12,90 7 20,58<br />
gaqra<br />
4 12,90 2 5,88<br />
Semcirda<br />
_ _ 2 5,88<br />
ucvleli darCa _ _ 2 5,88<br />
moimata<br />
_ _<br />
1 2,94<br />
mk-mde 5 16,12 3 8,82<br />
gaqra<br />
Semcirda<br />
ucvleli darCa<br />
4<br />
1<br />
_<br />
12,90<br />
3,22<br />
_<br />
1<br />
2<br />
_<br />
2,94<br />
5,88<br />
_<br />
mk-mde _ _ 2 5,88<br />
gaqra<br />
Semcirda<br />
ucvleli darCa<br />
_<br />
_<br />
_<br />
_<br />
_<br />
_<br />
2<br />
_<br />
_<br />
5,88<br />
_<br />
_
21<br />
ВЛИЯНИЕ ЭЛЕКТРОФОРЕЗА ВАНАДИЯ НА ПОКАЗАТЕЛИ<br />
КАРДИОГЕМОДИНАМИКИ У БОЛЬНЫХ ЗАТЯЖНОЙ ПНЕВМОНИЕЙ<br />
Н.Саакашвили, М. Табидзе, Н.Какулия, М.Абхази, И.Квиникадзе<br />
АКАДЕМИЯ НАУК ПРОФИЛАКТИЧЕСКОЙ МЕДИЦИНЫ ГРУЗИИ, ТБИЛИССКИЙ<br />
БАЛЬНЕОЛОГИЧЕСКИЙ КУРОРТ - НАУЧНО-ПРАКТИЧЕСКИЙ ЦЕНТР<br />
КУРОРТОЛОГИИ, ФИЗИОТЕРАПИИ, РЕАБИЛИТАЦИИ И ЛЕЧЕБНОГО ТУРИЗМА<br />
ГРУЗИИ<br />
Обследовано 65 больных затяжной пневмонией в возрасте от 25 до 63 лет, из которых у 31 отмечалась<br />
очаговая форма патологии, а у 34 - интерстициальная.<br />
Установлено, что лечение электрофорезом ванадия вызывает у больных указанной патологией<br />
нормализацию взаимоотношений между центральной и периферической гемодинамикой.<br />
Улучшение взаимоотношений между центральной и периферической гемодинамикой у больных затяжной<br />
пневмонией влечет за собой снижение повышенных величин сердечного и ударного индекса, некоторое<br />
увеличение удельного периферического сосудистого сопротивления, ускорение кровотока на участке “легкиеухо”,<br />
нормализацию патологически измененных величин пульса и показателей артериального давления,<br />
ослабление, вплоть до исчезновения, патологических электрокардиографических данных.<br />
Указанные положительные явления, вызванные лечением электрофорезом ванадия, оказались более<br />
выраженными при очаговой форме хронической пневмонии.<br />
THE INFLUENCE OF VANADIUM ELECTROPHORESIS<br />
ON CARDIOHEMODYNAMIC VALUES OF PATIENTS WITH<br />
PROLONGED PNEUMONIA<br />
N.Saakashvili, M.Tabidze, N.Kakulia, M.Abkhazi, I.Kvinikadze<br />
65 patients at the age <strong>of</strong> 25-63 have been examined. 31 <strong>of</strong> them had focal and 34 had interstitial pneumonia.<br />
It was stated that the treatment <strong>of</strong> diseased with pneumonia by Vanadium electrophoresis has improved<br />
relationship between central and peripheral hemodynamic parameters, normalized peripheral vessel specific<br />
resistance and stroke index, acceleration <strong>of</strong> blood flow on the region ,,lung-ear”, normalized pathologic changed<br />
pulse rate and dynamic blood arterial pressure, improved electrocardiographic data.<br />
These positive changes <strong>of</strong> cardiohemodynamic, caused by Vanadium electrophoresis, were more pronounced<br />
at local form <strong>of</strong> chronic pneumonia.<br />
literatura:<br />
1. Алексеев В.Г. Толерантность к физической нагрузке у больных различными формами пневмонии<br />
//12-ый Национальный конгресс по болезням дыхания. - Тезисы докладов. - М., 2002. - С. 28-29.<br />
2. Бартлетт Дж. Дж. Пневмония // Инфекции дыхательных путей. - М.: Бинам, 2000. - С. 10-103.<br />
3. Белов А.А., Лакшина Н.А. Изменения вентиляционной функции у больных острой и затяжной<br />
пневмонией // 12-ый Национальный конгресс по болезням дыхания. - Тезисы докладов. - М., 2002. - С. 12.<br />
4. Дворецкий Л.И. Пневмонии // Актуальные вопросы пульмонологии. - Сборник научных трудов.<br />
- М.: Ньюзиамед. - АО, 1999. - С. 3-44.<br />
5. Кудряшев В.А. Количественная оценка нарушений кровообращения с помощью велоэргометрии<br />
при пневмониях // Российский национальный конгресс пульмонологов. - Тезисы докладов. - Иваново,<br />
2006. - С. 34-35.<br />
6. Caretzky M., Cuuha B.A., Brandsletter R.D. The Pneumonias. - New York: Springer, 1993. - 356 p.<br />
7. Dunnil M.S. Pathophysiology <strong>of</strong> pulmonary circulation. - Edinburgh: Churchill Livingstone, 2004. - 392 p.
22<br />
dReba eqceva rogorc meningokokuri infeqciis<br />
mTlianad, ise gansakuTrebiT<br />
meningitis problemis Seswavlas. saqar-<br />
TveloSi am sakiTxze mxolod erTeuli<br />
Sromebi arsebobs (1).<br />
warmodgenili kvlevis mizania gaanalizebul<br />
iqnes qveyanaSi meningokokuri ininfeqciuri<br />
sneulebani, epidemiologia<br />
saqarTveloSi meningokokuri infeqciisa da<br />
baqteriuli meningitebis epidemiologiuri<br />
zedamxedvelobis gaumjobesebis gzebi<br />
i. mWedliSvili, T. mWedliSvili, m. eloSvili<br />
<strong>saqarTvelos</strong> pr<strong>of</strong>ilaqtikuri medicinis mecnierebaTa<br />
akademia, Tssu-is epidemiologiisa da biostatistikis<br />
departamenti,<br />
daavadebaTa kontrolisa da sazogadoebrivi janmrTelobis<br />
erovnuli centri<br />
feqciisa da baqteriuli meningitebis<br />
gavrcelebis done da dasaxul iqnes gzebi,<br />
romlebic xels Seuwyobs maTze efeqturi<br />
epidzedamxedvelobis ganxorcielebas.<br />
meningokokuri infeqciis avadobis<br />
<strong>of</strong>icialuri statistika gviCvenebs, rom<br />
mas klebis tendencia axasiaTebs (grafiki)<br />
da 2007 wels, 1997 welTan SedarebiT,<br />
avadoba 2,9-jer Semcirda. es, erTi mxriv,<br />
SeiZleba aixsnas avadobisaTvis damaxasiaTebeli<br />
periodulobiT.<br />
meningokokuri infeqciiT avadoba saqarTveloSi 1997-2007 wlebSi<br />
avadobis maCvenebel i 100 000 adamianze<br />
2<br />
1.8<br />
1.6<br />
1.4<br />
1.2<br />
1<br />
0.8<br />
0.6<br />
0.4<br />
0.2<br />
0<br />
1997w<br />
1998w<br />
1999w<br />
2000w<br />
2001w<br />
2002w<br />
2003w<br />
2004w<br />
2005w<br />
2006w<br />
2007w<br />
meningokokuri infeqcia erT-erTi mniSvnelovani<br />
infeqciuri daavadebaa, romelic<br />
seriozul zians ayenebs mosaxleobis janmrTelobas.<br />
misTvis damaxasiaTebelia<br />
rogorc lokaluri (naz<strong>of</strong>aringiti), ise<br />
generalizebuli formebi meningitisa da<br />
meningokokcemiis saxiT. naz<strong>of</strong>aringitisagan<br />
gasxvavebiT, generalizebuli formebi<br />
mZime mimdinareobiT da maRali letalobiT<br />
xasiaTdeba. amdenad, mTel ms<strong>of</strong>liosa<br />
da Cvens mezobel qveynebSic didi yura-<br />
cnobilia, rom am daavadebas axasiaTebs<br />
avadobis donis perioduli mateba da kleba<br />
10-15 wlis intervaliT. 1997 wels qveyanaSi<br />
aRiniSna avadobis perioduli mateba,<br />
ris Semdegac avadoba TandaTan mcirdeba.<br />
miuxedavad amisa, Cveni azriT, <strong>of</strong>ocialuri<br />
statistikuri monacemebi re-
23<br />
alurad ver asaxavs infeqciis gavrcelebis<br />
WeSmarit dones. amas adasturebs Semdegi<br />
faqtebi:<br />
1. 2006 wlidan saqarTveloSi <strong>of</strong>icialurad<br />
aRar aRiricxeba meningokokuri naz<strong>of</strong>aringiti,<br />
rac, bunebrivia, amcirebs<br />
meningokokuri infeqciiT avadobis<br />
maCveneblebs.<br />
2. <strong>of</strong>icialuri monacemebiT, 2006 wels<br />
meningokokuri infeqciis daregistrirebuli<br />
22 SemTxvevidan 21 iyo meningokokcemia<br />
da mxolod erTi meningokokuri<br />
meningiti. 2007 wels es cifrebi Sesabamisad<br />
30, 29 da 1-is tolia, anu ori wlis man-<br />
Zilze mxolod or SemTxvevaSi daisva meningokokuri<br />
meningitis diagnozi. maSin,<br />
rodesac igive <strong>of</strong>icialuri monacemebiT,<br />
2006 wels saqarTveloSi dafiqsirda baqteriuli<br />
meningitis 126 SemTxveva<br />
(maCvenebeli 100 aTas mcxovrebze 2.74-is<br />
tolia), xolo 2007 wels – 99 (maCvenebli<br />
2.15-s udris). samwuxarod, maTi etiologiuri<br />
gaSifrva ar xdeba.<br />
cnobilia, rom baqteriuli meningitebi<br />
polietiologiuri daavadebaa da<br />
SemTxvevebis 90-95% ganpirobebulia meningokokebiT,<br />
pnevmokokebiT da Heamophilus<br />
influenzae-s b serotipiT (Hib). maT Soris<br />
wamyvani adgili, gansakuTrebiT bavSveb-<br />
Si, meningokokebsa da Hib–s ukavia (2,3,4).<br />
saqarTveloSi ki 2 wlis manZilze maTgan<br />
gamowveuli meningitis sul 4 SemTxvevaa<br />
aRricxuli. Cveni azriT, gauSifravi etiologiis<br />
baqteriul meningitebSi, iseve<br />
rogorc sxva qveynebSi, wamyvani adgili<br />
meningokokur da b tipis Heamophilus influenzae-Ti<br />
gamowveul meningitebs unda ekavos.<br />
3. rogorc epidemiur kerebSi, ise janmrTel<br />
populaciaSi, aRiniSneba meningokokebis<br />
sakmaod intensiuri cirkulacia.<br />
magaliTad, 2006 wels gamokvleuli<br />
janmrTeli mosaxleobis 0.75%-s amoeTesa,<br />
xolo 2007 wels es ricxvi 5.12%-mde<br />
gaizarda. meningokokebis mtareblobis<br />
done ki avadobis realuri donis erTerTi<br />
mniSvnelovani indikatoria.<br />
aRniSnuli momentebidan gamomdinare,<br />
vfiqrobT, rom meningokokuri infeqciiT,<br />
gansakuTrebiT meningokokuri meningitiT<br />
avadobis done bevrad ufro maRalia, vidre<br />
es <strong>of</strong>ocialuri statistikuri monacemebiT<br />
aris dafiqsirebuli, amitom dRis<br />
wesrigSi dgas am daavadebis realuri donis<br />
dadgena qveyanaSi da baqteriuli meningitis<br />
etiologiuri sruqturis gaSifrva,<br />
radgan epidemiologiuri zedamxedvelobis<br />
safuZveli swored daavadebis<br />
SemTxvevebis sruli gamovlena da aRricxvaa.<br />
amisaTvis, Cveni azriT, saWiroa:<br />
a. kvlavac savaldebulo wesiT unda aRiricxos<br />
meningokokuri naz<strong>of</strong>aringitiT<br />
daavadebis SemTxvevebi.<br />
b. mkveTrad unda gaumjobesdes meningokokuri<br />
infeqciis, gansakuTrebiT ki<br />
baqteriuli meningitis laboratoriuli<br />
diagnostika, raSic wamyvani roli daavadebaTa<br />
kontrolis da sazogadoebrivi<br />
janmrTelobis erovnulma centrma unda<br />
iTavos, sadac Tav-zurgtvinis siTxisa da<br />
sisxlis gamokvleva moxdeba rogorc baqteriologiuri<br />
meTodiT, ise aglutinaciiT<br />
da polimerazis jaWvuri reaqciis<br />
gamoyenebiT.<br />
g. meningokokebis kulturis gamoy<strong>of</strong>is<br />
SemTxvevaSi saWiroa misi tipireba, raTa<br />
dadgindes, Tu romeli serojgufebi<br />
ufroa gavrcelebuli dRes saqarTvelo-<br />
Si. rogorc cnobilia, daavadebas Ziri-<br />
Tadad iwvevs A, B da C serojgufebi,<br />
romelTa mniSvneloba daavadebis gavrcelebaSi<br />
sxvadasxva teritoriaze da<br />
drois sxvadasxva monakveTSi sagrZnoblad<br />
meryeobs (2,3). Tanamedrove etapze<br />
dominirebuli serojgufebis dadgena miT<br />
ufro mniSvnelovania, rom amJamad meningokokebis<br />
infeqciis winaaRmdeg brZolis<br />
saqmeSi yvelaze efeqtur saSualebad iTvleba<br />
aqtiuri imunizacia. misi danergva ki<br />
manamde ver moxdeba, sanam ar gairkveva<br />
daavadebis gavrcelebis WeSmariti done da<br />
dominirebuli serojgufebi.<br />
d. baqteriuli meningitebis epidzedamxedvelobis<br />
mizniT, aseve aucileblad<br />
migvaCnia, meningokokebis rolis dadgenis<br />
garda, ganisazRvros am paTologiaSi Hibinfeqciis<br />
rolic, radgan uaxloes periodSi<br />
janmos da sxvadasxva saerTaSoriso<br />
<strong>samedicino</strong> organizaciis mxriv SeiZleba<br />
daisvas sakiTxi saqarTveloSi Hib infeqciis<br />
mimarT aqtiuri imunizaciis dawyebis<br />
Sesaxeb.<br />
amrigad, meningokokuri infeqciisa da<br />
baqteriuli meningitebis mimarT epidemiologiuri<br />
zedamxedvelobis efeqturobis<br />
gazrdis mizniT, upirveles yovlisa<br />
saWiroa maTi laboratoriuli diagnostikis<br />
xarisxis gaumjobeseba, rac Sesa-<br />
Zleblobas mogvcems davadginoT maTi<br />
gavrcelebis done da rac aseve metad<br />
mniSvnelovania, maTi etiologiuri struqtura.<br />
mxolod amis Semdeg aris SesaZlebeli<br />
meningokokuri infeqciis da Hib-iT<br />
gamowveuli daavadebis sawinaaRmdego vaqcinebis<br />
gamoyenebis sakiTxis dayeneba.
24<br />
ПУТИ УЛУЧШЕНИЯ ЭПИДЕМИОЛОГИЧЕСКОГО НАДЗОРА ЗА<br />
МЕНИНГОКОККОВОЙ ИНФЕКЦИЕЙ И БАКТЕРИАЛЬНЫМИ<br />
МЕНИНГИТАМИ В ГРУЗИИ<br />
И. Мчедлишвили, Т. Мчедлишвили, М. Элошвили<br />
АКАДЕМИЯ НАУК ПРОФИЛАКТИЧЕСКОЙ МЕДИЦИНЫ ГРУЗИИ,<br />
ДЕПАРТАМЕНТ ЭПИДЕМИОЛОГИИ И БИОСТАТИСТИКИ ТГМУ,<br />
НАЦИОНАЛЬНЫЙ ЦЕНТР КОНТРОЛЯ БОЛЕЗНЕЙ И ОБЩЕСТВЕННОГО<br />
ЗДОРОВЬЯ<br />
Анализ данных официальной статистики за 1997-2007 гг. показал, что заболеваемость менингококковой<br />
инфекцией в Грузии имеет тенденцию к снижению, что, по нашему мнению, не отражает реальную<br />
картину и во многом объясняется теми недостатками, которые имеют место в деле выявления и<br />
регистрации инфекционных болезней.<br />
Для улучшения качества эпидемиологического надзора за менингококковой инфекцией и<br />
бактериальными менингитами в Грузии необходимо изучение серогрупповой характеристики<br />
менингококков, определение этиологической структуры бактериальных менингитов и установление<br />
удельного веса менингококков, пневмококков и гемофильных палочек типа Hib этой патологии. С этой<br />
целью необходимо значительное улучшение качества лабораторной диагностики как менингококковой<br />
инфекции, так и бактериальных менингитов.<br />
WAYS OF IMPROVING SURVEILLANCE SYSTEM<br />
FOR MENINGOCOCCAL INFECTION AND BACTERIAL<br />
MENINGITIS IN GEORGIA<br />
I.Mchedlishvili, T.Mchedlishvili, M.Eloshvili<br />
Analysis <strong>of</strong> datas coming from <strong>of</strong>ficial statistics <strong>of</strong> the year 1997-2007 explored that the trend <strong>of</strong> morbidity <strong>of</strong><br />
Meningococal infections in <strong>Georgia</strong> decreases permanently.<br />
Our understanding is a bit different. We think that existing datas do not reflect the reality that is a result <strong>of</strong><br />
multiple gaps existing in the field <strong>of</strong> detection and registration <strong>of</strong> infectious diseases.<br />
In order to improve the quality <strong>of</strong> surveillance for Meningococcal Infection and Bacterial Meningitis in<br />
<strong>Georgia</strong>, it is absolutely crucial to learn appropriately Serogroup characteristics, to determine structural aetiology<br />
<strong>of</strong> bacterial meningitis as well as the role <strong>of</strong> pneumococcus, Haemophilus influenza type Hib and meningococcus<br />
in developing this pathology.<br />
Main objective and goal is to improve significantly the quality <strong>of</strong> Laboratory diagnostics for Meningococcal<br />
Infections as well as for Bacterial Meningitis.<br />
literatura<br />
1. bocvaZe e. meningokokuri infeqcia. Tbilisi 1995 w.<br />
2. Королева И.С, Белошицкий Г.В, Закроева И.М. Совершенствование эпиднадзора за<br />
менингококковой инфекцией и гнойными бактериальными менингитами в Российской Федерации.//<br />
Эпидемиология и инфекционные болезни.-2006-№4-C. 31-35.<br />
3. Платонов А.Е. Николаев М.К. Заболеваемость гнойнимы менингитами у детей в возрасте до<br />
5 лет в регионах России.//Эпидемиология и инфекционные болезни.-2007-№3-C. 10-18.<br />
4. Hart C.A, Thomson A.P. J. Meningococcal disease and its managment in children. BMJ, 2006,333<br />
(7570), 685-690.
25<br />
alergologia, fizioTerapia<br />
santimetruli diapazonis mikrotalRebis<br />
eleqtromagnituri velis gavlena bronquli<br />
asTmis dros<br />
n. saakaSvili, i. Tarxan-mouravi, n. jakobia<br />
<strong>saqarTvelos</strong> pr<strong>of</strong>ilaqtikuri medicinis mecnirebaTa<br />
akademia, Tbilisis balneologiuri kurorti – <strong>saqarTvelos</strong><br />
kurortologiis, fizioTerapiis, reabilitaciisa da<br />
samkurnalo turizmis samecniero-praqtikuli centri<br />
bolo aTwleulSi aRiniSneba bronquli<br />
asTmiT daavadebisa da paTologiis damZimebis<br />
uwyveti zrdis tendencia (2, 4, 5).<br />
es mdgomareoba aqtualurs xdis problemas,<br />
gamoiZebnos aRniSnuli paTologiis<br />
mkurnalobis axali saSualebebi da am<br />
miznisTvis ufro farTod iqnas gamoyenebuli<br />
fizioTerapiuli faqtorebi,<br />
romelsac ar gaaCnia farmakologiuri sa-<br />
SualebebisaTvis damaxasiaTebeli zogierTi<br />
gverdiTi movlena.<br />
amasTan dakavSirebiT did interess<br />
iwvevs santimetruli diapazonis mikrotalRebis<br />
eleqtromagnituri veli (sdm<br />
emv). dadgenilia, rom aRniSnuli veli<br />
axdens anTebissawinaaRmdego da hiposensibilizaciur<br />
moqmedebas (1, 3). amitom,<br />
Cven mier gadawyda Segveswavla sdm emv<br />
gamoyenebis mizanSewoniloba bronquli<br />
asTmis samkurnalod.<br />
gamokvlevisa da mkurnalobis meTodebi.<br />
gamokvleul iqna bronquli asTmis<br />
mqone 102 vadmy<strong>of</strong>i, romelTaganac 49-s<br />
aReniSneboda daavadebis msubuqi, xolo<br />
53-s – saSualo simZimis mimdinareoba.<br />
avadmy<strong>of</strong>ebSi, klinikuri mdgomareobis<br />
gamokvlevis fonze, mkurnalobamde da<br />
mkurnalobis Semdeg, Seswavlil iqna: organizmis<br />
alergiuli da imunologiuri<br />
reaqtiuloba, organizmis araspecifikuri<br />
rezistentoba, garegani sunTqvisa da kardiohemodinamikis<br />
maCveneblebi, Tirkmelzeda<br />
jirkvlis glukokortikoiduli<br />
funqcia, cilis fraqciebis Semcveloba<br />
sisxlis Sratsa da C reaqtiul cilaze precipitaciis<br />
reaqciis intensivoba.<br />
mkurnalobis meTodika moicavda sdm<br />
emv dasxivebas paravertebrulad, calcalke,<br />
TiToeuli filtvis hilusis midamoSi<br />
12-14 wuTiT. proceduris saerTo<br />
xangrZlivoba Seadgenda 24-28 wuTs. mkurnalobis<br />
kursisaTvis iniSneboda 14-15<br />
procedura.<br />
miRebuli Sedegebis ganxilva. dadgenil<br />
iqna, rom santimetruli diapazonis<br />
mikrotalRebis eleqtromagnituri<br />
veliT mkurnaloba iwvevs bronquli asTmis<br />
mqone avadmy<strong>of</strong>ebSi Tirkmelzeda<br />
jirkvlis qerqis glukokortikoiduli<br />
funqciis stimulirebas, rasac sisxlSi<br />
axlavs biologiurad aqtiuri glukokortikosteroid<br />
kortizolis zrda. es<br />
axdens madesinsibilizebel da anTebissawinaaRmdego<br />
moqmedebas, rac vlindeboda<br />
alergenis Seyvanaze kanis momatebuli<br />
mgrZnobelobisa da C reaqtiul cilaze<br />
precipitaciis reaqciis intensivobis SesustebiT,<br />
gaqrobamde; saerTo araspecifikuri<br />
imunoglobulin E-s, α 1<br />
da α 2<br />
–<br />
globulinebis SemcirebiT da albuminebis<br />
momatebiT sisxlis SratSi.<br />
organizmis sensibilizaciisa da bronqebSi<br />
anTebiTi procesis Sesusteba,<br />
gaqrobamdec ki, iwvevda bronquli gamavlobis<br />
gaumjobesebasa da hipoqsiis Semcirebas.<br />
bronquli gamavlobis gaumjobeseba<br />
iwvevda filtvebis sarezervo SesaZleblobebis<br />
zrdas. bronquli asTmis mqone<br />
avadmy<strong>of</strong>ebSi, romlebmac Caitares mkurnaloba<br />
sdm emv-iT, aRniSnuli Zvrebi vlindeboda<br />
filtvebis sasicocxlo tevadobisa<br />
da maqsimaluri ventilaciis, forsirebuli<br />
sasicocxlo tevadobisa da<br />
erTwamiani forsirebuli sasicocxlo<br />
tevadobis, sunTqvis Sekavebis cdebis sidideebis,<br />
amosunTqvisa da CasunTqvis<br />
simZlavreebis zrdiT.
26<br />
bronquli gamavlobis zrda xels uwyobda<br />
sunTqvis gaiSviaTebas da arteriuli<br />
sisxlis JangbadiT gajerebis zrdas.<br />
hipoqsiis Semcireba (gaqrobamde) aumjobesebda<br />
qsovilebis mier Jangbadis<br />
moxmarebas, rac bronquli asTmis mqone<br />
avadmy<strong>of</strong>ebSi, romlebsac CautardaT sdm<br />
emv-iT mkurnalobis kursi, iwvevda venuri<br />
sisxlis JangbadiT gajerebis matebas.<br />
bronquli gamavlobis gaumjobeseba,<br />
filtvebis sarezervo saSualebebis mateba,<br />
hipoqsiis Semcireba, gaqrobamdec ki,<br />
manormalizeblad moqmedebda kardiohemodinamikis<br />
maCvenebelze, rac vlindeboda<br />
gulisa da dartymiTi indeqsebis momatebuli<br />
sidideebis daqveiTebiT; kuTri<br />
periferiuli sisxlZarRvovani winaaRmdegobis<br />
zrdiT; `filtv-yuris~ monakveTze<br />
sisxlis nakadis siCqaris zrdiT.<br />
organizmis sensibilizaciis, bronqeb-<br />
Si anTebiTi procesisa da hipoqsiis Sesusteba<br />
gaqrobamdec ki, iwvevda imunitetis<br />
ujreduli rgolis da imunobiologiuri<br />
reaqtiulobis gaZlierebas, rac periferiul<br />
sisxlSi vlindeboda T-limfocitebisa<br />
da T-helperebis raodenobis zrdiT<br />
da T-supresorebis Semcvelobis SemcirebiT.<br />
imunitetis ujreduli rgolis ga-<br />
Zliereba manormalizeblad moqmedebda<br />
humoruli imunitetis maCvenebelze.<br />
bronquli asTmis mqone avadmy<strong>of</strong>ebSi,<br />
romlebmac Caitares mkurnaloba sdm emviT,<br />
es procesi vlindeboda periferiul<br />
sisxlSi b–limfocitebis raodenobis<br />
zrdiT da sisxlis SratSi A da G klasebis<br />
imunoglobulinebis daqveiTebuli raodenobis<br />
matebiT. M klasis imunoglobulinebis<br />
Semcveloba sisxlis SratSi,<br />
rogorc mkurnalobamde, aseve mkurnalobis<br />
Semdeg, meryeobda normis farglebSi.<br />
organizmis sensibilizaciis da bronqebSi<br />
anTebiTi procesis Sesusteba da imunitetis<br />
ujreduli rgolis gaZliereba<br />
iwvevda organizmis araspecifikuri rezistentobis<br />
zrdas, rac bronquli asTmis<br />
mqone avadmy<strong>of</strong>ebSi, romlebmac Caitares<br />
mkurnaloba sdm emv-iT, vlindeboda<br />
fagocituri ricxvisa da fagocituri indesis<br />
zrdiT.<br />
organizmis sensibilizciis, bronqebSi<br />
anTebiTi procesisa da hipoqsiis Sesusteba,<br />
gaqrobamdec ki, aumjobesebda RviZlis<br />
metabolur funqcias, rasac Tan axlda<br />
sisxlis SratSi β da γ–globulinebis<br />
raodenobis mateba.<br />
organizmis sensibilizaciis, bronqeb-<br />
Si anTebiTi procesisa da hipoqsiis Sesusteba,<br />
gaqrobamdec ki, garegani sunTqvis<br />
funqciis, kardiohemodinamikisa da RviZlis<br />
metaboluri funqciis gaumjobeseba<br />
- manormalizeblad moqmedebda klinikur<br />
mdgomareobaze, rac vlindeboda avadmy<strong>of</strong>ebSi<br />
Civilebis SesustebiT an gaqrobiT,<br />
filtvebis mxriv _ auskultaciuri<br />
maCveneblebis gaumjobesebiT.<br />
bronquli asTmis mqone avadmy<strong>of</strong>ebSi,<br />
romlebmac Caitares mkurnaloba sdm emviT,<br />
subieqturi da obieqturi monacemebis<br />
gaumjobeseba metad iyo gamoxatuli<br />
bronquli asTmis msubuqi mimdinareobis<br />
dros.<br />
sdm emv-iT mkurnalobam dadebiTi gavlena<br />
moaxdina paTologiis msubuqi mimdinareobis<br />
mqone yvela avadmy<strong>of</strong>sa da<br />
daavadebis saSualo simZimiT mimdinareobis<br />
mqone 49 gamokvleulze.<br />
ВЛИЯНИЕ ЭЛЕКТРОМАГНИТНОГО ПОЛЯ САНТИМЕТРОВОГО<br />
ДИАПАЗОНА НА БОЛЬНЫХ БРОНХИАЛЬНОЙ АСТМОЙ<br />
Н. Саакашвили, И. Тархан-Моурави, Н. Джакобия<br />
АКАДЕМИЯ НАУК ПРОФИЛАКТИЧЕСКОЙ МЕДИЦИНЫ ГРУЗИИ, ТБИЛИССКИЙ<br />
БАЛЬНЕОЛОГИЧЕСКИЙ КУРОРТ – НАУЧНО-ПРАКТИЧЕСКИЙ ЦЕНТР<br />
КУРОРТОЛОГИИ, ФИЗИОТЕРАПИИ, РЕАБИЛИТАЦИИ И ЛЕЧЕБНОГО ТУРИЗМА<br />
ГРУЗИИ<br />
Обследовано 102 больных бронхиальной астмой, из которых у 49 отмечалось легкое течение патологии,<br />
а у 53 - среднетяжелое.<br />
Лечение больных заключалось в облучении электромагнитным полем микроволн сантиметрового<br />
диапазона (ЭМП МСД), паравертебрально - в области проекции гилюсов каждого легкого, по 12-14<br />
мин. Общая продолжительность процедуры составляла 24-28 мин. На курс лечения назначалось 14-15<br />
процедур. Процедуры проводились ежедневно, кроме воскресных дней.<br />
Установлено, что лечение ЭМП МСД вызывает у больных бронхиальной астмой повышение в крови<br />
биологически активного глюкокортикостероида – кортизола, что оказывало противовоспалительное и<br />
гипосенсибилизирующее действие.
27<br />
Снижение, вплоть клинического до исчезновения, признаков сенсибилизации организма и<br />
воспалительного процесса в бронхах вызывало усиление иммунобиологической реактивности, клеточного<br />
звена иммунитета и неспецифической реактивности организма; нормализующе действовало на показатели<br />
гуморального иммунитета; улучшалo функцию внешнего дыхания, кардиогемодинамику, метаболическую<br />
функцию печени и общее клиническое состояние.<br />
Положительные изменения, вызванные лечением электромагнитным полем волн сантиметрового<br />
диапазона, уменьшались по мере степени тяжести патологии.<br />
Лечение ЭМП МСД оказало положительное действие на всех больных с легким течением<br />
бронхиальной астмы и на 49 - со среднетяжелым течением заболевания.<br />
EFFECT OF CENTIMETRIC RANGE ELECTROMAGNETIC FIELD<br />
ON PATIENTS WITH BRONCHIAL ASTHMA<br />
N. Saakashvili, I. Tarkhan-Mouravi, N. Jakobia<br />
Total <strong>of</strong> 102 patients with bronchial asthma were examined, among them 49 patients were with light form <strong>of</strong><br />
the pathology and 53 - with moderate-serious form.<br />
The treatment <strong>of</strong> these patients involved a paravertebral irradiation <strong>of</strong> hilus projection region <strong>of</strong> each lung<br />
with centimetric range microwave electromagnetic field during 12-14 minutes. The general duration <strong>of</strong> this<br />
process was 24-28 minutes. The course <strong>of</strong> treatment lasted 14-15 procedures. The procedure was carried on<br />
daily except Sundays.<br />
It has been established that the treatment with centimetric range microwave electromagnetic field induced<br />
an increase <strong>of</strong> biologically active glucocorticoid-cortisol in the blood <strong>of</strong> patients with bronchial asthma which had<br />
a desensitizing influence and anti-inflammatory action.<br />
The decrease <strong>of</strong> sensibilization <strong>of</strong> the organism and inflammatory process in the bronchus right up to disappearance<br />
evoked an intensification <strong>of</strong> immunobiological reactivity <strong>of</strong> cellular link <strong>of</strong> the immunity and nonspecific<br />
resistance <strong>of</strong> the organism. At the same time it affected the indices <strong>of</strong> humoral immunity, improved a<br />
function <strong>of</strong> external respiration and cardiohemodynamics, a metabolic function <strong>of</strong> the liver and clinical state <strong>of</strong><br />
the patient.<br />
Positive changes as a result <strong>of</strong> the treatment with centimetric range microwave electromagnetic field were<br />
reduced in accordance with a worsening <strong>of</strong> the pathology.<br />
The treatment with centimetric range microwave electromagnetic field had a positive action on all the patients<br />
with a light duration <strong>of</strong> bronchial asthma and 49 patients with moderate-serious form <strong>of</strong> the disease.<br />
literatura<br />
1. Боголюбов В.М., Пономаренко Г.Н. Общая физиотерапия. – М.: Медпрессинформ, 1999. – 258 с.<br />
2. Новые индустрияльные технологии и астма. Эпидемии астмы в России /Л.В. Лусс, А.В. Богова,<br />
В.Д. Прокопенко, Н.И. Ильина //International J. on Immunorehabilitation/ - 1999.- N11. - P. 117-121.<br />
3. Соколова Н.Г., Соколова Т.В. Физиотерапия. – Ростов-на-Дону.: Феникс, 2004. – 320 с.<br />
4. Хаитов Р.М., Игнатьева Г.А., Сидоревич И.Г. Иммунология. – М.: Медицина, 2000. – 430 с.<br />
5. Sim K.M., Kcogh B.F. Ventilation in severe acute asthma: is there safety in numbers //Thorax. – 2001. –<br />
Vol. 49. –P. 297-299.
28<br />
pr<strong>of</strong>paTologia<br />
Tbilisis metropolitenis muSakTa Sromis<br />
pirobebi, janmrTelobis mdgomareoba da misi<br />
gaumjobesebis RonisZiebebi<br />
r. kverenCxilaZe, m. cimakuriZe, l. baqraZe, n. xunaSvili<br />
<strong>saqarTvelos</strong> pr<strong>of</strong>ilaqtikuri medicinis mecnierebaTa<br />
akademia, Tbilisis saxelmwifo <strong>samedicino</strong> universitetis<br />
garemosa da pr<strong>of</strong>esiuli medicinis departamenti<br />
dasaqmebuli mosaxleobis Sromis usafrTxo<br />
pirobebis Seqmna da janmrTelobis<br />
dacva pr<strong>of</strong>ilaqtikuri medicinis,<br />
kerZod, Sromis medicinis erT-erTi prioritetuli<br />
mimarTulebaa [3,7,21]. muSak-<br />
Ta janmrTelobis mdgomareobis ganmtkicebisa<br />
da Sromisunarianobis amaRlebis<br />
ZiriTadi safuZveli Sromis racionaluri<br />
pirobebis uzrunvely<strong>of</strong>aa.<br />
sazogadoebis ganviTarebis Tanamedrove<br />
etapze erovnuli meurneobis sxvadasxva<br />
dargis sawarmoebSi formirebuli<br />
Sromis pirobebis damaxasiaTebeli<br />
Taviseburebaa sxvadasxva saxis pr<strong>of</strong>esiul<br />
faqtorTa kompleqsuri moqmedeba<br />
[8,10], rac kanonzomierad aisaxeba<br />
dasaqmebulTa janmrTelobis mdgomareobis<br />
darRvevebis specifikuri suraTis<br />
formirebaSi [13,18]. am faqtorTa kombinirebuli<br />
moqmedebis gamo, dasaqmebuli<br />
mosaxleobis Sromisa da janmrTelobis<br />
dacvis RonisZiebaTa sistemaSi sul ufro<br />
mniSvnelovania janmrTelobis riskis<br />
faqtorTa kompleqsuri Sefaseba [19,20],<br />
rac momuSaveTa Sromisunarianobis gazrdis,<br />
aqtiuri SromiTi saqmianobis periodisa<br />
da jansaRi sicocxlis gaxangrZlivebis,<br />
janmrTelobis maCveneblebis gaumjobesebisaken<br />
mimarTuli RonisZiebebis<br />
SemuSavebis safuZvelia [2,4,17]. es ki<br />
TavisTavad umniSvnelovanesi <strong>samedicino</strong>,<br />
socialuri da ekonomikuri problemaa<br />
[11,16].<br />
pr<strong>of</strong>esiuli faqtorebis moqmedebaze<br />
organizmis sapasuxo reaqciis speqtri<br />
mravalferovania da 6 Tanmimdevruli<br />
etapisagan Sedgeba: 1. ucnobi xasiaTis<br />
Zvrebi organizmSi; 2. janmrTelobis dar-<br />
Rvevis morfologiuri, funqciuri, bioqimiuri,<br />
imunologiuri niSnebi; 3. avadoba;<br />
4. invalidoba; 5. genotipis dazianebis<br />
niSnebi; 6. sikvdiloba [5]. aRniSnuli faqtorebis<br />
drouli gamovlena, pr<strong>of</strong>ilaqtikuri<br />
RonisZiebebis SemuSaveba da realizacia<br />
dasaqmebulTa janmrTelobis SenarCunebis<br />
mtkice garantiaa [6,14].<br />
Sromis medicinis pr<strong>of</strong>esionalebis<br />
mier <strong>saqarTvelos</strong> pirobebSi mniSvnelovani<br />
kvlevebia Catarebuli erovnuli<br />
meurneobis sxvadasxva dargSi dasaqmebulTa<br />
Sromis pirobebisa da janmrTelobis<br />
mdgomareobis Seswavlis mimarTulebiT,<br />
saTanado gamajansaRebeli<br />
RonisZiebebis SemuSavebiT, romelTa danergva<br />
<strong>samedicino</strong>, socialuri da<br />
ekonomikuri efeqtis mqonea.<br />
Tanamedrove etapze naklebadaa Seswavlili<br />
mosaxleobis dasaqmebis iseTi mniSvnelovani<br />
sfero, rogoricaa Sidasaqalaqo<br />
transportis eqspluatacia.<br />
es garemoeba gansakuTrebiT TvalsaCino<br />
xdeba sadReisod, rodesac Cveni qveynis<br />
mosaxleobis didi nawili dedaqalaqSia<br />
Tavmoyrili, rac ganapirobebs Sidasaqalaqo<br />
transportis rolis gazrdas,<br />
erTi mxriv, misi masobrivi gamoyenebiT,<br />
xolo meore mxriv satransporto saSualebebis<br />
eqspluataciaze dasaqmebuli<br />
pirebis raodenobis matebiT.<br />
Sidasaqalaqo transportis eqspluataciaze<br />
dasaqmebul pirTa Sromis pirobebisa<br />
da janmrTelobis mdgomareobis Seswavlis<br />
safuZvelze Sesabamisi RonisZiebebis<br />
SemuSavebas dRemde naklebi yuradReba<br />
eqceva.<br />
Tanamedrove msxvil qalaqebSi, maT<br />
Soris TbilisSi, Sidasaqalaqo transportis<br />
wamyvani saxea metropoliteni. ms<strong>of</strong>lios<br />
sxvadasxva qalaqSi 150-wliani eqspluataciis<br />
gamocdilebis miuxedavad,
29<br />
specialur literaturaSi metad mwiri<br />
monacemebia metropolitenis muSakTa<br />
Sromis medicinis problemebze. Seswavlili<br />
araa regionis klimatur-geografiuli<br />
Taviseburebebi, romelic gavlenas<br />
axdens Sromis pirobebis formirebaze,<br />
rac momuSaveTa janmrTelobis mdgomareobazec<br />
aisaxeba [12].<br />
Tbilisis metropolitenSi, misi arsebobis<br />
40 welze meti istoriis manZilze, Sromis<br />
medicinis TvalsazrisiT, calkeuli<br />
kvlevebi Catarda gasuli saukunis 70-ian<br />
wlebSi, ris safuZvelzec gaanalizebuli<br />
iyo ZiriTadad Ramis cvlaSi momuSaveTa<br />
Sromis pirobebisa da janmrTelobis mdgomareobis<br />
zogierTi aspeqti, agreTve, memanqaneTa<br />
organizmis fsiq<strong>of</strong>iziologiuri<br />
funqciis zogierTi maCvenebeli. kvlevis<br />
Sedegad dadginda gamokvleuli kontingentis<br />
Sromis araxelsayreli reJimis arseboba,<br />
rac gavlenas axdens momuSaveTa<br />
organizmis funqciasa da janmrTelobis<br />
mdgomareobaze [9].<br />
calkeuli gamokvleviT dadgenilia<br />
Tbilisis metropolitenis garemos zogierTi<br />
riskis faqtoris gavlena metropolitenis<br />
eqspluataciaze dasaqmebulTa<br />
janmrTelobis mdgomareobaze; dasabuTebulia<br />
kompleqsuri higienuri da<br />
klinikuri gamokvlevebis Catarebis aucilebloba<br />
samuSao garemosa da janmrTelobis<br />
mdgomareobis gaumjobesebis,<br />
<strong>samedicino</strong> momsaxurebis sistemis Semdgomi<br />
sruly<strong>of</strong>is TvalsazrisiT [1,15].<br />
<strong>saqarTvelos</strong> janmrTelobis dacvis<br />
samsaxurSi mimdinare kardinaluri reformebi,<br />
garkveulwilad, aisaxa Tbilisis<br />
metropolitenis muSakTa Sromis pirobebisa<br />
da janmrTelobis mdgomareobis<br />
uzrunvely<strong>of</strong>is organizaciazec.<br />
Tbilisis metropolitenis garemos<br />
mdgomareobis (meteorologiuri pirobebi,<br />
haerSi mtvrisa da toqsikuri airebis<br />
Semcveloba, xmaurisa da vibraciis doneebi)<br />
monitorings awarmoebs sauwyebo laboratoria<br />
- Tbilisis metropolitenis<br />
eleqtromeqanikuri samsaxuris laboratoriuli<br />
centri. igi, saTanado gamokvlevebis<br />
Catarebis safuZvelze, adgens<br />
garemos maCveneblebis Sesabamisobas<br />
higienur normativebTan da, saWiroebis<br />
SemTxvevaSi, rekomendaciebiT mimarTavs<br />
obieqtis administracias. ukanasknel periodSi<br />
misi uflebamosilebis areali<br />
mniSvnelovnad Seikveca - mis mier warmoebs<br />
mxolod haeris temperaturisa da<br />
tenianobis kontroli. es garemoeba metad<br />
arasaxarbieloa, vinaidan qveyanaSi ar arsebobs<br />
erTiani saxelmwifo sanitariuli<br />
samsaxuri da ar warmoebs garemo faqtorebis<br />
mdgomareobis sanitariuli kontroli.<br />
amdenad, kontrolis sferos miRmaa<br />
darCenili sawarmoo garemos iseTi<br />
mniSvnelovani faqtorebi, rogoricaa<br />
haerSi mtvrisa da toqsikuri airebis Semcveloba,<br />
xmauri da vibracia, rac arasasurvelad<br />
aisaxeba momuSaveTa janmrTelobaze.<br />
jandacvis samsaxuris reformamdel<br />
periodSi Tbilisis metropolitenSi<br />
dasaqmebulTa <strong>samedicino</strong> momsaxurebas<br />
awarmoebda sauwyebo <strong>samedicino</strong> dawesebuleba<br />
- <strong>saqarTvelos</strong> rkinigzis poliklinika.<br />
poliklinikis klinicistTa da<br />
laboratoriuli centris higienistTa<br />
mWidro TanamSromlobis safuZvelze<br />
tardeboda muSakTa janmrTelobis mdgomareobis<br />
<strong>samedicino</strong> monitoringi - perioduli<br />
<strong>samedicino</strong> gasinjvebi, saTanado<br />
rekomendaciebis SemuSavebiT. amJamad<br />
metropolitenis muSakTa janmrTelobaze<br />
dakvirveba - pirveladi <strong>samedicino</strong><br />
Semowmeba, xorcieldeba saxazo <strong>samedicino</strong><br />
punqtebis mier, romelic dakompleqtebulia<br />
saSualo <strong>samedicino</strong> personaliT<br />
(metros sadgurebSi `didube~ da<br />
`varkeTili~). metropolitenis muSakTa<br />
<strong>samedicino</strong> momsaxurebis organizacia<br />
aRniSnuli sqemiT aSkarad arasakmarisia<br />
da ver uzrunvely<strong>of</strong>s saTanado efeqts.<br />
arsebuli situaciis analizma aCvena,<br />
rom Tbilisis metropolitenis muSakTa<br />
Sromis pirobebisa da janmrTelobis<br />
mdgomareobis kontrolisa da dacvis realuri<br />
mdgomareoba ar Seesabameba sasurvels,<br />
rac aqtualurs xdis Sromis medicinis<br />
specialistTa Zalisxmevis gaZlierebas<br />
aRniSnuli mimarTulebiT.<br />
Tanamedrove etapze, qveynis socialur-ekonomikuri<br />
ganviTarebis mdgomareobis<br />
gaTvaliswinebiT, Tbilisis metropolitenis<br />
muSakTa Sromis pirobebisa da<br />
janmrTelobis mdgomareobis Semdgomi<br />
gaumjobesebis gadaudebel amocanaTa<br />
rigs miekuTvneba:<br />
Tbilisis metropolitenis muSakTa<br />
Sromis pirobebisa da janmrTelobis<br />
mdgomareobis sistematuri, gegmazomieri<br />
Seswavla sazogadoebrivi jandacvis samsaxuris<br />
Sesabamisi struqturebis mWidro<br />
TanamSromlobis safuZvelze, saTanado<br />
gamajansaRebeli RonisZiebebis SemuSavebiT;<br />
sawarmoo garemosa da SromiTi procesis<br />
mdgomareobis sistematuri kontroli;
30<br />
sauwyebo laboratoriis - Tbilisis<br />
metropolitenis eleqtromeqnikuri samsaxuris<br />
laboratoriuli centris aRWurva<br />
kvlevis Tanamedrove aparaturiTa da<br />
sxva saSualebebiT sawarmoo garemos faqtorebis<br />
(meteorologiuri pirobebi,<br />
haerSi mtvrisa da toqsikuri airebis Semcveloba,<br />
xmaurisa da vibraciis done)<br />
mdgomareobis sruly<strong>of</strong>ili kvlevis<br />
mizniT;<br />
sauwyebo laboratoriis saTanado<br />
uflebamosilebiT aRWurva sawarmoo<br />
garemos riskis faqtorebis gamokvlevisa<br />
da Sefasebis mizniT;<br />
Tbilisis metropolitenis muSakTa<br />
winaswari da perioduli <strong>samedicino</strong> gasinjvebis<br />
organizacia saTanado kanonqvemdebare<br />
aqtebis moTxovnaTa sruli<br />
dacviT; miRebuli Sedegebis analizi;<br />
Tbilisis metropolitenis muSakTa<br />
riskis faqtorebis Sefasebisa da janmrTelobis<br />
mdgomareobis Seswavlis<br />
safuZvelze kompleqsuri gamajansaRebeli<br />
RonisZiebebis SemuSaveba;<br />
SemuSavebuli da mowodebuli<br />
RonisZiebebis realizaciisa da efeqturobis<br />
monitoringi;<br />
Sromis medicinis samsaxuris (centris)<br />
Seqmna (<strong>saqarTvelos</strong> rkinigzis<br />
struqturaSi an damoukideblad), romelic<br />
mocemul sferoSi koordinacias gauwevs<br />
erovnuli meurneobis dasaqmebulTa<br />
Sromisa da janmrTelobis dacvasTan<br />
dakavSirebuli sakiTxebis realizacias.<br />
amdenad, metropolitenis eqspluataciaze<br />
dasaqmebulTa Sromisa da janmrTelobis<br />
dacvis sakiTxebis gadawyveta<br />
Tanamedrove socialur-ekonomikuri<br />
pirobebis gaTvaliswinebiT aqtualurs<br />
xdis kompleqsuri higienuri da klinikurfunqciuri<br />
kvlevebis Catarebas, ris<br />
safuZvelzec dadgindeba sawarmoo garemos<br />
riskis faqtorebis speqtri, higienurklinikuri<br />
Sepirispirebis gziT gamovlindeba<br />
momuSaveTa janmrTelobaze maTi<br />
gavlenis xasiaTi da xarisxi. es ki mizanmimarTuli<br />
kompleqsuri gamajansaRebeli<br />
RonisZiebebis SemuSavebis safuZvels Seqmnis,<br />
rac erovnuli meurneobis mocemul<br />
sferoSi dasaqmebulTa janmrTelobis<br />
ganmtkicebis winapirobaa.<br />
СОВРЕМЕННОЕ СОСТОЯНИЕ ИЗУЧЕНИЯ УСЛОВИЙ ТРУДА И<br />
ЗДОРОВЬЯ РАБОТНИКОВ ТБИЛИССКОГО МЕТРОПОЛИТЕНА И<br />
ОСНОВНЫЕ НАПРАВЛЕНИЯ ПО ИХ УЛУЧШЕНИЮ<br />
Р. Кверенчхиладзе, М. Цимакуридзе, Л. Бакрадзе, Н. Хунашвили<br />
АКАДЕМИЯ НАУК ПРОФИЛАКТИЧЕСКОЙ МЕДИЦИНЫ, ДЕПАРТАМЕНТ<br />
МЕДИЦИНЫ ОКРУЖАЮЩЕЙ СРЕДЫ И ПРОФЕССИОНАЛЬНОЙ МЕДИЦИНЫ<br />
ТБИЛИССКОГО ГОСУДАРСТВЕННОГО МЕДИЦИНСКОГО УНИВЕРСИТЕТА<br />
Труд и здоровье работников современного вида общественного транспорта - метрополитена требует<br />
пристального внимания специалистов медицины труда. Несмотря на150-летний опыт функционирования<br />
метрополитена, вопросы комплексного изучения условий труда и состояния здоровья работников<br />
метрополитена с разработкой оздоровительных мероприятий все еще требуют дальнейших исследований<br />
и разработок. Сведения литературы не учитывают климато-географические особенности региона,<br />
влияющие на формирование факторов риска и, следовательно, на состояние здоровья этих работников.<br />
На основании проведенных в 70-ые годы отдельных исследований на базе Тбилисского метрополитена<br />
установлены изменения психо-физиологического состояния здоровья работников в результате влияния<br />
факторов производственной среды и трудового процесса. Современное состояние охраны труда и здоровья<br />
работников Тбилисского метрополитена требует комплексного подхода к решению проблемы, что<br />
позволит значительно улучшить положение. В современных социально-экономических условиях среди<br />
задач, требующих пристального внимания, первостепенными являются мероприятия, направленные на<br />
улучшение контроля факторов риска производственной среды и трудового процесса; оптимизация<br />
медицинского обеспечения работающего контингента, в частности, проведение предварительных и<br />
периодических медицинских осмотров в соответствии с требованиями национальных нормативнометодических<br />
документов Грузии.
31<br />
CURRENT STATE OF THE STUDY OF TBILISI METRO WORKERS’<br />
HEALTH AND WORKPLACE CONDITIONS AND KEY ASPECTS OF ITS<br />
IMPROVEMENT<br />
R. Kverenchkhiladze, M.Tsimakuridze, L.Bakradze, N.Khunashvili<br />
The workplace conditions and the health <strong>of</strong> the workers’ engaged in the most common type <strong>of</strong> the modern<br />
transport industry – metro, require close attention from the occupational health pr<strong>of</strong>essionals. Despite the 150<br />
year working experience with metro, the issues <strong>of</strong> studying the workers’ state <strong>of</strong> health and working conditions<br />
and developing sanitation measures are not at the satisfactory level. Existing datas and literature do not take into<br />
account climate and geographical peculiarities <strong>of</strong> the region, that have an effect on risk factors and accordingly,<br />
on the workers’ health. On the basis <strong>of</strong> the research <strong>of</strong> Tbilisi metro, that were conducted in the 70s <strong>of</strong> the last<br />
century, some psycho –physiological changes in the workers state <strong>of</strong> health as a result <strong>of</strong> the working conditions<br />
and environment influence were determined. The current state <strong>of</strong> securing workers’ health requires complex<br />
approach <strong>of</strong> finding the solution, that will provide help for further improvements. At the time <strong>of</strong> current social and<br />
economical conditions, the issues <strong>of</strong> improving assessment <strong>of</strong> the risk in the industrial environment and working<br />
processes, optimizing the services provided by the working contingent and conducting preliminary and periodical<br />
medical examinations in accordance to the governmental normative and methodical document measures, in<br />
particular, are <strong>of</strong> primary importance.<br />
literatura<br />
1. baqraZe l., cimakuriZe m., zuraSvili d., xaWapuriZe d., maisuraZe e. dasaqmebuli<br />
mosaxleobis <strong>samedicino</strong> daxmarebis organizaciis Tanamedrove mdgomareoba (Tbilisis<br />
metropolitenis magaliTze). //samecniero SromaTa krebuli./Tssu. – t. XL. Tbilisi:<br />
2004. – gv. 57-59.<br />
2. kverenCxilaZe r., saakaZe v., javaxaZe r. da sxv. dasaqmebuli mosaxleobis janmrTelobis<br />
dacvis problemebi saqarTveloSi. //”<strong>saqarTvelos</strong> garemos higienis<br />
erovnuli programa”. /I erovnuli konferencia. /masalebi. Tbilisi: 2001. - gv. 203-205.<br />
3. saakaZe v. pr<strong>of</strong>esiuli daavadebebi. Tbilisi: zekari. - 2000. - 806 gv.<br />
4. cimakuriZe m. sawarmoo garemoTi gamowveuli paTologiis <strong>samedicino</strong> prevenciis<br />
Tanamedrove problemebi saqarTveloSi. //samecniero SromaTa krebuli. /Tssu. t.<br />
XXXIX. – 2003. - gv. 376-379.<br />
5. Измеров Н.Ф., Каспаров А.А. Медицина труда. Введение в специальность. М.: Медицина. -<br />
2002. - 392 с.<br />
6. Измеров Н.Ф. Концептуальные подходы к сохранению и укреплению здоровья работающего<br />
населения России.// Бюллетень научного совета “Медико-экологические проблемы работающих”. - 2003.<br />
- №1. - С. 4-10.<br />
7. Измеров Н.Ф., Сквирская Г.П. Социальная ответственность работодателя за здоровье<br />
работающих и роль медицины труда в современных условиях. //Медицина труда и промышленная<br />
экология. 2003. - №12. – С. 4-8.<br />
8. Каримова Л.К. Научные основы системы оценки и управления рисками в нефтехимической<br />
промышленности: Автореф. дисс. ... док. мед. наук.- Киев: 1999. - 48 с.<br />
9. Курашвили М.Е., Саакадзе В.П., Ломтатидзе Н.Г., Кверенчхиладзе Р.Г. Труд,<br />
заболеваемость и состояние здоровья рабочих Тбилисского метрополитена, занятых исключительно на<br />
ночных работах. //Сб. трудов ТГМИ. – Т. XXIV. Тбилиси: 1975. – С. 92-95.<br />
10. Липенецкая Т.Д., Дунаева С.А., Полякова С.П. Межцентральные отношения в коре больших<br />
полушарий головного мозга человека при хроническом действии неблагоприятных производственных<br />
факторов. //Медицина труда и промышленная экология. 2004. - №8. – С. 23-28.
32<br />
11. Молодкина Н.Н. Проблема профессионального риска. Оценка и социальная защита. //Медицина<br />
труда и промышленная экология. 1998. - №6. – С. 41-48.<br />
12. Ретнев В.М. К вопросу об оценке тяжести и напряженности трудового процесса в медицине<br />
труда. //Медицина труда и промышленная экология. 1999. - №10. – С.11-14.<br />
13. Ретнев В.М., Шляхецкий Н.С. Об определении понятий, необходимых при оценке вредного<br />
воздействия экологического фактора среды обитания. //Научные чтения “Белые ночи-2003” /Материалы<br />
VII Международных научных чтений Международной Академии наук экологии и безопасности<br />
жизнедеятельности. - МАНЭБ. - 2003.- С. 97-98.<br />
14. Тюрина И.А. Гигиеническое обоснование оптимизации условий труда при физико-химическом<br />
упрочении мощных угольных пластов и последующей их разработке: Автореф. дисс. ... канд. мед. наук.<br />
М.: 1992. - 22 с.<br />
15. Цимакуридзе М.П., Бакрадзе Л.Ш., Кверенчхиладзе Р.Г., Кварцхава М.Л., Майсурадзе<br />
Э.А. Принципы охраны труда и здоровья работников Тбилисского метрополитена в условиях новых<br />
социально-экономических отношений.//<strong>Georgia</strong>n <strong>Medical</strong> News. 2006. - #4 (133). - C.105-107.<br />
16. Якимова Л.Д. Состояние и социально-экономические проблемы охраны труда. //Бюллетень<br />
Научного Совета “Медико-экологические проблемы работающих”. - 2003. №1. - С. 29-33.<br />
17. Яковлева Т.П., Тихонова Г.И., Головкова Н.П. Влияние условий труда на предстоящую<br />
продолжтиельность жизни работников отдельных профессий. //Медицина труда и промышленная экология.<br />
2004. Т.№4.-С.14-19.<br />
18. Abueye C. Kelbessa U. Wolde-Gebriels Health effect <strong>of</strong> Cassava consum ption in south Elhiopici. //<br />
EastAfrican <strong>Medical</strong> Sournal. 75(3):16670. 1998 Mar.<br />
19. Bardana E.J., Montaro A.O., Hollaren M.T.//Occupational asthma. – USA, UK, Canada, 1995. –<br />
P. 267-282.<br />
20. Chiba S.E., Chiba H.P., Ong C.N. // Occup. Med. – 1996. – Vol. 46, № 1. – P. 59-64.<br />
21. Thomas P.T. // Toxicol. Subst. J. – 1990. – Vol. 10, N 3. – P. 241-273.
33<br />
aRniSnuli kontingentidan fsiq<strong>of</strong>iziologiuri<br />
kvlevis Catarebaze daTanxmda<br />
ZiriTadi jgufis 42 da sakontrolo<br />
jgufis 28 pacienti.<br />
sensorul-motoruli reaqcia Seiswavleboda<br />
landoltis tipis rgolebis<br />
gamoyenebiT kompiuterul reJimSi. ekranis<br />
muq fonze Cndeboda naTeli rgolebi<br />
3 an 5 WriliT, kadris eqspozicia – 36 mwm,<br />
intervalis xangrZlivoba kadrebs Soris<br />
– 1800 mwm. davaleba ki imaSi gamoixateboda,<br />
rom sakvlev pirs unda epasuxa sinaTlis<br />
yvela stimulze erTmniSvnelovnad<br />
– `mausis” marcxena Rilakze<br />
daWeriT. fsiqoemociuri (fsiqikuri)<br />
datvirTvisas ki (garCevisa da amorCevis<br />
amocana) – ekranis muq fonze Cndeboda<br />
rgolebi 3 an 5 (kenti) da 4 (luwi) WriliT.<br />
gamokvlevis obieqts kentWrilian rgolebze<br />
unda epasuxa `mausis” marcxena<br />
Rilakze daWeriT, xolo luwWrilian<br />
rgolebze – marjvena Rilakze daWeriT.<br />
kompiuteruli programa TiToeul signalze<br />
aregistrirebda reaqciis dros<br />
(Rt), swori, araswori, gamotovebuli pasuxebisa<br />
da Secdomebis raodenobas (e.i.<br />
muSaobis xarisxs).<br />
miRebuli Sedegebi da maTi ganxilva.<br />
rogorc aRvniSneT, sensomotoruli reqcia<br />
da fsiqoemociuri produqtiuloba<br />
Seswavlil iqna ZiriTadi jgufis 42 da sakontrolo<br />
jgufis 28 avadmy<strong>of</strong>ze. martivi<br />
sensomotoruli muSaobis Sesrulebisas,<br />
rogorc ZiriTadi, aseve sakontrolo<br />
jgufis pacientebi sinaTlis stimulze<br />
araswor pasuxs, praqtikulad, ar iZlediabetologia,<br />
fsiqologia<br />
sensomotoruli da fsiqoemociuri<br />
produqtiuloba araproliferaciuli<br />
retinopaTiiT garTulebuli Saqriani<br />
diabetis dros<br />
a. cibaZe, l. cucqiriZe, r. yuraSvili, m. korkelia, d. cibaZe<br />
<strong>saqarTvelos</strong> pr<strong>of</strong>ilaqtikuri medicinis mecnierebaTa<br />
akademia,<br />
<strong>saqarTvelos</strong> diabetis centri, Tbilisis saxelmwifo<br />
<strong>samedicino</strong> universiteti<br />
Saqriani diabetiT daavadebul pacientebSi<br />
xSirad vlindeba fsiqologiuri<br />
problemebi da fsiqikuri darRvevebi, rac<br />
uary<strong>of</strong>iTad moqmedebs daavadebis mimdinareobasa<br />
da mkurnalobis Sedegze (1,<br />
2, 3, 4). Cveni kvlevebis Tanaxmad, Saqriani<br />
diabetis tipi 1 da tipi 2 dros xSiria<br />
depresiuli gamovlinebebi, rac 53%-s<br />
Seadgens. garTulebis arsebobisas ki es<br />
gamovlinebebi gacilebiT metia, mag. araproliferaciuli<br />
retinopaTiis SemTxvevaSi<br />
84,8%-s aRwevs (5).<br />
zemoaRniSnulidan gamomdinare, miznad<br />
davisaxeT, Segveswavla Saqriani diabetiT<br />
daavadebul pirTa sensomotoruli da<br />
fsiqoemociuri produqtiuloba Semdgomi<br />
adekvaturi simptomaturi mkurnalobis<br />
Casatareblad.<br />
masala da meTodika. meTvalyureobis<br />
qveS imy<strong>of</strong>eboda Saqriani diabetiT daavadebuli<br />
250 avadmy<strong>of</strong>i, romlebic day<strong>of</strong>ili<br />
iyvnen ZiriTad (135 pacienti) da<br />
sakontrolo (115 pacienti) jgufebad.<br />
ZiriTad jgufSi araproliferaciuli retinopaTiiT<br />
garTulebuli tipi 1 diabetiT<br />
warmodgenili iyo 40 avadmy<strong>of</strong>i,<br />
xolo tipi 2-iT – 85. sakontrolo jguf-<br />
Si, garTulebis gareSe, tipi 1 diabeti<br />
aRiniSna 56 SemTxvevaSi, xolo tipi 2 – 59-<br />
Si. ZiriTadi jgufis pacientebidan 29<br />
pirs ar gamouvlinda depresia, xolo sa-<br />
Sualo simZimis depresiis simptomebi<br />
gamouvlinda 106 pirs. sakontrolo jguf-<br />
Si msubuqi xarisxis depresiis simptomebi<br />
gamouvlinda 61-s, xolo simptomebis<br />
gareSe iyo 54 avadmy<strong>of</strong>i.<br />
3. <strong>saqarTvelos</strong> <strong>samedicino</strong> <strong>Jurnali</strong>, 3, 2008 w.
34<br />
grama. Tu depresiis aramqone pacienteb-<br />
Si reaqciis drois histograma, rogorc<br />
martivi sensomotoruli amocanis gadawyvetisas,<br />
ise fsiqoemociuri datvirTvis<br />
dros, TiTqmis, normaluri ganawilebis<br />
formas atarebda. depresiis simptomebis<br />
mqone pacientebSi martivi sensomotoruli<br />
amocanis gadawyvetisas histograma<br />
iRebda uwesrigo xasiaTs, fsiqoemociuri<br />
datvirTvis SemTxvevaSi ki ufro organizebuli<br />
xdeboda (Tumca, mainc Sors iyo<br />
normaluri ganawilebisagan).<br />
amgvarad, Saqriani diabetiT daavadebul<br />
pacientebSi, rogorc sakontrolo,<br />
bi uSvebdnen SecdomaTa umniSvnelo<br />
raodenobas (2±1,5%), rac uaxlovdeboda<br />
janmrTeli pirebis monacemebs, maSin<br />
rodesac depresiis simptomebis mqone sakontrolo<br />
jgufis pacientebSi daSvebul<br />
SecdomaTa raodenoba 17±2,4%-s aRwevda.<br />
am ukanasknel qvejgufSi gamotovebulma<br />
pasuxebma 9±3,5% Seadgina. rac Seexeba<br />
ZiriTad jgufs, sagrZnoblad maRali iyo,<br />
rogorc daSvebul SecdomaTa, ise gamotovebuli<br />
pasuxebis raodenobac.<br />
gansakuTrebiT informaciuli aRmoCnda<br />
sinaTliT gamRizianebelze reaqciis<br />
drois xangrZlivobis ganawilebis histotipi<br />
1 da tipi 2 Saqriani diabetiT daavadebul<br />
pacientTa muSaobis xarisxi sensomotoruli da<br />
fsiqoemociuri datvirTvis dros<br />
sensomotoruli<br />
reaqcia<br />
fsiqomotoruli<br />
datvirTva<br />
tipi 1 da tipi 2 Saqriani diabetiT<br />
daavadebuli pacientebi n=64<br />
araswori<br />
pasuxi<br />
gamotovebuli<br />
pasuxi<br />
reaqciis dro<br />
araswori<br />
pasuxi<br />
gamotovebuli<br />
pasuxi<br />
reaqciis dro<br />
ZiriTadi<br />
jgufi n=42<br />
sakontrolo<br />
jgufi n=28<br />
depresiis niSnebis<br />
gareSe n= 18<br />
gamoxatuli depresiis<br />
simptomebi n=24<br />
depresiis niSnebis<br />
gareSe n= 19<br />
gamoxatuli depresiis<br />
simptomebi n=9<br />
0 3±1 452,3±2,5 11,3±3,7 8,2±2,1 726,7±11,5<br />
0 11±5,2 448±4,8 19,3±5,1 11,7±1,7 747,11±9,7<br />
0 2±1 430,6±3,6 2±1,5 5±1 620±7,4<br />
0 12±4,3 451,2±3,8 18±2,4 9±3 712,5±6,9<br />
odnen, aseve, minimaluri iyo gamotovebul<br />
pasuxTa ricxvic (cxrili). rac Seexeba,<br />
depresiis simptomebis mqone avadmy<strong>of</strong>ebs,<br />
orive jgufSi sinaTlis stimulze<br />
gamotovebuli pasuxebis raodenoba iyo<br />
11±5,2 da 12±4,3%. reaqciis drois saSualo<br />
sidide, praqtikulad, ar gansxvavdeboda<br />
arcerT jgufSi.<br />
kvlevis Semdeg etaps warmoadgenda<br />
fsiqoemociuri datvirTva, rac martiv<br />
sensomotorul reaqciasTan SedarebiT<br />
sakvlev pirTaTvis ufro rTuli procesia.<br />
aRniSnulis miuxedavad, depresiis<br />
aramqone sakontrolo jgufis paciente-<br />
ise ZiriTad jgufSi martivi sensomotoruli<br />
amocanis gadawyvetis dros gamovlinda<br />
gonebrivi produqtiulobis<br />
daqveiTeba sinaTlis stimulze gamotovebuli<br />
pasuxebis ricxvis zrdiT da reaqciis<br />
drois histogramis uwesrigo ganawilebiT.<br />
es, savaraudod, imaze<br />
metyvelebs, rom aRniSnul kontingentSi<br />
SeimCneva yuradRebis koncentraciis<br />
daqveiTeba erTferovani amocanis gadawyvetisas.<br />
sainteresoa, rom pacientTa aRniSnuli<br />
kontingenti ufro advilad sZlevs<br />
mravalferovani amocanis gadawyvetas
35<br />
fsiqoemociuri datvirTvis dros, vidre<br />
erTferovani, monotonuri samuSaos Sesrulebas<br />
martivi sensomotoruli amocanis<br />
gadawyvetisas.<br />
gamokvlevebma daadastura, rom<br />
reaqciis drois histograma ufro naTlad<br />
asaxavs pirovnebis SesaZleblobasa da<br />
damokidebulebas amocanis gadawyvetis<br />
mimarT, anu individur, specifikur reaqcias<br />
garCevisa da amorCevis amocanis Sesrulebisas,<br />
vidre homogenur jgufebSi<br />
monacemTa saSualo maxasiaTeblebi.<br />
СЕНСОМОТОРНАЯ И ПСИХОМОТОРНАЯ ПРОДУКТИВНОСТЬ НА<br />
ФОНЕ САХАРНОГО ДИАБЕТА, ОСЛОЖНЕННОГО<br />
НЕПРОЛИФЕРАТИВНОЙ РЕТИНОПАТИЕЙ<br />
А. Цибадзе, Л. Цуцкиридзе, Р. Курашвили, М. Коркелия, Д. Цибадзе<br />
АКАДЕМИЯ НАУК ПРОФИЛАКТИЧЕСКОЙ МЕДИЦИНЫ ГРУЗИИ, ЦЕНТР<br />
ДИАБЕТА ГРУЗИИ, ТБИЛИССКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ<br />
УНИВЕРСИТЕТ<br />
Цель: исследования изучить сенсомоторную и психомоторную продуктивность пациентов с сахарным<br />
диабетом (СД) и установить частоту депрессии на фоне непролиферативной диабетической ретинопатии<br />
(НДР). Материалы и методы: обследовано 250 пациентов с СД, которых подразделили на 2 группы:<br />
I группа, основная – 135 пациентов с ретинопатией (40 – СДТ1 и 85 – СДТ2) и II группа, контрольная –<br />
115 пациентов без ретинопатии (56 – СДТ1 и 59 – СДТ2). В I группе депрессия не выявлена у 29 человек,<br />
хотя симптомы депрессии средней тяжести имели 106 лиц. Во II группе симптомы легкой формы<br />
депрессии обнаружены у 61 пациента, отсутствие симптомов наблюдалось у 54 больных. Из общего<br />
числа обследованных на проведение психо-физиологического обследования дали согласие 42 пациента<br />
из I группы и 28 – из II. Соматомоторная реакция оценивалась в компьютерном режиме с помощью<br />
кругов Ландольта. Результаты: При выполнении простой соматомоторной работы пациенты обеих<br />
групп не проявляли неверной реакции в ответ на световые стимулы. Количество пропущенных ответов<br />
также было минимальным. В обеих группах среди пациентов с симптомами депрессии, количество<br />
пропущенных ответов в момент стимулирования светом составило 11±5,2% и 12±4,3%, соответственно.<br />
Особый интерес представляет гистограмма распределения длительности реакции на световые<br />
раздражители. Если при отсутствии депрессии распределение носило нормальный характер, то на фоне<br />
депрессии во время принятия решения при простых сенсомоторных задачах, гистограмма носила<br />
хаотический характер; при этом, она принимала относительно организованный характер на фоне психоэмоциональной<br />
нагрузки. Заключение: На фоне ДР и депрессии у пациентов I и II групп выявлено<br />
понижение умственной продуктивности при решении сенсомоторных задач.<br />
SENSOMOTOR AND PSYCHOMOTOR PRODUCTIVITY IN PATIENTS<br />
WITH DIABETES MELLITUS AND NON-PROLIFERATIVE<br />
RETINOPATHY<br />
A. Tsibadze, L. Tsutskiridze, R. Kurashvili, M. Korkelia, D. Tsibadze<br />
The aim: to study sensomotor and psychomotor productivity <strong>of</strong> patients (pts) with diabetes mellitus (DM)<br />
and to determine the prevalence <strong>of</strong> depression in those with diabetic retinopathy (DR). Materials and Methods:<br />
Totally 250 pts with DM were allocated to 2 groups (Gr.) Gr1, study group (n=135) – pts with DR (40DMT1<br />
/ 85DMT2), and Gr.2, control group (n=115) – pts without DR (56DMT1 / 59DMT2). In Gr.1 29 pts had no
36<br />
symptoms <strong>of</strong> depression, while remaining 106 had signs <strong>of</strong> mild depression. In Gr.2 – 54 pts had no signs <strong>of</strong><br />
depression, and 61 – had mild depression. Out <strong>of</strong> these pts 42 Gr.1 and 28 Gr.2 pts agreed to undergo psychophisiological<br />
testing. Somatomotor reaction was assessed in computer regimen with the use <strong>of</strong> Landolt type circles.<br />
Results: while fulfilling simple somatomotor work both group pts had no wrong reaction to light stimuli. Total<br />
number <strong>of</strong> missed questions was also very low. At the same time, pts with the signs <strong>of</strong> depression from the both<br />
groups had missing answers in reply to light stimuli (11=5.2% and 12=4.3%, respectively). Reaction <strong>of</strong> distribution<br />
histograms to light stimuli distribution was normal, its presence resulted in chaotic character when simple<br />
somatomotor decisions had to be made, though it looked relatively in order when psychomotor load was added.<br />
Conclusion: In DM pts with DR and depression, both from study and control groups, decrease in cognitive<br />
productivity while solving somatomotor tasks, was observed.<br />
literatura:<br />
1. Андрюшенко А.В. Депрессии\\Современная психиатрия – 1998 –No2. – C.21-24.<br />
2. Дубинцева Э. Б., Андрюшенко А. В. Депрессии\\ Современная психиатрия. – 1998. – No2. –<br />
С.10-14.<br />
3. Мосолов С. Н. Депрессии в общей соматической практике\\ Медицинв для всех. 1997. No2(4). –<br />
С.19-21.<br />
4. Сиронов С. Д., Корнилова Т. В., Суркова Е. В., Двойнишникова О.И., Анциферов М. Б.<br />
Психологические особенности больных сахарным диабетом типа 2; проблемы терапевтического<br />
обучения\\ Проблемы эндокринологии. – 2001. – т. 47. – No6. – С. 27-33.<br />
5. Коркелия М.Т., Цибадзе А.Д., Нанейшвили Г.Б. Сенсомоторная и психоэмоциональная<br />
продуктивность на фоне сахарного диабета тип 1\\ <strong>Georgia</strong>n <strong>Medical</strong> News. – 2005. No10. – C.85-88.
37<br />
anis janmrTelobas. swored amitom aris,<br />
rom mTel ms<strong>of</strong>lioSi prevenciuli medicinis<br />
calkeuli mimarTulebis ganvi-<br />
Tareba prioritetuladaa miCneuli, radgan,<br />
adamianis janmrTelobis dacvis<br />
TvalsazrisiT, daavadebaTa pr<strong>of</strong>ilaqtika<br />
gacilebiT ufro advilia da SedarebiT<br />
nakleb materialur xarjebTanaa dakav-<br />
Sirebuli, vidre ganviTarebuli daavadebiT<br />
dasneulebul pirTa mkurnaloba<br />
da reabilitacia.<br />
prevenciuli medicinis erT-erT kerZo<br />
mimarTulebas Sromis medicina warmoadgens,<br />
romlis Semadgeneli nawilebia Sromis<br />
higiena da pr<strong>of</strong>esiuli paTologia.<br />
pr<strong>of</strong>esiuli paTologia (pr<strong>of</strong>paTologia)<br />
_ klinikuri medicinis damoukidebeli<br />
disciplinaa, romelic medicinis<br />
danarCeni disciplinebisagan gansxvavebiT,<br />
etiologiuri principis mixedviT,<br />
gamoiyo zogadi paTologiidan Tanmimdevruli<br />
diferencirebis gziT, mecnierebisa<br />
da teqnologiebis miRwevebiT<br />
ganpirobebuli mrewvelobisa da s<strong>of</strong>lis<br />
meurneobis swraf zrda-ganviTarebasTan<br />
dakavSirebiT.<br />
pr<strong>of</strong>esiuli paTologia maintegrirebeli<br />
disciplinaa, radgan moicavs iseT<br />
nozologiur formebs, romelic mimdinareobs<br />
sasunTqi, nervuli, gul-sisxlZarRvTa,<br />
kuW-nawlavis, saSarde, Zvalsaxsrovani,<br />
endokrinuli sistemebis,<br />
mxedvelobisa da smenis analizatorebis,<br />
fsiqoemociuri sferos, kanis, sisxlis,<br />
sxva organoebisa da sistemebis upiratesi,<br />
iSviaTad ki _ izolirebuli dazianebiT.<br />
pr<strong>of</strong>esiuli paTologiis Teoriuli da<br />
praqtikuli sakiTxebi jerovan codnas<br />
moiTxovs medicinis dargis praqtikulad<br />
yvela specialistisagan, vinaidan pr<strong>of</strong>esipr<strong>of</strong>esiuli<br />
ganaTleba, pr<strong>of</strong>paTologia<br />
mosazrebani umaRles <strong>samedicino</strong> skolaSi<br />
pr<strong>of</strong>esiuli paTologiis swavlebis Sesaxeb<br />
m. cimakuriZe, vad. saakaZe, r. kverenCxilaZe<br />
<strong>saqarTvelos</strong> pr<strong>of</strong>ilaqtikuri medicinis mecnierebaTa<br />
akademia; Tbilisis saxelmwifo <strong>samedicino</strong> universitetis<br />
garemosa da pr<strong>of</strong>esiuli medicinis departamenti<br />
qveynis ganviTarebis TiToeul axal<br />
socialur-politikur, Sesabamisad, istoriul<br />
etaps cxovrebis nebismier sfero-<br />
Si Tan sdevs garkveuli cvlilebebi, rac<br />
gansakuTrebiT mkafiod aisaxeba xolme<br />
kulturisa da ganaTlebis dargSi. am<br />
mxriv ukanaskneli aTwleulebis manZilze<br />
saqarTveloSi ganviTarebuli movlenebi<br />
gamonakliss ar warmoadgens.<br />
am TvalsazrisiT, umaRlesi ganaTlebis<br />
sistemaSi, mravali mimarTuleba aRmocenda<br />
da damkvidrda. aSkarad SeiniSneba<br />
amgvari mcdeloba umaRlesi <strong>samedicino</strong><br />
ganaTlebis sistemaSic. TiToeuli<br />
<strong>samedicino</strong> disciplina _ fundamenturi<br />
Tu klinikuri mimarTulebis _ gansxvavebul<br />
iersaxesa da Sinaarss iZens: Cndeba<br />
axali aspeqtebi, swavlebis silabusebis<br />
Sevseba warmoebs ms<strong>of</strong>lioSi ukanasknel<br />
periodSi <strong>samedicino</strong> mecnierebis miRwevebis<br />
gaTvaliswinebiT, etapobrivad<br />
xdeba calkeuli dargis gaRrmaveba<br />
rogorc vertikaluri, ise horizontaluri<br />
mimarTulebiT.<br />
am TvalsazrisiT friad sayuradReboa<br />
samecniero-teqnikur progresTan<br />
mWidrod dakavSirebuli medicinis dargi<br />
_ prevenciuli medicina.<br />
cnobilia, rom nebismier movlenas gaaCnia<br />
rogorc dadebiTi, ise uary<strong>of</strong>iTi maxasiaTeblebi.<br />
am TvalsazrisiT arc samecniero-teqnikuri<br />
progresi warmoadgens<br />
gamonakliss. mrewvelobisa da s<strong>of</strong>lis<br />
meurneobis, teqnikuri dargebis, fizikisa<br />
da didi qimiis swrafma da Seuqcevadma ganviTarebam,<br />
mravali progresuli xasiaTis<br />
miRwevebTan erTad, warmoSva sruliad<br />
axali fizikuri da qimiuri faqtori,<br />
romelic iwvevs garemos dabinZurebas,<br />
rac seriozul saSiSroebas uqmnis adami-
38<br />
uli daavadebebis klinikur suraTSi umravles<br />
SemTxvevaSi aRiniSneba organizmis<br />
sxavadasxva sistemisa da organos<br />
erTdrouli dazianeba, rac xSir SemTxvevaSi<br />
SeiZleba diagnostikuri Secdomis,<br />
araadekvaturi mkurnalobis, daavadebis<br />
Seuqcevadi progresirebis mizezi gaxdes<br />
_ pr<strong>of</strong>esiuli, zogjer ki sruli mZime invalidobis<br />
ganviTarebiT.<br />
gasuli saukunis 50-iani wlebidan pr<strong>of</strong>esiuli<br />
paTologia, rogorc damoukidebeli<br />
disciplina, iswavleboda mxolod<br />
sanitariul-higienur fakultetze,<br />
romelic ms<strong>of</strong>lios sxvadasxva qveyanaSi<br />
pr<strong>of</strong>ilaqtikuri medicinis, prevenciuli<br />
medicinis, <strong>samedicino</strong>-pr<strong>of</strong>ilaqtikuri<br />
medicinis, sazogadoebrivi jandacvis<br />
fakultetebis saxelwodebiTaa cnobili.<br />
am fakultetze pr<strong>of</strong>paTologiis swavleba<br />
mimdinareobda farTo programiT oTxi<br />
semestris ganmavlobaSi _ IV-V kursze,<br />
mogvianebiT ki _ IV-VI kursze - etapobrivad<br />
da saxelmwifo gamocdebis gziT atestaciis<br />
wesiT; Tumca kursdamTavrebulebs<br />
praqtikulad ufleba eZleodaT<br />
emuSavaT mxolod eqim - higienistad nebismieri<br />
mimarTulebiT (komunaluri, radiaciuli,<br />
bavSvTa da mozardTa kvebis, Sromis<br />
higiena), magram eqim-pr<strong>of</strong>paTologad<br />
muSaoba ekrZalebodaT, miuxedavad imisa,<br />
rom im periodSi pr<strong>of</strong>paTologiis swavlebas<br />
win uZRoda sxva klinikuri disciplinebis<br />
(Terapia, qirurgia, nevrologia,<br />
mean-ginekologia da sxv.) swavleba sakmaod<br />
farTo programiT. amgvari paradoqsi<br />
gagrZelda momdevno periodSic, saxeldobr,<br />
70-iani wlebidan pr<strong>of</strong>paTologia,<br />
rogorc savaldebulo disciplina,<br />
saqarTveloSi Setanil iqna yvela ZiriTadi<br />
fakultetis saswavlo gegmaSi (garda<br />
farmacevtulisa) _ samkurnalo, pediatriuli,<br />
mogvianebiT samxedro-<strong>samedicino</strong>,<br />
fsiqosomaturi medicinis, xolo<br />
stomatologiur fakultetze _ arCeviTi<br />
disciplinebis nusxaSi. miuxedavad imisa,<br />
rom samkurnalo fakultetze pr<strong>of</strong>paTologia<br />
iswavleboda gacilebiT Sem<strong>of</strong>argluli<br />
formatiT (36 saaTi, nacvlad 92-isa<br />
sazogadoebrivi jandacvis fakultetze),<br />
samkurnalo fakultetis kursdamTavrebulebs<br />
ufleba eZleodaT emuSavaT eqimpr<strong>of</strong>paTologad,<br />
xolo pr<strong>of</strong>ilaqtikuri<br />
medicinis fakultetis kursdamTavrebulebs<br />
am specialobiT muSaoba mainc<br />
ekrZalebodaT. saqme mxolod 90-iani<br />
wlebidan gamosworda, rodesac pr<strong>of</strong>ilaqtikuri<br />
medicinis fakultetis VI kursze<br />
SemoRebul iqna subordinaciis calkeuli<br />
cikli - higienaSi, epidemiologiasa da<br />
pr<strong>of</strong>paTologiaSi. pr<strong>of</strong>paTologiaSi IV-<br />
V kursze miRebul codnas studentebi aRrmavebdnen<br />
am disciplinis subordinaturaSi<br />
swavliT (320 akademiuri saaTi)<br />
da saxelmwifo gamocdis Cabarebis Semdeg,<br />
kursdamTavrebuls ufleba eZleoda<br />
emuSava eqim-higienistad, eqim-epidemiologad<br />
da eqim-pr<strong>of</strong>paTologad.<br />
2003 wlidan kvlav gagrZelda saswavlo<br />
gegmebisa da, Sesabamisad, programebis<br />
Sesworeba-transformireba, romlis Sedegad,<br />
sadReisod, gaTvaliswinebulia sazogadoebrivi<br />
jandacvis fakultetze<br />
bakalavriatisa da magistraturis institutis<br />
Camoyalibeba: swavleba gaTvaliswinebulia<br />
oTxi wlis ganmavlobaSi.<br />
bakalavrs ufleba aqvs imuSaos specialistad<br />
higienasa da epidemiologiaSi. pr<strong>of</strong>esiuli<br />
paTologia ki iswavleba damamTavrebel<br />
kursze 100 saaTis moculobiT,<br />
rac Cveni azriT, sruliad sakmarisia<br />
da gamarTlebuli imisaTvis, rom Sromis<br />
medicinis dargSi momuSave specialists<br />
hqondes sruli warmodgena misi movaleobebis<br />
arealsa da calkeul aspeqtze<br />
SromiTi resursebis janmrTelobis sruly<strong>of</strong>ili<br />
dacvis Sesaxeb, saerTo xasiaTis<br />
daavadebebis prognozirebis, xolo pr<strong>of</strong>esiuli<br />
xasiaTis daavadebebis Tavidan<br />
acilebis swori warmarTviT - codnis<br />
Semdgomi gaRrmavebiT magistraturis<br />
calkeul mimarTulebaSi.<br />
amasTanave, xazgasmiT aRsaniSnavia, rom<br />
sworadaa dagegmili rezidenturis institutis<br />
SemoReba pr<strong>of</strong>esiul paTologia-<br />
Si medicinis fakultetis kursdamTavrebulTaTvis,<br />
rac ganmtkicebulia eqimTa<br />
specialobis nusxaSi eqim-pr<strong>of</strong>paTologebis<br />
nomenklaturis savsebiT logikuri<br />
SenarCunebiT.<br />
sadReisod, am fakultetze miRebuli<br />
programiT pr<strong>of</strong>esiuli paTologiis swavleba<br />
mkveTradaa Semcirebuli da dayvanilia<br />
30 saaTamde, rac gaumarTleblad<br />
zRudavs minimaluri dagegmili programis<br />
swavlebisa da miT ufro aTvisebis<br />
SesaZleblobas.<br />
pr<strong>of</strong>esiuli paTologia moicavs nozologiur<br />
formaTa did nusxas, romelTa<br />
Soris <strong>saqarTvelos</strong> pirobebSi gvxvdeba<br />
minimum 50 dasaxelebamde. bunebrivia, rom<br />
diplomamdeli momzadebis periodSi amgvari<br />
Sekvecili programiT sruly<strong>of</strong>ili<br />
swavleba SeuZlebelicaa da gaumarTlebelic,<br />
magram zogadi warmodgenis misaRe-
39<br />
bad aucilebelia saerTo formatis gazrda<br />
minimum oTx kreditamde mainc (8 akademiuri<br />
saaTi saleqcio, danarCeni 52 saaTi<br />
- praqtikuli mecadineoba). amasTan,<br />
calkeul klinikur disciplinaSi rezidenturis<br />
gavlisas savsebiT gamarTlebulia<br />
garkveuli modulebis daTmoba im<br />
pr<strong>of</strong>esiuli daavadebisaTvis, romelic<br />
e.w. pirobiT pr<strong>of</strong>esiul daavadebaTa<br />
jgufs miekuTvneba. mag., nevrologiaSi,<br />
otorinolaringologiaSi, <strong>of</strong>TalmologiaSi,<br />
dermatologiaSi, fsiqiatriaSi,<br />
ojaxis eqimis momzadebaSi.<br />
rezidenturis momzadebis procesSi<br />
amgvari midgomiT pr<strong>of</strong>esiuli paTologia,<br />
rogorc maintegrirebeli <strong>samedicino</strong><br />
mecniereba, sruly<strong>of</strong>ilad iqneba warmodgenili<br />
eqim - specialistebis momzadebis<br />
procesSi.<br />
aRsaniSnavia, agreTve, rom pr<strong>of</strong>esiuli<br />
paTologia mWidro urTierTkavSirSia<br />
Sromis higienasTan da gamarTlebuli<br />
iqneba, rom medicinis fakultetze higienis<br />
kursis swavlebisas jerovani yuradReba<br />
daeTmos Sromis higienis swavlebas;<br />
ufro metic, SeZlebisdagvarad, mizanSewonili<br />
iqneba am fakultetze Sromis<br />
higienas daeTmos minimum 2 krediti mainc,<br />
swavlebis procesSi dargis wamyvani specialistebis<br />
CarTviT.<br />
Cveni qveynis aRmSeneblobis rTul,<br />
gardamaval periodSi Tanmimdevrulad<br />
formirdeba axali Sigasaxelmwifoebrivi<br />
urTierTobebi, ixveweba arsebuli cxovrebis<br />
wesi, icvleba sakuTrebis formebi,<br />
yalibdeba SezRuduli pasuxismgeblobis<br />
sawarmoebi da organizaciebi, vi-<br />
Tardeba sabazro ekonomikis mimarTulebebi,<br />
adgili aqvs sazogadoebis demokratizacias<br />
da erovnuli meurneobis mar-<br />
Tvis decentralizacias, farTovdeba mosaxleobis<br />
savaldebulo <strong>samedicino</strong><br />
dazRvevis areali. yovelive es ki da-<br />
JinebiT moiTxovs momuSaveTa socialuri<br />
dacvis axali formebis SemuSavebas, danergvasa<br />
da SromiTi resursebis <strong>samedicino</strong><br />
daxmarebis sruly<strong>of</strong>as.<br />
samecniero-teqnikuri progresisa da<br />
qveyanaSi mimdinare socialur-ekonomikuri<br />
transformaciebis fonze warmoiSva<br />
mravali axali saxis pr<strong>of</strong>esiuli mavneoba.<br />
pr<strong>of</strong>esiuli daavadebebis nusxa Seivso<br />
axali formis pr<strong>of</strong>esiuli paTologiiT,<br />
ris gamoc es dargi saWiroebs jerovan<br />
yuradRebas ukve specialuri <strong>samedicino</strong><br />
ganaTlebis pirvelive etapidan.<br />
am mimarTulebebis ganxorcielebiT<br />
mravali dadebiTi perspeqtiva isaxeba:<br />
medicinis fakultetis kursdamTavrebuli<br />
jerovan codnas miiRebs SromiTi<br />
resursebis jandacvis mimarTulebiT; ma-<br />
Rali kvalifikaciis Sromis medicinis specialistebi<br />
efeqturad ganaxorcieleben<br />
mSromelTa janmrTelobis dacvas; Sedegad<br />
ki _ saxelmwifo dazogavs gaumarTlebel<br />
materialur danaxarjebs pr<strong>of</strong>esiuli pa-<br />
TologiiT dasneulebul pirTa reabilitaciasa<br />
da sapensio anazRaurebaze; warmoeba<br />
SeinarCunebs kvalificiur mSromel-<br />
Ta kontingents, romelic awarmoebs maRali<br />
xarisxis produqcias, materialurad<br />
aZlierebs warmoebis baziss da saxelmwifos;<br />
ojaxi SeinarCunebs janmrTel marCenals,<br />
xolo Tavad momuSave piri ganaxorcielebs<br />
sakuTari janmrTelobis dacvis<br />
konstituciur uflebas.<br />
demokratiuli qveynis mSeneblobisas<br />
prevenciuli medicinis dargis aRniSnuli<br />
mimarTulebiT warmarTva, udavod, perspeqtiuli<br />
da mniSvnelovania.
40<br />
СООБРАЖЕНИЯ ПО ПОВОДУ ОБУЧЕНИЯ<br />
ПРОФЕССИОНАЛЬНОЙ ПАТОЛОГИИ В СИСТЕМЕ<br />
ВЫCШЕГО МЕДИЦИНСКОГО ОБРАЗОВАНИЯ<br />
М. Цимакуридзе, Вад. Саакадзе, Р. Кверенчхиладзе<br />
АКАДЕМИЯ НАУК ПРОФИЛАКТИЧЕСКОЙ МЕДИЦИНЫ ГРУЗИИ,<br />
ДЕПАРТАМЕНТ МЕДИЦИНЫ ОКРУЖАЮЩЕЙ СРЕДЫ И ПРОФЕССИОНАЛЬНОЙ<br />
МЕДИЦИНЫ ТБИЛИССКОГО ГОСУДАРСТВЕННОГО МЕДИЦИНСКОГО<br />
УНИВЕРСИТЕТА<br />
Профессиональная патология - самостоятельная дисциплина клинической медицины, предметом<br />
изучения которой являются заболевания, развивающиеся под воздействием вредных факторов<br />
производственной среды (физических, химических, биологических, производственной пыли) или<br />
обусловленных особенностями трудового процесса. Эти заболеваения протекают, как правило,<br />
сочетанным поражением различных систем и органов, вследствие чего подобные больные практически<br />
могут оказаться в ареале медицинского обеспечения врача-клинициста любой специальности, у которого<br />
должны быть определённые знания в области профпатологии для своевременной правильной ориентации<br />
и направления подобных больных в специализированную профпатологическую клинику. Именно поэтому,<br />
подготовка медицинских кадров в системе высшего медицинского образования должна проводиться<br />
продуманно и в достаточном объёме (не менее четырёх кредит-часов) уже на этапе преддипломной<br />
подготовки студентов медицинского факультета, а для специального освоения специальности врачапрофпатолога<br />
в институте резидентуры-не менее двухлетней последипломной учёбы. Целесообразно в<br />
систему постдипломного обучения врачей вводить специальные профпатологические модули в программы<br />
соответствующих резидентур (неврология, ото-рино-ларингология, офтальмология, дерматология,<br />
психиатрия и др.). Важно, чтобы в системе преддипломной подготовки студентов медицинского<br />
факультета в должном объёме-не менее двух кредит-часов-проводилось также обучение основным<br />
принципам превенции профессиональных заболеваний путём включения специальности -гигиена труда.<br />
ASSUMPTIONS ABOUT TEACHING PROFESSIONAL PATHOLOGIES<br />
IN THE SYSTEM OF HIGHEST MEDICAL EDUCATION<br />
M. Tsimakuridze, V. Saakadze, R. Khverenchkhiladze<br />
Pr<strong>of</strong>essional pathology is an independent discipline <strong>of</strong> the clinical medicine. It’s mainly focused on studying<br />
diseases that develop under the influence <strong>of</strong> harmful industrial factors (physical, chemical, biological, industrial<br />
dust) under the peculiarities <strong>of</strong> the work process. During the development process these diseases damage<br />
different systems and organs, that’s why the patient may apply to a physician <strong>of</strong> any speciality, who should have<br />
necessary knowledge in pr<strong>of</strong>essional pathology in order to understand the state <strong>of</strong> the patient and send him to a<br />
specialized occupational clinic. For this reason the training <strong>of</strong> future physicians should be organized with care<br />
and it should last for a reasonable time (not less the 4 credit hours) at the level <strong>of</strong> pre-diploma education, for<br />
preparing a physician specialized in occupational pathologies the process should last no less than 2 years <strong>of</strong> post<br />
diploma practice. In post diploma education it is necessary to include occupational pathology modules. It is<br />
important that the physician in post diploma education had training in general principles <strong>of</strong> preventing occupational<br />
pathologies with introduction <strong>of</strong> industrial hygiene.
41<br />
komunaluri farmacia<br />
komunaluri farmaciis problemebi saqarTveloSi<br />
a.bakuriZe, v. eriaSvili, T.WumburiZe, n. nemsiwveriZe, i.wurwumia<br />
<strong>saqarTvelos</strong> pr<strong>of</strong>ilaqtikuri medicinis mecnierebaTa<br />
akademia, Tbilisis saxelmwifo <strong>samedicino</strong> universitetis<br />
socialuri da klinikuri farmaciisa da farmacevtuli<br />
teqnologiis departamentebi<br />
literaturis monacemebiT cnobilia,<br />
rom pacientTa didi nawili, romelic mimarTavs<br />
afTiaqs farmacevts sTxovs<br />
<strong>samedicino</strong> daxmarebas. bunebrivia, afTiaqi<br />
ar aris rTuli <strong>samedicino</strong> procedurebis<br />
Catarebis adgili, magram im qveynebSi,<br />
sadac afTiaqebSi klinicist- farmacevtebi<br />
muSaoben SesaZlebelia pirveladi<br />
<strong>samedicino</strong> daxmarebis miReba, SedarebiT<br />
martivi problemebis gadawyveta.<br />
magaliTad, inglisSi, Catarebuli<br />
gamokiTxvis safuZvelze, yoveldRiurad<br />
10 pacienti mainc Rebulobs konsultacias<br />
farmacevtisgan, rac qveynis masStabiT<br />
Seadgens 100 000 SemTxvevas dReSi<br />
(smiti da Tanaavtorebi 1990w).<br />
termini `komunaluri farmacia~, SedarebiT<br />
axalia, igi Semovida klinikuri farmaciis<br />
ganviTarebis Semdgom da gulisxmobs<br />
ara sanitariul normebs, aramed af-<br />
TiaqSi klinicisti farmacevtis konsultacias,<br />
rCevis micemas, komunaluri momsaxurebis<br />
gawevas. es ukanaskneli<br />
sagrZnoblad amaRlebs mosaxleobis<br />
wamliT uzrunvely<strong>of</strong>is xarisxis gaumjobesebas.<br />
farmacevtTa saerTaSoriso federaciis<br />
(FIP) masalebiT, komunaluri farmaciis<br />
praqtika gulisxmobs im SesaZleblobebs,<br />
romliTac farmacevti pacientisaTvis<br />
xdeba jandacvis sferos momsaxurebis yvelaze<br />
xelmisawvdomi specialisti. is uzunvely<strong>of</strong>s<br />
pacientis mkurnalobis menejments<br />
da <strong>samedicino</strong> momsaxurebis swori<br />
mimarTulebiT warmarTvas. pacientis informirebas<br />
urecepto wamlebiT TviTmkurnalobis<br />
SemTxvevebSi, konsultacias<br />
da monitorings. amgvari midgoma saSualebas<br />
aZlevs farmacevts iTanamSromlos pacientTan<br />
da jandacvis sferos pr<strong>of</strong>esionalebTan<br />
mkurnalobis swori gzis<br />
SerCevasa da realizaciaSi.<br />
farmaciis dargSi erT-erTi wamyvani<br />
obiurnis universitetis (aSS) komunaluri<br />
farmaciis samagistro programis Sefasebebis<br />
kriteriumebia:<br />
pacientis mdgomareobis Sefaseba _<br />
10%;<br />
medikamenturi mkurnalobis Sefaseba<br />
_ 10%;<br />
medikamenturi mkurnalobis monitoringi<br />
_ 15%;<br />
komunikaciebi _ 5%;<br />
gadawyvetilebis miReba farmakoTerapiis<br />
procesSi _ 5%;<br />
pr<strong>of</strong>esiuli eTika da qceva _ 10%;<br />
damoukidebeli swavleba _ 5%;<br />
soSg warmoeba _ 15%<br />
farmacevtuli informireba _ 10%;<br />
zogadi farmacevtuli unar-Cvevebi _<br />
15%;<br />
saqarTveloSi arsebuli socialurpolitikuri<br />
faqtorebis gaTvaliswinebiT,<br />
mosaxleobis sakmaod did nawils ara aqvs<br />
saSualeba droulad mimarTos eqims, Caitaros<br />
gamokvlevebi, miiRos eqimis daniSnuleba.<br />
gasaTvaliswinebelia, agreTve,<br />
zogierTi pacientis SiSis faqtori eqimisa<br />
da <strong>samedicino</strong> dawesebulebis winaSe.<br />
yovelive es zrdis farmacevtis pasuxismgeblobis<br />
donis amaRlebas.<br />
Cven mier Catarebuli kvlevis mizans<br />
Seadgenda imis garkveva, Tu ra saxis problemebia<br />
afTiaqSi komunaluri farmaciis<br />
TvalTaxedviT; komunaluri momsaxurebis<br />
xarisxi Tbilisis afTiaqebis magaliTze.<br />
saWiro informacia movipoveT 10 afTiaqis<br />
anketirebis safuZvelze.Cvens mizans
42<br />
yoveldRiurad pacientebi mimarTaven<br />
afTiaqs wnevis gazomvis TxovniT,<br />
zogjer Semodian inieqciis gakeTebis TxovniT<br />
(ixileT naxati).<br />
gamokiTxvis masalebis mixedviT arc<br />
erT afTiaqSi ar xdeba Saqris donis gansazRvra.<br />
Saqris donis ganmsazRvreli<br />
aparatebi da Cxirebi yvela afTiaqSi ar<br />
iyideba; pacientebs agzavnian specializebul<br />
afTiaqSi. Tumca arc iq ar aris am saxis<br />
momsaxureba.<br />
zemoaRniSnulidan SeiZleba davaskvnaT,<br />
rom, samwuxarod, komunaluri momsaxurebis<br />
done Tbilisis afTiaqebSi sakmaod dabalia.<br />
misi xarisxis gaumjobesebisaTvis<br />
pirvel rigSi saWiroa, ufro safuZvlianad<br />
iqnes Seswavlili momxmarebelTa<br />
moTxovnilebebi. maSin rodesac farmacevtuli<br />
firmebis marketologebi da<br />
Sesabamisi samsaxurebi pacientebis<br />
4<br />
3<br />
1<br />
2<br />
nax. anketis monacemebis mixedviT farmacevtisa<br />
da pacientis urTierTobis xasiaTi:<br />
1 - wamlis SerCeva pacientis Civilis Sesabamisad<br />
- 40%;<br />
2 - wamlis miRebis wesebis ganmarteba,<br />
gverdiTi efeqtebis Sesaxeb informireba<br />
- 35%<br />
3- martivi <strong>samedicino</strong> manipulaciebi -<br />
5%;<br />
4 - wamlis Secvla ufro iafi analogiT -<br />
20%.<br />
Seadgenda gamogvevlina is susti adgilebi<br />
da xarvezebi, romelTa aRm<strong>of</strong>xvriT ama-<br />
Rldeba momsaxurebis xarisxi.<br />
Catarebuli kvleva cxady<strong>of</strong>s, rom af-<br />
TiaqSi Semosuli pacientebis daaxloebiT<br />
40% ar gaaCnia eqimis daniSnuleba da amitom<br />
medikamentis arCevisaTvis isini konsultaciisaTvis<br />
farmacevts mimarTaven.<br />
`udiagnozo~ pacientebi xSir SemTxveva-<br />
Si farmacevtisgan rekomendacias iTxoven<br />
da ukmay<strong>of</strong>ilebas gamoxataven imis gamo,<br />
rom farmacevti aseT SemTxvevaSi ar ver<br />
aiRebs Tavis Tavze wamlis daniSnvis pasuxismgeblobas<br />
(yvelaze martivi SemTxvevebis<br />
garda).<br />
eqimis daniSnulebiT Semosul pacientTa<br />
20%-mde farmacevts Txovs Secvalos<br />
gamowerili medikamenti misTvis ekonomiurad<br />
ufro xelmisawvdomi preparatiT.<br />
xolo rac Seexeba wamlebis urTierTqmedebasTan<br />
dakavSirebul sakiTxebs, pacientebis<br />
umravlesoba TviTon ecnoba wamlis<br />
instruqcias. ZiriTadad interesdebian<br />
ukuCvenebebiT.<br />
wamlis moqmedebasTan dakavSirebuli pretenziebis<br />
umravlesoba dakavSirebulia eqimis<br />
daniSnulebis araswor gagebasTan da<br />
dozirebis reJimis daucvelobasTan.<br />
rac Seexeba pirveladi <strong>samedicino</strong> daxmarebis<br />
gawevas saafTiaqo pirobebSi es<br />
SedarebiT iSviaTi movlenaa. TiTqmis<br />
mozidvis mizniT qmnian fasdaklebis<br />
baraTebs. sasurveli iqneboda pacientebis<br />
moTxovnilebaTa gaTvaliswinebiT<br />
swored komunaluri momsaxurebis donis<br />
amaRleba. pacienti, romelic miiRebs<br />
kvalificiur daxmarebas, konsultacias<br />
da kmay<strong>of</strong>ili darCeba momsaxurebiT,<br />
kidev mova am afTiaqSi, rac, Tanamedrove<br />
farmacevtuli bazris konkurenciis<br />
pirobebSi, metad aqtualur da perspeqtiul<br />
mimarTulebad gvevlineba.
43<br />
ПРОБЛЕМЫ КОММУНАЛЬНОЙ ФАРМАЦИИ В ГРУЗИИ<br />
Бакуридзе А., Эриашвили В., Чумбуридзе Т., Немсицверидзе Н., Цурцумия И.<br />
АКАДЕМИЯ НАУК ПРОФИЛАКТИЧЕСКОЙ МЕДИЦИНЫ ТБИЛИССКИЙ ГОС.<br />
МЕДИЦИНСКИЙ УНИВЕРСИТЕТ, ДЕПАРТАМЕНТЫ СОЦИАЛЬНОЙ И<br />
КЛИНИЧЕСКОЙ ФАРМАЦИИ И ФАРМАЦЕВТИЧЕСКОЙ ТЕХНОЛОГИИ<br />
Под термином коммунальная фармация подразумевается оказание пациентам квалифицированной<br />
помощи в выборе лекарственных средств, также оказание коммунальных услуг (измерение давления<br />
инъекции и т.д.). Учитывая социально-политическую обстановку страны, часть населения не имеет<br />
материальных средств для своевременного обращения к врачу. Избегая обращения в больницу или<br />
поликлинику, якобы по пустякам, пациентами руководит чувство страха перед врачами и финансовыми<br />
затратами. Не всем пациентам доступно в домашних условиях измерять артериальное давление, уровень<br />
глюкозы в крови, выполнение инъекций. Целью исследования являлось изучение состояния коммунального<br />
обслуживания населения на примере аптек города Тбилиси. На основании проведенного анкетированного<br />
опроса сотрудников аптек, выявлен низкий уровень коммунального обслуживания населения. Такие услуги,<br />
как измерение уровня глюкозы в крови, вообще не практикуются; в основном измеряется давление,<br />
реже выполняются инъекции; проблемы связаны с тем, что в аптеках не предусмотрены подобные<br />
виды услуг, нет соответственных нормативных актов.<br />
PROBLEMS OF COMMUNITY PHARMACY IN GEORGIA<br />
Bakuridze A., Eriashvili V., Chumburidze T., Nemsitsveridze N.,Tsurtsumia I.<br />
The community pharmacy practice setting provides the opportunity for pharmacists to be “the most accessible<br />
health care providers”. To achieve this, pharmacist, must be able to provide cognitive services, such as<br />
disease management, triage <strong>of</strong> pacients to pharmacist-directed care or referral to medical services, individualized<br />
patient education including non- prescription self-care, counseling, and patient follow up and monitoring.<br />
Today community pharmacists face number <strong>of</strong> problems in <strong>Georgia</strong> and this article can be unical point for<br />
exploration <strong>of</strong> some <strong>of</strong> them FIP congress focuses on increasing the role <strong>of</strong> pharmacist as medical pr<strong>of</strong>essional<br />
in the managment and prevention <strong>of</strong> diseases, and provide patient- focused care.<br />
litetatura<br />
1. r.maxaraZe, n.menabde, l.xolodovi. farmakokinetikis safuZvlebi. Tbilisi. 2000.<br />
2. T.kezeli, r.maxaraZe. klinikuri farmacia farmakoTerapiiT. Tbilisi. 2001<br />
3. v. eriaSvili. socialuri farmacia. Tbilisi 2001.<br />
4. Camferlag Report. London. 1986.<br />
5. Bertran G.Kazung.Basic and clinical Pharmacology. Baltimore.VIIed 1998.<br />
6. Linda L. Hart, Dick R.Gourley, Eric T.Herfindal. Workbook for Clinical Pharmacy and Therapeutics.Fifth<br />
edition.Baltimore.1992.
44<br />
moSobili moTenTilobis normaluri SegrZnebaa,<br />
rac fiziologiuria da dasvenebis<br />
Semdeg TavisTavad qreba;<br />
asTenia aris anomaluri, spontanuri<br />
moTenTiloba, romelic viTardeba fizikuri<br />
datvirTvis Sedegad da, dasvenebis<br />
miuxedavad, grZeldeba xangrZlivad. igi<br />
paTologiuria;<br />
kunTovani (fizikuri) asTenia xSirad<br />
dakavSirebulia fizikuri da seqsualuri<br />
energiis dakargvasTan;<br />
Seuwyveteli da yoveldRiuri asTenia<br />
damaxasiaTebelia somaturi pa-<br />
TologiisaTvis;<br />
diliT gaRviZebisas arsebuli asTenia,<br />
romelic icvleba gadaRlilobis periodebiT,<br />
damaxasiaTebelia funqciuri<br />
paTologiisaTvis.<br />
asTeniis mizezebi da cru gamovlena<br />
aucilebelia naTlad SesamCnevi<br />
`izolorebuli~ asTeniis dadgena, romelic<br />
SesaZloa gamoixatos: cxelebiT, sxeulis<br />
masis daqveiTebiT, <strong>of</strong>lianobiT, arTlargiiT,<br />
qaviliT, xvelebiT. am dros<br />
saWiroa sruli klinikuri gamokvleva,<br />
radgan aRwerili darRvevebi garkveulwilad<br />
miuTiTebs organuli paTologiis<br />
arsebobis Sesaxeb;<br />
Tu pacienti dakavebuli iyo TviTmkurnalobiT,<br />
asTenia SesaZloa ganvi-<br />
Tarebuliyo beta-blokatorebis, diuretikebis,<br />
hipotenziuri an safaRaraToebis<br />
miRebis Sedegad;<br />
pacientis cxovrebis wesisa da pirovnuli<br />
Taviseburebebis codna mniSvnelovania<br />
funqciuri asTeniis diagnostikisaTvis.<br />
mas iwvevs nervuli daZabuloba, samuSao<br />
dRis Zalian didi xangrZlivoba, hiperaqtivoba<br />
(sportis CaTvliT), uZiloba da a.S.;<br />
kunTovani da nervuli sistemis sxvadasxva<br />
daavadeba iwvevs organuli xasijandacvis<br />
organizacia, nevrologia<br />
ojaxis eqimis roli asTeniis gamovlenasa da<br />
mkurnalobaSi<br />
m. Savdia, e. darbaiseli, n. Savdia, a. vaCeiSvili<br />
onkoprevenciis centris paliatiuri mzrunvelobis klinika<br />
(recenzenti - pr<strong>of</strong>esori i. baqraZe,<br />
mec. mecn. doqtori i. abesaZe)<br />
asTenia erT-erTi yvelaze xSiri simptomia,<br />
romlis gamoc pacientebi ojaxis<br />
eqimebs mimarTaven. igi vlindeba aranormaluri,<br />
spontanuri sisustiT, rac dakav-<br />
Sirebuli araa fizikur datvirTvasTan<br />
(1,3,7). pacientebi mas xSirad Cveul movlenad<br />
miiCneven da iwyeben TviTmkurnalobas,<br />
xolo eqimebi zogjer rogorc<br />
raRac banalurs ise aRiqvamen.<br />
asTeniuri mdgomareobisas aucilebelia<br />
gamomwvevi mizezis dadgena, radgan<br />
SesaZloa igi ganpirobebuli iyos organuli<br />
paTologiiT. magaliTad, avTvisebiani<br />
simsivniT, Sids-iT, tuberkuloziT. terminalur<br />
stadiaSi my<strong>of</strong>i pacientebisaTvis<br />
progresuli sisuste warmoadgens kvdomis<br />
procesis nawils. viTardeba intoqsikaciis,<br />
infeqciuri da sxva mZime daavadebebisas,<br />
agreTve, emociuri, fizikuri da gonebrivi<br />
gadaRlisa da gadatvirTvisagan, xangrZlivi<br />
SimSilis Sedegad.<br />
asTeniis dadgenaSi ojaxis eqimebs eni-<br />
WebaTa gadamwyveti roli. kerZod, maT<br />
kargad ician pacientebi, maTi avadmy<strong>of</strong>obis<br />
istoria da aqvT warmodgena ganvi-<br />
Tarebuli procesis Sesaxeb, rac asTeniis<br />
mizezi gaxda. amitom, ojaxis eqimebs<br />
yvelaze metad SeuZliaT daexmaron pacients<br />
sxvadasxva simptomis an TviTneburad<br />
miRebuli wamlebis gaxsenebaSi, gamoikvlion<br />
da yovelmxriv Seafason maTi<br />
klinikuri mdgomareoba, raTa zustad<br />
daadginon organuli paTologiis an klinikuri<br />
anomaliis faqti. amdenad, ojaxis<br />
eqimebisaTvis aucilebelia asTeniis gamovlenis,<br />
mizezebisa da mkurnalobis codna,<br />
risTvisac Cven specialurad SeviswavleT<br />
Sesabamisi literatura (1,10).<br />
imisaTvis, rom gamovavlinoT asTenia<br />
unda vicodeT:<br />
asTenia araa daRliloba. daRliloba<br />
- fizikuri datvirTvis Sedegad war-
45<br />
aTis kunTovan sisustes anu cru asTenias.<br />
amitom, SecdomiT asTeniad SeiZleba miCneuli<br />
iyos: miasTenia, kortikosteroidebis<br />
xangrZliv miRebasTan dakavSirebuli<br />
miopaTia, genetikuri miopaTia, lambert-itonis<br />
sindromi, SedarebiT iSviaTad<br />
ki - polimioziti; cru asTeniad aseve<br />
SeiZleba miCneuli iyos nervuli sistemis<br />
paTologiebi - mravlobiTi sklerozi,<br />
amiotr<strong>of</strong>uli lateraluri sklerozi,<br />
polinevriti, paraparezi, Sarko-mari-tutas<br />
daavadeba (5).<br />
asTeniis Seswavla - gamokvlevis moculoba<br />
da mimarTuleba damokidebulia<br />
pacientis asaksa da cxovrebis wesze. axalgazrdebSi,<br />
romelTa cxovrebis wesi<br />
aradamakmay<strong>of</strong>ilebelia, eWvi unda iqnes<br />
mitanili funqciuri genezis asTeniaze da<br />
saTanado gamokvleva Catardes. asakovani<br />
pacientis SemTxvevaSi, romlis janmrTelobis<br />
mdgomareoba uaresdeba, saWiroa<br />
swrafi da detaluri gamokvleva.<br />
asTeniis drouli gamovlenis mizniT,<br />
qvemoT mogvyavs misi nairsaxeobebi.<br />
organuli bunebis izolirebuli asTenia<br />
anu metaboluri warmoSobis sisuste.<br />
standartulma bioqimiurma kvlevam (glikemia,<br />
kreatinemia, eleqtrolitebis done)<br />
SeiZleba gamoavlinos: 1. hiperglikemia -<br />
Saqriani diabetis pirveli dekompensaciisas;<br />
2. hiperkreatinemia - Tirkmlis ukmarisobisas;<br />
3. hiperkalciemia - ZvlebSi<br />
onkologiuri daavadebebis metastazebiT,<br />
agreTve, hiperTireoidizmiT; 4. hiponatremia<br />
- gamowveuli diuretikebiT da adh-s<br />
araadekvaturi sekreciiT, rac simsivnis<br />
arsebobaze miuTiTebs.<br />
endokrinuli warmoSobis asTenia. nebismier<br />
endokrinul darRvevas SeuZlia gamoiwvios<br />
asTenia. misi arseboba yovelTvis<br />
ar miuTiTebs, rom saqme gvaqvs endokrinuli<br />
paTologiis Sors wasul formasTan.<br />
zogjer asTenia aris hormonuli da metaboluri<br />
darRvevis gamovlena. amitom,<br />
saWiroa Tireotropuli hormonisa da kortizonis<br />
donis gansazRvra, rac dagvexmareba,<br />
rom gamovavlinoT endokrinuli<br />
genezis asTeniis 2 ZiriTadi mizezi: Tireoiduli<br />
disfunqcia da adisonis daavadeba.<br />
qvemoT ganvixilavT endokrinuli asTeniis<br />
sam formas, romelic yvelaze xSirad gvxvdeba<br />
klinikur praqtikaSi.<br />
asTenia da melanodermia safuZvels<br />
iZleva, rom vifiqroT adisonis daavadebaze.<br />
endokrinuli bunebis asTeniis tipuri<br />
forma Cveulebriv yalibdeba, rogorc<br />
Tirkmelzeda jirkvlis nela ganviTarebadi<br />
ukmarisobis (adisonis daavadeba) Sedegi.<br />
rogorc aRvniSneT, asTenia SesaZloa<br />
ganpirobebuli iyos fizikuri, fsiqologiuri,<br />
inteleqtualuri da seqsualuri<br />
mizezebiT, magram arasdros ar aris izolirebuli.<br />
igi xSirad asocirebulia melanodermiasTan,<br />
upiratesad sxeulis Ria nawilebze,<br />
Serwymulia sakvebis monelebis dar-<br />
RvevasTan (anoreqsia, yabzoba) da sxeulis<br />
masis daklebasTan. Cveulebriv, diagnozi<br />
efuZneba sisxlis plazmaSi kortizonis donis<br />
daqveiTebas. imis gamo, rom kortizolemiis<br />
done diliT Zalian variabeluria,<br />
Tavisufali kortizolis Seswavla rekomendebulia<br />
sadReRamiso SardSi (norma 20-60<br />
mkg/dReRameSi). kortizolis normaluri<br />
done imis safuZvelia, rom gamovricxoT as-<br />
Tenia, maSin rodesac dabali maCveneblebisas<br />
aucilebelia kortizolemiis Semowmeba,<br />
romelic sinaqtinis inieqciis stimulaciaze<br />
sisxlis plazmaSi akth-s maRal Semcvelobisas<br />
ar pasuxobs. diagnozis dasmis<br />
Semdeg aucilebelia mizezis gamovlena.<br />
Cveulebriv es tuberkulozia, magram ufro<br />
xSirad mizezad gvevlineba avtoimunuri adenokortikuli<br />
destruqcia.<br />
asTenia da kortikosteroiduli Terapia.<br />
praqtikaSi xSiria SemTxvevebi, rodesac<br />
kortikosteroidebiT mkurnalobis<br />
Semdeg viTardeba asTenia. igi SesaZloa<br />
ganviTardes kortikosteroidebis maRali<br />
Terapiuli an SemanarCunebeli dozebis<br />
Sedegad gamowveuli Tirkmelzeda jirkvlis<br />
meoradi ukmarisobiT, an kortikosteroidebis<br />
(romlebic kunTebSi aZlierebs<br />
metabolizms da kaliumis gamoy<strong>of</strong>as<br />
astimulirebs, uSualo moqmedebiTac,<br />
agreTve, ZiriTadi daavadebis ganviTarebiT,<br />
magaliTad hortonis daavadebis.<br />
disTireoidizmi. endokrinuli pa-<br />
Tologiis yvelaze xSiri mizezi, romelic<br />
iwvevs daRlilobas, farisebri jirkvlis<br />
disfunqciaa (hipo- an hiperfunqcia).<br />
hipoTireozze eWvi SeiZleba mivitanoT wonis<br />
zomieri matebisas, kanis simSralisas, sicivis<br />
gadautanlobisas, yabzobisadmi da<br />
bradikardiisadmi midrekilebisas. hipo-<br />
Tireozisas asTenia kavSirSia sxeulis masis<br />
klebasTan, gaZlierebul <strong>of</strong>lianobasTan,<br />
diareasTan, taqikardiasTan, siTbos gadautanlobasTan,<br />
sxva klinikuri formebi naklebad<br />
TvalsaCinoa: perikarditi, saWmlis<br />
monelebis darRveva gauvalobis tipis,<br />
fsevdomiotonia, gonebis dabindva an koma,<br />
zogjer SesaZloa ginekologiuri dar-<br />
Rvevebi hiperTireozis erTaderTi gamovlineba<br />
iyos. ritmis darRvevam da gulis ukmarisoba,<br />
fsevdodamblam an fsiqikurma<br />
gadaxram hiperTireozis diagnozis das-
46<br />
ma SeiZleba gaarTulos. yvela am SemTxvevaSi<br />
aucilebelia ganvsazRvroT T3 da<br />
T4 Semcveloba, romelTa Sefardeba yvelaze<br />
kargad asaxavs farisebri jirkvlis<br />
funqcias (hiperTireozis dros maRali,<br />
xolo hipoTireozisas - dabali).<br />
asTeniis cxelebiTi forma - vlindeba<br />
organizmSi sxvadasxva infeqciis arsebobis<br />
SemTxvevaSi. kerZod, e.w. `veragi~ infeqciuri<br />
endokarditi xSirad viTardeba gulis<br />
sarqvlebis proTezze. organizmSi infeqcia<br />
SesaZloa Setanili iyos urologiuri an<br />
gastroenterologiuri manipulaciebisas,<br />
instrumentuli gziT, Sinagan organoebze<br />
operaciuli Carevisas. endokarditi upiratesad<br />
viTardeba streptokokebis mizeziT,<br />
magram aris inficirebis SemTxvevebi<br />
iSviaTi mikroorganizmebiT - koksielebiT<br />
an qlamidiebiT. tuberkulozi aseve iwvevs<br />
miasTeniasa da gaxangrZlivebul cxelebas;<br />
tuberkulozs xSirad aqvs filtvs gareTa<br />
lokalizaciac (Rrma ganglioruli, Sardis<br />
gamomy<strong>of</strong>i gzebi, saxsrebi, genitaliis organoebi),<br />
rac zogjer diagnostikur<br />
sirTuleebs iwvevs. asTeniis cxelebiTi<br />
formisas aseve unda gvaxsovdes mwvave<br />
brucelozic, Tumca igi amJamad iSviaTad<br />
gvxvdeba.<br />
infeqciuri warmoSobis asTenia. Sei-<br />
Zleba aRiniSnos siyviTlis gareSe mimdinare<br />
mwvave virusuli hepatitis (A, B, C)<br />
an qronikuli virusuli hepatitis gamwvavebis<br />
dros.<br />
imunuri mgrZnobelobis virusisadmi<br />
seropozitiuri pasuxisas Sids-is simptomebis<br />
ganviTarebamde aRiniSneba izolirebuli<br />
asTenia, rac zogjer daavadebis<br />
pirveli niSania.<br />
literaturaSi qronikuli sisustis<br />
sindromis cnebisadmi mravali kiTxvaa:<br />
masSi igulisxmeba 6 Tveze met xans mimdinare<br />
gamoxatuli asTenia, dakavSirebuli<br />
cxelebasTan, mialgiasTan, gulisrevasTan,<br />
guneba-ganwyobisa da Zilis dar-<br />
RvevasTan, <strong>of</strong>lianobasTan, kisris limfadenopaTiasTan;<br />
zogjer es simptomebi<br />
Sedegia iseTi cnobili infeqciebisa,<br />
rogoricaa: mononukleozi, entero- an<br />
polivirusuli infeqciebi da a.S.<br />
hematologiuri warmoSobis asTenia.<br />
sisxlis saerTo analizi da eleqtr<strong>of</strong>orezi<br />
saSualebas gvaZlevs asTenia davukavSiroT<br />
Semdeg mdgomareobebs: 1.<br />
qronikul anemias (hemoglobinis done 8 g/<br />
dl-ze naklebi), romelic xSirad gamowveulia<br />
rkinis deficitiT; 2. qronikul<br />
mieloleikemias, romlis drosac asTenia<br />
mudmivi xasiaTisaa da sawyis simptomad<br />
iTvleba; 3. mwvave leikemias asTeniiT,<br />
agreTve, mielodisplaziur sindroms<br />
leikemiis transformaciis stadiaSi; 4. kaleris<br />
(mielomur) daavadebas, rodesac as-<br />
Tenia hiperkalciemiis gareSe erTader-<br />
Ti simptomia. 5. simsivnes.<br />
asTenia, rogorc avTvisebiani simsivnis<br />
erTaderTi simptomi. sisustis meqnaizmi<br />
aixsneba simsivnuri ujredebis mier anomaliuri<br />
nivTierebebis gamomuSavebiT, rac<br />
Cveuli metabolizmis darRvevasa da kun-<br />
Tovani qsovilis funqciis moSlas iwvevs.<br />
misi magaliTia simsivnuri intoqsikacia,<br />
rac onkopacientTa 85-90%-Si gvxvdeba.<br />
zogjer is SesaZloa gamovlindes pirvel<br />
simptomad: TirkmlebSi, sakvercxeebSi,<br />
RviZlSi, filtvebSi an limfoidur sistemaSi<br />
Rrmad ganTavsebuli pirveladi kibos<br />
dros; filtvis an RviZlis metastazebisas;<br />
agreTve, pacientTa mkurnalobis<br />
gverdiTi movlenebis (qirurgiuli, qimia-,<br />
imuno- da sxivuri Terapia) Sedegad, Tumca<br />
mkurnalobis dasrulebidan or kvira-<br />
Si xSirad TavisTavad qreba.<br />
funqciuri bunebis izolirebuli as-<br />
Tenia. zemoT aRwerili mdgomareobebis<br />
sawinaaRmdegod aseTi tipis asTenia<br />
pirveladia; is SeiZleba dakavSirebuli<br />
iyos fsiqikur darRvevebTan (reaqtiuli<br />
nevrozi, depresis, ipoqondria), insomniasTan<br />
(qronikuli uZiloba, nevrozi,<br />
mousvenroba, cvalebadi muSaoba) an fizikur<br />
gadatvirTvasTan (sportSi gadaWarbebuli<br />
varjiSi).<br />
filtv-gulis daavadebebi da asTenia.<br />
rodesac dakavSirebulia dispnoesTan,<br />
miuTiTebs am organoebis dazianebis<br />
Sesaxeb, gansakuTrebiT Tu TvalnaTeli<br />
anemia ar aris gamoxatuli.<br />
fsiqogenuri mizezebi da depresiuli<br />
mdgomareobebi. gansakuTrebiT xSiria<br />
asakovan adamianebSi, romelTaTvisac<br />
damaxasiaTebelia daRliloba, apaTia, iniciativis<br />
dakargva. axalgazrdebSi klinika<br />
ufro mravalferovani da atipuria.<br />
moxucebis gamokvlevisas sayuradReboa:<br />
dilis moduneba xom ar mcirdeba saRamo-<br />
Ti, aqvs Tu ara insomnia gamTeniisas, somatizacia,<br />
gonebrivi sisuste. Tu depresia<br />
axali dawyebulia an reaqtiulia, pasuxi<br />
mkurnalobaze ukeTesia. xanSiSesulebSi<br />
farTod gamoiyeneba antidepresantebi,<br />
xolo depresiis simptomebi mkurnalobas<br />
kargad ar emorCileba.<br />
inteleqtaluri darRvevebi da asTenia.<br />
50 wlis zemoT mravali adamiani uCivis<br />
mexsirebis gauaresebas, koncentraciis<br />
unaris daqveiTebas. sabednierod, maTi
47<br />
umravlesoba Sepyrobili araa alcheimeris<br />
daavadebiT. pacientebisaTvis tvinis<br />
fiziologiis kargi axsna, gamxneveba,<br />
rCevebi gonebrivi higienisaTvis, sruly<strong>of</strong>ili<br />
sazogadoebrivi cxovreba ufro<br />
nay<strong>of</strong>ieria, vidre anqsiolitebisa da sa-<br />
Zile saSualebebis gamoyeneba.<br />
cxovrebis wesi da asTenia. cxovrebis<br />
wesi SeiZleba dakavSirebuli iyos gada-<br />
Warbebul da zogjer gadautanel gadatvirTvasTan<br />
samsaxurSi, sazogadoebaSi,<br />
saxlSi. pacientis harmoniul mdgomareobaSi<br />
dasabruneblad aucilebelia multidisciplinuri<br />
midgoma. am dros<br />
saWiroa, rom eqimma mWidro kavSirSi iTanamSromlos<br />
fsiqologTan da socialur<br />
muSakTan. medikamentebis Cveneba am situaciaSi<br />
SezRudulia.<br />
iatrogenuri asTenia. samwuxarod,<br />
eqimis daniSnulebebi xSirad aris asTeniisa<br />
da sxvadasxva darRvevis mizezi. magali-<br />
Tad, orTostaturi hipotenzia, romelzec<br />
qvemoTaa saubari. mravali wamali moqmedebs<br />
kunTebis tonusze. iatrogenul<br />
asTenias iwvevs iseTi preparatebis ukontrolo<br />
daniSvna, rogoricaa beta-blokatorebi,<br />
antihipertenziuli, hipnotikuri,<br />
anqsiolituri da diuretikuli.<br />
erTdroulad ramdenime preparatis miRebis<br />
SemTxvevaSi, zogjer Znelia imis dadgena,<br />
Tu romeli maTgani iwvevs asTenias.<br />
fibromialgiuri asTenia. rodesac pacienti<br />
mTel sxeulSi aRniSnavs tanjvas.<br />
organuli warmoSobis paTologiis gamoricxvis<br />
Semdeg, unda vifiqroT fibromialgiaze.<br />
mas aseve uwodeben fibrozits, poliesTezopaTias<br />
an idiopaTiur difuzur<br />
polialgiur sindroms (Herisson). misi ZiriTadi<br />
simptomebia difuzuri polialgia,<br />
dilis SeboWiloba, Zilis darRveva da gansakuTrebiT<br />
asTenia. daRlilobis grZnoba<br />
praqtikulad aRiniSneba mudmivad, koncentrirebis<br />
an fizikuri mcdelobisas<br />
sisuste Zlierdeba. am mdgomareobebis<br />
etiologia da paTogenezi dRemde urTierTsawinaaRmdego<br />
rCeba. Zilis darRveva<br />
Zalian xSirad aRiniSneba, ris gamoc<br />
wamoyenebuli iyo hipoTeza Zilis aRdgenis<br />
Sesaxeb. bevri mkvlevari aRniSnavs<br />
garemos rols, gansakuTrebiT did mniSvnelobas<br />
aniWeben xmaurisa da stresis<br />
gavlenas. am monacemebis fonze da<br />
tkivildayuCebiTi da anTebis sawinaaRmdego<br />
Terpaiis SezRuduli Sedegebis<br />
gamo, zogierTi avtori gvTavazobs er-<br />
Tian midgomas mkurnalobisadmi (siTburi<br />
da relaqsaciuri procedurebis CaTvliT).<br />
aucilebelia aRiniSnos, rom qronikul<br />
sisustesa da gaurkveveli warmoSobis<br />
fibromialgias saerTo gamovlinebebi<br />
aqvT: zogadi asTenia, arTromialgia,<br />
Zilis darRveva. Goldberg-ma Tavisi<br />
kvleviT aCvena, rom qronikuli sisustiT<br />
Sepyrobil pacientTa 70% Seesabameba fibromialgiis<br />
kriteriums.<br />
orsulTa asTenia. Zalzed xSiri Civilia,<br />
romliTac orsulebi mimarTaven eqims. upirveles<br />
yovlisa aucilebelia organuli<br />
mizezis gamoricxva, radgan mas SeuZlia<br />
gaauaresos qalisa da nay<strong>of</strong>is prognozi. funqciuri<br />
asTeniis dros, umravles SemTxveva-<br />
Si, mdgomareoba mniSvnelovnad umjobesdeba<br />
dasvenebis Semdeg, dietis dacvis, cxovrebis<br />
pirobebis gaumjobesebisa da maT fonze<br />
Catarebuli fsiqoTerapiiT.<br />
moxucebulTa asTenia. am asakSi adamianebsa<br />
da maT axloblebs asTenia siberis<br />
ganuy<strong>of</strong>el atributad miaCniaT (6-10). eqimebi<br />
mas aRiqvamen rogorc banalurs, rasac<br />
ukavSireben organoTa fiziologiur<br />
daberebas, maTi funqciebis Caqrobas, mwarmoeblobis<br />
daqveiTabasa da sisustis subieqtur<br />
SegrZnebas. es midgoma arasworia, radgan<br />
mwarmoeblobis daqveiTeba (eqstremaluri<br />
situaciebisadmi adaptaciis unaris<br />
daqveiTeba) fiziologiuri movlenaa, xolo<br />
daRlilobis SegrZneba aseTi ar aris. moxucebSi<br />
asTeniis ganviTareba adasturebs, rom<br />
adgili aqvs somaturi an fsiqikuri bunebis<br />
darRvevas an cxovrebis wesis TaviseburebebiTaa<br />
ganpirobebuli, antiasTeniuri<br />
preparatebis miRebiT.<br />
orTostatiuli hipotenzia. xanSiSesulTa<br />
asTenia xSirad mimdinareobs lipoTiemiiT<br />
da mkveTrad gamoxatuli<br />
sisustiT (sawolSi Tavs ukeTesad<br />
grZnoben). am mdgomareobis diagnostirebisaTvis<br />
saWiroa arteriuli wnevis gasinjva<br />
jer mwoliare, Semdeg ki fexze dgomisas<br />
da erTdroulad pulsis daTvla<br />
disavtonomiis gamovlenisaTvis (vegetatiuri<br />
disfunqcia, parkinsonis daavadeba,<br />
stil-riCardsonis daavadeba, Saiadreijeris<br />
daavadeba). ortostatiuli<br />
hipotenziis ganviTarebis ZiriTadi<br />
mizezi SeiZleba iyos wamlebi.<br />
arasakmarisi kveba. es mniSvnelovani<br />
da naklebad cnobili mizezi dakavSirebulia<br />
rogorc arasakmaris kvebasTan, ise<br />
paTologiuri procesiT gamowveul Sinagani<br />
katabolizmis gaZlierebasTan. sxeulis<br />
masis kleba, dietis darRveva da sisxlSi<br />
albuminis 35 g/l-ze qvemoT dakleba<br />
miuTiTebs arasakmaris kvebasa da Sesabamisi<br />
koreqciis saWiroebaze.<br />
endokrinuli daavadeba. hiper- da
48<br />
hipoTireoidizmi pirvelia, romelzec<br />
SeiZleba vifiqroT. diagnozi am dros<br />
efuZneba Tireotropuli hormonis donis<br />
gansazRvras. Tirkmelzeda jirkvlis an<br />
hip<strong>of</strong>izis wina wilis ukmarisoba gvxvdeba<br />
gacilebiT iSviaTad, Tu pacienti ar<br />
aris namkurnalevi diuretikebiT<br />
(hiponatriemia, hiperkalemia). ar unda<br />
dagvaviwydes darRvevebi paraTireoiduli<br />
jirkvlis mxriv, gansakuTrebiT hiperkalciemiis<br />
fonze arsebuli hiperparaTireoidizmis<br />
dros.<br />
zogadi midgoma asTeniisadmi. sisustis<br />
mizezis dadgenis Semdeg, eqimma dauyovnebliv<br />
unda gaiTvaliswinos 3 ZiriTadi<br />
principi: mizezis mkurnaloba - mwvave<br />
da qronikuli organuli daavadebis,<br />
swori kveba, zogierTi daniSnulebis moxsna<br />
(diuretiki, beta-blokatori da a.S.).<br />
pacients mdgomareobidan gamosvlaSi<br />
unda davexmaroT bunebrivi kinezTerapiis,<br />
hidroTerapiisa da fsiqoTerapiis me-<br />
TodebiT, aseve zogierTi arahormonuli<br />
medikamenturi saSualebebiT, magaliTad<br />
citrulinis malatiT (stimoli).<br />
Catarebuli mimoxilvis safuZvelze<br />
SeiZleba davaskvnaT, rom:<br />
1. asTenia mravalfaqtoruli bunebisaa<br />
da igi aRmocendeba sxvadasxva mizeziT;<br />
2. asTeniaze xSir Civils unda mieqces<br />
gansakuTrebuli yuradReba, radgan igi<br />
SeiZleba faravdes ufro seriozul simptomebs<br />
(rogorc organulis, ise funqciuri<br />
xasiaTisas);<br />
3. saTanado Sefaseba unda mieces kvebis<br />
reJims, wonis cvlilebas, laboratoriul<br />
testebs da iatrogenul SemTxvevebs;<br />
4. adekvaturi mkurnaloba efiZneba<br />
paT<strong>of</strong>iziologiur monacemebs, risTvisac<br />
aucilebelia pacientis mravalmxrivi da<br />
srulfasovani gamokvleva Sesabamisi<br />
klinikuri analiziT.<br />
РОЛЬ СЕМЕЙННОГО ВРАЧА В ЛЕЧЕНИИ УТОМЛЯЕМОСТИ<br />
М.Шавдия, Э.Дарбаисели, Н. Шавдия, А.Вачеишвили<br />
КЛИНИКА ПАЛЛЯТИВНОГО УХОДА ЦЕНТРА ОНКОПРЕВЕНЦИИ<br />
Астения - жалоба, часто предъявляемая пациентами семейным врачам. При наличии астении<br />
необходимо исключить органические причины, способные ухудшить прогноз. При функциональной астении<br />
в большинстве случаев состояние значительно улучшается после отдыха, при соблюдении диеты,<br />
улучшении условий жизни, на фоне психотерапии и применения антиастенических препаратов. Часто<br />
астения пациентами и окружающими воспринимается как обычное явление и поэтому нередки случаи<br />
самолечения. Однако астения - это ненормальная, спонтанная слабость, возникающая без<br />
предшествующей нагрузки. Поэтому обязательно выяснение причины, так как астения может быть<br />
проявлением и органической патологии. Семейный врач, способный оценить эту жалобу, играет основную<br />
роль в обследовании и лечении подобных больных. Хорошо зная своих пациентов, их историю болезни и<br />
имея представление о процессе, послужившем основой для возникновения астении, семейный врач, как<br />
никто другой, способен точно выявить органическое или функциональное заболевание, наличием которой<br />
пациент пренебрегает, помочь больному вспомнить те или иные симптомы или факт самопроизвольного<br />
приема медикаментов. В подобных случаях семейный врач должен всесторонне обследовать и оценить<br />
клиническое состояние пациента. Описаны проявления астении у пожилых и беременных, ятрогенная<br />
астения, а также особенности астении, возникающей при эндокринологической патологии, на фоне<br />
инфекций, онкологических заболеваний и т.д. Для метаболического лечения астении авторы рекомендуют<br />
прем препарата малат цитруллина (стимол).
49<br />
THE ROLE OF A FAMILY DOCTOR IN THE TREATMNT OF<br />
FATIGUBILITY<br />
M.Shavdia, E.Darbaiseli, N. Shavdia, A.Vacheishvili<br />
Asthenia - is a very common complaint made by patients during their visits to a family doctors. The organic<br />
causes which can make prognosis poor should be first <strong>of</strong>f all excluded. In most patients with functional asthenia<br />
their condition considerably improves after rest or a diet, under better living conditions, with psychotherapy and<br />
use <strong>of</strong> antiasthenic drugs. Often fatigue with patients and the people surrounding them is perceived as normal, so<br />
patients <strong>of</strong>ten resort to self-treatment. However, the cause <strong>of</strong> fatigue or, more precisely, asthenia, i.e. abnormal,<br />
spontaneous weakness arising without previous load, have to be clarified, as the symptom may be a manifestation<br />
<strong>of</strong> organic pathology. The family doctor <strong>of</strong> general practice that can evaluate the complaint, plays a major<br />
role in the examination and treatment <strong>of</strong> patients with asthenia. Being well aware <strong>of</strong> their patients, their history<br />
and consequently understanding <strong>of</strong> the process, which served as a basis for the arising asthenia family doctor as<br />
no one else can accurately identify organic disease or clinical anomaly, neglected by the patient, help the patient<br />
recall any symptoms or the fact <strong>of</strong> reciving medicine without prescription, a doctor can conduct a survey and<br />
eventually fully asses the patient’s clinical condition. On the basis <strong>of</strong> the literature review recommended on<br />
diagnostic steps, to be taken in case <strong>of</strong> asthenia, we describe manifestation <strong>of</strong> asthenia in elderly patients and<br />
pregnants, iatrogenic asthenia, as well as, the specifics <strong>of</strong> asthenia occurring in endocrinological pathology or on<br />
the background <strong>of</strong> infections, cancer etc. For the metabolic treatment <strong>of</strong> asthenia citrulline malate (Stimol) is<br />
recommended.<br />
literatura<br />
1. paliatiuri mzrunveoba - <strong>samedicino</strong> da organizaciuli aspetebi (r.RvamiCavas<br />
redaqciiT). Tbilisi.-2003.-138 gv.<br />
2. m.Savdia. onkologiis enciklopediuri leqsikoni. Tbilisi: favoriti, 2004- 408 gv.<br />
3. paliatiuri mzrunveloba (saxelmZRvanelo eqimebisTvis, d.korZaias redaqciiT),<br />
Tbilisi: poligrafi 2005.-235 gv.<br />
4. M.Shavdia et all. Symptom prevalence in patients with advanced cancer, Annals <strong>of</strong> Oncology, Abstracts<br />
<strong>of</strong> the 31st ESMO Congress, Istanbul, Turkey, 29.IX-3.X. 2006, vol.17, sup l.9; 931P.<br />
5. L.Emnuel, F.Ferris, CF. Von Cunten, J.Von Roenn. EPEC-O. Participant’s Handbook, Module 3k:<br />
Symptoms - Fatigue; Chicago.-2005. p. 1-10.<br />
6. A.Ciurana. Diagnosis <strong>of</strong> fatigability, www.rmj.ru/articles_2789. p. 1-3.<br />
7. M.Berthel. Asthenia in elderly patients, http://www.rmj.ru/articles_2789. p. 3-5.<br />
8. Jean-Lois Wemeau. Asthenia in Endocrinology. www.rmj.ru/articles-2789. p. 6-7.<br />
4. <strong>saqarTvelos</strong> <strong>samedicino</strong> <strong>Jurnali</strong>, 3, 2008 w.
50<br />
saSualo skola da swavla gaagrZela<br />
Tbilisis saxelmwifo <strong>samedicino</strong> institutis<br />
samkurnalo fakultetze, romelic<br />
warmatebiT daamTavra 1962 wels.<br />
institutis damTavrebisTanave, saeqimo<br />
saqmianobas iwyebs imereTis erT-erT<br />
ulamazesi s<strong>of</strong>lis - RoreSas saubno saavadmy<strong>of</strong>os<br />
gamged.<br />
axalgazrda eqimisaTvis metad warmatebuli<br />
iyo s<strong>of</strong>lad muSaobis periodi. s<strong>of</strong>luri<br />
cxovrebis specifika, mosaxleobasTan<br />
xalasi damokidebuleba. yovelive<br />
es iq Casuli damwyebi mkurnalisTvis<br />
cxovrebiseuli da pr<strong>of</strong>esiuli gamocdilebis<br />
skolad iqca.<br />
ori wlis Semdeg, s<strong>of</strong>eli siyvaruliTa<br />
da sinanuliT gamoeTxova soso kapanaZes.<br />
iwyeboda axali etapi saeqimo saqmianobisa.<br />
is Tbilisis me-7 klinikuri saavadmy<strong>of</strong>os<br />
Terapiul gany<strong>of</strong>ilebaSi ordinatorad<br />
iwyebs muSaobas.<br />
me-7 klinikuri saavadmy<strong>of</strong>o imxanad<br />
eqsperimentuli da klinikuri Terapiis<br />
samecniero-kvleviT institutis klinikuri<br />
baza iyo, sadac moRvaweobdnen<br />
erovnuli Terapiuli skolis saxelovani<br />
warmomadgenlebi. maTma maRalma pedagogiurma<br />
unarma, piradulma eTikurzneobrivma<br />
Tvisebebma, mdidarma gamocdileiubilari<br />
sasiqadulo mamuliSvili<br />
70<br />
didi ilia WavWavaZe brZanebda: “gonieri<br />
da windaxeduli dasawyisi wamlobisa<br />
saWiroa yovelTvis da yovel Jams, raki<br />
satkivari SeniSnulia da cnobili”.<br />
am brZnul iliaseul sentenciaSi eqimis<br />
gonivruloba da windaxeduloba im warmarTvel<br />
Zalad igulisxmeba, romelmac<br />
sasikeTo Sedegi unda moutanos mas pr<strong>of</strong>esiul<br />
saqmianobaSi.<br />
pr<strong>of</strong>esori simon (soso) kapanaZe am<br />
Tvisebebis sruly<strong>of</strong>ili mflobelia. is<br />
srulfasovnad grZnobs sakuTar Tavs im<br />
garemoSi, rodesac misi yoveli qmedeba<br />
Tanmimdevrulad mimarTulia sxvaTa<br />
sasikeTod.<br />
70 wlis iubilaris yoveldRiuri y<strong>of</strong>a<br />
gaJRenTilia gancdebiTa da mzady<strong>of</strong>niT<br />
TanaugrZnos sneuls. pacientis mkurnalobisas<br />
miRweuli warmateba mas did<br />
sixaruls gvris. amitom aris soso kapanaZe<br />
aRiarebuli rogorc saxalxo mkurnali da<br />
sazogado moRvawe.<br />
zogierTi monacemi misi biografiidan:<br />
daibada 1938 wlis 27 maiss, qalaq foTSi<br />
(ramdenime aTeuli wlis Semdeg foTelebi<br />
mas sapatio moqalaqed airCeven). cnobili<br />
mSeneblis, <strong>saqarTvelos</strong> damsaxurebuli<br />
inJinris, baton daviT kapanaZis ojaxSi.<br />
oqros medalze daamTavra Tbilisis me-3
51<br />
cnobili <strong>Jurnali</strong>sti da sazogado moRvawe ruslan rusia da<br />
pr<strong>of</strong>esori soso kapanaZe<br />
bam da daxvewilma pr<strong>of</strong>esiulma azrovnebam<br />
yovlismomcveli gavlena iqonia axalgazrda<br />
eqimis samomavlo karieraze.<br />
Terapiis samecniero-kvleviTi instituti,<br />
romelic Seiqmna 1961 wels akademikos<br />
nodar y<strong>of</strong>SiZis TaosnobiT, im droisaTvis<br />
<strong>samedicino</strong> azrovnebis erT-erTi<br />
cnobili centri iyo saerTaSoriso mas-<br />
StabiT. 1966 wels Terapiis institutSi,<br />
pirvelad saqarTveloSi, Seiqmna miokardiumis<br />
infarqtis gany<strong>of</strong>ileba miokardiumis<br />
mwvave infarqtiT Sepyrobil pacientTa<br />
specializebuli <strong>samedicino</strong> daxmarebis<br />
mizniT. aqedan iwyeba axalgazrda<br />
eqimis s.kapanaZis pr<strong>of</strong>esiuli aRmavlobis<br />
gza _ miokardiumis infarqtis gany<strong>of</strong>ilebis<br />
umcrosi mecnier muSakidan _<br />
wamyvan specialistamde.<br />
1994 wels, qarTvel kardiologTa didi<br />
ZalisxmeviTa da dargSi miRweuli warmatebaTa<br />
saerTaSoriso aRiarebis Sedegad,<br />
TbilisSi daarsda Tanamedrove donis<br />
gadaudebeli kardiologiis centri. batoni<br />
soso dRidan daarsebisa centris direqtoris<br />
moadgiled iniSneba. am postze<br />
saqmianobas is 32 wlis saeqimo da samecniero<br />
moRvaweobis gamocdilebiT Seudga.<br />
manamde iyo saeqimo saqmianobaSi miRweuli<br />
zogierTi sagulisxmo warmatebebi:<br />
1974 wels medicinis mecnierebaTa kandidatis<br />
samecniero xarisxis mosapoveblad<br />
disertaciis — `miokardiumis ganmeorebi-<br />
Ti infarqtebi” — warmatebiT dacva. 1975<br />
wels iniSneba dedaqalaqis mTavar Terapevtad<br />
da oci weliwadi Seucvlelad<br />
uZRveboda qalaqis Terapiul samsaxurs.<br />
1981 wels, <strong>saqarTvelos</strong> wamyvan kardiologebTan<br />
erTad, mieniWa saxelmwifo premia<br />
miokardiumis mwvave infarqtis diagnostikisa<br />
da mkurnalobis Tanamedrove<br />
efeqturi meTodebisa da mowinave gamocdilebis<br />
Tbilisis pirobebSi danergvisaTvis,<br />
xolo 1988 wels <strong>saqarTvelos</strong> damsaxurebuli<br />
eqimis sapatio wodeba eniWeba.<br />
1994 wels batoni soso icavs sadoqtoro<br />
disertacias Temaze — `iSemiuri dazianebis<br />
Sem<strong>of</strong>argvla miokardiumis infarqtis<br />
dros”. am Sromas xarisxebis mimniWebeli<br />
sabWos wevrTa erTsulovani mxardaWera<br />
xvda wilad.<br />
1997 wels gadaudebeli kardiologiis<br />
centrSi gaixsna gul-sisxlZarRvTa<br />
kaTeterizaciis laboratoria da pirvelad<br />
saqarTveloSi farTod dainerga gulis<br />
iSemiuri daavadebis diagnostikisa da<br />
mkurnalobis maRalteqnologiuri invaziuri<br />
da intervenciuli (seleqciuri koronarografia,<br />
transluminaluri balonuri<br />
angioplastika da stentireba) me-<br />
Todebi. am siaxlis kardiologiur praqtikaSi<br />
danergvam safuZveli Suqmna gulis<br />
iSemiuri daavadebis mkurnalobis qiru-
52<br />
rgiuli meTodebis ganviTarebas. 2001 wels<br />
gadaudebeli kardiologiis centrSi<br />
Seiqmna kardioqirurgiuli gany<strong>of</strong>ileba,<br />
farTod dainerga koronaruli Suntirebis<br />
operaciebi. gulis iSemiuri daavadebis<br />
diagnostikisa da mkurnalobis Tanamedrove<br />
meTodebis farTo danergvam, meoradi<br />
koronaruli prevenciis aqtiurad warmarTvam,<br />
sagrZnoblad gaaumjobesa<br />
saqarTveloSi gulis iSemiuri daavadebiT<br />
pacientebis prognozi da Seamcira letaloba<br />
miokardiumis infarqtis dros. 2004<br />
wels saqarTveloSi gulis iSemiuri daavadebis<br />
diagnostikisa da mkurnalobis ma-<br />
Ralteqnologiuri (invaziuri da intervenciuli)<br />
meTodebis danergvisaTvis,<br />
centris TanamSromlebTan erTad, pr<strong>of</strong>.<br />
s.kapanaZes mieniWa (meored) <strong>saqarTvelos</strong><br />
saxelmwifo premia. 2003 wels mis mier gamoqveynda<br />
mniSvnelovani monografia —<br />
`aTerosklerozis daumkvidrebeli riskis<br />
faqtorebi da paTogenezuri Terapiis<br />
axali perspeqtivebi”, romelSic am mimarTulebiT<br />
ganazogada Tavisi prioritetuli<br />
gamocdileba.<br />
droTa ganmavlobaSi batoni sosos<br />
samecniero-praqtikuli moRvaweobis potenciali<br />
mniSvnelovnad gaizarda. misi<br />
biografiuli monacemebi Setanilia kembrijis<br />
universitetis `internacionaluri<br />
biografTa centris” 1997 wels XXV saiubileo<br />
krebulSi da mieniWa oqros medali.<br />
1998 wels mosaxleobis janmrTelobis<br />
dacvis saqmeSi Setanili piradi didi wvlilis,<br />
nay<strong>of</strong>ieri samecniero-praqtikuli da<br />
sazogadoebrivi moRvaweobisaTvis batoni<br />
soso “Rirsebis ordeniT” dajildovda.<br />
2002 wels gansakuTerebuli damsaxurebisaTvis<br />
qarTuli medicinis winaSe gadaeca<br />
jandacvis saministros `sapatio medali”.<br />
metad masStaburia batoni sosos sazogadoebriobasTan<br />
saqmiani urTierToba.<br />
misi pirovnuli Tvisebebidan gamomdinare,<br />
yvelgan keTili guli Seaqvs da<br />
keTili guliTve pasuxoben. uyvarT misi<br />
mosmena. sikeTes aravis ar daukargavs da<br />
Tavisi gulis siTbosac zed daayolebs.<br />
yovelive amis Sedegia Cveni qveynis saxelovani<br />
adamianebis didi pativiscema da<br />
siyvaruli mis mimarT. sasiqadulo mweralma<br />
nodar dumbaZem “maradisobis<br />
kanonis” pirveli egzempliari Semdegi<br />
warweriT uZRvna mis mkurnals — `soso kapanaZes!<br />
am qveynad Cemi meored mosvlis<br />
uSualo monawiles, uzomo madlierebiT<br />
da siyvaruliT” — nodar dumbaZe, 27 dekemberi,<br />
1979 weli.<br />
aseTive siTboTi aris gaJRenTili cnobili<br />
<strong>Jurnali</strong>stisa da sazogado moRvawis<br />
ruslan rusias leqsis striqonebi:<br />
“wamliT ki ara, guliT mkurnalobT<br />
guls — tanjviT, dardiT, garjiT gadaRlils.<br />
sxvaTaTvis mudam rom gulmzianobT<br />
iqneb imadac garja ara gRliT”<br />
kidev erTi sasiqadulo poetis gamonaTqvami<br />
batoni sosos misamarTiT: “batono<br />
soso ar damaviwydeba, palataSi rom mobr-<br />
ZandiT da gamamxneveT _ nirwamxdari da<br />
“sikvdilisa meWveli”. miguleT Tqvens<br />
Zmad! tariel Wanturia.<br />
aseTia, gulwrfeli survilebi im adamianis<br />
mimarT, romelic avadmy<strong>of</strong>is sicocxlis<br />
SenarCunebisaTvis erTgulebasa da<br />
Tavdadebas iCens.<br />
batoni soso <strong>saqarTvelos</strong> <strong>samedicino</strong>socialuri<br />
mecnierebaTa akademiisa da<br />
kavkasiis xalxTa mecnierebaTa akademiis<br />
namdvlili wevria. <strong>saqarTvelos</strong> internistTa<br />
sazogadoebis gamgeobis, <strong>saqarTvelos</strong><br />
kardiologTa asociaciis prezidiumis,<br />
Tbilisis saxelmwifo <strong>samedicino</strong><br />
universitetis `kardiologiis” dargSi<br />
samecniero xarisxebis mimniWebeli specializebuli<br />
sabWos, evropis kardiologTa<br />
asociaciisa da saerTaSoriso sazogadoeba<br />
“aTerosklerozis” wevria.<br />
rogorc aRvniSneT arCeulia foTis sapatio<br />
moqalaqed. 159 samecniero-praqtikuli<br />
naSromis avtoria.<br />
batoni soso drois Sesaferisi moRvawea,<br />
ganswavluli pirovneba da WeSmariti moqalaqea,<br />
romelic Tavisi TavdadebiTa da<br />
niWierebiT xels uwyobs saqarTveloSi klinikuri<br />
da Teoriuli kardiologiis winsvlasa<br />
da ganviTarebas.<br />
vusurvebT warmatebul klinicists, mecniers,<br />
sazogado moRvawes mxneobas da did<br />
miRwevebs erovnuli medicinis samsaxurSi.<br />
g.CafiZe,<br />
gadaudebeli kardiologiis<br />
centris direqtori, pr<strong>of</strong>esori<br />
j.mamalaZe,<br />
`<strong>saqarTvelos</strong> <strong>samedicino</strong> <strong>Jurnali</strong>s~<br />
mTavari redaqtori, pr<strong>of</strong>esori
53<br />
gaxseneba<br />
megobris xsovnas<br />
rCeulTa xvedria maTi saxelis moxseneba da<br />
pativis migeba amqveyniuri cxovrebis winaSe<br />
valmoxdis Semdeg.<br />
guram baqraZem, Tavisi rainduli bunebis<br />
wyalobiT, moqalaqeobrivi vali moixada qveynis,<br />
xalxis winaSe, pr<strong>of</strong>esiuli movaleoba - pacientebis,<br />
avadmy<strong>of</strong>ebis mimarT. siyvaruli da<br />
Tanadgoma ar dauklia megobrebis, kolegebis,<br />
TanamoazreebisaTvis. yvela gaWirvebuls<br />
gverdSi edga da Rirseulad amayobda amiT.<br />
misi pirovnebis pirvelsaywiss sikeTe, kacTmoyvareoba<br />
warmoadgenda. es misi bunebis Sinagan<br />
aucileblobasa da yoveldRiur cxovrebiseul<br />
movaleobas Seadgenda.<br />
guram baqraZe, TbilisSi, tradiciul ojax-<br />
Si daibada. 1953 wels warCinebiT daamTavra<br />
dedaqalaqis pirveli saSualo skola da imave<br />
wels Tbilisis saxelmwifo <strong>samedicino</strong> institutis<br />
samkurnalo fakultetis studenti gaxda.<br />
swored aqedan iwyeba Cveni nacnoboba masTan<br />
da SemdgomSi megobrobamac bunebrivad iCina<br />
Tavi. studentobis periodSi Cvens Tvalwin yalibdeboda<br />
axali samyaro. es is xanaa, rodesac<br />
saeqimo ganaTlebas dawafebuli axalgazrdoba<br />
garemoculia saxelovan pedagogTa mzrunvelobiT,<br />
pirovnuli magaliTebiT, avadmy<strong>of</strong>isadmi<br />
sibraluliTa da TanadgomiT, saeqimo<br />
pr<strong>of</strong>esiisadmi siamayis grZnobiT. axalgazrda<br />
kacis TvaliT aRqmuli es movlenebi sasikeTo<br />
gavlenas axdens mis momaval karieraze.<br />
guramma Cinebulad auRo alRo saeqimo pr<strong>of</strong>esiis<br />
sikeTes, mis sakacobrio humanizms, radgan<br />
masSi arsebuli pirovnuli Tvisebebis masazrdoebel<br />
Zalas swored es idealebi warmoadgenda.<br />
guram baqraZis saeqimo azrovnebis zogierTi<br />
individuri Tviseba SesaniSnavad gamovlinda mis<br />
pr<strong>of</strong>esiul da pedagogiur ostatobaSi. kerZod,<br />
niWiereba, zogadi ganaTleba, novatoruli Ziebis<br />
unari, sakoleqcio da praqtikuli masalis gadacemis<br />
Cinebuli floba, misTvis Cveuli xaverdovani<br />
iumori, xmatkbili galoba da sxva.<br />
guram baqraZis samecniero da pedagogiuri<br />
moRvaweoba uSualod iyo dakavSirebuli eqim-<br />
Ta daxelovnebis Tbilisis saxelmwifo institutTan,<br />
orTopediisa da travmatologiis<br />
samecniero-kvleviT centrTan. aq is Camoyalibda<br />
rogorc dastaqari, mkvlevari, pedagogi.<br />
yovelive es misi pr<strong>of</strong>esiuli ostatobis Semadgenel<br />
niSan-Tvisebad iqca.<br />
arcTu xangrZlivi amqveyniuri cxovrebiT<br />
icxovra guramma. Svid aTeul welze odnav meti<br />
wlis asakSi eziara maradisobas. mogonebad dar-<br />
Ca misi pirovnuli samyaro, emociuri ganwyoba.<br />
icxovra yvela im TvisebiT, romelic qarTveli<br />
adamianis Sinagan bunebaSi devs.<br />
samwuxarod, dRes gulistkiviliT vigonebT im<br />
adamians, romelmac sicocxleSive farTod gauRo<br />
gulis kari yvelas, TavdadebiT emsaxura qveyanas,<br />
pr<strong>of</strong>esias da valmoxdili wavida Cvengan.<br />
Tengiz kaWaxiZe<br />
jangir mamalaZe
54<br />
icxovra sikeTiT sxvaTa mimarT<br />
gardasul droTa mexsierebas SemorCa<br />
mogoneba im adamianis Sesaxeb, romelmac<br />
icxovra sikeTiT, siyvaruliTa da miseuli<br />
xibli da kacTmoyvareobis uxvi magaliTebi<br />
dagvitova.<br />
dRevandeli y<strong>of</strong>idan saubari amgvari<br />
adamianis Sesaxeb sasikeTo gavlenas<br />
axdens yvela Cvenganze.<br />
jemal mgalobliSvili, gasuli saukunis<br />
60-iani wlebis dasawyisSi, <strong>saqarTvelos</strong><br />
politeqnikur institutSi avtomobilebisa<br />
da saavtomobilo meurneobis<br />
specialistis wodebis miniWebis Semdeg,<br />
Seunelebeli interesiT eziara pr<strong>of</strong>esiul<br />
saqmianobas.<br />
dedaqalaqSi dabadebul da gazrdil<br />
Wabuks kargad esmoda Sromisadmi erTguleba,<br />
TanatolebTan Tanadgoma, ufrosi<br />
Taobis mimarT pativiscemiTa da subordinaciiT<br />
mopovebuli pirovnuli avtoritetis<br />
fasi.<br />
mokrZaleba da pativiscema sxvaTa mimarT,<br />
Cveuli sisadave da Tavmdabloba ara<br />
marto genetikuri, aramed misi Tvisebis<br />
Semadgeneli nawili iyo. `megobroba mxolod<br />
imas SeuZlia, visac ZaluZs vinme an<br />
raime uangarod uyvardes~ konstantine<br />
gamsaxurdias es cnobili sentencia upirobod<br />
esadageba mis pirovnebas, amitom aRiares<br />
batoni jemali sasurvel da saimedo<br />
partniorad saqmeSic da megobrobaSic.<br />
gansakuTrebulad gamorCeuli iyo jemal<br />
mgalobliSvilis pirovnuli Tvisebebi<br />
rogorc xelmZRvanelisa. yvelgan, sadac<br />
ki umuSavia mas, miuxedavad mosagvarebel<br />
sakiTxTa sirTulisa da masStaburobisa,<br />
misTvis Cveuli zomierebiTa da<br />
pr<strong>of</strong>esionalizmiT erTveboda problemaTa<br />
efeqturad daZlevisaTvis, rac sasurveli<br />
SedegiT iyo garantirebuli.<br />
xangrZlivi periodi iRvawa batonma jemalma<br />
<strong>saqarTvelos</strong> janmrTelobis dacvis<br />
sistemaSi. 1979 wlidan moyolebuli,<br />
TiTqmis or aTeul welze meti xnis ganmavlobaSi,<br />
xelmZRvanelobda saministros<br />
avtosatransporto gaerTianebas. 1991
55<br />
wlidan iniSneba <strong>saqarTvelos</strong> jandacvisa<br />
da socialuri uzrunvely<strong>of</strong>is saministros<br />
momaragebisa da transportis respublikuri<br />
gaerTianebis generalur<br />
direqtorad, xolo aRniSnuli gaer-<br />
Tianebis reorganizaciis Semdeg saxazino<br />
saawarmoo `medavtoservizcentris~ generalur<br />
direqtorad.<br />
misi cxovrebisa da moRvaweobis bolo<br />
periodi emTxveva qveyanaSi, Cvens sazogadoebaSi<br />
mimdinare urTules procesebs.<br />
misi moqalaqeobrivi pozicia Tavisufali,<br />
demokratiuli qveynis aRmSeneblobis,<br />
sasikeTo momavlisaTvis brZolisaTvis<br />
mzady<strong>of</strong>naSi gamoixata.<br />
erovnuli cnobierebisadmi erTgulebiT<br />
icxovra da iRvawa batonma jemalma.<br />
misi amqveyniuri arsebobis yvela<br />
monakveTi qveynisa da xalxis mimarT<br />
Tavdadebis, megobrebis, kolegebisadmi<br />
Tanadgomis Cinebuli gamoxatuleba iyo.<br />
ai rogor Sefasebas aZlevda baton jemals<br />
<strong>saqarTvelos</strong> jandacvis saministros<br />
xelmZRvaneloba mis mimarT gacemul<br />
<strong>of</strong>icialur dokumentSi: `jemal mgalobliSvili<br />
niWieri da kargi organizatoria,<br />
gamoirCeva saqmis codniT, energiulobiT,<br />
saTanado principulobiTa<br />
da momTxovnelobiT, yuradRebiTa da<br />
TavmdablobiT~.<br />
arc Tu xangrZlivi cxovrebiT icxovra<br />
batonma jemalma. samwuxarod, is<br />
ver moeswro misi mravali Canafiqris<br />
ganxorcielebas, magram darCa saxeli da<br />
saqmeni adamianisa, romlis gaxseneba da<br />
pativis migeba yvelas valia, radgan man<br />
datova piraduli magaliTi momavlisaTvis.<br />
jangir mamalaZe,<br />
pr<strong>of</strong>esori
56<br />
nekrologi<br />
praqtikuli moRvaweoba daiwyo 1946<br />
wlidan. is eqvsi wlis ganmavlobaSi (1952<br />
wlamde) muSaobda, rogorc qirurgi<br />
onkologi, Semdeg ki saTaveSi Caudga<br />
<strong>saqarTvelos</strong> janmrTelobis dacvis saministros<br />
onkologiuri dispanseris paTomorfologiur<br />
laboratorias. akademikos<br />
vladimer JRentis rekomendaciiT,<br />
1959 wels, man saqarTveloSi axlad<br />
daarsebul onkologiis institutSi Camoayaliba<br />
paTomorfologiuri laboratoria<br />
da arCeul iqna am laboratoriis xelmZRvanelad.<br />
1959 wels daicva sakandidato, xolo<br />
1968 wels sadoqtoro disertacia, 1970<br />
wels mieniWa pr<strong>of</strong>esoris wodeba.<br />
1976 wels onkologiis samecniero centris<br />
Seqmnisas moxda laboratoriis reor<strong>saqarTvelos</strong><br />
sazogadoebrioba, qarTveli medikosebi gulistkiviliT<br />
gamoeTxovnen erovnuli onkologiuri skolis TvalsaCino moRvaweebs -<br />
qalbaton gulnara gersamiasa da baton levan Carkvians.<br />
`<strong>saqarTvelos</strong> <strong>samedicino</strong> <strong>Jurnali</strong>s~ saredaqcio kolegia da sabWo,<br />
redaqciis TanamSromlebi uerTdebian maTi gardacvalebiT<br />
gamowveul mwuxarebas da TanaugrZnoben gansvenebulTa ojaxebs<br />
vaqveynebT maTi saxelovani cxovrebisa da moRvaweobis amsaxvel zogierT<br />
epizods.<br />
gulnara gerasmia<br />
qalbatoni gulnara iyo medicinis mecnierebaTa<br />
doqtori, pr<strong>of</strong>esori, mecnierebis<br />
damsaxurebuli moRvawe, medikur-biologiuri<br />
akademiis akademikosi, niuiorkis<br />
mecnierebaTa akademiis namdvili<br />
wevri, ms<strong>of</strong>lio saerTaSoriso akademiis<br />
akademikosi, saxelmwifo premiis laureati,<br />
pr<strong>of</strong>. a. RvamiCavas saxelobis nacionaluri<br />
centris paTanatomiis gany<strong>of</strong>ilebis gamge.<br />
daibada 1924 wels TbilisSi. 1941 w. warmatebiT<br />
daamTavra Tbilisis me-8 saS. skola,<br />
1946 wels ki Tbilisis saxelmwifo<br />
<strong>samedicino</strong> institutis pediatriuli<br />
fakulteti. institutis damTavrebisTanave<br />
muSaoba daiwyo <strong>saqarTvelos</strong> janrmTelobis<br />
dacvis saministros respublikur<br />
onkologiur dispanserSi qirurgordinatorad.
57<br />
ganizacia. qalbatoni gulnara arCeul iqna<br />
aRniSnuli laboratoriis xelmZRvanelad.<br />
misi Sromebi gamoqveynebulia kibos<br />
sawinaaRmdego araerTi saerTaSoriso<br />
kongresis masalebSi.<br />
pr<strong>of</strong>. g. gersamias samecniero-kvlevi-<br />
Ti muSaobis produqts warmoadgens 250-<br />
ze meti samecniero naSromi. Sromebis<br />
ZiriTad mimarTulebas warmoadgens simsivneebis<br />
Terapiuli paTomorfozi praqtikul<br />
da Teoriul aspeqtSi.<br />
pr<strong>of</strong>. g. gersamia dauRalavad eweoda,<br />
agreTve, pedagogiur muSaobasac. misi xelmZRvanelobiT<br />
laboratoriaSi Sesrulebul<br />
iqna 35 sadoqtoro da sakandidato<br />
disertacia. mis mier aRzrdil da<br />
daxelovnebul iqna mravali sxvadasxva<br />
pr<strong>of</strong>ilis eqimi, romlebic amJamad<br />
muSaoben sxvadasxva pr<strong>of</strong>ilis laboratoriasa<br />
da klinikaSi, maT Soris sazRvargareTac.<br />
pr<strong>of</strong>. g. gersamia iyo paTolog-anatom-<br />
Ta, onkologTa da radiologTa sazogadoebebis<br />
wevri. mravali weli iyo <strong>saqarTvelos</strong><br />
onkologTa respublikuri da Tbilisis<br />
samecniero sazogadoebis generaluri<br />
mdivani. wlebis manZilze iyo onkologiis<br />
samecniero centris, samecniero-saatestacio<br />
sabWos swavluli mdivani. xelmZRvanelobda<br />
onkocentris sakoordinacio sabWos.<br />
zemoT aRniSnuli xangrZlivi mecnieruli<br />
moRvaweobis safuZvelze pr<strong>of</strong>. g.<br />
gersamias miRebuli aqvs uamravi jildo. is<br />
aqtiuri wevri iyo sazogadoeba `Tbiliselis~<br />
qalTa sakrebuloSi.<br />
yvelaferi zemoganxiluli gaxda<br />
safuZveli imisa, rom pr<strong>of</strong>. gersamia:<br />
1983 wels <strong>saqarTvelos</strong> umaRlesi sab-<br />
Wos prezidiumis brZanebiT iRebs mecnierebis<br />
damsaxurebuli moRvawis wodebas.<br />
1987 wels samamulo qirurgiis ganviTarebis<br />
saqmeSi Setanili wvlilisaTvis jildovdeba<br />
grigol muxaZis sapatio medliT.<br />
1993 wels adgilobrivad gavrcelebuli<br />
filtvis kibos qirurgiuli mkurnalobis<br />
samecniero naSromisaTvis iRebs andro<br />
RvamiCavas saxelobis premias.<br />
1994 wels xdeba <strong>saqarTvelos</strong> medikurbiologiuri<br />
akademiis akademikosi.<br />
1996 wels <strong>saqarTvelos</strong> janmrTelobis<br />
dacvis mier saqarTveloSi onkologiuri<br />
samsaxuris daarsebidan 50 wlisTavTan<br />
dakavSirebiT xangrZlivi da nay<strong>of</strong>ieri<br />
muSaobisaTvis jildovdeba sapatio<br />
sigeliT.<br />
1997 wels qarTuli onkologiis mecnierebis<br />
ganviTarebisaTvis, <strong>saqarTvelos</strong><br />
prezidentis mier jildovdeba Risebis<br />
ordeniT.<br />
1997 wels Setanilia qarTul enciklopediaSi.<br />
1999 wels saukeTeso samecniero naSromisaTvis<br />
radiologiis dargSi eniWeba<br />
amiran CaCavas saxelobis premia.<br />
2000 wels Tbilisis meriis gankargulebiT<br />
jildovdeba `Tbilisis erTgulebis<br />
medliT~.<br />
2002 wels qarTuli medicinis winaSe<br />
gansakuTrebuli damsaxurebisaTvis jandacvis<br />
ministris mier jildovdeba sapatio<br />
medliT.<br />
qalbatoni gulnaras saxels ukavSirdeba<br />
onkomorfologiis Camoyalibeba da ganviTareba<br />
saqarTveloSi da is samarTlianad<br />
iTvleba mis erT-erT fuZemdeblad.<br />
misi dakargva, udavod, didi danaklisia,<br />
rogorc onkologiis nacionaluri centris<br />
koleqtivisa da paTanatomiuri sazogadoebisaTvis,<br />
aseve TiToeuli im adamianisaTvis,<br />
visTanac qalbaton gulnaras<br />
hqonda Sexeba.
58<br />
levan Carkviani<br />
qarTulma <strong>samedicino</strong> sazogadoebam,<br />
<strong>saqarTvelos</strong> mecnierebaTa akademiam,<br />
onkologiis erovnulma centrma dakarga<br />
saxelovani mecnieri, akademikosi, mravali<br />
samecniero akademiis wevri, saxelmwifo<br />
premiis laureati, <strong>saqarTvelos</strong> da<br />
Tbilisis onkologTa da <strong>saqarTvelos</strong><br />
ginekolog-onkologTa sazogadoebebis<br />
_ Tavkaci; ginekologiurma klinikam xelmZRvaneli<br />
da maswavlebeli, didi<br />
dastaqari da gulisxmieri eqimi; qarTvelma<br />
mosaxleobam didi mkurnali, xolo<br />
mTlianad saqarTvelom didi eriskaci da<br />
sazogado moRvawe - levan iosebis Ze<br />
Carkviani.<br />
levan Carkviani saxelovani Carkvianebis<br />
dinastiis warmomadgenelia. misi mama,<br />
batoni iosebi erT-erTi pirveli pr<strong>of</strong>esori,<br />
mean-ginekologi iyo da misi saxeli<br />
mikuTvnebuli aqvs baTumis samSobiaro<br />
saxls. am ojaxSi cxovrobs da moRvaweobs<br />
mravali eqimi, pr<strong>of</strong>esori da axalgazrda,<br />
momavali eqimi...<br />
levan Carkviani daibada 1923 wels. 1940<br />
wels daamTavra baTumis #8 saSualo skola<br />
da Cairicxa <strong>samedicino</strong> institutis<br />
samkurnalo fakultetze, romelic war-<br />
CinebiT daamTavra 1944 wels. ganawilebiT<br />
muSaoba daiwyo aWaris maRalmTian s<strong>of</strong>el<br />
riyeTis saeqimo ubnis gamged. 1945-47<br />
wlebSi is xelmZRvanel samuSaoze iniSneba<br />
- baTumis raionis janmrTelobis gany<strong>of</strong>ilebis<br />
gamged. am dros Caeyara safuZveli<br />
qalTa mosaxleobis kibos sawinaaRmdego<br />
pr<strong>of</strong>ilaqtikur gasinjvebs. 1948-49<br />
wlebSi is gadadis klinikaSi samuSaod da<br />
amzadebs sakandidato disertacias akad.<br />
_.serebrovisa da l. Sabadis xelmZRvanelobiT<br />
da icavs 1951 wels. 1954 wlidan<br />
is baTumis samSobiaro saxlis mTavari<br />
eqimia da SeTavsebiT eweva pedagogiur<br />
muSaobas. 1963 wels ki daicva sadoqtoro<br />
disertacia.<br />
misi sadoqtoro disertacia iyo sabWo-<br />
Ta kavSiris masStabiT pirveli soliduri<br />
naSromi kibos epidemiologiaSi, ramac<br />
gansakuTrebuli popularoba moutana<br />
samecniero sarbielze. igi gamodis moxsenebebiT<br />
ukrainaSi (1961), moskovSi<br />
(1962) da sxva.
59<br />
1964 wels medicinis mecnierebaTa doqtors<br />
l. Carkvians konkursiT irCeven<br />
<strong>saqarTvelos</strong> jandacvis saministros<br />
onkologiis samecniero-kvleviTi institutis<br />
ginekologiuri gany<strong>of</strong>ilebis xelmZRvanlad,<br />
sadac is sicocxlis bolomde<br />
muSaobda. misi xelmZRvanelobiT klinika<br />
erT-erTi mowinave da saCvenebeli dawesebuleba<br />
gaxda mTel sabWoTa kavSirSi.<br />
1965 wels Tbilisis onkologiis samecniero-kvleviT<br />
institutSi l. Carkvianis<br />
xelmZRvanelobiT Camoyalibda ssrk<br />
<strong>samedicino</strong> akademiis ginekologiuri kibos<br />
epidemiologiuri kvlevis saerTa-<br />
Soriso centri, romelic SemdegSi ekonomiur<br />
urTierTdaxmarebis qveynebis (euq)<br />
da ssrk amerikis TanamSromlobis centrad<br />
iqca ginekologiuri kibos epidemiologiis<br />
dargSi.<br />
l. Cakviani saqarTveloSi pirvelad<br />
akeTebs saSvilosnos gafarToebul operaciebs<br />
(e.w. verThemis operacia). mas ukve<br />
aRiareben pirvel qirurg-ginekologad<br />
ara marto Cvens qveyanaSi, aramed mis farglebs<br />
gareTac. gamoCenilma qarTvelma<br />
qirurgma irakli mgalobliSvilma mas<br />
oqros lanceti uZRvna warweriT.<br />
ginekologiur klinikaSi, ormoci wlis<br />
manZilze, Catarebulia 2500-ze meti ase-<br />
Ti operacia. Seswavlil da damuSavebulia<br />
TiToeuli etapi, daxvewili da modificirebulia<br />
calkeuli detalebi, Seqmnilia<br />
specialuri instrumenti. es sakiTxebi<br />
formdeboda batoni levanis xelmZRvanelobiT<br />
misi monawileobiT sakandidato<br />
da sadoqtoro disertaciebad.<br />
mowafeebi ki mravlad hyavda saqarTvelo-<br />
Si da sabWoTa kavSiris gareT - avRaneTSi,<br />
ungreTSi da a.S.<br />
l. Carkvianisa da mis mier Camoyalibebul<br />
onko-ginekologiuri samsaxuris<br />
(SemdgomSi ki skolis) avtoritetma ganapiroba<br />
mravali sakavSiro da saerTa-<br />
Soriso simpoziumis samuSao TaTbiris<br />
(1969, 1971, 1985, 1986, 1990, 1996) da sabWo-<br />
Ta kavSir-amerikis epidemiologiuri Sexvedris<br />
(1975, 1979) mowyoba. monawileoba<br />
rumineTisa da bulgareTis onkologTa<br />
kongresebze (1969), hiustoni (1970) X saer-<br />
TaSoriso kongresze, baqoSi (1975),<br />
talinSi (1972), sadac is airCies Jurnal<br />
`Вопросы онкологии~ saredaqcio sabWos<br />
wevrad, italiaSi (1974) onkologTa XI<br />
saerTaSoriso kongresze, amerikis qalaq<br />
betesdaSi (1977) amerika-ssrk pirvel samuSao<br />
TaTbirze, sadac misi moxseneba ZiriTadi<br />
da meTodologia pr<strong>of</strong>ilaqtikis<br />
sakiTxebze specialurad iTargmna inglisurad;<br />
kibos XII saerTaSoriso kongresze<br />
buenos-airesSi (1978) da a.S. da a.S.<br />
baton levans gamoqveynebuli aqvs 13<br />
koleqtiuri da damoukidebeli monografia,<br />
misi xelmZRvanelobiT momzadebulia<br />
da daculia 30 sakandidato da sadoqtoro<br />
disertacia, gamoqveynebulia 340-ze meti<br />
samecniero naSromi.<br />
ginekologiuri klinika da misi mecnierebi<br />
aqtiurad TanamSromloben berlinis,<br />
budapeStis, praRis, paduas (italia)<br />
samecniero centrebTan da xdeba TanamSromelTa<br />
gacvla-gamocvla.<br />
80-iani wlebidan gany<strong>of</strong>ileba aqtiurad<br />
ebmeba tr<strong>of</strong>oblasturi daavadebebisadmi<br />
miZRvnil kongresSi. sidnei (avstralia-1992),<br />
seuli (samx.korea - 1996),<br />
ierusalimi (israeli - 1998), amerika (2001).<br />
pr<strong>of</strong>. l. Carkviani arCeulia italiis<br />
mecn-ginekologTa sazogadoebis sapatio<br />
wevrad, yazaxeTis, belorusis onkolog-<br />
Ta samecniero sazogadoebis sapatio<br />
wevrad. evropis ginekolog-onkologTa<br />
sazogadoebis sapatio wevrad, <strong>saqarTvelos</strong><br />
ginekolog-onkologTa sazogadoebis<br />
prezedentad, <strong>saqarTvelos</strong> da Tbilisis<br />
onkologTa sazogadoebis Tavmjdomared.<br />
batoni levani iTvleba <strong>saqarTvelos</strong><br />
medicinis mecnierebaTa akademiis erTerT<br />
damfuZneblad da pirvel akademikosad,<br />
misi biografia Setanilia saerTa-<br />
Soriso cnobarSi `ms<strong>of</strong>lios gamoCenili<br />
adamianebi~.<br />
baton levans miRebuli aqvs mTavrobis<br />
mravali jildo.<br />
baton levans dideba da aRiareba sicocxleSive<br />
eRirsa. dRes ginekologiuri<br />
klinika akademikos l. Carkvianis saxels<br />
atarebs.
60<br />
saredaqcio kolegiisa da<br />
sabWos Tavmjdomare -<br />
giorgi menabde<br />
mTavari redaqtori -<br />
jangir mamalaZe<br />
saredaqcio kolegia:<br />
zaza beriSvili,<br />
nodar baqraZe,<br />
klara gelaSvili,<br />
oTar gerzmava,<br />
SoTa gogoxia,<br />
Tamar dekanosiZe (mTavari<br />
redaqtoris moadgile),<br />
fridon Todua,<br />
paliko kintraia,<br />
dimitri korZaia,<br />
gia lobJaniZe,<br />
vadim saakaZe (mTavari<br />
redaqtoris moadgile),<br />
irakli favleniSvili,<br />
merab qavTaraZe,<br />
eTer qemerteliZe,<br />
levan qurcikaSvili,<br />
zezva RuRuniSvili,<br />
nodar yifSiZe,<br />
roman SaqariSvili,<br />
ramaz Sengelia,<br />
gulnara CafiZe (mTavari<br />
redaqtoris moadgile),<br />
daviT WavWaniZe,<br />
simon xeCinaSvili,<br />
ramaz xecuriani<br />
ПРЕДСЕДАТЕЛЬ РЕДАКЦИОННОЙ<br />
КОЛЛЕГИИ И СОВЕТА -<br />
Г.Т. МЕНАБДЕ<br />
ГЛАВНЫЙ РЕДАКТОР -<br />
ДЖ.А. МАМАЛАДЗЕ<br />
РЕДАКЦИОННАЯ КОЛЛЕГИЯ:<br />
З.Л. Беришвили,<br />
Н.Д. Бакрадзе,<br />
К.Д. Гелашвили,<br />
О.Х.Герзмава,<br />
Ш.Д. Гогохия,<br />
З.Г. Гугунишвили,<br />
Т.И. Деканосидзе (зам.<br />
гл.редактора),<br />
М.Н. Кавтарадзе,<br />
Э.П. Кемертелидзе,<br />
П.Я. Кинтраиа,<br />
Н.Н. Кипшидзе,<br />
Д.Дж. Кордзаиа,<br />
Л.С. Курцикашвили,<br />
Г.В. Лобжанидзе,<br />
И.В. Павленишвили,<br />
В.П. Саакадзе (зам. главного<br />
редактора),<br />
Ф.И. Тодуа,<br />
Р.Г. Хецуриани,<br />
С.Н. Хечинашвили,<br />
Д.Г. Чавчанидзе,<br />
Г.Э. Чапидзе,<br />
Р.Р. Шакаришвили,<br />
Р.М. Шенгелиа (зам. главного<br />
редактора)<br />
THE CHAIRMAN OF EDITORIAL<br />
BOARD AND COUNCIL -<br />
G. MENABDE<br />
CHIEF EDITOR -<br />
J. MAMALADZE<br />
EDITORIAL BOARD:<br />
Z. Berishvili,<br />
N. Bakradze<br />
D. Chavchanidze,<br />
G. Chapidze,<br />
T. Dekanosidze,<br />
K. Gelashvili,<br />
O. Gerzmava,<br />
Sh. Gogokhia,<br />
Z.Gugunishvili,<br />
M. Kavtaradze,<br />
E. Kemertelidze,<br />
S. Khechinashvili,<br />
R. Khetsuriani,<br />
P. Kintraia,<br />
N. Kipshidze,<br />
D. Kordzaia,<br />
L. Kurtsikashvili,<br />
G. Lobjanidze,<br />
I. Pavlenishvili,<br />
V. Saakadze,<br />
R. Shakarishvili,<br />
R. Shengelia,<br />
P. Todua<br />
saredaqcio sabWo:<br />
a. aladaSvili (Tbilisi)<br />
m. apostolovi (bulgareTi)<br />
i. beraZe (Tbilisi)<br />
m. boxua (Tbilisi)<br />
r. gagua (Tbilisi)<br />
g. gegeSiZe (samtredia)<br />
l. gujabiZe (Tbilisi)<br />
j. gujabiZe (Tbilisi)<br />
a. diamandopulosi (saberZneTi)<br />
i. eliaSvili (tyibuli)<br />
n. emuxvari (Tbilisi)<br />
g. vasaZe (Tbilisi)<br />
g. vekua (Tbilisi)<br />
n. vefxvaZe (Tbilisi)<br />
o. zurabiSvili (parizi)<br />
o. ToiZe (Tbilisi)<br />
z. T<strong>of</strong>uria (Tbilisi)<br />
s. kapanaZe (Tbilisi)<br />
i. kvaWaZe (Tbilisi)<br />
a. kvezereli-kopaZe (Tbilisi)<br />
r. kverenCxilaZe (Tbilisi)<br />
v. kiknaZe (Tbilisi)<br />
n. kintraia (Tbilisi)<br />
z. kirtava (Tbilisi)<br />
a. koWlamazaSvili (Tbilisi)<br />
l. managaZe (Tbilisi)<br />
v. margvelaSvili (Tbilisi)<br />
i. megrelaZe (Tbilisi)<br />
m. mixaili (israeli)<br />
g. muxaSavria (Tbilisi)<br />
i. mWedliSvili (Tbilisi)<br />
q. nemsaZe (Tbilisi)<br />
T. sanebliZe (marneuli)<br />
r. sefiaSvili (moskovi)<br />
r. surmaniZe (baTumi)<br />
m. tatiSvili (Tbilisi)<br />
a. tuveidi (vaSingtoni)<br />
i. faRava (Tbilisi)<br />
e. qarTveliSvili (Tbilisi)<br />
b. qobulia (Tbilisi)<br />
v. yifiani (Tbilisi)<br />
r. yuraSvili (Tbilisi)<br />
a. CarTolani (mestia)<br />
T. CxikvaZe (Tbilisi)<br />
l. WeliZe (Tbilisi)<br />
n. xatiaSvili (Tbilisi)<br />
a. xomasuriZe (Tbilisi)<br />
n. javaxiSvili (Tbilisi)
61<br />
axali wignebi<br />
1. zurab xelaZe - kritikuli medicina, gamomcemloba `universali~. 2007 w.<br />
2. n. lebaniZe, s. qajaia - anesTeziologia da reanimatologia, kiTxvebsa da<br />
pasuxebSi.<br />
3. lin s. bikli - beitsis klinikuri gamokvlevis safuZvlebi, Tssu, 2007 w.<br />
4. jon p. kloherti - neonatologia, 2008 w.<br />
5. T. Ciqovani - imunologia, 2007 w.<br />
6. tompsoni da tompsoni - genetika medicinaSi, 2008 w.<br />
7. o. gerzmava - sazogadoebrivi jandacva da menejmenti, 2008 w.<br />
8. avtorTa jgufi - fsiqologiis safuZvlebi, 2007 w.<br />
9. l. metreveli - funqciuri neiroanatomiis safuZvlebi, 2007 w.<br />
10. k. mardaleiSvili, T. baramiZe - yba-saxis avTvisebiani simsivneebi, Tssu,<br />
2008 w.<br />
11. r. Sengelia - dawunebuli qvis monasteri, gamomcemloba `<strong>saqarTvelos</strong> macne~,<br />
2008w.<br />
wignebis SeZena SegiZliaT<br />
Tbilisis saxelmwifo <strong>samedicino</strong> universitetis<br />
administraciuli korpusis jixurSi, vaJa-fSavelas 33.<br />
2008 wlis #2-Si latviuri kompania `Grindeks~-is mier gamoqveynebul masalaSi<br />
`uZiloba da misi mkurnaloba~ daSvebulia uzustoba. sityva ‘farmaciis~ nacvlad<br />
unda eweros `farmacevtuli~; Tea sxirtlaZe aris kompaniis xelmZRvaneli da ara<br />
praqtikosi eqimi.<br />
redaqciis misamarTi: Tbilisi, vaJa-fSavelas gamz. 33<br />
АДРЕС РЕДАКЦИИ: ТБИЛИСИ, ПРОСПЕКТ ВАЖА-ПШАВЕЛА 33<br />
xelmowerilia dasabeWdad: 30.09.08 w., formati 70 X 108 1/16<br />
fizikuri nabeWdi Tabaxi 5.0<br />
saaRricxvo-sagamomcemlo Tabaxi 3,5, tiraJi 300,<br />
fasi saxelSekrulebo
Change language