პირველად აჭარაში: ინსულტების მართვის თანამედროვე მეთოდები – ,,მედცენტრში”
ნინო ცხვარაძე 591 98 24 30
insulti sisxlZarRvovani mizeziT ganpirobebuli Tavis tvinis funqciebis swrafad ganviTarebuli kerovani an globaluri moSlaa, romelic grZeldeba 24 saaTze met xans, an iwvevs sikvdils drois am intervalSi. tvinis funqciaTa globalur moSlaSi igulisxmeba komatozuri mdgomareobebi da subaraqnoiduli sisxlCaqceva (tvinis garsebSi sisxlCaqceva)
ra aris insulti, ramdenad gavrcelebuli daavadebaa da rogor xdeba misi marTva? am da sxva saintereso da yuradsaReb sakiTxebze `aWarasTan~ nevrologi, medicinis doqtori jambul makaraZe saubrobs.
– cerebruli insulti msoflios zrdasruli mosaxleobis erT-erTi yvelaze xSiri, damainvalidebeli da letalobis maRali maCveneblis mqone daavadebaa. insulti ori tipisaa: iSemiuri insulti anu tvinis infarqti da hemoragiuli – tvinSi sisxlCaqceva. iSemiuri insulti viTardeba maSin, roca Tavis tvinis mkvebavi romelime arteria daixSoba, tvinis nivTierebis Sesabamisi ubani ganicdis mwvave sisxlnaklebobas da yalibdeba infarqti. SedarebiT iSviaTad gvxvdeba venuri infarqtic, roca iTrombeba tvinidan gamomavali romelime venuri koleqtori, viTardeba venuri stazi (Segubeba) da ziandeba mimdebare tvinis qsovili.
hemoragiuli insultis dros Tavis tvinis romelime arteria skdeba da viTardeba sisxlCaqceva tvinis qsovilSi, parkuWebSi (tvinis RruebSi) an tvinis garsebSi (subaraqnoiduli sisxlCaqceva).
yovelwliurad msoflioSi insultis 20 milioni SemTxveva registrirdeba: 70-85 procenti iSemiuri (Tavis tvinis infarqti), 15-25 procenti – Tavis tvinSi sisxlCaqceva, 3-5 procenti – subaraqnoiduli sisxlCaqceva.
insultiT avadobis sixSire gansxvavebulia sxvadasxva populaciaSi da qveyanaSi. zogadad, is ufro xSiria ganviTarebad qveynebSi da SavkanianebSi, aseve iaponiasa da CineTSi. saqarTveloSi Catarebuli klinikur-epidemiologiuri populaciuri kvlevebiT (maT Soris, erTi kvleva Cven CavatareT 1998-1999 ww) gamovlinda, rom 100 000 mosaxleze weliwadSi axlad ganviTarebuli insultis sixSire saSualod 150-
170-ia, maRalia sisxlCaqcevis tipis insultebi da insultiT gamowveuli sikvdilianoba.
– ra simptomebiT vlindeba insulti?
– insultis uxSiresi simptomebia: saxis asimetria, cal mxares kidurTa dabuJeba an/da Zalis dakargva, koordinaciis da metyvelebis moSla, aseve mxedvelobis velis SezRudva, ylapvis gaZneleba, gabrueba, cnobierebis daTrgunva, Tavis tkivili da pirRebineba.
– SesaZlebelia Tu ara misi Tavidan acileba?
– insultis Tavidan acileba xSirad SesaZlebelia, Tuki droulad gamovavlenT riskfaqtorebs da CavatarebT prevenciul RonisZiebebs. amisaTvis aucilebelia pirveladi jandacvis rgolis efeqturi muSaoba da mosaxleobis farTo masebis informireba insultis Sesaxeb.
– batono jambul, ra iwvevs insults?
– insulti polietiologiuri daavadebaa da gaaCnia mravali riskfaqtori, romelic sxvadasxva avtoris mier sxvadasxvanairad aris klasificirebuli. Aase magaliTad, tradiciuli da aratradiciuli, modificirebadi da aramodificirebadi, dadasturebuli da SesaZlo (saTuo) da a.S. pirobiTad insultis riskfaqtorebi or did jgufad SeiZleba davyoT: a) cxovrebis stilze, Cvevebze da garemoze damokidebuli, b) TviTdaavadebebi, romlebic warmoadgenen insultis prediqtorebs. riskfaqtorebs Soris mniSvnelovan rols asrulebs ZiriTadi, e.w. aTerogenuli riskfaqtorebi.
cxovrebis stilze, Cvevebze an garemoze damokidebuli riskis faqtorebidan aRsaniSnavia alkoholis xSiri moxmareba, Tambaqos moxmareba, dieturi Taviseburebebi, fizikuri inaqtivoba (hipodinamika), oraluri kontraceptivebi qalebSi, socialuri deprivacia da stresebi. rogorc vxedavT, insultis riskfaqtorebi, romlebic damokidebulia cxovrebis stilze, Cvevebze da garemoze, warmoadgens e.w. modificirebad riskfaqtorebs, anu iseTs, romelTa koreqcia praqtikulad, SesaZlebelia, rac mniSvnelovnad Seamcirebs populaciaSi insultis ganviTarebis risks. cerebruli insultis ZiriTadi riskfaqtorebi e.w. aTerogenuli riskfaqtorebia. es aris daavadebebi, romlebic uSualod warmoadgenen insultis prediqtorebs: arteriuli hipertenzia (maRali wneva), Saqriani diabeti, winagulTa fibrilacia (ariTmia), gulis iSemiuri daavadeba, gulis ukmarisoba, kisris da periferiuli arteriebis aTerosklerozi, qolesterinis maRali done, sisxlis daavadebebi.
insultis erT-erTi yvelaze mZlavri riskfaqtoria asaki. mis matebasTan erTad xdeba sxvadasxva riskis (wneva, aTerosklerozi, gulis ukmarisoba, ariTmia) kumulacia, rac mniSvnelovnad zrdis insultis ganviTarebis albaTobas.
– rogor imarTeba insulti?
– insulti aris gadaudebeli samedicino mdgomareoba, amitom misi sworad marTva SesaZlebelia mxolod hospitalurad, am daavadebaze orientirebuli, gamocdili, multidisciplinuri samedicino personalis mier.
– dro gadamwyveti faqtoria?
– diax, daavadebis simZimesTan erTad, dro gadamwyveti faqtoria, gansakuTrebiT, iSemiuri insultis SemTxvevaSi. Tavis tvinis infarqtis Camoyalibebas sWirdeba garkveuli dro, amitom drouli da swori strategiiT SesaZlebelia tvinis jer kidev bolomde dauzianebeli qsovilis gadarCena, Tuki e.w. Terapiuli fanjris periodSi mivaRwevT arteriaSi arsebuli Trombis liziss – galRobas, an mis meqanikur eqstraqcias (gamoRebas). `Terapiuli fanjara~ gulisxmobs insultis niSnebis dawyebidan maqsimum 4,5 saaTs. dadgenilia, rom Trombolizisis yoveli 15 wuTiT adre Catareba iwvevs kargi gamosavlis 4%-iT gazrdas. amitomac arsebobs gamoTqma – `dro tvinia~.
– batono jambul, ras gvetyviT pirveladi jandacvis da saswrafo daxmarebis brigadebis rolze insultis marTvaSi?
– maTi roli mniSvnelovania, gansakuTrebiT, saswrafo samedicino daxmarebis brigadebis, vinaidan maTzea damokidebuli insultiani pacientisTvis pirveladi daxmarebis adekvaturad gaweva da misi drouli transportireba iseT klinikaSi, sadac SesaZlebelia Tanamedrove meTodebiT mkurnalobis Catareba.
– ramdenadac vici, insultis marTvis mimarTulebiT maRalteqnologiur hospital `medcentrSi~ siaxleebia. ratom unda gaakeTos pacientma arCevani `medcentrze?~
– pirvelad aWaris regionSi Cvens klinikaSi daviwyeT TrombolizisiT mkurnaloba. rogorc zemoT aRvniSne, Trombolizisi gulisxmobs iSemiuri insultis pirvelive saaTebSi intravenurad iseTi nivTierebis Seyvanas (alteplaza), romelsac aqvs Trombis daSlis da arteriaSi sisxlnakadis aRdgenis unari. mkurnalobis es meTodi ar aris panacea, anu yovelTvis ar iZleva sasurvel Sedegs, magram misi upiratesoba standartul (Cveulebriv) mkurnalobasTan SedarebiT, didi xania dadgenilia. amitomac msoflios bevr qveyanaSi, upiratesad dasavleTSi, Trombolizisi rutinulad tardeba mraval klinikaSi. Cveni klinikis xelmZRvanelobam insultebis marTvis iseTi Tanamedrove meTodebi danerga, rogoricaa Trombolizisi, Trombeqstraqcia, anevrizmebis qoilingi da sxva. neiromedicinis departamentis personals ramdenimejer Cautara leqcia-seminari Cvens mier mowveulma evropis insultis organizaciis eqspert-konsultantma. vxelmZRvanelobT evropisa da amerikis insultis marTvis gaidlainebiT da Sesabamisi protokolebiT. amitomac, gvaqvs ambicia, rom insultTan brZolis sakiTxSi viyoT mowinave poziciaze.
