Ffiltvebis qronikuli obstuqciuli daavadeba da misi marTva lali miqiaSvili tfdc. 2 marti, 2010.
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Transcript of Ffiltvebis qronikuli obstuqciuli daavadeba da misi marTva lali miqiaSvili tfdc. 2 marti, 2010.
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Ffiltvebis qronikuli obstuqciuli daavadeba da misi marTva
lali miqiaSvilitfdc. 2 marti, 2010
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Ffiltvebis qronikuli obstuqciuli daavadeba (fqod) (Chronic obstructive pulmonary disease- COPD)
janmo-s 2005 wlis monacemebi: 80 mln adamiani daavadebulia fqod-s
saSualo an mZime formiT. 3 mln adamiani gardaicvala fqod-iT,
rac globaluri sikvdilianobis 5%-s Seadgens.
sikvdilianobis 90% modis saSualo da dabalSemosavlian qveynebze.
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janmo-s monacemebi:
2002 wels fqod-m daikava V adgili sikdilianobis mxriv;
2030 wels savaraudod daiWers III adgils.
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Ffiltvebis qronikuli obstuqciuli daavadeba (fqod): (Chronic obstructive pulmonary disease- COPD)
aSS-Si uWiravs me-4 adgili sikvdilianobis mxriv;
aSS-Si sikvdilianobis 10 yvelaze xSirad gamomwvev daavadebas Soris, fqod aris erTaderTi, romlis sikvdilianobis maCvenebelic izrdeba.
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Ffqod-s gansazRvreba:(ERS/ATS)
Ffqod-s aris daavadeba, romlis mkurnaloba da prevencia SesaZlebelia da xasiaTdeba:
ventilaciis darRveviT, romelic arasrulad Seqcevadia;
Cveulebriv progresirebs; asocirebulia gamRizianebel agentze
filtvebSi araadeqvaturi anTebadi pasuxis ganviTarebasTan;
asocirebulia sistemur garTulebebTan.
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fqod aerTianebs :
1. qr. obstruqciuli bronqiti;2. emfizema;3. α-1 antitrifsinis deficiti.
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garTulebebi:
filtvismieri guli; policitemia; sunTqvis ukmarisoba; Ramis hipoqsia; bronqogenuli karcinoma; motexilobebi; barZayis Zvlis mineralizaciis darRveva; kataraqta depresia
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saWiroa fqod-s adreuli gamovlena:
klinicistebis ganswavla;
fqod-s specifiuri skriningi;
specialuri kiTxvaris roli pirveladi jandacvis qselSi
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spirometria
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Ffqod-s stadia
Bbronqodilatatoris miRebis Semdeg
tifnos indeqsi (FEV1/FVC):
bronqodilatatoris miRebis Semdeg
FEV1 %:
I - msubuqi </= 0.7 >/= 80%
II –saSualo simZimis
</= 0.7 50-80%
III -mZime </= 0.7 30-50%
IV-Zalian mZime
</= 0.7 < 30%
spirometria:(Global Strategy for Diagnosis, Management, and Prevention of
COPD).
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Ffqod-s mkurnaloba miznad isaxavs:
respiratoruli Civilebis Seamcirebas;
gamwvavebebis Semcirebas;
filtvis funqciis gaumjobesebas;
sicocxlis xangrZlivobis gazrdas.
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individualuri pacientisaTvis unda ganisazRvros ras vmkurnalobT :
sunTqvis ukmarisobas?
gamwvavebebs? – hospitalizaciis prevencia an misi vadis Semcireba?
aqtivobis gazrdas?
eqimsac da avadmyofsac naTlad unda esmodeT mkurnalobis mizani
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Ffqod-s stadia
daxasiaTeba rekomendaciebi
yvela risk-faqtorebis moSoreba;
gripis sawinaaRmdego vaqcinacia
I msubuqi FEV1/FVC < 0.70; FEV1 >/= 80%
SA-BD saWiroebisas;
II saSualo FEV1/FVC < 0.70 FEV1-50-80%
samkurnalo sqema: orkomponentiani- BD;
reabilitaciaA
III mZime FEV1/FVC < 0.70 FEV1-30-50%
samkurnalo sqema:erT- an orkomponentiani-BD;+ sainhalacio kortikosteroidi;reabilitaciaA
IV Zalian mZime
FEV1/FVC < 0.70FEV1 < 30%
samkurnalo sqema: erT- an orkomponentiani-BD + sainhalacio kortikosteroidi;oqsigenoTerapia, qirurgia, reabilitaciaA
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Ffqod-s samkurnalo preparatebi:
antiqolinerguli bronqodilatatorebi;
xangrZlivi moqmedebis β-agonistebi;
sainhalacio kortikosteroidebi (kombinaciaSi);
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asTmisa da fqod-s samkurnalo medikamentebi gansxvavdeba erTmaneTisagan
fqod-s dros ar gamoiyeneba:
qromolini; leikotrinebis antagonistebi; sainhalacioKkortikosteroidebis
monoTerapia
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miRwevebi fqod-s mkurnalobaSi:
or- da samkomponentiani reJimi: bronqodilatatorebis sxvadasxva klasis kombinacia β2-agonistebi: a. xanmokle moqmedebis (Albuterol) b. gaxangrZlivebuli moqmedebis (salmeteroli,
formeteroli) antiqolinerguli saS-bebi: a. xanmokle moqmedebis (Ipratropium bromide) ; b. gaxangrZlivebuli moqmedebis (Tiotropium)mag. Tiotropium+ formeterol; Tiotropium+salmeterol.
kortikosteroidebi bronqodilatatorebTan kombinaciaSi.
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iotropium
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Ppnevmoniis signali
Psainhalacio kortikosteroidebi
pnevmoniis signali: maRali dozis kortikosteroidebis gamoyeneba asocirebulia pnevmoniasTan;
ar arsebobs sarwmuno cnobebi sikvdilianobis matebaze;
sikvdilianobis maCvenebeli klebulobs kombinirebuli Terapiisas.
kvlevebi: TORCH, INSPIRE, SMART, UPLIFT, Registry Study in America, Erst and Suisa
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reabilitacia:
fizikuri varjiSi zeda da qveda kidurebis aqtiuri datvirTviT;
sasunTqi kunTebis varjiSi; fizioTerapia; fsiqosocialuri daxmareba (depresia); ganaTleba.
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oqsigenoTerapia
PCvenebebi:
1. PPaO2 < 7,3 kPa ; SaO2 < 80%
2. Aan PaO2 = 7,3 - 7,8 kPa
+ filtvismieri guli, policitemia. Ooqsigenaciis mizani: PPaO2 > 8kPa, SaO2 > 90%
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qirurgia: National Emphysema Treatment Trial (NETT)
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qirurgia: National Emphysema Treatment Trial (NETT)2
Patients
90 Day Mortality
LVRS
90 Day Mortality Medical Therapy
P Value
29,2mos Mortality
LVRS
29,2mos MortalityMedical Therapy
Risk Ratio
P Value
Group A
20/70(28,6)
0/70(0) <.001 42/70 30/70 1,82 .06
Group B
4/139(2,9) 5/151(3,3) 1.00 26/139 51/151 0,47 .005
Group C
6/206(2.9) 2/213(0,9) 0.17 34/206 39/213 0,98 .70
Group D
7/84(8,3) 0/65(0) 0,02 28/84 26/65 0,81 .49
Group E
11/109 (10,1)
1/111(0,9) 0,003 27/109 14/111 2,06 .02
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sicocxlis xangrZlivoba:
Ffam1
(FEV1)sicocxlis
xangrZlivoba
>/= 1,2L 10 weli
=1L 5 weli
<700 ml 2 welze naklebi
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janmo-s prevenciuli RonisZiebebi
Seiqmna: GARD(Global Alliance against Chronic
Respiratory Disease)Mmisi erTerTi nawilia GOLD (Global Initiative for Chronic
Obstructive Disease)
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Tambaqos mowevaze kontroli
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sabinao pirobebSi haeris dabinZureba
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daskvna
aucilebelia fqod-s adreuli gamovlena; gasaumjobesebelia fqod-s gamovlenis
strategia; prevenciuli RonisZiebebis aqtiuri Catareba; aucilebelia kombinirebuli Terapiis Catareba
fqod-s gamosavlis gasaumjobeseblad; pacientis mkurnalobaze damyolobis
gaumjobeseba; axali, efeqturi Terapiis aucilebloba.
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gmadlobT
yuradRebisaTvis