zeda sasunTqi gzebis mwvave infeqciebi · iSviaTad mwvave faringiti SeiZleba iyos mwvave...
Transcript of zeda sasunTqi gzebis mwvave infeqciebi · iSviaTad mwvave faringiti SeiZleba iyos mwvave...
zeda sasunTqi gzebis mwvave
infeqciebi
klinikuri mdgomareobis marTvis saxelmwifo
standarti
(protokoli)
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mwvave faringiti
(pirveladi jandacva)
definicia
mwvave faringiti orofaringealuri aris anTebiTi procesia. mwvave
faringiti SeiZleba aRwerili iqnes rogorc `yelis tkivili~
(avadmyofobaTa saerTaSoriso klasifikaciis meaTe gadaxedvis mixedviT
is Seesabameba diagnozs mwvave faringiti - J02).
etiologia
ZiriTadi etiologiuri faqtorebia:
• virusi (40%): rinovirusi, koronavirusi, eqovirusi, koksaki, gripis da
paragripis virusi. SedarebiT iSviaTia epStein-baris virusi,
citomegalovirusi, adenovirusi, martivi herpesis virusi;
• baqteriuli (30%) flora _ A jgufis B hemolizuri streptokoki
ganapirobebs faringitis SemTxvevaTa 10-15%-s mozrdilebSi da 30%-s
bavSvebSi;
• qimiuri (sigaretis moxmareba);
• meqanikuri agenti (nakawri, naCxapni Zvlis fragmentiT);
• alergia;
• postnazaluri wveTi;
• iSviaTad kibo (adreul stadiaSi kibo xSirad vlindeba tkivilis
simptomiT).
kriteriumebi
faringitis klasikuri simptomebi moicaven yelis tkivils, disfagias,
cxelebas, saerTo sisustes, Tavis tkivils.
obieqturi gamokvlevisas vlindeba xaxisa da nuSura jirkvlebis
anTebiTi cvlilebebi (hiperemia, Sesiveba), Cirqovani nadebi nuSura
jirkvlebze, kisris wina limfuri jirkvlebis Sesiveba. arc erTi es
niSani ar aris paTognomuri streptokokuli etiologiis
faringitisaTvis, Tumca maTi arsebobis SemTxvevaSi daavadebis
baqteriuli etiologia ufro SesaZlebelia.
daavadebis virusul etiologiaze miuTiTebs: cxviridan gamonadeni,
xvela, xmis CaxleCa, koniunqtiviti da diarea;
streptokokuli etiologiisaTvis damaxasiaTebelia aseve
temperaturis uecari mateba (380-ze meti) Semcivnebis gareSe;
iSviaTad mwvave faringiti SeiZleba iyos mwvave epiglotitis an zemo
sasunTqi gzebis sxva seriozuli daavadebis gamovlena. Tu am dros
aRiniSneba sunTqvis gaZnelebac saswrafod gadaagzavneT avadmyofi
stacionarSi da moerideT xaxis gamokvlevas.
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diagnostika da specialistTa konsultaciebi
pjd doneze diagnozi eyrdnoba klinikur niSnebs.
baqteriuli da virusuli genezis faringitis diferencirebis
saSualebas iZleva laboratoriuli gamokvlevebi: xaxis nacxis
baqteriologiuri gamokvleva an antigenis deteqciis swrafi testi
(RAT). am testebis rutinuli gamoyeneba pjd doneze rekomendebuli ar
aris. gamokvlevebis aucileblobas gansazRvravs specializebuli
dawesebulebis samedicino personali.
specialistis konsultacia da/an hospitalizacia naCvenebia:
peritonzilarul celulitsa an abscesze saeWvo SemTxvevebSi
Tu saxezea disfagia
Tu saxezea dehidratacia
Tu yelis tkivils Tan axlavs stridori an sunTqvis gaZneleba
(saswrafo hospitalizacia)
mkurnaloba
mwvave faringitis yvela SemTxveva ar aris baqteriuli etiologiis, ase
rom alogikuria mwvave faringitis yvela SemTxvevaSi gamoyenebul iqnes
antibiotiki.
xSirad savsebiT sakmarisia:
adeqvaturi tkivilgamayuCebeli saSualebebi: aspirini an paracetamoli.
reis sindromis ganviTarebis riskis gamo bavSvebSi aspirinis gamoyeneba ar
aris daSvebuli.
arasteroiduli anTebis sawinaaRmdego saSualebebis gamoyenebis riskis
gamo maTi rutinuli gamoyeneba mwvave faringitis dros rekomendebuli ar
aris.
erTeul kvlevebSi aris dadasturebuli savlebi saSualebebis
(benzidaminis hidroqloridis) efeqturoba tkivilis da disfagiis
Semcirebis TvalsazrisiT, magram es Sedegebi Semdgom dadasturebas
moiTxoven.
antibiotikebis gamoyeneba
antibiotiki iniSneba:
daavadebis mZime mimdinareobisas, rodesac pacientis zogadi
mdgomareoba mZimea
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pirveli rigis antibiotikebs miekuTvneba:
penicilini V 250 4-jer an 500 mg 2-jer an 4-jer dReSi 10 dRis
ganmavlobaSi; bavSvebSi 250 mg 2-jer an 3-jer dReSi, 10 dRe per os
an
penicilini G (benzatin penicilini) erTjeradad kunTebSi, 1.200.000
mozrdilebSi, 27 kg-mde wonis bavSvebSi _ 600.000.
gaviTvaliswineT, rom mZime faringiti da kisris limfuri jirkvlebis
gadideba SeiZleba infeqciuri mononukleozis niSani iyos, amitom
pirveli rigis preparatad ampicilinis gamoyeneba mizanSewonili ar
aris.
penicilinze alergiis SemTxvevaSi rekomendebulia makrolidebis
gamoyeneba.
meore rigis antibiotikebs miekuTvneba:
amoqsicilini
gansakuTrebuli SemTxvevebi
morecidive faringiti
gaiTvaliswineT recidivis mizezebi: araadeqvaturi antibiotikoTerapia.
gamomwvevi: penicilin-rezistentuli beta-laqtamis maproducirebeli
Stamebi
rekomendebuli mkurnaloba: benzatin-penicilini (penicilini G),
cefuroqsimi an klindamicini
streptokokuli morecidive faringitis dros 10 dRiani
antibiotikoTerapia amcirebs gamwvavebaTa sixSires.
streptokokuli faringitis profilaqtikis mizniT antibiotikebis
xangrZlivi gamoyenebis efeqtianoba dadasturebuli ar aris.
tonzileqtomia morecidive faringitis dros naCvenebia pacientebSi,
romlebic akmayofileben yvela qvemoT CamoTvlil kriteriumebs:
• mwvave faringitis mizezi tonzilitia;
• erTi wlis ganmavlobaSi aRiniSneba mwvave faringitis 5 an meti
epizodi;
• simptomebi grZeldeba, sul mcire, erTi wlis ganmavlobaSi;
• mwvave faringitis mimdinareoba iseTi mZimea, rom xels uSlis
avadmyofis normalur yoveldRiur saqmianobas.
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vinaidan, xSir SemTxvevaSi Zneli dasadgenia mwvave faringitebis zusti
sixSire an iyo Tu ara mwvave faringitis mizezi realurad mwvave
tonziliti, rekomendebulia tonzileqtomiamde 6 Tviani dakvirvebis
periodi, romlis ganmavlobaSi zustdeba yelis tkivilis gamomwvevi
mizezebi.
mas Semdeg, rac gadawyvetileba miRebuli iqneba, operacia unda Catardes
rac SeiZleba swrafad.
gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _ “zeda
sasunTqi gzebis mwvave infeqciebi”.
adamianuri da materialur-teqnikuri resursi
adamianuri resursi: ojaxis eqimi, ubnis pediatri an Terapevti.
materialur-teqnikuri resursi: gamanaTebeli mowyobiloba xaxis
dasaTvaliereblad, enis supresori (Spadeli), fonedoskopi.
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mwvave faringiti
(stacionari)
definicia
mwvave faringiti orofaringealuri aris anTebiTi procesia.
avadmyofobaTa saerTaSoriso klasifikaciis meaTe gadaxedvis mixedviT
is Seesabameba diagnozs mwvave faringiti - J02.
simptomebi da niSnebi
faringitis klasikuri simptomebi moicaven yelis tkivils, disfagias,
cxelebas, saerTo sisustes, Tavis tkivils. obieqturi gamokvlevisas
vlindeba xaxisa da nuSura jirkvlebis anTebiTi cvlilebebi (hiperemia,
Sesiveba), Cirqovani nadebi nuSura jirkvlebze, kisris wina limfuri
jirkvlebis Sesiveba. arc erTi es niSani ar aris paTognomuri
streptokokuli etiologiis faringitisaTvis, Tumca maTi arsebobis
SemTxvevaSi daaadebis baqteriuli etiologia ufro SesaZlebelia.
streptokokuli etiologiisaTvis damaxasiaTebelia aseve temperaturis
uecari mateba (380-ze meti) Semcivnebis gareSe.
cxviridan gamonadeni, xvela, xmis CaxleCa, koniunqtiviti da diarea
iSviaTia, da Tu es niSnebi gamoCnda, safiqrebelia daavadebis virusuli
etiologia.
iSviaTad mwvave faringiti SeiZleba iyos mwvave epiglotitis an zemo
sasunTqi gzebis sxva seriozuli daavadebis gamovlena.
stacionarSi moTavseba iSviaTad aris aucilebeli. aseTia
peritonzilaruli celulitis an abscesis SemTxvevebi, rodesac saWiroa
otolaringologis meTvalyureoba da parenteraluri antibiotikebi.
iSviaTad hospitalizaciis mizezi SeiZleba gaxdes disfagia an
dehidratacia.
diagnostikur-laboratoriuli testebi da specialistTa konsultaciebi
a) pirvel 24 saaTSi
• sisxlis saerTo analizi;
• baqteriologiuri kvleva;
b) pirvel 3 dReSi
• sisxlis saerTo analizi;
• Sardis saerTo analizi;
• baqteriologiuri kvleva;
• serologiuri kvleva (Cvenebis mixedviT);
• ekg (Cvenebis mixedviT).
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mwvave faringitis diagnozi SeiZleba daeyrdnos klinikur niSnebs, Tumca
misi etiologiuri faqtori damatebiT gamokvlevebs saWiroebs.
baqteriologiuri kvleva _ baqteriologiuri kvlevis dadebiTi Sedegi
adasturebs daavadebis streptokokul etiologias, Tumca uaryofiTi
pasuxi ar gamoricxavs daavadebis baqteriul etiologias. garda amisa,
aris SemTxvevebi, rodesac xaxis nacxidan izolirebulia streptokoki,
Tumca infeqcia serologiurad ar dasturdeba. SemTxvevaTa 40%-Si aseve
aRniSnulia streptokokis asimptomuri mtarebloba. nuSura jirkvlebis
zedapiridan aRebuli flora yovelTvis ar Seesabameba tonzilebis
siRrmidan miRebul masalas, arada swored es ukanaskneli aris
pasuxismgebeli daavadebis ganviTarebaze. serologiurad dadasturebuli
infeqciis SemTxvevaSi xaxis nacxi ar xasiaTdeba maRali specifiurobiT
da mgrZnobelobiT. is aseve zrdis daavadebis Rirebulebas da SeiZleba
ganapirobos araaucilebeli medikamenturi mkurnaloba.
antigenis deteqciis swrafi testi ( R A T ) _ stacionarSi SeiZleba
gamoyenebuli iqnes antigenis deteqciis swrafi testi. xaxis an nuSura
jirkvlebis nacxSi streptokokis antigenis gansazRvris testis
upiratesobaa misi siswrafe da maRali specifiuroba (95-100%). misi
gamoyenebiT SesaZlebelia aseve SeizRudos antibiotikebis
gaumarTlebeli gamoyeneba. mis ZiriTad uaryofiT mxares warmoadgens
meTodis dabali mgrZnobeloba (50-95%).
serologiuri diagnostika _ avadmyofis organizmis imunur pasuxze
vlaparakobT maSin, rodesac antistreptolizinis, anti-dnm-is, an sxva
antistreptokokuli antisxeulebis titri 4-jer matulobs.
imunoserologiuri kvleva streptokokuli infeqciis erT-erTi saimedo
meTodia, Tumca misi mgrZnobeloba mcirdeba antibaqteriuli Terapiis
fonze. daavadebis mwvave periodSi antistreptokokuri antisxeulebis
titri maqsimums aRwevs me-2-3 kviras.
saWiroebis SemTxvevaSi SeiZleba Catardes otorinolaringologis,
kardiologis an nefrologis konsultacia (garTulebebis arsebobisas).
mkurnaloba
mwvave faringitis diagnozi ar niSnavs, rom aucileblad unda dainiSnos
antibiotiki. adeqvaturi tkivilgamayuCebeli saSualebebi xSirad savsebiT
sakmarisia mkurnalobisaTvis.
tkivilgamayuCebeli saSualebebi _ simptomuri saSualebebi aspirinis an
paracetamolis saxiT savsebiT sakmarisia tkivilis moxsnisaTvis. aqve
unda aRiniSnos, rom reis sindromis ganviTarebis riskis gamo bavSvebSi
aspirinis gamoyeneba ar aris daSvebuli.
mravali kvleva aRwers arasteroiduli anTebis sawinaaRmdego
saSualebebis gamoyenebas mwvave faringitis da tonzilitis dros.
naCvenebia, rom mkurnalobis ori-sami dRis Semdeg ufro swrafad xdeba
tkivilis, cxelebis, disfagiis, xiluli hiperemiis, limfadenopaTiis
Semcireba placebosTan an paracetamolTan SedarebiT. amave dros,
arasteroiduli anTebis sawinaaRmdego saSualebebis gamoyeneba
dakavSirebulia gastrointestinaluri sisxldenis, gulisrevis,
Rebinebis, muclis tkivilis da diareis ganviTarebis dadasturebul
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riskTan. amitom arasteroiduli anTebis sawinaaRmdego saSualebebis
gamoyenebis riskis gamo maTi rutinuli gamoyeneba mwvave faringitis
dros rekomendebuli ar aris.
damatebiTi Terapia
erTeul kvlevebSi aris dadasturebuli savlebi saSualebebis
efeqturoba tkivilis da disfagiis Semcirebis TvalsazrisiT, magram es
Sedegebi Semdgom dadasturebas moiTxoven.
antibiotikebi
mwvave faringitis yvela SemTxveva ar aris baqteriuli etiologiis, ase
antibiotiki yovelTvis ar unda dainiSnos.
daavadebis mZime mimdinareobisas da savaraudod baqteriuli etiologiis
SemTxvevaSi pirveli rigis antibiotiks warmoadgens penicilini
(penicilini V 250 4-jer an 500 mg 2-jer an 4-jer dReSi 10 dRis
ganmavlobaSi; bavSvebSi 250 mg 2-jer an 3 jer dReSi, 10 dRe per os) an penicilini G (benzatin penicilini) erTjeradad kunTebSi, 1.200.000
mozrdilebSi, 27 kg-mde wonis bavSvebSi – 600.000.
unda gaviTvaliswinoT, rom mZime faringiti da kisris limfuri
jirkvlebis gadideba SeiZleba infeqciuri mononukleozis niSani iyos,
amitom unda moveridoT pirveli rigis preparatad ampicilinis
gamoyenebas. amave dros, bavSvebSi pirveli rigis preparatad SeiZleba
gamoviyenoT amoqsicilini.
penicilinze alergiis SemTxvevaSi mizanSewonilia makrolidebis
(eriTromicini, klindamicini, azitromicini) daniSvna. eriTromicinis
gamoyeneba misi gverdiTi movlenebis (gulisreva, diarea) SedarebiT
SezRudulia.
antibiotikebi morecidive faringitis dros
mwvave faringitis morecidive mimdinareoba im pacientebSi, romlebic
iRebdnen antibiotikebs, miuTiTebs, rom gamoyenebul iqna Seusabamo
antibiotiki, antibiotiki daniSnuli iyo araadeqvaturi doziT an
xangrZlivobiT, pacienti ar daemorCila mkurnalobas, aRiniSna re-
infeqcia an daavadebis gamomwvevi iyo penicilin-rezistentuli beta-
laqtamazis maproducirebeli Stamebi. aseT SemTxvevebSi naCvenebia
benzatin-penicilinis (penicilini G), cefuroqsimis, ko-amoqsiklavis an
klindamicinis gamoyeneba.
ar arsebobs sakmarisi informacia, romelic daadasturebs
antibiotikebis gamoyenebis aucileblobas mwvave morecidive
arastreptokokuli faringitis dros.
damatebiTi Terapia morecidive faringitis dros
randomozebuli, ormagi brma, placebo-kontrolirebadi multicentruli
kvleviT dadasturebulia imunoaqtiuri baqteriuli eqstraqtiT (OM-85, bronqo-vaqsomi, saqarTveloSi registrirebulia bronqo-munali)
imunostimulaciis mniSvneloba zemo sasunTqi gzebis morecidive
infeqciebis (morecidive faringiti) dros.
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reabilitacia da dakvirveba
Sesabamisi antimikrobuli mkurnalobis SemTxvevaSi dadebiTi efeqti
miiReba 24-48 saaTis Semdeg. efeqtis ararsebobis mizezi SeiZleba iyos
uefeqto antibiotikoTerapia, garTulebebis darTva an sxva Tanarsebuli
daavadebis arseboba.
pacientTa umravlesoba pasuxobs antibiotikoTerapias da aRiniSneba
streptokokis eradikacia. ganmeorebiTi dakvirveba an baqteriologiuri
kvleva mkurnalobis kursis damTavrebis Semdeg aucilebeli ar aris.
gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _ “zeda
sasunTqi gzebis mwvave infeqciebi”
adamianuri da materialur-teqnikuri resursi
adamianuri resursi: pediatri, Terapevti, otolaringologi.
materialur-teqnikuri resursi: gamanaTebeli mowyobiloba xaxis
dasaTvaliereblad, enis supresori (Spadeli), fonedoskopi.
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mwvave sinusiti
(pirveladi jandacva)
definicia
mwvave sinusiti paranazaluri sinusebis lorwovani garsis anTebiTi
dazianebaa, romelic gamowveulia daxSul RruSi baqteriebis zrdiT da
romlis xangrZliobac 4 kviraze naklebia. sinusitis ganviTareba
uxSiresad iwyeba rinitis fonze, ris gamoc mas xSir SemTxvevaSi
uwodeben rinosinusits.
damadasturebeli kriteriumebi
daavadebis diagnostika efuZneba daavadebis anamnezs, klinikur suraTs,
simptomebis xangrZlivobas, obieqtur gasinjvas da, saWiroebisas,
rentgenologiuri gamokvlevis Sedegebs.
sinusitis arc erTi klinikuri niSani damoukideblad ar aris
mgrZnobiare da specifiuri diagnozis dasasmelad.
baqteriuli sinusitis klinikuri niSnebia:
• zemo sasunTqi gzebis infeqciis klinika, romelic ar
umjobesdeba 10-14 dRis ganmavlobaSi da romelsac Tan axlavs 2
niSani:
• cxviridan lorwovan - Cirqovani gamonadeni
da
• gaxangrZlivebuli aradamakmayofilebeli mdgomareoba.
• aseve SesaZlebelia:
• cxeleba;
• xvela;
• agzneba;
• saxis tkivili.
obieqturad SeiZleba gamovlindes:
• saxis Sesieba an eriTema dazianebis areSi;
• mgrZnobeloba sinusis palpaciis an perkusiis dros (palpaciisas
mcire asakis bavSvebSi saxis tkivili da sinusis mgrZnobeloba
ar vlindeba, Tumca es simptomebi kargi indikatoria saskolo
asakis bavSvebsa da mozardebSi);
• periorbitaluri Sesiveba;
• cxviris lorwovani garsis eriTema an SeSupeba;
• ZiriTadi kbilebis mgrZnobeloba;
• Tanmxlebi Sua yuris anTeba bavSvebSi.
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ZiriTadi simptomebi, romelsac efuZneba diagnozi:
• zemo sasunTqi gzebis infeqciis klinika, romelic ar umjobesdeba
10-14 dRis ganmavlobaSi;
• cxviriT sunTqvis blokireba/cxviridan gamonadeni (SeiZleba
mxolod lorwovani, Sesqelebuli, lorwovan-Cirqovani);
• persistuli xvela, romelic Zlierdeba RamiT.
SedarebiT iSviaTad vlindeba gulisreva, yuris da yelis tkivili, saxis
tkivili, SeSupeba.
diagnostikur-laboratoriuli testebi da specialistTa konsultaciebi
sinusitis mkurnaloba SesaZlebelia daiwyos mxolod klinikur suraTze
dayrdnobiT.
rentgenologiuri kvlevis Catareba saWiroa Semdeg SemTxvevebSi:
• mwvave sinusitis diagnozisas, Tu saeWvoa subperiostuli an
orbitaluri abscesi;
• mwvave sinusitis diagnozisas, Tu saeWvoa intrakraniuli
garTulebebi;
• Tu mkurnalobis miuxedavad ar aris gaumjobeseba da saWiroa
diagnozis dadastureba.
gaurTulebeli mwvave sinusitis dros sisxlis saerTo analizis an
nazofaringiuli kulturis rutinulad Catareba ar aris rekomendebuli.
mkurnaloba
antibiotikoTerapia
antibiotikoTerapiis Cvenebaa:
• simptomebis persistireba (magaliTad, Tu klinikuri niSnebi
grZeldeba 7 - 10 dReze meti);
• mZime simptomatika (mag: profuzuli Cirqovani gamonadeni
cxviridan, saxis tkivili da sistemuri dazianebis niSnebi);
• pacientis mdgomareobis da simptomebis gauareseba.
pirveli rigis preparats miekuTvneba amoqsicilini. Tu arsebobs
alergiuli anamnezi penicilinebis jgufis antibiotikebis mimarT
SeiZleba dainiSnos doqsiciklini (mozrdilebSi), azitromicini da
klaritromicini.
meore rigis preparatebs miekuTvneba: ko-amoqsiklavi, II Taobis
cefalosporini, ftorqinoloni (levofloqsacini, 12 wlis zemo asakSi).
Tu antibiotikis meore kursis Semdeg pacientis mdgomareoba ar
umjobesdeba, aucilebelia pacientis referali stacionarSi.
orsul qalebTan da meZuZur dedebTan gamoiyeneba eriTromicini.
miuxedavad imisa, rom klaritromicinTan da azitromicinTan SedarebiT
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is metad aRizianebs kuW-nawlavis traqts da Haemophilus influenzae–ze naklebad moqmedebs, dadgenilia eriTromicinis usafrTxoeba orsulebSi.
antibiotikoTerapiis saSualo xangrZlivoba 10 dRea.
analgetiuri da antipiretuli saSualebebi
tkivilisa da temperaturuli reaqciis kupirebis mizniT bavSvebSi
naCvenebia paracetamolis an iboprufenis gamoyeneba.
dekongestantebi
intranazaluri dekongestantebis gamoyeneba moklevadiani kursiT
SesaZlebelia sinusitis samkurnalod, intranazaluri dekongestantebis
xangrZlivi droiT (7 dRe da meti) gamoyeneba ar aris rekomendebuli.
sxva saSualebebi
ar arsebobs klinikuri mtkicebulebebi nazalurad fiziologiuri
xsnaris gamoyenebis Sesaxeb. Tumca SesaZlebelia fiziologiuri xsnaris
gamoyenebam xeli SeuSalos fufxebis warmoqmnas da gaaTxelos sekreti,
rac gaaioloebs mis drenaJs.
dakvirveba
Tu pacients mkurnaloben antibiotikebiT da misi mdgomareoba ar
umjobesdeba, an Tu ver xerxdeba antibiotikis miReba, magaliTad
Rebinebis SemTxvevaSi, ganmeorebiTi viziti saWiroa Catardes 72 saaTSi.
Tu pacientis mdgomareoba antibiotikoTerapiis fonze ar umjobesdeba,
saWiroa:
• gadaisinjos diagnozis adeqvaturoba;
• Sefasdes garTulebebis arseboba;
• Sefasdes, Tu ramdenad asrulebs pacienti eqimis daniSnulebas.
Tu pacienti ar asrulebs sworad eqimis daniSnulebas:
• SeiZleba gagrZeldes mocemuli antibiotiki;
Tu antibiotikze aRiniSneba Rebineba
• igi unda Seicvalos sxva pirveli rigis preparatiT an dainiSnos
saineqcio antibiotiki, sanam ar moxdeba Rebinebis kupireba, ris
Semdegac kvlav xdeba gadasvla oralur antibiotikze.
Tu pacienti sworad asrulebs eqimis daniSnulebas:
• saWiroa meore rigis antibiotikebis gamoyeneba
Tu saeWvoa baqteriuli sinusitis garTuleba, aucilebelia referali
stacionarSi.
gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _ “zeda
sasunTqi gzebis mwvave infeqciebi”
13
adamianuri da materialur-teqnikuri resursi
adamianuri resursi: ojaxis eqimi an ubnis pediatri/Terapevti, an
otorinolaringologi.
materialur-teqnikuri resursi: gamanaTebeli mowyobiloba xaxis
dasaTvaliereblad, enis supresori (Spadeli), fonedoskopi, rentgenis
aparati.
14
mwvave sinusiti
(stacionari)
definicia
mwvave sinusiti paranazaluri sinusebis lorwovani garsis anTebiTi
dazianebaa, romelic gamowveulia daxSul RruSi baqteriebis zrdiT da
romlis xangrZliobac 4 kviraze naklebia. sinusiti uxSiresad iwyeba
rinitis fonze, ris gamoc mas xSir SemTxvevaSi uwodeben rinosinusits.
damadasturebeli kriteriumebi
daavadebis diagnostika efuZneba daavadebis anamnezs, klinikur suraTs,
simptomebis xangrZlivobas, obieqtur gasinjvas da, saWiroebisas,
rentgenologiuri gamokvlevis Sedegebs.
sinusitis arc erTi klinikuri niSani damoukideblad ar aris
mgrZnobiare da specifiuri diagnozis dasasmelad.
baqteriuli sinusitis simptomebia:
• zemo sasunTqi gzebis infeqciis klinika, romelic ar umjobesdeba
10-14 dRis ganmavlobaSi da romelsac Tan axlavs 2 niSani:
• cxviridan lorwovan - Cirqovani gamonadeni
da
• gaxangrZlivebuli aradamakmayofilebeli mdgomareoba.
• aseve SesaZlebelia:
• cxeleba;
• xvela;
• agzneba;
• saxis tkivili.
obieqturad SeiZleba gamovlindes:
• saxis Sesieba an eriTema dazianebis areSi;
• mgrZnobeloba sinusis palpaciis an perkusiis dros (palpaciisas
mcire asakis bavSvebSi saxis tkivili da sinusis mgrZnobeloba ar
vlindeba, Tumca es simptomebi kargi indikatoria saskolo asakis
bavSvebsa da mozardebSi);
• periorbitaluri Sesiveba;
• cxviris lorwovani garsis eriTema an SeSupeba;
• ZiriTadi kbilebis mgrZnobeloba;
• Tanmxlebi Sua yuris anTeba bavSvebSi.
15
ZiriTadi simptomebi, romelsac efuZneba diagnozi:
• zemo sasunTqi gzebis infeqciis klinika, romelic ar umjobesdeba
10-14 dRis ganmavlobaSi;
• cxviriT sunTqvis blokireba/cxviridan gamonadeni (SeiZleba
mxolod lorwovani, Sesqelebuli, lorwovan-Cirqovani);
• persistuli xvela, romelic Zlierdeba RamiT.
SedarebiT iSviaTad vlindeba gulisreva, yuris da yelis tkivili, saxis
tkivili, SeSupeba.
diagnostikur-laboratoriuli testebi da specialistTa konsultaciebi
a) pirvel 4 saaTSi
• sisxlis saerTo analizi;
b) pirvel 24 saaTSi
• sisxlis saerTo analizi;
• cxviris danamati Rruebis rentgenologiuri kvleva;
g) pirvel 3 dReSi
• sisxlis saerTo analizi;
• cxviris danamati Rruebis rentgenologiuri kvleva;
• mikrobiologiuri kvleva (Cvenebis mixedviT);
sawyis etapze sinusitze saeWvo SemTxvevebSi rutinuli rentgenologiuri
kvleva ar aris saWiro. ar aris rekomendebuli sinusebis
rentgenografiis Catareba 6 wlamde asakSic. sinusitis mkurnaloba
SesaZlebelia daiwyos mxolod klinikur suraTze dayrdnobiT.
rentgenologiuri kvlevis Catareba saWiroa Semdeg SemTxvevebSi:
• mwvave sinusitis diagnozisas, Tu saeWvoa subperiostuli an
orbitaluri abscesi;
• mwvave sinusitis diagnozisas, Tu saeWvoa intrakraniuli
garTulebebi;
• Tu mkurnalobis miuxedavad ar aris gaumjobeseba da saWiroa
diagnozis dadastureba.
yvela SemTxvevaSi rentgenografia unda Catardes pacientis vertikalur
poziciaSi, raTa rentgenogramaze Sefasdes sinusSi haeri-siTxis done.
garTulebuli sinusitebis SemTxvevaSi diagnostikis “oqros standartad”
iTvleba sinusis aspiracia da baqteriuli kulturis Seswavla.
kompiuteruli tomografiis gamoyeneba naCvenebia, Tu saeWvoa cxviris
danamati Rruebis avTvisebiani paTologia, Tu pacientebs esaWiroebaT
sinusitis qirurgiuli mkurnaloba. kompiuteruli tomografiis
gamoyeneba agreTve mizanSewonilia:
16
• sinusitis mZime garTulebebis ganviTarebis SemTxvevaSi;
• qronikuli an morecidive sinusitis dros;
• daavadebis mZime mimdinareobis SemTxvevaSi, rodesac medikamenturi
mkurnaloba uefeqtoa.
mkurnaloba
antibiotikoTerapia
baqteriuli sinusitis mkurnalobis mizania sinusis Rrus SigTavsis
drenireba da paTologiuri baqteriebis zrdis Seferxeba. antibiotiko-
Terapiis Cvenebaa:
• simptomebis persistireba (magaliTad, Tu klinikuri niSnebi
grZeldeba 7 - 10 dReze meti);
• mZime simptomatika (mag: profuzuli Cirqovani gamonadeni
cxviridan, saxis tkivili da sistemuri dazianebis niSnebi);
• pacientis mdgomareobis da simptomebis gauareseba.
pirveli rigis preparats miekuTvneba amoqsicilini. Tu arsebobs
alergiuli anamnezi penicilinebis jgufis antibiotikebis mimarT
SeiZleba dainiSnos doqsiciklini (mozrdilebSi), azitromicini da
klaritromicini, dadgenilia maTi maRali efeqturoba sinusitis
gamomwvevebis, gansakuTrebiT Haemophilus influenzae da Moraxella catarrhalis mimarT.
meore rigis preparatebs miekuTvneba: ko-amoqsiklavi, II Taobis
cefalosporini, ftorqinoloni (levofloqsacini, 12 wlis zemo asakSi).
Tu saeWvoa anaerobuli baqteriebiT gamowveuli sinusiti SesaZlebelia
mkurnalobaSi gamoyenebuli iqnas metronidazoli.
Tu antibiotikis meore kursis Semdeg pacientis mdgomareoba ar
umjobesdeba, mizanSewonilia sinusis punqcia da aspiratidan kulturis
mgrZnobelobis gansazRvra.
orsul qalebTan da meZuZur dedebTan gamoiyeneba eriTromicini.
miuxedavad imisa, rom klaritromicinTan da azitromicinTan SedarebiT
is metad aRizianebs kuW-nawlavis traqts da Haemophilus influenzae–ze naklebad moqmedebs, dadgenilia eriTromicinis usafrTxoeba orsulebSi.
antibiotikoTerapiis saSualo xangrZlivoba 10 dRea.
analgetiuri da antipiretuli saSualebebi
tkivilisa da temperaturuli reaqciis kupirebis mizniT bavSvebSi
naCvenebia paracetamolis an iboprufenis gamoyeneba.
17
dekongestantebi
intranazaluri dekongestantebis gamoyeneba moklevadiani kursiT
SesaZlebelia sinusitis samkurnalod, intranazaluri dekongestantebis
xangrZlivi droiT (7 dRe da meti) gamoyeneba ar aris rekomendebuli.
sxva saSualebebi
ar arsebobs klinikuri mtkicebulebebi nazalurad fiziologiuri
xsnaris gamoyenebis Sesaxeb. Tumca SesaZlebelia fiziologiuri xsnaris
gamoyenebam xeli SeuSalos fufxebis warmoqmnas da gaaTxelos sekreti,
rac gaaioloebs mis drenaJs.
dakvirveba
Tu pacients mkurnaloben antibiotikebiT da misi mdgomareoba ar
umjobesdeba, an Tu ver xerxdeba antibiotikis miReba, magaliTad
Rebinebis SemTxvevaSi, ganmeorebiTi viziti saWiroa Catardes 72 saaTSi.
Tu pacientis mdgomareoba antibiotikoTerapiis fonze ar umjobesdeba,
saWiroa:
• gadaisinjos diagnozis adeqvaturoba;
• Sefasdes garTulebebis arseboba;
• Sefasdes, Tu ramdenad asrulebs pacienti eqimis daniSnulebas.
Tu pacienti ar asrulebs sworad eqimis daniSnulebas:
• SeiZleba gagrZeldes mocemuli antibiotiki;
Tu antibiotikze aRiniSneba Rebineba
• igi unda Seicvalos sxva pirveli rigis preparatiT an dainiSnos
saineqcio antibiotiki, sanam ar moxdeba Rebinebis kupireba, ris
Semdegac kvlav xdeba gadasvla oralur antibiotikze.
Tu pacienti sworad asrulebs eqimis daniSnulebas:
• saWiroa meore rigis antibiotikebis gamoyeneba
Tu saeWvoa baqteriuli sinusitis garTuleba, aucilebelia
otorinlarigologis, ofTalmologis, neiroqirurgis konsultacia.
gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _ “zeda
sasunTqi gzebis mwvave infeqciebi”
adamianuri da materialur-teqnikuri resursi
adamianuri resursi: pediatri, Terapevti an otorinolaringologi.
materialur-teqnikuri resursi: gamanaTebeli mowyobiloba xaxis
dasaTvaliereblad, enis supresori (Spadeli), fonedoskopi, rentgenis
aparati.
18
mwvave otiti
(pirveladi jandacva)
definicia
mwvave otitis samuSao definiciad mowodebulia Sua yuris anTeba
swrafad ganviTarebuli adgilobrivi (yuris tkivili) da zogadi
simptomatikiT (cxeleba, gaRizianeba, cudi Zili). SesaZlebelia adgili
hqondes zeda sasunTqi gzebis daavadebisTvis damaxasiaTebel simptomebs:
xvelas da rinoreas.
damadasturebeli kriteriumebi
mwvave otitis diagnozi moiTxovs: daavadebis simptomebis ganviTarebis
mwvave dasawyiss; gamonadenis arsebobas Sua yurSi (timpanuri membranis
SeSupeba, timpanuri membranis mobilurobis SezRudva an ararseboba,
otorea); Sua yuris anTebis niSnebis da simptomebis arsebobas (timpanuri
membranis hiperemia, otalgia).
klinikuri niSnebi
Sua yuris anTebis uxSiresi simptomebia: tkivili, cxeleba,
gaRizianebadoba, otorea (gamonadeni yuridan), leTargia, anoreqsia da
Rebineba. specifiuri niSnebis nakleboba, gansakuTrebiT or wlamde
asakSi, arTulebs Sua yuris mwvave anTebis dignozis dadgenas.
Sua yuris anTeba gamonadeniT SesaZloa saerTod simptomebis gareSe
mimdinareobdes da gamovlenil iyos mxolod urTierTobis, qcevis,
swavlis da metyvelebis problemebiT.
diagnostika
mwvave otitis diagnozi SeiZleba daisvas mxolod klinikuri niSnebiT da
otoskopiuri kvlevis safuZvelze.
rekomendebulia pacientebSi morecidive mwvave otitiT gansakuTrebuli
yuradReba daeTmos Civils smenis daqveiTebis, metyvelebis Seferxebis
Sesaxeb.
marTva
analgetikebi _ tkivilis SemTxvevaSi aucilebelia analgetikebis
(acetaminofeni, ibuprofeni) gamoyeneba. tkivilis marTva, gansakuTrebiT
daavadebis pirvel 24 saaTSi, aucilebelia antibiotikoTerapiis
miuxedavad. tkivilis marTvaSi paracetamols upiratesoba unda mieniWos
arasteroiduli anTebis sawinaaRmdego saSualebebTan SedarebiT am
ukanasknelis gverdiTi movlenebis gamo. mSoblebs unda miewodoT
informacia mosalodneli safrTxis Sesaxeb dozis gadaWarbebisas. reis
sindromis ganviTarebis riskis gamo bavSvebSi aspirinis gamoyeneba ar
aris mizanSewonili.
19
yuris wveTebi
rekomendebulia, rom yvela bavSvSi mwvave otitiT unda moxdes tkivilis
Sefaseba da tkivilis arsebobis SemTxvevaSi unda dainiSnos
analgetikebi. unda gaviTvaliswinoT, tkivili mwvave otitis dros,
rogorc wesi, TavisiT gaivlis. amitom, aucileblobis SemTxvevaSi
efeqturi da usafrTxo analgetikebis xelmisawvdomoba ufro
mniSvnelovania, vidre is, Tu romeli medikamenti gamoviyenoT. es
preparatebia paracetamoli, ibuprofeni an yuris topikuri wveTebi.
pacientebSi, romlebTanac saeWvoa dafis apkis perforacia da/an
gamonadeni yuridan, Tavi unda avaridoT garegani saSualebebis
moxmarebas, radgan maT gamoyenebas SesaZloa Tan mohyves Zlieri
Tavbrusxveva da Rebineba.
antibiotikebi
antibiotikebi gamoyenebuli unda iqnes rutinulad 2 wlamde asakis
bavSvebSi an orxrivi otitis dros.
pirveli rigis preparats warmoadgens amoqsicilini.
Tu amoqsiciliniT 72 saaTiani Terapia uefeqtoa, an Tu pirveli rigis
preparatze aRiniSna alergiuli reaqcia, rekomendebulia meore rigis
preparatis: amoqsicilini/klavulinis mJavis an peroraluri
cefalosporinebis gamoyeneba.
Tu simptomebi grZeldeba amoqsicilini/klavulinatis miRebis Semdegac,
an Tu medikamentis peroraluri miReba SeuZlebelia, mizanSewonilia
ceftriaqsonis intramuskularuli ineqciebi 1-3 dRis ganmavlobaSi.
amoqsiciliniT Terapiis uefeqtobis SemTxvevaSi ar aris rekomendebuli
makrolidebis gamoyeneba.
gaurTulebeli mwvave otitis dros mkurnalobis 5 dRiani kursi
efeqturia. garTulebuli mwvave otitis dros da riskis jgufis
bavSvebSi mizanSewonilia 10 dRiani antibiotikoTerapia.
mwvave otitis dros antihistaminuri preparatebis da dekongestantebis
rutinuli gamoyeneba rekomendebuli ar aris.
Semdgomi dakvirveba da referali
Tu mdgomareoba ar umjobesdeba, aucilebelia bavSvis ganmeorebiTi
gamokvleva 48-72 saaTis Semdeg.
stacionarSi referali aucilebelia: Tu gareTa sasmen milSi daiwyo
Cirqovani gamonadeni, gansakuTrebiT Tu igi pulsirebad xasiaTs atarebs;
gamoCnda iseTi garTulebebi, rogoricaa saxis nervis paralizi an
mastoiditi; Tu eqvsi Tvis ganmavlobaSi aRiniSna mwvave otitis sami an
meti epizodi, an oTxi epizodi aRiniSna 12 Tvis ganmavlobaSi; Tu
mkurnalobis damTavrebis Semdeg eWvi gaqvT smenis deficitze
(gamoikvlieT yvela avadmyofi. CurCuli unda ismodes daaxloebiT 6
metrze).
gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _ “zeda
sasunTqi gzebis mwvave infeqciebi”
20
adamianuri da materialur-teqnikuri resursi
adamianuri resursi: ojaxis eqimi an ubnis pediatri/Terapevti,
otorinolaringologi.
materialur-teqnikuri resursi: otoskopi, gamanaTebeli mowyobiloba
xaxis dasaTvaliereblad, enis supresori (Spadeli).
21
mwvave otiti
(stacionari)
definicia
mwvave otitis samuSao definiciad mowodebulia Sua yuris anTeba
swrafad ganviTarebuli adgilobrivi (yuris tkivili) da zogadi
simptomatikiT (cxeleba, gaRizianeba, cudi Zili). SesaZlebelia adgili
hqondes zeda sasunTqi gzebis daavadebisTvis damaxasiaTebel simptomebs:
xvelas da rinoreas.
damadasturebeli kriteriumebi
mwvave otitis diagnozi moiTxovs: daavadebis simptomebis ganviTarebis
mwvave dasawyiss; gamonadenis arsebobas Sua yurSi (timpanuri membranis
SeSupeba, timpanuri membranis mobilurobis SezRudva an ararseboba,
otorea); Sua yuris anTebis niSnebis da simptomebis arsebobas (timpanuri
membranis hiperemia, otalgia).
klinikuri niSnebi
Sua yuris anTebis uxSiresi simptomebia: tkivili, cxeleba,
gaRizianebadoba, otorea (gamonadeni yuridan), anoreqsia, Rebineba.
specifiuri niSnebis nakleboba, gansakuTrebiT or wlamde asakSi,
arTulebs Sua yuris mwvave anTebis diagnozis dadgenas.
Sua yuris anTeba gamonadeniT SesaZloa saerTod simptomebis gareSe
mimdinareobdes da gamovlenil iyos mxolod urTierTobis, qcevis,
swavlis da metyvelebis problemebiT.
rekomendebulia, rom pacientebSi morecidive mwvave otitiT
gansakuTrebuli yuradReba daeTmos Civils smenis daqveiTebis,
metyvelebis Seferxebis Sesaxeb.
aucileblad unda iqnes gaTvaliswinebuli, rom otitisaTvis
damaxasiaTebeli simptomebi da niSnebi SeiZleba gaqres membranis
perforaciis Semdeg. garda amisa, daavadebis gadatanis Semdeg Sua yurSi
gamonadeni SeiZleba darCes mwvave otitis simptomebis gaqrobis Semdeg
diagnostikur-laboratoriuli testebi da specialistTa konsultaciebi
a) pirvel 4 saaTSi
• sisxlis saerTo analizi;
• otoskopia;
b) pirvel 24 saaTSi
• sisxlis saerTo analizi;
• otoskopia;
• timpanometria.
22
g) pirvel 3 dReSi
• sisxlis saerTo analizi;
• otoskopia;
• timpanometria;
• audiometria (Cvenebis mixedviT).
mkurnaloba
analgetikebi
tkivilis SemTxvevaSi aucilebelia analgetikebis (acetaminofeni,
ibuprofeni) gamoyeneba. tkivilis marTva, gansakuTrebiT daavadebis
pirvel 24 saaTSi, aucilebelia antibiotikoTerapiis miuxedavad.
tkivilis marTvaSi paracetamols upiratesoba unda mieniWos
arasteroiduli anTebis sawinaaRmdego saSualebebTan SedarebiT am
ukanasknelis gverdiTi movlenebis gamo. mSoblebs unda miewodoT
informacia mosalodneli safrTxis Sesaxeb dozis gadaWarbebisas. reis
sindromis ganviTarebis riskis gamo bavSvebSi aspirinis gamoyeneba ar
aris mizanSewonili.
yuris wveTebi
rekomendebulia, rom yvela bavSvSi mwvave otitiT unda moxdes tkivilis
Sefaseba da tkivilis arsebobis SemTxvevaSi unda dainiSnos
analgetikebi. unda gaviTvaliswinoT, tkivili mwvave otitis dros,
rogorc wesi, TavisiT gaivlis. amitom, aucileblobis SemTxvevaSi
efeqturi da usafrTxo analgetikebis xelmisawvdomoba ufro
mniSvnelovania, vidre is, Tu romeli medikamenti gamoviyenoT. es
preparatebia paracetamoli, ibuprofeni an yuris topikuri wveTebi.
pacientebSi, romlebTanac saeWvoa dafis apkis perforacia da/an
gamonadeni yuridan, Tavi unda avaridoT garegani saSualebebis
moxmarebas, radgan maT gamoyenebas SesaZloa Tan mohyves Zlieri
Tavbrusxveva da Rebineba.
antibiotikebi
antibiotikebi gamoyenebuli unda iqnes rutinulad 2 wlamde asakis
bavSvebSi an orxrivi otitis dros.
pirveli rigis preparats warmoadgens amoqsicilini.
Tu amoqsiciliniT 72 saaTiani Terapia uefeqtoa, an Tu pirveli rigis
preparatze aRiniSna alergiuli reaqcia, rekomendebulia meore rigis
preparatebis: amoqsicilini/klavulinis mJavis an peroraluri
cefalosporinebis gamoyeneba.
Tu simptomebi grZeldeba amoqsicilini/klavulinatis miRebis Semdegac,
an Tu medikamentis peroraluri miReba SeuZlebelia, mizanSewonilia
ceftriaqsonis intramuskularuli ineqciebi 1-3 dRis ganmavlobaSi.
amoqsiciliniT Terapiis uefeqtobis SemTxvevaSi ar aris rekomendebuli
makrolidebis gamoyeneba.
23
gaurTulebeli mwvave otitis dros mkurnalobis 5 dRiani kursi
efeqturia. garTulebuli mwvave otitis dros da riskis jgufis
bavSvebSi mizanSewonilia 10 dRiani antibiotikoTerapia.
mwvave otitis dros antihistaminuri preparatebis da dekongestantebis
rutinuli gamoyeneba rekomendebuli ar aris.
Semdgomi dakvirveba da referali
Tu mdgomareoba ar umjobesdeba, aucilebelia bavSvis ganmeorebiTi
gamokvleva 48-72 saaTis Semdeg.
otolaringologis konsultacia aucilebelia: Tu daewyo gareTa sasmen
milSi Cirqovani gamonadeni, gansakuTrebiT Tu igi pulsirebad xasiaTs
atarebs; gamoCnda iseTi garTulebebi, rogoricaa saxis nervis paralizi
an mastoiditi; Tu eqvsi Tvis ganmavlobaSi aRiniSna mwvave otitis sami
an meti epizodi, an oTxi epizodi aRiniSna 12 Tvis ganmavlobaSi; Tu
mkurnalobis damTavrebis Semdeg eWvi gaqvT smenis deficitze
(gamoikvlieT yvela avadmyofi. CurCuli unda ismodes daaxloebiT 6
metrze).
gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _ “zeda
sasunTqi gzebis mwvave infeqciebi”
adamianuri da materialur-teqnikuri resursi
adamianuri resursi: pediatri an Terapevti, otorinolaringologi.
materialur-teqnikuri resursi: otoskopi, gamanaTebeli mowyobiloba
xaxis dasaTvaliereblad, enis supresori (Spadeli).
24
gacieba
(pirveladi jandacva)
definicia
gacieba ganixileba rogorc mwvave, msubuqad mimdinare kataruli
sindromi, romelic, rogorc wesi, ar saWiroebs medikamentur
mkurnalobas (avadmyofobaTa saerTaSoriso klasifikaciis meaTe
gadaxedvis mixedviT is Seesabameba mwvave nazofaringits _ J00 da zeda sasunTqi gzebis mwvave infeqciebs _ J06).
etiologia _ virusuli (miqsovirusebi, paramiqsovirusebi: paragripi,
respiraciul-sincitiuri virusi, adenovirusi, pikornavirusi
(rinovirusi) da koronavirusi). gripis virusi xSirad iwvevs gaciebis
msgavsi klinikuri simptomatikis ganviTarebas.
epidemiologia
• mozrdilebSi wlis ganmavlobaSi aRiniSneba gaciebis 2-4 epizodi.
• bavSvebSi misi sixSire SesaZlebelia 10-mdec ki iyos.
paTofiziologia
inkubaciuri periodi grZeldeba 24-72 saaTi gamomwvevis xasiaTis
gaTvaliswinebiT.
simptomebi da niSnebi klinikuri niSnebi
• uxSiresi simptomebia gamonadeni cxviridan, cxviriT sunTqvis
gaZneleba, yelis tkivili an fxaWnis SegrZneba, Tavis tkivili da
xvela. SesaZlebelia aRiniSnos xmis CaxleCa, gemovnebis an
ynosvis dakargva, Tvalebis wva, yuris dagubeba an wnevis
SegrZneba;
• xvela aRiniSneba gaciebis 30%-Si;
• sxeulis temperaturis momateba;
• adreuli asakis bavSvebSi: agznebadoba, kvebis gaZneleba
cxviridan gamonadenis gamo da diarea.
25
diagnostika
diagnozi emyareba anamnezs da daavadebis klinikur niSnebs.
diferencialuri diagnozi unda gatardes
• alergiul da araalergiul rinitTan;
• faringitTan;
• gripTan;
• bavSvebSi ucxo sxeulTan cxvirSi;
• adreuli asakis bavSvebSi unda gamoiricxos ufro seriozuli
mdgomareobebi: pnevmonia, sefsisi.
mkurnaloba
• medikamenturi marTva gulisxmobs simptomur Terapia.
rekomedebulia sicxis damwevi da tkivilgamayuCebeli
saSualebebi _ paracetamoli. alternativa: arasteroiduli
anTebis sawinaaRmdego saSualebebi _ aspirini (mozrdilebSi) da
ibuprofeni (bavSvebSi);
• damxmare saSualebebi: upirveles yovlisa, daarwmuneT pacienti,
rom gacieba msubuqi daavadebaa, romelic ar moiTxovs
medikamentur mkurnalobas. aqcenti unda gakeTdes siTxis
adeqvatur miwodebaze, ZuZuTi kvebaze myof bavSvebSi ufro xSir
kvebaze;
• mkurnalobis qvemoT CamoTvlili saSualebebis efeqtianoba
sarwmuno mecnieruli kvlevebiT dadasturebuli ar aris, mag.
bavSvebSi fiziologiuri xsnaris cxvirSi CawveTeba, orTqlis
inhalaciebi, C vitaminis maRali dozebi, oraluri an nazaluri
dekongestantebi (fsevdoefedrini, oqsimetazolini,
qsilometazolini) amosaxvelebeli da antihistaminuri
saSualebebi, eqinacea;
• pacientebSi filtvis qronikuli obstruqciuli daavadebebiT,
romlebsac gaciebis fonze aReniSnebaT, sul mcire, ori niSani
qvemoT CamoTvlilidan: sunTqvis ufro meti gaZneleba, naxvelis
raodenobis mateba da Cirqovani naxvelis gaCena _
rekomendebulia antibiotikoTerapia.
meTvalyureoba da prognozi gacieba saSualod grZeldeba erTi kvira. SemTxevaTa 25%-Si
daavadeba xangrZlivdeba 2 kviramde.
26
garTulebebi
• adreuli asakis bavSvebSi SeiZleba ganviTardes bronqioliti,
virusuli pnevmonia, krupi;
• 3 Tvemde asakis bavSvebSi SesaZlebelia qvemo sasunTqi gzebis meoradi
baqteriuli infeqciis ganviTareba;
• 60 wlis zemoT asakSi daaxloebiT 65%-Si mosalodmelia qvemo
sasunTqi gzebis daavadebaTa ganviTareba;
• am garTulebaTa ganviTarebis riski gansakuTrebiT matulobs Tambaqos
mwevelebSi;
• SemTxvevaTa 2%-Si gacieba rTuldeba mwvave otitis ganviTarebiT
(gansakuTrebiT bavSvebSi);
• paranazaluri sinusebis baqteriuli infeqcia (0,5%);
• avadmyofebSi filtvis qronikuli obstruqciuli daavadebiT
rinovirusuli etiologiis gacieba amZimebs da axangrZlivebs fqod-s.
gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _ “zeda
sasunTqi gzebis mwvave infeqciebi”.
adamianuri da materialur-teqnikuri resursi
adamianuri resursi: ojaxis eqimi, ubnis pediatri an Terapevti.
materialur-teqnikuri resursi: gamanaTebeli mowyobiloba xaxis
dasaTvaliereblad, enis supresori (Spadeli), otoskopi (TandarTuli
mwvave otitis gamosaricxad), foneidoskopi.
27
mwvave sinusitis marTvis algoriTmi
mwvave sinusitis diagnostika imonokompetentur pacientSi bavSvi:
• cxviridan gamonadenis gaxangrZliveba;
• xveleba dRis saaTebSi;
• 10-14 dReSi ar aris gaumjobeseba.
mozrdili:
• Cirqovani gamonadeni cxviridan; • tkivili zeda ybis areSi (gans. calmxrivi);
• cal mxares sinusis mgrZnobeloba;
• sawyisi gaumjobesebis Semdeg mdgomareobis
gauareseba;
• gaumjobesebis ararseboba7-10 dRis Semdeg;
• sinusis rentgenografia morecidive an qronikuli
sinusitis dros.
pacienti mwvave mZime sinusitiT bavSvi da mozrdili:
• maRali (>390C) an mudmivi cxeleba (>3-4 dReze)
• periorbituli SeSupeba
• 10-14 dReSi ar aris gaumjobeseba
• saxis/kbilis Zlieri
tkivili
• am simptomebis arsebobisas, miuxedavad maTi
xangrZlivobisa, saWiroa
dauyovneblivi daxmareba
xangrZlivoba < 7-14 dReze
(an met xans Tu gaumjobese-
ba aris) an simptomebi
msubuqad aris gamoxatuli
7-10 dRe (mozrdilebSi) an 10-14 dRe (bavSvebSi) gaum-
jobesebis gareSe an ufro met xans saSualo simZimis
an mZime simptomatika, mudmivi serozul-Cirqovani
gamonadeni cxviridan da/an xvela dRis saaTebSi
simptomuri mkurnaloba fiziologiuri xsnaris Ca-
wveTeba, analgetiki/anti-
piretiki, adgilobrivi da/an
oraluri dekongestatebi,
(antibiotikebi ara efeqtu-
ria mwvave respiraciuli
infeqciis dros da ar ax-
dens baqteriuli sinusitis
prevencias0
Tu 4-5 dReSi ar iqna
gaumjobeseba, saWiroa
ganmeorebiTi konsultacia
romelime risk-faqtori saxezea? asaki 2 w-mde, aRzrda
organizebul koleqtivebSi, antibiotikebis gamoyeneba
bolo 3 Tvis manZilze an morecidive infeqcia.
airCieT erTi
• amoqsicilini:
mozrdilebi 1500
mg/dReSi 2 an 3
miRebaze; bavSvebSi: 45
mg/kg/dReSi 2 an 3
miRebaze
• penicilinze WeSmariti
alergia:* azitromicini
an klaritromicini
mkurnaloba unda
gagrZeldes myari
gaumjobesebidan 7 dRe
airCieT erTi
• amoqsicilini:
mozrdilebi 3
g/dReSi 2 an 3
miRebaze; bavSvebSi:
90 mg/kg/dReSi 2 an
3 miRebaze
• penicilinze
WeSmariti
alergia:*
cefalosporini
da/an
alergologis
konsultacia
gaumjobeseba ar aris 48-72 saaTSi? mxolod mudmivi
gamonadeni ar aris mkurnalobis Secvlis Cveneba
• ko-amoqsiklavi;
• cefuroqsimi; • penicilinze WeSmariti alergia:* respiraciuli ftorqinolini 18
welze meti asakis pacientebSi
mkurnaloba unda gagrZeldes myari gaumjobesebidan 7 dRe
SeniSvna * penicilinze WeSmariti alergia:
urtikaria an anafilaqsia penicilinze
miuTuTebs WeSmarit alergiaze.
makulopapuluri gamonayari ar aris
WeSmariti alergia Tu anamnezSi aris
penicilinze WeSmariti alergia,
cefalosporinis daniSvnamde miiReT
alergologis konsultacia an ifiqreT
respiraciul ftorqinolinze 18 welze
meti asakis pacientebSi
** klavulanis mJavis doza ar unda
aRematebodes 10mg/kg/dReSi
28
ara
mwvave otitis marTvis algoriTmi
yuris mwvave infeqciis (yuris tkivili, cxeleba) an
Sua yuridan gamonadenis (dafis apkis hiperemia)
niSnebi da simptomebi
mwvave Sua yuris anTeba
1. gamonadenis arseboba (SeiniSneba gasinjvis dros an
dgindeba pnevmaturi otoskopiiT)
da 2. mwvave infeqciis niSnebi da simptomebi (yuris tkivili,
cxeleba)
Sua yuris anTeba gamonadeniT
gamonadenis arseboba
(SeiniSneba gasinjvis dros an
dgindeba pnevmaturi
otoskopiiT)
mwvave infeqciis niSnebis da
simptomebis gareSe. tkivilis mkurnaloba
risk faqtori: 2 wlamde asaki, bavSvi dadis baRSi an skolaSi, antibiotikis miReba bolo 3 TveSi
diax ara
• amoqsicilini:* 45 mg/kg/ dReSi
2-3 miRebaze (Tu 2 welze met
asakSi daavadeba mZimed mimdina-
reobs, saWiroa maRali doza -
90 mg/kg/ dReSi 2-3 miRebaze)
• penicilinze WeSmariti
alergia:** cefalosporini
• amoqsicilini:* 90 mg/kg/
dReSi 2-3 miRebaze
• penicilinze WeSmariti
alergia:** cefalosporini
da/an alergologis
konsultacia
aris gaumjobeseba 2-3 dReSi?
(mxolod gamonadeni ar aris mkurnalobis Secvlis Cveneba) diax
mkurnaloba grZeldeba;
ganmeorebiTi konsulta-
cia saWiroa 4-8 kviris
Semdeg da gauaresebis
SemTxvevaSi
• amoqsicilini: 90 mg/kg/ dReSi, ko-amoqsiklavi *** 2-3 miRebaze 10 dRe. an: ceftriaqsoni
kunTebSi (pacientebSi, penicilinebis autanlobis SemTxvevaSi).
• penicilinze WeSmariti alergia**
SeniSvna
* 2 wlamde mkurnalobis xangrZlivoba 10 dRe, Tu 2 welis zemoT (Tu garTuleba ar aris), 5 dRe
** penicilinze WeSmariti alergia: WeSmarit alergiaze miuTiTebs urtikaria da anafilaqsia
penicilinis mimarT. makulo-papuluri gamonayari ar miuTiTebs WeSmarit alergiaze. Tu alergia
gamoxatulia cefalosporinis daniSvnamde, saWiroa alergologis konsultacia
*** klavulonis doza ar unda aRematebodes 10 mg/kg/dReSi
referalis Cveneba:
otolaringologTan
• mastoiditis niSnebis arseboba; • Tu simptomebi uaresdeba an ar umjobesdeba 2 dReSi.
nevrologTan
• Tu gamoixata saxis nervis dazianebis simptomebi.
audiologiuri gamokvleva saWiroa, Tu
• daavadeba grZeldeba 3 Tveze met xans da/an Tu SeimCneva metyvelebis, smenis darRveva.
antibiotiki ar aris naCvenebi,
saWiroa dakvirveba 3 Tve
Tu gamonadenis
xangrZlivoba > 3
Tveze - saWiroa
referali
otolaringologTan,
smenis Sefaseba