Transcript Ffiltvebis qronikuli obstuqciuli daavadeba da misi marTva lali

Ffiltvebis qronikuli obstuqciuli daavadeba da misi marTva
lali miqiaSvili
tfdc. 2 marti, 2010
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.
janmo-s monacemebi:
 2002 wels fqod-m daikava V adgili sikdilianobis mxriv;
 2030 wels savaraudod daiWers III adgils.
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.
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.
fqod aerTianebs :
1.
2.
qr. obstruqciuli bronqiti;
emfizema;
3. α-1 antitrifsinis deficiti.
garTulebebi:









filtvismieri guli;
policitemia;
sunTqvis ukmarisoba;
Ramis hipoqsia;
bronqogenuli karcinoma;
motexilobebi;
barZayis Zvlis mineralizaciis darRveva;
kataraqta
depresia
saWiroa fqod-s adreuli gamovlena:
 klinicistebis ganswavla;
 fqod-s specifiuri skriningi;
 specialuri kiTxvaris roli pirveladi jandacvis qselSi
spirometria
spirometria:
(Global Strategy for Diagnosis, Management, and Prevention of
COPD).
Bbronqodilatatoris miRebis Semdeg
tifnos indeqsi (FEV1/FVC):
</= 0.7
bronqodilatatoris miRebis Semdeg
II –saSualo simZimis
</= 0.7
50-80%
III -mZime
</= 0.7
30-50%
IV-Zalian mZime
</= 0.7
< 30%
Ffqod-s stadia
I - msubuqi
FEV1 %:
>/= 80%
Ffqod-s mkurnaloba miznad isaxavs:
 respiratoruli Civilebis Seamcirebas;
 gamwvavebebis Semcirebas;
 filtvis funqciis gaumjobesebas;
 sicocxlis xangrZlivobis gazrdas.
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
Ffqod-s stadia
daxasiaTeba
yvela
rekomendaciebi
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:
IV Zalian mZime
FEV1/FVC < 0.70
FEV1 < 30%
samkurnalo sqema: erT- an orkomponentiani-BD + sainhalacio
kortikosteroidi;
oqsigenoTerapia, qirurgia, reabilitaciaA
erT- an orkomponentiani-BD;
+ sainhalacio kortikosteroidi;
reabilitaciaA
Ffqod-s samkurnalo preparatebi:
 antiqolinerguli bronqodilatatorebi;
 xangrZlivi moqmedebis β-agonistebi;
 sainhalacio kortikosteroidebi (kombinaciaSi);
asTmisa da fqod-s samkurnalo medikamentebi gansxvavdeba
erTmaneTisagan
fqod-s dros ar gamoiyeneba:
 qromolini;
 leikotrinebis antagonistebi;
 sainhalacioKkortikosteroidebis monoTerapia
miRwevebi fqod-s mkurnalobaSi:
or- da samkomponentiani reJimi:


bronqodilatatorebis sxvadasxva klasis kombinacia
β2-agonistebi: a. xanmokle moqmedebis (Albuterol)
b. gaxangrZlivebuli moqmedebis
(salmeteroli, formeteroli)

mag.
antiqolinerguli saS-bebi: a. xanmokle moqmedebis
(Ipratropium bromide) ;
b. gaxangrZlivebuli moqmedebis
(Tiotropium)
Tiotropium+ formeterol;

Tiotropium+salmeterol.
kortikosteroidebi bronqodilatatorebTan kombinaciaSi.
iotropium
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
reabilitacia:





fizikuri varjiSi zeda da qveda kidurebis aqtiuri datvirTviT;
sasunTqi kunTebis varjiSi;
fizioTerapia;
fsiqosocialuri daxmareba (depresia);
ganaTleba.
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%
qirurgia: National Emphysema Treatment Trial (NETT)
qirurgia: National Emphysema Treatment Trial (NETT)2
Patient
s
90 Day
Mortality
LVRS
90 Day
Mortality
Medical
Therapy
P
Value
29,2mos 29,2mos
Mortality Mortality
Medical
LVRS
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
sicocxlis xangrZlivoba:
Ffam1
sicocxlis xangrZlivoba
>/= 1,2L
10 weli
=1L
5 weli
<700 ml
2 welze naklebi
(FEV1)
janmo-s prevenciuli RonisZiebebi
Seiqmna:
 GARD(Global Alliance against Chronic
Respiratory Disease)
Mmisi erTerTi nawilia
 GOLD (Global Initiative for Chronic
Obstructive Disease)
Tambaqos mowevaze kontroli
sabinao pirobebSi haeris dabinZureba
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.
gmadlobT
yuradRebisaTvis