Mwvave bronqiti
stacionarSi mwvave bronqitis
marTvis gaidlaini
avtorebi: T.maRlakeliZe, k.vaWaraZe, i.CxaiZe, p.gvetaZe,
n.yavlaSvili
eqspertebi: v.qacarava, q.Sarangia
Tbilisi
2006
gaidlainis aucilebloba. mwvave bronqiti traqeobronquli xis anTebiTi procesia, romlis sixSire gansakuTrebiT matulobs zamTris periodSi, rodesac gansakuTrebiT maRalia mwvave respiraciuli infeqciebis ricxvi. marto aSS-Si mwvave bronqitis diagnoziT 12 milioni adamiani mimarTavs eqims, ris gamoc yovelwliurad 300.000 mln dolaris wamali iniSneba.
definicia
mwvave bronqiti bronquli xis lorwovani garsis mwvave anTebaa, romelic grZeldeba 2-3 kviramde da romlis aucilebel simptoms warmoadgens xvela naxvelis gamoyofiT an mis gareSe.
epidemiologia
mwvave bronqiti ojaxis eqimis mier erT-erTi yvelaze xSirad dasmuli diagnozia. is xSiria zamTris periodSi, rodesac Warbobs respiraciuli virusuli infeqciebi. bronqiti Sedis eqimTan vizitis uxSires mizezTa xuTeulSi. bronqiti Tanabrad gvxvdeba orive sqesis pacientebSi. yvelaze xSirad 5 wlamde asakis bavSvebi avaddebian. aseve maRalia misi sixSire 9-15 wlis bavSvebSi. mwvave bronqitis sixSire wlis ganmavlobaSi aSS-Si saSualod 87 SemTxvevaa/100.000 mosaxleze/kviraSi, xolo zamTris periodSi misi sixSire 150 SemTxvevaa/100.000 mosaxleze/kviraSi. britaneTSi skolis moswavleebSi bronqitis gavrceleba 20,7%-mdea. saqarTvelos Sromis, janmrTelobis da socialuri dacvis saministros daavadebaTa kontrolis da samedicino statistikis erovnuli centris 2004 wlis monacemebiT saqarTveloSi mwvave bronqitis diagnoziT hospitalizebul iqna 3.214 avadmyofi, maT Soris 14 wlamde asakis 2.655 bavSvi. 100.000 mosaxleze maCvenebeli Seadgens 73.5-s. letalobis maCvenebeli 0,1%-ia.
etiologia
mwvave bronqiti uxSiresad dakavSirebulia respiraciul virusebTan, rogoricaa gaciebis gamomwvevi virusebi (rinovirusi, koronavirusi), gripis virusi, adenovirusi, rs-virusi, paragripis virusi, martivi herpesis virusi. mwvave bronqitis SedarebiT umniSvnelo nawili ganpirobebulia sxva mizezebiT:
baqteriebi:
1. Streptococcus Pneumoniae
2. Heamophilus Influenza
3. Moraxella catarrhalis (Branhamella catarallis)
4. Bordetella pertusis (da parapertusis)
atipuri gamomwvevebi
1. Mycoplasma pneumoniae
2. Chlamydia pneumoniae
3. Legionella
sokoebi:
1. Blastomyces dermatitidis
2. Candida albicans
3. Coccidiodes immitis
4. Cryptococcus neoformans
5. Histoplasma capsulatum
garemos gamRizianeblebi
1. haeris dabinZureba
2. Tambaqos boli (15 wlamde bavSvebSi bronqitis sixSire korelirebs pasiur mowevasTan (mtkicebuleba IV)
mwvave bronqitis gamomwvevTa asakobrivi Tavisebureba bavSvebSi aseTia:
1 wlamde:
1. respiraciul-sincitiuri virusi (zamTari-gazafxuli)
2. paragripis virusi (Semodgoma)
3. koronavirusi (zamTari-gazafxuli)
1-10 weli
1. paragripis virusi (Semodgoma)
2. enterovirusi (Semodgoma)
3. respiraciul-sincitiuri virusi (zamTari-gazafxuli)
4. rinovirusi (Semodgoma)
10 welze met asakSi
1. gripis virusi (zamTari-gazafxuli)
2. respiraciul-sincitiuri virusi (zamTari-gazafxuli)
3. adenovirusi.
cxrilSi moyvanilia mwvave bronqitis uxSires gamomwvevTa epidemiologiis da klinikuri mimdinareobis Taviseburebani.
| |
|gamomwvevi agenti |Tavisebureba |
|Influenza A |epidemiis dros avaddeba yvela asakobrivi jgufis warmomadgeneli |
|Influenza B |avaddeba yvela asakobrivi jgufis warmomadgeneli |
|Parainfluenza 1–3 |erTeuli SemTxvevebi, epidemia iSviaTia |
|Adenovirus | |
|Pneumococcus |saSualo asakSi an moxucebSi |
| |uecari dasawyisi |
| |zemo sasunTqi gzebis dazianebis simptomebi |
|Mycoplasma |epidemia 30 wlamde asakSi gvxvdeba |
| |daavadebis daswyisSi damaxasiaTebelia zemo sasunTqi gzebis dazianebis simptomebi |
| |mSrali xvela |
|Bordetella pertussis |gaxangrZlivebuli xvela |
|Haemophilus influenzae |mwevelebSi an pirebSi qronikuli bronqitiT |
|Moraxella catarrhalis |qronikuli bronqiti, imunodeficiti |
paTogenezi
mwvave bronqitis dros viTardeba bronqis lorwovanis SeSupeba da lorwos hipersekrecia. xvela SeiZleba, erTi mxriv, gamowveuli iyos sasunTqi gzebis epiTeliumis destruqciiT, meore mxriv ki anTebis mediatorebis gamomuSavebiTa da mukociliuri aparatis dazianebiT, Tumca xvelis ganviTarebis meqanizmi bolomde naTeli ar aris. ufro maRali virulentobis mqone virusebisaTvis, rogoricaa gripi da adenovirusi, xvelis mizezi SeiZleba iyos lorwovani garsis epiTeliumis daSla. ufro naklebi virulentobis mqone virusebisaTvis, rogoricaa rinovirusi, xvelas SesaZloa ganapirobebdes anTebis mediatorebis aqtivacia da bronqis mukociliaruli funqciis Secvla.
bronqitis ganviTarebasa da simptomebis gamwvavebas xels uwyobs Tambaqos boli da haeris dabinZureba. mwvave bronqitis dros ganviTarebuli anTebiTi cvlilebebi gardamavalia, Tumca xvela SeiZleba gaxangrZlivdes 3 kviramde.
mwvave bronqitis risk-faqtorebia:
• gadacieba;
• cxviriT sunTqvis gaZneleba;
• cxvir-xaxis qronikuli infeqciebi;
• imunodeficituri mdgomareobebi;
• bavSvTa da xandazmuli asaki;
• Tambaqos moweva (pasiuric);
• alkoholizmi;
• refluqs-ezofagiti;
• garemos dabinZureba.
klinikuri niSnebi
mwvave bronqiti uxSiresad gamowveulia respiraciuli virusebiT, amitom igi iwyeba respiraciuli infeqciis niSnebiT, rogoricaa Semcivneba, saerTo sisuste, msubuqi cxeleba (araumetes 3 dRe), cxviridan gamonadeni, yelis tkivili, kunTebis tkivili, xmis caxleCa.
ZiriTadi klinikuri niSani xvelaa, romelic daavadebis dawyebidan 2-4 dRis Semdeg iCens Tavs. Tavidan is mSrali, Semawuxebeli xasiaTisaa, Semdeg produqtiuli xdeba. naxveli Tavidan lorwovania, mogvianebiT Cirqovani SeiZleba gaxdes. Tumca Cirqovani naxveli gamowveulia leikocitebis migraciiT da yovelTvis ar miuTiTebs baqteriuli infeqciis arsebobaze. adreuli asakis bavSvebi naxvels ylapaven, rasac SeiZleba mohyves Rebineba. dinamikaSi naxveli TandaTan Txierdeba da 5-10 dReSi xvela gaivlis. bronqitis simptomebi Cveulebriv 2 kviramde grZeldeba, Tumca iSviaTad SeiZleba xvela gaxangrZlivdes 4-6 kviramde.
obieqturi gamokvleva
obieqturi gamokvlevis Sedegebi damokidebulia pacientis asaksa da daavadebis stadiaze. temperatura, rogorc wesi, normaluria, Tumca SesaZlebelia subfebrilur cifrebsac aRwevdes. adreul etapze SesaZloa gamoxatuli iyos nazofaringiti, koniunqtiviti da riniti. filtvebis auskultaciuri monacemebi am etapze ar aris Secvlili. daavadebis progresirebis da xvelis intensivobis matebastan erTad filtvebis auskultaciuri monacemebi icvleba, sunTqviTi xmianoba xdeba mkvrivi, moismineba mSrali da sxadasxva yalibis sveli xixini. zog pacientSi SeiZleba moisminebodes mstvinavi sunTqva. bronqitisaTvis ar aris damaxasiaTebeli lokaluri simptomatika: lokaluri krepitacia, bronquli sunTqva, perkutoruli xmianobis moyrueba. aseT SemTxvevaSi gamosaricxia pnevmoniis arseboba.
garTulebebi
• pnevmonia (viTardeba pacientTa 5%-Si);
• sunTqvis mwvave ukmarisoba.
simZimis Sefaseba
mwvave bronqiti, rogorc wesi, mimdinareobs msubuqad an saSualo simZimiT, Cveulebriv, is ar saWiroebs hospitalizacias
hospitalizaciis Cvenebebi
mwvave bronqitis mkurnaloba uxSiresad ambulatoriulad tardeba. hospitalizaciis Cvenebas warmoadgens:
• Tanmxlebi daavadebebi (gulis Tandayolili anomalia, filtvis qronikuli paTologia, nevrologiuri darRvevebi);
• socialuri problemebi - ojaxSi movlis, meTvalyureobis deficiti, transportirebis saSualebis ar arseboba (sarwmunoeba IV, rekomendacia D);
• simptomebis 2-3 kviraze metad gaxangrZliveba;
• toqsikozis niSnebi (saeWvoa baqteriuli traqeiti an pnevmonia);
• sicocxlisTvis saSiSi niSnebis arseboba (sarwmunoeba IV, rekomendacia D,);
• sakvebis da siTxis miRebis SeuZlebloba.
diagnozi
daavadebis diagnostika tardeba klinikuri niSnebis safuZvelze. bronqitze eWvi unda iqnes mitanili im pacientebSi, romelTanac mwvave respiraciuli infeqciis niSnebi asocirebulia xvelasTan. sruli anamnezuri gamokvleva unda moicavdes garemo aris da sigaretis zegavlenis dadgenas, epidemiologiur monacemebs. sruli obieqturi gamokvleva aucilebelia, raTa gamoiricxos xvelis sxva mizezebi, rogoricaa kardiovaskuluri daavadebebi da filtvis parenqimis dazianeba.
sisxlis saerTo analizi - ar iZleva daavadebis diagnostikis da misi mkurnalobis gansazrvris saSualebas (sarwmunoeba IV). amitom ar aris mizanSewonili misi rutinulad Catareba (rekomendacia C). mwvave bronqitis dros SeiZleba gamovlindes leikopenia an leikocitozi, limfocitozi, Tumca es ar aris specifiuri am daavadebisaTvis.
pulsoqsimetria, Jangbadis saturaciis gansazRvra (mZime mimdinareobisas). O2 saturaciis gansazRvra mizanSewonilia Cautardes Yyvela bavSvs, romelic hospitalizebulia sunTqvis mwvave ukmarisobiT (sarwmunoeba II, rekomendacia C).
rentgenologiuri gamokvleva – mwvave bronqitis dros gulmkerdis rentgenograma normaluria an aRiniSneba bronqogenuri gaZliereba. gulmkerdis rentgenografia ar tardeba rutinulad. gulmkerdis rentgenografiis Cvenebebia:
➢ pacients aqvs cxeleba, magram ar aqvs zemo sasunTqi gzebis dazianebis simptomebi;
➢ pacients aqvs Tanmxlebi davadeba, romelic xels uwyobs pnevmoniis ganviTarebas – bronqoeqtazia, diabeti, gulis, RviZlis an Tirkmlis paTologia;
➢ anamnezSi pnevmonia (< 1 weli);
➢ anamnezSi tuberkulozis arseboba;
➢ daavadebis gaxangrZliveba an uCveulo mimdinareoba;
➢ eWvi pnevmoniaze.
etiologiuri kvleva - nazofaringuli sekretidan SeiZleba virusis gamoyofa, Tumca es ar aris aucilebeli diagnozis dasasmelad an mkurnalobisTvis. vinaidan mwvave bronqiti ZiriTadad virusuli genezisaa, ar aris rekomendebuli naxvelis mikrobiologiuri Tu mikroskopuli kvlevis Catareba. serologiuri testiT SeiZleba gamomwvevis (mikoplazmis, qlamidiis) sawinaaRmdego specifiuri antisxeulebis dadgena. polimerazuli jaWvuri reaqciiT SesaZlebelia nebismieri etiologiuri faqtoris dadgena, Tumca es meTodi Zviria da stacionarSic ki rutinulad ar gamoiyeneba.
filtvis funqciis Seswavla - mwvave bronqitiT daavadebul pacientebSi dadgenilia filtvis funqciis daqveiTeba, magram spirografia ar aris rutinulad rekomendebuli. filtvis funqciis Seswavla tardeba bronqul asTmaze eWvis dros.
C-reaqtiuli cila – kvlevebi gviCveneben, rom es testi xasiaTdeba baqteriuli infeqciis mimarT maRali mgrZnobelobiT (80-100%), da dabali specifiurobiT (60-70%). C-reaqtiuli cila SeiZleba gamoyenebul iqnas antibiotikoTerapiis kriteriumad hospitalizebul bavSvebSi (rekomendacia B). Tumca dabali C-reaqtiuli cila ar gamoricxavs baqteriuli infeqciis arsebobas.
diferenciuliDdiagnozi
diferencialuri diagnozi tardeba Semdeg daavadebebTan:
➢ pnevmonia;
➢ asTma;
➢ qronikuli bronqitis gamwvaveba;
➢ yivanaxvela;
➢ ucxo sxeulis aspiracia;
➢ mukoviscidozi;
➢ bronqioliti;
➢ zeda sasunTqi gzebis infeqcia;
➢ sinusiti;
➢ nazofaringiti;
➢ refluqs-ezofagiti;
➢ bronqis simsivne;
➢ atipuri mikobaqteriuli infeqcia;
➢ baqteriuli traqeiti.
➢ riniti da post-nazaluri wveTi.
prognozi
prognozi pacientTa umravlesobaSi keTilsaimedoa. Tu xvela gaxangrZlivda, saWiroa damatebiTi gamokvlevebi.
marTva
mwvave bronqitis ZiriTadi gamomwvevia virusi, amitom antibiotikoTerapia ar aris naCvenebi. rva placebo-kontrolirebadi, ormagi brma, randomizebuli kvlevis meta-analizis Sedegad naCvenebia, rom ar arsebobs mwvave bronqitis dros antibiotikebis gamoyenebis efeqturobis damadasturebeli monacemebi. antibiotikebi ar axdendnen zegavlenas xvelis Semcirebaze, ar icavdnen meoradi baqteriuli infeqciebis ganviTarebisagan an maTi mZime mimdinareobisagan.
antibiotiki iniSneba, Tu saeWvoa baqteriuli infeqcia (sarwmunoebis done I, rekomendacia A). dadgenilia, rom mwvave bronqitis diagnoscirebisas eqimTa 50-79% niSnavs antibiotiks, miuxedavad imisa, rom antibiotiks aranairi sargebeli ar moaqvs. antibiotikoTerapiaze unda vifiqroT, Tu:
➢ zogadi mdgomareoba uaresdeba;
➢ cxeleba grZeldeba erT kviraze met xans;
➢ cxeleba Tavidan iwyeba;
➢ aRiniSneba profuzuli da Cirqovani naxveli;
➢ epidemiologiuri situaciidan gamomdinare eWvia mikoplazmur, qlamidiur infeqciaze an yivanaxvelaze;
➢ Tu mwvave bronqitis simptomebTan erTad aRiniSneba sinusiti an otiti;
➢ Tu daavadeba mimdinareobs im faqtorebis fonze, romelTac SeuZliaT gazardon pnevmoniis ganviTarebis riski (imunodeficiti, alkoholizmi, gulis qronikuli ukmarisoba, filtvis qronikuli paTologia).
mikoplazmur da qlamidiur infeqciaze eWvis dros rekomendebulia makrolidis gamoyeneba (sarwmunoebis done III, rekomendacia B).
mkurnalobis principebi bavSvebSi
1. mSvidi, komfortuli garemo;
2. siTxeebis damatebiTi miwodeba;
3. antipiretuli saSualebebi;
4. amosaxvelebeli saSualebebis efeqturoba da sargeblianoba bavSvebSi ar aris dadasturebuli;
5. bavSvebSi xvelis damTrgunvelebis gamoyeneba ar amcirebs daavadebis xangrZlivobas, amasTan naxvelis evakuaciis daTrgunvam SeiZleba xeli Seuwyos baqteriul garTulebas;
6. bavSvebSi ar arsebobs mwvave bronqitis dros β2-agonistebis efeqturobis damadasturebeli monacemebi;
7. antihistaminuri preparatebi ar aris rekomendebuli, radgan isini iwveven naxvelis gamoSrobas da SeiZleba gaaZlieron xvela.
mSobels unda miewodos informacia, rom dauyovnebliv mimarTos eqims, Tu bavSvs gamoexata Semdegi niSnebi: sunTqva gaxda ufro gaZnelebuli; daewyo FRebineba yoveli kvebis Semdeg; ver iRebs siTxeebs; gamoixata zogadi mZime mdgomareoba – daTrgunva, Zilianoba.
mkurnalobis principebi mozrdilebSi
1. siTxeebis damatebiT miwodeba bronquli sekretis gamoSrobis Tavidan acilebis mizniT;
2. sigaretis mowevisagan Tavis Sekaveba;
3. antipiretuli saSualebebi;
4. xvelis damTrgunveli saSualebebi xSirad iniSneba bronqitis, gansakuTrebiT Semawuxebeli xveliT mimdinare, dros. maT SeiZleba Seamciron xvela, magram maTi miReba ar amcirebs daavadebis xangrZlivobas.
5. amosaxvelebeli saSualebebis rutinuli gamoyeneba ar aris rekomendebuli. naxvelis gamaTxierebeli saSualebebis daniSvna SesaZlebelia mxolod webovani, Znelad gamosayofi naxvelis SemTxvevaSi;
6. bronqodilatatorebis gamoyeneba umniSvnelo efeqts iZleva gaxangrZlivebuli xvelis dros;
7. kortikosteroidebis gamoyeneba ar aris rekomendebuli, vinaidan ar arsebobs kvleva, romelic daadasturebs maT efeqturobas mwvave bronqitis dros.
prevencia
➢ dty vaqcinacia;
➢ gripis sawinaaRmdego vaqcinacia;
➢ Tambaqos bolisgan Tavis arideba.
meTvalyureoba
Semdgomi meTvalyureoba Cveulebriv ar aris saWiro, garda im SemTxvevebisa, roca:
➢ mdgomareoba uaresdeba an axali simptomebi Cndeba;
➢ xvela xangrZlivdeba >1 Tveze;
➢ simptomebi meordeba (>3 epizodze weliwadSi).
gaidlainis miRebis wyaro. winamdebare gaidlaini warmoadgenis sxvadasxva gaidlainebis (ix. literatura) Sejerebis da adaptaciis Sedegs.
mwvave bronqitis marTvis
protokoli
daavadebis definicia.
mwvave bronqiti bronquli xis lorwovani garsis mwvave anTebaa, romelic grZeldeba 2-3 kviramde da romlis aucilebel simptoms warmoadgens xvela naxvelis gamoyofiT an mis gareSe.
simptomebi da niSnebi
mwvave bronqiti uxSiresad gamowveulia respiraciuli virusebiT, amitom igi iwyeba respiraciuli infeqciis niSnebiT, rogoricaa Semcivneba, saerTo sisuste, msubuqi cxeleba (araumetes 3 dRe), cxviridan gamonadeni, yelis tkivili, kunTebis tkivili, xmis caxleCa.
ZiriTadi klinikuri niSani xvelaa, romelic daavadebis dawyebidan 2-4 dRis Semdeg iCens Tavs. Tavidan is mSrali, Semawuxebeli xasiaTisaa, Semdeg produqtiuli xdeba. naxveli Tavidan lorwovania, mogvianebiT Cirqovani SeiZleba gaxdes. Tumca Cirqovani naxveli gamowveulia leikocitebis migraciiT da yovelTvis ar miuTiTebs baqteriuli infeqciis arsebobaze. adreuli asakis bavSvebi naxvels ylapaven, rasac SeiZleba mohyves Rebineba. dinamikaSi naxveli TandaTan Txierdeba da 5-10 dReSi xvela gaivlis. bronqitis simptomebi Cveulebriv 2 kviramde grZeldeba, Tumca iSviaTad SeiZleba xvela gaxangrZlivdes 4-6 kviramde.
temperatura normaluria an subfebriluri. adreul etapze SesaZloa gamoxatuli iyos nazofaringiti, koniunqtiviti da riniti. daavadebis progresirebis da xvelis intensivobis matebastan erTad moismineba mSrali da sxadasxva yalibis sveli xixini. zog pacientSi SeiZleba moisminebodes mstvinavi sunTqva. bronqitisaTvis ar aris damaxasiaTebeli lokaluri simptomatika: lokaluri krepitacia, bronquli sunTqva, perkutoruli xmianobia moyrueba. aseT SemTxvevaSi gamosaricxia pnevmoniis arseboba.
bronqitze eWvi unda iqnes mitanili im pacientebSi, romelTanac mwvave respiraciuli infeqciis niSnebi asocirebulia xvelasTan. sruli anamnezuri gamokvleva unda moicavdes garemo aris da sigaretis zegavlenis dadgenas, epidemiologiur monacemebs. sruli obieqturi gamokvleva aucilebelia, raTa gamoiricxos xvelis sxva mizezebi, rogoricaa kardiovaskularuli daavadebebi da filtvis parenqimis dazianeba.
diagnostikur-laboratoriuli testebi
sisxlis saerTo analizi - ar iZleva daavadebis diagnostikis da misi mkurnalobis gansazrvris saSualebas. amitom ar aris mizanSewonili misi rutinulad Catareba. mwvave bronqitis dros SeiZleba gamovlindes leikopenia an leikocitozi, limfocitozi, Tumca es ar aris specifiuri am daavadebisaTvis.
rentgenologiuri gamokvleva – mwvave bronqitis dros gulmkerdis rentgenograma normaluria an aRiniSneba bronqogenuri gaZliereba. gulmkerdis rentgenografia ar tardeba rutinulad. gulmkerdis rentgenogramis Cvenebebia:
➢ pacients aqvs cxeleba, magram ar aqvs zemo sasunTqi gzebis dazianebis simptomebi;
➢ pacients aqvs Tanmxlebi davadeba, romelic xels uwyobs pnevmoniis ganviTarebas – bronqoeqtazia, diabeti, gulis, RviZlis an Tirkmlis paTologia;
➢ anamnezSi pnevmonia (< 1 weli);
➢ anamnezSi tuberkulozis arseboba;
➢ daavadebis gaxangrZliveba an uCveulo mimdinareoba;
➢ eWvi pnevmoniaze.
etiologiuri kvleva - nazofaringuli sekretidan SeiZleba virusis gamoyofa, Tumca es ar aris aucilebeli diagnozis dasasmelad an mkurnalobisTvis. vinaidan mwvave bronqiti ZiriTadad virusuli genezisaa, ar aris rekomendebuli naxvelis mikrobiolo-giuri Tu mikroskopuli kvlevis Catareba.
filtvis funqciis Seswavla. filtvis funqciis Seswavla tardeba bronqul asTmaze eWvis dros.
mkurnaloba
mwvave bronqitis ZiriTadi gamomwvevia virusi, amitom antibiotikoTerapia ar aris naCvenebi. antibiotikoTerapiaze unda vifiqroT, Tu:
➢ zogadi mdgomareoba uaresdeba;
➢ cxeleba grZeldeba erT kviraze met xans;
➢ cxeleba Tavidan iwyeba;
➢ aRiniSneba profuzuli da Cirqovani naxveli;
➢ epidemiologiuri situaciidan gamomdinare eWvia mikoplazmur, qlamidiur infeqciaze an yivanaxvelaze;
➢ Tu mwvave bronqitis simptomebTan erTad aRiniSneba sinusiti an otiti;
➢ Tu daavadeba mimdinareobs im faqtorebis fonze, romelTac SeuZliaT gazardon pnevmoniis ganviTarebis riski (imunodeficiti, alkoholizmi, gulis qronikuli ukmarisoba, filtvis qronikuli paTologia).
mikoplazmur da qlamidiur infeqciaze eWvis dros rekomendebulia makrolidis gamoyeneba.
mkurnalobis principebi bavSvebSi
1. mSvidi, komfortuli garemo;
2. siTxeebis damatebiTi miwodeba;
3. antipiretuli saSualebebi;
4. bavSvebSi xvelis damTrgunvelebis gamoyeneba ar amcirebs daavadebis xangrZlivobas, amasTan naxvelis evakuaciis daTrgunvam SeiZleba xeli Seuwyos baqteriul garTulebas;
5. bavSvebSi ar arsebobs mwvave bronqitis dros β2-agonistebis efeqturobis damadasturebeli monacemebi;
6. antihistaminuri preparatebi ar aris rekomendebuli, radgan isini iwveven naxvelis gamoSrobas da SeiZleba gaaZlieron xvela.
mSobels unda miewodos informacia, rom dauyovnebliv mimarTos eqims, Tu bavSvs gamoexata Semdegi niSnebi: sunTqva gaxda ufro gaZnelebuli; daewyo FRebineba yoveli kvebis Semdeg; ver iRebs siTxeebs; gamoixata zogadi mZime mdgomareoba – daTrgunva, Zilianoba.
mkurnalobis principebi mozrdilebSi
1. siTxeebis damatebiT miwodeba bronquli sekretis gamoSrobis Tavidan acilebis mizniT;
2. sigaretis mowevisagan Tavis Sekaveba;
3. antipiretuli saSualebebi;
4. xvelis damTrgunveli saSualebebi xSirad iniSneba bronqitis dros. maT SeiZleba Seamciron xvela, magram maTi miReba ar amcirebs daavadebis xangrZlivobas.
5. amosaxvelebeli saSualebebis rutinuli gamoyeneba ar aris rekomendebuli. naxvelis gamaTxierebeli saSualebebis daniSvna SesaZlebelia mxolod webovani, Znelad gamosayofi naxvelis SemTxvevaSi;
6. bronqodilatatorebis gamoyeneba umniSvnelo efeqts iZleva gaxangrZlivebuli xvelis dros;
7. kortikosteroidebis gamoyeneba ar aris rekomendebuli.
reabilitacia da dakvirveba
Semdgomi meTvalyureoba Cveulebriv ar aris saWiro, garda im SemTxvevebisa, roca:
➢ mdgomareoba uaresdeba an axali simptomebi Cndeba;
➢ xvela xangrZlivdeba >1 Tveze;
➢ simptomebi meordeba (>3 epizodze weliwadSi).
protokoli eyrdnoba saqarTvelos respiraciuli asociaciis “mwvave bronqitis marTvis” gaidlains.
literatura:
1. Meza R, Bridges-Webb C, Sayer G, et al. The management of acute bronchitis in general practice: results from the Australian morbidity and treatment survey. Australian Family Physician, 1994; 23: 1550-1553.
2. Samuel Ong, MD, Visiting Assistant Professor, Department of Emergency Medicine, University of California at Los Angeles Medical Center-Olive View Bronchitis Last Updated: December 29, 2004, WEBMD, eMedicine
3. Guideline for The Management of Acute Bronchitis - developed by an Alberta Clinical Practice Guideline Working Group, 2006 Update.
4. Family Practice Notebook, 2000
5. Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center Bronchitis, Acute and Chronic Last Updated: January 30, 2006, WEBMD, eMedicine
6. DiFranza JR, Lew RA. Morbidity and mortality in children associated with use of tobacco products by other people. Pediatrics 1996; 97 (4); 560-568
7. Hamm R, Hicks R, Bemben D. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J. Family Practice, 1996; 43: 56-62.
8. O’Brien K, Dowell S, Schwartz B, et al. Cough illness/bronchitis – principles of judicious use of antimicrobial agents.Paediatrics,1998;101: 178-81.
9. Gonzales R, Barrett P, Steiner J. The relationship between purulent manifestations and antibiotic treatment of upper respiratory tract infections. J. General Internal Medicine, 1999; 14:151-6.
10. Gwaltney J. Acute bronchitis. In: Mandell G, Bennett J, and Dolin R (eds.). Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 5th edition, Churchill and Livingstone, Edinburgh, 2000.
11. Becker L, Glazier R, McIsaac W, et al. Antibiotics for acute bronchitis (Cochrane Review). In: The Cochrane Library, Issue 3, 1998. Oxford: Update Software.
12. Hueston W. Albuterol delivered by metered dose inhaler to treat acute bronchitis. J. Family Practice, 1994; 39(5): 437-440.
13. Irwin R, Curley F, Bennett F. Appropriate use of antitussives and protussives: a practical review. Drugs, 1993; 46: 80-91.
14. Hueston W. Antibiotics: neither cost effective nor ‘cough’ effective. J. Family Practice, 1997; 44(3): 261-5.
15. Clinical practice guideline for the diagnosis and management of acute bronchitis - Inland empire health plan, San Bernandino, CA 2001
16. National Guideline Clearinghouse – Bronchitis, 2005
17. Gonzales R, Sande M. What will it take to stop physicians from prescribing antibiotics in acute bronchitis? Lancet, 1995; 345: 665-666.
18. Mainous A, Zoorob R, Hueston W. Current management of acute bronchitis in ambulatory care: the use of antibiotics and bronchodilators. Arch Fam Med, 1996; 5: 79-83.
19. National Guideline Clearinghouse – Use of antibiotics in pediatric care, 2002
20. Smuncy J, et al β2 agonists for acute bronchitis (Cochrane review) – The Cochrane Library, Issue 2, 2006
21. Acute Bronchitis - EBM Guidelines, 2004
22. Nelson - Textbook of pediatrics - 2005
23. Hueston W. J., Mainous A.G. Acute bronchitis. American Academy of Family Physicians, 1998
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[pic]
saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministro
[pic]
saqarTvelos respiraciuli asociacia
mwvave bronqitis marTvis algoritmi
• simptomebis kontroli;
• siTxeebis damatebiT miwodeba
• xvelis sawinaaRmdego saSualebebi**;
• antipiretuli saSualebebi;
• garemos gamRizianeblebTan kontaqtis SezRudva.
ganmeorebiTi konsultacia da gamokvleva saWiroa, Tu:
• mdgomareoba uaresdeba*** an Cndeba axali simptomebi;
• xvela xangrZlivdeba 1 Tveze met xans;
• simptomebi meordeba (>3 epizodze weliwadSi).
Tu dadasturda laboratoriuli kvleviT, gamoiyeneT makrolidi
ifiqreT yivanaxvelasa an atipur (mikoplazma, qlamidia) infeqciaze
**bavSvebSi xvelis damTr-gunveli da amosaxveleb-eli saSualebebis efeqtu-roba ar aris dadas-turebuli.
4.
pacientTan/mSobelTan isaubreT:
• antibiotikis uefeqtobaze;
• daavadebaze;
• antibiotikis gamoyenebas Tan dakavSirebul riskebze
gulmkerdis rentgenografia da sxva laboratoriuli kvleva rutinulad ar aris saWiro
***mSobelma dauyovnebliv unda mimarTos eqims, Tu bavSvs gamoexata: Zilianoba; gaZnelebuli sunTqva; Rebineba yoveli kvebis Semdeg; ver iRebs siTxeebs.
* bavSvebSi pnevmoniis erT-erT ZiriTad sadiagnostiko niSnad miCneulia sunTqvis sixSire:
• 2 Tvemde > 60-ze wuTSi,
• 2-dan 12 Tvemde > 50-ze wuTSi,
• 12 Tvidan 5 wlamde > 40-ze wuTSi,
• 5 welze meti asaki > 30 -ze wuTSi.
sunTqvis sixSiris daTvla unda moxdes erTi wuTis ganmavlobaSi, rodesac bavSvi mSvid mdgomareobaSia da ar tiris.
bavSvebSi gulmkerdis retraqcia (gulmkerdis qveda mesamedis Cazneqva sunTqvis procesSi) miCneulia mZime pnevmoniis erT-erT ZiriTad sadiagnostiko niSnad, Tumca gaTvaliswinebuli unda iyos, rom msubuqi retraqcia damaxasiaTebelia axalSobilebsa da Cvil bavSvTa asakisTvis da iTvleba normad.
ifiqreT sxva mizezze:
• asTma;
• ucxo sxeuli;
• tuberkulozi;
• mukoviscidozi;
• bronqoeqtazia;
• fqod da sxva.
[pic][?]- !#/>?ðÛȺ?ŽyjT>%>0h‡h‡5?B*CJ4OJQJaJ4mH ph3fsH *ht*5?B*CJ4OJQJaJ4mH ph3fsH *h‡5?B*CJ4OJQJaJ4mH ph3fsH h‡5?CJ0OJxangrZlivoba < 10-14 dReze, mdgomareoba damakmayofilebeli
xvelix xangrZlivoba 4-8 kvira
xvelis xangrZlivoba > 10-14 dReze
ara
pnevmoniis niSnebi saxezea?
• respiraciuli distresi;
• guliscemis sixSire >100/wT –ze;
• sunTqvis sixSire * >24/wT –ze;
• temperatura >380C;
• lokalurad perkutoruli xmis moyrueba, krepitacia, bronquli sunTqva
ifiqreT pnevmoniaze (ix. pnevmoniis marTvis gaidlaini)
diax
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