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Ffiltvebis qronikuli obstuqciuli daavadeba da misi marTva lali miqiaSvili tfdc. 2 marti, 2010.

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Presentation on theme: "Ffiltvebis qronikuli obstuqciuli daavadeba da misi marTva lali miqiaSvili tfdc. 2 marti, 2010."— Presentation transcript:

1 Ffiltvebis qronikuli obstuqciuli daavadeba da misi marTva lali miqiaSvili tfdc. 2 marti, 2010

2 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.

3 janmo-s monacemebi:  2002 wels fqod-m daikava V adgili sikdilianobis mxriv;  2030 wels savaraudod daiWers III adgils.

4 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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7 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.

8 fqod aerTianebs :  qr. obstruqciuli bronqiti;  emfizema; 3.α-1 antitrifsinis deficiti.

9 garTulebebi:  filtvismieri guli;  policitemia;  sunTqvis ukmarisoba;  Ramis hipoqsia;  bronqogenuli karcinoma;  motexilobebi;  barZayis Zvlis mineralizaciis darRveva;  kataraqta  depresia

10 saWiroa fqod-s adreuli gamovlena:  klinicistebis ganswavla;  fqod-s specifiuri skriningi;  specialuri kiTxvaris roli pirveladi jandacvis qselSi

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12 spirometria

13 Ffqod-s stadia Bbronqodilatatoris miRebis Semdeg tifnos indeqsi ( FEV 1 /FVC): bronqodilatatoris miRebis Semdeg FEV 1 %: 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 ).

14 Ffqod-s mkurnaloba miznad isaxavs:  respiratoruli Civilebis Seamcirebas;  gamwvavebebis Semcirebas;  filtvis funqciis gaumjobesebas;  sicocxlis xangrZlivobis gazrdas.

15 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

16 Ffqod-s stadia daxasiaTebarekomendaciebi 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 < 0.70 FEV1 < 30% samkurnalo sqema: erT- an orkomponentiani- BD + sainhalacio kortikosteroidi; oqsigenoTerapia, qirurgia, reabilitaciaA

17 Ffqod-s samkurnalo preparatebi:  antiqolinerguli bronqodilatatorebi;  xangrZlivi moqmedebis β-agonistebi;  sainhalacio kortikosteroidebi (kombinaciaSi);

18 asTmisa da fqod-s samkurnalo medikamentebi gansxvavdeba erTmaneTisagan fqod-s dros ar gamoiyeneba:  qromolini;  leikotrinebis antagonistebi;  sainhalacioKkortikosteroidebis monoTerapia

19 miRwevebi fqod-s mkurnalobaSi: or- da samkomponentiani reJimi:  bronqodilatatorebis sxvadasxva klasis kombinacia β 2 -agonistebi: a. xanmokle moqmedebis ( Albuterol) b. gaxangrZlivebuli moqmedebis (salmeteroli, formeteroli) antiqolinerguli saS-bebi: a. xanmokle moqmedebis (I pratropium bromide) ; b. gaxangrZlivebuli moqmedebis ( Tiotropium) mag. Tiotropium+ formeterol; Tiotropium+salmeterol.  kortikosteroidebi bronqodilatatorebTan kombinaciaSi.

20 iotropium

21 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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23 reabilitacia:  fizikuri varjiSi zeda da qveda kidurebis aqtiuri datvirTviT;  sasunTqi kunTebis varjiSi;  fizioTerapia;  fsiqosocialuri daxmareba (depresia);  ganaTleba.

24 oqsigenoTerapia  PCvenebebi:  P PaO 2 < 7,3 kPa ; SaO 2 < 80%  Aan PaO 2 = 7,3 - 7,8 kPa + filtvismieri guli, policitemia.  Ooqsigenaciis mizani: P PaO 2 > 8kPa, SaO 2 > 90%

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26 qirurgia: National Emphysema Treatment Trial (NETT)

27 qirurgia: National Emphysema Treatment Trial (NETT)2 Patient s 90 Day Mortality LVRS 90 Day Mortality Medical Therapy P Value 29,2mos Mortality LVRS 29,2mos Mortality Medical Therapy Risk Ratio P Value Group A 20/70 (28,6) 0/70(0)<.00142/7030/701,82.06 Group B 4/139(2,9)5/151(3,3)1.0026/13951/1510,47.005 Group C 6/206(2.9)2/213(0,9)0.1734/20639/2130,98.70 Group D 7/84(8,3)0/65(0)0,0228/8426/650,81.49 Group E 11/109 (10,1) 1/111(0,9)0,00327/10914/1112,06.02

28 sicocxlis xangrZlivoba : Ffam 1 (FEV 1) sicocxlis xangrZlivoba >/= 1,2L10 weli =1L5 weli <700 ml2 welze naklebi

29 janmo-s prevenciuli RonisZiebebi Seiqmna:  GARD(Global Alliance against Chronic Respiratory Disease) Mmisi erTerTi nawilia  GOLD (Global Initiative for Chronic Obstructive Disease)

30 Tambaqos mowevaze kontroli

31 sabinao pirobebSi haeris dabinZureba

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33 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.

34 gmadlobT yuradRebisaTvis


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