Tavi 24

arteriuli hipertenzia, stenokardia, miokardiumis infarqti da gulis ukmarisoba

kevin m o’Saugnesi

sinopsisi (mokle Sinaarsi)

kardiologiaSi didi yuradReba eTmoba arteriul hipertenziasa da gulis koronarul daavadebas.
hipertenzia aReniSneba aSS-s totaluri mosaxleobis 20%-s, 50 wlis Semdegi asakis pacientebis
upiratesobiT. inglissa da uelsSi sikvdilianobis mizezebs Soris gulis koronaruli daavadeba
mamakacebSi 30%-s Seadgens, qalebSi ki 22%-s. am daavadebebis marTva moiTxovs yuradRebis
gamaxvilebas rogorc klinikur, aseve farmakologiur detalebze.
cnobilia arteriul hipertenziisa da gulis koronarul daavadebis dros gamoyenebuli wamlebis
moqmedebis gzebi. preparatebi aRwerilia maTi farmakologiuri jgufebis mixedviT.
 hipertenzia da stenokardia: rogor moqmedeben wamlebi.
 wamlebi, romlebic gamoiyeneba hipertenziisa da stenokardiis dros
o Sardmdenebi
o vazodilatatorebi: organuli nitratebi, kalciumis arxebis blokatorebi, agf-inhibitorebi,
angiotenzin II receptorebis antagonistebi,
o  daadrenoreceptorebis blokatorebi.
o periferiuli simpaTikuri nervis terminali.
o avtonomiuri gangliebis blokatorebi.
o centraluri nervuli sistema.
o stenokardiis mkurnaloba.
 mwvave koronaruli sindromi da miokardiumis infarqti.
 arteriuli hipertenzia.
 seqsualuri funqcia da kardiovaskuluri preparatebi.
 feoqromocitoma.

amJamad, kargad aris Seswavlili gulis ukmarisobis xelisSemwyobi meqanizmebi. avadobisa da

sikvdilianobis maCveneblebze did zegavlenas axdens preparatebis frTxili SerCeva da mkurnalobis
msvlelobaze guldasmiTi monitoringi. gulis ukmarisobis mqone pacientebSi yvelaze didi riskia
parkuWovani ariTmia, romelic wamlebze ufro efeqturad eqvemdebareba saimplantacio
defibrilatoriTa ((ICD) da gulis resinqronizaciul Terapias( (CRT). am daavadebebis mqone
individumebisaTvis arCevanis farTo diapazonis gaTvaliswinebiT, nebismieri SemTxveva moiTxovs
specialistis konsultacias.
 preparatebi gulis ariTmiisTvis
 preparatebis ZiriTadi klasebi
 specifikuri mkurnaloba, maT Soris gulis gaCerebis dros gamoyenebuli saSualebebi
 gulis ukmarisobis samkurnalo saSualebebi.

hipertenzia: rogor moqmedeben preparatebi

ganvixiloT Semdegi urTierTkavSiri:
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 arteriuli wneva = gulis wuTmoculoba X periferiul winaaRmdegobaze
simarTlea, rom preparatebs SeuZliaT arteriuli wnevis daqveiTeba:
 arteriolebis, rezistentuli sisxlZarRvebis dilataciis gziT. sisxlZarRvebis gafarToeba
SesaZlebelia: gluvi kunTze uSualo moqmedebiT, arapirdapiri gziT _ an azotis oqsidis
gamomuSavebis stimulaciiT, an ki endogenuri vazokonstriqtorebis –
noradrenalin/norepinefrinis da angiotenzinis daTrgunviT.
 venebis, moculobiTi sisxlZarRvebis dilataciis gziT. gulisken venuri sisxlis ukumidinebis
(predatvirTva) Semcireba aqveiTebs gulis wuTmoculobas, gansakuTrebiT sxeulis vertikalur
mdgomareobaSi yofnis dros.
 gulis kunTis kumSvadobisa da guliscemis sixSiris SemcirebiT.
 organizmis natriumis gamofitviT. plazmis moculobis gardamavali Semcirebisa da
noradrenalin/norepinefrinze arteriolebis sapasuxo reaqciis daqveiTebis gziT.
 Tanamedrove antihipertenziuli preparatebi amcireben arteriul wnevas minimaluri CareviT,
homeostazis kontroliT, an mdebareobis SecvliT, varjiSiT.
stenokardia: rogor moqmedeben preparatebi
stenokardia SeiZleba ganvixiloT, rogorc Jangbadis miwodebisa da masze moTxovnis problema.
stenokardiis samkurnalo saSualebebi an zrdian Jangbadisa da sakvebi nivTierebebis miwodebas, an
amcireben maTze moTxovnas, an ki orive meqanizmiT moqmedeben.
miokardiumisTvis Jangbadis miwodeba SeiZleba gaizardos:
 koronaruli arteriebis gafarToebiT.
 gulis muSaobis SenelebiT (koronaruli sisxlis mimoqceva, calsaxad, diastolis periodSi
xorcieldeba, guliscemis sixSiris gaiSviaTeba ki axangrZlivebs diastolas).
Jangbadze miokardiumis moTxovnas amcirebs:
 postdatvirTvis daqveiTeba (anu periferiuli winaaRmdegobis daqveiTeba), radgan qsovilebis
perfuziisaTvis guls udro naklebi muSaoba uxdeba.
 predatvirTvis daqveiTeba (anu venuri Semavsebeli wnevis daqveiTeba). starlingis gulis
kanonis Tanaxmad, gulze datvirTva da Sesabamisad, gulis kunTis moTxovna Jangbadze
meryeobs gulis kunTis boWkoebis daWimulobis mixedviT.
 guliscemis gaiSviaTeba.
.
wamlebi, romlebic gamoiyeneba hipertenziisa da stenokardiis dros
hipertenziisa da stenokardiis samkurnalod gamoiyeneba preparatebis ori jgufi: adrenoblokatorebi
da kalciumis arxebis inhibitorebi. hipertenziis samkurnalo zogierTi preparati gulis ukmarisobis
samkurnalodac gamoiyeneba.
Sardmdenebi
Sardmdenebi, gansakuTrebiT ki Tiazidebi, efeqturi antihipertenziuli saSualebebia. isini
Tavdapirvelad aqveiTeben natriumis koncentracias, paralelurad ki amcireben sisxlisa da ujredSida
siTxis moculobas. Sardmdenebma SesaZloa 10%-mde Seamciron natriumis saerTo raodenoba,
magram efeqtis ar narCundeba. ramdenimeTviani mkurnalobis Semdeg qveiTdeba rezistentuli
sisxlZarRvebis mgrZnobeloba endogenuri vazokonstriqtorebis, ZiriTadad noradrenalin/norepinefrinis
mimarT, rac maTi arteriuli wnevis damaqveiTebeli efeqtis ZiriTadi meqanizmia. am
hiposensitiurobis mizezi SesaZloa natriumis raodenobis daqveiTebacaa, magram miuxedavad imisa,
rom maryuJovani SardmdenebTan SedarebiT, Tiazidebi gacilebiT ufro naklebad iwveven marilis
danakargs, isini gacilebiT ufro efeqturi antihipertenziuli saSualebebia. arsebobs sarwmuno
monacemebi imis Sesaxeb, rom Sardmdenebi damoukideblad moqmedeben sisxlZarRvebis gluvi
kunTis ujredebis membranebze lokalizebul daudgenel ionur arxebze. arteriul wnevaze maqsimaluri
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zemoqmedeba ramdenime kvira grZeldeba, amitom mkurnalobis reJimSi sxva preparatebis CarTva
umjobesia am periodis Semdeg.
Sratis kaliumze, sisxlis lipidebze, glukozis tolerantobasa da SardmJavas metabolizmze
Tiazidebis arasasurveli metaboluri efeqtebis gamo, ganxilul iqna winadadeba maTi Canacvlebis
Sesaxeb axali preparatebiT, romlebsac ar gaaCniaT es arasasurveli movlenebi. amJamad ki
dadgenilia, rom warsulSi Tiazidebi iniSneboda zedmetad maRali dozebiT da rom dabali dozebiT
gamoyenebisas (mag., bendroflumeTiazidi dRiuri doziT 1,25 _ 2,5 mg an naklebi, agreTve
hidroqlorTiazidi dRiuri doziT 12,5 _ 25mg) isini sakmaod efeqturia, amasTanave kargi amtanobiTac
xasiaTdeba. ufro metic, isini yvelaze iafi antihipertenziuli saSualebebia mTel msoflioSi, zogierTi
klinikuri kvleviT ki dadgenilia, rom isini hipertenziis, miokardiumis infarqtisa da insultis mTavari
garTulebebis saprofilaqtiko yvelaze efeqturi preparatebia. Tiaziduri Sardmdenebi amcireben
kalciumis Tirkmlismier eqskreciis, rac xandazmul pacientebSi xangrZlivi mkurnalobis dros amcirebs
barZayis motexilobebis sixSires, e ski Zalze xelsayrelia postmenopauzuri osteoporozis mqone
qalebis mkurnalobisas.

sisxlZarRvTa gamafarTovebeli saSualebebi (vazodilatatorebi)

organuli nitratebi
organuli nitratebi (da nitritebi) medicinaSi me-19 saukunidan gamoiyeneba. gluvi kunTebis ujredebSi
de-nitracia aTavisuflebs mTavar fiziologiur vazodilatators, azotis oqsids (NO), romlis sinTezic
normaluri endoTeluri ujredebis funqciaa. nitrodilatatorebi (NO-s gamomanTavisuflebeli, an NO-s
msgavsi moqmedebis wamlebis gamomxatveli saerTo termini) sisxlZarRvebis gluvi kunTis
ujredebSi aaqtiveben xsnad guanilatciklazas da zrdian ujredSida cikluri guanozinmonofosfatis
(GMP) koncentracias. es meoradi sasignalo molekula amcirebs kalciumis marags da iwvevs gluvi
kunTis modunebas. es iwvevs venulebis (moculobiTi sisxlZarRvebi) generalizebul, xolo arteriolebis
(rezistentuli sisxlZarRvebis) ufro naklebad gafarToebas. amis Sedegad arteriuli wneva mkveTrad
qveiTdeba, upirvelesad horizontaluri mdgomareobidan vertikalurSi gadasvlis dros (posturuli
hipotenzia). gansakuTrebiT farTovdeba msxvili koronaruli arteriebi. zogierT vazodilatators
axasiaTebs `moparvis fenomeni~, anu iwvevs sisxlis gadanawilebas fiqsirebulad Seviwroebuli
aTeromatuli arteriidan sxva, moSorebuli janmrTeli arteriisken. endogenuri NO-s gazrdis gamo,
savaraudod, nitratebi sapirispirod unda moqmedebdnen. aTeroma iwvevs endoTelur disfunqcias,
amitom mcirdeba NO-s gamoTavisufleba da Cqardeba misi daSla aTeromaSi arsebuli daJanguli
dabali simkvrivis lipoproteiniT (LDL).
venebis gafarToebaa iwvevs gulisaken venuri sisxlis ukumidinebis Semcirebasa da marcxena
parkuWis avsebis wnevisa da dartymiTi moculobis daqveiTebas, magram amasTanave, arteriuli
wnevis daqveiTebiT ganpirobebuli refleqsuri taqikardia gulis wuTmoculobis SenarCunebis
saSualebas iZleva.
farmakokinetika
nitratebi kargad Seiwoveba kanidan, piris lorwovani garsidan da nawlavis kedlidan. nawlavidan
Sewovili nitratebi ganicdian pirveladi gavlis metabolizms RviZlSi. amitom, am gziT saWiroa ufro
maRali dozebi, vidre enis qveS aplikaciis dros (amiT aixsneba, Tu ratom ar iZleva Sedegs gliceril
trinitratis sublingvuri tabletis gadaylapva). isini jer ganicdian de-nitirebas da Semdeg ukavSirdebian
glukuronis mJavas. nitratebs gansxvavebuli t1/2 periodi axasiaTebT (ix. qvemoT), magram gliceril
trinitratisTvis (GTN) igi 1-4 wT-ia. GTN-is de-nitrireba genetikurad determinebulia, radgan am
procesSi monawile fermenti mitoqondriuli alkoholdehidrogenaza - ALDH2 polimorfulia da im
pirebSi, romlebsac kodirebis saerTo varianti gaaCniaT (E504K), sublingvuri gliceriltrinitratis
efeqturoba 2-jer daqveiTebulia.
vazodilatatorebi iwveven Tavis tkivils, romlis mimarTac swrafad viTardeba tolerantoba da
swrafadve mTavrdeba (saaTebSi). tolerantobis prevenciisaTvis plazmaSi ar unda Seiqmnas nitratis
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stabiluri koncentracia. es advilad miRwevadia GTN–is iSviaTi miRebis SemTxvevaSi, magram
xangrZlivi t1/2-is mqone nitratebis (ix. qvemoT), agreTve GTN–is xangrZlivad gamomaTavisuflebeli
farmacevtuli formis daniSvnisas aucilebelia dozirebis reJimis winaswar dagegmva, ise rom plazmaSi
4-8 sT-is ganmavlobaSi (mag., mTeli Ramis ganmavlobaSi) SenarCunebuli iyos preparatis dabali
koncentracia. alternatulad, tolerantobis Tavidan acilebis mizniT, transdermuli emplastroc ramdenime
saaTiT unda moixsnas.
gamoyeneba. ZiriTadad, nitratebi gamoiyeneba stenokardiis Setevis mosaxsnelad, zogjer ki gulis
marcxena parkuWis ukmarisobis dros. arteriuli wnevis zedmetad daqveiTeba amcirebs koronarul
sisxlis mimoqcevas da iwvevs gonebis dakargvas Tavis tvinis sisxlis mimoqcevis daqveiTebis gamo.
aqedan gamomdinare, mniSvnelovania dozis SemTxveviTi gadaWarbebis Tavidan acileba.
stenokardiis mqone pacientebi informirebulni unda iyvnen dozis gadaWarbebis simptomebis
(gaxSirebuli guliscema, Tavbrusxveva, mxedvelobis dabindva, Tavis tkivili da saxis uecari
wamowiTleba, rasac mosdevs sifermkrTale) Sesaxeb da icodnen rogor unda moiqcnen maTi
gamovlenisas (ix. qvemoT).
mas Semdeg, rac aRmoCnda, rom Trombozis Sedegad koronaruli arteriis daxSoba TandaTan,
ramdenime saaTis ganmavlobaSi viTardeba da dakavSirebulia koronaruli xis sxva nawilebSi
ganviTarebul vazospazmTan, daiwyes izosorbidis dinitratis (izoketi) intravenuri xangrZlivi infuziis
gamoyeneba, tkivilis xarisxis Sesabamisad. es meTodi arastabiluri stenokardiis dros analgeziis
logikuri da efeqturi formaa.
zogjer, pacientebs aReniSnebaT sxva gluvi kunTebis spazmiT (kolika) ganpirobebuli gardamavali
saxis tkivili, aqedan gamomdinare, nitratebis mier gulmkerdis tkivilis Semcireba ar adasturebs
stenokardiis diagnozs.
anemiiT ganpirobebuli stenokardiis dros ukunaCvenebia nitratebis gamoyeneba.
arasasurveli movlenebi. nitratebis yvelaze xSiri gverdiTi movlenaa dozis gadaWarbebiT
gamowveuli arteriuli wnevis dacema da kolafsi. gulisken venuri sisxlis ukumidinebis aRsadgenad
pacienti unda daawvinoT zurgze da qveda kidurebi zemoT wamouwioT. pacientma aseve unda
gadmoagdos, an gadaylapos tabletis narCeni.
nitratiT gamowveuli Tavis tkivili, zogjer sakmaod Zlieri, savaraudod viTardeba meningealuri
arteriebis irgvliv tkivilisadmi mgrZnobiare qsovilebis daWimvis gamo, adgilobrivi vazodilataciis
Tanmxlebi gazrdili pulsaciis Sedegad. Zlieri Tanmxlebi Tavis tkivilis SemTxvevaSi doza unda
ganaxevrdes. maRali dozebiT mkurnalobisas iqmneba meThemoglobinemiis riski.
urTierTqmedeba. nitratebisa (da zogadad, NO dilatatorebis) da fosfodiesTerazas (PDE)
inhibitorebis (mag., sildenafili _ viagra da tadalafili _ sialisi) erTad gamoyenebisas adgili aqvs
vazodilataciuri efeqtis potencirebas. am preparatebis samiznea sisxlZarRvebis kedelis
fosfodiesTerazas (PDE-s) izoforma (PDE-5). meTilqsantinic (mag., Teofilini) PDE-as inhibitoria,
magram ufro sustad moqmedebs PDE-5 izoenzimze,
amitom nitratebTan erTad gamoyenebisas ar iwveven msgavs urTierTqmedebas, asTmis dros
rekomendebuli efeqturi dozebis pirobebSic. aRwerilia arteriuli wnevis mniSvnelovani daqveiTebiT
ganpirobebuli perikoituri sikvdilianobis SemTxvevebi im pacientebSi, romlebic nitratTan erTad
iRebdnen sildenafils. es aris ironiuli gadaxveva im ereqciuli disfunqciis samkurnalo pirveli rigis
preparatis Sesaxeb, romelic dasawyisSi Seiqmna, rogorc stenokardiis samkurnalo saSualeba.
gliceril trinitrati
gliceril trinitrati (1879) (trinitrini, nitroglicerini, GTN) (t1/2 3 wT) zeTovani, araaalebadi, magram
feTqebadi siTxea,romlis afeTqebis Zalac denTisaze metia. samedicino praqtikaSi igi inertul
nivTerebebTan narevi tabletis saxiT gamoiyeneba. am formiT igi usafrTxo da sakmaod stabiluria.
aRsaniSnavia, rom SefuTvis gaxsnidan 8 kviraSi, agreTve sicxeSi an Tavdauxuravad Senaxuli
tabletebi, aorTqlebis gamo kargaven Zalas da unda ganadgurdes. aqtiuri GTN-is Semcveli

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sublingvuri tableti iwvevs wvis SegrZneba enis qveS. alternatiulia nitroglicerinis sprei (ix. qvemoT),
romelic Seicavs Txevad GTN-s da vargisia sul mcire 3 wlis ganmavlobaSi.
GTN stenokardiuli Setevis samkurnalo arCevis preparatia. tabletebi unda daiReWos da
gaixsnas enis qveS, an loyis RarSi, saidanac ufro swrafad da saimedod Seiwoveba. garkveuli dros
saWiro, imisaTvis raTa pacientebi darwmundnen imaSi, rom tabletebis miRebis gza da gabruebis
SegrZneba usafrTxoa. wamali moqmedebas iwyebs 2 wT-Si da efeqti 30 wT grZeldeba. standartuli
tabletis dozaa 300 mkg, xelmisawvdomia agreTve 500 an 600 mkg-iani tabletebi. zogadad,
maqsimaluri dRiuri dozaa 6 mg, magram Tu pacienti saWiroebs kviraSi 2-3 tabletze mets, maSin
umjobesia mas daeniSnos nitratis xangrZlivad moqmedi preparati. GTN miiReba tkivilis
dawyebisTanave, an tkivilis prevenciis mizniT uSualod nebismieri fizikuri an emociuri daZabvis
win. xelmisawvdomia xangrZlivad moqmedi bukaluri tabletebi (suskardi, 1-5 mg). kuW-nawlavis
traqtidan gliceril trinitrati kargad Seiwoveba, magram RviZlSi mniSvnelovan presistemur eliminacias
eqvemdebareba, amitom upiratesoba eniWeba sublingvalur an bukalur gzas. alternatiulia oraluri
aerozolis enis qveS Sefrqveva (nitrolingvuri sprei).
profilaqtika. xangrZlivad moqmedi GTN miiReba oralurad (loyis plastiri an gadaylapva, sustaki), an
kanis emplastros (an malamos) saxiT. es farmacevtuli formebi Ramis stenokardiis dros5
gamoiyeneba.
venopunqcia. malamom SeiZleba gaaadvilos rTuli venopunqcia, xolo intravenuri infuziis adgilis
mimdebared mikruli transdermuli emplastro ki Tavidan gvacilebs sisxlCaqcevasa da flebits,
amasTanave axangrZlivebs infuziis efeqturobas.
izosorbid dinitrati (cedokardi)(t1/2 20 wT) stenokardiis profilaqtikisa da gulis SegubebiTi
ukmarisobis (sublingvuri da oraluri tabletebi) dros gamoiyeneba. intravenurad 500 mkg/ml (izoketi)
gamoiyeneba gulis marcxena parkuWis ukmarisobisa da arastabiluri stenokardiis dros.
izosorbid mononitrati (elantani)(t1/2 4 sT) gamoiyeneba stenokardiis profilaqtikis mizniT (oraluri
tabletebi). izosorbid dinitratTan SedarebiT, mas ufro msubuqi RviZlismieri presistemuri eliminacia
axasiaTebs, amitom misi sistemuri bioSeRwevadobac ukeTesia.
pentaeriTritil tetranitrati (peritrati)(t1/2 8 sT) nakleb efeqturia, vidre misi metaboliti pentaeriTritil
trinitrati (t1/2 11 sT).

kalciumis arxebis blokatorebi

kalciumi monawileobs gluvi kunTisa da gulis ujredebis SekumSvaSi, agreTve gulSi impulsebis
gavrcelebaSi.
sisxlZarRvebis gluvi kunTis ujredebi. am ujredebis SekumSva ujredul membranebSi kalciumis
Sesvlazea damokidebuli. ujredSi kalciumi Sedis voltaJdamokidebuli ionuri arxebis (VOCs)
meSveobiT. ujredSi Sesuli kalciumis nakadi aTavisuflebs sarkoplazmuri retikulumis ujredSida
depoebSi sekvestrirebul kalciums. voltaJdamokidebuli kalciumis ionuri arxebi (VOCs) SedarebiT
xangrZlivad aris Ria, amitom kalciumis didi nakadis gatareba SeuZlia. maT L-tipis arxebi ewodebaT.
ujredSida Tavisufali kalciumis koncentraciis gazrda iwvevs kumSvadi cilebis – miozinisa da aqtinis
gaaqtivebas, miofibrilebis damoklebasa da gluvi kunTis SekumSvas. gluvi kunTis modunebis fazaSi
kalciumi Tavisufldeba miofibrilebidan da an ukan, sarkoplazmaSi brundeba, an ki ujredis zedapirze
lokalizebuli Na/Ca gamcvleli tumbos meSveobiT ujredidan Zevdeba.
kalciumis arxebis blokatorebi sami struqturulad gansxvavebuli jgufis saxiT aris warmodgenili:
 dihidropiridinebi (yvelaze mravalricxovani).
 fenilalkilaminebi (ZiriTadad, verapamili).
 benzoTiazepinebi (dilTiazemi).

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maT klinikur efeqtebs Soris arsebobs garkveuli gansxvaveba, rac nawilobriv aixsneba L-tipis
kalciumis arxebis sxvadasxva nawilebTan maTi SekavSirebiT. am jgufis yvela wevri vazodilatatoria,
zog maTgani zegavlenas axdens gamtari qsovilis riTmis wamyvan ujredebze da iwvevs uaryofiT
inotropul da uaryofiT qronotropul efeqtebs gulze. konkretuli preparatis daxasiaTeba qvemoT aris
ganxiluli.
kalciumis arxebis blokatorebis Terapiuli sargebeli hipertenziisa da stenokardiis dros, ZiriTadad,
maTi vazodilataciuri moqmedebiT aixsneba. aradihidropiridinebi gulzec moqmedeben, rac maT
aniWebs damatebiT rols: isini ekuTvnian antiariTmuli saSualebebis me-4 jgufs.
farmakokinetika. kalciumis arxebis blokatorebi kargad Seiwoveba kuW-nawlavis traqtidan.
sxvadasxva preparatis sistemuri bioSeRwevadoba damokidebulia nawlavis kedelsa da RviZlSi maTi
pirveladi gavlis metabolizmis gansxvavebul xarisxze. nebismieri maTgani metabolizdeba naklebad
aqtiur produqtebamde, ZiriTadad, citoqrom P450-is CYP 3A izoenzimis mier, amitom maT mravali
wamalTSorisi urTierTqmedeba axasiaTebT am izofermentis induqtorebTan da inhibitorebTan.
kalciumis arxebis blokatorebis moqmedebis dasruleba ZiriTadad metabolizmzea damokidebuli,
amitom Tirkmelebis funqciis daqveiTebisas doza koreqcias ar saWiroebs.
gamoyenebis Cvenebebi
 hipertenzia: amlodipini, isradipini, nikardipini, nifedipini, verapamili.
 stenokardia: amlodipini, dilTiazemi, nikardipini, nifedipini, verapamili.
 gulis ariTmia: verapamili.
 reinos daavadeba: nifedipini.
 iSemiuri nevrologiuri dazianebis profilaqtika subaraqnoiduli sisxlCaqcevis Semdeg:
nimodipini.
arasasurveli movlenebi. miRebidan pirveli ramdenime saaTis ganmavlobaSi SeiZleba gamovlindes
Tavis tkivili, saxis uecari wamowiTleba, Tavbrusxveva, guliscemis gaxSireba da hipotenzia, ris
mizezadac plazmaSi preparatis koncentraciis gazrda gvevlineba. es movlenebi gansakuTrebiT Zalian
maRali sawyisi dozis an koncentraciis Zalian swrafad gazrdis dros. SeiZleba ganviTardes koWebis
SeSupeba, savaraudod, prekapilaruli arteriolebis seleqciuri dilataciiT ganpirobebuli kapilarSida
wnevis gazrdis gamo. aqedan gamomdinare, SeSupeba ar aris natriumis Sekavebis niSani. igi ar
ixsneba SardmdeniT, magram qreba sxeulis horizontaluri mdebareobis miRebisas, mag., Ramis
ganmavlobaSi, wolis Semdeg. SeiZleba ganviTardes bradikardia da ariTmia, gansakuTrebiT
aradihidropiridinebis gamoyenebisas. kuW-nawlavis traqtis mxriv viTardeba yabzoba, gulisreva da
Rebineba. SeiZleba aRiniSnos gaZlierebuli guliscema, moduneba da Zilianoba.
arsebobs garkveuli SeSfoTeba imis gamo, rom xanmokle moqmedebis kalciumis arxebis
blokatorebi uaryofiTad moqmedeben miokardiumis infarqtis mimdinareobaze da zrdian kardialuri
sikvdilianobis risks. es mtkicebuleba efuZneba SemTxveva-kontrolirebad kvlevebs, romlebmac ver
gamoricxes imis albaTobas, rom kvlevaSi CarTul avadmyofebs aReniSnebodaT mZime
mimdinareobis hipertenzia an stenokardia. kalciumis arxebis blokatorebis usafrTxoebisa da
efeqturobis Sesaxeb Sexeduleba gaaZliera bolo dros Catarebulma orma sxva kvlevam, romelic
mieZRvna am farmakologiuri jgufis sxva antihipertenziul saSualebebTan prospeqtul Sedarebas.
wamalTSorisi urTierTqmedeba. kalciumis arxebis blokatorebs mravali wamalTSorisi
urTierTqmedeba axasiaTebT. zogadad, am jgufis preparatebi intensiurad metabolizdeba, amitom
fermentebis induqtorebi (mag., rifampicini) aqveiTeben maT efeqtebs, fermentebis inhibitorebi ki
(mag., ketokonazolis an cimetidini) piriqiT, zrdian. TviTon kalciumis arxebis blokatorebic
amcireben ramdenime sxva preparatis plazmur klirenss, maTi metabolizmis gaxangrZlivebis gziT.
mag., dilTiazemi da verapamili aZliereben karbamazepinis, qinidinis, statinebis, ciklosporinis,
metoprololis, Teofilinisa da (aiv-is) proteazebis inhibitorebis moqmedebas. verapamili xels uSlis
digoqsinis naRvelTan erTad eqskrecias, amitom zrdis mis plazmur koncentracias. -
adrenoreceptorebis blokatorebma SeiZleba gaamwvavon verapamiliT an dilTiazemiT ganpirobebuli

6
atrioventrikuluri blokada da gulis ukmarisoba. greifrutis wveni zrdis dihidropiridinebis (amlodipinis
garda) da verapamilis plazmur koncentracias, xolo mcenare “krazana”, romelic CYP3A4-is
induqtoria, amcirebs verapamilisa da dihidropiridinebis bioSeRwevadobas.
individualuri kalciumis arxebi blokatori
nifedipini (t1/2 2 sT) dihidropiridinebis prototipia. igi seleqciurad afarToebs arteriebs, venebze ki
mas susti efeqti axasiaTebs. verapamilTan SedarebiT, nifedipini ufro naklebad iwvevs uaryofiT
inotropul da qronotropul efeqtebs. xelmisawvdomia nifedipinis gaxangrZlivebuli moqmedebis
tabletebi, rac misi dReSi 1-jer daniSvnis saSualebas iZleva. garda amisa, maTi gamoyenebisas rac
minimumamde mcirdeba plazmuri koncentraciis maqsimalur da minimalur maCveneblebi, xolo
koncentraciis swrafi meryeobis Semcireba Sesabamisad aqveiTebs arasasurveli movlenebis
gamovlenis risks. preparatebis xangrZlivi da Tanabari miwodebis uzrunvelsayofad gamoiyeneba
sxvadasxva meTodi, magram am farmacevtul formebs Soris bioeqvivalentobis gansazRvra Znelia,
amitom eqimma unda gamoweros preparati savaWro saxeliT, raTa pacientamde mivides is forma,
romelsac igi gulisxmobda. kalciumis blokatorebis yoveli dozis miRebis dros SeiZleba gamovlindes
simpaTikuri sistemis gaaqtiurebiT ganpirobebuli xanmokle gverdiTi efeqtebi. nifedipinis dRiuri
dozis diapazonia 30-90 mg. zemoT CamoTvlili gverdiTi movlenebis garda, SeiZleba aRiniSnos
RrZilebis hipertrofia. nifedipinis miReba SeiZleba sublingvurad, tabletis CaReWviT da fragmentebis
enis qveS moTavsebiT. faqtiurad, amgvarad miRebuli tabletis Sewova kuW-nawlavis traqtidan
mniSvnelovania da am meTodis gamoyeneba gadaudebeli hipertenziuli mdgomareobis dros sariskoa
dros, radgan arteriuli wnevis araprognozirebadma daqveiTebam SesaZloa gamoiwvios tvinis iSemia.
amlodipins xangrZlivi naxevardaSlis periodi (t1/2 40sT) gaaCnia da igi nifedipinis gaxangrZlivebuli
tabletis msgavsad moqmedebs, amitom ar aris misi specialuri formis saWiroeba. L-arxebTan misi
neli SekavSirebisa da xangrZlivi moqmedebis gamo, igi ar gamoiyeneba arteriuli wnevis gadaudebeli
daqveiTebis saWiroebisas, radgan es mdgomareoba dozis xSir koreqcias saWiroebs. meores mxriv,
SemTxveviT gamotovebuli dozas ar eniWeba didi mniSvneloba. am TavSi ganxiluli sxva
dihidropiridinebisgan gansxvavebiT, usafrTxoa amlodipinis gamoyeneba gulis ukmarisobis dros
(PRAISE kvleva)8.
verapamili (t1/2 4 sT) arteriuli vazodilatatoria, garkveuli venodilataciuri efeqtiT. igi iwvevs uaryofiT
inotropul da qronotropul efeqtebs. misi Cveulebrivi tableti dReSi 3-jer iniSneba, gaxangrZlivebuli
tabletebi ki dReSi erTxel. miokardiumis gamtar da kumSvad ujredebze uaryofiTi efeqtebis gamo, igi
ar eniSneba bradikardiis, gulis II an III xarisxis blokadis an volf-parkinson-uaitis sindromis mqone
pacientebs, winagulebis TrTolvisa da fibrilaciis moxsnis mizniT. amiodaroni da digoqsini aZliereben
verapamilis moqmedebas gamtar sistemaze, amitom zrdian AV blokadis ganviTarebis risks.
verapamili zrdis plazmaSi qinidinis koncentracias da am urTierTqmedebam SeiZleba mZime
hipotenzia gamoiwvios.
dilTiazemis (t1/2 5 sT) Cveulebrivi tableti dReSi 3-jer iniSneba, gaxangrZlivebuli tabletebi ki dReSi
erTxel an orjer. verapamilTan SedarebiT, igi naklebad iwvevs miokardiumis depresias da AV
gamtareblobis gaxangrZlivebas, magram ar gamoiyeneba bradikardiis, gulis II an III xarisxis
blokadis an sinusis kvanZis sisustis sindromis dros.
nimodipini Tavis tvinis arteriebis zomieri vazodilatatoria. subaraqnoiduli sisxlCaqcevis Semdeg
ganviTarebuli tvinis iSemiis nawilobriv mizezad SesaZloa sisxlZarRvebis spazmi gvevlineba.
klinikuri kvlevebis Tanaxmad, subaraqnoiduli sisxlCaqcevis Semdeg nimodipinis miReba amcirebs
tvinis infarqtis rogorc zomas, aseve gamovlenis sixSires. nimodipinis dabali efeqturobis miuxedavad
da ufro efeqturi alternativis ararsebobis gamo, subaraqnoiduli sisxlCaqcevidan pirveli ramdenime
dRis ganmavlobaSi nebismier pacients rutinulad eniSneba nimodipinis 60 mg 4 sT-Si erTxel.
klinikurma kvlevebma ver daadgina insultis sxva formebze nifedipinis msgavsi efeqturoba.
kalciumis arxebis blokatorebis farmakologiuri jgufis sxva preparatebia: felodipini, isradipini,
lacidipini, lerkanidipini, nisoldipini.

7
angiotenzinis gardamqmneli fermentis (აგფ) inhibitorebi, angiotenzinis II receptoris
blokatorebi (arb) da reninis inhibitorebi
renini fermentia, romelic Tirkmelebis mier gamomuSavdeba sxvadasxva faqtorebis sapasuxod,
romelTagan yvelaze mniSvnelovania adrenerguli (1 receptori) aqtivoba, agreTve natriumis
koncentraciis daqveiTeba. renini gardaqmnis mocirkulire glikoproteins (angiotenzinogens)
biologiurad inertul angiotenzin I-ad, romelic Semdeg angiotenzin-gardamqmneli fermentis (აგფ, an
kininaza II) meSveobiT Zlier vazokonstriqtorad, angiotenzin II-ad gardaiqmneba. აგფ kapilaruli
endoTeluri ujredebis sanaTuriskena zedapirzea lokalizebuli, gansakuTrebiT filtvebSi. renin-
angiotenzinuri sistema mraval organoSi gvxvdeba, mag., Tavis tvinSi, gulSi, Tumca maTi aqtualoba
jerjerobiT ucnobia.
angiotenzin II moqmedebs or G-cilasTan SekavSirebul receptorebze, romelTagan angiotenzinis
mimarT mgrZnobiare receptorebis erT-erTi qvetipi, `AT1~, pasuxismgebelia angiotenzinis yvela
klasikur efeqtze. vazokonstriqciis garda, angiotenzin II astimulirebs aldosteronis (natriumis
Semnaxveli hormoni) gamomuSavebas Tirkmelzeda jirkvlis qerqidan. angiotenzin II mniSvnelovan
zegavlenas axdens arteriul wnevaze. garda amisa, astimulirebs gulisa da sisxlZarRvebis gluvi
kunTebis ujredebis zrdas da savaraudod, hipertenziis dros, procesis dawyebisTanave xels uwyobs
mis progresirebas. AT2-receptorebis qvetipis meSveobiT angiotenzin II Trgunavs kunTebis zrdasa da
proliferacias, magram savaraudod amas naklebi mniSvneloba eniWeba mozrdilTa gul-sisxlZarRvTa
sistemaSi. angiotenzin II-is antagonisti wamlebisaTvis mniSvnelovani samiznea angiotenzinuri
receptorebis AT1 qvetipi, Tumca am farmakologiuri jgufebis saxelebia: angiotenzin II-is blokatorebi,
AT1-receptorebis blokatorebi an akronimi arb.
bradikininic (sisxlZarRvebis kedlebSi aRmoCenili endogenuri vazodilatatori) agf-s substratia. agf-
inhibitorebi iwveven bradikininis efeqtebis potencirebas, es ki xels uwyobs agf-inhibitorebis
hipotenziuri efeqtis ganviTarebas im pacientebSi ki, romelTa arteriuli wnevis gazrdaSic renini
naklebad monawileobs. bradikinini, an agf-s erT-erTi neirokininuri substrati (mag., rogoric aris
substancia P) iwveven xvelis stimulacias (ix. qvemoT). agf-inhibitorebisagan gansxvavebiT, arb-ebi
ar moqmedeben bradikininze, aqedan gamomdinare ar iwveven xvelas. arsebobs angiotenzin I-idan
angiotenzin II-is warmoqmnis damatebiTi gzac (ara-agf), romelSic fermenti qimaza monawileobs,
amitom agf-inhibitorebTan SedarebiT, arb-ebi odnav ufro efeqturad ewinaaRmdegebian angiotenzin
II-iT ganpirobebul vazokonstriqcias. meore mxriv, plazmaSi reninis normaluri an dabali donis mqone
pacientebSi aldosteronis produqcias ufro efeqturad Trgunaven agf-inhibitorebi.
gamoyeneba
hipertenzia. აგფ-inhibitorebis, არბ-ebisa da reninis inhibitorebis antihipertenziuli efeqti ZiriTadad,
vazodilataciiT (periferiuli winaaRmdegobis SemcirebiT) aris ganpirobebuli, radgan isini
umniSvnelod cvlian gulis wuTmoculobas, an guliscemis sixSires. maTi zegavleniT SeiZleba
gaizardos Tirkmelebis sisxlis mimoqceva. აგფ-inhibitorebis hipotenziur moqmedebas xels uwyobs
agreTve maTi mainhibirebeli zegavlena aldosteronis produqciaze. rCeba orive farmakologiuri jgufi
anelebs glomerulopaTiis progresirebas. jer kidev sakamaToa sakiTxi: arteriuli hipertenziis dros am
preparatebis xangrZlivi gamoyenebisgan miRebuli sargebeli aWarbebs Tu ara mxolod arteriuli
wnevis daqveiTebiT miRebul mosalodnel sargebels.
agf-inhibitorebi, arb-ebi da reninis inhibitorebi hiperteziis samkurnalo yvelaze farTod
gamoyenebuli saSualebebia, gansakuTrebiT reninis Warbi produqciiT mimdinare hipertenziis (mag.,
renovaskuluri hipertenzia), an sxva antihipertenzuli saSualebebis (mag., Sardmdenebi, an kalciumis
antagonisti) konkurentuli gamoyenebiT ganpirobebuli renin-damokidebuli arteriuli wnevis dros. am
preparatebis zegavleniT arteriuli wneva swrafad qveiTdeba, gansakuTrebiT xanmokle moqmedebis
აგფ-inhibitorebis gamoyenebisas, amitom sasurvelia mkurnalobis dawyeba dabali dozebiT,
gansakuTrebiT Tirkmelebis funqciis daqveiTebis SemTxvevaSi, an cerebrovaskulur daavadebaze
eWvis arsebobis dros. dauSvebelia am pacientebis SardmdenebiT paraleluri mkurnaloba, renin-
angiotenzin-aldosteronis sistemaze moqmedi preparatebis daniSvnidan pirveli ramdenime dRis
8
ganmavlobaSi. renin-angiotenzin-aldosteronis sistemaze moqmedi preparatebis antihipertenziuli
efeqti progresulad izrdeba kvireebis ganmavlobaSi (iseve, rogorc sxva antihipertenziuli
saSualebebis), amitom rekomendebulia dozis gazrda mxolod 2 kviriani intervalebiT.
gulis ukmarisoba. აგფ-inhibitorebs gaaCniaT gulis ukmarisobis nebismieri stadiis samkurnalod
aucilebelia vazodilataciuri, agreTve diurezuli saSualebis damzogavi (magram ara Camnacvlebeli)
efeqtebi. isini aqveiTeben sikvdilobis maCvenebels, savaraudod imitom, rom yvela sxva
vazodilatatorisgan gansxvavebiT, agf-inhibitorebi ar iwveven simpaTikuri nervuli sistemis refleqsur
gaaqtivebas.
agf-inhibitorebTan SedarebiT, arb-ebi gacilebiT ufro dabali efeqturobiT xasiaTdebian, amitom
gulis ukmarisobis dros isini mxolod აგფ-inhibitorebis mimarT autanlobis SemTxvevaSi iniSneba.
klinikurma kvlevam, romelic eZRvneboda gulis ukmarisobis dros kandesartanis zegavlenis Sefasebas
avadobisa da sikvdilianobis maCvenebelze (CHARM), daadgina, rom gulis ukmarisobisa da
gandevnis dabali fraqciis mqone pacientebSi -blokatorebiTa da agf-inhibitorebiT mimdinare
mkurnalobis reJimze efeqturia arb-ebis damateba.
diabeturi nefropaTia. tipi 1 diabeti (insulindamokidebuli) dros hipertenzias xSirad Tan axlavs
gamoxatuli nefropaTia. aseT pacientebSi aucilebelia arteriuli wnevis agresiuli kontroli, winaaRmdeg
SemTxvevaSi mosalodnelia Tirkmelebis funqciis mniSvnelovani daqveiTeba. აგფ-inhibitorebs
Tirkmelebis damcavi specifikuri efeqti gaaCniaT, savaraudod, angiotenzin II-is rolis gamo
glomeruluri hiperfiltraciis stimulaciaSi. amJamad, es preparatebi tipi 1 diabetis Tanmxlebi
hipertenziis samkurnalo pirveli rigis saSualebebs warmoadgenen, miuxedavad imisa, rom pacientebis
umravlesobas esaWiroeba meore an mesame antihipertenziuli saSualeba, am mdgomareobisTvis
sasurveli arteriuli wnevis maCveneblis misaRwevad. gacilebiT ufro rTulia maTi roli Tirkmelebis
dazianebis adreuli gamovlinebis, mikroalbuminuriis, progresirebis prevenciaSi. arsebobs
monacemebi, rom tipi 1 diabetis dros არბ--inhibitorebi ar aneleben mikroalbuminurias, xolo არბ-
ebi ki realurad kidec zrdian amis sapirispirod, agf-inhibitorebi anaxevreben mikroalbuminuriis
sixSires tipi 2 diabetis mqone hipertenziul pacientebSi. paralelur sakvlev jgufSi hipertenziis
sakontrolod iyenebdnen mxolod verapamils, magram am SedarebiTma kvlevam ver daadgina
mikroalbuminuriis sixSireze zegavlenis realuri mizezi: ganpirobebulia Tu ara igi renin-angiotenzin-
aldosteronis (RAAS) RerZis daTrgunviT, Tu ar scildeba ubralod arteriuli wnevis damaqveiTebel
efeqts. rogorc arb-ebi, aseve agf--inhibitorebi icaven Tirkmelebis funqcias da aqveiTeben
makroproteinurias gamoxatuli nefropaTiiT mimdinare hipertenziis dros tipi 2 diabetis mqone
pacientebSi. mtkicebulebis Tanaxmad, am TvalsazrisiT isini arian Canacvlebadi. jer kidev ucnobia
icavs Tu ara ufro metad Tirkmelebis funqcias am ori jgufis preparatebis kombinirebuli gamoyeneba
(`ormagi bloki~), Tumca `ormagi blokada~ realurad ufro metad amcirebs SardTan erTad cilis
danakargs, vidre TiToeuli preparati calk-calke.

miokardiumis infarqti (MI). miokardiumis infarqtis Semdeg ganviTarebuli marcxena parkuWis

mwvave ukmarisobis mizezia mofunqcionire qsovilis dakargva, xolo grZelvadian perspeqtivaSi ki
marcxena parkuWis ukmarisoba viTardeba `remodelirebis~ procesis Sedegad, danawiburebuli
parkuWis kedlis gaTxelebisa da gafarToebis gamo. am orive procesSi mTavar rols asrulebs
angiotenzin II, amitom miokardiumis infarqtis Semdeg agf-inhibitorebiT mkurnaloba sagrZnoblad
amcireben gulis ukmarisobis risks. efeqturia maTi gamoyeneba agreTve miokardiumis infarqtis
konvalescentur fazaSi (3-10 dRe) marcxena parkuWis dabali gandevnis fraqciis (<40%) mqone
pacientebSi, gamoxatuli niSnebis gareSe mimdinare gulis ukmarisobis. aseT pacientebs klinikur
kvlevaSi SAVE12 eZleodaT kaptoprili. 60 Tviani Tvalyuris midevnebis Semdeg kvlevam daadgina,
rom placebosTan SedarebiT, kaptoprili 37%-iT amcirebs progresirebadi gulis ukmarisobis sixSires.
miokardiumis infarqtis Semdeg agf-inhibitorebiT mkurnaloba iZleva damatebiT sargebels
(TrombolizurebiT, aspiriniTa da -blokatorebiT mkurnalobis Semdeg). miokardiumis infarqtis

9
Semdeg remodelirebis processa da gulis ukmarisobis ganviTarebas arb-ebic uSlian xels, Tumca
aRsaniSnavia, rom `ormag blokadas~ ar moaqvs damatebiTi sargebeli.
sifrTxile
აგფ-inhibitorebis gamoyenebas aqvs garkveuli SezRudvebi:
 gulis ukmarisoba: აგფ-inhibitorebma SeiZleba gamoiwvios Zlieri hipotenzia xandazmulebSi,
agreTve im pacientebSi, romlebic iReben Sardmdenebs, an aReniSnebaT hipovolemia,
hiponatriemia, Tirkmelebis daqveiTebuli funqcia an sistoluri arteriuli wneva 100 mm vwy.sv-
ze naklebi. aseT pacientebSi mkurnaloba iwyeba kaptoprilis oraluri sacdeli doziT (6,25 mg),
romlis moqmedeba grZeldeba mxolod 4-6 sT. pacientis mier sacdeli dozis kargi amtanobis
SemTxvevaSi dasaSvebia mkurnalobis gagrZeleba xangrZlivad moqmedi agf-inhibitorebis
dabali doziT.
 Tirkmelebis arteriis stenozi (RAS, calmxrivi, ormxrivi, an generalizebuli aTeroskleroziT
ganpirobebuli): am SemTxvevaSi აგფ-inhibitorma SeiZleba gamoiwvios Tirkmelebis
ukmarisoba, amitom ukunaCvenebia maTi gamoyeneba. Tirkmelebis arteriis stenozis dros
angiotenzin II iwvevs gamomtani arteriolis spasms, rac mniSvnelovan rols asrulebs glomeruluri
perfuziis SenarCunebaSi Tirkmelebis arteriis stenozis SemTxvevaSi, amitom am situaciaSi
არბ-is gamoyeneba arc aucilebelia da arc usafrTxo.
 aortis stenozi/marcxena parkuWidan sisxlis gadinebis obstruqcia: agf-inhibitorma SeiZleba
Zalian swrafad gamoiwvios mZime, hipotenzia, romlis simZimis Sesabamisad, an SedarebiT,
an ki absoluturad ukunaCvenebia agf-inhibitorebis gamoyeneba aortis stenozis dros.

 orsuloba absoluturi ukuCvenebaa (ix. qvemoT).

 SeiZleba gamoiwvios angioedema (ix. qvemoT).
arasasurveli movlenebi
agf-inhibitorebi:
 pacientTa 10-15%-Si vlindeba mudmivi mSrali xvela.
 gacilebiT iSviaTad vlindeba urtikaria da angioedema (sixSiriT 1:100-ze naklebi), ZiriTadad,
mkurnalobis pirvel kviraSi. angioSeSupebis simZimis diapazoni farToa: enis msubuqi
SeSupebidan, traqeis sicocxlisTvis saSiS obstruqciamde. mZime angioSeSupebis
SemTxvevaSi rekomendebulia adrenalini/epinefrinis kanqveSa ineqcia. reaqciis safuZveli ufro
farmakologiuria (bradikininis monelebis inhibireba), vidre alergiuli.
 Tirkmelebis funqciis darRveva SeiZleba gamoiwvios: glomeruluri avsebis wnevis
daqveiTebam, sistemurma hipotenziam an glomerulonefritma. mkurnalobis dawyebamde da
mkurnalobis periodSi aucilebelia plazmaSi kreatininis donis monitoringi.
 SeiZleba ganviTardes hiponatriemia, gansakuTrebiT SardmdenebiT paraleluri mkurnalobis
dros. Tirkmelebis funqciis darRvevis dros SesaZloa gamovlindes klinikurad mniSvnelovani
hiperkaliemia (ix. agreTve zemoT: aldosteronis efeqti) aRiniSneba.
 orsulobis pirvel trimestrSi agf-inhibitorebi iwveven nayofis ganviTarebis mankebs, meore
trimestrSi ki avlenen fetotoqsikurobas _ aqveiTeben Tirkmelebis perfuzias, iwveven
hipotenzias, oligohidramnions da nayofis sikvdils.
 vlindeba neitropenia da sisxlis diskrazia. dafiqsirebulia sxva reaqciebic: gamonayari, gemos
Secvla (disgezia), Zvlebisa da kunTebis tkivili, proteinuria, RviZlis dazianeba da pankreatiti.
agf-inhibitorebis msgavsad, ukunaCvenebia არბ-ebis gamoyeneba orsulobis dros, Tumca am
preparatebis gamoyenebisas iSviaTad vlindeba sxva iseTi garTulebebi, rogoricaa xvela da
angioSeSupebas. faqtiurad, არბ-ebi arian antihipertenziuli saSualebebi, `tipiuri~ gverdiTi
movlenebis gareSe.

10
urTierTqmedeba. kaliumis Semnaxveli SardmdenebTan erTad gamoyeneba iwvevs hiperkalemias.
isini amcireben liTiumis Tirkmlismier klirenss, amitom izrdeba plazmaSi liTiumis toqsikuri
koncentraciis Seqmnis riski. SardmdenebTan (ix. zemoT), qlorpromazinTan da SesaZloa, sxva
fenoTiazinebTan erTad gamoyenebisas SeiZleba ganviTardes mZime hipotenzia.

individualuri preparatebi
kaptoprilis (kapoteni) naxevardaSlis periodi (t1/2) 2 sT-ia. igi nawilobriv metabolizdeba, nawilobriv
ki ucvleli saxiT gamoiyofa organizmidan. gverdiTi movlenebi ufro xSirad Tirkmelebis darRveuli
funqciis fonze vlindeba. igi iniSneba dReSi 2-jer an 3-jer. kaptoprili yvelaze xanmokled moqmedi
აგფ-inhibitoria. igi აგფ-inhibitorebis im mcirericxvovan jgufs ekuTvnis, romlebic aqtiuria
oralurad miRebisas da efeqtis gamosavlenad ar saWiroebs SewovisSemdgom de-eTerizacias.
enalaprili (inovaki) prowamalia (t1/2 35 sT), romelic gardaiqmneba aqtiur enalaprilatad (t1/2 10 sT).
arteriuli wnevis 24 sT-iani efeqturi kontrolisTvis saWiroa enalaprilis miReba dReSi 2-jer.
sxva preparatebia: cilazaprili, fosinoprili, imidaprili, lizinoprili, moeqsiprili, perindoprili,
qvinaprili, ramiprili da trandolaprili. enalaprilTan SedarebiT, lizinoprils (enalaprilatis lizinuri
analogi) ufro xangrZlivi naxevardaSlis periodi (t1/2) gaaCnia, rac amarTlebs mis popularobas, rogorc
“dReSi 1-jer misaRebi agf-inhibitori”. zogierT sxva preparats ufro xangrZlivi moqmedeba
axasiaTebs, qvinaprilsa da ramiprils ki sisxlZarRvis qsovilSi agf-is inhibirebis ufro maRali unari
gaaCniaT. Tumca, am gansxvavebebis klinikuri mniSvneloba sakamaToa. gulze Sedegebis
profilaqtikis kvlevaSi (HOPE- Heart Outcomes Prevention Evaluation), romelSic monawileobda 9297
pacienti, ramiprilma 20-30%-iT Seamcira sikvdilianobis, miokardiumis infarqtisa da insultis sixSire
maRali riskis farTo speqtris mqone pacientebSi, romlebmac ar icodnen, rom hqondaT gandevnis
dabali fraqcia, an gulis ukmarisoba14. avtorebma CaTvales (savaraudod, SecdomiT), rom Sedegebis
asaxsnelad mxolod arteriuli wnevis daqveiTeba ar aris sakmarisi.
arb-ebidan did britaneTSi pirveli losartani iyo licenzirebuli. igi konkurentuli blokatoria,
arakonkurentuli aqtiuri metabolitiT. preparats aqvs xanmokle naxevardaSlis periodi (t1/2 2 sT),
magram metaboliti ufro xangrZlivad moqmedebs (t1/2 10 sT), ris gamoc dReSi 1-jer iniSneba.
klinikurad sxva arb-ebic gamoiyeneba: kandesartani, eprosartani, irbesartani, telmisartani da
valsartani. SesaZloa zogierTi maTgani losartanze ufro efeqturad aqveiTebs arteriul wnevas, Tumca
mwiria maTi maqsimaluri dozebis SedarebiTi kvlevebi. Cveulebriv, losartani hidroqloroTiazidTan
erTad iniSneba. saorientacio kvlevis monacemebis mixedviT, insultis profilaqtikis TvalTaxedviT es
kombinacia 25%-iT ufro efeqturia atenololisa da hidroqlorTiazidis kombinaciasTan SedarebiT15.
preparatebis am jgufs kargi amtanoba axasiaTebs. klinikur kvlevebSi maTi gverdiTi movlenebis
profili TiTqmis ar gansxvavdeba placebosgan, ufro metic, ukeTesia. agf-inhibitorebisgan
gansxvavebiT, isini ar iwveven xvelas da kargi alternativaa pacientTa im 10-15%-isTvis, romlebsac
xvelis gamo uxdebaT agf-inhibitorebis miRebis Sewyveta. arb-ebi gamoiyeneba hipertenziis,
miokardiumis infarqtis Semdgomi marcxena parkuWovani ukmarisobis da gulis dadasturebuli
ukmarisobis samkurnalod. isini ar arian agf-inhibitorebze ukeTesi saSualebebi, gamonakliss
warmoadgens mxolod gulis qronikuli ukmarisoba.
აგფ-inhibitorebis sifrTxiliT gamoyenebis Cvenebebi (ix. zemoT) არბ-ebzec vrceldeba.
აგფ-inhibitorebTan SedarebiT, reninis inhibitorebic arb-ebis msgavsi upiratesobiT sargebloben (ar
iwveven xvelasa da angioedemas. renin-angiotenzin-aldosteronis sistemaze moqmedi sxva
saSualebebis msgavsad, orsulobis dros arc reninis inhibitorebis ar gamoiyeneba.
urTierTqmedeba. kaliumis Semnaxvel SardmdenebTan erTad gamoyenebisas maRalia
hiperkalemiis riski. pirveli dozis hipotenzia viTardeba mocirkulire reninis donis gamzrdeli
saSualebebis (Sarmdenebi, gansakuTrebiT maryuJovani, agreTve efeqturi vazodilatatorebi) Semdeg
gamoyenebisas.
11
individualuri preparatebi
aliskireni erTaderTi oralurad aqtiuri reninis arapeptiduri inhibitoria (t1/2 40 sT). preparati sakmaod
kargad aitaneba, Tu ar CavTvliT doza-damokidebul faRaraTs. aris Tu ara faRaraTi am
farmakologiuri jgufis wevrebis saerTo arasasurveli movlena jer kidev ar aris dadgenili. აგფ-
inhibitorebTan, arb-ebTan, kalciumis arxebis blokatorebTan da TiazidebTan erTad gamoyenebisas
aliskireni iwvevs damatebiT hipotenzur efeqts. jer-jerobiT ar mogvepoveba monacemebi aliskirenis
efeqturobis Sesaxeb hipertoniasTan asocirebuli kardiovaskuluri garTulebebis prevenciis
TvalsazrisiT, amitom rekomendebulia aleskirenis daniSvna im pacientebSi, romlebic ver itanen
rennin-angiotenzin-aldosteronis sistemis sxva mainhibirebel saSualebebs.

sxva vazodilatatorebi
ramdenime Zveli preparati sakmaod Zlieri vazodilatatoria, magram hipertenziis samkurnalod maTi
rutinuli gamoyeneba SezRudulia gverdiTi movlenebis gamo. specialuri CvenebebiT dRemde
gamoiyeneba minoqsidili da nitroprusidi.
diazoqsidisa da hidralazinis msgavsad, minoqsidilic ufro metad arteriolebis seleqciuri
vazodilatatoria. misi aqtiuri sulfaturi metaboliti xsnis atf-damokidebul kaliumis arxebs. igi
maRalefeqturi hipetenziuri saSualebaa, magram nebismieri Zlieri arteriuli vazodilatatoris msgavsad,
minoqsidilis hipotenziur moqmedebas Tan axlavs kompensatoruli, baroreceptoriT ganpirobebuli
simpaTikuri ganmuxtva, es ki iwvevs taqikardiasa da gulis wuTmoculobis gazrdas. amasTanave,
simpaTikuri ganmuxtva zrdis reninis gamoTavisuflebas, marilisa da wylis meoradi SekavebiT, rac
SemdgomSi ewinaaRmdegeba minoqsidilis hipotenziur efeqts (e.w. `tolerantoba~ xangrZlivi
gamoyenebisas). aqedan gamomdinare, minoqsidili gamoiyeneba -blokerTan da maryuJovan
SardmdenTan kombinaciaSi (hidralazinis msgavsad; ix. qvemoT). minoqsidilis arasasurvel efeqtebs
Soris yvelaze cnobilia hipertriqozi. oralurad miRebis dros Tmebis zrda generalizebul xasiaTs atarebs
da ra Tqma unda qalebisTvis did kosmetikur problemas warmoadgens, magram minoqsidilis 2-5%-
iani adgilobrivi moxmarebis xsnari(regaini) mamakacis tipis Tmis cvenis samkurnalod gamoiyeneba.
intravenuri gamoyenebis dros natriumis nitroprusidi maRalefeqturi antihipertenziuli saSualebaa.
misi efeqti dauyovnebliv iwyeba da grZeldeba 1-5 wT. amitom, rekomendebulia misi mxolod zustad
kontrolirebadi intravenuri infuziis saxiT gamoyeneba. igi afarToebs rogorc arteriolebs, aseve venebs,
rac iwvevs kolafss pacientis sawolidan wamodgomis dros (mag., tualetis saWiroebisas). natriumis
nitroprusidis gamoyenebisas adgili aqvs kompensatorul simpaTikur gaaqtivebas, taqikardiiTa da
preparatis mimarT taqifilaqsiiT.
nitroprusidis moqmedeba wydeba eriTrocitebSi metabolizmiT. kerZod, hemoglobinis rkinidan
nitroprusidze eleqtronis gadatana iwvevs methemoglobinisa da nitroprusidis arastabiluri radikalis
warmoqmnas. es gaxleCa aTavisuflebs citoqrom oqsidazas (Sesabamisad, ujreduli sunTqvis)
mainhibirebel cianidur radikalebs. sabednierod, cianidis umravlesoba eriTrocitebs SigniT rCeba
SekavSirebuli saxiT, Tumca mcire fraqcia gamodis plazmaSi da gardaiqmneba Tiocianatad. aqedan
gamomdinare, nitroprusidis xangrZlivi (dReebis ganmavlobaSi) infuziis saWiroebisas, mosalodneli
sistemuri cianiduri toqsikurobis Tavidan asacileblad, aucilebelia plazmaSi Tiocianatis koncentraciis
monitoringi. mowamvla SeiZleba iyos manifestirebuli, progresuli metaboluri acidozis saxiT,
SeiZleba agreTve gamovlindes deliriumis an fsiqikuri simptomebis saxiT. mowamlul pirebs aqvT
cianwyalbadmJavas damaxasiaTebeli mware nuSis suni. cxadia, rom nitroprusidis infuzia did
sifrTxiles saWiroebs, amitom araspecializebul samkurnalo dawesebulebaSi ufro usafrTxo iqneba, Tu
specialistebi airCeven maTTvis kargad nacnobantihipertenzul saSualebas.
natriumis nitroprusidi gamoiyeneba gadaudebeli hipertenziisa da gulis refraqteruli ukmarisobis
dros, agreTve qirurgiaSi, kontrolirebadi hipotenziis mizniT. infuzia SeiZleba daiwyos siCqariT 0,3-
1,0 mkg/kg/wT, arteriuli wnevis kontroli sasurvelia daiwyos 0,5-6,0 mkg/kg/wT dozaze.
12
savaldebuloa arteriuli wnevis guldasmiT, mWidro monitoringi, ZiriTadad, umjobesia pirdapiri
arteriuli monitoringi. infuziis siCqaris cvlileba dasaSvebia yovel 5-10 wT-Si.
diazoqsidic imeorebs atf-damokidebul kaliumis arxebis sxva gamxsnelebis (KCOs) moqmedebas.
naxevardaSlis periodi (t1/2) 36 sT-ia. qsidili). diazoqsidi adre gamoiyeneboda mZime hipertenziis
gadaudebeli mkurnalobisaTvis, intravenuri bolus ineqciis saxiT, magram mniSvnelovan hipotenziis
riski aRemateba sargebels, amitom misi es gamoyenebis Cveneba amJamad moZvelebulia.
antihipertenziuli saxiT gamoyenebisas aRmoCnda, rom diazoqsidi iwvevs hiperglikemias,
radgan kaliumis arxebis sxva gamxsnelebisgan gansxvavebiT, igi aaqtiurebs pankreasis kunZulebis
ujredebSi lokalizebul sulfonilSardovanas mimarT mgrZnobiare, atf-damokidebul kaliumis arxebs,
rac iwvevs insulinis gamoTavisuflebis “gamorTvas”. misma am efeqtma gamoyeneba hpova
pankreasis kunZulebis ujredebis simsivniT an hiperplaziiT ganpirobebuli endogenuri insulinis Warbi
sekreciis mkurnalobaSi (qronikuli hipoglikemiis dros). minoqsidilis msgavsad, diazoqsidis
xangrZlivi gamoyenebac iwvevs Tmis zrdis problemas (Tumca ufro naklebad).
hidralazini amJamad isviaTad gamoiyeneba hipertenziis samkurnalod naklebad gamoiyeneba, garda
orsulobasTan dakavSirebuli hipertenziisa (radgan igi ar aris teratogenuli), Tumca gulis ukmarisobis
dros, rogorc vazodilatatorebs (plus nitratebi), man SeiZleba garkveuli rolic ki Seasrulos. igi
afarToebs arteriolebs da amcirebs
periferiul winaaRmdegobas, venebze ki umniSvnelod moqmedebs. sisxlZarRvebis momadunebeli
meqanizmi ucnobia. t1/2 1 sT-ia.
hipertenziis umravlesi gadaudebeli SemTxvevebis dros (ganSrevebadi anevrizmis garda) venaSi
SeyavT hidralazinis 5-20 mg 20 wT-is ganmavlobaSi. maqsimaluri efeqti miiReba 10-80 wT-Si.
saWiroebis mixedviT SeiZleba misi gameoreba, Semdeg ki pacienti gadayavT oralur preparatze 1-2
dRis ganmavlobaSi.
50 mg-ze maRali dRiuri doziT hidralazinis xangrZlivma gamoyenebam SeiZleba gamoiwvios
sistemuri mgluras msgavsi sindromi, romelic Savkanian mosaxleobasTan SedarebiT, ufro xSiria
TeTrkanian populaciaSi, agreTve nel acetilatorebSi.
sami sxva vazodilatatori gamoiyeneba sxva daavadebeisa da darRvevebis (ara hipertenziis) dros:
nikorandili ori moqmedebis gamoa efeqturi: igi nitratis msgavsad moqmedebs: cikluri gmf-is
gaaqtivebis gziT (ix. zemoT), magram amasTanave iwvevs membranis hiperpolarizacias, atf-
damokidebuli kaliumis arxebis gaxsniT. ujredidan kaliumis gamosvla amcirebs kalciumis ionebis
ujredSi Sesvlas da iwvevs sisxlZarRvebis gluvi kunTebis modunebas. nikorandili gamoiyeneba
stenokardiis dros da mas aqvs -blokatorebis, nitratebis an kalciumis arxebis blokatorebis msgavsi
efeqturoba axasiaTebT. igi oralurad miiReba. nikorandili stenokardiis samkurnalo alternatuli
preparatia da gamoiyeneba an nitratebis mimarT tolerantobis dros, an ki rodesac stenokardiis
samkurnalo sxva jgufebis gamoyeneba ukunaCvenebia asTmis an gulis ukmarisobis gamo.
nikorandils nitratebis msgavsi gverdiTi movlenebi axasiaTebT. Tavis tkivili aRiniSneba pacientebis
35%-Si. igi stenokardiis samkurnalo erTaderTi preparatia, romlis sul mcire erTma kvlevam aCvena
dadebiTi gavlena daavadebis Sedegze18.
papaverini opiumis alkaloidia, magram struqturulad igi gansxvavdeba morfinisgan. papaverini
fosfodiesTerazas inhibitoria da igi iwvevs yvela gluvi kunTebis modunebas, gansakuTrebiT
sisxlZarRvebisas. igi iSviaTad gamoiyeneba adgilobrivi vazodilataciis mizniT, gansakuTrebiT
arteriebsia da venebis irgvliv, sisxlZarRvovani qirurgiis dros spazmis mosaxsnelad. igi mamakacebis
ereqciuli disfunqciis samkurnalodac gamoiyeneba (ix. gv. 465).
alprostadili prostaglandin E1-is stabiluri formaa. igi fsiqogenuri da neiropaTuli ereqciuli disfunqciis
uSualo intrakorporaluri ineqciis saxiT gamoiyeneba (ix. gv. 465), xolo axalSobilebSi ki gulis
Tandayolili mankis dros intravenurad, arteriuli sadinaris SenarCunebis mizniT.
vazodilatatorebis roli gulis ukmarisobis mkurnalobaSi
13
vazodilatatorebis roli periferiuli sisxlZarRvebis daavadebebis mkurnalobaSi
mkurnalobis mizania kidurebSi sisxlis midinebis gazrda, Sesabamisad periferiuli arteriolebis
dilatacia, arteriuli wnevis mniSvnelovani daqveiTebis gareSe. mkurnaloba ufro efeqturia
sisxlZarRvebis spazmiT ganpirobebuli sisxldinebis daqveiTebis dros (reinos sindromi), radgan
organuli obstruqciuli cvlilebebis SemTxvevaSi (aTerosklerozi, xangamoSvebiTi koWloba, biurgeris
daavadeba [maoblitirebeli Trombangiiti]) Zalze Znelia preparatebis sapasuxo vazodilataciis
miRweva.
xangamoSvebiTi koWloba. pacientebma unda `Sewyviton moweva da iaron fexiT~, anu xSirad
ivarjiSon SesaZleblobis farglebSi. paralelurad aucilebelia sxva risk-faqtorebis, gansakuTrebiT ki
hipertenziisa da hiperlipidemiis, aqtiuri mkurnaloba. pacientebma aseve unda miiRon Trombocitebis
agregaciis damTrgunveli saSualeba, mag., aspirini (sadReRamiso doziT 75 mg). xangamoSvebiTi
koWlobis mqone pacientebis umravlesoba iRupeba iSemiuri an cerebrovaskuluri daavadebiT,
amitom mkurnalobis mTavari mizania kardovaskuluri da cerbrovaskuluri garTulebebis prevencia.
naftidrofurilis (praqsileni) da pentoqsifilinis (trentali) msgavsi vazodilatatorebi zrdian sisxlis
midinebas ufro metad kanisken, vidre kunTebisken, amitom isini gamoiyeneba qveda kidurebis
venuri wylulebis (varikozuli da travmuli) samkurnalod. xangamoSvebiTi koWlobis dros Rirs am
wamlebis daniSvna, magram ramdenime kviriani uefeqto mkurnalobis SemTxvevaSi wamlis miReba
unda Sewydes.
naftidrofurils ramdenime moqmedeba axasiaTebs. preparati aaqtivebs ferment suqcinat
dehidrogenazas, zrdis atf-is miwodebas da amcirebs laqtatis koncentracias kunTSi, amitom igi
klasificirebulia, rogorc metaboluri gamaZlierebeli. amasTanave, naftidrofurili ainhibirebs 5HT2
receptorebs da Trgunavs Trombocitebis serotoniniT inducirebul agregaciasa da vazokonstriqciasa
pentoqsifilini aumjobesebs Jangbadis miwodebas iSemiur qsovilSi, ris mizezadac gvevlineba
erTi mxriv eriTrocitebis deformirebis unaris gaumjobeseba da sisxlis siblantis daqveiTeba, meore
mxriv ki plazmis fibrinogenis Semcireba. arc erTi ganxiluli preparati ar aris pirdapiri vazodilatatori,
iseve rogorc gardamavali koWlobis dros gamoyenebadi mesame preparati – inozitol nikotinati.
mtkicebuleba, rom inozitol nikotinati pirvel orze ufro Zlieria, dadasturda efeqturobis meta-analizuri
kvleviT (zrdis fexiT siarulis distancias). vazodilatatorebis umravlesoba seleqciurad moqmedebs
janmrTel sisxlZarRvebze da iwveven sisxlis gadanawilebas (`moparvis fenomeni~) aTerosklerozuli
sisxlZarRvebidan.
xangamoSvebiT koWlobas axasiaTebs Ramis krunCxvebi da misi prevenciisaTvis qininis
gamoyenebis Sesaxeb urTierTgamomricxavi Sexedulebebia. magram garkveulwilad aqvs sakamaTo
reputacia maT profilaqtikaSi. miuxedavad amisa, 6 ormagi brma kvlevis meta-analizma daadastura,
rom qininis Ramis doza amcirebs krunCxvebis epizodebis sixSires (ara marto periferiuli
sisxlZarRvebis daavadebasTan asocirebuls), magram ar moqmedebs maT simZimesa da
xangrZlivobaze. efeqti SeiZleba ar gamovlindes pirveli oTxi kviris ganmavlobaSi.
reinos fenomenis dros SeiZleba efeqturi iyos nifedipini, rezerpini (dabal dozebSi efeqturi -
adrenoreceptoris blokatoria), agreTve da glicerilis trinitratis adgilobrivi forma. rezistentul
SemTxvevebis samkurnalod dasaSvebia nebismieri vazodilatatoris gamoyeneba. enalaprils (აგფ-
inhibitori) ar aris sakmaod efeqturi. mZime SemTxvevebSi, gansakuTrebiT wylulebis mqone
pacientebSi mdgomareobis xangrZliv gaumjobesebas iwvevs endogenuri vazodilatatoris –
prostaciklinis (epoprostenoli) xangamoSvebiTi infuzia (yovel ramdenime saaTSi).
-adrenoreceptorebis blokatorebi auareseben isedac daqveiTebul perfuzias, amitom
amwvaveben periferiuli sisxlZarRvebis daavadebasa da reinos fenomens, -seleqciuri
adrenoreceptorebis blokatorze gadasvlac usargebloa, radgan gverdiTi movlenebi ganpirobebulia ara
vazokonstriqciiT (daublokirebeli α-adrereceptorebiT gamowveuli), aramed gulis wuTmoculobis
SemcirebiT.
adrenoreceptorebis blokatorebi
14
adrenoreceptorebis mablokirebeli saSualebebi ikaveben ra adrenoreceptorebs, ewinaaRmdegebian
maT urTierTqmedebas nervuli terminalebidan gamoTavisuflebul, an ineqciis saxiT miRebul
adrenalin/epinefrinTan da noradrenalin/ norepinefrinTan (da sxva simpaTomimetur aminebTan).
arsebobs adrenoreceptorebis ori gansxvavebuli jgufi,  da .
-adrenoreceptorebis blokatorebi
arsebobs  adrenoreceptorebis ori ZiriTadi qvetipi:
 `klasikuri~ 1 adrenoreceptorebi, lokalizebuli efeqtorul organoze (postsinafsurad), iwveven
vazokonstriqcias.
 2 adrenoreceptorebi, lokalizebuli zogierT efeqtorul qsovilSi (postsinafsurad), agreTve nervul
daboloebebze (presinafsurad). presinafsuri receptorebi (anu autoreceptorebi) Trgunaven
qemotransmiteris (noradrenalin/norepinefrinis) gamoTavisuflebas, anu isini uzrunvelyofen
transmiteris gamoTavisuflebis kontrols uaryofiTi ukukavSiris meqanizmiT. isini cns-Sic arian
lokalizebuli.
imidazolinebi (mag., fentolamini) -adrenoblokatorebis pirveli Taobaa. isini ainhibireben rogorc
1, aseve 2 adrenoreceptors. zogadad, sawolidan wamodgomis, an varjiSis dros simpaTikuri nervuli
sistemis fiziologiur (baroreceptorebiT) gaaqtivebas aqvs adgili. aseTi wamlebis fonze normaluri
vazokonstriqciuli () efeqti (arteriuli wnevis SenarCuneba) iblokeba preparatiT, am sapasuxo
reaqciis ukmarisoba ki iwvevs simpaTikuri nervuli sistemis Semdgom gaaqtiurebas da damatebiTi
transmiteris gamoTavisuflebas. normaSi, es procesi izRudeba uaryofiT ukukavSirSi monawile
autoreceptorebiT, magram imidazolinebis zegavleniT es receptorebic dablokilia.
 adrenoreceptorebi ar aris dablokili da adrenergul daboloebebidan Warbad gamoTavisuflebuli
transmiteri Tavisuflad moqmedebs maTze da iwvevs usiamovno taqikardias. aqedan gamomdinare,
-adrenoreceptoris araseleqciuri blokatori hipertenziis dros ar gamoiyeneba.
-adrenoreceptoris seleqciuri blokatoris (romelic ar moqmedebs -adrenoreceptorze) fonze
SenarCunebulia noradrenalinis gamoTavisuflebis uaryofiTi ukukavSiris inhibirebis meqanizmi, rac
ufro sasargebloa hipertenziis dros (naklebad vlindeba taqikardia da posturuli Tu datvirTviT
ganpirobebuli hipotenzia). aseTi preparatia prazozini.

-adrenoreceptorebis blokatorebis gamoyeneba

 hipertenzia
o esenciuri: doqsazozini, labetaloli
o feoqromocitoma: fenoqsibenzamini; fentolamini (krizis dros)
 sisxlZarRvebis periferiuli daavadeba
 winamdebare jirkvlis keTilTvisebiani hipertrofia (saSarde gzebis obstruqciis gamomwvevi
kafsuluri gluvi kunTebis mosaduneblad).

gverdiTi movlenebi. rac mamakacebSi prostatizmis mkurnalobisaTvis aris sasargebloa, is qalebSi

gverdiTi movlenaa Sardis Seukaveblobis saxiT. -adrenoblokatorebis sxva gverdiTi movlenebia
posturuli hipotenzia, cxviris lorwovanis SeSupeba, sunTqvis gaZnelebiT da sklerebis siwiTle,
mamakacebSi ki eakulaciis gaZnelebac. aseve, mosalodnelia stenokardiis simptomebis gamwvaveba.
TiToeuli preparatisTvis damaxasiaTebeli gverdiTi movlenebi ixileT qvemoT.
SeniSvnebi TiToeuli preparatisTvis

15
prazozini Trgunavs postsinafsur 1 receptorebs (magram ara moqmedebs presinafsur 2
autoreceptorebze). mas axasiaTebs `pirveli dozis efeqti~: pirveli dozis miRebidan 2 sT-is
ganmavlobaSi (iSviaTad, ufro xangrZlivad) SeiZleba arteriuli wnevis swrafma dacemam
gamoiwvios gonebis dakargva. aqedan gamomdinare, pirveli miRebisaTvis pacients eniSneba dabali
doza (0,5 mg) saRamos, dawolis win. am arasasurveli efeqtisa da moqmedebis xanmokle
naxevardaSlis periodis (t1/2 3sT) gamo, upiratesoba eniWeba xangrZlivad moqmed preparatebs.
doqsazozini (t1/2 8 sT) pirveli xangrZlivad moqmedi -adrenoreceptoris blokatoria, romelic dReSi 1-
jer iniSneba. mas ufro naklebad axasiaTebs “pirveli dozis efeqti”. miuxedavad amisa, sasurvelia
mkurnaloba daiwyos rekomendebulze naklebi doziT. mosaxerxebelia, mag., dReSi 1 mg daniSvna, 1
kviris Semdeg ki dozis gaormagebiT, arteriuli wnevis gazomvis gareSe. aqtiuri substanciis nela
gamomaTavisuflebeli formis, doqsazozin XL-is SemanarCunebeli sadReRamiso dozaa 4 mg.
winamdebare jirkvlis simptomebis dros gamoyenebadi sxva -adrenoreceptorebis blokatorebia
alfuzozini da terazozini.
indoramini Zveli 1-adrenoblokatoria, romelic naklebad gamoiyeneba hipertenziis sakontrolod,
magram kvlav gamoiyeneba winamdebare jirkvlis simptomebis dros. igi miiReba 2-3-jer dReSi.
fentolamini araseleqciuri 1-adrenoblokatoria. igi hipertenziuli krizebis (mag., feoqromocitomis
dros), an monoaminoqsidazas inhibitorebisa da simpaTomimeturebis (“yvelis reaqcia”)
urTierTqmedebiT ganpirobebuli reaqciis samkurnalod gamoiyeneba intravenurad xanmokle efeqtis
misaRebad. -adrenoreceptoris blokadis garda, fentolamins gaaCnia pirdapiri vazodilataciuri efeqti,
agreTve gulze inotropuli moqmedeba. hipertenzuli krizis dros igi gamoiyeneba doziT 2-5 mg
intravenurad, saWiroebis SemTxvevaSi dasaSvebia gameoreba (wuTebidan saaTamde). fentolaminis
testi feoqromocitomis sadiagnostikod ar aris saimedo!
fenoqsibenzamini Seuqcevadi, araseleqciuri -adrenoblokatoria, romlis efeqtic SeiZleba 2 dReze an
ufro met xans gagrZeldes, aqedan gamomdinare, rekomendebulia misi dRiuri dozis nela, TandaTan
gazrda. igi Seuqcevadi antagonistia, amitom SeuZlebelia sisxlis mimoqcevaze fenoqsibenzaminis
zegavlenis Sewyveta noradrenalin/norepinefrinis gamoTavisuflebis gazrdiT, an sxva
simpaTomimeturi preparatiT. am Tvisebis gamo, mas eniWeba upiratesoba feoqromocitomis
mkurnalobaSi.
regularul gamoyenebamde, mizanSewonilia fenoqsibenzaminis erTjeradi, test-dozis efeqtebze
dakvirveba.
oralurad miRebisas igi iwvevs dispepsiur movlenebsa da Rebinebas, amitom umjobesia misi
sakvebTan erTad miReba.
moqsiziliti (Timoqsamini) araseleqciuri -adrenoblokatoria, romelic gamoiyeneba mxolod reinos
fenomenis samkurnalod.
labetaloli - da -adrenoreceptorebis blokatoria. misi es moqmedeba sxvadasxva izomeriT aris
ganpirobebuli (ix. -adrenoreceptorebis blokada, qvemoT). labetalolis parenteruli preparati
gadaudebeli hipertenziis mniSvnelovani samkurnalo saSualebaa.
sxva efeqtebTan erTad qlorpromazini da amitriptilini klinikurad mniSvnelovani -
adrenoreceptorebis blokadasac iwveven, rac xandazmulebSi zrdis posturuli hipotenziisa da dacemis
risks.

-adrenoblokatorebi
moqmedeba

16
es preparatebi seleqciurad Trgunaven noradrenalin/norepinefrinis da adrenalin/ epinefrinis -
adrenoreceptorebTan urTierTqmedebas. isini SeiZleba iyvnen sufTa antagonistebi, an gaaCndeT
garkveuli damatebiT agonisturi moqmedeba (nawilobrivi agonistebi).
gulis “Sinagani” riTmi. simpaTikuri aqtivoba (1 adrenoreceptorebis meSveobiT) axSirebs,
parasimpaTikuri aqtivoba (muskarinuli M2 receptorebis meSveobiT) ki aiSviaTebs gulis riTms. -
adrenoreceptorebis blokatoriTa da atropiniT gulze simpaTikuri da parasimpaTikuri moqmedebis
erTdroulad da adeqvaturad blokirebis SemTxvevaSi, guli iwyebs muSaobas `Sinagani~ riTmiT.
Cveuli riTmisgan gansxvavebiT (80 dartyma/wT) “Sinagani riTmis” sixSire daaxloebiT 100
dartymaa wT-Si, anu normaSi gulze Warbobs parasimpaTikuri vagusuri tonusi, romelic asakis
matebasTan erTad qveiTdeba.
-adrenoblokatorebis gul-sisxlZarRvTa sistemaze zegavlena damokidebulia simpaTikuri tonusis
intensivobaze. ZiriTadi efeqtebi simpaTikuri nervuli sistemis moqmedebis daqveiTebiT aris
gamowveuli:
 avtomatizmis daqveiTeba (guliscemis sixSire).
 miokardiumis kumSvadobis daqveiTeba (parkuWSi wnevis gazrdis sixSire).
 iuqstaglomeruluri aparatidan Tirkmelebis qerqSi reninis sekreciis daqveiTeba.
gulis riTmis gaiSviaTeba amcirebs gulis wuTmoculobis da iwvevs gulis mier Jangbadis moxmarebis
daqveiTebas. mosvenebis mdgomareobasTan SedarebiT, es efeqti ufro metad aris gamoxatuli fizikuri
datvirTvis dros. sufTa -blokatoris (anu Sinagani simpaTomimeturi aqtivobis armqone -blokatori)
mwvaved gamoyenebisas izrdeba sisxlZarRvebis periferiuli winaaRmdegoba. amis savaraudo
mizezia Semcirebul wuTmoculobaze refleqsuri sapasuxo reaqcia, agreTve isic, rom SesaZloa, -
adrenoreceptorebiT ganpirobebuli efeqtebi (vazokonstriqtori) aRar neitraldeba -adrenoreceptorebis
stimulaciiT gamowveuli efeqtebiT (dilatatori). qveiTdeba periferiuli sisxlis mimoqceva. -blokatoris
qronikuli gamoyenebisas periferiuli winaaRmdegoba ubrundeba mkurnalobamde arsebul an odnav
dabal dones (Sinagani simpaTomimeturi aqtivobis ( ISA) arsebobis an ararsebobis Sesabamisad),
magram periferiuli sisxlis mimoqceva kvlav daqveiTebuli rCeba. qronikul Terapias Tan axlavs
kidurebis gaciveba, rac savaraudod, periferiuli () dilataciuri receptorebis blokadaze ufro metad
gulis wuTmoculobisa da periferiuli sisxlis mimoqcevis SemcirebasTan unda iyos asocirebuli.
RviZlis sisxlis mimoqceva SeiZleba Semcirdes 30%-iT, es ki axangrZlivebs cximSi xsnadi im
preparatebis naxevardaSlis periods (t1/2), romelTa metabolizmis siCqarec RviZlis sisxlis
mimoqcevazea damokidebuli, anu romlebsac imdenad maRali presistemuri eliminacia axasiaTebT,
rom mis SemzRudav faqtors mxolod RviZlis sisxliT momarageba warmoadgens. es preparatebia
ariTmiebis samkurnalo saSualebebi propranololi, verapamili da lidokaini.
efeqtebi
arteriuli wneva qveiTdeba -blokatoriT mkurnalobis dawyebidan ramdenime saaTSi. amis mizezad
-blokatoris mier gulis wuTmoculobis (gulis SekumSvaTa sixSire da gulis kunTis kumSvadoba)
daqveiTeba gvevlineba. magram es efeqti ar aris mdgradi.-blokatoris qronikuli gamoyenebisas ki
arteriuli wnevis daqveiTebis ZiriTadi mizezia reninis sekreciis inhibireba. arteriuli wnevis
daqveiTebis kidev erTi mizezia natriurezuli peptidis sekreciis -adrenoreceptorebis blokadiT
ganpirobebuli gazrda (or-samjer).
hipertenziis dros -adrenoreceptorebis blokadis mniSvnelovani upiratesoba imaSi mdgomareobs,
rom fiziologiur stress (mag., fizikuri varjiSi, fexze dgoma da garemos maRali temperature) aRar
axlavs hipotenzia, rac esoden damaxasiaTebelia homeostazur meqanizmebze -adrenoreceptorebis
meSveobiT moqmedi preparatebisTvis. -blokadasTan erTad aucilebelia, rom adaptaciuri -
receptorebis vazokonstriqtoruli meqanizmebi ucvleli darCes.
erTi SexedviT, TiTqos -blokatorebis efeqtebi gulze ufro arasasurvelia, vidre sasurveli. da
marTlac, maqsimaluri fizikuri datvirTvis moculoba mcirdeba. magram, guls aqvs mniSvnelovani
17
funqciuri rezervi, amitom qvemoT CamoTvlili daavadebebis (mag., stenokardiis) dros gulis
ukmarisobis gamowvevis gareSe iZleva-blokatorebis gamoyeneba sasurvel Sedegs. marTlac,
amJamad gulis zomieri ukmarisobis mqone pacientebSi -blokatorebis gamoyeneba rutinul
praqtikad iqca. Tumca gasaTvaliswinebelia, rom gulis mniSvnelovnad Semcirebuli rezervis mqone
pacientebSi -blokatorebis gamoyenebam SeiZleba gamoiwvios gulis ukmarisoba.
-blokatorebis zegavlena plazmaSi kaliumis koncentraciaze.

arteriul wnevaze efeqti swrafad (saaTebSi, dReebSi) viTardeba, magram xSirad Semdgomi neli
daqveiTeba aRiniSneba ramdenime kviris ganmavlobaSi.
-adrenoreceptoris seleqciuroba
zogierT -blokators gulisa da periferiul 2 receptorebTan SedarebiT, gulis 1 receptorebis mimarT
gacilebiT ufro maRali afinurobiT gamoirCeva. preparatebis seleqciurobis sazomia preparatis im
dozis Tanafardoba, romelic receptorebis ori qvetipis inhibirebisTvis aris saWiro (ix. cxrilSi 23.1-is,
gv. 384, SeniSvna terminebis `-seleqciuroba~ da `kardioseleqciuroba~ gamoyenebasTan
dakavSirebiT). ismis kiTxva: ra SemTxvevaSi aqvs klinikuri upiratesoba seleqciuri da araseleqciuri
-blokatoris gamoyenebas. Teoriulad, -blokatorebi naklebad iwveven bronqokonstriqcias, magram
praqtikulad, asTmis dros mxolod ramdenime -blokatoria imdenad seleqciuri, rom usafrTxod
SeiZleba dainiSnos asTmis dros. aseT gamonakliss warmoadgenen bisoprololi da nebivololi,
romlebic -blokatorebis mkacri aucileblobis SemTxvevaSi mcire dozebiT SeiZleba dainiSnos
zomieri mimdinareobis asTmis dros. saeWvoa, rom odesme damakmayofilebeli iyos usafrTxoebis
monacemebi msgavsi gamoyenebisTvis. -adrenoreceptorebis seleqciuri blokadis ZiriTadi praqtikuli
upiratesobaa diabetis mqone pacientebSi maTi daniSvna, radgan  receptorebzea damokidebuli
rogorc hipoglikemiis simptomebi, aseve hipoglikemiis sawinaaRmdegod mimarTuli glukozis donis
maregulirebeli metaboluri sapasuxo reaqciebi.
zogierT -blokators (antagonists) agonisturi moqmedebac (ISA) axasiaTebs, anu aris nawilobrivi
agonisti. sufTa antagonistebTan SedarebiT, es preparatebi naklebad aiSviaTeben guliscemas
mosvenebul mdgomareobaSi, amitom maTi gamoyeneba naklebad efeqturia mZime stenokardiis
dros, rodesac gansakuTrebiT mniSvnelovania guliscemis sixSiris Semcireba. Sinagani
simpaTomimeturi aqtivobis mqone (ISA) -blokatorebi wuTmoculobasac ufro naklebad amcireben,
amitom pacientebis mxolod mcire nawili ganicdis kidurebis arasasurvel sicives. nebismieri -
blokatori auaresebs gardamavali koWlobis mimdinareobas. -blokatorebis orive jgufma SeiZleba
gamoiwvios gulis ukmarisoba. da marTla, mosalodneli ar aris mniSvnelovani gansxvaveba, radgan
gulis ukmarisobis mqone pacientebs ukve momatebuli aqvT simpaTikuri tonusi (magram,
aRsaniSnavia, rom -blokadis SeiZleba gamoyenebul iqnas gulis ukmarisobis samkurnalod).
Sinagani simpaTomimeturi aqtivobis mqone (ISA) -blokatorebiT mkurnalobis swrafma
Sewyvetam SeiZleba arc ki gamoiwvios simptomebis ganaxleba, radgan isini receptorebis
gaxangrZlivebul blokadasTan SedarebiT, ufro naklebad iwveven receptorebis “up-regulacias”.
zogierT -blokators membranis mastabilizebeli (qinidinis an adgilobrivi saanesTezio saSualebis
msgavsi) efeqti gaaCnia. saSualo Terapiuli dozebis gamoyenebisas es efeqti sustia, magram
mniSvnelovania dozis gadaWarbebisas (ix. qvemoT). garda amisa, glaukomis samkurnalod
adgilobrivad gamoiyenebisas am efeqtis mqone preparatebi iwveven Tvalis anesTezias (glaukomis
samkurnalod gamoiyeneba Timololi, radgam mas es Tviseba ar axasiaTebs).
cxrili 23-1. -adrenoreceptoris mablokirebeli saSualebebi: Tvisebebi Terapiul dozebSi
preparati nawilobrivi agonisturi efeqti membranomastabilizebeli
(Sinagani simpaTomimeturi efeqti) efeqti (qinidinis msgavsi
efeqti)
18
 nawili I: araseleqciuri () blokada
I jgufi oqsprenoloni + +
II jgufi propranololi _ +
III jgufi pindololi + _
IV jgufi sotaloli _ _
Timololi _ _
nadololi _ _
nawili II: -(`kardio~)a-seleqciuri blokadab
I jgufi acebutoli + +
III jgufi esmololi + +
IV jgufi atenololi _ _
bisoprololi _ _
metoprololi _ _
nebivololi _ _
betaqsololi _ _
celiprololig _ _
nawili III: araseleqciuri -blokada + -blokada
II jgufi karvediloli _ +
g
IV jgufi labetaloli _ _

-adrenoreceptoris blokada axangrZlivebs terfis refleqsis modunebis dros ankle jerk relaxation time, rac
SeiZleba mcdarad iyos Sefasebuli hipoTireozis diagnostirebis da marTvis dros.
farmakokinetika
ramdenime mizezis gamo, rTulia -blokatoris plazmismier koncentraciasa da mis efeqtebs Soris
damokidebuleba: plazmidan preparatis eliminacia pirveli rigis kinetikis mixedviT mimdinareobs,
magram receptoris blokadis Semcireba nulovani rigisaa. amas aqvs praqtikuli mniSvneloba: venaSi
propranololis 20 mg-is Seyvanidan 4 sT-Si plazmaSi misi koncentracia 50%-iT mcirdeba, magram
receptoris blokada (rac datvirTviT ganpirobebuli taqikardiis mixedviT izomeba) mxolod 35%-iT
mcirdeba. preparatis plazmismier koncentraciasa da mis efeqtebs Soris kavSiri kidev ufro rTuldeba,
Tu igi farmakologiurad aqtiur metabolitebs warmoqmnis. garda amisa, zogierTi cximSi xsnadi -
blokatoris (gansakuTrebiT Timololis) plazmis naxevardaSlis periodi (t1/2) SeiZleba ar asaxavdes -
blokadis xangrZlivobas, radgan plazmaSi umniSvnelo koncentraciis pirobebSic ki preparati
SekavSirebuli rCeba receptoris axlomdebare qsovilebTan.
-blokatorebis umravlesoba oralurad iniSneba dReSi 1-jer misaRebad, Cveulebrivi an
gaxangrZlivebuli formebi saxiT, radgan farmakodinamikuri efeqtebis t1/2 aRemateba mSobeli
nivTierebis sisxlidan eliminaciis t1/2. organizmidan Tirkmelebis gziT eqskretirebad wyalSi xsnad -
blokatorebTan SedarebiT, cximSi xsnadi nivTierebebi ufro intensiurad metabolizdeba
(hidroqsilireba, koniugacia). pacientebSi farTod meryeobs (20-jer metad) im preparatebis plazmuri
koncentracia, romlebsac RviZlSi intensiuri presistemuri eliminacia axasiaTebT, radgan TviTon
procesi damokidebulia or Zalian meryev faqtorze: Sewovis siCqaresa da RviZlis sisxlis nakadze, es
ukanaskneli ki procesis SemzRudavi faqtoria.
19
 cximSi xsnadi nivTierebebi advilad aRweven ujredebis membranebSi da maT ganawilebis
maRali moculoba axasiaTebT. isini aseve advilad aRweven centralur nervul sistemaSi (cns), mag.,
wyalSi xsnad atenololTan SedarebiT, 20-jer ufro maRalia cximSi xsnadi propranololis koncentracia
Tavis tvinSi.
wyalSi xsnadi nivTierebebi naklebad ganicdian RviZlSi metabolizms da Tirkmelebis meSveobiT
gamoiyofian organizmidan Seucvleli saxiT, amitom maTi plazmuri koncentracia ufro
prognozirebadia. Tirkmelebis ukmarisobis dros maTi naxevardaSlis periodi Zalian xangrZlivdeba,
mag., atenolilis t1/2 7 sT-dan 24 sT-mde izrdeba. Tirkmlebis daavadebis mqone pacientebSi ar
iniSneba nebismieri preparati, romelsac aqvs xangrZlivi t1/2 da organizmidan Tirkmelebis meSveobiT
gamoiyofa. wyalSi xsnad -blokatorebi naklebad nawildebian organizmSi, amitom ცნს-is mxrivi
arasasurveli efeqtebic (mag., Ramis koSmarebi) naklebad axasiaTebT.
 cximSi yvelaze xsnadi preparatebia propranololi, metoprololi, oqsprenololi da labetaloli.
 cximSi yvelaze naklebad xsnadi (wyalSi ufro xsnadi) preparatebia atenololi, sotaloli da
nadololi.
 danarCeni preparatebi Sualeduria.
-blokatorebis klasifikacia
 farmakokinetikuri: cximSi xsnadi, wyalSi xsnadi, ixileT zemoT.
 farmakodinamikuri. Cveuli dozebiT gamoyenebisas mcire klinikuri mniSvneloba aqvs
maTTan asocirebul Tvisebebs (nawilobrivi agonistis moqmedeba da
membranomastabilizebeli moqmedeba), ufro metic, xSir SemTxvevaSi es efeqtebi
SeumCnevelic ki rCeba, magram aucilebelia maTi codna, radgan zogjer maT SeiZleba
hqondeT garkveuli mniSvneloba, radgan miuTiTebdnen momaval movlenebze.
-adrenoreceptoris blokatorebi, romlebic ar aris mocemuli cxrilSi 24.1:
 araseleqciuri: karteololi, bufuraloli.
 -receptoris mimarT seleqciuri: betaqsololi, esmololi (ultra xanmokle moqmedeba: wuTebi).
 - da -adrenoreceptorebis blokatori: bukindololi.
-adrenoblokatorebis gamoyeneba
kardiovaskuluri gamoyeneba:
stenokardia: -adrenoreceptorebis blokada amcirebs gulis muSaobas da Jangbadis moxmarebas.
hipertenzia: -adrenoreceptorebis blokada amcirebs reninis sekrecias da gulis wuTmoculobas;
mcired moqmedebs homeostazur refleqsebze.
gulis taqiariTmiebi: -adrenoreceptorebis blokada amcirebs gulis riTmis matareblebze
(peismeikerebis) simpaTikur zegavlenas: SesaZlebelia relevanturia meoradi Tvisebebic aseve.
miokardiumis infarqti da -adrenoreceptoris blokatorebi: mwvave sikvdilianobis sixSiris
Sesamcireblad da ganmeorebiTi infarqtis prevenciisaTvis (e.w. `kardioproteqciuli~ efeqti) -
blokatorebi ori meTodiT gamoiyeneba:
 adreuli gamoyeneba, infarqtis ganviTarebidan pirvel 6 sT-Si (an maqsimum 12 sT-Si, pirveli
24 sT-is ganmavlobaSi intravenurad, Semdeg ki 3-4 kviris ganmavlobaSi oralurad). sasargeblo
Sedegs iZleva mxolod atenololi. gulis muSaobis daqveiTeba 25%-ze metad amcirebs infarqtis
ubnis zomas da icavs guls rupturisagan. saocaria, rom taqiariTmiis gamovlenis sixSire ar
mcirdeba, savaraudod imitom, rom atenololi ar ainhibirebs gulis  adrenoreceptorebs.
maqsimaluri efeqti pirvel 24-36 sT-Si vlindeba, magram sikvdilianobis riski dabali rCeba 1
welze meti xnis ganmavlobaSi. adreuli gamoyenebis ukuCvenebebi moicavs bradikardias (<55
dartyma/wT), hipotenzias (sistoluri arteriuli wneva <90 mm vwy.sv.) da marcxena parkuWis
ukmarisobas. pacients, romelic ukve iRebda -blokators, SeiZleba mieces damatebiTi doza.
20
  gviani gamoyeneba, miokardiumis ganmeorebiTi infarqtis prevenciis mizniT. preparatis
miReba iwyeba infarqtis ganviTarebis me-4 dRidan me-4 kviramde drois periodSi da
grZeldeba sul mcire 2 weli.
 preparatis SerCeva. preparati unda iyos sufTa antagonisti, anu Sinagani simpaTomimeturi
aqtivobis (ISA) gareSe.
aortis ganSreveba da subaraqnoiduli sisxlCaqcevis Semdeg: sistoluri gandevnis Zalisa da
siCqaris (kumSvadobis) Semcirebisa da arteriuli wnevis daqveiTebis mizniT.
parkuWovani sisxlis mimoqcevis obstruqcia, sadac anatomiur anomaliebTan erTad aRiniSneba
simpaTikuri aqtiuroba, mag., falos tetrada (cianozuri Setevebi), hipertrofuli subaortuli stenozi
(stenokardia), mitraluri sarqvelis daavadebis zogierTi SemTxveva.
RviZlis portuli hipertenzia da varikozuli sisxldena saylapavidan: portuli wnevis Semcirebis
mizniT.
gulis ukmarisoba: prospeqtuli kvlevebiT ar aris miRebuli zusti mtkicebuleba imis Sesaxeb, rom
gulis zomieri ukmarisobis mqone nebismier pacientSi-adrenoreceptorebis blokada efeqturad zrdis
pacientTa sicocxlis xangrZlivobas. kvlevebis monacemebis mixedviT, SeiZleba rogorc araseleqciuri
(karvediloli, romelic -blokatoricaa), aseve seleqciuri (metoprololi da bisoprololi) preparatebis
gamoyeneba. sargebeli, pacientTa sicocxliunarianobis gazrdis TvalsazrisiT, ufro maRalia, vidre
აგფ-inhibitorebisa placebosTan mimarTebaSi. uaryofiTi inotropuli efeqtebi mainc iyos
xelisSemSleli, amitom mkurnaloba iwyeba dabali doziT (mag., bisoprololis sawyisi oraluri dozaa
1,25 mg, diliT, dReSi erTxel, xolo karvedilolisa ki 3,125 mg orjer dReSi, sakvebTan erTad) da
maTi gamoyeneba SeiZleba mxolod damatebiTi Terapiis saxiT, gulis ukmarisobis sawinaaRmdego
ZiriTad mkurnalobasTan erTad (mag., SardmdenebTan erTad).
gamoyeneba endokrinologiaSi
hiperTiroidizmi: -adrenoreceptorebis blokada amcirebs simpaTikuri hiperaqtivobiT
ganpirobebul arasasurvel simptomebs. aseve SeiZleba gavlena moaxdinos Tiroqsinis metabolizmze
(T4-is T3-ad periferiuli deiodireba). araseleqciuri - blokatori (propranololi) iniSneba gulis
efeqtebisa (da ) da tremoris () dros.
feoqromocitoma: mocirkulire kateqolaminebis -agonisturi efeqtebis blokadasTan erTad
aucilebelia -adrenoreceptorebis adeqvaturi blokadac, amitom - da -blokatorebi yovelTvis erTad
iniSneba. aRsaniSnavia isic, rom feoqromocitomis dros -blokatoris mxolod mcire dozebia saWiro.
sxva mizniT gamoyeneba
 centraluri nervuli sistema
o SfoTva somaturi simptomebiT (-seleqciur blokadasTan SedarebiT, ufro efeqturia
adrenoreceptorebis araseleqciuri blokada)
o Sakikis profilaqtika (ix. gv. 292)
o esenciuri tremoris zogierT SemTxveva
o alkoholisa da opioidebis mwvave moxsnis simptomebi.
 Tvali:
o glaukoma: karteololis, betaqsololis, levobunololisa da Timololis Tvalis wveTebi
iwveven Tvalis namis warmoqmnis daqveiTebas da gadinebis gaadvilebas.
-adrenoreceptorebis blokadiT ganpirobebuli arasasurveli reaqciebi
bronqokonstriqcia (receptori), romelic gacilebiT ufro mniSvnelovania gansakuTrebiT asTmis
mqone pacientebSi (romelTaTvisac Tvalis wveTebis saxiT gamoyenebac ki saSiSia). qronikuli
bronqitis mqone xandazmul pacientebSi bronqokonstriqciis intensivoba izrdeba TandaTan, kvireebis
ganmavlobaSi (Tvalis wveTebis saxiT gamoyenebis drosac). cxadia, riski ufro maRalia araseleqciuri

21
preparatebis SemTxvevaSi, Tumca ar unda dagvaviwydes, rom receptorebis seleqciur
blokatorebsac SeiZleba hqondeT -receptorTan SekavSirebis mniSvnelovani unari da gamoiwvion
asTmis Seteva.
Tu gulis wuTmoculoba damokidebulia maRal simpaTikur gadacemaze, maSin blokatorebma
SeiZleba gamoiwvion gulis ukmarisoba (magram, aRsaniSnavia, rom gulis zomieri ukmarisobis
mkurnaloba SeiZleba ganxorcieldes -blokatoris Zalian dabali doziT; ix. zemoT). -blokatorebi
iwveven gulis blokadis xarisxis saxifaTo gauaresebas.
-blokatorebi auareseben tolerantobas fizikuri datvirTvis mimarT, radgan aqveiTeben
simpaTikuri nervuli sistemis agznebis sapasuxo reaqcias gul-sisxlZarRvTa sistemis mxridan.
miokardiumis infarqtis Semdeg -blokatorebis gamoyeneba iwvevs hipotenzias.
hipertenzias -blokatorebi im SemTxvevaSin iwveven, rodesac adrenoreceptorebis blokada
xels uwyobs ukve arsebuli efeqtebis gaZlierebas, mag., feoqromocitomis dros.
periferiuli sisxlis mimoqcevis daqveiTeba, gansakuTrebiT araseleqciuri -blokatorebiT, iwvevs
kidurebis gacivebas, rac iSviaTad gvevlineba nekrozis mizezad. -blokatorebma SesaZloa
gaauareson gardamavali koWlobis mimdinareoba.
RviZlisa da Tirkmelebis sisxlis mimoqceva daqveiTeba, amcirebs preparatebis metabolizms,
agreTve maT naRvlismier da Tirkmlismier eqskrecias, rasac didi mniSvneloba eniWeba RviZlis, an
Tirkmelebis daavadebebis dros.
hipoglikemia: adrenoreceptorebzea damokidebuli rogorc hipoglikemiis simptomebi, aseve
glukozis koncentraciis maregulirebeli metaboluri sapasuxo reaqciebi. araseleqciuri -blokatorebi,
ainhibireben ra receptorebsac, asusteben sisxlSi glukozis donis SemanarCunebel normalur,
simpaTikuri nervuli sistemiT ganpirobebul homeostazur meqanizmebs. amis Sedegad xangrZlivdeba
hipoglikemiuri mdgomareobis aRdgena. amas didi mniSvneloba eniWeba diabetisa da seriozuli
fizikuri datvirTvis Semdeg. garda amisa, SeiZleba ganviTardes hipertenzia (romelic SeiZleba
sakmaod mZime), radgan sisxlSi glukozis donis aRdenisaken mimarTuli simpaTikuri nervuli
sistemis ganmuxtvebi iwveven daublokavi adrenoreceptorebis stimulacias. -blokatorebi
niRbaven hipoglikemiis im simptomebs, romlebic simpaTikuri nervuli sistemis stimulaciiT aris
ganpirobebul (SfoTva, Zlieri guliscema). oflianoba ar iniRbeba, radgan is qolinerguli xasiaTisaa.-
blokatorebis fonze pacientebs SesaZloa gamorCeT hipoglikemiis sagangaSo simptomebi da
Cavardnen komaSi. aqedan gamomdinare, diabetiani pacientebis mkurnalobisas upiratesoba -
receptorebis seleqciur blokatorebs eniWeba.
plazmis lipoproteinebi: araseleqciuri -blokatorebiT qronikuli mkurnalobisas mcirdeba maRali
simkvrivis qolesterinis raodenoba da da izrdeba trigliceridebis koncentracia. hiperlipidemiis
SemTxvevaSi upiratesoba -seleqciur blokatorebs eniWeba, radgan isini gacilebiT ufro msubuqad
moqmedeben lipidur speqtrze.
seqsualuri funqcia: gavlena iSviaTia da zogadad, ar aris dadgenili placebo-kontrolirebadi
kvlevebiT.
mkurnalobis uecari Sewyveta SeiZleba saSiSi iyos stenokardiis dros da miokardiumis infarqtis
Semdeg. wamlis moxsna unda nela, TandaTan ganxorcieldes. mag., dabal dozebamde Semcireba da
am dabali doziT mkurnalobis gagrZeleba ramdenime dRis ganmavlobaSi. -blokatoris moxsnis
fenomenis arseboba da mizezi ganxilvis sagania, Tumca savaradod, igi gamowveulia 
adrenoreceptorebis ap-regulaciiT. gulis iSemiuri daavadebis mqone pacientebSi gansakuTrebiT
saSiSia da dauSvebelia -blokatoris miRebis SewyvetisTanave -blokatoriT mkurnalobis
dawyeba, radgan -blokatori iwvevs simpaTikuri nervuli sistemis refleqsur gaaqturebas.-
blokatoris moxsnis fenomeni yvelaze naklebad axasiaTebs nawilobrivi agonistebs da yvelaze metad -
-seleqciur antagonistebs. “rikoSetuli” hipertenzia umniSvneloa.
22
arasasurveli reaqciebi, romlebic ar aris uSualod dakavSirebuli -adrenoreceptorebis
blokadasTan
zogadad, esenia keTildReobis SegrZnebis dakargva, daRlili fexebi, sisuste, depresia, Zilis
darRvevebi (uZiloba, usiamovno sizmrebi), kuW-nawlavis traqtis mxrivi Civilebi da gamonayari.
okulomukokutaneuri sindromi viTardeba praqtololis qronikuli gamoyenebis dros (amJamad,
moZvelebulia), erTeul SemTxvevaSi ki misi gamoyenebis Sewyvetis Semdeg. am jgufis sxva
wevrebi an ar iwveven am sindroms, an imdenad iSviaTad iwveven, rom SeiZleba mxolod
vivaraudoT igi, amitom maTi sworad daniSvnisas, sargebeli bevrad aRemateba aseT dabal risks.
sindromis meqanizmi ucnobia, savaradod igi imunologiuri bunebisaa.
dozis gadaWarbeba
dozis gadaWarbeba (maT Soris TviTmowamvlis mizniT) iwvevs bradikardias, gulis blokadas,
hipotenzias da gulis ukmarisobas dabali wuTmoculobiT, rac SeiZleba gadaizardos kardiogenul
SokSi. sikvdilianoba ufro aRiniSneba im preparatebis gamoyenebisas, romlebsac aqvT membranis
mastabilizebeli moqmedeba. bronqokonstriqcia SeiZleba iyos mZime, zogjer fataluric ki
bronqospazmuri daavadebis mqone pacientebSi. gonebis dakargvas iwveven cximSi xsnadi
nivTierebebi, , romlebic advilad aRweven cns-Si. receptorebis blokada gacilebiT ufro xangrZlivia,
vidre preparatis plazmaSi persistencia.
racionaluri mkurnaloba moicavs:
 atropini (1-2 mg intravenurad, 1 an 2 bolus ineqciis saxiT) konkurenciis gareSe darCenili
vagusuri aqtivobis mosaxsnelad, rac bradikardiis mizezia. pacientebis umravlesoba saWiroebs
agreTve gulis pirdapiri stimulacias.
 glukagoni, romelsac gaaCnia gulis -adrenoreceptorebisgan damoukidebeli inotropuli da
qronotropuli moqmedeba (50-150 mkg/kg glukozis 5% sxnarSi intravenurad, saWiroebisas
dasaSvebia gameoreba) mZime SemTxvevebSi Tavidanve iniSneba (aralicenzirebuli Cveneba).
 sapasuxo reaqciis ararsebobis SemTxvevaSi, alternatiuli saSualebaa -adrenoreceptorebis
agonistis, mag., izoprenalinis intravenuri ineqcia an infuzia (4 mkg/wT, 1-3 wT-ian
intervalebiT dozis gazrdiT manmade, sanam gulis riTmis ar gaxdeba 50/70 dartyma/wT-Si).
 sxva simpaTomimeturi saSualebebis gamoyeneba gansjis sagania da gadawyvetileba miiReba
klinikuri mdgomareobisaTvis Sesabamisi receptoris () agonistis saWiroebis mixedviT,
mag., dobutamini, dopamini, dopeqsamini, noradrenalini, adrenalini.
 bronqokonstriqciis dros gamoiyeneba salbutamoli. aminofilini iwvevs araadrenergul inotropul
da bronqodilataciur efeqtebs. swrafi hipotenziis Tavidan asacileblad igi Zalian neli intravenuri
ineqciis saxiT gamoiyeneba.
 gulis riTmis dasaCqareblad SeiZleba gulis peismeikeris gamoyeneba.
mkurnalobas SeiZleba ramdenime dRe daWirdes. drouli da swrafi mkurnalobis dros sikvdili
iSviaTad viTardeba.
urTierTqmedeba
farmakokinetikuri. RviZlis metabolizmis damTrgunveli preparatebisa (mag., cimetidini) da im -
blokatorebis erTad daniSvna, romlebic RviZlSi metabolizdebian, iwvevs plazmaSi -blokatoris
koncentraciis mniSvnelovan zrdas. RviZlis fermentis induqtorebi aZliereben am klasis -blokatorebis
metabolizms. TviTon -blokatorebi amcireben RviZlTan sisxlis midinebas (gulis wuTmoculobis
Semcirebis gamo), amitom aqveiTeben -blokatorebisa da im preparatebis metabolizms, romelTa
eliminaciac RviZlSi maTi Sesvlis siCqarezea damokidebuli, mag., lidokaini, qlorpromazini.
farmakodinamikuri. orive adrenoreceptoris ( da  mimarT agonisti simpaTomimeturi
saSualebebisa da -blokatoris erTdrouli gamoyenebisas izrdeba arteriuli wneva, -
adrenoreceptorebis stimulaciiT ganpirobebuli vazokonstriqciis gamo (adgilobriv saanesTezio
saSualebebze adrenalinis damatebac ki iwvevs hipertenzias -blokatoris fonze). savaraudod,
23
klonidinis miRebis swrafad Sewyvetis dros hipertenziac am meqanizmiT viTardeba. -blokatorisa da
sxva antiariTmuli saSualebebis erTad gamoyenebisas potencirebas aqvs adgili, mag., hipotenziis,
bradikardiis, gulis blokadis. atrioventrikuluri kvanZis an marcxena parkuWis disfunqciis dros Zalze
saxifaToa verapamilTan (i/v) kombinacia, radgan kalciumis arxebis sxva blokatorebTan SedarebiT,
verapamils yvelaze Zlieri uaryofiTi inotropuli da qronotropuli efeqtebi axasiaTebs.
anTebis sawinaaRmdego arasteroiduli saSualebebis (asas) umravlesoba aqveiTebs -
blokatorebis antihipertenziul efeqts (atenololis garda), savaraudod, Tirkmelebis vazodilataciuri
prostaglandinebis produqciis daTrgunvis gziT. es ki iwvevs natriumis Sekavebas.
-adrenoblokatorebisa da arteriuli hipertenziis samkurnalo sxva saSualebebis erTad
gamoyenebisas Zlierdeba antihipertenzuli efeqti, gansakuTrebiT maSin, rodesac gulis riTmis gazrda
homeostazuri sapasuxo reaqciis nawilia (kalciumis arxebis blokatorebi da -adrenoreceptorebis
blokatorebi).
araseleqciuri -blokatorebi aZliereben insuliniTa da sulfanilSardovanas preparatebiT
ganpirobebul hipoglikemias.
orsuloba
-blokatorebi gamoiyeneba orsulobasTan asocirebuli hipertenziis dros, preeklamfsiis CaTvliT.
magram aRsanisnavia, rom rogorc cximSi, aseve wyalSi xsnadi preparatebi aRweven nayofSi da
SeuZliaT gamoiwvion neonataluri bradikardia da hipoglikemia. isini ar arian teratogenuli, magram
zogierTi klinikuri kvlevis monacemebis mixedviT, isini iwveven nayofis zrdaSi CamorCenas.
individualuri -blokatori
propranololi xelmisawvdomia standartuli (2-3-jer dReSi) da aqtiuri substanciis nela
gamomaTavisuflebeli (1-jer dReSi) tabletebis saxiT. gulis ariTmiis an Tireotoqsikozis dros
propranololis intravenur ineqcias (siCqariT 1 mg/wT 1 wT-is ganmavlobaSi; saWiroebisas
dasaSvebia gameoreba yovel 2 wT-Si. maqsimaluri doza 10 mg) win unda uZRodes atropinis
intravenuri ineqcia (1-2 mg venaSi), mniSvnelovani bradikardiis prevenciis mizniT; SeiZleba
aRiniSnos hipotenzia.
atenolols seleqciuroba tolia 1:15. igi farTod gamoiyeneba stenokardiisa da hipertenziis dros,
doziT 25-100mg oralurad, 1-jer dReSi. adre atenololi saWiroze gacilebiT maRali doziT iniSneboda.
Tavdapirvelad iTvleboda, rom propranololisgan gansxvavebiT, atenolols ar saWiroebda dozis
ranJireba. es imiT iyo ganpirobebuli, rom mcdari sawyisi doza ukve doza-efeqtis mrudis
mwvervalze iyo. Sewovili preparatis 90% TirkmelebiT, amitom Tirkmelebis disfunqciis dros doza
unda Semcirdes, mag., Tu glomeruluri filtraciis siCqare tolia 15-35 ml/wT, maSin dRiuri doza 50
mg-mde mcirdeba. glomeruluri filtraciis 10 ml/wT-ze naklebi siCqaris SemTxvevaSi preparati ar
iniSneba. atenololis naxevardaSlis periodi (t1/2)7 sT-ia.
bisoprololi atenololze ufro metad seleqciuria adrenoreceptorebis mimarT (Tanafardoba 1:50).
miuxedavad imisa, rom bisoprololi cximSi SedarebiT xsnadi nivTierebaa, igi erT-erTi yvelaze
xangrZlivad moqmedi -blokatoria (t1/2 11 sT) da propranololisgan gansxvavebiT, ar saWiroebs dozis
farTo diapazons. arasasurveli daRlilobis SegrZnebis prevenciisa da misi seleqciurobisgan
maqsimaluri sargebelis miRebis mizniT aucilebelia mkurnalobis dawyeba dabali doziT (5 mg).
Tirkmelebis an RviZlis disfunqciis dros dozis cvlileba saWiro ar aris.
nebivololi, lipofilurobisa da naxevardaSlis periodis (t1/2 10 sT) TvalsazrisiT hgavs bisoprolols,
magram igi ufro metad seleqciuria  receptorebis mimarT (Tanafardoba 1:300). pirdapiri
vazodilataciuri moqmedeba nebivololis unikaluri Tvisebaa (racematis d-izomeri vazodilatatoria, L-
izomeri ki -antagonisti). vazodilataciuri efeqtis meqanizmi sisxlZarRvis endoTeliumis mier azotis
oqsidis gamomuSavebis gaaqtiurebaSi mdgomareobs.
kombinirebuli, - da -adrenoreceptorebis blokatorebi
24
labetaloli racemuli narevia: erTi izomeri -adrenoreceptorebis blokatoria (araseleqciuri), meore ki 
adrenoreceptorebis. sisxlZarRvebze misi ormagi efeqtis gamo, minimumamde mcirdeba
araseleqciuriblokadisTvis damaxasiaTebeli vazokonstriqcia. ase rom, praqtikuli TvalTaxedviT,
labetololis efeqti -seleqciuri -blokatoris msgavsia. hipertenziis rutinuli mkurnalobisTvis igi
atenololze, an bisoprololze naklebad efeqturia, magram sasargebloa sxva specifikuri Cvenebebis
dros.
-blokada 4-10-jer Zlieria-blokadaze, Tumca meryeobs dozisa da miRebis gzis mixedviT.
labetaloli arteriuli wnevis swrafad daqveiTebis saWiroebisas iniSneba parenterulad. Cveulebrivi -
blokatorebi Zalian nela aqveiTeben arteriul wnevas, nawilobriv imitom, rom daublokavi 
receptorebis refleqsuri stimulacia xels uSlis arteriuli wnevis daqveiTebas. umravles SemTxvevaSi,
mZime hipertenziis drosac ki, sasurvelia arteriuli wnevis TandaTanobiT, nela daqveiTeba tvinis an
Tirkmelebis hipoperfuziis riskis asacileblad. magistraluri sisxlZarRvis dazianebis, an krunCxvis dros
ki ufro swrafi efeqtia saWiro (ix. qvemoT).
posturuli hipotenzia (damaxasiaTebelia -receptorebis blokadisTvis) vlindeba mkurnalobis
dawyebisTanave, an dozis Zalian swrafad gazrdis SemTxvevaSi. Tumca, xangrZlivi mkurnalobis
dros es ar warmoadgens problemas, radgan -receptoruli komponenti mniSvnelovnad aris
pasuxismgebeli antihipertenziul efeqtze,
qalebSi labetaloli amcirebs hipertenziul sapasuxo reaqcias orgazmze.
naxevardaSlis periodi (t1/2) 4 sT-ia. igi pirveli gavlis dros intensiurad metabolideba RviZlSi.
preparati miiReba 2-jer dReSi, doziT 100-800 mg.
mZime hipertenziis saswrafo kontrolisTvis (orsulTa CaTvliT) yvelaze mosaxerxebeli reJimia
infuziis dawyeba, siCqariT 1 mg/wT da Semdeg, saWiroebis mixedviT, dozis aRmavali titracia
naxevarsaaTiani intervalebiT. bradikardiis SemTxvevaSi venaSi SeyavT atropini (600 mkg bolus–
ineqciis saxiT). arteriuli wnevis sasurveli maCveneblis miRwevis Semdeg labetalolis infuzia wydeba
(SesaZloa saWiro gaxdes 200 mg-ze meti). infuzia saWiroebisas meordeba, regularuli oraluri
Terapiis warmatebiT danergvamde.
periferiuli simpaTikuri nervuli terminali
adrenerguli neironis blokatorebi
adrenerguli neironebis blokatorebi adrenerguli nervul daboloebebSi xvdebian
noradrenalin/epinefrinis ukumitacebis aqtiuri meqanizmebis meSveobiT (ukumitaceba 1). nervul
terminalebSi maTi moqmedeba kompleqsuria. isini SedarebiT msubuqad aqveiTeben arteriul wnevas
(Tu ar CavTvliT maT efeqturobas fexze dgomis dros), amitom maTi am mizniT gamoyeneba
moZvelebulia. Tumca, guaneTidini dRemde licenzirebulia did britaneTSi arteriuli wnevis swrafi
kontrolisTvis. igi gamoiyeneba agreTve regionuli intravenuri simpaTikuri blokadisTvis Znelad
gankurnebadi reinos daavadebis mqone pacientebSi.
meta-iodobenzilguanidini (MIBG) iodis Semcveli kontrastis saxiT gamoiyeneba qromafinuri
simsivneebis (feoqromocitoma da neiroblastoma) diagnozisa da lokalizaciis dadgenis mizniT (am
jgufis preparatebi grovdeba qromafinuri simsivneebSi).
sxeulis vertikalur isini grovdeba noradrenalinis Semnaxav vezikulebSi, Caanacvleben ra
noradrenalins, Sesabamisad amcireben nervuli impulsis sapasuxod gamoTavisuflebuli noradrenalinis
raodenobas (`cru transmiteruli~ efeqti). isini aseve pirdapir blokaven vezikulebis meqanizms. saerTo
efeqti srulad auqmebs presinafsur simpaTikur funqcias. amiT aixsneba mZime posturuli hipotenzia
maTi gamoyenebisas (amJamad moZvelebulia) hipertenziis sakontrolod (). is.
transmiteris (noradrenalin/norepinefrinis) maragis gamofitva
mcenare rauvolfias gvaris alkaloidi rezerpini uZvelesi droidan gamoiyeneba medicinaSi fsiqozis
samkurnalod. rezerpini fitavs adrenerguli neironis noradrenalin/norepinefrinis marags, ZiriTadad,
25
Semnaxvel vezikulebSi noradrenalinis transportirebis inhibirebis gziT. misi antihipertenziuli efeqti
ZiriTadad, periferiuli moqmedebis Sedegia, magram igi aRwevs cns-Si da centralur kateqolaminur
maragsac fitavs. amiT aixsneba rezerpinisaTvis damaxasiaTebeli sedacia, depresia da parkinsonis
msgavsi gverdiTi movlenebi. amJamad, rezerpini Zalze iSviaTad gamoiyeneba, magram misi dabali
Rirebuleba kvlav mimzidveli rCeba.
transmiteris sinTezis inhibireba
meTirozini (-meTil-p-Tirozini) ferment Tirozin hidroqsilazas konkurentuli inhibitoria. ferment
Tirozin hidroqsilazas meSveobiT Tirozini dopa-ad gardaiqmneba. igi erTeul SemTxvevaSi
gamoiyeneba feoqromocitomis inoperabeluri formis adiuvanturi samkurnalo saSualebis saxiT
(fenoqsibenzaminTan erTad). meTiroziniT samdRiani mkurnaloba 80%-ze metad amcirebs
kateqolaminebis sinTezs. igi cns-Sic aRwevs da amcirebs ra noradrenalin.norepinefrinisa da
dopaminis centralur marags, iwvevs rezerpinis msgavs gverdiT movlenebs (ix. zemoT). aqedan
gamomdinare, preparatis saWiroeba guldasmiT Sefasebas moiTxovs.
avtonomiuri gangliebis mablokirebeli preparatebi
heqsameToniumi hipertenziis samkurnalo oralurad aqtiuri pirveli preparatia. amJamad, igi
klinikurad aRar gamoiyeneba, radagan avtonomuri nervuli sistemis orive nawilis blokada
(simpaTikurisa da parasimpaTikuris) mZime gverdiT movlenebTan aris asocirebuli.
trimetafani xanmokled moqmedi nivTierebaa da hipertenziis saswrafo kontrolis mizniT
gamoiyeneba intravenurad. rodesac seleqciurobis ararseboba sasargebloa, wnevis regulireba SeiZleba
sxeulis daxriT, `wuTi wuTze~ kontrolis uzrunvelsayofad.
centraluri nervuli sistema
2-adrenoreceptoris agonistebi
klonidini imidazolinis nawarmia. igi Tavis tvinis 2 adrenoreceptorebis (postsinafsuri) agonistia. am
receptorebis stimulacia Trgunavs simpaTikuri impulsebis warmoSobas da aqveiTebs arteriul wnevas.
2 adrenoreceptorebTan SedarebiT, am tipis preparatebi ufro metad seleqciuria imidazolinis
receptorebis (I1) mimarT. molekulur doneze aseTi receptorebi ar aris identificirebuli, xolo genetikuri
eqsperimentis mixedviT ki dadgenil iqna, rom faqtiurad, isini arian imidazolinuri preparatebis
arteriuli wnevis damaqveiTebel moqmedebaze pasuxismgebeli 2 receptorebi. klonidinis maRali
dozebi adrenergul nervul daboloebaze lokalizebul periferiul2 adrenoreceptorebsac (presinafsur
autoreceptorebs) aaqtiurebs, rac iwvevs noradrenalin/norepinefrinis gamoTavisuflebis daTrgunvas
uaryofiTi ukukavSiris meqanizmiT.
klonidinis hipotenzuri moqmedeba farmakologebis mier laboratoriaSi cdebis Sedegad ar
aRmoCenila. es efeqti SeamCnia eqimma, romlebic iyenebda mas gacivebis dros, cxviris wveTebis
saxiT. klonidinis naxevardaSlis periodi (t1/2) 6 sT-ia. klonidini aqveiTebs arteriul wnevas. mas
posturuli an fizikur datvirTvasTan dakavSirebuli wnevis vardna mxolod umniSvnelod axasiaTebs.
klonidinis miRebis ucbad Sewyveta, an Tundac TandaTanobiTi moxsna iwvevs “rikoSetul”
hipertenzias, rac misi yvelaze seriozuli naklia. am mdgomareobisas plazmaSi kateqolaminebis
iseTive maRali koncentracia viTardeba, rogorc feoqromocitomisTvis damaxasiaTebeli hipertenziuli
Setevebis dros. “rikoSetuli” hipertenzia SeiZleba swrafad (ramdenime saaTSi) ganviTardes, zogjer ki
SeiZleba 2 dRis Semdeg. misi intensivoba 2-3 dReSi mcirdeba. klonidinis miRebis SewyvetiT
ganpirobebuli “rikoSetul” hipertenziis dros an unda aRdges klonidinis miReba (saWiroebisas
kunTebSi inqcia), an ki umkurnaloT, rogorc feoqromocitomis Setevas (ix. qvemoT). klonidinis
arasdros ar gamoyeneba -blokatorebTan erTad, radgan es ukanaskneli aZlierebs moxsnis
sindromTan asocirebul hipertenzias. klonidinis sxva xSiri gverdiTi efeqtebia sedacia da piris
simSrale.
tricikluri antidepresantebi xels uSlian klonidinis antihipertenziul moqmedebas da zrdian moxsnis
sindromis risks (“rikoSetuli” hipertenziis). klonidinis dabali dozis Semcveli preparati (diqsariti, 50
26
-75 mg 2-jer dReSi) umniSvnelo rols asrulebs Sakikis profilaqtikaSi. mas zogjer menopauzuri
alebisa da qoreis drosac iyeneben.
imidazolinis xangrZlivad moqmed preperatebs moxsnis sindromi (“rikoSetuli” hipertenzia)
naklebad axasiaTebs, mag., moqsonidinis erTi dozis miRebis gamotoveba ar iwvevs “rikoSetul”
hipertenzias.
cru transmiteri
cns-is qemotransmiterebi da receptorebi periferiuli transmiterebisa da receptorebis msgavsia, amitom,
rogorc mosalodnelia, am qveTavSi ganxilul wamlebs periferiuli moqmedebac axasiaTebT.
meTildofa ZiriTadad, tvinis Reros vazomotorul centrebze moqmedebs. igi
noradrenalin/norepinefrinis masinTezebeli fermentebis substratia (L-dopas msgavsad). cns-is 2
receptorebis tonuri stimulacia iwvevs-meTilnoradrenalinis sinTezs. -meTilnoradrenalini ar
metabolizdeba monoaminoqsidazas mier da igi seleqciurad astimulirebs 2 adrenoreceptors, aqedan
gamomdinare meTildofa klonidinis msgavsad moqmedebs. meTildofa kargad Seiwoveba kuW-
nawlavis traqtidan da advilad aRwevs cns-Si. misi naxevardaSlis periodi (t1/2) 1,5 sT-ia.
arasasurveli movlenebi moicavs: sedacias (xSirad), Ramis koSmarebs da depresias. ufro
iSviaTad aRiniSneba hemolizuri anemia kumbsis dadebiT testiT, xolo Zalze iSviaTad ki
sicocxlisTvis saSiSi hepatiti.
am da sxva mizezebis gamo, meTildofa aRar aris pirveladi arCevis preparagamoiyeneba
hipertenziis rutinuli marTvisTvis, magram igi usafrTxoa nayofisaTvis, amitom popularulia sameano
praqtikaSi, orsulTa hipertenziis samkurnalod.
stenokardiis, miokardiumis infarqtisa da hipertenziis medikamenturi mkurnaloba
stenokardia25
stenokardiuli Setevas26 maSin aqvs adgili, rodesac miokardiumis moTxovnileba Jangbadze
aRemateba koronaruli cirkulaciiT Jangbadis miwodebas. daZabvis stenokardia (yvelaze xSiri forma)
da mosvenebis dros ganviTarebuli arastabiluri stenokardia (preinfarqti an “kresCendo”) (ix.
qvemoT), is ZiriTadi formebia, romlebic medikamentur mkurnalobas saWiroebs. variantuli
(princmetalis tipis) stenokardia (Zalian iSviaTia) gamowveulia koronaruli msxvili arteriis spazmiT.
stenokardiis sawinaaRmdego preparatebi Semdegnairad moqmedeben:
 organuli nitratebi amcireben predatvirTvas da postdatvirTvas da afarToeben mTavar koronarul
arteriebs (ufro ukeT, vidre arteriolebs).
 -adrenoreceptorebis blokatorebi amcireben miokardiumis kumSvadobas da aneleben gulis
riTms. maT SeiZleba gazardon koronaruli arteriebis spazmi variantuli stenokardiis dros.
 kalciumis arxebis blokatorebi amcireben gulis kumSvadobas, afarToeben koronarul arteriebs
(sadac aRiniSneba spazmi) da amcireben postdatvirTvas (afarToeben periferiul arteriolebs).
preparatebis es jgufebi avseben erTmaneTs da SeiZleba maTi erTad gamoyeneba. sxva preparatebis
winaaRmdegCvenebis SemTxvevaSi alternativaa nitratisa da kaliumis arxebis gamaaqtivebeli
saSualebis, nikorandilis erTad daniSvna.

mkurnalobis Sejameba
 saWiroa nebismieri xelSemwyobi mizezis mkurnaloba, mag., anemiis, ariTmiis.
 Setevebis sixSiris Sesamcireblad icvleba cxovrebis wesi; Zalian sasargebloa wonis Semcireba;
unda Sewydes Tambaqos xmareba.
 fizikuri an emociuri daZabvis uSualod wina, dauyovnebeli profilaqtika: gliceril trinitrati enis
qveS an nifedipini (kafsulis CaReWva da siTxis gaCereba pirSi RruSi, an gadaylapva).

27
  mwvave Setevis dros: gliceril trinitrati (enis qveS) an nifedipini (kafsulis CaReWva, ix.
zemoT).
xangrZlivi profilaqtikisaTvis:
 1-adrenoreceptorebis blokatori, mag., bisoprololis regularuli miReba (da ara mxolod
mosalodneli Setevis dros). doza unda SeirCes pasuxis Sesabamisad. zogi rekomendacia
iTvaliswinebs dozis zeda zRvars, zogis mixedviT ki mkurnaloba iwyeba dabali doziT, misi
TandaTan gazrdiT maqsimalurad asatan dozamde tolerantulamde (mosvenebul
mdgomareobaSi gulis SekumSvaTa sixSire ar unda Semcirdes 55 dartymaze/wT-ze metad); an
doza unda gaizardos im donemde, romlis Semdegac dozis gazrda aRar Trgunavs fizikuri
datvirTviT ganpirobebul taqikardias. stenokardiis mZime mimdinareobis dros upiratesoba
eniWebaT sufTa antagonistebs, anu im blokatorebs, romelsac ar aqvT nawilobrivi agonistis
moqmedeba, radgan nawilobrivi agonistebi arasakmarisad amcireben guliscemis sixSires.
pacienti informirebuli unda iyos moxsnis sindromis riskis Sesaxeb.
 kalciumis arxebis blokatorebi, mag., nifedipini an dilTiazemi, -adrenoreceptoris blokatoris
alternativaa. isini koronaruli spazmis dros gamoiyeneba, gansakuTrebiT haergatari gzebis
nebismieri Seqcevadi obstruqciis SemTxvevaSi.
 xangrZlivad moqmedi nitrati, izosorbid dinitrati an izosorbid mononitrati: erideT tolerantobis
ganviTarebas.
 nikorandili, xangrZlivi moqmedebis kaliumis arxebis gamaaqtiveblebs ar axasiaTebT nitratebis
msgavsi tolerantoba.
 medikamenturi mkurnaloba SeiZleba adaptirebul iqnas stenokardiis Setevebis pacientisaTvis
Cveuli drois mixedviT, mag., Ramis Setevebi (transdermuli gliceril trinitrati, an izosorbidis
mononitrati Sinagani wesioraluri doza Zilis win).
 arastabiluri stenokardiis mqone pacientebSi Trombocitebis agregaciis Semaferxebeli
saSualebebiT (aspirini an klopidogreli) monoTerapia, an maTi heparinis dabal dozebTan
kombinacia amcirebs miokardiumis infarqtis fataluri da arafataluri SemTxvevebis sixSires.
 qirurgiuli revaskularizacia calkeul SemTxvevebSi (perkutaneuli koronaruli intervencia (PCI) da
stentireba).
mkurnalobis axali meTodebi
ivabradini iwvevs bradikardias. igi ainhibirebs e.w. “peismeikeris” an sinoatriuli kvanZis neli
depolarizaciis makontolebel natriumis arxebs, anelebs sinusis kvanZis funqcias da amcirebs gulis
muSaobas. β-blokerebisgan gansxvavebiT, SeiZleba ivabradinis gamoyeneba asTmis dros, magram
preparati ainhibirebs igive arxebs baduraSic, amitom iwvevs mxedvelobis simaxvilis gauaresebas,
rac misi gamoyenebis SemzRudavi faqtoria. ranolazini natriumis gvian arxebs ainhibirebs, rac xels
uSlis iSemiuri ubanis gadatvirTvas kalciumiT. mas antiariTmuli Tvisebac gaaCnia da ucnobi
meqanizmiT, diabetis dros igi aqveiTebs glukozisa (uzmod) da HbA1c-is dones. miuxedavad amisa,
ranolazinis zusti roli kvlav ganusazRvrelia.
stenokardiis mkurnalobis dros aucileblad unda gvaxsovdes, rom mkurnalobis mizani ar aris
mxolod simptomebis Semcireba. mkurnalobis erT-erT mTavar mizans warmoadgens garTulebebis
profilaqtika (gansakuTrebiT miokardiumis infarqtisa da uecari sikvdilis). es moiTxovs yvela risk-
faqtoris (hipertenzia, hiperlipidemia, Saqriani diabeti) energiul mkurnalobas, da ra Tqma unda,
Tambaqos moxmarebis Sewyvetas. mtkicebuleba imis Sesaxeb, Tu rogor aisaxeba mkurnalobis
Sedegze TviTon medikamenturi an qirurgiuli simptomuri mkurnaloba mwiria, garda im
pacientebisa, romlebic saWiroeben qirurgiuli Carevas marcxena koronaruli arteriis mTavari Reros
stenozis gamo. miuxedavad imisa, rom aspirinis gamoyeneba stabiluri stenokardiis mqone
pacientebSi specifikurad ar aris Seswavlili, amJamad, sxva pacientTa jgufebSi aspirinis kvlevebis
masalebis eqstrapolirebiT miCneulia, am kategoriis pacientebSi aspirinis gamoyeneba misaRebi
prevenciuli RonisZiebaa.

28
miokardiumis infarqti (MI)
mimoxilva
ekg-sa da plazmaSi troponinis donis mixedviT mwvave koronaruli sindromi amJamad klasificirdeba:
(1) ST segmentis elevaciiT mimdinare miokardiumis infarqti (STEMI; ekg); (2) ST segmentis
elevaciis gareSe mimdinare miokardiumis infarqti (non-STEMI; ekg da troponinis dadebiTi testi) da
(3) arastabiluri stenokardia (ekg da troponinis uaryofiTi testi). aRniSnuli miuTiTebs, rom es aris
swrafad ganviTarebadi sfero, magram Terapuli strategiebi viTardeba mwvave koronaruli sindromis
am formebis Sesabamisad.
diagnozis dadgenamde an pacientis hospitalSi moTavsebamde zogadi praqtikis eqims an
paramedikoss SeuZlia sawyisi mkurnalobis dawyeba, kerZod:
 morfini an diamorfini (2,5 an 5 mg venaSi, radgan Trombolizuri mkurnalobis fonze kunSTi
ineqcias mosdevs hematomis ganviTareba).
 aspirini 150-300 mg oralurad.
 60% Jangbadi.
mkurnalobis dauyovnebeli mizania tkivilis moxsna da sikvdilianobis damaqveiTebeli mkurnalobis
dawyeba. miokardiumis infarqtis diagnozis dasmis Semdeg mkurnalobis mizania garTulebebis
(ariTmia, gulis ukmarisoba da Tromboembolia) mkurnaloba da re-infarqtis prevencia.
ST segmentis elevaciiT mimdinare miokardiumis infarqtis (STEMI) SemTxvevaSi karg Sedegs
iZleva miokardiumis adreuli re-perfuzia. adre, perfuziis aRdgenas cdilobdnen farmakologiurad,
amJamad ki mravali centri upiratesobas aniWebs uSualo koronarul angioplastikas, stentirebiT an mis
gareSe. Trombolizis saWiroebisas igi unda ganxorcieldes hospitalSi misvlisTanave, Trombolizisis
yvela winaaRmdegCvenebis gaTvaliswinebiT (ix. qvemoT). Trombolizuri saSualebebi SesaZloa
iyvnen efeqturi ST segmenti elevaciis gareSe mimdinare miokardiumis infarqtis (non-STEMI)
SemTxvevaSi, gansakuTrebiT im pacientebSi, romlebsac hisis konis marcxena totis blokada
aReniSnebaT. magram zogierTi kvlevis mixedviT, ekg-s cvlilebebis gareSe (an ST depresiiT)
mimdinare infarqtisa da aratsabiluri stenokardiis Trombolizuri saSualebebis efeqturoba Zalze
dabalia.
Trombolizuri saSualebis SerCeva damokidebulia erTi mxriv kargi dizainis mqone kvlevebis
Sedegebze, meore mxriv ki mkurnalobis fasze. miokardiumis pirveli infarqtis SemTxvevaSi
(kardiogenuli Sokis gareSe mimdinare) pacients pirveli 1 sT-is ganmavlobaSi eniSneba
streptokinazas 1 500 000 , intravenuri infuzii saxiT. garda im SemTxvevisa, rodesac aRiniSneba
kardiogenuri Soki. antistreptokinazas mimarT antisxeulebis arsebobis gamo, ganmeorebiTi
infarqtebis dros iniSneba rekombinanturi qsovilovani plazminogenis aqtivatori alteplaza (an
reteplaza). alteplaza da streptokinaza ukavSirdebian plazminogens da gardaqmnian mas fibrinis
lizisze pasuxismgebel plazminad. mocirkulire plazminogenTan SedarebiT, alteplazas fibrinTan
SekavSirebuli plazminogenis mimarT ufro maRali afinuroba gaaCnia. es seleqciuroba alteplazas
raime Terapiul upiratesobas ar aniWebs, radgan Trombolizisis Semdgomi mZime sisxldena TiTqmis
yovelTvis sisxldenis an travmis Zvel ubnebze warmoqmnili koltis lizisis Sedegia. sinamdvileSi,
mocirkulire fibrinogenTan erTad fibrinis lizisis tendencia streptokinazas antikoagulantur
moqmedebasac aniWebs. es efeqti ar gaaCnia alteplazas, amitom preparatis gamoyenebasTan erTad
da misi gamoyenebis Semdeg saWiroa heparinis daniSvna.
miokardiumis infarqtis sikvdilianobis maCveneblis damaqveiTebeli mesame mkurnaloba
iTvaliswineba -adrenoreceptorebis blokadas. ISIS-1 kvlevis dros iyenebdnen atenolols 5 mg jer
intravenurad, Semdgom ki agrZelebdnen mkurnalobas oraluri 50 mg-iT. kvlevam daadastura
sikvdilianobis Semcireba, ZiriTadad, gulis rupturis prevenciis gamo. aRsaniSnavia, rom
Trombolizuri mkurnaloba ar amcirebs miokardiumis infarqtis garTulebas - gulis rupturis sixSires.
marTalia, -adrenoreceptorebis blokadas gaaCnia ukuCvenebebi, magram miokardiumis pirveli
infarqtis SemTxvevaSi pacientebis umravlesobam unda SeZlos am mkurnalobis Catareba.
29
Trombocitebis agregaciis damTrgunveli sxva saSualebebi. Trombis warmoqmnisaTvis
Trombocitebis agregaciis Cveuli gzis bolo safexuria Trombocitis ujredebis zedapirze glikoprotein
IIb/IIIa receptorebis eqspresia. es receptorebi maRali afinurobiT ikavSirebs fibrinogens. IIb/IIIa
receptorebis mainhibirebeli saSualebebia specifikuri monoklonuri antisxeulebi (absiqsimabi),
agreTve receptorebis specifikuri antagonistebis swrafad mzardi jgufis warmomadgenlebi, mag.,
eptifibatidi da tirofibani. agregaciis kidev erTi damTrgunveli, klopidogreli, ainhibirebs
Trombocitebis ADP-damokidebul agregacias. igi iSemiuri insultis, an kardiovaskuluri sikvdilianobis
profilaqtikisaTvis gamoiyeneba maRali riskis pacientebSi, an ST segmentis elevaciiT mis gareSe
mimdinare miokardiumis infarqti (non-STEMI) dros da am TvalsazrisiT igi aspirinze ufro maRali
efeqturobiT xasiaTdeba
es preparatebi arastabiluri stenokardiis samkurnalo damatebiTi saSualebebia, isini Trombozis
profilaqtikisTvisac iniSneba perkutaneuli revaskularizaciuri procedurebis dros (angioplastika,
koronaruli arteriis stenozi, gansakuTrebiT Semogarsuli stentis SemTxvevaSi).
Trombolizisis ZiriTadi ukuCvenebebi
 hemoragiuli diaTezi.
 orsuloba.
 peptikuri wylulis an kuW-nawlavidan sisxldenis simptomebi.
 qirurgiuli procedura (proceduris wina 10-14 dRe), gansakuTrebiT neiroqirurgiuli.
 gaxangrZlivebuli kardiopulmonuri reanimacia.
 proliferaciuli diabeturi retinopaTia.
 mZime, arakontrolirebadi hipertenzia (diastoluri wneva > 120 mm vwy.sv.)

arastabiluri stenokardia saWiroebs hospitalizacias. mkurnalobis mizania tkivilis moxsna da

miokardiumis infarqtisa da uecari sikvdilis prevencia. mkurnaloba iwyeba aspiriniT, misi 150-300
mg tabletis CaReWviT an wyalSi gaxsnilis oralurad miRebiT, da grZeldeba bunebrivi hepariniT, an
erT-erTi dabalmolekuluri hepariniT, mag., daltepariniT, an enoqsapariniT. nitratebidan sasurvelia
izosorbidis dinitratis intravenuri infuzia, romelic grZeldeba tkivilis moxsnidan kidev 24 sT.
mkurnalobas emateba -adrenoblokatori, mag., metoprololi, oralurad an intravenurad. -blokatoris
ukunaCvenebis SemTxvevaSi pacients mis nacvlad eZleva kalciumis arxebis blokatori, mag.,
dilTiazemi an verapamili. maRali riskis mqone pacientebSi aseve SeiZleba dainiSnos glikoprotein
IIb/IIIa inhibitori, mag., eptifibatidi an tirofibani.
meoradi prevencia
miokardiumis infarqtis riskis saukeTeso maCvenebelia winamorbedi miokardiumis infarqti.
diagnozis dadgenidan pirveli ramdenime saaTis ganmavlobaSi mkurnalobis ZiriTadi mizania
infarqtis ganviTarebis prevencia. saavadmyofodan gawerisas pacientebma unda miiRon rCevebi
fizikuri datvirTvisa da dietis Sesaxeb. maTi umravlesoba erTveba sareabilitacio programaSi.
zogadad, izRudeba najeri cximebiT mdidari sakvebis miReba, amasTanave arsebobs mtkicebuleba
kvebis racionSi Tevzisa da zeiTunis zeTis CarTvis sasargeblod.
wamlebi, romlebic gamoiyeneba meoradi prevenciisaTvis
nebismierma pacientma sul mcire 2 wlis ganmavlobaSi unda miiRos aspirini, აგფ-inhibitori da -
blokatori (ra Tqma unda, am wamlebis winaaRmdegCvenebis ararsebobis SemTxvevaSi).
miokardiumis infarqtis Semdeg -blokatoris daniSvnis ukuCvenebaa gulis gardamavali ukmarisoba
(romelic amJamad iSviaTad gvxvdeba miokardiumis pirveli infarqtis Semdeg), gulis sxvadasxva
xarisxis blokada da bradiariTmia. Cveulebriv, es mdgomareobebi gardamavalia da konvalescenciis
dros ukve dasaSvebia -blokatorebis daniSvna. aseT pacientebSi agf-inhibitori Caanacvlebs -

30
blokators (magram, -blokada SeiZleba saWiro gaxdes marcxenaparkuWovani ukmarisobis
Semdgomi grZelvadiani marTvisTvis; ix. qvemoT).
nebismieri es preparati, aspirini, -blokatori an agf-inhibitori 20-25%-iT amcirebs ganmeorebiTi
infarqtis sixSires, miuxedavad imisa, rom maTi damatebiTi sargebeli kvlevebis Sedegad ar aris
dadgenili.
am preparatebis garda, pacientebis umravlesobas unda daeniSnos statini, plazmaSi qolesterinis
donis miuxedavad. miokardiumis infarqtis Semdeg dabali simkvrivis lipoproteinebis Semcirebisgan
grZelvadiani sargebels iZleva simvastatini (dRiuri doza 20-40 mg) da pravastatini (dRiuri doza 40
mg).
Cveulebriv, ar aris saWiro ariTmiis rutinuli prevencia, an grZelvadiani antikoagulacia.
gamonakliss warmoadgens marcxena parkuWis funqciis daqveiTeba da ariTmia.
arteriuli hipertenzia
antihipertenzuli saSualebebis klinikuri Sefaseba cdilobs pasuxi gasces or kiTxvas:
1. axangrZlivebs Tu ara pacientis sicocxles arteriuli wnevis xangrZlivi daqveiTeba, amasTanave, aris
Tu ara es RonisZieba arteriuli hipertenziis garTulebebis prevencia?; am kiTxvaze pasuxis gamcemi
klinikuri kvlevebi moiTxovs dakvirvebas pacientTa mravalricxovan jgufebze, xangrZlivia da
amasTanave sakmaod Zviria.
2. SeuZlia Tu ara preparats arteriuli wnevis efeqturi, usafrTxo da komfortuli kontrolis uzrunvelyofa 1
wlis ganmavlobaSi? amJamad, ukve dagrovilia sakmarisi mtkicebuleba arteriuli wnevis daqveiTebis
aucileblobis Sesaxeb, amitom wamlis maregulirebeli organoebi aRar iTxoven pirveli rigis kvlevas
yoveli axali preparatisTvis. aqedan gamomdinare, axali preparatis danergvisTvis SedarebiT
xanmokle kvlevebic sakmarisad iTvleba. msgavsi kvlevebi ver avlenen wamlis metaboluri efeqtebis
Soreul Sedegebs, mag., preparatis zegavlena sisxlSi glukozis doneze, rac uaryofiTad moqmedebs
koronaruli daavadebis riskze. placebo efeqtebi cnobilia am xanmokle kvlevebSi da yuradRebiT unda
gakontroldes kvlevis dizainiT.

mkurnalobis miznebi
mkurnalobis ZiriTadi, grZelvadiani mizania insultisa da miokardiumis infarqtis, amasTanave gulis
ukmarisobis (gansakuTrebiT xandazmulebSi) prevencia. prevencia sxva risk-faqtorebze (mag.,
Tambaqos moxmareba da plazmis qolesterinis done) yuradRebis gamaxvilebasac gulisxmobs.
mkurnalobis dauyovnebeli mizani ki arteriuli wnevis normalur maCvenebelTan daaxloebaa,
simptomuri hipotenziis an cxovrebis xarisxis gauaresebis gareSe.
mZime SemTxvevebSi, mkurnalobis miznis miRwevis Semdeg, mniSvnelovani simptomuri
gaumjobeseba aRiniSneba: retinopaTia, da masTan erTad mxedvelobac umjobesdeba, Tavis tkivilic
qreba. mkurnalobis gareSe datovebuli maRali arteriuli wneva sxvadasxva saxis Seuqcevad
dazianebas iwevs, ise rom, mkurnalobis miuxedavad, Tirkmelebis ukmarisoba progresirebs,
marcxena parkuWis hipertrofia ar ganicdis ukuganviTarebas, arteriebis dazianeba ki iSemiuri
movlenebis (insultisa da miokardiumis infarqtis) wyaro xdeba.
sasurvelia mkurnalobis dawyeba Seuqcevadi cvlilebebis ganviTarebamde, rac gulisxmobs
usimptomo msubuqi da zomieri mimdinareobis arteriuli hipertenziis SemTxvevebis droul
gamovlenas skriningis Sedegad mkurnalobis droulad dawyebas.
mkurnalobis zRurbli da miznebi
didi britaneTis hipertenziis asociaciisa da klinikuri upiratesobis nacionaluri institutis (NICE)
erToblivi gaidlainebis mixedviT, antihipertenziuli mkurnaloba unda daiwyos:
 rodesac arteriuli wneva aRemateba 160/100 mm vwy.sv. an
31
  rodesac arteriuli wnevis diapazonia 140-159/90-99 mm vwy.sv., magram ukve saxezea
samizne organoebis dazianeba, kardiovaskuluri daavadeba an 20%-ze maRali kardiovaskuluri
riskis 10 wliani anamnezi.
 rodesac pacients aReniSneba diabeti da arteriuli wneva aRemateba 140/90 mm vwy.sv.
nebismier pacientSi mkurnalobis optimaluri mizania arteriuli wnevis daqveiTeba 140/85 mm
vwy.sv.-mde (an ufro qvemoT). gamonakliss warmoadgenen pacientebi, romlebsac aReniSnebaT
Tirkmelebis funqciis darRveva, diabeti an kardiovaskuluri daavadeba. maTTvis rekomendebulia
arteriuli wnevis 130/80 mm vwy.sv.-ze ufro metad daqveiTeba.
efeqturi mkurnaloba amcirebs nebismieri garTulebis risks (insultisa da miokardiumis infarqtis,
gulis ukmarisobis, Tirkmelebis ukmarisobis, amasTanave SesaZloa demenciisac). individualur
kvlevebSi advilia insultis profilaqtikisken mimarTuli mkurnalobis sargeblis demonstrireba, radgan
insultis riskisa da arteriuli wnevis kavSiris amsaxveli mrudi, miokardiumis infarqtis mrudze TiTqmis
orjer ufro cicaboa. es zeviT wevs SedarebiTi da absoluturi riskis sakiTxs.
SedarebiTi riski gulisxmobs, rom igive asakisa da sqesis normotenziul pacientTan SedarebiT,
hipertenzul pacients gazrdili aqvs garTulebis albaToba. absoluturi riski gulisxmobs erTidaigive
asakis, sqesisa da arteriuli wnevis mqone 100 pacientidan SemTxvevaTa im raodenobas, romlebsac
savaraudod unda ganuviTardeT garTuleba momdevno 10 wlis ganmavlobaSi. aqedan gamomdinare,
hipertenziul pacientebSi miokardiumis infarqtis SedarebiTi riski fiqsirebulia, magram SeiZleba
absoluturi riskis mniSvnelovani daqveiTeba hiperqolesterinemiisa da arteriuli wnevis kontrolis
meSveobiT. es imaze miuTiTebs, rom orive faqtori damoukideblad uwyobs xels miokardiumis
infarqtis ganviTarebas, maSin roca arteriuli hipertenzia insultis ganviTarebis ufro mniSvnelovani
risk-faqtoria (hiperqolesterinemiasTan SedarebiT).
esenciuri hipertenziis mkurnaloba mTeli sicocxlis manZilze grZeldeba, radgan mkurnalobis
Sewyvetisas arteriuli wneva swrafa ubrundeba pirvandel cifrebs. Tu es ase ar xdeba, maSin
hipertenziis diagnozi eWvis qveS dgeba, radgan esenciuri hipertenziis diagnozi moiTxovs 3 Tvis
ganmavlobaSi arteriuli wnevis momatebis sul mcire 3 epizodis dafiqsirebas.
hipertenziis SedarebiTi riski da arteriuli hipertenziis mkurnalobis sargebeli xandazmulebSi ufro
naklebia, vidre 65 wlamde asakis pacientebSi, magram am kategoriis pacientebSi absoluturi riski da
mkurnalobis sargebeli ufro maRalia. mkurnalobis farTo arCevanis xelmisawvdomobis gamo,
cxovrebis gaumjobesebuli xarisxiT eqimebi veRar amarTleben hipertenziis mkurnalobisagan Tavis
Sekavebas xandazmulebSi. sawyisi mkurnalobisaTvis wamlebis dozebi unda ganaxevrdes, Semdeg
ki da SesaZloa misaRebi iyos arteriuli wnevis ufro naklebad daqveiTeba.
banaluria imaze saubari, rom mkurnalobis gverdiTi movlenebi mniSvnelovania, radgan
pacientTa Zalian didi raodenoba itarebs antihipertenzul mkurnalobas, magram mxolod ramdenimes
SesaZloa gamouvlindes gverdiTi movlena (im TvalsazrisiT, rom amis dasadgenad saWiroa aseulobiT
pacientis mkurnaloba); es aris daavadebis profilaqtikisTvis gankuTvnili wamlebis damaxasiaTebeli
Tviseba.
antihipertenziuli Terapiis principebi
ZiriTadi maCveneblebi SeiZleba sakmarisi iyos zomieri SemTxvevebis gasakontroleblad:
 simsuqne: misi Semcireba.
 alkoholi: rekomendebuli dozebiT miReba, mag., qalebisTvis 14 erTeuli kviraSi,
mamakacebisTvis ki 21 erTeuli kviraSi.
 Tambaqos moxmareba: Sewydes gamoyeneba.
 kveba: dadasturebulia, rom arteriuli wnevis xanmokle daqveiTebas iwvevs cximiT mdidari
sakvebis SezRudva da xilis, bostneulis, agreTve boWkoTi mdidari sakvebis moxmarebis
gazrda. damatebiT sasargeblis motana SeuZlia marilis miRebis SezRudvas (dRiurad 6 g-ze
naklebi): unda SeizRudos Zalian mariliani sakvebi (mag., wnili, konservi), xolo
axalmomzadebul sakvebs ki ar unda daamaton marili31.
32
  relaqsaciuri Terapia: mniSvnelovania maRali motivaciis mqone pacientebisTvis.

medikamenturi mkurnaloba
am Tavis dasawyisSi CamoTvlili nebismieri erTi an meti RonisZiebis Sedegad SesaZlebelia arteriuli
wnevis daqveiTeba. xelmisawvdomia arteriuli wnevis damaqveiTebeli sxvadasxva farmakologiuri
jgufis preparatebis didi raodenoba, amitom paradoasulia, rom randomulad SerCeuli preparati
saukeTeso iyos konkretuli pacientisTvis. reninis statusisa da masze wamlebis zegavlenis mixedviT
mixedviT hipertenziuli preparatebi da pacientebi or jgufad iyofa.
 tipi 1, an reninis maRali donis mqone pacientebi, arian axalgazrda (<55 welze), kavkasiuri
rasis, maTze ukeT moqmedebs agf-inhibitorebi, angitenzinuri receptorebis blokatorebi an-
blokatorebi.
 tipi 2, an reninis dabali donis mqone pacientebi, romlebSic efeqturia SardmdenebiT an
kalciumis blokatorebiT monoTerapia.
TiToeuli preparati moqmedebs arteriuli wnevis makontrolebel mxolod erT an or meqanizmze,
amitom danarCeni adaptaciuri faqtorebi, romlebzec ar moqmedebs monoTerapias, iwveven Seguebas
(homeostazuri meqanizmi), ewinaaRmdegebian wamlis hipotenzur efeqts da aRadgenen pirvandel
mdgomareobas.

arsebobs msgavsi adaptaciis, an tolerantobis ori principuli meqanizmi:

1. mocirkulire sisxlis moculobis gazrda: amas iwvevs nebismieri preparati, romelic amcirebs
periferiul winaaRmdegobas (zrdis intravaskulur moculobas), an ki renin-angiotenzinuri sistemis
gaaqtiurebis gamo, aqveiTebs gulis wuTmoculobas (aqveiTebs glomerulur sisxlis midinebas).
Sedegad, izrdeba gulis wuTmoculoba da arteriuli wneva. mkurnalobis reJimSi Sardmdenis
damateba iwvevs am kompensatoruli efeqtis prevencias.
2. baroreceptoruli refleqsebi: arteriuli wnevis daqveiTeba iwvevs simpaTikuri sistemis refleqsur
gaaqtiurebas da Sedegad, periferiuli winaaRmdegobisa da gulis aqtivobis (gulis riTmis sixSirisa
da kumSvadobis) gazrdas.
amitom, rTulad samarTavi arteriuli hipertenziis dros iniSneba ramdenime wamlis kombinacia,
SerCeuli preparatebi ki arteriuli wnevis makontrolirebel samive ZiriTad komponentze unda
moqmedebdnen, kerZod:
 sisxlis moculobaze
 periferiul winaaRmdegobaze
 gulis wuTmoculobaze.
aseTi kombinaciebiT SesaZlebelia:
 antihipertenziuli efeqturobis maqsimalizacia, gul-sisxlZarRvTa sistemis sam sxvadasxva
wertilze zemoqmedebis gziT.
 homeostazuri antagonisturi efeqtebis minimizacia, sisxlis moculobis, sisxlZarRvovani tonusisa
da gulis funqciis kompensatoruli cvlilebebis blokirebis gziT.
 uaryofiTi efeqtebis minimizacia, sxvadasxva wertilze moqmedi da sxvadasxva arasasurveli
efeqtebis mqone preparatebis dabali dozebis gamoyenebiT.
“pirveli dozis hipotenzia” iSviaTia. igi ZiriTadad, venebze moqmedi preparatebis gamoyenebisas
aRiniSneba (-adrenoreceptorebis blokatorebi, agf-inhibitorebi) da barorefleqsis gaaqtivebis
darRveviT aris ganpirobebuli (mag., xandazmuli asaki, an SardmdenebiT gamowveuli intravaskuluri
moculobis Semcireba).
hipertenziismkurnaloba
33
jandacvisa da klinikuri daxelovnebis erovnuli institutis/britaneTis hipertenziis sazogadoebis 2006
wels gaaxlebuli gaidlainebi xelmisawvdomia misamarTze: http://www.nice.org.uk/CG034

1. Tu pacienti axalgazrdaa (<55 welze), an ar aris Savkaniani, gamoiyeneba agf- inhibitori (an
angiotenzinuri receptoris blokatori)(A). ufro asakovan pacientebSi pirveli rigis mkurnalobis
saxiT iwyeben an kalciumis arxebis blokators an Tiazidur Sardmdens (C an D). Tu preparati
efeqturia, magram pacienti mas ver egueba, maSin iniSneba preparatebis sxva wyvili.
2. Tu arteriuli wneva ver kontroldeba 4 kviris ganmavlobaSi, mkurnalobis kurss unda daematos
meore preparati, pirveli preparatis sawinaaRmdego wyvili, mag., Tu pacienti iRebs agf-
inhibitors, emateba kalciumis arxebis blokatori an Tiaziduri Sardmdeni (A+C an A+D), radgan
vazodilatacia, an diurezis gaZliereba astimulirebs renin-angiotenzinur sistemas da ara-
renindamokidebuli hipertenzia gadayavs renin-damokidebul hipertenziaSi.
3. Tu arteriuli hipertenzia ormagi Terapiis drosac ver kontroldeba adeqvaturad, maSin idealuria
sammagi reJimi A+C+D.
4. Tu saWiroa damatebiTi Terapia, am etapze efeqturia -blokada, blokavs ra zogierTi sxva
preparatis barorefleqsuri pasuxis vazokonstriqtorul komponents. Zalian cota pacients SeiZleba
dasWirdes minoqsidilis an meTildofas msgavsi Zveli klasis preparatebi (im pirobiT, rom
maryuJovani Sardmdeni da -blokatori aseve miiReba siTxis mZime Sekavebisa da taqikardiis
dasablokad).
5. Tu sammagi Terapiis fonze arteriuli wneva kvlav samizne maCvenebelze maRalia, maSin
mkurnaloba unda gaZlierdes damatebiTi diurezuli efeqtiT, mag., spironolaqtoniT, an damatebiTi
α-adrenoreceptorebis, an ki β-adrenoreceptorebis blokadiT. aris mtkicebuleba imis Sesaxeb, rom
aseT SemTxvevaSi “cdisa da Secdomis” midgomis Tavidan acileba SesaZlebelia plazmaSi
reninis gansazRvriT, radgan reninis dabali koncentracia damatebiTi diurezuli saSualebis
(spironolaqtonis) saWiroebaze miuTiTebs.
mkurnaloba da daavadebis simZime
zomieri hipertenziis adeqvaturi mkurnaloba SesaZlebelia erT preparatiT. vazokonstriqciiT, an
nstriumis siWarbiT ganpirobebuli hipertenziis mkurnalobac SesaZlebelia erTi preparatiT. umravlesi
gaidlainis mixedviT umravlesi pacientisaTvis sistoluri wnevis samizne maCvenebelia <140
mm.vwy.sv. da xSirad amis misaRwevad saWiro xdeba ori an meti wamali. mZime hipertenziis
mqone pacientebis umravlesobas mkurnaloben etapobrivad (ix. zemoT). bolo dromde konvencia
gvTavazobda “nabij-nabij” zrunvas erTi wamlidan kombinirebul mkurnalobamde, magram
mkurnalobis arasasurveli efeqtebis riski da arakontrolirebuli hipertenziis garTulebebi SeiZleba
Semcirdes Tu mkurnaloba Tavidanve daiwyeba ramdenime wamliT34.
mxolod iSviaTad arsebobs arteriuli wnevis ufro swrafad daqveiTebis aucilebloba. es
mniSvnelovania, radgan konkretuli preparatis efeqturoba da tolerantoba SeiZleba Sefasdes TiToeuli
pacientisTvis.
monitoringi
arteriuli wnevaze meTvalyureobas (monitorings) axorcielebs eqimi, an medda (gansakuTrebiT
mniSvnelovania xandazmulebSi), zogjer ki TviTon pacienti. `oqros standartia~ arteriuli wnevis
ambulatoriuli monitoringis 24 sT-iani sistema ( ABPM), magram amisaTvis saWiro xelsawyo sakmaod
Zviria da ar aris xelmisawvdomi yvela pacientisaTvis. da mainc, arteriuli wnevis 24 sT-iani profili
gamosavalis prognozisaTvis gacilebiT ukeTesia, radgan eqims exmareba rTuli an maRali riskis
mqone pacientisaTvis damatebiT preparatis saWiroebis dadgenaSi. sfigmomanometri vargisianobis
SemTxvevaSi (standartulTan) monitoringis iafi alternativaa binaze meTvalyureoba. gamosayeneblad
martivia majis monitorebi, magram samwuxarod, arasaimedoa im pacientebisTvis, romlebic itareben
medikamentur mkurnalobas.
34
Sardmdenebi da kaliumi. hipertenziis dros gamoiyeneba kaliumis organizmidan gamomaZevebeli
(kaliurezuli) Sardmdenebi, romlebic organizmis kaliums 10-15%-iT amcireben. Tumca, am
Sardmdenebis dabali dozebi (mag., bendroflumeTiazidis dRiuri doza 2.5 mg ) ar iwveven
mniSvnelovan hipokalemias da zrdian konis sindromze eWvs. mgrZnobiare pacientebSi (mag.,
xandazmulebSi) unda gakontroldes kaliumis koncentracia mkurnalobis dawyebidan 3 TveSi, Semdeg
ki yovel 6-12 TveSi. saWiroebis dros, hipoklemiis koreqciisaTvis Sardmdeni/kaliumis qloridis
kombinirebul preparatTan (danamatebis umravlesoba Seicavs KCl-is 8 mmol, rac nebismier
SemTxvevaSi arasakmarisia) SedarebiT, upiratesoba eniWeba Tiazidisa da kaliumis damzogveli
Sardmdenis (mag., amiloridi) fiqsirebuli dozis Semcvel kombinirebul preparats (ko-amilozidi).
kaliumis damzogveli Sardmdenebi frTxilad gamoiyeneba diabetis, an Tirkmelebis funqciis
daqveiTebis SemTxvevaSi, gansakuTrebiT Tu es pacientebi imavdroulad iReben agf-inhibitorebs an
angiotenzinuri receptorebis blokatorebs.
pacientis mier mkurnalobis reJimis dacva. mravalkomponentiani mkurnalobis reJimi
pacientebs garkveul problemas uqmnis. hipertenziis mkurnaloba mTeli sicocxlis manZilze
mimdinareobs, amitom didi mniSvneloba eniWeba yoveli individualuri pacientisaTvis misTvis
mosaxerxebeli mkurnalobis reJimis agebas. iq sadac SesaZlebelia, upiratesoba fiqsirebuli dozebis
Semcveli kombinirebuli preparatebis daniSvnas eniWeba. xelmisawvdomia umravlesi
antihipertenzuli saSualebis erTjeradi dRiuri dozis Semcveli farmacevtuli formebi, saWiroebisamebr
ki aqtiuri substanciis nela gamomanTavisuflebuli gaxangrZlivebuli formebis gamoyenebac aris
SesaZlebeli.
kaliumis balansis kontroli gansakuTrebiT mniSvnelovania, Tu pacienti aseve iRebs digoqsins
(hipokaliemia aZlierebs mis moqmedebas). hiperkaliemiis riskis gamo, amiloridi ar iniSneba im
pacientebSi, romlebic iReben agf inhibitorebs, Tu Tirkmlis funqcia normaluria.
urTierTqmedeba
mravali preparatiT mkurnalobaiwvevs mniSvnelovan problemas. radgan mkurnaloba xangrZlivia,
sasurvelia yvelaze mosaxerxebeli reJimis Sedgena yvela individualur SemTxvevaSi da Semdeg
fiqsirebuli dozis kombinaciaze gadayvana. 1-jeradi dRiuri doza idealuri iqneba da xangrZlivad
gamoTavisuflebadi formulisa da fiqsirebuli dozis kombinaciis SerCeva sasargebloa. mag.: tenoretiki
(atenololi+qlortalidoni), tenifi (atenololi+nifedipini), zestoretiki (lizinoprili+hidroqlorTiazidi), ko-
diovani (valsartani+hidroqlorTiazidi).

gadaudebeli hipertenziuli mdgomareobebis mkurnaloba

mniSvnelovania sami garemoebis gamoyofa, romlebic SeiZleba arsebobdes calk-calke an erTad;
mwvave hipertenzia TavisTavad ar aris arteriuli wnevis gadaudebeli (an mniSvnelovani) daqveiTebis
Cveneba.
 Zalze iSviaTad, arteriuli wneva saWiroebs gadaudebel (kritikul) daqveiTebas maSinac ki,
rodesac hipertenzia mZime ar aris, gansakuTrebiT rodesac arteriul wnevas swrafi zrdis
tendencia gaaCnia.
 daCqarebuli fazis (avTvisebian) hipertenzia iSviaTad saWiroebs arteriuli wnevis gadaudebel
daqveiTebas, piriqiT, arteriuli wneva nela unda daqveiTdes pirveli ramdenime dRis
ganmavlobaSi.
arteriuli wnevis saswrafo daqveiTebis saWiroeba iSviaTad dgeba. am mdgomareobebs ekuTvnis:
 hipertenzuli encefalopaTia (eklampsiis CaTvliT).
 gulis marcxena parkuWovani mwvave ukmarisoba (hipertenziiT ganpirobebuli).
 aortis ganSrevebadi anevrizma.

35
am mdgomareobebis dros arteriuli wneva unda Semcirdes 1 sT-is ganmavlobaSi. ganSrevebadi
anevrizmis mqone pacients ganSrevebamde arteriuli wnevis maCveneblebi SesaZloa normaluric ki
hqondes, Tumca, aRsaniSnavia, rom maTTvis samizne arteriuli wneva daaxloebiT 110/70 mm
vwy.sv.-ia. ase, rom, arteriuli wnevis mciredi daqveiTebac ki, xsnis sagangebo mdgomareobas.
daCqarebuli fazis hipertenzias adre uwodebdnen `avTvisebian~ hipertenzias, radgan mkurnalobis
imdroindeli mwire SesaZleblobebis gamo (samkurnalo saSualebebis simwire), diagnozis dasmidan 1
wlis ganmavlobaSi letaluri gamosavaliT mTavrdeboda. mas axasiaTebs wvrili arteriebis fibrinoiduli
nekrozi, ris Sedegadac irRveva Tavis tvinisa da Tirkmelebis sisxlismimoqcevis autoregulacia,
amitom arteriuli wnevis nebismieri daqveiTeba am organoebis perfuziis proporciul Semcirebas
ganapirobebs. aqedan gamomdinare, sasicocxlod aucilebelia mkurnalobis pirvel dRes diastoluri
arteriuli wnevis ara umetes 20 mm vwy.sv.-iT daqveiTeba, sawinaaRmdego SemTxvevaSi izrdeba
cerebruli infarqtis riski.
mkurnaloba. venis diagramis nebismieri wris saukeTeso samkurnalo saSualebaa -blokatori
(gamoyenebis winaaRmdegCvenebis ararsebobis SemTxvevaSi), mag., atenololis 25 an 50 mg
oralurad. gadaudebel SemTxvevebSi, intravenurad damatebiT iyeneben vazodilatators.
Teoriulad, magram ara praqtikulad, upiratesi alternativaa vazodilatatoris, nitroprusidis
intravenuri infuzia. ganSrevebadi anevrizmis dros, -blokatoris gareSe vazodilatatoris gamoyeneba
ar aris sasurveli, radgan am dros arasasurvelia pulsis gaxSireba. labetaloli venis diagramis samive
wris pacientebis (asTmianebis garda) samkurnalo mosaxerxebeli meTodia. igi oralurad an
parenterulad iniSneba. unda vaRiaroT, rom es ar aris mkurnalobis yvelaze efeqturi meTodi da
arteriuli wnevis Semdgomi Semcirebis .saWiroebisas nifedipinis gaxangrZlivebuli moqmedebis
tabletebis damatebas mimarTaven.
Tu pacients ukve miRebuli sxva antihipertenziul saSualeba, an mas daqveiTebuli aqvs
Tirkmelebis funqcia, maSin yvela wamali dabali doziT unda iqnas gamoyenebuli.
mZime hipertenziis oraluri SemanarCunebeli mkurnaloba SeZlebisdagvarad swrafad unda
daiwyos; iSviaTad aris aucilebeli 48 sT-ze ufro xangrZlivi parenteruli mkurnaloba.
orsulTa hipertenzia
orsulobiT ganpirobebuli hipertenziis efeqturi mkurnaloba aumjobesebs nayofis perinatalur
gadarCenas. aRsaniSnavia, rom mwiria kargi klinikuri kvlevebi, romlebzec SesaZlebeli iqneboda
rekomendaciebis dafuZneba, amitom preparatis SerCeva ZiriTadad misi gamoyenebis xangrZliv
gamocdilebas eyrdnoba (nayofze aSkara zianis miyenebis gareSe moqmedeba). amis
gaTvaliswinebiT, mravali meanisTvis meTildofa kvlav rCeba arCevis pirveli rigis preparatad.
kalciumis arxebis blokatorebi (gansakuTrebiT nifedipini) xSirad gamoiyeneba meore rigis
preparatad, xolo parenteruli hidralazini ki mkurnalobis sarezervo preparatia da orsulobis gvian
etapze arteriuli wnevis gadaudebeli daqveiTebisTvis gamoiyeneba, sasurvelia -blokatorTan
kombinaciaSi, arasasurveli taqikardiis Tavidan acilebis mizniT.
-blokatorebi (labetaloli da atenololi) xSirad efeqturia da orsulobis mesame trimestrSi SesaZloa
arCevis preparatebsac warmoadgenen. mtkicebuleba imis Sesaxeb, rom orsulobis pirvel da meore
trimestrSi -blokatoris gamoyeneba iwvevs nayofis zrdis Seferxebas, sakmaod mwir monacemebzea
dafuZnebuli. Sardmdenebi amcireben preeklamfsiis ganviTarebis albaTobas, magram TviT
preeklamfsiis dros isini ar gamoiyeneba, radgan am pacientebs ukve aqvT Semcirebuli cirkulaciuri
moculoba.
orsulobis periodSi absoluturad ukunaCvenebia agf-inhibitorebis (da angiotenzin II receptorebis
blokatorebi) gamoyeneba: orsulobis pirvel trimestrSi isini iwveven ganviTarebis mankebs, meore
trimestrSi ki nayofis sikvdils. aqedan gamomdinare, umjobesia isini ar daeniSnos Svilosnobis asakis
qalebs, ZiriTadad maT vinc ar itarebs efeqtur kontracepcias, radgan Znelia orsulobis aRmoCena
pirveli trimestris gvian periodamde. Tu isini mainc iyeneben agf-inhibitorebs, an angiotenzinuri

36
receptorebis blokatorebs, maSin maT unda mieceT instruqtaJi orsulobis dadasturebisTanave am
mkurnalobis Sewyvetis Sesaxeb.
maRali arteriuli wneva da proteinuria (preeklamfsia) orsulobis garTulebaa da 2-8%-Si
gvxvdeba. igi SeiZleba gadaizardos eklamfsiaSi, romelic dedaTa da bavSvTa sikvdilianobis ZiriTadi
mizezia. magniumis sulfati anaxevrebs eklamfsiis progresirebis risks (Cveulebriv, 4 g intravenuri neli
ineqciis saxiT, xangrZlivobiT 5-10 wT, Semdeg ki bolo krunCxvidan 24 sT-is ganmavlobaSi
intravenuri infuzia siCqariT 1 g/sT).
garda amisa, Tu qals ukve hqonda erTi krunCxva (mkurnaloba diazepami), maSin momdevno
krunCxvebis prevenciis TvalsazrisiT, diazepamze an fenitoinze ufro efeqturia magniumi.
adreul kvlevebis mixedviT, risk-kgufis pacientebSi preeklamfsiis SemTxvevebis Sesamcireblad
rekomendebuli iyo aspirinis dabali doza, magram bolodroindeli kvlevebis meta-analiziT es ar aris
dadasturebuli. aqedan gamomdinare, aspirini ar aris rekomendebuli rutinuli gamoyenebisaTvis.
antihipertenziuli saSualebebis arasasurveli wamalTSorisi urTierTqmedeba
specifikuri urTierTqmedeba individualur preparatTan erTad aris ganxiluli. qveviT ki mocemulia
wamalTSorisi urTierTqmedebebis zogadi magaliTebi sxvadasxva jgufis preparatebisaTvis.
alkoholis miReba hipertenziis xelSemwyobi faqtoria, zogjer ki mizezic da yovelTvis unda iyos
ganxiluli, rogorc mkurnalobaze cvladi pasuxis an uSedego mkurnalobis mizezi (SesaZloa damxmare
iyos -glutamil transpeptidazas da sisxlis wiTeli ujredebis saSualo korpuskuluri moculobis gazomva).
prostaglandinebis sinTezi. აასს, mag., indometacini, amcireben -adrenoreceptorebis blokatorebisa
da Sardmdenebis antihipertenziul efeqts, savaraudod, Tirkmelebis prostaglandinebis (vazodilataciuri)
sinTezis daTrgunvis gamo. es mniSvnelovania marcxena parkuWis mZime ukmarisobis dros
Sardmdenebis gamoiyenebisas.
fermentebis inhibireba. ciprofloqsacini da cimetidini Trgunaven cximSi xsnadi -blokatorebis
(mag., metoprololis, labetalolis, propranololis) RviZlismier metabolizms, Sedegad zrdian maT efeqts.
meTildofam da მაო-s inhibitorma SeiZleba gamoiwvion SfoTva da halucinaciebi.
farmakologiuri antagonizmi. -blokatorebis fonze simpaTomimeturi saSualebebma (mag.,
amfetamini, fenilpropanolamini, romelic Sedis madis damaqveiTeblebis, agreTve gacivebisa da
xvelis sawinaaRmdego saSualebebis SemadgenlobaSi) SeiZleba gamoiwvion -blokatorebis
antihipertenziuli efeqtis daqveiTeba da hipertenziuli reaqcia, ris mizezadac -adrenoreceptorebis
stimulacia gvevlineba.
qirurgiuli anesTeziis dros arsebobs arteriuli wnevis swrafi da mniSvnelovani daqveiTebis riski im
pacientebSi romlebic iReben antihipertenziul saSualebebs. ar aris aucilebuli qirurgiul Carevamde
nebismieri pacientis antihipertenziul mkurnalobaSi cvlilebebis Setana rutinulad, Tumca cxadia, rom
es faqti namdvilad arTulebs operaciamde da operaciis Semdgom zrunvas pacientze. asea Tu ise,
anesTeziologma aucileblad unda icodes pacientis antihipertenzuli mkurnalobis Sesaxeb.

seqsualuri funqcia da kardiovaskuluri preparatebi

simpaTikuri avtonomuri aqtivobis damaqveiTebel nebismier preparats gaaCnia mamakacis
sqesobrivi funqciis xelisSemSleli unari, rac gamoixateba eakulaciis darRveviT, an ereqciis
SenarCunebis gaZnelebiT. Tumca, placebo-kontrolirebad kvlevebSi xazgasmiT aris aRniSnuli, rom
aranamkurnaleb mamakacebSi es simptomi zogjer 20-30%-s aRwevs. amasTanave, cnobilia, rom
hipertenziasac Tavis mxriv axlavs seqsualuri disfunqciis garkveuli riski, radgan am daavadebis
adreuli paTofiziologiuri niSania sisxlZarRvis endoTeliumis mier azotis oqsidis gamomuSavebis
daqveiTeba.

37
 umetes SemTxvevaSi arasworia antihipertenziuli preparatebis dadanaSauleba, gansakuTrebiT
axali Taobis preparatebis. mag., kalciumis arxebis blokatorebis, agf- inhibitorebisa da angiotenzin II
(AT1) receptorebis blokatorebis sqesobriv disfunqciis gamomwvevi unari ar gansxvavdeba
placebosgan. am preparatebis gamoyenebis dros simptomebis arseboba saWiroebs darRvevis realuri
mizezis dadgenas. nebismieri antihipertenziuli saSualebis fonze sildenafilis (viagra) gamoyeneba did
sifrTxiles saWiroebs.
antihipertenziuli mkurnalobis garda, am dros pacientebSi SesaZloa sxva problemac arsebobdes,
rogoricaa seqsualuri aqtis mcdelobis SiSi. es SiSi xSirad Rrmavdeba asakTan, agreTve Tanmxleb
koronaruli arteriebis daavadebasTan erTad.

seqsualuri urTierToba da gul-sisxlZarRvTa sistema

orgazmian normalur seqsualur urTierTobas Tan axlavs gardamavali, magram swrafi fiziologiuri
cvlilebebi, mag., taqikardia 180 dartymaze meti wT-Si, anu 1 wT-ze nakleb droSi gulis SekumSvaTa
sixSire izrdeba 100 dartmiT. sistoluri arteriuli wneva SeiZleba gaizardos 120 mm vwy.sv.-iT, xolo
diastoluri 50 mm vwy.sv.-iT. normaluri wnevis pirobebSic ki orgazms SeiZleba Tan axldes arteriuli
wnevis gardamavali gazrda 230/130 mm vwy.sv.-mde. ekg-ze cvlilebebi janmrTel mamakacebsa da
qalebSi ki aRiniSneba. izrdeba sunTqvis sixSirec _ 60-mde wT-Si.
janmrTel pirebSi es fiziologiuri cvlilebebia, arajanmrTel pirebSi (hipertenziis, stenokardiis an
gadatanili miokardiumis infarqti ) ki es SesaZloa cudis momaswavebeli iyos: seqsualuri kavSiris
dros, an umalve mas Semdeg, xSiria uecari sikvdili (parkuWovani fibrilacia an subaraqnoiduli
sisxlCaqceva). es gansakuTrebiT xSirad xdeba saidumlo viTarebaSi – bordelSi an qalbatonis
sawolSi, gansakuTrebiT xandazmuli mamakacisa da axalgazrda qalis urTierTobis dros. magram
aseTi faqtebi mainc vrceldeba presaSi. uecari sikvdilis dafiqsirebuli faqtis 0,6% viTardeba seqsualuri
kavSiris dros da am SemTxvevaTa naxevarSi partniors aRiniSneboda gulis daavadeba. cxadia, gulis
koronaruli daavadebis mqone pacienti asakis momatebasTan erTad frTxilad unda moekidos im
hemodinamikuri simaRleebis dapyrobas, romelic aseTi advili iyo axalgazrdobaSi.
sqesobrivi aqtis dros ganviTarebuli uecari kardiovaskuluri sikvdilis faqti qalebSic aris
dafiqsirebuli, magram es Zalze iSviaTia.
sqesobrivi kavSiris dros kardiovaskuluri stresis (hipertenzia an ariTmia) riskis arsebobis
SemTxvevaSi, orive sqesis adamianSi gamarTlebulia labetalolis miReba sqesobriv kavSiramde 2 sT-
iT adre (ra Tqma unda sxva samkurnalo saSualebebis gaTvaliswinebiT, romlebic ukve miRebuli aqvs
pacients). magram, aRsaniSnavia, rom pacientebs, romlebic stenokardiis profilaqtikis mizniT
xangrZlivad iReben -blokators, labetalolis fonze koitusis dros aRiniSnebaT gulis SekumSvaTa
sixSiris pikis Semcireba 122-dan 82 dartymamde wT-Si.
stenokardiis mqone pacientebma sqesobriv aqtamde 10 wT-iT adre unda gamoiyenon gliceril
trinitrati an izosorbid dinitrati, fizikuri datvirTvis profilaqtikis mizniT. magram, isini aucileblad
unda iyvnen informirebulebi nitratebisa da sildenafilis (viagra) potenciurad fataluri
urTierTqmedebis Sesaxeb (ix. gv. 394).
Sejameba
 hipertenziisa da stenokardiis mkurnaloba saWiroebs preparatebs, romlebic amcireben gulis
muSaobas, uSualod gulze moqmedebiT, an sisxlZarRvebis periferiuli winaaRmdegobis
Semcirebis gziT.
 hipertenziisa da stenokardiis mkurnalobisas SeiZleba gamoyenebul iqnas -
adrenoreceptorebis blokada, rac ZiriTadad iwvevs gulis wuTmoculobis Semcirebas, agreTve
kalciumis arxebis blokada, rac iwvevs arteriebis seleqciur dilatacias.
 vazodilatatorebidan zogi gamoiyeneba hipertenziis samkurnalod (agf-inhibitorebi,
angiotenzinis (AT1) receptoris blokatorebi da -adrenoreceptoris blokatorebi), zogi ki
38
 stenokardiis dros (nitratebi).
 miokardiumis infarqtis mkurnaloba saswrafod saWiroebs Tromboliziss, aspirins da -
adrenoreceptorebis blokadas. infarqtis meoradi profilaqtikis mizniT, bolo ori maTganiT
mkurnaloba grZeldeba sul mcire 2 weli,.
 seleqciur pacientebSi miokardiumis infarqtis meoradi profilaqtikis sxva mniSvnelovani
safexurebia: gulis ukmarisobis dros - agf-inhibitorebi, hiperqolesterinemiis dros ki statinebi.

filtvismieri hipertenzia
mkurnaloba ZiriTad gamomwvev mizezzea damokidebuli. qronikuli obstruqciuli daavadebis
Tanmxlebi hipoqsiis dros xangrZlivi mkurnaloba JangbadiT mkurnaloba aumjobesebs simptomebsa
da prognozs. filtvebis mravaljeradi emboliis dros sasicocxlod aucilebelia antikoagulacia Terapia.
idiopaTuri (pirveladi) filtvebis arteriuli hipertenzia. simptomur gaumjobesebas iZleva verapamili.
pirveladi filtvismieri hipertenziis samkurnalod gamoiyeneba prostanoidebis preparatebi intravenuri
epoprostenoli (prostaciklini) da sainhalacio iloprosti. xanmokle moqmedeba da mkurnalobaze
heterogenuli sapasuxo reaqciebi prostanoidebis preparatebis gamoyenebis SemzRudavi faqtorebia.
mtkicebulebebis mixedviT, daavadebis mniSvnelovan paTogenur rgols warmoadgens endoTelini,
Zlieri endogenuri vazokonstriqtori. misi antagonistebi bosentani, ambrisentani da sitoqsentani
aumjobeseben simptomebsa da datvirTvisadmi tolerantobas, magram hepatotoqsikurobis gamo,
dozebi limitirebulia. alternatuli samkurnalo saSualebebia ferment fosfodiesTeraza-5-is inhibitorebi
sildenafili, tadalafili da vardenafili. mxolod tadalafili zrdis pacientTa gadarCenis maCvenebels,
magram am sami preparatis SedarebiTi kvlevis dros dadgenil iqna, rom fizikuri datvirTvis mimarT
tolerantobas mxolod sildenafili zrdis. gulisa da filtvebis transplantacia rekomendebulia axalgazrda
pacientebSi.

feoqromocitoma
feoqromocitoma qromafinuri qsovilis simsivnea, romelic ZiriTadad Tirkmelzeda jirkvlis tvinovani
nivTierebidan warmodgeba. feoqromocitoma upiratesad gamoimuSavebs noradrenalin/norepinefrins,
magram xSirad adrenalin/epinefrinis garkveul raodenobasac awarmoebs. feoqromocitomas
simptomebic amiT aris ganpirobebuli. hipertenzia SeiZleba iyos mudmivi an gardamavali. simsivnis
mier mxolod noradrenalin/norepinefrinis (romelic astimulirebs  da  adrenoreceptorebs)
gamomuSavebis SemTxvevaSi, arteriuli wnevis momatebas Tan axlavs vagusis gaaqtivebiT
ganpirobebuli refleqsuri bradikardia, es ki sakmarisia -receptorebis stimulaciiT gamowveuli
qronotropuli efeqtis dasaZlevad. kateqolaminebisaTvis damaxasiaTebeli simptomebis fonze (mag.,
SfoTva, tremori an oflianoba) bradikardiis arseboba am iSviaTi sindromis SesaZlo arsebobaze
miuTiTebs, radgan simpaTikuri nervuli sistemis fiziologiuri gaaqtivebis dros vagusi “iTiSeba” da
taqikardias aqvs adgili. Tu simsivne ,  da  adrenoreceptorebis mastimulirebel
adrenalin/epinefrinsac gamoimuSavebs, maSin arteriuli wneva da gulis riTmi paralelurad icvleba.
amis mizezia adrenalin/epinefrinis mier rezistentuli arteriebis vazodilataciuri  receptorebis
stimulacia, raac xels uSlis diastoluri wnevis momatebas da vagusis gaaqtiveba sakmarisi ar aris
imisaTvis, rom winaaRmdegoba gauwios - da -receptorebis kombinirebuli stimulaciiT
Ganpirobebul qronotropul efeqts.
diagnozis dasadastureblad mimarTaven sisxlSi an 24-saaTian SardSi kateqolaminebis
(adrenalin/epinefrinisa da noradrenalin/norepinefrinis) O-meTilirebuli metabolitis, normetanefrinis
gansazRvras. fermenti kateqol-O-meTiltransferaza ar aris simpaTikur nervul daboloebebSi, magram
igi aRmoCenilia feoqromocitomaSi, amitom “fraqcionirebuli metanefrinebis” (erTmaneTisagan
gancalkevebuli normetanefrini da metanefrini) testis specifikuroba da mgrZnobeloba, Zvel
diagnostikur testebTan SedarebiT 90%-ia, amitom odnavi momatebac ki eqimebis mier ar unda iyos
ignorirebuli. simsivnis vizualizaciur meTodTan SedarebiT, feoqromocitomis bioqimiuri diagnostika

39
ufro saimedoa. metafrainis (da normetanefrinis) sekreciis momateba simsivnis Tirkmelzeda jirkvalSi
lokalizebaze miuTiTebs, radgan mxolod Tirkmelzeda jirkvlis simsivneebs aqvT
noradrenalin/norepinefrinis adrenalin/epinefrinad gardaqmnis unari, radgan kortizolis maRali
koncentraciis pirobebSi aqtiurdeba noradrenalin/norepinefrinis adrenalin/epinefrinad meTilirebaze
pasuxismgebeli fermenti fenileTanolamin_N_meTiltransferaza. simsivnis zrdasTan erTad
progresulad irRveva portokapilaruli sisxlismimoqceva qerovan da tvinovan Sreebs Soris, ase rom
Zalze didi zomis simsivnis SemTxvevaSi SesaZloa Sewydes adrenalin/epinefrinis sekrecia.
bioqimiuri testebis mosazRvre Sedegebis SemTxvevaSi mimarTaven farmakologiur supresul
testebs. ganglioblokatori pentoliniumi an centralurad moqmedi α2adrenoreceptorebis agonisti
klonidini ainhibirebs metafrinebis fiziologiur momatebas, magram ar moqmedebs maT simsivnismier
sekreciaze. SesaZlebeli da isini saukeTesod sruldeba specializebul ganyofilebebSi, mcdari Sedegebis
asacileblad. provokaciuli testebis ganzrax gamoyeneba saxifaToa, magram feoqromocitomis
Tavdapirveli kvlevis dros pacientma anamnezSi SesaZloa aRniSnos dopaminis antagonistiT (mag.,
metoklopramidi), an histaminis gamomanTavisuflebeli nebismieri preparatiT (opioidebi, kurare,
trimetafani) ganpirobebuli hipertenziuli krizi.
antihipertenziulma preparatebma SeiZleba Secvalos kateqolaminebis koncentracia
(gansakuTrebiT, romlebic iwveven simpaTikuri aqtiurobis refleqsur zrdas, mag., vazodilatatorebi).
cru-dadebiTi testebi SeiZleba aRiniSnos, Tu warsulSi pacientebs CautardaT arasaWiro operaciebi.
qirurgiul proceduramde, an inoperabelur SemTxvevaSi periferiul vazokonstriqciis Tavidan
asacileblad da arteriuli wnevis sakontrolod -adrenoreceptorebis blokadas mimarTaven. -
adrenoreceptorebis blokadis mniSvnelobani funqcia mxolod arteriuli wnevis kontroli ar aris, aramed
intravaskuluri moculobis gafarToebaa. feoqromocitoma sufTa vazokonstriktoruli hipertenziis
sakeTeso magaliTia. kompensatoruli natriureziT. Sesabamisad, pacientebs moculobis daqveiTeba
aReniSnebaT, xSirad mZime, amitom operaciamde aucilebelia misi koreqcia.
arc Tu iSviaTad, natriurezi mTlianad akompensirebs sisxlZarRvebis Seviwroebas da im pacientebs,
romlebsac hipertenziis garda sxva niSnebic axasiaTebs, siTxisgan gamofitvis Semdeg hopotenziis
epizodic ki uviTardebaT. aseT pacientebs qirurgiuli proceduris win, moculobis gafarToebis mizniT
esaWiroebaT -adrenoreceptorebis blokada, radgan aseT pacientebSi maRalia postoperaciuli
hipotenziis riski, saTanado momzadebis gareSe datovebis SemTxvevaSi. adrenalin/epinefrinis
masekretirebeli simsivneebis mqone pacientebSi aseveaucilebelia -adrenoreceptorebis blokadac,
taqikardiis prevenciis mizniT. rogorc zemoT iqna aRniSnuli, simsivnis zrdasTan erTad mcirdeba
adrenalinis sekreciac, amitom taqikardia mTavar problemad aRar ganixileba. -blokatoriT
mkurnalobis dawyeba iwvevs taqikardiis gamoaSkaravebas, radgan baTildeba baroreceptorebiT
ganpirobebuli vagusuri aqtivoba. dauSvebelia mxolod -blokatoris daniSvna, radgan
adrenalin/epinefrinis periferiuli vazodilataciuri efeqtebis gauqmeba Zlier  efeqtebs
winaaRmdegobis gawevis gareSe tovebs. -blokadis dros usafrTxoa-seleqciuri blokatoris dabali
dozis (mag., bisoprololis 5 mg) daniSvna. Zalze iSviaTad, atipiuri adrenalin/epinefrinis mosekretire
feoqromocitomis dros  blokadis dadgomis Semdeg saWiro xdeba -adrenoreceptorebis
araseleqciuri blokada, -efeqtebis (taqikardia, tremori) mkurnalobis mizniT.
feoqromocitomis dros ar iniSneba esenciuri hipertenziis samkurnalo -adrenoreceptorebis
seleqciuri blokatori. feoqromocitomis dros upiratesoba eniWeba Seuqcevadi moqmedebis -
blokators, fenoqsibenzamins (dRiuri doziT 10-80 mg), romlis efeqtsac ver daZlevs kateqolaminebis
gadmosrola, mag., simsivneze qirurgiuli manipulaciis dros. dozis titraciis dros saWiroa
meTvalyureoba wnevaze sauRle venaSi (moculobis Canacvlebis indeqsis saxiT), agreTve arteriuli
wnevis kontroli horizontalur da vertikalur poziciaSi. mkurnaloba unda gagrZeldes ramdenime kvira,
Tu SesaZlebelia, operaciamde, Semcirebuli sisxlZarRvSida moculobis gasazrdelad, rac yovelTvis
aRiniSneba feoqromocitomis mqone pacientebSi.

40
 qirurgiuli proceduris dros (Cveulebriv, laparaskopiuli adreneleqtomia) xelT unda gvqondes
fentolamini (an natriumis nitroprusidi), simsivnes amokveTis periodSi momatebuli arteriuli wnevis
gasakontroleblad. Tirkmelzeda jirkvlis venebis gadakvanZis Semdeg, arteriuli wnevis
SesanarCuneblad xSirad saWiro xdeba moculobis gazrda, adeqvaturi preoperaciuli -blokadis
drosac ki. presoruli agentis infuziis saWiroebisas upiratesoba izoprenalins eniWeba, radgan -
receptorebis blokadis gamo, pacienti kargavs mgrZnobelobas adrenoreceptorebis agonistebis
mimarT.
avTvisebiani feoqromocitomas dros garkveuli warmatebiT gamoiyeneba meTirozini (-
meTilTirozini), kateqolaminebis sinTezis inhibirebis mizniT.
meta-iodobenzilguanidins (mibg, guaneTidinis analogi) aqtiurad itacebs adrenerguli qsovili,
amitom igi feoqromocitomaSi koncentrirdeba. radio-iodirebuli mibg ([123I] mibg) simsivneebis
lokalizaciis da metastazebis aRmoCenis, amasTanave funqcionirebadi metastazebis, an qromafinuri
qsovilis sxva simsivneebis (mag., karcinoidis) mkurnalobisas maTi seleqciuri dasxivebis saSualebas
iZleva.
konis sindromi
hipertenziuli pacientebis 2-3%-s aReniSneba Tirkmelzeda jirkvlis qerqis keTilTvisebiani adenoma,
romelic asekretirebs natriumis Semakavebel hormons, aldosterons. konis sindromis sinonimia
pirveladi aldosteronizmi, Tumca am terminma SesaZloa moicvas pacientTa didi raodenoba,
romlebsac plazmaSi aldosteron/reninis maRali fardoba aReniSnebaT, aldosteronis sekreciis
lateralizacviis gareSe. konis sindromis dros plazmaSi daqveiTebulia reninis done, aldosteronis donis
daqveiTebis gareSe. kompiuteruli tomografiisa da magnitur-rezonansuli kvleviT vlindeba
Tirkmelzeda jirkvlis adenoma. zrdasruli mosaxleobis 5%-s Tirkmelzeda jirkvlis arafunqciurebadi
adenoma aReniSneba, amitom laretalizacia diagnozis damadasturebeli mniSvnelovani safexuria.
lateralizacia niSnavs adenomis mier aldosteronis Warbi sekreciis demonstrirebas. Cveulebriv, es
keTdeba Tirkmelzeda jirkvlis venidan aRebuli sisxlis nimuSiT. diagnostikis alternatuli gzaa F18-iT
moniSnuli saanesTezio saSualeba metomidatis (romelsac steroid sinTazas mimarT maRali afinuroba
aReniSneba) indikatoruli doziT pozitron emisiuri tomografiis (PET-CT) Catareba specializirebul
klinikaSi.
dadasturebuli aldosteronomas mkurnaloba laparaskopiul adrenaleqtomiaSi mdgomareobs. es
rekomendebulia axalgazrda pacientebisaTvis, romlebsac surT arteriuli hipertenziisagan gankurneba,
agreTve xandazmulebSi, romlebic ar arian tolerantulni wamlebis mimarT, an romelTa hipertenzia ar
eqvemdebareba mkurnalobas. qirurgiuli Carevis win, an rodesac qirurgiuli Careva ar igegmeba,
hipertenziisa da hiperkalemiis sakontrolod pacientebs eZlevaT mineralokortikosteroiduli receptorebis
antagonistebi spironolaqtoni an eplerononi da Sardmdeni amiloridi, romlebic ainhibireben Na+-is
epiTelur arxebSi Na+-is transports, romelic Cveulebriv aldosteronis kontrolis qveSaa. yvelaze
efeqturia spironolaqtoni (dRiuri doziT 25-100mg), magram qronikuli gamoyenebisas igi iwvevs
ginekomastias. saukeTeso strategiaa eplerononis an spironolaqtonis dabali dozisa da amiloridis
(dRiuri doziT 5-10 mg) SeuRleba. aucilebelia eleqtrolitebis regularuli monitoringi, hiperkalemiisa da
hiponatremiis prevenciis mizniT.
gulis ukmarisoba da misi mkurnaloba
fiziologia da paTofiziologia
gulis wuTmoculoba (gw) damokidebulia gulis SekumSvebis sixSiresa (gSs) da sistolur moculobaze,
dartymiT moculobaze (დმ). es gamoixateba formuliT:
გქ=გშს X დმ
sistolur moculobas aregulirebs sami faqtori: predatvirTva, postdatvirTva da kumSvadoba.

41
  predatvirTva aris gulze Seqmnili datvirTva, romelsac qmnis marcxena winagulidan marcxena
parkuWSi CaRvrili sisxlis is moculoba (parkuWis diastolis bolos), romelsac isvris parkuWi
yoveli SekumSvis Semdeg. igi SeiZleba ganxilul iqnas agreTve, rogorc marcxena parkuWis
gaWimvis sidide. predatvirTva gazrdasTan erTad izrdeba gulis kunTis boWkoebis gaWimvis
xarisxi da sigrZe. amgvarad, predatvirTva aris moculobiT datvirTva da SeiZleba iyos Warbi,
mag., sarqvlovani ukmarisobis dros.
 postdatvirTva aris datvirTva kumSvad parkuWze, anu parkuWis mier gadasrolili sisxlisadmi
Seqmnili arteriuli sistemis winaaRmdegoba (anu totaluri periferiuli winaaRmdegoba).
amgvarad, postdatvirTva aris wneviT datvirTva da Warbia, mag., arteriuli hipertenziis dros.
 kumSvadoba aris miokardiumis unari gamoimuSavos Zala, romelic saWiroa predatvirTvis
sapasuxod da postdatvirTvis dasaZlevad.
gulis qronikuli ukmarisobis definicia
msoflioSi izrdeba mosaxleobis sicocxlis xangrZlivoba, agreTve umjobesdeba miokardiumis mwvave
infarqtis mkurnaloba, amitom imdenad izrdeba gulis qronikuli ukmarisobis sixSire, rom ukve
saubroben gulis ukmarisobis `epidemiaze~. qronikuli ukmarisobis dros guls ar ZaluZs yvela organos
sisxliT momarageba maTi moTxovnilebis Sesabamisad. es gansazRvreba aerTianebs or elements:
pirveli, gulis wuTmoculoba SeiZleba normaluri iyos mosvenebis dros, magram meore, moTxovnis
gazrdis SemTxvevaSi, sasicocxlo organoebis (tvini da Tirkmlebi) perfuzia sxva qsovilebis xarjze
xdeba, gansakuTrebiT ConCxis kunTebis. saerTo jamSi, sistemuri arteriuli wneva am darRvevis
gvian stadiamde narCundeba. gulis ukmarisoba iwvevs neiroendokrinul gaaqtivebas.
am mdgomareobis paTofiziologiis Terapiuli mniSvneloba imaSi mdgomareobs, rom gulis
ukmarisobis Tanmxlebi mravali neiroendokrinologiuri darRveva, gansakuTrebiT reninis gamoyofisa
da simpaTiuri aqtivobis momateba, SeiZleba gamowveuli iyos rogorc medikamenturi mkurnalobiT,
aseve TviT daavadebiT. gulis ukmarisobis adreul fazaSi Tirkmelebis perfuzia normaluria, maSin
roca Sardmdenebi da vazodilatatorebi astimulireben reninis da noradrenalin/norepinefrinis
gamomuSavebas, Sesabamisad Tirkmelebis iuqstaglomerulur aparatsa da arteriebis baroreceptorebze
zemoqmedebiT. gulis yvela saxis daavadebas Tan axlavs adreuli endokrinuli darRveva: gulis
hormonebis, natriurezuli peptidebis anp da bnp (a-atriuli, b-Tavis tvinis, sadac pirvelad iqna
aRmoaCenili) gazrdili gamoTavisufleba. bnp-is plazmismieri koncentracia mkacri prognozuli
maCvenebelia nebismieri stadiis gulis ukmarisobis mqone pacientisaTvis, radgan plazmaSi bnp-is
gazrdili koncentracia daavadebis mgrZnobiare indikatoria42. normaSi es peptidebi Trgunaven reninisa
da aldosteronis gamomuSavebas, magram gulis ukmarisobis dros ikargeba es makontrolirebeli
funqcia, amitom bnp-is gansazRvra gulis ukmarisobis diagnozis dasmaSi gvexmareba.
starlingis mrudi da gulis ukmarisoba
starlingis mrudi aRwers gulis kunTis boWkoebis gazrdili daWimulobis sapasuxod gulis kunTis
kumSvadobis gazrdas, magram mTeli parkuWis mimarTebaSi misadagebis SemTxvevaSi, SeiZleba
Sevsebis wnevasa da gulis wuTmoculobas Soris arsebuli kavSiris axsna. gulis ukmarisobis mqone
pacientebis umravlesoba imyofeba urTierTobis faza `a~-Si, anu ar gadadian `dekompensaciis~ fazaSi
(b), romelSic aRiniSneba parkuWis dilatacia. SardmdenebiT mkurnaloba aumjobesebs gulis
ukmarisobis SegubebiT simptomebs, romlebic gamowveulia Sevsebis wnevis (predatvirTvis)
gazrdiT, magram umravles pacientebSi Sardmdenebi faqtiurad amcireben gulis wuTmoculobas.
aqedan gamomdinare, imisda mixedviT, romelia gulis ukmarisobis wamyvani simptomi - dispnoe
(filtvis venuri Segubebis gamo) Tu daRliloba (gulis Semcirebuli wuTmoculobis gamo),
SardmdenebiT mkurnalobis periodSi pacientebis TviTSegrZneba an umjobesdeba, an ki piriqiT
uaresdeba. gulis ukmarisobis dros agf-inhibitorebis gamoyenebis ZiriTadi efeqturoba maTi zomieri
Sardmdeni efeqtiT aris ganpirobebuli.
gulis qronikuli ukmarisobis WeSmariti codna
gulis dazianeba (mag., miokardiumis infarqti, hipertenzia) iwvevs adaptaciur (`kompensaciur~)
molekulur, ujredul da intersticiul cvlilebebs, romelic aisaxeba gulis zomaze, formasa da funqciaze.
42
hemodinamikuri datvirTvis, neirohormonuli aqtivobisa da sxva faqtorebis sapasuxod iwyeba
miokardiumis hipertrofia da `remodelireba~ da es procesi kvirebisa da Tveebis ganmavlobaSi
mimdinareobs. am procesis Sedegi damokidebulia stimulze: problema aris wneva Tu moculobiT
gadatvirTva. drois gasvlis, agreTve maladaptaciis gamo iwyeba gulis `dekompensacia~ da gulis
ukmarisobis mimdinareoba uaresdeba.
gulis ukmarisobis simZimis klasifikacia eyrdnoba pacientis aqtivobis xarisxs, romelic pacients
SeuZlia ganaxorcielos dispnoes gareSe. niu-iorkis gulis asociaciis (NYHA) klasifikacia gvTavazobs
agreTve savaraudo prognozs. am klasifikaciis mixedviT gulis ukmarisobis yvelaze uaresi xarisxis
(klasi IV) dros prognozi iseTive arakeTilsaimedoa, rogorc kibos dros. gulis ukmarisobis mqone
mravali pacienti iRupeba ariTmiiT da ara terminaluri dekompensaciis gamo, amitom is saSualebebi,
romlebic ewinaaRmdegebian kateqolaminebiTa da vazodilatatorebiT ganpirobebul efeqtebs gulze
(ix. qvemoT), mniSvnelovnad aumjobeseben prognozs.

mkurnalobis miznebi
gulis ariTmiebis dros mkurnalobis mizania avadobisa (simptomebis Semcireba hospitalizaciis
prevencia) da sikvdilianobis Semcireba.
am or mizans Soris arsebobs garkveuli winaaRmdegobrioba: mdgomareoba damauZlurebelic
aris da sasikvdiloc da Sardmdenebi da vazodilatatorebi droebiT aumjobeseben simptomebs, magram
SeiZleba safrTxe Seuqmnan pacientis gadarCenas. .arsebobs kidev erTi problema: vumkurnaloT
wuTmoculobis daqveiTebas, Tu Segubebas. gulis wuTmoculobis daqveiTebis ZiriTadi simptomia
daRliloba, romlis raodenobrivi Sefasebac rTulia, amitom pacientebi ufro metad cdiloben venuri
Segubebis sawinaaRmdegod mimarTon mkurnaloba.
medikamenturi mkurnalobis hemodinamikuri miznebi
gulis mwvave an qronikul ukmarisobis ZiriTadi mizezebia TviTon miokardiumis daavadeba
(upiratesad iSemiuri), an arteriuli hipertenziiT, sarqvlovani aparatis paTologiiT, an arteriul-venuri
SuntiT ganpirobebuli zedmeti datvirTva gulze. gulis qronikuli ukmarisobis marTva iTvaliswinebs
nebismieri gankurnebadi an damamZimebeli mizezis aRmofxvras da uSualod gulis ukmarisobis
sawinaaRmdegod mimarTul mkurnalobas.
TerapiisaTvis sasargebloa im gansxvavebis codna, romelic arsebobs gulis mier sisxlis
gadamtumbav SesaZleblobasa da im winaaRmdegobas Soris, romelic gulma unda gadalaxos sisxlis
gadatumbvis dros. miokardiumis ukmarisobis dros simpaTikuri nervuli sistemis mniSvnelovan
gaaqtivebas aqvs adgili (kompensatoruli moqmedeba kumSvadobis gaZlierebis mizniT), amitom
simpaTikuri gadacemis medikmentur gaZlierebas azri ekargeba. bolo wlebis manZilze farmacevtul
bazarze sxvadasxva kandidati wamlis gamoCenis miuxedavad, digoqsini kvlav rCeba erTaderT
oralurad aqtiur, xangrZlivad gamosayenebel inotropul preparatad.
amis sapirispirod, SesaZloa sakmaod efeqturi aRmoCndes pre- an postdatvirTvis
damaqveiTebeli saSualebebi, gansakuTrebiT marcxena parkuWis moculoba gazrdis SemTxvevaSi
(marjvena parkuWis ukmarisobis SemTxvevaSi maTi efeqturoba nakleb mosalodnelia). am
saSualebebis gamoyenebisas mTavar saSiSroebas warmoadgens gulis wuTmoculobis mkveTri
daqveiTeba, gansakuTrebiT im iSviaT pacientebSi, romelTa gulis wuTmoculobac damokidebulia
marcxena parkuWis maRali avsebis wnevaze, mag., romlebsac daqveiTebuli aqvT sisxlis saerTo
moculoba Sardmdenebis gamoyenebis gamo, an mitraluri mZime stenozis dros.
preparatebis klasifikacia
predatvirTvis Semcireba
Sardmdenebi zrdian marilisa da wylis danakargs, amcireben sisxlis saerTo moculobas da
aqveiTeben venur wnevas. isini TiTqmis yovelTvis saWiroa filtvebisa da periferiuli SeSupebis
Sesamcireblad. gulis zomis zrdasTan erTad gulis wuTmoculobac izrdeba (ix. starlingis mrudis
43
mimoxilva, zemoT). Sardmdenebi moqnilad gamoiyeneba: mkurnaloba iwyeba maTi dabali dozebiT;
dasawyisSi iniSneba Tiazidebi, Semdeg furosemidze gadasvliT, yvelaze ukidures SemTxvevebSi ki
metolazonis gaazrebulad damatebiT.
nitratebi aduneben venebis gluv kunTs, zrdian venuri sarecelis moculobas (romelic normaSi
SeiZleba moicavdes mTeli sisxlZarRvovani sistemis 80%-s), amasTanave amcireben parkuWis
avsebis wnevas, riTac aqveiTeben gulis kunTis daWimulobas da miokardiumis moTxovnilebas
Jangbadze. maTi arteriolebis gamafarTovebeli moqmedeba SedarebiT umniSvneloa. marcxena
parkuWis mwvave ukmarisobis dros efeqturia gliceril trinitratis enis qveS (tabletis an spreis saxiT)
miReba, an intravenuri infuzia. marcxena parkuWis qronikuli ukmarisobis dros nitratebi ar
gamoiyeneba, radgan ufro efeqturia აგფ-inhibitorebi.
postdatvirTvis Semcireba
hidralazini adunebs arteriebis gluv kunTs da amcirebs sisxlZarRvovan periferiul winaaRmdegobas.
refleqsuri taqikardia misi gamoyenebis SemzRudavi faqtoria. 100 mg-ze maRali doziT
gamoyenebisas maRalia wamlismieri wiTeli mgluras ganviTarebis riski.
pre- da postdatvirTvis Semcireba
agf-inhibitorebi da angiotenzin II-is receptorebis blokatorebi (არბ) moqmedeben:
 postdatvirTvis SemcirebiT: angiotenzin I-is aqtiur formad _ angiotenzin II-ad gardaqmnis,
angiotenzin II-is mimarT mgrZnobiare receptorebis inhibirebis gziT, angiotenzin II arteriebis
Zlieri konsqriktoria, amasTanave gulis ukmarisobis dros maRalia misi koncentracia plazmaSi.
 predatvirTvis SemcirebiT: angiotenzin II-is efeqtebis daTrgunva iwvevs aldosteronis
warmoqmnis inhibirebas, ris gamoc mcirdeba marilisa da wylis Sekaveba (mcirdeba sisxlis
moculoba).
agf-inhibitorebi erTaderTi farmakologiuri jgufia, romelic amcirebs periferiul winaaRmdegobas
(postdatvirTvas) simpaTikuri sistemis refleqsuri gaaqtiurebis gareSe. saetapo kvleva CONSENSUS
mieZRvna enalaprilis efeqturobis Sedarebas placebosTan mimarTebaSi, NYHA klasifikaciiT gulis
ukmarisobis IV xarisxis mqone pacientebSi. 6 Tvis Semdeg enalaprilis jgufSi gardaicvala pacientTa
26%, sakontrolo jgufSi ki 44%. sikvdilianobis maCvenebeli Semcirda gulis progresirebadi
ukmarisobis mqone pacientebSi. amJamad, xangrZlivi kvlevebis mixedviT arsebobs mtkicebuleba,
rom agf inhibitorebi da არბ-ebi axangrZliveben pacientebis sicocxlis da amcireben gulis
ukmarisobiT gamowveuli hospitalizaciis sixSires.
praqtikaSi mimarTaven xanmokle moqmedebis აგფ-inhibitoris (mag., oraluri ramiprilis 1,25 mg)
test-dozis gamoyenebas gulis ukmarisobis mqone, an diurezul Terapiaze (nebismieri mizezis gamo,
mag., hipertenziis sakontrolod) myof pacientebSi. aseT pacientebSi arteriuli wneva mniSvnelovnad
aris damokidebuli renin-angiotenzin-aldosteronis sistemis aqtivobaze, amitom agf-inhibitoris an არბ-
is standartulma dozam SeiZleba gamoiwvios arteriuli wnevis mkveTri vardna. aRsaniSnavia, rom
amJamad xelmisawvdom mraval agf-inhibitors gaxangrZlivebuli moqmedeba axasiaTebs da
kumulaciuri efeqtis gamo, sawyisi doza arteriul wnevaze ramdenime dRis ganmavlobaSi
moqmedebs. xangrZlivi moqmedebis agf-inhibitorebs, mag., lizinoprilsa (t1/2 12 sT) da perindoprils
(t1/2 31 sT) naklebad axasiaTebT arteriuli wnevis an Tirkmlis funqciis (glomeruluri filtraciis) pirveli
dozis Semdgomi mkveTri daqveiTebis unari. es preparatebi ambulatoriulad im pacientebs
eniSnebaT, romlebsac ar aReniSnebaT reninis maRali koncentracia plazmaSi (SeSupebis gareSe,
aTerosklerozuli daavadebis gavrcelebis gareSe mimdinareoba), magram gasaTvaliswinebelia, rom
pirveli doza sawolSi dawolis win dainiSnos. mkurnaloba iwyeba agf-inhibitoriT, am ukanasknelebis
autanlobis SemTxvevaSi icvleba არბ-iT, xolo mdgradi simptomebis dros აგფ-inhibitori da არბ-i
erTad iniSneba.
-adrenoreceptorebis blokatorebi. renin-angiotenzin-aldosteronis sistemisa da simpaTikuri nervuli
sistemis gaaqtivebam SeiZleba uaryofiTad imoqmedos gulis qronikuli ukmarisobis mimdinareobaze.
44
am faqtma ubiZga mecnierebs SeeswavlaT iqnas adrenoreceptorebis blokadis SesaZlo sargebeli.
klinikurma kvlevebiT dadgenil iqna, rom standartuli mkurnalobis kursze (Sardmdenebi, digoqsini da
აგფ-inhibitori) bisoprololis, karvedilolis an metoprololis damateba amcirebs sikvdilianobisa da
hospitalizaciis sixSires (ix. qvemoT).
spironolaqtoni. gulis ukmarisobis dros plazmaSi izrdeba aldosteronis done. aldosteronis receptorebis
konkurentuli blokatori, spironolaqtoni moqmedebs rogorc Sardmdeni, magram damatebiT mas aqvs
Zlieri efeqti gulis ukmarisobis gamosavalze (ix. qvemoT). mineralokortikoidebis kidev erTi
antagonisti eplerenoni efeqturia msubuqi da zomieri gulis ukmarisobis dros.
miokardiumis stimulacia
zogadad, digoqsini aumjobesebs miokardiumis kumSvadobas (dadebiTi inotropuli efeqti), magram
gulis dilataciuri ukmarisobis dros ufro efeqturad da ufro xangrZlivad, gansakutrebiT gulis
ukmarisobis epizodis kontrolis qveS ayvanis Semdeg. es efeqti vlindeba sinusuri riTmis mqone
pacientebSi da gansxvavdeba digoqsinis gulis riTmis damaqveiTebeli moqmedebisgan (uaryofiTi
qronotropuli), romelic sasurvelia winagulebis fibrilaciis dros (aumjobesebs parkuWis avsebas).
wyalmankis samkurnalod digitalisis pirveli gamoyenebidan 200 wlis gasvlis Semdeg, eqimebisTvis
digoqsinis xangrZlivi efeqturobis monacemebis mopovebis gasaadvileblad, Catarda DIG kvleva48,
romlis mixedviTac yvela sxva dadebiTi inotropuli saSualebebisgan gansxvavebiT, digoqsini ar zrdis
saerTo sikvdilianobis maCvenebels an ariTmiis risks.
enoqsimoni da milrinoni miokardiumis fosfodiesTerazas seleqciuri inhibitorebia. maT dadebiTi
inotropuli efeqti gaaCniaT da isini gulis mZime SegubebiTi ukmarisobis xanmokle mkurnalobisTvis
gamoyeneba. grZelvadiani gamoyenebis Sesaxeb mtkicebulebebis mixedviT, es preparatebi
amcireben sicocxlis xangrZlivobas.

gulis ukmarisobis medikamenturi marTva

gulis qronikuli ukmarisoba
gulis ukmarisobis mqone nebismierma pacientma (gulis ukmarisobis msubuqi mimdinareobis drosac
ki) unda miiRos agf-inhibitori, pirveli rigis samkurnalo saSualebis saxiT. ramdenime xangrZlivi
kvlevis mixedviT, agf-inhibitorebi axangrZliveben sicocxles.
sxva eTnikur jgufebTan SedarebiT, Savkanian mosaxleobas reninis dabali aqtivoba
aReniSnebaT. adreuli kvlevebis qvejgufebis analizma aCvena, rom randomizebulad SerCeul III da
IV klasis (niu-iorkis gulis asociaciis (NYHA) mixedviT) gulis ukmarisobisa da dilatirebuli
parkuWebis mqone 1050 Savkaniani pacienti iRebda izosorbid dinitratisa (dRiuri doziT 120 mg) da
hidralazinis (dRiuri doziT 225 mg) kombinacias an placebos etapobrivi kvlevis. kvleva naadrevad
dasrulda placebos jgufSi mniSvnelovnad maRali sikvdilianobis maCveneblis gamo (10,2%), vidre im
jgufSi, romelic irebda aqtiur kombinacias (6,2%, P = 0.02)
simptomebis samarTavad Zalian mosaxerxebelia SardmdenebiT mkurnaloba, magram ar zrdis
sicocxlis xangrZlivobas. pacientebis umravlesobas eniSneba maryuJovani Sardmdenebi, mag.,
furosemidi, sawyisi dRiuri doziT 20-40 mg dReSi. agf-inhibitorebis kaliumis Semnaxveli efeqtis
gamo, ar xdeba aucilebeli furosemidTan erTad kaliumis Semnaxveli Sardmdenis, amiloridis
gamoiyeneba, gansakuTrebiT maryuJovani Sardmdenis dabali dozebiT gamoiyenebis SemTxvevaSi.
xangrZlivi drois ganmavlobaSi iTvleboda, rom uaryofiTi inotropuli efeqtis gamo, dauSvebeli iyo
-blokatorebis daniSvna gulis ukmarisobis dros. amJamad xelmisawvdomia utyuari mtkicebuleba -
blokatorebis efeqturobis Sesaxeb gulis qronikuli ukmarisobis dros. adreuli kvlevebi arasakmarisi iyo,
magram meta-analizma daadgina, rom -blokatorebi sikvdilianobis 31% Semcireba. mogvianebiT,
kvlevebma CIBIS-2 da MERIT-HF damoukideblad daadastura, rom qronikul -blokadas aqvs
sicocxlis gamaxangrZlivebeli efeqti gulis zomieri da mZime ukmarisobis (NYHA III/IV) dros51.
orive kvlevis mixedviT sikvdilianobis maCvenebeli 1/3-iT Semcirda. MERIT-HF-Si 1 wliani
45
mkurnalobis Semdeg sicocxle SeunarCunes 27 pacients, rac imas nisnavs, rom agf-inhibitorebTan
SedarebiT, -blokatorebiT mkurnalobas ukeTesi xarjT-efeqturobis profile gaaCnia. es moqmedeba
savaraudod -blokatorebis mTel klass axasiaTebs, amJamad arsebuli preparatebis gansxvavebuli
farmakologiis miuxedavad. .
sikvdilianobis Semcireba agf-is inhibirebiT ganpirobebuli damatebiTi Sedegia da uecari
sikvdilianobis maCveneblis daqveiTebis gamo xangrZlivdeba pacientTa sicocxle mniSvnelovania,
agf inhibitorebiT gamowveuli gulis progresuli ukmarisobis Semcirebisgan gansxvavebiT.
sayuradReboa mxolod is, rom gulis ukmarisobis kontrolis dekompensaciis Tavidan acilebis mizniT,
pacientebs -blokatoriT mkurnaloba ewyebaT dabali sawyisi dozebiT (mag., bisoprololis dRiuri
doza 1,25 mg, an karvedilolis 3,125 mg 2-jer dReSi), mkurnalobaSi CarTuli sxva preparatebis
(gansakuTrebiT maryuJovani Sardmdenebis) dozebis regulirebis fonze.
spironolaqtonis gamoyenebas mxars uWers RALES kvleva, romelmac daadgina, rom gulis
ukmarisobis dros agf-s inhibireba, Tundac agf-inhibitorebis maRali dozebiT, ver Trgunavs efeqturad
hiperaldosteronizms. sasargeblo efeqti viTardeba spironolaqtonis saocrad dabali doziT (25
mg/dReSi). savaraudod, es ganpirobebulia kaliumisa da magniumis konservaciiT (orive
antiariTmulia) da aldosteroniT ganpirobebuli miokardiumis fibrozis ukuganviTarebiT.
standartuli mkurnalobisaTvis arc erTi xelmisawvdomi fosfodiesTerazas oraluri inhibitori ar
gamoiyeneba, radgan mier kumSvadobis xanmokled gazrda ver gadawonis am preparatebis fonze
ganviTarebuli sikvdilianobis sixSires (savaraudod, ariTmiis Sedegad) maTi xangrZlivi gamoyenebis
SemTxvevaSi. isini mxolod simptomebis xanmokle kontrolisTvis gamoiyeneba, mag., transplantaciis
win.
marcxena parkuWis mwvave ukmarisoba
miuxedavad imisa, rom miokardiumis infarqtis Trombolizuri Terapiis xelmisawvdomobam
mniSvnelovnad Seamcira marcxena parkuWis mwvave ukmarisobis sixSire, igi dResac rCeba xSir
gadaudebel samedicino mdgomareobad. mkuranlobis qvakuTxedia maryuJovani Sardmdenis
intravenuri ineqcia (mag., furosemidis 40-80 mg), rac ormag Sedegs iZleva: predatvirTvis swraf da
Zlier Semcirebas venodilataciisa da gaZlierebuli diurezis gamo. unda davarwmunoT SeSfoTebuli
pacienti, rom aucileblad unda ijdes Zirs CamoSvebuli fexebiT, sistemuri venuri midinebis
Sesamcireblad. Tu pacienti egueba saxis niRabs, mas eZleva Jangbadi, amasTanave intravenurad
diamorfini an morfini, romlebsac SfoTvisa da tkivilis sawinaaRmdego efeqtTan erTad, damatebiTi
mniSvnelovani venodilataciuri efeqtic gaaCniaT.
miuxedavad imisa, rom dabali wuTmoculobiT mimdinare marcxena parkuWis ukmarisobis
konkretuli SemTxveva SesaZloa inotropuli saSualebebis xanmokled gamoiyenebasac ki
saWiroebdes, gasaTvaliswinebelia, rom gulis hipoqsiis dros inortopuli saSualebebis umravlesoba
mniSvnelovnad zrdis ariTmiebis risks. gadaudebel SemTxvevebSi digoqsini ar gamoiyeneba, misi
farmakokinetikuri profilis gamo. unda ganixiloT filtvebis damxmare ventilaciis SesaZlebloba, radgan
Tu mTavari problemaa filtvebis SeSupeba, maSin ventilacia inotropul saSualebebze ufro usafrTxo da
efeqturi meTodia.
gulis ukmarisobis qirurgiuli mkurnaloba
es meTodi klinikuri farmakologiis sazRvrebs cdeba, magram imis dadgena, Tu rodis veRar SeZlebs
medikamenturi mkurnaloba simptomebis an prognozis gaumjobesebas, mkurnalobis miznebis erT-
erTi mniSvnelovani elementia da ris Semdegac eqimma unda ganixilos qirurgiuli Carevis
SesaZlebloba. transplantaciis garda, qirurgiuli Careva SeiZleba moicavdes sxva procedurebsac, mag.,
gulis ukmarisobis xelSemwyobi faqtoris, sisxlZarRvebis stenozis dros Suntireba, an stentireba, zogjer
ki marcxena parkuWis damxmare mowyobiloba, an totaluri xelovnuri guli. xandaxan gvexmareba
pacientis darwmuneba imaSi, rom gulis ukmarisoba da preparatebis uefeqtoba sruliadac ar niSnavs
gzis dasasruls.

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Sejameba
 gulis ukmarisobas maSin aqvs adgili, rodesac guli ver uzrunvelyofs yvela organos sisxliT
momaragebas maTi moTxovnis Sesabamisad.
 sistoluri moculoba regulirdeba predatvirTviT, postdatvirTviT da gulis kunTis kumSvadobiT.
 gulis qronikuli ukmarisobis dros Sardmdenebi da nitratebi amcireben predatvirTvas da
uzrunvelyofen simptomebis Semcirebas.
 agf-inhibitorebi aqveiTeben pre- da postdatvirTvas da amcireben avadobisa da sikvdilianobis
sixSires pacientTa daaxloebiT 1/3-Si.
 gulis zomieri an mZime ukmarisobis (NYHA III an IV) mqone pacientebSi -
adrenoreceptorebis blokatorebs agf-inhibitorebis eqvivalenturi efeqti gaaCniaT.
 spironolaqtonis dabali doza damatebiT sargebels iZleva.
 digoqsini ufro efeqturad aumjobesebs dilatirebuli gulis miokardiumis kumSvadobas.
 marcxena parkuWis mwvave ukmarisobis ZiriTadi samkurnalo saSualebebia furosemidi,
diamorfini da Jangbadi.

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