sasunTqi sistema

mokle mimoxilva
 xvela: moqmedebis meTodebi da xvelis sawinaaRmdego saSualebebis gamoyeneba
 respiratoruli stimulatorebi: maTi gamoyeneba TerapiaSi
 filtvis surfaqtanti
 JangbadiT Terapia: misi gamoyeneba da saSiSroebebi
 histamini, antihistaminuri saSualebebi da alergiebi
 bronquli asTma: tipebi, profilaqtikis meTodebi, misi samkurnalo preparatebi da maTi gamoyeneba
sxvadasxva simZimis asTmis dros
 infeqciebi xvela
arsebobs ori saxis xvela: sasargeblo da usargeblo. xvela sasargebloa, rodesac is efeqturad iRebs sekrets an
ucxo sxeulebs sasunTqi sistemidan anu rodesac aris produqtiuli. is usargebloa, rodesac araproduqtiulia da
mudmivi. sasargeblo xvelas unda vacadoT Tavisi miznis ganxorcieleba da unda davTrgunoT mxolod
maSin, rodesac pacientisTvis damRlelia an saSiSi, mag., Tvalis operaciis Semdeg. usargeblo mudmivi
xvela unda Sewydes. asTma, rinosinusitebi (iwveven cxvirxaxaSi sekretis gadasvlas) da ezofageuri
refluqsi mudmivi xvelis yvelaze xSiri mizezebia. cota xnis win, eozinofiluri bronqiti aRiarebul iqna
rogorc SesaZlo mniSvnelovani mizezi. is kargad eqvemdebareba sainhalacio an oralur kortikosteroidebs.
cxadia mudmivi xvelisadmi saerTo midgoma unda moicavdes gamomwvev faqtorebze yuradRebas.
britaneTis Torakalurma sazogadoebam gamoaqveyna xvelisa da misi marTvis saxelmZRvanelo1.
mkurnalobis moqmedebis adgilebi
periferiuli adgilebi
xvelis refleqsis aferentuli mxare: amcirebs stimulis miwodebas yelidan, xorxidan, traqeadan, Tbil tenian
haers aqvs damamSvidebeli moqmedeba xaxaze.
xvelis refleqsis eferentuli mxare: RonisZiebebi sekretis ufro advilad amosaRebad (mukolizuri
saSualebebi, posturuli drenaJi) amcireben xvelis saWiroebas misi efeqturobis gazrdiT.
saukeTeso xvelis sawinaaRmdego saSualeba pirvel rigSi xsnis xvelis mizezs anu mkurnalobs
gamomwvev mizezebs (ix. zemoT). hipertenziis an gulis ukmarisobis mqone pacientebSi mSrali xvelis
mTavari mizezia agf inhibitoriT mkurnaloba. misi gaCereba SeiZleba angiotenzin II receptoris
blokatorze, mag., lozartanze gadasvliT.
centraluri nervuli sistema
preparatebi SeiZleba moqmedebdnen:
 xvelis refleqsis tvinovan gzebze (opioidebi)
 tvinis qerqze
 qerqqveSa gzebze (opioidebi da sedaciuri saSualebebi zogadad).
xvela aseve aris mniSvnelovani nebayoflobiTi kontrolis qveS, SeiZleba gamowveuli iyos fsiqogenuri
faqtorebiT (mag., SfoTva xvelas ar iwvevs wynari musikaluri koncertis dros) da mcirdeba placeboTi.
msgavsi sakiTxebi mniSvnelovania praqtikosi TerapevtebisTvis.
xvelis daTrgunva
periferiulad moqmedi xvelis sawinaaRmdego saSualebebi
mwevelebma unda Sewyviton moweva.
zeda sasunTq gzebSi warmoqmnil xvelas xSirad uxdeba sirofebi da sawuwni abebi, romlebic webvadia
da damamSvideblad faraven xaxas (damamSvidebeli saSualebebi 2), mag., martivi miqstura (ZiriTadad,
Saqris fuZeze damzadebuli sirofi). patara bavSvebi ylapaven sawuwn abebs, amitom sasurvelia tkbili
tabletebi iyos joxze.

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miqsturebi damamSvidebeli preparatebia, romlebic gamoiyeneba rogorc monoTerapiis saxiT, aseve sxva
specifikuri xvelis sawinaaRmdego saSualebebis gadamtanebad. is, rom maTi zusti Semadgenloba
kritikuli ar aris, cnobili iyo da aswavlidnen samedicino institutis studentebs 1896 wels.
mravalma Tqvenganma icis, rom es (martivi) miqstura adre ufro sqeli iyo vidre axlaa da savaraudod, sqeli
miqstura ufro efeqturi iyo. mizezi, Tu ratom gaxda is Txeli SemdegSi mdgomareobs. aRmoCnda, rom
qirurgiuli operaciis mizniT stacionarSi moxvedrili bavSvebis umravlesobas, romlebsac aReniSnebodaT
xvela, miecaT miqstura, magram misi preparatis saxiT gamoyenebis nacvlad, isini mas aZlevdnen moxuc
qals smitfildis bazarSi, romelic bavSvebs sanacvlod aZlevda 1 penis, mihqonda maTi miqstura da misgan
amzadebda murabis namcxvars3.
qveda sasunTq gzebSi warmoqmnili xvela xSirad ixsneba wylis aerozolis inhalaciebiT da Tbili garemoTi
- `orTqlis~ inhalaciiT. rTuli benzois nayeni4 gamoiyeneba inhalaciisTvis Terapiuli aromatis
misaniWeblad (aromatuli inhalacia). amas SeiZleba placeboze meti efeqti hqondes Txeli lorwos sekreciis
stimulaciisTvis, romelic damcavi safarvelis saxiT faravs anTebad lorwovan garss. alternativaamenToli da
evkalipti.
adgilobrivi saanesTezio saSualebebi aseve SeiZleba gamoyenebul iqnas adgilobrivad sasunTq gzebSi
lorwovani xvelis receptorebis pirdapir dasablokad (cvlis daWimvis receptorebs da C-boWkos
daboloebebs). Sefrqveuli lidokaini, mag., amcirebs xvelas boWkovanoptikuri bronqoskopiis dros da
aseve efeqturia Znelad mosaxsneli xvelis dros, romelic SeiZleba Tan axldes bronqul karcinomas.
centralurad moqmedi xvelis sawinaaRmdego saSualebebi
es preparatebi, ZiriTadad, xvelas Trgunaven misi mizezis miuxedavad, tvinSi xvelis centris blokadiT.
opioidebi, mag., metadoni da kodeini Zalian efeqturia, Tumca xvelis sawinaaRmdego efeqtma nawilobriv
SeiZleba gamoiwvios sedaciuri efeqti umaRles nervul centrebSi. miuxedavad amisa, opioidebis xvelis
sawinaaRmdego moqmedeba zogadad cud urTierTkavSirSia maT sunTqvis daTrgunvis gamowvevis
unarTan.
deqstrometorfans (kodeinis analogis, levorfanolis d-izomeri) da folkodins aseve aqvT xvelis
sawinaaRmdego efeqti, romelic ar iblokeba naloqsoniT, ara -tipis opioiduri receptorebic albaT CarTulia
(da gaormagebulia -tipi). gasakviri ar aris, rom am opioidebs aseve aqvT umniSvnelo
tkivilgamayuCebeli an sunTqvis damTrgunveli efeqtebi im dozebiT, romlebic saWiroa maTi xvelis
sawinaaRmdego moqmedebisTvis.
opioidebi, ZiriTadad, gamodis xvelis sawinaaRmdego miqsturebis saxiT. gadawyvetileba romelime
preparatis gamoyenebis Sesaxeb damokidebulia imaze, sedacia da analgezia aris Tu ara miqsturis
sasurveli moqmedeba. aqedan gamomdinare, metadonis an diamorfinis miqstura SeiZleba umjobesi iyos
bronquli karcinomis mqone pacientebSi. piriqiT, folkodini, ar aris sedaciuri da ar iwvevs miCvevas,
farTod Sedis ureceptod gayidvad miqsturebSi.
sedacia zogadad amcirebs xvelis refleqsis mgrZnobelobas. aqedan gamomdinare, Zvelma sedaciurma
antihistaminurma saSualebebma, mag., difenhidraminma, SeiZleba daTrgunos xvela ara H1-receptoruli
moqmedebiT. saWiro dozebi xSirad iwveven Zlier Zilianobas, amitom sxva preparatebTan, mag.,
folkodinTan da deqstrom-TorfanTan kombinacia Sedis ureceptod gayidvad xvelis sawinaaRmdego
saSualebebSi.
mukolizuri da amosaxvelebeli saSualebebi
sasunTq sistemaSi yoveldRiurad gamomuSavdeba daaxloebiT 100 ml siTxe da misi umetesoba iylapeba.
sasunTqi sistemis lorwo, ZiriTadad, Seicavs wyals da misi webvadi xasiaTi ganpirobebulia disulfiduri
xidakebiT glikoproteinebis ganivi kavSirebiT. paTologiis dros gamomuSavdeba ufro meti lorwo. plazmis
cilebis eqsudacia, romlebic xidakebiT dakavSirebulia glikoproteinebTan da qmnian ufro did polimerebs,
lorwos ufro metad webvads xdis. gulmkerdis daavadebebis, mag., kistozuri fibrozisa da bronqoeqtazebis
mqone pacientebs uWirT xveliT blanti naxvelis amoxveleba, radgan bronquli wamwamebis moqmedeba
uefeqtoa. Sedegs iZleva lorwos gamaTxierebeli saSualebebi.

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mukolizuri saSualebebi
karbocisteins da mecisteins aqvs Tavisufali sulfhidriluri jgufebi, romlebic xsnian disulfidur xidakebs
lorwoSi da amcireben mis siblantes. isini miiReba Sinagani wesiT an inhalaciiT (an instilaciiT) da
gansakuTrebiT efeqturia blanti sekretis (kistozuri fibrozi, traqeostomis movla) dros. mukolizurma
saSualebebma SeiZleba gamoiwvion kuW-nawlavis gaRizianeba da alergiuli reaqcia.
wylis inhalacia aerozolis saxiT (sunTqva cxeli abazanis Tavze) iafi da efeqturi amosaxvelebeli Terapiaa
bronqoeqtazebis dros. dehidratirebuli pacientis ubralo hidratacias aseve SeiZleba hqondes kargi efeqti
naxvelis siblantis Sesamcireblad.
dornaze aris adamianis fosforilirebuli glikozirebuli rekombinanturi deoqsiribonukleaza. is miiReba
yoveldRiurad Sesafrqvevi xsnaris inhalaciis saxiT, romelic Seicavs 2500 erT (2,5 mg). is gamoiyeneba
mxolod cisturi fibrozis mqone pacientebSi, rodesac qloris transportis genetikuri defeqti iwvevs
gansakuTrebiT blant naxvels. sasunTqi gzebis daxSoba, iseve rogorc naxveli TavisTavad, aris
paTogenisTvis saukeTeso maxe, SemoWrili neitrofilebis lizisi iwvevs cisturi fibrozis mqone sasunTq
gzebSi Tavisufali da Zalian blanti dnm-is mniSvnelovan matebas.
amosaxvelebeli saSualebebi
produqciuli xvelis stimulacia zrdis bronquli sekretis moculobas. arsebobs mcire klinikuri mtkicebulebebi
da maT SeiZleba placeboze meti mniSvneloba ar hqondeT. es jgufi moicavs zRvis xaxvs, guafenezins,
ipekakuanas, kreozotebs da eTerzeTebs.
xvelis miqsturebi
yvela farmakologiuri cnobari savsea xvelis sawinaaRmdego, amosaxvelebeli, mukolizuri,
bronqodilataciuri da sedaciuri saSualebebis kombinaciebiT. miuxedavad imisa, rom arCevani didia,
aqtiuri nivTierebebis codna mniSvnelovania, radgan zogierTi maTgani Seicavs sedaciur antimuskarinul
antihistaminebs an fenipropanolaminebs (antihipertenziuli saSualebebis antagonistebs). glicerolis an
sirofis, rogorc xvelis damamSvidebeli preparatis, an martivi miqsturis (limonmJavas) gamoyeneba albaT
gamarTlebulia.
preparatebiT mkurnalobis arCeva xvelis dros
rogorc yovelTvis, nebismieri mkurnalobis dawyebamde aucilebelia naTeli idea arsebuli problemebis
gadasaWrelad. mag., xvelisadmi midgoma bronqSi simsivnis SeWris dros gansxvavdeba qronikuli
sinusitis gamo cxvirxaxaSi lorwos gadasvlis an qronikuli bronqitis dros midgomisgan. ixileT Semdgomi
zogadi rekomendaciebi.
usargeblo xvelis martivi daTrgunva
kodeinis, folkodinis, deqstrometorfanis da metadonis miqsturebi farTod gamoiyeneba mcire dozebiT.
bavSvebSi, xvela TiTqmis yovelTvis sasargebloa da sedacia RamiT ufro efeqturia mosvenebis mizniT.
sedaciuri antihistaminuri saSualeba mosaxerxebelia (mag., prometazini), Tumca uaryofiTi aqvs naxvelis
gasqeleba. yivanaxvelas dros SeiZleba kodeinis da atropinis meTonitratis gamoyeneba.
bronquli sekretis odnav gazrda da misi gaTxiereba
wylis aerozolis menToliT an mis gareSe da benzois inhalaciam, an menTolisa da evkaliptis inhalaciam
SeiZleba uzrunvelyos usafrTxo komforti.
karbocisteini an sxva mukolizuri saSualeba Sinagani wesiT zogjer SeiZleba sasargeblo iyos.
preparati, romelic Seicavs antimuskarinuli moqmedebis mqone nivTierebas, arasasurvelia, radgan is
asqelebs bronqul sekrets. Jangbadis inhalacia aSrobs sekrets da xdis ufro blants. Jangbadi pacientisTvis
miwodebisas unda gatardes wyalSi da pacients SeiZleba dasWirdes RonisZiebebi naxvelis
gasaTxiereblad.
xaxis regionSi warmoqmnili xvela

3
webvadi tkbileuli an sawuwni tabletebi (damamSvidebeli saSualebebi), Trgunaven Tu ara xvelas,
saWiroebis SemTxvevaSi gamoiyeneba.
sunTqvis mastimulirebeli saSualebebi
am mizniT gamoyenebadi preparatebi (analefsiuri saSualebebi) astimulireben cns-s da Terapiulze maRali
dozebiT SeiZleba krunCxvebi gamoiwvion. aqedan gamomdinare, maTi gamoyeneba saWiroa
meTvalyureobis qveS.
doqsaprami zrdis sunTqvis sixSiresa da siRrmes tvinSi sunTqvis centrebis pirdapiri da refleqsuri,
karotiduli sxeulakis stimulirebis gziT.venaSi 1,5-4,0 mg/wT uwyveti infuzia SeyavT pacientis Sedegis
Sesabamisad.xvela da laringospazmi, romelic viTardeba misi gamoyenebis Semdeg, SeiZleba iyos
normaluri damcvelobiTi pasuxis aRdgena.
gverdiTi efeqtebi moicavs mousvenrobas, krunCxviT SekumSvebs, qavils, Rebinebas, saxis siwiTles,
bronqospazms da gulis ariTmiebs da damatebiT, doqsaprami iwvevs pacientebSi gardamavalsiTbos
SegrZnebas. maRali dozebiT is zrdis arteriul wnevas.
aminofilini (Teofilinisa da edta-s kompleqsi) misi sxva moqmedebebis garda (ix. aseve gv. 170),
astimulirebs sunTqvas da SeiZleba misi gamoyeneba neli infuziis saxiT (500 mg 6 sT-Si).
gamoyeneba
sunTqvis stimulatorebis roli mniSvnelovnad Semcirda sunTqvis mwvave ukmarisobis marTvaSi, rasac
mosdevs cxviriT maRali wneviT ventilaciis gazrda sunTqvis ukmarisobisTvis.situaciebi, rodesac isini jer
kidev gamoiyenebian:
 filtvis qronikuli daavadebis gamwvaveba hiperkapniiT, ZilianobiTa da xvelis uunarobiT an
CasunTquli Jangbadis dabali koncentraciebisadmi (24%) Segueba (haeris 21% aris Jangbadi).
sunTqvis mastimulirebel saSualebas SeuZlia gamoiwvios pacientis agzneba efeqturi fizioTerapiis
Casatareblad da sunTqvis stimulaciiT aumjobesebs ventilacia-perfuzias. xanmokle RonisZiebis
saxiT, misi gamoyeneba SeiZleba damxmare ventilaciasTan erTad traqeis intubaciis (BIPAP5)
gareSe da amgvarad, xdeba `drois mogeba~ qimioTerapiisTvis infeqciis gasakontroleblad da traqeis
intubaciisa da xelovnuri ventilaciis asacileblad.
 apnoe dRenaklul axalSobilebSi. aminofilini da kofeini SeiZleba efeqturi iyos zogierT
SemTxvevaSi.
sunTqvis stimulatorebi sifrTxiliT gamoiyeneba epilefsiis mqone pacientebSi (krunCxvebis riski). sxva
SedarebiTi ukuCvenebebia gulis iSemiuri daavadeba, mwvave mZime xarisxis asTma (`asTmuri
statusi~), mZime hipertenzia da Tireotosikozi.
gamaRizianebel orTqlebs inhalaciisas aqvT analefsiuri moqmedeba gonebis dakargviT, gansakuTrebiT,
Tu aris fsiqogenuri, mag., amiakis (saynosi marili) aromatuli xsnari. maT zogjer `aqvT anamnezuri
reaqcia Warb da mSral spirtebze maTTvis damaxasiaTebeli mdgomareobiT6~.
filtvis surfaqtanti
endogenuri surfaqtantis sistema iwvevs alveolebis zedapiris stabilur dabal daWimulobas da xels uSlis
maT kolafss. bunebrivi surfaqtantis gamomuSavebis Sewyveta iwvevs respiratorul distres sindroms, maT
Soris axalSobilebSic. amJamad, SesaZlebelia sinTezuri fosfolipidebis intratraqeuli Seyvana, romlebic
moqmedeben surfaqtantis msgavsad: kolfosceril palmitati, poraqtanti  da beraqtanti. isini inaxeba
siciveSi da mwarmoeblis instruqcias unda mivyveT sifrTxiliT, radgan sxeulis temperaturamde
gaTbobisas maTi fizikur-qimiuri Tvisebebi swrafad icvleba. maTi funqcia aris alveolebis zedapiris
dafarva da Ria mdgomareobaSi SenarCuneba. maTi daniSvna asrulebs mTavar rols respiratoruli distres
sindromis mqone dRenaklul axalSobilebSi sikvdilianobisa da Soreuli garTulebebis SemcirebaSi.
JangbadiT mkurnaloba
TerapiaSi gamoyenebadi Jangbadi iseTive sifrTxiliT iniSneba, rogorc nebismieri preparati. saWiroa
miznis kargad gansazRvra da misi efeqtebis obieqturi kontroli.
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absoluturi Cvenebaa CasunTquli haeriT qsovilebis araadeqvaturi oqsigenacia. klinikuri niSnebi SeiZleba
iyos arazusti, saeWvo SemTxvevaSi unda Sefasdes arteriuli sisxlis airebi. qsovilebis hipoqsia SeiZleba
vivaraudoT, rodesac PaO2 mcirdeba 6,7 kpa (50 mm vwy.sv.) qvemoT Cveulebriv mwvave avadmyof
pacientSi, mag., miokardiumis infarqtis, mwvave filtvismieri darRvevebis, preparatis dozis
gadaWarbebis, ConCx-kunTovani an Tavis travmis dros. qronikul hipoqsiur pacientebSi SeiZleba
SenarCundes qsovilebis adeqvaturi oqsigenacia 6,7 kpa-ze naklebi PaO2 dros kompensatoruli adaptaciis
saSualebiT, romelic moicavs wiTeli ujredebis raodenobis gazrdas da Secvlili hemoglobin-Jangbadis
kavSiris maxasiaTeblebs. JangbadiT mkurnaloba gamoiyeneba:
 Jangbadis maRali koncentraciiT mkurnaloba gamoiyeneba dabali PaO2 dros normaluri an dabali
PaCO2 (sunTqvis ukmarisobis I tipi) fonze, rac aRiniSneba: filtvis emboliis, pnevmoniis, filtvis
SeSupebis, miokardiumis infarqtis da axalgazrda pacientebSi mZime xarisxis mwvave asTmis dros.
100%-ze meti Jangbadis koncentraciis gamoyeneba SeiZleba xanmokle vadiT, radgan aris
hipoventilaciisa da naxSirorJangis dagrovebis ganviTarebis mciredi riski.
 Jangbadis dabali koncentraciiT mkurnaloba gamoiyeneba dabali PaO2 da gazrdili PaCO2
(ukmarisobis II tipi) dros, romelic Cveulebriv aRiniSneba filtvis qronikuli obstruqciuli daavadebis
gamwvavebis dros. sunTqvas astimulirebs gazrdili PaCO2, magram es kontroli ar xdeba qronikuli
hiperkapniis mqone pacientebSi, romelTa respiratorul moqmedebas iwvevs hipoqsia. PaO2 gazrda
aseT pacientebSi Jangbadis maRali koncentraciebis miRebiT, xsnis maT ventilaciis stimuls, Zalian
zrdis naxSirorJangis dagrovebas da SeiZleba gamoiwvios fataluri respiratoruli acidozi. aseT
pacientebSi mkurnalobis mizania sakmarisi Jangbadis miwodeba hipoqsiis Sesamcireblad,
hiperkapniis da respiratoruli acidozis gaZlierebis gareSe. normaSi CasunTquli Jangbadis
koncentracia ar unda aRematebodes 28%-s da zogjer 24%-ic SeiZleba iyos sakmarisi.
 JangbadiT xangrZlivi mkurnaloba binaze utardeba mZime mudmivi hipoqsiis da filtvismieri gulis
mqone pacientebs filtvis qronikuli obstruqciuli daavadebis gamo (ix. qvemoT). pacientebi
uzrunvelyofili arian Jangbadis koncentratoriT. klinikuri kvlevebi gviCveneben, rom Jangbadis
miReba dReSi 15 sT-ze meti xnis ganmavlobaSi aumjobesebs sicocxlis xangrZlivobas.
histamini, antihistaminuri saSualebebi da alergiebi
histamini bunebrivi aminia, romelmac ukve didi xania moxibla farmakologebi da eqimebi. igi
aRmoCenilia mraval qsovilSi araaqtiuri SeboWili formis saxiT. farmakologiurad aqtiuri Tavisufali
histamini, romelic gamoTavisufldeba stimulis sapasuxod, rogoric aris fizikuri travma an imunoglobulin E
gamowveuli moqmedeba, aris mwvave anTebis pasuxis mniSvnelovani komponenti.
histaminis fiziologiuri funqciebi gamowveulia organizmSi misi ganawilebiT:
 organizmis epiTeliumSi (nawlavSi, sasunTq sistemaSi da kanSi), sadac is gamoTavisufldeba ucxo
nivTierebebis SeWris sapasuxod
 jirkvlebSi (kuWis, nawlavis, sacremle, sanerwyve), sadac is uzrunvelyofs normaluri sekreciuli
procesebis nawils
 foyier ujredebSi sisxlZarRvebis axlos, sadac is TamaSobs rols mikrocirkulaciis regulirebaSi.
moqmedeba
histamini moqmedebs, rogorc adgilobrivi hormoni (avtakoidi) serotoninis an prostaglandinebis msgavsad
anu is funqcionirebs misi gamoTavisuflebis adgilebis uSualo siaxloves. kuWis sekreciis dros, mag.,
histaminis Semcvel ujredebze receptorebis stimulacia iwvevs histaminis gamoTavisuflebas, romelic Tavis
mxriv moqmedebs parietuli ujredebis receptorebze da isini gamoimuSaveben wyalbadis ionebs (ix.
kuWis sekrecia, 31 Tavi). histaminis moqmedeba klinikurad mniSvnelovania:
gluv kunTebze
zogadad, histamini iwvevs gluvi kunTebis SekumSvas (arteriolebis garda, magram moqmedebs did
arteriebze). orsuli adamianis saSvilosnos stimulacia umniSvneloa. bronqospazmis swrafi Seteva SeiZleba
gamoiwvios alergiis, gansakuTrebiT asTmis mqone pirebSi.

5
sisxlZarRvebze
arteriolebi gafarToebulia da mcirdeba arteriuli wneva. es moqmedeba nawilobriv ganpirobebulia
histaminis receptoris gaaqtiurebis sapasuxod, arteriolebis endoTeliumidan azotis oqsidis
gamoTavisuflebiT. aseve izrdeba kapilarebis gamtaroba, gansakuTrebiT, postkapilaruli venulebis, rac
iwvevs SeSupebas. arteriolebze da kapilarebze am efeqtebiT gamowveuli saxis siwiTle da buStukebiaris
Tomas levisis mier aRwerili sammagi pasuxis komponentebi 7. mesame nawili, anTebiTi hiperemia,
gamowveulia arteriolebis dilataciiT aqsonis refleqsis Sedegad, romelic gamoaTavisuflebs neiropeptidebs
C-boWkovani daboloebebidan.
kanze
histaminis gamoTavisuflebam kanSi SeiZleba gamoiwvios qavili.
kuWis sekreciaze
histamini zrdis mJavasa da pepsinis Semcvelobas kuWis wvenSi.
zemoT aRwerili moqmedebebidan gamomdinare, anafilaqsiuri Soki, romelic gamowveulia didi
raodenobiT histaminis gamoTavisuflebiT, xasiaTdeba sisxlis mimoqcevis moSliT da bronqospazmiT.
yvelaze swrafi efeqturi antidotia adrenalini (epinefrini) (ix. qvemoT), aseve SeiZleba antihistaminuri
saSualebis (H1 receptori) miReba.
sxvadasxva qimiurma nivTierebam SeiZleba gamoiwvios histaminis gamoTavisufleba. maTgan yvelaze
Zlierebi (proteolizuri fermentebi da gvelis Sxami) TerapiaSi ar gamoiyeneba, magram zogierTi
sasargeblo preparati, rogoric aris D-tubokurarini, morfini da kidev zogierTi antihistaminuri saSualeba,
iwvevs histaminis gamoTavisuflebas. anafilaqsiuri (anu IgE damoukidebeli) efeqti, ZiriTadad, klinikurad
zomieria da vlindeba arteriuli wnevis gardamavali SemcirebiT an kanis adgilobrivi reaqciiT, magram
asTmis mqone pirebSi SeiZleba aRiniSnos mniSvnelovani bronqospazmi.
metabolizmze
histamini warmoiqmneba aminomJava histidinisgan da ZiriTadad, inaqtivirdeba deaminirebiTa da
meTilirebiT. sxva adgilobrivi hormonebis msgavsad, es Zalian swrafi procesia.
histaminur receptorebze
histamini ukavSirdeba H1, H2 da H3 receptorebs, romlebic SekavSirebulni arian G-cilasTan. H1 receptori
pasuxismgebelia pro-anTebiTi efeqtebis, maT Soris vazomotoruli cvlilebebis, sisxlZarRvebis
gamtareblobis gazrdis da sisxlZarRvis endoTeliumze molekulebis adheziis zeregulaciis ganviTarebaze
(ix. gv.425), anu iwvevs SeSupebasa da histaminis sisxlZarRvovan efeqtebs. H2 receptorebi iwveven
kuWis mJavas gamoyofas (ix. gv. 561). histaminisH1 da H2 receptorebis blokadas aqvs mniSvnelovani
Terapiuli sargebeli.
H3 receptorebi aRiniSneba mraval qsovilSi, tvinisa da nervuli daboloebebis CaTvliT da maTi funqciaa
histaminis inhibitorebisa da sxva neirotransmiterebis ukukavSiri.axlaxans aRmoCenilia H4 receptori,
romelic monawileobs leikocitebis qemotaqsisSi.
histaminis antagonizmi da H1- da H2-receptorebis antagonistebi
histaminis efeqtebze moqmedeba SeiZleba sami gziT:
 sawinaaRmdego efeqtebis mqone preparatebis gamoyenebiT. histamini iwvevs bronqebis
konstriqcias, vazodilatacias da zrdis sisxlZarRvebis gamtarobas; adrenalini (epinefrini)  da 2
adrenoreceptorebis gaaqtiurebiT, iwvevs sapirispiro efeqtebs - e.w. fiziologiuri antagonizmi.
 histaminis SeboWvis dablokviT misi moqmedebis adgilebze (receptorebze), anu H1 da H2-receptoris
konkurentuli antagonistebis gamoyenebiT.
 depo ujredebidan histaminis gamoTavisuflebis dablokviT. glukokortikoidebs da natriumis
kromoglikats SeuZlia IgE-Ti gamowveuli histaminis gamoTavisuflebis daTrgunva foyieri
ujredebidan. 2 agonistebs aqvT msgavsi efeqti.
6
pirvelad dainerga H1 histaminuri receptorebis konkurentuli blokatorebi da pirobiTad maT
`antihistaminebs~ uwodeben. isini efeqturad Trgunaven sammagi pasuxis komponentebs da nawilobriv
xels uSlian histaminis hipotenziur efeqts, magram isini ar moqmedeben histaminiT gamowveul kuWis
sekreciaze, romelic iTrguneba histaminis H2 receptorebis blokadiT. amgvarad, histaminis antagonistebi
klasificirdeba, rogorc:
 histaminis H1 receptorebis antagonistebi (ix. qvemoT)
 histaminis H2 receptorebis antagonistebi: cimetidini, famotidini, nizatidini, ranitidini
 histaminis H3 receptorebis antagonistebi.
seleqciuroba, rac igulisxmeba terminSi `antihistamini~, aradamakmayofilebelia, radgan Zveli, pirveli
Taobis antagonistebi (ix. qvemoT) avlenen muskarinuli receptorebis da xSirad, aseve serotoninisa da -
adrenerguli receptorebis sawinaaRmdego mniSvnelovan mablokirebel moqmedebas. es Tvisebebi
arasasurvelia, rodesac H1antihistaminuri saSualebebi gamoiyeneba konkretulad histaminis efeqtebis
sawinaaRmdegod, mag., alergiis dros. aqedan gamomdinare, meore Taobis H1 antagonistebis gamoCena,
romlebic ufro seleqciuria H1 receptorebis mimarT da ar aqvT antimuskarinuli da sedaciuri efeqtebi (ix.
qvemoT), mniSvnelovani winapirobaa. isini SeiZleba ganxilul iqnan erTad.
moqmedeba
H1 receptorebis antihistaminuri saSualebebi sxvadasxva xarisxiT ewinaaRmdegebian gamoTavisuflebuli
histaminis efeqtebs.isini, ZiriTadad, arian konkurentuli, dasaZlevi inhibitorebi da Zlierad blokaven
sammagi pasuxis yvela komponents (sufTa H1-receptoruli efeqti), magram mxolod nawilobriv uSlian xels
histaminis maRali dozebis hipotenziur efeqts (Sereuli H1- daH2-receptoruli efeqti). H1 antihistaminuri
saSualebebi naklebad gamoiyenebian asTmis dros, romelSic arahistaminuri mediatorebi -cisteinil-
leikotrienebi, arian ZiriTadi konstriqtorebi. isini ufro efeqturia, Tu gamoiyeneba histaminis
gamoTavisuflebamde da Tavisufali histaminis efeqtebis moxsna ufro advilad miiRweva adrenalinTan
(epinefrini) fiziologiuri antagonizmis Sedegad, romelic pirveli gamoiyeneba sicocxlisTvis saSiSi alergiuli
reaqciebis dros.
Zveli, pirveli Taobis H1 antihistaminuri saSualebebi iwveven Zilianobas. pacientebi gafrTxilebul unda
iqnan, rom ar SeiZleba avtomanqanis an sxva teqnikuri saSualebis marTva da efeqti Zlierdeba
alkoholTan erTad. paradoqsulad, maT SeuZliaT gazardon krunCxvebis sixSire epilefsiis mqone pirebSi,
gansakuTrebiT bavSvebSi da gamoiwvion krunCxvebi araepilefsiur pirebSi dozis gadaWarbebisas. axali,
meore Taobis H1 antihistaminuri saSualebebi naklebad aRweven hematoencefalur barierSi da ar aqvT
aseTi centraluri efeqtebi. pirveli Taobis H1 antihistaminuri saSualebebis antimuskarinul efeqtebs zogjer
Terapiuli upiratesoba eniWeba parkinsonizmisa da zRvis avadmyofobis dros.
farmakokinetika
H1 antihistaminuri saSualebebi miiReba Sinagani wesiT da kargad Seiwoveba. isini, ZiriTadad
metabolizdeba RviZlSi. gamoiyofa dedis rZeSic, ramac SeiZleba gamoiwvios Zilianoba axalSobilebSi.
isini iniSneba Sinagani wesiT, aseve SeiZleba kunTSi an venaSi Seyvana.
gamoyeneba
H1 antihistaminuri saSualebebi gamoiyeneba alergiis simptomebis - Tivis cxelebisa da WinWris ciebis
Sesamcireblad (ix. qvemoT).maT aqvT msgavsi Terapiuli efeqturoba.
individualuri H1-receptoruli antihistaminuri saSualebebi
arasedaciuri meore Taobis preparatebi
es axali preparatebi SedarebiT seleqciuria H1 receptorebisTvis, naklebad aRweven tvinSi, vidre Zveli
antihistaminuri saSualebebi da ar aqvT arasasurveli antimuskarinuli efeqtebi. gansxvavdebian
moqmedebis xangrZlivobiT.
cetirizini (t1/2 7 sT), loratadini (t1/2 15 sT) da terfenadini (t1/2 20 sT) efeqturia, miiReba dReSi 1-jer da
Sesabamisia zogadi gamoyenebisTvis. akrivastins (t1/2 2 sT) imdenad xanmokle moqmedeba aqvs, rom
7
misi gamoyeneba SeiZleba wyvetili Terapiis dros, mag., rodesac simptomebi aRiniSneba pacientSi,
romelic adgilobrivad mkurnalobs Tivis cxelebas. sxva arasedaciuri antihistaminuri saSualebebia
desloratadini, feqsofenadini, levocetirizini da mizolastini.
gverdiTi movlenebi
meore Taobis antihistaminuri saSualebebi kargad gadaitaneba, magram sayuradRebo efeqti aqvs
terfenadins. am preparats SeuZlia QTc intervalis gaxangrZliveba ekg-ze, kaliumis arxebis dablokviT
gulSi (kaliumis dinebis Semanelebeli reqtifikatorisswrafi komponenti, Ikr), rac iwvevs damaxasiaTebel
parkuWovan taqikardias (torsade de pointes, ix. gv. 459) da albaT amiT aixsneba uecari sikvdili
terfenadinis adreuli gamoyenebis dros. SemTxveva aRiniSneba terfenadinis maRali dozebis an misi
metabolizmis inhibirebis dros. terfenadini damokidebulia mxolod citoqrom P450 3A4 izoformaze da
ainhibireben preparatebi eriTromicini, ketokonazoli da kidev greifrutis wveni. feqsofenadins, terfenadinis
aqtiur metabolits, aqvs gacilebiT dabali afinuroba Ikr arxis mimarT da usafrTxoa am mxriv.
pirveli Taobis sedaciuri preparatebi
qlorfenamini (t1/2 20 sT) efeqturia urtikariis dros da misi sedaciuri efeqti sasargebloa.
difenhidramini (t1/2 32 sT) Zlieri sedaciuri saSualebaa da aqvs antimuskarinuli efeqtebi. is aseve
gamoiyeneba parkinsonizmisa da zRvis daavadebis dros.
prometazini (t1/2 12 sT) imdenad Zlieri sedaciuri saSualebaa, rom gamoiyeneba rogorc saZile saSualeba
mozardebsa da bavSvebSi.
alimemazini, azatadini, bromfeniramini, klemastini, ciproheptadini, difenilpiralini, doqsilamini,
hidroqsizini da triprolidini msgavsia.
gverdiTi movlenebi
sedaciis garda, moicavs: Tavbrusxvevas, daRlilobas, uZilobas, momatebul agznebadobas, kankals da
antimuskarinul efeqtebs, mag., piris simSrales, dabindul mxedvelobas da kuW-nawlavis traqtis mxriv
darRvevebs. SeiZleba aRiniSnos dermatiti da agranulocitozi. dozis gadaWarbebis gamo mZime
mowamvlis Sedegad viTardeba koma da zogjer krunCxvebi.
preparatebis marTva zogierTi alergiuli mdgomareobis dros
histamini gamoTavisufldeba mravali alergiuli mdgomareobis dros, magram is ar aris simptomebis
erTaderTi mizezi. sxva qimiuri mediatorebic, mag., leikotrienebi da prostaglandinebi, aseve arian
CarTulni. aqedan gamomdinare, H1-receptoruli antihistaminuri saSualebebis sargebeli alergiuli statusis
dros cvladia da damokidebulia im moculobaze, romliTac histamini sxva mediatorebze ukeT iwvevs
klinikur gamovlinebebs.
aqve, SeniSvna, rom H2-receptorebis antagonistebis (kuWis mJavas sekreciis Semcirebis funqciis garda)
gamoyeneba SeiZleba I tipis hipermgrZnobelobis pasuxis efeqtebis, mag., rinitis, urtikariis da
koniunqtivitisSesamcireblad.
Tivis cxeleba
Tu simptomebi Semoifargleba mxolod rinitiT, glukokortikoidi (beklometazoni, betametazoni, budesonidi,
flunisolidi an triamcinoloni), ipratropiumi an natriumis kromoglikati gamoiyeneba adgilobrivad spreis an
Sefrqvevis saxiT, rogorc xSirad aris saWiro. mxolod Tvalis simptomebi kargad eqvemdebareba natriumis
kromoglikatis wveTebs. rodesac aRiniSneba cxvirisa da Tvalis simptomebi erTad, an sasisa da yurebis
qavili, iniSneba sistemuri arasedaciuri H1-receptoruli antihistaminuri saSualeba. simpaTomimeturi
vazokonstriqtorebi, mag., efedrini adgilobrivi gamoyenebisas maSinve iZleva efeqts, magram preparatis
moxsnisas viTardeba cxviris lorwovani garsis SeSupeba. iSviaTad, sistemuri glukokortikoidi, mag.,
prednizoloni gamarTlebulia mZime pacientSi simptomebis Sesamcireblad mokle vadiT, mag.,
gamocdebis periodSi8.

8
hiposensibilizacia, romelic tardeba kanqveSa ineqciiT etapobrivad da zrdian balaxebisa da xeebis mtvris
eqstraqtis raodenobas, aris alternativa sezonuri alergiuli Tivis cxelebis dros mtvris gamo (romelic ar
eqvemdebareba alergiis sawinaaRmdego preparatebs), xolo futkrisa da bzikis alergenebis eqstrati im
adamianebisTvis, romlebsac aReniSnebaT alergia am Sxamebis mimarT (romelTa zemoqmedebac
SeiZleba sicocxlisTvis saSiSi iyos). Tu hiposensibilizacia xorcieldeba, xelmisawvdomi unda iyos
aparatura dauyovnebeli kardiopulmonuri reanimaciis gansaxorcieleblad anafilaqsiis riskis
gamo.ganviTarebadi strategiaa IgE sawinaaRmdego monoklonuri antisxeulebis (omalizumabi)
gamoyeneba, romelic iwvevs plazmaSi IgE koncentraciis swraf, doza-damokidebul da myar daqveiTebas
atopiuri da egzogenuri asTmis mqone pacientebSi. antisxeulebi ukavSirdebian IgE molekulis nawils,
romelic maRali afinurobiT urTierTqmedebs IgE receptorTan foyier ujredebsa da bazofilebSi, riTac xels
uSlis am ujredebis gaaqtiurebas SekavSirebuli IgE-s jvaredini kavSiriT.
urtikaria
anafilaqsiuri Soki
bronquli asTma
asTma aRiniSneba didi britaneTis mosaxleobis 10-15%-Si. es sixSire izrdeba.
paTofiziologia
bronqebi hiperreaqciuli xdeba mudmivi anTebiTi procesis Sedegad, biologiuri agentebis Semcveli
gamRizianeblebis, mag., alergenebis, virusebis da garemos qimiuri damabinZureblebis, rogoric aris ozoni
da glutaraldehidi, sapasuxod. anTebis mediatorebi gamoTavisufldebian foyieri ujredebidan,
eozinofilebidan, neitrofilebidan monocitebidan da makrofagebidan. zogierTi mediatori, mag., histamini,
aris mza forma da gamoTavisuflebisTanave iwvevs dauyovnebel bronqul reaqcias. sxvebi yalibdebian
ujredebis gaaqtiurebis Semdeg da iwveven ufro xangrZliv bronqospazms. esenia araqidonis mJavas
metabolitebi orive - ciklooqsigenazuri, mag., prostaglandini D2 da lipooqsigenazuri, mag., cisteinil-
leikotrienebi C4 da D4, gzebidan. garda amisa, Trombocitebis gaaqtiurebis faqtori aRiarebulia, rogorc sul
ufro metad mniSvnelovani mediatori.
mravali mediatoris fardobiTi mniSvneloba zustad ar aris gansazRvruli, magram isini urTierTqmedeben
da iwveven lorwovanis SeSupebas, lorwos sekrecias da wamwamovani epiTeliumis dazianebas. damcavi
epiTeluri barieris darRveva xels uwyobs hiperreaqciulobas, romelic narCundeba bronqokonstriqtoruli
nivTierebebiT an adgilobrivi aqsonebis refleqsebiT, daucveli nervuli boWkoebis saSualebiT. Sedegad,
viTardeba xixinebi da sunTqvis gaZneleba. bronquli cvlilebebi aseve xels uSlian sainhalacio preparatebis
miwodebas periferiaze, ris gamoc maT SeiZleba saTanado Sedegi ar hqondeT.
asTma, sxva mravali qronikuli daavadebis (hipertenzia, diabeti)msgavsad, poligenuri daavadebaa da ukve
IgE-s produqciis gazrdasTan an bronqul hiperreaqciulobasTandakavSirebuli genetikuri lokusi aRiniSna
asTmis gazrdili SemTxvevebis mqone zogierT ojaxSi.
Setevis dawyebamde aRiniSneba hiperventilacia, amitom Pao2 SenarCunebulia da Paco2 mcirdeba,
magram sasunTqi gzebis obstruqciis gazrdisas Pao2 mcirdeba da Paco2 izrdeba, rac miuTiTebs asTmis
seriozul epizodze.
asTmis tipebi
specifikur alergiul reaqciebTan dakavSirebuli asTma
egzogenuri tipi yvelaze gavrcelebulia da aRiniSneba im pacientebSi, romlebSic alergia viTardeba
antigenuri nivTierebebis SesunTqvisas. isini aseve xSirad aris atopiuri, romlebic gviCveneben dadebiT
pasuxs kanis Cxvletis testis dros igive antigenebiT.hipermgrZnobelobis reaqcia filtvebSi (da kanSi) aris
dauyovnebeli (tipi 1) da moicavs IgE gamowveul foyieri ujredebis gaaqtiurebas. alergenis Tavidan
acileba gansakuTrebiT mniSvnelovania am tipis asTmis marTvaSi.
asTma, romelic dakavSirebuli ar aris cnobil alergiasTan (ucnobi etiologiis asTma?)

9
zogierT pacients aReniSneba xixinebi da sunTqvis gaZneleba xiluli alergenis an atopiis ararsebobis dros.
fiqroben, rom maT aqvT endogenuri (memkvidreobiTi) asTma da identificirebuli antigenis ararsebobis
gamo, alergenis Tavidan acileba ar gamoiyeneba mis marTvaSi.
fizikur datvirTvasTan dakavSirebuli asTma
zogierT pacients xixinebi regularulad uviTardeba datvirTvidan ramdenime wuTSi. msgavsi pasuxi
aRiniSneba civi haeris CasunTqvis Semdeg, rogorc Cans saerTo meqanizmi iwvevs sasunTqi gzebis
simSrales. 2-adrenoreceptoris agonistis, natriumis kromoglikatis (ix. qvemoT) an erT-erTi uaxlesi
leikotrienis receptoris antagonistis (ix. qvemoT) inhalacia mniSvnelovnad uSlis xels bronqospazmis
ganviTarebas.
filtvebis qronikul obstruqciul daavadebasTan dakavSirebuli asTma
sasunTqi gzebis mudmivi obstruqciis mqone pacientebis raodenoba gviCvenebs sasunTqi gzebis
rezistentobis cvlilebebs da dros, romelic saWiroa maTze bronqodilataciuri preparatebis samoqmedod.
mniSvnelovania imis gamocnoba, rom asTmas SeiZleba Tan axldes filtvebis qronikuli obstruqciuli
daavadeba da bronqodilatatorebze an glukokortikoidebze maTi pasuxis Sefaseba drois raRac periodSi
(sunTqvis funqciis formalurma testebma ar SeiZleba sarwmunod ivaraudon klinikuri pasuxi am
situaciaSi).
mkurnalobisadmi midgomebi
zemoT aRniSnuli diskusiis gaTvaliswinebiT, logikuria mkurnalobisadmi Semdegi midgoma:
 alergen(eb)is zemoqmedebis profilaqtika
 bronquli anTebisa da hiperreaqtiulobis Semcireba
 Seviwrovebuli bronqebis dilatacia.
es miznebi Semdegnairad miiRweva:
alergen(eb)is zemoqmedebis profilaqtika
es midgoma Seesabameba egzogenuri asTmis mqone pirebs. alergenis identificirebaSi SeiZleba
dagvexmaros pacientis istoria (xixinebis ganviTareba balaxTan, mtverTan, cxovelebTan kontaqtisas),
SerCeuli antigenis kanSi ineqcia an specifikuri IgE antisxeulebis aRmoCena pacientis SratSi anu RAST
(radioalergosorbentuli testi) testi. alergenis acileba SeiZleba, rodesac es dakavSirebulia gansakuTrebul
SemTxvevasTan, mag., profesiul saqmianobasTan, magram naklebad SesaZlebelia, Tu alergeni farTod
aris gavrcelebuli, rogorc saxlis mtvris tkipa.
bronqebis anTebisa da hiperreaqtiulobis Semcireba
mudmivi anTeba mTavaria bronqebis hiperreaqciulobis ganviTarebSi, amitom, logikuria anTebis
sawinaaRmdego preparatebis gamoyeneba.
glukokortikoidebi iwveven bronqebis hiperreaqciulobis etapobriv Semcirebas. isini asTmis mkurnalobis
ZiriTadi Semadgenelia. moqmedebis zusti meqanizmebi jer kidev ganxilvis sagania, magram savaraudod,
moicavs: filtvebSi anTebiTi ujredebis Semodinebis daTrgunvas alergenis eqspoziciis Semdeg;
makrofagebidan da eozinofilebidan mediatorebis gamoTavisuflebis daTrgunvas; am mediatorebiT
gamowveuli mikrosisxlZarRvovani gaJonvis Semcirebas. asTmis dros gamoyenebadiglukokortikoidebia
prednizoloni (Sinagani wesiT) da beklometazoni, flutikazoni da budesonidi (inhalaciiT).
natriumis kromoglikati (kromolini, intali) amcirebs alergenze dauyovnebliv pasuxs da adre fiqrobdnen,
rom moqmedebda foyieri ujredebidan mediatorebis gamoTavisuflebis daTrgunviT. monacemebi
amJamad migviTiTeben, rom dagvianebuli alergiuli pasuxi da bronqebis hiperreaqciuloba aseve
iTrguneba da kromoglikati efeqturad moqmedebs sxva anTebiT ujredebzec da adgilobrivi aqsonebis
refleqsebze. kromoglikati cudad Seiwoveba kuW-nawlavis traqtidan, magram kargad Seiwoveba
filtvebidan da miiReba inhalaciiT (rogorc fxvnili, aerozoli an nebulaizeri). is ucvleli saxiT gamoiyofa
SardiT da naRveliT.

10
radgan is ar ewinaaRmdegeba mediatorebis bronqokonstriqciul efeqts maTi gamoTavisuflebis Semdeg,
kromoglikati uefeqtoa Setevis mosaxsnelad anu is ufro xels uSlis bronqokonstriqcias, vidre xels uwyobs
bronqodilatacias. specialuri formulebi gamoiyeneba alergiuli rinitisa da alergiuli koniunqtivitis dros.
natriumis kromoglikati efeqturia egzogenuri (alergiuli) asTmis dros, bavSvebSi asTmisa da fizikuri
datvirTviT gamowveuli asTmis CaTvliT, magram misi gamoyeneba Semcirda mas Semdeg, rac aSkara
gaxda kortikosteroidis dabali doziT inhalaciis efeqturoba da usafrTxoeba.
es aratoqsikuria.garda amisa, fxvniliT gamowveuli xvela da bronqospazmi iSviaTad iwvevs alergiul
reaqciebs. TvalSi CawveTebam SeiZleba gamoiwvios adgilobrivad wvis SegrZneba da Sinagani wesiT
miRebam - gulisreva.
natriumis nedokromili (tiladi) struqturulad gansxvavdeba kromoglikatisgan, magram aqvs msgavsi
moqmedeba da misi gamoyeneba SeiZleba dozirebuli aerozolis saxiT kromoglikatis magivrad.
sxva preparatebi
ketotifeni aris histaminis H1-receptoris blokatori, romelsac aseve SeiZleba hqondes asTmis
sawinaaRmdego efeqtebi, magram misi Sedegi saimedo ar aris. sxva antihistaminuri saSualebebis
msgavsad, is iwvevs Zilianobas.
Seviwrovebuli bronqebis dilatacia
es yvelaze efeqturad miiRweva bronqebis kunTebis SekumSvis fiziologiuri antagonizmiT, kerZod,
adrenerguli bronqodilataciuri meqanizmebis stimulaciiT. konkretuli bronqokonstriqtoris farmakologiuri
antagonizmi nakleb efeqturia, radgan an individualuri mediatorebi ar arian pasuxismgebelni
bronqokonstriqciis umravles SemTxvevaSi (acetilqolini, adenozini, leikotrienebi) an imitom, rom
mediatori saerTod ar gamomuSavdeba asTmis Setevis dros (histamini).
2-adrenoreceptoris agonistebi
bronqebSi upiratesad warmodgenilia 2 tipis adrenoreceptorebi da maTi stimulacia iwvevs bronqis
kunTebis modunebas. 2-adrenoreceptoris gaaqtiureba aseve iwvevs poxieri ujredebis stabilizacias.
farTod gamoyenebadi agonistebia salbutamoli, terbutalini, fenoteroli, eformoteroli da salmeteroli.
salmeteroli xangrZliv moqmedia, radgan misi lipofiluri gverdiTi jaWvi amagrebs preparats membranis
mimdebare receptorze da anelebs qsovilebidan misgamoyofas.
nakleb seleqciuri adrenoreceptoris agonistebi, rogoric aris adrenalini (epinefrini), efedrini, izoetarini,
izoprenalini da orciprenalini naklebad usafrTxoa, radgan ufro savaraudoa, rom gamoiwvon gulis
ariTmiebi. -adrenoreceptoris gaaqtiureba xels uwyobs bronqokonstriqcias, magram -adrenoreceptoris
antagonistebma ar gaamarTles praqtikaSi.
Teofilini, meTilqsantini, adunebs bronqebis kunTebs, Tumca misi moqmedebis zusti meTodi kvlav
ganxilvis sagania. fosfodiesTerazas, gansakuTrebiT misi tipi 4 izoformis inhibireba savaraudod, xsnis mis
bronqodilataciur da axlaxan aRmoCenil anTebis sawinaaRmdego efeqtebs. adenozinis receptorebs
umniSvnelod blokavs. Teofilinis sxva moqmedebebia: qronotropuli da inotropuli efeqtebi gulze da
pirdapiri efeqti Sardwarmoqmnis sixSireze (diurezi).
Teofilini kuW-nawlavis traqtSi swrafad da srulad Seiwoveba.misi 90% metabolizdeba RviZlSi da
arsebobs monacemebi, rom procesi gajerebulia Terapiul dozebSi. t1/2 8 sT-ia, mniSvnelovani meryeobiT.
is gaxangrZlivebulia mZime gul-filtvis daavadebis da cirozis mqone pacientebSi. simsuqne da
dRenakluloba dakavSirebulia gamoyofis sixSiris SemcirebasTan. Tambaqos moxmareba zrdis Teofilinis
klirenss RviZlis P450 fermentis saSualebiT.es farmakokinetikuri faqtorebi da dabali Terapiuli indeqsi
aucilebels xdian plazmaSi Teofilinis monitorings, saukeTeso Sedegebis misaRebad. sasurveli
koncentraciis diapazonia 10-20 mg/l (55-110 mkmol/l).
Teofilini SedarebiT uxsnadia da qmnis marils qolinTan erTad (qolinis Teofilinati) an kompleqss edta-
sTan erTad (aminofilini). aminofilini kargad xsnadia Teofilinis intravenuri gamoyenebisTvis mwvave
mZime asTmis (asTmuri statusi) dros. swrafi ineqcia venaSi iwvevs arasasurvel efeqtebs (ix. qvemoT),
11
radgan gulsa da tvinSi aRwevs maRali koncentraciebiT ganawilebis damTavrebamde. venaSi SeyavT
nela (dartymiTi doza 5 mg/kg 20 wT-ze meti xnis ganmavlobaSi, Semdgomi infuziiT 0,9 mg/kg/sT,
Teofilinis plazmuri koncentraciis Sesabamisad). dartymiTi doza ar gamoiyeneba im pacientSi, romelic
ukve iRebs meTilqsantinis preparats (yovelTvis hkiTxeT amis Sesaxeb pacients ineqciamde).
arsebobs mravali nela-gamoTavisuflebadi oraluri forma qronikuli asTmis dros gamosayeneblad, magram
radgan isini ar arian bioeqvivalenturi, pacienti ar unda gadaviyvanoT sxva preparatze, Tu is stabilurad
morgebulia konkretul preparatze.
gverdiTi movlenebi
maRali Terapiuli dozebiT zogierT pacients aReniSneba gulisreva da faRaraTi da plazmaSi koncentracia
aRemateba gulis ariTmiisa da krunCxvebis riskis rekomendebul diapazons. eriTromicinis,
ciprofloqsacinis, alopurinolis an oraluri kontraceptivebis mier fermentis inhibireba zrdis Teofilinis
koncentracias plazmaSi. fermentis induqtorebi, mag., karbamazepini, fenitoini da rifampicini amcireben
koncentracias.
Teofilinis dozis gadaWarbebas didi mniSvneloba aqvs nela gamoTavisuflebadi preparatebis
gamoyenebisas, radgan xangrZlivdeba toqsikuri efeqtebi. plazmaSi maqsimaluri koncentracia miiRweva
miRebidan 12-24 sT-Si. Rebineba SeiZleba mZime iyos, magram mTavari saSiSroebaa gulis ariTmia,
hipotenzia, hipokaliemia da krunCxvebi. gaaqtiurebuli naxSiri miiReba yovel 2-4 sT-Si, vidre plazmaSi
koncentracia ar Camova 20 mg/l qvemoT. kaliumis aRdgena mniSvnelovania ariTmiis saprofilaqtikod,
diazepami gamoiyeneba krunCxvebis sakontrolod.
antimuskarinuli bronqodilatatorebi
acetilqolinis gamoTavisufleba vagusis nervuli daboloebebidan sasunTq gzebSi aaqtiurebs muskarinul
(M3) receptorebs bronqebis gluv kunTebSi, rac iwvevs bronqospazms. am receptorebis blokada atropiniT
iwvevs bronqodilatacias, miuxedavad imisa, rom sasurveli antimuskarinuli preparatebi klinikur praqtikaSi
aris sainhalacio ipratropiumi, oqsitropiumi an axali Semosuli, xangrZliv moqmedi Tiotropiumi (misi
efeqtebi grZeldeba 24 sT-ze metad). es sinTezuri naerTebi, atropinisgan gansxvavebiT, xangrZlivad
ukavSirdebian molekulebs, rac xels uSlis mniSvnelovan absorbcias inhalaciis Semdeg da amiT
minimumamde amcireben antimuskarinul efeqtebs filtvebis gareT. isini, ZiriTadad, gamoiyeneba filtvebis
qronikuli obstruqciuli daavadebis mqone xandazmul pacientebSi, magram aseve efeqturia mwvave
mZime asTmis dros 2-adrenoreceptoris agonistebTan kombinaciaSi. vagusiT gamowveuli bronqospazmi
mniSvnelovania mwvave asTmis dros, magram SedarebiT umniSvneloa qronikuli stabiluri asTmis mqone
pirebis umravlesobaSi.
leikotrienis receptoris antagonistebi, mag., montelukasti da zafirlukasti, konkurentulad uSlian xels
cisteinil-leikotrienebis (C4, D4 da E4) bronqospazmur efeqtebs maTi saerTo cysLT1 receptoris dablokviT.
maT aqvT dabali doziT inhalirebuli glukokortikoidis msgavsi efeqturoba. arasakmarisi Sedareba arsebul
preparatebTan, maT aniWebs meore an mesame rigis rols mkurnalobaSi. isini SeiZleba Seicvalon meore
etapze an mogvianebiT stadiebze asTmis 5 etapian reJimSi. ar arsebobs kvlevebi, romlebic gaamarTleben
maT gamoyenebas steroid-damzogveli (bevrad naklebad, CanacvlebiTi) Terapiis saxiT.rodesac zogjer am
gziT gamoiyeneba pacientebSi, romlebsac ar undaT an ar SeuZliaT dozirebuli inhalatorebis gamoyeneba,
aucilebelia spirometriis TanmimdevrobiTi kontroli.
montelukasti miiReba 1-jer dReSi da zafirlukasti 2-jer dReSi. leikotrienis receptoris antagonistebi,
ZiriTadad, kargad gadaitaneba, miuxedavad imisa, rom Carg-Strausis sindromi iSviaTad aRiniSneba
maTi gamoyenebisas. es savaraudod aris daavadebis gamovlena glukokortikoidebis moxsnis da
leikotrienis receptoris antagonistis daniSvnis Semdeg. am moqmedebis sagangaSo gamovlinebebia
vaskuluri gamonayari, eozinofilia, sunTqvis simptomebis gauareseba, gulis mxriv garTulebebi da
periferiuli neiropaTia.
sainhalacio preparatebiT mkurnaloba

12
preparatebis Seyvanis sainhalacio gza SemuSavda upiratesad imitom, rom mniSvnelovnad Semcirebuliyo
preparatebis, gansakuTrebiT glukokortikoidebis arasasurveli sistemuri zemoqmedeba. sainhalacio
saSualebebis gamoyenebis farmakokinetikuri upiratesoba oralur gamoyenebasTan SedarebiT aSkarad
amcirebs dozaze moTxovnebs: salbutamoli 100 mkg aerozolis inhalacia iseTive bronqodilatacias iwvevs,
rogorc Sinagani wesiT miRebuli 2000 mkg.
preparatis inhalaciamde, is jer unda gadaviyvanoT nawilakovan formaSi. nawilakebis optimaluri zoma
wvril bronqebSi SesaRwevad da dasaleqad, aris daaxloebiT 2 m. aseTi nawilakebi filtvebSi aRweven
aerozolis saxiT anu airSi dispersirebuli, rac SeiZleba ganxorcieldes sxvadasxva gzebiT:
aerozoli maRali wnevis qveS
preparati siTxed gardaiqmneba dabal duRilis wertilze balonSi wnevis qveS. sarqvlis gaxsnisas
gamoTavisufldeba siTxis konkretuli doza da gamoifrqveva atmosferoSi. gadamtani siTxe maSinve
orTqldeba da tovebs preparatis aerozols, romlis CasunTqvac xdeba. bolo dromde, gadamtani iyo
qlorofluorokarboni, magram vinaidan is iwvevda atmosferuli ozonis Semcirebas, Canacvlebul iqna
hidrofluoroalkaniT, romelic ar azianebs ozons. aman gamoiwvia zogierTi inhalatoris gemos SesamCnevi
cvlilebebi, magram ufro mniSvnelovnad man Secvala sainhalacio glukokortikoidebis bioeqvivalenturoba.
hidrofluoroalkanis Semcveli sainhalacio glukokortikoidi zogadad ufro Zlieria, vidre qlorofluorokarbonis
Semcveli, tuCebTan erTi da igive dozis miwodebis dros (Cveulebriv, efeqturoba ormagdeba).
preparatis optimaluri miwodebis uzrunvelsayofad, aucilebelia inhalatoris moqmedebis koordinireba
CasunTqvasTan da sunTqvis SekavebasTan. mravali pacienti, gansakuTrebiT axalgazrdebi da
xandazmulebi, amas Zalian rTulad miiCneven da `speiseri~ xSirad gamoiyeneba inhalatorsa da tuCebs
Soris. es moqmedebs aerozolis moculobaze da aseve amcirebs aerozolis Sesvlas pirxaxaSi. adgilobrivma
deponirebam SeiZleba gamoiwvios gverdiTi movlenebi piris RruSi, gansakuTrebiT, kandidozi
sainhalacio glukokortikoidebis gamo. speiseri xsnis am problemas.
nebulaizerebi preparatis xsnars an suspenzias gardaqmnian aerozolad. Wavluri nebulaizerebi saWiroeben
mamoZravebel airs, ZiriTadad, haers kompresoridan saxlSi gamoyenebisTvis an Jangbads hospitalSi.
xsnari nebulaizeris kameraSi iSleba wveTebad WavliT da ufro msxvili wveTebi ifiltreba, wvrili wveTebi
ki rCeba sainhalaciod. ultrabgeriTi nebulaizeri xsnars gardaqmniserTi zomis nawilakebad piezo-eleqtruli
kristaliT (romelic eleqtroobas gardaqmnis meqanikur vibraciad)gamowveuli vibraciis Sedegad.
nebismieri meTodiT aerozoli miewodeba pacients mundStukiT an niRbiT, ase rom koordinacia saWiro ar
aris da doza SeiZleba Seicvalos xsnaris simkvrivis SecvliT. ufro didi dozebi SeiZleba dainiSnos
nebulaizeriT, vidre maRali wnevis qveS myofi aerozoliT.
mSrali fxvnilis inhalatorebi
xdeba mikronizebuli fxvnilis formis mqone da mowyobilobaSi, mag., spinhalerSi an diskhalerSi
moTavsebuli preparatis inhalacia. pacientebi xSirad iyeneben mas, rodesac uSedegoa dozirebuli
aerozolebi. fxvnilis inhalacia zogjer iwvevs gardamaval bronqospazms.
preparatebiT mkurnaloba
es damokidebulia asTmis simZimesa da tipze. arsebobs zogadi wesi, rom preparatisa da dozis cvlilebis
efeqturoba etapobrivad unda gakontroldes martivi respiratoruli funqciis testiT, rogoric aris maqsimaluri
amosunTqvis siCqare an forsirebuli amosunTqvis moculoba 1 wm-Si. arc pacientis SegrZnebebi da arc
fizikuri gamokvleva marto sakmarisi ar aris gaumjobesebis dasadgenad. rodesac asTmuri Seteva mZimea,
unda gaizomos arteriuli sisxlis airebic.
mudmivi da perioduli asTma
2003 wlis britaneTis Torakaluri sazogadoebissaxelmZRvanelo gvirCevs qronikuli asTmis preparatebiT
marTvis 5 etapian midgomas. sqema iwyeba pacientisTvis saWiro SemTxveviTi 2-adrenoreceptoris
agonistiT da Semdeg mosdevs anTebis sawinaaRmdego mkurnalobis mzardi damateba. gansakuTrebuli
mniSvneloba eniWeba:

13
1. xanmokle moqmedebis 2-adrenoreceptoris agonisti gamoiyeneba mwvave simptomebis gadaudebeli
mkurnalobisTvis.
2. pacientebi ganxilul unda iqnan regularulad, radgan isini SeiZleba sqemaze zemoT an qvemoT
gadaadgildnen.
3. gansakuTrebuli yuradReba unda mieqces inhalaciis teqnikas, radgan es mkurnalobis uSedegobis
mniSvnelovani mizezia. pacientebs, romlebic ver itareben sainhalacio mkurnalobas speiseris an mSrali
fxvnilis mowyobilobis gamoyenebiT, unda CautardeT oraluri mkurnaloba, Tumca mas SeiZleba axldes
ufro meti sistemuri gverdiTi movlenebi.
dasawyisSi gamoiyeneba sainhalacio 2-adrenoreceptoris agonisti. salbutamoli an terbutalini (1-2
Sesxureba 4-jer dReSi) arian xanmokle moqmedebis2-adrenoreceptoris agonistebi, romelTa
bronqodilataciuri efeqtic swrafad iwyeba (ramdenime wuTSi) da grZeldeba 4-6 sT. salmeterols da
eformoterolsaqvT ufro xangrZlivi moqmedeba (12-24 sT), ris gamoc isini efeqturia Ramis simptomebis
dros. isini ar gamoiyeneba `samaSvelo~ bronqodilatatoris saxiT (gansakuTrebiT, salmeteroli, radgan misi
bronqodilataciuri moqmedeba grZeldeba 15-30 wT) da arc sainhalacio glukokortikoidis Camanacvleblis
saxiT (ix. 3 etapi). 2-adrenoreceptoris agonistebi iwveven doza-damokidebul tremors, gansakuTrebiT
oraluri, vidre sainhalacio miRebis dros.
anTebis sawinaaRmdego mkurnalobas iwyeben natriumis kromoglikatiT an sainhalacio
glukokortikoidis dabali doziT (2 etapi). amJamad gamoyenebadi sainhalacio glukokortikoidebi
(beklometazoni, budesonidi da flutikazoni) xasiaTdeba dabali oraluri bioSeRwevadobiT, RviZlSi
pirveladi gavlis maRali metabolizmis gamo (TiTqmis 100% flutikazonisTvis). es Tviseba
mniSvnelovania, radgan amcirebs sainhalacio glukokortikoidis sistemur efeqtebs, romlis 80-90%-ic
faqtiurad iylapeba. swored am mizezis gamo, prednizolons an hidrokortizons naklebi upiratesoba aqvs
(Sinagani wesiT miRebasTan SedarebiT) inhalaciisas, radgan isini Seiwoveba nawlavidan da cirkulaciaSi
xvdebian SedarebiT patara pre-sistemuri metabolizmiT. dabali doziT sainhalacio glukokortikoidebi aseve
avlenen cximSi maRal xsnadobas da efeqturobas, vidre Sinagani wesiT miRebisas. efeqturoba, ZiriTadad,
umniSvneloa oralur preparatebTan SedarebiT, magram mniSvnelovania adgilobrivad misaRebi
preparatebisTvis.
sainhalacio glukokortikoidebi, ZiriTadad, usafrTxoa dabali dozebiT. adgilobrivi efeqtebi (oraluri
kandidozi da disfonia) ixsneba speiseris gamoyenebiT da piris gamovlebiT. maRali dozebi (>2000 mkg
dReSi) mcired zrdis kataraqtisa da glaukomas risks. es ufro metad SeiZleba gamowveuli iyos adgilobrivi
aerozolis deponirebiT, vidre WeSmariti sistemuri efeqtiT. Zvlis rezorbcia izrdeba mozrdilebSi, rac
miuTiTebs daCqarebuli osteoporozis xangrZliv riskze da Zvlis zrda SeiZleba Semcirdes bavSvebSi
(Tumca, mtkicebuleba miuTiTebs, rom zrdasrulis simaRle SeiZleba normaluri iyos).aqedan
gamomdinare, mniSvnelovania, pacients SeunarCundes sainhalacio glukokortikoidis minimaluri doza,
romelic aucilebelia simptomebis kontrolisTvis.
Sinagani wesiT miRebuli prednizoloni Zalian efeqturia mZime gamwvavebebis dros da xSirad miiReba
mokle kursebis saxiT (mag., 30 mg dReSi 5-7 dRe). Tu simptomebi da pikuri nakadi swrafad
eqvemdebareba mkurnalobas, ufro xangrZlivi kursebi an dozis gaxangrZlivebuli Semcireba saWiro ar
aris. oraluri glukokortikoidis xangrZlivi gamoyenebis dros (5 etapi), doza unda daregulirdes ufro nela.
kortikosteroidebis gverdiTi efeqtebi SeiZleba Semcirdes mxolod dilis dozis daniSvniT, romlis miRebac
unda daemTxves kortizolis normaluri koncentraciis piks (da amiT minimalurad daiTrguneba
hipoTalamur-Tirkmelzeda jirkvlis sistemis ukukavSiri). es SesaZlebelia maTi xangrZlivi biologiuri
efeqtis gamo (18-36 sT), plazmur t1/2 SedarebiT (3 sT prednizolonisTvis). dilis dozirebas sainhalacio
glukokortikoidTan erTad aseve aqvs prednizolon-damzogveli efeqti. zogierTma pacientma SeiZleba
Semdgomi prednizolon-damzogveli efeqtisTvis nebulaizeriT miiRos maRali doziT budesonidi, 1-2 mg 2-
jer dReSi an 500 mg flutikazoni 2-jer dReSi.
gulmkerdis infeqciebi asTmis dros

14
antimikrobuli saSualebebi zedmetad gamoiyeneba asTmis gamwvavebebis dros. sasunTqi sistemis
infeqciebi iwveven sasunTqi gzebis obstruqciis gazrdas da bronqebis hipermgrZnobelobas, magram
xSirad damnaSavea virusebi da ara baqteriebi. antimikrobuli saSualebebi unda dainiSnos mxolod maSin,
Tu arsebobs didi eWvi sasunTqi sistemis baqteriul infeqciaze, mag., Cirqiani naxveli.SeniSvna,
makroliduri antibiotikebi, eriTromicini da klaritromicini xels uSlian Teofilinis metabolizms.
mwvave mZime asTma (asTmuri statusi)
es aris sicocxlisTvis saSiSi mdgomareoba, romelic saWiroebs swraf agresiul mkurnalobas. sasunTqi
gzebi SeiZleba refraqteruli gaxdes 2-adrenoreceptoris agonistis mimarT 36-48 sT-is Semdeg, nawilobriv
farmakologiuri mizezis (savaraudod, receptorebis mgrZnobelobis daqveiTeba) da nawilobriv
gaxangrZlivebuli respiratoruli acidozis gamo. am mdgomareobisTvis damaxasiaTebeli lorwovani
sacobebi aseve xels uSlian sainhalacio preparatebis SeRwevas distalur sasunTq gzebSi.
Semdgomi CamonaTvali, garkveuli ganmartebebiT, aris britaneTis Torakaluri sazogadoebis 9
rekomendaciebi mwvave mZime asTmis samarTavad:
gadaudebeli mkurnaloba
 Jangbadi niRbiT (datenianebuli, naxvelis gasaTxiereblad). naxSirorJangiT narkozi iSviaTad
gamoiyeneba asTmis dros da 60%-Si SeiZleba misi gamoyeneba, Tu diagnozi saeWvo ar aris.
xandazmul pacientebSi an rodesac arsebobs naxSirorJangis qronikuli dagrovebis problema,
iwyeben 28% JangbadiT da amowmeben, rom Paco2 ar gaizardos, vidre pacients ar miewodeba
35% Jangbadi.
 salbutamoli nebulaizeriT doziT 2,5-5 mg daaxloebiT 3 wT, 15 wT-Si ganmeorebiT. alternatiulia
terbutalini 5-10 mg.
 prednizoloni 30-60 mg Sinagani wesiT an hidrokortizoni 100 mg venaSi.
 moerideT nebismieri saxis sedacias.
 gulmkerdis rentgenografia saWiroa pnevmoToraqsis gamosaricxad.
Tu aRiniSneba sicocxlisTvis saSiSi niSnebi (sunTqviTi xmianobis ararseboba, cianozi, bradikardia,
daRlilobis niSnebi, amosunTqvis maqsimaluri moculobis siCqare <33% mosalodnelze an saukeTeso,
arteriuli Jangbadis saturacia < 92%):
 ipratropiumi 0,5 mg unda daematos nebulaizerSi 2-agonists.
 ganixileba magniumis sulfatis venaSi Seyvana (1,2-2 g 20 wT-is ganmavlobaSi).
 Setyobineba reanimaciul ganyofilebaSi.
Semdgomi marTva
Tu pacientis mdgomareoba gaumjobesda, grZeldeba:
 40-60% Jangbadi.
 prednizoloni 30-60 mg dReSi an hidrokortizoni 100-200 mg yovel 6 sT-Si.
 nebulaizeriT salbutamoli an terbutalini yovel 4 sT-Si.
Tu pacientis mdgomareoba ar gaumjobesda 15-30 wT-is Semdeg:
 grZeldeba Jangbadi da glukokortikoidi.
 nebulaizeriT miewodeba 2-adrenoreceptoris agonisti ufro xSirad, mag., salbutamoli 10 mg/sT.
 nebulaizerSi emateba ipratropiumi 0,5 mg da imeoreben yovel 6 sT-Si, vidre pacianetis
mdgomareoba ar gaumjobesdeba.
Tu pacientis mdgomareoba kvlav ar umjobesdeba:
 ganixileba venaSi aminofilinis infuzia (0,9 mkg/kg/wT) an
 ganixileba alternativis saxiT venaSi 2-adrenoreceptoris agonistis, mag., salbutamolis Seyvana
(rogorc zemoT) 250 mkg 10 wT-Si, Semdeg 20 mkg/wT infuziis saxiT (radgan nebulaizeriT
salbutamolma SeiZleba ver miaRios distalur sasunTq gzebamde).
15
  intensiuri Terapiis ganyofilebasTan dakavSireba intubaciisa da filtvebis xelovnuri ventilaciis
gansaxilvelad.
mkurnalobaze pasuxis monitoringi
 amosunTqvis pikuri moculobis sixSire yovel 15-30 wT-Si.
 Jangbadis saturacia: >92% SenarCuneba.
 sisxlis airebis gazomva Tu sawyisi Paco2< 8 kpa (60 mm vwy.sv.) da/an sawyisi Paco2 normaluria
an imatebs (taqipnoe savaraudod Seamcirebs Paco2 pacientebis umravlesobaSi).
mkurnaloba intensiuri Terapiis ganyofilebaSi
gadayvana (Tan axlavs eqimi saintubacio mowyobilobiT) saWiroa, Tu:
 nebismieri zemoT aRniSnuli uaresdeba maqsimaluri mkurnalobis miuxedavad
 pacienti daRlilia, modunebuli an dabinduli aqvs goneba
 Tu aRiniSneba koma an sunTqvis gaCereba.
mkurnaloba saavadmyofodan gamoweris dros
pacientma unda:
 gaagrZelos maRali dozebiT glukokortikoidis inhalacia da daasrulos prednizolonis Sinagani wesiT
miReba.
 gaakontrolos sakuTari amosunTqvis pikuri moculobis sixSire da ar unda Seamciros doza misi
daqveiTebisas an Tu naCvenebia dilis naadrevi Rrma palpaciisgameoreba (pacienti ar unda
gaeweros, vidre amosunTqvis pikuri moculobis sixSiris maCveneblebis dRe-Ramuri cvlilebebi 25%
naklebia).
gafrTxileba
asTma SeiZleba gamoiwvios -adrenoreceptoris blokadam da -adrenoreceptoris antagonistis
gamoyeneba ukunaCvenebia asTmis mqone pirebSi. fataluri asTma SeiZleba gamoiwvios -blokatoris
Tvalis wveTebma, savaraudod, 1-seleqciurma preparatebmac ki.
2-adrenerguli agonistis zedmetad gamoyeneba saSiSia. 1960-iani wlebis SuaSi, aRiniSna asTmis
mqone axalgazrdebis uecari sikvdilis epidemia saavadmyofos gareT. es dakavSirebuli iyo izoprenalinis
(1 da 2 agonisti) didi dozis Semcveli dozirebuli aerozolis SemosvlasTan. msgavsi ram ar aRiniSna im
qveynebSi, sadac ar iyo Setanili didi dozebi12.epidemia britaneTSi Semcirda, rodesac eqimebi gaafrTxiles
da daiwyes aerozolebis mxolod receptiT gacema. miuxedavad imisa, rom 2-receptoris agonistis
gamoyenebasa da sikvdils Soris kavSiri mizezobrivia, sikvdilis realuri mizezi ucnobia. dozis
gadaWarbebiT gamowveuli gulis ariTmia ar aris erTaderTi mizezi. seleqciuri 2-receptoris agonistis
Semdgomi ganviTareba iyo usafrTxoebis garanti, magram axal zelandiaSi 1980-ian wlebSi mimoxilviT
aRmoCnda, rom fenoterolis (2 seleqciuri) gamoyeneba dozirebuli inhalaciis saxiT dakavSirebuli iyo
sikvdilianobis riskis gazrdasTan mZime asTmis dros da mogvianebiTma analizma daadgina, rom es iyo
yvelaze savaraudo mizezi. SeSfoTebis Semdegi mizezia 19 klinikuri kvlevis meta-analizi, romliTac
dadginda, rom xangrZliv moqmedi  agonistebi zrdian mZime da sicocxlisTvis saSiSi asTmis
gamwvavebebs da asTmasTan dakavSirebul sikvdilianobas.
filtvebis qronikuli obstruqciuli daavadeba (fqod)
maSin, roca asTmas axasiaTebs sasunTqi gzebis Seqcevadi obstruqcia da bronqebis hiperreaqciuloba,
fqod xasiaTdeba sasunTqi gzebis nawilobriv Seqcevadi obstruqciiT da lorwos hipersekreciiT. is
upiratesad aris wvrili sasunTqi gzebis daavadeba. miuxedavad amisa, am ori daavadebis gansxvaveba
SeiZleba rTuli iyos zogierT pacientSi da erTi mosazrebiT, asTma mwevelebSi iwvevs fqod-isadmi
winaswarganwyobas (holandiuri hipoTeza). praqtikaSi, imitom, rom sasunTqi gzebis obstruqcia yvelaze
metad aRiniSna fqod-is dros, mniSvnelovania Seqcevadi komponentis maqsimalurad gazrda. es SeiZleba
Sefasdes forsirebuli amosunTqvis moculobiT 1 wm-Si, oraluri prednizolonis kursamde da mis Semdeg,
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mag., sul mcire 30mg dReSi 2 kviris ganmavlobaSi. Seqcevadoba TviTneburad ganisazRvreba forsirebuli
amosunTqvis moculobis 1 wm-Si gazrdiT 15%-ze (da 200 ml) metad. mniSvnelovani sifrTxilea saWiro,
radgan pacientebis simptomebi zogjer umjobesdeba mcire an ararsebuli Seqcevadobis miuxedavad,
radgan forsirebuli amosunTqvis moculoba 1 wm-Si gveCvenebs msxvili sasunTqi gzebis funqcias da
fqod-iT, ZiriTadad, ziandeba wvrili sasunTqi gzebi.
fqod-is samkurnalo preparatebi igivea, rac asTmis samkurnalo, antimuskarinuli saSualebebis -
ipratropiumis an xangrZlivad moqmedi Tiotropiumis garda, romlebic 2 agonistebze ufro efeqturi
bronqodilatatorebi arian. sasunTqi gzebis Seqcevadi obstruqciis mqone pacientebma aseve unda miiRon
sainhalacio glukokortikoidi da misma kombinaciam xangrZliv moqmed 2 agonistTan SeiZleba
gaaumjobesos kontroli, gansakuTrebiT zomieri an mZime daavadebis (forsirebuli amosunTqvis
moculoba 1 wm-Si mosalodnelze <50%-iT) dros, mag., flutikazoni+salmeteroli (seretidi). es strategia
miznad isaxavs ufro daavadebis gamwvavebebis sixSiris Semcirebas, vidre uSualod gauaresebul filtvis
funqciaze zemoqmedebas.
Teofilini aseve efeqturi SeiZleba iyos mZime daavadebis mqone pacientebSi, magram saWiroebs
specialur movlas xandazmulebSi, plazmaSi Teofilinis donis kontrolis CaTvliT.mukolizuri preparatebi
amcireben fqod-is mwvave epizodebs da avadmyofobis dReebs. isini saukeTesoa daavadebis Seqcevadi,
gaxangrZlivebuli an mZime gamwvavebebis mqone pacientebisTvis. mowevis Sewyveta aris filtvis
funqciis SesanarCunebeli erTaderTi qmedeba, romlis efeqturobac dadasturebulia fqod-is dros.
JangbadiT xangrZlivi mkurnaloba aumjobesebs sicocxlis xangrZlivobas hipoqsiis mqone
pacientebSi.isnaCvenebia, rodesac:
 Pao2naklebia 7,3 kpa (56 mm vwy.sv.), rodesac stabiluria optimalur samedicino mkurnalobaze.
 Pao2 7,3-8,0 kpa da arsebobs mtkicebuleba gulis marjvenamxrivi ukmarisobis (filtvismieri guli)
Sesaxeb.
Sejameba
 asTma xasiaTdeba hipermgrZnobelobiT endogenuri bronqokonstriqtorebis, acetilqolinisa da
histaminis mimarT da sasunTqi gzebis Seqcevadi obstruqciiT.
 acetilqolinisa da histaminis moqmedebis damTrgunveli preparatebi sustia an uefeqto asTmis
mkurnalobaSi.
 asTmis sawinaaRmdego mkurnaloba Sedegad mimarTulia anTebiTi citokinebis gamoTavisuflebis
Semcirebisken (glukokortikoidebi da natriumis kromoglikati) an pirdapiri bronqodilataciisken
bronqebis 2 adrenoreceptorebis stimulaciiT.
 glukokortikoidebis agresiuli gamoyeneba, gansakuTrebiT sainhalacio gziT, mTavaria asTmis
marTvis Tanamedrove midgomaSi.
 antihistaminuri saSualebebi pirobiTad miuTiTebs H1 receptoris antagonistebze da farTod
gamoiyeneba alergiuli daavadebebisa da anafilaqsiis dros.
 Zveli pirveli Taobis antihistaminuri saSualebebis ZiriTadi gverdiTi efeqtia sedacia, rasac avicilebT
axali meore Taobis preparatebis gamoyenebiT, romlebic ar aRweven cns-Si.
 mowevis Sewyveta da JangbadiT xangrZlivi mkurnaloba aris erTaderTi Careva, romelic cnobilia,
rom aumjobesebs sicocxlis xangrZlivobas filtvebis qronikuli obstruqciuli daavadebis dros.

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