zeda sasunTqi gzebis mwvave infeqciebi · iSviaTad mwvave faringiti SeiZleba iyos mwvave...

zeda sasunTqi gzebis mwvave

infeqciebi

klinikuri mdgomareobis marTvis saxelmwifo

standarti

(protokoli)

2

mwvave faringiti

(pirveladi jandacva)

definicia

mwvave faringiti orofaringealuri aris anTebiTi procesia. mwvave

faringiti SeiZleba aRwerili iqnes rogorc `yelis tkivili~

(avadmyofobaTa saerTaSoriso klasifikaciis meaTe gadaxedvis mixedviT

is Seesabameba diagnozs mwvave faringiti - J02).

etiologia

ZiriTadi etiologiuri faqtorebia:

• virusi (40%): rinovirusi, koronavirusi, eqovirusi, koksaki, gripis da

paragripis virusi. SedarebiT iSviaTia epStein-baris virusi,

citomegalovirusi, adenovirusi, martivi herpesis virusi;

• baqteriuli (30%) flora _ A jgufis B hemolizuri streptokoki

ganapirobebs faringitis SemTxvevaTa 10-15%-s mozrdilebSi da 30%-s

bavSvebSi;

• qimiuri (sigaretis moxmareba);

• meqanikuri agenti (nakawri, naCxapni Zvlis fragmentiT);

• alergia;

• postnazaluri wveTi;

• iSviaTad kibo (adreul stadiaSi kibo xSirad vlindeba tkivilis

simptomiT).

kriteriumebi

faringitis klasikuri simptomebi moicaven yelis tkivils, disfagias,

cxelebas, saerTo sisustes, Tavis tkivils.

obieqturi gamokvlevisas vlindeba xaxisa da nuSura jirkvlebis

anTebiTi cvlilebebi (hiperemia, Sesiveba), Cirqovani nadebi nuSura

jirkvlebze, kisris wina limfuri jirkvlebis Sesiveba. arc erTi es

niSani ar aris paTognomuri streptokokuli etiologiis

faringitisaTvis, Tumca maTi arsebobis SemTxvevaSi daavadebis

baqteriuli etiologia ufro SesaZlebelia.

daavadebis virusul etiologiaze miuTiTebs: cxviridan gamonadeni,

xvela, xmis CaxleCa, koniunqtiviti da diarea;

streptokokuli etiologiisaTvis damaxasiaTebelia aseve

temperaturis uecari mateba (380-ze meti) Semcivnebis gareSe;

iSviaTad mwvave faringiti SeiZleba iyos mwvave epiglotitis an zemo

sasunTqi gzebis sxva seriozuli daavadebis gamovlena. Tu am dros

aRiniSneba sunTqvis gaZnelebac saswrafod gadaagzavneT avadmyofi

stacionarSi da moerideT xaxis gamokvlevas.

3

diagnostika da specialistTa konsultaciebi

pjd doneze diagnozi eyrdnoba klinikur niSnebs.

baqteriuli da virusuli genezis faringitis diferencirebis

saSualebas iZleva laboratoriuli gamokvlevebi: xaxis nacxis

baqteriologiuri gamokvleva an antigenis deteqciis swrafi testi

(RAT). am testebis rutinuli gamoyeneba pjd doneze rekomendebuli ar

aris. gamokvlevebis aucileblobas gansazRvravs specializebuli

dawesebulebis samedicino personali.

specialistis konsultacia da/an hospitalizacia naCvenebia:

peritonzilarul celulitsa an abscesze saeWvo SemTxvevebSi

Tu saxezea disfagia

Tu saxezea dehidratacia

Tu yelis tkivils Tan axlavs stridori an sunTqvis gaZneleba

(saswrafo hospitalizacia)

mkurnaloba

mwvave faringitis yvela SemTxveva ar aris baqteriuli etiologiis, ase

rom alogikuria mwvave faringitis yvela SemTxvevaSi gamoyenebul iqnes

antibiotiki.

xSirad savsebiT sakmarisia:

adeqvaturi tkivilgamayuCebeli saSualebebi: aspirini an paracetamoli.

reis sindromis ganviTarebis riskis gamo bavSvebSi aspirinis gamoyeneba ar

aris daSvebuli.

arasteroiduli anTebis sawinaaRmdego saSualebebis gamoyenebis riskis

gamo maTi rutinuli gamoyeneba mwvave faringitis dros rekomendebuli ar

aris.

erTeul kvlevebSi aris dadasturebuli savlebi saSualebebis

(benzidaminis hidroqloridis) efeqturoba tkivilis da disfagiis

Semcirebis TvalsazrisiT, magram es Sedegebi Semdgom dadasturebas

moiTxoven.

antibiotikebis gamoyeneba

antibiotiki iniSneba:

daavadebis mZime mimdinareobisas, rodesac pacientis zogadi

mdgomareoba mZimea

4

pirveli rigis antibiotikebs miekuTvneba:

penicilini V 250 4-jer an 500 mg 2-jer an 4-jer dReSi 10 dRis

ganmavlobaSi; bavSvebSi 250 mg 2-jer an 3-jer dReSi, 10 dRe per os

an

penicilini G (benzatin penicilini) erTjeradad kunTebSi, 1.200.000

mozrdilebSi, 27 kg-mde wonis bavSvebSi _ 600.000.

gaviTvaliswineT, rom mZime faringiti da kisris limfuri jirkvlebis

gadideba SeiZleba infeqciuri mononukleozis niSani iyos, amitom

pirveli rigis preparatad ampicilinis gamoyeneba mizanSewonili ar

aris.

penicilinze alergiis SemTxvevaSi rekomendebulia makrolidebis

gamoyeneba.

meore rigis antibiotikebs miekuTvneba:

amoqsicilini

gansakuTrebuli SemTxvevebi

morecidive faringiti

gaiTvaliswineT recidivis mizezebi: araadeqvaturi antibiotikoTerapia.

gamomwvevi: penicilin-rezistentuli beta-laqtamis maproducirebeli

Stamebi

rekomendebuli mkurnaloba: benzatin-penicilini (penicilini G),

cefuroqsimi an klindamicini

streptokokuli morecidive faringitis dros 10 dRiani

antibiotikoTerapia amcirebs gamwvavebaTa sixSires.

streptokokuli faringitis profilaqtikis mizniT antibiotikebis

xangrZlivi gamoyenebis efeqtianoba dadasturebuli ar aris.

tonzileqtomia morecidive faringitis dros naCvenebia pacientebSi,

romlebic akmayofileben yvela qvemoT CamoTvlil kriteriumebs:

• mwvave faringitis mizezi tonzilitia;

• erTi wlis ganmavlobaSi aRiniSneba mwvave faringitis 5 an meti

epizodi;

• simptomebi grZeldeba, sul mcire, erTi wlis ganmavlobaSi;

• mwvave faringitis mimdinareoba iseTi mZimea, rom xels uSlis

avadmyofis normalur yoveldRiur saqmianobas.

5

vinaidan, xSir SemTxvevaSi Zneli dasadgenia mwvave faringitebis zusti

sixSire an iyo Tu ara mwvave faringitis mizezi realurad mwvave

tonziliti, rekomendebulia tonzileqtomiamde 6 Tviani dakvirvebis

periodi, romlis ganmavlobaSi zustdeba yelis tkivilis gamomwvevi

mizezebi.

mas Semdeg, rac gadawyvetileba miRebuli iqneba, operacia unda Catardes

rac SeiZleba swrafad.

gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _ “zeda

sasunTqi gzebis mwvave infeqciebi”.

adamianuri da materialur-teqnikuri resursi

adamianuri resursi: ojaxis eqimi, ubnis pediatri an Terapevti.

materialur-teqnikuri resursi: gamanaTebeli mowyobiloba xaxis

dasaTvaliereblad, enis supresori (Spadeli), fonedoskopi.

6

mwvave faringiti

(stacionari)

definicia

mwvave faringiti orofaringealuri aris anTebiTi procesia.

avadmyofobaTa saerTaSoriso klasifikaciis meaTe gadaxedvis mixedviT

is Seesabameba diagnozs mwvave faringiti - J02.

simptomebi da niSnebi

faringitis klasikuri simptomebi moicaven yelis tkivils, disfagias,

cxelebas, saerTo sisustes, Tavis tkivils. obieqturi gamokvlevisas

vlindeba xaxisa da nuSura jirkvlebis anTebiTi cvlilebebi (hiperemia,

Sesiveba), Cirqovani nadebi nuSura jirkvlebze, kisris wina limfuri

jirkvlebis Sesiveba. arc erTi es niSani ar aris paTognomuri

streptokokuli etiologiis faringitisaTvis, Tumca maTi arsebobis

SemTxvevaSi daaadebis baqteriuli etiologia ufro SesaZlebelia.

streptokokuli etiologiisaTvis damaxasiaTebelia aseve temperaturis

uecari mateba (380-ze meti) Semcivnebis gareSe.

cxviridan gamonadeni, xvela, xmis CaxleCa, koniunqtiviti da diarea

iSviaTia, da Tu es niSnebi gamoCnda, safiqrebelia daavadebis virusuli

etiologia.

iSviaTad mwvave faringiti SeiZleba iyos mwvave epiglotitis an zemo

sasunTqi gzebis sxva seriozuli daavadebis gamovlena.

stacionarSi moTavseba iSviaTad aris aucilebeli. aseTia

peritonzilaruli celulitis an abscesis SemTxvevebi, rodesac saWiroa

otolaringologis meTvalyureoba da parenteraluri antibiotikebi.

iSviaTad hospitalizaciis mizezi SeiZleba gaxdes disfagia an

dehidratacia.

diagnostikur-laboratoriuli testebi da specialistTa konsultaciebi

a) pirvel 24 saaTSi

• sisxlis saerTo analizi;

• baqteriologiuri kvleva;

b) pirvel 3 dReSi


• Sardis saerTo analizi;

• baqteriologiuri kvleva;

• serologiuri kvleva (Cvenebis mixedviT);

• ekg (Cvenebis mixedviT).

7

mwvave faringitis diagnozi SeiZleba daeyrdnos klinikur niSnebs, Tumca

misi etiologiuri faqtori damatebiT gamokvlevebs saWiroebs.

baqteriologiuri kvleva _ baqteriologiuri kvlevis dadebiTi Sedegi

adasturebs daavadebis streptokokul etiologias, Tumca uaryofiTi

pasuxi ar gamoricxavs daavadebis baqteriul etiologias. garda amisa,

aris SemTxvevebi, rodesac xaxis nacxidan izolirebulia streptokoki,

Tumca infeqcia serologiurad ar dasturdeba. SemTxvevaTa 40%-Si aseve

aRniSnulia streptokokis asimptomuri mtarebloba. nuSura jirkvlebis

zedapiridan aRebuli flora yovelTvis ar Seesabameba tonzilebis

siRrmidan miRebul masalas, arada swored es ukanaskneli aris

pasuxismgebeli daavadebis ganviTarebaze. serologiurad dadasturebuli

infeqciis SemTxvevaSi xaxis nacxi ar xasiaTdeba maRali specifiurobiT

da mgrZnobelobiT. is aseve zrdis daavadebis Rirebulebas da SeiZleba

ganapirobos araaucilebeli medikamenturi mkurnaloba.

antigenis deteqciis swrafi testi ( R A T ) _ stacionarSi SeiZleba

gamoyenebuli iqnes antigenis deteqciis swrafi testi. xaxis an nuSura

jirkvlebis nacxSi streptokokis antigenis gansazRvris testis

upiratesobaa misi siswrafe da maRali specifiuroba (95-100%). misi

gamoyenebiT SesaZlebelia aseve SeizRudos antibiotikebis

gaumarTlebeli gamoyeneba. mis ZiriTad uaryofiT mxares warmoadgens

meTodis dabali mgrZnobeloba (50-95%).

serologiuri diagnostika _ avadmyofis organizmis imunur pasuxze

vlaparakobT maSin, rodesac antistreptolizinis, anti-dnm-is, an sxva

antistreptokokuli antisxeulebis titri 4-jer matulobs.

imunoserologiuri kvleva streptokokuli infeqciis erT-erTi saimedo

meTodia, Tumca misi mgrZnobeloba mcirdeba antibaqteriuli Terapiis

fonze. daavadebis mwvave periodSi antistreptokokuri antisxeulebis

titri maqsimums aRwevs me-2-3 kviras.

saWiroebis SemTxvevaSi SeiZleba Catardes otorinolaringologis,

kardiologis an nefrologis konsultacia (garTulebebis arsebobisas).

mkurnaloba

mwvave faringitis diagnozi ar niSnavs, rom aucileblad unda dainiSnos

antibiotiki. adeqvaturi tkivilgamayuCebeli saSualebebi xSirad savsebiT

sakmarisia mkurnalobisaTvis.

tkivilgamayuCebeli saSualebebi _ simptomuri saSualebebi aspirinis an

paracetamolis saxiT savsebiT sakmarisia tkivilis moxsnisaTvis. aqve

unda aRiniSnos, rom reis sindromis ganviTarebis riskis gamo bavSvebSi

aspirinis gamoyeneba ar aris daSvebuli.

mravali kvleva aRwers arasteroiduli anTebis sawinaaRmdego

saSualebebis gamoyenebas mwvave faringitis da tonzilitis dros.

naCvenebia, rom mkurnalobis ori-sami dRis Semdeg ufro swrafad xdeba

tkivilis, cxelebis, disfagiis, xiluli hiperemiis, limfadenopaTiis

Semcireba placebosTan an paracetamolTan SedarebiT. amave dros,

arasteroiduli anTebis sawinaaRmdego saSualebebis gamoyeneba

dakavSirebulia gastrointestinaluri sisxldenis, gulisrevis,

Rebinebis, muclis tkivilis da diareis ganviTarebis dadasturebul

8

riskTan. amitom arasteroiduli anTebis sawinaaRmdego saSualebebis

gamoyenebis riskis gamo maTi rutinuli gamoyeneba mwvave faringitis

dros rekomendebuli ar aris.

damatebiTi Terapia

erTeul kvlevebSi aris dadasturebuli savlebi saSualebebis

efeqturoba tkivilis da disfagiis Semcirebis TvalsazrisiT, magram es

Sedegebi Semdgom dadasturebas moiTxoven.

antibiotikebi

mwvave faringitis yvela SemTxveva ar aris baqteriuli etiologiis, ase

antibiotiki yovelTvis ar unda dainiSnos.

daavadebis mZime mimdinareobisas da savaraudod baqteriuli etiologiis

SemTxvevaSi pirveli rigis antibiotiks warmoadgens penicilini

(penicilini V 250 4-jer an 500 mg 2-jer an 4-jer dReSi 10 dRis

ganmavlobaSi; bavSvebSi 250 mg 2-jer an 3 jer dReSi, 10 dRe per os) an penicilini G (benzatin penicilini) erTjeradad kunTebSi, 1.200.000

mozrdilebSi, 27 kg-mde wonis bavSvebSi – 600.000.

unda gaviTvaliswinoT, rom mZime faringiti da kisris limfuri

jirkvlebis gadideba SeiZleba infeqciuri mononukleozis niSani iyos,

amitom unda moveridoT pirveli rigis preparatad ampicilinis

gamoyenebas. amave dros, bavSvebSi pirveli rigis preparatad SeiZleba

gamoviyenoT amoqsicilini.

penicilinze alergiis SemTxvevaSi mizanSewonilia makrolidebis

(eriTromicini, klindamicini, azitromicini) daniSvna. eriTromicinis

gamoyeneba misi gverdiTi movlenebis (gulisreva, diarea) SedarebiT

SezRudulia.

antibiotikebi morecidive faringitis dros

mwvave faringitis morecidive mimdinareoba im pacientebSi, romlebic

iRebdnen antibiotikebs, miuTiTebs, rom gamoyenebul iqna Seusabamo

antibiotiki, antibiotiki daniSnuli iyo araadeqvaturi doziT an

xangrZlivobiT, pacienti ar daemorCila mkurnalobas, aRiniSna re-

infeqcia an daavadebis gamomwvevi iyo penicilin-rezistentuli beta-

laqtamazis maproducirebeli Stamebi. aseT SemTxvevebSi naCvenebia

benzatin-penicilinis (penicilini G), cefuroqsimis, ko-amoqsiklavis an

klindamicinis gamoyeneba.

ar arsebobs sakmarisi informacia, romelic daadasturebs

antibiotikebis gamoyenebis aucileblobas mwvave morecidive

arastreptokokuli faringitis dros.

damatebiTi Terapia morecidive faringitis dros

randomozebuli, ormagi brma, placebo-kontrolirebadi multicentruli

kvleviT dadasturebulia imunoaqtiuri baqteriuli eqstraqtiT (OM-85, bronqo-vaqsomi, saqarTveloSi registrirebulia bronqo-munali)

imunostimulaciis mniSvneloba zemo sasunTqi gzebis morecidive

infeqciebis (morecidive faringiti) dros.

9

reabilitacia da dakvirveba

Sesabamisi antimikrobuli mkurnalobis SemTxvevaSi dadebiTi efeqti

miiReba 24-48 saaTis Semdeg. efeqtis ararsebobis mizezi SeiZleba iyos

uefeqto antibiotikoTerapia, garTulebebis darTva an sxva Tanarsebuli

daavadebis arseboba.

pacientTa umravlesoba pasuxobs antibiotikoTerapias da aRiniSneba

streptokokis eradikacia. ganmeorebiTi dakvirveba an baqteriologiuri

kvleva mkurnalobis kursis damTavrebis Semdeg aucilebeli ar aris.


sasunTqi gzebis mwvave infeqciebi”


adamianuri resursi: pediatri, Terapevti, otolaringologi.


dasaTvaliereblad, enis supresori (Spadeli), fonedoskopi.

10

mwvave sinusiti


definicia

mwvave sinusiti paranazaluri sinusebis lorwovani garsis anTebiTi

dazianebaa, romelic gamowveulia daxSul RruSi baqteriebis zrdiT da

romlis xangrZliobac 4 kviraze naklebia. sinusitis ganviTareba

uxSiresad iwyeba rinitis fonze, ris gamoc mas xSir SemTxvevaSi

uwodeben rinosinusits.

damadasturebeli kriteriumebi

daavadebis diagnostika efuZneba daavadebis anamnezs, klinikur suraTs,

simptomebis xangrZlivobas, obieqtur gasinjvas da, saWiroebisas,

rentgenologiuri gamokvlevis Sedegebs.

sinusitis arc erTi klinikuri niSani damoukideblad ar aris

mgrZnobiare da specifiuri diagnozis dasasmelad.

baqteriuli sinusitis klinikuri niSnebia:

• zemo sasunTqi gzebis infeqciis klinika, romelic ar

umjobesdeba 10-14 dRis ganmavlobaSi da romelsac Tan axlavs 2

niSani:

• cxviridan lorwovan - Cirqovani gamonadeni

da

• gaxangrZlivebuli aradamakmayofilebeli mdgomareoba.

• aseve SesaZlebelia:

• cxeleba;

• xvela;

• agzneba;

• saxis tkivili.

obieqturad SeiZleba gamovlindes:

• saxis Sesieba an eriTema dazianebis areSi;

• mgrZnobeloba sinusis palpaciis an perkusiis dros (palpaciisas

mcire asakis bavSvebSi saxis tkivili da sinusis mgrZnobeloba

ar vlindeba, Tumca es simptomebi kargi indikatoria saskolo

asakis bavSvebsa da mozardebSi);

• periorbitaluri Sesiveba;

• cxviris lorwovani garsis eriTema an SeSupeba;

• ZiriTadi kbilebis mgrZnobeloba;

• Tanmxlebi Sua yuris anTeba bavSvebSi.

11

ZiriTadi simptomebi, romelsac efuZneba diagnozi:

• zemo sasunTqi gzebis infeqciis klinika, romelic ar umjobesdeba

10-14 dRis ganmavlobaSi;

• cxviriT sunTqvis blokireba/cxviridan gamonadeni (SeiZleba

mxolod lorwovani, Sesqelebuli, lorwovan-Cirqovani);

• persistuli xvela, romelic Zlierdeba RamiT.

SedarebiT iSviaTad vlindeba gulisreva, yuris da yelis tkivili, saxis

tkivili, SeSupeba.


sinusitis mkurnaloba SesaZlebelia daiwyos mxolod klinikur suraTze

dayrdnobiT.

rentgenologiuri kvlevis Catareba saWiroa Semdeg SemTxvevebSi:

• mwvave sinusitis diagnozisas, Tu saeWvoa subperiostuli an

orbitaluri abscesi;

• mwvave sinusitis diagnozisas, Tu saeWvoa intrakraniuli

garTulebebi;

• Tu mkurnalobis miuxedavad ar aris gaumjobeseba da saWiroa

diagnozis dadastureba.

gaurTulebeli mwvave sinusitis dros sisxlis saerTo analizis an

nazofaringiuli kulturis rutinulad Catareba ar aris rekomendebuli.

mkurnaloba

antibiotikoTerapia

antibiotikoTerapiis Cvenebaa:

• simptomebis persistireba (magaliTad, Tu klinikuri niSnebi

grZeldeba 7 - 10 dReze meti);

• mZime simptomatika (mag: profuzuli Cirqovani gamonadeni

cxviridan, saxis tkivili da sistemuri dazianebis niSnebi);

• pacientis mdgomareobis da simptomebis gauareseba.

pirveli rigis preparats miekuTvneba amoqsicilini. Tu arsebobs

alergiuli anamnezi penicilinebis jgufis antibiotikebis mimarT

SeiZleba dainiSnos doqsiciklini (mozrdilebSi), azitromicini da

klaritromicini.

meore rigis preparatebs miekuTvneba: ko-amoqsiklavi, II Taobis

cefalosporini, ftorqinoloni (levofloqsacini, 12 wlis zemo asakSi).

Tu antibiotikis meore kursis Semdeg pacientis mdgomareoba ar

umjobesdeba, aucilebelia pacientis referali stacionarSi.

orsul qalebTan da meZuZur dedebTan gamoiyeneba eriTromicini.

miuxedavad imisa, rom klaritromicinTan da azitromicinTan SedarebiT

12

is metad aRizianebs kuW-nawlavis traqts da Haemophilus influenzae–ze naklebad moqmedebs, dadgenilia eriTromicinis usafrTxoeba orsulebSi.

antibiotikoTerapiis saSualo xangrZlivoba 10 dRea.

analgetiuri da antipiretuli saSualebebi

tkivilisa da temperaturuli reaqciis kupirebis mizniT bavSvebSi

naCvenebia paracetamolis an iboprufenis gamoyeneba.

dekongestantebi

intranazaluri dekongestantebis gamoyeneba moklevadiani kursiT

SesaZlebelia sinusitis samkurnalod, intranazaluri dekongestantebis

xangrZlivi droiT (7 dRe da meti) gamoyeneba ar aris rekomendebuli.

sxva saSualebebi

ar arsebobs klinikuri mtkicebulebebi nazalurad fiziologiuri

xsnaris gamoyenebis Sesaxeb. Tumca SesaZlebelia fiziologiuri xsnaris

gamoyenebam xeli SeuSalos fufxebis warmoqmnas da gaaTxelos sekreti,

rac gaaioloebs mis drenaJs.

dakvirveba

Tu pacients mkurnaloben antibiotikebiT da misi mdgomareoba ar

umjobesdeba, an Tu ver xerxdeba antibiotikis miReba, magaliTad

Rebinebis SemTxvevaSi, ganmeorebiTi viziti saWiroa Catardes 72 saaTSi.

Tu pacientis mdgomareoba antibiotikoTerapiis fonze ar umjobesdeba,

saWiroa:

• gadaisinjos diagnozis adeqvaturoba;

• Sefasdes garTulebebis arseboba;

• Sefasdes, Tu ramdenad asrulebs pacienti eqimis daniSnulebas.

Tu pacienti ar asrulebs sworad eqimis daniSnulebas:

• SeiZleba gagrZeldes mocemuli antibiotiki;

Tu antibiotikze aRiniSneba Rebineba

• igi unda Seicvalos sxva pirveli rigis preparatiT an dainiSnos

saineqcio antibiotiki, sanam ar moxdeba Rebinebis kupireba, ris

Semdegac kvlav xdeba gadasvla oralur antibiotikze.

Tu pacienti sworad asrulebs eqimis daniSnulebas:

• saWiroa meore rigis antibiotikebis gamoyeneba

Tu saeWvoa baqteriuli sinusitis garTuleba, aucilebelia referali

stacionarSi.



13


adamianuri resursi: ojaxis eqimi an ubnis pediatri/Terapevti, an

otorinolaringologi.


dasaTvaliereblad, enis supresori (Spadeli), fonedoskopi, rentgenis

aparati.

14

mwvave sinusiti

(stacionari)

definicia

mwvave sinusiti paranazaluri sinusebis lorwovani garsis anTebiTi

dazianebaa, romelic gamowveulia daxSul RruSi baqteriebis zrdiT da

romlis xangrZliobac 4 kviraze naklebia. sinusiti uxSiresad iwyeba

rinitis fonze, ris gamoc mas xSir SemTxvevaSi uwodeben rinosinusits.


daavadebis diagnostika efuZneba daavadebis anamnezs, klinikur suraTs,

simptomebis xangrZlivobas, obieqtur gasinjvas da, saWiroebisas,

rentgenologiuri gamokvlevis Sedegebs.

sinusitis arc erTi klinikuri niSani damoukideblad ar aris

mgrZnobiare da specifiuri diagnozis dasasmelad.

baqteriuli sinusitis simptomebia:


10-14 dRis ganmavlobaSi da romelsac Tan axlavs 2 niSani:

• cxviridan lorwovan - Cirqovani gamonadeni

da

• gaxangrZlivebuli aradamakmayofilebeli mdgomareoba.

• aseve SesaZlebelia:

• cxeleba;

• xvela;

• agzneba;

• saxis tkivili.

obieqturad SeiZleba gamovlindes:

• saxis Sesieba an eriTema dazianebis areSi;

• mgrZnobeloba sinusis palpaciis an perkusiis dros (palpaciisas

mcire asakis bavSvebSi saxis tkivili da sinusis mgrZnobeloba ar

vlindeba, Tumca es simptomebi kargi indikatoria saskolo asakis

bavSvebsa da mozardebSi);

• periorbitaluri Sesiveba;

• cxviris lorwovani garsis eriTema an SeSupeba;

• ZiriTadi kbilebis mgrZnobeloba;

• Tanmxlebi Sua yuris anTeba bavSvebSi.

15

ZiriTadi simptomebi, romelsac efuZneba diagnozi:


10-14 dRis ganmavlobaSi;

• cxviriT sunTqvis blokireba/cxviridan gamonadeni (SeiZleba

mxolod lorwovani, Sesqelebuli, lorwovan-Cirqovani);

• persistuli xvela, romelic Zlierdeba RamiT.

SedarebiT iSviaTad vlindeba gulisreva, yuris da yelis tkivili, saxis

tkivili, SeSupeba.


a) pirvel 4 saaTSi


b) pirvel 24 saaTSi


• cxviris danamati Rruebis rentgenologiuri kvleva;

g) pirvel 3 dReSi


• cxviris danamati Rruebis rentgenologiuri kvleva;

• mikrobiologiuri kvleva (Cvenebis mixedviT);

sawyis etapze sinusitze saeWvo SemTxvevebSi rutinuli rentgenologiuri

kvleva ar aris saWiro. ar aris rekomendebuli sinusebis

rentgenografiis Catareba 6 wlamde asakSic. sinusitis mkurnaloba

SesaZlebelia daiwyos mxolod klinikur suraTze dayrdnobiT.

rentgenologiuri kvlevis Catareba saWiroa Semdeg SemTxvevebSi:

• mwvave sinusitis diagnozisas, Tu saeWvoa subperiostuli an

orbitaluri abscesi;

• mwvave sinusitis diagnozisas, Tu saeWvoa intrakraniuli

garTulebebi;

• Tu mkurnalobis miuxedavad ar aris gaumjobeseba da saWiroa

diagnozis dadastureba.

yvela SemTxvevaSi rentgenografia unda Catardes pacientis vertikalur

poziciaSi, raTa rentgenogramaze Sefasdes sinusSi haeri-siTxis done.

garTulebuli sinusitebis SemTxvevaSi diagnostikis “oqros standartad”

iTvleba sinusis aspiracia da baqteriuli kulturis Seswavla.

kompiuteruli tomografiis gamoyeneba naCvenebia, Tu saeWvoa cxviris

danamati Rruebis avTvisebiani paTologia, Tu pacientebs esaWiroebaT

sinusitis qirurgiuli mkurnaloba. kompiuteruli tomografiis

gamoyeneba agreTve mizanSewonilia:

16

• sinusitis mZime garTulebebis ganviTarebis SemTxvevaSi;

• qronikuli an morecidive sinusitis dros;

• daavadebis mZime mimdinareobis SemTxvevaSi, rodesac medikamenturi

mkurnaloba uefeqtoa.

mkurnaloba

antibiotikoTerapia

baqteriuli sinusitis mkurnalobis mizania sinusis Rrus SigTavsis

drenireba da paTologiuri baqteriebis zrdis Seferxeba. antibiotiko-

Terapiis Cvenebaa:

• simptomebis persistireba (magaliTad, Tu klinikuri niSnebi

grZeldeba 7 - 10 dReze meti);

• mZime simptomatika (mag: profuzuli Cirqovani gamonadeni

cxviridan, saxis tkivili da sistemuri dazianebis niSnebi);

• pacientis mdgomareobis da simptomebis gauareseba.

pirveli rigis preparats miekuTvneba amoqsicilini. Tu arsebobs

alergiuli anamnezi penicilinebis jgufis antibiotikebis mimarT

SeiZleba dainiSnos doqsiciklini (mozrdilebSi), azitromicini da

klaritromicini, dadgenilia maTi maRali efeqturoba sinusitis

gamomwvevebis, gansakuTrebiT Haemophilus influenzae da Moraxella catarrhalis mimarT.

meore rigis preparatebs miekuTvneba: ko-amoqsiklavi, II Taobis

cefalosporini, ftorqinoloni (levofloqsacini, 12 wlis zemo asakSi).

Tu saeWvoa anaerobuli baqteriebiT gamowveuli sinusiti SesaZlebelia

mkurnalobaSi gamoyenebuli iqnas metronidazoli.

Tu antibiotikis meore kursis Semdeg pacientis mdgomareoba ar

umjobesdeba, mizanSewonilia sinusis punqcia da aspiratidan kulturis

mgrZnobelobis gansazRvra.

orsul qalebTan da meZuZur dedebTan gamoiyeneba eriTromicini.

miuxedavad imisa, rom klaritromicinTan da azitromicinTan SedarebiT

is metad aRizianebs kuW-nawlavis traqts da Haemophilus influenzae–ze naklebad moqmedebs, dadgenilia eriTromicinis usafrTxoeba orsulebSi.

antibiotikoTerapiis saSualo xangrZlivoba 10 dRea.

analgetiuri da antipiretuli saSualebebi

tkivilisa da temperaturuli reaqciis kupirebis mizniT bavSvebSi

naCvenebia paracetamolis an iboprufenis gamoyeneba.

17

dekongestantebi

intranazaluri dekongestantebis gamoyeneba moklevadiani kursiT

SesaZlebelia sinusitis samkurnalod, intranazaluri dekongestantebis

xangrZlivi droiT (7 dRe da meti) gamoyeneba ar aris rekomendebuli.

sxva saSualebebi

ar arsebobs klinikuri mtkicebulebebi nazalurad fiziologiuri

xsnaris gamoyenebis Sesaxeb. Tumca SesaZlebelia fiziologiuri xsnaris

gamoyenebam xeli SeuSalos fufxebis warmoqmnas da gaaTxelos sekreti,

rac gaaioloebs mis drenaJs.

dakvirveba

Tu pacients mkurnaloben antibiotikebiT da misi mdgomareoba ar

umjobesdeba, an Tu ver xerxdeba antibiotikis miReba, magaliTad

Rebinebis SemTxvevaSi, ganmeorebiTi viziti saWiroa Catardes 72 saaTSi.

Tu pacientis mdgomareoba antibiotikoTerapiis fonze ar umjobesdeba,

saWiroa:

• gadaisinjos diagnozis adeqvaturoba;

• Sefasdes garTulebebis arseboba;

• Sefasdes, Tu ramdenad asrulebs pacienti eqimis daniSnulebas.

Tu pacienti ar asrulebs sworad eqimis daniSnulebas:

• SeiZleba gagrZeldes mocemuli antibiotiki;

Tu antibiotikze aRiniSneba Rebineba

• igi unda Seicvalos sxva pirveli rigis preparatiT an dainiSnos

saineqcio antibiotiki, sanam ar moxdeba Rebinebis kupireba, ris

Semdegac kvlav xdeba gadasvla oralur antibiotikze.

Tu pacienti sworad asrulebs eqimis daniSnulebas:

• saWiroa meore rigis antibiotikebis gamoyeneba

Tu saeWvoa baqteriuli sinusitis garTuleba, aucilebelia

otorinlarigologis, ofTalmologis, neiroqirurgis konsultacia.




adamianuri resursi: pediatri, Terapevti an otorinolaringologi.


dasaTvaliereblad, enis supresori (Spadeli), fonedoskopi, rentgenis

aparati.

18

mwvave otiti


definicia

mwvave otitis samuSao definiciad mowodebulia Sua yuris anTeba

swrafad ganviTarebuli adgilobrivi (yuris tkivili) da zogadi

simptomatikiT (cxeleba, gaRizianeba, cudi Zili). SesaZlebelia adgili

hqondes zeda sasunTqi gzebis daavadebisTvis damaxasiaTebel simptomebs:

xvelas da rinoreas.


mwvave otitis diagnozi moiTxovs: daavadebis simptomebis ganviTarebis

mwvave dasawyiss; gamonadenis arsebobas Sua yurSi (timpanuri membranis

SeSupeba, timpanuri membranis mobilurobis SezRudva an ararseboba,

otorea); Sua yuris anTebis niSnebis da simptomebis arsebobas (timpanuri

membranis hiperemia, otalgia).

klinikuri niSnebi

Sua yuris anTebis uxSiresi simptomebia: tkivili, cxeleba,

gaRizianebadoba, otorea (gamonadeni yuridan), leTargia, anoreqsia da

Rebineba. specifiuri niSnebis nakleboba, gansakuTrebiT or wlamde

asakSi, arTulebs Sua yuris mwvave anTebis dignozis dadgenas.

Sua yuris anTeba gamonadeniT SesaZloa saerTod simptomebis gareSe

mimdinareobdes da gamovlenil iyos mxolod urTierTobis, qcevis,

swavlis da metyvelebis problemebiT.

diagnostika

mwvave otitis diagnozi SeiZleba daisvas mxolod klinikuri niSnebiT da

otoskopiuri kvlevis safuZvelze.

rekomendebulia pacientebSi morecidive mwvave otitiT gansakuTrebuli

yuradReba daeTmos Civils smenis daqveiTebis, metyvelebis Seferxebis

Sesaxeb.

marTva

analgetikebi _ tkivilis SemTxvevaSi aucilebelia analgetikebis

(acetaminofeni, ibuprofeni) gamoyeneba. tkivilis marTva, gansakuTrebiT

daavadebis pirvel 24 saaTSi, aucilebelia antibiotikoTerapiis

miuxedavad. tkivilis marTvaSi paracetamols upiratesoba unda mieniWos

arasteroiduli anTebis sawinaaRmdego saSualebebTan SedarebiT am

ukanasknelis gverdiTi movlenebis gamo. mSoblebs unda miewodoT

informacia mosalodneli safrTxis Sesaxeb dozis gadaWarbebisas. reis

sindromis ganviTarebis riskis gamo bavSvebSi aspirinis gamoyeneba ar

aris mizanSewonili.

19

yuris wveTebi

rekomendebulia, rom yvela bavSvSi mwvave otitiT unda moxdes tkivilis

Sefaseba da tkivilis arsebobis SemTxvevaSi unda dainiSnos

analgetikebi. unda gaviTvaliswinoT, tkivili mwvave otitis dros,

rogorc wesi, TavisiT gaivlis. amitom, aucileblobis SemTxvevaSi

efeqturi da usafrTxo analgetikebis xelmisawvdomoba ufro

mniSvnelovania, vidre is, Tu romeli medikamenti gamoviyenoT. es

preparatebia paracetamoli, ibuprofeni an yuris topikuri wveTebi.

pacientebSi, romlebTanac saeWvoa dafis apkis perforacia da/an

gamonadeni yuridan, Tavi unda avaridoT garegani saSualebebis

moxmarebas, radgan maT gamoyenebas SesaZloa Tan mohyves Zlieri

Tavbrusxveva da Rebineba.

antibiotikebi

antibiotikebi gamoyenebuli unda iqnes rutinulad 2 wlamde asakis

bavSvebSi an orxrivi otitis dros.

pirveli rigis preparats warmoadgens amoqsicilini.

Tu amoqsiciliniT 72 saaTiani Terapia uefeqtoa, an Tu pirveli rigis

preparatze aRiniSna alergiuli reaqcia, rekomendebulia meore rigis

preparatis: amoqsicilini/klavulinis mJavis an peroraluri

cefalosporinebis gamoyeneba.

Tu simptomebi grZeldeba amoqsicilini/klavulinatis miRebis Semdegac,

an Tu medikamentis peroraluri miReba SeuZlebelia, mizanSewonilia

ceftriaqsonis intramuskularuli ineqciebi 1-3 dRis ganmavlobaSi.

amoqsiciliniT Terapiis uefeqtobis SemTxvevaSi ar aris rekomendebuli

makrolidebis gamoyeneba.

gaurTulebeli mwvave otitis dros mkurnalobis 5 dRiani kursi

efeqturia. garTulebuli mwvave otitis dros da riskis jgufis

bavSvebSi mizanSewonilia 10 dRiani antibiotikoTerapia.

mwvave otitis dros antihistaminuri preparatebis da dekongestantebis

rutinuli gamoyeneba rekomendebuli ar aris.

Semdgomi dakvirveba da referali

Tu mdgomareoba ar umjobesdeba, aucilebelia bavSvis ganmeorebiTi

gamokvleva 48-72 saaTis Semdeg.

stacionarSi referali aucilebelia: Tu gareTa sasmen milSi daiwyo

Cirqovani gamonadeni, gansakuTrebiT Tu igi pulsirebad xasiaTs atarebs;

gamoCnda iseTi garTulebebi, rogoricaa saxis nervis paralizi an

mastoiditi; Tu eqvsi Tvis ganmavlobaSi aRiniSna mwvave otitis sami an

meti epizodi, an oTxi epizodi aRiniSna 12 Tvis ganmavlobaSi; Tu

mkurnalobis damTavrebis Semdeg eWvi gaqvT smenis deficitze

(gamoikvlieT yvela avadmyofi. CurCuli unda ismodes daaxloebiT 6

metrze).



20


adamianuri resursi: ojaxis eqimi an ubnis pediatri/Terapevti,

otorinolaringologi.

materialur-teqnikuri resursi: otoskopi, gamanaTebeli mowyobiloba

xaxis dasaTvaliereblad, enis supresori (Spadeli).

21

mwvave otiti

(stacionari)

definicia

mwvave otitis samuSao definiciad mowodebulia Sua yuris anTeba

swrafad ganviTarebuli adgilobrivi (yuris tkivili) da zogadi

simptomatikiT (cxeleba, gaRizianeba, cudi Zili). SesaZlebelia adgili

hqondes zeda sasunTqi gzebis daavadebisTvis damaxasiaTebel simptomebs:

xvelas da rinoreas.


mwvave otitis diagnozi moiTxovs: daavadebis simptomebis ganviTarebis

mwvave dasawyiss; gamonadenis arsebobas Sua yurSi (timpanuri membranis

SeSupeba, timpanuri membranis mobilurobis SezRudva an ararseboba,

otorea); Sua yuris anTebis niSnebis da simptomebis arsebobas (timpanuri

membranis hiperemia, otalgia).

klinikuri niSnebi

Sua yuris anTebis uxSiresi simptomebia: tkivili, cxeleba,

gaRizianebadoba, otorea (gamonadeni yuridan), anoreqsia, Rebineba.

specifiuri niSnebis nakleboba, gansakuTrebiT or wlamde asakSi,

arTulebs Sua yuris mwvave anTebis diagnozis dadgenas.

Sua yuris anTeba gamonadeniT SesaZloa saerTod simptomebis gareSe

mimdinareobdes da gamovlenil iyos mxolod urTierTobis, qcevis,

swavlis da metyvelebis problemebiT.

rekomendebulia, rom pacientebSi morecidive mwvave otitiT

gansakuTrebuli yuradReba daeTmos Civils smenis daqveiTebis,

metyvelebis Seferxebis Sesaxeb.

aucileblad unda iqnes gaTvaliswinebuli, rom otitisaTvis

damaxasiaTebeli simptomebi da niSnebi SeiZleba gaqres membranis

perforaciis Semdeg. garda amisa, daavadebis gadatanis Semdeg Sua yurSi

gamonadeni SeiZleba darCes mwvave otitis simptomebis gaqrobis Semdeg


a) pirvel 4 saaTSi


• otoskopia;

b) pirvel 24 saaTSi


• otoskopia;

• timpanometria.

22

g) pirvel 3 dReSi


• otoskopia;

• timpanometria;

• audiometria (Cvenebis mixedviT).

mkurnaloba

analgetikebi

tkivilis SemTxvevaSi aucilebelia analgetikebis (acetaminofeni,

ibuprofeni) gamoyeneba. tkivilis marTva, gansakuTrebiT daavadebis

pirvel 24 saaTSi, aucilebelia antibiotikoTerapiis miuxedavad.

tkivilis marTvaSi paracetamols upiratesoba unda mieniWos

arasteroiduli anTebis sawinaaRmdego saSualebebTan SedarebiT am

ukanasknelis gverdiTi movlenebis gamo. mSoblebs unda miewodoT

informacia mosalodneli safrTxis Sesaxeb dozis gadaWarbebisas. reis

sindromis ganviTarebis riskis gamo bavSvebSi aspirinis gamoyeneba ar

aris mizanSewonili.

yuris wveTebi

rekomendebulia, rom yvela bavSvSi mwvave otitiT unda moxdes tkivilis

Sefaseba da tkivilis arsebobis SemTxvevaSi unda dainiSnos

analgetikebi. unda gaviTvaliswinoT, tkivili mwvave otitis dros,

rogorc wesi, TavisiT gaivlis. amitom, aucileblobis SemTxvevaSi

efeqturi da usafrTxo analgetikebis xelmisawvdomoba ufro

mniSvnelovania, vidre is, Tu romeli medikamenti gamoviyenoT. es

preparatebia paracetamoli, ibuprofeni an yuris topikuri wveTebi.

pacientebSi, romlebTanac saeWvoa dafis apkis perforacia da/an

gamonadeni yuridan, Tavi unda avaridoT garegani saSualebebis

moxmarebas, radgan maT gamoyenebas SesaZloa Tan mohyves Zlieri

Tavbrusxveva da Rebineba.

antibiotikebi

antibiotikebi gamoyenebuli unda iqnes rutinulad 2 wlamde asakis

bavSvebSi an orxrivi otitis dros.

pirveli rigis preparats warmoadgens amoqsicilini.

Tu amoqsiciliniT 72 saaTiani Terapia uefeqtoa, an Tu pirveli rigis

preparatze aRiniSna alergiuli reaqcia, rekomendebulia meore rigis

preparatebis: amoqsicilini/klavulinis mJavis an peroraluri

cefalosporinebis gamoyeneba.

Tu simptomebi grZeldeba amoqsicilini/klavulinatis miRebis Semdegac,

an Tu medikamentis peroraluri miReba SeuZlebelia, mizanSewonilia

ceftriaqsonis intramuskularuli ineqciebi 1-3 dRis ganmavlobaSi.

amoqsiciliniT Terapiis uefeqtobis SemTxvevaSi ar aris rekomendebuli

makrolidebis gamoyeneba.

23

gaurTulebeli mwvave otitis dros mkurnalobis 5 dRiani kursi

efeqturia. garTulebuli mwvave otitis dros da riskis jgufis

bavSvebSi mizanSewonilia 10 dRiani antibiotikoTerapia.

mwvave otitis dros antihistaminuri preparatebis da dekongestantebis

rutinuli gamoyeneba rekomendebuli ar aris.

Semdgomi dakvirveba da referali

Tu mdgomareoba ar umjobesdeba, aucilebelia bavSvis ganmeorebiTi

gamokvleva 48-72 saaTis Semdeg.

otolaringologis konsultacia aucilebelia: Tu daewyo gareTa sasmen

milSi Cirqovani gamonadeni, gansakuTrebiT Tu igi pulsirebad xasiaTs

atarebs; gamoCnda iseTi garTulebebi, rogoricaa saxis nervis paralizi

an mastoiditi; Tu eqvsi Tvis ganmavlobaSi aRiniSna mwvave otitis sami

an meti epizodi, an oTxi epizodi aRiniSna 12 Tvis ganmavlobaSi; Tu

mkurnalobis damTavrebis Semdeg eWvi gaqvT smenis deficitze

(gamoikvlieT yvela avadmyofi. CurCuli unda ismodes daaxloebiT 6

metrze).




adamianuri resursi: pediatri an Terapevti, otorinolaringologi.

materialur-teqnikuri resursi: otoskopi, gamanaTebeli mowyobiloba

xaxis dasaTvaliereblad, enis supresori (Spadeli).

24

gacieba


definicia

gacieba ganixileba rogorc mwvave, msubuqad mimdinare kataruli

sindromi, romelic, rogorc wesi, ar saWiroebs medikamentur

mkurnalobas (avadmyofobaTa saerTaSoriso klasifikaciis meaTe

gadaxedvis mixedviT is Seesabameba mwvave nazofaringits _ J00 da zeda sasunTqi gzebis mwvave infeqciebs _ J06).

etiologia _ virusuli (miqsovirusebi, paramiqsovirusebi: paragripi,

respiraciul-sincitiuri virusi, adenovirusi, pikornavirusi

(rinovirusi) da koronavirusi). gripis virusi xSirad iwvevs gaciebis

msgavsi klinikuri simptomatikis ganviTarebas.

epidemiologia

• mozrdilebSi wlis ganmavlobaSi aRiniSneba gaciebis 2-4 epizodi.

• bavSvebSi misi sixSire SesaZlebelia 10-mdec ki iyos.

paTofiziologia

inkubaciuri periodi grZeldeba 24-72 saaTi gamomwvevis xasiaTis

gaTvaliswinebiT.

simptomebi da niSnebi klinikuri niSnebi

• uxSiresi simptomebia gamonadeni cxviridan, cxviriT sunTqvis

gaZneleba, yelis tkivili an fxaWnis SegrZneba, Tavis tkivili da

xvela. SesaZlebelia aRiniSnos xmis CaxleCa, gemovnebis an

ynosvis dakargva, Tvalebis wva, yuris dagubeba an wnevis

SegrZneba;

• xvela aRiniSneba gaciebis 30%-Si;

• sxeulis temperaturis momateba;

• adreuli asakis bavSvebSi: agznebadoba, kvebis gaZneleba

cxviridan gamonadenis gamo da diarea.

25

diagnostika

diagnozi emyareba anamnezs da daavadebis klinikur niSnebs.

diferencialuri diagnozi unda gatardes

• alergiul da araalergiul rinitTan;

• faringitTan;

• gripTan;

• bavSvebSi ucxo sxeulTan cxvirSi;

• adreuli asakis bavSvebSi unda gamoiricxos ufro seriozuli

mdgomareobebi: pnevmonia, sefsisi.

mkurnaloba

• medikamenturi marTva gulisxmobs simptomur Terapia.

rekomedebulia sicxis damwevi da tkivilgamayuCebeli

saSualebebi _ paracetamoli. alternativa: arasteroiduli

anTebis sawinaaRmdego saSualebebi _ aspirini (mozrdilebSi) da

ibuprofeni (bavSvebSi);

• damxmare saSualebebi: upirveles yovlisa, daarwmuneT pacienti,

rom gacieba msubuqi daavadebaa, romelic ar moiTxovs

medikamentur mkurnalobas. aqcenti unda gakeTdes siTxis

adeqvatur miwodebaze, ZuZuTi kvebaze myof bavSvebSi ufro xSir

kvebaze;

• mkurnalobis qvemoT CamoTvlili saSualebebis efeqtianoba

sarwmuno mecnieruli kvlevebiT dadasturebuli ar aris, mag.

bavSvebSi fiziologiuri xsnaris cxvirSi CawveTeba, orTqlis

inhalaciebi, C vitaminis maRali dozebi, oraluri an nazaluri

dekongestantebi (fsevdoefedrini, oqsimetazolini,

qsilometazolini) amosaxvelebeli da antihistaminuri

saSualebebi, eqinacea;

• pacientebSi filtvis qronikuli obstruqciuli daavadebebiT,

romlebsac gaciebis fonze aReniSnebaT, sul mcire, ori niSani

qvemoT CamoTvlilidan: sunTqvis ufro meti gaZneleba, naxvelis

raodenobis mateba da Cirqovani naxvelis gaCena _

rekomendebulia antibiotikoTerapia.

meTvalyureoba da prognozi gacieba saSualod grZeldeba erTi kvira. SemTxevaTa 25%-Si

daavadeba xangrZlivdeba 2 kviramde.

26

garTulebebi

• adreuli asakis bavSvebSi SeiZleba ganviTardes bronqioliti,

virusuli pnevmonia, krupi;

• 3 Tvemde asakis bavSvebSi SesaZlebelia qvemo sasunTqi gzebis meoradi

baqteriuli infeqciis ganviTareba;

• 60 wlis zemoT asakSi daaxloebiT 65%-Si mosalodmelia qvemo

sasunTqi gzebis daavadebaTa ganviTareba;

• am garTulebaTa ganviTarebis riski gansakuTrebiT matulobs Tambaqos

mwevelebSi;

• SemTxvevaTa 2%-Si gacieba rTuldeba mwvave otitis ganviTarebiT

(gansakuTrebiT bavSvebSi);

• paranazaluri sinusebis baqteriuli infeqcia (0,5%);

• avadmyofebSi filtvis qronikuli obstruqciuli daavadebiT

rinovirusuli etiologiis gacieba amZimebs da axangrZlivebs fqod-s.


sasunTqi gzebis mwvave infeqciebi”.


adamianuri resursi: ojaxis eqimi, ubnis pediatri an Terapevti.


dasaTvaliereblad, enis supresori (Spadeli), otoskopi (TandarTuli

mwvave otitis gamosaricxad), foneidoskopi.

27

mwvave sinusitis marTvis algoriTmi

mwvave sinusitis diagnostika imonokompetentur pacientSi bavSvi:

• cxviridan gamonadenis gaxangrZliveba;

• xveleba dRis saaTebSi;

• 10-14 dReSi ar aris gaumjobeseba.

mozrdili:

• Cirqovani gamonadeni cxviridan; • tkivili zeda ybis areSi (gans. calmxrivi);

• cal mxares sinusis mgrZnobeloba;

• sawyisi gaumjobesebis Semdeg mdgomareobis

gauareseba;

• gaumjobesebis ararseboba7-10 dRis Semdeg;

• sinusis rentgenografia morecidive an qronikuli

sinusitis dros.

pacienti mwvave mZime sinusitiT bavSvi da mozrdili:

• maRali (>390C) an mudmivi cxeleba (>3-4 dReze)

• periorbituli SeSupeba

• 10-14 dReSi ar aris gaumjobeseba

• saxis/kbilis Zlieri

tkivili

• am simptomebis arsebobisas, miuxedavad maTi

xangrZlivobisa, saWiroa

dauyovneblivi daxmareba

xangrZlivoba < 7-14 dReze

(an met xans Tu gaumjobese-

ba aris) an simptomebi

msubuqad aris gamoxatuli

7-10 dRe (mozrdilebSi) an 10-14 dRe (bavSvebSi) gaum-

jobesebis gareSe an ufro met xans saSualo simZimis

an mZime simptomatika, mudmivi serozul-Cirqovani

gamonadeni cxviridan da/an xvela dRis saaTebSi

simptomuri mkurnaloba fiziologiuri xsnaris Ca-

wveTeba, analgetiki/anti-

piretiki, adgilobrivi da/an

oraluri dekongestatebi,

(antibiotikebi ara efeqtu-

ria mwvave respiraciuli

infeqciis dros da ar ax-

dens baqteriuli sinusitis

prevencias0

Tu 4-5 dReSi ar iqna

gaumjobeseba, saWiroa

ganmeorebiTi konsultacia

romelime risk-faqtori saxezea? asaki 2 w-mde, aRzrda

organizebul koleqtivebSi, antibiotikebis gamoyeneba

bolo 3 Tvis manZilze an morecidive infeqcia.

airCieT erTi

• amoqsicilini:

mozrdilebi 1500

mg/dReSi 2 an 3

miRebaze; bavSvebSi: 45

mg/kg/dReSi 2 an 3

miRebaze

• penicilinze WeSmariti

alergia:* azitromicini

an klaritromicini

mkurnaloba unda

gagrZeldes myari

gaumjobesebidan 7 dRe

airCieT erTi

• amoqsicilini:

mozrdilebi 3

g/dReSi 2 an 3

miRebaze; bavSvebSi:

90 mg/kg/dReSi 2 an

3 miRebaze

• penicilinze

WeSmariti

alergia:*

cefalosporini

da/an

alergologis

konsultacia

gaumjobeseba ar aris 48-72 saaTSi? mxolod mudmivi

gamonadeni ar aris mkurnalobis Secvlis Cveneba

• ko-amoqsiklavi;

• cefuroqsimi; • penicilinze WeSmariti alergia:* respiraciuli ftorqinolini 18

welze meti asakis pacientebSi

mkurnaloba unda gagrZeldes myari gaumjobesebidan 7 dRe

SeniSvna * penicilinze WeSmariti alergia:

urtikaria an anafilaqsia penicilinze

miuTuTebs WeSmarit alergiaze.

makulopapuluri gamonayari ar aris

WeSmariti alergia Tu anamnezSi aris

penicilinze WeSmariti alergia,

cefalosporinis daniSvnamde miiReT

alergologis konsultacia an ifiqreT

respiraciul ftorqinolinze 18 welze

meti asakis pacientebSi

** klavulanis mJavis doza ar unda

aRematebodes 10mg/kg/dReSi

28

ara

mwvave otitis marTvis algoriTmi

yuris mwvave infeqciis (yuris tkivili, cxeleba) an

Sua yuridan gamonadenis (dafis apkis hiperemia)

niSnebi da simptomebi

mwvave Sua yuris anTeba

1. gamonadenis arseboba (SeiniSneba gasinjvis dros an

dgindeba pnevmaturi otoskopiiT)

da 2. mwvave infeqciis niSnebi da simptomebi (yuris tkivili,

cxeleba)

Sua yuris anTeba gamonadeniT

gamonadenis arseboba

(SeiniSneba gasinjvis dros an

dgindeba pnevmaturi

otoskopiiT)

mwvave infeqciis niSnebis da

simptomebis gareSe. tkivilis mkurnaloba

risk faqtori: 2 wlamde asaki, bavSvi dadis baRSi an skolaSi, antibiotikis miReba bolo 3 TveSi

diax ara

• amoqsicilini:* 45 mg/kg/ dReSi

2-3 miRebaze (Tu 2 welze met

asakSi daavadeba mZimed mimdina-

reobs, saWiroa maRali doza -

90 mg/kg/ dReSi 2-3 miRebaze)


alergia:** cefalosporini

• amoqsicilini:* 90 mg/kg/

dReSi 2-3 miRebaze


alergia:** cefalosporini

da/an alergologis

konsultacia

aris gaumjobeseba 2-3 dReSi?

(mxolod gamonadeni ar aris mkurnalobis Secvlis Cveneba) diax

mkurnaloba grZeldeba;

ganmeorebiTi konsulta-

cia saWiroa 4-8 kviris

Semdeg da gauaresebis

SemTxvevaSi

• amoqsicilini: 90 mg/kg/ dReSi, ko-amoqsiklavi *** 2-3 miRebaze 10 dRe. an: ceftriaqsoni

kunTebSi (pacientebSi, penicilinebis autanlobis SemTxvevaSi).

• penicilinze WeSmariti alergia**

SeniSvna

* 2 wlamde mkurnalobis xangrZlivoba 10 dRe, Tu 2 welis zemoT (Tu garTuleba ar aris), 5 dRe

** penicilinze WeSmariti alergia: WeSmarit alergiaze miuTiTebs urtikaria da anafilaqsia

penicilinis mimarT. makulo-papuluri gamonayari ar miuTiTebs WeSmarit alergiaze. Tu alergia

gamoxatulia cefalosporinis daniSvnamde, saWiroa alergologis konsultacia

*** klavulonis doza ar unda aRematebodes 10 mg/kg/dReSi

referalis Cveneba:

otolaringologTan

• mastoiditis niSnebis arseboba; • Tu simptomebi uaresdeba an ar umjobesdeba 2 dReSi.

nevrologTan

• Tu gamoixata saxis nervis dazianebis simptomebi.

audiologiuri gamokvleva saWiroa, Tu

• daavadeba grZeldeba 3 Tveze met xans da/an Tu SeimCneva metyvelebis, smenis darRveva.

antibiotiki ar aris naCvenebi,

saWiroa dakvirveba 3 Tve

Tu gamonadenis

xangrZlivoba > 3

Tveze - saWiroa

referali

otolaringologTan,

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