Tavi I

Teimuraz gogiZe
cofi, misi prevencia
da nakbeni Wrilobebis
qirurgiuli mkurnaloba
Tbilisi
2010
1
uak
UDC (uak
uak) 616.98:578.824.11+617-083.98+619:616.98:578.824.11
g-594
winamdebare monografia mieZRvna msoflio mniSvnelobis
aRmoCenas - lui pasteris mier cofis sawinaaRmdego vaqcinis
Seqmnidan 125 wlisTavs.
aRniSnuli naSromi warmoadgens damxmare literaturas,
saxelmZRvanelos medikosebisaTvis da mkiTxvelTa farTo
fenebisaTvis.
es wigni aris avtoris ocdaSvidwliani Teoriuli da
praqtikuli saqmianobis Sedegi - nakbeni Wrilobebis
qirurgiuli mkurnalobisa da cofis prevenciis kuTxiT.
recenzentebi: profesori elza vaSakiZe
profesori paata imnaZe
profesori gia TomaZe
redaqtori: medicinis doqtori ramaz ruxaZe
saqarTvelos antirabiuli samedicino daxmarebis centris emblemis
dizaini: profesori Temo Wyonia
mxatvari: profesori gogi wereTeli
teqredaqtori: uCa nebieriZe
koreqtori: maia SayulaSvili
damkabadonebeli: giorgi kakabaZe
Teimuraz gogiZe 2010 ©
saavtoro uflebebi daculia
ISBN 978-9941-0-2175-6
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am naSroms vuZRvni
mSoblebisa da pedagogebis
naTel xsovnas da pirveli
SviliSvilis dabadebas
w i n a T q m a
cofis gavrcelebis TvalsazrisiT saqarTveloSi Seqmnili mZime
ekonomikuri, epizootiuri da epidemiologiuri situacia kvlav
realur safrTxes uqmnis qveynis mosaxleobas. saqarTvelos mTeli
teritoria cofiT inficirebis kerad iTvleba, razedac miuTiTebs rogorc adrindeli, aseve bolo wlebis statistika.
q. Tbilisis bavSvTa #2 mravalprofiluri saavadmyofos bazaze jer kidev 1996 wels sazogadoebriv sawyisebze Seqmnilma
antirabiuli samedicino daxmarebis erovnulma centrma, itvirTa ra mTeli pasuxismgebloba Seqmnili viTarebis gamosasworeblad, daiwyo qveyanaSi rabiologiuri qirurgiis samsaxuris Camoyalibeba.
prioritetulia erT profesionalSi rabiologiuri da qirurgiuli codna-gamocdilebis gaerTianeba, rac ufro efeqturs
xdis rogorc nakbeni Wrilobis mkurnalobas, cofisa da tetanusis prevenciasTan erTad.
monografiaSi didi adgili uWiravs istoriul narkvevs, cofis
epizootologias, diagnostikas, klinikur masalas, ferad ilustraciebs, statistikur monacemebs. es monografia Cem mier
gamocemul adrindel naSromebTan erTad kidev ufro ganamtkicebs da ganaviTarebs TiTqmis sami aTeuli wlis win Camoyalibebul antirabiul samsaxurs da Seqmnis qirurg-rabiologTa
skolis arsebobis myar garantebs saqarTveloSi.
monografiaSi qronologiurad, principiT _ `aravin da araferi
ar unda iyos daviwyebuli~ _ warmodgenilia saqarTveloSi
cofsawinaaRmdego samedicino RonisZiebaTa istoria.
wignis gasrulebaSi mniSvnelovania monografiis Tavebis Tanaavtoris naTia gogiZis roli.
gansakuTrebiT unda aRiniSnos aw gardacvlili mecnieri medikosebisa da praqtikosi eqimebis mxridan qveynis wamyvani antirabiuli qirurgiuli samsaxuris mxardaWera da aRiareba.
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didi pativiTa da siTboTi movixsenieb maT saxelebs _ akademikosebs: Tamar dekanosiZes, vaxtang boWoriSvils, nodar boxuas,
profesorebs: levan avalians, givi Jvanias, mariam grigalaSvils,
aleqsandre simoniSvils, Tamaz gaCeCilaZes, sergo xundaZes, zurab
cxakaias, giorgi boWoriSvils, docentebs: cira xecurians, uCa
rusaZes, noe mTvaraZes, sergo CxartiSvils, bavSvTa qirurgiis
ganyofilebis gamgeebs: mixeil WavWaniZes, giorgi (joto) abulaZes, nodar pirvels, mTavar eqimebs: daviT germesaSvils, joni
Tofurias, jemal onians, bavSvTa qirurgebs: daTo CxaiZes, guram
sayvareliZes, Temur maxaraZes, avTandil tyemalaZes. wamyvan epidemiologebs: giorgi nadaraias, mixeil elikaSvils, suliko kirTaZes, nana terelaZes, eTer gulisaSvils da sxva.
didi madloba saqarTvelos yvela qirurg_rabiologs da rabiologiaSi momuSave sxvadasxva dargis specialistebs, mosaxleobisaTvis cofis problemis moxsnis saqmeSi gaweuli RvawlisaTvis.
madloba Cems, rogorc kolegebs, aseve megobrebs, mTeli am
winaaRmdegobiT aRsavse xangrZlivi periodis ganmavlobaSi qveynis sabazo antirabiuli samsaxuris gulSematkivrobisaTvis.
agreTve madliereba minda gamovxato Cemi cxovrebis Tanamgzavris, Rirseuli pirovnebis da gamocdili eqimis dali dunduagogiZis mimarT, qirurg-rabiologis metad sapasuxismgeblo da
rTul saqmianobaSi TanadgomisaTvis.
da bolos, msurs giTxraT, rom ar arsebobs imaze meti bedniereba, rodesac dReniadag grZnob sakuTari Sromis asaxvas Seni
kolega qirurg-rabiologebis nayofier muSaobaSi. Cem Tavs ki
vusurveb ufro met Sromas da sicocxlis bolomde im principis erTgulebas, romelsac gvaswavlis erTi brZnuli Cinuri
andaza: “icxovre yoveldRe ise, TiTqos es Seni ukanaskneli dRea
da daisaxe iseTi miznebi, TiTqos Sens win maradisobaa”.
avtorisagan
4
r e c e n z i a
Teimuraz gogiZis monografiaze “cofi, misi prevencia da
nakbeni Wrilobebis qirurgiuli mkurnaloba”
cofi uxsovari droidanaa cnobili da dRemde farTod gavrcelebuli mwvave virusuli zoonozia. igi centraluri nervuli sistemis mZime dazianebiT mimdinareobs da ZiriTadad sikvdiliT
mTavrdeba. ganviTarebad qveynebSi adamianTa da umravles ZuZumwovarTa virusuli daavadebiT gamowveul sikvdilobaSi cofs
pirveli adgili uWiravs. Mmsoflios jandacvis organizaciis
monacemebiT mTel msoflioSi yovelwliurad adamianTa cofis
30 000-de SemTxveva unda iyos, roca 1 000-ze meti araa aRricxuli. Ddaavadebis Tavidan asacileblad msoflioSi yovelwliurad 4 milionze met adamians antirabiuli acrebi utardeba. saqarTveloSi cofi aqtualuri samedicino problemaa, rasac
adasturebs cxovelebSi, ZiriTadad mawanwala ZaRlebSi laboratorulad dadasturebuli aTeulobiT SemTxveva da yovelwliurad aTeulamde adamianis cofiT sikvdilis SemTxvevebi.
monografiis avtori meoTxed saukuneze metia muSaobs am
rTul da mZime problemaze. igi praqtikulad saqarTveloSi
antirabiuli samsaxuris erT-erTi organizatoria.
jer kidev hipokrates droidan aris cnobili, Tu ra didi
mniSvneloba aqvs cxovelisagan dakbenil adamianSi cofis
profilaqtikisaTvis Wrilobis pirvelad movlasa da mis saTanadod damuSavebas. sworad Catarebuli Wrilobis pirveladi
damuSavebisas cofis ganviTarebis riski 90%-de mcirdeba. Mmxolod am mimarTebiT avtoris rudunebiTa da maRali profesionalizmiT aseulobiT adamianis, maT Soris umZimesi dazianebebiT bavSvis sicocxlea gadarCenili da SenarCunebuli.
avtoris mdidari klinikuri gamocdileba kargadaa asaxuli
monografiaSi, romelic didi interesiT ikiTxeba da metad mniSvnelovan informacias Seicavs ara mxolod praqtikosi qirurgrabiologebisaTvis.
didia avtoris Rvawli antirabiuli profilaqtikis aseve
umniSvnelovanesi sakiTxis - antirabiuli imunoglobulinisa da
vaqcinis kombinirebulad gamoyenebis Tanamedrove usafrTxo sqemebis aprobaciasa da praqtikaSi farTod danergvaSi.
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marTalia, monografia ZiriTadad eqimi-qirurgebisTvisaa gankuTvnili, amasTan masSi saTanado adgili aqvs daTmobili cofis
klinikuri niSnebis detalur gadmocemas, cofis diagnozis laboratoriulad dadasturebis Tanamedrove meTodebis aRwerasa
da Sefasebas, riTac mniSvnelovnad FfarTovdeba mis mimarT dainteresebul specialistTa wre.
monografia mniSvnelovani SenaZenia ojaxis eqimebis, infeqcionistebisa, rezidentebis, aseve
samedicino universitetis
studentebisaTvis. igi didad Seuwyobs xels Cvens qveyanaSi
antirabiuli samsaxuris gaumjobesebasa da am urTulesi problemis winaaRmdeg efeqtur brZolas.
Tssu infeqciur sneulebaTa departamentis xelmZRvaneli,
medicinis doqtori,
elza vaSakiZe
sruli profesori
6
r e c e n z i a
T. gogiZis monografiaze “cofi, misi prevencia da
nakbeni Wrilobebis qirurgiuli mkurnaloba”
hidrofobia (cofi) kvlav mniSvnelovan problemad rCeba qveynis sazogadoebrivi janmrTelobisaTvis. epizootiuri da epidemiologiuri situacia. sakmaod arasaxarbieloa saqarTvelos mTel
teritoriaze, razedac miuTiTebs rogorc cxovelebSi laboratoriulad dadasturebuli aTeulobiT SemTxveva, aseve adamianTa daavadebis faqtebi.
Tbilisis bavSvTa #2 mravalprofiluri saavadmyofos bazaze
jer kidev 1996 wels sazogadoebriv sawyisebze Seqmnilma antirabiuli samedicino daxmarebis erovnulma centrma didi roli
iTamaSa viTarebis gaumjobesebaSi, daiwyo qveyanaSi qirurgiuli
rabiologiuri mimarTulebis Camoyalibeba.
avtoris mier 27 wlis ganmavlobaSi dagrovili gamocdileba
da maRali kvalifikacia gaxda dedaqalaqisa da qveynis sxvadasxva regionis antirebiuli samsaxuris muSaobis gaumjobesebis erT-erTi winapiroba.
monografiaSi warmoCenilia antirabiuli profilaqtikuri
mkurnalobis umniSvnelovanesi roli cofis problemis gadasawyvetad aucilebel RonisZiebaTa kompleqsSi.
metad mniSvnelovania rabiologiuri da qirurgiuli mimarTulebebis codna-gamocdilebis kompleqsurad warmoCena, rac
ufro efeqturs xdis rogorc nakbeni Wrilobis mkurnalobas,
aseve antirabiul specifikur profilaqtikas antitetanur imunizaciasTan erTad. avtoris didi wvlili miuZRvis saqarTveloSi
1997 wlidan axali ti pis 5-6 ineqciani antirabiuli vaqcinaciis kursis SemuSaveba-danergvaSi, manamde moqmedi 48 ineqciani
kursis nacvlad, aseve saTanado dokumentaciis formebis Seqmnasa
da praqtikaSi danergvaSi, ramac gaaumjobesa dazaralebulTa
antirabiul profilaqtikur mkurnalobaSi Cabma da misi srulyofili Catarebis monitoringi.
gansakuTrebiT aRsaniSnavia antirabiuli samsaxuris organizaciis
da qirurg-rabiologTa momzadeba-gadamzadebis sakiTxebis kompetenturi gadmocema. didi praqtikuli mniSvneloba aqvs qi7
rurg-rabiologis saqmianobaSi mosalodneli garTulebebisa da
Secdomebis aRsakveTad mowodebul rekomendaciebs.
monografiaSi mniSvnelovani adgili uWiravs avtoriseul
klinikur masalas, STambeWdav ilustraciebs, mondomebiT damuSavebul statistikur monacemebs.
monografiaSi qronologiurad warmodgenilia saqarTveloSi
cofis sawinaaRmdego samedicino RonisZiebaTa istoria.
es monografia, avtoris mier gamocemul wina naSromebTan erTad, xels Seuwyobs antirabiuli qirurgiuli daxmarebis xarisxis
gaumjobesebas qveyanaSi da qirurg-rabiologTa kvalifikaciis
amaRlebas. igi saintereso da sasargeblo iqneba sxva specialobis eqimebisa da studentebisaTvisac.
paata imnaZe
medicinis doqtori
profesori
8
r e c e n z i a
T. gogiZis monografiaze `cofi, misi prevencia da nakbeni
Wrilobebis qirurgiuli mkurnaloba”
cofi kargad cnobili zoonozuri neiroinvaziuri virusul
infeqciaa, romliT dainficirebac saTanado profilaqtikis gareSe
fataluri SedegiT Tavdeba.
msoflioSi yovelwliurad cofiT 55 000 adamiani iRupeba.
literaturaSi mxolod 6 SemTxvevaa aRwerili cofiT daavadebis Semdeg araletaluri gamosavlisa. amrigad, miuxedavad imisa,
rom daavadeba uxsovari droidanaa cnobili, misi Sedegebi Zalian
seriozulia, rac ganapirobebs mis aqtualobas.
warmodgenil monografiaSi, saqarTveloSi cofis sawinaaRmdego samedicino RonisZiebaTa istoriasTan erTad, Tavmoyrilia
avtoris 27 wliani gamocdileba saqarTveloSi rabiologiuri
samsaxuris organizebis mimarTulebiT. avtoris uSualo monawileobiT daixvewa saqarTvelos antirabiuli samsaxuri, momzadda ara erTi aTeuli rabiologi.
monografiaSi xazgasmiTaa aRniSnuli antirabiuli profilaqtikuri mkurnalobis mniSvneloba cofis mkurnalobis RonisZiebaTa kompleqsSi, Tavmoyrilia am mimarTulebiT arsebuli rabiologiuri da qirurgiuli gamocdileba. masala kargadaa ilustrirebuli.
monografiaSi warmodgenil informacias aqvs ara marto
Teoriuli, aramed praqtikuli mniSvnelobac. rabiologiuri
qirurgia 2000 wlidan iswavleba saqarTvelos postdiplomuri
ganaTlebis sistemaSi. Cemi Rrma rwmeniT medicinis am mimarTulebas
ufro meti yuradReba unda daeTmos umaRlesi samedicino
ganaTlebis diplomamdeli swavlebis procesSic.
profesori gia TomaZe
Tbilisis saxelmwifo samedicino
universitetis saxelSekrulebo bazaze
arsebuli gadaudebeli qirurgiisa da
travmatologiis samecniero-pedagogiuri
centris profesori, medicinis mecnierebaTa doqtori
9
Tavi I
istoriuli narkvevi
cofi (Lyssa, Hydrophobia. Aerophobia, LaRage, Rabies, Tolluut.
LaRabia. Kudür, Veszettseg, Wscieklina, Vzteklina, Turbare) cxovelTa da adamianTa uZvelesi daavadebebis ricxvs miekuTvneba. aRmosavleTis Zveli periodis eqimebi Cv. w. aR-mde 3000 wlis win
aRwerdnen daavadebas, romelic cxovelebsa da adamianebs anadgurebda.
cofi cnobili iyo indoelebisaTvis, CinelebisaTvis, Zveli
berZnebisaTvis, romaelebisaTvis, ebraelebisaTvis, arabebisaTvis,
qarTvelebisa da slavebisaTvis.
TalmudSi moyvanilia am daavadebis 5 niSnis gamovlineba ZaRlebSi: `maT piri aqvT Ria, romlidanac nerwyvi uwyvetad moedineba,
yurebi - Camoyrili, kudi - Camovardnili kidurebs Soris, xma xrinwiani an ar moismineba. rekomendebulia misi mokvla Soridan~.
yvelaze adrindeli cnoba cofze gvxvdeba Zveli babilonis
eSnunis kanonebis kodeqsSi. aRniSnul kodeqsSi weria, rom ZaRlis gacofebis SemTxvevaSi xelisufleba valdebulia, daadginos
misi patroni, Tu cxoveli sabmelis gareSe iyo da misgan dakbenili adamiani mokvda, patronma unda gadaixados 40 sekli vercxli. Tu dakbenili iyo mona, misi sikvdilis gamo ixdidnen 15
sekl vercxls (Sellers-is mixedviT, 1954).
Tavis erT-erT poemaSi Zveli aRmosavleTis didi poeti nizami
aRniSnavs: ,,bednieria is, visac piri aqvs mokumuli, radgan ena
gadmogdebuli mxolod cofian ZaRls aqvs.~
cxovelebSi cofiT daavadeba detalurad aRwera demokritem
(500 weli Cv. w. aR-mde), aristoteles (322 weli Cv. w. aR-mde)
azriT, cofiani cxovelis mier dakbenili yvela cxoveli cofiT
avaddeba (n. maris mixedviT, 1909). plutarqes cnobebiT, cofi da
lepra italiaSi qristianul welTaRricxvamde 100 wlis win
gaCnda.
adamianSi hidrofobia pirvelad aRwera kornelius celsiusma
Cveni welTaRricxvis pirvel saukuneSi. manve SeamCnia, rom daavadeba adamians gadaecema ZaRlisagan dakbenis Sedegad. hidrofo10
biis Tavidan acilebis mizniT igi mimarTavda nakbeni Wrilobis
mowvas gavarvarebuli rkiniT (SanTiT), haleni (Cveni welTaRricxvis me-2 saukune) ki ufro Sors wavida, igi Tavis Tanamedroveebs nakbeni kiduris amputacias urCevda.
saqarTveloSi cofi uxsovari droidan yofila cnobili. uZveles qarTul ZeglSi ,,wameba wmindisa SuSanikisa~ (me-5 saukune) naxsenebia daavadebis saxelwodeba da misi ZiriTadi niSanTviseba: ,,yioda da iZaxda viTarca cofi~. amave periodidan SemorCenilia sityvebi: ,,gacofda~, ,,cofians hgavs~, ,,cofiani~ da sxva.
did interess iwvevs Zvel qarTul samedicino wignebsa da karabadinebSi daculi informacia am daavadebis Sesaxeb. kananeli
(XI saukune) aRwers cofiT daavadebuli ZaRlebisagan adamianis
dasnebovnebas. es maSin, roca am mosazrebas msoflioSi bevri
didi moazrovne, maT Soris aristotelec ki, uaryofda. Cvenma
winaprebma yuradReba miaqcies cofis diagnostikas: `ra ZaRli
gabrazdebis, gaSterdebis, feri Seecvlebis da rasac iqs, veRaras
Seityobs. mudam irbens da Tu dawvebis, kuds fexSiga daiWers
da SoriTa damoklebuls gvandes, pirsa peruli mosdiodes, xma
Cauvardebis... ufro Tu Seityo nakbeni braziani aris da Tu ara
es unda rame cota puri ZaRls miugdo, Tu arc usunos da arc
Wamos, icode rom braziani aris, nakbenis sisxli dascxos pursa
da Tu Wamos, ar aris braziani~ (`usworo karabadini~). moyvanil
amonaridSi aRwerilia cofis simptomebi ZaRlSi (ZaRlisTvis
sakvebis migdeba, sisxliani puris naWriT cofis amocnoba).
gansakuTrebul interess iwvevs adamianSi cofiT daavadebis
aRweriloba, romelic XII saukunis samedicino Zegl `wigni saaqimoSia~ mocemuli: `niSani misi igi ars, romel razomTa dReTa
ukan tani misi gawiTldes da asoTagan ofli sdiodes dia, da
wylisagan dia eSinodes da iqnebis romel ZaRliviT ybedobdes
da kacsa Semoutyobdebdes~. `iadigar daudSi~ (XVI saukune)
mocemulia daavadebis simptomatika adamianebSi: `da ese braziani
ZaRli rome kacsa Seexos da an kacsa ukbinos, Svidsa dResa
ukana mali xuliasaviTa Seiqmnebis, asre rom martod yofa moundebis da sinaTlesa daeridebis, bnelsa saxlSiga Sevardebis,
cudamdsa fiqrebsa iqs da rasac naxavs, isiv braziani ZaRli
egonebis da SeSindebis da bevrjuel asre iqnebis, rome miwa Siga
gagordebis da asoebi SeeSlebis da miWuritina rome miuSviro,
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Tavis saxesa miWuritina rome Tavisi Tavi dainaxos, braziani
ZaRli egonebis da SeSindebis da iqnebis rome xelsa da fexSiga
Zali moakldebis, iqnebis rome ZaRlsaviT yuils daiwyebs da
yeli da xaxa gauxmebis, ver daiyefebs, kacis kbena moundebis da
visca ukbens, isica amasaviTa Seiqmnebis da sadamdisi wyalsa
ridebasa dauwyebs, manamdisi da amisi wamali advili aris. da Tu
Tvisi saxe miWuritinaSiga ver amoicnas, mas ukan misiT wamali
aRar iqnebis, da ufrore erTi ormocsa dRemdisin iqnebis.~
amave informaciiT, cofi Tavs iCens ZaRlis kbenidan Svidi
dRis Semdeg. aqve aRwerilia daavadebis Tanamdevi fsiqikuri
movlenebi: melanqolia, martoobisa da sibnelisadmi ltolva,
aseve yelisa da xaxis simSrale, agresiuloba.
`iadigar daudSi~ mocemulia mkurnalobis erT-erTi profilaqtikuri saSualeba, romelic kvebas ukavSirdeba: `brazianma ZaRlma roma kacsa ukbinos, asre unda, es braziani ZaRli moklan da
am ZaRlis RviZli moxarSon da ama nakbensa kacsa aWamon da
maSinve eSvelebis.~
yuradRebas imsaxurebs davadebis zusti ganmarteba, romelic
mocemuli aqvs sulxan-saba orbelians Tavis leqsikonSi: `cofi
_ goneba da cnoba moZarcvuli”.
cofis Tema uyuradRebod ar darCenia iakob gogebaSvils (romelic marTebulad iTvleba axali saliteraturo qarTuli enis
erT-erT fuZemdeblad ilia WavWavaZesTan da akaki wereTelTan
erTad), sabavSvo moTxroba `cofian ZaRlSi~. Cveni azriT, aRniSnuli moTxrobis srulad moyvana didad waadgeba mosaxleobis
cofis Tavidan acilebis saqmes.
cofiani ZaRli
Svidi wlisa viqnebodi; gazafxuli idga. SemaRlebuls jejilebs mwvaned gahqondaT RaRani da Tavisken izidavdnen adamiansa. am jejilebSi icoda famfara, erTnairi rZiani balaxi, romelic
gemrieli saWmeli iyo adamianisaTvis. Cveni soflelni, qalebi da
vaJebi, xSirad daiarebodnen mindvrad famfaras mosatanad. erTs
kaSkaSa dRes Cemi umcrosi da da Zma amitydnen: wagviyvane famfarazedao. mec mindoda famfara, karga xani ar meWama da amitom
siamovnebiT avusrule patarebs survili, aviReT patara kalanCx12
ebi da gavswieT dasavleTiT RaRana jejilebisaken. mezoblis
ori patara Svilic Tan gamomyva. ukan gavidevneT ZaRlebic, rom
nadiris SiSi ara gvqonoda.
gaviareT erTi didi jejili, gavcdiT meore jejilsaca da
mivediT rus pirze, sadac ufro bevri da ukeTesi famfara gveguleboda. jer famfaras krefa ar dagvewyo, rom ZaRlebi facxafucxiT Secvivdnen ruSi da iqiTa napirs gavardnen. gavixede
qveviT da iqiT napiris moSorebiT gavarCie veeberTela ZaRli,
romelsac daRrenili piridan dorbli gasdioda, kudi lajebsa
da mucels qveS hqonda amoZuebuli da balani metad aburgZnoda.
- `vaime, dedav, cofiani ZaRli~, - SiSiT wamoviZaxe xmamaRla,
magram vigrZeni, rom windauxedaoba momixda am wamoZaxebiT, bavSvebma SiSisagan tirili morTes da fexi moekveTaT. maTma tirilma SiSi mec ufro kidev gamiZliera, magram Tavi Sevimagre da
vuTxari bavSvs dasamSvideblad: `ara, ara, tyuilia, cofiani ar
aris, ise ZaRlia, gexumreT, mainc ki axlave Sin unda wavideT, rom
ara gvavnos – ra, mere movalT da famfara sad wagviva~, - bavSvebi
isev male damSvidnen, rogorc male aRrialdnen.
bavSvebi win gamoviZRole da ukan movsdevdi, veCqarebodiT, rac
ki SegveZlo. me didi imedi mqonda Cveni didi ZaRlebisa, romelnic
mgelsac ar SeuSindebodnen, magram es imedi gamicruvda. roca
ukan movixede, davinaxe, rom cofian ZaRls Cvenis ZaRlebisaTvis
SiSi zari daeca, win gamoereka da moarbeninebda, dafeTebuli
ZaRlebi SlapaSlupiT gamocvivdnen ruSi. gagviswres wina da
soflisaken garbodnen. verc dayvavebiT da verc gajavrebiT me
isini ver SevaCere, davrCi uSemweod oTxi patara bavSvi cofianis ZaRlis msxverplad. Cveni gadarCena saswauliT Tu moxdeboda.
kidev movixede ukana, rom Semetyo, ras sCioda cofiani ZaRli.
is jer kidev rus iqiT napirs iyo, xan zeviT airbenda, xan qveviT
Cairbenda, xids eZebda gamosasvlelad; magram axlomaxlo xidis
WaWanebac ar iyo. meti Rone ar iyo, unda wyalSi gamoetopna da
dagvdevneboda, magram wylisa saSinlad eSinoda, ver Semoebeda
ruSi da iyo erTs wvalebSi, bolos, erTi sazarlad daiymuvla,
Semovarda ruSi da gamovarda aqeTa napirsa.
am dros me Cemi bavSvebiT gamocilebuli viyavi iqiTa jejilsa. am jejilis aqeTa napirs patara ru Camodioda. am ruze ido
13
nergis xidi, romelzedac gamosvla Zneli iyo bavSvebisaTvis. ai,
rogorc iyo yvelani gamovsxi, mec Sevdeqi xidze da gamovdivar.
swored am dros movarda ZaRli; wyals rom moaxlovda, Sesdga;
etyoboda, rom aTrTolda, SeSinda, Tvalebi auWrelda, davTrebi
sul dakarga. bolos mainc gabeda da xidze Semodga. me movaswari,
xids xeli avkari da wyals miveci. ZaRls ori wina fexi ruSi
Cauvarda da saSinlad daiymuvla; mere daixia ukan, aikriba fexebi, gasworda napirze da dauwyo Zebna rus viwro adgils, gadmoxtomas apirebda; magram ver i pova moxerxebuli adgili da
zeviT daioTxa. zemoT, ori miwis saqcevze, bogiri iyo; am ruze
gamovidoda da mogveweoda. amitom veCqarebodiT Sinisaken, rac
ki SegveZlo. gadmoviareT jejili, mivaRwieT Cven karmidamozeda,
da Tavi gadarCenili megona, magram kinaRam am samSvidoboSi ar
gavxdi msxverpli im wyeulis ZaRlisa. swored im dros, roca
saxlSi SevdiodiT, ZaRli movarda Cvens karebTan da kinaRam ar
momwvda fexSi; erTi fexiT Zlivs Sevaswari oTaxSi da Zlivs
movaswari karebis moketa.
Cvenze rom ver iyara Tavisi brazi cofianma ZaRlma, daeria
ZaRlebSi da arc erTi dauglejeli ar gadurCa. Tavis kbilebs
ufro Tavsa da pirSi uyrida da sazarlad hkbenda. ufro metad
dahkbina didi da Ronieri ZaRlebi, romlebic ar SeuSindnen mas,
ebrZodnen da hkbendnen, rac ki SeeZloT. xolo cofiani ZaRli
TiTqos sulac ar grZnobda tkivilsa da mouridebliv hglejda
Tavis mebrZolTa. es mebrZolni SemdegSi yvelan dacofiandnen
da patronebma TofebiT daxoces.
mezoblebi, Tavzardacemulni, saxlebSi Sevidnen da iqidan ucqerdnen saSinels oinebs cofianis ZaRlisasa. Cvenc fanjridan
Tvals vadevnebdiT. uceb ZaRlma dainaxa wyaroze kokiT mimavali
Teqvsmet-Cvidmeti wlis biWi. ZaRlebs Tavi aneba da gaeqana
imisken. `ariqa, leqso (es saxeli erqva biWs), Tavs uSvele!
cofiania, cofiani!~ - davuZaxeT Cvenca da mezoblebmaca. - `vai,
dedasa, ra biWs gaafuWebs eg SeCvenebuli ZaRli!~ - ismoda aqeTiqidan.
marTlac, leqso Tavis tolebSi pirveli biWi iyo tanadobiT,
simarjviT, RoniT, sityva-pasuxiT, zrdilobiT da amasTan saocars
uSiSrobas iCenda xifaTis drosa. sxvaTa Soris, saca gvels
moaswrebda, mokvdeboda da cocxals ar gauSvebda. gvelis sinsi14
la TiTqmis gaawyo Cvens sofelSi. yvela am Rirsebis gamo
leqso mTeli soflis sayvareli iyo. kidev amitom ukvdeboda
guli yvelas, vinc ki xedavda, ra saSineli xifaTi daawyda Tavsa
am samagaliTo biWsa. rogor unda gadaerCina Tavi? joxi arsad
hqonda, Senobebi Sors iyo, versad Seefareboda. magram leqsom
aqac gamoicina samagliTo simarjve da daamtkica, rom is swored
Rirsi iyo sayovelTao siyvarulisa.
dainaxa Tu ara cofiani ZaRli misken gaqanebuli, leqsom
saCqaros dadga koka wyaros Tavze da maSinve daavlo xelebi
ors mozrdils qvasa. Cairbina wyaros Tavidan qvemoT, iqiT napirsa da SeCerda. wyaro maRlobis ZirSi did nakadulad gadmodioda da es nakaduli midioda ors amoSenebuls maRals napirs
Sua. maRali napirebi Sori-Sors iyo erTmaneTze da erTi napiridan meoreze gadaxtomas moaxerxebda mxolod Zlieri mardi
biWi. leqso idga iqiT napiras. rawams ZaRli wyaros Tavidan
misken daeSva, leqsom iskupa da aqeT napiras gadmoxta. ZaRlmac
moindoma gadaxtoma, Tan gadayola, magram ver gabeda, radganac
gadasaxtomi ganieri daxvda da TviTonac gaZlierebuli cofisagan da ZaRlebTan brZolisagan misustebuli iyo. saCqarod hqmna
piri zemoT. avarda wyaros Tavzeda da axla aqedan mouara
leqsos. aman xelaxlad iskupa da iqiTa napirs moeqca. gabrazebulma ZaRlma Tavi axla ki veRar Seimagra da viTonac gadaeSva.
magram daxe bedsa, weli veRar miatana da mxolod wina fexebiT
uwia iqiTa napirsa, ukana fexebi ki wyalSi Cauvarda. moisma
erTi saSineli Rmuili. leqsom moaswro da, rac Zali da Rone
hqonda, Sig SublSi sTxliSa veeberTela qva, im wamsve zed daayola meore qvac da ZaRli imdenad gabnida, rom wyalSi CaioTxa.
dastaca xelebi leqsom qvebsa da ZaRls sul setyvasaviT daayara. ramdensame wams Semdeg cofiani ZaRli wyalSi egdo mTlad
gaguduli.
“mokvda, mokvda, gamodi, nu geSiniaT!” – mxiaruli xmiT dagviZaxa mezoblebs leqsoma. aramc Tu maxlobeli mezoblebi mTeli
sofeli moaskda wyaros Tavze. yvela leqsos aqebda, yvela mas
Sehxaroda: didi da patara, qali da kaci da marTla, qebis
Rirsic iyo. vin icis, ramdeni qali da kaci daeglija cofian
ZaRls da usaSinlesi sikvdili mieyenebina, rom uSiSar da marjve leqsos ar moeswrafebina misTvis dRe.
15
leqsos ki ukvirda amodena qeba-dideba da ambobda: ra vqna, ra
didi rama vqeni, cofiT mimkvdarebuli ZaRli movkali, meti xom
araferio. (iakob gogebaSvili `saganZuri~ gamomcemloba ganaTleba,
Tbilisi, 1982w.)
cofTan dakavSirebuli saintereso cnobebia moyvanili ilia
WavWavaZis mier daarsebul ,,iveriaSi~, romelic iTvleboda imdroindeli qarTuli presis flagmanad da aSuqebda eris saWirboroto sakiTxebs.
me-19 saukunis miwurulSi saqarTveloSi jer kidev ar iyo
daarsebuli pasteris sadgurebi, amitom cofiani ZaRlisa da
mglis nakbenisagan adamianebi xSir SemTxvevaSi iRupebodnen. swored
amitom ,,iverias~ araerTxel dausvams sakiTxi TbilisSi pasteris sadguris gaxsnis Taobaze.
1888 wlis 22 martis ,,iveriaSi~ (#47) moTavsebulia g.
SaraSiZis werili ,,ubeduri SemTxveva guriaSi.~ am werilidan
irkveva, rom sami guruli cofian mgels daukbenia da Segrovili
fuliT isini odesaSi gaugzavniaT samkurnalod.
imave wlis 16 aprilis nomerSi iv. e-lis xelmoweriT gamoqveynebulia sakmaod vrceli statia, romelSic pasteris mier
cofis sawinaaRmdego acris aRmoCenazea saubari. garda amisa,
aRniSnulia, rom im droisaTvis ruseTSi pasteris meTodiT
mkurnalobdnen peterburgSi, moskovSi, odesaSi, xarkovSi, varSavasa da samaraSi. yvelaze saukeTesod ki miCneulia odesis
samkurnalo, romelsac xelmZRvanelobdnen i. i. meCnikovi da misi
TanaSemweebi, bardaxi da gamaleia.
g. SaraSiZe mogviTxrobs, rogor ganikurna odesis samkurnaloSi ramdenime qarTveli da vrclad aRgviwers cofiani mglisagan dakbenili sami gurulis ambavs. iqve moxseniebulia mkurnali Tofuria da iq myofi qarTveli studentebi, romelTac
morigeoba dauwesebiaT avadmyofebTan da samive avadmyofi gankurnebuli gamoustumrebiaT samSobloSi.
avtori mwuxarebas gamoTqvams, rom am dros TbilisSi ar aris
pasteris sadguri.
imave wlis 19 aprilis nomerSi (#84) dabeWdilia imave g.
SaraSiZis werili cofiani mglisagan dakbenili sami guruli
glexis odesidan dabrunebis Sesaxeb; mokled aris aRwerili, Tu
rogor Cautares maT mkurnaloba. gankurnebulni didi madlo16
biT ixsenieben eqimebs, gameleiasa da bardaxs, ferSal qals, ivanovas, b-n Tofurias da iq myof qarTvel studentebs. maT sanaxavad
or-samjer i. t. gurielic yofila. iagor maxaraZes ki Seugrovebia fuli maT dasabruneblad da gamosamgzavreblad.
,,iveriis~ furclebze moTxrobilia daniis sataxto qalaq
kopenhagenSi Catarebuli saeqimo krebis (kongresis) angariSi.
krebas daswrebia 1400 mecnieri eqimi. gazeTi wers: ,, am krebaze
mraval mecnierTa Soris pirveli adgili eWiraT: pasters, safrangeTis umTavres warmomadgenels, virxovs _ germaniis da
pejets _ inglisis warmomadgenels.~
kongresis monawileni gansakuTrebuli aRfrTovanebiT Sexvedrian pasters, romelic meore sxdomaze cofis Taobaze moxsenebiT gamosula.
werilSi xazgasmulia pasteris mier cofis sawinaaRmdego
acris SemoRebis didi mniSvneloba. am aRmoCenas redaqcia ,,TiTqmis
epoqis Semadgenel aRmoCenas~ uwodebs.
1890 wlis 2 ivnisis ,,iveriaSi” (#114) dabeWdilia pasteris
institutis 4 wlis manZilze gaweuli Sromis angariSi.
pasteris dabadebis 70 wlisTavs ,,iveria~ calke werils uZRvnis
saTauriT ,,lui pasteri~ (1892 wlis 14 (22) dekemberi) ,,am
TariRs guSin mTeli ganaTlebuli qveynebi dResaswaulobdnen,~
_ wers gazeTi.
,,...pasterma friad didi sargebloba moutana mTels kacobriobas. pasteris wyalobiT exla Zlier bevri avadmyofoba ise
saSiSi aRar aris, rogorc winad iyo. pasterma gamoigona cimbiris Wiris wamloba, cofis acra. xoleris winaaRmdeg brZola
kacobriobas Zlier gauadvila pasterma xoleris bacilebis
aRmoCeniT. vazis avadmyofobas, mildiusa da filoqseras winaaRmdeg
imave pasterma gamoigona wamali.~
1886 wlis 27 ivlisis ,,iveriaSi” (#162) dabeWdilia ilia
xonelis statia, romelSic moTxrobilia TbilisSi cofiT Sepyrobili 3 wlis bavSvis sikvdilis Sesaxeb. amasTan dakavSirebiT
werilis avtori ixseniebs pasteris mier cofis sawinaaRmdego
acras da samarTlian sayvedurs gamoTqvams: ,,aravis ar mosvlia
TavSi imisTana ubralo azri, rom kargi iqneba visargebloT
mecnierebis axalis saSualebiT da gamoviyenoT igi cxovrebaSio.~ peterburgidan, moskovidan, odesidan da saratovidan eqime17
bi gagzavnes parizSi mkurnalobis Sesaswavlad da iq gaxsnes
pasteris samkurnaloebi. saWiroa Cveni eqimebis wasvla parizSi,
am saqmis Seswavla da pasteris samkurnalos daarseba. amas
moiTxovs ara mxolod Tbilisis, aramed mTeli amierkavkasiis
mosaxleobis interesebi da am saqmeze unda izrunos Tbilisis
qalaqis mmarTvelobamo, _ wers gazeTi.
1888 wlis 1 ivlisis ,,iveriis” (#136) mowinave statia
mTlianad cofis sawinaaRmdego acras eZRvneba. avtori miesalmeba TbilisSi pasteris sadguris daarsebis ganzraxvas.
amave nomerSi, meore gverdze, axali ambebis ganyofilebaSi, dabeWdilia saeqimo mmarTvelobis gankarguleba da pasteris sadgurSi avadmyofebis miRebis wesi: ,,1888 wlis 1 ivlisidan TbilisSi higienur laboratoriasTan (Tbilisi. saafTiaqo maRaziis
sadgomSi, riyis quCaze, iunkerebis saswavleblis maxloblad)
gamarTuli iqneba sadguri, sadac pasteriseburi meTodiT cofs
aucrian pirutyvebisagan dakbenilebs, rogorc samxedro uwyebis
kacebs, agreTve samoqalaqosac. amasTanave saeqimo mmarTveloba
sayoveTaod acxadebs, rom axal sadgurs ar eqneba bina avdmyofebisaTvis, xolo ufasod aucrian mosiarule avadmyofebs, qalaqis
mcxovrebT da Camosulebs. Camosulebs sazogado wesisamebr fasiT daabinaveben Tbilisis mixeilis saavadmyofoSi. SesaZloa
kerZo sadgomSi daabinaon Tavisi xarjiT an sazogadoebaTa da
dawesebulebaTa xarjiT, romlebic gamogzavnian, xolo jariskacT, CamosulT, daabinaveben kavkasiis mexuTe zurgis qveviTa batalionSi, romelic sadguris maxloblad mdebareobs.~
amave 1888 wlis 3 agvistos ,,iveriam” (#162) mowinave miuZRvna pasteris aRmoCenas da aRniSna: ,,mecnierebam saxelovani
pasteris RvawliT iqamde miaRwia, rom es saSineli Wiri cotad
Tu bevrad Seumsubuqa kacobriobas, magram uebar wamlobamde jer
kidev Sors arian kacTmoyvare mecnierni. dabejiTebiT Tqma ar
SeiZleba, rom cofis wamali uebrad napovni iyos, magram imedi
unda viqonioT, rom dResa Tu xval mecniereba am wamals miagnebs.~
aqve aRniSnulia, rom Sedgenilia vrceli proeqti dacofianebis SemcirebisaTvis. saamisod saWiroa:
a) aikrZalos piraukvreli ZaRlebisa da katebis gamoSveba;
b) upatrono mawanwala ZaRlebi unda daixocnen;
18
g) ZaRlebis mepatroneebs dauwesdeT gadasaxadi da am Tanxidan gasamrjelo gadaexados am saqmisaTvis daniSnul zedamxedvels. ZaRlis patronebs soflad SeRavaTi eqnebaT qalaqSi mcxovreblebTan SedarebiT, radgan qalaqelebs ZaRlebi hyavT gasarTobad, xolo soflad _ saWiroebisaTvis;
d) mokluli mglis safasurad dawesdes fuladi jildo.
es proeqti samkurnalo departamentma dagzavna yvelgan. ,,Segrovili azri gadaisinjeba da waredgineba dasamtkiceblad kanonmdebloba,~ _ wers gazeTi.
mowinave werilSi gamoTqmulia azri: sofleli unda gaTavisufldes gadasaxadisagan, radgan soflad am saqmis zedamxedveloba
SeiZleba Cabardes soflis nacvals, romelsac araviTari gasamrjelo ar eZlevao.
,,iveria~ cofis sawinaaRmdego acris SemoRebas, mecnierebis am
miRwevas, friad didi mniSvnelobis movlenad Tvlis. amiT aixsneba is garemoeba, rom gazeTis momdevno nomrebSi am sakiTxze
saintereso cnobebs kvlav vxvdebiT. ase magaliTad, 1889 wlis 9
agvistos nomerSi (#168) dabeWdilia parizis studentTa sazogadoebis Tavmjdomaris Sometonis sityva, romliTac man pasters mimarTa.
1893 wlis 9 ianvris ,,iveriaSi~ (#5) dabeWdilia vrceli
informacia pasteris 70 wlis iubilesTan dakavSirebiT. saiubileo sxdoma gamarTula sorbonaSi 1892 wlis 15 dekembers.
iubile didi zeimiT Catarebula. sityviT gamosulTa Soris
yofila mecnierebaTa akademiis prezidenti abado. mas pasterisaTvis gadaucia oqros medali, romlis erT mxareze gamosaxuli
yofila pasteri. sityviT gamosulan sxvadasxva qveynis gamoCenili mecnierebi, maT Soris cnobili ingliseli qirurgi listeri. dasasrul, pasters didi madloba gadauxdia damswre sazogadoebisaTvis.
cofi, bunebrivia, did SiSs iwvevda imdroindel mosaxleobaSi.
amis Taobaze ara erTi saintereso werilia dabeWdili ,,iveriaSi~. ase magaliTad, rkinigzis sadgur natanebis meisre, ivane
doliZe, daukbenia turas. doliZes tura xeliT dauxrCvia, radgan iaraRi Tan ar hqonia. damxrCvali tura xurjinSi Caudia da
TbilisSi Camoutania eqimebisaTvis _ cofiani xom ar ariso. (ix.
,,iveria~, #9, 14 ianvari, 1893). Telavis mazraSi cofian mgels
19
rva kaci daukbenia, romelTagan erTi gardacvlila Tbilisis
sabaqteriologio samkurnaloSi. (ix. ,,iveria~, #55, 16 marti,
1893w.)
cofis problema dResac aqtualuria. bunebrivi da qalaqis
ti pis cofis Tanamedrove epizootiebs axasiaTebT globaluri
gavrceleba. hidrofobia adamianTa daavadebebis erT-erT yvelaze
mZime, elvisebur da gardauvali letalobis paTologiad rCeba.
cofiani cxovelebis mier miyenebuli nakbenebi yovel konkretul SeTxvevaSi moiTxovs qirurgiul da antirabiuli-profilaqtikuri mkurnalobis aucilebel kurss.
hidrofobiis epidemiologia
aSS-sa da evropis qveynebSi saSualod registrirdeba adamianis hidrofobiiT daavadebis 1 SemTxveva, cxovelebSi ki _ cofis
2000-4000 SemTxveva.
XIX saukuneSi hidrofobiiT inglisSi weliwadSi saSualod
79 adamiani iRupeboda, avstriaSi – 58, ungreTSi ki 80. 18101819ww. prusiaSi 1953 adamiani gardaicvala hidrofobiiT. daavadebis asobiT SemTxveva iyo pasteramde periodis safrangeTSi.
pirveli msoflio omis Semdeg hidrofobiam mkveTrad moimata
rogorc evropaSi, ise aziaSi, amerikasa da afrikaSi. ase magaliTad, 1920 wels aSS-Si oficialuri monacemebiT hidrofobiiT
105 adamiani gardaicvala, 1924 wels ki italiaSi 150 SemTxveva
dafiqsirda.
cofiT daavadebis axali talRa wamovida meore msoflio omis
Semdeg ufro metad aziis, amerikisa da afrikis qveynebSi. magaliTad, iaponiaSi 1949w. dafiqsirda hidrofobiis 49 SemTxveva,
xolo 1950 w. _ 63. 1946 wels daavadebis 446 SemTxveva dafiqsirda iranSi, tailandSi _ 1946 wels 245, xolo 1955 wels 265
SemTxveva.
ruseTSi hidrofobiiT daavadebis piki iyo 1902 wlidan 1914
wlamde, ris gamoc 497-1917 adamiani daiRupa am daavadebiT, rac
saSualod 1042 gardacvlils Seadgens.
aSS-sa da gansakuTrebiT ki indoeTSi hidrofobiiT ufro
xSirad bavSvebi avaddebian. zogierTi amerikeli avtori safuZvlianad ganixilavs hidrofobias, rogorc pediatriul proble20
mas. daavadebis xvedriTi wili bavSvebSi, kerZod 5-dan 15 wlamde
asakis bavSvebSi, maRalia msoflios sxva qveynebSic.
aRsaniSnavia, rom qalaqis macxovreblebTan SedarebiT soflis
mcxovrebni ufro masobrivad avaddebodnen hidrofobiiT, magaliTad: yofil sabWoTa kavSirSi 1964-1974w.w. am daavadebis procentuli maCveneblebi aseTia: soflis mcxovrebi 85,3%, xolo
qalaqis _ 14,7%. statistikuri monacemebiT mamakacebis hidrofobiiT daavadebis SemTxvevebi ufro xSiria (72,4%), vidre qalebisa
(27,6%).
hidrofobiiT daavadebas ara aqvs gamokveTili sezonuroba.
igi registrirdeba yvela sezonSi, magram daavadebis maCvenebeli
zafxulsa da Semodgomaze, maissa da seqtemberSi imatebs. drois
am periodSi mosaxleoba xSirad imyofeba Ria cis qveS, tansacmeli ki ver icavs sxeuls dakbenisagan.
yofili sabWoTa kavSiris monacemebiT daavadebulebSi dakbenebis lokalizaciis adgilebidan gamoirCeva zeda kidurebis
midamo _ 60,7%, Tavis, saxis an kisris midamo _ 24,7%, qveda
kidurebis midamo – 10,7%.
hidrofobia ar iTvleba profesiul daavadebad. SesaZlo cofian cxovelebTan kontaqtis gamo, inficirebis riskis jgufs
ganekuTvnebian mecxoveleebi da veterinaruli muSakebi, agreTve
ZaRlebmWeri brigadebi.
cofis etiologia
cofis etiologiuri kvlevis istoriidan (iseve rogorc sxva
virusuli daavadebebis istoriidan) cnobilia periodi, rodesac
aRmoaCines sxvadasxva kokebi, mikrokokebi, umartivesebi, romlebsac SecdomiT Tvlidnen cofiT daavadebis gamomwvevad. d. ivanovskis
mier virusebis aRmoCenamde (1892w.) ramdenime wliT adre pasterma ganaxorciela cofis virusis warmatebuli kultivireba
laboratoriaSi, SeimuSava misi paTologiuri Tvisebebis mizanmimarTuli cvlilebebis meTodika, Semoitana quCis virusis da
fiqsirebuli virusis cneba.
quCis anu `veluri~ virusi Zlier paTogenuria. bunebaSi mocirkulire mis Stamebs aqvT Semdegi damaxasiaTebeli niSnebi:
21
a) Tbilsisxlian ZuZumwovar cxovelTa mimarT paTogenuroba
intracerebraluri (tvinSida), kanSida, kanqveSa, kunTebSi da sxva
gzebiT misi Seyvanisas;
b) adamiansa da ZuZumwovar cxovelebSi iwveven daavadebis
klinikur suraTs, sadac wamyvani encefalitis ganviTarebaa;
g) infeqciis inkubaciuri periodi bocverebSi, maTi intracerebrulad Seyvanis gziT, grZeldeba 12-28 dRe, xolo TeTr
TagvebSi _ 8-28 dRe. virusi ZiriTadad grovdeba cns-Si;
d) cns-is garda virusi aRiniSneba sacremle, sanerwyve jirkvlebSi, periferiul nervul boWkoebSi, rqovanaSi. virusis niSnebi
SeiZleba aRmoCndes TirkmelebSi, kuWukana jirkvalSi. virusi,
rogorc wesi, ar aris sisxlSi, filtvebSi, RviZlSi, elenTaSi,
limfur jirkvalSi, nawlavebSi;
e) sinaTlis mikroskopiT cns-is neironebsa da periferiul
gangliebSi vlindeba citoplazmuri CanarTebi, anu babeS-negris
sxeulakebi.
v) sainteresod migvaCnia Cven TanamemamuleTa Sedegebi. v. a.
jmuxaZem TanaavtorebTan erTad (1972w.) miaqcia yuradReba Stamebs,
romlebic iyvnen gamoyofili bunebrivi infeqciis bunebrivi kerebidan saqarTveloSi. aRniSnuli Stamebi virTagvebsa da siriul
zazunebSi calkeul SemTxvevebSi iwvevdnen daavadebas inkubaciuri periodiT 69-78 dRe, klinikuri periodi grZeldeboda 2429 dRe, daavadebis klinika xasiaTdeba landris ti pis aRmavali
paraliCebiT.
o. g. anjafariZe ZaRlebisa da katebis (SesaZlo inkubaciur
periodSi myofi) tvinidan gamoyofda cofis viruss 1,7 % da
0,3 % -Si (v. d. soloviovi, 1954).
bunebriv pirobebSi quCis virusi cirkulirebs gareul cxovelTa organizmSi.
lui pasteris cdebSi Zroxis tvinidan gamoyofili cofis
quCis virusis Stami (19 noemberi 1981 w.) SemdgomSi bocverebSi subduralurad Seyvanis gziT magrdeboda. pirvel pasaJebSi
bocvrebSi daavadebis inkubaciuri periodi 14-17 dRe iyo. me-12
pasaJze inkubaciuri periodi 12 dRemde Semcirda, xolo 90-ze
met pasaJze – 7 dRemde (Pasteur e.a, 1884). Semdgom pasaJebSi
pasteris laboratoriaSi inkubaciuri periodi mudmivi, fiqsirebuli rCeboda. fiqsirebuli virusis kanqveS Seyvanis Semdeg
22
ZaRlebi cofis (quCis) virusiT daavadebis mimarT imunurebi
gaxdnen.
amrigad, fiqsirebuli virusi cofis gamomwvevis vaqcinuri
variantia, miRebuli l. pasteris mier. igi bocvrebis, Sinauri
cxovelebisa da adamianisaTvis arapaTogenuria.
antirabiuli vaqcinebis dasamzadeblad gamoiyeneba virusis
pasteris, babeSis vaqcinirebuli da fliuris fiqsirebuli Stamebi.
cofis virusuli buneba daadgina p. remlenJem 1903 wels.
cofis virusi – Neuroryctes rabid _ miekuTvneba mikrovirusebis
jgufs Lyssavirus-is gvars da Rhabdoviridae-s ojaxs. igi rnm-is
Semcveli neirotropuli virusia, mravldeba qsovilovan kulturebSi.
virusi didxans uZlebs gayinvas (700 dRemde), gamZlea fenolisa da antibiotikebis mimarT. ver uZlebs maRal temperaturas: 560C-ze inaqtivirdeba 15 wuTSi, xolo duRilis dros ki 2 wuTSi. mgrZnobiarea ultraiisferi da mzis pirdapiri sxivebis mimarT. swrafad inaqtivirdeba 1-2% lizolis, 3-5% karbolis mJavis, 2-3% qloraminis da sulemis 1:1000 xsnaris zemoqmedebiT. virusi paTogenuria ZiriTadad Tbilsisxliani cxovelebisa da mtacebeli frinvelebisaTvis.
paTologiuri anatomia da paTogenezi
cofis paTogenezsa da paTologiur anatomiaSi wamyvan niSnebs
warmoadgens mTeli nervuli sistemis, maT Soris gansakuTrebiT
zogierTi organos nervuli gangliebis dazianeba, magaliTad, sanerwyve jirkvlebisa, romelTa saSualebiTac virusi garemoSi
gamoiyofa.
Tavis tvinisa da zurgis tvinis, sanerwyve da Tirkmelzeda
jirkvlebis paTologoanatomiuri cvlilebebi xasiaTdeba SeSupebiT, sisxlZarRvebis sisxlsavseobiT, sisxlCaqcevebis ubnebiT.
Tavis tvinis histologiuri gamokvlevisas saqme gvaqvs difuzur encefalitTan. igi gansxvavebulia im lokaluri dazianebebisagan, romlebic cns-is sxva infeqciebis dros gvxvdeba. aRiniSneba aSkara Seusabamoba mZime rabiuli encefalitis klinikuri
suraTisa da SedarebiT mwiri ultrastruqturuli anTebadi
23
cvlilebebisa babeS-negris sxeulakebis irgvliv, sustad aris
gamoxatuli mikrogliisa da garsebis anTebadi reaqcia.
cofis virusi cns-Si umTavresad rux nivTierebaSi grovdeba.
specifikuri antigeni xSirad amonis rqis neironebSi, naTxemis
piramidalur ujredebSi, Tavisa da zurgis tvinis neironebisa
da sxva ubnebSi, aseve sanerwyve jirkvlebis, Tvalis rqovanas
epiTelur ujredebSi aRmoCndeba xolme da ar gvxvdeba meningialur, epindimalur, gliur ujredebSi, aseve cns-is sisxlZarRvebis
endoTeliumSi (Yamamoto, 1965; Johnson, 1971).
cofi neirotropuli infeqciaa. virusis gavrcelebis hematogenuri gzis winaaRmdeg miuTiTebs Semdegi garemoebebi: 1) mravali avtoris monacemebiT, hidrofobiiT daavadebuli adamianis
sisxlidan virusi ver iqna miRebuli, aseve uiSviaTesad iwvevs
cxovelTa daavadebas didi koncentraciis cofis virusis uSualo Seyvana maTi sisxlis nakadSi; 2) SeuZlebelia cofis virusis intraplacentaluri gadacema avadmyofi dedidan nayofSi.
yofil sabWoTa kavSirSi daregistrirebulia hidrofobiiT daavadebuli dedebis mier janmrTeli bavSvis dabadebis 2 SemTxveva.
cofis virusi centriskenuli moZraobiT SeaRwevs rogorc
cns-Si, ise sanerwyve jirkvlebSi, sadac is mravldeba nervul
gangliebsa da epiTeliumis ujredebSi. daavadebebis klinikuri
niSnebis ganviTarebamde, virusis sakmarisi raodenobiT dagrovebamde, iwyeba eskreqcia misi sanerwyve jirkvlebidan gare sivrceSi. virusi aqtiurad mravldeba erTdroulad Tirkmelzeda da
sanerwyve jirkvlebSi, muclisa da gulmkerdis Rrus umravles
Sinagan organoebSi virusi ar mravldeba. mxolod Ramuris amerikuli virusi xasiaTdeba viscerotropulobiT, gamoiyofa sisxlidan, Sardidan, filtvis qsovilidan, gulidan da daavadebuli
cxovelebis ganivzoliani muskulaturidan.
adamianis organizmSi cofis virusi SeiWreba nakbeni Wrilobidan an mikrotravmidan inficirebuli cxovelis kbenis, dakawvris
an dadorbvlis Sedegad; iSviaTad virusi SeiZleba SeiWras
lorwovani garsebidanac. infeqciis SeWris karidan cofis gamomwvevi virusi nervuli boWkoebisa da perinevruli sivrceebis saSualebiT miemarTeba centraluri nervuli sistemisaken,
azianebs ra Tavisa da zurgis tvins, igi koncentrirdeba da
24
mravldeba upiratesad mogrZo tvinis neironebSi, hipokampSi.
ena-xaxisa da enisqveSa nervebis birTvebis dazianebis gamo, viTardeba saylapavi da sasunTqi kunTebis krunCxvebi. simpaTikuri
nervuli sistemis gaRizianebis Sedegad vlindeba Zlieri nerwyvdena da oflianoba. cns-dan virusi vrceldeba daRmavali gziT,
miemarTeba periferiisaken, aRwevs sanerwyve jirkvlebs da gadadis nerwyvSi. nervul boWkoebSi virusis gadaadgilebis siCqare
Seadgens 3 mm/sT-s.
Tanamedrove Sexedulebis Tanaxmad, miuxedavad safuZvliani
argumentisa, ar aris gamoricxuli cofis virusis organizmSi
gavrcelebis hematogenuri da limfogenuri gza.
encefaliti, nervuli ujredebis anTebiT – degeneraciuli da
nevrozuli cvlilebebi histologiurad vlindeba, maqsimalurad
ki gamovlindeba mogrZo tvinSi. dazianebuli ujredebis irgvliv Cndeba limfocitaruli infiltratebi (rabiuli kvanZebi).
dazianebuli tvinis ujredebis citoplazmaSi (xSirad amonis
rqis neironebSi) warmoiqmneba oqsifiluri CanarTebi (babeSnegris sxeulakebi), romlebic cofis virionebis produqciisa
da dagrovebis adgils warmoadgenen.
cofiT daavadeba letalurad mTavrdeba. es dResac ukurnebeli senia.
cofis epizootologia
cofis epizootia ZiriTadi ekologiuri niSniT, infeqciis gamomwvevis mixedviT, iyofa bunebrivi ti pis epizootiad, romelsac qmnian gareuli mtacebeli cxovelebi, da qalaqis ti pis
epizootiad, romelsac Sinauri cxovelebi qmnian. Soreul warsulSi cofi arsebobda, rogorc gareuli cxovelebis daavadeba,
xolo ZaRlebis moSinaurebis Semdeg cofma adamianis sacxovrebelSi SeaRwia. mniSvnelovani epizootiebi warmoiSva mxolod msxvili dasaxlebebis, qalaqebis warmoqmnasa da iq ZaRlebis didi
raodenobis koncentraciasTan erTad. Eichwald, Pitzchke-s monacemebiT (1967w.) 1971 – 1968 wlamde evropaSi 50-ze meti
cofis epizootiaa aRwerili, gamowveuli rogorc ZaRlebis, ise
mglebis mier. aseve aRsaniSnavia meliebiT gamowveuli cofis
epizootia – irlandiaSi 1658 wels, SveicariaSi 1803 wels,
germaniaSi 1804 wels, ruseTSi 1810, 1818 da 1824 wlebSi.
25
qalaqis ti pis cofis epizootia
ZaRlebSi cofis gavrcelebaze jer kidev aristotele (322w.
Cv. w. aR-mde) werda. adamianebSi daavadeba pirvelad kornelius
celsiusma (I saukune Cv. w. aR.) aRwera.
VIII da XIXs.s. cofis epizootia aRiniSneboda evropis yvela
qveyanaSi, amerikaSi, aziasa da afrikaSi.
ZaRlebSi cofis epizootia mglebis maRal avadobasTan erTad
farTod iyo gavrcelebuli mefis ruseTSi, romelsac garkveuli
avtorebi evropaSi mTavar endemur kerad Tvlidnen (s. k. konstansovi, 1926).
XIX saukunis bolosTvis ZaRlebSi cofi praqtikulad aRmofxvrili iyo did britaneTSi, SveicariaSi, daniaSi, norvegiaSi
germaniis zogierT raionSi, magaliTad, bavariaSi; mkveTrad iqna
Semcirebuli holandiasa da SveicariaSi. pirveli msoflio omis
(1914-1918w.w.) Semdeg evropis mTel rig qveynebSi: germaniaSi,
poloneTSi, ungreTSi, rumineTSi, avstriaSi, CexoslovakiaSi, safrangeTSi, TurqeTSi, iugoslaviaSi, espaneTSi, italiaSi, bulgareTsa da a.S. aRiniSna cofis axali msxvilmasStabiani epizootia ZaRlebSi. ase magaliTad, 1923 wels cxovelebSi cofis
daregistrirebis SemTxveva germaniaSi 7314-s aRwevs, ungreTSi –
8096-s, italiaSi – 3986-s, espaneTSi – 713-s, poloneTSi –
11501-s, rumineTSi – 1511-s, safrangeTSi – 1566-s, CexoslovakiaSi – 3134 SemTxvevas (a. i. saveteevi, 1927). imavdroulad amerikaSi
dafiqsirebuli iyo 5170, xolo iaponiaSi 3000 SemTxveva.
meore msoflio omis dawyebamde cofis epizootia mkveTrad
Semcirda. ase rom centraluri evropis qveynebSi am periodSi
cofi mniSvnelovan problemas ar warmoadgenda.
yofil sabWoTa kavSirSi 30-iani wlebi cofis mxriv keTilsaimedo periodia, razec metyvelebs antirabiuli acrebis saWiroebis da daavadebis raodenobis mkveTri Semcireba.
40-ian wlebSi amerikis SeerTebul Statebsa da kanadaSi, evropul
qveynebTan erTdroulad, daiwyo cofis didi epizootia meliebSi,
skunsebSi, koiotebsa da sxva cxovelebSi. samxreT amerikaSi
qalaqis ti pis epizootia da bunebrivi epizootia dakavSirebulia infeqciis gavrcelebasTan Ramura-vampirebSi. CrdiloeT
amerikaSi avadobis 72,7% modis sxvadasxva velur cxovelze.
magaliTad, skunsebis epizootia misisi pisa da misuris zemo
26
welSi. janmos monacemebiT afrikaSi cofi 46 saxelmwifodan
40-Si registrirdeba.
aziuri kontinenti mravali wlis ganmavlobaSi iyo cnobili,
rogorc cofis erT-erTi seriozuli endemuri kera. infeqcia
praqtikulad likvidirebulia iaponiaSi, singapurSi, taivanze,
mkveTrad Semcirebulia malaiziaSi. magram arseboben arakeTilsaimedo qveynebi, romelTac ganekuTvnebian: indoeTi, indonezia,
pakistani, nepali, laosi, Sri-lanka, birma, filipinebi, avRaneTi,
samxreT korea, koreis saxalxo demokratiuli respublika, tailandi, erayi, kamboja. daavadeba sporadiulad registrirdeba iranSi,
monRoleTSi.
ZaRlebis cofi problemuria CineTSi – gavrcelebis sixSire
ar aris dadgenili.
zemoT CamoTvlil qveynebSi naklebia informacia cofiT daavadebis Sesaxeb velur cxovelebSi. indoeTi, irani, erayi, avRaneTi
floben informacias mglebis, turebis, mangustebis cofis Sesaxeb. meore msoflio omis Semdeg yofil sabWoTa kavSirSi dafiqsirda ZaRlebis cofis didi epizootia, xolo leningradis olqSi,
latviasa da estoneTSi 50-iani wlebis bolos qalaqis ti pis
epizootia qveynis mraval raionSi aRmoifxvra ZaRlebis masobrivi profilaqtikuri imunizaciisa da zogadi sanitarul-veterinaruli RonisZiebebis Catarebis gziT.
aRsaniSnavia is garemoeba, rom turebi (Cuonaurens mesomelas)
da veluri ZaRli (Cuon alpicus) xels uwyoben cofis lokalur
afeTqebas tropikebSi, subtropikebSi, aziis samxreTiT da afrikis CrdiloeTiT. tura msoflios 30 qveyanaSi rabiuli infeqciis wyarod iTvleba, umravles SemTxvevaSi es aziasa (indoeTi, pakistani) da afrikaSia (alJiri, rodezia, tunisi, uganda,
samxreT afrika da sxv.). erTeuli SemTxveva daregistrirda
kavkasiaSi, Sua aziasa da moldaveTSi.
enotiseburi ZaRlis (Nycterentes procyonoides) samSobloSi _
iaponiaSi _ ar aris cnobili cofis bunebrivi kerebi, rasac ver
vityviT CineTze, koreaze, ruseTsa da baltiispireTis qveynebze.
am cxovelma SeaRwia CexeTsaA da centraluri evropis sxva
qveynebSic.
meliebi (Vulpes) sxva velur cxovelebTan SedarebiT msoflios yvela kuTxeSi gavrcelebis didi odenobiT gamoirCevian.
27
isini gvxvdebian yvela materikze, garda antarqtidisa. wiTeli
melia (Vulpes vulva) da ruxi melia bunebriv kerebs qmnian evropasaA da amerikaSi (Urocyon cinereoargentus).
mglis cofi gvxvdeba CineTSi, kavkasiaSi, belorusiaSi, baltiispireTSi, yazaxeTSi.
cofis gamomwvevi kvernisebrni (Mustelidae): warmodgenilia
skunsebiT, maCvebiT, TriTinebiT, kvernebiT, yaryumiT, siasamuriT,
waulaTi.
skunsebis cofi 150 welze metia, rac registrirdeba amerikaSi. maT gansakuTrebuli epizootologiuri mniSvneloba gaaCniaT aSS-sa da nawilobriv kanadisTvis.
jer kidev XIX saukunis dasawyisSi literaturaSi aRwerilia
sacxovrebel saxlebSi skunsebis SeRwevisa da maTi adamianebze
Tavdasxmis SemTxvevebi. 1850-1910w.w. ganmavlobaSi aSS-Si mravali adamiani daiRupa skunsebis dakbenisagan gamowveuli hidrofobiiT. skunsebSi cofis yvelaze didi epizootia aRiniSna 1973
wels – 1851 SemTxveva. 30 Statidan, romlebSic gavrcelebulia
epizootia skunsebSi, metad dazaralda kaliforniis, minesotis,
ilinois da texasis Statebi. CrdiloeT amerikaSi cofiT daavadeba sporadiulad diagnostirdeba TriTinisagan (Mustela nivalis), sindiofalasagan (Mustela putorius), waulasagan (Mustela vison).
maCvi (Meles meles) gvxvdeba evropaSi, aziasa da, mcire raodenobiT, afrikaSi, XX saukunis bolosaTvis baltiispireTis qveynebSi _ 23-24 aTasi da 15 aTasi _ ukrainaSi.
maCvebi CarTulni arian meliebis mier gamagrebul ZiriTad
epizootur rgolSi. cofis damoukidebeli epizootiebi maCvebSi ar aris cnobili. evropaSi maCvis daavadeba cnobili gaxda
mxolod meliebis epizootiis Semdeg.
kvernis (Martes) 10 saxeoba gavrcelebulia evropaSi, aziasa
da CrdiloeT amerikaSi. evropasa da yofili sabWoTa kavSiris
qveynebis evropul nawilSi gvxvdeba tyis kverna (Martes Martes),
xolo Sua aziasa da ruseTis federaciis zogierT regionSi
aris qvis kverna (Martes foina). kievis olqsa da ukrainis sxva
regionSi didi raodenobiT cxovrobs tyis kverna, romlebic
bunebrivi cofis epizootur rgolSi erTvebian. maTi raodenoba
40 aTass aRwevs. daavadebis calkeuli SemTxvevebi dadginda am
28
cxovelis Tavdasxmis msxverpli adamianisa da cxovelis gvamebis
gamokvleviT (mTeli veluri cxovelebis cofis 3-4,5%).
zazuna (Mustela nivalis), yaryumi (Mustela erminea) gvxvdebian
evropaSi, aziaSi, CrdiloeT amerikaSi. statistikuri masalebi
adastureben maT rols bunebaSi cofis virusis gavrcelebisas.
mangustisebrni gvxvdebian samxreT afrikaSi, aziaSi. agreTve
indoeTis da atlantikuri okeanis kunZulebze, sadac isini warmodgenili arian mangustebiT, viverebiT da genetebiT, ruxi mangustiT (Herpestes edwardsi), induri mangustiT (Herpestes javanicus auropunstatus), romlebic me-19 saukuneSi gvelebTan sabrZolvelad Seiyvanes dasavleT indoeTis da atlantikis kunZulebze.
mkveTrad moimata maTma ricxovnobam sxva qveynebSic. magaliTad,
1870 wels iamaikaze da grenadaSi Seiyvanes 7 wyvili mangusti.
100 wlis Semdeg 600 daWerili mangustidan 23 inficirebuli
iyo. mangustebi iTvlebian rabiuli infeqciis rezervuarad kubaSi,
puerto-rikoSi, grenadaSi, panamasa da karibis zRvis kunZulebze.
yviTeli mangustebi, rogorc kolonialuri cxovelebi, cofis
epizootias aZliereben samxreT afrikaSi.
aRsaniSnavia, rom evropuli veluri kata (F.Silvestris), afrikuli veluri kata (F.Libyca) da amerikuli focxveri (F.rufa) aseve
monawileoben cofis gavrcelebis bunebriv ciklSi.
aSS-Si, arizonis, texasis, kaliforniis, tenesis StatebSi focxverisagan cofiT daavadebis aTobiT SemTxvevaa aRwerili.
calkeuli SemTxvevaa kanadaSi, erTeuli – CexeTSi, yofil sabWoTa kavSiris respublikebSi. TiTo SemTxveva diagnostirebulia
avazebSi (P.Pardes) marokosa da rodeziaSi.
literaturaSi gvxvdeba cnobebi cofiT daavadebis kazuistikuri SemTxvevebisa _ vefxvisa, pumisa, lomisa da leopardisa
_ zooparkSi an tyveobaSi kerZo pirebTan.
amrigad veluri katisebrTa ojaxis warmomadgenlebi epizootur rgolSi monawileoben SemTxveviT, damoukidebeli epizootiebi
maT Soris ar arsebobs. es aixsneba maTi arajoguri cxovrebis
wesiT. isini, rogorc faunis yvelaze Zlieri warmomadgenlebi,
daculi arian cofiani cxovelebis Tavdasxmisagan.
gienebis ojaxis mtaceblebSi (Hyaenidae) rabiuli infeqcia
erTeul SemTxvevebSi gvxvdeba afrikaSi (malaizia, tanzania, kenia).
29
daTvebi (Ursidae) msoflios sxvadasxva nawilSi xandaxan erTvebian epizootur rgolSi. kerZod daTvebis cofis SemTxvevebi
dafiqsirebuli iyo CexeTSi, meqsikaSi, TurqeTSi, ruseTSi, kanadaSi.
gareuli Roris, taxis (Sus serofa), cofis calkeuli SemTxveva
aRwerilia germaniaSi, CexeTsa da poloneTSi.
maimunebi (Simiae), miuxedavad maTi SedarebiT maRali ricxovnebisa da gavrcelebisa, cofis ciklSi SedarebiT iSviaTad
erTvebian. literaturaSi aRwerilia cofis mxolod ori spontanuri afeTqeba maimunebSi: pirveli _ fili pinebis kunZulebze
(Schmitter, 1914), meore _ centralur afrikaSi, pavianebSi (Mc
Diarmid, 1962). me-20 saukunis 60-70-ian wlebSi aRiniSna cofis
calkeuli SemTxveva maimunebSi indoneziaSi, indoeTSi, nepalSi,
Sri-lankaSi, nikaraguaSi, meqsikaSi, venesuelaSi, peruSi, paragvaiSi,
nigeriaSi, mozambikaSi, eTiopiaSi, sudanSi. aseve inglisSi, aSS-Si,
yofil sabWoTa kavSirsa da sxva qveynebSi, sadac yovelwliurad
aziidan da afrikidan aTobiT aTasi maimuni SemohyavT.
inglisSi 1969 wels 28488 maimuni Semoiyvanes da maT Soris
cofis mxolod erTi SemTxveva dafiqsirda.
veluri wyvilCliqosnebi (Ungulata) cofiT xSirad avaddebian
infeqciis bunebriv kerebSi. germaniaSi 5 wlis manZilze daavadda 2000-mde iremi (Capreolus capreolus) da 10-mde mufloni (Ovis
mousimon). am jgufis cxovelebSi cofi gvxvdeba agreTve SveicariaSi, poloneTSi, CexeTSi, avstriaSi, safrangeTSi, belgiaSi,
luqsemburgsa da evropis sxva qveynebSi. infeqcia gvxvdeba SvlebSi (C. Capreolus), qurcikebSi (Dama dama). afrikaSi cofisagan ecemian antilopebi, kanadaSi – irmebi. amrigad, wyvilCliqosani
cxovelebi rabiuli infeqciis msxverplni ufro xSirad xdebian,
vidre xorcismWamelebi katisebrTa ojaxidan, daTvebidan da gienebidan. amis miuxedavad, infeqciis rgols wyvilCliqosnebi ar
warmoadgenen (epizooturi Cxiri).
frinvelebi (Avis) sxva TbilsisxlianebTan SedarebiT cofis
virusis mimarT yvelaze dabali mgrZnobelobis arian. evropasa
da afrikaSi iSviaTi cnobebia cofis SemTxvevebze mtacebel
frinvelebSi – Sevardeni, mimino (Noury, 1963; Pitzschke, 1965; Kauker, 1966).
bunebriv pirobebSi cofi Sinaur frinvelebSi uiSviaTesad
gvxvdeba.
30
Paarman-i (1955) erTaderTi avtoria, romelmac cofi biocdis
saSualebiT daadgina 15 qaTamSi, 2 ixvsa da batSi, TiTo-TiTo
bulbulSi, kakaCaSi, kaWkaWSi, ZeraSi, qorSi, yvavSi.
mRrRnelebi (Rodentia) cofiT avaddebian, iseve rogorc yvela
sxva am infeqciasTan mgrZnobiare ZuZumwovari cxovelebi. didi
xania cnobilia virTagvebisa da Tagvebis sporadiuli daavadeba.
n. s. pikulma (1939) kievSi 30 saxlis virTagvis gamokvlevisas
cofis diagnozi 2 SemTxvevaSi daadgina. ak. SublaZem da s. i.
gaidamoviCma 50-ian wlebSi cofis epizootiis dros moskovSi
1285 virTagva da 1272 Tagvi gamoikvlies da arc erT SemTxvevaSi ar aRmoCnda cofis virusi.
aSS-Si me-20 saukunis meore naxevarSi, kerZod, 1956-1965w.w.,
cofis diagnozi dadginda 199 mRrRnelSi; daavadeba SedarebiT
xSirad viTardeboda ciyvebSi (75), memindvriebSi (34), virTagvebSi (19). maTSi laboratoriulad dadasturebuli cofis SemTxveva 0,5%-s Seadgens (Winkler, 1966).
24 SemTxveva dafiqsirda: bocvrebSi an kurdRlebSi, ciyvebSi,
andatrebSi, virTagvebSi, zazunebSi, TagvebSi (World Rabies survey,
WHO, 1968-1970).
evropaSi iyo informacia cofis virusis gamoyofaze zazunebidan Cricetus cricetus da Microtus arvalis (Nokolitich, 1968), indoeTSi - ruxi da Savi virTagvebidan Rattus norvegicus, Rattus rattus
Bandicoot malaberica (D’Sonza e. a., 1968); samxreT afrikaSi –
miwis ciyvidan Gitellus and Xerus pp (Greval and Nicholas, 1940;
Neitz, 1949).
literaturaSi moi poveba informaciebi mRrRnelebidan cofis
virusis gamoyofisa. Smith TanaavtorebTan erTad (1968) endemur kerebSi 1000 gamokvleuli virTagvidan cofis viruss gamoyofs 7,9% SemTxvevaSi.
cofis epizootia RamurebSi.
am mxriv didia problemebi samxreT da CrdiloeT amerikaSi.
evropa, azia da afrika amisagan ZiriTadad daculia.
am problemas adgili hqonda amerikis aRmoCenamde. indielebis
naTqvamia: `Tu Tqven gikbenT Ramura, Wkuidan SeiSlebiT da mokvdebiT~ (Irvin, 1970).
Constantine (1970) Tavis mimoxilvaSi bunebaSi 2000-mde Ramuris saxeobis arsebobas miuTiTebs. isini zomiT Zlier gansx31
vavdebian: yvelaze mcire zomisas frTaTaSorisi manZili 2,5 smia, xolo yvelaze didisa _ 1,5 m-ze meti.
zogi Ramura ikvebeba mwerebiT, neqtariT, xiliT, zogi ki _
sisxliT, xorciT, TevziT, an yvelafris mWamelia. yvelaze didi
raodenobiT isini tropikebSi arian, iq isini aqtiurebi arian
mTeli wlis ganmavlobaSi. bnel da notio gamoqvabulSi aTasobiT Ramura cxovrobs.
amerikaSi cofis bunebriv keras xels uwyoben Ramurebis 2
jgufi: 1. sisxlismwoveli anu vampirebi; 2. mweriWamiebi da xorcismWamelebi.
jer kidev XVII saukuneSi Piso-m (1658) SeamCnia kavSiri adamianebsa da vampirebSi mimdinare daavadebas Soris. vampirebi ikvebebian umTavresad msxvilrqosani saqonlis (iSviaTad Txis, cxvris, Roris, frinvelebis, ZaRlis) sisxliT. zogjer isini esxmian Tavs adamianebs, romlebsac sZinavT Ria cis qveS an daucvel
(badegaukvrel) SenobebSi. yoveli vampiri weliwadis ganmavlobaSi 21,7 litramde sisxls wovs (Constantine, 1970). basri
kbilebiT isini kraterisebur Wrilobas qmnian da grZeli enis
saSualebiT iolad woven sisxls, vinaidan maT nerwyvi antikoagulantebs Seicavs. infeqciis yvelaze mniSvnelovan wyaros vampirebi warmoadgenen (Desmodus rotundus).
aSS-Si cofi pirvelad mwerismWamel RamurebSi Dasypterus floridanus daadgines 1953 wels, roca es cxoveli Tavs daesxa biWs,
romelic beisbols TamaSobda. marto 1953-1972w.w. aSS-Si daregistrirda hidrofobiiT daavadebis 9 SemTxveva, infeqciis wyaros
warmoadgenen Ramurebi. kvleviT laboratoriebSi momuSave adamianebis inficirebis riski maRalia: aRiniSna 14 dakbena 100
Ramuraze, xolo im mosaxleobaSi, romlebsac Ramurebi saxlSi
hyavT, rogorc moyvarulebs, – 30 dakbena 100 Ramuraze. rom ara
antirabiuli acrebi, gacofebulTa raodenoba gacilebiT meti
iqneboda.
daavadebuli Ramurebi Zalian agresiulni arian, kbenen umizezod da ase gadascemen infeqcias.
rabiuli infeqciis SenarCunebis da gavrcelebis ZiriTadi
meqanizmebi ZaRlebSi da katebSi cofi mimdinareobs Smagi an
paralitiuri formiT da grZeldeba 2-dan 5 dRemde, iSviaTad 612 dRis ganmavlobaSi mimdinareobs.
32
v. uSakovis (1945) monacemebiT, erTma cofianma ZaRlma dakbina
89 adamiani.
azri, rom cofi absoluturi sasikvdilo daavadebaa, rogorc
cxovelebSi ise adamianebSi, momdinareobs mravali praqtikosi
eqimis saukunovani dakvirvebis safuZvelze.
sxva infeqciebisagan gansxvavebiT meliisa da mglis cofis
epizootias ara aqvs gamokveTili sezonuroba, daavadeba yvela
sezonze gvxvdeba.
cofis mTavar bunebriv rezervuarad iTvleba melia, romelic
kargad adaptirdeba sxvadasxva landSaftebze.
cofi kvlav iTvleba cns-is mwvave letalur infeqciad, romlis gamomwvevi virusi Wrilobis gziT xvdeba organizmSi, sadac
inkubaciuri periodis xangrZlivobis xarjze xdeba virusis
rezervireba.
antirabiuli daxmarebis organizaciis msoflio istoria
rogorc cnobilia, 1886 wels parizSi, lui pasteris mSobliur qalaqSi, cofTan brZolis mizniT daarsda msoflioSi pirveli instituti pasteris saxelobisa. aRniSnulma garemoebam msoflioSi didi rezonansi gamoiwvia – mraval qveyanaSi Seiqmna
pasteris sadgurebi: imave wels gaixsna pasteris sadgurebi mefis ruseTis sivrceSi: q. odesaSi gamoCenili mecnierebis, i.
meCnikovisa da n. gamaleas, iniciativiT; moskovSi qirurgiuli
sazogadoebisa da misi Tavmjdomaris n. sklifasovskis TaosnobiT. q. TbilisSi analogiuri sadguri samxedro samedicino
laboratoriaSi 1888 wels daaarsa pasteris mowafem i. finkelSteinma.
1946 wels, meore msoflio omis Semdeg, yofil sabWoTa kavSirSi 46 pasteris sadguri iyo Tavisi punqtebiT.
pasteris sadgurebi Sediodnen respublikuri, samxareo da
saolqo sanepidsadgurebis an epidemiologiisa da mikrobiologiis
institutebis SemadgenlobaSi da asrulebdnen antirabiuli daxmarebis srul kompleqss, kerZod: antirabiuli vaqcinis damzadeba,
acrebis Catareba, adamianis damkbeni cxovelebis laboratoriul-diagnostikuri gamokvleva, infeqciis wyaros winaaRmdeg zomebis
33
miRebis organizacia, kadrebis momzadeba, sanitaruli propagandis Catareba, samecniero-kvleviTi muSaobis warmoeba.
sainteresoa antirabiuli daxmarebis organizacia safrangeTSi,
sadac yvelaferi isea SenarCunebuli, rogorc iyo didi pasteris
dros. pasteris instituti Tavis nayofier samecniero-kvleviT
muSaobasTan erTad eweva mosaxleobis antirabiul daxmarebasac
parizsa da mis mimdebare regionebSi. antirabiuli mkurnalobis
centrebi lionis pasteris institutSi, strasburgis higienis
institutsa da sxva dawesebulebaSi mosaxleobas regionaluri
principiT utareben antirabiul daxmarebas safrangeTis 59 departamentSi. maTve aqvT dakisrebuli adamianebis damkben cxovelTa laboratoriuli diagnostika. yoveli diagnostikuri
centri emsaxureba 2-3 departaments. aRniSnuli regionaluri
centrebis koordinacias axorcielebs pasteris instituti parizSi,
romelic Sesabamis veterinarul samsaxurebTan erTad axorcielebs
sakonsultacio daxmarebas, amaragebs diagnostikumebiT, amzadebs kadrebs, iRebs monawileobas sanitaruli propagandis organizaciasa da infeqciis wyaros winaaRmdeg brZolaSi.
specializirebuli antirabiuli daxmarebis sistema msoflios
mraval qveyanaSia SenarCunebuli. samecniero-kvleviT muSaobasTan
erTad samkurnalo centrebis funqcias asruleben aziisa da
afrikis mTeli rigi qveynebis pasteris institutebi. me-20 saukunis bolosaTvis indoeTSi 1564 antirabiuli mkurnalobis centri iyo. 9 institutSi yovelwliurad mzaddeba 25 tona antirabiuli vaqcina.
pasteris instituti, rogorc yofili iugoslaviis nacionaluri centri, vaqcinis warmoebasTan erTad atarebs antirabiul
acrebsac.
belorusi rabiologebi (b. elberti) epidemiologebis IX sakavSiro yrilobaze jer kidev 1926 wels gamovidnen winadadebiT
mosaxleobisaTvis antirabiuli acrebi xelmisawvdomi, SesaZlebeli yofiliyo saubno saavadmyofoebSic ki, xolo maT Catarebaze uflebamosileba dakisrebodaT samkurnalo dawesebulebebis
instruqcia gavlil eqimebs.
mogvianebiT, 1940 wels, cofTan dakavSirebul sakavSiro konferenciaze g. falavandovi (albaT falavandiSvili) amtkicebda
34
antirabiuli acrebis sayovelTao xelmisawvdomobis aucileblobas.
iyvnen mowinaaRmdegenic (i. stepanov-grigorievi, a. vladimirovi,
s. dubrovski da sxvebi), romlebic specialuri pirobebis ararsebobis gamo aprotestebdnen antirabiuli acrebis Catarebas saubno
saavadmyofoebsa da ambulatoriebSi. isini SiSobdnen, mosalodneli garTulebebis gamo.
s. zlatogorovma antirabiuli daxmarebis decentralizaciis
sakiTxi SesTavaza cofisadmi miZRvnil I saerTaSoriso konferencias, romelic parizis pasteris institutSi Catarda. cnobilma ucxoelma rabiologebma – Mckendrick, Remlinger, Roux,
Mari, Galmette da sxva. erTsulovnad gadawyvites am sakiTxis
ganxilva moxsniliyo, radgan antirabiuli acrebis gamoucdeli
personalis xelSi gadacemas SeuZleblad miiCnevdnen.
meore msoflio omis damTavrebis Semdeg sabWoTa kavSiris
jandacvis ministris mier gamocemuli # 367( 22/VI 1948w.) da
# 819 (15/IX – 1950w) brZanebebiT pasteris sadgurebis qselis
likvidacia moaxdines, magram respublikur, samxareo, saolqo da
saqalaqo sanepidsadgurebSi antirabiuli ganyofilebebis organizaciiT SenarCunda antirabiuli daxmarebis centralizebuli
specializirebuli forma.
friad sagulisxmoa 1958 wlis sabWoTa kavSiris monacemebi:
hidrofobiiT daavadda 195 adamiani, hidrofobiis 146 SemTxvevis analizma Semdegi suraTi dagvixata: daavadebulTa 64%-ma
saerTod ar mimarTa antirabiul daxmarebas, 29,4 icrebodnen
arasworad an Sewyvites acra da mxolod 6,6%-ma Caitara
swori mkurnaloba (dagvianebuli mimarTva).
adamianis damkbeni cxovelebis karantinis, operatiuli da zusti
laboratoriul-diagnostikuri monacemebis safuZvelze mkveTrad
mcirdeba antirabiul acrebSi CabmulTa raodenoba, rac naTlad
Cans ucxoeTis qveynebis gamocdilebidan. magaliTad, aSS-Si yovelwliurad registrirdeba cxovelebis nakbeni 2,5 mln. SemTxveva,
magram antirabiul mkurnalobas mxolod 3500-mde (1,2%) adamiani itarebs.
mosaxleobis antirabiuli daxmareba epizotiurad arakeTilsaimedo (ZiriTadad soflis) regionebSi rCeboda mravalricxo35
vani, arasaTanadod momzadebuli da xSirad cvladi eqimi-qirurgebis an sxva specialobebis eqimebis xelSi.
janmos evropuli biuros II konferenciis rezoluciaSi (mainis
franqfurtSi, 1971w.) kvlav mieqca yuradReba samkurnalo acrebis Catarebas antirabiuli mkurnalobis centrebSi (an maT kedlebSi momzadebuli gamocdili eqimebis mier), aseve sakonsultacio
daxmarebis gawevas Soreuli regionebis specialistebisaTvis.
hidrofobiis klinika da mkurnaloba
mokle inkubaciuri periodi axasiaTebs gareuli balaxismWameli cxovelebis Sedegad dakbenilebs saxis, Tavis, xelis mtevnis
TiTebis dazianebebisas. es periodi bavSvebSi ufro xanmoklea,
vidre mozrdilebSi. inkubaciuri periodi, savateevis (1927) mixedviT, 84,4% SemTxvevaSi 72-dan 99 dRemdea. Sartorius-ma da Tanaavtorebma (1957) aRweres 7-dRiani inkubaciuri periodi meliis
mier dakbenil bavSvSi. calkeul SemTxvevaSi virusis inkubacia
SeiZleba 2 wlamde da met xansac ki gagrZeldes (Van Rooyen,
Rhodes, 1948; a. savateevi, 1927; s. smelovski, 1950).
statistikuri monacemebiT, saxifaTo lokalizaciis dros inkubaciuri periodi acril kontingentSi ufro xanmoklea, vidre
aucrelebSi. m. selimovis (1978) masaliT, hidrofobiiT daavadebul 1183 adamianSi (romelTagan 652 adamianma ar Caitara antirabiuli acrebi) inkubaciuri periodi acrebSi CabmulebSi saSualod 54, xolo aucrelebSi 77 dRes Seadgenda, 14 wlamde
asakis bavSvebSi analogiuri monacemebi Sesabamisad 43,1 da 70,9
dRes Seadgens. saSualo inkubaciurma periodma Tavisa da saxis
areSi dakbenil 786 acril dazaralebulSi Seadgina 33,6 dRe.
yovelive zemoT xsenebulis axsna SeiZleba, erTi mxriv, acril
kontingentSi saxifaTo lokalizaciis dakbenis mqone adamianTa
simravliT, radgan samedicino daxmarebas isini xSirad mimarTaven, meore mxriv, ki imiT, rom saxifaTo lokalizaciis nakbenis
mqone pirebSi ara marto ver xerxdeba vaqcinaluri imunitetis
formireba, aramed, piriqiT, vaqcinacia aqveiTebs organizmis bunebriv rezistentobas da inkubaciuri periodis Semcirebas.
gansakuTrebuli yuradReba unda mieqces Zilis darRvevasa da
uZilobas; hidrofobiiT daavadebulma SeiZleba ar iZinos ram36
denime Rame erTimeoris miyolebiT. isini xedaven koSmarul sizmrebs,
romlebic cxovelebis TavdasxmasTan aris dakavSirebuli.
tkivili, rogorc wesi, iradirebs centriskenuli mimarTulebiT,
nawiburis adgilze aRiniSneba SewiTleba, SeSupeba, anesTezia,
hi posTezia, nawiburis irgvliv ki gamoxatulia hi peresTezia,
niSnebi, romlebsac eqimebi SecdomiT ukavSireben miozits an
revmatiuli xasiaTis tkivilebs.
hidrofobiis SetevebTan erTad daavadebulebs axasiaTebT haeris qrolviT (aerofobia), naTeli SuqiT (fotofobia), xmamaRali sityviT, xmauriT an braxuniT (aukofobia) gamowveuli Setevebi. gansakuTrebiT Zlieri gamaRizianebeli civi haeria.
daavadebuli xdeba Zlier mWevrmetyveli. es gansakuTrebiT
bavSvebisTvis aris damaxasiaTebeli. am dros metyvelebis wyvetiloba gamowveulia haeris ukmarisobiT da dasvenebis aucileblobiT. agznebisas Setevebi mimdinareobs bodvebiT, mamakacebSi
bodvas erotikuli xasiaTi aqvs, mimdinare agresiiTa da bilwsityvaobiT, halucinaciebi dakavSirebulia saSineli cxovelebis
an adamianebis naxvasTan: `palataSi mgelia,~ `kedelze dacocaven
Wiebi da tarakanebi~ da a.S.
Setevebs Soris periodSi cnobiereba SenarCunebulia, avadmyofi cnobs irgvlivmyofT, Sedis maTTan kontaqtSi, swrafad pasuxobs kiTxvebs.
agznebis dawyebiT periodSi SenarCunebulia piris simSrale,
ena nadebiT, tuCebis mSral yaeTnebze warmoiqmneba qerqebi. agznebis periodis dasasrulisTvis nerwyvi ufro Txieri xdeba
da matulobs salivacia, rac miuTiTebs parasimpatikuri nervebis
tonusis momatebaze. Txieri nerwyvi uxvad da SeuCereblad gamoiyofa, avadmyofs ar SeuZlia misi gadaylapva, afurTxebs, rogorc
Tavis Tavs, ise garSemomyofT, amas xSirad Tan erTvis gulisreva,
slokini da Rebineba. zogierT SemTxvevaSi Rebinebas sisxliani
xasiaTi aqvs. gugebi gafarToebulia, sustad reagireben sinaTleze,
saxis nakveTebi wawvetebulia.
nervuli sistemis dazianeba aRiniSneba agznebis periodSic. Tu
daavadebis mauwyebel periodSi parezi an paraliCi ganviTarda,
agznebis stadiaSi isini progresirdebian. paraliCi damokidebulia rogorc periferiuli (kidurebis paraliCi), ise qala-tvi37
nis nervebis dazianebaze. xSirad aRiniSneba xorxisa da xaxis
kunTebis parezi da paraliCi. avadmyofs ar SeuZlia ylapva.
Tu agznebis periodSi uecrad warmoqmnili sunTqvis da gulsisxlZarRvTa centrebis paraliCis Sedegad avadmyofi ar mokvda, avadmyofoba gadava bolo, paralizur stadiaSi. paraliCis
(damblis) periodi xasiaTdeba qerqis da qerqqveSa zonebis gamovardniT, Semdgom ki vegetatiuri nervuli sistemis dazianebiT.
zogierT SemTxvevaSi dakbenis are da adreuli paraliCebis lokalizacia erTmaneTs Tanxvdeba. ase magaliTad, saxeSi dakbenilT
naadrevad ewyebaT qala-tvinis nervebis paralizeba an parezebi,
quTuToze an Tvalze dakbenilT sawyis periodSi SeiZleba aReniSnoT ftozi, sielme, xolo qveda kidurebze dakbenilebs ki aReniSnebaT menjis organoebis funqciis darRveva.
paraliCebis stadiaSi avadmyofi wevs gaunZrevlad, naxevrad
Ria TvalebiT, orive quTuTos ftozis gamo. saxe wawvetebuli,
Tvalebi Cacvenili, saxeze, xelebsa da mTel sxeulze aReniSneba
oflis msxvili wveTebi. oflis dena imdenad aris gamoxatuli,
rom TeTreuli mTlianad sveldeba da saWiro xdeba misi gamocvla
dReSi ramdenimejer, grZeldeba uxvi nerwyvis dena.
organizmis mkveTri gauwylovnebis gamo, avadmyofi elviseburad kargavs wonas; grZeldeba halucinaciebi, avadmyofi iRimeba, TavisTvis raRacas CurCulebs; Tvalis mamoZravebeli nervebis
paraliCis gamo, gugebi Zlier farTovdeba da sinaTleze aRar
reagireben; menjis organoebis funqciis darRvevis gamo, aRiniSneba Sardis Sekaveba an Seukavebloba; agznebisa da krunCxvebis
gaqrobis gamo, sunTqva umsubuqdeba; avadmyofs SeuZlia ylapva,
Wama da sma. am dros avadmyofs da mis axloblebs mdgomareobis
SesamCnevi gaumjobesebis STabeWdileba rCebaT. samwuxarod, es
moCvenebiTi, `sabediswero simSvidea~. n. m. krolis (1936) mixedviT, es moaxloebuli sikvdilis mrisxane niSnad iTvleba. aRweril moCvenebiT mdgomareobas mohyveba wnevis mkveTri dacema, gulis muSaobis daqveiTeba, maja xdeba Zafiseburi, Znelad isinjeba,
sunTqva zerele da xSiria, goneba dabinduli. mokle agoniis
periods mohyveba gulis paraliCi, rac avadmyofis sikvdilis
mizezi xdeba. sikvdilis win t 41-420C-mde iwevs. paralitiuri
periodi ramdenime saaTidan 2-3 dRemde mimdinareobs.
38
hidrofobiis mimdinareoba yovelTvis ar aris ti puri. igi
damokidebulia makroorganizmis Taviseburebebze, damkben cxovelSi arsebul virussa (Ramuris virusi, rogorc cnobilia, iwvevs
hidrofobiis paralitiur formas) da sxva faqtorebze. aRniSnuli garemoeba xels uSlis swori diagnozis dasmas, vinaidan
xandaxan daavadeba mimdinareobs paTognomuri niSnebis: hidro da
aerofobiis, agznebisa da agresiis gareSe.
yovelTvis ar aris daculi daavadebis cikluroba. mxedvelobaSi unda viqonioT, agreTve, hidrofobiis infeqciuri da arainfeqciuri daavadebebiT garTulebis SesaZlebloba.
1957 avadmyofis istoriis analizma gviCvena, rom 80,2% SemTxvevaSi daavadebis xangrZlivoba 3-dan 7 dRemde iyo. ver gamovlinda arsebiTi gansxvavebebi avadmyofobis xangrZlivobaSi aucrelebsa da acrilebSi, sruli an Sewyvetili vaqcinaciis kursis dros. rCeba STabeWdileba, rom mokle inkubaciuri periodiT
mimdinare hidrofobiis SemTxvevaSi Sesabamisad mcirdeba daavadebis xangrZlivobis droc.
hidrofobiis atipuri mimdinareobis dros daavadebis swori
diagnozis dasma sirTules warmoadgens. ase magaliTad, hidrofobiis paralitikuri formis SemTxvevaSi aucilebelia diferencialuri daignozis gatareba landris tipis paraliCTan, postvaqcinalur neiroparalitiur garTulebebTan, poliomielitTan,
sxvadasxva neirovirusul infeqciebTan, tetanusTan, atropiniT
da sxva SxamebiT mowamvlasTan.
poliomielitTan, sxva neirovirusuli daavadebebsa da mowamvlebTan diferenciis dros gvexmareba anamnezuri monacemebi –
kbenis faqtori, Wrilobis areSi paresteziebi da sxva. anamnezuri monacemebi, romlebic miuTiTeben cxovelebis mier miyenebul Wrilobebze, SeiZleba iyos tetanusis SemTxvevaSic, Tumca
tetanusiT daavadeba cxovelis nakbenis Sedegad Zalze iSviaTad
gvxvdeba. amas garda, saSualo da msubuqi kategoriis dakbenebisas hidrofobiis inkubaciuri periodi, rogorc wesi, 3 kviraze
mets Seadgens, tetanusis dros ki igi gacilebiT naklebia. xaxis
kunTebis spazmi, romelic tetanusis dros zogjer gvxvdeba
xolme, emTxveva opistotonusisaTvis damaxasiaTebel simptomebs,
magram cofis dros saReWi kunTebis trizmi spazmuri krizebis
39
gavlis Semdeg kunTebis moSvebiT mTavrdeba, xolo tetanusis
SemTxvevaSi ki _ ara.
unda gvaxsovdes cru hidrofobia an egreT wodebuli lisafobia,
is gvxvdeba fsiqopatur pirebSi, romlebic literaturidan arian informirebuli cofis Sesaxeb.
literaturaSi aRwerilia SemTxvevebi, rodesac lisafobiiT
Sepyrobili avadmyofebi mcdari warmodgenebiT cxovroben: TavianT Tavze aRiqvamen cofis sxvadasxva niSnebs, wylis SiSis CaTvliT. mxolod maRali temperatura da gugebis gafarToeba ar
SeimCneva maTSi. eqimis darwmunebisa da STagonebis Semdegac ki
zogierTi avadmyofi Znelad eleva viTomda `gamovlenili~ cofis
niSnebs. lisafobiidan gamosavali yovelTvis keTilsaimedoa.
postmortaluri gamokvlevebisas sasurvelia virusis gamoyofa Tavis da zurgis tvinidan, agreTve ybis qveSa sanerwyve jirkvlebidan.
hidrofobiiT daavadebuli avadmyofis kliniko-laboratoriuli sisxlis, zurg-tvinis siTxisa da Sardis gamokvlevebs ara
aqvs didi diagnostikuri mniSvneloba. daavadebis ganviTarebis
periodSi leikocitebis momatebis fonze aRiniSneba eozinofilia, limfocitopenia da monocitopenia. zurg-tvinis siTxe gamWvirvalea, masSi leikocitebis ara umetes 100 ujredia 1mm3-Si,
Sardis xvedriTi wona maRalia, masSi cilisa da Saqris Semcveloba aRiniSneba.
hidrofobiis prognozi dReisaTvis arasaimedoa. misi mkurnalobis mizniT medicinaSi cnobili yvela saSualeba gamoiyenes,
dawyebuli rusuli abanoTi, finuri sauniT da damTavrebuli
Tanamedrove antibiotikebiT. arasaimedo gamodga mkurnalobis
mcdeloba ZiliT da antirabiuli gama-globuliniT. amJamad Tanamedrove reanimaciul saSualebebsa da aparaturasTan erTad
yuradReba SeCerebulia sinTetikur polinukleotidebze (interferonis induktorebze).
msoflioSi cnobili mecnierebi agrZeleben Ziebas saSualebebisa, romlebic pirdapir imoqmedebda cofis virusze.
meoce saukunis bolos damtkicda, rom xelovnuri sunTqvis
aparatisa da intensiuri Terapiis saSualebebiT SeiZleba gaxangrZlivdes ara sicocxle, aramed daavadebis klinikuri mimdinareoba.
40
Emmons-i TanaavtorebTan erTad (1973) aRwers hidrofobiiT
daavadebuli 2 wlis bavSvis klinikuri mimdinareobis 133 dRemde gagrZelebas, romlis gamosavali mainc letaluri iyo.
hidrofobiis klinikaSi, ise rogorc postvaqcinaluri encefalomielitis dros, daavadebis simZime da gamosavali ganisazRvreba
sunTqvisa da gulsisxlZarRvTa sistemebis funqciebis ukmarisobiT. dRevandeli reanimaciuli da intensiuri Terapiis Tanamedrove saSualebebis gamoyenebis mizniT aucilebelia hidrofobiiT daavadebulis hospitalizacia intensiuri Terapiis ganyofilebis calke palataSi. usafrTxoebis mizniT sakmarisia mxolod avadmyofis izolacia, dezinficireba da, ra Tqma unda, samedicino personalis mier individualuri dacvis wesebis Sesruleba:
xelTaTmanebiT, niRbiT, dacviTi saTvaleebiT muSaoba, xelebis
guldasmiT damuSaveba sapniani wyliT. rekomendirebulia agreTve
personalis profilaqtikuri imunizacia antirabiuli vaqcinaciiT.
hidrofobiis specifikuri an medikamentozuri mkurnalobis
cdebi eqsperimentis pirobebSi mimdinareobs.
rekomendirebuli mkurnalobis sqemas ganviTarebuli hidrofobiis dros simptomaturi xasiaTi aqvs:
1) avadmyofis maqsimaluri dacva gareTa gamRizianeblebisgan:
xmauri, haeris moZraoba (gansakuTrebiT, civis), mkveTri Suqis
morideba. amitom avadmyofs aTavseben mSvid, Tbil da Cabnelebul
palataSi, sadac ar unda iyos arc erTi zedmeti nivTi, romlebic
agznebis Setevis dros avadmyofma SeiZleba agresiuli miznebisTvis gamoiyenos;
2) SfoTvis, SiSis, hidrofobiis Setevebisa da maTTan dakavSirebuli tkivilebis moxsna sedatiuri, antispazmuri, narkotikuli da saZile saSualebebiT. jer kidev mimRebSi SeiZleba
morfinis, pantoponis (1-2ml, 1% xsnari kanqveS) ineqcia. oynis
gakeTeba bromiT, qloralhidratiT (2% xsnaris 60-70ml, 1-2jer dReSi). krunCxvebis sawinaaRmdego saSualebebi: 2,5%-iani
aminazini (2-3-jer dReSi).
3) gul-sisxlZarRvTa sistemis moqmedebis SenarCunebisa da
kvebis uzrunvelyofis mizniT venaSi qafuris, glukozis (20-40
ml 40% xsnaris 2-jer dReSi venaSi), sisxlis, plazmis da sxva
sisxlis Semcvlelebis gadasxma (1l. dRe-RameSi). diuretikuli
41
preparatebi hi pofizis antidiuretikuli hi pofizuri hormonis
sekreciis SenarCunebis mizniT.
4) qalaSida wnevis Sesamcireblad aucilebelia intralumbaluri punqcia, romelsac diagnostikuri mniSvnelobac gaaCnia;
5) naadrevi traqeotomia da xelovnuri sunTqvis aparatis
CarTva sunTqvis funqciis SenarCunebisa da hi poqsiis Tavidan
acilebis mizniT.
cofis specifikuri mkurnaloba dRemde ar arsebobs. simptomuri mkurnalobis principebi aseTia: avadmyofs aTavseben intensiuri Terapiisa da reanimaciis ganyofilebis calke palataSi;
mkurnaloben simptomuri saSualebebiT. agznebis stadiaSi saWiroa
antispazmuri, sedatiuri, narkotikuli da saZile saSualebebis
daniSvna. paralizur stadiaSi iyeneben sunTqvisa da gulsisxlZarRvTa mastimulirebel saSualebebs. dakarguli siTxis
aRsadgenad da kvebis mizniT saWiroa marilxsnarebis gadasxma.
avadmyofi daculi unda iyos yovelgvari gaRizianebisgan. avadmyofs aTavseben Cabnelebul, xmaurisagan izolirebul, Tbil palataSi. didi dozebiT ukeTdeba morfinis, pantoponis, aminazinis,
dimedrolis ineqciebi da qloralhidrati oyniT Per rectum.
kurares magvarma preparatebma, avadmyofis gadayvanam filtvebis
xelovnur ventilaciaze SeiZleba gaaxangrZlivos mxolod daavadebis klinikuri mindinareoba gamojanmrTelebis gareSe. prognozi yovelTvis arasaimedoa.
antirabiuli profilaqtikuri mkurnaloba
nakbeni Wrilobebis pirveladi qirurgiuli damuSaveba,
tetanusis profilaqtika, dazaralebulTa hospitalizaciis
Cveneba, gadaudebeli RonisZiebebi.
nakbeni Wriloba bavSvTa da mozrdilTa xSiri travmuli dazianebaa. cofiT daavadebuli cxovelis dorblSi arsebulma
gamomwvevma (virusma) SesaZlebelia gamoiwvios adamianis dainficireba da hidrofobiis (cofis) ganviTareba. qirurg-rabiologis gamocdilebasa da profesionalizmze bevrad aris damokidebuli am sasikvdilo daavadebis Tavidan acileba.
42
yvela samkurnalo-profilaqtikuri dawesebuleba, cxovelebis
mier dakbenili, dakawruli da dadorblili pirebis, an cofiT
daavadebuli, an am daavadebaze eWvmitanili cxovelebis dakvlis,
an dacemuli cxovelebis leSis gatyavebis, damuSavebis, an cofiT
gardacvlili adamianis gvamis gakveTis Sedegad dazaralebul
pirTa mimarTvisas, valdebulia dauyovnebliv aRmouCinos pirveladi samedicino daxmareba: sapniani wylis WavliT kargad mohbanon Wrilobebi, nakawri, dadorblili areebi, daadon steriluri naxvevi. nakbeni Wrilobebis dros, ise rogorc sxva travmebis dros, tardeba tetanusis saswrafo profilaqtika mowodebuli sqemis mixedviT. Semdgom ki cxovelebis mier dazaralebulebi antirabiuli acrebis daniSvna-CatarebisaTvis unda gaigzavnon Sesabamisi antirabiuli qirurgiuli samsaxuris mqone
samkurnalo-profilaqtikur dawesebulebebSi.
cofis virusi adamianis organizmSi SeiZleba moxvdes daavadebuli cxovelis nerwyvidan ara mxolod TvaliT SesamCnevi Wrilobebidan (nakbeni, nakawri), aramed mikrotravmebidanac (dadorbvlisas).
nakbeni Wrilobebis qirurgiuli damuSavebis dros daculi
unda iyos Semdegi wesebi:
- nakbeni Wrilobebis kideebi da fuZe ar ikveTeba mravalricxovani nervuli daboloebis dazianebaTa gamo.
- Wriloba irecxeba jer uxvi sapniani (sasurvelia sameurneo
saponi) wylis WavliT, Semdeg nakben Wrilobaze edeba aseptiuri
naxvevi.
- sasicocxlo Cvenebis (sisxldena dazianebuli sisxlZarRvebidan) garda, nakbeni Wrilobebis gakerva 3 dRis ganmavlobaSi
ar SeiZleba, vinaidan nakerebis dadebisas iqmneba idealuri pirobebi
nervul daboloebebze cofis virusis moxvedrisaTvis (janmrTelobis dacvis msoflio organizaciis monacemebis mixedviT). 3
dRis Semdeg Cvenebisamebr SesaZlebelia Catardes nakbeni Wrilobis mTlianobis operaciuli aRdgena.
43
nakbeni Wrilobebis mkurnalobis dros cofis Tavidan
acilebasTan erTad aucilebelia tetanusis profilaqtika
gare safarvelis mwvave specifikuri infeqciebidan – tetanusi,
cofi _ vaqcinoprofilaqtikis TvalsazrisiT yvelaze meti
praqtikuli mniSvneloba tetanuss eniWeba.
tetanusi (gaSeSeba) mwvave infeqciuri daavadebaa, romlis gamomwvevi specifikuri anaerobuli Cxiri (CI. tetani) organizmSi
dazianebuli kanis meSveobiT SeiWreba.
tetanusi Wrilobis erT-erTi yvelaze mZime infeqciuri daavadebaa, tetanusis gamomwvevi (Cxiri an spora), WrilobaSi moxvedrisas Tu xelsayreli (anaerobuli) pirobebi Seeqmna, iwyebs
egzotoqsinis (tetanospazminis) gamomuSavebas, romelic sisxlisa da periferiuli nervebis mamoZravebeli boWkoebis gziT
aRwevs zurgisa da mogrZo tvins, Tavis tvinis Reros retikulur formacias, rac sabolood iwvevs tetanusisaTvis damaxasiaTebeli tonur-klonuri krunCxvebis Camoyalibebas.
tetanusis toqsini azianebs sunTqvis centrsa da vagusis
birTvebs. viTardeba simpaTikuri nervuli sistemis hi perreaqtiulobac, rasac mosdevs gul-sisxlZarRvTa sistemis funqciis
moSla _ sisxlis wnevis momateba, taqikardia, ariTmia da sxva.
ylapvis gaZneleba, angina, tkivili zurgis areSi tetanusis
adreuli niSnebia. daavadebis paTognomuri niSania trizmi _
piris gaRebis gaZneleba, saReWi kunTebis krunCxvis gamo. dasawyisSive gamoixateba mimikuri kunTebis tonuri SekumSva, rac qmnis
Tavisebur gamometyvelbas _ ,,tetanusis saxes~ _ ,,sardonikul
Rimils~ (Risus sardonicus).
mZime SemTxvevaSi gamoxatulia xaxisa da saylapavi milis
kunTebis krunCxvebi, bgeriTi iogebis spazmi, ris gamoc tetanusi
Zlier emsgavseba cofs, avadmyofs uWirs wylis daleva _ Tetanus
hydrophobicus.
tetanusis aqtiuri da pasiuri imunizacia metad mniSvnelovani specifikuri profilaqtikuri RonisZiebaa. tetanusis
araspecifikur profilaqtikas uzrunvelyofs Wrilobis srulyofili pirveladi qirurgiuli damuSaveba.
inkubaciuri periodi tetanusis dros meryeobs 1 dRidan 1
Tvemde, zogjer erTi Tvis Semdegac viTardeba. aRsaniSnavia, rom
44
bavSvebSi, gansakuTrebiT axalSobilebSi, inkubaciuri periodis
xangrZlivoba ufro moklea, vidre mozrdilebSi.
sayuradReboa, rom letaloba tetanusis dros damokidebulia inkubaciuri periodis xangrZlivobaze (Rose-s mixedviT),
rac asaxulia qvemoT moyvanil cxrilSi:
inkubaciis xangrZlivoba (dReebSi) letaloba (%)
1–7
_
91
7-14
_
81.3
14 dRis Semdeg _
52.9
1 Tvis Semdeg _
50
danarTi # 1 cxrilSi warmodgenilia tetanusis saswrafo
profilaqtikis taqtika.
nakbeni WrilobebiT dazaralebulTa hospitalizaciis
Cvenebebi:
1. mravlobiTi nakbeni Wrilobebi saxis, kisris, xelis mtevnisa
da TiTebis areSi;
2. inficirebuli (daCirqebuli) nakbeni Wrilobebi (gansakuTrebiT xelis mtevnis areSi);
3. damZimebuli alergiuli anamnezi, postvaqcinaluri
garTulebebi da reaqciebi antirabiul preparatebze;
4. damZimebuli nevrologiuri da fsiqonevrologiuri anamnezi;
5. nebismieri lokalizaciis mZime xarisxis nakbeni Wrilobebi.
gadaudebeli RonisZiebebi
xSirad cxovelis mier dazaralebuli, Sokis qveS myofi bavSvi
aRgznebulia da saWiroa misi damSvideba, tkivilis Semsubuqeba,
Tavisuflad SeiZleba analgetikebis daniSnva.
cxovelis (ufro xSirad ZaRlis) nerwyvi Seicavs polimorful mikrobul floras piogenuri mikrooganizmebis (stafilokokebis, streptokokebis) da anaerobebis SemcvelobiT.
ZaRlebis 30-60% aris asimptomatiuri matarebeli Pasterurellas sxvadasxva Stamisa. ZaRlis nakbeni Wrilobebis SemTxvevaSi
infeqciis ganviTarebis sixSire zogadad 5-15%-ia. cxovelebis
45
mier dakbenisas, im adamianTa 50%-ze mets, romlebic moiTxoven
saswrafo hospitalizacias, Wrilobebis pirdapiri gamokvlevisas aReniSnebaT mikrofloris arseboba.
didi mniSvneloba aqvs meoradi infeqciis profilaqtikisaTvis
antibiotikoTerapias. saukeTeso Sedegs iZleva 7-10 dRis ganmavlobaSi amoqsacilinis gamoyeneba, romlis Terapiuli sqemaa
50mg/kg.
aucilebelia antibiotikoTerapia nakbeni Wrilobis anTebis
lokaluri an lokoregionaluri niSnebisas. nakbeni Wrilobebi
ganekuTvnebian ubedur SemTxvevaTa ricxvs, SesaZlo infeqciuri,
funqcionaluri da esTetikuri garTulebebiT. samedicino daxmarebis (gamorecxva, antibiotikoTerapia, Semdeg qirurgiuli nakerebi Cvenebisamebr) xarisxi Tavidan agvacilebs movlenebs, romlebmac SeiZleba seriozulad gaarTulos bavSvis esTetikuri
da funqcionaluri momavali.
cofis sawinaaRmdego samkurnalo - profilaqtikuri
(posteqspoziciuri) daxmareba
Cveneba: eqspozicia (dakbena, dadorbvla, dakawvra) cofiani, cofze
saeWvo cxovelis mier.
cofze saeWvod miiCneva yvela ZuZumwovari, romelmac nebismier pirobebSi adamians dazianeba miayena.
posteqspoziciuri vaqcinaciisaTvis ukuCveneba
ar arsebobs.
antirabiuli samkurnalo-profilaqtikuri daxmareba Sedgeba Wrilobis adgilobrivi damuSavebisa da antirabiuli preparatebis gamoyenebisagan.
antirabiuli daxmarebis kabineti aRWurvili unda iyos antiSokuri Terapiuli saSualebebiT.
amJamad saqarTveloSi hidrofobiis vaqcino profilaqtikisaTvis ZiriTadad gamoiyeneba ruseTis medicinis mecnierebaTa
akademiis m. Cumakovis saxelobis poliomielitisa da virusuli
encefalitebis institutis mier warmoebuli 6-ineqciani intramuskularuli koncentrirebuli gawmendili kulturaluri an46
tirabiuli vaqcina, romelic damzadebulia janmrTelobis dacvis
msoflio organizaciis mier rekomendebuli (9 dasaxelebidan
erT-erTi) vnukovo-32 savaqcine Stamidan. aRniSnuli vaqcina
qveyanaSi pirvelad dainerga 1997 wels q. Tbilisis bavSvTa #2
mravalprofiluri saavadmyofos bazaze moqmedi antirabiuli
samedicino daxmarebis centris mier. sazRvargareT, zemoT naxsenebi antirabiuli vaqcinis garda, gamoiyeneba intramuskuluri
5-inieqciani (keTdeba 0, 3, 7, 14 da 28-e dRes) da intradermuli
vaqcinebi. maTi registraciis SemTxvevaSi SesaZlebelia isini
gamoyenebul iqnes saqarTveloSi, mwarmoebelis instruqciis
Sesabamisad.
koncentrirebuli antirabiuli vaqcina ainducirebs cofis
sawinaaRmdego antisxeulebis gamomuSavebas. erTjeradi doza
(1.0 ml) Seicavs 2,5 s.e. antigens.
Seyvanis wesebi: vaqcinas (ampulis SigTavss) xsnian 1,0 ml.
saineqcio wyalSi. gaxsnili vaqcina nel-nela SehyavT deltisebur kunTSi (bavSvebs 5 wlamde _ barZayis kunTis wina gverdiTa
zeda nawilSi).
akrZalulia vaqcinis Seyvana dundulo kunTSi
vaqcinirebuli adamiani imyofeba samedicino meTvalyureobis
qveS 30 wuTis ganmavlobaSi. imunoTerapiuli kursis Catarebis
Semdeg gaicema cnoba, sadac aRniSnulia gamoyenebuli preparatis
ti pi da seria, acrebis kursi, postvaqcinaluri reaqcia.
47
antirabiuli koncentrirebuli vaqciniT da imunoglobuliniT
samkurnalo-profilaqtikuri imunizaciis sqema
2
3
4.
dazianeba ar aris an
kontaqti arapirdapiria.
nebismieri lokalizaciis
kanis
dauzianebeli
safarvelis dadorbvla
Sinauri cxovelis mier
kanis
dazianebuli
safarvelis dadorbvla,
erTjeradi zedapiruli
nakbenebi da nakawrebi
zeda da qvemo kidurebze
(garda
Tavis,
saxis,
mtevnis, xelisa da fexis
TiTebis, Sorisisa da
genitaliebisa)
janmrTelia
ar iniSneba
-
daavadebulia
cofiT
a) janmrTelia
b) janmrTelia
janmrTelia,
daavadda,
daiRupa,
daikarga
g) saeWvoa cofze
janmrTelia
d) cofiT daavadebuli cxoveli gaiqca,
mokles, diagnozi
ucnobia
____
janmrTelia
Sinauri cxovelis mier a) janmrTelia an
lorwovani
garsebis saeWvoa cofze
dadorbvla; dazianebuli
kanis
safarvelis
nebismieri
dadorbvla,
dakawvra,
dazianeba, b) janmrTelia an
dakbena
Tavis,
saxis, saeWvoa cofze
kisris, mtevnis, xelisa
g) cofiT
da
fexis
TiTebis,
daavadebuli
Sorisis,
genitaliebis
cxoveli gaiqca,
areSi;
nebismieri lokalizaciis mokles, diagnozi
ucnobia.
mravlobiTi nakbenebi da
masiuri
dazianebebi;
erTeuli Rrma nakbenebi
da nakawrebi
gareuli
cxovelebis,
Ramurebisa da mRrRnelebis
mier nebismieri lokalizaciis
dazianebuli kanis safarvelisa
da
lorwovani
garsebis
dadorbvla, agreTve nebismieri
nakawri, dazianeba, nakbeni.
rekomendirebuli mkurnaloba
10 dRiani
meTvalyureobis
Sedegi
dazianebis
kategoria
1
informacia cxovelze
kbenis
momentisaTvis
kontaqtis xasiaTi
daavadda
daiRupa
daikarga
____
a)
mkurnaloba ar iniSneba;
b)
mkurnaloba
iwyeba
cxovelSi
daavadebis pirveli niSnebis gamovlenis
an dakargvisTanave. TiTo ml vaqciniT
0, me-3, me-7, me-14, 30-e da 90-e dRes;
g) mkurnaloba iwyeba dauyonebliv
TiTo ml vaqciniT 0, me-3, me-7 me-14,
30-e da 90-e dRes. mkurnalobas
wyveten,
Tu
cxoveli
10
dRis
ganmavlobaSi janmrTeli darCa;
d) mkurnaloba iwyeba dauyonebliv
TiTo ml vaqciniT 0, me-3, me-7 me-14,
30-e da 90-e dRes.
a) dauyonebliv iwyeba kombinirebuli
mkurnaloba:
antirabiuli
imunoglobuliniT
0-van dRes + vaqcinis TiTo ml 0, me3, me-7, me-14, 30-e da 90-e dRes.
mkurnaloba wydeba, Tu cxoveli 10
dRis ganmavlobaSi janmrTeli darCa;
b) dauyonebliv iwyeba kombinirebuli
mkurnaloba:
antirabiuli
imunoglobuliniT
0-van dRes + vaqcinis TiTo ml 0, me3, me-7, me-14, 30-e da 90-e dRes.
g) dauyonebliv iwyeba kombinirebuli
mkurnaloba:
antirabiuli
imunoglobuliniT
0-van
dRes
+
vaqcinis TiTo ml 0, me-3, me-7, me-14,
30-e da 90-e dRes.
dauyonebliv
iwyeba
kombinirebuli
mkurnaloba:
antirabiuli
imunoglobuliniT
0-van dRes + vaqcinis TiTo ml 0, me3, me-7, me-14, 30-e da 90-e dRes.
_____
_____
48
antirabiuli (ruseTis warmoebis) imunoglobulinis dozebi:
heterologiuri
(cxenis)
antirabiuli imunoglobulini iniSneba doziT: 40 s.e. 1kg. sxeulis masaze; homologiuri
(adamianis) - 20 s.e. 1kg. sxeulis masaze.
Pantirabiuli profilaqtikuri (preeqspoziciuri)
imunizacia
pirveladi imunizacia
sami ineqcia 0. me-7, 30-e dRes
TiTo ml-iT
wlis erTi ineqcia 1,0 ml-iT
pirveli revaqcinacia 1
Semdeg
Semdegi revaqcinacia yovel
weliwadSi
3 erTi ineqcia 1,0 ml-iT
aRniSnuli sqemiT antirabiuli profilaqtikuri (preeqspoziciuri) imunizacia utardebaT im pirebs, romelTa samuSao
dakavSirebulia daavadebis riskTan: laboratoriebis TanamSromlebs, romlebic muSaoben cofis quCis virusTan, veterinarebs,
monadireebs, metyeveebs, ZaRlTa damWeri brigadis wevrebs, sasaklaoebis muSakebs, taqsidermistebs (mefituleebs).
profilaqtikuri (preeqspoziciuri) imunizaciis
ukuCvenebebi:
1. mwvave daavadebebi, qronikuli daavadebebi gamwvavebis an
dekompensaciis stadiaSi – acrebs atareben gamojanmrTelebidan
erTi Tvis Semdeg;
2. mocemuli preparatis Seyvanaze sistemuri alergiuli
reaqciebi (generalizebuli gamonayari, kvinkes SeSupeba da sxva);
3. alergiuli reaqciebi aminoglikozidebis rigis antibiotikebze;
4. orsuloba;
5. wina vaqcinaciis Semdgomi garTulebebi.
donorebis imunizacias antirabiuli imunoglobulinis warmoebisaTvis atareben Semdegi sqemiT: TiTo ml. intramuskularulad 0, me-3, me-7, me-14, 30-e da 90-e dRes.
49
reaqcia antirabiuli preparatis Seyvanaze
1. vaqcinis Seyvanam SeiZleba gamoiwvios adgilobrivi an zogadi reaqcia. adgilobrivi reaqcia xasiaTdeba umniSvnelo SeSupebiT, SewiTlebiT, qaviliT, regionaluri limfuri kvanZebis gadidebiT. zogadi reaqcia SeiZleba gamovlindes sisustiT, Tavis
tkiviliT, temperaturis momatebiT. rekomendirebulia simptomuri Terapia desensibilizirebuli da antihistaminuri saSualebebiT. iSviaTad aRiniSneba
nevrologiuri simptomebi. am
SemTxvevaSi saWiroa saswrafo hospitalizacia.
2. heterologiuri (cxenis Sratze damzadebuli) antirabiuli imunoglobulinis Seyvanis Semdeg SeiZleba aRiniSnos Semdegi garTulebebi: anafilaqsiuri Soki, adgilobrivi alergiuli
reaqcia (viTardeba Seyvanidan 1-2 saaTidan 1-2 dReSi), Sratismieri daavadeba, (uxSiresad viTardeba Seyvanidan me-7-me-14 dRes).
anafilaqtoiduri reaqciis ganviTarebis SemTxvevaSi kanqveS SehyavT 0,3 ml adrenalini (1:1000), romlis gameoreba SeiZleba 15
wT-is intervaliT 3-jeradad (bavSvebSi ki adrenalinis dozaa
0,1-0,15) an 0,2-1,0 ml-mde 5%-iani efedrini (asakis gaTvaliswinebiT). Sratismieri daavadebis samkurnalod rekomendirebulia dimedroli 0,05-0,1 ml 3-4-jer dReSi, kalciumis qloridi intravenurad an per os, kortikosteriodebi (prednizoloni, kortizoni) da hospitalizacia saTanado Cvenebisas.
gamoSvebis forma: vaqcinas uSveben ampulebSi 10 ml (1 doza)
gamxsneli – gamoxdili wyali 1,0 ml
SefuTvaSi 10 ampulaa. aqedan 5 gamxsnelia.
cxenis Sratze damzadebul imunoglobulins uSveben 5,0 an
10,0 ml-ian ampulebSi, kompleqtSi TiToeul ampulas Tan axlavs 1,0 ml 1:100 ganzavebis igive imunoglobulini alergiuli
sinjisTvis.
antirabiuli vaqcinis Senaxvis wesebi da vadebi
Senaxvis vada Cveulebriv 1,5 weli; inaxaven mSral, sinaTlisagan dacul adgilas 5±30 C-ze.
transportireba dasaSvebia `civi jaWvis~ princi pis dacviT
5±30 C temperaturis pirobebSi.
50
SeniSvna
SeniSvna: antirabiul profilaqtikur mkurnalobaSi, kerZod,
dazaralebulTa im kategorias, romelic iRebs kortikosteroidebsa da imunodepresantebs, unda ganesazRvros specifiuri antisxeulebis titri. is unda awarmoon: eqimebma, romlebmac daniSnes
aRniSnuli preparatebi da specializirebulma laboratoriam.
es aucilebelia antirabiuli mkurnalobis Semdgomi koreqciisaTvis.
antirabiuli heterologiuri (cxenis) da homologiuri
(adamianis) imunoglobulini
imunologiuri Taviseburebebi
antirabiul imunoglobulins gaaCnia cofis virusis neitralizaciis unari, rogorc in vitro, ise in vivo.
daniSnuleba
gamoiyeneba gansakuTrebul SemTxvevaSi antirabiul vaqcinasTan erTad hidrofobiis profilaqtikisaTvis.
dozireba da miRebis wesebi
specifiuri mkurnalobis dawyebamde amowmeben ampulis vargisianobas, mTlianobas da mis etikets. xmarebisTvis uvargisia
preparati, Tu darRveulia ampulis mTlianoba, Secvlilia misi
fizikuri Tvisebebi (feri, gamWvirvaloba da a.S.), gasulia vada
an daculi ar aris Senaxvis pirobebi. ampulis gaxsna da preparatis
Seyvana xorcieldeba aseptikisa da antiseptikis wesebis mkacri
dacviT.
heterologiuri saxis antirabiuli imunoglobulini SehyavT
doziT 40Ms.e.E1kg wonaze; homologiuri (adamianis) antirabiuli imunoglobulini ki 20 s.e. 1 kg sxeulis masaze. mag.: da
zaralebulis wonaa 60 kg, xolo imunoglobulinis aqtivoba
(miTiTebulia etiketze) aris 200 s.e.M1/ml-Si. imisaTvis, rom
ganvsazRvroT SeyvanisaTvis aucilebeli doza, masa unda gavamravloT 40 s.e.-ze da gavyoT preparatis aqtivobaze anu 200 s.e.ze e.i.
60X40 : 200 =12ml
51
antirabiuli imunoglobulinis Seyvanamde ucxo cilaze mgrZnobelobis dasadgenad aucileblad atareben kanSiga sinjs 1:100
ganzavebuli imunoglobuliniT (ampula markirebulia wiTeli
feriT), romelic imyofeba preparatian yuTSi (ampula markirebulia lurji feriT).
0,1 ml ganzavebuli imunoglobulini SehyavT kanSi winamxris
momxrel zedapirze. cda uaryofiTia, Tu 20 wT-Si siwiTle an
SeSupeba Seyvanis adgilas 1sm-ze naklebia. cda dadebiTia, Tu igi
aRemateba 1 sm-s. Tu cda uaryofiTia, kanqveS SehyavT 0,7 ml
1:100-ze ganzavebuli imunoglobulini. 30 wT-is ganmavlobaSi
reaqciis ar arsebobisas, iwyeben imunoglobulinis mTeli dozis
Seyvanas 10-15 wT-is intervaliT 3-jeradad; imunoglobulini
SehyavT SemTbari 370 C ±0,50C da yoveli porciisaTvis preparats iReben gauxsneli ampulidan.
gaTvlili doziT infiltracia unda moxdes Wrilobis garSemo
da mis siRrmeSi. Tu Wrilobis anatomiuri mdebareoba (TiTebi
da a.S.) ar iZleva mTeli dozis Wrilobis garSemo Seyvanis
saSualebas, maSin darCenili imunoglobulini SehyavT sxva, vaqcinis Seyvanis adgilisagan gansxvavebul kunTSi (dundulo da
barZayis). antirabiuli imunoglobulinis mTeli doza SehyavT 1
sT-is ganmavlobaSi. yvelaze efeqturia preparatis adreuli
Seyvana travmidan pirveli dRis ganmavlobaSi.
dadebiTi kanSiga sinjis SemTxvevaSi an alergiuli reaqciebis gamovlinebisas imunoglobulini SehyavT gansakuTrebuli
sifrTxiliT. rekomendirebulia Tavdapirvelad Seiyvanon 1:100
ganzavebuli preparati mxris kanqveSa qsovilSi dozirebiT 0,5
ml, 2 ml, 5 ml 15-20 wT-is intervaliT, Semdeg iqve 0,1 ml
ganuzavebeli imunoglobulini da 30-60 wT-is Semdeg darCenili doza kunTebSi (SemTbari 37 0 C±0,50C-mde), wiladobrivad
sam Seyvanaze 10-15 wT-is intervaliT. pirveli ineqciis win
rekomendebulia antihistaminuri preparatebis parenteraluri
Seyvana (suprastini, dimedroli da sxva). Sokis profilaqtikis
mizniT imunoglobulinTan erTad SehyavT 0,1% adrenalni an 5%
efedrini asakobrivi dozebiT. antirabiuli imunoglobulinis
Seyvanisas yovelTvis mzad unda iyos adrenalinis, efedrinis,
dimedrolisa da suprastinis xsnarebi.
52
alergiuli xasiaTis garTulebebis Tavidan asacileblad, imunoglobulinis Seyvanis Semdeg aucilebelia peroralurad antihistaminuri preparatebis daniSvna (suprastini, dimedroli, diprazoli, fenkaroli da sxva) asakobrivi dozebiT orjer dReSi, 7-10
dRis ganmavlobaSi.
dazaralebuls, romelsac uaxloes 24 sT-Si gaukeTda antitetanuri Srati, antirabiul imunoglobulins ukeTeben winaswari
kanSiga sinjis gareSe. antirabiuli imunoglobulinis Seyvanis
Semdeg pacienti samedicino meTvalyureobis qveS imyofeba aranakleb
1 sT-isa. Catarebuli acra registrirdeba Sesabamis ‘antirabiuli qirurgiuli daxmarebis da acrebis~ baraTebSi, dozis, TariRis, preparatis gamomSvebi dawesebulebis, seriis, Seyvanaze reaqciis
miTiTebiT.
homologiuri imunoglobulini SehyavT kanSiga alergiuli
sinjis gareSe.
reaqcia Seyvanaze
antirabiuli imunoglobulinis Seyvanaze SeiZleba ganviTardes
alergiuli reaqciebi, anafilaqsiuri Sokisa da Sratismieri
daavadebis CaTvliT.
ukuCveneba
ukuCveneba ar arsebobs: antirabiuli imunoglobulinis Seyvanisas mkveTri dadebiTi reaqciis SemTxvevaSi, aseve dazaralebulis alergiuli anamnezisas antitetanur Sratze an cxenis
Sratis sxva preparatebze – antirabiuli imunoglobulinis Seyvana
rekomendebulia reanimaciisa da intensiuri Terapiis ganyofilebis
mqone stacionaris pirobebSi.
gamoSvebis forma
gamodis muyaos kolofSi - 5 kompleqti.
kompleqti Sedgeba: 1 ampula imunoglobulini (5 an 10 ml) da
1 ampula (1 ml) 1:100 ganzavebuli imunoglobulini.
53
Senaxvis vada da pirobebi
Senaxvis vada – 2 weli;
inaxeba – daxurul, mSral, bnel adgilas 5±20C temperaturaze;
transportireba – ,,civi jaWvis~ princi pis dacviT 5±20C temperaturis pirobebSi.
homologiuri antirabiuli imunoglobulini_
imunoglobulini_IMOGAM RAG
generiuli dasaxeleba
dasaxeleba:
Humen rabies immunoglobulinum
Semadgenloba:
1 ml preparati Seicavs aqtiur nivTierebas adamianis antirabiul imunoglobulins 150 s.e.
gamoSvebis forma:
forma saineqcio xsnari flakonebSi 150 s.e. (10ml)
farmakoTerapiuli jgufi
jgufi:
cofis sawinaaRmdego imunoglobulini
farmakologiuri Tvisebebi
`imogam raJi~ warmoadgens adamianis specifikuri imunoglobulinis buferul izotonur xsnars, romelic miiReba cofis
profilaqtikisTvis saWiro inaqtivirebuli vaqciniT imunizirebuli donoris sisxlis plazmisgan.
vaqcina warmoadgens adamianis di ploiduri ujredebis kulturaze gazrdili cofis virusis Stam Wistar-is koncentrirebul gawmendil fiqsirebul kulturas da Seicavs specifiuri
antisxeulebis maRal maCveneblebs.
axasiaTebs imunomastimulirebeli moqmedeba (cofis virusis
mimarT pasiuri imunitetis formireba, romelic xorcieldeba
specifikuri antisxeulebis SeyvaniT).
54
klinikuri farmakologia
seroprofilaqtikuri mizniT es preparati heterospecifiur
pasiur imunoTerapiasTan SedarebiT xasiaTdeba Semdegi upiratesobiT: ar arsebobs sensibilizacia (homologiuri antisxeulebi), riski, umravles SemTxvevaSi kargad itans organizmi, antisxeulebi xangrZlivi drois ganmavlobaSi arsebobs, SesaZlebelia preparatis dabali Terapiuli dozebis gamoyenebisas maRali efeqtis miRweva.
inficirebis Semdeg organizmSi preparatis Seyvana aZlierebs
cofis virusis mimarT pasiuri imunitetis Camoyalibebis process, axangrZlivebs inkubaciur periods, riTac cofis kompleqsuri imunoprofilaqtikis Catarebis dros xels uwyobs vaqcinaciis efeqturobas.
Cveneba:
adamianis pasiuri samkurnalo-profilaqtikuri imunizacia
cofiani an cofze saeWvo cxovelTan kontaqtis dros.
rekomendebulia imunizaciis saswrafod dawyeba (gansakuTrebiT bavSvebSi), kanis safarvelis nebismieri dazianebis, kbenis
dros (umniSvnelo, mniSvnelovani, mravlobiTi), saxeze, Tavze, kiserze,
mtevnebze, terfebze, tanze nebismieri Wrilobisa da Rrma nakawrebisas, romlebic miyenebulia cxovelebis mier (cofiani an
cofze saeWvo cxovelebi, cxovelebi, romlebic veterinalur
aRricxvaze imyofebian, gareuli cxovelebi).
winaaRmdegCveneba:
ar arsebobs (radgan cofiT daavadebis dros letaloba 100%ia).
orsuloba da laqtacia:
am dros preparatis gamoyeneba dasaSvebia.
55
gverdiTi movlenebi:
SesaZlebelia lokaluri tkivili. iSviaTad _ sxeulis temperaturis momatebiT mimdinare sistemuri reaqciebi.
urTierTqmedeba sxva preparatebTan:
preparatis gamoyeneba SesaZlebelia antirabiul vaqcinasTan
erTad kombinaciaSi. imunoglobulini (pasiuri imunizacia) SesaZlebelia gamoviyenoT im droisgan damoukideblad, romelic
gasulia inficirebis momentidan me-8 dRemde antirabiuli vaqcinis pirveli ineqciis Semdeg. (cofis inkubaciuri periodi
Seadgens uSualod 1 Tves, Tumca xandaxan grZeldeba 3-4 Tve da
meti, 1 wlamde).
rekomendebulia gansakuTrebiT adamianis di ploiduri ujredebis kulturaze damzadebuli inaqtivirebuli antirabiuli
vaqcinis gamoyeneba, romelic xasiaTdeba maRali imunogenobiT da
aqtiuri antivirusuli imunitetis inducirebiT (pacientebSi
damatebiTi antisxeulebis SeyvaniT). antirabiul vaqcinaciasTan
erTad SesaZlebelia tetanusis sawinaaRmdego seroprofilaqtika da antibiotikebis daniSvna (mosalodneli superinfeqciis
riskTan dakavSirebiT).
miRebis wesi da dozireba:
misaRebi dozis naxevari SehyavT kunTebSi, meore naxevari infiltrirebuli unda iqnas Wrilobis irgvliv. bavSvebsa da
mozrdilebSi erTjeradi ineqciis saxiT iyeneben 20 s. e. kg
wonaze.
rekomendirebulia preparatis Seyvana rac SeiZleba male, savaraudo inficirebidan ara ugvianes 48 sT-isa. preparati unda
gavaTboT oTaxis temperaturaze. erTdroulad tardeba vaqcinoprofilaqtika. amave dros vaqcinis gakeTebis adgili maqsimalurad daSorebuli unda iyos imunoglobulinis ineqciis
adgilidan.
im SemTxvevaSi, rodesac imunoglobulini ar SehyavT vaqcinasTan erTad, mizanSewonilia misi gamoyeneba momdevno 8 dRis
56
ganmavlobaSi. preparatis gakeTeba imave SpriciT, romliTac keTdeba antirabiuli vaqcina, ar SeiZleba.
imunoglobulinis da vaqcinis Seyvana xdeba sxeulis sxvadasxva wertilebSi.
sifrTxile:
anamnezSi sisxlis preparatebis mimarT hi permgrZnobelobis
dros saWiroa antihistaminuri preparatis gamoyeneba. amave dros
saWiroa pacientze sistematuri dakvirveba.
atenuirebuli cocxali virusuli vaqcinebis gamoyenebis win
saWiroa ara umcires 6 kviriani intervalis dacva (umjobesia 3
Tviani) imunoglobulinis Seyvanis Semdeg.
winaaRmdegnaCvenebia imunoglobulinis venaSi Seyvana (Sokis
ganviTarebis riskis gamo). ineqciis Catarebis dros saWiroa
davrwmundeT, rom nemsi ar aris moxvedrili sisxlZarRvSi.
dakbenis dros saWiroa Wrilobis frTxilad gamorecxva jer
sapniT an natriumis hidroqloridis xsnariT, Semdeg sufTa wyliT.
dezinfeqciisTvis rekomendebulia amoniumis hidroJangis gamoyeneba, radgan aRniSnuli SenaerTebi xasiaTdebian maRali gamaneitralebeli aqtivobiT cofis virusis mimarT.
winaaRmdegnaCvenebia Wrilobis yrud gakerva. aucileblobis
SemTxvevaSi SesaZlebelia Wrilobis kideebis erTmaneTTan martivi SeerTeba.
Senaxvis vada:
18 Tve.
Senaxvis pirobebi:
sinaTlisgan dacul adgilas +2ºC-dan +8º C-mde temperaturaze.
preparatis gayinva akrZalulia.
SefuTva:
1 flakoni an ampula 150 s.e. (10,0 ml)
1 flakoni an ampula 300 s.e. (20,0 ml)
mwarmoebeli:
,,AVENTIS PASTEUR”
safrangeTi
57
antirabiuli vaqcinaciis garTulebani, maTi mizezebi,
diagnostika, mkurnaloba
antirabiuli acrebis Catarebis dros garTulebebis mizezebi:
1. imunoprofilaqtikis teqnikis darRveva;
2. uxarisxo antirabiuli preparatis gamoyeneba;
3. acrebis Catarebis kalendris Tanmimdevrobis sqemis darRveva;
4. acrebis Catarebis dros dazaralebulis mier dawesebuli
reJimis darRveva.
zemoT CamoTvlili mizezebis gamo antirabiuli preparatebis
miRebisas aRiniSneba garTulebebi, romelTa Soris yvelaze seriozuli nervuli sistemis dazianebebia.
amJamad medicina did arsenalsa da gamocdilebas flobs postvaqcinaciuri garTulebebis samkurnalod. neiroparalizuri
garTulebebis SemTxvevaSi gamoiyeneba kortikosteroidebis didi
dozebi. maTi adreuli gamoyeneba sakmaod efeqturia.
gamoyofen garTulebis sxvadasxva formebs, romlebic mimdinareoben nervuli sistemis lokaluri dazianebiT.
neiroparalizuri garTulebis garda, gvxvdeba sxva rigis
garTulebebic: anafilaqsiuri Soki, kanis alergiuli reaqcia da
Sratismieri daavadeba.
I garTulebebi cns-is lokaluri dazianebiT
1) cns-is dazianebebi
meningoencefaliti – aRiniSneba Tavis tkivili, Rebineba, temperatura 38-390C, tkivili da gulyrebi. nevrologiuri gamokvlevebisas aRiniSneba anizokoria, kunTebis tonusis, refleqsebis
daqveiTeba, amasTan erTad aRiniSneba paTologiuri refleqsebi
(babinski da openheimi). zogjer aRiniSneba tvinis garsebis dazianebis simptomebi (kefis kunTebis rigidoba, kernigisa da bruZinskis simptomebi), sisxlSi - neitrofiluri leikocitozi. zurgis
tvinis siTxeSi - umniSvnelo pleocitozi da cilebis momateba.
mieliti - SeiZleba daziandes zurgis tvinis nebismieri ubani.
mosalodnelia paTologiuri procesis gavrceleba mezobel ub58
nebzec. amiT aixsneba klinikuri gamovlinebebis mravalferovneba.
saerTo sisustisa da maRali temperaturis fonze aRiniSneba
tkivili zurgisa da welis midamoSi, simZime qveda kidurebSi,
gaZnelebuli Sardva. nevrologiuri gamokvlevisas vlindeba qveda
dune paraparezi an paraplegia. mZime mimdinareobisas yvela simptomi mkveTradaa gamoxatuli da Zalze iSviaTad SeiZleba letalobiT damTavrdes.
xSir SemTxvevaSi simptomebi TandaTan ukuganviTardeba, nelnela aRdgeba moZraoba qveda kidurebSi.
gansakuTrebiT mZimed mimdinareobs mielitis aRmavali forma,
romlis drosac ganviTarebuli paresTeziisa da paraplegiis
fonze aRiniSneba paTologiuri procesis gavrceleba sxeulis
zeda nawilebSi, rac klinikurad vlindeba zeda kidurebis moZraobisa da mgrZnobelobis darRveviT, muclisa da gulmkerdis inervaciis darRveviT. procesis progresirebisas viTardeba bulbaruli simptomebi – metyvelebis, sunTqvis, ylapvis gaZneleba,
gul-sisxlZarRvTa sistemis funqciis darRveva, zogjer aRiniSneba procesis ukuganviTareba da sruli gajansaReba yovelgvari
narCeni movlenebis gareSe.
aRwerilia fsiqikis darRvevis erTeuli SemTxvevebi, rac gamovlindeba apaTiiT, depresiiTa da iSviaTi agznebiT. Cveulebriv,
fsiqikis darRvevebi mTavrdeba sruli gamojansaRebiT.
2) periferiuli nervuli sistemis dazianebebi
calkeul SemTxvevebSi aRiniSneba poliradikulonevriti mimdinare gien-bares tipiT, agreTve mononevritis saxiT. poliradikulonevriti, Cveulebriv, mimdinareobs keTilTvisebianad da mTavrdeba
gamojanmrTelebiT 1-3 TveSi. mononevritis dros xSirad ziandeba saxis nervi da kidurebis calkeuli nervebi, msubuq SemTxvevebSi dazianeba gaivlis 2-4 kviraSi.
postvaqcinaluri garTulebebis diagnostika
postvaqcinaluri garTulebebis diagnostika SemTxvevaTa umravlesobaSi sakmaod martivia. ti puri klinikuri suraTi gvexmareba swori diagnozis dasmaSi. problemebia mxolod ati purad
59
mimdinare formis dros (`Cumi~ anu `paralizuri~ forma, romelic viTardeba landris aRmavali ti piT wylis SiSis, agznebisa
da halucinaciis gareSe), romelic xSirad letalurad mTavrdeba. saeWvo SemTxvevebSi diagnozs adasturebs daRupuli adamianis an cxovelis Tavis tvinSi babeS-negris sxeulakebis aRmoCena (laboratoriulad).
xSir SemTxvevaSi garTulebis pirveli simptomebi vlindeba I
an II ineqciis dros, rac gamoixateba saerTo sisustiT, Tavis
tkiviliTa da normaluri an momatebuli temperaturis foniT
da paresTeziebiT. aRniSnuli simptomebis gamovlinebisas aucilebelia nevropaTologis konsultacia.
nervuli sistemis dazianebiT mimdinare postvaqcinaluri
garTulebebis mkurnaloba
nervuli sistemis garTulebebis mkurnalobis erTaderTi da
ZiriTadi efeqturi saSualebaa didi dozebiT kortikosteroidebis daniSvna. nebismieri saxis garTulebis an saeWvo SemTxvevaSi simZimis formis miuxedavad, aucilebelia:
1. saswrafo hospitalizacia;
2. mkacri woliTi reJimi;
3. hormonoTerapia. prednizoloni, calkeul SemTxvevaSi kortizoni. mozrdilebs prednizolons uniSnaven 1 kviris ganmavlobaSi 80-100 mg dRe-RameSi, oTxjeradi miRebiT. kortizoni
iniSneba 75-100 mg 4 X dReSi e. i. (300-400 mg dRe-RameSi)
bavSvTa (1-2 mg 1kg-ze) sadReRamiso dozebi (eZleva 4X)
asaki
2 wlamde
2-5 weli
5-10 weli
10-16 weli
prednizoloni (mg)
5-10
10-20
20-30
30-40-50
kortizoni
20-30
30-40
7-100
100-150-180
mkurnalobis erTkviriani kursis Semdeg TandaTanobiT doza
mcirdeba mis srul moxsnamde. hi pertenziis SemTxvevaSi hormonebis doza qveiTdeba.
60
hormonaluri Terapiis fonze avadmyofs eZleva cilebiT da
kaliumiT mdidari sakvebi, unda gamoiricxos mariliani sakvebi.
1. dezintoqsikacia: ringeris xsnari 15-20-30 ml 1 kg-ze, forsirebuli diurezi, osmodiuretikebi _ manitoli 10-15 ml 1 kgze, intravenurad _ IV;
2. antihistaminuri preparatebi _ suprastini, tavegili, pipolfeni 0,2 ml/welze, intramuskularulad _ IM an intravenurad _ IV;
3. saWiroebis SemTxvevaSi antibiotikebis Seyvana. penicilini,
rocefini (ceftriaqsoni) 50-60-80-150 mg/kg-ze, intramuskularulad _ IM an intravenurad _ IV;
4. antikonvulsiuri saSualebebi _ krunCxvis an krunCxviTi
mzaobis dros _ diazepami 0,2-0,4 mg/kl-ze (2 ml/10mg), intramuskularulad _ IM an intravenurad _ IV;
5. mkurnalobis yvela etapze farTod gamoiyeneba simptomuri
saSualebebi;
6. sunTqvis darRvevis niSnebis SemTxvevaSi saWiroa marTviT
sunTqvaze gadayvana;
7. aRdgeniT periodSi iniSneba samkurnalo fizkultura da
masaJi, vitaminoTerapia (B1, B6, B2 ), B12 ki 0,2-0,5 erTjeradad
Cveulebrivi dozebiT.
neiroparalizuri garTulebebis profilaqtika
garTulebis Tavidan acilebis mizniT aucilebelia acrebis
Catareba mxolod Cvenebis mixedviT, mcire niSnebis (garTulebebis) SemTxvevaSic ki aucilebelia hospitalizacia da kortikoiduli Terapia. gansakuTrebuli sifrTxiliT eniSnebaT vaqcinacia im pirebs, romelTac adre ukve CautardaT antirabiuli
acra. ganmeorebiTi vaqcinacia tardeba mxolod stacionaris
pirobebSi.
profilaqtika gulisxmobs vaqcinirebulis Sromisa da dasvenebis mkacri reJimis dacvas.
61
II vaqcinis Semdgomi Soki
gvxvdeba SedarebiT iSviaTad. damaxasiaTebelia hi peremia, kanis
sifermkrTale, pirSi metalis gemo, Tavbrusxveva, kefis midamoSi
tkivili, civi ofli, Rebineba. mZime SemTxvevaSi aRiniSneba sunTqvis
gaZneleba da cianozi, gulyrebi, uneblie Sardva.
iSviaT SemTxvevebSi Soki iwyeba uecari gonebis dakargviT.
amis Tavidan acilebis mizniT aucilebelia vaqcinaciis Catareba
mwoliare mdgomareobaSi.
Sokis dros gamoiyeneba niSaduris spirti, kordiamini, kofeini,
adrenalini da sxva.
mZime formis Sokis dros gamoiyeneba intravenurad heparini
(5000-10000 erTeuli) 1-2 X dReSi.
III kanis alergiuli reaqcia
zogierT pirobebSi vaqcinaciis adgilze aRiniSneba gamkvriveba,
romelic TandaTan gaiwoveba, sxvadasxva ti pis alergiuli gamonayari. siwiTles, romelic zogjer aRiniSneba, Tan axlavs qavili
da regionaluri limfuri jirkvlebis gadideba. msubuq SemTxvevaSi ineqciis adgilze aRiniSneba hi peremia, romelic TavisiT
gaivlis 2-3 sT-is Semdeg. zogjer 5-7 dRis ganmavlobaSi ineqciis adgilze rCeba gamkvriveba, daaxloebiT 5 sm da meti
diametris. kani gamkvrivebis adgilze SewiTlebulia, es siwiTle
iSviaTad SeiZleba gavrceldes. siwiTles Tan axlavs qavili da
regionaluri limfuri jirkvlebis gadideba. aseT adgilobriv
reaqcias iSviaTad Tan sdevs saerTo sisuste da subfebriliteti. aseT SemTxvevaSi gamoiyeneba antihistaminuri preparatebi
(dimedroli, kalci qlorati, diazolini, citrali). adgilobrivad gamoiyeneba saTburebi da kompresi.
IV anafilaqsiuri Soki
anafilaqsiuri Soki mwvave generalizirebuli alergiuli
reaqciaa hemodinamikis dekompensirebuli moSliT, romelic ganpirobebulia alergiuli reaqciis I ti piT (IgE-Ti gaSualebuli reaginuli).
62
antigeni organizmSi SeiZleba moxvdes: parenteraluri gziT
(medikamentebis Seyvanis Semdeg), oraluri gziT (kvebiTi alergiebi), inhalaciuri gziT da adgilobrivad (kbenis Sedegad).
poxieri ujredebidan antigenis zemoqmedebis Sedegad xdeba
anafilaqsiis mediatorebis – histamini, acetilqolini, serotoninisa da sxva leikotrienebis gamomuSaveba.
klinikurad rac ufro naklebi dro gadis alergenis kontaqtidan simptomebis gamovlenamde, miT ufro mwvaved da mZimed
viTardeba anafilaqsiuri Soki.
klinikurad: avadmyofi kargavs gonebas, gamovlindeba profuzuli oflianoba, ganavlisa da Sardis Seukavebloba, respiratoruli darRvevebi vlindeba xmis CaxleCviT, moxrCobis SegrZnebiT, sunTqvis ukmarisobiT. gul-sisxlZarRvTa sistemis mxriv
vlindeba taqikardia, gulis tonebis moyrueba, hi potenzia susti
avsebis pulsiT, ariTmiebiT, kuW-nawlavis sistemis mxriv –
mucelSi spazmuri tkivilebiT, RebinebiT, diareiT.
mkurnloba: avadmyofs aTavseben gverdze, uzrunvelyofen sasunTqi gzebis gamavlobas, preparatis Seyvanis an nakbenis zemoT
adeben laxts, xolo dazianebul adgilze adeben yinulis buSts,
Sewovis Semcirebis mizniT.
1. kanqveS SehyavT 0,1% adrenalini an 1% mezatoni an noradrenalini 0,01 ml/kg-ze, kofeinis xsnari 0,1-1 ml an kordiamini
0,1-1 ml-mde. Tu ar moxerxda arteriuli wnevis aweva, maSin
adrenalini SehyavT Semdegi dozebiT: intravenurad 1 ml-s azaveben 10 ml izotonur xsnarSi da SehyavT 0,1 ml/kg-ze intravenurad.
2. SehyavT glukokortikosteroidebi _ prednizoloni 30100 mg;
3. bronqospazmis dros eufilini SehyavT intravenurad _
2,4%-10 ml 1 ml welze;
4. gul-sisxlZarRvTa ukmarisobis dros SehyavT glukagoni
0,225ml 1 ml kg-ze da sagule glikozidebi 0,1-0,3 ml;.
5. SehyavT antihistaminuri preparatebic: H1 histaminoblokatorebi – suprastini, tavegili.
H2 histaminoblokatorebi – cimetidini 5 mg/kg-ze an ranitidini
1 mg/kg-ze.
63
V Sratismieri daavadeba
Sratismieri daavadebisaTvis damaxasiaTebelia sistemuri imunopaTologiuri darRvevebi, romlebic ganpirobebulia parenteraluri gziT organizmSi ucxo cilis – Sratis SeyvaniT. Sratismieri daavadeba gvxvdeba avadmyofTa 5-10%-Si.
Sratismieri daavadeba SeiZleba ganviTardes Sratis rogorc
pirveladi, ise ganmeorebiTi Seyvanis dros – antitetanuri, antirabiuli preparatebis Seyvanis Semdeg.
Sratismieri daavadebis ganviTarebis meqanizmia ucxo cilis
xangrZlivi cirkulacia sisxlSi, meoradi antigenebis, xolo Semdeg
ki mocirkulire imunuri kompleqsebis warmoqmna. mocirkulire
imunuri kompleqsebi ileqeba maT mier dazianebul qsovilebze,
rac TavisTavad iwvevs didi raodenobiT biologiurad aqtiuri
aminebis (histamini, serotonini) gamomuSavebas, rac, Tavis mxriv,
gansazRvravs daavadebis klinikur suraTs (hipermgrZnobelobis
III ti pi). aseT SemTxvevaSi daavadebis inkubaciuri periodia 12 kvira, xolo mis paTogenezSi ZiriTadi roli eniWeba alergiul reaqcias, romelic mimdinareobs artiusis ti piT.
sxva SemTxvevaSi, rodesac damaxasiaTebeli klinikuri suraTi
viTardeba, 1-5 dRis ganmavlobaSi alergiuli reaqcia mimdinareobs anafilaqsiuri tipis mixedviT (paTogenezSi gadamwyveti
mniSvneloba eniWeba kanmasensibilizerebel antisxeulebs).
klinikurad Sratismieri daavadebis dros, rogorc wesi, me-7me-12 dReze TandaTanobiT viTardeba Semdegi klinikuri gamovlinebebi: temperaturis momateba (90%-Si), limfuri kvanZebis
(upiratesad regionaluri) da elenTis gadideba (20%); kanismieri gamovlinebebi (eriTematozuli da papulovezikuluri)
Zlieri qaviliT (90%); saxsrebis dazianeba (arTralgiebi, SeSupeba, hi peremia) (50%); mialgia, saxis kanis SeSupeba da sifermkrTale, zomieri oliguria, taqikardia da arteriuli wnevis
sazRvrebis daqveiTeba, gulis sazRvris gadideba, Sardis sindromi (albuminuria, cilindruria), nevrologiuri garTulebebi
(asTenia, kunTovani sisuste, nevritebi, gien-bares periferiuli
neiropaTia).
msubuqi mimdinareobis dros 1-3 dRis ganmavlobaSi xdeba klinikuri niSnebis ukuganviTareba, mZime mimdinareobisas isini Sei64
Zleba gagrZeldes 2-3 kviris ganmavlobaSi. prognozulad arakeTilsaimedoa gulis, Tirkmelebis, nervuli sistemis dazianebebi, hemoragiuli sindromis ganviTareba.
mkurnaloba simptomaturia. anafilaqsiuri Sokis ti piT mimdinare formebis dros mkurnaloba igivea. iniSneba simptomuri
Terapia organoebis dazianebis mixedviT.
profilaqtika
amerikis pediatriis akademiis komitetis mier (1994) antitetanuri Sratis Seyvanisas mowodebulia Semdegi Tanmimdevroba:
1. winamxris wina zedapirze akeTeben gakawvras da awveTeben
Sesayvani Sratis 1 wveTs 1:100 ganzavebiT. dadebiTad iTvleba
reaqcia _ eriTema 3mm-ze zeviT (kiTxuloben 15-20 wT-is Semdeg).
2.uaryofiTi reaqciis dros kanSi SehyavT 0,02 ml Srati
1:100 ganzavebiT, xolo 20 wuTis Semdeg, Tu ar aris pozitiuri
reaqcia, SehyavT 1:100-ze ganzavebiT. akvirdebian 30 wuTis ganmavlobaSi, uaryofiTi reaqciis dros ki mTliani doza SehyavT
kunTebSi.
Tu saWiroa preparatis intravenuri Seyvana, maSin winaswar
SehyavT 0,5 ml Srati, ganzavebuli 10 ml izotonur xsnarSi,
akvirdebian 30 wT-is ganmavlobaSi da 30 wT Semdeg SehyavT
mTliani doza.
65
desensibilizacia ati pur
purii da alergiuli diaTezebiT
Sepyrobil bavSvebSi unda ganxorcieldes Semdegi sqemiT:
dozis
jeradoba
#
1
2
3
4
5
6
7
8
9
10
11
12
13
Seyvanis gza
Srati
ganzavebuli
izotonurSi
1:1000
kanSiga
1:1000
kanSiga
1:1000
kanqveS
1:100
kanqveS
1:100
kanqveS
1:100
kanqveS
1:10
kanqveS
1:10
kanqveS
1:10
kanqveS
ganuzavebeli
kanqveS
ganuzavebeli
kanqveS
ganuzavebeli intramuskularulad
ganuzavebeli intramuskularulad
ganzavebuli
Sratis
moculoba
0,1
0,3
0,6
0,1
0,3
0,6
0,1
0,3
0,6
0,1
0,2
0,6
1,0
antirabiuli samsaxuris mkurnalobis organizacia
mkafiod unda ganisazRvros am metad seriozuli da sapasuxismgeblo saqmeSi antirabiuli samsaxuris TiToeuli struqturis funqcia, rac xels Seuwyobs adamianebSi cofiT daavadebis Tavidan acilebas.
antirabiuli qirurgiuli samsaxuris valdebulebebi:
a) nakbeni Wrilobebis damuSaveba, maTi Semdgomi mkurnaloba
- aRdgena da Cvenebis mixedviT antirabiuli mkurnalobis Catareba;
b) maRal xarisxiani, srulyofili antirabiuli momsaxureobis
uzrunvelyofa;
g) Sesabamisi raionis sazogadoebrivi jandacvis centrisaTvis
saswrafo Setyobinebis miwodeba:
- cxovelis an cxovelebis mier dazaralebulTa mimarTvis yvela
SemTxvevis;
66
- acrebis Tavidan aridebis an maTi TviTneburad Sewyvetis yvela
SemTxvevis;
- vaqcinaciis Semdgomi garTulebis yvela SemTxvevis;
d) yvela im dazaralebulis hospitalizaciiT uzrunvelyofa,
visi Wrilobac ganekuTvneba mZime kategoriis dazianebas, ganmeorebiT icreba da anamnezSi aReniSneba alergiuli reaqciebi da
nervuli sistemis daavadebebi;
e) mkurnalobis kursis warmarTva veterinaruli samsaxuris
mier warmodgenili daskvnis safuZvelze;
v) dazaralebulis mkurnalobisas ZiriTadad xelT arsebuli
antirabiuli preparatebis TandarTuli instruqciiT xelmZRvaneloba;
z) antirabiuli preparatebis moTxovnis wardgenasa da maragis arsebobaze drouli zrunva;
T) antirabiuli preparatebis Senaxva TandarTul instruqciaSi miTiTebuli pirobebis dacviT.
sazogadoebrivi jandacvis epidemiologiuri samsaxuris
valdebulebebi:
a) adamianis hidrofobiiT daavadebis yvela SemTxvevaSi keraSi
epidkvlevis Catareba, im pirebis gamovlena, romelTac esaWiroebaT antirabiuli profilaqtikuri mkurnaloba da maTze konsultaciis Catarebis aucilebloba antirabiul kabinetSi;
b) samedicino dawesebulebis antirabiuli qirurgiuli samsaxurisgan erTi an ramdenime cxovelis mier miyenebuli jgufuri dazaralebis Sesaxeb saswrafo Setyobinebis miRebisTanave
keraSi epidkvlevis dauyovneblivi dawyeba, im pirebis gamovlena,
romelTac esaWiroebaT antirabiuli profilaqtikuri mkurnaloba
da maTze konsultaciis Catarebis aucilebloba antirabiul
kabinetSi;
g) acrebis Tavidan aridebis an maTi TviTneburad Sewyvetis
yvela SemTxvevaSi dazaralebulis xelweriliT gafrTxileba
SesaZlo Sedegebze;
d) dazaralebulTa aRricxvis srulyofilebasa da saswrafo
Setyobinebis droulobaze monitoringis ganxorcielebis aucilebloba;
67
e) antirabiuli preparatebis maragis arsebobasa da Senaxvis
xarisxze monitoringis warmoeba. antirabiuli preparatebis maragis deficitis da araadekvaturi Senaxvis faqtebis Sesaxeb Sesabamisi samsaxurebis Setyobineba;
v) uzrunvelyos kontroli damkbeni cxovelis vetsamkurnaloSi gamokvlevisa da aT dRiani karantinizaciisaTvis miyvanaze;
z) antirabiuli qirurgiuli samsaxurisaTvis dazaralebulis
damkben cxovelze Catarebuli aTdRiani karantinisa da cxovelis Tavis tvinis laboratoriuli kvlevis Sedegebis drouli
Setyobineba;
T) epizootiuri da epidemiologiuri mdgomareobis sakiTxebSi mudmivi urTierT informacia veterinaruli zedamxedvelobis organoebTan momsaxureobis mTel teritoriaze;
i) regularuli (yovel kvartaluri) informireba samkurnalo profilaqtikuri qselis antirabiuli qirurgiuli samsaxurebisa cofis epizootiuri situaciisa da misi cvlilebebis
Sesaxeb vetsamsaxuris monacemebis safuZvelze.
qirurg-rabiologTa momzadeba:
2000 wlis 18 seqtembers saxelmwifo samedicino akademiis
zogadi qirurgiis kaTedrasTan Seiqmna qirurgiuli rabiologiis cikli. ciklis mizania: nakbeni Wrilobebis mkurnalobis warmarTva swori qirurgiuli taqtikiT da Cvenebisamebr kvalificiuri antirabiuli imunizacia; cofis gavrcelebis sawinaaRmdego farTo profilaqtika; hidrofobiiT daavadebulTa ricxvis Semcireba; qirurgiuli rabiologiis samsaxuris muSaobis
srulyofa.
qirurgiuli rabiologiis ciklis gavlis Semdeg msmeneli unda
flobdes:
• nakbeni Wrilobebis damuSavebis qirurgiul taqtikas;
• Cvenebisamebr antirabiuli imunizaciis Catarebas;
• qirurgiuli rabiologiuri samsaxuris muSaobisaTvis saWiro
dokumentaciis gamoyenebas;
• hidrofobiis profilaqtikisaTvis aucilebel Teoriul codnas
mosaxleobis sanitaruli ganaTlebis donis asamaRleblad.
68
nakbeni Wrilobebis anatomiuri mTlianobis
aRdgenis pr
inci pebi
princi
nakbeni Wrilobis gakerva 3 dRis ganmavlobaSi ar SeiZleba,
vinaidan nakerebis dadebisas iqmneba idealuri pirobebi nervul
daboloebebze cofis virusis mosaxvedrad (janmrTelobis dacvis
msoflio organizaciis monacemebis mixedviT), vinaidan es qmnis
virusis gavrcelebis safrTxes. nakbenis Wrilobis cxovelis
nerwyviT dabinZurebas masSi swrafi anTebiTi reaqcia mosdevs. 3
dRis (cofis virusis cxovelmyofelobis vada infeqciis Semaval keraze) Semdeg, sanaciis Sedegad Wrilobis baqteriuli
dabinZurebis saboloo likvidaciis Semdeg, ukve sufTa Wrilobaze, SeiZleba mivmarToT Cvenebisamebr misi anatomiuri mTlianobis
aRdgenas. gansakuTrebiT faqiz qirurgiul midgomas moiTxovs
nakbeni Wrilobebi saxis areSi, maTi kosmetikuri aRdgena zogjer
mikroqirurgiuli meTodebiTa da teqnikiT (lupa, mikroqirurgiuli instrumentebi, atravmuli nemsebi da Zafebi) tardeba.
rekomendaciebi
cofis sawinaaRmdego samkurnalo-profilaqtikuri imunizaciis efeqturad CatarebisaTvis gansakuTrebuli mniSvneloba eniWeba dazaralebuli piris mier Sromisa da dasvenebis mkacri
reJimis dacvas. mkurnalobis periodSi gadaRlas, fizikur datvirTvas, intensiur varjiSebs, SejibrebebSi monawileobas, daZabul
fizikur Sromas da a.S. ukuCveneba aqvs.
sastikad akrZalulia, agreTve, nebismieri saxis gamaRizianebeli faqtoriT intoqsikacia (alkoholuri sasmelebis, Zliermomqmedi wamlebis miReba da a.S.), gadaxureba, gaciveba. alkoholi
asustebs imunitetis gamomuSavebas. dazaralebulma unda daicvas Zilisa da dasvenebis normaluri reJimi. uzmoze acrebi ar
unda Catardes.
antirabiuli vaqcinaciis periodSi da misi damTavrebidan ori
Tvis ganmavlobaSi akrZalulia yvela profilaqtikuri acris
(tetanusis garda) Catareba.
nervuli sistemis daavadebis pirveli niSnebis (Tavis tkivili,
welis tkivili, temperatura, sisuste kidurebSi da a.S.) ga69
momJRavnebisTanave saWiroa vaqcinaciis droebiT Sewyveta da
dazaralebulis saswrafo hospitalizacia.
dazaralebulma unda ganagrZos Cveulebriv reJimSi cxovreba,
Seasrulos Tavisi yoveldRiuri movaleobani.
1999 wels jandacvis saministros samkurnalo daxmarebis
organizaciis departamentis monawileobiTa da mxardaWeriT antirabiuli
samedicino daxmarebis centrma Seadgina `antirabiuli qirurgiis
daxmarebis da acrebis baraTi~ #045-is Sesworebuli da gadamuSavebuli
pirveli qarTulenovani samedicino #045a saaRricxvo baraTi.
qvemoT warmodgenilia aRniSnuli baraTi, romelic danergilia
praqtikaSi:
saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saminsitro
antirabiuli samedicino
daxmarebis centri
samedidino dokumentacia
forma #045 a/s
damtkicebulia saqarTvelos
Sromis, janmrTelobisa da socialuri
dacvis ministris mier
dawesebulebis dasaxeleba _______________________
antirabiuli qirurgiuli daxmarebis da acrebis baraTi
‘______~ ‘______________~ #
momarTvis TariRi
1. gvari, saxeli, mamis saxeli ___________________________
________________________________________________________
2. asaki _______________________________________
3. binis misamarTi, telefoni ___________________________
________________________________________________________
4. saqmianoba (sabavSvo baRi, skola, umaRlesi saswavlebeli,
samuSao)
misamarTi, telefoni ________________________________
5. nakbeni Wrilobis (dakawvris, danerwyvis) miRebis TariRi
________________________________________________
6. romel samkurnalo dawesebulebas mimarTa kbenis gamo da
rodis
__________________________________________________________
7. dazianebis aRwera da misi lokalizacia ________________
70
8. qirurgis taqtika nakbeni Wrilobis damuSavebis dros
______________________________________________________________________________________________________________
9. cnobebi damkbeni cxovelis Sesaxeb. kbenis, dakawvris, danerwyvis
garemoeba _____________________________________
________________________________________________________
10. dakbenili cxovelis gacofeba dadasturebuli vetsamsaxuris
mier
a)klinikurad ___________________________________
b)laboratoriulad ______________________________
11. dazaralebulis anamnezi:
nervuli sistemis daavadeba __________________________
iRebs Tu ara spirtian sasmelebs, ra sixSiriT ____________
v) cnobebi adre Catarebul antirabiul acrebze ___________
g)aReniSneba Tu ara sxvadasxva saxis alergia
_____________________________________________________
d) informacia tetanusis sawinaaRmdego acrebis Sesaxeb
_____________________________________________
e) sxva cnobebi ________________________________
12. saWiroebisamebr eqim specialistis (Terapevti, nevropaTologi,
infeqcionisti) konsultacia _______________________
_______________________________________________________
_______________________________________________________
13. antirabiuli acrebis Cveneba (mZime an msubuqi kategoriis
dakbena, ucnobi an daavadebuli cxoveli da a.S.) __________
__________________________________________________________
__________________________________________________________
14. daniSnuli reJimi ________________________________
15. antirabiuli imunoglobulinis seria, titri, doza, Seyvanis
adgili, TariRi __________________________________
_______________________________________________________
16. kanSiga sinjze reaqcia (hi peremia, SeSupeba),
pirveli sinji (ganzavebuli 1:100 imunoglobulini 0,1 ml)
_______________________________________________________
17. kanqveSa sinjze reaqcia (hi peremia, SeSupeba), ______________
meore sinji (ganzavebuli 1:100 imunoglobulini 0,7 ml)
_______________________________
71
Cvenebisamebr ganmeorebiTi Seyvana ___________________
18. vaqcinaluri garTulebebi (nervuli sistemis dazianeba,
anafilaqsiuri Soki, zogadi-adgilobrivi reaqciebi) da
maT sawinaaRmdegod Catarebuli RonisZiebebi_________
______________________________________________________
19. acrebis kursi dasrulda, Sewyda (cxovelis monaxvisa da
vetmeTvalyureobis daskvnis safuZvelze) ______________
_______________________________________________________
20. dazaralebulma acrebi TviTneburad Sewyvita. ra RonisZiebebi
iqna miRebuli TviTneburad Sewyvetili antirabiuli acrebis
gasagrZeleblad ______________________________
____________________________________________________
21.
SeniSvna______________________________________
qirurg-rabiologis xelmowera ______________________
gavecani acrebis Catarebis da Sesabamisi reJimis dacvis wesebs,
viReb pasuxismgeblobas Cems sicocxleze, razedac xels vawer:
_________________
(0-15 wlamde _ meurve, Semdgom dazaralebuli) ______________
#
TariRi
vaqcinis
doza
vaqcinis
Seyvanis
adgili
vaqcinis seria,
kontroli,
vargisianoba
1
2
3
4
5
6
72
vaqcinaciis
Semsruleblis
xelmowera
dazaralebul
is
xelmowera
73
mozrdilebi
bavSvebi da mozardebi
miuxedavad vadisa
vada ukanaskneli
acridan
danarTi #1
0.5
ar SeyavT
ar SeyavT
ar SeyavT7
30008
ar SeyavT7
30008
30008
30008
30008
ar SeyavT7
30008
250
ar SeyavT7
250
ar SeyavT
ar SeyavT
ar SeyavT
ar SeyavT7
250
ar SeyavT7
250
250
250
ar SeyavT
gamoyenebuli preparati
aati 2
anatoqsini
atS 3
ml 1
arsebobs dokumenturi dadastureba wina acris Sesaxeb
bavSvebi da mozardebi
miuxedavad vadisa
ar SeyavT4
ar SeyavT
ar SeyavT
asakobrivi jgufi
ara umetes 5 wlisa
ar SeyavT
5 welze meti
0.5
ori acra6
yvela asaki
ara umetes 5 wlisa
0.5
5 welze meti
1.0
erTi acra
yvela asaki
ara umetes 2 wlisa
0.5
2 welze meti
1.0
aucreli
bavSvebi 5 Tvemde
_
ar SeyavT
danarCeni asaki
_
1.0
ar arsebobs dokumenturi dadastureba Catarebuli acrebis Sesaxeb
bavSvebi 5 Tvemde
_
ar SeyavT
acrebis anamnezi ar aris cnobili,
xolo anamnezSi ar iyo
bavSvebi 5 Tvidan,
_
0.5
winaaRmdegCveneba acrisadmi
mozardebi, samxedroebi
danarCeni kontingenti
yvela asaki
_
1.0
asakis Sesabamisi gegmiuri acrebis
sruli kursi
gegmiuri acrebis kursi asakobrivi
bolo revaqcinacii Sesaxeb
imunizaciis sruli kursi5
wina acrebis kursi (T-is nebismier
anatoqsinis Semcveli preparatiT
tetanusis saswrafo profilaqtika
1. tetanusis saswrafo profilaqtikisas SesaZloa dt vaqcinis
gamoyeneba;
2. unda gamoqveyndes erT-erTi dasaxelebuli preparati aati
(adamianis antitetanuri imunoglobulini) an atS (antitetanuri Srati), amasTan umjobesia aat-is Seyvana, Tu es preparati
ar aris, maSin saWiroa atS;
3. es exeba agreTve kalendris gareSe acril bavSvebs da mozardebs, magram revaqcinaciis miRebiT: travmasTan dakavSirebiT Semdgomi
gegmiuri an saswrafo revaqcinacia saWiroa gakeTdes arauxSiresad 1- jer 5 weliwadSi;
4. inficirebuli Wrilobisas Tu wina revaqcinaciidan gasulia
5 weli, SehyavT 0.5 ml antitetanuri anatoqsini;
5. mozrdilTaTvis antitetanuri anatoqsiniT imunizaciis sruli kursi Sedgeba ori acrisagan 0.5 ml TiToeuli 30-40 dRis
intervaliT da revaqcinacia 6-12 Tvis Semdeg imave doziT. Semoklebuli sqemisas sruli kursi Seicavs antitetanuri anatoqsiniT erTjerad vaqcinacias ormagi doziT (1 ml) da revaqcinacia 6-12 Tvis Semdeg 0.5 ml-iT;
6. ori acra imunizaciis Cveulebrivi sqemiT (mozrdilebisa da
bavSvebisaTvis) da erTi acra mozrdilebis imunizaciis Semoklebuli sqemisas;
7. dainficirebuli Wrilobisas SehyavT aati an atS;
yvela piri, romelTac miRebuli aqvT aqtiur-pasiuri profilaqtika, imunizaciis kursis dasamTavreblad da atS-is ganmeorebiT
Seyvanis aucileblobis gamosaricxad, 6-12 Tvis Semdeg unda
iqnan revaqcinirebulni 0.5 ml antitetanuri anatoqsiniT;
74
antirabiuli imuniteti
cofis virusis mimarT bunebrivi imuniteti aqvT kus, bayaysa
da sxva civsisxlian qvewarmaval cxovelebs (a. muratova da
sxv, 1934 Remlingen. Baily, 1929; Battaglino, 1932)
rac Seexeba Tbilsisxlian cxovelebs, es damokidebulia
saxeobebis Taviseburebebze, asakze, virusis SeWris adgilsa da
individualur virusmgrZnobelobaze. ase magaliTad, axalSobili
da mcire asakis cxovelebi naklebad rezistenturebi arian, vidre mozrdilebi: zazuna, kurdRelze ufro mgrZnobiarea. Tbilsisxliani cxovelebis kanis dauzianebeli safarveli SeuRwevadia cofis virusisaTvis. bunebriv bariers warmoadgens aseve
kuWi da nawlavebi TavianTi mJavianobiT da fermentebiT. yvela
es faqtori unda ganvixiloT rogorc araspecifikuri bunebrivi imunitetis gamovlineba. rogorc cnobilia, cofiani cxovelebis mier dakbenili cxovelebis 56,6% hidrofobiiT avaddeba (Veeraraghavan, 1972).
cofis WeSmariti imunologia – es xelovnurad SeZenili aqtiuri vaqcinaluri da pasiuri imunitetia imunoglobuliniT.
ansxvaveben cofis virusis SeRwevisa da gamravlebisagan organizmis dacvis 3 mimarTulebas: 1) dacvis bunebrivi faqtorebi –
dauzianebeli kanis safarvelebi; 2) antisxeulebi _ SesaZloa
leikocitebis mateba infeqciis Semaval WiSkarSi (infeqciis
winandeli imuniteti); 3) SesaZloa Seiqmnas winaaRmdegoba periferiuli nervebis gziT virusis gadaadgilebisas.
samkurnalo an postinfeqciuri imunizaciis dros SesaZloa
dacviTi roli iTamaSon rogorc antisxeulebma, aseve interferonma da ujreduli imunitetis faqtorebma.
infeqciis wyaros winaaRmdeg mimarTuli RonisZiebebis
kompleqsi
jer kidev pirogovis saxelobis me-11 yrilobaze (1910) v.
uSakovis winadadebiT erTsulovnad miiRes, rom cofiani cxovelebis mier dakbenilTa daxmarebas aqvs paliatiuri, samkurnalo da ara profilaqtikuri-prevenciuli xasiaTi.
75
antirabiul acrebs, miuxedavad maTi efeqturobisa, ar SeuZliaT iqonion gavlena infeqciis wyaroze, Seamciron dakbenilTa da
cofis virusiT inficirebulTa raodenoba. am saSiSroebis Sesamcireblad saWiroa cofTan brZola sanitaruli da epidsawinaaRmdego normebis mkacri dacviT.
jer kidev 1890 wels inglisSi cofTan dakavSirebiT gamoica
zogad saxelmwifoebrivi kanoni (Rabies order), romelSic asaxulia Sinauri cxovelebis Senaxvis iuridiuli safuZvlebi. amis
Semdeg cxovelebis mflobelebis pasuxismgebloba ZaRlebis Senaxvaze centraluri xelisuflebis kontrols daeqvemdebara. am
kanonis Tanaxmad, alikapis tareba aucilebeli gaxda yvela ZaRlisTvis (muzzling all dogs). aRniSnuli kanonis darRvevis gamo,
mflobelTaTvis dawesda fuladi jarimebi. dawesda karantini
importirebul ZaRlebsa da katebze, intensiurad iWerdnen mawanwala cxovelebs (Hill, 1971). aRniSnuli kanonis miRebis Semdeg,
1892 wlisaTvis, cofiT daavadeba sagrZnoblad (38 SemTxvevamde)
Semcirda rogorc adamianebSi, ise cxovelebSi. am kanons gamouCndnen
mowinaaRmdegeebi ZaRlebis `megobarTa~ rigebidan. kontroli
cxovelTa Senaxvis wesebze faqtiurad Sewyda, ramac gamoiwvia
infeqciis axali msxvili afeTqeba da ukve 1835 wels cxovelebSi cofis 727 (!) SemTxveva dafiqsirda. presis furclebze
gaimarTa xelCarTuli brZola, gamoikveTa azri, rom `adamianis
sicocxle ZaRlebis Tavisuflebaze maRla dgas~ (n. mari, 1909).
magaliTad, inglisSi mgeli, rogorc biologiuri saxeoba, gaanadgures (bolo mgels qalaq karmentenSi Zegli daudges).
sainteresoa ramdenime qveyanaSi XX saukunis 60-iani wlebis
monacemebi ZaRlebisa da katebis raodenobaze: aSS 34 mln ZaRli
da amdenive kata, did britaneTSi 6 mln ZaRli da 4 mln kata,
safrangeTSi ki 7 mln ZaRli da 5 mln kata.
mniSvnelovani problemaa ZaRlebis an katebis TavdasxmiT miyenebuli fizikuri da fsiqologiuri travmebi. magaliTad 1965w.
aSS 2 500 000-ma adamianma miiRo sxvadasxva travma cxovelebisagan maT Soris 200.000-ze meti saWiroebda samedicino daxmarebas da 40.000-s Cautarda antirabiuli mkurnaloba (Cohen,
1973).
me-20 saukunis gariJraJze, evropaSi ZaRlebis cofis epizootiis
dros, am ambiT Sewuxebulma da aRSfoTebulma ungrelma rabi76
ologma Högyes (1900) gamoxata Tavisi mkveTri damokidebuleba:
`cofis likvidaciis yvelaze saimedo saSualeba dedamiwis zurgze
arsebuli yvela ZaRlis ganadgurebaa.~ ra Tqma unda, aRniSnuli
mosazrebis praqtikulad ganxorcieleba SeuZlebeli da dauSvebelia.
ZaRli xom adamianis mier moSinaurebuli da misive sasikeTod
motivirebuli erTguli dasayrdeni da saimedo megobaria. adamianma ZaRlebis saerTo winaprisagan, mglisagan, kacobriobis istoriis manZilze 400-ze meti saxeobis ZaRlis jiSi gamoiyvana,
romlebic did daxmarebas uweven xalxs yoveldRiur cxovrebaSi. ZaRli, rogorc monadire, daraji, gzis gamkvalavi, sanitari,
mzveravi, mebaJe, saxelmwifo sazRvrebis damcveli, samecniero
eqsperimentebisa da Semdgomi miRebuli Sedegebis adamianze warmatebiT danergvis safuZveli, uamravi adamianis gadamrCeni omebSi, eqstremaluri situaciebis dros da a.S. istoriulad cnobilia, rom rogorc evropaSi, ise sxva kontinentebze cofis
epizotiisas aRiniSneboda ZaRlebis ricxovnobis mateba. rogorc
wesi, ZaRlebis ricxvi ganisazRvreba mosaxleobasTan mimarTebiT
im qveynebSi, sadac ZaRlebis didi raodenobaa (magaliTad, bulgareTSi, saberZneTSi 1 ZaRli modis 5-6 adamianze da ara 50-60ze), cofis gavrcelebis saSiSroeba metia.
iaponelebma daadgines, rom ZaRlebis raodenobasTan erTad cofis
ganviTareba damokidebulia dauregistrirebel, mouvlel da mawanwala ZaRlebze (82,2% - Shimada, 1971).
ZaRlebsa da katebze damokidebulia ara mxolod cofis, aramed
adamianisa da cxovelebis sxva daavadebebi: toqsoplazmozi, salmonelozi, eqinokokozi, leiSmaniozi da sxva.
am sakiTxis pirveli iuridiuli safuZveli ganixileboda jer
kidev 23 saukunis win Cv. welTaRricxvamde Zveli babilonis
eSnunis kanonebSi. am garemoebam asaxva hpova XIX saukunis dasawyisSi evropis bevr qveyanaSi gamocemul ZaRlebis ricxobrivi Semcirebisa da maTi Senaxvis reJimis ganmsazRvrel kanonebSi.
cofTan brZolis saerTaSoriso mniSvnelobis saxelmwifo kanonebSi asaxuli moTxovnebis ganxorcielebis pirobebSi daavadebis
raodenoba mkveTrad Semcirdeba. aRniSnuli moTxovnebia: a) ZaRlebis
izolirebuli Senaxva sacxovrebeli binebis oTaxebSi, dawesebulebebSi mokle sabmeliT, alikapiT, sazogadoebrivi TavSeyris
77
adgilebSi maTi gamoyvanis akrZalva, rom maT ver SeZlon xalxis
dakbena;
b) sayovelTao registracia da ZaRlebis Senaxvaze xelisuflebisgan oficialuri nebarTvis gacema.
alikaps, Cveni azriT, udidesi mniSvneloba eniWeba cofis ganviTarebisa da, saerTod, nakbeni Wrilobebis prevenciisaTvis. unda
Seicvalos alikapisadmi, rogorc ZaRlebis diskriminaciuli saSualebisadmi, damokidebuleba: adamianebis usafrTxoeba ZaRlebis
`Tavisuflebaze~ maRla unda davayenoT. piriqiT, alikapi diskriminaciuli ki ara, humanuri saSualebaa. alikapiani ZaRli
Tavisuflad svams da ikvebeba, mxolod kbena ar SeuZlia. kanonis
damrRvev mflobelTaTvis dawesebuli jarima da sayovelTao
baJi ZaRlebis mflobelobaze aamaRlebs maT patronTa pasuxismgeblobas TanamoqalaqeTa usafrTxoebaze, ra Tqma unda, Sesabamis saxelisuflebo organoebTan erTad.
adamians unda hqondes dasaxlebul punqtebSi Tavisuflad gadaadgilebis ufleba, raTa uvnebeli mivides daniSnul adgilze.
patroniani cxovelebis mier dakbenili udanaSaulo adamianebis
mkurnaloba unda anazRaurdes `damnaSave~ cxovelebis mflobelebis mier. pirad angariSsworebas ar unda hqondes adgili.
cofis profilaqtikis samedicino da veterinaluri propagandis upirvelesi mizania mosaxleobis mzrunveli, keTili damokidebuleba `adamianebis megobrebis~, ZaRlebis da katebis mimarT,
winaaRmdeg SeTxvevaSi ki, (rac gamoixateba maT quCaSi gayrasa da
likvidaciaSi) unda dadges uxeS, daundobel mflobelTa piradi
pasuxismgeblobis sakiTxi.
mawanwala, quCaSi gayrili, sazogadoebaze gaborotebuli cxoveli, Cveni azriT, mosaxleobis usulgulobis, sanitaruli kulturis uaryofiTi maCvenebelia, ris gamoc didi mniSvneloba
eniWeba ZaRlmWeri brigadebis muSaobas. XIX saukunis peterburgSi mawanwala ZaRlebis daWeraze piradi pasuxismgebloba
general-policmaisters ekisreboda. Semdgom es misia daekisra
saxanZro samsaxurs. ZaRlebs klavdnen joxebiT, sawamlaviT da
a.S., rac arahumanuri iyo. ase grZeldeba dResac. yofil socialistur sabWoTa kavSirSi mawanwala ZaRlebis daWera evalebodaT adgilobrivi mmarTvelobis organoebis komunalur samsaxurebs. imis gamo, rom komunaluri samsaxurebi srulad ver
78
uzrunvelyofdnen am misias, TbilisSi, taSkentsa da sxva qalaqebSi
veterinarulma samsaxurma Tavis Tavze nebayoflobiT aiRo es
funqcia. am mizniT aRniSnul qalaqebSi daarsda `ZaRlsaWeri
ezoebi~, romlebic veterinarul samsaxurs daeqvemdebarnen, rogorc
metad dainteresebul uwyebas.
50-iani wlebis bolos pirvelad ukrainasa da saqarTveloSi,
Semdgom ki sxva respublikebSic, organizebuli iyo sanitarul-veterinaruli sadgurebi cofTan brZolis ganyofilebebiT, romlebic Tavs arTmevdnen infeqciis wyaros winaaRmdeg brZolis
kompleqsis iseT mniSvnelovan elements, rogoricaa mawanwala
ZaRlebis daWera.
yofili sabWoTa kavSiris soflis meurneobis saministros
veterinariis mTavarma sammarTvelom moixsna pasuxismgebloba am
epizootiis sawinaaRmdego RonisZiebaze, gadasca es funqciebi
isev komunalur samsaxurebs, romlebic, samwuxarod, arasakmarisad
muSaobdnen. am mxriv muSaoba didad arc dRevandel saqarTveloSi Secvlila.
ra Tqma unda, veterinaruli samsaxuri Sesabamis uwyebebTan
erTad unda iRebdes aqtiur monawileobas infeqciis ZiriTadi
wyaros, mawanwala ZaRlebis, winaaRmdeg mimarTuli brZolis koordinaciaSi, rac udavod waadgeba Cveni qveynis mosaxleobas cofis
problemis moxsnaSi.
ucxoeTSi cofis epizootiis winaaRmdeg mimarTul RonisZiebebze veterinaruli samsaxuria pasuxismgebeli. ase magaliTad,
aSS-Si mawanwala ZaRlebis daWera xorcieldeba kvalificirebuli eqimebiT dakompleqtebuli brigadebiT, romlebic uzrunvelyofili arian teqnikuri personaliTa da Tanamedrove danadgarebiT. isini aRWurvilni arian cofis diagnostikis, mkurnalobisa da profilaqtikuri RonisZiebebis Catarebis specialuri veterinaruli kabinetebiT.
ZaRlmWerebs aqvT spectansacmeli, kbena gaumtari xelTaTmanebi, sanomre Jetonebi, agreTve, specialuri avtotransporti. kargad aris mowyobili cofze saeWvo cxovelebis karantinisa da
dacemul cxovelTa utilizaciis saqme. aRniSnul cxovelTa
saxlebis momsaxureba fasiania, magram isini iReben damatebiT
subsidiebs dainteresebuli organizaciebisagan, kerZod qalaqis
79
munici palitetisagan da a.S.. aSS-Si ZaRlmWerebi policiis TanxlebiT muSaoben.
cxovelebis saerTaSoriso gadayvanebi
janmos komitetis eqspertebis rekomendaciebis Tanaxmad, arsebobs umkacresi da mkacri moTxovnebi cxovelebis erTi qveynidan meoreSi gadasayvanad. es moTxovnebia: karantini 4 Tvis
ganmavlobaSi, Semdgom 2-Tviani damatebiTi SezRudva (izolirebuli Senaxva). karantingavlili ZaRlebisa da katebis aucilebeli imunizacia inaqtivizirebuli antirabiuli vaqcinebiT.
Tu umkacresi moTxovnebis Sesruleba ver xerxdeba, unda gatardes aucilebeli zomebi, kerZod: ZaRlebisa da katebis vaqcinireba unda moxdes maT gadayvanamde ara ugvianes 30 dRisa da
1 wlamde drois monakveTSi;
- aucilebelia TiToeul cxovelze gaices oficialuri veterinaruli organoebis mier xelmowerili sertifikati. arasrulyofili imunizaciis Catarebaze eWvis arsebobis SemTxvevaSi
cxoveli aravaqcinirebulad unda CaiTvalos;
- aravaqcinirebuli cxovelebi daniSnulebis adgilze CayvanisTanave unda iyvnen imunizirebulni da maT CautardeT 30 dRiani karantini damatebiTi SezRudvebiT Semdegi 60 dRis ganmavlobaSi. cofis mxriv arakeTilsaimedod iTvleba qveyana, sadac
ganvlili 2 wlis ganmavlobaSi adamianis an cxovelis daavadebis 1 SemTxvevac ki iqneba dafiqsirebuli.
veterinaruli samsaxuris organoebi, sxva dainteresebul uwyebebTan TanamSromlobis pirobebSi, cofiT daavadebis keraSi
amzadeben cofis keris likvidaciis gegmas. am ukanasknelSi Sedis:
karantinis dauyovnebeli gamocxadeba, kompleqsuri Semovlebi
cxovelebis mier dazaralebul pirTa gamovlenis da maTi rabiologTan gagzavnis mizniT; cofian cxovelTan kontaqtSi myofi
yvela ZaRlisa da katis gamovlena da ganadgureba, an 10-dRiani
karantinis daweseba adamianis damkben cxovelebze, dacemul cxovelTa leSis laboratoriul-diagnostikuri gamokvlevebis
Casatareblad gagzavna, vaqcinacia da revaqcinacia yvela cocxlad darCenili ZaRlisa da katisa. infeqciis keris dezinfeqcia;
80
ZaRlebisa da katebis gamofenebisa da gadayvanis akrZalva;
intensiuri sanitaruli propaganda; gaZlierebuli veterinaruli dakvirveba; zemdgomi organoebisa da mezobeli regionebis
informireba.
sasoflo-sameurneo daavadebaze saeWvo cxovelebis mimarT vrceldeba samecniero-praqtikuli rekomendaciebi: Zroxebi, cxvrebi da sxva rqosani pirutyvi, romlebsac daavadebis klinikuri
niSnebi ar aReniSnebodaT, SeiZleba daiklas da maTi xorci
(Tavis da dakbenis adgilis midamos garda) ki sakvebad vargisia
dakbenis momentidan pirveli 8 dRis ganmavlobaSi.
dakbenis momentidan me-8 dRes karantinis dasrulebamde xorcis sakvebad gamoyeneba saxifaToa, vinaidan SeiZleba daavadebuli cxovelis organizmSi cofis virusi gamravldes.
cofis laboratoriuli diagnostika, misi mniSvneloba
antirabiuli daxmarebis taqtikis gansazRvrisaTvis
cofis laboratoriul diagnostikas Tanamedrove organizaciuli RonisZiebebis gamoyenebiT udidesi mniSvneloba eniWeba
rogorc infeqciis wyaros winaaRmdeg brZolaSi, aseve dazaralebuli adamianisaTvis antirabiuli acrebis swori daniSnulebisa
da CatarebisaTvis.
cofis pirvelive SemTxvevis dauyovnebelma laboratoriulma
dadasturebam hidrofobiis SemTxvevebze, obieqturma informaciam, infeqciis geografiuli gavrcelebis codnam unda Seqmnas
safuZveli daavadebis epizootiis efeqturi meTvalyureobisa
da brZolisa. Cveulebrivi sinaTlis mikroskopis Tanamedrove
teqnikuri SesaZleblobebi saSualebas iZleva cofiT dacemuli
cxovelis Tavis tvinSi dafiqsirdes babeS-negris sxeulakebi da
2-4 saaTSi dadasturdes cofis diagnozi.
cofis eqspres-diagnostikaSi Zalze mniSvnelovania antisxeulebis meTodika (mfa).
medicinis mecnierebaTa akademiis moskovis poliomielitisa
da virusuli infeqciebis institutSi arsebuli janmos centris mier yofil sabWoTa kavSirSi 100 veterinarul laboratoriaSi farTod dainerga mfa. mfas specifikuroba praqtikiT
damtkicebulia. mfa imdenad sarwmuno da saimedoa, rom ucxoeT81
Si mis Sedegebze dayrdnobiT dgindeba an gamoiricxeba cofis
saboloo diagnozi. misi monacemebis Tanaxmad wydeba sakiTxi
dazaralebul adamianze acrebis Catarebis Sesaxeb, umTavresi
pirobis (samedicino personalis gamocdilebisa da maTi maRali
kvalifikaciis) dacviT.
farTod gamoiyeneba axalgazrda Tagvebis dasnebovnebis meTodika (biocda). axalSobil cxovelebze dayenebuli biocda 6-7
dReSi adgens cofis diagnozs.
B@
vet-laboratoriis saqmianoba
qveynis masStabiT cofis daavadebis sadiagnostiko saqmianoba
dakisrebuli aqvs soflis meurneobis saministros laboratorias, (direqtori T. onaSvili), romelic mravalprofiliani
organizaciaa. igi daarsebulia 1907 wels, mis SeqmnaSi monawileoba miiRo pasteris Tanamedrovema da megobarma, eqimma i.
finkelSteinma. laboratoriis srulyofili da maRalkvalificiuri saqmianoba gasuli saukunis 60-iani wlebidan iwyeba. am
periodSi didi yuradReba daeTmo cofis daavadebis diagnostikis, profilaqtikisa da salikvidacio RonisZiebebis gegmiurad gatarebis sakiTxebs.
1965 wlidan virusologiur ganyofilebas, sadac cofis diagnostika tardeboda, xelmZRvanelobda veterinariis mecnierebaTa
kandidati m. gulievi, romelmac didi wvlili Seitana diagnostikis axali meTodebis danergvaSi, masve ekuTvnis sadiagnostikos fluorescirebuli antirabiuli Sratis momzadebis teqnologiis SemuSavebac. masTan erTad am periodidan moyolebuli diagnostikaze muSaobdnen: s. grigalaSvili, m. lebaniZe, n.
ToxaZe, c. nersesova, d. bogoredeckaia, n. xaiauri, l. farcvania, l.
diRmelaSvili, l. kvitaiSvili, l. sumbaTaSvili, n. ZaZamia, x.
abesalaSvili, e. CoCia, q. goginaSvili. aseve aw gardacvlili
specialistebi: l. CxaiZe, e. xuxunaSvili da z. WanuyvaZe.
amJamad cofis diagnostikas uZRvebian maRalkvalificiuri da
gamocdili specialistebi: n. ToxaZe da n. xaiauri.
unda aRiniSnos, rom 1972 wels mTavrobis specialuri dadgenilebiT Seiqmna gansakuTrebiT saSiSi gadamdebi daavadebebis
laboratoria, romlis virusologiur ganyofilebas xelmZRv82
anelobda axalgazrda specialisti c. maCitiZe. masTan erTad
wlebis manZilze muSaobdnen: n. ToxaZe, n. kobaxiZe, e. CoCia, m.
malania, c. aspaniZe, n. jamelaSvili, T. beritaSvili, z. murvaniZe, n.
tabucaZe, i. mamaTelaSvili, m. gorgasliZe da sxvebi.
80-ian wlebSi c. maCitiZem SeimuSava cofze sadiagnostiko
paT. masalis nacxebis fiqsaciis swrafi meTodi, romelic dainerga maSindeli sabWoeTis respublikebSi da aRmosavleT evropis qveynebSi, aseve SemuSavda da mecnierulad dasabuTda bunebaSi gareul cxovelTa imunizaciis sakiTxi, swored isini warmoadgenen daavadebis gavrcelebis ZiriTad rezervuars. aRniSnulis danergvam qveyanaSi 1997 wlidan garkveulwilad Seamcira
daavadebis gamomwvevi virusis gadacemis albaToba, rac daavadebis saxeobriv dinamikaSi mkafiod Cans.
aseve 80-ian wlebSi c. maCitiZis xelmZRvanelobiT Catarda
samecniero-kvleviTi samuSaoebi farTo sawarmoo cdaze myofi
kulturaluri antirabiuli vaqcinisa, romelic damzadda ssrkis medicinis mecnierebaTa akademiis poliomielitisa da virusuli encefalitebis samecniero kvleviT institutSi akademikos m. selimovis mier Seqmnil `vnukovo – 32~ Stamze.
vaqcinis xarisxis maRalma maCveneblebma da savaqcine Stamis
Rrma atenuaciam gansazRvra SemdgomSi adamianebze gamocda da
danergva am vaqcinisa, romelic amJamad mraval qveyanaSi gamoiyeneba.
mizanSewonilad migvaCnia aqve warmovadginoT 2000-2007 wlebSi
saqarTveloSi cofis daavadebaze kvlevis masalebi da dinamika.
#
wlebi
1
2
3
4
5
6
7
8
2000
2001
2002
2003
2004
2005
2006
2007
dadebiTi
m/S mawanw.
sul
cxovelebi
64
7
115
14
92
11
93
15
102
15
101
8
98
9
82
11
gamokvleuli
masalebis
raodenoba
146
230
287
289
341
352
362
343
83
hidrofobiis
SemTxvevebi
7
10
10
10
12
10
5
4
84
dadebiTi fluorescencia ZaRlis
tvinis masalaSi /quCis virusi/
gadidebuli 900 – jer
a – wvrili naTeba, Zroxis
tvinis nervul qsovilebSi
b – ZaRlis neironis naTeba
g – meliis hipokamis naTeba
85
d – katis amonis rqis masala
e – Zroxis neironis naTeba
v – CVS Stampi – TeTri
Tagvis masalaSi. /vaqcinisa da
samecniero cdebis
sakontrolo Stami/
a – quCis virusi. ZaRlis tvini,
babeS-negris mravlobiTi
ti puri sxeulakebi
citoplazmaSi da neironebSi.
manis meTodiT SeRebva + 1550.
86
b – fiqsirebuli virusi
qsovilovan kulturaSi.
sxvadasxva formisa da sididis
citoplazmuri CanarTebi.
binis meTodiT SeRebva +1550.
g – quCis virusi, Zroxis tvini
CanarTi citoplazmaSi. selersis
meTodiT SeRebva +1550.
d – katis tvini. araspecifikuri
CanarTebi citoplazmaSi. manis
meTodiT SeRebva +1550.
87
e – maimunis tvini, specifiuri
CanarTebi, nervul kvanZebSi.
hematoqsilin-eoziniT SeRebva
+600
v. - fiqsirebuli virusi
qsovilovan kulturaSi.
imunoperoqsidazis reaqciis
daxmarebiT. +1550
88
daskvna
cofi letaluri daavadebaa, mwvave zoonozuri bunebrivkerovani bunebisa, igi did safrTxes qmnis da janmrTelobis msoflio organizaciis (janmos) monacemebiT, miyenebuli ekonomikuri
zaralis mxriv, infeqciur daavadebaTa Soris me-5 adgils ikavebs.
cofiT daavadeba msoflios umravles (167) qveyanaSi gvxvdeba.
yovelwliurad 10 mln adamiani iRebs sxvadasxva dazianebas
cxovelebisagan, xolo 4 mln adamianze meti ki _ specifikur
antirabiul daxmarebas. cofi dRemde ganukurnebel senad rCeba,
misgan yovelwliurad 50 aTasze meti adamiani iRupeba.
ganviTarebad qveynebSi epizootio-epidemiologiuri viTareba
imdenad mZimea, rom cofTan brZolis gaZliereba gadaudebeli da
aucilebeli gaxda rogorc adamianebSi, aseve cxovelebSi.
Tanamedrove etapze msoflioSi rabiuli infeqciis globaluri zrda aRiniSneba, ris gamoc Sesabamisad matulobs cofTan
dakavSirebuli problemebis aqtualobac.
did socialur mniSvnelobasTan erTad cofs seriozuli
ekonomikuri problemebi axasiaTebs. didia cofisagan miyenebuli
ekonomiuri zarali dacemuli sasoflo-sameurneo cxovelebisagan, radgan maTgan ver xdeba esoden saWiro produqciis miReba.
aseve didia daxarjuli Tanxebi, rogorc upatrono, moxetiale
cxovelebis, ise gareuli cxovelebis raodenobis regulaciis
mizniT, mimarTuli adamianis infeqciis wyaros winaaRmdeg.
milionebi ixarjeba rogorc gareuli da Sinauri cxovelebis, ise adaminebis vaqcinaciaze; adamianis importuli antirabiuli imunoglobulinis SeZenaze mZime kategoriis dakbenebisas.
aranaklebi Tanxa ixarjeba cofis kerebis likvidaciis mizniT.
kompleqsuri profilaqtikuri RonisZiebebi, romlebic adre
yofil sabWoTaA kavSirSi tardeboda, uzrunvelyofdnen ra epizooturi mdgomareobis stabilizacias, TandaTanobiT amcirebdnen hidrofobiisagan miRebul danakargebs.
amJamad postsabWour sivrceSi moxvedril damoukideblobis
mqone qveynebSi socialuri problemis gamwvavebis fonze da centralizebuli finansebis Sewyvetis pirobebSi, organizaciulsameurneo xasiaTis profilaqtikuri RonisZiebebis mxriv, mdgomareoba sagrZnoblad gauaresda, rac Sedegze aisaxa.
89
Cvens qveyanaSi muSaobs antirabiuli samedicino daxmarebis
programa (jandacvis saministro, sadazRvevo fondi).
mosaxleobis vaqcinoprofilaqtika saxelmwifos nacionalur
politikas warmoadgens da erT-erT umniSvnelovanes adgils
ikavebs bioterorizmisa da biokatastrofebis prevenciis saqmeSi.
vaqcinebis mecnieruli SemuSaveba, warmoeba da gamoyeneba qveynis nacionaluri usafrTxoebis interesTa sferos warmoadgens.
125 weli gavida pasteris mier aRmoCenili antirabiuli vaqcinaciis Seqmnidan, romlis istoria savsea romantikiT, samecniero gmirobiTa da vaJkacobiT. pasteris Semdgomi periodi xasiaTdeba cofTan brZolis mniSvnelovani progresiT yvela mimarTulebiT.
Tanamedrove miRwevebi cofiT daavadebis Seswavlisa da
profilaqtikis saqmeSi unda ganixilebodes rogorc Sedegi im
didi Sromisa, romelsac msoflios gamoCenili mecnierebi eweodnen
parizis pasteris institutis TaosnobiT. pasteris saqmis bolo
periodis gamgrZeleblebma – Lepin, Atanasio da maTma TanamSromlebma didi wvlili Seitanes virusis morfologiisa da struqturis, babeS-negris sxeulakebis bunebis SeswavlaSi, hidrofobiis specifikuri profilaqtikisa da laboratoriuli diagnostikis ganviTarebaSi.
molekuluaruli rabiologiis, epizootologiis, specifikuri
profilaqtikisa da cofis gamomwvev wyarosTan brZolis saqmeSi
mniSvnelovani roli eniWebaT amerikel mecnierebs, gansakuTrebiT, karl heibls - janmrTelobis institutidan, aseve vistaris
institutidan (aSS) x. koprovskis da t. viqtoris jgufebs.
gamokvlevebis koordinaciisa da ganviTarebis saqmeSi, romelic
tardeba msoflios sxvadasxva qveynebSi, Seufasebeli roli iTamaSa janmrTelobis msoflio organizaciis konsultaciurma komitetma m. kaplanisa da m. abdusalamis xelmZRvanelobiT. es
araCveulebrivi estafeta Taobidan Taobas tradiciulad gadaecema.
90
Tavi II
cofis gavrcelebis, misi prevenciisa da
nakben WrilobaTa qirurgiuli mkurnalobis
statistika saqarTveloSi (1991-2005 w.w.)
klinikuri masala, ilustraciebi
am TavSi warmodgenilia cofsa da mis prevenciasTan, aseve
nakben WrilobebTan dakavSirebuli yvela statistikuri monacemi cxrilebis, grafikebis, diagramebis saxiT, romelTa SedarebiTi
analizi naTlad warmoaCens 1991-2005 wlebSi daavadebasTan
dakavSirebul mraval problemas da maTi gadawyvetis saSualebebs hidrofobiis prevenciis, WrilobaTa damuSavebisa da qirurgiuli mkurnalobis kuTxiT.
warmodgenilia klinikuri masala feradi ilustraciebiT dinamikaSi.
91
92
582
599
550
660
1994
1995
1996
639
1992
1993
624
1991
weli
621
514
571
550
620
606
momarTvis
ZaRlis
SemTxvevaTa
nakbeni
raodenoba
2
1
24 (20maimunis, 2
cxenis, 1 lomis, 1 kurdRlis)
7 (7-maimunis)
5
18 (15 maimunis,
3 krdRlis)
6
11 (10 maimunis,
1-meliis)
7
11
7 (6 maimunis, 1
tyis Roris)
24 (23-maimunis,
1-kurdRlis)
katis
nakbeni
gareuli da
sxva
cxovelebis
nakbeni
12
88
30 (28
virTagvis, 2
zazunis)
10
8
4
1
cofiani
cxovelebis
mier
travmirebulTa
raodenoba
11(virTagva)
5 (virTagva)
1 (zazunis)
2 (zazunis)
-
mRrRnelebis
nakbeni
0-antirabiul
centrSi, 9qveyanSi
96-qveynis sxva
regioni, 9Tbilisi
131-qveynis sxva 0-antirabiul
regioni, 27centrSi, 21 –
Tbilisi
qveyanaSi
585 (Tbilisi –
520, qveynis
sxva regioni 65)
gagrZeleba Semdeg gverdze
63-qveynis sxva
regioni, 5Tbilisi
0-antirabiul
centrSi, 9qveyanaSi
0-antirabiul
centrSi, 4qveyanaSi
0-antirabiul
centrSi, 8qveyanSi
18-qveynis sxva
regioni, 5Tbilisi
19-qveynis sxva
regioni, 4Tbilisi
0-antirabiul
centrSi, 1qveyanaSi
hidrofobiiT
garadvclil
adamianTa
raodenoba
19-qveynis sxva
regioni, 1Tbilisi
cxovelebSi
cofi
302 (Tbilisi –
272, qveynis
sxva regioni 30)
228 (Tbilisi –
201, qveynis
sxva regioni 27)
219 (Tbilisi 180, qveynis
sxva regioni 39)
327 (Tbilisi –
307, qveynis
sxva regioni 20)
400 (Tbilisi
– 371, qveynis
sxva regioni 29)
antirabiuli
mkurnaloba
saqarTvelos antirabiuli samedicino daxmarebis centri
(moqmedi Tbilisis mravalprofiluri #2 bavSvTa klinikuri saavadmyofos bazaze - 1991-2000 w.w.)
93
7735
sul
1029
1999
1137
905
1998
2000
1010
1997
7124
1014
876
825
936
11 (3 mglis, 2
maimunis, 1ponis, 2-cxenis,
2-Zroxis, 1Txis)
19 (11-maimunis,
3-meliis, 1lomis, 1daTvis, 1mglis)
14 (9-maimunis,
1-daTvis,
cxenis-2,
Roris-1, 1ciyvis, 1mglis)
23 (13 maimunis,
3-mglis, 4Roris, 3cxenis)
154 (maimunis116, lomis-1,
mglis-8,
daTvis-2,
Roris-6,
kurdRlis-4,
cxenis-8,
ciyvis-1,
meliis-4,
ponis-2,
Zroxis-2, Txis1
145
49
22
20
22
309
279-virTagva,
24-zazuna,
2-zRarbi
38
72 (65
virTagva, 7zazuna)
18
56
44 (42virTagvas, 2zazunis)
51 (6 zazuna,
45-virTagva)
74
41 (36
virTagvis, 3zazunis, 2zRarbis)
qveynis sxva
regioni – 680,
Tbilisi – 75.
4769 (Tbilisi
– 4319, qveynis
sxva regioni 451)
54-qveynis sxva
regioni, 1Tbilisi
615 (Tbilisi –
596, qveynis
sxva regioni 19)
65-qveynis sxva
regioni, 4Tbilisi
71-qveynis sxva
regioni, 0Tbilisi)
681 (Tbilisi 578, qveynis
sxva regioni 103)
687 (Tbilisi 641, qveynis
sxva regioni 46)
144-qveynis
sxva regioni,
20-Tbilisi
725 (Tbilisi –
65, qveynis sxva
regioni - 73)
0-antirabiul
centrSi, 88 –
qveyanaSi.
0-antirabiul
centrSi, 7
qveyanaSi
0-antirabiul
centrSi, 13qveyanaSi.
0-antirabiul
centrSi, 4qveyanaSi.
0-antirabiul
centrSi, 12
qveyanaSi.
hidrofobia 2004-2005 wlebSi mxareebis mixedviT
2004w.
2005 w.
regionebi,
raioni
SemTxveva
Tbilisi
2
0,19
2
0,17
0
kaxeTi
1
0,25
1
0,25
0
siRnaRi
0
0
1
dedofliswaro
1
3,3
0
-1
-1
qvemo qarTli
5
1,0
1
0,2
-4
rusTavi
gardabani
marneuli
mcxeTa-mTianeTi
0
2
3
1
0
1,8
2,6
0,8
1
0
0
0
0
0
0
mcxeTa
zemo qarTli
1
1
1,6
*
0
1
*
-1
samegrelo
2
0,50
4
0,99
+2
zugdidi
1
0,6
2
+1
walenjixa
0
0
1
+1
martvili
abaSa
guria
0
1
0
3,5
+1
-1
0
0
1
0
1
0
0
0,28
10
ozurgeTi
sul
12
incidentoba SemTxveva incidentoba
94
mateba,
kleba
+1
+1
-2
-3
-1
-1
0,7
+1
0,23
+1
-2
1
antirabiuli daxmarebis dinamika 2004-2005 wlebSi
mimarTvaTa raodenoba samedicino dawesebulebebSi mxareebis
mixedviT
regioni
aWara
Tbilisi
kaxeTi
imereTi
samegrelo
Sida qarTli
qvemo qarTli
guria
samcxe-javaxeTi
mcxeTa-mTianeTi
raWa-leCxumi
q. foTi
z. svaneTi
sul
SemTxvevaTa raodenoba
2004
2005
2713
2939
8841
10626
2472
3945
5821
6624
2568
3262
4423
4895
2890
3333
757
1168
1293
1094
1259
1092
231
291
520
507
2
23
33892
39799
incidentoba
2004
2005
728,7
789,4
825,4
992,0
613,2
978,7
840,0
955,8
637,9
810,2
1422.6
1574,5
586,6
676,5
532,7
822
628,6
531,8
1014,5
879,9
456,5
575,1
1115,9
1088
14,2
163,1
782,9
919,4
mateba/kleba
%
+8,3
+20,2
+59,6
+13,8
+27,0
+10,7
+15,3
+54,3
-15,4
-13,3
+25,9
-2,5
+1050
+17,4
posteqspoziciuri mkurnalobis pirobiTi kursi mxareebis
mixedviT
regioni
aWara
Tbilisi
kaxeTi
imereTi
samegrelo
Sida qarTli
qvemo qarTli
guria
samcxe-javaxeTi
mcxeTa-mTianeTi
raWa-leCxumi
q. foTi
z. svaneTi
sul
SemTxvevaTa raodenoba
2004
2005
1783
2164
3401
5699
1276
1963
3104
3691
643
1190
2487
3885
1934
2320
298
603
691
675
649
649
110
128
138
139
0
0
16568
23106
95
incidentoba
2004
2005
478,9
581,3
317,5
532,0
316,5
487
447,9
532,6
159,7
295,6
799,9
1249,6
392,6
470,9
209,7
424,3
335,9
328,1
523
523
217,4
253
296
298,3
0,0
0
382,7
533,4
mateba/kleba
%
+21,4
+67,6
+53,8
+18,9
+85,1
+56,2
+20,0
+102,3
-2,3
0
+16,4
+0,72
0
+39,5
posteqspoziciuri mkurnalobis sruli kursi mxareebis mixedviT
regioni
aWara
Tbilisi
kaxeTi
imereTi
samegrelo
Sida qarTli
qvemo qarTli
guria
samcxe-javaxeTi
mcxeTa-mTianeTi
raWa-leCxumi
q. foTi
z. svaneTi
sul
SemTxvevaTa raodenoba
2004
2005
810
696
1891
2393
433
771
970
956
725
516
855
490
470
462
275
492
110
85
345
126
38
43
220
116
0
2
7144
7148
incidentoba
2004
2005
217.6
186,9
176,5
223,4
107,4
191,3
140.0
138
180.1
128,2
275,0
157,6
95.4
93.8
193,5
346,2
53,5
41,3
278,0
101,5
75,1
85
472,1
248,9
0.0
14,2
165,0
165,1
mateba/kleba
%
-14,1
+26,5
+78
-1,4
-28,8
-42,7
-1,7
+78,9
-22,7
-63,5
+13,2
-47,3
+
+0,06
sul posteqspoziciuri mkurnaloba mxareebis mixedviT
regioni
aWara
Tbilisi
kaxeTi
imereTi
samegrelo
Sida qarTli
qvemo qarTli
guria
samcxe-javaxeTi
mcxeTa-mTianeTi
raWa-leCxumi
q. foTi
z. svaneTi
sul
SemTxvevaTa raodenoba
2004
2005
2593
2860
5292
8092
1709
2734
4074
4647
1368
1706
3342
4375
2404
2782
573
1095
801
760
994
775
148
171
358
255
0
2
23712
30254
96
incidentoba
2004
2005
696,5
768,2
494.1
755,5
424,0
678,2
587,9
670,6
339,8
423,7
1074,9
1407,2
488,0
564,7
403,2
770,6
389,4
369,4
801,0
624,5
292,5
337,9
768,2
547,2
0,0
14,2
547,8
698,9
mateba/kleba
%
+10,3
+52,9
+60
+14,1
+24,7
+30,9
+15,7
+91,1
-5,1
-22,0
+15,5
-28,8
0
+27,6
cxovelebSi cofis laboratoriulad dadasturebuli SemTxvevebi
2004-2005
wlebSi – veterinariis departamentis monacemebi
mxare,
raioni
ZaRli
kata
sxva
sul
2004
2005
mat. kl
2004
2005
mat. kl.
2004
2005
mat. kl.
2004
2005
Tbilisi
11
15
+4
1
1
0
1
0
-1
13
16
mat. kl.
+3
kaxeTi
2
14
+12
0
0
0
1
7
+6
3
21
+18
siRnaRi
1
3
+2
0
0
0
0
1
+1
1
4
3
Telavi
sagarejo
1
0
0
2
-1
+2
0
0
0
0
0
0
0
0
0
1
0
+1
1
0
0
3
-1
+3
gurjaani
0
7
+7
0
0
0
1
2
+1
1
9
+8
lagodexi
0
2
+2
0
0
0
0
0
0
0
2
+2
dedoflis wyaro
0
0
0
0
0
0
0
3
+3
0
3
+3
guria
1
0
-1
0
0
0
0
0
0
1
0
-1
ozurgeTi
1
0
-1
0
0
0
0
0
0
1
0
-1
qv. qarTli
16
11
-5
0
0
0
3
1
-2
19
12
-7
rusTavi
T. wyaro
marneuli
2
3
0
0
1
2
-2
-2
+2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
3
0
0
1
2
-2
-2
+2
gardabani
10
8
-2
0
0
0
1
1
0
11
9
-2
bolnisi
1
0
-1
0
0
0
0
0
0
1
0
-1
dmanisi
0
0
0
0
0
0
2
0
-2
2
0
-2
imereTi
7
15
+8
1
0
-1
6
2
-4
14
17
+3
quTaisi
4
12
+8
0
0
0
0
0
0
4
12
+8
zestafoni
0
1
+1
0
0
0
0
0
0
0
1
+1
xaragauli
0
1
+1
0
0
0
0
0
0
0
1
+1
wyaltubo
WiaTura
baRdaTi
3
0
0
0
0
0
-3
0
0
1
0
0
0
0
0
-1
0
0
0
3
1
1
1
0
+1
-2
-1
4
3
1
1
1
0
-3
-2
-1
saCxere
0
1
+1
0
0
0
1
0
-1
1
1
0
vani
0
0
0
0
0
0
1
0
-1
1
0
-1
mcxeTa-mTianeTi
16
5
-11
0
0
0
7
5
-2
23
10
-13
mcxeTa
11
4
-7
0
0
0
0
2
+2
11
6
-5
duSeTi
2
0
-2
0
0
0
3
2
-1
5
2
-3
TianeTi
3
0
-3
0
0
0
3
0
-3
6
0
-6
axalgori
0
1
+1
0
0
0
1
1
0
1
2
+1
raWa-leCxumi
1
0
-1
0
0
0
0
0
0
1
0
-1
cageri
Sida qarTli
gori
1
4
2
0
6
0
-1
+2
-2
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
+2
0
1
4
2
0
8
0
-1
+4
+1
qareli
1
1
0
0
0
0
0
1
+1
1
2
+1
kaspi
xaSuri
1
0
5
0
+4
0
0
0
0
0
0
0
0
0
0
1
0
+1
1
0
5
1
+4
+1
samcxe-javaxeTi
7
1
-6
0
0
0
1
0
-1
8
1
-7
axalcixe
aspinZa
3
0
0
0
-3
0
0
0
0
0
0
0
0
1
0
0
0
-1
3
1
0
0
-3
-1
borjomi
4
0
-4
0
0
0
0
0
0
4
0
-4
ninowminda
0
1
+1
0
0
0
0
0
0
0
1
+1
samegrelo
2
2
0
0
1
+1
0
0
0
3
3
0
martvili
0
1
+1
0
0
0
0
0
0
0
1
+1
zugdidi
0
1
+1
0
1
+1
1
0
-1
1
2
+1
foTi
2
0
-2
0
0
0
0
0
0
2
0
-2
aWara
12
11
-1
0
0
0
1
1
0
13
12
-1
sul
79
80
+1
2
2
0
21
18
-3
102
100
-2
statistikuri masala damuSavda Tssu samedicino fizikisa
da biofizikis departamentis mier.
97
raodenoba
cxovelebSi cofi
wlebi
TbilisSi %-Si
raodenoba
qveynis regionebSi %-Si
wlebi
hidrofobiiT gardacvlil adamianTa raodenoba
qveyanaSi (TbilisSi 0%)
98
raodenoba
wlebi
raodenoba
cofian cxovelebTan kontaqtirebulTa raodenoba
wlebi
antirabiuli imunizacia
antirabiuli imunizacia respublikaSi %-Si
antirabiuli imunizacia TbilisSi %-Si
99
raodenoba
raodenoba
wlebi
mRrRnelebis mier dakbenilTa raodenoba
wlebi
gareul cxovelTa mier dakbenilTa raodenoba
100
raodenoba
wlebi
raodenoba
dakbenis SemTxvevaTa raodenoba
wlebi
15 wlamde asakis dazaralebulebis dedaqalaqSi Catarebul
mkurnalobaTa raodenoba 1998 w.
101
raodenoba
raodenoba
wlebi
qveynis sxvadasxva regionebidan 15 wlamde asakis dazaralebulTa
raodenoba 1998 w.
ZaRlis mier dakbenilTa raodenoba
102
wlebi
raodenoba
wlebi
katis mier dakbenilTa raodenoba
103
104
4 cofiani cxovelebis mier travmirebulTa raodenoba
23 cxovelebSi cofi (qveynis xvadasxva regioni - 18 Tbilisi - 5)
8 hidrofobiiT gardacvlil adamianTa raodenoba, (0 - antirabiul centrSi,
8- qveyanaSi)
219 antirabiuli mkurnaloba (qveynis sxvadasxva regioni - 39, Tbilisi - 180)
6 katis nakbeni
2 mRrRnelebis nakbeni (2 zazuna)
1992 weli
11 gareuli da sxva cxovelebis nakbeni (6 - maimuni, 1 -tyis Rori)
620 ZaRlis nakbeni
639 momarTvis SemTxvevaTa raodenoba
1 cofiani cxovelebis mier travmirebulTa raodenoba
0 mRrRnelebis nakbeni
228 antirabiuli mkurnaloba (qveynis sxvadasxva regioni - 201, Tbilisi - 27)
20 cxovelebSi cofi (qveynis xvadasxva regioni - 19 Tbilisi - 1)
1 hidrofobiiT gardacvlil adamianTa raodenoba, (0 - antirabiul centrSi,
1- qveyanaSi)
7 gareuli da sxva cxovelebis nakbeni (6 - maimuni, 1 -tyis Rori)
11 katis nakbeni
1991 weli
606 ZaRlis nakbeni
624 momarTvis SemTxvevaTa raodenoba
105
10 cofiani cxovelebis mier travmirebulTa raodenoba
5 mRrRnelebis nakbeni (virTagva)
5 katis nakbeni
18 gareuli da sxva cxovelebis nakbeni (15-maimuni, 3 - kurdReli)
599 momarTvis SemTxvevaTa raodenoba
571 ZaRlis nakbeni
8 cofiani cxovelebis mier travmirebulTa raodenoba
1994 weli
105 cxovelebSi cofi (qveynis xvadasxva regioni - 96 Tbilisi - 9)
9 hidrofobiiT gardacvlil adamianTa raodenoba, (0 - antirabiul
centrSi, 9- qveyanaSi)
400 antirabiuli mkurnaloba (qveynis sxvadasxva regioni - 29, Tbilisi - 371)
24 gareuli da sxva cxovelebis nakbeni (23-maimunis, 1 - kurdRlis)
7 katis nakbeni
1 mRrRnelebis nakbeni (zazuna)
327 antirabiuli mkurnaloba (qveynis sxvadasxva regioni - 20, Tbilisi - 307
23 cxovelebSi cofi (qveynis xvadasxva regioni - 19 Tbilisi -4)
4 hidrofobiiT gardacvlil adamianTa raodenoba, (0 - antirabiul
centrSi, 4 - qveyanaSi)
550 ZaRlis nakbeni
582 momarTvis SemTxvevaTa raodenoba
1993 weli
106
88 cofiani cxovelebis mier travmirebulTa raodenoba
30 mRrRnelebis nakbeni (28-virTagva, 2-zazuna)
2 katis nakbeni
621 ZaRlis nakbeni
7 gareuli da sxva cxovelebis nakbeni (7-maimuni)
660 momarTvis SemTxvevaTa raodenoba
12 cofiani cxovelebis mier travmirebulTa raodenoba
11 mRrRnelebis nakbeni (36-virTagva, 3-zazuna, 2-zRarbi)
1 katis nakbeni
514 ZaRlis nakbeni
24 gareuli da sxva cxovelebis nakbeni (2-maimunis, 1-ponis,
2-cxenis, 2-Zroxis, 1-Txis)
550 momarTvis SemTxvevaTa raodenoba
1996 weli
1995 weli
158 cxovelebSi cofi (qveynis xvadasxva regioni - 131, Tbilisi -27)
21 hidrofobiiT gardacvlil adamianTa raodenoba, (0 - antirabiul centrSi,
21 - qveyanaSi)
585 antirabiuli mkurnaloba (qveynis sxvadasxva regioni - 65, Tbilisi - 520
68 cxovelebSi cofi (qveynis xvadasxva regioni - 63, Tbilisi -5)
9 hidrofobiiT gardacvlil adamianTa raodenoba, (0 - antirabiul
centrSi, 9 - qveyanaSi)
302 antirabiuli mkurnaloba (qveynis sxvadasxva regioni - 30, Tbilisi - 272
107
56 cofiani cxovelebis mier travmirebulTa raodenoba
44 mRrRnelebis nakbeni (45-virTagva, 6-zazuna)
20 katis nakbeni
825 ZaRlis nakbeni
16 gareuli da sxva cxovelebis nakbeni (11-maimunis, 1-mglis,
3-meliis, 1-lomis, 1-daTvis)
905 momarTvis SemTxvevaTa raodenoba
74 cofiani cxovelebis mier travmirebulTa raodenoba
41 mRrRnelebis nakbeni (36-virTagva, 3-zazuna, 2-zRarbi)
11 gareuli da sxva cxovelebis nakbeni (2-maimunis,
1- ponis, 2-cxenis, 2-Zroxis, 1-Txis)
22 katis nakbeni
1010 momarTvis SemTxvevaTa raodenoba
936 ZaRlis nakbeni
1998 weli
1997 weli
71 cxovelebSi cofi (qveynis xvadasxva regioni - 71, Tbilisi -0)
4 hidrofobiiT gardacvlil adamianTa raodenoba, (0 - antirabiul
centrSi, 4 - qveyanaSi)
681 antirabiuli mkurnaloba (qveynis sxvadasxva regioni - 103, Tbilisi 578)
12 hidrofobiiT gardacvlil adamianTa raodenoba,
(0 - antirabiul centrSi, 12 - qveyanaSi)
725 antirabiuli mkurnaloba (qveynis sxvadasxva regioni - 75, Tbilisi - 652)
164 cxovelebSi cofi (qveynis xvadasxva regioni - 144, Tbilisi -20)
108
2000 weli
18 cofiani cxovelebis mier travmirebulTa raodenoba
51 mRrRnelebis nakbeni (45-virTagva, 6-zazuna)
23 gareuli da sxva cxovelebis nakbeni (13-maimuni, 3-mglis,3cxenis, 4-Roris)
49 katis nakbeni
1014 ZaRlis nakbeni
1137 momarTvis SemTxvevaTa raodenoba
cofiani cxovelebis mier travmirebulTa raodenoba
mRrRnelebis nakbeni (65-virTagva, 7-zazuna)
katis nakbeni
7 hidrofobiiT gardacvlil adamianTa raodenoba,
(0 - antirabiul centrSi, 7 - qveyanaSi)
687 antirabiuli mkurnaloba (qveynis sxvadasxva regioni - 46, Tbilisi - 6
69 cxovelebSi cofi (qveynis xvadasxva regioni - 65, Tbilisi -4)
hidrofobiiT gardacvlil adamianTa raodenoba,
(0-antirabiul centrSi, 13 - qveyanaSi)
cxovelebSi cofi (qveynis xvadasxva regioni - 55, Tbilisi -0)
825 ZaRlis nakbeni
gareuli da sxva cxovelebis nakbeni (9-maimuni,
1-daTvi, 2-cxeni, 1-Rori, 1-ciyvi)
615 antirabiuli mkurnaloba (qveynis sxvadasxva regioni - 19, Tbilisi - 59
1029 momarTvis SemTxvevaTa raodenoba
1999 weli
antirabiuli samedicino daxmarebis centris
(T.s.s.u.pediatriuli klinikis bazaze)
muSaoba 2001 w.
1623 momarTvaTa SemTxvevebi
1403 ZaRlis nakbeni (1176 - nacnobi, 227 - ucnobi)
13 gareuli cxovelebis nakbeni
56 katis nakbeni
77 mRrRnelebis nakbeni
63 kontaqti cofian cxovelebTan
3 kontaqti hidrofobiiT daavadebul adamianebTan
134 cofis SemTxvevebi cxovelebSi
30 cofze saeWvo cxoveli mokvda da ar gamokvleula
1279antirabiuli mkurnaloba (1107 - Tbilisi, 172 - regionebi)
109
110
100 oqtomberi
77 noemberi
66 dekemberi
99 dekemberi
131 seqtemberi
210 seqtemberi
104 noemberi
208 agvisto
240 agvisto
155 oqtomberi
87 ivnisi
132 maisi
195 ivlisi
107 aprili
113 ivnisi
85 aprili
138 maisi
92 marti
240 ivlisi
81 Tebervali
81 marti
66 Tebervali
53 ianvari
antirabiuli mkurnaloba 2001 w. Tveebis mixedviT
65 ianvari
2001 wels momarTvaTa SemTxvevebi Tveebis mixedviT
2001 wels antirabiul centrSi dazaralebulebis momarTvaTa da antirabiuli
mkurnalobis SemTxvevebi Tveebis mixedviT
65 ianvari momarTva - 65, (antirabiuli mkurnaloba - 53)
Tebervali 66 (58)
marti 92 (81)
aprili 107 (85)
maisi 132 (138)
ivnisi 113 (87)
ivlisi 240 (195)
agvisto 240 (208)
seqtemberi 210 (131)
oqtomberi 155 (100)
noemberi 104 (77)
dekemberi 99 (66)
111
112
Raodenoba
309 cofiani cxovelebis mier travmirebulTa raodenoba
279 mRrRnelebis nakbeni (6 zazuna, 45 virTagva)
154 gareuli da sxva cxovelebis nakbeni (13 - maimunis,
3 - mglis, 4 - Roris, 3 - cxenis)
145 katis nakbeni
7124 ZaRlis nakbeni
7735 momarTvis SemTxvevaTa
88 hidrofobiiT gardacvlil adamianTa raodenoba
(0 -antirabiul centrSi, 88 - qveyanaSi)
756 cxovelebSi cofi (qveynis sxvadasxva regioni - 680,
4769 antirabiuli mkurnaloba (resp. sxvadasxva regioni - 451,
sul 1991-2000 weli
2001 wels antirabiul centrSi dazaralebulebis momarTvaTa da antirabiuli
mkurnalobis SemTxvevebi Tveebis mixedviT
ianvari momarTva - 65 (antirabiuli mkurnaloba -53)
Tebervali 66 (58)
marti 92 (81)
aprili 107 (85)
maisi 132 (138)
ivnisi 113 (87)
ivlisi 240 (195)
agvisto 240 (208)
seqtemberi 210 (131)
oqtomberi 155 (100)
noemberi 104 (77)
dekemberi 99 (66)
113
2001 wels antirabiul centrSi dazaralebulebis momarTvaTa da antirabiuli
mkurnalobis SemTxvevebi Tveebis mixedviT
ianvari momarTva - 65 (antirabiuli mkurnaloba -53)
Tebervali 66 (58)
marti 92 (81)
aprili 107 (85)
maisi 132 (138)
ivnisi 113 (87)
ivlisi 240 (195)
agvisto 240 (208)
seqtemberi 210 (131)
oqtomberi 155 (100)
noemberi 104 (77)
dekemberi 99 (66)
114
raodenoba
nakben WrilobaTa yvelaze xSiri lokalizacia 2004 w.
18
16
14
12
10
8
6
4
2
0
1
2
3
4
5
6
7
8
9
10
11
12
Tveebi
vaJebi d
vaJebi s
gogoebi d
gogoebi s
winamxris midamo
raodenoba
nakben WrilobaTa yvelze xSiri lokalizacia 2004 w.
14
12
10
8
6
4
2
0
1
2
3
4
5
6
7
8
9
10
11
Tveebi
vaJebi d
vaJebi s
gogoebi d
gogoebi s
barZayis midamo
115
12
nakben WrilobaTa yvelze xSiri lokalizacia 2004 w.
18
16
14
12
10
8
6
4
2
0
1
2
biWebi d
B
3
4
biWebi S
5
6
7
8
gogoebi d
9
10
gogoebi S
11
Tveebi
wvivis midamo
nakben WrilobaTa yvelze xSiri lokalizacia 2004 w.
20
18
16
14
12
10
8
6
4
2
0
1
B
biWebi
2
3
4
5
6
7
8
gogoebi
9
10
Tveebi
mravlobiTi nakbenebi
116
11
12
12
raodenoba
nakben WrilobaTa yvelze xSiri lokalizacia 2004 w.
70
60
50
40
30
20
10
0
1
B
2
3
biWebi
4
5
6
7
8
9
10
11
12
Tve
gogoebi
raodenoba
saxis midamo
70
60
50
40
30
20
10
0
1
2
3
4
5
6
7
8
9
10
11
12
Tve
antirabiuli imunoglobulinizacia (pirobiTi kursi)
antirabiuli imunoglobulinizacia (upirobo kursi)
imunoglobulinis gamoyenebis SemTxvevaTa raodenoba dazaralebul pirebSi,
rogorc pirobiTi, ise upirobo antirabiuli profilaqtikuri mkurnalobis dros
117
nakben WrilobaTa yvelaze xSiri lokalizacia 2005 w.
Tssu pediatriuli klinika
raodenoba
18
16
14
12
10
8
6
4
2
0
1
2
vaJebi d
3
4
vaJebi s
5
6
7
8
9
10
11
gogoebi s
gogoebi d
12
Tveebi
xelis mtevani
nakben WrilobaTa yvelaze xSiri lokalizacia 2005 w.
Tssu pediatriuli klinika
raodenoba
14
12
10
8
6
4
2
0
1
vaJebi d
2
3
vaJebi s
4
5
6
7
gogoebi d
winamxris midamo
118
8
9
gogoebi s
10
11
12
Tveebi
raodenoba
nakben WrilobaTa yvelaze xSiri lokalizacia 2005 w.
Tssu pediatriuli klinika
12
10
8
6
4
2
0
1
2
3
vaJebi
4
5
6
7
8
9
10
gogoebi
11
12
Tveebi
mravlobiTi nakbeni
nakben WrilobaTa yvelaze xSiri lokalizacia 2005 w.
Tssu pediatriuli klinika
raodenoba
16
14
12
10
8
6
4
2
0
1
vaJebi
2
3
4
5
6
7
8
gogoebi
9
10
11
Tveebi
saxis midamo
119
12
raodenoba dazaralebulebisa, romelTac mimarTes Tssu pediatriul
klinikas 2004-05 wlebSi
raodenoba
250
200
150
100
50
0
1
2
3
2004 w.
4
5
6
7
8
9
10
2005 w.
11
12
Tveebi
cofian cxovelebTan kontaqtirebulTa raodenoba Tveebis mixedviT
raodenoba
2004 w.
12
10
8
6
4
2
0
1
saeWvo
2
3
4
5
6
7
dadginda cofi
8
9
10
11
Tveebi
120
12
raodenoba
dakbenaTa SemTxvevebi Tveebis mixedviT 2004 weli
35
30
25
20
15
10
5
0
1
2
3
4
5
6
7
8
9
10
11
12
Tveebi
vaJebi
gogoebi
Cvil bavSvTa asakis kontigenti (1-3 w)
raodenoba
dakbenaTa SemTxvevebi Tveebis mixedviT 2004 weli
6
5
4
3
2
1
0
1
vaJebi
2
3
4
5
6
7
8
9
10
gogoebi
11
Tveebi
axalSobilTa kontigenti (0-1 wlamde)
121
12
raodenoba
nakben WrilobaTa yvelaze xSiri lokalizacia 2004w.
30
25
20
15
10
5
0
1
2
3
vaJebi d
4
5
vaJebi s
6
7
8
9
gogoebi d
10
11
12
gogoebi s
Tveebi
xelis mtevnis TiTebi
raodenoba
nakben WrilobaTa yvelaze xSiri lokalizacia 2004w.
18
16
14
12
10
8
6
4
2
0
1
2
vaJebi d
3
4
vaJebi s
5
6
7
8
gogoebi d
xelis mtevani
122
9
10
11
gogoebi s
12
Tveebi
raodenoba
cofian cxovelebTan kontaqtirebulTa raodenoba Tveebis mixedviT 2005 weli
14
12
10
8
6
4
2
0
1
2
3
4
5
6
7
8
9
dadginda cofi
saeWvo
10
11
12
Tveebi
raodenoba
vaJebisa da gogoebis dakbenaTa raodenoba Tveebis mixedviT 2005 weli
160
140
120
100
80
60
40
20
0
1
2
vaJebi
3
4
5
6
gogoebi
7
8
9
10
Tveebi
123
11
12
raodenoba
antirabiuli vaqcinaciis pirobiTi (arasruli) kursis Sefardeba Tvebis mixedviT
2005 weli
200
180
160
140
120
100
80
60
40
20
0
1
2
3
4
5
imunoglobulini gaukeTda
6
7
8
9
10
11
pirobiTi kursi
12
Tveebi
antirabiuli vaqcinaciis upirobo (sruli) kursis Sefardeba Tveebis
mixedviT 2005 weli
raodenoba
60
50
40
30
20
10
0
1
2
3
4
imunoglobulini gaukeTda
5
6
7
upirobo kursi
124
8
9
10
11
weli
12
raodenoba
6
dakbenaTa SemTxvevebi Tveebis mixedviT 2005 weli
5
4
3
2
1
0
1
2
3
vaJebi
4
5
6
7
8
9
10
11
gogoebi
12
Tveebi
axalSobilTa kontigenti (0-1w.)
raodenoba
dakbenaTa SemTxvevebi Tveebis mixedviT 2005 weli
30
25
20
15
10
5
0
1
vaJebi
2
3
4
5
6
7
8
9
10
gogoebi
Cvil bavSvTa asakis kontigenti (1-3 w.)
125
11
12
nakben WrilobaTa yvelaze xSiri lokalizacia 2005 w.
Tssu pediatriuli klinika
raodenoba
25
20
15
10
5
0
1
2
3
vaJebi d
4
5
vaJebi s
6
7
8
gogoebi d
9
10
11
12
gogoebi s
Tveebi
xelis mtevnis TiTebi
raodenoba
nakben WrilobaTa yvelaze xSiri lokalizacia 2005 w.
Tssu pediatriuli klinika
25
20
15
10
5
0
1
vaJebi d
2
3
vaJebi s
4
5
6
gogoebi d
wvivis midamo
126
7,5
8
gogoebi s
9
10
11
Tveebi
12
nakben WrilobaTa yvelaze xSiri lokalizacia 2005 w.
Tssu pediatriuli klinika
raodenoba
10
9
8
7
6
5
4
3
2
1
0
1
2
vaJebi d
3
4
vaJebi s
5
6
7
gogoebi d
barZayis midamo
127
8
9
gogoebi s
10
10.8
12
Tveebi
antirabiuli samedicino daxmarebis analizis forma
(mowodebuli saqarTvelos antirabiuli samedicino
daxmarebis centris mier)
dazianebis lokalizacia:
saxis midamo
Tvalbude
tuCi
yuris midamo
kisris midamo
Tavis midamo
mravlobiTi nakbeni
xelis mtevnis TiTebi
dazaralebuli mosaxleoba:
qalaqis
regionebis
sul
bavSvebi – 15 wlamde
0-1 wlamde
1-3 wlamde
damkbeni cxovelebi:
ZaRli (ucnobi jiSi)
ucnobi ZaRli
kata (cnobili)
ucnobi kata
virTagva
zazuna
sxvadasxva cxoveli
kontaqti cofze saeWvo
cxovelTan
kontaqti klinikurad da
laboratoriulad dadasturebul
cofian cxovelTan
dazaralebuli:
biWebi
gogonebi
mozrdilebi
128
xelis mtevani
sxiv-majis saxsari
winamxari
idayvis saxsari
mxari
gulmkerdis midamo
zurg-welis midamo
muclis midamo
dunduloebis midamo
sasqeso organoebi
barZayi
muxlis saxsari
wvivi
koW-wvivis saxsari
qusli
terfis midamo
terfis TiTebi
klinikuri masala, ilustraciebi
dazaralebuli: vaJi b., 2 wlis da 8 Tvis, ist. #876.
Semovida 2002 wlis 9 marts, daavadebidan meeqvse dRes daavadeba daewyo temperaturuli reaqciiT 37,50-mde, iSviaTi xveliT,
romelsac Tan daerTo ylapvis gaZneleba, gamoixata adinamia.
bavSvi mivarda, ris gamoc mimarTes mcxeTis saavadmyofos, saidanac toqsikoinfeqciaze saeWvo diagnoziT gagzavnes bavSvTa
respublikur saavadmyofoSi. iq gamoiricxa toqsikoinfeqcia da
bavSvi mSoblebma moiyvanes Tssu pediatriul klinikaSi. anamnezuri monacemebiT 28 Tebervals avadmyofs gaukeTda poliomielitis acra. zemoT aRniSnulidan gamomdinare, daisva winaswari
klinikuri diagnozi: virusuli polinevriti (saeWvo poliomielitze dune tetraparezi, bulbaluri damblis sindromi. avadmyofs daewyo hormonaluri, sindromuli da simptomuri mkurnaloba aRdgeniT TerapiasTan erTad. miuxedavad mkurnalobisa, dinamikaSi avadmyofis mdgomareoba swrafad gauaresda, gamoixata
cnobierebis dabindva, tetraparezi, gamoxatuli sunTqvis paTologiuri riTmi da, sunTqvis mwvave ukmarisobis ganviTarebis
gamo, avadmyofi gadaiyvanes marTviT sunTqvaze. miuxedavad amisa,
avadmyofs gamoexata tvinis SeSupebis – atoniuri komis _ klinikuri suraTi (cnobiereba dabinduli, CxvletiT gaRizianebaze
ar reagirebs, gamoxatulia midriazi, guga sinaTleze ar reagirebs). vinaidan gamoxatuli nevrologiuri klinika scildeboda profilaqtikuri bunebis polinervuli sindromis klinikas, saWiro iyo diferencialuri diagnozis gatareba difteriasTan, romlis sawinaaRmdegod miuTiTebda difteriuli nadebebis ararseboba arc nuSurebze da arc xaxaSi (konsultirebuli iyo otolaringologis mier) neiroinfeqcionistis konsultaciisas gairkva mSoblebis mier manamde damaluli informacia:
daaxloebiT 9-12/II 2002 w. bavSvi saxis areSi dakbina katam.
kata ramdenime dReSi momkvdara. pacients aravisTvis ar miumarTavs, acrebi ar Catarebia, amitom zemoT aRniSnuli nevrologiuri
klinikis etiologiur faqtorad
CaiTvala cofis virusi.
dacemuli katis leSi ver naxes, ris gamoc vetlaboratoriaSi misi Tavis tvinis gamokvleva cofze ver moxerxda. avadmyofs ugrZeldeboda sindromuli Terapia, mdgomareoba ukiduresad
129
mZime rCeboda (atonuri komis gamo). dinamikaSi gamoixata bradiariTmia da 25/III-2002 w. dafiqsirda biologiuri sikvdili.
sikvdilis uSualo mizezia gulis gaCereba (hidrofobiiT
gamowveuli).
gakveTis oqmi #12
25 marti 2002 w.
T.s.s.u. pediatriuli klinika ist #876
m/r gardacvlili avadmyofi - vaJi b., 2 w. 8 Tvis
gardaicvala 25/III 2002 w. 10 00 gaikveTa 25/III 2002 w.
paTologiuri diagnozi:
cofi: Tavis tvinis hi pokapnidan, olivebidan, varolis xididan,
amonis rqidan aRebul seqciur masalaSi imunoflurescenciis
meTodiT dadginda cofi. Tavis tvinis rbili garsebis Zlieri
sisxlsavseoba peteqiuri da laqovani sisxlCaqcevebiT upiratesad bazalur nawilebSi, neirocitebis hidropuli distrofia,
qromatozuli perovaskuluri limfoiduri infiltracia, gliozi,
encefaliti, Tavis tvinis SeSupeba (daukonservebel masalaSi).
* * *
dazarebuli vaJi e., 14 wlis, ist. #2962
diagnozi: travmuli Soki, ZaRlis mier miyenebuli mravlobiTi
nakbeni Wrilobebi orive winamxris, marjvena wvivisa da marcxena
laviwqveSa areSi.
11 /X-1998 w. ukiduresad mZime mdgomareobaSi moTavsda reanimaciisa da intensiuri Terapiis ganyofilebaSi. mdgomareobis
simZime ganpirobebulia Sokuri mdgomareobiT, agznebadia. kon130
taqtSi Semodis dagvianebiT, A/T 80-40 mm, p-140, R-30 aReniSneba
Rebineba. kidurebi SexebiT civi, mikrocirkulacia darRveuli.
zogadi narkoziT gaukeTda operacia – damuSavda marcxena
mxris midamo – dazianebulia kani, kanqveSa yvela qsovili mxris
Zvlamde, periostaluri Sre darRveuli ar aris. kunTovanmyesovani sistema mTlianad daglejilia mxris Sua mesamedSi,
sigrZiT 12-14 sm, cirkularulad. kiduris idayvis saxsarSi
moxriT mitanili kunTebi da myesebi SeZlebisdagvarad gaikera
Ï-s magvari msxvili ketgutis situaciuri nakerebiT. kanze daedo abreSumis kvanZovani situaciuri nakerebi. WrilobaSi Caido
rezinis filTa, aqve laviwqveSa midamoSi aReniSneba Wriloba
sigrZiT 10 sm, romelic kvanZovani situaciuri nakerebiT gaikera. marjvena mxris Sua mesamedSi aRiniSneba nafleTovani Wriloba sigrZiT 10 sm, kunTebis dazianebiT mxris Zvlamde, romelic
SedarebiT advilad aRdga.
marjvena wvivis midamoSi arsebuli ori sxvadasxva zomis
nafleTovani Wriloba _ zerele, daedo kvanZovani abreSumis
nakerebi, marcxena zeda kidurze daedo TabaSiris longeti.
operaciidan meore dRes marcxena mxris areSi arsebuli Wrilobidan kvlav Jonavda hemoragiuli gamonadeni, daedo damatebiTi nakerebi hemostazis mizniT. ukeTdeboda dicinoni. marcxena
zemo kiduri SexebiT Tbili, TiTebs amoZravebs, hemoglobinis
done sisxlSi stabiluri. utardeboda dezintoqsikaciuri, vitamino, antibiotiko Terapia. Sexvevebi yoveldRe wyalbadis zeJangis 3%, dioqsidinis 1% gamorecxvis Semdeg - rivanolis
xsnarSi dasvelebuli naxvevi.
Wrilobebis Sexorceba moxda meoradi daWimviT.
gaewera gaumjobesebul mdgomareobaSi poliklinikis qirurgis meTvalyureobis qveS.
131
* * *
dazaralebuli: vaJi n.W., 13 wlis, 29/XII-2001 w. ist #792.
diagnozi: hemofilia ‘A“, ZaRlis mier miyenebuli nakbeni nafleTovani Wrilobebi marjvena quTuTosa da Txemis areSi, masiuri
hematoma Sublisa da marjvena loyis areSi.
avadmyofi 13 wlis, aRricxvazea sisxlis gadasxmis institutSi 1990 wlidan diagnoziT hemofilia ‘A“. 2001 wlis 26/
XII bavSvs Tval-Sublis areSi ukbina ZaRlma. nakbeni Wriloba
marjvena quTuTosa (zomiT1,5-2 sm) da Txemze (2,5 X2 sm).
mSoblebma baTumSi ar gaakeTebines cofis sawinaaRmdego vaqcina. imis gamo, rom 27/XII daewyo sisxldena da baTumSi ver
moxerxda sisxlis VIII faqtoris gadasxma, bavSvi gamogzavnes
TbilisSi.
obieqturad: kani da xiluli lorwovani Zlier fermkrTali,
marjvena Tvalis orbita gamodis Tvalbudedan, masiuri hematomis gamo. hematoma aRiniSneba marjvena loyaze mTlianad qveda
ybamde. quTuTodan da Txemis Wrilobebidan aRiniSneba sisxldena.
imave dRes Cvenebebisamebr diagnoziT: mZime kategoriis dakbena
(damkbeni cxoveli _ mezoblis agresiuli kavkasiuri jiSis
nagazi) arasrulad Catarebuli cofsawinaaRmdego acrebi – daewyo
antirabiuli imunoTerapia.
132
koagulogramis kontrolis qveS gadaesxa sisxlis VIII faqtori, krioplazma. konsultirebulia okulistis mier. marjvena
Tvalis zeda quTuToze aRiniSneba nakbeni Wriloba. Tvalis retrobulbarul sivrceSi aris hematoma. ZiriTadi daavadebidan
gamomdinare, amJamad Careva SeuZleblia. daeniSna tetraciklinis Tvalis malamo, dinamikaSi dakvirveba.
03.01.2002 w. ofTalmologis ganmeorebiTi konsultacia marjvenamxrivi egzofTalmi da lagofTalmi, zeda quTuTos Wriloba. rqovanas garsi SemRvreulia (gamomSralia), ukan mdebare nawilebis daTvaliereba SeuZlebelia. savaraudoa retrobulbaruli
hematoma (mxedvelobis nervis atrofia?)
OD- rqovana perforirebulia da sisxliT imbibirebuli, saWiroa
enukleacia (zogadi mdgomareobisa da meore Tvalis funqciis
SesaZlo gauaresebis gaTvaliswinebiT).
avadmyofi uCivis mxedvelobis uqonlobas marjvena TvalSi.
marjvena zeda quTuTo SeSupebuli, daSvebuli lorwovani. Tvalis daTvaliereba ver xerxdeba. quTuToze aReniSneba nakerebi,
safenebi marjvena Tvalbudis areSi. maqsitrolis wveTbi CasawveTeblad, aqtoveginis Jele.
mkurnaloba gaugrZelda specializebul ofTalmologiur klinikaSi.
* * *
dazaralebuli: vaJi g., 13 wlis, agvisto 2005 weli, istoriis
# 3717
diagnozi: mglis nakbeni Wrilobebi sxeulis sxvadasxva areSi,
travmuli sisxlmdeni Rrma Wrilobebi Tavis, saxisa da kidurebis areSi.
133
obieqturad: nafleTovani Wrilobebi, romlebic iwyeba Txemidan da Sublis midamoSi gadmodis. cxviris Zvali damsxvreuli
da xrtilovan nawilTan erTad moglejili, rogorc Sublis
Zvlidan, aseve tuCis mimagrebis adgilidan marcxena loyis areSi
mravlobiTi nafleTovani Wrilobebi.
marjvena orbitis mfaravi kani, kanqveSa cximovani qsovili
moglejili orbitis Zvlidan. Wrilobebi kisris areSi marjvniv da orive yuris niJaris areSi.
yvela Wriloba aris Rrma da sisxlmdeni.
qveda tuCis gamWoli Wriloba, marjvena quTuToebi mocilebuli da dakidebuli, quTuToebis kani mTlianad SeWmuli.
SemosvlisTanave Cautarda antirabiuli mkurnalobis kombinirebuli kursi imunoglobulini + vaqcina. Cautarda yba-saxis qirurgisa da ofTalmologis konsultacia.
zogadi narkoziT gaukeTda operacia – sasicocxlo CvenebiT
- dazianebuli saxis midamos plastika. gaewera 1 Tvis Semdgom
damakmayofilebel mdgomareobaSi. samwuxarod, gaweridan 10 dReSi ganviTarda sefsisi, romelic gamoiwvia naoperacieb areSi
generalizebulma lpobiTma infeqciam, ramac pacienti imsxverpla.
134
* * *
dazaralebuli: gogona e., 1 wlis 3 Tvis,
diagnozi: ZaRlis mravlobiTi nakbeni Wrilobebi Tavisa da
saxis areSi.
Sublis Zvlisa da orbitis zeda kidis kompresiuli motexiloba maragi garsis dazianebiT, Subli-Txemis Zvlis kompresiuli motexiloba xazze sagitaluri sinusis dazianebiT da
detritis gamoyofiT.
16.09.05w.-s bavSvi s/d manqaniT moiyvanes Tssu pediatriuli
klinikis antirabiul centrSi diagnoziT _ travmuli Soki,
nakbeni Wrilobebi Tavisa da saxis areSi. moTavsda reanimaciul
ganyofilebaSi. Sokidan gamosvlis Semdeg igi gadayvanil iqna
bavSvTa respublikuri saavadmyofos neiroqirurgiul ganyofilebaSi. gaukeTda Tavis tvinis kisris malis kompiuteruli tomografia: qala-tvinis travma Sublis Zvlis mravlobiTi, fragmentovani, impresiuli motexiloba. Tavis tvinis daJeJiloba.
tvinis nivTierebebis mravlobiTi, post-travmuli, kontuziuri
ubnebi. gamoxatuli intrakranialuri hi pertenzia, rac SeiZleba
iyos tvinis SeSupebis gamovlinebis debiuti; kisris malebis
travmuli dazianebis niSnebi kompiuterul tomogramaSi ar aRiniSna.
16/IX- Cvenebebisamebr (mZime kategoriis dakbena) SemosvlisTanave,
miuxedavad umZimesi mdgomareobisa da 1 wlis asakisa, sasicocxlo CvenebiT daewyo antirabiuli mkurnalobis kombinirebuli
kursi. winaswari sinjebiT 1:100 ganzavebuli antirabiuli imunoglobulini 201 intervaliT I kanSiga, II kanqveSa sinji _
reaqcia ar hqonia, ris Tanaxmadac kunTSi gaukeTda mTliani
doza (wonis mixedviT) ganuzavebeli imunoglobulinisa da 301
135
intervaliT ki _ antirabiuli vaqcinis 1 doza. reaqcias adgili ar hqonia.
19.09.05 w.-s winaswar momzadebis Semdeg gaukeTda operacia _
Sublis Zvlis Catexili fragmentebis mocileba, marjvniv magari
garsis plastikiT, Txemis zeda nawilis Camsxvreuli Zvlebis
mocileba sagitaluri sinusis gadakvanZviT da magari garsis
plastikiT.
operaciamde aRmoCnda didi zomis Catexili ubani, romlis
epicentri mdebareobda sagitaluri sinusis saproeqto areSi,
Catexili fragmentis vertikaluri mdebareobiT, romelic aTrombebda sagitalur sinuss. gamoCnda magari garsis defeqti 2X2
sm-ze, saidanac miRebul iqna Zlieri sisxldena, romelic SeCerda
sinusis gadakvanZviT. darCa defeqti 4X3 sm-ze. gverdebidan
gaikera magari garsi, Wriloba Sreobrivad aRdga. nakerebi moexsna me-7 dRes. naoperaciebi Wrilobebis Sexorceba pirveladi
daWimviT.
* * *
dazaralebuli: vaJi g.
2002 wlis 25 agvistos q. Tbilisis maxloblad, wyneTis
tyeSi, ipoves Rorebis mier dakbenili mitovebuli axalSobili.
stacionaris avadmyofobis samedicino baraTi #3136.
katastrofis centris saswrafo manqaniT axalSobili jer
samSobiaroSi gadaiyvanes, Semdeg ki Tssu pediatriuli klinikis
antirabiul samedicino daxmarebis centrSi. klinikis morige
qirurgiuli brigadisa da reanimaciuli samsaxuris swori muSaobis Sedegad bavSvi gamovida umZimesi mdgomareobidan.
samwuxarod, Rorisagan moWmul kanze dakidebuli TiTebis gadarCena SeuZlebeli iyo da pataras Cautarda marcxena xelis
mtevnis sami (III-IV-V) TiTis amputacia.
136
axalSobils sasicoxlo CvenebiT pirvelive dRidan daewyo
antirabiuli profilaqtikuri mkurnaloba da antitetanuri
imunizacia.
aRniSnuli SemTxveva uprecendento gamodga. antirabiul centrSi cofis sawinaaRmdego mkurnaloba CautarebiaT virTagvebis
mier saxis areSi dakbenili axalSobilisaTvis, 10 da 14 dRis
bavSvebisaTvis, magram erTi dRis bavSvs acrebi Cvens praqtikaSi
pirvelad Cautarda da amas araviTari garTuleba ar mohyolia.
samedicino literaturaSi aseTi faqti jerjerobiT cnobili
ar aris. gaewera damakmayofilebel mdgomareobaSi.
* * *
dazaralebuli: vaJi a., ist. #5991 2004 w.
diagnozi: marcxena TeZos frTis ukana da welis midamos vrceli hematoma, viris mier miyenebuli dartymis Semdgomi.
operacia – hematomis gaxsna, drenireba zogadi endotraqealuri
narkoziT. 20X20sm zomis gadaWimuli, mtkivneuli hematoma, vrceli kanqveSa sisxlnaJRenTiT.
ganakveTi TeZos frTis zemoT marjvniv gaixsna hematoma. miRebuli iqna didi raodenobiT koltebi. magistraluri sisxlZarRvebi dazianebuli ar aris. Wriloba gaikera Sreobrivad situaciurad. Cautarda antirabiuli mkurnaloba gaurTuleblad.
137
* * *
dazaralebuli: vaJi g., 6 wlis, 1998wlis 16 oqtomberi, ist.
#3397.
diagnozi: bulterieris nakbeni Wrilobebi cxviris, marcxena
loyisa da zeda ybis gardamavali naoWis areSi.
16/X-98 w.-s dakbina mezoblis bulterieris jiSis ZaRlm.a
inspeqciiT dazianebuli cxviris marcxena gverdiTi zedapiri,
Ria gamWoli Wriloba 4X2 sm zomiT, romelic gadadis cxviris
niJaraze, zeda tuCze. marcxena loyis midamoSi aRiniSneba 3X1
sm. zomis Wriloba. Cautarda yba-saxis qirurgisa da yel-yurcxviris eqimis konsultacia.
19/X-98 gaukeTda operacia _ cxviris, marcxena loyisa da
zeda ybis gardamavali naoWi anatomiuri mTlianobis aRdgena.
zogadi (intubaciuri-orotraqealuri) narkoziT – ftorotan
+ 02 + fentanili 0,005% + kalifsolis 5%-iani xsnari 2.0
Wrilobebis antiseptiuri damuSavebis Semdeg mocilda mcire
zomis 0,3 sm diametris Zvlovani fragmenti cxviris midamos
Wrilobidan. Wriloba cxviris midamoSi gamWolia da aRiniSneba cxviris Zvalze marcxniv 0,5 sm diametris defeqti. ganaxlda
Wrilobis kideebi _ mocilda fibrinuli nadebi. cxviris Rrus
lorwovanze daedo 4 kvanZovani nakeri, aSrevda cxviris kani,
romlis mobilizaciis Semdeg aRdga cxviris zurgisa da marcxena nestos anatomiuri mTlianoba. adgilobrivad marcxena loyis
areSi Seyvanil iqna 0,5 ml klaforani. ganaxlda Wrilobis
kideebi, kani gaikera atravmuli sakeravi masaliT. piris Rrus
zeda ybis gardamaval naoWze aRiniSna Wriloba, romelic kideebis ganaxlebis Semdeg gaikera yrud ketgutis nakeriT. Cautarda
antirabiuli da antibiotiko mkurnaloba. gaewera janmrTeli
22/X-98.
138
* * *
dazaralebuli: gogo n., 5 wlis, Semosvlis TariRi 27.06.2007w.,
ist. # 2589
diagnozi: nakbeni Wriloba marcxena Tvalis quTuToebis areSi.
27.06.2001 w.-s dakbina ZaRlma.
obieqturad: mxedvelobis gamokvleva ver xerxdeba, bavSvis asakisa
da Wirveulobis gamo. marcxena Tvalis kaklis mTlianoba darRveuli ar aris. Tvalis fskeri paTologiuri cvlilebebis
gareSe.
marcxena Tvalbudis areSi aReniSneba mravlobiTi nafleTovani nakbeni Wrilobebi: zeda quTuTos Tavisufali kidis 3
adgilze gaglejiT, Tvalbu dis kuTxeSi Rrma Wriloba – moCans
orbitis Zvlebi.
vinaidan arsebobda saSiSroeba, rom quTuTo Sexorcdeboda
arasworad da gamoiwvevda simaxinjes, gadawyda operaciis gakeTeba zeda quTuTos Tavisufali kidis mTlianobis aRsadgenad
da daedo situaciuri nakerebi WrilobaSi drenaJis CadgmiT.
aRdga quTuTos mTlianoba. gareTa kuTxeSi Rrma Wrilobebi
(Cadioda orbitis Zvlebamde), Caido drenaJi, daedo 3 situaciuri nakeri.
Catarebuli antirabiuli da antibiotiko mkurnalobis Semdgom
binaze janmrTeli gaewera.
139
* * *
dazaralebuli: vaJi n., 12 wlis, 1/VII-9VIII 1994 w., ist. #2612
diagnozi: nafleTovani inficirebuli Wrilobebi marjvena wvivis
areSi, marjvena wvivis orive Zvlis Ria ganivi motexiloba qvemo
mesamedSi cdomiT.
travma miiRo 1/VII-94 dakbina rotveileris jiSis ZaRlma,
romelmac kbenis Semdeg ybebi Sekra 1-2 wuTis ganmavlobaSi,
ramac gamoiwvia marjvena wvivis orive Zvlis Ria motexiloba
qvemo mesamedSi cdomiT.
dazaralebuls zogadi narkoziT gaukeTda operacia _ Wrilobis pirveladi qirurgiuli damuSaveba, ConCxovani daWimva
marjvena quslis Zvlidan.
operaciis Semdgom periodSi utardeboda antibiotiko (ampicilini, linkomicini), madensebilizebeli, vitaminoTerapia antirabiuli profilaqtikuri mkurnaloba.
yoveldRe Sexvevebi antiseptiuri xsnarebiT, fermentebiT sakontrolo rentgenogramaze _ motexili fragmentebis dgoma,
RerZis mxriv, damakmayofilebeli, aRiniSneba susti periostaluri korZis ganviTareba – Zvlebi osteoporozulia _ destruqciis kera ar aReniSneba.
Wrilobis Sexorceba meoradi daWimviT. ConCxovani daWimva
moexsna da daedo TabaSiris cirkularuli naxvevi _ Wrilobis
saproeqcio areSi fanjris datovebiT.
gaewera saxlSi poliklinikis qirurgis meTvalyureobis qveS
saTanado antirabiuli prevenciuli daxmarebis Semdgom.
* * *
dazaralebuli vaJi, 14 wlis, travmatologiuri klinika 13/III99 _ 20VIII-1999 ist. # 275
140
diagnozi: cxenis nakbenis Sedegad miRebuli marcxena winamxris
Zvlebis Ria motexiloba Sua mesamedSi (idayvis Zvlis ormagi)
motexiloba cdomiT, mravlobiTi Wrilobebi winamxarze, sisxlis
mimoqcevis kompensirebuli moSla, sxivisa da idayvis nervebis
travmuli nevriti. mtevnis iSemiuri kontraqtura.
13/VII – 1999 wels travmatologiur klinikaSi miiyvanes
marcxena winamxris areSi Zlier tkivilsa da sisxldenaze
CivilebiT. 3 saaTis win i podromze miiRo travma, dakbina cxenma. mimarTes jer qalaqis me-9 saavadmyofos. iq Wrilobebze
daedo nakerebi, imobilizacia TabaSiris RariT, rentgenografia.
obieqturad: gakerili Wrilobebi marcxena winamxris Sua, wina
da ukana zedapirze, sigrZiT 5 da 4 sm, da sami mcire zomis
1X0,5 sm Wriloba uswormasworo kideebiT. agreTve aRiniSneboda paTologiuri moZraoba motexil fragmentebs Soris. mtevani
civi, cianozuri pulsacia a.radialis ar isinjeba. mgrZnobeloba
Sesustebuli I TiTis areSi. TiTebSi moZraoba SezRuduli.
darCenili Wrilobebi klinikaSi zogadi gautkivarebiT gafarTovda, damuSavda, gakeril Wrilobaze nakerebi moexsna, gakeTda erTmomentiani repozicia da imobilizacia TabaSiris ormxrivi
RariT. Cautarda antibaqteriuli da dezintoqsikaciuri mkurnaloba: klaforani, venaSi metroJili, glukoza, fiziologiuri
xsnari. antitetanuri Srati da anatoqsini, antirabiuli vaqcinacia. konsultacia gauwia nevropaTologma. dadginda marcxena
sxivisa da idayvis nervebis travmuli nevriti – daeniSna trentali, vitamini “C” da prozerini, ris Sedegadac mtevnis kveba
aRdga – darCa TiTebis kontraqtura.
ukeTdeboda Sexvevebi, kiduris Sesiveba nawilobriv dacxra,
Wrilobebi xorcdeba meoradad.
saTanado antirabiuli prevenciis Semdeg gaewera binaze. (foto)
141
* * *
dazaralebuli: mamakaci v., 33 wlis, ist. # 2260
travma miiRo 15/X-2004 w. dakbenila nadirobis dros datora daTvma. dazianebebi aRiniSa marjvena wvivis areSi. orTabrZolis dros monadirem imarjva, mokla cxoveli cecxlsasroli
iaraRiT da gadairCina Tavi.
imave dRes mimarTes Sps aspinZis saavadmyofo-poliklinikur
gaerTianebas. iq gaukeTda antitetanuri Srati, Semdeg ki gamoigzavna q. TbilisSi. 16/X-dan daewyo antirabiuli kombinirebuli mkurnaloba antirabiuli imunoglobuliniTa da vaqciniT.
qalaqis #1 saavadmyofos travmatologiur klinikaSi daisva
diagnozi: daTvis mier miyenebuli Wrilobebi marjvena wvivis
areSi orive Zvlis damsxvreuli motexilobiT qvemo mesamedSi.
marjvena wvivis midamoSi daedo ilizarovis aparati. sasicocxlo CvenebiT Cautarda saTanado antirabiuli prevencia.
* * *
dazaralebuli: mamakaci a., 63w., ist. # 938. 2003 wlis 06
oqtombers akademikos
o. RuduSauris klinikaSi Semovida
tkivilebisa da deformaciis arsebobaze CivilebiT marjvena
winamxris areSi, ZaRlis nakbeni mravlobiTi Wrilobebis arsebobaze CivilebiT orive winamxrisa da mtevnis areSi.
142
gadaRebul rentgenogramebze dafiqsirda marjvena winamxris
Zvlebis (Ria) fragmentovani motexiloba qvemo mesamedSi cdomiT.
zogadi gautkivarebiT gakeTda operacia _ nakbeni Wrilobebis
damuSaveba, marjvena winamxris Zvlebis arakerovani osteosinTezi ilizarovis aparatiT ucxo sxeulis (ZaRlis kbili) amoReba
marjvena sxivis proqsimaluri fragmentidan. Cautarda antirabiuli profilaqtikuri mkurnaloba garTulebebis gareSe.
travmatologiuri klinikidan gaewera janmrTeli.
* * *
dazaralebuli: mamakaci v., 54 wlis, ist. #95.
diagnozi: wina terfis amputirebuli Wriloba, travmuli Soki.
momyoli pirebis ganmartebiT, 3 dRe iyo dakarguli mcxeTis
raionis sof. armazis tyeSi – sapatrulo policiam ipova da
miiyvana mcxeTis raisaavadmyofoSi, iqidan ki respublikur saavadmyofoSi.
zogadi mdgomareoba umZimesi, kontaqtis damyareba SeuZlebelia. sapatrulo policiisagan srulyofili informaciis miReba
ver xerxdeba. aReniSneba kankali, TrTolva, marjvena terfis
midamoSi didi zomis uxeSi danekrozebuli kideebis mqone
inficirebuli Wriloba, Zlier dabinZurebuli. TiTebi amputire143
bulia. WrilobaSi moCans I metatarzaluri Zvlis Tavi. savaraudoa, rom TiTebi moaWames gareulma cxovelebma. orive terfi
cianozuri, civi, moruxo marmariloseburi elferiT. marcxena
terfis TiTebi moyinulia, pulsacia art.dorsalis pedis orive
mxareze ar arsebobs.
pulsacia tibialur arteriebze ar isinjeba, muxlqveSa da
barZayis arteriebze bilateralurad damakmayofilebeli pulsacia. anamnezidan gamomdinare, safiqrebelia moyinva.
obieqturad: marjvena wina terfi amputirebuli, WrilobaSi
warmodgenili daJeJili kideebiT, magram sicocxlisunariani qsovilebiT, darCenili terfis proqsimalur areSi kanis kideebi
dakbilulia, takvis areSi zog ubanze moCans Zvlis wvetiani
fragmentebi quslis areSi, lateralurad SeiniSneba kanis marmarilosebri aforiaqeba. terfis darCenili nawili SexebiT Tbili,
pulsacia muxlqveSa arteriaze isinjeba.
marcxena terfis I da II TiTebi cianozuria marmarilosebri
aforiaqebiT.
avadmyofs Cautarda antirabiuli profilaqtikuri mkurnaloba
garTulebebis gareSe. qirurgiuli mkurnalobis Semdeg pacienti
ganikurna.
* * *
dazaralebuli: vaJi p.
stacionari 8/X 1995 w.
diagnozi: lomis datorili, Wrilobebi orive marjvena wvivisa
da terfis areSi.
obieqturad: marjvena terfis wina zedapirze iribi 7X2,5sm,
3X1 sm, marjvena wvivis zemo mesamedSi 2X1 sm; lateralurad
Sua da qvemo mesamedSi 10X3 sm zomis; marcxena wvivis medialurad 8X3 sm, 4X1,5sm, lateralurad 6X2 sm, 4X1 sm Sua mesamedSi
da 3X1 sm zemo mesamedSi.
144
Wrilobebis anatomiuri mTlianoba aRdgenilia meoradi nakerebiT.
Catarebulia antirabiuli profilaqtikuri mkurnaloba. gaewera
janmrTeli.
* * *
vaJi g. dabadebuli 12.04.1997 w., 4 wlis.
istoriis #3614
diagnozi: mwvave bronqiti (obstruqciuli)
Tanmxlebi movlenebi: 15/IX ZaRlma ukbina marjvena xelis mtevnis
areSi, ZaRli mokvda, cxovelis Tavis tvinis gamokvleviT dadginda cofi.
daiwyo antirabiuli mkurnalobis kombinirebuli kursi imunoglobulini vaqciniT (15/IX). meore vaqcinis gakeTebis Semdeg
(18/IX) Tan daerTo laringotraqeobronqiti da maRali sicxe –
400 da am fonze ganviTarda sunTqvis ukmarisoba. hqonda SeteviTi xasiaTis myefavi xvela, xmis tembri Secvlili, gamoxatuli iyo agzneba. kani sufTa, mkrTali, gulis tonebi moyruebuli,
filtvebSi auskulaciiT mSrali xixini, qoSini. monawileobda
neknTaSua kunTebi. ena Selesili, RviZli 1 sm-iT gamodis neknTa
rkalidan.
145
miuxedavad postvaqcinaluri garTulebisa da hidrofobiis
msgavsi simptomatikisa, antirabiuli mkurnaloba dazaralebuls sasicocxlo CvenebiT gaugrZelda. Catarebuli qmediTi
antirabiuli profilaqtikuri mkurnalobis Sedegad bavSvi gadaurCa hidrofobias da gamojanmrTelebuli gaewera saxlSi.
* * *
dazaralebuli: mamakaci, 50 wlis, istoriis # 2.
2003 wlis 31 dekembers samsaxuris teritoriaze dakbina
monadire ZaRlma marcxena xelis mtevnis I TiTis areSi. 2004
wlis 1 ianvars dazaralebulma mimarTa q. quTaisis samxareo
klinikur saavadmyofos. mimarTvisTanave mimReb ganyofilebaSi
Cvenebisamebr gaukeTda antirabiuli imunoglobulini, romlis
Seyvanis Semdeg ganuviTarda anafilaqsiuri Sokis elviseburi
forma. klinikuri sikvdilis (kani da xiluli lorwovani garsebi
Savi, aReniSneba apnoe, ar reagirebda aranair gaRizianebaze, gugebi
gafarToebuli. pulsi magistralur arteriebze ar isinjeboda.
wneva ar izomeba, gulis tonebi ar moismineba) mdgomareobaSi
moTavsda kritikuli medicinisa da intensiuri Terapiis ganyofilebaSi.
avadmyofs dauyonebliv Cautarda traqeis intubacia, gadayvanil iqna marTviT sunTqvaze. paralelurad daewyo gulis arapirdapiri masaJi. gulis RruSi gaukeTda: Sol. CaCl 10%+Sol.
Adrenalini 0,1 %-1,0. Cautarda agreTve marjvena laviwqveSa venis
kaTeterizacia – didi dozebiT ukeTdeboda kortikosteroidebi, utardeboda monitoringi. Cautarda defibrilacia.
miuxedavad reanimaciuli RonisZiebebisa, 1/I-04 1805 sT-ze dafiqsirda biologiuri sikvdili.
diagnozi: anafilaqsiuri Soki IV xarisxi – terminaluri
mdgomareoba – klinikuri sikvdili.
damkbeni cxoveli sakarantino drois gasvlis Semdeg cocxali,
janmrTeli.
* * *
dazaralebuli: qali, 22 w., istoriis #2187
2002 wlis 6 agvistos mimarTa q. Tbilisis infeqciuri paTologiis, Sidsisa da klinikuri imunologiis samecniero praq146
tikul centrs q. rusTavis centraluri saavadmyofos mimarTviT, diagnoziT mwvave mielopoliradikulonevriti?. poliradikuloneiropaTiis diagnoziT moTavsda neiroinfeqciur
ganyofilebaSi da daewyo Sesabamisi mkurnaloba. meore dRes,
dilis 6 saaTidan, avadmyofi cofis klinikuri niSnebiT (hidrofobia, aerofobia) gadaiyvanes boqsirebul ganyofilebaSi. rogorc
anemnezidan irkveva, klinikaSi avadmyofi Semovida daavadebis me4 dRes. daavadeba daewyo tkiviliT marcxena terfis I TiTis
areSi (sadac 1 Tvis win ukbina ZaRlis lekvma). obieqturad
aRiniSneba sisxlnaJRenTi lokalurad.
sagulisxmoa is garemoeba, rom cnobebi damkbeni cxovelis
mdgomareobaze araerTgvarovani iyo, rac antirabiuli imunoglobulinis Seyvanis mizezi gaxda. utardeboda hormonoTerapia. mdgomareoba ar gaumjobesda, agznebam moimata, SfoTavda,
hqonda uZiloba, halucinaciebi, grZeldeboda hidro da aerofobia. specifikur mkurnalobas daemata sasowarkveTis Terapia
(diazepami, aminazini). miuxedavad patronebis dabejiTebiTi mtkicebisa damkbeni cxovelis uvneblobis Sesaxeb, hidrofobiis
diagnozi eWvs aranairad ar iwvevda.
mdgomareoba gauaresda, gamoixata qvemo kidurebis sruli dambla, sakvebs da siTxes ar Rebulobda, gamoixata sunTqvisa da
gul-sisxlZarRvTa sistemis mwvave ukmarisoba. 10/VIII 410 sT-ze
gauCerda guli da sunTqva, Catarebulma reanimaciulma RonisZiebebma Sedegi ver gamoiRo da dafiqsirda sikvdili.
* * *
dazaralebuli: vaJi, 13 wlis.
diagnozi: cofiani ZaRlis mier nakbeni Wriloba marcxena
wvivis areSi.
1993 w. 16/XII dakbina ZaRlma, romelic mokvda. mikroskopuli
pasuxi cofze uaryofiTi, biocdaze 21-dReze dadginda cofi.
zestafonis regionis antirabiulma samedicino samsaxurma ver
aiRo Tavis Tavze cofis prevencia, mTavari eqimisa da raionis
mesveurebis TanxlebiT mogvmarTes Cven (25-e dRes), dagvianebiT
Cautarda warmatebuli antirabiuli mkurnaloba.
147
* * *
dazaralebuli: vaJi, 10 Tvis, stacionarSi Semovida 11/X-91
w.-s, ist. #8536.
diagnozi: gareuli Roris nakbeni inficirebuli Wrilobebi
marcxena mtevnis II-III-IV TiTebis areSi safrCxile falangebis
amputaciiT, mravlobiTi eqskoriaciebi marcxena winamxris areSi.
travma miiRo 11/X-1991 w.-s – dakbenilia sofelSi, tyis piras
mdebare saxlSi, gareuli Roris mier, marcxena mtevnis areSi.
bavSvi miiyvanes raisavaadmyofoSi, saidanac mimarTviT gamoigzavna antirabiul centrSi.
zogadi mdgomareoba Semosvlisas mZime. simZime ganpirobebuli
intoqsikaciiT, nekrozuli anTebebis arsebobiT marcxena mtevnis
midamoSi.
adgilobrivi niSnebi: nakbenis Sedegad marcxena mtevnis II da
III TiTebis safrCxile falangebi amputirebuli, aRiniSneba Rrma
Wrilobebi marcxena xelis gulis areSi, aqve nekrozuli anTebebi, SeSupeba marcxena mxris midamoSi, mravlobiTi eqskoriaciebi
marcxena winamxris areSi.
dazaralebuls klinikaSi Cautarda Wrilobebis pirveladi
qirurgiuli damuSaveba, antirabiuli da antitetanuri imunizacia; marcxena zeda kiduris imobilizacia krameris artaSniT;
dezintoqsikaciisa da mikrocirkulaciis gaZlierebis mizniT
venaSi wveTovnad hemodezisa da reopoliglukinis xsnarebi; yoveldRe Sexvevebi antiseptikuri xsnarebiT.
Catarebuli mkurnalobis Sedegad dazaralebuli gankurnebuli gaewera saxlSi.
* * *
dazaralebuli: gogo T., 2 wlis, ist. # 3434. Semovida 12/X/
95 w.-s, gankurnebuli gaewera 3/XI/95w.-s.
dianozi: cxenis nakbeni nafleTovani Wriloba piris kuTxesa
da marjvena loyis areSi rbili qsovilebis defeqtiT.
travma miiRo 12/X-95w. – dakbina mezoblis cxenma.
zogadi mdgomareoba saSualo simZimis. SemosvlisTanave da
SemdgomSi, 3 dRis ganmavlobaSi, nakbeni Wrilobis damuSaveba
xdeboda sapniani wylis WavliT. savaraudo cofis virusis meqanikurad gamoZevebis mizniT Cautarda antirabiuli da antiteta148
nuri imunoTerapia. 16/X-95 w. zogadi narkoziT gaukeTda operacia _ nakbeni Wrilobis gakerva da plastika. aRedgina piris
Rrus lorwovani piris kuTxemde – defeqti daifara kaniT.
operaciisSemdgomi periodi – gaurTuleblad. gaewera gankurnebuli.
miuxedavad mcirewlovani bavSvis saxis areSi nakbeni Wrilobis didi defeqtisa, saqarTvelos cofis mxriv arakeTilsaimedo
zonad gamocxadebis gamo, Cvenebisamebr 3 dRe (virusis cxovelmyofelobis vada) utardeboda antirabiuli RonisZiebebi,
xolo Semdgom gaukeTda nakbeni Wrilobebis plastika (`jer
sicocxle, Semdeg silamaze~). aRedgina piris Rrus lorwovani
piris kuTxemde, defeqti daifara kaniT.
operaciis Semdgomi periodi _ gaurTuleblad. gaewera gankurnebuli.
es iyo antirabiuli centris istoriaSi 2 wlis bavSvis cxenis
mier dakbenis erTaderTi SemTxveva.
* * *
dazaralebuli: vaJi d., 12 wlis, ist. #641.
diagnozi: lomis nakbeni mravlobiTi nafleTovani Wrilobebi
marcxena Txem-safeTqlisa da loyis areSi, marjvena Tvalbudisa
da yuris areSi, skalpireburi Wriloba marjvena winamxris wina
zedapirze.
travma miiRo 15/I 1989 w.-s. moiyvanes manqaniT Sokur mdgomareobaSi q. Tbilisis bavSvTa #2 klinikur saavadmyofoSi. Semosvlamde 1 saaTiT adre moskovis moZravi zoocirkis lomis galiaSi bavSvs Seuvarda moneta, romlis gamosatanad man xeli
Seyo aRniSnul sivrceSi, lomma miayena mravlobiTi nakbeni Wriloba.
Semosvlisas reaqcia gaRizianebaze susti, araswori da dagvianebuli pasuxi SekiTxvebze. Zlieri sisxldena marcxena loyaze
arsebuli Wrilobebidan.
149
gaukeTda saswrafo operacia – Wrilobis pirveladi qirurgiuli damuSaveba zogadi narkozis qveS. operaciis dros nanaxi iqna, rom dazianebuli iyo zeda ybis arteria art.maxilaris,
romelic gadaikvanZa, sisxldena SeuCerda. arsebuli Wrilobebis
anatomiuri mTlianoba aRdga situaciuri nakerebiT - atravmuli nemsiT. Cautarda antirabiuli da antitetanuri imunizacia.
gaukeTda antigangrenozuli Srati. 5/II 89 w. saTanado momzadebis Semdeg Cautarda operacia _ kanis gadanergva marjvena winamxris
wina zedapirze winaswar momzadebuli sadonoro ubnidan (marjvena barZayis wina da medialuri zedapiri).
operaciis Semdgom periodSi Cautarda infuzioTerapia - mdgomareoba gaumjobesda. gadanergili kanis SeuTavsebloba ar aRiniSneba. gaewera binaze gankurnebuli.
150
mizanSewonilad migvaCnia warmogidginoT nakbeni
Wrilobebis saintereso SemTxvevebi da maTi
mkurnalobis Sedegebi
1. suraTi #1 (a, b, g, d) dakbenili qali, 44 wlis.
Wrilobebi zeda tuCsa da marcxena loyaze. Cautarda antirabiuli profilaqtika da dazianebis midamos plastika.
(damkbeni cxoveli _ kavkasiuri nagazi).
2. suraTi #2 (a, b, g) dakbenili vaJi, 7 wlis.
Wrilobebi marjvena Txemis, kefis, marjvena yuris areSi, kiserze.
Cautarda antirabiuli profilaqtika da Wrilobebis plastika - me-4 dRes (damkbeni cxoveli - kavkasiuri nagazi).
151
3. suraTi #3 (a, b, g) dakbenili vaJi, 5 wlis.
Wrilobebi nikapis, loyis, kisris areSi, mtevanze. Cautarda
antirabiuli profilaqtika da Wrilobebis plastika dazianebidan – me-4 dRes (damkbeni cxoveli _ rotveileri).
4. suraTi #4 (a,b) dakbenili gogo, 8 wlis.
Wrilobebi marcxena loyaze. Cautarda antirabiuli profilaqtika da Wrilobis kosmetikuri plastika dazianebidan me-4 dRes
(damkbeni cxoveli _ quCis ZaRli).
152
5. suraTi #5 (a,b) cofiani ZaRlis mier dakbenili vaJi, 11
wlis.
Wrilobebi marjvena Tvalbudis (defeqtiT) da Txem-Sublis
areSi marjvniv. Cautarda antirabiuli profilaqtika da Wrilobis plastika (damkbeni cxoveli _ quCis cofiani ZaRli).
6. suraTi #6 (a,b) dakbenili gogo, 5 wlis.
Wrilobebi marjvena Tvalbudis qveda areSi, cxvirze, loyaze.
Cautarda antirabiuli profilaqtika da Wrilobebis plastika
(damkbeni cxoveli _ monadire ZaRli, pointeri).
153
7. suraTi #7 (a, b, g) dakbenili gogo, 6 wlis.
nafleTovani Wriloba marjvena loyis areSi. Cautarda antirabiuli profilaqtika da Wrilobis plastika me-4 dRes (damkbeni cxoveli _ quCis ZaRli).
8. suraTi #8 (a, b, g) dakbenili vaJi, 2 wlis.
Wrilobebi saxis areSi. Cautarda antirabiuli profilaqtika
da Wrilobebis plastika (damkbeni cxoveli _ quCis ZaRli).
154
9. suraTi # 9 (a, b, g, d) dakbenili gogo, 5 wlis.
Wrilobebi marjvena loyis, cxvirisa da tuCis areSi. Cautarda antirabiuli profilaqtika da Wrilobebis plastika (damkbeni
cxoveli - quCis ZaRli)
155
10. suraTi # 10 (a, b, g) dakbenili vaJi, 5 wlis.
Wrilobebi marcxena loyis areSi. Cautarda antirabiuli
profilaqtika da Wrilobebis plastika me-3, me-4 dRes (damkbeni cxoveli _ quCis ZaRli).
11. suraTi #11 (a,b) dakbenili vaJi, 10 wlis.
Wriloba skrotumze, Cautarda antirabiuli profilaqtika da
Wriloba Sexorcda meoradad (damkbeni cxoveli _ quCis ZaRli).
156
12. suraTi #12 (a, b, g, d) dakbenili vaJi, 12 wlis.
Wriloba skrotumze (saTesle parkze), Cautarda antirabiuli
profilaqtika da Wrilobis plastika (damkbeni cxoveli _
quCis ZaRli).
13. suraTi # 13 (a,b) dakbenili vaJi, 13 wlis.
Wriloba koW-wvivis areSi marjvniv, daCirqebiT. Cautarda antirabiuli profilaqtika, me – 10 dRes gakeTda plastika
(damkbeni cxoveli _ quCis ZaRli).
157
14. suraTi # 14 (a, b, g, d, e, v, z) dakbenili vaJi, 4 wlis.
nafleTovani GWrilobebi Txemis, Sublis, safeTqlis, kefis midamoSi. Cautarda antirabiuli profilaqtika.
Wrilobebis
plastika (damkbeni cxoveli _ kavkasiuri
nagazi).
158
15. suraTi #15 (a, b, g) dakbenili gogo, 15 wlis.
Wrilobebi da hematoma marjvena barZayis ukana zedapirze.
Cautarda antirabiuli profilaqtika. Sexorceba meoradad (damkbeni _ kavkasiuri nagazi).
16. suraTi #16 dakbenili biWi, 1,5 wlis.
lokaluri alergiuli reaqcia antirabiuli vaqcinaciis Semdgom
(damkbeni cxoveli _ kata).
159
17. suraTi #17 dakbenili biWi, 14 wlis.
alergiuli reaqcia antirabiuli vaqcinaciis Semdgom (damkbeni cxoveli _ zazuna).
18. suraTi #18 (a, b, g) dakbenili biWi, 12 wlis.
Sratismieri daavadeba antirabiuli vaqcinaciis Semdgom (damkbeni
cxoveli _ quCis ZaRli).
160
19. suraTi (a,b) dakbenili mamakaci, 50 wlis.
cofiani ZaRlis mier dakbenili. ganuviTarda hidrofobia
acrebis Cautareblobis fonze. gamosavali letaluri.
1. sur. #1(a, b, g, d) dazaralebuli gogo, 10 wlis.
nafleTovani Wrilobebi saxis areSi, marcxniv. gaikera regionSi, pirvel dRes _ rac Secdomaa. Wriloba daCirqda. TbilisSi
mkurnalobis paralelurad Wrilobis aRdgena moxda me-5 dRes.
Cautarda antirabiuli profilaqtika.
161
2. sur. #2 dazaralebuli biWi, 1,5 wlis.
marjvena yuris niJara moWmulia ZaRlis mier
(damkbeni cxoveli _ mawanwala ZaRli).
plastika, antirabiuli profilaqtika.
3. sur. #3 dazaralebuli biWi, 2 wlis.
tuCis da nikapis midamoSi nafleTovani Wriloba miyenebulia
cxenis mier. Wriloba aRdga me-4 dRes. antirabiuli profilaqtika.
162
4. sur. #4 dazaralebuli axalgazrda qali, 25 wlis.
ZaRlis mier miyenebuli Wriloba marcxena wvivis areSi orsulobis me-9 Tveze. sasicocxlo CvenebiT (damkbeni cxoveli
cofiania) Cautarda antirabiuli warmatebuli profilaqtika.
5. sur.#5 dazaralebuli gogo, 9 wlis.
dakbena marjvena loyis areSi (damkbeni cxoveli _ ZaRli).
Wrilobis plastika. antirabiuli profilaqtika.
163
6. sur. #6 dazaralebuli vaJi, 12 wlis.
alergiuli reaqcia, ZaRlis nakbenis gamo. Cautarda profilaqtika antirabiuli mkurnalobis Semdeg.
7. sur. #7 (a,b) dazaralebuli gogo, 2 wlis.
nafleTovani Wriloba saxis areSi, marjvniv (damkbeni cxoveli
_ mawanwala ZaRli).
8. sur. #8 (a, b) dazaralebuli gogo, 8 wlis.
Wriloba saxis areSi, marjvniv. gaikera pirvel dRes raionSi,
rac Secdomaa. Wriloba daCirqda. TbilisSi mkurnalobis paralelurad me-6 dRes gakeTda Wrilobis plastika.
164
9. sur. #9 dazaralebuli gogo, 6 wlis.
nakbeni Wrilobis xSiri lokalizacia.
165
Tavi III
cofsawinaaRmdego samedicino RonisZiebaTa
istoria saqarTveloSi
1. Tbilisis pasteris sadguris Seqmna da muSaoba (1888-1982
w.w.)
saqarTveloSi antirabiuli (cofis sawinaaRmdego) samsaxurs,
q. Tbilisis samxedro samedicino laboratoriaSi daarsebul
pasteris sadgurs, romelic erTaderTi iyo kavkasiaSi, safuZveli
Caeyara 1888 wels lui pasteris mowafis, eqim i. finkelSteinis
mier (msoflioSi pirveli pasteris instituti daarsda parizSi 1885 wels).
1925 wels Tbilisis pasteris sadguris bazaze cnobili qarTveli mecnieris, giorgi eliavas, xelmZRvanelobiT Seiqmna samecniero-sawarmo gaerTianeba ,,baqteriofagi~ antirabiuli acrebis
Catarebis SenarCunebiT.
saqarTveloSi pasteris sadguris daarseba nakarnaxevi iyo
imdroindeli epizootiuri da epidemiologiuri viTarebiT. c.
maCitiZis (1972w.) cnobiT, 1888 wlidan 1913 wlamde saqarTveloSi
cxovelebSi laboratoriulad dadginda cofis 2493 SemTxveva.
Semdegi farTo epizootia cofisa saqarTveloSi me-20 saukuneSi aRiricxa. 1925 wlidan 1931 wlamde registrirebuli iyo
cofiT daavadebis 1454 SemTxveva.
saqarTveloSi cofiT daavadebis oficialuri registracia
mimdinareobs XIX saukunis bolodan, 1888 wlidan, anu mas Semdeg,
rac q. Tbilisis samxedro-samedicino laboratoriis bazaze Camoyalibda pasteris sadguri, romelic atarebda antirabiul acrebs.
amierkavkasiis veterinaruli sazogadoebis monacemebiT, aRniSnul regionSi XX saukunis dasawyisSi cofiT daavadeba didad
gavrcelda. 1889 wlidan 1909 wlamde registrirebulia cofis
182 SemTxveva, xolo 559 SemTxvevaSi dadginda pirutyvis cofi.
1889-1910 wlebSi Tbilisisa da quTaisis guberniebSi aRmoCnda
305 Tavi cofiT daavadebuli pirutyvi. Tbilisis samxedrosamedicino laboratoriis 1888-1891 w.w. klinikis monacemebiT,
paTologiur-anatomiuri kvlevisa da laboratoriuli gamokv166
levebis Sedegad cxovelebs Soris dafiqsirda cofiT daavadebis 345 SemTxveva.
gansakuTrebiT aRsaniSnavia cofiT daavadebis monacemebi gareul
cxovelebs Soris. amasTan, es monacemebi exeba im SemTxvevebs,
rodesac aRmoCenilebi iyvnen gareuli cxovelebis mier dakbenili adamianebi. 1895-dan 1913 wlis CaTvliT Tbilisis samxedrosamedicino laboratoriis klinikam Caatara cofis sawinaaRmdego acrebi dazaralebulebze, romlebic dakbenilebi iyvnen
cofiani mglis (69 dazaralebuli), turis (13 adamiani), meliebis ( 10 adamiani) da sxvadasxva cxovelebis mier.
saqarTveloSi cofis epidemiis mesame afeTqeba dafiqsirda
1939-1942 wlebSi, rodesac gacofebuli cxovelebis saerTo
raodenobam 246_s miaRwia.
saqarTveloSi ZaRlebis gegmiuri profilaqtikuri vaqcinacia
1943 wlidan mimdinareobs, xolo 1946 wlidan dainerga
sasoflo_sameurneo cxovelebis iZulebiTi vaqcinacia.
1943-1946 w.w.-Si cofiT daavadeba sagrZnoblad Semcirda, rac
dakavSirebuli iyo Sinauri cxovelebis mniSvnelovan SemcirebasTan II msoflio omis wlebSi.
saqarTveloSi bolo, omisSemdgomi, epozootia daiwyo 1947
wels, rodesac cofis 242 SemTxveva daregistrirda. SemdgomSi
ki daavadeba ufro gaizarda 1951-1952 w.w.-Si (136-142 SemTxveva), aseve 1958, 1959, 1960 w.w.-Si (127, 149 da 131 SemTxveva).
cofis geografiul gavrcelebasTan dakavSirebiT aRsaniSnavia
is faqti, rom rogorc 80 wlis win, aseve axlandel droSi
keTilsaimedo iyo respublikis centraluri da dasavleTi raionebi. amierkavkasiis veterinaruli sazogadoebis monacemebiT, 80ian wlebSi XIX saukunisa da XX saukunis dasawyisSi farTo
gavrceleba hpova cofiT daavadebam Tbilisis, quTaisis, baTumis
guberniebSi da soxumis olqSi. XX saukunis bolo wlebSi
cofiT daavadeba gavrcelda raionebSi, romlebic ganlagebulia
Tbilisis gareSemo (mcxeTa, kaspi, gori, xaSuri, cxinvali da
sxva).
respublikis CrdiloeTi (mestia, lentexi, cageri, ambrolauri,
oni) da samxreT raionebi (dmanisi, bolnisi, axalqalaqi, axalcixe) iyo da rCeba raionebad, romlebSic daregistrirda cofiT
daavadebis calkeuli SemTxvevebi.
167
amgvarad, saqarTveloSi bolo 80 wlis ganmavlobaSi cofiT
daavadeba daregistrirda adgilebSi, romlebic mosaxleobiT
mWidrod aris dasaxlebuli. sadac amasTan dakavSirebiT Catarebuli dakvirvebis Sedegad cofis SemTxvevebis maRali raodenoba aRmoCnda xorcismWamel Sinaur cxovelebs Soris, gansakuTrebiT
ZaRlebSi.
Cvens respublikaSi cofTan gegmiuri brZola mimdinareobs
gasuli saukunis 50-iani wlebis dasawyisidan, rodesac cofTan
brZolis sakiTxebi cxovelTa Soris mTlianad gadaeca veterinarul samsaxurs (saqarTvelos soflis meurneobis saministros brZanebuleba @#2-231 31 oqtomberi 1956 w.).
amasTan dakavSirebiT 1955-1959 wlebSi TbilisSi, soxumSi,
baTumSi, rusTavSi, cxinvalSi, borjomSi, gagraSi, foTSi, tyibulSi
gaixsna veterinarul-sanitaruli sadgurebi, romlebic uzrunvelyofda mawanwala ZaRlebis daWerasa da likvidacias. aseve
atarebda profilaqtikur antirabiul acrebs.
aRsaniSnavia, rom 1953 wlamde cxovelebis cofis sawinaaRmdego profilaqtikuri vaqcinacia saqarTvelos respublikaSi ar
atarebda masiur saxes. mTel respublikaSi vaqcinirebuli cxovelebis raodenoba wlis ganmavlobaSi ar aRemateboda 4687325-s. 1956 wlidan vaqcinirebul cxovelTa raodenoba sagrZnoblad gaizarda: 1956 wels aicra 32 372, 1960 w-s 104522 da
1964w-s 127527 cxoveli, maT Soris 115804 Sinauri ZaRli.
veterinarul-sanitaruli sadgurebis organizebam, mawanwala
cxovelebis daWeris samuSaoebis mxriv, mdgomareoba sagrZnoblad gaaumjobesa. Tu respublikaSi 1954 wels daWerili iyo
2969 mawanwala cxoveli, 1960 wels daWeril cxovelTa raodenobam 45437-s miaRwia.
cofTan brZolis erT-erT ganyofilebas warmoadgens saqarTvelos respublikis veterinaluri laboratoriis virusuli ganyofileba, romlis winaSec dasmuli iyo sakiTxi cofis diagnostikis aTvisebisa da praqtikaSi danergvis axali daCqarebuli,
maRalefeqturi meTodebis gamoyenebiT.
veterinariis doqtoris r. avalianis monacemebiT (1995 w.),
1955 wels qarTvelma veterinarebma, kerZod: i. jamruliZem, g.
WeliZem, a. kaWaxiZem, m. samaTaSvilma sabWoTa kavSirSi erT-erTma
pirvelTaganebma SeimuSaves cofis sawinaaRmdego vaqcinebis li168
ofizirebis meTodika rabiologiaSi. aRniSnul meTodikas didi
mniSvneloba hqonda antirabiuli vaqcinebis imunogenuri da fizikoqimiuri Tvisebebis stabilurobis SenarCunebisaTvis yovelgvar
klimatur pirobebSi.
rac Seexeba evropaSi cofis epizootiur situaciis Sefasebas,
ar gamarTlda 1966 wels q. beiruTSi SedarebiTi paTologiis
msoflio VII kongresze gamoTqmuli prognozi imis Taobaze, rom
evropis kontinentze 1970-1980 wlebSi cofis daavadebis warmavali periodi iqneboda, moxda piriqiT, evropis yvela qveyanaSi
am wlebSi gagrZelda da dResac grZeldeba tyis cofis didi
intensivobiT gavrceleba.
epizootologTa analiziT, evropaSi cofis epizootis fronti farTovdeba weliwadSi 30-40 kilometris siCqariT. misi
ZiriTadi mizezi Warbad momravlebuli meliaa, mecnier-rabiologTa
safuZvliani daskvnebiT, swored meliis saerTo raodenobis 7080% Semcirebis Sedegad moxdeba cofis mxriv arakeTilsaimedo
stacionaluri kerebis gaCenis aRkveTa. am mizniT, bunebaSi cofis
infeqciis rezervuarTa mosaspobad da gareuli cxovelebis raodenobis Sesamcireblad, wlebis ganmavlobaSi farTod gatarebul
RonisZiebebs _ cecxlsasroli iaraRiT daxocva, xafangebi, Sxamebi, hormonaluri preparatebi _ bolo periodSi daemata aRniSnuli cxovelebis vaqcinacia oraluri meTodiT. pirveli didi
masStaburi sawarmoo gamocda Catarda 1978 wels Sveicariis
alpur zonaSi, Semdgom periodSi germaniaSi, amerikasa da bevr
sxva mowinave qveyanaSi.
antirabiuli imunizacia oraluri meTodiT 1987-1991 wlebSi
saqarTvelos 5 regionSic Catarda (c. maCitiZe, g. gulievi).
vaqcinad gamoiyenes `vnukovo – 32~, satyuarad _ qaTmis Tavi da
xorcis burTulebi. acrebidan 3 Tvis Semdeg mokluli 7 meliisa da 2 turas sisxlis SratSi aRmoCnda Seqmnili imunitetis
damadasturebeli specifikuri antisxeulebi.
169
2. qveynis antirabiuli qirurgiuli samsaxuris Camoyalibeba da misi Semdgomi saqmianoba (1982 wlidan dRemde)
bolo 27 wlis ganmavlobaSi mniSvnelovani klinikuri
gamocdileba dagrovda nakbeni Wrilobebis qirurgiul mkurnalobasa da cofis prevenciaSi, rac aucileblad waadgeba rogorc
qveynis rabiologiur qirurgiul samsaxurs, aseve dazaralebul
mosaxleobas.
qronologiurad mogvyavs qveynis antirabiuli qirurgiuli
samsaxuris Camoyalibebisa da misi Semdgomi saqmianobis mniSvnelovani TariRebi:
1982 wels bavSvTa #1 klinikuri saavadmyofos bazaze Camoyalibda qveynis pirveli antirabiuli qirurgiuli samsaxuri
(nacvlad imave wels likvidirebuli pasteris sadguris antirabiuli daxmarebis samsaxurisa, sadac epidemiologebis mier
tardeboda mxolod antirabiuli acrebi, xolo nakbeni Wrilobebis samkurnalod dazaralebulebi igzavnebodnen qirurgebTan);
saqarTvelos janmrTelobis dacvis saministros 1975 wlis 6
oqtombris #597 brZanebiT eqim-qirurgebs nakbeni Wrilobebis
mkurnalobasTan da tetanusis profilaqtikasTan erTad daevalaT antirabiuli acrebis Catarebac. 1987 wlidan aRniSnuli
samsaxuri gadavida q. Tbilisis bavSvTa #2 klinikuri saavadmyofos bazaze.
1993 wels gamomcemloba ,,saqarTvelom~ gamoaqveyna Teimuraz
gogiZis damxmare saxelmZRvanelo ,,nakben WrilobaTa mkurnaloba bavSvebSi~;
170
171
Teimuraz gogiZe
`nakben WrilobaTaA mkurnaloba bavSvebSi~
saqarTvelos respublikis ganaTlebis saministros mier
damtkicebulia damxmare saxelmZRvanelod samedicino
institutis studentebisa da zogadsaganmanaTleblo
skolis moswavleebisaTvis
gamomcemloba `saqarTvelo~
Tbilisi 1993
172
naSromi exeba bavSvTaA qirurgiaSi naklebad Seswavlil
sakiTxs, nakben WrilobaTaA damuSavebasa da mkurnalobis Taviseburebebs, maT specifikur garTulebebs, rogorebicaa tetanusi da,
gansakuTrebiT, cofi, romelic ganukurnebel, sasikvdilo daavadebaTa rigs ganekuTvneba.
mocemulia cofis etiologia, gavrcelebis gzebi, diagnostika,
klinika, nakben WrilobaTa mkurnalobis qirurgiuli taqtika.
warmodgenilia Camoyalibebuli sqemebi, romelTa mixedviTac
unda Catardes profilaqtikuri da samkurnalo acrebi. axsnilia bavSvebSi cofis gavrcelebis mizezebi da misi stacionaluri
mkurnalobis Cvenebebi. naSromi ilustrirebulia sakuTari klinikuri masalis amsaxveli feradi slaidebiT.
winamdebare gamocema xels Seuwyobs eqimTa swor orientacias
am umZimesi daavadebebis profilaqtikuri mkuranalobis sworad
warmarTvis saqmeSi da respublikis mosaxleobis sanitaruli
codnis donis amaRlebas.
recenzentebi:
mecn. damsax. moRvawe, med. mecn. doqtori,
profesori l. avaliani
med. mecn. doqtori, profesori g. Jvania
samecniero redaqtori: docenti c. xecuriani
173
cofis samkurnalo-profilaqtikuri samsaxuri gulisxmobs
rogorc profilaqtikur (dasnebovnebamde), ise samkurnaloprofilaqtikur antirabiul acrebs (aSkara dasnebovnebis an
masze eWvis mitanis SemTxvevaSi) da ra Tqma unda, dakbenili
Wrilobis adgilobriv qirurgiul damuSavebasTan erTad, romelzedac damokidebulia specifikuri mkurnalobis efeqturoba.
cofi veragi daavadebaa. jer erTi imitom, rom yvela daavadebuli iRupeba; meore – cofis klinikuri niSnebis gamovlinebamde, garegnulad janmrTeli daavadebuli cxoveli, romelic garegnulad janmrTelad gamoiyureba, ukve saxifaToa irgvlivmyofTaTvis; mesame – axasiaTebs daavadebis gavrcelebis farTo
speqtri – agznebis periodSi cofiani cxoveli swrafi da agresiulia. did manZilze sirbilisas gzadagza kbens cxovelebsa da
adamianebs, riTac xels uwyobs cofis gavrcelebas; meoTxe –
cofis viruss SeuZlia uxilavad SeaRwios organizmSi dazianebuli kanisa da lorwovanis gziT, rac momakvdinebelia.
mogiTxrobT erT saintereso SemTxvevas:
cofianma ZaRlma bavSvs dauxia palto, magram kbena ver moaxerxa, roca am bavSvis deda mis paltos akerebda, kbilebiT Cawyvita Zafi. qalis dazianebul tuCebSi SeaRwia cofis virusma. 2
Tvis Semdeg qali cofiT mokvda.
antirabiuli acrebis warmateba damokidebulia ara marto
imunitetis Zalaze, aramed misi ganviTarebis vadazec, cofis faruli
periodis gaxangrZlivebaze.
samkurnalo-profilaqtikuri acrebi tardeba sasicocxlo
Cvenebebis mixedviT, maTi ukuCveneba ar arsebobs.
cofis sawinaaRmdego acrebi dazaralebulebs eniSnebaT qirurgis mier, romelmac gaiara specialuri momzadeba rabiologiaSi da aiTvisa antirabiuli mkurnalobis kursi.
samwuxarod, bevrs jer kidev ar esmis, xSir SemTxvevaSi arc
unda gaigos daavadebis veragoba da acrebis aucilebloba, yvelanairad cdiloben Tavi aaridon acrebs an TviTneburad Sewyviton mkurnalobis kursi. giambobT, rogori tragedia mohyva aseT
daudevrobas. 1983 wlis 14 maiss ZaRlma dakbina 9 wlis Tbiliseli bavSvi, romelsac, samedicino personalis mier mravaljeradi axsna-ganmartebis miuxedavad, srulyofilad ar Cautares
antirabiuli acrebis kursi. 1989 wels moxda amis msgavsi 2
174
SemTxveva, orive avadmyofi daiRupa. aseT SemTxvevebSi dauSvebelia avadmyofisa da misi axloblebis uyuradReboba. mosaxleoba
meti gulisyuriT unda ekidebodes samedicino-sanitarul ganaTlebas, rac sazRvargareTis qveynebSi maRal donezea da did
rolsac TamaSobs daavadebaTa Tavidan acilebasa da warmatebiT gankurnebaSi. movitan erT magaliTs: 1985 wels Tbilisis
bavSvTa pirvel saavadmyofoSi movidnen ingliseli moqalaqeebi,
romlebmac katisagan dakbenili 12 wlis Svili moiyvanes. isini
kurort dagomisSi isvenebdnen. dakbenisTanave matarebliT
gamoeSurnen TbilisSi da pirdapir saavadmyofos moakiTxes. es
magaliTi aSkarad miuTiTebs samedicino-sanitaruli ganaTlebisa da sanitaruli kulturis maRal doneze inglisSi.
sworad Catarebuli mkurnalobiT cofiani ZaRlis mier dakbenili 8 wlis WiaTureli bavSvis gadarCenac SevZeliT. cofis
profilaqtikuri mkurnalobis sruli upirobo kursis CatarebiT dazaralebuli gadarCa.
175
respublikis antirabiuli samsaxuris struqtura
საქართველოს ჯანდაცვის სამინისტრო
ქალაქის ჯანდაცვის
რესპ. სანეპიდსადგური
საშიშ ინფექციათა განყოფილება
ქალაქის სანეპიდსადგური
ეპიდემიოლოგიური განყოფილება
სამმართველო
რაიონების
რაიონების სანეპიდსადგურები
მთავარი ექიმები
სტაციონარი
პოლიკლინიკა
მთავარი
mTavari eqimi ექიმი
მთავარი ექიმი
მთ.ექიმის მოადგილე
მთ.ექიმის მოადგილე
ქირურგიული ან ტრავმატოლოგიური
ქირურგიულ კაბინეტთან ან
განყოფილების გამგე
ტრავმპუნქტთან არსებული
ანტირაბიული
სამსახური
ანტირაბიული სამსახური
ქირურგი – რაბიოლოგი
176
ქირურგი – რაბიოლოგი
T. gogiZis mier gamoqveynebuli monografia `nakben WrilobaTa
mkurnaloba bavSvebSi” pirveli cdaa, saqarTveloSi farTod gaSuqebuliyo nakben WrilobaTa mkurnalobis taqtika da is garTulebebi, romlebic nakben Wrilobas SeiZleba mohyves, saxeldobr
cofi da tetanusi. SromaSi mocemulia cofis etiologia, paTogenezi da klinika.
misi profilaqtika da mkurnaloba antirabiuli (cofis sawinaaRmdego) gamaglobuliniTa da vaqciniT, ganxilulia agreTve
tetanusis saswrafo profilaqtika. Sroma uaRresad aqtualuria,
radgan ukanaskneli monacemebiT msoflioSi yovelwliurad iRupeba
50 aTasze meti adamiani.
monografia dawerilia kargi qarTuli eniT, ilustrirebulia
feradi suraTebiTa da cxrilebiT.
saqarTvelos samedicino sazogadoebam miiRo saWiro da metad
sasargeblo naSromi.
profesori a. S. simoniSvili
1994 wels q. Tbilisis bavSvTa Nme-2 klinikuri saavadmyofos
bazaze Seiqmna saqarTvelos antirabiuli sazogadoeba, SemdgomSi saqarTvelos rabiologTa asociacia;
1995 wels jandacvis saministros xelmZRvanelobiT SemuSavda antirabiuli samsaxuris saxelmwifo programa, romelic
SemdgomSi safuZvlad daedo mosaxleobis antirabiuli samedicino daxmarebis programas.
177
saqarTvelos respublika
janmrTelobis dacvis saministro
antirabiuli samsaxuris saxelmwifo
p r o g r a m a
Tbilisi 1995 w.
178
Semdgeneli - eqimi-qirurgi, medicinis mecnierebaTa kandidati,
q. Tbilisis bavSvTa #2 klinikuri saavadmyofos antirabiuli
qirurgiuli samsaxuris xelmZRvaneli, Tbilisis mTavari
rabiologi Teimuraz gogiZe.
antirabiuli samsaxuris saxelmwifo programa
1 winasityvaoba
cofi (rabies, hidrofobia) aTaswleulebis manZilze sasikvdilo
daavadebaTa rigs ganekuTvneba, mis winaSe uZluria msoflio
medicina. jandacvis msoflio organizaciis monacemebiT dedamiwaze
yovelwliurad 60 aTasze meti adamiani iRupeba cofisagan.
cofi saqarTveloSi uxsovari droidan aris cnobili. daavadeba
aRwerilia samedicino da saveterinaro xelnawerebSi –
karabadinebSi.
aRsaniSnavia, rom saqarTvelos medicinis uZveles werilobiT
ZeglSi (kananeli - XI saukune) aRwerilia cofiT daavadebuli
ZaRlebisagan adamianis daavadeba, es maSin, rodesac am mosazrebas
bevri gamoCenili pirovneba, maT Soris berZeni filosofosi
aristotele, uaryofda.
cofis epizootiuri analizi cxadyofs, rom XX saukunis
ormocdaaTian wlebSi daiwyo qalaqis ti pis cofis epizootiis
tyis cofiT Senacvleba. is dRemde grZeldeba da amis gamo
infeqciis fronti dReniadag farTovdeba.
dRevandel damoukidebel saxelmwifoTa Tanamegobrobis 12
qveyanaSi (yofil sabWoTa kavSiris respublikebSi) cofi yvelgan
aris registrirebuli. rac Seexeba saqarTvelos, cofis
epizooturi situaciis gamwvavebaze laparakobs bolo 5 wlis
respublikuri veterinaluri statistika.
1990 wels Cveni qveynis 17 raionSi gamovlinda daavadebebis
22 kera, 1994 wels _ 28 raionSi _ 82 kera (73.0%-ze meti).
Sesabamisad, cofiT daavadda 1990 wels 23 da 1994 wels 95
cxoveli. cofiT daavadebuli cxovelebis (yvela saxis cxoveli)
ricxvi oTxjer gaizarda.
179
cofis epizooturi viTareba msoflioSi ara Tu Senelda, aramed
bolo wlebSi cofis epizootiam globaluri xasiaTi miiRo.
cofis epizootia pirdapirproporciul damokidebulebaSia
hidrofobiis epidemiur viTarebasTan, romelic bolo wlebSi
respublikaSi Zalze daiZaba. magaliTad, 1993 wels saqarTveloSi
hidrofobiiT 4 adamiani daiRupa, xolo 1994 wels 2-jer meti
– 9 adamiani imsxverpla cofma.
dRes msoflios mecnier-rabiologTa SefasebiT, cofiT daavadeba
warmoadgens aramarto cxovelTa
infeqciuri paTologiis
mniSvnelovan Tanamedrove problemas, igi iqca ekologiur,
epizootur, epidemiologiur da, bolo periodSi, ekonomikur
problemadac.
bolo wlebSi msoflioSi yovelwliurad 50 aTasze meti
adamiani da 2 milionamde cxoveli iRupeba cofiT, xolo milionze
meti adamiani iZulebiTi wesiT eqvemdebareba profilaqtikur
vaqcinacias.
saqarTvelos respublikis ministrTa kabinetis 1994 wlis 16
maisis #305 dadgenilebiT `cofTn brZolis gaZlierebis
RonisZiebaTa Sesaxeb~ cxovelebSi cofis kerebis lokalizaciisa
da likvidaciis mizniT dasaxulia farTomasStabiani RonisZiebani.
programis ZiriTadi daniSnulebaa, respublikaSi Seiqmnas cofis
profilaqtikis mwyobri meqanizmi, rac ueWveli sikvdilisagan
gadaarCens mraval adamians, vinaidan, cofis virusiT inficirebuli
dazaralebuli, Tu Tavis droze ar mimarTavs qirurg-rabiologs
da ar Caitarebs masTan antirabiul da qirurgiul mkurnalobas,
ganwirulia sasikvdilod. aRniSnuli garemoeba ki damRupvelad
imoqmedebs isedac mcirericxovani qarTveli eris genofondze.
2. Sesavali
nakbeni Wrilobebi respublikis mosaxleobis xSir mwvave
travmul dazianebaTa rigs miekuTvneba (weliwadSi saSualod
45 000 dakbena). misi Taviseburebaa Wrilobis dabinZureba
cxovelis nerwyviT, romelic Seicavs sxvadasxva mikrobs da maT
Soris, SesaZlebelia, cofis gamomwvev virussac. cofis virusi
adamians gadaedeba daavadebul cxovelTan kontaqtiT (dakbenadadorbvla-dakawvra).
cxovelisgan cofi SeiZleba gadaedos adamians daavadebis faruli
periodis ukanaskneli 10 dRis ganmavlobaSi.
180
cofi, iseve rogorc tetanusi, cimbiris wyluli da Wrilobis
difTeria, mwvave qirurgiuli specifikuri infeqciaa. am umZimesi
sasikvdilo daavadebis gamomwvevi virusi bunebaSi SenarCunebulia
ZaRlis saxeobaTa gareul cxovelebSi, rogoricaa mgeli, mela.
adamianisaTvis saSiSia ara marto cxovelis nakbeni, aramed
nakawri – TaTiT CamofxaWnili. daavadebul kanze mosalodneli
TvaliT uxilavi dazianebis gziT cofis virusi organizmSi
SeiWreba da periferiuli nervuli gzebiT moxvdeba centralur
nervul sistemaSi, Semdeg ki mravldeba Tavis, zurgis tvinis
ujredebSi, sanerwyve jirkvlebis nervul kvanZebsa da sxva
organoebSi.
aRsaniSnavia cofis inkubaciuri periodis farTo sazRvrebi –
7 dRidan 1 wlamde da met xansac ki.
problemebis aqtualobidan gamomdinare, respublikaSi 1994
wels Seiqmna antirabiuli sazogadoeba (registracia #1469,
prezidenti – med. mecn. kand. T. gogiZe).
3. problemis formireba (aqtualoba)
cxovelebis mier dazianebuli adamianebis cofis sawinaaRmdego
samkurnalo profilaqtikuri efeqturi imunizacia Tanamedrove
medicinis erT-erTi yvelaze aqtualuri problemaa. hidrofobia,
anu wylis SiSi, umZimesi daavadebaa, romelsac letalur
gamosavlamde mihyavs adamiani.
aRsaniSnavia, rom cofis sawinaaRmdego samkurnalo acrebis
Catareba
dRemde aradamakmayofilebelia, rac ganapirobebs
letalobis sakmaod did sixSires (yovelwliurad 50 aTasze
meti adamiani, jandacvis msoflio organizaciis monacemebiT),
saqarTveloSi gasul wels cxovelis mier dakbenili 9 dazaralebuli mokvda hidrofobiiT, cxovelebSi ki vetlaboratoriis
mier 95 SemTxvevaSi dafiqsirda cofi.
cofiT avadoba ufro bavSvebSi SeimCneva, vidre mozrdilebSi.
es cxovelebTan bavSvebis aqtiuri urTierTobebiT aixsneba. amitom
saWiroa, zogadsaganmanaTleblo skolebis, umaRlesi da saSualo
specialuri samedicino saswavleblebis moswavle-studentobisa
da maTi mSoblebis sanitaruli codnis donis amaRlebas seriozuli
yuradReba mieqces; biologiuri disci plinebis programebSi
ramdenime saaTi daeTmos nakbeni Wrilobis mrisxane garTulebas
_ cofs.
181
4. monacemebi qveynis Sesaxeb
saqarTvelo msoflioSi erT-erTi uZvelesi qveyanaa, daaxloebiT
sami-oTxi aTasi wlis winaT qarTveli xalxis Soreul winaprebs
ukve hqondaT Tavisi sakuTari saxe.
- misi teritoria 70 000 kvad/km Seadgens;
- mosaxleoba 5 400 000-ze metia;
- dedaqalaqi _ Tbilisi;
- erovnuli Semadgenloba: qarTveli, rusi, somexi, azerbaijaneli,
berZeni, ukraineli, ebraeli, germaneli, qurTi da sxva;
- ZiriTadi religia – qristianuli (marTmadidebluri).
5. specifikuri monacemebi qveynis faunis Sesaxeb
saqarTvelos cxovelTa samyaro mravalferovania – ZuZumwovrebis 100-mde saxeoba, frinvelebis 330-ze meti saxeoba da
sxva. tyis zonas saqarTveloSi sakmaod vrceli farTobi ukavia. igi respublikis dasavleT nawilSi kavkasiis samxreT kalTebze
iwyeba da maWiswyalze (lagodexis maxloblad) mTavrdeba. ZuZumwovrebidan aRsaniSnavia: Rori, Sveli, iremi da mgeli, romelic
TiTqmis yvelgan aris. mravalganaa tura, kavkasiuri mTis mela,
maCvi. alpur zonaSi, kavkasionis mTamaRalze, binadroben jixvebi.
tyeebsa da tyispirebSi mravladaa kurdReli.
amrigad, saqarTvelos faunisaTvis damaxasiaTebeli mravalferovneba, simravle da tyis zonis farTobi (qveynis teritoriis
40%-mde tyiTaa dafaruli), xelsayrel pirobebs uqmnis cofis
bunebriv rezervuars.
6. programis marTva da Semsruleblebi
programas xelmZRvanelobs jandacvis saministro (samedicino
programebis mTavari sammarTvelo), meToduri xelmZRvaneloba
da koordinacia Catardeba respublikis antirabiuli sazogadoebis mier (koordinatori – medicinis mecnierebaTa kandidati T. gogiZe).
programis SesrulebaSi mTavari mniSvneloba mieniWeba antirabiuli samsaxuris Seqmna-ganmtkicebas.
programis SesrulebaSi monawileobs antirabiuli samsaxuris
mqone yvela saavadmyofo da ambulatoriul-poliklinikuri
dawesebuleba, epidemiologiuri respublikuri sesis gansakuTrebiT saSiS infeqciaTa ganyofileba da veterinaruli samsaxurebi, saWiroebisamebr unda CaerTon xelisuflebis organoebi.
182
infrastruqtura
antirabiul samsaxurze pasuxismgebeli eqimi-qirurgi da mis
mier rabiologiaSi gadamzadebuli eqTani da sanitari.
programis Sesrulebis ZiriTad meqanizms warmoadgens sami
ZiriTadi rgolis: samkurnalo, epidemiologiuri da veterinaruli
samsaxuris mwyobri, urTierTSeTanxmebuli muSaoba.
7. programis biujeti (ZiriTadi maCveneblebi)
programis biujeti mocemulia programis bolos. masSi
mocemulia xelfasis fondis odenoba, teqnikuri bazis
gaaqtiurebisaTvis dasaxarji finansebi, medikamentebi (danarTi
#1), mivlinebis Tanxebi da waxalisebis fondebi, romlebic
ZiriTadad uzrunvelyofili iqneba saqarTvelos jandacvis
saministrosa da respublikuri antirabiuli sazogadoebis mier.
8. programis mizani
cofis gavrcelebis sawinaaRmdego farTo profilaqtikis,
mkurnalobis organizebisa da koordinaciis gziT rabiuli
infeqciis gakontroleba da misi Semdgomi likvidacia. antirabiuli
samsaxuris muSaobis srulyofa, misi maRal doneze dayeneba.
9. ZiriTadi amocanebi
- respublikaSi cofis sawinaaRmdego farTo sanitaruli
propaganda (presa, radio, televizia, literaturis gavrceleba);
- nakbeni Wrilobebis mkurnalobis gaumjobeseba, samecniero
kvlevis xelSewyoba;
- cofis problemis irgvliv statistikuri da ekonomikuri
kvleva, monitoringi;
- saganmanaTleblo meTodebis SemuSaveba, arsebulis srulyofa
mosaxleobaSi cofsa da tetanusze warmodgenis Sesaqmnelad;
- daavadebis sawinaaRmdego samkurnalo-profilaqtikuri
preparatebis SemotanaSi aqtiuri monawileoba qveyanaSi
saxelmwifo Tu ara saxelmwifo struqturebTan erTad:
- antirabiuli preparatebis operatiuli da diferencirebuli
(sxvadasxva raionsa Tu qalaqSi epidsituaciis gaTvaliswinebiT)
ganawileba;
- cofTan dakavSirebul saerTaSoriso programebSi monawileoba;
- qalaqis meriebsa da raionebis gamgeblebTan erTad upatrono
ZaRlebis problemis mosagvareblad erTiani taqtikis SemuSaveba;
- perspeqtivaSi saqarTveloSi antirabiuli vaqcinis gamoSveba.
183
10. ZiriTadi strategiebi
qveynis axalgazrdobis sanitarul-saganmanaTleblo codnis
donis asamaRleblad zogadsaganmanaTleblo skolebis moswavleebis, umaRlesi da saSualo specialuri samedicino saswavleblebis studentTaTvis gankuTvnil saswavlo disci plinebSi
arsebul naklebad Seswavlilsa da gaSuqebul sakiTxs nakben
WrilobaTa da maT garTulebaTa sferoSi srulad Seavsebs T.
gogiZis 1993 wels gamocemuli damxmare saxelmZRvanelo `nakben WrilobaTa mkurnaloba bavSvebSi~.
cxovelebis mier dazaralebulis momarTvis yvela etapze
saWiroa saavadmyofo da ambulatoriul-poliklinikur dawesebulebaSi iyos nakbeni Wrilobebis mkurnalobis erTiani qirurgiuli taqtika. Wrilobebis pirveladi damuSaveba sapniani
wylis WavliT, maTi ar gakerva 3 dRis ganmavlobaSi, sasicocxlo
Cvenebis garda (ix. instruqcia).
samecniero kvlevis Catareba Tanamedrove doneze da miRebuli
Sedegebis danergva nakbeni Wrilobebisa da maTi garTulebebis
mkurnalobis gaumjobesebis mizniT.
cofiT avadobis sruli likvidacia Sinaur cxovelebs Soris
realuria da, upirvels yovlisa, mosaxleobis sanitarul doneze, Segnebulobasa da moqalaqeobriv aqtivobaze iqneba damokidebuli.
maRalkvalificiurad Catarebuli antirabiuli imunizacia
efeqturia.
saWiroa cofis sawinaaRmdego samsaxurSi momuSave pirTa
kvalifikaciis amaRleba.
mosaxleoba, miznobrivi jgufebi:
a) ZaRlis damWerebi, veterinalur sadiagnostiko laboratoriis TanamSromlebi (profilaqtikuri vaqcinacia);
b) skolamdeli asakis bavSvebi da moswavle axalgazrdoba
cxovelebTan maTi aqtiuri urTierTobis gamo;
g) cxovelebis mier dazaralebuli soflad mcxovrebni, romelTa
umravlesoba ar mimarTavs samedicino daxmarebas.
11. RonisZiebebi
- cofis likvidaciisaTvis
saWiroa qveynis antirabiuli
sazogadoebis, mosaxleobis jandacvis organoebis, veterinaruli
184
samsaxuris, qalaqebis meriebisa da raionis gamgeobebis, policiis,
monadireTa kavSirisa da komunaluri samsaxuris gaerTianebuli
RonisZiebebi ministrTa kabinetis xelmZRvanelobiT.
- yvela saavadmyofo da ambulatorul-poliklinikuri
dawesebuleba pirvel samedicino daxmarebas (sapniani wylis WavliT
damuSaveba) gauwevs im pirebs, romlebic mimarTaven maT yovelgvari
cxovelis dakbenis, dakawvris an dadorbvlis gamo.
cofis sawinaaRmdego imunizacia Catardeba mxolod antirabiuli
mkurnalobisaTvis gamoyofil qalaqisa Tu raionis poliklinikebis qirurgiul kabinetSi (danarTi #2).
adamianebTan kontaqtSi myof cocxal cxovelebze dawesdeba
veteqimis 10 dRiani sakarantino zedamxedveloba. cofis niSnebis
mqone cxovelebi ki unda daixocon tyviiT, amis Sesaxeb ecnobeba
vetdawesebulebas. veterinaruli muSakebis mier daavadebis keraSi
tardeba dezinfeqcia
da sxva epizooturi RonisZiebebi.
cxovelebis leSi gadaitaneba vetlaboratoriaSi paTologoanatomiuri gakveTis, histologiuri da virusologiuri
gamokvlevisaTvis masalis aRebis mizniT.
epidsituaciebisa da resursebis Sefaseba:
- respublika cofis mxriv arakeTilsaimedo, gansakuTrebiT
dasavleT saqarTvelos regionebi;
- daavadebis ZiriTadi epidmaCveneblebi: respublikaSi cxovelebis
mier dazaralebulTaA ricxvi yovelwliurad saSualod 15 000
Seadgens, dedaqalaqSi ki dakbeniliTa raodenoba 3000 aRwevs;
- riskis jgufs Seadgenen bavSvebi, rac ZaRlebTan maTi aqtiuri
urTierTobiT aixsneba da soflad mcxovrebni, romlebic
statistikuri monacemebiT, cxovelebisagan miRebuli travmebis
Semdeg samedicino daxmarebas ar mimarTaven: ZaRlis damWerebi,
samecniero kvleviTi da diagnostikuri laboratoriebis
TanamSromlebi, romlebic muSaoben cxovelebis paTmasalaze cofis
virusis dadgenaze.
- materialur teqnikuri baza: Senoba-nagebobebi, samedicino
aparaturis aRWurviloba, erTjeradi sargeblobis instrumentebi,
Sesaxvevi masala, samkurnalo preparatebi, Sesabamisoba moTxovnasa
da momaragebas Soris;
- inteleqtualuri resursebi: eqimTa da sxva medpersonalis
raodenoba, swavlebis sistema aRniSnul dargSi, momzadebis done,
185
maTi daxelovneba, maRalkvalificiuroba, diagnostikis, mkurnalobisa
da profilaqtikis efeqturoba, eqim-rabiologTa kvalifikaciis
amaRlebis mizniT seminarebis sistematurad Catareba, seminarebi,
meTodgaerTianebis sxdomebi, Ria mecadineobebi, gamocdilebis
gaziarebis mizniT damwyebi rabiologebis mimagreba gamocdil
rabiologTan;
- qveynis antirabiuli samsaxuris muSaobas xelmZRvanelobs
janmrTelobis dacvis saministros mTavari rabiologikoordinatori, romelsac exmarebian qalaqebisa da regionebis
mTavari rabiologebi;
- specialuri literatura qarTul enaze Raribia, rac imiT
aixsneba, rom rabiologiur Teoriul-samecniero sferoSi
faqtiurad mxolod ramdenime specialisti muSaobs;
- jerovani yuradReba ar eqceva mosaxleobaSi rabiologiuri
codnis propagandas. dazaralebulma unda mimarTos mxolod
qirurg-rabiologs, sxva SemTxvevaSi savalalo Sedegi gveqneba;
- rabiologiis sferoSi momuSaveTa simravlis miuxedavd, ar
arsebobs erTiani centraluri sabazo samsaxuri, romelic Tavs
mouyris da gaaerTianebs qirurg-rabiologebs, rabiologiaSi
momuSave pirebs, rabiologebs, warmarTavs maT muSaobas,
uxelmZRvanelebs da saWiro SemTxvevaSi moaxdens saTanado
koregirebas;
- rabiologTa atestaciis Catareba xels Seuwyobs maTi
pasuxismgeblobis amaRlebas da xels SeuSlis dekvalifikacias.
daavadebis gavrcelebis ZiriTadi xelSemwyobi faqtorebi
1. daavadebis gavrcelebis ZiriTadi faqtorebia gareul da
Sinaur cxovelebs Soris da maTgan adamianebSi cofis virusis
cirkulacia. jaWvi ar wydeba, virusi cirkulirebs;
2. monadireTa mier gareuli cxovelebis ganadgureba ar xdeba,
Sinauri cxovelebis acris sakiTxebis mougvarebloba, moxetiale
da upatrono ZaRlebis ganadgurebis erTiani sistemis ararseboba
da maTi kontaqti adamianebTan xels uwyobs cofis gavrcelebas;
3. moxetiale ZaRlebisa da katebis katastrofuli zrda;
4. sanitarul-saganmanaTleblo muSaobis arasistematurad da
dabal doneze Catareba.
186
ZiriTadi dabrkolebebi programis Sesrulebis gzaze
1. aradamakmayofilebelia mawanwala ZaRlebisa da upatrono
katebis saerTo regulirebis RonisZiebebi, ris gamoc yovelwliurad izrdeba am cxovelebiT dakbenilTa da dakawrulTa
ricxvi;
2. ar xdeba Sinauri cxovelebis zusti registracia da
srulyofili profilaqtikuri acrebi;
3. epizootiis bunebrivi kerebis arseboba gareul cxovelebSi;
4. ver xerxdeba ZaRlebis Senaxvis wesebis mkacri Sesruleba,
moxetiale ZaRlebisa da katebis sistematuri gamoWera;
5. ar xdeba cofis drouli gamocnoba leSis gamokvlevis
laboratoriuli meTodebis saSualebiT;
6. infeqciis kerebis gauvnebovnebis arasrulyofili RonisZiebebi (maT Soris TiToeul dakbenilze drouli da amomwuravi
informacia);
7. arasakmarisi materialur-teqnikuri baza (aparatura, reaqtivebi, transporti, sawvavi da sxva).
ZiriTadi resursebi
inteleqtualuri resursebi: cofis profilaqtikur mkurnalobas
dauflebuli eqimi-qirurgebi, rabiologiaSi maT mier gadamzadebuli damxmare samedicino personali, epid da vetsamsaxuris
TanamSromlebi, qveynis antirabiul sazogadoebaSi gaerTianebuli
aqtiuri poziciis mqone moqalaqeTa jgufebi.
187
188
პოლიკლინ
ქირურგი–
რაბიოლობი
პასუხისმგებელი
იკა
ქირურგი–რაბიოლოგი
სტაციონარები
სამსახურის მქონე
ეპიდგანყოფილე
ბა
. ს.ე.ს.
ბა
ეპიდგანყოფილე
ა
განყოფილებ
ინფექციათა
ით საშიშ
განსაკუთრებ
საზღვარგარეთის
კავშირი
ლეშის აღოჩენა და სხვა
(პრემია) ეგერების მიერ
ტვინის გამოკვლევა
ცოფზე
განადგურების საკითხი
ცხოველის თავის
გარეული ცხოველების
მონადირეთა
ანტირაბიულ პროგრამაში
მონაწილეობა
თანამშრომლობა,
ურთიერთობა–
და სხვადასხვა სახის
საზოგადოებებთან
ანალოგიურ სტრუქტურებსა
რია
ადგილობრივი
მმართველობის ორგანოები
მუშაობა
სან. საგანმანათლებლო
რეგიონალური ჯგუფები
ანტირაბიული საზოგადოება
ვეტლაბორატო
დაწესება ცხოველზე
10 დღიანი კარანტინის
ლო
ვეტ.სამკურნა
რაიონ
ქალაქ
. ს.ე.ს.
ს.ე.ს
კოორდინატორი
ანტირაბიული
რესპ.
რეგიონის
სამსახურის
სანიტარული
დეპარტამენტი
რესპუბლიკი
ანტირაბიული
მედიცინის
სამინისტრო
დეპარტამენტი
ვეტერინარული
საქართველოს ჯანდაცვის
qveynis antirabiuli samsaxuris struqtura
Sefasebis sistema da monitoringi
amocana RoniZieba
skolis moswavleebis,
studentebis, yvela
asakis mosaxleobis
sanitarulsaganmanaTleblo
codnis donis amaRleba
cofis profilaqtikis
sakiTxebSi
maCvenebeli
monitoringisaTvis
Catarebuli kursebis,
leqciebis, gakveTilebis,
saubrebis, seminarebis
raodenoba, dabeWdili
gavrcelebuli
TvalsaCinoebis raodenoba
efeqtianobis
kriteriumi
cofiT avadobis
kleba cxovelebSi,
Semcireba da
Semdgomi
likvidacia
adamianebSi.
procedura
statistikuri
masalis
damuSaveba,
gamokiTxva
specialur
kiTxvarTa
meSveobiT.
samuSao gegma
#
RonisZiebebis dasaxeleba
1
skolamdeli asakis
aRsazrdelebisaTvis
saganmanaTleblo muSaobis
programis SemuSaveba
skolis moswavleTaTvis umaRlesi
saswavleblebis studentebisaTvis
Tematuri saswavlo-meToduri
literaturisaA da
TvalsaCinoebis momzadeba
T. gogiZis cofis problemis
amsaxveli damxmare
saxelmZRvanelos `nakben
WrilobaTa mkurnaloba bavSvebSi~
Setana zogadsaganmanaTleblo
skolebis, umaRlesi da
saSualo specialuri samedicino
saswavleblebis saswavlo
programebSi
respublikis mosaxleobis farTo
fenebis informireba (sawarmoodawesebulebebi) cofis
profilaqtikis sakiTxze
leqcia-seminaris saxiT.
yovelwliurad qirurgrabiologTa TaTbir-seminarebi
gamocdilebis gaziarebis mizniT
qirurgebis kvalifikaciis
amaRlebis mizniT rabiologiis
sakiTxebis Setana samedicino
institutis zogadi qirurgiis
kursSi, eqimTaA daxelovnebis
institutSi
2
3
4
5
6
Sesrulebis vada,
Tve, weli
pasuxismgebeli organizacia
12.95
jandacvis saministro,
antirabiuli sazogadoeba,
ganaTlebis saministro.
12.96
jandacvis sam., ganaTlebis
sam., antirabiuli
sazogadoeba, beWdviTi
sityvisaA da
gamomcemlobaTa komiteti.
12.95-2000
jandacvis saministro,
antirabiuli sazogadoeba,
ganaTlebis saministro
yovelwliurad
1995-2000
antirabiuli sazogadoeba
yovelwliurad
1995-2000
jandacvis saministro
jandacvis saministro
12.95
189
7
policiis komunalur
dawesebulebaTa, monadireTa
kavSiris, satyeo nakrZalebis
muSakebisaTvis codnis amaRlebis
mizniT specialuri leqciebis
Catareba TvalsaCinoebiT, raTa am
uwyebebis yvela muSaki gaecnos
cofis etiologiis
epidemiologias.
cxovelTa mier
dazaralebulebisagan
sazogadoebrivi aqtivobis Seqmna
da maTi muSaobis sworad
warmarTva
8
sanitaruli departamenti
antirabiuli sazogadoeba
12. 95-2000
antirabiuli sazogadoeba
12.95-2000
teqnikuri proeqti
programis Sesasruleblad saWiro materialur faseulobaTa
da RonisZiebaTa Rirebuleba
#
danaxarjis saxe
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
person. kompiuteri
printeri
qir. oper. nakrebi
slaidoskopi
saproeqcio ekrani
saswarafo daxmarebis manqana
televizori
saoperacio magida
samanipulacio magida
samedicino karada
macivari
saweri magida
skami
savarZeli
samedicino taxti
damxmare samedicino magida
Taroebi wignis
Sokis sawinaaRmdego afTiaqi
zomis
erTeuli
cali
cali
cali
cali
cali
cali
cali
cali
cali
cali
cali
cali
cali
cali
cali
cali
cali
cali
saWiro
raodenoba
1
1
3
1
1
1
1
3
5
5
5
3
24
5
3
3
10
50
190
Rirebuleba
dro
1000-1200
250-400
1200
150-60
8-10
8000
250-350
900
500
500
3500
250
720
500
300
150
100
7500
96-97
96-97
96
96-97
96-97
96-97
96-97
96-98
96-98
96-98
96-98
96-97
96-97
96-97
96-97
96-98
96-98
96-99
danarTi #1
nakbeni Wriloba (saSualo da mZime xarisxis, II-III kategoria –
pirobiTi kursi)
raodenoba: wlis manZilze – 100
operacia Wrilobis pirveladi damuSaveba
dRis stacionari
gamokvlevebi
raodenoba
fasi (aSS dolari US $)
konsultacia
(nevropaTologi,
alergologi, Terapevti)
mkurnaloba
1
0.800
1. paracetamoli M 24
2. ampicilini # 66
3 hipertonuli xsnari
MM 286
4. spirti M 323
5. Sprici erTjeradi
M 320
6. antitetanuri
anatoqsini
7. antirabiuli vaqcina
erTeuli
doza
raodenoba
abi
fl
1 ml
500 mg
500 mg
10 %
2
20
100
fasi (aSS
dolari)
0.050
0.126
0.600
100
2
3.00
0.100
1 ml.
2 ml.
amp
1.0
1
1.250
1 kompleqti
3.0
2
5.00
gamokvlevisa da mkurnalobis Rirebulebis jami = 10.926 US $
nakbeni Wriloba (msubuqi xarisxis, I kategoria- upirobo kursi)
raodenoba 1 wlis manZilze – 30
Wrilobis specifikuri damuSaveba
dRis stacionari
gamokvlevebi
raodenoba
fasi aSS dolari UUS $
konsultacia
(nervopaTologi,
alergologi, Terapevti)
mkurnaloba
1
0.800
1. paracetamoli M 24
2. ampicilini M 66
3 spirti MM 323
4. Sprici erTjeradi
M 320
5. antirabiuli vaqcina
erTeuli
doza
raodenoba
abi
fl
1 ml
5 ml.
500 mg
500 mg
4
2120
100100
1009
fasi aSS
dolari
0.100
0.756
3.000
0.567
1 kompleqti
3.0
29
22.5000
gamokvlevisa da mkurnalobis fasi = 27.723 US $
191
nakbeni Wrilobebis (saSualo xarisxis, II a kategoria- upirobo
kursi) dainiSneba 1 wlis manZilze
operacia – Wrilobis pirveladi damuSaveba
dRis stacionari.
gamokvlevebi
konsultacia (nevropaTologi,
alergologi, Terapevti)
mkurnaloba
1. paracetamoli # 24
2. ampicilini # 66
3 spirti MM 323
4. Sprici erTjeradi M 352
5. antirabiuli vaqcina
6. antitetanuri anatoqsini M
250
raodenoba
fasi aSS dolari UUS $
1
0.800
seriuli
abi
fl
1 ml
5 ml.
1
kompleqti
amp
doza
500 mg
500 mg
10%
3.0
raodenoba
4
12
100
1009
14
fasi aSS dolari
0.10
0.756
3.000
0.88
35.000
1.0
1
1.250
gamokvlevisa da mkurnalobis fasi = 41,788 US $
nakbeni Wriloba (saSualo xarisxis, II b
kategoria-upirobo kursi)
daniSnuleba 1 wlis manZilze – 20
operacia – Wrilobis pirveladi damuSaveba
dRis stacionari
gamokvlevebi
konsultacia (nevrpaTologi,
alergologi, Terapevti)
mkurnaloba
1. paracetamoli M 24
2. ampicilini M 66
3 spirti MM 323
4. Sprici erTjeradi M 352
5. antirabiuli vaqcina
6.antitetanuri anatoqsini M 250
7. Sprici erTjeradi M 320
raodenoba
fasi aSS dolari UUS $
1
0.800
seriuli
doza
raodenoba
abi
fl
1 ml
5 ml.
1 kompleqti
amp
2 ml
500 mg
500 mg
4
20
100
22
42
1
20
3.0
1.0
gamokvlevisa da mkurnalobis fasi + 113.796 US $
192
fasi aSS
dolari
0.100
1.260
3.000
1.000
1.386
105.000
1.250
nakbeni Wriloba mZime xarisxis III
kategoria-upirobo kursi
raodenoba 1 wlis manZilze – 25
operaciaTa-Wrilobis pirveladi damuSaveba
sanol-dReebi
#
1
gamokvlevebi
sisxlis saerTo analizi
raodenoba
1
fasi US $
0.400
1
0.800
raodenoba fasi US $
6
0.150
20
1.260
100
0.600
100
3.00
2
0.126
3
0.150
20
1.000
40
2.520
6
0.300
1
0.025
2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
mkurnaloba
paracetamoli M 24
ampicilini M66
hipertonuli xsnari M 286
spirti M 323
bandi steriluri M317
bandi arasteriluri M 318
Sprici erTjeradi M320
Sprici erTjeradi M352
antihistaminuri (prometazini) M 10
tetanusis sawinaaRmdego
imunoglobulini (Srati) M 246
antitetanuri anatoqsini M250
antirabiuli vaqcina
antirabiuli gamaglobulini M262
prednizoloni M35
adrenalini M33
leikoplastiri
erTeuli
abi
fl
1 ml
1 ml
Sekvra
2 ml
5 ml.
doza
500 mg
500 mg
10%
abi
fl
25 mg
500 erT
amp
1 kom
fl
amp
amp
1 sm
sigrZis
1.0
3.0
100 erT
20mb/ml
1 mb/ml
1
48
1
1
1
200
gamokvlevisa da mkurnalobis fasi=135.241 US $
193
1.250
120.000
0.750
0.375
0.375
2.000
1996 wels 18 noembris jandacvis ministris #544/o brZanebiT ,,cofTan brZolis RonisZiebaTa gaZlierebis Sesaxeb~ q.
Tbilisis #2 bavSvTa mravalprofiluri saavadmyofos bazaze
Seiqmna antirabiuli samedicino daxmarebis centri;
194
195
amonaweri brZanebidan #544/o
saqarTvelos janmrTelobis dacvis saministrosadmi
18.11.1996w.
cofTan brZolis gaZlierebis RonisZiebaTa Sesaxeb
ukanasknel wlebSi qveyanaSi Zalze daiZaba cofis epizootiuri viTareba, tyis ti pis cofis epizootiis qalaqis ti pis
cofTan Senacvlebis xarjze.
saqarTveloSi cofis gadamdeb cxovelTa mravalferovneba (ZuZumwovrebis 100-mde saxeoba) da tyis zonis vrceli farTobi
(qveynis teritoriis 40%-mde) xelsayrel pirobebs uqmnis cofis
bunebriv rezervuars.
cofis epizootiuri situaciis gamwvavebaze miuTiTebs ukanaskneli wlebis statistikac. 1990 wels qveynis 17 raionSi
gamovlinda daavadebis 22 kera, 1994 wels ki 28 raionSi – 82
kera. Sesabamisad gaizarda cofiT daavadebuli cxovelebis raodenobac. 1996 wels vetsamsaxuris mier laboratoriulad dadasturebulia cofis SemTxveva 22 qalaqsa da raionSi.
cofis epizootia pirdapirproporciul damokidebulebaSia
epidemiur viTarebasTan, romelic bolo wlebSi sakmaod damZimda. ase magaliTad, 1994-95 wlebSi daavadda 18 adamiani, xolo
wels ukve _ 17.
arsebuli mdgomareoba kidev ufro daZaba da sagangaSo gaxada
im garemoebam, rom dasaxlebul adgilebSi katastrofulad momravlda upatrono, mawanwala cxovelebi, xolo upatrono cxovelebis raodenobis zrdis paralelurad, yovelwliurad izrdeba
dakbenil-dadorblil-dakawrul pirTa raodenobac, romelTa Soris
umetesoba bavSvebi da moxucebia.
miuxedavad jandacvis saministros araerTi mimarTvisa, rogorc
q. Tbilisis, aseve mravali regionisa da raionis xelmZRvanelobas jerac ar SeuZenia vaqcina da ar gautarebia saqarTvelos
respublikis ministrTa kabinetis 1994 wlis 16 maisis #305
dadgenilebiT gaTvaliswinebuli gadaudebuli RonisZiebebi. am
situaciaSi gadamWreli roli eniWeba, erTi mxriv, dasaxlebuli
punqtebis gawmendas upatrono, mawanwala cxovelebisagan da Sinauri cxovelebis masobriv acrebs, xolo meore mxriv, dakbenildadorblil-dakawrul pirTa droul gamovlinebas da pirvelad
196
samedicino daxmarebas, dazaralebulTa Soris saTanado profilaqtikuri RonisZiebebis gatarebas, rasac emsaxureba qveynis samkurnalo-profilaqtikur dawesebulebebSi moqmedi antirabiuli
kabinetebi.
aRniSnuli kabinetebis gamarTuli funqcionirebisaTvis mizanSewonilia Seiqmnas antirabiuli samedicino daxmarebis centri,
romelic qveynis samkurnalo dawesebulebebs meTodur-organizaciul da praqtikul daxmarebas gauwevs cofis profilaqtikis
saqmeSi.
zemoT aRniSnulis gaTvaliswinebiT:
v a m t k i c e b:
1. antirabiuli samedicino daxmarebis centris debulebas
(danarTi #1).
2. mosaxleobis antirabiuli samkurnalo-profilaqtikuri
imunizaciis sqemas (danarTi #2).
3. cxovelebis mier dazianebul (dakbenil, dadorblil, dakawrul)
pirTa pirveladi samedicino daxmarebis RonisZiebaTa moculobas (danarTi #3).
4. antirabiuli vaqcinaciis droebiT standartebs (danarTi
#4).
5. antirabiuli vaqcinebis ganawilebis sqemas (danarTi #5)
v b r Z a n e b:
1.0. daevalos samedicino programebis marTvis da sazogadoebrivi jandacvis departamentebs 1997 wlis municipaluri programebis savaldebulo minimumSi Seitanon cofis profilaqtikuri mkurnaloba. vaqcinebis Rirebuleba anazRaurdes Sesabamisi raionebis jandacvis fondebidan.
2.0. daevalos wamlisa da farmaciis departaments (batoni r.
maxaraZe), uzrunvelyos raionebis jandacvis fondebidan Semosuli TanxebiT vaqcinebis maragis ganaxleba.
3.0. mimdinare wlis bolomde cofis sawinaaRmdego vaqcinaciis Rirebuleba, vaqcinis fasis gamoklebiT, anazRaurdes janmrTelobis dacvis saxelmwifo fondidan, katastrofebisa da rezervebis
programidan sazogadoebrivi jandacvis departamentis moTxovnis safuZvelze.
197
4.0. q. Tbilisis bavSvTa #2 saavadmyofos bazaze Seiqmnas
antirabiuli samedicino daxmarebis centri.
5.0 centris xelmZRvanelad dainiSnos medicinis mecnierebaTa
kandidati, q. Tbilisis mTavari rabiologi Teimuraz gogiZe.
6.0. daevalos antirabiuli samedicino daxmarebis centris
xelmZRvanels, baton T. S. gogiZes, uzrunvelyos:
- centris muSaoba damtkicebuli debulebis Sesabamisad;
- qveynis samkurnalo-profilaqtikur dawesebulebebSi moqmed
antirabiul kabinetebze meTodur-organizaciuli da praqtikuli daxmareba, maTi saTanado instruqciebiT, debulebebiT, samkurnalo-profilaqtikuri sqemebiT da samaxsovroebiT momarageba,
samedicino personalis profesiuli momzadeba;
- cofis sawinaaRmdego profilaqtikuri RonisZiebebis propaganda da saganmanaTleblo muSaoba masobrivi sainformacio saSualebis farTod gamoyenebiT;
- antirabiuli samsaxuris muSaobis Sesaxeb informaciis warmodgena saqarTvelos janmrTelobis dacvis saministros samedicino programis marTvis departamentSi weliwadSi 2-jer; cofiT
gardacvlilebis yvela SemTxveva moamzados kolegiis sxdomaze
gansaxilvelad.
7.0. daevalos q. Tbilisis bavSvTa #2 savadmyofos mTavar
eqims, baton j. onians:
- gaataros organizaciuli xasiaTis RonisZiebebi centris
Seuferxebeli Camoyalibebisa da misi Semdgomi normaluri funqcionirebisaTvis.
8.0. daevalos aWarisa da afxazeTis avtonomiuri respublikebis jandacvis ministrebs (b-bi a. beriZe, e. beria), q. Tbilisis
jandacvis mTavari sammarTvelos ufross (b-ni v. doborjginiZe),
jandacvis marTvis samxareo centrebis direqtorebs (q-ni d.
Selia, b-bi g. gozaliSvili, a. ComaxaSvili, b. Zagania, v. beTlemiZe,
z. jalabaZe, n. SafaTava, l. baiajani, v. yufunia, v. vekua, a. murusiZe):
8.1. uzrunvelyon maT daqvemdebarebaSi myof ambulatoriulpoliklinikur da samkurnalo dawesebulebamde informaciis dayvana
q. Tbilisis bavSvTa #2 saavadmyofos bazaze antirabiuli samedicino daxmarebis centris Seqmnis Sesaxeb.
8.2. daamyaron mudmivi da mkacri kontroli maT daqvemdebarebaSi myof samedicino dawesebulebebSi moqmedi antirabiuli kab198
inetebisa da samsaxurebis muSaobaze, cofis sawinaaRmdego
profilaqtikuri RonisZiebebis droulad da xarisxianad Catarebaze, mosaxleobis antirabiuli samkurnalo-profilaqtikuri
imunizaciis warmoebaze aRniSnuli brZanebiT damtkicebuli sqemis Sesabamisad.
8.3. sazogadoebrivi jandacvis departaments raionebisa da
qalaqebis mixedviT yovelTviurad warudginon informacia samedicino dawesebulebebis mier gatarebuli cofis sawinaaRmdego
RonisZiebebis Sesaxeb.
8.4. cofze saeWvo diagnoziT gardacvalebis yvela SemTxvevaSi uzrunvelyon paTologiuri masalis gadagzavna respublikur
vetlaboratoriaSi, diagnozis dazustebis SemTxvevaSi ki _ masalebis gadacema sagamoZiebo organoebisaTvis.
8.5. uzrunvelyon cofis sawinaaRmdego vaqcinis gatana da
samoqmedo teritoriebze antirabiuli kabinetebis Seuferxebeli momarageba (TandarTuli ganawilebis mixedviT) danarTi #5.
8.6. antirabiuli samedicino daxmarebis centrTan SeTanxmebiT,
mosaxleobis antirabiuli daxmarebis gaumjobesebis mizniT, uzrunvelyon cofis sawinaaRmdego vaqcinaciis gatarebaze brZanebiT
gamoyofili samedicino personalis profesiuli momzadebis donis
amaRleba centris bazaze;
9.0. daisvas sakiTxi soflis meurneobisa da kvebis mrewvelobis ministris winaSe (batoni b. gulua):
- weliwadSi orjer warudginos informacia qveyanaSi cofis
gavrcelebasa da epizootiuri viTarebis Sesaxeb janmrTelobis
dacvis saministros moTxovnis Sesabamisad;
10.0. daisvas sakiTxi aWarisa da afxazeTis avtonomiuri
respublikebis qalaqebis meriebis, mmarTvelobis adgilobrivi
organoebis xelmZRvanelebis winaSe gaataron qmediTi RonisZiebebi maTdami daqvemdebarebul teritoriebze saqarTvelos ministrTa kabinetis 1994 wlis 16 maisis # 305 dadgenilebis pirobebis uTuo SesrulebisaTvis;
11.0. kontroli aRniSnuli brZanebis Sesrulebaze daevalos
ministris pirvel moadgiles baton vl. giorgaZes.
ministri:
sworia:
a. jorbenaZe
q. fanqvelaSvili
199
danarTi #1
debuleba
antirabiuli samedicino daxmarebis centris Sesaxeb
zogadi debuleba
1. antirabiuli samedicino daxmarebis centri iqmneba mravalprofiluri klinikuri saavadmyofos bazaze;
2. centris xelmZRvanelad iniSneba maRalkvalificiuri specialisti qirurgiuli rabiologiis dargSi;
3. centris xelmZRvanels niSnavs da aTavisuflebs janmrTelobis dacvis ministri;
4. centris muSaoba xorcieldeba saqarTvelos jandacvis
ministris mier damtkicebuli gegmis mixedviT da eqvemdebareba
janmrTelobis dacvis zemdgom organoebs;
5. centri Tavis saqmianobaSi xelmZRvanelobs damtkicebuli
debulebiT.
miznebi da amocanebi
1. centris saqmianobis ZiriTad mizans warmoadgens qveyanaSi
cofis sawinaaRmdego profilaqtikis, mkurnalobis organizeba
da Sesabamisi samsaxuris koordinireba infeqciis Semdgomi likvidaciisaTvis;
2. cofis sawinaaRmdego farTo sanitaruli propaganda (presa,
radio, televizia, literaturis gavrceleba);
3. nakbeni Wrilobebis mkurnalobis wesebis srulyofa;
4. qalaqebsa da raionebSi cofis sawinaaRmdego samsaxurisaTvis organizaciuli, meToduri da praqtikuli daxmarebis
aRmoCena;
5. meToduri rekomendaciebisa da specialuri saxelmZRvaneloebis Sedgena qirurgiuli rabiologiis sferoSi;
6. nakbeni Wrilobebis qirurgiuli mkurnalobisa da antirabiuli imunizaciis uaxlesi meTodebis aTviseba, gamoyeneba, daxvewa
da SeZlebisdagvarad modificireba;
7. samecniero-praqtikuli xasiaTis konferenciebis, sesiebisa da simpoziumebis organizeba.
200
centrs gaaCnia ufleba
1. Seiswavlos samedicino dawesebulebebSi moqmedi antirabiuli samsaxuris mdgomareoba da saWiroebisamebr moaxsenos
jandacvis saministrosa da adgilobrivi jandacvis organoebs;
2. miiRos monawileoba zemdgom organoebSi cofis, rogorc
socialurad saSiSi daavadebis, problemebsa da maTi Tavidan
acilebis RonisZiebis dasaxvis sakiTxis dayenebaSi;
3. isargeblos saqarTvelos jandacvis saministros mier
damtkicebuli statistikuri angariSiT, pirveladi samedicino
dokumentaciiT;
4. saqarTvelos jandacvis saministros Sesabamis struqturul qveganyofilebebTan SeTanxmebiT isargeblos da adgilobrivi organoebidan moiTxovos damatebiTi informacia antirabiuli daxmarebis Sesrulebis mdgomareobaze;
misces rekomendaciebi janmrTelobis dacvis adgilobrivi
organoebis xelmZRvanelebs antirabiuli daxmarebis gaumjobesebis
201
202
3
2
1
1
#
mZime
saSualo
simZimis
2
msubuqi
simZimis
dazianebis
kategoria
b) nebismieri Wriloba miyenebuli gareuli
cxovelebis mier – Ramurebis CaTvliT
a) nebismieri nakbeni Wriloba an nakawri,
mravalobiTi Rrma dazianebebi saxis, Tavis,
kisris, xelis mtevnis TiTebis da sxeulis sxva
danarCeni nawilis, miyenebuli Sinauri
cxovelebis mier
b) zerele erTeuli nakbeni an nakawri xelis
mtevnis, Rrma erTeuli dazianeba mxris,
winamxris, tanis, qveda kidurebis, miyenebuli
Sinauri cxovelebis mier, uxvi dadorbvla
(alokva) dauzianebeli xelis mtevnis.
a) dadorbvla dauzianebeli lorwovanis, zerele
erTeuli nakbeni Wriloba mxris, winamxris, qveda
kidurebis, tanis areSi Sinauri cxovelebis mier
miyenebuli. eWvi dauzianebeli xelis mtevnis da
TiTebis dadorbvlaze
3
dadorbvla, dauzianebeli kanis safarvelis,
erTeuli nakawri, kanis mTlianobis zerele
dazianeba, mxris, winamxris, qveda kidurebis an
tanis areSi miyenebuli, Sinauri cxovelis mier.
cofiT daavadebuli cxovelis Termulad
daumuSavebeli xorcis sakvebad gamoyeneba.
kontaqtis xasiaTi
janmrTeli
daavadda
cofiT, mokvda,
daikarga
janmrTeli
daavadda
cofiT, mokvda,
daikarga
janmrTeli
daavadda
cofiT, mokvda,
daikarga
janmrTeli
daavadda
cofiT, mokvda,
daikarga
janmrTeli
dakbenis
momenti
4
janmrTeli
daavadda
cofiT,
mokvda,
daikarga
janmrTeli
daavadda
cofiT,
mokvda,
daikarga
janmrTeli
daavadda
cofiT,
mokvda,
daikarga
daavadda
cofiT,
mokvda,
daikarga
janmrTeli
dakvirveba 10
dRis
ganmavlobaSi
monacemebi cxovelze
40erT.
sxeulis
masaze
40erT.
sxeulis
masaze
40erT.1kg.
sxeulis
masaze
40erT.
sxeulis
masaze
1kg.
1kg.
1kg.
40erT. 1kg.
sxeulis
masaze
40erT. 1kg.
sxeulis
masaze
40erT. 1kg.
sxeulis
masaze
21 dRe
21 dRe
1dRe
21dRe
18 dRe
1 dRe
antirabiuli gamaglobulini
mozr-is da 8
8 wlamde
welze
ZiriTadi
bavSvebiufrosi
kursi
sTvis
bavSvis
5
ar eniSneba
ar eniSneba
ar
eniSneba
ar eniSneba
ar eniSneba
7 dRe
ar eniSneba
ar eniSneba
7 dRe
me-10 me-20
35-e dRe
ZiriTadi
kursis
damTavrebidan
5ml. (2,52,5) Wipis
orive
mxareze
kanqveS
me-10 me-20
35-e dRe
ZiriTadi
kursis
damTavrebidan
5ml. (2,52,5) Wipis
orive
mxareze
kanqveS
5ml. (2,52,5) Wipis
orive
mxareze
kanqveS
5ml. (2,52,5) Wipis
orive
mxareze
kanqveS
me-10 me-20
35-e dRe
ZiriTadi
kursis
damTavrebidan
me-10 me-20
35-e dRe
ZiriTadi
kursis
damTavrebidan
4ml
(2,0-2,0)
4ml
(2,0-2,0)
4ml
(2,0-2,0)
antirabiuli kulturaluri vaqcina
doza
8 wlamde
mozrdilTa
bavSvebida 8 welze
saTvis
meti bavSv.
6
ar eniSneba
ar eniSneba
ar
eniSneba
me-10 me-20
3ml
2ml
dRe ZiriTadi
kursis
3ml
2ml
damTavrebidan
me-10, me-20
dRe ZiriTadi
kursis
damTavrebidan
me-10 me-20
5ml. (2,54ml
35-e dRe
2,5) Wipis
(2,0-2,0)
ZiriTadi
orive
kursis
mxareze
damTavrebidan
kanqveS
revaqcinaciis
vadebi
danarTi #2
mosaxleobis antirabiuli samkurnalo-profilaqtikuri imunizaciis sqema
danarTi #3
cxovelebis mier dazianebul pirTa (dakbenili, dadorblili,
dakawruli) pirveladi samedicino daxmarebis RonisZiebebis moculoba
RonisZiebebis moculoba
1
ambulatoriaSi da ubnis
saavadmyofoSi
cxovelebis mier
dakawrul da
dadorblil pirebs
dauyovnebliv unda
aRmoeCinos pirveladi
samedicino daxmareba:
sapniani wylis WavliT
kargad gamoirecxos
nakbeni Wrilobebi, maTi
kideebi damuSavdes iodis
nayeniT da daedos
steriluri naxvevi.
nakbeni Wrilobis kideebi
pirvel sam dRes ar unda
amoikveTos, ar gaikeros,
garda iseTi
dazianebebisa, romlebic
moiTxoven sasicocxlo
CvenebiT specialur
qirurgiul Carevas.
nakbeni Wrilobebis dros
tardeba tetanusis
saswrafo profilaqtika,
iseve rogorc sxva
travmebisas. (bolo 10
wlis ganmavlobaSi
araimunizirebul
pirebSi)
gaigzavnos dazaralebuli
(saWiroebisamebr
satransporto
samobilizacio
artaSnebis gamoyenebiT)
antirabiuli acrebis
daniSvna-CatarebisaTvis,
amisaTvis gamoyofil
raipoliklinikis an
qalaqis poliklinikis
qirurgiul kabinetebSi
(saWiroebisamebr Sokis
sawinaaRmdego
RonisZiebebi). momarTvis
Sesaxeb telefonogramiT
ecnobos teritorialur
(raionul saqalaqo)
epidemiologs da
amasTanave gadaugzavnon
saswrafo Setyobinebis
baraTi - forma #58,
vinaidan cxovelebis mier
dakbenis, dakawvris,
dadorbvlis yoveli
SemTxveva ganixileba,
rogorc cofiT
daavadebaze saeWvo.
personali
2
eqimi
instrum. da saeqimo mowy.
3
1.sapniani wyliT savse 3
litriani qila (1/2
sarecxis saponi da 3l.
wyali) TiTo
dazaralebulisaTvis.
2. pincetebi: qirurgiuli,
anatomiuri, keanebi,
skalpeli, makrateli.
3. laxti, sakace.
4. sterilizatorebi:
instrumentebisaTvis,
SpricebisaTvis
203
medikamentebi
4
analgetikebi:
analgini 50%
baralgini
dimedroli
prednizoloni
komunikaciebi
5
telefoni
telefonogramebis
gadasacemad.
transporti mZime
xarisxis
dazianebulebis
gadasayvanad.
adgilobrivi
xelisuflebis
CarTva cofis
sawinaaRmdego
RonisZiebebSi.
dazaralebulni
cofis klinikuri
niSnebiT
igzavnebian
mimarTviT
infeqciuri
saavadmyofos
reanimaciul
ganyofilebaSi.
cxovelis leSis
gadagzavna
centralur vetlaboratoriaSi
gamosakvlevad
(vet-samsaxuris
mier).
qalaqis poliklinikebis
antirabiuli
daxmarebisaTvis
gamoyenebuli
qirurgiuli kabinetebi,
agreTve raipoliklinikis
(raisaavadmyofo) im
SemTxvevebSi, romlebic
zemoTaa aRniSnuli,
valdebulia gadasces
telefonograma da masTan
erTad gadaugzavnos
saswrafo Setyobinebebis
baraTi _saaRricxvo
forma #58, Tavisi
raionis epidemiologs,
Seavsos yovel
dazaralebulze
antirabiauli
daxmarebisaTvis baraTi –
saaRricxvo forma #77,
dauniSnos da
uzrunvelyos
antirabiuli acrebis
kursis Catareba
antirabiuli vaqcinisa da
antirabiuli
imunoglobulinis
gamoyenebis Sesaxeb
darigebis Sesabamisad,
maT Soris SabaTs, kviras
da uqme dReebSic.
uzrunvelyos yvela im
dazaralebulis
hospitalizacia
stacionarSi, romelTac
acrebis sruli kursi
daeniSnaT da aran mZimed
dakbenilni, an soflad
cxovroben, an
ganmeorebiT icrebian
anda anamnezSi aqvT
alergiuli, nervuli
daavadebebi. cxovelze
dakvirvebis Sedegebis
Sesaxeb vetsamkurnalo
dawesebulebebis cnobis
an mokluli cxovelis
laboratoriuli
gamokvlevebis Sesaxeb
epidemiologis cnobis
safuZvelze daazustos
acrebis kursi:
- uzrunvelyos yvela
dazaralebulisaTvis
daniSnuli kursis
srulad Catareba,
miiRos ra qmediTi
zomebi acrebisaTvis
Tavis aridebis an
TviTneburad acrebis
Sewyvetis SemTxvevaSi.
saWiroebis SemTxvevaSi
mimarTos
qirurgirabiologi
1.mcire qirurgiuli
operaciuli nakrebi, laxti,
sakace samobilizacio
artaSnebi, TabaSiri
2.pincetebi: qirurgiuli,
anatomiuri, peanebi,
skalpeli, makrateli
3.laxti, sakace
4.sterilizatori:
instrumentebisaTvis,
SpricebisTvis
204
telefonitransporti
dazaralebulebis
gadasayvanad.
samedicino
dawesebulebis
administraciisa
da xelisuflebis
organoebis CarTva
organizaciul
sakiTxebSi.
jandacvis adgilobrivi
sakoordinacio centris
xelmZRvanelobas.
- droulad acnobos
Tavisi samoqmedo
teritoriis
epidemiologs:
a)im dazaralebul pirTa
Sesaxeb, romlebmac
daniSnuli acrebis
sruli kursi ar
daasrules da
sacxovreblad sxva
adgilze gadavidnen;
b)cofis sawinaaRmdego
acrebis Catarebis
Sedegad gamowveuli
garTulebis yvela
SemTxvevis Sesaxeb;
g) gadaigzavnos im
pirebze, romelTac
acrebis sruli kursi
daamTavres, saaRricxvo
qirurgiforma #045-is aslebi.
rabiologi
awarmoos cofiT
daavadebulebis cofze
saeWvo SemTxvevebis
acrebis Sedegad
gamowveuli
garTulebebisa da
Catarebuli
profilaqtikuri acrebis
aRricxvianoba (forma
60-infeqciuri
daavadebebis saaRricxvo
Jurnali).
antirabiuli
stacionari (centri)
valdebulia moaTavsos
saavadmyofoSi mZimed
dakbenilni, romelTac
acrebis sruli kursi
daeniSnaT, an ganmeorebian
icrebian an anamnezSi
aqvT alergiuli,
nervuli sistemis
daavadebebi – momarTviT
operatiuli
epidRonisZiebebi
telefonograma, forma
#58.
im SemTxvevaSi,
rodesac dazaralebuli
pirvelad uSualod
mimarTavs stacionars
aRmouCinos daxmareba
(rogorc zemoTaa
aRniSnuli), gadasces
telefonograma da
gadaugzavnos forma #58
Sesabamis epidemiologs.
Tu dazaralebuli ar
saWiroebs
hospitalizacias,
qirurgiuli operaciuli
nakrebi, mikroqirurgiuli
instrumentebi, atravmuli
Zafebi, erTjeradi Spricebi.
205
analgetikebi:
analgini
50%
baralgini
dimedroli
prednizoloni
tavegili
pipolfeni
antirabiuli
preparatebi
telefonitransporti
dazaralebulebis
gadasayvanad.
samedicino
dawesebulebis
administraciisa
da xelisuflebis
organoebis CarTva
organizaciul
sakiTxebSi.
Cautardes qirurgrabiologis
konsultacia da gaices
forma #27.
antirabiul
imunizaciasTan erTad
saWiroebisamebr Catardes
antibiotiko,
madesensibilizebeli,
vitaminoTerapia.
roca nakbeni Wriloba
gasufTavdeba, SeiZleba
plastikuri operaciis
Catareba (meoradi
nakerebis dadeba).
gansakuTrebul
yuradRebas moiTxovs
saxis midamos Wrilobebi,
romelTa kosmetikuri
aRdgenisaTvis zogjer
saWiroa
mikroqirurgiuli
meTodebis (lupa,
mikroqirurgiuli
instrumentebi,
atravmuli Zafebi)
gamoyeneba.
nakbeni Wrilobebis
SemTxvevaSi, ise rogorc
sxva dazianebebis dros,
unda Catardes tetanusis
profilaqtika.
SeniSvna:
1. Tu 2 wlis da meti xnis ganmavlobaSi teritoria Tavisufalia, cofisagan daudgeneli diagnozis Sinauri cxovelebis
mier dakbenisas imunoglobulini ar keTdeba, unda Catardes vaqcinacia 12 dRis ganmavlobaSi 3 ml. doziT, Semdgomi revaqcinaciebiT me-10, me-20, da 35-e dRes;
2. kombinirebuli kursis Catarebisas vaqcinacia tardeba
imunoglobulinis Seyvanidan 24 saaTis Semdeg;
3. gareuli cxovelebis mier dakbenisas, cofis mxriv keTilsaimedo regionebSi tardeba antirabiuli vaqcinacia 12 dRis
ganmavlobaSi 3 ml. doziT Semdgomi revaqcinaciebiT me-10, me-20
da 35-e dRes;
4. adamianis imunoglobulinis dozireba – 20erT. 1kg. sxeulis masaze;
5. mRrRnelebis (virTagva, zazuna da sxva) dakbenisas cofis
mxriv arakeTilsaimedo zonaSi unda daeniSnos antirabiuli vaqcinaciis kursi – naxevari doziT 12-15 dRis ganmavlobaSi;
206
6. cofiT daavadebul adamianTan kontaqtirebul lorwovanis an kanis safarvelis aSkara dadorbvlisas eniSneba antirabiuli vaqcinacia;
7. hospitalizacias eqvemdebareba:
a) mZime xarisxis dakbena (Tavis, saxis, kisris, xelis mtevnis
TiTebis, mravlobiTi Wrilobebi, gareuli cxovelebis mier miyenebuli Wrilobebi);
b) xelmeored dakbenilni;
g) dazaralebulni, romelTac anamnezSi nervuli da alergiuli daavadebebi aqvT;
d) antirabiuli imunizaciis Catarebisas garTulebis SemTxvevebi.
8. nakbeni Wrilobebis mkurnalobasa da antirabiul imunizacias atarebs qirurgi-rabiologi.
9. vaqcinis instruqciaSi imunizaciis sqemis sxva variantis
SemTxvevaSi isargebleT vaqcinis instruqciaSi mocemuli sqemiT.
saqarTvelos janmrTelobis dacvis saministro
antirabiuli samedicino daxmarebis erovnuli centri
q. Tbilisi, bavSvTaA #2 klinikuri saavadmyofo, lublianas q.
#21, tel.: 35 10 92
instruqcia
adamianTa cofiT daavadebis profilaqtikis mizniT saavadmyofo, ambulatoriul-poliklinikur dawesebulebaTa muSaobis
wesis Sesaxeb
yvela saavadmyofo da ambulatorul-poliklinikuri dawesebuleba pirvel samedicino daxmarebas (sapniani wylis WavliT
damuSaveba, aseptikuri naxvevi) gauwevs im pirebs, romlebic mimarTaven maT nebismieri cxovelis dakbenis, dakawvris an dadorbvlis gamo;
cofis sawinaaRmdego imunizacia Catardeba dedaqalaqisa
da msxvili qalaqebis mxolod antirabiuli mkurnalobisaTvis
specialurad gamoyofil stacionarebSi, saqarTvelos yvela regio207
nis raisaavadmyofoebSi, qalaqis Tu raionis poliklinikebis qirurgiul kabinetebSi;
qirurgi-rabiologi valdebulia cxovelebis mier dazianebulTa qirurgiul mkurnalobaze, Cvenebisamebr antirabiuli imunizaciis Catarebasa da Sesabamisi dokumentaciis Sevsebaze.
saswrafo Setyobinebebis gadacemasa da SexvevebSi eqimTan erTad
monawileoba evalebaT qirurgi-rabiologis mier rabiologiaSi
gadamzadebul eqTansa da sanitars;
antirabiul stacionarSi mkurnalobas eqvemdebareba cxovelTa mier dazaralebulTa Semdegi kategoriebi:
1) mZime xarisxis (III kategoria) nakbeni WrilobebiT;
2) pirebi, romelTac acrebis sruli upirobo kursi sWirdebaT;
3) soflad mcxovrebni;
4) ganmeorebiT acrebSi Cabmulni;
5) anamnezSi nervuli da alergiuli daavadebebis mqoneni.
- damyardes mWidro kavSiri Sesabamis sanepidsadgurebTan, epidgamokvlevis mizniT, da vetsamsaxurTan, damkben cxovelze karantinis dawesebis, leSis Tavis tvinis operatiuli gamokvlevis
mizniT;
- ar daiSvas cofis sawinaaRmdego acrebis TviTneburad Sewyveta vetlaboratoriis saboloo pasuxis miRebamde (mikroskopuli uaryofiTi pasuxi cofze yvela SemTxvevaSi ar miuTiTebs
damkbeni cxovelis janmrTelobaze);
- damyardes mWidro kavSiri soflis meurneobis saministrosTan
(sasoflo-sameurneo cxovelebi: cxenebi, Zroxebi, cxvrebi da
Rorebi, romlebTanac aqtiur urTierTobaSia adamiani, advilad
iTviseben cofis viruss);
- damyardes urTierToba qalaqis meriasa da qveynis yvela
raionis gamgeobasTan.
1996 wels SemuSavda antirabiuli vaqcinaciis droebiTi
standartebi, ganisazRvra dazaralebul pirTa pirveladi samedicino
daxmarebis RonisZiebaTa moculoba. imata antirabiul centrSi
momarTulTa raodenobam.
208
Catarebuli qmediTi profilaqtikuri mkurnalobis Sedegad
cofis problema moexsna valdorfis skolis dazaralebul
moswavleebs.
209
210
krwanisi
mTawminda
vake
resp. antirabiuli
centri
isani
CuRureTi
saburTalo
naZaladevi
didube
samgori
raioni
#5 savad. polik.
gareT
#4 samk. prof. centri
#17 m/p
#26 m/p
#2 m/p
#3 samk. prof. centri
#4 saavadmyofo
#11 S/p
#9 m/p
#1 samk. prof. centri
b/saavadmyofo #2
poliklinikis 3
Tamaz SaraSiZe
Wedia vaxtang
qarosaniZe irina
maxaraZe vaxtang
gurgeniZe giorgi
Ciqovani zurab
petriaSvili SoTa
kobaxiZe marina
morgoSia Tamaz
maxaTaZe Temur
kutubiZe ramaz,
mT. rabiologi
T. gogiZe
vazisubnis das. IV m/r
winamZRvriSvilis q. #21
vaJa-fSavelas q. #26
dadianis q. #20
diRmis VI k. baqos #4
gudamayaris q. #4
axundovis q. #3
qiaCelis q. #18
vaja-fSavelas q. #83
lublianas q. #21
mTavari eqimi
qinZmaraulis Ses. #7
misamarTi
antirabiuli kabinetebi
sazogadoebrivi jandacvis departamenti
29 04 55
95 93 54
39 14 76
34 30 36
38 69 30
99 63 69
31 40 04
38 45 89
95 31 41
95 66 63
22 60 60
saxli
52 95 40
74 34 53
95 98 6*
39 05 27
95 15 25
52 59 22
61 01 01
92 16 60
99 63 33
32 58 08
52 99 84
99 84 67
samsax.
telefoni
respublikuri antirabiuli centris (q. Tbilisis bavSvTa #2 klinikuri saavadmyofos bazaze
moqmedi) koordinaciiT cofTan brZola efeqturad tardeba antirabiul kabinetebSi.
1997 wels saqarTveloSi dainerga msoflios wamyvan qveynebSi
aprobirebuli axali ti pis 6-inieqciani antirabiuli vaqcinacia,
nacvlad 48-inieqciisa muclis areSi.
1998 wels jandacvis saministros sazogadoebrivi jandacvis
departamentis dakveTiT gamoica broSura ,,cofi~;
211
1999 wels gamoqveynda naSromi rabiologiaSi - ,,saqarTvelos
antirabiuli samedicino daxmarebis centris muSaobis efeqtianoba~
amierkavkasiis qirurgTa me-12 yrilobis masalebSi.
* * *
antirabiulma centrma Tavdauzogavi SromiT qveyanaSi aRiareba
da ndoba moi pova, rac naTlad gamoixata qarTuli sazogadoebis
kolorituli warmomadgenlis, momReral oTar ramiSvilis
striqonebSi.
212
1999 wels SemuSavda `antirabiuli qirurgiuli daxmarebisa da
acrebis baraTi~, romelic farTod dainerga qveynis qirurg-rabiologTa praqtikaSi;
2000 wels Tssu g. Jvanias saxelobis sauniversiteto klinikis
bazaze moqmedi antirabiuli samedicino daxmarebis centri Setanilia saqarTvelos samedicino katalogSi qveynis wamyvan samedicino centrebTan erTad.
antirabiuli centris muSaobam warmoSva qirurgiaSi axali mimarTulebis rabiologiuri qirurgiis saWiroeba. am mizniT 2000 w.
18 seqtembers reqtoris #79/k brZanebis Tanaxmad saxelmwifo
samedicino akademiis qirurgiis kaTedrasTan (amJamad Tssu universiteti) Seiqmna rabiologiis kursi (xelmZRvaneli docenti Teimuraz gogiZe), romelsac strategiuli mniSvneloba eniWeba qveynis
qirurgTa rabiologiaSi momzadebis saqmeSi.
kaTedrebis monacemebi
qirurgiis kaTedra travmatologiis kursiT
#
1.
2.
3.
Tanamdeboba
kaT. gamge
profesori
docenti
doc. (travm.)
4.
5.
asistenti
saleqcio
asistenti
gvari, saxeli, mamis saxeli
CaxunaSvili oTari sergos Ze
macaberiZe giorgi Salvas Ze
arvelaZe anzori mixeilis Ze
baCiaSvili aleqsandre beqas Ze
beriaSvili zurabi artemis Ze
SaniZe Tengizi vaxtangis Ze
mesxiSvili rolandi terentis Ze
gvaxaria giorgi nodaris Ze
baqraZe guram sergos Ze
gogiZe Teimuraz Salvas Ze
kurdRelia revaz ivanes Ze
beriaSvili zurab Tengizis Ze
stomatovi roland giorgis Ze
mekokiSvili lali avTandili as
kalandaZe nora ilias as
laRiZe cismari petres as
adamiani adami sergos Ze
213
xarisxi
mmd. prof
mmd. prof.
mmd. prof.
mmd. prof.
mmd. prof.
mmk.
mmk. doc.
mmk. doc.
mmk. doc.
mmk. doc.
mmk.
mmk.
214
215
rabiologiis cikli gaiares da Sesabamisi mowmoba miiRes
eqimebma:
2000 weli
1. axvlediani xviCa – martvilis raisaavadmyofos eqimi-qirurgi, 18 IX.-18/X
2001 weli
1. jolbordi daviTi – q. Tbilisis #4 klinikuri saavadmyofos eqimi-qirurgi, 15/II-15III;
2. fesvianiZe gogi – q. Tbilisis #9 poliklinikis eqimiqirurgi 21/II-21/III;
3. lorTqifaniZe mamuka – q. Tbilisis #9 poliklinikis
eqimi-travmatologi, 21/II-21/III;
4. pitiuriSvili nino – gurjaanis raiopoliklinikis eqimi,
17/V-17/VI.
5. garSaulaSvili darejani – axmetis raisaavadmyofos eqimiqirurgi, 23/IX-23/X;
6. SurRaia cotne – xobis raisaavadmyofos eqimi-qirurgi, 27/
XI-27/XII.
2002 w.
1. TavidaSvili akaki – q. Tbilisis #4 saavadmyofos eqimiqirurgi, 3/X-3/XI;
2. jangulaSvili irakli – q. rusTavis saavadmyofos eqimitravmatologi, 21/X – 21XI;
3. vardosaniZe vasili – gurjaanis raisaavadmyofos qirurgiuli ganyofilebis gamge, 1/XII-31XII.
2003w.
1. samxaraZe aleqsandre – bolnisis raisaavadmyofos eqimiqirurgi, 10/II-10/III;
2. mamrikiSvili nugzari – q. quTaisis centraluri saavadmyofo, 28/V-28/VI;
3. gaxokiZe valeriani – q. quTaisis centraluri saavadmyofo,
mimRebi ganyofilebis gamge, 16/IX-16/X.
216
2004w.
1. gibiSvili Tamazi – gardabnis raionis sarTiWalis eqimiqirurgi, 9II/-9/III;
2. barbaqaZe jambuli – saCxeris raisaavadmyofos qirurgiuli
ganyofilebis gamge, 10/IV-10/V;
3. elisaSvili xaTuna – q. xaSuris saavadmyofos eqimi-qirurgi, 8/XII-7/I.
2005w.
1. tyemalaZe mixeili – WiaTuris saavadmyofos eqimi-qirurgi,
1/II-6/III;
2. nadiraSvili vladimeri – Tssu pediatriuli klinikis eqimi-qirurgi, 1/II-6/III;
3. kvaracxelia nugzari – walenjixis raisaavadmyofos eqimiqirurgi, 17/II-17/III.
4. mamageiSvili ramazi – Tssu pediatriuli klinikis eqimiqirurgi, 23/III-23/IV;
5. kviciani vaJa – Tssu pediatriuli klinikis eqimi-qirurgi,
23/III-23/IV.
6. xeCuaSvili aleqsandre – Tssu pediatriuli klinikis eqimi-qirurgi, 23/III-23/IV;
7. Tuxareli gela – goris raionis centraluri saavadmyofos eqimi qirurgi, 13/V-13/VI;
8. zveriaSvili mixeili – gurjaanis raisaavadmyofos eqimiqirurgi, 10/VI-10/VII;
9. saganeliZe gia – bolnisis raisaavadmyofos qirurgiuli
ganyofilebis gamge, 15/VI-15/VII;
10. gugulaSvili a. – gurjaanis raisaavadmyofos eqimi-qirurgi, 21/VI-21/VII;
11. orvelaSvili gela – gurjaanis raisaavadmyofos eqimiqirurgi, 21/VI-21/VII;
12. bolqvaZe avTandili – mecnierebaTa akademiis poliklinikis eqimi-qirurgi, 10/X-10/XI;
13. ozurgeTi-guriis regioni. 14/XI-14/XII;
14. vaSalomiZe omari – ozurgeTis raisaavadmyofos eqimiqirurgi, 14/XI-14/XII;
15. gabunia zaza – ozurgeTis raisaavadmyofos eqimi-qirurgi;
16. doliZe ilia – ozurgeTis raisaavadmyofos eqimi-qirurgi;
17. ToiZe nestori – ozurgeTis raisaavadmyofos eqimi-qirurgi;
217
18. mgelaZe tite – ozurgeTis raisaavadmyofos eqimi-qirurgi;
19. skamkoCaiSvili saSa – ozurgeTis raisaavadmyofos eqimitravmatologi;
20. tabataZe Tamazi – ozurgeTis raisaavadmyofos eqimi-travmatologi;
21. kotrikaZe leri – ozurgeTis raisaavadmyofos eqimi-travmatologi;
22. gogitiSvili lia – ozurgeTis raisaavadmyofos eqimiqirurgi, 14/XI-14/XII.
2005-2006ww.
1. kunWulia giorgi – saqarTvelos mezRvaurTa samedicino
centris direqtoris moadgile samkurnalo dargSi, eqimi-qirurgi, 5/XII-5/Iw;
2006w.
zugdidi – samegrelo - zemo svaneTis regioni, 29/VI-24/VII.
1. mosiZe enveri – q. zugdidis mravalprofiliani klinikuri saavadmyofo `respublika~. mTavari eqimis moadgile, eqimitravmatologi, 29/VI-24/VII;
2. gigiberia aleqsandre – q. zugdidis mravalprofiliani
klinikuri saavadmyofo `respublika~, eqimi-travmatologi;
3. gabisonia sulxani – q. zugdidis mravalprofiliani klinikuri saavadmyofo `respublika~, eqimi-travmatologi;
4. Sonia badri – q. zugdidis mravalprofiliani klinikuri
saavadmyofo `respublika~, eqimi-travmatologi;
5. qarCava Tandila – q. zugdidis mravalprofiliani klinikuri saavadmyofo `respublika~, eqimi-travmatologi;
6. qiria guladi – q. zugdidis mravalprofiliani klinikuri saavadmyofo `respublika~, eqimi-travmatologi;
7. lamanZia rabo – q. zugdidis iZulebiT gadaadgilebul
pirTa poliklinika, eqimi-travmatologi;
8. xaraSvili SoTa – q. zugdidis iZulebiT gadaadgilebul
pirTa poliklinika, mTavari eqimi, eqimi-qirurgi;
9. lomaZe Temuri – q. foTis centraluri klinikuri saavadmyofos eqimi-travmatologi;
10. jafariZe ilia – mestiis raionuli saavadmyofos eqimiqirurgi.
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2007w.
1. CitaZe akaki – q. xaSuris saavadmyofos mimRebi ganyofilebis gamge, eqimi-qirurgi, 2/VII-28/VII.
2008 w.
1. miqataZe revazi – q. Tbilisis bavSvTa #1 klinikuri saavadmyofos eqimi-qirurgi. 24/III – 24/IV.
2. gugunaZe goderZi - q. Tbilisis Sps #5 saavadmyofopoliklinikuri gaerTianebis eqimi-travmatologi, 17/IX-16/X.
2009 w.
1. papeliSvili omari – q. Tbilisis #4 klinikuri saavadmyofos eqimi-travmatologi, 27/IV – 29/V.
2. daTiaSvili amirani – q. Tbilisis # 4 klinikuri saavadmyofos eqimi-travmatologi, 27/IV – 29/V.
3. meliqiZe gurami – q. Tbilisis #4 klinikuri saavadmyofos
eqimi – qirurgi, medicinis doqtori, 29/IV-30/V.
4. darsaveliZe daviTi - q. Tbilisis # 4 klinikuri saavadmyofos eqimi-travmatologi, 29/IV-30/V.
5. gvilava giorgi - q. Tbilisis # 4 klinikuri saavadmyofos
eqimi-travmatologi, 7/V-8/VI.
6. beruaSvili fridoni - q. goris samxedro hospitlis eqimiqirurgi, mimRebi ganyofilebis gamge, 20/XI-20/XII.
2009-2010w.
1. xalilovi mexmani - q. marneulis raionTaSoriso centraluri
saavadmyofos eqimi-travmatologi. 7/XII - 8/I.
2010
1. kapanaZe badri - saCxeris saavadmyofo-poliklinikuri gaerTianebis eqimi-travmatologi. 3/II - 4/II.
2. tefnaZe giorgi - saCxeris saavadmyofo-poliklinikuri gaerTianebis mimRebi ganyofilebis eqimi-qirurgi. 3/II - 4/II.
3. xaCiZe akaki - q. goris saqarTvelos Tavdacvis saministros
samxedro hospitlis eqimi reanimatologi. 30/IV - 31/V
2000 wels saqarTvelos saxelmwifo kancelariis socialur
sakiTxTa samsaxurs waredgina T. gogiZis proeqti ‘saqarTvelos
antirabiuli samedicino daxmarebis centris muSaobis efeqturobis gaumjobesebis Sesaxeb”, Seswavlili da mowonebuli saqarTvelos soflis meurneobisa da sursaTis saministros veterinariis departamentis mier.
219
saqarTvelos soflis meurneobisa da sursaTis saministro
veterinariis departamenti
q. Tbilisi, TamaraSvilis q. #15
#3-01/1107
29 dekemberi 2000 w.
saqarTvelos saxelmwifo kancelariis
socialur sakiTxTa samsaxuris
ufrosis moadgiles
baton m. jafariZes
asli: antirabiuli samedicino daxmarebis
centris xelmZRvanels, medicinis
mecnierebaTa kandidats
baton T. gogiZes
2000 wlis 7 noembris #420/5 oqmis safuZvelze ‘saqarTvelos antirabiuli samedicino daxmarebis centris muSaobis efeqturobis gaumjobesebis Sesaxeb” – gacnobebT, rom departamentma
Seiswavla baton T. gogiZis proeqti da mTlianad moiwona igi.
aRniSnuli proeqtis ganxorcieleba veterinaruli TvalsazrisiT
ar ewinaaRmdegeba veterinariis departamentis programas antirabiuli RonisZiebebis ganxorcielebaSi, rameTu igi mTlianad
aqcentirebulia dazaralebul adamianTa gamosavalze.
veterinaruli RonisZiebebis mimdinareoba jandacvis sistemisa
da damkben cxovelebSi zedamxedvelobis ganxorcielebaSi mimdinareobs veterinariuli da samedicino samsaxurebis urTierTSeTanxmebis safuZvelze da proeqtSi moyvanili sakarantino saqmianoba mimdinareobs dadgenili wesis Sesabamisad.
saqarTvelos antirabiuli samedicino daxmarebis centris
muSaobis efeqturoba ar warmoadgens veterinaruli samsaxuris
prerogativas, radgan aRniSnuli centris muSaobis efeqturoba
veterinariis qselis kompetenciaSi ar Sedis.
pativiscemiT,
Tavmjdomare:
/v. gvarjalaZe/
220
SemuSavebuli iqna 2000 wlis proeqti `cofis profilaqtikis damatebiTi RonisZiebebis Sesaxeb”, romelic waredgina
saqarTvelos mTavrobas.
cofis profilaqtikis damatebiTi RonisZiebebis Sesaxeb
(2000 wlis proeqti)
saqarTvelos prezidentis 1997 wlis 20 ianvris #70 brZanebulebis Sesabamisma saministroebma da mmarTvelobis adgilobrivma organoebma garkveuli samuSaoebi Caatares cofis profilaqtikis saqmeSi arsebuli darRvevebisa da naklovanebebis aRmosafxvrelad.
masTan erTad, cofis gavrcelebis TvalsazrisiT, kvlavindeburad rTuli epidsituaciaa rogorc q. TbilisSi, aseve qveynis
regionebSi, ver xerxdeba damkbeni cxovelebis dafiqsireba, maTi
organizebuli ayvana meTvalyureobaze da Sesabamisad, maTi izolireba. antirabiuli samedicino daxmarebis centris efeqturi
funqcionireba SezRudulia infeqciis SesaZlo wyaroze (adamianTa damkbeni cxovelebze) kontrolis SeuZleblobiT. ar klebulobs adamianTa cofiT gardacvalebis faqtebi.
zemoT aRniSnulidan gamomdinare:
1. afxazeTisa da aWaris avtonomiuri respublikebis ministrTa sabWoebma, samxareo administraciebsa da mmarTvelobis adgilobrivi organoebis xelmZRvanelebma personaluri pasuxismgeblobiT:
Seiswavlon saqarTvelos prezidentis 1997 wlis 10 ianvris
#70 brZanebulebis `cofis profilaqtikis RonisZiebaTa gaZlierebis Sesaxeb~ muxlobrivi Sesrulebis mdgomareoba da
Sesabamisi informacia acnobon saxelmwifo kancelarias;
SeimuSaon, daamtkicon da kontrolze aiyvanon cofis profilaqtikis damatebiTi RonisZiebani;
mimdinare wlis mais-ivnisSi yvela dainteresebuli samsaxuris monawileobiT moawyon cofis profilaqtikis orTviuri;
2. cnobad iqnes miRebuli, rom janmrTelobisa da socialuri
dacvis saministrosTan funqcionirebs antirabiuli samedicino
daxmarebis centri;
221
3. saqarTvelos janmrTelobisa da socialuri dacvis saministrom: ori Tvis vadaSi SeimuSaos cofis efeqturi profilaqtikis strategia, gansakuTrebuli yuradReba dauTmos q. TbilisSi cofis epizooturi mdgomareobis arsebiT gajansaRebas;
dakbenil pirTa mkurnalobis Zirfesviani gaumjobesebis mizniT
antirabiuli samedicino daxmarebis centrTan Seiqmnas damkben
cxovelTa izolatori, romelSic moxerxdeba konkretuli adamianis damkbeni konkretuli cxovelebis izolireba, veterinaluri meTvalyureobis dasaweseblad, maTi aRricxva, registracia, vaqcinacia, damatebiTi RonisZiebebis Catareba;
uzrunvelyos antirabiuli centris damkben cxovelTa izolatori saStato erTeulebiT;
4. saqarTvelos soflis meurneobisa da sursaTis saministrom qmediTi daxmareba aRmouCinos antirabiul samedicino centrs adamianebis damkben cxovelTa izolatoris maRalkvalificiuri veterinari specialistebiT dakompleqtebis saqmeSi;
5. q. Tbilisis meriam Sesabamis samsaxurebTan erTad:
5.1 erTi Tvis vadaSi gamouyos janmrTelobisa da socialuri dacvis saministros antirabiuli samedicino daxmarebis
centrs miwis nakveTi (0,5 ha.) diRmis teritoriaze adamianTa
damkben cxovelTa izolatoris mosawyobad;
ori Tvis vadaSi uzrunvelyos aRniSnuli izolatoris saproeqto samuSaoebis Catareba, raTa mimdinare wlis ivlisidan moxerxdes am obieqtis mSeneblobis dawyeba;
5.3 gadawyvitos adgilobrivi biujetidan am obieqtis mSeneblobis dafinansebis sakiTxi;
6. saqarTvelos finansTa saministrom 2001 wlis biujetis
proeqtSi gaiTvaliswinos municipaluri samsaxurebisTvis cofis
profilaqtikis programiT gaTvaliswinebuli samuSaoebis dafinanseba;
7. antirabiuli samedicino daxmarebis centris adamianTa damkben
cxovelTa izolatoris samuSaoTa forsirebisaTvis mimdinare
wels prezidentis fondidan gamoiyos 30 000 (ocdaaTi aTasi)
lari;
8. saqarTvelos televiziisa da radiomauwyeblobis korporaciam, centralurma da adgilobrivma masobrivi informaciis sa222
Sualebebma xeli Seuwyon Sesabamis saministroebsa da uwyebebs
cofis profilaqtikis sakiTxebis gaSuqebaSi;
9. brZanebulebis Sesrulebaze kontroli daevalos saqarTvelos janmrTelobisa da socialuri dacvis saministros;
10. brZanebuleba gamoqveyndes presaSi.
2001 wels gamocemul saserTifikacio test-kiTxvarSi specialoba ,,bavSvTa qirurgia~ pirvelad iqna Setanili Tavi ,,rabiologia~;
test-kiTxvari
pretesti
daavadebaTa ra jgufs miekuTvneba cofi?
a. protozoozi
b. riketsiozi
g. boreliozi
d. zoonozi
e. helminTozi
cofis damadasturebeli klinikuri niSani?
a. aerofobia
b. klaustrofobia
g. hidrofobia
d. akustikofobia
e. fotofobia
vin aRwera pirvelad cofi?
a. hi pokrate
b. avicena
g. pasteri
d. celsiusi
e. haleri
nakbeni Wrilobis yvelaze saSiSi lokalizacia cxovelis
dakbenis SemTxvevaSi?
a. winamxris midamos dakbena
223
b.
g.
d.
e.
muxlis saxsris midamos dakbena
saxisa da mtevnis TiTebis daboloebebis dakbena
barZayis midamos dakbena
gava-welis midamos dakbena
antirabiuli preparatebis organizmSi Seyvanisas aris saSiSroeba ganviTardes?
a. hemoragiuli Soki
b. septiuri Soki
g. anafilaqsuri Soki
d. kardiogenuri Soki
e. plevro-pulmonaruli Soki
test-kiTxvari
pottesti
ra gzebiT xvdeba cofis virusi dakbenilis organizmSi?
a. ZuZumwovari cxovelis sisxlidan
b. ZuZumwovari cxovelis fekaliebidan
g. ZuZumwovari cxovelis nerwyvidan
d. ZuZumwovari cxovelis limfidan
e. ZuZumwovari cxovelis kuWis wvenidan
rogor xdeba ZuZumwovari cxovelis mier dakbenili adamianis Wrilobis damuSaveba?
a. hi pertoniuli xsnariT
b. iodiT
g. spirtiT
d. sapniani wyliT
e. qloraminis xsnariT
rogori kideebi aqvs cxovelis mier miyenebul nakben Wrilobas?
a. sworxazovani
b. skalpirebuli _ daJeJili, usicocxlo.
g. skalpirebuli, uswormasworo
224
d. dakbiluli
e. daCeCqvili
dakbenidan ramden xanSi unda Catardes cxovelis nakbeni
Wrilobis gakerva-kosmetikuri mizniT?
a. Wrilobis miyenebisTanave
b. 24 saaTSi
g. 48 saaTSi
d. 72 saaTSi
e. arc erTi pasuxi ar aris swori
ra SemTxvevaSi xdeba cxovelis nakbeni Wrilobis gakervayrud?
a. nafleTovani Wrilobis dros
b. didi zomis Wrilobis dros
g. sasicocxlo CvenebiT didi yalibis sisxlZarRvebis gadaWris dros
d. uswormasworo kideebiani Wrilobis dros
e. skalpirebuli Wrilobis dros
upirvelesad ra saSiSroebaa Tu qirurgma arasworad daamuSava cxovelis mier miyenebuli Wriloba?
a. araferia dazaralebulisTvis saziano
b. nakbeni Wriloba Znelad Sexorcdeba
g. gaxangrZlivdeba cofis inkubaciuri periodi
e. daziandeba myesebi
cofis virusi organizmSi vrceldeba?
a. hematogenuri gziT
b. haer-wveTovani gziT
g. limfogenuri gziT
d. neirogenuri gziT
e. peroraruli gziT
romeli cxovelebisaTvis aris paTogenuri cofis virusi?
a. Tevzebi
b. mwerebi
225
g. amfibiebi
d. ZuZumwovrebi
e. qvewarmavlebi
cofis inkubaciuri periodis xangrZlivoba?
a. 1-2 Tve
b. 7 dRe
g. 14 dRe
d. 8-10 dRidan erT wlamde da metxans
e. 1-3 dRe
cofis inkubaciuri periodis xangrZlivoba razea damokidebuli?
a. nakbeni Wrilobis siRrmeze
b. dazaralebulis asakze
g. nakbeni Wrilobis lokalizaciaze
d. nakbeni Wrilobis farTze
cofis ati piuri mimdinareobisas, romel daavaebasTan unda
gatardes diferencialuri diagnozi?
a. anaerobuli gangrena
b. tetanusi
g. difTeria
d. cimbiris wyluli
e. tularemia
226
`medinfos~ monacemebiT 2001 wlis yvelaze aqtualuri samedicino samsaxuri gaxda Tssu g. Jvanias saxelobis sauniversiteto
klinikis bazaze moqmedi antirabiuli samedicino daxmarebis centri.
2002 wels jandacvis saministros sabWos sxdomaze gatanili
iqna sakiTxi `antirabiuli samsaxuris~ Sesaxeb;
2003 wels enciklopedia ,,TbilisSi~ Setanili iqna Tssu pediatriul klinikur bazaze moqmedi antirabiuli samedicino daxmarebis centri;
227
2003 wlis 19 seqtembers saqarTvelos Sromis, janmrTelobisa
da socialuri dacvis ministris #221/o brZanebiT damtkicda T.
gogiZis meToduri saxelmZRvanelo ,,cofiT daavadebis profilaqtikuri mkurnaloba~ (me-2 Sevsebuli gamocema 2007w.).
228
saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministro
antirabiuli samedicino daxmarebis centri
Teimuraz gogiZe
cofiT daavadebis profilaqtikuri
mkurnaloba
(meToduri saxelmZRvanelo)
Tbilisi
2007
229
saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis ministris
brZaneba
19.09.2003w.
# 211/m
Tbilisi
meToduri saxelmZRvanelos – “cofiT daavadebis
profilaqtikuri mkurnaloba” damtkicebis Sesaxeb
ukanasknel wlebSi saqarTveloSi cofi erT-erT seriozul
problemas warmoadgens: mkveTrad daiZaba epizooturi situacia,
xolo avadobis SemTxvevebs aqvs zrdis tendencia.
cofis sawinaaRmdego RonisZiebaTa kompleqsSi umniSvnelovanesi roli eniWeba prevenciuli RonisZiebebis gatarebas.
saqarTvelos 2001 wlis 8 ivnisis kanonis “saeqimo saqmianobis Sesaxeb” (Tavi I, muxli 5, punqti `i~) uwyveti samedicino
ganaTleba, moTxovnebidan gamomdinare, saqarTvelos mosaxleobisadmi antirabiuli samsaxuris muSaobis efeqturobis, qveyanaSi
hidrofobiis profilaqtikis ganxorcielebisaTvis da antirabiuli samsaxuris srulyofili muSaobis mizniT
v b r Z a n e b :
1. damtkicdes “cofiT daavadebis profilaqtikuri mkurnaloba” meToduri saxelmZRvanelo (danarTi ¹
1).
2. daevalos saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros janmrTelobis dacvis politikis
departaments “cofiT daavadebis profilaqtikuri mkurnaloba”
meToduri saxelmZRvanelos Sesabamisi samsaxurebisaTvis miwodeba.
3. kontroli brZanebis Sesrulebaze daevalos ministris
pirvel moadgiles.
230
231
232
233
recenzia
T.gogiZis meTodur saxelmZRvaneloze
`cofiT daavadebs profilaqtikuri mkurnaloba~
bolo wlebis statistika miuTiTebs, rom cofis gavrcelebis
TvalsazrisiT saqarTveloSi Seqmnili epidsituacia kvlav safrTxes uqmnis qveynis mosaxleobas. saqarTvelos mTeli teritoria iTvleba `cofiT inficirebis kerad~.
1996 wels hidrofobiiT gardaicvala 22 adamiani, maT Soris
6 bavSvi. imave wels q. Tbilisis bavSvTa #2 klinikuri saavadmyofos bazaze Seqmnilma antirabiulma samedicino daxmarebis
centrma (xelmZRvaneli T. gogiZe) itvirTa mTeli pasuxismgebloba, cofis profilaqtikuri mkurnalobis mxriv, Seqmnili
viTarebis gamosasworeblad. daiwyo Tanamedrove moTxovnebis
antirabiuli qirurgiuli samsaxurebis Camoyalibeba qveynis masStabiT.
T.gogiZis mier ori aTeuli wlis ganmavlobaSi dagrovili
gamocdileba, maRali kvalifikacia da rac mTavaria, Tavdadebuli
Sroma aisaxa, rogorc Tbilisis aseve qveynis sxvadasxva regionebSi Camoyalibebuli antirabiuli samsaxurebis muSaobaSi.
meToduri saxelmZRvanelo klasikuri sqemis mixedviTaa Sedgenili. gamoyenebulia didi literatura rogorc qarTveli, ise
ucxoeli avtorebi. gamaxvilebulia yuradReba imaze, rom dRes
ar aris gamoricxuli erTi adamianidan meoreze daavadebis gavrceleba, rac aucileblad unda gaiTvaliswinos Tavis muSaobaSi
daavadebulTan kontaqtSi myofma samedicino personalma. calke
Tavebad aris gamoyofili postvaqcinuri garTulebebi da maTi
koreqcia. dawvrilebiT aris aRwerili tetanusis profilaqtika.
sagulisxmoa, rom 1997 wels avtoris mier saqarTveloSi
pirvelad iqna praqtikaSi danergili axali ti pis 6-inieqciani
antirabiuli vaqcinaciis kursi, nacvlad manamde moqmed 48-inieqciani kursisa, ramac mniSvnelovnad Seamsubuqa dazaralebulTa antirabiul acrebSi Cabma.
T.gogiZis meTodur saxelmZRvanelos aqvs praqtikuli Rirebuleba. igi did samsaxurs gauwevs rogorc eqim rabiologTa
momzadeba-gadamzadebas, aseve mniSvnelovnad daexmareba praqtikos eqimebs hidrofobiis profilaqtikis saqmeSi.
234
235
2003 wlis 28 marts saxelmwifo samedicino akademiis didi
sabWos sxdomaze damtkicebuli iqna medicinis mecnierebaTa
doqtoris saZiebo xarisxis mosapovebeli samecniero muSaobis
gegma-ruqa
d R i s
w e s r i g i
1. rezidenturaSi misaRebi gamocdebis Sedegebis Sesaxeb.
prof. n. koWlavaSvili
2.
samedicino-biologiuri kvlevebis oqmebis eTikuri Sefasebis aucileblobis Sesaxeb
doc. g.javaSvili
3. uwyveti samedicino ganaTlebis programebis wadgenis angariSi
doc. n. gogoxia
4. sadoqtoro disertaciis gegma-ruqis damtkiceba:
1. `rabiologiuri samsaxuris organizacia da misi Camoyalibebis ZiriTadi etapebi saqarTveloSi~ - m.m.k. Teimuraz gogiZe
Temis samecniero konsultantebi: prof. o.. gerzmava, prof.
d. korZaia, prof. o. CaxunaSvili
5. sabWos wevrTa sakiTxebi
Tavmvjdomare
profesori
swavluli mdivani
docenti
r.SaqaraSvili
m. beTaneli
236
2003 wels saqarTvelos rabiologTa asociaciam mimarTa
winadadebiT qveynis prezidents cofTan brZolis
RonisZiebebis efeqturobis Sesaxeb..
saqarTvelos prezidents
mis aRmatebulebas baton e. SevardnaZes
batono prezidento,
qveyanaSi, kerZod, dedaqalaqSi, arsebuli rTuli finansuri da
ekonomikuri pirobebis gamo, Seiqmna mZime situacia socialurad
saSiS, sasikvdilo daavadebis, cofis, gavrcelebasTan dakavSirebiT, razedac miuTiTebs gardacvlil adamianTa raodenoba da
cxovelebis mier dakbenilTa mkveTri mateba. yovelwliurad marto
dedaqalaqSi fiqsirdeba aTasobiT dakbenis, dakawvrisa da dadorbvlis SemTxveva.
miuxedavad Tqveni qveynis mosaxleobis sasicocxlo interesebis gamomxatveli 1997 wlis 20 ianvris #70 brZanebulebisa
`cofis profilaqtikis RonisZiebaTa gaZlierebis Sesaxeb~, saxelmwifo kancelariis doneze gadadgmuli mniSvnelovani nabijebisa
Tu finansuri sirTuleebisa am metad sapasuxismgeblo, sasicocxlo daniSnulebis saqmeSi. ver xerxdeba damkbeni cxovelis
fiqsireba, maTi vetmeTvalyureobaze organizebuli ayvana da Sesabamisad, maTi izolireba.
mogaxsenebT, rom 1994 wels Seiqmna saqarTvelos antirabiuli sazogadoeba, registrirebuli iusticiis saministros mier
(SemdgomSi saqarTvelos rabiologTa asociacia). 1996 wlis 18
noembris #544 brZanebiT `cofTan brZolis RonisZiebaTa gaZlierebis Sesaxeb~ q. Tbilisis bavSvTa #2 mravalprofiluri
saavadmyofos bazaze ASeiqmna abtirabiuli samedicino daxmarebis centri (xelmZRvaneli – docenti T. gogiZe) gamoica damxmare saxelmZRvanelo `nakben WrilobaTa mkurnaloba bavSvebSi~,
samaxsovro `cofi~. Sedgenil iqna antirabiuli samsaxuris saxelmwifo programa, romelic, samwuxarod, im periodSi ver dafinansda, magram safuZveli daedo jandacvis ministris zemoT xsenebul brZanebas, romelic, Tavis mxriv, SemdgomSi gaxda qveynis
mosaxleobis antirabiuli daxmarebis programis safuZveli. unda
aRiniSnos, rom aRniSnulma centrma gadaarCina klinikurad da
laboratoriulad dadasturebuli cofiani cxovelebiT dakbenili oTxasze meti dazaralebuli adamianis sicocxle.
2000 wlis 18 seqtembers jandacvis ministris #96 brZanebis
Tanaxmad saxelwmifo samedicino akademiaSi Seiqmna qirurgiuli
237
rabiologiis cikli (xelmZRvaneli docenti T. gogiZe), romelsac strategiuli mniSvneloba eniWeba qveynis qirurgTa rabiologiaSi momzadebis saqmeSi. jandacvis ministris bolo periodSi gamocemuli brZanebebisa da qveynis prezidentis 2002 wlis
16 aprilis #173 brZanebulebis Tanaxmad antirabiuli centris
mier SemuSavda da gamosacemad mzaddeba meToduri rekomendaciasaxelmZRvanelo ‘cofiT daavadebis profilaqtikuri mkurnaloba~, recenzirebuli qveynis cnobili mecnier-eqspertebis mier.
zemoT aRniSnuli antirabiuli samedicino daxmarebis centris
xelmZRvanelobiTa da koordinaciiT moxda koncentracia cofTan
brZolis ori mniSvnelovani ujredisa – nakben WrilobaTa mkurnaloba da saWiroebis SemTxvevaSi cofisa da tetanusis sawinaaRmdego acrebis Catareba. cofTan brZolis profilaqtikaSi
danergil am kompleqss sruli efeqtis misaRwevad aklia erTi
umniSvnelovanesi ujredi – antirabiuli daxmarebisaTvis momarTuli dazaralebulebis damkben cxovelTa (cofis savaraudo
infeqciis wyaro) sakarantino meurneoba.
vinaidan cofTan brZolis mTavar mizans warmoadgens mosaxleobis sikvdilianobis Semcireba da SemdgomSi misi aRmofxvra,
cofsawinaaRmdego RonisZiebebis kompleqsurad warmarTvis mizniT
gTxovT, daavaloT q. Tbilisis merias, qalaqis ganapira raionSi,
pirdapiri gankargvis wesiT, gamogviyos 2500 m2 miwis nakveTi,
sadac Sesabamisi saerTaSoriso donori organizaciebis daxmarebiT mogvardeba antirabiuli daxmarebisaTvis momarTuli dazaralebulTa damkbeni cxovelebis izolacia, maTi janmrTelobis
mdgomareobis Semowmeba-meTvalyureoba, rac mTel rig SemTxvevebSi moxsnis sasicocxlo CvenebiT Catarebul cofsawinaaRmdego
vaqcinaciis saWiroebas an mniSvnelovanwilad Seamcirebs mkurnalobis periods. yovelive es ki Svebas moutans cxovelebis
mier dazaralebul mosaxleobas da dazogavs antirabiuli vaqcinaciisaTvis saWiro saxelmwifo Tanxebs.
rogorc cnobilia, 2003 weli gamocxadebulia msoflioSi
cofTan brZolis wlad da imedia, Tqveni ZalisxmeviT dadebiTad
gadawydeba aRniSnuli proeqti.
P.S. werils Tan erTvis jandacvisa da soflis meurneobis
saministroebis, Sesabamisi departamentebis daskvnebi aRniSnul
proeqtze.
pativiscemiT,
saqarTvelos rabiologTa
asociaciis prezidenti,med.
mecn. kandidati, docenti
/Teimuraz gogiZe/
238
aRniSnul mimarTvas daedo saqarTvelos prezidentis
dadebiTi rezolucia:
saqarTvelos prezidenti
asociaciis winadadeba misasalmebeli da mxardasaWeria
baton i. zodelavas
ganixileT da warmoadgineT
arsebuli wesiT gaformebuli masalebi
nu gaaWianurebT
2003 w. 14 Tebervali e. SevardnaZe
#126/15
* * *
2005 wels SemuSavda: a) ,,rabiologiis qirurgiuli aspeqtebi~; b) ,,rabiologia pediatriisaTvis~; g) ,,rabiologia ojaxis
eqimebisaTvis~;
amave wels SemuSavda mosaxleobis urgentuli momsaxurebis
antirabiuli samedicino daxmarebis saxelmwifo programaSi
monawile T.s.s.u g. Jvanias sax. klinikis rabiologiuri samsaxuris struqtura.
239
mosaxleobis urgentuli momsaxureobis antirabiuli
samedicino daxmarebis saxelmwifo programaSi monawile
T.s.s.u g. Jvanias sax. klinikis rabiologiuri samsaxuris
struqtura
1. dRis samsaxuri -2 qirurgi-rabiologi;
2. morige personali - 4 morige qirurgi-rabiologi da 2
dRis qirurgi-rabiologi ( sul 6 eqimi);
3. muSaobis ganrigi (dRis eqimebi 10-dan 17 sT-mde. morige
eqimebi 17-dan
10 sT-mde);
4. dRis samsaxuris ufleba-movaleobebi:
4.1. mkacrad daicvas klinikis Sinaganawesi, Tanamdebobrivi instqruqciebi, usafrTxoebis teqnikis wesebi;
4.2. angariSvaldebulia samkurnalo dawesebulebis direqciisa da saqarTvelos socialuri dazRvevis erTiani saxelmwifo
fondis winaSe.
4.3. awarmoos samedicino dokumentacia mkacrad dadgenili
wesiT;
4.4. droulad warudginos zemdgom uwyisebs informacia gaweuli
saqmianobis Sesaxeb;
4.5. rogorc qveynis wamyvanma, gamocdilma rabiologiurma samsaxurma gauwios kvalifikaciuri konsultacia da maRal mecnierul doneze aRmouCinos xarisxiani antirabiuli samedicino
daxmareba q. TbilisSi da respublikis sxvadasxva regionebidan
gamogzavnil dazaralebulebs da Sesabamis antirabiul kabinetebs;
4.6. awarmoos klinikis antirabiuli samsaxuris saorganizacio-meToduri zedamxedveloba;
4.7. gansakuTrebiT rTul SemTxvevaSi (mZime kategoriis dazianeba, postvaqcinaluri garTulebebi, alergiuli statusi da
a.S.) TviTon miiRos gadawyvetileba sxvadasxva specilistTa
konsultaciebis gaTvaliswinebiT;
4.8. iyos pasuxismgebeli antirabiuli samsaxuris saorganizacio da samecniero meTodur muSaobaze;
5. morige eqimebis ufleba movaleobebi:
5.1. aRmouCinos pirveladi antirabiuli daxmareba (nakbeni
Wrilobis saTanado damuSaveba, Cvenebisamebr antirabiuli pasiur-aqtiuri imunizacia).
240
5.2. gaweuli pirveladi daxmarebis dafiqsireba socialuri
dazRvevis erTiani saxelwmifo fondis xelSekrulebaSi miwodebul formebSi. mimRebis Sesabamis Jurnalebsa da `antirabiuli
qirurgiuli daxmarebisa da acrebis~ #045-a baraTSi.
5.3. dauyonebliv acnobos zemdgom uwyebebs cofis epidafeTqebebis saSiSroebisa, misi konkretuli SemTxvevebisa da agreTve
cofze saeWvo cxovelebis mier masobrivi, jgufuri dakbenebis
Sesaxeb.
2006 wels jandacvis saministros xelmZRvanelobiT SemuSavda axali ti pis standartebi rabiologiaSi;
2006 wels saxelmwifo akreditacia gaiara T. gogiZis mier
wardgenilma moklevadianma programam `rabiologia – Tanamedrove aspeqtebi~;
2007 wels saxelmwifo akreditacia gaiara T. gogiZis mier
wardgenilma programam `nakbeni Wrilobebis profilaqtikuri
mkurnalobis Tanamedrove moTxovnebi~.
2007 wels SemuSavda `cofTan brZolis koncefcia~. strategiis ganmsazRvreli dokumenti saqarTvelos parlamentisTvis.
cofTan brZolis koncefcia
(strategiis ganmsazRvreli dokumenti saqarTvelos parlamentisaTvis)
21
marti
2007
weli
mTavari motivacia: saqarTvelo cofis gareSe.
XXI saukuneSi (2001-2006 w.w.) saqarTvelos mosaxleobaSi
dafiqsirda cofis 60 SemTxveva, rac mcirericxovani qveynisaTvis sagangaSo maCvenebelia.
qveyanaSi da kerZod, dedaqalaqSi, arsebuli rTuli finansuri
da ekonomiuri pirobebis gamo, Seiqmna mZime situacia socialurad saSiS, sasikvdilo daavadebis, cofis, gavrcelebasTan dakavSirebiT, razedac miuTiTebs gardacvlil adamianTa raodenoba da
cxovelebis mier dakbenilTa mkveTri mateba. yovelwliurad marto
241
dedaqalaqSi fiqsirdeba aTasobiT dakbenis, dakawvrisa da dadorbvlis SemTxveva.
cofi erT-erTi uZvelesi daavadebaa msoflioSi. am daavadebas
Zveli aRmosavleTis eqimebi jer kidev Cv.w.aR-mde 3000 wlis
winaT aRwerdnen.
cofi adamianebSi pirvelad aRwera kornelius celsiusma (Cv.w.aRis I saukune). Mmanve SeamCnia, rom daavadeba adamians ZaRlis
nakbenisagan emarTeba.
saqarTveloSi cofi uxsovari droidan aris cnobili. Ddaavadebis Sesaxeb moxseniebulia uZveles samedicino karabadinebsa
da savetirinaro xelnawerebSi.
saukuneebis ganmavlobaSi ver moiZebna cofis Tavidan acilebis gza. TandaTan yalibdeboda mosazreba, rom samedicino mecniereba uZluri iyo cofis winaSe. Aase gagrZelda gamoCenili
frangi mecnieris lui pasteris periodamde, romlis saxelTanac
aris dakavSirebuli cofis sawinaaRmdego vaqcinis aRmoCena, ramac dausva wertili am daavadebis uZlevelobas. 1885 wlis 6
ivliss, pasteris laboratoriaSi, pirvelad msoflioSi, parizis
cnobili klinicistebis e. viulpianis da J. granSes mier cofiani ZaRlisagan mZimed dakbenil 9 wlis Jozef meisters Cautarda antirabiuli vaqcinacia. bavSvi gadaurCa gardauval sikvdils,
ramac faqtiurad safuZveli Cauyara antirabiul samedicino samsaxurs.
dRes cofi warmoadgens aramarto samedicino, aramed ekologiur
da ekonomiur problemasac. yovelwliurad msoflioSi hidrofobiiT iRupeba 60 aTasze meti adamiani, ixoceba milionobiT
sxvadasxva saxis gareuli da Sinauri cxoveli. weliwadSi milionze meti eqvemdebareba ,,iZulebiT~ antirabiul vaqcinoTerapias. cofis epizootiis fronti weliwadSi 30-40km. siCqariT
farTovdeba (janmo-s monacemebi).
cofi zogadsakacobrio problemaa. Ddaavadebis mTavar rezervuars warmoadgenen gareuli mtacebeli cxovelebi: ZaRlebi, katebi
da mRrRnelebi. cofis virusis gadacemis erTaderTi gzaa daavadebuli cxovelis mier miyenebuli nakbeni Wriloba, dadorbvla an dakawvra.
cofTan brZolaSi gansakuTrebuli mniSvneloba eniWeba drouli
profilaqtikuri RonisZiebebis gatarebas. qveyanaSi adamianTa
242
hidrofobiiT avadobis SemTxvevebi kvlav problemad rCeba, vinaidan mas zrdis tendencia axasiaTebs da, rac mTavaria, utoldeba mTeli rigi didi qveynebis analogiur maCveneblebs. aRniSnuli problemis mniSvnelobas aZlierebs isic, rom cofi ukurnebeli daavadebaa.
qveyanaSi hidrofobiis profilaqtikisa da kontrolis RonisZiebaTa gaumjobesebis mizniT sxvadasxva doneze gamocemulia
mTeli rigi dokumentebi:
saqarTvelos Sromis, janmrTelobisa da socialuri dacvis
ministris brZanebebi:
1. 1996w. 18.11 #544/o ,,cofTan brZolis gaZlierebis RonisZiebaTa Sesaxeb~;
2. 1999w. 14.05 #160/o ,,hidrofobiis profilaqtikisa da
kontrolis RonisZiebaTa Semdgomi gaumjobesebis Sesaxeb~;
3. 1999w. 6.09 #358/o ,,gorisa da lagodexis r-Si hidrofobiis SemTxvevebis Sesaxeb~;
4. 2000w. 14.03 #38/o ,,epidemiologiurad saSiS daavadebaTa
profilaqtikis damatebiTi RonisZiebebis gatarebis Sesaxeb~;
5. 2000w. 6.06 #96/o ,,cofis profilaqtikis Sesaxeb~.
gamocemulia saqarTvelos prezidentis brZanebulebebi:
1. 1997w. 28.01 #70 ,,cofis profilaqtikis RonisZiebaTa
gaZlierebis Sesaxeb~;
2. 2002w. 16.04 #173 ,,cofis profilaqtikis RonisZiebaTa
gaZlierebis Sesaxeb brZanebulebaSi cvlilebis Setanis Taobaze~.
yvela dasaxelebuli dokumentis mizani iyo qveyanaSi antirabiuli daxmarebis gaumjobeseba. samwuxarod, unda aRiniSnos,
rom ar Sesrulda saqarTvelos prezidentis 1997 wlis zemoT
aRniSnuli brZanebulebis ZiriTadi punqtebi, romlebic exeboda
mmarTvelobis adgilobrivi organoebis, qalaqis meriebisa da
soflis meurneobis veterinaruli gaerTianebis mier samarxebis
(,,bekeris ormo~) uzrunvelyofas an krematoriumebis mowyobas,
sakarantino volierebTan dakavSirebul sakiTxebs, cxovelTa
aRricxva-registraciis, vaqcinaciis srulyofilad ganxorcielebas
da a.S.
243
antirabiuli daxmareba Tavisi arsiT urgentuli samedicino
daxmarebaa, romelic Setanilia savaldebulo urgentuli stacionaruli daxmarebis komponentSi, Sesabamisad antirabiuli
preparatebis Sesyidvasa da programaSi CarTul samedicino dawesebulebebze ganawilebas awarmoebs samedicino dazRvevis saxelmwifo fondi. antirabiuli samedicino daxmarebis ZiriTad ganmaxorcielebel rgols warmoadgens antirabiuli qirurgiuli
samsaxuri.
informacia antirabiuli qirurgiuli samsaxuris Sesaxeb:
saqarTvelos janmrTelobis dacvis saministros 1975 wlis 6
oqtombris #597 brZanebiT eqim-qirurgebs nakbeni Wrilobebis
mkurnalobasa da tetanusis profilaqtikasTan erTad daevalaT
antirabiuli acrebis Catarebac, romelsac adre pasteris sadguris epidemiologebi emsaxurebodnen. am mizniT q. Tbilisis
bavSvTa #1 klinikuri saavadmyofos bazaze 1982 wels Seiqmna
qveyanaSi pirveli antirabiuli qirurgiuli samsaxuri, romelic
1987 wlidan gadavida q. Tbilisis bavSvTa #2 klinikuri saavadmyofos bazaze. 1993 wels gamoqveynda damxmare saxelmZRvanelo ,,nakben WrilobaTa mkurnaloba bavSvebSi”(T. gogiZe, gamomcemloba ,,saqarTvelo”), recenzirebuli cnobili qirurgebis
mier.
1995 wels janmrTelobis dacvis saministros xelmZRvanelobiT q. Tbilisis bavSvTa #2 klinikuri saavadmyofos antirabiuli samsaxuris xelmZRvanelis T. gogiZem SeimuSava qveynis
antirabiuli daxmarebis saxelmwifo programa, romelic ar dafinansda, magram safuZveli gaxda jandacvis ministris 1996 wlis
18 noembris #544/o brZanebisa “cofTan brZolis gaZlierebis
RonisZiebaTa Sesaxeb” (romelic SemdgomSi safuZvlad daedo
mosaxleobis antirabiul samedicino daxmarebis programas). amave
brZanebis Tanaxmad, qveyanaSi cofis mxriv situaciis mkveTrad
gauaresebis gamo (1996 wels hidrofobiiT gardaicvala 22 adamiani, maT Soris 6 bavSvi), q. Tbilisis bavSvTa #2 mravalprofiliani saavadmyofos (amJamad Tssu pediatriuli klinika) bazaze sazogadoebriv sawyisebze Seiqmna antirabiuli samedicino
daxmarebis centri, romlis xelmZRvanelad dainiSna med. mecn.
244
kandidati, q. Tbilisis mTavari rabiologi Teimuraz gogiZe.
antirabiul centrs daevala qveynis samkurnalo-profilaqtikur
dawesebulebebSi moqmedi antirabiuli qirurgiuli samsaxurebis meTodur-organizaciuli da praqtikuli daxmareba. antirabiulma centrma Tavis Tavze aiRo udidesi pasuxismgebloba qveynis srulyofili antirabiuli qirurgiuli samsaxuris Camoyalibebisa da misi koordinaciis saqmeSi. centris xelmZRvanelobiTa
da uSualo monawileobiT daxmareba gaewia cxovelebis mier
dazaralebul aTasobiT adamians. saqarTvelos asobiT moqalaqe,
klinikurad da laboratoriulad dadasturebuli cofiani
cxoveliT dakbenili, dadorblili, dakawruli, gardauval sikvdils
gadaurCa. Cvenebisamebr didi zomis nakbeni Wrilobebis anatomiuri mTlianobis aRdgena mikroqirurgiuli teqnikis gamoyenebiT
xdeba.
1997 wels antirabiul centrSi qveyanaSi praqtikaSi pirvelad dainerga 6-ineqciani intramuskularuli koncentrirebuli
gawmendili kulturaluri antirabiuli vaqcina. 1998 wels
jandacvis saministrosa da sazogadoebrivi jandacvis departamentis dakveTiT antirabiuli centris mier gamoica samaxsovro
- “cofi”. 1999 wels Seadgines “antirabiuli qirurgiuli daxmarebisa da acrebis” baraTi, SeTanxmebuli jandacvis saministros statistikur sammrTvelosTan. es baraTi SemdgomSi warmatebiT dainerga praqtikaSi. amave wels Catarebul amierkavkasiis qirurgTa XII yrilobis masalebSi daibeWda naSromi antirabiuli qirurgiuli samsaxuris muSaobis wamyvan rolze hidrofobiis profilaqtikis saqmeSi. antirabiuli centris moRvaweobam
warmoSva qirurgiaSi axali mimarTulebis – qirurgiuli rabiologiis – saWiroeba. am mizniT 2000 wlis 18 seqtembers
jandacvis ministris #96 brZanebis Tanaxmad saxelmwifo samedicino akademiis qirurgiul kaTedraze Seiqmna rabiologiis
cikli, romelsac strategiuli mniSvneloba eniWeba qveynis qirurgTa rabiologiaSi momzadebis saqmeSi. qveynis masStabiT 2000
wlidan dRemde 48 eqimma-qirurgma gaiara momzadeba aRniSnul
ciklze rabiologiaSi. 2003 wels antirabiuli centris mier
SemuSavda programa “rabiologia pirveladi jandacvis eqimebisaTvis”, romelmac uwyveti samedicino ganaTlebis egidiT miiRo
monawileoba saqarTvelos eqimTa pirveli kongresis muSaobaSi.
245
2003 wlis 19 seqtembers saqarTvelos Sromis, janmrTelobisa
da socialuri dacvis ministris #211/o brZanebiT damtkicda
meToduri saxelmZRvanelo “cofiT daavadebis profilaqtikuri
mkurnaloba”, romelic recenzirebulma mecnier-eqspertebma ganixiles saxelmwifo samedicino akademiis saswavlo-meToduri centris prezidiumis sxdomaze da, rogorc sazogadoebrivi jandacvis departamentma, aseve daavadebaTa kontrolisa da samedicino statistikis erovnulma centrma dadebiTad Seafases. q.
Tbilissa da qveynis sxvadasxva regionebSi momuSave samedicino
personalis gamoxmaurebis mixedviT, aRniSnuli naSromi metad
saWiro da sasargeblo iqneba cofTan brZolis saqmeSi. qveynis
wamyvani antirabiuli samsaxuris mier ori aTeuli wlis ganmavlobaSi dagrovili gamocdileba, maRali kvalifikacia, da rac
mTavaria, Tavdadebuli Sroma aisaxa rogorc Tbilisis, aseve
qveynis sxvadasxva regionebSi Camoyalibebuli antirabiuli samsaxurebis muSaobaSi. antirabiuli samedicino daxmarebis centrisa da saqarTvelos saxelmwifo samedicino akademiis qirurgiis kaTedris rabiologiis ciklis mier (2003-2006w. w.)
wardgenilma xuTma treningma akreditacia gaiara. 2006 w. saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros
xelmZRvanelobiT antirabiuli samedicino daxmarebis centrma
Seadgina axali ti pis standartebi rabiologiaSi, romlebic xels
Seuwyobs qirurg-rabiologTa metad rTuli da sapasuxismgeblo muSaobis srulyofas.
cofTan brZolis ZiriTadi mimarTulebebi:
1. qveyanaSi erTiani antirabiuli profilaqtikuri mkurnalobis strategiis, rabiologiaSi programebis SemuSavebisa da koordinaciis, samedicino dawesebulebebSi moqmed antirabiul qirurgiul kabinetebze meTodur-organizaciuli da praqtikuli daxmarebis, samedicino personalis kvalifikaciis amaRlebis, maTi
saTanado saxelmZRvaneloebiT, instruqciebiT, rekomendaciebiTa
da samaxsovroebiT uzrunvelyofis, praqtikaSi axali ti pis antirabiuli preparatebis danergvis mizniT g. Jvanias sax. sauniverstiteto klinikis bazaze sazogadoebriv sawyisebze moqmed an246
tirabiul samedicino daxmarebis centrs unda mieniWos sauniverstiteto saswavlo-klinikuri centris iuridiuli statusi;
2. saqarTveloSi unda ganxorcieldes msoflioSi aprobirebuli sqema _ antirabiuli daxmarebis decentralizacia, centralizebuli makoordinirebeli saswavlo-klinikuri centris
xelmZRvanelobiT;
3. sakanonmdeblo – parlamentis janmrTelobisa da socialur
sakiTxTa komitetisa da aRmasrulebeli organos – saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros
xelmZRvanelobiT aRniSnuli centri unda iyos cofTan brZolis wina xazze, rogorc saswavlo-klinikuri da meTodur-organizaciuli baza qveyanaSi moqmedi antirabiuli qirurgiuli samsaxurebisa. ra Tqma unda, epidemiologiur da agreTve soflis
meurneobis saministros veterinarul samsaxurTan erTad;
4. antirabiuli saswavlo-klinikuri centris mier, Tssu _
uwyveti samedicino ganaTlebisa da uwyveti profesiuli ganviTarebis institutis egidiT, rabiologiaSi programebis SemuSaveba
Tanamedrove moTxovnebis gaTvaliswinebiT;
5. antirabiul saswavlo-klinikur da sakoordinacio centrs
unda hqondes kompiuteruli momsaxureoba (sainformacio banki),
farTo sakomunikacio saSualebebi, raTa operatiulad moxdes
saWiroebisamebr qveynis nebismier regionSi dakavSireba _ informaciis miRebis, konsultaciis gawevisa da praqtikuli daxmarebis mizniT;
6. saqarTvelos Sromis, janmrTelobisa da socialuri dacvis
saministros Sesabamisi uwyebebisaTvis aRniSnuli centris mier
rekomendaciis gaweva antirabiuli profilaqtikuri mkurnalobisaTvis saWiro preparatebiT uwyveti momaragebisa da ganawilebis saqmeSi qveyanaSi cofis mxriv Seqmnili mdgomareobis
mixedviT;
7. jandacvis sistemis Sesabamisi uwyebebis mier antirabiuli
qirurgiuli kabinetebis Seuferxebeli momarageba cofis sawinaaRmdego preparatebiT _ sasicocxlo CvenebiT antirabiuli
profilaqtikuri mkurnalobis Catarebis mizniT;
8. qveynis antirabiul saswavlo-klinikur centrs unda hqondes
xelSeuxebeli maragi Sesabamisi preparatebisa, raTa gauTvaliswinebel SemTxvevebSi Seqmnili wyvetilobis pirobebSi yovel247
gvari akrZalvisa da SezRudvis gareSe gaewios qmediTi, kvalificiuri daxmareba mosaxleobis cxovelebis mier dazaralebul
kontigents;
9. cofis SemTxvevebis Rrma epidemiologiuri Seswavla. saWiroebis SemTxvevaSi mopovebuli masalebis ganxilva ministris sabWoze;
10. antirabiuli qirurgiuli samsaxuris Setyobinebis Tanaxmad adamianis dakbenis yoveli SemTxvevis skurpulozuri
epidzedamxedveloba, acrebis TviTneburad Sewyvetis SemTxvevaSi
epidemiologiuri samsaxuris mier qmediTi RonisZiebebis gatareba
cofis Tavidan acilebis mizniT;
11. mosaxleobis antirabiuli samedicino daxmarebis programa,
cofTan brZolis sajaro miznebis gaTvaliswinebiT, dazaralebulTaTvis aucileblad unda iyos ufaso. saxelmwifom unda
itvirTos cofsawinaaRmdego acrebis sayovelTaoba;
12. yovlad dauSvebelia farmacevtuli firmebis mier kerZo
klinikebSi gaxsnil imunizaciis centrebSi tendenciurad (mxolod maT mier mowodebuli vaqcina aris ,,usafrTxo~) reklamirebuli ZviradRirebuli vaqcinebiT cofTan brZola, mosaxleobis didi nawilisaTvis fasiani acrebis xelmiuwvdomelobis
gamo. cofiT sikvdilis mizezi dazaralebulTa ufuloba ar
unda iyos;
13. cofTan brZolaSi mTavari mainc saTanadod momzadebuli
da aprobirebuli preparatebiT aRWurvili qirurg-rabiologis
gamocdileba da Tavis saqmianobaze pasuxismgeblobaa da ara
vaqcinis mwarmoebeli qveynis dasaxeleba. Ddazaralebuls aqvs
ufleba TviTon airCios eqimi da samedicino dawesebuleba, miTumetes, roca saqme socialurad saSiS, sasikvdilo daavadebas
exeba;
14. daavadebis Tavidan acilebis mizniT saWiroa saqarTvelos
parlamentis mier cofis zedamxedvelobis momwesrigebeli kanonis miReba (samTavrobo instruqciebi, qveyanaSi cofis mxriv Seqmnili viTarebidan gamomdinare, aSkaradOarasakmarisia);
15. cofTan brZolaSi konsensusis misaRwevad aucilebelia
mudmivi koordinacia adgilobrivi mmarTvelobis organoebs, jandacvisa da soflis meurneobis saministros uwyebebs Soris;
248
16. saWiroa ZaRlebis populaciis marTva, patroniani da sacxovrebel korpusebTan mikedlebuli cxovelebis registracia, maTi
masobrivi cofsawinaaRmdego vaqcinacia da specialuri saniSnebis dadeba;
17. aucilebelia mRrRnelebis populaciis kontroli; Bbevria
moxetiale kata. Aar arsebobs monacemebi katebis populaciis
Sesaxeb;
18. ZaRlebis gamravlebis kontroli. Mmawanwala ZaRlebis
daWera, acra da Sesabamisi niSnis gakeTeba. saSiSi, avadmyofi
ZaRlebis organizebuli amoReba civilizebuli meTodebiT;
19. ZaRlmWeri samsaxuris muSaoba ufro qmediTi unda gaxdes,
aucilebelia ZaRlmWerTa profilaqtikuri vaqcinacia;
20. veterinaruli zedamxedvelobis samsaxuris saimedo muSaobaze bevri ram aris damokidebuli: kerZod damkben cxovelze aTdRiani sakarantino meTvalyureoba da maTze janmrTelobis mdgomareobis Sesaxeb daskvnis gacema;
21. cofTan brZolis sami umniSvnelovanesi rgolis _ antirabiuli qirurgiuli, epidemiologiuri da veterinaruli samsaxuris saimedo, srulyofili, maRalkvalificiuri da koordinirebuli muSaoba daavadebis Tavidan acilebis garantiaa;
22. cxovelebis populaciis dinamika pirdapir kavSirSia antisanitariasTan, Aamitom dasufTavebis samsaxuris operatiul
muSaobas _ dasaxlebuli punqtebidan nagvis yoveldRiur gatanas _ cofTan brZolaSi udidesi mniSvneloba eniWeba.
Teimuraz gogiZe
Tssu rabiologiis programebis koordinatori,
eqsperti, medicinis doqtori
249
250
2
1
1
1
bavSvTaA asakis qirurgia
axalSobilTa qirurgia
rabiologia
bavSvTA asakis urgerntuli
qirurgia
dasaxeleba
xangrZ.
(Tve)
profesiuli reabilitaciis ciklebi:
m.m.d. p. gvetaZe
m.m.d. r. ruxaZe
m.m.d. T. gogiZe
m.m.d. p. gvetaZe
m.m.d. r. ruxaZe
m.m.d. p. gvetaZe
m.m.d. r. ruxaZe
programis
xelmZRvaneli,
koordinatori
1-31/XI 2007 w.
1-30 (yvela Tvis)
1-31/XII 2007 w.
cilkebi
Catardeba
mxolod
miTiTebul
vadebSi
(1 Tve-100 l)
Catarebis TariRi
3/IX-31/X 2007 w.
profesiuli reabilitaciis programebi
bavSvTa qirurgia
2008 wels SemuSavda profesiuli reabilitaciis programa `rabiologia~ eqimi-qirurgebisa da
travmatologebisaTvis;
251
1
1
1
gulmkerdis travmuli dazianebani
rabiologia
2
xangrZ.
(Tve)
zeda kidurebis travmuli dazianebani
travmatologia
dasaxeleba
profesiuli reabilitaciis ciklebi:
m.m.d. T. gogiZe
m.m.d. g. baqraZe
m.m.d. g. baqraZe
m.m.d. g. baqraZe
programis xelmZRvaneli,
koordinatori
1-30 (yvela Tvis)
1-31/XI 2007 w.
1-30/XI 2007 w.
cilkebi Catardeba
mxolod miTiTebul
vadebSi
(1 Tve-100 l)
Catarebis TariRi
3/IX-31/X 2007 w.
profesiuli reabilitaciis programebi
travmatologia
252
2
2
2
1
1
endovideoqirurgia (sruli kursi)
muclis Rrus organoebis
qirurgiuli daavadebebi
rabiologia
muclis Rrus organoebis
gadaudebeli qirurgia
xangrZ.
(Tve)
laparaskopiuli qirurgia
dasaxeleba
profesiuli reabilitaciis ciklebi:
m.m.d. r. mesxiSvili
m.m.d. T. gogiZe
m.m.d. a. arvelaZe
m.m.d. a. abaCiaSvili
prof. g. fifia m.m.d. l.
maWaraSvili
prof. g. fifia m.m.d. d.
abulaZe
programis
xelmZRvaneli,
koordiantori
1-30/XI 2007 w.
1-30 (yvela Tvis)
3/IX-31/X 2007 w.
1/XI-31/XII 2007
w.
3/IX-31/X 2007 w.
ciklebi Catardeba
mxolod miTiTebul
vadebSi (1 Tve-100
lari)
Catarebis TariRi
zogadi qirurgia
profesiuli reabilitaciis programebi
253
janmrTelobis
xelSewyoba da
socialuri
marketingi
saeqimo
praqtikaSi
komunikaciis
axali
teqnologiebi
saeqimo
praqtikaSi
antibaqteriuli
Terapiis
Tanamedrove
principebi
nakbeni
Wrilobebis
profilaqtikuri
mkurnalobis
Tanamedrove
moTxovnebi
2006187
2007191
2006199
2006188
2006162
programis
dasaxeleba
sabrZolo stresi
akred..#
[email protected]
Tb. WavWavaZis g #33;
tel.: 22 33 22, 23 42
03; 899 518136
373586
faqsi: 899 32 23 03
91
el. fosta:
Tssu-s mikrob. da
imunol. depart. vaJafSavelas #29
d. CikvilaZe
T. gogiZe
Tssu-s jandacvis
departamenti. vaJafSavelas #29
Tssu, eqstremaluri
medicinis centri. vaJafSavelas gamz. #33
Tssu-s jandacvis
departamenti. vaJafSavelas #29
Catarebis adgili
o. gerzmava
o. gerzmava
programis
xelmZRvaneli
v. afxazava
30
30 l.
27.07.08
29.11.2007
15 l
15
29.11.2007
akreditaciis
vadis dasruleba
29.09.2007
29.11.2007
15 l
25 l
fasi
15 l.
6-8/IX; 22-24/X;
29-31/X; 5-7/
XI; 15-17/XI; 2224/XI
ganxorcielebis
TariRi
15
15
I tipis
upg/q
25
Tssu di plomisSemdgomi samedicino ganaTlebis da uwyveti profesiuli
ganviTarebis instituti
yvela klinikuri specialobisTvis
254
2007226
2007191
2007056
2006192
2006191
2006190
2006189
2006165
2006146
2006145
#
dedidan bavSvze aiv
infeqciis gadacemis
profilaqtika
xarisxis kontrolis
sistemis moqmedebis
Taviseburebebi jandacvis
sistemaSi
jandacvis menejmenti
(Sesavali kursi)
jandacvis ekonomikis
safuZvlebi
lideris roli jandacvis
sistemaSi
daavadebaTa saerTaSoriso
klasifikacia
nakbeni Wrilobebis
profilaqtikuri
mkurnalobis Tanamedrove
moTxovnebi
saavadmyofos higienis
aqtualuri sakiTxebi
adamianis ekologiisa da
garemos medicinis
aqtualuri sakiTxebi
wyali da janmrTeloba
programis dasaxeleba
T. asaTiani
T. gogiZe
e. mirvelaSvili
o. gerzmava
o. gerzmava
o. gerzmava
o. gerzmava
k. gelaSvili
k. gelaSvili
k. gelaSvili
programis
xelmZRvaneli
Tss-u-s jandacvis departamenti
vaJa-fSavelas q.#29
Tss-u-s jandacvis departamenti
vaJa-fSavelas q.#29
Tss-u-s jandacvis departamenti
vaJa-fSavelas q.#29
dipl. Semd da upg.inst.
WavWavaZis gamz. #29
Tb. WavWavaZis g #33;
tel.: 22 33 22, 23 42 03;
899 518136, 373586
faqsi: 899 32 23 03 91
el. fosta:
[email protected]
Tb. c. dadianis q. #255 tel:
tel.: 69 60 34;
faqsi.: 69 60 34
el.
fosta:[email protected]
vaJa-fSavelas q. #29 higienis
kaTedra
Tss-u-s jandacvis departamenti
vaJa-fSavelas q.#29
vaJa-fSavelas q. #29 higienis
kaTedra
vaJa-fSavelas q. #29 higienis
kaTedra
Catarebis adgili
15
30
15
15
50
50
15
25
30
25
I etepis
upg/q
ganxorcielebis
TariRi
15 l.
30 l.
15 l.
15 l.
50 l.
50 l.
15 l.
25 l.
45 l.
35 l.
fasi
27.07.08
27.07.08
05.03.2008
29.11.2007
29.11.2007
29.11.2007
29.11.2007
29.09.2007
29.09.2007
29.09.2007
akreditaciis
vadis
dasruleba
Tssu di plomisSemdgomi samedicino ganaTlebis da uwyveti profesiuli ganviTarebis
instituti
pirveladi jandacva
saqarTvelos antirabiuli qirurgiuli samsaxuri wlebis ganmavlobaSi eweoda cofis prevenciis farTo sanitarul propagandas qveynis masmediis (televizia, radio, Jurnal-gazeTebi) saSualebiT.
frTxilad – cofis sezoni aqtiurdeba
cofis wyaro aTidan cxra SemTxvevaSi ZaRlia
cofi uZvelesi, kacobriobis asakis daavadebaa. axasiaTebs nakbeni Wrilobis SesaZlebeli specifikuri garTuleba. daavadebas
iwvevs neirotropiuli virusi, romelic daavadebuli cxovelis
nerwyvSia.
TbilisSi imravla mawanwala ZaRlebis ricxvma. yvelaze aqtiuri sezoni cofis gavrcelebisaTvis gazafxuli da zafxulia,
xSiri SemTxvevebia aprilsa da maisSi.
yovelwliurad cofiT msoflioSi 50 aTasze meti adamiani
iRupeba, bolo aTi wlis ganmavlobaSi saqarTveloSi 51 adamiani
gardaicvala. bolo oTxi wlis statistikuri monacemebiT, cxovelTa mier dazaralebuli pirebis raodenoba aseTia: 2000
wels – 2776 adamiani dazaralda; 2001 wels _ 4390; 2002
wels _ 5289; 2003 wels – 5980; 2004 wlis 5 TveSi – 3403.
amaTgan antirabiul (cofsawinaaRmdego samsaxurs) miakiTxa, vaqcinacia Cautarda da cofs gadaurCa: 2000 w. – 2000; 2001 w.
– 3227; 2002 w. – 3364; 2004 w. – 1692 adamiani (5 Tvis
monacemebiT).
gardacvalebis SemTxvevebi dafiqsirda: 2001 wels 2 kaci;
2003 wels – ori; 2004 wlis xuTi Tvis ganmavlobaSi gardaicvala erTi bavSvi, 2002 da 2004 wels gardacvalebis SemTxvevebi ar aRricxula, gardacvlilebze Tavis droze antirabiuli imunizacia ar CautarebiaT.
meriis jandacvisa da socialuri dacvis saqalaqo samsaxuris
mTavari specialistis, lia egutiZis, TqmiT, cofTan brZolis
upirvelesi saSualeba mawanwala ZaRlebis mospobaa. am daavadebebis matarebelia: Ramura, mela, mgeli, mRrnelebi. cofis wyaro
aTidan cxra SemTxvevaSi ZaRlia.
qalaqis veterinarTa sammarTveloSi `axal versias~ acnobes,
rom TbilisSi yovelwliurad aTi aTasamde mawanwala ZaRlis
255
likvidacia xdeba. qalaqis gamgeobebSi gamoyofilia specialuri ZaRlsaWeri brigadebi.
cofiT dasnebovnebas Semdegi simptomebi aReniSneba: qavili,
xangrZlivi tkivili nakben adgilze, nawiburze SewiTleba, SeSupeba, revmatiuli xasiaTis tkivilebi, wylis danaxvaze adamians
saxe emanWeba, emarTeba xaxisa da xorxis kunTebis Zlieri
spazmi, avadmyofi uxvad gamoyofs nerwyvs, aRgznebas mosdevs
dambla, romelic qveda kidurebidan iwyeba da mTavrdeba gulisa
da sunTqvis funqciis moSliT, rasac avadmyofis sikvdili mosdevs. cofs berZnulad hidrofobias – wylis SiSs uwodeben.
xSirad dakbenil adamians darRveuli aqvs sxeulis mTlianoba,
gansakuTrebiT saSiSia TavTan axlomdebare ubnebi, kidurebi.
cofisagan Tavis dasacavad ZaRlis dakbenisTanave unda mivakiTxoT antirabiul samsaxurs. Tu warsulSi cofis asacileblad mucelSi 40 nemsis gakeTeba iyo saWiro, 1997 wlidan
qveynis wamyvani rabiologis Temur gogiZis mier CvenTanac dainerga msoflioSi aprobirebuli meTodi, rac swraf, gamartivebul
da efeqturi mkurnalobis kurss warmoadgens. pacienti 40 nemsis nacvlad 6 nemss ikeTebs mxris areSi.
dResdReobiT antirabiuli centri – antirabiul-qirurgiul,
epidemiologiul, epidemiologiur da veterinalur samsaxurebs
moicavs. gamartivda mkurnalobis sistema, dazaralebulebs adgilzeve, operatiulad ukeTdebaT plastikuri qirurgia.
cofis inkubaciis periodi xSirad weliwadze met xansac moicavs.
mkurnalobis pirobebSi cofi gamoricxulia. dazaralebulma unda
Caitaros mkurnalobis sruli kursi, rac sawyis etapze moicavs
damamSvidebeli medikamentebiT mkurnalobas. Semdeg keTdeba antirabiuli vaqcina (antitetanuri Srati da anatoqsini). antirabiuli Srati wlebis ganmavlobaSi ufasod keTdeba, acrebis
ganmavlobaSi da misi damTavrebis Semdeg akrZalulia alkoholiani sasmelis miReba.
naTia nodia
gazeTi `versia” - #190 28-29 ivnisi, 2004 w
256
cofi, igive hidrofobia (berZnulad - ‘wylis SiSi~), uZvelesi
droidanaa cnobili. `iliadas~ erT-erT mTavar gmirs, uZlevel
heqtors, berZnebi ‘cofian ZaRls~ eZaxdnen. daavadeba pirvelad
kornelius celsma aRwera, cofis sawinaaRmdego acra ki lui
pasterma gabeda. mas Semdeg wlebi, aTwleulebi, saukuneebic ki
gavida, magram es daavadeba jer kidev SiSis zars scems kacobriobas,
arc aris gasakviri: Tu acra odnav mainc dagvianda, adamiani kvdeba.
hidrofobiis Sesaxeb gvesaubreba Tssu g. Jvanias saxelobis pediatriuli klinikis antirabiuli qirurgiuli samsaxuris xelmZRvramdenad
aneli, qveynis wamyvani rabiologi, docenti Teimuraz gogiZe.ramdenad
gavrcelebulia cofi Cvens qveyanaSi?
qveyanaSi?es daavadeba, romliTac msoflioSi yovelwliurad 60 000-mde
adamiani iRupeba, dRemde saqarTvelosTvisac mwvave problemad
rCeba. katastrofulad izrdeba cxovelebis mier dakbenilTa
ricxvi, gasul wels TbilisSi 9000-mde SemTxveva aRiricxa,
ra daavadebaa
mTlianad izrdeba gazafxul-zafxulis periodSi.ra
cofi?
cofi?cofi, iseve rogorc tetanusi, specifikuri mwvave qirurgiuli
infeqciaa, romelsac nervuli sistemis mZime dazianeba axasiaTebs
ra SemTxvevaSi avaddeba
da, rogorc wesi, sikvdiliT sruldeba.ra
adamiani cofiT?
cofiT?es sneuleba adamians maSin gadaedeba, Tu cofianma cxovelma,
257
frinvelma an mRrRnelma dakbina, dakawra an dadorbla. daavadebis gamomwvevia virusi, romelic mxoloddamxolod Tbilsisxliani cxovelisa da adamianis nerwyvSi, zurgisa da Tavis tvinSi
budobs. dakbenis Semdeg cxovelis nerwyvis meSveobiT WrilobaSi moxvedrili virusi centralur nervul sistemamde aRwevs
da daavadebac viTardeba. maS, mxolod ZaRlis kbenisa ar unda
gveSinodes...
gveSinodes...samwuxarod, asea. cofiT SeiZleba daavaddes yvela Tbilissisxliani cxoveli, Tumca hidrofobias yvelaze metad mainc ZaRli,
kata, mgeli da mela avrceleben.civsisxlian cxovelebs (qvewarmavlebs) cofi ar emarTebaT. kbenidan ramden xanSi unda velodeT cofis gamovlenas?
gamovlenas?am daavadebis inkubaciuri (faruli) periodi ramdenime dRidan erT
wlamde, zogjer amaze met xansac gastans. sainkubacio periodi
moklea maSin, roca adamiani Zlieraa dakbenili, Tanac Wrilobebi
saxeze, Tavze, xelebze aqvs. garda amisa, mokle faruli periodi
aReniSnebaT bavSvebs. cnobilia, rom kbenis Semdeg cofiani cxovelis qceva icvleba, mainc, rogor uvlindeba cofi ZaRls?
ZaRls?kbenis Semdeg ZaRls 10 dRis manZilze unda daakvirdeT. cofian
cxovels Semdegi niSnebiT icnobT: umizezod yefs, iqavebs nakben
adgils, ar Wams, ar svams, RrRnis da ylapavs uCveulo sagnebs –
lursmans, qvas, tilos naWers da a.S. Cveulebrivze xSirad elaquceba patrons, imaleba sibneleSi an, piriqiT, agznebulia; Tu dabmulia, cdilobs, aiwyvitos da Tu nebas miscemT, did manZilze
gaiqceva; umizezod esxmis Tavs da kbens cxovelebs, frinvelebs,
ucxo adamianebs da patronsac ki, ramdenime dRis Semdeg uviTardeba damblis niSnebi, yefs xrinwiani xmiT, Camosdis dorbli,
barbaciT dadis da kidurebs miaTrevs, uWirs sunTqva, bolos ki
waiqceva da kvdeba.
adamians rogorRa uvlindeba hidrofobia?
- cofiT daavadebis pirveli niSnebia qavili, mWreli da mwvave
tkivili nakben adgilas. nawiburi SewiTldeba da Supdeba. adamians uviTardeba revmatuli xasiaTis tkivilebi, erRveva saWmlis
258
moneleba – awuxebs umadoba, piris simSrale,
gulisreva, pirRebineba, yabzoba, SeiZleba, sxeulis
temperaturamac moimatos
38-40 gradusamde. ramdenime dReSi iwyeba agznebis periodi: wylis danaxvisas avadmyofs SiSi i pyrobs, tanjvisgan saxe
emanWeba, aReniSneba xaxisa
da xorxis kunTebis Zlieri spazmi, Zalze agresiuli xdeba, garSemo
yvelafers amtvrevs, bodavs, uxvad gamoyofs nerwyvs.
agznebas mosdevs dambla, romelic qvemo kidurebidan iwyeba da
sruldeba gulisa da sunTqvis funqciaTa moSliT, rasac sikvdili
mosdevs.
rogor moviqceT, Tu ZaRlma dagvkbina?
dagvkbina?dakbenis Semdeg, pirvel yovlisa, profilaqtikuri RonisZiebebi
unda CaitaroT:
nakbeni daimuSaveT ara iodiTa da spirtiT, aramed sapniani
wyliT.
droulad mimarTeT qirurg-rabiologs, romelic Wrilobas
saTanadod daamuSavebs da cofis sawinaaRmdego acrebs CagitarebT. Cveni klinikis antirabiuli samsaxuris meoxebiT praqtikaSi dainerga axali ti pis vaqcinaciis sruli eqvsineqciani
(arasruli kursi – sami ineqcia) msoflioSi aRiarebuli kursi,
nacvlad Zveli, 48-ineqciianisa. ase,
rom acris procedurac gaiolda.
- aramc da aramc ar gakeroT
Wriloba pirveli sami dRis ganmavlobaSi, Tu, ra Tqma unda, amas
sasicocxlo Cveneba (magaliTad,
Zlieri sisxldena) ar moiTxovs.
daixsomeT: kbenis, dakawvris, an
dadorbvlis SemTxvevaSi, Tundac
cxoveli arafriT hgavdes avadmyofs, uTuod mimarTeT eqims –
259
daavadebis faruli periodis ukanaskneli 10 dRis ganmavlobaSi
cofis virusi ukve nerwyvSia da gamoricxuli ar gaxlavT, erTi
SexedviT janmrTeli cxoveli cofiT daavadebuli aRmoCndes.
cnobilia, rom adamians acris Semdeg ramdenime rekomendacias
aZleven. ra rekomendaciebia eseni?
- cofis sawinaaRmdego vaqcinaciis Semdeg ramdenime rCevis
gaTvaliswineba marTlac mogixdebaT:
eqvsi Tvis ganmavlobaSi arafriT ar SeiZleba alkoholis
miReba, ludisac ki. sasmeli asustebs cofis virusis mimarT
organizmis winaaRmdegobis unars.
erideT gadaRlas, gadacivebas, magram nurc metismetad CaifuTnebiT.
guldasmiT daicaviT kanis higiena.
antirabiuli (cofis sawinaaRmdego) vaqcinaciis periodSi
da misi dasrulebidan 2 Tvis manZilze ar CaitaroT araviTari
profilaqtikuri acra, garda antitetanurisa.
dabolos, ras urCevdiT Cvens Tanamemamuleebs?
cofis profilaqtikis sakiTxs isevdaisev mawanwala ZaRlebis
problemamde mivyavarT, maTTan brZola ki qalaqis keTilmowyobisa da sxva Sesabamisi samsaxurebis prerogativaa. xolo mosaxleobas minda vurCio, maqsimalurad moeridon quCis ZaRlebs,
dakbenis SemTxvevaSi ki dauyovnebliv eqims mimarTon. cofTan
xumroba ar SeiZleba, is momakvdinebeli senia.
ina vaCiberiZe
Jurnali `janmrTeli sicocxle~ - Healthy Life #6
(13)2005
260
261
Jurnali `aversi - janmrTeli sicocxle~ #6-2008 weli
262
saqarTvelos antirabiuli samedicino daxmarebis centrma
urTierToba daamyara humanitarul organizaciasTan `veterinarebi
sazRvrebs gareT” (Sveicaria), wiTeli jvris saerTaSoriso
organizaciasTan da rac gansakuTrebiT mniSvnelovania, cofTan
brZolis msoflio mniSvnelobis centr - pasteris institutTan
parizSi.
2009 wels Sromis, janmrTelobisa da socialuri dacvis
saministrom saqarTvelos rabiologiuri qirurgiis sabazo samsaxuri da misi xelmZRvanelis Teimuraz gogiZis kandidatura,
konkursis wesiT SearCia da maTi muSaobis Sedegebi janmrTelobis msoflio organizaciis 2010 wlis safondo premiaze waradgina. am wardginebaSi naTqvami iyo, rom Tanamedrove etapze msoflioSi rabiuli infeqciis globaluri zrda aRiniSneba, ris
gamoc Sesabamisad matulobs cofTan dakavSirebuli problemebis aqtualobac. saqarTveloSi Zalian did problemas warmoadgenda cofi radgan daavadebulTa ricxvi dRiTidRe matulobda,
rac gamowveuli iyo rogorc mZime socialuri mdgomareobiT,
bevri mawanwala ZaRlebis arsebobiT da rac mniSvnelovania am
sferos sruli ucodinarobiT, ar iyo literatura ar iyo aranairi
prevencia, vaqcinacia, da rac mTavaria misi mniSvneloba ar iyo im
doneze aRTqmuli rasac igi namdvilad warmoadgenda da ris
gamoc SemTxvevebis da letalobis ricxvi geometriuli progresiiT izrdeboda.
263
27 wlis win eqim-qirurgma Teimuraz gogiZem gadawyvita am
metad aqtualur problemaSi garkveva da RonisZiebebis Catareba,
magram es arc Tu ise advili iyo im periodisaTvis, rodesac ar
iyo aranairi literatura, ar moipoveboda aranairi naSromebi am
Temaze, ar iyo Tanamedrove teqnologiebi iseTi rogoric aris
interneti da sabWoTa eqimisTvis arc ucxouri literaturis
moiZieba iyo advili, yvelaferi amis gaTvaliswinebiT misi am
saqmis dawyeba iyo praqtikulad enTuziazmi. miuxedavad amisa
mas ar dauSurebia arc dro, arc saxsrebi da arc energia imisaTvis, rom mas mieRwia SedegebisaTvis.
kerZod 1983 wels man Camoayaliba antirabiuli qirurgiuli
samsaxuri, 1987 wels aRniSnuli antirabiuli samsaxuri Camoayaliba bavSvTa #2 klinikur saavadmyofoSi, sadac Tavadve Caudga
saTaveSi.
1988 wels axalgazrda qirurgTa samecniero konferenciaze
pirvelad gamoaqveyna pirveli samecniero naSromi aRniSnul Temaze.
1994 wels Camoyalibda ukve saqarTvelos antirabiuli sazogadoeba, ris Tavmjdomaredac TviTon gaxda. ufro mogvianebiT ki
2000 wels rabiologTa kavSiris (asociaciis) prezidentis Tanamdeboba daikava.
1995 wels jandacvis saministros xelmZRvanelobiT Seadgina
antirabiuli samsaxuris saxelmwifo programa, romelic Semdgom
safuZvlad daedo mosaxleobis antirabiuli samedicino daxmarebis programas.
1996 wlis 18 noembers jandacvis saministros brZanebiT `cofTan
brZolis gaZlierebis Sesaxeb” dainiSna q.Tbilisis #2 bavSvTa
mravalprofiluri saavadmyofos bazaze Seqmnili antirabiuli
samedicino daxmarebis centris xelmZRvanelad. amave wels, ukve
rogorc eqspertma rabiologiis sferoSi Seadgina antirabiuli
vaqcinaciis droebiTi standartebi, gansazRvra dazaralebul pirTa
pirveladi samedicino daxmarebis RonisZiebaTa moculoba.
1999 wels jandacvis saministros xelmZRvanelobiT Teimuraz gogiZem Seadgina pirveli qarTulenovani `antirabiuli qirurgiuli daxmarebisa da acrebis baraTi”romelic Semdgom dainerga qveynis qirurg-rabiologTa praqtikaSi.
2000 wels saxelmwifo samedicino akademiaSi qirurgiis kaTedraze Seqmna rabiologiis cikli, rasac Tavadve xelmZ-Rvanelobda
264
(ris Sedegadac qveynis 61 qirurgma da travmatologma gaiares
momzadeba rabiologiaSi, raSic miiRes saxelmwifo licenzia).
man Seqmna 22 samecniero naSromi, aseve damxmare saxelmZRvanelo `nakben WrilobaTa mkurnaloba bavSvebSi”, broSura saxelwodebiT `cofi”.
2003 wels SeimuSava programa `rabiologia pirveladi jandacvis eqimebisaTvis”, romelmac uwyveti samedicino ganaTlebis
egidiT monawileoba miiRo saqarTvelos eqimTa pirveli kongresis muSaobaSi.
2003 wlis 19 seqtembers saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris brZanebiT damtkicda docent T.gogiZis meToduri saxelmZRvanelo `cofi daavadebis
profilaqtikuri mkurnaloba”
amave wels akreditacia gaiara gogiZis mier wardgenilma samma
programam 1)`rabiologiis qirurgiuli aspeqtebi”, 2)`rabiologia pediatrebisaTvis”, 3)`rabiologia ojaxis eqimebisaTvis”. es
programebi warmatebiT monawileoben uwyveti samedicino ganviTarebis sistemaSi.
2006 wels gogiZem jandacvis saministros xelmZRvanelobiT
Seadgina axali ti pis standartebi rabiologiaSi. amave wels
saxelmwifo akreditacia gaiara misma programam `rabiologia Tanamedrove aspeqtebi”
2007 wels gamoica axali meToduri saxelmZRvanelo “cofiT
daavadebis profilaqtikuri mkurnaloba” amave wels damtkicda
mis mier warmodgenili moklevadiani programa rabiologiaSi
“nakbeni Wrilobebis profilaqtikuri mkurnalobis Tanamedrove
moTxovnebi” (saxelmwifo akreditaciis #2007191), amave 2007
wels man Seadgina `cofTan brZolis koncefcia: strategiis
ganmsazRvreli dokumenti saqarTvelos parlamentisaTvis.
2008wels Seadgina profesiuli reabilitaciis programa `rabiologia”.
misi ZalisxmeviT dafuZnda regionaluri antirabiuli centrebi qveynis mTels teritoriaze, sadac dauyovnebliv da Zvirfasi drois dakargvis gareSe SesaZlebelia drouli da rac
mTavaria ukve kvalificiuri daxmarebis miReba, aseve misi moqmedebiT mudmivad xorcieldeba ukve eqim rabiologTa gadamzadeba da rabiologiaSi Tanamedrove miRwevebis danergva, (magal265
iTad rogoric aris savaldebulo 48 inieqciidan ufro dazogviTi 3-5 ineqciaze Camoyvanis meTodis danergva), antirabiuli imunoglobulinis nakben WrilobaSi Seyvana pasiuri imunizaciis mizniT mZime kategoriebis nakbenebis dros. aseve axali
kvlevebi, klinikurad aRsaniSnavia kidev erTi umniSvnelovanesi
da uprecendento meTodi romelic gulisxmobs mikroqirurgiuli meTodis gamoyenebas rabiologiaSi, kerZod misi meTodiT
xdeba nakbeni Wrilobebis anatomiuri mTlianobis aRdgena mikroskopiuli teqnikis gamoyenebiT rac Tavis mxriv dazaralebulisaTvis Zalian praqtikulia da mas aRar sWirdeba 2 etapiani
qirurgiuli daxmarebis aRmoCena, rogorc es mTels msoflioSi
xdeba, rodesac pirveli etapi moicavs Wrilobis mxolod damuSaveba da mogvianebiT rekonstruqciuli operaciis Catareba
meore etapad.
aRniSnuli prevenciuli zomebis danergviT mosaxleobis vaqcinoprofilaqtikam miiRo saxelmwifos nacionaluri politikis
saxe, da mniSvnelovani adgili daikava bioterorizmisa da biokatastrofebis prevenciis saqmeSi.
aseve unda aRiniSnos isic, rom literaturis, naSromebis da
rac mTavaria mosaxleobis informirebis Semdeg, sagrZnoblad
iklo cofis SemTxvevebma kerZod: 80-90-ian wlebSi, marto saqarTvelos teritoriaze letaluri SemTxvevebi weliwadSi aRwevda
ramodenime aTeuls, am bolo 5 wlis monacemebiT ki letalobis
maCvenebelma daiwia 7-8 SemTxvevaze, rac saqarTvelos mosaxleobis procentuli raodenobidan gamomdinare mainc ar aris mcire.
aseve erTi-aTad iklo cofiani cxovelebis gamovlenam, radganac
SemuSavebuli programebi moicavda aucilebel ufaso vaqcinacias mawanwala Tu Sinauri cxovelebisa, rac mudmivi monitoringiTa da ZalisxmeviT warmatebiT mimdinareobs saqarTveloSi.
yovelive amis gaTvaliswinebiT Tamamad SeiZleba iTqvas, rom
jandacvis am sferoSi miRweulia STambeWdavi Sedegebi, rac namdvilad yvelanair jildos imsaxurebs, da yovelive es miuTiTebs
imaze, rom Tu gagrZelda kvlevebi da muSaoba am mimarTulebiT,
SegviZlia vivaraudoT, rom ramodenime weliwadSi srulad Tu
ara 99%-Si iqneba es daavadeba da mis mier gamowveuli mZime
Sedegebi aRmofxvrili.
266
267
dasasruls, unda aRiniSnos, rom mizani miRweulia _ Seiqmna
rabiologiis Tanamedrove qarTuli skola, romlis warmomadgenlebi, rabiologiaSi momzadebuli eqimi-qirurgebi, travmatologebi amJamad unarianad xelmZRvaneloben dedaqalaqisa da regionebis antibiul qirurgiul samsaxurebs.
Seiqmna sadReRamiso samsaxurebi aWaris, imereTis, guriis, samegrelos, kaxeTis, Sida qarTlis, qvemo qarTlisa da sxva regionebSi.
ganisazRvra nakbeni Wrilobis aRdgeniTi mkurnalobis swori
qirurgiuli taqtika Wrilobis infeqciisa da hidrofobiis ganviTarebis Tavidan acilebis motivaciiT.
ganxorcielda nakbeni Wrilobebis damuSavebis (Semdgomi mkurnalobis) da antirabiuli acrebis Serwyma, romelsac atarebs
qirurgiis axali mimarTulebis specialisti, qirurgi-rabiologi.
qveyanaSi arsebulma cofis sawinaaRmdego sabazo samsaxurma
didi wvlili Seitana erTiani antirabiuli strategiis SemuSavebasa
da danergvaSi. Seswavlilia postvaqcinaluri garTulebebis SesaZleblobebi. saTanado muSaoba iqna Catarebuli nakben WrilobaTa
mkurnalobis qirurgiuli taqtikis zedmiwevniT dacvis saqmeSi
yvela zogadi qirurgis, travmatologisa da, ra Tqma unda, qirurgi-rabiologebis mier.
amJamad, Cvenebisamebr tardeba dadgenil vadebSi aqtiuri aRdgeniTi operaciebi, mZime kategoriis dakbenebis SemTxvevebSi.
udidesi yuradReba eniWeboda antirabiuli samsaxuris organizaciisa da qirurg-rabiologTa momzadeba-gadamzadebis wesebsa
da gzebs. 1997 wels dainerga antirabiuli profilaqtikuri
mkurnalobis msoflios standartebTan misadagebuli sqema axali
ti pis 5-6-inieqciani vaqcinis gamoyenebiT da adgilobrivad nakben WrilobaSi antirabiuli imunoglobulinis aqtiuri SeyvaniT,
ramac aRniSnuli mkurnaloba ufro daxvewili da dazaralebulebisaTvis ufro xelsayreli gaxada.
didi muSaoba Catarda mosaxleobis umetesi nawilis informaciuli vakuumis Sesavsebad (tele da radio gamosvlebi, statiebi
Jurnal-gazeTebSi, broSurebi), rac erT-erTi yvelaze mTavari
iaraRia cofTan brZolaSi. gaizarda dazaralebulTa drouli
momarTvianoba, rac maRalkvalificiur antirabiul mkurnalobasTan
erTad aisaxa Sedegze. mimdinareobs intensiuri muSaoba arakvalificiuri mkurnalobis aRmosafxvrelad. Sedgenil iqna praqtikuli
rekomendaciebi rabiologiur samsaxurSi mosalodneli Secdomebis aRsakveTad.
cofTan brZolis garda, didi yuradReba eTmoboda tetanusis
profilaqtikas.
268
antirabiuli sabazo samsaxuris prioritetad iTvleba qirurgisa da rabiologis muSaobis sinTezi, ramac Camoayaliba specialisti qirurgi-rabiologi, Seiqmna Sesabamisi samedicino dokumentacia da rabiologiis praqtikaSi dainerga qirurgiaSi axali mimarTuleba rabiologiuri qirurgia (nakben WrilobaTa
operaciuli mkurnaloba hidrofobiisa da tetanusis profilaqtikiT). aRniSnuli samsaxuris muSaobaSi nakbeni Wrilobebis aRdgeniTi operaciebis dros, gansakuTrebiT saxis areSi, warmatebiT
gamoiyeneba mikroqirurgiuli meTodi (lupa, mikroqirurgiuli
instrumentebi, atravmuli Zafebi).
antirabiuli saswavlo klinikuri centris ZalisxmeviT qveyanaSi farTod dainerga lui pasteris mier mowodebuli zedmiwevniT zusti termini - `antirabiuli profilaqtikuri mkurnaloba~, agreTve marTebulad CaiTvala hidrofobiis prevenciisas
termin - `dazaralebuli~-s gamoyeneba (nacvlad `pacientisa~),
xolo daavadebis ganviTarebisas ki samedicino dokumentaciaSi
`pacienti~-s Cawera.
didi yuradReba eqceva hidrofobiiT daavadebulis (samedicino
personali) kontaqts (uxvi nerwvis moxvedra) sxva adamianis
dazianebul kanze da lorwovan garsebze, kontaqtirebulTa antirabiul acrebSi Cabmaze sasicocxlo CvenebiT.
mTeli am periodis ganmavlobaSi didi Zalisxmeva iyo Cadebuli
antirabiuli veterinaruli, epidemiologiuri da qirurgiuli
samsaxurebis TanamSromlobisa da maTi erTiani koordinaciis
saqmeSi, ramac ufro qmediTi gaxada cofTan brZola saqarTveloSi.
dabolos, unda aRiniSnos, rom antirabiul centrSi momarTul
rogorc klinikurad, ise laboratoriulad dadasturebuli cofiani cxovelebis mier dazaralbulTagan (maT Soris droebiT
dakarguli teritoriebidan - afxazeTi da cxinvalis regioni),
RvTis SewevniT da Cveni ZalisxmeviT hidrofobiiT arc erTi ar
daRupula, miuxedavad imisa, rom saqarTvelo cofiT gardacvlilTa procentuli maCvenebliT msoflioSi pirvel adgilzea.
xalxis mxridan qveynis rabiologiuri sabazo samsaxurisadmi
ndobis maRali reitingi da Cveni udidesi optimizmi TiToeul
dazaralebulis antirabiul profilaqtikur mkurnalobaze gvaZlevs imeds, rom cofis qmediTi prevenciiT hidrofobiis ganviTarebis dReisaTvis arsebuli maRali maCvenebeli minimumamde
daiyvaneba.
269
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S i n a a r s i
winaTqma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
recenziebi monografiaze . . . . . . . . . . . . . . . . . . . . . . . 5
Tavi I
istoriuli narkvevi (T. gogiZe, n. gogiZe*) . . . . . . . . . . . 10
hidrofobiis epidemiologia . . . . . . . . . . . . . . . . . . . . 20
cofis etiologia . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
paTologiuri anatomia da paTogenezi . . . . . . . . . . . . . . 23
cofis epizootologia . . . . . . . . . . . . . . . . . . . . . . 25
cofis epizootia RamurebSi . . . . . . . . . . . . . . . . . . . . 31
antirabiuli daxmarebis organizaciis msoflio istoria . . 33
hidrofobiis klinika da mkurnaloba . . . . . . . . . . . . . . . 36
antirabiuli profilaqtikuri mkurnaloba . . . . . . . . . . . 42
nakbeni Wrilobis pirveladi qirurgiuli damuSaveba . . . . 42
tetanusis profilaqtika . . . . . . . . . . . . . . . . . . . . . . 44
dazaralebulTa hospitalizaciis Cveneba . . . . . . . . . . . . 45
gadaudebeli RonisZiebebi . . . . . . . . . . . . . . . . . . . . . . 45
samkurnalo profilaqtikis imunizaciis sqema . . . . . . . . . 48
antirabiuli vaqcinaciis garTulebani maTi mizezebi,
diagnostika, mkurnaloba . . . . . . . . . . . . . . . . . . . . . . 58
anafilaqsiuri Soki . . . . . . . . . . . . . . . . . . . . . . . . . 62
Sratismieri daavadeba . . . . . . . . . . . . . . . . . . . . . . . 64
antirabiul qirurgiuli samsaxuris valdebulebebi . . . . . 66
sazogadoebrivi jandacvis epidemiologiuri samsaxuris
valdebulebebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
nakbeni Wrilobis anatomiuri mTlianobis
aRdgenis princi pebi . . . . . . . . . . . . . . . . . . . . . . . . . 69
antirabiuli imuniteti . . . . . . . . . . . . . . . . . . . . . . . 75
infeqciis wyaros winaaRmdeg mimarTuli
RonisZiebebis kompleqsi . . . . . . . . . . . . . . . . . . . . . . . 75
cxovelebis saerTaSoriso gadayvanebi. . . . . . . . . . . . . . . 80
cofis laboratoriuli diagnostika, misi mniSvneloba
antirabiuli daxmarebis taqtikis gansazRvrisaTvis . . . . . . 81
daskvna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
* n. gogiZe - naTia gogiZe, eqimi-rezidenti
273
Tavi II
cofis gavrcelebis, misi prevenciis da nakben WrilobaTa
qirurgiuli mkurnalobis statistika saqarTveloSi
(1991-2005w.w).
klinikuri masala, ilustraciebi (T. gogiZe, n. gogiZe) . . . . 91
Tavi III
cofsawinaaRmdego samedicino RonisZiebaTa istoria
saqarTveloSi
1. Tbilisis pasteris sadguris Seqmna da muSaoba
(1888-1982w.w.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
2. qveynis antirabiul qirurgiuli
samsaxuris Camoyalibeba da misi Semdgomi saqmianoba
(1982 wlidan dRemde) . . . . . . . . . . . . . . . . . . . . . . . 170
literatura . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270
274
profesiuli biografia
gvari – gogiZe
saxeli - Teimurazi
sqesi – mamrobiTi
ojaxuri mdgomareoba - daojaxebuli
dabadebis TariRi
TariRi: 28 ivlisi 1952
telefoni: +995 99 518136
el.fosta: [email protected]
ganaTleba
• 1959-1969 q. Tbilisis pirveli eqsperimentaluri skola;
• 1973-1979 q. iaroslavis (ruseTi) saxelmwifo
samedicino instituti (pediatria);
• 1980-1982 klinikuri ordinatura (ruseTis pediatriisa
da bavSvTa qirurgiis institutis bazaze - q.moskovis #9
bavSvTa klinikuri saavadmyofo);
• 1995 disertacia Temaze: `mikroqirurgiuli
entero-entero anastomozi da misi morfologiurfunqcionaluri Sefaseba~;
• 2007 medicinis doqtori.
praqtikuli saqmianoba:
•1983 antirabiuli qirurgiuli samsaxuris xelmZRvaneli;
•1994 saqarTvelos antirabiuli sazogadoebis Tavmjdomare;
•1995 q.Tbilisis mTavari rabiologi;
•2000 saqarTvelos rabiologTa asociaciis prezidenti;
•1996 respublikis mTavari rabiologi, eqsperti;
•2000 Tssu rabiologiis saswavlo klinikuri programis
xelmZRvaneli.
275
samuSao gamocdileba:
•
1982 _1987 q.Tbilisis #1 bavSvTa klinikuri
saavadmyofos eqimi – qirurgi;
1987 q.Tbilisis #2 bavSvTa klinikuri saavadmyofos
eqimi - ordinatori, antirabiuli qirurgiuli
samsaxuris xelmZRvaneli;
1990 saqarTvelos eqimTa asociaciis 9 aprilis
komitetis Tavmjdomare;
1991 mcxeTis raionis gldanis sakrebulos deputati;
1995 q.Tbilisis mTavari rabiologi;
1996 q.Tbilisis #2 bavSvTa mravalprofiluri
saavadmyofos bazaze Seqmnili antirabiuli samedicino
daxmarebis centris xelmZRvaneli;
2000 qirurgiis kaTedris rabiologiis ciklis
xelmZRvaneli;
2002 qirurgiis kaTedris rabiologiis ciklis
docenti;
2007 saqarTvelos xarisxis marTvis universitetis
jandacvis fakultetis qirurgiis mimarTulebis sruli
profesori.
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samecniero miRwevebi da naSromebi:
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1988 monawileoba saqarTvelos axalgazrda
medikosTa XVII samedicino konferenciaSi –
bakuriani;
1988 saqarTvelos bavSvTa, axalgazrda qirurgTa
samedicino konferencia, Tbilisi;
1992 q.Tbilisis eqimTa daxelovnebis institutSi
kvalifikacia travmatologia-orTopediaSi;
1993 damxmare saxelmZRvanelo `nakben WrilobaTa
mkurnaloba bavSvebSi”, gamomcemloba “saqarTvelo~;
1995 antirabiuli samsaxuris saxelmwifo programis
Sedgena, romelic SemdgomSi safuZvlad daedo
276
•
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mosaxleobis antirabiuli samedicino daxmarebis
programas;
1996 antirabiuli vaqcinaciis droebiTi standartebi,
dazaralebul pirTa pirveladi samedicino daxmarebis
RonisZiebaTa moculobis gansazRvra;
broSura `cofi”, saqarTvelos janmrTelobis
saministros dakveTiT;
1999 pirveli qarTulenovani “antirabiuli
qirurgiuli daxmarebisa da acrebis baraTi”-s Sedgena,
romelic dainerga qveynis qirurg-rabiologTa
praqtikaSi;
1999 monawileoba qirurgTa XII saerTaSoriso
yrilobaSi
2001 saserTifikacio test-kiTxvaris `bavSvTa
qirurgia” Tanaavtoroba;
2003 programis SemuSaveba `rabiologia pirveladi
jandacvis eqimebisaTvis“ romelmac uwyveti
samedicino ganaTlebis egidiT monawileoba miiRo
saqarTvelos eqimTa pirveli kongresis muSaobaSi;
2003 meToduri saxelmZRvanelo `cofiT daavadebis
profilaqtikuri mkurnaloba”;
2003 sami akreditirebuli programa. 1. `rabiologiis
qirurgiuli aspeqtebi”, 2. `rabiologia
pediatrebisTvis”, 3. `rabiologia ojaxis eqimebisTvis”,
romlebic warmatebiT monawileoben uwyveti
samedicino ganviTarebis sistemaSi;
2006 axali ti pis standartebi rabiologiaSi;
2006 saxelmwifo akreditacia gaiara moklevadianma
programam “rabiologia- Tanamedrove aspeqtebi”;
2007 meToduri saxelmZRvanelo “cofiT daavadebis
profilaqtikuri mkurnaloba” (meore Sevsebuli
gamocema);
2007 moklevadiani programa rabiologiaSi “nakbeni
Wrilobebis profilaqtikuri mkurnalobis
Tanamedrove moTxovnebi”;
277
•
2007 “cofTan brZolis koncefcia” (strategiis
ganmsazRvreli dokumenti saqarTvelos
parlamentisTvis);
• 2008 profesiuli reabilitaciis programa
rabiologiaSi;
• 2009 T. gogiZis kandidatura konkursis wesiT
SearCia saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministrom da waradgina
janmrTelobis dacvis msoflio organizaciis 2010
wlis safondo premiaze.
278
XXI saukuneSi cofTan brZola kvlavac aqtualuria.
`saqarTvelov, Sen vin mogca Svili dasakargavi...~
279