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t uberkulozis mkurnalobis gaidlaini

t uberkulozis mkurnalobis gaidlaini. medea gegia. 1. tuberkulozis SemTxvevaTa klasifikacia , definiciebi. Zveli rekomendaciis mixedviT gamoiyeneboda SemTxvevaTa dayofa kategoriebad: I II III IV. axali rekomendaciis mixedviT, kategoriebad dayofa aRar gamoiyeneba.

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t uberkulozis mkurnalobis gaidlaini

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  1. tuberkulozismkurnalobisgaidlaini medea gegia

  2. 1. tuberkulozisSemTxvevaTaklasifikacia, definiciebi Zveli rekomendaciis mixedviT gamoiyeneboda SemTxvevaTa dayofa kategoriebad: • I • II • III • IV axali rekomendaciis mixedviT, kategoriebad dayofa aRar gamoiyeneba

  3. 1. tuberkulozisSemTxvevaTaklasifikacia, definiciebi SemTxvevis klasificireba emyareboda Semdeg kriteriumebs: • daavadebis lokalizacia • baqteriologiuri kvlevis monacemebi • warsulis farmakologiuri anamnezi • daavadebis simZime

  4. 1. tuberkulozisSemTxvevaTaklasifikacia, definiciebi axali rekomendaciis mixedviT: • daavadebis lokalizacia • baqteriologiuri kvlevis monacemebi • warsulis farmakologiuri anamnezi • daavadebis simZime

  5. 1. tuberkulozisSemTxvevaTaklasifikacia, definiciebi daavadebis lokalizaciis mixedviT: • filtvis • filtvgareSe • miliaruli tuberkulozi klasificirdeba rogorc “filtvis” forma

  6. filtvismgb(+) tuberkulozi adre arsebuli rekomendaciiT, pacientTan mgb (+) filtvis tuberkulozi diagnostirdeba, Tu: • naxvelis nacxis mikroskopuli gamokvlevis erTi dadebiTi Sedegi da filtvis formis aqtiuri tuberkulozisaTvis damaxasiaTebeli rentgenologiuri cvlilebebi; 

  7. filtvismgb(+) tuberkulozi axali rekomendaciiT, mgb (+) SemTxveva klasificirdeba, im SemTxvevaSic ki Tu mxolod erTi nacxia dadebiTi, sxva klinikur/laboratoriuli kvlevis monacemebis arsebobis da/an ararsebobis SemTxvevaSi

  8. SemTxvevisdefinicia adre arsebuli monacemebisgan gansxvavebiT, definicia “sxva SemTxveva” Gar moicavs “qronikul formebs”. ganmeorebiTi qimioTerapiis SemTxvevaSi pacients eniWeba definicia yvelaze axali wina qimioTerapiis kursis Sedegis mixedviT: (mag. ,,uSedego” ; “Sewyvetili”; relafsi)

  9. definicia ,,sxvaSemTxveva” moicavs: • yvelaimSemTxvevas, romelicverTavsdebazemoTaRniSnuldefiniciebSi • “warsulSinamkurnalevSemTxvevebs” ucnobigamosavliT • pacientebs, romelTacwarsulSiukveCaitarestubsawinaaRmdegomkurnalobadaamJamaddaudgindaTmgb (-) filtvistuberkulozisdiagnozi

  10. 2. standartuliqimioTerapia 2.1. rifampicinis miRebis xangrZlivoba “axal SemTxvevebSi” 2HRZE/4 HR Tu 2 HRZE/6 HE? • filtvis tuberkulozis “axali SemTxvevis” dros rifampicini iniSneba mkurnalobis mTeli kursis ganmavlobaSi - 2 HRZE/4 HR • alternatiuli sqema 2 HRZE / 6 HE aRar gamoiyeneba susti Terapiuli efeqtis gamo

  11. 2. standartuliqimioTerapia M 2.2. mkurnalobis xangrZlivoba F   igivea rogorc filtvis aseve filtvgareSe formebis dros

  12. 2. standartuliqimioTerapia M 2.2. mkurnalobis xangrZlivoba F   zogierTi eqspertis mixedviT, SesaZlebelia mkurnalobis kursis gaxangrZliveba Zval-saxsris da tubmeningitis SemTxvevaSi (9-12)

  13. 2.3. tubsawinaaRmdegomedikamentebismiRebissixSire 2. standartuliqimioTerapia intensiuri/yoveldRiuri Tu intermitiuli reJimi? • ,,axali SemTxvevebis” dros unda dainiSnos wamlebis miRebis yoveldRiuri reJimi mTeli samkurnalo kursis ganmavlobaSi

  14. intensiurfazaSi: wamlebisintermitiulimiRebarekomendebuliararis • gagrZelebisfazaSi: alternatiulirekomendacia wamlebisintermitiulimiReba (kviraSi 3-jer) SesaZlebeliamxolodimSemTxvevaSi, TuTiToeulidozismiRebazexorcieldebauSualomeTvalyureoba

  15. 2.4.samkurnalo reJimiizoniazidzemaRalirezistentobisSemTxvevaSi gagrZelebis fazaSiHRE Tu HR? • zogierTi eqspertis mixedviT: gagrZelebis fazaSi HR–is nacvlad, SesaZlebelia dainiSnos alternatiuli sqema - HRE

  16. 2.5. samkurnaloreJimiaivdatuberkuloziTkoinficirebisas • iniSneba wamlebis miRebis yoveldRiuri reJimi mTeli samkurnalo kursis ganmavlobaSi • mkurnalobis xangrZlivoba aiv (+) da aiv (-) pirebSi erTidaigivea

  17. 2.6. mkurnalobisxangrZlivobaaxalimgb (+) dadebiTituberkulozisdros ramdenad efeqturia intensiuri fazis gaxangrZliveba relafsisa da uSedego mkurnalobis prevenciisaTvis?

  18. Tu 2 HRZE-is bolos, pacienti rCeba mgb (+) dadebiTi, mkurnaloba unda gagrZeldes 4HR samkurnalo reJimiT aqedan gamomdinare, “damatebiTi intensiuri faza” saWiro aRar aris

  19. 2.7. “warsulSinamkurnalebiSemTxvevebi” • Tu gamoiyeneba DST kvlevis tradiciuli meTodi Sedegi miiReba SedarebiT gvian da amitomac pasuxis miRebamde iniSneba empiriuli mkurnaloba, xolo Semdeg reJimi icvleba Sesabamisad

  20. empiriulisamkurnalosqema iniSneba Semdeg SemTxvevebSi: • pirveli rigiT mkurnalobis Sedegi Sefasebul iqna rogorc “uSedego mkurnaloba” • albaToba multirezistentobisa sakmaod maRalia magram wamlis mimarT gamZleobis testis Sedegi jer cnobili ar aris

  21. multirezistentulituberkuloziaxaldawarsulSinamkurnalebSemTxvevebSi, 1994-2007 Anti tuberculosis drug resistance in the world, WHO, 2008 - Data from 105 and 94 countries

  22. 2.8. rodisundaCatardesnaxvelismonitoringi? “axali SemTxvevebis” dros: • Tu pacienti rCeba mgb (+) dadebiTi intensiuri fazis dasrulebis Semdeg, ganmeorebiTi baqterioskopia unda Catardes me-3 Tvis dasrulebis Semdegac • dadebiTi pasuxis SemTxvevaSi, damatebiT unda Cautardes kulturaluri gamokvleva da wamlis mimarT gamZleobis testi

  23. 2.8. rodisundaCatardesnaxvelismonitoringi? “warsulSi namkurnalebi SemTxvevebis” dros: • Ymkurnalobis dawyebisTanave, unda Catardes kulturaluri gamokvleva da wamlis mimarT gamZleobis testi • intensiuri fazis Semdeg, Tu pacienti rCeba mgb (+) dadebiTi, unda Cautardes kulturaluri gamokvleva da wamlis mimarT gamZleobis testi

  24. 2.9. tuberkulozismkurnalobagansakuTrebuliSemTxvevebisdros: tuberkulozi da RviZlis daavadebebi adre arsebuli samkurnalo reJimi 9RE Aaxali rekomendaciiT 9 HRE 2 HRSE/6HR 6 RZE 2 HES/10HE

  25. 2.9. tuberkulozismkurnalobagansakuTrebuliSemTxvevebisdros: tuberkulozi da Tirkmlis ukmarisoba adre arsebuli samkurnalo reJimi 6HRE axali rekomendaciiT 6HREZ

  26. 3. tuberkulozibavSvebSi

  27. 4. rezistentulituberkulozismkurnaloba

  28. 4.1. mkurnalobisxangrZlivoba • mkurnalobisxangrZlivobaganisazRvrebakulturiskonversiismixedviT. • mkurnalobagrZeldeba minimum 18 TvekulturiskonversiisSemdeg. • mkurnalobiskursisgaxangrZliveba–konversiidan24 Tve - naCvenebiamxolodgarkveulSemTxvevebSi

  29. 4.2. mono/polirezistentulituberkulozi • mono da polirezistentuli tuberkulozis samkurnalo sqemebi mowodebulia mxolod kargad organizebuli programebisaTvis

  30. 4.2. mono/polirezistentulituberkulozi

  31. magaliTad: • samkurnalo sqema : 2 HRZE • 2.5 Tvis Semdeg DST Sedegi: R- HE ; S-R am SemTxvevaSi polirezistentuli tuberkulozis samkurnalo sqema ar unda iqnas gamoyenebuli.

  32. zogadi wesi masalis aRebis TariRi DST pasuxis miRebis TariRi > 1 Tve mono/polirezistentuli tuberkulozis sqema ????

  33. 4.3.saineqcio medikametismiRebisxangrZlivoba saineqcio medikamentis miReba grZeldeba minimum 6 Tve an sul mcire 4 Tvemas Semdeg rac pacienti gaxda da darCa kultura uaryofiTi.

  34. 4.3. saineqciomedikamentisxangrZlivoba • ufro xangrZlivad saineqcio medikamentebis gamoyeneba unda eyrdnobodes sxva monacemebs • saineqcio medikamentebis kviraSi samjer miReba rekomendebulia mxolod gansakuTrebuli situaciebis dros.

  35. ZiriTadirekomendaciebi: • samkurnalo kategoriebad dayofa aRar gamoiyeneba • axal SemTxvevebSi “damatebiTi intensiuri faza” ar gamoiyeneba • filtvis tuberkulozis “axali SemTxvevis” dros rifampicini iniSneba mkurnalobis mTeli kursis ganmavlobaSi • 6 HE aRar gamoiyeneba susti Terapiuli efeqtis gamo

  36. ZiriTadirekomendaciebi: • izoniazidzemaRalirezistentobisSemTxvevaSi, SesaZlebeliadainiSnos - HRE • multirezistentulituberkulozisxangrZlivobaganisazRvrebakulturisskonversiismixedviT, minimum 18 Tve • polirezistentulituberkulozissamkurnalosqemisSerCevisasundaiqnasgaTvaliswinebulimasalisaRebisdaDST-is pasuxismiRebisTariRi

  37. gmadlob yuradRebisTvis

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