tbilisis saxelmwifo samedicino...
TRANSCRIPT
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Tbilisis saxelmwifo samedicino universiteti
xelnaweris uflebiT
nino emuxvari
miokardiumis mwvave infarqtis warmoSobaze moqmedi ZiriTadi
risk-faqtorebis kompleqsuri socialur-higienuri Sefaseba
14.00.33 – sazogadoebrivi jandacva da menejmenti
disertacia
medicinis mecnierebaTa kandidatis samecniero
xarisxis mosapoveblad
samecniero xelmZRvaneli
medicinis mecnierebaTa doqtori,
profesori o. gerzmava
Tbilisi
2006
2
S i n a a r s i
Sesavali ------------------------------------------------------------------------------ 5
Tavi I
literaturis mimoxilva ---------------------------------------------------- 8
Tavi II
kvlevis masala ----------------------------------------------------------------- 26
kvlevis meTodebi --------------------------------------------------------------- 29
Tavi III
miRebuli Sedegebi
hiperqolesterinemiiT avadmyofTa Trombolizuri
Terapia ---------------------------------------------------------------------------------------31
arteriuli hipertenziiT avadmyofTa mkurnalobis
Sedegebi ---------------------------------------------------------------------------------------35
Tambaqos mwevel avadmyofTa gamokvlevis Sedegebi ----39
Trombolizuri Terapia simsuqniT avadmyofebSi ----------------------41
sqesis roli Trombolizuri mkurnalobis dros ---------------------45
Trombolizuri Terapiis Sedegebi sxvadasxva asakis
pacientebSi ------------------------------------------------------------------------------------49
Saqriani diabetis mqone avadmyofTa Trombolizuri
3
Terapiis Sedegebi ----------------------------------------------------------------------------54
Trombolizuri Terapiis Sedegebi gid risk-faqtorebis
mixedviT --------------------------------------------------------------------------------------------57
Tavi IV
Sedegebis ganxilva --------------------------------------------------------------------------61
daskvnebi --------------------------------------------------------------------------------------------71
praqtikuli rekomendaciebi -------------------------------------------------------------73
gamoyenebuli literatura ------------------------------------------------------------- 74
4
disertaciaSi gamoyenebuli Semoklebebi
ah – arteriuli hipertenzia
gid – gulis iSemiuri daavadeba
gu – gulis ukmarisoba
gqu – gulis qronikuli ukmarisoba
gf – gandevnis fraqcia
CK-MB – kreatinkinazas MB fraqcia
HDL – maRali simkvrivis lipoproteidi
LDL – dabali simkvrivis lipoproteidi
mi – miokardiumis infarqti
mpmu – marcxena parkuWis mwvave ukmarisoba
TQ – saerTo qolesterini
TG – trigliceridebi
pe – parkuWovani eqstrasistolia
pf – parkuWTa fibrilacia
Sd – Saqriani diabeti
5
Sesavali
mosaxleobis cxovrebis jansaRi wesis formirebis problema
dResdReobiT warmoadgens saqarTvelos jandacvis sistemis
ganviTarebis ZiriTad mimarTulebas. amasTan, modificirebadi da
aramodificirebadi risk-faqtorebis (hiperqolesterinemia,
arteriuli hipertenzia, Tambaqos weva, Saqriani diabeti, simsuqne
da sxv) profilaqtikaze mimarTuli RonisZiebaTa ganxorcieleba
arsebul pirobebSi gaZnelebulia. Aam kuTxiT qveyanaSi Seiqmna
gansakuTrebiT rTuli situacia mosaxleobaSi gul-
sisxlZarRvTa sistemis daavadebaTa da, maT Soris, miokardiumis
mwvave infarqtis farTo gavrcelebasTan dakavSirebiT.
gulis mwvave iSemiuri daavadeba ara marto klinikuri
kardiologiis, aramed epidemiologiis, socialuri medicinis,
jandacvis ekonomikis, mTlianad sazogadoebis seriozul da
Znelad gadasaWrel problemas warmoadgens. jandacvis
msoflio organizaciis eqspertTa mier es paTologia xasiaTdeba
rogorc me-20 saukunis epidemia. amis dadasturebaa mwvave gid-iT
avadobis mkveTri zrda, pacientTa mier Sromis unaris dakargvis
maRali xarisxi, is faqti, rom gid mosaxleobis sikvdilobis
erTerTi umTavresi mizezia.
bolo wlebSi mniSvnelovnad Seicvala miokardiumis mwvave
infarqtis mkurnaloba, rac ganpirobebulia iseTi faqtorebiT
rogoricaa: diagnostikis axali meTodebis SemoReba,
randomizebuli kvlevebis Sedegebze dayrdnobiT konservatiuli
da qirurgiuli mkurnalobis unificirebuli meTodebis danergva,
specializirebuli samedicino dawesebulebebis ricxvis zrda da
sxv. Tu jer kidev 60-ian wlebSi miokardiumis infarqtiT
letaloba 30-50%-s Sedgenda. mkurnalobis da dakvirvebis
6
Tanamedrove meTodebma am mizeziT gamowveuli sikvdilobis
SemTxvevaTa sixSire TiTqmis gaanaxevra, xolo Trombolizuri
preparatebis gamoyenebam sikvdiloba 7-5%-de Seamcira.
miuxedavad amisa, miokardiumis mwvave infarqtis
warmatebuli profilaqtikis erT-erTi mniSvnelovani sawindaria
RonisZiebaa risk-faqtorebis Tavidan acileba, rac daavadebis
warmoSobis SemTxvevaSic zedmiwevniT mniSvnelovania
mkurnalobis prognozis gaTvaliswinebiT. Dadasturebulia isic,
rom risk-faqtorebis drouli koreqcia amcirebs miokardiumis
infarqtis Soreuli garTulebebis sixSires.
miuxedavad rigi dadebiTi Zvrebisa, saqarTveloSi Seqmnili
situacia ar iZleva SesaZleblobas, raTa mosaxleobaSi
gatardes farTo profilaqtikuri RonisZiebebi, mimarTuli
miokardiumis mwvave infarqtis profilaqtikaze, pacientTa
droul hospitalizaciaze. amasTan, Tavis muSaobaSi,
kardiologiur klinikaSi momuSave specialistebi nakleb
yuradRebas uTmoben risk-faqtorebis mniSvnelobis Sefasebas
pacientTa mkurnalobisa da reabilitaciis prognozirebis
procesSi.
zemoaRniSnulidan gamomdinare, kvlevis mizans warmoadgens
miokardiumis mwvave infarqtis warmoSobaze da prognozze
moqmedi risk-faqtorebis Seswavla da maTi korelaciuri
kavSiris dadgena daavadebis hospitalur da Soreul
garTulebebTan saTanado praqtikuli rekomendaciebis
SemuSavebis mizniT.
dasmuli miznis misaRwevad gadawyvetili iyo Semdegi
amocanebi:
7
- miokardiumis mwvave infarqtis gavrcelebis dinamikis
Seswavla (1990 - 2004 wlebis monacemebiT) calkeuli
regionebisa da qalaqebis mixedviT.
- pacientebze moqmedi ZiriTadi risk-faqtorebis
(socialur-ekonomikuri, socialur-higienuri da
samedicino-biologiuri) urTierTkavSiris dadgena;
- miokardiumis mwvave infarqtis mqone pacientebSi
Catarebuli Trombolizuri Terapiis Semdeg
modificirebadi da aramodificirebadi risk-faqtorebis
(hiperqolesterinemia, arteriuli hipertenzia, Tambaqos
weva, Saqriani diabeti, simsuqne, memkvidreoba, asaki, sqesi)
rolis gansazRra ganviTarebul garTulebebaTa
sixSireze;
- miokardiumis mwvave infarqtis garTulebaTa
profilaqtikaze mimarTuli saorganizacio
RonisZiebebis daxasiaTeba da maTi efeqturobis
kompleqsuri Sefaseba;
- miRebuli monacemebis safuZvelze daavadebis
profilaqtikis, mkurnalobisa da reabilitaciis
efeqtianobis gazrdis mizniT saTanado praqtikuli
rekomendaciebis SemuSaveba.
kvlevis mecnieruli siaxle: pirvelad iqna Seswavlili:
- miokardiumis mwvave infarqtis gavrcelebis
Taviseburebebi qveynis calkeuli regionebisa da
qalaqebis mixedviT;
- modificirebadi da aramodificirebadi risk-faqtorebis
(hiperqolesterinemia, arteriuli hipertenzia, Tambaqos
weva, Saqriani diabeti, simsuqne, memkvidreoba, asaki, sqesi,
8
Semosavlaii, dasaqmeba, samedicino aqtiuroba da sxv.)
gavlena miokardiumis mwvave infarqtis gavrceleba;
- Catarebuli Trombolizuri Terapiis Semdeg avadmyofTa
prognozis gansazRvraSi sxvadasxva faqtorebis (Saqriani
diabeti, dislipidemia, arteriuli hipertenzia, asaki,
sqesi da sxv.) rolis Seswavla
naSromis praqtikuli mniSvneloba:
- kvlevis Sedegad miRebul iqna mniSvnelovani
informacia mosaxleobaSi miokardiumis mwvave infarqtis
gavrcelebis TaviseburebaTa Sesaxeb, romelic saSualebas
iZleva obieqturad Sefasdes am kontingentis janmrTelobis
mdgomareoba, gamokveTos daavadebis prevenciaze mimarTuli
prioritetuli problemebi;
- Seswavlil iqna miokardiumis mwvave infarqtis
gavrcelebaze moqmedi risk-faqtorebis gavlenis specifika;
- dadginda, rom miokardiumis mwvave infarqtis prevencia
moiTxovs saTanado samkurnalo-profilaqtikuri RonisZiebebis
safexurebrivi sqemiT Catarebas, rac xels uwyobs adeqvaturi
mkurnalobis ganxorcielebas, mniSvnelovnad amcirebs am
daavadebiT gamowveuli garTulebebis sixSires, aumjobesebs
avadmyofTa cxovrebis xarisxs.
- kvlevis Sedegebi SesaZlebelia safuZvlad daedos
profilaqtikur programebs, romelTa gatareba mizanSewonilia
rogorc qveynis, aseve calkeuli jandacvis dawesebulebis da
indivividualur doneze.
9
dasacavad warmodgenili ZiriTadi debulebebi:
- miokardiumis mwvave infarqtis prevenciis gaumjobesebaze
mimarTuli socialuri da jandacviTi RonisZiebebis
qmediTunarianobis Sefasebis sqema;
- sxvadasxva marTvadi da aramarTvadi risk-faqtoris
(Saqriani diabeti, dislipidemia, arteriuli hipertenzia,
asaki, sqesi da sxv.) roli Catarebuli Trombolizuri
Terapiis prognozis gansazRvraSi;
disertaciis aprobacia da publikaciebi: disertaciis
ZiriTadi debulebebi moxsenda sxdomaze. disertaciis
Temaze gamoqveynebulia 4 statia:
disertaciis moculoba da struqtura: naSromi warmodgenilia
qarTul enaze 103 nabeWdi gverdiT. moicavs Sesavals,
literaturis mimoxilvas, gamokvlevis meTodikas da masalis
saerTo daxasiaTebas, sakuTari gamokvlevebis Sedegebs,
miRebuli Sedegebis analizs, daskvnebs, praqtikul
rekomendaciebs, danarTs, 22 cxrils, 1 diagramas.
bibliografia moicavs 176 literaturis wyaros, maT Soris
qarTuli - 10 ucxouri _ 166.
10
Tavi I
literaturuli mimoxilva
gulis mwvave iSemiuri daavadebis gavrcelebaze moqmedi
risk-faqtorebi
saqarTvelos jandacvis sistemis ganviTarebis ZiriTad
mimarTulebas qronikul daavadebaTa prevenciaze mimarTuli
RonisZiebebis Semdgomi gafarToeba da daxvewa warmoadgens. am
kuTxiT gansakuTrebiT mZime situaciaa Seqmnili gul-
sisxlZarRvTa sistemis daavadebaTa profilaqtikis saqmeSi. gid-
is da maT Soris, miokardiumis mwvave infarqtis
gavrcelebamWidrodaa dakavSirebuli mosaxleobis cxovrebis
jansaRi wesis formerebasTan.
bolo wlebSi mniSvnelovnad Seicvala miokardiumis
infarqtis mkurnaloba, rac ganpirobebulia axali
diagnostikuri meTodebis SemuSavebiT da danergviT,
unificirebuli mkurnalobis meTodebis farTo gamoyenebiT,
specializebuli dawesebulebebis da eqimkardiologTa
raodenobis gazrdiT da sxv. jer kidev 60-ian wlebSi letaloba
miokardiumis infarqtiT 30-50%-s Seadgenda. mkurnalobis da
dakvirvebis Tanamedrove meTodebma ki sikvdilobis sixSire
gaanaxevra, xolo Trombolizuri preparatebis gamoyenebam
sikvdiloba 7-5%-mde Seamcira (8,29,84,146).
miuxedavad amisa, Semdgom daxvewas moiTxovs miokardiumis
infarqtis warmatebul mkurnalobaze da garTulebaTa
profilaqtikaze mimarTuli mniSvnelovani RonisZiebebis, gid-is
risk-faqtorebze zemoqmedebis axali meTodebis danergva.
dadasturebulia, rom am faqtorebis koreqcia amcirebs
miokardiumis infarqtis Soreuli garTulebebis sixSires,
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kerZod igi klebulobs TiTqmis 70%-iT im pacientebSi, romelsac
utardebad hipoqolesterinemiuli mkurnaloba. analogiuri
kleba aRiniSneba arteriuli hipertenziis, sisxlSi glukozis
da Sededebis zogierTi faqtoris cvlilebis drouli koreqcia.
kerZod, im pacientebSi, romlebmac Secvales arajansaRi
cxovrebis wesi, Sewyvites Tambaqos moweva. aseT pacientebs
uaxloes 3 weliwadSi ganmeorebiTi infarqtis warmoSobis riski
gauTanabrda aramwevelTa risks.
gul-sisxlZarRvTa daavadebebs Soris gid pirveli adgili
uWiravs rogorc gavrcelebis, ise sikvdilobis TvalsazrisiT.
mag., ruseTSi gul-sisxlZarRvTa daavadebebiT iRupeba 20-64 wlis
mamakacTa 34% da qalTa 39%. saerTo sikvdilobis struqturaSi
gul-sisxlZarRvTa daavadebebis xvedriTi wilia 48,2%
mamakacebisTvis da 49% qalebisTvis (28,59,60,118 ).
yuradsaRebia is garemoeba, rom Tu ganviTarebul qveynebSi
gulis mwvave iSemiuri daavadebis mizeziT gardacvlilTa
ricxvi ganuyrelad klebulobs, aRmosavleT evropis da
gansakuTrebiT dsT-s da baltiispireTis qveynebSi es maCvenebeli
gacilebiT maRalia (ix.cxrili )
cxrili
gulis mwvave iSemiuri daavadebiT gardacvlilTa ricxvi (1970-
2001 ww. monacemebiT) zogierT dasavleT evropis qveynebSi
(yovel 1000000 mosaxleze)
qveynebi 1970 1980 1990 2001
fineTi 310,14 277,33 238,72 164,99
luqsemburgi 142,78 108,14 76,58
holandia 208,15 173,88 130,2
norvegia 239,28 209,46 187,21 110,44
portugalia 93,1 83,41
avstria 206,5 152,89 153,35 125,19
12
gacilebiT mZime mdgomareobaa yofil socialistur
qveynebSi, sadac, miuxedavad SemTxvevaTa garkveuli klebisa
mainc aRiniSneba sikvdilianobis maRali done (ix.cxrili)
cxrili
gulis mwvave iSemiuri daavadebiT gardacvlilTa ricxvi (1970-
2001 ww. monacemebiT) zogierT centraluri evropis qveynebSi
(yovel 1000000 mosaxleze)
qveynebi 1970 1980 1990 2001
bulgareTi 227,48 185,26 230,09 190,03
qorvatia 78,01 162,83
ungreTi 248,34 229,37 239,66 225,46
rumineTi 104,06 152,3 202,2 228,36
poloneTi 81,36 108,59 120,95 133,47
slovakia 322,29 287,99
slovenia 121,7 100,15
CexeTi 303,17 299,96 310,98 184,2
kidev ufro mZime mdgomareoba dafiqsirebulia dsT-s da
baltiispireTis qveynebSi (ix.cxrili )
cxrili
gulis mwvave iSemiuri daavadebiT gardacvlilTa ricxvi (1970-
2001 ww. monacemebiT) zogierT dsT-s qveynebSi
(yovel 1000000 mosaxleze)
qveynebi 1980 1990 2001
somxeTi 374,17 282,97
azerbaijani 389,38 405,48
estoneTi 432,52 330,70
saqarTvelo 378,49 303,05
yazaxeTi 306,84 420,22
yirgizeTi 266,75 337,51
latvia 473,68 389,42 306,39
litva 429,27 343,48
moldaveTi 357,29 558,12
ruseTi 388,09 325,44 379,43
belarusi 335,99 456,92
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baltiispireTis qveynebSi gul-sisxlZarRvTa daavadebebiT
gamowveuli sikvdiloba 55,3%-s Seadgens, xolo maT Soris gid
sikvdiloba 61,6%-ia (11,15,17,18). ukrainaSi gul-sisxlZarRvTa
daavadebebiT gamowveuli sikvdilobis erT-erTi maRali
maCvenebelia msoflioSi. 2000 wlisTvis man 61% Seadgina (117 ).
literaturis monacemebiT, 1989 wels kanadaSi gul-
sisxlZarRvTa daavadebebiT 80 859 adamiani gardaicvala, maT
Soris 49 148 – gardaicvala gid-iT, 14 232 – insultiT. gid
sikvdilobis yvelaze xSiri mizezi iyo 40 welze meti asakis
mamakacebSi da 60 welze meti asakis qalebSi. 1987w gul-
sisxlZarRvTa daavadebebiT daiRupa 77 790 adamiani, 100 000
mosaxleze sikvdiloba mamakacebs Soris iyo 324 da qalebs
Soris – 283. mamakacebs Soris sikvdiloba matebas iwyebs 10
wliT adre, vidre qalebSi, Tumca sabolood es monacemebi
daaxloebiT erTnairia. gul-sisxlZarRvTa daavadebebis saerTo
sikvdiloba SedarebiT myarad mcirdeba 1950 wlidan. 2000
wlisTvis 100 000 mosaxleze sikvdilobis Semcirebam 35-dan 90
wlamde asakis mamakacebSi da qalebSi Seadgina 780- da 415 –dan
655- da 310-mde Sesabamisad (73,86,93,96).
gul-sisxlZarRvTa daavadebebiT gamowveuli avadoba da
sikvdiloba saqarTveloSi mainc maRali rCeba. 1970-dan 1992
wlamde am daavadebebiT gamowveuli sikvdilobis xvedriTi wili
saerTo sikvdilobis struqturaSi 58,2%-dan 70,4%-mde gaizarda
(9). 1997-98 wlebSi saqarTveloSi registrirebuli iyo 121197 gul-
sisxlZarRvTa paTologiis axali SemTxveva. am daavadebebis gamo
gardaicvala 23966 adamiani. saqarTveloSi yovelwliurad 2547
adamiani avaddeba miokardiumis mwvave infarqtiT, maTgan
daaxloebiT 18% fataluria. (10).
14
mravalricxovani masobrivi kardiologiuri kvlevebis
monacemebi gul-sisxlZarRvTa daavadebebis da gansakuTrebiT
gid ganviTarebis risk-faqtorebis gavrcelebis Sesaxeb
obieqturi monacemebis miRebis saSualebas iZleva. dadgenilia,
rom gid ganviTarebis yvelaze mniSvnelovan sam risk-faqtors
warmoadgens hiperqolesterinemia, arteriuli hipertenzia da
Tambaqos weva. gansakuTrebiT saxifaToa am faqtorebis
Tanxvedra. samive faqtoris kombinaciis dros pacientTa
sikvdilobis riski 8-jer izrdeba, ori faqtoris kombinaciisas –
4-jer, xolo 1 faqtoris arsebobisas – 2-jer im pacientebTan
SedarebiT, visac gid risk-faqtorebi ar gaaCnia
(2,7,14,26,27,36,55,142,175 ).
miokardiumis mwvave iSemiis mizezi SeiZleba iyos
koronaruli arteriis daxSoba aTerosklerozuli folaqiT,
Trombis warmoqmna an sisxlZarRvis spazmi. koronaris mzardi
daxSoba ganapirobebs miokardiumis qronikul iSemias, rac
vlindeba stabiluri stnokardiis saxiT. Trombis warmoqmna an
spazmi iwvevs miokardiumis sisxliT momaragebis mwvave
ukmarisobas, anu miokardiumis infarqtis ganviTarebas.
gid ganviTarebis 95-97%-Si mizezi aTerosklerozia, Tumca
igi ar aris gid erTaderTi mizezi. gid risk-faqtorebs
pirobiTad or jgufad yofen: modificirebadi da
aramodificirebadi risk-faqtorebi.
modificirebad risk-faqtorebs miekuTvneba: arteriuli
hipertenzia, Tambaqos weva, sxeulis Warbi wona, naxSirwylovani
cvlis darRveva (kerZod, Saqriani diabeti), hipodinamia, kvebis
darRveva, sisxlSi qolesterinis donis momateba da sxva.
15
aramodificirebad risk-faqtorebs miekuTvneba: asaki (50-60welze
zeviT), mamrobiTi sqesi, damZimebuli memkvidreoba.
zogierT wyaroSi SeiZleba inaxos sxva saxis
klasifikaciebi, ris mixedviTac gid risk-faqtorebi iyofa
socialur-kulturul (egzogenuri) da Sinagan (endogenuri)
faqtorebad. socialur-kulturul risk-faqtorebs uwodeben im
faqtorebs, romlebic ganpirobebulni arian adamianis
sacxovrebeli garemoTi. maT Soris mniSvnelovania: araswori
kveba (maRalkaloriuli sakvebis Warbi miReba), hipodinamia,
nervul-fsiqikuri daZabva, Tambaqos weva, alkoholizmi, qalebSi
gid ganviTarebis riski izrdeba hormonuli kontraceptivebis
xangrZlivi miRebiT. Sinagan risk-faqtorebs uwodeben im
faqtorebs, romlebic avadmyofis mdgomareobiTaa ganpirobebuli:
hiperqolesterinemia, arteriuli hipertenzia, simsuqne,
nivTierebaTa cvlis darRveva, naRvelkenWovani daavadeba,
adamianis pirovnuli da qceviTi Taviseburebebi, memkvidreoba,
asaki, sqesi.
aTerosklerozis ganviTarebaSi qolesterinuli hipoTezis
SeqmnaSi prioriteti n. aniCkovs da s. xalatovs ekuTvnis, Tumca
50-ian wlebamde am mxriv seriozuli kvlevebi ar Catarebula.
pirvelma kvlevebma, romlebic Catarda 60-iani wlebis dasawyisSi
daamtkica, rom qolesterinis done gul-sisxlZarRvTa
daavadebebiT gamowveuli avadobis da sikvdilobis prediqtors
warmoadgens. 3 500 000-ze met adamianze dakvirvebis Sedegad
dadginda, rom saerTo qolesterinis donis momatebisas 200 mg%-
mde (5,2 mmol/l) gid riski mkveTrad izrdeba. qolesterinis
donis momatebisas 250 mg%-mde (6,5 mmol/l) es riski ormagdeba,
xolo 300 mg%-mde (7,8 mmol/l) – 4-jer izrdeba. ufro
16
saintereso iyo is faqti, rom pirebisTvis, visac qolesterinis
done 200-dan 167 mg%-mde aqvT, gid riski 70%-ia. (22,31,51,54,70 ).
dadgenilia, rom yvelaze ufro arakeTilsaimedo faqtoria
maRali simkvrivis lipoproteidebis HDL-qolestrinis daqveiTeba
39 mg%-ze (1 mmol/l) qvemoT da saerTo qolesterinis Sefardeba
HDL–qolestrinis da, gansakuTrebiT, dabali simkvrivis
lipoproteidebis LDL- qolesterinis HDL –qolestrinis
donesTan Sefardebis momateba 5,5-ze metad. (72,77,80,102) am
parametrebis kontroli gid avadobisa da sikvdilobis riskis
gansazRvris mniSvnelovani RonisZiebaa. gansakuTrebiT
mniSvnelovania maRali riskis pacientebisTvis, romelTac
pirvel rigSi miekuTvnebian pirebi gadatanili miokardiumis
infarqtiT. Trombolizurma mkurnalobam, β- blokerebisa da
ACE- inhibitorebis gamoyenebam bevrad gaaumjobesa gid pacientTa
prognozi, magram yvela es RonisZieba ar zemoqmedebs
koronaruli arteriebis aTerosklerozis arsze. 90-iani wlebis
bolos Catarebulma gamokvlevebma aCvena, rom statinebis
gamoyeneba miokardiumis infarqtiT avadmyofebSi mniSvnelovnad
amcirebs gid sixSires da sikvdilobas. kerZod, simvastatiniT
mkurnalobis dros sikvdilis riski Semcirda 34%-iT, xolo
pravastatiniT mkurnalobisas – 24%-iT ( 92,93,127).
Catarebulma gamokvlevebma aCvena, rom statinebis efeqti
miokardiumis infarqtiT avadmyofebSi vlindeba sisxlSi
sxvadasxva lipiduri speqtris dros ( maT Soris praqtikulad
normaluri maCveneblebis dros). es faqti adasturebs, rom
`normis~ cneba pirobiTia. meore mxriv ki, miokardiumis
infarqtiT avadmyofebisTvis saerTo qolesterinis da LDL-
17
qolesterinis SedarebiT dabali cifrebic ki zrdis gid
avadobis da sikvdilobis risks (67,145,152).
lipiduri speqtris am maCveneblebTan erTad aseve
mniSvnelovania trigliceridebis roli gid ganviTarebSi.
hipertrigliceridemiis, rogorc damoukidebeli risk-faqtoris
roli didi xnis ganmavlobaSi diskusiis sagans warmoadgenda.
mravali epidemiologiuri kvlevis analiziT, trigliceridebis
koncentracia 5 mmol/l (450 mg%) sarwmunod zrdis gid risks
(24, 74, 75, 97). avadmyofTa garkveuli jgufebisTvis
hipertrigliceridemiis, rogorc gid mniSvnelovani risk-
faqtoris arseboba udaoa. esenia meore tipis Saqriani diabetiT
avadmyofebi da qalebi. qalebSi, gansakuTrebiT 50 welze zemoT,
hipertrigliceridemiis mniSvnelovani prognozuli roli
dadgenilia fremingemis kvlevSi (80, 105 ). Stockholm Prospective Study
kvlevaSi, sadac 1500 qals swavlobdnen 12 wlis ganmavlobaSi,
dadginda, rom hipertrigliceridemia iyo faqtori, romelic
miuTiTebda fataluri infarqtis, insultis da saerTo
sikvdilobis riskze ( 128 ). damajerebeli monacemebia miRebuli 6
didi prospeqtuli kvlevis analiziT,romlebic mieZRvna
hipertrigliceridemiis kavSiris Seswavlas gid-Tan (147, 148, 63).
trigliceridebis koncentraciis momateba 1 mmol/l-iT gid
risks mamakacebSi zrdis 32%-iT, qalebSi – 76%-iT. xolo HDL –
qolesterinis donis SesworebiT, trigliceridebis, rogorc
risk-faqtoris roli TiTqmis 2-jer mcirdeba, Tumca qalebisTvis
mainc ufro maRali rCeba da Sesabamisad Seadgens 14 da 37%-s.
hipertrigliceridemiis Tavisebureba imaSi mdgomareobs, rom is
iSviaTia izolirebulad da xSirad Tan axlavs sxva metaboluri
18
darRvevebi, rac dReisTvis erTiandeba metaboluri sindromis
saxelwodebiT ( 25, 34, 43, 52, 91, 105, 108, 169).
arteriuli hipertenzia warmoadgens gid meore mniSvnelovan
risk-faqtors. dReisaTvis arteriuli hipertenzia arainfeqciur
pandemias warmoadgens. is gansakuTrebiT xSiria Tavisi
garTulebebiT, rac iwvevs avadmyofTa invalidobas da sikvdils.
epidemiologiuri monacemebi aCveneben, rom marcxena parkuWis
hipertrofia damoukidebel risk-faqtors warmoadgens
( 19, 23, 62, 162). sistoluri wnevis sidide ufro mniSvnelovani
risk-faqtoria, vidre diastoluris sidide, radgan asakovan
pacientTa 65-75%-Si izolirebuli sistoluri hipertenzia
gvxvdeba. gul-sisxlZarRvTa sistemis garTulebebis risksa da
sistoluri wnevis sidides Soris wrfivi damokidebuleba
arsebobs. kvlevebiT nanaxai, rom miokardiumis infarqtiT
avadmyofebs, romelTac arteriuli hipertenzia aReniSnebaT,
miuxedavad Catarebuli mkurnalobisa (Trombolizuri Terapiis
CaTvliT), sikvdilobis ufro maRali riski aqvT (40, 46, 168).
Martines S et al (1997) monacemebiT, arteriuli hipertenziiT da
miokardiumis infarqtiT pacientebs, romelTac CautardaT
Trombolizuri Terapia, cocxladdarCenis ufro dabali
procenti hqondaT, vidre pacientebs arteriuli hipertenziis
gareSe – 70,4% da 85,9% Sesabamisad (135 ).
Tambaqos moweva gul-sisxlZarRvTa daavadebebis
ganviTarebis erT-erTi mniSvnelovani risk-faqtoria. dadgenilia,
rom Tambaqos kvamlis moqmedeba gul-sisxlZarRvTa sistemaze
ganpirobebulia nikotiniT da naxSirbadis JangiT. axalgazrda
janmrTel pirebSi Tambaqos gavlenis Taviseburebebis Seswavlam
aCvena, rom yoveli erTi Reri sigaretis mowevis Semdeg izrdeba
19
guliscemis sixSire, gulis wuTmoculoba, mcirdeba dartymiTi
moculoba fizikuri datvirTvis dros. ( 1, 5, 32 ).
gid ganviTarebis riski mwevelTaTvis 1,2-2-jer ufro
maRalia, vidre aramwevelTaTvis da es erTnairad exeba qalebsac
da mamakacebsac. SedarebiTi riski izrdeba moweuli sigartis
raodenobasTan, kvamlis CasunTqvis siRrmesa da mowevis dawyebis
asakTan erTad. sxvadasxva populaciaSi Catarebuli
epidemiologiuri kvlevebi aCveneben, rom miokardiumis infarqtis
riski (maT Soris ganmeorebiTi infarqtis) izrdeba mowevis
intensiurobasTan erTad da maRal asakobriv jgufSi,
gansakuTrebiT 70 welze zeviT. gamoTvlebma aCvena, rom yoveli
moweuli sigareti gid sikvdilis risks 35-44 w pirebSi 3,5%-iT
zrdis, xolo 65-74 w pirebSi – 2%-iT (12, 35, 48).
Tambaqos moweva ganapirobebs gid yvela letaluri
gamosavlis 80%-s 35-44 w mamakacebSi da 27%-s – 45-64 w qalebSi.
risk-faqtorebis SedarebiTma Seswavlam aCvena, rom mwevelebSi 2-
jer gazrdilia stenokardiisa da miokardiumis infarqtis
ganviTarebis riski, 4,9-jer – uecari sikvdilis riski. im
mamakacebSi, romlebic dreSi 20 Rer sigarets ewevian, iseTi
risk-faqtorebi, rogoricaa hiperqolesterinemia, arteriuli
hipertenzia, Saqriani diabeti 5-8-jer zrdian riskis xarisxs.
mZime mwevelebSi gid gamowveuli sikvdiloba 55 wlamde asakis
pirebSi 5-jer maRalia. mwevel qalebSi miokardiumis infarqti 3-
jer ufro xSirad viTardeba, vidre aramwevelebSi (58, 65, 103 ).
axalgazrda mwevelebSi sikvdilis riski gacilebiT
maRalia, vidre aramwevelebSi. 45 wlamde asakis mZime mweveli
mamakacebi 10-15-jer ufro xSirad iRupebian miokardiumis
infarqtiT, vidre aramwevelebi ( 66 ).
20
gid ganviTarebis maRali riskis faqtorebs miekuTvneba
aseve hipodinamia, sxeulis Warbi wona, naxSirwylovani cvlis
moSla, pirvel rigSi Saqriani diabeti.
II tipis Saqriani diabetiT avadmyofebs xSirad aReniSnebaT
koronaruli arteriebis aTerosklerozi. epidemiologiuri
gamokvlevebiT dadgenilia, rom II tipis Saqriani diabetiT
avadmyofTa sikvdilis ZiriTadi mizezi miokardiumis infarqtia.
Tumca am pirebSi iseTi risk-faqtorebi, rogoricaa
hiperqolesterinemia da arteriuli hipertenzia 2-4-jer zrdis
infarqtis ganviTarebis sixSires, vidre saerTo populaciaSi (61,
63, 74 ).
Saqriani diabetiT da gul-sisxlZarRvTa sistemis
daavadebebiT pirebSi metaboluri darRvevebis Seswavlam didi
interesi gamoiwvia hiperinsulinemiis da insulinrezistentobis
mimarT, rogorc gid SesaZlo risk-faqtorebis mimarT.
hiperinsulinemia xSirad asocirdeba gid iseT risk-faqtorebTan,
rogoricaa sxeulis Warbi wona, hiperglikemia, arteriuli
hipertenzia, dislipoproteinemia (81, 88, 134). zogierT
prospeqtul kvlevaSi naCvenebia, rom sisxlSi bazaluri
insulinis donis momateba mniSvnelovnad zrdis mamakacebSi gid
ganviTarebis risks ( 97 ).
Никитин Ю.П. и др (2001) monacemebiT, 25-64w mamakacebSi gid
sixSire 2-4 jer maRalia sisxlSi insulinis maRali doniT
pirebSi. maT daadgines pirdapiri kavSiri sisxlSi bazaluri
insulinis da trigliceridebis dones, sxeulis masis indeqss
Soris da ukukavSiri HDL qolesterins Soris ( 43 ).
II tipis Saqriani diabeti mniSvnelovnad auaresebs
miokardiumis infarqtiT avadmyofTa gamosavals Trombolizuri
21
Terapiis fonzec. kerZod, am pacientebSi maRalia sikvdiloba,
xSiria gulis ukmarisoba, 4-wliani cocxladdarCena mxolod
50%-ia ( 106, 114 ).
gid iseTi risk-faqtorebis mniSvneloba, rogoricaa
sxeulis Warbi wona, zogierTi mkvlevaris azriT bevrad
dabalia, vidre zemoT ganxiluli mTavari risk-faqtorebi (132 ).
ufro metic, zogi avtori, eyrdnoba ra kohortuli kvlevebis
masalebs, uaryofs sxeulis Warbi wonis, rogorc gul-
sisxlZarRvTa daavadebebiT gamowveuli sikvdilobis
damoukidebeli prediqtoris rols (156). amasTan, bevr
prospeqtul kvlevaSi, sadac Seswavlilia sikvdilobis kavSiri
sxeulis wonasTan, dadgenilia misi roli arteriul
hipertenziasTan, gul-sisxlZarRvTa sistemis daavadebebiT
gamowveul avadobasa da sikvdilobasTan ( 167 ).
populaciaSi sxeulis Warbi wonis gavrceleba mraval
faqtorzea damokidebuli, romelTa Soris gamoyofen
socialur-ekonomiurs, kulturuls, qceviT, fsiqologiur,
genetikur da sxva faqtorebs (21, 33, 49 ). zogierTi es faqtori
arasasurvel gavlenas axdens adamianis janmrTelobaze, zogi ki
Tavis uaryofiT gavlenas axdens sxva faqtorebis gziT
(arteriuli hipertenzia, Saqriani diabeti), kerZod, sxeulis
masis gziT. am SemTxvevaSi sxeulis Warbi wona warmoadgens
arteriuli hipertenziis, gid, cerebrovaskuluri
daavadebebis markers
(20, 64 ).
Константинов В.В. и др (2002) Seiswavles sxeulis Warbi wonis
gavrceleba da misi kavSiri gul-sisxlZarRvTa sistemis
daavadebebiT gamowveul sikvdilobasTan. maTi monacemebiT,
22
populaciaSi sxeulis Warbi wona ganapirobebs arteriuli
hipertenziis, dislipoproteinemiis maRal sixSires da
arasasurvl gavlenas axdens sikvdilobaze ( 37 ).
dReisaTvis, gid risk-faqtorad iTvleba ara sxeulis Warbi
wona, aramed cximis ganawileba organizmSi. maRali riski
korelaciaSia abdominur simsuqnesTan da misi gazrda, Tavis
mxriv, zrdis arteriuli hipertenziis, hiperglikemiis da
dislipoproteinemiis albaTobas ( 78 ).
umoZraoba, anu cxovrebis mjdomare wesi risk-faqtoria
iseTi daavadebebis ganviTarebisTvis, rogoricaa koronaruli
daavadeba, insulti, arteriuli hipertenzia, insulin-
damoukidebeli Saqriani diabeti da osteoporozi. fizikurad
aqtiuri pirebi orjer ufro midrekilni arian gul-
sisxlZarTvTa daavadebebis ganviTarebisken, vidre fizikurad
aqtiurni ( 7 ).
ojaxuri anamnezis da memkvidreobis prognozuli
mniSvneloba gid avadobasa da sikvdilobaSi sxvadasxva kvlevaSi
araerTmniSvnelovnad ganixileba (83, 151). rig SromebSi
aRiniSneba, rom gid adre gamovlena pirveli xarisxis
naTesavebSi risk-faqtors warmoadgens, xolo asakis matebasTan
erTad memkvidreobis roli mcirdeba da pirvel planze garegani
faqtorebi gamodis ( 41, 122 ).
gul-sisxlZarRvTa sistemis daavadebebis ris-faqtorebis
codna, aseve mtkicebulebebi sxvadasxva profilaqtikuri da
samkurnalo RonisZiebebis efeqturobaze samwuxarod yovelTvis
ar gamoiyeneba praqtikaSi. literaturaSi xSirad aris
moxsenebuli, rom gul-sisxlZarRvTa sistemis daavadebebis
ganviTarebis riskis Semcireba SesaZlebelia cxovrebis wesis
23
SecvliT da farmakoTerapiiT, gansakuTrebiT antihipertenziuli
da hipolipidemiuri preparatebis gamoyenebiT.
zemoTqmulidan gamomdinare, gul-sisxlZarRvTa sistemis
daavadebebis maRali riskis pacientebis warmatebuli
mkurnalobis ZiriTadi momentebi unda iyos gul-sisxlZarRvTa
sistemis daavadebebis ganviTarebis risk-faqtorebis
urTierTqmedebis gaTvaliswineba, mravalricxovani medikamentis
swori SerCeva da prevenciuli RonisZiebebis Catareba.
1.2. miokardiumis mwvave infarqtiT avadmyofTa riskis
xarisxis Sefaseba
miokardiumis mwvave infarqtis dros riskis xarisxis
Sefaseba aucilebelia im pacientTa gamosavlenad, visac
garkveuli samedicino Careva gauumjobesebs klinikur
gamosavals. mag., ufro intensiuri medikamenturi mkurnaloba an
revaskularizacia naCvenebia ganmeorebiTi iSemiis maRali riskis
gamo. iseTi preparatebis daniSvna, rogoricaa β-blokerebi an
aspirini, Tanabrad amcirebs SedarebiT risks yvela jgufSi.
Tumca am preparatebis gamoyenebiT absoluturi riskis Semcireba
gansxvavebulia. amitom, klinikuri taqtikis mniSvnelovani
komponentia konkretuli pacientis adreuli da mogvianebiTi
riskis raodenobrivi Sefaseba (44, 116, 117 ).
24
cxrili
gul-sisxlZarRvTa daavadebebis warmoCinebaze moqmedi
ZiriTadi da damatebiTi risk-faqtorebi
ZiriTadi damatebiTi
mamrobiTi sqesi an menopauza
qalebSi
sigaretis moweva
`a~ qolesterinis
Semcveloba sisxlSi (76,5
mmoli/l da meti)
damZimebuli ojaxuri
anamnezi
gul-sisxlZarRvTa
daavadebebis adreuli
warmoCineba (qalebSi <65
weli da mamakacebSi <55
weli)
mslq-s Semcireba
dslq-s gazrda
diabetTan TandarTuli
mikroalbuminuria
tolerantobis darRveva
glukozis mimarT
Warbi wona
hipodinamia
fibrinogenis maRali done
plazminogenis endogenuri
qsoviluri aqtivatori
`a~ lipoproteinebis momateba
VI faqtori momateba
homocistein D-dimeris momateba
testi dadebiTi C-reaqtiuli
cilaze
estrogenebis deficiti
`Chlamydia pneumoniac~-is
warmoCineba
daZabuli social-ekonomikuri
situacia
eTnikuri kuTvnilebi
geografiuli regioni
25
miokardiumis infarqtiT avadmyofTa riskis Sefaseba exeba
stacionarul periods, Tumca pacientis gaweris win gamokvleva
riskis gansazRvris mniSvnelovani komponentia, aseve Zalian
mniSvnelovania adreuli da dinamikuri Sefaseba, rac SeiZleba
moxdes ararTuli meTodebiT uSualod pacientis sawolTan.
riskis gansazRvris aucileblobas bevri mizezi aqvs. pirvel
rigSi, mi gadatanidan pirveli wlis ganmavlobaSi sikvdilis
SemTxvevaTa 25% aRiniSneba stacionarSi yofnis pirvel 48 sT-Si
( 50, 120, 130 ).
miokardiumis infarqtis dros riskis Sefaseba iwyeba
anamnezis SekrebiTa da obieqturi gamokvleviT. infarqtis
ganviTarebidan 30 dRis ganmavlobaSi sikvdilis riskis yvelaze
mniSvnelovan faqtorebs miekuTvneba asaki, sistoluri wneva da
guliscemis sixSire pirveli gasinjvisas, gulis ukmarisobis
niSnebi, infarqtis lokalizacia da anamnezSi gadatanili mi (131)
am faqtorTa mniSvneloba dadasturebulia mravali klinikuri
gamokvleviT.
cxrili
miokardiumis mwvave infarqtis warmoSobis riskis
stratifikaciis kriteriumebi
riskis faqtorebi samizne organoebis
dazianeba
asocirebuli
klinikuri
mdgomareoba
mamakacebi >55 w.
qalebi >65 w.
sigaretis moweva
hipelqolesterinemia
samuSao pirobebi
marcxena parkuWis
hipertrofia(ekg,eqokg an
rentgenografia);
proteinuria da/an krea-
tinemia 1,2_2,0 mg/dl;
cerebrovaskularuli
daavadebebi
iSemiuri insulti
hemoragiuli insulti
tranzitoruli
26
socialuri pirobebi
ojaxuri anamnezi
gul-sisxlZarRvTa
daavadebis adreuli
formebi (qalebi<65
w., mamakacebi <55 w.)
hipertoniuli
daavadeba
Saqriani diabeti
aTerosklerozuli
bolaqis ultrabgeriTi
an rentgenologiuri
niSnebi
arteriis badis genera-
lizebuli an keruli
Seviwroeba
iSemiuri Seteva
gulis daavadebebi
stenokardia
operacia koronarul
arteriebze
SegubebiTi gulis
ukmarisoba
Ribeiro DG et al (2003) Seiswavles klinikuri da demografiuli
faqtorebis kavSiri mi avadmyofTa hospitalur sikvdilobasTan.
maT Seiswavles 373 pacienti, romelTagan 84 gardaicvala.
avadmyofebi ganawilebulni iyvnen sqesis, asakis, Catarebuli
Trombolizuri mkurnalobis, gid risk-faqtorebis, mi
lokalizaciis, gulis ukmarisobis xarisxis mixedviT. avtorTa
monacemebiT, gardacvlil avadmyofTa jgufSi ufro meti iyo
pacientebi Saqriani diabetiT, 70 welze meti asakis, ukana
kedlis infarqtiT. kvlevis Sedegad gamovlinda, rom mi
sikvdilobis damoukidebeli prediqtorebi iyo 70 welze meti
asaki, gulis ukmarisoba da Saqriani diabeti ( 149 ).
Павликова Е.П. и др (2002) Seiswavles 120 pacienti miokardiumis
infarqtiT, maTgan 66-s Cautarda Trombolizuri Terapia
streptokinaziT. pirveli jgufis pacientebis asaki iyo 66-75
weli, meore jgufis – 70 welze meti. avtorTa monacemebiT,
meore jgufSi ufro xSiri iyo (47,4%) marcxena parkuWis mwvave
ukmarisoba, gulis qronikuli ukmarisoba ganviTarda 36,8%-Si,
erTwliani sikvdiloba pirvel jgufSi iyo 9,1%, meoreSi – 22,8%.
75 w asakis pacientTa sikvdiloba orive jgufSi maRali iyo
27
( 144 ).
asakis, rogorc sikvdilobis risk-faqtoris mniSvneloba
didia. nacionaluri registris monacemebiT, mi hospitaluri
sikvdiloba farTo diapazonSi icvleba: 3%-dan 55 wlamde
pirebSi, 28%-mde 80w da meti asakis pirebSi ( ). rac ufro
asakovania pacienti, miT ufro didia marcxena parkuWis funqciis
darRvevebis albaToba da gid-is ufro mZime mimdinareoba.
asakovan pacientebSi ufro xSiria gulis SegubebiTi
ukmarisobis da kardiogenuli Sokis ganviTareba ( 119 ).
mi-is adreuli sikvdilis riski maRalia qalebSi. es faqti
nawilobriv aixsneba ara marto sqesiT, aramed sxva klinikuri
faqtorebiTac. mag., xandazmuli asakiT da Tanmxlebi
paTologiebiT ( 68, 69, 86, 96 ).
Nicolau JC et al (2004) Seiswavles 686 mi pacienti, romelTac
CautardaT Trombolizuri Terapia. maTi monacemebiT, 14-dRiani
sikvdiloba ufro dabali iyo mamakacebSi, vidre qalebSi: 8,5%
da 16% Sesabamisad. Soreuli sikvdilobis riski sqesis mixedviT
ar iyo gansxvavebuli mamakacebsa da qalebSi da Seadgenda 65,1%
da 64,8%-s Sesabamisad ( 140 ).
avadmyofTa obieqturi gamokvleva damatebiT informacias
iZleva, rac aseve Zalian mniSvnelovania riskis gansazRvrisTvis.
marcxena parkuWis disfunqciis klinikuri niSnebi (arteriuli
hipotonia, taqikardia, galopis ritmi III tonis gaCenasTan erTad,
periferiuli perfuziis gauareseba, sisxlis mimoqcevis mcire
wreSi Segubeba) maRali riskis pacientebis gamovlenis
saSualebas iZleva. gulis ukmarisobis xarisxi gansazRvruli
Killip-is klasifikaciiT, rac efuZneba sisxlis mimoqcevis mcire
wreSi Segubebis arsebobas, periferiuli perfuziis arseboba an
28
maTi Serwyma mi gamosavalis saimedo prognozuli kriteriumebia
( 133, 137 ).
ekg gamokvleva ara mxolod mi diagnostikaSi gvexmareba,
aramed aseve Zalian mniSvnelovan prognozul informacias
Seicavs. yvelaze Rirebulad iTvleba ST segmentis elevaciis
arseboba an ar arseboba, rac gansazRvravs reperfuziuli
mkurnalobis efeqturad Catarebis SesaZleblobas. garda amisa,
mniSvneloba aqvs mi lokalizacias. ST segmentis elevaciiT
pacientebs wina kedlis mi-iT sikvdilobis riski 2-jer ufro
maRali aqvT, vidre ukana kedlis infarqtis dros ( 139 ). riskis
xarisxis ufro zusti gansazRvris saSualebas iZleva ST
segmentis izoeleqtruli xazidan gadaxris raodenobrivi
Sefaseba. Trombolizuri Terapiis efeqturoba pirdapir
korelaciaSia ekg ganxrebis raodenobasTan, sadac ST segmentis
elevacia aRiniSneba da yvela ganxraSi ST segmentis jamur
gadaxrasTan (150). mag., mi pirveli 30 dRis ganmavlobaSi
gardacvlil pacientebSi ST segmentis jamuri gadaxra ufro
metia, vidre am periodSi gadarCenil pacientebSi.
Mauri f et al (2002) Seiswavles 8731 mi-iT pacientSi ST segmentis
elevacia ganxrebis raodenobis mixedviT da pacientTa xanmokle
da Soreuli sikvdiloba. pacietebi dayves 4 jgufad: A, B, C, D ST
segmentis elevaciiT 2 an 3 ganxraSi, 4 an 5 ganxraSi, 6 an 7
ganxraSi da 8 da met ganxraSi Sesabamisad. 10 wlis Semdeg
sikvdilobam Seadgina 36,6%, 44%, 47,9% da 51,2% Sesabamisad
jgufebSi. 30-dRiani sikvdilobis riski sarwmunod maRali iyo B,
C da D jgufebSi ( 136 ).
sikvdilobis maRal riskze mimaniSnebelia ekg-ze
gamovlenili gamtareblobis darRvevebi, maRali xarisxis A-V
29
blokada ( 89 ) da mocimcime aritmia ( 176 ). garda amisa, ekg
monacemebi saSualebas iZleva gamoiyos im pacientebis
qvejgufebi, romelTac sikvdilobis ufro maRali riski aqvT.
mag., miuxedavad imisa, rom ukana kedlis mi-is prognozi ukeTesia,
vidre wina kedli, ukana kedlis infarqtis Tanxvedra ST
segmentis mniSvnelovan dawevasTan prekordialur ganxrebSi an
marjvena parkuWis dazianebis niSnebTan, 4-jer zrdis gulis
SegubebiTi ukmarisobis, ganmeorebiTi infarqtis da sikvdilobis
risks. ( 93 ).
riskis faqtorebis gamovlena sisxlis analiziTacaa
SesaZlebeli. mi simptomebis gaCenidan 12 sT-is ganmavlobaSi
diagnozis dazusteba SesaZlebelia saerTo kreatinfosfokinazas
aqtiobis, miokardiuli izofermentis CK-MB da
laqtatdehidrogenazas izofermentis gansazRvriT ( 85 ). Tumca
mi mwvave periodSi am fermentebis aqtiobis momateba aReniSneba
pacientTa 34%-s. garda amisa, fermentebis aqtioba momatebulia
12%-Si mi ar arsebobisas. amgvarad, fermentebis erTjeradi
gansazRvra ver gamoricxavs mi diagnozs. bolo dros gamoiyeneba
miokardiumis dazianebis sxva markerebi mi Semdgomi riskis
prognozirebisTvis ( 172 ). pacientebSi ST segmentis elevaciis
gareSe sisxlSi T troponinis momateba stacionaruli
sikvdilobis niSvnelovani prognozuli kriteriumia (9% - T
troponinis momatebis dros da 1% - misi normaluri donis
dros), aseve kardiogenuli Sokis ganviTarebis (6% da 2%
Sesabamisad) da gulis SegubebiTi ukmarisobis ganviTarebis
prognozuli kriteriumia (16% da 17% Sesabamisad). ( 172 ).
risk-faqtorebis gamovlenaSi mniSvnelovania
eqokardiografiuli gamokvleva ( 141 ). Trombolizuri Terapiis
30
Catarebisas eqokardiografia saSualebas iZleva informacia
miviRoT reperfuziis procesze, mi zomaze da miokardiumis
mdgomareobaze ( 107 ). aseve damxmare meTodia gaurkvevel
SemTxvevebSi, mag., ST segmentis elevaciis ar arsebobisas (38, 39
). mTel rig gamokvlevebSi ( 98, 131 ) Seswavlilia
eqokardiografiis mniSvneloba riskis xarisxis adreul
SefasebaSi. 86 kvlevaSi naCvenebia, rom iSemiuri sindromebis
dros eqokardiografiulad marcxena parkuWis funqciis da
mitraluri regurgitaciis gansazRvra prognozuli informaciis
miRebis saSualebas iZleva, romelic avsebs anamnezur da ekg
monacemebs ( 104 ). 83 kvlevaSi daadgines, rom hipokineziuri
ubnis gamovlena mi simptomebis gaCenidan 12 sT-is ganmavlobaSi
saSualebas iZleva gamoiyos pacientebi, romlebsac eqnebaT
gulis ukmarisobis, avTvisebiani aritmiebis da sikvdilobis
maRali riski ( 105, 143 ). marcxena parkuWis gandevnis fraqciis
Semcireba 40%-ze qvemoT mi dawyebidan 72 sT-is ganmavlobaSi
aseve korelaciaSia sikvdilobis maRal riskTan ( 130 ).
miokardiumis infarqti mwvave stadiaSi miokardiumis
vizualizaciis SesaZlebloba SezRudulia imiT, rom adre
arsebuli kardiosklerozuli ubnebi praqtikulad ar
gansxvavdeba axali iSemiuri ubnebisagan. garda amisa, jerac ar
aris damtkicebuli, rom vizualizaciis meTodebi ufro did
informacias iZleva, vidre anamnezis Sekreba, obieqturi
gamokvleva da ekg.
miokardiumis infarqtis Semdgomi maRali riskis niSnebi
xSirad vlindeba gamojanmrTelebis etapze. amitom,
stacionaridan gaweris win eqimis amocanaa, gamoavlinos maRali
riskis pacientebi. am amocanis gadasawyvetad SemuSavebulia
31
mravali testi, Tumca imisTvis, rom es testebi efeqturad
gamoiyenebodes klinikur praqtikaSi, maT unda hqondeT maRali
mgrZobeloba da specifikuroba.
miokardiumis infarqtis dros marcxena parkuWis funqciis
klinikuri Sefaseba naCvenebia rogorc prognozis
gansazRvrisTvis, ise mkurnalobis SerCevisTvis. cnobilia, rom
sikvdiloba da iSemiuri garTulebebis riski gandevnis fraqciis
sididis ukuproporciulia. randomizebuli kvlevebiT aRiniSna,
rom swored SerCeuli mkurnaloba aumjobesebs mi da marcxena
parkuWis disfunqciiT avadmyofTa Soreul prognozs. ( 133 ).
marcxena parkuWis funqciis darRveva advilad dgindeba
obieqturi gamkvlevebiT (filtvebSi xixiniT, diastoluri
samwevra galopis ritmiT, arteriuli hipotoniiT). Tavis mxriv,
ekg mi gavrcelebis Sefasebis saSualebas iZleva ( 138 ).
klinikuri da ekg monacemebis safuZvelze Silver M et al SeimuSaves
klinikuri prognozirebis wesi, romelic ar saWiroebs
specialur gamokvlevebs ( 155 ). retrospeqtuli analiziT
avtorebma aCvenes, rom wina kedlis infarqtis dros gulis
ukmarisobis niSnebis, ekg interpretaciis gamarTulebeli
niSnebis (hisis konis marcxena fexis blokada, marcxena parkuWis
hipertrofia da gadaZabva) an anamnezSi Q kbilovani infarqtis ar
arsebobisas, marcxena parkuWis gandevnis fraqciis
prognozirebadi sidide 40% da metia ( 160 ).
mi Semdeg aritmiebis uecari ganviTarebis riskis gazrdaze
miuTiTebs ramodenime klinikuri maCvenebeli: marcxena parkuWis
disfunqcia, wina kedlis an transmuruli infarqti, Killip-is
mixedviT III an IV funqciuri klasis gulis ukmarisoba,
ramodenime koronaruli arteriis dazianeba, gavrcelebuli mi.
32
uecari sikvdilis riskis ufro zusti SefasebisTvis
mowodebulia ramodenime arainvaziuri meTodi. erT-erTi yvelaze
martivia ekg monitorirebiT polimorfuli an xSiri parkuWovani
eqstrasistoluri aritmiis gamovlena. mag., parkuWovani
eqstrasistolebis sixSiris mateba (gansakuTrebiT sT-Si 6-ze
meti), morecidive parkuWovani taqikardia an fibrilacia
sikvdilis risks zrdis daaxloebiT 60%-iT ( 90, 100 ). uecari
sikvdilis riskis zrdaze miuTiTebs parkuWTa fibrilaciis an
myari parkuWovani taqikardiis ganviTareba mi pirvel 48 sT-is
ganmavlobaSi ( 153 ).
Alegret JM et al (2001) Seiswavles 54 pacienti, romelTac wina
kedlis mi dros ganuviTarda hisis konis marjvena fexis
blokada. avadmyofebi dayofili iyo 2 jgufad: pirveli jgufi,
visac Cautarda Trombolizuri Terapia da meore jgufi
Trombolizuri Terapiis gareSe. Seiswavles blokadis
damokidebuleba hospitalur sikvdilobasTan. sikvdiloba ufro
maRali iyo avadmyofebSi, visac blokada gaugrZelda
hospitalizaciidan 24 sT-is ganmavlobaSi, vidre im pacientebSi,
visac blokada gaugrZelda 24 sT-ze naklebi droiT, anu hisis
konis marjvena fexis blokadis gaqroba ukeTes prognozTan iyo
dakavSirebuli ( 71 ).
arteriuli hipertoniis gavrcelebaze moqmedi risk- faqtorebis gavlenis
intensiuroba
cvladebi β-koeficienti c2 p
konstanta -2.754 119.66 <0.001
Warbi wona 1.178 280.97 <0.001
asaki 0.045 84.62 <0.001
alkoholis Warbi moxmareba 0.002 63.86 <0.001
ganaTlebis done -0.330 27.23 <0.001
hipertrigliceridemia (htg) 0.461 20.13 <0.001
sigaretis moweva 0.137 16.15 <0.001
33
hiperqolestirinemia (hqs) 0.236 11.45 <0.001
hipo-α-qs -0.161 3.45 <0.05
Otasevich P et al (2003) aseve Seiswavles parkuWovani aritmiebis
ganviTareba, marcxena parkuWis remodelireba da 5-wliani
sikvdiloba Trombolizuri Terapiis dros. maTi monacemebiT,
marcxena parkuWis remodelireba parkuWovani aritmiiT
pacientebSi ar progresirebs stacionaridan gaweris Semdeg da
Sesabamisad, ar asocirdeba 5-wliani letalobis zrdasTan (143).
amgvarad, gulis iSemiuri daavadebis risk-faqtorebis
koreqcia amcirebs miokardiumis infarqtis Soreuli
garTulebebis sixSires, amitom avadmyofTa swori SerCeva
meoradi profilaqtikuri RonisZiebebis CatarebisTvis
miokardiumis infarqtis riskis xarisxis dadgenis mniSvnelovani
RonisZiebaa.
Tavi II
kvlevis masala da meTodebi
dasmuli miznebidan da amocanebidan gamomdinare, gamokvlevaSi
gamoyenebulia saqarTvelos Sromis, janmrTelobisa da socialuri
dacvis saministros, saqarTvelos statistikis saxelmwifo
departamentis, samedicino statistikisa da informaciis centris,
samedicino dazRvevis saxelmwifo kompaniis saorganizacio-
normatiuli masalebi.
sainformacio Ziebis procesSi gamoyenebul iqna rogorc
internetiT moZiebuli masalebi, aseve sxvadasxva qveyanaSi
gamocemuli literatura, romlis safuZvelzec gakeTda informaciuli
mimoxilva.
34
damuSavda sxvadasxva qveynebis monacemebi, romleboc Seexeboda
mosaxleobis miokardiumis mwvave infarqtiT gamowveuli avadobisa
da sikvdilianobis TaviseburebaTa analizs.
miokardiumis mwvave infarqtis warmoSobaze moqmedi
modificirebadi da aramodificirebadi risk-faqtorebis
(hiperqolesterinemia, arteriuli hipertenzia, Tambaqos weva,
Saqriani diabeti, simsuqne, memkvidreoba. asaki, sqesi) Seswavlis
mizniT gaanalizebul iqna Tssu-is # 1 klinikis kardiologiur
ganyofilebaSi hospitalizebul avadmyofTa istoriebi,
romelTac 2000-2003 wlebSi CautardaT Trombolizuri Terapia
(170 pacienti).
sakontrolo jgufs Seadgenda miokardiumis mwvave
infarqtis diagnoziT hospitalizebulma 50-ma avadmyofma,
romelTac CautardaT miokardiumis infarqtis standartuli
mkurnaloba, rac moicavda aspirins, β-blokerebs, agf
inhibitorebs, nitratebs.
asakisa da sqesis mixedviT pacientebi ganawilda
Semdegnairad (ix.cxrili )
cxrili
gamokvleul pacientTa ganawileba asakisa da sqesis mixedviT
30-39 w. 40-49 w. 50-59 w 60-69 w. 70w.da meti sul
abs.ricxvi 6 25 36 61 42 170
%%. 4.0 15.0 21.0 36.0 25.0 100.0
abs.ricxvi %%
mamakaci 114 67.0
qali 56 33.0
sul 170 100.0
35
agreTve Ggaanalizebul iqna Trombolizuri Terapiis
Semdeg ganviTarebuli garTulebebis sixSire, mkurnalobis
Soreuli Sedegebi da 5-wliani sikvdiloba. am maCveneblebze
risk-faqtorebis koreqciis gavlena.
gid risk-faqtorebis Seswavlisas agamoyenebuli iqna
Semdegi klinikur-statistikuri kvlevis meTodebi:
arteriuli hipertenziis diagnostika da xarisxis dadgena
xdeboda jandacvis msoflio organizaciis mier 1999 w
mowodebuli rekomendaciis safuZvelze:
sistoluri wnevis stabiluri momateba 140 mmvwysv da/an
diastoluris – 90 mm vwy sv-ze metad.
Saqriani diabetis dadgena xdeboda amerikis diabetologTa
asociaciis mier 1997 wels mowodebuli kriteriumebis
safuZvelze: 1. Saqriani diabetis simptomebs damatebuli sisxlSi
glukozis koncentraciis momateba 11 mmol/l-ze metad dRis
nebismier dros SemTxveviT gansazRvrisas. 2. uzmoze sisxlSi
glukozis koncentraciis momateba 7,0 mmol/l-ze metad. 3.
glukozisadmi tolerantobis testis Catarebisas sisxlSi
glukozis donis momateba 11,1 mmol/l-ze metad. aseve dgindeboda
Saqriani diabetis tipebi: I tipi – insulindamokidebuli, II tipi
– insulindamoukidebeli.
simsuqnis xarisxis dadgena xdeboda sxeulis masis indeqsis (smi)
saSualebiT gersous meTodiT: smi = wona(kg) : simaRle (m²). roca
indeqsia 20-24,9-mde, 0 xarisxis simsuqnea; 25-29,9 – I xarisxis
simsuqnea, 30-40-mde – II xarisxis da 40 da meti – III xarsixis
simsuqnea.
miokardiumis infarqtis diagnostika xdeboda klinikuri,
ekg, laboratoriuli da eqokardiografiuli kvlevebis
36
monacemebis safuZvelze. Trombolizuri Terapiis dawyebisas
tkivilis xangrZlivoba ar aRemateboda 6 sT-s, aRiniSneboda ST
segmentis elevacia 2 da met ganxrebSi 0,1 mV-ze metad,
Trombolizuri Terapia tardeboda streptokinaziT, romlis
erTjeradi doza iyo 1 500 000 erT. Trombolizuri Terapiis
Catarebis dros gaTvaliswinebuli iyo 1997 w mowodebuli
Cvenebebi da ukuCvenebebi. streptokinazas Seyvana xdeboda
infuzomatis saSualebiT 40 wT-is ganmavlobaSi, ris Semdegac
grZeldeboda heparinis 48 sT-iani infuzia. reperfuziis
arapirdapir kriteriumebad iTvleboda: ST segmentis elevaciis
Semcireba ekg informatiul ganxrebSi Trombolizuri Terapiis
dawyebidan 60 – 90 wT-is farglebSi, tkivilis Semcireba an
Sewyveta, reperfuziuli aritmiebis gaCena, daavadebis dawyebidan
16 sT-is ganmavlobaSi kreatinkinazas maqsimaluri aqtiobis
miRweva.
infarqtis diagnozis verifikacia xdeboda segmenturi
asinergiis ubnebis gamovleniT. centraluri hemodinamikis
mdgomareobis Sefasebis mizniT vswavlobdiT marcxena parkuWis
funqciur maCveneblebs: gandevnis fraqcia, damoklebis fraqcia,
saboloo sistoluri da diastoluri zomebi da moculobebi,
iTvleboda dartymiTi moculoba, wuTmoculoba.
miokardiumis infarqtis simZimis dadgena xdeboda infarqtis
zomis: Q- kbilovani (msxvilkerovani) da Q- kbilis gareSe
(wvrilkerovani), gavrcelebis da garTulebebis mixedviT.
zogadklinikuri gamokvlevebis garda avadmyofebs
utardeboda sisxlSi lipiduri cvlis maCveneblebis (saerTo
qolesterini, maRali simkvrivis lipoproteinebis – HDL
qolesterini, dabali simkvrivis lipoproteinebis – LDL
37
qolesterini, Zalian dabali simkvrivis lipoproteinebis – VLDL
qolesterini, trigliceridebi) gansazRvra. qolesterinis
sasurveli koncentracia sisxlSi aris 5,2 mmol/l (200 mg%)-mde,
zomier momatebad iTvleba 5,2 – 6,2 mmol/l (200 – 239 mg%),
Zlier momatebad iTvleba qolesterinis koncentracia sisxlSi
6,2 mmol/l (240 mg%)-ze meti.
Trombolizuri Terapiis efeqturobis Sefasebis mizniT
vikvleviT sisxlis SratSi ferment kreatinkinazas dinamikas
tkivilis dawyebidan 8, 16, 24sT-is Semdeg. bioqimiuri kvlevebi
tardeboda mowodebuli meTodikiT BIO-SYSTEM –is firmis
(espaneTi) fotometrze amave firmis reaqtivebis gamoyenebiT.
Eekg-s gadaReba xdeboda 12 standartul ganxraSi zogadad
miRebuli meTodikiT SIEMENS-ELEMA Ffirmis MINGOGRAF 34
modelis Camwerze 25 mm/wm siCqariT. ST segmentis elevacia
izomeboda J wertilidan da iTvleboda ST segmentis elevaciis
xarisxis jamiT standartul ganxrebSi. ekg registracia xdeboda
klinikaSi Semosvlisas, streptokinazas gadasxmidan 1 sT-is
Semdeg yoveldRe 1 kviris ganmavlobaSi. klinikidan gaweris
Semdeg ki yovel 6 TveSi erTxel.
eqokardiografiuli kvleva erT da organzomilebian
reJimSi OTE-BIOMEDICA-s firmis SIM-5000 aparatze, 2,5 mghc-is
sixSiris gadamwodiT standartuli meTodikiT. gamokvleva
tardeboda Semdegi standartuli poziciebidan: parasternaluri
grZeli da mokle RerZi (mitraluri sarqvlis da papilaruli
kunTebis doneze), apikaluri or- da oTxkameriani poziciebidan.
gamokvlevisas fasdeboda miokardiumis infarqtis lokalizacia
da gavrceleba. miokardiumis lokaluri kumSvadobis Sefaseba
xdeboda parasternalur grZel da mokle RerZebze da apikalur
38
or- da oTxkamerian poziciebSi. gamoyenebuli iyo amerikis
gulis asociaciis mier mowodebuli marcxena parkuWis dayofa 16
segmentad.
gamokvlevis Sedegad miRebuli yvela monacemi damuSavda
Tanamedrove statistikuri meTodebiT (yvela SemTxvevaSi
gaTvlili iyo saSualo ariTmetikuli M da saSualo
cdomileba m. niSanTa Soris gamovlenili sxvaobis sarwmunoebis
xarisxis Sefaseba xdeboda stiudentis t kriteriumis
gamoyenebiT).
Tavi III
gul-sisxlZarRvTa daavadebebis gavrcelebis Taiseburebebi
saqarTveloSi
saqarTvelos istoriuli ganviTarebis bolo periodis
uaRresad mokle monakveTSi moxda mosaxleobis janmrTelobis
Ziritadi indikatorebis gamoxatuli cvalebadoba (Tumca bolo
dromde aRiarebuli iyo maTi maRali inerciuloba). amasTan
aRsaniSnavia, rom sxvadasva dros gamovlinebuli tendenciebis
gaTvaliswineba da maTze saTanado reaqcia saxelmwifos mxridan
udavod Searbilebda dResdReobiT arsebul demografiul kriziss.
zemoTaRniSnulma, Cvenis azriT mniSvnelovnad ganapiroba qveyanaSi
ara marto e.w. socialuri daavadebebis (maT Soris tuberkulozi,
narkomania da toqsikomania, fsiqiuri moSlilobani da sxv.) aramed,
qroniukuli daavadebebis farTo gavrceleba (ix.cxrili )
39
cxrili
saqarTvelos mosaxleobis daavadebianobis da avadobis
maCveneblebi 2004 wlis monacemebiT (100000 mosaxleze),
daavadebaTa ZiriTadi
klasebi IX dsk-s
mixedviT
sul daavade
bianoba
m.S. axali
SemTxvevebi
avadoba
su l 1444941 33053,4 621027 14206,2
infeqciuri da
parazituli
daavadebebi
78080 1786,1 55577 1271,3
simsivneebi 40902 935,6 8347 190,9
endokrinuli sistemis,
kvebis, nivTierebaTa
cvlis da imunitetis
darRvevebi
158603 3628,1 29920 684,4
sisxlis da sisxlmbad
organoTa daavadebebi 16175 370,0 8605 196,8
fsiqiuri aSlilobebi 106921 2445,8 7637 174,7
nervuli sistemis da
grZnobaTa organoebis
daavadebebi
143783 3289,1 51520 1178,5
sisxlis mimoqcevis
sistemis daavadebebi 283921 6494,8 70648 1616,1
sunTqvis organoTa
daavadebebi 306984 7022,3 235532 5387,9
saWmlis momnelebeli
organoTa daavadebebi 113272 2591,1 41885 958,1
Sardsasqeso sistemis
daavadebebi 69913 1599,3 31485 720,2
orsuloba, mSobiaroba
da Semdgomi periodis
garTulebebi
7329 631,6 6052 521,6
kanisa da kanqveSa
ujredisis daavadebebi 33859 774,5 23770 543,7
ZvalkunTovani sistemis
da SemaerTebeli
qsovilis daavadebebi
31978 731,5 10731 245,5
Tandayolili
anomaliebi 6438 147,3 1192 27,3
40
perinatalur periodSi
warmoqmnili calkeuli
mdgomareobebi
4020 86,7 2477 53,4
simptomebi da
arazustad aRniSnuli
mdgomareobebi
5815 133,0 3161 72,3
travmebi da mowamvlebi 39948 845,2 32488 743,2
mosaxleobis sikvdilobis struqtura asaxavs im Zvrebs,
romlebic moxda ukanasknel wlebSi: swrafad izrdeba sikvdilobis
maCveneblebi dakavSirebuli gulsisxlZarRvTa, onkologiuri,
nerviul-fsiqikuri, endokrinuli paTologiis matebasTan.
qveyanaSi ganuxrelad izrdeba iseTi mZimed mimdinare
daavadebebis ricxvi, rogoricaa gulis mwvave da qronikuli
iSemiuri daavadeba (naxati ).
naxati
gul-sisxlZarRvTa daavadebebis gavrcelebis dinamika saqarTveloSi
1998 – 2004ww. (yovel 100000 mosaxleze)
4039,8
6494,85776,85322,44870,64273,64661,1
1616,11481,7
1299,61306,1
1002,81060,2
1146,0
0,0
1000,0
2000,0
3000,0
4000,0
5000,0
6000,0
7000,0
8000,0
9000,0
1998 1999 2000 2001 2002 2003 2004
daavadebianoba avadoba
warmodgenili monacemebi mowmobs, rom ukanasknel
aTwleulSi mkveTrad imata rogorc mosaxleobis
41
daavadebianobam, aseve avadobam sisxlis mimoqcevis sistemis
daavadebebis. amasTan am daavadebebis struqturis analizaiT
irkveva, rom ZiriTadad es mateba ganpirobebulia hipertoniuli
daavadebis, gulis mwvave da qronikuli iSemiuri daavadebebis da
Tavis tvinis vaskularuli daavadebebis TiTqmis ormagi zrdis
xarjze (ix.cxrili )
cxrili
sisxlis mimoqcevis sistemis daavadebebis struqtura
saqarTveloSi 1998 – 2004 ww.
(100000 sul mosaxleze)
1998 w. 2003 w. 2004 w.
sul 4039.8 5776.8 6494,8
aqedan sicocxleSi pirvelad
dadgenili diagnoziT 1146.0 1481.7 1616,1
gulis revmatiuli daavadebebi 368.2 358.8 350,6
aqedan sicocxleSi pirvelad
dadgenili diagnoziT 71.7 68.9 76,0
hipertoniuli daavadeba 1628.8 2730.6 3108,2
aqedan sicocxleSi pirvelad
dadgenili diagnoziT 446.3 686.4 801,9
gulis iSemiuri daavadeba 1397.0 1875.7 1955,1
aqedan sicocxleSi pirvelad
dadgenili diagnoziT 442.0 441.0 449,8
mwvave infarqti 62.5 69.8 75,8
aqedan sicocxleSi pirvelad
dadgenili diagnoziT 18.0 32.0 39,6
stenokardia 423.1 560.0 575,9
aqedan sicocxleSi pirvelad
dadgenili diagnoziT 179.8 125.5 140,0
Tavis tvinis vaskularuli
daavadebebi 142.0 244.2 189,9
aqedan sicocxleSi pirvelad
dadgenili diagnoziT 41.5 91.3 107,8
sisxlis mimoqcevis sistemis daavadebebis gavrceleba
saqarTvelos regionebSi araTanabaria. Tu TbilisSi da
42
axlomdebare regionebSi avadobis maCveneblebi wlidan wlamde
matulobs aWaraSi, da gansakuTrebiT qvemo qarTlSi igi TiTqmis
orjer naklebia (ix.cxrili )
cxrili
sisxlis mimoqcevis sistemis daavadebebis gavrceleba
saqarTvelos regionebSi 2004 wlis monacemebiT
(yovel 100000 mosaxleze)
2004
daavadebianoba avadoba
Tbilisi 9086,7 1688,6
aWara 2496,4 1077,9
kaxeTi 6001,0 1305,1
imereTi 5614,3 1902,6
samegrelo 5337,5 1199,3
Sida qarTli 3790,3 1297,0
qvemo qarTli 2920,6 809,0
guria 5101,9 1477,4
samcxe-javaxeTi 4880,1 1582,4
mcxeTa-mTianeTi 5020,6 1318,5
raWa-leCxumi 22019,3 2515,8
saqarTvelo 6494,8 1616,1
Cvenis azriT avadobis maCveneblebis esoden didi gansxvaveba
mravali faqtoriT aris ganpirobebuli, romelTa Soris wamyvanad
migvaCnia is garemoeba, rom saqarTvelos mTel rig regionebSi
zedmiwevniT dabali Sobadobis fonze swrafad mimdinareobs
mosaxleobis e.w. demografiuli dabereba. TavisTavad, ufrosi asakis
pirTa xvedriTi wilis zrdas Tan sdevs maTTvis damaxasiaTebeli
daavadebebis, da maT Soris gul-sisxlZarRvTa paTologiis farTo
gavrcelebac.
Tu ganvixilavT miokardiumis mwvave infarqtis gavrcelebis
statistikas SesaZloa davaskvnad, rom bolo wlebSi igi
xasiaTdeba mTeli rigi seriozuli ZvrebiT (ix.cxrili )
43
cxrili
miokardiumis mwvave infarqtis da stenokardiis gavrceleba
saqarTveloSi 1998 – 2004 ww. monacemebiT
(100000 sul mosaxleze)
11998 11999 22000 22001 22002 22003 22004
mwvave infarqti 62.5 92.0 55.0 56.2 70.9 69.8 75,8
aqedan sicocxleSi
pirvelad dadgenili
diagnoziT
18.0 22.6 20.7 22.5 35.1 32.0 39,6
stenokardia 423.1 487.7 416.8 491.3 519.6 560.0 575,9
aqedan sicocxleSi
pirvelad dadgenili
diagnoziT
179.8 111.3 95.6 116.0 117.8 125.5 140,0
rogorc cxrilSi warmodgenili monacemebi mowmobs
pacientTa ricxvi miokardiumis mwvave infarqtis sixSire 1998-
2004 wels TiTqmis 200%-iT gaizarda, aseve imata im pacientTa
raodenobam, romelTac es diagnozi sicocxleSi pirvelad
daudginda. amasTan, yuradsaRebia, rom stenokardiis SemTxvevaTa
saerTo ricxvma TiTqmis samjer imata, maSin rodesac
sagrZnoblad iklo pacientTa raodenobam, romlebsac es
diagnozi sicocxleSi pirvelad daudgindaT. Cvenis azriT
arsebuli sxvaoba miuTiTebs im garemoebaze, rom pacientTa didi
raodenoba stenokardiis simptomebis warmoCinebis SemTxvevaSi
saerTod ar mimarTavs eqims da cdilobs sakuTari ZalebiT
daZlios warmoqmnili situacia. AtviTvkurnalobis farTo
gavrcelebas aSkarad xels uwyobs saafTiaqo qselSi
44
Zliermoqmedi medikamentebis Tavisufali gayidva. Da, rogorc
Sedegi – mosaxleobaSi miokardiumis mwvave infarqtis
SemTxvevaTa gamoxatuli gaxSireba.
warmoSobili situaciis erTerT ZiriTad mizezad SesaZloa
CaiTvalos mosaxleobis cxovrebis wesis Secvla, daavadebis
gavrcelebaze moqmedi SedarebiT axali jgufis risk-faqtorebis
gaxSireba (narkomania, toqsikomaniebi, alkoholizmi da sxv.). ase,
magaliTad qveyanaSi mkveTrad gaizarda Tambaqos moxmareba,
romelmac moicva mosaxleobis is jgufebi, sadac es Cveva sul cota
xnis win erTeul SemTxvevebSi aRiniSneboda (mozardebi, qalebi da
sxv.).
Tambaqos moxmareba saqarTveloSi sazogadoebrivi
jandacvis erT-erT umTavres problemas warmoadgens. sxvadasxva
sabaziso kvlevebis monacemebiT, sadReisod Tambaqos moixmars
qveynis mosaxleobis daaxloebiT 37-40%. mamakacebs Soris
mwevelia 50-65%, xolo qalebs Soris 16-22%. Zalze sayuradReboa
mdgomareoba mozardebs Soris. skolis moswavleebis 22,1%
mwevelia, xolo qalebs Soris mwevelobis progresi
katastrofulia – igi bolo 16 wlis ganmavlobaSi TiTqmis 6-jer
gaizarda (m.S. Tambaqos moxmarebis gavrceleba gazrdilia
orsulebSi).
sxvadasxva kvlevebiT dadasturda, rom saqarTvelos
mosaxleobis umetesi nawili imyofeba Tambaqos permanentuli da
intensiuri zemoqmedebis qveS. Tambaqos moxmarebis sixSire
rogorc mamakacebSi, aseve qalebSi yvelaze maRalia 26-59 wlis
asakobriv jgufSi, isini ewevian mTeli moxmarebuli sigaretis
60,5%-s. maTze modis sigaretis SeZenaze daxarjuli mTeli
Tanxis ori mesamedi.
45
sakmarisia aRiniSnos, rom Tu evropaSi sigaretze
moTxovnilebam, erT mozrdil mosaxleze, bolo aTwleulis
manZilze iklo 7%-iT, aSS-Si da 6%-iT kanadaSi, imavdroulad
dsT-s qveynebSi, da maT Soris saqarTveloSi igi gaizarda - 42%-
iT (ix.cxrili ).
cxrili
zogierT qveynis mosaxleobis mier moxmarebuli sigaretis saSualo
wliuri raodenoba (erT sul mosaxleze)
1980 w. 1990 w. 2002 w.
evropa (mTlianad) 1856 1679 1678
belgia 1842 1751 1403
CineTi 1489 1436 1019
saqarTvelo 700 950 1583
TurqeTi 1088 1304 1607
SvedeTi 1569 1254 985
ukanasknel wlebSi saqarTveloSi mkveTrad Seicvala kvebis
produqtebis moxmarebis dinamika. arsebuli monacemebiT mosaxleobis
umetesi nawilis yoveldRiur racionSi gamoxatulad gaizarda purisa
da purproduqtebis (sxvadasxva socialuri jgufebisaTvis 65-dan
85%-mde) da kartofilis- (8-14%) moxmarebam, rac ZiriTadad moxda
rZisa da rZis produqtebis (2-8% sxvadasxva jgufebis mixedviT),
xorcisa da xorcis produqtebis (5-12%), Saqrisa da sakonditro
nawarmis (2-6%) Semcirebis xarjze. amasTan, aRiniSneba qveynis
mosaxleobis yoveldRiuri sakvebis racionis kaloriulobis kleba
(ix. cxrili ).
46
cxrili
saqarTvelos da zogierTi sxva qveynis mosaxleobis yoveldRiuri
sakvebis kaloriuloba (1990 da 1995 ww. monacemebiT)
1990 29002
sasomxeTi 2794 1975
azerbaijani 2577 2095
saqarTvelo 3028 2222
safrangeTi 3534 3588
fineTi 3077 3022
israeli 3276 3271
ruseTi 3122 2926
miuxedavad imisa, rom mosaxleobis kvebis racionis
kaloriulobam sxva qveynebSidac iklo, dsT-s qveynebSi, da maT Soris
saqarTveloSi es procesi gacilebiT swrafad mimdinareobs. amasTan,
amierkavkasiis qveynebSi sakvebis racionis kaloriuloba ufro
dabalia, vidre dadgenili fiziologiuri norma (sxvadasxva avtoris
azriT igi 3200-2800 kalorias Seadgens).
zemoaRniSnuli dasturdeba Cvens mier miokardiumis mwvave
infarqtiT Seswavlili ZiriTadi da sakontrolo jgufis
avadmyofTa monacemebiTac (ix.cxrili )
cxrili
miokardiumis mwvave infarqtiT ZiriTadi da sakontrolo jgufis
avadmyofebSi zogierTi risk-faqtoris gavreceleba
ZiriTadi jgufi sakontrolo jgufi
abs ricxvi % abs ricxvi %
47
mamakaci
qali
asaki
mi Q kbiliT
mi Q kbilis gareSe
wina kedlis
ukana kedlis
hiperqolesterinemia
arteriuli
hipertenzia
Saqriani diabeti
Tambaqo
simsuqne
memkvidreoba
hipodinamia
115
55
67,1 ± 0,9
115
54
89
80
129
112
24
81
37
49
18
67,4%
32,6%
68%
32%
52,7%
47,3%
76,3%
66,3%
14,2%
47,9%
21,9%
30%
10,6%
31
19
69,3 ± 0,6
33
17
28
22
39
34
7
29
9
7
4
62%
38%
66%
34%
56%
44%
78%
68%
14%
58%
18%
14%
8%
rogorc cxrilidan Cans, ZiriTadi da sakontrolo jgufis
avadmyofebi iyvnen Sedarebadni asakis, sqesis, miokardiumis
infarqtis zomis, lokalizaciis mixedviT. mamakacebi orjer
ufro meti iyo, vidre qalebi, Sesabamisad 114 (67,4%) da (55 –
32,6%). saSualo asaki iyo Sesabamisad 67,1 ± 0,9 da 69,3 ± 0,6 weli.
orive jgufSi Warbobda wina lokalizaciis infarqti,
Sesabamisad 89 – 52,7% da 28 – 56% da aseve Warbobda infarqti Q
kbiliT, Sesabamisad 115 – 68% da 33 – 66%.
miokardiumis infarqtis risk-faqtorebis Seswavlam aCvena,
rom avadmyofTa umravlesobas rogorc ZiriTad, aseve
sakontrolo jgufSi hqonda hiperqolesterinemia 129 (76,3%) da
39(78%) avadmyofs, arteriuli hipertenzia, Sesabamisad 112 – 66,3%
da 34 – 68% pacients, sixSiriT mesame adgilze iyo Tambaqos weva
48
– Sesabamisad 81 – 47,9% da 29 – 58%, avadmyofTa daaxloebiT
erT mesameds aReniSneboda gid memkvidreobaSi, erT mexuTeds –
21,9%-s simsuqne da yvelaze nakleb procentSi gvxvdeboda
hipodinamia.
Tavi IY
miokardiumis mwvave infarqtis mqone pacientebze,
modificirebadi risk-faqtorebis gavlenis Seswavlis Sedegebi
4.1. gamokvleul pacientTa klinikuri daxasiaTeba
mi-iT 169 avadmyofidan arteriuli hipertenzia aReniSneboda
ZiriTadi jgufis 112(66,3%) avadmyofs: 65(58%) mamakacs da 47(42%)
qals da sakontrolo jgufis 34(68%) pacients: 15(30%) mamakacs
da 19(70%) qals. klinikurma gamokvlevam aCvena, rom 57(50,9%)
avadmyofs aReniSneboda wina kedlis infarqti, 77(68,7%) –s
infrqti Q kbiliT, 19(1,9%) –s Saqriani diabeti, 79(70,5%)-s
hiperqolesterinemia, 41(36,6%)-s Warbi wona, 43(38,4%) avadmyofi
iyo mweveli, 12(10,7%)-s aReniSneboda gid memkvidreobaSi, 15(13,4%)-
s – hipodinamia (ix. cxrili5)
49
cxrili5
avadmyofTa klinikuri daxasiaTeba
mamakaci qali sul
arteriuli hipertenzia 65 – 58% 47 - 42% 112 – 66,3%
wina kedlis infarqti 35 – 31,2% 22 – 46,8% 57 – 50,9%
infarqti Q kbiliT 48 – 42,8% 29 – 61.7% 77 – 68,7%
hiperqolesterinemia 44 – 39,3% 35 – 74,5% 79 – 70,5%
Saqriani diabeti 8 – 7,1% 11 – 23,4% 19 – 1,9%
Warbi wona 16 – 14,3% 25 – 53,2% 41 – 36,6%
Tambaqo 39 – 34,8% 4 – 8,5% 43 – 38,4%
memkvidreoba 8 – 7,1% 4 – 8,5% 12 – 10,7%
hipodinamia 9 – 13,8% 6 – 12,8% 15 – 13,4%
4.2. hiperqolesterinemiis mqone avadmyofTa Trombolizuri
Terapiis efeqturobis Seswavlis Sedegebi
miokardiumis infarqtis mqone 169 avadmyofidan
hiperqolesterinemia aReniSneboda 129(76,3%)–s: 44(80%) qals da
85(74,6%) mamakacs. 92(71,3%) avadmyofs aReniSneboda arteriuli
hipertenzia, 18(13,9%)-s – Saqriani diabeti, 72(55,8%) iyo Tambaqos
mweveli, 12(9,3%)-s aReniSneboda hipodinamia, 28(21,7%)-s –
damZimebuli memkvidreoba. sakontrolo jgufSi
hiperqolesterinemia aReniSneboda 38(76%) avadmyofs: 18(47,4%)
mamakacs da 20(52,6%) qals. am avadmyofTa laboratoriuli
gamokvlevis Sedegebi SevadareT gaurTulebeli infarqtiT
avadmyofTa monacemebs rogorc ZiriTad, ise sakontrolo
jgufebSi. aRmoCnda, rom garTulebebis mqone pacientebs
aReniSnebodaT glukozis da ß-lipoproteidebis ufro maRali
50
done. saerTo qolesterinis da trigliceridebis done erTnairi
iyo yvela jgufis pacientSi. (cxrili2)
cxrili2
lipiduri cvlis maCveneblebi garTulebuli da
gaurTulebuli infarqtiT avadmyofebSi
ZiriTadi jgufi sakontrolo jgufi
laboratoriuli
maCveneblebi
garTulebis
gareSe
garTulebuli garTulebis
gareSe
garTulebuli
glukoza
qolesterini
ß-lipoproteidebi
α –lipoproteidebi
trigliceridebi
7,9±0,05
231,4±1,9
130,4±0,6
38,6±1,7
165,6±1,5
9,3±0,5
240,8±1,6
138,2±1,1
30,4±0,8
163,2±0,9
7,6±0,2
230,6±1,4
128,9±1,2
36,2±1,1
158,4±1,3
9,8±0,7
252,1±0,9
139,9±1,2
31,4±0,8
160,2±1,1
sisxlSi saerTo qolesterinis donis mixedviT avadmyofebi
davyaviT 4 jgufad: I jgufSi Sevida 40(31%) avadmyofi, romelTa
saerTo qolesterinis done 200 mg%-mde iyo, II jgufSi – 72(55,8%)
avadmyofi 200-dan 250mg%-mde saerTo qolesterinis doniT,
IIIjgufSi – 47(36,4%) avadmyofi 250-dan 300mg%-mde saerTo
qolesterinis doniT da IVjgufSi – 10(7,8%) avadmyofi 300 mg%-ze
meti saerTo qolesterinis doniT. .#3 cxrilSi mocemulia
lipiduri cvlis maCveneblebi jgufebis mixedviT.
51
cxrili3
avadmyofTa ganawileba cximovani cvlis maCveneblebis
mixedviT
I jgufi II jgufi III jgufi IV jgufi
TQ 198.5±2.8 238.2±3.5 267.6±2.4 318.3±1.6
LDL 134.6±2.4 160.1±3.1 167.7±3.6 174.4±2.1
HDL 39.5±0.6 36.8±1.02 35.4±0.9 31.1±0.5
VLDL 28.9±0.3 32.6±0.9 33.7±0.8 34.1±0.2
TG 148.7±2.5 170.2±5.8 172.8±5.7 179.1±4.1
aTerogenobis
indeqsi
3.2±0.1 5.2±0.3 5.8±0.2 7.9±0.8
hipolipidemiuri mkurnalobis Sedegad saerTo qolestrinis
done rogorc ZiriTad aseve sakontrolo jgufebSi Semcirda
19,8%-iT, LDL qolesterinis done – 28,2%-iT, HDL qolesterinis
done gaizarda 6,1%-iT, trigliceridebis done Semcirda 10,2%-iT.
jgufebis mixedviT saerTo qolesterinis donis cvlilebis
Seswavlam aCvena, rom I jgufSi misi done Semcirda 8,2%-iT, II
jgufSi – 13,5%-iT, III jgufSi – 20,2%-iT da IV jgufSi – 18,1%-iT.
(cxrili4)
cxrili4
lipiduri cvlis maCveneblebi hipolipidemiuri mkurnalobis
Semdeg
I jgufi II jgufi III jgufi IV jgufi
TQ 175.5±2.3 213.2±3.1 222.6±1.9 224.3±1.2
LDL 113.6±2.1 115.1±1.8 123.7±2.6 144.4±1.5
HDL 39.9±0.8 38.8±1.02 37.4±0.9 32.1±0.5
VLDL 27.6±0.3 30.6±0.9 27.7±0.8 26.1±0.2
TG 138.7±2.5 165.2±5.6 162.8±4.8 168.1±3.1
52
aTerogenobis
indeqsi
3.1±0.1 4.2±0.3* 4.0±0.2* 5.1±0.8*
p<0.05
avadmyofTa mkurnalobis Soreuli Sedegebis Seswavlam
gamoavlina, rom postinfarqtuli stenokardia aReniSneboda
ZiriTadi jgufis 39(30,2%) da sakontrolo jgufis 7(77,8%)
avadmyofs. lipiduri speqtris mixedviT es avadmyofebi
miekuTvnebodnen III da IV jgufs rogorc ZiriTad, ise
sakontrolo jgufebSi. gulis qronikuli ukmarisoba
aReniSneboda ZiriTadi jgufis 8(14,8%) da sakontrolo jgufis
5(55,6%) avadmyofs. ganmeorebiTi infarqti ZiriTadi jgufis
19(14,7%) avadmyofs ganuviTarda, xolo sakontrolo jgufSi
aRiniSna 7(18,4%) SemTxvevaSi.
letalobis Seswavlam aCvena, rom stacionaruli
mkurnalobis periodSi gardaicvala ZiriTadi jgufis 6(4,8%) da
sakontrolo jgufis 6(15,4%) avadmyofi. 5-wliani dakvirvebis
periodSi gardaicvala ZiriTadi jgufis 15(11,6%) da
sakontrolo jgufis 7(18,4%) avadmyofi. 15 avadmyofidan 2
miekuTvneboda II jgufs, 5 – III da 8 – IV jgufs. sakontrolo
jgufSi pacientebi Sesabamisad ase ganawildnen: 1,1,2 da 3
avadmyofi.
amgvarad, hiperlipidemiiT pacientTa gamokvlevam aCvena, rom
am jgufSi aRiniSna postinfarqtuli stenokardiisa da
ganmeorebiTi infarqtis ufro maRali sixSire gid sxva risk-
faqtorebis mqone pacientebTan SedarebiT. amave dros 5-wliani
letaloba statistikurad sarwmunod gansxvavdeboda ZiriTad da
sakontrolo jgufebSi.
53
hospitalur etapze miokardiumis infarqtis garTulebebis
Seswavlam aCvena, rom ZiriTad jgufSi marcxena parkuWis mwvave
ukmarisoba ganuviTarda 10(8,9%) avadmyofs, sakontrolo jgufSi
– 5(14,7%)-s. adreuli postinfarqtuli stenokardia ganuviTarda
ZiriTadi jgufis 8(7,1%) da sakontrolo jgufis 7(20,6%)
avadmyofs; stacionaridan gawerisas marcxena parkuWis funqciis
Seswavlam aCvena, rom ZiriTadi jgufis 18(16,1%) avadmyofs
aReniSneboda II fk gulis ukmarisoba, 16(14,3%)-s - III fk gulis
ukmarisoba. marcxena parkuWis gandevnis fraqcia iyo 43,9±1,2.
sakontrolo jgufSi 9(26,5%) –s hqonda II fk gulis ukmarisoba,
12(35,3%) –s - III fk gulis ukmarisoba, 2(5,9%)-s IV fk. marcxena
parkuWis gandevnis fraqcia iyo 36,1±1,4. 30 dRis ganmavlobaSi
gardaicvala ZiriTadi jgufis 5(4,5%) da sakontrolo jgufis
4(11,8%) pacienti.
avadmyofTa mkurnalobis Soreuli Sedegebis Seswavlam
gamoavlina, rom postinfarqtuli stenokardia aReniSneboda
ZiriTadi jgufis 9(15,8%) da sakontrolo jgufis 7(77,8%)
avadmyofs. gulis qronikuli ukmarisoba aReniSneboda ZiriTadi
jgufis 8(14,8%) da sakontrolo jgufis 5(55,6%) avadmyofs.
ganmeorebiTi infarqti ZiriTadi jgufis arc erT avadmyofs ar
ganuviTarda, xolo sakontrolo jgufSi aRiniSna 2(22,2%)
SemTxvevaSi.
letalobis Seswavlam aCvena, rom stacionaruli
mkurnalobis periodSi gardaicvala ZiriTadi jgufis 4(7%) da
sakontrolo jgufis 2(22,2%) avadmyofi. 5-wliani sikvdilobis
maCvenebeli ZiriTad jgufSi iyo 9(15,8%) da sakontrolo jgufSi
– 3(33,3%).
54
antihipertenziuli mkurnalobis Sedegebis mixedviT
avadmyofebi ZiriTad da sakontrolo jgufebSi davyaviT 2-2-
jgufebad. ZiriTad jgufSi sistoluri wneva iyo 181,2±0,9 mmvwysv,
diastoluri –106,4±0,2 mmvwysv. mkurnalobis Semdeg I jgufSi
sistoluri wneva gaxda 158,8±1,2 mmvwysv, diastoluri 92,3±0,4
mmvwysv, II jgufSi sistoluri wneva gaxda 134,2±0,8 mmvwysv,
diastoluri – 83,5±0,8 mmvwysv. aseve davyaviT sakontrolo
jgufis avadmyofebic. arteriuli wnevis sididis mixedviT
avadmyofTa klinikuri monacemebis ganawileba mocemulia #8
cxrilSi.
cxrili8
infarqtis garTulebebis sixSire arteriuli wnevis
mixedviT
ZiriTadi jgufi sakontrolo jgufi
I N II I II
sistoluri wneva 158,8±1,2 134,2±0,8 161,2±0,9 131,8±0,5
diastoluri wneva 92,3±0,4 83,5±08 91,8±0,7 80,1±0,6
ganmeorebiTi
infarqti
5-10% 1-1,4% 4-28,6% 1-5%
stenokardia 8-16% 4-5,6% 7-50% 5-25%
gu 30-60% 11-15,3% 12-85,7% 8-40%
sikvdiloba 8-16% 2-2,8% 5-35,7% 3-15%
rogorc cxrilidan Cans, garTulebebis sixSire da
sikvdilobis maCveneblebi erTnairad maralia Ziritadi da
sakontrolo jgufebis marali arteriuli wneviT avadmyofebSi.
avadmyofTa mkurnalobis Soreuli Sedegebis Seswavlam
gamoavlina, rom postinfarqtuli stenokardia aReniSneboda
ZiriTadi jgufis 12(10%) da sakontrolo jgufis 12(35,3%)
55
avadmyofs. gulis qronikuli ukmarisoba aReniSneboda ZiriTadi
jgufis 41(36,6%) da sakontrolo jgufis 20(58,9%) avadmyofs.
ganmeorebiTi infarqti ganuviTarda ZiriTadi jgufis 6(5,4%),
xolo sakontrolo jgufis 5(14,7%) avadmyofs. 5-wliani
letalobis Seswavlam aCvena, rom ZiriTad jgufSi gardaicvala
10(8,9%) da sakontrolo jgufis 8(23,5%) avadmyofi.
amgvarad, Trombolizuri Terapia sarwmunod amcirebs mi
garTulebebis sixSires da stacionarul letalobas. aseve
sarwmunod dabalia ZiriTadi jgufis 5-wliani letaloba.
4.3 Tambaqos mwevel avadmyofTa gamokvlevis Sedegebi
169 avadmyofidan Tambaqos eweoda 81(47,9%): 76(58,9%) mamakaci
da 5 qali(3,9%). sakontrolo jgufSi mweveli iyo 29(58%)
pacienti: 25(50%) mamakaci da 4(8%) qali. klinkurma gamokvlevam
aCvena, rom ZiriTadi jgufis 28(34,6%) da sakontrolo jgufis
13(44,8%) avadmyofs hqonda infarqti Q kbiliT. 48(59,2%) da
20(68,9%)-s – wina kedlis infarqti. ZiriTadi jgufis 65(80,2%) da
sakontrolo jgufis 20(68,9%) pacients aReniSneboda
hiperqolesterinemia, 42(51,8%) da 13(44,8%)-s Sesabamisad
arteriuli hipertenzia. 8(9,9%) da 4(13,7%) – Saqriani diabeti.
21(25,9%) da 6(20,7%)-s – Warbi wona. (cxrili)
56
cxrili
Tambaqos mwevel avadmyofTa klinikuri monacemebi
klinikuri monacemebi ZiriTadi jgufi sakontrolo
jgufi
raodenoba
wina kedlis
Q kbiliT
hiperqolesterinemia
arteriuli hipertenzia
Saqriani diabeti
QWarbi wona
81 – 47,9%
48 – 59,2%
28 – 34,6%
65 – 80,2%
42 – 51,8%
8 – 9,9%
21 – 25,9%
29 – 58%
20 – 68,9%
13 – 44,8%
20 – 68,9%
13 – 44,8%
4 – 13,7%
6 – 20,7%
hospitalur etapze miokardiumis infarqtis garTulebebis
Seswavlam aCvena, rom ZiriTad jgufSi marcxena parkuWis mwvave
ukmarisoba ganuviTarda 5(6,2%) avadmyofs, sakontrolo jgufSi
– 2(6,9%)-s. adreuli postinfarqtuli stenokardia ganuviTarda
ZiriTadi jgufis 8(9,9%) da sakontrolo jgufis 4(13,7%)
avadmyofs; stacionaridan gawerisas marcxena parkuWis funqciis
Seswavlam aCvena, rom ZiriTadi jgufis 10(12,3%) avadmyofs
aReniSneboda II fk gulis ukmarisoba, 3(3,7%)-s - III fk gulis
ukmarisoba. sakontrolo jgufSi – Sesabamisad 6(20,7%) da
4(13,7%) pacients. 30 dRiani letaloba iyo ZiriTad jgufSi
12(14,8%) da sakontrolo jgufSi 6(20,7%).
stacionaridan gaweris Semdeg ZiriTadi jgufis 60(69,1%)-ma
da sakontrolo jgufis 14(48,3%) pacientma Sewyvita Tambaqos
weva.
ambulatoriuli meTvalyureobis periodSi stenokardia
aReniSneboda ZiriTadi jgufis 12(14,8%), pacients, romelTagan 9
57
Tambaqos mweveli iyo. sakontrolo jgufSi stenokardia
aReniSneboda 12(44,4%) pacients, romelTagan 10 Tambaqos mweveli
iyo. ganmeorebiTi miokardiumis infarqti ganuviTarda ZiriTadi
jgufis 8(9,9%) mwevel pacients, sakontrolo jgufSi – 6(20,7%)
pacients, romelTagan 5 mweveli iyo. 5-wliani letaloba ZiriTad
jgufSi iyo 10(12,3%) da sakontrolo jgufSi – 7(24,1%).
amgvarad, Tambaqos mwevel pacientebSi yvelaze xSiri iyo
hiperqolesterinemia (80,2%). Tambaqos wevis Sewyveta erTnairad
amcirebs mi garTulebebsa da sikvdilobas rogorc ZiriTad,
aseve sakontrolo jgufSi.
4.4. Trombolizuri Terapia Warbi wonis mqone avadmyofebSi
miokardiumis infarqtiT 169 avadmyofidan 57(33,7%) –s hqonda
Warbi wona, maT Soris 27(23,7%) mamakacs da 30(54,5%) qals.
pacientTa sxeulis saSualo wona iyo 84,2±0,9 kg, sxeulis masis
indeqsi 33,2±1,5. avadmyofTa klinikurma gamokvlevam aCvena, rom
42(73%)-s hqonda infarqti Q kbiliT, 15(27%)-s - Q kbilis gareSe.
38(66,7%)-s hqonda wina kedlis, xolo 19(33,3%)-s – ukana kedlis
infarqti. 33(57,9%) avadmyofs aReniSneboda arteriuli
hipertenzia, 18(31,9%)-s – Saqriani diabeti, 20(35,1%) iyo Tambaqos
mweveli, 12(21,1%)-s aReniSneboda hipodinamia, 8(14%)-s –
damZimebuli memkvidreoba, 43(75,4%) avadmyofs aReniSneboda
hiperqolesterinemia. (cxrili10)
58
cxrili10
simsuqniT avadmyofebSi gid risk-faqtorebis ganawileba
ZiriTadi jgufi sakontrolo jgufi
avadmyofTa r-ba
mamakaci
qali
infarqti Q kbiliT
Q kbilis gareSe
wina kedeli
ukana kedeli
hiperqolesterinemia
arteriuli hipertenzia
Saqriani diabeti
Tambaqo
hipodinamia
memkvidreoba
57(33,7%)
27(23,7%)
30(54,5%)
42(73%)
15(27%)
38(66,7%)
19(33,3%)
43(75,4%)
33(57,9%)
18(31,9%)-
20(35,1%)
12(21,1%)
8(14%)
9(18%)
4(44,4%)
5(55,6%)
6(66,7%)
3(33,3%)
6(66,7%)
3(33,7%)
7(77,8%)
5(55,6%)
3(33,3%)
3(33,3%)
3(33,3%)
3(33,3%)
sismsuqnis xarisxis mixedviT avadmyofebi ase ganawilda:
32(56,1%) avadmyofs hqonda I xarisxis simsuqne, maT Soris 15(13,1%)
iyo mamakaci, 17(30,9%)- qali. II xarisxis simsuqne hqonda 25(43,9%)
pacients, maT Soris 12(10,5%) mamakacs da 13(23,6%) qals.
I xarisxis simsuqniT avadmyofTagan 12(37,5%)-s hqonda
Saqriani diabeti, 18(56,2%) – s arteriuli hipertenzia, gulis
ukmarisoba aReniSneboda 7(21,9%) avadmyofs, saerTo
qolesterinis done sisxlSi iyo 238,5±3,2 mg%.
II xarisxis simsuqniT avadmyofTagan 6(24%)-s hqonda Saqriani
diabeti, 15(60%)-s arteriuli hipertenzia, gulis ukmarisoba
hqonda 10(40%) avadmyofs, saerTo qolesterinis done sisxlSi
iyo 246,2 ± 1,2 mg%. (cxrili11)
59
cxrili11
avadmyofTa ganawileba simsuqnis xarisxis mixedviT
I xarisxis simsuqne II xarisxis simsuqne
avadmyofTa r-ba
qali
mamakaci
infarqti Q kbiliT
arteriuli hipertenzia
Saqriani diabeti
saerTo qolesterini
gulis ukmarisoba
32 – 56,1%
17 – 30,9%
15 – 13,1%
23 – 71,9%
18 – 56,2%
12 – 37,5%
238,5 ± 3,2
7 – 21,9%
25 – 43,9%
13 – 23,6%
12 – 10,5%
19 – 76%
15 – 60%
6 – 24%
246 ± 1,2
10 – 40%
hospitalur etapze miokardiumis infarqtis garTulebebis
Seswavlam aCvena, rom ZiriTad jgufSi marcxena parkuWis mwvave
ukmarisoba ganuviTarda 4(7%) avadmyofs, sakontrolo jgufSi –
4(18,2%)-s. adreuli postinfarqtuli stenokardia ganuviTarda
ZiriTadi jgufis 2(3,5%) da sakontrolo jgufis 5(55,6%)
avadmyofs; stacionaridan gawerisas marcxena parkuWis funqciis
Seswavlam aCvena, rom ZiriTadi jgufis 5(8,8%) avadmyofs
aReniSneboda II fk gulis ukmarisoba, 2(3,5%)-s - III fk gulis
ukmarisoba. sakontrolo jgufSi 4(44,6%) –s hqonda II fk gulis
ukmarisoba, 3(33,3%) –s - III fk gulis ukmarisoba. (cxrili12)
60
cxrili12
avadmyofTa ganawileba miokardiumis infarqtis garTulebebis
mixedviT
ZiriTadi
jgufi
sakontrolo
jgufi
kardiuli asTma
postinfarqtuli stenokardia
II fk gu
IIIfk gu
4 – 7%
2 – 3,5%
5 – 8,8%
2 – 3,5%
4 – 44,6%
5 – 55,4%
4 – 44,6%
3 – 33,3%
avadmyofebs daeniSnaT dieturi kveba da dozirebuli
fizikuri varjiSi. wonis kontrolma aCvena, rom 57 avadmyofidan
simsuqne aReniSneboda 24(14,2%) pacients, maT Soris 17(70,8%) I
xarisxis, 7(29,2%)-s - II xarisxis. sxeulis saSualo wona iyo
73,8±0,3 kg, xolo sxeulis masis indeqsi – 29,9±0,8. xangrZlivma
dakvirvebam aCvena, rom simsuqniT avadmyofebSi postinfarqtuli
stenokardia aReniSneboda 9(37,5%) avadmyofs, xolo normaluri
woniT 145 pacientidan 21(14,5%)-s. genmeorebiTi infarqti
ganviTarda simsuqniT avadmyofTa 6(25%) SemTxvevaSi, xolo
danarCen pacientebSi 20(13,8%) SemTxvevaSi. 5 wliani sikvdiloba
simsiqniT avadmyofebSi iyo 5(20,5%), danarCen pacientebSi –
18(12,4%) SemTxvevaSi. amrigad, kvlevam aCvena, rom Trombolizur
TerapiasTan erTad Warbi wonis koreqcia sarwmunod amcirebs mi
garTulebebsa da sikvdilobas.
cxrili7
61
avadmyofTa ganawileba miokardiumis infarqtis garTulebebis
mixedviT
ZiriTadi
jgufi n=112
sakontrolo
jgufi n=34
kardiuli asTma
postinfarqtuli stenokardia
II fk gu
IIIfk gu
IVfk gu
gf
sikvdiloba
10 – 8,9%
8 – 7,1%
18 – 16,1%
16 – 14,3%
_
43,9±1,2
5 – 4,5%
5 – 14,7%
7 – 20,6%
9 – 26,5%
12 – 35,3%
2 – 5,9%
36,1±1,4
4 – 11,8%
4.5. miokardiumis infarqtiT avadmyofebSi sqesis roli
Trombolizuri mkurnalobis dros
miokardiumis infarqtiT 169 avadmyofidan 114(67,5%) iyo
mamakaci da 55(32,5%) – qali. mamakacTa asaki meryeobda 36-dan 83
wlamde, saSualo asaki iyo 63,2±1,2 weli. qalTa asaki meryeobda
35-dan 88 wlamde, saSualo asaki iyo 69,7±1,4 weli. sakontrolo
jgufi Seadgina 50-ma avadmyofma: 31(62%)- qalma da 19(38%) –
mamakacma. saSualo asaki iyo 64,9±1,6 weli. ZiriTadi da
sakontrolo jgufis avadmyofTa klinikuri daxasiaTeba
mocemulia cxrilebSi #13 da 14.
62
cxrili13
ZiriTadi jgufis avadmyofTa klinikuri daxasiaTeba
mamakaci qali sul
avadmyofTa r-ba 114 – 67,5% 55 – 32,5% 169
saSualo asaki 63,2±1,2 69,7±1,4 67,1 ± 0,9
mi Q kbiliT 80 – 47,3% 35 – 20,7% 115
mi Q kbilis gareSe 34 – 20,1% 20 – 11,8% 54
mi wina kedlis 64 – 37,9% 25 – 14,8% 89
mi ukana kedlis 50 - 29,6% 30 – 17,8% 80
cxrili14
sakontrolo jgufis avadmyofTa ZiriTadi daxasiaTeba
mamakaci qali sul
avadmyofTa r-ba 19 - 38% 31 - 62% 50
saSualo asaki 65,9±1,4 70,1±0,3 69,3±0,6
mi Q kbiliT 17 – 34% 16 – 32% 33
mi Q kbilis gareSe 7 – 14% 10 – 20% 17
mi wina kedlis 18 – 36% 10 – 20% 28
mi ukana kedlis 20 – 40% 12 – 24% 32
gid risk-faqtorebis Seswavlam aCvena, rom arteriuli
hipertenzia da hiperqolesterinemia ufro xSiri iyo qalebSi,
vidre mamakacebSi, Saqriani diabeti daaxloebiT erTnairi
sixSiriT iyo gamovlenili, Tambaqos mwevelebi ZiriTadad
63
mamakacebi iyvnen, aseve mamakacebSi Warbobda memkvidruli
faqtori. ix. cxrilebi #15, 16.
cxrili15
ZiriTadi jgufis avadmyofTa ganawileba gid risk -
faqtorebis mixedviT
mamakaci qali sul
arteriuli hipertenzia 60 – 52,6% 48 – 87,3% 108 – 63,9%
hiperqolesterinemia 82 – 68,9% 44 – 80% 162- 96%
Saqriani diabeti 16 – 14% 8 14,5% 24 -14,2%
simsuqne 27 – 23,7% 30 – 54,5% 57 – 33%
Tambaqo 76 – 66,7% 5 – 9,1% 81 – 47,9%
hipodinamia 12 – 10,2% 4 – 7,3% 16 – 9,5%
memkvidreoba 24 – 20,2% 8 14,5% 32 – 18,9%
cxrili16
sakontrolo jgufis avadmyofTa ganawileba gid risk -
faqtorebis mixedviT
mamakaci qali sul
arteriuli hipertenzia 15 – 30% 19 – 70% 34- 68%
hiperqolesterinemia 20 – 40% 23 – 46% 43 – 86%
Saqriani diabeti 3 – 6% 4 – 8% 7 – 14%
simsuqne 2 – 4% 7 – 14% 9 – 18%
Tambaqo 24 – 48% 5 – 10% 29 – 58%
hipodinamia 3 – 6% 1 – 2% 4 – 8%
memkvidreoba 5 – 10% 2 – 4% 7 – 14%
SeviswavleT miokardiumis infarqtis mimdinareoba da
garTulebebi mkurnalobis stacionarul da ambulatoriul
etapebze. miRebuli Sedegebi mocemulia cxrilebSi #17
64
cxrili17
miokardiumis infarqtis mimdinareoba da garTulebebi
ZiriTadi jgufis pacientebSi
jgufi mamakaci 114 qali 55
ariTmia 32 – 18,9% 12 – 7%
mpmu 6- 3,5% 11- 6,5%
gqu 8 – 4,7% 13 – 7,7%
postinfarqtuli
stenokardia
7 – 4,1%
11 – 6,5%
ganmeorebiTi infarqti 4 – 2,4% 6 – 3,6%
cxrili18
miokardiumis infarqtis mimdinareoba da garTulebebi
sakontrolo jgufis pacientebSi
jgufi mamakaci 31 qali 19
ariTmia 10 – 20% 5 – 10%
mpmu 4 – 8% 8 – 16%
gqu 3 – 6% 7 – 14%
postinfarqtuli
stenokardia
5 – 10% 6 – 12%
ganmeorebiTi infarqti 2 – 4% 3 – 6%
rogorc cxrilebidan Cans, mamakacebSi rogorc ZiriTad, ise
sakontrolo jgufebSi ufro xSirad viTardeboda riTmis
darRvevebi, xolo qalebSi ufro xSiri iyo gulis ukmarisobis,
stenokardiisa da ganmeorebiTi infarqtis ganviTareba.
65
stacionaruli letalobis Seswavlam aCvena, rom qalebis
sikvdiloba sarwmunod maRali iyo mamakacebTan SedarebiT da
Sesabamisad Seadgenda 9(16,4%) da 6(5,3%) ZiriTad jgufSi da
5(26,3%) da 4(12,9%) sakontrolo jgufSi. 5-wliani sikvdilobis
Seswavlam aCvena, rom 70 wlamde asakis pacientebSi aseve
Warbobda qalebis sikvdiloba mamakacebisas da Seadgenda
ZiriTad jgufSi 7(22,62%) da 6(8,2%), sakontrolo jgufSi –
5(31,2%) da 3(18,7%). 70 welze maRali asakis pacientebSi qalebisa
da mamakacebis letalobas Soris sarwmuno sxvaoba ar
aRiniSneboda: ZiriTad jgufSi iyo 3(25%) da 7(29,2%) da
sakontrolo jgufSi – 3(33%) da 6(40%) Sesabamisad.
4.6. Trombolizuri Terapiis efeqturoba sxvadasxva asakis
pacientebSi
miokardiumis infarqtiT avadmyofTa asaki meryeobda 35-dan
88 wlamde, saSualo asaki iyo 69,8. Trombolizuri Terapiis
efeqturobis Sefasebis mizniT avadmyofebi daiyo asakobriv
jgufebad (cxrili19).
cxrili19
avadmyofTa ganawileba asakobriv jgufebSi
jgufi asaki mamakaci qali sul
I < 50 29 – 15,5% 3 – 5,5% 32 – 18,9%
II < 60 35 – 30,7% 6 – 10,9% 41 – 24,3%
III < 70 38 – 33,3% 22 – 40% 60 – 35,5%
IV > 70 12 – 10,5% 24 – 43,6% 36 – 21,3%
66
orive jgufis avadmyofebs aReniSneba hiperglikemia, saerTo
da ß-qolesterinis momateba, Semcirebulia α- qolesterinis
done, gansakuTrebiT maRalia trigliceridebis done, aseve
momatebulia aTerogenobis indeqsi.
hospitalur etapze miokardiumis infarqtis garTulebebis
Seswavlam aCvena, rom ZiriTad jgufSi marcxena parkuWis mwvave
ukmarisoba ganuviTarda 4(13,3%) avadmyofs, sakontrolo jgufSi
– 5(16,7%)-s. adreuli postinfarqtuli stenokardia ganuviTarda
ZiriTadi jgufis 3(10%) da sakontrolo jgufis 5(16,7%)
avadmyofs; stacionaridan gawerisas marcxena parkuWis funqciis
Seswavlam aCvena, rom ZiriTadi jgufis 2(6,7%) avadmyofs
aReniSneboda II fk gulis ukmarisoba, 3(10%)-s - III fk gulis
ukmarisoba. marcxena parkuWis gandevnis fraqcia iyo 39,9±1,7.
sakontrolo jgufSi 5(16,7%) –s hqonda II fk gulis ukmarisoba,
4(13,3%) –s - III fk gulis ukmarisoba. marcxena parkuWis gandevnis
fraqcia iyo 37,1±1,8. stacionaruli mkurnalobis periodSi
gardaicvala ZiriTadi jgufis 2(6,6%) da sakontrolo jgufis
4(13,3%) pacienti. (cxrili27 )
cxrili27
avadmyofTa ganawileba miokardiumis infarqtis garTulebebis
mixedviT
ZiriTadi
jgufi
sakontrolo
jgufi
kardiuli asTma
postinfarqtuli stenokardia
II fk gu
IIIfk gu
gf
sikvdiloba
4 - 13,3%
3 - 10%
2 - 6,7%
3 - 10%
39,9±1,7
2 – 6,6%
5 - 16,7%
5 - 16,7%
5 – 16,7%
4 - 13,3%
37,1±1,8
4 – 13,3%
67
avadmyofTa mkurnalobis Soreuli Sedegebis Seswavlam
gamoavlina, rom postinfarqtuli stenokardia aReniSneboda
ZiriTadi jgufis 5(16,7%) da sakontrolo jgufis 9(30%)
avadmyofs. gulis qronikuli ukmarisoba aReniSneboda ZiriTadi
jgufis 8(26,7%) da sakontrolo jgufis 13(43,3%) avadmyofs.
ganmeorebiTi infarqti ganuviTarda ZiriTadi jgufis 3(10%),
xolo sakontrolo jgufis 4(13,3%) avadmyofs. 5-wliani
letalobis Seswavlam aCvena, rom ZiriTad jgufSi gardaicvala
7(23,3%) da sakontrolo jgufis 9(30%) avadmyofi.
amrigad, Saqriani diabetiT avadmyofebSi yvelaze didi
sixSiriT gamovlinda lipiduri cvlis darRveva, gansakuTrebiT
gamoxatulia trigliceridebis momateba da maRali
aTerogenobis indeqsi. aseve xSiria arteriuli hipertenzia
(63,3%) da simsuqne (56,7%). Trombolizuri Terapia sagrZnoblad
aumjobesebs avadmyofTa klinikur mdgomareobas stacionarul
periodSi. mkurnalobis Soreuli Sedegebi, kerZod, ganmeorebiTi
infarqtis da letalobis sixSire statistikurad ar
gansxvavdeba ZiriTad da sakontrolo jgufebSi.
4.6. Trombolizuri Terapiis Sedegebi gid risk-faqtorebis
sixSiris mixedviT
Trombolizuri Terapiis Sedegebze gid risk-faqtorebis
gavlenis Sesaswavlad avadmyofebi davajgufeT am risk-
faqtorebis sixSiris mixedviT (cxrili28)
cxrili28
68
risk-faqtorebis sixSire mi avadmyofebSi
risk-faqtorebis r-ba ZiriTadi jgufi sakontrolo jgufi
erTi 21 – 12,4% 6 – 12%
ori 51 – 30,2% 12 – 24%
sami 60 – 35,5% 18 – 36%
oTxi 37 – 21,9% 14 – 28%
21 avadmyofidan, romelTac 1 risk-faqtori aReniSnebodaT,
8(38%)_s hqonda arteriuli hipertenzia, 9(42,9%)-s –
hiperqolesterinemia da 4(19,1%) iyo Tambaqos mweveli.
51 avadmyofidan 2 risk-faqtoriT, 18(35,3%)-s aReniSneboda
hiperqolesterinemia da arteriuli hipertenzia, 17(33,3%)-s
hiperqolesterinemia da Tambaqo, 5(9,8%)–s - arteriuli
hipertenzia da Saqriani diabeti, 5(9,8)–s - arteriuli
hipertenzia da Warbi wona, 6(11,8%) – s - sxvadasxva.
60 avadmyofidan 3 risk-faqtoriT, 15(25%)-s aReniSneboda
arteriuli hipertenzia, hiperqolesterinemia da Warbi wona.
23(38,3%)-s - arteriuli hipertenzia, hiperqolesterinemia da
Tambaqo. 9(15%)-s – hiperqolesterinemia, Warbi wona, datvirTuli
memkvidreoba. 6(10%)-s - arteriuli hipertenzia,
hiperqolesterinemia da Saqriani diabeti.
37 avadmyofidan 4 risk-faqtoriT, 11(29,7%)-s aReniSneboda
arteriuli hipertenzia, hiperqolesterinemia, Saqriani diabeti,
Warbi wona. 10(27%)-s - arteriuli hipertenzia,
hiperqolesterinemia, Warbi wona, Tambaqo. 7(18,9%)-s –
hiperqolesterinemia, Warbi wona, datvirTuli memkvidreoba,
69
Tambaqo. 6(16,2%)-s - arteriuli hipertenzia, hiperqolesterinemia,
datvirTuli memkvidreoba, Tambaqo. 3(8,1%)-s – sxvadasxva.
avadmyofTa jgufebSi SevuswavleT mi garTulebebi da
letaloba.
stacionarul etapze 1 risk-faqtoriT avadmyofebSi
stenokardia ganuviTarda mxolod sakontrolo jgufis 1(16,7%)
pacients. 2 risk-faqtoriT – 3(5,9%)-s ZiriTadi da 2(16,7%)
pacients sakontrolo jgufidan. 3 risk-faqtoriT – stenokardia
ganuviTarda 4(6,7%) da 2(11,1%) pacients da 4 risk-faqtoriT
avadmyofTagan, Sesabamisad, 2(5,4%) da 2(14,3%) pacients.
marcxena parkuWis mwvave ukmarisoba 1 risk-faqtoriT
avadmyofebSi ganuviTarda ZiriTadi jgufis 3(14,2%) da
sakontrolo jgufis 1(16,7%) pacients. 2 risk-faqtoriT – 2(3,9%)-
s ZiriTadi da 2(8,3%) pacients sakontrolo jgufidan. 3 risk-
faqtoriT – 4(6,7%) da 2(11,1%) pacients da 4 risk-faqtoriT
avadmyofTagan, Sesabamisad, 5(13,5%) da 4(15,3%) pacients.
gulis ukmarisobis NYHA-s mixedviT avadmyofebi ase
ganawilda: 1 risk-faqtoriT NYHA-II fk aReniSneboda ZiriTadi
jgufis 3(14,3%) da sakontrolo jgufis 2(33,3%) pacients. 2 risk-
faqtoriT NYHA-II fk aReniSneboda 8(15,7%) da 2(16,6%) pacients.
NYHA-III fk – 3(6%) da 2(16,7%)-s Sesabamisad. 3 risk-faqtoriT -
NYHA-II fk aReniSneboda 12(20%) da 5(27%) pacients. NYHA-III fk –
5(8,2%) da 2(14,3%) avadmyofs Sesabamisad. NYHA-IV fk
aReniSneboda 2(8,2%) da 2(14,3%) avadmyofs Sesabamisad. 4 risk-
faqtoriT - NYHA-II fk aReniSneboda 10(27%) da 5(35,7%) pacients.
NYHA-III fk –8(21,6%) da 5(35,7%)-s Sesabamisad. NYHA-IV fk
aReniSneboda Sesabamisad 2(5,4%) da 2(14,3%) pacients.
70
dakvirvebis periodSi ganmeorebiTi infarqti 1 risk-
faqtoriT avadmyofTagan aravis ganuviTarda. 2 risk-faqtoriT
avadmyofTagan ganuviTarda ZiriTadi jgufis 4(7,8%) da
sakontrolo jgufis 2(16,7%) pacients. 3 risk-faqtoriT,
Sesabamisad, 6(10%) da 4(22,2%) pacients. 4 risk-faqtoriT –
6(16,2%) da 4(28,6%) pacients Sesabamisad.
30-dRiani sikvdilobis Seswavlam aCvena, rom 1 risk-
faqtoriT avadmyofTagan arcerTi avadmyofi ar gardacvlila. 2
risk-faqtoriT ZiriTad jgufSi gardaicvala 2(3,9%) da
sakontrolo jgufSi – 1(8,3%) pacienti. 3 risk-faqtoriT
gardaicvala 5(8,3%) da 3(16,7%) pacienti. 4 risk-faqtoriT,
Sesabamisad, 5(13,5%) da 3(21,4%) pacienti.
5-wliani sikvdilobis Seswavlam aCvena, rom 1 risk-
faqtoriT avadmyofTagan ZiriTad jgufSi gardaicvala 2(9,5%) da
sakontrolo jgufSi – 2(33,3%) pacienti. 2 risk-faqtoriT
ZiriTad jgufSi gardaicvala 8(15,7%) da sakontrolo jgufSi –
4(33,3%) pacienti. 3 risk-faqtoriT gardaicvala 9(15%) da 6(38,9%)
pacienti. 4 risk-faqtoriT, Sesabamisad, 4(10,8%) da 5(45,4%)
pacienti (cxrili29)
mi avadmyofTa sikvdiloba gid risk-faqtorebis mixedviT
cxrili29
30-dRiani 5-wliani
risk-faqtorebis
r-ba
ZiriTadi sakontrolo ZiriTadi sakontrolo
erTi
ori
sami
oTxi
_
2 - 3,9%
5 - 8,3%
5 - 13,5%
_
1 – 8,3%
3 – 16,7%
3 – 21,4%
2 – 9,5%
8 – 15,7%
9 – 15%
4 – 10,8%
2 – 33,3%
4 – 33,3%
6 – 38,9%
5 – 45,4%
sul 12 – 7,1% 7 – 14% 23 – 13,6% 17 – 34%
71
amgvarad, risk-faqtorebis raodenobis mixedviT
sikvdilobis SeswavliT aRmoCnda, rom misi sidide korelaciaSia
risk-faqtorebis raodenobasTan, xolo Trombolizuri Terapia
sarwmunod amcirebs sikvdilobas sakontrolo jgufTan
SedarebiT risk-faqtorebis miuxedavad.
Tavi V
miRebuli Sedegebis ganxilva
gid kvlavac rCeba mosaxleobis yvelaze Sromisunariani
nawilis invalidobis da sikvdilobis uxSires mizezad. 40%-ze
met SemTxvevaSi gid uecari sikvdiliT mTavrdeba, xolo am
pacientTa naxevars sikvdilamde ar aReniSneboda gid raime
klinikuri gamovlineba. miuxedavad imisa, rom miokardiumis
infarqtiT sikvdiloba bolo wlebSi mkveTrad Semcirda, igi
mainc rCeba sikvdilobis yvelaze xSir mizezad. gul-
sisxlZarRvTa daavadebebis risk-faqtorebis codna, sxvadasxva
profilaqtikuri da Terapiuli RonisZiebebis efeqturobis
dadasturebuli mtkicebulebebis gaTvaliswineba yovelTvis ar
xdeba praqtikaSi. mravali klinicisti miuTiTebs, rom jer kidev
rCeba zRvari gul-sisxlZarRvTa daavadebebis risk-faqtorebis
koreqciis Teoriul codnasa da mis praqtikul ganxorcielebas
Soris (4, 9 ).
2003 weli mniSvnelovani iyo mTeli rigi evropuli
rekomendaciebis mowodebiT gid avadmyofTa mkurnalobis
Sesaxeb, sadac didi adgili uWiravs gid pirvelad da meorad
72
profilaqtikas. SemTxvevaTa umravlesobaSi miokardiumis
infarqti gid pirvel gamovlinebas warmoadgens. miokardiumis
mwvave infarqti ara marto daavadebis arsebobaze miuTiTebs,
aramed warmoadgens SesaZleblobas, ganawyos pacienti cxovrebis
wesis Secvlisadmi, radgan dadgenilia, rom gid meoradi
profilaqtika avadobis da sikvdilobis Semcirebis saSualebas
iZleva (10, 13, 30 ).
miokardiumis infarqtis mkurnalobaze Tanamedrove
warmodgenebis Tanaxmad, koronaruli sisxlis mimoqcevis
aRdgena, rac saSualebas iZleva nawilobriv an mTlianad
aviciloT Tavidan Seuqcevadi iSemiis ganviTareba, yvelaze
mniSvnelovan amocanas warmoadgens. misi gadaWra amcirebs
hemodinamikuri darRvevebis xarisxs, aumjobesebs avadmyofTa
prognozs da cocxladdarCenas (79). Trombolizuri Terapia
qirurgiul meTodebTan erTad, dReisaTvis ganixileba Q –
kbilovani infarqtiT avadmyofTa ZiriTad mkurnalobad.
miuxedavad imisa, rom es meTodi mowodebulia SedarebiT didi
xnis win (1959 w) da Catarebulia mravali gamokvleva (71, 107), maT
Soris multicentruli (126 ), ar aris sakmarisad Seswavlili
gid risk-faqtorebis gavlena Trombolizuri Terapiis
efeqturobasa da Soreul Sedegebze. marTalia, Trombolizisma
miokardiumis infarqtis mwvave periodSi, ß- blokerebisa da agf-
inhibitorebis gamoyenebam mniSvnelovnad Secvala avadmyfTa
prognozi ukeTesobisken, arcerTi es samkurnalo saSualeba ar
zemoqmedebs koronaruli arteriebis aTerosklerozis arsze.
yvela eqim-kardilogisTvis kavSiri aTerosklerozis
ganviTarebisa sisxlSi qolesterinis donis matebasTan aSkaraa.
amitom, bunebrivad Cndeba survili gairkves, Tu rogor
73
moqmedebs qolesterinis donis Semcireba avadmyofTa prognozze.
SesaZlebelia Tu ara gaumjobesdes gid avadmyofTa prognozi
dietis, cxovrebis wesis Secvlis, Tambaqos Sewyvetis da bolos,
hipolipidemiuri preparatebis gamoyenebis gziT.
gid da hiperqolesterinemiiT avadmyofTa rekomendaciebSi
mniSvnelovania dietis dacva, Tumca yvelaze mkacri dietac ki
ar iwvevs qolesterinis donis Semcirebas 8-10%-ze metad, radgan
misi Semcveloba umTavresad regulirdeba RviZlis ujredebSi
endogenuri sinTeziT (67, 111, 123 ). am problemisadmi xelaxali
interesi gaCnda axali klasis preparatebis gamoCenis Semdeg. es
aris ferment 3-hidroqsi-3-meTilglutaril-koenzim A reduqtazas
inhibitorebi, romlebic mniSvnelovan rols asruleben
qolesterinis endogenur sinTezSi. am jgufis preparatebi,
pirvel yovlisa, lovastatini, simvastatini da pravastatini
klinikur praqtikaSi gamoiyeneba 80-90-iani wlebidan, Tumca
Tavidan am preparatebis gamoyenebis mizanSewoniloba eWvis qveS
idga. 90-iani wlebis bolodan aSkara gaxda, rom statinebis
gamoyeneba miokardiumis infarqtis gadatanis Semdeg saSualebas
iZleva mniSvnelovnad Semcirdes gid garTulebebi da
sikvdiloba. kerZod, 4S (Scandinavian Simvastatin Survival Study) kvlevam
aCvena, rom hipolipidemiuri mkurnalobis dros gid
garTulebebis sixSire 70%-iT dabalia im pacientebTan
SedarebiT, visac utardebodaT tradiciuli mkurnaloba (174 ).
miuxedavad imisa, rom saerTo qolesterinis done sawyisTan
SedarebiT mcirdeba infarqtis gadatanidan 2 Tvis Semdeg,
pirvel 24-48 sT-Si gansazRvruli lipiduri speqtri zustad
asaxavs lipiduri cvlis mdgomareobas (169 ). amitom,
miokardiumis infarqtiT avadmyofebSi aucilebelia pirveli 24
74
sT-is ganmavlobaSi ganisazRvros lipiduri speqtri.
rekomendaciebis Tanaxmad, romelic SemuSavebulia NCEP (National
Cholesterol Education Program) programis farglebSi,
hiperqolesterinemiis koreqcia miokardiumis infarqtis
ganviTarebis dros dauyovnebliv unda daiwyos (77, 161 ).
Cvens kvlevaSi miokardiumis infarqtis garTulebebi da
sikvdloba SeviswavleT avadmyofebSi saerTo qolesterinis
sawyisi donis mixedviT, ris gamoc isini davyaviT 4 jgufad.
jgufebSi SeviswavleT lipiduri cvlis maCveneblebis dinamika,
postinfarqtuli stenokardiis, ganmeorebiTi infarqtis sixSire
da sikvdiloba infarqtis gadatanidan 5 wlis ganmavlobaSi.
aRmoCnda, rom hipolipidemiuri mkurnalobis Sedegad saerTo
qolesterinis donis Semcireba miT ufro didi iyo, rac ufro
maRali iyo misi sawyisi done. anu I jgufSi Semcirda 11,6%-iT, II
jgufSi – 10,5%-iT, III jgufSi – 16,8%-iT da IV jgufSi – 29,5%-iT.
postinfarqtuli stenokardiisa da ganmeorebiTi infarqtis
sixSire miuxedavad Catarebuli Trombolizuri Terapiisa,
damokidebuli iyo lipiduri speqtris maCveneblebis sidideze.
kerZod, postinfarqtuli stenokardiisa da ganmeorebiTi
infarqtis sixSire ufro maRali iyo II da III jgufis pacientebSi.
aseve sikvdilobac ufro maRali iyo am jgufebSi, Tumca
sarwmunod dabali sakontrolo jgufis pacientebis
letalobasTan SedarebiT, Sesabamisad 15 (11,6%) da 7(18,4%).
gul-sisxlZarRvTa daavadebebis ganviTarebaSi arteriul
hipertenzias didi roli eniWeba iseT faqtorebTan erTad,
rogoricaa Tambaqo, simsuqne, dislipidemia, Saqriani diabeti,
mikroalbuminuria. arteriuli wnevis erTnairi sididis
pirobebSi, marcxena parkuWis hipertrofiis, stenokardiis,
75
gadatanili miokardiumis infarqtis an insultis, gulis
ukmarisobis, sisxlSi kreatininis donis momatebis, retinopaTiis,
periferiuli arteriebis daavadebebis arsebobisas sikvdilobis
riski mniSvnelovnad izrdeba. aseTi avadmyofebi saWiroeben
aqtiur antihipertenziul mkurnalobas. arteriuli hipertenziis
mkurnaloba ufro advilia, vidre dislipidemiis, miuxedavad
amisa, saWiroO stabiluri Terapiuli efeqtis miRweva mxolod
20%-Si xdeba. antihipertnziuli mkurnalobis arasruli efeqti
stenokardiis refraqterobis erT-erTi yvelaze xSiri mizezi
xdeba (121, 157 ).
Cvens kvlevaSi 112(66,3%) pacients aReniSneboda arteriuli
hipertenzia. mikardiumis infarqtis garTulebebisa da
sikvdilobis Seswavlam aCvena, rom im pacientebSi, visac rCeboda
maRali arteriuli wneva, ufro xSiri iyo postinfarqtuli
stenokardia, ganmeorebiTi infarqti, gulis ukmarisoba da
maRali iyo letaloba. amave dros Trombolizisis da
sakontrolo jgufebSi am maCveneblebs Soris sxvaoba sarwmuno
iyo.
gid mesame kardinaluri risk-faqtoria Tambaqos weva.
laboratoriuli kvlevebiT dadgenilia, rom Tambaqos weva
zrdis aTerosklerozis ganviTarebis risks, aseve aZlierebs
Trombocitebis adhezias, zrdis guliscemis sixSires, arteriul
wnevas da aritmiis ganviTarebis sixSires. qsovilebi iReben
nakleb Jangbads, vinaidan wvis Sedegad warmoqmnili naxSirbadis
monoqsidi ufro mWidro kavSirs qmnis hemoglobinis
molekulasTan, vidre Jangbadi. nikotini aseve azianebs
sisxlZarRvebs, rac kidev ufro aCqarebs aTerosklerozis
ganviTarebas. pacientebSi, romelTac miokardiumis infarqtis
76
gadatanis Semdeg Sewyvites Tambaqos weva, ukve 3 wlis Semdeg
ganmeorebiTi infarqtis riski uTanabrdeba aramwevelebis
risks
(42, 45 ).
Cvens kvlevaSi 81(47,9%) pacienti iyo Tambaqos mweveli.
stacionaridan gaweris Semdeg ZiriTadi jgufis 60(69,1%)-ma da
sakontrolo jgufis 14(48,3%) pacientma Sewyvita Tambaqos moweva.
kvlevam aCvena, rom ganmeorebiTi infarqti ganuviTarda ZiriTadi
jgufis 8(9,9%) pacients, romelTagan 7 mweveli iyo, sakontrolo
jgufSi ki 6(20,7%) pacients, romelTagan 5 iyo mweveli.
sikvdilobis Seswavlam aCvena, rom aramwevelebSi gardaicvala
3(5%) da mwevelebSi 7(33,3%) pacienti ZiriTad jgufSi.
sakontrolo jgufSi Sesabamisad 2(14,3%) da 5(33,3%). rogorc
Sedegebidan Cans, sigaretis Sewyveta amcirebs sikvdilobas,
xolo mwevelTa sikvdiloba erTnairia miuxedavad Catarebuli
Trombolizuri Terapiisa.
simsuqne xSirad asocirebulia arteriul hipertenziasTan,
hiperqolesterinemiasTan da Saqrian diabetTan, yvela erTad ki
zrdis gid ganviTarebis risks (47, 82). simsuqnis roli
aTerosklerozis ganviTarebaSi ar aris dadasturebuli, Tumca
wonis koreqcia mniSvnelovani faqtoria arteriuli
hipertenziis, hiperlipidemiis da Saqriani diabetis
kontrolisTvis. klinikuri kvlevebiT nanaxia, rom dietaSi
cximis SezRudva amcirebs gid ganviTarebas an mis simptomebs.
gid meorad profilaqtikaSi dietis rolis Seswavla daiwyo 30
wlis win `oslos dieta-gulis kvlevaSi~ (113). 11 wliani
dakvirvebis manZilze miokardiumis infarqtiT gamowveuli
sikvdiloba Semcirda 44%-iT (112, 115). aseve nanaxia, rom wonis
77
kleba da fizikuri aqtioba zomierad amcirebs sisxlSi LDL-C-is
dones da ufro mniSvnelovnad zrdis HDL-C-is da amcirebs TG-
is dones.
Cvens kvlevaSi simsuqne aReniSneboda 57(33,7%) pacients.
sxeulis saSualo wona iyo 84,2±0,9 kg, sxeulis masis indeqsi –
33,2±1,5. dietisa da dozirebuli fizikuri varjiSis Sedegad
simsuqniT avadmyofTa ricxvi Semcirda 24(14,2%)-mde. Cven
SeviswavleT stenokardiisa da ganmeorebiTi infarqtis sixSire
da sikvdiloba simsuqniT pacientebSi da SevadareT es
maCveneblebi normaluri wonis mqone pacientTa monacemebs.
kvlevam aCvena, rom es maCveneblebi sarwmunod gansxvavdeboda am
jgufebSi. aseve sarwmunod naklebi iyo sikvdiloba normaluri
wonis pacientebSi: Sesabamisad 12,4% da 20,8%.
Saqriani diabetiT avadmyofebs 2-4-jer maRali aqvT gid
sikvdilobis riski, vidre diabetis armqone pirebs. am
pacientebSi gul-sisxlZarRvTa daavadebebiT sikvdilis sixSire
50-75%-s warmoadgens. mamakacebSi diabeti gid ganviTarebis risks
2-3-jer zrdis, xolo qalebSi – 3-7-jer. TandarTuli risk-
faqtorebi, rogoricaa dislipidemia, arteriuli hipertenzia da
abdominuri simsuqne xSiria Saqriani diabetiT avadmyofebSi (158,
159).
diabetiT daavadebul mamakacebs gid sikvdilobis
gacilebiT maRali riski aqvT, vidre Tanabari asakis da
erTnairi risk-faqtorebis mqone aradiabetiT mamakacebs (164, 165
). aseve dadgenilia, rom gid sikvdilobis riski diabetiT
avadmyofebSi, romelTac ar gadautaniaT miokardiumis infarqti,
Tanabaria im pirebis riskisa, romelTac ar aqvT diabeti, magram
gadatanili aqvT infarqti.
78
Saqriani diabetiT pacientebSi xSirad aRiniSneba e.w.
`diabeturi dislipidemia~, rac xasiaTdeba Semdegi darRvevebiT:
dabali HDL-C, maRali TG, zomierad momatebuli LDL-C, mcire
zomis LDL nawilakebis da apolipoprotein a-s momateba (76, 125).
Cvens kvlevaSi Saqriani diabeti aReniSneboda 30(17,7%)
avadmyofs. am pacientebSi yvelaze didi sixSiriT gamovlinda
lipiduri cvlis darRveva, gansakuTrebiT gamoxatuli iyo
trigliceridebis momateba da maRali aTerogenobis indeqsi.
aseve xSiri iyo – 63,3% - arteriuli hipertenzia da simsuqne –
56,7%. letalobis Seswavlam aCvena, rom ZiriTadi jgufis 23
gardacvlili avadmyofidan 7(30,4%)-s Saqriani diabeti hqonda,
romelTa Soris 5 qali iyo. saerTo sikvdilobis Sedarebam
aCvena, rom diabetiT avadmyofebSi man Seadgina 23,3%, xolo
danarCen avadmyofebSi – 11,5%.
gid avadobisa da sikvdilobis absoluturi riski asakTan
erTad mkveTrad izrdeba. aSS-Si gid-iT 25 mln pacienti 65 wels
gadacilebulia. prospeqtuli kohortuli kvlevebiT dadgenilia,
rom xandazmul asakSi miokardiumis infarqtTan mWidrod aris
dakavSirebuli asaki, sqesi, sistoluri wneva da sisxlSi
glukozis done. amis sapirispirod, Tambaqo da dislipidemia
xandazmul asakSi naklebad aris dakavSirebuli miokardiumis
infarqtiT sikvdilobasTan. izolirebuli sistoluri
hipertenzia arteriuli hipertenziis yvelaze xSiri formaa
xandazmul asakSi. amitom misi kontroli gid da
cerebrovaskuluri daavadebebis profilaqtikis saSualebas
iZleva (124, 171, 173).
Cvens kvlevaSi pacientebi davyaviT asakobriv jgufebad.
maRal asakobriv jgufSi (70 w-ze zeviT) Warbobdnen qalebi,
79
ufro xSiri iyo Q –kbilovani infarqti, Saqriani diabeti, xolo
axalgazrda asakis pacientebSi Warbobdnen simsuqniT da mweveli
pirebi. gamokvlevis Sedegebma aCvena, rom maRali asakis
pacientebSi yvelaze xSiri iyo aritmiebis, gansakuTrebiT
parkuWovani eqstrasistoliis ganviTareba (17,7%), aseve xSiri iyo
marcxena parkuWis mwvave ukmarisoba (17,7%). am maCveneblebis
sixSire ufro maRali iyo sakontrolo jgufSi, Sesabamisad
22,7% da 40,9%. maRali asakis pacientebSi marcxena parkuWis
mwvave ukmarisobis didi sixSire, rogorc Cans dakavSirebuli
iyo gandevnis fraqciis sawyis dabal sididesTan, riTac aixsneba
am garTulebis maRali sixSire rogorc ZiriTad, ise
sakontrolo jgufSi. asakovan pacientebSi ufro xSiri iyo
postinfarqtuli stenokardia, III da IV fk gulis ukmarisoba
rogorc ZiriTad, ise sakontrolo jgufSi, Tumca sikvdiloba
statistikurad sarwmunod gansxvavdeboda ZiriTad da
sakontrolo jgufebSi. kerZod, ZiriTad jgufSi asakis mixedviT
I jgufSi iyo 9,4%, II jgufSi – 12,2%, III jgufSi – 11,1% da IV
jgufSi – 22,2%. sakontrolo jgufSi Sesabamisad: 20%, 33,3%,
35,7% da 50%. Cveni monacemebi saSualebas gvaZlevs davaskvnaT,
rom didi asakis pacientebSi miokardiumis infarqtis
mimdinareoba xasiaTdeba garTulebebis maRali sixSiriT rogorc
Trombolizisis, ise sakontrolo jgufSi, Tumca Trombolizuri
Terapia am garTulebebis da sikvdilobis Semcirebis saSualebas
iZleva sakontrolo jgufTan SedarebiT.
sqesis, rgorc gid aramodificirebadi risk-faqtoris
Seswavlam aCvena, rom ganviTarebul qveynebSi qalTa
sikvdilobis wamyvani mizezi miokardiumis infarqtia. gid-iT
daavadebul qalebs igive risk-faqtorebi aqvT, rac mamakacebs,
80
Tumca zogierTi mtkicebulebiT, qalebSi ufro xSiria Saqriani
diabeti. trigliceridebis da HLDL-C-s done aseve did rols
asrulebs qalebSi gid0is ganviTarebaSi. epidemiologiuri
kvlevebiT dadgenilia, rom HLDL-C-s 1 mg%-iT momateba 3%-iT
zrdis gid risks qalebSi da 2%-iT – mamakacebSi, xolo
trigliceridebis donis momateba 88,5 mg%-iT gid risks qalebSi
zrdis 76%-iT da 32%-iT – mamakacebSi. aseve 2-3-jer izrdeba gid
riski menopauzis periodSi (53, 154, 166, 170).
Cvens kvlevaSi qalTa da mamakacTa asaki daaxloebiT
erTnairi iyo, wina kedlis infarqti ufro xSiri iyo mamakacebSi.
qalebSi ufro xSiri iyo arteriuli hipertenzia,
hiperqolesterinemia da simsuqne. Trombolizuri Terapiis fonze
miokardiumis infarqtis garTulebebis sixSire mamakacebsa da
qalebs Soris statistikurad ar gansxvavdeboda, Tumca
sikvdiloba ufro maRali iyo qalebSi, rac ganpirobebuli iyo
maTSi arteriuli hipertenziis maRali sixSiriT.
avadmyofebSi letaloba SeviswavleT risk-faqtorebis
saxesa da raodenobasTan kavSirSi, risTvisac pacientebi
davyaviT 4 jgufad. 1 risk-faqtoriT avadmyofTagan ZiriTad
jgufSi 30 dRis ganmavlobaSi arc erTi ar gardacvlila, xolo
5-wliani sikvdiloba 9,5% iyo. sakontrolo jgufSi – 33,3%. 2
risk-faqtoriT avadmyofebSi 30-dRiani sikvdiloba iyo 3,9%, 5-
wliani – 15,7%. am avadmyofebSi yvelaze xSiri risk-faqtori iyo
arteriuli hipertenzia da hiperqolesterinemia. 3 risk-faqtoriT
avadmyofebSi arteriuli hipertenziasa da
hiperqolesterinemiasTan erTad didi iyo mwevelebis raodenoba,
SedarebiT iSviaTi iyo Warbi wona da memkvidruli faqtori. am
avadmyofTa sikvdiloba kidev ufro maRali iyo da 30 dReze
81
Seadgina 8,3%, 5 wlis Semdeg – 15%. 4 risk-faqtoriT
avadmyofebSi Warbobda arteriuli hipertenzia,
hiperqolesterinemia, Tambaqo, Saqriani diabeti. am avadmyofTa 30-
dRiani sikvdiloba iyo 13,5%, 5-wliani – 10,8%.
Trombolizuri Terapiis Catarebis Semdgom periodSi
pirveli wlis ganmavlobaSi 72(42,6%) pacients Cautarda
koronarografia, romelTagan 54 (32%)-s dasWirda stentireba. am
avadmyofTagan umetesoba iyo Saqriani diabetiT, Tambaqos
mwevelebi da aReniSnebodaT gulis ukmarisoba. es monacemebi
saSualebas gvaZlevs davaskvnaT, rom gid risk-faqtorebis
modificireba intervenciuli Terapiis gadavadebis saSualebas
iZleva.
amrigad, am monacemebidan gamomdinareobs, rom asakis da
sqesis gaTvaliswinebis gareSe, miokardiumis infarqtiT
sikvdilobis yvelaze mniSvnelovani risk-faqtori arteriuli
hipertenziaa. qalebSi am faqtors emateba Saqriani diabeti da
sxeulis wona. mamakacebSi sikvdilobis ZiriTadi risk-
faqtorebia arteriuli hipertenzia da Tambaqo. aseve
modificirebadi risk-faqtorebis koreqcia zrdis
Trombolizuri Terapiis efeqturobas rogorc xanmokle, ise
xangrZlivi dakvirvebis periodSi.
82
d a s k v n e b i
1. gid risk-faqtorebis modificireba SesaZleblobas iZleva
Semcirdes daavadebis gamwvavebis sixSire da gaizardos
sicocxlis xangrZlivoba im avadmyofebSi, romelTac ar
CatarebiaT angioplastika an aorto-koronaruli Suntireba.
2. iseT modificirebad risk-faqtorebze zemoqmedeba, rogoricaa
Tambaqos weva, simsuqne, hipodinamia, mkveTrad amcirebs
miokardiumis infarqtis ganviTarebis sixSires, garTulebebsa
da sikvdilobas rogorc Trombolizisis, ise sakontrolo
jgufSi.
3. modificirebadi garegani risk-faqtorebidan yvelaze did da
xangrZliv efeqts iZleva Tambaqos wevis mitoveba, Semdeg
modis sxva garegani risk-faqtorebi. aqedan gamomdinare,
aucilebelia am mimarTulebiT profilaqtikuri RonisZiebebis
gatareba. aseTive xangrZliv remisias iZleva arteriuli wnevis
mudmivi monitoringi ambulatoriul pirobebSi.
4. Trombolizur TerapiasTan erTad arteriuli wnevis, sisxlSi
lipidebis da glukozis donis mowesrigeba sarwmunod
amcirebs miokardiumis infarqtis ganviTarebis sixSires,
garTulebebs da sikvdilobas sakontrolo jgufTan
SedarebiT.
5. Trombolizuri Terapia intervenculi Terapiis alternatiul
meTods warmoadgens, romliTac SesaZlebeli xdeba
miokardiumis infarqtis ganviTarebis gadavadeba an misi zomis
mkveTri Semcireba.
83
6. 32% avadmyofebSi Trombolizisis Semdeg 1 wlis ganmavlobaSi
aucilebeli gaxda intervenciuli Terapia, rac kidev erTxel
adasturebs im faqts, rom Trombolizisi aris Sualeduri
procedura intervenciul mkurnalobamde, magram rogorc
garegani, aseve Sinagani risk-faqtorebis modificireba
intervenciuli Terapiis gadavadebis saSualebas iZleva.
praqtikuli rekomendaciebi
1. miokardiumis mwvave infarqtis dros sikvdilobis riskis
xarisxis da garTulebebis profilaqtikisTvis mizanSewonilia
gid modificirebadi garegani da Sinagani risk-faqtorebis
gamovlena.
2. gid modificirebadi risk-faqtorebis drouli gamovlena da
masze zemoqmedeba saSualebas miscems pacients, `gadaavados~
intervenciuli Terapiuli RonisZiebebi miokardiumis mwvave
infarqtis SesaZlo ganviTarebis, garTulebebisa da
sikvdilobis Semcirebis mizniT.
3. Trombolizuri Terapiis Catarebis Semdeg aucilebelia gid
meoradi profilaqtika ambulatoriul pirobebSi, mimarTuli
risk-faqtorebis modificirebisken.
4. Trombolizuri Terapiis Semdgom gid risk-faqtorebis
modificirebasTan erTad pacientebi aucileblad saWiroeben
koronarografias mkurnalobis meTodis SesarCevad.
84
l i t e r a t u r a
1. gerzmava a, gurgeniZe R. Tambaqos moweva, rogorc socialuri
problema. `sazogadoebrivi jandacvis zedamxedvelobis
sainformacio sistemebis Sesaxeb~ konferenciis masalebi.
Tbilisi, 1996: 45.
2. TaTaraZe r. gul-sisxlZarRvTa daavadebebis prevencia
pirveladi samedicino rgolis praqtikaSi. Tbilisi 1999: 13-59.
3. megrelaZe i., gorgoSiZe m, avaliani S. gulis iSemiuri
daavadebis pirveladi prevencia. Tbilisi 1999:17-22.
4. sumbaZe n. gul-sisxlZarRvTa daavadebaTa risk-faqtorebis
Tavidan acilebis efeqturi zomebis dagegmvisaTvis. `qronikul
daavadebaTa epidemiologia da profilaqtika~ (konferenciis
masalebi. Tbilisi, 1998:36-37.
5. trapaiZe d, sxirtlaZe l, abesaZe T da sxv. brZola Tambaqos,
rogorc arainfeqciur daavadebaTa erTerTi ZiriTadi risk-
faqtoris winaaRmdeg. `qronikul daavadebaTa epidemiologia
da profilaqtika~ (konferenciis masalebi. Tbilisi, 1998:38.
6. uruSaZe r, TaTaraZe r, avaliani n. gul-sisxlZarRvTa da sxva
arainfeqciur daavadebaTa prevenciis strategiis politikis
ganviTareba saqarTveloSi. `qronikul daavadebaTa
epidemiologia da profilaqtika~ (konferenciis masalebi.
Tbilisi, 1998:1-7.
7. qobulia b, burdiSvili b, burkaZe n da sxv. gul-
sisxlZarRvTa ZiriTadi daavadebebis (arteriuli hipertenzia,
gulis iSemiuri daavadeba) prevenciis erovnuli programa.
`qronikul daavadebaTa epidemiologia da profilaqtika~
(konferenciis masalebi. Tbilisi, 1998:42-43.
85
8. qobulia b, CafiCaZe z. Trombinis specifkuri inhibitori
bivalirudinis (hirulongi) Sedareba heparinTan
streqtokinaziT miokardiumis mwvave infarqtis mkurnalobis
dros. HERO-2 randomizebuli kvleva. `gul-sisxlZarRvTa
sistemis daavadebaTa prevenciis, diagnostikis da
mkurnalobis Tanamedrove aspeqtebi~ (konferenciis masalebi).
Tbilisi 2002:9-10.
9. SaraSiZe n, saaTaSvili g. miokardiumis infarqtis Semdgomi
periodis marTva. postinfarqtuli periodis marTva –
reabilitacia da meoreuli profilaqtika. (leqciebis
krebuli, saswavlo-meToduri rekomendacia eqimebisa da
studentebisTvis). Tbilisi, 2002:9-23.
10. xviTaria d, mdivani s, dumbaZe n. gulis iSemiuri daavadebis
prevencia, miokardiumis infarqtis Semdeg cxovrebis stilis
Secvla. postinfarqtuli periodis marTva – reabilitacia da
meoreuli profilaqtika. (leqciebis krebuli, saswavlo-
meToduri rekomendacia eqimebisa da studentebisTvis).
Tbilisi, 2002:23-29.
11. Абина Е.А.,Волож О.И.,Солодкая З.С. и др. Динамика распространенности
ишемической болезни сердца у населения Таллина 30-54 лет с 1984 по 1994
г. Кардиология 1997;6:13-18.
12. АкимоваЕ.В., Гафаров В.В., Драчева Л.В. и др. Изучение
распространенности и интенсивности курения среди взрослого населения
Тюмени с использованием почтового опроса (популяционного
исследования). Тер арх 2000;1:33-35.
13. Алмазов В.А., Чирейкин Л.В., Тожиев М.С. и др. Эффективность первичной
и вторичной профилактики заболеваний сердечно-сосудистой системы в
86
организованных коллективах при исполбзовании автоматизированных
систем. Здравоохр. Рос. Федерации 1993;4:3-5.
14. Балахметова С.А., Жапарханова З.С. Среднее значение показателей
факторов риска ишемической болезни сердца и их процентильные
распределения в алма-атинской популяции мужчин 20-40 лет. Тер арх
991;1:17-20.
15. Блужас Й., Реклайтенс Р., Тамошюнас А.А. и др. Распространенность
ишемической болезни сердца и показатели смертности у населения Каунаса
35-64 лет по данным проспективного исследования. Кардиология 2002;2:72-
75.
16. Валеева Р.М., Лещинский Л.А. Особенности клиники, диагностики и
терапии инфаркта миокарда у лиц старшей возрастной группы. Клин.
геронтол. 2001;7(5-6):53-56.
17. Волож О.И. Мутсо Ю.Х. Распространенность ишемической болезни сердца
и основные факторы риска среди мужчин 35-59 лет в таллине. Кардиология
1984;11:20-24.
18. Волож О.И.. Саава М.Э., Тур И.П. и др. Факторы риска ишемической
болезни сердца и атеросклероза у жителей Таллина: связь с возрастом,
полом, этнической принадлежностью (популяционное исследование).
Кардиология 1991;7:20-24.
19. Гафаров В.В. Эпидемиология и профилактика сердечно-сосудистых
заболеваний в условиях крупного промышленного центра Западной
сибирию Новосибирск. 1992.
20. Гафаров В.В., Виноградова Т.Е., Воеводова М.И. и др. Эпидемиология
ишемической болезни сердца, сосудистых заболеваний головного мозга, их
факторов риска в открытой популяции 25-64 лет Новосибирска. Тер арх
1991;9:80-83.
87
21. Гафаров В.В., Гагулин И.В. Популяционное исследование социально-
психолгических факторв риска ишемической болезни сердца в мужской
популяции Новосибирска. Тер арх 2000;4:40-43.
22. Глазунов И.С. О критериях ишемической болезни сердца в
эпидемиологических исследованиях (эпидемиология артериальной
гипертонии и коронарного атеросклероза). Под ред. И.А. Рывкина. М.
1968;170-176.
23. Дамионаитене Р.А. Баубинене А.В., Кучинскене З.З. Распространенность
ишемической болезни сердца и ее факторов риска и возможность коррекции
последних в условиях организованного контингента. Кардиология
1987;9:101-102.
24. Доборджгинидзе Л.М., Грацианский Н.А., Масенко В.П. и др.
Триглицериды, но не С-реактивный белок независимо связаны с наличием
коронарной болезни сердца у женщин 45-55 лет. Кардиология 2001;4:12-19.
25. Доборджгинидзе Л.М., Нечаева А.С., Грацианский Н.А. Метаболические
факторы риска у женщин с преждевременной ишемической болезнью
сердца. Кардиология 1999;98:31-40.
26. Жуковский Г.С. Основные факторы риска и ИБС у мужчин трудоспосоного
возраста (20-59 лет). Бюл ВКНЦ АМН СССР 1984;1:70-78.
27. Замотаев Ю.Н., Кремнев Ю.А., Мандрыкин Ю.В. Сравнительная оценка
факторов риска ишемической болезни сердца у военнослужащих,
перенесших операцию аортокоронарного шунтирования. Кардиология
2001;8:34-37.
28. Зяблов Ю.И., Округин С.А., Орлова С.Д.Возникновение, течение и
ближайщий исход острого инфаркта миокарда у мужчин и женщин. Клин.
мед. 2001;11Ж26-28.
29. Иванов А.Г., Опалева-СтеганцеваВ.А. Выживаемость больных с острым
инфарктом миокарда. Здравоохр. Рос. Федерации 1991;3:26.
88
30. Калинина А.М., Чазова Л.В., Павлова Л.И и др. Отдаленные результаты
проведения программы многофакторной профилактики ишемической
болезни сердца в Москве (10-летнее наблюдение). Кардиология 1993;4:23-
28.
31. Карпов Р.С., Дудко В.И. Современные проблемы атеросклероза. Врач
2000;2:7.
32. Климов А.Н. Эподемиология и факторы риска ишемической болезни сердца.
Л: Медицина 1989;174.
33. Константинов В.В., Жуковский Г.С. Ишемическая болезнь сердца, факторы
риска среди мужского населения в связи с уровнем образования. .
Кардиология 1996;1:37-41.
34. Константинов В.В., Жуковский Г.С., Жданов В.С. и др. Факторы риска,
ишемическая болезнь сердца и атеросклероз среди мужчин коренной и
некоренной национальности в городах некоторых регионов. Кардиология
1997;6:19-23.
35. Константинов В.В., Жуковский Г.С., Шестов Д.Б. и др. Эподемиология
ишемической болезни сердца и ее связь с основными факторами риска среди
мужского населения в некоторых городах СССР (кооперативное
исследование). Тер. арх.1991;1:11-16.
36. Константинов В.В., Деев А.Д., Капустина А.В. и др. Связь потребления
алкоголя с факторами риска и смертностью от сердечно-сосудистых и
некоторых других хронических неинфекционных заболеваний среди
мужского населения (по материалам одномоментного исследования и 20-
летнего проспективного наблюдения). Кардиология 1998;2:29-36.
37. Константинов В.В., Деев А.Д., Капустина А.В. и др. Распространенность
избыточной массы тела и ее связь со смертностью от сердечно-сосудистых и
других хронических неинфекционных заболеваний среди мужского
населения в городах разных регионов. Кардиология 2002;10:45-49.
89
38. Люсов В.А. Инфаркт миокарда (по материаламактивной речи на заседании
Ученого совета Росийского государственного медицинского университета,
посвященного 100-летнему юбилею П.Е. Лукомского). Кардиология
1999;9:8-12.
39. Малютина С.К. Стенокардия напряжения, выявленная в
эпидемиологическом исследовании, при сопоставлении с результатами
комплекса нагрузочных ЭКГ проб.
40. Мелле Ф., Школьников В.,Эртриш В и др. Современные тенденции
смертности по причинам смерти в России (196501994) Национальный
институт демографических исследований (Париж), Центр демографии и
экологии человека (Москва). INED-27, rue du Commandeur-75675 Paris Cedex
14, 1996;2:140.
41. Никитин Ю.П., Воевода М.И., Максимов В.Н. и др. Распространенность
наследственной отягощенности по ишемической болезни сердца в
неорганизованной популяции Новосибирска и ее связь с этим заболеванием.
Кардиология 2001;4:20-22.
42. Никитин Ю.П., Малютина С.К. Симонова Г.И. и др. Сердечно-сосудистые
заболевания в Сибири (Сибирская МОНИКА). В кн.:Диагностика, лечение и
профилактика сердечно-сосудистых заболеваний. Новосибирск 1996;103-
104.
43. Никитин Ю.П.,Казека Г.Р. Бабин В.П. и др. Распространенность
ишемической болезни сердца у лиц с гиперинсулинемией (популяционное
исследование) Кардиология 2001;1:12-15.
44. Оганов Р.Г. Первичная профилактика ИБС. М: Медицина 1990;158.
45. Оганов Р.Г. Успехи и проблемы профилактики сердечно-сосудистых
заболеваний в конце ХХ века. Профилактика заболеваний и укрепление
здоровья 1998;5:3-9.
46. Оганов Р.Г.Смертность от сердечно-сосудистых заболеваний в России и
некоторые влияющие на нее факторы. Кардиология 1994;3:80-83.
90
47. Оганов Р.Г. Масленникова Г.Я. Сердечно-сосудистые заболевания в
Российской Федерации во второй половине ХХ столетия: тенденции,
возможные причины, перспективы. . Кардиология 2000;6:4-7.
48. Оганов Р.Г., Деев А.Д., Жуковский Г.С и др. Влияние курения на смертность
от хронических неинфекционных заболеваний по результатам
проспективного исследования. Профилактика заболеваний и укрепление
здоровья 1998;3:13-15.
49. Оганов Р.Г., Александрова В.Ю., Суслова Е.А. и др. Динамика
распространенности психосоциальных факторов риска при хронических
неинфекционных заболеваний в 1988-1994гг. Медицинская наука Армении
1997;3(4):165-169.
50. Павлова Л.И., Чазова Л.В., Калинина А.М. и др. Изучение показателей
смертности в программе многофакторной профилактики ишемической
болезни сердца. Тер арх. 1991;1:35-38.
51. Перова Н.В. Суммарный риск ИБС и показания к лечению
гиперхолестеринемии (применение европейских рекомендации 1994 г к
росийским условиям). Кардиология 1996;3:47-53.
52. Плавинская С.Ш. Шестов Д.Б. Связь ряда гормональных показателей с
факторами риска ИБС и ее распространенностью по данным крупного
популяционного исследования. Тер. арх 1995;9:17-21.
53. Плавинская С.Ш., Шестов Д.Б.Сравнительная характеристика смертности
мужчин и женщин от основных сердечно-сосудистых заболеваний по
данным проспективного исследования. Тер арх. 1991;12:69-73.
54. Плавинский С.Л. Повышение уровня продуктов перекисного окисления
липидов как фактор риска смерти в проспективном исследовании. Физиол
человека 2002;1Ж116-20.
55. Роуз Д. Эпидемиологические методы изучения сердечно-сосудистых
заболеваний. ВОЗ (Женева) 1984;207-210.
91
56. Свистов А.С. Галиуллина Р.Х. Обрезан А.Г. Особенности факторов риска
ишемической болезни сердца, данных велоэргометрических проб, суточного
монитирирования ЭКГ и коронарографии у женщин молодого возраста,
перенесших инфаркт миокарда. . Кардиология 2003;3:54-58.
57. Семисотова Е.Ф. Инфаркт Миокарда у людей пожилого и старческого
возраста. Владивосток: Дальнаука; 1994.
58. Тамошюнас А.А., Домаркене С.Б., Реклайтене Р.А. и др. Сравнительная
оценка смертности и заболеваемости ишемической болезнью сердца среди
участников и неучастников популяционного исследования. Кардиология
1989;3:78-81.
59. Тожиев М.С., Воробьев А.М., Цветкова Т.Л. и др. Распространенность
ишемической болезни сердца. ее факторов риска и результаты длительной
многофакторной профилактики заболевания у рабочих и служащих
организованных коллективов. Под ред. В.А. Алмазова, Л.В. Чирейкина. Л
1990;5-10.
60. Тожиев М.С.,Шестов Д.Б. Быков И.Н. и др. Динамика распространенности
сердечно-сосудистых заболеваний и результаты многофакторной
профилактики при многолетних наблюдениях в организованных
коллективах. Тер арх. 2000;1:11-15.
61. Тожиев М.С., Норбеков М.С., Шестов Д.Б. Распространенность
ишемической болезни сердца, основных факторов риска ее развития и
эффективность многолетней многофакторной профилактики на
предприятиях в ряде регионов России. Тер арх. 2004;1:33-37.
62. Трубочева В.В., Жуковский Г.С., Тимофеева Т.Н. Эпидемиологическая
характеристика взрослой (25-64 лет) неорганизованной популяции г. Томска
по распространенности ишемической болезни сердца, основных
модифицируемых факторов риска и уровню информированности. Томск;
2000:192-195.
92
63. Халтаев Н.Г., Жуковский Г.С., Халтаева Е.Д. и др. Возрастная динамика и
распространенности ишемической болезни сердца, артериальной гипертонии
и средний уровень факторов риска у мужчин в возрасте 20-69 лет в связи с
характером питания. Тер арх. 1985;1:17-21.
64. Халтаева У.Д., Халтаев Н.Г. Избыточная масса тела, ишемическая болезнь
сердца и факторы риска. Кардиология 1982;8:11-15.
65. Шальнова С.А., Деев А.Д., Оганов Р.Г . Распространенность курения в
России. Результаты обследования национальной представительной выборки
населения. Профилактика заболеваний и укрепление здоровья 1998;3:9-12.
66. Шестов Д.Б., Деев А.Д., Жуковский Г.С. Итоги 7-летнего проспективного
изучения смертности в выборочных группах мужчин в Москве и
Ленинграде. В кн.: Эподемиология и факторы риска ишемической болезни
сердца. Под ред. А.Н. Климова. Л: Медицина 1989;11-123.
67. Чазова Л.В. Глазунов И.С. Баубинене А.В. и др. Многофакторная
профилактика ишемической болезни сердца (кооперативное исследование).
Бюл Всесоюз кардиол науч центра 1983;1:43-48.
68. Чурина С.К. Притыкина Н.Я. Жуковская Н.Е. Некоторые оссобенности
патогенеза ИБС у женщин до 50 лет (до наступления менопаузы). Тер. арх
1975;12:43-48.
69. Чурина С.К. Особенности патогенеза ишемической болезни сердца у
женщин молодого и среднего возрастс. Л: Наука 1983;133.
70. AHA Scientific Statement Evidence-Vased Guidelines for Cardiovascular Disease
Prevention in Women. Circulation 2004;109:672-693.
71. Alegret JM, Marty V, Rodrigez-Font E et al. Effect of thrombolysis in the
evolution of right bundle-branch block complicationg an acute myocardial
infarction. Acta Cardiol.2001 Oct;56(5):297-301.
72. Allen JK, Young DR, Blumenthal RS et al. Prevalence of hypercholesterolemia
among siblings of persons with premature coronary heart disease. Application of
93
the Second Adult Treatment Panel guidelines. Arch Intern Med 1996;156:1654-
1660.
73. American Heart Association. Heart Disease and Stroke Statistics – 2003 Update.
Dallas, Tex: American Heart Association; 2002.
74. Austin MA.Plasma triglyceride as a risk factor for coronary heart disease : the
epidemiologic evedense and beyond. Am J Epidemiol 1989;129:249-259.
75. Barren-Connor E, Cohn БА, Wingard DL, Edelstein SL: Why is diabetes mellitus
a stronger risk factor for fatal ischemic heart disease in women than in men?
JAMA 265:627-631,1991. 63. USRDS 1995 Annual Data Report: incidence and
causes of treated ESRD. Am J Kidney Dis 26:539-550,1995.
76. Barbir M, Wile D, Trayner I et al. High prevalence of hypertriglyceridemia and
apolipoprotein abnormalities in coronary artery disease. Br. Heart J.
1988;112:432-437.
77. Betterige DJ, Morrell JM. Clinicians ' guide to lipids and coronary heart disease.
London. Neinheim. New York: Chapman and hall medical 1998;276.
78. Bray GA. Obesity increases risk of diabetes. Int J Obesity. 1992;16 (SupplE):513-
7.
79. Brauwald E. Evolution of the management of acute myocardial infarction: a 20th
century saga. Lancet 1998; 352: 1771-4.
80. Castelli WP. Lipids, risk factors and ischemic heart disease. Atherosclerosis.
1996;124(suppl):S1-S9.
81. Castelli WP. The triglyceride issue. A view from Framingem. Am Heart J
1986;112:432-437.
82. Colditz GA, Willet WC, Rotsnitzky A, Manson JE: Weight gain as a risk factor
for clinical diabetes in women. Ann Intern Med. 122:481-486,1995.
83. Conroy RM, Mulcahy R, Hickey N et al. Is a family history of coronary heart
disease an independent risk factor? Br Heart J 1985;53:378-381.
94
84. Cragg D.R., Friedman H.Z., Bonema J.D., Jaiyesimi I.S., Ramos R.G., Timmis
G.C., et al. Outcome of patients with acute myocardial infarction who are
ineligible for thrombolytic therapy. Ann Intern Med 1991;115:173—7.
85. Dangas G, Fier C, Ambrose Ja. Thrombolytic therapy in acute myocardial
infarction. Drugs Today (Barc) 1998 Aug;34(8):727-36.
86. Diethrich EB, Cohan C. Women and heart disease. New York: Ballantine books
1994;314.
87. Dittrich H., Gilpin E., Nicod P., Cali G., Henning H., Ross J. Jr. Acute myocardial
infarction in women: influence of gender on mortality and prognostic variables.
Am J Cardiol 1988;62:1—7.
88. Donnan PT, Boyle DL, Broomhall J et al. Prognosis following first acute
myocardial infarction in Type 2 diabetes: a comparative population study. Diabet
med 2002 Jun;19(6):448-55.
89. Dubois С., Pierard L.A., Albert A., Smeets J.P., Demoulin J.C., Boland J., et al.
Short-term risk stratification at admission based on simple clinical data in acute
myocardial infarction. Am J Cardiol 1988;61:216—9.
90. Eldar M., Sievner Z., Goldbourt U., Reicher-Reiss H., Kaplinsky E., Behar S.
Primary ventricular tachycardia in acute myocardial infarction: clinical
characteristics and mortality. The SPRINT Study Group. Ann Intern Med 1992;
117:31—6.
91. Eschwege E, Richard JL, Thibult N et al. Coronary heart disease mortality in
relation to diabetes, blood glucose and plasma insulin levels. The Paris
Prospective Study, ten years later. Horm Metab Res 1985;15:Suppl:Series:41-46.
92. Evans M, Roberts A, Reese A. The future direction of cholesterol-lowering
therapy. Curr Opin Lipidol. 2002;13:663-669.
93. European Atherosclerosis Society Study Group. Strategies for the prevention of
coronary artery disease: a policy statement of the European Atherosclerosis
Society. Eur Heart J. 1987;8:77-88.
95
94. Europian guidelines of CVD prevention. To improve the quality of clinical
practice and patient care in Europe. Third Joint European Societies Task Force of
Cardiovascular Disease Prevention in Clinical Practice.
95. Fallen E.L., Armstrong P., Cairns J., Dafoe W., Frasure-Smith N., Langer A., et
al. Report of the Canadian Cardiovascular Society's consensus conference on
Management of the Postmyocardial Infarction Patient. Can Med Assoc J
1991;144:1015—25.
96. Fiebach N.H., Viscoli C.M., Horwitz R.I. Differences between women and men in
survival after myocardial infarction. Biology or methodology? JAMA
1990;263:1092—6.
97. Flack JM, Sowers J.R. Epidemiologic and clinical aspects of insulin resistance and
hyperinsulinemia. Am J Med 1991;91(Suppl 1A):11-21.
98. Fleischmann K.E., Goldman L., Robiolio P.A., Lee R.T., Johnson P.A., Cook
E.F., et al. Echocardiographic correlates of survival in patients with chest pain. J
Am Coll Cardiol 1994;23:1390—6.
99. Goldmen L, Phillips KA, Coxcon P et al. The effect of risk factor reductions
between 1981 and 1990 on coronary heart disease incidence, prevalence, mortality
and cost. J Am Coll Cardiol. 2001;38:1012-1017.
100. Gomes J.A., Winters S.L., Stewart D., Horowitz S., Milner M., Barreca P. A
new noninvasive index to predict sustained ventricular tachycardia and sudden
death in the first year after myocardial infarction: based on signal-averaged
electrocardiogram, radionuclide ejection fraction and Holter monitoring.
J Am Coll Cardiol 1987;10:349—57.
101. Gotto AM. Triglyceride as a risk factor for coronary artery disease. Am J
Cardiol 1998;82:9A:22-25.
102. Gordon DJ, Probstfield JL, Garrison RJ et al. High-density lipoprotein
cholesterol and cardiovascular disease: four prospective American studies.
Circulation.1989;79:8-15.
96
103. Grines C.L., Topol E.J., O'Neill W.W., George B.S., Kereiakes D., Phillips
H.R., et al. Effect of cigarette smoking on outcome after thrombolytic therapy for
myocardial infarction. Circulation 1995;91:298—303.
104. Greenberg H., McMaster P., Dwyer E.M. Jr. Left ventricular dysfunction after
acute myocardial infarction: results of a prospective multicenter study. J Am Coll
Cardiol 1984;4:867—74.
105. Grundy SM. Hypertriglyceridemia, insulin resistance and the metabolic
syndrome. Am J Cardiol 1999;83:25F-29F.
106. Grundy SM, Howard B, Smith S Jr et al. Prevention conference VI:Diabetes
and Cardiovascular Disease:executive summary: conference proceeding for
healthcare proffesionals from a special writing group of the American
Association. Circulation 2002;105:2231-2239.
107. Gurwitz J.H., Gore J.M., Goldberg R.J., Rubison M., Chandra N., Rogers W.J.
Recent age-related trends in the use of thrombolytic therapy in patients who have
had acute myocardial infarction. National Registry of Myocardial Infarction. Ann
Intern Med 1996;124:283—91.
108. Haragreaves AD, Logan RL, Elton RA et al. Glucose tolerance, plasma insulin,
HDL cholesterol and obesity:12-year follow-up and development of coronary
heart disease in Edinburg men. Atherosclerosis 1992;94:61-69.
109. Henning H., Gilpin E.A., Covell J.W., Swan E.A., O'Rourke R.A., Ross J. Jr.
Prognosis after acute myocardial infarction: a multivariate analysis of mortality
and survival. Circulation 1979;59:1124—36.
110. Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for
cardiovascular disease independent of high-density lipoprotein cholesterol level: a
meta-analysis of population-based prospective studies. J Cardiovasc Rsk.
1996;3:213-219.
111. Hooper L, Summerbell CD, Higgins JPT et al. Dietary fat intake and
prevention of cardiovascular disease: systematic review. BMJ 2001;322:757-763.
97
112. Hjermann I, Byre KV, Holme I et al. Effect of diet and smoking intervention
on the incidence of coronary heart disease. Lancet.1981;ii:1303-1310.
113. Hjermann I, Holme I, Leren P. Oslo Study Diet and Antismoking Trial: results
after 102 months. Am J Med 1986;80(suppl 2A):7-11.
114. Hsu LF, Mak KH, Lau KW et al. Clincal outcomes of patients with diabetes
mellitus and acute myocardial infarction treated with primary angioplasty or
fibrinolysis. Heart 2002 Sep;88(3):260-5.
115. Jousilahti P, Tuomilehto J, Varianinen E et al. Body Weight, Cardiovascular
Risk Factors and Coronary Mortality . 15-year follow-up of middle-aged men and
women in eastern Finland. Circulation 1996;93:1372-1379.
116. Kandelaki M, Tavadze T, Abashidze M et al. Coronary artery disease absolute
risk development in subsequent decade in Tbilisi population. GMN
2003;12(105:18-20.
117. Kannel WB, Neaton JD, Wentworth DD et al. Overal and coronary heart
disease mortality rats in relation to major risk factors in 325 348 men screened for
the MRFIT. Am Heart J 1986;112:825-836.
118. Kannel WB, Wilson PW. Risk factors that attenuate the female coronary
disease advantage. Arch Intern Med. 1995;155:57-61.
119. Kannel WB. Coronary heart disease risk factors in the elderly. Am J Geriatr
Cardiol. 2002;11:101-107.
120. Keys A. Seven countries: a multivariate analisis of deth and Coronary heart
disease. Cambridge, Massachusetts: Harvard University Press 1980;381.
121. Kipshidze N, Khachidze E, Kakauridze N. Some metabolic risk-factors in
women with arterial hypertension. GMN 2003;12(105):36-38.
122. Kipshidze N, Chaduneli EP, Lobzhanidze TV et al. The vascular wall
functional activity in coronary heart disease in heredity family members. GMN
2003;12(105):20-22.
98
123. Kromhout D, Coulader C, Arntrenius A et al. Changes in body weight and total
cholesterol and their effect on CHD in the Zutpten Study and the leiden
intervention trial. CVD Epidemiol Newslet 1984;35:61.
124. Krumholz H.M. The clinical challenges of myocardial infarction in the elderly.
West J Med 1989;151:304—10.
125. Lamarche B, Tchernof A, Moorjani S et al. Small dense low-density
lipoprotein particles as a predictor of risks of ischemic heart disease. Circulation
1997;95:69-75.
126. Lee K.L., Woodlief L.H., Topol E.J., Weaver W.D., Betriu A., Col J., et al.
Predictors of 30-day mortality in the era of reperfusion for acute myocardial
infarction. Results from an international trial of 41,021 patients. GUSTO-1
Investigators. Circulation 1995;91:1659—68.
127. Leren P. The effect of plasma cholesterol lowering diet in male survivors of
myocardial infarction: a controlled clinical trial. Acta Med Scand Suppl.
1966;466:1-92.
128. Leren P. The oslo Diet-Heart Study; eleven-year report. Circulation.
1970;42:935-942.
129. Lincoff A.M., Califf R.M., Ellis S.G., Sigmon K.N., Lee K.L., Topol E.J.
Thrombolytic therapy for women with myocardial infarction: is there a gender
gap? Thrombolysis and Angioplasty in Myocardial Infarction Study Group. J Am
Coll Cardiol 1993;22:1780—7.
130. Ludwigs U, Csatlos M, Hulting J. Predicting in-hospital mortality in acute
myocardial infarction: impact of thrombolytic therapy on APACHE II
performance. Scand Cardiovasc J 2000 Aug;34(4):371-6.
131. Madsen Е.В., Gilpin E., Henning H. Short-term prognosis in acute myocardial
infarction: evaluation of different prediction methods. Am Heart J
1984;107:1241—51.
132. Manson JE, Willet WC, Sampler MJ et al. Body weight and mortality among
women. N Engl J Med 1995;333:677-81.
99
133. Marchlinski F.E., Buxton A.E., Waxton H.L., Josephson M.E. Identifying
patients at risk of sudden death after myocardial infarction: value of the response
to programmed stimulation, degree of ventricular ectopic activity and severity of
left ventricular dysfunction. Am J Cardiol 1983;52:1190—6.
134. Martin M.J, Hulley SB, Browner WS et al. Serum cholesterol, blood pressure
and mortality: implications from a cohort of 36 16162 men/ Lancet 1986;2:993-
936.
135. Martinez Sandle JL, Gonzales-Juanatery JR, Garcia-Acuna JM et al. Influence
of systemic arterial hypertension on mid-term survival of patients with acute
myocardial infarction treated with fibrinolytic agents. Med Clin (Barc) 1997Oct
25;109(14):532-7.
136. Mauri F, Franzosi MG, Maggioni AP et al. Clinical value of 12-lead
electrocardiography to predict the long-term prognosis of GISSI-1 patients. J Am
Coll Cardiol. 2002 May 15;39(10): 1594-600.
137. Morris R.M., Barnaby P.F., Brandt P.W., Geary G.G., Whitlock R.M., Wild
C.J., et al. Prognosis after recovery from first acute myocardial infarction:
determinants of reinfarction and sudden death. Am J Cardiol 1984;53:408—13.
138. Moss A.J. Prognosis after myocardial infarction. Am J Cardiol 1983;52:667—
9.
139. Mukharji J., Rude R.E., Poole W.K., Gustafson N., Thomas L.J. Jr., Strauss
H.W., et al. Risk factors for sudden death after acute myocardial infarction: two-
year follow-up. Am J Cardiol 1984;54:31—6.
140. Nicolau JC, Auxiliadora Ferraz M, Nogueira PR et al. The role of gender in the
long-term prognosis of patients with myocardial infarction submitted to
fibrinolytic treatment. Ann Epidemiol 2004 Jan;14(1):17-23.
141. Nishimura R.A., Tajik A.J., Shub C., Miller F.A. Jr., Ilstrup D.M., Harrison
C.E. Role of two-dimensional echocardiography in the prediction of in-hospital
complications after acute myocardial infarction. J Am Coll Cardiol 1984;4:1080—
7.
100
142. Nora JJ, Lortscher RH, Spangler RD et al. Genetic-epidemiological study of
early-onset ischemic heart disease. Circulation 1980;61:504-508.
143. Otasevic P, Nescovic AN, Popovic Z et al. Effect of thrombolytic therapy on
occurrence of complex ventricular arrhythmias in the late hospitalization period in
acute myocardial infarct: relation with long-term remodeling of left ventricle.
Vojnosanit Pregl. 2003 Sep-Oct;60(5):547-53.
144. Pavlikova EP, Tereshchenko CN, Karavaeva et al. Thrombolytiv therapy of
acute myocardial infarction in elderly patients. Immediate and long-term remote
prognosis. Kardiologia2002;42(4):12-18.
145. Pedersen TR, Kjekshus J, Berg K, et al. Randomized Trial of Cholesterol
lowering in 4444 Patients with Coronary Heart Disease: The Scandinavian
Simvastatin Survival Study (4S). Lancet 1994; 344: 1383-9.
146. Pilote L, Miller DP, Califf RM et al. Recurrent ischemia after thrombolysis for
acute myocardial infarction. Am Heart J 2001 Apr;14(4):559-65.
147. Prevention of coronary heart disease: Scientific background and new clinical
guidelines. Recommendations of the European Atherosclerosis Society prepared
by the International Task Force for Prevention of Coronary heart disease. Nat
Metab cardiovasc Dis 1992;2:113-156.
148. Prevention of coronary heart disease in clinical practice. Recommendations of
the Task Force of the European Society of Cardiology, European Atherosclerosis
Society and European Society oh Hypertension. Eur Heart J 1994;15:1300-1331.
149. Ribeiro DG, de Andrade PJ, paes J et al. Acute myocardial infarction:
predictors of mortality at a public hospital in the city of Fortaleza. Arq Bras
Cardiol 2003 Jun;80(6):614-20.
150. Risk stratification and survival after myocardial infarction. Multicenter Post-
Infarction Research Group. N Engl J Med 1983;309:321—6.
151. Roncaglioni MC, Santoro L, D'Avanzo B et al. Role of family history in
patients with myocardial infarction. An Italian case-contrl study GISSI-EFRIM
Investigators. Circulation 1992;85:2065-2072.
101
152. Sacks FM, Pfeffer MA, Move LA, et al. The Effect of Pravastatin on Coronary
Events After Myocardial Infarction in Patients with Average Cholesterol Levels.
The Cholesterol and Recurrent Events Trial (CARE). N Engl J Med 1996; 335:
1001-9.
153. Sans S, Kesteloot H, Kromhout D. on benefit of the Task Force. The burden of
cardiovascular diseases mortality in Europe. Task Force of the European Society
of Cardiology on cardiovascular mortality and morbidity dtatistics in Europe. Eur
Heart J 1997;18:1231-1248.
154. Skafar DF, Xu R, Morales J, Ram J, Sowers JR: Female sex hormones and
cardiovascular disease in women. J Clin Endocrinol Metab 82:3913-3918,1997.
155. Silver M.T., Rose G.A., Paul S.D., O'Donnell C.J., O'Gara P.T., Eagle K.A. A
clinical rule to predict preserved left ventricular ejection fraction in patients after
myocardial infarction. Ann Intern Med 1994;121:750—6.
156. Sowers J.R. Obesity and cardiovascular disease. Clinical chemistry
1998;44:1821-1825.
157. Sowers J.R. Ferrow SL. Treatment of elderly hypertensive patients with
diabetes, renal diseaseand coronary heart disease. Am J Geriat Cardiol 1996;5:57-
70.
158. Sowers J.R.Epstein M. Diabetes mellitus and hypertension: an update.
Hypertension 1995;26:869-79.
159. Sowers JR; Diabetes mellitus and cardiovascular disease in women. Arch
intern Med 158:617-621,1998.
160. St. John Sutton M., Pfeffer M.A., Plappert T. Rouleau J.L., Moye L.A.,
Dagenais G.R., et al. Quantitative two-dimensional echocardiographic
measurements are major predictors of adverse cardiovascular events after acute
myocardial infarction. The protective effects of captopril. Circulation 1994;
89:68—75.
102
161. Superco HR, Krauss RM. Coronary artery disease regression. Convincing
evidence for the benefit of aggressive lipoprotein management. Circulation
1994;90:1059-1069.
162. Terol I, Lorenzo J, Quintana E et al. Epidemiological Study and coronary heart
disease and risk factors in 100 men. In: International Conference on Preventive
Cardiology: Moscow 1985;100:Abstr.
163. The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID)
Study Group. Prevention of Cardiovascular Events and Death with Pravastatin in
Patients with Coronary Heart Disease and a Broad Range of Initial Cholesterol
Levels. N Engl J Med 1998; 339: 1349-57.
164. Tikiz H, Tezcan U, hery M et al. Diabetes mellitus adversely affects the
outcomes of thrombolytic therapy in patients with acute myocardial infarction.
Angiology. 2003 Jul-Aug;54(4):449-56.
165. Timmer JR, Ottervanger JP, Thomas K et al. Long-term, cause-specific
mortality after myocardial infarction in diabetes. Eur Heart J 2004
Jun;25(11):926-31.
166. Vaccarino V., Krumholz H.M., Berkman L.F., Horwitz R.I. Sex differences in
mortality after myocardial infarction. Is there evidence for an increased risk for
women? Circulation 1995;91: 1861—71.
167. Van Gaal LF, Wanters T, DeLeeuw IH. The benefical effects of modest weght
loss on cardiovascular risk factors. Int J Obesity 1997;21:5-9.
168. Volpi A., De Vita C., Franzosi M.G., Geraci E., Maggioni A.P., Mauri F., et al.
Determinants of 6-month mortality in survivors of myocardial infarction after
thrombolysis. Results of the GISSI-2 data base. The Ad hoc Working Group of the
Gruppo Italiano per lo Studio della Sopravvivenza nell'infarto Miocardio (GISSI)-
2 Data Base. Circulation 1993;88:416—29.
169. Walsh MF, Domingues LJ, Sowers JR. Metabolic abnormalities in cardiac
ischemia. Cardiol Clin 1995;13:529-38.
103
170. Weaver W.D., White H.D., Wilcox R.G., Aylward P.E., Morris D., Guerci A.,
et al. Comparisons of characteristics and outcomes among women and men with
acute myocardial infarction treated with thrombolytic therapy. GUSTO-I
Investigators. JAMA 1996;275:777—82.
171. Williams MA, Fleg JL, Ades PA et al. Secondary prevention of coronary heart
disease in the elderly (with emphasis on patients ≥75 years of age): an American
Heart Association scientific statement from the Council on Clinical Cardiology
Subcommittee on Exercise, Cardiac Rehabilitation and Prevention. Circulation
2002;105:1735-1743.
172. Winter R, Koster R, Sturk A et al. Value of myoglobin, Troponin T and CK-
MB mass in ruling out an acute myocardial infarction in the emergency room.
Circulation. 1995;92:3401-3407.
173. Wood D, De Backer G, Faergeman O et al. Prevention of coronary heart
disease in clinical practice: recommendations of the Second Joint Task Force of
European and other Societies on Coronary Prevention. Eur Heart J. 1998;19:1434-
1503.
174. Wright RS, Murphy JG, Bybee KA et al. Statin lipid-lowering thrapy for acute
myocardial infarction and unstable angina: efficacy and mechanism of benefit.
Mayo Clin Proc. 2002;23:1931-1937.
175. Yusuf HR, Giles WH, Croft JB et al. Impact of multiple risk factor profiles on
determining cardiovascular disease risk. Prev Med. 1998;27:1-9.
176. Zhang Y.Z., Wang S.W., Hu D.Y., Zhu G.Y. Prediction of life-threatening
arrhythmia in patients after myocardial infarction by late potentials, ejection
fraction and Holter monitoring. Jpn Heart J 1992;33:15—23.