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1 ìïáïîàâåäëì ìïèåæòúòíë èëïèþå ìïèåúíòåîë-ðîïáüòêóäò ýóîíïäò ýóîíïäò æïïîìæï 1922 ùåäì 2 aprili - ivnisi 2005 öïíãòî èïèïäïûå (èàïâïîò îåæïáüëîò) ìïîåæïáúòë êëäåãòï: ë. ãåîçèïâï, ê. ãåäïøâòäò, à. æåêïíëìòûå (èàïâïîò îåæïáüëîòì èëïæãòäå), ô. àëæóï, ã. òëìåäòïíò, ð. êòíüîïòï, â. ìïïêïûå, å. áåèåîüåäòûå, ä. áóîúòêïøâòäò, ç. éóéóíòøâòäò, í. ñòôøòûå, î. øïáïîòøâòäò, ä. øåùòîóäò, ì. õå òíïøâòäò, î. Õåúóîòïíò radiaciuli medicina, onkologia

2 radiaciuli foni wyaltubosi da misi higienuri Sefaseba mosaxleobis onkologiuri daavadebebis ganvitarebis TvalsazrisiT prof. k. gelasvili, prof. r. gagua, r. jorbenaze Tbilisis saxelmwifo samedicino universiteti, a. RvamiCavas saxelobis onkologiis erovnuli centri wyaltubo mdidaria radonis Semcveli miwisqvesa wylebit, romlebic zedapirze gamodis da ateuli wlebis ganmavlobasi gamoiyeneba balneoterapiis miznit. am processi xdeba radonis emanacia garemosi, SenobebSi ian wlebsi samecniero publikaciebsa da monografiebsi, romlebic exeboda radiaciul usafrtxoebas, didi yuradreba daetmo radonis problemas, gansakutrebit mis koncentracias SenobebSi. radoni ariares filtvis kibos gamomwvevad, romelsac, Tambaqos Semdeg, pirveli adgili ukavia am daavadebis sixsiris matebasi. es sakitxi imdenad aqtualuri iyo, rom skandinaviis qveynebsi asi atasobit Senoba daangries, romelta saseni masala momatebuli raodenobit gamoyofda radons [1]. amave wlebsi moxda axladasasenebel da ukve asenebul SenobebSi radonis Semcvelobis normireba, romelmac asaxva hpova Cvens nacionalur sanitariul kanonmdeblobasic [2]. radonis problemis mnisvnelobam ganapiroba amerikisa da evropis qveynebsi, agretve, rusetsi mravalmilioniani da miliardiani dafinansebit specialuri programebis _ `radoni~ Seqmna, romelic exeboda radonis radiaciuli usafrtxoebis sakitxebs. aman ganapiroba isic, rom warsulsi iseti mnisvnelovani samkurnalo metodi, rogoricaa radonterapia, gamocxadebuli iyo rogorc principulad mavne da asaxva hpova gaertianebuli erebis organizaciis atomuri radiaciis moqmedebis samecniero komitetis fundamentur moxsenebasi [3]. ukanasknel wlebsi gacnda publikaciebi, romlebic uaryofs radonterapiit gamowveuli dasxivebis mcire dozebis kancerogenur moqmedebas da, piriqit, Tvlis, rom am dozas axasiatebs e.w. `gormezisi~, anu, garkveul intervalsi dozebi antikancerogenulia da, ufro metic, rekomendebulia Zalzed dabali radiaciuli fonis pirobebsi misi gazrda, vtqvat, radonit balneoterapiis gzit, ris Sedegadac simsivnuri daavadebebis raodenoba mcirdeba (agretve, infeqciurisac), Zlierdeba imuniteti, izrdeba sicocxlis xangrzlivoba, nayofiereba[4,5]. radonis mcire dozis dadebiti moqmedeba (`radiaciuli gormezisi~) aisaxa UNSCAR is 1994 wlis moxsenebasic [6], Tumca saerto azri, romelsac yvela ariarebs, is aris, rom radonit dasxivebis dozis simzlavris (anu drois erteulsi mirebuli dozis) zrdastan ertad, simsivnis gacenis albatoba izrdeba (magalitad, uranis sabadoebsi momusave pirta Soris es daavadeba Zalzed xsiria). radonis `radiaciuli gormezisis~ sawinaarmdegod mravali mecnieri dresac Tvlis, rom maionebeli gamosxivebis mcire doza iwvevs avtvisebiani simsivneebis gacenas, genetikur cvlilebebs, sicocxlis xangrzlivobis Semcirebas, organizmis winaarmdegunarianobis daqveitebas garemos mavne faqtorebis moqmedebis mimart, imunitetis datrgunvas da sxv. [7,8,9,10,11]. amitomac radiologiuri dacvis

3 saertasoriso komiteti (ICRP) nebismieri mcire dozis moqmedebas adamianis organizmze mavned miicnevs (e.w. `uzrvro moqmedebis~ koncefcia). Tumca unda arinisnos, rom es koncefcia, ZiriTadad, ganpirobebulia personalisa da mosaxleobis radiaciuli usafrtxoebis maqsimaluri dacvis uzrunvelsayofad. aseti maqsimalizmi gamomdinareobs iqidan, rom jer kidev araa srulad Seswavlili maionebeli gamosxivebis mcire dozis organizmze moqmedebis mavne efeqti da zustad dadgena sad gadis zrvari mcire dozis `sxivur gormezissa~ da patologiur moqmedebas Soris, dasxivebis simzlavris gatvaliswinebit, jerjerobit Zalian rtulia. yovelive zemotqmulidan gamomdinare, miznad davisaxet Segvedarebina wyaltubos radiaciuli foni da am regionsi arsebuli onkologiuri daavadebebis, gansakutrebit filtvis kiboti daavadebebis sixsire da dagvedgina mat Soris mizez-sedegobrivi kavsiri wels, Cven mier, gazomili iyo wyaltubos gama-radiaciuli foni Ria adgilebsa da SenobebSi (sasualod 95,2 da 117,9 ngr/st Sesabamisad). raime arsebiti gadaxra, saqartvelos danarceni regionebis gama-radiaciul fontan SedarebiT, ar dafiqsirebula (imeretis regionsi _ 100,3 da 107,0 ngr/st, qutaissi _ 6,5 da 126,2 ngr/st), dasavlet saqartvelosi _ 112,4 da 123,9 ngr/st, armosavlet saqartvelosi _ 85,8 da 120,6 ngr/st Sesabamisad [12,13,14]. ar dafiqsirda, agretve, raime mnisvnelovani sxvaoba Ria adgilebisa da Senobebis gama-radiaciul fons Soris, rac arapirdapiri gzit migvanisnebs, rom SenobebSi ar unda iyos radonis marali koncentracia. am gamokvlevebis paralelurad, gavaanalizet, agretve, saqartvelos onkologiuri daavadebebis erovnuli centris statistikuri monacemebi imeretis regionis mosaxleobis filtvis kiboti daavadebianobis Sesaxeb (mtlianad imeretis regioni, qutaisi da wyaltubo). wyaltubos mosaxleobis avtvisebiani simsivneebit yvela avadobis sasualo intensiuri macvenebeli (71,3) statistikurad sarwmunod naklebia imeretisa da qutaisis mosaxleobis avadobis macvenebelze (1,4 da 1,6 jer Sesabamisad). aseve Semcirebulia wyaltubos mosaxleobis filtvis kiboti avadobis sasualo intensiuri macvenebeli ww., igi Seadgens 10,2, anu qutaisis macvenebelze 4,7-iT, xolo imeretis macvenebelze 3,6-iT naklebs, Tumca es sxvaoba statistikurad sarwmuno ar aris (t=1<2). miuxedavad imisa, rom imeretis regionisa da mat Soris qutaisisa da wyaltubos mosaxleoba cxovrobs erti da igive klimatur-geografiul pirobebsi, arian erti etnikuri kutxis mcxovrebni, aqvt erti da igive tradiciebi, Cveulebebi da kvebis Taviseburebebi, ireben erti da igive sasmels da sakvebs, mati avtvisebiani simsivneebit avadoba gansxvavdeba (rogorc qalebsi, ise mamakacebsi) da es gansxvaveba statistikurad sarwmunoa. rac Seexeba wyaltubos mosaxleobis filtvis kiboti avadobis intensiur macvenebels rogorc mamakacebsi, ise qalebsi naklebia qutaisisa da mteli imeretis Sesabamis macvenebelze, magram es gansxvaveba statistikurad sarwmuno ar aris. savaraudoa, rom wyaltubos mosaxleobis avtvisebiani simsivnit avadobis dabali macvenebeli qutaisis (da mteli imeretis) mosaxleobis avadobastan SedarebiT, mxolod filtvis kibos avadobasi gansxvavebit ar aris ganpirobebuli, xolo radiaciuli foni, rogorc ukve arvnisnet, TiTqmis ertnairia imeretis regionsi, qutaissa da wyaltubosi da arsebitad ar gansxvavdeba mteli saqartvelos radiaciuli fonisagan. amdenad, wyaltubos radiaciul fons raime gavlena filtvis kiboti daavadebianobis matebasi ara aqvs. piriqit, SeimCneva tendencia misi klebisaken.

4 amrigad, savaraudoa, rom radonis is koncentracia, romelic aris wyaltubos Ria adgilebsa da SenobebSi, ar iwvevs filtvis simsivnit avadobis matebas. piriqit, arinisneba misi klebis tendencia. ismeba kitxva: xom ar gvaqvs saqme radonis alfagamosxivebis garkveuli dozis `gormezisul~ moqmedebastan? sakitxi metad aqtualuria, sawiroebs Semdgom mizanmimartul gamokvlevasa da analitikur qmedebas. kerzod, usualod wyaltubos Ria adgilebsa da SenobebSi radonis koncentraciis dadgenas da misi biologiuri moqmedebis Sefasebas, mit ufro Tu gavitvaliswinebt literaturasi arsebul minisnebebs, rom radonis dozebs garkveul intervalebsi aqvs e.w. `gormezisuli~ qmedeba [4,5]. p=ä,=ö,% /L -% 0.=ë23K%, åã% ã,ã,å,)å *= %öå *= " " ƒ,!=ƒ",2,åì % *%ë%ã,)å *,. ƒ=k%ëå"=,l = åëå, o!%-. j. cåë=ø", ë,, C!%-. p. c=ã3=, p. d %!Kå =äƒå ŠK, ë, *, L ã% 3ä=! 2"å /L ìåä, ö, *, L 3, "å!, 2å2, m=ö, % =ëü /L öå 2! % *%ë%ã,,, ì. `. c"=ì, ="= hƒ3 å ã=ìì=-!=ä,=ö,% /L -% 0.=ë23K% # %2*!/2/. ìå 2 % 2åL, ƒä=, L!=ƒë, /. =ƒ = å, L, *%2%!/L %*=ƒ=ë " C!åäåë=. C%*=ƒ=2åëåL hìå!å2, *%ã%!åã, % =, ã.j32=,,, " ål c!3ƒ,,. p=ƒ, ö= " C%*=ƒ=2åë. -% = %2*!/2/. ìå 2 % 2åL, C%ìå?å, L å"åë, *=, 2% *% "å % 3*=ƒ/"=å2 = %2 32 2", å "/ %*,. *% öå 2!=ö, L!=ä% = " C%ìå?å,.. o% *%ëü*3 %K?åC!, ƒ = =!%ëü!=ä% = "!=ƒ", 2,, ƒë%*= å 2"å %ã% C!%öå = ëåã*,., K/ë %K!=K%2= 2=2, 2, å *, L ì=2å!, =ë % *%ƒ=k%ëå"=åì% 2, hìå!å2, *%ã%!åã, % =, ã.j32=,,, 0*=ë23K%. r 2= %"ëå % 2=2, 2, å *, ä% 2%"å! %å 3ìå üøå, å C%*=ƒ=2åëåL, 2å, " % 2, %K?åL % *%ë%ã, å *%L ƒ=k%ëå"=åì% 2, " ã. 0*=ë23K%, C%!=" å, þ ã.j32=,,,!åã, % = " öåë%ì. g=k%ëå"=åì% 2ü!=*%ì ëåã*%ã% 2=* å ƒ =, 2åëü % 3ìå üøå =,. %2 2=2, 2, å *, åä% 2%"å! %. p=ä, =ö, % /L -% (*% öå 2!=ö,!=ä% = " "%ƒä3. å, C%ìå?å,.) 0. =ë23k% å "/ƒ/"=å2 C%"/øå, ƒ=k%ëå"=åì% 2, = åëå,!=*%ì ëåã*%ã%; %K =!3, "=å2 ä= å 2å äå ö, * å, å, þ. b/ *=ƒ/"=å2 C!åäC%ë% å, å % C!% "ëå,, œãå!ìåƒ, =B %C!åäåëå /. ä%ƒ!=ä% =. Hygienic assessment of Tskhaltubo radiation background in relationship with oncologic morbidity of population K. Gelashvili, R. Gagua, R. Jorbenadze Gamma-radiation backgrounds of Tskhaltubo open areas and buildings of various functions - have been studied. It is within the range of Imereti region, Kutaisi and the whole Georgia. Differences between radiation background rates of open areas and buildings are small, which obliquely shows, that there are not high concentrations of radon in buildings. Due to the well-known fact, that high concentration of radon causes pulmonary cancers, statistic materials of pulmonary oncomorbidity of Imereti region, Kutaisi and Tskaltubo have been studied. Reduction of oncomorbidity factors in Tskhaltubo as compared with whole region is statistically valid. Pulmonary cancer morbidity is significantly reduced as well, but it is not statistically valid. In conclusion, radiation background of Tskhaltubo does not cause increase of pulmonary cancer morbidity of population. Manifestation of Gormezis of certain doses of radon has been proposed. literatura: k, 2å!=23!=:

5 1. p=ä, =ö,, ä%ƒ/,.--å*2/,!, *. l% *"=,, ƒä. l,!, 1988, 78 2!. 2. radiaciuli usafrtxoebis normebi _ 2000, h.n h%, ƒ,!3þ?åå, ƒë3 å, å. h 2%, *,, K, %ë%ã, å *, å.--å*2/. d%*ë=ä mjd`p ƒ= 1982 ã. cå å!=ëü %L ` =ìkëå, nnm o!, ë% å, å, 2!.220. müþ-i%!* (UNSCEAR, 1982). 4. c3 =!%" h.h., d3k%! *, L `.b. _ o!%këåì/!=ä% %2å!=C,, : C%ëüƒ=, "!åä. b%c!% / *3!%!2%ë%ã,,, -, ƒ, %2å!=C,,, ëå åk %L -, ƒ, å *%L *3ëü23!/. l.: låä, ö, =, p=ƒ3ì%" `.m., c3 =!%" h.h., qåìå %" a.m., aåëå, å" `.~., d3k%" *, L `.b. _ p=ä, =ö, % /L ã%!ìåƒ,,!=ä% %2å!=C,,!=ä% %C!%-, ë=*2, *= ƒ=k%ëå"=åì% 2,. b%c!. *3!%!2%ë%ã,,, -,ƒ, %2å!=C,,, ëå åk %L -, ƒ, å *%L *3ëü23!/, 2001, 15, h%, ƒ,!3þ?åå, ƒë3 å, å. h 2%, *,,.--å*2/, %, ƒ,!3þ?åã%, ƒë3 å,. d%*ë=ä mjd`p ƒ= 1994 ã. cå å!=ëü %L ` =ìkëå, nnm. müþ-i%!* (UNSCEAR, 1994). 7. jål!, ì-l=!*3 h.a. _ n %Kå % 2, ë3 å"%ã% *= öå!%ãå åƒ= 3 åë%"å*= C!, ì=ë/. ä%ƒ=., ì=ë%l ì%? % 2, ä%ƒ/. p=ä, =ö. K, %ë. p=ä, %.*%ë%ã,, 1998, 38, 15, båc."=äƒå m.p., cåë=ø", ë, j.d., j, ë=äƒå m.`. _ o% ëåä 2", )å! %K/ë *%L ="=!,, äë c!3ƒ,,, Cå! Cå*2, "/.C, äåì, %ë%ã, å *,., ëåä%"=, L. II ìå ä3 =!ëä = *% -. n2äåëå /å ìåä, ö, **, å C% ëåä 2", )å! %K/ëü *%L *=2= 2!%-/. j, å", f, ëå *% l.h., tåä%!%" l.b. _ q% 2%, å ƒä%!%"ü Kå!åìå /.,!%ä, ëü, ö, %"%!% äå /. " 3 ë%",. "%ƒäål 2", ì=ë/. ä%ƒ!=ä, =ö,,. `*3øå! 2"%, ã, å*%ë%ã,. 1999, xå" å *% b.`. _ q%"!åìå /å C!%Këåì/ %öå *, ã, ã, å, å *%ã%!, *= %Kë3 å, åë%"å*=. p=ä, =ö.k, %ë%ã,. p=ä, %.*%ë., 2000, 40, 15, *3K%" *, L-kå *, L ~.n., j=ëü, ö*, L q.`. _ r!%"å ü!=ä, =ö, % %ã%!, *= C!,, C%ëüƒ%"=,,, %, ƒ,!3þ?åã%, ƒë3 å, " ìåä, ö, å, `mph, 2004, 13, 2! cxovrebaze i., xvedelize g. _ imeretis regionis Ria adgilebis radiaciuli foni. Jur. `mkurnali~, 2000, #2-3 (31-32), gv gelasvili k., cxovrebaze i., xvedelize g. _ imeretis regionis mosaxleobis garegani dasxiveba Senobebis (sacxovrebeli, samrewvelo, sayofacxovrebo) radiaciuli fonit. Black-Sea Countries III International Conference `Advances of Clinical and Theoretical Medicine and Biology~ _ konferenciis masalebi, 2001, wyaltubo, gv gelasvili k., vefxvaze n., xazaraze r., cicqisvili m., giorgobiani m., siwinava z., melqaze T. _ mosaxleobis radiaciuli usafrtxoebis aqtualuri sakitxebi saqartvelosi. I erovnuli konferencia, 2001 w., Tbilisi, gv qirurgiuli daavadebebis gamovlineba nawlavta infeqciebis ganyofilebasi infeqciuri sneulebebi, qirurgia doc. a. xabazi, T. qvelize, e. xabazi Tbilisis saxelmwifo samedicino universitetis infeqciur sneulebata katedra. infeqciis, patologiis, Sidsisa da klinikuri imunologiis centri mwvave qirurgiuli daavadebebis adreuli diagnostikis didi mnisvneloba sayoveltaodaa cnobili. amastan, qirurgiuli daavadebisa da nawlavta infeqciis SeuRleba artulebs diagnostikas da xsirad saeqimo Secdomis mizezi xdeba (1,3,4). miznad davisaxet Segveswavla qirurgiul daavadebata gamovlinebis mdgomareoba nawlavta infeqciebis ganyofilebasi diareit Sepyrobil avadmyofta Soris. am

6 miznit, gavaanalizet ganyofilebasi gatarebuli 345 avadmyofis avadmyofobis istoria. mat Soris 29-s (8,46%) qirurgiuli daavadebis diagnozi daesva. mati ganyofilebasi mirebis diagnozebi iyo: savaraudo infeqciuri warmosobis diarea, salmonelozi, Sigelozi, amebiazi. mimrebsi arc ert SemTxvevaSi ar yofila gamotqmuli ewvi SesaZlo qirurgiuli daavadebis Sesaxeb, garda ertisa, roca mimreb ganyofilebasi ewvi miitanes apendicitze. avadmyofebs stacionarsi daudgindat Semdegi qirurgiuli daavadebebi: msxvili nawlavis simsivne _ 9-s (31%); RviZlis abscesi _ 5-s (17,2%); gauvaloba _ 4-s (14,76%), mwvave muceli _ 4-s; apendiciti _ 2-s, TiTo-TiTos: nawlavidan sisxldena, adneqsiti, sasvilosnos gareorsuloba, naadrevi msobiaroba. avadmyofta Soris mamakaci iyo _ 16 (55,18%), qali _ 13 (44,82%). asaki: weli _ 9, weli _ 5, weli _ 6, 71 wlisa da metis _ 9. sul xansisesuli iyo 15 (51,32%) avadmyofi. e. Suvalovas monacemebit, Sigelozis diagnozit stacionarsi motavsebul avadmyofta 1/3-Si dgindeba msxvili nawlavis simsivnis arseboba. Cveni masalis mixedvit, msxvili nawlavis simsivnem 8,4% Seadgina, e.i. yoveli me-12, 13-e SemTxveva. gamomgzavni da mimrebi ganyofilebis diagnozis sxvaobis mizezebi daavadebis anamnezis arasruli Sekreba da klinikuri gamokvlevaa. avadmyofebs, romeltac ramdenime Tvis xangrzlivobis diareis anamnezi aqvt, ar CatarebiaT iseti savaldebulo gamokvlevebi, rogoricaa reqtoromanoskopia an TiTiT gasinjva. SecdomaTa mizezia, agretve, avadmyofta asakis gautvaliswinebloba (simsivnit 9 avadmyofidan 6 iyo 70 welze meti asakis). rac Seexeba sisxlis saerto analizis cvlilebebs (leikocitozi, acqarebuli eds) gamoxatuli iyo 80%-Si. 1_6 Tvis ganmavlobasi diarea arenisna 7 avadmyofs. diarea-yabzobis monacvleoba, sisxliani defekacia, mkurnalobis araefeqturoba aucilebels xdida Catarebuliyo instrumentuli gamokvleva. ert SemTxvevaSi avadmyofs anamnezsi hqonda, 4 wlis win, operacia msxvili nawlavis simsivnis gamo. or SemTxvevaSi muclis palpaciit isinjeboda warmonaqmni-konglomerati. masalis klinikuri analizi gvicvenebs, rom droze Sekrebili sruli anamnezi, yvela simptomis gamovlena, gamomgzavn da mimrebis eqimebs sasualebas miscemda swori diagnozis dasmasi da pacientisatvis drouli qirurgiuli daxmarebis aucileblobis mirebasi. rceba STabeWdileba, rom gamomgzavni eqimebi am misias infeqciur stacionars akisreben, TviTon ar urrmavdebian diareis genezs. amrigad, saqme gvaqvs subieqturi faqtorebit gamowveul SecdomasTan. apendiciti gavrcelebuli da kargad Seswavlili daavadebaa. miuxedavad amisa, 2 SemTxvevaSi igi gamomgzavni da mimrebi ganyofilebis eqimta Secdomis mizezi gaxda. literaturis monacemebit, apendicitis mimdinareobis dros diarea 2%-Si gvxvdeba (3,4). arsanisnavia, rom apendicitis diagnozi, orive SemTxvevaSi, stacionarsi daisva pirveli otxi saatis ganmavlobasi da avadmyofebi gadayvanil iqnen qirurgiul stacionarsi. RviZlis amebur abscesze 5 SemTxvevaSi ewvi ar iyo mitanili gamomgzavni da mimrebi ganyofilebis mier, 2-Si gamogzavnis diagnozi iyo nawlavta amebiazi, TiTo SemTxvevaSi _ Sigelozi da virusuli hepatiti. ert SemTxvevaSi mimrebsi ewvi gamoitqva abscesis arsebobaze, danarcenebsi swori diagnozi me-3-7 dreze daisva. yvela SemTxvevaSi Catarda eqoskopuli gamokvleva. ar iyo gatvaliswinebuli RviZlis gadideba, simzimis SegrZneba da tkivili marjvena ferdqvesa aresi, cxeleba da oflianoba xangzlivad, ert kviraze meti xnis ganmavlobasi. virusuli hepatitis diagnozit gamogzavnil avadmyofs arenisneboda sklerebis subiqteriuloba da RviZlis zomasi momateba masin, roca RviZlis funqciuri sinjebi normis farglebsi iyo. yvela SemTxvevaSi RviZlis abscesis mkurnaloba 5-7 drit dagvianda. amis mizezi daavadebis klinikuri nisnebis Seufasebloba da

7 laboratoriuli, instrumentuli kvlevis Sedegebis lodini gaxda. arsanisnavia epidemiologiuri situaciis gautvaliswineblobac. cnobilia 1998 wlis amebiazis epidafetqeba TbilisSi. rac Seexeba mwvave muclisa da nawlavta gauvalobis diagnostikas, igi sakmaod rtulia, xolo ginekologiuri daavadebebi, roca igi diareit mimdinareobs Zalian xsiradaa diagnostikuri Secdomis mizezi, gansakutrebit adneqsiti (salpingooforiti). Cven SemTxvevaSi es daavadeba hospitalizaciis me-2 dres gamovlinda. nawlavuri infeqciis ganyofilebasi qirurgiuli daavadebebis gamovlineba da avadmyofta gadayvana profilur stacionarsi pirvel 4 saatsi moxda 6 SemTxvevaSi, 24 saatsi _ 7, 72 saatsi _ 3, 4-5 dresi _ 4, 7-8 dresi ki 2 SemTxvevaSi. arsanisnavia, rom gadayvanili avadmyofebidan arc ert SemTxvevaSi ar moxsnila Cveni dasmuli diagnozi. miuxedavad imisa, rom avadmyofta gamokvlevis metodebi mnisvnelovnadaa gazrdili, qirurgiuli daavadebebis gamovlineba diareit Sepyrobil avadmyofta Soris mainc gaznelebulia. amave ganyofilebasi ( ww) nawlavta infeqciebis diagnozit gamogzavnil avadmyofta Soris msxvili nawlavis simsivne gamovlinda 82 SemTxvevaSi (1). rogorc Cans, nawlavta simsivnis diagnostikasi Secdomebi kvlav xsiria. dasvebuli Secdomebis analizi ki gvicvenebs, rom igi ZiriTadad dakavsirebulia klinikur-instrumentuli gamokvlevebis arasrulad gamoyenebastan an kvlevis Sedegebis arasatanadod SefasebasTan. ZiriTadad ki eqimta dabali, profesiuli donitaa ganpirobebuli. eqimi valdebulia aqtiurad ezebos daavadebis simptomebi, Seagrovos monacemebi daavadebis Sesaxeb. es, martalia, rtulia, magram aucilebelia imisatvis, rom Tavidan avicilot Secdomebi, avadmyofi ki vixsnat mosalodneli sasisroebisagan. amrigad, diareit mimdinare qirurgiuli daavadebebi xsirad dagvianebit gamovlindeba, amitom pacientebi droulad ver ireben Sesabamis daxmarebas. qirurgiuli daavadebis mimdinareoba da gamosavali ki swored misi gamovlenis droitaa gansazrvruli. b/ "ëå, å.,!3!ã, )å *,. ƒ=k%ëå"=, L " %2äåëå,, *, øå) /., -å*ö, L d%ö. `. u=k=ƒ,, Š. j"åë, äƒå, }. u=k=ƒ, j=-åä!=, -å*ö, % /. K%ëåƒ ål Šclr, 0å 2!, -å*ö, % %L C=2%ë%ã,,, qohd=, *ë,, å *%L, ìì3 %ë%ã,, 0 åëü, ëåä%"=, - *ë,, å *, L = =ë, ƒ "/ "ëå /. " %2äåëå,, *, øå /., -å*ö, L.,!3!ã, å *,. ƒ=k%ëå"=, L. hƒ3 å % 345, 2%!, L K%ëåƒ,. m=! ä3 *ë,, *%-ë=k%!=2%! /ì,,!å 2ãå %ë%ã, å *, ì,, ëåä%"=, ì,, C!%"%ä, ë, ü!å*2%!%ì= % *%C, å *, å, -, K!%*%ë% % *%C, å *, å,..% *%C, å *, å, ëåä%"=,. b/ "ëå % 29.,!3!ã, å *,. ƒ=k%ëå"=, L: %C3.%ëü 2%ë 2%L *, ø*, -9, =K öå Cå å, -5, åc!%.%ä, ì% 2ü *, øå, *= - 4, % 2!/L, "%2-4, =CCå ä, ö, 2-2, " åì=2% = Kå!åìå % 2ü, =ä å*, 2, C!å!"= = Kå!åìå % 2ü, %K% 2!å, å.!%, å *%ã% C= *!å=2, 2= # C% %ä %ì3 K%ëü %ì3. a%ëü /å

8 C% 23C=ë, " %2äåëå, å ä, =ã %ƒ%ì: ä, =!!å, =ìåk, =ƒ, ø, ãåëëåƒ, =ëüì% åëëåƒ (Kåƒ C%ä%ƒ!å, =.,!3!ã, å *, å K%ëåƒ, ). ` =ë, ƒ ì=2å!, =ë= C%*=ƒ=ë, 2% C!,, %L C%ƒä åã% "/ "ëå,.,!3!ã, å *,. K%ëåƒ ål "ë å2 :.%ä 2"%! ä=, ìc2%ì%" *, øå /., -å*ö, L, å*%2%!/..,!3!ã, å *,. K%ëåƒ ål; å", ì=2åëü % 2ü "!= ål C!, %öå *å = =ì åƒ=,,ìc2%ì%" K%ëåƒ ål;, ã %!,!%"=, å %KA ƒ=2åëü /. ìå2%ä%" %K ëåä%"=, (!å*2% *%C,, *%ë% % *%C,, C=ëüöå"%å, ëåä%"=, å), åc%ë %å %K ëåä%"=, å, C%, å, å Kä, 2åëü % 2, "!= ål * % 2!/ì.,!3!ã, å *, ì K%ëåƒ ì. Revealing of surgical diseases in the department of intestinal infections A. Khabazi, T. Kvelidze, E. Khabazi The aim of the investigation is clinical analysis of the revealed surgical diseases taking place in the department of intestinal infections. 345 medical cards were investigated. Clinical-laboratory and X-ray investigations as well as rectoromanoscopic, fibrocolonoscopic and ultrasound examinations were performed. The following 29 cases of surgical diseases: cancer of the large intestine - 9, liver abscess - 5, intestinal obturation - 4, appendicitis 2 and also single cases of the following nozologies: extrauterine pregnancy, adnexitis, interrupted pregnancy, exacerbation of the chronic pancreatitis were revealed. All patients were admitted to the hospital with the following diagnosis: diarrhea, amebiasis, shigellosis, salmonollosis - without any signs of the surgical diseases. The analysis of the materials showed that the cause of the late surgical manifestations were: resemblance of some intestinal infections and surgical diseases; lack of the doctors attention while filling the history of the patients and assessment of symptoms of the diseases; ignorence of some necessary methods of investigation (rectoscopy, colonoscopy, bimanual examination), incomplete investigation and relax of doctors vigilance to severe surgical diseases. literatura: k, 2å!=23!=: 1. xabazi a., burwulaze p., kvitaisvili g., jafarize g. _ saqartvelos samedicino moambe, #6, 1991, gv a%ã%ì%ë%" a.o., ä!. _ n =ëüì% åëëåƒ åì Cå!, 2%, 2å. jë. ìåä. 19,1992, c%ã, e.e. _ Šå!. =!.. 14, 1990, ; 4. x3"=ë%"= e.o. _ nø, K*, " ä, =ã % 2, *å, -. K%ëåƒ ål, k., bavsvta infeqciebi bavsvebsi qlamidiuri infeqciit

9 ganpirobebuli reaqtiuli artritis klinikurlaboratoriuli Sefaseba m. grigorasvili, med.mecn.doqt. m. Jvania Tbilisis saxelmwifo samedicino universitetis pediatriuli klinika, pediatriasi specializaciis katedra saxsrebis antebit daavadebebs Soris mnisvnelovani adgili ukavia reaqtiul artrits (rea), romelic imunokompleqsuri daavadebaa. reaze laparakoben masin, rodesac artriti dakavsirebulia romelime konkretul infeqciastan an gamomwvev agenttan [1]. termini `reaqtiuli artriti~ pirvelad 1969 wels Semoitanes finelma mecnierebma P. Ahvonen-ma, K. Aho da K. Sievers-ma gadatanili iersiniozuli infeqciis fonze ganvitarebuli steriluri artritis arsanisnavad [3]. mis xsir gamomwvevad urogenitaluri infeqcia itvleba, romelta Soris patogenobit Chlamydia trachomatis gamoirceva [2]. reas klinika polimorfizmit, xsiri recidivebit, progresirebadi mimdinareobita da araisviatad qronizaciit xasiatdeba. Cveni dakvirvebis qves imyofeboda 1-15 wlamde asakis 130 avadmyofi (70 gogona, 60 vaji). yvelas arenisneboda reiteris triada (r.t.). avadmyofebma momartes klinikas daavadebis dawyebidan 3 Tvidan 2 wlamde. pirveladi mcdari diagnozebi iyo; revmatizmi (7,6%), iuveniluri revmatoiduli artriti (9,6%), iridocikliti (1,5%). Tavidanve Cven mier 81% SemTxvevaSi swored iyo dasmuli reas diagnozi. avadmyofebma, gamorceulad, artritis gamo, momartes klinikas. upiratesad arinisneboda qveda kidurebis msxvili saxsrebis asimetriuli dazianeba, kuntebis hipotrofiisa da e.w. dilis SeboWilobis grznobit. daavadebis pirvel nisanta Soris gamovlinda muxlis (57,6%), idayvis (19,2%), menj-barzayis (11,5%), mxris (7,6%) saxsrebis antebiti cvlilebebi. saxsrebis dazianebis analizma gvicvena, rom daavadebis dasawyissi, statistikurad sarwmunod (P<0,001) xsirad dafiqsirda monoartrituli dazianeba (57,6%) oligoartrittan (42,3%) SedarebiT. klinikuri suratis sruli Camoyalibebis Semdeg, saxsrebis dazianeba, ZiriTadad, oligoartrituli xasiatis iyo (61,5%), monoartrituli 38,4% SemTxvevaSi gvxvdeboda. rentgenologiuri monacemebis analizit, daavadebis dasawyissi ZiriTadad arinisneboda epifizuri osteoporozi (32%) da rbili qsovilebis zomasi momateba (65%). mogvianebit rbili qsovilebis SeSupebisa da osteoporozis sixsiris matebastan ertad (P<0,01), wvrili kistozuri warmonaqmnebi (6,1%) da sasaxsre zedapiris Seviwroeba (19,2%) arinisna. reas dros, saxsrovan sindromtan ertad, yuradrebas ipyrobda sxva klinikuri nisnebic. zogjer fiqsirdeboda zogadinfeqciuri sindromi (temperaturuli reaqcia da intoqsikaciis nisnebi), romelic vlindeboda ara marto daavadebis dasawyissi, aramed misi klinikuri suratis sruli gaslis fazasic. mas upiratesad zomieri xasiati hqonda da ZiriTadad fiqsirdeboda reas mwvave dasawyissi. temperaturuli reaqcia arinisna 30 SemTxvevaSi (23%) da ZiriTadad atarebda subfebrilur xasiats. reas dros kanis dazianeba keratodermiis saxit gamovlinda 3 SemTxvevaSi (2,3%). piris Rrus lorwovani garsis dazianeba stomatitis saxit arinisneboda daavadebis mwvave dasawyissi (60%). vegetatiuri nervuli sistemis dazianeba

10 gamovlinda jer kidev daavadebis dasawyissi (mwvave _ 35,1% da qvemwvave _ 38,9%) agznebis, Zilis darrvevisa da zogadi datrgunvis sindromis saxit. reas dros, gul-sisxlzarrvta sistemis dazianeba daavadebis mwvave dasawyissi (65%) gamoikveta sinusuri aritmiis (30%), sinusuri taqikardiis (15%) saxit, rac 20% SemTxvevaSi klasificirdeboda rogorc ararevmatuli karditi. gansakutrebuli yuradreba eqceoda kuw-nawlavis traqtis patologias, romelic, daavadebis rogorc mwvave dasawyissi, aseve mimdinareobisas, avadmyofta naxevars (50%) arenisneboda. nawlavuri disfunqcia vlindeboda 35%-Si, gastriti, qolecistiti, koliti arenisneboda avadmyofta 14%-s, limfadenopatia, hepatosplenomegalia _ 50% SemTxvevaSi mwvave mimdinareobisas. saxsrovani sindromis ganvitarebas xsirad win uswrebda Tvalisa da Sard-sasqeso organoebis dazianeba. Tvalis dazianeba vlindeboda koniunqtivitis (100%) da iridociklitis (1,5%) saxit. urogenitaluri sistemis dazianeba arenisneboda yvela avadmyofs da vlindeboda Semdegi simptomebit: diurezuli movlenebi, sasqeso organoebidan gamonadeni da qavili. klinikuri nisnebis paralelurad, Seswavlil iqna laboratoriuli macveneblebi. damaxasiatebeli iyo leikocitozi 10,97±5,19; CxirbirTviani neitrofilebis mateba 7,36±4,42 da e.d.s acqareba 23,92±11,38. sisxlis bioqimiuri macveneblebidan arinisna antistreptolizinis titris (430,41±139,14) mateba. sisxlsi momatebuli iyo antiqlamidiuri antisxeulebis IgA (1,94±1,50); IgM (1,74±0,92); IgG (1,77±1,48) titri. Cven SeviswavleT reati daavadebulta imunologiuri statusi. vlindeboda yvela avadmyofis limfocitebis saerto raodenobis Semcireba. upiratesad gamoxatuli iyo T ujredovani sistemis disfunqcia, rac mdgomareobda supresor ujredta (CD8) momatebuli aqtivobis fonze helperta (CD4)-(27,07±1,16) donis datrgunvit (CD4/CD8)-(1,09±0,12). aseve darrveuli iyo neitrofielbis fagocituri aqtivoba, gamoxatuli arasruli fagocitozit. gazrdili iyo leikocitta spontanuri stimulirebis macvenebeli (NBT testi), rac ertxel kidev adasturebs infeqciuri procesis arsebobas. humoruli imunitetis mxriv darrveva upiratesad sisxlis plazmasi IgA (0,81±0,48); IgM (1,25±0,73); IgG (6,60±3,03) donis daqveitebit vlindeboda. mirebuli monacemebi natlad metyvelebs, rom reati daavadebulebsi infeqciuri patologiis ganvitareba mimdinareobda helper ujredta donisa (P<0,001) da neitrofilebis fagocituri aqtivobis datrgunvit (P<0,001), rac savaraudoa daavadebis gaxangrzlivebisa da qronizaciis mizezad SeiZleba CaiTvalos. reas mkurnalobis Tanamedrove principi itvaliswinebs makroliduri jgufis antibiotikebis (bolo Taobis preparatis - vilprafenis), antebis sawinaarmdego arasteroiduli preparatebis (movalisi, feldeni), imunomakoregirebeli (ronkoleikini) da mravalmxrivi simptomuri sasualebebis gamoyenebas. arnisnuli mkurnalobis fonze 130 avadmyofidan 45 arenisna reas erti gamwvaveba, 85-is daavadeba mimdinareobda talriseburad da hqonda progresirebuli xasiati, mtlianobasi 120 avadmyofsi mirweuli iyo remisia saxsrovani komponentis likvidaciit (dakvirvebis xangrzlivoba 3 wlamde). amjamad or avadmyofs arenisneba reas aqtiuri mimdinareoba. amgvarad, miuxedavad imisa, rom rea polisistemuri, progresirebuli daavadebaa, drouli adekvaturi Terapia izleva myari remisiis mirebis sasualebas.

11 jë,, *%-ë=k%!=2%! =.=!=*2å!, 2, *=!å=*2, " %ã% =!2!, 2=.ë=ì, ä, %ƒ %L.2, %ë%ã,, 3 äå2ål l. c!, ã%!=ø", ë,, ä%*2.ìåä. =3*. l. f"=, j=- åä!= Cåö, =ë, ƒ=ö,, C% Cåä, =2!,, Šclr nk ëåä%"=, å 130 äå2ål!å=*2, " /ì =!2!, 2%ì C%*=ƒ=ë%, 2% ƒ=k%ëå"=, å.=!=*2å!, ƒ3å2 C!%ã!å,!3þ?, ì 2å å, åì C%ë,, 2åì /ì, C!% "ëå, ì,. l, øå üþ C!,!å=*2, " %ì =!2!, 2å "ë å2 3 2=" %L, ä!%ì. kå å, å!å=*2, " %ã% =!2!, 2= "*ëþ =å2 C!, ìå å, å = 2, K, %2, *%" ã!3cc/ ì=*!%ë, ä%", å*%!2, *% 2å!%, ä /. C!%2, "%"% C=ë, 2åëü /.,,ìì3 %*%!!, ã,!3þ?,.!åä 2", = 2=* å ì %ã% 2%!% þþ, ìc2%ì=2, å *3þ 2å!=C, þ. m= -% å C!%"åäå %ã% ëå å,,ƒ 130 K%ëü / %2ìå =ë= ü ë, øü %ä = "%ë = ƒ=k%ëå"=,. r 85 äå2ål!å=*2, " /L =!2!, 2.=!=*2å!, ƒ%"=ë "%ë %%K!=ƒ /ì C!%ã!å,!3þ?, ì 2å å, åì. b öåë%ì K%ëü /. ä% 2, ã 32= 2%L*=!åì,, (äë, 2åëü % 2ü =Këþäå, ä% 3 ëå2) ë, *", ä=ö, ål 3 2=" %ã%, ä!%ì=. b = 2%?åå "!åì 3 ä"3. K%ëü /. %2ìå =å2 =*2, " %å 2å å, å ƒ=k%ëå"=,. qëåä%"=2åëü %, "%å"!åìå = =äå*"=2 = 2å!=C, ä=å2 "%ƒì% % 2ü ä% 2, ã 32ü 2%L*%L!åì,,, C!,!å=*2, " %ì =!2!, 2å. Clinical and laboratory estimation of reactive Arthritis of Chlamydial etiology among children M. Grigorashvili, M. zhvania Observational data on the 130 children with reactive arthritis give an opportunity to conclude that the disease is characterized by progressive course, polysistemic manifestation. Joint syndrom represents the scoff organ. Treatment of reactive arthritis includes macrolide antibiotics, NSAID, immunocorrecting agents and multilateral symptomatic therapy. Against the background of the treatment only one wave of illness attack was marked in 45 children out of 130 ones. In 85 children reactive arthritis is characterized by waved progressive course. In 120 patients resistant remission (prolongation of observation nearly three years) by liquidation of joint syndrome was achieved. Nowadays two patients have active flows of the disease. By this means, despite the fact that reactive arthritis is polisistemic progressive disease, contemporary adequate therapy gives possibility to reach the stable remission. literatura: k, 2å!=23!=: 1. h"=ø*, b. Š., q3ë2= %" b. j. _ n 2!/å =!2!, 2/, " ƒ= /å, -å*ö, ål. jë,. ìåä. 1989, N2, q%!%*=ë=2 ~. b., d, ì, 2!%"= m. `., n %K3ä*, L h. `.,, ä!. _ jë,, *%-ä, =ã % 2, å *, å = Cå*2/!å=*2, " /. =!2!, 2%" 3 äå2ål. Šåƒ, / ä%*ë=ä%" IV b å %þƒ %ã% üåƒä=!å"ì=2%ë%ã%". l, *, 1991, Aho K., ahvonen P., Sievers K. _ Akta Rheum Seand. 1969, v. 15, p profesiuli daavadebebi

12 avadoba puris warmoebis musata Soris prof. v. saakaze, n. kverencxilaze, m. cimakurize n. maxvilazis saxelobis Sromis medicinisa da ekologiis samecniero-kvleviti instituti erovnuli meurneobis konkretul sawarmosi musata Sromis pirobebis da, Sesabamisad, mati janmrtelobis mdgomareobis gaumjobeseba miirweva kompleqsuri gamajansarebeli RonisZiebebis danergvit [2]. janmrtelobis calkeuli macveneblis Taviseburebebis formirebaze, Sromis konkretuli pirobebis gavlenis dasadgenad, fartod gamoiyeneba kvlevis kompleqsuri metodebi, kerzod, avadoba Sromis droebiti uunarobit [3]. puris warmoebis profesiuli faqtorebis musata organizmze moqmedebis Sedegad ganvitarebuli cvlilebebis xasiatisa da intensiurobis gamovlenisa da kompleqsuri Sefasebis miznit, Catarda musata janmrtelobis mdgomareobis samedicino-statistikuri gamokvleva musata droebiti Sromisuunarobis wlebis masalis analizis safuzvelze. gamovlinda, rom Seswavlili warmoebis musata avadobis saerto done e.k.m%2*, - is [4] mier mowodebuli skalis safuzvelze, SemTxvevaTa ricxvis mixedvit, Sefasdeba rogorc sasualoze dabali, xolo moavade pirta ricxvis, Sromisuunarobis dreebis ricxvisa da erti dabali, SemTxvevis sasualo xangrzlivobis mixedvit - rogorc sasualoze marali. martalia, avadobis ZiriTadi macveneblebi marali ar aris, magram mnisvnelovnad aremateba sakontrolo jgufis monacemebs. kerzod, moavade pirta ricxvi yovel 100 momusaveze Seadgens 50,4 (P<0,002), SemTxvevaTa ricxvi - 75,4 (P<0,005), xolo Sromisuunarobis dreta raodenoba ,3 (P<0,05). mirebuli Sedegebis SedarebiT, 90-iani wlebis dasawyissi, analogiur sawarmoebsi Catarebuli gamokvlevebis monacemebtan [1], gamovlinda avadobis saerto donis mnisvnelovani (1,6-1,9-jer) Semcireba, rac sazogadoebis ganvitarebis Tanamedrove mdgomareobis specifikuri TaviseburebebiT aixsneba, ris Sedegadac mkvetrad Semcirda samedicino dawesebulebebsi mimartvianoba. avadobis yvelaze marali done arinisneba orcxobilas saamqrosi, sadac yovel 100 momusaveze registrirdeba 130,7 SemTxveva da 1524,4 Sromisuunarobis dre. mnisvnelovania avadobis done, agretve, ZiriTad saamqrosic, sadac arnisnuli macveneblebi Seadgens 77,5 SemTxvevas da 1150,4 dres. am dones garkveulad CamorCeba qartuli puris saamqro. arsanisnavia, rom 3 wlis monacemebit, avadobis yvelaze dabali done gamovlinda warmoebis administraciasi dasaqmebulta Soris (10,8 SemTxveva da 208,4 Sromisuunarobis dre). mtel warmoebasi avadobis done qalta Soris ufro maralia rogorc SemTxvevaTa ricxvis (96,7), ise Sromisuunarobis dreebis mixedvit (1235,2). mamakacta kontingents Soris es macveneblebi Sesabamisad Seadgens 50,5 da 602,2. gansakutrebit maralia avadobis done orcxobilis saamqrosi momusave qalta Soris (140,2 SemTxveva da 1653,6 Sromisuunarobis dre). aqve unda arinisnos, rom warmoebis administraciis

13 momusaveta avadobis intensiur macveneblebsi amgvari mkvetri sqesobrivi diferenciacia ar arinisneba. avadobis intensiuroba yovel 100 momusaveze yvelaze dabalia 1-5 wlis stajis jgufsi. musaobis stajis matebastan ertad, arinisneba avadobis saerto donis zrda, romelic maqsimums wlamde stajis mqone pirebsi arwevs (imatebs 1,8-jer). rac Seexeba avadobis analizs asakobrivi jgufebis mixedvit, arsanisnavia, rom mkvetrad gamoxatuli korelacia asakis matebasa da avadobis donis cvlilebebs Soris, gamoxatuli ar aris da talrisebri cvlilebit xasiatdeba. warmoebis momusave kontingentsi yvelaze metad gavrcelebulia e.w. meteotropuli daavadebebi, rogoricaa gripi da mwvave respiratoruli daavadeba, angina, bronqiti, faringiti, traqeiti, gava-welis mwvave radikuliti, nevriti, agretve, gul-sisxlzarrvta sistemis daavadebebi, romelta xvedriti wili avadobis struqturasi Seadgens 53,5%-s SemTxvevaTa ricxvis mixedvit da 41,7%-s Sromisuunarobis dreta mixedvit. am daavadebebis garda, mnisvnelovnadaa momatebuli RviZlis, sanarvle gzebisa da sayrden-mamozravebeli aparatis daavadebebis raodenoba. ZiriTadi da sakontrolo jgufis avadobis struqtura SemTxvevaTa ricxvis monacemta mixedvit, statistikurad sarwmunod gansxvavdeba ertmanetisagan - X2=16,92 22,63 (X20,05=15,23). rac Seexeba puris warmoebis musata faqtiurad da ganmeorebit moavade pirta macveneblebs, unda arinisnos, rom sasualod 3 wlis monacemebit moavade pirta ricxvi warmoebis musata saerto ricxvis 50,4%-s Seadgens, rac 5,7-jer aremateba sakontrolo jgufis macvenebels. moavade qalta xvedriti wona (54,8%) mnisvnelovnad maralia moavade mamakacta xvedrit wonastan (38,7%) SedarebiT. ganmeorebit moavade pirta Sorisac qalta avadobis macveneblebi aremateba mamakactaakontingentis jeradobas. amrigad, avadobis masalis analizit, askarad ikveteba sawarmoo-profesiul faqtorta garkveuli roli mat formirebasi. Catarebuli gamokvlevebis safuzvelze SemuSavda gamajansarebel RonisZiebaTa kompleqsi. g=k%ëå"=åì% 2ü!=K%),..ëåK%Cå*=! %ã% C!%, ƒ"%ä 2"= o!%-. b.o. q==*=äƒå, m.p. j"å!å )., ë=äƒå, l.o. 0, ì=*3!, äƒå mhh ìåä, ö, / 2!3ä=,.*%ë%ã,,, ì.m.h. l=.", ë=äƒå hƒ3 å / 3 ë%", 2!3ä=, % 2%, å ƒä%!%"ü!=k%,..ëåk%cå*=! %ã% C!%, ƒ"%ä 2"=. o!%= =ë, ƒ,!%"= / ì=2å!, =ë/ ƒ=k%ëå"=åì% 2, "!åìå %L 32!=2%L 2!3ä% C% %K % 2, ƒ= Cå!, %ä ãã. nk?, L 3!%"å ü ƒ=k%ëå"=åì% 2, %*=ƒ=ë å"/ %*, ì,.%2 " % %" %L ã!3ccå, % " å å " 5,0-7,0!=ƒ= C!å"/ø=å2

14 = =ë%ã, /å ä= /å *% 2!%ë. }2%2 3!%"å ü C% 2åCå % C%"/ø=å2 C% ìå!å 3"åë, å, "%ƒ!= 2=,, % %Kå %, 2= =!=K%2/. b = 2 % 2,, C% ìå!å 3"åë, å, 2= = - " 1,8!=ƒ. r!%"å ü ƒ=k%ëå"=åì% 2, "/ %*, ìå % 3!=K%,. % %" %L ã!3cc/ åkë=ã%c!, 2 /ì, 3 ë%", ì, 2!3ä= (3 ã!3ƒ, *%" # " 1,4!=ƒ= "/øå %K?åC!%, ƒ"%ä 2"å %ã% C%*=ƒ=2åë, " 7,2!=ƒ= "/øå C%*=ƒ=2åë *% 2!%ëü %L ã!3cc/). j%ë, å 2"% K%ëåþø,. ë, ö " 5,7!=ƒ= "/øå " % %" %L ã!3ccå. b 2!3*23!å ƒ=k%ëå"=åì% 2, "åä3?åå ìå 2% ƒ=, ì=þ2 2.. ìå2å%2!%c /å K%ëåƒ,, % 2="ë þ?, å 53,5% %2 " å. ë3 =å", 41,7% %2 " å. ä ål å2!3ä% C% %K % 2,. q2!3*23!a ƒ=k%ëå"=åì% 2, % %" %L, *% 2!%ëü %L ã!3cc 2=2, 2, å *, ä% 2%"å! %%2ë, =å2 ä!3ã %2 ä!3ã= (X2=16,92 22,63). p=ƒ!=k%2= / *%ìcëå* /å %ƒä%!%", 2åëü /å ìå!%c!, 2,. Morbidity of Workers of Bakery Production V. Saakadze, N. Kverenchkhiladze, M. Tsimakuridze The conditions of work and state of health of workers of the bakery production was studied. The data of morbidity with temporary disability during years was analysed. The common level of morbidity appeared to be mot so high, though in the main group it was nevertheless 5,0 7,0 times higher than analogous data of the controle. As the age and especially length of service of workers in increased this level progressively increases. The level of morbidity is rather high mainly among workers of the main group with unfavourable conditions of work. Meteorotropic diseases take the leading place in the structure of morbidity. The structure of morbidity of the main and controle groups statistically, reliably differes from one another X2=16,92 22,63 (X20,05=15,23). Complex sanitation measures are formulated. literatura: k, 2å!=23!=: 1. CxaiZe n., wereteli m., javaxaze r. da sxv. _ sawarmoo gaertianeba `Tbilpuris~ musata Sromis pirobebis da janmrtelobis mdgomareobis Seswavla. n. maxvilazis sax. Sromis higienisa da profdaavadebata s/k institutis angarisi. Tbilisi: gv. 2. b=!ë=ì%" c.b. _ o%"/øå, å.--å*, " % 2, C!%-å, % =ëü %ã%%2k%!=* äå 2åëü % 2, ".* 2!åì=ëü /. 3 ë%",.: `"2%!å-. ä,. *= ä. ìåä. =3*. l.: låä, * b.`. _ g=k%ëå"=åì% 2ü = åëå, :, 2%!,, %"!åìå %å % 2%, å, ìå2%ä%ë%ã,,ƒ3 å,. # l.: låä, ö, = m%2*, e.k. _ nk 3ãë3Këå %ì = =ë, ƒå ä= /. ƒ=k%ëå"=åì% 2, "!åìå %L å2!3ä% C% %K % 2üþ. c, ã., = c puris warmoebis musata janmrtelobis mdgomareoba saqartvelosi med. mecn. kand. r. javaxaze, n. kverencxilaze, prof. v. saakaze, m. cimakurize n. maxvilazis saxelobis Sromis medicinisa da ekologiis samecniero-kvleviti instituti erovnuli meurneobis dargebs Soris, Sromis medicinis TvalsazrisiT, metad mnisvnelovania puris warmoeba [2]. saqartvelos klimatur-geografiul pirobebsi

15 Catarebulia samusaoebi puris warmoebis musata Sromis pirobebisa da janmrtelobis mdgomareobis Sesaxeb [1]. sakitxis aqtualobidan gamomdinare, kompleqsuri gamajansarebeli RonisZiebebis SemuSavebis miznit, saqartvelos klimatur-geografiuli pirobebis gatvaliswinebit, SeviswavleT saqartvelos puris warmoebis musata Sromis pirobebis SesaZlo gavlena janmrtelobis mdgomareobis formirebaze. warmoebis pirobebsi gamokvleuli iyo Tbilisis puris 3 sawarmos 300 musa (240 ZiriTadi da 60 sakontrolo jgufi). praqtikulad janmrteli armocnda warmoebis ZiriTadi jgufis musata naxevarze meti (56,2%), xolo sakontrolo jgufsi 1,3-jer meti (73,3%). klasikuri profesiuli daavadeba, gamowveuli marcvleulisa da fqvilis mtvrit, kerzod, alergozi, Seswavlil kontingentsi ar gamovlinda. askarad gamoikveta daavadebis ori jgufi, romelic dakavsirebulia ZiriTadi profesiis musebis saqmianobastan da warmoebis teqnologiuri procesebit ganpirobebul samusao operaciebtan. am daavadebebs miekutvneba: 1. gulsisxlzarrvta sistemis patologia - 2,3-jer ufro xsiria sakontrolo jguftan SedarebiT; mat Soris hipertoniuli daavadeba _ 4,7-jer ufro xsiria; 2. nervuli sistemis daavadebebi _ nevrasteniuli sindromisa da gava-welis radikulitis saxit _ 1,2-jer ufro metad. sagulisxmoa, rom am daavadebata ricxvi izrdeba rogorc asakis, ise musaobis stajis zrdis paralelurad. miuxedavad amisa, ar SeiZleba ugulebelyofa Cven mier dadgenili faqtisa, rom ZiriTad jgufsi gamovlenili sxva mravali daavadebis SemTxvevaTa raodenobrivi zrdis msgavsi kanonzomieri kavsiri asakisa da samusao stajis matebis paralelurad ar vlindeba. es sawyisi argumentia, romelic imaze miutitebs, rom unda veziot garkveuli mizezobrivi kavsiri gamovlenil gul-sisxlzarrvta da nervuli sistemis patologiasa da ZiriTadi jgufis musebis Sromis pirobebs Soris. meore argumenti imasi mdgomareobs, rom SedarebiTi analizisas gamoikveta arnisnuli ori sistemis daavadebebis zrda asakisa da stajis matebis paralelurad, magram ricxobrivi monacemebis SedarebiTi analizi cxadyofs, rom umetes SemTxvevaSi stajis matebis gavlena ufro Warbobs asakis matebis Sedegad mirebul raodenobriv matebas. mtavari argumenti ki is aris, rom rogorc hipertoniuli daavadebebit, ise nevrasteniuli sindromita da gava-welis radikulitit daavadebul pirta raodenoba, udavod, Warbobs im profesiebis adamianebsi, romelta Sromis pirobebi dakavsirebulia iset profesiul mavne faqtorebtan, romelta moqmedeba arnisnuli daavadebebis CamoyalibebaSi sayoveltaodaa cnobili. saxeldobr, jer kidev 1976 wels, pirvelad saqartvelosi, arwerili iyo simptomuri hipertoniis axali forma marali sawarmoo temperaturis gavlenit [3]. arteriuli hipertonia puris warmoebis profesiis, upiratesad, im musebs gamouvlindat, romelta organizmze marali temperatura moqmedebs 37 SemTxvevidan 27 (73%) merumele iyo, romelta organizmze, marali temperaturis garda, uaryofit gavlenas axdenda infrawiteli gamosxiveba. mat samusao zonasi haeris temperatura 39,80C arwevda (dasasvebi norma 290C), gansakutrebit qartuli puris cxobis processi. swored amitom aris, rom arnisnuli 27 merumeledan 12 (45%) qartuli puris cxobaze iyo dakavebuli. marali temperaturis pirobebsi, Warbi oflis gamoyofis gamo, organizmsi vitardeba eleqtrolituri disbalansi, irrveva Tirkmlebis parcialuri funqcia da yalibdeba arteriuli hipertenzia.

16 puris warmoebasi analogiuri SemTxvevebi specialur literaturasi arwerili ar aris. migvacnia, rom Cven mier mirebuli Sedegebi Semdgomi mizanmimartuli kvlevis gagrzelebas sawiroebs. Seswavlili warmoebis sxva profesiebis musebic ZiriTadi samusaoebis warmoebisas imyofebian araxelsayrel mikroklimatur pirobebsi, magram es faqtori mat samusao processi naklebi intensiurobit xasiatdeba. temperaturul faqtortan ertad, mat organizmze gavlenas axdens sxva mavne profesiuli faqtorebi, rogoricaa sawarmoo xmauri (ZiriTadi saamqros memanqane), mzime fizikuri datvirtva da musaobis dazabuli ritmi (ZiriTadi saamqros operatori da qartuli puris saamqros comis gamsleli). am profesiebis musebis fiziologiuri statusis gamokvlevit (arsebuli higienuri normatiuli dokumentis safuzvelze) dadginda, rom mati Sroma mzime kategorias miekutvneba, rac xels uwyobs gamoxatuli nevrasteniuli sindromisa da vegetatiur-sisxlzarrvovani distoniis ganvitarebas, romlis ert-erti klinikuri varianti hipertoniuli tipit mimdinareobs. nervuli sistemis patologia ki upiratesad im profesiis musebsi gamovlinda, romelta Sroma dakavsirebulia mzime fizikur datvirtvastan, samusao operaciebis maral temptan da Sromis ertgvarovan, monotonur xasiattan, rac xels uwyobs nevrasteniuli sindromisa da gava-welis radikulitis ganvitarebas. dabolos, daskvniti argumenti Cveni mosazrebisa imasi mdgomareobs, rom ZiriTadi jgufis musebis organizmsi gamovlenili funqciuri Zvrebi da SromisuunarobiT mimdinare avadobis macveneblebi savsebit adasturebs gul-sisxlzarrvta sistemisa da nevrologiuri patologiis siwarbis kavsirs am musebis profesiul saqmianobastan. amdenad, sruli safuzveli arsebobs imisa, rom puris warmoebis ZiriTadi profesiebis musebsi gamovlenili arteriuli hipertonia, nevrasteniuli sindromi da gava-welis radikuliti ganvixilot, rogorc e.w. profesiit ganpirobebuli daavadebebi. sakitxi imis Sesaxeb, warmoadgens Seswavlili profesiis musebsi arteriuli hipertonia daavadebas sui generis, Tu simptomur hipertonias, specialur mizanmimartul gamokvlevas sawiroebs. kvlevis am etapze, arteriuli wnevis monitoringis samedicino dokumentaciis gaanalizebisa da damatebiti instrumentul-funqciuri gamokvlevis Sedegebis safuzvelze, Cven mier gamovlenili patologia ganvixilet, rogorc profesiit ganpirobebuli hipertoniuli daavadeba. profpatologiuri kvlevis Sedegebi safuzvels izleva damatebiti gamajansarebeli rekomendaciebisatvis, rogoricaa Seswavlili warmoebis musebs Soris vitaminizebuli mwvane Cais sasmeli rejimis danergva, mzime SromiTi operaciebis sruli avtomatizacia, Sromisa da dasvenebis racionaluri rejimis dacva, sawarmoo pauzebisa da varjisebis danergva, profilaqtikuri samedicino gasinjvebisas mizandasaxuli dispanseruli kontroli. arnisnuli daavadebebis gamovlenisas sawiroa yuradrebis gamkacreba e.w. `profpatologiuri sifxizle~ da sxva. q% 2%, å ƒä%!%"ü!=k%),..ëåk%cå*=! %ã% C!%, ƒ"%ä 2"= c!3ƒ,,

17 *= ä. ìåä. =3* p.d. d ="=.=äƒå, m.p. j"å!å )., ë=äƒå, C!%-. b.o. q==*=äƒå, l.o. 0, ì=*3!, äƒå mhh ìåä, ö, /,.*%ë%ã,, 2!3ä=, ì.m.h. l=.", ë=äƒå q öåëüþ 3 2= %"ëå, ƒ=*% %ìå! % 2, "ë,, C!%, ƒ"%ä 2"å %-C!%-å, % =ëü /. -=*2%!%" " -%!ì,!%"=,, % 2%, ƒä%!%"ü!=k%,. C!%"åäå % %%2"å2 2"3þ?åå *ë,, *%--3 *ö, % =ëü %å, ëåä%"=, å!=k%,..ëåk%cå*=! /. C!%, ƒ"%ä 2" ã. ŠK, ë,,. r 2= %"ëå %, 2%*%ìCëå* åkë=ã%c!, 2 /. C!%, ƒ"%ä 2"å %-C!%-å, % =ëü /. -=*2%!%" %*=ƒ/"=å2 "ë,, å =% %Kå % 2, % 2%, ƒä%!%"ü!=k%,.. b % %" %L ã!3ccå!=k%,. "/ "ëå %" 1,3!=ƒ= ìå üøå C!=*2, å *, ƒä%!%"/. ë, ö. b 2!3*23!å ƒ=k%ëå"=, L C!%-C=2%ë%ã, å *%L 2% *, ƒ!å, %C!åäåë, ë, ü ä"å ã!3cc/ C=2%ë%ã,, # å!äå %- % 3ä, 2%L (" 2,3!=ƒ= =?å), å!" %L, 2åì (" 1,2!=ƒ= =?å),!=ƒ", 2,å *%2%!/. 2å % " ƒ= % *% *!å2 /ì, 3 ë%", ì, 2!3ä=!=K%,. % %" /. C!%-å, L. o!%-å, % =ëü /L ãå åƒ.2,. ƒ=k%ëå"=, L C%ä2"å! ä=å2 -=*2%ì,. 3 =?å,, =, K%ëåå %2 å2ë, "%C% ìå!å 2= =!=K%2/. jë,, *%-ã, ã, å, å *, å C=!=ëëåë, C%ƒ"%ë þ2 %2 å 2,.2, C=2%ë%ã,, * ã!3ccå C!%-å, % =ëü % %K3 ë%"ëå /. ƒ=k%ëå"=, L. p=ƒ!=k%2= /!å*%ìå ä=ö,, C%ä=ëü åløåì3 3ë3 øå, þ 3 ë%", L 2!3ä=, % 2%, ƒä%!%"ü!=k%,.. The Health Condition of workers in the bakery production in Georgia R. Djavakhadze, N. Kverenchkhiladze, V. Saakadze, M. Tsimakuridze Appropriate clinical and functional examination of the workers of bakery productions for stipulating conformity of the effect of productional and professional factors in formation of health condition of workers was carried out. It was stated that complex of unfavourable productional and professional factors adversely affects health condition of workers. In the structure of the diseases from prophylactic and pathologic point of view two groups of pathology cardiovascular and nervous systems were defined the development of which is closely associated with particular conditions of labour of workers of the main professions. Clinical and hygienic parallels permit to classify these pathologies as the group of professionally determined diseases. Professional genesis of these diseases are confirmed by the fact of their frequency, more distinctly according the length of service. The recommendations for further improvement of the workers health and their working conditions in the factory are worked out. literatura: k, 2å!=23!=: 1. saakaze v., yurasvili m., kvanwaxaze g. da sxv. _ puris warmoebis musata Sromis pirobebi da janmrtelobis mdgomareoba. samecn. SromaTa krebuli. Tbilisis sax. samedicino universiteti. t. XXXII, Tbilisi, 1996, gv c å!ø*%", c.l., målì= n.a. _ c, ã, å, å *= %öå *=3 ë%", L 2!3ä=!=K%,. =.ëåk%ƒ="%äå. j!=2*, å 2åƒ, / ä%*ë=ä%" XIV m=3 %-C!=*2,. *% -å!. "!= ål q}q kå, ã!=ä=. k.: 1975.c q="", ä, u.j., q==*=äƒå b.o., p=2 å! m.`. _ n %"%L -%!ìå, ìc2%ì=2, å *%L =!2å!, =ëü %L ã, Cå!2%,,. qk. =3. 2!3ä%" c!3ƒ,. mhh ã, ã. 2!3ä=, C!%-ƒ=K%ë.ŠK, ë,,: c

18 amoniumis gvarjilis warmoebis musata Sromis pirobebi doc. d. zurasvili, m. cimakurize, e. maisuraze n. maxvilazis saxelobis Sromis medicinisa da ekologiis samecniero-kvleviti instituti konkretuli sawarmos Sromis pirobebis Seswavla musata janmrtelobis pirobebis gaumjobesebisaken mimartuli RonisZiebebis SemuSavebis safuzvelia [1], rac Tavis mxriv, rogorc samedicino, ise socialur-ekonomikuri problemebis [3] gadawyvetis sasualebaa. erovnuli meurneobis dargebidan metad mnisvnelovania qimiuri mrewveloba, romelic xasiatdeba sawarmoo garemosa da SromiTi procesis faqtorebis mravalferovnebit [2,4]. amoniumis gvarjilis warmoeba, romelic rustavis `azotis~ SemadgenlobaSi funqcionirebs, Sromis medicinis TvalsazrisiT, sruliad Seuswavlelia. Cveni kvlevis mizans warmoadgenda amoniumis gvarjilis sawarmos musata Sromis pirobebis Seswavla, rata gagverkvia musata janmrtelobis mdgomareobaze sawarmoo faqtorebis gavlenis xarisxi, xasiati da SegvemuSavebina satanado gamajansarebeli RonisZiebebi. Catarebuli higienuri gamokvlevebis safuzvelze davadginet, rom amoniumis gvarjilis warmoebis musata Sromis pirobebi xasiatdeba sawarmoo garemosa da SromiTi procesis araxelsayreli faqtorebis kompleqsis arsebobit, rac garkveul gavlenas axdens momusaveta Sromisunarianobasa da janmrtelobis mdgomareobaze. amoniumis gvarjilis mirebis mteli teqnologiuri cikli mimdinareobs daxuruli sqemit, zogierti operacia vakuumis pirobebsi.aamdenad, warmoebis teqnologiuri

19 gadawyveta higienuri TvalsazrisiT misarebia. amastan, arinisneba calkeuli naklovaneba, rac xels uwyobs sawarmoo garemosa da SromiTi procesis araxelsayreli faqtorebis formirebas, romeltagan wamyvania samusao zonis haersi warmoebis teqnologiur processi gamoyenebuli toqsikuri nivtierebebis momatebuli Semcveloba. kerzod, azotmjavas ortqlisa da azotis oqsidebis Semcveloba ZiriTad samusao adgilebze 1,8-2,4-jer aremateba zdk-s. haeris temperaturis sasualo macveneblebi normis dasasvebi sidideebis farglebsia, magram misi meryeobis zeda sazrvari mnisvnelovnad aremateba dasasveb sidides. imis gamo, rom warmoebis teqnologiuri procesi ar Txoulobs sitbos pirvelad wyaroebs, sawarmoo satavsebsi haeris temperaturis macveneblebi ZiriTadad imeorebs gare atmosferuli haeris temperaturis parametrebs. misi mciredit (2-30C) momatebuli parametrebi, gare atmosferostan SedarebiT, aixsneba warmoebis ZiriTadi teqnologiuri procesis Sesrulebisas sawarmoo arwurvilobidan sitbos generaciit. arnisnuli garemoebis gamo, umravles samusao adgilze, haeris temperatura C-s arwevs haeris mozraobis dabali sicqaris fonze. SefardebiTi tenianobis sidideebi sxvadasxva samusao adgilze met-naklebi identurobit xasiatdeba da ZiriTadad imeorebs am teritoriistvis damaxasiatebel parametrebs. misi minimaluri macveneblebi normis optimaluri sididis qveda zrvarzea an umnisvnelod (2%-iT) naklebia masze. xmauris done calkeul samusao adgilze aremateba zrvrulad dasasveb dones. kerzod, bgeris gansakutrebit momatebuli done - 89 dba registrirdeba neitralizaciis ganyofilebasi, rac 9 dba-it aremateba zdd-s. aseve maralia misi done saboloo produqtis calobiti SefuTvis ubanze 81 dba, rac 1 dba-it aremateba zdd-s. bgeriti wnevis sidide xasiatdeba SedarebiTi mudmivobit da speqtris yvela diapazonsi met-naklebad Tanabari gadanawilebit. neitralizaciis ubanze bgeriti wnevis done momatebulia 3-11 db-it sasualo da marali sixsiris diapazonsi ( hc); SefuTvis ubanze misi momateba 1-2db-iT registrirdeba dabali da sasualo sixsiris ( hc) diapazonsi. samusao adgilis vibracia (zogadi) zdd-s 1-5 db-it aremateba SefuTvis ganyofilebasi da transportirebis ubanze, neitralizaciis ubanze ki _ 1 db-it 31,5 hc sixsiris diapazonsi. warmoebis yvela ZiriTadi profesiis musas (mtvirtavi, SemfuTveli, meaparate, operatori) sawarmoo operaciebis Sesruleba uxdeba sxeulis izulebit mdgomareobasi (fexze dgomit, damjdari, sxeulis win da gverdebze gadaxrit da sxv.); amastan, SromiTi procesi sakmaod intensiuria - faqtiuri musaobis xangrzlivoba meryeobs samusao dris 66,7-89,6% farglebsi. zemoarnisnulidan gamomdinare, SegviZlia davaskvnat, rom rustavis `azotis~ amoniumis gvarjilis warmoebis sawarmoo garemos faqtorebis Seswavlis Sedegad gamovlinda mravali araxelsayreli faqtori, romelic uaryofit gavlenas axdens momusaveta Sromisunarianobasa da janmrtelobis mdgomareobaze. Catarebuli gamokvlevebis safuzvelze SemuSavda Seswavlili warmoebis musata Sromis pirobebis gaumjobesebis RonisZiebebi. 3 ë%", 2!3ä=!=K%),. C!%, ƒ"%ä 2"=, 2!=2= =ìì%, d%ö. d.c.g3!=ø", ë,, M.o.0, ì=*3!, äƒå, }.`.l=l 3!=äƒå

20 mhh ìåä, ö, /,.*%ë%ã,, 2!3ä=, ì. m.h. l=.", ë=äƒå m=% %"=,, *%ìcëå* %ã%, ƒ3 å, 3 ë%", L 2!3ä=!=K%,. %ä %ã%, ƒ % %" %ã%c!åäc!, 2,., ì, å *%L C!%ì/øëå % 2, c!3ƒ,, -C!%, ƒ"%ä 2"=, 2!=2==ìì%, 3 2= %"ëå %: " C!%, ƒ"%ä 2"å, C%ëüƒ3þ2., ì, å *, å %åä, å, C%"/øå %L %C= % 2,, 2%%C!åäåë å2 % %K/e 2!åK%"=, * 2å. %ë%ã, å *, ì C!%öå =ì. r ë%", 2!3ä=, ƒ3 å /. C!%, ƒ"%ä 2".=!=*2å!, ƒ3þ2 åkë=ã%c!, 2 /ì % 2%, åì C!%, ƒ"%ä 2"å %L!åä/, 2!3ä%"%ã%C!%öå =. Š!3ä!=K%,. % %" /. C!%-å, L.=!=*2å!, ƒ3å2 "/ %*%L Cë%2 % 2üþ!=K% ål ìå / (66,7-89,6%), = 2/ì =.% äå, åì " "/ 3 äå %ì C%ë% å,, 2åë=. b *%ìcëå* å åkë=ã%c!, 2 /. C!%, ƒ"%ä 2"å %-C!%-å, % =ëü /. -=*2%!%" "åä3?, ì "ë å2 ƒ=ã! ƒ å, å "%ƒä3ø %L!åä/ 2%*, å *, ì, =ƒ%2% %äå! =?, ì, ã=ƒ=ì, (" 1,8-2,4!=ƒ="/øå odj). b 2åCë/L Cå!, %ä ã%ä=ì, *!%*ë, ì=2 "ë å2 åkë=ã%c!, 2 /ì " ", äå C%"/øå %L 2åìCå!=23!/ "%ƒä3.=,, ƒ*%l åå C%ä", % 2,. x3ì, %K?= ", K!=ö, =K%ëüø, 2"å!=K%,. ìå 2 C!å"/ø=þ2 odr =3-11äa, 1-5 äa %%2"å2 2"å %. m=% %"=,, C!%"åäå /., ëåä%"=, L!=ƒ!=K%2= *%ìcëå* %ƒä%!%", 2åëü /. ìå!%c!, 2,L C% 3ë3 øå, þ 3 ë%", L 2!3ä=, % 2%, ƒä%!%"ü!=k%,., ƒ3 å %ã%c!%, ƒ"%ä 2"=. Labour conditions of workers producing Ammonia nitrate D. G. Zurashvili, M. P. Tsimakuridze, E. A. Maisuradze A complex study of workers labour conditions at enterprises producing Ammonia nitrate have been performed. It was stated that during the production process dangerous chemical compounds are used. It was distinguished that labor conditions of studied industry are in unfavourable state. The most important problem is air pollution with toxic gazes. The atmosphere at the enterprises producing ammonia nitrate is significantly polluted by the ammonia, nitrous acid and nitrogenous gases, that are times higher then MPC. Concentration of toxic substances depends on the character of the technological process. Unfavourable state of air environment is mainly due to the damages of impermeability and defects of industrial equipments. High air temperature has bad effects on health during warm periods of the year. Air temperature reaches C at most working places. Noise factor and general industrial vibration exceed acceptable level in the majority of working area. They are 3-11decibel and 1-5 decibel higher then the maximum permissible level. On the basis of carefully performed study a complex of recreation measures for improvement of service conditions has been carried out. literatura: khše p`šrp`: 1. a åë å" e.m., d%ì, q.c., q2åc= %" q.`. _ n.!= =ƒä%!%"ü!=k%2=þ?åã% = åëå, " %"!åìå /. 3 ë%",.. låä, ö, =2!3ä=, C!%ì/øëå =.*%ë%ã, c j3 ä, å" ~. h., q2å *=b.`., dì, 2!3.=m.m., ä!. _ g=",,ì% 2ü, ƒìå å,,ìì3 /., K, %., ì, å *,. ìå.=, ƒì%" C%ääå! =, ã%ìå% 2=ƒ=%2 ì=2å!, =ëü %L *3ì3ë ö,, ", ö=" %!ã=, ƒìå. låä, ö, =2!3ä=, C!%ì/øëå =.*%ë%ã, q *, ì%"=k.d. _ q% 2%, å, %ö, =ëü %-.*% %ì, å *, å C!%Këåì/ %.!= / 2!3ä=. a þëëå2å ü m=3 %ã% q%"å2=œlåä, *%-.*%ë%ã, å *, å C!%Këåì/!=K%2=þ?,.B c Schierhout G.H., Myers J.E. _ Amer. J. Ind. Med Vol.30. ¹1. p

21 amoniumis gvarjilis warmoebis musata avadoba m. cimakurize n. maxvilazis saxelobis Sromis medicinisa da ekologiis samecniero-kvleviti instituti saqartvelosi Qqimiuri mrewvelobis ert-ert mnisvnelovan dargs warmoadgens amoniumis gvarjilis warmoeba. qimiur mrewvelobasi dasaqmebuli mosaxleobis janmrtelobis mdgomareobaze mnisvnelovan zegavlenas axdens warmoebasi arsebuli Sromis pirobebi [2]. amoniumis gvarjilis warmoebasi arsebuli Sromis pirobebis musata janmrtelobis mdgomareobaze moqmedebis xasiatis gamovlenis miznit, SeviswavleT Sromis droebiti uunarobit SezRudul musata avadoba wlebis monacemebis mixedvit. am masalis analizma sasualeba mogvca dagvedgina avadobis zogierti Tavisebureba da garkveuli kavsiri Sromis pirobebtan. SeviswavleT warmoebis musata avadobis saerto done, e.k.m%2*, -is [4] mier mowodebuli Skalis safuzvelze, moavade pirta raodenobis, SemTxvevaTa ricxvis, Sromisuunarobis dreebis raodenobis da erti SemTxvevis sasualo xangrzlivobis mixedvit Sefasda rogorc sasualoze dabali. musata avadobis aseti dabali done damaxasiatebelia sazogadoebis ganvitarebis Tanamedrove periodisatvis: mzime socialur-ekonomikuri pirobebis gamo, samedicino daxmarebisatvis mosaxleobis mimartvianoba mkvetrad Semcirebulia [1]. am mosazrebas adasturebs isic, rom warsulsi saqartvelosi qimiuri mrewvelobis sawarmoebisatvis damaxasiatebeli iyo avadobis gacilebit marali macvenebeli [3]. kvlevis Sedegad dadginda, rom avadobis dabali macveneblis miuxedavad, ZiriTadi jgufis musata avadobis maxasiateblebi mnisvnelovnad (statistikurad sarwmunod) aremateba sakontrolo jgufisas. ZiriTad jgufsi gaertianebul musebsi moavade pirta ricxvi 5,1-jer (P<0,01), SemTxvevaTa ricxvi 5,0-jer (P<0,001), xolo Sromisuunarobis dreebis raodenoba 3,6-jer (P<0,001) aremateba sakontrolo jgufis amave macveneblebs. amastan, sakontrolo jgufsi erti SemTxvevis sasualo xangrzlivoba 1,4-jer Warbobs ZiriTadi jgufis amave maxasiatebels. ZiriTad jgufsi, qalta avadobis saerto done SemTxvevaTa ricxvis mixedvit, 4,0- jer aremateba sakontrolo jgufis monacemebs, xolo mamakacta Soris es macvenebeli 5,6-jer gansxvavdeba ertmanetisagan. Sromisuunarobis dreta ricxvi ZiriTadi jgufis qalebisatvis 2,6-jer maralia sakontrolo jguftan SedarebiT, xolo mamakacebisatvis - 4,2-jer.

22 musata asakis zrdis Sesabamisad, avadobis saerto done garkveuli cvlilebebit xasiatdeba. kerzod, SemTxvevaTa ricxvis mixedvit, saerto avadobis maqsimaluri done (72,7 SemTxveva 100 momusaveze) arinisneba sawyis asakobriv jgufsi (20-29 ww) da TandaTan mcirdeba (58,1 SemTxvevamde 100 momusaveze) maqsimalur asakobriv jgufsi (50 w da meti). avadobis saerto macveneblis aseti dinamika asakobriv WrilSi SeiZleba aixsnas e.w. `profesiuli SerCevis~ principis praqtikuli realizaciit, ris Sedegadac warmoebasi rceba SedarebiT janmrteli kontingenti. meore mxriv, drota ganmavlobasi am movlenis ganvitarebasi garkveul rols asrulebs sawarmoo Sxamebis moqmedebisadmi adaptaciac. musaobis stajis mixedvit, avadobis saerto donis macvenebeli mcire stajis (5 wlamde) mqone pirebsi 48,9 Seadgenda 100 momusaveze da es macvenebeli 2,9-jer gaizarda marali stajis (10 w da meti) jgufsi. Sromisuunarobis dreta raodenobis mixedvit, avadobis donis ganxilvisas gamovlinda, rom es macvenebeli Tanmimdevrulad izrdeba, Tumca ufro mkvetrad (2,8-jer) marali stajis (10 w. da meti) jgufsi. warmoebasi wlis ganmavlobasi ganmeorebit moavade pirta raodenoba ZiriTad jgufsi 4,4-jer maralia sakontrolostan SedarebiT. imisatvis, rom gagverkvia sawarmoo-profesiul faqtorta gavlena avadobis saerto donis formirebaze, gaanalizda ZiriTadi profesiebis musata avadobis macveneblebi. ZiriTadi profesiebis umetes jgufsi avadobis macveneblebi, rogorc SemTxvevaTa ricxvis, ise Sromisuunarobis dreta raodenobis mixedvit, mnisvnelovnad aremateba warmoebis sasualo monacemebs. kerzod, SemTxvevaTa ricxvis mixedvit, avadobis yvelaze marali done registrirdeba mtvirtavta Soris 91,9 SemTxveva, rac 1,4-jer maralia warmoebis sasualo monacemebze da 7,2-jer meti sakontrolostan SedarebiT. SemTxvevaTa ricxvis done maralia, agretve, meaparateebs, elmontiorebs, zeinklebs Soris 72,2, 71,9 da 69,4 Sesabamisad. Sromisuunarobis dreta raodenobis mixedvit, avadobis (1,4-jer meti warmoebis sasualo macvenebeltan SedarebiT) marali done arinisneba elmontiorebs Soris 959,4 dre, rac 5,1-jer metia sakontrolo jguftan SedarebiT. AaRniSnuli macvenebeli maralia mtvirtavebs Soris 932,4 Sromisuunarobis dre, agretve, zeinklebs Soris 911,1 Sromisuunarobis dre (100 momusaveze gadaangarisebit). calkeuli nozologiuri formita da daavadebata ZiriTadi jgufebis mixedvit avadobis masalis analizisas gamovlinda, rom musata avadobis donis formirebasi wamyvania sasuntqi, Zval-kunTovani, gul-sisxlzarrvta, nervuli, sasarde sistemebis, sawmlis momnelebeli organoebis daavadebebi. CamoTvlili daavadebebis xvedriti wili avadobis saerto donis formirebasi mnisvnelovania igi ZiriTad jgufsi Seadgens SemTxvevaTa ricxvis 77,7%-s da Sromisuunarobis dreta 76,0%-s. CamoTvlil daavadebata sixsire (100 momusaveze) mnisvnelovnad aremateba analogiur macvenebels sakontrolo jgufsi. ZiriTadi da sakontrolo jgufebis avadobis struqtura SemTxvevaTa ricxvis monacemta mixedvit statistikurad sarwmunod gansxvavdeba ertmanetisagan (X2=20,34 30,17). amrigad, avadobis masalis analizit askarad ikveteba sawarmoo-profesiul faqtorta garkveuli roli mat formirebasi. Catarebuli gamokvlevebis safuzvelze SemuSavda gamajansarebel RonisZiebaTa kompleqsi. ƒ=k%ëå"=åì% 2ü!=K%),. C!%, ƒ"%ä 2"=, 2!=2= =ìì%,

23 l.o. 0, ì=*3!, äƒå mhh ìåä, ö, / 2!3ä=,.*%ë%ã,,, ì.m.h. l=.", ë=äƒå q öåëüþ, ƒ3 å, "ë,, 3 ë%", L 2!3ä= =-%!ì,!%"=, å % %Kå % 2åL % 2%, ƒä%!%"ü C!%= =ë, ƒ,!%"= / ì=2å!, =ë/ ƒ=k%ëå"=åì% 2, "!åìå %L 32!=2%L 2!3ä% C% %K % 2,!=K%,. C!%, ƒ"%ä 2"=, 2!=2==ìì%, ƒ=cå!, %ä ã.ã. r 2= %"ëå %, 2%.%2 " öåë%ì %K?, L 3!%"å ü ƒ=k%ëå"=åì% 2, å"/ %*, %ä =*%.2%2 C%*=ƒ=2åëü " % %" %L ã!3ccå " -2=*, " 3,6-5,1!=ƒ=C!å"/ø=å2 = =ë%ã, /L " *% 2!%ëü %L ã!3ccå. o%ìå!å 3"åë, å, "%ƒ!= 2=,, % %Kå %, 2= =!=K%2/ 3!%"å ü ƒ=k%ëå"=åì% 2, C% 2åCå %C%"/ø=å2 ( C% 2= 3 -" 2,8!=ƒ=). o%*=ƒ=2åëü =, K%ëåå "/ %* 3!=K%,. åkë=ã%c!, 2 /ì, 3 ë%", ì, 2!3ä=: 2=*,!åä, ã!3ƒ, *%" # " 1,4!=ƒ="/øå %K?åC!%, ƒ"%ä 2"å %ã% C%*=ƒ=2åë, " 7,2!=ƒ= "/øå C%*=ƒ=2åë *% 2!%ëü %L ã!3cc/. ), ë%c%"2%! %K%ëå"ø,. ë, ö " 4,4!=ƒ= "/øå " % %" %L ã!3ccå. b 2!3*23!å ƒ=k%ëå"=åì% 2, "åä3?åå ìå 2% ƒ=, ì=þ2 K%ëåƒ, ä/.=2åëü %L, *% 2 %-ì/øå %L, å!äå %- % 3ä, 2%L, å!" %L, ì% å"/äåë, 2åëü %L, C,?å"=!, 2åëü %L, 2åì, % 2="ë 76,0% %2 %K?åã%, ë= ë3 =å", 77,7% - %2 %K?åã%, ë=ä ål å2!3ä% C% %K % 2,. b öåë%ì, 2!3*23!a ƒ=k%ëå"=åì% 2, % %" %L, *% 2!%ëü %L ã!3cc 2=2, 2, å *, ä% 2%"å! %%2ë, =å2 ä!3ã %2 ä!3ã= (X2=20,34 30, 17). m=% %"=,, C!%"åäå /., ëåä%"=, L!=ƒ!=K%2= *%ìcëå* %ƒä%!%", 2åëü /. ìå!%c!, 2,L. Morbidity among workers producing ammonia nitrate M. Tsimakuridze In order to reveal the general and occupational diseases the labor conditions and the state of health among workers producing ammonia nitrate have been studied. The figures for sickness rate of workers with temporary loss of ability for work during years have been analyzed. It has been stated that general rate of morbidity is not high, but this index in basic group times exceeds the analogues figure in the control group. The level of morbidity increases 2.8 times in line with the record of service. This index is higher in laborers working in unfavourable labor conditions: for example, this index among loaders 1.4 times exceeds the manufacturing parameter and 7.2 times prevails the figure in the control group. The number of repeatedly ill people is 4.4 times higher in basic group. In the structure of morbidity diseases of respiratory, musculoskeletal, cardiovascular, neuro, kidney and digestive systems are frequent and they amount to 76% of the whole cases. In general, the structure of morbidity statistically differs in basic and control groups ( 2 = ). On the bases of careful study a complex of recreation measures for improvement of service conditions has been worked out. literatura: khše p`šrp`: 1. gvalia m. _ hipertoniuli daavadebis gartulebata prevenciis socialuri problemebi izulebit gadaadgilebul pirebsi: avtoref. med. mecn. kand. Tbilisi: gv. 2. j%!k=*%"=`.h., q%!*, =m.q.,l%ë%ä*, =m.m., ä!. _ q", åö, åã%äål 2", å =%!ã=, ƒì. låä, ö, = 2!3ä=, C!%ì/øëå =.*%ë%ã, c l= ä ã=ë=äƒå p.m., b=ø=*, äƒå b.h., uå!%ä, =ø", ë, `.g., ä!. _ bë,, å C!%, ƒ"%ä 2"å %- C!%-å, % =ëü /. -=*2%!%" = % 2%, å ãå å!=2, " %L -3 *ö,,!=k%2, ö p3 2=" *%ã%., ì, å *%ã% *%ìk, =2=.n2 å2 mhp mhh ã, ã, å / 2!3ä=, C!%-ƒ=K%ëå"=, L, ì. m.h. l=.", ë=äƒå lg c qqp. ŠK, ë,,: m%2*, e.k. _ nk 3ãë3Këå %ì = =ë, ƒå ä= /. ƒ=k%ëå"=åì% 2, "!åìå %L 32!=2%L å2!3ä% C% %K % 2,. c, ã., = c

24 puris warmoebis musata Sromis pirobebi n. kverencxilaze n. maxvilazis saxelobis Sromis medicinisa da ekologiis samecniero-kvleviti instituti saqartvelos erovnuli meurneobis dargebs Soris fartodaa ganvitarebuli kvebis mrewvelobis ert-erti wamyvani puris warmoeba. purfuntuseulis sawiro raodenobis sawarmoeblad, puris warmoebis teqnologiuri procesebis meqanizaciis marali donis pirobebsic ki, mtlianad kvebis mrewvelobasi, dakavebulia momusaveta aranakleb 10-12% [2]. puris warmoebis teqnologiuri procesebis meqanizaciis xarisxi da Sromis higienuri pirobebi mnisvnelovnadaa damokidebuli calkeuli warmoebis simzlavresa da teqnikur-teqnologiuri arwurvis doneze, rac mnisvnelovanwilad ganapirobebs warmoebuli produqciis xarisxs, musata Sromisunarianobis donesa da janmrtelobis mdgomareobis xasiats [3]. warmoebis teqnologiuri procesebis cvlilebebtan, meqanizaciisa da avtomatizaciis danergvis donestan, aseve maralmwarmoebluri sawarmoo danadgarebis praqtikasi gamoyenebastan mwidrodaa dakavsirebuli warmoebis Secvlili Sromis pirobebis formireba, rac satanado higienur Sefasebas moitxovs. amave konteqstsi unda ganvixilot qartuli puris warmoebis sruliad gansxvavebuli teqnologiuri procesic, romelic, higienuri TvalsazrisiT, saertod araa Seswavlili. arnisnuli sakitxebis kvleva, efeqturi kompleqsuri gamajansarebeli RonisZiebebis SemuSavebis miznit, metad aqtualuria. saqartvelos puris warmoebis obieqtebis musata Sromis pirobebis racionalizaciisa da janmrtelobis mdgomareobis gaumjobesebis RonisZiebaTa SemuSavebis miznit, Catarda Sesabamisi kompleqsuri sawarmoo gamokvlevebi Tbilisis puris 3 sawarmos bazaze. puris warmoebis teqnologiuri sqema ZiriTadad sami saamqrotia warmodgenili: ZiriTadi, orcxobilasi da qartuli puris. warmoebis ZiriTadi profesiebia: fqvilis gamcreli da Semrevi, comis mzelavi da damwreli, mcxobeli (merumele), funtusis damwreli, damwyobi da SemfuTavi. Catarebuli sawarmoo gamokvlevebis safuzvelze dadginda, rom Seswavlili warmoebis musata Sromis pirobebi xasiatdeba profesiul faqtorta speqtrit (marali temperatura da infrawiteli gamosxiveba, mtveri, xmauri, intensiuri fizikuri datvirtva da sxv.).

25 kompleqsuri qronometrajuli, ergonomikuli da profesiagrafiuli gamokvlevebis safuzvelze dadginda, rom warmoebis ZiriTadi profesiebis musata SromiTi procesisatvis damaxasiatebelia sxvadasxva sawarmoo operaciis Sesruleba, romlis drosac musata organizmze moqmedebs sawarmoo garemosa da Sromis organizaciis faqtorta rtuli kompleqsi. SromiTi procesis damaxasiatebeli faqtoria musaobis marali simkvrive, romelic sasualod 84,1%-s Seadgens. SromiTi procesis Sesruleba dakavsirebulia mnisvnelovan fizikur dazabvastan. umetes profesiebsi musaoba sruldeba sxeulis izulebit mdgomareobasi magidastan, fexze mdgomi, odnav moxrili, kidurebis ertferovani monotonuri mozraobit. warmoebis profesiul faqtorta speqtrsi wamyvania sitburi datvirtva, romelic armosavlet saqartvelos klimatur-geografiul pirobebsi (msrali subtropikuli klimati) intensiur xasiats atarebs. sawarmoo satavsebis mikroklimatis formirebaze upirates gavlenas axdens Sida sawarmoo pirobebi, kerzod, sitbos wyaroebis simwidrove da gamoyenebis rejimi. Seswavlil warmoebasi haeris temperatura mnisvnelovnad aremateba dasasveb paremetrebs. kerzod, qartuli puris merumelis samusao adgilze, wlis Tbil periodsi, misi sidide 38,80C-mde arwevs, xolo wlis civ periodsi 29,60C-mde, rac aremateba saqartvelos sanitariul-higienuri normatiuli dokumentit dadgenil maqsimalur (29,00C) sidides [1]. haeris SefardebiTi tenianoba da mozraobis sicqare ZiriTadad dasasvebi normis farglebsia. gansakutrebit arsanisnavia organizmis intensiuri sitburi dasxiveba merumeleebs Soris, romelic ZiriTadad qalebitaa warmodgenili. am dros xdeba muclisa da mcire menjis midamoebis dasxiveba. es mdgomareoba mnisvnelovani higienuri momentia qalta janmrtelobis (gansakutrebit, reproduqciuli) formirebis TvalsazrisiT. Tumca, Tavisi didi samedicino-socialuri mnisvnelobidan gamomdinare, sakitxi specialur kvlevas sawiroebs. araxelsayreli (cxeli) mikroklimatis formirebis ZiriTadi ganmsazrvreli faqtoria puris sacxobi Rumelebis higienuri TvalsazrisiT araracionaluri konstruqcia da Tboizolacia. zogierti teqnologiuri operaciis Sesruleba (ZiriTadad, warmoebis sawyis etapze) dakavsirebulia samusao zonis haersi alergiul-fibrogenuli moqmedebis marcvleulis fqvilis mtvris gamoyofastan. misi koncentracia dasasvebs sasualod 2,5-5,5-jer aremateba fqvilis gamcreltan da SemrevTan, safuaris momrevtan, comis mzelavtan da damwreltan SedarebiT. sawarmoo arwurvilobis musaobis Sedegad generirebuli farto speqtris (ZiriTadad, marali sixsiris) xmauris done gansakutrebit momatebulia comsazel agregattan (5-20 db-it, sasualod - 18 db-it). puris warmoebasi Sesasrulebeli sawarmoo operaciebis xasiati moitxovs ganatebis garkveuli rejimis Seqmnas. mxedvelobiti samusaos xasiatis mixedvit, puris warmoebis ZiriTadi profesiebi miekutvneba IV-V kategoriis samusaoebs. warmoebis satavsebsi arsebuli ganatebis done ar Seesabameba higienur normebs. bunebrivi ganateba normis motxovnebs mxolod 54,9%-iT akmayofilebs, xolo xelovnuri ganateba 60,9%-iT. samusao zedapirebis ganatebis aseti dabali done ganpirobebulia rogorc teqnikur-teqnologiuri, ise dagegmarebiti da saeqspluatacio mizezebit. amrigad, puris warmoebis musata Sromis pirobebi xasiatdeba sawarmoo-profesiul faqtorta rtuli kompleqsis moqmedebit organizmze, romeltagan TiToeuli garkveul motxovnebs uyenebs organizms, rac ganapirobebs janmrtelobis mdgomareobis Taviseburebebis formirebas.

26 Catarebuli kompleqsuri gamokvlevebi safuzvlad daedo puris warmoebis musata Sromis pirobebisa da janmrtelobis mdgomareobis gaumjobesebis RonisZiebaTa SemuSavebas. r ë%", 2!3ä=!=K%),..ëåK%Cå*=! %ã% C!%, ƒ"%ä 2"= m.p. j"å!å )., ë=äƒå mhh ìåä, ö, / 2!3ä=,.*%ë%ã,,, ì.m.h. l=.", ë=äƒå j%ìcëå* /ì, ã, ã, å %--, ƒ, %ë%ã, å *, ì,, ëåä%"=, ì, 3 2= %"ëå %, 2%3 ë%", 2!3ä=!=K%,..ëåK%Cå*=! %ã%c!%, ƒ"%ä 2"=.=!=*2å!, ƒ3þ2 =ë,, åì åkë=ã%c!, 2 /. C!%, ƒ"%ä 2"å %- C!%-å, % =ëü /. -=*2%!%". Š!3ä%"%L C!%öå.=!=*2å!, ƒ3å2 "/ %*%L Cë%2 % 2üþ!=K% ål ìå /, % 2="ë þ?ål "!åä åì 84,1%. b/c%ë å, å 2!3ä%"%ã%C!%öå = " ƒ= % % ƒ =, 2åëü %L -, ƒ, å *%L =ã!3ƒ*%l!=k%,., = 2/ì =.% äå, åì,. 2åë=" "/ 3 äå %ì C%ë% å,,. båä3?, ì, åkë=ã%c!, 2 /ì, -=*2%!=ì, C!%, ƒ"%ä 2"å %L!åä/ "ë þ2 =ã!å"=þ?, L ì, *!%*ë, ì=2 ("/ %*= 2åìCå!=23!="%ƒä3.=,, -!=*!= %å, ƒë3 å, å), =ë,, å =ëëå!ãå %--, K!%ãå %L ì3 %L C/ë, " "%ƒä3.å!=k% ål ƒ% /, *% öå 2!=ö, *%2%!%L " 2,5-5,5!=ƒ=C!å"/ø=å2 odj, C!%, ƒ"%ä 2"å /L ø3ì, C!%, ƒ"%ä 2"å %å % "å?å, å. p=ƒ!=k%2= / %ƒä%!%", 2åëü /å ìå!%c!, 2, öåëüþ 3ë3 øå, þ 3 ë%", L 2!3ä=!=K%,.. Conditions of Workers in the Bakery Production N. Kverenchkhiladze Using complex hygienic and physiologic examinations it was stated that unfavourable productional and professional factors make working conditions at bakery productions unsatisfactory. Working process is characterized with density of working shift, comprising on average 84,1%. The complementation of working process is connected with heavy physical overloading of workers and very often with their forced work and conditions. The main unfavourable factors of production environment are: heating microclimate (the high temperature of the air and infrared eradiation), concentration of allergenic and fibrogenic dust of flour in the area of industrial production which is more that it is aflowed, production noise and light. The sanitation measures for improvement the conditions of workers are worked out. literatura: k, 2å!=23!=:

27 1. higienuri motxovnebi sawarmoo satavsebis mikroklimatisadmi. sanitariuli wesebi da normebi. sanwdan l=*ëþ*%" h.h., x3ø=å" t.c. _ o!%ì/øëå /å Cå,.ëåK%Cå*=! %ã%, *% ä, 2å! *%ã%c!%, ƒ"%ä 2"=. l.: o,?å"= C!%ì/øëå % 2ü rì=!%" g., m3.ì=.ì=ä%" l. _ q%"å!øå 2"%"=, å %!ã=, ƒ=ö,, 2!3ä=".ëåK%Cå*=! %L C!%ì/øëå % 2, Š=ä, * *%L qqp. Šåƒ, / ä%*ë=ä%" II på C3Kë, *= *%L =3 %L *% -å!å ö,, C%C!%Këåìå ã, ã, å / 2!3ä=, C!%-ƒ=K%ëå"=, L. d3ø= Kå: 1971.c kvebis higiena studentta racionaluri kvebis zogierti higienuri norma doc. q. dadiani, prof. a. fircxalava, med.mecn.kand. n. arabuli, med.mecn.kand. i. beraia, med.mecn.kand. q. berize, T. xuwua, b. oniani g. natazis saxelobis sanitariisa da higienis samecniero-kvleviti instituti, Tbilisis iv. javaxisvilis saxelobis saxelmwifo universiteti mosaxleobis janmrtelobis dasacavad didi mnisvneloba eniweba sxvadasxva jgufisatvis mecnierulad dasabutebuli swori kvebis organizebas garemos mavne faqtorebis intensiuri zrdis fonze. aseti kvleva sasualebas izleva mosaxleobis didi nawilis msyidvelobiti unaris mkvetri daqveitebisa da aseve

28 jansari, racionaluri kvebis sakitxebsi, ganatlebis dabali donis miuxedavad, SemuSavdes kvebis swori politika. sadreisod saqartvelosi ar Catarebula fartomasstabiani kvleva studentta kvebiti statusisa da mastan dakavsirebuli janmrtelobis mdgomareobis cvlilebebis dasadgenad, miuxedavad imisa, rom studentebi mosaxleobis organizebuli kategoriis is gansakutrebuli jgufia, romelta Sromisa da cxovrebis specifikuri pirobebi sawiroebs zogierti Taviseburebis gatvaliswinebas sakvebis kvebit RirebulebasTan mimartebasi. kvlevis mizans warmoadgenda medicinis fakultetis studentta motxovnilebis Seswavla sakvebis energetikul Rirebulebasa da rig nutrientul Semcvelobaze. gamokvlevasi monawileobas irebda 240 studenti (193 qali da 47 vaji). gamosakvlevi kontingentis SerCeva ganxorcielda SemTxveviTi SerCevis metodit. studentebi daiyvnen sam asakobriv jgufad ww. (I-II kursi), ww. (III-IV kursi) da ww (V-VI kursi). Seswavlil iqna studentta faqtiuri kveba da energoxarjva (qronogramebis gamoyenebit). saboloo Sedegebis mecnierulma analizma gvicvena, rom sarwmuno gansxvaveba asakobriv jgufebs Soris energoxarjvas, sakvebit mirebul energiasa da ZiriTad nutrientebs Soris ar arsebobs, amitom gtavazobt sasualo monacemebs, dajgufebuls mxolod sqesobrivi nisnit (cxrili 1). Sromisunariani mosaxleobis profesiuli da saqmianobis nisnit diferencirebisas, dadgenilia, rom humanitaruli specialobis studentebi energoxarjvis mixedvit, gaertianebuli arian I jgufsi _ gonebrivad momusave pirebi. am jgufsi gaertianebuli pirebis fizikuri aqtivobis koeficientis (organizmis energoxarjvis Sefardeba ZiriTadi cvlis sididestan) mnisvnelobaa 1,4. kvlevis Sedegad, medicinis fakultetis studentta energoxarjvis SeswavliT dadginda, rom mati fizikuri aqtivobis koeficienti (gogonebisa da vajebisatvis) iyo 1,68 (cxrili 1), ris gamoc, gamokvleuli kontingentis populacia gaertianda ara I jgufsi, rogorc mosalodneli iyo, aramed II jgufsi. unda arinisnos, rom fizikuri datvirtvis mixedvit, amave jgufs miakutvneben meddebs, sanitrebs, zogierti specialobis eqims. am daskvnis safuzvelze, medicinis fakultetis studentta fiziologiuri motxovnilebis normebi ganxilul iqna ara I jgufsi gaertianebuli kontingentis fiziologiuri motxovnilebis normebis gatvaliswinebit, aramed II profesiuli jgufistvis dadgenili organizmis fiziologiuri motxovnilebebis sarekomendacio sidideebis Sesabamisad. gamokvleuli kontingentis gogonebsi, dadgenil normebtan SedarebiT, kvebis gzit mirebuli energiis mnisvneloba tendenciurad mimartulia klebisken. vajebtan mimartebasi aseti tendencia ar arinisneba. amastan, gogonebsi sakvebi racionis energetikuli Rirebulebis 33% modis cximebze, rac odnav aremateba normas, xolo 53% _ naxsirwylebze, rac mkvetrad daqveitebulia normastan SedarebiT. aqedan gamomdinare, gogonebsi sakvebi racionis energetikuli Rirebuleba Semcirebulia ZiriTadad naxsirwylebis xarjze. cilebze ki modis racionis energetikuli Rirebulebis 12-14%. Sedegebi moyvanilia meore da mesame cxrilebsi. vajebis kvebit racionsi ZiriTad sakveb nivtierebebze energetikuli Rirebulebis gadanawileba TiTqmis Seesabameba normebs. organizmis individuri fiziologiuri motxovnilebis dadgenili normebis Sesabamisad, cila: cximi : naxsirwylebi Sefardeba Sesabamisad unda iyos qalebsi: 1: 0,9 : 5,6, vajebsi _ 1: 0,9 : 5,3. kvlevis Sedegad miviret, rom Sefardeba cila: cximi : naxsirwylebi qalebsi aris 1: 1: 3,8, xolo vajebsi _ 1: 0,9: 4,3. Sefardebidan Cans, rom racionsi mkvetradaa Semcirebuli naxsirwylebis fardobiti wili ufro metad gogonebsi, vidre vajebsi. gogonebsi kvebit racionsi naxsirwylebis wilis

29 Semcireba ganpirobebulia rtuli naxsirwylebis (kerzod, puri da purproduqtebi) mirebis mkvetri cxrili 1 studentta ZiriTadi cvla, energoxarjva da fizikuri aqtivobis koeficienti (f.a.k.) energoxarjva (kkal) ZiriTadi cvla (kkal) f.a.k. qalebi ,72 vajebi ,59 f.a.k.-is sasualo mnisvneloba mteli kontingentistvis 1,68 SezRudviT, xolo vajebsi naxsirwylebis macveneblis umnisvnelo Semcireba ganpirobebulia martivi naxsirwylebis (Saqari, tkbileuli) mirebis SezRudviT. amavdroulad, gogonebsi martivi naxsirwylebit organizmis dakmayofilebis done ufro maralia, vidre vajebsi. energoxarjvis Seswavlam gamoavlina kvebiti racionis arabalansebuloba energetikuli TvalsazrisiT, rac aisaxa studentta masa-simarlis macveneblis (BMI) gamokvlevis Sedegadac (cxrili 4). Sedegebis analizma gvicvena, rom gogonata is jgufi, romelta BMI naklebi iyo normalur macvenebelze, anu sagrznobi iyo wonis deficiti (gogonata 30%), raodenobrivad sagrznoblad aremateboda Warbi wonis gogonata jgufs. paralelurad vajta kontingentsi wonis deficiti ar arinisneboda. gogonebsi, wonis deficitis sixsire, vajebtan SedarebiT, ganpirobebulia, erti mxriv, medicinis fakultetis studentta marali fizikuri aqtivobit, xolo meore mxriv, arabalansebuli, dieturi an marxvis procesi mirebuli kvebiti racionit, romelic energetikulad arasrulfasovania. cxrili 2 studentta kvebiti racionis energetikuli Rirebuleba da nutrientuli Semcveloba energia (kkal) cila (gr) cximi (gr) naxsirwylebi (gr) dadgenili sidideebi mirebuli Sedegebi II jgufi II jgufi qalebi vajebi qalebi ,9 70,8 256,7 vajebi , ,4 m1 ±105 ±6,6 ±5,7 ±5,1 m2 ±268 ±10 ±±11,5 ±42,35

30 m1 sasualo aritmetikulis cdomileba qalebsi m2 sasualo aritmetikulis cdomileba vajebsi cxrili 3 racionsi cila-cximi-naxsirwyalze mosuli energetikuli Rirebuleba norma qalebi vajebi cila 12% 14% 14% cximi 25% 33% 27% naxsirwylebi 63% 53% 59% cxrili 4 studentta gadanawileba BMI-is mixedvit gogonebi vajebi mteli kontingenti wonis deficiti 30% 0 21% norma 57% 81% 64% I xarisxis simsuqne 10% 6% 9% II xarisxis simsuqne 3% 13% 6% III xarisxis simsuqne å*%2%!/å c, ã, å, )å *, å %!ì/!=ö, % =ëü %ã% C, 2=, 23äå 2%" ä%ö. j. d=ä, =,, o!%-. `. o,!ö.=ë="=, *= ä.ìåä. =3* m. `!=K3ë,, *= ä. ìåä. =3* h. aå!=,, *= ä. ìåä. =3* j. aå!=äƒå, Š. u3)3=, a. n, =, mhh =, 2=!,,, ã, ã, å /, ì. c.m=2=äƒå, ŠK, ë, */L ã% 3ä=! 2"å /L 3, "å!, 2å2, ì. h. d ="=., ø", ë, dë C% 2!%å,!=ö, % =ëü %ã%c, 2=,,ƒ3 å =C%2!åK % 2ü %!ã=, ƒì= äå 2%" ìåä, ö, *%ã% -=*3ëü2å2= ". å!ã,,, C,?å"/. "å?å 2"=.. r 2= %"ëå = å%k.%ä, ì% 2ü %C% 2="ëå, C%2!åK % 2åL 23äå 2%" ". å!ã,,, C,?å"/. "å?å 2"=. -, ƒ, %ë%ã, å *, ì, %!ì=ì, C,2=,,!=ƒ!=K%2= /ì, äë "2%!%L ã!3cc/ "ƒ!% ë%ã%2!3ä% C% %K %ã% = åëå,. h2%ã%"/å ä= /å C%%!ã=, å *%ì3 % 2="3!=ö, % %" C, 2=, 23äå 2%" C%*=ƒ=ë,, 2%!=ö, % 23äå 2%" å *%ã%c%ë=äå-, ö, 2å C%3ãëå"%ä %ì3 % 2="3 (% %Kå %ƒ= å2.ëåk%k3ë% /., ƒäåë, L). r 30% äå"% å* ì= = 2åë=%2 2=å2 %2, äå=ëü %L, 3 10% -ì= = 2åë=3"åë, å = =10%.

31 Some Hygienic Requirements of Rational Feeding of Students A. Pirtskhalava, K. Dadiani, N. Arabuli, I. Beraia, T. Khuchua, B. Oniani, K. Beradze Requirements of organism of 240 students of medical department for energy and food substances have been studied for construction of rational feeding. The data on definition of requirements for energy showed the necessity of correlation between requirements of students for energy and food substances and physiologic standards of feeding devised for the second group of adult, able-bodied population. Concluding data on organic formulation of ration of feeding showed that ration of female students is characterized by lack of carbohydrate (especially at the expense of rools and buns). Body mass of nearly 30% of girls is less than ideal; in 10% of girls body mass is increased by 10%. studentta sakvebi produqtis xarisxis zogierti macveneblis Sefaseba prof. a. fircxalava, doc. q. dadiani, med.mecn.kand. n. arabuli, med.mecn.kand. i. beraia, n. filia, med.mecn.kand. q. berize, T. xuwua, b. oniani g. natazis saxelobis sanitariisa da higienis samecniero-kvleviti instituti, Tbilisis iv. javaxisvilis saxelobis saxelmwifo universiteti mosaxleobis TiToeuli jgufisatvis racionaluri kvebis SemuSaveba xasiatdeba garkveuli TaviseburebebiT. sanitariul-higienur da samedicino rekomendaciebs didi mnisvneloba eniweba adamianis `higienuri~ qcevis gansazrvrasi, romelzec mnisvnelovnadaa damokidebuli adamianis janmrteloba. am mxriv gansakutrebuli yuradreba unda iqnes gamaxvilebuli axalgazrda Taobebis, kerzod, studentebis jansari cxovrebis wesze.

32 mosaxleobis kvebastan dakavsirebuli janmrtelobis Sefaseba efuzneba organizmis kvebiti statusis Seswavlis macveneblebs. kvebis xarisxis dasadgenad, praqtikasi xsirad gamoiyeneba sakvebi racionis balansebuloba mikroelementebita da vitaminebit, romlis adekvaturobis ganmsazrvreli kriteriumia kapilarebis rezistentoba, SardSi askorbinis mjavas Semcveloba, sisxlis SratSi zogierti vitaminis Semcvelobis donis dadgena da vitaminebis ukmarisobis klinikuri nisnebis gamovlena. kapilarebis rezistentobis sinji warmoadgens sakvebis srulfasovnebis irib maxasiatebels, romelic miutitebs sakveb racionsi askorbinis mjavasa da bioflavinoidebis (vitamini P) naklebobaze. kapilarebis rezistentobis dadgena ganxorcielda angiorezistometrit. mirebuli Sedegebis Tanaxmad (cxrili 1), studentta 25%-s wina mxris wina zedapirze gamouvlinda 30-ze meti peteqia, rac PP an C vitaminebis deficitis nisans warmoadgenda. cxrili 1 kapilarebis rezistentobis cdis Sedegebi qalebis raodenoba vajebis raodenoba 5-15 peteqia (norma) peteqia da meti peteqia kvebis, organizmis fiziologiur motxovnilebebtan adekvaturobis Sesafaseblad, Seswavlil iqna zogierti bioqimiuri kriteriumic, kerzod, sisxlsi A vitaminisa da β-karotinis, aseve SardSi C vitaminis Semcveloba (cxrili 2, 3, 4). rogorc meore cxrilidan Cans, studentta 91%-s sisxlis SratSi A vitamini armoacnda normis farglebsi, xolo 9%-s _ hipervitaminozi. β-karotintan mimartebasi gamokvleulta 55%-s, normastan SedarebiT, arenisneboda β-karotinis donis daqveiteba sisxlis SratSi, xolo 45%-s _ hqonda normis farglebsi. organizmis vitaminebit dakmayofilebis Seswavlisas, armocnda, rom igi ZiriTadad gamoixata b-karotinit dakmayofilebis deficitsi. kvebis gzit β-karotinis mireba sarwmunod daqveitebulia. b-karotini mcenareuli warmosobis yviteli pigmentia, romelic organizmsi moxvedris Semdeg RviZlsa da nawlavebsi ferment β-karotin- 15, 15 dioqsigenazas moqmedebit, gardaiqmneba retinolad. am ukanasknelis ardgenit, ki miireba A vitamini. A vitaminis deficiti bioqimiuri macveneblebit ar gamovlenila. es Sedegebi faqtiuri kvebis monacemebis Sesatyvisia, kerzod, studentta kvebiti racioni naklebi raodenobit Seicavs im mcenareuli warmosobis produqtebs, romlebic warmoadgens β-karotinis wyaros.

33 cxrili 2 sisxlis SratSi A vitaminis gansazrvra studentta raodenoba >70 mkg/ml norma mkg/ml <30 mkg/ml qalebi 47 3 (10%) 24 (90%) 0 vajebi 32 1 (6%) 15 (94%) 0 mteli kontingenti 86 4 (9%) 39 (91%) 0 cxrili 3 sisxlis SratSi β-karotinis gansazrvra studentta raodenoba >230 mkg/ml norma mkg/ml <80 mkg/ml qalebi vajebi mteli kontingenti (45%) 11 (55%) cxrili 4 SardSi C vitaminis gamoyofis done C vitamini studentta raodenoba >0.8 2 (6%) (88%) < (6%) SardSi C vitaminis gamoyofis donis dadgenis Sedegad, es vitamini normis farglebsi armoacnda studentta 88 %-s, 6%-s _ normaze meti, 6%-s _ normaze naklebi. organizmis kvebiti statusis Sesafaseblad, gamoyenebul iqna jandacvis msoflio organizaciis eqspertta mier rekomendebuli vitaminebit dakmayofilebis araadekvaturobis Sesafasebeli Semdegi klinikuri simptomebi: sibnelis mimart mxedvelobis adaptaciis mosla, angularuli stomatiti, xeilozi, cvlilebebi enis, kanisa da frcxilebis mxriv. am nisnebis gamovlenis sixsire Seswavlil iqna 114 studentsi. (cxrili 5). tucis naskdomebi gamouvlinda 46 students, kanis simsrale _ 30-s, enis hipertrofirebuli dvrilebi_26-s, anguliti_22-s, xolo sisxlmdeni RrZilebi _ 22-s.

34 cxrili 5 vitaminebis deficitis klinikuri nisnebi vitaminebis deficitis klinikuri nisnebi ganmapirobebeli vitamini studentta raodenoba sisxlmdeni RrZilebi C, P 22 (9%) kanis simsrale A 30 (12%) anguliti B 2, B 6 22 (9%) tucis naskdomebi B 2, B 6, PP 46 (19%) enis hipertrofiuli dvrilebi B 2, B 6, PP 26 (11%) amastan, ramdenime vitaminis deficitit ganpirobebuli nisani gamouvlinda studentta 8%-s. arsanisnavia, rom bioqimiuri gamokvlevebis garda, vitaminebis deficitis klinikuri nisnebis Seswavlam, sasualeba mogvca studentta kontingentsi gamogvevlina zogierti vitaminit (B2, B6, PP, C, P) organizmis dakmayofilebis dabali macvenebelic. monacemebis saerto analizi natlad metyvelebs studentta kvebis racionis arabalansebul xasiatze zogierti vitaminis mxriv. es faqti metad sagulisxmoa im TvalsazrisiTac, rom kvebiti ukmarisobit gamowveul daavadebebs Tan axlavs organizmis bioqimiuri konstantebis mdgradi cvlilebebi. vitaminebis deficitisadmi mgrznobeloba mit ufro maralia, rac ufro axalgazrdaa organizmi. yovelive es sawiroebs studentta orientaciis gazrdas racionaluri kvebis Sesaxeb da saswavlo programebsi kvebis higienis sakitxebisadmi ufro meti saatebis datmobas. nöå *= å*%2%!/. C%*=ƒ=2åëåL *=)å 2"= C,?å"/. C!%ä3*2%" 23äå 2%" o!%-. `. o,!ö.=ë="=, *= ä.ìåä. =3* j. d=ä, =,, *= ä.ìåä. =3* m. `!=K3ë,, *= ä.ìåä. =3* h. aå!=,, m. o, ë,, Š. u3)3=, a. n, =, mhh =, 2=!,,, ã, ã, å /, ì. c.m=2=äƒå, ŠK, ë, *, L ã% 3ä=! 2"å /L 3, "å!, 2å2, ì. h. d ="=., ø", ë, dë!=ƒ!=k%2*,!å, ì=!=ö, % =ëü %ã%c, 2=,,ƒ3 å =%Kå Cå å % 2ü %!ã=, ƒì= äå 2%" ìåä, ö, *%ã%-=*3ëü2å2=", 2=ì, =ì,. q.2%l öåëüþ, C%ëüƒ%"= / K, %., ì, å *, å *!, 2å!,, =äå*"=2 % 2, C, 2=,, *ë,, å *, å, ìc2%ì/ ", 2=ì, %L åä% 2=2% % 2,. o!, "%ä 2 ä= /å % % 2%,,!åƒ, 2å 2 % 2, *=C, ëë!%", %äå! =, " ì% å = *%!K, %"%L *, ë%2/, " *!%", -", 2=ì, %" `, β# *=!%2, =, =2=* å ì, *!%, ìc2%ì=2, *=", 2=ì, %L åä% 2=2% % 2,.

35 Estimation of Some Indices of Alimentary status of Students A. Pirtskhalava, K. Dadiani, N. Arabuli, I. Beraia, N. Pipia, T. Khuchua, B. Oniani Providing the organism of 240 students of medical faculty with some vitamins have been studied for construction rational diet. For this purpose biochemical criteria of adequate feeding and clinical symptoms of vitamin deficiency were used. In the given work concluding data on capillary resistance, content of ascorbic acid in the urine, content of vitamin A and β-carotin in the blood and microsymptoms of vitamin deficiency are presented. hemofiliis dros Trombocitebis morfofunqciuri maxasiateblebi klinikuri hematologia med.mecn.kandidatebi c.gelikasvili, l.rlonti, med.mecn.doqt. i.mestiasvili, biol.mecn.kand. e.zarize, n.mamforia, x.rexviasvili, biol.mecn.kand n.maxaraze iv. javaxisvilis saxelobis Tbilisis saxelmwifo universitetis hematologiisa da transfuziologiis katedra, gr. muxazis saxelobis hematologiisa da transfuziologiis samecniero-kvleviti instituti cnobilia, rom hemofiliisas sisxldena ganpirobebulia plazmuri faqtoris deficitit, Tumca pirveladi hemostazistvis mnisvnelovani roli eniweba Trombocitebis funqciur mdgomareobasac [1]. literaturasi mcirea monacemebi am sakitxis Sesaxeb. zogi avtori arnisnavs, rom hemofiliis dros Trombocitebis raodenobrivi da funqciuri macveneblebi normaluria [3], zogi ki, fazakontrastuli metodit gamokvlevisas, miutitebs mat mnisvnelovan cvlilebebze [4]. zemotqmulidan gamomdinare, miznad davisaxet kompleqsuri metodebit Segveswavla Trombocitebis morfofunqciuri mdgomareoba hemofiliis dros. kerzod, optikuri da fazakontrastuli mikroskopita da citoqimiuri reaqciebit, daavadebis simzimis gatvaliswinebit, recidivisa da remisiis dros.

36 gamokvlevebi Catarebuli iyo 34 avadmyofze. Ffazakontrastuli mikroskopit Seswavlil iqna Trombocitograma da Trombocitebis adheziisa da agregaciis unari. citoqimiuri ingredientebidan vswavlobdit glikogensa da mjave fosfatazas Semcvelobas. gamokvleuli avadmyofebidan hemofiliis mzime formit daavadebuli iyo 22 pacienti, sasualo formit _ 9, msubuqi formit _ 3. rogorc hemofiliis mzime, ise sasualo formit daavadebuli pacientebi davyavit or-or qvejgufad: I qvejgufsi gaertiandnen avadmyofebi, romeltac uaxloes dreebsi arenisnebodat hemoragiuli movlenebi, II qvejgufsi ki avadmyofebi, romeltac gamokvlevamde, ukanaskneli ati dris ganmavlobasi, hemoragiebi ar hqoniat. gamokvlevebma gvicvena, rom Trombocitebis absoluturi raodenoba sisxlsi, mzime da sasualo formit daavadebulta sxvadasxva qvejgufsi, didad ar gansxvavdeboda ertmanetisagan da ZiriTadad zomierad iyo momatebuli. fazakontrastuli mikroskopit dadginda, rom mzime formit daavadebul avadmyofebs, romeltac uaxloes dreebsi hqondat he moragiuli gartulebebi (avadmyofta I qvejgufi), TrombocitogramaSi arenisnebodat aqtiuri Trombocitebis raodenobis momateba 90%-95% (norma -75%-87%, p<0.001). es formebi normis maral zrvarze hqonda (79%-87%) sasualo simzimis avadmyofta I qvejgufsac (uaxloes dreebsi hemoragiuli gartulebebit), avadmyofta II qvejgufsi ki aqtiuri Trombocitebis raodenoba rogorc mzime, ise sasualo formebis dros didad ar gansxvavdeboda normisagan (65%-75%), matulobda intaqturi Trombocitebis raodenoba 17-27% (norma - 2%-10%). rac Seexeba Trombocitebis spontanuri adheziis unars, misi macvenebeli hemoragiuli gartulebebit mimdinare SemTxvevebSi normis maral zrvarze an odnav momatebuli iyo rogorc mzime, ise sasualo formis dros (75%-81% da 72%- 80% Sesabamisad), agregaciis macvenebeli ki orive formis dros marali iyo (78%- 85% mzime formisas _ 78%-82% sasualo formis dros, norma - 39%-72%, orive SemTxvevaSi p<0,01). hemoragiebis garese mimdinare SemTxvevebSi spontanuri adheziisa da agregaciis macveneblebi rogorc mzime, ise sasualo formis dros iyo normaluri (adheziis indeqsi 57%-68%, agregaciis indeqsi 40%-52% mzime formisa da adheziis indeqsi 57%-64%, agregaciis indeqsi 60%-64% sasualo formis dros). orientirebuli fibrinuli qseli Trombocitebis garsemo, rac damaxasiatebelia janmrtel pirta TrombocitebisaTvis (sur.1), surati 1 orientirebuli fibrinuli qseli janmrteli adamianis Trombocitebis garsemo fazakontrastul mikroskopsi, periferiuli sisxli.

37 hemofiliis arc ert SemTxvevaSi ar arinisneboda (sur. 2). surati 2 Trombocitebis spontanuri adhezia da agregacia hemoragiuli gartulebebit mimdinare hemofiliis dros fazakontrastul mikroskopsi, periferiuli sisxli. Trombocitebis garsemo ar aris orientirebuli fibrinuli qseli. hemofiliit daavadebul avadmyofta sisxlis preparatebis sinatlis mikroskopit gamokvlevam gvicvena, rom, janmrteli pirebis Trombocitebisagan gansxvavebit, hemofiliit daavadebulta Trombocitebi gamoirceva mkvetrad gamoxatuli anizocitozit mikro- da makroformebis xarjze, giganturi da degeneraciuli formebic mcire raodenobit gvxvdeba. es cvlilebebi arinisneba yvela gamokvleul jgufsi im gansxvavebit, rom hemoragiebit mimdinare SemTxvevebSi Warbobs makroformebi. literaturis monacemebit, Trombocitebis makroformebi didi raodenobit gvxvdeba stimulebuli Trombocitopoezis dros [2]. savaraudoa, rom Cven SemTxvevebSic makroformebis siwarbe gamowveulia Trombocitopoezis stimulaciit, rac dakavsirebuli unda iyos uaxloes hemoragiebtan. Mmakroformebi mnisvnelovani raodenobit gvxvdeba avadmyofta im qvejgufsic, sadac hemoragiuli gartulebebi, ukanaskneli 10 dris ganmavlobasi, ar arinisneboda, magram hemofiliis mzime da sasualo formit daavadebulebs es gartulebebi saertod xsirad aqvt, rac unda iwvevdes Trombocitopoezis stimulacias. am avadmyofebsi Aamasve mowmobs Trombocitebis raodenobis momatebac. yvela avadmyofis sisxlis nacxsi gvxvdeboda Trombocitebis grovebi, rac, TavisTavad, mat normalur agregaciis unarze miutitebs. rac Seexeba citoqimiur macveneblebs, glikogenze dadebiti Trombocitebis raodenoba momatebuli iyo hemoragiit mimdinare SemTxvevebSi rogorc hemofiliis mzime, ise sasualo formebis dros da Seadgenda 70.30±1.40 (norma 53.05±1.23, p<0.02), gansakutrebit intensiuri iyo reaqcia Trombocitebis makroformebsi. literaturis monacemebit [5], Trombocitebis aqtiuri formebis, adheziisa da agregaciis marali macveneblebis dros arinisneba glikogenze dadebiti Trombocitebis raodenobis momatebac, rac Cveni SemTxvevebiTac vlindeba. mjave fosfatazaze dadebiti Trombocitebis raodenoba yvela qvejgufsi uaxlovdeba normas an odnav dabalia, sxvadasxva jgufsi raime gansxvaveba mjave fosfatazas aqtivobis mxriv ar SegvimCnevia, amitom isini gavaertianet da mogvyavs sasualo macvenebeli 6.29%±0.37 (norma %±0.43). amrigad, hemofiliit daavadebul avadmyofta Trombocitebis gamokvlevam rogorc sinatlis, ise fazakontrastuli mikroskopita da citoqimiuri metodebit SesaZlebloba mogvca, gamogvevlina Trombocitebis gaaqtiureba hemoragiuli gartulebebis dros, rac gamoixata aqtiuri formebis, makroformebisa da

38 glikogenze dadebiti Trombocitebis raodenobis, adheziisa da agregaciis macveneblebis momatebasi. Cveni azrit, es organizmis kompensatoruli Tvisebis gamovlinebaa, rac pirveladi hemostazistvisaa sawiro. l%!- %-- 3 *ö, % =ëü /å.=!=*2å!, 2, *, 2!%ìK%ö, 2%" C!, ãåì%-,ë,, j= ä.ìåä. =3* 0.cåë, *=ø", ë,, *= ä.ìåä. =3* k.cë% 2,, ä%*2.ìåä. =3* h.lå 2, =ø", ë,, *= ä.k, %ë. =3* e.g=!, äƒå, m.l=ìc%!,, u.på.", =ø", ë,, *= ä.k, %ë. =3* m.l=.=!=äƒå j=- åä!= ãåì=2%ë%ã,,, 2!= - 3ƒ, %ë%ã,, Šcr, ì. h.d ="=., ø", ë,, mhh ãåì=2%ë%ã,,, 2!= - 3ƒ, %ë%ã,,, ì. c.l3.=äƒå l%!-%--3 *ö, % =ëü /å.=!=*2å!, 2,*, 2!%ìK%ö, 2%" C!, ãåì%-, ë,,,ƒ3 å / 3 34 C=ö, å 2%" 3 å2%ì 2 å 2, ƒ=k%ëå"=,, ä=" % 2, *!%"%2å å,. o!, ìå å / ìå2%ä/ "å2%"%l, -=ƒ%*% 2!= 2 %L ì, *!% *%C,,, ö, 2%., ì, å *, å, ëåä%"=,, ( =ãë, *%ãå, *, ë3þ -% -=2=ƒ3), %C!åäåëå / =ã!åã=ö, % =, =äãåƒ, " = -3 *ö,, 2!%ìK%ö, 2%". b/ "ëå ==*2, "=ö, 2!%ìK%ö, 2%" C!, ãåì%!!=ã, å *,. % ë% å,.: C%"/øå, å, ë==*2, " /. 2!%ìK%ö, 2%", ì=*!%-%!ì, C%ë%, 2åëü /. =ãë, *%ãå 2!%ìK%ö, 2%", =2=* å C%"/øå, å,. =äãåƒ, " %L, =ã!åã=ö, % %L C% %K % 2,. Morpho - Functional Characteristics of Thrombocytes in cases of Hemophilia Ts.Gelikashvili, L.Glonti, I.Mestiashvili, E.Zaridze, N.Mamphoria, Kh.Rekhviashvili, N.Makharadze Morpho functional characteristics of thrombocytes in 34 cases of haemophilia were studied taking into consideration haviness of the disease and remoteness of haemorrhage. Light and phasecontrast microscopy and cytochemical methods ( for glycogen and acide phosphatase), as well as adhesion and aggregation tests were used. Activation of thrombocytes in cases of haemorrhagic complications were revealed: increased number of active thrombocytes, macroforms and glycogen-positive thrombocytes as well as intensification of their aggregation and adhesion function. literatura: k, 2å!=23!=: 1. kasperi k.k. _ hemofiliisa da fon vilebrandis daavadebis mkurnalobis protokoli, hemofilia, hemofiliis msoflio federaciis mier gamocemuli monografiebis krebuli, gamomcemloba `evro~, Tbilisi, 2003 w. gv a å! = 3 x2. _ jë,, å *= ãåì=2%ë%ã,, a3.=!å 2,1985, b%!%küå" `.h., a =!*=ã% g.q., a!, ë, = 2 l.d., dåì, ä%"=`.b. _ qc!="%, * C!=*2, å *%ã%"!= =, 2. I, 1990, " ãë="å œ a%ëåƒ,, 2åì/ *!%"/, 2! l=*=ë=2, = 0.q. _ t=ƒ%*% 2!= 2 = ì, *!% *%C, " *ë,, *%-ãåì=2%ë%ã, å *,., ëåä%"=, L. `="2%!å-. ä%*2. ä,., c ë% 2, k.l. _ låã=*=!, %ö, 2%-Cë= 2, =2/L =CC=!=2 " %!ìå, C!, ì, åë%c!%ë, -å!=2, " /. ƒ=k%ëå"=,. (.!%, å *, L ì, åë%ëål*%ƒ, % 2å%ì, åë% *ëå!%ƒ,.!, 2!åì, ), ="2%!å-. j= ä.d,.,1971.

39 hojkinis limfomis dros CD95 antigenis eqspresiis prognozuli mnisvneloba i. datikasvili-davidi saqartvelos saxelmwifo samedicino akademiis hematologiisa da transfuziologiis katedra sakitxis aqtualoba: onkohematologiur daavadebata mkurnalobis saqmesi arsebuli warmatebebis miuxedavad, dremde ert-ert umtavres problemad rceba hemoblastozebis qimiaterapiisadmi mgrznobelobis winaswari gansazrvra, rac mkurnalobis diferenciuli taqtikis SemuSavebis sasualebas izleva. cnobilia, rom ujredta programuli kvdoma, erti mxriv, gansazrvravs mraval daavadebata patogenezs da amave dros medikamentebis samkurnalo efeqti swored darrveuli apoptozis ardgenazea damyarebuli, rac xorcieldeba rogorc pirdapiri, ise CD95 damokidebuli citotoqsikurobis gzit. yovelive zemoarnisnulidan gamomdinare, gansakutrebuli mnisvneloba eniweba CD95/Fas/Apo-1 antigenis eqspresiis Sefasebas onkohematologiur daavadebata mimdinareobis prognozirebasa da mkurnalobis taqtikis SemuSavebaSi. kvlevis mizani: miznad davisaxet ert-erti apoptozuri markeris _ CD95/Fas/Apo-1 prognozuli mnisvnelobis dadgena hojkinis limfomis mimdinareobasa da qimiaterapiisadmi mgrznobelobis winaswar SefasebaSi. sakvlevi masala da gamoyenebuli metodebi: pacientebi wlebsi mkurnalobdnen saxelmwifo samedicino akademiishhematologiisa da transfuziologiis katedris klinikasi. periferiuli limfocitebis spontanuri 24-saaTiani apoptozis gansazrvra xdeboda Tbilisis saxelmwifo universitetis imunologiis katedris laboratoriasi. dakvirvebis qves imyofeboda hojkinis limfomit daavadebuli 50 avadmyofi, romlebsac mkurnaloba CautardaT qimiaterapiis sqemebis ( BEACOPP, EPOCH, OEAP, ABVD, CEVD, LABO, OPPA, CEM, Dexa-BEAM, DHAP ) mixedvit. gamokvleulta asaki meryeobda 15-dan 75 wlamde. daavadebis stadia ganisazrvreboda 1971 wels q. anarborsi mirebuli klasifikaciis mixedvit. avadmyofebis riskis jgufebad dayofa xdeboba `saertasoriso prognozul faqtorta proeqtis~ (International Prognostic Factors Project (IPFP)) Sesabamisad. sawyis etapze klinikur-hematologiur monacemebtan ertad, yvela pacients, gamdinare citometris ( Becton& Dickinson ) gamoyenebit, Cautarda periferiuli limfocitebis CD95/FAS/APO-1 antigenis eqspresiis gansazrvra anti-fas fluorescinizocianattan (FITC)-koniugirebuli Tagvis monoklonuri antisxeulebit (mka) ( Dako ). saerto gadarcenadobis gamotvla vawarmoet aqtuarialuri metodit (a å! ƒ*, d. 1982). mirebuli Sedegebi da mati gansja: Fas antigenis mixedvit, avadmyofta gadarcenadobis Sefasebis Sedegad armocnda, rom CD95 uaryofit pacientta

40 (CD95<25%) saerto gadarcenadoba iyo 53%, xolo antigenis pozitiuri eqspresiisas (CD95>25%) _ 81% (diagrama 1). diagrama 1 avadmyofta saerto gadarcenadoba CD95 antigenis eqspresiis mixedvit IPFP prognozuli jgufebisa da APO-1 antigenis eqspresiis mixedvit, avadmyofta saerto gadarcenadobis analizit nateli gaxda, rom dabali avtvisebianobis jgufebsi CD95 uaryofit da dadebit pacientta gadarcenadobam Seadgina 67% da 81%,xolo prognozulad araketilsaimedo jgufsi Sesabamisad _ 50% da 80% (diagrama 2). diagrama 2 avadmyofta saerto gadarcenadoba CD95 antigenis eqspresiis mixedvit TiToeul prognozul jgefsi amrigad, hojkinis limfomis mimdinareobis gansasazrvrad SegviZlia rekomendacia gavuwiot CD95 antigenis raodenobrivi Sefasebis gamoyenebas rogorc damoukidebeli prognozuli faqtoris, ise IPFP damatebiti kriteriumis saxit.

41 o!%ã % 2, )å *%å ƒ =)å, å.* C!å,, = 2, ãå = CD95 3 C=ö, å 2%" K%ëåƒ üþ u%ä *, = h.c. d=2, *=ø", ë,-d=", ä, j=- åä!= ãåì=2%ë%ã,,, 2!= - 3ƒ, %ë%ã,, c% 3ä=! 2"å %L ìåä, ö, *%L =*=äåì,, c!3ƒ,, `C%C2% 2, å *, å = 2, ãå /, ã!=þ2 "åä3?3þ!%ëü *=* " C=2%ãå åƒå, 2=*, " %öå *å 3" 2", 2åëü % 2, * ö, 2% 2=2, å *, ì C!åC=!=2=ì C!, au. 0 åëüþ!=k%2/ "ë ë% ü "/ "ëå, å "%ƒì% %L *%!!åë ö,, ìå ä3.* C!å, ål CD95/Fas/A po-1= 2, ãå =, 2å å, åì a u. lå2%ä%ì C!%2% %L ö, 2%ìå2!,, Cåö, -, å *, ì, = 2, -CD95 ì/ ø, / ì, = 2, ãå =ì, C!%, ƒ"%ä, ë% ü, ƒìå!å, å 24- = %"%ã% C% 2= %ã%=c%c2%ƒ= Cå!, -å!, å *,. ë, ì-%ö, 2%" 48 K%ëü /. a u " "%ƒ!= 2å %2 15 ä%75 ëå2. nk?= "/, "=åì% 2ü (nb)cd95- åã=2, " /. (25%)%*=ƒ=ë= ü!=" %L 53%, =C!, C%ë%, 2åëü %L.* C!å,, -81%. o!, = =ë, ƒå nb " %2äåëü /. IPFP C!%ã % 2, å *,. ã!3cc=. %*=ƒ=ë% ü, 2%" ã!3ccå, ƒ*%ã%!, *=" CD95(), CD95(+) C%äã!3CC=. nb K/ ë=67%, 80%, =" ã!3ccå "/ %*%ã%!, *=C!, CD95(-)nb!=" ë= ü 50%,.%2 C!, CD95(+)- 81%. qëåä%"=2åëü %, C!, au C%ƒ, 2," =.* C!å, CD95 = 2, ãå = "ë å2.%!%ø, ì C!%ã % 2, å *, ì -=*2%!%ì *=* =ì% 2% 2åëü %, 2=*, " = %ö, =ö,, IPFP *!, 2å!, ì,. The prognostic significance of apoptosisrelated CD95 antigen expression in patients with Hodjkin s Disease I. Datikashvili-David Apoptosis-related proteins might play an important role in pathogenesis and sensibility to the chemotherapeutical drugs in patients with Hodjkin s Disease. In the study the author tried to find out the relation between the expression of CD95/Fas/Apo-1 antigen and clinical outcome of HD patients. 24-hour spontaneous apoptosis of peripherial lymphocytes on flow cytometer using specific monoclonal anti-cd95 mouse antibodies in 48 patients aged 15-75yy have been measured. Fas expression proved to be a significant prognostic factor in predicting overall survival (OS) because in CD95 - (<25%) pts. OS was 53% vs. CD95 + _ 81%. After grouping pts. by IPFP score in low risk-group in Fas negative and positive cases OS occurred to be 67% and 80%, although in unfavorable risk-group the OS values differed according to the CD95 expression 50% vs. 81%. So it can be concluded that Apo-1 positive expression appears to be predictive of good overall survival as an independent prognostic parameter and in association with IPFP criteria as well. literatura: k, 2å!=23!=: 1. b%ë*%"=l.`. _ jë,, å *= % *%ãåì=2%ë%ã, Astar Winoto _ Cell death in the regulation of immune responses~ Current Opinion in Immunology 1997, 9: ; 3. Gruszka-Westwood A. M., Hamoudi R. A. et al. _ p53 abnormalities in splenic lymphoma with villous lymphocytes~ Blood, June 1, 2001; 97(11): P. R.K. Koduru, K. Raju et al. _ Correlation Between Mutation in P53, p53 Expression, Cytogenetics, Histologic Type, and Survival in Patients With B-Cell Non-Hodgkin s Lymphoma~ Blood, November 15, 1997; 90(10): Sang-Kyun Sohn, Jong-Gwang Kim, Tae-in Park et al. _ The prognostic significance of apaptosis-raleted proteins in Korean patients with diffuse large D-cell lymphoma~. Annals of Oncology, 2002, Vol.13, Supplement 5 pp-121.

42 mwvave leikemiis sxvadasxva stadiisas SratSi rkinis macveneblebi da eritromorfograma x.rexviasvili, biol.mecn.kand e.zarize, med.mecn.doqt. i.mestiasvili, biol.mecn.kand. n.maxaraze, med.mecn.kand. c.gelikasvili, biol.mecn.kand. m.dolaberize iv. javaxisvilis saxelobis Tbilisis saxelmwifo universitetis hemofiliisa da transfuziologiis katedra, gr. muxazis saxelobis hematologiisa da transfuziologiis samecniero-kvleviti instituti mwvave leikemiis mravalmxrivi kvleva gasuli saukunidan irebs sataves [1,3]. dedamiwis ekologiuri fonis gauaresebisa da daavadebis sixsiris matebis gamo, gansakutrebit aqtualuri xdeba XX saukunis meore naxevridan [1,6,7]. Cveni winaswari dakvirvebit, hemoglobinis dabali donis miuxedavad, mwvave leikemiit daavadebulebsi feradobis macvenebeli normis farglebsia an marali, rac specialur literaturasic aris arnisnuli, Tumca, gansxvavebuli monacemebic arsebobs [2,4,5]. TiTqmis Seuswavlelia eritrocitebis morfologiuri maxasiateblebi, eritrocituli indeqsebi, rkinis cvla. zemotqmulidan gamomdinare, miznad davisaxet Segveswavla periferiuli sisxlis witeli Stos macveneblebi mwvave leikemiis sxvadasxva stadiaze. gamovikvliet mwvave leikemiis sxvadasxva variantit daavadebuli 22 pacienti, mwvave mieloblasturit _ 5, mwvave monoblasturit _ 4, mwvave mielo-monoblasturit _ 4, mwvave limfoidurit _ 4, mwvave aradiferenciulujredovanit _ 2, mwvave eritromielozit _ 3, dinamikasi (gaslili stadia da pirveli remisia). sisxlis saerto analizis garda (aqcentit eritrocitebis morfologiaze), vsazrvravdit SratSi rkinis dones, rkinis SeboWvis saerto unars, Tavisufali transferinis dones da transferinis rkinit gajerebis koeficients. rogorc Cvenma gamokvlevebma gvicvena, mwvave leikemiis gaslil stadiaze ocdaoridan oc pacients (90%) arenisneboda hemoglobinis dabali done 31g/l- 110g/l farglebsi, eritrocitebis raodenoba meryeobda 0.67¾X 10¹²l 3.7 X 10¹²l farglebsi, Fferadobis macvenebeli normis farglebsi meryeobda an aremateboda normas amave pacientebis eritromorfogramasi arinisneboda zomieri anizocitozi mikro- da ZiriTadad makrocitebis xarjze, umnisvnelo poikilocitozi, normoqromia an midrekileba hiperqromiisaken, cremlismagvari eritrocitebis siwarbe. pacientta amave jgufsi Sratis rkinis done marali iyo (27.3 mkmoli/l mkmoli/l) ocdaoridan oc SemTxvevaSi. aseve normaze marali iyo transferinis rkinit gajerebis koeficienti (41% - 69 %). amave pacientebis rkinis SeboWvis saerto unari normis farglebsi meryeobda (60.1 mkmoli/l 70.3 mkmoli/l), xolo Tavisufali transferinis done normaze dabali iyo (18.8 mkmoli/l 29.4 mkmoli/l). gaslil stadiasi gamokvleuli 22 pacientidan gamonakliss warmoadgenda ori (10%), romeltac feradobis macvenebeli normaze dabali hqondat (0.76 ; 0.78 ). amave dros eritromorfogramasi arenisnebodat zomieri mikrocitozi hipoqromiisadmi midrekilebit. Sratis rkinis done normaze dabali hqondat (10.7 mkmoli/l da 11.3

43 mkmoli/l), aseve normaze dabali iyo transferinis rkinit gajerebis koeficienti (14 % da 15 %). amave pacientebs arenisnat rkinis SeboWvis saerto unaris (74.6mkmoli/l da 72.3 mkmoli/l) da Tavisufali transferinis normaze marali macvenebeli (63.9 mkmoli/l da 61,0 mkmoli/l). orive pacients arenisneboda gazlierebuli hemoragiebi. rac Seexeba remisiis stadias, ocdaorive pacients hqonda askara tendencia hematologiuri parametrebis normalizebisaken: Hhemoglobini 120 g/l 132 g/l, eritrocitebis ricxvi 3.8 X 10¹² l X 10 l, feradobis macvenebeli eritromorfogramasi _ mxolod umnisvnelo anizocitozi. SratSi rkinis macveneblebis Seswavlisas gamovlinda, agretve, tendencia normalizaciisaken. Sratis rkinis done normasi iyo (14,6mkmoli/l 25,8 mkmoli/l), normis farglebsi meryeobda rkinis SeboWvis saerto unari (50,5mkmoli/l 70,2mkmoli/l), Tavisufali transferinis done (36,4mkmoli/l 50,3mkmoli/l) da transferinit rkinis gajerebis koeficienti (21% - 35%). amrigad, mwvave leikemiis sxvadasxva variantit daavadebuli pacientebis periferiuli sisxlis witeli Stos gamokvlevam gvicvena, rom gaslil stadiaze damaxasiatebelia eritromorfogramasa da rkinis cvlasi darrveva, rac askara tendencias avlens pirveli remisiis stadiaze normalizebisaken. o%*=ƒ=2åë, /"%!%2%) %ã% åëåƒ=,.!, 2!%ì%!- %ã!=ìì= =!=ƒë, ) /. 2=ä,. % 2!%ã% ëål*%ƒ= u.på.", =ø", ë,, *= ä.k, %ë. =3* e.g=!, äƒå, ä%*2.ìåä. =3* h.lå 2, =ø", ë,, *= ä.k, %ë. =3* m.l=.=!=äƒå, *= ä.ìåä. =3* 0.cåë, *=ø", ë,, *= ä.k, %ë. =3* l.d%ë=kå!, äƒå j=- åä!= ãåì=2%ë%ã,,, 2!= - 3ƒ, %ë%ã,, Šcr, ì. h.d ="=., ø", ë,, mhh ãåì=2%ë%ã,,, 2!= - 3ƒ, %ë%ã,,, ì. c.l3.=äƒå nk ëåä%"= %22 C=ö, å 2=% 2!%L ëål*åì, L "!=ƒ"å! 32%L 2=ä,,, C!, Cå!"%L!åì,,,. hƒ3 =ë, ü C%*=ƒ=2åë, /"%!%2% %ã% åëåƒ=,.!, 2!%ì%!-%ã!=ìì=. b 90% ë3 =å" 3 2= %"ëå %C%"/ øå, å 3!%" / "%!%2% %ã% åëåƒ=, C%, å, å %K?åL åëåƒ% " ƒ/ "=þ?ål C% %K % 2, / "%!%2*, *!%",, C%, å, å 3!%" "%K%ä %ã% 2!= -å!, =, C%"/ øå, å *%.--, ö, å 2= = /?å, å 2!= -å!, = åëåƒ%ì. b.!, 2!%ì%!-%ã!=ììå %2ìå =ë 3ìå!å / L =, ƒ%ö, 2%ƒ ƒ= å2 ì=*!%ö, 2%", %!ì%.!%ì,,ë, *ë% % 2ü * ã, Cå!.!%ì,,, =ë,, å ëåƒ%", ä /..!, 2!%ö, 2%". o!, Cå!"%L!åì,,, *% 2=2,!%"= = " = 2å äå ö, * %!ì=ë, ƒ=ö,,, ƒ3 å /. C=!=ìå2!%".

44 SERUM IRON AND ERYTROMORPHOGRAMME IN DIFFERENT STAGES OF ACUTE LEUKEMIA Kh.Rekhviashvili, E.Zaridze, I.Mestiashvili, N.Makharadze, Ts.Gelikashvili, M.Dolaberidze 22 patients on different stages of acute leukemia have been investigated. Serum iron and erytromorphogramme were studied. Increased levels of serum iron, decreased total ironbinding capacity, decreased transferring level and increased transferring iron saturation were revealed. Anisocytosis due macrocytes, normo- or hyperchromie, numerous tear drops were mentioned in erytromorphogramme of patients in developed stage of the disease. In the presence of first remission marked tendention to normalization of parameters studies was revealed. literatura: Ëèòåðàòóðà: 1. SeylaSvili m., zedginize i., Tanaavt. _Lleikozebi da avtvisebiani limfomebi, Tbilisi, 1996 w. gv a å! = 3 x2. _ jë,, å *= ãåì=2%ë%ã, b%!%küå" `.h. _ p3*%"%ä 2"% C%ãåì=2%ë%ã,,. l% *"= Dick JE. _ Assays for human leukemic stem cells. Hematology. 1999: [RTF bookmark start: R168][RTF bookmark end: R168]. 5. Griffin J, Löwenberg B. _ Clonogenic cells in acute myeloblastic leukemia. Blood. 1986;68: [RTF bookmark start: R166][RTF bookmark end: R166] [Medlaine]. 6. Takahashi; Hoshuyama, Tsutomu; Pan Guowei; Feng Yiping _ Geographical correlation between ambient UVB level and mortality risk of leukemia in Japan ; VOL. 92 ; ISSUE: 2 ; PII: S ; Copyright (c) 2003 Elsevier Science B.V., Amsterdam, The Netherlands. 7. Josie Golden _ New evidence of radiation risk in childhood leukaemia. 7-Sep-2004.

45 samedicino ekologia mosaxleobis janmrtelobaze garemo faqtorebis uaryofiti zemoqmedebis analizi med.mecn.kand. i. farava, prof. a. fircxalava, med.mecn.kand. m. lasxauri, m. grzelisvili, q. kiknaze, n. SubiTiZe g. natazis saxelobis sanitariisa da higienis samecniero-kvleviti instituti mosaxleobis janmrteloba qveynis ekonomikuri, inteleqtualuri da kulturuli potencialis ganmsazrvreli ert-erti macvenebelia. sazogadoebrivi janmrtelobis dacvis sakitxebtan dakavsirebuli problemebis gadawyvetisas saxelmzrvanelod mirebul unda iqnes janmrtelobis dacvis msoflio organizaciis (janmo) elementaruli mititebebi, romlebic gulisxmobs garemos obieqtebis sanitariulepidemiologiur da ekologiur ketilsaimedoobas, rogorc janmrtelobis mdgomareobis Sefasebisa da profilaqtikuri RonisZiebebis gatarebis aucilebel pirobas. Tanamedrove koncefciit `janmrteloba~ aris adamianis sruli fizikuri, fsiqologiuri sijansare, ekologiuri, sanitariul-epidemiologiuri da socialuri ketildreoba. ukanasknel wlebsi garemos iset faqtorebze, rogoricaa atmosferuli haeri, wyali, niadagi, sakvebi produqtebi, gaizarda kompleqsuri datvirtva, romelsac arastabiluri xasiati da zrdis araketilsasurveli tendencia aqvs wlis janmo-s eqspertta monacemebit, yvela daavadebis 23% da daregistrirebuli onkologiuri patologiebis 25% gapirobebulia garemo faqtorebis zemoqmedebit. proeqtis _ `adamianis genomis~ (Environmental Genome Project) _ Sedegebis mixedvit, arsebobs 200-ze meti geni, romelic akontrolebs adamianis mier garemo faqtorebit gamowveuli daavadebebis mimreblobas. amdenad, sistemasi `saarsebo garemo _ adamianis janmrteloba~ kvlevis Catareba metad aqtualuria (1,2). Tanamedrove literaturis monacemebi, axlandeli da momdevno Taobebis janmrtelobaze dabinzurebuli garemos moqmedebit gamowveuli patogenetikuri Sedegebis Sesaxeb, gvkarnaxobs am problemis saxelwifoebriv doneze gadawris aucileblobas, janmrtelobisa da garemos dacvis sferosi iseti regionuli politikis SemuSavebas, romelic aqtiurad gamoiyenebs axal teqnologiebs. mosaxleobis janmrtelobaze garemo faqtorebis uaryofiti zemoqmedebis riskis Semcirebisa da profilaqtikuri RonisZiebebis SemuSavebisaTvis didi mnisvneloba eniweba socialur-higienuri monitoringis sistemis (shms) ganxorcielebas. socialur-higienuri monitoringi dafuznebulia garemo faqtorebsa da mosaxleobis janmrtelobis mdgomareobas Soris mizez-sedegobrivi kavsiris gamovlenaze, janmrtelobis mdgomareobis Sesaxeb monacemta bazis Seqmnasa da analizze, mravalwliani gamajansarebeli RonisZiebebis SemuSavebasa da sazogadoebis informirebaze. shms-is danergvit srulfasovnad ganxorcieldeba rogorc higienuri, ise garemo faqtorebis moqmedebit gamowveuli janmrtelobis

46 winanozologiuri mdgomareobis diagnostika da pirveladi profilaqtika. am sistemis efeqtianobis miznit, aucilebelia sxvadasxva profilis specialistebis koordinirebuli moqmedeba, xolo RonisZiebebis gasatareblad gadawyvetilebebis momzadebasa da Sesrulebaze _ sxvadasxva uwyebis (adgilobrivi mmartvelobisa da TviTmmarTvelobis organoebis, sanitariuli zedamxedvelobisa da garemos dacvis samsaxurebisa da sxv.) pasuxismgebloba. monitoringi sanitariuli zedamxedvelobis samsaxurebs aniwebs rogorc sazedamxedvelo da makontrolebel, ise kvlevit da diagnostikur funqcias, ritac profilaqtikuri medicina, sxva dargebisagan gansxvavebit, icavs `janmrteli adamianis janmrtelobas~ (2) wlidan saqartvelosi aqtiurad mimdinareobs Sromis, janmrtelobisa da socialuri dacvis saministros mier sanitariul-higienuri da epidemiologiuri normirebis ertiani saxelmwifo sistemis Seqmna, erovnuli normatiul-metoduri dokumentebis SemuSaveba da amoqmedeba. amjamad, qartul Tanamedrove sanitariul kanonmdeblobasi moqmedebs garemo faqtorebisatvis (haeri, wyali, niadagi, sakvebi produqti) higienuri normativebi, romlebic itvaliswinebs, daavadebebis pirveladi profilaqtikis miznit, mati mavneobis srul armofxvras an usafrtxo donemde dayvanas. aseve SemuSavebulia da moqmedebs sanitariuli kodeqsi, erovnuli samoqmedo gegmit _ `garemo da janmrteloba~. gansazrvrulia janmrtelobisa da garemos dacvis gasaumjobesebeli, konkretuli, mokle da grzelvadiani RonisZiebebi konkretuli uwyebebis ufleba-movaleobebit. sadreisod, aqtiurad mimdinareobs saerto evropul sivrcesi integraciis procesi. wylis higienis sferosi normatiuli sakanonmdeblo bazis Seqmnisa da srulyofis procesi saertoevropul motxovnebtan harmonizebastan ertad, moitxovs qveynis regionuli Taviseburebebis, klimatur-geografiuli pirobebis, ekonomikursocialuri mdgomareobis, garemo obieqtebisa da mosaxleobis janmrtelobis mdgomareobis aucilebel gatvaliswinebas. wylis obieqtebsa da mat Soris, wyalsacavebis wylisa da sarekreacio garemoze antropogenuri faqtoris zemoqmedebis masstabi da forma obieqturi da subieqturi xasiatis mizezebis gamo ki ar mcirdeba, aramed perspeqtivasi ufro mravalferovani xdeba, amitom mati kompleqsuri gamoyenebisas didi mnisvneloba eniweba swori wyaldamcavi politikis gatarebasa da iseti erovnuli standartebisa da normatiuli dokumentebis SemuSavebas, romelic uzrunvelyofs wyalmomaragebis wyaroebis sanitariuli dacvis, wylis obieqtebis sarekreacio zonebis (mat Soris wyalsacavebis) swor SerCevas, mowyobas, mat dacvas, sanitariul ketilsaimedoobas, janmrtelobisatvis sasmeli da sabanao wylis xarisxis usafrtxoebasa da Sesabamisi profilaqtikur-gamajansarebeli RonisZiebebis SemuSaveba-ganxorcielebas (3,4,5). wylis garemosatvis normatiuli bazis xarisxis asamarleblad mizansewonilia misi harmonizeba evropuli direqtivebis normebtan iset sakitxebsi, rogoricaa: 1. wyalsargeblobis martvis dagegmva; 2. wylis mdgomareobis gansazrvrisas Sefasebis principis gamoyeneba; 3. wylis obieqtebis sanitariuli dacvis zonebis registrebis SemoReba; 4. wylis garemosatvis sasisi nivtierebebis nusxis formireba; 5. Camdinare wylebis normirebis pirobebis, sasmeli da sabanao wylis xarisxis parametrebis dadgena; 6. wylis xarisxis normebis darrvevaze sanqciebis gamkacreba; 7. wylis resursebis mdgomareobis Sesaxeb informaciis miwodebis wesis gansazrvra (6,7).

47 am sakitxebis gadawyveta xels Seuwyobs saqartvelosi wyalsargeblobis martvis meqanizmebis evropul donestan miaxloebasa da wylis resursebis, rogorc udidesi simdidris, SenarCunebasa da gafrtxilebas. q%"!åìå /å C%ä.%ä/ * %öå *å %2!, ö=2åëü %ã% "ë,, - =*2%!%" %*!3 =þ?ål!åä/ = ƒä%!%"üå = åëå, j= ä.ìåä. =3* h. o=ã="=, C!%-. `. o,!ö.=ë="=, *= ä.ìåä. =3* l. k=ø.=3!,, l. c!äƒåë, ø", ë,, j. j, * =äƒå, m. x3k, 2, äƒå mhh =, 2=!,,, ã, ã, å /, ì. c. m=2=äƒå q%ãë= %ä= / ì %"!åìå %L ë, 2å!=23!/, C=2%ãå å2, å *, å C% ëåä 2",, "/ ƒ"= / å "ë,, åì ƒ=ã! ƒ %L %*!3 =þ?ål!åä/ =ƒä%!%"üå / åø åã%, K3ä3?åã%C%*=ëå, L, ", äå2åëü 2"3þ2 %K %ã!%ì %ì ƒ = å,, C!=", ëü %ã%c!%"åäå, "%ä%%.!= %L C%ë, 2,*,, =2=* å % å%k.%ä, ì% 2,!=ƒ!=K%2*, %!ì=2, " /. ä%*3ìå 2%", *%2%!/ å %Kå Cå =2 "/ K%!, 3 2!%L 2"%, =, 2=! %å Kë=ã%C%ë3, å c=, 2=! %-ƒ=?, 2 /. ƒ%, 2%, *%" C, 2üå"%ã%"%ä% =K å,, C!,.2%ì K%ëüø%å ƒ = å, å, ìåå2 %Kå Cå å, å *= å 2"=C, 2üå"%L, *3C=ëü %L "%ä/. må%k.%ä, ì%!=ƒ!=k%2=2ü, C!%"å 2, %%2"å2 2"3þ?, å %ƒä%!%", 2åëü %-C!%-, ë=*2, å *, å ìå!%c!, 2,. Modern Approaches of Estimation of Harmful influence of Environmental Factors on Health of Population i. Pagava, A. Pirtskhalava, M. Lashkhauri, M. Grdzelishvili, K. Kiknadze, N. Shubitidze Up to date literatory data on the pathogenic consequences caused by the influence of polluted environment on the health of the present and future generations points to the decisive importance of performing correct water protection policy by the government as well as working out state normative documents that guarantee choosing and equipping proper recreation zones for water objects (reservoir as well), ensuring their sanitary reliability, bathing water and beach soil proper quality, conducting appropriate sanitation and prophylactic operations. literatura: k, 2å!=23!=: 1. q=, 2=!,, ã, ã, å = ã q=, 2=!,, ã, ã, å =. 2001ã j%"=ë " `. _ c äå ë3 ø, å Cë,? e"!%c= lå2%ä, å *, å 3*=ƒ=, bng %Kåƒ%C= /. "%ä /.!åä=.,, C%ëüƒ3åì/. "!å*!å=ö, % /. öåë.. 5. c, ã, å, å *, å 2!åK%"=, * ƒ% =ì!å*!å=ö,, "%ä /. %KAå*2%" c nqš Concil Directive of 8 December 1975 concerting the Quality of bathing Water (76/160/EEC). 7. Jurnal officiel des Communautes Europeennes #L 327.

48 uretruli mikroflora fiziologiuri orsulobisa da sameano - ginekologiuri patologiis dros epidemiologia, meanoba-ginekologia n. borcasvili, prof. k. afridonize, prof. v. rexviasvili, biol.mecn.kand. m. gobecia, n. qsutasvili saqartvelos saxelmwifo samedicino akademiis mikrobiologiisa da epidemiologiis katedra, k. CaCavas saxelobis perinataluri medicinisa da meanobaginekologiis samecniero-kvleviti instituti sameano-ginekologiuri patologiebis diagnostikasi udidesi mnisvneloba aqvs laboratoriul gamokvlevebs. am TvalsazrisiT, gansakutrebit informaciulia vaginidan da cerviqsidan arebuli masalis morfofunqciuri Seswavla da igive masalis baqteriologiuri, virusologiuri, parazitologiuri da mikologiuri kvleva. zemoarnisnuli agentebi udides rols asrulebs vaginitebis, cervicitebis, baqteriuli vaginozis, urogenitaluri kandidozis, mikoplazmozisa da araspecifikuri infeqciebis dros [3,4,5]. vaginaluri biocenozis morfologiuri da mikrobiologiuri kvlevis safuzvelze SemuSavebulia qalis genitaliumis dabinzurebis anu sisuftavis xarisxis kriteriumebi [1,3]. miuxedavad imisa, rom sameano-ginekologiuri gamokvlevebisas masalis areba da Seswavla xdeba sami adgilidan uretridan, vaginidan da cerviqsidan, aqcentirebulad Seswavlis obieqti xdeba sasodan da cerviqsidan arebuli masala, xolo uretruli gamonadenis Seswavlas ratomrac meorexarisxovani roli eniweba da mis Sefasebas mxolod `damatebiti~ mnisvneloba aqvs. kulturaluri kvlevebi CanaTesebiT sakveb niadagebze mikroorganizmebis identifikaciit, sufta kulturis gamoyofit, antibiotikmgrznobelobis gansazrvrit sameano-ginekologiur dawesebulebebsi ZiriTadad tardeba vaginidan da cerviqsidan arebuli masalit. aseti kvleva uretruli sekretebis gamoyenebit SedarebiT isviatia. etiologiuri TvalsazrisiT, urogenitaluri sistemis morfofunqciuri siaxlovis pirobebsi apriorulad savaraudoa urologiuri sistemis infeqciebis kontaminaciis marali riski qalta genitaliumsi, gansakutrebit mwvave da qronikuli, specifikuri da araspecifikuri uretritebis, bartolinitebis, cistitebis, Tirkmlebis darmavali antebiti da veneruli daavadebebis dros. savaraudoa, rom am SemT xvevasi patogenezuri kavsiri uretrul da vaginalur biocenozebs Soris ormxrivia veqtoruli TvalsazrisiT da amave dros savaraudoa Sereuli urogenitaluri, e.w. miqst-infeqciebi, rogorc mwvave, ise qronikuli mimdinareobit. kvlevis mizans Seadgenda Segveswavla qalta uretruli mikroflora fiziologiuri orsulobisa da sxvadasxva ginekologiuri patologiis dros. Seswavlili iyo 52 qalis uretruli gamonadeni mikromorfologiurbaqterioskopuli metodebit da kulturaluri baqteriologiuri, mikologiuri da vaginaluri triqomonadebis saidentifikacio niadagebis gamoyenebit.

49 52 pacientidan fiziologiuri orsulobit iyo 22 qali, xolo ginekologiuri patologiit 30. uretruli masalis areba xdeboda steriluri tamponebit, xolo Camonafxekebis steriluri folkmanis kovzis gamoyenebit. nacxebs vrebavdit romanovski-gimzas da gramis wesit. mikrobiologiuri kvleva tardeboda sayoveltaod mirebuli metodebis gamoyenebit [2,6,7]. sokovani patologiebis saidentifikaciod CanaTesebi ketdeboda saburos niadagze, vaginaluri triqomonadebis saidentifikaciod ki TV niadagze (merki - germania). kvlevis pirvel etapze miznad davisaxet orsul qalebsi Segveswavla uretruli mikroflora orsulobis sxvadasxva periodsi. mtlianobasi Seswavlili iyo 22 orsuli qalis uretruli mikroflora kviris orsuli iyo 3, kviris 14, kviris 5. Seswavlili 22 orsuli qalis uretruli masalidan izolirebuli iyo 138 mikrobuli kultura, mirebuli Sedegebi moyvanilia pirvel cxrilsi. cxrili 1 uretris mikroflora orsul qalebsi mikroorganizmebi amotesvis sixsire %-Si S. epidermidis 81,8% C. albicans 59,0% TR.V 50,0% S. aureus 18,1% E. coli 18,1% difteroidebi 9,0% St. fecalis 4,5% rogorc moyvanili monacemebidan Cans, amotesvis sixsiris mixedvit, pirvel adgilzea S.epidermidis; Semdegzea safuarisebri soko Calbicans; metad StambeWdavia vaginaluri triqomonadebis xvedriti wili, romelic pacientta 50%-s gamoeyo; Tanabari raodenobitaa S. aureus da E. coli; Semdeg difteroidebi da bolos S. fecalis (enterokokebi.). monoinfeqcia gamoeyo 5 orsuls, rac Seadgens 22,7%-s da warmodgenilia S. epidermidis it; orsulta umravlesobas (17 pacienti 77,3%) arenisneboda Sereuli infeqcia, mat Soris: ormikrobiani asociaciit (S. epidermidis+ C. albicans, S. epidermidis + S. aureus, E. coli an difteroidebi +) - 27,2%; 8 orsulis (36,3%) uretrul florasi identificirebuli iyo sammikrobiani Sereuli infeqcia (S. epidermidis+, C. albicans +, TR.V). 3 orsul qals (13,6%) arenisna otxmikrobiani Sereuli infeqcia identuri SemadgenlobiT S.epidermidis + E.coli. + C.albicans + TR.V. kvlevis Sedegebma gvicvena, rom fiziologiuri orsulobis dros uretruli mikroflora stabilurad ertnairia orsulobis vadebis dinamikasi (5,5 kviridan kviramde) da eqvemdebareba im kanonzomierebas, romelic zemot warmovadginet. gansakutrebit saintereso iyo sxvadasxva ginekologiuri patologiis mqone qalebis uretruli floris kvlevis Sedegebi. Cven mier Seswavlili iyo 30 pacienti ginekologiuri patologiit. mat Soris: triqomonaduli kolpitit 9 pacienti, sokovani kolpitit 5, baqteriuli vaginozit 3, amenoreit 3, hiperprolaqtinemiit, qronikul adneqsitit, araspecifikuri vaginitit, sasvilosnos miomit 2-2 pacienti da sxva. sxvadasxva saxis ginekologiuri patologiis dros uretruli mikrofloris Seswavlis mikrobiologiuri kvlevis Sedegebi warmodgenilia meore cxrilsi.

50 cxrili 2 uretruli mikroflora ginekologiuri patologiis dros mikroorganizmebi amotesvis sixsire %-Si S. epidermidis 80,3% C. albicans 60,0% TR.V 30,6% E. coli 10,6% S. aureus 10,3% St. pyogenes 6,6% baqteroidebi 6,6% difteroidebi 6,6% rogorc moyvanili monacemebidan Cans, ginekologiuri pacientebis uretrul florasi dominirebs S. epidermidis, C. albicans, TR.V, E. coli, S. aureus, xolo Tanabari raodenobit gvxvdeba St. pyogenes, baqteroidebi da difteroidebi. ginekologiur pacientta uretrul florasi monoinfeqcia arenisneboda 6 pacients 20%, romelic ZiriTadad warmodgenilia S. epidermidis-it da SedarebiT isviatad - S. aureus it. Sereuli mikrobuli flora gamoeyo ginekologiur pacientta 80%-s, mat Soris 40% SemTxvevaSi es iyo ormikrobiani asociacia (S. epidermidis+ C. albicans; S. epidermidis + TR.V). sammikrobiani asociacia (S. epidermidis+ C. albicans, + TR.V) warmodgenili iyo 33,4%-Si. otxmikrobiani asociacia (S. epidermidis,+ C. albicans, + TR.V, +St. pyogenes an difteroidebi) ki 6,6%-Si. kvlevis SedegebiT, ginekologiuri patologiis dros, dominirebul etiologiur agentad gvevlineba gram (+) S. epidermidis. SeviswavleT arnisnuli mikrobis mgrznobeloba antimikrobuli preparatebisa da baqteriofagebis mimart, romelic mocemulia mesame cxrilsi.

51 cxrili 3 S.epidermidis-is mgrznobeloba antimikrobuli preparatebisa da fagebis mimart # antimikrobuli preparatebi amotesvis sixsire %-Si 1 oflotazi 93,7% 2 furamagi 90,6% 3 cefazolini 87,5% 4 ciprofloqsacini 84,4% 5 gentamicini 81,2% 6 doqsiciklini 71,8% 7 tercefi 71,8% 8 raciocefi 71,8% 9 levomicetini 71,8% 10 cefamezini 68,7% 11 ampioqsi 65,6% 12 5 noki 65,6% 13 rifampicini 65,6% 14 ampicilini 62,5% 15 amikini 62,5% 16 likacini 59,4% 17 klaforani 59,4% 18 norfloqsacini 53,1% 19 retarpini 50,0% 20 floqsani 50,0% 21 ampizidi 46,9% 22 tetraciklini 43,8% 23 metaciklini 43,8% 24 azrocini 43,8% 25 zinacefi 37,7% 26 penicilini - g 34,4% 27 cefaleqsini 34,4% 28 makropeni 34,4% 29 biseptoli 28,1% 30 uropimidi 21,9% 31 kanamicini 18,7% 32 penicilini 9,4% 33 sumetrolimi 6,3% # baqteriofagebi mgrznobeloba (%) 1 stafilofagi 59,4% 2 piofagi 42,2%

52 mirebuli Sedegebis mixedvit S.epidermidis-is Cven mier izolirebuli Stamebi karg mgrznobelobas avlenda oflotazis, furamagis, cefazolinis, ciprofloqsacinis, gentamicinis, doqsiciklinis, tercefis, raciocefis, levomicetinis, cefamezinis, ampioqsis, 5-nokis, rifampicinis, ampicilinis, amikinis, likacinis da klafo ranis mimart. sasualo mgrznobelobas - norfloqsacinis, retarpinis, floqsanis, ampizidis, tetraciklinis, metaciklinis, azrocinis da zinacefis mimart. xolo rezistentuli armocnda - kanamicinis, uropimidis, biseptolis, cefaleqsinis, penicilin G-is, sumetrolimis da penicilinis mimart. gansakutrebul yuradrebas imsaxurebs S.epidermidis-is stabilurad marali mgrznobeloba stafilokokuri da piofagebis mimart, rac mnisvnelovania praqtikuli TvalsazrisiT. amgvarad, Cven mier Catarebulma kvlevebma gvacvena rom, fiziologiuri orsulobis dros uretruli flora ZiriTadad warmodgenilia Sereuli mikrobuli florit - S.epidermidis, C.albicans, TR.V.-is SemadgenlobiT, xolo 22,7%-Si monoinfeqciis saxit gamoyofili iyo S.epidermidis. sainteresoa is faqti, rom uretruli mikrobiocenozi orsul qalebsi ertnairi iyo orsulobis mteli dinamikis periodsi. ginekologiuri patologiis dros (kolpiti, vaginozi, amenorea, hiperprolaqtinemia, adneqsiti, araspecifiuri vaginiti, sasvilosnos mioma da sxva) uretrul mikroflorasi dominirebs: S.epidermidis 80,3%, C.albicans, - 60%, TR.V. 30,6%, xolo SedarebiT isviatad gamoiyofoda E.coli, S.aureus, St.pyogenes, baqteroidebi. monoinfeqciebi arnisnuli iyo 20%-Si da warmodgenilia S.epidermidis-iT, xolo Sereuli infeqciebi ZiriTadad warmodgenili iyo S.epidermidis it, C.albicans it, TR.V. it iseve, rogorc normaluri orsulobis dros. etiologiurad S.epidermidis-is antimikrobuli preparatebis mimart mgrznobelobis Seswavlam gvicvena, rom es mikrobi maral mgrznobelobas inarcunebs aminoqinolebis, cefalosporinebis III da IV Taobis preparatebis, sintezuri penicilinebis, levomicetinis mimart. gansakutrebit sayuradreboa S.epidermidis is stabilurad marali mgrznobeloba baqteriofagebis mimart. Tu gavitvaliswinebt im faqts, rom saqartvelo baqteriofagebis meore samsobloa da atwleulebis manzilze CvenTan mzaddeboda maralefeqturi baqteriofagebi, mnisvnelovnad migvacnia mati farto klinikuri gamoyeneba sameano-ginekologiuri da urologiuri patologiis mkurnalobisatvis da misi prevenciisatvis rogorc sawarmoo seriis baqteriofagebis gamoyenebit, ise autofagebis SerCevis gzit, perspeqtiulia, agretve, fagebis kombinirebuli gamoyeneba antibiotikebtan da sxva sintezur antimikrobul preparatebtan, gansakutrebit Rru organoebis uretris, vaginis, sasvilosnos yelis adgilobrivi instilaciit, tamponadita da sefsisuri mdgomareobis dros intravenuri fagebis gamoyenebit.

53 r!å2!=ëü = ì, *!%- ë%!= C!, -,ƒ, %ë%ã, )å *%L Kå!åìå % 2,, =*3øå!%-ã, å*%ë%ã, )å *,. C=2%ë%ã,. m. a%!)=ø", ë,, C!%-. j. `C!, ä%, äƒå, C!%-. b. på.", =ø", ë,, *= ä.k, %ë. =3* l. c%kå),, m. jø32=ø", ë, j=- åä!= ì, *!%K, %ë%ã,,,.c, äåì, %ë%ã,, c% 3ä=! 2"å %L ìåä, ö, *%L =*=äåì,, c!3ƒ,,. m=3 %-, ëåä%"=2åëü *, L, 2, 232 Cå!, =2=ëü %L ìåä, ö, /, =*3øå! 2"=, ã, å*%ë%ã,,, ìå, j. )= ="= o!%"åäå / ì, *!%K, %ë%ã, å *, å, ëåä%"=, 3!å2!=ëü %L ì, *!%-ë%!/ å?, " ä, =ì, *å -, ƒ, %ë%ã, å *%L Kå!åìå % 2,, 3 K%ëü /.!=ƒë, / ì, ã, å*%ë%ã, å *, ì, C=2%ë%ã, ì,. nk =!3 å %, 2%3 Kå!åìå /. å?, " ä, =ì, *å 2!, ìå 2!%", " % %" %ì, "/ äåë å2 ìåø= = ì, *!%K = -ë%!= % 2%?=, ƒ S. epidermidis, C. albicans, TR.V. b ", äå ì% %*3ëü23!/ (22,7%)"/ äåë, ë S. epidermidis. r K%ëü /. *%ëüc, 2=ì,, "=ã, %ƒ=ì,, =ìå %!åål, ã, Cå!C!%ë=*2, åì, ål, =ä å*, 2=ì,, å Cåö, -, å *, ì, "=ã,, 2=ì,, ì, %ì%l, ä!., " ì, *!%-ë%!å 3!å2!/ ä%ì,,!%"=ë, S. epidermidis (80,31%), C. albicans (60%), TR.V. (30,6%), " % %" %ì ", äå ìåø= /., -å*ö, L. }2, %ë%ã, å *, ƒ =, ì/ ì %*=ƒ=ë ì, *!%K S. epidermidis, %K =!3, "ø, L "/ %*3þ 3" 2", 2åëü % 2ü * =ì, %., %ë% =ì, öå-=ë% C%!, =ì III-IV C%*%ëå,,, 2å2, å *, ì Cå, ö, ëë, =ì, ëå"%ì, öå2, 3. n %K/ L, 2å!å C!åä 2="ë å2 "/ %*= 3" 2", 2åëü % 2ü S. epidermidis * 2=-, ë%*%**%"%ì3, C, %K=*2å!, %-=ã3, 2%3*=ƒ/ "=å2 = å%k.%ä, ì% 2ü ø,!%*%ã%c!, ìå å,.2,. K=*2å!, =ëü /. C!åC=!=2%". Urethral Microflora with Physiological Pregnancy and Obstetric-Gynecologic Pathologies N. Borchashvili, K. Apridonidze, V. Rekhviashvili, M. Gobechia, N. Kshutashvili The authors present microbiological studies of urethral microflora of women in the dynamics of physiological pregnancy and during different gynecological pathologies. It was established that the women pregnancy dynamics is mainly characterized by compound microbe flora consisting of S. epidermidis, C. albicans and TR.V. In the form of monoculture S. epidermidis (22,7%) is notable. The urethral flora of the patients with gynecological pathologies (colpitis, vaginosis, amenorrhea, hyperprolactinemia, adnexitis, nonspecific vaginitis, myoma etc.) is dominated by S. epidermidis (80,3%), C. albicans (60%) and TR.V. (30,6%) mainly in the form of mixed infections. Etiologically important microbe S. epidermidis revealed high sensitivity towards aminochinols, cephalosporins III and IV generation preparations, synthesized penicillin and chloramphenicol. Of particular interest is high sensitivity of S. epidermidis towards staphylococci and pyobacteriophages that indicates to necessity of wide application of the preparations. literatura: k, 2å!=23!=: 1. gobecia m. vaginaluri mikroekologia normisa da patologiis pirobebsi. biologiur mecnierebata kandidatis samecniero xarisxis mosapoveblad warmodgenili disertaciis avtoreferati. 2. a,!ãå! l.n. # qc!="%, * C%ì, *!%K, %ë%ã, å *, ì, ",!3 %ë%ã, å *, ì ìå2%ä=ì, ëåä%"=,. l.: l åä, ö, =

54 3. j,!=e.t. # a=*2å!, =ëü / L "=ã, %ƒ. `"2%!å-. ä,. ä-!=ìåä. =3*.qo a. 1995, j=-=! *=- k.h., j%!ø3 %"=n.b., e -, ì%" a.`., b %ë%ä, m.m., j%!ø3 %" b.l. # fl }h, ! m=ƒ=!%"=e.j., c, ììåëü-=!k e.h., q%ƒ=å" k.c. # jë,, å *= ë=k%!=2%! = ä, =ã % 2, *=2003, 12, 2! o%*!%" *, L b.l., o %ƒäåå" n.j. # l åä, ö, *= ì, *!%K, %ë%ã,. c å%2=! ìåä, ö, =. l % *"= cxvir-xaxis baqteriuli floris gavlena kardioqirurgiuli operaciis Semdgom gartulebebze kardioqirurgia, infeqciuri sneulebebi n. jasiasvili, doc. a. nanuasvili, med.mecn.kand. a. cincaze, i. metreveli, m. CxaiZe, v. xelasvili, med.mecn.kand. e. mgelaze Tbilisis saxelmwifo samedicino akademiis infeqciur sneulebata katedra, jo enis saxelobis samedicino centri kvlevis mizani iyo bavsvta asaksi Segveswavla kardioqirurgiuli operaciis win cxvir-xaxis baqteriuli flora da patogenuri baqteriebis mtareblobis korelacia operaciis Semdgom periodsi ganvitarebul infeqciur gartulebata sixsiresa da etiologiastan. jo enis saxelobis bavsvta kardioqirurgiul klinikasi SeviswavleT 265 pacienti, romeltac 2002 wlis ianvridan 2004 wlis dekembramde CautardaT kardioqirurgiuli operacia. operaciis win, Cven mier Seswavlil pacientebs utardebodat cxvir-xaxis nacxis baqteriologiuri gamokvleva. 265 pacientidan patologiuri floris mtarebloba arinisna 116 SemTxvevaSi (44%), upiratesad gamovlinda gramdadebiti flora, kerzod, oqrosferi stafilokoki, romlis mtareblobam Seadgina 40%. 265 pacientidan operaciis Semdgom periodsi infeqciuri gartuleba arinisna 21 SemTxvevaSi (7,9%-Si). Cveni gamokvlevis mixedvit, cxvir-xaxasi arsebuli patologiuri flora ar zrdis operaciis Semdgom periodsi infeqciur gartulebata risks, Tumca gartulebebis etiologia korelaciasia patologiuri floris mtareblobastan.

55 adamianis cxvir-xaxa warmoadgens pirobit-patogenuri floris ert-ert ZiriTad rezervuars. miuxedavad imisa, rom xsiria asimptomuri mtarebloba, pirobit patogenuri baqteriebi warmoadgens mnisvnelovan etiologiur faqtors umetesi infeqciebis ganvitarebasi. bavsvta asaksi pirobit-patogenuri flora ZiriTadad warmodgenilia gramdadebiti baqteriebit, kerzod, stafilokokebita da streptokokebit [2,7,4]. mas Semdeg, rac ganvitarda oqrosferi stafilokokis rezistentoba penicilinis jgufis antibiotikebis mimart, is itvleba mzime hospitaluri infeqciebis gamomwvev ert-ert ZiriTad baqteriad. meticilin-rezistentuli stafilokokis (MRSA) pirveli SemTxvevebi dafiqsirda 1961 wels, mas Semdeg mtel msofliosi arinisneba MRSA-s gavrcelebis zrdis tendencia [3]. MRSA-Ti gamowveuli infeqciis mkurnaloba warmoadgens ert-ert mnisvnelovan problemas, radgan mas gaacnia rezistentoba yvela β-laqtamuri da sxva jgufis antibiotikis mimart. zemoarnisnuli zrdis avadobis xangrzlivobas da mnisvnelovnad azvirebs mkurnalobis Rirebulebas. arsebuli monacemebis mixedvit, ukanasknel wlebsi, aseve sagrznoblad moimata St. pneumoniae-s rezistentobis problemam [9]. bavsvta asaksi oqrosferi stafilokokis asimptomuri mtarebloba 24-50%-is [2,5,3], St. pneumoniea-is ki 8,6-40%-is farglebsi meryeobs [7,4,9,8]. St. pneumoniea-s mtarebloba SedarebiT maralia mcire asakis bavsvebsi. asakis matebastan ertad, mtareblobis macvenebeli SedarebiT mcirdeba. gramuaryofiti floris mtarebloba upiratesad hospitalizebuli da xandazmuli asakis pacientta Soris arinisneba da SedarebiT dabalia bavsvebsi. Tumca unda arinisnos, rom baqteriata mtareblobis macveneblebi SesaZloa gansxvavebuli iyos rogorc geografiulad gansxvavebul sxvadasxva regionsi, ise sxvadasxva populaciasic. zogierti kvlevis Sedegebis mixedvit, pirobit-patogenuri floris mtarebloba garkveul korelaciasia rogorc infeqciur gartulebata risktan, ise ganvitarebul infeqciata etiologiastan. aqedan gamomdinare, arsebobs rekomendaciebi, romlis mixedvitac perioperaciul periodsi rekomendebulia xaxis nacxis baqteriologiuri kvlevis Catareba, rac eqims orientacias azlevs gansazrvros SesaZlo infeqciuri gartulebebis riski. ganvitarebis SemTxvevaSi ki ifiqros savaraudo etiologiaze baqteriologiuri kvlevis Sedegebis mirebamde, Tumca arnisnuli mosazrebebi jer kidev sakamatoa [1,10,6]. Cveni kvlevis mizans Seadgenda Segveswavla bavsvebsi cxvir-xaxis baqteriuli floris mtarebloba kardioqirurgiuli operaciis win, Tu ra damokidebulebasia cxvir-xaxidan kultivirebuli patologiuri flora operaciis Semdgom infeqciur gartulebastan, kerzod, zrdis Tu ara am gartulebis ganvitarebis risks an warmoadgens Tu ara operaciis Semdgom infeqciuri gartulebis SesaZlo etiologiur faqtors. masala da metodebi. jo enis saxelobis bavsvta kardioqirurgiul klinikasi SeviswavleT 265 pacienti, romeltac 2002 wlis ianvridan 2004 wlis dekembramde CautardaT kardioqirurgiuli operacia. pacientta asaki meryeobda erti dridan 18 wlamde. yvela Catarebuli operaciis win pacientis cxvir-xaxidan xdeboda nacxis baqteriologiuri kvleva. kultivaciistvis, mikrobiologiuri identifikaciistvis gamoiyeneboda Bio Merioux (safrangeti) diagnostikumebi. Sedegebi da mati ganxilva. SeviswavleT 265 pacienti, romeltac CautardaT kardioqirurgiuli operacia. operaciis win cxir-xaxidan patologiuri flora amoetesa 116 pacients (44%). gamokv leul bavsvebsi, upiratesad, arinisna

56 gramdadebiti floris mtarebloba, saidanac dominantur patogens warmoadgenda oqrosferi stafilokoki, romlis kultivacia arinisna 106 SemTxvevaSi (40%), gramuaryofiti floris mtareblobam ki Seadgenda 4%, aqedan: nawlavis Cxiri-8 (3%), proteusi-1 (0,4%), Pseudomonas aeruginosa -1 (0,4%). 149 SemTxvevaSi cxvirxaxidan klinikuri mnisvnelobis patologiuri flora ar amoitesa. operaciis Semdgom periodsi infeqciuri gartuleba arinisna 21 SemTxvevaSi (7,9%- Si), aqedan cxvir-xaxis nacxis baqteriologiuri gamokvlevit patologiuri floris mtarebloba ar arenisnebodat 12 SemTxvevaSi (8%), xolo patologiuri floris mtareblobis dros ki 9 SemTxvevaSi (7,8%). pacientebs, romlebsac xaxis nacxis baqteriologiuri gamokvlevit arenisnebodat oqrosferi stafilokokis mtarebloba, infeqciuri gartuleba ganuvitardat 9 SemTxvevaSi, aqedan or SemTxvevaSi (1,9%-Si) operaciis Semdgomi infeqcia gamowveuli iyo oqrosferi stafilokokit, xolo im pacientebsi, romlebic ar warmoadgendnen oqrosferi stafilokokis mtareblebs, operaciis Semdgomi infeqciuri gartuleba arc ert matgansi ar iyo gamowveuli stafilokokuri florit. amrigad, mirebuli Sedegebis mixedvit, bavsvta asaksi operaciis win patologiuri floris mtareblobam Seadgina 44%, aqedan upiratesi mtarebloba modis gramdadebit floraze, kerzod, oqrosfer stafilokokze (40%). rac Seexeba gramuaryofiti floris mtareblobas, misi wili gacilebit umnisvneloa Seswavlil kontingentsi da Seadgens 4%-s. mirebuli Sedegebis mixedvit, operaciis Semdgom periodsi infeqciur gartulebata procentuli macvenebeli im pacientebs, romlebsac Catarebuli xaxis nacxis baqteriologiuri gamokvlevit arenisnebodat patologiuri flora, arsebitad ar gansxvavdeboda im pacientebsi ganvitarebuli infeqciuri gartulebebis procentuli macveneblisgan, romlebsac ar arenisnebodat patologiuri floris mtarebloba, magram ganvitarebuli operaciis Semdgomi infeqciis etiologia garkveul TanxvedraSi armocnda operaciis win cxvir-xaxis patologiuri floris mtareblobastan. aqedan gamomdinare, Cveni kvlevis monacemebis mixedvit, cxvir-xaxasi arsebuli patologiuri flora ar zrdis operaciis Semdgom periodsi infeqciur gartulebata risks, Tumca gartulebebis etiologia korelaciasia patologiuri floris mtareblobastan. bë,, å K=*2å!, =ëü %L - ë%!/ % %ãë%2*, = C% 2*=!ä, %.,!3!- ã, )å *, å % ë% å, m. d =ø, =ø", ë,, ä%ö. `. m= 3=ø", ë,, `. 0, ö=äƒå, *= ä.ìåä. =3* h. lå2!å"åë,, l. ).=, äƒå, b. uåë=ø", ë,, *= ä.ìåä. =3* e. lãåë=äƒå j=-åä!=, -å*ö, % /. ƒ=k%ëå"=, L c% 3ä=! 2"å %L ìåä, ö, *%L =*=äåì,, c!3ƒ,,, då2 *= *=!ä, %.,!3!ã, å *= *ë,, *=, ì. d %} =

57 d%*=!ä, %.,!3!ã, å *,. %Cå!=ö, L 3 äå2ål, ƒ3 =ë= ü K=*2å!, =ëü = -ë%!= % %ãë%2*,, C=2%ãå / å K=*2å!,,,*%!!åë ö, ìå ä3 =ë,, åì C=2%ë%ã, å *%L -ë%!/, = 2%2%L,.2, %ë%ã, ål, -å*ö, % /. % ë% å, L,!=ƒ", "=þ?,. " C% 2%Cå!=ö, % %ì Cå!, %äå. b äå2 *%L *=!ä, %.,!3!ã, å *%L *ë,, *å, ì. d %} =%K ëåä%"= %265 C=ö, å 2%", *%2%!/ ì "=! 2002 ã. ä%äå*=k!ü 2004 ã. K/ ë, C!%"åäå / *=!ä, %.,!3!ã, å *, å %Cå!=ö,,. d%%cå!=ö,, C!%"%ä, ë, ü K=*2å!, %ë%ã, å *, å, ëåä%"=, ì=ƒ*=, ƒ % %ãë%2*,. q!åä, 265 C=ö, å 2%" =ë,, å C=2%ë%ã, å *%L -ë%!/ "/ "ëå %3 116 (44%); C!å, ì3? å 2"å %ã!=ìc%ë%, 2åëü = -ë%!=: ƒ%ë%2, 2/ å 2=-, ë%*%**, (40%), ã!=ì åã=2, " = -ë%!=( 4%). h -å*ö, % / å % ë% å, "/ "ëå / 321(7,9%), ƒ 265. Š=*, ì %K!=ƒ%ì, C=2%ë%ã, å *= -ë%!= % %ãë%2*, å 3"åë,, "=å2!, *=, -å*ö, % /. % ë% å, L " C% 2%Cå!=ö, % %ì Cå!, %äå, %ä =*%.2, %ë%ã, C% 2%Cå!=ö, % /. *=!ä, %.,!3!ã, å */. % ë% å, L *%!!åë,!3å2 =ë,, åì C=2%ë%ã, å *%L -ë%!/. Correlation of nasopharyngeal bacterial flora with infectious complications following cardiac surgery A. Nanuashvili, N. Jashiashvili, I. Metreveli, A. Tsintsadze, M. Chkhaidze, V. khelashvili, E. Mgeladze The purpose of the research was to study the bacterial flora of nasopharynx, the carriage of pathogenic bacteria before the cardiosurgical operations in children, and the correlation of the carriage with the frequency and etiology of the infectious complications developed in the postoperative periods. At the Joe En Children s Cardiosurgical Clinic we studied 265 patients, who were operated during the period of time from January 2002 to December Before the operations the bacteriological investigation of the patients nasopharynx smears were carried out. In 116 cases (44%) out of 265 ones the carriage of pathological flora, mainly that of the gram-positive flora, particularly of the staphylococcus aureus, the carriage of which constituted 40% was observed. The gram-negative flora carriage was of 4%. In 21 cases (7.9%) out of 265 the infectious complications were observed in the patients in postoperative periods. According to the data of the research conducted, the pathological flora available in nasopharynx does not increase the risk of infectious complications in postoperative periods, although the etiology of infectious complications correlates with the carriage of pathological flora. literatura: k, 2å!=23!=: 1. Abdalla O. A. Ahmed, Alex van Belkum, Ahmed H. Fahal, A. E. Abu Elnor, El Sir A. M. Abougroun, Marjolein F. Q. VandenBergh, Ed E. Zijlstra, and Henri A. Verbrugh J _ Clin Microbiol December; 36(12): Aires de Sousa, I. Santos Sanches, Ferro M. L, Lencastre H. de. _ Microbial Drug Resistance. June 2000, Vol. 6, No. 2, Pages Henry F. Chambers, M.D Professor of medicine. _ The APUA Newsletter vol. 21 No Hörü Gazi, Semra Kurutepe, Süheyla Sürücüoglu, Asli Teker _ Indian J Med Res 120, November 2004, pp Hussain, Farid M.MD; Boyle-Nanra, Susan PhD; daum, Robert s. MD. _ Pediatric Infectious Disease Journal. 20(8): , August Kluytmans J A J W, Mouton J W, Ijzerman E P F, Vandenbroucke-Grauls C M J E, Maat A W P M, Wagenvoort J H T, Verbrugh H A. _ J Infect Dis 1995;171: Millar, M. R. WalshT. R., Linton C. J.Zhang., S., Leeming, J. P. Bennet P. M. _ Journal of Antimicrobial Chemotherapy (2001) 47, May 01.

58 8. Paola Marchisio, Susanna Esposito, Gian Carlo Schito, Anna Marchese, Roberta Cavagna, Nicola Principi, and the Hercules Project Collaborative Group. _ Emerg Infect Dis 8(5), Susan S. Chiu, Pak Leung Ho, Frankie. K.H.Chow,Kwok Yung Yuen, and Lung Lau _ Antimicrobial Agents And Chemotherapy, Oct. 2001, p Trish M.Perl, M.D., Joseph J.Cullen, M.D.,Richard P.Wenzel, M.D., M.Bridget Zimmerman, PHD. _ N Engl J Med, Vol. 346, No. 24 June 13, uretraprostatitebis mkurnaloba mgrznobiare antibiotikebit, proteolizuri fermentita da axtalis talaxit urologia, fizioterapia n. Savdia saqartvelos saxelmwifo samedicino akademia Tanamedrove venerologiis ert-ert aqtualur problemas warmoadgens mamakacis Sardsasqeso sistemis, kerzod, uretrisa da prostatis dazianeba rogorc gonoreuli, ise aragonoreuli infeqciisas. uretraprostatebis dros arinisneba reproduqciuli sistemisa da spermatogenezis darrveva, romlis SemTxvevaSi mamakacs SeiZleba ganuvitardes seqsualuri nevrastenia. is xdeba introventi, Sromis unars kargavs 25 %-it da socialurad araadaptirebul pirovnebad yalibdeba. infeqciuri uretraprostatitebis dros Seuswavlelia miqst-infeqciis gamomwvevi mikroorganizmebis mgrznobeloba-rezistentoba antimikrobuli preparatebis mimart da am preparatebis moqmedebis meqanizmi uretrasa da prostatis infiltraciul cvlilebebsa da reproduqciul sistemaze. Seuswavlelia, agretve, mgrznobiare antibiotikis, proteolizuri fermentis da axtalis talaxis gamoyenebis Semdeg reproduqciuli sistemis regulacia. Cvens mizans warmoadgens SevimuSaoT mkurnalobis originaluri metodi mgrznobiare antibiotikit,

59 proteolizuri ferment lidazit da eleqtrotalaxit, romelic gamoyenebuli iqna Sardsasqeso sistemasi trofikuli cvlilebebis regulaciisa da reproduqciuli sistemis koreqciisatvis. kvlevis masala da metodebi. masalad gamoviyenet prostatis wveni, uretris gamonadeni, sisxlis plazma. sekretis morfologiuri da baqteriaskopiuli SeswavlisaTvis gamoiyeneboda rogorc natiuri preparatebi, ise gramis wesit SeRebili nacxebi. baqteriologiuri kvleva tardeboda aerobuli floris standartuli metodit, xolo antimikrobuli preparatebis mimart mgrznobeloba-rezistentobas vswavlobdit diskodifuziis metodit. sisxlis plazmasi hormonebis Semcvelobis gansazrvrisatvis gamoviyenet imunofermentuli metodebi. mirebuli Sedegebi. gamovikvliet Semdegi mikroorganizmebi: Trichomona vaginalis, Candida albicans, Chlamidia trahomatis; Herpes I, II tipis virusi. CMV; Ureaplasma urealiticum; Micoplasma hominis, N. gonorrhoeae; S. pyogenes, S. Aureus. am mikroorganizmebis kulturebi maral mgrznobelobas icenda cefalosporinebis, aminoglikozidebis, linkozamidebis, ftorqinolinis, tetraciklinis jgufebis antibiotikebis mimart. infeqciuri uretraprostatitebis dros arinisneboda hiperprolaqtinemia, folida liutropinis dabali da progesteronis marali done da hormonuli fonis estrogenizacia. gamovikvliet infeqciuri uretraprostatitebit daavadebuli 150 avadmyofi da 80 donori. 150 avadmyofidan 40-s Cautarda etiopatogenezuri mkurnaloba tradiciuli metodebit, 110 avadmyofs ki Cven mier SemoTavazebuli originaluri mkurnaloba mgrznobiare antibiotikit, proteolizuri fermentita da axtalis talaxit. infeqciuri uretraprostatitebis dros mkurnalobis ert-ert efeqtur metods warmoadgens proteolizuri fermentis lidazis gamoyeneba. is aumjobesebs qimiapreparatis gamavlobas qsovilovani barieris gavlit, qmnis qimiapreparatis maral koncentracias daavadebul kerasi da acerebs nawiburis Camoyalibebis process. amitom viyenebdit lidazas mgrznobiare antibiotiktan ertad anusidan 2,5 sm mosorebit, saidanac prostatasi iqmneboda antibiotikis marali koncentracia. antibiotokebs vunisnavdit Sesabamisi sqemis mixedvit, 7-10 dris ganmavlobasi. prostatitebis dros viyenebdit talaxterapias. axtalis talaxterapiis sitburi, qimiuri da meqanikuri moqmedebisas umjobesdeba mikrocirkulacia da trofikuli procesebi. is astimulirebs nivtierebata cvlas, antebiti infiltratis gawovas, iwvevs nawiburis darbilebas da astimulirebs hipotalamur-hipofizur da simpatoadrenalur sistemebs. mas aqvs baqteriociduli moqmedeba, massi Sedis baqteriofagisa da antibiotikis Tvisebebis mqone nivtierebebi. talaxterapiis ert-erti efeqturi metodia talaxis eleqtroforezi, rodesac efeqts varwevt receptorebze denisa da talaxis qimiuri elementebis dadebiti moqmedebit. 1-2 wutis ganmavlobasi avadmyofs utardeboda prostatis masaji, Semdeg specialuri teqnologiit gamtbari talaxis reqtaluri tamponada da, bolos, prostatis midamosi _ eleqtroforezi, wutis ganmavlobasi. Cven mier SemoTavazebuli mkurnalobis Semdeg SeviswavleT hipofizur-gonaduri sistemis macveneblebi. sarwmunod gaizarda gonadotropinebis, foli- da liutropinis done, amarlda testosteronis Semcveloba janmrtelta donemde, rac satesle jirkvlebsi androgenopoezis ardgenaze miutitebs.

60 tradiciul mkurnalobastan SedarebiT, SemoTavazebuli mkurnalobis metodebis Semdeg, rbili infiltratis narceni movlenebi Semcirda 24 %-dan 14 %-mde, magari da gardamavali infiltratis SemTxvevaSi 22 %-dan 11 %-mde, palpatoruli cvlilebebis gaqrobis macveneblebi Semcirda 80 %-dan 20 %-mde. prostatis wvenis ardgenis vada Semcirda 120 dridan 57 dremde. Mmkurnalobidan 3 Tvis Semdeg, prostatis wvensi SenarCunebuli leikocitebis raodenoba Semcirda 34 %-dan 11 %- mde. amgvarad, mgrznobiare antibiotiki, proteolizur ferment lidazastan da axtalis talaxis samkurnalo procedurebtan kompleqssi iwvevs mikrobebis eliminacias, uretrasi gonadebisa da prostatasi trofikuli cvlilebebis regeneracias da reproduqciuli sistemis koreqcias. kå)å, å 3!å2!%C!% 2=2, 2%" )3" 2", 2åëü /ì = 2, K, %2, *%ì, C!%2å%ë, 2, )å *, ì - å!ìå 2%ì " *%ìk, =ö,, ã! ƒåëå)å, åì = *3!%!2å `.2=ë= m. x="ä, c% 3ä=! 2"å = ìåä, ö, *= =*=äåì, c!3ƒ,, n ä %L, ƒ =*23=ëü /. C!%Këåì %"!åìå %L "å å!%ë%ã,, "ë å2 C%"!å äå, å 3!å2!/, C!% 2=2/ *=* ã% %!ål %L, 2=*, åã% %!ål %L, -å*ö, ål. q öåëüþ!=ƒ!=k%2*, %!, ã, =ëü /. ìå2%ä%" ëå å, 3" 2", 2åëü / ì = 2, K, %2, *%ì C!%2å%ë, 2, å *, ì -å!ìå 2%ì ë, ä=ƒ%l,.ëå*2!%ã! ƒüþ, C!åä3 ì%2!å /!åã3ë ö, 2!%-, å *,., ƒìå å, L " ì% åc%ë%"%l, 2åìå, *%!!å*ö,!åc!%ä3*2, " %L, 2åì/. n K =!3 å / ì, *!%%!ã=, ƒì/ : Trichomona vaginalis, Candida albicans, Chlamidia trachomatis, b o c 1, bo c` 2, CMV, Ureoplasma urealiticum, Micoplasms hominis, N.gonorrhoeae, S. Pyogenes, S. Aureus, 3" 2", 2åëü / å * öå-=ë% C%!, =ì, =ì, %ãë, *%ƒ, ä=ì, ë, *%ƒ=ì, ä=ì, -2%!., %ë, =ì, 2å2!=ö, *ë, =ì. q%!%*=k%ëü / ì, ƒ 150 C!%"åë, 2!=ä, ö, % %å ëå å, å, % 2=ëü / ì 110 -= 2, K, %2, *%ì, -å!ìå 2%ì ë, ä=ƒ%l, ã! ƒüþ `.2=ë, *%ã%ìå 2%!% äå, " ", äå!å*2=ëü /. 2=ìC% %",.ëå*2!%-%!åƒ=. r 2= %"ëå % 3"åë, å, å 3!%" ã% =ä%2!%c, %", "% 2= %"ëå, å = ä!%ãå %C%.ƒ=, % 2=2% / å "ëå, ì ã*%ã%, -, ëü2!=2= %*!=2, ë, ü %2 24 ä%14 %; 2"å!ä%ã%, Cå!å.%ä? åã%, -, ëü2!=2=- %2 22 ä%11%. b% 2= %"ëå, å %*=C!åä 2=2åëü %L åëåƒ/ =Këþä=ë% ü " 2å å, å %2 120 ä%57 ä ål. )å!åƒ 3 ìå. C% ëå ëå å, *%ë, å 2"%% 2=2% /. ëål*%ö, 2%" " %*å C!åä 2=2åëü %L åëåƒ/ %*!=2, ë% ü %2 34 ä%11%. Treatment of Urethroprostatitis Using Sensitive Antibiotics, Proteolytic Ferment in Combination with Akhtala Mud N. shavdia Injury of urethra and prostate with neisserosis and unneisserosis infection is the most actual problem of up- to- data venerology. The aim of the work is to devise unique methods of treatment by means of sensitive antibiotic, proteolytic ferment and electromud that will be directed to the regulation of trophic changes in urogenital system and correction of reproductive system.

61 While examination the following microorganism: Trichomona vaginalis, Candida albicans, Chlamidia trachomatis, CMV, Ureoplasma urealiticum, Micoplasms hominis, N.gonorrhoeae, S. Pyogenes, S. Aureus, were revealed. The cultures of these microorganisms were sensitive towards cephalosporin, aminoglycoside, linkosamid, fluorquinoline, tetracycline. Out of 150 patients 40 ones have been subjected to traditional treatment, the rest underwent rectal tamponade and electrophoresis using antibiotic, ferment lydasa and Akhtala mud. The study of the indices of hypophysial and gonadal systems showed increased level of gonodotrophin, recovery of androgenesis; residual effects of soft infiltrate was contracted from 24 to 14%, hard and transitory infiltrate from 20 to 11%, renewal of prostatic fluid from 120 to 57 days. After the treatment on the elapse of three months the number of residual leukocytes in prostatic fluid was contracted from 34 to 11%. literatura: k, 2å!=23!=: 1. CxikviSvili m., jimseleisvili o. _ axtalis talaxis gamoyenebis gamocdileba qronikuli prostatitebis samkurnalod. SromaTa krebuli XVIII, kanisa da vensneulebata samecniero-kvleviti instituti, Tbilisi, 1975, gv o %*!%" *, L b.h. o%ƒä åå" n.j. # l åä, ö, *= ì, *!%K, %ë%ã,. l.: l åä, ö, =, 1999, Š, 2%"=Š.l., j=!c3., =h.b., qåì %"=e.b. # j%ìcëå* %å C!, ìå å, å = 2, K, %2, *%",, ìì3 %ì%ä3ë 2%!%", -,ƒ, %2å!=C,, C!, 3!%ãå, 2=ëü /., -å*ö,. 3 ì3,. j3!%!2%ë%ã,, 1, 1999, !%ë%ã, l å2%ä c åì% 2=ƒ= C!, ìå å, åì!= 2, 2åëü /. C%ë, -å %ë%" l. d. ).=, äƒå c% 3ä=! 2"å = ìåä, ö, *= =*=äåì, c!3ƒ,, o!%këåì=ãåì% 2=ƒ=" åãä=ƒ=, ì=ë=% %K%å ìå 2% " ìåä, ö, å. d ë å!åøå,, C!%K%"= % åì=ë%!=ƒë, /. ìå2%ä%". må*%2%!/ å, ƒ,. = åã%ä ø, L äå ü C!åä 2="ë þ2 ë, øü, 2%!, å *3þ öå % 2ü, %å 2ü, ƒ= ë3, "=þ?,å ", ì=, ìå2%ä/. b ã%ä=. C!%øë%ã%"å*= åì=ë/ L.--å*2 C!%, ƒ" ë ìåä, ö, *, L *ëål, o %Kå % =% %"å ö, =*!, =[1, 2]. n ä =*%,, 2å!å * åì3 " *%!å C!%C=ë, ƒ ƒ=åã% åä% 2=2% %L =ä % 2,, 2%*, % 2, [3].

62 b 3!%ë%ã, å *%L C!=*2, *å C!%Këåì/ *!%"%2å å, "%ƒ, *=þ2 % %Kå %C!, 2!= 3!å2!=ëü /. %Cå!=ö,.. h.%ä, ƒ Cåö, -,*, ìå2%ä=, " ä= %L, 23=ö,, ë%*=ëü %å % 3? å 2"ëå, å ãåì% 2=ƒ=!å=ëü %2%ëü*%C32 ì.ëå*2!%*%=ã3ë ö,,, %,.2%2 ìå2%ä " å*%2%!/. ë3 =. å =ä å. b ìå 2å 2åì, *!%ìå *!%"%2å å,, ".%äå %Cå!=ö,, K%ëüø3þ %C= % 2ü C!åä 2="ë å2,!!, ã=ö, % = ä, 2,ëë,!%"= = "%ä=, " = / "=åì= "å %ƒ / ì, *!%"å % / ì, % 3ä=ì,, 2% 2= %", 2 C!,, %L ãåì%ë, ƒ=, &Š3!-, ä!%ì=[. d ë!åøå, "/ øå3*=ƒ= %L C!%Këåì/ ì/!åø, ë,, C%ëüƒ%"=2ü -å %ëü / å %åä, å,!= 2, 2åëü %ã%c!%,.% äå,, *%2%!/ å, "ƒ=, ì%äål 2"3 Kåë*=ì,, %K!=ƒ3þ2 *%ìcëå* / å %åä, å, [5, 6]. o!%= 2%ö, =, ä/ C!% "ë þ2 "/ %*3þ K, %ë%ã, å *3þ =*2, " % 2ü, =ä %ƒ=?,?= *!%"å % / å % 3ä/, =2=* å C32åì = 2, ",!3 %ã%, = 2, ã, 2=ì, %ã%, = 2, *=!, å %ã%äål 2",. }2, K, %ë%ã, å *, å "å? å 2"= "ë þ2, ëü / ì, = 2, %*, ä= 2=ì, [9]. b = =ëü %L 2=ä,, C!%2å, %- C%ë, -å %ë%"%ã%"ƒ=, ì%äål 2", % %" 3þ " ƒü C!åä 2="ë å2 "%ä%!%ä = " ƒü, *%2%!= % 3øå 2"ë å2 ìå ä3 CåC2, ä / ì, ã!3cc=ì,, ã, ä!%*, ë=ì, -å %ë%"/. ì%ëå*3ë [7; 8]. r 2= %"ëå %, 2%C!, "ƒ=, ì%äål 2",, C%ë, -å %ë%" Kåë*=ì,, C!,, ƒ*%l 2åì!å!=23!å (20-250q)"%ƒ, *=å2 C%ë, -å %ë%-kåë*%"/ L ã, ä!%ë, ƒ,!3åì/ L *%ìcëå*, = C!, "/ %*%L 2åìCå!=23!å (600q)- åã, ä!%ë, ƒ,!3åì/ L Kåë*%"%-., % %"/ L C!%ä3*2 "ƒ=, ì%äål 2",. d ë C!%"åäå, %C/ 2=K/ ë, "ƒ 2/ C%ë, -å %ë/, C%ë3 å / å, ƒ ", %ã!=ä /. ( %!2= p*=ö, 2åë, )*% 2% å*, =, ƒ Kåë*%"/. "å? å 2" åë=2,. d= = *%ìk, =ö,, C%ä 3 ë%" / ì =ƒ"=, åì &a32=[, K/ ë=, C%ëüƒ%"= =".* Cå!, ìå 2å [4]. }* Cå!, ìå 2/ C!%"åäå / =17 %K=*=. (ì= %L 12-16*ã), 10 *!%ë, *=. (ì= %L 3-3,5 *ã). f, "%2 / å K/ ë, C%ä!=ƒäåëå / =2!, ã!3cc,. b Cå!"%L ã!3ccå K/ ë%12 %K=*, "% "2%!%L - 5; " 2!å2üåL # 10 *!%ë, *%". f, "%2 / ì Cå!"%L ã!3cc/ " C!åä 2=2åëü 3þ åëåƒ3 øc!, ö%ì ""%ä, ë, 4% C%ë, -å %ë%"3þ, ä*% 2ü. g=2åì 23ä= å, ä!3ã, ì øc!, öåì ""%ä, ë, 2% å *%ë, å 2"%4%!= 2"%!= åë=2, =2=*, ì %K!=ƒ%ì, 2%K/ %K?,L %KA ì ""åä /., ä*% 2åL % 2="ë ë 60-80% %KA ì= =ì%l åëåƒ/. }ëå*2!% % %ì C!%, ƒ"%ä, ë, C%3 ãë3k%*,. å*ö, L " %Kë= 2, C!="%L, ëå"%l ä%ëü C!% 2=2/. b%"2%!%l ã!3ccå C!%"%ä, ë= ü 2= å =ì= %Cå!=ö,, %ä %*% å*ö,, K/ ë, = å å / Kåƒ C!åä"=!, 2åëü %ã%""åäå, C!åC=!=2=&a32=[. b %K%,. ë3 =. C!%, ƒ"%ä, ë= ü ", ƒ3=ëü = %öå *=, 2å, " % 2, *!%"%2å å,, =ä % 2, ãåì% 2=ƒ=ìå ä3 %K!=K%2= / ì,, å%k!=k%2= / ì, ä%ë ì, C!% 2=2/. o%%*% =,, %Cå!=ö,,,ƒ C!åä 2=2åëü %L åëåƒ/ "/!åƒ=ë, ü *3 % *, äë ã, 2%ë%ã, å *%ã%= =ë, ƒ=. b 2!å2üåL ã!3ccå % 2!/. %C/ 2%" " 3 ë%",. %K? åã%%kåƒk%ë, "=, " 3ø 3þ "å 3 ""%ä, ë, ü *%ìc% å 2/ C!åC=!=2=&a32=[ (%KA ì%ì 2 ìë)" 2%L å *% öå 2!=ö,,, C% ëåä%"=2åëü % 2,, C!%C%!ö,,. o% ëå.2%ã%, "%2 /. 3 / Cë ë,, C!%, ƒ"%ä, ë, ì=*!%ì%!-%ë%ã, å *, å, ƒ3 å, 3ø %L "å /, å!äö=, =%!2/, ë ã*,. = 2=* å ë ã% /. =!2å!, L, Cå å,, C% å*. r 2= %"ëå %, 2%C!, ""åäå,, C!åC=!=2=&a32=[ " C!åä 2=2åëü %L åëåƒå "%ƒ, *=å2 åëå%k!=ƒ = ì= =, *%2%!= C!, *% 2=*2å 2*= ì, C!åä 2=2åëü %L åëåƒ/ (" % %" %ì Kåë*=ì, ) ë%*=ëü %"/ äåë å2 " ", äå äå =23!=2=. o%ë, -å %ë%"= " ƒü, 2å, " åå " åã%3 2= ="ë, "=å2 Kåë*%"/ ì, "å? å 2"=ì, *!%",, 2=* *=* *!%"ü =, K%ëåå = /? å = "%K%ä / ì/ Kåë*=ì,. }2%2 C!%öå, ìåå2 2!%ã%%ã!=, å / L ë%*=ëü / L.=!=*2å!. d= / å C%ä2"å! ä=þ2!åƒ3ëü2=2=ì,.* Cå!, ìå 2=" 2!å2üåL ã!3ccå, "%2 /., ãäå ""åäå, å C!åC=!=2=&a32=[ C!%"%ä, ë% ü åc%!åä 2"å %" "å %ƒ / å % 3ä/ " =C!="ëå,, %2 Cå!, -å!,, * öå 2!3,, å ì%2! =.2%, ã!=, ö/ ãåì%*%=ã3ë ö,, K/ ë,!åƒ*%%ã!=, å / *%!%2*, ì, "å %ƒ / ì, 3 = 2*=ì,. j%=ã3ë ö, å!= C!% 2!= ë= ü " =C!="ëå,, ì=ã, 2!=ëü /. *!%"å % /. % 3ä%", å "/ ƒ/ "=ë= ö,!*3ë 2%! /. =!3øå, L " %2ä=ë /., ƒ å %"= /. %!ã= =.. b ëåä 2", å ã, Cå!2å!ì, å *%ã%"%ƒäål 2", =2*= ü C!% 2=2/ C!%,.%ä, 2 ãë3k%*= C%ë, ìå!, ƒ=ö,

63 Cå!", %ã%kåë*%"%ã% %åä, å,, "%ƒ, * %"å, å ã%ì%ãå %L Cë *,, *%2%!= %Këåã=å2!åƒåö,!%"= 3þ C%"å!. % 2ü (% %Kå % 2å *, *!%"å % /. % 3ä%"), ƒ=c%ë å2,. C!% "å2/. b å "/ øåcå!å, ëå / å -=*2/ ì% %, 2=2ü "å üì=, 2å!å / ì, *ë,, å *%L 2% *, ƒ!å,, 2=* *=* C!åä 2="ë þ2 Cå! Cå*2, " / ì, äë, C%ëüƒ%"=, " 2!= 3!å2!=ëü /. %Cå!=ö,.. o%*!/ 2,å C%ë, ìå! %L Cë *%L *!%"å % /. % 3ä%",!åƒåö,!%"= %L C%"å!. % 2, C!% 2=2/, ä= 2 "%ƒì% % 2ü C!åä%2"!=2, 2ü, %ä %L 2%!% /,, 2å, " / å *!%"%2å å,, = ä!3ã%l -, ƒkå =2ü %C= % 2, "%ƒ, * %"å, &Š3!-, ä!%ì=[. qëåä3å2 %2ìå2, 2ü, 2%C%ë, -å %ë/ *=2å., %"%L ã!3cc/, ".%ä?,å " % 2=" "/ øå3c%ì 32/. "å? å 2", å 2%ëü*% å 2%*, /, %, "ë þ2 ì%? / ì, = 2, %*, ä= 2=ì,. m=ì C!åä 2="ë å2, 2%3C%ì 32/ L ìå2%ä ä= 2 "%ƒì% % 2ü!=ä, *=ëü %ã%, Kåƒ%C= %ã%c!%"åäå, %Cå!=ö,,, ä= å C!, K%ëüø%L ì= å ã, Cå!Cë=ƒ,!%"= %L C!åä 2=2åëü %L åëåƒ/ (>80ã). qimiuri hemostazi mcenareuli polifenolebis gamoyenebit m. CxaiZe saqartvelos saxelmwifo samedicino akademiis urologiis katedra prostatis adenomis qirurgiuli mkurnalobis, egret wodebuli `oqros standarti~ _ transuretruli rezeqcia xasiatdeba iseti gartulebebit, rogoricaa meoradi sisxldena da tur-sindromi. Cven mier eqsperimentsi (17 ZaRli da 10 bocveri) SemuSavebuli da klinikasi (20 pacienti) aprobirebulia specialuri metodi, romelic Tavidan agvacilebs zemoxsenebul gartulebebs. operaciis win, usualod, hiperplaziur qsovilsi jer nemsit Segvyavs mcenareuli warmosobis polifenoli, xolo Semdeg Jelatinis xsnari, romelic urtiertqmedebs qsovilovan cilebtan da rezeqtoskopis maryujis marali temperaturis gavlenit, lokalurad warmoqmnis mtkice polimerul apks. misi sasualebit axsobs sisxlzarrvta sanaturs, Sesabamisad, acerebs rogorc sisxldenas, ise sairigacio sitxis Sewovas organizmsi. polimerizaciis procesi mimdinareobs lokalurad da ar iwvevs zogad cvlilebebs organizmsi. arnisnuli metodi sasualebas izleva gavafartoot tur-operaciebis Cveneba. SedarebiT didi

64 zomis (>80gr) adenomis SemTxvevaSi amcirebs operaciisatvis gamoyofili drois xangrzlivobas. Chemical Hemostasis by Polyphenols M. Chkhaidze In spite of permanent optimization of Gold Standard in prostate surgery-transurethral resection (TURP) the hazards of immediate and secondary bleeding as well as the TUR-syndrome associated with absorption of irrigative fluid are still high. As a result of experimental (on 17 dogs and 10 rabbits) and clinical (on 20 patients) investigations we have elaborated a special method for their prevention. The essence of our method is that just before the TURP-operation the polymer substance Buta is injected into the prostate both transperineally and transurethrally by means of cystoscope. Under the influence of high temperature from the loop of resectoscope this substance undergoes polymerization and creates a thin film on the surface of resected prostate and prevents both the bleeding and absorption of irrigative fluid and development of TUR-syndrome. The described method significantly widens the indications for classical standard TURP because it increases the possible weight of resecting prostate above 80 gr and duration of operation above one hour without the hazards of bleeding and TUR-syndrome. Peculiarities and advantages of the described method are discussed. literatura: k, 2å!=23!=: 1. c=ã3=`.l. _ n K.--å*2, " % 2, C!, ìå å, ö, =*!, =äë % 2= %"*, C=!å., ì=2%ƒ %ã%*!%"%2å å,. }* Cå!, ìå 2=ëü =.,!3!ã,, = å 2åƒ, %ë%ã,, 1963, 16, o å2!%" *, L a.b., c, ã=3!, b.q., l ë/, * b.e. _ qc% %K % 2= %"*, C=!å., ì=2%ƒ %ã%*!%"%2å å,. }* Cå!, ìå 2=ëü =.,!3!ã,, = å 2åƒ, %ë%ã,, 1973, 15, o, =!å" *, L `.`., b %L2/ =q.b. _ j!, %ãå / L ìå2%ä %Cå!=ö, L, % 2= %"*, *!%"%2å å, = C=!å., ì=2%ƒ /. %!ã= =. (.* Cå!, ìå 2=ëü = *!, %.,!3!ã, ). }* Cå!, ìå 2=ëü =.,!3!ã,, = å 2åƒ, %ë%ã,, 1973, 16, å!å2åë, a. q., x, %ø", ë, Š. h., ).=, äƒå l. d. _ j%ìk, =ö, äë C!%-, ë=*2, *, *!%"%2å å,, Šr p-, ä!%ì=c!, 2!= 3!å2!=ëü %L %Cå!=ö,, =C!% 2=2å. o=2å 2 =, ƒ%k!å2å, å GE P B å!å2åë, a.q., q23!3=g.x., ).=!2, ø", ë, m.m. _ b ƒ=, ì%äål 2", å *% äå,!%"= %ã%2=, = =ì, %*, ë%2=ì,. b, %ã!=ä, ", %p%,,, 1998, 13, ).=!2, ø", ë, m.m., q23!3=g.x. 0 å!å2åë, a.q. _ h ëåä%"=, å C!%öå = 2=, -Kåë*%"%ã% "ƒ=, ì%äål 2", " ", %ì=2å!, =ë=.. b, %ã!=ä, ", %p%,,, 1998, 12, Memnys Iorn P., Davis Kenneth G., Lilley Terence H., Haslam Edwin _ The association of proteins with polyphenols. J. Chem. Soc. Chem. commun., 1981, 7, pp Pascal Ribereon-gayon _ Plant Phenilics. University reviews in Botany. - Oliver Boyd, London, 1979, 254 p. 9. Williams R. L, Elliott M. S. _ Antioxidants in grapes and wine: chemistry and health effects. natural antioxidants: chemistry, health and application. Ed. Shahidi. F. - AOCS Press, 1997, pp

65 infeqciuri uretraprostatitebis etiologiuri struqtura urologia, mikrobiologia prof. b. iakobaze, n. Savdia, prof. k. afridonize saqartvelos saxelmwifo samedicino akademiis mikrobiologiisa da epidemiologiis katedra infeqciuri etiologiis uretraprostatitebs gansakutrebuli adgili uwiravs mamakacta Sardsasqeso sistemis patologiebs Soris. mamakacta % dasnebovnebulia am daavadebit. uretraprostatitebis marali riski dakavsirebulia winamdebare jirkvlis anatomiur-topografiul mdebareobastan da Sardsasqeso sistemis organoebis anatomiur urtiertkavsirtan. mikroorganizmebi, romlebic iwvevs qronikul, infeqciuri etiologiis uretraprostatitebs, ZiriTadad mamakacis uretridan xvdeba. prostatitis etiologiuri struqtura mravalferovania. prostatis wvensi armocenilia stafilokokebi, streptokokebi, nawlavis Cxiri, proteusi, klebsiela, triqomonadebi, gonokokebi, qlamidiebi, mikoplazma, ureaplazma, patogenuri sokoebi da sxva aerobuli mikrobebi. infeqciuri uretraprostatitebis dros etiologiuri baqteriebis mgrznobelobarezistentobis Seswavla antimikrobuli preparatebis mimart da am preparatebis moqmedebis meqanizmis gansazrvra Sardsasqeso sistemaze Tanamedrove venerologiis ert-ert aqtualur problemas warmoadgens. misi aqtualoba ganpirobebulia infeqciis zrdis tendenciit. infeqciuri uretraprostatitebis dros Seuswavlelia prostatis wvenis mikroflora, Sereuli anu miqst-infeqciis gamomwvevi mikroorganizmebis mgrznobeloba-rezistentoba antimikrobuli preparatebis mimart, antimikrobuli preparatebis Sardsasqeso sistemis trofikul cvlilebebze moqmedebis meqanizmi. Cvens mizans warmoadgens infeqciuri uretraprostatitebis etiologiasi miqstinfeqciis mikroorganizmebis rolis dadgena. miznis gansaxorcieleblad dasaxuli iqna Semdegi amocanebi: 1. SeviswavloT etiologiurad mnisvnelovani baqteriebis mgrznobelobarezistentoba infeqciuri uretraprostatitebis dros. 2. SevimuSavoT antibiotikebis mgrznobelobaze baqteriuli datesvis mkurnalobis originaluri metodebi. kvlevis masala da metodebi. prostatis sekretis areba xdeboda jirkvlis masajis Semdeg. sekretis morfologiuri da baqterioskopiuli SeswavlisaTvis gamoiyeneboda rogorc natiuri preparatebi, ise gramis wesit SeRebili nacxebi. aerobuli mikroorganizmebis gamoyofa da identifikacia warmoebda xotingeris bulionze damzadebuli myari da Txieri sakvebi niadagebit. stafilokokebis saxeobis gansazrvrisatvis gamoiyeneboda testebis kompleqsi: plazmakoagulaciuri, lecitinozuri da hemolizuri aqtivoba. streptokokuli identifikacia warmoebda hemolizuri testit. neiserebis identifikacia xdeboda Semdegi testebit: reaqcia katalazaze, oqsidazaze pigmentis warmoqmna.

66 nawlavuri jgufis baqteriebis dadgena warmoebda Semdegi testebit: rezistentoba kaliumis teluritis mimart, hemolizi. proteolizi, naxsirwylebis fermentacia da mozraobis unari naxevrad Txevad agarze. patogenuri sokoebis gamoyofisatvis prostatis sekreti iteseboda saburos niadagze 250C-ze saatit. triqomonadebis gamovlenis miznit, mzaddeboda prostatis sekretis CaTesva sakveb niadagebze (LFS da TV niadagebze, germania). ujredsida infeqciebis gamovlenis miznit, avadmyofebs CavutareT gamokvlevebi dnm hibridizaciis metodit. reaqciis Casatareblad viyenebdit rusuli warmoebis `saturnis~ mier warmoebuli dnm hibridizaciis test-sistemebs. gonokokis gamokvlevas vawarmoebdit baqterioskopiuli metodit, romelic mdgomareobs gramis wesit mikrobis armocenasi, agretve, viyenebdit baqteriul datesvas gonokokze. antimikrobuli preparatebis mimart mrznobeloba-rezistentobas vswavlobdit diskodifuziis metodit. baqteriologiuri kvlevisatvis gamoyenebuli iyo prostatis sekreti da uretris gamonadeni 150 avadmyofisagan. mirebuli Sedegebi. infeqciuri uretraprostatitebis dros mikroorganizmebi aseti TanmimdevrobiT gvxvdeba: Trichomona vaginalis - 59,4 %; Candida albicans - 71,3 %; Chlamidia trahomatis - 24,9 %; Herpes I, II tipis virusi. 23,7 %; CMV - 11,3 %; Ureaplasma urealiticum - 18,9 %; Micoplasma hominis - 9,8 %; N. gonorrhoeae - 7,8 %; S. pyogenes - 4,7 %; S. Aureus - 7,14 %. kvlevis Semdgom etapze SeviswavleT identificirebuli mikrobebis mgrznobelobarezistentoba antibiotikebis mimart. infeqciuri uretraprostatitebis dros miqst-infeqciuri mikroflora mgrznobiare iyo cefalosporinebis jgufis (klaforani, cefazolini, ceftriaqsoni, raciocefi, rocefini, dardumi, fortumi, maqsipeni), aminoglikozidebis (gentamicini, netromicini), linkozamidebis (linkomicini, linkocini, klindomicini, dalacini), ftorqinolinis (cifrinoli, nolicini, ciprobai), tetraciklinis (vibramicini, doqsaciklini) antibiotikebis mimart. miqst-infeqciis gamomwvevi mikroorganizmebi ZiriTadad rezistentuli iyo penicilinis (penicilini G, prokain penicilini, retorpeni), amino- penicilinis (amoqsacilini, ampicilini), karboqsi penicilinis (karbencilini, oqsacilini) da polipeptidebis jgufis (polimiqsini) antibiotikebis mimart. zemoarnisnulidan gamomdinare, SevimuSaveT da aprobacia gavuketet infeqciuri uretraprostatitebit daavadebuli 150 avadmyofis etiologiuri da patogenezuri mkurnalobis metodebs mgrznobiare antibiotikit, romlebic mimartuli iyo uretrasa da prostatasi mikrobebis eliminaciisaken da Sardsasqeso sistemasi trofikuli cvlilebebis regeneraciisaken. }2, %ë%ã, )å *= 2!3*23!=, - å*ö, % /. 3!å2!%C!% 2=2, 2%" o!%-. a. *%K=äƒå, m. x="ä, C!%-. j. `C!, ä%, äƒå j=-åä!=ì, *!%K, %ë%ã,,,.c, äåì, %ë%ã,, c% 3ä=! 2"å %L ìåä, ö, *%L =*=äåì,, c!3ƒ,,

67 q!åä, C=2%ë%ã, L ì% åc%ë%"%l, 2åì/ 3 ì3, 3!å2!%C!% 2=2, 2/, -å*ö, % %L.2, %ë%ã,, ƒ=, ì=þ2 % %K%å ìå 2% (K%ëåþ % ì3, ). l, *!%%!ã=, ƒì/, "/ ƒ/ "=þ?,å!=ƒ", 2,å ƒ=k%ëå"=, C!%, *=þ2, ƒ ì3 *%L 3!å2!/. }2, %ë%ã, å *= 2!3*23!=C!% 2=2, 2%" ì %ã%%k!=ƒ =. b %*å C!åä 2=2åëü %L åëåƒ/ %K =!3 å / 2=-, ë%*%**,, 2!åC2%*%**,, *, øå = C=ë% *=, C!%2å3, *ëåk, åëë=, 2!,.=ì% =ä/, ã% %*%**,,.ë=ì, ä,,, ì, *%Cë=ƒì=, 3!å=Cë=ƒì=, C=2%ãå / å ã!, K*,. n ä 3, ƒ =*23=ëü /. 2åì %"!åìå %L "å å!%ë%ã,, C!åä 2="ë å2, ƒ3 å, å 3" 2", 2åëü % 2, -!åƒ, 2å 2 % 2, K=*2å!, L * = 2, K, %2, *=ì, ìå.=, ƒì äål 2",.2,. C!åC=!=2%" =ì% åc%ë%"3þ, 2åì3. a=*2å!, %ë%ã, å *, ì,, K=*2å!, % *%C, å *, ì,,,ìì3 %-å!ìå 2 / ì, ìå2%ä=ì,,ƒ3 å / ì, *!%%!ã=, ƒì/,ƒ %*=C!% 2=2/, "/ äåëå, L, ƒ 3!å2!/. h ƒ3 å, å 3" 2", 2åëü % 2,!åƒ, 2å 2 % 2,.2, %ë%ã, å *, "= /. ì, *!%K%" * = 2, ì, *!%K / ì C!åC=!=2=ì C%*=ƒ=ë%, 2%äë.ìC,!, å *%ã%ëå å, Cå! Cå*2, " / : *ë=-%!=, öå-=ƒ%ë,, öå-2!, =* %,!%öå-,,!=ö, %öå-, ä=!ä3ì, -%!23, ì=*, Cå, ãå 2=ì, ö,, å2!%ì, ö,, ë, *%ì, ö,, ë, *%ö,, *ë, ä%ì, ö,, ä=ë=ö,, ö, C!%K=L, ö, C!, %ë, %ë, ö,, ", K!=ì, ö,, ä%*, ö, *ë,. Etiologic Structure of Infectious Urethroprostatitis N. Shavdia, B. Iakobadze, K. Apridonidze Among pathologies of urogenital system urethroprostatitis of infectious etiology hold peculiar place % of men suffer from this disease. Microor anisms causing chronic infectious urethroprostatitis penetrate from male urethra. Etiologic structure of prostatitis is multiformed. In prostatic fluid staphylococci, streptococci, E. coli, Proteus, Trichomonas, gonococci, chlamidias, klebsiela, Mycoplasma, Ureaplasma, pathogenic fungi were revealed. One of the most actual subject of up-to-date venerology is to study bacterial resistance and sensitivity towards antibiotics and mechanism of action of these preparations on urogenital system. Bacteriologic, bacterioscopic and immunofermental methods were used in the study of microorganisms. literatura: k, 2å!=23!=: 1. msvenieraze d. _ anaerobuli baqteriebis roli qronikuli prostatitebis etiologiasi. sakand. disertacia, Tbilisi, q=ë=*= p.c., b =ä= *%!, c.`., `ì,! m.a., 0, ö=äƒå n.b. # }2, %ë%ã, å *= 2!3*23!= å Cåö, -, å *,. C!% 2=2, 2%", "åƒ, *3ë, 2%", ƒ=ä,. 3!å2!, 2%". saqartvelos ssr mecnierebata akademiis moambe, tomi 134, # a,!ãå! l.n. # qc!="%, * C%ì, *!%K, %ë%ã, å *, ì, ",!3 %ë%ã, å *, ì ìå2%ä=ì, ëåä%"=,. l.: l åä, ö, =, 1982, j=cë3 l.h. # a=*2å!, %ë%ã, å *, å, ëåä%"=, K%ëü /..!%, å *, ì C!% 2=2, 2%ì. l =2å!, =ë/ III b å %þƒ %ã% Aåƒä=3!%ë%ã%". l, *, 1984, l å2%ä, å *, å 3*=ƒ=, C%%C!åäåëå, þ 3" 2", 2åëü % 2, ì, *!%%!ã=, ƒì%" * = 2, K, %2, *=ì ìå2%ä%ì ä, --3ƒ,, " =ã=!, C%ëüƒ%"=, åì ä, *%", l % *"=, 1983, 15.

68 Terapiuli stomatologia parodontitit daavadebulebsi autoimunuri procesis ujreduli reaqciebi m. kobaxize, med.mecn.doqt. l. jasi Tbilisis damoukidebeli universiteti `gorgasalis~ stomatologiis katedra, Tbilisis saxelmwifo samedicino universitetis Terapiuli stomatologiis katedra piris Rrus patologiebs Soris ert-erti yvelaze gavrcelebuli da problemuri daavadebis _ parodontitis etiologiisa da patogenezis kvleva stomatologiis aqtualuri sakitxia. Tanamedrove mosazrebit, am daavadebis ganvitareba, mimdinareoba, progresirebis xasiati mnisvnelovnad aris ganpirobebuli imunuri statusis cvlilebebit [4,5,6,7,8,10]. dadgenilia, agretve, rom parodontitis dros vitardeba autoimunuri procesi, romelic gamomjravndeba rogorc ujreduli reaqciebit, ise humoruli meqanizmebis cvlilebebit [1,7,8,10,12,13]. literaturis monacemebit cnobilia, rom mravalricxovani endo- da egzogenuri faqtoris gavlenit SeiZleba dairrves imunuri sistemis funqcionireba [3,9,11]. am TvalsazrisiT, gansakutrebuli mnisvneloba eniweba ekologiurad mavne sawarmoo faqtorebis adamianis organizmze zemoqmedebis Seswavlas. imunuri sistema, rogorc maralmgrznobiare meqanizmi, ekopatogenebtan kontaqtis yvelaze adreul periodsi reagirebs adaptaciuri reaqciebit, mogvianebit vitardeba imunopatologiuri reaqciebi, mat Soris _ organizmis zemgrznobeloba da patologiuri procesebis aqtivacia [3,9]. dres, stomatologiasi SedarebiT naklebad Seswavlili Temaa, Tu ra roli ganekutvneba sxvadasxva profilis warmoebis ekologiurad mavne faqtorebs mattan kontaqtis pirobebsi ganvitarebuli parodontitis imunopatogenezsi wlebsi CavatareT piris Rrus daavadebata farto masstabis kompleqsuri, SedarebiTi gamokvleva metalurgiuli da qimiuri mrewvelobis ori udidesi obieqtis _ zestafonis ferosenadnobta qarxnis (fsq) da rustavis `azotis~ musamosamsaxureta Soris. kvlevis mizani iyo, am sawarmota ekologiurad mavne profesiuli faqtorebis rolis dadgena stomatologiur daavadebata ganvitarebasi da im meqanizmebis gamovlena, romlebic am faqtorebis zemoqmedebis fonze apirobebs parodontis qsovilis funqciis darrvevas. warmodgenil nasroms safuzvlad udevs monacemebi arnisnuli gamokvlevebidan. kerzod, massi ganxilulia autoimunuri procesis ujreduli reaqciebi parodontitit daavadebul im pirta Soris, romlebic dasaqmebuli iyvnen fsq-s sadnob saamqroebsi (metalurgiuli mrewveloba) da amave qarxnisa da `azotis~ manganumisa da manganumis orjangis eleqtrolizuri gzit mimreb saamqroebsi (qimiuri mrewveloba). es kontingenti musaobis processi ganicdida mavne profesiuli faqtorebis zemoqmedebas, romelta Soris wamyvani roli miekutvneboda maral temperaturas (370 _ Rumelis wina moedanze) _ sadnob saamqroebsi da manganumis orjangis mtvers _ rogorc sadnob, ise eleqtrolizur saamqroebsi. amastan, manganumis orjangis mtvrit samusao zonis gacilebit marali

69 dabinzureba dafiqsirda eleqtrolizur saamqroebsi, vidre sadnobsi (6,0 mg/m3 _ SedarebiT 0,9 mg/m3-tan). sayuradreboa isic, rom orive qarxanasi, eleqtrolizuri saamqroebi is sawarmoo zona armocnda, sadac parodontitis gavrcelebis gansakutrebit marali sixsire gamovlinda: 70,32 ± 5,22% (fsq) da 66,34 ± 3,82% (azoti) (sadnob saamqroebsi _ 25,61 ± 1,2%, p<0,01]. masala da metodebi. gamosakvlevi pirebi davyavit or jgufad: pirvelsi Sedioda sadnobi saamqroebis intaqturi parodontis mqone 20 (sakontrolo qvejgufi) da parodontitit daavadebuli 51 (ZiriTadi qvejgufebi) piri. meoresi _ igive principit da igive raodenobit SerCeuli eleqtrolizuri saamqroebis musamosamsaxureebi. gamosakvlev pirta asaki meryeobda 20-dan 45 wlamde, samusao staji 10 welze zevit. ujreduli imunitetis cvlilebebs vswavlobdit leikergiis [5] da leikocitebis migraciis datrgunvis (MIF) [2,7] reaqciebis mesveobit. leikergiis dros viyenebdit RrZilis kompleqsur antigens. mas vamzadebdit qirurgiuli operaciebis dros arebuli RrZilis qsovilisagan [7] misi rogorc normaluri, ise patologiurad Secvlili hipertrofiuli nawilisagan. donorad varcevdit pirs, romelic musaobda saamqros im ganyofilebasi, sadac yvelaze marali iyo damtverianeba manganumis orjangit (gamowvis, gamotutvis ganyofilebasi). MIF-is dros viyenebdit n. gogebasvilis mier damzadebul imunosorbents _ bromcianit aqtivirebuli sf4b marcvlebze adsorbirebuli I tipis kolagens. leikergiis reaqciis dros sensibilizebuli leikocitebis aglomeraciis xarisxs vafasebdit sakontrolo da sacdel sinjarebsi Semowmebuli leikocitebis (aranakleb 3 leikocitisa) procentuli sxvaobit [5]. MIF-is (in vivo) reaqciis dros migraciis datrgunvis indeqss vangarisobdit formulit: sadac N1 aris neitrofilebis sawyisi ricxvi piris Rrus sitxis 1 mm3-si, N2 _ neitrofilebis ricxvi piris Rrus sitxis 1 mm3-si, antigenis gamoklebis Semdeg. dadebitad vtvlidit reaqcias, rodesac leikocitebis migraciis datrgunva xdeboda 30-ze meti procentit [2]. monacemebs vamusavebdit statistikurad. Sedegebi da mati ganxilva. kvlevis Sedegebi motanilia pirvelsa da meore cxrilsi. rogorc am monacemebidan Cans, leikergiis xarisxi, RrZilis antigenis mimart, orive jgufsi izrdeba parodontitis procesis progresirebastan ertad. amastan, reaqciis macvenebeli rogorc sakontrolo, ise ZiriTad jgufebsi gacilebit maralia eleqtrolizur warmoebasi, vidre sadnob saamqroebsi. msubuqi formis parodontitit daavadebulebsi leikergiis xarisxi 30%-ze meti armoacnda gamokvleulta 32, 48%-s _ sadnob saamqroebsi, 37,84%-s _ eleqtrolizur warmoebasi. sasualo simzimit daavadebultagan 36,66%-s _ sadnob saamqroebsi, 41,67%-s _ eleqtrolizur warmoebasi (sakontrolo jgufebs _ 6,06% _ sadnobsi, 10% _ eleqtrolizursi) p<0,001c =0,44. Senelebuli tipis zemgrznobelobis autoalergiul reaqcias _ leikergias ganapirobebs cirkulaciasi myofi sensibilizebuli leikocitebis unari, miewebos sisxlzarrvis endoteliums in vivo, xolo minas _ in vitro. misi meqanizmi ukavsirdeba organizmis dacvit, araspecifikur reaqcias, romelsac Tan axlavs ujredsida metabolizmis aqtivacia da leikocitebis zedapiruli dawimulobis gadideba, ramac SeiZleba gamoiwvios leikocitebis baqteriologiuri da fagocituri

70 aqtivobis amarleba [5]. leikergiis reaqciis stimulireba sxvadasxva antigenit ganixileba, rogorc leikocitebis sensibilizaciis ganmsazrvreli Sesabamisi antigenis mimart [5]. Cven mier mirebuli Sedegebi adasturebs, gamokvleul kontingentsi, leikocitebis gamoxatul sensibilizacias RrZilis antigenis mimart. cxrili 1 leikergiis (leikocitebis aglomeraciis) reaqciis Sedegebi RrZilis antigenis mimart I sadnobi saamqroebi II eleqtrolizu ri warmoeba jgufebi parodontitis formebi sakontrolo jgufi n=30 parodontiti msubuqi formis n=37 parodontiti sasualo simzimis n=60 sakontrolo jgufi n=30 parodontiti msubuqi formis n=37 parodontiti sasualo simzimis n=60 15%-ze naklebi % % % 15 50% leikocitebis aglomeraciis xarisxi 16_20% 21_25% 25_30% 3 10% % % 6 20% % 2.70% 9 15% 3 5% % % % % % % 3 10% % 15 25% % % 18 30% 30%-ze meti % % % 3 10% % % kompleqsuri RrZilis antigenis mimart ujreduli imunitetis cvlilebis gamovlenis Semdeg, SevecadeT ufro zustad dagvedgina, konkretulad ra saxis ujredebis an antigenis mimart vitardeboda autoimunizaciis procesi. cxrili 2 leikocitebis migraciis datrgunvis reaqciis Sedegebi (kolagen I-is mimart leikocitebis sensibilizacia) jgufebi parodontitis formebi dadebiti reaqciebi (%) nietrofilebis raodenoba 1 mm 3 piris Rrus sitxesi migraciis datrgunvis indeqsi (%) N 1 N 2 M ±m sakontrolo jgufi n=30 n= ± parodontiti msubuqi formis n=37 parodontiti sasualo simzimis n=60 n= % n= % ± ± sakontrolo jgufi n=30 n= ± parodontiti msubuqi formis n=37 parodontiti sasualo simzimis n=60 n= % n= % ± ± p<0.001 migraciis datrgunvis indeqsis mnisvnelobebi statistikurad sarwmunoa: 2 da 3 1-Tan, 3 _ 2-Tan, 5 _ 6 _ 4-Tan, 6 _ 5-Tan, 5 _ 2-Tan, 6 _ 3-Tan.

71 literaturiis monacemebit cnobilia, rom parodontitis ganvitarebasi ert-erti ZiriTadi meqanizmi parodontis SemaerTebeli qsovilisa da misi ZiriTadi cilis _ kolagenis metabolizmis darrvevaa, romelsac Tan axlavs misi barieruli funqciisa da organizmis saerto reaqtiulobis cvlilebebi [1, 4]. kolagenis patogenetikuri roli natlad vlindeba autoimunuri procesis dros, rodesac kolageni gamodis autoantigenis rolsi da iwvevs imunitetis ujreduli da humoruli reaqciebis inducirebas [1]. am monacemebis gatvaliswinebit, kvlevis Semdeg etapze gamoviyenet kolagenis antigeni _ I tipis kolageni. mis mimart autoimunizaciis procesi imave jgufebsi SeviswavleT piris RruSi (in vivo) leikocitebis migraciis datrgunvis reaqciis magalitze. Sedegebi motanilia meore cxrilsi. rogorc am monacemebis analizi gvicvenebs, Cven mier gamokvleul jgufebsi kolagen I-is zemoqmedebit vitardeba piris RruSi neitrofiluri leikocitebis migraciis mkvetri datrgunva. dadebiti reaqciebi gamovlinda: sadnob saamqroebsi _ gamokvleulta 62,16%-Si msubuqi formis parodontitis dros, 66,66%-Si sasualo simzimis dros. eleqtrolizur warmoebasi, Sesabamisad _ 67,56%-Si da 70,0%-Si. sakontrolo jgufeb Si yvela reaqcia uaryofiti armocnda. migraciis datrgunvis indeqsis mnisvneloba saswrafod izrdeba parodontitis klinikuri mimdinareobis progresirebastan ertad. amastan, migraciis datrgunvis reaqcia meti sirrmit aris gamoxatuli manganumis eleqtrolizuri warmoebis musebsi, vidre sadnobi saamqroebis kontingentsi: msubuqi formis parodontitis dros indeqsis mnisvneloba sadnob saamqroebsi _ 34,65 ± 2,01, sasualo simzimis generalizebuli parodontitis dros _ 42,80 ± 1,02, eleqtrolizur warmoebasi _ Sesabamisad _ 45,88 ± 0,51 da 51,86 ± 1,03. Cven mier mirebuli monacemebis safuzvelze SeiZleba davaskvnat: metalurgiuli da qimiuri warmoebis ekologiurad damzimebul garemosi dasaqmebul musamosamsaxureta Soris, parodontitis daavadebis dros, vitardeba autoimunuri procesi, rasac mowmobs Senelebuli tipis zemgrznobelobis reaqciebis _ leikergiisa da leikocitebis migraciis datrgunvis gamovlineba. leikocitebis autosensibilizacia gamoxatulia kompleqsuri RrZilis qsovilis antigenisa da I tipis kolagenis mimart. autoimunizaciis ujreduli rgolis cvlilebebi pirdapir damokidebulebasia parodontitis procesis simzimestan da manganumis orjangis mtvrit garemos dabinzurebis xarisxtan. amas adasturebs autosensibilizaciis ufro marali macveneblebi parodontitis gartulebuli formebis dros da eleqtrolizuri warmoebis musata Soris, romlebsac im sawarmoo zonasi uwevdat saqmianoba, sadac gansakutrebit marali iyo damtverianeba manganumis naertit. zemoarnisnuli aweuli mgrznobelobis reaqciebi SeiZleba gamoyenebul iqnes parodontitis procesis aqtivobis Sesafaseblad, avadmyofta imunuri statusis dasaxasiateblad, parodontis patologiis diagnostikisa da mkurnalobis metodebis srulyofis miznit.

72 jëå2%) /å!å=*ö,, =32%, ì33 %ã% C!%öå = C!, C=!%ä% 2, 2å l.b. j%k=., äƒå, ä%*2.ìåä. =3* k.l.d =ø, måƒ=",, ì/l 3, "å!, 2å2 &c%!ãc =ë, [, ŠK, ë,,, *=- åä!= 2%ì=2%ë%ã,,; ŠK, ë, *, L ã% 3ä=! 2"å /L ìåä, ö, *, L 3, "å!, 2å2, *=- åä!= 2å!=Cå"2, å *%L 2%ì=2%ë%ã,, h ƒ3 å /,ƒìå å, *ëå2% %ã%ƒ"å ==32%, ìì3 %ã%c!%öå = C!, C=!%ä% 2, 2å!åä,!=K%,. ìå2=ëë3!ã, å *%ã%(cë=", ëü / å öå.=),., ì, å *%ã%(.ëå*2!%ë, 2, å *, å öå.=ì=!ã= ö=, ä"3%*,, ì=!ã= ö=)öå.%" ƒ="%ä=-å!!% Cë="%" ã. g å 2=-%,, C!%, ƒ"%ä 2"=# &`ƒ%2, [ ã. p3 2=",. m=% %"å!=ƒ", 2,!å=*ö,, ëål*å!ã,,, 2%!ì% å, ì, ã!=ö,, ëål*%ö, 2%" 3 2= %"ëå ="/!= å = =32% å, K, ë, ƒ=ö, ëål*%ö, 2%" C!%2, " *%ìcëå* %ã%= 2, ãå =äå /, Cåö, -, å *%ã%*%ëë=ãå =I 2, C=. b ìå 2å 2åì, = 2%2="/ "ëå, 3*=ƒ= /. 3Cå! 3" 2", 2åëü /.!å=*ö, L, 2åCå ü å, K, ë, ƒ=ö,, ëål*%ö, 2%" =.%ä, 2 " C! ì%l " ƒ, 2 å 2üþ C!%öå = C=!%ä% 2, 2=, C%*=ƒ=2åëåì ƒ=ã! ƒ å, C!%, ƒ"%ä 2"å %L!åä/ C/ëüþ ä"3%*,, ì=!ã= ö=. Cellular Reactions of Autoimmune Process in the presence of Parodontitis M. Kobakhidze, L. Jashi In the proceeding changes of cellular link of autoimmune process in cases of parodontitis among workers of metallurgical (melting shops of Zestaphoni s Farroalloy Plant) and chemical (electrolytic shops of manganese and dioxide manganese of Zestaphoni s Ferroalloy Plant and Rustavi s Azoti ) production are studied. On the basis of development of reaction of leucergy and inhibition of migration of leucocytes is set expressed autosensitization of leucocytes against complex antigen of gum and specific collagen of Ist type. At he same time frequency of exposure of mentioned supersensitive reactions and the degree of sensitization of leukocytes is in direct coupling with the heaviness of the process of parodontitis and the activities of pollution of production environment with the spray of manganese of dioxide. literatura: k, 2å!=23!=: 1. jasi l. _ pirveli tipis kolagenis mimart organizmis sensibilizacia parodontitebis dros. Tssu samecniero SromaTa krebuli. t. XXXIII. Tbilisi, 1997, gv. 438_ `ä%`.d., a % ä=!å"=š.š., ), 2=å"=b.Š. _ t å %ìå 2%!ì% å, ì, ã!=ö,, ëål*%ö, 2%" in vivo, in vitro C!, ëå*=! 2"å %L =ëëå!ã,,. q2%ì=2%ë%ã,, 1980 ã., 3, d =ø, k.l. _ h ƒìå å, å C=!%ä% 2=,,ìì3 %ë%ã, å *, å ä", ã, 3!=K%,..*%ë%ã, å *, %2 ã%? å %ã% C!%, ƒ"%ä 2"=. Iì3 %ë%ãi 2==ëå!ã%ë%ãi. j, å", 1998, 4.! h "= %" b.q. _ g=k%ëå"=, C=!%ä% 2=. l.: l åä, ö, =, 1989, j=k=*%" a.d., a åëü, *%" }.b. _ b%c!% /, ìì3 %ë%ã,, C=!%ä% 2=. k.: l =*, ì%" *, L ~.l., ),!*%"=Š.d., t!%ë%"=š.`., ä!. _ jë,, *%-, ìì3 %ë%ã, å *, å % %Kå % 2, C=2%ãå åƒ=*=2=!=ëü %ã%ã, ã, ", 2=. q2%ì=2%ë%ã,, , l =? å *%h.q. _ p å=*ö, 2%!ì% å, ì, ã!=ö,, ëål*%ö, 2%" " %2"å2 =äå å"%l = 2, ãå 3 K%ëü /. C=!%ä% 2%ƒ%ì. q2%ì=2%ë%ã,, 1977, 5, n!å.%"=k.~. _ h ìì3 %ë%ã, å *%å ìå.=, ƒì/ " C=2%ãå åƒå "% C=ë, 2åëü /. ƒ=k%ëå"=, L C=!%ä% 2=. `"2%!å-.ä,.ä%*2.ìåä. =3*, k.: 1997, u=,2%" p.l., o, åã, a.b., h 2=ì%" u.h. _ }*%ë%ã, å *=, ìì3 %ë%ã,. l.: 1995, b mh pn, åc%" k.l., n!å.%"=k.~. _ h ìì3 = 2å!=C, "% C=ë, 2åëü /. ƒ=k%ëå"=, L C=!%ä% 2=:, ëëþƒ,,,ë,!å=ëü % 2ü? o =!%ä% 2%ë%ã,, 12(12), 1999,. 3.

73 11.!, ì, `.`._ n %"/,ìì3 %ë%ã,,. l.: l åä, ö, =, Ivagi Y., Wilton J.M., Yehner T. _ Cell mediated immynity in periodontal disease, cytotoxicity, migration inhibition and lymphocyte transformation studies. J. Immunol., 1972, v. 22, N 1, p Page R.C. _ Host response tests for diagnosting periodontal disease. J. Periodontal, 1992, v. 63, N 3, p recidiuli afturi stomatitis riskis faqtorebi x. qorize saqartvelos saxelmwifo samedicino akademia recidiuli afturi stomatiti piris Rrus ert-ert yvelaze gavrcelebuli daavadebaa. Sromis mizans warmoadgens recidiuli afturi stomatitis riskis faqtorebis dadgena da fardobiti Sansis gamotvla yoveli faqtorisatvis. Cven mier Seswavlilia 20-dan 70 wlis asakamde 62 afturi stomatitit daavadebuli da igive asakis 61 sakontrolo (stomatitis garese) pacientis klinikuri masala Tbilisis omis veteranta hospitlis kontingentidan. kvleva Catarda retrospeqtulad. kvlevis tipi SemTxveva-kontroli. Sefasebul iqna Sansebis fardoba da sarwmunobis intervali TiToeuli faqtorisatvis jgufebis mixedvit. jgufebs Soris gansxvavebis Sefasebas vaxdendit 2 kriteriumit (Pearson). matematikuri uzrunvelyofa ganxorcielda programebis paketis SPSS 11-5 is gamoyenebit. dadginda, rom recidiuli afturi stomatitis fardobit Sanss gansazrvravs Semdegi faqtorebi: socialur-biologiuri (OR=5,19; 95%CI:1,07-25,12); sawarmoo mtvris moqmedeba (OR=9,24; 95%CI:1,11-76,04); sacxovrebeli adgilis mavne ekologiuri faqtorebi (OR=14,94; 95%CI:1,88-118,91); kuw-nawlavis traqtis patologiebi (OR=2,19; 95%CI:1,05-4,54); fokaluri infeqciis kerebi (OR=3,09; 95%CI:1,03-9,28); respiratoruli infeqciebi (OR=4,13; 95%CI:1,60-10,64); lorwovani garsis travmebi (OR=2,19; 95%CI:1,05-4,58); emociuri stresi (OR=2,68; 95%CI:1,07-25,12); parodontiti (OR=2,72; 95%CI:1,25-5,94); gingiviti (OR=4,22; 95%CI:1,55-11,49); higienuri indeqsi - cudi (OR=10,56; 95%CI:1,29-86,12) da higienuri indeqsi - Zalian cudi (OR=5,88; 95%CI:1,23-28,09); genetikuri faqtori (OR=3,55; 95% CI:1,08-11,72).

74 recidiuli afturi stomatiti warmoadgens piris Rrus ert-ert yvelaze gavrcelebul daavadebas. misi gavrcelebis sixsire msofliosi meryeobs 3-66%-Si, yvelaze metad gavrcelebulia CrdiloeT amerikasi 22% [8].TeTrkanianebSi Seadgens 20,87%, meqsikel-amerikelebsi 12.88%, SavkanianebSi ki SedarebiT naklebia 4,96%[9]. recidiuli afturi stomatitis etiologia dremde ar aris garkveuli. im faqtorebs Soris, romlebic ganapirobebs stomatitisadmi midrekilebas, gamoirceva kuw-nawlavis daavadebebi, rkinis, B12-is da foliumis mjavis deficiti, daavadeba SeiZleba provocirebuli iyos stresit an adgilobrivi travmit. xsirad arinisneba piris Rrus lorwovani garsis sxva daavadebebis TandarTva. mkurnalobis efeqturi metodis SerCevisaTvis aucilebelia daavadebis genezis garkveva da prediqtorebis gansazrvra [2,6,7,10]. Sromis mizans warmoadgenda qronikuli recidiuli afturi stomatitis riskis faqtorebis dadgena da yoveli faqtorisatvis fardobiti Sansis gamotvla. masala da metodebi. Cven mier Seswavlil iqna 20-dan 70 wlis asakamde 62 afturi stomatitit daavadebuli da igive asakis 61 sakontrolo (stomatitis garese) pacientis klinikuri masala Tbilisis omis veteranta hospitlis kontingentidan. kvleva Catarda retrospeqtulad. kvlevis tipi SemTxveva-kontroli. CarTvis kriteriumebi: klinikasi wlebsi Semosuli afturi stomatitit daavadebuli yvela pacienti. sakontrolo jgufi SeirCa randomizaciit. Cven mier SerCeul iqna stomatitis savaraudo riskis faqtorebi: pacientis socialur-biologiuri mdgomareoba, manifestaciis asaki, mavne Cvevebi, sawarmooprofesiuli faqtorebi, fonuri da TandarTuli daavadebebi, kvebis tipi, kbilebis patologia, Tankbilvis saxeoba, higienuri indeqsi - fiodorov-volodkinas mixedvit [3], genetikuri midrekileba, daavadebis sezonuroba, ZiriTadi patologiis forma, piris Rrus mdgomareoba, lorwovani garsis dazianeba. faqtorebis SerCevis Semdeg, movaxdinet mati kodireba. yovelma faqtorma SeiZleba miiros gansazrvruli mnisvneloba (1 an 0). orive jgufsi, gamotvlil iqna mati sixsireebi, Semdeg ganvsazrvret gansxvavebis statistikuri Sefaseba calkeuli nisnis mixedvit. Sefasebul iqna Sansebis fardoba da sarwmunoobis intervali TiToeuli faqtorisatvis jgufebis mixedvit [1,5]. jgufebs Soris gansxvavebis Sefasebas vaxdendit X2kriteriumiT(Pearson). Tu c2>3,84, p<0,05 [4]. matematikuri uzrunvelyofa ganxorcielda programebis paketis SPSS 11-5 is gamoyenebit. kvlevis Sedegebi. sakvlev jgufsi stomatitis formebis mixedvit avadmyofebi Semdegnairad ganawilda: fibrinozuli forma - 55,7%; nekrozuli _ 6,6%; glanduruli _ 24,6%; nawiburovani _ 4,9%; deformuli _ 8,2%. lorwovani garsis dazianeba: - bustuki _ 8,2%; afta _ 63,9%; erozia _ 36,1%; wyluli _ 11,5%; naprali _ 8,2%; nawiburi _ 3,3%; aftebis lokalizacia: - ena _ 37,3%; magari sasa _ 32,5%; tucebi _ 31,1%; loya _ 19,7%; daavadebis mimdinareoba: msubuqi _ 52,5%, sasualo _ 29,5%, mzime _ 18,0%; arinisneboda Semdegi mikrobuli flora: - mikrobi _ 88,5%; virusi _ 3,3%; soko _ 24,6%; pacientis Civilebi: - wva _ 44,30%; Cxvleta _ 18,0%; parestezia _ 1,6%; tkivili sakvebis mirebisas _ 88,5%; aftebis epitelizaciis vadebi: 7-14 dre _ 70,5%; dre _ 21,3%; 30 dre da meti _ 11,5%; remisiis vadebi: 3-4 Tve _ 55,7%; 2-4 Tve _ 27,9%; 1-2 Tve _ 17,5%. SeviswavleT recidiuli afturi stomatitis riskis faqtorebi da recidiuli afturi stomatitis ganvitarebis fardobiti Sansi TiToeuli faqtoris moqmedebis pirobebsi sakvlev da sakontrolo jgufsi (cxrili).

75 recidiuli afturi stomatitis riskis faqtorta SedarebiTi analizi da daavadebis fardobiti Sansi macveneblebi sixsire avadmyofta jgufsi sixsire sakontrolo jgufsi χ 2 OR CI-OR CI+OR 1 sqesi mdedrobiti sqesi 0,525 0,387 2,34 1,75 0,85 3,58 2 socialurbiologiuri mosamsaxure 0,672 0,919 11,60 0,18 0,06 0,52 3 musa 0,066 0,032 0,74 2,11 0,37 11,94 4 faqtorebi, glexi 0,148 0,032 5,02 5,19 1,07 25,12 5 mavne Cvevebi sigaretis weva 0,492 0,629 2,35 0,57 0,28 1,17 6 alkoholis Warbi mireba 0,033 0,000 0,11 0,87 0,40 1,90 7 sawarmooprofesiuli sawarmoo mtvris faqtorebi moqmedeba 0,131 0,016 6,00 9,21 1,11 76,04 8 sacxovrebeli adgilis mavne ekologiuri faqtorebi 0,197 0,016 10,61 14,94 1,88 118,91 9 fonuri da kuw-nawlavis TandarTuli daavadebebi traqtir patologiebi 0,672 0,484 4,47 2,19 1,05 4,54 10 endokrinuli daavadebebi 0,098 0,016 3,87 6,65 0,78 57,02 11 anemia 0,131 0,000 8,70 12 centr. da veget.nerv.sistemis 0,213 0,129 1,535 1,83 0,70 4,79 funqc. darrveva 13 gul-sisxlzar- RvTa daavadebebi 0,426 0,548 1,84 0,61 0,30 1,25 14 hipovitaminozi 0,164 0,258 1,634 0,56 0,23 1,37 15 emociuri stresi 0,689 0,452 7,04 2,68 1,28 5,61 16 fokaluri infeqciis kerebi 0,213 0,081 4,32 3,09 1,03 9,28 17 respiratoruli infeqciebi 0,344 0,113 9,36 4,13 1,60 10,64 18 meqanikuri lorwovani faqtori garsis travmebi 0,492 0,306 4,41 2,19 1,05 4,58 19 gaznelebuli me-8 kbilis amowra 0,033 0,016 0,36 2,07 0,18 23,42 20 wamlebis mireba 0,377 0,258 2,01 1,74 0,81 3,76 21 kvebis tipi upiratesad naxsirwylovani 0,033 0,048 0,19 0,67 0,11 4,14 22 upiratesad cilovani 0,066 0,081 0,10 0,80 0,20 3,13 23 cxare sakvebis xsiri mireba 0,508 0,452 0,39 1,25 0,62 2,55 24 obligaturi alergenebi 0,066 0,113 0,85 0,55 0,15 1,99 25 tkbileuli 0,311 0,403 1,13 0,67 0,32 1,41

76 sakvlevi da sakontrolo jgufis Sedarebisas armocnda, rom sakvlev jgufsi sarwmunod momatebulia Semdeg faqtorta sixsire: socialur- biologiuri faqtori glexi; sawarmoo-profesiuli faqtorebi _ sawarmoo mtvris moqmedeba da sacxovrebeli adgilis mavne ekologiuri faqtorebi; fonuri da TandarTuli daavadebebidan nisnadi armocnda - kuw-nawlavis traqtis patologiebi; endokrinuli daavadebebi; emociuri stresi; fokaluri infeqciis kerebi; respiratoruli infeqciebi; kbilebis patologia - parodontiti; gingiviti; higienuri indeqsi - cudi; Zalian cudi; lorwovani garsis travmebi. sarwmunod marali sixsirit gamoirceva genetikuri faqtori - stomatiti I-II xarisxis natesavebsi. rogorc gamokvlevam acvena es faqtorebi gansazrvravs daavadebis ganvitarebis sarwmunod maral fardobit Sanss yvela SemTxvevaSi (OR>1). avadmyofta jgufsi sarwmunod mcirea mosamsaxureta sixsire, ortognaturi Tankbilvis saxeoba; higienuri indeqsis kargi da damakmayofilebeli done. Sedegebis ganxilva. kvlevis Sedegad armocnda, rom maralia im pirta recidiuli afturi stomatitit daavadebis fardobiti Sansi, romeltac I-II xarisxis natesavebsi arenisnebat stomatiti, rac miutitebs stomatitis etiopatogenezsi daavadebisadmi genetikuri midrekilebis rolze. recidiuli afturi stomatitis marali fardobiti Sansi aqvt soflis meurneobasi dasaqmebul pirebs (socialur-biologiuri faqtori glexi), rac SeiZleba gamowveuli iyos Sxamqimikatebisa da pesticidebis moqmedebit, am varauds adasturebs isic, rom marali fardobiti SansiT gamoirceva sawarmoo mtvris moqmedeba da sacxovrebeli adgilis mavne ekologiuri faqtorebi. fonuri da TandarTuli daavadebebidan stomatitis fardobit Sanss zrdis Semdegi faqtorebi: kuw-nawlavis traqtis patologiebi; fokaluri infeqciis kerebi; daavadebis patogenezsi infeqciis mnisvnelobas xazs usvams isic, rom daavadebis ganvitarebis fardobit Sanss zrdis piris Rrus higienis dabali done, saxeldobr, higienuri indeqsebi cudi da Zalian cudi; riskis faqtorebidan arsanisnavia piris Rrus lorwovani garsis iseti patologiebis arseboba, rogoricaa parodontiti da gingiviti, rac SeiZleba aixsnas rogorc saerto etiopatogenetikuri faqtorebis arsebobit, ise mat Soris mizez-sedegobrivi kavsirit. daavadebis gamsveb meqanizmad SeiZleba moiazrebodes lorwovani garsis travmebi, respiratoruli infeqciebi, emociuri stresi; recidiuli afturi stomatitis fardobit Sanss amcirebs Semdegi faqtorebi: socialur-biologiuri faqtori - mosamsaxure; Tankbilvis saxeoba _ ortognaturi; higienuri indeqsis damakmayofilebeli da kargi done. daskvnebi: recidiuli afturi stomatitis ganvitarebas gansazrvravs genetikuri midrekileba. recidiuli afturi stomatitis ganvitarebis fardobit Sanss zrdis qronikuli da mwvave infeqciebi, piris Rrus higienis dabali done, piris Rrus lorwovani garsis sxva patologiebis arseboba. recidiuli afturi stomatitis gamovlenis fardobit Sanss zrdis Semdegi maprovocirebeli faqtorebi: lorwovani garsis travmebi, respiratoruli infeqciebi, emociuri stresi.

77 - =*2%!/!, *= =- 2%ƒ %ã% 2%ì=2, 2= u. j%!, äƒå c% 3ä=! 2"å = ìåä, ö, *= =*=äåì, c!3ƒ,, `-2%ƒ / L 2%ì=2, 2 C!åä 2="ë å2 %ä %, ƒ =ì/.!= C!% 2!= å /. ƒ=k%ëå"=, L C%ë% 2,!2=. 0 åëü!=k%2/ : %C!åäåëå, å -=*2%!%"!, *==-2%ƒ %ã% 2%ì=2, 2=, "/, ëå, å %2 %, 2åëü %ã%ø= = äë *= ä%ã%-=*2%!=. n K ëåä%"= 61K%ëü %L ŠK, ë, *%ã%ã% C, 2=ë "å2å!= %" "%L / ; *% 2!%ëü 3þ ã!3cc3 % 2=", ë, 62 C=ö, å 2= å"% C=ë, 2åëü / ì, ƒ=k%ëå"=, ì, C%ë% 2,!2=. h ëåä%"=, å C!%"%ä, ë,!å2!% Cå*2, " %, 2, C, ëåä%"=, : ë3 =L-*% 2!%ëü. q2=2, 2, å *= %K!=K%2*=ä= /. "*ëþ =ë=c%ä å2!åä,. =!, -ìå2, å *,. "åë,, (l ), 2= ä=!2 %ã% %2*ë% å,!åä,. =!, -ìå2, å *,. Std. p=, 2/"=ë, %2 %, 2åëü / L ø= (OR). d% 2%"å! / å!=ƒë,, C%*=ƒ=2åëåL ìå ä3 ã!3cc=ì, äë *%ë, å 2"å /. C%*=ƒ=2åëåL!=, 2/"=ë, ü C% *%.--, ö, å 23 c2 o,! % =. ` =ë, ƒ C!%"%ä, ë, C%ì%? üþ C=*å2= 2=2, 2, å *,. C!%ã!=ìì SPSS 11.5 r 2= %"ëå %, 2%%2 %, 2åëü / L ø= =-2%ƒ %ã% 2%ì=2, 2=%C!åäåë þ2 ëåä3þ?,å -=*2%!/ : %ö, =ëü %- K, %ë%ã, å *, å # åëü *%å = åëå, å (OR=5,19; 95%CI:1,07-25,12); C!%ì/ øëå = C/ ëü (OR=9,24; 95%CI:1,11-76,04); "!åä / å.*%ë%ã, å *, å -=*2%!/ C%ìå 23, 2åëü 2"=(OR=14,94; 95%CI:1,88-118,91); C=2%ë%ã, åë3ä% %-*, øå %ã%2!=*2=(or=2,19; 95%CI:1,05-4,54); % =ã, -%*=ëü %L, -å*ö,, (OR=3,09; 95%CI:1,03-9,28);!å C,!=2%! / å, -å*ö,, (OR=4,13; 95% CI:1,60-10,64); 2!="ì/ ë, ƒ, 2%L %K%ë% *, (OR=2,19; 95%CI:1,05-4,58);.ì%ö, % =ëü / L 2!å (OR=2,68; 95%CI:1,07-25,12); C=!%ä% 2, 2 (OR=2,72; 95%CI:1,25-5,94); ã, ã, ", 2 (OR=4,22; 95%CI:1,55-11,49); ã, ã, å, å *, å, äå* / - Cë%.%L (OR=10,56; 95%CI:1,29-86,12), % å ü Cë%.%L (OR=5,88; 95%CI:1,23-28,09); ãå å2, å *, L -=*2%! (OR=3,55; 95%CI:1,08-11,72). Risk factors of aphthous stomatitis Kh. Koridze Aphthous stomatitis represents one of the most wide-spread disease of an oral cavity. The purpose of the work: definition of risk factors of an aphthous stomatitis and calculation of relative chance for each factor. The work has been fulfilled on the basis of research of 61 patients from a quota of the Tbilisi hospital of the veterans of the war. As a control a state of the oral cavity of 62 patients suffering from noninflammatory pathologies was studied. Research spent retrospectiv, phylum of research - case - control. The statistical data processing included inventory arithmetic means of values (Ì), standard deviation of arithmetic means Std. Have calculated Odds ratio (OR). The authentic differences of parameters between groups for quantitative parameters settled up on quotient c2 Pearson. Analysis were carried out with the help of a package of statistical programs SPSS 11.5 It was found, that the relative chance of an aphthous stomatitis is determined by the following factors social - biological - peasant (OR=5,19; 95%CI:1,07-25,12); effect of industrial saw (OR=9,24; 95%CI:1,11-76,04); harmful ecological factors of residences (OR=14,94; 95%CI:1,88-118,91); pathologies of gastrointestinal tract (OR=2,19; 95%CI:1,05-4,54); the loci of focal infection contaminations (OR=3,09; 95%CI:1,03-9,28); respiratory infection contaminations (OR=4,13; 95%CI:1,60-10,64); traumata of a mucosa (OR=2,19; 95%CI:1,05-4,58); an emotional stress (OR=2,68; 95%CI:1,07-25,12); parodontitis (OR=2,72; 95%CI:1,25-5,94); ulitis (OR=4,22; 95%CI:1,55-11,49); hygienic indexes - bad (OR=10,56; 95%CI:1,29-86,12) and very bad (OR=5,88; 95%CI:1,23-28,09); the genetic factor (OR=3,55; 95% CI:1,08-11,72). literatura: k, 2å!=23!=: 1. c=l 22 c., på, d. _ o32å"%ä, 2åëü, 2=2åë ìåä, ö, *%L ë, 2å!=23!/ # o!, ö, C/ *ë,, å *%L C!=*2, *,, % %"= %L =ä%*=ƒ= %ì. h ƒä=2åëü 2"%.l åä, q-å!=. l. 2003

78 2. d!%k%2ü*%k.m.. q2!=.%"=q.~. _ o!%-, ë=*2, *=, ëå å, å ƒ=k%ëå"=, L ë, ƒ, 2%L %K%ë% *, C%ë% 2,!2=pl f, Š , j3öå"ë * b.t., k=.2s ~.b. _ Pmd e jqm` n0pmj` o `pndn mš`k mn c n qš`šr qr m=" =ëü %- ìå2%ä,, L C% S K, * q3ì, bbo œl!s -1B kšd p åk!%"=n.~. _ q2=2, 2, å *, L = =ë, ƒ ìåä, ö, *,. ä= /.. l % *"=: l åä, q-å!= t ëå2 å! p., t ëå2 å! q. b=ã å! }. _ jë,, å *=.C, äåì, %ë%ã, (% %"/ ä%*=ƒ=2åëü %L ìåä, ö, / ). l % *"=: l åä, = -å!=, c: 6. Akintoye SO, Greenberg MS. _ Recurrent aphthous stomatitis. Dent Clin North Am Jan;49(1): Davis CC, Squier CA, Lilly GE: _ Irritant contact stomatitis: a review of the condition. J Periodontol 1998 Jun; 69(6): Jul;74(1): Rivera-Hidalgo F, Shulman JD, Beach MM. _ The association of tobacco and other factors with recurrent aphthous stomatitis in an US adult population. Oral Dis Nov;10(6): Vincent SD, Lilly GE. _ Clinical, historic, and therapeutic features of aphthous stomatitis. Literature review and open clinical trial employing steroids. Oral Surg Oral Med Oral Pathol biopolimeruli firfitebis gamoyeneba piris Rrus lorwovani garsis daavadebata samkurnalod med.mecn.kand. m. SaniZe, n. menabde Tbilisis saxelmwifo universitetis samedicino fakultetis stomatologiuri katedra ÐÉÒÉÓ ÙÒÖÓ ÃÀÀÅÀÃÄÁÀÈÀ ÌÊÖÒÍÀËÏÁÉÓ ÃÒÏÓ ÀÃÂÉËÏÁÒÉÅÀà ÅÉÚÄÍÄÁÈ ÀÍÔÉÓÄÐÔÉÊÖÒ, ÀÍÈÄÁÉÓ ÓÀßÉÍÀÀÙÌÃÄÂÏ, ÒÄÂÄÍÄÒÀÝÉÉÓ ÃÀÌÀÜØÀÒÄÁÄË ÐÒÄÐÀÒÀÔÄÁÓ. ÂÀÍÓÀÊÖÈÒÄÁÉÈ ÃÉÃÉ ÚÖÒÀÃÙÄÁÀ ÄØÝÄÅÀ ÁÀØÔÄÒÉÏËÏÂÉÖÒ ËÏÒÀÆÄ ÆÄÌÏØÌÄÃÄÁÀÓ ÀÍÔÉÁÉÏÔÉÊÄÁÉÓÀ ÃÀ ÀÂÄÁÉÓ ÂÀÌÏÚÄÍÄÁÉÈ. ÓÀÌÊÖÒÍÀËÏ ÓÀÛÖÀËÄÁÄÁÉ ÂÀÌÏÉÚÄÍÄÁÀ ÓÀÅËÄÁÉÓ, ÀÁÀÆÀÍÉÓ, ÀÐËÉÊÀÝÉÉÓ ÓÀáÉÈ. ÓÀÌßÖáÀÒÏÃ, ÐÒÄÐÀÒÀÔÄÁÉÓ ÖÌÒÀÅËÄÓÏÁÀ ÌÏØÌÄÃÄÁÓ ÌáÏËÏà ÄÒÈÌáÒÉÅÀà ÃÀ ÀÒÀ ÒÀÌÃÄÍÉÌÄ ÀØÔÏÒÆÄ ÄÒÈÃÒÏÖËÀÃ. ÀÌÉÔÏÌ ÓÀàÉÒÏÀ ÚÅÄËÀ ÌÄÃÉÊÀÌÄÍÔÉÓ ÈÀÍÌÉÌÃÄÅÒÏÁÉÈ ÂÀÌÏÚÄÍÄÁÀ, ÒÀÝ ÃÉà ÃÒÏÓÀ ÃÀ áàòãó ÌÏÉÈáÏÅÓ. ÀÌÀÓÈÀÍ, ÝáÉÌÏÅÀÍ ÓÀ ÖÞÅÄËÆÄ ÃÀÌÆÀÃÄÁÖËÉ ÌÀËÀÌÏÄÁÉ ÆÙÖÃÀÅÓ ÌÀÈÛÉ ÀÒÓÄÁÖË ÀÍÔÉÁÀØÔÄÒÉÖË ÓÀÛÖÀËÄÁÄÁÓ ØÓÏÅÉËÛÉ ÙÒÌÀà ÉÌÏØÌÄÃÏÓ ÁÀØÔÄÒÉÖË ËÏÒÀÆÄ ÃÀ ÒÀÝ ÌÈÀÅÀÒÉÀ, ÐÉÒÉÓ ÙÒÖÛÉ ÛÄÔÀÍÉËÉ ÐÒÄÐÀÒÀÔÄÁÉÓ ÌÏØÌÄÃÄÁÀ ÂÒÞÄËÃÄÁÀ ÌÏÊËÄ áíéè, ÒÀÃÂÀÍ ÐÒÄÐÀÒÀÔÄÁÉ ÂÀÌÏÉÒÄÝáÄÁÀ ÃÀ ÂÀÍÆÀÅÃÄÁÀ ÍÄÒßÚÅÉÓ, ÙÒÞÉËÉÓ ãéáéó ÓÉÈáÉÓ, ÓÄÒÏÆÖËÉ ÃÀ ÜÉÒØÏÅÀÍÉ ÂÀÌÏÍÀÃÄÍÉÓ ÆÄÌÏØÌÄÃÄÁÉÈ. ÀÌÉÔÏÌ ÐÉÒÉÓ ÙÒÖÓ ËÏÒßÏÅÀÍÉ ÂÀÒÓÉÓ ÃÀÀÅÀÃÄÁÀÈÀ ÓÀÌÊÖÒÍÀËÏà ÓÀàÉÒÏÀ ÉÓÄÈÉ ÌÄÈÏÃÉÊÉÓ ÛÄÒÜÄÅÀ, ÒÏÌÄËÉÝ ÖÆÒÖÍÅÄËÚÏ Ó ÀÃÂÉËÏÁÒÉÅÀà ÐÀÈÏËÏÂÉÖÒ ÊÄÒÀÆÄ ÓáÅÀÃÀÓáÅÀ ÐÒÄÐÀÒÀÔÉÓ áàíâòþëéå ÆÄÌÏØÌÄÃÄÁÀÓ. ÀÌ ÌÉÆÍÉÈ, ÐÉÒÉÓ ÙÒÖÓ ÃÀÀÅÀÃÄÁÀÈÀ ÓÀÌÊÖÒÍÀËÏà ÌÉÆÀÍÛÄßÏÍÉËÉÀ ÁÉÏÐÏËÉÌÄÒÖËÉ ÉÒ ÉÔÄÁÉÓ ÂÀÌÏÚÄÍÄÁÀ. ÉÒ ÉÔÀ, ÒÏÌÄËÛÉÝ ÜÀÔÅÉÒÈÖËÉÀ ÓÀÌÊÖÒÍÀËÏ ÐÒÄÐÀÒÀÔÉ, ÃÀÄÊÒÏÁÀ ËÏÒßÏÅÀÍ ÂÀÒÓÓ ÃÀ ÒÀÌÃÄÍÉÌÄ ÓÀÀÈÉÓ ÂÀÍÌÀÅËÏÁÀÛÉ ÂÀÍÀáÏÒÝÉÄËÄÁÓ ÐÒÄÐÀÒÀÔÉÓ ÌÏØÌÄÃÄÁÀÓ ÐÀÈÏËÏÂÉÖÒ ÖÁÀÍÆÄ.

79 ÐÉÒÉÓ ÙÒÖÓ ËÏÒßÏÅÀÍÉ ÂÀÒÓÉÓ ÓáÅÀÃÀÓáÅÀ ÃÀÀÅÀÃÄÁÉÓ ÓÀÌÊÖÒÍÀËÏà ÀÃÂÉËÏÁÒÉÅÀà ÂÀÌÏÅÉÚÄÍÄÈ ÀáÀËÉ ÓÀÌÀÌÖËÏ ÐÒÄÐÀÒÀÔÉ -,, ÀÂÏÁÉÏÃÄÒÌÉ ÃÄÍÔÀ, ÒÏÌÄËÉÝ ÛÄÉØÌÍÀ ÓÀÌÄÃÉÝÉÍÏ ÐÏËÉÌÄÒÄÁÉÓÀ ÃÀ ÁÉÏÌÀÓÀËÄÁÉÓ ÝÄÍÔÒÛÉ ÐÒÏ. Ò.ØÀÝÀÒÀÅÀÓ áäëìþùåàíäëïáéè.,, ÀÂÏÁÉÏÃÄÒÌÉ ÃÄÍÔÀ ßÀÒÌÏÀÃÂÄÍÓ ÁÉÏÃÄÂÒÀÃÉÒÄÁÀà ÐÏËÉÌÄÒÓ, ÛÄØÌÍÉËÉÀ ÀËÉ ÀÔÖÒÉ ÃÉÊÀÒÁÏÍÌÑÀÅÄÁÉÓÀ ÃÀ ÛÄÖÝÅËÄËÉ ÀÌÉÍÏÌÑÀÅÄÁÉÓ ÓÀ ÖÞÅÄËÆÄ, ÒÏÌÄËÛÉÝ ÉÌÐÒÄÂÍÉÒÄÁÖËÉÀ ÐÉÏ ÀÂÉ, ÄÒÌÄÍÔÉ á ØÉÌÏÔÒÉ ÓÉÍÉ, ÀÍÔÉÁÉÏÔÉÊÄÁÉ ÃÀ ÀÍÄÓÈÄÔÉÊÉ. ÁÉÏÃÄÂÒÀÃÉÒÄÁÀÃÉ ÐÏËÉÌÄÒÄÁÉ ÄØÅÄÌÃÄÁÀÒÄÁÀ ÊÏÍÔÒÏËÉÒÄÁÖË ÁÉÏÃÄÂÒÀÃÀÝÉÀÓ. ÌÀÈÉ ÃÀÛËÉÓ ÃÒÏÓ ÂÀÌÏÉÚÏ À ÀØÔÉÖÒÉ ÓÀßÚÉÓÉ, ÀÓÄÅÄ ÃÀÁÀËÌÏËÄÊÖËÖÒÉ ÐÒÏÃÖØÔÄÁÉ, ÒÏÌËÄÁÉÝ ÉßÅÄÅÓ ÌÀÊÒÏ ÀÂÄÁÉÓ ÂÀÀØÔÉÖÒÄÁÉÓ ÓÔÉÌÖËÀÝÉÀÓ ÃÀ ÀÜØÀÒÄÁÓ ÃÀÆÉÀÍÄÁÖËÉ ØÓÏÅÉËÉÓ ÒÄÐÀÒÀÝÉÖË ÐÒÏÝÄÓÄÁÓ. ÁÉÏÃÄÂÒÀÃÉÒÄÁÀÃÉ ÉÒ ÉÔÄÁÉ ÌÏÚÅÉÈÀËÏ ÛÄ ÄÒÉËÏÁÉÓÀÀ, ÆÏÌÉÈ 80 x 10 x 0,1 ÌÌ, ÀÃÅÉËÀà ÉàÒÄÁÀ ÃÀ ÛÄÉÞËÄÁÀ ÌÉÅÝÄÈ ÓÀÓÖÒÅÄËÉ ÏÒÌÀ. ÌÊÖÒÍÀËÏÁÀ ÜÀÖÔÀÒÃÀ 53 ÐÀÝÉÄÍÔÓ ÌßÅÀÅÄ ÃÀ ØÒÏÍÉÊÖËÉ ÔÒÀÅÌÉÓ, ÓÔÒÄÐÔÏÊÏÊÖËÉ ÃÀ ÓÔÀ ÉËÏÊÏÊÖÒÉ ÉÍ ÄØÝÉÄÁÉÓ ÃÀ ØÒÏÍÉÊÖËÉ ÒÄÝÉÃÉÖËÉ À ÈÏÆÖÒÉ ÓÔÏÌÀÔÉÔÉÓ ÃÉÀÂÍÏÆÉÈ. ÆÏÂÀÃÉ ÌÊÖÒÍÀËÏÁÉÓ ÏÍÆÄ ÀÃÂÉËÏÁÒÉÅÉ ÌÊÖÒÍÀËÏÁÀ ÔÀÒÃÄÁÏÃÀ ÛÄÌÃÄÂÉ ÓØÄÌÉÈ: ÀÍÔÉÓÄÐÔÉÊÖÒÉ ÃÀÌÖÛÀÅÄÁÉÓ ÛÄÌÃÄÂ, ÐÉÒÉÓ ÙÙÖÓ ËÏÒßÏÅÀÍ ÂÀÒÓÆÄ ÅÀÊÒÀÅÃÉÈ,, ÀÂÏÁÉÏÃÄÒÌÉ ÃÄÍÔÀÓ ÉÒ ÉÔÄÁÓ, ÄÒÏÆÉÄÁÉÓ, ßÚËÖËÉÓÀ ÃÀ À ÈÄÁÉÓ ÀÒÓÄÁÏÁÉÓ ÛÄÌÈáÅÄÅÀÛÉ. ÉÒ ÉÔÉÈ Å ÀÒÀÅÃÉÈ ÖÛÖÀËÏà ÐÀÈÏËÏÂÉÖÒ ÊÄÒÀÓ ÃÀ ÅÔÏÅÄÁÃÉÈ ÐÉÒÉÓ ÙÒÖÛÉ 4 5 ÓÀÀÈÉÈ ÓÀÊÅÄÁÉÓ ÌÉÙÄÁÀÌÃÄ. ÐÒÏÝÄÃÖÒÀÓ ÅÉÌÄÏÒÄÁÃÉÈ ÃÙÄÛÉ ÒÀÌÃÄÍãÄÒÌÄ. ÐÉÒÉÓ ÙÒÖÛÉ ÛÄÔÀÍÀÌÃÄ ÉÒ ÉÔÄÁÓ 5 ßÖÈÉÓ ÂÀÍÌÀÅËÏÁÀÛÉ ÅÀÌÖÛÀÅÄÁÃÉÈ ÍÀÔÒÉÖÌÉÓ ÁÉÊÀÒÁÏÍÀÔÉÓ 3 %-ian áóíàòûé. ÐÉÒÅÄËÉ ÐÒÏÝÄÃÖÒÉÓ ÜÀÔÀÒÄÁÉÓ ÛÄÌÃÄÂ, ÐÀÝÉÄÍÔÄÁÓ ÄáÓÍÄÁÀÈ ÔÊÉÅÉËÉÓ, ÃÉÓÊÏÌ ÏÒÔÉÓ ÛÄÂÒÞÍÄÁÀ. ÐÀÈÏËÏÂÉÖÒÉ ÄËÄÌÄÍÔÄÁÉÓ ÄÐÉÈÄËÉÆÀÝÉÀ áãäáà ÌÄ-2, 3 ÃÙÄÓ. ÌÉÙÄÁÖË ÛÄÃÄÂÄÁÆÄ ÃÀÚÒÃÍÏÁÉÈ, ÛÄÂÅÉÞËÉÀ ÀÙÅÍÉÛÍÏÈ, ÒÏÌ ÁÉÏÐÏËÉÌÄÒÖËÉ ÉÒ ÉÔÀ,, ÀÂÏÁÉÏÃÄÒÌÉ ÃÄÍÔÀ ÄÒÈÃÒÏÖËÀà ÀáÏÒÝÉÄËÄÁÓ ÔÊÉÅÉËÃÀÌÀÚÖÜÄÁÄË, ÀÍÈÄÁÉÓ ÓÀßÉÍÀÀÙÌÃÄÂÏ, ÒÄÂÄÍÄÒÀÝÉÉÓ ÃÀÌÀÜØÀÒÄÁÄË ÆÄÌÏØÌÄÃÄÁÀÓ ÌÀÓÛÉ ÜÀÔÅÉÒÈÖËÉ ÀÍÄÓÈÄÔÉÊÉÓ, ÀÍÔÉÁÉÏÔÉÊÄÁÉÓ, ÄÒÌÄÍÔÄÁÉÓÀ ÃÀ ÐÉÏ ÀÂÉÓ ÆÄÌÏØÌÄÃÄÁÉÈ ÃÀ, ÔÒÀÃÉÝÉÖË ÌÄÈÏÃÄÁÈÀÍ ÛÄÃÀÒÄÁÉÈ (ÓÀÅËÄÁÉ, ÀÐËÉÊÀÝÉÀ), ÓÀÂÒÞÍÏÁËÀà ÀÌÝÉÒÄÁÓ ÌÊÖÒÍÀËÏÁÉÓ áàíâòþëéåïáàó. ÐÒÄÐÀÒÀÔÉ ÀÒ ÉßÅÄÅÓ ÂÅÄÒÃÉÈ ÌÏÅËÄÍÄÁÓ, ÉÒ ÉÔÄÁÉÓ ÂÀÌÏÚÄÍÄÁÀ ÞÀËÉÀÍ ÌÀÒÔÉÅÉ ÃÀ ÌÏáÄÒáÄÁÖËÉÀ ÐÀÝÉÄÍÔÉÓÀÈÅÉÓ. ÁÉÏÐÏËÉÌÄÒÖËÉ ÉÒ ÉÔÄÁÉ ÂÅÄáÌÀÒÄÁÀ ÈÀÅÉÃÀÍ ÀÅÉÝÉËÏÈ ÌÒÀÅÀËãÄÒÀÃÉ ÐÒÏÝÄÃÖÒÀ ÃÀ ÃÉÃÉ ÒÀÏÃÄÍÏÁÉÈ ÌÄÃÉÊÀÌÄÍÔÄÁÉÓ ÂÀÌÏÚÄÍÄÁÀ, ÃÀ ÒÀÝ ÌÈÀÅÀÒÉÀ, ÉÒ ÉÔÄÁÉ ÓÀÛÖÀËÄÁÀÓ ÂÅÀÞËÄÅÓ ÌÀÈÛÉ ÃÄÐÏÍÉÒÄÁÖËÉ ÐÒÄÐÀÒÀÔÄÁÉÓ ÐÒÏËÏÍÂÉÒÄÁÖËÉ ÆÄÌÏØÌÄÃÄÁÉÈ ÓßÒÀ Àà ÌÉÅÀÙßÉÏÈ ÓÀÓÖÒÅÄË Ä ÄØÔÓ. o!, ìå å, å K, %C%ë, ìå! /. Cë= 2, %* äë ëå)å, ƒ=k%ëå"=, L ë, ƒ, 2%L %K%ë%)*, C%ë% 2,!2= j`md.led.m`rj l. x`mhdge, m. lem`ade j=- åä!= 2%ì=2%ë%ã,, ìåä, ö, *%ã% - =*3ëü2å2= Šcr o!, ìå å, å %"%ã%c!åc=!=2=&t =ã%k, %äå!ì-äå 2=[ " ëå å,, å*%2%!/. ƒ=k%ëå"=, L ë, ƒ, 2%L %K%ë% *, C%ë% 2,!2="/ %*%.- -å*2, " %. o!åc=!=2.=!=*2å!, ƒ3å2 K%ëå32%ë þ?,ì, C!%2, "%"% C=ë, 2åëü / ì äål 2", åì, 2, ì3ë,!3å2 C!%öå /!åãå å!=ö,,, %*!=? =å2!%*, ëå å,. o ëå *=C!% 2= " C!, ìå å,,, å, ìåå2 C%K% /. "ëå, L, C%öå å ä% 23C =äë C=ö, å 2%".

80 APPLICATION OF BIOPOLYMER TABS FOR THE TREATMENT OF MUCOUS MEMBRANE OF ORAL CAVITY M.Shanidze, N. Menabde The application of new preparation Phagobioderm denta in cavity gives good results. The preparation has analgetic, antiinflammatory actions, stimulates the processes of regeneration and reduces the time of treatment. It has no side effects, is rather simple while usage and not expensive. literatura: k, 2å!=23!=: 1. ÝÉÍÝÀÞÄ È., ÌÀÒÊÏÉÛÅÉËÉ Ê., ÀÒÙÀËÀÅÀ Ã., ÀËÀÅÉÞÄ Æ., ßÉÈËÀÍÀÞÄ Â., ØÀÝÀÒÀÅÀ Ò., ÂÏÍÂÀÞÄ Í. ÁÉÏÊÏÌÐÏÆÉÝÉÖÒÉ ÓÀÛÖÀËÄÁÄÁÉÓ,, ÀÂÏÁÉÏÃÄÒÌÉÓ àòéëïáäáéó ÛÄÌÀáÏÒÝÄÁÄËÉ ÈÅÉÓÄÁÄÁÉ ÃÀ ÊËÉÍÉÊÖÒÉ Ä ÄØÔÖÒÏÁÀ. ÓÀØÀÒÈÅÄËÏÓ ÓÀáÄËÌßÉ ÏÄÁÒÉÏÁÉÓ 3000 ßËÉÓÈÀÅÉÓÀÃÌÉ ÌÉÞÙÅÍÉËÉ ÓÀØÀÒÈÅÄËÏÓ ÉÆÉÏËÏÂÈÀ ÌÄÏÒÄ ÚÒÉËÏÁÉÓ ÌÀÓÀËÄÁÉ. ÈÁÉËÉÓÉ ÂÅ Š3 *, k., 0, ö=äƒå Š., 0, 2ë= =äƒå c., l %, ö!=c, ø", ë, l., `ë=", äƒå g., j=ö=!="=p., c%äå!äƒ, ø", ë, l. # l å.=, ƒì!= =ƒ=, "ë þ? åã%äål 2",!åä 2"=&t =ã%k, %äå!ì[. Georgian Medical News, 2000, 16(63), , ö=äƒå Š.c. # n öå *=% %ã%ƒ=, "ë þ? åã%äål 2",, = 2, ì, *!%K %L =*2, " % 2,!åä 2"= &t =ã%k, %äå!ì[. l å ä3 =!%ä = =3 = *% -å!å ö, =2åì3: &`*23=ëü / å C!%Këåì/ K, %ë%ã,,, ìåä, ö, / [. ŠK, ë, *, L ã% 3ä=! 2"å / L 3, "å!, 2å2, ì. h.d ="=., ø", ë,, ŠK, ë, *= ìåä, ö, *= =*=äåì,,, 2, 232 K, %ë%ã, å *%L ìåä, ö, /,.*%ë%ã,,. ŠK, ë,,, 2001, 2! Markoishvili K., MD, Tsitlanadze G., MD, R.Katsarava, PhD, Glenn Morris J., Jr., MD, and Sulakvelidze A. A novel sustained-release matrix based on biodegradable poly(esteramide)s and impregnated with bacteriofages and an antibioticshows promise in management of infected venous ulcers and other pooly healing wounds. International Journal of Dermatology, 2002, 41, pp ÛÀÍÉÞÄ Ì., ÊÀÍÃÄËÀÊÉ Ø. ØÒÏÍÉÊÖËÉ ÒÄÝÉÃÉÖËÉ À ÈÏÆÖÒÉ ÓÔÏÌÀÔÉÔÉÓ ÌÊÖÒÍÀËÏÁÉÓ ÓÀÊÉÈáÄÁÉ. I ÓÀÄÒÈÀÛÏÒÉÓÏ ÓÀÌÄÝÍÉÄÒÏ ÌÄÈÏÃÖÒÉ ÊÏÍ ÄÒÄÍÝÉÀ. ÌÄÃÉÝÉÍÀ ÊËÀÓÉÊÖÒ ÓÀÖÍÉÅÄÒÓÉÔÄÔÏ ÂÀÍÀÈËÄÁÀÛÉ. ÓÀÌÄÝÍ. ÛÒ. ÊÒÄÁÖËÉ. ÈÁÉËÉÓÉ 2002 ß.

81 parodontitebis mikrobuli ekologia da etiologiuri mkurnaloba T. nemsaze saqartvelos saxelmwifo samedicino akademiis mikrobiologiisa da epidemiologiis katedra parodontis daavadeba yba-saxis midamos patologiebs Soris ert-erti yvelaze gavrcelebuli da rtuli patologiaa. jandacvis saertasoriso organizaciis monacemebit, parodontitit daavadebulia dedamiwis mosaxleobis 80%. parodontitebis etiopatogenezsi prioritetulia infeqciuri Teoria. samamulo samedicino literaturasi naklebad aris warmocenili parodontitebis etiopatogenezi. infeqciuri agentebis rolis Sesaxeb ar arsebobs monacemebi arnisnuli patologiis ganvitarebasi, gansakutrebit anaerobuli baqteriebis Sesaxeb. parodontitebis mkurnalobis sirtule, erti mxriv, aixsneba mikrobuli floris mudmivi cvlilebit, xolo, meore mxriv, infeqciuri agentebis mgrznobeloba-rezistentobis meryeobit. gamokvlevis mizans Seadgenda gangvesazrvra parodontis mikrobuli ekostruqtura, dagvedgina aerobuli da anaerobuli baqteriebis etiologiuri roli, gangvesazrvra mati bioqimiuri Tvisebebi da mgrznobeloba-rezistentoba antimikrobuli preparatebis mimart. warmodgenili nasromi Sesrulebulia saxelmwifo samedicino akademiis mikrobiologiisa da epidemiologiis katedraze wlebsi. mikrobiologiuri gamokvlevebi tardeboda arnisnul katedrastan arsebul samecniero-analitikur centrsi da Sveicaria-saqarTvelos ertobliv diagnostikur centr,,cito -Si. mikrobiologiuri gamokvlevis samusao masalas Seadgenda parodontitit daavadebuli 18 avadmyofis parodontuli jibidan arebuli eqsudati an kiuretajis Sedegad mirebuli masala. avadmyofebis asaki meryeobda 9-dan 65 wlamde. sakvlevi masalis morfologiuri da baqterioskopuli SeswavlisaTvis gamoiyeneboda rogorc natiuri preparatebi, ise gramis wesit SeRebili nacxebi. aerobuli baqteriebis identifikacia da biologiuri Tvisebebis Seswavla xdeboda klasikuri baqteriologiuri metodebit (sufta kulturis gamoyofa, identifikacia, morfologiuri, bioqimiuri da sxva) [2;3;4]. aerobuli baqteriebis antibiotikebis mimart mgrznobeloba-rezistentobis gansazrvra xdeboda diskodifuzuri metodit [3,4]. anaerobuli baqteriebis identifikacia da bioqimiuri Tvisebebis Seswavla warmoebda marali sizustis Api 20 A sistemit (biomerieux safrangeti), xolo mgrznobeloba-rezistentobas vsazrvravdit ATB ANA sistemit [1]. gamokvlevebis dros mikrobta izolireba moxerxda yvela SemTxvevaSi. sul amotesilia 39 baqteriuli Stami da safuarasebri sokos C. albicans-is 8 Stami, rac gamokvleuli avadmyofebis 44,5%-ia (cxrili 1). baqteriebi monokulturasi gamoiyo 11,1%-Si (2 SemTxveva), xolo asociaciasi _ 88,9%-Si.

82 mirebuli monacemebis sumirebit ikveteba parodontitebis etiologiasi aerobuli baqteriebis dominireba anaerobul baqteriebze. kerzod, aerobuli baqteriebi gamovlinda 69.23±7.39%-Si (27 Stami), xolo anaerobuli baqteriebi ±7.39%-Si (12 Stami). Tu izolirebul baqteriebs davajgufebt gramis wesit SeRebvis mixedvit, masin parodontitebis baqteriul florasi gramdadebiti baqteriebi Warbobs (82.05±6.14%) gramuaryofitebs (17.95±6.14%). izolirebuli aerobuli da anaerobuli baqteriebis bioqimiuri Tvisebebi stabiluri iyo da ar arinisneboda variabeloba saxeobissida doneze. ase magalitad S. epidermidis-is Stamebi ar axdenda qsilozis, parabinozis, manitis, tregalozis, qsilitis daslas. koagulazis hemolizuri aqtivobis da dnm-azis testebi uaryofiti iyo 100%-Si. saqarozis, fruqtozis, nitratebis ardgenis, tutovani fosfatazas, ureazis, hialuronidazis da fibrinolizinis testebi dadebiti iyo 100%-Si. gamoyofili S. epidermidis-is yvela Stami Slida manozas da iyo laqtozadadebiti. S. aureus-is yvela izolirebuli Stami gamoimusavebda moyvitalo feris pigments. qsilozis, arabinozis, rafinozis, qsilitis testebi yvela SemTxvevaSi uaryofiti iyo, xolo saqarozis, manitis, tregalozis, manozis, laqtozis, fruqtozis, nitratebis ardgenis, tutovani fosfatazis, hialuronidazis, hemolizuri aqtivobis, dnm-azas, ureazuli aqtivobis testebi dadebiti iyo 100%-Si. aseve stabiluri iyo S. pyogenes-is Stamebis kulturalurbioqimiuri Tvisebebi. yvela Stami icenda beta hemolizur aqtivobas hemolizinis, fibrinolizinis, laqtozis, saqarozis, salicilis mimart. argininis testebi 100%- Si iyo dadebiti, xolo manitis, sorbitis, rafinozis, arabinozis, glicerinis, apulenis, Jelatinis testebi da reaqcia metilis lurjze uaryofiti. zemot arvnisnet, rom anaerobuli baqteriebis Stamebis kulturalur-bioqimiuri Tvisebebi stabiluri iyo. ase magalitad S. intermediusis-is Stamebi ar warmoqmnida indols, ureazas da ar Slida glukozas, manits, qsilozas, arabinozas, Jelatins, glicerins, manozas, melezitozas, rafinozas, sorbits, ramnozas da katalazas, xolo laqtozas, saqarozas, maltozas, salicils, eskulins, celobiozas, manozas da tregalozas Slida 100%-Si. L. acidofilus-is Stamebi Slida glukozas, ar aradgenda nitratebs, ar Slida kazeins, warmoqmnida pigments, laqtozisa da citoqromoqsidazas testebi uaryofiti iyo. xolo B. adolescentis-is Stamebi Slida glukozas, laqtozas, saqarozas, manits da iyo katalazauaryofiti. Cveni gamokvlevebis dros C. albicans 18 avadmyofidan 8 (44.5%) SemTxvevaSi izolirebul iqna. dafiqsirda mati saxeobsida izolantebis metaboluri Tvisebebis meryeoba, saxeldobr, adonitis, sorbitis, tregalozas testebis mimart dadebiti iyo izolantebis 62.5% (5 Stami). laqtozas, arabinozas, celobiozasa da rafinozas testebisadmi dadebiti iyo 12.5% (1Stami). saqarozasa da glicerinis testebisadmi dadebiti iyo 87.5% (7 Stami). yvela izolanti ax denda glukozisa da galaqtozis fermentacias, xolo maltozisa da melezitozis testebi yoveltvis uaryofiti iyo. kvlevis Sedegebma gvicvena parodontitebis dros gamoyofili sxvadasxva baqteriis 39 Stamis mgrznobeloba-rezistentobis variabeluri surati. aerobuli baqteriebis mgrznobeloba-rezistentobis gansazrvra warmoebda antibiotikebisa da fagebis Semdegi rigis mimart: penicilini G, prokain-penicilini, streptomicini, eritromicini, tetraciklini, doqsiciklini, kefzoli, cefazolini, cefamezini, klaforani, cepdazimidi, zinacepi, kanamicini, gentamicini, levomicetini, oleandomicini, linkomicini, klindamicini, ciprofloqsacini, klaritromicini,

83 biseptoli, 5-noki, rifampicini, polimiqsini M, makropeni, stafilofagi, streptofagi, piofagi, kolifagi. gamoyofili anaerobuli baqteriebis mgrznobelobis speqtris gansazrvra warmoebda ATB ANA sistemis sasualebit antimikrobuli preparatebis Semdeg rigze: penicilini G, augmentini, piperacilini, tazocini, timentini, cefoqsitini, cefotateni, imipenemi, klindamicini, qloramfenikoli, metronidazoli, ampiqsicilini, amoqsicilini 16, augmentini 16, tikarilini 64. aerobuli baqteriebis mgrznobeloba antimikrobuli qimiapreparatebisa da fagebis mimart warmodgenilia meore cxrilsi. rogorc cxrilidan Cans, aerobuli baqteriebi stabilurad maral mgrznobelobas icens cefalosporinebis, I, II, da III Taobis, tetraciklinebis, qinolebis I da II Taobis antibiotikebis mimart da SeiZleba tradiciulad gamoyenebad preparatebad CaiTvalos. aerobuli baqteriebi dabal mgrznobelobas icenda penicilinis, aminoglikozidebis, linkozamidebis, makrolidebis, polipeptidebis jgufis warmomadgenlebis mimart da amitom mati gamoyeneba parodontitebis dros mizansewonilia sarezervod. aerobuli baqteriebi damakmayofilebel mgrznobelobas icens homologiuri fagebis _ stafilofagis, streptofagis, piofagis da kolifagis mimart da amitom SeiZleba fartod gamoviyenot parodontitebis mkurnalobasi. amrigad, anaerobuli baqteriebi zomier, sasualo da maral mgrznobelobas icenda penicilinebis, cefalosporinebis II Taobis, karbapenemebis, betalaqtamaza inhibitorebis, linkozamidebis warmomadgenlebis mimart. anaerobuli baqteriebi rezistentulia metronidazolis mimart, romelsac, literaturis mixedvit, parodontitebis dros prioritetul samkurnalo sasualebad miicneven. veni gamokvlevebit parodontitebis baqteriuli flora mravalferovania. martalia aerobuli baqteriebi Warbobs anaerobuls, Tumca am ukanasknelis xvedriti wili (30,77%) parodontitebis etiologiasi sakmaod maralia da rac, Tavis mxriv, migvititebs parodontitebis dros avadmyofebis aucilebel gamokvlevas anaerobul infeqciebze. Cven mier izolirebuli infeqciuri agentebis mgrznobeloba-rezistentobis macveneblebi imaze migvititebs, rom parodontitebis etiotropuli mkurnaloba unda efuznebodes konkretuli antibiotikgramebis monacemebs, xolo fago-mgrznobelobis Sesaxeb monacemebi mianisnebs baqteriofagebis farto danergvasa da gamoyenebaze parodontitebis mkurnalobasi. l, *!%K = 2!3*23!= C=!%ä% 2, 2%",.2, %ë%ã, )å *%å ëå)å, å Š. måì =äƒå j=- åä!= ì, *!%K, %ë%ã,,,.c, äåì, %ë%ã,, c% 3ä=! 2"å %L ìåä, ö, *%L =*=äåì,, c!3ƒ,, q öåëüþ %C!åäåëå, ì, *!%K %L 2!3*23!/ äë 3 2= %"ëå,.2, %ë%ã, å *%ã%ëå å, " ãã. C!%"åäå / ì, *!%K, %ë%ã, å *, å, ëåä%"=, 18 K%ëü /. C=!%ä% 2, 2%ì. h ëåä%"=, C%*=ƒ=ë,, 2%" K=*2å!, =ëü %L -ë%!å ä%ì,,!%"=ë, S. epidermidis # 20,5@6,46 %, S. pyogenes 17,94@6,14%, S. intermedius 15,38@5,77%, ä!3ã, å =.!%K/, == =.!%K / å K=*2å!,, "/ å, "=ë, ü!=", 2åëü %!å å: =.!%K / å K=*2å!,, "/ "ëå / " 69,23@7,39%, = =.!%K / å - " 30.77@7,39%.

84 h ƒ%ë,!%"= / å ø2=ìì/ =.!%K /. K=*2å!, L C!% "ë ë, "/ %*3þ 3" 2", 2åëü % 2ü * = 2, K, %2, *=ì I, II, III C%*%ëå, L %", 2å2!=ö, *ë, %", I, II C%*%ëå, ì., %ë%"; = =.!%K / å K=*2å!,, C!% "ë ë,!åä þþ, "/ %*3þ 3" 2", 2åëü % 2ü * C!åä 2=", 2åë ì Cå, ö, ëë, %", * II C%*%ëå, þ öå-=ë% C%!, %", *=!K=Cå åì%", K.2=ë=*2=ì=ƒ=, ã, K, 2%!%", ë, *%ƒ=ì, ä%". b/ ", ë= ü, ƒ*= 3" 2", 2åëü % 2ü (, %ãä=!åƒ, 2å 2 2 % 2ü)* ìå2!%, ä=ƒ%ë3, *%2%!/ L C%ä= / ì ë, 2å!=23!/ "ë å2 C!, %!, 2å2 / ì ëå åk / ì C!åC=!=2%ì C!, C=!%ä% 2, 2=.. Microbe Ecology of Periodontitis and Aspects of etiologic Treatment T. Nemsadze In order to assess the microbe structure of periodontitis for defining etiologic treatment, 18 patients suffering from periodontitis were subjected to microbiologic examination. Examinations proved that in bacterial flora dominated: S. epidermidis 20,5±6,46%, S. pyogenes 17,94±6,14%, S. intermedius 15,38±5,77%, but aerobic and anaerobic bacteria were slightly sowed (aerobic bacteria were in 69,23±7,39% and anaerobic bacteria in 30,77±7,39% of cases). Isolated strains of aerobic bacteria showed high sensitivity towards cephalosporins I, II, and III generations, tetracyclines, quinolones I and II generations antibiotics, but anaerobic bacteria showed common, intermediate and high sensitivity towards penicillin, cephalosporins II generation, carbapenems, betalactamaza inhibitors, lincosamides representatives. Flora revealed low sensitivity and resistance towards metronidazole which according to medical literature is the main medical means in the treatment of periodontitis. literatura: k, 2å!=23!=: 1. kereselize m. _ klinikuri baqteriologia. Tbilisi,,,evro~, 2001 w. 2. j=ë, =c.o., b, %ã!=ä%"=k.`., Š!3, =c.l. _ l å2%ä, å *, å!å*%ìå ä=ö,, C%, äå 2, -, *=ö,, ã!=ì%2!, ö=2åëü /. ì, *!%%!ã=, ƒì%". l.: 1985, o%*!%" *, L b. h., o %ƒä åå" n.j. _ l åä, ö, *= ì, *!%K, %ë%ã,. l.:,,l åä, ö, =~, 1999, c a,!ãå! l.n. _ qc!="%, * C%ì, *!%K, %ë%ã, å *, ì, ",!3 %ë%ã, å *, ì ìå2%ä%ì, ëåä%"=,. l.: l åä,, =, 1982, c. 461.

85 qartuli ojaxis struqturulfunqciuri cvlilebebis gavlena Sobadobaze n. vasaze Tbilisis saxelmwifo samedicino universitetis sazogadoebrivi jandacvisa da menejmentis katedra ukanasknel wlebsi momxdarma socialur-ekonomikurma situaciam gavlena iqonia qartuli ojaxis struqturul da funqciur cvlilebebze. miuxedavad imisa, rom Cvens qveyanas ojaxis institutis kvlevis xangrzlivi istoria gaacnia, romelic sawyiss irebs jer kidev XIX saukunesi. bolo wlebsi momxdari movlenebi mainc moitxovs garrmavebul, mecnierul kvlevas demografebis, istorikosebis, ekonomistebis, fsiqologebis monawileobit. ojaxis cneba misi specifikidan da sirtulidan gamomdinare, sabolood, albat, ver iqneba srulyofili, radgan arc erti arsebuli ganmarteba ar amowuravs im sakitxs, romlis garese SeuZlebelia universaluri ojaxis definiciis Camoyalibeba. luis morganis azrit, `arc ert sazogadoebriv organizacias ar hqonia iseti mdidari da Sinaarsiani istoria, arc ert matgans ar ganuxorcielebia ufro xangrzlivi da mravalmxrivi cdis Sedegebi, rogorc ojaxs, romelmac Tanamedrove saxis mirebamde ganvitarebis didi gza ganvlo; ojaxi sazogadoebis aqtiuri elementia, romelic mudmivad icvleba da ganicdis isetive evoluciur ganvitarebas, rogorc mtlianad sazogadoeba~. ojaxis, rogorc sazogadoebis calke ujredis ganvitarebasi aisaxeba yvela mimdinare movlena. igi sazogadoebasi warmoqmnil yvela mnisvnelovan process asaxavs. mecnierebis interesi, ojaxis institutis kvlevastan dakavsirebit, gamowveulia TviT ojaxisa da pirovnebis im funqciuri mnisvnelobit, rasac isini asruleben sazogadoebasa da ertmanettan mimartebasi. sazogadoebis struqturasi ojaxs specifikuri adgili ukavia. igi SemakavSirebeli rgolia did socialur ertobebsa (eri, klasi da a.s.) da pirovnebebs Soris. ojaxis ert-ert umtavres funqcias ganekutvneba STamomavlobis Seqmnis, anu adamianta modgmis gagrzeleba, romelic ertgvarad gadajawvulia ekonomikur funqciebtan da safuzvlad udevs monogamiuri ojaxis Seqmnas. ojaxi pirovnebis normaluri arzr dis aucilebel faqtors warmoadgens. aq safuzveli eyreba pirovnebis RirebulebaTa orientaciasa da misi motxovnilebis mteli sistemis Camoyalibebas. aqedan gamomdinare, ojaxis garese arzrdil bavsvebs calmxrivi ganvitarebis ufro didi sasisroeba aqvt, vidre msoblebtan ertad mcxovrebt. matze ojaxis zemoqmedebis faqtori iseve mnisvnelovania, rogorc mtlianad sazogadoebis zemoqmedeba. termini `ojaxi~ Turquli warmosobisaa. igi keras, saxls nisnavs da SedarebiT gvianaa fexmokidebuli saqartvelosi. istoriul dokumentebsi igi pirvelad `samoqalaqo hsjuldebasi~ ( wlebi) gvxvdeba. Sesabamisi termini Zvel qartulsi iyo `saxli~, romelic mtel sagvareulos, gvars nisnavda. istoriuli dokumentebisa da kulturuli wyaroebis analizit, ivane javaxisvilma daasabuta, rom ukve V saukunesi saqartvelosi `saxli~ ara marto sagvareulos da gvars nisnavda, aramed ert col-qmrobaze damyarebul ojaxsac. SemdgomSi ki amgvari mnisvneloba ufro da ufro ganmtkicda. Tanamedrove qartul ojaxs siyvarulis niadagze armocenebuli qorwineba da ojaxis wevrta urtiertkavsiri udevs safuzvlad. amis garantiasac ojaxis

86 simtkice warmoadgens, rac ganpirobebulia istoriulad Camoyalibebuli iseti elementebis arsebobit, rogoricaa msoblebisa da Svilebis, ojaxis sxva wevrebis mwidro, mravalmxrivi da tradiciuli kavsiri, natesauri grznobis sizliere, gansakutrebuli zrunva axalgazrda Taobis arzrdisadmi. ramdenime ojaxsi warmosobili urtiertobebi xsir SemTxvevaSi samartlebriv xasiats atarebs, romlebic mowesrigebulia satanado kanonebit. qveyanasi mimdinare demografiuli procesis Sefasebisas gatvaliswinebul unda iqnes mati sistemuri buneba, romlis elementebs (mosaxleobis raodenoba, Sobadoba, sikvdilianoba da a.s.) Soris mwidro urtiertkavsiri arsebobs. erti romelime matganis cvlileba aisaxeba danarcenebzec. saqartvelos amjamindeli demografiuli mdgomareobis daxasiateba sakmaod rtulia Tundac imitom, rom mosaxleobis raodenobac ki ar aris zustad cnobili, arasrulfasovnad xorcieldeba dabadebis, gardacvalebisa da mosaxleobis migraciis arricxva (cxrili 1). wlebi cxrili 1 saqartvelos mosaxleobis raodenoba (atasebsi) sasualo wliuri wlis dasawyisi ukanaskneli atwleulis ganmavlobasi ganvitarebulma socialurma da ekonomikurma krizisma, samoqalaqo omma, devnilta nakadma, gazrdilma umusevrobam, mosaxleobis didi nawilis cxovrebis pirobebis gauaresebam da migraciis intensiobam, uaryofiti gavlena moaxdina ara marto mosaxleobis janmrtelobaze, aramed demografiuli ganvitarebis ZiriTad tendenciebzec, ris gamoc qveyanasi daiwyo depopulaciis procesi. amas asaxavs meore cxrilsi moyvanili monacemebi. saqartvelos mosaxleobis bunebrivi matebis mnisvnelovani Semcireba ukanasknel wlebsi met-naklebad gamoxatulia yvela regionsi. statistikis saxelmwifo departamentis monacemebit, qveynis masstabit bunebrivi matebis macvenebeli 1988 wels dafisqirebulia 8,2-dan, 1997 wels _ 3,2-mde, xolo 1999 wels igi Semcirda 0,1- mde wels, pirvelad saqartvelos uaxles istoriasi, dafiqsirda mosaxleobis

87 bunebrivi klebis faqti, rac gamoixata macveneblis uaryofiti (-0,2) mnisvnelobit. martalia, 2001 wels bunebrivi matebis macvenebeli odnav gaizarda da 0,2-s gautolda, magram is mainc Zalzed dabalia. regionul WrilSi sayuradreboa is garemoeba, rom Tu 1997 wels bunebrivi kleba arinisna rawa-lecxumsa da qvemo svanetsi, 1998 wels mas daemata kaxeti da guria, 1999 wels Tbilisi da imereti, xolo 2000 wels mcxeta-mtianeti. bunebrivi mateba jer kidev SenarCunebulia qveynis mxolod sam regionsi awarasi, qvemo qartlsa da samcxe-javaxetsi (cxrili 2). cxrili 2 ZiriTadi demografiuli macveneblebi regionebis mixedvit (1000 sul mosaxleze) Sobadoba gardacvaleba bunebrivi mateba qorwineba ganqorw. saqartvelo Tbilisi awara guria rawa-lecxumi da qvemo svaneti samegrelo da zemo svaneti mcxeta-mtianeti samcxe-javaxeti qvemo qartli imereti kaxeti Sida qartli saqartvelos mosaxleobis saerto ricxvis gamoxatuli kleba ganpirobebulia mravali mizezit, romelmac Tavis mxriv, gavlena iqonia mosaxleobis rogorc bunebrivi, ise meqanikuri (migraciuli) mozraobis macveneblebis cvalebadobaze. mosaxleobis bunebrivi mozraobis dinamikasi yvelaze SemaSfoTebelia Sobadobis ukiduresi Semcireba. ukanaskneli 10 wlis ganmavlobasi, Sobadobis macvenebeli TiTqmis 2-jer Semcirda. Tum ca, arsanisnavia is garemoebac, rom ukanaskneli 5 wlis monacemebis mixedvit, gamoikveta Sobadobis klebis tempis Senelebis tendencia, romelic 2000 wlidan arinisneba. daskvnebi: 1. Catarebulma gamokvlevam daadastura, rom qveyanasi arsebuli demografiuli situaciis gamoxatuli gauaresebis da dawyebuli depopulaciis procesis miuxedavad, naklebi yuradreba eqceva ojaxis institutis ganmtkicebas. ukanasknel wlebsi ganvitarebuli movlenebi, xsiri stresuli situacia, arasrulfasovani kveba, bavsvta movlis problemis gazneleba mteli simwvavit aisaxa demografiuli procesebis Senelebaze, bavsvta da mozardta janmrtelobis mdgomareobaze. 2. kvlevis Sedegebma cxadyo, rom qartuli ojaxis cxovrebis wesi da misi xarisxi aradamakmayofilebelia. Oojaxi mtliani speqtrit ver asrulebs Tavis funqcias bavsvisa da mozardis arzrdis, misi janmrtelobis dasacavad. 3. seriozul problemas warmoadgens ojaxis ekonomikuri mdgomareoba. gamokitxuli ojaxebis wevrta umetesobis azrit, mati materialuri ketildreoba ver uzrunvelyofs minimaluri motxovnilebebis dakmayofilebas, 20%-ma arnisna,

88 rom aqvs cudi sacxovrebeli pirobebi. gamokitxulta 23%-is azrit, mati ojaxis wevrebi cudad ikvebebian. bë,, å 2!3*23! %-- 3 *ö, % =ëü /., ƒìå å, L ã!3ƒ, *%L åìü, =!% ä=åì% 2ü m. b= =äƒå j=- åä!= %K?å 2"å %ã% ƒä!="%%.!= å,, ìå åä ìå 2= ŠK, ë, *%ã% ã% 3ä=! 2"å %ã% ìåä, ö, *%ã% 3, "å!, 2å2= q%ö, =ëü %-.*% %ì, å *, å, ƒìå å,, C!%, øåäø, å " c!3ƒ,, ƒ=c% ëåä åå "!åì, å!üåƒ %C%"ë, ë, = 2!3*23! %--3 *ö, % =ëü / å, ƒìå å, ã!3ƒ, *%L åìü,, " *% å %ì,2%ãå C!åä%C!åäåë, ë, %"!åìå / å 2å äå ö,,!% ä=åì% 2,, %K3 ë%", "ø, å = =ë%äåc%c3ë ö,, = åëå, öåë%ã%! ä=*!3c /.!åã, % %". q, 23=ö, þ ì% %%.=!=*2å!, ƒ%"=2ü *=* *!, 2, å *3þ, 3, 2/"= "/!= å %å " 2!= å, å, å å 2å 2"å %ã%c!,!% 2= " öåë%ì. a åƒ3 ë%" %, " ë3 =å åc!, 2, äål 2"å /. ìå!, =C!="ëå /. =!= ø,!å, å C%ì%?, åìü ì, ƒ*, ì, ä%.%ä=ì,, C!%C=ã= ä3 ì %ã%äå2 % 2,,!= ø,!å, "%ƒì% % 2åL äë %2ä/.=, ëå å, äå2 *%ã% = åëå,.2=2å äå ö, å? å K%ëåå %K% 2!, 2 C!%Këåì/, *= =þ?,å C%"/ øå, %ö, =ëü %-.*% %ì, å *%ã%3!%" 2!= /. o!åäë% å / ìå!/, =C!="ëå / å =, ƒìå å, å 3? å 2"3þ?,. 2å äå ö, L. sasualo samedicino personalis momzadebisa da dasaqmebis problemebi saqartvelosi v. kiknaze Tbilisis saxelmwifo samedicino universitetis sazogadoebrivi jandacvisa da menejmentis katedra saqartvelosi mimdinare jandacvis sistemis reformis pirobebsi swori sakadro politikis gatareba gansakutrebul mnisvnelobas izens. ukanasknel wlebsi, Tu

89 saeqimo kadrebis momzadebisa da dasaqmebis sakitxebis gadawyvetis saqmesi arinisneba garkveuli dadebiti Zvrebi, sasualo samedicino kadrebtan dakavsirebuli problemebi jer kidev mougvarebelia. zedmiwevnit mzime pirobebsi uxdeba musaoba sasualo samedicino kadrebis momzadebis sistemas, romelic arsebul situaciasi naklebad itvaliswinebs jandacvis sistemis axal motxovnebs. amoqmedda atobit kerzo sasualo samedicino saswavlo dawesebuleba, romelsac ar gaacnia sakutari baza, pedagogiuri personali, saswavlo-metoduri masala. ar xorcieldeba dasaqmebuli sasualo samedicino kadrebis musaobis xarisxze kontroli, mati profesiuli codnis amarleba, licenzireba da sxv. amastan, qveyanasi naklebadaa gamoyenebuli wina wlebsi dagrovili gamocdileba, romelic xels Seuwyobs im saorganizacio RonisZiebebis dagegmvas, romelta gatarebis garese SeuZlebelia jandacvis sistemis strategiuli miznebis mirweva. seriozul problemad rceba sasualo samedicino kadrebis momzadebis processi iseti sakitxebis ganxilva, rogoricaa adamianis janmrtelobaze cxovrebis jansari wesisa da cxovrebis xarisxis zemoqmedeba. imis dasadgenad, Tu ramdenad arian am sakitxebsi gatvitcnobierebuli momavali eqtnebi _ sasualo samedicino saswavlo dawesebulebis studentebi, sociologiuri gamokvlevisatvis SerCeul iqna TbilisSi ganlagebuli saswavleblebis studentta nawili. gamokvlevis Casatareblad damusavda specialuri ruka. igi Sedgeba 62 kitxvisagan, romelic itvaliswinebs: gamokitxulta demografiuli qcevis, janmrtelobis mdgomareobis, socialuri statusis, socialur-fsiqologiuri Taviseburebebis Sefasebis, samedicino dawesebulebebsi mimartvebis Sinaarsis, raodenobisa da sxva sakitxebsi garkvevas. garda amisa, calke blokad iqna gamoyofili gamosakvlevi kontingentis socialuri da sayofacxovrebo problemebis Sesaswavli sakitxebi. arsanisnavia, rom wina weltan SedarebiT, jandacvis sistemasi sasualo samedicino personalis dasaqmeba. mkvetrad klebulobs, sawinaarmdegod _ mkvetrad matulobs saeqimo Tanamdebobebis, gansakutrebit qirurgta, kardiologta, anesteziologta, urologta, onkologta, nevropatologta, oftalmologta, stomatologta ricxvi (cxrili 1). cxrili 1 eqimebisa da sasualo samedicino kadrebis dasaqmebis dinamika ww eqimebi (fizikuri piri) sasualo samed. personali rogorc cxrilsi moyvanili monacemebidan irkveva, eqimebis dasaqmebis macvenebli saqartvelosi bevrad maralia msoflios umetes qveyanastan SedarebiT. amastan, eqimta da sasualo samedicino personalis dasaqmebis optimaluri Sefardeba (1.0:4.0-Tan, 1.0:3.0-Tan) ki ar matulobs, aramed bolo wlebsi sul ufro klebulobs amitom, gamokitxul studentta umetesoba uimedod afasebs Tavisi momavali dasaqmebis perspeqtivas. mnisvnelovania isic, rom gamokitxulta did nawils bundovni warmodgena aqvs im funqciebze, romelic mat daekisrebat momavalsi, Tu specialobit imusaveben.

90 gansakutrebul SeSfoTebas iwvevs is faqti, rom studentta umetesoba arasakmarisad flobs eqtnis profesias daavadebata profilaqtikis saqmesi. mosaxleobis mier cxovrebis jansari wesis dacvastan dakavsirebit, seriozul yuradrebas moitxovs saswavlo programebis daxvewa studentis mier riskis faqtorebis cnebis ufro fartod gacnobis miznit. amas adasturebs is faqti, rom kitxvaze, Tu ra faqtorebi axdens yvelaze did gavlenas adamianis janmrtelobaze, respondentebis umetesobam miutita, rom garemos dabinzurebam SeiZleba ziani moutanos adamianis janmrtelobas. mxolod 5% Tvlis, rom dabali fizikuri aqtivoba, agretve, mavned moqmedebs adamianis janmrtelobaze (cxrili 2). cxrili 2 faqtorebi, romelic, studentta azrit, uaryofit gavlenas axdens adamianis janmrtelobaze # riskis faqtorebi % 1. garemos dabinzureba a 2. Tambaqos weva alkoholis mireba uxarisxo sakvebi xmauri stresuli situacia fizikuri aqtivobis daqveiteba 8. cudi sacxovrebeli pirobebi miwirs pasuxis gacema 19.4 s u l rogorc cxrilsi moyvanili monacemebi cxadyobs, studentta did nawils (19.4%) uwirs pasuxi SekiTxvaze, Tu romeli wamyvani riskis faqtori moqmedebs janmrtelobaze. igive azrisani arian cxovrebis cudi pirobebis gavlenis Sesaxeb janmrtelobaze, mxo lod 4.6%-is azrit, janmrtelobis mdgomareobis gauareseba SeiZleba gamoiwvios ama Tu im daavadebam; mxolod 15.0%-s miacnia, rom janmrtelobaze cudad moqmedebs Tambaqos weva da 19.9%-is azrit, alkoholiis mireba, 3.3%-is azrit, sakvebi produqtebis SemadgenlobaSi mavne qimiuri nivtierebebis arseboba. respondentebis mxolod mcire nawili aris sworad orientirebuli im problemebze, romelic Seexeba janmrtelobaze moqmed riskis faqtorebs. miuxedavad imisa, rom samedicino saswavleblebis programebi itvaliswinebs studentis mier pirveladi samedicino daxmarebis Cvevebis atvisebas, SekiTxvaze _ SeuZliaT Tu ara respondentebs gauwion pirveladi samedicino daxmareba dazaralebuls, mxolod 55%-ma gasca dadebiti pasuxi. zemomoyvanili monacemebidan gamomdinare gasagebia, rom respondentebis did nawili Tavs aridebs dazaralebulisatvis sawiro daxmarebis gawevas. am azrs adasturebs isic, rom kanqvesa inieqciis gaketeba SeuZlia mxolod respondentebis 20%-s; xelovnuri suntqvis Catareba 15%-s; naxvevis dadeba 23%-s; sisxlidenis SeCereba 13%-s; arteriuli wnevis gazomva 29%-s da a.s.; SeSfoTebas iwvevs is faqti, rom mxolod respondentebis 12% miutitebs, rom flobs xelovnuri suntqvis Catarebis proceduras.

91 amrigad, Cven mier mirebuli monacemebi mkvetrad asabutebs im WeSmaritebas, rom sasualo samedicino personalis profesiuli momzadebis donis srulyofis miznit, sawiroa swavlebis uaxlesi formebisa da metodebis danergva, saswavlo materialur-teqnikuri bazis gaumjobeseba, arsebuli situaciis informaciuli uzrunvelyofa, unar-cvevebis atviseba klinikuri aprobaciis pirobebsi. yovelive es, sasualo samedicino personals sasualebas miscems, aimarlos profesiuli done, srulyofilad gaerkves Seqmnil situaciasi da efeqturad warmartos dakisrebuli movaleoba. o!%këåì/ C%äã%2%"*,, ƒ= 2% 2,!åä,. ìåä, ö, *,.!=K%2, *%" " c!3ƒ,, b. j, * =äƒå j=- åä!= %K?å 2"å %ã% ƒä!="%%.!= å,, ìå åä ìå 2= ŠK, ë, *%ã% ã% 3ä=! 2"å %ã% ìåä, ö, *%ã% 3, "å!, 2å2= o!%këåì=c%äã%2%"*,, ƒ= 2% 2,!åä,. ìåä, ö, *,.!=K%2, *%" " c!3ƒ,, 3 å2%ì %"!åìå /. 2!åK%"=, L, C!åä 2="ë å2 % %K/ L, 2å!å " ëåä 2", å %ö, =ëü %L ƒ =, ì% 2,. m=ì,,ƒ3 å / 3!%" ü %!, å 2,!%"= % 2, 23äå 2%" ìåä, ö, *,. 3, ë,? ="%ƒì% % 2ü 2!3ä%3 2!%L 2"=C% ëå %*% =, %K3 å,,,. % "åä%ìëå % 2ü " % %" /. "%C!% =.,*= =þ?,. % 3? å 2"ëå, *= å 2"å %ã% ìåä, ö, *%ã%%k ë3, "=, = åëå,. r 2= %"ëå %, 2%K%ëüø, 2"%!å C% äå 2%" ä% 2=2% %Cå, ì, 2, %%öå, "=å2 "%ƒì% % 2, "%åã% 2!3ä%3 2!%L 2"=. h ìå %.2, ì, C%-", ä, ì%ì3, %K3 ë%"ëå 2%2 -=*2, 2%ƒ =, 2åëü = = 2ü 23äå 2%" åä% 2=2% %ì%2, ",!%"= =, å =öåëå = =% "%å, å ƒ =, L " %Kë= 2, C!%-, ë=*2, *, ƒ=k%ëå"=, L. på*%ìå ä%"= / ìå!/, =C!="ëå / å =3ë3 øå, å %ƒä="? ål %K 2= %"*,. Problems of training and employment of middle medical personnel in Georgia V. Kiknadze Problem of training and employment of middle medical personnel having regard to modern requirements is of special interest due to its social importance. In connection with this, the scientific research, which is directed on an establishment of a level of orientation of students of medical schools on an opportunity of employment after the termination of training, a level of their awareness is carried out in the field of the problems being basic during realization of qualitative health services of the population. It was stated, that estimation of the majority of respondents concerning possibility of thier employment is rater pessimistic. As it seems, the fact that the important part of students is insufficiently motivated and is not aimed to acquire knowledge in the prophylactic sphere of diseases, is foreseen by this fact. The number of measures directed to the correction of existed situation are offered. Thus, the data obtained, strictly ground that use of modern forms and methods, improvement of training materialtechnical base, informational provision of existed situation, adoption of necessary abilities in conditions of clinical approbation are needed for improvement the level of training the professional middle medical personnel. All these will give possibility to medical personnel to raise professional level of medical personnel, to be found out in the situation and effectively conduct their obligations.

92 literatura: k, 2å!=23!=: 1. janmrtelobis dacva, saqartvelo, 2003, statistikuri cnobari, Tbilisi, 2003, kacaze a. _ Tbilisis mosaxleobis formirebis procesebi. Tbilisi, `mecniereba~, 1991w., gv saqartvelos janmrtelobis dacvis sistemis reorientaciis ZiriTadi mimartulebebi. saqartvelos jandacvis saministro. jandacvis martvis nacionaluri centri. Tbilisi, 1996w. gv jandacvis msoflio organizaciis mier mowodebuli gamokvlevis Catarebis metoduri rekomendaciebi. Jeneva, 1995 w., gv Wise PH, First L.R, Lamb G.A. _ Qn avoling repationship among infant mortality, health care and socio-economic change. Pediatrics, 1988, 81, 4, }jqoephlemš`k m` ledh0hm` n ål!%ã3ì%!=ëü %ì ìå.=, ƒìå!åã3ë,!%"=, ìå.= % å %! %L ã%ìå% 2=2, )å *%L - 3 *ö,, åë3ä*= l. j32=2åë=äƒå, C!%-. `. ` =2, =, j=- åä!= %!ì=ëü %L -,ƒ, %ë%ã,, Šclr b C!åäC!, 2%ì!= åå, ëåä%"=,, (2,4,5) =ì, ="ƒ!% ë/. %K=*=..!%, å *%L -, 23ë%L åë3ä*=c%ìå2%ä3 a = %"=, " %!, ã, =ëü %ì.* Cå!, ìå 2å K/ ë%c%*=ƒ= %, 2% C% ëå = /? å,, 2.å. %2*=ƒ=%2 ä=ëü åløåã%c!, åì=c,?,,, *3 2"å %å (C%!åä 2"%ì -, 23ë/ ) = 2, %å %C%!% å, å åë3ä*=, " %2ë,, å %2 å 2å 2"å %ã% (-, ƒ, %ë%ã, å *%ã%), ƒ=*% %ìå! %C!, "%ä, 2 * "%ƒ%k %"ëå, þ C!, åì=, "% C%ë å, þ åë3ä% %ã% %äå!, ì%ã%" 2å å, å äë, 2åëü %ã%"!åìå, C% ëå %2*=ƒ=%2 C,?,, 2.å. C!=*2, å *, " åã%cå!, %ä= = /? å,. }2%2 C%"åäå å *, L.--å*2 K/ ë %K3 ë%"ëå C!å, ì3? å 2"å %!=ƒä!= å, åì ìå.= %!åöåc2%!%" åë3ä*=, % åì ", äå2åëü 2"3þ2 ì%äåëü / å %C/ 2/ "% C!%, ƒ"åäå, åì C,? å"/. C%"åäå å *,.!å=*ö, L C32åì, ƒìå å,!= 2 å, 2å %* åë3ä*=!åƒ, %"/ ì K=ëë% %ì ƒ=c%ë åì/ ì!=ƒë, / ì %KAåì%ì 2åCë%L "%ä/. n2ìå å / å "/ øå, 2å!%öåC2, " / å C,? å"/ å C%"åäå å *, å.--å*2/ " %2"å2 =!=ƒë, %L 2åCå,!= 2 å, å 2å %* åë3ä*= %K=* = 2%ëü*%ƒ=*% %ìå! /, "% C!%, ƒ"%ä, ì/, 2%ì/ % ë, "C%ë å %K% %"= / ì ä%c3 2, 2ü =ë,, å 3 åë3ä*=

93 ìå.= % å %! %L ã%ìå% 2=2, å *%L -3 *ö,,, C% *%ëü*3, C%ëüƒ%"= / å ".* Cå!, ìå 2å, "%2 / å C%C, 2=, þ, 2!3*23!å, ìå.=, ƒì=ì!åã3ë,!%"=, C,?å"%L äå 2åëü % 2, =, K%ëåå Kë, ƒ*, * åë%"å*3. }2,.--å*2/ å "%ƒ, *=þ2 C!, å 2å 2"å %ì %C%!% å,, åë3ä*=-."=*3=ö,, åë3ä% %ã% %äå!, ì%ã%" 12-Cå! 2 3þ *, ø*3, 2%%KA å2 %3 = 2, åì C% ëåä ål " C%ääå! =,, = /? å,. m=.2% å 3*=ƒ/ "=þ2,!åƒ3ëü2=2/ %C/ 2%", C!%"åäå /. = C%ë, -, 23ëü /. ( åë3ä%*, = =ëü / L, ä, 2=ëü / L %2äåë/ *, øå, *=) %K=*=.: 3 2= %"ëå %, 2%12-Cå! 2 = *, ø*=c!,, ì=å2 3 = 2, å " C%ääå! =,, = /? å, ë, øü C!, *%ìcëå* %ì!=ƒä!= å,,, 2å!%öåC2%!%" " åã% = =ëü %ã%%2äåë= åë3ä% %-*, øå %ã%2!=*2= " å 2å 2"å %L C% ëåä%"=2åëü % 2, C,? å"=!, 2åëü %ã% C!%öå = " % å2=,, ìå.= % å %! / ì, C!%öå =ì, " åë3ä*å. e 2å 2"å %, 2%3 "ƒ!% ë/. %K=* " C,? å"= äå 2åëü % 2ü,," = 2 % 2,, ìå.= % å %! = ã%ìå% 2=2, å *= -3 *ö, åë3ä*=,!åã3ë,!3å2 *=* å!" / ì,, 2=*, ã3ì%!=ëü / ì, ìå.=, ƒì=ì,. h ƒ3 å, å å*%2%!/., ƒ,., ", ë% ü öåëüþ ä= %L!=K%2/. l å2%ä, *=, ëåä%"=,. nc/2/ C!%"åäå / =10 "ƒ!% ë/. %K=*=. =ìö=..!%, å *%L -, 23ë%L åë3ä*=c%ìå2%ä3 a = %"=. b å, "%2 / å =.%ä, ë, ü =%ä %!=ƒ%"%ì C,? å"%ì!=ö, % å, ƒ=*ëþ =þ? åì " %ä %*!=2 %ì C!, åìå C,?,, C!, ã%2%"ëå %L, ƒ 2= ä=!2 %ã% 3.%ã%C,? å"%ã% *% öå 2!=2=-`> 3C "å!ì, øåëå"/ L ì %ìœ (190 ã.),!=ƒ"åäå / L 0,5 ë. "%ä/ ä%k="ëå, åì 300 ã. å! %ã%.ëåk= =*= ä3þ C%!ö, þ. b%" å. %C/ 2=., " 3 ë%",. "%K%ä %ã%ä% 23C=,.23, ä*3þ %ä, =*%"%ã% % 2="=, *% öå 2!=ö,,, 2åìCå!=23!/ C,? 3 ä="=ë,, "%2 / ì " å%ã!=, å %ì *%ë, å 2"å, ä%%2*=ƒ=%2 C!, åì=. o å!"% = =ëü %3 2= ="ë, "=ë, -% -%KAåì C%åä=åì%L C,?,, C!, "%ä?,l*%2*=ƒ3, 2.å. Cå!", %ì3 = /? å, þ, =2=* å ƒ=2!= å %å "!åì # %2 %2*=ƒ=, ä%"%ƒ%k %"ëå, C!, åìå C,?,. o%.2%l å.åìå %C/ 2/ C!%"%ä, ë, ü C!, ì, ì%ì *%!ìëå,, å!åƒ åë3ä% 3þ -, 23ë3. o,?å"3þ!å=*ö, þ %öå, "=ë, *=* C%ë%, 2åëü 3þ, å ë, %K=*= C/ 2=ë= ü C!, 2ü C,? 3,, *=* %2!, ö=2åëü 3þ - C!, %2*=ƒå, =2=* å C%*%ë, å 2"3 (%KAåì3) Aåäå %L C,?,. d ë "/ "ëå,!%ë, ="2% %ì %L ("åãå2=2, " %L) å!" %L, 2åì/ "!å=ë, ƒ=ö,,.--å*2%".* Cå!, ìå 2=ëü %ã%, 2å!%öåC2, " %ã%"%ƒäål 2", K/ ë C!, ìå å ìå2%ä.,!3!ã, å *%L äå å!"=ö,, åë3ä*=-ä"3 2%!% 2!= Cëå"!=ëü = "=ã%2%ì,,!å2!%cå!, 2% å=ëü = Cë=., *%2%ì,,*=* " %2äåëü % 2,, 2=* C!,,. % å2=,,. j!%ìå 2%ã%, K/ ë C!åäC!, 2 -=!ì=*%ë%ã, å *, L = =ë, ƒ. q.2%l öåëüþ, C%ëüƒ%"=ë, ü ëåä3þ?,å C!åC=!=2/ : =2!%C, (0,1ìã/*ã), = 2,.%ë, å!ã, å *%å äål 2", å *%2%!%ã% "/ ƒ/ "=å2 "/!= å %å C%, å, å 2% 3 = åë3ä*=; C!%ƒå!, (0,04 ìã/*ã), = 2,.%ë,. 2å!=ƒ = =*2, " % 2ü *%2%!%ã%"/ ƒ/ "=å2 %2 å2ë, "%å C%"/ øå, å 2% 3 = åë3ä*=; C!=ƒ%ƒ, (0,1ìã/*ã), =ä!å %Kë%*=2%!,, ƒk,!=2åëü %äål 2"3þ?,L = C% 2, =C2, å *, å 1-=ä!å %!åöåc2%!/. d ë %öå *, -,ƒ, %ë%ã, å *%L ƒ =, ì% 2,.* Cå!, ìå 2=ëü /. "%ƒäål 2", L, "/ "ëå, "%ƒì% %ã%3 = 2, %ä %ã%, ƒ =, K%ëåå "å!% 2 %ã%ìå2=k%ë, å *%ã%!åã3ë 2%!= C,? å"%l äå 2åëü % 2, (9,10), ìå2%ä%ì `*!%" /. *!= %"B (1)" %2äåëü /., ì %ã%*!=2 % "ƒ 2/.!=ƒë, / ì, 2å!"=ë%ì "!åìå, C%!ö,. *!%",,-%2%*%ë%!, ìå2!, å *, %C!åäåë ë, ãëþ*%ƒ3. r, 2/"=, 2%3!%"å ü "%ƒk3 äå, C,?å"%ã%öå 2!=" 0mq ì% å2 %C!åäåë 2ü 3 "%å, åì ãëþ*%ƒ/ åã%ãëþ*%!åöåc2%!=ì, (6,8), 2%, 2%Cå å ü "ë å2 ì%k, ëü / ì äåc%ãë, *%ãå =(7), C%!åä 2"%ì `*!%" /. *!= %"œ %äå! =, å ãëþ*%ƒ/ %C!åäåë ë% ü " C%!ö,. *!%",, C!, 2å*=þ? ål, %22å*=þ? ål %2 ã%ë%" %ã%ì%ƒã=, =2=* å "å %ƒ %ã%, 3 =Cå å,. 0,-!%"/ å ä= / å %K!=K=2/ "=ë, ü 2=2, 2, å *,,, C%ëüƒ3 t-2å 2 q2üþäå 2=. p=ƒ % 2ü C!,, ì=ë= ü ä% 2%"å! %L C!, p < 0,05.

94 påƒ3ëü2=2/, ëåä%"=,,,. %K 3 äå, å. nc/2/ %C!åäåëå, åì %äå! =, ãëþ*%ƒ/ " *!%", äë %öå *, -,ƒ, %ë%ã, å *%L ƒ =, ì% 2,.* Cå!, ìå 2=ëü /. "%ƒäål 2", L C%ä2"å!ä, ë,, 2% Cå!"%L å ì, 32/ = =ë=c!, åì=c,?, %äå! =, å ãëþ*%ƒ/ " *!%",,"ƒ 2%L, ƒ "å %ƒ %ã%, 3 =Cå å,, ä% 2%"å! %(p<0,05)c%"/,ë% ü. l % % ã%"%!, 2ü %*!=2*%"!åìå %ì `>Cå å % %ì "/ K!% åœ ãëþ*%ƒ/ " " ƒ, C!, åì%ì C,?, ã%ë%ä /. %K=*, C!%.%ä?,ì%K/ %C!, "/!= å %ì.ì%ö, % =ëü %ì "%ƒk3 äå,, -, "%2 / å å %2!/ "= ü =ä % Aåä=ë, C,?3. n ä =*%C!, ä= å C,?, " å%ã!=, å %ì *%ë, å 2"å, * ì%ìå 23 %2*=ƒ=%2 åå 3!%"å ü ãëþ*%ƒ/ " *!%",,%22å*=þ? ål %2 Cå å,, K/ 2!%C%, =ë, C%-", ä, ì%ì3, "!åƒ3ëü2=2å ìå.= % å %! %L, ã =ë, ƒ=ö,,, C% 23C=þ? ål, ƒ åë3ä*=, "/ ƒ"= %L ƒ=c%ë å, åì Cå!"%ã%C,? å"%ã%äåc%. j äå 2%L ì, 32å C% ëå %2*=ƒ=%2 C,?,, 3!%"å ü ãëþ*%ƒ/ " *!%", "å %ƒ %ã%, 3 = å *%ëü*% 2=K, ë, ƒ,!%"=ë, %ä =*%" ä=ëü åløåì " 2å å,, 11/2-2 = %", *=* C!=", ë%, =Këþä=ë% ü ƒ=ìå2 %å åã%c%"/ øå, å. `!2å!, %"å %ƒ =!=ƒ, ö=(abp)" %äå! =, ãëþ*%ƒ/ =2%? =* 3 %K=* " C!, 2å*=þ? ål (a. Temporalis superficialis), %22å*=þ? ål (v. A uricularis magna)*!%", ã%ë%" %ã%ì%ƒã= % 2="ë ë=l =12 ìã/äë (m=@2,5 ìã/äë). o!, ä= å C,?, " å%ã!=, å %ì *%ë, å 2"å ABP 3"åë,, "=ë= ü (p<0,05)c=!=ëëåëü %"%ƒ!= 2=, þ %äå! =, ãëþ*%ƒ/ " *!%", "å %ƒ %ã%, 3 = Cå å,,%ä =*%, A BP %äå! =, ãëþ*%ƒ/ K/ ë= =, ìå üøål (l =6ìã/äë, m=@3 ìã/äë)* ì%ìå 23 %2*=ƒ=%2 C,?,. h Aå*ö, =2!%C, = å %*=ƒ/ "=ë= "ë,, = = =ëü / L *!=2*%"!åìå / L "/ K!% ãëþ*%ƒ/,ƒ Cå å,, " ƒ= / L C!, åì%ì C,?,, %ä =*%" ä=ëü åløåì, C%!=" å, þ -% %"/ ì, ä= / ì,, C!%ä%ë, 2åëü %%2ìå =ë% ü K%ëåå, ƒ*%å %äå! =, å ãëþ*%ƒ/ " *!%",,%22å*=þ? ål %2 Cå å,. d% 2%"å! %å "ë,, å =2!%C, = = 2åCå ü 3 "%å, ì%ƒã%ì ãëþ*%ƒ/, C%ä= / ì ABP, =2=* å C!, = 2, %ì %C%!% å,, åë3ä*=, "/ ", 2ü å 3ä=ë% ü. r, 2/"=, ä%ë / ì %K!=ƒ%ì,!%ëü ãëþ*%ƒ/,*=* K/ 2!%ã%ìå.=, ƒì=ã3ì%!=ëü %L!åã3ë ö,, C,?å"%L äå 2åëü % 2,, = 2=* å 2%, 2%*ëå2*, 0mq (C,? å"%ã%öå 2!=) "%þ ä%"%ëü %"/ %*3þ C%2!åK % 2ü ". å!ã,, C% 2, öåë, *%ì C%*!/ "=þ2 ƒ= å2 ãëþ*%ƒ/ Kåƒ 3 = 2,, 3ë, =, =ë,, å ãëþ*%!åöåcö,, " ã%ë%" %ì ì%ƒãå, Cå å,, " åë3ä*å, " å å ä%c3 *=åì, 2%-=*2%! ãëþ*%ƒ/, C%-", ä, ì%ì3, å "ë å2!åø=þ?,ì " ì %ã%-=*2%! %ì ål!%ã3ì%!=ëü %ì ìå.=, ƒìå!åã3ë,!%"=, C,?å"%L äå 2åëü % 2,,, " = 2 % 2,,!å=ë, ƒ=ö,, " å 2å 2"å /. 3 ë%",. åë3ä*=c%ë, å %! %ƒ=c3 *=åì/. C,? å"/. C%"åäå å *,.!å=*ö, L. nc/2/.,!3!ã, å *%L äå å!"=ö, ål åë3ä*=c%*=ƒ=ë,, 2%, 2å!%öåC2, " % ƒ=c3 *=åì/ å C,? å"/ å C%"åäå å *, å!å=*ö,, " %2"å2 = = 2, %å %C%!% å, å åë3ä*=%2 C,? å"%ã% %äå!, ì%ã% %.!= ë, ü. Š=*, C% ëå K, ë=2å!=ëü %L 2!= Cëå"!=ëü %L "=ã%2%ì,,,!å2!%cå!, 2% å=ëü %L Cë=., *%2%ì,, (*=*!=ƒäåëü %, 2=*, C!,,. % å2=,,)%, ä=åì%å Kë%*,!%"=, å, 2å!%öåC2, " /. C,? å"/. C%"åäå å *,.!å=*ö, L å "/ "ëå %. n ä =*%3 "=ã%2%ì,!%"= /., "%2 /. %2ìå =ë% ü å*%2%!%å C%, å, å >` 3" 2", 2åëü % 2, œ åë3ä*=, äë C%ë3 å, C%"åäå å *%ã%.--å*2="%ƒ, *ë= å%k.%ä, ì% 2ü " K%ëüøå, %C%!% å,, åë3ä*=. p åƒ3ëü2=2/ %C/ 2%" C%*=ƒ=ë, 2=* å, 2%äë C%"2%! %ã%3ä%"ëå2"%!å, "%ƒ, *øål C,? å"%l C%2!åK % 2, %KAåì C%åä=åì%L C,?,!åƒ*%"=!ü,!%"=ë. b %2ë,, å %2 K, ë=2å!=ëü %L Cë=., *%2%ì,,, C% ëå C!%, ƒ"åäå, K, ë=2å!=ëü %L "=ã%2%ì,, C%2!åKë åì/ L %KAåì C,?,, C!, "%ä?,l* C!å*!=? å, þ =*2=åä/,%K/ % 3"åë,, "=ë ("!åä åì =30%),.%2, %"!åìå åì (30-60 ä ål), å *%ëü*%3ìå üø=ë, 2=K, ë, ƒ,!%"=ë. o% ëå K, ë=2å!=ëü %L "=ã%2%ì,,, å ì%2! = =ë,, å Cë= 2, å *%ã%2% 3 =, C%!%ã ìå.= % å %! %L 3" 2", 2åëü % 2, åë3ä*=, "ë, þ? ål =C,? å"3þ äå 2åëü % 2ü K/ ë C%"/ øå, % åì ", äå2åëü 2"3þ2!åƒ3ëü2=2/ ì%äåëü /. %C/ 2%", *%ãä= å%k.%ä, ì%k/ ë% K%ëüøå, ƒìå 2ü 2åCå ü!= 2 ã, "=, 2å %* åë3ä*=k=ëë% %ì (C32åì ""åäå,,

95 "/ "åäå, K%ëüøåã%%KAåì="%ä/ ), å%k.%ä, ì%ã%äë å *%ëü*%ƒ=ìåäëå %ã% = 23Cëå,, %%2"å2 2"å %%2!, ö=2åëü %L, C%ë%, 2åëü %L C,? å"/ ì C!%K=ì. a ë%*,!%"=2ü C,? å"/ å!å=*ö,, " %2"å2 = = 2, %å %C%!% å, å åë3ä*= å 3ä=ë% ü, -=!ì=*%ë%ã, å *, ì C32åì, *=* =-% å = 2,.%ë, å!ã, å *%ã% äål 2", =2!%C, =, 2=*, C!, = 2,.%ë,. 2å!=ƒ %L =*2, " % 2, C!%ƒå!, =. o% ëå, Aå*ö,, C!%ƒå!, = *%ë, å 2"%C%åä=åì%L %K=*=ì, C,?,!åƒ*%3ìå üø=ë% ü. }2%, C%-", ä, ì%ì3, ëåä3å2 %KA, 2ü 3ìå üøå, åì 2% 3 = åë3ä*=,, " " ƒ,.2, ì, 3, ëå, ì =--å!å 2 %L, ìc3ëü =ö,,, " ƒ= %L åã% =C%ë å, åì C% 23C=þ? ål C,? ål, 2%C%ä2"å! ä=þ2!åƒ3ëü2=2/ %C/ 2%", *%ãä=c% ëå K, ë=2å!=ëü %L "=ã%2%ì,, ""åäå, å C!%ƒå!, = å "/ ƒ/ "=ë%3ìå üøå, *%ë, å 2"=C%2!åKë åì%l %K/ %, ä*%l C,?,. h Aå*ö, =ä!å %Kë%*=2%!=C!=ƒ%ƒ, =2=* å å C%ä="ë ë=ƒ=c3 *=åì3þ, ƒ åë3ä*= C%"åäå å *3þ!å=*ö, þ. a%ëåå 2%ã%, " %C/ 2=., C%ëüƒ%"=, åì C!=ƒ%ƒ, =,, ƒk,!=2åëü %äål 2"3þ? åã% =a-=ä!å %!åöåc2%!/, "/ "ë ë= ü "/ %*= 3" 2", 2åëü % 2ü åë3ä*=: "/ "åäå, å C%!åä 2"%ì -, 23ë/ ì,, ì=ëü %ã%%kaåì= %äå!, ì%ã% (10%) åìåäëå %"/ ƒ/ "=ë%c%2!åkëå, å C,?,, "% C%ë þ? åå C%2å!þ. }23!å=*ö, þ " 2å å, å %C/ 2= ì% %K/ ë%"% C!%, ƒ"%ä, 2ü å%ä %*!=2 %, C!, åì å!åƒ *= ä/ å 2-4 ì, 32/. d%c%ë, 2åëü %å ""åäå, å =2!%C, = =!3ø=ë%ƒ=*% %ìå! % 2, C%ë3 å,.--å*2%". ` =ë%ã, / å, K%ëåå å2*, å.* Cå!, ìå 2=ëü / å.--å*2/ C,? å"%l äå 2åëü % 2,, K/ ë, C%ë3 å / " ì%äåëü /. %C/ 2=. C!, ìå å, åì 2%ëü*%ìå.=, å *%ã%!=ƒä!= å, 2å %* åë3ä*=, 2!=ã= 2!=ëü / ì K=ëë% %ì, Cå!, %ä, å *, ìå þ? ål "åë,, %L %KAåì="%ä/. o%ë3 å / å.* Cå!, ìå 2=ëü / å ä= / å ", äå2åëü 2"3þ2 % 3? å 2"å %L!%ë, ìå.= %!åöåcö,, åë3ä*=" C!%öå å C,? å"%l äå 2åëü % 2,. b/ "ëå %ƒ = å, å "=ã=ëü %L, å!"=ö,, "!å=ë, ƒ=ö,,,, ëåä3åì%l ìå.= % å %! %L ã%ìå% 2=2, å *%L -3 *ö,, åë3ä*=. b ìå 2å 2åì, C!,.%ä, 2 *% 2=2,!%"=2ü, 2%, ƒ3 å / å C,? å"/ å C%"åäå å *, å!å=*ö,, " %2"å2 = = 2, %å %C%!% å, å åë3ä*= å 3ä=å2 2ü %2*ëþ å, åì, = *%ëü*%.2%"%ƒì% %, "åãå2=2, " %L, å!"=ö,, åë3ä*=, *=*.,!3!ã, å *, ì, 2=*, -=!ì=*%ë%ã, å *, ì C32åì. qëåä%"=2åëü %, ƒ =, ì= äë C,? å"%l äå 2åëü % 2, =--å!å 2 = ìå.= % å %! =, ã =ë, ƒ=ö,,ƒ åë3ä*=ì% å2 ä% 2, ã 32ü C,? å"%ã%öå 2!= å 2%ëü*%C! ì/ ì å!" / ì C32åì. qëåä3å2 ä%c3 2, 2ü "%ƒì% % 2ü!å=ë, ƒ=ö,,.2,. "ë,, L 3 = 2, åì %C!åäåëå /. ã3ì%!=ëü /. -=*2%!%",, ƒ Cå*2!= ã= 2!%, 2å 2, =ëü /. ã%!ì% %",. 2å!, %",!åã3ë 2%! /. CåC2, ä%". q, 2=åì öåëå %%K!=ƒ / ì ä=ëü åløåå, ëåä%"=, å.2%ã%"%c!% =, C% *%ëü*3 å? å " 1900 ã. ). xå!!, ã2% (11)%K!=2, ë ", ì=, å =2%, 2%, "%2 %å ä= å C% ëå C%ë %ã% 3ä=ëå, åë3ä*=" >` % 2%,, ã%ë%ä=œ C!% "ë å2 2!åìëå, å * C,? å. q3? å 2"3å2 2=* å K%ëüø%L *ë,, å *, L %C/ 2 =Kä%ì, =ëü %L.,!3!ã,, 2%2=ëü %L!åƒå*ö, ål åë3ä*=3 åë%"å*=. b å.2% ="%ä, 2 =ì/ ëü, 2%!å=*ö,,, " ƒ= / å C,? å"%l äå 2åëü % 2Aþ, ì%ãë, K/ % 3? å 2"ë 2ü, " %2 32 2",, *=*%L-ë, K%, ã =ë, ƒ=ö, L, ƒ!åöåc2%!%" åë3ä*=. n ä =*%,!åƒ"/ =L %"= %3, 2/"=2ü " 32!,, 2åì 3þ *%ìcå =ö, þ -3 *ö, L åë3ä*=, %K3 ë%"ëå 3þ "/ %*%L Cë= 2, % 2üþ -3 *ö, L " åã% C,? å"=!, 2åëü %ã%2!=*2=, 2.å. C% %K % 2üþ, ƒìå 2ü 3!%"å ü "%åã% -3 *ö, %,!%"=,, "ƒ=, ì%ƒ=ìå 2ü å!" / å, ã3ì%!=ëü / å C32,, ã =ë, ƒ=ö,, % =ë,,, C,?å"%L C%2!åK % 2, äë C%ääå! =, C% 2% 2"=" 32!å ål!åä/ %!ã=, ƒì=. o!, ìå =2åëü %, 2%C% ëå K, ë=2å!=ëü %L "=ã%2%ì,, " 2å å, å %C!åäåëå %ã% "!åìå, (30-40 ä ål), ì/ %2ìå =ë, C%"/ øå, å ìå.= % å %! %L >` 3" 2", 2åëü % 2, œ åë3ä*=. d= / å ë, 2å!=23!/ (3) ", äå2åëü2"3þ2 %ƒ =, 2åëü %ì!=.% äå,, ä= /. %C/ 2= C%, ƒ3 å, þ "ë,, Kë%*,!%"=, Kë3 ä=þ?,. å!"%" = % 2=, å C,? å"%l äå 2åëü % 2,. q, 2=åì, 2%ìå.= % å %! =!åöåcö, åë3ä*=" %!ìå, ìåå2 3? å 2"å %å ƒ = å, å äë!åã3ë ö,,, C,?å"%L äå 2åëü % 2,, " ƒ= %L

96 C%ääå! =, åì ã%ìå% 2=ƒ=. r 2!= å, å.2%l, ã =ë, ƒ=ö,,.,!3!ã, å *, ì, -=!ì=*%ë%ã, å *, ì ìå2%ä=ì, ì% å2 K/ 2ü *%ìcå,!%"= %, %ä =*%!åã3ë ö, C!,.2%ì 2= %", 2ü ìå åå %"å!øå %L. kuwis meqansensoruli homeostatikuri funqciis regulirebis neirohumoruli meqanizmebi m. qutatelaze, prof. a. asatiani Tbilisis saxelmwifo samedicino universitetis normaluri fiziologiis katedra qronikuli eqsperimentis pirobebsi zrdasrul mamal ZaRlebs, romeltac hqondat kuwis fundalur nawilze dadebuli basovis fistula, utardebodat fistulidan kuwis nawilobrivi dacla misi SigTavsis sxvadasxva moculobit, standartuli Txieri sakvebit danayrebis Semdeg, rasac mohyveboda kanonzomieri qceviti reaqciebi _ sakvebis mirebis ganaxleba dakarguli odenobis moculobis anazraurebit. arnisnuli qceviti efeqtis realizaciisas, vegetatiuri nervuli sistemis monawileobis gamosavlenad, gamoiyeneboda kuwis denervaciis metodi, rogorc qirurgiuli tomia, ise farmakologiuri zemoqmedeba. sawmlis monelebis Seswavlis yvelaze dasasvebi metaboluri maregulebeli metodis `sisxlis onkanebis~ gamoyenebit, rogorc calkeul, mravaljeradad arebul Tavis tvinisken mimaval da iqidan gamomaval (arteria-venuri sxvaoba avs), ise RviZlis venuri sinusidan arebuli sisxlis ulufebsi isazrvreboda glukozis raodenoba fotokalorimetriuli metodit. gamokvlevis Sedegebidan Cans, rom glukoza kanonzomierad aris dakavsirebuli mazrrobis arsebobis CamoyalibebasTan (kvebis dawyebisas RviZlidan mcire gamosvla, avsebis avs-is monacemebit Tavis tvinis mier glukozis atvisebis paraleluri mateba da sakvebis mirebis uaryofis momentsi Sesabamisi Semdgomi dakleba). glukozisa da kuwis interceptuli gamsvebi qcevis reaqciebs Soris kavsiris gamovlena ver moxerxda. On Neuro - Humoral Mechanism regulating the mechanosensoric, Homeostatic function of the Stomach M.Kutateladze, A. Asatiani Adult male-dogs with Basov s fistula on fundle part of the stomac in chronic experiments were feeded by unlimited standard watery pabulum up to satiety condition approached. At this moment its contents in various volumes were

97 partially evacuated. In this manner the regularly reaction of food behavior occurred - the animal recommended eating, thus filling up loss with an amount of anued food taking. For definition the role of nervous vegetative system in realization of the given behavioral effect the method of denervation of the stomach by surgical as well as pharmacologic influence was applied. In order to show how one of the possible feeding metabolism regulator works by blood-tap method separately multiple portions of blood flowing to and out of head brain ( arterio-venous difference-avd), also from liver s venous sinus, by the way of photocalorimetry method, glucose maintenance was defined. Results of experiments show that glucose is naturally concerned with satiation (short-term reject from liver, while starting food intake, as ADV shows simultaneous increase assimilation of glucose by brain tissue and decrease at the moment of denying the food intake). However the connection of glucose with neglected behavioral reaction introspectively from stomach was impossible to reveal. Surgical denervation of the stomach (bilateral Transpleural vagotomy and retroperitoneal splanchnicotomy) and also pharmacologic (atropine, proserin, prazozin) influence does not block the introspective behavioral reaction. So all results of the provided experiments give right to confirm that mechanosensoric reception in normal state has an essential significance in regulation of digestion activityes, connected with maintenance of homeostatic condition. Removal of these impulses by surgical or pharmacologic tummies can be compensated, but its regulation will be less perfect. literatura: k, 2å!=23!=: 1. ` =2, =, `.b., a =*3!=äƒå `.m. _ mål!%ã3ì%!=ëü / å ìå.=, ƒì/ C,?å"%L äå 2åëü % 2,. ŠK, ë,,: l åö, å!åk=,1974, ` =2, =, `.b., j32=2åë=äƒå l.h., l ="= =äƒå d.x. _ n!%ë, åë3ä*="!åã3ë ö,, C!, åì=c,?,. l =2å!, =ë/ VI!å C. =3.*% -. br g%" c!3ƒ,, ŠK., 1986, j=, ëü b.c. _ p åöåcö, åë3ä% %-*, øå %ã%2!=*2=, C,?å"%å C%"åäå, å b K.: o!%këåì/, 2å!%öåCö,,,!åã3ë ö,, -,ƒ, %ë. -3 *ö,,, C%"åäå,. m=3*=. 1978, j32=2åë=äƒå l.h. _ n "ë,,,!= 2 å, 2å %* åë3ä*= =-%!ì,!%"=, å Cå!", %ã% = /? å,. l =2. IV =3 %L *% -. ch dr b, ŠK., 1982, j32=2åë=äƒå l.h., ` =2, =, `.b. _ p%ëü ìå.= %!åöåcö,, åë3ä*=" -%!ì,!%"=,, = /? å,. Georg. Med. News. 2005, 4, Anand B.K. at all. _ Glucoreceptor mechanism in the hypothalamic feeding center. Ind. I. Med. Res. 1961,- 49-4, Guyton A.C., Hall J.E. _ Metabolism of Carbohydrates. Textbook of Med. Physiology W.B. Saunders Co. 9th Edition 1996,-67, Marshall N.B., Mayer J.J. _ Energy balance in goldthioglucose obesity. Am. J. Ahysiol 1954,-178, Mayer J.J. _ The Glucostatic theory of regulation of food intake and the problem of obesity. Bull. New. Engl. Med. Cent. 1952,14, Mayer J.J. _ Glucostatic theory and lipostatic hypothesis. Ann. N.Y. Acad Jci. 955,-63, Sherrington C.S. _ Experiments on the value of vascular and visceral factors to the genesis of emotion. Proc. Roy. Joc, , -66,-390,-399.

98 xsovna erovnuli medicinis morvawe gardaicvala profilaqtikuri medicinis gamocenili morvawe, medicinis mecnierebata doqtori, profesori, saqartvelos profilaqtikuri medicinis mecnierebata akademiis akademikosi guram kiknaze. daibada 1929 wels, TbilisSi. sasualo skolis damtavrebis Semdeg, swavla ganagrzo Tbilisis saxelmwifo samedicino institutis sanitariul-higienur fakultetze. institutis damtavrebis Semdeg musaobda TeTriwyaros raionis sanepidsadgursi jer eqim-epidemiologad, xolo Semdeg mtavar eqimad wlidan musaoba ganagrzo Tbilisis vaqcinebisa da Sratebis samecnierokvleviti institutis epidemiologiur ganyofilebasi umcros mecnier TanamSromlad, xolo Semdeg - laboratoriis xelmzrvanelad wlidan, g. natazis saxelobis sanitariisa da higienis samecniero-kvlevit institutsi, is xelmzrvanelobda tifo-paratifozuli infeqciebis laboratorias wels, sanitariisa da higienis institutis reorganizaciastan dakavsirebit, batoni gurami gadayvanil iqna s. virsalazis saxelobis samedicino parazitologiisa da tropikuli medicinis samecniero-kvlevit institutsi, salmonelozuri infeqciebis epidemiologiuri ganyofilebis xelmzrvanelad wlebsi samusao mivlinebit imyofeboda aljiris saxalxo-demokratiul respublikasi epidemiologebisa da baqteriologebis jgufis xelmzrvanelad wlidan gadayvanil iqna gansakutrebit sasis infeqciata samecnieropraqtikul centrsi (amjamad daavadebata kontrolisa da samedicino statistikis erovnuli centri), sadac gardacvalebamde musaobda hospitaluri infeqciebis ganyofilebis gamged. wlebis ganmavlobasi batoni gurami iyo epidemiologta, mikrobiologta da parazitologta samedicino-samecniero sazogadoebis gamgeobis Tavmjdomare da Tbilisis saxelmwifo samedicino institutis samecniero xarisxebis mimniwebeli sabwos wevri. guram kiknazis xelmzrvanelobit daculia ramdenime sakandidato disertacia. aris 60-ze meti samecniero Sromis avtori. batoni gurami iyo dargis wamyvani specialisti, principuli, momtxovni, amave dros gulisxmieri TanamSromelTa mimart. qveynis winase damsaxurebisatvis 1999 wels dajildovda Rirsebis ordenit. wavida Cvengan Rvawlmosili specialisti. misi nateli xsovna mudam darceba qveynis samedicino sazogadoebisa da TanamSromelTa Soris.

99 daavadebata kontrolisa da samedicino statistikis erovnuli centri; profilaqtikuri medicinis mecnierebata akademia mecnierisa da pedagogis gaxseneba mimdinare wlis 25 maiss cnobil qartvel mecniers, profesor mayvala zurabasvils 80 weli Seusruldeboda. sami weli gavida mas Semdeg, rac is Cvens gverdit arar aris. qalbatoni mayvala ara marto higienis dargis cnobili mecnieri da pedagogi, aramed SesaniSnavi pirovnebac iyo. man saxelovani gza ganvlo - aspirantobidan katedris gamgemde. mudam kargad esmoda im axalbedebis, romlebic mxolod iwyebdnen profesiis atvisebas. gamorceuli optimisti, ar isurebda mattvis imedian da ketil rcevas. mis gverdit axalgazrda kolegebi yoveltvis Tavs imedianad grznobdnen; nebismieri situaciidan poulobda gamosavals. sicocxlis bolo wutamde ar daukargavs uketesi momavlis imedi. wavida Cvengan valmoxdili. dagvitova didi mwuxareba da gulistkivili. qalbaton mayvalas misi kolegebi, megobrebi, mowafeebi da axloblebi arasodes daiviwyeben. is mudam darceba adamianurobisa da profesionalizmis simbolod. Tssu-is garemos higienisa da profesiul daavadebata katedra