dakavSirebul tkivilze da am tkivilis Sesamsubuqebel meTodebze. samedicino personali, romelTanac urTierToba giwevTY(mag.: Tqveni anesTeziologi, bebiaqali an meani) ufro met informacias mogawvdiT yvela im meTodis Sesaxeb, rasac im droisTvis samSobiaro saxli Tu saavadmyofo gTavazobT. Cven vimedovnebT, rom Tuki Tqven gecodinebaT tkivilis Semsubuqebis ra meTodebia xelmisawvdomi, mSobiaroba TqvenTvis gacilebiT sasiamovno procesi iqneba. yvela is masala, romliTac winamdebare bukletis Seqmnisas vixelmZRvaneleT amave bukletSia miTiTebuli.
mSobiarobis tkivilebis Semsubuqeba
3rd Edition, January 2008
aRniSnuli bukleti warmodgenas SegiqmniT mSobiarobasa da bavSvis gaCenasTan
ra SeiZleba igrZnoT mSobiarobis periodSi?
fexmZimobis periodSi, drodadro, Tqven SesaZloa saSvilosnos SekumSvebi, e.w. breqsTon-hiksis SekumSvebi (Braxton-hicks contractions) igrZnoT. mSobiarobis periodSi aRniSnuli SekumSvebi regularuli da gacilebiT Zlieri xdeba.
saSvilosnos SekumSviT gamowveuli SesaZlo tkivili, rogorc perioduli tkivili ise aRiqmeba. igi mSobiarobis periodSi Zlierdeba. qalebi aRniSnul tkivils sxvadasxvanairad aRweren.
Cveulebriv, pirveli mSobiaroba yvelaze xangrZlivia. Tuki mSobiarobis dasawyebad an dasaCqareblad medikamentebia
gamoyenebuli, saSvilosnos SekumSvebi metad mtkivneulia. qalTa umravlesoba mSobiarobis tkivilebis marTvisTvis
mravalnair xerxs mimarTavs (ix. masalebi, 1). umjobesia iyoT dadebiTad damuxtuli.
mSobiarobisTvis momzadeba mSobiarobisTvis mosamzadeblad specialuri kursebi dagexmarebaT. aRniSnuli kursebi sxvadasxva organizaciebis mier momavali mSoblebis mxardasaWerad tardeba. mSobiarobisas ganviTarebuli movlenebis ukeT gasagebad da mosalodneli mSobiarobiT gamowveuli SfoTvis Sesamcireblad igi did daxmarebas gagiwevT. kursebis ganmavlobaSi, bebiaqali mogawvdiT informacias mSobiarobis tkivilebis Sesamsubuqebeli meTodebis Sesaxeb. Tu Tqven met interess epiduruli gautkivarebis (welis areSi ineqcia, romelic sxeulis qveda naxevris gabuJebas iwvevs) Sesaxeb gamoiCenT, igi SegaxvedrebT anesTeziologs, romelic am proceduras dawvrilebiT agixsniT. im SemTxvevaSi ki, Tu ver gaivliT aRniSnul kursebs, mSobiarobis tkivilTa Semsubuqebis meTodebis Sesaxeb SegiZliaT ubralod Tqvens bebiaqals hkiTxoT. mSobiarobis tkivilebis intensivobaze SesaZloa gavlena moaxdinos garemom sadac mSobiaroba mimdinareobs. mTavaria qali iyos dadebiTad ganwyobili, relaqsirebuli, naklebad mSfoTvare. (ix. masalebi, 2). amitomac zogierTi qali saxlSi mSobiarobas amjobinebs, bevri orsulisTvis ki samSobiaroSi Tu saavadmyofoSi mSobiarobaa metad misaRebi. zogierTi samSobiaro saxli mSobiareebs iseT oTaxebs sTavazobs, sadac qali Tavs ise igrZnobs, rogorc sakuTar saxlSi. aqve orsuls SeuZlia is musika CarTos da mousminos, romelic mas relaqsirebaSi daexmareba. Tu Tqven samSobiaroSi an saavadmyofoSi mSobiaroba dagegmeT umjobesia gaarkvioT ra SesaZlebobebi gaaCnia Tqvens mier arCeul dawesebulebas.
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mSobiarobis periodSi axloblis an sxva mSobiaris gverdiT yofna da masTan sakuTari azrebis, Civilebis gaziareba SesaZloa TqvenTvis sasargeblo aRmoCndes. (ix. masalebi, 3). aRniSnuli bukleti warmodgenas SegiqmniT mSobiarobasa da bavSvis gaCenasTan dakavSirebul tkivilze da am tkivilis Sesamsubuqebel meTodebze. samedicino personali, romelTanac urTierToba giwevTY(mag.: Tqveni anesTeziologi, bebiaqali an meani) ufro met informacias mogawvdiT yvela im meTodis Sesaxeb, rasac im droisTvis samSobiaro saxli Tu saavadmyofo gTavazobT. Cven vimedovnebT, rom Tuki Tqven gecodinebaT tkivilis Semsubuqebis ra meTodebia xelmisawvdomi, mSobiaroba TqvenTvis gacilebiT sasiamovno procesi iqneba.
mSobiarobis tkivilebis Semsubuqebis ra gzebi arsebobs? Tavdapirvelad Znelia imis codna, tkivilis Semsubuqebis Tu romeli meTodia TqvenTvis saukeTeso. bebiaqali, romelic mSobiarobis periodSi Tqvens gverdiTaa, rCevis mosacemad saukeTeso personaa. Cven aqve mogawvdiT zogierT informacias mSobiarobis tkivilebis Semsubuqebis ZiriTadi meTodebis Sesaxeb.
TviTdaxmarebis meTodebi
mSvidi, Rrma sunTqva kunTebis jangbadmomaragebis gazrdis gamo amcirebs tkivilis intensivobas. amasTan, mSobiaris yuradReba sunTqvaze fokusirdeba da tkivilic naklebad aRiqmeba.
saerTod Znelia relaqsacia im dros, roca gtkiva. amitomac, ufro praqtikulia relaqsireba, romlis uamravi meTodic arsebobs, orsulma mSobiarobis periodis dawyebamde iswavlos.
mSobiarobis periodSi masaJi Zalzed komfortulia da dadebiTad moqmedebs.
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samSobiaro auzebis gamoyeneba samSobiaro auzebis sargeblianobisa da riskis Sesaxeb bevri kvleva ar moipoveba. Tumca naCvenebia, rom wyalSi mSobiaroba nakleb tkivilTan asocirdeba. (ix. masalebi, 4). zogierTi monacemiT, Tuki auzSi wyali metismetad Tbilia SesaZloa axalSobils distresis niSnebi gamouvlindes. miuxedavad imisa, rom am TvalsazrisiT wyalSida da wyalgareT mSobiarobis riski dedisa da nayofisTvis erTnairia, dResdReobiT samSobiaro auzi mraval samSobiaro saxls gaaCnia.
damxmare Terapiebi (ar moicavs medikamentur Terapias) damxmare Terapiebi (mag.; aromaTerapia) bevr qals mSobiarobis tkivilebs umsubuqebs. Tuki Tqven gadawyvetT damxmare Terapias mimarToT, umjobesia rCeva am sakiTxSi trenirebuli specialistisgan miiRoT. aRniSnul bukletSi saubari ar aris homeopaTiasa (Zalzed ganzavebuli ingredientebis gamoyeneba tkivilis Sesamsubuqeblad) da mcenareul saSualebebze.
aromaTerapia SiSis SemcirebisTvis, ganwyobisa da mSvidad yofnisTvis koncentrirebuli surnelovani zeTebis gamoyenebas gulisxmobs.
refleqsologia dafuZnebulia ideaze, rom xelebsa da fexebze ganTavsebuli wertilebi kavSirSia mTels sxeulSi arsebul wertilebTan. Cven ar viciT es meTodi Tu rogor muSaobs, magram SesaZloa misi meqnizmi akupunqturis msgavsi iyos. (ix. qvemoT). refleqsologi mSobiaris fexebze arsebul wertilebze zewoliT amsubuqebs tkivilebs.
hipnozi da akupunqtura
mSobiareTa mier Terapiis es ori saxe erT-erTi yvelaze xSirad gamoyenebadia. magram, gamomdinare iqedan, rom am serviss qalebs Zalian cota samSobiaro sTavazobs, orsuli iZulebulia mSobiarobis periodis dadgomamde kvalificiuri specialisti ipovos. hipnozis saSualebiT Tqven moiSorebT tkivilis grZnobas. SesaZlebelia es Tavadac gaakeToT (TviThipnozi) da es aucileblad mSobiarobis periodis dadgomamde unda iswavloT. Tumca SesaZlebelia hipnoTerapevti mSobiarobis dasrulebamde qalis gverdiT iyos.
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akupunqtura sxeulis ama Tu im wertilSi specialuri nemsebiT
Cxvletas gulisxmobs da igi aucileblad specialistma unda Seasrulos.
zogierTi kvlevis Tanaxmad, es procedura gansakuTrebiT efeqturia da
medikamentebis SezRudulad gamoyenebis saSualebasac iZleva. (ix.
masalebi, 5). magram, jer kidev mraval qveyanaSi, akupunqturis
specialistebis deficitia da Tavad procedurac Zalzed Zviria.
nervis transkutaneuri (kangavliTi) eleqtruli stimulacia
(ntes)
welis areSi dakruli oTxi brtyeli firfitis saSualebiT kanSi nazi
eleqtruli deni tardeba. am dros Tqven msubuq Cxvletebs igrZnobT.
denis Zabva Tqven TviTonve SegiZliaT areguliroT.
meTodi gansakuTrebiT sasargebloa welis tkivilis dominirebisas. mas
saxlSive SegiZliaT mimarToT.
aqvs Tu ara aRniSnul proceduras nayofze mavne zegavlena cnobili ar
aris.
5
entonoqsi
entonoqsi azotis oqsidisa da Jangbadis (1:1) narevi airia. zogjer gazis
da haeris saxeliT moixsenieben.
Tqven sunTqavT mas niRabis an milis saSualebiT.
moqmedeba swrafi da efeqturi aqvs da Sedegic ramdenime wuTSi dgeba.
SesaZloa igrZnoT xanmokle simsubuqe an mciredi sisuste.
igi ar aris mavnebeli Tqveni bavSvisTvis, piriqiT TqvenTvisac da
nayofisTvisac umjobesia masSi Semavali damatebiT Jangbadis gamo.
marTalia tkivils saerTod ver xsnis, magram Sesamsubuqeblad
efeqturia.
entonoqsi SegiZliaT mSobiarobis nebismier etapze gamoiyenoT.
maqsimaluri efeqtis misaRebad entonoqsiT sunTqvis dawyeba
rekomendebulia saSvilosnos SekumSvis SegrZnebidan rac SeiZleba male.
ar girCevT mis gamoyenebas SekumSvaTa Soris periodSi an xangrZlivi
droiT, radgan am dros SesaZloa gaRizianeba da diskomforti igrZnoT.
zog samSobiaroSi entonoqss sxva komponentebsac umateben
marTalia am dros igi ufro efeqturi xdeba, magram
mas Zilismomgvreli efeqti axasiaTebs.
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opioidebi: morfinis msgavsi tkivilgamayuCeblebi
opioidebs Semdegi preparatebi ganekuTvneba: fetidini, diamorfini
(romelic gaerTianebul samefoSi dRiTidRe popularuli xdeba),
morfini, meptazinoli, fentanili da remifentanili. maTi moqmedebis
meqanizmi msgavsia.
opioidebis ineqcia mxris an barZayis did kunTSi xdeba.
tkivilis Semsubuqeba xSirad SezRudulia. efeqti daaxloebiT
naxevari-erTi saaTis Semdeg iwyeba da ramodenime saaTs grZeldeba.
opioidebi entonoqsTan SedarebiT naklebi efeqturobiT xasiaTdebian.
magram, zogierTi qali opioids amjobinebs da ambobs, rom efeqti
ukeTesia (ix. masalebi, 6)
gverdiTi movlenebi
opioidebma SesaZloa Zili moggvaroT.
SesaZloa igrZnoT sisuste, romlis aRmosafxvreladac medikamentebis
miRebaa saWiro.
opioidebis zegavleniT ferxdeba kuWis dacla, ramac zogadi
anesTeziis saWiroebis SemTxvevaSi SesaZloa problemebi Seqmnas.
opioidebis zemoqmedebam SesaZloa sunTqvis sixSiris Semcireba da
Sesabamisad Jangbadmomaragebis daqveiTeba ganapirobos. am dros
saWiro xdeba TqvenTvis damatebiTi Jangbadis miwideba da Tqveni
Jangbadis doneTa monitorireba.
opioidebma SeiZleba axalSobilis sunTqvis Senelebac gamoiwvios, rac
aRmofxvrili iqneba Sesabamisi preparatis ineqciis Semdeg.
opioidebma SesaZloa axalSobils Zili mohgvaros, rac imas niSnavs,
rom bavSvis normaluri kveba Seferxdeba. (es upiratesad fetidins
exeba)
uSualod bavSvis dabadebis win, mSobiaris mier am jgufis
preparatebis gamoyeneba axalSobilebSi yvelaze naklebi gverdiTi
efeqtebiT xasiaTdeba.
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pacientkontrolirebadi analgezia (pka)
swrafi efeqtis misaRebad SesaZloa, specialuri, Tqvens mier
kontrolirebadi pampiT opioidebis venaSi ineqciac. pka-s iseT
samSobiaroebSi vxvdebiT, sadac epiduruli gautkivareba xelmisawvdomi
araa da mSobiaresac sxva meTodis gamoyeneba ar surs.
pka saSualebas gaZlevT opioidis imdeni doza SeiyvanoT organizmSi
ramdenic gindaT. miuxedavad imisa, rom usafrTxoebis mizniT pka zRudavs
opioidebis Seyvanis sisCqares, rekomendebuli ar aris am jgufis
preparatebis xangrZlivi gamoyeneba, rac organizmSi opioidTa
dagrovebiT da gacilebiT meti gverdiTi movlenebis ganviTarebiT
aixsneba.
zog samSobiaroSi SesaZloa pka gamoyenebiT iseTi opioidi
SemogTavazon, rogoric remifentanilia. (ix. masalebi, 7,8). remifentanili
organizmSi maleve iSleba, amgvarad TiToeuli dozis efeqti didxans ar
grZeldeba. marTalia es preparati tkivilis Semsubuqebis efeqturobiT
xasiaTdeba, magram sunTqvis aqtzec damTrgunvelad moqmedebs. gverdiTi
movlenebi maleve kupirdeba da bavSvzec mavne gavlenas ar axdens.
epiduruli da spinuri gautkivareba epiduruli da spinuri gautkivareba mSobiarobis tkivilebis
Sesamsubuqebeli yvelaze kompleqsuri meTodebia, romlebic
anesTeziologis mier sruldeba.
anesTeziologi eqimia, romelmac kargad icis gautkivarebis teqnika da
saWiro medikamentebis moqmedebis meqanizmi. operaciebis dros tkivilis
kupireba zogadi anesTeziiT, epiduruli da spinuri anesTeziiT
xorcieldeba. sakeisro kveTis gautkivarebis meTodebis Sesaxeb girCevT
waikiTxoT Cveni bukleti saTauriT “Tqveni anesTezia sakeisro
kveTisas”
epiduruli da spinuri gautkivareba tkivilis Semsubuqebis yvelaze
efeqturi saSualebebia.
epiduruli gautkivarebisTvis anesTeziologs nemsi Sehyavs welis areSi
da misi saSualebiT nervebTan axlos dgams epidurul kaTeters (Zalian
wvrili milaki). nemsis evakuaciis Semdeg kaTeteri rCeba, romlis
8
saSualebiTac orsuli tkivilgamayuCeblebs mSobiarobis mTeli
periodis ganmavlobaSi iRebs. tkivilgamayuCeblad adgilobriv
saanesTezio saSualebebs, mcire doziT opioidebs an orives erTad
iyeneben.
mTeli es procedura da sasurveli efeqtis dadgoma daaxl. 40 wuTs
moicavs.
epiduruli gautkivarebis dros Tqven Zilianobas an sisustes ver
grZnobT.
epiduruli anesTeziisas izrdeba Sansi imisa, rom SesaZloa means
axalSobilis misaRebad maSebis an sxva damxmare xelsawyoebis
gamoyeneba dasWirdes.
spinaluri da kombinirebuli spinur-epiduruli (kse) gautkivareba tkivilgamayuCebel preparatebi gacilebiT male moqmedeben Tuki maT
uSualod im siTxovan toprakSi SeviyvanT, romelic Tqveni xerxemlis
areSi ganTavsebul nervebs akravs gars. am process spinuri gautkivareba
ewodeba. gansxvavebiT epiduruli anesTeziisgan, spinuri gautkivarebis
dros kaTeteri ar idgmeba da tkivilgamayuCeblebis Seyvana erTjeradad
xdeba. Tu am dros epiduruli kaTeteric Caidga, maSin gautkivarebas
kombinirebuli spinur-epiduruli ewodeba.
zogierT saavadmyofoSi kse gautkivareba TiTqmis yvela qals utardeba,
zogSi ki mxolod im mSobiareebs, romelTac tkivilTa intensivobis
Zalian Semcireba undaT.
visTvis SeiZleba an ar SeiZleba epiduruli gautkivareba? esaTuis paTologia (mag.: zurgis tvinis Tiaqari, sisxlis SededebasTan
dakavSirebuli problemebi, manamde xerxemalze Catarebuli operaciebi)
SesaZloa epiduruli gautkivarebis winaaRmdeg Cveneba iyos. amitomac,
yvelaze kargi xana am problemaTa gamosaricxad, swored mSobiarobamde
periodia. Tu Tqven garTulebuli an gaxangrZlivebuli mSobiaroba
geqnebaT, Tqveni meani an bebiaqali anesTeziologTan erTad epiduruli
gautkivarebis aucileblobas gadawyvets, rac TqvenTvis da Tqveni
patarasTvis sasargeblo iqneba.
9
im SemTxvevaSi, Tuki Warbwoniani brZandebiT, SesaZloa epiduruli
gautkivarebis Sesruleba gaZneldes da kaTeteris Cadgmas didi dro
dasWirdes.
rogor sruldeba epiduruli gautkivareba? Tavdapirvelad, xelze, venaSi kaTeteri (wvrili plastmasis milaki) –
CagedgmebaT, romlis saSualebiTac mSobiarobis mTels periodSi
siTxeebi da medikamentebi (Tuki amis aucilebloba iqneba) gadagesxmebaT.
amis Semdeg, bebiaqali gTxovT dawveT gverdze da maqsimalurad
moixaroT an dajdeT da win gadaixaroT. anesTeziologi welis ares
antiseptikuri saSualebiT dagimuSavebT. Semdeg, anesTeziologi, kanSi
adgilobriv anesTetiks SegiyvanT, raTa Semdgomi procedura TqvenTvis
umtkivneulo iyos. epiduruli kaTeteri nervebTan axlos, xerxemalSi
Tavsdeba. anesTeziologi am dros frTxilad unda iyos, raTa ar
daazianos am nervebis irgvliv arsebuli siTxovani toprakis kedeli,
ramac SesaZloa SemdgomSi Tavis tkivili gamoiwvios. proceduris dros
10
ar unda gainZreT, mas Semdeg ki, rac anesTeziologi kaTeters
leikoplastiriT daafiqsirebs ukve SegiZliaT imoZraoT.
epiduruli kaTeterizaciis Semdeg, anesTeziologs masSi
tkivilgamayuCebeli Sehyavs. epiduruli kaTeteris Cadgmas daaxl 20 wuTi,
xolo sasurveli efeqtis dadgomas aseve 20 wuTi sWirdeba.
gautkivarebis dasawyisidan bebiaqali sisxlis wnevas regularulad
gikontrolebT. anesTeziologi ki mucelsa da fexebze yinulis natexis
dadebiT amowmebs ramdenad grZnobT Tqven mas da amiT gautkivarebis
koreqtulobas akontrolebs. zogjer, epiduruli gautkivareba ver
miiRweva, risTvisac saWiro xdeba kaTeteris Sesworeba an amoReba da
Tavidan Cayeneba.
mSobiarobis periodSi, epidurul kaTeterSi saanesTezio preparatebis
Seyvana an mudmivi, neli dinebiT xdeba, an masSi medikamentebi swrafad,
nakadiT Segvyavs, an kidev tkivilgamayuCeblebi daniSnulebis adgils
pacientkontrolirebadi epiduruli analgeziis (pkea) pampiT aRwevs. am
ukanasknelis dros, Tqven Tavad SegiZliaT saTanado Rilakze daWeriT
TqvenTvis sasurveli doza SearCioT.
epidurul kaTeterSi saanesTezio nivTierebebis swrafad, nakadiT
Seyvanisas, bebiaqali kvlav regularulad gadaamowmebs Tqvens sisxlis
wnevas.
epiduruli gautkivarebis mizania saSvilosnos SekumSviT gamowveuli
tkivilebis daTrgunva. Cveulebriv, am meTodiT mSobiarobisSemdgomi
tkivilebis marTvacaa SesaZlebeli.
zogierTi qali mSobiarobis periodis tkivilebis nawilobriv
daTrgunvas amjobinebs, raTa ukeTesad SeZlos nayofis gamoZeveba.
dResdReobiT SesaZlebelia mSobiarobis tkivilebis
kupireba sxeulis qveda nawilebis gamoxatuli
dabuJebisa da sisustis gareSe. am Tanamedrove
meTods “mobiluri epiduruli
gautkivareba ewodeba.” epiduruli
gautkivarebis Semdeg,
axalSobilis ZuZuTi kveba
daSvebulia.
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ra moxdeba im SemTxvevaSi, Tu operacia dagWirdaT? aseT dros, epiduruli kaTeteris saSualebiT anesTeziologs gacilebiT
Zliermoqmedi saanesTezio saSualeba Sehyavs, rac sxeulis qveda
nawilebis iseT Rrma gabuJebas iwvevs, rom sakeisro kveTis Catarebac
SesaZlebelia. gautkivarebis es saxe zogad anesTeziasTan SedarebiT
gacilebiT usafrTxoa.
Tu Tqven sakeisro kveTa gesaWiroebaT da epiduruli kaTeteris gareSe
xarT, maSin CagitardebaT spinuri gautkivareba, oRon gacilebiT maRali
dozis anesTetikebiT, vidre es Cveulebriv fiziologiuri mSobiarobis
dros.
sakeisro kveTis gautkivarebis meTodebis Sesaxeb girCevT waikiTxoT
Cveni bukleti saTauriT “Tqveni anesTezia sakeisro kveTisas”
epiduruli gautkivarebis riski da sargebeli monacemebi randomizebuli da observaciuli kvlevebidan movipoveT.
randomizebulia kvleva, rodesac qalebs mkurnalobis esa Tu is saxe
utardebaT da Semdeg miRebuli Sedegebi erTmaneTs dardeba.
mkurnalobis ori meTodidan pacienti erTs randomulad irCevs
(msgavsad monetis mxaris gamocnobisa). kvlevis dros umTavresad iseTi
qalebis monacemebi dardeba, romelTagan erTni magaliTad, epidurul
gautkivarebas itareben, xolo meoreni tkivilis Sesamsubuqeblad
opioidebs an entonoqs iReben. (ix masalebi, 9, romelic mimoxilvaa
mSobirobis dros Catarebuli epiduruli gautkivarebis yvela
randomuli kvlevisa). aRniSnuli mimoxilva koxreinis monacemTa bazis
– damoukidebeli samecniero organizaciis mieraa Sesrulebuli.
epiduruli gautkivarebis efeqtebi, romelzedac Cven axla visaubrebT,
swored am mimoxilvidanaa aRebuli.
observaciuli kvlevebis dros mravalricxovan samizne jgufSi
epiduruli gautkivarebis Sedegebze dakvirveba xdeba. es erTaderTi
gzaa Zalzed iSviaTi movlenebis ganviTerebis riskis dasadgenad.
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Semdegi informacia dafuZnebulia randomizebul kvlevaTa Sedegebze epiduruli gautkivarebis sargebeli epiduruli gautkivareba mSobiarobis tkivilebis Sesamsubuqebeli
yvelaze efeqturi saSualebaa.
epiduruli gautkivarebis dros, axalSobilis sisxlSi mJavas
Semcveloba sxva meTodebTan SedarebiT yvelaze naklebia. (ix. masalebi,
10)
mSobiaris epiduruli gautkivarebisas, axalSobili ar saWiroebs
sunTqvis medikamentur stimulacias, rogorc es opioidebis gamoyenebis
(ineqcia kunTebsa Tu venaSi) dros xdeba.
epiduruli gautkivarebisas, sakeisro kveTis saWiroebis Sansi maRali
araa.
epiduruli kaTeteris amoRebis Semdeg, SesaZloa kaTeteris adgilze
darCes Semkvriveba, romelic ramdenime Tve grZeldeba. (ix. masalebi, 11)
epiduruli gautkivarebis riski
epiduruli anesTeziisas Sansi imisa, rom SesaZloa means axalSobilis
misaRebad maSebis an sxva damxmare xelsawyoebis gamoyeneba dasWirdes
14%-ia. gautkivarebis gareSe ki es maCvenebeli 7%-s Seadgens.
epiduruli gautkivarebisas mSobiarobis meore etapi (saSvilosnos
yeli sruliad gaxsnilia) xangrZlivdeba da SekumSvaTa
gasaZliereblad medikamentis (oqsitocini) gamoyeneba saWiro xdeba.
epiduruli gautkivarebis dros sisxlis wnevis Semcirebis Sansi metia.
fexebSi igrZnobT sisustes manam, sanam epiduruli kaTeteri imuSavebs.
epiduruli anesTeziisas gagiZneldebaT moSardva, risTvisac Sardis
drenaJisTvis Sardis buStSi kaTeteris Cadgma gaxdeba saWiro.
epiduruli gautkivarebisas SesaZloa igrZnoT qavili.
epiduruli gautkivarebisas SesaZloa gagiviTardeT cxeleba, rac
asocirebuli iqneba axlSobilis distresTan.
im SemTxvevaSi Tuki, epidurulad opioidebis didi doza iqna Seyvanili,
didia Sansi imisa, rom axalSobils dasWirdes sunTqvis
mastimulirebeli Terapia (ix. masalebi,12), xolo Tqven gagiWirdeT
bavSvis kveba (ix. masalebi,13).
13
sxva riski
Cveulebriv epidurul gautkivarebas Tavis tkivili ar axlavs, magram
Tu SemTxveviT nemsiT gaiCxvlita im siTxovani toprakis kedeli,
romelic nervebs gars akravs (amas “magari garsis punqcia” ewodeba),
SesaZloa gagiviTardeT Tavis mwvave tkivili, romelic ramdenime dRe
an kvira grZeldeba da romlis aRmosafxvreladac Sesabamisi
mkurnalobis Catarebaa saWiro (ix. masalebi, 14)
Semdegi informacia dafuZnebulia observaciul kvlevaTa
Sedegebze
epiduruli da spinuri gautkivarebis riskebi cxrilSia ganTavsebuli
(ix. masalebi, 15-20)
epiduruli gautkivarebis gamo, 13 000 –dan erT qals xangrZlivi droiT
nervis dazianeba aReniSneba, rac erT fexSi kunTebis sisustiTa da
dabuJebisa da WianWvelebis cocvis SegrZnebiT gamovlindeba. Tumca
aseTi garTuleba SesaZloa maSinac ganviTardes, roca epidurul
gautkivarebas adgili ara aqvs. (ix. masalebi,15) da am dros misi
sixSire 2500 qalSi erTs Seadgens.
monacemebi imis Sesaxeb, rom epiduruli gautkivareba adgilobrivad
nervebis SeSupebasa da tkivils iwvevs dagenili araa. (ix. masalebi, 21)
14
mSobiarobis tkivilebis SemcirebisTvis epiduruli da spinaluri gautkivarebis riskebi
riskis saxe ganviTarebis sixSire SemTxveviToba sisxlis wnevis mniSvnelovani daqveiTeba
yovel 50 qalSi erTi
SemTxveviTi
aRniSnuli meTodebiT gautkiva- reba ar aris sakmarisi da saWiroa sxva saSualebebis gamoyeneba aRniSnuli meTodebiT gautkiva-reba ar aris sakmarisi sakeisro kveTisTvis da saWiroa zogadi anesTezia
yovel 8 qalSi erTi yovel 20 qalSi erTi
Cveulebriv zogjer
Tavis mwvave tkivili
yovel 100 qalSi erTi (epidurulis dros) yovel 500 qalSi erTi (spinuris dros)
uCveulo
nervis dazianeba (dabuJeba da sisuste fexebSi) efeqtebi, romlebic 6 Tveze met xans grZeldeba
droebiTi – yovel 1000 qalSi erTi mudmivi – yovel 13 000 qalSi erTi
iSviaTi iSviaTi
epiduruli abscesi (infeqcia) meningitis epiduruli hematoma (sisxlis kolti)
yovel 50 000 qalSi erTi yovel 100 000 qalSi erTi yovel 170 000 qalSi erTi
Zalian iSviaTi Zalian iSviaTi Zalian iSviaTi
gonebis uecari kargva
yovel 100 000 qalSi erTi
Zalian iSviaTi
mwvave dazianeba, maT Soris parezi
yovel 250 000 qalSi erTi
ukiduresad iSviaTi
15
literatura
1 Intrapartum care. Care of healthy women and their babies during childbirth. National Collaborating Centre for Women’s and Children’s Health. Commissioned by the National Institute for Health and Clinical Excellence. 2007 RCOG Press, London.
2 Waldenstrom U Nilsson CA. Experience of childbirth in birth center care. A randomised controlled study. Acta Obstetricia et Gynecologica Scandinavica 1994; 73: 547-554.
3 Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2003, Issue 3. Article Number: CD003766. Date of Issue: 10.1002/14651858.CD003766.
4 Cluett E R, Nikodem VC, McCandlish RE, Burns EE. Immersion in water in pregnancy, labour and birth. Cochrane Database of Systematic Reviews 2002, Issue 2. Article Number: CD000111. Date of Issue: 10.1002/14651858.CD000111.pub2.
5 Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews 2006, Issue 4. Article Number: CD003521. Date of Issue: 10.1002/14651858.CD003521.pub2.
6 Olofsson C, Ekblom A, Ekman-Ordeberg G, Hjelm A, Irestedt L. Lack of analgesic effect of systemically administered morphine or pethidine on labour pain. British Journal of Obstetrics and Gynaecology 1996; 103:
7 Volmanen P, Akural E, Raudaskoski T, Ohtonen P, Alahuhta S. Comparison of remifentanil and nitrous oxide in labour analgesia. Acta Anaesthesiologica Scandinavica 2005; 49: 453-458.
8 Volikas I, Butwick A. Maternal and neonatal side effects of remifentanil PCA. British Journal of Anaesthesia 2005; 95: 504-509.
9 Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2005, Issue4. Article Number: CD000331. Date of Issue: 10.1002/14651858.CD000331.pub2
10 Reynolds F, Sharma S, Seed PT. Analgesia in labour and funic acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. British Journal of Obstetrics and Gynaecology 2002; 109: 1344-1353.
11 Russell R, Dundas R, Reynolds F. Long term backache after childbirth: prospective search for causative factors. British Medical Journal 1996; 312: 1384-1388. 12 COMET Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of
delivery: a randomised controlled trial. Lancet 2001; 358: 19-23. 13 Beilin Y, Bodian CA, Weiser J, Hossain S, Arnold I, Feierman DE, Martin G, Holzman I. Effect of labor
epidural analgesia with and without fentanyl oninfant breast-feeding: a prospective, randomized, double-blind study. Anesthesiology 2005; 103: 1211-1217.
14 Sudlow C, Warlow C. Epidural blood patching for preventing and treating post- dural puncture headache. Cochrane Database of Systematic Reviews 2001, Issue 2. Article Number: CD001791. Date of Issue: 10.1002/14651858.CD001791.
15 Holdcroft A, Gibberd FB, Hargrove RL, Hawkins DF, Dellaportas CI. Neurological complications associated with pregnancy. British Journal of Anaesthesia 1995; 75: 522-526.
16 Jenkins K, Baker AB. Consent and anaesthetic risk. Anaesthesia 2003; 58:962-984. 17 Jenkins JG, Khan MM. Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002.
Anaesthesia 2003; 58: 1114-1118. 18 Jenkins JG. Some immediate serious complications of obstetric epidural analgesia and anaesthesia: a
prospective study of 145,550 epidurals. International Journal of Obstetric Anesthesia 2005; 14: 37-42. 19 Reynolds F. Infection a complication of neuraxial blockade. International Journal of Obstetric Anesthesia
2005; 14: 183-188. 20 Ruppen W, Derry S, McQuay H, Moore RA. Incidence of epidural hematoma, infection, and neurologic
injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology 2006; 105: 394-399. 21 Rice I, Wee MYK, Thomson K. Obstetric epidurals and chronic adhesivearachnoiditis. British Journal of
Anaesthesia 2004; 92: 109-120.
16
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