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.

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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

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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.

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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

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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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