1

Tbilisis saxelmwifo samedicino universiteti

xelnaweris uflebiT

nino emuxvari

miokardiumis mwvave infarqtis warmoSobaze moqmedi ZiriTadi

risk-faqtorebis kompleqsuri socialur-higienuri Sefaseba

14.00.33 – sazogadoebrivi jandacva da menejmenti

disertacia

medicinis mecnierebaTa kandidatis samecniero

xarisxis mosapoveblad

samecniero xelmZRvaneli

medicinis mecnierebaTa doqtori,

profesori o. gerzmava

Tbilisi

2006

2

S i n a a r s i

Sesavali ------------------------------------------------------------------------------ 5

Tavi I

literaturis mimoxilva ---------------------------------------------------- 8

Tavi II

kvlevis masala ----------------------------------------------------------------- 26

kvlevis meTodebi --------------------------------------------------------------- 29

Tavi III

miRebuli Sedegebi

hiperqolesterinemiiT avadmyofTa Trombolizuri

Terapia ---------------------------------------------------------------------------------------31

arteriuli hipertenziiT avadmyofTa mkurnalobis

Sedegebi ---------------------------------------------------------------------------------------35

Tambaqos mwevel avadmyofTa gamokvlevis Sedegebi ----39

Trombolizuri Terapia simsuqniT avadmyofebSi ----------------------41

sqesis roli Trombolizuri mkurnalobis dros ---------------------45

Trombolizuri Terapiis Sedegebi sxvadasxva asakis

pacientebSi ------------------------------------------------------------------------------------49

Saqriani diabetis mqone avadmyofTa Trombolizuri

3

Terapiis Sedegebi ----------------------------------------------------------------------------54

Trombolizuri Terapiis Sedegebi gid risk-faqtorebis

mixedviT --------------------------------------------------------------------------------------------57

Tavi IV

Sedegebis ganxilva --------------------------------------------------------------------------61

daskvnebi --------------------------------------------------------------------------------------------71

praqtikuli rekomendaciebi -------------------------------------------------------------73

gamoyenebuli literatura ------------------------------------------------------------- 74

4

disertaciaSi gamoyenebuli Semoklebebi

ah – arteriuli hipertenzia

gid – gulis iSemiuri daavadeba

gu – gulis ukmarisoba

gqu – gulis qronikuli ukmarisoba

gf – gandevnis fraqcia

CK-MB – kreatinkinazas MB fraqcia

HDL – maRali simkvrivis lipoproteidi

LDL – dabali simkvrivis lipoproteidi

mi – miokardiumis infarqti

mpmu – marcxena parkuWis mwvave ukmarisoba

TQ – saerTo qolesterini

TG – trigliceridebi

pe – parkuWovani eqstrasistolia

pf – parkuWTa fibrilacia

Sd – Saqriani diabeti

5

Sesavali

mosaxleobis cxovrebis jansaRi wesis formirebis problema

dResdReobiT warmoadgens saqarTvelos jandacvis sistemis

ganviTarebis ZiriTad mimarTulebas. amasTan, modificirebadi da

aramodificirebadi risk-faqtorebis (hiperqolesterinemia,

arteriuli hipertenzia, Tambaqos weva, Saqriani diabeti, simsuqne

da sxv) profilaqtikaze mimarTuli RonisZiebaTa ganxorcieleba

arsebul pirobebSi gaZnelebulia. Aam kuTxiT qveyanaSi Seiqmna

gansakuTrebiT rTuli situacia mosaxleobaSi gul-

sisxlZarRvTa sistemis daavadebaTa da, maT Soris, miokardiumis

mwvave infarqtis farTo gavrcelebasTan dakavSirebiT.

gulis mwvave iSemiuri daavadeba ara marto klinikuri

kardiologiis, aramed epidemiologiis, socialuri medicinis,

jandacvis ekonomikis, mTlianad sazogadoebis seriozul da

Znelad gadasaWrel problemas warmoadgens. jandacvis

msoflio organizaciis eqspertTa mier es paTologia xasiaTdeba

rogorc me-20 saukunis epidemia. amis dadasturebaa mwvave gid-iT

avadobis mkveTri zrda, pacientTa mier Sromis unaris dakargvis

maRali xarisxi, is faqti, rom gid mosaxleobis sikvdilobis

erTerTi umTavresi mizezia.

bolo wlebSi mniSvnelovnad Seicvala miokardiumis mwvave

infarqtis mkurnaloba, rac ganpirobebulia iseTi faqtorebiT

rogoricaa: diagnostikis axali meTodebis SemoReba,

randomizebuli kvlevebis Sedegebze dayrdnobiT konservatiuli

da qirurgiuli mkurnalobis unificirebuli meTodebis danergva,

specializirebuli samedicino dawesebulebebis ricxvis zrda da

sxv. Tu jer kidev 60-ian wlebSi miokardiumis infarqtiT

letaloba 30-50%-s Sedgenda. mkurnalobis da dakvirvebis

6

Tanamedrove meTodebma am mizeziT gamowveuli sikvdilobis

SemTxvevaTa sixSire TiTqmis gaanaxevra, xolo Trombolizuri

preparatebis gamoyenebam sikvdiloba 7-5%-de Seamcira.

miuxedavad amisa, miokardiumis mwvave infarqtis

warmatebuli profilaqtikis erT-erTi mniSvnelovani sawindaria

RonisZiebaa risk-faqtorebis Tavidan acileba, rac daavadebis

warmoSobis SemTxvevaSic zedmiwevniT mniSvnelovania

mkurnalobis prognozis gaTvaliswinebiT. Dadasturebulia isic,

rom risk-faqtorebis drouli koreqcia amcirebs miokardiumis

infarqtis Soreuli garTulebebis sixSires.

miuxedavad rigi dadebiTi Zvrebisa, saqarTveloSi Seqmnili

situacia ar iZleva SesaZleblobas, raTa mosaxleobaSi

gatardes farTo profilaqtikuri RonisZiebebi, mimarTuli

miokardiumis mwvave infarqtis profilaqtikaze, pacientTa

droul hospitalizaciaze. amasTan, Tavis muSaobaSi,

kardiologiur klinikaSi momuSave specialistebi nakleb

yuradRebas uTmoben risk-faqtorebis mniSvnelobis Sefasebas

pacientTa mkurnalobisa da reabilitaciis prognozirebis

procesSi.

zemoaRniSnulidan gamomdinare, kvlevis mizans warmoadgens

miokardiumis mwvave infarqtis warmoSobaze da prognozze

moqmedi risk-faqtorebis Seswavla da maTi korelaciuri

kavSiris dadgena daavadebis hospitalur da Soreul

garTulebebTan saTanado praqtikuli rekomendaciebis

SemuSavebis mizniT.

dasmuli miznis misaRwevad gadawyvetili iyo Semdegi

amocanebi:

7

- miokardiumis mwvave infarqtis gavrcelebis dinamikis

Seswavla (1990 - 2004 wlebis monacemebiT) calkeuli

regionebisa da qalaqebis mixedviT.

- pacientebze moqmedi ZiriTadi risk-faqtorebis

(socialur-ekonomikuri, socialur-higienuri da

samedicino-biologiuri) urTierTkavSiris dadgena;

- miokardiumis mwvave infarqtis mqone pacientebSi

Catarebuli Trombolizuri Terapiis Semdeg

modificirebadi da aramodificirebadi risk-faqtorebis

(hiperqolesterinemia, arteriuli hipertenzia, Tambaqos

weva, Saqriani diabeti, simsuqne, memkvidreoba, asaki, sqesi)

rolis gansazRra ganviTarebul garTulebebaTa

sixSireze;

- miokardiumis mwvave infarqtis garTulebaTa

profilaqtikaze mimarTuli saorganizacio

RonisZiebebis daxasiaTeba da maTi efeqturobis

kompleqsuri Sefaseba;

- miRebuli monacemebis safuZvelze daavadebis

profilaqtikis, mkurnalobisa da reabilitaciis

efeqtianobis gazrdis mizniT saTanado praqtikuli

rekomendaciebis SemuSaveba.

kvlevis mecnieruli siaxle: pirvelad iqna Seswavlili:

- miokardiumis mwvave infarqtis gavrcelebis

Taviseburebebi qveynis calkeuli regionebisa da

qalaqebis mixedviT;

- modificirebadi da aramodificirebadi risk-faqtorebis

(hiperqolesterinemia, arteriuli hipertenzia, Tambaqos

weva, Saqriani diabeti, simsuqne, memkvidreoba, asaki, sqesi,

8

Semosavlaii, dasaqmeba, samedicino aqtiuroba da sxv.)

gavlena miokardiumis mwvave infarqtis gavrceleba;

- Catarebuli Trombolizuri Terapiis Semdeg avadmyofTa

prognozis gansazRvraSi sxvadasxva faqtorebis (Saqriani

diabeti, dislipidemia, arteriuli hipertenzia, asaki,

sqesi da sxv.) rolis Seswavla

naSromis praqtikuli mniSvneloba:

- kvlevis Sedegad miRebul iqna mniSvnelovani

informacia mosaxleobaSi miokardiumis mwvave infarqtis

gavrcelebis TaviseburebaTa Sesaxeb, romelic saSualebas

iZleva obieqturad Sefasdes am kontingentis janmrTelobis

mdgomareoba, gamokveTos daavadebis prevenciaze mimarTuli

prioritetuli problemebi;

- Seswavlil iqna miokardiumis mwvave infarqtis

gavrcelebaze moqmedi risk-faqtorebis gavlenis specifika;

- dadginda, rom miokardiumis mwvave infarqtis prevencia

moiTxovs saTanado samkurnalo-profilaqtikuri RonisZiebebis

safexurebrivi sqemiT Catarebas, rac xels uwyobs adeqvaturi

mkurnalobis ganxorcielebas, mniSvnelovnad amcirebs am

daavadebiT gamowveuli garTulebebis sixSires, aumjobesebs

avadmyofTa cxovrebis xarisxs.

- kvlevis Sedegebi SesaZlebelia safuZvlad daedos

profilaqtikur programebs, romelTa gatareba mizanSewonilia

rogorc qveynis, aseve calkeuli jandacvis dawesebulebis da

indivividualur doneze.

9

dasacavad warmodgenili ZiriTadi debulebebi:

- miokardiumis mwvave infarqtis prevenciis gaumjobesebaze

mimarTuli socialuri da jandacviTi RonisZiebebis

qmediTunarianobis Sefasebis sqema;

- sxvadasxva marTvadi da aramarTvadi risk-faqtoris

(Saqriani diabeti, dislipidemia, arteriuli hipertenzia,

asaki, sqesi da sxv.) roli Catarebuli Trombolizuri

Terapiis prognozis gansazRvraSi;

disertaciis aprobacia da publikaciebi: disertaciis

ZiriTadi debulebebi moxsenda sxdomaze. disertaciis

Temaze gamoqveynebulia 4 statia:

disertaciis moculoba da struqtura: naSromi warmodgenilia

qarTul enaze 103 nabeWdi gverdiT. moicavs Sesavals,

literaturis mimoxilvas, gamokvlevis meTodikas da masalis

saerTo daxasiaTebas, sakuTari gamokvlevebis Sedegebs,

miRebuli Sedegebis analizs, daskvnebs, praqtikul

rekomendaciebs, danarTs, 22 cxrils, 1 diagramas.

bibliografia moicavs 176 literaturis wyaros, maT Soris

qarTuli - 10 ucxouri _ 166.

10

Tavi I

literaturuli mimoxilva

gulis mwvave iSemiuri daavadebis gavrcelebaze moqmedi

risk-faqtorebi

saqarTvelos jandacvis sistemis ganviTarebis ZiriTad

mimarTulebas qronikul daavadebaTa prevenciaze mimarTuli

RonisZiebebis Semdgomi gafarToeba da daxvewa warmoadgens. am

kuTxiT gansakuTrebiT mZime situaciaa Seqmnili gul-

sisxlZarRvTa sistemis daavadebaTa profilaqtikis saqmeSi. gid-

is da maT Soris, miokardiumis mwvave infarqtis

gavrcelebamWidrodaa dakavSirebuli mosaxleobis cxovrebis

jansaRi wesis formerebasTan.

bolo wlebSi mniSvnelovnad Seicvala miokardiumis

infarqtis mkurnaloba, rac ganpirobebulia axali

diagnostikuri meTodebis SemuSavebiT da danergviT,

unificirebuli mkurnalobis meTodebis farTo gamoyenebiT,

specializebuli dawesebulebebis da eqimkardiologTa

raodenobis gazrdiT da sxv. jer kidev 60-ian wlebSi letaloba

miokardiumis infarqtiT 30-50%-s Seadgenda. mkurnalobis da

dakvirvebis Tanamedrove meTodebma ki sikvdilobis sixSire

gaanaxevra, xolo Trombolizuri preparatebis gamoyenebam

sikvdiloba 7-5%-mde Seamcira (8,29,84,146).

miuxedavad amisa, Semdgom daxvewas moiTxovs miokardiumis

infarqtis warmatebul mkurnalobaze da garTulebaTa

profilaqtikaze mimarTuli mniSvnelovani RonisZiebebis, gid-is

risk-faqtorebze zemoqmedebis axali meTodebis danergva.

dadasturebulia, rom am faqtorebis koreqcia amcirebs

miokardiumis infarqtis Soreuli garTulebebis sixSires,

11

kerZod igi klebulobs TiTqmis 70%-iT im pacientebSi, romelsac

utardebad hipoqolesterinemiuli mkurnaloba. analogiuri

kleba aRiniSneba arteriuli hipertenziis, sisxlSi glukozis

da Sededebis zogierTi faqtoris cvlilebis drouli koreqcia.

kerZod, im pacientebSi, romlebmac Secvales arajansaRi

cxovrebis wesi, Sewyvites Tambaqos moweva. aseT pacientebs

uaxloes 3 weliwadSi ganmeorebiTi infarqtis warmoSobis riski

gauTanabrda aramwevelTa risks.

gul-sisxlZarRvTa daavadebebs Soris gid pirveli adgili

uWiravs rogorc gavrcelebis, ise sikvdilobis TvalsazrisiT.

mag., ruseTSi gul-sisxlZarRvTa daavadebebiT iRupeba 20-64 wlis

mamakacTa 34% da qalTa 39%. saerTo sikvdilobis struqturaSi

gul-sisxlZarRvTa daavadebebis xvedriTi wilia 48,2%

mamakacebisTvis da 49% qalebisTvis (28,59,60,118 ).

yuradsaRebia is garemoeba, rom Tu ganviTarebul qveynebSi

gulis mwvave iSemiuri daavadebis mizeziT gardacvlilTa

ricxvi ganuyrelad klebulobs, aRmosavleT evropis da

gansakuTrebiT dsT-s da baltiispireTis qveynebSi es maCvenebeli

gacilebiT maRalia (ix.cxrili )

cxrili

gulis mwvave iSemiuri daavadebiT gardacvlilTa ricxvi (1970-

2001 ww. monacemebiT) zogierT dasavleT evropis qveynebSi

(yovel 1000000 mosaxleze)

qveynebi 1970 1980 1990 2001

fineTi 310,14 277,33 238,72 164,99

luqsemburgi 142,78 108,14 76,58

holandia 208,15 173,88 130,2

norvegia 239,28 209,46 187,21 110,44

portugalia 93,1 83,41

avstria 206,5 152,89 153,35 125,19

12

gacilebiT mZime mdgomareobaa yofil socialistur

qveynebSi, sadac, miuxedavad SemTxvevaTa garkveuli klebisa

mainc aRiniSneba sikvdilianobis maRali done (ix.cxrili)

cxrili

gulis mwvave iSemiuri daavadebiT gardacvlilTa ricxvi (1970-

2001 ww. monacemebiT) zogierT centraluri evropis qveynebSi

(yovel 1000000 mosaxleze)

qveynebi 1970 1980 1990 2001

bulgareTi 227,48 185,26 230,09 190,03

qorvatia 78,01 162,83

ungreTi 248,34 229,37 239,66 225,46

rumineTi 104,06 152,3 202,2 228,36

poloneTi 81,36 108,59 120,95 133,47

slovakia 322,29 287,99

slovenia 121,7 100,15

CexeTi 303,17 299,96 310,98 184,2

kidev ufro mZime mdgomareoba dafiqsirebulia dsT-s da

baltiispireTis qveynebSi (ix.cxrili )

cxrili

gulis mwvave iSemiuri daavadebiT gardacvlilTa ricxvi (1970-

2001 ww. monacemebiT) zogierT dsT-s qveynebSi

(yovel 1000000 mosaxleze)

qveynebi 1980 1990 2001

somxeTi 374,17 282,97

azerbaijani 389,38 405,48

estoneTi 432,52 330,70

saqarTvelo 378,49 303,05

yazaxeTi 306,84 420,22

yirgizeTi 266,75 337,51

latvia 473,68 389,42 306,39

litva 429,27 343,48

moldaveTi 357,29 558,12

ruseTi 388,09 325,44 379,43

belarusi 335,99 456,92

13

baltiispireTis qveynebSi gul-sisxlZarRvTa daavadebebiT

gamowveuli sikvdiloba 55,3%-s Seadgens, xolo maT Soris gid

sikvdiloba 61,6%-ia (11,15,17,18). ukrainaSi gul-sisxlZarRvTa

daavadebebiT gamowveuli sikvdilobis erT-erTi maRali

maCvenebelia msoflioSi. 2000 wlisTvis man 61% Seadgina (117 ).

literaturis monacemebiT, 1989 wels kanadaSi gul-

sisxlZarRvTa daavadebebiT 80 859 adamiani gardaicvala, maT

Soris 49 148 – gardaicvala gid-iT, 14 232 – insultiT. gid

sikvdilobis yvelaze xSiri mizezi iyo 40 welze meti asakis

mamakacebSi da 60 welze meti asakis qalebSi. 1987w gul-

sisxlZarRvTa daavadebebiT daiRupa 77 790 adamiani, 100 000

mosaxleze sikvdiloba mamakacebs Soris iyo 324 da qalebs

Soris – 283. mamakacebs Soris sikvdiloba matebas iwyebs 10

wliT adre, vidre qalebSi, Tumca sabolood es monacemebi

daaxloebiT erTnairia. gul-sisxlZarRvTa daavadebebis saerTo

sikvdiloba SedarebiT myarad mcirdeba 1950 wlidan. 2000

wlisTvis 100 000 mosaxleze sikvdilobis Semcirebam 35-dan 90

wlamde asakis mamakacebSi da qalebSi Seadgina 780- da 415 –dan

655- da 310-mde Sesabamisad (73,86,93,96).

gul-sisxlZarRvTa daavadebebiT gamowveuli avadoba da

sikvdiloba saqarTveloSi mainc maRali rCeba. 1970-dan 1992

wlamde am daavadebebiT gamowveuli sikvdilobis xvedriTi wili

saerTo sikvdilobis struqturaSi 58,2%-dan 70,4%-mde gaizarda

(9). 1997-98 wlebSi saqarTveloSi registrirebuli iyo 121197 gul-

sisxlZarRvTa paTologiis axali SemTxveva. am daavadebebis gamo

gardaicvala 23966 adamiani. saqarTveloSi yovelwliurad 2547

adamiani avaddeba miokardiumis mwvave infarqtiT, maTgan

daaxloebiT 18% fataluria. (10).

14

mravalricxovani masobrivi kardiologiuri kvlevebis

monacemebi gul-sisxlZarRvTa daavadebebis da gansakuTrebiT

gid ganviTarebis risk-faqtorebis gavrcelebis Sesaxeb

obieqturi monacemebis miRebis saSualebas iZleva. dadgenilia,

rom gid ganviTarebis yvelaze mniSvnelovan sam risk-faqtors

warmoadgens hiperqolesterinemia, arteriuli hipertenzia da

Tambaqos weva. gansakuTrebiT saxifaToa am faqtorebis

Tanxvedra. samive faqtoris kombinaciis dros pacientTa

sikvdilobis riski 8-jer izrdeba, ori faqtoris kombinaciisas –

4-jer, xolo 1 faqtoris arsebobisas – 2-jer im pacientebTan

SedarebiT, visac gid risk-faqtorebi ar gaaCnia

(2,7,14,26,27,36,55,142,175 ).

miokardiumis mwvave iSemiis mizezi SeiZleba iyos

koronaruli arteriis daxSoba aTerosklerozuli folaqiT,

Trombis warmoqmna an sisxlZarRvis spazmi. koronaris mzardi

daxSoba ganapirobebs miokardiumis qronikul iSemias, rac

vlindeba stabiluri stnokardiis saxiT. Trombis warmoqmna an

spazmi iwvevs miokardiumis sisxliT momaragebis mwvave

ukmarisobas, anu miokardiumis infarqtis ganviTarebas.

gid ganviTarebis 95-97%-Si mizezi aTerosklerozia, Tumca

igi ar aris gid erTaderTi mizezi. gid risk-faqtorebs

pirobiTad or jgufad yofen: modificirebadi da

aramodificirebadi risk-faqtorebi.

modificirebad risk-faqtorebs miekuTvneba: arteriuli

hipertenzia, Tambaqos weva, sxeulis Warbi wona, naxSirwylovani

cvlis darRveva (kerZod, Saqriani diabeti), hipodinamia, kvebis

darRveva, sisxlSi qolesterinis donis momateba da sxva.

15

aramodificirebad risk-faqtorebs miekuTvneba: asaki (50-60welze

zeviT), mamrobiTi sqesi, damZimebuli memkvidreoba.

zogierT wyaroSi SeiZleba inaxos sxva saxis

klasifikaciebi, ris mixedviTac gid risk-faqtorebi iyofa

socialur-kulturul (egzogenuri) da Sinagan (endogenuri)

faqtorebad. socialur-kulturul risk-faqtorebs uwodeben im

faqtorebs, romlebic ganpirobebulni arian adamianis

sacxovrebeli garemoTi. maT Soris mniSvnelovania: araswori

kveba (maRalkaloriuli sakvebis Warbi miReba), hipodinamia,

nervul-fsiqikuri daZabva, Tambaqos weva, alkoholizmi, qalebSi

gid ganviTarebis riski izrdeba hormonuli kontraceptivebis

xangrZlivi miRebiT. Sinagan risk-faqtorebs uwodeben im

faqtorebs, romlebic avadmyofis mdgomareobiTaa ganpirobebuli:

hiperqolesterinemia, arteriuli hipertenzia, simsuqne,

nivTierebaTa cvlis darRveva, naRvelkenWovani daavadeba,

adamianis pirovnuli da qceviTi Taviseburebebi, memkvidreoba,

asaki, sqesi.

aTerosklerozis ganviTarebaSi qolesterinuli hipoTezis

SeqmnaSi prioriteti n. aniCkovs da s. xalatovs ekuTvnis, Tumca

50-ian wlebamde am mxriv seriozuli kvlevebi ar Catarebula.

pirvelma kvlevebma, romlebic Catarda 60-iani wlebis dasawyisSi

daamtkica, rom qolesterinis done gul-sisxlZarRvTa

daavadebebiT gamowveuli avadobis da sikvdilobis prediqtors

warmoadgens. 3 500 000-ze met adamianze dakvirvebis Sedegad

dadginda, rom saerTo qolesterinis donis momatebisas 200 mg%-

mde (5,2 mmol/l) gid riski mkveTrad izrdeba. qolesterinis

donis momatebisas 250 mg%-mde (6,5 mmol/l) es riski ormagdeba,

xolo 300 mg%-mde (7,8 mmol/l) – 4-jer izrdeba. ufro

16

saintereso iyo is faqti, rom pirebisTvis, visac qolesterinis

done 200-dan 167 mg%-mde aqvT, gid riski 70%-ia. (22,31,51,54,70 ).

dadgenilia, rom yvelaze ufro arakeTilsaimedo faqtoria

maRali simkvrivis lipoproteidebis HDL-qolestrinis daqveiTeba

39 mg%-ze (1 mmol/l) qvemoT da saerTo qolesterinis Sefardeba

HDL–qolestrinis da, gansakuTrebiT, dabali simkvrivis

lipoproteidebis LDL- qolesterinis HDL –qolestrinis

donesTan Sefardebis momateba 5,5-ze metad. (72,77,80,102) am

parametrebis kontroli gid avadobisa da sikvdilobis riskis

gansazRvris mniSvnelovani RonisZiebaa. gansakuTrebiT

mniSvnelovania maRali riskis pacientebisTvis, romelTac

pirvel rigSi miekuTvnebian pirebi gadatanili miokardiumis

infarqtiT. Trombolizurma mkurnalobam, β- blokerebisa da

ACE- inhibitorebis gamoyenebam bevrad gaaumjobesa gid pacientTa

prognozi, magram yvela es RonisZieba ar zemoqmedebs

koronaruli arteriebis aTerosklerozis arsze. 90-iani wlebis

bolos Catarebulma gamokvlevebma aCvena, rom statinebis

gamoyeneba miokardiumis infarqtiT avadmyofebSi mniSvnelovnad

amcirebs gid sixSires da sikvdilobas. kerZod, simvastatiniT

mkurnalobis dros sikvdilis riski Semcirda 34%-iT, xolo

pravastatiniT mkurnalobisas – 24%-iT ( 92,93,127).

Catarebulma gamokvlevebma aCvena, rom statinebis efeqti

miokardiumis infarqtiT avadmyofebSi vlindeba sisxlSi

sxvadasxva lipiduri speqtris dros ( maT Soris praqtikulad

normaluri maCveneblebis dros). es faqti adasturebs, rom

`normis~ cneba pirobiTia. meore mxriv ki, miokardiumis

infarqtiT avadmyofebisTvis saerTo qolesterinis da LDL-

17

qolesterinis SedarebiT dabali cifrebic ki zrdis gid

avadobis da sikvdilobis risks (67,145,152).

lipiduri speqtris am maCveneblebTan erTad aseve

mniSvnelovania trigliceridebis roli gid ganviTarebSi.

hipertrigliceridemiis, rogorc damoukidebeli risk-faqtoris

roli didi xnis ganmavlobaSi diskusiis sagans warmoadgenda.

mravali epidemiologiuri kvlevis analiziT, trigliceridebis

koncentracia 5 mmol/l (450 mg%) sarwmunod zrdis gid risks

(24, 74, 75, 97). avadmyofTa garkveuli jgufebisTvis

hipertrigliceridemiis, rogorc gid mniSvnelovani risk-

faqtoris arseboba udaoa. esenia meore tipis Saqriani diabetiT

avadmyofebi da qalebi. qalebSi, gansakuTrebiT 50 welze zemoT,

hipertrigliceridemiis mniSvnelovani prognozuli roli

dadgenilia fremingemis kvlevSi (80, 105 ). Stockholm Prospective Study

kvlevaSi, sadac 1500 qals swavlobdnen 12 wlis ganmavlobaSi,

dadginda, rom hipertrigliceridemia iyo faqtori, romelic

miuTiTebda fataluri infarqtis, insultis da saerTo

sikvdilobis riskze ( 128 ). damajerebeli monacemebia miRebuli 6

didi prospeqtuli kvlevis analiziT,romlebic mieZRvna

hipertrigliceridemiis kavSiris Seswavlas gid-Tan (147, 148, 63).

trigliceridebis koncentraciis momateba 1 mmol/l-iT gid

risks mamakacebSi zrdis 32%-iT, qalebSi – 76%-iT. xolo HDL –

qolesterinis donis SesworebiT, trigliceridebis, rogorc

risk-faqtoris roli TiTqmis 2-jer mcirdeba, Tumca qalebisTvis

mainc ufro maRali rCeba da Sesabamisad Seadgens 14 da 37%-s.

hipertrigliceridemiis Tavisebureba imaSi mdgomareobs, rom is

iSviaTia izolirebulad da xSirad Tan axlavs sxva metaboluri

18

darRvevebi, rac dReisTvis erTiandeba metaboluri sindromis

saxelwodebiT ( 25, 34, 43, 52, 91, 105, 108, 169).

arteriuli hipertenzia warmoadgens gid meore mniSvnelovan

risk-faqtors. dReisaTvis arteriuli hipertenzia arainfeqciur

pandemias warmoadgens. is gansakuTrebiT xSiria Tavisi

garTulebebiT, rac iwvevs avadmyofTa invalidobas da sikvdils.

epidemiologiuri monacemebi aCveneben, rom marcxena parkuWis

hipertrofia damoukidebel risk-faqtors warmoadgens

( 19, 23, 62, 162). sistoluri wnevis sidide ufro mniSvnelovani

risk-faqtoria, vidre diastoluris sidide, radgan asakovan

pacientTa 65-75%-Si izolirebuli sistoluri hipertenzia

gvxvdeba. gul-sisxlZarRvTa sistemis garTulebebis risksa da

sistoluri wnevis sidides Soris wrfivi damokidebuleba

arsebobs. kvlevebiT nanaxai, rom miokardiumis infarqtiT

avadmyofebs, romelTac arteriuli hipertenzia aReniSnebaT,

miuxedavad Catarebuli mkurnalobisa (Trombolizuri Terapiis

CaTvliT), sikvdilobis ufro maRali riski aqvT (40, 46, 168).

Martines S et al (1997) monacemebiT, arteriuli hipertenziiT da

miokardiumis infarqtiT pacientebs, romelTac CautardaT

Trombolizuri Terapia, cocxladdarCenis ufro dabali

procenti hqondaT, vidre pacientebs arteriuli hipertenziis

gareSe – 70,4% da 85,9% Sesabamisad (135 ).

Tambaqos moweva gul-sisxlZarRvTa daavadebebis

ganviTarebis erT-erTi mniSvnelovani risk-faqtoria. dadgenilia,

rom Tambaqos kvamlis moqmedeba gul-sisxlZarRvTa sistemaze

ganpirobebulia nikotiniT da naxSirbadis JangiT. axalgazrda

janmrTel pirebSi Tambaqos gavlenis Taviseburebebis Seswavlam

aCvena, rom yoveli erTi Reri sigaretis mowevis Semdeg izrdeba

19

guliscemis sixSire, gulis wuTmoculoba, mcirdeba dartymiTi

moculoba fizikuri datvirTvis dros. ( 1, 5, 32 ).

gid ganviTarebis riski mwevelTaTvis 1,2-2-jer ufro

maRalia, vidre aramwevelTaTvis da es erTnairad exeba qalebsac

da mamakacebsac. SedarebiTi riski izrdeba moweuli sigartis

raodenobasTan, kvamlis CasunTqvis siRrmesa da mowevis dawyebis

asakTan erTad. sxvadasxva populaciaSi Catarebuli

epidemiologiuri kvlevebi aCveneben, rom miokardiumis infarqtis

riski (maT Soris ganmeorebiTi infarqtis) izrdeba mowevis

intensiurobasTan erTad da maRal asakobriv jgufSi,

gansakuTrebiT 70 welze zeviT. gamoTvlebma aCvena, rom yoveli

moweuli sigareti gid sikvdilis risks 35-44 w pirebSi 3,5%-iT

zrdis, xolo 65-74 w pirebSi – 2%-iT (12, 35, 48).

Tambaqos moweva ganapirobebs gid yvela letaluri

gamosavlis 80%-s 35-44 w mamakacebSi da 27%-s – 45-64 w qalebSi.

risk-faqtorebis SedarebiTma Seswavlam aCvena, rom mwevelebSi 2-

jer gazrdilia stenokardiisa da miokardiumis infarqtis

ganviTarebis riski, 4,9-jer – uecari sikvdilis riski. im

mamakacebSi, romlebic dreSi 20 Rer sigarets ewevian, iseTi

risk-faqtorebi, rogoricaa hiperqolesterinemia, arteriuli

hipertenzia, Saqriani diabeti 5-8-jer zrdian riskis xarisxs.

mZime mwevelebSi gid gamowveuli sikvdiloba 55 wlamde asakis

pirebSi 5-jer maRalia. mwevel qalebSi miokardiumis infarqti 3-

jer ufro xSirad viTardeba, vidre aramwevelebSi (58, 65, 103 ).

axalgazrda mwevelebSi sikvdilis riski gacilebiT

maRalia, vidre aramwevelebSi. 45 wlamde asakis mZime mweveli

mamakacebi 10-15-jer ufro xSirad iRupebian miokardiumis

infarqtiT, vidre aramwevelebi ( 66 ).

20

gid ganviTarebis maRali riskis faqtorebs miekuTvneba

aseve hipodinamia, sxeulis Warbi wona, naxSirwylovani cvlis

moSla, pirvel rigSi Saqriani diabeti.

II tipis Saqriani diabetiT avadmyofebs xSirad aReniSnebaT

koronaruli arteriebis aTerosklerozi. epidemiologiuri

gamokvlevebiT dadgenilia, rom II tipis Saqriani diabetiT

avadmyofTa sikvdilis ZiriTadi mizezi miokardiumis infarqtia.

Tumca am pirebSi iseTi risk-faqtorebi, rogoricaa

hiperqolesterinemia da arteriuli hipertenzia 2-4-jer zrdis

infarqtis ganviTarebis sixSires, vidre saerTo populaciaSi (61,

63, 74 ).

Saqriani diabetiT da gul-sisxlZarRvTa sistemis

daavadebebiT pirebSi metaboluri darRvevebis Seswavlam didi

interesi gamoiwvia hiperinsulinemiis da insulinrezistentobis

mimarT, rogorc gid SesaZlo risk-faqtorebis mimarT.

hiperinsulinemia xSirad asocirdeba gid iseT risk-faqtorebTan,

rogoricaa sxeulis Warbi wona, hiperglikemia, arteriuli

hipertenzia, dislipoproteinemia (81, 88, 134). zogierT

prospeqtul kvlevaSi naCvenebia, rom sisxlSi bazaluri

insulinis donis momateba mniSvnelovnad zrdis mamakacebSi gid

ganviTarebis risks ( 97 ).

Никитин Ю.П. и др (2001) monacemebiT, 25-64w mamakacebSi gid

sixSire 2-4 jer maRalia sisxlSi insulinis maRali doniT

pirebSi. maT daadgines pirdapiri kavSiri sisxlSi bazaluri

insulinis da trigliceridebis dones, sxeulis masis indeqss

Soris da ukukavSiri HDL qolesterins Soris ( 43 ).

II tipis Saqriani diabeti mniSvnelovnad auaresebs

miokardiumis infarqtiT avadmyofTa gamosavals Trombolizuri

21

Terapiis fonzec. kerZod, am pacientebSi maRalia sikvdiloba,

xSiria gulis ukmarisoba, 4-wliani cocxladdarCena mxolod

50%-ia ( 106, 114 ).

gid iseTi risk-faqtorebis mniSvneloba, rogoricaa

sxeulis Warbi wona, zogierTi mkvlevaris azriT bevrad

dabalia, vidre zemoT ganxiluli mTavari risk-faqtorebi (132 ).

ufro metic, zogi avtori, eyrdnoba ra kohortuli kvlevebis

masalebs, uaryofs sxeulis Warbi wonis, rogorc gul-

sisxlZarRvTa daavadebebiT gamowveuli sikvdilobis

damoukidebeli prediqtoris rols (156). amasTan, bevr

prospeqtul kvlevaSi, sadac Seswavlilia sikvdilobis kavSiri

sxeulis wonasTan, dadgenilia misi roli arteriul

hipertenziasTan, gul-sisxlZarRvTa sistemis daavadebebiT

gamowveul avadobasa da sikvdilobasTan ( 167 ).

populaciaSi sxeulis Warbi wonis gavrceleba mraval

faqtorzea damokidebuli, romelTa Soris gamoyofen

socialur-ekonomiurs, kulturuls, qceviT, fsiqologiur,

genetikur da sxva faqtorebs (21, 33, 49 ). zogierTi es faqtori

arasasurvel gavlenas axdens adamianis janmrTelobaze, zogi ki

Tavis uaryofiT gavlenas axdens sxva faqtorebis gziT

(arteriuli hipertenzia, Saqriani diabeti), kerZod, sxeulis

masis gziT. am SemTxvevaSi sxeulis Warbi wona warmoadgens

arteriuli hipertenziis, gid, cerebrovaskuluri

daavadebebis markers

(20, 64 ).

Константинов В.В. и др (2002) Seiswavles sxeulis Warbi wonis

gavrceleba da misi kavSiri gul-sisxlZarRvTa sistemis

daavadebebiT gamowveul sikvdilobasTan. maTi monacemebiT,

22

populaciaSi sxeulis Warbi wona ganapirobebs arteriuli

hipertenziis, dislipoproteinemiis maRal sixSires da

arasasurvl gavlenas axdens sikvdilobaze ( 37 ).

dReisaTvis, gid risk-faqtorad iTvleba ara sxeulis Warbi

wona, aramed cximis ganawileba organizmSi. maRali riski

korelaciaSia abdominur simsuqnesTan da misi gazrda, Tavis

mxriv, zrdis arteriuli hipertenziis, hiperglikemiis da

dislipoproteinemiis albaTobas ( 78 ).

umoZraoba, anu cxovrebis mjdomare wesi risk-faqtoria

iseTi daavadebebis ganviTarebisTvis, rogoricaa koronaruli

daavadeba, insulti, arteriuli hipertenzia, insulin-

damoukidebeli Saqriani diabeti da osteoporozi. fizikurad

aqtiuri pirebi orjer ufro midrekilni arian gul-

sisxlZarTvTa daavadebebis ganviTarebisken, vidre fizikurad

aqtiurni ( 7 ).

ojaxuri anamnezis da memkvidreobis prognozuli

mniSvneloba gid avadobasa da sikvdilobaSi sxvadasxva kvlevaSi

araerTmniSvnelovnad ganixileba (83, 151). rig SromebSi

aRiniSneba, rom gid adre gamovlena pirveli xarisxis

naTesavebSi risk-faqtors warmoadgens, xolo asakis matebasTan

erTad memkvidreobis roli mcirdeba da pirvel planze garegani

faqtorebi gamodis ( 41, 122 ).

gul-sisxlZarRvTa sistemis daavadebebis ris-faqtorebis

codna, aseve mtkicebulebebi sxvadasxva profilaqtikuri da

samkurnalo RonisZiebebis efeqturobaze samwuxarod yovelTvis

ar gamoiyeneba praqtikaSi. literaturaSi xSirad aris

moxsenebuli, rom gul-sisxlZarRvTa sistemis daavadebebis

ganviTarebis riskis Semcireba SesaZlebelia cxovrebis wesis

23

SecvliT da farmakoTerapiiT, gansakuTrebiT antihipertenziuli

da hipolipidemiuri preparatebis gamoyenebiT.

zemoTqmulidan gamomdinare, gul-sisxlZarRvTa sistemis

daavadebebis maRali riskis pacientebis warmatebuli

mkurnalobis ZiriTadi momentebi unda iyos gul-sisxlZarRvTa

sistemis daavadebebis ganviTarebis risk-faqtorebis

urTierTqmedebis gaTvaliswineba, mravalricxovani medikamentis

swori SerCeva da prevenciuli RonisZiebebis Catareba.

1.2. miokardiumis mwvave infarqtiT avadmyofTa riskis

xarisxis Sefaseba

miokardiumis mwvave infarqtis dros riskis xarisxis

Sefaseba aucilebelia im pacientTa gamosavlenad, visac

garkveuli samedicino Careva gauumjobesebs klinikur

gamosavals. mag., ufro intensiuri medikamenturi mkurnaloba an

revaskularizacia naCvenebia ganmeorebiTi iSemiis maRali riskis

gamo. iseTi preparatebis daniSvna, rogoricaa β-blokerebi an

aspirini, Tanabrad amcirebs SedarebiT risks yvela jgufSi.

Tumca am preparatebis gamoyenebiT absoluturi riskis Semcireba

gansxvavebulia. amitom, klinikuri taqtikis mniSvnelovani

komponentia konkretuli pacientis adreuli da mogvianebiTi

riskis raodenobrivi Sefaseba (44, 116, 117 ).

24

cxrili

gul-sisxlZarRvTa daavadebebis warmoCinebaze moqmedi

ZiriTadi da damatebiTi risk-faqtorebi

ZiriTadi damatebiTi

mamrobiTi sqesi an menopauza

qalebSi

sigaretis moweva

`a~ qolesterinis

Semcveloba sisxlSi (76,5

mmoli/l da meti)

damZimebuli ojaxuri

anamnezi

gul-sisxlZarRvTa

daavadebebis adreuli

warmoCineba (qalebSi <65

weli da mamakacebSi <55

weli)

mslq-s Semcireba

dslq-s gazrda

diabetTan TandarTuli

mikroalbuminuria

tolerantobis darRveva

glukozis mimarT

Warbi wona

hipodinamia

fibrinogenis maRali done

plazminogenis endogenuri

qsoviluri aqtivatori

`a~ lipoproteinebis momateba

VI faqtori momateba

homocistein D-dimeris momateba

testi dadebiTi C-reaqtiuli

cilaze

estrogenebis deficiti

`Chlamydia pneumoniac~-is

warmoCineba

daZabuli social-ekonomikuri

situacia

eTnikuri kuTvnilebi

geografiuli regioni

25

miokardiumis infarqtiT avadmyofTa riskis Sefaseba exeba

stacionarul periods, Tumca pacientis gaweris win gamokvleva

riskis gansazRvris mniSvnelovani komponentia, aseve Zalian

mniSvnelovania adreuli da dinamikuri Sefaseba, rac SeiZleba

moxdes ararTuli meTodebiT uSualod pacientis sawolTan.

riskis gansazRvris aucileblobas bevri mizezi aqvs. pirvel

rigSi, mi gadatanidan pirveli wlis ganmavlobaSi sikvdilis

SemTxvevaTa 25% aRiniSneba stacionarSi yofnis pirvel 48 sT-Si

( 50, 120, 130 ).

miokardiumis infarqtis dros riskis Sefaseba iwyeba

anamnezis SekrebiTa da obieqturi gamokvleviT. infarqtis

ganviTarebidan 30 dRis ganmavlobaSi sikvdilis riskis yvelaze

mniSvnelovan faqtorebs miekuTvneba asaki, sistoluri wneva da

guliscemis sixSire pirveli gasinjvisas, gulis ukmarisobis

niSnebi, infarqtis lokalizacia da anamnezSi gadatanili mi (131)

am faqtorTa mniSvneloba dadasturebulia mravali klinikuri

gamokvleviT.

cxrili

miokardiumis mwvave infarqtis warmoSobis riskis

stratifikaciis kriteriumebi

riskis faqtorebi samizne organoebis

dazianeba

asocirebuli

klinikuri

mdgomareoba

mamakacebi >55 w.

qalebi >65 w.

sigaretis moweva

hipelqolesterinemia

samuSao pirobebi

marcxena parkuWis

hipertrofia(ekg,eqokg an

rentgenografia);

proteinuria da/an krea-

tinemia 1,2_2,0 mg/dl;

cerebrovaskularuli

daavadebebi

iSemiuri insulti

hemoragiuli insulti

tranzitoruli

26

socialuri pirobebi

ojaxuri anamnezi

gul-sisxlZarRvTa

daavadebis adreuli

formebi (qalebi<65

w., mamakacebi <55 w.)

hipertoniuli

daavadeba

Saqriani diabeti

aTerosklerozuli

bolaqis ultrabgeriTi

an rentgenologiuri

niSnebi

arteriis badis genera-

lizebuli an keruli

Seviwroeba

iSemiuri Seteva

gulis daavadebebi

stenokardia

operacia koronarul

arteriebze

SegubebiTi gulis

ukmarisoba

Ribeiro DG et al (2003) Seiswavles klinikuri da demografiuli

faqtorebis kavSiri mi avadmyofTa hospitalur sikvdilobasTan.

maT Seiswavles 373 pacienti, romelTagan 84 gardaicvala.

avadmyofebi ganawilebulni iyvnen sqesis, asakis, Catarebuli

Trombolizuri mkurnalobis, gid risk-faqtorebis, mi

lokalizaciis, gulis ukmarisobis xarisxis mixedviT. avtorTa

monacemebiT, gardacvlil avadmyofTa jgufSi ufro meti iyo

pacientebi Saqriani diabetiT, 70 welze meti asakis, ukana

kedlis infarqtiT. kvlevis Sedegad gamovlinda, rom mi

sikvdilobis damoukidebeli prediqtorebi iyo 70 welze meti

asaki, gulis ukmarisoba da Saqriani diabeti ( 149 ).

Павликова Е.П. и др (2002) Seiswavles 120 pacienti miokardiumis

infarqtiT, maTgan 66-s Cautarda Trombolizuri Terapia

streptokinaziT. pirveli jgufis pacientebis asaki iyo 66-75

weli, meore jgufis – 70 welze meti. avtorTa monacemebiT,

meore jgufSi ufro xSiri iyo (47,4%) marcxena parkuWis mwvave

ukmarisoba, gulis qronikuli ukmarisoba ganviTarda 36,8%-Si,

erTwliani sikvdiloba pirvel jgufSi iyo 9,1%, meoreSi – 22,8%.

75 w asakis pacientTa sikvdiloba orive jgufSi maRali iyo

27

( 144 ).

asakis, rogorc sikvdilobis risk-faqtoris mniSvneloba

didia. nacionaluri registris monacemebiT, mi hospitaluri

sikvdiloba farTo diapazonSi icvleba: 3%-dan 55 wlamde

pirebSi, 28%-mde 80w da meti asakis pirebSi ( ). rac ufro

asakovania pacienti, miT ufro didia marcxena parkuWis funqciis

darRvevebis albaToba da gid-is ufro mZime mimdinareoba.

asakovan pacientebSi ufro xSiria gulis SegubebiTi

ukmarisobis da kardiogenuli Sokis ganviTareba ( 119 ).

mi-is adreuli sikvdilis riski maRalia qalebSi. es faqti

nawilobriv aixsneba ara marto sqesiT, aramed sxva klinikuri

faqtorebiTac. mag., xandazmuli asakiT da Tanmxlebi

paTologiebiT ( 68, 69, 86, 96 ).

Nicolau JC et al (2004) Seiswavles 686 mi pacienti, romelTac

CautardaT Trombolizuri Terapia. maTi monacemebiT, 14-dRiani

sikvdiloba ufro dabali iyo mamakacebSi, vidre qalebSi: 8,5%

da 16% Sesabamisad. Soreuli sikvdilobis riski sqesis mixedviT

ar iyo gansxvavebuli mamakacebsa da qalebSi da Seadgenda 65,1%

da 64,8%-s Sesabamisad ( 140 ).

avadmyofTa obieqturi gamokvleva damatebiT informacias

iZleva, rac aseve Zalian mniSvnelovania riskis gansazRvrisTvis.

marcxena parkuWis disfunqciis klinikuri niSnebi (arteriuli

hipotonia, taqikardia, galopis ritmi III tonis gaCenasTan erTad,

periferiuli perfuziis gauareseba, sisxlis mimoqcevis mcire

wreSi Segubeba) maRali riskis pacientebis gamovlenis

saSualebas iZleva. gulis ukmarisobis xarisxi gansazRvruli

Killip-is klasifikaciiT, rac efuZneba sisxlis mimoqcevis mcire

wreSi Segubebis arsebobas, periferiuli perfuziis arseboba an

28

maTi Serwyma mi gamosavalis saimedo prognozuli kriteriumebia

( 133, 137 ).

ekg gamokvleva ara mxolod mi diagnostikaSi gvexmareba,

aramed aseve Zalian mniSvnelovan prognozul informacias

Seicavs. yvelaze Rirebulad iTvleba ST segmentis elevaciis

arseboba an ar arseboba, rac gansazRvravs reperfuziuli

mkurnalobis efeqturad Catarebis SesaZleblobas. garda amisa,

mniSvneloba aqvs mi lokalizacias. ST segmentis elevaciiT

pacientebs wina kedlis mi-iT sikvdilobis riski 2-jer ufro

maRali aqvT, vidre ukana kedlis infarqtis dros ( 139 ). riskis

xarisxis ufro zusti gansazRvris saSualebas iZleva ST

segmentis izoeleqtruli xazidan gadaxris raodenobrivi

Sefaseba. Trombolizuri Terapiis efeqturoba pirdapir

korelaciaSia ekg ganxrebis raodenobasTan, sadac ST segmentis

elevacia aRiniSneba da yvela ganxraSi ST segmentis jamur

gadaxrasTan (150). mag., mi pirveli 30 dRis ganmavlobaSi

gardacvlil pacientebSi ST segmentis jamuri gadaxra ufro

metia, vidre am periodSi gadarCenil pacientebSi.

Mauri f et al (2002) Seiswavles 8731 mi-iT pacientSi ST segmentis

elevacia ganxrebis raodenobis mixedviT da pacientTa xanmokle

da Soreuli sikvdiloba. pacietebi dayves 4 jgufad: A, B, C, D ST

segmentis elevaciiT 2 an 3 ganxraSi, 4 an 5 ganxraSi, 6 an 7

ganxraSi da 8 da met ganxraSi Sesabamisad. 10 wlis Semdeg

sikvdilobam Seadgina 36,6%, 44%, 47,9% da 51,2% Sesabamisad

jgufebSi. 30-dRiani sikvdilobis riski sarwmunod maRali iyo B,

C da D jgufebSi ( 136 ).

sikvdilobis maRal riskze mimaniSnebelia ekg-ze

gamovlenili gamtareblobis darRvevebi, maRali xarisxis A-V

29

blokada ( 89 ) da mocimcime aritmia ( 176 ). garda amisa, ekg

monacemebi saSualebas iZleva gamoiyos im pacientebis

qvejgufebi, romelTac sikvdilobis ufro maRali riski aqvT.

mag., miuxedavad imisa, rom ukana kedlis mi-is prognozi ukeTesia,

vidre wina kedli, ukana kedlis infarqtis Tanxvedra ST

segmentis mniSvnelovan dawevasTan prekordialur ganxrebSi an

marjvena parkuWis dazianebis niSnebTan, 4-jer zrdis gulis

SegubebiTi ukmarisobis, ganmeorebiTi infarqtis da sikvdilobis

risks. ( 93 ).

riskis faqtorebis gamovlena sisxlis analiziTacaa

SesaZlebeli. mi simptomebis gaCenidan 12 sT-is ganmavlobaSi

diagnozis dazusteba SesaZlebelia saerTo kreatinfosfokinazas

aqtiobis, miokardiuli izofermentis CK-MB da

laqtatdehidrogenazas izofermentis gansazRvriT ( 85 ). Tumca

mi mwvave periodSi am fermentebis aqtiobis momateba aReniSneba

pacientTa 34%-s. garda amisa, fermentebis aqtioba momatebulia

12%-Si mi ar arsebobisas. amgvarad, fermentebis erTjeradi

gansazRvra ver gamoricxavs mi diagnozs. bolo dros gamoiyeneba

miokardiumis dazianebis sxva markerebi mi Semdgomi riskis

prognozirebisTvis ( 172 ). pacientebSi ST segmentis elevaciis

gareSe sisxlSi T troponinis momateba stacionaruli

sikvdilobis niSvnelovani prognozuli kriteriumia (9% - T

troponinis momatebis dros da 1% - misi normaluri donis

dros), aseve kardiogenuli Sokis ganviTarebis (6% da 2%

Sesabamisad) da gulis SegubebiTi ukmarisobis ganviTarebis

prognozuli kriteriumia (16% da 17% Sesabamisad). ( 172 ).

risk-faqtorebis gamovlenaSi mniSvnelovania

eqokardiografiuli gamokvleva ( 141 ). Trombolizuri Terapiis

30

Catarebisas eqokardiografia saSualebas iZleva informacia

miviRoT reperfuziis procesze, mi zomaze da miokardiumis

mdgomareobaze ( 107 ). aseve damxmare meTodia gaurkvevel

SemTxvevebSi, mag., ST segmentis elevaciis ar arsebobisas (38, 39

). mTel rig gamokvlevebSi ( 98, 131 ) Seswavlilia

eqokardiografiis mniSvneloba riskis xarisxis adreul

SefasebaSi. 86 kvlevaSi naCvenebia, rom iSemiuri sindromebis

dros eqokardiografiulad marcxena parkuWis funqciis da

mitraluri regurgitaciis gansazRvra prognozuli informaciis

miRebis saSualebas iZleva, romelic avsebs anamnezur da ekg

monacemebs ( 104 ). 83 kvlevaSi daadgines, rom hipokineziuri

ubnis gamovlena mi simptomebis gaCenidan 12 sT-is ganmavlobaSi

saSualebas iZleva gamoiyos pacientebi, romlebsac eqnebaT

gulis ukmarisobis, avTvisebiani aritmiebis da sikvdilobis

maRali riski ( 105, 143 ). marcxena parkuWis gandevnis fraqciis

Semcireba 40%-ze qvemoT mi dawyebidan 72 sT-is ganmavlobaSi

aseve korelaciaSia sikvdilobis maRal riskTan ( 130 ).

miokardiumis infarqti mwvave stadiaSi miokardiumis

vizualizaciis SesaZlebloba SezRudulia imiT, rom adre

arsebuli kardiosklerozuli ubnebi praqtikulad ar

gansxvavdeba axali iSemiuri ubnebisagan. garda amisa, jerac ar

aris damtkicebuli, rom vizualizaciis meTodebi ufro did

informacias iZleva, vidre anamnezis Sekreba, obieqturi

gamokvleva da ekg.

miokardiumis infarqtis Semdgomi maRali riskis niSnebi

xSirad vlindeba gamojanmrTelebis etapze. amitom,

stacionaridan gaweris win eqimis amocanaa, gamoavlinos maRali

riskis pacientebi. am amocanis gadasawyvetad SemuSavebulia

31

mravali testi, Tumca imisTvis, rom es testebi efeqturad

gamoiyenebodes klinikur praqtikaSi, maT unda hqondeT maRali

mgrZobeloba da specifikuroba.

miokardiumis infarqtis dros marcxena parkuWis funqciis

klinikuri Sefaseba naCvenebia rogorc prognozis

gansazRvrisTvis, ise mkurnalobis SerCevisTvis. cnobilia, rom

sikvdiloba da iSemiuri garTulebebis riski gandevnis fraqciis

sididis ukuproporciulia. randomizebuli kvlevebiT aRiniSna,

rom swored SerCeuli mkurnaloba aumjobesebs mi da marcxena

parkuWis disfunqciiT avadmyofTa Soreul prognozs. ( 133 ).

marcxena parkuWis funqciis darRveva advilad dgindeba

obieqturi gamkvlevebiT (filtvebSi xixiniT, diastoluri

samwevra galopis ritmiT, arteriuli hipotoniiT). Tavis mxriv,

ekg mi gavrcelebis Sefasebis saSualebas iZleva ( 138 ).

klinikuri da ekg monacemebis safuZvelze Silver M et al SeimuSaves

klinikuri prognozirebis wesi, romelic ar saWiroebs

specialur gamokvlevebs ( 155 ). retrospeqtuli analiziT

avtorebma aCvenes, rom wina kedlis infarqtis dros gulis

ukmarisobis niSnebis, ekg interpretaciis gamarTulebeli

niSnebis (hisis konis marcxena fexis blokada, marcxena parkuWis

hipertrofia da gadaZabva) an anamnezSi Q kbilovani infarqtis ar

arsebobisas, marcxena parkuWis gandevnis fraqciis

prognozirebadi sidide 40% da metia ( 160 ).

mi Semdeg aritmiebis uecari ganviTarebis riskis gazrdaze

miuTiTebs ramodenime klinikuri maCvenebeli: marcxena parkuWis

disfunqcia, wina kedlis an transmuruli infarqti, Killip-is

mixedviT III an IV funqciuri klasis gulis ukmarisoba,

ramodenime koronaruli arteriis dazianeba, gavrcelebuli mi.

32

uecari sikvdilis riskis ufro zusti SefasebisTvis

mowodebulia ramodenime arainvaziuri meTodi. erT-erTi yvelaze

martivia ekg monitorirebiT polimorfuli an xSiri parkuWovani

eqstrasistoluri aritmiis gamovlena. mag., parkuWovani

eqstrasistolebis sixSiris mateba (gansakuTrebiT sT-Si 6-ze

meti), morecidive parkuWovani taqikardia an fibrilacia

sikvdilis risks zrdis daaxloebiT 60%-iT ( 90, 100 ). uecari

sikvdilis riskis zrdaze miuTiTebs parkuWTa fibrilaciis an

myari parkuWovani taqikardiis ganviTareba mi pirvel 48 sT-is

ganmavlobaSi ( 153 ).

Alegret JM et al (2001) Seiswavles 54 pacienti, romelTac wina

kedlis mi dros ganuviTarda hisis konis marjvena fexis

blokada. avadmyofebi dayofili iyo 2 jgufad: pirveli jgufi,

visac Cautarda Trombolizuri Terapia da meore jgufi

Trombolizuri Terapiis gareSe. Seiswavles blokadis

damokidebuleba hospitalur sikvdilobasTan. sikvdiloba ufro

maRali iyo avadmyofebSi, visac blokada gaugrZelda

hospitalizaciidan 24 sT-is ganmavlobaSi, vidre im pacientebSi,

visac blokada gaugrZelda 24 sT-ze naklebi droiT, anu hisis

konis marjvena fexis blokadis gaqroba ukeTes prognozTan iyo

dakavSirebuli ( 71 ).

arteriuli hipertoniis gavrcelebaze moqmedi risk- faqtorebis gavlenis

intensiuroba

cvladebi β-koeficienti c2 p

konstanta -2.754 119.66 <0.001

Warbi wona 1.178 280.97 <0.001

asaki 0.045 84.62 <0.001

alkoholis Warbi moxmareba 0.002 63.86 <0.001

ganaTlebis done -0.330 27.23 <0.001

hipertrigliceridemia (htg) 0.461 20.13 <0.001

sigaretis moweva 0.137 16.15 <0.001

33

hiperqolestirinemia (hqs) 0.236 11.45 <0.001

hipo-α-qs -0.161 3.45 <0.05

Otasevich P et al (2003) aseve Seiswavles parkuWovani aritmiebis

ganviTareba, marcxena parkuWis remodelireba da 5-wliani

sikvdiloba Trombolizuri Terapiis dros. maTi monacemebiT,

marcxena parkuWis remodelireba parkuWovani aritmiiT

pacientebSi ar progresirebs stacionaridan gaweris Semdeg da

Sesabamisad, ar asocirdeba 5-wliani letalobis zrdasTan (143).

amgvarad, gulis iSemiuri daavadebis risk-faqtorebis

koreqcia amcirebs miokardiumis infarqtis Soreuli

garTulebebis sixSires, amitom avadmyofTa swori SerCeva

meoradi profilaqtikuri RonisZiebebis CatarebisTvis

miokardiumis infarqtis riskis xarisxis dadgenis mniSvnelovani

RonisZiebaa.

Tavi II

kvlevis masala da meTodebi

dasmuli miznebidan da amocanebidan gamomdinare, gamokvlevaSi

gamoyenebulia saqarTvelos Sromis, janmrTelobisa da socialuri

dacvis saministros, saqarTvelos statistikis saxelmwifo

departamentis, samedicino statistikisa da informaciis centris,

samedicino dazRvevis saxelmwifo kompaniis saorganizacio-

normatiuli masalebi.

sainformacio Ziebis procesSi gamoyenebul iqna rogorc

internetiT moZiebuli masalebi, aseve sxvadasxva qveyanaSi

gamocemuli literatura, romlis safuZvelzec gakeTda informaciuli

mimoxilva.

34

damuSavda sxvadasxva qveynebis monacemebi, romleboc Seexeboda

mosaxleobis miokardiumis mwvave infarqtiT gamowveuli avadobisa

da sikvdilianobis TaviseburebaTa analizs.

miokardiumis mwvave infarqtis warmoSobaze moqmedi

modificirebadi da aramodificirebadi risk-faqtorebis

(hiperqolesterinemia, arteriuli hipertenzia, Tambaqos weva,

Saqriani diabeti, simsuqne, memkvidreoba. asaki, sqesi) Seswavlis

mizniT gaanalizebul iqna Tssu-is # 1 klinikis kardiologiur

ganyofilebaSi hospitalizebul avadmyofTa istoriebi,

romelTac 2000-2003 wlebSi CautardaT Trombolizuri Terapia

(170 pacienti).

sakontrolo jgufs Seadgenda miokardiumis mwvave

infarqtis diagnoziT hospitalizebulma 50-ma avadmyofma,

romelTac CautardaT miokardiumis infarqtis standartuli

mkurnaloba, rac moicavda aspirins, β-blokerebs, agf

inhibitorebs, nitratebs.

asakisa da sqesis mixedviT pacientebi ganawilda

Semdegnairad (ix.cxrili )

cxrili

gamokvleul pacientTa ganawileba asakisa da sqesis mixedviT

30-39 w. 40-49 w. 50-59 w 60-69 w. 70w.da meti sul

abs.ricxvi 6 25 36 61 42 170

%%. 4.0 15.0 21.0 36.0 25.0 100.0

abs.ricxvi %%

mamakaci 114 67.0

qali 56 33.0

sul 170 100.0

35

agreTve Ggaanalizebul iqna Trombolizuri Terapiis

Semdeg ganviTarebuli garTulebebis sixSire, mkurnalobis

Soreuli Sedegebi da 5-wliani sikvdiloba. am maCveneblebze

risk-faqtorebis koreqciis gavlena.

gid risk-faqtorebis Seswavlisas agamoyenebuli iqna

Semdegi klinikur-statistikuri kvlevis meTodebi:

arteriuli hipertenziis diagnostika da xarisxis dadgena

xdeboda jandacvis msoflio organizaciis mier 1999 w

mowodebuli rekomendaciis safuZvelze:

sistoluri wnevis stabiluri momateba 140 mmvwysv da/an

diastoluris – 90 mm vwy sv-ze metad.

Saqriani diabetis dadgena xdeboda amerikis diabetologTa

asociaciis mier 1997 wels mowodebuli kriteriumebis

safuZvelze: 1. Saqriani diabetis simptomebs damatebuli sisxlSi

glukozis koncentraciis momateba 11 mmol/l-ze metad dRis

nebismier dros SemTxveviT gansazRvrisas. 2. uzmoze sisxlSi

glukozis koncentraciis momateba 7,0 mmol/l-ze metad. 3.

glukozisadmi tolerantobis testis Catarebisas sisxlSi

glukozis donis momateba 11,1 mmol/l-ze metad. aseve dgindeboda

Saqriani diabetis tipebi: I tipi – insulindamokidebuli, II tipi

– insulindamoukidebeli.

simsuqnis xarisxis dadgena xdeboda sxeulis masis indeqsis (smi)

saSualebiT gersous meTodiT: smi = wona(kg) : simaRle (m²). roca

indeqsia 20-24,9-mde, 0 xarisxis simsuqnea; 25-29,9 – I xarisxis

simsuqnea, 30-40-mde – II xarisxis da 40 da meti – III xarsixis

simsuqnea.

miokardiumis infarqtis diagnostika xdeboda klinikuri,

ekg, laboratoriuli da eqokardiografiuli kvlevebis

36

monacemebis safuZvelze. Trombolizuri Terapiis dawyebisas

tkivilis xangrZlivoba ar aRemateboda 6 sT-s, aRiniSneboda ST

segmentis elevacia 2 da met ganxrebSi 0,1 mV-ze metad,

Trombolizuri Terapia tardeboda streptokinaziT, romlis

erTjeradi doza iyo 1 500 000 erT. Trombolizuri Terapiis

Catarebis dros gaTvaliswinebuli iyo 1997 w mowodebuli

Cvenebebi da ukuCvenebebi. streptokinazas Seyvana xdeboda

infuzomatis saSualebiT 40 wT-is ganmavlobaSi, ris Semdegac

grZeldeboda heparinis 48 sT-iani infuzia. reperfuziis

arapirdapir kriteriumebad iTvleboda: ST segmentis elevaciis

Semcireba ekg informatiul ganxrebSi Trombolizuri Terapiis

dawyebidan 60 – 90 wT-is farglebSi, tkivilis Semcireba an

Sewyveta, reperfuziuli aritmiebis gaCena, daavadebis dawyebidan

16 sT-is ganmavlobaSi kreatinkinazas maqsimaluri aqtiobis

miRweva.

infarqtis diagnozis verifikacia xdeboda segmenturi

asinergiis ubnebis gamovleniT. centraluri hemodinamikis

mdgomareobis Sefasebis mizniT vswavlobdiT marcxena parkuWis

funqciur maCveneblebs: gandevnis fraqcia, damoklebis fraqcia,

saboloo sistoluri da diastoluri zomebi da moculobebi,

iTvleboda dartymiTi moculoba, wuTmoculoba.

miokardiumis infarqtis simZimis dadgena xdeboda infarqtis

zomis: Q- kbilovani (msxvilkerovani) da Q- kbilis gareSe

(wvrilkerovani), gavrcelebis da garTulebebis mixedviT.

zogadklinikuri gamokvlevebis garda avadmyofebs

utardeboda sisxlSi lipiduri cvlis maCveneblebis (saerTo

qolesterini, maRali simkvrivis lipoproteinebis – HDL

qolesterini, dabali simkvrivis lipoproteinebis – LDL

37

qolesterini, Zalian dabali simkvrivis lipoproteinebis – VLDL

qolesterini, trigliceridebi) gansazRvra. qolesterinis

sasurveli koncentracia sisxlSi aris 5,2 mmol/l (200 mg%)-mde,

zomier momatebad iTvleba 5,2 – 6,2 mmol/l (200 – 239 mg%),

Zlier momatebad iTvleba qolesterinis koncentracia sisxlSi

6,2 mmol/l (240 mg%)-ze meti.

Trombolizuri Terapiis efeqturobis Sefasebis mizniT

vikvleviT sisxlis SratSi ferment kreatinkinazas dinamikas

tkivilis dawyebidan 8, 16, 24sT-is Semdeg. bioqimiuri kvlevebi

tardeboda mowodebuli meTodikiT BIO-SYSTEM –is firmis

(espaneTi) fotometrze amave firmis reaqtivebis gamoyenebiT.

Eekg-s gadaReba xdeboda 12 standartul ganxraSi zogadad

miRebuli meTodikiT SIEMENS-ELEMA Ffirmis MINGOGRAF 34

modelis Camwerze 25 mm/wm siCqariT. ST segmentis elevacia

izomeboda J wertilidan da iTvleboda ST segmentis elevaciis

xarisxis jamiT standartul ganxrebSi. ekg registracia xdeboda

klinikaSi Semosvlisas, streptokinazas gadasxmidan 1 sT-is

Semdeg yoveldRe 1 kviris ganmavlobaSi. klinikidan gaweris

Semdeg ki yovel 6 TveSi erTxel.

eqokardiografiuli kvleva erT da organzomilebian

reJimSi OTE-BIOMEDICA-s firmis SIM-5000 aparatze, 2,5 mghc-is

sixSiris gadamwodiT standartuli meTodikiT. gamokvleva

tardeboda Semdegi standartuli poziciebidan: parasternaluri

grZeli da mokle RerZi (mitraluri sarqvlis da papilaruli

kunTebis doneze), apikaluri or- da oTxkameriani poziciebidan.

gamokvlevisas fasdeboda miokardiumis infarqtis lokalizacia

da gavrceleba. miokardiumis lokaluri kumSvadobis Sefaseba

xdeboda parasternalur grZel da mokle RerZebze da apikalur

38

or- da oTxkamerian poziciebSi. gamoyenebuli iyo amerikis

gulis asociaciis mier mowodebuli marcxena parkuWis dayofa 16

segmentad.

gamokvlevis Sedegad miRebuli yvela monacemi damuSavda

Tanamedrove statistikuri meTodebiT (yvela SemTxvevaSi

gaTvlili iyo saSualo ariTmetikuli M da saSualo

cdomileba m. niSanTa Soris gamovlenili sxvaobis sarwmunoebis

xarisxis Sefaseba xdeboda stiudentis t kriteriumis

gamoyenebiT).

Tavi III

gul-sisxlZarRvTa daavadebebis gavrcelebis Taiseburebebi

saqarTveloSi

saqarTvelos istoriuli ganviTarebis bolo periodis

uaRresad mokle monakveTSi moxda mosaxleobis janmrTelobis

Ziritadi indikatorebis gamoxatuli cvalebadoba (Tumca bolo

dromde aRiarebuli iyo maTi maRali inerciuloba). amasTan

aRsaniSnavia, rom sxvadasva dros gamovlinebuli tendenciebis

gaTvaliswineba da maTze saTanado reaqcia saxelmwifos mxridan

udavod Searbilebda dResdReobiT arsebul demografiul kriziss.

zemoTaRniSnulma, Cvenis azriT mniSvnelovnad ganapiroba qveyanaSi

ara marto e.w. socialuri daavadebebis (maT Soris tuberkulozi,

narkomania da toqsikomania, fsiqiuri moSlilobani da sxv.) aramed,

qroniukuli daavadebebis farTo gavrceleba (ix.cxrili )

39

cxrili

saqarTvelos mosaxleobis daavadebianobis da avadobis

maCveneblebi 2004 wlis monacemebiT (100000 mosaxleze),

daavadebaTa ZiriTadi

klasebi IX dsk-s

mixedviT

sul daavade

bianoba

m.S. axali

SemTxvevebi

avadoba

su l 1444941 33053,4 621027 14206,2

infeqciuri da

parazituli

daavadebebi

78080 1786,1 55577 1271,3

simsivneebi 40902 935,6 8347 190,9

endokrinuli sistemis,

kvebis, nivTierebaTa

cvlis da imunitetis

darRvevebi

158603 3628,1 29920 684,4

sisxlis da sisxlmbad

organoTa daavadebebi 16175 370,0 8605 196,8

fsiqiuri aSlilobebi 106921 2445,8 7637 174,7

nervuli sistemis da

grZnobaTa organoebis

daavadebebi

143783 3289,1 51520 1178,5

sisxlis mimoqcevis

sistemis daavadebebi 283921 6494,8 70648 1616,1

sunTqvis organoTa

daavadebebi 306984 7022,3 235532 5387,9

saWmlis momnelebeli

organoTa daavadebebi 113272 2591,1 41885 958,1

Sardsasqeso sistemis

daavadebebi 69913 1599,3 31485 720,2

orsuloba, mSobiaroba

da Semdgomi periodis

garTulebebi

7329 631,6 6052 521,6

kanisa da kanqveSa

ujredisis daavadebebi 33859 774,5 23770 543,7

ZvalkunTovani sistemis

da SemaerTebeli

qsovilis daavadebebi

31978 731,5 10731 245,5

Tandayolili

anomaliebi 6438 147,3 1192 27,3

40

perinatalur periodSi

warmoqmnili calkeuli

mdgomareobebi

4020 86,7 2477 53,4

simptomebi da

arazustad aRniSnuli

mdgomareobebi

5815 133,0 3161 72,3

travmebi da mowamvlebi 39948 845,2 32488 743,2

mosaxleobis sikvdilobis struqtura asaxavs im Zvrebs,

romlebic moxda ukanasknel wlebSi: swrafad izrdeba sikvdilobis

maCveneblebi dakavSirebuli gulsisxlZarRvTa, onkologiuri,

nerviul-fsiqikuri, endokrinuli paTologiis matebasTan.

qveyanaSi ganuxrelad izrdeba iseTi mZimed mimdinare

daavadebebis ricxvi, rogoricaa gulis mwvave da qronikuli

iSemiuri daavadeba (naxati ).

naxati

gul-sisxlZarRvTa daavadebebis gavrcelebis dinamika saqarTveloSi

1998 – 2004ww. (yovel 100000 mosaxleze)

4039,8

6494,85776,85322,44870,64273,64661,1

1616,11481,7

1299,61306,1

1002,81060,2

1146,0

0,0

1000,0

2000,0

3000,0

4000,0

5000,0

6000,0

7000,0

8000,0

9000,0

1998 1999 2000 2001 2002 2003 2004

daavadebianoba avadoba

warmodgenili monacemebi mowmobs, rom ukanasknel

aTwleulSi mkveTrad imata rogorc mosaxleobis

41

daavadebianobam, aseve avadobam sisxlis mimoqcevis sistemis

daavadebebis. amasTan am daavadebebis struqturis analizaiT

irkveva, rom ZiriTadad es mateba ganpirobebulia hipertoniuli

daavadebis, gulis mwvave da qronikuli iSemiuri daavadebebis da

Tavis tvinis vaskularuli daavadebebis TiTqmis ormagi zrdis

xarjze (ix.cxrili )

cxrili

sisxlis mimoqcevis sistemis daavadebebis struqtura

saqarTveloSi 1998 – 2004 ww.

(100000 sul mosaxleze)

1998 w. 2003 w. 2004 w.

sul 4039.8 5776.8 6494,8

aqedan sicocxleSi pirvelad

dadgenili diagnoziT 1146.0 1481.7 1616,1

gulis revmatiuli daavadebebi 368.2 358.8 350,6

aqedan sicocxleSi pirvelad

dadgenili diagnoziT 71.7 68.9 76,0

hipertoniuli daavadeba 1628.8 2730.6 3108,2

aqedan sicocxleSi pirvelad

dadgenili diagnoziT 446.3 686.4 801,9

gulis iSemiuri daavadeba 1397.0 1875.7 1955,1

aqedan sicocxleSi pirvelad

dadgenili diagnoziT 442.0 441.0 449,8

mwvave infarqti 62.5 69.8 75,8

aqedan sicocxleSi pirvelad

dadgenili diagnoziT 18.0 32.0 39,6

stenokardia 423.1 560.0 575,9

aqedan sicocxleSi pirvelad

dadgenili diagnoziT 179.8 125.5 140,0

Tavis tvinis vaskularuli

daavadebebi 142.0 244.2 189,9

aqedan sicocxleSi pirvelad

dadgenili diagnoziT 41.5 91.3 107,8

sisxlis mimoqcevis sistemis daavadebebis gavrceleba

saqarTvelos regionebSi araTanabaria. Tu TbilisSi da

42

axlomdebare regionebSi avadobis maCveneblebi wlidan wlamde

matulobs aWaraSi, da gansakuTrebiT qvemo qarTlSi igi TiTqmis

orjer naklebia (ix.cxrili )

cxrili

sisxlis mimoqcevis sistemis daavadebebis gavrceleba

saqarTvelos regionebSi 2004 wlis monacemebiT

(yovel 100000 mosaxleze)

2004

daavadebianoba avadoba

Tbilisi 9086,7 1688,6

aWara 2496,4 1077,9

kaxeTi 6001,0 1305,1

imereTi 5614,3 1902,6

samegrelo 5337,5 1199,3

Sida qarTli 3790,3 1297,0

qvemo qarTli 2920,6 809,0

guria 5101,9 1477,4

samcxe-javaxeTi 4880,1 1582,4

mcxeTa-mTianeTi 5020,6 1318,5

raWa-leCxumi 22019,3 2515,8

saqarTvelo 6494,8 1616,1

Cvenis azriT avadobis maCveneblebis esoden didi gansxvaveba

mravali faqtoriT aris ganpirobebuli, romelTa Soris wamyvanad

migvaCnia is garemoeba, rom saqarTvelos mTel rig regionebSi

zedmiwevniT dabali Sobadobis fonze swrafad mimdinareobs

mosaxleobis e.w. demografiuli dabereba. TavisTavad, ufrosi asakis

pirTa xvedriTi wilis zrdas Tan sdevs maTTvis damaxasiaTebeli

daavadebebis, da maT Soris gul-sisxlZarRvTa paTologiis farTo

gavrcelebac.

Tu ganvixilavT miokardiumis mwvave infarqtis gavrcelebis

statistikas SesaZloa davaskvnad, rom bolo wlebSi igi

xasiaTdeba mTeli rigi seriozuli ZvrebiT (ix.cxrili )

43

cxrili

miokardiumis mwvave infarqtis da stenokardiis gavrceleba

saqarTveloSi 1998 – 2004 ww. monacemebiT

(100000 sul mosaxleze)

11998 11999 22000 22001 22002 22003 22004

mwvave infarqti 62.5 92.0 55.0 56.2 70.9 69.8 75,8

aqedan sicocxleSi

pirvelad dadgenili

diagnoziT

18.0 22.6 20.7 22.5 35.1 32.0 39,6

stenokardia 423.1 487.7 416.8 491.3 519.6 560.0 575,9

aqedan sicocxleSi

pirvelad dadgenili

diagnoziT

179.8 111.3 95.6 116.0 117.8 125.5 140,0

rogorc cxrilSi warmodgenili monacemebi mowmobs

pacientTa ricxvi miokardiumis mwvave infarqtis sixSire 1998-

2004 wels TiTqmis 200%-iT gaizarda, aseve imata im pacientTa

raodenobam, romelTac es diagnozi sicocxleSi pirvelad

daudginda. amasTan, yuradsaRebia, rom stenokardiis SemTxvevaTa

saerTo ricxvma TiTqmis samjer imata, maSin rodesac

sagrZnoblad iklo pacientTa raodenobam, romlebsac es

diagnozi sicocxleSi pirvelad daudgindaT. Cvenis azriT

arsebuli sxvaoba miuTiTebs im garemoebaze, rom pacientTa didi

raodenoba stenokardiis simptomebis warmoCinebis SemTxvevaSi

saerTod ar mimarTavs eqims da cdilobs sakuTari ZalebiT

daZlios warmoqmnili situacia. AtviTvkurnalobis farTo

gavrcelebas aSkarad xels uwyobs saafTiaqo qselSi

44

Zliermoqmedi medikamentebis Tavisufali gayidva. Da, rogorc

Sedegi – mosaxleobaSi miokardiumis mwvave infarqtis

SemTxvevaTa gamoxatuli gaxSireba.

warmoSobili situaciis erTerT ZiriTad mizezad SesaZloa

CaiTvalos mosaxleobis cxovrebis wesis Secvla, daavadebis

gavrcelebaze moqmedi SedarebiT axali jgufis risk-faqtorebis

gaxSireba (narkomania, toqsikomaniebi, alkoholizmi da sxv.). ase,

magaliTad qveyanaSi mkveTrad gaizarda Tambaqos moxmareba,

romelmac moicva mosaxleobis is jgufebi, sadac es Cveva sul cota

xnis win erTeul SemTxvevebSi aRiniSneboda (mozardebi, qalebi da

sxv.).

Tambaqos moxmareba saqarTveloSi sazogadoebrivi

jandacvis erT-erT umTavres problemas warmoadgens. sxvadasxva

sabaziso kvlevebis monacemebiT, sadReisod Tambaqos moixmars

qveynis mosaxleobis daaxloebiT 37-40%. mamakacebs Soris

mwevelia 50-65%, xolo qalebs Soris 16-22%. Zalze sayuradReboa

mdgomareoba mozardebs Soris. skolis moswavleebis 22,1%

mwevelia, xolo qalebs Soris mwevelobis progresi

katastrofulia – igi bolo 16 wlis ganmavlobaSi TiTqmis 6-jer

gaizarda (m.S. Tambaqos moxmarebis gavrceleba gazrdilia

orsulebSi).

sxvadasxva kvlevebiT dadasturda, rom saqarTvelos

mosaxleobis umetesi nawili imyofeba Tambaqos permanentuli da

intensiuri zemoqmedebis qveS. Tambaqos moxmarebis sixSire

rogorc mamakacebSi, aseve qalebSi yvelaze maRalia 26-59 wlis

asakobriv jgufSi, isini ewevian mTeli moxmarebuli sigaretis

60,5%-s. maTze modis sigaretis SeZenaze daxarjuli mTeli

Tanxis ori mesamedi.

45

sakmarisia aRiniSnos, rom Tu evropaSi sigaretze

moTxovnilebam, erT mozrdil mosaxleze, bolo aTwleulis

manZilze iklo 7%-iT, aSS-Si da 6%-iT kanadaSi, imavdroulad

dsT-s qveynebSi, da maT Soris saqarTveloSi igi gaizarda - 42%-

iT (ix.cxrili ).

cxrili

zogierT qveynis mosaxleobis mier moxmarebuli sigaretis saSualo

wliuri raodenoba (erT sul mosaxleze)

1980 w. 1990 w. 2002 w.

evropa (mTlianad) 1856 1679 1678

belgia 1842 1751 1403

CineTi 1489 1436 1019

saqarTvelo 700 950 1583

TurqeTi 1088 1304 1607

SvedeTi 1569 1254 985

ukanasknel wlebSi saqarTveloSi mkveTrad Seicvala kvebis

produqtebis moxmarebis dinamika. arsebuli monacemebiT mosaxleobis

umetesi nawilis yoveldRiur racionSi gamoxatulad gaizarda purisa

da purproduqtebis (sxvadasxva socialuri jgufebisaTvis 65-dan

85%-mde) da kartofilis- (8-14%) moxmarebam, rac ZiriTadad moxda

rZisa da rZis produqtebis (2-8% sxvadasxva jgufebis mixedviT),

xorcisa da xorcis produqtebis (5-12%), Saqrisa da sakonditro

nawarmis (2-6%) Semcirebis xarjze. amasTan, aRiniSneba qveynis

mosaxleobis yoveldRiuri sakvebis racionis kaloriulobis kleba

(ix. cxrili ).

46

cxrili

saqarTvelos da zogierTi sxva qveynis mosaxleobis yoveldRiuri

sakvebis kaloriuloba (1990 da 1995 ww. monacemebiT)

1990 29002

sasomxeTi 2794 1975

azerbaijani 2577 2095

saqarTvelo 3028 2222

safrangeTi 3534 3588

fineTi 3077 3022

israeli 3276 3271

ruseTi 3122 2926

miuxedavad imisa, rom mosaxleobis kvebis racionis

kaloriulobam sxva qveynebSidac iklo, dsT-s qveynebSi, da maT Soris

saqarTveloSi es procesi gacilebiT swrafad mimdinareobs. amasTan,

amierkavkasiis qveynebSi sakvebis racionis kaloriuloba ufro

dabalia, vidre dadgenili fiziologiuri norma (sxvadasxva avtoris

azriT igi 3200-2800 kalorias Seadgens).

zemoaRniSnuli dasturdeba Cvens mier miokardiumis mwvave

infarqtiT Seswavlili ZiriTadi da sakontrolo jgufis

avadmyofTa monacemebiTac (ix.cxrili )

cxrili

miokardiumis mwvave infarqtiT ZiriTadi da sakontrolo jgufis

avadmyofebSi zogierTi risk-faqtoris gavreceleba

ZiriTadi jgufi sakontrolo jgufi

abs ricxvi % abs ricxvi %

47

mamakaci

qali

asaki

mi Q kbiliT

mi Q kbilis gareSe

wina kedlis

ukana kedlis

hiperqolesterinemia

arteriuli

hipertenzia

Saqriani diabeti

Tambaqo

simsuqne

memkvidreoba

hipodinamia

115

55

67,1 ± 0,9

115

54

89

80

129

112

24

81

37

49

18

67,4%

32,6%

68%

32%

52,7%

47,3%

76,3%

66,3%

14,2%

47,9%

21,9%

30%

10,6%

31

19

69,3 ± 0,6

33

17

28

22

39

34

7

29

9

7

4

62%

38%

66%

34%

56%

44%

78%

68%

14%

58%

18%

14%

8%

rogorc cxrilidan Cans, ZiriTadi da sakontrolo jgufis

avadmyofebi iyvnen Sedarebadni asakis, sqesis, miokardiumis

infarqtis zomis, lokalizaciis mixedviT. mamakacebi orjer

ufro meti iyo, vidre qalebi, Sesabamisad 114 (67,4%) da (55 –

32,6%). saSualo asaki iyo Sesabamisad 67,1 ± 0,9 da 69,3 ± 0,6 weli.

orive jgufSi Warbobda wina lokalizaciis infarqti,

Sesabamisad 89 – 52,7% da 28 – 56% da aseve Warbobda infarqti Q

kbiliT, Sesabamisad 115 – 68% da 33 – 66%.

miokardiumis infarqtis risk-faqtorebis Seswavlam aCvena,

rom avadmyofTa umravlesobas rogorc ZiriTad, aseve

sakontrolo jgufSi hqonda hiperqolesterinemia 129 (76,3%) da

39(78%) avadmyofs, arteriuli hipertenzia, Sesabamisad 112 – 66,3%

da 34 – 68% pacients, sixSiriT mesame adgilze iyo Tambaqos weva

48

– Sesabamisad 81 – 47,9% da 29 – 58%, avadmyofTa daaxloebiT

erT mesameds aReniSneboda gid memkvidreobaSi, erT mexuTeds –

21,9%-s simsuqne da yvelaze nakleb procentSi gvxvdeboda

hipodinamia.

Tavi IY

miokardiumis mwvave infarqtis mqone pacientebze,

modificirebadi risk-faqtorebis gavlenis Seswavlis Sedegebi

4.1. gamokvleul pacientTa klinikuri daxasiaTeba

mi-iT 169 avadmyofidan arteriuli hipertenzia aReniSneboda

ZiriTadi jgufis 112(66,3%) avadmyofs: 65(58%) mamakacs da 47(42%)

qals da sakontrolo jgufis 34(68%) pacients: 15(30%) mamakacs

da 19(70%) qals. klinikurma gamokvlevam aCvena, rom 57(50,9%)

avadmyofs aReniSneboda wina kedlis infarqti, 77(68,7%) –s

infrqti Q kbiliT, 19(1,9%) –s Saqriani diabeti, 79(70,5%)-s

hiperqolesterinemia, 41(36,6%)-s Warbi wona, 43(38,4%) avadmyofi

iyo mweveli, 12(10,7%)-s aReniSneboda gid memkvidreobaSi, 15(13,4%)-

s – hipodinamia (ix. cxrili5)

49

cxrili5

avadmyofTa klinikuri daxasiaTeba

mamakaci qali sul

arteriuli hipertenzia 65 – 58% 47 - 42% 112 – 66,3%

wina kedlis infarqti 35 – 31,2% 22 – 46,8% 57 – 50,9%

infarqti Q kbiliT 48 – 42,8% 29 – 61.7% 77 – 68,7%

hiperqolesterinemia 44 – 39,3% 35 – 74,5% 79 – 70,5%

Saqriani diabeti 8 – 7,1% 11 – 23,4% 19 – 1,9%

Warbi wona 16 – 14,3% 25 – 53,2% 41 – 36,6%

Tambaqo 39 – 34,8% 4 – 8,5% 43 – 38,4%

memkvidreoba 8 – 7,1% 4 – 8,5% 12 – 10,7%

hipodinamia 9 – 13,8% 6 – 12,8% 15 – 13,4%

4.2. hiperqolesterinemiis mqone avadmyofTa Trombolizuri

Terapiis efeqturobis Seswavlis Sedegebi

miokardiumis infarqtis mqone 169 avadmyofidan

hiperqolesterinemia aReniSneboda 129(76,3%)–s: 44(80%) qals da

85(74,6%) mamakacs. 92(71,3%) avadmyofs aReniSneboda arteriuli

hipertenzia, 18(13,9%)-s – Saqriani diabeti, 72(55,8%) iyo Tambaqos

mweveli, 12(9,3%)-s aReniSneboda hipodinamia, 28(21,7%)-s –

damZimebuli memkvidreoba. sakontrolo jgufSi

hiperqolesterinemia aReniSneboda 38(76%) avadmyofs: 18(47,4%)

mamakacs da 20(52,6%) qals. am avadmyofTa laboratoriuli

gamokvlevis Sedegebi SevadareT gaurTulebeli infarqtiT

avadmyofTa monacemebs rogorc ZiriTad, ise sakontrolo

jgufebSi. aRmoCnda, rom garTulebebis mqone pacientebs

aReniSnebodaT glukozis da ß-lipoproteidebis ufro maRali

50

done. saerTo qolesterinis da trigliceridebis done erTnairi

iyo yvela jgufis pacientSi. (cxrili2)

cxrili2

lipiduri cvlis maCveneblebi garTulebuli da

gaurTulebuli infarqtiT avadmyofebSi

ZiriTadi jgufi sakontrolo jgufi

laboratoriuli

maCveneblebi

garTulebis

gareSe

garTulebuli garTulebis

gareSe

garTulebuli

glukoza

qolesterini

ß-lipoproteidebi

α –lipoproteidebi

trigliceridebi

7,9±0,05

231,4±1,9

130,4±0,6

38,6±1,7

165,6±1,5

9,3±0,5

240,8±1,6

138,2±1,1

30,4±0,8

163,2±0,9

7,6±0,2

230,6±1,4

128,9±1,2

36,2±1,1

158,4±1,3

9,8±0,7

252,1±0,9

139,9±1,2

31,4±0,8

160,2±1,1

sisxlSi saerTo qolesterinis donis mixedviT avadmyofebi

davyaviT 4 jgufad: I jgufSi Sevida 40(31%) avadmyofi, romelTa

saerTo qolesterinis done 200 mg%-mde iyo, II jgufSi – 72(55,8%)

avadmyofi 200-dan 250mg%-mde saerTo qolesterinis doniT,

IIIjgufSi – 47(36,4%) avadmyofi 250-dan 300mg%-mde saerTo

qolesterinis doniT da IVjgufSi – 10(7,8%) avadmyofi 300 mg%-ze

meti saerTo qolesterinis doniT. .#3 cxrilSi mocemulia

lipiduri cvlis maCveneblebi jgufebis mixedviT.

51

cxrili3

avadmyofTa ganawileba cximovani cvlis maCveneblebis

mixedviT

I jgufi II jgufi III jgufi IV jgufi

TQ 198.5±2.8 238.2±3.5 267.6±2.4 318.3±1.6

LDL 134.6±2.4 160.1±3.1 167.7±3.6 174.4±2.1

HDL 39.5±0.6 36.8±1.02 35.4±0.9 31.1±0.5

VLDL 28.9±0.3 32.6±0.9 33.7±0.8 34.1±0.2

TG 148.7±2.5 170.2±5.8 172.8±5.7 179.1±4.1

aTerogenobis

indeqsi

3.2±0.1 5.2±0.3 5.8±0.2 7.9±0.8

hipolipidemiuri mkurnalobis Sedegad saerTo qolestrinis

done rogorc ZiriTad aseve sakontrolo jgufebSi Semcirda

19,8%-iT, LDL qolesterinis done – 28,2%-iT, HDL qolesterinis

done gaizarda 6,1%-iT, trigliceridebis done Semcirda 10,2%-iT.

jgufebis mixedviT saerTo qolesterinis donis cvlilebis

Seswavlam aCvena, rom I jgufSi misi done Semcirda 8,2%-iT, II

jgufSi – 13,5%-iT, III jgufSi – 20,2%-iT da IV jgufSi – 18,1%-iT.

(cxrili4)

cxrili4

lipiduri cvlis maCveneblebi hipolipidemiuri mkurnalobis

Semdeg

I jgufi II jgufi III jgufi IV jgufi

TQ 175.5±2.3 213.2±3.1 222.6±1.9 224.3±1.2

LDL 113.6±2.1 115.1±1.8 123.7±2.6 144.4±1.5

HDL 39.9±0.8 38.8±1.02 37.4±0.9 32.1±0.5

VLDL 27.6±0.3 30.6±0.9 27.7±0.8 26.1±0.2

TG 138.7±2.5 165.2±5.6 162.8±4.8 168.1±3.1

52

aTerogenobis

indeqsi

3.1±0.1 4.2±0.3* 4.0±0.2* 5.1±0.8*

p<0.05

avadmyofTa mkurnalobis Soreuli Sedegebis Seswavlam

gamoavlina, rom postinfarqtuli stenokardia aReniSneboda

ZiriTadi jgufis 39(30,2%) da sakontrolo jgufis 7(77,8%)

avadmyofs. lipiduri speqtris mixedviT es avadmyofebi

miekuTvnebodnen III da IV jgufs rogorc ZiriTad, ise

sakontrolo jgufebSi. gulis qronikuli ukmarisoba

aReniSneboda ZiriTadi jgufis 8(14,8%) da sakontrolo jgufis

5(55,6%) avadmyofs. ganmeorebiTi infarqti ZiriTadi jgufis

19(14,7%) avadmyofs ganuviTarda, xolo sakontrolo jgufSi

aRiniSna 7(18,4%) SemTxvevaSi.

letalobis Seswavlam aCvena, rom stacionaruli

mkurnalobis periodSi gardaicvala ZiriTadi jgufis 6(4,8%) da

sakontrolo jgufis 6(15,4%) avadmyofi. 5-wliani dakvirvebis

periodSi gardaicvala ZiriTadi jgufis 15(11,6%) da

sakontrolo jgufis 7(18,4%) avadmyofi. 15 avadmyofidan 2

miekuTvneboda II jgufs, 5 – III da 8 – IV jgufs. sakontrolo

jgufSi pacientebi Sesabamisad ase ganawildnen: 1,1,2 da 3

avadmyofi.

amgvarad, hiperlipidemiiT pacientTa gamokvlevam aCvena, rom

am jgufSi aRiniSna postinfarqtuli stenokardiisa da

ganmeorebiTi infarqtis ufro maRali sixSire gid sxva risk-

faqtorebis mqone pacientebTan SedarebiT. amave dros 5-wliani

letaloba statistikurad sarwmunod gansxvavdeboda ZiriTad da

sakontrolo jgufebSi.

53

hospitalur etapze miokardiumis infarqtis garTulebebis

Seswavlam aCvena, rom ZiriTad jgufSi marcxena parkuWis mwvave

ukmarisoba ganuviTarda 10(8,9%) avadmyofs, sakontrolo jgufSi

– 5(14,7%)-s. adreuli postinfarqtuli stenokardia ganuviTarda

ZiriTadi jgufis 8(7,1%) da sakontrolo jgufis 7(20,6%)

avadmyofs; stacionaridan gawerisas marcxena parkuWis funqciis

Seswavlam aCvena, rom ZiriTadi jgufis 18(16,1%) avadmyofs

aReniSneboda II fk gulis ukmarisoba, 16(14,3%)-s - III fk gulis

ukmarisoba. marcxena parkuWis gandevnis fraqcia iyo 43,9±1,2.

sakontrolo jgufSi 9(26,5%) –s hqonda II fk gulis ukmarisoba,

12(35,3%) –s - III fk gulis ukmarisoba, 2(5,9%)-s IV fk. marcxena

parkuWis gandevnis fraqcia iyo 36,1±1,4. 30 dRis ganmavlobaSi

gardaicvala ZiriTadi jgufis 5(4,5%) da sakontrolo jgufis

4(11,8%) pacienti.

avadmyofTa mkurnalobis Soreuli Sedegebis Seswavlam

gamoavlina, rom postinfarqtuli stenokardia aReniSneboda

ZiriTadi jgufis 9(15,8%) da sakontrolo jgufis 7(77,8%)

avadmyofs. gulis qronikuli ukmarisoba aReniSneboda ZiriTadi

jgufis 8(14,8%) da sakontrolo jgufis 5(55,6%) avadmyofs.

ganmeorebiTi infarqti ZiriTadi jgufis arc erT avadmyofs ar

ganuviTarda, xolo sakontrolo jgufSi aRiniSna 2(22,2%)

SemTxvevaSi.

letalobis Seswavlam aCvena, rom stacionaruli

mkurnalobis periodSi gardaicvala ZiriTadi jgufis 4(7%) da

sakontrolo jgufis 2(22,2%) avadmyofi. 5-wliani sikvdilobis

maCvenebeli ZiriTad jgufSi iyo 9(15,8%) da sakontrolo jgufSi

– 3(33,3%).

54

antihipertenziuli mkurnalobis Sedegebis mixedviT

avadmyofebi ZiriTad da sakontrolo jgufebSi davyaviT 2-2-

jgufebad. ZiriTad jgufSi sistoluri wneva iyo 181,2±0,9 mmvwysv,

diastoluri –106,4±0,2 mmvwysv. mkurnalobis Semdeg I jgufSi

sistoluri wneva gaxda 158,8±1,2 mmvwysv, diastoluri 92,3±0,4

mmvwysv, II jgufSi sistoluri wneva gaxda 134,2±0,8 mmvwysv,

diastoluri – 83,5±0,8 mmvwysv. aseve davyaviT sakontrolo

jgufis avadmyofebic. arteriuli wnevis sididis mixedviT

avadmyofTa klinikuri monacemebis ganawileba mocemulia #8

cxrilSi.

cxrili8

infarqtis garTulebebis sixSire arteriuli wnevis

mixedviT

ZiriTadi jgufi sakontrolo jgufi

I N II I II

sistoluri wneva 158,8±1,2 134,2±0,8 161,2±0,9 131,8±0,5

diastoluri wneva 92,3±0,4 83,5±08 91,8±0,7 80,1±0,6

ganmeorebiTi

infarqti

5-10% 1-1,4% 4-28,6% 1-5%

stenokardia 8-16% 4-5,6% 7-50% 5-25%

gu 30-60% 11-15,3% 12-85,7% 8-40%

sikvdiloba 8-16% 2-2,8% 5-35,7% 3-15%

rogorc cxrilidan Cans, garTulebebis sixSire da

sikvdilobis maCveneblebi erTnairad maralia Ziritadi da

sakontrolo jgufebis marali arteriuli wneviT avadmyofebSi.

avadmyofTa mkurnalobis Soreuli Sedegebis Seswavlam

gamoavlina, rom postinfarqtuli stenokardia aReniSneboda

ZiriTadi jgufis 12(10%) da sakontrolo jgufis 12(35,3%)

55

avadmyofs. gulis qronikuli ukmarisoba aReniSneboda ZiriTadi

jgufis 41(36,6%) da sakontrolo jgufis 20(58,9%) avadmyofs.

ganmeorebiTi infarqti ganuviTarda ZiriTadi jgufis 6(5,4%),

xolo sakontrolo jgufis 5(14,7%) avadmyofs. 5-wliani

letalobis Seswavlam aCvena, rom ZiriTad jgufSi gardaicvala

10(8,9%) da sakontrolo jgufis 8(23,5%) avadmyofi.

amgvarad, Trombolizuri Terapia sarwmunod amcirebs mi

garTulebebis sixSires da stacionarul letalobas. aseve

sarwmunod dabalia ZiriTadi jgufis 5-wliani letaloba.

4.3 Tambaqos mwevel avadmyofTa gamokvlevis Sedegebi

169 avadmyofidan Tambaqos eweoda 81(47,9%): 76(58,9%) mamakaci

da 5 qali(3,9%). sakontrolo jgufSi mweveli iyo 29(58%)

pacienti: 25(50%) mamakaci da 4(8%) qali. klinkurma gamokvlevam

aCvena, rom ZiriTadi jgufis 28(34,6%) da sakontrolo jgufis

13(44,8%) avadmyofs hqonda infarqti Q kbiliT. 48(59,2%) da

20(68,9%)-s – wina kedlis infarqti. ZiriTadi jgufis 65(80,2%) da

sakontrolo jgufis 20(68,9%) pacients aReniSneboda

hiperqolesterinemia, 42(51,8%) da 13(44,8%)-s Sesabamisad

arteriuli hipertenzia. 8(9,9%) da 4(13,7%) – Saqriani diabeti.

21(25,9%) da 6(20,7%)-s – Warbi wona. (cxrili)

56

cxrili

Tambaqos mwevel avadmyofTa klinikuri monacemebi

klinikuri monacemebi ZiriTadi jgufi sakontrolo

jgufi

raodenoba

wina kedlis

Q kbiliT

hiperqolesterinemia

arteriuli hipertenzia

Saqriani diabeti

QWarbi wona

81 – 47,9%

48 – 59,2%

28 – 34,6%

65 – 80,2%

42 – 51,8%

8 – 9,9%

21 – 25,9%

29 – 58%

20 – 68,9%

13 – 44,8%

20 – 68,9%

13 – 44,8%

4 – 13,7%

6 – 20,7%

hospitalur etapze miokardiumis infarqtis garTulebebis

Seswavlam aCvena, rom ZiriTad jgufSi marcxena parkuWis mwvave

ukmarisoba ganuviTarda 5(6,2%) avadmyofs, sakontrolo jgufSi

– 2(6,9%)-s. adreuli postinfarqtuli stenokardia ganuviTarda

ZiriTadi jgufis 8(9,9%) da sakontrolo jgufis 4(13,7%)

avadmyofs; stacionaridan gawerisas marcxena parkuWis funqciis

Seswavlam aCvena, rom ZiriTadi jgufis 10(12,3%) avadmyofs

aReniSneboda II fk gulis ukmarisoba, 3(3,7%)-s - III fk gulis

ukmarisoba. sakontrolo jgufSi – Sesabamisad 6(20,7%) da

4(13,7%) pacients. 30 dRiani letaloba iyo ZiriTad jgufSi

12(14,8%) da sakontrolo jgufSi 6(20,7%).

stacionaridan gaweris Semdeg ZiriTadi jgufis 60(69,1%)-ma

da sakontrolo jgufis 14(48,3%) pacientma Sewyvita Tambaqos

weva.

ambulatoriuli meTvalyureobis periodSi stenokardia

aReniSneboda ZiriTadi jgufis 12(14,8%), pacients, romelTagan 9

57

Tambaqos mweveli iyo. sakontrolo jgufSi stenokardia

aReniSneboda 12(44,4%) pacients, romelTagan 10 Tambaqos mweveli

iyo. ganmeorebiTi miokardiumis infarqti ganuviTarda ZiriTadi

jgufis 8(9,9%) mwevel pacients, sakontrolo jgufSi – 6(20,7%)

pacients, romelTagan 5 mweveli iyo. 5-wliani letaloba ZiriTad

jgufSi iyo 10(12,3%) da sakontrolo jgufSi – 7(24,1%).

amgvarad, Tambaqos mwevel pacientebSi yvelaze xSiri iyo

hiperqolesterinemia (80,2%). Tambaqos wevis Sewyveta erTnairad

amcirebs mi garTulebebsa da sikvdilobas rogorc ZiriTad,

aseve sakontrolo jgufSi.

4.4. Trombolizuri Terapia Warbi wonis mqone avadmyofebSi

miokardiumis infarqtiT 169 avadmyofidan 57(33,7%) –s hqonda

Warbi wona, maT Soris 27(23,7%) mamakacs da 30(54,5%) qals.

pacientTa sxeulis saSualo wona iyo 84,2±0,9 kg, sxeulis masis

indeqsi 33,2±1,5. avadmyofTa klinikurma gamokvlevam aCvena, rom

42(73%)-s hqonda infarqti Q kbiliT, 15(27%)-s - Q kbilis gareSe.

38(66,7%)-s hqonda wina kedlis, xolo 19(33,3%)-s – ukana kedlis

infarqti. 33(57,9%) avadmyofs aReniSneboda arteriuli

hipertenzia, 18(31,9%)-s – Saqriani diabeti, 20(35,1%) iyo Tambaqos

mweveli, 12(21,1%)-s aReniSneboda hipodinamia, 8(14%)-s –

damZimebuli memkvidreoba, 43(75,4%) avadmyofs aReniSneboda

hiperqolesterinemia. (cxrili10)

58

cxrili10

simsuqniT avadmyofebSi gid risk-faqtorebis ganawileba

ZiriTadi jgufi sakontrolo jgufi

avadmyofTa r-ba

mamakaci

qali

infarqti Q kbiliT

Q kbilis gareSe

wina kedeli

ukana kedeli

hiperqolesterinemia

arteriuli hipertenzia

Saqriani diabeti

Tambaqo

hipodinamia

memkvidreoba

57(33,7%)

27(23,7%)

30(54,5%)

42(73%)

15(27%)

38(66,7%)

19(33,3%)

43(75,4%)

33(57,9%)

18(31,9%)-

20(35,1%)

12(21,1%)

8(14%)

9(18%)

4(44,4%)

5(55,6%)

6(66,7%)

3(33,3%)

6(66,7%)

3(33,7%)

7(77,8%)

5(55,6%)

3(33,3%)

3(33,3%)

3(33,3%)

3(33,3%)

sismsuqnis xarisxis mixedviT avadmyofebi ase ganawilda:

32(56,1%) avadmyofs hqonda I xarisxis simsuqne, maT Soris 15(13,1%)

iyo mamakaci, 17(30,9%)- qali. II xarisxis simsuqne hqonda 25(43,9%)

pacients, maT Soris 12(10,5%) mamakacs da 13(23,6%) qals.

I xarisxis simsuqniT avadmyofTagan 12(37,5%)-s hqonda

Saqriani diabeti, 18(56,2%) – s arteriuli hipertenzia, gulis

ukmarisoba aReniSneboda 7(21,9%) avadmyofs, saerTo

qolesterinis done sisxlSi iyo 238,5±3,2 mg%.

II xarisxis simsuqniT avadmyofTagan 6(24%)-s hqonda Saqriani

diabeti, 15(60%)-s arteriuli hipertenzia, gulis ukmarisoba

hqonda 10(40%) avadmyofs, saerTo qolesterinis done sisxlSi

iyo 246,2 ± 1,2 mg%. (cxrili11)

59

cxrili11

avadmyofTa ganawileba simsuqnis xarisxis mixedviT

I xarisxis simsuqne II xarisxis simsuqne

avadmyofTa r-ba

qali

mamakaci

infarqti Q kbiliT

arteriuli hipertenzia

Saqriani diabeti

saerTo qolesterini

gulis ukmarisoba

32 – 56,1%

17 – 30,9%

15 – 13,1%

23 – 71,9%

18 – 56,2%

12 – 37,5%

238,5 ± 3,2

7 – 21,9%

25 – 43,9%

13 – 23,6%

12 – 10,5%

19 – 76%

15 – 60%

6 – 24%

246 ± 1,2

10 – 40%

hospitalur etapze miokardiumis infarqtis garTulebebis

Seswavlam aCvena, rom ZiriTad jgufSi marcxena parkuWis mwvave

ukmarisoba ganuviTarda 4(7%) avadmyofs, sakontrolo jgufSi –

4(18,2%)-s. adreuli postinfarqtuli stenokardia ganuviTarda

ZiriTadi jgufis 2(3,5%) da sakontrolo jgufis 5(55,6%)

avadmyofs; stacionaridan gawerisas marcxena parkuWis funqciis

Seswavlam aCvena, rom ZiriTadi jgufis 5(8,8%) avadmyofs

aReniSneboda II fk gulis ukmarisoba, 2(3,5%)-s - III fk gulis

ukmarisoba. sakontrolo jgufSi 4(44,6%) –s hqonda II fk gulis

ukmarisoba, 3(33,3%) –s - III fk gulis ukmarisoba. (cxrili12)

60

cxrili12

avadmyofTa ganawileba miokardiumis infarqtis garTulebebis

mixedviT

ZiriTadi

jgufi

sakontrolo

jgufi

kardiuli asTma

postinfarqtuli stenokardia

II fk gu

IIIfk gu

4 – 7%

2 – 3,5%

5 – 8,8%

2 – 3,5%

4 – 44,6%

5 – 55,4%

4 – 44,6%

3 – 33,3%

avadmyofebs daeniSnaT dieturi kveba da dozirebuli

fizikuri varjiSi. wonis kontrolma aCvena, rom 57 avadmyofidan

simsuqne aReniSneboda 24(14,2%) pacients, maT Soris 17(70,8%) I

xarisxis, 7(29,2%)-s - II xarisxis. sxeulis saSualo wona iyo

73,8±0,3 kg, xolo sxeulis masis indeqsi – 29,9±0,8. xangrZlivma

dakvirvebam aCvena, rom simsuqniT avadmyofebSi postinfarqtuli

stenokardia aReniSneboda 9(37,5%) avadmyofs, xolo normaluri

woniT 145 pacientidan 21(14,5%)-s. genmeorebiTi infarqti

ganviTarda simsuqniT avadmyofTa 6(25%) SemTxvevaSi, xolo

danarCen pacientebSi 20(13,8%) SemTxvevaSi. 5 wliani sikvdiloba

simsiqniT avadmyofebSi iyo 5(20,5%), danarCen pacientebSi –

18(12,4%) SemTxvevaSi. amrigad, kvlevam aCvena, rom Trombolizur

TerapiasTan erTad Warbi wonis koreqcia sarwmunod amcirebs mi

garTulebebsa da sikvdilobas.

cxrili7

61

avadmyofTa ganawileba miokardiumis infarqtis garTulebebis

mixedviT

ZiriTadi

jgufi n=112

sakontrolo

jgufi n=34

kardiuli asTma

postinfarqtuli stenokardia

II fk gu

IIIfk gu

IVfk gu

gf

sikvdiloba

10 – 8,9%

8 – 7,1%

18 – 16,1%

16 – 14,3%

_

43,9±1,2

5 – 4,5%

5 – 14,7%

7 – 20,6%

9 – 26,5%

12 – 35,3%

2 – 5,9%

36,1±1,4

4 – 11,8%

4.5. miokardiumis infarqtiT avadmyofebSi sqesis roli

Trombolizuri mkurnalobis dros

miokardiumis infarqtiT 169 avadmyofidan 114(67,5%) iyo

mamakaci da 55(32,5%) – qali. mamakacTa asaki meryeobda 36-dan 83

wlamde, saSualo asaki iyo 63,2±1,2 weli. qalTa asaki meryeobda

35-dan 88 wlamde, saSualo asaki iyo 69,7±1,4 weli. sakontrolo

jgufi Seadgina 50-ma avadmyofma: 31(62%)- qalma da 19(38%) –

mamakacma. saSualo asaki iyo 64,9±1,6 weli. ZiriTadi da

sakontrolo jgufis avadmyofTa klinikuri daxasiaTeba

mocemulia cxrilebSi #13 da 14.

62

cxrili13

ZiriTadi jgufis avadmyofTa klinikuri daxasiaTeba

mamakaci qali sul

avadmyofTa r-ba 114 – 67,5% 55 – 32,5% 169

saSualo asaki 63,2±1,2 69,7±1,4 67,1 ± 0,9

mi Q kbiliT 80 – 47,3% 35 – 20,7% 115

mi Q kbilis gareSe 34 – 20,1% 20 – 11,8% 54

mi wina kedlis 64 – 37,9% 25 – 14,8% 89

mi ukana kedlis 50 - 29,6% 30 – 17,8% 80

cxrili14

sakontrolo jgufis avadmyofTa ZiriTadi daxasiaTeba

mamakaci qali sul

avadmyofTa r-ba 19 - 38% 31 - 62% 50

saSualo asaki 65,9±1,4 70,1±0,3 69,3±0,6

mi Q kbiliT 17 – 34% 16 – 32% 33

mi Q kbilis gareSe 7 – 14% 10 – 20% 17

mi wina kedlis 18 – 36% 10 – 20% 28

mi ukana kedlis 20 – 40% 12 – 24% 32

gid risk-faqtorebis Seswavlam aCvena, rom arteriuli

hipertenzia da hiperqolesterinemia ufro xSiri iyo qalebSi,

vidre mamakacebSi, Saqriani diabeti daaxloebiT erTnairi

sixSiriT iyo gamovlenili, Tambaqos mwevelebi ZiriTadad

63

mamakacebi iyvnen, aseve mamakacebSi Warbobda memkvidruli

faqtori. ix. cxrilebi #15, 16.

cxrili15

ZiriTadi jgufis avadmyofTa ganawileba gid risk -

faqtorebis mixedviT

mamakaci qali sul

arteriuli hipertenzia 60 – 52,6% 48 – 87,3% 108 – 63,9%

hiperqolesterinemia 82 – 68,9% 44 – 80% 162- 96%

Saqriani diabeti 16 – 14% 8 14,5% 24 -14,2%

simsuqne 27 – 23,7% 30 – 54,5% 57 – 33%

Tambaqo 76 – 66,7% 5 – 9,1% 81 – 47,9%

hipodinamia 12 – 10,2% 4 – 7,3% 16 – 9,5%

memkvidreoba 24 – 20,2% 8 14,5% 32 – 18,9%

cxrili16

sakontrolo jgufis avadmyofTa ganawileba gid risk -

faqtorebis mixedviT

mamakaci qali sul

arteriuli hipertenzia 15 – 30% 19 – 70% 34- 68%

hiperqolesterinemia 20 – 40% 23 – 46% 43 – 86%

Saqriani diabeti 3 – 6% 4 – 8% 7 – 14%

simsuqne 2 – 4% 7 – 14% 9 – 18%

Tambaqo 24 – 48% 5 – 10% 29 – 58%

hipodinamia 3 – 6% 1 – 2% 4 – 8%

memkvidreoba 5 – 10% 2 – 4% 7 – 14%

SeviswavleT miokardiumis infarqtis mimdinareoba da

garTulebebi mkurnalobis stacionarul da ambulatoriul

etapebze. miRebuli Sedegebi mocemulia cxrilebSi #17

64

cxrili17

miokardiumis infarqtis mimdinareoba da garTulebebi

ZiriTadi jgufis pacientebSi

jgufi mamakaci 114 qali 55

ariTmia 32 – 18,9% 12 – 7%

mpmu 6- 3,5% 11- 6,5%

gqu 8 – 4,7% 13 – 7,7%

postinfarqtuli

stenokardia

7 – 4,1%

11 – 6,5%

ganmeorebiTi infarqti 4 – 2,4% 6 – 3,6%

cxrili18

miokardiumis infarqtis mimdinareoba da garTulebebi

sakontrolo jgufis pacientebSi

jgufi mamakaci 31 qali 19

ariTmia 10 – 20% 5 – 10%

mpmu 4 – 8% 8 – 16%

gqu 3 – 6% 7 – 14%

postinfarqtuli

stenokardia

5 – 10% 6 – 12%

ganmeorebiTi infarqti 2 – 4% 3 – 6%

rogorc cxrilebidan Cans, mamakacebSi rogorc ZiriTad, ise

sakontrolo jgufebSi ufro xSirad viTardeboda riTmis

darRvevebi, xolo qalebSi ufro xSiri iyo gulis ukmarisobis,

stenokardiisa da ganmeorebiTi infarqtis ganviTareba.

65

stacionaruli letalobis Seswavlam aCvena, rom qalebis

sikvdiloba sarwmunod maRali iyo mamakacebTan SedarebiT da

Sesabamisad Seadgenda 9(16,4%) da 6(5,3%) ZiriTad jgufSi da

5(26,3%) da 4(12,9%) sakontrolo jgufSi. 5-wliani sikvdilobis

Seswavlam aCvena, rom 70 wlamde asakis pacientebSi aseve

Warbobda qalebis sikvdiloba mamakacebisas da Seadgenda

ZiriTad jgufSi 7(22,62%) da 6(8,2%), sakontrolo jgufSi –

5(31,2%) da 3(18,7%). 70 welze maRali asakis pacientebSi qalebisa

da mamakacebis letalobas Soris sarwmuno sxvaoba ar

aRiniSneboda: ZiriTad jgufSi iyo 3(25%) da 7(29,2%) da

sakontrolo jgufSi – 3(33%) da 6(40%) Sesabamisad.

4.6. Trombolizuri Terapiis efeqturoba sxvadasxva asakis

pacientebSi

miokardiumis infarqtiT avadmyofTa asaki meryeobda 35-dan

88 wlamde, saSualo asaki iyo 69,8. Trombolizuri Terapiis

efeqturobis Sefasebis mizniT avadmyofebi daiyo asakobriv

jgufebad (cxrili19).

cxrili19

avadmyofTa ganawileba asakobriv jgufebSi

jgufi asaki mamakaci qali sul

I < 50 29 – 15,5% 3 – 5,5% 32 – 18,9%

II < 60 35 – 30,7% 6 – 10,9% 41 – 24,3%

III < 70 38 – 33,3% 22 – 40% 60 – 35,5%

IV > 70 12 – 10,5% 24 – 43,6% 36 – 21,3%

66

orive jgufis avadmyofebs aReniSneba hiperglikemia, saerTo

da ß-qolesterinis momateba, Semcirebulia α- qolesterinis

done, gansakuTrebiT maRalia trigliceridebis done, aseve

momatebulia aTerogenobis indeqsi.

hospitalur etapze miokardiumis infarqtis garTulebebis

Seswavlam aCvena, rom ZiriTad jgufSi marcxena parkuWis mwvave

ukmarisoba ganuviTarda 4(13,3%) avadmyofs, sakontrolo jgufSi

– 5(16,7%)-s. adreuli postinfarqtuli stenokardia ganuviTarda

ZiriTadi jgufis 3(10%) da sakontrolo jgufis 5(16,7%)

avadmyofs; stacionaridan gawerisas marcxena parkuWis funqciis

Seswavlam aCvena, rom ZiriTadi jgufis 2(6,7%) avadmyofs

aReniSneboda II fk gulis ukmarisoba, 3(10%)-s - III fk gulis

ukmarisoba. marcxena parkuWis gandevnis fraqcia iyo 39,9±1,7.

sakontrolo jgufSi 5(16,7%) –s hqonda II fk gulis ukmarisoba,

4(13,3%) –s - III fk gulis ukmarisoba. marcxena parkuWis gandevnis

fraqcia iyo 37,1±1,8. stacionaruli mkurnalobis periodSi

gardaicvala ZiriTadi jgufis 2(6,6%) da sakontrolo jgufis

4(13,3%) pacienti. (cxrili27 )

cxrili27

avadmyofTa ganawileba miokardiumis infarqtis garTulebebis

mixedviT

ZiriTadi

jgufi

sakontrolo

jgufi

kardiuli asTma

postinfarqtuli stenokardia

II fk gu

IIIfk gu

gf

sikvdiloba

4 - 13,3%

3 - 10%

2 - 6,7%

3 - 10%

39,9±1,7

2 – 6,6%

5 - 16,7%

5 - 16,7%

5 – 16,7%

4 - 13,3%

37,1±1,8

4 – 13,3%

67

avadmyofTa mkurnalobis Soreuli Sedegebis Seswavlam

gamoavlina, rom postinfarqtuli stenokardia aReniSneboda

ZiriTadi jgufis 5(16,7%) da sakontrolo jgufis 9(30%)

avadmyofs. gulis qronikuli ukmarisoba aReniSneboda ZiriTadi

jgufis 8(26,7%) da sakontrolo jgufis 13(43,3%) avadmyofs.

ganmeorebiTi infarqti ganuviTarda ZiriTadi jgufis 3(10%),

xolo sakontrolo jgufis 4(13,3%) avadmyofs. 5-wliani

letalobis Seswavlam aCvena, rom ZiriTad jgufSi gardaicvala

7(23,3%) da sakontrolo jgufis 9(30%) avadmyofi.

amrigad, Saqriani diabetiT avadmyofebSi yvelaze didi

sixSiriT gamovlinda lipiduri cvlis darRveva, gansakuTrebiT

gamoxatulia trigliceridebis momateba da maRali

aTerogenobis indeqsi. aseve xSiria arteriuli hipertenzia

(63,3%) da simsuqne (56,7%). Trombolizuri Terapia sagrZnoblad

aumjobesebs avadmyofTa klinikur mdgomareobas stacionarul

periodSi. mkurnalobis Soreuli Sedegebi, kerZod, ganmeorebiTi

infarqtis da letalobis sixSire statistikurad ar

gansxvavdeba ZiriTad da sakontrolo jgufebSi.

4.6. Trombolizuri Terapiis Sedegebi gid risk-faqtorebis

sixSiris mixedviT

Trombolizuri Terapiis Sedegebze gid risk-faqtorebis

gavlenis Sesaswavlad avadmyofebi davajgufeT am risk-

faqtorebis sixSiris mixedviT (cxrili28)

cxrili28

68

risk-faqtorebis sixSire mi avadmyofebSi

risk-faqtorebis r-ba ZiriTadi jgufi sakontrolo jgufi

erTi 21 – 12,4% 6 – 12%

ori 51 – 30,2% 12 – 24%

sami 60 – 35,5% 18 – 36%

oTxi 37 – 21,9% 14 – 28%

21 avadmyofidan, romelTac 1 risk-faqtori aReniSnebodaT,

8(38%)_s hqonda arteriuli hipertenzia, 9(42,9%)-s –

hiperqolesterinemia da 4(19,1%) iyo Tambaqos mweveli.

51 avadmyofidan 2 risk-faqtoriT, 18(35,3%)-s aReniSneboda

hiperqolesterinemia da arteriuli hipertenzia, 17(33,3%)-s

hiperqolesterinemia da Tambaqo, 5(9,8%)–s - arteriuli

hipertenzia da Saqriani diabeti, 5(9,8)–s - arteriuli

hipertenzia da Warbi wona, 6(11,8%) – s - sxvadasxva.

60 avadmyofidan 3 risk-faqtoriT, 15(25%)-s aReniSneboda

arteriuli hipertenzia, hiperqolesterinemia da Warbi wona.

23(38,3%)-s - arteriuli hipertenzia, hiperqolesterinemia da

Tambaqo. 9(15%)-s – hiperqolesterinemia, Warbi wona, datvirTuli

memkvidreoba. 6(10%)-s - arteriuli hipertenzia,

hiperqolesterinemia da Saqriani diabeti.

37 avadmyofidan 4 risk-faqtoriT, 11(29,7%)-s aReniSneboda

arteriuli hipertenzia, hiperqolesterinemia, Saqriani diabeti,

Warbi wona. 10(27%)-s - arteriuli hipertenzia,

hiperqolesterinemia, Warbi wona, Tambaqo. 7(18,9%)-s –

hiperqolesterinemia, Warbi wona, datvirTuli memkvidreoba,

69

Tambaqo. 6(16,2%)-s - arteriuli hipertenzia, hiperqolesterinemia,

datvirTuli memkvidreoba, Tambaqo. 3(8,1%)-s – sxvadasxva.

avadmyofTa jgufebSi SevuswavleT mi garTulebebi da

letaloba.

stacionarul etapze 1 risk-faqtoriT avadmyofebSi

stenokardia ganuviTarda mxolod sakontrolo jgufis 1(16,7%)

pacients. 2 risk-faqtoriT – 3(5,9%)-s ZiriTadi da 2(16,7%)

pacients sakontrolo jgufidan. 3 risk-faqtoriT – stenokardia

ganuviTarda 4(6,7%) da 2(11,1%) pacients da 4 risk-faqtoriT

avadmyofTagan, Sesabamisad, 2(5,4%) da 2(14,3%) pacients.

marcxena parkuWis mwvave ukmarisoba 1 risk-faqtoriT

avadmyofebSi ganuviTarda ZiriTadi jgufis 3(14,2%) da

sakontrolo jgufis 1(16,7%) pacients. 2 risk-faqtoriT – 2(3,9%)-

s ZiriTadi da 2(8,3%) pacients sakontrolo jgufidan. 3 risk-

faqtoriT – 4(6,7%) da 2(11,1%) pacients da 4 risk-faqtoriT

avadmyofTagan, Sesabamisad, 5(13,5%) da 4(15,3%) pacients.

gulis ukmarisobis NYHA-s mixedviT avadmyofebi ase

ganawilda: 1 risk-faqtoriT NYHA-II fk aReniSneboda ZiriTadi

jgufis 3(14,3%) da sakontrolo jgufis 2(33,3%) pacients. 2 risk-

faqtoriT NYHA-II fk aReniSneboda 8(15,7%) da 2(16,6%) pacients.

NYHA-III fk – 3(6%) da 2(16,7%)-s Sesabamisad. 3 risk-faqtoriT -

NYHA-II fk aReniSneboda 12(20%) da 5(27%) pacients. NYHA-III fk –

5(8,2%) da 2(14,3%) avadmyofs Sesabamisad. NYHA-IV fk

aReniSneboda 2(8,2%) da 2(14,3%) avadmyofs Sesabamisad. 4 risk-

faqtoriT - NYHA-II fk aReniSneboda 10(27%) da 5(35,7%) pacients.

NYHA-III fk –8(21,6%) da 5(35,7%)-s Sesabamisad. NYHA-IV fk

aReniSneboda Sesabamisad 2(5,4%) da 2(14,3%) pacients.

70

dakvirvebis periodSi ganmeorebiTi infarqti 1 risk-

faqtoriT avadmyofTagan aravis ganuviTarda. 2 risk-faqtoriT

avadmyofTagan ganuviTarda ZiriTadi jgufis 4(7,8%) da

sakontrolo jgufis 2(16,7%) pacients. 3 risk-faqtoriT,

Sesabamisad, 6(10%) da 4(22,2%) pacients. 4 risk-faqtoriT –

6(16,2%) da 4(28,6%) pacients Sesabamisad.

30-dRiani sikvdilobis Seswavlam aCvena, rom 1 risk-

faqtoriT avadmyofTagan arcerTi avadmyofi ar gardacvlila. 2

risk-faqtoriT ZiriTad jgufSi gardaicvala 2(3,9%) da

sakontrolo jgufSi – 1(8,3%) pacienti. 3 risk-faqtoriT

gardaicvala 5(8,3%) da 3(16,7%) pacienti. 4 risk-faqtoriT,

Sesabamisad, 5(13,5%) da 3(21,4%) pacienti.

5-wliani sikvdilobis Seswavlam aCvena, rom 1 risk-

faqtoriT avadmyofTagan ZiriTad jgufSi gardaicvala 2(9,5%) da

sakontrolo jgufSi – 2(33,3%) pacienti. 2 risk-faqtoriT

ZiriTad jgufSi gardaicvala 8(15,7%) da sakontrolo jgufSi –

4(33,3%) pacienti. 3 risk-faqtoriT gardaicvala 9(15%) da 6(38,9%)

pacienti. 4 risk-faqtoriT, Sesabamisad, 4(10,8%) da 5(45,4%)

pacienti (cxrili29)

mi avadmyofTa sikvdiloba gid risk-faqtorebis mixedviT

cxrili29

30-dRiani 5-wliani

risk-faqtorebis

r-ba

ZiriTadi sakontrolo ZiriTadi sakontrolo

erTi

ori

sami

oTxi

_

2 - 3,9%

5 - 8,3%

5 - 13,5%

_

1 – 8,3%

3 – 16,7%

3 – 21,4%

2 – 9,5%

8 – 15,7%

9 – 15%

4 – 10,8%

2 – 33,3%

4 – 33,3%

6 – 38,9%

5 – 45,4%

sul 12 – 7,1% 7 – 14% 23 – 13,6% 17 – 34%

71

amgvarad, risk-faqtorebis raodenobis mixedviT

sikvdilobis SeswavliT aRmoCnda, rom misi sidide korelaciaSia

risk-faqtorebis raodenobasTan, xolo Trombolizuri Terapia

sarwmunod amcirebs sikvdilobas sakontrolo jgufTan

SedarebiT risk-faqtorebis miuxedavad.

Tavi V

miRebuli Sedegebis ganxilva

gid kvlavac rCeba mosaxleobis yvelaze Sromisunariani

nawilis invalidobis da sikvdilobis uxSires mizezad. 40%-ze

met SemTxvevaSi gid uecari sikvdiliT mTavrdeba, xolo am

pacientTa naxevars sikvdilamde ar aReniSneboda gid raime

klinikuri gamovlineba. miuxedavad imisa, rom miokardiumis

infarqtiT sikvdiloba bolo wlebSi mkveTrad Semcirda, igi

mainc rCeba sikvdilobis yvelaze xSir mizezad. gul-

sisxlZarRvTa daavadebebis risk-faqtorebis codna, sxvadasxva

profilaqtikuri da Terapiuli RonisZiebebis efeqturobis

dadasturebuli mtkicebulebebis gaTvaliswineba yovelTvis ar

xdeba praqtikaSi. mravali klinicisti miuTiTebs, rom jer kidev

rCeba zRvari gul-sisxlZarRvTa daavadebebis risk-faqtorebis

koreqciis Teoriul codnasa da mis praqtikul ganxorcielebas

Soris (4, 9 ).

2003 weli mniSvnelovani iyo mTeli rigi evropuli

rekomendaciebis mowodebiT gid avadmyofTa mkurnalobis

Sesaxeb, sadac didi adgili uWiravs gid pirvelad da meorad

72

profilaqtikas. SemTxvevaTa umravlesobaSi miokardiumis

infarqti gid pirvel gamovlinebas warmoadgens. miokardiumis

mwvave infarqti ara marto daavadebis arsebobaze miuTiTebs,

aramed warmoadgens SesaZleblobas, ganawyos pacienti cxovrebis

wesis Secvlisadmi, radgan dadgenilia, rom gid meoradi

profilaqtika avadobis da sikvdilobis Semcirebis saSualebas

iZleva (10, 13, 30 ).

miokardiumis infarqtis mkurnalobaze Tanamedrove

warmodgenebis Tanaxmad, koronaruli sisxlis mimoqcevis

aRdgena, rac saSualebas iZleva nawilobriv an mTlianad

aviciloT Tavidan Seuqcevadi iSemiis ganviTareba, yvelaze

mniSvnelovan amocanas warmoadgens. misi gadaWra amcirebs

hemodinamikuri darRvevebis xarisxs, aumjobesebs avadmyofTa

prognozs da cocxladdarCenas (79). Trombolizuri Terapia

qirurgiul meTodebTan erTad, dReisaTvis ganixileba Q –

kbilovani infarqtiT avadmyofTa ZiriTad mkurnalobad.

miuxedavad imisa, rom es meTodi mowodebulia SedarebiT didi

xnis win (1959 w) da Catarebulia mravali gamokvleva (71, 107), maT

Soris multicentruli (126 ), ar aris sakmarisad Seswavlili

gid risk-faqtorebis gavlena Trombolizuri Terapiis

efeqturobasa da Soreul Sedegebze. marTalia, Trombolizisma

miokardiumis infarqtis mwvave periodSi, ß- blokerebisa da agf-

inhibitorebis gamoyenebam mniSvnelovnad Secvala avadmyfTa

prognozi ukeTesobisken, arcerTi es samkurnalo saSualeba ar

zemoqmedebs koronaruli arteriebis aTerosklerozis arsze.

yvela eqim-kardilogisTvis kavSiri aTerosklerozis

ganviTarebisa sisxlSi qolesterinis donis matebasTan aSkaraa.

amitom, bunebrivad Cndeba survili gairkves, Tu rogor

73

moqmedebs qolesterinis donis Semcireba avadmyofTa prognozze.

SesaZlebelia Tu ara gaumjobesdes gid avadmyofTa prognozi

dietis, cxovrebis wesis Secvlis, Tambaqos Sewyvetis da bolos,

hipolipidemiuri preparatebis gamoyenebis gziT.

gid da hiperqolesterinemiiT avadmyofTa rekomendaciebSi

mniSvnelovania dietis dacva, Tumca yvelaze mkacri dietac ki

ar iwvevs qolesterinis donis Semcirebas 8-10%-ze metad, radgan

misi Semcveloba umTavresad regulirdeba RviZlis ujredebSi

endogenuri sinTeziT (67, 111, 123 ). am problemisadmi xelaxali

interesi gaCnda axali klasis preparatebis gamoCenis Semdeg. es

aris ferment 3-hidroqsi-3-meTilglutaril-koenzim A reduqtazas

inhibitorebi, romlebic mniSvnelovan rols asruleben

qolesterinis endogenur sinTezSi. am jgufis preparatebi,

pirvel yovlisa, lovastatini, simvastatini da pravastatini

klinikur praqtikaSi gamoiyeneba 80-90-iani wlebidan, Tumca

Tavidan am preparatebis gamoyenebis mizanSewoniloba eWvis qveS

idga. 90-iani wlebis bolodan aSkara gaxda, rom statinebis

gamoyeneba miokardiumis infarqtis gadatanis Semdeg saSualebas

iZleva mniSvnelovnad Semcirdes gid garTulebebi da

sikvdiloba. kerZod, 4S (Scandinavian Simvastatin Survival Study) kvlevam

aCvena, rom hipolipidemiuri mkurnalobis dros gid

garTulebebis sixSire 70%-iT dabalia im pacientebTan

SedarebiT, visac utardebodaT tradiciuli mkurnaloba (174 ).

miuxedavad imisa, rom saerTo qolesterinis done sawyisTan

SedarebiT mcirdeba infarqtis gadatanidan 2 Tvis Semdeg,

pirvel 24-48 sT-Si gansazRvruli lipiduri speqtri zustad

asaxavs lipiduri cvlis mdgomareobas (169 ). amitom,

miokardiumis infarqtiT avadmyofebSi aucilebelia pirveli 24

74

sT-is ganmavlobaSi ganisazRvros lipiduri speqtri.

rekomendaciebis Tanaxmad, romelic SemuSavebulia NCEP (National

Cholesterol Education Program) programis farglebSi,

hiperqolesterinemiis koreqcia miokardiumis infarqtis

ganviTarebis dros dauyovnebliv unda daiwyos (77, 161 ).

Cvens kvlevaSi miokardiumis infarqtis garTulebebi da

sikvdloba SeviswavleT avadmyofebSi saerTo qolesterinis

sawyisi donis mixedviT, ris gamoc isini davyaviT 4 jgufad.

jgufebSi SeviswavleT lipiduri cvlis maCveneblebis dinamika,

postinfarqtuli stenokardiis, ganmeorebiTi infarqtis sixSire

da sikvdiloba infarqtis gadatanidan 5 wlis ganmavlobaSi.

aRmoCnda, rom hipolipidemiuri mkurnalobis Sedegad saerTo

qolesterinis donis Semcireba miT ufro didi iyo, rac ufro

maRali iyo misi sawyisi done. anu I jgufSi Semcirda 11,6%-iT, II

jgufSi – 10,5%-iT, III jgufSi – 16,8%-iT da IV jgufSi – 29,5%-iT.

postinfarqtuli stenokardiisa da ganmeorebiTi infarqtis

sixSire miuxedavad Catarebuli Trombolizuri Terapiisa,

damokidebuli iyo lipiduri speqtris maCveneblebis sidideze.

kerZod, postinfarqtuli stenokardiisa da ganmeorebiTi

infarqtis sixSire ufro maRali iyo II da III jgufis pacientebSi.

aseve sikvdilobac ufro maRali iyo am jgufebSi, Tumca

sarwmunod dabali sakontrolo jgufis pacientebis

letalobasTan SedarebiT, Sesabamisad 15 (11,6%) da 7(18,4%).

gul-sisxlZarRvTa daavadebebis ganviTarebaSi arteriul

hipertenzias didi roli eniWeba iseT faqtorebTan erTad,

rogoricaa Tambaqo, simsuqne, dislipidemia, Saqriani diabeti,

mikroalbuminuria. arteriuli wnevis erTnairi sididis

pirobebSi, marcxena parkuWis hipertrofiis, stenokardiis,

75

gadatanili miokardiumis infarqtis an insultis, gulis

ukmarisobis, sisxlSi kreatininis donis momatebis, retinopaTiis,

periferiuli arteriebis daavadebebis arsebobisas sikvdilobis

riski mniSvnelovnad izrdeba. aseTi avadmyofebi saWiroeben

aqtiur antihipertenziul mkurnalobas. arteriuli hipertenziis

mkurnaloba ufro advilia, vidre dislipidemiis, miuxedavad

amisa, saWiroO stabiluri Terapiuli efeqtis miRweva mxolod

20%-Si xdeba. antihipertnziuli mkurnalobis arasruli efeqti

stenokardiis refraqterobis erT-erTi yvelaze xSiri mizezi

xdeba (121, 157 ).

Cvens kvlevaSi 112(66,3%) pacients aReniSneboda arteriuli

hipertenzia. mikardiumis infarqtis garTulebebisa da

sikvdilobis Seswavlam aCvena, rom im pacientebSi, visac rCeboda

maRali arteriuli wneva, ufro xSiri iyo postinfarqtuli

stenokardia, ganmeorebiTi infarqti, gulis ukmarisoba da

maRali iyo letaloba. amave dros Trombolizisis da

sakontrolo jgufebSi am maCveneblebs Soris sxvaoba sarwmuno

iyo.

gid mesame kardinaluri risk-faqtoria Tambaqos weva.

laboratoriuli kvlevebiT dadgenilia, rom Tambaqos weva

zrdis aTerosklerozis ganviTarebis risks, aseve aZlierebs

Trombocitebis adhezias, zrdis guliscemis sixSires, arteriul

wnevas da aritmiis ganviTarebis sixSires. qsovilebi iReben

nakleb Jangbads, vinaidan wvis Sedegad warmoqmnili naxSirbadis

monoqsidi ufro mWidro kavSirs qmnis hemoglobinis

molekulasTan, vidre Jangbadi. nikotini aseve azianebs

sisxlZarRvebs, rac kidev ufro aCqarebs aTerosklerozis

ganviTarebas. pacientebSi, romelTac miokardiumis infarqtis

76

gadatanis Semdeg Sewyvites Tambaqos weva, ukve 3 wlis Semdeg

ganmeorebiTi infarqtis riski uTanabrdeba aramwevelebis

risks

(42, 45 ).

Cvens kvlevaSi 81(47,9%) pacienti iyo Tambaqos mweveli.

stacionaridan gaweris Semdeg ZiriTadi jgufis 60(69,1%)-ma da

sakontrolo jgufis 14(48,3%) pacientma Sewyvita Tambaqos moweva.

kvlevam aCvena, rom ganmeorebiTi infarqti ganuviTarda ZiriTadi

jgufis 8(9,9%) pacients, romelTagan 7 mweveli iyo, sakontrolo

jgufSi ki 6(20,7%) pacients, romelTagan 5 iyo mweveli.

sikvdilobis Seswavlam aCvena, rom aramwevelebSi gardaicvala

3(5%) da mwevelebSi 7(33,3%) pacienti ZiriTad jgufSi.

sakontrolo jgufSi Sesabamisad 2(14,3%) da 5(33,3%). rogorc

Sedegebidan Cans, sigaretis Sewyveta amcirebs sikvdilobas,

xolo mwevelTa sikvdiloba erTnairia miuxedavad Catarebuli

Trombolizuri Terapiisa.

simsuqne xSirad asocirebulia arteriul hipertenziasTan,

hiperqolesterinemiasTan da Saqrian diabetTan, yvela erTad ki

zrdis gid ganviTarebis risks (47, 82). simsuqnis roli

aTerosklerozis ganviTarebaSi ar aris dadasturebuli, Tumca

wonis koreqcia mniSvnelovani faqtoria arteriuli

hipertenziis, hiperlipidemiis da Saqriani diabetis

kontrolisTvis. klinikuri kvlevebiT nanaxia, rom dietaSi

cximis SezRudva amcirebs gid ganviTarebas an mis simptomebs.

gid meorad profilaqtikaSi dietis rolis Seswavla daiwyo 30

wlis win `oslos dieta-gulis kvlevaSi~ (113). 11 wliani

dakvirvebis manZilze miokardiumis infarqtiT gamowveuli

sikvdiloba Semcirda 44%-iT (112, 115). aseve nanaxia, rom wonis

77

kleba da fizikuri aqtioba zomierad amcirebs sisxlSi LDL-C-is

dones da ufro mniSvnelovnad zrdis HDL-C-is da amcirebs TG-

is dones.

Cvens kvlevaSi simsuqne aReniSneboda 57(33,7%) pacients.

sxeulis saSualo wona iyo 84,2±0,9 kg, sxeulis masis indeqsi –

33,2±1,5. dietisa da dozirebuli fizikuri varjiSis Sedegad

simsuqniT avadmyofTa ricxvi Semcirda 24(14,2%)-mde. Cven

SeviswavleT stenokardiisa da ganmeorebiTi infarqtis sixSire

da sikvdiloba simsuqniT pacientebSi da SevadareT es

maCveneblebi normaluri wonis mqone pacientTa monacemebs.

kvlevam aCvena, rom es maCveneblebi sarwmunod gansxvavdeboda am

jgufebSi. aseve sarwmunod naklebi iyo sikvdiloba normaluri

wonis pacientebSi: Sesabamisad 12,4% da 20,8%.

Saqriani diabetiT avadmyofebs 2-4-jer maRali aqvT gid

sikvdilobis riski, vidre diabetis armqone pirebs. am

pacientebSi gul-sisxlZarRvTa daavadebebiT sikvdilis sixSire

50-75%-s warmoadgens. mamakacebSi diabeti gid ganviTarebis risks

2-3-jer zrdis, xolo qalebSi – 3-7-jer. TandarTuli risk-

faqtorebi, rogoricaa dislipidemia, arteriuli hipertenzia da

abdominuri simsuqne xSiria Saqriani diabetiT avadmyofebSi (158,

159).

diabetiT daavadebul mamakacebs gid sikvdilobis

gacilebiT maRali riski aqvT, vidre Tanabari asakis da

erTnairi risk-faqtorebis mqone aradiabetiT mamakacebs (164, 165

). aseve dadgenilia, rom gid sikvdilobis riski diabetiT

avadmyofebSi, romelTac ar gadautaniaT miokardiumis infarqti,

Tanabaria im pirebis riskisa, romelTac ar aqvT diabeti, magram

gadatanili aqvT infarqti.

78

Saqriani diabetiT pacientebSi xSirad aRiniSneba e.w.

`diabeturi dislipidemia~, rac xasiaTdeba Semdegi darRvevebiT:

dabali HDL-C, maRali TG, zomierad momatebuli LDL-C, mcire

zomis LDL nawilakebis da apolipoprotein a-s momateba (76, 125).

Cvens kvlevaSi Saqriani diabeti aReniSneboda 30(17,7%)

avadmyofs. am pacientebSi yvelaze didi sixSiriT gamovlinda

lipiduri cvlis darRveva, gansakuTrebiT gamoxatuli iyo

trigliceridebis momateba da maRali aTerogenobis indeqsi.

aseve xSiri iyo – 63,3% - arteriuli hipertenzia da simsuqne –

56,7%. letalobis Seswavlam aCvena, rom ZiriTadi jgufis 23

gardacvlili avadmyofidan 7(30,4%)-s Saqriani diabeti hqonda,

romelTa Soris 5 qali iyo. saerTo sikvdilobis Sedarebam

aCvena, rom diabetiT avadmyofebSi man Seadgina 23,3%, xolo

danarCen avadmyofebSi – 11,5%.

gid avadobisa da sikvdilobis absoluturi riski asakTan

erTad mkveTrad izrdeba. aSS-Si gid-iT 25 mln pacienti 65 wels

gadacilebulia. prospeqtuli kohortuli kvlevebiT dadgenilia,

rom xandazmul asakSi miokardiumis infarqtTan mWidrod aris

dakavSirebuli asaki, sqesi, sistoluri wneva da sisxlSi

glukozis done. amis sapirispirod, Tambaqo da dislipidemia

xandazmul asakSi naklebad aris dakavSirebuli miokardiumis

infarqtiT sikvdilobasTan. izolirebuli sistoluri

hipertenzia arteriuli hipertenziis yvelaze xSiri formaa

xandazmul asakSi. amitom misi kontroli gid da

cerebrovaskuluri daavadebebis profilaqtikis saSualebas

iZleva (124, 171, 173).

Cvens kvlevaSi pacientebi davyaviT asakobriv jgufebad.

maRal asakobriv jgufSi (70 w-ze zeviT) Warbobdnen qalebi,

79

ufro xSiri iyo Q –kbilovani infarqti, Saqriani diabeti, xolo

axalgazrda asakis pacientebSi Warbobdnen simsuqniT da mweveli

pirebi. gamokvlevis Sedegebma aCvena, rom maRali asakis

pacientebSi yvelaze xSiri iyo aritmiebis, gansakuTrebiT

parkuWovani eqstrasistoliis ganviTareba (17,7%), aseve xSiri iyo

marcxena parkuWis mwvave ukmarisoba (17,7%). am maCveneblebis

sixSire ufro maRali iyo sakontrolo jgufSi, Sesabamisad

22,7% da 40,9%. maRali asakis pacientebSi marcxena parkuWis

mwvave ukmarisobis didi sixSire, rogorc Cans dakavSirebuli

iyo gandevnis fraqciis sawyis dabal sididesTan, riTac aixsneba

am garTulebis maRali sixSire rogorc ZiriTad, ise

sakontrolo jgufSi. asakovan pacientebSi ufro xSiri iyo

postinfarqtuli stenokardia, III da IV fk gulis ukmarisoba

rogorc ZiriTad, ise sakontrolo jgufSi, Tumca sikvdiloba

statistikurad sarwmunod gansxvavdeboda ZiriTad da

sakontrolo jgufebSi. kerZod, ZiriTad jgufSi asakis mixedviT

I jgufSi iyo 9,4%, II jgufSi – 12,2%, III jgufSi – 11,1% da IV

jgufSi – 22,2%. sakontrolo jgufSi Sesabamisad: 20%, 33,3%,

35,7% da 50%. Cveni monacemebi saSualebas gvaZlevs davaskvnaT,

rom didi asakis pacientebSi miokardiumis infarqtis

mimdinareoba xasiaTdeba garTulebebis maRali sixSiriT rogorc

Trombolizisis, ise sakontrolo jgufSi, Tumca Trombolizuri

Terapia am garTulebebis da sikvdilobis Semcirebis saSualebas

iZleva sakontrolo jgufTan SedarebiT.

sqesis, rgorc gid aramodificirebadi risk-faqtoris

Seswavlam aCvena, rom ganviTarebul qveynebSi qalTa

sikvdilobis wamyvani mizezi miokardiumis infarqtia. gid-iT

daavadebul qalebs igive risk-faqtorebi aqvT, rac mamakacebs,

80

Tumca zogierTi mtkicebulebiT, qalebSi ufro xSiria Saqriani

diabeti. trigliceridebis da HLDL-C-s done aseve did rols

asrulebs qalebSi gid0is ganviTarebaSi. epidemiologiuri

kvlevebiT dadgenilia, rom HLDL-C-s 1 mg%-iT momateba 3%-iT

zrdis gid risks qalebSi da 2%-iT – mamakacebSi, xolo

trigliceridebis donis momateba 88,5 mg%-iT gid risks qalebSi

zrdis 76%-iT da 32%-iT – mamakacebSi. aseve 2-3-jer izrdeba gid

riski menopauzis periodSi (53, 154, 166, 170).

Cvens kvlevaSi qalTa da mamakacTa asaki daaxloebiT

erTnairi iyo, wina kedlis infarqti ufro xSiri iyo mamakacebSi.

qalebSi ufro xSiri iyo arteriuli hipertenzia,

hiperqolesterinemia da simsuqne. Trombolizuri Terapiis fonze

miokardiumis infarqtis garTulebebis sixSire mamakacebsa da

qalebs Soris statistikurad ar gansxvavdeboda, Tumca

sikvdiloba ufro maRali iyo qalebSi, rac ganpirobebuli iyo

maTSi arteriuli hipertenziis maRali sixSiriT.

avadmyofebSi letaloba SeviswavleT risk-faqtorebis

saxesa da raodenobasTan kavSirSi, risTvisac pacientebi

davyaviT 4 jgufad. 1 risk-faqtoriT avadmyofTagan ZiriTad

jgufSi 30 dRis ganmavlobaSi arc erTi ar gardacvlila, xolo

5-wliani sikvdiloba 9,5% iyo. sakontrolo jgufSi – 33,3%. 2

risk-faqtoriT avadmyofebSi 30-dRiani sikvdiloba iyo 3,9%, 5-

wliani – 15,7%. am avadmyofebSi yvelaze xSiri risk-faqtori iyo

arteriuli hipertenzia da hiperqolesterinemia. 3 risk-faqtoriT

avadmyofebSi arteriuli hipertenziasa da

hiperqolesterinemiasTan erTad didi iyo mwevelebis raodenoba,

SedarebiT iSviaTi iyo Warbi wona da memkvidruli faqtori. am

avadmyofTa sikvdiloba kidev ufro maRali iyo da 30 dReze

81

Seadgina 8,3%, 5 wlis Semdeg – 15%. 4 risk-faqtoriT

avadmyofebSi Warbobda arteriuli hipertenzia,

hiperqolesterinemia, Tambaqo, Saqriani diabeti. am avadmyofTa 30-

dRiani sikvdiloba iyo 13,5%, 5-wliani – 10,8%.

Trombolizuri Terapiis Catarebis Semdgom periodSi

pirveli wlis ganmavlobaSi 72(42,6%) pacients Cautarda

koronarografia, romelTagan 54 (32%)-s dasWirda stentireba. am

avadmyofTagan umetesoba iyo Saqriani diabetiT, Tambaqos

mwevelebi da aReniSnebodaT gulis ukmarisoba. es monacemebi

saSualebas gvaZlevs davaskvnaT, rom gid risk-faqtorebis

modificireba intervenciuli Terapiis gadavadebis saSualebas

iZleva.

amrigad, am monacemebidan gamomdinareobs, rom asakis da

sqesis gaTvaliswinebis gareSe, miokardiumis infarqtiT

sikvdilobis yvelaze mniSvnelovani risk-faqtori arteriuli

hipertenziaa. qalebSi am faqtors emateba Saqriani diabeti da

sxeulis wona. mamakacebSi sikvdilobis ZiriTadi risk-

faqtorebia arteriuli hipertenzia da Tambaqo. aseve

modificirebadi risk-faqtorebis koreqcia zrdis

Trombolizuri Terapiis efeqturobas rogorc xanmokle, ise

xangrZlivi dakvirvebis periodSi.

82

d a s k v n e b i

1. gid risk-faqtorebis modificireba SesaZleblobas iZleva

Semcirdes daavadebis gamwvavebis sixSire da gaizardos

sicocxlis xangrZlivoba im avadmyofebSi, romelTac ar

CatarebiaT angioplastika an aorto-koronaruli Suntireba.

2. iseT modificirebad risk-faqtorebze zemoqmedeba, rogoricaa

Tambaqos weva, simsuqne, hipodinamia, mkveTrad amcirebs

miokardiumis infarqtis ganviTarebis sixSires, garTulebebsa

da sikvdilobas rogorc Trombolizisis, ise sakontrolo

jgufSi.

3. modificirebadi garegani risk-faqtorebidan yvelaze did da

xangrZliv efeqts iZleva Tambaqos wevis mitoveba, Semdeg

modis sxva garegani risk-faqtorebi. aqedan gamomdinare,

aucilebelia am mimarTulebiT profilaqtikuri RonisZiebebis

gatareba. aseTive xangrZliv remisias iZleva arteriuli wnevis

mudmivi monitoringi ambulatoriul pirobebSi.

4. Trombolizur TerapiasTan erTad arteriuli wnevis, sisxlSi

lipidebis da glukozis donis mowesrigeba sarwmunod

amcirebs miokardiumis infarqtis ganviTarebis sixSires,

garTulebebs da sikvdilobas sakontrolo jgufTan

SedarebiT.

5. Trombolizuri Terapia intervenculi Terapiis alternatiul

meTods warmoadgens, romliTac SesaZlebeli xdeba

miokardiumis infarqtis ganviTarebis gadavadeba an misi zomis

mkveTri Semcireba.

83

6. 32% avadmyofebSi Trombolizisis Semdeg 1 wlis ganmavlobaSi

aucilebeli gaxda intervenciuli Terapia, rac kidev erTxel

adasturebs im faqts, rom Trombolizisi aris Sualeduri

procedura intervenciul mkurnalobamde, magram rogorc

garegani, aseve Sinagani risk-faqtorebis modificireba

intervenciuli Terapiis gadavadebis saSualebas iZleva.

praqtikuli rekomendaciebi

1. miokardiumis mwvave infarqtis dros sikvdilobis riskis

xarisxis da garTulebebis profilaqtikisTvis mizanSewonilia

gid modificirebadi garegani da Sinagani risk-faqtorebis

gamovlena.

2. gid modificirebadi risk-faqtorebis drouli gamovlena da

masze zemoqmedeba saSualebas miscems pacients, `gadaavados~

intervenciuli Terapiuli RonisZiebebi miokardiumis mwvave

infarqtis SesaZlo ganviTarebis, garTulebebisa da

sikvdilobis Semcirebis mizniT.

3. Trombolizuri Terapiis Catarebis Semdeg aucilebelia gid

meoradi profilaqtika ambulatoriul pirobebSi, mimarTuli

risk-faqtorebis modificirebisken.

4. Trombolizuri Terapiis Semdgom gid risk-faqtorebis

modificirebasTan erTad pacientebi aucileblad saWiroeben

koronarografias mkurnalobis meTodis SesarCevad.

84

l i t e r a t u r a

1. gerzmava a, gurgeniZe R. Tambaqos moweva, rogorc socialuri

problema. `sazogadoebrivi jandacvis zedamxedvelobis

sainformacio sistemebis Sesaxeb~ konferenciis masalebi.

Tbilisi, 1996: 45.

2. TaTaraZe r. gul-sisxlZarRvTa daavadebebis prevencia

pirveladi samedicino rgolis praqtikaSi. Tbilisi 1999: 13-59.

3. megrelaZe i., gorgoSiZe m, avaliani S. gulis iSemiuri

daavadebis pirveladi prevencia. Tbilisi 1999:17-22.

4. sumbaZe n. gul-sisxlZarRvTa daavadebaTa risk-faqtorebis

Tavidan acilebis efeqturi zomebis dagegmvisaTvis. `qronikul

daavadebaTa epidemiologia da profilaqtika~ (konferenciis

masalebi. Tbilisi, 1998:36-37.

5. trapaiZe d, sxirtlaZe l, abesaZe T da sxv. brZola Tambaqos,

rogorc arainfeqciur daavadebaTa erTerTi ZiriTadi risk-

faqtoris winaaRmdeg. `qronikul daavadebaTa epidemiologia

da profilaqtika~ (konferenciis masalebi. Tbilisi, 1998:38.

6. uruSaZe r, TaTaraZe r, avaliani n. gul-sisxlZarRvTa da sxva

arainfeqciur daavadebaTa prevenciis strategiis politikis

ganviTareba saqarTveloSi. `qronikul daavadebaTa

epidemiologia da profilaqtika~ (konferenciis masalebi.

Tbilisi, 1998:1-7.

7. qobulia b, burdiSvili b, burkaZe n da sxv. gul-

sisxlZarRvTa ZiriTadi daavadebebis (arteriuli hipertenzia,

gulis iSemiuri daavadeba) prevenciis erovnuli programa.

`qronikul daavadebaTa epidemiologia da profilaqtika~

(konferenciis masalebi. Tbilisi, 1998:42-43.

85

8. qobulia b, CafiCaZe z. Trombinis specifkuri inhibitori

bivalirudinis (hirulongi) Sedareba heparinTan

streqtokinaziT miokardiumis mwvave infarqtis mkurnalobis

dros. HERO-2 randomizebuli kvleva. `gul-sisxlZarRvTa

sistemis daavadebaTa prevenciis, diagnostikis da

mkurnalobis Tanamedrove aspeqtebi~ (konferenciis masalebi).

Tbilisi 2002:9-10.

9. SaraSiZe n, saaTaSvili g. miokardiumis infarqtis Semdgomi

periodis marTva. postinfarqtuli periodis marTva –

reabilitacia da meoreuli profilaqtika. (leqciebis

krebuli, saswavlo-meToduri rekomendacia eqimebisa da

studentebisTvis). Tbilisi, 2002:9-23.

10. xviTaria d, mdivani s, dumbaZe n. gulis iSemiuri daavadebis

prevencia, miokardiumis infarqtis Semdeg cxovrebis stilis

Secvla. postinfarqtuli periodis marTva – reabilitacia da

meoreuli profilaqtika. (leqciebis krebuli, saswavlo-

meToduri rekomendacia eqimebisa da studentebisTvis).

Tbilisi, 2002:23-29.

11. Абина Е.А.,Волож О.И.,Солодкая З.С. и др. Динамика распространенности

ишемической болезни сердца у населения Таллина 30-54 лет с 1984 по 1994

г. Кардиология 1997;6:13-18.

12. АкимоваЕ.В., Гафаров В.В., Драчева Л.В. и др. Изучение

распространенности и интенсивности курения среди взрослого населения

Тюмени с использованием почтового опроса (популяционного

исследования). Тер арх 2000;1:33-35.

13. Алмазов В.А., Чирейкин Л.В., Тожиев М.С. и др. Эффективность первичной

и вторичной профилактики заболеваний сердечно-сосудистой системы в

86

организованных коллективах при исполбзовании автоматизированных

систем. Здравоохр. Рос. Федерации 1993;4:3-5.

14. Балахметова С.А., Жапарханова З.С. Среднее значение показателей

факторов риска ишемической болезни сердца и их процентильные

распределения в алма-атинской популяции мужчин 20-40 лет. Тер арх

991;1:17-20.

15. Блужас Й., Реклайтенс Р., Тамошюнас А.А. и др. Распространенность

ишемической болезни сердца и показатели смертности у населения Каунаса

35-64 лет по данным проспективного исследования. Кардиология 2002;2:72-

75.

16. Валеева Р.М., Лещинский Л.А. Особенности клиники, диагностики и

терапии инфаркта миокарда у лиц старшей возрастной группы. Клин.

геронтол. 2001;7(5-6):53-56.

17. Волож О.И. Мутсо Ю.Х. Распространенность ишемической болезни сердца

и основные факторы риска среди мужчин 35-59 лет в таллине. Кардиология

1984;11:20-24.

18. Волож О.И.. Саава М.Э., Тур И.П. и др. Факторы риска ишемической

болезни сердца и атеросклероза у жителей Таллина: связь с возрастом,

полом, этнической принадлежностью (популяционное исследование).

Кардиология 1991;7:20-24.

19. Гафаров В.В. Эпидемиология и профилактика сердечно-сосудистых

заболеваний в условиях крупного промышленного центра Западной

сибирию Новосибирск. 1992.

20. Гафаров В.В., Виноградова Т.Е., Воеводова М.И. и др. Эпидемиология

ишемической болезни сердца, сосудистых заболеваний головного мозга, их

факторов риска в открытой популяции 25-64 лет Новосибирска. Тер арх

1991;9:80-83.

87

21. Гафаров В.В., Гагулин И.В. Популяционное исследование социально-

психолгических факторв риска ишемической болезни сердца в мужской

популяции Новосибирска. Тер арх 2000;4:40-43.

22. Глазунов И.С. О критериях ишемической болезни сердца в

эпидемиологических исследованиях (эпидемиология артериальной

гипертонии и коронарного атеросклероза). Под ред. И.А. Рывкина. М.

1968;170-176.

23. Дамионаитене Р.А. Баубинене А.В., Кучинскене З.З. Распространенность

ишемической болезни сердца и ее факторов риска и возможность коррекции

последних в условиях организованного контингента. Кардиология

1987;9:101-102.

24. Доборджгинидзе Л.М., Грацианский Н.А., Масенко В.П. и др.

Триглицериды, но не С-реактивный белок независимо связаны с наличием

коронарной болезни сердца у женщин 45-55 лет. Кардиология 2001;4:12-19.

25. Доборджгинидзе Л.М., Нечаева А.С., Грацианский Н.А. Метаболические

факторы риска у женщин с преждевременной ишемической болезнью

сердца. Кардиология 1999;98:31-40.

26. Жуковский Г.С. Основные факторы риска и ИБС у мужчин трудоспосоного

возраста (20-59 лет). Бюл ВКНЦ АМН СССР 1984;1:70-78.

27. Замотаев Ю.Н., Кремнев Ю.А., Мандрыкин Ю.В. Сравнительная оценка

факторов риска ишемической болезни сердца у военнослужащих,

перенесших операцию аортокоронарного шунтирования. Кардиология

2001;8:34-37.

28. Зяблов Ю.И., Округин С.А., Орлова С.Д.Возникновение, течение и

ближайщий исход острого инфаркта миокарда у мужчин и женщин. Клин.

мед. 2001;11Ж26-28.

29. Иванов А.Г., Опалева-СтеганцеваВ.А. Выживаемость больных с острым

инфарктом миокарда. Здравоохр. Рос. Федерации 1991;3:26.

88

30. Калинина А.М., Чазова Л.В., Павлова Л.И и др. Отдаленные результаты

проведения программы многофакторной профилактики ишемической

болезни сердца в Москве (10-летнее наблюдение). Кардиология 1993;4:23-

28.

31. Карпов Р.С., Дудко В.И. Современные проблемы атеросклероза. Врач

2000;2:7.

32. Климов А.Н. Эподемиология и факторы риска ишемической болезни сердца.

Л: Медицина 1989;174.

33. Константинов В.В., Жуковский Г.С. Ишемическая болезнь сердца, факторы

риска среди мужского населения в связи с уровнем образования. .

Кардиология 1996;1:37-41.

34. Константинов В.В., Жуковский Г.С., Жданов В.С. и др. Факторы риска,

ишемическая болезнь сердца и атеросклероз среди мужчин коренной и

некоренной национальности в городах некоторых регионов. Кардиология

1997;6:19-23.

35. Константинов В.В., Жуковский Г.С., Шестов Д.Б. и др. Эподемиология

ишемической болезни сердца и ее связь с основными факторами риска среди

мужского населения в некоторых городах СССР (кооперативное

исследование). Тер. арх.1991;1:11-16.

36. Константинов В.В., Деев А.Д., Капустина А.В. и др. Связь потребления

алкоголя с факторами риска и смертностью от сердечно-сосудистых и

некоторых других хронических неинфекционных заболеваний среди

мужского населения (по материалам одномоментного исследования и 20-

летнего проспективного наблюдения). Кардиология 1998;2:29-36.

37. Константинов В.В., Деев А.Д., Капустина А.В. и др. Распространенность

избыточной массы тела и ее связь со смертностью от сердечно-сосудистых и

других хронических неинфекционных заболеваний среди мужского

населения в городах разных регионов. Кардиология 2002;10:45-49.

89

38. Люсов В.А. Инфаркт миокарда (по материаламактивной речи на заседании

Ученого совета Росийского государственного медицинского университета,

посвященного 100-летнему юбилею П.Е. Лукомского). Кардиология

1999;9:8-12.

39. Малютина С.К. Стенокардия напряжения, выявленная в

эпидемиологическом исследовании, при сопоставлении с результатами

комплекса нагрузочных ЭКГ проб.

40. Мелле Ф., Школьников В.,Эртриш В и др. Современные тенденции

смертности по причинам смерти в России (196501994) Национальный

институт демографических исследований (Париж), Центр демографии и

экологии человека (Москва). INED-27, rue du Commandeur-75675 Paris Cedex

14, 1996;2:140.

41. Никитин Ю.П., Воевода М.И., Максимов В.Н. и др. Распространенность

наследственной отягощенности по ишемической болезни сердца в

неорганизованной популяции Новосибирска и ее связь с этим заболеванием.

Кардиология 2001;4:20-22.

42. Никитин Ю.П., Малютина С.К. Симонова Г.И. и др. Сердечно-сосудистые

заболевания в Сибири (Сибирская МОНИКА). В кн.:Диагностика, лечение и

профилактика сердечно-сосудистых заболеваний. Новосибирск 1996;103-

104.

43. Никитин Ю.П.,Казека Г.Р. Бабин В.П. и др. Распространенность

ишемической болезни сердца у лиц с гиперинсулинемией (популяционное

исследование) Кардиология 2001;1:12-15.

44. Оганов Р.Г. Первичная профилактика ИБС. М: Медицина 1990;158.

45. Оганов Р.Г. Успехи и проблемы профилактики сердечно-сосудистых

заболеваний в конце ХХ века. Профилактика заболеваний и укрепление

здоровья 1998;5:3-9.

46. Оганов Р.Г.Смертность от сердечно-сосудистых заболеваний в России и

некоторые влияющие на нее факторы. Кардиология 1994;3:80-83.

90

47. Оганов Р.Г. Масленникова Г.Я. Сердечно-сосудистые заболевания в

Российской Федерации во второй половине ХХ столетия: тенденции,

возможные причины, перспективы. . Кардиология 2000;6:4-7.

48. Оганов Р.Г., Деев А.Д., Жуковский Г.С и др. Влияние курения на смертность

от хронических неинфекционных заболеваний по результатам

проспективного исследования. Профилактика заболеваний и укрепление

здоровья 1998;3:13-15.

49. Оганов Р.Г., Александрова В.Ю., Суслова Е.А. и др. Динамика

распространенности психосоциальных факторов риска при хронических

неинфекционных заболеваний в 1988-1994гг. Медицинская наука Армении

1997;3(4):165-169.

50. Павлова Л.И., Чазова Л.В., Калинина А.М. и др. Изучение показателей

смертности в программе многофакторной профилактики ишемической

болезни сердца. Тер арх. 1991;1:35-38.

51. Перова Н.В. Суммарный риск ИБС и показания к лечению

гиперхолестеринемии (применение европейских рекомендации 1994 г к

росийским условиям). Кардиология 1996;3:47-53.

52. Плавинская С.Ш. Шестов Д.Б. Связь ряда гормональных показателей с

факторами риска ИБС и ее распространенностью по данным крупного

популяционного исследования. Тер. арх 1995;9:17-21.

53. Плавинская С.Ш., Шестов Д.Б.Сравнительная характеристика смертности

мужчин и женщин от основных сердечно-сосудистых заболеваний по

данным проспективного исследования. Тер арх. 1991;12:69-73.

54. Плавинский С.Л. Повышение уровня продуктов перекисного окисления

липидов как фактор риска смерти в проспективном исследовании. Физиол

человека 2002;1Ж116-20.

55. Роуз Д. Эпидемиологические методы изучения сердечно-сосудистых

заболеваний. ВОЗ (Женева) 1984;207-210.

91

56. Свистов А.С. Галиуллина Р.Х. Обрезан А.Г. Особенности факторов риска

ишемической болезни сердца, данных велоэргометрических проб, суточного

монитирирования ЭКГ и коронарографии у женщин молодого возраста,

перенесших инфаркт миокарда. . Кардиология 2003;3:54-58.

57. Семисотова Е.Ф. Инфаркт Миокарда у людей пожилого и старческого

возраста. Владивосток: Дальнаука; 1994.

58. Тамошюнас А.А., Домаркене С.Б., Реклайтене Р.А. и др. Сравнительная

оценка смертности и заболеваемости ишемической болезнью сердца среди

участников и неучастников популяционного исследования. Кардиология

1989;3:78-81.

59. Тожиев М.С., Воробьев А.М., Цветкова Т.Л. и др. Распространенность

ишемической болезни сердца. ее факторов риска и результаты длительной

многофакторной профилактики заболевания у рабочих и служащих

организованных коллективов. Под ред. В.А. Алмазова, Л.В. Чирейкина. Л

1990;5-10.

60. Тожиев М.С.,Шестов Д.Б. Быков И.Н. и др. Динамика распространенности

сердечно-сосудистых заболеваний и результаты многофакторной

профилактики при многолетних наблюдениях в организованных

коллективах. Тер арх. 2000;1:11-15.

61. Тожиев М.С., Норбеков М.С., Шестов Д.Б. Распространенность

ишемической болезни сердца, основных факторов риска ее развития и

эффективность многолетней многофакторной профилактики на

предприятиях в ряде регионов России. Тер арх. 2004;1:33-37.

62. Трубочева В.В., Жуковский Г.С., Тимофеева Т.Н. Эпидемиологическая

характеристика взрослой (25-64 лет) неорганизованной популяции г. Томска

по распространенности ишемической болезни сердца, основных

модифицируемых факторов риска и уровню информированности. Томск;

2000:192-195.

92

63. Халтаев Н.Г., Жуковский Г.С., Халтаева Е.Д. и др. Возрастная динамика и

распространенности ишемической болезни сердца, артериальной гипертонии

и средний уровень факторов риска у мужчин в возрасте 20-69 лет в связи с

характером питания. Тер арх. 1985;1:17-21.

64. Халтаева У.Д., Халтаев Н.Г. Избыточная масса тела, ишемическая болезнь

сердца и факторы риска. Кардиология 1982;8:11-15.

65. Шальнова С.А., Деев А.Д., Оганов Р.Г . Распространенность курения в

России. Результаты обследования национальной представительной выборки

населения. Профилактика заболеваний и укрепление здоровья 1998;3:9-12.

66. Шестов Д.Б., Деев А.Д., Жуковский Г.С. Итоги 7-летнего проспективного

изучения смертности в выборочных группах мужчин в Москве и

Ленинграде. В кн.: Эподемиология и факторы риска ишемической болезни

сердца. Под ред. А.Н. Климова. Л: Медицина 1989;11-123.

67. Чазова Л.В. Глазунов И.С. Баубинене А.В. и др. Многофакторная

профилактика ишемической болезни сердца (кооперативное исследование).

Бюл Всесоюз кардиол науч центра 1983;1:43-48.

68. Чурина С.К. Притыкина Н.Я. Жуковская Н.Е. Некоторые оссобенности

патогенеза ИБС у женщин до 50 лет (до наступления менопаузы). Тер. арх

1975;12:43-48.

69. Чурина С.К. Особенности патогенеза ишемической болезни сердца у

женщин молодого и среднего возрастс. Л: Наука 1983;133.

70. AHA Scientific Statement Evidence-Vased Guidelines for Cardiovascular Disease

Prevention in Women. Circulation 2004;109:672-693.

71. Alegret JM, Marty V, Rodrigez-Font E et al. Effect of thrombolysis in the

evolution of right bundle-branch block complicationg an acute myocardial

infarction. Acta Cardiol.2001 Oct;56(5):297-301.

72. Allen JK, Young DR, Blumenthal RS et al. Prevalence of hypercholesterolemia

among siblings of persons with premature coronary heart disease. Application of

93

the Second Adult Treatment Panel guidelines. Arch Intern Med 1996;156:1654-

1660.

73. American Heart Association. Heart Disease and Stroke Statistics – 2003 Update.

Dallas, Tex: American Heart Association; 2002.

74. Austin MA.Plasma triglyceride as a risk factor for coronary heart disease : the

epidemiologic evedense and beyond. Am J Epidemiol 1989;129:249-259.

75. Barren-Connor E, Cohn БА, Wingard DL, Edelstein SL: Why is diabetes mellitus

a stronger risk factor for fatal ischemic heart disease in women than in men?

JAMA 265:627-631,1991. 63. USRDS 1995 Annual Data Report: incidence and

causes of treated ESRD. Am J Kidney Dis 26:539-550,1995.

76. Barbir M, Wile D, Trayner I et al. High prevalence of hypertriglyceridemia and

apolipoprotein abnormalities in coronary artery disease. Br. Heart J.

1988;112:432-437.

77. Betterige DJ, Morrell JM. Clinicians ' guide to lipids and coronary heart disease.

London. Neinheim. New York: Chapman and hall medical 1998;276.

78. Bray GA. Obesity increases risk of diabetes. Int J Obesity. 1992;16 (SupplE):513-

7.

79. Brauwald E. Evolution of the management of acute myocardial infarction: a 20th

century saga. Lancet 1998; 352: 1771-4.

80. Castelli WP. Lipids, risk factors and ischemic heart disease. Atherosclerosis.

1996;124(suppl):S1-S9.

81. Castelli WP. The triglyceride issue. A view from Framingem. Am Heart J

1986;112:432-437.

82. Colditz GA, Willet WC, Rotsnitzky A, Manson JE: Weight gain as a risk factor

for clinical diabetes in women. Ann Intern Med. 122:481-486,1995.

83. Conroy RM, Mulcahy R, Hickey N et al. Is a family history of coronary heart

disease an independent risk factor? Br Heart J 1985;53:378-381.

94

84. Cragg D.R., Friedman H.Z., Bonema J.D., Jaiyesimi I.S., Ramos R.G., Timmis

G.C., et al. Outcome of patients with acute myocardial infarction who are

ineligible for thrombolytic therapy. Ann Intern Med 1991;115:173—7.

85. Dangas G, Fier C, Ambrose Ja. Thrombolytic therapy in acute myocardial

infarction. Drugs Today (Barc) 1998 Aug;34(8):727-36.

86. Diethrich EB, Cohan C. Women and heart disease. New York: Ballantine books

1994;314.

87. Dittrich H., Gilpin E., Nicod P., Cali G., Henning H., Ross J. Jr. Acute myocardial

infarction in women: influence of gender on mortality and prognostic variables.

Am J Cardiol 1988;62:1—7.

88. Donnan PT, Boyle DL, Broomhall J et al. Prognosis following first acute

myocardial infarction in Type 2 diabetes: a comparative population study. Diabet

med 2002 Jun;19(6):448-55.

89. Dubois С., Pierard L.A., Albert A., Smeets J.P., Demoulin J.C., Boland J., et al.

Short-term risk stratification at admission based on simple clinical data in acute

myocardial infarction. Am J Cardiol 1988;61:216—9.

90. Eldar M., Sievner Z., Goldbourt U., Reicher-Reiss H., Kaplinsky E., Behar S.

Primary ventricular tachycardia in acute myocardial infarction: clinical

characteristics and mortality. The SPRINT Study Group. Ann Intern Med 1992;

117:31—6.

91. Eschwege E, Richard JL, Thibult N et al. Coronary heart disease mortality in

relation to diabetes, blood glucose and plasma insulin levels. The Paris

Prospective Study, ten years later. Horm Metab Res 1985;15:Suppl:Series:41-46.

92. Evans M, Roberts A, Reese A. The future direction of cholesterol-lowering

therapy. Curr Opin Lipidol. 2002;13:663-669.

93. European Atherosclerosis Society Study Group. Strategies for the prevention of

coronary artery disease: a policy statement of the European Atherosclerosis

Society. Eur Heart J. 1987;8:77-88.

95

94. Europian guidelines of CVD prevention. To improve the quality of clinical

practice and patient care in Europe. Third Joint European Societies Task Force of

Cardiovascular Disease Prevention in Clinical Practice.

95. Fallen E.L., Armstrong P., Cairns J., Dafoe W., Frasure-Smith N., Langer A., et

al. Report of the Canadian Cardiovascular Society's consensus conference on

Management of the Postmyocardial Infarction Patient. Can Med Assoc J

1991;144:1015—25.

96. Fiebach N.H., Viscoli C.M., Horwitz R.I. Differences between women and men in

survival after myocardial infarction. Biology or methodology? JAMA

1990;263:1092—6.

97. Flack JM, Sowers J.R. Epidemiologic and clinical aspects of insulin resistance and

hyperinsulinemia. Am J Med 1991;91(Suppl 1A):11-21.

98. Fleischmann K.E., Goldman L., Robiolio P.A., Lee R.T., Johnson P.A., Cook

E.F., et al. Echocardiographic correlates of survival in patients with chest pain. J

Am Coll Cardiol 1994;23:1390—6.

99. Goldmen L, Phillips KA, Coxcon P et al. The effect of risk factor reductions

between 1981 and 1990 on coronary heart disease incidence, prevalence, mortality

and cost. J Am Coll Cardiol. 2001;38:1012-1017.

100. Gomes J.A., Winters S.L., Stewart D., Horowitz S., Milner M., Barreca P. A

new noninvasive index to predict sustained ventricular tachycardia and sudden

death in the first year after myocardial infarction: based on signal-averaged

electrocardiogram, radionuclide ejection fraction and Holter monitoring.

J Am Coll Cardiol 1987;10:349—57.

101. Gotto AM. Triglyceride as a risk factor for coronary artery disease. Am J

Cardiol 1998;82:9A:22-25.

102. Gordon DJ, Probstfield JL, Garrison RJ et al. High-density lipoprotein

cholesterol and cardiovascular disease: four prospective American studies.

Circulation.1989;79:8-15.

96

103. Grines C.L., Topol E.J., O'Neill W.W., George B.S., Kereiakes D., Phillips

H.R., et al. Effect of cigarette smoking on outcome after thrombolytic therapy for

myocardial infarction. Circulation 1995;91:298—303.

104. Greenberg H., McMaster P., Dwyer E.M. Jr. Left ventricular dysfunction after

acute myocardial infarction: results of a prospective multicenter study. J Am Coll

Cardiol 1984;4:867—74.

105. Grundy SM. Hypertriglyceridemia, insulin resistance and the metabolic

syndrome. Am J Cardiol 1999;83:25F-29F.

106. Grundy SM, Howard B, Smith S Jr et al. Prevention conference VI:Diabetes

and Cardiovascular Disease:executive summary: conference proceeding for

healthcare proffesionals from a special writing group of the American

Association. Circulation 2002;105:2231-2239.

107. Gurwitz J.H., Gore J.M., Goldberg R.J., Rubison M., Chandra N., Rogers W.J.

Recent age-related trends in the use of thrombolytic therapy in patients who have

had acute myocardial infarction. National Registry of Myocardial Infarction. Ann

Intern Med 1996;124:283—91.

108. Haragreaves AD, Logan RL, Elton RA et al. Glucose tolerance, plasma insulin,

HDL cholesterol and obesity:12-year follow-up and development of coronary

heart disease in Edinburg men. Atherosclerosis 1992;94:61-69.

109. Henning H., Gilpin E.A., Covell J.W., Swan E.A., O'Rourke R.A., Ross J. Jr.

Prognosis after acute myocardial infarction: a multivariate analysis of mortality

and survival. Circulation 1979;59:1124—36.

110. Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for

cardiovascular disease independent of high-density lipoprotein cholesterol level: a

meta-analysis of population-based prospective studies. J Cardiovasc Rsk.

1996;3:213-219.

111. Hooper L, Summerbell CD, Higgins JPT et al. Dietary fat intake and

prevention of cardiovascular disease: systematic review. BMJ 2001;322:757-763.

97

112. Hjermann I, Byre KV, Holme I et al. Effect of diet and smoking intervention

on the incidence of coronary heart disease. Lancet.1981;ii:1303-1310.

113. Hjermann I, Holme I, Leren P. Oslo Study Diet and Antismoking Trial: results

after 102 months. Am J Med 1986;80(suppl 2A):7-11.

114. Hsu LF, Mak KH, Lau KW et al. Clincal outcomes of patients with diabetes

mellitus and acute myocardial infarction treated with primary angioplasty or

fibrinolysis. Heart 2002 Sep;88(3):260-5.

115. Jousilahti P, Tuomilehto J, Varianinen E et al. Body Weight, Cardiovascular

Risk Factors and Coronary Mortality . 15-year follow-up of middle-aged men and

women in eastern Finland. Circulation 1996;93:1372-1379.

116. Kandelaki M, Tavadze T, Abashidze M et al. Coronary artery disease absolute

risk development in subsequent decade in Tbilisi population. GMN

2003;12(105:18-20.

117. Kannel WB, Neaton JD, Wentworth DD et al. Overal and coronary heart

disease mortality rats in relation to major risk factors in 325 348 men screened for

the MRFIT. Am Heart J 1986;112:825-836.

118. Kannel WB, Wilson PW. Risk factors that attenuate the female coronary

disease advantage. Arch Intern Med. 1995;155:57-61.

119. Kannel WB. Coronary heart disease risk factors in the elderly. Am J Geriatr

Cardiol. 2002;11:101-107.

120. Keys A. Seven countries: a multivariate analisis of deth and Coronary heart

disease. Cambridge, Massachusetts: Harvard University Press 1980;381.

121. Kipshidze N, Khachidze E, Kakauridze N. Some metabolic risk-factors in

women with arterial hypertension. GMN 2003;12(105):36-38.

122. Kipshidze N, Chaduneli EP, Lobzhanidze TV et al. The vascular wall

functional activity in coronary heart disease in heredity family members. GMN

2003;12(105):20-22.

98

123. Kromhout D, Coulader C, Arntrenius A et al. Changes in body weight and total

cholesterol and their effect on CHD in the Zutpten Study and the leiden

intervention trial. CVD Epidemiol Newslet 1984;35:61.

124. Krumholz H.M. The clinical challenges of myocardial infarction in the elderly.

West J Med 1989;151:304—10.

125. Lamarche B, Tchernof A, Moorjani S et al. Small dense low-density

lipoprotein particles as a predictor of risks of ischemic heart disease. Circulation

1997;95:69-75.

126. Lee K.L., Woodlief L.H., Topol E.J., Weaver W.D., Betriu A., Col J., et al.

Predictors of 30-day mortality in the era of reperfusion for acute myocardial

infarction. Results from an international trial of 41,021 patients. GUSTO-1

Investigators. Circulation 1995;91:1659—68.

127. Leren P. The effect of plasma cholesterol lowering diet in male survivors of

myocardial infarction: a controlled clinical trial. Acta Med Scand Suppl.

1966;466:1-92.

128. Leren P. The oslo Diet-Heart Study; eleven-year report. Circulation.

1970;42:935-942.

129. Lincoff A.M., Califf R.M., Ellis S.G., Sigmon K.N., Lee K.L., Topol E.J.

Thrombolytic therapy for women with myocardial infarction: is there a gender

gap? Thrombolysis and Angioplasty in Myocardial Infarction Study Group. J Am

Coll Cardiol 1993;22:1780—7.

130. Ludwigs U, Csatlos M, Hulting J. Predicting in-hospital mortality in acute

myocardial infarction: impact of thrombolytic therapy on APACHE II

performance. Scand Cardiovasc J 2000 Aug;34(4):371-6.

131. Madsen Е.В., Gilpin E., Henning H. Short-term prognosis in acute myocardial

infarction: evaluation of different prediction methods. Am Heart J

1984;107:1241—51.

132. Manson JE, Willet WC, Sampler MJ et al. Body weight and mortality among

women. N Engl J Med 1995;333:677-81.

99

133. Marchlinski F.E., Buxton A.E., Waxton H.L., Josephson M.E. Identifying

patients at risk of sudden death after myocardial infarction: value of the response

to programmed stimulation, degree of ventricular ectopic activity and severity of

left ventricular dysfunction. Am J Cardiol 1983;52:1190—6.

134. Martin M.J, Hulley SB, Browner WS et al. Serum cholesterol, blood pressure

and mortality: implications from a cohort of 36 16162 men/ Lancet 1986;2:993-

936.

135. Martinez Sandle JL, Gonzales-Juanatery JR, Garcia-Acuna JM et al. Influence

of systemic arterial hypertension on mid-term survival of patients with acute

myocardial infarction treated with fibrinolytic agents. Med Clin (Barc) 1997Oct

25;109(14):532-7.

136. Mauri F, Franzosi MG, Maggioni AP et al. Clinical value of 12-lead

electrocardiography to predict the long-term prognosis of GISSI-1 patients. J Am

Coll Cardiol. 2002 May 15;39(10): 1594-600.

137. Morris R.M., Barnaby P.F., Brandt P.W., Geary G.G., Whitlock R.M., Wild

C.J., et al. Prognosis after recovery from first acute myocardial infarction:

determinants of reinfarction and sudden death. Am J Cardiol 1984;53:408—13.

138. Moss A.J. Prognosis after myocardial infarction. Am J Cardiol 1983;52:667—

9.

139. Mukharji J., Rude R.E., Poole W.K., Gustafson N., Thomas L.J. Jr., Strauss

H.W., et al. Risk factors for sudden death after acute myocardial infarction: two-

year follow-up. Am J Cardiol 1984;54:31—6.

140. Nicolau JC, Auxiliadora Ferraz M, Nogueira PR et al. The role of gender in the

long-term prognosis of patients with myocardial infarction submitted to

fibrinolytic treatment. Ann Epidemiol 2004 Jan;14(1):17-23.

141. Nishimura R.A., Tajik A.J., Shub C., Miller F.A. Jr., Ilstrup D.M., Harrison

C.E. Role of two-dimensional echocardiography in the prediction of in-hospital

complications after acute myocardial infarction. J Am Coll Cardiol 1984;4:1080—

7.

100

142. Nora JJ, Lortscher RH, Spangler RD et al. Genetic-epidemiological study of

early-onset ischemic heart disease. Circulation 1980;61:504-508.

143. Otasevic P, Nescovic AN, Popovic Z et al. Effect of thrombolytic therapy on

occurrence of complex ventricular arrhythmias in the late hospitalization period in

acute myocardial infarct: relation with long-term remodeling of left ventricle.

Vojnosanit Pregl. 2003 Sep-Oct;60(5):547-53.

144. Pavlikova EP, Tereshchenko CN, Karavaeva et al. Thrombolytiv therapy of

acute myocardial infarction in elderly patients. Immediate and long-term remote

prognosis. Kardiologia2002;42(4):12-18.

145. Pedersen TR, Kjekshus J, Berg K, et al. Randomized Trial of Cholesterol

lowering in 4444 Patients with Coronary Heart Disease: The Scandinavian

Simvastatin Survival Study (4S). Lancet 1994; 344: 1383-9.

146. Pilote L, Miller DP, Califf RM et al. Recurrent ischemia after thrombolysis for

acute myocardial infarction. Am Heart J 2001 Apr;14(4):559-65.

147. Prevention of coronary heart disease: Scientific background and new clinical

guidelines. Recommendations of the European Atherosclerosis Society prepared

by the International Task Force for Prevention of Coronary heart disease. Nat

Metab cardiovasc Dis 1992;2:113-156.

148. Prevention of coronary heart disease in clinical practice. Recommendations of

the Task Force of the European Society of Cardiology, European Atherosclerosis

Society and European Society oh Hypertension. Eur Heart J 1994;15:1300-1331.

149. Ribeiro DG, de Andrade PJ, paes J et al. Acute myocardial infarction:

predictors of mortality at a public hospital in the city of Fortaleza. Arq Bras

Cardiol 2003 Jun;80(6):614-20.

150. Risk stratification and survival after myocardial infarction. Multicenter Post-

Infarction Research Group. N Engl J Med 1983;309:321—6.

151. Roncaglioni MC, Santoro L, D'Avanzo B et al. Role of family history in

patients with myocardial infarction. An Italian case-contrl study GISSI-EFRIM

Investigators. Circulation 1992;85:2065-2072.

101

152. Sacks FM, Pfeffer MA, Move LA, et al. The Effect of Pravastatin on Coronary

Events After Myocardial Infarction in Patients with Average Cholesterol Levels.

The Cholesterol and Recurrent Events Trial (CARE). N Engl J Med 1996; 335:

1001-9.

153. Sans S, Kesteloot H, Kromhout D. on benefit of the Task Force. The burden of

cardiovascular diseases mortality in Europe. Task Force of the European Society

of Cardiology on cardiovascular mortality and morbidity dtatistics in Europe. Eur

Heart J 1997;18:1231-1248.

154. Skafar DF, Xu R, Morales J, Ram J, Sowers JR: Female sex hormones and

cardiovascular disease in women. J Clin Endocrinol Metab 82:3913-3918,1997.

155. Silver M.T., Rose G.A., Paul S.D., O'Donnell C.J., O'Gara P.T., Eagle K.A. A

clinical rule to predict preserved left ventricular ejection fraction in patients after

myocardial infarction. Ann Intern Med 1994;121:750—6.

156. Sowers J.R. Obesity and cardiovascular disease. Clinical chemistry

1998;44:1821-1825.

157. Sowers J.R. Ferrow SL. Treatment of elderly hypertensive patients with

diabetes, renal diseaseand coronary heart disease. Am J Geriat Cardiol 1996;5:57-

70.

158. Sowers J.R.Epstein M. Diabetes mellitus and hypertension: an update.

Hypertension 1995;26:869-79.

159. Sowers JR; Diabetes mellitus and cardiovascular disease in women. Arch

intern Med 158:617-621,1998.

160. St. John Sutton M., Pfeffer M.A., Plappert T. Rouleau J.L., Moye L.A.,

Dagenais G.R., et al. Quantitative two-dimensional echocardiographic

measurements are major predictors of adverse cardiovascular events after acute

myocardial infarction. The protective effects of captopril. Circulation 1994;

89:68—75.

102

161. Superco HR, Krauss RM. Coronary artery disease regression. Convincing

evidence for the benefit of aggressive lipoprotein management. Circulation

1994;90:1059-1069.

162. Terol I, Lorenzo J, Quintana E et al. Epidemiological Study and coronary heart

disease and risk factors in 100 men. In: International Conference on Preventive

Cardiology: Moscow 1985;100:Abstr.

163. The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID)

Study Group. Prevention of Cardiovascular Events and Death with Pravastatin in

Patients with Coronary Heart Disease and a Broad Range of Initial Cholesterol

Levels. N Engl J Med 1998; 339: 1349-57.

164. Tikiz H, Tezcan U, hery M et al. Diabetes mellitus adversely affects the

outcomes of thrombolytic therapy in patients with acute myocardial infarction.

Angiology. 2003 Jul-Aug;54(4):449-56.

165. Timmer JR, Ottervanger JP, Thomas K et al. Long-term, cause-specific

mortality after myocardial infarction in diabetes. Eur Heart J 2004

Jun;25(11):926-31.

166. Vaccarino V., Krumholz H.M., Berkman L.F., Horwitz R.I. Sex differences in

mortality after myocardial infarction. Is there evidence for an increased risk for

women? Circulation 1995;91: 1861—71.

167. Van Gaal LF, Wanters T, DeLeeuw IH. The benefical effects of modest weght

loss on cardiovascular risk factors. Int J Obesity 1997;21:5-9.

168. Volpi A., De Vita C., Franzosi M.G., Geraci E., Maggioni A.P., Mauri F., et al.

Determinants of 6-month mortality in survivors of myocardial infarction after

thrombolysis. Results of the GISSI-2 data base. The Ad hoc Working Group of the

Gruppo Italiano per lo Studio della Sopravvivenza nell'infarto Miocardio (GISSI)-

2 Data Base. Circulation 1993;88:416—29.

169. Walsh MF, Domingues LJ, Sowers JR. Metabolic abnormalities in cardiac

ischemia. Cardiol Clin 1995;13:529-38.

103

170. Weaver W.D., White H.D., Wilcox R.G., Aylward P.E., Morris D., Guerci A.,

et al. Comparisons of characteristics and outcomes among women and men with

acute myocardial infarction treated with thrombolytic therapy. GUSTO-I

Investigators. JAMA 1996;275:777—82.

171. Williams MA, Fleg JL, Ades PA et al. Secondary prevention of coronary heart

disease in the elderly (with emphasis on patients ≥75 years of age): an American

Heart Association scientific statement from the Council on Clinical Cardiology

Subcommittee on Exercise, Cardiac Rehabilitation and Prevention. Circulation

2002;105:1735-1743.

172. Winter R, Koster R, Sturk A et al. Value of myoglobin, Troponin T and CK-

MB mass in ruling out an acute myocardial infarction in the emergency room.

Circulation. 1995;92:3401-3407.

173. Wood D, De Backer G, Faergeman O et al. Prevention of coronary heart

disease in clinical practice: recommendations of the Second Joint Task Force of

European and other Societies on Coronary Prevention. Eur Heart J. 1998;19:1434-

1503.

174. Wright RS, Murphy JG, Bybee KA et al. Statin lipid-lowering thrapy for acute

myocardial infarction and unstable angina: efficacy and mechanism of benefit.

Mayo Clin Proc. 2002;23:1931-1937.

175. Yusuf HR, Giles WH, Croft JB et al. Impact of multiple risk factor profiles on

determining cardiovascular disease risk. Prev Med. 1998;27:1-9.

176. Zhang Y.Z., Wang S.W., Hu D.Y., Zhu G.Y. Prediction of life-threatening

arrhythmia in patients after myocardial infarction by late potentials, ejection

fraction and Holter monitoring. Jpn Heart J 1992;33:15—23.