tavis tkivilis martva pirvelad jandacvasi · 2017-06-02 · 2 tavis tkivilis martva pirvelad...

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danarTi 2

Tavis tkivilis marTva pirvelad

jandacvaSi

klinikuri mdgomareobis marTvis saxelmwifo standarti

(protokoli)

damtkicebulia saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 2010 wlis 11 oqtombris

# 333/o brZanebiT

miRebulia “klinikuri praqtikis erovnuli rekomendaciebis (gaidlainebi) da daavadebaTa marTvis saxelmwifo

standartebis (protokolebi) SemuSavebis, Sefasebisa da danergvis erovnuli sabWos"

2009 wlis 30 dekembris #2 sxdomis gadawyvetilebis Sesabamisad

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Tavis tkivilis marTva pirvelad jandacvaSi

(protokoli)

1. daavadebis/problemis ganmarteba

Tavis tkivili ewodeba tkivils Tavis areSi, romelic lokalizebulia Tvalebisa da yurebis zemoT, kefaSi an kisris zeda nawilis ukan.

Tavis tkivili zogadad klasificirdeba, rogorc pirveladi an meoreuli, xolo aRniSnuli formebi ki SemdgomSi iyofa Tavis tkivilis specifiur tipebad. pirveladi Tavis tkivili ewodeba tkivils, romelic ar aris asocirebuli sxva gamomwvev paTologiasTan da igi moicavs Sakiks, daZabvisa da klasterul Tavis tkivils. meoreuli ewodeba Tavis tkivils, romelic ukavSirdeba romelime gamomwvev paTologiur mdgomareobas da masSi Sedis infeqciuri, neoplaziuri, vaskuluri, medikamentebiT gamowveuli an idiopaTiuri warmoSobis Tavis tkivili.

gaidlainSi gamoyenebulia Tavis tkivilis saerTaSoriso sazogadoebis klasifikaciis (ICHD-II) SerCeviTi diagnostikuri kriteriumebi.

2. sadiagnozo kriteriumebi

Tavis tkivilis diagnozi anamnezs, obieqturi gasinjvisa da laboratoriul-instrumentuli gamokvlevebis Sedegebs eyrdnoba. Tavis tkivilis anamnezuri SekiTxvebis magaliTi ixileT danarTSi.

qvemoT mocemulia Tavis tkivilis saerTaSoriso sazogadoebis klasifikaciis (ICHD-II) SerCeviTi diagnostikuri kriteriumebi, romelSic ar aris Sesuli klasifikaciis yvela erTeuli; Sesabamisad, numeraciis Tanmidevrulobac darRveulia.

1. Sakiki

1.1. Sakiki auris gareSe.

aRweriloba: Tavis tkivilis morecidive paTologia, romelic vlindeba 4-72 saaTis xangrZlivobis SetevebiT. Tavis tkivilis tipiuri damaxasiaTebeli niSania calmxrivi lokalizacia, mopulsire xasiaTi, saSualo an mZime xarisxis intensivoba, gauareseba Cveuli fizikuri aqtivobis Sedegad da Tanmxlebi Rebineba da/an fotofobia da fonofobia.

sadiagnostiko kriteriumebi:

A. sul mcire 5 Setevidan, erTi unda akmayofilebdes B-D sadiagnostiko kriteriumebs;

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B. Tavis tkivilis Seteva grZeldeba 4-72 saaTis ganmavlobaSi (mkurnalobis ararsebobis an warumatebeli mkurnalobis pirobebSi);

C. Tavis tkivils axasiaTebs qvemoT CamoTvlilidan sul mcire ori niSani:

1. calmxrivi lokalizacia;

2. mopulsire (mfeTqavi) xasiaTi;

3. tkvilis intensivoba saSualo simZimis an mZimea;

4. gauareseba dakavSirebulia Cveul fizikur aqtivobasTan an tkivilis gamo xdeba fizikuri aqtivobisTvis (magaliTad, fexiT siarulis, an safexurebze asvlis) Tavis arideba.

D. Tavis tkivilis dros adgili aqvs qvemoT CamoTvlilidan sul mcire erT niSans mainc:

1. gulisreva da/an Rebineba;

2. fotofobia da fonofobia.

E. ar aris dakavSirebuli sxva paTologiasTan.

1.2. Sakiki auriT

aRweriloba: morecidive paTologia, romelic vlindeba Seqcevadi fokaluri nevrologiuri simptomebis Setevebis saxiT. Setevebi Cveulebriv, viTardeba TandaTanobiT 5-20 wuTis ganmavlobaSi da grZeldeba sul mcire, 60 wuTis manZilze. auris simptomebs Cveulebriv, Tan sdevs Tavis tkivilis ganviTareba, romelic xasiaTdeba auris gareSe mimdinare SakikisTvis damaxasiaTebeli niSnebiT. ufro iSviaTad Tavis tkivili moklebulia Sakikis maxasiaTeblebs, an igi saerTod ar vlindeba.


A. sul mcire 2 Seteva, romelic akmayofilebs B kriteriums;

B. Sakikis aura akmayofilebs 1.2.1-1.2.6 qvetipebis B da C

kriteriumebs;

C. ar aris dakavSirebuli sxva paTologiasTan.

1.2.1. tipuri aura Sakikis tipis Tavis tkiviliT


A. sul mcire, 2 Seteva, romlebic akmayofilebs B-D kriteriumebs;

B. aura, romelic moicavs qvemoT CamoTvlilidan sul mcire, erT-erTs mainc, magram ara motorul sisustes:

1. srulad Seqcevadi vizualuri simptomebi, pozitiuri niSnebis (magaliTad, sinaTlis cimcimi, laqebi an xazebi) da/an

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negatiuri niSnebis (magaliTad, mxedvelobis dakargvis) CaTvliT.

2. srulad Seqcevadi sensoruli simptomebi pozitiuri (magaliTad, Cxvletisa da SerWobis SegrZneba) da/an negatiuri (magaliTad, dabuJebis) niSnebis CaTvliT;

3. metyvelebis srulad Seqcevadi disfaziuri darRveva.

C. qvemoT CamoTvlilidan xul mcire oris arseboba:

1. homonimuri vizualuri simptomebi da/an unilateraluri sensoruli simptomebi;

2. auris sul mcire erTi simptomi mainc, romelic TandaTanobiT viTardeba ≥ 5 wuTis manZilze da/an aurisgan gansxvavebuli simptomi, romelic vlindeba Tanmimdevrulad ≥ 5 wuTis Semdeg;

3. TiToeuli simptomi grZeldeba ≥ 5 da ≤ 60 wuTis ganmavlobaSi.

D. 1.1 Sakiki auris gareSe-s B-D kriteriumebis damakmayofilebeli Tavis tkivili viTardeba auris periodSi an moyveba mas 60 wuTis ganamvlobaSi.


1.5.1. qronikuli Sakiki

A. Tavis tkivili (daZabulobis tipis Tavis tkivili da/an Sakiki), romelic grZeldeba TveSi ≥ 15 dRis manZilze sul mcire 3 Tvis ganmavlobaSi;

B. uviTardeba pacientebs, romelTac aqvT sul mcire 5 Seteva, romelic akmayofilebs 1.1. Sakiki auris gareSe-s sadiagnostiko kriteriumebs;

C. sul mcire 3 Tvis manZilze ≥ 8 dRis ganmavlobaSi Tavis tkivili akmayofilebs qvemoT moyvanil C1 da/an C2 kriteriumebs, rac niSnavs imas, rom dakmayofilebulia tkivilisa da asocirebuli simptomebis kriteriumebi SakikisaTvis auris gareSe:

1. vlindeba sul mcire ori a-d niSnebidan:

(a) calmxrivi lokalizacia;

(b) mopulsire xasiaTi;

(c) tkivilis saSualo an mZime intesivoba;

(d) gauareseba dakavSirebulia Cveul fizikur aqtivobasTan an tkivilis gamo xdeba fizikuri aqtivobisTvis (magaliTad, fexiT siarulis, an safexurebze asvlis) Tavis arideba.

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da sul mcire erTi niSani a an b kriteriumebidan:

(a) gulisreva da/an Rebineba;

(b) fotofobia da fonofobia.

2. tkivili gadis an msubuqdeba triptanebis an ergotaminis zemoqmedebiT zemoT moyvanili mosalodneli C1 simptomebis ganviTarebamde miRebis SemTxvevaSi.

D. adgili ara aqvs medikamentebis Warbad gamoyenebas da ar aris dakavSirebuli sxva mizezobriv paTologiasTan.

2. daZabulobis tipis Tavis tkivili

2.1. iSviaTi epizoduri daZabulobis tipis Tavis tkivili

aRweriloba: Tavis tkivilis iSviaTi epizodebi, romlebic grZeldeba ramdenime wuTidan ramdenime dRemde. tkivili tipiur SemTxvevebSi bilateraluria, damwoli an moWeriTi xasiaTis, msubuqi an saSualo intensivobis da misi gauareseba ar xdeba rutinuli fizikuri aqtivobis Sedegad. am dros adgili ara aqvs gulisrevas, magram SesaZlebelia gamovlindes foto - an fonofobia.


A. sul mcire 10 epizodi, romelic viTardeba saSualod TveSi < 1 dReze sixSiriT (< 12 dReze weliwadSi) da akmayofilebs B-D kriteriumebs;

B. Tavis tkivili grZeldeba 30 wuTidan 7 dRemde;

C. Tavis tkivili xasiaTdeba qvemoT CamoTvlilidan sul mcire, ori niSniT:

1. bilateraluri lokalizacia;

2. zewoliTi/moWeriTi (ara mfeTqavi) xasiaTi;

3. msubuqi an saSualo intensivobis;

4. ar uaresdeba iseTi Cveuli fizikuri aqtivobis fonze, rogoricaa magaliTad fexiT siaruli an kibeebze asvla.

D. qvemoT CamoTvlilidan orive:

1. ar aRiniSneba gulisreva an Rebineba (SesaZlebelia gamovlindes anoreqsia);

2. fotofobiidan an fonofobiidan vlindeba mxolod erT-erTi.


± manualuri palpaciiisas perikraniuli kunTebis momatebuli daWimuloba.

2.2. xSiri epizoduri daZabulobis tipis Tavis tkivili

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igivea, rac 2.1. iSviaTi epoizoduri daZabulobis tipis Tavis tkivilis SemTxvevaSi, garda:

A. sul mcire 10 epizodi, romelic viTardeba TveSi ≥ 1, magram < 15 dRis ganmavlobaSi, sul mcire 3 Tvis manZilze (≥ 12 da < 180 dReze weliwadSi) da akmayofilebs B-D kriteriumebs (2.1).

2.3. qronikuli daZabulobis tipis Tavis tkivili


igivea, rac 2.1. iSviaTi epoizoduri daZabulobis tipis Tavis tkivilis SemTxvevaSi, garda:

A. Tavis tkivili, romelic viTardeba ≥ 15 dReze saSualod > 3 Tvis ganmavlobaSi (≥ 180 dReze wlis manZilze) da akmayofilebs B-D kriteriumebs (2.1).

3. klasteruli Tavis tkivili da sxva trigeminul-avtonomiuri cefalalgiebi

3.1. klasteruli Tavis tkivili

aRweriloba: mkveTrad unilateraluri Tavis Zlieri tkivilis Setevebi, romelic xasiaTdeba orbitaluri, supraorbitaluri, temporaluri, an am areebis raime saxis kombinirebuli lokalizaciiT, grZeldeba 15-180 wuTis ganmavlobaSi da viTardeba yoveldRiurad erTidan 8 Setevamde sixSiriT. Setevebi asocirebulia CamoTvlilidan erT an met niSanTan, romelTaganac TiToeuli ifsilateraluria: koniunqtivis hiperemia, cremldena, cxvirT sunTqvis gaZneleba, rinorea, Sublisa da saxis oflianoba, miozi, ftozi, quTuTos SeSupeba. pacientTa umravlesoba Setevis periodSi mousvenari an aJitirebulia.


A. sul mcire 5 Seteva, romelic akmayofilebs B-D kriteriumebs.

B. mZime an Zalian mZime unilateraluri, supraorbitaluri da/an temporaluri tkivili, romelic grZeldeba 15-180 wuTis ganmavlobaSi;

C. Tavis tkivils Tan sdevs qvemoT CamoTvlilidan erT-erTi:

1. koniunqtivis ifsilateraluri hiperemia da/an cremldena;

2. cxviris ifsilateraluri gaWediloba da/an rinorea;

3. quTuTos ifsilateraluri SeSupeba;

4. Sublisa da saxis ifsilateraluri oflianoba;

5. ifsilateraluri miozi da/an ftozi;

6. mousvenrobis an aJitirebis SegrZneba.

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D. Setevebis sixSire meryeobs yoveldRiurad erTidan 8-mde dReSi;

E. ar aris dakavSirebuli sxva daavadebasTan.

3.1.1. epizoduri klasteruli Tavis tkivili

klasteruli tkivilis sul mcire ori periodi, romelic grZeldeba 7-365 dRis ganmavlobaSi da erTmaneTisagan gancalkevebulia 1 Tveze naklebi xangrZlivobis remisiis periodiT.

3.1.2. qronikuli klasteruli Tavis tkivili

Setevebi viTardeba 1 welze meti drois ganmavlobaSi remisiis periodebis gareSe an remisiis periodiT, romlis xangrZlivobac < 1 Tveze.

3.2. paroqsizmuli hemikrania

aRweriloba: Tavis tkivilis Setevebi, romelTa tkivilis maxasiaTeblebi da asocirebuli simptomebi da niSnebi msgavsia klasteruli Tavis tkivilisa, magram xasiaTdeba naklebi xangrZlivobiT. Setevebi ufro xSiria, metad gavrcelebulia qalebSi da absoluturad emorCileba indometaciniT mkurnalobas.


A. sul mcire 20 Seteva, romelic akmayofilebs B-D kriteriumebs;

B. mZime unilateraluri orbitaluri, supraorbitaluri an temporaluri lokalizaciis tkivilis Setevebi, romlebic grZeldeba 2-30 wuTis ganmavlobaSi;

C. Tavis tkivils Tan sdevs qvemoT CamoTvlilidan sul mcire erTi mainc:

1. koniunqtivis ifsilateraluri hiperemia da/an cremldena;

2. cxviris ifsilateraluri gaWediloba da/an rinorea;

3. quTuTos ifsilateraluri SeSupeba;

4. Sublisa da saxis ifsilateraluri oflianoba;

5. ifsilateraluri miozi da/an ftozi.

D. Setevebi SesaZlebelia ganviTardes 5-jer mTeli dRis manZilze, xolo sangrZlivoba naxevar dReze meti iyos; Tumca SesaZlebelia aRiniSnebodes naklebi sixSiris periodebic;

E. Setevebis Tavidan acileba srulad SesaZlebelia indometacinis Terapiuli dozebis saSualebiT;

F. ar aris dakavSirebuli sxva paTologiasTan.

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3.2.1. epizoduri paroqsizmuli hemikrania

Setevebis sul mcire ori periodi, xangrZlivobiT 7-365 dRe, romlebic erTmaneTisagan gancalkevebulia remisiis ≥ 1 Tveze SualediT.

3.2.2. qronikuli paroqsizmuli hemikrania

Setevebi, romlebic viTardeba > 1 welze periodSi remisiis Sualedebis gareSe, an remisiis SualedebiT, romelTa xangrZlivobac naklebia 1 Tveze.

3.3. xanmokle calmxrivi nevralgiismagvari Tavis tkivilis Setevebi koniunqtivis SewiTlebiT da cremldeniT (SUNCT)

aRweriloba: es sindromi xasiaTdeba unilateraluri Tavis tkivilis xanmokle SetevebiT, romlebic ufro naklebi xangrZlivobisaa, vidre nebismieri sxva tipis trigeminuli nevralgiebis dros da Zalian xSirad Tan sdevs ifsilateraluri Tvalis gamoxatuli cremldena da siwiTle.



B. unilateraluri orbitaluri, supraorbitaluri an temporaluri lokalizaciis gamWoli an mfeTqvi tkivilis Setevebi, romlebic grZeldeba 5-240 wamis ganmavlobaSi;

C. tkivils Tan sdevs koniunqtivis ifsilateraluri hiperemia da cremldena;

D. Setevebi viTardeba dReSi 3-dan 200-mde sixSiriT;


xanmokle calmxrivi nevralgiismagvari Tavis tkivilis Setevebi kraniuli vegetatiuri simptomebiT (SUNA)

aRweriloba: es sindromi xasiaTdeba Tavis tkivilis xanmokle SetevebiT, romelTa xangrZlivobac bevrad naklebia, vidre nebismieri sxva tipis trigeminuli nevralgiebis dros da Zalian xSirad Tan sdevs gamoxatuli kraniuli avtonomiuri niSnebi.



B. unilateraluri orbitaluri, supraorbitaluri an temporaluri lokalizaciis gamWoli an mfeTqavi xasiaTis tkivilis Setevebi, romlebic grZeldeba 2 wamidan 10 wuTamde.

C. Tavis tkivils Tan axlavs qvemoT CamoTvlilidan erT-erTi:

1. koniunqtivis hiperemia da/an cremldena;

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2. cxviris gaWediloba da/an rinorea;

3. quTuTos SeSupeba.

D. Setevebi viTardeba dReSi 1-ze meti sixSiriT dRis xangrZlivobis naxevarze meti drois ganmavlobaSi;

E. trigeruli areebis gaRizianebis Sedegad provocirebul tkivilis Setevebs ar mohyveba refraqteruli periodi;

F. ar aris dakavSirebuli sxva paTologiasTan.

4. sxva pirveladi Tavis tkivilebi

4.1. pirveladi mCxvletavi Tavis tkivili

aRweriloba: Tavis mCxvletavi tkivilis gardamavali da lokalizebuli Setevebi, romlebic viTardeba spontanurad struqturuli an kraniuli nervebis organuli daavadebis ararsebobis pirobebSi.


A. Tavis tkivili, romelic viTardeba erTaderTi gamWoli Setevis an misi seriebis saxiT da akmayofilebs B-D kriteriumebs;

B. eqskluziurad an ZiriTadad SeigrZnoba samwvera nervis pirveli totis sainervacio zonaSi (orbita, safeTqeli da Txemis are);

C. Setevebi grZeldeba ramdenime wamis manZilze da viTardeba araregularuli sixSiriT dReSi erTidan ramdenime Setevamde;

D. ar axasiaTebs Tanmxlebi simptomebis arseboba;


4.2. pirveladi xvelis Tavis tkivili

aRweriloba: Tavis tkivili, romelic viTardeba xvelis an daWimvis Sedegad raime intrakraniuli paTologiis ararsebobis pirobebSi.


A. Tavis tkivili, romelic akmayofilebs B da C kriteriumebs;

B. uecari dasawyisi da xangrZlivoba erTi wamidan 30 wuTamde;

C. misi provocireba da ganviTareba xdeba mxolod xvelis, gazmorebis da/an valsalvas sinjis Sedegad;

D. ar aris dakavSirebuli sxva paTologiasTan.

4.3. pirveladi Tavis tkivili fizikuri datvirTvisas

aRweriloba: Tavis tkivili, romlis provocirebac xdeba fizikuri datvirTvis raime formiT.

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A. mfeTqavi xasiaTis Tavis tkivili, romelic akmayofilebs B da C kriteriumebs;

B. grZeldeba 5 wuTidan 48 saaTamde;

C. misi provocireba da ganviTareba xdeba mxolod fizikuri datvirTvis Semdeg;


4.4. seqsualur aqtivobasTan dakavSirebuli pirveladi Tavis tkivili

aRweriloba: Tavis tkivili, romlis provocirebac xdeba sqesobrivi aqtivobiT, Cveulebriv iwyeba rogorc yru xasiaTis bilateraluri tkivili sqesobrivi agznebis matebasTan erTad da uecrad gardaiqmneba intensiur tkivilad orgazmis dros, raime intrakraniuli paTologiis ararsebobis pirobebSi.

4.4.1. preorgazmuli Tavis tkivili


A. yru xasiaTis tkivili Tavisa da kisris areSi, romelic asocirebulia kisris da/an qveda ybis kunTebis daWimulobasTan da akmayofilebs B kriteriums.

B. viTardeba sqesobrivi aqvtivobis dros da Zlierdeba sqesobrivi agznebis matebasTan erTad;


4.4.2. orgazmuli Tavis tkivili


A. uecari Zlieri Tavis tkivili, romelic akmayofilebs B kriteriums;

B. viTardeba orgazmis dros;


4.5. Zilis Tavis tkivili

aRweriloba: Tavis yru xasiaTis tkivilis Setevebi, ris gamoc pacients yovelTvis uwevs gaRviZeba.


A. yru xasiaTis Tavis tkivili, romelic akmayofilebs B-D kriteriumebs;

B. viTardeba mxolod Zilis periodSi da aRviZebs pacients;

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C. damaxasiaTebelia qvemoT CamoTvlilidan sul mcire ori niSani:

1. viTardeba TveSi 15 Setevaze xSirad;

2. gaRviZebis Semdeg grZeldeba ≥ 15 wuTze xangrZlivad;

3. pirvelad viTardeba 50 wels zemoT asakSi.

D. ar aRiniSneba vegetatiuri simptomebi; agreTve, ar aRiniSneba erTze meti simptomi Semdegi simptomebidan: gulisreva, fotofobia an fonofobia;


4.6. pirveladi “mexis dacemismagvari” Tavis tkivili

aRweriloba: uecari dasawyisis mqone Zlieri intensivobis Tavis tkivili, romelic msgavsia Tavis tvinis anevrizmis gaskdomis Sedegad ganviTarebuli tkivilisa.


A. Tavis Zlieri tkivili, romelic akmayofilebs B da C

kriteriumebs;

B. qvemoT CamoTvlilidan orive damaxasiaTebeli niSani:

1. uecari dasawyisi, romelic maqsimalur intensivobas aRwevs 1 wuTze naklebi drois ganmavlobaSi;

2. grZeldeba 1 saaTidan 10 dRemde.

C. kvirebis an Tveebis ganmavlobaSi regularuli recidivebi ar viTardeba;


4.7. uwyveti hemikrania

aRweriloba: mudmivi, mkacrad unilateraluri Tavis tkivili, romelic emorCileba indometaciniT Terapias.


A. Tavis tkivili > 3 Tveze periodSi, romelic akmayofilebs B-D

kriteriumebs;

B. qvemoT CamoTvlilidan yvela damaxasiaTebeli niSani:

1. unilateraluri tkivili mxaris cvlilebis gareSe;

2. yoveldRiuri da uwyveti, tkivilisgan Tavisufali periodebis gareSe;

3. saSualo xarisxis intensivobis, Tumca gamwvavebebis dros SesaZlebelia Zlieri tkivili.

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C. gamwvavebis dros vlindeba qvemoT CamoTvlilidan sul mcire erTi vegetatiuri simptomi, romelic tkivilis ifsilateralurad vlindeba:

3. koniunqtivis hiperemia da/an cremldena;

4. cxviriT sunTqvis gaZneleba da/an rinorea;

5. ftozi da/an miozi.

D. indometacinis Terapiuli dozebis sruli efeqti;


4.8. axali yoveldRiuri Tavis tkivili (NDPH)

aRweriloba: Tavis tkivili, romelic yoveldRiuria da dawyebis Semdeg Zalian male (uxSires SemTxvevaSi 3 dReSi) iqceva daumorCilebel tkivilad. igi tipiur SemTxvevebSi bilateraluria, zewoliTi an moWeriTi xasiaTis da saSualo an msubuqi intensivobis. SesaZloa, adgili hqondes fotofobias, fonofobias an msubuq gulisrevas.

8. nivTierebebis miRebasTan an maT moxsnasTan dakavSirebuli Tavis tkivili

8.2. medikamentebis Warbi moxmarebiT gamowveuli Tavis tkivilii


A. Tavis tkivili, romelic aRiniSneba TveSi ≥ 15 dRis ganmavlobaSi;

B. Semdegi mwvave/simptomuri medikamentebis regularuli Warbi gamoyeneba 3 Tveze meti drois ganmavlobaSi:

1. ergotaminis preparatebis, triptanebis, opioidebis an kombinirebuli analgetikebis regularuli gamoyeneba TveSi ≥ 10 dRis ganmavlobaSi 3 Tveze meti drois manZilze;

2. martivi analgetikebis an ergotaminis, triptanebis da tkivilgamayuCebeli opioidebis nebismieri kobinaciis regularuli xmareba TveSi ≥ 15 dRis ganmavlobaSi 3 Tveze meti drois manZilze, medikamentebis calke aRebuli romelime jgufis gadaWarbebuli gamoyenebis gareSe.

C. Tavis tkivili ganviTarda an mniSvnelovnad gauaresda medikamentebis gadaWarbebuli gamoyenebis fonze.

11. Tavis an saxis tkivili, dakavSirebuli Tavis qalas, kisris, Tvalebis, yurebis, cxviris, sinusebis, kbilebis, piris, agreTve, saxis an Tavis qalas sxva struqturebis paTologiasTan

11.2.1. cervikogenuli Tavis tkivili

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A. tkivili, romelic gadaecema kisridan, SeigrZnoba Tavis da/an saxis erT an met regionSi da akmayofilebs C da D kriteriumebs;

B. kisris malebis an kisris rbili qsovilebis klinikurad, laboratoriulad da/an gamosaxviTi kvleviT dadasturebuli paTologia an dazianeba, romelic CaiTvleba Tavis tkivilis gamomwvev Rirebul mizezad;

C. mtkicebuleba, romlis mixedviTac tkivili SeiZleba davukavSiroT kisris paTologias an dazianebas, qvemoT CamoTvlilidan sul mcire erT niSanze dayrdnobiT:

1. klinikuri niSnebis gamovlineba, rac miuTiTebs tkivilis wyaroze kisris areSi;

2. Tavis tkivilis gaqroba cervikaluri struqturebis an misi nervebis diagnostikuri blokadis Semdeg placebos an sxva adekvaturi kontrolis gamoyenebiT.

D. gamomwvevi paTologiis an dazianebis warmatebuli mkurnalobidan 3 TveSi tkivilis gaqroba.

11.7. Tavis an saxis tkivili, ganpirobebuli safeTqel-qveda ybis saxsris paTologiiT


A. morecidive tkivili Tavis da/an saxis erT an met regionSi, romelic akmayofilebs C da D kriteriumebs;

B. rentgenografiuli, magnitur-rezonansuli da/an Zvlis scintigrafiuli kvleviT vlindeba safeTqel-qveda ybis saxsris paTologia;

C. mtkicebuleba, rom tkivili SesaZlebelia ukavSirdebodes safeTqel-qveda ybis saxsris paTologias, romelic eyrdnoba qvemoT CamoTvlilidan sul mcire erT niSans:

1. tkivilis provocireba xdeba ybis moZraobisas da/an mkvrivi da uxeSi sakvebis ReWvis dros;

2. piris gaRebis sifarTe Semcirebulia;

3. ybis moZraobisas vlindeba xmauri erT-erTi an orive safeTqel-qveda ybis saxsris areSi.

4. erT-erTi an orive safeTqel-qveda ybis saxsris kafsulis mgrZnobeloba momatebulia.

D. tkivili gadis safeTqel-qveda ybis saxsris paTologiis warmatebuli mkurnalobidan 3 Tvis Semdeg da misi recidivebi aRar viTardeba.

14

3. simptomebi da niSnebi

Sakikis dros ganviTarebuli Tavis tkivilisTvis damaxasiaTebelia:

1. calmxrivi lokalizacia; 2. mfeTqavi xasiaTi; 3. gaZliereba wuTebidan saaTebamde drois periodSi; 4. saSualo xarisxis an Zlieri intensivoba; 5. asocirebulia gulis revasa da/an RebinebasTan da/an momatebul

mgrZnobelobasTan sinaTlis da/an xmauris mimarT; 6. fizikuri uunaroba; 7. damZimeba Cveuli fizikuri aqtivobis fonze.

daZabulobis tipis Tavis tkivilis simptomebi:

1. tipiur SemTxvevebSi tkivili bilateraluria, zewoliTi an moWeriTi xasiaTis da msubuqi an saSualo intensivobis.

2. adgili ara aqvs gulis revas da ar xdeba Tavis tkivilis gauareseba fizikuri datvirTvis fonze.

3. SesaZlebelia saxeze iyos perikranialuri struqturebis momatebuli mgrZnobeloba, sinaTlisa an xmauris autanloba.

avtonomiur-trigeminuli cefalalgiebis simptomebi:

1. Zlieri unilateraluri tkiviliT samwvera nervis sainervacio zonaSi. 2. igi asocirebulia TvalsaCino kranialur vegetatiur niSnebTan. 3. klasteruli Tavis tkivili yvelaze gavrcelebul tvc-s miekuTvneba. 4. paroqsizmuli hemikraniis diagnostika savaraudod saTanadod ar

xdeba. 5. xanmokle nevralgiuri Tavis tkivilis Setevebi koniunqtivis

hiperemiiTa da cremldeniT (SUNCT) da xanmokle nevralgiuri Setevebi kraniuli vegetatiuri simptomebiT (SUNA) Zalzed iSviaTia.

meoreuli Tavis tkivilis “wiTeli droSis” niSnebi:

axlad dawyebuli Tavis tkivili an misi xasiaTis cvlileba 50 wels zeviT asakis pacientebSi;

“mexisebri“ Tavis tkivili: Tavis tkivili piks aRwevs Zalian swrafad (wamebidan 5 wuTamde);

fokaluri nevrologiuri simptomatika (magaliTad, kidurebis sisuste, aura <5 wuTze da >1 saaTze);

ara-fokaluri nevrologiuri simptomatika (magaliTad, cnobierebis darRveva)

Tavis tkivilis xasiaTis, sixSirisa an asocirebuli simptomebis cvlileba;

15

obieqturi nevrologiuri gamokvlevisas gamovlenili paTologia;

Tavis tkivili, romelic icvleba poziciis cvlilebisas;

Tavis tkivili, romelic aRviZebs pacients (Sakiki dilis Tavis tkivilis mizezebs Soris yvelaze xSiria);

Tavis tkivili, romelic mwvavdeba fizikuri aqtivobis fonze an valsalvas manevris Sesrulebisas (magaliTad, xvelis, sicilis, gazmorebis dros);

pacientebi cerebruli venuri Trombozis risk-faqtorebiT;

ybis saxsris paTologia an vizualuri dazianeba;

kisris daWimuloba;

cxeleba;

axlad ganviTarebuli Tavis tkivili adamianis imunodeficitis virusiT (aiv) inficirebul pacientSi;

axlad ganviTarebuli Tavis tkivili pacientSi, romelTac anamnezSi aReniSneba kibo.

4. instrumentul-laboratoriuli gamokvlevebi da

specialistTa konsultaciebi

pacientebs, romelTac pirvelad mogmarTes Tavis tkivilis gamo, an Tuki Tavis tkivilma icvala Cveuli xasiaTi, unda CautardeT klinikuri gamokvleva, nevrologiuri gamokvleva, fundoskopia da arteriuli wnevis gazomva;

nevrologiuri gamokvleva pacientebSi axlad ganviTarebuli Tavis tkiviliT unda moicavdes:

o fundoskopias;

o krnialuri nerevebis Sefasebas, gansakuTrebiT, gugebis, mxedvelobis velis, Tvalebis moZraobis sifarTis, saxis kunTebis Zalisa da mgrZnobelobis da bulbaruli funqciebis (rbili sasis, enis moZraobis) gamokvlevas;

o oTxive kiduris tonusis, Zalis, refleqsebisa da koordianciis Sefasebas;

o plantarul refleqsebs;

o siarulis, maT Soris quslebsa da fexis wverebze siarulis unaris Sefasebas.

ufro detaluri Sefaseba saWiroa im SemTxvevaSi, Tuki amaze miuTiTebs anamnezuri monacemebi. gasinjva specialurad mimarTuli unda iyos fokaluri nevrologiuri simptomebis aRmoCenisaken.

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Tavis tkivilis dros zogadad laboratoriul-instrumentul gamokvlevebs Tavi unda avaridoT, Tuki mis safuZvelze ar aris mosalodneli marTvis gegmis cvlileba an Tu gamokvlevis saSualebiT Sesabamisi paTologiis aRmoCenis albaToba dabalia.

neirogamosaxviTi gamokvlevis Catareba ar aris rekomendebuli Sakikis TvalsaCino anamnezis mqone pacientebSi meoreuli Tavis tkivilis ”wiTeli droSis” niSnebis gareSe da nevrologiuri gasinjvis normaluri SedegebiT.

Tavis tvinis kt unda Cautardes Tavis tkivilis mqone pacientebs auxsneli paTologiuri nevrologiuri simptomebiT, Tuki klinikuri anamnezis safuZvelze ar aris naCvenebi mrt-kvleva.

ICHD-II klasifikaciis mixedviT pirveladi ”mexis dacemismagvari” Tavis tkivilis diagnozis dasmamde aucilebelia Tavis tvinis gamosaxviTi kvlevisa da Tav-zurgtvinis siTxis analizis normaluri Sedegebis arseboba.

subaraqnoidul sisxlCaqcevaze eWvis SemTxvevaSi Tavis tvinis kompiuteruli tomografia unda Catardes rac SeiZleba swrafad maqsimaluri mgrZnobelobis miRebis mizniT. kt-s mgrZnobeloba subaraqnoiduli sisxlCaqcevis pirvel 12 saaTSi 98%-ia, xolo 24 saaTSi ki – 93%.

Tavis tvinis kt-s normaluri Sedegi arasakmarisia subaraqnoiduli sisxlCaqcevis gamosaricxad da amisaTvis aucilebelia lumbaluri punqciis ganxorcileba im pacientebSi, visac normaluri tomografiuli monacemebi aReniSnebaT.

subaraqnoidul sisxlCaqcevaze eWvis SemTxvevaSi pacientebs Tavis tvinis kt-s uaryofiTi SedegiT, lumbaluri punqcia unda CautardeT simptomebis dawyebidan 12 saaTis gasvlis Semdeg SeZlebisdagvarad swrafad;

pacientis dagvianebuli momarTvis SemTxvevaSi lumbaluri punqciis Catareba SesaZlebelia ganxorcieldes simptomebis dasawyisidan 2 kviris ganmavlobaSi.

pacientebs giganturujredul arteriitze eWviT unda CautardeT eds-is da/an C-reaqtiuli cilis gamokvleva (maqsimaluri specifiurobisa da mgrZnobelobis miRebis mizniT sasurvelia am diagnostikuri testebis kombinirebuli gamoyeneba).

specialistis konsultacia naCvenebia Semdeg SemTxvevebSi:

qvemwvave da/an progresirebadi Tavis tkivili Tveebis ganmavlobaSi;

axlad dawyebuli Tavis tkivili an misi saxecvlileba;

“yvelaze uaresi Tavis tkivili”;

dawyebisTanave maqsimaluri intensivobis nebismieri Tavis tkivili;

Tavis tkivilis dawyeba 50 wels zemoT asakSi;

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sistemuri daavadebis simptomebi;

krunCxvebi;

nebismieri nevrologiuri niSani;

Tavis tkivilis mkurnalobis warumatebloba;

“wiTeli droSis” simptomebi.

5. mkurnaloba

Sakikis mkurnaloba

Sakikis mkurnaloba moicavs mwvave Setevebisa da prevenciul Terapias

rekomendacia:

900 mg aspirini rekomendebulia Sakikis mwvave Setevis mkurnalobis mizniT nebismieri intensivobis tkivilis SemTxvevaSi (A);

400 mg ibuprofeni rekomendirebulia Sakikis mwvave Setevis mkurnalobis mizniT (A);

Sakikis mwvave Setevis mkurnalobis mizniT SesaZlebelia anTebis swinaaRmdego sxva arasteroidebis gamoyenebac (tolfenamis mJava, diklofenaki, naproqseni, flurbiprofeni) (D);

Sakikis msubuqi da saSualo intensivobis Setevebis mkurnalobis mizniT rekomendebulia 1000 mg paracetamolis gamoyeneba (B);

oraluri triptanebis gamoyeneba rekomendebulia Sakikis nebismieri simZimis mwvave Setevis samkurnalod, Tuki ver xerxdeba misi kontroli martivi analgetikebis saSualebiT (A);

Sakikis mwvave Setevis mkurnalobis mizniT peroraluri triptanebidan upiratesoba eniWeba 12,5 mg almotriptanis, 40-80 mg eletriptanis an 10 mg rizatriptanis gamoyenebas (A);

Tuki tkivilis Semsubuqeba ver xerxdeba erTi triptanis miRebiT, alternativis saxiT aucilebelia gansxvavebuli triptanis SeTavazeba (B);

triptanis miReba rekomendebulia Tavis tkivilis Setevis dawyebisTanave an dawyebidan rac SeiZleba male (D).

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cxrili 1. triptanebis sxvadasxva saxeobebi, maTi dozireba da gverdiTi movlenebi.

samkurnalo

saSualeba dozireba gverdiTi movlenebi

almotriptani

oraluri: 6.25-12.5mg sawyisi doza. SeiZleba ganmeordes 2 sT-iani intervaliT maqsimum: 25mg/dReSi

xSirad: gulisrevis SegrZneba, Rebineba, Zilianoba, piris simSrale, sisuste, Tavbrusxveva, diarea, taqikardia, paresTezia, vazodilatacia. iSviaTad: ezofagospazmi, hipertenzia, hiperqolesterinemia, arTritebi, miopaTia, diplopia, mSrali Tvali,Sua yuris anTeba, laringiti, sinkope, nerwyvdenis gaZliereba.

eletriptaniO

oraluri: 20-40mg sawyisi doza. SeiZleba ganmeordes 2 sT-iani intervaliT maqsimum: 80mg/dReSi

flovatpiftani

oraluri: 2.5mg sawyisi doza. SeiZleba ganmeordes 2 sT-iani intervaliT maqsimum: 7.5mg/dReSi

naratriptani

oraluri: 2.5mg sawyisi doza. SeiZleba ganmeordes 4 sT-iani intervaliT maqsimum: 5mg/dReSi

sumatriptani

oraluri: 50-100mg sawyisi doza.SeiZleba ganmeordes 2 sT-iani intervaliT maqsimum: 200mg/dReSi kanqveS: 6mg sawyisi doza. SeiZleba ganmeordes 1 sT-iani intervaliT; maqsimum: 12mg/dReSi intranazalurad: 20 mg SeiZleba ganmeordes 2 sT-iani intervaliT maqsimum: 40mg/dReSi D

rizatriptani

oraluri: 10mg sawyisi doza. SeiZleba ganmeordes 2 sT-iani intervaliT maqsimum: 30mg/dReSi

zolmitriptani

oraluri: 2.5-5mg sawyisi doza. SeiZleba ganmeordes 2 sT-iani intervaliT maqsimum: 10mg/dReSi intranazalurad: 5 mg SeiZleba ganmeordes 2 sT-iani intervaliT maqsimum: 10mg/dReSi

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SakikisPprevenciuli medikamenturi Terapiis zogadi principebia:

gverdiTi efeqtebis minimumamde dayvanis mizniT prevenciuli medikamentebis umravlsobis doza nel-nela unda gaititros efeqtur an maqsimalur dozamde;

prevenciuli wamlis SerCeva unda moxdes Tanxmlebi daavadebebisa da gverdiTi movlenebis gaTvaliswinebiT;

prevenciuli medikamentis miReba saWiroa dozis titraciidan sul mcire, 6-8 kviris ganmavlobaSi;

6-dan 12 Tvemde xangrZlivobis efeqturi prevenciuli Terapiis Semdeg gasaTvaliswinebelia wamlis TandaTanobiTi moxsna.

cxrili 2. prevenciuli medikamentebi Sakikis mqone pacientebisTvis

prevenciuli medikamenti

sifrTxiliT gamoiyeneba Semdegi mdgomareobebis dros (CamonaTvali arasrulyofilia)

SesaZlebelia upiratesoba mieniWos Semdegi mdgomareobebis dros

beta-blokerebi

asTma; diabeti; bradikardia; pariferiuli sisxlZarRvebis daavadeba; depresiis Tanaarseboba.

SfoTvis Tanaarseboba

tricikluri antidepresantebi

daxurul-kuTxovani glaukoma

depresiis Tanaarseboba; daZabulobis tipis Tavis tkivilis Tanaarseoba; Zilis darRveva.

topiramati1 TirkmelkenWovani daavadeba; daxurul-kuTxovani glaukoma; orsuloba.

simsuqnis Tanaarseboba

valproati

simsuqne; RbiZlis daavadeba; orsuloba.

depresiis Tanaarseboba

1 es preparati Zalian Zviria da amdenad, misi rutinuli gamoyeneba prevenciis mizniT saqarTvelos pirobebSi SeuZlebelia.

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daZabulobis tipis Tavis tkivilis (dTt) mkurnaloba

daZabvis Tavis tkivilis mkurnaloba moicavs daZabvis Tavis tkivilis epizodebis mkurnalobas, dTt-is profilaqtikas da aramedikamentur mkurnalobas.

cxrili 3 – daZabulobis tipis Tavis tkivilis Setevis samkurnalo medikamentebi

samkurnalo saSualeba dozireba gverdiTi movlenebi

acetaminofeni 325-650 mg yovel 4-6 sT-Si saWiroebisamebr maqsimum 4000 mg/dReSi

gulisreva, Rebineba, hepatotoqsikuria

aspirini

500 – 1000mg

dispefsia, gastrointestinaluri darRvevebi, gulisreva, diarea, nefropaTia

ibuprofeni 400 mg yovel 4-6 sT-Si saWiroebisamebr maqsimum 3200 mg/dReSi

dispefsia, gastrointerstinaluri darRvevebi, gulisreva, diarea, nefropaTia

naproqseni 500 mg yovel 12-sT-Si saWiroeisamebr maqsimum 1250 mg/dReSi

dispefsia, gastrointersti-naluri darRvevebi, gulisreva, diarea,nefropaTia

rekomendacia (A):

aspirini da paracetamoli rekomendebulia daZabulobis tipis Tavis tkivilis mwvave Setevebis mkurnalobis mizniT.

cxrili 4. – daZabulobis tipis Tavis tkivilis prevenciuli samkurnalo saSualebebi

samkurnalo

saSualeba dozireba gverdiTi movlenebi

amitriptilini 25 mg sawyisi; maqsimum 100 mg/dReSi

pirisa da Tvalebis simSrale, sedacia, wonaSi momateba, ariTmiebi, TvalSida wnevis momateba. gulisreva, Rebineba, anoreqsia

beta blokerebi: atenololi nadololi propranololi

50-100 mg 1jer dReSi 40 mg 1jer dReSi 80 mg 1jer dReSi Tavidan 2-3 miRebaze gayofili;

gulisreva, diarea, bronqospazmi, hipotenzia, orTostatuli hipotenzia, civi kidurebi, dispnoe, bradikardia, atrio-ventrikuluri gamtareblobis darRveva, kanze gamonayari

21

rekomendacia (A):

Tuki qronikuli daZabulobis tipis Tavis tkivilis mqone pacients unda daeniSnos prevenciuli Terapia, tricikluri antidepresantebi, gansakuTrebiT ki amitriptilini 25-150 mg dReSi, rekomendebulia arCevis preparatis saxiT.

trigeminul-avtonomiuri cefalalgiebis mkurnaloba

klasterul Tavis tkivilis mkurnaloba moicavs mwvave Setevisa da profilaqtikur mkurnalobas. abortuli (mwvave Setevis simptomuri) mkurnaloba:

Jangbadi;

triptanebi;

prednizoloni;

dihidroergotamini;

ergotamini;

lidokaini;

procedurebi trigeminul nervul kvanZebze.

klasteruli Tavis tkivilis prevencia:

pacienti unda moeridos Semdeg maprovocirebel faqtorebs, rogoricaa: alkoholi, TvalismomWreli kaSkaSa ganaTeba, Zilis darRveva, stresi.

prevenciuli mkurnaloba, Cveulebriv, saWiroebs kombinirebul Treapias ori (verapamili da liTiumi, an verapamili da topiramati)

an sami medikamentiT ( mag. verapamili, liTiumi da ergotamini).

gabapentini;

beta blokerebi;

valprois mJava;

amitriptilini, serotoninis ukumitacebis seleqtiuri inhibitori;

akupunqtura

fsiqologiuri Terapia, rogoricaa: relaqsacia, hipnozi.

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cxrili 5 – klasteruli Tavis tkivilis mwvave Setevis samkurnalo saSualebebi

samkurnalo saSualeba

dozireba gverdiTi movlenebi

eletriptaniO


xSirad: gulisrevis SegrZneba, Rebineba, Zilianoba, piris simSrale, sisuste, Tavbrusxveva, diarea, taqikardia, paresTezia, vazodilatacia. iSviaTad: ezofagospazmi, hipertenzia, hiperqolesterinemia, arTritebi, miopaTia, diplopia, mSrali Tvali,Sua yuris anTeba, laringiti,sinkope, nerwyvdenis gaZliereba.

naratriptani2

oraluri: 2.5mg sawyisi doza. SeiZleba ganmeordes 4 sT-iani intervaliT maqsimum: 5mg/dReSi

sumatriptani

oraluri: 25-100mg sawyisi doza. SeiZleba ganmeordes 2 sT-iani intervaliT maqsimum: 200mg/dReSi intramuskularuli: 6mg sawyisi doza. SeiZleba ganmeordes 1 sT-iani intervaliT; maqsimum: 12mg/dReSi

rizatriptani2


zolmitriptani

oraluri: 2.5-5mg sawyisi doza. SeiZleba ganmeordes 2 sT-iani intervaliT maqsimum: 10mg/dReSi

2 es preparatebi saqarTveloSi registrirebuli ar aris.

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cxrili 6 – klasteruli Tavis tkivilis prevenciuli samkurnalo saSulebebi

samkurnalo

saSualeba

dozireba

gverdiTi movlenebi

verapamili oraluri: swrafi Semsubuqeba: 80 mg 3jer dReSi xangrZlivi Semsubuqeba 120-480mg/dReSi

სიმხურვალის შეგრძნება, ჰიპერემია,

ჰიპოტენზია, გულის უკმარისობის

სიმპტომები, თავბრუსხვევა, ბრადიკარდია,

გადაღლილობა, გასტროენტერული

დარღვევები -ხშირად ყაბზობა,

გულისრევა, ზოგჯერ გაღიზიანებადობა,

ნეvrozuli მდგომარეობა; - იშვიათად-

ერითემა, ქავილი, ანგიონევროზული

შეშუპება

liTiumi oraluri: 300mg 4-jer dReSi maqsimaluri: 1200 mg/dReSi

gulisreva, diarea, gastroenteraluri darRvevebi, onis momateba, siuste, vertigo, tremori, akne, fsoriazi, leikocitozi, hipoTireoidizmi, poliuria, ekg cvlilebebi

ergotamini oraluri: 2 mg Setevisas,SeiZleba ganmeores 1 sT-iani intervaliT maqsimaluri 6 mg/dReSi an 10mg/kviraSi

gulisreva, Rebineba, vazokonstriqcia, paresTeziebi, vertigo, sisuste, qavili

antiepilefsiuri saSualebebi: valproati gabapentini topiramati

sawyisi 500 mg/dReSi, sawyisi: 300mg/dReSi; maqsimaluri:3600mg/dReSi sawyisi: 25-50 mg 1-2-jer maqsimaluri: 200 mg/dReSi

sedacia, gastroenteruli darRvevebi, wonis da madis momateba sedacia, sisuste, ataqsia, Tavbrusxveva sedacia, ataqsia, sisuste, Tavbrusxveva, paresTezia, mexsierebis daqveiTeba,

prednizoloni oraluri(mwvave): 20 mg 3-jer dReSi mkurnalobis kursi: 14 dRe; oraluri(profilaqtika): 60-80 mg 1-jer dReSi mkurnalobis kursi: 7 dRe;

diarea, gulisreva, madis momateba, kuWisa da 12-goja nawlavis wyluli. wonis momateba, hirsutizmi, TvalSida wnevis momateba, imunosupresia, Tirkmelzeda jirkvlis qerqis funqciis daTrgunva.

paroqsizmuli hemikraniis, uwyveti hemikraniis da SUNCT-is

mkurnaloba

indometacinze dadebiTi sapasuxo reaqcia paroqsizmuli hemikraniisa da uwyveti hemikraniis sadiagnostiko kriteriumia. indometacini efeqturia paroqsizmuli da uwyveti hemikraniis SemTxvevaSi dReSi 225 mg-mde doziT. lamotrijini SeiZleba efeqturi iyos SUNCT sindromis mkurnalobaSi.

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rekomendacia (D):

indometacini dReSi 225 mg-mde doziT rekomendebulia paroqsizmuli hemikraniis da uwyveti hemikraniis prevenciuli Terapiis mizniT.

medikamentebis gadaWarbebul gamoyenebasTan dakavSirebul Tavis

tkivilis mkurnaloba

rekomendacia:

medikamentebis gadaWarbebul xmarebasTan dakavSirebuli Tavis tkivilis mqone pacientis yvela SemTxvevaSi saWiroa ganxorcieldes wamlis moxsnis mcdeloba (D);

pacientebs medikamentebis gadaWarbebul gamoyenebasTan dakavSirebuli Tavis tkiiliT, romlebic iReben martiv analgetikebs an triptanebs, unda erCioT ucbad Sewyviton am medikamentebis miReba. pacientTa umravelsobaSi aRniSnulis ganxorcieleba SesaZlebelia ambultoriulad struqturirebuli rCeva-darigebis fonze (C);

pacientebs, romelTa Tavis tkivilic gamowveulia opioidebiT da opioidebis Semcveli analgetikebis gadaWarbebuli miRebiT, unda erCioT am medikamentebis TandaTanobiTi Sewyveta (D).

orsuloba, kontraceptivebi, menstruacia da menopauza

rekomendacia:

orsulebSi Sakikis da daZabulobis tipis Tavis tkivilis dros 1000 mg paracetamoli arCevis pirveli rigis medikamentia im SemTxvevaSi, Tuki tkivilis intensivoba moiTxovs analgeziuri saSualebis gamoyenebas (D);

Tuki paracetamoli ver uzrunvelyofs adekvatur analgezias, orsulobis pirvel da meore trimestrSi SesaZlebelia 300 mg aspirinis an 400 mg ibuprofenis gamoyeneba (D).

qalebma, romelTac aReniSnebaT Sakiki auriT ar unda miiRon kombinirebuli oraluri kontraceptivebi (B);

35 wels zeviT asakis qalebma, romelTac aReniSnebaT Sakiki auris gareSe, ar unda miiRon kombinirebuli oraluri kontaceptivebi (D).

menstruaciasTan dakavSirebuli Sakikis mwvave Setevebis mkurnalobis mizniT SesaZlebelia mefenamis mJavis an aspirinis, paracetamolisa da kofeinis kombinaciis gamoyeneba (A);

menstruaciasTan dakavSirebuli Sakikis mwvave Setevebis samkurnalod rekomendebulia sumatriptanis, zolmitriptanis, naratriptanisa da rizatriptanis gamoyeneba (A).

25

frovatriptani 2.5 mg/dReSi an naratriptani 1 mg orjer dReSi SeiZleba gamoviyenoT menstrualuri Sakikis prevenciis mizniT menzesis dawyebamde ori dRiT adre, xolo Semdeg 4 an 5 dRis ganmavlobaSi Sesabamisad.

HRT (hormonCanacvlebiTi Terapia) SeiZleba dainiSnos Sakikis mqone pacientebSi menopauzisa da perimenopauzis dros (D).

Tuki hormonCanacvlebiTi Terapiis fonze pacients aReniSneba Sakikis gauareseba, HRT unda CaiTvalos mis gamomwvev SesaZlo mizezad (D).

Tuki peroraluri hormonCanacvlebiTi Terapiis fonze adgili aqvs Sakikis simptomebis gauaresebas, unda gaviTvaliswinoT misi daniSvnis transdermuli gza (D).

Sakikis mqone pacientebs unda erCioT, moeridon kvebis gamotovebas.

stresis marTva ganxiluli unda iqnes, rogorc kombinirebuli Terapiis nawili, pacientisTvis SakikTan dakavSirebuli Tavis tkivilis sixSirisa da intensivobis SemcirebaSi daxmarebis mizniT.

spinaluri manualuri Terapia unda gaviTvaliswinoT cervikogenuri Tavis tkivilis mqone pacientebSi.

Sakikis mqone pacientTa SemTxvevaSi prevenciuli Terapiis mizniT unda gaviTvaliswinoT akupunqturis SesaZlebloba.

6. reabilitacia/meTvalyureoba

qronikuli Tavis tkivilis mqone pacientebze meTvalyureoba iTvaliswinebs mwvave Setevebis mkurnalobasa da prevencias, pacientTa simptomebis Semsubuqebas, maTi Sromis unaris gazrdasa da sicocxlis xarisxis gaumjobesebas.

Sakikis, klasteruli Tavis tkivilisa da daZabulobis tipis Tavis tkivilis mqone pacientebze meTvalyureobis mizniT rekomendebulia maTi ambulatoriuli Semowmeba 6 TveSi erTxel.

prevenciuli Terapiis daniSvnis dros rekomendebulia pacientis ganmeorebiTi vizitis organizeba sawyisidan 6-8 kviraSi, medikamnetis dozis titraciisa da saukeTeso efeqturi Terapiuli dozis SerCevis mizniT.

warmatebuli prevenciuli Terapiis SemTxvevaSi aucilebelia wamlis moxsnis mcdelobis ganxorcieleba 6-12 TveSi.

ganmeorebiTi vizitebis dros aucilebelia pacientis ganaTleba Semdeg sakiTxebze:

SeZlebisdagvarad Tavi aaridos stresul situaciebs;

daicvas Zilis regularuli reJimi;

regularulad ivarjiSos;

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ikvebos balansirebulad;

Tavi aaridos arakomfortul poziciebs yoveldRiuri saqmianobis an Zilis dros;

Tavi aaridos Tvalebis gadaZabvas;

miewodos informacia bio-ukukavSirisa da relaqsaciis teqnikis Sesaxeb.

7. Sesabamisi gaidlaini, romelsac eyrdnoba aRniSuli

protokoli

- `Tavis tkivilis marTva pirvelad jandacvaSi~

8. adamianuri da materialur-teqnikuri resursi

resursi funqciebi/mniSvneloba SeniSvna adamianuri

ojaxis eqimi an ubnis eqimi/Terapevti

klinikuri Sefaseba diagnozis dadastureba specialistis konsultaciis saWiroebis gansazRvra medikamenturi mkurnalobis Taobaze gadawyvetileba mimdinare meTvalyureoba

zogadi praqtikis eqTani

riskis profilis Sefaseba (m.S anamnezi, “wiTeli droSios” niSnebi) risk-faqtorebis, aramedikamenturi mkurnalobis, prevenciisa da medikamentebis gverdiTi efeqtebis Taobaze konsultireba.

nevrologi

pacientis Sefaseba axlad dawyebuli Tavis tkiviliT; neirogamosaxviT kvlevasa da lumbalur punqciaze gadawyvetilebis miReba; Tavis tkivilis warumatebeli mkurnalobis SemTxvevaSi pacientis konsultireba; pacientis konsultireba saSiSroebis niSnebis arsebobis SemTxvevaSi.

registratori mimdinare meTvalyureobisaTvis pacientis gamoZaxebis uzrunvelyofa.

menejeri/administratori

gaidlainisa da protokolis danergvis xelSewyoba; danergvaze meTvalyureoba; auditis Catareba da Sedegebis analizi

27

materialur-teqnikuri Tavis tkivilis anamnezuri SekiTxvebis formebi

diagnozis dasma sasurveli

Tavis tkivilis yovelkvireuli dRiuri

riskis profilis Sefaseba sasurveli

sfigmomanometri riskis profilis Sefaseba savaldebulo Tavis tkivilis Taobaze pacientis saganmanaTleblo masalebi

pacientis informireba sasurveli

laboratoria sisxlis saerTo analizis gansazRvrisTvis

riskis profilis Sefaseba savaldebulo

fundoskopi, nevrologiuri CaquCi

riskis profilis Sefaseba savaldebulo

neirogamosaxviTi kvlevebisaTvis saWiro aparatura (mrt, kt)

riskis profilis Sefaseba mimarTva specializirebul dawesebulebaSi

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9. danarTebi

Tavis tkivilis anamnezTan dakavSirebuli SekiTxvebi: 1. Tavis tkivilis ramden gansxvavebul tips aRwers pacienti?

aucilebelia TiToeuli tipisaTvis calk-calke anamnezis Sekreba. kargia, Tuki moxdeba koncentrireba pacientisaTvis yvelaze Semawuxebel tipze, magram danarCenebsac aucileblad sWirdebaT gamokvleva im SemTxvevaSi, Tuki isini klinikurad mniSvnelovania.

2. drosTan dakavSirebuli kiTxvebi: a) ratom mogmarTaT konsultirebisTvis amJamad? b) ramdeni xania, rac tkivili daiwyo? g) ramdenad xSiria da drois mixedviT rogor viTardeba

(gansakuTrebiT mniSvnelovania epizodur da yoveldRiur an qronikul Tavis tkivils Soris gansxvaveba)?

d) tkivilis xangrZlivoba. 3. xasiaTobrivi kiTxvebi:

a) tkivilis intensivoba; b) tkivilis buneba da xarisxi; g) tkivilis lokalizacia da gavceleba; d) asocirebuli simptomebi.

4. mizezobrivi kiTxvebi: a) winaswarganmwyobi da/an maprovocirebeli faqtorebi; b) damamZimebeli da/an Semamsubuqebeli faqtorebi; g) analogiuri Tavis tkivilis ojaxuri anamnezi.

5. mkurnalobasTan dakavSirebuli kiTxvebi: a) ras mimarTavs pacienti Tavis tkivilis dros? b) ramdenad limitirebulia aqtivoba (funqciuri unari) an ramdenad

xdeba misTvis Tavis arideba? g) ra medikamentebs iyenebda an iyenebs amJamad pacienti da ra saxiT?

6. janmrTelobis mdgomareoba Setevebs Soris periodSi: a) absoluturad janmrTelia, Tu aRiniSneba narCeni an persistiuli

simptomebi? b) azrebi, SfoTva da SiSi ganmeorebiTi Setevebis da/an maTi

mizezebis Taobaze.

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Tavis tkivilis yovelkvireuli dRiuri

kvira I aRwereT Tqveni Tavis tkivili 10-quliani sistemiT da miuTiTeT, Tuki gaqvT CamoTvlilidan romelime simptomi

orS samS oTxS xuTS parask Sab kvira

Tavis tkivili (0=ar aris, 10=yvelaze uaresi) avadmyofobis SegrZneba (diax/ara) Rebineba (diax/ara) sxva simptomebi (diax/ara) Setevis xangrZlivoba (saaTi) wamowolis aucilebloba (diax/ara) dro. romlis ganmavlobaSic ver eweodiT normalur aqtivobas

miRebuli medikamentebis tabletebis raodenoba: daniSnuli sakuTari iniciativiT SeZenili

menstuacia (diax/ara)

30

Tavis tkivilis sadiagnozo algoriTmi

pacienti UuCivis Tavis tkivils?

mniSvnelovani pirveli nabijebi:

detaluri anamnezi;

fokusirebuli obieqturi gasinjva;

fokusirebuli nevrologiuri gasinjva.

eWvis mizezebi:

qvemwvave da/an progresirebadi Tavis tkivili Tveebis ganmavlobaSi;

axlad dawyebuli Tavis tkivili an misi saxecvlileba;

“yvelaze uaresi Tavis tkivili”;

dawyebisTanave maqsimaluri intensivobis nebismieri Tavis tkivili;

Tavis tkivilis dawyeba 50 wels zemoT asakSi;

sistemuri daavadebis simptomebi;

krunCxvebi;

nebismieri nevrologiuri niSani.

detaluri anamnezi:

Tavis tkivilis maxasiaTeblebi;

funqciuri uunarobis Sefaseba;

warsuli samedicino anamnezi;

Sakikis ojaxuri anamnezi;

mimdinare medikamenturi mkurnaloba (eqimis mier daniSnuli Tu TviT-mkurnaloba);

socialuri anamnezi;

organoTa sistemebis Sefaseba sistemuri daavadebis gamoricxvis mizniT.

saxezea mizezebi eWvisTvis?

akmayofilebs pirveladi Tavis

tkivilis kriteriumebs?

meoreuli Tavis tkivili

gaiTvaliswineT Tavis tkivilis meoradi mizezebi

naCvenebia specialistis kons.-tacia?

Cvenebis SemTxvevaSi CaatareT diagnostikuri gamokvleva

Sedegebi metyvelbs meorad Tavis

tkivilze?

gaagzavneT specialistTan

pirveladiTavis

tkivilis diagnozi dadastur-

da?

SeafaseT pirveladi Tavis tkivilis tipi; daiwyeT pacientis ganaTleba da cxovrebis stilis modificireba

Sakiki (ix. Sakikis marTva)

daZabvis Tavis tkivili (ix. marTva)

klasteruli Tavis tkivili (ix. marTva)

meoradi Tavis tkivili (ix. marTva)

sinusuri Tavis tkivili SakikTan asocirebuli simptomebis dros xSirad arasworad ismeba sinusuri

Tavis tkivilis diagnozi. amis Sedegia Sakikis arasaTanado diagnostireba da mkurnaloba.

Tavis tkivilis saerTaSoriso sazogadoebis (International Headache Society – IHS) definiciis mixedviT sinusuri Tavis tkivilis diagnozi ganisazRvreba Semdegi kriteriumebis safuZvelze: Cirqovani gamonadeni cxviridan, cxviris danamati wiaRebis paTologia gamosaxviTi kvlevisas, sinusitisa da Tavis tkivilis erTdrouli dawyeba, Tavis tkivili, romelic lokalizebulia sinusebisTvis specifiur saxisa da kranialur areebSi.

gansazRvreT meoreuli Tavis tkivilis mizezi (ix. gaidlaini)

diax

diax

diax

diax

ara

ara

ara ara

31

Sakikis profilaqtikuri mkurnalobis algoriTmi

pacienti akmayofilebs Sakikis kriteriumebs

profilaqtikuri mkurnaloba SeafaseT faqtorebi, romlebmac SesaZloa gadawyvitos Sakikis pirveli rigis mkurnaloba: *medikamentebi -beta-blokerebi -tricikluri antidepresantebi *antiepilefsiuri medikametebi -divalproeqsi -topiramati -gabapentini -verapamili *gaanaTleT pacientis da miawodeT informacia cxovrebis stilis Sesaxeb; *mxedvelobaSi iqonieT sxva mkurnaloba (bioukukavSiri, relaqsacia); *gamoavlineT, xom ar aris depresia an generalizebuli SfoTva.

warmatebulia?*

scadeT sxva pirveli rigis medikamenti an igive jgufis sxva wamali

warmatebulia?*

beta-blokerebis da tricikluri antidepresantebis kombinacia

warmatebulia?*

mesame rigis profilaqtikuri mkurnaloba an nevrologis konsultacia

gaagrZeleT mkurnaloba 6-12 Tve da Semdeg ganmeorebiT SeafaseT mdgomareoba



warmatebulia? warmateba ganisazRvreba rogorc: -Tavis tkivili mcirdeba 50%-T an metad; -misaRebi gverdiTi movlenebi;

diax

diax

diax

ara

ara

ara

ara

32

daZabulobis tipis Tavis tkivilis algoriTmi

mkurnaloba warmatebulia?

daZabvis Tavis tkivili

pacienti akmayofilebs daZabvis Tavis

tkivilis kriteriumebs

pacienti profilaqtikuri mkurnalobis

kandidati aris?

profilaqtikuri mkurnaloba *amitriptilini *ssva tricikluri antidepresantebi *venlafaqsini XR

*tizanidini *damatebiTi Terapia


rekomenda-ciisgan gansxvavebuli mkurnaloba

damatebiTi mkurnaloba *stresis marTva *fsiqoTerapia

daubrundiT diagnostikur algoriTms

mwvave Setevis mkurnaloba:

*acetaminofeni; *aspirini; *anTebis sawinaaRmdego arasteroidebi; *midrini (kombinirebuli preparati: acetaminofeni, izometepteni da diqlorafenazoni); *damatebiTi Terapia.

*mxedvelobaSi iqonieT sxva mwvave an profilaqtikuri mkurnaloba; *gadaamowmeT diagnozi; *mxedvelobaSi iqonieT medikamentebis Warbad gamoyeneba; *mxedvelobai iqonieT specialistis konsultacia.

gaagrZeleT mkurnaloba


amJamad pacients aReniSneba Tavis

tkivili?

ara

diax

ara

ara

ara

diax

diax

33

klasteruli Tavis tkivilis algoriTmi

klasteruli

Tavis tkivili

gaagrZeleT Terapia ciklis ganmavlobaSi, Semdeg SeamcireT.

akmayofilebs klasteruli tkivilis

kriteriumebs?

amJamad pacienti imyofeba klasterul

ciklSi?

mwvave mkurnaloba: *Jangbadi; *sumatriptani; *dihidroergotamini; *daiwyeT profilaqtikuri mkurnaloba.

profilaqtikuri mkurnaloba: *moeridos alkoholis miRebas klasteruli ciklis dros; *verapamili (pirveli rigis).

*verapamili – maRali dozebi; *steroidebi da sxvebi; *liTiumi; *depakoti; *topiramati.


daubrundiT diagnostikur algoriTms

*gaaZliereT pacientis ganaTleba; *mxedvelobaSi iqonieT pre-klasterul ciklSi specialistis konsultacia.

*gaagrZeleT da SecvaleT mwvave mkurnaloba; *gaagrZeleT da SecvaleT profilaqtikuri mkurnaloba; *mxedvelobaSi iqonieT specialistis konsultacia.

mkurnaloba warmatebulia??

mxedvelobaSi iqonieT specialistis konsultacia/ rekomendaciisgan gansxvavebuli midgoma

ara

diax

diax

ara

ara

ara

ara

diax

diax

diax

diax

34

menstruaciasTan asocirebuli Sakikis mkurnaloba

menstruaciasTan asocirebuli Sakiki

menstrualuri Sakikis diagnozi dasturdeba menstruaciis CanaweriT?

daubrundiT Sakikis mkurnalobis algoriTms


mxolod menstrualuri: *Tavis tkivili aRmocendeba mxolod menzesis dasawyisidan ±2 dReSi

asocorebulia magram ar Semoifargleba mxolod menstruaciiT: *TveSi 6-8 dReze metjer *Tavis tkivili ≥3 dRis/TveSi roca pacients utardeba optimaluri mkurnaloba, magram siptomebi mainc Somisuunaros xdis.

ixileT Sakikis mkurnalobis

algoriTmi



cikluri profilaqtika *anTebis sawinaaRmdego arasteroidebi; *triptanebi; *ergotebi.



hormonuli profilaqtika: *estradiolis plastirebi; *estrogenis Semcveli kontraceptivebi; *GnRH (gonadotropin rilizing hormonis) agonistebi- ixileT estrogenis Semcveli kontraceptivebis Sakikis algoriTmi



Tavis tkivilis specialistTan konsultacia

diax

diax

diax

diax

ara

ara

ara

ara

35

perimenopauzuri da monopauzuri Sakikis algoriTmi

perimenopauzuri an menopauzuri pacienti aqtiuri Sakikis anamneziT

aris pacienti hormonuli Terapiis kandidati?

pacienti Tanaxmaa daiwyos hormonuli Terapia?


scadeT Terapia Sakikis profilaqtikuri mkurnalobis algoriTmis mixedviT

warmatebulia?


hormonuli Terapia *oraluri an transdermuli estrogenebi; *progestini Cvenebebis SemTxvevaSi; *estrogenebis Semcveli kontraceptivebi. ixileT ICSI-s menopauzis da hormonuli Terapiis rekomendacias, aseve estrogenebis Semcveli kontraceptivebis Sakikis algoriTmi.

warmatebulia?

gaagrZeleT mkurnaloba da dakvirveba

kidev erTxel gaiTvaliswineT hormonuli Terapia

warmatebulia?

*specialistis konsultacia; *daubrundiT Sakikis mkurnalobis algoriTms.

gaiTvaliswineT estrogenebis da progestinis miwodebis gzis cvlileba an medikamenturi formis Taviseburebebi

ara

ara

ara

diax

diax

diax

ara

ara diax

36

estrogenebis Semcvel kontraceptivebze myofi an estrogenebi

Semcveli kontraceptivebis kandidatebSi Sakikis algoriTmi

i. Silberstein SD, Olesen J, Bousser MG, Diener HC, Dodick D, Firest M, et al. The International Classification of Headache Disorders, 2nd edition (ICHD-II) – revision of criteria for 8.2 – Medication overuse headache. Cephalgia 2005; 25(6): 460-5.

estrogenebis Semcvel kontraceptivebze myofi an estrogenebis Semcveli kontraceptivebis

kandidatebi, visac aReniSneba Sakiki

iTvaliswinebT araestrogenul Sobadobis kontrols?

SeafaseT insultis risk faqtorebi: *Sakikis aura; *hiperkoagulaciis laboratoriuli niSnebi; *gadatanili arteriuli Tromboemboliuri daavadeba; *Tambaqos moxmareba

*progestinuli meTodebi: - mxolod progestinis Semcveli kontraceptivebi

- depo-provera *arahormonuli kontracefciis meTodebi; *saSvilosnosSida mowyobilobebi, barieruli meTodebi.

riskis qveS?

estrogenebis dabali Semcvelobis kontraceptivebi

Tavis tkivili gauaresda? *gaxSirda *gaZlierda *ganviTarda aura

ganagrZeT profilaqtikuri mkurnaloba

Tavistkivili gauaresda? *gaxSirda *gaZlierda *ganviTarda aura

ganagrZeT mkurnaloba

* mxedvelobaSi iqonieT progestinebis Sewyveta;

* ganmeorebiT SeafaseT gauaresebis mizezebi;

* mxedvelobaSi iqonieT specialistis konsultacia;

* daubrundiT Sakikis mkurnalobis algoriTms.

*mxedvelobaSi miiReT oraluri an transdermuli estrogenebi placebos kviris ganmavlobaSi; *SewyviteT estrogenebis Semcveli kontraceptivebi; *mxedvelobaSi iqonieT progestinuli meTodebi an arahormonuli kontracefciis meTodebi; *ganmeorebiT SeafaseT gauaresebis mizezebi; *mxedvelobaSi miiReT specialistis konsultacia.

ara

diax

diax ara

diax

diax ara

ara

tavis tkivilis martva pirvelad jandacvasi · 2017-06-02 · 2 tavis tkivilis martva pirvelad...

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