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ცხვირიდან სისხლდენის მართვის ახალი პერსპექტივები

თარიღი: 16 ივნისი, 2017

ცხვირიდან სისხლდენის მართვის ახალი პერსპექტივები

ცხვირიდან სისხლდენა საკმაოდ ხშირად გვხვდება სამედიცინო პრაქტიკაში, მსუბუქი ფორმიდან დაწყებული (მინიმალური სისხლდენა და თვითშეჩერება) მძიმე შემთხვევის ჩათვლით (უხვი სისხლის დანაკარგი).რომელიც საფრთხის ქვეშ აყენებს პაციენტის სიცოცხლეს და საჭიროებს დროულ , კომპენტენტურ სამედიცინო ჩარევას. ყველაზე ხშირად ამ პრობლემას აწყდებიან -ოტოლარინგოლოგები და მოიხსენიებენ ტერმინით - ეპისტაქსისი, რომელიც ბერძნული წარმოშობის სიტყვაა (ბერძნ. ეპი ზედ, ზევიდან, სტაზო ჩამოვედინები).

ცხვირიდან სისხლდენა -ეს არის ნოზოლოგია, რომლის თუნდაც ერთ ეპიზოდთან შეხება ჰქონია ყველა ადამიანს თავისი სიცოცხლის განმავლობაში. ამ პრობლემის განვითარებაზე და მასთან ბრძოლის საშუალებებზე გვესაუბრება ხუჯაძე-გოგნიაშვილის კლინიკის წამყვანი ოტორინოლარინგოლოგი, მედიცინის მეცნიერებათა დოქტორი ბატონი გიორგი გოგნიაშვილი

ბატონო გიორგი, ცხვირიდან სისხლდენა რომელ ასაკობრივ ჯგუფშია უფრო აქტუალური და თუ ახასიათებს სეზონურობა?

- საერთაშორისო სტატისტიკის მიხედვით, ცხვირიდან სისხლდენა სპონტანურ სისხლდენებს შორის მეორე ადგილზეა. გავრცელება ასაკის მიხედვით ატარებს ბიმოდალურ ხასიათს, პიკებით ბავშვებში (2-10 წელი) და მოზრდილებში (50-80 წელი). ეპისტაქსისის გავრცელებას სქესის მიხედვით აქვს ტენდენცია - მამაკაცებში მაღალი გავრცელება ქალებთან შედარებით და ასევე ახასიათებს სეზონურობა, უფრო აქტუალურია შემოდგომის ბოლოს და ზამთრის თვეებში.

- რა მიზეზებმა შეიძლება გამოიწვიოს ცხვირიდან სისხლდენა., რა ხელშემწყობი ფაქტორები არსებობს?
ცხვირიდან სისხლდენის მიზეზები პირობითად შეიძლება დავყოთ 2 ჯგუფად:
ადგილობრივი მიზეზები (მაგალითად, ცხვირის ღრუს ლორწოვანი გარსის გაღიზიანება, სიმშრალე, ზედა სასუნთქი გზების ქრონიკული ინფექცია, ტრავმა, უცხო სხეული, ქირურგიული ჩარევა ცხვირზე და დანამატ წიაღებზე, ალერგია, ნაზალური პოლიპები.

სისტემური მიზეზებიდან აღსანიშნავია მაღალი არტერიული წნევა სისხლის დაავადებები (ჰემოფილია, თრომბოციტოპენია) ლეიკემია, ვილებრანდის დაავადება, თირკმლის და ღვიძლის პათოლოგიები, აგრეთვე ეპისტქსის მიზეზი შეიძლება იყოს სხვადახვა მედიკამენტის რეგულარული მიღება (არასტეროიდული ანთების საწინააღმდეგო საშუალებები, ანტიკუაგულანტები, ანტიაგრეგანტები, ნაზალური სტეროიდები.), ასევე უნდა აღინიშნოს იდიოპათიური ეპისტაქსისი ,როდესაც ყოველთვის ვერ ხერხდება ცხვირიდან სისხლდენის რაიმე კონკრეტული მიზეზის დადგენა. ცხვრიდან სისხლდენის მქონე პაციენტების დაახლოებით 10% ესმევა იდიოპათიური,რეკურენტული ეპისტაქსისის დიაგნოზი.

ლოკალიზაციის მიხედვით ეპიტაქსისი შესაძლოა დაიყოს 2 კატეგორიად- წინა და უკანა ცხვირიდან სისხლდენა.
ცხვირიდან სისხლდენების 90% აღმოცენდება ცხვირის წინა ნაწილში, ე.წ ლიტლის მიდამოში, კისელბახის წნულიდან. უკანა სისხლდენა ვითარდება 5-10 % შემთხვევაში ცხვირის ღრუს უკანა მიდამოებიდან ე.წ. ვუდრაფის წნულიდან, წინა სისხლდენისგან განსხვავებით ხშირად არტერიული წარმოშობისაა და უფრო უხვი და ინტენსიურია.

- მკურნალობის რა ტაქტიკას მიმართავთ ცხვირიდან სისხლდენის დროს?

- მკურნალობის მიზანს, რა თქმა უნდა, წარმოადგენს პირველ რიგში მწვავე სისხლდენის შეჩერება და განმეორიბითი ეპიზოდების პროფილაქტიკა. ამის შემდგომ უნდა მოხდეს ცხვირიდან სისხლდენის ძირითადი გამომწვევი მიზეზის დადგენა და აღმოფხვრა.

ცხვირიდან სისხლდენის მკურნალობის სტრატეგია დამოკიდებულია ცხვირიდან სისხლდენის ინტენსივობაზე, ჯერადობაზე და ლოკალიზაციაზე.

მცირე ინტენსივობის დროს საკმარისია ცხვირზე მექანიკური ზეწოლა გარედან და ადგილობრივად ინიშნება მკურნალობა.

ასევე ხდება ცხვირიდან სისხლდენის მკურნალობა ელექტროკუაგულაციური მეთოდით. ზემოთაღნიშნული მეთოდების უეფექტობის შემთხვევაში მიმართავენ წინა ან უკანა ტამპონადას.

რთული შემთხვევების დროს მიმართავენ ზედა ყბის არტერიის ანგიოგრაფიულ ემბოლიზაციას, მაგრამ აღნიშნული მეთოდის ბევრი გვერდითი ეფექტის გამო ემბოლიზაციის პოპულარულ ალტერნატივად ითვლება დაზიანებული სისხლძარღვის ქირურგიული ლიგირება.

- ბატონო გიორგი,თქვენ ახსენეთ ცხვირიდან სისხლდენის ადგილობრივი მკურნალობა, გვაინტერესებს რომელ საშუალებებს ანიჭებთ უპირატესობას?

- წლების განმავლობაში ცხვირიდან სისხლდენას სხვადასხვა ადგილობრივი საშუალებით ებრძოდნენ. დღეს უკვე საქართველოში არსებობს პრეპარატი -ემოფიქსი. ემოფიქსი არის ჰემოსტაზური ბარიერული მალამო, რომელიც გამოიყენება ეპისტაქსისის როგორც მწვავე ეპიზოდების კუპირებისთვის, ასევე განმეორებითი ეპიზოდების პროფილაქტიკისთვის. გარდა სისხლდენის შეჩერებისა, ემოფიქსის მალამო ხელს უწყობს დაზიანებული ცხვირის ლორწოვანის სწრაფ რეგენერაციას და დატენიანებას.

ანტისეპტიკური თვისების წყალობით ემოფიქსის მალამო ახდენს ცხირის ლორწოვანის ღია ჭრილობიდან აღმავალი ინფექციის გავრცელების პროფილაქტიკას.

მალამოს თან ახლავს ცხვირის აპლიკატორი კანულა, რაც მის გამოყენებას პაციენტისთვის კომფორტულს ხდის, ემოფიქსის მალამო გამოიყენება ყველა ასაკობრივ ჯგუფში, ორსულებში და მეძუძურ დედებში.