nevrologiuri simptomatika bronquli

nevrologiuri simptomatika bronquli asTmiT daavadebul mozrdilebSi.

m. lomia, m.m.k., (bavSvTa reabilitaciis centri)

m. fruiZe (Tbilisis me-9 poliklinika)

bronquli asTma warmoadgens kacobriobis erT-erT yvelaze gavrcelebul daavadebas. sxvadasxva avtoris monacemebiT, dedamiwis mosaxleobis 3-4%-s aReniSneba bronquli asTma (Atljcttd7 {kjgjnjdf7 1988) da mosaxleobis kidev 4%-s asTma anamnezSi aReniSneba (O’Connor et al, 1986).

miuxedavad imisa, rom bronquli asTmis ganviTarebaSi da mimdinareobaSi wamyvani adgili alergiul procesebs ukavia, nervuli sistemis roli bronquli asTmis aRmocenebaSi da mimdinareobaSi yovelTvos ipyrobda mecnierTa yuradRebas. jer kidev akicenas miaCnda, rom bronquli asTma warmoadgens nervuli sistemis dazianebis Sedegs (F,e Fkb B,y Cbyf7 1981). me-19 saukuneSi Laennec-s (1826), Biermer-s (1882), <jnrby-s (1855), Fraerkel-s (1891) da mraval sxva bronquli astma nevrologiur daavadebad miaCndaT.

imis Semdegac ki, rac Meltzer-ma (1910) da Walker-ma (1917) wamoayenes bronquli asTmis alergiuli genezis Teoria, nervuli sistemis roli bronquli asTmis dros izidavs mkvlevarTa yuradRebas.

garda avtonomiuri nervuli sistemis mdgomareobisa, mecnierTa yuradRebas centraluri nervuli sistemis mdgomareobac iwvwvs. kvlevebi ZiriTadad exeba eqsperimentSi bronquli asTmis dros Secvlili bronquli tonusis centraluri neirogenuri komponentis dadgenas da mkurnalobas ({feybyf7 !)^!), hipoTalamusis da Tavis tvinis qerqis zogierTi ubnebis monawileobas alergiul reaqciebis ganxorcielebaSi (Ahjkjd7 Eylhbwjd7 Vfrfhtyrj !)*) da Tavis tvinSi eleqtrofiziologiuri procesebis Taviseburebebs (Fylhttdf7 !)(!7 Gkfnrjd7 Rfkbyby7 !)(#). did yuradRebas ipyrobs bronquli asTmis genezSi fsiqiuri faqtorebis monawileoba (Alexander, 1971).

monacemebi nevrologiuri refleqsuri fonis Sesaxeb bronquli asTmis dros did iSviaTobas warmoadgenen. arsebobs erTeuli monacemebi refleqsuri asimetriis da sxva umniSvnelo nevrologiuri simptomebis Sesaxeb bronquli asTmis dros (N.hby7 Rjktcjd7 !)^%9 <jujktgjd7 Fhbcnjdf7 !)*#9 Rfufyjd b lh87 !)*$9 Rfgkfy7 !)*^9 Ve[nfhjdf7 !)($9 Renby7 !)((). amave dros, am publikaciebSi ar Cans, ramdenad damaxasiaTebelia es nevrologiuri niSnebi bronquli asTmiT daavadebulTaTvis, radgan ar momxdara maTi Sedareba jamrTeli populaciis refleqsuri fonis monacemebTan. amitom Cven gadavwyviteT gamogvekvlia nevrologiuri refleqsuri foni bronquli asTmiT daavadebulebSi da Segvedarebina es monacemebi igive asakis janmrTel adamianTa sakontrolo jgufis monacemebTan.

gamokvleva Catarda 30-50 wlis asakis 80 adamianze. 40 maTgani bronquli asTmiT iyo daavadebuli, 40 ki _ pirobiTad jamrTeli iyo. 40-ve avadmyofs aSS-s janmrTelobis erovnuli institutis mier mowonebuli klasifikaciis mixedviT (Global Initiative for Asthma, NIH Publication No 95-3659, 1995) aReniSneboda saSualo simZimis yoveldRiuri SetevebiT persistirebulad mimdinare bronquli asTma. arc erT avadmyofs ar aReniSneboda raime sxva TandarTuli daavadeba.

aRmoCnda, rom asTmiT daavadebulebSi mxolod 2 adamians (saerTo raodenobis 5%-s) ar aReniSneboda aranairi paTologiuri refleqsi an msubuqi nevrologiuri simptomatika, maSin rodesac janmrTelebSi aseTi 9 adamiani (22,5%) iyo. cxvir-tuCis naoWis msubuqi gasadaveba erT mxareze aReniSneboda bronquli asTmiT daavadebul 17 adamians (42,5%), da 5 janmrTel adamians (12,5%), oraluri avtomatizis paTologiuri refleqsebi aReniSneboda 12 avadmyofs (30%) da 14 janmrTels (35%), marinesku-rafdoviCis paTologiuri refleqsi aReniSneboda 14 asTmiT avadmyofs (35%) da 12 janmrTels (30%). babinskis paTologiuri refleqsi aReniSneboda 6 avadmyofs (15%) da mxolod 1 janmrTels (2,5%). rosolimos paTologiur refleqss aReniSneboda 5 asTmiT avadmyofs (12,5%) da ar aReniSneboda arcerT janmrTels.

myesTa refleqsebis spastiuroba an maTi gamowveva gafarToebuli zonidan aReniSneboda asTmiT daavadebul 15 avadmyofs (37,5%) da 14 janmrTels (35%). myesTa refleqsebis asimetriuloba aReniSneboda 15 asTmiT avadmyofs (37,5%) da mxolod 3 janmrTels (7,5%).

sakoordinacio cdebs odnav uxerxulad asrulebdnen da rombergis pozaSi aReniSnebodaT msubuqi xarisxis deviacia da aramyaroba 6 avadmyofs (15%) da 6 janmrTels (15%).

bronquli asTmis mqone 4 avadmyofs aReniSneboda rbili sasis SekumSvisas umniSvnelo asimetria (10%), aseve 4 avadmyofs aReniSneboda dayenebiTi nistagmi (10%). asTmiT daavadebuli 2 avadmyofi uCioda Zlier oflianobas (5%).

aseve bronquli asTmiT daavadebulebs aReniSnebodaT Sakikis, xelis gulebis hiperhidrozis, yurebSi Suilis da Tavbrusxvevis, troqotilomaniis, tikozuri hiperkinezebis erTeuli SemTxvevebi.

avadmyofTa umravlesobas ar qondaT monacemebi sakuTari perinataluri anamneziis Sesaxeb. mxolod 2 avadmyofma aRniSna, rom isini daibadnen mZime mSobiarobis Sedegad. avadmyofTa umetesobas hqonda darRveuli Zili, rasac Tavad ukavSirebdnen Ramis asTmur Setevebs.

rogorc vxdedavT, arsebobs refleqsuri fonis garkveuli Tavisebureba bronquli asTmiT daavadebul avadmyofebSi. maTSi 5-jer ufro xSiria myesTa refleqsebis asimetria (37,5%) vidre janmrTelebSi (7,5%), 3,5-jer ufro xSiria cxvir-tuCis naoWis calmxrivi gasadaveba (42,5%), vidre janmrTelebSi (12%). aseve yuradRebas ipyrobs babinskis refleqsis 6-jer ufro maRali sixSire asTmiT daavadebulTa jgufSi (15%), vidre janmrTelebSi (2,5%).

Cveni gansakuTrebuli yuradReba miipyro erTma garemoebam. aRmoCnda rom, Cvens mier SerCeul asTmiT daavadebulTa 40 kacian jgufSi 23 adamians aRmoaCnda terfis zurgis eqskavacia (amoburculoba), rac avadmyofTa 57,5%-s Seadgens da amave dros janmrTelebSi es mxolod 7 admians aRmoaCnda, rac janmrTelTa raodenobis 17,5%-s Seadgens.

miRebuli refleqsuri fonis maCveneblebidan gamomdinare, SeiZleba vivaraudoT bronquli asTmiT daavadebulebSi msubuqi piramiduli deficitis arsebobis SedarebiT ufro maRali sixSireze, vidre es janmrTelebSi aRiniSneba. am fenomenis genezi CvenTvis ucnobia. SesaZlebelia, rom is gamowveuli iyos asTmis dros arsebuli qronikuli hipoqsiis mdgomareobiT an warmoadgendes asTmis premorbidul fons. amis garkveva SesaZlebeli iqneba mxolod mas Semdeg, roca dadgindeba asTmiT avdmyofTa nevrologiuri statusis da refleqsuri fonis korelacia daavadebis simZimesTan da xangrZlivobasTan, SetevaTa sixSiresTan, garegani sunTqvis parametrebis cvlilebebTan da a.S., rac calke kvlevis sagans warmoadgens. rac Seexeba terfis zurgis amoburculobas (eqskavacias), misi genezi aseve bundovania. cnobilia, rom terfis zurgis amoburculoba xvdeba fridraixis daavadebisas (Gekfnjd7 Ybrbajhjd7 !)(#), da mis arsebobis erT_erT damaxasiaTebel niSans warmoadgens (Z[yj b lh8 !))%). gansxvavebiT am tipis terfisagan, asTmiT daavadebul avadmyofebs aReniSnebaT mxolod terfis zurgis amoburculoba da terfis sxva nawilebi ucvlelia. mxolod erT SemTxvevaSi aRiniSneboda tipiuri fridraixis terfi: zurgis eqskavaciiT, terfis qveda zedapiris mniSvnelovani TaRovani amaRlebiT (e.w. “Rru terfi”), da amasTan erTad _ TiTebis ZiriTadi falangebis eqstenzia da frCxilebis falangebis flefsia. yvela sxva SemTxvevaSi Cven aRmovaCineT mxolod terfis zurgis amoburculoba, terfis qveda nawilis da TiTebis cvlilebis gareSe.

cnobilia, rom asTmis genezSi mniSvnelovani adgili uWiravT genetikur faqtorebs. savsebiT SesaZlebelia, rom terfis zurgis amoburculoba garkveulwilad warmoadgens asTmis genetikur markerebTan dakavSirebul niSans, rac calke kvlevis sagans warmoadgens.

ra Tqma unda, miRebuli monacemebi ver asaxavdnen bronquli asTmis dros arsebul nevrologiuri refleqsuri fonis da konstituciuri Taviseburebebis yvela aspeqts. saamisod Casatarebelia damatebiTi gamokvlevebi asTmiT daavadebulTa yvela asakobriv jgufSi.

l i t e r a t u r a:

1) Atljcttd U8<87 {kjgjnjdf U8G8 <hjy[bfkmyfz fcnvf8 K87 “Vtlbwbyf”, 1988.

2) O’Connor GT, Weiss ST, Speizer FE. The epidemiology of asthma. In: Bronchial asthma, Principles of diagnosis and treatment. Grune and Stratton, Orbndo, NY, San Diego, etc., 1986.

3) F,e Fkb B,y Cbyf8 Rfyjy dhfxt,yjq yferb8 Nfirtyn7 “Afy”, 1981.

4) Laennec RT. De l’iauscultation mediate, ou traite du diagnostic des maladies des poumons et du coeur, t, 1-2. Paris, 1826.

5) Trousseau. Lehrbuch da nervenkrank-heiten. In: Clinique med., 3, Edit. 2. 3 Aufl. Berlin 1855.

6) Biermer. Ueber Bronchial asthma In: Volkmanns Sammlung. Heft 3, 1882

7) <jnrby C8G8 Rehc rkbybrb dyenhtyyb[ ,jktpytq b rkbybxtcrbt ktrwbb8 CG<87 !((*

8) Fraehkel B. Berl. Klin. Wocherschr, 1881, #164,17

9) Meltzer SG. Bronchial asthma as a phenomenon of anaphylaxis. IAMA, 1910, 55, 1021-1024.

10) Walker IC. Causes of bronchial asthma. I. Med. res., 1917, 36, May, 295

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15) Alexander F. Emotional reactions to stress in bronchial asthma. In: Psychosomatic medicine. N.Y., 1971, vol. 33, 4, 323-327

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