gul-filtvis reanimaciis Tanamedrove midgomebi

giorgi kutubiZe giorgi SaiSmelaSvili

22.03.11

reanimaciis adreuli

mcdelobebi

istoriuli faqtebi1740  parizis mecnierebaTa akademiam oficialurad gaukeTa rekomendacia piriT-pirSi sunTqvis gamoyenebas daxrCobis dros;1767   wyalSi damxrCvalTa gadarCenis sazogadoebas (the Society for the Recovery of Persons Apparently Drowned) hqonda pirveli organizebuli Zalisxmevis mcdelobebi uecari da moulodneli sikvdilis SemTxvevebis samarTavad;1891   Dr. Friedrich Maass-ma ganaxorciela pirveli dokumentirebuli gulmkerdis kompresia adamianebSi;1903   Dr. George Crile-ma aRwera gulmkerdis garegani kompresiis pirveli warmatebuli gamoyeneba; 1904   Dr. George Crile-ma ganaxorciela pirveli gulmkerdis garegani masaJi aSS-Si;. 1954   James Elam-ma daadastura, rom amosunTquli airi sakmarisia oqsigenaciisTvis;1956   Peter Safar-ma da James Elam-ma gamoigones piriT-pirSi reanimacia Tanamedrove saxiT; 1957   aSS-s samxedro uwyebam moaxdina aRniSnuli reanimaciis meTodis adaptireba ugonod myofi dazaralebulebis gacocxlebis mizniT; 1960   ganviTarda gul-filtvis reanimacia (CPR) . amerikis gulis asociaciam daiwyo gacnobiTi xasiaTis treningebis Catareba eqimebisTvis da amavdroulad gaxda lideri gul-filtvis reanimaciis swavlebaSi. 1963   kardiologma Leonard Scherli-ma wamoiwyo amerikis gulis asociaciis CPR-is komiteti. amave wels amerikis gulis asociaciam formalurad miiRo CPR. 1966  amerikis wiTeli jvris da sxva organizaciebis moTxovniT amerikis mecnierebaTa akademiis nacionalurma kvleviTm sabWom Caatara specialuri konferencia gul-filtvis reanimaciis standartebis da misi universaluri swavlebis SesamuSaveblad. 1972   Leonard Cobb-ma Caatara msoflioSi pirvelad gfr-s masobrivi treiningi moqalaqeebisTvis qalaq sietlSi. am treningma pirveli 2 wlis manZilze moicva 100000-ze meti adamiani;1981   aSS- qalaq King County-Si daiwyo programa _ telefoniT instruqciebis miwodeba gfr-s dros. dReisaTvis aSS-Si es servisi standartulad xorcieldeba EMT–s da saxanZro departamentis dispeCerebis meSveobiT.

piter safari mkvlevarTa jgufTan da moxaliseebTan erTad

1. kompresiebis Catarebis xarisxi saWiroebs Semdgom gaumjobesebas

2. arasamedicino dawesebulebebSi gulis gaCerebis SemTxvevaSi gadarCenis xarisxi mniSvnelovnad damokidebulia im personalze vinc atarebs gul-filtvis reanimacias

3. arasamedicino dawesebulebaSi gulis uecari gaCerebis SemTxvevaSi dazaralebuli droulad ver Rebulobs saTanado daxmarebas (ar utardeba gul-filtvis reanimacia)

gadarCenis maCvenebeli (%) da misi Sefardeba gulmkerdis kompresiebis Soris

pauzis xangrZlivobasTan, fibrilaciis SemTxvevaSi

3 sec 10 sec 15 sec 20 sec0

20

40

60

80

100

Yu - Circulation 106:368 2002

gadarCenis maCveneblebi Cveulebrivi gul-filtvis reanimaciisa (CPR) da mxolod gulmkerdze zewolebis (CCR) dros

CPR CCR0

10

20

30

40

1997-1999

9%28/314

Terry Valenzuela MD AHA Resuscitation Science Symposium 2006 . Tucson, Arizona

2003-2006

25%34/136

spontanuri cirkulaciis aRdgena prehospitalur etapze

CPR CCR0

20

40

60

80

100

Bobrow and SHARE study group. Kansas City

15%52%

gamosavali intaqturi nevrologiiT Cveulebrivi gul-filtvis reanimaciisa (CPR) da mxolod

gulmkerdze zewolebis (CCR) dros

CPR CCR0

10

20

30

40

50

15%

40%

Bobrow and SHARE study group , Wisconsin data

aris Tu ara CasunTqvebi aucilebeli?ABG aRebulia reanimaciis dawyebidan (VF gamo) 7 wuTSi

SaO2 PCO2 pH

CPR 92 ±1 25 ±2 7.49 ±0.02

CCR 76 ±6 37 ±5 7.41 ±0.3

Berg. Circulation 1997

Series1

gfr

15 %

68 %

mxolod zewolebi

(CCP)

Locke et al. University of Arizona CPR Research Group; Arch Intern Med 1995; 155:938-943

CautarebdiT Tu ara ucnobs reanimacias?

reanimaciis arCatarebis mizezebi

• saWiro unarebis ararseboba

• manipulaciis SedarebiTi sirTule (sasunTqi gzebis gaxsna, piriT pirSi Caberva)

• raime daavadebis SiSi

• raimes gafuWebis, dazianebis SiSi

Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8

reanimaciis samfaziani modeli

0 2 4 6 8 10 12 14 16 18 20dro gulis gaCerebidan (wT.)

 1 2

 3

0

100%miokardiumis ATP 1. eleqtruli faza

2. cirkulaciuri faza3. metaboluri faza

avtomaturi gareganidefibrilatorebi (AED)sazogadoebriviTavSeyris adgilebSi

avtomaturi garegani defibrilatori (AED)

ABC (Airway Breathing Circulation) Tanmimdevrobis cvlileba CAB-Ti

• ABC sicocxlis gadarCenis algoriTmi Seicvalos CAB-Ti yvela asakobriv jgyfSi (garda axalSobilebisa)

• gulis gaCerebis mqone pacientebis sicocxlis SenarCunebisTvis mniSvnelovania gul-mkerdze zewolebi da drouli defibrilacia.

• ABC Tanmimdevrobis gamoyenebisas zewolebi uxSiresad gviandeba.

• CAB Tanmimdevrobisas gulmkerdze zewolebi iwyeba naadrevad, xolo xelovnuri sunTqva tardeba minimaluri dayovnebiT.

• CAB algoriTmis SemTxvevaSi prioriteti eniWeba C–s (Circulation).

• mocemuli CAB algoriTmi sruldeba TanmimdevrobiT roca reanimacias atarebs erTi adamiani, Tumca ramdenime reanimatoris arsebobis SemTxvevaSi maT SeuZliaT funqciebi gadainawilon

dazaralebuli ugonodaa, ar sunTqavs an sunTqavs araadekvaturad

gamoiZaxedaxmareba

moiZie defibrila-tori

daiwye gfr

Seamowme ritmi, saWiroa Tu ara eleqtroSoki. Tu ki gaimeore yovel 2 wuTSi

Zlieri da swrafi

zewolebi

mozrdilTa reanimaciis gamartivebuli

algoriTmi

• gulis gaCerebis adreuli diagnostireba da daxmarebis drouli gamoZaxeba

• adreuli gul-filtvis reanimacia, ZiriTadi aqcentiT kompresiebze

• swrafi defibrilacia

• sicocxlis gadarCenis daxvewili algoriTmis efeqturad Catareba

• gulis gaCerebis Semdgomi RonisZiebebi

yoveli wuTi gulmkerdiskompresiis gareSe

sasikvdiloa !!!

gmadlobT yuradRebisaTvis