1

recenzentebi medicinis mecnierebaTa doqtori

m. focxveria
medicinis mecnierebaTa doqtori, profesori
a. fircxalava
samedicino samsaxuris polkovniki
n. gabunia

redaqtori q. kvantriSvili

kompiuteruli uzrunvelyofa s. qvarcxava, n. masuraSvili

Tbilisi 2019

GIVI KATSITADZE

Energency Toxicology

Tbilisi 2019

2
 eZRvneba batoni
givi kacitaZis xsovnas

givi kacitaZe

prioritetuli moqmedebebi
mwvave mowamvlebisas

saxelmZRvanelo

umaRlesi samedicino saswavleblebis

studentebisa da eqimebisaTvis

Tbilisi
2019

3
4
 meore gamocemis winasityvaoba

klinikuri toqsikologiis pirveli qarTuli saxelmZRvanelo

profesorma givi kacitaZem miuZRvna qarTvel toqsikologTa pirvel
Taobas.
amave saxelmRvanelos winamdebare gamocema ki mieZRvnilia profe-
sor givi kacitaZis xsovnisadmi.
wignis calkeuli Tavebis avtorebia meore Taobis toqsikologebi
_ eqimebi, prof, givi kacitaZis moswavleebi da TanamSromlebi, ro-
melTa profesiul gazrdasa da CamoyalibebaSi udidesi damsaxureba
miuZRvis profesor givi kacitaZes: Tbilisis saxelmwifo samedicino
universitetis profesorebi nino lobJaniZe, eka qurdaZe, daviT To-
furia. TaTia rusieSvili. kavkasiis medicinis centris gadaudebeli
samedicino daxmarebis departamentis xelmZRvaneli oTar dixaminjia,
wminda miqael mTavarangelozis sax. saavadmyofos toqsikologiuri
samsaxuris ufrosi soso kutubiZe.
meore gamocemaSi damatebulia Tavebi: „marixuanaTi mowamvla“, „ro-
denticidebis toqsiuri efeqti“. „dariSxaniT mowamvla“.
bunebriviarom damatebuli Tavebi ar iqneba moklebuli naklo-
vanebebs da maT gaumjobesebasTan dakavSirebul saqmian SeniSvnebs
miviRebT didi madlierebiT.

Teimuraz kobiZe
Tbilisis sax. samedicino universitetis asocirebuli profesori,
saqarTvelos klinikur toqsikologTa asociaciis gamgeobis Tavmj-
domare.

5
, d. Tofuria

6
Tavi 31
rodenticidebis toqsiuri efeqti e. qurdaZe, d. Tofuria
Tavi 32
marixuaniT mowamvla T. kobiZe, oTar dixaminjia
Tavi 33
dariSxaniT mwvave mowamvla l. rusieSvili
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nawili I

zogadi
toqsikologia

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nawili II

zogadi
toqsikologia

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 Tavi 31

eka qurdaZe, daviT Tofuria

rodenticidebis toqsiuri efeqti

rodenticidebi warmoadgens heterogenur jgufs nivTirebebisa,

romlebic gansakuTrebuli toqsiurobiT gamoirCevian cocxali
organizmisaTvis. isini yvelaze toqsiur sayofacxovrebo Sxamebs
miekuTvneba.
gamoyofen rodenticidebis mTel rig jgufebs. meoce saukunis
Sua periodamde gamoiyeneboda mZime liTonTa naerTbi (dariSxani,
Taliumi). meoce saukunis Sua periodidan rodenticidebis ZiriTad
nivTierebas warmoadgens antikoagulaciuri naerTebi.
2017 wlis monacemebiT antikoagulaciuri rodenticidebis
mowamvlis 5185 SemTxveva dafiqsirda mowamvlaTa 8930 SemTxvevidan,
rac rekordul maCvenebels warmoadgens mowamvlaTa monacemebis
erovnuli sistemisaTvis (NPDS- National Poison Data System).
rodenticidi aris pesticidebi (Sxamqimikati),romlebic gamoiyeneba
mRrRnelebis da Tagvebisa mosaklavad. es naerTebi, rogorc satyuara,
xSirad mimzidvelad formdeba, mag. rogoricaa araqisis karaqi an
sxva tkbileulis formiT. rac xSirad bavSvebis an zrdasruli
adamianis SemTxveviT mowamvlis mizezi. amitom am formiT maT
gamoSvebas zRudavs regulaciebi.
rodenticidebi, moqmedebis mixedviT dayofilia: antikoagulaciuri
da araantikoagulaciuri moqmedebis mixedviT.
mTeli istoriis ganmavlobaSi, mRrRnelebis kontroli arsebiTi
iyo mosaxleobis gadarCenisa da janmrTelobisTvis. mRrRnelebi
mravali daavadebis gadamtanebi arian, azianeben kulturebs da swrafad
mravldebian. mRrRnelebis populaciis ganadgureba umtkivneulo
procesi araa, radgan maTvis Seqmnili satyuara xSirad xdeba sxva
mcire cxovelebis, ZuZumwovrebis da adamianis sikvdilis mizezi.
yvela rodentcidi toqsikuria organizmSi peroralurad
moxvedris SemTxvevaSi. rodencicidebis umravlesoba aseve toqsikuria
inhalaciis dros da kanTan kontaqtis dros. gamonaklisia varfarini,
romelic dabalia toqsikurobiT gamoirCeva inhalaciis an kanTan
kontaqtis dros. striqnini, qolekalciferoli da TuTiis fosfini
SedarebiT dabali toqsikurobiT gamoirCeva aseve analogiuri gziT
439
SeRwevisas. bromeTalini zomierad toqsikurobiT gamoirCeva kanis
gziT SeRwevis SemTxvevaSi.
dResdReisobiT arsebobs uamravi rodencidi, romlebic
gansxvavebulad muSaoben, vidre antikoagulantebi. isini amJamad
gamoiyeneba SeerTebuli StatebSi da ara marto, registrirebulia
bevr qveyanaSi: brometalini, qolekalciferoli, TuTia fosfini da
striqniini. TiToeuli es pesticidi sxvadasxva gziT muSaobs.
bromeTalini pirvelad iqna registrirebuli aSS-s garemos dacvis
saagentos (EPA) mier 1984 wels. es naerTi aCerebs centraluri
nervuli sistemis ujredebSi energiis warmoqmnas. iwvevs nervuli
ujredebi SeSupebas, axdens zewolas tvinze, rasac maleve mohyveba
dambla da sikvdili. bromeTalinis mTavari produqti ufro
toqsikuria, vidre Tavad bomeTalini. bomeTalinis daSlis sxvadasxva
saxeobis gansxvavebulma SesaZleblobam SeiZleba axsnas is, Tu ratom
aris igi ufro toqsikuri zogi cxovelebisTvis, vidre sxvebi.
bromeTalini ganixileba erTjeradi doziT rodentcid.
qolekalciferoli pirvelad daregistrirda rodenticidad Seer­
Tebul StatebSi 1984 wels. qolekalciferoli aris vitamini
D3. vitamini D organizms kalciumis balansis SenarCunebaSi
exmareba, kalciumis nawlavidan da Tirkmelebidan Sewovis gziT.
qolekalciferolis toqsikuri dozebi iwvevs sisxlSi Zalian didi
raodenobiT kalciumis dagrovebas, ramac SeiZleba gavlena moaxdinos
centralur nervul sistemaze, kunTebze, kuW-nawlavis traqtze,
gul-sisxlZarRvTa sistemaze da Tirkmelebze. kalciumis saTanado
donis SenarCunebisas Wirdeba dro. mRrRnelebma unda SeWamos am
rodanticidis ramdenime doza, rom gamoiwvios mRrnelis letaloba.
adamianebis mowamvla Zalze iSviaTia.
TuTiis fosfati pirvelad 1947 wels daaregistrires. TuTiis
fosfidma SeiZleba gamoiwvios Rebineba Wamis Semdeg erTi saaTis
ganmavlobaSi. amasTan, toqsikurobis niSnebi SeiZleba ar gamovlindes
4 saaTis ganmavlobaSi, zogierT SemTxvevaSi ki 18 saaTze metxans.
naRebinebi masebi SeiZleba sisxli Seicavdes. intoqsikaciis niSnebia:
SfoTva, diskomforti, sisuste, sunTqvis gaZneleba da krunCxvebi,
pirRebineba, agzneba, sicive, qoSini da xvela, deliriumi, krunCxvebi
da koma. peroraluri miRebisas fosfinis airSi gadadis wylisa
da mJavas urTierTqmedebiT, ramac SeiZleba gamoiwvios filtvebis
seSupeba da sikvdili.
fosfinis zemoqmedeba gansakuTrebiT sazianoa gulis, tvinis,
Tirkmelebis da RviZlisTvis.

440
 striqnini pirvelad daregistrirda 1947 wels, magram mas Semdeg
mravali wlis ganmavlobaSi iyenebdnen. misi gamoyeneba SesaZlebelia
mxolod miwisqveS. striqninis produqtebis 0,5% -ze meti SeizRuda.
isini mxolod sertificirebul aplikantebze striqiniT mowamvla
iwvevs kunTebis uneblie spazms rogorc adamianebSi, aseve cxovelebSi.
es spazmebi SeiZleba iyos mZime, niSnebi SeiZleba daiwyos 15 wuTSi
adamianebSi, xolo cxovelebSi ori saaTis ganmavlobaSi striqninis
Wamis Semdeg. sikvdili gamowveulia sunTqvis ukmarisobiT.
antikoagulanturi rodencidis zemoqmedebam SeiZleba gamoiwvios
sisxldena, Tumca xSirad usimptomod mimdinareobs. axasiaTebs aseve
sunTqvis gaZneleba, sisuste da letargia. naklebad gavrcelebuli
niSnebia xveleba, Rebineba, sisxliani ganavali, RrZilebidan sisxldena,
krunCxvebi, sisxlCaqcevebi, muclis Seberiloba da tkivili. xSirad,
vidre Sededebis agentebis maragi ar amoiwureba, klinikurad
SesaZloa usimptomod mimdinareobdes ramdenime dRe da mxolod
Sxamis miRebidan mexuTe dRes gamoixatos klinika.
adamianebSi pirveladi niSnebi xSirad vlindeba sisxldeniT
cxviridan, RrZilebidan an kanqveS. SesaZloa intrakranialuri
sisxlCaqcevis ganviTarebac. zogi produqti Seicavs cisfer an mwvane
saRebavebs. Seferilobis mixedviT advili dasadgenia bavSvma Wama
Tu ara Sxamqimikati, Tumca naklovanebac axlavs lamazad (ferad)
gaformebul Sxams, erTgvari satyuaraa bavSvebisaTvis.
antikoagulanturi rodencidebi: varfarini pirveli antikoagulanti
rodentcidi iyo, misi registracia 1950 wels moxda (zogierTi
wyaros cnobiT 1940 wlidan registrirebulia rogorc varfarinis
ti pis pirveli antikoagulaciuri moqmedebis rodenticidi).
varfarini aRmoaCines molurjo tkbil samyuraSi, romelis Wamis
Semdeg msxvilqrosani pirutyvi avad gaxada. mkvlevarebma SemdgomSi
daadgines, rom sokoebs qimikaciiT, SeuZliad ufro toqsiur naerTad
aqcios varfarini, vidre bunebrivi samyuraa. varfarini farTod
gamoiyeneboda manam, sanam mRrRnelebs ar gauCndaT mis mimarT
gamZleoba. aman ganapiroba axali rodencicidebis Seqmna. ase gaCnda
supervarfarini, ufro Zlieri rodenticidi. antikoagulantebis
`pirvel Taoba~ an `meore Taoba~. mravali wyaro maT moixseniebs
rodentcidebs rogorc erTjeradi an mravaljeradi doziT, radgan
es naklebad damabnevelia.
1975 wlidan Seiqmna meore generaciis supervarfarini brodifakumi,
varfarin rezistentuli mRrRnelebis sazogadoebrivi janmrTelobis
problemis mosagvareblad - igi aris kumarinis warmoebuli

441
rodentcidi. brodifakumi arsebobs rogorc cis- da trans-
izomerebi, romlebic SeiZleba gamoyofili iyos qromatografiiT da
identificirdes birTvuli magnitur-rezonansuli speqtroskopiiT.
brodifakumi aris TeTri fxvnili. es aris susti mJava, romelic
advilad ar warmoqmnis wylis xsnad marilebs. igi ar kargavs
aqtivobas 30 dRis Semdegac mzis pirdapiri moqmedebisas. es rodencidi
efeqturia varfarinis rezistentuli virTxebis winaaRmdeg. es
Cveulebriv iyideba, rogorc mza satyuara.
eqspozicia adamianze: samizne aris hematologiuri Sededebis
sistema. ZiriTadi riskebi ukavSirdeba potenciurad fatalur kuW-
nawlavidan da qalasSida sisxldenas. Tu toqsikuri raodenobiT
iqna miRebuli, koagulacia qveiTdeba, iwyeba RrZilebidan sisxldena,
epistaqsi, eqsimozi, SesaZloa ganviTardes hematoma, melena da
hematuria. peroraluri eqspozicia organizmSi moxvedris yvelaze
gavrcelebuli gzaa. brodifakumi advilad Seiwoveba kuW-nawlavis
traqtSi. gansakuTrebiT saSiSia orsulebisaTvis, gadis placentarul
bariers, mwvave periodSi iwyvevs sisxlCaqcevas da nayofis sikvdils
(varfarinisgan gansxvavebiT teratogenobiT ar gamoirCeva).
brodifakumi warmoadgens uaRresad letalur 4-hidroqsi
kumarins, vitamin K antagonist antikoagulantur Sxams. bolo
wlebis ganmavlobaSi, igi gaxda msoflioSi erT-erTi yvelaze xSirad
gamoyenebuli pesticidi. igi, rogorc wesi, gamoiyeneba rogorc
rodentcidi, magram aseve gamoiyeneba ufro mavne mavne cxovelebis
gasakontroleblad, rogoricaa oposumebi.
brodifakums aqvs yvelaze xangrZlivi naxevrad daSlis periodi,
romelic ramdenime Tvemde meryeobs, moiTxovs xangrZliv antidotur
mkurnalobas K1 vitaminiT, rogorc adamianis, aseve Sinauri cxovelebis
mowamvlebis dros. mas aqvs meoradi mowamvlis yvelaze maRali
riski, anu brodifakumiT dabinZurebuli xorcis Wamisas Tavisuflad
SeiZleba moiwamlos adamiani. aSS-s xuT StatSi 2018 wlis martSi mZime
koagulopaTiis da sisxldenis SemTxvevebi dafiqsirda brodifakumiT
dabinZurebuli sinTezuri kanabinoidis gamoyenebis Semdgom.
mowamvlis dros iseve rogorc varfarini moqmedebs II, VII, IX da
X faqtorebis Semcirebaze. biologiuri naxevrad daSlis periodi
brodifakums aqvs daaxloebiT 120 dRe. Sesabamisad koagulaciuri
faqtorebis deficiti sakmaod xangrZlivad grZreldeba. rac Seexeba
laboratoriul cvlilebebs,miuxedavad imisa,rom RviZli brodifakumis
metabolizmis adgilia, koagulopaTiis garda aSkara klinikuri
efeqtebi ar Cans. garda amisa, brodifakumi (iseve, rogorc sxva

442
antikoagulantebi toqsikur dozebSi) zrdis sisxlis kapilarebis
gamtarianobas; sisxlis plazma da sisxli TavisTavad iwyeben wvril
sisxlZarRvebidan gaJonvas. mowamluli cxoveli ganicdis Sinagani
sisxldenis progresirebas, rac iwvevs Soks, cnobierebis dakargvas da
sabolood sikvdils.
brodifakumi ukiduresad letaluria ZuZumwovrebis da
frinvelebisTvis, aseve TevzebisaTvis (yvelaze metad). misi maRali
kumulaciuri Tvisebis, maRali li pofilurobis da Zalian neli
eliminaciis gamo.
brodifakumis mowamvlis ZiriTadi antidotia K1 vitaminis
dauyovnebeli miReba (doza adamianisTvis: Tavdapirvelad SeaneleT
10-25 mg intravenuri ineqciebi, ganmeorebiT 3-6 saaTSi, proTrombinis
drois normalizebamde, Semdeg 10 mg oralurad oTxjer dReSi,
rogorc `SenarCunebeli~) doza~. es aris Zalze efeqturi antidoti,
im SemTxvevaSi, Tu intoqsikaciis adreul etapze moxda diagnostireba,
sisxldenis dawyebamde. imis gamo, rom brodifakumis maRalma dozebma
SeiZleba gavlena moaxdinon sxeulze mravali Tvis ganmavlobaSi,
antidoti gamoiyeneba regularulad xangrZlivi periodis ganmavlobaSi
(ramdenime Tve, nivTierebis naxevargamoyofis dacviT) proTrombinis
drois xSiri monitoringiT.
adreul etapze (toqsikogenur stadiaSi), sanam Sxami jer kidev
saWmlis momnelebel sistemaSia, SeiZleba saWiro gaxdes kuWis
amorecxva, rasac moyveba aqtivirebuli naxSiris miReba.
simptomuri mkurnaloba klinikuri suraTis mixedviT, moicavs:
sisxlis an plazmis infuzias hi povolemiuri Sokis sawinaaRmdegod,
xolo mZime SemTxvevebSi,sisxlis Sededebis faqtorebis koncentraciis
infuzias.

prioritetuli moqmedebebi:
• ZiriTad sasicocxlo funqciaTa monitoringi.
• dekontaminacia, Sxamis mocileba adreul etapze.
• antidotoTerapia _ (brodifakumis SemTxvevaSi vitamini K1
(fitomenadioni)
• simptomuri mkurnaloba, garTulebebis mkurnaloba, oqsigenTerapia.
• kliniko-laboratoriuli monacemebis monitoringi.
• mosalodneli garTulebebis prevencia.

443
 Tavi 32

Teimuraz kobiZe, oTar dixaminjia

marixuaniT mowamvla
marixuanis Sesaxeb pirveli cnobebi gvxvdeba CineTis xalxur
medicinaSi, Cvens welTaRricxvamde meore saukuneSi. marixuanas ro­
gorc samkurnalo saSualebas (Zilobis,kunTebis spazmis mosaxsnelad)
iyenebdnen asirielebi, sparselebi, berZnebi, romaelebi da maias tomis
indielebi.. aSS zogierT StatSi marixuana oficialurad gamoiyeneba
preparat dronabilis abebis saxiT, onkologiuri avadmyofebis
samkurnalod (gulisrevis sawinaaRmdegod da madis gasaZliereblad),
xolo Sidsis mkurnalobisas ki rogorc antimikrobuli saSualeba.
amis miuxedavad, marixuana miekuTvneba narkotikebs da misi gamo-
ye­
neba socialur sakiTxad iTvleba. moxmarebis sixSiriT mas
msoflioSi mesame adgili ukavia Tambaqosa da alkoholis Semdeg.
marixuana, miiReba kanafisagan, (Cannabis Sativa) sxvadasxva meTo-
debiT. kanafs aqvs Taviseburi struqtura, romlebic gamoimuSavebs
fisis­magvar sekrets.
es sekreti Seicavs 60 mde niTierebas, e.w. kanabinoidebs. maTgan
adamia nis fsiqikaze yvelaze Zlieri zemoqmedebis unari aqvs L_9
tetrahidrokana binols (L_9 thk). aralegalurad damzadebul
kanafis preparatebSi aRniS nuli nivTiereba (L_9 thk). sxvadasxva
raodenobiT gvxvdeba, es ki ra Tqma unda, cns ze sxvadasxva simZlavris
gamovlinebebs ganapirobebs.
es saSualebebi gamoiyeneba inhalaciuri (sigaretis bolis saxiT),
an peroraluri gziT. aseTi gamoyenebis dros arsebuli (L_9 thk)
praqtikulad ar amoisunTqeba da misi 50% xvdeba sisxlSi. kvamls
mkveTri suni aqvs. marixuanas peroraluri doza inhalaciur dozaze
3 jer metia.
marixuanas erTida igive dozis miReba sxvadasxva efeqts iZleva,
minimaluri zemoqmedebiT gamowveuli Tavbrusxvevidan, damTarebuli
azrovnebis, ganwyobilebis da fizikuri aqtivobis SecvliT.

marixuanas farmakokinetika
sufTa tetrahidrokanabinolis (L_9 thk) 50 % iSleba mowevis
dros, arsebuli maRali temperaturis zemoqmedebiT.
tetrahidrokanabinolis (L_9 thk). s toqsiuri dozaa 70 kg masis
mqone mozrdili adamianisaTvis _ 0.035 mg/kg;
444
 efeqti viTardeba kvamlis CasunTqvidan ramodenime wuTSi,
peroraluri miRebidan _ ki 30-120 wuTSi da piks aRwevs 2-3 saaTis
Semdeg. marixuanis subieqturi efeqti mowevis dros grZeldeba 2-3
saaTs, peroraluri miRebis Semdeg ki 3-6 saaTs.
L_9 thk. metabolizdeba RviZlSi da gardaiqmneba karboqsilur
metabo liad, romelic ar moqmedebs fsiqikaze. es metaboliti
monawileobs nawlav-RviZlis cirkulaciaSi da gamoiyofa ganavliT
(50%); SardiT 35 %;
L_9 thk kargad ixsneba cximebSi, RviZlSi pirveli gavlis dros
mniSvnelovnad ar inaqtivirdeba, sisxlidan gadadis cximovan qsovilSi,
grovdeba li pidebSi da Semdeg ki TandaTanobiT, nel-nela isev gadadis
sisxlSi. L_9 thk. s naxevradgamoyofis periodi 3 dRemdea.

paTogenezi da intoqsikaciis klinika

L_9 thk. simTvralis msgavs mdgomareobas iwvevs. jer iwyeba garkve-
uli mamoZravebeli, motoruli agzneba da verbaluri gamovlinebebi,
SesaZ- lebelia sasiamovmo halucinaciebis warmoqmna, udardelobisa
da sasiamovno moTenTilobis SegrZneba. Semdeg viTardeba Tvlemis
mdgomareoba, romelic gadadis sasiamovno sizmrebian ZilSi.
marixuanis, haSiSisa da kanafis sxva preparatebis moqmedeba damoki
debulia adamianis individualur Taviseburebebze, miRebul dozaze
da masSi aqtiuri nivTierebis _ L_9 thk. s Semcvelobaze.
eTanolis efeqtebisagan gansxvavebiT, marixuanis moqmedebis
sawyisi efeqti SeiZleba daZleuli iqnes adamianis nebisyofiT.
misi qceva, azrovneba da metyveleba SeiZleba ucvleli, normaluri
iyos. ramodenime saaTis Semdeg, roca marixuanas subieqturi efeqti
gaivlis, viTardeba moTenTiloba da sulieri apaTia, gaRizianeba
advilad gadadis mrisxanebaSi, viTardeba sisuste, romelic gadadis
ZilSi. depresiis dros Zlierdeba simSilis SegrZneba. `nabaxusevi~
s mdgomareoba ar vlindeba.
zogjer marixuanas amateben fenciklidins, opiums, kokains. aseTi
kombi nirebuli preparatebis gamoyeneba iwvevs mZime fsiqikur
aSlilobebs: cnobierebis moSlas, dezorientacias, SiSs, Rrma depre-
sias, mwvave paranoias, mwvave fsiqozs, panikas.
marixuanas, haSiSisa da kanafis sxva preparatebis gamoyenebas
Cveulebrivad Tanaxlavs sasiamovno SegrZnebebi, magram mosalodnelia
arasasurveli reaqciebis ganviTarebac mwvave fsiqozisa da panikis saxiT.
intoqsikaciuri fsiqozis dros viTardeba agzneba, cnobierebis
dabindva, dezorientacia, mxedvelobiTi halucinaciebi, deliriumi.

445
pirovneba depersonalizebulia. mwvave panikur reaqcias SeiZleba
erTvodes tkivilebi muclis areSi, Tavis tkivili, SiSi, depresia,
SfoTva, arakontrolirebadi agresia.
panikuri da fsiqozuri reaqciebi xSiria marixuanis gamoyenebis
damwyeb pirebSi.
marixuanis moweva iwvevs koordinaciis,drois,sivrcis da sagnebamde
manZilis aRTqmis, sagnebis feris aRTqmis moSlas. SesaZlebelia
cnobierebis xanmokle dakargva.
yuradRebis, sifxizlis moSla da qcevisa da SegrZnebis CamoTvlili
cvlilebebis ganviTareba mosalodnelia eiforiis Semdeg da
Sesalebelia 12-24 saaTs gagrZeldes.
marixuanas qronikul mwevels aqvs piris Rrusa da xaxis mSrali,
zogjer Sewebebuli, Camxmari lorwovani, taqikardia, wiTeli Tvalebi
(skleris sisxlZarRvebis gafarTovebis gamo); pirsa da xaxaSi wvis
SegrZneba, mSrali xvela, SesaZlebelia mexsierebis moSla, dabalia
skolaSi (an sxva saswavlebelSi) akademiuri moswreba.
gaxurebuli kvamlis SesunTqva iwvevs cxviris lorwovanis
SeSupebas, bronqits, bronquli asTmis gamwvavebas. alveol;ebSi da
filtvebis intersticialur qsovilebSi viTardeba difuzuri
infiltracia mononuklearuli leikocitebiT.
marixuanas da haSiSis kvamlSi ufro meti kancerogenuli nivTiere-
bebia, vidre Tambaqos kvamlSi. marixuanas Semcvel sigaretSi bevria
toqsiuri danamati, romlebsac SeuZlia bronqospazmis da filtvebis
toqsiuri SeSupebis gamowveva. marixuanas, haSiSisa da kanafis sxva
preparetebis xangrZlivad momxmareblebs uviTardebaT imunuri
sistemis, ujredebis metabolizmis da reproduqciuli funqciis
moSla. orsulebSi _ brkoldeba nayofis ganviTareba.
am preparatebis xangrZlivi moxmarebis dros aRwerilia Tavis
tvinis struqturis cvlilebebi.
marixuanis qronikulad momxmareblebis fsiqikuri mdgomareoba
ganixileba rogorc amotivaciur sindromi, romlisTvisac
damaxasiaTebelia normidan Semdegi gadaxrebi:
• cxovrebisadmi interesis dakargva, apaTia, pasiuroba,
• reaqciis dakargva cudad Sesrulebuli samuSaosadmi,
• sisuste, advilad daRla.
• pirquSoba
• feTxumoba
momxmareblis azrovneba mi pyrobilia marixuanisa da misi msgavsi
nivTierebebis Sovnisaken. aseT pirovnebebs aqvT cxovrebis asocialuri

446
wesi, garbian saxlidan, ar dadian saswavlebelSi an samsaxurSi,
iwyeben kriminalur qmedebebs, xvdebian policiaSi, iwyeben sxva,
akrZalul nivTierebebis gamoyenebas.
marixuanisa moxmarebis Sewyvetidan 10-14 dRis Semdeg SeiZleba
ganviTardes abstinenciuri sindromi da fsiqozi. mosalodnelia
depresia, SiSi, deliriumis epizodebi, potenciis daqveiTeba.
marixuanas mwevelebSi fsiqikis darRveva vlindeba maniakaluri,
depresiuli formis, fsiqomotoruli agznebis saxiT, an fsevdo­
paralizur simptomebTan (anizokoria, dizarTria, ataqsia, refleq-
sebisa da tkivilis SegrZnebis cvlilebebi) Tanxvedrili cnobierebis
dabindviT.
diferenciuli diagnozi: pirvel rigSi unda gamoiricxos
fsiqikuri daavadebebi (Sizofrenia, depresia), Semdeg ki eTanoliT
da halucinogenebiT mowamvla (fenciklidini, amfetaminebi, antiqo­
linerguli saSualebebi, kokaini da sxv);

marixuanis mwvave zedozirebis mkurnaloba.

qmedebebi:
• pirveladi daTvaliereba: cnobierebis donis, sunTqvis, gul-
sisxlZarRvTa sistemis Sefaseba,
• stabilizacia.
• antidoti ara aqvs
• hemodilucia: infuzioTerapia marilovani da glukozis izotonuri
xsnarebiT, Ht 39-40% farglebamde.
• wyal-marilovani da naxSirwylebis cvlis koreqcia
• simptomuri Terapia
• Tu preparati miRebulia peroralurad,aucilebelia avadmyofisaTvis
aqtivrebuli naxSiris da marilovani safaRaraTos micema.
• fsiqozuri reaqciis ganviTarebis SemTxvevaSi tardeba sedaciuri
Terapia kardiomonitoringi.
• marixuanas qronikuli momxmareblebis mkurnaloba aucilebelia
tardebodes dRis stacionarebSi.

mowamvlis toqsikogenuri da somatogenuri fazebis

mimdinareobis Taviseburebebi
marixuana zomierad toqsikuri SenaerTia. mis gamoyenebas Tan
erTvis `araswori qceva~, magram arseboben Taviseburebebi, romlebsac
unda mieqces yuradReba:

447
 toqsikogenur fazaSi:
• avadmyofis garegani daTvalierebisas unda Sefasdes fsiqomotoruli
SfoTvis done. mizani sxva, ufro toqsiuri narkogenis (kokaini,
heroini); anti- qolinerguli preparatebis, antidepresantebis
gamoyenebis gamoricxvaa. gansakuTrebiT ki anamnezSi marixuanis
xangrZlivad momxmareblebSi.
• yvela avadmyofisaTvis aucilebelia ekg kontroli
• laboratoriuli gamokvlevebis Tvisobrivi analizi
- eqspresmeTodi - planSetebis saSualebiT
- Txelfenovani qromatografiiT unda Catardes
tetrahidrokanabinolis Tvisobrivi aamokvlevebi.
• somatogenur fazaSi unda gadawydes avadmyofis binaSi (ojaxis
wevrebis meTvalyureobiT) an specializirebul stacionarSi
mkurnalobisaTvis gadayvanis sakiTxi

marixuanaTi intoqsikaciis niSnebi, romelic unda icodes eqimma da

ojaxis wevrebma:
• CawiTlebuli (wiTeli) Tvalebi
• daRlilobisa da damtvreulobis grZnoba
• madis gaZliereba
• medikamentebisadmi interesis gaZliereba
• qronikuli xvela
• Zilianoba
• xSiri gaciveba
• menstrualuri ciklis darRveva
• mexsierebis daqveiTeba
• ganmartebis dros sityvebis SerCevis gaZneleba
• saxlidan umotivod gaparva
• problemebi saswavlebelSi (Cxubi da sxv)
• xasiaTis cvalebadoba pasiurobidan agresiulobamde
• paranoiis elementebi (eWvianoba an gulRioba)
• swavlaSi CamorCena

448
 Tavi 33

lia rusieSvili

dariSxaniT mwvave mowamvla

dariSxaniTa da misi naerTebiT mowamvla cnobilia uZvelesi
droidan.
dariSxani-perioduli sistemis 33-e elementi _ gvxvdeba organuli
(arsini (ArH3) da araorganuli (arsenitebi, arsenatebi da elementuri
dariSxani) saxiT. ismoi poveba:
• niadagSi _ yvelaze didi raodenobiT dariSxans Seicavs niadagi,
aseve gruntis da zedapiruli wylebi. maTSi dariSxani arsenitebisa
da arsenatebis narevis saxiTaa warmodgenili.
• sakveb produqtebSi _ dariSxani sakmaod xSirad gvxvdeba zRvis
produqtebSi, gansakuTrebiT kibosnairebSi.
• adamianis yofa-cxovrebis dros gamoyofil mavne danamatebSi -
naxSiris wvis dros gamoyofil da metalis madnis gamowvis dros
warmoqmnil kvamlSi, aseve dariSxanis Semcveli sasoflo-sameurneo
produqtebis wvis dros.
• samrewvelo nawarmebSi _ dariSxani SesaZloa Sediodes herbicidebis,
fungicidebis, sakvebis konservantebis, saRebavebis, cxvrebis matylSi
mcxovrebi parazitebis sawinaaRmdego preparatebis SemadgenlobaSi.
es elementi saRebavis saxiT aseve gamoiyeneba minis warmoebaSi,
naxevargamtarebisa da sxva eleqtromowyobilobebis damzadebisas.
Sua saukuneebSi dariSxans, rogorc sawamlavs, amzadebdnen Semdegi
gziT: gombeSoebs aWmevdnen dariSxans da Semdeg mkvdari cxovelebisgan
iRebdnen Sxamian siTxes _ Venin de crapau.
dariSxans, rogorc samkurnalo saSualebas, gamoiyenebdnen Zvel
romSi da saberZneTSi. hi pokrate wylulebis samkurnalod iyenebda
dariSxanis Semcvel malamoebs. 1800-ian wlebSi dariSxanis xsnari
(fuleris xsnari, 1%-iani arseniti) gamoiyeneboda leikemiis,
fsoriazisa da asTmis samkurnalod. fuleris siTxes amerikeli
eqimebi praqtikaSi iyenebdnen meoce saukunis TiTqmis ormocdaaTian
wlebamde. farmakologiuri firma `Erlich&Berthein~ sifilisis
samkurnalod awarmoebda dariSxanis Semcvel 1000-mde preparats.
dResac dariSxanis Semcveli samkurnalwamlo saSualeba Mel B
iTvleba afrikuli tri panosomis meningoencefalituri stadiis
mkurnalobis arCevis preparatad.
449
 iqidan gamomdinare, rom dariSxans ar aqvs gemo da garegnulad
Zalian hgavs Saqars, mas xSirad gamoiyenebdnen xolme kriminaluri
miznebisaTvis.
italiaSi renesansis epoqaSi papis aleqsandre VI-s da misi vaJis
Cezare borjias SekveTili mravalricxovani mkvleloba dariSxaniT
iyo Cadenili (garkveul periodSi dariSxans asec eZaxdnen _ „borjias
Sxami“). dariSxani _ es aris mTeli epoqa Sxamebis borotad gamoyenebis
istoriaSi. zogierTi istorikosi Tvlis, rom dariSxaniT mowamvlis
msxverplTa Soris iyvnen napoleoni, cnobili frangi maTematikosi
kondorse, ingliseli poeti Cestertoni da sxv.
mZime metalTa naerTebiT mowamvla xSiri iyo meoce saukuneSic.
dariSxaniT da mZime metalTa naerTebiT mowamvlisas adreul
wlebSi letaloba 65-84% iyo, mkurnalobis Tanamedrove meTodebis
gamoyenebiT is 15-19%-mdea dasuli.
dariSxani organizmSi aRwevs enteraluri da inhalaciuri gziT,
aseve kanis saSualebiTac. dariSxani sakmaod swrafad gadadis sisxlis
plazmidan eriTrocitebSi da ukavSirdeba hemoglobinis cilovan nawils
_ globins. 24 saaTis ganmavlobaSi xdeba misi gadanawileba RviZlSi,
elenTaSi, Tirkmelebs da kuW-nawlavis traqtis organoebSi. dariSxani
arRvevs ujreduli sunTqvis process mitoqondriuli fermentebis
inhibirebis gziT. amas garda, is ablokirebs piruvatdehidrogenazas
aqtivobas, rasac Tan axlavs krebsis ciklis reaqciis damuxruWeba.
peroraluri mowamvlisas es naerTebi Seiwoveba ionizirebuli
saxiT, rasac xels uwyobs kuWis wvenSi qloridebis arseboba da
nawlavebis wvenis tute reaqcia. Sewovis ZiriTadi adgili aris
Tormetgoja nawlavi da msxvili nawlavis sawyisi nawili.
sisxlSi es naerTebi cirkulireben ionebis saxiT, romlebic
dakavSirebulia aminomJavebsa da cximovan mJavebTan. dariSxanis
transportSi wamyvani roli ekisreba cilebs, romlebic masTan qmnian
mtkice kavSirebs.
dariSxani TiTqmis yvela organoSi nawildeba da deponirdeba
Tveebis ganmavlobaSi. es nivTierebebi grovdeba maRali koncentraciiT
da didi xniT rCeba RviZlsa da TirkmelebSi, rac aixsneba imiT, rom
RviZlisa da Tirkmlis qsovilebi didi raodenobiT Seicavs Tiolis
jgufebiT mdidar gansakuTrebuli cilas _ metalobionins.
organizmidan dariSxani gamoiyofa TirkmelebiT, RviZliT (naRvlis
wveni), kuWis lorwovani garsiT da msxvili nawlavebiT (ganavalTan
erTad), saofle da sanerwyve jirkvlebiT, rasac Tan axlavs am
organoebis gamomyofi unaris dazianeba.

450
 arsebobs mWidro kavSiri metalis toqsikurobasa da mis fizikur-
qimiur Tvisebebs Soris. toqsikuroba damokidebulia metalis
kompleqsebis cilebTan dakavSirebis unarze, wyalsa da li pidebSi
mis xsnadobaze.
dariSxanis sasikvdilo doza aris 0,1-0,2 gr.

toqsikuri zemoqmedebis paTogenezi

dariSxanis toqsikuri moqmedebis meqanizmi kavSirSia mis
adgilobriv da SewoviT zemoqmedebasTan. adgilobrivi zemoqmedeba
vlindeba qsovilebis destruqciiT da damokidebulia dariSxanis
naerTebis disociaciis unarze.
rezorbciuli moqmedeba damyarebulia struqturuli cilebisa
da cila-fermentebis funqciurad aqtiuri jgufebis blokirebaze.
yvelaze didi mniSvneloba eniWeba im sulfhidriluri (Tiolis)
jgufebis (SH) blokirebas, romlebic uzrunvelyofen cila-
fermentebis daaxloebiT 50%-is biologiur aqtivobas. blokireba
Seexeba agreTve aminur, karboqsilur da sxva jgufebs. imis Sedegad,
rom proteidebi kargaven bevr fizikur, qimiur da biologiur
Tvisebebs, irRveva cilovani, cximovani da naxSirwylovani cvla.
irRveva ujredis garsis struqtura, rac iwvevs ujredidan kaliumis
gamosvlas da natriumisa da wylis Sesvlas.
dariSxanis da misi naerTebis SerCeviTi toqsikurobis ZiriTad
sferos warmoadgens Tirkmelebis, RviZlisa da nawlavebis specifikuri
epiTeliumi, eriTrocitebi da nervuli ujredebi, sadac aRi­niSneba am
nivTierebebis momatebuli koncentracia, amitom nefropaTia, RviZlis
toqsikuri distrofia, gamoxatuli nevrologiuri simptomatika da
hemolizi klinikur suraTSi xSirad wamyvania.

mowamvlis paTomorfologiuri Taviseburebebi

hemolizis ganviTarebisas aRiniSneba mwvave hemoglobinuriuli
nefrozi. RviZlSi fiqsirdeba difuzuri centrolobuluri nekrozis
kerebi, biliaruli stazi, hemolizis dros - pigmenturi hepatozi
kerovani nekrozis Semdgomi ganviTarebiT.

dariSxanis toqsikuri moqmedebis klinikuri gamovlineba

simptomebi Tavs iCens Sxamis organizmSi moxvedridan 30 wuTis
Semdeg. amasTan, dariSxanis sakvebTan erTad miRebisas mowamvlis
simptomebis gamomJRavneba SesaZloa dagviandes. intoqsikaciis niSnebi

451
araspecifikuria da moicavs Tavis tkivils, sisustes, gulisrevas,
pirRebinebas, spastikur tkivilebs muclis areSi. xSirad viTardeba
hi potenzia da taqikardia. dariSxaniT mowamvlisas ganavlovani
masebi waagavs brinjis naxarSs (qoleris msgavsi diarea). iSviaTad
fiqsirdeba TiTistaras formis parkuWovani taqikardia (Torsades
de pointes). intoqsikaciis erTerTi damaxasiaTebeli niSania is, rom
amonasunTq haers aqvs nivris suni. mowamvlidan ramodenime saaTis
Semdeg Sardi muqdeba, xolo siyviTle Tavs iCens 1-2 dRis Semdeg.
centraluri nervuli sistemis dazianeba- cns-is dazianebis
simptomebia _ deliriumi, krunCxvebi, komuri mdgomareoba da amis
Sedegad, letaluri gamosavali.
dariSxaniT mowamvlisas SemTxvevaTa 5,75%-Si aRiniSneba
toqsikuri encefalopaTia, romelic klinikurad vlindeba eiforiiT,
fsiqomotruli agznebiT an stuporiT, soporiT da komiT. vegetati-
uri darRvevebi xasiaTdeba arteriuli wnevis jer aweviT, Semdeg _
daweviT, qoSiniT, saxis hi peremiiT an cianoziT, kanis sifermkrTaliT.
aRiniSneba mxedvelobis daqveiTeba da droebiTi di plopia, aseve zeda
da qveda kidurebis mtkivneuli tonuri krunCxvebi an epilefsiuri
krunCxvebi.
dariSxanis didi doziT miRebam (1-2 gr. da meti) SesaZloa gamoiwvios
mkveTrad gamoxatuli encefalopaTia (sopori, koma, generalizebuli
krunCxvebi, sunTqvis centris dambla, kolafsi), romelic axasiaTebs
dariSxaniT mowamvlis nervul-paralitur formas.
parasimpatikuri nervuli sistemis dazianeba - periferiuli
neiropaTia formirdeba mowamvlidan 1-2 kviris Semdeg. ZiriTadad
ziandeba qveda kidurebis nervebi.
gul-sisxlZarRvTa sistemis dazianeba _ ekg-zeaRiniSneba
gamtareblobis moSlis mravalricxovani cvlilebebi, QT intervalis
gaxangrZliveba da T kbilis deformacia. qronikuli mowamvlisas
viTardeba miokarditi da perikarditi. dariSxani iwvevs
sisxlZarRvebis dilatacias da arRvevs endoTeliumis funqcias,
rasac Tan axlavs hi potenzia. yvelaferi es iwvevs hemodinamikis
progresirebad darRvevasa da Soks.
sasunTqi sistema _ mwvave mowamvlisas viTardeba filtvebis
SeSupeba, mwvave distres-sindromi da sunTqvis mwvave ukmarisoba, rac
gamowveulia kunTovani sisustiT.
saWmlis momnelebeli sistema _ damaxasiaTebelia gauwyloeba,
gaZlierebuli wyurvili da saWmlis momnelebeli traqtis lorwovani
garsis koroziuli dazianeba, rac klinikurad vlindeba hemoragiuli

452
gastritiT. iSviaTad, SeiZleba toqsikuri hepatitis ganviTareba.
kuW-nawlavis dazianeba aRiniSeba avadmyofebis 97,3%-Si da
gamowveulia rogorc dariSxanis da misi naerTebis koroziuli
zemoqmedebiT, aseve isic, rom maTi gamoyofa xdeba piris da msxvili
nawlavis lorwovan garsiT (gamomyofi stomatiti da koliti).
kuW-nawlavis dazianeba subieqturad vlindeba pirSi metalis
gemoTi, gulisreviT, ylapvis dros saylapavis gaswvrivtkiviliT,
tkiviliT muclis areSi, romelic lokalizdeba epigastriumSi an
vrceldeba mTel mucelze.
obieqturad aRiniSneba pirRebineba, xaxisa da sasis ukana
nawilis hi peremia, palpaciiT mtkivneulia saylapavis kisris nawili,
epigastriumis are, tkivili vrceldeba nawlavis mTel proeqciaze,
uxSiresad daRmavali kolinjis areSi an muclis mTel wina zedapirze.
rTul SemTxvevebSi aRiniSneba Txevadi ganavlis ganmeorebiTi
gamoyofa, avadmyofTa 22%-Si pirvel saaTebSi aRiniSneba saylapav-
kuWidan an nawlavuri sisxldena. dariSxaniT mowamvlisas pirnaRebi
masebi SeiZleba iyos momwvano feris. gastroenteritis mkveTrad
gamokveTili simptomatika, romelsac aqvs qoleris mgavsi xasiaTi,
Tavs iCens dariSxanis gamokveTili toqsikuri moqmdebis Sedegad,
romelic iwvevs nawlavebis kapilarebis parezs, nawlavebis kedlis
gamavlobis matebas da didi raodenobiT siTxis transudacias
nawlavis sanaTurSi (mowamvlis e.w. gastrointestinuri forma).
egzotoqsikuri Soki aRiniSneba avadmyofTa 25.7 %-Si da uxSiresad
gvxvdeba dariSxaniT intoqsikaciis im SemTxvevebSi, romelsac Tan
axlavs kuW-nawlavis traqtis garcelebuli damwvroba.
sxvadasxva xarisxis RviZlis toqsikuri distrofia fiqsirdeba
SemTxvevaTa 51,4 %-Si da Cveulebriv viTardeba 1-3 dRes,nefropaTiasTan
erTad.
sisxli _ dariSxaniT mwvave mowamvlisas aRiniSneba hemolizi, zog
SemTxveveaSi _ pancitopenia da absoluturi eozinofilia.sisxlis
toqsikuri dazianeba vlindeba hemoliziTa da anemiiT. hemolizi
upiratesad damaxasiaTebelia dariSxanis wyalbadTan SenaerTiT
(ArH3) intoqsikaciisaTvis, xasiaTdeba didi xangrZlivobiT (6 dRemde)
da sisxlis plazmaSi Tavisufali hemoglobinis maRali cifrebiT
(20 gr/l-mde).
sisxlis morfologiuri cvlileba aRiniSneba SemTxvevaTa 85,8%-
Si da xasiaTdeba leikocitoziT, neitrofiloziT formulis
marcxniv gadaxriT, limfo da monocitopeniiT, eds-is aCqarebiT.
rTul SemTxvevebSi periferiul sisxlSi gamodian umwifari formebi,

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mielocitebi, aRiniSneba anizo- da poikilocitozi, normoblastozi.
sxeulis temperatura imatebs 39-40 °C-mde.
anemia aRiniSneba avadmyofTa 41,5%-Si da aqvs normo- da
hi poqromuli xasiaTi. misi ganviTarebis mizezebia dariSxanis
toqsikuri zemoqmedeba Zvlis tvinze da hemolizis ganviTareba.
kani _ dariSxanis sistemuri zemoqmedebisas fiqsirdeba kanis
dazianebis niSnebi: eriTema, romelsac Tan axlavs hi perpigmentacia,
hi perkeratozi, epiTeliumis gamkvrivebiT da desqvamaciiT, rac Semdeg
gadadis eqsfoliaciur dermatitSi. hi perpigmentacia upiratesad
vlindeba quTuToebze, yvrimalebze, kiserze da iRliis fosoebSi,
ZuZus dvrilebsa da saTesle parkze.
dariSxaniT qronikuli mowamvlisas pacientis frCxilebze Cndeba
TeTri xazebi, romelsac mees xazi ewodeba. am xazebis gaCena aixsneba
dariSxaniT qronikuli zemoqmedebis fonze frCxilebis zrdis
SeCerebiT.
toqsikuri nefropaTia uviTardeba pacientebis 67,6%-s. dazianebis
msubuqi xarisxis dros gamoixateba Sardis naleqis Sedgenilobis
zomieri cvlileba 5-7 dRis ganmavlobaSi, saSualo simZimis dazianebis
dros _ diurezis Semcireba 2-3 dRis ganmavlobaSi, Tirkmlebis
azotgamomyofi funqciisa da filtraciis zomieri darRveva 27-60
ml/wT.-mde, rezorbciis unaris darRveva _ 92-97%-mde. ukiduresad
rTuli SemTxvevebis dros viTardeba mZime formis nefropaTia _
Tirkmelebis mwvave ukmarisoba.

inhalaciuri mowamvlis Taviseburebebi

dariSxanis Semcveli airiT inhalaciuri mowamvla iwvevs Semdegi
saxis fsiqonevologiur simptomebs: aRgznebadobas, uZilobas,
gaRizianebadobas, di plopias, ylapvis gaZnelebas, depresias an
deliriums, dezorientacias.
metalebTan dariSxanis Semcveli nivTierebebis urTierTqmedebisas
warmoiqmneba naerTi _ arsini. es naerTi SeiZleba warmoiqmnas mJavis
xsnariT im WurWlis recxvisas, romelSic inaxeboda dariSxanis
Semcveli pesticidebi. arsiniT intoqsikaciisTvis damaxasiaTebelia
klinikuri triada: tkivili mucelSi, hematuria da siyviTle.
eriTrocitebze zemoqmedebisas arsini iwvevs hemolizs, romelic
rTuldeba Tirkmelebis mwvave ukmarisobiT da letaluri gamosavliT.
arsini aris ufero, Zalian toqsikuri airi nivris suniT.

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 mowamvlis klasifikacia
ganasxvaveben dariSxaniT mowamvlis sam xarisxs: msubuq, saSualo
simZimis da mZime intoqsikaciebs.
msubuqi mowamvlis klinikuri suraTi, rogorc wesi, vlindeba
dispefsiuri darRvevebiT, romelic mcirdeba momdevno saaTebSi, xaxis
da piris lorwovani garsis damwvrobiT. damaxasiaTebelia msubuqi
xarisxis nefropaTia.
saSualo simZimis intoqsikaciis dros kuW-nawlavis mxriv
darRvevebi ufro gamoxatulia, SesaZloa Tan axldes sisxldenebi
saylapavidan da kuWidan, romelic grZeldeba dReebis ganmavlobaSi.
TiTqmis yovelTvis vlindeba stomatiti. damaxasiaTebelia RviZlis
toqsikuri distrofiisa da saSualo simZimis nefropaTiis ganviTareba.
avadmyofebis mkurnaloba grZeldeba 10-18 dRis ganmavlobaSi.
mZime mowamvlebisas kuW-nawlavis mxriv gamoxatuli darRvevebi
SesaZloa gagrZeldes ramdenime dRe da kuW-nawlavidan sisxldena
SeiZleba sikvdilis mizezic gaxdes. kargad gamoixateba stomatiti da
koliti. egzotoqsikuri Soki mimdinareobs dekompensaciis niSnebiT,
rac SeiZleba gaxdes sikvdilis mizezi 1-2 dRis ganmavlobaSi.
hemolizi xasiaTdeba sisxlis plazmaSi Tavisufali hemoglobinis
didi raodenobiT (11-60 gr/l) da simyariT (2-6 dRemde). hemoglobinis
raodenoba SesaZloa Semcirdes. damaxasiaTebelia RviZlisa da
Tirkmelebis mwvave ukmarisobis ganviTareba. avadmyofebis mkurnalobis
xangrZlivoba izrdeba 20-40 dRemde da met xans.
mowamvlis toqsikogenuri fazis gansakuTrebuli xangrZlivobis
gaTvaliswinebiT (2 kviramde da met xans) gamoyofen mowamvlis
adreul da gvian periodebs. toqsikogenuri fazis adreuli periodis
ganmavlobaSi sisxlSi dariSxanis naerTebis udidesi koncentracia
fiqsirdeba 2-3 dRis ganmavlobaSi da viTardeba RviZlis toqsikuri
distrofia da nefropaTia. RviZlisa da Tirkmelebis ukmarisobis
ganviTareba miuTiTebs toqsikogenuri fazis gviani periodis
dadgomaze.

mowamvlis diferencialuri diagnostika

dariSxaniT intoqsikaciisas saWiro misi diferencireba kuW-
nawlavis mwvave dazianebisgan,Tirkmelebis aratoqsikologiuri mizeziT
dazianebisagan, Tavis tvinis sisxlismimoqcevis mwvave darRvevasTan
(dariSxaniT mowamvlis „elviseburi“ an neiroparalizuri formis
dros).

455
 laboratoriuli diagnostika
dariSxaniT intoqsikaciis eWvisas saWiroa dariSxanis koncentraciis
dadgena sisxlsa da SardSi. normaSi sisxlSi dariSxanis raodenoba
aris <70 mkg/l-ze. SardSi dariSxanis koncentraciis dasadgenad
sasurvelia analizisTvis aRebuli iyos Sardis 24 saaTiani porcia.
SardSi dariSxanis toqsikuri koncentracia aris 250 mkg/l-ze.
dariSxanis Semcveli rentgenokontrastuli nivTierebiT
mowamvlisas unda gakeTdes Sard-sasqeso organoTa rentgenografia
(Tirkmelebis, SardsawveTebis, Sardis buStis).
dariSxaniT mowamvlis laboratoriuli diagnostikis erT-erT
meTods miekuTvneba sisxlSi Tavisufali hemoglobinis gansazRvra
fotoeleqtrokalori-metriis meTodiT;

mwvave mowamvlis kompleqsuri mkurnaloba

organizmis detoqsikaciis meTodebi
Tu dariSxanis toqsikuri dozis miRebidan cota droa gasuli,
aucilebelia kuWis amorecxva. gaaqtivebuli naxSiri dariSxans
cudad STanTqavs. mniSvnelovania sisxlis moculobis kontroli
da misi normalur doneze SenarCuneba. Tirkmlis milakebSi daSlis
produqtebis Calagebis Tavidan asacileblad saWiroa sisxlis
gatutianeba. kuWis amorecxva saWiroa dReSi 2-3-jer, paralelurad
kuWis amorecxvis dasawyissa da dasasruls kuWSi zondiT SehyavT
50-100 ml 5%-iani uniTiolis xsnari. kuW-nawlavis traqtis
gawmendisaTvis gamoiyeneba safaRaraTo saSualebebi (kastoris an
vazelinis zeTi).
msubuqi mowamvlisas forsirebuli diurezi da plazmis gatutianeba
warmoadgens efeqturi detoqsikaciis meTods. mowamvlis saSualo da
mZime xarisxis dros es meTodi emateba xelovnuri detoqsikaciis
meTodebs.
forsirebuli diurezis paralelurad intravenurad SehyavT
uniTiolis 5%-iani xsnaris 200-300 ml.
mowamvlis ti piuri klinikuri suraTis gamovlenisas, rodesac
anamneziT dadasturebulia nivTierebis toqsikuri doziT miReba,
saWiroa xelovnuri detoqsikaciis aqtiuri meTodebis gamoyeneba.
hemodializis gamoyenebis didi efeqturoba vlindeba mowamvlis
toqsikogenuri fazis adreul periodSi _ Sxamis miRebidan 1-3 dRis
ganmavlobaSi (adreuli hemodializi).
am dros Catarebuli hemodializi axdens intoqsikaciis adreuli
simptomebis kupirebas, stomatitisa da kolitis gamovlenis Tavidan

456
acilebas, mniSvnelovnad amcirebs letalobas da mkurnalobis vadebs.
mZime mowamvlisas hemodializi efeqturia, Tu is daiwyeba
Sxamis miRebidan araugvianes 12 saaTisa da gagrZeldeba 8-9
saaTis ganmavlobaSi.proceduris efeqturoba aixsneba toqsikuri
nivTierebisagan sisxlis intensiuri gawmendiT.
mowamvlis klinikuri suraTis SenarCunebisas da sisxlSi
dariSxanis maRali koncentraciis dros aucilebelia proceduris
ganmeorebiTi Catareba. ganmeorebiTi dializi iseTive xangrZlivi
unda iyos, rogorc erTjeradi dializi, radgan misi gamoyenebisas
xdeba organoebSi dagrovili toqsinis TandaTanobiT gamodevna.
warmatebuli hemodializis aucilebel pirobad iTvleba
hemodializis ganmavlobaSi uniTiolis 5%-iani xsnaris intravenuri
wveTovani infuzia (30-40 ml/sT mZime mowamvlis dros da 20-30 ml/
sT saSualo simZimis mowamvlis dros). uniTiolis jamuri raodenobis
meoTxedi nawili SehyavT hemodializis win, riTac anxorcieleben
„antidotur datvirTvas“ kompleqsebis warmoqmnis uzrunvelsayofad
dializis dasawyisSi.
peritonealuri dializi nakleb efeqturia, vidre hemodializi.
misi gamoyenebis mTavar Cvenebad iTvleba sisxlSi Sxamis toqsikuri
koncentraciis xangrZlivi cirkulacia. mZime SemTxvevebis nawilSi,
roca ganmeorebiTi hemodializic ki arasakmarisia, saWiroa
hemodializTan erTad peritonealuri dializis Catarebac. hemo­
dializis efeqturobis gazrdisaTvis sadializo siTxeSi umateben
uniTiolis 5%-iani xsnaris 1 ml-s. amasTan erTad, aucilebelia
5%-iani uniTiolis xsnaris 200-300 ml intravenuri Seyvana
hemodializis yovel seansze. dializis dros toqsikuri nivTierebis
gamodevnis procesze kargad moqmedebs sadializo xsnarSi natriumis
hidrokarbonatis 4%-iani xsnaris 25-50 ml. raodenobiT damateba.
sisxlidan dariSxanis gamoyofis gazrda uniTiolis xsnaris damatebiT
da intravenuri SeyvaniT iwvevs dariSxan-uniTiolis kompleqsebis
warmoqmnas, romlebsac ufro mcire zoma aqvT, vidre dariSxan-cilis
kompleqss, amitom ukeT dializirdeba da gamoidevneba sisxlidan.
natriumis hidrokarbonatis damateba sadializo siTxeSi iwvevs am
siTxis PH-is daqveiTebas, rac Tavis mxriv amcirebs metali-cilis
kompleqsis mdgradobas da xels uwyobs dariSxanis dializis
gaumjobesebas.

457
 specifikuri antidoturi Terapia
imis gamo, rom dariSxans aqvs unari, dagrovdes RviZlSi, aseve
vinaidan samkurnalwamlo preparatebis transumbilikaluri Seyvanisas
medikamentis efeqturoba metia, gamarTlebulia uniTiolis Seyvana
Wi pis veniT RviZlis toqsikuri distrofiisa da nefropaTiis
profilaqtikis da mkurnalobis mizniT.
mkurnalobis es meTodi naCvenebia saSualo da mZime mowamvlis
toqsikogenuri fazis mTeli adreuli periodis ganmavlobaSi,
detoqsikaciis sxva aqtiur meTodebTan erTad. uniTiolis 5%-iani
xsnari SehyavT wveTovnad wuTSi 60-100 wveTi siCqariT, dRe-RameSi
50-150 ml. ganzavebuli glukozis 10%-iani xsnaris 400-800 ml-Si.
am sqemiT detoqsikacia grZeldeba 4-6 dRis ganmavlobaSi.
antidotTan erTad transumbilikalurad SehyavT vitaminebi,
li potropuli preparatebi, rac Tavidan icilebs an gacilebiT
amsubuqebs RviZlisa da Tirkmelebis toqsikuri distrofiis
gamovlinebas.
kompleqsur mkurnalobaSi gansakuTrebuli mniSvneloba aqvs
specifikuri Terapiis sxva saSualebebsac: dariSxanwyalbadiT
mowamvlisas SehyavT mekaptidi (40%-iani xsnaris 1-2 ml, kunTSi _
6-8ml/dReSi).
qelatebi, mag. britanuli antiluiziti, ukavSirdeba da xels uwyobs
organizmidan momwamvleli liTonebis gamodevnas. aseve gamoiyeneba
D-penicilinamini. dadgenilia, rom dimerkaptoqarvis mJava (suqcimeri)
kargad gamodevnis organizmidan dariSxans, tyvias da vercxliswyals.
dariSxniT intoqsikaciis niSnebis aRmoCenisas, rodesac dariSxanis
koncentracia sisxlSi aRemateba 2 mg/l-s,aseve Tu Tirkmlis ukmarisoba
ukve saxezea, an mosalodnelia misi ganviTareba, heodializTan erTad
saWiroa qelatebiT mkurnalobis dawyeba.
dimerkaproli, igive britanuli antiluiziti (BAL) SehyavT
mxolod kunTSi. mas xsnian araqisis cximSi, amitom misi i/v Seyvana
ar SeiZleba. (luiziti _ es aris momwamvleli nivTiereba, romelSic
Sedis dariSxani. mas iyenebdnen pirvel msoflio omSi. meore msoflio
omis dros iyo misi gamoyenebis saSiSroeba, amitom Seiqmna antidoti,
britanuli antiluiziti, igive BAL, romelic im droisaTvis
mxolod adgilobrivad gamoiyeneboda).

simptomuri Terapia
egzotoqsikuri Sokis profilaqtika da mkurnaloba mimdinareobs
sayovelTaod miRebuli princi pebis mixedviT (narkotikuli

458
analgetikebis, kortikosteroiduli hormonebis, spazmolitikebis
Seyvana, masobrivi infuziuri Terapia).
1. hemolizis mkurnaloba gulisxmobs plazmis gatutianebas,
forsirebul diurezs, gaxangrZlivebuli da marecidirebeli
hemolizis dros (dariSxan wyalbadiT intoqsikaciis dros)
naCvenebia sisxlis CanacvlebiTi Terapia.
2. saWiroa kuW-nawlavis traqtis damwvrobis specifikuri Terapia.
3. toqsikuri nefropaTiis mkurnaloba
4. RviZlis toqsikuri distrofiis mkurnaloba

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