Tmbiry (koma) da kentronakan nyardayin hamakargi gorcuneutyan xory tchnshvacutyan vitchakn e, vori zhamanak mardy korcnum e gitakcutyuny, artaqin grgrichnerin ardzaganqelu karoghutyuny (reakcia), teghi en unenum organizmi tarber hamakargeri kensagorcuneutyan canr xaxtumner:
Tmbirayin vitchaki hangecmany npastogh hivandutyan bacahaytumn u buzhumy hatchax shat dzhvar e, namanavand: naxahivandanocayin phulum: Tmbiri zhamanakin axtoroshumy, hivandin naxabzhshkakan ev bzhshkakan ognutyan arag, tchisht cucaberumy, hivandanoci verakendanacman bazhanmunq nran anmijapes teghaphoxely tmbirayin vitchakic hivandin hanelu himnakan baghkacucichnern en:
Hivandutyan cagman, zargacman pattcharagitutyuny (etiopatogenez):
Kaxvac pattcharic: tmbiry linum e arajnayin ev erkrordayin: Kisagnderi kam gangugheghi coghuni anmijakan ojaxayin vnasmamb bnutagrvogh arajnayin tmbiry kazmum e gitakcutyan tchnshman bolor depqeri motavorapes 30%-y: Gangugheghayin tmbi himnakan pattcharnern en:
- anotayin hivandutyunnery (nerugheghayin ev entaostaynayin aryunazeghum, ishemik katvac),
- gangugheghayin vnasvacqy (gangugheghi salajard, nergangayin aryunayin urucq (hematoma),
- varakayin axtaharumnery (ugheghaborb (encefalit), gangugheghi kam voghnugheghi patyanneri borboqum (meningit), ugheghi taraxakuyt (absces),
- noragoyacutyunnery (nergangayin naxnakan urucqner, varatakan (metastatik) urucqner),
- vernotayin (epilepsayin)nopanery, hetnopayin vitchaky:
Glxugheghi coghuni ev keghevi sphrun axtaharumy bnorosh e erkrordayin tmbirnerin: Ayn hetevanq e:
- nerqin organneri ev nerzatich geghdzeri canr axtaharumneri (lyardayin, erikamayin, entastamoqsageghdzayin, gershaqararyunayin (hiperglikemiakan), makerikamayin, entavahanageghdzayin, sakavaryunayin ev ayl tmbirner),
- tunayin gorconneri (etanoli, barbituratneri, trankvilizatorneri, shmol gazi, fosforayin nyuteri ev aylni azdecutyun),
- fizikakan gorconneri (jermayin, nvazajermayin ev ayl tmbirner),
- sovacacman (snndaxangarayin tmbir):
Tmbirayin vitchaki canrutyuny paymanavorvac e glxugheghi ev organizmi ayl hamakargeri, arajin hertin sirtanotayin ev shncharakan organneri axtaharman astitchanov:
Tmbirayin vitchaki zargacman mexanizmnery, chnayac dranc pattcharneri bazmazanutyany, unen yndhanur gcer: Hyusvacqneri ttvacnayin qaghci zargacumy (ttvacnaqaghc: hipoqsia), vor bnorosh e tmbirin, aveli hatchax ughekcvum e dzevaphoxakan (metabolik) ttvagarutyan (acidoz) arajacmamb, organizmi elektrolitayin havasarakshrutyan, bjijnerum ev hyusvacqnerum energetikakan gorcyntacneri xaxtmamb: Kentronakan nyardayin hamakargi tchnshmany bnorosh en bjjayin karucvacqneri ishemian, mikroshrjanarutyan xaxtumnery, anoti artaqin taghanti aytuci arajacumy ev aryunazeghumy, nergangayin tchnshman bardzracumy, ugheghi ev ugheghi taghanti aytucy:
Tmbiri zargacumn ughekcvum e organizmi karevor organneri gorcuneutyan, arajin hertin shncharutyan ev aryan shrjanarutyan xatarmamb (hevoc, shnchargelutyun), voronc npastum en havelyal gorconner: lezvi hetankum, phsxanqayin zangvacneri klanum, kokordi aytuc ev ayln: Aryan shrjanarutyan xatarumnery bnoroshum en anotayin larvacutyan (tonus) ev zarkerakayin tchnshman ijecmamb, shrjanarvogh aryan cavali nvazumov, srti ritmi xangarumov, srtayin sur anbavararutyan zargacmamb (toqeri aytucner):
Axtoroshumy: Tmbirayin vitchakneri pattcharneri bacahaytumy erbemn zgalioren dzhvar e: Arajin hertin da veraberum e ayn iravitchakin, erb hnaravor che havaqel hivandi ancyali ev krac hivandutyunneri masin tvyalner (anamnez) ev bacakayum en hivandutyany kam hivandagin vitchakin bnorosh ayn nshannery, voronq npastum en tmbiri zargacmany (artaqin azdecutyun): Bzhishknern u buzhquyrery aydpisi dzhvarutyunneri chen handipum ayn depqum, erb arka e tmbirayin vitchaki zargacman yntacqum axtoroshvac hivandutyuny:
Tmbiri axtoroshman hamar mec nshanakutyun uni hivandi harazatneric u shrjapati mardkancic nra ancyali ev krac hivandutyunneri veraberyal teghekutyunner havaqeln u nran znnely: Anhrazhesht e harcuphordzov parzel gitakcutyan ynktchvacutyany naxordogh hangamanqnery: nmanatip erevuytner naxkinum drsevorve±l en, i±nch hivandutyunneric e tarapum hivandy ev stano±ւm e ardyoq deghorayqayin buzhum: Ays paragayum zgalioren ognum en hivandi mot arka bzhshkakan phastatghtery, deghatomsery, bzhshkakan patrastuknery: Axtoroshman gorcum bzhshkin eakanoren karogh en ognel voch vagh ancyali vnasvacqneri, alkoholi, tmramijocneri gorcacman veraberyal teghekutyunnery ev ayln:
Fizkal hetazotutyan mijocov buzhquyry karogh e ardzanagrel tmbiri canrutyan 3 astitchan:
- arajin (makeresayin tmbir): gitakcutyan liakatar korust, hivandin hnaravor che artnacnel, cavayin grgirnerin hivandn ardzaganqum e parzaguyn ankanon sharzhumnerov,
- erkrord (xory tmbir): makeresayin tmbiric ayn tarbervum e cavayin grgirneri nkatmamb sharzhoghakan reakciayi bacakayutyamb,
- errord (ankorovutyun kam atonik tmbir): uzhegh cavayin grgrumneri ev refleqsneri (bbayin, eghjrakayin ev ayln) nkatmamb sharzhoghakan reakciayi liakatar bacakayutyun:
Hivandi hangamanali znnumy hatchax npastum e tmbiri cagumnabanutyany veraberogh arandznahatuk nshanneri bacahaytmany: Gnahatvum e mashki, berani xorochi ev lezvi lordzataghanti, inchpes naev aknaxndzori, bberi vitchaky, anotazarky, shncharutyuny, marmni jermastitchany, zarkerakayin tchnshumy: Voroshaki axtoroshich arzheq uni hivandi artashnchac odi hoty: Axtoroshman arumov nshanakali ozhandakogh gorcon e hivandi nyardabanakan kargavitchaki gnahatumy (refleqsneri, meningitayin axtanshanneri ev ayl hivandutyunneri arkayutyun):
Nerkayacnum enq bzhshkakan praktikayum tmbirayin vitchaki himnakan pattcharnery ev klinikakan aravel aknaru nshannery:
1. Ugheghayin tmbiry, kaxvac dra harucman pattcharneric, uni klinikakan yntacqi voroshaki tarberutyunner:
Ugheghi kam entaostaynayin taracutyan aryunazeghumy bnutagrvum e tmbiri hankarcahas zargacmamb, hatchax: anzspeli phsxumov, hogesharzhichayin grgrumov, dogherocqayin cncumnerov: Erakazarky darnum e larvac ev hatchaxakiacac, zarkerakayin tchnshman makardaky bardzranum e, shncharutyuny: hatchaxakianum, marmni jermastitchany: bardzranum, isk entaostaynayin aryunazeghman depqum i hayt e galis meningitayin axtanshanneri mi amboghj hamalir:
Gangugheghayin vnasvacqi depqum hnaravor e gitakcutyan inchpes akntartayin (vnasvacqi pahin), aynpes el astitchanabar xoracogh korust: Erkrord depqin naxordum en hogesharzhichayin grgiry, glxacavy, srtxarnocy, phsxumy: Znnman tvyalnery hastatum en tmbiri hetvnasvacqayin cagumy: glxi artaqin vnasvacqnery (aryunazeghumic goyacac urucq ev ayln), akanjic kam qtic aryunahosutyuny, aknakapitchneri shrjanum aryan entazeghumnery, bberi tarber mecutyuny (asimetria):
Tonik ev klonik jghadzgutyunneri het mektegh gitakcutyan hankarcahas korusty, shrtunqneri phrphrakalely, lezun kcely, akama mizumy ev kghumy, mashki vra aryan entazeghumnery, bberi laynacumy bnorosh en vernotayin tmbirin:
Varakich hivandutyunneri nergorcutyamb arajacac tmbiry (meningit, encefalit ev ayln) zarganum e dandagh. dran naxordum e marmni jermutyan bardzracum, tunavorman erevuytner (yndhanur tulutyun, glxacaver, srtxarnoc, phsxum, axorzhaki vatacum ev ayln), mashki vra cani arajacum (aryunazeghayin can), erakazarki ev shncharutyan hatchaxacum, meningitayin axtanshanneri hamaxumb (cocrakayin mkanneri pndutyun ev ayln):
Tmbirayin hamanman: astitchanakan zargacman erevuyt nkatvum e naev ugheghi urucqneri depqum: i hetevans ugheghi aytuci, nra coghuni teghasharzhi ev nergangayin tchnshman bardzracman: Gitakcutyan korusty vra e hasnum subyektiv drsevorumneri (mshtakan glxacav, qnkotutyun, gitakcutyan mshushman kartchatev paher, srtxarnoc, tetevacman chhangecnogh phsxum ev ayln) bavakanin tevakan phulic ev obyektiv naxanshanneric (ojaxayin nyardabanakan axtanshanner, zarkerakayin tchnshman: erakazarki dandaghumov zugordvogh bardzracum) heto:
2. Nerqin organneri ev nerzatich geghdzeri gorcaruytneri canr xangarman hetevanqov arajacogh tmbiry zarganum e astitchanabar (bacarutyun e nvaz shaqaraynutyan (hipoglikemia) hetevanqov arajacogh tmbiry):
Lerdayin (lyardayin) tmbiry lyardi virusayin sur borboqman, qronikakan lerdaborbi, lyardi torshomman (ciroz), lyardagrgir tuynerov lyardi axtaharman (meruk) bardutyun e: Dra hivandaharuyc eutyuny phoxanakutyan nyuteri (amiak, fenolin ev ayln) kutakumn e organizmum, ttvahimnayin hamakcman xaxtumnery (dzevaphoxakan ttvagarutyan (acidoz) zargacum) ev glxugheghi tarber karucvacqneri axtaharmany npastogh u gitakcutyan korsti hangecnogh elektrolitayin havasarakshrutyan xatarumnery: Tmbiri zargacmany naxordum en hogehuzakan grgrumy, hankarcahas ev sur zarancanqneri phulery: tonik ev klonik jghadzgutyunov zugordvogh ev ynktchaxtov u qnkotutyamb hertagayvogh: Lerdayin tmbiri arandznahatuk naxanshanneri tvin en dasvum beranic ardzakvogh lerdahoty, mashki ev tesaneli lordzataghantneri deghnukaynutyuny, ------ y, mazanotneri kayun laynacumy, vor hatchax artahaytvum e demqi vra bosorakarmir xaleri dzevov, mashki vra kaptuknery ev aryan entazeghumnery, teghayin geraryunutyuny (hiperemia) apherin (aphayin karmramashkutyun), phori jrakalumy: phori vra erakayin artahaytvac gcagrmamb, lyardi mecacumy (ezry: pind u xordubord): Erakazarky: hatchaxaki, hatchax: telanman, zarkerakayin tchnshumy: ijac, shncharutyuny: xory, aghmkot: Hatchaxaki teghi e unenum phsxum, qtic stamoqsaghiqayin aryunahosutyun, nvazum e mizartadrutyuny. hivandy niharum e, jermutyuny: bardzranum: Sepsisi zargacman het sovorabar teghi e unenum varakneri miaxarnum:
Mizaryunayin tmbiry zarganum e lyardayin qronikakan anbavararutyan verjin phulum: Ayn hetevanq e mi sharq qronikakan hivandutyunneri, arajin hertin: pielonefriti, erikami malpigyan marmniki anotayin kciki borboqman, zarkerakayin tchnshman xist bardzracman hivandutyan, shaqarayin diabeti, miakcogh hyusvacqi hamakargayin hivandutyunneri (hamakargayin karmir gaylaxt (mashki tuberkuloz)), mizabanakan (mizaqarayin hivandutyun ev ayln) ev mi sharq ayl hivandutyunneri:
Erikamayin qronikakan hivandutyunnerin yurahatuk: erikamneri hamakentronacnogh ev artazatogh gorcaruyti xatarumy ughekcvum e organizmic spitakucneri, tcharperi ev acxajreri mshakumic artacvac dzevaphoxvac nyuteri dursberman xangarmamb, aryan mej kreatini, mizanyuti ev nyuteri hamakentronacman bardzracmamb, jraelektrolitayin havasarakshrutyan ev ttvahimnayin haraberakcutyan xatarumnerov: Ays phophoxutyunnery hangecnum en organizmi jghayin ev ayl hamakargeri tunavorman ev tmbirayin vitchaki astitchanakan xoracman:
Erikamayin tmbiri depqum beranic mezi hot e galis, hivandi bbery negh en, mashky: chor ev gunat, erbemn: deghnavun, vori vra nkateli en vardacan (ketayin aryunazeghumner), kaptukner, aryan entazeghumner: Ays hivandutyany bnorosh en mkanneri arandzin xmberi telikayin cncumnery (erbemn linum e jghadzgutyun), demqi ev verjuytneri aytucvely: Xory, aghmkot shncharutyunn astitchanabar darnum e makeresayin ev ankanon: Erakazarky hatchaxacac e ev larvac, zarkerakayin tchnshumy: bardzr: Ays depqum hatchax astitchanabar i hayt e galis srti qronikakan anbavararutyun ev toqeri mizaryunayin aytuc: Ays tmbiri klinikakan patkern amboghjacnum e phsxumy, dzhvar buzhvogh lucy, mezi dzhvar artazatumy: sakavamizutyan u anmizutyan arajacmamb: Tmbiri yntacqy canracnum en varakayin bardutyunnery, voronq darnum en mahvan pattchar:
Shaqarayin diabeti yntacqy bardacnum en ger shaqararyunayin ev nvaz shaqararyunayin (ketoacidotiakan ev gerosmolyar) tmbirnery:
Gershaqararyunayin ketoacidotik tmbirn aravelapes zarganum e arajin tipi shaqarayin diabetic tarapoghneri shrjanum: var artahaytvac insulinayin anbavararutyan ardyunqum, vorn el paymanavorvac e buzhman rezhimi xatarmamb (insulini chaphabazhni nvazum), varakich hivandutyunnerov, vnasvacqov, virahatakan mijamtutyamb, qaghcumov: Insulini anbavararutyunn ughekcvum e hyusvacqnerum qaghcranyuti (glyukoza) caxsman xangarumov, aryan mej dra hamakentronacman bardzracmamb (gershaqararyunutyun), aryan u mezi mej ketonayin marminneri parunakutyan avelacmamb (hamapatasxanabar: ketonemia ev ketonuria), dzevaphoxakan ketoacidozi zargacmamb: Ketoacidozi het hamakcvac gershaqararyunutyuny npastum e hyusvacqneri ttvaynutyan nvazmany (ttvacnaqaghc) ev jrazrkmany, elektrolitayin xatarumnerin, vor i verjo hangecnum e glxugheghi ev ayl organneri vnasman, tmbiri arajacman:
Tmbirayin vitchaki zargacmany naxordum e axorzhaki vatacumy kam bacakayutyuny, yndhanur ktruk tulutyuny, mashki qory, caravy, shatamizutyuny, glxacavery, srtxarnocn u phsxumy, sharunakakan phoracavery: Tmbirin bnorosh hivandagin nshanneri sharqin en dasvum: artashnchac odum acetoni hoty, sary mashki gunatutyunn u chorutyuny, lezvi chorutyunn u gorshavun pharakalutyuny, mashki larvacutyan ev aknaxndzori tonusi ijecumy: Erakazarky: hatchaxacac, xory, aghmkot: Astitchanabar zarganum e anmizutyun, hnaravor e marmni jerastitchani bardzracum:
Gershaqararyunayin gerosmolyar tmbiry bardacnum e erkrord kargi (tipi) shaqarayin diabeti yntacqy, vor bnorosh e glxavorapes tarec hivandnerin: Dra zargacumy hrahrum en aynpisi gorconner, voronq aryan osmotik tchnshman bardzracman depqum arajacnum en jrazrkum. ayd gorconnern en phsxumy, lucy, aratamizutyuny, mizamugh mijocneri ogtagorcumy, zarkerakayin tchnshman xist bardzracman dem lucuytneri nerarkumnery, heghuki ogtagorcman nvazecumy: Tmbirayin vitchaki cagumn u zargacumn yndhanur gcerov kareli e ayspes nerkayacnel. jrayin ev elektrolitayin havasarakshrutyan xaxtumneri het hamakcvac gershaqararyunutyuny npastum e aryan xtacmany, organizmi hyusvacqneri ktruk jrazrkmany, shrjanarvogh aryan nvazmany: hipovolemiakan shoki arajacmamb: Aryan xtacman ev makardeliutyan bardzracman hetevanqov arajanum en anotneri trombozner:
Gerosmolyar tmbiri depqum (i tarberutyun ketoacidotik) bacakayum en ttvahimnayin haraberakcutyan (ketoacidoz) xatarumnery, ev dra het kapvac: artashnchvac odum acetoni hoty, ketonemian ev ketonurian, bayc aravel artahaytvac en hyusvacqneri jrazrkman nshannern u jghabanakan xatarumnery: Tmbirayin vitchaki astitchanakan arajacmany sovorabar ughekcum en yndhanur ktruk tulutyuny, caravi zgacman uzhgnacumy, jrazrkman nshanneri ccunutyuny (mashki ev tesaneli lordzataghantneri chorutyun, mashki ev aknaxndzori larvacutyan nvazum, mizartadrutyan nvazum: yndhup anmizutyan zargacum), mkanayin tonusi bardzracumy, teghayin kam yndhanur karkamy (spazm), meningitayin axtanshannery, kisalucanqy (hemiparez) ev ayl erevuytner: Erakazarky: hatchaxacac, hatchax: telanman, zarkerakayin tchnshumy: cacr:
Aryan mej qaghcranyuti nshanakali nvazman depqum gershaqararyunayin tmbiry bnutagrvum e arag zargacmamb: Ayspisi iravitchakum aveli hatchax haytnvum en shaqaraxtic tarapoghnery: i hetevans snndakargi xaxtman, shaqarn ijecnogh patrastukneri (insulin, sulfanilamidner ev ayln), fizikakan tevakan canrabernvacutyan:
Aryan mej qaghcranyuti makardaki nvazumy (hipoglikemia) xatarum e snucumy (energetik phoxanakutyan) ev kentronakan nyardayin hamakargi gorcuneutyuny, npastum e glxugheghi aytucmann u urchelun, busnoghakan (vegetativ) nyardayin hamakargi aktivutyan atchin (grgrum) ev verjin hashvov paymanavorum e gershaqararyunayin tmbiri klinikakan drsevorumy: Hnaravor e naxanshanneri kartchatev shrjan: paymanavorvac katexolaminneri (adrenalin ev ayln) bardzr aktivutyamb ev bnorosh grgrvacutyamb, srtxphocov, amboghj marmni dogherocqov, profuz qrtnartadrutyamb, qaghci zgacumov: Hivandin znnelis nkatvum e tmbirayin vitchaki xoracmany hamapatasxan gunatutyun, xonavutyun, mashki mrsacutyun, mkanneri larvacutyan (jlayin refleqsneri) bardzracum: dranc hajordogh ijecmamb, tonik ev klonik jghadzgutyunner, ojaxayin nevrologiakan axtanshanner: Erakazarky: hatchaxacac, zarkerakayin tchnshumy karogh e tarber linel, bayc aveli hatchax bnakanon e kam bardzr: Shncharutyan xangarumnery ev jrazrkman nshanner chkan:
Organizmi vra alkoholayin xmichqneri, deghayin, ayd tvum tmradeghayin mijocneri, qimiakan miacutyunneri ev ayl nyuteri tunavor nergorcutyamb paymanavorvac tmbirn aveli hatchax arag e xoranum, hazvadep: dandagh:
Alkoholayin tmbiri i hayt galy paymanavorvac e etilayin spirti (etanol), alkoholayin xmichqneri nergorcutyamb: qronikakan alkoholizmi paragayum ev nshanakalioren hazvadep: alkohol arajin angam gorcacelis: Tmbirayin vitchaki axtacnutyan mej karevor der en xaghum etanoli hogemet azdecutyuny, dra dzevaphoxutyan argasiqneri ev aryan dzevaphoxakan ttvagarutyan azdecutyuny bjjahyusvacqayin karucvacqneri vra, vori hetevanqov xaxtvum en glxavorapes kentronakan nyardayin hamakargi, shncharakan organneri ev lyardi gorcaruytnery:
Harbecoghutyany, huzakan ankayunutyany, datoghutyan korstin, sharzhumneri koordinaciayi xatarumnerin ev ayl axtanshannerin astitchanabar hajordum e tmbiry: I hayt e galis gunatutyun, hivandi marminy sarum e, xonavanum, mashkacackuyti larvacutyunn ijnum e, mkannery tulanum en, teghi e unenum akama mizardzakum ev kghum, phsxum, anhetanum en refleqsnery, liovin korsvum e gitakcutyuny: Erakazarky: hatchaxacac, telanman, hatchax: voch ritmik, shncharutyuny: makeresayin, zarkerakayin tchnshumy: cacr: Hnaravor e jghadzgutyun, phsxuki artaccum, mexanikakan shnchaheghdzuk ev shncharutyan kang:
Qnaber mijocnerov: barbituratnerov (fenobarbital, barbital, barbital-natrium ev ayln), trankvilizatornerov-benzodiazepinnerov (nitrazepam, triazolam, oqsazepam ev ayln) ev ayl xmberi patrastuknerov tunavorvelu depqum tmbir aveli hatchax zarganum e hogekan ev nervabanakan hivandutyunnerov tarapoghneri organizmum, erb arka e qronikakan ginemolutyun ev qni erkaratev xatarum:
Tmbirayin vitchaki arajacmany hangecnogh glxavor gorconnern en very tvarkvac hogemet (qnaber, tmramijoc) ev neyrotoqsik nergorcutyuny glxugheghi, voghnugheghi ev erkaravun ugheghi vra, vori hetevanqov xatarvum e (tchnshvum e) dranc gorcaruyty, teghi e unenum lezvi hetankum, phsxuki artaccum, hazi refleqsi ynktchum ev shncharakan mkanunqi lucanq (paralich) xoracnum e shncharakan anbavararutyuny, arajanum e toqaborb: Teghi en unenum phaphuk hyusvacqneri snndayin (trofikakan) xangarumner, vori hetevanqov arajanum en xory parkelaharukner ev varakayin bardutyunner:
Hivandi znnman tvyalnery. mashki ev lordzataghanti kaptuk (cianoz), mashky xonav e ev sary, larvacutyuny: ijac, bbery laynacac en, mkannery: tulacac, refleqsnery nvazac en kam chkan: Shncharutyuny makeresayin e, xrpot: Erakazarky: hatchaxacac, shat hatchax: antesaneli ev voch ritmik, zarkerakayin tchnshumy: cacr: Nkatvum e hipotermia (hazvadep: hipertermia), mizartadrutyan nvazum (sakavamizutyun, anmizutyun):
Aphionayin tmbiri arajacman vtangin himnakanum entaka en ayn tmramolnery, vovqer ogtagorcum en aphioni alkaloidner (morfin, promedol, fentanol, heroin, tramadol ev ayln) parunakogh tmradeghayin analgetikner:
Kentronakan nyardayin hamakargi vra hogemet ev neyrotoqsik nergorcutyun unecogh, hazayin ev shncharakan kentronneri aktivutyuny tchnshogh, tapharogh nyardi aktivutyuny xtanogh ayd nyuteri mec chaphabazhinner yndunely hatchax npastum e tmbirayin vitchaki bavakanin arag arajacmany: Dra himnakan klinikakan nshannern en: mashki ev tesaneli lordzataghantneri kaptuky, armunkayin nerqnacalqi shrjanum nerarkman hetqer, hipotermia, bberi zgali neghacum kam aravelaguyn laynacum: luysi nkatmamb reakciayi bacakayutyamb, refleqsneri nvazum kam bacakayutyun, erbemn: tonik ev klonik jghadzgutyunner, mizartadrutyan nvazum: Shncharutyuny: makeresayin, hatchax: voch ritmik: yndhup nra liakatar kang: Erakazarky: hazvadep (bradikardia), zarkerakayin tchnshumy: ijac:
Acxacni monooqsidov (shmol gazov) tunavormamb paymanavorvac tmbiry bavakanin hatchaxaki e teghi unenum: Tunavorman pattchar karogh en linel avtomeqenaneri nerqin ayrman sharzhichneri ardzakac gazery, hrdehi vayrum shmol gazi azdecutyuny, jerucman hamakargi ansarqutyuny ev harkabazhnum anbavarar odaphoxutyuny:
Acxacni monooqsidy hemoglobinic durs e mghum ttvaciny: arajacnelov karboqsihemoglobin , vorn ughekcvum e tarber hyusvacqner ttvacni matakararman nvazumov (dranc ttvacnaqaghcov): Baci ayd, shmol gazy ughghaki tunavor nergorcutyun e unenum bjjayin karuycneri vra ev ttvacnaqaghci het ՙgorcakcelov՚: npastum e organizmi ayn hamakargeri gorcaruytneri xatarmany, voronq aravel xoceli en (kentronakan nyardayin, sirtanotayin hamakarger):
Tmbirayin vitchaky bnutagrvum e hetevyal axtanshannerov: mkanneri larvacutyan (tonus) bardzracum (pndutyun, rigidutyun), tonik ev klonik jghadzgutyunner, refleqsneri nvazum kam bacakayutyun, bavakanin hatchax: voch kamacin mizardzakum ev kghum, hipertermia: Erakazarky: hatchaxacac, makeresayin, zarkerakayin tchnshumy: cacr: Shncharutyuny: makeresayin: Ays vitchakin bnorosh e ugheghayin aryan shrjanarutyan xangarumy (katvac), ugheghi aytucy, shncharutyan kangy, hnaravor e srtamkani sur infarkt:
Tmbiri hastatumy, vorpes kanon, buzhqroj hamar mec dzhvarutyun chi nerkayacnum, minchder dra pattcharneri (tesakneri) bacahaytumy, vor mtnum e bzhshki dzernahasutyan volorti mej, hatchax bavakanin bard xndir e: hatkapes naxahivandanocayin phulum: Tmbiri tesaki nuynakanacmany npastum en laborator hetazotutyunnery: hemoglobini ev qaghcranyuti parunakutyan (shaqararyunutyan makardaki) voroshumy hamapatasxan analizatorneri ognutyamb, mezi mej ketonurayin ev hogemet mijocneri, inchpes naev etanoli (etilayin spirt) arkayutyuny tqi mej: tesoghakan test-oghoghumnery: Stacionar paymannerum irakanacvogh amenaarzheqavor hetazotutyuny handisanum e aryan verlucutyuny: qaghcranyuti, bilirubini, mizanyuti, kreatini, elektrolitneri (natrium, kalium, kalcium, magnezium, fosfor), ttvahimnayin haraberakcutyuny, alaninaminotransferazneri, asparataminotransferazneri, alkaliakan fosfatazneri aktivutyuny aryan mej, mezi yndhanur verlucutyuny:
Elektrasrtagrutyan, aknaznnman, elektragangugheghagrutyan, voghnugheghayin heghuki hetazotman, gangi, voghnashari paranocayin masi ev krcqavandaki rentgenagrutyan ev glxugheghi hamakargchayin ev magnisakan-ardzaganqayin teghagrutyan mijocov tchshgrtum en tmbirayin vitchaki cagumnabanutyuny:
Ete kaskac ka, vor tmbiry toqsik cagum uni (etilayin spirt, tmradeghayin analgetikner, barbituratner, trankvilizatorner, fosfororganakan nyuter ev ayln) irakanacnum en stamoqsi axtoroshich lvacum ev kensamijavayri (aryun, mez, phsxuk, lvacman jrer) qimiatunabanakan hetazotutyun:
Anhetadzgeli ognutyan baghadrichnery
Tmbirayin vitchakum gtnvogh hivandin buzhquyry cucaberum e anhetadzgeli naxabzhshkakan ognutyun ev npastum e nran anmijapes hivandanoc teghaphoxelun:
Buzhqroj gorcoghutyunnery hivandin naxabzhshkakan ognutyun cucaberelis.
- anmijapes bzhishk kanchel,
- hivandin chteghaphoxel, nra marmni ev glxi dirqy chphoxel,
- jur chxmecnel ev chstugel hivandi klanelu karoghutyuny,
- gluxy zgushutyamb mi koghmi vra teqel,
- storin cnoty bacel, ete ka protez: hanel, lezun brnel, berani xorochy ev ympany maqrel snndi mnacordneric,
- gnahatel erakazarky ev shncharutyuny (hatchaxutyuny, ritmikutyuny), zarkerakayin tchnshumy,
- texnikakan hnaravorutyunneri arkayutyan depqum kirarel xonavacvac ttvacni inhalyacianer:
Ankax tmbiri pattcharic, bzhshki koghmic cucabervogh artahert ognutyunn ir mej nerarum e organizmi karevor gorcaruytneri: shncharutyan ev aryan shrjanarutyan verakangman (kam pahpanman) mijocarumner: jraelektrolitayin havasarakshrutyan ev ttvahimnayin haraberakcutyan xaxtumneri shtkum: Shtap ognutyan brigadneri bzhishkneri karevoraguyn xndirn e minchhivandanocayin phulum verakangnel shnchughineri ancaneliutyuny ev katarel toqeri ardyunavet odaphoxutyun (ttvacnaterapia) dimaki, qti kateteri kam endotraxeal xoghovaki ognutyamb: Shnchughineri ancaneliutyan apahovumy handisanum e anhrazhesht payman hetaga anhetadzgeli mijocarumner, ayd tvum toqasrtayin verakangnum katarelu hamar (shncharutyan ev aryan shrjanarutyan ktruk xatarman (kam bacakayutyan) depqum):
Ayd gorcaruytnery pahpanelis phordzum en veracnel hemodinamikayi xangarumnery, arajin hertin: hipovoleminery (KTchX) ev zarkerakayin hipotenzian: Ays npatakov katarum en byureghanmanneri lucuytneri (0,9% ---- aghi lucuyt, 5% qaghcranyuti lucuyt, bazmaglyukin, reobazmaglyukin, reomakrodeqs ev ayln) ev zarkerakayin tchnshumy bardzracnogh mijocneri (0,005% dofamini lucuyt, 0,1% adrenalini kam 0,2% noradrenalini lucuyt 5% qaghcranyuti lucuytum) nerarkumner: Byureghanmanneri lucuytnery npastum en hyusvacqneri jrazrkman ev organizmi tunavorman kanxmany:
Aryan mej qaghcranyuti hamakentronacman bnakanon mecutyan kam nvazman fonin sakavshaqararyunutyan shtkumy irakanacvum e qaghcranyuti 20-40 ml 40%-anoc lucuyti: bolyusayin nermucmamb (hatchax: 2 angam), isk ttvahimnayin haraberakcutyan, aravelapes dzevaphoxakan ttvagarutyan shtkumn irakanacvum e natriumi erkkarbonati kam laktati nerarkayin katilayin nerarkman mijocov:
Tvarkvac artakarg mijocarumnery, vor veraberum en tmbirayin vitchaki axtanshanayin terapiayin, sksvum en naxahivandanocayin, ayd tvum hivandi teghaphoxman phulum ev sharunakvum en hivandanoci verakendanacman bazhanmunqum: Stacionar paymannerum hivandi vitchakin gorcun kerpov hetevelov handerdz: amboghj cavalov laborator ev gorciqayin hetazotutyun katarely, axtoroshman gorcyntacin masnagetneri (reanimatolog, nyardaban, endokrinolog, tunaban, varakaban, srtaban) yndgrkely npastum en tmbiri tesaki i hayt bermany, ev irakanacvum e pattcharagitakan ev axtacagumnabanakan buzhum:
Arajnayin (glxugheghayin) tmbiri etiotrop mijocarumneri aknaru orinaky, vor paymanavorvac e varakayin gorconnerov (ugheghaborb, gangugheghi kam voghnugheghi patyanneri borboqum), handisanum e aktiv hakabakterial ev tunazercogh terapian: Voskrayin bekorneri ev nergangayin aryunayin urucqi (hematoma) heracman npatakov shtap mijamtutyuny hatchax irakanacnum en glxugheghayin tmbiri vnasvacqayin cagman depqum:
Ugheghayin aryan shrjanarutyan sur xaxtumneri (katvac) hetevanqov arajacac tmbiri axtacagumnabanakan terapiayi volortum e dzevaphoxakan ev aryan matakararumy barelavogh deghamijocneri (gliatilin, citoflavin, berlition) ogtagorcumy kentronakan nyardayin hamakargi xaxtumnery veracnelu npatakov: Tmbiri tarber tesakneri depqum hakaaxtacnakan buzhakan mijocarumneri canky shat bazmazan e, dra mej mtnum en, orinak, insulini ev qaghcranyuti lucuytneri ogtagorcumy hamapatasxanabar gershaqararyunayin ev sakavshaqararyunayin tmbiri, hakatuynery: tunayini, aryan phoxnerarkayiny: sakavaryunayin tmbiri depqum:
Hivandin dinamikoren hetevelu yntacqum buzhquyry verahskum e bzhshki nshanakac buzhakan mijocarumnery, bacahaytum e deghamijocneri koghmnaki (anbarenpast) nergorcutyuny ev ayd masin teghekacnum e bzhshkin: Na amen or gnahatum e hivandi yndhanur vitchaky, kensagorcuneutyan himnakan cucichnery (erakazark, zarkerakayin tchnshum, marmni jermastitchan), tmbiri yntacqi arandznahatkutyunnery: 1) tmbirayin vitchakic durs galy, 2) yndhanur vitchaki drakan dinamikayi bacakayutyun, 3) tmbiri xoracum ev bardutyunneri i hayt galy:
Tmbirayin vitchakum hivandi erkaratev linelu depqum buzhquyrn apahovum e zondov kam parenteral kerakrumy, verahskum ev kargavorum e mizardzakumn u kghumy, irakanacnum e mashki ev lordzataghantneri snndayin (trofikakan) xangarman, gangayin toqaborbi, storin verjuytneri erakneri trombi kanxargelumy: Verjuytnerum sharzhumneri xatarumneri depqum na dranq tchisht dirqi e berum: aryan shrjanarutyan xatarumneri ev krkanqi arajacumy kanxelu hamar:
Tmbirayin vitchakum gtnvogh hivandi xnamqn irakanacvum e deontologiakan skzbunqneri pahpanmamb: Hivandi nerkayutyamb chi kareli qnnarkel nra vitchakn u entadrutyun anel hivandutyan elqi masin: Harazatneri het zruyci yntacqum buzhquyry petq e hivandi vitchaky nkaragrogh barern yntrelis zguysh lini, aveli shat ushadrutyun dardzni hivandi xnamqin, pahpani drakan elqi nkatmamb havaty:
Tmbirayin vitchakic durs galu chaphin hamapatasxan gitakcutyan verakangnumn astitchanabar e teghi unenum. goyutyun uni mshushvac gitakcutyan phul: Ayd phulum anhrazhesht e achalrjoren hskel hivandin, cucaberel hogebanakan ajakcutyun, nrbankatoren bacatrel teghi unecacy: Anhrazhesht e hivandin tramadrel karucoghakan varqi: ughghvac tmbiri hetevanqneri veracman payqarin: organizmi nyardayin ev ayl hamakargeri gorcaruytnery verakangnelu payqarin: