2 wlamde asakis bavSvis kveba

klinikuri praqtikis erovnuli rekomendacia

(gaidlaini)

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klinikuri praqtikis erovnuli rekomendacia (gaidlaini) `2
wlamde asakis bavSvis kveba~ miRebulia klinikuri praqtikis
erovnuli rekomendaciebis (gaidlainebi) da daavadebaTa marTvis
saxelmwifo standartebis (protokolebi) SemuSavebis, Sefasebis
da danergvis erovnuli sabWos 2008 wlis 5 noembris #1 sxdomaze
da damtkicebulia saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis ministris 2009 wlis 14 aprilis # 153/o
brZanebiT.

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 2 wlamde asakis bavSvis kveba

definicia, sinonimebi, klasifikacia, terminologia

kveba mniSvnelovan gavlenas axdens bavSvis ganviTarebaze. adreul asakSi
aracionaluri kveba da araswori praqtika iwvevs iseT darRvevebs, romlebic
aisaxeba adamianis janmrTelobaze, ara mxolod bavSvobis, aramed
mozardobisa da mozrdilobis periodSic. kerZod, ferxdeba zrdis procesi,
gonebrivi, inteleqtualuri da motoruli ganviTareba, izrdeba bavSvTa
avadobisa da sikvdilobis riski, mozrdilobis asakSi ki – qronikuli
daavadebebis ganviTarebis albaToba. Sesabamisad, 2 wlamde asakSi bunebrivi
kvebis principebis dacva, ZuZuTi kvebis xelSewyoba, damatebiTi sakvebis
drouli dawyeba da asakis Sesabamisi sakvebi ingredientebis gamoyeneba
bavSvis janmrTelobis erT erT mniSvnelovan safuZvels warmoadgens.

• eqskluziuri ZuZuTi kveba anu mxolod ZuZuTi kveba - Cvilis kveba qalis
(deda /donori) rZiT, xseniT, gamowvelili rZiT 6 Tvemde, sxva sakvebisa
da siTxeebis (maT Soris wylis) Sematebis gareSe (gamonakliss
warmoadgens medikamentebi, ORS, vitaminebi, mineraluri danamatebi)
• predominantuli ZuZuTi kveba anu upiratesad ZuZuTi kveba. _ dedis
(donoris) rZesTan erTad mcire raodenobis siTxeebis miReba (wyali, Cai,
wveni)
• komplementuri kveba - qalis rZesTan erTad naxevradmyari an myari
damatebiTi sakvebis miReba.
• ZuZuTi kveba _ kvebis wesi, rodesac bavSvi ikvebeba dedis rZiT da iRebs
nebismier sxva saxis sakvebs, maT Soris qalis rZis Semcvlelebs.
• prelaqtaciuri sakvebi – qalis rZis Semcvleli an nebismieri siTxe,
romelic gamoiyeneba ZuZuTi kvebis dawyebamde
• kani kanTan kontaqti – mSobiarobis Semdeg janmrTeli SiSveli
axalSobilis moTavseba dedis sxeulze.

gaidlaini gankuTvnilia
• samedicino personalisaTvis, romelic muSaobs 2 wlamde asakis bavSvebTan
samSobiaro saxlSi, stacionarSi da jandacvis pirvelad rgolSi –
neonatologebis, mean-ginekologebis, pediatrebis, ojaxis eqimebis, bebia-
qalebis, axalSobilTa da patronaJis meddebisTvis.

gaidlainis samizne jgufi:

• 2 wlamde asakis bavSvebi

gaidlaini ar moicavs:
• dRenakluli da mcire wonis axalSobilis kvebis principebs;
• xelovnuri kvebis principebs;
• 2 welze meti asakis bavSvis kvebas;
• avadmyofi bavSvis kvebas.

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gamoyenebuli Semoklebebi:
ILKA _ laqtaciis konsultantTa saerTaSoriso asociacia;
IBFAN _ bavSvTa kvebis saerTaSoriso qseli;
WABA _ ZuZuTi kvebis msoflio aliansi;
Baby Milk Action - ZuZuTi kvebis qseli;
WHO _ janmrTelobis msoflio organizacia (janmo);
UNICEF – gaeros bavSvTa fondi;
IQ _ inteleqtualuri koeficienti;
aiv/Sidsi _ adamianis imunodeficitis virusi/SeZenili imunodeficitis
sindromi;
HTLV _ adamianis T-limfotropuli virusi.

epidemiologia
2005 wlis statistikuri monacemebis mixedviT samSobiaro saxlebSi ZuZuTi
kveba mSobiarobidan erT saaTSi iwyeba - 64,1%-Si, 1-8 saaTSi – 23%-Si,
samSobiarodan gamowerili axalSobilebis 90% imyofeba ZuZuTi kvebaze.
saxelmwifo satatikur monacemebis mixedviT 3 Tvemde asakis bavSvTaA 52,11%
ikvebeba ZuZuTi, gaeros bavSvTa fondis da ACTS Georgia-s mier 2005 wels
Catarebuli kvlevis SedegebiT eqskluziuri ZuZuTi kvebis maCvenebeli 36%-s
Seadgens.

2 wlamde asakis bavSvis kvebis ZiriTadi princi pebi

ZuZuTi kveba
qalis rZe cocxali biologiuri substanciaa, romelic mudmivad icvleba
bavSvis moTxovnilebis Sesabamasad da idealuri sakvebia axalSobili
B
da Cvili bavSvisTvis (mtkicebulebis done I, rekomendaciis xarisxi
B)1,12,25.

ZuZuTi kvebis upiratesoba

ZuZuTi kvebis upiratesoba bavSvisTvis
II
• qalis rZe srulad akmayofilebs Cvilis nutriciul moTxovnilebas
6 Tvis asakamde (mtkicebulebis done II)1,28, igi Seicavs bavSvis
optimaluri zrda-ganviTarebisTvis saWiro yvela sakveb ingredients
saukeTeso TanafardobiT: makro- da mikroelementebs (cila, I,II
naxSirwylebi, cximi, vitaminebi, mineralebi, wyali,) (mtkicebulebis
done I; II) 1,2,3,4,5

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• qalis rZe
_ advilad mosanelebelia;
_ steriluria;
_ mudmivad icvleba bavSvis moTxovnilebis da asakis Sesabamisad,
agreTve bavSvis avadmyofobis dros31.
_ xasiaTdeba tkivildamayuCebeli efeqtiT (mtkicebulebis done I
I)6,7.
• ZuZuTi kveba amcirebs Semdegi daavadebebis ganviTarebis risks I,II
(mtkicebulebis done I, II):
_ diarea6,11;
_ respiraciuli infeqcia6,10;
_ otiti6,11;
_ baqteriuli meningiti11;
_ mwvave nekrozuli enterokoliti153;
_ Cvilis uecari sikvdilis sindromi 8,12;
_ simsuqne pubertatul da mozrdil asakSi15,143;
_ alergiuli daavadebebi, maT Soris asTma da atopuri dermatiti154,155;
_ I da II tipis Saqriani diabeti11,155,156 - ZuZuTi kvebis xangrZlivobasa
da insulindamokidebuli diabetis gamovlinebas Soris aRiniSneba
ukuproporciuli damokidebuleba;
_ arsebobs kvlevebi, romelic miuTiTebs ZuZuTi kvebis SemTxvevaSi
bavSvTa asakSi leikozis da avTvisebiani simsivneebis riskis
Semcirebaze158,159.
• bunebrivi kveba xels uwyobs:
_ bavSvis optimalur fizikur ganviTarebas15;
_ gonebriv ganviTarebas (bunebriv kvebaze gazrdili bavSvebis
II
IQ testi mozrdilobis asakSi ufro maRalia, vidre xelovnur
kvebaze myofi bavSvebis) (mtkicebulebis done II) 11,18,19,48;
_ mxedvelobis srulfasovan ganviTarebas;
_ saxis Zvlebis da kunTovani sistemis ganviTarebasa da swori
I
Tankbilvis Camoyalibebas (mtkicebulebis done I)20;
_ deda–Svils Soris mWidro fsiqoemociuri kavSiris damyarebas,
bavSvTan usafrTxoebis grZnobis da ndobis Camoyalibebas II
(mtkicebulebis done II) 20,21,22,23,24.

ZuZuTi kvebis upiratesoba dedisTvis

ZuZuTi kveba mniSvnelovan gavlenas axdens dedis janmrTelobis
mdgomareobaze. kvebis adreuli dawyeba iwvevs saSvilosnos SekumSvas II
da icavs qals mSobiarobis Semdgomi sisxldenisagan, ZuZuTi kveba
xels uwyobs saSvilosnos involucias (mtkicebulebis done II)11,20,32.
ZuZuTi kveba xels uwyobs:
_ sarZeve jirkvlisa da sakvercxeebis simsivnuri daavadebebis
ganviTarebis riskis Semcirebas (mtkicebulebis done II); II
_ dedis xelaxali daorsulebisagan dacvas - laqtaciuri
amenorea (mtkicebulebis done II)33,44;
_ qalis wonaSi klebas (mtkicebulebis done II)34; II
_ Zvlis mineralizaciis procesis gaumjobesebas, rac amcirebs
postklimaqsur periodSi motexilobebis sixSires160,161.

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dadgenilia, rom ZuZuTi kvebis gagrZeloba bavSvis an dedis avadmyofobis
da hospitalizaciis dros aumjobesebs, maTi janmrTelobis xarisxs
(mtkicebulebis done II, III)35,36. II, III

ZuZuTi kvebis upiratesoba ojaxisa da qveynisaTvis

ZuZuTi kveba ekonomiuria ojaxisa da qveynisTvis _ icavs ojaxs xelovnur
kvebasTan dakavSirebuli danaxarjisagan, amcirebs bavSvis mkurnalobisa da
hospitalizaciis xarjebs. aSS-Si Catarebuli kvleviT dadgenilia, rom igi
amcirebs jandacvaze moxmarebul xarjebs 3,6 bilioniT11, 37,38.

xelovnur kvebasTan dakavSirebuli risk-faqtorebi:

mravalricxovani kvlevebiT dadgenilia, rom xelovnuri kveba zrdis mravali
daavadebis ganviTarebis risks:
_ diarea, maT Soris persistiuli diarea da respiraciuli
infeqciebi165;
_ kvebis ukmarisoba da vitamin A-s deficiti78;
_ alergia da rZis autanloba78,165;
_ zogierT qronikuli daavadeba, maT Soris diabeti163;
_ simsuqne15,143;
_ anemia163,164.

qalis rZis Semadgenloba da misi mniSvneloba

dedis rZe axalSobili da Cvili bavSvis srulfasovani sakvebia
(mtkicebulebis done I; II), masSi saukeTeso TanafardobiT aris I, II
warmodgenili bavSvis optimaluri zrda-ganviTarebisTvis saWiro
yvela sacicxlo nivTiereba: wyali, cila, naxSirwyali, cximovani mJavebi,
vitaminebi da mineralebi. dedis rZe Secavs fermentebsa da damcvelobiT
nivTierebebs, ris gamoc igi advili mosanelebelia da mniSvnelovani
damcvelobiTi funqciac gaaCnia1,2,3,5,28,39,43,44.

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 cxrili 1

gansxvaveba xelovnur narevs, qalisa da cxovelur rZes Soris

qalis rZe cxoveluri rZe xelovnuri narevebi

baqteriuli ar aris SesaZlebelia SesaZlebelia

dabinZureba
infeqciis
sawinaaRmdego arsebobs ar arsebobs ar arsebobs
faqtorebi
zrdis
faqtorebi arsebobs ar arsebobs ar arsebobs
cilebi saWiro raodenoba, Warbi, Znelad nawilobriv
iolad asaTvisebeli asaTvisebeli koregirebuli
Sratis cilebi 65-80 % 20 % nawilSi _ 40-60 %

kazeini 20-40 % 80 % 40-80 %

cximebi sakmarisi raodenoba, ujeri cximovani ujeri cximovani

ZiriTadad – ujeri mJavebis deficiti, mJavebis deficiti,
cximovani mJavebis myari, aqroladi zogierT narevi
Semcveloba, romelic mJavebis siWarbe Seicavs ujer cximebs
ioli mosanelebelia
omega6 /omega3 Seicavs sakmarisi mcire raodenoba zogierT narevs
cximovani raodenobiT damatebuli aqvs
mJavebi

lipaza Seicavs ar Seicavs ar Seicavs

laqtoza sakmarisi raodenoba, arasakmarisi koregirebuli, ufro

β laqtoza- raodenoba, xSirad iwvevs
uzrunvelyofs α laqtoza- Esherichia Coli-s zrdas
bifidum baqteriis uzrunvelyofs nawlavSi, Tumca
zrdas nawlavSi Esherichia Coli-s SesaZlebelia
zrdas nawlavSi damatebuli hqondes
eubiotikebi
rkina mcire raodenoba, mcire raodenoba, xelovnurad
kargad Seiwoveba cudad Seiwoveba damatebuli, cudad
Seiwoveba
sakmarisi A da C vitaminebis xelovnurad
vitaminebi raodenobiT deficiti damatebuli
vitaminebis nakrebi
wyali sakmarisi Txoulobs SeiZleba saWiro
raodenobiT damatebas gaxdes damateba.

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cila 1,2,3,5,28,39,43,44

cilis Semcveloba qalis rZeSi srulad Seesabameba bavSvis kvebiT

moTxovnilebas. cila aucilebeli komponentia bavSvis fizikuri da gonebrivi
ganviTarebisaTvis. D
• qalis rZis cila ZiriTadad warmodgenilia Sratis cilebiT
α laqtalbuminiTa da laqtoferiniT, romlebic bavSvisTvis Seucvleli
aminomJaveebis wyaroa. qalis rZis 20 aminomJavidan 8 Seucvleleli
aminomJavaa, romlis sinTezi bavSvis organizms ar SeuZlia. maRalia
taurinis raodenoba, romelic organizmSi mxolod mcire raodenobiT
sinTezirdeba da aucilebelia nervuli qsovilis ganviTarebisa da
momwifebisTvis;
• qalis rZis cila advilad iSleba da aiTviseba. qalis rZeSi naklebia
kazeinis Semcveloba. Tanafardoba Sratis cilebsa da kazeins Soris
Seadgens 60-70/40-30. qalis rZis kazeini Zroxis rZis kazeinisgan
gansxvavdebiT SedarebiT advilad mosanelebelia;
• qalis rZis cilebis garkveuli nawili (imunoglobulinebi, laqtoferini,
lizocimi da sxv.) dauSlelad gadis kuW-nawlavis traqts da aqtiurad
monawileobs damcvelobiTi funqciis SesrulebaSi.

cximi 1,2,3,5,28,39,43,44

cximi bavSvis organizmisTvis energiis erT-erT ZiriTad wyaros warmoadgens.

• cximze modis qalis rZis kaloriulobis daaxloebiT naxevari;
• qalis rZis cximi advilad iSleba da aiTviseba bavSvis kuW-nawlavis
traqtSi. rZeSi Semavali fermenti lipaza xels uwyobs cximis monlebis
process;
• qalis rZe gamoirCeva ujeri cximovani mJavebis maRali SemcvelobiT. ujeri
cximovani mJavebi, maT Soris grZeli da saSualojaWvovani
trigliceridebi (araqidonis da linolenis, omega-3) aucilebelia bavSvis
nervuli qsovilis, gansakuTrebiT ki tvinis qerqis ganviTarebisa da
mxedvelobis normaluri funqciis CamoyalibebisTvis, ris gamoc maT
xSirad tvinis arqiteqtorebsac uwodeben;
• qalis rZe mdidaria qolesteriniT;
• sicocxlis pirveli Tveebis ganmavlobaSi bavSvs ar Seswevs unari najeri
cximovani mJavebi gardaqmnas ujer cximovan mJavebad. am nivTierebebis
wyaros mxolod dedis organizmi warmoadgens, romelic amaragebs ujeri
cximovani mJavebiT nayofs orsulobis periodSi, axalSobilsa da Cvils
ZuZuTi kvebis dros;
• cximis Semcveloba qalis rZeSi icvleba:
_ dRis ganmavlobaSi (diliT SedarebiT naklebia, saRamos meti);
_ bavSvis asakTan erTad;
_ uSualod kvebis procesSi (wina rZe Seicavs nakleb, xolo ukana rZe
meti raodneobiT cxims).

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naxSirwyali 1,2,3,5,28,39,43,44

naxSirwylebi qalis rZeSi ZiriTadad laqtoziT (β) da oligosaqaridebiT

aris warmodgenili.
• naxSirwylebze modis qalis rZis kaloriulobis daaxloebiT 40%;
• qalis rZis naxSirwylebi advilad aiTviseba, qalis rZeSi Semavali
fermenti laqtaza gardaqmnis maT martiv Saqrebad;
• naxSirwylebi warmoadgens energiis erT-erT ZiriTad wyaros bavSvis
organizmisTvis;
• laqtoza Tavis tvinis ujredebis ZiriTadi energetikuli wyaroa da xels
uwyobs tvinis ganviTarebas;
• β laqtoza xels uwyobs nawlavis normaluri floris Camoyalibebas
(kerZod, ki Bifudm Bacteriae-s zrdas) da Sesabamisad kuW-nawlavis traqtis
normalur funqcionirebas.

vitaminebi da mineralebi
qalis rZeSi vitaminebisa da mikroelementebis Semcveloba mniSvnelovanwilad
damokidebulia dedis kvebaze28,43,44,45,46.
• Tu deda mravalferovani sakvebiT ikvebeba, rZe sakmarisi raodebiT Seicavs
aRniSnul nivTierebebs da 6 Tvis asakamde bavSvTan mikroelementebis
deficitis ganviTarebis riski dabalia;
• qalis rZeSi arsebuli vitaminebi da mikroelementebi advilad aiTviseba
bavSvis organizmis mier.
dedis rZeSi arsebuli mikroelementebi da vitaminebi or jgufad iyofa78:
I jgufi - mikroelementebi, romelTa Semadgenloba dedis rZeSi
damokidebulia dedis kvebasa da janmrTelobis mdgomareobaze.
II jgufi - mikroelementebi, romelTa Semadgenloba dedis rZeSi ar aris
damokidebuli dedis kvebasa da janmrTelobis mdgomareobaze (ix. cxrili 2.)

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 cxrili 2

dedis rZeSi arsebuli mikroelementebi da vitaminebi

I jgufi II-jgufi
• vit _ B1 • TuTia
• vit _ B2 • rkina
• vit – B6 • foliumis mJava
• vit – B12 • kalciumi
• vit – D
• vit – A
• iodi
• seleniumi
daxasiaTeba
daxasiaTeba
• dedis mier aRniSnuli
mikroelementebis moxmarebis dabali • dedis mier am mikroelementebis
done iwvevs maTi koncentraciis moxmarebis dabali done, an maTi
daqveiTebas rZeSi, rac aisaxeba deficiti
bavSvis ganviTarebaze _ naklebad aisaxeba maT
• bavSvs aqvs aRniSnuli Semcvelobaze rZeSi, ar axdens
mikroelementebis mcire maragi. maTi gavlenas mikroelementebis
saWiro donis SenarCuneba koncentraciaze
damokidebulia miRebul sakvebze _ bavSvi rZiT iRebs maT sakmaris
raodenobas
• dedis racionaluri kveba advilad
_ dedasTan maRalia mocemuli
aRadgens mikroelementebis
mikroelementebis deficitis
koncentracias dedis rZeSi.
ganviTarebis riski.

• rkina - qalis rZeSi rkina SedarebiT dabali koncentraciiT aris

warmodgenili, Tumca misi aTvisebis unari daaxloebiT oTxjer ufro
maRalia rkiniT gamdidrebul xelovnur sakvebTan SedarebiT. droul
axalSobils dabadebisas rkinis sakmarisi maragi aqvs da eqskluziuri
ZuZuTi kvebis SemTxvevaSi qalis rZe srulad akmayofilebs Cvilis
moTxovnilebas rkinaze 6 Tvis asakamde.
• kalciumi da fosfori - qalis rZeSi kalciumisa da fosforis
Tanafardoba saukeTesoa mocemuli mikroelementebis srulyofili
SewovisaTvis.
• TuTia - TuTiis Semcveloba qalis rZeSi dabalia, Tumca igi ufro kargad
aTviseba, vidre xelovnuri narevis an sxva sakvebi produqtis TuTia.
eqskluziur ZuZuTi kvebaze myof bavSvebs 6 Tvemde praqtikulad ar
uvlindebaT TuTiis deficiti.

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 cxrili 3
vitaminebisa da mikroelementebis funqciebi
vitamini wyaro funqcia deficitiT gamowveuli
minerali mdgomareoba

vit A RviZli, rZis yvela organos (maT zrdaSi CamorCena,

produqtebi, Tevzis Soris mxedvelobis) mxedvelobis
qoni, mwvane da funqcionirebasa da daqveiTeba,
narinjisferi zrdis procesSi gansakuTrebiT RamiT
bostneuli monawileoba e.w. ”qaTmis sibrmave”.
xSiri avadoba imuni
tetis daqveiTebis gamo
vit D Tevzi, Tevzis qoni, Zvlebis formireba, Zvlebis darbileba da
RviZli, kvercxis guli zrdaSi monawileoba deformacia –“raqiti”
vit C citrusebi, bulgaruli yvela saxis ujredis suravandi, pirovnuli
wiwaka, askili funqcionirebaSi Tvisebebis cvlileba,
pomidori, kombosto monawileoba. reaqciis da aqtivobis
daqveiTeba, daRliloba
vit B2 mwvane foTlovani nervuli sistemis pirovnuli Tvisebebis
bostneuli, xorci, moqmedebasa da cvlileba, reaqciis
kvercxi, rZe zrdaSi monawileoba unaris da aqtivobis,
daqveiTeba, daRiloba
vit B1 marcvleuli, pur- naxSirwylebis koncentraciis da
funTuSeuli, barda, aTvisebaSi mexsierebis daqveiTeba,
soio, lobio, Txili, monawileoba gaRizianebadoba da
xorci depresia. mozardebSi
agresiuli qceva
vit B12 xorci, Tevzi, kvercxi, sisxlis warmoqmnasa sisxlnakleboba -
rZe da nervuli sistemis anemia
funqcionirebaSi
monawileoba
folis safuari, forToxali, sisxlis warmoqmnaSi sisxlnakleboba -
mJava Tirkmeli, RviZli, monawileoba anemia
mwvane foTlovani
bostneuli
rkina RviZli, xorci, kvercxis sisxlis warmoqmna, anemia, zrdaSi
guli, Tevzi, marcvle- gonebrivi ganviTrebis CamorCena, gonebrivi
uli, lobio, barda, xelSewyoba ganviTarebis Seferxeba,
soio, ispanaxi, vaSli Sromisunarianobis
daqveiTeba
kalciumi rZis produqti, Tevzi, Zvlebis da kbilebis Zvlebis darbileba da
mwvane foTlovani Camoyalibeba, zrdis deformacia, krunCxva,
bostneuli processa da kunTebis zrdis Seferxeba
muSaobaSi
monawileoba

11
iodi iodiani marili, zRvis gonebrivi ganviTare Ciyvi, gonebrivi
produqtebi bis xelSewyoba ganviTarebis mkveTri
Seferxeba (kretinizmi)

TuTia xorci, Tevzi, kvercxi, fizikuri ganviTareba, zrdaSi CamorCena,

marcvleuli, parkosnebi sasqeso organoebis sqesobrivi
funqcionirebaSi ganviTarebis Seferxeba.
monawileoba,
Wrilobebis
Sexorceba
ftori ftorirebli wyali, Zvlebisa da kbilebis Zvlebis deformacia da
Cai,zRvis produqti Camoyalibeba kbilebis dazianeba

wyali
qalis rZe 80-90% wyals Seicavs da xSiri kvebis SemTxvevaSi dedis rZe
srulad akmayofilebs bavSvis moTxovnilebas siTxeebze. amitom II
eqskluziuri ZuZuTi kvebis dros bavSvi ar saWiroebs damatebiT
siTxeebis miRebas (mtkicebulebis done II)41.

fermentebi28,43,44,47
qalis rZe, daaxloebiT, 20 ferments Seicavs (laqtaza, lipaza, amilaza,
ribonukleaza, peroqsidaza da sxv), romlebic xels uwyoben:
• qalis rZeSi Semavali sakvebi ingredientebis monelebas;
• mikroelementebis da vitaminebis aTvisebas.
mocemuli fermentebis nawili xasiTdeba baqteriociduli TvisebebiT.

zrdis faqtorebi
qalis rZe Sicavs sxvadasxva zrdis faqtors, mag. epidermuli, nervuli
qsovilis da sxv.
epidermuli zrdis faqtori xels uwyobs:
• kuW-nawlavis traqtis qsovilebis momwifebasa da diferenciacias;
• nawlavis barieruli funqciis Camoyalibebas, rac Tavis mxriv amcirebs
antigenebis Sewovas.
nervuli qsovlis zrdis faqtori xels uwyobs:
• nervuli qsovilebis momwifebasa da diferencirebas.
arsebobs mravali sxva zrdis faqtori, romelTa funqciac sakmarisad
Seswavlili ar aris.

hormonebi
qalis rZe Seicavs TxuTmetamde hormons, romlebic xels uwyoben bavSvis
organoTa da sistemebis momwifebas.

12
damcvelobiTi nivTierebebi
qalis rZe Seicavs mraval nivTierebas, romelic erTi mxriv icavs bavSvs
mravali infeqciuri, arainfeqciuri da alergiuli daavadebisagan, xolo
meore mxriv xels uwyobs bavSvis imunuri sistemis momwifebas.

cxrili 4

qalis rZis zogierTi damcvelobiTi nivTiereba da misi efeqti

faqtori
sekretoruli A
imunoglobulini (SIg A)
laqtoferini
lizocimi
bifidum–faqtori
makrofagi
limfociti
komplementi
interferoni
oligosaqaridi
B12 da foliumis
damakavSirebeli cilebi
antistafilokokuri
faqtori
antilambliuri faqtori
zrdis faqtorebi
antioqsidanti
imunoglobulinebi
α2- makroglobulini
araqidonis mJava, omega 3,6
cximovani mJavebi
antioqsidantebi
funqcia
icavs nawlavis kedels mis sanaTurSi
arsebuli antigenebis zemoqmedebisagan, axdens
axalSobilis imunuri sistemis stimulacias
konkurencias uwevs baqteriebs rkinis
aTvisebaSi da, aqedan gamomdinare, Trgunavs
maT zrdas
antibaqteriuli fermenti: axorcielebs
mikrobis garsis liziss
xels uwyobs bifidum baqteriebis zrdas
STanTqavs baqteriebs
gamoimuSavebs imunoglobulinebs B
(limfocitebi) da limfokinebs
xels uwyobs baqteriebis liziss
antivirusuli faqtori
ainhibirebs baqteriis dafiqsirebas qsovilis
epiTelze
konkurencias uwevs baqteriebs am vitaminebis
aTvisebaSi da, aqedan gamomdinare, Trgunavs
maT zrdas
antistafilokokuri moqmedebis lipidi
antilambliuri moqmedebis lipidi
nawlavis momwifebis xelSewyoba
icavs Tavisufali radikalebis
zemoqmedebisagan
antibaqteriuli da antivirusuli moqmedeba
antivirusuli moqmedeba
nervuli qsovilis da Tavis tvinis ujreduli
membranis Semadgeneli nawili
icaven qsovilebs Tavisufali radikalebiT
gamowveuli dazianebisagan

rZis produqcia
rZis produqcia da gamoyofa ZiriTadad hipofizis hormonebiT _
prolaqtiniTa da oqsitociniT regulirdeba. ZuZus wovis procesi
astimulirebs orive hormonis gamomuSavebas. Sesabamisad, rac ufro xSirad
wovs bavSvi, miT ufro maRalia hormonebis koncentracia dedis sisxlSi da
miT metia gamomuSavebuli rZis raodenoba.

13
 • prolaqtini xels uwyobs rZis warmoqmnas. prolaqtinis produqcia
gansakuTrebiT maRalia Ramis saTebSi Aamdenad, Ramis kveba
erTerTi mniSvnelovani faqtoria rZis gamomuSavebis II
regulirebisTvis (mtkicebulebis done II) 14,21 .
• oqsitocini ganapirobebs sarZeve jirkvlis kunTovani ujredebis
SekumSvas, rasac Tan sdevs rZis gamoyofa. oqsitocinis done
damokidebulia qalis fsiqologiur mdgomareobazec: bavSvTan
siaxlove, dedis survili ZuZuTi kvebos bavSvi, dadebiTi emociuri
ganwyoba, mSvidi da myudro garemo xels uwyobs oqsitocinis
gamomuSavebas da piriqiT, stresuli situacia, gaRizianeba aferxebs
mas. oqsitocini moqmedebs saSvilosnos kunTovan qsovilzec,
II
Sesabamisad misi maRali done mniSvnelovania saSvilosnos
SekumSvisTvis (mtkicebulebis done II)11,14,21,33.
• inhibitorebi aregulireben rZis sekreciis kontrols da icaven
sarZeve jirkvals Zlieri gadavsebisagan. aRniSnuli nivTierebebi
aqveiTeben rZis gamomuSavebis intensivobas, im SemTxvevaSi, Tu
ZuZuSi rZe didxans rCeba. rZis produqciisTvis gansakuTrebuli II
mniSvneloba sarZeve jirkvlis bolomde daclas eniWeba
(mtkicebulebis done II) 51,52
• dedis mier Warbi siTxis miReba ar axdens gavlenas rZis I
produqciaze (mtkicebulebis done I) 49

rZis produqciis intensivoba da gamomuSavebuli rZis raodenoba

damokidebulia sarZeve jirkvlis daclis sixSireze da ara mxolod dedis
hormonebis doneze (mtkicebulebis done II)44,45,51,52,54.

miuxedavad imisa, rom organizmis orive sarZeve jirkvali erTi da imave

hormonebis moqmedebas eqvemdebareba, rZis raodenoba SesaZlebelia maTSi
gansxvavebuli iyos, rac ganpirobebulia bavSvis mier TiToeuli sarZeve
jirkvlidan gamowovili rZis raodenobiT44,45,46,78.

optimaluri ZuZuTi kvebis principebi

janmos rekomendaciiT optimaluri ZuZuTi kvebis principebia44,45,46:
1. ZuZuTi kvebis adreuli dawyeba da kani kanTan kontaqti;
2. moTxovnilebiTi, xSiri ZuZuTi kveba (RamiT kveba, orive ZuZudan kveba);
3. eqskluziuri ZuZuTi kveba 6 Tvemde;
4. ZuZuTi kvebis gagrZeleba 2 wlamde.

1. ZuZuTi kvebis adreuli dawyeba da kani kanTan kontaqti

janmrTeli, drouli axalSobilis kani kanTan kontaqti dedasTan da
D
ZuZuze pirveli moWideba unda ganxorcieldes dabadebidan pirveli 1
sT-is ganmavlobaSi. kani kanTan kontaqtis xangrZlivoba minimum 30
wuTi unda iyos da sasurvelia gagrZeldes 2 saaTi168,169. kani kanTan kontaqtis
procesSi unda ganxorcieldes pirveli moWideba, mas Semdeg, rac bavSvi
gamoxatavs kvebisTvis mzaobas (rekomendacia - D)44. sakeisro kveTis dros

14
kani kanTan kontaqti tardeba dedis narkozidan sruli gamofxizlebis
Semdeg5.
kani kanTan kontaqti da ZuZuTi kvebis adreuli dawyeba xels uwyobs:
• efeqturi woviTi refleqsebis Camoyalibebas (mtkicebulebis II
done II) 58,59;
• axalSobilis sxeulis normaluri temperaturis SenarCunebas I
(mtkicebulebis done I)56,60,61;
• laqtaciis process (mtkicebulebis done II)14,24,55,62,64;
• oqsitocinis gamomuSavebas, saSvilosnos SekumSvas da qalis II
dacvas mSobiarobis Semdgomi sisxldenisagan (mtkicebulebis
done II)21;
• dedasa da bavSvs Soris mWidro fsiqoemociuri kavSiris II
damyarebas (mtkicebulebis done II)22,23,24,32,63.
ZuZuze pirveli moWidebis dros axalSobili iRebs pirvel rZes – xsens,
romelic maRalkaloriuli nivTierebaa. igi mcire raodenobiT gamoiyofa,
saSualod 30-100 ml pirvel 24 sT-Si, Tumca xSiri kvebis SemTxvevaSi
mTlianad akmayofilebs bavSvis moTxovnilebas sakvebsa da siTxeze. xsenis
moculoba Seesabameba axalSobilis kuWis mcire tevadobas
(mtkicebulebis done II)70. igi advilad mosanelebelia, mdidaria II
Sratis cilebis identuri wvrildispersiuli cilebiT, Seicavs
natriumisa da magniumis marilebs rac xels uwyobs nawlavebis
peristaltikis gaZlierebas da mekoniumis gamoZevebas. xsenis miReba
amcirebs enterohepatul cirkulacias da Sesabamisad aqveiTebs
axalSobilTa siyviTlis ganviTarebis albaTobas (mtkicebulebis II
done II)55,61,65,66. xsenis miReba xels uwyobs metabolur aqtivobas
(mtkicebulebis done I), aregulirebs Saqris dones (mtkicebulebis II
done II)56,61,68,69.
xsenSi didi raodenobiT aris vitaminebi, gansakuTrebiT ki A vitamini da
karotini, rac xels uwyobs mxedvelobis formirebas. xseni mdidaria
bunebrivi antisxeulebiT, imunoglobulinebiT. damcvelobiTi nivTierebebis
maRali Semcvelobis gamo xsenis miRebas pirvel imunizaciasac uwodeben.

rekomendacia:
dabadebidan pirveli erTi saaTis ganmavlobaSi axalSobilisTvis
B
aucileblia xsenis miReba (rekomendacia B)71,72,73,74.
ar aris mizanSewonili prelaqtaciuri sakvebis gamoyeneba.
prelaqtaciuri sakvebi (formula, glukozis xsnari, wyali da sxv.) B
xels uSlis laqtaciis Camoyalibebas da zrdis axalSobilis
inficirebis risks (rekomendacia B)71,72,73,74.

2. moTxovnilebiTi, xSiri ZuZuTi kveba

ZuZuTi kveba unda ganxorcieldes bavSvis moTxovnilebis mixedviT, dedam
bavSvs ZuZu unda miawodos maSinve, rogorc ki igi iwyebs SimSilis niSnebis
gamoxatvas. SimSilis niSnebia11, 43, 44, 45:
• sxvadasxva saxis bgerebi,

15
 • tuCebis cmacuni,
• woviTi moZraoba,
• tirili da sxv.
tirili bavSvis mier SimSilis grZnobis gamoxatvis ukiduresi
C
saSualebaa, sasurvelia bavSvs sakvebi SesTavazon manam, sanam tirils
daiwyebs ( rekomendacia - C)11, 43, 44, 45.
•
kvebis sixSire
axalSobilis kvebis sixSire dRe-Ramis ganmavlobaSi saSualod unda
I, II
Seadgendes 8-12-s (mtkicebulebis done I, II)50,53,54.
rZis gazrdili produqcia da bavSvis Segueba woviT procesebTan iwvevs
kvebis jeradobis Semcirebas. 1-1,5 Tvis asakSi Cvili gamoimuSavebs kvebis
sakuTar rutinul wess da ikvebeba daaxloebiT 7-10-jer dRe-RameSi. kvebaTa
Soris intervali am periodSi ar unda aRematebodes 3 sT-s. Tu bavSvi wonaSi
kargad imatebs da dedasTan ar aris gamoxatuli hipogalaqtiis niSnebi,
xangamoSvebiT, dasaSvebia mxolod erTi 6 sT-iani intervali (sasurvelia
Ramis periodSi).
zogierTi axalSobili SimSilis SemTxvevaSi axangrZlivebs Zilis periodebs,
Tu bavSvi Tavad ar iRviZebs 3 saaTis Semdeg, igi unda gaaRviZon da
kvebon ZuZuTi (mtkicebulebis done III)51,82,83. gaRviZebisTvis SeiZleba III
Semdegi xerxebis gamoyeneba:
_ tansacmlis da safenebis gamocvla;
_ xelSi ayvana;
_ zurgis, muclis an kidurebis msubuqi masaJi.

kvebis xangrZlivoba da miRebuli sakvebis moculoba

Cvili Tavad aregulirebs erT jerze misaRebi sakvebis raodenobas. drouli,
janmrTeli axalSobili da Cvili saSualod wovs 15-30 wT. iSviaT SemTxvevaSi
40 wT81. ar aris mizanSewonili wovis xangrZlivobis SezRudva. kvebis
xangrZlivoba damokidebulia TiToeuli bavSvis individualur Tvisebebze da
mis aqtivobaze.
dadgenilia, rom Tu qalis rZe Seicavs naklebi raodnebiT cxims
I, II
Cvili moTxovnilebis dasakmayofileblad ufro didxans wovs
(mtkicebulebis done I, II)78,79.
kvebis dros bavSvma bolomde unda dacalos erTi sarZeve jirkvali, raTa man
miiRis rogorc wina, ise ukana rZe. Tu bavSvi ver clis bolomde ZuZus,
saWiroa darCenili rZis gamowvela da misi damateba kovziT.
Tu bavSvi mTlianad clis erT ZuZus da ar kmayofildeba, kveba unda
II
gagrZeldes meore sarZeve jirkvlidan. Semdegi kveba iwyeba im ZuZuTi,
romliTac damTavrda wina kveba (mtkicebulebis done II)78,79.

16
rekomendacia:
axalSobilma da Cvilma ZuZu unda wovos, sanam ar dakmayofildeba.
erT kvebaze bavSvi unda ikvebebodes orive ZuZudan. D
Ramis kveba xels uwyobs laqtaciis process (rekomendacia D).

3. eqskluziuri ZuZuTi kveba 6 Tvemde

pirveli 6 Tvis ganmavlobaSi qalis rZe mTlianad akmayofilebs bavSvis
nutriciul moTxovnilebas30.
6 Tvemde bavSvs ar sWirdeba sakvebis, siTxis an wylis damateba.
dadgenilia, rom moTxovnilebiT ZuZuTi kvebaze myof Cvilebs ar I, II
esaWiroebaT wylis damateba cxeli klimatis pirobebSic ki
(mtkicebulebis done I, II)41,80.
6 Tvis Semdeg aucilebelia kvebis racionSi damatebiTi sakvebis Setana.

rekomendacia
pirveli 6 Tvis ganmavlobaSi Cvili unda ikvebebodes mxolod ZuZuTi A
(rekomendacia A)30,44,45,46.
• ar aris rekomendebuli mikroelementebis deficitis Sevsebis mizniT 6
Tvis asakamde damatebiTi sakvebis dawyeba. aucilebelia, dedis dietis
daregulireba da saWiroebis SemTxvevaSi mikroelementebis
medikamenturi formiT daniSvna28,82,86.

4. ZuZuTi kvebis gagrZeleba 2 wlamde

bunebrivi kvebis gagrZeleba rekomendebulia 2 wlis asakamde, 6 Tvidan D
damatebiT sakvebTan erTad (rekomendacia D)44,45,46;
ZuZuTi kvebaze myofi bavSvebi 12-23 Tvis asakSi dedis rZidan iReben maTTvis
aucilebeli energiis 35-40%-s27;
2 wlamde ZuZuTi kveba xels uwyobs bavSvis gonebriv ganviTarebas11,18,19,48,
mozrdil asakSi qronikuli daavadebebisa da simsuqnis ganviTarebis riskis
Semcirebas15,45,46.
ZuZuTi kvebis gadaCveva mizanSewonilia daiwyos 2 wlis asakisTvis,
dedis rZis Canacvleba warmoebs TandaTanobiT, asakis Sesabamisi D
sxvadasxva sakvebis gamoyenebiT (rekomendacia D).

ZuZuTi kvebis teqnika

ZuZuTi kvebis teqnikis dacva uzrunvelyofs laqtaciis normalur
mimdinareobas da zrdis mis xangrZlivobas (mtkicebulebis done II) II
87,88,89.

ZuZuTi kveba wovisa da ylapvis mudmiv koordinacias moiTxovs. kvebis

efeqturoba ganisazRvreba swori moWidebiTa da kvebis poziciiT III
(mtkicebulebis done III)89,90,91.

17
 cxrili 5
swori da araswori moWidebisa da poziciis niSnebi
swori moWidebis da poziciis araswori moWidebis da poziciis
niSnebi niSnebi
bavSvi mTeli sxeuliT bavSvi Semotrialebulia dedisken,
Setrialebulia dedisaken da exeba magram ar exeba mis sxeuls
mis sxeuls
piri farTod aris gaRebuli, tuCis piri mokumulia ise, TiTqos
lorwovani Cans moWidebulia sawovaraze, tuCis
lorwovani ar Cans
loyebi gamoberilia da ar loyebi Cavardnilia da monawileobs
monawileobs wovis aqtSi wovis aqtSi
bavSvis nikapi mibjenilia ZuZuze nikapi ar aris ZuZuze mibjenili

bavSvis piris RruSi dvrilTan bavSvis piris RruSi moTavsebulia

erTad moTavsebulia areolas 2,5 sm mxolod dvrili
bavSvis zeda tuCTan areolas ufro areola kargad Cans orive tuCis gareT
meti nawili Cans, vidre qveda
tuCTan
1-2 woviT aqts moyveba ylapva ismis wklapuni. ylapva moyveba 10-12
woviT moZraobas
bavSvi kmayofilia, da mSvidi bavSvi ukmayofiloa, tiris
deda ar ganicdis tkivils deda grZnobs dvrilis tkivils
dedis xeliT fiqsirebulia bavSvis dedis xeliT fiqsirebulia Txemis
kefa da kiseri midamo
bavSvis Tavi, kiseri da sxeuli erT bavSvis Tavi da sxeuli ar aris erT
xazzea swor xazze, dedisken mitrialebulia
mxolod Tavi

18
rekomendacia:
samedicino personalma dedas unda aswavlos ZuZuze swori moWidebisa
D
da swori poziciis niSnebi: (rekomendacia D, mtkicebulebis done I,
II);
ZuZuze swori moWideba mkveTrad amcirebs dvrilebis dazianebis risks I, II
(mtkicebulebis done I, II)88,91;
ZuZuTi kvebis poza ise unda SeirCes, rom qalic da bavSvic Tavs
komfortulad grZnobdnen81.

A
akvnis pozicia ragbis burTis pozicia

pirvel dReebSi deda ZuZus awovebs mwoliare mdgomareobaSi, ,,gverdze

wolis’’ pozicias xSirad mimarTaven epiziotomiebis, sakeisro kveTis Semdeg
an hipergalaqtiis dros. ZuZuTi kveba SesaZlebelia mjdomare mdgomareobaSic
_ ,,akvnis’’ an ,,ragbis burTis’’ pozicia, aseTi poziciis dros mosaxexebelia
baliSis gamoyeneba. ,,daTvis’’ pozicias iyeneben im SemTxvevaSi Tu bavSvs
xSirad aReniSneba wamoqafeba – kvebis dros dedas bavSvi vertikalurad
uWiravs, aseTi mdgomareoba xels uwyobs kuWis advilad daclas da
wamoqafebis sixSiris Semcirebas.
kvebis dros bavSvi mTeli sxeuliT unda ekvrodes dedas, mibrunebuli iyos
misken, ise rom xedavdes dedis saxes da Tvlebs. Dkvebis procesSi deda ar
unda daiRalos, ar unda daeZabos kunTebi, Sesabamisad iseTi pozicia unda
SearCios, romelSic maqsimalurad moxerxebulad igrZnobs Tavs.

G
gverdze wolis pozicia zurgze wolis pozicia
19
sawovara da boTli
ZuZuTi kvebis dros ar aris mizanSewonili sawovaras da boTlis gamoyeneba,
gansakuTrebiT sawyis etapze, vidre bavSvs kargad ar Camouyalibdeba swori
moWidebis Cveva. vinaidan boTlidan wovis procesSi bavSvi
gansxvavebulad eWideba sawovaras, misi xSiri gamoyenebis SemTxvevaSi D
ki veRar axerxebs ZuZuze swori moWidebis ganxorcielebas (piris
aparatis Sesabamisi kunTebis ganviTarebis Seferexebis gamo), rac
seriozulad aferxebs ZuZuTi kvebis warmatebiT ganxorcielebas
(rekomendacia D)44,45,46.
• boTlidan kvebis gamoyeneba zrdis ZuZuze uaris Tqmis risks I, II
(mtkicebulebis done I, II)8,9.
• sawovaras da satyuaras sistematuri gamoyeneba zrdis ZuZuTi
kvebis problemebis risks (mtkicebulebis done I, A
rekomendacia A )8,9.
• satyuaras sistematuri gamoyeneba zrdis otitis ganviTarebis II
risks (mtkicebulebis done II)8,9.

kvebis koreqcia
intensiuri zrdisa da ganviTarebis gamo bavSvs SesaZlebelia dasWirdes
zogierTi vitaminisa da mineraluri nivTierebis damateba. miuxedavad imisa,
rom qalis rZe saukeTeso sakvebia, sxva mikroelementebsa da vitaminebTan Se-
darebiT xSiria K, D vitaminebis, agreTve rkinis da fToris deficiti.
K vitaminis fiziologiuri deficiti viTardeba sicocxlis pirvel dReebSi,
rac ganpirobebulia qalis rZeSi misi dabali SemcvelobiT, xsenis mcire
rodenobiT da bavSvis organizmis uunarobiT moaxdinos mocemuli vitaminis
sinTezi. aqedan gamomdinare, yvela axalSobils samSobiaro saxlSi eniSneba
K vitamini. (ix. gaidlaini ,,axalSobilis movla samSobiaro saxlSi”), rac
amcirebs axalSobilTa hemoragiuli daavadebis ganviTarebis risks.
D vitaminis aTviseba qalis rZidan sakmaod maRalia, amitom avtorTa
umravlesoba, bunebrivi kvebis dros, D vitaminis deficitis ZiriTad mizezad
Tvlis insolaciis naklebobas.
• SedarebiT naklebi insolaciis pirobebSi, raqitis prevenciis mizniT,
mizanSewonilia 6 Tvis asakamde D vitaminis medikamenturi
III
formis saprofilaqtiko dozis (200-400 se) gamoyeneba
(mtkicebulebis done III)28,82,145.
• rkinis deficiti Cvils SesaZlebelia gamouvlindes wlamde asakSi.
pirveli Tveebis ganmavlobaSi bavSvi moixmars orsulobis bolo
periodSi mis organizmSi deponirebuli rkinis marags. Cveulebriv,
aRniSnuli maragis utilizacia xdeba 4-6 Tvis, xolo paTologiuri
orsulobis da dRenaklulobis SemTxvevaSi 2-3 Tvis asakisTvis, rac
ganapirobebs e.w. fiziologiuri anemiis ganviTarebas. Tu
rkinadeficituri mdgomareoba gamoixateba 6 Tvemde, misi koreqcia
rekomendebulia rkinis preparatebiT da ara sakvebi danamatebiT. 6
Tvis Semdeg mizanSewonilia racionSi rkiniT mdidari produqtebis
gamoyeneba145.

20
ioddeficitis endemur kerebSi SesaZlebelia bavSvis, iseve, rogorc dedis
sakvebs dasWirdes iodis damateba.
fToris deficiti gansakuTrebiT xSiria iseT adgilebSi, sadac ar xdeba
sasmeli wylis fTorireba. mraval qveyanaSi rekomendebulia fToris
minimaluri doziT (0,25 mg/ dRe-RameSi) daniSvna 6 Tvis asakis Semdeg, Tu
sasmeli wyali Seicavs 0,3 mg/l-ze nakleb fTors. amave dros dauSvebelia
misi daniSvna profilaqtikis mizniT, Tu ar aris cnobili sasmel wyalSi
fToris Semcveloba.
kalciumis da fosforis deficitis SemTxvevaSi iniSneba maTi Semcveli
preparatebi.

ZuZuTi kvebis efeqturobis Sefaseba

ZuZuTi kvebis warmatebiT ganxorcielebis erTerT aucilebel pirobas
warmoadgens kvebis efeqturobis Sefaseba, rac aucileblad unda
ganaxorcielos rogorc samSobiaro saxlis, ise pirveladi jandacvis
rgolis samedicino personalma. Sefasebis Sedegebi unda aisaxos D
92
samedicino istoriaSi (rekomendacia D, mtkicebulebis done II, III) .

ZuZuTi kvebis efeqturobis Sefasebis meTodebi

• anamnezis Segroveba (diurezi, defekacia);
• kvebis teqnikis Sefaseba;
• wonis namatis Sefaseba;
• dedis sarZeve jirkvlisa da dvrilis mdgomarobis Sefaseba.

samSobiaro saxli – ZuZuTi kvebaze dakvirveba mizanSewonilia warmoebdes

dRis ganmavlobaSi 1-2-jer. fasdeba kvebis teqnika, bavSvis wona, Sardvis
sixSire, nawlavTa moqmedeba, dedis sarZeve jirkvlis mdgomareoba.
pirveladi jandacvis rgoli - Sefaseba unda ganxorcieldes patronaJis
vizitebis dros. gansakuTrebuli mniSvneloba aqvs pirvel vizits, romlis
drosac gamoiyeneba Sefasebis yvela meTodi. kvebasTan dakavSirebuli
problemebis gamovlenis SemTxvevaSi Sefaseba grZeldeba Semdeg vizitebzec.
Sefasebis Sedegebi unda dafiqsirdes bavSvis samedicino istoriaSi.

1.Aanamnezi
anamnezis Segrovebisas gansakuTrebuli yuradReba eqceva Semdeg maCveneblebs:
• kvebis sixSire (axalSobili unda ikvebebodes 8-12-jer, 6 Tvemde II
Cvili minimimum 7-jer 24 saaTSi) (mtkicebulebis done II)1,150,53,54;
• diurezi – pirvel dReebSi SesaZlebelia gamovlindes Sardvis sixSiris
ufro dabali maCvenebeli fiziologiuri anuriis gamo. sicocxlis
mesame-meoTxe dRidan ki 24 saaTSi minimum 6-jer, rac miTiTebs imaze,
rom bavSvi iRebs sakmarisi raodenobiT rZes. (Tu iyeneben pampers,
Sardvis sixSiris gansazRvrisTvis rekomendeulia bavSvs gaxadon
pampersi da 24 saaTis ganmavlobaSi daiTvalon sveli safenebis
raodenoba)1,92;

21
 • defekaciis sixSire da ganavlis konsistencia – pirveli 48 saaTis
Semdeg sixSire unda iyos 1-3 dRe-RameSi, me-4-5 dRisTvis ganavali xdeba
moyviTalo feris fafisebri konsistenciis1,92;
• axalSobilis qceva – kmayofili da mSvidi yvela kvebis Semdeg;
• kvebis saSualo xangrZlivoba xSirad ar unda aRematebodes 40 wT-s81.

2. kvebis teqnikis Sefaseba

kvebis teqnikis Sefaseba xorcieldeba kvebaze uSualo dakvirvebiT I, II
(mtkicebulebis done I, II).
fasdeba:
• ZuZuze moWideba (swori moWidebis niSnebi);
• pozicia kvebis dros;
• rZis gadmodinebis refleqsi (rZis nakadis intensivobis Sefaseba
dedasTan da bavSvTan).

ZuZuze moWideba (swori moWidebis niSnebi):

_ farTod gaRebuli piri;
_ gadmobrunebuli tuCebi, romlis lorwovani garsi Cans;
_ nikapi ebjineba ZuZus;
_ areolas meti wili Cans bavSvis zeda tuCidan.

kvebis dros swori poziciis niSnebi:

_ bavSvis Tavi da sxeuli erT swor xazzea;
_ bavSvi mTeli sxeuliT mibrunebulia dedisken da ekvris mis sxeuls;
_ deda Tavs komfortulad grZnobs.

rZis gadmodinebis refleqsi (fasdeba rZis nakadis intensivoba)

rZis nakadis intensivobis Sefaseba dedasTan (rekomendacia D )92: D
_ rZis gadmosvlis SegrZneba, romelic ar aris mtkivneuli;
_ mSobiarobis Semdeg pirveli dReebis ganmavlobaSi muclis tkivili,
rac ganpirobebulia saSvilosnos SekumSviT;
_ kvebis dros rZis gadmodineba meore ZuZudan;
_ dedis wyurvilis SegrZneba bavSvis kvebis procesSi;
_ relaqsacia da Zilianoba kvebis Semdeg; II
_ mkerdis darbileba kvebis Semdeg (mtkicebulebis done II);
rZis nakadis intensivobis Sefaseba bavSvTan (rekomendacia D)92
D
_ wovisa da ylapvis xma;
_ 1-2 woviT moZraobas moyveba ylapva;
_ sveli rZiani piri;
_ wovis dros moSvebuli sxuli.

3. wonis Sefaseba (rekomendacia D)92: D

axalSobilisa da Cvilis normaluri wonis maCveneblebia:
• samSobiaro saxlSi wonis danakargi 7-10%-ze naklebi 25,94;
• wonaSi klebis SeCereba sicocxlis mesame dRidan;
• wonaSi matebis dawyeba sicocxlis mexuTe dRidan;

22
 • dabadebis wonis aRdgena sicocxlis me-10-14 dRes;
• me-10-14 dRis Semdeg – wonis saSualo namati
_ minimum 500 g pirvel TveSi;
_ Semdeg 125-250g kviraSi (detaluri informaciisTvis ix.
gaidlaini bavSvis fizikuri ganviTareba).

4. sarZeve jirkvlisa da dvrilis mdgomareoba (rekomendacia D)92: D

fasdeba:
_ naxeTqebis arseboba dvrilze;
_ herpesuli gamonayari dvrilze;
_ dvrilis kandidozuri infeqcia;
_ sarZeve jirkvlis gajirjveba;
_ gamkvrivebuli ubnis arseboba sarZeve jirkvalSi;
_ sarZeve jirkvlis hiperemia.

kvebis Sefaseba SesaZleblobas iZleva dadgindes ZuZuTi kvebis efeqturoba

da droulad moxdes ZuZuTi kvebis problemebis identificireba.
Tu kveba efeqturia, unda gagrZeldes dinamiuri dakvirveba da Catardes
Sesabamisi konsultireba gegmuri vizitis dros.
araefeqtur ZuZuTi kvebaze miuTiTebs Semdegi niSnebis arseboba D
(rekomendacia D)92:
• sicocxlis pirveli 3-4 dRis Semdeg Sardvis sixSire naklebi 6-ze
24 saaTis ganmavlobaSi;
• ar ismis ylapvis xma wovis dros;
• bavSvi mudmivad mSieria da ver kmayofildeba;
• bavSvi iSviaTad tiris, ar iTxovs sakvebs 4-6 saaTis ganmavlobaSi;
• axlSobilebSi kvebaTa sixSire naklebi 8-ze, CvilebSi-7-ze;
• TiTqmis yvela kveba grZeldeba 45 wT-ze didxans;
• gamoxatuli yabzoba, mkvrivi konsistenciis, muqi feris ganavliT;
• wonis namatis SeCereba an normaze mcire namati (normaze mcire
namati SeiZleba gamowveuli iyo jvebis teqnikis darRveviT,
rodesac bavSvi ar clis ZuZus bolomde da iRebs mxolod wina
rZes).

araefeqturi ZuZuTi kvebis dros, saWiroa arsebuli problemis gamovlena,

dedis konsultireba da ganmeorebiTi vizitis dagegmva (2-3 dReSi).
Tu Cvili saerTod ver wovs ZuZus an aReniSneba xSiri Rebineba, aucilebelia
misi dauyovnebliv gadagzavna stacionarSi.

ZuZuTi kvebis ukuCvenebebi da dabrkolebebi

ZuZuTi kvebis ukuCveneba – SeiZleba iyos dedismxrivi da bavSvismxrivi,

absoluturi da droebiTi.

23
ZuZuTi kvebis dedismxrivi ukuCveneba
absoluturi
• Sidsi - Aarsebobs SeZenili imunodeficitis virusis rZiT gadacemis
albaToba. SidsiT daavadebulma dedam ar unda kvebos bavSvi ZuZuTi,
Tu SesaZlebelia usafrTxo alternatiuli sakvebis gamoyeneba. Tu
aseTi SesaZlebloba ar arsebobs SidsiT daavadebuli dedis
rZis gamoyeneba SeiZleba pasterizaciis Semdeg (ix. Tavi ZuZuTi I,II,
kveba da aiv/Sidsi (mtkicebulebis done I,II,III)95,96.
• adamianis T-limfotropul (TLV-1) virusze seropozitiuri deda - aseT
SemTxvevaSi dasaSvebia dedis rZis gamoyeneba, mxolod misi
gayinva-galRobis Semdeg, vinaidan am procesiT xdeba HTLV-1 II
virusis gauvnebelyofa (mtkicebulebis done II) 97,98.

droebiTi
• zogierTi medikamentis miReba - citostatikebiT, radiaqtiuri
preparatebiT Terapiis SemTxvevaSi kveba wydeba manam, sanam dedis
sxeulidan ar moxdeba medikamentis eliminacia
(mtkicebulebis done III)1,100,101. III
• dvrilebis herpesuli dazianeba _ droebiT unda Sewydes kveba
dazianebuli mkerdidan.
• sarZeve jirkvlis abscesi - droebiT unda Sewydes kveba dazianebuli
mkerdidan.
• narkomani deda (mtkicebulebis done III)104. III
tuberkulozis Ria formis dros ukunaCvenebia kontaqti dedasa da bavSvs
Soris, vidre dedas ar Cautardeba mkurnalobis sruli kursi. axalSobils
unda Cautardes imunizacia da profilaqtikuri mkurnaloba. infeqcia
ar gadadis rZiT, amitom bavSvi unda ikvebebodes dedis gamowvelili III
rZiT (mtkicebulebis done III)99.

dedis zogierTi mdgomareoba arasworad iTvleba ZuZuTi kvebis ukuCvenebad.

maT Soris:
• dedis cxeleba;
• B da C hepatiti, citomegalovirusuli infeqcia;
_ Tu deda C hepatitiTaa dainficirebuli, mizanSewonilia Tavi
Seikavos ZuZuTi kvebisagan, Tu aReniSneba dvrilis naxeTqebi da
sisxldena108;
_ Tu deda B hepatitiTaa inficirebuli, axalSobils dabadebidan 12
saaTSi ukeTdeba B hepatitis sawinaaRmdego imunoglobulini da
imunizacia da daculia infeqciisagan da Cveulebrivad
xorcieldeba ZuZuTi kveba.
• dedis virusuli an baqtriuli infeqci;
• Tambaqos moxmareba
_ Tambaqo iwvevs laqtaciis Semcirebas. mweveli qali unda ecados ar
mowios an Seamciros Tambaqos moxmareba orsulobisa da ZuZuTi
kvebis periodSi. magram Tu qali agrZelebs mowevas, misi rZe
mainc saukeTeso sakvebia bavSvisTvis. Ddedam ar mowios, II
rodesac bavSvi xelSi uWiravs (mtkicebulebis done II)103,104;

24
 • alkoholis gamoyeneba dasaSvebia iSviTad, mcire raodenobiT
II
(mtkicebulebis done II)107.

ZuZuTi kvebis bavSvismxrivi ukuCveneba

bavSvis mxriv ZuZuTi kvebis absolutur ukunaCvenebas warmoadgens II, III
sxvadasxva tipis fermentopaTia (mtkicebulebis done II, III) 109:
• fenilketonuria
• galaqtozemia
• leicinuria (nekerCxlis sirofis daavadeba)

rekomendacia:
samedicino personalma unda moaxdinos ZuZuTi kvebis ukuCvenebebis
identificireba, urCios mSoblebs ar ganaxorcielos ZuZuTi kveba da D
SeurCios bavSvs alterantiuli, usafrTxo sakvebi. (rekomendaciis
xarisxi - D) 45

ZuZuTi kvebis dabrkolebas warmoadgens bavSvis zogirTi mdgomareoba II

@(mtkicebulebis done II, III)25,110.
• Rrma dRenakluloba (wovisa da ylapvis refleqsebis ararseboba);
• enis lagami;
• tuCis defeqti – e.w “kurdRlis tuCi”;
• sasis naprali – e.w. “mglis xaxa”.

ZuZus wovis ukuCvenebaa:

• mZime nevrologiuri dazianeba (samSobiaro travma, qalasSiga
sisxlCaqceva);
• mkveTrad gamoxatuli respiraciuli distresi;
• gulis mZime Tandayolili manki.
am dros ukunaCvenebia wova da ara dedis rZe. amitom mizanSewonilia bavSvis
kveba gamowvelili rZiT. kveba Cvenebis mixedviT unda ganxorcieldes kovzis
an zondis saSualebiT (ar SeiZleba boTlidan kveba).

ZuZuTi kvebis marTva problemebis dros

samedicino personals unda SeeZlos ZuZuTi kvebis problemebis drouli

gamovlena da ZuZuTi kvebis swori marTva.
medpersonalis mier ZuZuTi kvebis problemebis dagvianebuli identificireba,
dedis informirebulobis dabali done da problemis marTvis
araswori meTodebis gamoyeneba xSirad ZuZuTi kvebis Sewyvetis mizezi I, II
xdeba (mtkicebulebis done I, II)111,112.

25
brtyeli da Cabrunebuli dvrilebi
definicia
brtyeli dvrili – gadasworebulia da ar scildeba areolas zedapirs.
Cabrunebuli dvrili _ Cazneqilia areolas zedapiridan qvemoT. ganarCeven
araWeSmaritad da WeSmaritad Cabrunebul dvrils.
• araWeSmaritad Cabrunebuli dvrili wevadia, areolas gaRizianebiT da
dvrilis wevadobis varjiSiT igi advilad swordeba da areolas
zemoT amodis. Tu dvrili wevadia, igi ar warmoadgens dabrkolebas
ZuZuTi kvebis ganxorcielebisTvis;
• WeSmaritad Cabrunebuli dvrili ar aris wevadi, areolas gaRizianebiT
da wevadobis varjiSiT ar swordeba, warmoadgens seriozul
dabrkolebas ZuZuTi kvebis ganxorcielebisTvis.

marTva:
brtyeli da araWeSmaritad Cabrunebuli dvrili
aucilebelia
• daxmarebis aRmoCena mSobiarobidan 1 saaTis ganmavlobaSi pirveli
moWidebis dros91;
• dedis darwmuneba, rom igi SeZlebs ZuZuTi kvebis efeqturad
ganxorcielebas, Tu bavSvi sworad moeWideba ZuZus. bavSvi I
eWideba areolas da ara dvrils (mtkicebulebis done I)91;
• ZuZuze moWidebis ganxorcielebamde dvrilis gaRizianeba da win
wamoweva (dvrilis damuSaveba ori an sami TiTiT). am mizniT
SesaZlebelia rZis gamosawveli saSualebebis gamoyeneba (ix. nax.1),
efeqturia wovis procesSi specialuri dvrilis safaris
gamoyeneba; II
• bavSvis ZuZuze swori moWidebis uzrunvelyofa (mtkicebulebis
done II)111,112;
• dedisTvis konsultirebis gaweva da dvrilis wevadobis varjiSis
swavleba;
• dedisTvis bavSvis kvebis sxvadasxva poziciis SerCeva, mag. ”ragbis
burTis” pozicia102;
• saWiroebis SemTxvevaSi bavSvis kveba gamowvelili rZiT finjaniT an
kovziT.

Nnax. 1

26
WeSmaritad Cabrunebuli dvrili
• WeSmaritad Cabrunebuli dvrilis arsebobis dros aucilebelia bavSvis
kveba gamowvelili rZiT, vinaidan bavSvi ver eWideba areolas da ver
gamowovs rZis saWiro raodenobas;
• Tu rZis gamowvela ver xerxdeba bavSvs unda SesTavazon alternatiuli
sakvebi;
brtyeli da Cabrunebuli dvrilebis winaswar damuSaveba da dvrilis
wevadobis varjiSi antenatalur periodSi ar aris rekomendebuli. dvrilis
gaRizianeba iwvevs oqsitocinis gamomuSavebis gaZlierebas da
SesaZloa naadrevi mSobiarobis mizezi gaxdes. (mtkicebulebis done II
II)25.

dvrilis wevadobis varjiSi

dvrilis wevadobis varjiSis ramdenime martivi meTodi arsebobs: varjiSis
dawyebamde TiTebis nazi moZraobiT areolas garSemo xdeba dvrilis
gaRizianeba. Ddeda dvrils kidebs xels saCvenebeli, cera da Sua TiTiT da
win gamoswevs, Semdeg uSvebs xels da dvrili ubrundeba sawyis mdgomareobas.
aseTi moZraoba daaxloebiT 8-10-jer mainc unda Sesruldes dRis
ganmavlobaSi. igive sixSiriT SesaZlebelia meore varjiSis Sesruleba. deda
TiTebs Soris aTavsebs dvrils, odnav win gamoswevs da asrulebs naxevrad
brunviT moZraobas morigeobiT – marjvniv da marcxniv, ise TiTqos fanqars
atrialebs xelSi. varjiSis Sesruleba SesaZlebelia orive sarZeve
jirkvalze erTdroulad an morigeobiT.

sarZeve jirkvlis gamkvriveba

definicia:
sarZeve jirkvlis gamkvriveba ZuZus gajirjveba da SeSupebaa, romlic
ganpirobebulia sarZeve jirkvlis rZiT gadavsebiT, uxSiresad vlindeba
mSobiarobidan pirveli kviris ganmavlobaSi.
mizezebi:
• rZis Warbi produqcia;
I
• ZuZuTi kvebis dagvianebuli dawyeba (mtkicebulebis done I)91;
• bavSvis araswori moWideba (mtkicebulebis done I)91;
I
• iSviaTi, saaTobrivi kveba;
• ZuZus arasruli dacla.

klinikuri simptomebi:
• tkivili, SeSupeba;
• gamkvriveba, simZimis SegrZneba;
• rZis nakadis intensivobis Semcireba;
• iSviaTad temperaturuli reaqcia.

27
marTva
samedicino personalma unda SeZlos:
• dedisTvis bavSvis kvebis swori poziciis SerCeva I
(mtkicebulebis done I)91,93.
• bavSvis xSiri moTxovnilebiTi kvebis uzrunvelyofa I
(mtkicebulebis done I)50,53,54,113;
• kvebis dawyebamde ZuZudan rZis mcire raodenobis gamowvela,
bavSvis ZuZuze ukeT moeWidebis uzrunvelsayofad II
(mtkicebulebis done II) 114,217 ;
• kvebis dawyebamde sarZeve jirkvalze Tbili safenis dadeba (10-15 wT),
kisris midamos da sarZeve jirkvlis msubuqi masaJi (zemodan qvemo
mimarTulebiT, ar aris rekomendebuli masaJis dros areolas
gaRizianeba); kvebis Semdeg sarZeve jirkvalze civi safenis II
gamoyeneba 10-15 wT (mtkicebulebis done II)115,214;
• SesaZlebelia dazianebul sarZeve jirkvalze kombostos safenis
gamoyeneba (mtkicebulebis done I, II)115-117; I,II

profilaqtika
sarZeve jirkvlis gamkvrivebis profilaqtikaa ZuZuTi kvebis adreuli dawyeba,
kvebis Tavisufali reJimi, ZuZus bolomde dacla da swori moWidebis
uzrunvelyofa.

mastiti
definicia
mastiti – sarZeve jirkvalis erTi an ramdenime alveolis da sadinaris
anTeba.

mizezebi:
dadasturebulia mastitis gamomwvevi 2 ZiriTadi mizezi88,118:
• rZis Segubeba
da
• inficireba

rZis Segubebas ganapirobebs:

• sarZeve jirkvlis arasruli dacla;
II
• iSviaTi, saaTobrivi kveba (mtkicebulebis done II)60,90,113;
• ZuZuze araswori moWideba da kvebis dros araswori pozicia
(mtkicebulebis done II)119; II
• kvebis dros tansacmlis an TiTebis zewoliT gamowveuli
sadinris daxSoba;
• rZis nakadis intensivobis Seferxeba stresis, gadaWarbebuli fizikuri
da fsiqologiuri datvirTvis dros.

28
inficireba
dvrilze arsebuli naxeTqebi xSirad xdeba sarZeve jirkvalSi
infeqciis SeWris mizezi60,63. mastitis gamomwvev mikroorganizmebs II
ZiriTadad miekuTvneba (mtkicebulebis done - II)120
• Staphylococcus aureus88,122,123,124,126;
• Escherichia coli21;
• Streptococcus 3,21,88,125,126.

klinikuri simptomebi
• sarZeve jirkvlis romelime ubnis gamkvriveba;
• tkivili;
• SewiTleba;
• dazianebuli ubnis kanis simxurvale;
• temperaturuli reaqcia;
• Semcivneba;
• zogadi sisuste;
• hipogalaqtia.
Semcivneba, temperaturis momateba, zogadi sisuste miuTiTebs infeqciuri
mastitis arsebobaze.

marTva
mkurnalobis ZiriTadi principebia:
• sarZeve jirkvlis dacla;
• saWiroebis SemTxvevaSi antibiotikoTerapia;
• simptomuri Terapia.

rZis SegubebiT gamowveuli mastitis marTva

• xSiri kveba, sarZeve jirkvlis bolomde dacla (mtkicebulebis I,II
done I, II)50,113;
• kvebis swori poziciis SerCeva - sxvadasxva pozicia kvebis dros,
xels uwyobs ZuZus Tanabarzomier daclas32. mizanSewonilia
I,II
SeirCes iseTi pozicia, rom bavSvis nikapi da qveda yba moeqces
dazianebuli ubnis mxares (mtkicebulebis done I, II)91,119;
• kvebis dawyeba janmrTeli mkerdidan, gansakuTrebiT tkivilis
SemTxvevaSi;
• kvebis damTavrebis Semdeg ZuZus gamowvela (mtkicebulebis done I,III
I,III)58.

infeqciuri mastitis marTva

antibiotikoTerapiis dawyeba rekomendebulia63,124,127,128, Tu gamoxatulia
• sarZeve jirkvlis mkveTri SewiTleba,
II
• tkivili (mtkicebulebis done II);
• dvrilze aRiniSneba naxeTqebi, saidanac SesaZlebelia infeqciis SeWra;
• temperaturuli reaqcia da Semcivneba;

29
 • mZime zogadi mdgomareoba (mtkicebulebis done I, II, III)128,129. I,II

antibiotikis SerCeva efuZneba ZiriTadi gamomwvevebis mgrZnobelobas

antibiotiki doza
eriTromicini5,23,36,163,130,132 250-500 mg 6 sT-Si erTxel
amoqsicilini 94,131 250-500 mg 8 sT-Si erTxel
cefaleqsini5,23,36,50,122,163,130,132,136 250-500 mg 6 sT-Si erTxel

antibiotikoTerapiis kursi grZeldeba 7-10 dRe, miuxedevad imisa, rom erT an

or dReSi mdgomareoba SeiZleba gaumjobesdes. Tu antibiotikoTerapia
tardeba moklevadiani kursiT maRalia mastitis klinikuri niSnebis
ganmeorebis riski32. Tu antibiotikebis miRebidan 2 dReSi mdgomareoba ar
gaumjobesda, unda gamoiricxos abscesis arseboba.

simptomuri mkurnaloba
• paracetamoli - yovel 6 sT-Si erTxel maRali temperaturisa I,II
da tkivilis gayuCebis mizniT (mtkicebulebis done I, II)
• ibuprofeni, rogorc tkivilgamayuCebeli, ise anTebis saawinaRmdego
saSualeba (dauSvebelia sxva anTebis sawinaaRmdego preparatebis
gamoyeneba)

problemis efeqturi marTvis aucilebeli komponentebia:

• dedis Tavisufali tansacmlis gamoyeneba;
• kvebis an gamowvelis win ZuZus dazianebul ubanze Tbili
safenis dadeba 10-15 wT 32,131,135 . Tbili safenis gamoyeneba Aar aris II
rekomendebuli, Tu rZe Tavisuflad modis (mtkicebulebis done
II)127;
• kvebis damTavrebis Semdeg grili safenis gamoyeneba tkivilis
Semcirebis mizniT. dazianebul sarZeve jirkvalze dasaSvebia I,II
kombostos safenis dadeba (mtkicebulebis done I, II)117,127;
• kvebis dros dazianebuli ubnis msubuqi masaJi, zemodan qvemo
mimarTulebiT. ar aris rekomendebuli masaJis dros areolas
gaRizianeba130,135.

rekomendacia32,131:
aucilebelia infeqciuri mastitis diferencireba abscesisagan, romlis
klinikuri niSnebi infeqciuri mastitis identuria. abscesis damadasturebel
indikatorad gamoiyeneba bambis an saSrobi qaRaldis zedapirze darCenili
yviTeli laqa, gamowvelili rZis dawveTebis Semdeg. abscesi warmoadgens
ZuZuTi kvebis droebiT ukuCvenebas. abscesis SemTxvevaSi aucilebelia
referali qirurgTan abscesis drenireba da antibiotikoTerapia.

30
mastitis profilaqtika
• ZuZuTi kvebis adreuli dawyeba;
• kvebis Tavisufali reJimi;
• ZuZus bolomde dacla;
• swori moWidebis uzrunvelyofa.

dvrilis anTeba, naxeTqi

definicia
dvrilis naxeTqi areolas da dvrilis kanis zedapiris mTlianobis
darRvevaa, romelic uxSiresad vlindeba mSobiarobidan pirveli kviris
ganmavlobaSi da seriozul problemas qmnis ZuZuTi kvebis
ganxorcielebisTvis.
ZuZuTi kvebis dawyebis pirvel dReebSi dedebis umravlesobas
aReniSneba dvrilis susti tkivili, romelic ar aris dakavSirebuli II
naxeTqis arsebobasTan (mtkicebulebis done II)91.

mizezebi:
• bavSvis ZuZuze araswori moWideba91 (mtkicebulebis done I);
I
• dedis mWidro tansacmeli sarZeve jirkvlis midamoSi;
• antiseptikuri xsnarebis da malamoebis gamoyeneba dvrilisa da
areolas damuSavebis mizniT;
• sapnis xSiri gamoyeneba dvrilisa da areolas damuSavebis mizniT
(yvela kvebis win);
• dvrilisa da bavSvis piris Rrus kandidozuri infeqcia
91,120 II
(mtkicebulebis done II) .

klinikuri niSnebi
• dvrilisa da areolas zedapiris mTlianobis darRveva;
• sixldena naxeTqidan;
• tkivili.

marTva:
• ZuZuze swori moWidebis uzrunvelyofa (mtkicebulebis done II); II
• bavSvis swor poziaciaSi kveba (mtkicebulebis done II)119;
• antiseptikuri xsnarebis, losionebis da malamoebis gamoyenebis II
SezRudva (mtkicebulebis done II);
• sapnis gamoyeneba mxolod zogadi higienuri abazanis dros
(mtkicebulebis done III)137; III
• galaqtoreis SemTxvevaSi rZis mimRebis (xufi) xmareba
(mtkicebulebis done II) ;137

• kvebis Semdeg dvrilsa da areolaze gamowvelili rZis wasma da misi

haerze SeSroba;
II
• Tbili wylis an Cais kompresis gamoyeneba dvrilze tkivilis
Sesamcireblad (mtkicebulebis done II)137;

31
 • profilaqtikis an mkurnalobis mizniT ar aris rekomendebuli sarZeve
jirkvalze malamoebis, sapnis, spirtis da sxva antiseptikuri
xsnarebis gamoyeneba (rekomdenacia D)25. D

rZiana da dvrilis kandidozuri infeqcia

definicia
rZiana da dvrilis kandidozuri infeqcia gamowveulia candida-s mikrobiT da
Serwymulia bavSvis piris lorwovanis kandidozur infeqciasTan (rZiana).

simptomebi120
dedasTan dakavSirebuli
• dvrilisa da areolas kanis zedapiris SewiTleba, priali, mTlianobis
darRveva;
• dvrilis qavili, tkivili.

bavSvTan dakavSirebuli
• TeTri feris nadebi piris, loyebis, enis lorwovan garsebze;
• Wirveuloba;
• ZuZuze uaris Tqma.

marTva
dedis mkurnaloba
• dvrilebis damuSaveba gencianvioletis 0,5%-iani xsnariT, dReSi 2-jer
daavadebis niSnebis gaqrobamde;
• daavadebis siptomebis gaqrobis Semdeg dRegamoSvebiT 6-7 dRis
ganmavlobaSi;
• dvrilis damuSaveba nistatinis malamoTi 100.000/g dReSi oTxjer ZuZuTi
kvebis Semdeg. malamos gamoyeneba mizanSewonilia gagrZeldes
daavadebis niSnebis gaqrobidan kidev 7 dRis ganmavlobaSi44,45,46 .

bavSvis mkurnaloba
• piris damuSaveba 0,25%-ian gencianvioletis xsnariT dReSi 2-jer 5 dRis
(aranakleb 3 dRis) ganmavlobaSi;
• 100.000/g nistatinis suspenziis pirSi CawveTeba 1 ml. odenobiT oTxjer
dReSi Wamis Semdeg 7-10 dRe.

rekomendacia:
profilaqtikis mizniT aucilebelia dedasTan da bavSvTan higienis wesebis
dacva, unda Sewydes satyuaras, sawovrebis da dvrilis xufebis
gamoyeneba44,45,46.
'
32
hipogalaqtia
definicia
hipogalaqtia rZis naklebobaa, ganarCeven “WeSmarit” da “cru” hipogalaqtias.
• “cru” hipogalaqtia uxSiresad vlindeba sicocxlis me-3-4 dRes, me-3-4
kviras da me-3-4 Tves, egreTwodebul “kritikuli periodebSi’’, rodesac
bavSvis moTxovnileba sakvebze izrdeba, rac ganpirobebulia misi
asakisa da wonis matebiT. am periodSi bavSvi iwyebs SedarebiT xSir
kvebas, rac dedas uqmnis rZis naklebobis STabeWdilebas. kritikul
periodebSi bavSvis xSiri kveba ZuZuTi kvebis gaxangrZlivebis
aucilebeli pirobaa (mtkicebulebis done II, III). am dros ar II,III
aris rekomdenebuli sakvebis Semateba.
• ,,WeSmariti’’ hipogalaqtia - gamoxatulia rZis naklebobis sarwmuno
niSnebi.

WeSmariti hipogalaqtiis mizezebi (mtkicebulebis done I)91:

• kvebis dagvianebuli dawyeba; I
• iSviaTi, xanmokle an saaTobrivi ZuZuTi kveba;
• ZuZuze araswori moWideba da araswori pozicia;
• boTlidan kveba;
• enis mokle lagami;
• dedis fsiqologiuri faqtori - rwmenis ukmarisoba, stresi, gadaRla;
• dedaze zogierTi mavne faqtoris gavlena – alkoholi, moweva, Casaxvis
sawinaaRmdego abebi, diuretikebi, Zlieri gamofitva.

klinikuri niSnebi
sarwmuno niSnebi
• mcire raodenobiT koncentrirebuli Sardis gamoyofa (Sardva 6-jer-ze
naklebi 24 sT);
• wonis mcire namati (500 g-ze naklebi TveSi, an 125 g-ze naklebi I,II
kviraSi) (mtkicebulebis done I, II)68,135;
• gaiSviaTebuli nawlavTa moqmedeba, muqi feris, mkvrivi
konsistenciis ganavliT (mtkicebulebis done I, II)32. I,II

arasarwmuno niSnebi
• bavSvi ver kmayofildeba kvebis Semdeg, xSirad iTxovs ZuZus da tiris;
• bavSvi uars ambobs ZuZuze;
• gamowvelisas rZe ar gamodis.

marTva
samedicino personalma problemis marTvamde unda daadginos hipogalaqtia
WeSmaritia, Tu araWeSmariti. gaarkvios rZis naklebobis SesaZlo mizezi.
rekomendebulia kvebis efeqturobis Sefasebis meTodebis gamoyeneba
gamoyeneba (ix. kvebis efeqturobis Sefaseba).

marTvis ZiriTadi principebi:

III
• xSiri ZuZuTi kvebis uzrunvelyofa (8-12 jer 24 sT-Si),
(mtkicebulebis done III)29,32:

33
 • sarZeve jirkvlis bolomde dacla; sarZeve jirkvlis II,III
gamowvela yvela kvebis Semdeg, gamowvelili rZiT bavSvis kveba
kovziT an WiqiT (mtkicebulebis done II, III)50; K
• periodulad (dReSi ramdenjerme) kani kanTan kontaqtis
ganxorcieleba (rekomendacia B ); B
• RamiT kvebis ZuZuTi kvebis uzrunvelyofa (rekomendacia B);
• kvebis swori poziciis SerCeva (mtkicebulebis done I)91;
• dedis racionaluri kvebis uzrunvelyofa, siTxeebis miReba
moTxovnilebis Sesabamisad, gaZlierebuli wyurvilis grZnobis
dasakmayofileblad. siTxis miReba dasaSvebia bavSvis kvebis
procesSic (mtkicebulebis done I)49; I
• dedisTvis stresuli situaciis Tavis arideba, xSiri dasveneba.

rZis “momyvani” saSualebebis gamoyenebas ar aqvs gavlena rZis produqciaze

(rekomendacia B). Tu deda darwmunebulia “rZis momyvani”
saSualebebis efeqturobaSi da mocemuli saSualeba usafrTxoa, B
mizanSewonilia misi gamoyeneba dedis dadebiTi fsiqologiuri
ganwyobis Camosayalibeblad.
WeSmariti hipogalaqtiis SemTxvevaSi, SesaZlebelia saWiro gaxdes
alternatiuli sakvebis droebiT Semateba laqtaciis aRdgenamde. Tu marTvis
yvela meTodis gamoyenebis Sedegad ver xerxdeba laqtaciis aRdgena,
mizanSewonilia bavSvis Sereul kvebaze gadayvana.

Sesamatebeli sakvebi - donoris rZe da xelovnuri formula130,131

mtkicebulebaTa umetesobis mixedviT ar arsebobs mniSvnelovani gansxvaveba
dedis rZesa da donoris rZes Soris, Sesabamisad Sesamatebel sakvebad
saWiroebis SemTxvevaSi SeiZleba donoris rZis gamoyeneba
B
usafrTxoebis zomebis gaTvaliswinebis Semdeg (rekomendacia B)130,131.
donoris SerCevisas saWiroa Semdegi pincipebis dacva130,131:
• daavadebaTa gadacemis Tavidan acilebis mizniT, donorma unda
B
gaiaros sisxlis testireba aiv da HTLV I da II virusebze
(rekomendacia B);
• rZis Cabarebisas donors ar unda hqondes miRebuli 150-200 ml
D
kofeinis Semcveli siTxe dRis ganmavlobaSi sam jerze metad
(rekomendacia D);
• Tu donoris rZe ar aris Semowmebuli, misi gamoyeneba SeiZleba
mxolod pasterizaciis Semdeg.
xelovnuri formula – rekomendebulia bavSvis asakis Sesabamisi
adaptirebuli narevis gamoyeneba.

sakvebis Sematebis teqnika

• yvela kvebis dros bavSvma unda dacalos orive sarZeve jirkvali da
mxolod amis Semdeg unda miiRos Sesamatebeli sakvebi kovziT an
WiqiT. Tavdapirvelad Sesamatebeli sakvebi eZleva mxolod erT

34
 kvebaze mcire raodenoboT (30 ml), Semdeg TandaTanobiT xdeba
raodenobis gazrda da Semateba yvela kvebaze;
• Sesamatebeli sakvebis raodenobas gansazRvravs Tavad bavSvi;
• ar aris rekomendebuli erTi kvebis mTlianad Sesamatebeli sakvebiT
Canacvleba, radgan es amcirebs ZuZuTi kvebis sixSiresa da Sesabamisad
laqtacias.

ZuZuze Tavis danebeba

ZuZuTi kveba unda gagrZeldes 2 wlamde. ZuZuTi kvebaze Tavis danebeba
SeiZleba iyos103:
• bunebrivi – bavSvi Tavad anebebs Tavs ZuZus wovas, ZuZuTi kvebis
jeradobis TandaTan SemcirebiT, damatebiTi sakvebis
moculobisa da kvebis sixSiris matebis paralelurad (12-24 Tve) A
(rekomendacia A, mtkicebulebis done III);
• dagegmili _ ZuZuTi kvebis Sewyveta xdeba dedis gadawyvetilebiT,
bavSvis survilisa da ZuZuze Tavis danebebis mzaobis gaTvaliswinebis
gareSe;
• uecari _ gansakuTrebuli mizezis gamo, romelic ar aris
dakavSirebuli dedis survilTan.

ZuZuTi kvebis uecari Sewyveta

ZuZuTi kvebis uecarma Sewyvetam SeiZleba gamoiwvios garkveuli problemebi
da diskomforti, rogorc dedasTan, ise bavSvTan. problemebis gamovlenis
albaToba miT ufro maRalia, rac ufo mcire asakisaa bavSvi da aqtiuria
laqtacia.
ZiriTadi problemebia:D
• dedis sarZeve jirkvlis gamkvriveba
• dedis mastiti an sarZeve jirkvlis abscesi
• dedis da bavSvis fsiqologiuri problemebi

marTva
rekomendebulia103
• rZis gamowvela sarZeve jirkvlis gadavsebis SemTxvevaSi;
• sarZeve jirkvalze civi safenis da kombostos furclis dadeba
gamowvelis Semdeg;
• sarZeve jirkvlis masaJi;
• tkivilgamayuCebeli saSualebebis gamoyeneba;
• Tavisufali konfortuli tansacmlis gamoyeneba.
ar aris rekomendebuli sarZeve jirkvlis gakvra, vinaidan arsebobs sadinaris
daxSobisa da momavalSi sarZeve jirkvlis paTologiebis ganviTarebis
albaToba103.

35
ZuZuTi kvebis Ddagegmili Sewyveta103
rekomendebulia
• kvebis dros bavSvTan urTierTobis minimumamde Semcireba;
• kvebaTa SorisD bavSvis damSvideba da xSiri mofereba;
• ZuZuTi kveba Rrma Zilis periodSi, an roca bavSvi axali gaRviZebulia;
• kvebis poziciis xSiri cvla da bavSvis kvebisTvis sxvadasxva adgilis,
maT Soris sxvadasxva oTaxis SerCeva, kvebasTan dakavSirebuli
refleqsebis SesustebisaTvis;
• ZuZuTi kvebis alternatiuli sakvebiT TandaTan Canacvleba.
ZuZuze Tavis danebebis mizniT ar aris rekomendebuli bavSvis ,,SimSili” da
dedis da bavSvis erTmaneTisgan daSoreba.

rekomendacia:
samedicino personalma unda gamoarkvios ZuZus Sewyvetis mizezi, Tu
arsebobs ZuZuTi kvebis SenarCunebis realuri SesaZlebloba dedas
gauwios Sesabamisi konsultacia ZuZuTi kvebis or wlamde A
gaxangrZlivebis da ZuZuTi kvebis bunebrivi gziT Sewyvetis Taobaze
(rekomendacia A).

gamowvelili rZis Senaxva

usafrTxoebis mizniT aucilebelia gamowvelili rZis Senaxvis principebis
dacva:
• rZe inaxeba 25 0C-ze 3-4 saaTis ganmavlobaSi.
• rZe inaxeba 4 0C-ze macivarSi 48 saaTis ganmavlobaSi.
rZis gaTboba SeiZleba Tbil wylian WurWelSi. dauSvebelia rZis gaTboba
mikrotalRovan RumelSi an misi aduReba (rekomendacia D).
D
dauSvebelia narCeni rZis kvlav macivarSi Senaxva da gamoyeneba.

meZuZuri dedis kveba

bunebrivi kvebis efeqturoba damokidebulia meZuZuri qalis janmrTelobis
mdgomareobaze da kvebiT statusze. dedis kveba mniSvnelovan gavlenas ar
axdens rZis ZiriTadi ingredientebis (cila, cximi, naxSirwyali)
Semcvelobaze, Tumca moqmedebs garkveuli vitaminebisa da mikroelementebis
koncentraciaze47 (ix. cxrili 2). dedis kvebis deficiti pirvel rigSi
aisaxeba mis janmrTelobis mdgomareobaze.
meZuZuri dedis dRiuri energetikuli moTxovnileba 500 kkal-iT metia (mag.:
damatebiT 2 Wiqa mawoni) orsulobamdel periodTan SedarebiT.
meZuZurma qalma unda miiRos mravalferovani sakvebi da siTxeebi A
moTxovnilebis mixedviT (rekomendacia A). dedis mier Warbi siTxis
miReba ar axdens gavlenas rZis produqciaze (mtkicebulebis done II)28,49;
dedam yoveldRiurad unda miiRos sakvebis erTi saxeoba mainc sakvebi
produqtis yvela jgufidan43,44,45:
_ naxSirwylebiT mdidari - puri da marcvleuli,

36
 _ vitaminebiT mdidari - xili da bostneuli,
_ ciliT, rkiniT da kalciumiT mdidari - xorci da rZis produqti,
_ cximebi – mcenareuli da cxoveluri, upiratesoba eniWeba
mcenareul cxims.
ioddeficitis zonaSi rekomendebulia sakvebSi iodiani marilis gamoyeneba.

meZuZuri dedisTvis ar aris rekomendebuli:

• alkoholuri sasmeli (maT Soris ludi) _ advilad gadadis rZeSi. ar
aris sabolood gansazRvruli minimaluri raodenoba, romelic ar
iwvevs bavSvis janmrTelobis problemebs (mtkicebulebis done III
III)32,107;
• didi raodenobiT kofeinis Semcveli (muqi Cai, yava, koka-kola) da ga-
ziani sasmelebi;
• zedmetad mlaSe da cxare sakvebi, umi xaxvi da niori, saneleblebi _
cvlis rZis suns da gemos, rac xSir SemTxvevaSi ZuZuze uaris Tqmis
mizezia;
• Tambaqo _ iwvevs laqtaciis Semcirebas103,104.
• Sebolili sakvebi.
iSviaT SemTxvevaSi saWiro xdeba dedis kvebis racionidan im sakvebis
droebiT amoReba, romelic Cvils problemebs uqmnis (kolika, alergia
da sxv) (rekomendacia B, mtkicebulebis done II, III). Tu bavSvs B
uvlindeba alergia, mizanSewonilia dedam Tavi Seikavos Semdegi
produqtis gamoyenebisagan: Txili, nigozi, miwis Txili, kvercxi, Zroxis rZe,
Tevzi, citrusebi11,12.
samedicino personalma unda gaiTvaliswinos, rom im SemTxvevaSic, ki roca
qalis kveba ar aris racionaluri, dedis rZis Semadgenloba mniSvnelovnad
ar icvleba da igi mainc saukeTesi sakvebia bavSvisTvis. kvebis deficitis
SemTxvevaSi dedasTan rekomendebulia vitaminebis da sakvebi danamatebis
gamoyeneba.

medikamenturi Terapia da laqtacia166,167

ZuZuTi kvebis dros dedis mier miRebuli samkurnalo preparatebis
umravlesoba xvdeba qalis rZeSi da zogierTma maTganma SeiZleba gverdiTi
movlenebi gamoiwvios. Sesabamisad medikamentis daniSvnamde aucilebelia
wamlis moqmedebis meqanizmis gacnoba. Tu medikamenti ukunaCvenebia laqtaciis
dros, saWiroa alternatiuli preparatis SerCeva. gamonaklis SemTxvevebSi
SesaZlebelia saWiro gaxdes ZuZuTi kvebis Sewyveta. prepatatebi laqtaciis
periodSi gamoyenebis mixedviT SesaZlebelia daiyos 4 jgufad: I - usafrTxo,
II - SesaZlebelia gamoyeneba, Tumca iSviaTad aRiniSneba gverdiTi efeqti, III
- potenciurad saSiSi; IV - winaaRmdegnaCvenebi.
laqtaciis periodSi medikamentis gamoyenebisas aucilebelia:
• medikamentis usafrTxoebaSi darwmuneba;
• misi daniSvna mxolod aucilebelobis SemTxvevaSi;
• medikamentis SeZlebisdagvarad mcire doziT da xanmokle kursiT
gamoyeneba;
• gaxangrZlivebuli moqmedebis preparatebis gamoyenebisagan Tavis arideba;

37
 • medkamentis miReba bavSvis kvebaTa Soris yvelaze xangrZlivi intervalis,
an uSualod kvebis dros;
• preparatis Secvla, Tu igi bavSvTan iwvevs gverdiT efeqts;
• ZuZuTi kvebis Sewyveta, Tu dedasTan aucilebelia im preparatis daniSvna,
romelic ukunaCvenebia laqtaciis periodSi.
minimumamde unda iyos dayvanili iseTi medikamentebis daniSvna, romlebic
laqtacias amcireben (mag.: estrogenebis Semcveli kontraceptivebi, Tiazidis
Semcveli diuretikebi).

cxrili 6
medikamentebi da laqtacia
IV jgufi - laqtaciis periodSi winaaRmdegnaCvenebi medikamentebi _ mocemuli
medikamentebis gamoyenebis aucileblobis SemTxvevaSi saWiroa ZuZuTi kvebis
Sewyveta

• citostatikebi • oqros marilebi

• radioaqtiuri nivTierebebi • salicilatebi (maRali doziT)
• bromidebi • metronidazoli
• qloramfenikoli; tetraciklini, • iodidebi (topikuri moxmarebis
qinolonis rigis antibiotikebi CaTvliT)
(ciprofloqsacini)
III jgufi - potenciurad saSiSi medikamentebi, romelTa gamoyenebis dros
SesaZlebelia gamovlindes gverdiTi efeqti

• antihistaminurisa da • estrogenis Semcveli

dekongestantis kombinacia * kontraceptivebi *
• atenololi • etosuqsimidi
• benzodiazepinebi • narkotiuli saSualebebi
• klindamicini • nikotini (moweva) *
• rezerpini • Tiazidis jgufis diuretikebi
(gaxangrZlivebuli moqmedebis an
• nitrofuranebi maRali doziT) *
• sulfanilamidebi • piroqsikami
• fenobarbitali (antikonvulsiuri
doza)
II jgufi - medikamentebi, romelTa gamoyeneba SesaZlebelia, iSviaTad
aRiniSneba gverdiTi efeqti

• aminoglikozidebi • butirofenonebi (mag.

haloperidoli)
• antiqolinerguli preparatebi
• oraluri dekongestantebi*
• antikonvulsantebi
(fenobarbitalis da etosuqsimidis • flukonazoli
garda)
• H2 histaminoblokatorebi

38
• antihistaminebi • arasteroiduli
anTebissawinaaRmdego saSualebebi
• antituberkulozuri (umjobesia ibuprofeni)
• azaTioprini • metoklopramidi
• barbituratebi (fenobarbitalis • salicilatebi
garda)
• terfenadini
• verapamili
• spironolaqtoni
• tricikluri antidepresantebi
• Tiaziduri diuretikebi, xanmokle
• tetraciklini moqmedebis (dabali doza)

I jgufi - medikamentebi, romelTa gamoyeneba usafrTxoa Cveulebrivi

dozirebiT
• paracetamoli • sainhalacio steroidebi da
bronqodilatatorebi
• antacidebi
• magnezia
• cefalosporinebi eriTromicini
• lidokaini
• penicilinebi
• digoqsini
• vankomicini
• Teofilini
• kortikosteroidebi
• prpranooli
• nazaluri dekongestantebi
• mikonazoli, klotrimazoli
• heparini
* es medikamentebi damatebiT iwvevs laqtaciis Semcirebas

ZuZuTi kveba da aiv/Sidsi

bolo 15 wlis ganmavlobaSi mTel msofloiSi SidsiT dainficrebulia 3
milionamde bavSvi, maT Soris 90% SemTxvevaSi dainficireba aRiniSneba
vertikaluri transmiiT dedidan bavSvze.

ZuZuTi kveba da dedidan bavSvze Sidsis gadacemis riski

• bavSvis SidsiT dainficireba SesaZlebelia orsulobis dros,
mSobiarobis procesSi da ZuZuTi kvebis dros140.
• Tu bavSvi imyofeba ZuZuTi kvebaze dedidan bavSvze Sidsis virusis
transmisia Seadgens daaxloebiT 5-20%-s (mtkicebulebis done I,
II)35,124,138,139; I, II
• dedidan bavSvze Sidsis virusis transmiis riski mcirdeba
dedasTan antiretrovirusuli mkurnalobiT, mSobiarobis sakeisro
kveTis meTodis gamoyenebiT da ZuZuTi kvebisgan Tavis SekavebiT.
(rekomednacia - A)138,139; A
• dedis rZiT virusis transmisiis riski ufro maRalia im
SemTxvevaSi, Tu dedis inficireba xdeba laqtaciis periodSi.

39
dedidan bavSvze Sidsis virusis gadacemis riskis Semcireba
• samedicino personalma unda urCios aiv dadebiT dedebs ar
A
kvebon bavSvi ZuZuTi (rekomednacia – A), Tu SesaZlebelia
usafrTxo alternatiuli sakvebis miwodeba. ZuZuTi kveba ar
unda ganxorcieldes, miuxedavad imisa utardeba dedas II
specifiuri mkurnaloba Tu ara (mtkicebulebis done - II)
• avtorTa nawili Tvlis, rom im SemTxvevaSi Tu adekvaturi da usafrTxo
sakvebi ar aris xelmisawvdomi, bavSvi unda ikvebebodes mxolod dedis
rZiT 4-6 Tve damatebiTi sakvebis miRebamde. inficirebis riski naklebia
eqskluziuri ZuZuTi kvebis dros predominantul da parcialur ZuZuTi
kvebasTan SedarebiT. ganviTarebul qveynebSi Sidsi iTvleba ZuZuTi
kvebis absolutur ukuCvenebad.
• Tu deda aiv inficirebulia da ar aqvs usafrTxo da adekvaturi
xelovnuri sakvebis gamoyenebis SesaZlebloba, rekomendebulia dedis
rZis pasterizeba141.142. stacionaris pirobebSi pasterizacia tardeba
62,50C 30 wuTis ganmavlobaSi. Tu ar aris pasterizaciis SesaZlebloba,
saxlis pirobebSi mizanSewonilia dedis rZis wamoduReba, Semdeg
gagrileba da bavSvisTvis miwodeba139.
• saWiroa dedisgan informirebuli Tanxmoba bavSvis kvebis meTodze,
risTvisac mas unda miewodos srulyofili informacia, rogorc ZuZuTi
kvebis sargeblianobis, aseve bunebrivi kvebis dros aiv infeqciis
gadacemis SesaZlo riskis Taobaze.

damatebiTi kveba

pirveli 6 Tvis ganmavlobaSi qalis rZe mTlianad akmayofilebs Cvilis

moTxovnilebas sakvebsa da siTxeze. bavSvis intensiur zrdasTan erTad
izrdeba misi kvebiTi da energetikuli moTxovnileba, ris gamoc aucilebeli
xdeba dedis rZesTan erTad damatebiTi sakvebis miwodeba kvebiTi racionis
ciliT, cximiT, naxSirwyliT, mikroelementebiTa da vitaminebiT Sesavsebad.

definicia
damatebiTi kveba - 6 Tvis Semdeg dedis rZesTan (xelovnur narevTan) erTad
naxevradmyari damatebiTi sakvebis miReba.
damatebiTi sakvebi _ produqti da siTxe, romelic gamoiyeneba Cvili bavSvis
sakvebad 6 Tvidan.

damatebiT sakvebi iyofa or jgufad:

•
I jgufi – gardamavali periodis sakvebi, romelic gamoyeneba 6 Tvidan
1 wlamde78,145. misi saSualebiT xdeba asakobrivi kvebiTi
moTxovnilebebis dakmayofileba, ZuZuTi kvebis TandaTanobiT
Canacvleba da bavSvis ojaxis sakvebTan Segueba.

40
 • II jgufi - sakvebi saerTo (ojaxis) magididan, romelic gamoiyeneba 1
welze meti asakis bavSvis kvebiTi moTxovnilebis
dasakmayofileblad 78,145.

damatebiTi kvebis vadebi

damatebiTi sakvebis dawyebis vadebis gansazRvra emyareba bavSvis mzaobas
miiRos naxevradmyari sakvebi, rac Tavis mxriv dakavSirebulia nerv-kunTovani,
saWmlis momnelebli, Sard-gamomyofi sistemebis momwifebasTan.

nerv-kunTovani sitema47,78,145
4-5 TvisTvis viTardeba ,,ReWvis refleqsi”, bavSvs SeuZlia lukmis
formireba, gadaadgileba da gadaylapva, rac ganpirorbebulia Semdegi
asakobivi TaviseburebebiT (rekomednacia D)78:
D
• qreba sakvebis gadmogdebis refleqsi;
• Cndeba pirveli ReWviTi moZraobebi, izrdeba wovis Zala;
• bavSvs Tavisuflad uWiravs Tavi da amoZravebs kisers;
• iwevs sakvebisken da aRebs pirs, roca Sia.

cxrili 7
kvebasTan dakavSirebuli refleqsebi

asaki/Tve refleqsebi da unarCvevebi

0-6 wova da ylapva
4-7 pirveli ReWviTi moZraobis gaCena, wovis Zalis gazrda.
7-12 tuCebiT kovzis molokva, ReWva, kbeCa, enis gverdiTi moZraoba da
sakvebis kbilebTan gadaadgileba
12-24 brunviTi ReWviTi moZraobebi

saWmlis momnelebeli sistema78,145

sekretoruli funqcia _ 4-5 Tvidan saWmlis momnelebeli fermentebis
sekreciis srulyofa ganapirobebs cilebis, cximebis da naxSirwylebis
srulfasovan monelebasa da Sewovas.
kuWis tevadoba sakmaod mcirea, daaxleoebiT 30 ml/kg, ris gamoc ar aris
mizanSewonili didi moculobis da dabali energetikuli Rirebulebis
sakvebis miwodeba.
kuW-nawlavis barieruli funqcia 6 Tvis asakisTvis srulyofas ganicdis.
kerZod imatebs kuWis mJavianoba, izrdeba lorwovani garsis damcvelobiTi
unari, iwyeba sekretoruli imunoglobulinis (sIgA) gamomuSaveba, Zlierdeba
peristaltika, yalibdeba nawilavis flora. Sesabamisad bavSvis kuW-nawlavis
sistema momwifebulia da mzad aris axali sakvebis misaRebad

41
Sard-gamomyofi sistema
6 TvisTvis bavSvis Tirkmeli momwifebulia, srulfasovnad SeuZlia wylis
SenarCuneba da nivTierebaTa cvlis Sedgad warmoqmnili narCenebis eqskrecia,
amitom 6 Tvemde ar aris mizanSewonili damatebiTi kvebis dawyeba. damatebiTi
kvebis adreuli dawyebisas Cvilis moumwifebeli TirkmelebiT gaZnelebulia
Warbi cxoveluri cilis daSlis produqtebis gamoyofa.

amrigad, bavSvis mzardi kvebiTi moTxovnilebebisa da ganviTarebis

fiziologiuri Taviseburebis gaTvaliswinebiT damatebiTi sakvebis daniSvnis
saukeTeso periodad 6 Tvis asakia miCneuli78,45,46,145.
• janmrTelobis msoflio organizaciis rekomendaciiT bavSvebi
eqskluziur ZuZuTi kvebaze unda imyofebodnen 6 Tvis asakamde I
(mtkicebulebis done I)78,145,155. mkacri samedicino Cvenebebis
arsebobisas, damatebiTi kveba individualurad SesaZlebelia dai-
niSnos 4 Tvidan (araviTar SemTxvevaSi _ 4 Tvemde). damatebiTi kvebis
adreuli dawyebis Cvenebaa: janmrTeli bavSvis masis matebis SeCereba,
bavSvis mudmivi daukmayofilebloba da SimSili ZuZuTi SeuzRudavi
kvebis fonze.

damatebiTi sakvebis naadrevi dawyeba amcirebs laqtacias da zrdis dispef-

siuri movlenebis, diareis, alergiuli daavadebebis, Saqriani diabetis
ganviTarebis da dedis xelaxali daorsulebis risks45,146, 155;
damatebiTi sakvebis dagvianebuli dawyeba xels uSlis saReWi
kunTebis srulfasovan Camoyalibebas da iwvevs: makro da C
mikronutrientebis deficitis ganviTarebas, sakvebis gemos da
struqturis aRqmis unaris Seferxebas (rekomendacia C)55, 78,145,148.

damatebiTi kvebis etapebi78,145

ZuZuTi kvebidan ojaxis sakvebze gadasvla xorcieldeba etapobrivad. bavSvis
sakvebis moculoba da energetikuli Rirebuleba yvela etapze unda
Seesabamebodes mis fiziologiur moTxovnilebas.
I etapi - bavSvi eCveva sakvebis kovzidan miRebas da swavlobs tuCebis
gamoyenebas, piris RruSi sakvebis gadaadgilebas da gadaylapvas. pirveli
damatebiTi sakvebi unda iyos rbili konsistenciis da Seicavdes mxolod erT
ingredients. damatebiTi sakvebi bavSvma unda miiRos mcire raodenobiT erTi-
orjer dRis ganmavlobaSi, ZuZuTi kvebis damTavrebis Semdeg. am periodSi ar
aris rekomendebuli ZuZuTi kvebis mTlianad Canacvleba damatebiTi sakvebiT.
bavSvma aucileblad unda gaagrZelos ZuZuTi kveba igive sixSiriT, rogorc
eqskluziuri ZuZuTi kvebis dros.
II etapi - mas Semdeg, rac bavSvi mieCveva kovzidan kvebas, bavSvs unda
SesTavazon mravalferovani SedarebiT sqeli konsistenciis sakvebi (sqeli
piure da fafa). ZuZuTi kveba kvlav grZeldeba moTxovnilebis mixedviT,
magram misi sixSire ufro naklebia, vidre eqskluziuri ZuZuTi kvebis dros.
bavSvma damatebiTi sakvebi (xili, bostneuli, parkosnebi, xorci) unda miiRos
2-3-jer dReSi.

42
III etapi - bavSvs SeuZlia miiRos ufro sqeli konsistenciis dakepili da
daWyletili sakvebi, rac xels uwyobs ReWvis ganviTarebas. ZuZuTi kveba
grZeldeba moTxovnilebis mixedviT, Tumca igi aRar aris makronutrientebis
ZiriTadi wyaro. 9 Tvis Semdeg bavSvs unda miscen jer damatebiTi sakvebi,
Semdeg ZuZu. unda SesTavazon iseTi sakvebi, romelic SeuZlia xeliT aiRos.
damatebiTi sakvebi eZleva 2-3 jer dReSi, kvebaTa Soris mizanSewonilia
waxemseba (orcxobila, xili da sxva.).
IV etapi - erTi wlis Sedeg bavSvs SeuZlia miiRos sakvebi saerTo magididan.
sakvebi unda iyos kargad gaqnili da dakepili. mozrdilma xeli unda
Seuwyos damoukidebeli kvebis Cvevebis Camoyalibebas. Tumca bavSvi kvebis
dros marto ar unda darCes. ZuZuTi kveba unda gagrZeledes 2 wlamde.

damatebiTi sakvebis Semadgenloba da kvebis teqnika145,146

bavSvi unda ikvebebodes mravalferovani sakvebiT. asakis gaTvaliswinebiT man
yoveldRe unda miiRos produqti sakvebis yvela jgufidan78,145
• xili da bostneuli;
• burRuleuli;
• xorci da rZis produqti;
• cximebi (mcenareuli da cxoveluri) .
kvebiTi moTxovnilebis dakmayofilebas ganapirobebs Semdegi faqtorebi:
• sakvebis energetikuli Rirebuleba - damatebiTi sakvebis daniSvnisas
gaTvaliswinebuli unda iyos misi Semadgenloba da kaloriuloba145.
rekomendebulia sakvebis gamdidreba cximiT;
• sakvebis konsistencia;
• kvebis sixSire.

damatebiTi sakvebis konsistencia145,148

• asakis matebasTan erTad didi mniSvneloba eniWeba SedarebiT mkvrivi
konsistenciis sakvebis miwodebas swori artikulaciisa da metyve-
lebis CamoyalibebisaTvis, kuW-nawlavis traqtis, saReWi
muskulaturis, fermentuli procesebisa da nawlavis motorikis D
gaaqtivebisa da stimulaciisTvis 78
(rekomednacia D) .
• 6 Tvidan 8 Tvemde Cvils SeuZlia miiRos piures tipis, gatarebuli
sakvebi. sakvebi unda iyos homogenuri, 8 Tvidan bavSvma unda miiRos
naxevrad myari da myari sakvebi, 12 Tvis Semdeg bavSvi ukve unda
ikvebebodes ojaxis sakvebiT.
• Tu myari sakvebis gamoyeneba iwyeba 10 Tvis Semdeg an ufro
gvian es zrdis mogvianebiT kvebiTi problemebis ganviTarebis C
risks (rekomendacia C)78,145,148.
•

43
 cxrili 8

sxvadasxva tipis sakvebis daniSvnis vadebi refleqsebsa da unar-CvevebTan

mimarTebaSi
asaki TveebSi refleqsebi-Cvevebi Pproduqtis tipi
0-6 wova da ylapva siTxeebi
4-7 pirveli ReWviTi moZraobis siTxeebi-6 Tvemde, piures tipis
gamoCena, wovis Zalis gazrda sakvebi - 6 Tvidan
7-12 tuCebiT kovzis molokva, ReWva, gaxexili da dakepili
kbeCa, enis gverdiTi moZraoba da produqti, 8-9 Tvidan myari
sakvebis kbilebTan gadaadgileba sakvebi
12-24 brunviTi ReWviTi moZraobebi sakvebi saerTo magididan

damatebiTiKkvebis sixSire145
janmrTelma ZuZuTi kvebaze myofma bavSvma damatebiTi sakvebi unda miiRos
dReSi saSualod:
• 6-8 Tvis asakSi - 2-3 jer;
• 9-11 Tvis asakSi - 3-4 jer;
• 12-24 Tvis asakSi - 4 jer.
damatebiT kvebaTa Soris aucilebelia saaTobrivi reJimis mkacri dacva,
aranakleb 3,5-4 saaTisa. kvebaTa Soris dasaSvebia waxemseba (mag: xil-fafis
miwodeba) 1-2 jer dReSi.

damatebiTi sakvebis daniSvnis vadebi 46,144,149

produqti asaki TveebSi
6 7 8 9-12
xilfafa
bostneulis piure /sufi
marcvleulis fafa

mawoni
kvercxis guli
xorcis piure
yveli (umarilo)
naduRi
puri, orcxobila
mcenareuli zeTi/ karaqi
Tevzi
xaWo
xorcis naxarSi

44
wlamde ar SeiZleba cximis SezRudva, radgan is energiis ZiriTad wyaros
warmoadgens (rekomendacia A)168.
A

• damatebiTi kvebis teqnika47,162:

• bavSvisTvis sakvebi unda momzaddes yoveli kvebis win;
• sakvebis momzadebisas aucilebelia higienuri normebis dacva;
• bavSvis Segueba axal sakvebTan unda moxdes TandaTanobiT. sasurvelia
axali sakvebis pirveli ulufa dRis ganmavlobaSi Seadgendes
saSualod 5-10g (1-2 Cais kovzi) daNNTandaTan gaizardos. damatebiTi
sakvebis minimalur raodenobad miCneulia 4 sufris kovzi (saSualod
80-100g) sakvebi, romelic 9 Tvemde asakis bavSvs eZleva ZuZuTi kvebis
Semdeg, 9 Tvis asakis Semdeg ki ZuZuTi kvebis win;
• marcvleulis fafis damateba iwyeba ugluteno marcvleuliT (wiwbura,
brinji, simindi);
• xilfafis da bostneulis piures dawyebisas Tavdapirvelad iyeneben
erTi saxeobis produqts, romelsac TandaTan emateba gansxvavebuli
xili da bostneuli 1-2 dRiani intervaliT;
• bavSvis kveba unda ganxorcieldes kovziT, romelic xels uwyobs
bavSvis saReWi kunTovani aparatis ganviTarebas.

ar aris rekomendebuli
• bavSvisTvis ori an meti axali sakvebis erTdroulad micema. Semdgomi
axali produqtis gamoyeneba, umjobesia, ramdenime dRiani intervalis
dacviT, mas Semdeg, rac bavSvi iRebs wina damatebiT sakvebis srul
ulufas;
• damatebiTi sakvebis miwodeba boTliT da sawovaraTi;
• bavSvis sakvebisTvis marilis an Saqris damateba;
• 12 Tvis asakamde Zroxis rZis gamoyeneba, radgan igi iwvevs rkinis
Sewovis Seferxebas da anemias46,144,149;
• citrusis da kvercxis cilis 12 Tvis asakamde miwodeba alergiis
ganviTarebis riskis Semcirebis mizniT145;
• Taflis gamoyeneba - wlamde asakSi asocirdeba alergiis,
konservirebuli ki botulizmis ganviTarebis riskTan92.
• Cai - Seicavs didi raodenobiT taninebs da amcirebs rkinisa da sxva
mikroelementebis Sewovas92,143.

erTidan or wlamde asakis bavSvis kveba

1 wlis Semdeg bavSvi agrZelebs intensiur zrda-ganviTarebas, iwyebs aqtiur
moZraobas, siaruls, TamaSs da Sesabamisad meore wlis ganmavlobaSi misi
moTxovnileba energiasa da ZiriTad sakveb nivTierebebze ufro metia, vidre
pirveli wlis bolos47,162.
janmos rekomendaciiT 2 wlis asakamde ojaxis sakvebTan erTad bavSvi unda
iRebdes dedis rZes44,46,145. qalis rZe am periodSi mniSvnelovani kvebiTi
RirebulebiT aRar gamoirCeva, magram 1 wlis Semdeg mis SemadgenlobaSi
izrdeba damcvelobiTi faqtorebis raodenoba. 1-dan 2 wlamde periodSi

45
izrdeba bavSvis garemosTan urTierTobis areali, patara aqtiurad daxoxavs,
xSirad ecema siarulis dros, TamaSobs qviSaSi, pirSi idebs sxvadasxva
sagnebs da saTamaSoebs, rac zrdis bavSvis inficirebis risks. dedis rZis
miReba ki uzrunvelyofs mas damcvelobiTi nivTierebebiT.
aucilebelia cilebze bavSvis asakobrivi moTxovnilebis B
dakmayofileba (rekomendacia B)168.
naxSirwylebi unda Seadgendes sakvebis kaloraJis 40-50%-s
(rekomendacia C)168. C
1-2 wlamde asakis bavSvis energetikuli da nutriciuli moTxovnilebis
uzrunvelsayofad mis dRiur racionSi unda Sediodes sakvebi qvemoT
moyvanili produqtis yvela jgufidan iseTi TanafardobiT, rogorc amas
janmos mier mowodebuli ,,sakvebis piramida’’ warmoadgens. misaRebi sakvebis
raodenoba regulirdeba ulufebis mixedviT.

puri, marcvleuli, brinji da makaroni – 6 ulufa dReSi

erT ulufas Seadgens:
• 1 naWeri puri (30-40 gr)
• 4 patara krekeri
• 1/2 Wiqa fafa (marcvleulis)
• 1/2 Wiqa moxarSuli makaroni
an brinji
bostneuli – 3 ulufa dReSi
erT ulufas Seadgens:
• 1/2 Cais Wiqa moxarSuli bostneuli
• 1/2 Cais Wiqa umi bostneuli
• 1/2 Cais Wiqa bostneulis wveni
xili – 2 ulufa dReSi
erT ulufas Seadgens:
• 1/2 cocxali vaSli an atami
• 1 cali qliavi
• 1/2 Cais Wiqa xilis wveni (arakonservirebuli)
• 1/2 Cais Wiqa daWrili cocxali xili.
rZe da rZis produqti – 4 ulufa dReSi
erT ulufas Seadgens:
• 1/2 Cais Wiqa rZe
• 1 naWeri yveli
• 1/2 Cais Wiqa mawoni
• 1/4-1/3 Cais Wiqa xaWo, naduRi.
xorci, kvercxi da parkosnebi – 2 ulufa dReSi
erT ulufas Seadgens:
• 70 g xorci (qaTami, saqoneli, Tevzi)

46
 • 1/2 Cais Wiqa moxarSuli parkosnebi
• 1 kvercxi.

cximebi (karaqi, erbo, mcenareuli zeTi), tkbileuli da marili

B
2 wlamde bavSvebSi ar SeiZleba cximis raodenobis SezRudva
(rekomendacia B)168. umjobesia bavSvma meti mcenareuli cximi miiRos,
vidre cxoveluri. tkbileuli da marili unda miewodos SezRuduli
raodenobiT.

siTxeebi
• Zroxis rZis miRebuli raodenoba ar unda aRematebodes 2 Wiqas
dReSi;
• xilis wveni – ar unda aRematebodes 1/2 Wiqas;
• wyali –kvebaTa Soris survilis mixedviT.
1-dan 2 wlamde asakis bavSvis kvebis sixSire saSualod 4-5 jeradia,
SeiZleba gamoyenebuli iyos samjeradi ZiriTadi sakvebi 2 waxemsebiT. ZuZuTi
kveba sakmarisia dReSi 1-2-jer, aseTi sixSire srulad uzrunvelyofs bavSvs
damcvelobiTi niTierebebis saWiro raodenobiT.

2 wlamde ar aris rekomendebuli Semdegi sakvebis gamoyeneba:

• tkbili siTxeebi da didi raodebiT xilis wvenebi maTi dabali
energitikuli da nutriciuli Rirebulebis gamo. amave dros isini
aqveiTeben bavSvis madas142,143,145;
• Cai (xSiri gamoyeneba) - Seicavs didi raodenobiT taninebs da amcirebs
rkinisa da sxva mikroelementebis Sewovas92,143;
• am asakSi bavSvs ar unda miawodon iseTi sakvebi, romelic SeiZleba
gadacdes (kenkra, Txili, yurZnis marcvali da a.S.) 78.145.

bavSvze zrunva kvebis dros

bavSvze zrunva kvebis dros miekuTvneba fsiqo-socialuri zrunvis
principebs145,151.
mecnierebi miiCneven, rom damatebiTi kvebis optimaluroba ganisazRvreba ara
mxolod imiT, Tu ras Wams bavSvi, aramed imiTac, Tu sad, rodis, rogor da
vin aWmevs mas145.
• bavSvis kvebis dros ufrosi unda ijdes mis pirispir;
• kvebis dros bavSvis yuradReba ar unda iyos gafantuli, bavSvis kveba
sasurvelia mimdinareobdes mSvidad da auCqareblad, ar aris
mizanSewonili sakvebis daZaleba;
• wlis Semdeg bavSvs esaWiroeba ufrosis daxmareba, roca is cdilobs
damoukideblad Wamas;
• Tu bavSvi xSirad ambobs uars sakvebze, rekomendebulia SesaTavazon
mas sxvadasxva sakvebi;

47
 • erTidan or wlamde asakSi mizanSewonilia bavSvi mieCvios sisufTavis
wesebis dacvas (xelebis dabana kvebis win, kbilebis gawmenda);
• kvebis procesi aris bavSvis swavlis, masTan Tbili urTierTobis da
pirispir kontaqtis damyarebis saukeTeso periodi.

avadmyofi bavSvis kveba

bavSvis avadmyofobis dros didi mniSvneloba aqvs racionaluri kvebis
principebis dacvas, avadmyofi bavSvis fiziologiuri moTxovnilebebis
gaTvaliswinebiT. uxSiresad avadmyofobis dros organizmis moTxovnileba
siTxeebze ufro metia. Sesabamisad, am periodSi rekomendebulia
bavSvis siTxeebiT datvirTva, Tu bavSvi ZuZuzea, mas ZuZu ufro A
xSirad unda SesTavazon (rekomendacia A). A
avadmyofobis dros bavSvisTvis damaxasiaTebelia madis daqveiTeba. Tu bavSvi
ZuZusTan erTad damatebiT sakvebs iRebs an ojaxis sakvebiT ikvebeba, ar aris
rekomendebuli sakvebis daZaleba, sasurvelia damatebiTi sakvebis xSirad da
mcire ulufebiT SeTavazeba. mizanSewonilia bavSvis kvebis sixSire erTi
kvebiT gaizardos.
bavSvma unda miiRos mikroelementebis Semcveli, mravalferovani da advilad
mosanelebeli sakvebi, rac xels uwyobs gamojanmrTelebis process.
avadmyofobis dros ufrosi unda Seecados moamzados iseTi sakvebi, romelic
bavSvs uyvars, an romelsac is xSirad iTxovs27,145.
avadmyofobis Semdeg aucilebelia kvebis sixSiris gazrda,
mikroelementebiTa da energiiT mdidari mravalferovani sakvebis gamoyeneba,
imisTvis, rom bavSvma droulad aRidginos, rogorc wonis, ise kvebiTi
(nutriciuli) danakargi. Sesabamisad ufrosma xeli unda Seuwyos
gamojanmrTebul bavSvs, rom 2 kviris ganmavlobaSi man dReSi erTi kvebiT
meti mainc miiRos, vidre avadmyofobis periodamde iRebda145.
kvebis Sefaseba
kvebis Sefaseba unda ganxorcieldes individualurad (rekomendacia
C
C)169. Ffasdeba:
• kvebiTi anamnezi;
• kvebiTi unar-Cvevebi;
• dieta (kvebis racioni);
• medikamentebis gamoyeneba;
• fizikuri ganviTarebis maCveneblebi - anTropometria;
• laboratoriul kvlevis Sedegebi.
kvebis Sefasebis sixSire ganisazRvreba individualurad da efuZneba
pacientis mdgomareobas, nutriciuli problemis simZimes C
(rekomendacia C)169

konsultireba bavSvis kvebis dros

bavSvis racionaluri kvebis danergvisa da farTod gavrcelebisaTvis
yvelaze efeqtur saSualebas konsultireba warmoadgens. mSobelTa
konsultireba adreuli asakis bavSvis kvebis Sesaxeb unda moicavdes Semdeg

48
sakiTxebs: ZuZuTi kvebis ZiriTadi principebi, damatebiTi kvebis mniSvneloba
da misi daniSvnis vadebi, bavSvis kveba 1 wlis Semdeg.
dadgenilia, rom mSobelTa konsultireba ZuZuTi kvebis sakiTxebze
da konsultirebasTan erTad maTi uzrunvelyofa nabeWdi sainfarmacio I
masaliT, xels uwyobs ZuZuTi kvebis sixSiris 5-10%-iT zrdas
(mtkicebulebis done - I)92, ojaxis sxva wevrebis CarTva ganaTlebis procesSi
xels uwyobs ZuZuTi kvebis xangrZlivobis gazrdas (mtkicebulebis
done - II)145. konsultireba ZuZuTi kvebis sakiTxebze unda daiwyos II
antenatalur periodSi, gagrZeldes samSobiaro saxlSi da patronaJis
vizitebis dros92.
patronaJis vizitebis dros dedas konsultireba unda gaewios aseve
damatebiTi sakvebis mniSvnelobaze da daniSvnis vadebze.

antenatalur periodSi konsultirebis ZiriTad mizans warmoadgens dedis

motivireba, bavSvis kvebis Sesaxeb swori gadawyvetilebis misaRebad.
gansakuTrebuli yuradReba unda daeTmos Semdeg sakiTxebs:
• ZuZuTi kvebis upiratesoba dedisa da bavSvisTvis;
• kani kanTan kontaqti da ZuZuTi kvebis adreuli dawyebis mniSvneloba;
• samSobiaro saxlSi dedisa da bavSvis erTad yofnis mniSvneloba;
• dedis kveba orsulobis periodSi.

konsultaciis sakvanZo rekomendaciebi:

• qalis rZe Cvilis saukeTeso sakvebia, romelic mudmivad icvleba
bavSvis moTxovnilebis Sesabamasad da xels uwyobs mis srulfasovan
ganviTarebas;
• ZuZuTi kveba amcirebs bavSvTa avadobisa da sikvdilobis risks;
• ZuZuTi kveba icavs bavSvs mravali infeqciuri Tu alergiuli
daavadebisagan;
• ZuZuTi kveba amcirebs dedasTan sarZeve jirkvlisa da sakvercxeebis
simsivnuri daavadebebis ganviTarebis risks da icavs qals xelaxali
daorsulebisagan;
• janmrTeli, drouli axalSobilis kani kanTan kontaqti dedasTan da
ZuZuze pirveli moWideba dabadebidan pirveli 1 sT-is ganmavlobaSi
unda ganxorcieldes. kani kanTan kontaqtis xangrZlivoba minimum 30
wuTia, sasurvelia 2 sT gagsZeldes;
• ZuZuTi kvebis adreuli dawyeba (sicocxlis pirvel saaTSi) xels
uwyobs saSvilosnos SekumSvas da icavs qals mSobiarobis Semdgomi
sisxldenisagan. xsenis (pirveli rZe) miReba icavs bavSvs mravali
daavadebisagan. xseni axalSobilis pirvel imunizacias warmoadgens;
• samSobiaro saxlSi dedisa da bavSvis erTad yofna mniSvnelovnad
amcirebs daavadebebis ganviTarebis risks, xels uwyobs
moTxovnilebiTi kvebis, maT Soris Ramis kvebis ganxorcielebas,
dedisa da bavSvis fsiqoemuciur kavSirs;
• dedis racionalur kvebas orsulobis periodSi didi mniSvneloba aqvs
nayofis ganviTarebis xelSewyobisTvis.

49
samSobiaro saxlSi da patronaJis vizitebis dros konsultirebis ZiriTadi
mizania meZuZuri dedis daxmareba, raTa man efeqturad ganaxorcielos
axalSobili da Cvili bavSvis ZuZuTi kveba.Aam periodSi gansakuTrebuli
yuradReba unda daeTmos Semdeg sakiTxebs:
• rZis produqcia;
• optimaluri ZuZuTi kvebis principebi;
• ZuZuTi kvebis teqnika;
• ZuZuTi kvebis problemaTa prevencia;
• meZuZuri dedis kveba;
• bavSvze zrunva kvebis dros;
• kvebis principebi bavSvis avadmyofobis dros.

konsultaciis sakvanZo rekomendaciebi:

• moTxovnilebiTi xSiri ZuZuTi kveba 8-12-jer dRe-RameSi. rZis
produqcia damokidebulia ZuZus wovis sixSireze. rac ufro xSirad
wovs bavSvi da clis ZuZus, miT meti rZe gamomuSavdeba. es moTxovnisa
da miwodebis erTiani sistemaa;
• eqskluziuri ZuZuTi kveba 6 Tvemde, 6 Tvis Semdeg damatebiTi sakvebi;
• ZuZuTi kvebis gagrZeleba 2 wlamde;
• damatebiT sakvebad mravalferovani, axalad momzadebuli
naxevradmyari sakvebis gamoyeneba. mniSvnelovania kvebis racionSi
rkinis da A vitaminis Semcveli sakvebis damateba. 1 wlis Semdeg
saWiroa ojaxis sakvebis miwodeba. sakvebis momzadebisas higienis
wesebis dacva;
• kvebis procesi aris bavSvis swavlis, masTan Tbili urTierTobis da
pirispir kontaqtis damyarebis saukeTeso periodi;
• ZuZuTi kvebis gagrZeleba da sixSiris gazrda bavSvis avadmyofobis
dros. Tu bavSvi 6 Tveze meti asakisaa ZuZusTan erTad saWiroa
damatebiTi siTxeebis miwodeba. avadmyofobis Semdeg aucilebelia 1
damatebiTi kvebis gamoyeneba 2 kviris ganmavlobaSi.

50
 danarTi 1

saqarTvelos kanoni “bavSvTa bunebrivi kvebis dacvisa da xelSewyobis,

xelovnuri sakvebis kontrolirebadi moxmarebis Sesaxeb”

metad mniSvnelovania, samedicino personali icnobdes saqarTvelos kanons

“bavSvTa bunebrivi kvebis dacvisa da xelSewyobis, xelovnuri sakvebis
kontrolirebadi moxmarebis Sesaxeb”, gansakuTrebiT ki mis im nawils,
romelic samedicino dawesebulebebis da personalis ufleba movaleobebs
asaxavs.

T a v i III
samedicino saqmianobis samarTalsubieqtebi
muxli 17.
samedicino saqmianobis samarTalsubieqti movalea daicvas da xeli
Seuwyos Cvili da adreuli asakis bavSvTa bunebriv kvebas.
muxli 18.
orsuli da meZuZuri qalebis, Cvili da adreuli asakis bavSvebis
kvebasTan dakavSirebuli samedicino sakiTxebis mowesrigebis ufleba aqvs
mxolod janmrTelobis dacvis saministros mier dadgenili wesiT
registrirebul, akreditebul da licenzirebul samedicino saqmianobis
samarTalsubieqts.
muxli 19.
samedicino saqmianobis samarTalsubieqts ekrZaleba bavSvTa xelovnuri
kvebisa da sakvebis, sawovriani boTlebisa da satyuarebis nebismieri formiT
reklamireba da propaganda an aseTi qmedebisaTvis xelSewyoba.
muxli 20.
samedicino saqmianobis samarTalsubieqts bavSvTa xelovnuri sakvebi
ufasod an fasdaklebiT samedicino dawesebulebaSi gamosayeneblad an
gasavrceleblad SeiZleba gadaeces mxolod janmrTelobis saministros
werilobiTi TxovniT da werilobiTi nebarTviT, romelSic aRniSnulia
gadasacemi produqtis raodenoba. gamonaklisi daiSveba 21-e muxlSi aRniSnul
SemTxvevebSi.
muxli 21.
oboli da mSoblebis zrunvas moklebul bavSvebis samedicino
dawesebulebas xelovnuri sakvebi ufasod an fasdaklebiT SeiZleba gadaeces
nebismieri raodenobiT janmrTelobis dacvis saministros werilobiTi
Txovnisa da werilobiTi nebarTvis gareSe.
muxli 22.
samedicino saqmianobis samarTalsubieqti, romelic ufasod an
fasdaklebiT gaavrcelebs bavSvTa xelovnur sakvebs me-7 muxlSi aRniSnuli
pirobis Sesabamisad, valdebulia uzrunvelyos SerCeuli kontingentisaTvis
igive pirobebiT xelovnuri sakvebis miwodebis uwyvetoba am ukanasknelis
saWiroebis mTeli drois ganmavlobaSi.
muxli 23.
samedicino saqmianobis samarTalsubieqts ekrZaleba:

51
1. bavSvTa xelovnuri sakvebis mwarmoeblisagan an gasaRebis agentisagan
xelovnuri sakvebis nimuSis, partiis, sxva raime nebismieri sagnis, nivTis an
Tanxis saCuqrad miReba.
2. bavSvTa xelovnuri sakvebis mwarmoeblis da/an gasaRebis agentisaTvis
orsuli qalebis da Cvili da adreuli asakis bavSvebis dedebis vinaobisa
da misamarTis gadacema.
muxli 24.
samedicino dawesebulebaSi dauSvebelia bavSvTa xelovnuri sakvebis,
sawovriani boTlebis, satyuarebis Sesaxeb sareklamo, sainformacio,
saswavlo masalebis gamokvra, xelovnuri sakvebis mwarmoeblebis an gasaRebis
agentebis safirmo an sxva raime niSnebiT, maTi saxelwodebiT,
gamosaxulebebiT Tanxlebuli nivTis an sagnis xmareba an ganTavseba.
muxli 25.
dauSvebelia bavSvTa xelovnuri sakvebis mwarmoeblebis an gasaRebis
agentebis mier samedicino-biologiuri kvlevebis dafinanseba, samedicino
personalis samecniero da praqtikuli (yriloba, konferencia, sesia,
simpoziumi da sxv.) an nebismieri sxva saxis Sexvedris, mivlinebebis,
staJirebis, uwyveti samedicino ganaTlebis, agreTve samedicino asociaciebis
saqmianobis sponsoroba.

gaidlainis gadasinjvisa da ganaxlebis vada – 4 weli

gaidlainis miRebis xerxi/wyaro

gaidlainis SemuSavebis meTodologia
• 2 wlamde asakis bavSvTa bunebrivi kvebis Sesaxeb arsebobs
samecniero mtkicebulebis safuZvelze Seqmnil rekomendaciaTa
sakmarisi raodenoba. mocemuli gaidlainis Seqmnis procesSi
samuSao jgufis gadawyvetilebiT moZiebuli da Sefasebuli iqna
ukve arsebuli praqtikuli rekomendaciebi. moxda arsebuli
rekomendaciebis adaptirebuli variantis SemuSaveba, romelic
erTis mxriv pasuxebs saerTaSoriso moTxovnebs, xolo meore
mxriv iTvaliswinebs saqarTvelos samedicino dawesebulebaTa
rogorc adamianur, ise teqnikur resursebs.
• rekomendaciaTa moZieba xorcieldeboda eleqtronuli monacemTa
bazis gamoyenebiT.
cxrili 2
qveyana da resursis internet-misamarTi
dasaxeleba
aSS
US National Guideline http://www.guideline.gov
Clearinghouse (NGC)
Centers for Disease Control and http://www.phppo.cdc.gov/CDCRecommends/Adv
Prevention (CDC) SearchV.asp
Agency for Healthcare http://www.ahrq.gov/clinic/cpgsix.htm
Research and Quality (AHRQ)

52
 Health Services Technology http://hstat.nlm.nih.gov
Assessment Text (HSTAT) and
National Library of Medicine
(NLM)
Institute of Clinical Systems http://www.icsi.org
Improvement (ICSI)
American Medical Association http://www.ama-assn.org

Canadian Medical Association http://mdm.ca/cpgsnew/cpgs/index.asp

(CMA)
Health Canada – Population and http://www.hc-sc.gc.ca/pphb-dgspsp/dpg_e.html
Public Health Branch (PPHB)
didi britaneTi
National Institute for Clinical http://www.nice.org.uk
Excellence (NICE)
Sheffield Evidence for http://www.shef.ac.uk/seek/guidelines.htm
Effectiveness and Knowledge
(SEEK)
National electronic Library for http://www.nelh.nhs.uk/guidelinesfinder
Health (NeLH)
PRODIGY Clinical Guidance http://www.prodigy.nhs.uk/ClinicalGuidance

Scottish Intercollegiate http://www.sign.ac.uk

Guidelines Network (SIGN)
German Guideline Information http://www.leitlinien.de/english/english/view;
Service (GERGIS)
avstralia
Australian National Health and http://www.health.gov.au/hfs/nhmrc/publicat/cp-
Medical Research Council (NHMRC) home.htm
axali zelandia
New Zealand Guidelines Group http://www.nzgg.org.nz/library.cfm
(NZGG)
mtkicebiTi medicinis http://www.osdm.org
specialistTa
regionTaSorisi
sazogadoeba

klinikuri rekomendaciebis da mtkicebulebebis moZiebis damatebiTi wyaroebi

da meTodebi

• koxreinis biblioTeka - The Cochrane Library 2006, Issue 2,

• amerikis samedicino biblioTekis mier Seqmnil eleqtronul
bibliografiul monacemTa baza - medlaini – MEDLINE

53
publikaciebis CarTvis/gamoricxvis kriteriumebi

• arCeul iqna kvlevebi Semdegi dizainiT: randomizebuli,

kontrolilerabadi, sistemuri mimoxilvebi da meta-analizi,
erTmomentiani, kohortuli kvlevebi.
• rekomendaciis momzadebisas ZiriTadad dadgenili iyo drois 12
wliani SezRudva. Tumca zogjer gamoyenebuli iyo ufro adreuli
publikaciebi, romlebic dResac aqtualuria da safuZvlad udevs
sxva Tanamedrove mtkicebulebebs.
• dadgenili iyo enobrivi SezRudvebi, radganac samuSao jgufs
SesaZlebloba hqonda literaturis wyaroebi Seeswavla mxolod
inglisur da rusul enebze.

moZiebuli klinikuri rekomendaciebisa da mtkicebulebebis analizi

• samuSao jgufis mier tardeboda moZiebuli wyaroebis analizi.

Catarebuli Ziebis Sedegad miRebuli iyo ramdenime klinikuri
meToduri rekomendacia axalSobilTa axalSobilTa bunebrivi kvebis
marTvis sakiTxebze, romlebic Seicavda jgufis miznis Sesaferis
saWiro informacias. am rekomendaciebis Sefasebisas gamoyenebuli iyo
rekomendaciaTa atestaciisa da eqspertizis kiTxvari - AGREE (94,96-98).
Sefasebis Sedegad amorCeuli iyo qvemoT CamoTvlili organizaciebis
gaidlainebi:
⇒ janmrTelobismsoflo organizacia
⇒ amerikis pediatrTa akademia
⇒ kanadis pediatrTa sazogadoeba
⇒ laqtaciis konsultantTa saerTaSoriso asocia (ILKA)
gaTvaliswinebuli iyo bavSvTa kvebis saerTaSoriso qseli (IBFAN)
ZuZuTi kvebis msoflio aliansi (WABA), Baby Milk Action ZuZuTi kvebis
qselis masalebi
samuSao jgufi xelmZRvanelobda saqarTvelos Sromis, janmrTelobisa
da socialuri dacvis saministros mier SemuSavebuli nacionaluri
gaidlainebis gzamkvleviT.
• rekomendaciebis mtkicebulebaTa doneebis gansazRvrisas gamoyenebuli
iyo saqarTvelos Sromis janmrTelobisa da socialuri dacvis
saministros mier mowodebuli mtkicebulebebis donisa da
rekomendaciebis xarisxis sqema.

54
mtkicebulebaTa doneebisa da rekomendaciebis xarisxis sqema

done mtkicebulebis siZlieris xarisxi rekomendaciis xarisxi

done (Muir Gray) (Cook et al)
I Zlieri mtkicebuleba, A eyrdnoba I donis
eyrdnoba minimum erT mtkicebulebas da
sistemur mimoxilvas, Sesabamisad mtkiced
romelic efuZneba swori rekomendebulia
dizainis mqone
randomizebul
kontrolirebad kvleva
II Zlieri mtkicebuleba, B eyrdnoba II donis
eyrdnoba minimum erTi mtkicebulebas da
swori dizainis mqone Sesabamisad mtkiced
randomizebul rekomendebulia
kontrolirebad kvleva
III klinikuri kvleva C eyrdnoba III donis
randomizaciis gareSe, mtkicebulebas SeiZleba
kohortuli da SemTxveva- CaiTvalos Sesabamisad
kontrolis kvlevebi
IV araeqsperimentuli D eyrdnoba IV da V donis
multicentruli kvlevebi mtkicebulebas saWiroebs
konsesuss
Va avtoritetul
profesionalTa mosazreba
Vb klinikuri gamocdileba,
aRwerilobiTi kvlevebi an
eqspertTa angariSi

klinikuri rekomendaciebis piloturi gamocda

samedicino personali, romelic uSualod muSaobs axalSobilTan (SaraSiZis
samedicino centri, axalSobilTa reanimaciis da gadaudebeli daxmarebis
ganyofilebebi, samSobiaro saxli „bibida“, saerTaSoriso organisazacia
IBFAN-is saqarTvelos jgufi arasamTavrobo organizacia „klaritasi“) gaecno
klinikur gaidlains. gaidlainis SemuSavebis procesSi gaTvaliswinebuli iyo
maTi SeniSvnebi da praqtikuli rekomendaciebi.
bunebrivi kvebis xelSewyobis programa saqarTvelos Sromis janmrTelobisa
da socialuri dacvis saministros mier aRiarebulia saxelmwifo programad
da saerTaSoriso organizaciebis - gaeros bavSvTa fondi „UNICEF“, „UMCOR“
WABA, ACTS Georgia finansuri xelSewyobiT inergeba 1996 wlidan. mocemuli
periodis ganmavlobaSi gaumjobesda ZuZuTi kvebis maCveneblebi:
samSobiarodan gamowerili axalSobilTa 90 % imyofeba ZuZuTi kvebaze,
dainerga eqskluziuri ZuZuTi kvebis praqtika, romlis maCvenebelmac gaerosa
bavSvTa fondis da ACTS is mier Catarebuli kvlevis SedegebiT 2005w.
Seadgina 36 %. 1999 wels saqarTvelos parlamentis mier damtkicda
saqarTvelos kanoni “bavSvTa bunebrivi kvebis dacvisa da xelSewyobis,
xelovnuri sakvebis kontrolirebadi moxmarebis Sesaxeb”.
55
alternatiuli gaidlani ar arsebobs

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outcomes associated with 3 compared with 6 month of exclusive breastfeeding. Am J Clin
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3. Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding: a systematic review. Adv Exp
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169. WHO - Managing newborn problems: A guide for doctors, nurses and midwives 2003

avtorTa jgufi

pediatrTa da neontologTa kavSiri `alternativa~

samuSao jgufi:

• Tamar manjaviZe – medicinis doqtori, baksis eqsperti-gare

Semfasebeli, saqarTvelos kanoni “bavSvTa bunebrivi kvebis dacvisa
da xelSewyobis, xelovnuri sakvebis kontrolirebadi moxmarebis
Sesaxeb” – avtori. pediatrTa da neontologTa kavSiri
`alternativa~-s wevri;
• maia xerxeuliZe – medicinis doqtori. Tbilisis saxelmwifo
samedicino universitetis zogadi pediatriis departamentis asistent-
profesori. pediatrTa da neontologTa kavSiri `alternativa~-s
wevri;
• nani yavlaSvili - medicinis doqtori. Tbilisis saxelmwifo
samedicino universitetis zogadi pediatriis departamentis asistent-
profesori. pediatrTa da neontologTa kavSiri `alternativa~-s
wevri;
• eka kandelaki _medicinis doqtori, Tbilisis saxelmwifo samedicino
universitetis zogadi pediatriis departamentis asistent-profesori.
pediatrTa da neontologTa kavSiri `alternativa~-s wevri.

eqsperti:
• qeTevan nemsaZe – medicinis doqtori, profesori, Tbilisis saxelmwifo
samedicino universitetis zogadi pediatriis departamentis ufrosi,
saqarTvelos kanoni “bavSvTa bunebrivi kvebis dacvisa da xelSewyobis,
xelovnuri sakvebis kontrolirebadi moxmarebis Sesaxeb” – avtori
62
• medea beleSaZe _ medicinis doqtori, baksis eqsperti-gare Semfasebeli,
saqarTvelos kanoni “bavSvTa bunebrivi kvebis dacvisa da xelSewyobis,
xelovnuri sakvebis kontrolirebadi moxmarebis Sesaxeb” – avtori

• lela woworia _ saqarTvelos Sromis, janmrTelobisa da socialuri

dacvis saministros jandacvis departamenti;

• Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa da socialuri

dacvis saministros jandacvis departamenti.

63