KUZOZ

KUZOZ (Tetanus), kosashikanak, dardi shakhak, yak nav bemorii nihoyat vaznin. Az zamonhoi qadim malum meboshad. Alomathoi K.-ro bori avval Buqrot (Gippokrat) tavsif kardaast, zero pisari u az hamin bemori favtida bud. Solhoi pesh paydoishi K.-ro ba oseb va zakhm bardoshtan vobasta mekardand. On khususan dar davrahoi jangu khunreziho avj megirift.
Angezandai bemori Clostridium tetani meboshad; daroziash 4 – 8 va barash 0,3 – 0,8 mkm. Angezanda spora hosil mekunad, ki shakli on ba nazorachub monand ast. Sporaho ba tasiri omilhoi khimiyavi va tabii ustuvorand. Onho dar tarkibi najosat, khok va g. solhoi ziyod mahfuz memonand. Sporaho dar sharoiti anaerobioz (dar haror. 37°S), mavjudiyati namii kofi va bakteriyahoi aerobi (stafilokokkho, bakteriyahoi khasbeda va g.) numu yofta, ba shaklhoi nashvi (vegetativi) mubaddal megardand. Cl. tetani harakat mekunad (20 adad qamchinak dorad).
Zahri angezandai K. mansubi ekzotoksinho buda, az tetanospazmin (khosiyati neyrotoksinro dorad) va tetanogemolizin (eritrosithoro hal mekunad) iborat ast. Faoliyati toksin zeri tasiri garmi, rushnoii oftob va ishqorho zud barham mekhurad. Fermenthoi rohi medavu rudaho toksinro tajziya namekunand. Vale vay tavassuti luobpardai ruda jabbida nameshavad, binobar in dar mavridi ba dahon aftodan, bezarar ast.
Angezandai K. dar tabiat farovon ast. Dar rudai hayvonoti alafkhor va odam zindagi mekunad. Tavassuti najosat ba khok guzashta, ba spora tabdil meyobad. Baroi zisti on khususan khoki namnok musoid ast.
Sporaho (goho shaklhoi nashvii angezanda) az khok ba saru libos va badani odam aftoda, dar mavridi andake zakhmdor shudan yo kharosh yoftani pust va luobpardaho boisi sar zadani bemori megardand. K. khususan dar natijai kharoshida shudani pusti poy beshtar ba vuqu mepayvandad. Poi barahna gashtan, ba kafi poy khalidani khor yo yagon chizi tez baroi siroyati angezandahoi K. sharoiti musoid faroham meorand.
Angezandahoi K. asosan az joyhoi zakhmdori pust voridi organizm meshavand. Hususan zakhmhoi chuqur, ki baroi afzoishu ikhroji zahri angezandaho muvofiqand, khavfi kalon dorand.
Zahr tavassuti torhoi asabi kanori va jarayoni khun ba harommagz, magzi darozruya va tashkilai mushabbaki (farmatsiyai retikulyari) tana meravad. Dar natija neyronhoi vasatii kamonhoi reflektorii polisinapsi falaj meshavand. Binobar in junbaho (impulsho) az neyronhoi muharrik (motoneyronho) ba mushakho muttasil va benizom meoyand va boisi hamesha dar holati taranjish budani tonusi mushakhoi skelet megardand. Dar natijai purzur gashtani seli junbahoi markazrav (afferenti), ki ba angezahoi nomakhsus (sado, rushnoi, buy va g.) vobastaand, tashannuj ba vujud meoyad. Gustarish yoftani ravandi bemori ba afzudani hayajoni qishr, sokhtorhoi retikulyarii mayna, illati markazi nafaskashi va hasta (yadro)-i asabi gumroh musoidat mekunad.
Binobar rukh namudani aloimi tashannuj, ki dar navbati khesh tashannujhoi tonusi va kuzoziro taqviyat medihad, asidozi mubodilavi inkishof meyobad. Badi az sar guzarondani K. masuniyat (immunitet) hosil nameshavad. Masuniyati ustuvor faqat dar natijai moyakubi bo anatoksin ba vujud meoyad.
Az sababi tashannuj mumkin ast shikastani ustukhon, khususan ustukhoni sutunmuhra (tetanuskifoz), daridani mushaku payho ba vuqu payvandad.
K. vobasta ba daromadgohi angezaho se khel meshavad: 1) osebi (badi zakhm, jarrohi, tavallud, doru firistodan, sukhtan va barq zadan padid meoyad; 2) iltihobi va zakhmi (yara, kafidani omosho); 3) kriptogeni (daromadgohi angezahoyash nomalum).
Marizi chor davra dorad: nihoni, ogoz, avj va shifoyobi. Davrai nihonii K. 5 – 14 ruz, goho 1 – 4 yo to 30 ruz ast. Alomathoi peshkhabari bemori sardard, purhayajoni, asaboniyat, seraraqi va paridani mushakhoi atrofi yara meboshand. Bisyor vaqt bemori shadid ogoz meyobad. YAke az alomathoi nakhustini K. shakh shudani jog ast (kushodani dahon dushvor megardad). Hamzamon bo in mushakhoi ruy kashish khurda, mariz ba khud qiyofai makhsus – tabassumi giryaolud megirad (tabassumi sardoniki – risus serdonicus); peshoni purchin, dahon boz, kunji labho ovezon ast. Dar ayni zamon alomathoi digar niz paydo meshavand: furu burda natavonistani luqma (binobar kashish khurdani mushakhoi gulu), dardi mushakhoi pasi gardan va g. Mushakho az bolo ba poyon, yane az mushakhoi gardan sar karda to mushakhoi takhtapusht, shikam, dastu poyho meparand. Vobasta ba taranjishi in yo on guruhi mushakho, jismi mariz holati gunogun megirad (tetanus acrobaticus). Binobar tashannuji sakhti mushakhoi takhtapusht sar qafo meravad, mariz dar rui bistar misli kamon qat shuda, faqat ba gardan va kafi poy takya mekunad (opistotonus). Minbad mumkin mushakhoi dastu po va mushakhoi shikam niz kashish khurda, ba monandi chub sakht bigardand. Mariz bardoruzan mekunad, melarzad.
Tashannuj az chand soniya to chand daqiqa davom karda, bemor az holat meravad. Dar mavridi sabuk budani bemori tashannuji mushakho ruze 1 – 2 marotiba, dar lahzahoi vaznin boshad, beist (dar tuli yak soat dahho marotiba) ba vujud meoyad. Hini khuruji tashannuj rui bemorro araqi dona-dona pakhsh mekunad, az chehra osori anduh padid meoyad, rangi ru kabudcha, jism kamonshakl megardad, tarhi mushakhoi gardan, badan va dast baralo namuda meistad. Mariz ba haros aftoda, dandon mekhoyad, az dard nolish mekunad. Tashannuji mushakhoi nafas, rogi ovoz va diafragma nafaskashiro yakbora taboh sokhta, mumkin boisi favti mariz gardad. Dar chunin holatho bemor, odatan, az hush nameravad, ki in shikanjai uro duchand mesozad. SHakhs bekhobi mekashad, doruhoi khobovar tasir namerasonand.
K. 4 daraja dorad: bisyor vaznin (darajai IV); vaznin (darajai III); miyona (darajai II); sabuk (darajai I).
K.-i sabuk khele kam duchor meoyad. Davrai nihonii on ziyoda az 20 ruz ast. Alomathoi marizi badi 5 – 6 ruz padidi meoyand. Davrai nihonii K.-i vazniniash miyona 15 – 20 ruz meboshad. Alomathoi saririi on dar muddati 3 – 5 ruz inkishof meyoband. Goho harorati badan baland meshavad. K.-i vaznin davrai nihonii nisbatan kutoh (7 – 14 ruz) dorad. Alomathoi saririi bemori khele zud, dar zarfi 24 – 48 soat rukh menamoyand. Dar asnoi K.-i nihoyat vaznin davrai nihonii marizi az 7 ruz kam ast. Bemori ba tavri barqoso bo takhikardiyai sakht, takhipnoe, tashannuji sakht va pay dar pay, sianoz, bugishavi ogoz meyobad.
K.-i sari Brunner yo K.-i «bulvari» yake az shaklhoi vaznintarini marizi buda, hangomi on qismhoi boloi maynai darozruya va harommagz (markazi nafaskashi, hastai asabi gumroh va g.) illat meyoband. Bemor dar natijai falaji dil yo nafaskashi mefavtad.
K.-i ginekologi niz khele vaznin ast. Vay badi isqoti gayriqonuni yo dar khona tavallud kardani kudak ba amal meoyad. Oqibati chunin bemoriho, odatan, nokhush meboshad.
K.-i navzodon ham bisyor vaznin surat megirad. Asosan dar natijai siroyat yoftani nof sar mezanad (90 – 100 foizi chunin marizon mefavtand).
Ba orizahoi K. bronkhit, pnevmoniya, ufunat (sepsis), daridani mushakho, kandani pay, shikastanu baromadani ustukhonho, saktai dil, falaji mushaki dil, takhikardiya, gipotoniya, kaj shudani sutunmuhra, falaji asabhoi kosakhonai sar va g. mansuband.
Bahri tashkhisi K. ba nazar giriftani zarbu lat va zakhmhoi peshina niz muhim ast. Az alomathoi mamul ba etibor giriftani hayajonpazirii refleksi, bisyor araq kardan, tabassumi «maskharaomez», shakh shudani jog (trizm) ahamiyati kalon dorand.
Muolijai K. boyad kompleksi boshad: 1) nest kardani angezandaho dar manbahoi avvalini siroyat; 2) bezarar gardondani zahre, ki ba khun aftodaast; 3) tabobati tashannuj; 4) hifz kardani amalhoi asosii baroi hayot muhimmi organizm; 5) peshgirii gipertermiya, asidoz, talafi ob; 6) peshgiri va tabobati orizaho; 7) istemoli khuroki sergizo, nigohubini durust.
Tamomi zakhmu jarohatho boyad durust toza va bezarar gardonda shavand. Bo maqsadi ba organizm kamtar aftodani zahr atrofi zakhmro bo zardobi ziddi kuzoz «suzan zadan» lozim. Amaliyoti jarrohi boyad zeri narkoz guzaronida shavad, to ki ehsosi dard boisi khuruji tashannuj nagardad.
Zahrro dar organizm bo istifoda az zardobi ziddi kuzozi asp bezarar megardonand. Zardob yak marotiba ba mushak firistoda meshavad (baroi kalonsolon 100000 – 150000 ME, baroi navzodon 20000 – 40000 ME, baroi kudakoni kalontar 80000 – 100000 ME).
YAke az pozahrhoi behtarin immunoglobulini ziddi K.-i odam ba shumor meravad. Voyai muolijii on 900 ME (6 ml) buda, yak marotiba ba mushak firistoda meshavad.
Bo maqsadi peshgirii tashannuj qabl az hama angezandahoi beruniro, ki sababi khuruji bemori meshavand, bartaraf kardan lozim ast. Baroi in bemor dar utoqi alohidai hattalimkon orom joy doda meshavad. u boyad hamesha zeri nazorati dukhtur boshad. Az doruhoi taskinbakhsh va miorelaksantho, ki bo silsilai asabhoi markazi tasir rasonda tonusi mushakhoro sust menamoyand, istifoda burda meshavad.
Dar mavridi K.-i sabuk va miyona muolijaro az huqnai khloralgidrat (dar har huqna 1,5 – 2 g) ogoz menamoyand. Mariz dar yak shaboruz 3 – 4 marotiba huqna (klizma) karda meshavad.
Tashannuji sakht va ikhtiloli nafaskashiro hangomi K.-i darajai III metavon bo rohi tazriqi voyai ziyodi neyroleptikho (odatan yakjoya bo tazriqi dokhilimushakii barbituratho) raf binmud. Dar mavridi K.-i vaznin (darajai IV) vositai yagonai bosamar relaksanthoi mushak (khosa tubokurarin) ba shumor meravand. Samarai relaksanthoro istifodai diazepam, barbituratho yo oksibutirati natriy meafzoyad. Baroi bartaraf sokhtani asidoz, ikhtiloli mubodilai obu namak va safedaho mahlulhoi ishqorron, mahlulhoi poliioni, plzmai khun, albumin va doruhoi digar kor farmuda meshavand. Baroi tabobati K. hamchunin nigohubini durust va khuroki sergizo muhim ast.
Baroi peshgirii K. hamai kudakoni az 5 – 6-moha to 12-sola, hamchunin khonandagoni maktabho, korgaroni sanoati mudofia, sokhtmonchiyon, varzishgaron, zaminkovon va korgaroni rohi ohan hatman bo anatoksin moyakubi karda meshavand. Kudakonro bo vaksinahoi AKDS va ADS, ki muqobili surfakabutak va guluzindonak niz masuniyat hosil mekunand, moyakubi menamoyand. Odamoni kalonsol boyad du marotiba moyakubi bishavand. Anatoksin (0,5 ml) ba zeri pust bo fosilai yak moh (bayni har tazriq) firistoda meshavad. Moyakubii takrori (revaksinatsiya)-i avvalin pas az 9 – 12 mohi moyakubii yakum, moyakubihoi takrorii minbada pas az 5 – 10 sol (bo hamon voya) surat megirad.
Hini sar zadani khavfi inkishofi K. (dar mavridi zakhmdor shudan, sukhtagii darajahoi II va III, sarmozanii darajahoi II va III, dar khona zoidan, jarrohii rohi medavu ruda) jilavgirii ojili on zarur ast. Bo in maqsad ba odamone, ki moyakub shudaand 0,5 ml anatoksini kuzoz guzarondan kofist. Ba ashkhose, ki moyakubi nashudaand, 1,0 ml anatoksini K.-ro bo 3000 ME zardobi ziddi K. (novobasta ba sinnu sol) yakjoya (ammo bo suzandorui alohida va dar digar joi badan) mefiristand. Ba mushak firistodani gamma-globulini donori (to 3 ml) niz ravost.

H. Q. Qamardinov.