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GRIPP

GRIPP (Grippus), bemorii siroyatii virusie, ki bo zahroludii umumii organizm (baland shudani harorati badan, beholi, dardi sar, dilbehuzuri, bazan qaykuni) va iltihobi luobpardai rohi nafas jarayon megirad. Angezandai G. virushoi tipi A, V, S meboshand.
Angezahoi gripp ba oilai ortomiksovirusho (Orthomyxoviridae) mansuband. Ba in oila se jins – virushoi grippi A, virushoi grippi V, hamchunin virushoi grippi S taalluq dorad. Zarracha (virion)-hoi virusi grippi A mudavvar, rishtashakl, nokshakl va kirmshakl meboshand. Hususan zarrachahoi mudavvari on bisyorand (diametrashon 80 – 120 nm). Virionhoi mazkur doroi KRN, safeda, angishtob, lipidho, hamchunin gemagglyutinin va neyraminidaza meboshand; serotipi onho hangomi ishora kardani shtammhoi virusi A nishon doda meshavad. Muvofiqi Fehristi baynalmilali shtammhoi virusi A az rui naqshai standarti tavsif meyoband. Virushoi navi A vobasta ba khosiyathoi antigenii glikoproteidhoi pardai beruni – gemagglyutinin (N) va neyraminidaza (N) ba zertipho judo karda meshavand.
Virushoi G. ba tasiri harorati past purbardosht buda, hangomi garm kardan va jushondan, zud mahv meshavand. Virushoi G. khususan ba afkanishoti ultrabunafsh va tasiri vasoiti gandzudo (dezinfeksiyavi) hassosiyati baland dorand.
Manbai siroyat shakhsi bemor, hamchunin ashkhose, ki G. dar onho ba tavri nihoni surat giriftaast, ba shumor meravand. Mariz baroi atrofiyon khususan dar davrai ogozi bemori khavfnok ast. Virusho to ruzhoi 4 – 7 marizi dar vaqti guftugu, surfidan va atsa zadan khorij karda meshavand (hangomi rukh namudani pnevmoniya – 10 – 12 ruz). Siroyat dar natijai tavassuti havo ba rohi nafas aftodani angezaho ba vuqu mepayvandad. G. chun epidemiya paydo meshavad. Vay nogahon sar shuda, zud pahn megardad va hatto mumkin ast ba pandemiya tabdil yobad. Dar davrai epidemiya giriftori ba G. va amrozi zukomii digar 10 – 12 marotiba meafzoyad. Dar in davra roli tagyirpazirii sokhtori antigenii virusi G. kalon ast. Badi pandemiya virusi nav biduni tagyirot boz 2 – 3 soli digar faoliyat menamoyad. Ba pahn gashtani G. omilhoi mazkur musoidat menamoyand: tavassuti havo zud intiqol yoftani angezaho; tagyirpazirii sokhtori antigenii virus; kutoh budani davrai nihoni (inkubatsiyavi). Avji bemori ba faslhoi zimistonu bahor rost meoyad.
Angezandai G. hangomi nafaskashi, guftugu, sulfa, atsa zadan, tavassuti chakrahoi obi dahon, luobi bini va balgam ba havo guzashta, ba atrofiyon siroyat menamoyad. Bozichaho, pistonak, kosavu tabaq, sachoq va g. niz metavonad vositai siroyat az angezandai G. shavand. Dar asnoi sabuk jarayon doshtan, G. baroi atrofiyon khele khatarnok ast. CHunki bemoron ba dukhtur narafta, bistari nameshavad va bo hamin roh virushoi G.-ro pahn mekunand.
Ba G. odamoni sinnu solashon gunogun dar hama fasli sol (beshtar tiramohu zimiston) giriftor meshavand. Dar muddati 11 – 18 sol navhoi digari virusho ba vujud meoyand, binobar in bemori qismi ziyodi aholii in yo on mamlakatro ba domi khud mekashad (epidemiya), bazan ba tamomi jahon pahn meshavad (pandemiya).
Virusho badi siroyat namudan ba organizm, qisman nobud shuda, moddai zahrnok (endotoksin) judo mekunand. Ruzhoi avvali bemori tablarza, beholi, dardi bandu bugum va mushakho, tab (to 37,1 – 37,20S) ba mushohida merasad.
Bemori nogahon sar mezanad: odami solim dar yak muddati kutoh kasali vaznin meshavad. Zimni zahroludii organizm (az endotoksini G.) tablarza, harorati baland (38 – 390S), sarcharkhzani, dardi sar (asosan dar peshoni, chakkai sar, chashmkhona), beholi, dardi bandu bugumho va mushak, dilbehuzuri, qay va vujud meoyand; rui bemor surkh meshavad. Aksaran az avvali bemori yo ruzi digar alomathoi nazla (nafasgirii dushvor, zukom, khorishi gulu, sulfai khushk, dardi gulu hangomi furubari) padid meoyand. Bazan obi chashm rafta, bemor ba rushnoi nigarista nametavonad. Agar bemori oqibati bad naorad, harorat badi 2 – 4 ruz mutadil meshavad. Alomati nazla tadrijan nest shavad ham, bemor chand ruz khudro bemador his mekunad.
Jarayoni bemori metavonad sabuk yo mubham (dar in holatho bemor khudro andak bad his mekunad) boshad. Bo vujudi in agar rejimi bistariyu tavsiyahoi dukhtur rioya nashavand, orizahoi noguvor (mas., gazaki shush, gaymorit), gazaki javfhoi ilovagii bini, otit (gazaki gush), illati dil, iltihobi pardahoi magzi sar va g. ba amal omadanashon mumkin ast. Orizai nisbatan mamuli G. pnevmoniya ast. Dar davrai ogozi bemori osebi virusii shush dar khunravi (hemoragiya) va varam padid meoyad, ki biduni tagyiri iltihobi ast. In asos bar on nest, ki guyo pnevmoniyai sirf virusi paydo shuda boshad. Illathoi iltihobi dar shush hangomi asari takrorii bakteriyaho ba vujud meoyand. On mumkin ast binobar siroyati ekzogeni (beshtar siroyati pnevmokokkho) yo dar natijai faol gashtani mikroflorai endogeni (stafilokokkho, streptokokki hemolizi va g.) rukh namoyad. Paydoishi pnevmoniyaro hangomi G. faqat ba bakteriyaho vobasta kardan khatost. Dar mavridi khelhoi orizanoki G. bo kumaki usuli immunoflyuoresenti dar organizm to 10 – 14 ruz vujud doshtani virushoi G.-ro muqarrar kardan mumkin ast (hini G.-i beoriza virus az organizm dar ruzhoi 4 – 5 marizi nest meshavad). Hamin tavr, hangomi G. paydoishi pnevmoniyaro metavon virusiyu bakteriyavi nomid. Onro dar vaqti andeshidani tadbirhoi muolijavi va ziddi epidemiyavi ba etibor giriftan shart ast.
Dar asnoi G. az orizahoi digari bakteriyavi hamchunin frontit, gaymorit, otit, mastoidit, bronkhiolit duchor meoyand. Osebi zahrii miokard (miokarditi grippi) dar kalon shudani dil, takhikardiya va besubotii nabz ba nazar merasad. Goho dardhoi stenokardi va ikhtiloli nizomi kori qalb mushohida khohand shud. Digargunii mushakhoi dil dar EKG niz dida meshavad. Orizahoi az jonibi asabiyai markazi rukhnamuda natijai toksikoz meboshand va ba tagyiroti iltihobi vobasta nestand. Dar bobati sarsom yo ensefaliti grippi niz fikr rondan beasos ast. Angezishi zahrii (toksikii) pardai magzi sar boisi digargunihoi iltihobii moei harommagz nameshavad. Va durust mebud, ki chunin orizaro meningizm binomem. Hangomi G. osebhoi vaznin va khavfnoki mayna (ensefalopatiya) ba vujud meoyand, ki sababi onho khunshorii magzi sar va varami mayna meboshad. Az jihati alomathoi sariri onho ba ensefalit shabohat dorand.
Dar mavridi az sar guzaronidani G. hamchunin mumkin ast bemorihoi muzmini peshina (sil, tarbod, tonzilliti kuhan, kholesistokholangit, pielit va g.) avj girand. Masalai ba bemorkhona khobondani bemorro dukhtur hal mekunad.
YAke az shaklhoi vaznini G., ki boisi favti odamon meshavad, G.-i murgon ast. Onro virusi H5N1 meangezad. Virus s. 1997 dar Syangan (Gonkong) oshkor karda shud. On bevosita az parrandaho ba odam siroyat mekunad. S. 1997 onro yakbora dar 30 mamlakati dunyo ba qayd giriftand. Holathoi az odam ba odam guzashtani virusi G.-i murgon muqarrar nashudaast. Alomathoi G.-i murgon az G.-i muqarrari farq nadorand. Orizahoi on (pnevmoniya, osebi gurdayu jigar, uzvhoi khunofar va g.) khavfnok meboshand. Manbai virus murgu murgobi, goz, qu, kabutar, murgi marjon va dig. parrandagon mahsub meshavand.
Solhoi okhir dar bisyor mamlakathoi dunyo navi digari G., ba istiloh G.-i khukon, ba qayd girifta shudaast. G.-i khukonro shtammhoi virusi A/H1N1, A/H1N2, A/H3N2 meangezand. Onho dar bayni khukho pahn shuda, ba odamon va parandagon niz siroyat mekunand. Angezandai G.-i khukon, ki s. 2009 dar bisyor mamoliki Amriko, Avrupo va Osiyo gustarish yoft, shtammi virusi H1N1 bud. Alomathoi G.-i khukon ba misli digar shaklhoi G. ast. Beshtar dar ashkhosi giriftori bemorihoi muzmini dil, shush, gurda, jigar, diabeti qand, omoshoi gunogun, odamoni farbeh, solkhurda, zanhoi homila, kudakon, kormandoni hifzi tandurusti va g. duchor meoyad.
Hangomi dar khona tabobat kardani bemor, baroi pahn nashudani siroyat, marizro ba khonai alohida khobondan yo joykhobi uro bo parda judo kardan lozim ast. Bemor boyad dar vaqti guftugu, sulfa va atsa zadan, dahonu biniashro bo ruymolcha pushonad. Parastori bemor boyad ba dahonu bini niqob yo bandinai dokagi (4 – 6 qabat) doshta boshad. Dokaro shusta darzmol mekunand. Ham dar davomi tab (davrai varaja), ham chand ruz badi on, bemor boyad bistari boshad. Bemori haroratash baland va tablarza giriftaro ba joygahi garm khobonda, ba poyash garmkunak (400S) meguzorand, limuchoyi garm medihand. Harorati khona boyad 18 – 200S boshad; havoi khonaro zud-zud toza, jildi bolisht va joypushro har ruz ivaz namudan zarur ast. Bisyor nushidani choy (bo qiyomi nastaran), obi sabzi, afshurai sabzavotu meva, limuchoy va murabbo (az tamashk va marminjon) naf dorad. Azbaski bemor beishtihost ba u dar yak shaboruz 6 – 7 marotiba kam-kam khurok medihand. Dar tarkibi khurok safedahoi zudhazm boyad ziyod boshand (gushtob, kotleti gushtin va mohigini dampukht tvorog va g.). Badi istemoli gizo dahonro bo mahluli sodai khurdani chayqonda (ba 1 istakon ob 1/4 qoshuqcha soda), dandonhoro ruze du marotiba toza kardan lozim.
Baroi tabobati G. dorui makhsus nest. Az in ru khudmuolija zarar dorad. Kosavu tabaqi bemorro judo karda, onro dar mahluli sodai 1% (ba 1 l ob 2 qoshuqcha sodai khurdani) yo dar mahluli ohaki khlornoki 0,5%-i sofkorishuda (ba 1 l ob 1 qoshuqi choykhuri) 5 daq. jushondan lozim. Ba khuroki pasmonda ob andokhta, 5 daq. mejushonand va sipas ba kanalizatsiya merezand. Liboshoi tagi bemorro boyad 15 daq. jushond. Farsh va jihozi khonai uro har ruz 2 marotiba ba lattai tar (mahluli 0,5%-i ohaki khlornok) pok kardan shart ast.
Dar vaqti epidemiyai G. ba bemorkhona va profilaktoriyaho daromadani odamoni solim man meboshad; baroi qabuli bemoroni G. dar poliklinikaho khonai dari daromad va baromadash alohidaro judo mekunand.
Baroi peshgirii G. obutobi organizm, varzishi jismoni va sport, muolijai illati uzvhoi nafas ahamiyati kalon dorad. Gayr az in, davoi makhsus – vaksinai ziddi G.-ro istifoda mebarand. Moyaguzaroni hama vaqt G.-ro peshgiri namekunad, ammo bemori sabuk jarayon megirad.
Ad: Qamardinov H.Q. (va dig.), Bemorihoi siroyati, D., 2000; SHuvalova E.P., Infeksionnie bolezni, M., 1999; Qamardinov H.Q., Infeksionnie i parazitarnie bolezni, D., 2009.

SH.A. Tosheva.

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