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VABO

choleraVABO (Cholera), bemorii shadidi siroyatist, ki boisi illat yoftani rudai borik, vazninii holati umumii organizm va kamobii badan megardad. Angezandai V. vibrionho meboshand. Hangomi V. rudai borik az tasiri zahri angezanda oseb yofta, mubodilai obu elektrolitho vayron, khun galiz, faoliyati jigar va gurdaho kharob meshavad.
Angezai V.-ro s. 1883 R. Kokh kashf kardaast. Vibrioni V. (Vibiro cholerae) vergulshakl, grammanfi va aerob buda, binobar qamchinak doshtanash, harakat mekunad.
Az rui sokhtori antigeni vibrioni V. doroi se navi serologi ast: inaba, ogava, gikoshima. YAke az shaklhoi vibrion biotipi El-Tor meboshad, ki onro s. 1905 Gotshlikh kashf kardaast.
Vibrioni V. az tasiri nuri oftob, harorati baland va khushkonidan zud mahv meshavad. Dar asnoi jushonidan, hamon lahza va hangomi to 60°S garm kardan, dar tuli 30 daqiqa nobud megardad; dar obhoi ravon az 3 to 5 ruz zinda memonad. Dar tarkibi najosati mariz vibrionho metavonand muddati ziyod (to yak moh, dar joi toriku namnok to 2 moh) mahfuz monand. Vibrioni V. ba tasiri moddahoi gandzudo va mahluli kislotaho tob nameorad. Mahluli kislotai khlorid hatto badi bo tanosubi 1:10000 hal kardan niz vibrioni A.-ro dar tuli chand soniya mahv mesozad.
Manbai siroyat mariz, bemori shifoyofta va homiloni angezai V. ba shumor meravand. Angezahoi bemori ba muhit tavassuti najosat va moddai qay khorij meshavand. Dar bobati pahn namudani angezai V. khususan odamoni mubtaloi shakli sabuk va nihonii in bemori khavfnokand.
Angezai V. tavassuti khurokvori, ob, hamchunin dast va asbobhoi ruzgor, ki az najosat va moddai qayi mariz oluda gashtaand, intiqol meyobad. Dar pahn kardani angezai V. khususan magasho maqomi kalon dorand. Vobasta ba omilhoi intiqol va rohhoi pahn gashtani vibrion epidemiyahoi V. tamosi, maishi, obi, gizoi va omekhta meshavand. Az hama beshtar epidemiyahoi obi va obivu tamosii V. duchor meoyand. V. bemorii mavsimi (tobistonu tiramoh) ast.
Angezahoi V. ba organizmi odam az rohi uzvhoi hozima vorid meshavand. Onho bisyor vaqt dar meda binobar tasiri kislotai khlorid mahv megardand. Bemori hamon vaqt paydo meshavad, ki agar angezaho az saddi meda guzashta, dar rudai borik joy girand. Onho dar rudai borik afzoish karda, ekzotoksin khorij menamoyand.
Davrai nihonii V. az chand soat to 5 shaboruz (beshtar 2 – 3 ruz) ast. Vobasta ba zuhuroti alomatho V. sabuk, miyona, vaznin va behad vaznin meshavad. Inro az rui darajai talafi ob dar organizm muayyan mekunand. Olimi rus V.I. Pokrovskiy chand darajai kamob gashtani organizmro judo kardaast: Darajai I – ob barobari 1 – 3 foizi massai badan talaf meyobad (shakli sabuki V.); Darajai II – talafi moeot ba 4 – 6 foiz merasad (shakli vazniniash miyona); Darajai III – dar asnoi bemori 7 – 9 foizi moeoti organizm talaf khohad yoft (shakli vaznin); Darajai IV – talafi moeot 9 foizro tashkil mekunad (shakli behad vaznin).
V. nogahon khuruj karda, shabona yo pagohi dar mariz khohishi beisti qazoi hojat paydo meshavad. SHikam dard namekunad va tob namedihad. Najosat avval muqarrari buda, yakjoya bo qismhoi gizo meoyad; sipas vay obakii zard va minbad misli jushobi birinj meshavad. Dar chunin holatho najosat bebuy ast yo bui mohiro medihad.
Bemor dar yak shaboruz az 3 to 10 marotiba qazoi hojat mekunad, kamishtiho va tashna meshavad. Harorati badan bisyor vaqt mutadil ast. Nabz tez, zabon khushk buda, shikam qur-qur mekunad. Dar surati sabuk guzashtani bemori, ishol az chand soat to 1 – 2 shaboruz davom meyobad. Talafi moe 1 – 3 foizi massai badanro tashkil medihad (kamobii darajai I). Hosiyathoi fizikaviyu khimiyavii khun betagyir buda, mariz sihat meshavad.
Dar holathoi ru ba vaznini ovardani bemori mariz zud-zud (dar yak shaboruz 15 – 20 marotiba) ba qazoi hojat meravad; najosat obaki buda, ba jushobi birinj memonad. Dil behuzur nameshavad, ammo bemor bisyor qay mekunad; qay obaki va zardcha (binobar omekhta shudan ba talkha) ast. Dar tuli chand soat talafi moei organizm ba 4 – 6 foizi massai badan barobar meshavad (kamobii darajai II). Vazi umumii mariz bad va u behol meshavad, tashna memonad, dahonash mekhushkad. Binobar gipoksiyai boftaho, ikhtiloli mubodilai obu elektrolitho va inkishofi atsidoz dar baze marizon ikhtiloji (ragkashii) muvaqqatii mushakhoi soqi poy, kaf va panjaho rukh menamoyad, peshob kam megardad. Harorati badan, odatan, mutadil ast. Pusti mariz betarovat, khaltashakl va kabud meboshad; luobpardaho niz mekhushkand, ovoz megirad.
Dar mavridi sarivaqt va durust muolija kardan, qay va ishol gum shuda, ikhroji peshob va unsurhoi tarkibi khun barqaror megardand, vazi mariz ru ba behbudi meorad.
Hangomi dar muolija takhir kardan, dar tuli chand soat talafi moeot ba 7 – 8 foizi massai badan merasad (kamobii darajai III). Vazi mariz khele bad meshavad, nishonahoi toksikozi vozeh inkishof meyoband: tarhi ruy tegador shuda, chashm furu meravad, luobpardahovu pust mekhushkand, pusti panjaho khalta mezanad; fishori sharayon yakbora past khohad shud. Harorati badan mutadil yo past ast; dar holathoi vaznin shudani jarayoni bemori talafi moe ba 10 foizi massai badan merasad (kamobii darajai IV). Vazi mariz ru ba tabohi meorad: ishol va qay, ki zud-zud rukh menamudand, kam yo batamom qat megardand. Nugi bini, gush, lab va pilki chashm bunafsh yo purra siyoh, chehra teg doda, atrofi chashm kabud meshavad; guzai chashmho dar kosakhona meshinand va ba tarafi bolo tob mekhurand. Ovozi mariz khele girifta ast, harorati badan to 35 – 34°S past mefaroyad. Pust sard va khaltamonand shuda, hangomi qabza kardan, misli khamir to der hamvor namegardad. Nabz khele sust ast, damkutahi rukh menamoyad, nafaskashi berabt, sathi (dar 1 daqiqa 40 – 60 marotiba) ast; bemor binobar nafastang shudan, bo dahoni boz nafas megirad. SHikam ba takhtapusht meshinad, dar mavridi ikhtiloji mushakho dard mekunad. In shakli V. az chand soat to chand shaboruz davom meyobad. Dar mavridi sarivaqt tabobat nakardan, bemor az hush rafta bugi meshavad. Holathoi favt 60 foizro tashkil medihand.
V. barqoso niz meshavad. On nogahon ogoz yofta, bisyor tezu tud jarayon megirad, organizm obi khele ziyod talaf medihad. V.-i barqoso khususan baroi kudakoni to yaksola khavfnok ast. Binobar nomukammal budani mekhanizmhoi fiziologii mutobiqat dar kudakon zud beobii talofinopazir ba vujud meoyad.
Anjomi V. hangomi sarivaqt va durust muolija kardan nek ast. Vaboi barqoso va ba takhir mondani tabobat metavonad oqibati nokhush ba bor orad.
Tashkhisi V. dar davrai epidemiya chandon dushvor nest. Onro hatto metavon faqat dar asosi alomathoi bolini (kliniki) muqarrar binmud. Dar on mahalhoe, ki V. bori avval ba qayd girifta shudaast, hatman malumoti bakteriologi niz zarurand. Dar navohii vabozada bemoron va ashkhose, ki giriftori amrozi shadidi medavu ruda meboshand, boyad oshkor karda shavand, korkunoni tibbi havli ba havli gardand va bemoronro ba qayd girifta, dar shifokhona bistari gardonand.
Vasoite, ki baroi tabobati V. istifoda meshavand, muvozanati obu namaki organizmro barqaror karda, zahroludiro raf va angezai bemoriro mahv menamoyand. Odamoni bemoriashon vazninro, ki muhtoji tabobati betakhirand, ba shubai qabul naburda, zud dar utoqi obishtagari (regidratatsiyavi) joy medihand. Onhoro hamon lahza dukhtur muoina mekunad. Dar tuli 5 daqiqai avval boyad nabz, nafaskashi, fishori sharayon, vazni badani mariz, vazni khosi plazma, miqdori ionhoi K va Na muqarrar karda shavad. Bemorro dar kati makhsusi «vabo», ki baroi khorij shudani najosat surokhi dorad, joy medihand. Dar zeri kat satili chenakdor guzoshta meshavad (tavassuti on miqdori ikhrojotro chen menamoyand). Sipas zud az pai barqaror sokhtani obu namakhoi talafdodai organizm meshavand. Bo in maqsad mahluli standartii N1-ro bo tarkibi 5, 4, 1, ki 38 – 40° garm karda shudaast, mefiristand: ba 1000 ml obi tabnaofar (apirogeni) 5 g khloridi natriy, 4 g bikarbonati natriy va 1 g khloridi kaliy ilova menamoyand.
Miqdori mahlule, ki ba organizm mefiristand, az rui darajai talafi ob muayyan karda meshavad: mahluli N1 dar mavridi vaznin budani bemori ba miqdori 10 – 12 foiz, hangomi vazninii miyona 5 – 8 foiz va dar asnoi sabuk budani on ba miqdori 3 – 4 foizi vazni badani mariz firistoda meshavad.
Avval 2 l mahlulro ba varid dar tuli 30 daqiqa ravon mekunand; sipas surati firistodani mahlulro tadrijan kam karda, badi 1,5 – 2 soat ba 5 – 10 ml dar yak daqiqa merasonand.
Odatan pas az 15 – 25 daqiqai istifodai mahluli namak nabz va fishori sharayon ru ba behbudi meorad. Badi 30 – 45 daqiqa damkutahi raf va kabudii pust (sianoz) kam shuda, zabon tar megardad, ovoz paydo va nabz barqaror meshavad. Minbad ba organizm hamon miqdor mahlul firistoda khohad shud, ki mariz talaf dodaast. Dar mavridi ziyod shudani qay va ishol miqdori mahluli tabobatiro niz muvofiqan meafzoyand. SHaboruzi avval bemor boyad ba hisobi miyona 10 – 15 l (goho beshtar) mahlul qabul namoyad. Miqdori umumii mahlule, ki ba marizi kalonsol dar muddati 3 – 5 ruzi muolija doda meshavad, metavonad ba 30 – 100 l barobar boshad.
Bahri ba digar mahalho pahn nagashtani V. manbai onro zud nest kardan lozim ast. Tadbirhoe, ki bo in maqsad andeshida meshavand, ba chorahoi jilavgiri az digar bemorihoi siroyatii khavfnok monand meboshand: tartib dodani naqshai muboriza bo V., omoda sokhtani binoho dar surati oshkor shudani in bemori, tayyor kardani korkunoni tibbi, har moh ba qayd giriftani amrozi shadidi ruda, nazorati muntazami behdoshti mahal va g.
S-hoi 90-umi a. 20 va miyonai solhoi 2000-um dar baze nohiyahoi Tojikiston hodisahoi ba V. giriftor shudani odamon joy doshtand. Dar yak muddati kutoh sadho nafar odamon mariz gashtand. Vale binobar andeshidani tadbirhoi sarivaqti peshi rohi epidemiya bozdoshta shud.
Hangomi ba qayd giriftani vabo mahalro mamnu (karantin) elon karda, raftuomadi odamonro man menamoyand. Bemoron va ashkhosi ba bemorii V. gumonbar zud dar bemoriston bistari va joi iqomati onho gandzudoi (dizinfeksiya) karda meshavad. Homiloni vibrion va odamoni bo onho aloqadoshtaro niz dar joi alohida bistari mekunand, mahalli sukunat va chizu choraashonro bezarar megardonand.
Bemoroni shifoyofta badi 3 marotiba natijai manfi dodani tahqiqi (kishti) najosat javob doda khohand shud. Onho va hamchunin ashkhose, ki bo marizon aloqa doshtand, tuli yak sol zeri nazorati dispanseri qaror megirand.
Ad.: Rudnev G.P., Klinika karantinnikh infeksiy, M., 1972; Rukovodstvo po klinike, diagnostike i lecheniyu opasnikh infeksionnikh bolezney, M., 1994; Kamardinov H.K., Akhmedov A.A., Holera El-Tor. Klinika, lechenie, diagnostika, dispanserizasiya perebolevshikh i sanasiya vibrionositeley, D., 1994.

H. Q. Qamardinov.

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