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MUOINAI BEMOR

muoinai-bemorMUOINAI BEMOR, tadbirest, ki bahri tashkhis va mushohidai bemori, muqarrar kardani khususiyathoi bemor, intikhobi usuli bosamari tabobat va muayyan namudani peshomadi marizi andeshida meshavad.
Muoinai umumi va makhsusro farq mekunand. Muoinai umumi dar mavridi hama guna bemoriho ba ijro rasonda meshavad; maqsadi on ba dast ovardani malumot dar borai bemor, muqarrar kardani aloqa bayni bemorii uzvi judogona (mas., uzvhoi bosira, somea) va holati uzvhoi digar meboshad. Muoinai makhsus az rui nishondodhoi muayyan yo mutobiq ba tartibi aznazarguzaronii dispanseri bahri oshkor sokhtani bemorihoe, ki khosi sohahoi mustaqili tib (mas., dermatovenerologiya, nevrologiya, psikhiatriya, stomatologiya, oftalmologiya, urologiya va g.) meboshand, ba amal barovarda meshavad.
Muoinai bemor az rui naqshai muayyan surat girifta, dar mavridi on hama qoidahoi deontologiya rioya karda meshavand.
Usulhoi tadqiqi koinikiro, ki hangomi M. b. istifoda megardand, ba asosi va ilovagi judo mekunand. Ba usulhoi asosi pursuju (jam ovardani anamnez) va az nazar guzaronidai bemor, angushtzani, palmosidan, auskultatsiya mansuband. Usulhoi ilovagi tadqiqoti gunoguni laboratori va asbobi, az jumla sfigmomanometriya, tadqiqi rentgenologi, tashkhisi radionuklidi va ultrasadoi, sanjishi funksionali va g.-ro darbar megirand.
Pursujui bemorro az muqarrar kardani shikoyatho sar mekunand (ham shikoyathoi asosi va ham on chizhoe, ki ba fikri bemor beahamiyat nestand). Bad dar borai bemori (anamnez) va hayoti bemor malumot jam meoarand, ba on etibor dodan lozim, ki munosibati mariz nisbati bemori chi guna ast. Dar in mavrid mumkin ast illati ruhi doshtani bemor niz oshkor shavad (on sanjishi makhsus mekhahad). Suhbat boyad oromona va bovarnok boshad. Az rui shikoyati bemor dar navbati avval faoliyati uzvro sanjidan yo mas., joi osebro az nazar guzarondan lozim ast; fishori arteriyaro chen yo kori dilro gush mekunand va g.
Muoinai umumi (az rui arzyobii aqlu hush, holati ruhi, qiyofa, budan yo nabudani nafastangi, sianoz, zardparvin va g.) dar borai darajai vazninii bemori malumoti nakhustin medihad. Hamchunin habitus (majmui nishonahoi zohirii bemor) niz ba nazar girifta meshavad (yane jussa, konstitutsiya, qadu qomat, tarzi rohravi, tanosubi takhminii qad va vazni badan). Sipas paydarpay sar, ruy, gardan, badan, dastu poy, holati pust, luobpardaho, nasji zeri pust, uqdahoi limfavi va mushakho, dar mavridi zarurat azoi jinsiro az nazar meguzaronand. Natijai muoina baroi tashkhisi qablii bemori khele muhim ast; dar baze mavridho on hatto baroi tashkhis bo yak nazar «kumak merasonad». Mas., hangomi muoina oshkor shudani majmui chunin alomatho, ba monandi ekzoftalm, kharobi, larzidani angushtoni dast va kalon budani gadudi siparshakl dalolat bar on ast, ki bemor giriftori jogari zahrogin meboshad.
Badi purra az nazar guzarondani bemor uzvu boftahoro bo angushton mepalmosand. In imkon medihad, ki varam, omos, kalon budani uqdahoi limfavi va g. oshkor karda shavand. Palmosidan baroi arzyobii harorati umumi va juzii badan, tonusi mushakho, hajm va topografiyai baze uzvho, omosho va dardmandii onho, turgori boftaho, nabz, kori dil musoidat mekunad.
Angushtzani baroi oshkor sokhtani andoza, shakl va sarhadi baze uzvhoi darun, darajai havogirii shush (baroi tashkhisi pnevmoniya, emfizemai shush, atelektazi shush muhim ast), gireh zadani ruda (ba mushohida rasidani meteorizm), mavjudiyati obiyat dar javfi shikam va plevra (nig. Astsit, Gidrotoraks, Plevrit) muhim ast. Ba tavassuti auskultatsiya dar borai faoliyati dil, shush, ragho, meda, ruda malumot ba dast meorand.
Usulhoi ilovagii M. b. baroi aniq kardani tashkhis ahamiyati kalon dorand; hangomi baze bemoriho, khususan dar davrai avvali inkishof, ki onho hanuz alomathoi vozeh nadorand (mas., davrahoi avvali omoshoi badfarjomi uzvhoi darun), tashkhisro metavon faqat dar natijai tadqiqoti rentgenologi, ultrasadoi va laboratori guzosht. Barkhe az usulhoi ilovagii M. b. ba naqshai muoinahoi umumii kliniki dokhil gashtaand, mas., antropometriya, chen kardani fishori arteriya (FA) va haror. badan, tahlili umumii khun, peshob va pasafkand, tahqiqi rentgenologii uzvhoi sanduqi sina, baroi odamoni az 40-sola bolo – elektrokardiografiya.
YAk qator usulhoi ilovagii muoina vobast ba nishondodhoi bemori tain karda meshavand, mas., tomografiya, rentgenokimografiya, tahqiqi rentgenokontrasti (meda, talkharoha, ruda, gadudi shir va g.), dar dispanserho – flyuorografiya; khususan tomografiyai kompyuteri ahamiyati kaloni tashkhisoti dorad. Usulhoi tahqiqi radioizotopi, nuskhabardorii gadudi siparshakl, jigar, sipurz, gurda va dig. uzvho imkon medihand, ki digarguniho dar joygiri, andoza, holati parenkhima va faoliyati onho muqarrar karda shavand. Solhoi okhir bahri muoina tadqiqoti ultarsadoi mavqei khossaro ishgol kardaast. On dar baze holatho az tadqiqoti rentgenologi afzaliyat dorad, mas., hangomi tahqiqi dil (ekhokardiografiya), gurda, bachadon, tukhmdon, talkhadon. Az usulhoi elektrofiziologi gayr az elektrokardiografiya hamchunin elektroensefalografiya va reografiyaro kor mefarmoyand.
Ba sifati tashkhisot khususan usulhoi tadqiqoti endeskopi, az jumla bronkhoskopiya, gastroskopiya, rektoromanoskopiya, kolonoskopiya, sistoskopiya, peritoneoskopiya va g. tasiri musoid rasondand. Onho imkon medihand, ki holati uzvhoi dokhili omukhta, dar mavridi zarurat bo maqsadi tashkhisi sitologi biopsiya guzaronda shavad. Murod az istifodai usulhoi suzankhali – biopsiyai gurda, jigar va uqdahoi limfavi, trepanobiopsiya, punksiyai javfi shush, perikard va shikam, ki bevosita az rui pust ba amal ovarda meshavad, mahz dar hamin ast.
Usulhoi tashkhisi vazifavi (spirografiya, fonokardiografiya, elektrokardiografiya, pnevmotakhografiya va g.) hangomi M. b. ba maqsadi muqarrar kardani vazi korii uzvhoi gunogun istifoda meshavand. Nishondodhoi faoliyati dil (mas., EKG) va dig. uzvho zeri tasiri kori jismoni, hamchunin dar davomi vaqti muayyan (yak shaboruz va beshtar), ahamiyati beandozai tashkhisoti dorand. Bo in maqsad az testho bo tasiroti chenaki (mas., veloergometriya), EKG-i monitori, FA-i monitori va g. istifoda mekunand. Tashkhisoti laboratori az usulhoi sershumori hujayravi va khimiyavi, omuzishi khususiyathoi fiziki, biologi va khimiyavii boftahoyu moehoi organizm, nishondodhoi immunitet, inchunin oshkor kardani angezandahoi bemorihoi siroyati iborat ast.
Sanjishhoi laboratori, odatan, dar asosi muoinai umumii bemor tain karda meshavand. Vale baze sanjishhoi laboratoriro qati nazar az bemorii asosi niz meguzaronand. Mas., dar bemorkhona dar barobari tahlili umumii khun, peshob va akhlot (baroi tukhmi kijja) khuni hamai bemoronro ba reaksiyai Visserman, SPID, hamchunin mavjudiyati glyukoza, bilirubin, kholesterin, durdai peshob niz tahqiq mekunand.
U. R. Rasulov.

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