Ólim-jitimi joghary infeksiyalyq emes aurular turaly әngime qozghalghanda, jýrek-qan tamyrlary jәne onkologiyalyq aurular jayly jii aitylady. Alayda, bizding elimizde aityla bermeytin taghy bir auru bar. Búl ókpening sozylmaly obstruktivti auruy nemese SOÓA turaly.

20 qarasha - osy dertpen dýniyejýzilik kýres kýni. Osy kýn qarsanynda joghary sanatty dәriger-pulimonolog, aimaqtyq diagnostikalyq ortalyqtyng pulimonolog-konsulitanty, Almaty qalasynyng «pulimonologtar qoghamy» QB tóraghasy Eraliyev Sattar Molybekúly qazaqstandyqtardyng tynys alu jýiesining aurulary turaly, ókpe aurularynyng damuyna qauip tóndiretin qanday faktorlar bar jәne pulimanolog-dәrigerine qashan baru kerektigi turaly egjey-tegjeyli aityp berdi.

- Sattar Molybekúly, tynys alu jýiesi aurularynyng payda bolu sebebi qanday faktorlargha baylanysty, sonday-aq olar bizding aghzamyzgha qanday jaghymsyz saldar әkeledi?

- Tynys alu organdary aurularynyng damuyna әser etetin faktorlar turaly aita otyryp, jiti jәne sozylmaly «ókpe patologiyasy» bar ekenin naqtylau qajet.

SOÓA turaly aitqanda, eng aldymen, búl temeki shegu qateri. Degenmen, shylym shegushilerding barlyghy SOÓA auyruyna shaldyqpaytynyn da atap ótu kerek. Biz temeki shegushilerding búl aurugha shaldyghyp ekinshi bireui nelikten auyrmaytynyn týsindire almaymyz. Alayda, kez kelgen temeki shegushi qauip-qater tobynda. Al SOÓA auruynyng 70%-gha juyghy temeki shegumen baylanysty. SOÓA nauqastarynyng qalghan 30%-ynda basqa da pollutanttar, qorshaghan ortany lastaytyn zattar, mysaly, «ýi» pollutanttary, olardyng biri ýidi jylytu kezinde tas kómirmen bólinetin elementter bolyp tabylady.

Adam aghzasyna teris әserding jyldam ósui «syrtqy» pollutanttardyng - qorshaghan ortanyng zaqymdaushy faktorlarynyng arasynda da bayqalady. Ásirese, dem alyp jatqanymyzdyng barlyghy birinshi kezekte tynys alu organdaryna - bizding ókpemizge týsu faktisi. Áriyne, tynys alu joldarynyng qorghanysh mehanizmderi de bar, biraq olar atmosferagha shygharylatyn agressivti zattardyn, birinshi kezekte, industriyalyq ortalyqtar men iri megapolisterding jappay әser etui kezinde tez tausylady.

Basqa pulimonologiyalyq patologiyamen auyratyndardyng sany da ósude. Mәselen, bronh demikpesi. Búl aurudyng taraluynda qorshaghan ortanyng belsendi lastanuy (demikpe triggerleri), sintetikalyq materialdardy, mysaly, qúrylys jәne túrmystyq himiya ónimderin jii paydalanu jaghymsyz ról atqarady.

- Degenmen, sebep nede: ekologiyada ma әlde ómir sýru saltynda ma? Biz Almaty qalasyndaghy ekologiyalyq jaghday nashar ekenin bilemiz. Megapoliste halyqtyng qansha payyzy tynys alu jýiesi aurularymen auyrady?

- Almaty - Qazaqstannyng eng lastanghan aimaqtarynyng biri. Almaty ózining biregey geografiyalyq shúnqyrynda ornalasuyna baylanysty, lastanuy «statikalyq sipatqa» iye. Qala auasy qanshalyqty lastanghan? Tipti qalalyq biylikke adal Qazgidrometting ózi de auadaghy azot dioksiydining jәne basqa da ziyandy zattardyng qúramy turaly qorqynyshty sandardy jariyalap otyr.

Bizding pulimonologiyalyq qogham jaqynda tynys alu organdarynyng sozylmaly aurularyna arnalghan konferensiya ótkizdi. QazÚU professory Vinnikov D. V. óz sózinde qalamyzdyng aua sapasy boyynsha tәuelsiz zertteu mәlimetterin keltirdi. Onyng mәlimetterine sәikes, jyldyng jyly kezeninde 17 kýn ziyandy zattardyng shekti rúqsat etilgen konsentrasiyasynyng 9%-gha, suyq kezende búl 155 kýnde 85%-gha artuy bayqaldy. Búl 2,5 mikron diametri bar zattar. Olar tynys alu joldaryna tereng enip, olardy zaqymdaydy. Almatynyng atmosferasyn bizding qalalyq biylikting aituynsha, avtokólikter emes, kómirmen júmys isteytin TES-ter jәne óz ýilerin jylytu ýshin kómirdi paydalanatyn jeke ýilerding túrghyndary lastaydy. Ókinishke oray, tynys alu organdarynyng aurularynan (BOD) zardap shegetinderding sany boyynsha Qazaqstanda syrqattanushylyq pen ólim-jitim kórsetkishi DDÚ-dyng Europalyq aimaghyndaghy eng joghary kórsetkish bolyp túr.

- Almaty qalasynan basqa, Qazaqstannyng qay ónirlerining túrghyndary ekologiyalyq jaghdaydyng nasharlyghyna baylanysty ókpe aurularyna úshyraydy?

- Birinshi kezekte búl Óskemen, Temirtau, Qaraghandy jәne Pavlodar siyaqty iri industriyalyq ortalyqtar. Ókinishke oray, búl әlemdik trend. Qytay men Ýndistan siyaqty iri elderdegi jyldam ekonomikalyq ósim qorshaghan  ortanyng qatty lastanuymen birge jýredi. 2008 jylghy Olimpiada kezinde qalanyng tóniregindegi barlyq zauyttardyng júmysyn toqtatqan Pekin osynyng jarqyn mysaly. Shyghystaghy kórshilerimiz tek qazir ghana damudyng belgili bir ósuine qol jetkizip, qorshaghan ortany qorghau turaly oilanyp, eng las óndiristi qaladan tys jerlerge kóshirdi. Industriyalyq ósim adamnyng syrtqy ómir sýru ortasynyng lastanuymen birge jýredi. Qazaqstanda da solay. Zauyttary kóp emes aimaqtarda, mysaly, Qyzylordada aua әldeqayda taza.

- Kóptegen ókpe aurulary jótelden bastalady. Biraq kóp jaghdayda adamdar búghan mәn bermeydi. Bronhit әdette JRVY tudyratyn virustardan tuyndaydy.  Bronhit pnevmoniyadan nemen erekshelenedi?

- Iya, jótel tómengi tynys alu joldarynyng tynys alu aghzalary aurularynyng eng aiqyn belgisi.  Dauys baylamynan tómen. Jer túrghyndarynyng 5 payyzynda «әdettegi» jótel bar jәne adamdar kóbine mamandargha jýginbeydi. Búl olardyng 2 payyzynda SOÓA-gha әkeledi. Ayta ketu kerek, biz әdette demikpe payda bolghangha deyin nazar audarmaytyn kәdimgi jótel SOÓA әkeledi. Ol tek osy aurudyng aldynghy habarshysy ekenin bilgen abzal.

Qazir tynys joldarynyng keng taralghan aurularynyng biri - ótkir bronhiyt. Zertteuler kórsetkendey, biz qarapayym «suyq tiygen» deytin jaghdaydyng 84%-y is jýzinde ótkir bronhit bolyp tabylady. Pnevmoniya, ol tek ótkir týrde bolady. Búl ókpede qabynu bar degen sóz. 70% jaghdayda bronhit antibiotiktermen emdelmeydi. Sebebi negizgi qozdyrghyshtar antibiotik әser etpeytin virustar bolyp tabylady. Biraq, pnevmoniyany emdegende biz keri jaghdaydy kóremiz – ol tek antibiotiktermen emdeledi.

Keyde jótel basqa ókpe aurularynyng belgisi boluy mýmkin. Tuberkulez nemese ókpe isigi. Sondyqtan, eger jótel «suyqtan» keyin qaytpasa, tekserilu qajet. «Qaldyq jótel» jýrek, refluks-ezofagitter, qúlaq jәne múryn quysy aurularynyng alghysharty boluy mýmkin.

- Qazir tuberkulez taqyryby ózekti bolyp otyr. Qazaqstanda tuberkulezben kýresu ýshin qanday sharalar qoldanylady?

- Áriyne, búl saualdy ftiziatrlargha qoyghan dúrys bolar edi. Shetelde tuberkulez, ókpe obyry siyaqty aurulardy pulimonologtar emdeydi. Bizde búrynghy Kenes odaghy kezinde-aq, tuberkulez indeti onyng diagnostikasy men emi jeke salagha - ftiziatriyagha bólingen. Qazir Qazaqstanda tuberkulezben syrqattanushylyq tómen. Degenmen, bizde dәrilik jaghynan tuyndaghan tuberkulez problemasy әli de bar. Múnda da ózekti mәsele ol, júqpaly aurularmen kýres boyynsha Amerikandyq qoghamnyng (IDSA) kýsh-jigerimen tuberkulezge qarsy preparattardyng uyttylyghy, sonyng ishinde «jana antibiotikter» tuberkulezben syrqattanushylyq problemasy siyaqty qaluda.

- Pulimonologiyada aurulardy emdeuding erekshe, joghary tehnologiyalyq nemese innovasiyalyq әdisteri bar ma?

- Áriyne, pulimonologiyada medisinanyng basqa salalaryndaghy siyaqty emdeuding joghary tehnologiyalyq jәne innovasiyalyq әdisteri payda boldy. Ásirese tynys alu organdarynyng auyr aurularyn emdeude. Mysaly, demikpe. Shyn mәninde, demikpe, kóp jaghdayda emge qolayly. Demikpesi bar adamdardar ishinde olimpiada chempiondary atanghan adamdar da bar. Siz, bәlkim, norvegiyalyq shanghyshylar turaly estigen bolarsyz... Olar óz demikpesin jaba otyryp, salbutamoldy, ústama týsiretin jәne jýrek júmysyn bir mezgilde yntalandyratyn preparatty, yaghny doping qoldandy dep dep aiyptalghan bolatyn.

Adamdar demikpeden qorqady, sebebi «auyr» demikpesi bar pasiyentterdi kóredi. Emdelushilerding tek 8-12% ghana auyrady. Biraq búl әli kýnge deyin ýlken medisinalyq, dәlirek aitqanda pulimonologiyalyq problema.

Biomolekulalardy - monoklonaldy antiydenelerin qoldana otyryp emdeuding innovasiyalyq әdisteri bar. Ókinishke oray, búl preparattarmen emdeu óte qymbat. Joghary tehnologiyalyq әdisterge bronhialdy termoplastika jatady. Ol sol «auyr» demikpeni emdeude qoldanylady. Biraq emdeuding eng innovasiyalyq jәne qoljetimdi әdisi - búl emdik (bazistik) preparattardy tynys alu joldaryna tikeley, ingalyasiya arqyly jetkizu qúraldaryn әzirleu kezindegi revolusiyalyq ózgerister. Maghan senseniz, búl qiyn mindet.

Siyrek, biraq emi joq, auru - idiopatiyalyq ókpe fibrozy bar. Búl dertke osy kýnge  deyin dәri-dәrmek joq. Songhy uaqytta osy diagnozy bar nauqastargha ýmit syilaghan eki preparat sintezdeldi.

- Boljam boyynsha, 2020 jylgha qaray ókpening sozylmaly obstruktivti auruy artyp, búl ólimge әkelip soqtyratyn ýshinshi sebep bolady deydi...

- SOÓA әlemning kóptegen elderinde ólim-jitim boyynsha ýshinshi oryngha shyqty. Búl júqpaly emes aurular arasyndaghy jalghyz patologiya. Ólim-jitim әli kýnge deyin ósip keledi. Óte tiyimdi bazistik preparattar payda bolghanyna qaramastan búl dertten kóz júmatyndar qatary artpasa kemimey otyr.

2019 jyly SOÓA emdeu boyynsha strategiyalyq qújat bolyp tabylatyn GOLD bayandamasynda 2012 jyly SOÓA ýsh millionnan astam adam qaytys boldy dep kórsetilgen. Búl әlemdegi barlyq ólimderding 6%-yn qúraydy. SOÓA ólimning sebebi retinde ýshinshi orynnan besinshi-altynshy oryngha kóshken keybir batys elderining tabysy әriyne optimizm tudyrady.

- Aurudyng aldyn alu maqsatynda ókpe rentgenin qanshalyqty jii jasau kerek jәne tynys alu organdaryn nyghaytu ýshin qanday kenester berer ediniz?

- Keude quysy mýshelerining rentgenografiyasy - ókpe aurularyn diagnostikalaudyng qarapayym jәne tiyimdi әdisterining biri. Postkenestik elder tuberkulezdi erte anyqtau maqsatynda dekrettelgen kontingent ýshin, atap aitqanda múghalimder ýshin mindetti bolyp tabylatyn rentgenografiyany (fluorografiyany) jýrgizedi. Onyng tiyimdiligin baghalay almaymyn. Óitkeni, ózderiniz kórip otyrsyzdar, tekseristen ótken adamdar arasynda da tuberkulez shyghyp jatady. Sebebi anyq emes. Búl dәriger-rentgenologtyng qatesi nemese aurudyng tez damuy bolar. Biraq eger adamda úzaq jótel bolsa nemese tuberkulezben auyratyn nauqaspen baylanysta bolsa, onda mindetti rentgenologiyalyq zertteu qajet jәne sәulelenuding aldynda qorqynysh bolmauy tiyis.

Aldyn alu maqsatynda 50 jastan keyin anamnezi auyrlaghan adamdargha, mysaly, tәuligine 2 qorap temeki shegetin adamdargha mamandardyng túraqty tekseruden ótuin úsynugha bolady.

Qala ómiri men ónerkәsip ortalyqtary jaghdayynda biz tynys alu organdarynyng manyzdy problemalaryna әkelui mýmkin ziyandy faktorlardy tolyq joqqa shyghara almaymyz. Biraq bizding qolymyzda bar ziyandy azaytu tújyrymdamasynyng qaghidattaryna sәikes osy faktorlardyng densaulyqqa keri әserin tómendete alamyz. Mysaly, týtindi ýi-jaylardy jii jeldetip túru arqyly. Nemese taza auada jii bolyp, fizikalyq belsendilik turaly da úmytpau kerek. Tynys alu búlshyqetterin nyghaytatyn jýgiru, jýru nemese jýzu siyaqty dene qozghalysyna kóshu. Alayda, aldymen qala auasynyng tazalyghy ýshin kýresuimiz kerek. Sebebi siz kýn sayyn qansha jýgirip nemese skandinaviyalyq jýrispen qansha jýrseniz de, lastanghan auada sportpen ainalysyp jýrip-aq ziyandy zattardy aghzanyzgha siniresiz.

- Súhbat ýshin rahmet!

Súhbatty әzirlegen - «Aman-saulyq» Qoghamdyq qory

Abai.kz