Ж.ЕРМЕК: Иргэд ханиад гэсэн онош өөртөө тогтоочихоод сүрьеэгээр өвчилснөө мэддэггүй

 Жил бүрийн 3 дугаар сарын 24-ний өдрийг дэлхийн Сүрьеэтэй тэмцэх өдөр болгон тэмдэглэдэг. Цар тахлын үед сүрьеэ өвчний нөхцөл байдал дүүргийн эмнэлгүүдэд ямар байгаа талаар Сүхбаатар дүүргийн Эрүүл Мэндийн Төвийн сүрьеэгийн эмч Ж.Ермектэй ярилцлаа.
 
 
 

Манай улс халдварт өвчин, тэр дундаа сүрьеэ өвчнийг бууруулахад олон жил ажиллаж байна. Өнөөдрийн байдлаар Сүхбаатар дүүрэгт сүрьеэ өвчний гаралт хэр зэрэг байна вэ?
Монгол Улсад сүрьеэгийн тандалтын тогтолцоо 1962 оноос өнөөг хүртэл явагдаж байгаа. Энэ өвчнөөр жилд 4000 гаруй тохиолдол шинээр бүртгэгдэж байна. Нийт халдварт өвчний 10 гаруй хувийг сүрьеэ өвчин дангаар эзэлдэг гэсэн үг. Тиймээс манай улс олон улсын донор байгууллагуудтай хамтран өвчлөлийг бууруулах, эрт илрүүлэх, урьдчилан сэргийлэх зэрэг ажлуудыг тогтмол хийдэг. Үүний үр дүнд жил ирэх тусам өвчлөлийн тоо буурч, илрүүлэлтийн тоо нэмэгдсэн судалгаа гарсан. Гэсэн хэдий ч бид тайвшралгүй сүрьеэ өвчнийг бууруулах бүх талын оролцоогоо нэмэгдүүлэх нь чухал. Сүхбаатар дүүргийн ЭМТ-д жилд дунджаар давтан болон шинээр 180-200 тохиолдол бүртгэгдэж, амбулаториор эмчлэн хяналтад авдаг. Харин сүүлийн жилүүдэд манай дүүрэгт эмэнд тэсвэртэй сүрьеэ өвчний тохиолдол буурч байгаа.
Ер нь юунаас шалтгаалж сүрьеэ өвчин тусдаг вэ?
Сүрьеэ нь агаар дуслын замаар халддаг нийгмийн халдварт өвчин. Ханиад, томуутай адил амьсгалын замаар халдварлагддаг учир энэ өвчнөөр хэн ч өвчилж болно. Өөрөөр хэлбэл сүрьеэгийн савханцар хэмээх нянгаар үүсгэгддэг, хүнээс хүнд амьсгалын замаар халдварладаг тул аль ч насны, ямар ч мэргэжлийн хүн өвдөж болно. Сүрьеэ нь ядуурал, ажилгүйдэл болон ажлын хэт өндөр ачаалал зэрэг сөрөг үр дагавараас хамааран өвчлөл нэмэгддэг. Мөн дам тамхидалтад өртөх, Д амин дэмийн дутагдалтай байх, улирлын өөрчлөлт, сүрьеэгийн ойрын хавьталтай байх, хавсарсан өвчтэй нас нэмэх тусам сүрьеэгийн халдвар авах эрсдэл нэмэгддэг нь судалгаагаар тогтоогдсон.
Түүнчлэн уушгины халдвартай сүрьеэгээр өвдсөн хүн 15-20 хүнд агаар дуслаар халдвар тараадаг гэж үздэг. Тиймээс иргэд амны хаалт сайн зүүх, ханиаж найтаахдаа амаа дарах, салфетка хэрэглэх хэрэгтэй. Гэхдээ сүрьеэ бол эдгэрдэг өвчин. Тиймээс тууштай эмчилгээгээ хийлгэсэн олон хүн эрүүл саруул болж, ажил төрлөө хийгээд явж байна.
-Иргэд ханиад хүрсэн гэж яваад сүрьеэ өвчин туссанаа мэдэхгүй хүндрүүлэх тохиолдол байдаг гэж байсан?
Өвчний эхлэл ихэнх тохиолдолд аажим явагдах бөгөөд хэдэн долоо хоног үргэлжилж болно. Тухайлбал хоёр долоо хоногоос дээш хугацаагаар ханиалгах, ядрах, жин буурах, хөлрөх, цустай цэр гарах, халуурах, хоолонд дургүй болох, цээжээр өвдөх, амьсгаадах шинж тэмдэг илэрнэ.  Дээрх шинж тэмдгүүд илэрч, зовиурлаж байвал та яаралтай харьяа аймаг, дүүргийн сүрьеэгийн эмчид хандаж онош тодруулах, онош нь батлагдсан тохиолдолд яаралтай сүрьеэгийн эмчилгээнд орох  хэрэгтэй.  Иргэдийн дийлэнх нь ханиад хүрсэн байна гэсэн онош өөртөө тавиад сүрьеэгээ хүндрүүлээд ирэх тохиолдол их гардаг. Хүндэрсэн тохиолдолд хийгдэх эмчилгээнээс эхлээд, эдгэх нь удаан үргэлжилдэг гэдгийг ойлгох нь чухал.  Уушгины сүрьеэтэй хүний хувьд мэдэхгүй удаан явснаас болоод өвчин хүндэрч,  уушгинд хөндий үүсч, заавал хагалгаанд орох шаардлагатай болдог тохиолдол ч бий.
-Сүрьеэгийн халдвар авсан, өвчилсөн гэсэн хоёр өөр ойлголтууд яригдаж байна. Халдвар авсан хүмүүс цаашдаа өвчлөх магадлал өндөр гэсэн үг үү? Ер нь энэ хоёр ойлголтыг уншигчдад тайлбарлаж өгөхгүй юу?
Сүрьеэгийн хувьд халдвар авах, өвчлөх гэдэг хоёр өөр ойлголт. Дээр хэлсэнчлэн сүрьеэ бол амьсгалын замын халдварт өвчин. Тиймээс хэн ч өвдөж болно. Халдвар авсан хүний биеийн дархлаа сулрахаар биед орсон халдвар нь идэвхжээд өвчилдөг.
Халдвар авсан гэдэг нь сүрьеэгийн микробактерийн эсрэг хүний дархлааны систем идэвхжиж, сүрьеэгийн микробактерийг унтаа байдалд оруулдаг. Өөрөөр хэлбэл сүрьеэгийн халдвар авсан нь сүрьеэгээр өвчилсөн гэсэн үг биш. Энэ тохиолдолд  байнгын дасгал хөдөлгөөн хийж, дархлаагаа сайн дэмжих хэрэгтэй. Мөн халдвар авсан хүн бусдад халдвар тараахгүй. Харин сүрьеэгээр өвчилсөн гэдэг нь ерөнхийдөө дархлаа нь суларсантай холбоотойгоор дээрх шинж тэмдгүүд илэрч, оношилгоогоор батлагдсан тохиолдлыг хэлнэ. Энэ үед эмчилгээг эрт эхлүүлэх нь чухал.
Ер нь харьцангуй эрүүл хүн бол сүрьеэгээр өвчлөхгүй гэсэн үг. Амьдралын зөв хэв маягтай, зөв хооллолт, спортоор хичээллэдэг, архи согтууруулах ундаа зохицуулж хэрэглэдэг, тамхи татдаггүй, архаг суурь өвчнөө маш сайн хянадаг хүмүүс сүрьеэгээр өвчлөх нь бага. Манай улсын хүн амын гуравны нэг нь сүрьеэгийн халдвар авсан гэж үздэг. Гэвч бүгд өвчлөхгүй байгаа нь амьдралын хэв маягтай шууд холбоотой.
-Урьдчилан сэргийлэх зорилгоор иргэд сүрьеэгийн шинжилгээг өгч болох уу?
Болно. Манай улсын хувьд эрт илрүүлэг, урьдчилан сэргийлэх чиглэлээр олон жил ажилласны үр дүнд тогтсон зохион байгуулалттай болсон. Иргэн сүрьеэгийн шинжилгээ өгөхөөр бол дүүргийнхээ болон харьяа аймгийнхаа эмнэлэгт очоод үнэгүй шинжилгээ өгч, эмчийн үзлэгт орно. Шинжилгээний хувьд цээжний рентген болон цэрний шинжилгээ /түрхэц, Xpert MTB/RIF/ зэргийг хийдэг.
Сүрьеэгээр халдварлагдсан эсэхийг тодруулах, ялангуяа хүүхдийн сүрьеэг илрүүлэхэд туберкулины сорилыг өргөнөөр хэрэглэдэг. Сүүлийн жилүүдэд халдварын болон вакцины дараах урвалыг ялгахын тулд туберкулины сорилыг орлох IGRA сорил хэрэглэх болсон. Үүнийг цусны шинжилгээгээр хийдэг. Тухайлбал, туберкулины сорил тавиулж, 72 цагийн дараа хэмжилт хийж хариу гардаг байсан бол IGRA сорилын хариу нь 24 цагийн дотор гардаг болсон.  
Сүрьеэ эдгэрдэг өвчин боловч эмчилгээний үр дүн янз бүр байдаг. Үүний шалтгаан юу вэ?
Эмчилгээний үр дүн олон зүйлээс хамаарна. Эмнэлгийн тусламж, үйлчилгээ болон өвчтөний  дэглэм маш чухал. Аль болох эрт оношлогдож, эрт эмчилгээнд орж, эмч, сувилагчийн шууд хяналтад эмээ таслахгүй ууснаар бүрэн төгс эмчилгээ болж, эдгэрдэг. Харамсалтай нь эрт оношлогдож чадаагүйгээс болж өвчнөөр хүндрэх, ойр дотны хүмүүс болон бусдад халдвар тараах эрсдэлтэй.
Сүрьеэгийн гол эмчилгээ нь сүрьеэгийн эсрэг эмийг хэрэглэх. Энэ эм нь өвчтөнд үнэ төлбөргүй олгогддог бөгөөд оношилгоо, эмчилгээ нь ч үнэ төлбөргүй. Нөгөө талаараа сүрьеэгээр өвчилж буй хүмүүсийн ихэнх нь санхүүгийн чадамж муутай, эмчилгээ хийлгэхгүй бол нас баралтаар төгсөх, үхэн үхтлээ халдвар тараах архаг явцтай өвчин учраас эмчилгээг үнэ төлбөргүй хийдэг байгаа. Эмчилгээнд эрт орж, эмчилгээний зарчим баримталснаар өвчтөн 15-20 хоногт халдвар ялгаруулахгүй болно. Өөрөөр хэлбэл ингэснээр гэр бүлийнхэндээ болон ойр орчимдоо халдвар тараахгүй гэсэн үг. Тиймээс эмээ таслахгүй хугацаандаа уух нь чухал. Сүүлийн илүүдэд Глобаль сангийн дэмжлэгтэй ДОХ,Сүрьеэгийн төслөөс хэвтэрт байгаа, эмнэлэгт очиж эмээ уух боломжгүй иргэдэд явуулын баг гарган эмийг нь уулгах, эмчилгээг нь хийх ажлууд тогтмол хийгдэж байна.
Манай улсад ид хөдөлмөр эрхлэх насны хүмүүс эмэнд тэсвэртэй сүрьеэгээр өвдөх тохиолдлууд нэмэгдсэн гэсэн. Эмчинй заавраар эмээ уухгүй бол яваандаа эмэндээ дасалтай болдог гэсэн үг үү?
Сүрьеэ нь мэдрэг болон эмэнд дасалтай гэсэн хоёр төрөл байдаг. Эмэнд дасалтай сүрьеэ нь гол үйлчилгээ үзүүлдэг үндсэн эмэнд тэсвэртэй, нянгаар үүсгэгдсэн хэлбэр юм. Өвчтөн эмчилгээний горимыг дагаж мөрдөөгүйгээс, эмийг зохих тунгаар бүрэн хугацаагаар уугаагүй үед нян устахгүй үлдэж, нэг болон хэд хэдэн эмийн дасалтай болдог. Харин эмэнд дасалтай өвчтөн ярих, найтаах, ханиалгах үед эмийн дасалтай нян агаарт цацагдаж, өмнө нь сүрьеэгээр өвдөх болон сүрьеэ эмчилгээ хийлгэж байгаагүй эрүүл хүн эмэнд дасалтай сүрьеэгээр анхдагчаар өвддөг. Тиймээс олон эмэнд тэсвэртэй сүрьеэгийн эмчилгээ хийлгэдэг. Эмэнд тэсвэртэй сүрьеэ нь хоруу чанар ихтэй, илүү хүндэрсэн хэлбэр рүүгээ орж байгаа юм.
Манай улсын хувьд эмэнд тэсвэртэй сүрьеэгийн тохиолдол жилд 200 гаруй бүртгэгдэж, 80 орчим хувь нь эмчилгээнд хамрагддаг судалгаа байна. Бусад орны хувьд дархлаа султай, өндөр настай хүмүүс сүрьеэгээр илүү өвчилдөг бол манай орны хувьд ид хөдөлмөрийн насны буюу нийгмийн идэвхтэй харилцаанд байдаг залуучуудын дунд тархалт хамгийн их байгаа нь ажиглагддаг. Нөгөө талаас энэ нь манай хүн амын дунд сүрьеэгийн тархалт өндөр, үүгээр өвчлөх биологи, нийгэм, эдийн засгийн эрсдэлт хүчин зүйл их байгааг харуулж байгаа юм. Тиймээс тогтмол оношилгоонд хамрагдах, эмчилгээ хийлгэж байгаа бол эмчийн заавраар огт таслахгүй хийлгэх нь маш чухал. Ингэснээр та өөрийгөө болон ойр дотны хүмүүсээ уг өвчнөөс хамгаалах юм. Сүрьеэ нь нийгмийн халдварт өвчин гэдгийг сайн ойлгох хэрэгтэй.
-Иргэд энэ өвчнөөс урьдчилан сэргийлэхийн тулд ямар арга хэмжээ авах ёстой вэ?
Хамгийн гол нь биеийн дархлааг сайн байлгах, тэжээллэг хоол хүнс хэрэглэх, ажил амралтаа зохицуулж ядрахгүй байх, Өрөө тасалгаандаа байнга агааржуулалт хийх, эмчийн заавраар Д аминдэм хэрэглэх, архи тамхи зэрэг хорт зуршлаас татгалзах хэрэгтэй. Мөн олон нийтийн газар ханиаж, найтаах нь ариун цэврийн хувьд ч , эрүүл ахуйн хувьд ч анхаарах зүйл учир амаа таглаж, халдвар тараахаас сэргийлэх дадалтай болох хэрэгтэй.

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