Д.Энхтуяа: Манайд хэрх, үе судлал хөгжөөгүй, хаягдсан

1-р сарын 5, 2017 10:03 am Нийтлэгч: Ангилал Нийгэм , Эрүүл мэнд Уншсан: 102
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Р.ОЮУН

 

УНТЭийн ХэрхҮе судлал, сэргээх төвийн Ревматологийн клиникийн профессор, тэргүүлэх зэргийн их эмч, Монголын ревматологиэмнэл зүйн дархлал судлалын нийгэмлэгийн тэргүүн Д.Энхтуяатай ярилцлаа.

Ревматологи гэж юу юм бэ. Ямар эмгэгүүдийг судалдаг юм бол. Энэ талаар яриагаа эхлэх үү?

Ревматологи буюу хэрх, үе судлал нь дэлхий нийтэд харьцангуй хожуу хөгжиж байгаа анагаахын шинжлэх ухааны салбар юм. Гэхдээ дархлаа судлал, микробиологи, биохими, эм зүйн шинжлэх ухаанд гарч буй шинэ ололт амжилтуудыг мэдээлэл зүйн технологийн тогтолцоотой хамтран нэвтрүүлснээр хэрхийн эмгэг үүсгэж байгаа шалтгааныг тогтоох тал дээр үсрэнгүй дэвшил гарснаар энэ салбар дэлхийд хурдацтай хөгжиж байна. Монгол Улсад эдгээр өвчнөөр өвчлөгсдийг уушги, зүрх судасны эмгэгүүдтэй нэгтгэн нэг тасагт хавсран эмчилж байсан нь саяхан. УНТЭт 2006 оноос хэрх, үе судлалын кабинет нээн ажиллуулснаар бие даасан анагаахын салбар хөгжих боломж нээгдсэн. Ревматологийн шинжлэх ухаан нь ревматизмийн эмгэгүүд болон тулгуур хөдөлгөөний эрхтэний үйл ажиллагааны алдагдлыг судалдаг. Ревматизм буюу хэрхийн эмгэг үүсэх шалтгааныг ойлгохын тулд холбогч эд, дархлааны тогтолцоо хэрхэн ажилладаг талаар ярих хэрэгтэй болно.

Хэрхийн эмгэг яаж илэрдэг юм бэ. Энэ талаар тайлбарлахгүй юу?

Хэрх гэдэг нь 20 гаруй бие даасан эмгэгийг багтаасан том өвчний салбар. Уушги, зүрх судасны эмгэгтэй адилхан. Хэрхийн эмгэг нь олон өвчнийг багтаасан шинжлэх ухааны нэршил болохоос өвчний онош биш юм. Хэрхийн эмгэг байж магадгүй гол илэрхийлэл нь шалтгаан тодорхойгүй халуурч, ядарна, турна, нүд улайна, наранд гарахаар нүүрэн дээгүүр тууралт гарч, үе мөчөөр янгинаж өвддөг. Ийм шинж тэмдэг илэрвэл халдвар, хавдрын эмгэг үгүйсгэгдсэн, онош тодрохгүй бол ревматологи буюу хэрх эмгэг судлалын эмчид хандах хэрэгтэй.

Тэгвэл хэрхийн эмч нар хаана байдаг юм бэ. Иргэд хаана, яаж үзүүлэх вэ?

Иргэд хаана хандах вэ гэдэг нь хамгийн тулгамдаад байгаа чухал асуудал. Энэ салбар, шинжлэх ухаан хөгжөөд 120 гаруй жил болж байгаа ч манайд энэ өвчнөөр өвчилж байсан хүмүүс зүрх судас, уушгины эмгэгийн хажууд хавчуулагдан эмчлэгдэж, оношлогдож явсан учраас хөгжөөгүй, хаягдсан. Энэ өвчнөөр өвчилсөн хүмүүс харьяалагдах эмч, эмнэлэг, тасаггүй болоод олон жил болж байна. Манай эмнэлэг салбарын анхдагч, манлайлагч байна гэсэн зорилгодоо хүрч 2006 онд анх хэрх, үе судлалын кабинетийг нээсэн. Ингэснээр хэрхийн болон үе мөчний өвчтэй хүмүүс маань хандах эмчтэй болсон. Үүнээс хойш кабинет маань өргөжиж 2011 онд Хэрх, үе судлал, үе сэргээх төв гэж байгуулагдсан. 2015 онд энэ төв маань өөрийн бие даасан мэс заслын болон дотрын ортой болж хөгжиж байна.

Манайд энэ салбарын эмч хэр хүрэлцээтэй байдаг юм бол. Өнөөдрийн байдлаар танай тасагт хэдэн эмч ажиллаж байна вэ?

Манай тасагт ревматологийн хоёр эмчийн орон тоотой, улсын хэмжээнд гарын таван хуруунд багтах эмч ажиллаж байна. Манай эмнэлэгт үзүүлж байгаа тусламж, үйлчилгээ нь гурван сая хүндээ хүрэлцэхгүй байгаа. Яагаад гэвэл олон улсын эмчийн хангагдах ёстой тоог харвал 10 мянган хүнд нэг ревматологи эмч байх ёстой гэсэн стандарт байдаг. Гэтэл Монгол Улс гурван сая хүнтэй гэж бодоход 300 ревматологи эмч байж энэ салбарын үйл ажиллагааг бүрэн хангаж, ачааллыг авч явах ёстой. Гэвч манай эмнэлэгт энэ салбар хөгжиж байгаа ч ард түмэн тусламж, үйлчилгээгээ хүртээмжтэй авч чадаж байна уу гэвэл учир дутагдалтай байна. Сүүлийн хоёр жилийн хугацаанд II, III эмнэлэгт ревматологийн нарийн мэргэжлийн эмч нар бэлтгэгдэж гарсан. Цаашид хоёрдугаар шатлал, аймаг, сумдын болон дүүргүүдийн нэгдсэн эмнэлгүүдэд энэ эмч нарыг бэлтгэж гаргахгүй бол дараагийн хяналт, эмчилгээ алдагдахаар өвчтөнүүд гүйцэт эдгэхгүй, эмийн хэрэглээгээ зөв тохируулж чадахгүй хүндрэх асуудал тулгарч байгаа.

Ревматологийн эмч нарыг бэлтгэж байна гэлээ. Энэ эмч нарын ажиллах ажлын байр бэлэн байна уу?

УНТЭ 2016 оны хоёрдугаар хагасаас эрүүл мэндийн салбарын сургалтын бааз эмнэлэг болж өргөжсөн. Тиймээс нарийн мэргэжил олгож байгаа бүх эмч манай эмнэлгээс сургалт авч байгаа. Одоо над дээр гурав дахь ревматологийн эмч нар бэлтгэгдэж байна. Хэрэв орон нутгийн Эрүүл мэндийн газар, яам тусгай бодлогоороо энэ салбарыг хөгжүүлье гэвэл орон тоогоо бэлдээд эмчээ сургаж хангах хэрэгтэй. Жилд дотрын мэргэжлээр 30-40 эмч сурлаа гэхэд ревматологийн эмч болох сонирхолтой эмч олон байгаа ч төгсч очиход ажлын байрны орон тоо байхгүй учраас сурч чадахгүй байна. Тэгэхээр орон нутаг, дүүргүүд нь эмчийнхээ орон тоог гаргана гэвэл залуу эмч нарын халаа энэ салбар руу орж суралцаж мэргэших сонирхол их байна.

Сүүлийн үед иргэд ам дамжсан яриагаар үе мөчөө буруу эмчилснээс өвчнөө хүндрүүлээд ирж байна. Энэ талаар та юу хэлэхсэн бол?

Үеэр илэрч гардаг 120-оос дээш өвчин байдаг. Аль өвчнөө мэдэхгүйгээр тэр сайн, энэ сайн, тэнд нэг тариа хийлгэчих, энэ эмийг уувал зүгээр байна гэснээр өвчнөө хүндрүүлдэг. Тиймээс үеийг өвдүүлж байгаа өвчнийхөө гол үндсэн өвчин юү вэ гэдгийг олж эмчлүүлэх ёстой. Тэгэхгүйгээр буруу эмчлүүлбэл үндсэн суурь өвчин нь цааш хүндрээд олон эрхтэнийг хамарч хүндэрдэг. Үеэр өвддөг гол эмгэгүүд гэвэл хэрхийн эмгэг дотроос хэрх төст гэж өвчин бий. Энэ нь олон том, жижиг үеийг хамарсан, алгуур давшгуй, удаан явцтай, насан туршдаа эм уудаг. Дээр дурдсан хэрхийн эмгэгүүдтэй адилхан шалтгаантай. Дархлааны тогтолцоо алдагдсан эмгэг учраас дур мэдэн эм, тан ууж болохгүй. Харин ч өвчнийг улам хүндрүүлж ганцхан үенүүд гэмтэх байсан бол уушги, элэг, бөөр, зүрх, нүд, чих, хамрыг гэмтээдэг. Тиймээс үеийг өвдүүлж байгаа гол өвчнөө оношлуулах нь чухал. Үеийг өөрийг нь гэмтээдэг нэг эмгэг байдаг. Үүнийг манайхан үеэнд яс ургах гэдэг. Энэ өвчин түгээмэл тохиолддог эмгэг нь. Насжилттай холбоотойгоор өсдөг, энэ эмгэг хүний амь насанд хүрэх хэмжээнд хүндрэл өгдөггүй. Үүнийг өөрөөр эмчилж, оношлоно.

Манайхан хоолойн ангина үе мөчиндөө орлоо гэдэг. Энэ талаар?

Ревматизм буюу хэрх онош биш ээ. Хэрхийг манайхан хоолойн ангина үе мөчинд орлоо гэж буруу ойлгодог. “Хэрхийн жихүүдэс”-ийн эмгэгтэй ялгаж салгахгүй явдаг. Хэрхийн жихүүдэс буюу хоолойн ангина хүүхэд байхад өвдөөд үүний дараа үе мөчөөр дамжин хэрж өвдөх, ой тогтоомж алдагдах, зүрх дэлсэх гэсэн зовиураар илэрдэг хэрхийн жихүүдэс гэдэг өвчин байдаг. Хүүхэд насанд илэрсэн хэрхийн жихүүдэс өвчин үеийг гэмтээдэггүй. Тухайн үедээ өвдөөд бага зэрэг хавдаж болно. Эмчлэхэд үе бүрэн сэргэж, эрүүл болдог. Түүнээс хоолойн ангина үе мөчиндөө орсон гэсэн онош байдаггүй.

Хэрх, үе судлалыг бие даан хөгжүүлэхэд тулгамдаж буй ямар бэрхшээл байна вэ?

Хэрх, үе судлал гэдэг салбар 2006 оноос Монгол Улсад УНТЭт бие дааж хөгжих алхам нь тавигдсан байгаа. 2008 онд АШУҮИС дээр зүрх судасны тэнхимээс хэрх, үе судлалын тэнхим салсан. Өнөөдөр Бөөрний тасагт ревматологийн өвчнийг эмчлэх зургаан ор байгаа. Үүний дөрөв дээр нь эмэгтэй, хоёр орон дээр нь эрэгтэйг авч эмчилдэг. Цаашид тусдаа бие даасан тасаг байгуулъя гэхээр эмнэлгийн байрны хүртээмж хэцүү байна. Дэлхий нийтийн чиг хандлагыг бодвол энэ нь хоцрогдсон асуудал. ХХI зуунд ревматологийн салбарыг мэддэг эмч нар төгсч байгаа. Цаашид хамгийн гол нь эмчлэгч эмчээ нарийн мэргэжлээр мэргэшүүлэх хэрэгтэй байна.

Ялангуяа, холын аймгууд, аймгийн бүсийн төвүүд, дүүргүүдийн нэгдсэн эмнэлгүүд ревматологийн эмчээ бэлтгэж, орон тоогоор нь хангах нь туйлын зорилго. Бид залгамж халаагаа бэлтгэх шаардлагатай байна. Ревматологийн талаар эмч нарт зориулсан сурах бичиг, гарын авлага манайд байгаагүй учраас 2010, 2011 онд I, II боть сурах бичгийг бэлт­гэж гаргасан. Үүнээс хойш ч гэсэн сурах бичгүүдийг гаргах хэрэгтэй байна. Олон улсын ревматологийн холбоонд элсэн орох, тэнд нарийн мэргэжлийн эмч нарынхаа мэдлэгийг дээшлүүлэх гэсэн асуу­дал өмнө минь байна. Энэ асуудлыг цаашид аймгуудын Эрүүл мэндийн газар, Эрүүл мэндийн яам анхааралдаа авч энэ салбарыг хөгжүүлэхэд бодлогоо боловсруулж, дэмжинэ гэдэгт найдаж байна.

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