Bo6pMHCKaH MpMHa reoprweBHa

Coxob Cepreft TanycraHOBMH

AHMCMMOBa EBreHMH HwKonaeBHa

H eoTJio>K H bie CH TyauH ii b CTOMaTOJiarHH

MocKBa

2017
YflK 616.31-08-039.57:
614.88 (075.9)
BBK 56.6fl77+53.50+54.50
H 52

P e iţe H 3eHTbi:
CBHpHjqoB Cepreii Bmktopobmh, floicrop mc^mijmhckmx HayK, npo-
4>eccop, 3aBeflyroiiţMMKac|)eflpoMaHecTe3MonorMM, peaHMMaTonomn h
mhtchcmbhom TepanMMneneOHoro <j>aicynbTeTa TBOY BIIO «Poccmh-
CKMMHaiJMOHanbHblM MCCneflOBaTeTIbCKMMMeAMIţHHCKMMyHMBepCMTeT
mm. H.PLIlMporoBa» MMH3flpaBa Poccmm
ByTpoB ÂH^pen BanepbesMH, 3aBeflyiomMM Ka<J>eflpOMaHecre3MO-
norMMm peaHMMaTonoruM PYjZJH, npo<j>eccop, /iaypeaT Iocy-
flapcTBeHHOMnpeMMMCCCP, npeflce^aTenb accoijMaijMM aHecTe3M-
onoroB-peaHMMaTonoroB tţeHTpanbHoro <J>e,nepanbHoro OKpyra PO,
maBHbiM pe^aKTop xcypHaaa «Hoboctm aHecre3MonorMM mpeaHMMa-
TonorMM».

Bo6pHHCKaa HpMHa IeoprHeBHa

Coxob Cepreii TanycTaHOBHH
AHHCHMOBa EBreHiw HHKOjiaeBHa

HeoTJioacHbie CHTyauHH b CTOMamnorHH

ISBN 978-5-4465-1541-7

Bee npaBa aBTopoB 3aiiţMiiţeHbi. Hm oflHa nacTb 3Toro M3flaHna He mo-

TKeT Own» 3aHeceHa b naMATb KOMnbioTepa mhm BOcnpoM3BefleHa tho-
6biM cnoco6oM 6e3 npejţBapMTenbHoro im cbM eH H oro pa3pemeHMH.
 O rjia e jie H H e
BsefleHMe. HeoT/io>KHbie cmyai^HH b CTOMaTO/iornH..................... 4
Diasa 1. npMHMHbl n MexaHH3MbI pa3BHTHH HeOT/IOvKHbIX
COCTOHHMM............................................. 7
Diasa 2. AnropHTM onaxaH hh CTOMaTOTiomHecKOH noMoiiţn
naiţiiemaM c conyTcrsyioiiţiiMif 3a6o7ieBaHMHMM........................... 12
Diasa 3 .3a6onesai»ui cepflenHo-cocy^MCTOM cmctcmh.................... 34

Diasa 4. IUok ........................................................................ 7

Diasa 5. O crpas AbixarejibHan He^ocTaTOHHOCTb.............................. 80
Diasa 6. Tpom6 o3m6 o;imh /ieroHHOM apTepMH................ 89
Tnasa 7. Komw.........................................................................................92
Tnasa 8 .3jiOKaHecTseHHas rnnepTepMHS........................................ 95
Diasa 9. OcraHOBKa Kposoo6panţeHHH........................................ ......98
 B ee^eH ue
HeoTJicwKHfeie cHTyai|HH b CTOMaTOJionm

PeaKUHH opraHH3Ma Ha arpeccHio mnnercsi ciioco6om

3amHTbi »h3hh, ho ocyiHecTBJUieTCH oHa jih6o nyrevr
«6ercTBa», yxojţa ot BpejţHoro (Jraicropa, jih6o nyreM
6opb6bI C HHM.
A . J Ia 6opH

CTOMaTononw «BJiaeTca oahhm m caMtix BO<ripe6oBaHHbix pa3-

aejioB MejţHiţHHbi. CTOMaTOJioraHecKOH noMOUţbio nojii>3yioTca na-
iţneHTti Bcex B03pacTHbix rpynn, hto co3jxaer ocoObie ycjioBHX jinx
pHCKa pa3BHTH3 pa3JIHHHbIX 3KCTpeHHbIX CHTyaiţHH, CBX3aHHHX KaK C
ocoSeHHOCTBMH caMHx CTOMaTOJiorHHecKHx BMemaTejibCTB (pa6ora
b6jih3h BepxHHx flMxarejibHbix nyreii, Soraraa peijenTopHafl 30Ha co-
MaTHHeCKOH HBereTâTHBHOH HepBHOH CHCTeMLl), TaK H CKOJIHHeCTBOM
h xapaicrepOM conyTCTByiomux 3a6ojieBaHHH naiineHTOB cTOMarojio-
rEraecKHx kjihhhk, t.k. HanOonee nacTo BCTpenaiomHHCJi KOHTHirreHT
nanneHTOB — Jiiomn cpe^Hero h nomuioro B03pacra, HaKonHBinHe 3a
CBOK) 3KH3Hb HCMaJIO3a60JieBaHHH.
HecMOTpa Ha 3HaHHrejn>HO B03pocmHH ypoBem» 6e3onacHocra naipi-
eHTOB (coBpeMeHHbie MeroAM o6e36ojiHBaHHH, 6onee coBepniemiaa anna-
paiypa, Marepnajibi h T.n.), croMarojioraa TpazpnpiOHHO ocraerca <omo-
UHOHanbHo onacHOH» oSnacrbio mc^hujihckoh noMomji. OcoOeimo 3to
Kacaerca aMSyjiaropHbix croMaTOJiorHnecKHx BMemareubCTB. IIoaTOMy
BOnpOCBI 3KCTpeHHBIXCHTyaiJHHBCTOMaTOJIOrHHHBJBHOTCHaKiyaJIbHblMH.
B CTOMaTOJIOrHH, KaKH BOMHOIHXflpyTHX C^epax MeflHHHHbl, BpeMS
ot BpeMeHHcjiyqaioTca TpanraecKHe coObrma h poxoBbie ohihOkh, BJiexy-
nţHe 3a co6oh KaracTpo^HHecKHe nocjie^CTBHa.
nosTOMy ynpaBJieHHe pncKaMH, npo^HJiaicrHKa h CBoeBpeMeHHoe
jieneHHe KpHTHnecKHX coctohhhh, CB»3aHHbix c npoBej^eHHeM cTOMa-
TOJiorHnecKHx BMemaTejibCTB, xBJixeTca npHOpHTeTHOH 3a#aHeH coBep-
meHCTBOBaHHB CTOMaTOJIOrHHeCKOHnOMOLU,H.
B CTpyicrype cMepTHOcra ot HOKejiarejibHbix 3(jxj>eKTOB jienernw
ecn., no HeKoropbiM zţamibiM, h cTOMaTonoranecKHe naimembi, cTara-
CTHnecKHe AaHHbie BapbHpyiOT ot 1 CMepra Ha Kaac^bie 450 000 cjiy-
naeB npH Hcnojib30BaHHH mccthoh aHecTe3HH jjo 1 CMepra Ha Kaxc^bie
162 000 cnynaeB [Seldin HM, 1955].
» 4
 I lo MHOI til 10 UcCMHpiloW o p ia ilH ia iiH H 1/lpUBOOXpaHCHHJt, npOBOGh
rjiu eiim u cH coapeMOiuiyto K o tm c ru o fio oOccncHCHHa 6c jo n a c n o c T H na~
UHOHTOB, HOfijUIIXHipUNTIIblC IIOCJICVIC I HUM lipH OK838HHH MCJWUHHCKOM
noM O m ii oG yonoHJicHM , n p o x /i e a c c r o , CTpyicrypHbiMH, o p r anw ja n w o n -
UblMH I! OllOpni'HlUIblMM IICVIOC 1III KitMH CMCTCMbl UipaBOOXpaMCHHH, KO-
TQpbie upeACTUiiMciiKi h u p o rp a M M c ncpcncK T H B H oro p a m a rn a 2 0 0 5 r.
O&iiaico, C JieaycT noMHMTb, h t o o r kom iictciiiim m e p a n a , c r o k jih h h b c -
CXOIO OllblTU, CBOCHpCMCIIHOrO H lipaBHJIbMOrO OKaiaHHH HeoGxOAMMOft
HOMOUUI npM B03HHKHOBCHMH HCOTJIOlKHbIX COCTOHHHH y HaiţHeHTa B
CTOMUTO/lOt HHCCKOM ICJIHMHKC lUBHCM I pa3BHTHe CHTyaUHH H HCXOfl Jie-
wcmi>i, KU'iecTBo h G esonacH O C Tb CTOMaTOJiorHHecxoit noM om w .
H e n p c p b iu iio c npo({)@ccHOHajibHoe o 6 p a u )B a n w e , p e ry jia p H o e n o B b i-
lUCHltO KWt.llll(|)nKUHim, COBCpillCHCTBOBUHIIC 3HâHMM H npaKTHHeCKHX
HaBblKOB, 6e3yKOpH3H6HHOe BbinOJIHeHHe MCJIHUHHCKHX TeXHOJIOrHH
T103B0J1HT OKaSblBaTb CTOMBTOilOrMHeCKyiO riOMOLUb Ha BblCOKOM COBpe-
MCHHOM ypOBHC, XaHCCTBCHHO H 6c30liaC H 0.
IloH C M y mm n p eflB a p a eM «CnpaBOHHHK» c b c z ic h u h m h o TeopH H n e -
OTJIOXCHblX (KpHTHHeCKHX) COCTOaHHfi? 3anOMHHTb BCe HeOTJIOXCHbie
COCTOBHHB H6B03MOHCHO, HO IlOHHMaHHe lipOHCCCOB, npOHCXOflaiUHX B
UCJIOCTHOM OpraHH3MC OpH TCX HJTH HHbIX H3M6H6HHXX, nOMOXCCT, He
T e p a a A p a r o u e H H o r o e p c M c im , iip c ju ip u tia T b H e o m o x c H b ie M e p u .
Bpan B c e r a a c t o h t n e p e f l npoG neivioft o x a 3 a n H a M axcHM ajibHO « n o -
jiesH O ® » no M o u iH h ii3 6 c ru im n bosm o x ch o ix ), a HHorzţa HeoTBpaTHMO-
r o B p e a a ScuibHOMy. P em eH rae 3 t o h npo& neM bi BicniOHaeT x a x y p o B eH b
npo(J)eccH O H ajibH oft noaroTO BX H B p an a, T ax h x T p o re H H io ( r p e n e c x o e
«iatros» — Bpan h « g e n e s » n o p o x c ^ a e M o e B panoM ). flT p o re H H a — 3 t o
He o6fl3aTejibH O HerpaMOTHOCTb B p a n a ( x o t h b 6ojibuiH H C TB e c jiy n a e B
IIMCHHO OHa HBJlHCTGfl npHHHHOH HaHeCCHUH B pC^a GOJIbHOMy), HO H
tic iriO c x c iih ic ocjioxcH eH H a, CBX3aHHue c flHarHOCTHHecxHMH h jie n e S -
HblMH ^eftCTBHHMH B flaHHOH CJIOXCHOfi CHTyaUHH [B.M. C eflO B , 2010].
Macro o n p aB ^ aH H eM
fljia B 03H H K m ero ocjioxcH eH H a a a n a io T c a BHeniHH e
oOcTOHTejibCTBa: oco6eH H O CTH O o jib H o ro , HajiHHHe y H e ro M HoxcecTBa
c o n y T C T B y io m H x 3a6ojieB aH H H , x o T o p u e , a x o 6 b i, co 3 aaiO T y c jio B H a a n a
HenpeflBHflCHHOCTH, HCB03MOXCHOCTH liporH 03H pO B aH H a pa3BHTHH o c -
jioxcHeHHH. T a x MoxeeT 6 h iT b , h o e c T b h a p y r a e npHHHHbi — h c b h h m b -
TejibHOCTb Bpana, H eyM eH H e xoH T pojiH poB aT b h o u e m iB a T b p e3yjibT aT bi
cbohx AeftcTBHH. Xopoiuo c x a 3 a ji B.B. BepecaeB «...n ep ea m c a h u h -
5
HOH CTOHT 3KHBOH HeJlOBCHeCKHft OpraHH3M C feCKOHeHHO CJI05KH0K) H
3anyTaHHOio 3kh3hbio. . .». H sto Bpan nojiaceH Bceraa iiomhhtb, ocy-
meCTBJIHB CBOK) fleflTeJIbHOCTb. FIOApo6HOe, BHHMaTeJIBHOe o6cjie/ţo-
BaHHC SojibHoro nepea mc^huhhckhm BMemaTejibCTBOM cymecTBeHHo
MOaceTCHH3HTb OnaCHOCTb pa3BHTHB He0TJI05KHbIX, 3KCTpeHHblX CHTya-
IţHH, B TOM HHCJie ----H B CT0 M3T0J10rHHeCK0 H IipaKTHKe (aM6 yJiaTOpHOH
H CTai^HOHapHOft).
Bee 3KCTpeHHbie CHTyaquH T peSyioT He3aMe,zyiHTejibHoro BMeiua-
TeJIbCTBa, T.K. OT BpeMeHH H avana OKa3aHH« nOMOLLJH 3aBHCHT HCXOfl
jieneHHH. Bpan-CTOMaTOJior aojraceH yM en» p a3JiHHarb H3MeHeHHa, bo3-
HHKaiomHe b c o c t o b h h h nanneH T a, flHarHOCTHpoBan» h x xapaicrep,
OKa3biBaTb n ep B yio noM oujb n o T ex n o p , n o x a noaBHTca B03M03KH0 crb
OKa3am ifl cn eiţH ajin 3HpoBaHHOH noMonjH.
 Ijia e a 1
r i p H H H U b l H M e x a H H 3 M U p a 3 B H T H H HeOTJKHKHUX
COCTOHHHH
HeoTJio»CHbie coctobhhh xapaicrepH3yioTCJi KpaHHefi crenenbio Ha-
pymeHHH cJ)yHKUHOHHpOBaHHa, npeaczţe Bcero, raaBHtix cncreM acH3He-
o6ecneHeHH« — KpoBoo6pameHHH h abixaHHa, a Taioxe aKTHBH3auneH
MexaHH3MOB a^airramiH h KOMneHcaiiHH c SbicrpbiM nocjieayiomHM hx
yraeTeHHeM b cb»3H c HeflocTaiOTHOCTfeio 3HeprermrecKoro o6ecne*ie-
hhh a^arrraiiHOHHbix peaiaiHH. n o c jie ^ e e ziejiaer HeB03MoacHbiM ca-
MOCTOBTeJTbHBIH BblXOfl H3 yipCOKaKHIjerO 5KH3HH COCTOflHHB H IIpH 3a-
flep5KKe HJIH OTCyTCTBHH KB3JIH(J)HIIHpOBaHHbIX JIOTe6HbIX MeponpHBTHH
HeH3M6HHO npHBQZţHT K CM6pTH IiaUHeHTa.
KpHTHHecKHe cocroam ra — 3to oGnjenarojiorHHecKHe HecneiiH(J)H-
necKHe cocToaHHa, naroreHe3 Koropbix o/pmaKOB He3aBHCHMO o r 3tho-
jionrqecKoro 4>aicropa. KmnniHecKHe npoaBJieHHa KpuTHHeciooro cocro-
am ra npH ocrpoM HH<J)apKTe MHOKappa, TjoxejiOH coHeraHHOH TpaBMe,
3K3oreHHwx orpaBJieHHHX, aHa(J)HJiaKTHHecKOM inoxe noxoacH. O to 06 -
yciroBJieHO TeM, h to MexamoM pa3Birma xpHTHHecxHX coctobhhh np«
jiio 6 bix 3a6ojieBaHH»x opimaxoB.
KaKOB MexaHH3M pa3BHTBM HeOTJIOMCHHX (xpHTHHeCKHX) COCTOBHHH?
O h npocT — z u h o k c u h . JIk>6oh bha nm oK cra (flwxarenbHaa, impicy-
jiaropH aa, reMHHecKaa, rprroroKCiPiecKaa) aBJiaerca raaBHOH npHHHHOH
3HeprernHecKOH HeflocraroHHoerH, npHBQzţanţen k Henpcay h anoirro3y
KJieTOK H He3(J)(J)eKTHBHOCTH apaHTailMOHHblX, 3amHTHbIX peaKHHH.
3HEPr00BPA30BAHHE

IEEB5L yrjieBOflM 6ejiKH |

Puc. 1.1. CxeMCi o6pa3oeemwi MaicpodpzoQ

7 «a
 IlyCKOBM M (j)aKTOpOM WM p a 3BHTHH HUIOKCHH 9BJ1BI0TCB H a p y ilie -
HHH (JjyHKUHH flblX aH H fl H KpOBOo 6 p a m e H H f l.
npH nepBirmoM HapymeHHH BHenraero w*xamw (bchthjmuhh
jiencHx) npoHexoAHT HapymeHHe Tpancnopra B03ayxa, coaepacamero
KHCJIOpOa B JierKHX. ripHHHHbl, KOTOpbie npHBOZWT K 3TOMy, pa3HOO-
6pa3Hbi: HapymeHHH perynximH abixaHna, crocKeHHe 3kthbhocth qu-
xaTejibHbix Mbimp, pbctjdkhmocth jienatx h rpynHOH kjictkh, o6rypa-
khlh atixaTejibHbix nyreH. Bee 3to HBnaercH pe3ynbTaTOM xpoHHnecKHx
3a6ojieBaHHH: XOBJI, GpoHXHajibHa» acTMa, xpoHHHeciam SpoHxirr,
MHacTeHHH, «JieroHHoe cepane» h ap., ofnypaipui auxaTejibHwx nyreH
(b tom HHCJie— npn 3anaaeHHH Kopira jobnea, o6mojx)hhom cociohhhh,
acnnpaqHH HHopoaHbix Ten, oSjiomkob 3v6ob, h ap)- CmEKaercx Ha-
npaaceHne Kncjiopoaa b ajibBeonax h, kbk caeaersne aroro, cmcKemie
HanpaaceHHH KHcaopoaa b aprepnaabHOH xpoBH — rcmoKceMHX. IIpH
mnoKceMHH TpaHcnopr KHcaopoaa k KaencaM cHnacaerca, pa3BHBaioT-
ca auxareabHaa rnnoKCua h SHeprerEraecKaa HeaocTaroHHOCTb.
Ilpn HapymeHHHx KpOBOoSpanjeHHfl — mnnance, Hapyrnemux
pHTMa cepaqa, ocnpoM majjapicre Mnoxapaa, cna3Me cocyaoB Ha 4>OHe
3MOE[HOHajibHoro HanpaaceHHH, aHa(|)HnaKTHHecKOH peaKUHH h ap.
CHHacaroTca cepaeHHbin BbiSpoc, aprepHaabHoe aaaneHHe, KpoBoroK
b MHKpoqHpKyaaTopHOM pycae h aocTaBKa KHcaopoaa, npHBoaamee k
HHpKyaaTopHOH nmoKCHH, a cmnKeHHe 3Heproo6pa30BaHHH k 3Hepre-
•mnecKOH HeaocraTOHHOCTH.
IIpH ocTpOM CHHacemiH KonimecTBa reMornoSmia, name Bcero npa
KpoBonorepax, pa3BHBaeTca reMHnecKaa thhokchh b cbjbh c Heaocrar-
kom nepeHOCHHKa KHcaopoaa — chidkchhoh KHcaopoaHon cmkocth
KpOBH.
tţHTOTOKCHHecKaa nmoKCHH o6ycaoBaeHa HapyrnemuiMH ynunm -
TTPTVfKHcaopoaa MHTOXOHapHHMH.
UnTOTOKCHHecKaa nmoKCHH B03HHKaeT irpn OTpaBaeHHH opramra-
Ma qnaHHaaMH, cimpraMH, ypeTaHOM h pa3HHHHhiMH aeKapCTBemibiMH
BemecTBaMH. Ilpn 3tom nponcxoaHT HHaKTHBaqHH nan CHHaceHHe chh-
Te3a atixaTeabHbix (J)epMeHTOB, hto npenarcTByeT npoHHKHOBeHHio
KHcaopoaa b KaeiKy.
Han6oaee paHHHM h ochobhmm npoaBaeHHeM rnnoKCHH XBaxeTca
paccTpOHCTBO o6MeHa BeiqecTB. AKTHBHpyiOTCfl iaHKonra h annoaH3
(KaK ocHOBHbie KOMneHcaTopHbie peaKiţHH 3H eproo6ecneneH H Ji),

D> 8
hto conpoBCWKflaeTCfl paiBHTHeM BHyTpH- h BHexjieToqHoro anuncna
c HapymeHHeM <j)yHKiţHii opranoB h chctcm, anorrrosoM h HeicpoGOM
KJieTOK.

Puc. 1.2. IIoepeoicdeHue KjiemoK npu zunoKcuu

[ModutpuKaifUH 11.0. JIumeuifKozo, 2012]

^ţeficTBHe n a roreHHbJx <t>aicropoB

▼ ▼

/ţe(J)HUHT
KHCJiopoaa/cyScTpaTOB
AT4> c noM Oiubio
flocTaBKa
AflO-AT<I>-TpaHCJiOKa3ia
h K»K
t
CHKXCeHHe 8KTHBHOCTH YMeHbuieHHe aKTHBHOcm
4>epMeHTOB TK. AbIXaHHB AT<Da3: Na7K*-AT«I>a3M,
h niHKojiHja noBpexcfleHHe Ca2*-AT<t>a3H h jjp.
MHTOXOHapHH, me ■

ocymecTBjiaeTca
u h k j i K p e 6c a

Puc. 1.3. Paccmpoucmea onepzemuHecKozo odecnenemin kjienvoi

[no I I.0 . JIumeutfKQMy, 2012]

9 «a
 HapymeHHH (jjymcuHH opraHOB npH rnnoxcHH, npeayje Bcero, xaca-
eTca ueHTpajibHOH HepBHOH chctcmu xax Han6ojiee HyBCTBHTejibHOH
k HeyocTarxy xHCJiopoya h 3Heproo6ecneHeHH«. noHBJiaeTca omyme-
HHe AHCKDM(|)OpTa, CHHHCeHHe KpHTHKH, 3H(j)OpHfl, nOBLHlieHHe B036y-
ahmocth, cyzţoporH, a b yajibHeimieM HapyiueHHe C03HaHHa. Co cto-
poHbi cepfleHHO-cocyzţHCTOH CHCTeMbi rnnoKCHHecKHe noBpeacyeHHJi
HBJIHIOTCfl pe3yiIbTaTOM B03^eHCTBHH THIIOKCHH Ha XapZţHOMHOHHTbl,
HapymeHHa (jjyHKUHH BereTarHBHOH HepBHOH CHCTeMbi — sto raaBHaa
aflairraHHOHHaa peaxyHa, ho OHa ace oyHOBpeMeHHO aBjweTca narojio-
nraecKOH, t.k. Bbi6poc KarexojiaMHHOB yBejiHHHBaeT nocTHarpy3xy Ha
cepyye, noBbimaeT noTpeSHocTb MHoxapzţa b 3HepreTHHecxoM o6ecne-
neHHH, HapymaeT MHxpoyHpxyjMHHK) b opraHax, H3MeHxeT peojionno
xpoBH h cnoco6cTByeT pa3BHTHio nmoBOJieMHH h CHPDKeHHio cepyen-
Horo Bbi6poca. Cna3MHpyioTCH cocyyw jierxHX. JleroHHaa ranepreH-
3hh conpoBoacyaeTca B03HHXH0BeHHeM npaBoacejiyyoHKOBOH Heyocra-
tohhocth, OTexoM JierxHX, pa3pymeHHeM cyp(J)axTaHTa h, b kohchhom
cneTe, cmoxeHHeM jieroHHoro ra30o6MeHa. HapymeHH» MeTa6ojffl3Ma
3axjiioHaK)TCH b pa3BHTHHMeTa6ojiHHecxoro ayHyo3a, xoTOpHH, b cboio
onepeyb, nopoayţaeT pay naTOJiorHnecxHX npoyeccoB, ycyry6jwiomHx
nmoxcHio.
METAEOJIHHECKHH AIţH#03
HAPytUEHHEnEPMOEPMHECKOrO HAPyiilEHMECMCTEMHOIO | nOBblUJEHMEnPOHHUAEMOCTM I
KPOBOOEPALUEHMa KPOBOOEPAmEHMfl JpocyflHcroro shaote/ihb

CHMWEHPIETOHyCA 1
V
W1OTPMLlATE/lbHblfi 1
V
YCM/1EHME<DM/lbTPAqMM
cocyflOB MHOTPOnHblCi 30OEKT WHAKOCTO

CHMMEHHE CHMWEHME
O
PEAKUHHHABA30K0HCTPHKT0Pbl CEPAEHHOrOBblEPOCA rVinOBOJlEMHfl

M3MEHEHME0YHKUMMA/lbBYMMHAnPMMETABO/IHHtCKCM
-.... -

(— nOflflEP>KAHME
TPAHCTIOPTHOH OHKOTHMECKOrOflABAEHUfl HHrHEMPOBAHME(1POTEA3
______________________ 1___________________
CHMJKEHME CPOflCTBA rEMOmOEMHA K KMC/IOPOfly

HacbiuteHMe reMor/io6 HHa kmoiopoaom B sierKMX - Hb0 2- CHMmaeTcn

Puc. 1.4
10
 M ohcho npoAOJixcarb iicpchhcjichhc HapyuieHHfi <J)yHKUHfi opraHOB h
CHCTCM, HO OHH B03HHKai0T II03MCC, He B yCJIOBHHX aNl6yJiaTOpHbIX CTO”
MaTOJiorHHecKHx BMeiuaTejibCTB. O/uiaKo cjieAyeT aiaţeHTHpoBaxb bhh-
M aH H e B p a n a H a t o m , h t o :
1. rHnoKCHH — npouecc caMOBOcnpoH3BOAHmHficfl h caMonojwep-
ACHBaiOIHHHCH H MO5K0T 6 b IT b n p e p B a H TOJIbKO JieHe6HbIM H A efi-
CTBHHMH B p a n a .
2. rnnoKCHH «BJiaeTca «HaAe>KHbiM» nyreM TaHaroreHe3a, noaroMy
CJieAyeT, oiţeHHBaa pHCK, He AonycicaTb eg pa3BHTHJi h npepbi-
BaTb naToreHeTHnecKyio iţerib.
 D ia n a 2
AjiropHTM oKajaiiHH CTOMaTOJiorHHecKOH noMonm
iiam iem aM c conyTCTByioixiHMH 3a6ojieBaHHHMH
Ochobhhm cnocoSoM npo^HJiaKTHKH HeoTJioacHwx cocroasHH y na-
LţHeHTOB c conyTCTByiomeH naTOJiorneH aBJiaerca co6moaeHne uporo.
KOJia OKa3aHiw CTOMaTOJiorHHecKOH noMonm, cocToamero H3:
1. c6opa aHaMHe3a b paBJiHHHBix 4>opMax;
2. npoBe^eHHa aHajnm B3aHMOAencTBHa 4)aPMaK0JIorHHecKîR
npenapaTOB, npHHHMaeMHX nanneHTOM, co cpe^CTBaMH Mecr-
hofo o6e36ojiHBaHHH h ce/ţaiţini;
3. onpe^ejieHHa <j>yHKiţHOHajibHoro coctojihhji naqHeHTa nepejj
npoBe^eHHeM croMaTOJiorHHecKoro BMemarejn»CTBa — A#,
HCC, MHO, ypoBeHb ejiioko3h ;
4. onpe,zţejieHHa bo3moîkhocth 0Ka3aima CTOMaTOJiorHHecKOH no-
MonţH b aMSynaropHLix ycjiOBiwx;
5. oSasaxejibHOH KoppeKiţHH ^Hcrpecca — ncHxofloranecKHM,
(^apMaKOJiorHHecKHM hjih KOMOHHHpoBaHHbiMcnoco6aMH;
6. oSocHOBaHHoro Bti6opa 3<J)<}>eKTHBHoro h 6e3onacHoro Mecrao-
ro o6e36ojiHBarora;
7. peKOMeimyeMoro MOHHTopHHra reMo^ţHHaMHHecKHx noKa3are-
Jien bo BpeMa npoBe^eHiM CTOMaTOJiorHHecKoro jieneHna.
MoaceT jih croMaronor opHenrapoBaTbca b conyrcTByiomeH naroao-
n m naiţHeirra? /ţa, Mo^ceT, Tax KaK b nporpaMMy o6yneroia ciyaeHTOB
CTOMaTOJioraHecKKx (J)aKyjibTeTOB Me^ţmţHHCKHx BY3ob bxqoht H3y-
HeHHe ^hcuhiudih: BHyrpeHHHe h xnpypranecKHe 6ojie3HH — no 216
yn.Hac., (JmpMaicojioraa — 180 yn.nac, HepBHtie 6one3HH, ncHxnarpHH,
HH(J)eKLţHOHHbie 6ojie3HH, aKymepcTBo, K05K.BeH.6ojie3HH, jiyqeBaa jm-
arHocTHKa — no 108 yn.nac. Ha Kaayjyio .zmcmnurnHy. n o 72 yn.na-
ca ciyaeHTw CTOMaroJiorn H3ynaioT cya.Me^.3KcnepTH3y, oprammnmo
3/ţpaBOOxpaHeroM, JIOP-6ojie3HH, KJiHHHHecKyio (J)apMaKOJiorHK), Me^H-
ipmcKjno pea6njnrranmo. OcBoemno HeoraoHCHOH noMomn h (jmoHa-
Tprni b yneOHOM nnaHe npeaycMorpeHO no 36 yn.Hac.
TaKHM o6pa30M, BY3oBCKaa oSmeicjiHHHnecKaa no^roroBKa ctome-
TOJiora npeflycMarpjiBaeT bo3mokhoctb ^HamocTHKH (^ymomoHajib-
Horo coctohhhh nanneHTa nepea rmaHupyeMbiM CTOMaTOJiornqecKHM
jieneHneM.
D> 12
 1 flop AHNMIHHflMHMNIII /tBMHtitft jtiltt KMIIIWICftlIff
^nyiV t ^VWlllHk nDlitvMMiiil'tecMtix iido:i(MNNll
fttfMlA 0RA1AMMAM GtOMatfWHM'MMACRoM UOMOIIIH HCotixo/IMMO
VHYOpAYA GHâtHMA O CtK'îMMMH 1/tnpoBb* 0O/1bMOIO, OGcntnOM-
\\\\§ UAOttGMîA COCTOWT Ml MAeKOJtbKMX tiattOB, ricpBMM Ml KOTOpMX
AAMGWM MOApAMGftMWtt rtlIKCl MponrtHHC, K COXta/ieHHK), C/IWlofi
VvWM)MMYVMV\to tjlOpMW rtHKiM ottpoCMMKOH B P<î> H0 Ccro/IMJUmiHM
^GMA MG pAipAĂOîAHlV RMMMMRM pâlJîMMMblX <|)OpM C06ctBCMH0CTM
npGflJtAfAK)T MMHMCMty yRatatb imbhmbc iicpcmmcjichmwx iadone-
AAWttit Ho Mt Aceiyţa MOAteî yKatâîb Ha KaKMe-iiwGo ia-
CkVAGAaMW* MpOGft) ttOWMy, Mit) MC 1M0CT 06 MX H0J1MMHM. y^Htfcl-
aa* vYWf maium ROJtJterM Mi CU1Â CMMîatot ue/tecooâpaiHbiM
A awrgtav GMpaiMttaatb nauMCMia o MaMfionee pacnpocrpaHeHHbtx
GttMMmiax tafiortGaaMMtt, Mit) Mt‘ia 6ojîbiiioro KOJiMMcctaa Bonpo-
GOAIMAMtttG^bHO yAGAHMHAaeî ApCMB npOBWHMH aHKCTHpOBaHMX,
MOtt03A0ît*GT AWBAttTb y ttaUMCHTtt ttftJtMMMC naîOJlOî*MH, fla*C eCJTH
faRAHoft HG3MBJ1 o weft [Malamed Stanley F). flaHHbie, nojiyMeHHbie
A XttytG AMRGTttpOAaHHf^ 6bltb TWaTeJîbHO npoaHâJIH3HpO-
aamw ApAMOM &© npoAG&GHMB onpoca> H bo BpeMH ero npOBCiieHHX
mw pGROMGwayGM 3a#arb ^OMOJiHMTejtbHbie Bonpocw no yKaaauMbiM
MffojtGA&ttttltMi
Hptt btOM ApaM ftOJttRGH BbMtCHHTb, RBRHC MMCHHO 3a60JieBaHHX
mgpgmgg itfttţvtGttTţ oco6 ghho eoxpamnomHecH b nacToxmee bpcmx.
HG06XQRttM0 AWBGHMfbţ ItpM RBRHX oSCTOJtîeJIbCTBaX B03HMKai0T
ewMMtOMW cepaeMHO'COcyaMCTbrx 3a6oneBaHHtt: 3MouHOHajibHoe
ManpA)Ketme> xjmiHUGCRaB m h RaRaa-JinCo apyrax HarpysKa. 3 to
Racaetea, upoR^G Acero* ypoBH» aptepnaabnoro aaBJieHHa, Macro-
tw w pntMa GGp&cMHbix coRpamenHît, najmana opTOcraTHMeckhx
h xmghchhîi apîepMajtbHoro ^asjtetma (HajtHMne rojioBOKpyxeeHMH,
HOftpi goshaim» itpw ncpexo^e «3 ropMaontajibHoro nojioxceHHa b
AeprMRa^bMoe)v O S patim BHHMatme Ha pa3BHTne 3nn30A0B napy-
highma co numn# rtpn nepepa3rn6aHHH (aanpoRHflWBaHHH) ronoBbi,
mto CH!t;iGtGJtber»ycr o HâJiHMHH nepe6po-BacKyjixpHoft Heaocra-
tOMHOGTM, 3 to ocoGghho Ba*Ho npM ORaaaHHH croMaTOJiorHMecKofi
OOMOtltH,
HgoGxojwmo taioRe BbtxcHHTb HajiHMHe 3a6ojieBaHHH opraHOB
tWtBMHX. flptt ^JTMTGJtbHOM nOJTOKGHHH naUHeHTa C OTKpHTMM
» CD
pTOM «ycTanocTb» MceBaTejibHbix Mbium MoaceT npHBecTH k Hapy-
iueHHK) AbixaHHa, Tame, Kate h CMemeHHe KopHa H3biica najibuaMH
Bpana. O co6oe BHHMaHHe cjieayeT yzjejiHTb HajiHHHio y naim enra
(jjaKTOpOB, npOBOIţHpyiOmHX pBOTHBIH petjuiexc*
BaxcHOH HH<j>opMaimeH aBJiaerca HajiHHHe caxapHoro jmaGeia
(I hjih II THna), Tax xax HapymeHHa speMeHH npneMa mmm npn
Hcnojib30BaHHH HHcyjiHHa hjih flpyrax npenapaTOB 3Toro THna fleii-
CTBHfl MOryT CnpOBOHHpOBaTb pa3BHTHe KOMaT03HOro COCTOHHHa.
06fl3aTejibHo .zţojiaceH 6biTb co6paH ajuieprojiorHHecKHH aHaM-
He3, nocKOJibxy ajuiepreHaMH Moryr 6bm> He tojibko jiexapcTBeH-
Hbie npenapaTbi hjih nnmeBbie npoayKTbi, ho h 3anaxH, pa3JiHHHbie
xHMHHecKne BenţecTBa, npHMeHaeMLie b cTOMaTOJiorHnecKOH kjih-
HHKe.
Ilp n 6ece^e c naimeHTOM BpaH-CTOMamnor jţojiaceH o6paTHTb
BHHMaHHe Ha nCHX03M0HH0HaJIbH0e COCTOHHHe 6oJH»HOrO, COCTOa-
HHe ero sereTaTHBHOH HepBHOH chctcmbi. CTpax, bojihchhc naim -
eHTa yace npn ocMOTpe h Secede aojdkhli HacTpansaTb Bpana Ha He-
o6xo,zţHMocTb KoppeKiţHH jm crp ecca nepejţ npoBejţeHHeM cTOMaTO-
jiorHnecKoro BMeniaTejibCTBa juia co3,a,aHHa kom<J>opthoh hchxojio-
ranecKOH oScTaHOBKH fljia naimeHTa h TopMoaceHHa BereTaTHBHbix
peaKHHH. IIo6jiejiHeHHe xoacHbix noKpOBOB jiniţa CBHjţeTenbCTByeT
o npeBajiHpoBaHHH cnMnanmecKOH, b t o BpeMa xax noKpacHeHHe
— £Kopee o napacHMnaTHHecKOH b k th b h o c th BereTaTHBHOH HepB-
h o h CHCTeMbi. H b tom , h apyroM cjiynaax y naimeHTa bo3mo5khm
ocjioacHeHHa co CTOpOHH KpoBOoSpameHHa bo BpeMa npoBeAeHHa
BMeniaTejibCTBa h M oiyr noTpeSoBaTtca 3KCTpeHHbie Mepw oxa3a-
h h a noMom,H. CHTyaijHa MoaceT 6bitb npejiOTBpameHa peineHHeM
B onpoca o HeoSxojţHMOCTH KOHcyjibTaiţHH cneiinaJiHCTa jţo- hjih bo
BpeMa oxa3aHHa cTOMaTOJiormie ckoh iiomoihh .
YneT B03pacTH£ix oco6eHHOCTeH naimeHTOB noxa3aji, h to npn
npOBe^eHHH CTOMaTOJiorHHecKHX BMemaTejibCTB yBejiHHHBaeTca
pncK ocjioacHeHHH: y noaouibix naimeHTOB cHHacaeTca kojihhcctbo
HepBHbIX BOJIOKOH (aKCOHOB), HHHepBHpyiOIHHX MbHIHJbl, B TOM
HHCJie h aceBaTejibHbix, h to Be^eT k mbiiuchhoh aTpo^HH. 3 t o C03-
jţaeT noBbimeHHHH p n cx acnnpaimoHHbix ocjioacHeHHH, jm cjioxa-
Hhh KopHa a3bixa, HenpOH3BOJibHOMy 3aKpbiBaHHio pTa, npn koto-
pOM Hejib3a HCKJiiOHHTb TpaBMaTHHecKHe noBpeacfleHHa cjih3hctoh

O 14
 odojiOHKH a opranoB ho/iocth pTa. HxMeHeHHa ccpacHHo-cocyim-
CTOtt CHCTCMM CBB3aHbI C yMCHbfflCHMCM KOMneHCâTOpHHX peaKIIHH
H 6o/tee SblCTpWM pa'JBM'fHCM KpHTHHeCKHX COCTOBHHÎf Ha <|>OHe
nepeHeceHHbix 3a6ojieBaHHlL HsMeHeHHa b jientHX (yMeHsnieHHe
BJiaCTMHHOCTH H MCXaHHHCCKHX CBOflCTB, yMeHbllieHHe aJIbB€OJIBp-
Horo npocTpaHCTBa) CHHxcaiOT JieroHHwfi rasoodMeH, KcnropbiH He
Mower 6birb KOMnencHpOBaH b ycjiOBHax ncHxoaMOUHOHanbHoro
HanpxxceHHB. B pe3yjibTaxe Moryr noaBHTbcx rnnoKCHHecKHe Ha-
pyiueHHB, ycyry6jiaiomHe HapymeHHB KpoBOodpameHHB h Abixa-
hhb. CHHxcaioTCB h a p y ra e a#anTHBHbie cnoco6HOCTH opraHH3Ma:
CHM/KCHMC peHMH-aHrHOTCH3HHHOH aKTHBHOCTH, yMeHbmeHHe KOH-
tţeHTpauHH ajibflocTepoHa b imasMe KpoBH, h to npHBOAHT k rn n o -
BOJieMHH (yMeHbuieHHio QI1K) h ranepKajiHeMHH, a b coneTaHnn
yBejiHHHBaex pHCK HapymeHHH KpOBOoOpameHHB.
CiieayeT otmcthtb, hto hmchho Ha 3 T an e o n p o c a nponcxojţHT
ycTaHOBJieHHe KOHTaKxa «B p an -n aiţH eH T » .
TmaTeiibHbifi c6op aHaMHe3a no 3 BOJixeT bmbbhtb npo6jieMbi 3ao-
poBba nauneHTa h onpe^ejiaeT miaH CTOMaTOJiorHHecKoro jienemia,
o&beM KOToporo 6ya&T 3aBHceTb o t cTeneira pa3BHTHa conyTCTBy-
loiileft naTOJiorHH.
HaMH 6biJi npoBe^eH aHajins paOoTH 48 cTOMaTOJiorHnecKHx
KJ1HHHK (4500 HCTOpHH 6oJie3HH IiaiţHeHTOB B B03paCTe OT 18—87
JieT) pa3JIHHHbIX (j)OpM COOCTBCHHOCTH H pa3HBIX n o HIT3THOH HHC-
jieHHocTH Bpaqeft-CTOMaTOJioroB. Pe3yjibTaTbi CBHfleTejibCTByioT,
hto:

1. AHKeTHpOBaHHe (HCn0JIB30BaHHe OnpOCHHKOB) npHMeHXIOT-

ca b 50% H CC JieayeM bix
kjihhhk, H3 hhx o n p o chhkh npH M e-
HBJIHCb B 20% TOCyZţapCTBeHHblX, H 30% KOMMepHeCKHX.
2. B HCTOpHH 6ojie3hh b rpatfje «nepeHeceHHbie 3a6ojieBaHHa»
OTMenaiOTCx: npocTyzţHwe 3a6ojieBaHHB — 71,2%; rpH im —
45,3%; fleTCKHe hh^ckuhh — 24,2%; flHaOeT — 18,7%;
HH(J>apKT MHOKap^a — 2,5 %; rHnepTOHHHecicaa 6ojie3Hb —
1, 2 %.

15
 AnanMa paCoTbi 4 8 cTOMaTO/iorMHOCKMX k/ ihhmk (4 5 0 0 mctopmm
6one3HM) paa/IMHHbIX CpOpM COCCTBeHHOCTH M pa3HblX
n o uiTaTHOM MMcneHHOCTM BpaMon-CTOMaTonoroB n o x a a a n :
71,2%—I—rr—— —

50% — IIpOBOAHT aHKC I MpOBaUHe 453% -r p .n H

B rpa<t>e
«nepeHeceHHue3iHontuinn»
nauHeHTbi ynounun
Ahhchmobs E.H., 2016

Puc. 2.1
A6cojiiotho oHeBH^HO, hto hh3khh irpoiţeHT OTMeneHmax conyrcrBy-
ronmx 3a6ojieBaHnn, b tom hhcjic cepaeHHo-cocyzţHcrwx, cBHZţerejn.cTBy-
er o HeBHHMarejiBHOM c6ope aHaMHesa BpanoM. IIo /ţaHHMM, ncwiyqeH-
hmm npo<|)eccopoM 3 . OaKKO (HTajnia), jiK>6bie HeorcioxcHLie cocto«hhh
MQ5KHOIipeflOTBpaTHTB TQţaTOJIBHLIMc6opOM 3HaMHeCTHHeCKHX ^aHHblX.

npoBe;ieHiie aHajiH3a B3aHMoaeăcTBwi npinvieHHeMOH

naiţHeHTOM JieicapcTBeHHOH r e p a in m co cpe^CTBaMH M e c m o ro
o6e36ojmBaHHH h c e i a n n n

Bojituioe KOJiHHecTBO conyrcTByiomHX 3a6ojieBaHHH BJieneT 3a co-

6oh nojiHnparMa3HK> — npneM 6ojibmoro KOjmnecTBa JieKapcTBeHHwx
npenapaTOB. B coBpeMeHHOH kjihhhhcckoh npaKTHKe nrapOKO Hcnojit-
3yioTca pa3JiHHHbie KOM6nHaipiH jieKapcTBeHHux cpe^cTB h hcoGocho-
BaHHoe oflHOBpeMeHHoe Ha3HaneHHe 6ojiee 5-th npenapaTOB /ym Jiene-
him o^Horo 3a6ojieBaHiM — oflHa H3 npoSneM coBpeMeHHOH Mejymn-
hm. IlojiHnparMa3iM nacTO «BJMeTca npHHHHOH pa3BHTiM He6jiaronpn-
Hmoro B3aHM03encTBHB JieKapcTBeHHLix cpeflCTB. Ilpn npHeMe 8-mh
16
npenapoTos ocstoxnemin mmieaMemomcm lepasms Bcrpesawnrc*
y 10% 6ojibfaix, a npH fipnetce 16 — y 40% oaimeaioB [T o p ra n a
JI.A.. BapwiuHHKOBa HA.]. Anaiwi c;iyHaeB no;mnpan«a3WH b cTauno-
Hapax Mockbw noxaiax *tto oHa BCTpeHaeTc* b 25% caynaeB neHeHH*
[Crooua UIhx E.B].
Bee HcnojiKjyeKMe nasmemoH ^apMamionroecxHe npenaparni
J0.12JHH 6i>rn> BHecenu b Hcropmo Ooseam. Bbioop mcttojob c e »
mm h MecTHoro o6e36ojiHBaHHa onpejejiaeres Ha ocHOBamm aaajnoa
hx B3aHMOneHCTBHX c tcmh iieKapciBCHHUMH npenaparraMH. nnopue
npHHHMaeT naiineHT npw aeneHHH con\TCTBVToiiiHx la&xnesaHHH. Bpa-
qa-CTOMaTOJiora oonxea mnepecoeaTb seeb nepeseHb jiexapcrBeHHUx
npenapaTOB. Koropwe b iiaHHHH momcht npwHHMaer naiiweHT.
TmaTCJILHMH c6 op aHHMHe3a H aHaJIH3 roaHMOaeHCIBHB B03 M0 K-
Horo HeraiHBHoro B3aHMO^eHCTBH« jienapciBeiraux npenaparroB co
qjeacTBaMH o6e36ouiHBaHHx h ceaauHH no3BOJiHT moexan» rocejiux
oOniecoMamqecKHx ocnoxHeHHH bo Bpe»oi CTOMaTQJiorHHecxDro npH-
eMa. Ho CTOHTnoMHHTb, hto nanaeHT He Bceraa yiomreaeT na HanHHHe
y Hero paHee ^HamocmpoBaHHHx 3a6oneBaHHjL
npH Hcnojn>30BaHHH MeemoaHecxe3HpyK)mero pacTBopa c Ba30-
KDHcrpHKTopoM (name Bcero airaHeifopHHOM) y nauneHra, npHHHMa-
tomero 6era-6jiOKaTopbi, bo3mo*ch non&eM aprepHajibHoro aaBJie-
HHa H3-3a CHHXeHHB mnOteH3HBHOrO 3(JxJ)eKTa- CHMnaTOMHMeTHXH
(KapeeflHJioa, onoKCH(j>eHOKCHMeTHJi, MemnoKeajţHasoji) ocjia6junor
3$$eKT ajiwJja- h 6era- aapeHo&ioxaTopoB. Ilpenapara H3 rpynnu
AHyperHKOB ocjia6junor aeifCTBHe Ba30K0HCTpHKT0pa, *rro Moacer
HpHBeCTH X yMeHbnieHHK) 3<f)<f)eKTHBHOCTH H aJIHTCJIbHOCTH MeCTHO-
ro aHeereTHKa. npH o/ţHOBpeMeHHOMnpHMeHeHHH 1,4-jţnrHapoiiHpH-
JţHHbl (HH^eAHnHH, HHTpeHHHUHH, HHKap^HHHH H XJţ.) C CHMHaTOMH-
MeTHKaMH BC3M05KHO yMeHbineHHe aHTHrHnepreH3HBHoro aeăcTBjw
BcaeacTBHe 3a,aepacKH Harpna. IIpH Hcnom>30BaHHH anase^pim a
OAHOBpeMeHHO CKapAHOTOHHHeCKHMH Cpe^ICTBâMH (îţOnaMHHOM,
HHB3<j)pHH) B03pacraer pHCK pa3BHTHft apHTMHH. Heo6xQQHMO yHH-
THBan» npneM aHTHapHTMHHecxHx npenaparoB (^htokchh). Tax xax
aapeHOMHMeTHKH Tax 3xe yBejiHHHBaioT Bepoareocrb pa3BHTHa aperr-
mhh [AHHCHMOBa E.H. PasainţeB H.A., OpexoBa H.B.].
HpneM namieHTOMpaaJIHHHWXHeHpOJieHTHMOB, TpaHKBHJIH3aTOpOB,
CHOTBopHbix h aHKCHOJiHTHKOBnpe^piojiaraeT OCTOpOaCHUH Bu6op Me-
17 CJ
TOflOB H Cpe^CTB flflSl MeCTHOH aHCCTC3HH. TaK, AponepHAOJI H rmtpOK-
ch3hh cHHacaiOT npeccopHoe rchctbhc 3nHHe<j>pHHa, xjiopnpoMa3HH
ycHJiHBaeT aencTBHe MecTHbix aHecTeniKOB. OjiyneHTHKCOJi npH o,n-
HOBpeMeHHOM Hcnojib30BaHHH c 3nHHe<j)pnHOM Moacer Bbi3Barb pe3Koe
na^emie aprepnajibHOFO #aBJieHHH [Ahhchmobb E.H., Ephjihh E.A.].
y 60JIbLUHHCTBa aHTHKOaryJlHHTHLIX JieKapCTBeHHLIX Cpe^CTB He
onncaH O hx B3anMO,qeHCTBHe c Ba3 0 KOHCTpHKTopaMH, ho npH coneraH-
hom npHMeHeHHH Bap4>apHHa c JiH#OKanHOM yBejiHHHBaerca phck pa3-
bhthb KpOBoreHeHHB [MaKCHMOBa M .K )., P »3aHHeB H .A .] .
Ecjih naiţHeirr npHHHMaeT aHTHKoaryjiaHTH, to 3<jHj>eKT oueHHBajOT
c noMombio MeayjyHapoflHoro HopMajm30BaHHoro oTHOuieHHa (MHO).
Ecjih 3HaneHHe MHO MeHbine hjih paBHO 2.0, bo3mojkho npoBejieHHe
CTOMaxojiorHHecKoro JieneHHa. npH 3HaneHHH MHO Oojibme 3,0 —
HeoOxoAHMa KOHcynbTauna c jienamHM BpanoM o bo3mo>khocth chh-
aceHHH ao3bi aHTHKoaryjMHTOB j^isl flocrraaceHHa 3HaneHHH MeHee 3,0.
Ecjih jieHanţHH Bpan flejiaer 3aKjHOHeHHe o tom, h to H3MeHeHH2 b npH-
eMe aHTHKoaryjwHTOB HCB03MoacHbi, to jieneHHe npoBO/ţHTca 6e3 chh-
JKCHHH A03LI, TaK KaK pHCKH, CBH3aHHbie C B03MOJKHOCTBIO HOBTOpHblX
HHCyjILTOB 3HaHHTeJIbHO BblHie, HCMpHCKH, CBH3aHHbIC C KpOBOTCHCHH-
hmh [MaKCHMOBa M.K)., PiraamieB H.A.].
B 3aBHCHMOCTH or pe3yjibTaTOB KOHTeHTHoro aHajiH3a onpe^ejiaerca
BbiOop npenapaTOB fljia cejţaiiHH h Mecraoro o6e36ojiHBaHHa, KoropbiH
no3BOJiHT H36eacaTb HeoTJioacHbix coctohhhh b ycjiOBHax aMOyjiarop-
Horo CTOMaTOJiorHHecKoro npneMa.

OnpeaejieHHe <|>yHKiiHOHajibHoro coctohhhh nauneura nepea

CTOMaTOJIOrHHeCKHM BMemaTeJIbCTBOM
BHe 3aBHCHMOCTH OT H3JIHHHH HJIH OTCyTCTBHH COIiyTCTByiOIIţeH na-
TOJiorHH BceM naiţHeHTaM HeoOxo^HMa oiţemca (JjyHKiiHOHajibHoro co-
ctobhhh nepeji iipneMOM CTOMaTOJiora, BKJnonaiomaji 3Kcnpecc-oiţeincy
aprepnajibHoro naBnemw (A/Q h onpeaejieHHe nacTOTbi cepneqHtix
coKpanţeHHH (HCC).
MemoduKa onpedenemm AJJ
Toro, htoObi onpe^eJiHTb noKa3aTeJiH aprepnajibHoro flasneinw
h nacTOTy cep/ţeHHbix coKpameHHH caMbiM npocTbiM h aociyraibiM ay-
CKyjibTaTHBHbiMbiM MeTOflOM no H.C. KoponcoBy CTOMaTOJiory norpe-
6yerca He 6ojiee 5-th MHHyr. ^onycKaeTca npHMeHeHHe aBTOM3TH3H-
D> 18
 pOB&HHbIX (ayCKyjlbTffTHBHWX HJ1H OCUHJUIOMeTpHHCCfCHX) rtpn6opOB,
HO TOJIbKO B Tex CJiyHaflX, Koma HX TOHHOCTb B KJIHHMHCCHOtil npBKTHKC
noATBepjKAena b cn eiw ajib H u x Hccjic/ioBaHHHx [E.H.MaaoB]. B coepe-
MeHHbix icjiHHHKax nofloOnbic annaparu ycraHaanHBaiorrc* b CMorpOBOM
KaGuncTc hjih n p n Bxo^e b KJiHHHKy. lloJiyHeHHue pexyjibTarrbi mohcho
BHecTH b HCTopmo 6ojie3HH. riauHcuraM, noica3arrejiH aprepHanbHoro
^aBJieHHB KDTOpbix npeBbimaiOT HopMy, ruiaHOBoe CTOMamnoiunecicoe
jieneHHe peKOMeimoBano orjiowHTb [AHHCHMOBa E.H. c coaar.], a hcot-
jioxcHyio CTOMaronorHHecKyK) noMoim» peKOMetmoBano oKaibiBarb n o
cue KOppeKqHH aprepnajibHoro naBJieHHJi [AHHCHMOBa E.H., c coaerr.].
ripoBefleHHbie HccjieaoBaHHH c iţejibio BbiaaneHHa nacrorbi Bcrpena-
eMOCTH nanneHTOB c AT Ha aM6yjiaropHOM CTOMaTonorHHecKOM np«-
eMe y 1590 naiţneHTOB b B03pacTe or 18-85 Jier, hx hhx 730 mjokhhh
h 860 xceHiiţHH noKa3ajiH, hto Ha XHpyprHnecKOM cTOMaranortPiecKOM
npHeMe noKa3aTejiH aprepHaJibHoro /ţaBJieHHx: CA/ţ>140 mm pr. ct. h
AAA >90 m m . pT. ct. BCTpenaiOTca y 75% naimeHTOB (pwc. 2.2) [AHH­
CHMOBa E.H., AaBtWOBa C.C., OpexoBa H.B.]. Ha TepaneBTHnecicoM
npHeMe nepe# 0Ka3aHweM luiaHOBOH cTOMaTOJionwecKoft noMomH,
noKa3aTejiH aprepHaJibHoro flaBJieHHa: CAA^140 mm pr. ct. h AAA
>90 m m pr. ct. OTMeHeHbi y 34,6% nauneHTOB, a nepe# HeorjioacHbiM
CTOMaxojiorHHecKHM BMemarejibCTBOM y 65,9% naiţHeHTOB 6buio 3a-
perHCTpHpoBaHo noBumeHne noKa3arejieH aprepHaJibHoro ziaBJieHHH.
Ha oproneflHHecKOM cxoMaTOJiorHHecKOM npHeMe noBbimeHHe noKa3a-
TejieH aprepHaJibHoro ^aBJieHHa 6 bijio bmabjicho y 29,5% naimeHTOB
[OpexoBa H.B., AHHCHMOBa E.H., AaB^WOBa C.C., P»3aHueB H.A.].
OproneaHHecKHH CTOMarojiorHHecKHH 29,50%
npneM
TepaneBTHHecKHH CTOMaTOJiorHHecKHH
65,90%
npneM (HeoTJioHCHaa noMonţb)
TepaneBTHHecKHH cTOMarojiorHHecKOH
34,40%
npHeM (nnaHOBaa noMomb)
XHpyprHHecKHHcTOMffrcuiorHHecKHfi
npneM
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
■ IlaiţHeHTbi c noKa3aTejntMH aprepH&robHoro flaBJieHiw CAJţil40 mm pr.CT. u
/PVl >90 MM.pr.CT.
Puc. 2.2. IJcnţueHmbi c noKasamejismu apmepucuibHOZo daenenun CAff>140 mmpm.
cm. u /JAJJ >90 mmpm. cm.
19 CD
 Onpedeneme uacmomu cepdeHHbix coKpaufenuu (HCC)
OnpefleneHHe HCC npoBOAflT no oneHKe nyjibcaiţHH Ha JiyneBOH ap-
TepHH neBOH pyKH KOHHHKaMHII, III h IV najibiţeB, oxBarbiBaa npaBon
pyKOH pyny naiţneHTa b oOnacTH jiynesaiwcTHoro cycTaBa. Ilocjie o6>
Hapyacemra nyjibcnpyiomeH JiyneBOH apTepHH onpe^ejiaioT cbohctbs
aprepHanbHoro nyjibca: nacTOTy yaapOB b MHHyry, phtmhhhoctb, Ha-
npaaceHHe, HanojiHeHHe, BejiHHHHy. HacTora nyjibca MeHbrne, neM 60
yzţapOB b MHHyTy pacneHHBaeTca KaKOpaAHKapAHa, a nacrora or 90 ao
120 yzţapoB b MHHyry KaKTaxHKapAHa.
J\jw nanHemoB, crpaAaiomHx caxapHbiMAnaOeroM, b nporoKon onemai
hx (J)H3HKajibHorococroamra b aM6ynaropHbix ycjiOBHax bxoaht onpeAene-
HHe ypoBHs nnoK03bi b kpobh c noMoiubK) pa3JiHHHbix npnOopoB — nno-
KOMerpoB, Koropbie Moryr 6brn> KaKb kjihhhkc. Tax h c co6oh y naiţHeHTa.
Ecjih naiţHeHT npHHHMaeT aHTHKoaryjiaHTbi h/hjih aHTHarperambi, to
nepeA xHpypraqecKHM CTOMaTOJioruHeckhm BMemarejibCTBOM peKOMeH-
AyeTca b ycjiOBHax aMOynaropHoro croMarojiorHHecKoro npweMa onpe-
AejiaTb noKa3arejiH CBepTbreamia KpOBH (MeayţyHapOAHoe HopMajiH30-
BaHHoe oTHomeHHe — MHO).
TaKHM o6pa30M, c nejibio npo(J)HjiaKTHKH HecrnioacHbix coctohhhh
nepeA CTOMarojiorHHecKHM npneMOM o6»3arejn>Hi>iM ycjiOBHeM aBJiaeT-
ca onpeAejieHHe (j)yHKu,HOHajibHoro cocToaHHa nanneHTa.
Konmpojib zeModuHcmuHecKux noKa3amejieu:
Bo BpeMfl npOBeAeHHa CTOMarojiorHHecKHX BMemarejibCTB y nainieH-
tob c conyTCTByiomeH naiojiornen peKOMeHAyeTca MOHHropnpoBaHHe
reMOAHHaMHnecKHx noKa3aTeneH. C 3toh nejibio MoaceTHcnojib30Ban»ca
nyjibcoKCHMerp, TOHOMeTp (pnc. 2.3) hjih OTAejibHbiH mohhtop, npeAHa-
3HaneHHbiH juw npoBeAemia aHecTe3HOJiorHnecKoro noco6na (pnc. 2.4).

Puc. 2.3. HsAtepenue Puc. 2.4. MoHumopupoeanue zeModuHOMuneacux

apmepucuibHozo daejienm noK03ameneu npu oko3ohuu cmoMamonozunecmii
MexammecKUM moHOMempoM noMOupi e audynamopubix ycjioemx
o 20
 Am uţiri pnSoTht 4 8 - mh croNtarojionmccKitx kjihhhk (45(H) mcrop mii
Gojicbhh naiiHOHTOB » Hoipuero o r 18 -87 jict) pauiiniiihix tjnipM eo6-
cibchhocth u p aiuuix n o m n n iio ii hhcjichhocth BpaMCH-croMaTonoroB
uoKauuu hto oupcjicjiem ic (ţtyHKiutoiuuthiioro cocToami» itam tcirra
tieptvv cim iaiwuonm ecK HM bmouihtcjihcthom hcxoahmc noKa wrrc-
jiii AJ\%4CC \ unoKOtw u MHO — ohuui 3&hccchu b iiccjic; iohuhiii.ic
ucToptiti 6 ojig3HH rcuiuKo a cjiynne jicmchhh lum nem a cobmcctho c
auec ix'auojioroM (1 0 % cjiy'iaea).

Kjiaccii4>HKaiţiiH a iie c rc m o.toiim ecK oro pitCKâ ASA

lip ii jicmchhh namicHTOB c o6mecoMaTHMecKoii naToaonteil y c to -
Ntaxojiora ne B03HHK&CT rpyuHOCTeii itptt iicnoiibiOBamoi pauntMHbix
COBpCMCHHMX rOXHOJIOnilt, HO B03HHKatOT BOTipOCbl 6e30naCH0CTH
otcasatma aMoyjuvropHovi noMomti.
y nam ictrroB c (ţnucTOpoM pucKa b aHaMHcae BpaH-CTOMamrior onpe-
Acjihct Heo6xoAHMocTb KOHcyjibTauiiH c JienamHM apaMOM namteHTa
(TepaneBTOM, HMMynojioroM h t j j . ) h ero ABJibneiluiero o6cneAOBamiH.
Ha ocHOBaHiiti noxtynenHUX a o h h h x o t cneuHanHCTOB Bpan-cxoMaTO-
jxor peiiiaex Bonpoc o m cctc otcasamifl CTOMaTOJiorHMecKofi iiomolhh
(b ycjiOBtiax MHoronporjiHJibHoro hjih cneuHajiHJHpoBaHHoro CTaiui-
onapa, im ii B ycjioBHHx aM6yjiaTopHoro croMaTOJioniMecicoro ynpexc-
ach h h ), orinpaacb na MeacAynapOAHyto KJWccvi(})HKai\mo aHecTeanono-
niMecKoro pucKa A SA , b tcoTopoil BbwejiatOT 5 tcnaccoB (ţmiHHectcoro
COCTOflHHH 1U1HHCHTOB.

M eJK dynapodnax KJiaccuipuKanuH

a n ec m m u m o m H ecK o so p u c m .45.-1

ypoeeilb
Kjiucc IlpHMep PeivOMeiuamiii
X’iopottbtt
1 SAopoBbiM nauH- Xopouiaa Hex ocoSbix
eHT. nepeHOCHMOCTb pe komch, umilii.
4>H3HHeCKHX
Harpy30K, oTcyrcTBHe
TpeBoru hjih Mana*
eâ BbipaaceHHOCTb,
HOpMajibHoe AJ\.

21 «CD
 2 Jlgnoie KoHTpojiHpyeMbiH A«a- ILiaHOBaa ctome-
CHCTeMHbie 6ct 2 rana, arauiencHa, TOJiorHHecKaa no-
3a6ojieBaHMa. acTMa, AHC^yHKHHa MOIHb, B03M0»CHa
HţHTOBHZţHOH JKeJie3bI, KOppeKuna iuiaHa
BbipaaceHHaa TpeBora, jieneHHa.
B03pacT cTaprne 60
jieT, SepeMeHHOCTb,
Manbie CHCTeMHbie
HapymeHHa, oacHpemie
(HMT>30), yMepemiaa
aprepHajibHaa ranep-
TeH3Ha (140-159/90-94
mm pr. CT.).

3 Taacenbie CHCTeM- CTaOnjibHaa creHOKap- ILiaHOBaa cto-

HLie 3a6ojieBaHHH, Ana; HH^apKT MHOKap- MarojiorHnecKaa
orpaHHHHBaio- Aa, M03ra b aHaMHe3e noMomb. KoHcynb-
nme aKTHBHOCTb (6ojiee 6 MecaneB); ah- TaiiHa cneunaJiH-
naimenra, ho He a6eT 1 rana; BA nocjie era no ocHOBHOMy
HHBajraAH3Hpyio- <J)H3HHeCKHX Harpy30K; npo(J)Hjno 3a6ojie-
mne ero. HeKoppeKrapyeMaa Bamia. Kom6hhh-
amuiencHa; cHMirroMa- poBaHHoe o6e36o-
THnecKaa AHC^ymcinia jmBaHHe.
ihhtobhahoh »cejie3bi;
AR 160-199/95-114
MMpT. CT.
4 3a6ojieBaHHH, hh- HecTa6HJibHaa ctcho- HeoTJioaaHaa hchh-
Bajffl,HH3HpyK)HţHe KapAHa; HH(J>apKT mho- Ba3HBHaa noMonţb.
SojibHoro h Hecy- KapAa, M03ra b aHaMHe- HHBa3HBHOe
H|He nOCTOHHHyiO 3e (MeHee 6 MecaneB); jieneHHe TOJibKo b
yrpo3y »ch3hh. HeKOHTpojiHpyeMbie ycjiOBHax eranHO-
cyAopoacHbie npnnaA- Hapa.
kh; AJX >200/>115 mm
pT. CT. -
5 IlaHHeHTbi, CHCTeMHbie IlajuiHaTHBHaa
KOTopwe Moryr 3a6ojieBaHHa noMouţb.
yMepeTbB B COCTOaHHH
TeneHHe 24 nacoB. ACKOMneHcaiţHH.

D> 22
 B aM6yjiaTopHbix yc/ioBHax boimcwkch npn£M naimeirroB 1-ro h
2-ro KJiaccoB. I Ipnt‘Mnanneimm 3-ro ftnacca b aMfynarropHux yc/ioBH-
xx peKOMeHAOBaHo npoBOAHTb c ynacTHCM aHccTerHo/iora [Malamed
Stanley F],

Pwc. 2.5. UlKcuia anecme3uojioeunecKOZO pucm ASA (no C. Majumedy)

KOHTpOJIb TpeBOJKHOCTH [laUMdlTa

BojiHeHHe, HanpajKeHHe, nepexoAamee b crpax nepeA BpanoM-CTO-
MaTOJioroM cHJibHee, neM nepeA BpanaMH Apyrwx cneimajibHOcrefi, h
Ha TO eCTb MHOHCeCTBO npHHHH. n o AaHHbIM pa3JIHHHNX 3BT0p0B, OKO-
jio 72% naiţHeHTOB ouiymaioT TpeBoxcHocTb h HacTopoxceHHOcn» nepeA
BH3HTOM K CTOMaTOJIOiy, a B 5% CJiyHaeB HdlblTblBaiOT CHJlbHeHIUHH
CTpax [AHHCHMOBa H.K).]. n o Mepe ycmiemw nyBCTBa CTpaxa yBejiH-
HHBaeTCH H HyBCTBHTeJIbHOCTb K 60JIH. 3TO npHBOAHT K H3MGHGHHK)
4>yHKUHH LţeHTpaJlbHOH H BereTaTHBHOH HepBHOH CHCTeM H K aKTHBa-
u,hh rHnoTanaMO-rHno(J)H3apHO-HaAnoHeHHHKOBOH chctcmm. B cbjkh
c 3THM MoaeeT npoHBHTbca aKTHBHoe norooTAejieHHe, ABHraTenbHoe
B036y»ACHHe, H3MeHeHne cepnenHoro pHTMa, noBbiineHHe KpOBBHoro
AaBJieHHa, npHBOAanţee k hihcmhh MHOKapAa, HapymeHHio M03roBoro
KpoBoo6pameHna h t.a .
Oco6eHHO ocipo Ha noAo6Hbie H3MeHeHna pearapyior nauneHTbi
c cooTBeTCTByiomeH conyTerayiomeH narojionieH b aHaMHe3e, no-
3TOMy KoppeKAHa AHCTpecca y tbkhx naiţneHTOB Heo6xoAHMa. Mm
npeAJiaraeM ncnxojiorHHecKHe (yHHBepcajibHoe Hcnojib30BaHHe npn
HaJIHHHH HaBbIKOB nCHXOJIOrHHeCKOIX) CHHXCeHHX TpeBOXCHOCTH), 4>ap-
23 «CD
 MaKOJioraqecKHe (n p n orcyTCTBHH aojihchoid KDHTaicra c naimeirroM
BbipajKeHHOM crp ax e h HeaceJiaHHH npeoflOJieBan» cBoe HanpaaceHHe) u
KOM6HHHpOBaHHbie Cn0 C0 6 w KOppeKUHH 3MOUHOHaJU»HOrO COCTOHHH*
nai^HCHTOB. IIp n bwcokoh CTeneHH BbipajKeHHocTH cTpaxa h Tpeson,
cTOMaTOJiorHHecKoe JieneHHe peKOMeHflyercx nposoflHTb c aHecre3H-
ojiorHHecKHM nocoSneM — no/* BHyrpHBeHHOH ce^aim ew c coxpaneH-
HMMC03 H3 HHeM [ÂHHCHMOBa H.K).].
^HaraocTHKy ^HCTpecca npOBOAHT annaparabiMH MeTO/ţaMH: npo-
rpaMMHO-annapaTHbiH komiuickc «nyjibC-AHTHcrpecc» perHcrpHpyer
h aHajiH3HpyeT napaMeTpbi nyjibcoBOH bojihbi, ypoBeHb crpecca no no-
Ka3aTejwM ajib(J)a-aMHJia3bi b cjuoHe onpe,zţejBnoT npndopoM «Coroco
metr». rionynapHOCTbio cpe^n cTOMarojioros nojn»3yiorca ncHxojiorH-
necKHe TecTbi: imcajia Ha BbiaBJieHHe CTOMaTO<j)o6HH Kopaxa h nncajia
CnHJi6eprepa-XaHHHa Ha onpe^ejieHHe cHiyamBHOH h jihhhocthoh
TpeBO^cHocTH naiţneHTa.
B KanecTBe <j)apMaKOJiorHnecKHX MeroflOB KOppeioţHH 3 MonHOHajib-
Horo cocto^hha naiţHeirra caMOCToaTejibHO BpanoM-CTOMaronoroM
Moiyr Ha3HaHaTbca ceflaraBHbie npenapaTbi pacnrrejibHoro npoHC-
xoayţeHHa, He BbBbiBaiomHe y naiţHeirra 3aBHCHMocm h BbipaaceHHbix
noSoHHbix aeHCTBHH. K TaKHM npenapaTaM mo»cho crraecTH nepceH,
HoBonaccHT, hbctohich BajiepnaHbi, IlycTbipHHKa, IlHOHa, a Taoce
KopBajioji, BanoKapAHH. 3HaHHTejn>Hyio 3<jxj>eKTHBHOCTb npn Kypco-
bom npneMe noKa3ajiH cejieKTHBHbiH aHKCHOJiHTHK A(|)o6a30Ji, ho o t-
ponHbie npenapaTbi OeHOTpomui, TeHOTeH — ohh TaioKe Hcnojib3yiOT-
cx o^HOKpaTHO nepe# npoBeflemieM nenemra. IIpenapaT rpamţaKCHH,
OTHOcanţHHca k rpyime aHKcuonuTHKOB, oSna^aeT hh3koh tokchhho-
CTbio h MoaceT CHH3HTB 3Mou,HOHajibHoe HanpiDKeHHe nanneHTa npn
o,zpiOKpaTHOM npneMe. ChyiejibHyio rpyniiy ceflaraBHbix cpe^CTB co-
cTaBJiaioT roMeonaTHHecKHe npenapaTbi HepBoxeJib, BanepnaHoxenb,
A^peHajiHH C30, cnocoSHbie cHH3HTb ypoBeHb cmyaTHBHOH TpeBoac-
h o c th [ÂHHCHMOBa E.H., racaHOBa 3.M., PjnamieB H.A.].
Hapmţy c <j>apMaKOJiorHHecKHMH MeTOjţaMH Bbicoxyio 3$ $ ckthb-
HOCTb noKa3aji ncnxojiornnecKHH Mero# KoppeicnHH TpeBomiocTH na-
HneHTOB MeTO^aMH noBe^eHnecKOH ncHxoTepannn [ÂHHCHMOBa E.H.,
ÂHHCHMOBa H.K).].
3HaHHTejibHO CHH3HTb ypoBeHb cHTyaTHBHOH TpeBoacHOCTH nepea
CTOMaTOJIOTHHeCKHM npHCMOM M05KCT HCn0JIb30BaHHe Cn0C06a MOTH-

C* 24
BaUHOHHOFO HHTCpBblOHpOBaHHJI, KOTAa BHC laBHCHMOCTH OT IKHXO-
jiorHHCCKoro cTaxyca naimeHTa npHMeiMfOTcji npHHUffnu npoxanemu
3MnaTHH, yCHJICHHB npOTHBOIIO/KWKHOCTH CyXACHHX, H36eraHfM co-
npOTHBJieHHa h noAAepxaHHa nojioxHTexibHcrfi caMooueHKH naiweii-
Ta, icor^a C03AacTC« 6naroîKeJiaxe,nbHaa h AOBepHTenbHaa aTM0C{|>epa
o6mcHH« Bpana-CTOMaTOJiora c TpeBOXHbiM nauHemroM [AHHCHMOBa
E.H., AHHCHMOBa H.K).].
Ha pHcyHKe 2.6 npeacTaBJieHbi pesyjibTaTbi cpaBHHTeubHbix nccue-
AOBaHHft (jjapMaKOJioranecKHX h ncHXonoranecKHX mctoaob KoppeK-
HHH ^HCTpecca, npoBe^eHHbie y 320 naimenTOB (145 MyxqHH h 175
xceHiiţHH) b B03pacTe OT 18 ^o 59 Jier c KOMneHcnpoBaHHOH 4>opMOH
HMeBiueiica narojioniH c hcxoaho cpeAHHM ypoBHeM cinyaTHBHOH
TpeBoacHocTH no imcane CnnjiSeprepa-XaHHHa. JXhhslmmksl ypoBHa ch-
TyaTHBHOH TpeBoacHOCTH naimeHTa ao npoBeAemw BMemarejibCTBa h
nepe3 50 MHHyT nocjie npOBeACHHOH KoppeioiHH aBjnuiacb KpHTepweM
3(j)(j)eKTHBHOCTH HCnOJIbSOBaHHfl pa3JIHHHHX CHOC06OB B 33BHCHMOCTH
OT noceineHHa. OapMamflornHecKaa Koppeioma npeAcraBJieHa npena-
paTOM A(J)o6a30Ji 10 mt nepeA npoBeAeroieM BMemarejibCTBa, ncnxojio-
rHHecKaa — MeTOAaMH noBeACHwecKon ncHxorepaimH h MOTHBaimoH-
HOTO HHTepBblOHpOBaHHa.

■ 1 nocememe
■ le noceiqeHHe nepe3 50 to
» 2e noceiueHHe
■ 2e nocemeHHe nepe3 50 to
■ 3e noceiqeHHe
■ 3e noceiqeHHe nepe3 50 to

Puc. 2.6. fluHOMUKa cumyamuenou mpeeoDtcHocmu nmfueHmoe no uuaue

Cmui6epzepa-XaHUHa npu ucnonhsoeanuu pauiunubix cnocodoe Koppaapm
ducmpecca e 3aeucuMocmu om noceufetmu

25 <□
 JJflR ycneniHoro B3anMojţeiicTBHa Bpana-CTOMarojiora c namfenroM
ncHxoJiorHHecKHe MeTOAbi cHHHceHHa HanpaaceHHa M oryr ekthbho
npHMeHHTbca Ha 3Tane c6opa aHaMHe3a, xoraa ycraHaBJiHBaioTCH aoBe-
pHTejibHwe oTHOineHHa h nauneHT, nyBCTBya ce6a b 6e3onacHOCTH, #e-
JIHTCH CBOHMH HyBCTBBMH H OnaCCHHBMH, HTO 3HaHHTeJIbHO nOflaBIWeT
pHCK HeOTJIOJKHbIX COCTOflHHH.

KOHTpOJlb HHTeHCHBHOCTH 60JIH.

Bbi6op MecTHoro o6e36oJiHBaHHH
3(J)$eKTHBH0CTb h 6e3onacHOCTb MecTHoro o6e36oJiHBamw 33bh-
cht xaK ot npaBHJibHoro Bbi6opa MecTHoaHecre3Hpyiomero pacraopa,
Tax h ot cnoco6a ero BBefleima b tkbhh HejiKxrmo-JiHijeBOH oGnacTH.
CnejiyeT yHHTbiBara CTeneHb 6ojie3HeHHOCTH, o6i>eM h npoflOJiaarrejiL-
HOCTb npOBO^HMBIX CTOMaTOJIOrHHeCXHX BMefflaTCJIbCTB, Tax xax BM-
nojiHeHHe caMbix cnoacHbix BpaneSHbix MaHraiynaijHH bo3mobcho tojib-
xo b ycJiOBHHX xoM(J)opTa h 6e3onacHocTH naipieHTa.
3<J)<j>eXTHBH0CTb MeCTHOH aHeCTC3HH MOÎKHO OHCHHTb CyGbeXTHBHO
c noMombio aHajioro-BH3yajibHbix rnxaji h o&bexTHBHO — MeroflaMH
(jjyHXIţHOHaJlbHOH AHarHOCTHXH [AHHCHMOBa E.H., Coxob C.T.].
TpazţHiţHOHHO 6e3onacHOCTb Hcnojn»3yeMoro o6e36ojiHBaHHa ae-
MOHCTpHpyeTca onpe,n;ejieHHeM hcxoahofo 4>yHxiţHOHajibHoro cocroa-
hha naiţneHTa #0 npOBe^eHna BMemaTejibCTBa h MOHHTopHpoBaHHeM
reMOAHHaMHHecxHx noxa3aTejieH bo BpeMa Jienemis [Ahhchmobb E.H.,
OpexoBa H.B., Coxob C.T., Pa3aHiţeB H.A.].
IlpenapaTaMH BbiSopa y naiţneHTOB c conyrcrayiomeH narojiorHeii
6ynyr aHeCTe3HpyK)mHe pacTBOpu c hh3koh tokchhhoctbk) h bmcoxoh
cxopocTbio MeTa6ojiH3Ma (apTHxaHH, MeiiHBaxaHH, jumoxami). Eojib-
moe 3HaneHHe HMeeT kojiuhcctbo Hcnojn»3yeMoro npenapaTa — Max-
cHManbHo AonycTHMaa ,503a onpe^ejiaeTca c yneTOM Toro (fjaxra, hto
y naiţHeHTOB o t 70 jieT Hcnojn>3yK)T 2/3 MaxcHMajibHo flonyciHMOH
,s[03bi, a o t 80 JieT — 1/2 MaxcHMajibHo AonycniMOH 503M.
H3MeHeHHa co cropOHbi cepaeHHo-cocyAHCTOH chctcm h Moryr bo3-
HHxaTb H3-3a Toro, h to b cocTaB MecTHOo6e36ojiHBaiomero pacraopa
BXOflHT Ba30X0HCTpHXT0p 3IIHHe<j>pHH, BHyTpHCOCyZţHCTOe BBeaemie
xoroporo npHBOflHT x naTOJiorHHecxHM H3MeHeHHaM. Ho mhoidhhc-
jieHHbiMH Hccjie^oBaHHaMH E.H. Ahhchmoboh 6ujio noxa3aHO, ana
3(J)4)exTHBHoro o6e36ojiHBaHHa BMeniaTejibcra Ha TBepAbix TxaHax h
O 26
nyjiMie syfxm hcoBxojmuo hhjmhht wimmcvfmnujm • n n w poo-
TBopa mcctkojo ancei enuca lAnwe**cwa E Ji, Imrnrrrr* HJO > »
tom mtcjie h y naiwcmo* c pm**.
Bun npotejiCH epamummmM mamr* m Bern-
nacHOCTH Hcnonk'iomHH* itcmmncnrmfiy w im t vpruapnm *4%
pacTBop aprMKaHHa c * 3% p o rn o ? n r— i
KaHHa) H MX CJIOCOGOB WpOiWJWWMOOOflQ y MKl^-
HCTCJIJOCTHOr0 OTBCpciMX M Mo>iM4wMMpoeai»*pro ■app J OOiaaMWWO
[AHHCHMOBa E,H„ c coam,J obcachm* y 1250 moKfonoo or 42 j» C2
jict; M3h h x 760 MyxmMH h 490 neamm c cfpmnmx o cywtcmk mam
jioniefi (Ar, nepcHeceHHue Hucynvr h wdpapKi, cTcworiipaw, tftC}.
noMynennwe pe3y;u>TaTH/maom'in o6oc»OKnnfc »o6op mcmmm
Qfi&zftojimmm y naunefiTOB c 4^«rropoMpneica:
—JlencHHe h ym^CHHC3y0oBHasepxifdf i &wktu mmsnamomdtm^
rnocrn bo (j)poHTajibHOMoijutnc pemmm&mauo npomKorrb c mcmom-
30B&HHCM 4% paCTBOpa apTHKaUHa C Ba30«CWCTp«eT0p0M fc â M ii
noa HH^HJIbTpaUMOHHUMCJIOC060M06d 60JUtBama MCMOpOCTHOMe>
JlCHm — 1 MJl/UHH,
B b i6op M ecTHoro oSeaftofiwBaHMJi
y nai4M0HTOB c cpatcropoM pMcica
JleneH Ke h yAaxieHue 3 y 6 o s
Ha BepxHeM H e m o cn i h HMXHeM
BO (jjpOHTailbHOM oTAene

CKOpoCTb
M H 4)M /1bTpa-
BoeneHuti
LlMOHHblM 1 MJl
M e TOA B MMHyTy

E H , 2017

43
 — JleneHHe h yaarreHHe MOJiapOB Ha hhtkhch hcjiiocth peKOMeu-
MOBaHo npoBOflHTb nocjie Hcnojib30BaHH« npoBOAHHKOBoro cnoco6a y
HHJKHeHejiiocTHoro OTBepcnw c o6fl3aTejibHbiM npoBeneHneM acirapa-
iţHOHHOH npo6bi npenapaTOM 6e3 Ba30KOHCTpHKropa — 3% pacrBopoM
MenHBaicaHHa co CKopocn»io BBe,zţeHHJi npenapaTa 1 mji/mhh. noBume-
HHe 3(j)<j)eKTHBHOCTH 06e360JIHBaHHJI flOCTHraeTCH napOJIOHTaJIbHMM
MeTO^OM BBe^eHHH 4% pacTBopa apTHxaHHa c Ba3OKOHcrrpHKT0p0M
1:200000.
Bbi6op M ecTHoro o6e36ojiwBaHM* y naupieHTOB
c cpaKTopoM pMcxa
JleseHiie my/ţaneHiie moubpob
Ha HMJKHeMWeJIlOCTM

riapoiaoHTajibHbiM
MeTOfl

E. N. Anisimova, AA. Bukengolts, 2015): the patent for the invention N a 2424002 “A method o f local anaesthesia for lower molar teeth
treatment without pathology o f periodontal disease” July 20,2011. Co-authored with N. Y. Anisimova, YL. Vasilyev; E.V Oleynikova, A A .
Bukengolts, G. S. Nikolaeva. - show efficiency and safety o f designed periodontal anaesthesia use for loner molar teeth treatment, including
periodontal disease in I and II Classes on therapeutic dental treatment o f caries and its complications.
A hhchmoba EJH., 2017

Heo6xqzţHMO noMHHTb, hto cpe/ţn scex o6 mnx ocnomiemiH, bo3hh-

KaiomHx #o, bo Bpem h nocjie CTOMaTOJiornHecKoro jieneHHJi, caMbm
bhcokhh npoiţeHT — 54,9% — npoHexoflHT nocjie npOBeaeinw hht>-
eiciţHH MecTHOo6 e36ojiHBaiomero npenapaTa [Matsuura H.]. A Beposrr-
HOCTb MeCTHbIX OCJIOHCHeHHH B03MO)KHa B 34,4%, B TOM HHCJIC H3-3a
aHTHcenTHKH (a6 ctţecc, (})jierMOHa) — 2,8%; TexHHnecKOH Bpane6 HOH
oihh6kh (BHyrpHCOcyaHCToe BBeaeHne, nepefl03HpoBica, onm6 onHoe
BBe^eHHe Apyroro npenapaTa) — 6%; HenpaBHJibHon tcxhhkh npOBe-
flemra o6e36ojiHBaHHa (reMaroMa, mneMiw, TpH3M, HeBpHT, nT03 n t&)
— 11,6 % [AnpaneTBH C.M., Coxob C.T.].

D 28
 B e p O fIT H O C T ft» O CflO M CH eH M M M e c T H o r o
o 6 e 3 6 o iiM B a H M fi
34 , 4 %
11, 6%

AâpaneTOH C.M., Coxob C.T. 2011

C o ic p a u ţe H M e p u c ic a B p a n e â H b i x

ouim 6o k
(C o x o b C .T ., 2 0 1 5 )

PeeyjiHpubiu paioop cjiojtcnbix 22,6%

cjiynaee na KompepeHiţunx

OdmameJibHOcmb
donojiHumejibHOZo odynenux
25,1 %
Pezyjixpnoe noebiiuenue
Keanu(pUKaiiUU cneiţuajiucmoe
25,4 %
Tlojinoma coopa anoMneia,
ncuxojiozuuecKOH KoppeKUfiw ■■ 25, 8 %
ducmpecca, adeneamnan oiţenna
pucKoe

29 a
 CnrraeM HerâxojţHMtiM HanoMHim» [AmfCHMOBa E.H.], hto hc-
nonb3osauHe 4% pacTBopa apTHKaHna c amme^puHOM b KOHixeHTpa-
ijh h 1:200000 no3BOJineT npaKTHMecKH 6e36ojie3HeHHO npoBOflHTb Bce
croMamnormecicHe BMemarejibCTBa AJHrrenBHOCTbio mo 40 MHHyr.
rioBumeroie KOHuempamoi aapeHajiHHa b 4% pacrreope apraxaHHa
mo 1:100000 He npHBOAHJio k flOCTOBepHOMy noBumeHHio 3<j)(j)eKTHB>
HOCTH o6 e 36oJIHBaHH», a CTOHKHH 3(j)(})eKT HHICMHH TKEHeH CJIH3HCTOH
o6ojio*noi ajiLBeojiapHoro orpocnca, napojtoîrra. nyjitnu jmnn> npo-
jioHTHpyer aHecTe3Hio. IIoaroMy Hcnoni>30BaHHe KOHHeHTpauHH Baso-
KDHCTpHKTOpa 1:100000 b 4% paciBOpe apnncaHHa SBJiaeTC» HeoSa-
3aTejiLHWM — CTOMaronora H3 crpaH EsponBi b CBoen kjihhhhcckoh
npaKTHKe Hcnoan>3yioT ero b 0-8% cjiynaeB. CroMarronorH Pocchh, k
OoHBfflOMy HameMy coacajieHmo, iipej^nonuraiorr ero BceM jţpyrHM Me-
CToaHecresHpyiomHM npenaparaM BHe 3aBHCHMOCTH or ^aceHeHpHKa.
IIpHMeHeHHe KOHueHTpamm snime^piiHa 1:100000 b npenaparrax 4%
apTHKaHHa cocraBJiser or 80-95%, hto b cjiynae oKa3aHHs croMarojio-
nraecKOH noM onţa naiţHeHTaM c ^asropoM p n c s a He/ţonycTHMO.
H ecM O Tpa Ha HajiHHHe ocjiomieHHH n p s Hcnojn»30BaHHH Mecraoro
o6e36ojiHBaHH» kmk Mecmoro, Tax h oomero xapaicrepa, Heo6xo;ţHMO
noHHMan», h to OTcyrcrBHe aaeKBamoro o6e36ojiHBaHH» y nauneHTOB
c conyrcTByiomeH naronomeH He MeHee onacHO h moxcct noBneat 3a
c o 6 o h p a 3BHT«e ocjioacHeHHH 3a c n e x cTpeccoBoă peaiomn opraHH3Ma
Ha6ojn>.
TaKHM o6pa30M, npoBejeHHbie HCCJieflOBaHH» noKasMBaror, h to c to -
MarojiorHHecKoe jieneHHe narţacnroB c conyrcTByiomeH naroJiorneH
Mosseî 6tm> 6e3onacHtiM npn BbinojmeHHH cjiejiyiomero ajiropHTMa
(pnc. 2.7):

C!> 30
 CEOP AHAMHE3A
(aHKrrapoBaMHe n onpoc)

KOHTEHTHWH AHAJIH3
npHMefliieMux naiweHTOw npenaparos co
cpe^cTBaMH MecxHoro o6eidaiRBaHif h c e ja n i

OUEHKA *tyHKUHOHA-lbHOrO COCTOflHHfl

(8 3 MepeHHe A&
HCC, Hit, MHO, ypoBH» r.ii0K03Bi b KpOBi)

OHPEiţEJIEHHE B03M05KH0CTH JTEHEHHH

(aMfiyjiaropHoe hjih eramioHapHoe iienemie - no nnoLie ASA)

KOPPEKIţHH TPEBO/KHOCTH
(^apMaKOJiorHHecKHe, ncHxojionnecKHe e KOMOHHHpoBaHHwe
Meiiwu)

BWBOP MECTHOFO OBE3BOUIHBAHHH

(HH(J)H.lI>TpanHOHHOrO, npOBOJHHKOBOrO HJIH
napojOHTa.ibHbix MeTojOB o6e30o.iHBaHHH)

MOHHTOPHPOBAHHE Afl, H HCC

(oueHKa reMOjHHa.MHHecKHx noraiaTejieH nanHenra b
nenpepuBHOM peacHMe)

Puc. 2.7. CxeMa amoptanMa

31 a
 ^pyrHM, He MeHee BaxcHbiM acneKTOM, aanweTca ocHameunocmb
cmoMamojiozunecKozo Kadunema cjie/iameH h JieneOHOH armaparypoH
h JieKapCTBeHHWMH npenapaTaMH. MoHHTopHoe HadjiiqqeHHe 3a cocto-
HHHeM nauţHeHTa aojdkho 6wtb npaBHJiOM, ocoOeHHo y no^auiHx na-
HHeHTOB C OTaromeHHbIM aHaMHe30M. MOHHTOpHHT AOJI5KCH BKJiman
noKa3aTejiH apTepnajibHoro AaBJieHiw, nacTorw cepjţenHux coKpame-
hhh, 4>OTOiuieTH3MorpaMMy (OnT) c HH^opManneH o HacbimeHHH
reMoraoSHHa khcjiopoaom. HajiHHue (J)OTOiuieTH3MorpaMMbi aaer bo3>
MOJKHOCTb ObICTpO COpHeHTHpOBaTbCA B COCTOBHHH COCyZţHCTOrO pyC-
Jia: cmoKeroie aMiuiHTyzţbi OIIT CBH^eTejitcTByeT o cna3Me cocyuoB,
a yBejiHHeHHe — o pacmHpeHHH cocyzţoB. Ora HH^pMaipia noMoacer
6wcTpo oneHHTb npHHHHy H3MeHeHHH aprepHajiLHoro AaBJieHHB.
^CenaTejiLHo oOecneneHHe CTOMarojiorHHecKoro otacjichim (hjih
Ka6HHeTa) TpaHcnoprabiM annapaTOM zyia noAnepacamM BeHTHJi»imn
JierKHx. B annapaTe HMeeTca KHCJiopoAHbin 6ajuiOH, jiHtţeBaa MacKa
/pis HHrajMHHH KHCJiopo^a h ^BixaTejibHbiH MernoK p n nposeAernw
npHHyzţHTejibHoro (BcnoMorarejibHoro) ^bixaHHa npH ero HapyuieHHsx
HJIH OCTaHOBKe.
B ocHaiiţeHHe coBpeMeHHbix CTOMarojiorHHecKHx oxzţejieHHH aoji-
JKeH 6bITb BKJIIOHeH aBTOMaTHHeCKHH ^e(j)H6pHJIJIHTOp. PaHHee HCnOJIb-
30BaHHe ,zţe4)H6pHJijMHHH npH OCTaHOBKe cepzma MoaceT 6trn> pernaio-
IHHM (J)aKTOpOM B HCXOfle KJIHHHHeCKOH CMepTH.
JleKapcTBeHHbie npenapaTbi ajw 3KCTpeHHoro HcnoJib30BaHHa aojek-
hh BKJHonaTb Ba3onpeccopbi (aApeHajiHH, HopaApeHajiHH, AO(J>aMHH,
Me3aTOH) H Ba30AHJMTaT0pbI (HHTporJIHLţepHH, KanTOnpHJI, KOpHH(j)ap,
KJio4>ejiHH), KopTHKOCTepOHAM (npeAHH30Ji0H, rHApOKopTH30H, Aexca-
30H, MeranpeA), pacTBOp rAK)K03bi — 20% hjih 40%, iuia3M03aMemaio-
mne pacTBopbi — <J)H3HOAorHHecKHH pacTBop.
CjieAyiomHM BaxcHbiM ycjioBHeM OKa3aHHa 3KCTpemioH noMonţH
naiineHTaM CTOMaroJiorHHecKHX kahhhk abjiactck OBJiaAeime mcah-
Hhhckhm nepcoHaAOM (BpanaMH h mcahhhhckhmh cecipaMH) yMeHH-
eM npaBHJibHO oiţeHHBaTb pe3yjibTaTbi mohhtophoid HafxnioAeHHJi. ,Zţjia
pemeHHK 3toh npoOjieMbi cymecTByeT HenpepuBHoe MeAHinmcKoe
o6pa30BaHHe (HMO). Iţejib HMO ^ noBbimeHHe KanecTBa mcahahh-
ckoh noMoiiiH h MaKCHMaAbHoe oOecneneHHe 6e3onacHOCTH naiineHTa.
OcynţecTBJMeTca HMO pa3JiHHHbiMH cnocoOaMH: Kypcbi noBbraieHHa
KBajiH(f)HKaHHH, AHCTaHHHOHHoe, 3AeKipoHHoe o6pa30BaHHe. Ho B

o 32
H a c T o a m e e BpeMa 6oJibiuoe 3HaneHHe n p iio a e rc a caMoo6yneHHio, ko-
Topoe CKjiaAHBaeTca H3 nocemeHHa koh(J)epehuhh, KOHrpeccoB, Ma-
CTep-KJiaccoB, TpeHHHroB, npoBczieHHe kjihhhmcckhx pa36opoB , n p o -
Be^eHHe Hccjie#oBaTejibCKOH p a 6 o rb i c ny6jiHKauneH pesyrcbTaroB b
nepHO^HHecKOH nenaTH.
B Jiene6HOH pa6cxre span ^ojdkch Hcnojib30Ban> pesyjibTarrbi, no#-
TBepacAeHHbie MeTO^aMH £OKa3aTejibHOH mc^huhhh — mc^huhhckoh
npaKTHKH, OTJiHHaiomeHca npHMeHCHHeM b jienemiH or^ejibHoro na-
uneHTa tojibko Tex BMemaTejibCTB (mctoaob ^narHOCTHKH, npcxjjHJiaK-
thkh, JieneHHa), 3(})<j)eKTHBHOCTb KOTOpwx ^OKa3aHa BbicoKOKanecTBeH-
HblMH HayHHbIMH HCCJie^OBaHHaMH.
ripHHHHaMH pa3BHTHa KpHTHHeCKHX COCTOJIHHH B CTOMaTOJIOnfHe-
ckoh KJiHHHKe name Bcero aBJiaiorca HapyuieHHa (jjyHKUHH KpoBoo6pa-
meHHa h flbixaHHa. npH 3tom BaxcHO noMHHTb, wto 0Ka3aHHe Heonrjioac-
hoh noMomH aBJiaeTca Bpane6HbiM ^ojitom He3aBHCHMO or BpaneoHOH
cneunajibHOCTH. Tojibko cBoeBpeMeHHoe h rpaMcrraoe B M em arejibC TB O
Bpana Mo^ceT coxpaHHTb nocTpa^aBineMy 3kh3hb. BpeMa jsjw nocraHOB-
kh AHarH03a h Hanajia npOBeAemia HeomoacHbix neneSHux ^chctbhh
KpaHHe Mano. A npe^oTspaTHTb pa3BHTHe HeomoacHwx coctobhhh m o
»ceT Hcnojib30BaHHe pa3pa6oraHHoro h npeacTaBneHHoro anropHTMa.
 D ia e a 3
3a6ojieeannH cepaeHHO-cocyaHCTOH chctcmw
H iiicm h»iecK an 6 oJie 3Hb e e p a n a
(e r e iioK a p a w n ; K o p o iiap iib iH Tpoivi6 o 3, n e iip u B o aam H H k
MII(J)apKTy MHOKapaa, OCTpblH HHCţiapKT MHOKap.ia)

MmeMHHecKaa 6ojie3Hb cepAiţa aBJiaerca oahhm H3 Han6ojiee pac-

npocTpaHeHHMX 3a6ojieBaHHH nejioBeKa, noaroMy b croMaroiioriîqe-
ckoh KJiHHHKe 3th OojibHwe BCTpenaiOTca Macro.
HineMHHecKaa 6ojie3m> cepaiţa (HBC) npeacTaBJiaeT co6oh nopa-
acemie MHOKapzţa b crh3h c KopOHapHOH HeflocraroMHOCTbio. IIpH 3tom
B03HHKaeT AHc6ajiaHC Meayţy noTpeOHOcxbio MHOKapaa b KHCJiopoae h
ero AOCTaBKOH, mxo npHBOAHx k HineMHH MHOKapAa. JJocxaBKa KHCJiopo-
fla k MHOKapzţy onpeaejiaexca KopOHapHbiM kpobotokom, noxpeOHoexb
b KHCJiopo/ţe qacTOTOH cepfleHHbix coKpamemm h coKpaxHMOCxbio
MHOKapAa. /^Hc6ajiaHc aocxaBKH h noxpeSHocxH b KHCJiopoae Moacei
B03HHKHyn> npH BHpaaceHHOH apxepnajibHOH rHnoreH3HH. y SonbHtix
c rHnepTOHHnecKOH 6ojie3Hbio apxepnajibHaa ranoTeH3Ha flHaraocrra-
pyexca npH cmoKeHHH aprepnajibHoro aaBJieHHa Ha 30-40%%, npn aw-
xaTejibHOH HeflOCTaTOHHOCTH c CHHXceHHeM HanpaaceHHH KHCJiopoaa b
apTepHaJIbHOH KpOBH, y 6oJIbHbIX c OCXpOH aHeMHOH HJIH y 6q]q>hhx
c xpOHHHecKOH aHoMHeH npn noBbimeHHH norpeOHOCTH MHOKapaa b
KHCJiopofle. nocjieflCTBHBMH ancOanaHca KHcaopoaHoro oGecneneHHa
MHOKapAa aBJiaexca cHuaceHHe coKpaxHMoexn MHOKapaa c yBejiHaeHH-
eM flHacrojiKraecKoro aaBaemia b jicbom acenyaoHKe, aeroHHaa rnnep-
TeH3Ha h ^HcnHoa. AKTHBaijHs aHaapoOHoro MeTa6ojiH3Ma b MHOKapae
BefleT K HaKOIUieHHK) pa3JIHHHbIX MeTaSoJIHTOB, HeKOTOpHe H3 KOTOpLIX
Moryr B03fleHCTB0BaTb Ha OojieBbie peiţenxopbi Mnoxapaa h Bbi3biBan>
CHMnTOMbl CTeHOKapflHH [Jl. JIhjijih, 2010].
KjIHHHHeCKH pa3JIHHaiOT 3 <j)OpMbI HUieMHHeCKOH 6oJie3HH cepaaa
(HBC): cxeHoxapamo, HH(J)apKT MHOKapaa h nocxHH<j>apxxHbiH xap-
flHocKJiepo3. OcjioacHeHHaMH HBC aBJiaioTca BHe3anHaa xopoHapHas
cMeprb, HapymeHHa pHTMa, cepaeHHaa HeaoexaxoHHoexb.
CTEHOKAP^Hfl
Pa3jniH aioT CTaSHJibHyio h H ecT aSnjibH yio CTeHOKapamo. Cra6Hjn>Haa
creH O K ap^na pa3B H B aeica n p n ycroHHHBOM cy acein m n p o c B e ra xopoHap-
hoh aprepH H Sjuuiikoh h xapajK repH 3yerca B03HHKHOBeHHeM GoneBoro

m\ 34
 cHHApoivta Ha 4 >OHe noBw m eH H H nonrpe6Hocnf MHoxapoa b KHCJiopoae.
K coHcajieHHio, h b HacToamee BpeMH, Koraa cTOManronormecicaa no-
Ntomb AOCTHma 3HanHTejibHbix ycnexoe h, npe>KAe Bcero, b ncnojiKJOBa-
hhh mctquob cemauHH H o6e36ojiHBaHH«, nocemeHHe BpaHa-croManronora
Bce-raKH npe;unaBJiHcr Gojibiiiyio 3MouHOHanbHyio Harpy3Ky.
HecTa6HJibHaa creHOKapAHa, npoaBJiaioiuaaca BHe3anHbiM yxyzmieHH-
cm cocroaHHa 6ojibHoro c yBejiHHeHHeM h h t c h c h b h o c t h h npoaojDKfflejib-
hocth 6cwieBoro npHciyna, noaBJiaerca Ha (j)OHe noxoa. B crmmHe o r cra-
6 HJlbHOH CTeHOKap/lHH, naTO(}>H3HOJIOrHHeCKOH npHHHHOH Hecrra6HJIbHOH
creHOKap^HH aBJiaerca p a 3 p b iB arepocKJiepoTHHecKOH G jih u ik h , arperauna
TpOMGouHTOB b oGjiacTH pa3pbiBa h o6pa30BaHHe TpoM6a. Bo3HHxaiomaa
AHCt^ymcuHa 3Haorrejraa KopoHapm»ix cocyzţoB npoaBJiaerca He/ţocraroH-
Hoft npoayKUHeH OKCHAa a3ora (NO), npocraiţHKJiHHOB h 3to cnocoGcray-
eT C0XpaH6HHK) Ba30KDHCipHKUHH C ee HeraTHBHbIM BOaaeHCTBHeM Ha
KpoBOCHa6>KeHwe MHoxapna. Bo3HHKaer ynacroK Hexpo3a MHOxapaa —
OCTpblH HH(J)apKT MHOKapAa C CHHDKeHHeMcepzieHHoro Bbl6pOCa.
IIpaBHJibHO h noApo6HO co6paHHbiH aHaMHe3 jjaer B03Moamocrb bblh-
BHTb npOBOEţHpyioiipie ^aKTopbi, noBbimaiomHe ncnpe6HOCTb MHOxapua
B KHCJIOpQae H <(>aKTOpbI pHCKB.
OaiCTopbi, npe/ipacnojiaraiom iie k bojhiikhobchhio cTeHOKapuHH:
L <E>H3HHecKaa h 3MoiţHOHajibHaa Harpy3Ka, B03HHKaK>maa h co-
xpaHaiomaaca 3a^onro ao nocemeHHa cTOMaronora.
2. AprepHajibHaa rnnepTeH3Ha.
3. TaxmcapAHH.
4. A T epociciiepo3 KopoHapHbix aprepHH, H apym aioiiţH H B a30M 0T0p-
Hbie peaK iţH H .
5. rioBbiiiieHHe bjkîkocth KpoBH, ecjiH naiţHeHT AJiHTejibHoe BpeMH
B03AepxcHBajica o t ripweMa >khakocth (6ojieBaa peaiciţHH, 6ojib-
Hbie c 3a6oJiesaHH5iMH tţHC).
6. 3m 6ojihh KopoHapHbix apTepHH y naiţHeHTOB c npoTC3HpOBaH-
HbiMH KJiananaMH, y naiţHeHTOB c HapKOMaHHeH, ocoGeimo —
npH Hcn0Jib30BaHHH npenapaTOB KOKaHHa.
7. KypeHHe.
8. n in ep x o jiecT ep H H eM H Ji.
9. CaxapHbiH AHa6eT.
10. OOHJibHan e^a.
11. XonoAHaa norozia.
35 a
 J le n e H n e
jţiiarHOCTHKa JleweiiHe ________ FlpHWCTiaHHe_____
KynMpoBaHMe npacryna HHTponUfliepHH, H30C0p6HAa
CTCHOKapaHH____________ AHHHTpar, H3Ocop6H0a
1 HeMeAneHHO irpeKpaniTb 5-MOHOHKTpar — pacuiHpaicrr
cTOMaTO/iornnecKoe BCH03HWH OTACfl COCyOHCTOro
BMemaTejibCTBo; pycaa icax b Oojimuom, Tax h b
2. npHflarb 6ojjbHOMy Ma/iOM icpyrax KpoBooOpaiqeioia,
nojiycHAflHee nojioaceHHe; cHnacator npeAHarpyaxy
3. flarb noA «3biK Ta6jien<y Ha cepflue, yMeHbmaior
HHTponiHuepHHa — 0.5 norpeOHocTb MHOKapqa b
mt; KHCJlOpOAe.
4. o6ecneHHTb AocTyn OcjiO/KHeHHa — aprepHanbHaa
CBeacero B03Ayxa, rHnoreH3Ha, rojiOBHaa (xwib,
Jiyqme — KHCJiopoaa pe(J)jieKTopHaa TaxHicapAHa
HHTponnipepHH MoaceT ripoTHBonoKa3aHHe k
Eojib npn CTeiioKap/jHH
6bITb HCn0JIb30BaH npHMeHeHHK) — aprepHajibHaa
OmymeHHe CAaBJieHtra,
nOBTOpHO. rHnoreH3Ha
xaacecTH, pacimpaHHfl,
acaceHH» 3a rpyzjHHOH AcnapHH AmnarperaHT, CHHacaer
— «aHrHH03Haa arperaiiHK) tpomGohhtob,
6ojib», HppaaHHpyipHe npoBoimpyer KpoBoreHeHna
b jieByio pyny, noA (ocoOeHHQ b opraHax )KKT).
nonaTKy, b meio, /ţp y r n e cpeacT B a c m e x a h h 3mom fleăcTBHfl
HH5KHIOK) HejHOCTb, B HHTporjiHuepHHa
BepxHioK) qacTb acHBOTa. H30Ker-a3p030Jib — 1 Haacarae. HHTpoiuiacTbipb "Aenorarr"
IlpOflOJiaCHTeJIbHOCTb— TpaHCAepMajibHoe cpeAcreo, co3Aawmee nocroaHHbiH iiotok
SojieBoro npHCTyna 1-5HHTponiHuepHpHa b cocyzţbi. IliiacTbipb HaKJieHBaerca Ha
MHHyr. Eojib B03HHKaerjno6yio KoacHyio noBepxHOCTb, ho 6e3 BbipaaceHHoro BOJiocimoro
BHe3amio. noKpoBa. Kapdmem. TpaAnpnoHHOH flBJiserca TaftnenipoBaHHaa
OSbeKTHBHbie 4>opMa H30cop6HA AH-HHTpara, coAepacamaa b oahoh TaOjience
npH3HaKH: 20,40 h 60 Mr npenapara (KapAHKer 20, KapAHKeT 40 h KapAHKeT
nOTJIHBOCTb, TaxHKapflna, 60). HanHHaioT jieneHHe c A03bi 20.
rHnepTeH3H». IIpH KoMOHHapna HHTparoB c P- P- (ăioKaropbi CHHacaioT norpefr-
aycicyjibTauHH jierioix 6jiOKaTopaMH. CeJieKTHBHbie HOCTb MHOKapAa B KHCJIOpOAe,
BbicJiyuiHBaiOTca xpHnbi P- SnoKaTopu: areHOJioji, yMeHbiuaioT TaxHKapAmo, chh-
6HConpojioji, MeTonpojioji HCaiOTCOKpaTHMOCTb MHOKapAa.
Moacer B03HHKan> BbipaaceHHaa
6paAHKapAH», 6poHxocna3M,
cjiaGocTb

IIpinuaKH, He xapaicrepHbie hjih CTenoKapuHH:

1. X ap aicrep 6 ojih — H oiom aa.
2. E ojib He CB5i3aHa c 3MOHHOHajiBHBiM hjih (J)H3HHecKHM HaiipsacemieM.
3. /^JiHTejitHOCTb 6 ojih npeBbim aeT 15 MHHyT.
4. E ojib He npoxo^HT n p n npHeMe HHTporjiHiţepmia.

Q 36
 O C T P blft KOPOHAPIf b lft CHH/IPOM
O c T p b iH icopoHapHbift cHtm poM n p c f l C T a B / i a c r co6oh pC3Koc y x y jx -
lUCHltC COCTOHHIIH 6oJlbHOIX) Iip»l H8J1HHHH y HCFO CTaftH/IbHOH CTCHO-
KapAHll. O t CTa6HJlbHOH CTCHOKap/lHH OCTpblff KOpOFfapffblff CHFIJipOM
oTJiHHaeTca to m , h to b Koponapiibix aprcpnax B03HHfcaer TpOM6o3.
O c T p b iH K D pO H apH blH C H H ^pO M npC ^C T aB JIF ieT C0 6 0 K B O C n a/IH T C Jflr-
h u h n p o u e c c . B o c n a j i e m n o n o a B e p r a e T C * p a 3o p B a B u i a * c a « p a u m v i a a »
6 n a u iK a . B 3 t o m M e c r e B c m iH K a e T aK T H B a u H a t p o m 6 o i | h t o b h t p o m 6 o 3 .
3 x 0 n p H H H H a H eC T a 6 HJIbHOH CTGHOKapAHH.

P u c.3 .1 . KopoHapHbiu mpoM6o3 [n o L.S. Lilly» 2 0 1 0 ]

— - La- -L a - J L
Hop.ua flenpeccusi Jţenpeccux Hneepcun 3neeatfux ceziuenma ST
cezMeuma ST cezMenmaST 3yoifaT
(eopusonmajibHast) (KocoHiicxodmifcut)
Cy&mdoKapduanhHa* uiucmum TpaHcneypantHO* uuulmuh

Puc.3.2. Flpexodmuue utueMunecKue HapyiuenuH na 3 K T

HecTaSHJiBHaa cTeHOKapflHJi mchkct 6brri> npeABecTHHKOM ocrporo

HH(J)apKTa M H O K a p f la HUH IipHHHHOH (J)H 6 p H J lJ IH U H H HCeJiyaOHKOB.
O ra 6 H Jib H a H H e c T a G H J ib n a H
C T e n o ic a p A H H C T e H O K a p ilH H
n p o B O L ţH p y e T C H o a h h m n p o B o u H p y e rc am c h b u ic h
B o3H H K H O seH H e n p H C T y n a h T e M Mce y p o B H e M (J)H 3 H H eC K O H H a r p y 3 K O H
4>H 3H H eC K O H H a r p y 3 K H . H J1H B n O K O e.
EL pO A O iraCH TeJlbH O CTI» 6 o j i e e A J iH T e jiB H a a , h o
M e H e e 1 5 M H H y r.
1 npH C Tyna Me H u n e 1 5 M H H y r.

37 «CD
 noMoraeT imoxo, Hy*Ho
HHTpormmepHH noMoraer 1 Taftienca.
6ojn>me 1 Ta€uiencH.
KjiHHHKa HecTa6HJibHOH cienoKap uui. HecTa6njibHaa creHoxap-
nun MoaceT B03HHKHyTb BnepBbie hjih oSbiHHbie anrnH03Hbie npHCTynu
cTaHOBBTca name, cmibHee h npo^oji^cHTejibHee.
EflHHCTBeHHO B03M03KH0H npaBHJIbHOHTEKTHKOHB 3TOMCJtyHae HB-
jiaeTca cpoHHaa rocrorrajiimiţira OojibHoro.
O CTPbffl HHOAPKT MHOKAPM
OcTpbin HH^apKT MHoicapzţa aBJiaerca pe3ynbTaTOM ocTpon xopo-
HapHOH He^OCTaTOHHOCTH H npHBOflHT K HapyilieHHK) ero COKpaTH-
m o c th . HeflocTarox KHCJiopo^Horo oSecneneHna xapzţHOMHOiţHTOB
conpOBoayţaeTca h x 3HeprerHHecxoH HeflocraTonHOcrbio h b Teneroie
30-40 MHHyT npHBOflHT K Heo6paTHMbIM H3MeHeHHBM. Cjie^CTBHeM
yMeHbmeHHfl KOJiEraecTBa 3<jxj)exTHBH0 paOcrraioiuHx xapzţHOMHOiţHTOB
BBJiaeTca dncxemie coxpaTHTejibHOH chocoOhocth Mnoxapzţa.
Hanţe Bcero npHHHHon Hapyrnemw coKpaTHMoern Mnoxap/ia «b-
JiaeTca ocmpan Koponapnan nedocmamonnocmb, pa3BHBaionţaaca y
OojibHbix c HineMHHecxoH 6ojie3HbK) cepzţiţa (HEC).
3KT
Ocipaa 4>a3a HH^apicra MHOKapaa c flenpeccHeii HHTepBajia ST

J L 4 a X
Hopiua flenpeccH* HHTeptjajia ST HHBepcm 3y6naT

HH(J)apKTMHOKapflac rio/n>eMOMmrrepBajia ST

J L _ k 4 v .
Puc.3.3. HsMenenm 3KTnpu ocmpoM unfiapiane Muompda [no L.S.Lilly, 2010]
Y 6onbHbix c arepocxjiepo30M xopoHapHbix apTepnH M03xeT npon-
30hth pa3pbro arepocxjiepoTHHecKOH Ojmiiikh, hto Be^eT x TpoM6o3y h
^HC(J)yHXIţHH 3H,2ţOTeJIIWXOpOHapHbIX COCyiţOB. IlOCJieţţlM)! npOXBJWeT-
ca HeflocTaronHOH npQzţyxiţneH oxcuzţa a3crra (NO), npocTanuxjiHHOB,
hto cnoco6cTByeT coxpaHeHmo Ba30X0HCTpHxiţHH c ee HeraTHBHMM
O 38
 B03flCHCTBHeM Ha KpoBocHaOsKeHHe MHOKap^a. Bo3HHfcaer ynacTOK h c ~
Kp03a MHOKapAa---OCTpwfi HH^apKT MHOKapAa C CHM'/KeHHeM CCpACH-
Horo Bbi6poca.
HH(ţ>apKT MHoicapAa npH KopOHapHOH HeAocranroMHOcTH Mower pa3BH-
Baxbca MeAJieHHo Ha <f>oHe ycyry6jifliomeiiCB hiucmhh h rn 6 e sm fcnerofc.
ATHiiHHHoe TeneHHe: noHBJieHHe cjiaOocTH, oahiukh; 6 o n e sa si peak-
AHJI MOWeT OTCyTCTBOBaTb.
npOAOAwatoiitaacA CBbime 30 MHHyr 6ojii> a o a w h b pacueHHBarrbca
KaK npH3H3K HH(ţ)apKTa MHOKapAa. Ha 3 K T H3MeHeHHH noflBJBnoTC*
nom e.
OaKTopu, npeApacnojiaraiomHe k bo3hhkhob6Hhio creHOicapAHH:
1. rHnepxojiecTepH H eM H B.
2. ApTepHajibHaa rHnepreH3HH.
3. CaxapHbiH AHaOex
4. KypeHHe.
JleneHHe
KjiHHHHecKaa KapTHHa J le n e H H e
O&beKTHBHbie
2Kajio6bi
npH3HaKH
B o jib : T H iraH H aa 6 ojh> — TaxHKapnHH.
AJiHTenbHaa, HHTeHCHBHaa, XoJIOnHBlfi,
jiO K a jn o y e T c a b JIHITKHH nor,
rpyUHOH KJieTKe h j i h cy6$e6pHJibHaH
a u H ra c ip a jib H O H o 6 jiacT H . TeM nepaiypa. Ha
Eoni» MonceT HppaAHHpoBarb 3KT — nonteM
B BepXHHe KOHeHHOCTH, h j i h aenpeccHa
3KHBOT, CnHHy, HHXCHIOK) H H TepBajia ST.
n e jiio c T b h u ie io . CajibHoe
qyBCTBO crrpaxa cMepra.
n p H 3ECTOHHOU CepACHHOH
HeAOCTaTOHHOCTH MOHCeT HeMezuieHHfciH BbI30B CKOpOH
n o aB H T b ca o a b iu iK a ( n p n MeAHUHHCKOH ITOMOIHH.
orexe n e n a o c ) , cjia6ocn>, YMeHbineHHe 6cuieBoro (Jjaicropa
TOIUHOTa, pBOTa. ---HHTpOrJIHIiepHH (KaK
onncaHo Bume),
HeHapKOTHHecKHe aHaJibreTHKH:
50% pacTBop aHajibrHHa 1—2
mji, 6apajirHH — 5 mji.
06fl3arejibHO Hanarb HHrajiauHio
KHCJiopoaa nepe3 hocoboh
KareTep. _________________!

39 d
 APTEPHAJIbHAH rfflIEPTEH 31W
AprepHajiLHOH ranepTeH3HeH CTpaaaiOT ok o jio 90% Jiwmen CTapiue
55 JieT [JI. JIhjuih, naro<])H3HOJiorna cepaeHHO-cocyzmcroH chctcmw,
2010]. Pa3JiHHaioT 3ccennuajibnyio zunepmemuw (Koraa npHHHHH He
H3BecTHw), eio CTpa^aioT 95% Sojibhlix c aprepHajibHOH runepreioH-
eH h emopunuyto apmepuajitnyw zunepmemuw, Koraa npHHHHbi bo3-
MO)KHo ycTaHOBHTb. B 3TOMcjiynae JieneHHe 6ojiee a^eKTHBHo.
K ia cctnpukun u h apm epuajibuou zu n e p m e m u u y esp o a ib ix n o ypoe-
h w apm epuajibH ozo daenenusi

[no L.S. Lilly, 2010]

CHCTOJiHHecKoe /ţHacTOJiHHecKoe A il
KaTeropHH
( mm pT. CT.) (MM PT. CT.)
HopMa : <120 <80
IIperHnepTeH3Ha 120-139 80-99
rHnepreH3H« 1-h craflHH 140-159 90-99
riraepreH3iw 2-h examm ? :ii 160 >100

PeiyjiauHH chctcmhoix) aprepHajibHoro AaBJieHH» onpeflejweTC»

B3aHMQzţeHCTBHeM 2-x 4>aKT0p0B: cepzţenHoro BbiOpoca (CB) h nacTO-
te i cep^eHHbix coKpanţeHHH (HCC) — npn yBenKraeHHH HOC (zţo onpe-
^eneHHbix npe^enoB) BbiOpoc yBenHHHBaeTca. YBejiHHeHHe oObeMa
KpOBH npn 3a6ojieBaHHflx nonex (3a cneT yBejnweHH» KOHueHTpaunH
Na+ h 3aAep)KKH boabi: npn yBejnraeHHH 3kthbhocth CHMnaTHHecxoH
HepBHOH cncreMbi, yBejiHHeHHH BuOpoca ajibnocrepoHa, chhxcchhx
BbipaSoTKH npe^cep^Horo HaipmfypeTHHecxoro nerroma). yBejiHne-
HHe seH03Horo B03BpaTa KpOBH Taxace Be^eT k yBejuweHmo CB. Ilo-
BbimeHHK) OnCC cnocoOcTByeT m hoto <|>axTopoB, H3 Koropbix cjie^yer
Bbi/ţejiHTb noBbmieirae KOHpeHTpapHH b xpoBH KarexojiaMHHOB (npn
aKTHBauHH CHMnaTHHecKOH HepBHOH cHCTeMbi), cxHMyjrapyionţHx (32-a-
^peHopepenTopbi, noBHmeHHe b«3kocth KpOBH (yBejiHHeHHbm reMaro-
KpHT). noBbimeHHe OnCC Ha6jno,zţaeTCH h y Gojilhmx c h36htohhoh
Maccoii Tejia h caxapm>iM ^HaSeTOM II ran a (noBumeHHe ypoBHx HHcy-
JHffla HpH 3TOM 3a60JieBaHHH BbI3bIBaeT CTHMyJUmHK) CHMnaTHHeCKOH
HepBHOH CHCTeMbi H FHnepTpOljjHK) rJia^KHX MblUIH COCyaOB).
BTopHHHaa apTepnajibHaa nmepTeH3Ha MoaeeT pa3BHBan»ca BHe3an-
ho, nporexaeT 6onee Taacejio h Moacer BCTpenaTbca y j i h h m o jio u o to

o 40
 B0 3 p a c T a ( < 2 0 J ie r ) . Pa3BHTHio BropHHHofi rH nepreH 3H H c n o c o 6 c rB y -
k>t x p o H H H ec io fe 3a6ojieB aH H B n o n eK , (JjeoxpoMouHTOMa, chhapom Ky-
niH H ra, n m e p n i p e o 3 h a p .
AprepHanbHaa nmepreH3Ha conpOBoacAaerca aby\ia BH/ţaMH oc-
jioîKHeHHH: 1) rmiepTpo(|)HeH jieBoro acejiyaoHKa, Koropaa, b kohchhom
HTore, npHBOAHT k cep^eHHOH HeAocraTOHHOCTH, HH^apiciy MHoxapja;
2) noBpeac^eHHeM cocyaoB — nporpeccHpOBamno arepocicjieposa h
o6pa30BaHHK> aneBpH3M (aoprw, cocyaoB rojioBHoro M03ra h Ap.) ripw-
BO^amHM K HHCyjlBTaM, p33pbIBaM aOpTbl.
rHnepTOH HHecKOH 6 o jie 3 H b io C T p a jţa e r 4 0 % H acejieH H a n o c i i e 2 5
Jienr. IIp H 3 to m TOJibKO 2 0 % jn o A e ă , crp aA aio n ţH X om eproH H H ecK O H 6 0 -
jie3H bio, CHCTeMaxKraecKH nojib3yK »Tca rmioTeH3HBHbiMH cpeACTBaMH
H TOJibKO y nOJIOBHHbl H3 HHX 3TO JieHeHHe 3 <j)<})eKTHBHO. KpOM e TOID, y
H a e m 6 o jib H b ix c a p re p n a jib H O H ranepT eH 3H eH H e r A H arH 03a r m i e p r o -
HHHeCKOH 6oJie3H H H CBMH 6 oJIbHbie He 3 HaiOT O HeH. I l o COBpeMeHHOH
KJiaccH(J)HKaiiHH ( B 0 3 , 1 9 9 6 r .) nniepT O H H H ecK aa 6 o jie 3 Hb A e jm T ca H a
3 CTaA.HH B 3BBHCHMOCTH OT IIOpaaceHHA OpraHOB-MHHieHeH [JJjKSLHa-
uiH a n .X ., n ie s H e m c o H .M ., O jih ih c b k o C .B ., M ocK B a, 2 0 0 8 ] .

ICTaAHH
H e T npH3HaKOB n o p aace H H a opraHOB-MHUieHen (nOM ): cep A H e,
M 03r, noHKH, c o c y z ţb i).

II CTaAHH
n o p a a c e H H e o p raH O B M H m eH en c n oaB Jiem ieM , k b k m h h h m y m , o a h o -
ro H3 c jieA y io iH H x npH3HaKOb :
Cepdife: rH n e p ip o (])H H Jie B o ro acejiyAOHKa.
Dia3Hoe dno: cyaceHHe cocyzţOB cemancH.
II ohku: n p o T e H H y p H a , n m o a jn » 6 yM H HypHa h j i h noB bim eH H e y p o B H a
K p eam H H H a a o 1 7 5 m k m o jib /ji.
Cocydbi: a r e p o c io ie p o m H e c K H e H3 MeHeHHa b a p r e p n a x .
m CTajM H
OcjiOsKHeHHH AT:
Cepdiţe: c e p A e n H a a HeAOCTaroHHOCTb, creH O K apA na, HH(J)apicr
MHOKapAa.
M o3b : HapyiueHHa M 0 3 ro B o ro KpoBOo6pameHHa.
rn a m o e duo: kpoboh3ahahha h 3KCcyAaTbi b c e m a T K e .

41
 JUohku: HapymeHHfl (jjyHiaţHH noneK, noBtraiemie ypoBiw xpearmniHa
(BblLUe 175 MKMOJIb/jl).
Cocydbi: PaccjioeHHe aopra, OKKjno3HBHbie 3a6oJieBaHHa aprepHH
CoraacHO KJiaccH<j>HKamiH, B 0 3 1999 r. BbwejisiOT 3 creneHH no-
BbinieHM AJJ,:
1 CTeneHb - ţ- 140/90-160/100 mm pr. ct.
2 CTeneHb — 160/100-180/110 mm pr. cx
3 crenenb — 180/110 mm pr. ct. h Bbime.
HHtfHBuzţyajibHaa onemcapHCKa cep^eHHO-cocyaHCTbix ocjicckhchhh:
• HH3KHH pHCK (pHCK 1) — COCyZţHCTBIX OCJIOÎKHeHHH (HH(J)apKT
MHOKap^a, HHcynbT) h CMepra b Tenemie 10 Jiex MeHee 15%.
• Cpe/ţHHH pncK (pHCK 2) — BepoaTHOcn, ocjioacHeHHH 15-20%.
• BbICOKHH PHCK (pHCK 3 )---BepOBTHOCTb OCJIO)KHeHHH20-30%.

H H 3K H H ph ck : 1 c re n e H b A T (h&t <f>aKropoB p n c K a ( O P ) , n o p a a ce H H » o p r a -
H O B-M H m eH eâ ( I I O M ) h con y T C T B y io m H x 3 a6oneB aH H H )

C p e/ţH H H p h c k : 2 c re n e H b A T hjih 1 c re n e H b A T + 1 -2 O P

B ucokhh phck : 3 c r e n e H b A T h jih A T ( jiio S o h c re n e H H ) + 3 O P , h jih + I I O M

O H eH b BbICOKHH A T ( j i k ) 6 o h c re n e H H ) + c o n y T crB y io iE tH e 3 a 6 o j i e B a r o w
P hck:

<DaKTopbi, npe/ţpacnojiaraiouţHe k B03HHKHOBeHHio apTepnajib-

hoh rnnepTeH3Hn:
1. KypeHne.
2. .ZţHCjnraonporeHHeMHa.
3. OaoipeHHe.
4. rHnOflHHaMHB.
5. HacTBie HH(f)eKiţHOHHi>ie 3a6ojieBaHHa mohcblix nyren.
6. HeyMepeHHoe noTpeSjieHHe ajncorojw.
7. IIpHMeHeHHe jieKapcrBeHHtix npenapaTOB: dhokokopthkohali,
3CTporeffi>i, KOHTpau,enTHBbi.
rHIIEPTOHHHECKHH KPH3
r rHnepTOHHHeCKHH KpH3 ---3TO BHC3anHOe H 3HaHHTeJIbHOe nOBbl-
meHHe aprepHajibHoro /ţaBJieHHH c kjihhhhcckhmh npoaBJieHH»MH Ha-
pyraeHHa (J)yHKiţHH xcH3HeHHOBaxan>ix opraHOB: cep^iţa, rojiOBHoro

D 42
M03ra.I l o KJiaccH(f)HicauHH rH n e p ro H H 4 e c K H X KpHioB [ n o AJI. Mac*
HHKOBy] pa3JiH H aiO T 2 T H n a : 1 ) 6 b ic T p o n p o T e ic a io u jH ft ( o r n e c K O /iM tn x
MHHyT a o HecKOJibKHX l a c o s ) h n p o flB ji» iQ u ţH ftc x , m aB H bfM o 6 p a jo w ,
BereTâTHBHbiM H peaKUHBM H. 3 t o t T w n r n r ie p r o H H n e c f c o r o x p m a x a -
paicrepH 3yeT C H rH nepK H H eTH H ecK H M tm iio m K p o 0 o o 6 p a m e H H * ■— yac*
JIHHeHHblM CepAeHHbIM BblGpOCOM. rH nepT O H H H eC K H ft KpHl BTOpOrO
THna T e n e T A JiH T ejibH o, o t HecicojibKHX w a c o a a o necKo/ibKHx Aneft m
conpoBoxcAaeTcx rnnoKHHeTHHecKHMH w3MeneHHflMH xpoBootipaute-
H HH ---- HH3KHM CepACHHblM BblGpOCOM, HO BbICOKHM oGlUHM n e p H f J ) ^
pHHeCKHM COnpOTHBJieHHCM cocyAOB.
KjIHHHHeCKHe npOBBJieHHSI THnepTOHHHeCKHX kpH IOH
Tnn Kpwia >Kajio6bi Ofil.CICI HHIIMC npM lliaKM
I THn rojiOBHaa 6 ojib, omymeHwe TiinepeMMii hoxchux noxpoao»
xcapa, HapymeHHH 3peHHx: /iHua, mrcria rwnepeMHH ha J ts ie ,
TyMaH, «MyiiiKM» nepeA nia3aMH, KoxcHue noKpoBbi sjiawHMe,
OHeMeHne X3biica, ry 6 , koxch juma BupaxceHHoe B036yxcACHwe,
h pyx. TpCBOaCHOCTb. noBhimacTCJi.
maBHblM o6pa3QM. CMCTCWlMHeCICDC
aprepnajibHoe naaneHMe,
l im n ronoBHaa 6 ojib, 6 ojih b BflJIOCTb, 3aTOpMO)ICeHHOCTbv
o&iacTH rpyan, cjiaSocTb, SjieAHOCTb KOXCHhIX IIOKpOHOB
ronoBOKpyxceHHe, OflbiuiKa jum a, nacT03H0CTb a n n a . B
HapyuieHHe 3peHHfl (BnjioTb ao TJDKejibix cjiyMMx Ha&moAacTcx
cnenoTbi). MoxceT 6 bm» TOiiiHOTa, 3Hue(J>ajionaTHx c HapyuiCHHXMM
pBOTa. C03HaHHfl pa3JIH4HOM CTCnCHM
BbipaxeCHHOCTH.

OcTpbiH rmiepTOHHHecKHH KpH3 M03KeT npeACTaBJiBTb yrp03y >kh3-

HH. npH TJDKeJIOH 3Hne(J)aJ10naTHH MOryT B03HHKHyTb KJIOHHKO-TOHH-
necKne cyqoporn, npeABapxeMbie pesKoft rojiOBHOH 6ojibio, ncnxoMo-
TOpHBIM B036y»CAeHHeM, MHOrOKpaTHOH pBOTOft. y 6oJIbHbIX C HCABBHO
B03HHianeH apTepnajibHoft rnnepTeH3HeH (npH ocTpOM moMepyjiOHe^-
pH T e, T0KCHK036 GepeMeHHblx) CyAOpOMCHblH rHnepTeH3HBHUft KpH3
MOHCeT B03HHKHyTb npH OTHOCHTOJIbHO He60 JlbUI0 M nOBUUieHHH apTC-
p H ajib H o ro AaBjieHHB [B.B. PyxcHH, 1998], OcTpbift rHnepTCH3HBHbitt
KpH3 MOHCeT OCJIO>KHHTbCX HHCyJIbTOM HJIH OTCKOM JierKHX. Bo BCCX
3thx cjiynaax cHHaceHHe apTepnajibHoro AaBJieHH* aojdkho GbiTb 6 u -
CTpblM.
43 C3
 JleneHHe
BojibHoro c nraepTOHmeKHM KpH30M cjieflyer
HeMexuieHHO rocrarrajiH3HpoBafrb b npo4>mn>HUH
cramiOHap. O^Haico, no npae3fla CKopofi Mejm-
HHHCKOH nOMOIlţH MO>KHO nOIIblTaTbCfl CHH3HTb
aprepnajibHoe aasjieHHe. npHHHTo cHHrarb, *rro
aprepnajibHoe Aasnemie aojdkho 6bm» chhxccho b
TeneHHe o,iţHoro naca no ypoBHa 180/110-160/100
mm pr. ct. HanSojiee 3(J)(J)eKTHBHbiMH npenaparaMH
nflsi ycipaHeHHfl xaxcejioH aprepHajibHOH ninep-
TeH3HH HBJMIOTCfl HHTpODIHIţepHH HJIH HHTpOnpyCCHfl HaTpHH, BBQZţH-
Mbie BHyrpHBeHHO. O^HaKO, b ycjiOBiwx croMarojiorHHecKoro KafMfflera
3 to t Merofl jieneHHJi He Bcema b03M03KH0 Hcnojn>30BaTb, h oh TpeGyer
TnţarejibHoro Koinpojia A b cb»3h c Bbipa^ceHHbiM, ho KpaneoBpeMeH-
hum flencTBHeM. /IpyrHM cnoco6oM OKa3aHHB SKcrpemioH noMoniH npH
nînepTOHHHecKOM Kpn3e ABJiaeTCfl 3HTepajibHoe hjih cyOjiHHTBajibHoe
BBe^eHHe ranoTeH3HBHHx npenapaTOB.
lIpenapaTbi p a JieneHH H a p T e p n a jib H O H rH n ep T eH 3 H H n p n
________________ ranepTOHHHecKOM Kpn3e__________________
CnocoG
n p e n a p a ra
H a3B aH H e B seA eHH H
h MexamuM neficTBHH
/ţo3a IIp u M en aH H e
h H a n a jio
AeHCTBHH
HH(J)eflHnHH (K o p H H ^ a p , C y6jiH H T B ajitH 0 5 MT 3(J)(j)eKT HHAHBHAyajieH.
a a a a a r ) . E jio ic a ro p H epe3 5 - 1 0 M o x e r Bbi3Ban>
KaJIbUHeBMX MHHyT 3HaHHTejibHoe cHHMceHHe
K aH anoB ; p a c u r a p a e r AR, e cjiH paHee
n a im e H T
a p re p H a jiB H u e c o c y z p j b HM H e nOJIL30BaJlCH H
t.h. K opoH apH bie. H eH 3B ecreH e r o 3<J)<|)eKT.
npH OTCyTCTBHH
6paAHKapAHH MOJKHO
coneTaTb c aHanpHJiHHOM
HJIH ApyTHMH
6-6jioK aT opaM H .
K a ir r o n p ju i (K a n a re H ). 3H TepanbH 0 6,25-25 M r IIp H HajIHHHH nOHeHHOH
Hhth6htop AITO. H e p e 3 15 HeflOCTaTOHHOCTH
rip e n a T C T B y e T n p e B p a - MHHyT A03bl AOJDKHbl 6bITb
m e m n o aH TH oreH 3H H a yM eH biueH bi.
I B aHTHOTeH3HH II H
C H H ^caer ceKpeuHio
1a n tflo c T e p o H a .

» 44
 HHTpOI7IHllCpHH cy6n h h rneuthHo 0,5 Mr n p o T M R o n o n r» H M « :
CocyjoflpacuiHpHtomHti ninyitoM*, m y t pn*wpemma
npenapar n tn e p rc m n n .
tmpyui&HM Mmrofforo
fcponoo6pamtHHM,
tihfp'dWGHHMfi
uepeâpoarrepocKJfepcn.
no6oHHoe aeficTHHc:
uiytt b yuiax, rononnan
6ojib, ronoBOKpywcww,
TaXHKap/UM, nfflO T O H H X .

HAPyiUEHHH PHTMA CEP^UA

A n z o p u m M iK cm pen nou m e p a n u u n pu upum M unx
[iţHTHpoBaHO no J \. CnpnrHrc h JJj k . HaM6cpc, 2006]

P uc. 3 .4 . A nzopum M D Kcm pennou m ep a n u u n p u apum M ustx

Hapymemra pHTMa cepzwa nacTO CTaHOBHTca npHHHHOH reMo;jHHa-

MHHeCKHX H3MeHeHHH H TpeSyiOT HeOTJIOaCHOH nOM OlUH. ^ H a rH O C T H K a
Biwa apHTMHH cno5KHa h TpeOyeT npHcyrcTBHa cneunajmcTa Kap/ino-
45 <C3
jiora. Qzmaico jik>6oh span #pyroH cneuHajitHOCTH ^ojiaceH yMen» oiţe-
HHBaTb Han6ojiee onacHbie bh^w HapymeHHH pHTMa h6o 6ucrpoe Ha-
nano jieneHHa, Bbi30B Kapzmojiora hjih 6pnra^bi CKopoH mcjihuhhckoh
homoidh Moryr irpe^OTBpaTHTb pncK ocTaHOBKH KpoBooSpameHHJi.
Hapyrnemw pHTMa kjihhhhcckh Moryr npoaBJiaTbca HenpHaimiMH
omymeHiwMH b BHfle nepe6oeB cepzma hjih c c p m e d u e ism , idjiobo-
KpynceHHeM. IIpH apHTMHsx MoaceT B03HHKan> norepa co3 HaHHa, hto
h o ch t Ha3BaHHe — npHCiyn MopraHbH-AjţaMca-CTOKca. IIpHCTyn
B03HHKaeT b pe3yjn>TaTe hihcmkh h tchiokchh M03ra H3-3a orcyrcrBHa
cepzţemioro Bn6poca Ha <J)OHe 6pa,zpi- hjih TaxnapHTMHH hjih cnimpo-
Ma cjiaSocTH cmiycoBoro y3Jia.
H apyrnenne KjiHHHHecKne npoH BjieriH H
EpannapH TM H H
CHHHCeHHe aBTOM&TH3Ma CHHycoBaa 6pajţHKapnHH, cinmpoM cna6ocTH
CHHycoBoro y3na
EjioKa.ua npoBeaeHHH AB-6jiOKana 1,2. 3 CTeneHH
TaXHapHTMHH
ycHJiemie aBTOMaTH3Ma CHHycoBaa TaxHKapzuw
CHHycoBoro ysna
IIOBTOpHblH BXOn napoKCH3Majn>Haa HaflHcejiyaoHKOBaa TaxincapmiH,
B036y%^eHHfl (re-entry)MepnaxejibHaa apHTMHH, 4>h6phjijihijhh npencepflHH,
HcenyzţoHKOBaH TaxHKapflHH, (J)h 6 p h j i j i h u h h Hcejiyaonkob
3icronHnecKHH HMnyjibc ^ejiyzţoHKOBaH 3KCTpacHCTOjnw, acejiyaonKOBaa
H3 xcenyaonKa TaxmcapflHH, 4>h 6 p h j ij i h u h h aceJiyzţOHKOB
C WMemmiHMU [no L.S. Lilly, 2010]
CymecTByer nporHOCTHHecicaa KjiaccH(J)HKaiţHa acejiyuoHKOBbix apHT­
MHH, co3^aHHaa Bigger J.T., b Koropon pa3jiHnaiOT h o o h c h h o onacHbie
h acH3HeHHo HeonacHbie apHTMHH. K HeonacmjM apHTMHHM oraeceHLi
jno6bie apHTMHH, He Bbi3biBaioiHHe HapymeHHH reMO^HHaMHKH. C o o t-
BeTCTBeHHO, apHTMHH, BbI3bIBaH>IIţHe HapymeHHH reMOAHHaMHKH,
HBJ1HIOTCH HCH3He0naCHbIMH H Tpe6yiOT HeOTJIOHCHOH nOMOUIH.
SKcmpeHHcm noM oujb n a u ţe eceeo m pedyem cn n p u pc&JiimHbix eu dax
m axuK apduu (ocod enn o oicejiydoHKoeou, K om opan Mootcem 6 u m b npum t-
hou 6He3anHou CMepmu), M eptfam ejibnou apum xiuu, K om opan Mootcem
nepexodum b e (pudpw uim iw o otcenydomcoe u ocm cm oeK y K poeooâpaufe-
m m , am puoeeH m puKyjw pH bix 6/iOKad I I u III cm en em i, n p u cm yn a x M op-
zaH bu-AdaM ca-C m oKca.

C5 46
 OaKTopbi, npeapacnojiaraioiuMe k b o i h h k h o b c h h io HapyineHHÎi
pnTMa:
1. 3a6ojieBaHHa cepjieMHO-cocyaiicTOH cucTCMbi.
2. 3a6ojieeaH H S[ j i e n o i x h m tm e B o a a .
3. TlfpeOTOKCHKD3.
4. AuKorojibHoe nopaaeeime cepuua.
B03HHRH0BeHHe apHTMHH MOHCeT 6bITb jSţUaraOCTHpOBaHO He TOJIb-
ko Ha ocHoaaHHH acauoo GoubHoro h naubnaomi nyubca, ho, hto oco-
6eHHO BasKHO,— no 3KT Ha MOHHTope. Y namieHTOB c HampmeM ica-
k h x - j i h 6 o apHTMHH b aHaMHe3e cueuyeT oGjoarreubHO npoBoujrn» 3KT
---MOHHTOpHpOBaHHe.
BPAJIHAPHTMHH
npH GpaZţHapHTMHHX Hacrora
cepueHHtix coKpameHHH (HCC)
MeHbme 60 b MHHyry. Cmiyco-
sas SpazoiKapuna passHBaeTca Ha
<|)OHe HEC, KapAHOMHonarHH hjih
cuaOocra cHHycoBoro yaua, a TaK-
Xe --- B CBU3H C HCn0Ub30BaHHeM
HeKOTopux ueKapcTBeHHbix npe-
naparoB (p-SuoxaropoB, aHTaroHH-
ctob KanbUHeBhix KaHauoB — se- Puc. 3.5. Ilpoeodîtufue rtymu cepdtţa
panaMHu, uHuraa3eM).
ArpHOBeHTpHKyuapHbie qsokbum — 3to HapymeHHe npOBeuemni
HMnyubca Meayţy npeucepunuMH h aceuyuouxaMH
PasuEraaiOT AB-ojioxau&i Tpex creneneH.
n PHAB-Quoxane I crenenn BOSHmcaer t q j i b k d yauHHeHHe mrrepeaua PR

ams
S S t KBBBfea # 1 1-. IR E
m m
\iiiii^iat i n i i n r t i ^ i u u f F - M O «ell
b-U , m şşm
| HHTepsag PR |

IXpn AB-6inoKaue II creneHH Hapymaercu npoBouHMocTb AB-y3ua

h nocue 3y6rţa P H er aceuyuoHKOBoro KOMnnexca. PaauHHaiOT AB 6uo-
xaubi II creneHH I r a n a — Mo6oth — I h II r a n a — Mo6hth — IL
47 <□
 PauiHHHe Meayţy 3thmh nmaMH 3aKjnoHaiOTca b tom, hto npH nepBOM
nme ymnnweTCfl HHTepBaji PR biuiotb ao BbinaneHH» KOM imeKca QRS,
a npH BTopoMrane HHTepBaji PR He H3MeHaerca, a komihickc QRS Bwna-
AaeT BHe3airao. IIpH nepBOM nine AB-6noKam>i Hapyrnemw B03HHKaiar
Ha ypoBHe AB-y3Jia, a npn BTopoMm ne — Ha ypoBHe nyHKa Inca.

AB-6jiOKa.ua III cTeneHH — 3to nojiHoe orcyrcTBHe npoBeAemw

HMnyjiLca ot npeAcepAira k acejiyzţoHKy. 3y6qw P h KOMiuieKCBi QRS
B03HHKaroT He3aBHCHM0 Apyr ot Apyra.

Puc. 3.6. AmpuoeeHmpuKynsipHue ânoKadu

ATpHOBeinpHKyjiapHwe 6jioKaflM Moryr B03HHKaTb npn Hcnojn»30-
BaHHH jieKapcTBeHHbix npenapaTOB (dihko3hah, p-6jiOKaTopbi), npH
noBbimeHHH napacHMnaTHnecKoro TOHyca, npn HHfjjapicre MHOKapjja
— name HioKHero. HanSojiee onacHa AB-6jioKa^a III CTeneHH, t.k . npn
3T0M MOiyr B03HHKaTb CymeCTBCHHbie H3MeHeHHH reMOflHHaMHKH, B
TOM HHCJie H B IOJIOBHOM M03re---HapymeHHH C03HaHHB, IOJIOBOKpy-
3KeHHH.
JleneHH e 6 p a u i a p m \ i n H
MeflHKaMeHT03Hoe h HeMeAHKaMeHT03Hoe jie-
neHHe (sjieicrpoKapflHOCTHMyiwHHa) npoBOAHTCH
npn apHTMHH, conpOBoayţaiomeHCH SHanHTejit-
HMMH HapymeHHHMH reMOflHHaMHKH: npHcrrynbi
noTepn co3HaHH« — npHCTynu MopraHbH —
AnaMca — OroKca, aprepHajibHaa nmoTeH3ioi,
aHTHH03Haa 6ojn>, Hapacraiomaa SpaAHKapAna,
ocTpaa cepflenHaa HeAOCTaroHHOCTb. fljia mcah-

48
larntnoworo m m um m w m yw m *jwmpw €
aam jktfcrmte* — mptwm, wropuK ytttmmaer *my€
m r o fiep m , m o nţm fm m m m m m m w m cm m m K J jn fm v m n %ym~
jihhchmo HCC, lumutuettHio fipow w M m w w fty'tm fm&, JL t y r n u
MHMcntiecimc cpcfletmi; acruormn, a*y*em, vmppvm?
3th npenaparru M m m tfcrwyKn m $ t w e m p e u e tw r p H ce p m a , *p»-
«Vw k ynemtHCHHto **acroTwcepflcwtux wmtmwMv&,
B n4 .Vm m w c l lf f m w j i o r
(p9iBU|WTHNN 1
bB-§ROK&fi& I toporum Q£ -0,15 m «/» flpw «viip^cvinMMweiw
crenetiH BO M M XW W m ifW T arpiwwwBi iw w w b fiw > m w » 1
iypBiBww 24P wr « /s
cyHktapHoft ftorm 0/M mftti',
V^ikwUMH— 240 w */»
AB^wwaiAaK 1A /tpemutHH 2-10 m r/m m B otwwww Bpworonwwr
crewHH
r »
a^ yw w w , H M jp oti,

A B ^ flO K w III BpCNCHHM

CTeneHH 'ia&tpotuupwtKrtimyMiim I
ripOBe/lCHHe KapAHOBCpCHH HJlHyCl2M0W& BOJXHTeJI* pHTMA opo*t>
boahtc* TOJibKO6pnra,flofi peaHHMaTonoroB h KaponojioroB!
3KCT PAC'HCTOJIHH
3i(CTpacHCTOJia — 310 npexaespeMCHHoe Boidyac/jeHHC MHOfcapaa,
3KCTpacHCTO/iw Moryr Hcxo/um» H3 pauwHHHx ynacnoa Boi6yjw*iux
CHCTeMcepAua: H3 CHnycosoro ysna, hi npeAcepAHfi, hb arpHOBeHTpH-
fcynapHoro y3na, asejiyoontsoB cep/yţa, Ecjih Bo^GyacaewHe hcxoaht H3
oziHoro h Toro ace ynacTKa, to 3ftCTpacHCT0Jibi hocwt wnasuwe «mono-
TonHwe». Ec/ih h3 pauiHHHbix ynacTKOB— «nosimonnucn. MexamtiM
B03HHKH0BeHHB JKCTpUCHCTOJI 3ajCJKWaCTCH B IIOBTOpHOM B03BpSUUC~
hhh HMnyjibca (name no apnonumenhubua npoBoaaiiiHM nyrnu) —
«re-entry». 3KcrpacncTOJibi pa3JiH4aicrrc* no nacTore boshhkhobchh*:
pejiKHe, nacTbie, eAHHHHHwe, rpynnoBbie. npH npaBiuibHOM qepcao-
BaHHH 3KCTpaCHCTOJI OHH MOiyT CJIC/lOBaTb 3a KSOLffSAU HOpMaJIbHbfM
coKpameHHeM — 6nreMHHna, nocjie AByx nopMajibHwx coKpaniewifi
---TpHreMHHHH HT.fl,
Hame scero 3KCTpacHcrojiHH ne aenaerca aooneonacHbiM bh-
£om HapyuieHHa cep^ennoro pHTMa, no npn lafioaesaHMax MHoieap-
49 a
Aa, BKJiioHaa nocTHHtţmpKTHbm Kap/mocKJiep03, ohm Moiyr BbBMBaTt
HeSnaronpiMTHLiH reMO^HHaMHHecKHH 3<jxj)eKT, ocoSchho nacTbie h
rpyiraoBbie 3KCTpacHCTOJiw.

v2y ^ y ny >—

Puc. 3.7. 3KT npu 3Kcmpacucmojiax:

a —npedcepdnoH SKcmpacucmona (3-u KOMruieKc);
6 —ofcenydoHKoebie SKcmpacucmonu (2-u u 4-u KOMtvieKCbi);
e —2pynno6bie (5-u u 6-u KOMnneKcu), nommopfpHbie (J-u u 3-u
KOMruieKCbi) jtcenydoHKoebie 3Kcmpacucmonu
[U3B.B. PycKUH «HeomjiojfCHOH mpduojiozun» 1998]

JleneHHe
JleneH H e SKCTpacHcrojiHH 3 aKJiioHaeTca b n o a -
6 ope h oiţem ce s ^ e ie m B H o c T ii n p e n a p a ro B h h x
coneTaHHH h noaTOMy S ojibH oro c 3 th m h H apy-
niem uiM H pHTMa cjie^yeT HarrpaBHTb k KapflHO-
Jiory. H o n p n reMOflHHaMiraecKHX H a p y n ie im a x b
KanecTBe nepBOH noM onpi M o iy r 6 brn> H cnojib30-
BaHbi 6 eTa- 6 jioK aropbi (o63*m aH, areH cuion, Me-
T an p o n o ji h coneTaHHe SnoKaxopoB 6 eT a-a#peH 0 -
p eiţenT opoB c GnoKaropaMH K ajm eB ux KaHanoB
(KOp^apOH, c o raaeK c).
EeTa-ăuoKaTOpbi b MHOKapzţe (me npe^CTaBJieHLi, niaBHUM o6pa30M
Pj-peueirropbi) co3^aK)T orpHiţaTejibHbiH hhotpoiihlih, xpoHorpon-
HbiH, 6aTMOTponHbiH h ^pOMOTponHMH 3(j><|>eKTbi: yMeHbinaioT cHjiy
coKpamemra MHOKap^a, qacTOTy cep^eHHbix coKpameHHH, CHHxceHHe
B036ynHM0cra h CKopocTH npOBeaeHroi B036yameHHa nepe3 aTpHOBeH-
TpHKyjwpHbiH y3eji.

D> 50
 flpenaparr <l»op\ia
H n a jib H M wnm
BMnycKa
Ofw&MsaH(rrparrpOHanojT) ( Hccejtckthbh wfi Ta6n. 20 Mr
6era-6»o«anfop, BoţQ dknyei Ha 6era,- h 0,04 r
6erra 2-peueiTTopw (40 MT)
AreHOoKwr (itapjotoceneKmBHMfi 6era- Ta6n. 50 MT
6sic*anrop, BmfleircrByer tojtbko na 6era,- 25 — 50 — y IT05KHJIBJX---25 MT
pcuemopw) 100 MT IIoa KOHTponeM Af l.
AMHonapon (Kopaapon) ânonrpyer Ta6n. 200 MT
HOHHMe KaHairu: KarweBBie h, b MCHwneH n o 200 mt
cTeneHH, KanuweBue h HarpneBBie
BrrconpojioT (kohkop) Tafwi. Ilo 2 4 , 5-20 mt 1 pa3 b
(sappocenerrK BH uâ 6era-6jiOKarop, 5h 10 MT cynoi
BoaaeHcrByer tojîbko Ha 6eTat-perţexrropBi)
MeTorrpoaoa (SerairoK, anuiOK) Ta6n. Ilo 50 50 — 200 m t 1-2
(nfnHOcejKCTKBHuii Sera-SaoKarop, 1 100 MT pa3aB c y n o i
M S K i i r n y n tojtbko Ha 6eTar-peiţeirropBi)

TAXHAPHTM HH
K hhm othochtc»: xcejiyuoHKDBaa Taxmcapipw, Ha/pKenyaoHiooBbie
Tsxmcapffim — cHHycoBasr TaxHKapaHa, Mepqamie h xpeneraim e npefl-
ccpfffm.
HaAxejiynoqicoBue TaxHapHTMHH
B rpyim y cynpaBeHTpHKyjrapHbix TaxHapHTMHH bxqkst arpHOBeH-
TpHjtyjwpfiHe Ha^ţacenyaioHKOBwe TaxmeapaHH h CHHycoBhie Taxmcap-
AHH, Korroptie name B03HHKaiar y mqjioaux JncmeH.

A k. Cunycoeax manatapăwi [no L.S. Lilly, 2010]

npH CHHyCOBOH TaXHKapUHH HaCTOTa CepACTHUX COKpameHHH CO-
e r s a a o e r r 100-180 ya/MHH. 3y6eq P h KDMiuieKCU QRS He HTMeHeHU.

si «CD
CnHycoBaa TaxHKapflHH mojkgt B03HHKan> npH SMOijHOHajiBHOMHanpa-
HceHHH, HapymeHHH .zţBixaHHa c pa3BHTHCM nmoKceMHH. VcrpaHeHHe
yKa3aHHux npuHHH ycTpaHHT h HapymeHHe pHTMa.

Puc. 3.9. napoKcumcuibHOH HadoteenydouKoeoHmaxuKapdux [no L.S.Lilly, 2010]

npH napoKCH3Majn»HOH Hafl^cejiyzţOHKOBOH TaxHKapflHH qacTora
cepfleqHHx coKpameHHH MoaceT cocTaBJiarB or 140 ,zţo 250 b MHHyry
npOBBJiaeTca 3tot bh# apHTMHH nyBCTBOM yqameHHoro cep^neOH-
eHHH, ronoBOKpyaceHHeM, nyBCTBOMcTpaxa. Y noaciuibix jnomen Moaeer
B03HHKHyn. BHe3anHaa noTepa co3HaHHa, cTeHOKapzpia, oreK jiencHX
(KapAHoreHHLm).
JleneHMe
JleneHHe cynpaBeHTpHKynapHBix TaxHapHT-
mhh MoacHO HanaTb c npHMeHemia «eazycnbix
npueMoe» — npo6bi BajibcajibBbi h Maccaaca 06-
JiaCTHCOHHOHapTepHH (KapOTHflHOIX) CHHyCa).
IIpo6a Bcuibccuibebi 3aKJHOHaeTCH b co3/ţaHHH
noBBimeHHoro flaBjiemia b OpioumoH h rpyzţHOH
nOJIOCTHX, HTO yMeHBinaeT B6H03HBIH B03BpaT
KpOBH. npH nocjie,ayiomeM npeicpameHHH Hanpa-
aceHHa bchoshbih B03BpaT KpoBH yBejiHHHBaeTca,
yBejiHHHBaeTca yrţapHBiH o6bcm h cepzţeHHBiH BBi6poc, noBBimaeTca
aprepHajiBHoe ^aBJieHHe. HMnyjiBc npH pa3ApaaeeHHH OapopepenTopoB
KapomzţHOH 30HBI pacnpocipaHaeTCH no a3BiKornoroHHOMy HepBy b
npoflomroBaTBin OT^eji ronoBHoro M03ra h TaMnepeKjnonaeTca Ha aapa
Ojiyayţaionţero HepBa. IIosTOMy ypeacaerca nacTOTa cep^eHHbix co-
KpameHHH h CHHaeaerca aprepnajiBHoe flaBjiemie. Ilpo6a BajiBcajiBBBi
BtinojiHaeTca cjienyioiHHM o6pa30M: ^enaeTca rjiyOoKHH baox, a 3areM
bbiaox HBiraiOTca npoBecra Ha <J>OHe 3aKpBiTBix pra h Hoca b TeneHHe
10 cex. flpyrHM BapnaHTOM npo6bi aBJiaeTca HaayBaHHe B03^yuiHoro
mapmca jsjo MOMeHTa, xoraa oh JionHeT.
C3> 52
 riojicoKHTejibHbiM atjxjjeicr npo6bi npoxaruercs ycrpaHeHHeM cyfn»-
eKTHBHblX npH 3H aK O B TaXHKapAHH HJ1H, n p H HaJIHMHH KapflHOMOHHTO-
pa. Ha 3KT perHCTpHpyeTca CHHycoBbifi pHTM.
ripo6a 0Ka3biBaeTca HeatJx^eKTHBHOH npH CHHycoBofi TaXHKapAHH.
[IpH 3tom bo Bpeivta npoBeaeHHH caMOH npo6bi phtm ypea<aercH, ho
npH npeKpameHHH npo6bi TaxHKapflHH BoccTaHaBJiHBaerca. npH haa-
aceJiyaOHKOBblX TaXHKapZţHHXPHTMMOKeT He BOCCTaHOBHTbCa npH npo-
BeaeHHH npo6bi BajibcajibBbi. Flpn xcejiyzţOHKDBOH TaxHKapAHH npo6a
He BJHweT Ha ph tm cepAHa. IlpH MepuaTeabHOH apHTMHH phtm Moacer
HeCKOJIbKO yMeHbHIHTbCH.
TaKHM o6pa30M, npn npoBeseHHH npo6bi BajibcanbBU MoacHo nojiy-
HHTb He TOJIbKO JieHeSHblH 3(J){|)eKT, HO h O T flH ^ ^ e p e H im p o B a n rb HCTOH-
HHK H BHA TaX H apH T M H H .
Maccaotc Kapomudnozo cim yca
M accaac K apoT H A H oro
CH H yca npoBO flH T n p n n o -
jioaceHHH 6 o jib H o r o n e a c a H a
cnHHe, npHJKHMaa npaByio
coHHyro apTepHio. MeHee
AeHCTBeHHo HaaaBjiHBaHHe
Ha ma3Hbie hGjiokh. Maccaac
K a p o T H ^ H o ro C H H y ca n p o B o -
flH T ca b T e n eH H e 5 - 1 0 m h -
H yr. O n acH O C T b n p o B e ^ e H H a
3 T o ro n p H e M a y S o jib H b ix n o -
MMH I Puc. 3.10. Maccaotc Kapomudnozo cimyca
acH Jio ro B 0 3 p a c T a MoaceT Bbi- ..
3BaTb B b ip aa ceH H y io OpaAHK apAHio c 3HaHHTejibHMM cHHaceHHeM a p -
T e p H a jib H o ro ^ aB JieH H a h j ih B03HHKH0BeHHe aTpHOBeHTpHKyjiapHOH
OaoKa^bi.
K B a ry c H b iM n p o O a M othochtch Taicace n p o 6 a A n m e p a — H aaaB JiH -
BaHHe H a 3 aK p b iT b ie r a a 3 H b ie a S jio k h h pecjwieicc « H b ip a io m e H » c o 6 aK H
(3 a ^ e p a c K a A M x a m ia h n o rp y a c e H H e J i n p a b T a3 c xoaoahoh boaoh) h
oOKJiaAbiBaHHe J i n p a KycoHKaMH Jib ^ a .
M eA H K aM eH T 0 3 H o e Jie n eH H e T axnapH TM H H n p e A n o A a r a e T H cn o jn » -
30BaH H e aHTHapHTM HHecKHX cpeACTB (e c u H HeT B bipaaceH H bix re M o -
AHHaM HHecKHx H a p y n ie H H ii) : aH anpH JiH H , aTeH O Jioji, K o pA apoH , <j)H-
HOHTHH H Ap.
53 a
 4>opMa
npenapaT H a ia a b H a a 4 0 3 a
BbinycKa
ÂHanpHJiHH (nponpoHaJioji) Tafia. 20 Mr
(HecejieKTHBHbiH fieTa-fiaoKarop, 0,01 r
B03AeHCTByeT Ha fieTa,- h 6era2- (1 0 Mr)
peuenTopbi
ATeHOJioji (KapaHocejieKTHBHMH 6era- Tafia. 50 Mr
finoKaiop, B03fleHCTByeT ToabKO Ha fieTa,- 2 5 -5 0 - Y nooKHJiwx — 25 mt
penemopbi) 100 Mr Ilow KOHTpoaeM A #.
AMHoaapoH (KopwapoH) fiaoKHpyeT Tafia, no 200 MT
HOHHbie KaHajibi: KaaneBbie h, b Mehbineft 200 Mr
CTeneHH, KaabnneBbie h HaTpHeBbie
BHCOnpOJIOJI (KOHKOp) Tafia, no 5-20 mt 1 pa3 b cyncH
(KapflHOcejieKTHBHbifi 6eTa-6jioKaTop, 2,5,
B03^eftcTByeT TOJibKO Ha fieTa - 5h 10 Mr
penenTopbi)
MeTonponoji (6eTaaoK, anuioK) Ta6a. no 50 — 200 mt 1-2 pa3a b
(Kap^HocejieKTHBHbift 6eTa-6jioKaTop, 50 cyncH
B03fleftcTByeT TOJibKO Ha fieTa,- h 100 Mr
peuenTopbi)
EpeBHfiaoK (3cmojioji) BjioKHpyeT 6eTa,- AMn. 1 B/b b ao3e 500 mkt/
aapeHopeuenTopbi mh — KT B TeieHHe 1 MHH
riojiHbift TepaneBTHiecKHft stJxJieKT 10 MT (Harpy30HHaa wo3a), 3areM
pa3BHBaeTca Hepe3 2 mhh h npeKpamaeTca 3CMoaoaa 50 mkt/ kt/ mhh b xeneHne
nepe3 15-20 mhh
nocaewyionncc 4 mhh
IIpH Ha^aceJiyZţOHKOBOH TaXHKapAHH HeJIb38 BBOAHTb JltmOKaHH.
npH HazpKeJiyqOHKOBblX TaXHapHTMHBX 3(J)(|)eKTHBHbIM M05KCT 6bHb
Maccaac KapoTH^Horo cHHyca.
npH B03HHKH0BeHHH HaflXCeJiyZţOHKOBblX TaXHKapiţHH BO BpeMfl IipO-
Be^eHHa aHecTe3HOJioraHecKoro oSecnenemia b Hacroamee BpeMa 6onee
3(J)4)eKTHBHbiM aBJiaeTca Hcnojib30BaHHe Kap^HoceaeicraBHoro, He o&ia-
flaiom ero coSctbchhoh cuMnaroMUMeTHHecKOH aicraBHOCTbK) Ş-aape-
HofrnoKaTopa «6peBH6jiOK» (scmojioji). EpeBH6noK oSjia^aeT 6bicrpbiM
HananoM h kopotkoh jpiHTejibHOCTbio .qeHCTBHa. B csa3H c sthm ero hc-
nojib30BaHHe xopomo ynpaBJiaeMO. C ypeaceHHeM MacTOTM cep^eHHbix
coKpaipeHHH B03M03KH0 CHuaceHHe aprepHajibHoro ,zţaBjieHna.
HmpaoneparţHOHHO BHyrpHBeHHoe BBe/jeHHe GpeBH&ioKa HaHHHajoT c
Harpy30HH0H fl03bi 80 mt bbqohmoh Sojhocho b TeneHHe 15-30 ceicyHji c
nocjiejţyiomeH HH(J)y3HeH b a03e 150 mkt/kt/mhh. ,3,ajibHeimiee BBe/ţeHHe
6peBH6jiOKa ocym ecrajiaerca Mero^OM TmpoBaHHa r o 300 mkt/kt/mhh.
54
 lipii CHMHCCHMM uprcpHUJIbllOI'O /laiWICIIMH MJIH paiBHTHH Bbipa'/KeH-
HOtt 6pOAHKapAHH HHCjiySHlO f>pC»HC)JIOKa CHMXtâfOT op 12.5-25 mkt/kt/
MHH. 00 CKOpOCTbK) BBCACHMH.
Gcjih cynpaBCHTpHKynjipHbie TaxnapHTMHH conpoBoxziaioTCJi bm-
paxcoHHUMH HapyuieHMJiMH rcMo/ţHmiMMKM, TpeSyerc» hcotjuxkh&h
KapAMOBepcMB, hmiiojiiimcmum BpanaMH xapAHOJioraMH, aHccrcwojio-
raMH-peaHHMaTOJioraMM hjih BpanaMH CKopofi mcahuhhckoîi noMoiim.

M E P IţA T E J lb H A J I A P H T M IM
Mepiuvrejibuan apHTMH» BtanonaeT xpcncTauMe h MepuaHHe npeA-
cepAMia (HHorAa uastiBacMoe (ţ>H6pHJUiHUHeft npeAcepAHÎi).

Puc. 3.11. Tpenemanue npedcepduu. Cmpemai ym3bieaiom Ha eojiny coKpamemiH

npedcepduu [no L.S. Lilly, 2010]
IlpH TpeneTaHHH npeAcepAHfi: nacTOTa jKenyAOHKOBwx komiuickcob
3QBHCHT OT CKOpOCTH llpOBeAOHHH HMnyJIbCa B aTpHOBCHXpHKyjIHpHOM
yane. IlpH npoBeAOHHH HMnyjibca b AV-y3Jie 2:1 coicpameHHH xcenyAOH-
kob 6yzţyT nponcxoAHTb Ha KaxcAOM btopom coKpameHHH npeAcepAH»,
npn 3tom HacTOTa coKpauţeHHH McenyAOHKOB 6yqeT b ABa pa3a MeHbiue,
neM npeAcepAHÎi. IlpH bwcokoh npOBOAHMOCTH HMnyjibcoB b AV- yaae
(1:1) B03HHKaK>maa TaxHKapAH» MoxceT npHBecTH k HapyuieHHHM npo-
Boo6pameHHH, KorAa noTpeSyeTca 3KCTpeHHan noMoim».
TpeneTaHHH npeAcepAHil oGeihho B03HHKaK)T y Sojibhhx c HMeio-
iahmhch 3a6ojieBaHHHMH cepAiţa: H E C , cepAeHHax HeAocTaTOHHOcn»,
nopoKH MHTpajibHoro luianana peBMaTHnecKOH 3THOAOthh.
KjiHHHHecKaH KapTHHa n p n TpeneTaHHH npeAcepzţHH Moxcer BapbH-
pO BaTb OT He3HaHHTeJlbHOH AO THXCeJIOH. 3KaJI06bI SoJIbHOrO CBOAXTCH
k BHesariHO B03HHKineMy cepA iţeSH eurao, OAbiuiKe, oSm eft c jia S o c ra .
rip n B03HHKH0 BCHHH reMOAHHaMHHecKHX HapymeHHiî — aprepH ajib-

55 <3
HOH ranOTOHHH — SOJIbHOH M03KCT HCaJIOBaTbCJI H a rOJIOBOKpJOKeHHe.
H a n G o jie e TaxcejibiMH k jih h h h c c k h m h npoHBJieHHHMH c o n p o B O ^ a a ro r-
Cfl apHTMHH C SoJIbfflOH HaCTOTOH CepAeHHbIX COKpameHHH (CBbIHie 100
yu/MHH). npH 3 to m MoxceT B03HHKHyTb ocTaHOBKa cep/ma.
ApHTMHH )KaAo6bi O&beKTHBHbie KpHTepHH
TpeneTaHHe 06maa cjia6ocTb, cepAUeSne- 3KT- KapTHHa, H3mch6hhh
npe^cepflHH HH6, THHcejiaa oAbimica, roAOBo- HHTcpBajia ST, aprepHajibHaa
KpyjKeHHe, 6oah b rpyzjH rHnoTeH3HH

JleneHHe
Bbipa/KenHocxb xeMOAHHaMHnecKHx HapymeHHH
fT T j
Cmadwibnax zeModuHOMum, JJpu mxMcejiou
6e3 ebipaoKenubix Hapyiueuuu apmepuajibHOU
<pyHKi{uu jieeozo .vcmydonna zunomemuu
[3-aApeHo6jK)KaTopbi: b /b — 3AeKTpOCTHMyAHipW

1?lr
BepanaMHJi 1 0 Mr npeflcepAHH
MeTonpoAOA — 5 - 1 5 Mr;
* m nponpaHcmoji — 1 - 2 m a 0 ,2 5 %
pacTBopa
aMHOAapoH 1 5 0 - 4 5 0 mt

n p n nap o K C H 3 M e xpenexanHH npeAcepAHH na ţo n e WPW-CHHApoMa sse-

(IlponpaHOjioJi, Are-
A e m ie c e p a e H H b ix t j i h k o 3 h a o b ( a h f o k c h h ) , p - 6 .io K a i o p o B
HOJiOA, HaAOAOJi, Mexonpojioji), C a - 6 jio K a x o p o B (Bepanaiunji, /ţnjiTHa3eM) —
npoTHBonoKa3aHo!
I I p H H ajiH H H H cepAeHHoii H e a o e x a x o H H o e x H npHMeHCHHe p-aApeHOOJiOKa-
TopoB h B c p a n a v iH jia u p o x u B o n o K a i a i i o . I I p e n a p a x o M B b iO o p a HBJiHexca bmh-
OAapoH.

MEPIJAHHE (OHEPHJIJIHLţELfl) IIPEJJCEP^HH

IIpH MepnaTejibHOH apHTMHH Ha 3KT onpe^euaiOTca xaoTHHHBie
BOJiHMB036yxc,fl[eHHa npeacep^HH, x o th npeAcepflHbie 3y6ijbi P oSHapy-
xcHTb HeB03M0)KH0. 3KT npe/ţcTaBJineT c o 6 o h BOJiHoo6pa3Hbie KOJieGa-
h h h H303JieKTpHHecK0H jih h h h , nepeMexcaiomHecH KOMnjieKcaMH QRS.
MepijaTejibHaa apHTMHH B03HHKaeT npn cep^enHOH HeflocTaTOHHO-
c t h , aprepnajibHOH rHnepreH3HH, HEC, JieroHHOH THnepreH3HH. Bo
Bcex 3 t h x cjiynaax HMeeT MecTO yBejiHneHHe pa3Mepa h zţaBJieHHH b
npeacep^HHx, h t o h npOBOijHpyeT MepnaTejibHyio apHTMHio. KpoMe
TOTO, MepU,aTeJIbHaH apHTMHH MOHCeT B03HHKaTb npH THpe0T0KCHK03e H
H 56
nocne 3JioynoTpc6sieHHfl an«oro/ieM.
I [pH MCpnaTC/IbHOft apMTMHM yrpOTKatOmHC TKHIHH COCTOHHHH 8 0 3 -
HMKaiOT B CBH3 MC TCM, HTO IipH TaXHKapAHH (140-160 yfl/ MHH) CHH-
jKaerca cepACHHbfH Bbi6poc, paiBHBaeTca aprepH&nbHaa mnonreHiMB w
jieroHHaa rnneprefOMB. HiMCHacTca BHyTpHcepacHHaa reMOAHHaMH-
ica, hto conpoBOKAaercfl cra30M KpoBH b npeAcepAHax h noBbmiaeTca
pHCKtpom6o?m6ojihh ronoBHoro M03ra.
Pai/iMnaioi raxH- (Oojiee 100 yn/wimi) u Opa/tMCHcrojiHwccKyio (b
npcaenax 60 yn/M H H ) (ţ)opMy Mcpuanwa npeAcepAHft. KpOMe Toro, pa>
JTHHaiOT napOKCM3MaJIbHyiO MepuaTC^bHyK) apHTMHK)

h ffp T n ''
1Bo36y»A0HHe npeAcepoHft
Puc. 3.12. TaxucucmojiuuecKaH (jjopMa Mepifcmufi npedcepduu

Ecjih nauMcirr npHiueji Ha npneM k CTOMaroJiory c y*e Hiyieioineii-

ca napoKCH3MajibHofi TaxHKap/uiefi, jcoxopaa HaSnioAajiacb He MeHee 2
CyTOK, BOCCTaHOBJICHHe pHTMa MOJKer 6bITb OnaCHblM B03HHKH0BCHH6M
tpom6o3m6ojihh JieroHHoft aprepHH (ILX. /ţacanaiiiHa c coaer. 2008 r.).
npH MepiţaxejibHOH apnxMHH MeHee 2 cyxoK modkho nonwxaxbca Me-
AHKaMeHT03H0 BOCCXaHOBHXb pHTMCCpAUa.
JleneHH e

nPEIIAPAT A03M nPHMEHAHHE

BepanaMHJi ((Jjh- BHyrpHBeHHO—10 yMCHbOiaiOT Ma-
hoiithh) — 6jio~ Mr 1crory cepaeHHbix
Karop KajibiuieBbix BHyrpb — 80-120 c o fc p a m e iiH H . IlpH
KaHajioB MT cepaeHHoM u c a o -
CTSTOHHOCTH--
IipOl HBOIIOKHiUHO
063HAaH — BHyrpHBeHHO— YMCHbUiaiOT Ha-
P-aApeHo6aoKaTop 5mt CTory cepACMHbix
BHyrpb — 80 Mr COlCpamCHHM. IlpH
cepaeMHofl ne/io-
CTaTOHHOCTH—
npoTHBonoKa3aHO
57 <n
 IIPEIIAPAT fl03M nPHMEHAHHE
AMHoaapoH — SjioicaTop BHyrpHBeHHO 150-450 M r (5-7 I I p e n a p a T b i B b i-
KajmeBux icaHanoB Mr/icr Maccbi TeJia Ha 250 m ji 5% 6 o p a n p n h s u ih -
pacTBopa raioK03H. BHyrpb — 20 Mr HHH CepaCH HO H
Ilpona(J)eHOH — Ojioxa- BHyrpb 150 mt HeflOCTaTOHHOCTH
Top HaTpHeBwx KaHajiOB

0>HBPMJUUHţHfl ^CEJIY^OHKOB

OnSpiumamia acejiyzţOHKOB mohcct B03HHKHyn> Ha 4>OHe Hcenyucrc-

koboh TaxHKapflHH h craHanaeT ocTaHOBKy KpoBooSpamemra. Hajnrme
4>H6pHjmaiţHH acejiyzţOHKOB aBJiaerca noica3aHHeM k ajieicrpHHecKOH p&-
4>h6phjuihd;hh h npoBe^eHmo cepfleHHO-JieroHHOH peaHHMaijHH. Cep-
^eHHO-JieroHHyio peaHHMaimio -^HenpaMofi Maccaac cepaiia h HBJI
(jiio6k[m flociynHbiM choco6om: HeHHBa3HBHHM fltixaHHe «por-B-
poT», «por-B-HOC», c Hcnojit30BaHHeM MeniKa AMBY h jnmeBOH Ma-
CKH, nOJiyHHBa3HBHbIM---HCII0JH>30BaHHe pa3JIHHHHX B03flyXOBOflOB H
HHBa3HBHbiM : mny6aLfna Tpaxen).

HHTy6auHa ip a x e H K om 6 hti >k)6 ycTaHOBJieH H aa iwmeBOflOM

Puc. 3.14. BoccmcmoeJieHue npoxoduMocmu dbixamejibHbix nymeu u Memodu HBJI

li 58
 9/iejcTpnHecKafl A e< ^n6pnjvinnnn — r r o f w w t i e m f f e vicinpwMc-
CKHMTOKOMBblCOKOTO lianpH'/KCHMH (OT 150 /(O 350 /£«; 3-5 Aac/icr
MaccwTcaa) h Mano» ch/im toks, ripw 3/icKTpMwecKofi nc^tt6pH JiJtnnnu
npoHexoAHT rro/iapHiauHa bccx MCMfipan KapanoMHouMTOs ( b o ih h k b c t
acHCTOJwa) mcaeayjomnfi nwny/ibc bottom pwrua BocnpHHMMarrca
BCCMHKapAHOMHOUHTaMH OAHOBpCMCHHO, HTO COfipOBO'sKaac'fCB BOO
CT3HOB/ICHHCMCHHyCOBOrO pHTMU. PaCHOJKKKCMMC IBCICrpOAOB Ae<pH~
fipHM firopa — na ncpcAHcfi noBcpxHocTH rpyoH noa npaaotf kjikwh-
ufiPi h b oO/iacTH BepxyuiKH ccpaua.
3/ieKTpoAbi HaKJiaawBawTca Ha K o x y ncpei cmoh&hhmc 4)H3hoboth-
W CCKMMpaCTBOpOMCancjjCTKHHJIHCMa3blBa(OTCB CHCUH&ribHbIMrCJICM.
3toHeoOxoaHMo aaa chhjkchhb conpornbj/chhb kdtkh 3;icktphhccico-
MyToicy h npcaynpoKaacT iiomhjichmc oxoroB Ha Koxce.
3jieKTpHHecfcaH ae4)H6pHJiaauHB o&rcaTeabHo aonxcHa conpoBO-
waan>ca MaccaxccM cepaua ao- h nocjie npoBeacHH* paspaaa aaeicrpH-
HCCKOrOTOKa.
HC3(|)(|)CKTHBHOCTb SJJGKTpHHQCKOH
/tC(J)n6pMJIJIHUHMMOHCCT6bITb CBH3EHa
c:
1. HenjioTHMM npnjieraHHeM
aaeierpoaoB k komccOojibHoro;
2. HeaOCTaTOHHbIM HJIH H36bITOH-
HbiMHanpaxceHHeM;
3. anHTeJibHbiM nepepMBOM b
Maccaxce cepaua;
4. HaHeceHHeM pa3paaa Ha $OHe
M6JIK0B0JIH0B0H (j)H6pHJIJIfl- Puc. 3.15. PacnojioaceHue
uhh, 6e3 npoBeaeHHa Mepo- sjieKmpodoe npu sjieKmptwecxou
npHOTHft, noBbimaiomHx 3Hep- de<pu6pwuiHttuu
ropecypcbi MHOKapaa.
OCTPAfl CEP^EHHO-COCYAHCTAH HEflOCTATOHHOCTb
Ueaecoo6pa3HO pa3JiHHarb cepaennyio HeaocTaroHHOCTb h cocyaH-
ciyio HeaocTaroHHOCTb, nocicojibKy 3to pa3JiHHHbie no stmojioitih h na-
ToreHe3y coctohhhb. Ozmaxo, cepaeHHo-cocyaHcraa HeaocTaroHHOCTb
MOMcer 6bm> h KOMruieKCHbiM ocwacHeHneM apyrnx 3a6oneBaHHH, He
KacaiomHxca cepacHHo-cocyawcTofi cHCTeMbi.
OcTpax cepaenHaa HeaocTaTOHHOCTb(OCH). 3 to coctohhhc xapaicre-
59 «□
 w

pH3yeTca Hecnoco6Hocn>K) MHOKapzţa B&mojnwTb HacocHyio ^ymcpino

h co3^aBaTB cep^eHHBiH BBiSpoc fljia oGecneneHHH KpoBoo6pameHM.
OCH MOHCeT pa3BHTbCH KaK npH HaJIHHHH XpOHHHeCKOH CepaeHHOH He-
flocTaroHHOCTH, Tax h y 6 ojibhbix 6es xpoHmecKOH cepaeHHOH Hegocra-
tohhocth. B 3THOJioniH OCH maBHyio pojib HipaKxr 3a6ojieBaHHa cepa-
pa, TaKHe, xax ocipBiH Hmjjapicr MHOKapaa, nocnuKjiapKTHbiH Kapzpto-
cKJiepo3 h HeKOToptie apHTMHH: nojiHaa aTpHOBempHKynapHaa 6jiOKa.ua,
cynpaBeHTpHKyjiapHaa (HazpKeJiyzţOHKOBaa) Sjioicaaa. IIpoBOiţHpyionţHMH
(JjaKTOpaMH pa3BHTHfl OCTpOH Cep^eHHOH He^OCTaTOHHOCTH hbjdiiotcs:
HH(J)eKHHfl, aHeMHa, rHneprapeo3,6epeMeimocTb, HejieneHaa aprepHaiiB-
Haa rHnepreH3Ha, Heco6jiiqn;eHHe peacHMa MeaHKaMeimBHOH Teparom
xpoHKraecKOH cepaenHOH He/ţocTaTOHHOCTH, ynoTpeSjieHHe ajncorojia.
Ecjih cep^eHHaa HeaocTaTOHHOCTb pa3BHBaerca b pe3yjn»Tare CHHace-
Hua coKpaTHTejitHOH (JtyHKiiHH MHOKapaa hjih noBtnneHHa nocTHarpy3KH
(aprepHajibHaa nmepreraHa hjih aoprantHtiH creH03), to yMeHtniaerca
cep^eHHHH BBi6poc, yMeHBHiaeTca onopoacHemie acejiyaoHKa, yBejnwHBa-
erca kohchhbih chctojihhcckhh o6bcm acejiyapaica h sto h o ch t Ha3BaHHe
«cucmonmecKcm duc(pywcnun». n p n raneprpo(J)HH MHOKapaa (BCJiea-
CTBHe rHnepxoHHHecKOH 6oae3HH) anacraHHOCTb acejiyaoHKa h ero pacra-
JKHMOCTB cHHacaiorca, CHHacaerca kohchhbih flHacrojiHHecKHH o6r>eM ace-
JiyqoHKa h sto BeaeT k pa3BHTHio «duacmommecKou duafiymafuu».
B pe3yjiBTaTe cHCTOJiHHecKOH auccfjyHKHHH noBHinaeTca aaBaemie b
jieBOM acejiyaoHKe, Koropoe nepeaaerca Ha aaBaemie b npeacepam i, ae-
roHHbix BeHax h Karauuiapax. IIoBBimeHHe aaBaeHHa b Kamuuiapax yBe-
JIHHHBaeT (J)HJIbTpau;HK) 5KH£K0CTH H3 COCyHOB B HHTepCTHHHH aencoro, a
3aTeM h b ajibBeojiBi. Pa3BHBaeTca KJiHHKraecKaa xapTHHa orexa JiencHx.
IIpH flHaCTOJIHHeCKOH flHC(J)yHKHHH BBICOKOe flHaCTOJIHHeCKOe aaB-
aem ie nepeaaerca peiporpaaHO Ha aerom iyio aprepnio h npoaBaaerca
HpH3HaKaMH 3aCT0HH0H Cep^eHHOH HeZţOCTaTOHHOCTH.

CHCTOTJIHHECKAHflHCOYHKIţHJI

60
 JlE B 03K E Jiy,Z ţ0H K 0B A H H E ^O C T A T O H H O C T B

JIH A C T O JIH H E C K A H J IH C O Y H IO IiW

H a p y m e H H e p a c c jia & ie H H * HapymeHHe HanojraeHiu JieBoro x e n y w ix a

J l e B o r o a c e jiy a o H ic a ______________________
rnnepTpo$Ha JDK M H T p a jib H fc iH c r e H 0 3
KapOTOMHonarjTH T a M n o H a ja cepzuxa
( r jn j c ţr r p o 4 > i r q e c K a j i, p e c i p u K T i i B H a a )
I î p e x o a a m a a H in e M u s M H O K apaa

Puc. 3.16. MexoHU3Mbi JieeoofcenydoHKoeou nedocmamouHoemu [no L .S . L illy, 2 0 1 0 ]

IIpaBoxcejiyaoHKDBafl HeAOCTaTOHHOtm. KaK H30jrapoBaHHoe 3 a 6 o jie -
BaHHe pa3BHBaeTca pe^ce. IIpHHHHaMH pa3BHTHa npaBO*ejiyzţc>HKDBOH
HeaocraroHHocTH M o iy r 6i»m» HH(J)apKT MHOKapzţa n p a B o ro 3KejiyzţOH-
Ka, c re H 0 3 y e n .» neroHHOH aprepHH, «jieroHHoe c e p /m e » n p n o6cT pyK -
th b h m x 3a5oneBaHHax JiencHX, 6poHxo3KTarraiiecROH 6ojie3HH, n p n
3MOOJIHH jieroHHoîl aprepHH, jieBOHcejiyzţoHKDBaji He/ţocTaTOHHOcn> ( c o -
npoBO'yKaaiomaaca noBbiuiemieM conpoTHBJierora JieroHHbix cocyzţOB h
yBejiHHeHHeM nocraarpy3K H Ha npaBbm îKejiyzţOHeK). ITpaBo>KejiynoHKo-
Baa HejţocTaroHHOCTb conpoBoawaeTC» BeH03HbiM 3acroeM b G ojim hom
Kpyre KpoBoo6pameHHfl, t.k . noBbinieHHoe AnacTOJiHHecKoe jţaBJieHHe b
npasoM HtenyzţoHKe nepeflaeTca Ha npaB oe npe/ţcep/XHe. H 3-3a c h h îk c h h h
Bbiopoca H3 npaB oro HceuyzţOHKa cm oK aercji yaapHbiH o&beM h jieB o ro
*ejiyn,OHKa. Flpn Bbipa^ceHHOM c h h jk c h h h yzţapHoro o&beMa jie s o r o 3Ke-
jiyaoHKa MCOKeT B03HHKHyn> KOMneHcaTopHaa TaxHKapzţjra h jih cmDKe-
HHe aprepH ajibH oro /ţaBJieHHa.
ripHHHHbl npaBOHCeJiyiţOHKOBOH HeflOCTaTOHHOCTH
CepjiCTHO-cocyaHCTbie 3a6ojieBaHHH c o c y a o e
3a6oJiesaHHH jierKHX
îa6o.TeBaHMH JierKHX
1. JleBoacejiyaoHKOBaa 1. XOEJI. 1. 3 m 6 ojihx jieroM hoh
HeaOCTaTOHHOCTb. 2. CapKOHjţo3. aprepHH.
2. CxeH03 ycTBH jieroHHOH 3. OcTpbiH pecnHparopHbiH 2. nepBHHHaa
aprepH H . AHCTpeCC CHHApOM. jieroHHaa rHnepreH3HH.
3. Hrajtapirr npaBoro 4. XpoHMHecKHe
xeuyaoHKa HH(|>eKUHOHHbie 3a6ojieBaHHH
JierKHX, 6p0HX03KTa3M.

61 •a
 OCHOBHbIMH KOMneHCaTOpHbIMH peaKIţHBMH npH OCH HBJMIOTCfl
HeHpoaEmOKpHHHbie H3MeH6HHa*
1. AKTHBapHfl cHMnaroaapeHanoBOH CHCTeMUc Bbi6pocoM Karexo-
JiaMHHOB.
2. ÂKTHBaiţHa peHHH-aHTHOTeH3HHOBOH CHCTeMbI CBbl6pOCOMajlb-
flocTepoHa.
3. ybiuieHHe npoflyKpHH aHTH^nypeTHHecKoro ropMOHa.
3 th peaKiţHH HanpaBjieHbi Ha ycHJieHHe coKpararejibHOH cnocoS-
hocth MHOKap^a (KarexojiaMHHH) nozuţepacamie OLţK (ajn>#ocrepoH h
aHTHflHypeTHHecKHH ropMOH). PeHHH oGecneHHBaer npespameHHe aH-
raoTeH3HHoreHa b aHTHoreH3HH I, Koropbra npzţ BjnwHHeM aHTHoreH-
3HHnpeBpam;aK)Hţero (jjepMeHTa (AIIO) npeBpamaerca b aHTHoreH3HH II
c Bbipa>KeHHbiMcocyaocyacHBaiomHM ^eHCTBHCM. Ahthotchshh H, Kpo-
Me Toro, cnocoScTByeT yBejiHHeHHio OIJK qepe3 ycmieHMe JKaayxbi, cth-
Myjiaipno ceKpeipin ajib^ocTepoHa. B to xce BpeMH 3th KOMneHcarop-
Hbie peaiaţHH TpeSyioT yBejmHeHira 3HepreniHec k h x 3aTpar Ha pa6aiy
MHOKap^a. B ycjioBHax HapynieHHH KpoBOo6panţeHHH npn OCH aro yc-
jiOBHe He Mo^ceT SbiTb BbinojiHeHO, t.k. pa3BHBaeTC« udcejiaa zuhokcuh.
YBejiHHeHHe ^HacTOJinne ckoto o&beMa neBoro aceiiyzţoHKa npHBo/ţHT
k ^onojiHjrrejibHOMy pacraHcemno KapflHOMHOiţHTOB, yBejiHHeHHio co-
KpaTHMOCTH MHOKap^a H yBeJIHHCHHK) yZţapHOID O&beMa (3 aKOH OpaH-
Ka-CTapjiHHra). Bo 3moîkhocth s to h KOMneHcaropHon peaieiţHH Taoce
orpaHHHeHbi. YBejniHeHHe ^HacTOJiHHecKoro o&beMa jieBoro acejiyuon-
xa Moacer npHBecrH k JieroHHOH rHnepreH 3HH h orexy jiencHx c nocjie-
.ayiomeH ^bixarejibHOH He^ocTaxonHOCTbio h ycyry 6 neHHeM nmoKCHH.
KoMneHcaTOpHbie peaKiţHH npH JieBoacejiyzţOHKOBOH HeflocTaroHHO-
c th ocymecTBJMKyrca Taicace 6jiaro,napa Bbi6pocy npe,zţcep,zţHoro Ha-
TpHHypeTHHecKoro ropMOHa h 3HflOTejiHHa, KoropwH HBJiaeTca moih-
HblM Ba3OKOHCTpHKT0pOM.
KjiHHHHecKaa Kapmua ocTpofi JieBoacejiyaoHKOBoii
He^OCTaTOMHOCTH:

2Kajio6bi AaHHbie ocMOTpa

OflHiiiKa H3-3a HapymeHHS JieroHHoro ra30o6- Bjiaxcmae xprnibi b JiencHX.

MeHa B CB33H C OTdCOM JierKHX (HHTepCTHUHajIb-
HMM HJIH ajIbBeOJiapHHM) H yBCJIHHeHHH nOTpe-
6neHHH KHCJiopo^a ABixarejibHMMH MwnmaMH.

o 62
Oprantioa (yxyamciiMC j x m x u h h h h T a xm n o v,
ropH'ioMrajii.iioM iiojkokchmm, iicoGxoammoc'i h
npHHWTb cmaxaee iiojhmchhc c onymeimi.iMH
HoraMM, t.k. rro yMOiii/Uiacr hciioimi.iH l u r t u p t n
icpouM k ccp/m y m oGacmucr paCcriy cepanu).

Otck aerKMX (noobimeifMc auitaeiiHH a aeronnoft Akhcht II rona tia ae itpntoPt

aprepMH h uponoreBaiiMC wm/ ikoctm it acro'iiiMtt aprepMH,
MHTepCTMUM^ MBilbHCOabl).

C hhxcchmc A 4 - TaxMKapaaa, phtm raaona.

HeaocxaTOHHOCTi» a CoaiauoM icpyre 1laOyxattMc uiefiHMx gen.
Kpouoo6paui,eu m

Kj i i i i i h wccKau ic a p m iia o c i poii npaBOWMyAOHKOBoti

iic v io c ia ro 'iiio c m :

3Kajio6u JJaHHue ocMorpa

MyBCTBo HexBaTKM B03ayxa, oawoiKa. HadyxaHMe h nyabcaium oreftHbix
^HCKOMcjjopr b npasoM noapeSepbe, BeH, noBbiuieHHe 1UVI. T axatcap an x,
KHHXcaabHaa 6oab 3a rpyaHtioll (npn api epwaaMiax rMnoremna,
TpoM6o3M6oaHH aeroKHoft aprepnn). aKpouaaH03, otck acrxHx, aiatcHT
BToporo to na Haa acroHHott a prepnett.

OyHKUHOHajibHbie KJiaccbi cepA ennoft ncvtoci a ro u iio c i h

[no KJiaccH(J)HKauHH Hbio-ftopKCKofi accounauHH KapflHonoroB]
K aacc npH3H8KH
I Kaacc OH3HMecKaa aKTMBHOCTb He orpaHHiena.
II Kaacc JlerKoe orpanHHeHne aKTHBHocTH. Oabiunca h caaGocib nocae
yMepeHHofi 4)H3HHecK0^ narpytKn (nanpHMcp, nocae 6biCTporo
rioa'bejvia no aecTHHite).
III Kaacc BbipaaceiiHoe orpaHHweHMe aKTHBHOCTH. OabimKa nocae
MHHHMaabHoli (J)H3H'iecKOM Harpy3KH (HanpMMep, nocae
MeaaeHHoro noateMa no aecruHue).
IV Kaacc Taxceaoe orpaHHneHHe aKTHBHocTH. Chmotomm oepaemion
HeaOCTaTOHHOCTH B IIOKOe.

63 «□
 Cra/IHH pa3B H TH fl CepaeHHOH HeAOCTaTOHHOCTH

Ct w h O nH caH H e

B ojibH bie, B x o jw m n e b r p y n n y p n c ic a pa3BHTHa CH, h o

6 e 3 npH3HBKOB c T p y ic ry p H o ro H apyiueH H B (ţiyHKIţHH
A
c e p A u a (H an p H M ep , S o jib H b ie c HEC, n in e p r e H 3 H e H h jih c
KapAH O M H onaTH en b aH aM H e3e).

E o jib H b ie c CH h c npH3HaKaMH C TpyK TypH bix H apym eH H H

B
c ep A U a, OAHaKO 6 e 3 c o o T B e rc T B y io m e H CHMnTOMarHKH.

B ojibH bie C npOHBJieHHHMH CHMIJTOMOB CH (HJIH y KOTOpbIX OHH

C OTMenajiHCb p a H e e ) h c npH3HaKaM H CTpyK TypH bix H a p y rn e m m
cepA H a.

c npH3HaKaMH CTpyKTypHbix H apym eH H H

B ojibH bie c ep A U a,
c BbipaaceHHOH c h m iito m b th k o h , n p o H B Jia io m e H c a H a (J)OHe
D
HHT6HCHBHOH TepaiIH H , H Tpe6yK)IXţHe npHHBTHH KapAHHaJIbHbIX
M ep (H an p H M ep , nep ecaA K H c e p A p a .

JleneHHe
HeMeflJieHHbffl BBI30B CKOpOH MeflHIţHHCKOH
noMomn, Bpana-KapAHOJiora hjih Bpaqa-peaHH-
MaTOJiora.
B coKKmaHHH MeflHUHHCKOH iiomoiiih Heo6xo-
flHMO HanaTb HHrajiaiţHio yBJiamieHHoro khcjio-
pofla Hepe3 HOCOBbie KareTepbi. IIpH pa3BHTHH
ajibBeojiapHoro OTeica jierKHX y SojibHoro bo3hh-
KaeT Karnenb c noaBJieHHeM neHbi Ha ry6ax. Ilpn
HajiHHHHMOHHTopHoro HaOjnqzţeHHa 3a Hacbime-
HHeM KpOBH KHCJIOpOAOM(caTypaiţHa, Sp02) HMeeT MeCTO CHHXCeHHe
3Toro noKa3aTejia HHace 93%. IIpH chctojihhcckom /ţaBJieHHH Bbime
110 MM pr.CT., M05KH0 flaTb HHTpOrJIHIjepHH nOfl X3bIK no 0,5 MT, nO-
BTOpHO, n o f l K O HTpOJieM A J J .

OCTPAfl COCYflHCTAfl HE^OCTATOHHOCTb

KOJIJIAnC
Kojuianc — 3to cxnpaa cocyzţHCTaa HeflocTaTOHHOCTb, xapaicrepH-
3yioin,aaca na^eHHeM aprepHanbHoro h BeH03Horo .zţaBJieHHa. B ocHOBe
KOJuiancaJieaarr pacnnipeHHe aprepHOJi BCJieflCTBHe 6jioKa,Abi iţeinpajib-
Hbix h nepH(J)epnHecKHx MexaHH3MOB (JiopMHpoBaHHa h npoBeaeHHa
HMnynbcoB cHMnaraHecKOH HepBHOH CHCTeMbi hjih npaMoro BjmaHHa

m 64
pguiHHHbix (jmKTOpOB Ha nepH(J)epHHecKHe cocyaw. yBejiHHHBiuaaca co-
cynHcraa eMicocTb conpoBOKaaercH p 33bmthcm HecoorBcrcTBHJi ofoeMa
UHpKyjiHpyiomeft KpOBH (O IJ K ) c m k o c th c o cy n H c ro ro p y c a a , pa3BHTHeM
OTHOCHTCJlbHOft rHTIOBOJieMHH (nOCKOJILKy O U K He H3MeHSeTCH), CHH-
*eHHeM BeH03Horo B03BpaTa KpOBH k c e p a u y h nocaeayiom H M yMeHb-
iuchhcm cep aeH H o ro B bi6poca co chh^cchhcm aprepH ajibH oro aaajieHHH,
HapymeHHeM KpoBOCHaS^ceHHH TKaHeft h opraHOB, h pa3BHTHeM ra n o n -
chh. IIpHHHH pasBiiTHH KOJinancaaocTaroHHO MHoro: raneprepMHHecKHH
KpH3, m y6oK H fi HapK03, BbicoKaa cnHHHOM03roBaa hjih nepHaypajibHaa
aHecTe3Ha, o c r p b ie OTpaBaeHHH chotbophbimh, aHecTe3HpyiomHMH h
aapeHOJiHTHHecKHMH cpeacTBaMH, nepeao3HpoBKa raH nraoănoK aropoB ,
HaanoHeHHHKOBaa HeaocTaroHHOCTb h a p . Ho b aaHHOH cmyamm mh
nonaraeM BbiaejiHTb Taicne rrpHHHHbi, Kaic: ncnxoreH H aa, noBbinieHHaa
aKTHBHOCTb IiapaCHMIiaTHHeCKOH HepBHOH CHCTeMH (jIHHHOCTHbie OCO-
SeHHOCTH ^yHKIţHOHHpOBaHHB BereTaTHBHOH HepBHOH CHCTeMBi), pa3-
BHTHe a m m o 3 a npH thiiokchh, caxapHOM a n aG e re h ap-, a n cK e iffle aic-
thbhocth cHbmaToaapeHajiOBOH h rHno<J)H3apHO-aapeHajiOBOH chctcm,
opToeraxHHecKim m ju ia n c , oco6chho, ecjiH Sojilhoh aocraroH H O tu m -
TejibHoe B p e m He npHHHMaji im m y h Boay H3-3a 6ojih.

KjIHHHHeCKHe npOHBJieHHU
2K a jio 6bi OfrbOKTHBHbie npH3Hab'H
B H esan H O KoHeHHOCTH XQJIQflHbie, KOXCHbie nOKpOBbl H CnH3HCTbie 060JKWKH
paaBHBaerca GneaHbie c uiiaHOTHHHbiM orremcoM, xojioahm h n o r, ManbiH h
daoocT b. cnaobifi nynbc, o 6 u h h o yqameHHbm, BeHbi cnaB nraeca, AJ\ h o h h -

ronoBOKpyxeHHe, xem (b Sojibuiefi c re n e m i CHHaeaerca nHacTOJimecKoe AaBnemie,

UIYM HJIH 3BOH B
neM CHcrcwiHHecKoe, no3TOMy nynbcoBoe ^aaneHHe yBejiHHeHo),
y n ia x , y xyajneH H e
TOHbi cep jiu a m y x n e. TpeMop najibueB pyx, HH om a— cyaoporn.
apeHHfl. acaxcia.
P e a fa Q u 3paHKDB Ha c b c t san aa. PiHoraa mohcct Ha&noaaTbca
03H 0D .
HapymeHHe co3HaHHa (ocoSeroro, earn 6 o j h >h o h hoxoahtcm b

noncoKemiH c nptmoAHaTUM i t u i o b h u m kohhom — najioaceuHe

O oBJiepa). M o ry r noaBHTbca Toum ora h pBora.

j^HarH03 CTEBHTCa Ha OCHOBaHHH aHaMHeCTHHeCKHX aaHHBIX, »ca-

jio6 h oGbeiciHBHbix npH3HaKOB. OaHaico cjieayeT npeaynpeaurb, hto
icojuianc cueayeT an4)4)ePeHLlHPOBaTI> c KapanoreHHHM uiokom, kjih-
HHHecKHe npoaBJieHHa Koroporo cxoaHbi c KOJUiancoM. B 3toh CHiya-
qhh 6ojn»inyK) noMomb MO»ceT oxasaTb KpHBaa 4)0TOnjieTH3M0rPaMMtI
(«MET), HMeiomaaca Ha MOHHTOpe. npH KOJUiance OUT BbicoKoaMiMH-
lyaHaa (A), a npH KapanoreHHOM rnoKe — HH3KoaMrunnyaHaa (B)
65 «C0
 £
Puc. 3.17: A ^~ ebicoKoaMmumydnan 0 T ir npu huskom oâuţeM nepiupepmecKOM
conpomuenemu (Kojuianc); E — HUSKoaMnnumydaosi 01irnpu sucokom oâiqeM
neputpepmecKQM conpomuenem u ( mpduozeHHbiu iuok)

Jlenemie
ropH30HTajn»Hoe nojioaceHHe 6ojn»Horo c npn-
nOflHHTHM H05KHMM KOHLţOMKpeCJia (HUH KpOBa-
th). B w3ob peaHHMaTOJiora, a npH 3aT«HyBmeHc«
ranoreraini'— bboob 6pHrafli»i CKopoă Me/ţH-
LţHHCKOH nOMOUţH.
Ilp n KOJiJiance pe3Koe nafleroie TOHyca cocy-
flOB BBJUieTCB OCHOBHOH IIpHHHHOH CHIDKeHHfl
aprepHajibHoro flaBnerora. IIo3TOMy naroreHeTH-
necKHM bhaom jieneHHH «BJiaeTca BBeaeHHe Bao-
npeccopoB: HopajţpeHajiHHa, a^peHajiHHa, ao^aMHHa, Me3aroHa. 3 th
n p en a p ara bbjmiotch a/ţpeHeprHHecKHMH aroHHCTaMH c reMO/ţHHaMH-
HeCKHM 34>4>eKTOM.
MexaHH3M /ţeilCTBHH H reMOflHHaMHHeCKHM 3(j)(|)eK I arOHHCTOB
aipcHopeueinopoB
Ha3BaHHe A /ţp e H o p e u e n T o p b i rem OAHHaM HHeCKHH 3<|)<|)eKT
npenapaT a
AflpeHajiHH B HH3KHXA03ax (<0,01 m k t / kt / m h h )
(Ba30K0HCTpHKUHH) H yBejiHBHBaeT Hacrary cep/ţeHHbix
fi-j (COKpaTHMOCTb) coKpameHHÎi, cep/ţeHHbm suOpoc.
6 - 2 (Ba30flH JM TauH a B 6ojiee bhcokhx ao3ax 3HâHHTejibHo
KOpOHapHblX yBejfflHHBaer o6mee nepH^epuraecKoe
cocyqoB ) COnpOTHBJieHHe COCyiţOB, BeH03HbIH
B03Bpar KpoBH k cep,zmy.

H> 66
Hopa^peHajtHH a-,, a-2 B MCHbiueft CTencHH mmhct na Hacronry
(Ba30KOHCTpHKUMH) H cepACHiibix coKpameuHti, see ocranbHMe
13-, (cOKpETHMOCTb) 1CMO/WHaMM'ICCKHC 3(f)<peKTM CX09KH c
aapciiajiHiioM.
/J,onaMHM 13-, (COKpaTHMOCTb) M CpeAHHe A03M (2-10 M K r/K r/M M H )
(aHAoreHHbiR 13-2(Ba30flHJlBTaUHfl) CTHMyjfMpyior 13-, peuenTopu:
KaTexojiaMMH, °h noBbiajaeTca MCC, yBe/iMHCHHc
npeauuecTBeMHHK (Ba30K0HCTpMKUHfl) yaapnoro h MHHyTHoro o&bCMOB cepoua.
HOpaApeHajiMHa) BbICOKHe A03W (10 MKr/Kr/MHH)
c t h MynHpycT a-, peuenTopu:
noBbiuieHHe OHCC
HH3KMC A03bl (<2 MKr/Kr/MHH)
pacuiHpeHHe cocyaoB h o w c k h
6pbOKCMi<M, yBejiHHeHHe Anype3a.
/J,o6yraMHH B-, (COKpaTHMOCTb) H yfleaHHHBaer COKpaTHMOCTb MHOKapaa,
(CHHTeTHMeCKHft J3-2(Baao^HJiflTauHJi) ho He noBbiiuaeT OHCC, t . k .
ananor BosaeilcTByer oaHOBpeMeHHO h Ha a-,
AonaMHHa) (BaaOKOHCTpHKUHa) h Ha B-2peuenTopu. 1/pu.uenuemtH
npu lacmoiiHoit cepdemwu
nedocntamoHHocmu 6ei eunomoHUU.
Me33TOH a -l B 6ojii.iuch CTeneHH licm apyrne
(BaSOKOHCTpHKUHB) KaTexoaaMHHbi, oGjia/iaer
nOJIOXCHTeJIbHbIM HHOTpOIlHblM
ACHCTBHeM, yBeJiHHHBaa cepAennuft
BbiGpoc, ho MeHee BbipaxceHHUM
aciicTBiicM Ha nacTory cepACHHux
C O K p a iU C H H H .

OKa3bIB£ltt HHOTpOIlHblH h/HJIH TaXHKap^HTHMCCKHM 3tj)(J)eKT, BCe

npenapaTbi yBejiHHHBaioT noxpeSHOCTb MHOKapaa b KHCJiopoae, no-
3TOMy uejiecoo6pa3HO hx npHMeHemie conpoBoacaaTb HHrajismHefi
KHCJiopoAa. Bee npenapaTbi, KpoMe AO(j)aMHHa, cHHxcaiox noneHHbiH
KpoBOTOK. OnTHMajibHbiM nyreM BBeflenna npenaparoB XBJiaeTCH BHy-
TpHBeHHblH.
Ilpenapar Bojiioc b/ b riOCTOHIIHaB HII(J)V3HH
Me33TOH 50-100 MKT 0,15 MKr/Kr/MHH. ripH pa3BCAeHHH 10 Mr B 250 MA
(})H3HOAorHHecKoro pacTBopa b 1 ma coAepxcHTca 40
MKr MC3axona.
HopaApenajiHH 0,1 MKr/Kr/MHH. ripH pasBeaeimH 4 Mr b 250 ma
^)H3HOAorHHecKoro pacTBopa b 1 ma coaepxcHTca 16
MKr HopaApeHanHHa.

67 -a
 AApeHajiHH 0,3-0,5 Mr 0,015 mkt/kt/ mhh. npH pa3Be,zţeHHH 1 mT b 25o^ i
(J)H3HOJiorHHecKoro pacraopa b 1 mji cojţepjwrrc^
mkt aAP^HajiHHa.
AonaMHH 2-10 mkt/kt/ mhh. ripH pa3BeA6HHH 200 MTB 250kJ
$H3HOJIOTHHeCKOTO paCTBOpa B 1 MJI COAepXjrrcj,
800 MKT AO(]>aMHHa.

OEMOPOK HJffl CHHKOIIA

06mopok hjih cHHKona — npHCTyn KpaTKOBpeMeHHoif yrparw co-
3HBHHM, 06yCJI0BJieHHBIH BpeMeHHBIM CHHHCeHHCM M03rOBOTO KpOBOTo-
Ka. 06mopok pa3BHBaeTCH BHe3aimo, HenpoAOJDKHTejieH h o6paTHM.
npHHHHaMH o6MOpOKa flBJHIIOTCA pa3JIHHHBie HeHpOreHHbie CHTyailHH,
TaKHe KaK ncHX03M0ijH0HajiBH0e HanpaaceHHe, CTpax, BOJiHemie, tojio-
Aaime, npe6biBaHHe b ayniHOM noMemeHHH. OaicropaMH pHCKa pa3BH-
THfl o6MOpOHHHX coctoahhh Moiyr 6BITB 3a6ojieBaHHfl cepAenHo-co-
cyAMCTOH cHCTeMH, conpoBoacAaiomHecji CHHXceHHeM cepAeHHoro
BBi6poca — HapymeHna pHTMa cepAiţa (6paAH- h TaxuapHTMHH, cre-
H03BI aOpTBI HJIH JierOHHBIX apTepHH, HH(J)apKTBI MHOKapAa, npHCTynH
CTeHOKapAHH, aHeMHH, 3a6ojieBaHH^ opraHOB ABixaHHa). Bee 3th 3a-
6oJieBaHHH CnOCo6CTByK)T pa3BHTHK) pa3JIHHHBIX BHAOB THIIOKCHH.
06MOpOHHBie COCTOflHHfl MOiyr B03HHKHyTB KaK pe3yjIBTaT pe(j)JieK-
TopHBix bjihhhhh (cHMnTOMaTHHecKHe oGmopokh) npH 3a6ojieBaHm
^cejiHHoro ny3Bipa h AseHaAiţaTHnepcTHOH khhikh, npH nmepTOHirae-
Lckoh 6ojie3HH h aTepocKJiepo3e. Oahoh H3 npHHHH oGMopoxa momt
|6 b itb rHnepBeHTHJMiiiHa, B03HHKaiomaa npH CTpaxe, 3MoiţHOHajiBHOM
JHanp^xceHHH hjih npn accoiiHaiiHjix c HenpHHTHBiMH oinymeHMMH.
FnpH 3tom ochobhbim MexaHH3MOM o6MopoKa HBJiaeTCH cna3M cocy-
Aob ronoBHoro M03ra, oSycjiOBJieHHBiH rHnoKammeH. OaicropaMH pH-
CKa pa3BHTHH o6MOpOKa flBJIfllOTCJI OpTOCTaTHHeCKHe npHHHHBi: m H-
TejiBHoe cTOHHHe hah 6biCTpoe BCTaBaHHe. Ba30BarajiBHBie o6mopokh
npoBoiiHpyioTCH BOJiHeHHeM (b 3tom cjiynae ohh name pa3BHBaiOTC« b
AyniHOM, nepenoAHeHHOM jiioabmh noMemeHHH), cTpaxoM nepeyroM-
AeHHeM, TpaBMOH HJIH 60JIBK). IIOCTypaJIBHBIH HeHpOKapAHOreHHHH
(opTOCTaTHHeCKHH) o6MOpOK B03HHKaeT npH SblCTpOM H3MeHeHHH no-
jio)KeHHfl Tejia (6BicTpoe BCTaBaHHe), oco6eHHo5 eejm y nauneHTa HMe-
eTC« rHnoBOJieMHK (yMeHBineHHe OUK npn KpoBonoiepe, HeAOCTar-
Ke npneMa xchakocth — npn ocTpwx bocnajiHTejiBHBix npoiţeccax b
HCJIIOCTHO-AHUeBOH oftjiaCTH), npH 6epeMeHHOCTH, npH IIpHMeHeHHH

D> 68
 rnnoreH3HBHbIX CpeflCTB, AHypeTHKOB. CHHOKapOTH/IHbfH 0 6 MOPOK MO-
MceT B03HHKHyn> npw pc3KOM noBopore idjiobw, caaBJieHHH cHHoicapo-
TH^HOH 30HbI TyrHM BOpOTHHHKOM H ^p. 3tOT BHfl o6MOpOKa OCo6eHHO
xapaicrepeH /pi» noxcHJibix Jiioaeif c BbipaaceHHbiMH arepociaiepOTH-
qeCKHMH H3M6HeHH»MH M03r0BbIX COCy/ţOB. OcHOBHbIM M6XaHH3MOM
3 T oro BH/ţa oSMopoxa »BJi»eTC» noBbinieHHe TOHyca n. v ag u s n p u pa3-
^paxceHHH MexaHO- hjih SapopeuerrropOB cHHOKapoTH/mofi 30hm, ace-
jiyaoHHO-KHiueHHoro Tpaicra, MOHenojiOBOH c(ţ>epbi. I lo MexaHH3MaM
pa3BHTH» oSMopoxa Bbi//eji»K)T em e KapaHoreHHbie, B03HHKaiomHe Ha
4>OHe apHTMHH HJIH o6cTpyKTHBHbIX 3a6oJieBaHHH, npenHTCTByiOIUHX
cep^eHHOMy Bbi6pocy (aoprajibHbiH ctcho3, ctcho3 jieroHHOH aprepHH,
rerpana <t>ajuio, jieroHHaa rHnepreH3H»). U,epe6poBacKyjiapHwe 0 6 -
MopoKH o6ycjiOBjieHbi nopaaceHneM HHTpa- hjih 3 KCTpaiepaHHajibHbix
cocyaoB. Tanne oSmopokh B03HHicai0T npn cyaceHHH cohhwx aprepHH
aTepocKJiepoTHHecKHMH 6ji»uiKaMH. I lp n c/iaBJieHHH BepreSpajibHwx
aprepHH CHHKonanbHbie coctobhh» pa3BHBaiOTC« npn pe3KOM p a 3 n i6 a -
HHH rOJIOBbl--- «CHH/ţpOM CeKCTHHCROH Kanejuibi».
KjIHHHHeCKHe npOHBJieHHH
5 K a jio 6 b i O & beK T H B H bie npH 3H H K H
0 6 m a a c jia S o c T b , Bjie^HOCTb KOJKHbIX nOKpOBOB, IlOTJIHBOCTb,
rojiOBOKpyaceHHe, T O u iH o ra, CHH/KeHHe a p re p w a jib H o ro A aB Jiem ia, c n ad b iH
3 b o h b y m a x , M ejibKaH H e n y jib c , TaxHKapAHa h j i h 6pa.uH K ap.aH » , nnyxH e
«M yuieic» n e p e j i raa3 aM H . TOHbi c e p jm a , jibixaH H e p e a x o e h noB epxH ocT H oe,
3eBOTa, p acu iH p eH H e 3panKOB c c h h jk c h h c m h x

peaKUHH Ha cBex, n o r e p a c o 3H 3 h h » . t Î H o r a a M o iy r
B03HHKHyn> TOHHKo-KiioHHHecKHe c y a o p o r a H
HenpoH3BO JibH oe M OH encnycicaHHe.

Jle n e H H e

JJjim BbiBe/ţeHH» napneHTa H3 o6MopoHHoro

coctobhh» cjie/ryeT yjioaam» ero b ropH30HTajib-
Hoe nojioaceHHe c onymeHHbiM rojiOBHbiM koh-
UOM h npHno/XHBTbiMH HoraMH, HanaTb HHran»-
i/hk) KHCJiopo^a n e p e 3 JiHtţeByio Macxy, ocjia6HTb
noac, paccrrerHyTb BepxHHe nyroBHiţw py6aniKH,
nan> B^oxHyTb napbi HamaTbipHoro cimpra ot
BancH, pacnojioaceHHOH He 6jmace 2 cm ot JiHiţa

69
 SojibHoro. Ecjih y naimeHTa 6buia pBora, ero He cjieayeT yKnaflHBan,
Ha croiHy, t .k . 3 t o cnocoOcTByeT acimpaiţHH pBomtix M ac c . ITamieHT
flOJiaceH 6biTi> yjioaceH Ha npaB&m 6 o k , pBOTHBie M a c c w yuajieHbi H3 no-
jiocth pra (najibqeM hjih acimpHpOBaHBi otcocom). IlpH BbipaxceHHOH
ranoTeH3HH cjiejţyeT npoBo^HTb BHyipHBeHHyio HH(J)y3HK) iuia3M03a-
MenţaiomHx pacraopoB — <J)H3HOJiorHHecKHHp-p, p-p Pimrepa, nnoRo-
3bi (5-10%). Ecjih naiiHeHT Haxo^HTca b 6ecco3Harejn>HOM coctobhhh
Oojiee 1-2 MHHyr, to hcoOxo^hmo BBi3Ban> Bpana-peaHHMarojiora hjih
CKOpyio Me,mniHHCKyK) noMoiiţb. Tax ace cjie^yeT nociynan., ecjra y
OojiBHoro nocjie BoccTaHOBJieHHa co3Hairaa B03HHKaeT 6ojieBOH chh-
flpoM KaKOH-jni6o jioKajiH3arţHH: 3arpyaHHHaa 6ojib, 6ojib b aoroore,
rojiOBHaa 6ojib.
 Hiiaea 4
111OK
AHAOHJTAKTHHECKHfl 1UOK
KOCTpOHCOCyflHCTOfi HeflOCTaTOHHOCTHBCTOMaTOJIOnfHeCKDfi KJIH-
HHKe name Bcero MoaceT npHBecTH ajmepraHecicaa peaiama c pa3 BHTH-
eM atU K pujiaK m unecK ozo u u m a .
AHa(j)HJiaKTHHecKHHiiiok — 3to HMMyHHaHpeaKiţna HeMeaneHHoro
THna, pa3BHBaiomaaca npH noBropHOM BBeaeHHH b opraHH3M ajuiepre-
Ha. 3ia peaiojna MoaceT pa3BHTbca b Tenemie 30 MHHyr.
UIok xapaicrepH3yeTCfl CTpeMHTejibHbiM pa3BHrmeM, GypHHM
npoHBueHHeM, TaacecTbio TeneHita h nocjieflCTBHH. Ha o6myio icapTHHy
hraaeecTb TeneHHHaHacjjHnaKTHHecKoro rnoKa bh# ajuiepreHa He BJiHaer.
KjiHHHHecKan K apniH a aHat|>HJiaKTHHecKoro rnoK a
3Kajio6bi CojibHoro O&beKTHBHbie npH3H3KH
V 3ya KoacHhjih ayBCTBOxcapa bo BceM OnpacKa kojkhmx noKpoBOB Moacer
Tene («cjiobho KpaniiBon oSomctjio»), MeHHTbca: y 6ojibHoro c (wieflHOCTbio
V B036yagieHHe h 6 ecnoKOHCTBo, jiHua Koxca npHo6peraeT 3eMJiHCTO-
V BHe3anH0 Hacrynaiomaa o6maa cepbiH UBeTc imaH030M ry6 h kohhhkb
cjia6ocTb, Hoca.
V noKpacHeHne jinu,a, KpanHBHHpa, FanepeMHa kohchTynoBHipa,
HHxaHbe, Kamejib, BbicbinaHH» rana KpannBHHnbi;
V 38TpyqHeHHoe flbixaHHe, yzţyiiibe,
V crpax CMepiH, oreK Bex, ry6, Hoca H3biKa,
h

V npojiHBHOHnor, neHa y pra;

V rojioBOKpyaceHHe, xojioflHbiH, jinmcHHnor.
V noreMHeHHe b ma3ax, 3panKH oSbiHHOcyaceHbi, nonra He
V TOUIHOTa, pBOTa, pearapyiOT Ha cbct.
V 6ojih b oGnacTH xchbotb, HHoraa Ha6jnoaaK)TCfl TOHHnecKne hjih
V no3biBbi kfle^eKauHH, >khakhh CTyn KJioHHaecKHe cyfloporn.
(HHorjţa c npHMecbio kpobh), Ilyjibc nacTbin, cjiaGoro HanojmeHHH,
V HenpoH3BOJibHoe MoaeHcnycicaHHe, b laacejibix cjiynaax nepexoaHT b
V KOJuianc,
HHTeBHAHbiHhjih He npomyiibiBaeTCJi,
V noTepji co3 HaHH«.
AR CHHacaeTca.
KjiHHHHecKaa KapTHHa MoaceT npoaBJiaTbca c npeHMymecTBeHHWM
nopaaceHneM Tex hjih hhux chctcm h cooTBeTCTByiomeH cHMirroMaTH-
kdh. Ecjih nopaacaeTca cepaeHHo-cocyzţHCTaa CHCTeMa, to Ha nepBbm
iuiaH bwxo ^ ht apTepHajibHaa nmoTOHna, oSycjiOBJieHHaa KOJiJiancoM
cocyaoB. KojiJianc B03HHKaeT b pe3yjibTare aeHCTBHa pa/ţa Ba30AHJia-
71 «3
 TaropoB, BBipejiaiomHxca npH ajuieprHHecKHX peaxnnax h , tcm 5onee,
npH aHa(J)HJiaKTHHecKOM inoxe. PacmHpeHHe cocypoB — maBHWH na-
TO(J)H3HOJIOrHHeCKHH MeXEHH3M HapynieHHH Kp0B006pameHH3 npH
aHa(J)HJiaKTHHecKOM inoxe.
E cjih npeHMymecTBeHHO nopaacaerca AbixarejibHaa cncreMa, to
B03HHKaK)T CHNOITOMM3aTpyZţHeHHH PBIXafflia H3-3a pa3,Zţpaaceiffla CJIH-
3HCTOH 060JIOHKH SpOHXOB H IOJIOCOBBIX CBB30K OTCHHOH aCHpKOCTBK).
Han6ojiee raacejibie ocjioaoieHHa cBX3am>i c 6poHxo- h JiapHHrocna3-
mom. BMecTe c tcm MOiyr 6bitb h TaxHe npoaBJiemia, xax xamejib, hh-
xaHHe. M oiyr 6 litb npoaBJieHHa, cBa3amn>ie c nopaaceHHeM, raaBHbiM
o6pa30M, GJIH3HCTBIX oSOJIOHCK, B TOM HHCJie H BepXHHX PBIXaTeJIBHBIX
nyrenj^- ropraHH. IIpH 3tom pa3BHBaerca OTex ra n a Kbhhkc, xoropBra
MoaceT npHBecra x ac<j)HXCHH. Ilpn aHa^HnaxranecxoM rnoxe chmoto-
Maraxa MoaceT 6bitb CBa3aHa c npeHMymecTBeHHBiM nopaaceHHeM ace-
jiyaoHHO-xHmeHHoro Tpaxra. Ochobhbimh CHMnTOMaMH b stom cjiynae
aBJiaiorca ocrpBie 6ojih b annracTpHH, CHMynHpyjomne cocToamie, xa-
paxrepHoe wia «ociporo acHBOTa» npn nepHTomrre, ocTpon khuichhoh
HenpoxojpiMocra, npoOopeHHH jobbi acejiyzţxa hjih HBeHaniiaranepcT-
hoh khihkh. Bo3MoacHOCTB nocTaHOBXH H e n p a B H JiB H o ro £HarH03a oco-
6eHHO BBicoxa, ecjin y napneHTa HMeerca conyrcTByiomaa a3BeHHaa
6ojie3HB. OnraGxa b pHamo3e HpeBara HenpaBHJibHbiMH jieneOHBiMH
peHCTBHBMH. C n e p y e r otm cthtb, h to npn aSpoMHHajiBHOH <}>opMe aHa-
4)HJiaKTHHecKoro rnoxa CHnaceHne AJ\ MeHee BBipaaceHO.
Jlenemie
BBI30B CXOpOH MepHIţHHCXOÎI noMoipn h Bpa-
na aHecTe3HOJiora-peaHHMarojiora o6a3arejieH.
JleneHHe aHa<j>HJiaxraHecxoro rnoxa TpeSyeT
npoBepeima papa HeoTjioacHBix MeponpHarail,
opHOBpeMeHHO caepyeT npHHaTB MepBi no npep-
ynpeacpeHHK) ac<J>HXCHH b cbh3h c 3anapemieM
xopHa a3Hxa h acnKpapnen pbothbix Macc: 6ojib-
Horo Hapo yjioacHTB ropH30HTajn.HO, noBepHyB
rojiOBy b cTopOHy, h ypanHTB 3y6HBie npore3Bi
(ecjiH ohh ecxB). BBepeHne (BHyrpHMBimeHHo) Ba3oxoHcrpHXTop0B:
appeHajiHH 0,1% pacraop — 0,3-0,5 mji. AppeHajiHH bbophtcb no-
BTopHO b Tex ace po3ax (acejiarejiBHo — b pa3JiHHHBie Mecra, hto6bi
72
 He Bbi3Jt>iB£tTb cnatMa cocyoos » mcctc m cm cm hh h m u r p y rnu n b te n
caMbiM BcacbiBaHHC dapem m H H a tn Mtcra meaewM) [B ,il M t h i t i
2002]. AjipeHajiHH bboahtc* fcaacwe 10-15 MWHyr jk> lo rn m iM f
him apTepnajibHoro aaBJicHH* (o 6 m a n non* — 1 m t/kt c itaceofi t e n
70 Kr. npH OKa3aHMH Heorjioacno# ikmmoiuh — mo 10 mm), hmmv*~
cTaMHHHbie epejourrsa hb/miotch BcriOMorarcxbHMMH — 1% pacTBop
AHMe^pojia — 1-2 mji, ranenwa, crepoHjaHue ropMom (npawnoaoM
hjih ero anajiorn b cooroercroyioiiuix aowpoexax) — 90-120 mt, jr*~
caMera30H 8—20 Mr. JXnx bocctohobjichum omxmhh* Hcnsa&yioT xrm
paOHK) yKHAKOCTM H3 IIOJIOCTH p ia (CHIOHOOTCOCOM); HH2CHX* ■femOCTb
AOJDKHa noAaepzcHBarbca b Bw/jBHHyroM Bnepeji h B*epx nommemm
(ojm npeflynpeacneHiifl CMeuxeHHx xopwi xtuxa). n pH 6poBsoeta3MC
— BHyTpHBeHHoe BBeneHHc 2,4% pacrBopa yytyvum ta — 10 mx Upn
jiapHHFocna3Me npoBQaaT kohhkotom hio hjih HHiyOaiiHio rpaxex. ITp«
BbipaaseHHOM e rp a x e h jih cynopoacHOM cHHjipoMe HcnojiK3ycrcx BHy-
TpHBeHHO 5—10 Mr (0,5-1 mji) nnasenaMa (cejyKcctm),
llepBOOHepeAHbie Mepoupnaihh tlocjiejiym m M t ittptmymMrmM
IIpenapaT JXom flpenapaT Jkn*
Bcoonpeccop: n o 03-0,5 AnmuBuemoMutmue 1
AapeHajiHH0,1% MSI I&Mttbie npenapanm
10-15 MHH. MO JitweMpon 1% 1—2 M3
BoecrmoBJWHUH TaBeraa 0,1% 2 ms
AA
Kopmumcmepoudu
npejmmoMOH 90 120 mt
MOK^Mersaou 8-20 mt
TIpu dpoHXOcnasMe: 10 Mil Ha 10 MX
3y^fHMJusH 2,4% 4>H3HoaormecKDro
p-pa BHyrpHBCHHo
rHnOBOJIEMHHECKHfi UlOK
rHnoBOJieMHnecKHH iiiok pa3BHBaerca npH ycjiOBHH HecooiBer-
ctbhh o&beMa mipKyjiHpyiomeH kpobh (OL(K) cmkocth cocyaHcroro
pyejia. 3 to cocTOXHHe mojkct xapaKTepHSOBarbca jih6o yMeHbnieHHeM
OI(K (b pe3yjibTaTe KpOBonoTepn, iuia3MonorepH, ncrrepH b o w ), jih6o
b pe3yjibTaTe yBejiHHeHHa cmkocth cocyzvicroro pyciia (kbk 3to 6wjio
npH aHacJjHJiaKTHHecKOM uioKe). B jiHTeparype cymeerByeT 2 mhchhji
no noBO^y BKjnoneHHa pa3JiHHHMX bh^ob inoxa, oOycjiOBJieHHbjx yBe-
jiHneHHeM cm kocth cocynncToro pyejia: jih5o — b rpyraiy nmoBOJie-
73 «C0
 MHHecKoro uioKa, hjih BbiAeJiemm 3Toro BHAa uiOKa b caMocTOATeJib-
Hyio r p y n n y — nepepacnpe/ţejiHTejibHbiH qiok. OAHaico, nocKOJiBiey
MexaHH3MH pa3BHTH« aprepHajiBHOH nmoreH3HH npH 3thx BHUax
rnoKa pa3JiHHHbi (yMeHbmeHHe OUK b nepBOM c n y n a e h yBejnrqeH H e
eM K O cra cocyflHCToro p y c j i a — bo BTOpOMc jiy n a e ) , jieneH H e paanHHHo.
r HiioBOJieMHfl — yMeHbmeHHe o6beMa iţHpicynHpyiomeH kpobh
(OUK) no oTHomeHHoto k cmkocth cocyzţHcroro pycjia h pa3BHBaercA b
pe3yjn>TaTe KpoBonorepn, norepH boabi (npH pBore, Anapee, AJiHTejibHOM
B03^epxcaHHH o r npneMa jkhakocth, norepe boabi npH bbicokdh xeMne-
paiype, rHnepBeHTHJiamni), norepH ruia3MBi npn oacorax. Ilp n yMem>-
meHHH OIJK cmmcaeTca BeH03 Hbm B03Bpar KpoBH k cep.zmy, yMeHbina-
erca KpOBeHanojiHeHHe xcejiyAOHKDB cepAna h, coraacHO 3aK0Hy Opamca
a - CrapjmHra (33bhchmoctb CB o t CTeneHH pacDDKeHHH KapAHOMHOijH-
tob — neM 6ojibme pacraHyrti KapAHOMHOipriBi, tom 6ojn>me CHJia hx
coKpamemw), yMeHBinaeTCH cepneHHbiH BBiSpoc (CB).
CffiOKemie cepAenHoro Bbi6poca conpoBoacAaercH cHHxceHHeM A
H HapymeHHBMH MHKpOHHpKyjiatţHH C pa3BHTHeM LţHpKyjIBTOpHOH ra-
HOKCHH.
B CTOMaTOJiorHHecKOH KJiHHHKe 3HaHHTejiBHaa K p o B o n o r e p a (6 o n e e
40% OUK) BCTpenaeTCB, rjiaBHbiM o 6 p a 3 0 M , n p H xH p y p rH n ecK H X BMe-
m areA B C T B ax, OAHaKO b A H TepaT ype KpaHHe peAKO H M e io rc a o iiH c a m ra
TaKHX c jiy n a e B n p n noBpeacAeHHH cjih3hctoh o6oaohkh hojiocth p r a .
KjiHHHHecKan KapTHHa
B 3aBHCHMOCTH o t CTeneHH h CKopocTH norepH kpobh reMopparHne-
ckhh moK pa3A6AaK)T Ha: JiencoH CTeneHH, cpeAHen h tjdkcjioh CTeneHH.

/ţe4>HlIHT KjIHHHHCCKHe npH3HaKH

OQK
JJ,o 20% JierKaa KjiHHHHecKHe npH3HaKH cjiaGo BbipaaeeHU. Bo3mo>kho
yBejinqeHHe HacTora cepAeHHbix coicpameHHH Ha 10-20 yn. /
mhh npa nepexoae b BeprHKajibHoe nojioxceHHe.
20-30% cpeAHBfl ApTepnajibHoe aaBJieHHe Jieaca — Burne 100 m m pr.cr.,
xapaicrepHa oprocTaTHqecKaa ranoTeH3Hfl, HCCfc-^ ao 110 b
mhh.
31 -40% THacejia» ApTepnajibHoe AaBJiemie jieaca — HHxce 100 mm pr.cr.,
TaxHKapAHB — AO 120 b mhh., KoxcHbie noKpoBbi OjieAHbie,
xoAOAHbie, OAHrypHA (noHacoBOH AHypea Mem>me 50 MJi/qac
hjih 0,5 MJi/icr/qac)

d 74
I
CBbiuie 40% A prepH ajibH oe aaBJieHHe (chctotohcckoc) 70 mm p r x r .
i
1 xfl*ejiaH H H H «e, TaXHKapjXHH----CBHOie 120 B MHH., OTCyTCTBHC
n e p n ^ e p m e c K o r o n y n b ca , MpaMOpHocn. koxhu x noK posoB,
B|
V
OJiHTO- aHypHH, HapytueHHH co 3 H ain u (ra u io rb a o komh)

JEţnamo3 nmoBOJieMHHecKOFO moKa cTaBHTca Ha ocHOBaHHH npw-

Be^eHHOH BBIUie KJIHHHHeCKOH KapTHHH H aHaMHeCTHHeCKHX JţaHHHX.

KoMneHcaTopHbie p e a K u m i npa ranoBOJieMHH.

BaacHeHineii KOMneHcaropHOH peaKimeH npn ranoBOJieMHH aBJiaer-
ca iţeHmpajiu3atţUM Kpoeooâpau^enuH. 3 ia peaiajHa ocymecrBJiaeT-
ca 3a cneT aKTHBaipni CHMnaToaapeHajioBOH chctcmbi npn chhjkchhh
apTepHajiLHoro ^aBJieHna. B pe3ynBTaTe cmMyuamm cnMnanreeciooH
HepBHOH CHCT6MLI B03HHKaeT Ba30K0HCTpHKHHa (cna3M aprepHOJi, npe-
KarrajuiapoB h BeHyn) b o6nacTH kohchbix noKpOBOB, b mhiuchhoh nca-
hh, b pafle cruiaHXHHHeckhx opraHOB. TyMopajibHaa perynxmw 3a c tc t
Bbi6poca KarexojiaMHHOB HaflnoneHHHKaMH npHBOflHT k cna3My 3thx
ace oT^ejioB MHKpoiţHpKynaTopHbix cocyzţOB.
Pe3ynKraTOM 3toh KOMneHcaropHOH peaiapra aBJiaerca BOCcraHOB-
jieHHe cooTBeTCTBHa eMKOCTH cocyoHCToro pycua yMeHbiHHBiiieMyca
ofiteMy impKyjrapyiomeH KpOBH, hto h noftaepacHBaer KpoBoroK b op-
raHH3Me. 3a cneT 3toh peaKiţmi MoaceT a^^eicraBHO KOMneHCHpoBan,-
ca wo 25% KpoBonorepH.
O^HaKO KopoHapHbie h M03roBtie cocyzţw pearnpyiOT HHane Ha cth-
MynapHK) CHMnaTHHeCKOH HepBHOH CHCTeMLI. B KOpOHapHbIX cocyzţax
cHMnaxHHecKaa craMynapHa P2-aflpeHopeqerrropoB conpoBoamaerca
pacniHpeHHeM arax cocyzţoB. KpoMe Toro, H3MeHeHHe MeTaGojmqe-
ckhx noTpeSHOcreH MHOKapzţa MoaceT HMen> 6ojn>moe 3HaneHHe ana
TOHHHecKoro cocToaHHa KOpOHapHbix cocyzţOB. ÂHajiorHHHaa cmya-
ipia co3^aerca h b cocyzţax roaoBHoro M03ra.
AymozeModwiwUfUR — 3to peaicima, HanpaBnemraa Ha BoccTaHOB-
aemie OLţK. IIpH cna3Me aprepHOJi (iţeinpajiH3aiiHa) cimacaeTca naB-
jieHHe b Kamuuiapax h BO/ţa H3 HHTepcTHiţHajiBHoro npocnpaHCTBa h
BHyrpHKJieTOHHoro npocTpaHCTBa (npH MaccHBHOH KpoBonorepe) ne-
peMenţaeTca b cocyzţHCToe pycao.
Taxum pduH Taieace asnaeTca KOMneHcaropHOH peaKimeă, HanpaB-
jieHHOH Ha yBejiHHeHHe cep^enHoro BbiSpoca. OflHaioo ara KOMneHca-
iţna aBJiaeTca 3HeproeMKOH, hto HeoSxonHMO HMen» b BH,ay npn Jiene-
hhh nmoBOJieMHHecKoro rnoKa.
75 <□
 KoMneHcaropHbie peaxijHHHMeior orpHiţaTejibHyio cropOHy. Cna3M
cocyaoB h 6jioxa,na nepH<j)epHHecxoro KpoBOTOKa b 6ojibmoM MaccHBe
TKaHefi npH ijeHTpajiH3aiţHHxpoBOoSpamemra npHBO< zurr k chkdkchhio
aocTaBKH KHCJiopofla k 3thm TxaiMMh pa3BHTHio rnnoxcHH. Ayrore-
MOflHJiioijiMBtoBiBaeT flenwpaTaipno HHTepcTHitHajn>Horo h xjieroq-
Horo npocTpaHCTB. TaxHxapzţHa yBejiHHHBaeTnorpeăjieiffle KHCJiopofla
MHOKap^OMb ycjioBHax .zţe^HiţHTa ero aocTaBXH. IIoaroMy xoMneHca-
TOpHtie peaKiţHHHe cjie/ţyeT^JiHTejiBHoe BpeMfl coxparorn,, nocxojibxy
OHH,BKOHLţeKOHLţOB, CTaHOBflTCfl IIpHHHHaMHpa3BHTIMHOJIHOpraHHOH
He^oCTaTOHHOera. Ho ycTpaHeHHe xoMneHcaropHHx peaxiţHHaojukho
6bm> rpaMOTHHMh naToreHeTHHecKHo6ycjiOBJieHHHM.
JleneHHe
HeMeAJieHHblH BM30B CXOpOH Me/JHIJHHCKOH
noMoiiţH. £ o npHe3^a MauiHHbi CMI1 cjie^ţyeT Ha-
naTb BHyrpHBeHHoe BBeaeHiie pacTBopoB (4>h3h-
OJIOrHHeCKHH H AP- KpHCTaJUIOHZţHHe paCTBOpbl).
06e36ojiH BaH H e MoaceT 6biTb npoB ejţeH o tojibko
nocjie Havana BBe^eHHa >khzi;kocth b cocyoHCToe
pycjio, t.k. ycipaHeHHe 6ojih npn He BOcnojmeH-
hom OIJK npHBeaeT k ycHJieHHio apTepnajibHOH
nraoTeH3HH.

K A P^H O rEH H bffl UIOK

KapflHoreHHbiH ihok m u i e r e a peoreMOAHHaMHHecKHM h M eTa6ojm -
necKHM oxpaaceHHeM B bipaacem ioro n o p a a c e m w MHOxapzţa c HenocTa-
TOHHocTbio e r o HacocHOH (JjyHKHHH b pe3yjibT are Hea^eKBaTHoro xopo-
H apH oro KpoBOTOKa, 3a6ojieBaHHH MHOxapzţa hjih nepH xapzţa, KJianaH-
Hbix nopaaceHHH hjih o r coneTaHHa 3thx npHHHH. K apzm oreH H H H m ox
pa3JiHHaeTca n o ochobhoh Bbi3BaBiiieH e r o npHHHHe, Ha:
1. Hcthhhlih.
2. ApHTMOreHHbIH.
3. P e^jiexT opH brii.
H a n S o jie e xaacejio n p o re x a e T hcthhhhh xapzm oreH HbiH m o x , o6y-
CJIOBJieHHblH CHHaceHHeM COKpaTHMOCTH MHOXap^a.
B ocHOBe xapAHoreHHoro moxa JieacHT CHHacemie cepzţeHHoro bh-
6poca (CB).

76
 M ex aiiM jm w H a p y n ie n hh c e p a e m i o r o e u O p o c a
B 3BBHCHMOCTH OT T H fia Kap/lHOfeilHOI O IIIOKa
MexaHH3MiiapyiiieHMH
cepaenHoro suGpoca IIpHHMHM
HapyuieHHfl cepaeHHoro pHTMa

%
!20

!5

sa
S
f

l
CmXCHHC COKpaTHTeJIbHOH HuieMHB MHOKapzta,
ciioco6 hocth HHtJ)apKTMHOKapaa,
MHoicapAHT, MHOKapAHonama
CTpyKiypHbie noBpexyţeHHa MHTpajibHaa hjih aoprajibHaa perypnrramia,
cepaua nepcjjopauHH MOKaceayaonKOBOH
neperopoAKH, noBpeamerow HCKyccTBeHHWX
KJianaHOB
MexaHHnecKHe npenaTCTBHa HanpaaceHHHH nHeBMoropaKC,
BCH03H0MyOTTOKy HJ1H nepexcanie nojioîi Bern*,
HanojiHeHHK) acejiyaoHKOB TaMnoHaaa cepzwa, onyxojib npencepjuw hah
tPqm6
IlpeiurrcTBHe H3rnaHHio k j x >b h 3 m6ojih« JieroHHOH aprepHH
H3 McejiyaoMKa

Bpe3ym>Tare chpdkchkh cep^e^Horo Bbi6 poca npoHcxoAHT cna3Mne-

pH(J)epHHecKHX aprepHH c aprepno — BeH03m»iM myrnnpoBaHHeM Kpo-
BH, B CBA3H C HeM pa3BHBaeTCA TJDKeJia» nfflOKCHH, BHyipHCOCyHHCTaa
KoarynamiB KpOBH h CHHxceHHe peojionraecKHx cbohctb KpoBH.
Hcthhhmh Kap^HoreHHMH moK noApa3;ţejweTCfl Ha Kap/ţHoreHHWH
iiiok cpe/m en raxcecrra (I creneHH), TMKemmKapAHoremniH moK (II
creneHH) h apeaKTHBHbiH KapAHoreHHbiH hiok (HI creneHH). H c th h h h h
Kap^HoreHHbiH hiok — HanSojiee raxcejiaa (f)opMa rnoKa, pa3BHrae koto-
poro CBB3aHO co 3 HaHHTejibHMM HapymeHHeM coKpaTHTejibHOH cnoco6-
hocth MHOKapaa h conpOBOxyraerca BbipaxceHHbiM HapymeHHeM Mmcpo-
impKynauHH. IIpH I creneHH s to h 4>opMbi moica H3 MeHemni Bupaxeemj
MeHbme, npH EH creneHH flo c ra ra io r MaKCHMyMa c nojiHOH SjioicaAOH
MHKpoiţHpKynaTopHoro pycjia.
ApHTMoreHHbiH Kap^HoreHHbiH moK noApa3AejiaiOT Ha TaxHCHcrcum-
HeCKHH, BCJieaCTBHe TaXHKapZţHH, TaxnapHTMHH H 6paaHCHCTOJIHHeCKHH
— BCJieacTBHe 6paaHKapaHH h npeacep^HO-acejiyaoHKOBbix GaoKaA-
Pe^JieKTopHbm KapAHoreHHbm hiok pa3BHBaeTca npH raxcenoM 6 0 -
JieBOM CHHApOMe.
Tlamozenei KapduozeHHOzo uioko, CmixceHHe cepaeHHoro Bbi6po-
ca npHBOAHT k ranonep4)y3HH opraHOB h ncaHen c noBpexcaeHHeM hx
77 «a
<J>yHKiţHH. KoMneHcaTopHfcie peaKiţHH b BH^e aKTHBaiţHH CHMnaroa^pe-
HaJIOBOH H aHTHOTeH3HH-aJIbAOCTepOHOBOH aKTHBHOCTH nOBblIIiafOT no-
TpeSHOCTb opraHH3Ma b KHCJiopofle, b tom HHCJie h caMoro MHOKapaa,
hto ycyry6jweT rnnoKcmo. Pe3ym»TaroM 3Toro aBJiaeTca noBpeacaeHHe
3H#OTeJIHfl C Bbl6pOCOM SoJILHIOrO KOJIHHeCTBa MejţHaTOpOB H UHTOKH-
hob c HapacTaHneM anonT03a h HeKpo3a kjictok b opranax

MHOKapAHajibHaa He^ocTaTOHHocn»

YMeHbmemie c e p ^ e i H o r o
BbiSpoca

CHH/Kemie apTepHajibHoro AaBJieHHH

IIoBbiuieHHe oSmero
iiepHtjjepuHecKoro conpoTHBJieHHH

YMeHbmeHHe KpOBOTOKa B M H K pO U M pK V JIH TO pH O M pycjie

CHH/KeHne TpaHcnopTa KHCJiopo/ia

A nonT 0 3 h HeKpo3 kjictok

UoBpexţqeHHe (jjyHKiiHH
opranoB h cmctcm

Puc. 4.1. CxeMa namozenesa KapduozenHozo worn

78
 KjiHHHHecKa» Kap’f Miia Kap/iHor eHiioio uuoKa
XCajio6u Ofh»€KTHBHWe npH3HaKM
«r>nKCJia>i», «OKMMaiomaa», hh3koc aprepHa/ibHoe aaancHHe ( huxc
«pa3pbiBaiomafl» 6o;ib o6whho 90 MMpr.CT.---CHCTOJ7HHCCI60C),
B03HHKaCT B rciyOnHc rpMHOjS chhxchhoc nynjbcoBoe murjjchmc (<20
KJieTKMh no xapaKTepy HanoMHHaer mm pr.CT.) BbicoKoe LţBA h aaBacHHe
npncTynw CT6H0Kap/ţHH, OAHaxo 6ojiee 3aKflHHHBaHHB nCTWHOU aprepHH
HHTCHCHBHaB H npOj^OJDKHTejIbHaa. B CQ3JIA), pacuiHpeHHue apeMHue
THnHHHbix cjiynaax 6ojib omymaeTca b BeHM, TaxHKapAHa, HmeBHjjjibtii
ueHTpanbHoft Macro rpyuHofi kji&tku h/ nepmjjepnnecKHÎi nynbc, 6neanbie,
hjih b oSjiacTH anHracTpHfl. JlpuMepHO nenejibHoro orreHKa, xojioaHwe,
y 30% 6ojibHbix oHa Mppajumpyer BnaacHwe h uHaHOTHHHue KoacHbie
BBepXHHe KOHCHHOCTH, pOKe B nOKpOBM, MpaMOpHOCTb KOHCTHOCTeH,
o6nacTb xcHBora, cnnHbi, 3axBarbiBaa OJiHrypna (anype3 MeHee 20 MJi/nac),
hhxchioio HeniocTb h uieio. EOJIb KpenHTHpyiomHe xpnnbi b jiencHx,
MOXceT appa^HHpoBaTb ^axce b oSnacn» HapymeHHfl AUxaHHa h corHaHHa.
3aTbuiKa.

Jlenemie
HeMe^ţjieHHWH bbi3ob C M II. Jţo
npHe3^a 6pHraflBi C M II OonBHoro cjie^yeT yjio-
5KHTB r0pH30HTaJIBH0, C npHIIOflHÎITBIMH HOraMH
(Ha 10-15°, HanaTB HHrajumHio KHCJiopo,zţa Hepe3
HOCOBBie KareTepBi h jih MacKy HapK03Horo an-
napara. IIpH pe3KOM chhhcchhh A/J — HH<J>y3HJi
Hopa^peHajiHHa 1-15 m kt/m hh (npH h3jihhhh
BeH03Horo /ţocTyna) ,zţo noBBimeHHH c h c to -
jiHnecKoro b n p eaejiax 80-90 mm pr. c t. Ilo cjie
3Toro bo 3 Mohcho BB6^ţ6HH6 .zţonaMHHa — 400 m kt/m hh. /JonaMHH pac-
uiHpaeT KopoHapHBie cocyzţBi, M03roBBie cocyaw h cocyzţBi noneK.
 D iaea 5
OcTpan AbixaTejibHasi HeaocTaTOHHOCTb
^M XaTeJIbH aH He/ţOCTaTOHHOCTb|— COCTOHHHe, n p H KOTOpOM jih 6 o
H e o 6 e c n e H H B a e T c a noAA epxcaH H e H o p M au b H o ro r a 3 0 B o r o co crraB a ap-
TepH ajibH OH KpoBH, j ih 6 o n o c jie ^ H e e A ocT H raeT C a 3a cneT y B e jim e H -
h o h p a S o T u a n n a p a T a B H eniH ero A B ixam ia.
O cT paa AbixaTejibHaa HeAOCTaroHHOCTb xapaicrepH3yeTca n m o ic -
ceMHeH — yMeHbineHHeM Hanpaacemia KHCJiopoAa b aprepHajibHOH
KpoBH (Pa02), ranepKanHHei! — yBejiHHemieM H anpaaceim a ym e-
k h c jio tu b aprepHajibHOH KpoBH (PaC02). B CHiyarţHH, x o raa HMeer
MecTO KOMneHcaTOpHaa peaKipia, HanpaBJieHHaa Ha yMem>meHHe ra -
noKceMHH — nmepBeHTHJiaAHa, HanpaaeeHHe yrjieKHCJiorw b apre-
pnajibHOH KpoBH SyAeT cHHaceHo — rnnoKamiHa, a Hanpaaceim e khc-
jiopoAa b aprepHajibHOH KpoBH MoaceT 6brrb HOpMajibHbiM (b cjiynae
3(J)(^eKTHBHOCTH KOMneHCBTOpHOH nHiepBeHTHJiaiJHH) HJIH CHHACCHO
(b cjiynae He3(J)(^eKTHBH0CTH KOMneHcaTopHOH nmepBeHTHJiaHHH). B
3tom cjiynae AbixaTejibHaa HeAOCTaroHHOCTb moacct 6brn> komuchch-
pOBaHHOH h jih AeKOMneHCHpoBaHHOH, h o AbixaTejibHaa HeAOCTaroa-
HOCTb AHarHOCTHpyeTca b o6ohx cjiynaax h Tpe6yeT npoBeAemia ne-
ne6Hbix MeponpHaTHH. H3MeHeHHa ra30Boro cocTaBa KpoBH BeAyr k
pajţy HapymeHHH MeTa6ojiHHecKHX nponeccoB b CBa3H c pa3BHTHeM
rnnoKCHH, HapymeHHio KpoBoo6pameHHa b opraHax h HapymeHHio
(JjyHKijHH opraHOB, KpoBoo6pameHHa, Abixamia h iţeHTpajibHOH HepB-
HOH CHCTeMbl.
IIp eA p ac n o jia raio iH H M H (jjaicropaM H b pa3BHTHH O/JH aBJiaioTca
xpoH H H ecK H e o6cTpyKTHBHbie 3 a6oaeB aH H a jierK H x (XOBJI) — 6poH -
x n a jib H a a acTM a, KypeHH e; H apynieH H a Jiero H H o ro K p o B o ro x a h ah<|>-
^y3HOHHOÎI cnoco6H O C TH a e n c H x : a e ro H H a a a p re p H a jib H a a r n n e p re H -
3h h n p H cepACHHOH HeAOCTaTOHHOCTH, KJianaHHbix H a p y m eH H ax h AP-
K p o M e T o ro , He cjieA yeT 3a6braaT b, h t o A bixaTejibH aa HeAOCTaTOH-
HocTb B C T penaeT ca B ee n a m e H3-3a T o ro , h t o H a c e jie im e « cT apeeT »
— yB ejiH H H B aerca ripoAonacHTejibHOCTb aeH3HH h OAHOBpeMeHHO Bee
6 o jib in e «H3HamHBaH>Tca» opraHbi, b to m HHCJie h Jie n c n e . B o 3 pacT aeT
KOJiHHecTBo o c T p b ix B H pycH O -6airrepH ajibH bix 3a6ojieB aH H if JierKHX,
jieneH H e KOTopbix He B cerA a npHBOAHT k nojiHOM y BU3AOpoBJieHHio,
h t o yBejiHHHBaeT n a c T o iy BCTpenaeMOCTH XOBJI.

O 80
 rio a p o S H b iH c 6 o p a H a M H e 3 a n o H a n a jia c ro M a ro jio rH H e c K H X B M e u ia -
xeJibCTB n o 3 B O J ia e T c n p o r H 0 3 H p o B a n > b o 3 m o h c h o c ti> p n c x a pa3B H T H B
ocTpoH A M x a re jib H O H H e flo c T a ro H H O C T H h npeanpH H B T b M epbi k e e
npejaynpe^eH H io.
B CTOMarojiorHHecKOH kjihhhkc o c r p a a ,m>ixaTejibHa» H e^ocTarcw -
hoctb Moatcer pa3BHTbca npH acnnpaiţH H co/ţepacHM oro nojiocTH p r a
(CJIIOHM, KpOBH, OCKOJIKOB 3 y 6 0 B , M6JIKHX HHCTpyM eHTOB H J S p \ OffH-
HOHHblX KOpOHOK, H e (JjHKCHpOBaHHblX H a KOpOHKOBOH H3CTH 3 y 6 a , C M e-
memra KopHB H3biKa K3aAH h nepexpbiBaHHa hm ropraH H . Ilo c n e jm e e
Moacer 6 w T b y n a i t H e i r r o B n o a c H J io r o B 0 3 p a c T a n p n « y c r a B a H H H » M y -
C K y n aiy p ti H e jn o c T H O -jm H e B O H o S n a c r r a n p n .zyiHTejibHOM n o jio a c e H H H
c onncpbiTbiM pTOM .
AcnHpauH» — 3 t o n o n a ^ a H H e HHopoflHbix T e a b a b ix a re jib H b ie n y r a
— o6crpyKHHa A b ix arejib H b ix n y re H . n p H 3 to m B03HHKaeT 3aT pyzţH em ie
flbixaHH«: 3arpyzţHeH x a k b ^ o x . T ax h b m a o x . I l o M epe npoA O Jcxirrejn»-
h o c th HapymeHHfl npoxoAHMOCTH A bixaTeabH bix n y re H b xjiH H H necxoH
KapTHHe 6yzţeT H a p a c ra T b im aH 0 3 kcwkhbix noxpoBOB, T axH xapznra, ch h -
aceime A J ţ n o c n e e r o x p arxoB peM eH H oro noB binieH H a, H a p y r n e m u c o -
3HaHHX BHJIOTb RO KOMbl.
A jiro p H T M M e p o n p H H T H H n p n o 6 c T p y K i |H H a b i x a T e j i b H b i x n y r e H
H H O p O ^ H b lM TeJIO M

IIp H o 6 c T p y x H H H j i e r x o S C T en eH H n e n o B e x M o a c e r o t b c t h t b H a b o -
n p o c : «Bbi n o n e p x H y m i c b ? » , r o s o p H T , x a n u ia e T , a b in iH T h b tb k o m c j i y -
q a e H eo6xozţH M O no,zw ep3K H B aT b n p o a y x T H B H b iH x a m e j i b h H a G m o ^ a T b
3a n o c T p a A a B n iH M . n p H o 6 c r p y x n H H T H acenoH C T en eH H n e n o B e x H e
Moacer oT B erH T b H a B o n p o c , H e M oaceT ro B O p H T b , M o aceT x H B H y n » , H e
MoaceT A b im aT b h jih « b in iH T x p n i u i o , npO H 3B Q iţH T 6 e 3 3 B y m u e n o n b iT X H
OTKannraTbCH, T e p a e T c o 3 H a H H e .
n p n o 6 c T p y x H H H T a a c e n o H C T en eH H c c o x p a H e H H b iM c o 3 H a H H e M H e -
o6xoahmo BbinojiHHTb 5 y zţap O B n o c n H H e (P hc . 5.1):
• BCTaTb c 6 o x y h HecxojibKo no3azni o r nocT paaaB inero;
• noAaepacHBaa n o cT p aaaB in ero qqhoh: pyxoH 3a rpyzn», BTopon Ha-
xjioHHTb e ro Bnepea HacToubxo, h to 6 m , x o ra a HHopoAHoe Tejio cMe-
CTHTca, o h o Bbinajio 6m H3o p r a , a He o n y c n u io c b rjiy6ace b a m -
xarejibHbie n y r a ;

81 <3
 Puc. 5.1. M em odum eunonnem ui ydapoe no cnim e

• HaHecra ao rorra pe3KHX yaapOB ocHOBaHHeM jiaAOHH b o6nacn>

MQyKjjy JionaroK;
• nocjie Kaacaoro yaapa npoBeparb, He ocboGoahjihcb jih Auxarejib-
Hbie nyTH; CTpeMHTbca, h to6w Ka^cAbm yaap 6bui pe3ynbTarHBHbiM,
h cTaparbca aoSHTbca bo ccTaHOBJieHHa npoxoaHMOcra awxaTejib-
Hbix nyren 3a MeHbinee hhcjio yaapOB.
Ecjih 5 yaapoB no cnHHe OKa3ajracb He3<j)<j)eKTHBHbiMH, hco6xoahmo
BbinOJIHHTb 5 TOJIHROB B o6naCTb HCHBOTa (npHeM reiiMJiHxa, Phc. 5.2 .):

Puc. 5.2. MemoduKci ebinojmemM moJiHKoe

 , e c ra n » C32WH err n o c T p a n a B i i ie r o h o S x B a ra T b e r o H a ypoB H e s e p x -
hc Pl nacT H x c h b o tb o 6 e n M H pyx aM H ;
• HaKJioHHTb e r o T yjiO B H m e B n e p e a ;
» cacarb p y x y b K y jia x h n o M e c n m » e r o M exc^y nym coM h m c h c e h a h l im
OTpOCTKOM rp y flH H b i;
• oSXBaTHTb KynaK KHCTbK) BTOpofi pyKH H CAeJiaTb pe3KHH TOJIHOK no
HanpaBJieHHfO BHyrpb h e e e p x ;
• noBTopHTb M aH H nyjiH U H io n o n a r a p a 3 ;
• e c jra o 6 c rp y K U H K ) yc T p a H H T b H e y z ţa jio c b , noBropan» nonepeMeHHO
n o n a n » p a 3 y n a p w n o c r a n e h t o j i h k h b x c h b o t.
E c jih n o c T p a ^ a B in H H T e p a e x c o 3 H a r a e , HyxcHO aiacypaTHO n o jio -
TKHTb e r o H a n o n , BbOBaTL C M n h H an an » KOMnpeccHH rpyuH O H KJieT-
kh, K crropbie 6 y n y T c n o co 6 c T B O B a T b H3rHaHHK> H H o p o r a o r o T e jia H3
A U xareJibH bix n y r e f i . I I p w icaacAOM O T K pbm araH A b ix a rejib H b ix n y r e H
cjieay eT n p o B e p a T b poT O B y io n o n o c T b H a npeA M eT H a jiH ra a H H o p o r a o -
ro T en a, B b rro jiK H y T o ro H3 A b ix aT en b H b ix n y re H .
E c jih n o c n e p a 3 p e iu e H H a o 6 c T p y x r a H y n o c T p a jţa B m e ro c o x p a H a -
e rc a K a m ejib , 3 a rp y z ţH e H H e n iO T aH H a, s t o m o x c c t o 3 H a n a rb , h t o n a c r a
H H opoA H oro T e n a B e e e m e o c T a io T c a b A bixaT ejibH bix n y r a x , h n o c T p a -
A aB iuero HyxcHO o rn p a B H T b b J ie n e S H o e y n p e a m e H n e . B c e x n o c T p a jţa B -
iiiHx, KOTopbiM O K a3biB ajiH n o M O iiţb c npHM eHeHHeM yzţapoB n o c n r a e h
to jih k o b b x c h b o t, c jie A y e T ro cn H T ajiH 3 H p o B aT b h o 6 c n e n o B a T b H a n p e f l-
M er TpaBM.
n P H 3 a n a ;je n H H KOpHa a 3 b ix a KJiHHHHecKaa x ap x H H a n p m n n i r a a j i b -
h o He o rjiH H a e T c a o r o n n c a H H O H B b irn e n p H a c n H p a r a n , h o , n o c ic o jib K y
naqH eH T b co3H aH H H , t o H c n p aB H T b n o jio x ceH H e m o x ch o , a b b n a r a e H i y
OTAOXHyn».

XPOHH M ECKA JI O E C T P Y K T U B H A H EQ JIE3H B JIE rK H X

XpoHHHecicaa odcxpyKTHBHaa 6ojie3Hb jiencHX asjiaeTca oahhm h3
nacTbix 3a6ojieBaHHH b MHpe. Kax npHHHHa CMeprHOCTH XOEJI c to h t
Ha 4 Mecre. Ilp n XOEJI pa3BHBaeTca xpOHHHecxaa AbixarejibHaa hcao-
CTaroHHocTb b CBH3H c 3M(J)H3eMOH jierKHx, npH KOTOpOH HapymaeTca
34>4)eKTHBHOCTb p a 6 o x b i AbixaTeJibHbix Mbirniţ: He CMOTpa Ha n o B b i-
m eH H yio p a 6 o T y AbixaTejibHbix Mbimu, B eH T H Jiarţna JierKHx ocTaerca
CHHaceHHOH, ho n o T p e 6 jie H H e KHCJiopoAa AbixaTejibHbiMH MbimijaMH
83 <a
B 03pacT aeT h B 03pacT ai0T 3 H epreTHH ecKH e 3 a rp a n > i m o 6ecneneH H e
BCHTHJlfllţHH JierKHX, C03flaBaa CBOeo6pa3HHH «CHMIITOM o6Kpam>I-
BaHHH» B cex o cT ajibH bix opraH O B. JleroH H biH ra 3 0 o 6 M eH n pH X O EJI
CHHMceH, pa3BH BaeTca x p o ro re e c K a a n m o ic c e M H a , c o n e r a io in a a c a c
ra n ep K an H H eH . Jlero H H aa a p T e p n a jib H a a ra n e p r e H 3 H a co n p o B Q a y ţa er-
c a H ap y in em iaM H He to jib k o jie ro H H o ro K poB oroiea, h o h CHcreM Horo
K pO B oo6pam eH H a H3-3a pa3BHTHa « jie ro H H o ro c e p /m a » . y p a ^ a ffrwib-
Hbix H M eio m aa ca c e p jţe n H a a H eflocT aroH H ocT b n o c b o h m k jih h h h c c k h m
npoaBJieH H aM b b ix o ^ h t H a n e p B o e MecTO n o cpaB H eH H io c n w x a re jib -
HOH HeflOCTaTOHHOCTbK).
IIp H X O B JI H a p y m ae T c a flperoipO BaH H e M OKporbi, ycyryfw iaeT ca
o 6 cT pyicnH a .zţbixarejibHbix n y r e n , nosTOM y ycH JiH BaeTca p a 6 o r a flH-
xaH H a, H3M eHaeTca $ o p M a rpyzţHOH k jictk h , p a c re T n o rp e S jie H H e khc -

J io p o ^ a flbixarejibH biM H MbimnaMH, h to c n o co 6 c T B y e T no/m epacaH H io

pecifflp aro p H O H ranoKCHH.
B pa^e cjiy n a eB x p o m ra e c K a a a b ix a re jib H a a H eflocraronH O C T b npH
X O B JI cTaHOBHTca o c T p o ii. K tb k h m npHHHHaM OTHOcaTca He to jib k o
o c T p a a H H ^eK iţH a A bixaTenbHbix n y r e ii , h o Taicace 3Jioynorpe6jieH H e
GpOHxojiHTHKaMH h n oB peacflem ie JierKHX /ţpyrH M H npenapaT aM H , Ta-
k h m h Kax H eK oropbie rHnoTeH3HBHbie cpe^CTBa ( h h t h 6 h t o p l i A IIO ).
M exaHH3M 3T oro H eacejiarejibH oro aencT B H a npenapaT O B He Bnojrae
a ce H , n p e A n o jia ra e T c a , h t o o h o CBa3aH0 c H aK onneH neM b anHTejiHH
SpOHXOB 6paAHKHHHHa.
EPOHXHAJIfcHAfl ACTMA
BpOH XHajitHaa acTMa aBJiaeTca o ^ h o h H3 H 030JiorirqecK H x (])opM
X O B JI. A cT M aranecK H e npHCTynbi xapaicrepH 3yK )Tca pa3BHTneM 6poH-
x o cn a3 M a c n m e p c e K p e n n e H areicoM c jih 3 h c to h o 6 o jio h k h 6 p o h x o b .
IIo C Boeâ pacnpocTpaHeHHOCTH 6poH X H ajibH aa acTM a 3aHHMaeT 4 Me-
CTO. CpeAH (J)aKTOpOB, Cn 0 C0 6 CTByK)IHHX pa3BHTHK) 6pOHXHajn»HOH
acTMbi, c jie a y e T o t m c t h t b HacjieacTBeHHbie, a ju ie p ra n e c K H e , b tom
HHCJie Ha JieKapCTBeHHbie n p e n ap a T b i, M eT eop o jio ran ecicH e <j>aKTopH,
HH^eKHHio, <j>H3HHecKyio Harpy3Ky, ncHX03M0HH0HajibHi>ie (jjaicropbi.
Yace o a h o nepenHCJieHHe <j>aicropoB, c n o co 6 c T B y io m H x pa3BHTHK> a c r-
MaTHHecKoro n p n c T y n a , CBHfleTejibCTByeT o peajibHOH bo3m o3khocth
pa3BHTHa n p H c ry n a b CTOMaTOJiorHHecKOM K p e ca e .
A ronH H ecK aa 6 p o H x n ajib H aa acTMa (HH^eKimoHHO-aJiiieprHHecKOH

84
n p H p W ) 103HMIC10T HA pa3J1HHIIblO, AOCTflTOMHO pCIKHC lanaXM. flpH
3TX)Mp03BHia@TCfl OnJlOprHMOCKafl poaKUHH «aHTMrCH-aHTHTCJÎO», C Bbl-
AGJighmgm G ojibuioro KOJiHHOCTaa (hiojioi mmcckm b k th b h u x aemecTB:
$paaHKHHHHb(, TMCTaMHH, CCpOTOHHH, aHCTHJIXOflHH, npOCTamaHAHHU
KAP> HOCKOJlbKy 3TOT npOlţOCC npOHCXOAHT B CTGHKC CpOHXOB, TO BO>
hhkbgt npHOTyn y a y u ib a wu-ga cna3Ma G potixos.
KjIHIIIt'ICCKUH KapTHHa lipHCiytia 6pOHXHaJIbHOft aCTMbl CKJl^WBa-
CTCfl H3 H3MGHGHHA AbIXaHMH —§ KOpOTKHH BflOX H npOAOJIXCHTCHbHblfll
BMflOX C CBHCTXIUKMH XpHnaMH, CJIbllUHblMH HB pacCTOHHHM; BAMXaHKH
ynacTBytOT BcnoMoraTOJibHbic muluum rpyanow kjictkw, AHa4)parMa,
MI.IIIIUU XCHBOTa; IUIGHH npHIIOAHXTbl, Pu’JBHBaCTCH L(MaH03 AHLţa, Ha-
6yxaHHG Lucftnbix bch . B CBH3H c HapacTaiomcfl o&iypauHcN 6 jx >hxob ,
AbixaTGJibHbie myMbi Moryr ho npocnyuiHBaTbcx — «HCMax acTMa».
Y mhothx GojibHbix OTMGHaiOTCHnpeABCCTHHKH ripwcTyna BBHACCJia-
6octh, 3yaa b Hocy, MiixauM, nyBCTBa ckobuhhocth b rpyoHoft m ience.
Jimmie
riojioxceHHe 6ojibHoro aoawho 6bm> nojiy-
CHAXHHM. OAHOBpeMeHHO C JICKapCTBCHHOft
Teparweft hco 6 xoahmo npoBOAHTb HHrajixuHio
KHCJiopoAa. fljia KynHpoBaHHx acT M aw iecK O -
ro npHCTyna b n e p o y io o n e p e A t HcnojibayiOTca
6poHxojiHTHHecKHe n p e n a p a T u . MiirajiHUHon-
Hbie npenapaT bi CHHTaiOTca Gojicc npeAnoHTH-
TeJIbHblMH.

Ha3Bamie npenapaTa MexailH JMaeACTBHH llpmvieiiciiHc

CCJICKTHBHbie Pj-arOHHCTbl BpOHXOJlHTHKHC UUMilJIOM 1-2 HHraJlHKHH
(aapeHOMHMeTHKH KOpOTKOrO fleficTBHX 3-5 MHHyr h
Ae^cTBaa): AJlHTCJIbHOCTblOACftCTBHB
C&nbGyTaMOJi, bchtojihh, Seporex 4-5 nacoB
AHTHXOJIHHepi HMeCKHC BpOHXOJlHTHHeCKOC 2 HHrajiaimoHHbie
npenaparu: unpaTponnyM AeficTBHe 3a cneT (xnoicaAbi A03bl
SpoMHA— arpoB eH T M-xojiHHopeuenTopoB
HCMl'DKOHHJI TOliyCU
BjiyxcAaiomero nopoa.
JfylHTCJIbHOCTb ACHCTBHH
— AO6 wacoB

85 a
 AHTHJieHKOTpHeHOBbie aHTaroHHCTbi
n p e n a p a T b i: U H C T e H H H J IO B b lX

3a<f>HpjiyKacT ( a K O J i a r ) h (jieHKOTpHeHOBWX)
M OHTe n y K a c T ( c H H iy n a p ) peaenTOpOB h h h t h O h t o p m
c H H T e 3 a jieăKOTpneHOB

K o M 6 H H H p o B a H H b i e npenapaiu: 06jia#aiOT CeperHfl: o«Ha

ceperafl (coaepacHT 4>jnoTHKa30H 6 p O H X O J IH T H H e C K H M H HHTaJlBIţHB 2
n p o n M O H a r h cajibMerepoji), h n p O T H B O B O C n a JIH T e JIb H b IM pa3a/cyr,
c h m 6 h k o p t (coaepacHT 6yzţecoHHfl f l e n c T B H e M 3a cneT Ch m S h k o p t : no

h 4>opMorepoji) P2-arOHHCTOB H 1-2 HHTaJWIţHH, 2

HHTaJIflimOHHblX pa3a/cyr
KOpTHKOCTepOimOB

H e c e jie K T H B H b ie aencTByiOT Ha a- h f3- 03-0,7 m j i

aapeH O M H M eT H K n: peiţenTopu, BHyrpHMbimeHHo
a flp e H a jiH H , a ^ e a p n H f l e n c T B H e pa3BHBaeTCH HJIH nOAKOÎKHO
nepe3 3-5 MHHyr nocjie
BHyrpHMHineHHoro
BBeflemM h coxpaiweTCfl B
TeneHne 30-40 MHHyr

ACTMATHHECKHH CTATYC
«AcTMaraHecKHH CTaTyc ^ 3To nojiHOpraHHaa He#ocTaTOHHOCTb,
Bbi3BaHHaa HapymeHHeM ra30o6MeHa H3-3a o6cTpyKu,HH flbixarejib-
heix nyreH bjokoh HeoTKaniJiHBaeMOH MOKpoTOH h BocnajiemieM
CTeHOK fltixaTejiBHbix nyreH, npn KOTopoii TpeOyeTca HeMe^jiemioe
BoccTaHOBJieHHe npoxo^HMOCTH h pecnHpaTopHaa no,mţep»CKa» [A .n.
3iuib6ep, 2007].
ACTMaTHHeCKHH CTaTyC MOaceT B03HHKaTB Ha 4>OHe pa3JIHHHBIX
HecneHH(J)HHecKHX 3a6ojieBaHHH JiencHx: XOBJI, 3M(J)H3eMa jierKHx
h ap . IlpHHHHaMH acTMaTHHecicoro CTaTyca a b ju h o tc ji HeaooueHKa
BpanoM h SojibHbiM TaacecTH 3a6ojieBaHHa JierKHx, 3jioynoTpe6jieHHe
a3po30JibHHMH HHrajiau,naMH p~ a^peHOMHMeTHKOB, jieneHHe nno-
KOKOpTHKOH^aMH [A.IL 3njib6ep, 2007]. B ocHOBe acTMaranecKoro
CTaTyca JieacHT cnreic m cjikhx ^HxaTejibHbix n y ren h oOcTpyiojHfl hx
BH3KOH MOKpOTOH, 3 aTpyuHaiomnx BHflox. IloBbimeHHaH paS ora flbl-
xaTejibHbix M um a npHBOAHT k HapacTaHHio ranoKCHH, pHCKy pa3BH-
t h h ocTpofi npaBoacejiyaoHKOBOH He^ocTaTOHHOCTH. rnnoKCHa npH
acTMaranecKOM CTaTyce (npHCTynax, B03HHKaionţHx HeoAHOKparao,

86
C3>
no jţaHHMM aHaMHe3a) aBJiaerca Kapmusuibuoit npmvmok noimop-
raHHOH HeflOCTaTOHHOCTH. Il03T0My npH psaBHTHH aCTMBTHHeCKOrO
ctaryca B03M0)KHa aeKOMneHcamui He to jjlk o MuxarrejibHou ty y m -
uhh, ho h flpyrnx cjjyHKiţHH opraHH3Ma h, ripexcae Bcero, — cepm en-
HO-COCyaHCTOH CHCTeMBI, BIUIOTb £0 BHe3aiTHOif CMCpTH.
^ H ai HocTHKa acTMaTHHecKoro c ra iy c a
no MHeHHio A.II. 3HJH»6epa, ochobhwmh jx ^ b th o c th h c c k h u h npH -
3HaK8 MH acTMaTHHecKoro CTaiyca jranaioTca:
• HC3(J><])eKTHBHOCTb 6pOHXOAHJMTaTOpOB, HCII0JIb30BaBUIHXCX paHee;
• HeoTKanuiHBaeMaa MOKpora;
• aeKOMneHcatţHB KpoBOo6pameroia;
• flpyrae npOHBJieHHa AeKOMneHcaipm nojraopraHHOH HeaocrarcmociJL

Jlenemie
HeMej^rieHHWH bbi30b O pnra^B i CMTT. B ookhmbhhh n p H e3^ a 6pa-
rajţfci cjieAyeT Hanarb oKCHreHOTepanmo. Me^HKaMeHT03Hue cpe/ţcrBa
jieqeHHa acTMaTHHeciooro cTaiyca:
Ha3saHHe MexaHH3MaeHCTBHH lIpHMeHeHHe
npenapaTa
3y4>HJUTHH BpoHxojiHTHHecKoe, yMeHbuieHHe 1b/bchho 10 mji (3—4
(aMHHOtJjHJIJIHH) jieroHHoro cocyAHcroro 1mt/kt)
2,4%pacTBop conpoTHBJieHHa, ynynmemie KirapeHcaI
—aroHHCTP2- MOKpoTbi, yMepeHHoeAHypeTHHeciooe
peuenropoB, aeHCTBHe, TopM03HTocBo6o»cqeHHe |
H3TyHHbix KJieTOKajuieprHHecKHX I
Me^naTopoB
KopTHKDcrepoiiUbi: b/bchho. xanejibHO
npeflHH30JI0H 30MT |
87 <D
 HapymeHHH bchthjihumh jierKHx npH CTOMaTOJiorHHecKHX BMerna-
TejitcTBax MoryT npoHBJiaTbca b Bime ranepBeHTHJMiţHH — yBejiH-
HeHHH MHHyTHOH BeHTHJIHUHH JieiTCHX, KOTOpa» M05KeT B03HHKHyTb y
naipieirra npH sMoiţHOHajiBHOM HanpaaceHHH h 6ojicbom pa3^pa»ceHHH
h onacHa pa3BHBaK)mnMCH cna3MOM cocyzţoB Ha <j)OHe nmoKanHHH.
Upeayţe Bcero, 3to KacaeTca cocyzţOB M03ra, hto mojkct npHBecTH k
HapymeHHio co3HaHiw hjih ocTpoMy HapymeHHio M03roBoro KpoBoo-
6pamemM. JiflSL npeAynpe^yţeHHH 3Toro ocjioxcHerow cjie^yeT tojilko
BHHMarejiBHo Ha6juo,zjaTb 3a naiiHeirroM h ofecneran» a#eKBarHoe o6e-
36ojiHBaHHe hjih Hcnojn»30BaTB ce^aTHBHBie cpejţcTsa (^Ha3enaM hjih
.ZIOpMHKyM).
 D iaea 6
T po m 6 o 3m 6 o jim h jie ro H H o il a p r e p H H

TP0m6o3m6ojiiw JieroHHon aprepHH (T37IA) nsnnerrcH quhoh H3 Ha-

CTHX npHHHH CMepTH y 6oJTbHbIX, HaXQZţflmHXCfl B CTBUHOHapC. IlpH
3T0 MnacTOTa T3JIA KaK npnHHHbi jierajibH ocrn OonbHbix xapypnrae-
ckhx crraipiOHapoB cocTaBJiaeT 20% h 89% cpe,0H Oojibhhx TepaneBrn-
qecKHx CTaiţHOHapOB [AT. PyMBHiţeB c coaBT.]. T3JIA aBJiaerca ohhhm
H3KOMIIOHeHTOBH030JI0rHHeCK0H (J)O pM bI --- «BeH03HbIH TpOM6o3M6o-
JIH3M».
B ocHOBe naxoreHe3a TpoM6oo6pa30BaHtra jiem rr «Tpna.ua BnpxoBa»:
H a p y m e H H e iţejiocTHocra cocyzţncroH cremcn, 3aMe,zpieHHe KpOBoro-
Ka, noBbimeHHe CBepTbroaeMOCTH KpOBH. CoBpeMeHHaa <J>opMyjiHpoBKa
TpHa^ţbi 3ByHHT KaK! 1) HapymeHHe Mop^ojionmecKOH h (JjyHKimoHajib-
HOHIţeJIOCTHOCTH COCyZţHCTOH CTCHKH, 2) H3MeHCHHe XapaKTepa IIOTOKa
KpOBH — MaKpo- h MHKpopeojiorHnecKHX cb o h ctb , 3) cTOHKaH nmepKO-
arymmfl BCJiejţcTBne roObnoHHOH npOKoarynaHTHon aKTHBHOCTH, ne-
(JjHIIHTa eCTeCTBeHHbIX aHTHKOaryjIBHTOB h/hJIH (jmOpHHQJIHTHKDB [AT.
PyMjnnţeB].
H a n ţe Bcero T 3JIA BBJiaeTca ocnoHCHeHneM BeH03Horo TpoMOa jho-
6oh JioKajiH3au,HH: BeH hjdkhhx KOHenHOcren, iţeHTpajibHbix BeH, BHy-
TpHcepnenHbix TpOM6oB (b npaBbix or^ejiax) npn bo3hhkhobchhh Mep-
iţaTejibHOH apHTMHH. IlpH 3m6ojihh CTBOJia JieroHHOH aprepHH hjih
niaB H bix ee BeTBen pa3BHBaeTca TJCKenaa <J>opMa T3JIA (impKyjwropHaa
(J)opMa MaccHBHOH T3JIA no B.C. CaBejn»eBy). n p n okkjikohh qzjhoh H3
raaBHbix BeTBen JieroHHon aprepnn pa3BHBaeTca «pecnnparopHaa (J)opMa
MaccHBHOH T3J1A no B.C. CaBenbeBy», CBJoaHHaa c pa3BnrneM HH(J>ap-
icra Jiencoro. B pe3yjn»Tare okkjik>3HH cocyzmcToro pycna yBejiHHHBaeTca
MepTBoe npocrpaHCTBO b jiencnx —^ BeHTHJinpyeMoe, ho He nep<J)y3H-
pyeMoe npocTpaHCTBO. Pa3BHBaercfl nmoKceMna — npoaBJiemie JXbixa-
TeubHOH HenocTaroHHocTH. rnnoKceMHa npn MaccnBHon T3JIA Moacer
ycyryOjMTbca cOpocoM KpOBH H3 npaBoro npeAcepnna b JieBoe nepe3 or-
Kpwroe oBanbHoe oTBepcTne (y 25% B3pocjioro HaceneHna) b pe3yra»Tare
JieroHHon ranepTeH3HH n noBbiinemra rpaaneirra naBnemui Meayţy npa-
bwm h JieBbiM npeflcepmwMH — niyHTnpoBaHne KpoBH cnpasa HaneBO.
npenpacnojiaraionniMH 4>aicropaMH T3JIA asnaioTca AJinrejibHoe
yMeHbmeHne nonsnacHOCTH SojibHoro, OHKOJiornnecKHe 3a6oneBaHHX,

89 CD
 xHMHOTepamw, noaomoH B03pacr, craeHpeHHe, 6epeMeHHocm>, HajiHHHe
BapHK03H0 pacniHpeHHfcix Ben (icaic noBepxHOCTHbix, Tan h rny6oKHx),
3iffl30,m>i T3JIA b aHaMHe3e, h Ap.
KuHHHHecKaa KapraHa T3JIA 3aBHCHT or creneHH okkjikxjhh jie-
roHHOH aprepHH h ee ctbojiob.
OopMa revenue ypoeeHb nopaHceHHH jieroHHOH aprepHH
TaaceAaa MojiHHeHOCHoe CtBOJI HJ1HDiaBHbie BeTBH
CpeaHeTocejiaa Ocipoe flojieBbie, cemeHTapm.ie BeTBH
Jlencaa PeimzmBHpyiomee Mejnaie BerBH

KnuHunecKOH KJiaccuipuKimuR T3JIA n o K ).B . A m uejieeim ,

I A . CopoKunou Iiium . IIo B .B . PyveuH , 1998]
KjIHHHHeCKHH
OcoSeHHOCTH npOHBJieHHH TaxecTb T3JIA
npH3HaK
HHcrrapaTopHaa YMepeHHaa (ao 30 b mhh.), BbipaacemiaH
OAUimca (>5Q) Be3 xpHnoB h y^acraa
BcnoMoraTeubHbix Mump
Bojib b rpyzţHofî «ILieBpajibHaa», ycHAHBajomaaca npn xapaicrepHa Ana
KJieTKe AbIXaHHH, 3m6oJIHH MeJIKHX
ocTpaa, KOJiiomaa BeTBefi.

3arpyzţHHHaa 6ojib — BepoaTHee CBa3aHa xapaicrepHa Ana

c HmeMHeâ MHOKapzţa 3m6 ojihh KpynHbix
BeTBefi jieroHHofi
aprepHH
A6AOMHHajibHaa 6ojib — ocipaa,
cxBaTKOo6pa3Haa, b npaBOM noApe6epbe,
MoaceT conpoBoamaTbca pBorofi, hkotoh,
HKTepHHHOCTbK) CKJiep H KOKH
TaxHKapAHfl CHHycoBaa, TaxHCHCTOJiHHecKaa <J>opMa 3M6oAHa dBOJia
MepparejibHOH apHTMHH hah maBHUx BerBefi
AeroHHofi aprepHH
AprepHajibHaa O t yMepeHHOH, ao BMpaaceHHofi, c 3 m6 oahh CTBOAa
rHnoTeH3Ha oAHOBpeMeHHHM noBBimeHHeM LIB#. hah rnaBHux BeTBefi
B03M03KH0 pa3BHTHe OCTaHOBKH AeroHHofi aprepHH.
KpoBoo6paiiţeHHa b pe3ym>TaTe
3JieKTpOMexaHHHeCKOH AHCCOUHapHH
Kaiuejib CyXOH, COCKyAHOH CAH3HCTOfi MOKPOTOH
06MOpOK BcrpenaeTca peAKO, yKa3biBaeT Ha
cHHaceHHe pe3epBOB KpoBoo6pameHHa

O 90
 Jleneim e
Bm3ob 6pHra,ati CKOpOH mcahuhhckoh iiomouih, n o ripne3.aa — hh-
ranaipra; KHCJiopqaa, aBnrHKoarynaHTHaa Tepamvi.
AHTHKoaryjiHHTHan Tepaim a
IIp e n a p a T A o3a MexaHH3M aeficTB H fl
He(J)paKimoHHpoBaHHi>rK B /b , CO CBOpOCTblO H e ripaM O H aH T H K oaryjw H T ,
(K Jiaccm ecK H H ) renapHH MeHee 1250 ME/nac MeX3HH3M
R o yBejnraeHHW AHTB n p o T H B O C B e p rb iB a io m e ro
( aKTHBHpOBaHHOe aeHCTBHa o O y cn o B JieH
HaCTHHHOe B3aHMOAeHCTBHeM c
T poM S oruiacT H H O B oe aHTHTpOM6HHOM H I.
BpeMfl) b 1 , 5 - 2 p a 3 a EHOflOciynHOCTb — 30%
HH3KOMOJieKyJMpHbie KneKcaH (aH O K canapH H ) rip H M b ie aH TH K oaryjiH H Tbi
renapH H bi: 3 H O K ca n ap n H — noa.KoacHO 1 m t/k t MeX3HH3M
(KJieKcaH), H a a p o n a p H H (lOOe^i/icr) n p o T H B O C B e p rb iB a io m e ro
(cjjpaKCHnapHH), O paK cw napH H AeHCTBHH o6yCJlO B JieH
aa jrre n a p H H (4>parM H H ) (H a a p o n a p H H )— B3aHMOfleHCTBHeM c
noflKO^CHO, 90 ea/icr aHTHTpOM6HHOM I I I .
E H O flo c ry n H O C T b — 100%
 D iaea 7
Komm
H a p y m e H H » c o 3 HaHH» H M eior H ecm n b K O C T a/n m . O rn y m e H H e —
y ra e T e H H e co3H aH H » c coxpaH eH H eM o rp a H H H eH H o ro cjicm ecH oro
KOHTaKTa. Conop — ra y G o ico e yrH eT eH H e c o 3 H a im s , o^HaKO, y 6ojib-
H o ro co x p aH H eT ca p e a fa ţH » Ha pe3K H e, niaB H biM o 6 p a 3 0 M , 6ojieB bie h
3 ByKOBwe pa3apa3KeHHfl. K oM a — - orcyTC T B H e k b k o h 6 w t o h h 6bijio
peaKHHHHa b h 6 q ih h 6 pa3ApaacHTejra.
B ocHOBe Bcex bh#ob HapymeHH» co3HaHH» jichcht 3Hawrejn>Hoe
yMeHbmeHHe flocTaBKH KHCJiopofla k M03iy. B iojiobhom M03re Her
CKOJILKO-ffliSyZH» 3HaHHMHX3anaCOB KHCJIOpO^a, BTO5Ke BpeMH, rOJIOB-
hoh M03rnoTpeSjiaeT 25% Bcero TpaHcnoprapyeMoro b opraHH3Me khc-
jiopofla. npHHHHaMH HapymeHH» aoctbbkh KHCJiopoaa b mo3T Moryr
6brn> HapymeHH» M03roBoro KpoBOoSpamemia, HapymeHH» ra30o6MeH-
hoh (jjyHKHHHnerKHX(nmoKceMH», rmioKanHHa). HanSonee 3HaHHM0H
npHHHHOH HapymeHH» co3Hami» «BjiaeTC» mueMH» rojiOBHoro M03ra.
IIpH nmoKCHH M03ra Hapymaerc» ayroperyjianH» M03roBoro KpoBoro-
xa h nocjieAHHHCTaHOBHTC»33BHCHMMMot chctcmhoio apTepnajibHoro
AaBJieHH». Ecjih y 6ojn»Horo no KaKOH-jm6onpHHHHe B03HHKaeTaprepH-
ajibHaa nmoTomia, to mo3ioboh KpoBOTOKcmiHcaeTca.
B cTOMaTOJionmecKOHk jih h h k c Moiyr B03HHKHyrb KOMaTO3Hbie co-
c to » h h » , oSycjioBJieHHbie, raaBHHM o6pa30M, HapymeHHeM ynieBOfl-
Horo oSMeHa y 6ojibHbix c caxapHbiM,n;Ha6eTOM.
rHIlOrJIHKEMHHECKAB KOMA
rnnorjiHKeMHHecică» KOMapa3BHBaeTca ocrpo. Korna nepHoa npe/j-
BecTHHKOB Man, Toiyja KOMa pa3BHBaeTC» BHe3anH0. rHnoraHKeMHHe-
cieaa KOMaB03HHKaer npn chhxcchhh KOHiţempaHHHnnoK03bi b KpOBH
,zţo 1,5—
2,5 MMOJib/ji.
K nH H H H ecK an K apT H H a
P a 3 JiHHaioT 5 cTa/jHH b pa3BHTHH rHnorjiHKCMHHecKOH k o m h . Ile p B a a
c r a ^ n a npo»B JiaeT C » yM epeHHO BbipaaceHHbiM H H3MeHeHH»MH <J)yHK-
H h h »H 3H eH H 0 BcDKHbix opraH O B . IIpeK paT H T b ee A a Jib H e m n e e pa3BH-
r a e m o» ch o npocT biM H c n o c o S a M H , H e n p H 6 e r a s k Me,mncaMeHT03HBiM
cpe^CTBaM . JJfl» CBoeBpeMeHHOH f lH a ra o c r a K H H a n a n a n in o n iH K eM H -
necKOH KOMbi c n e n y e T BHHMaTejibHO c jie flim » 3 a c o c ro a H H e M 6ojibH bix
c cax a p H b iM flH a6eT 0M , He3aBHCHMO o r e r o r a n a .
D to
 ^ ---gplPBHTHH I HllOIJIMKCMH'ieCKOH pcaKIIHH piMMUNTT 5 CTSJffil
HCajioGbi Oih>eicTHBHue nponejieHHH
rioHBJieHHe TaxHKapoHB, BJiaxHocTb ko/khmx
wyBCTBa rojiofla, noKpoBOB. Hea^eKBamoe noveaernie,
paaapaxcMTejibHocTb, rnnepeMHa jimţa.
rojioBHaa 6ojib,
H3MeHeHHe HacrpoeHiui.
npo^y3Haa iiotjihbocti» npe»HHe.
flcmadux canHBauHa, TpeMop,
Amuiomui.

IloBwmeHHe MbimeHHoro TOHyca,

TOHHKO-KJioHHHecKHe cyaoporn,
HanoMHHaiomHe anmienTHHecKHH
jflcmadux npnnaaoic, pacuiHpeHHe 3paHKOB,
yCHJIHBaeTCH BJiaHCHOCTb KCHKHblX
noKpoBOB, TaxHKap.aHa, aprepHajiBHaa
nmepreH3Ha.

rioTepa co3HaHH«, noBhuneime

cyxoacunbHbix h nepwocTajibHbix
pe^jieKCOB, TOHyc ma3Hbix h6 jiok
HopManbHbiH hjih noBbimeH, 3panicn
IV cmadux. pacuiHpeHbi. Ko)KHbie noKpoBU
BJia^cHbie, AuxaHHe o6biHHoe,
nyjibc ynameH, aprepnajibHoe
AaBJieHHe HopMajibHoe hjih
He3HaHHT6JIbHO nOBblUieHO.
riporpeccHpoBaHHe KOMaro3Horo
coctohhha: ape(J)jieKCHB, cHHXcaercH
TOHyc Mbunu, npeKpamaeTca
VcmaduR
noTooTAejieHHe, HapymaeTca
—2jry6oKOU
cepaeHHbiH pHTM, CHH^caerca
KOMU
aprepnajibHoe /ţaajieHHe, bo3moîkho
HapyuieHHe abixaHHa peHTpaJibHoro
reHe3a.

flnarH 03 nmoniHKeMHHecKOH komli ycTaHaBJiHBaeTca no ypoB H io

niHKeMHH: chidkchhc coaepacaH iw nnoK03M b njia3M e kpobh n o 3,33
— 2,77 mmoWji xapaicrepH 3yeT noaB JieH ne rnnoraH K eM H H .

93
a
 JleneHHe
rioKa nauneHT b co3hbhhh, pa3BHTHe ranonraKeMini
mojkho npepBan», a aB nauHemy jienco ycBaHBaeMHe
yrneBOAbi: caxap, Mea, BapeHbe c naeM h OejiHMxjie6oM.
Ecjih nauneHT He MoaceT raoran», pexoMeH/iyioT ocro-
pcoKHO KanarB u o a jbhk pacTBop mi0K03bi. IlpH 6ojiee
Tocejibix npoHBJieHnax nmornHKeMHH BHyrpHBeHHo
BBOjun 40% pacTBop nnoK03bi 20-100 mji.
O^HOBpeMeHHO c HananoM 0Ka3amDi noMomH bbbh-
BaioT Opara^y CKOpoii mcahihihckoh noMonjH
3 n H J IE n T H H E C K H E IIP H IIA /ţK H
3mwenTHHecKHH npnnaflOK 4— 3to cocroamie, xapaicrepH3yK)-
meeca pa3BHTHeM cyaopor, HapymeHHeM co3HaHH«, paccTpoHCTBaMH
HyBCTBHTeJIbHOCTH. ^HTeJIbHOCTb n p H C T y n a oObIHHO flJIHTCfl 1-2 MH-
HyTbi, a 3aTeM HacTynaeT HenpoflOJDKHTejibHbrâ coh, anaraa, cnyraH-
HOCTb C03HaHHH.
3nHJienTHHecKHH cTaryc — 3T0 cepna reHepaaH30BaHHbix cio­
por C KOpOTKHMH HHTepBBJiaMH. Co3HaHHe B Tenemie HHTepBaJIOB He
BOCCTaHaBJiHBaeTca. Bo3HHKaiomaa bo BpeMH cyzţopor aHOKCH» Moacei
npHBecra k HeoOpaTHMbiM nopaaceHHHM ronoBHoro M03ra h cMepni.
KjiHHHHecKan KapTHHa
vKajioSbi O&beKTHBHbie npOHBJieHHfl
Flepea HananoM npHnajpca reHepajiH30BaHHbie tohhko- khohuhcCKHe
MOîKeT B03HHKaTb aypa: cyzţoponi, coKpaipeHHe ouxarejibHOH
rajunoipmapHH, hjuik)3hh, MycKyjiarypw, cacarae HemocreH c bo3mo)khum
HCKaacemie no3HaBarejn»HOH npHKycuBaHHeM H3Lnca, HapymeHHeM Abixamw,
CnOCOSHOCTH,COCTOflHHe BimoTb flo ocTaHOBKH, u,HaH030M, noreps
a(J)(j)eKTa. co3HaHHH, HeflepacaHHe mohh h Kajia.

Jleneune
HeMeaJieHHbiH blbob OpHra^w cieopOH mc^hibih-
ckoh noMomH. E cjih b ynpeayţeHHH HMeeTca aHecre3H-
ojior-peaHHMaTOJior, oh mojkct nonbrraTbca npH 3im-
nenTHnecKOM npHcryne bbccth MejyieHHO BHyrpHBeHHo
1% pacTBop THoneHTajia HaTpna (200-400 Mr) b coneTa-
hhh c 6eH3o,zma3enHHaMH (ana3enaM 5-10 mt), Boccra-
HOBHTb npOXOflHMOCTb JţHXaTeJIbHblX IiyiC H BIUIOTb R0
HHTyOaiţHH T p a x e n , n p o B o jţa OKCHreHOTepanHK)
 I Via n a 8
3iioK aH ecTBeH H afl rm iepTepM H Ji
3-H0KaMCCTBeHHajf rHneprepMHn — 3TOpaccrpoficTBO oeenerHo# My-
cKynarypw, HacncAycMoe no ayrocoMHOMy AOMHH^rraoMy Tuny (o «
rroro ran a Hac;ie/joBaHna xapaicrepHa paBHan BepcwnrHocrb Bcrpenae-
MOCTHAaHHoro npHTHaica, kek y MynoiHH, r a x h y aceHiiwH), ITpff ?tom
3a6 oneBaHHH Hapyujacrca xanbUHeBbifi roMeocrax HoHH3 HpoBaHHwfi
Kajibimfi HaKaruiHBaeTca b mrronna3Me h, c o e js H tv u c b c TponofomoM,
BH3WBaeT crofiKoe coKpameHne nonepenHononocarbix MMiueHHwx
bo/iojcoh. ^UnHTcatHoe coKpameHne Mbium Tpedyer 6ojibmoro Kosrane-
CTBa KHcnopona Ana Bospociuero Mera6onH3Ma. IIpn ttom nponcxooHT
BHneneHne 6onbiuoro KonnHecTsa ymeioicnoTH h Teiuia. noBwmeHHe
KDHueHTpaiiHH ymeKHCJiorw b KOHiie BHAOxa (ETC02) x b ju k t c x oahhm
H3 paHHHX npH3HaKOB 3JiOKaHecTBeHHOH rnneprepMHH. HcTOineHHe aa-
po6noro nyra nojiyneHHB 3Heprnn 3anycKaer aHa3po6HBiHMeradomoM,
hto npnBOAHT k HaKomieHHK) naKTara h MeTa6oiiHnecxoMy annAory. Pe-
3yjn»TaroM Ha6yxannn h oreica MwineHHOH ncami nannerc* noBpe*ae-
HHe MeMdpaHM MHonma h pa6AOMHOJiH3, hto npHBOAHT k nmepKajme-
mhh, rnnepKaJibUHeMHH, MHomo&HHypHH h noBbrniemno ypoBHa xpea-
THH(J)Oc4>OKHHa3bl B KpOBH. Pe3KH6 MeTa6oJIHHeCKHe H 3neKTpOJIHTHHe
HapynieHHB npHBOABT k yraereHHio cepACHHO-cocyAHCTOH chctcm h,
oreicy foaobhofo Mosra h ApyrHM opraHHbiM paccrponciBaM.
3noKanecTBeHHyK) rnneprepMHio BbOMBaioT npenaparbi, Hcnonbsy-
eMbie b aHecxesHOJiorHH: MbiineHHbie pejiaKcaHTH — cykixhhhjixojihh
(ahthahh), BeKypoHHH, naHKypOHHH, AeKaMeTOHHH, Bee hhtcuisihhoh-
H bie HapKOTHHecKne BemecTBa: ahsthaobbih acfmp, rajioraH, sHcjwno-
paH, H30 <J)JiK)paH, Ae3^niopaH, ceBO^niopaH.
3/ioKaHecTBeHHa» rnneprepMHa name B03HHKaeT npn HeSojibumx
BMemarejibCTBax (b CTOMaTOJiorHH, JIOP-xHpypnm), 6onee THnmma
a rm MOJiOAbix B3pocjibix MyncHHH,
KjiHHHHecKan K apnm a BecbMa pa3Hoo6pa3Ha, ho hot hh oahofo
Han6ojiee xapaicrepH oro npH3HaKa.
KjiHHHHecKan KapTHHa
KnpH3HaKaM 3JiOKanecTBeHHOH rnneprepMHH othocbtcb: TaxHKap-
Amb, TaxnnH03, rnneprepMHn (h o ch t MOJiHueHOCHbiH xapaicrep), uh-
aH03 h reHepajiH30BaHHaa MbimenHan phthahocti» (nacro B03HHKaeT
95 4H
pHra^HocTB xceBarejibHbix Mbiixiu), HecrraSHJibHoe aprepHanbHoe zţaB-
JieHHe (b Hanajie npoflBJieHHH oho Moacer 6 biTb noBbimeHHbiM, a 3arew,
Ha (J)OHe MeTa6 ojiHnecKHX HapymeHHH. CHHacaeTca), apHTMHH, cmc-
uiaHHbiH aiţHA03 (pecnHpaTOpHbiH h MeTaOojiHHecKHfi), Koarynonanw
(,ZţBC-CHHZţpOM).
HanSojiee iţeHHbiMH JiaOoparopHbiMH zţaHHbiMH b fluamocTHKe 3T
HBJiaiOTca 3HaHHTejn»Hoe noBbimeHHe PaC02, cmcKeHne Pa02, CMe-
HiaHHbm aiţHA03, ranepKajiHeMHfl. B pe3yjn»TaTe oOniHpHoro paOflOMH-
0JiH3a pa3BHBaeTca MHODioOnHeMira h MHorao6 HHypj«i. IloBbnneHHe
co^epacaHHa b iuia3Me KpeaTHHKHHa3bi, KajiHa, <J)oc<j)aroB.
JleneHHe
BceM nannenraM c npeApacnojioaceHHOCTbio
k 3Ji0KaHecTBeHH0 H rnneprepMHH (II3r) Heo6-
xo^HMa afleKBaraaa npeMe^nncainw 6eH3o#Ha-
3enHHaMH h 6 ap6 nTyparaMH jxjm npe^ynpeacfle-
hhh BepoaTHoro npeflonepaipioHHOiD crpecca.
B HapK03H0M annapaTe He aojhkho Sbitb cne^OB
HHraJMLţHOHHblX aHeCTeTHKOB. MoaCHO HCnOJIb-
30BaTb jih6o annapar, KOTOpbin HHKorna He 3kc-
imyaTHpoBajica c HHrajiaiţHOHHbiMH aHecTenuca-
MH, JIH60 npe^BapHTeJIbHO OHHIIţeHHblH HapK03-
HbiH aimapar. J\im nojiHon ohhctkh HapK03Horo
annapaTa TpeOyeTca:
• CHHTb Bee HcnapHTejiH;
• 3aMeHHTb Bee aocrynHbie iuiacTHKOBbie h pe3HHOBbie aeram
KOHTypa annapara;
• 3aMeHHTb a6 cop6 ep Ha hobbih;
• HCn0JIb30BaTb TOJIbKOHOBbie Tpy6KH HMaCKH;
• npOBeHTHjiHpoBaTb annapar hhctlim KHCJiopo,n,OM npn noroxe
10 JI/mHH KaKMHHHMyM 10 MHHyT.
npOTOKOJI Be/ţeHHa 60 JIbH0 r0 COCTpbIM3nH30A0M 3 r
1. HeMeAJieHHO npeKpanm, BBe^eHne Bcex TpnrrepHbix npenaparoB.
Bbi3Ban> noMonib!
2. rraiepBemHJiaipw Jiencnx 100% KHCJiopoflOM.

£> 96
3. B bccth b/b AampojieH b A03e 2—3 mt/kt. OOnţaa no3a BMecre c no-
BTOpHtiMH BBejţeHHHMH iipenapaTa MOQKer cocraBHTB 4 0 10 m t/kt h
6onee.
4 . K oppeiam a MeTaOojiHHecKoro a iw v m b/b BBe#eHHe 1 -3 m3 k b /k t
H C 0 3 -.
5. AKTHBHoe oxjiaagjeH H e naiţHeHTa. Bboahtb b/b oxnaacagHHWH (Jm-
3HOJiorHHecKHH pacTBop no 15 mji/kt KaacAwe 10 MHHyr 3 pa3a,
BtraojmaTb jiaBaac nojiocxeH Teaa xojioahbimh pacrsopaMH, n e n Ha
rojiosy, rneio, b nax.
6. KoppeKiţHa THnepKajnieMHH b/b BBe^eHMe KOHLţeHTpHpoBaHHHx
paCTBOpOB TJII0K03BI C HHCyJIHHOM (0,5 t/kT rJIK>K03BI H 0,15 E^/lCT
HHcyjiHHa), 3areM C aC ^ 2 -5 mt/kt.
7. JleneHHe apHTMHH b/ b BBe^eHHeM HOBOKaHHaMHUa (1 mt/ kt/ mhh ao
15 mt/ kt) huh JiHjjoKaHHa (1 mt/ kt). EjiOKaropM KajibimeBbix KaHa-
jiob b coHeraHHH c AamponeHOM npoTHBonoKa3aHbi.
8. nozwepacHBari» aaeK B arabiii AHype3 (He MeHee 1 MJi/Kr/nac) b / b BBe-
AeHHe MaHHHTOJia 0,5 t/k t ( b o (JwiaKOHe c aamponeHOM cQuepaarrca
MaHHHTOJI B KOJIHHeCTBe 150 MT Ha KaaC^BIH MT aaHTpOJieHa) HJIH
<j>ypoceMH#a (0,5—1,0 mt/kt). YcTaHOBHTB ypeTpauBHBiH Karerep.
9. KaTerepH3HpoBaTB LţeHTpajiBHyio seH y j s j v i npoBefleim a azţeKBar-
hoh HH(J)y3 HOHHOH TepanHH H H3MepeHHB LţB/ţ.
10. KaTeTepH3HpoBaTB aprepmo ,zyia npoBefleima HHBa3HBHoro reMomH-
HaMHHecKoro MOHHTOpHHra h aHajiH3a aprepHajiBHOH kpobh.
11. MoHHTopHpoBaTB khcjiotho-ochobhoh CTaiyc opraHH3Ma, ra3LI
KpOBH, KOHHeHTpaipnO CBIBOpOTOHHBIX 3JieKTpOJIHTOB (N a, K , C a,
C l, P), ypoBeHB KpeaTHH(J)oc(J)OKHHa3i>i, cocroBHHe reMOcra3a (kd-
aryjiauHOHHBie tcctb i) — Kaaczţbie 10 MHHyr.
12. KoppeKiţHH B03MoacHOH KoaryjionaTHH.
[hht. no IIpoKonBeB r.F., M hxcjibcoh B.A ., AraBejiaH 3.F., CnzţopoB B.A.
CoBpeMeHHBie B3ma^p»i Ha chh^P om 3JioKanecTBeHHOH rrnieprepMHH.
Me^HHHHa HeoTjioacHBix coctohhhh. — 2011. — N 7-8. — C . 73—79].
 D ia e a 10
OcTaHOBKa KpoBooOpameHHH
OcTaHOBKa KpoBoo6pameHMa — aro BHe3anHoe npeKpameHne cep-
aeHHOH ^eaTejiBHOCTH. IIo 3 THOJiorHH BbmejMK)T ABa BapnaHTa OK:
• IlepBHHHaa — pa3BHBaerca BCJie/ţcTBne narojiorHHecKHx npo-
tţeccoB b MHOKap^e (ocipaa HineMHa, HH^apicr MHOKap/ţa, Kap-
AHOMHonaTHH, BpoayţeHHBie h npHoOpeTeHHBie HapymeHHa npo-
BQZţHMOCTH, CTeH03 aOpTBI, paCCJIOeHHe aHeBpH3MBI aOpTBI, MHO-
Kap^HTBi, nopaaceHHe 3JieicrpHHecKHM tokom).
• BTOpjiHHaa — pa3BHBaeTca BCJie/ţcTBHe 3KCTpaKap/ţHajiBHBix
npHHHH (Taacenaa jţBixarejiBHaa, impKyjiaropHaa, reMEraecKaa ra-
noKcna, ranoraHKeMHa, rraioTepMHa, xaacejiHH aimzţ03, nmo-lm-
nepKajineMHa, mnoKCHKaima, TaMnoHazţa cepjţiţa, HanpaaceHHBiii
nHCBMOTopaKC, TpoM6o3M6ojiHfl JieroHHOH aprepHH, TpaBMa).
IIo naToreHe3y BbiaejinioT Tpn Bapaairra OK:
• <Dji6 pHjuiaiţHa acejiyzţOHKOB (<E>5K) — xaoTHnecKoe acHHxpOHHoe
B036y»yţeHHe ot^cjibhbix MBimenHBix bojiokoh hjih He6ojn»niHX
rpyim bojiokoh c ocTaHOBKoii cep^tţa h npeKpamemieM KpOBO-
oSpanţeHHa. Ha 3KT 03K BBirjia^HT KaK HenpepBiBHBie bojihli
pa3JiHHHOH (jjopMBi h aMiuiHTy^Bi c HacTOTOH400-600/mhh, Kpyn-
HBie h pejjKHe bojihbi c nacTOTOH 150-300/mhh (KpynHOBOJiHOBaa
Phc. 10.2). Taicace OK pa3BHBaeTca npn aceayzţoHKDBOH Ta-
XHKap/ţHH (5KT) 6e3 nyjiBca, KOTopaa HMeeT ckjiohhoctb nepepo-
ac^aTBca b (Phc. 10.3).

Puc. 10.1. MejiKoeojiHoean (puâpujimifUM Dtcenydonme

Puc. 10.2. KpymoeojmoeaH <pu6pwuunfUH Dtcenydonme

98
 Puc. 10,3, /Kenydowcoea* marMrapom oe? ny^bca [3]
• Achctojih# — BapwaHT OK, n p u Koropo* o rc yrcT B ym x n a z * -
p m a w x mejiynomoB h cepneR H ufi s& ktpee (P u c, 10.4),

£# £ Li '!
11 '■ 1

For, /f t 4. Acucmtma
• 3jieicrpoMexaHHHecKa>i /wccoaHamix (3M#)— BapHanrOKnpH
H3JIHHHH 0praHH30B3HH0H 3^eKTpH*ieCICOH 2EIMBH0CIM Cepilia.
Ha 3KT MOiyr Bfci*Bn*Tbca jnoCfeiephtmh, Kpowe a 3ET6ea
nyjibca. 3M # pa3BHBaerca BCJieacTBHe HecnocooHocra Miocap-
,oa coKpamTbca b orser Ha 3JieicrpHHecicyio jenonaproaiiHio. B
onpe^ţe^eHHBix cmyaoHax oiMcaaforca CGEpaffieMHg MHorapja.
ho cjihuikom caa6we ana oOecneqeHHS 3<fxj)eiTHBHoro iposoo-
6pameHHB. Ochobhbio hphhhhh 3M Jl — aianpaicapjHajtbHMe
(Txxenax ranoKCH*, rnnoBOneMH*, aromo3, rmo-;THnepsa.iH-
eMHa, mnoDiHiceMHa, ranorepMHa, mmoKCHKainw, TaMnoHaaa
cepuna, HanpjDKeHHMH mieBMoropaKc, tpom6o3m6qhhji aeroq-
hoh aprepHH, TpaBMa).
npH OTCyTCTBHH CBOCBpOMeHHOrO JieHCHHS OHHC2HHB1C MCXaHH3-
mh OK nacTO nocnenoBarejiMio cmchbiot #pyr jipyra: )KT 6es nynbca
cp)K 3M/I acHCTOJiHB. Hcxqah npw OK no MexainoMy acHCTQjmHhjih
3Mfl 3H3HHTCJibHOxyxe, neMnpH 9MK.
îOiHHHnecKaa cMeprB — oOpaTHMUH 3ran yMHpaHHa. nepexDjţHoe
cocToaHHe or jkhshh k CMepTH [HeroBCKHH B.A., 1951]. Ochobhhmh
npH3HEKaMH KJIHHHHeCKOH CMepTH HBJUnOTCa: OTCyTCTBHe C03H3HHS,
caMOCTOBTejiBHoro /ţwxaHHB, nyjibcaiţHH Ha MarHCTpajifcHHx aprepHsx,
pacniHpeHHe 3panK 0B (pa3BHBaeTc* b Tenerofe 1 mhh nocjie OK), ape<j>-
ncKcm (oTcyxcxBHe KOpHeajitHoro pe<jwieicca h peaiaiHH 3pa*iKOB Ha
99 P
cBex), Bbipa>KeHiiafl 6jieAH0CTb/uHaH03 kojkhwx n o K p o e o B . Ecjih kjih-
HHHecKaa CMepTb HacTymuia b pe3yjibTare HenpoAOJiXHTejibHoro arana
yMHpaHHa, to Bbicnm e OT^ejibi rojioBHoro M03ra nejioBeica Moiyr ne-
peHecTH O K b ycJiOBHax HopMOTepMHH b TeneHHe 4—6 mhh, b Te*ieHHe
KOTOpbIX H Heo6xOAHMO HBHHHaTb peaHHMaiţHOHHbie MeponpHHTHJI.
Ecjih yMHpaHHe opraHH3Ma npoHexoAHJio jyiHTejibHO, 6wjio Hcroiqa-
IOHIHM, TO oSbIHHO Heo6paTHMbie H3MCHCHHB B K O pe rOJIOBHOTO M03Ta
pa3BHBai0TCH eme ao OK . Ho Moacer 6bm> h BropoH c p o x kjihhhhcckoh
CMepTH, C KOTOpbIM BpaHaM npHXOAHTCH CTaJIKHBaTbCH npH OKa3aHHH
nOMOHIH B OCo6bIX yCJIOBHBX, KOTOpbra M03KCT npOAOJDKaTbCH JieCBTKH
MHHyT, H peaHHMailHOHHbie MepOnpHBTHB 6yayT 3<|>(|>eKTHBHbI. BTOpOH
c p o x KJiHHHHecKOH CMepTH Ha6jiK>AaeTCJi, Korna co3^aioTCB o co6w e yc-
jiobhh jţjia 3aMe,zţjieHHB npoiţeccoB noBpeayieHHB rojioB H oro M03ra (th-
noTepMHa, rnnepS apH necK aa OKcnreHaiina, H eH ponporeicropbi h AP-)
npH OTCyTCTBHH peaHHMaiţHOHHblX MepOnpHHTHH HJIH HX HC3(j)-
(J>eKTHBHOCTH bcjica 3a kjihhhhcckoh CMepTbK) pa3BHBaeTCB 6hojio-
rHHecKaa CMepTb — Heo6paTHMbiH 3Tan yMHpaHira. EHOJionnecKaji
CMepTb BbipaacaeTca nocMepTHbiMH H3MeHeHH»MH bo Bcex opraHax h
CHCTeMax, KOTOpbie hocht nocToamibiH, Heo6paraMbiH, TpynHMH xa-
paicrep: (JjyHKHHOHajibHbie (orcyrcTBHe co3HaHHH, AbixaHHH, nyjibca,
apTepnajibHoro AaBJieHHH, pecjmeicropHbix otbctob Ha see bhah pa3-
ApaacHTejien), HHCTpyMeHTajibHbie (3JieKTp03Hiie<})ajiorpa<j>HHecKHe,
aHraorpa(J)HHecKHe), GnojiorHHecKHe (MaKCHMajibHoe pacurapemie
3paHKOB, 6jieAHOCTb h/hJIH HHaH03, h/hJIH MpaMOpHOCTb (iMTHHCTOCTb)
K03KHMX noKpOBOB, cmoKeHHe TeMneparypbi Tejia) npH3HaKH h Tpyn-
Hbie H3MeHeHHa. ^3,HarH03 6HOJiorHHecKOH CMepTH ycTaHaBJiHBaioT Ha
OCHOBaHHH BbIHBJieHHH TpynHbIX H3MeHCHHH (paHHHe --- OTCyTCTBHe
peaioiHH raa3a Ha pa3ApaaceHHe, BbicbixaHHe h noMyraeHHe poroBHijbi,
CHMnTOM «KomaHbero rna3a»; no3AHHe — TpynHbie iraraa, TpynHoe
OKoneHeHHe).
PeaHHMaiiHH 3to CHCTeMa MeponpHHTHH, H a n p a B J ie H H b ix Ha boc-
cTaHOBJieHHe hjih BpeMeHHoe 3aMemeHHe yrpaHeHHbix hjih rpy6o Ha-
pymeHHbix (^yhkhhh opraHH3Ma c noMombio cnetţHajibHbix peaHHMa-
HHOHHblX MeponpHHTHH (KOMnpeCCHH ipyAHOH KJieTKH, HCKyCCTBeH HO e
AbIXaHHe, A6$H6pHJIJMHHH H Ap.)
KnaccHHecKaa nocjieAOBaTejibHOCTb peaHHMau,HOHHbix MeponpHH-
thh 6bma c<j>opMynHpoBaHa n . Ca<j>apOM:

O loo
 • SjieMeHTapHOe noflzţepacaHHe hch3Hh (cpoHHaa oKCHrenamw):
- A (Airways) — BOCcraHOBJieHHe npoxozţHMOCTH HHxarrejibHwx
nyren,
- B (Breathing) — noazţepacaHHe zţbixaHna,
- C (Circulation) — no/uţepacaHHe KpoBooSpameHna.
• JţajibHenmee no/mepacamie >kh3hh (BoccraHOBJieHHe cnoirraHHoro
KpoBOo6pameHHH):
- D (Drugs) -4 BBeaeHHe neicapcTB h jkh^koctch,
- E(ECG) — 3JieKTpoKapAHorpa<j)iw,
- F (Fibrillation) — jieneHHe (jmGpHJiJiaiţHH.
• ITpoflOJDKHTejibHoe nozmepacaHHe acH3HH (iţepeGpanbHaa peaHHMa-
iţn» h JieneHHe b nocTpeaHHMaiţHOHHOMnepnozţe):
- Gh—oiţemca coctohhhh b nocTpeaHHMaiţHOHHOMnepnoae,
3auţHTa M03ra,
- I — KOMiuieKCHaa HHTeHCHBHaa Tepanna b oxzţejieHHH peaHHMa-
TOJIOrHH.
npHHipmHajibHLiMHBJiaeTCBpaHHee pacno3HaBaHHe h paHHee Hana-
ao cepAeHHo-JieroHHoii peaHHMaiţHH (CJ1P).
HacToamne peKOMeHaaiţHH no npoBeaemno cepzţenHO-JieronHOH
peaHHMaiţHH cooTBeTCTByioT «MeTOflHHecKHMpeKOMenzţaiţHSM» EBpo-
neHCKoro CoBeTa no peaHHMaiţHH 2010 r. h npe,zţcTaBJieHO Ha ocho-
BaHHHyneOHO-MeTO/ţHnecKoro nocoGna «CepzţeHHO-JieronHaa h iţepe-
GpajitHaa peaHHMaiţna» B.B. Mopo3, HX EoGpHHCKaa, B.IO. Bacn-
jn.eB, A.H. Ky30BJieB, E.A. CnnpHAOHOBa. 2012 r.
He3aBHCHMO OT npHHHHBI OK, peaHHMaiţHOHHBie MepOnpHHTHH
^ojdkhm 6biTi> HanaTbi b npeflenax 5 mhh ot OK bo H36eacaHHe pa3-
BHTHHHeoGpaTHMMX H3MeHCHHH B FOJIOBHOMM03re. TOJIbKO flBa Me-
ponpHflTHa CJIP — paHHHe KOMnpeccHH rpyzţHOH kjictkh (HenpaMOH
Maccaac cep^iţa) h paHHaa .zţeijiHGpHJiJiaiţHa — yBejiHHHBaiOT bbdkh-
BaeMocTb Gojibhbix c OK. PaHHee Hanajio KOMnpeccHH rpyzţHOH KJieT-
kh yBejiHHHBaeT BbiacHBaeMocTb Gojibhux b 2 -3 pa3a. KOMnpeccHH
rpyzţHOH KJieTKH h ,zţe4)H6pHJiJiaiţHa, BbinojiHeHHbie b TeneHHe 3 -5
mhh ot OK, oGecnenHBaiOT BbiacHBaeMOCTb 49-75% . Kaayţaa MHHyra
npoMe^jieHHa c ^e^HGpHJiJiaiţHeH yMem>maeT BepoaraocTb BtiacHBa-
HHa Ha 10-15%.

101 a
 KoMnpeccHH rpy^HOH KJiencH no3BOJWK)T no/mep>KHBaTi, MantiH,
HO aOCTaTOHHO 3(J)4>eKTHBHE>m KpOBOTOK B COCyiţaX CepAUa H rOJIOB-
hom M03re. IIpOBefleHHe HenpepbiBHbix xoMnpeccHH rpyuHOH kjictkh
yBenHHHBaeT BepoaxHOCTb Toro, hto nocjie^ţyiomaH jxedpw&yunnmm
yCTpaHHT 05K H BOCCTaHOBHT reMO^HHaMHHeCKH 3<j)c[>eXTHBHbIHpHTM.
HenpeptiBHbie KoMnpeccHH rpyzmon kjigtkh ocoOchho BaaeHbi, Koraa
HeT B03M03XH0CTH npOBCCTH Ae(j)H6pHJUiaU,HK), H B paHHHH nepHOA no-
cjieAHee, xorAa coxpameHira cepAna enţe Me^neHHbie h cjia6we.
Ba30Bbie peaHHMaiţHOHHbie MeponpmiTHfl (BPM) BxmoqaioT b ce6a
o 6ecneqeHHe npoxoAHMocra AbixaTeubHbix nyreH, noAAepAcaHHe Kpo-
BooSpameHHa h AbixaHHa 6e3 Hcnojib30BaHHa cneiţnajibHbix ycTpoiiCTB,
KpOMe 3aiHHTHbIX.
ÂJirOpHTM SaiOBbIX peaHHMaiţHOHHblX MepOnpHHTHH
IIpOBepHTb peaxiimo nanHenra: axxyparao BCTpaxHyn» ero 3a rnie-
hh h rpOMKO cnpocHTb: «Hto c BaMH?».
Ecjih naiţHeHT He pearnpyeT, ero cjieayeT ynoacHTb Ha non noBep-
HyTb Ha cnHHy h BoccTaHOBHTb npoxoAHMOCTb AbixaTeAbHbix nyreă
nyreM 3anpoxHAMBaHHa roAOBbi h noATATHBaHHa noAOopOAxa — py-
koh HyacHO HaAaBHTb Ha ao6, a Apyron pyxoii noATAHyn» noASopOAOK
BnepeA h BBepx (Phc. 10.4). AAbTepHaraBHbiH cnoco 6 — 3anpoxHAH-
BaHHe roAOBbi nyreM noABeAeHHA oahoh pyxn noA meio SoAbHoro, a
Apyroil — HaAaBHTb Ha ao6 nocTpaAaBmero (Phc. 10.5).
IIoAAepacHBafl AtixaTeAbHbie nyrn OTxpbiTbiMH hco6xoahmo yBH-
AeTb, ycAbnnarb h nonyBCTBOBan. AbixaHHe, HaOAiOAaa 3a abhacchhamh
rpyAHOH KAeTKH, npHCAyniHBaacb k myMy AtixaHHA h omymaa ABHAce-
HHe B03Ayxa Ha CBoen mexe. HccneAOBaHne npOAonacaTb He GoAee 10
cex. (Phc. 10.6)

Puc. 10.4. Boccmamejieme npoxodimocmu dbixameubHbix nymeit

D 102
 Puc, / 0,5. AJibmepuamwfiibiU cnocoO (foccmmommuH
npoxoouMoemu âbixammbnhtx nymeU

Puc, 10.6, Haâjifoâenue 3a d b ix a n u e M âo/tbuogo

npHHflTb pemeHHc: AbixaHHe HopMajibHoe, ncnopMajibnoc hjih ot-
cyTCTBycT, Heo6xoAHMO noMHHTb o tom, hto y 40% nocrpaaaBiuHx
b nepBbie MHHyTbi nocjie octbhobkh KpoBooOpamcHHB mojkot paiBH-
BaTbCB aroHajibHoe jţbixaHHe (pe/ţKHe, icoponcHe, rciyOoKHe cyaopox-
Hbie ffblX& TCJlbH blC ABHHCCHHfl) HJIH #pyFHC naTOJlOrHHeCKHC THnbl Abl-
xaHHfl. AroHajTbHoe ^bixm m e mqmgt B03HHKHyrb bo bpcmh npoBejţe-
hhh KOMnpeccnft rpyzţHoft kjictkh xax npH3Hai< yjiyniueHHa nep<]>y3HH
rojioBHoro M03ra, ho H e n p H 3 H a x BOCCTaHOBJieHHfl cnonTaunoro Kpo-
BooOpameHHH.
Tukmm o6pa30M, OTcyTCTBHe cosnaHH» h jţbixaHHJi (hjih naronorH-
necKoe wxaHHe) — npwsHarcn octbhobkh KpoBooOpameHm h noKa3a-
hha k Hanajiy CJIP.
• Hanaxb KOMnpeccHH rpyziHoft kjictkh:
• BcTaTb na KOJieHH cSoKy ot nocTpaaaBuiero.
• PacnojioHCHTb ocHOBaHHe ojmoft jia^oHH Ha ueHTpe rpyzţHOH
icieTKH n o c T p a jţa B u ie ro ( t . c . Ha hhjkhkdk ) noJioBHHy rp y aH H u ).
103 CD
 • PacnoJiOHCHTb ocHOBaHHe #pyroH jia#OHH noBepx nepBOH Jia#o-
hh (Phc.10.7).
• CoMKHyrb najibUbi pyx b 3bmok h yqocTOBepHTbca, hto bw He
OKa3biBaeTe AaBjieHHe Ha pe 6 pa; pasorayn» pyKH b jioktcbhx cy-
CTaBax; He OKa3WBan> #aBJieHHe Ha BepxHioio nacTb jkhbote hjih
HHHCHIOK) HaCTb ipyZţHHLI.

Puc. 10. 7. Pacnonootcenue pyK na zpydnou KJiemKe d m npoeedemui nenpoMozo

Maccajfca cepdifa

• PacnojKMKHTb Kopnyc Tena BepTHKajibHO Ha# rpy#HOH kjictkoh

nocTpa#aBmero h Ha#aBHTb Ha ray6HHy kslk mhhhmym Ha 5 cm,
ho He 6onee 6 cm (Phc.10.8 ).

Puc. 10.8. IIojKKMceHuepeammamopa npu nenpuMOMMacccace cepdifa

• OSecneHHBaTb nojiHyio #eKOMnpeccHio rpyzţHOH kjictkh 6e3 no-

TepH KOHTaicra pyx c rpyzţHHOH nocjie Ka^c#oii KOMnpeccHH.
104
£>
 • npojţojraara, KoMnpeccHH rpyzmon mencH c HacToroH a r 100 mo
120/m hh.
• KoMnpeccHH h AeKOMnpeccHH rpyzKHOH mencH jaxK H u laifft-
Man> pasHoe BpeMx.
• KoMnpeccHH rpyzmoH KJienaf hcooxoahm o co^erarb c HCxyccTBe»-
HbIMH BHOXaMM («B30 pTa BpOT», <0130 p ia B HOO», «H30 p ia BTpaXC-
ocTOMy»). IT ocjie 3 0 KoMnpeccHH o n p m ^uxaie>n>Bue n y m , r a r
6mjio oimcaHO su m e :
• 3a3KaxB KpBun>x H oca 6 qjii>iiihm h yKa3arejiBHUM n a n u ţa n ii p y ra ,
pacnojio^ceHHOH Ha Ji6y.
• Otkpmti»poT, noTţrsTHBasi no^Oopo^oic.
• Cflenan. HopMajiBHUH baox m hjiotho oxBanm» cbohmh ry6aMH
por nocTpa^aemero.
• IIpOH3BecTH paBHOMepHUH b aox b TeneHHe 1 c a , Ha6.HQaai npH
3tom 3a nQABCMOM rpyoHOH KJienaf, n o c o o tb c t CTB\eT ju x a -
TejibHOMy o6x>eMy okojio 5 0 0 -6 0 0 mji (npH3Hax a şşssiE B H o ro
BTţoxa); H36erarb 4>opcHpoBam ujx baoxob.
• IIoAAepxcHBax w xarenbH ue nyra anqpumnfH, npHUOAHXTi»
cbok> rojiOBy h HaSmoAsn» 3a TeM, xax rpym aa m enea onycxa-
erex Ha BMAOxe.
• IIpHHXTb pemeHHe: ecjm n e p stm h ck y cctb ch h u h b aox OEa3an -
cx HeacJ^eKTHBHBiM, nepeA cjieAyK>mHM baoxom h co 6 xoahm o
yzţajiHTB HHopoAHwe xen a H30 pra naimeHTa. npoBepnm» aACK-
BaTHOcrb OTKpMBaHHx AMXBTejiBHux nyreiL He cneAyer Aenan»
6ojiee 2-x n onu roK HCKyccTBeHHux baoxob.
• C flenan. en ţe o a h h HcicyccTBeHHtiH baox. B cero hcooxoahm o
CAcnarb 2 HCKyccTBeHHux BAOxa, K oropue a o iek h u 3aHxn> He
6ojiee 5 cex.
PeaHHMaiţHOHHbie M eponpH xm x npexpanţaiOT toabkd npn npH sea-
hhh hx aOcoanoTHO 6 ecnepcneKTHBHUMH hjih KOHcrarraitHH O hojiofh-
XeCKOHCMepTH npH He3<^4>eKTHBHOCTH peaHHMaHHOHHUX MeponpH-
sth h b TeqeHHe 30 MHHyr.
AjiropHTM Hcnojii>30BaHHx aBTOMBTMh e c ko ro H apyxH oro
Ae<^H6 pHJUurropa (AH^Q
Haraan» 6a30B ue peaHHMauHOHHue M eponpHxrax (BPM ) n o odh-
caHHOMy BBirne ajrropHTMy. E cim cnacareni» oahh, h b pacnopxxeHHH

105 «a
 yjKe HMeeTCa AH# — HanaTb BPM c Hcnojib30BaHHH AH# — bkjiio.
HHTbA H# h HajiojKHTf, aneicrpo/ibi Ha rpyzmyio wiency nocrpaaaBiiiero
(Phc 10.9.).
IIpH H3JIHHHH BTOpOTO CnacaTeJW BO BpeMH HaJIOXCeHHH 3JieKrpO,flOB
cjieAyeT npoflOJiacaTb HenpepbiBHbie KOMnpeccHH rpyzjHOH kjictkh; aa-
jiee cjieaoBaTb ronocoBbiM h BH3yajibHMM KOManziaM AH#:
• YOeaHTbca, hto bo BpeMa aHajiH3a pHTMa hhkto He npHKacaerca k
nocTpaaaBineMy— 3to mo5kct HapyniHTb ajiropHTM aHamm pHTMa;
aBTOMaTHHeCKHH Hapy5KHbIH ae4>H^PHJUMT0P npOBOaHT aBTOM3TH-
3HpoBaHHbra aHajiH3 pHTMa nocTpaaaBmero no cneunajibHO pa3pa-
OoTaHHOMy KOMnbKxrepHOMy ajiropHmy: <X>)Kh )KT 6e3 nynbca pac-
no3HaiOTCH KaKpHTMbi, TpeOyionţHe ;xe<|>H6pHJiJumHH.
• Ecjih ae4>H6pHJuiaaHa noKa3ana (O^C hjih 5KT 6e3 nynbca), y6e-
aHTbca, hto hhkto He npHKacaercji k nocTpaaaBHieMy, h Ha»can> Ha
KHomcy (b cjiynae aBTOMaraneCKoro peacHMa pa6oTH AH# nami-
MaTb Ha KHomcy He HyiKHo); nocjie HaHeceHira pa3paaa npoflOJiHarn.
BPM b cooTHomeHHH 30:2 6e3 npoMe^jieHira; TaioKe cjieflOBan» ro-
JIOCOBHMH BH3yaJIbHWM KOMaH^aM A im .
• Ecjih ^e^HOpHjuwiţHH He noKa3aHa (acHCTOJina), npoflOJDKHTb BPM
b cooTHomeHHH 30:2 6e3 npOMe^JieHHH, cjieflOBan* ixmiocobbim h bh-
3yajibHbiM KOMaH^aM AH #.

Puc. 10.9. HanoDKeuue snetcmpodoe AHff

o 106
 AiiropHTM /icmctbmm b c jiy ia e oripe/ie/ienH» pn f via,
n o /uaiom erocfi w i e K i pm hcckoh ae<pn6pujtJtfiuMu
( 0 ) K hjih 2KT 6e3 nyjijbca):
Hanarb CJIP b c o o th o iu c h h h 3 0 :2 . Flpn tm m m uM Kap/woM onuTo-
pa — no^KjnoHHTb e ro k nocTpajaaBuicMy.
Ecjih OK npoH 3o m jia n p n CBHfleTejwx, t o peaHHMaiiHOHHbie Me-
ponpHHTHH M05KH0 HanaTb c HâHCCCHHfi o&noro npeK opjuiajibH oro
yaapa; h b h ccth OTpbiBHCTbifi yzţap n o HUTKHeU n a crn rpyzufHbf c bm-
coth 20 cm JiOKTCBbiM KpacM h jio th o cxeaToro Kyjiaxa.
Pa3p«fl Ne 1. E cjih n o AaHHbiM MOHHTopnHra nojţTBepjicjiacTca
HaJiHHHe 0 )K hjih >KT 6es nyjibca — HaHCcm 1 pa3pa,a (360 J1>k
— npn MOHO^asHOM HMnyjibce, 1 5 0 —2 0 0 — npn 6n(j)a3HOM),
MHHHMH3npya nay3bi Meacjţy npeKpameHHeM KOMnpeccHfi rpyoHOH
kjictkh h HaHecenHCM paspji^a. B cerjţa noMHHTb o 6e3onacHOCTH
cnacaTeji» h OKpymaionţHX np n npoBejţeHHH #e<|>H6pHJiJiauHH!
Cpa3y ace nocjie HaHeceHH* paspjm a, He Tepaa BpeMeHH Ha npo-
Bepicy pHTMa, npojţojDKHTb CJIP 3 0 :2 b TeneHHe 2 -x mhh — «zţaxee
ecJiH nepBbifi paspx# #e(j)H6 pHJunrropa BoccTaHOBHJi HopMajibHbm
pHTM cepjma, HanajibHbie coKpameHHa cepjw a cjihhikom cjia 6 bie h
pejucne, h TpeOyeTCH nojpţepmKa hx H3BHe.
riO C Jie 2-X M HH CJIP O C T aH O B H T bC X H n p O B e p H T b p H T M n o M O H H -
TOpy, saTparaBan Ha 3 to M H H H M a jib H o e BpeMa.
Pa3pa,a N e2. E cjih ch o b b n o a an h mm xapjiHOMOHHTopa BbiaBJiaeT-
ca d>JK hjih JKT 6 e 3 n y jib ca — H a n e c ra
BTopoă p a sp x # ( to h JKe MOuţHOCTH hjih 6 ojibiue) h 6e3 nay3 n p o -
jţojDKHTb CJIP 3 0 :2 b TeneHHe 2 -x m h h .
riOCJie 2-X MHH CJIP OCTaHOBHTbCX H npOBepHTb pHTM n o MOHH-
Topy, 3aTpaHHBaa Ha 3 to MHHHMajibHoe BpeM x.
Pa3pHA Ne3. E cjih CHOBa BbiHBJiaeTCH 03K hjih JKT 6e3 nyjibca
— HaHecTH TpeTHH p a 3 p w ( to h xce m o iuhocth hjih 6ojibme) h 6e3
nay3 npojţojixcHTb CJIP 3 0 :2 b xeneHHe 2 -x mhh. Ilocjie HaHecemix
TpeTbero paspa^a bo3mohcho BBe/ţeHHe jiexapcTB (ajţpeHajiHH 1 Mr,
aMHO^apoH 3 0 0 m t b/b,) napajuiejibHO c npoBejţeHHeM CJIP. Bo Bcex
cjiynaax jyiHTejibHbix peaHHMaiţHOHHbix MeponpHBTHH (6ojiee 3 0
m h h ) jyifl KoppeKHHH aiţH,qo3a, Ha 4>OHe KOToporo 6yzţyT He3<j><}>eK-

thbhm jipyrne JieicapcTBeHHbie npenapaTbi, b b o ah tb 6HKap6oHaT Ha-

TpH* b/b.
107 a
 .Zţajiee — oueHHBaTb phtm cepAUa no KapAHOMOHHTOpy league 2
mhh. ripn coxpaneHHH 0>K hjih >KT 6e3 n y jib c a — npoAouacarb no
onncaHHOMy aJiropHTMy, bboahtb a^ p eH aju m no 1 M r b/b, icaxcowe 3~5
mhh AO BOCCTaHOBJieHHn cnoHTaHHoro KpoBoo6pameHHH.
IlpH pa3BHTHH acHCTOJiHH — cm. AnTOpHTM achctbhh b cjiynae
onpeAejieHHa pHTMa, He noAAaioiuerocH ac4)h 6 phjuwuhh .
IlpH BblBBJieHHH no MOHHTOpy 0praHH30BaHH0r0 pHTMa cep Ana hjih
nOHBJieHHH npH3HaKOB BOCCTaHOBJieHHH cnoHTaHHoro KpOBOOGpauie-
hhh (ABHHceHHH, HopMaJibHoe AkixaHHc, Kamejib)— nonbiTaTbCH najib-
nnpoBaTb nyjibc Ha MaracTpajibHOH aprepHH. IlpH HajiHHHH nynbca—
HanaTb Jieneime no aJiropHTMy nocTpeaHHMaiţaoHHoro nepHQzţa. IlpH
coMHeHHH o HajiHHHH nyjibca — npOAOJiacHTb CJIP 30:2.

OnncaHHbie KpHTHHCCKHe COCTOHHHH, B03HHKatCLIIHe B CTOMaTOJIO-

rnnecKOH npaKTHKe (icaic aMOynaropHoii, Tax h rocimTajibHoii) npe^-
CTaBJIHIOT C0 6 0 H CJIOHCHOe COHeTaHHe H B3aHMOACHCTBHe JIHHHOCTH
Bpana, jih h h o cth nauneHTa, MopajibHo-aTHnecKoro coctohhhh o6 me-
CTBa, ero 3KOHOMHHecKoro h connajibHoro 6 jiaronojiyhhh.
KanecTBO mcahihihckoh noMonjH 3aBHCHT o t HecKOJibKHX (JjaicropoB:
• 3HaHHH h yMeHHH Bpanen h mcahhhhckhx cecTep.
• OpraHH3aiţHH h ocHameHHOCTH MeAHiţHHCicoro nponecca.
• IIpaBOBOH KyjibTypbi MeAHiţHHcicoro nepcoHajia.
• OOmeM KyjibTypbi Bpana.
Bpan — oco6aa jih h h o ctb . B CHJiy ero npocjjeccHH oh AOJiaceH o6-
jia^aTb o c o S b i M H KanecTBaMH npoiJieccHOHajibHoro h MopajibHO-anrae-
cKoro yKJiana. Oh MoaceT h aojihcch Aejian» Ao6po, h o MoaceT nejiaib
h 3Jio. He noTOMy h to oh 3Toro cnennajibHO xoneT, a b CHJiy cjiojkhb-
meHCH cmyaiţHH. H 3Ta CHTyatţHH Ha3braaeTca ^[TPOrEHHS. TepMHH
«HTporeHHH» (rpen. Iatros — Bpan, genes — nopoacAaeMbift) 03H anaeT
«Bbi3BaHHoe BpanoM». Bo Bee BpeMeHa Bpan 6bui oSjieneH oco6hm ao-
BepneM oSnţecTBa. E ojibhoh nenoBeic c HaAeacAOH oGpamaeTca k Bpany.
Oh Hiu;eT y Hero cnaceHHH. O t oOmeHHH Bpana c Sojibhum 3BBHcht
oneHb MHoroe h , npeacAe scero, — AOBepne 6ojibHoro.
«Si Bepio, h to HacTaHeT achb, xorna 6 ojh»hoh HeH3BecTHO neM nejio-
seK OTAacTca b pyKH (J)h3hkob. He cnpaniHBaa ero hh o neM, 3th (J»H3hkh
C3 » 108
I
^ B&Hfyr y »cro tcpoBb, BMBcxyr kzkuc^ to nocroanHue h nepCMHoxzr
fts ojm «a apyryio. 3areM, CBcpMBumcb c ra6mwtft, ohh buhchm cro
oBHoft-CAHHCTBCHHoft tinnioncto. M bc& jkc, ccjîh %lafiostao, to o6 pa-
atycb k m m uy-m fy/m crapoMy jeMCWMy Bp»ty. Oh bjhixhct m hchm
yromuM mm% nomynaer m m tkhbvt, npftnoxm k aonancaM aocotsoft
mmole h Bucjjymaer Mem. Oh KawjMHer, pactcypm e&cm Tpytfcy, no -
Tptr noflooponoK h yjjuâHdrca Mne, hto6m nynwe yio m m moso 6 ojib.
PasyMeerca, a socxmwtocb HayKofi. Ho a m em tm w eb h Myapocrwo..,
EflfMCTBCHHaa Hacroauxaa pocm uib — 3 to p o cico u ib H eaoB enecicoro 0 6 -
weHHa» (A. %e Cem~3mfonepft, 1970),
HcKyccTBO oOmeHH* Bpana c 6o/h>hmm BoemnuBaeTex Tpaamowi-
mh, Kynvrypofi, MoparibHUMH h 3thhockhmh ycrcwMH oOmecTBa.
lIowMy mu roBopuM 0 6 rroM? OoroMy hto mhofhx kphthhcckhx
cocroamfi moxho H36e*carb, ecim npasiuibHO nocrpoim» cboh otho-
memw c 6 o;ji>HMM h no/iyHHTb or Hero MaKCHMajibHyio aHaMHecTH-
necKyio HHcJjopMauHK). H a ocH oaaH H H npo$eccHOHajn»m>ix 3HaHHH h
onwTa BuOpan» oiiTHMajibHbift bha noMomn (^HaraocmHecKOH h Jie-
TmarejibHuft KOHTpojib 3a coctoahhcm OojibHoro bo BpeMa h
nocae BMeuiareabCTBa h ocMbicjieHHe nojiyaaeMofi HH^opMaiţmî. 3 to
i t caaraeMue, KOTOpwe Moryr npeaoTBparHTb MHorae HTporeHHue oc-
aa»HeHHB.
 eunepmoHuueacou Gojicjumo e ycnoewtx aMbynamopHozo cmoMamonozunecKozo
npucMa / / Mamepuwibi BcepoccuucKou Koncpepemjuu «Kapduanozwi e XXI eeke:
mpaduifuu u UHHoeatfUU» u Meoicdynapodnozo (popyma Monodtax Kapduonozoe
Poccuuckozo mpduojiozunecKozo oduţecmea, CdopnuK mejucoe. —2016. - C.
104-105.
29. TIpoKonbee FT., Muxenbcon B.A., Azaeejifm 3.F, Cudopoe B.A. CoepeMenmie
83ZJwdbi na cundpoM viOKauecmeeunou zunepmepMuu. Medutfuna neorruioMcnux
cocmoRHuu. - 2011. - N 7-8. - C. 73-79).
30. B.B. PyKcuH HeomnootcHciH KapduonozuH «Heeacuu duanexm», 1998 z.
31. ff. CnpuzuHzc, flote. ^îcmQepc Dncmpenuan Meditijima —duaznocmuKa u nenemte
HeomnootCHbix cocmomuu, Mocnea, 2006 z.
32. B.M. Cedoe HmpozenuH CIIB. Ihd. «Henoeen», 2010
33. CmoeaXC.M., IUuxE.B., BaunopoeMJ(. u dp. IIojiunpazMa3UH u jieKapcmeeHHue
63auModeucmeun npu neuenuu KOMopâudubix OojibHbtx apmepuanbHOU
zunepmoHueu e aMâyjiamopHO-nomiKjiuHimecKOU npatanuKe / / IJojiwoiuHUKa. -
2015. -N o 1-2. - C. 13-15.
34. HasoeE.M., PexoMendaifuii no duazHocmuKe unenemiio A r// Kapduonozuuecmu
eecntHUK. - 2015. -N sl. - C. 8-12.
35. Kaplan RF: Malignant hyperthermia, ASA Refresher Courses in Anesthesiology,
Philadelphia, 1994, JB Lippincott Co.
36. Ording H: Incidence o f malignant hyperthermia in Denmark, Anesth Analg
64:700-704, 1985
37. WingardDW: A stressful situation [Editorial], Anesth Analg 59:321, 1980.
38. Williams CH, Lasley JH: The mode o f inheritance o f the fulminant hyperthermia
stress syndrome in swine. In Henschel EO, ed: Malignant hyperthermia: current
concepts. New York, 1977, Appleton-Century-Crofts, p.141.
39. Schulman S: Malignant hyperthermia and pediatric anesthesia, Semin Anesth
12:54-64,1993.
40. Heiman-Pattersohn TH, Natter H, Rosenberg H, et al: Malignant hyperthermia
susceptibility in x-linked muscle dystrophies, Pediatr Neurol 2:356,1987.
41. Malamed Stanley F. Handbook o f Local Anesthesia, 6-th edition. St Louis: Mosby,
2013.
42. Facco E. Hipnosis in dentistry. - EFAAD congress. - Padua, Italy. - 2014.
43. Matsuura H. Analysis o f systemic complications and deaths during dental
treatment in Japan. - Anesthesia Progress 36:219-228. -1990.

o 112
 CKAHflM
HMBCA

COBPEMEHHbIM
f lo c T y n H b m ahectetmk
\ m f EBPOIIEI/ICKOrO KAHECTBA
V He coAepwMT 3flTA m napa6eHOB —He Bbi3biaaeT
an/ieprMMecKMX peaKunn
\ / rioAXOAHT Ann ncno/ib30BaHnn y nauneHTOB rpynnw
HI pMCKa°
H V fc a * y H3roTaB/inBaeTcn b coorBercreMM co craHAapTaMMGMP,
eBponeMCKOM C>apMaKonen m IS 0 13408 (acerrnmecKoe
<
n P mH ^ P 9 E | 1| npOM3BOACTBO
a I ifi I E 3|
nW Kp nU
/ lip O X O A M T 3 - 3 T a riH b lM aB T O M aT M 3M pO B 3H H blH K O H T pO H b

1 o K l K 3 M eC T B 3 H a n p O M 3 B O A C T B e

uH i h M £ | Ct I k I / 0 6 e c n e M H B a e T 6 b i c r p o e H a c T y n n e H n e n p o A O /iw M T e /ib H o ro
fe I > AeMCTBMB aHecTe3npyiomero atţxfceiora
K J j\
\ Iji xIU B ill \ y M e te e T u e e T O B o e n o / i b n o H a x a p n y n e
MAeHTM<j>MKauMMcoAepwaHnn aApeHanHHa
yA o6H O w

0 ■ [ p n *npx tcft—iiwnii J90

^ I V ** n T i fjapgrrt - rr*- ~ - -• npKCiftWW’t
cmpkw j»+om
mnmvcj '*

COO« ® A ? M -i:/? . 105005 Moocaa, hs5. Aicafle*iwca Tynoneaa, 15 crp. 2. BLlTyno/iee ri/»3a PHARMACIA
***•£» ■
vwciy4.com
 Q ţa H O b H a6op 11.05.2017
IloflnMcaHO b nenaTb 19.07.2017
OopM aT 148x210 mm.
ByMara MenoBaHHaa MaTOBan 90 iYm2.
TapHMTypa «Times New Roman». IleHaTb o^ceraaB
Yai. nen. n. 6,7425. Twpa^c 1000 3K3.
GrynHfi C.PoroBa,
127106, MocKBa, Foctmhmhhmm npoe3jţ, fl.8, Kopn. 1
 I Eo6pHHCKasi Mpmia rcopi HtBiia, r. MocKBa
I JţoKTop mcahuhhckhx HayK, npocţieccop KaiJjeApw anecTciHoaorH-
I H-peaHHMaToaorHH OTEOY BO MTMCY hm. A.H. EaaoKHMOBa.
Boaee 50 acT 3aHHMaeTca BonpocaMH o6e36oaHBaHH* aMGyaarop*
hbix BMemaTejibCTB, b tom HHcae h CTOMaraaonmecKHx; hhtchchb-
I hoh TepanHH tjokcjioh coHeTaHHOfi TpaBMW, BKJiKwafl luoKOBbie;
I aenenHeM ocTpoH KpoBonorepn npH onepaTHBHux BMemareab-
ctbbx; oco6chhocthmh coctohhha KpoBOoGpamenHa npa BuyrpH-
OpiomHOH ranepTeH3HH; HapyiueHHBMH BOAHOoaeKTpoaHTHoro GaaaHca npH kphthhc-
ckhx cocToxHHax. ilBJiBeTCH aBTopoM 6ojiee 270 ny6jiHKauHH, yneOHUx h mctoahhcckhx
nocoOHH.

C oxob C e p r e fi TaaycTaHOBHH, r. M o c k b s

I.Koicrop mcahuhhckhx Hayx, ripo(|)eccop Ka^eapu o6e36ojiHBaHiu b

CTOMaToaorHH OTEOY BO MTMCY hm. A.H. Ebaokhmob3, Bpau
IcTOMaTOJior-xHpypr. ^BJwexcH hjichom BceMHpnoH 4>eaepauHH
|cTOMaTOJioroB-aHecTe3HoaoroB (IFDAS), pyKOBOAHrcab Pocchh-
Ickoh cckuhh EBponeficKOH (JjeAepauHH no H3yHeHino o6e36ouHBa-
|h h h b CTOMaTOJiorHH(IFAAD), npe3HAOHTcckuhh o6e36oJiHBaHHB h
OKa3aHHH HeoraoxcHOH noMOiuH CTAP.
O kduo 40 a e r 3aHHMaeTca npo6aeMaMH MecTHoro o6e36ojiHBaHHa b croM aroaoniH ,
opraHH3auHeH CTOMaroaorHuecKOH noMOiuH. .flBaaeTca aBTopoM6oaee 170 nyOaHKaunii
b poccHHCKOH h 3apy6e>KHOH ncHaTH, 6oaee 40 naTeHTOB h aBTopcKHX CBHAereabCTB Ha
H3o6pereHHH, 6oaee 10 MOHorpa^HH.

AHHCHMOBa EBreHHH HnKOJiaeBna, r. MocKBa

KaHWiaaT mcahuhhckhx Hayx, aoucht Ka^eapw o6e36oaHBaHHH b
CTOMaroaorHH <t>TEOY BO MTMCY hm. A.H. Ebaokhmobb,
npaKTHKyioiuHH Bpau-croM aToaor. JIsaaeTca h j i c h o m Bccmhphoh
4>eAepauHH croMaToaoroB-aHecTe3HoaoroB (IFDAS), EBponeficKOH
4>eAepauHH no H3yneHHK) o6e36oaHBaHHa b CTOMamnonm
(IFAAD), BHue-npe3HA6HT cckuhh o6e36onHBaHHa h OKa3aHHa
HeoraoacHOH noMomw CTAP.
Boaee 25-th aer 3aHHMaeTca BonpocaMH H3yueHHa h pa3pa6onai
coBpeMeHHbix 3(J)(j)eKTHBHbix h 6e3onacHbix MeroAOB h cpcactb MecTHoro o6e36oaHBa-
hhb, b tom HHCJie y nauHeHTOB c conyTCTByioiueH naToaorneH, xax npo4>HaaicrHKH
HeoTJiojKHbix cocTOSHHH b aM6yjiaTopHoii CTOMaToaorHH. ^BJiaeTca aBTopoM 6oaee 250
nyOaHKauHH, 15 naTeirroB Ha H3o6pereHHa, yueOHHX h mctoahhcckhx noco6HH,
KOMnbioTepHbix oOynaioiuHx uporpaMM, MOHorpacJmH.

ISBN 978-5 -4 4 6 5 -1 5 4 1 -7

MOCKBA
2017
9 785446 515417 >