À.À. ÌÀÐ×ÅÍÊÎ, À.Ã. ÑÎÍÈÑ, È.Í. ÞÐ×ÅÍÊÎ ÏÐÎÔÈËÀÊÒÈÊÀ ÑÈÍÄÐÎÌÀ ÎÑÒÐÎÃÎ ÏÎÂÐÅÆÄÅÍÈß ÆÅËÓÄÊÀ

ÓÄÊ 616.33-002.44/.446:617-089-022]-084
À.À. ÌÀÐ×ÅÍÊÎ, À.Ã. ÑÎÍÈÑ, È.Í. ÞÐ×ÅÍÊÎ
Ñàìàðñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò
ÏÐÎÔÈËÀÊÒÈÊÀ ÑÈÍÄÐÎÌÀ ÎÑÒÐÎÃÎ ÏÎÂÐÅÆÄÅÍÈß ÆÅËÓÄÊÀ
Ó ÏÀÖÈÅÍÒΠÃÍÎÉÍÎ-ÕÈÐÓÐÃÈ×ÅÑÊÎÃÎ ÑÒÀÖÈÎÍÀÐÀ
 ñòàòüå ïðèâåäåí àíàëèç ëèòåðàòóðíûõ äàííûõ ïî ôàêòîðàì ðèñêà ðàçâèòèÿ îñòðûõ
ýðîçèâíî-ÿçâåííûõ ïîâðåæäåíèé âåðõíèõ îòäåëîâ æåëóäî÷íî-êèøå÷íîãî òðàêòà ó áîëüíûõ ãíîéíî-õèðóðãè÷åñêîãî ñòàöèîíàðà. Ïðåäñòàâëåíû ðåçóëüòàòû ñîáñòâåííûõ èññëåäîâàíèé äàííîé ïðîáëåìû.
Êëþ÷åâûå ñëîâà: ñòðåññîâûå ÿçâû, ñèíäðîì îñòðîãî ïîâðåæäåíèÿ æåëóäêà, æåëóäî÷íîå êðîâîòå÷åíèå, õèðóðãè÷åñêàÿ èíôåêöèÿ
Ìàð÷åíêî Àíòîí Àëåêñàíäðîâè÷ - âðà÷-õèðóðã õèðóðãè÷åñêîãî îòäåëåíèÿ ¹2 êëèíèêè ïðîïåäåâòè÷åñêîé õèðóðãèè Êëèíèê ÑàìÃÌÓ, àññèñòåíò êàôåäðû îáùåé õèðóðãèè, âðà÷ýíäîñêîïèñò ýíäîñêîïè÷åñêîãî îòäåëåíèÿ Êëèíèê ÑàìÃÌÓ. E-mail: a.a.marchenko1985@yandex.ru
Ñîíèñ Àëåêñàíäð Ãðèãîðüåâè÷ - ä.ì.í., äîöåíò, çàâåäóþùèé êàôåäðîé îáùåé õèðóðãèè.
E-mail: sonis_ag@mail.ru
Þð÷åíêî Èðèíà Íèêîëàåâíà - ê.ì.í., çàâåäóþùàÿ ýíäîñêîïè÷åñêèì îòäåëåíèåì Êëèíèê
ÑàìÃÌÓ, äîöåíò êàôåäðû ôàêóëüòåòñêîé òåðàïèè. E-mail: in-samendo@mail.ru
A.A. MARCHENKO, A.G. SONIS, I.N. YURCHENKO
Samara State Medical University
PREVENTION OF SYNDROME OF ACUTE LESION OF THE STOMACH
IN PATIENTS OF PURULENT SURGICAL DEPARTMENT
The article presents the analysis of published data on the risk factors for development of
acute erosive-ulcerative lesions of the upper gastrointestinal tract in patients of purulent
surgical department. The results of the own research of this problem are presented.
Keywords: stress ulcers, syndrome of acute lesion of the stomach, gastric bleeding,
surgical infection
Anton Marchenko - surgeon of the Surgical Department ¹2 of propaedeutic surgery clinic of
SSMU, assistant at the Department of General surgery, endoscopist of the Endoscopic Department of
SSMU Clinics, E-mail: a.a.marchenko1985@yandex.ru
Alexandr Sonis - doctor of Medical Sciences, Professor, Head of the Department of General surgery,
E-mail: sonis_ag@mail.ru
Irina Yurchenko - candidate of Medical Sciences, Head of the Endoscopy Department of SSMU
Clinics, associate professor at the Department of faculty therapy, E-mail: in-samendo@mail.ru
Ñèíäðîì îñòðîãî ïîâðåæäåíèÿ æåëóäêà (ÑÎÆÏ) – ýòî ïîâðåæäåíèå ñëèçèñòîé
îáîëî÷êè æåëóäêà è äâåíàäöàòèïåðñòíîé
êèøêè (ÄÏÊ), âîçíèêàþùåå ïðè íàðóøåíèè ôàêòîðîâ çàùèòû ó áîëüíûõ, íàõîäÿùèõñÿ â êðèòè÷åñêèõ ñîñòîÿíèÿõ [2]. Äëÿ
ïàöèåíòîâ, íå íàõîäÿùèõñÿ â êðèòè÷åñêèõ ñîñòîÿíèÿõ, ïðèíÿò òåðìèí «ñòðåññîâûå ÿçâû».  ïîñëåäíåå âðåìÿ îòìå÷àåòñÿ ïîñòåïåííîå ñëèÿíèå óêàçàííûõ
òåðìèíîâ. Äëÿ äàííîé ïàòîëîãèè òèïè÷íî áûñòðîå, â òå÷åíèå íåñêîëüêèõ äíåé
è äàæå ÷àñîâ, èõ âîçíèêíîâåíèå è ñòîëü
æå áûñòðîå çàæèâëåíèå ïîñëå óñòðàíåíèÿ ýòèîëîãè÷åñêèõ ôàêòîðîâ, à òàêæå
íåòèïè÷íàÿ êëèíè÷åñêàÿ êàðòèíà (ñòåðòîñòü áîëåâîãî ñèíäðîìà, îòñóòñòâèå ñåçîíí îñòè è ò.ä.). Íàèáîëåå îïàñíûì è
÷àñòûì îñëîæíåíèåì ÑÎÆÏ ÿâëÿþòñÿ
æåëóäî÷íî-êèøå÷íûå êðîâîòå÷åíèÿ, ëåòàëüíîñòü ïðè êîòîðûõ äîñòèãàåò 5% [3,
4, 5, 8, 9,10].
Öåëü èññëåäîâàíèÿ: óñòàíîâèòü
íàèáîëåå ÷àñòûå ïðè÷èíû ðàçâèòèÿ
æåëóäî÷íî-êèøå÷íûõ êðîâîòå÷åíèé ó ïàöèåíòîâ îòäåëåíèÿ ãíîéíîé õèðóðãèè è
âíåäðèòü â ïðàêòèêó ìåðû ïðîôèëàêòèêè ÑÎÆÏ.
Ìàòåðèàëû è ìåòîäû
Çà 2010–2012 ãîäû âûïîëíåí ðåòðîñïåêòèâíûé àíàëèç èñòîðèé áîëåçíè ïàöèåíòîâ, íàõîäèâøèõñÿ íà ëå÷åíèè â îòäåëåíèè ïðîïåäåâòè÷åñêîé õèðóðãèè
Êëèíèê Ñàìàðñêîãî ãîñóäàðñòâåííîãî
ìåäèöèíñêîãî óíèâåðñèòåòà ïî ïðîôèëþ «õèðóðãè÷åñêàÿ èíôåêöèÿ», êîòîðûì â
ýêñòðåííîì ïîðÿäêå áûëà âûïîëíåíà ýçîôàãîãàñòðîäóîäåíîñêîïèÿ (ÝÃÄÑ) è äèà-
Àñïèðàíòñêèé âåñòíèê Ïîâîëæüÿ ¹ 5-6, 2015. ×àñòü I
137
ãíîñòèðîâàí ÑÎÆÏ. Ó ïàöèåíòîâ áûëè
âûÿâëåíû ôàêòîðû ðèñêà ðàçâèòèÿ äàííîé ïàòîëîãèè. Çà 2013-2014 ãîäû îáñëåäîâàíû 64 ïàöèåíòà, ó êîòîðûõ âûÿâëåíû âûøå îáîçíà÷åííûå ôàêòîðû ðèñêà.
Äàííîé êàòåãîðèè áîëüíûõ, â êà÷åñòâå
äîïîëíèòåëüíîãî ìåòîäà èññëåäîâàíèÿ,
áûëà âûïîëíåíà ÝÃÄÑ, à òàêæå â õîäå ëå÷åíèÿ áûë ïðèìåíåí ñòàíäàðòíûé ïðîòîêîë ïðîôèëàêòèêè ðàçâèòèÿ ÑÎÆÏ ñ
äîïîëíåíèÿìè.
Ðåçóëüòàòû è îáñóæäåíèå
Âî âðåìÿ èçó÷åíèÿ èñòîðèé áîëåçíè
ìû îáðàòèëè âíèìàíèå íà òîò ôàêò, ÷òî
çà 2010-2012 ãã. ïðîèçîøåë ðîñò êîëè÷åñòâà ñëó÷àåâ âîçíèêíîâåíèÿ æåëóäî÷íîêèøå÷íûõ êðîâîòå÷åíèé (ÆÊÊ) ó ïàöèåíòîâ ñ ãíîéíî-õèðóðãè÷åñêîé ïàòîëîãèåé, â òî âðåìÿ êàê îáùåå êîëè÷åñòâî ïðîëå÷åííûõ â îòäåëåíèè ïàöèåíòîâ îñòàâàëîñü ïðèìåðíî îäèíàêîâûì èç ãîäà â ãîä è
ñîñòàâèëî 742±12 ÷åëîâåêà. Òàê, îñíîâûâàÿñü íà äàííûõ ñîáñòâåííûõ èññëåäîâàíèé,
çà ïåðèîä ñ 2007 ïî 2009 ãã. êîëè÷åñòâî
ýïèçîäîâ ðàçâèòèÿ ÆÊÊ íå ïðåâûøàëî 5
â ãîä.  àáñîëþòíîì áîëüøèíñòâå ñëó÷àåâ, êðîâîòå÷åíèå âîçíèêàëî íà ôîíå ñåïñèñà.  ñâîþ î÷åðåäü, ñ 2010 ïî 2012 ãã. îòìå÷àëñÿ ðîñò êîëè÷åñòâà êðîâîòå÷åíèé äî
8±2 ñëó÷àåâ â ãîä. Îáùåå êîëè÷åñòâî ïàöèåíòîâ çà ýòîò ïåðèîä, ó êîòîðûõ ïî äàííûì
ÔÃÄÑ áûëè âåðèôèöèðîâàíû ïîðàæåíèÿ
âåðõíèõ îòäåëîâ æåëóäî÷íî-êèøå÷íîãî
òðàêòà, ïîòåíöèàëüíî îïàñíûõ â ïëàíå
ðàçâèòèÿ æåëóäî÷íî-êèøå÷íîãî êðîâîòå÷åíèÿ, ñîñòàâèëî 33 ÷åëîâåêà.  ñòðóêòóðå äèàãíîçîâ, âûÿâëåííûõ ïðè ýíäîñêîïè÷åñêîì îáñëåäîâàíèè, âåäóùèìè áûëè
ÿçâåííûå ïîðàæåíèÿ – 16 ñëó÷àåâ, íà âòîðîì ìåñòå ýðîçèâíûå ïîðàæåíèÿ ÆÊÒ – 9
ñëó÷àåâ, è â 8 ñëó÷àÿõ âûÿâëåíà äðóãàÿ ïàòîëîãèÿ (ãåìîððàãè÷åñêèé ãàñòðèò, ðàñïàäàþùàÿñÿ îïóõîëü æåëóäêà è ò.ä.).
Ïî ïðè÷èíàì ãîñïèòàëèçàöèè â ñòàöèîíàð ïàöèåíòû áûëè ðàñïðåäåëåíû ñëåäóþùèì îáðàçîì: 12 ÷åëîâåê áûëè ãîñïèòàëèçèðîâàíû ñ äèàãíîçîì îáëèòåðèðóþùèé àòåðîñêëåðîç í/ê III – IVá ñò., êîãäà âûïîëíåíèå ðåêîíñòðóêòèâíîé îïåðàöèè áûëî íåâîçìîæíî è èìåëîñü îñëîæíåíèå â âèäå ðàíåâîé èíôåêöèè, 7 ÷åëîâåê ñ äèàãíîçîì ñåïñèñ, 5 ÷åëîâåê ñî ñâèùåâîé ôîðìîé îñòåîìèåëèòà, 3 ÷åëîâåêà
ñ ñàõàðíûì äèàáåòîì (íåéðîïàòè÷åñêàÿ
ôîðìà ñèíäðîìà äèàáåòè÷åñêîé ñòîïû) è
4 ÷åëîâåêà ñ èíûìè çàáîëåâàíèÿìè (ãíîéíûå çàáîëåâàíèÿ ìÿãêèõ òêàíåé). Ñðåäíèé âîçðàñò áîëüíûõ ñîñòàâëÿë 65±5 ëåò.
Áîëüøîå êîëè÷åñòâî ïàöèåíòîâ ñ àòåðîñêëåðîçîì ìîæíî îáúÿñíèòü ñëåäóþùèì îáðàçîì: ïîñëå èçó÷åíèÿ ëèòåðàòóðíûõ äàííûõ áûëî âûÿñíåíî, ÷òî â âîçðàñ-
138
òå 65±5 ëåò â 92% ñëó÷àåâ íàáëþäàåòñÿ
ìóëüòèôîêàëüíûé àòåðîñêëåðîç, ñ ñî÷åòàíèåì 2-õ è áîëåå ôîðì, à ó 62,7% ïàöèåíòîâ àáäîìèíàëüíàÿ èøåìèÿ ïðîòåêàåò
áåññèìïòîìíî [7]. Òàêèì îáðàçîì, êðàéíå
âûñîêà âåðîÿòíîñòü ñî÷åòàíèÿ îáëèòåðèðóþùåãî àòåðîñêëåðîçà íèæíèõ êîíå÷íîñòåé ñ ñèíäðîìîì àáäîìèíàëüíîé èøåìèè, è êàê ñëåäñòâèå – íàëè÷èå ó ïàöèåíòîâ ýðîçèâíî-ÿçâåííûõ äåôåêòîâ â ÆÊÒ.
Åùå îäíèì ôàêòîðîì, âëèÿþùèì
íà ÷àñòîòó âîçíèêíîâåíèÿ ýðîçèâíîÿçâåííûõ ïîðàæåíèé ó ïàöèåíòîâ ñ õèðóðãè÷åñêîé ãíîéíî-ñåïòè÷åñêîé ïàòîëîãèåé, ÿâëÿåòñÿ áåñêîíòðîëüíîå óïîòðåáëåíèå îáåçáîëèâàþùèõ ïðåïàðàòîâ, îòíîñÿùèõñÿ ê ãðóïïå íåñòåðîèäíûõ ïðîòèâîâîñïàëèòåëüíûõ ñðåäñòâ (ÍÏÂÑ).
Äëèòåëüíûé ïðèåì ÍÏÂÑ áûë îòìå÷åí â
65% ñëó÷àåâ ðàçâèòèÿ îñëîæíåíèé ñî ñòîðîíû âåðõíèõ îòäåëîâ ÆÊÒ è â 60% ñëó÷àåâ ðàçâèòèÿ æåëóäî÷íî-êèøå÷íûõ êðîâîòå÷åíèé. Ïî äàííûì çàðóáåæíûõ ýêñïåðòîâ, èñïîëüçîâàíèå â ìåäèöèíñêèõ
öåëÿõ îïèîèäñîäåðæàùèõ àíàëüãåòè÷åñêèõ ñðåäñòâ â ìèðå (â ïåðåñ÷¸òå íà ìîðôèí â êèëîãðàììàõ íà îäèí ìèëëèîí íàñåëåíèÿ) ïðåäñòàâëåíî ñëåäóþùèì îáðàçîì: Êàíàäà – 57,9 êã, Çàïàäíàÿ Åâðîïà è
ÑØÀ – îêîëî 32 êã, Ðîññèÿ – 0,5 êã [6]. Âñ¸
ýòî âëå÷¸ò çà ñîáîé ðåçêîå óâåëè÷åíèå ó
ïàöèåíòîâ êîëè÷åñòâà ýïèçîäîâ ðàçâèòèÿ àññîöèèðîâàííûõ ñ ïðèåìîì äàííûõ ïðåïàðàòîâ ýðîçèâíî-ÿçâåííûõ ïîðàæåíèé ÆÊÒ.
 ñëó÷àÿõ, êîãäà ýðîçèâíî-ÿçâåííûå
ïîðàæåíèÿ ðàçâèâàëèñü íå íà ôîíå ñåïñèñà è îáëèòåðèðóþùåãî àòåðîñêëåðîçà,
âåäóùèì ôàêòîðîì ñòàíîâèëîñü íàëè÷èå
ÿçâåííîé áîëåçíè âåðõíèõ îòäåëîâ ÆÊÒ
â àíàìíåçå.
Ñ 2013 ãîäà â íàøåé êëèíèêå íà÷àëè
ïðèìåíÿòü ðÿä ïðîôèëàêòè÷åñêèõ ìåðîïðèÿòèé äëÿ ïàöèåíòîâ, ïðè îñìîòðå è
îáñëåäîâàíèè êîòîðûõ âûÿâëåíû ôàêòîðû, ïîâûøàþùèå ðèñê ðàçâèòèÿ ÑÎÆÏ.
Êîìïëåêñ âêëþ÷àåò â ñåáÿ îáÿçàòåëüíûé
ïðèåì ïðåïàðàòîâ èç ãðóïïû áëîêàòîðîâ
ïðîòîííîé ïîìïû (ñîîòâåòñòâóåò êëèíè÷åñêîìó ïðîòîêîëó ïðîôèëàêòèêè ñèíäðîìà îñòðîãî ïîâðåæäåíèÿ æåëóäêà ó
áîëüíûõ â êðèòè÷åñêîì ñîñòîÿíèè, Ñàìàðà, 2014) [1], óìåíüøåíèå êîëè÷åñòâà
ïðèìåíåíèÿ ÍÏÂÑ çà ñ÷åò íàçíà÷åíèÿ â
ïîñëåîïåðàöèîííîì ïåðèîäå àíàëüãåòèêîâ èíûõ ãðóïï, ïî âîçìîæíîñòè ñêîðåéøóþ àêòèâèçàöèþ ïàöèåíòîâ.
Âñåãî â 2014 ãîäó â õîäå èññëåäîâàíèÿ
áûëî âûÿâëåíî 64 ïàöèåíòà, ïîïàäàþùèõ
â ãðóïïó ðèñêà ïî ðàçâèòèþ ÑÎÆÏ, 52-ì
èç íèõ âûïîëíåíî ýíäîñêîïè÷åñêîå èññëåäîâàíèå, ÷òî ñîñòàâèëî 81%. Îñòàëü-
Íàó÷íî-èíôîðìàöèîííûé ìåæâóçîâñêèé æóðíàë
íûì 12-òè ïàöèåíòàì (19%) èññëåäîâàíèå
íå âûïîëíÿëîñü â ñâÿçè ñ èõ îòêàçîì, ëèáî
òÿæåñòüþ ñîñòîÿíèÿ.  77% ñëó÷àåâ âûÿâëåíû ñîñòîÿíèÿ, ïîòåíöèàëüíî óãðîæàþùèå ïî ðàçâèòèþ æåëóäî÷íî-êèøå÷íîãî
êðîâîòå÷åíèÿ, â âèäå òåõ èëè èíûõ äåôåêòîâ ñëèçèñòîé âåðõíèõ îòäåëîâ ÆÊÒ, êîòîðûå â 87% (35 ÷åëîâåê) ïðîòåêàëè àáñîëþòíî áåññèìïòîìíî.
 ðåçóëüòàòå, ñ ìîìåíòà íà÷àëà ïðèìåíåíèÿ ìåð ïðîôèëàêòèêè â îòäåëåíèè
ïðîïåäåâòè÷åñêîé õèðóðãèè íàáëþäàëñÿ
ëèøü îäèí ýïèçîä ðàçâèòèÿ ýðîçèâíîÿçâåííîãî æåëóäî÷íî-êèøå÷íîãî êðîâîòå÷åíèÿ èç âåðõíèõ îòäåëîâ æåëóäî÷íîêèøå÷íîãî òðàêòà â ðàííåì ïîñëåîïåðàöèîííîì ïåðèîäå (ìåíåå 24 ÷àñîâ) ó ïàöèåíòà ñ ãåíåðàëèçîâàííûì àòåðîñêëåðîçîì, êîòîðûé áûë êóïèðîâàí êîíñåðâàòèâíûìè ìåòîäàìè.
Âûâîäû
Ñðåäè ïàöèåíòîâ ãíîéíî-õèðóðãè÷åñêîãî ñòàöèîíàðà ðèñê ðàçâèòèÿ ÑÎÆÏ
ïðèñóòñòâóåò ó ïàöèåíòîâ ñ îáëèòåðèðóþùèì àòåðîñêëåðîçîì íèæíèõ êîíå÷íîñòåé, ñàõàðíûì äèàáåòîì, ñåïñèñîì, ëèö
ïîæèëîãî è ñòàð÷åñêîãî âîçðàñòà, ëèö,
ïðèíèìàþùèõ ÍÏÂÑ.
Ðàçâèòèå ÑÎÆÏ ó òàêèõ ïàöèåíòîâ ÷àñòî ñîïðîâîæäàåòñÿ æåëóäî÷î-êèøå÷íûì
êðîâîòå÷åíèåì.
Èñïîëüçîâàíèå ó ïàöèåíòîâ ãðóïïû
ðèñêà ïðåïàðàòîâ èç ãðóïïû èíãèáèòîðîâ
ïðîòîííîé ïîìïû ïîçâîëÿåò äîñòîâåðíî ñíèçèòü ÷àñòîòó æåëóäî÷î-êèøå÷íûõ
êðîâîòå÷åíèé.
Ñïèñîê ëèòåðàòóðû
1. Êîðûìàñîâ Â.À., Ìà÷åõèí Ï.Â., Òðóõàíîâà È.Ã., Ñòàäëåð Â.Â. Êëèíè÷åñêèé ïðîòîêîë
ïðîôèëàêòèêè ñèíäðîìà îñòðîãî ïîâðåæäåíèÿ æåëóäêà ó áîëüíûõ â êðèòè÷åñêîì ñîñòîÿíèè. - Ñàìàðà: ÑàìÃÌÓ, 2014. - l0 ñ.
2. Ãåëüôàíä Á. Ð. Ïðîôèëàêòèêà ñòðåññïîâðåæäåíèé âåðõíåãî îòäåëà æåëóäî÷íîêèøå÷íîãî òðàêòà ó áîëüíûõ â êðèòè÷åñêèõ
ñîñòîÿíèÿõ / Á. Ð. Ãåëüôàíä [è äð.] // Õèðóðãèÿ. Consilium Medicum. 2003. Ïðèë. 2. Ñ. 16–20.
3. Ñòðåêàëîâñêèé Â. Ï. Êðîâîòå÷åíèÿ èç
âåðõíèõ îòäåëîâ æåëóäî÷íî- êèøå÷íîãî òðàêòà ïîñëå îïåðàöèé íà îðãàíàõ áðþøíîé ïîëîñòè / Â. Ï. Ñòðåêàëîâñêèé [è äð.] // Õèðóðãèÿ.
Æóðíàë èì. Í. È. Ïèðîãîâà. 2004. Ò. 8 Ñ. 15– 18.
4. Êóáûøêèí Â. À., Øèøèí Ê.Â. Ýðîçèâíîÿçâåííîå ïîðàæåíèå âåðõíèõ îòäåëîâ æåëóäî÷íîêèøå÷íîãî òðàêòà â ðàííåì ïîñëåîïåðàöèîííîì
ïåðèîäå // Consilium medicum. 2004. ¹ 1. Ñ. 29–32.
5. Õîõîëÿ Â. Ï., Áóðûé À. Í. Ýíäîñêîïè÷åñêàÿ äèàãíîñòèêà îñòðûõ ýðîçèé è ÿçâ æåëóäêà
è äâåíàäöàòèïåðñòíîé êèøêè // Âåñòíèê õèð.
1987. ¹ 7. Ñ. 9–15.
6. Êîëáàñîâà Ò.À. Æèòü áîëüíî… Ñòàòüÿ «Ìåäèöèíñêèé âåñòíèê», 2013. –¹6(619). Ñ.6.
7. Ïîêðîâñêèé À. Â., Êàçàí÷àí Ï. Î. Äèàãíîñòèêà è õèðóðãè÷åñêîå ëå÷åíèå ñèíäðîìà õðîíè÷åñêîé àáäîìèíàëüíîé èøåìèè. Ìåòîä. Ðåêîìåíäàöèè.– Ì., 1980. - Ñ.16.
8. Êîðûòöåâ Â.Ê. Ðàñøèðåíèå îáúåìà îïåðàòèâíîãî âìåøàòåëüñòâà ïðè ïåðôîðàòèâíîé ÿçâå äâåíàäöàòèïåðñòíîé êèøêè // Âåñòíèê õèðóðãèè, 2010. –¹3. – Ñ.99-100.
9. Cook D. J. The attributable mortality and length
of intensive care unit stay of clinically important
gastrointestinal bleeding in critically ill patients /
D. J. Cook [et al.] // Crit Care. 2001. ¹ 5. P. 368–375.
10. Champion G.D, Feng P.H„ Azuma T. et al.
NSAID-induced gastrointestinal damage // Drugs,
1997, 53: 6-19.
Àñïèðàíòñêèé âåñòíèê Ïîâîëæüÿ ¹ 5-6, 2015. ×àñòü I
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