Инфаркт сп ST неосложн 28.06.13

YrnepN4eH
flporoxo:rou 3xcneprnofi xotrtucclru
n0 BorlpooaM pa3BvTIJs' 3ApaBooxpaHeHl4q
c,r 28ltoHs 2013r.
llrrSaprcl
n,IIIoKapAat c IIoAbeNIoM cerMeHTar ST, c
sy6qou Q
(.rpaucuYPaJIbHbIfi)
I BBOAH/\-fl qACTb
l. Hassaune [poroKod.ra: ICluuuqecKl4fi nporoKoJl AI4afHocrrIKIr w re'{e}{I{fl
nnsapxra \,rrroKapAa
(r
roAbeMoM cefMeHra ST,
c,
3y6qoM
(l (rpaucuypa,rrnrrfi)
2. Koa [poloKor'Ia:
3. Koa (-u) NIKE-IO:
I2l - Ocrpr'rfi uu$apxr MI'loKaPIa
I21.0 - Ocrpsrii TparrcMypalrnuii un$apxr nepe4uefi crerIKI{ N{I4oKapAia
I2Ll - Ocrprifi TpaIIcMypaJIbHbII"{ uHSaprr nnxseil: cTeHKI{ MHoKapAa
Ocrptrii rpaHcMypalrHHil nuSapxr
I21.2
MHoICapAil ApyrI'IX yroqHeHHbIX
NOKtIJII43AUI4ft
I2|.3 - Ocrpsrfi rpaHcN{ypa,rrsuii nuQaprr MIroKapAa Heyroqr{eHHoii
I22 - llonropuslfi rarr{rapxr MI4oKapAa
I22.0 - llonropuuii raullapKr rlelleAHefi cresxu MI4oKapAa
I22.1- Ilorrropurrfi nrrlpaprr nzxcnefr creHKr MI4oKapJIa
I22.8 - llon:ropuuil urri[apKT
MI4oKap4a
roKa,'I]r1'3aI-JxtI
4pyroii yrorlHeHHofr :t'cxal}{3anlul4
4. Conpa ttleHllfl r Hc]uoJr[,3yeMl ble B rI poroKor'Ie
Af - aprepuiulbHat rurlePTeH3ntl
AA - aprepaaJILHoe AaBJIeHTIe
:
AKIII - aopro-KopoHapHoe uyHlfl4poBaHlre
AIIT - aJlaHuHaMlrHorpaHc$epa:la
AO - a6Aounsa,rbHoe oxorpeHl{e)
EAK - 6uo;<tll.luqecxuil aHaJIu3 I(poBIr
BKK - 6lollaropu Kan.btrIaeBbIX I(aHaJroB
6lorcaAa lesoii Ho)KKIztryr{Ka flacca
- rz:Ir eprp o Q u u e cxaq KapAHo N( tloilurvs.
rllreprpo$ur reBoro )Ke.ryAoqKa
EIIHnf f KM|I
|IIX Anil -
rkrc.nlrrlAeNluj{
- Enponeiicllss ofr[ecrBo .KapAIrOJlofoB
X.3 - )KenyAor{KoBa.f, SKcrpacvc'ronvfl
I4BC - ulle)Muqecxas 6oresHb cepAIIa
I4MT - LIHlleKc Macobi reJla
KAf - Kop,JHapoaumorPaSllr
KA - KooQ I4IIIieHTa'rep oreHHocf 'I'I
K@K - KpearnHQocQ clolHa:a
MC - Mera6or[qecxzrii cI'rHAPoI'{
OXC - o6urfi xoJrectieplaH
OKC61ST -- ocrpulr (erpoH?pHuii cilugponr 6es noAbeMa ceruesra ST
OKCcuST - ocrpblii KopoHapHrrfi cllu4porv-t c IIoAbeMoM c,erlteHra ST
EOK
OT - o6:sev ralrult
CAA - cplcroJlldqecKoe aprepl4anblloe AaBneHI'Ie
CA - caxapHblrft 4ua6er
CKO - cKopocrr rlySoqxosofi Qralrrpaquu
(IMAA
- cyToqHo e Mo HuTopupoBilHl{e
apTepuaJlbHoro Aal}IIeHIIt
'If - rpI{rnI{qePIrAbI
'ITf
- rl4peorponHnfr roPMoH
y3Af - ynbrpa3ByKoBal,IonnreporpaSur
OK - $Yurqu'cualumtfi liJlacc
TOH - ronepaHrcHocrb x Sra:nuecrofi Harpy3Ke
OP
- SarroPlt PI4cKa
XOEII-xpoHrlt{ecKatc'6crpyxrvrBuafl'6oresHlJIerKI4x
XCH - xpoHl4qecKaf, cepAer{Haq FteAocraroqHocrb
Xcn|I8il-X0JrecTepI{].InI4no[pOTeuAoBebtcoKoilIIJioTEtocTI{
XCnnHn_x.oJlecTepl{HJIlIIIofIp(]TeuAoBunsrorr]'IOTHOCTI,I
tlKB_qpecKoxHoeKopoHapHoeBMeIuaTeJIbcTBo
qCC - qacrora cepAer{Hrrx coKpettl]e:e^uit'
3Kf -
SxoKf
5.
orIeKrPoKaPAI'IorP
a$ar
- 3xol(aP4raorPa(rlrx
flara paspa6orKlr rporoKoJl:l:
2013
rol'
6. Kareroprrf rraqrleH'IoB: naLII4eHTbI c
IIOAO3peHI4eM
sa oKC c
IIoAbeMoM
ceruenra ST,
7. flo,rssollaTeJlu [poToKoJIa:
Bpaql4 crop<1fi IOMoIqu'
peaHI4MaToJIOrI4'
KapAI{OnofI',I' KapAI{OXnpypfI4'
TeparreBTbl, l:apAI{OJIOf'I4' I4HTepE'eHIIIIOHHbIe
g. yKasaHrre Ha orcy.r.crBlre rcousru{KTa [HTepecoB: orcyrcrByer'
9. Oupe4erreHrre: (EOK, 2012),
TepuuH<ocrpufizrrsapxrMl4oKapAa>(acutemyocardialinfarction)
ecTb KIHHI'IqecKI4e
ueo6>lO.4iltvtO [cIIOJIb3OBaTb' Kof,qa
MI4OKapAa' B
MI'IOI(apAa, o6ycloBJIeHI{bIe urueuuefi
HeKpol3a
AOKa3aTenbcTBa
CTABVTAfl'
113 HI'In{e [epequcnoHHllX CJIyr{aeB
AaHHbrx yclroBl4f,x ,rp,u ruo6ont
(OI4M/AMI)
Ar4arHo3 uHtPaPrra NrI4loKaPAa'
ypoBH',:{ (sHaueHufi)
o6napyxeHrre fIoBbIIIIeHu.fl ulutru cHI'IXeHItt npra ycJroBr{r{' qro6rt
rporroHr{Ha)
cepAer{Hbrx 6lrouapKeproB (UpeAnourr4TeJrbHo
BbIIIre 99-r'o rtpoueHTl4nfl BepxHefo
KaK Mr4Hr4t4yM OAHO 3Har{eH}ie 6rtno
ypol]Hr 6lrorr',rapKepa corIeTaJIOCb KaK
peQepeHrH0fo lpeAeJlil, H 3TO IIOBbIIIIeHI{e
npI{3HaKOB:
MI4HI{MyM c OAHI{M U3r CJIeAyroilII4X
-
CI4MTITOMbI I4IIIENTI4H;
r43Mel{eHuq oerMeHTa
HOBbIe HnI4 BepotTHO llioBble 3Har{uTeJlblrble
luca;
1' utturotBJleHl{e 6noxaAu resofi HoxKI'I nyqKa
:y6qa
-
ua
rrofiB.[eHl4e IIaTO.[OfuqecKnx:y6qon Q
3Kf;
ST
H
HJII{HOBbIX
o6uapyNierrr4e HollE,rx otrafoB HeXI{3HeCUOCO6UO|0 MI4OKapAet
-
oqafoBHapyIIIeHUHABII-x(eHI4trcTeHoKnpHpa3nI{IIHbI,KMeToAaX
Bi'dsy anr.f,arJvrkr M
I4
0
liapA
a;
BbLflBJIeHrre BHyrpI4KOpOHaFtHOfO rporra6a
-
[p]t
KoprlHapoaHfuofpaqhvr vnu
ayToIICHrI.
I4IrIeMI4Io MI4oKapAa'
Cep4evuari cMepTb c crrMnToMaMrr, yKa3bIBarcuII{N(rI Ha
l{3MeHeHI{r na 3K.f I4nI{ BHOBb
14, BO3MOX{HO, BHOBb l]otrrr}r4Brrl:aecfl H[IeMI4qecKI{e
(EJIHII|)' B }cJIroBH{x KorAa
rrorBrBrrraqcq droKaAa rr:sofi HoxKH tlyr{Ka fuca
l(poBl',I IIJII{ AO' TO|O KaK
cMepTb HacTyfltlrra Ao ']tofo, KaK 6rtlu B3{TbI aHaJIU3bI
Mofrrrl froBbrcrl'rbc{ yp ouFtu 6uonaapKepoB HeKpo3a MI4OKapAa.
I4n$apl:r IvIIIOliapAa, OB.fl3aHHbIl"l c
r{peclKo}(HblM KopoHapHbIM
l1',pv IIOBbIIUeHIII{ ypoBHt
BMerrraTeJlbcTlloM, IIO OOfJIaIXeHlaIo ycTaHaBJIHBaeTAfl'
qeM B 5 pas IIo OTHOTITeHI{rO K ylloBHro 99-ro
cepAer{Hbrx q)onoHnHoB 6olee,
ilpol]eHTl4n'-BepXH€|oCrTHocIITeJIbHofoJII4MI{Tawnrf'|prIIoBbIIIIeHHuypoBHq
l4cxollHoro ypoBHfl
,poaro"r"a 6onee, qeM Ha 20o/o, ecJlrr orMeqaJlocb r-IoBblllfeHr{e
KpOUe p.I4Havrlz.Kl4
arp" aag Cra6IllgroM 3HatIeHVI4 LIIuI CHI{)I(eHI{I4 B AIIHa'MHKe'
npI43HaKoB:
ypoBHr TponOHt{HoB AOII;KeH Ha6JIIOAaTbcfl' oAllH I{3 cneAyloqux
-
CI4MTON/IbI
I{[I0MI4I4 MUOKapAa;
HoBbre rpr,r3HaKr4 r4rrreMl4l4
-Ha
3Kf
I4III4 HOBari 6IOx.aAa
JIHfIf;
aHfr{or*pa$uuecr<n AoKa3aHHOe HapylxeHl{e [poxoAIIMOCT]t'I
KOpOHapHbIX
COC
OCHOBHbIX
yAOB I4Jri',IBerBefi ;
-BbIpaxr3HHOg3aM-e,4JIeHIreKpoBoroKaI',IJII43M6OnI4t:;
MI4OKapA'a
- o6uapl.xeHr{e HOBbrx orlafoB HexH3HeCnoco6HoI'O
vnv
or{afoB Hapylxr3rllrt ABX}KeHI{fi cTeHOK npLI pa3nl4r{Hlblx
Bl{3yan I{3 a\krrt
M
14
0
HoBbIX
MeTOAaX
KapAa'
IIO AaHHbIM
IrIH$ap'nT Mr4OK.alpAa, CnggasnHfi c TpoM6o3oM cTeHTa
Vr IIOAbeMa uluttu
aHfr{ofpaoutr vrvr ayroHcr{u , )-Ipv ycTaHoBn eHt]tl I4UeMI4I4
qro6rt KaK MI{tluMyM oAHo 3Har{eHue
cHr{xeHrr fl Kerp*Vannir6rx6uoMapKepoB TaK'
[peAeJIa' HO IIpI4 3TOM'
6ruro Bbrrrre 99-ro rlp0t(eHTnnf, BepxHero pe$epeHTHOI'O
6raolaapxeprr BbICBO6OAuIIMCI B
cMepTb, HacTtyrrr4na Io TOfO, l(aK cepAer{Hble
CepAerIHbIX 6uoMapKepoB'
KpoBb r,InI{ Ao T'orO, Ka.K IIoBbI cvt.Ttlcb 3Har{eHI'If
IIo
Ll"SapKr MI{o!:apAa, cB,t3aHHblfi c KopoHapHoM IxyHrI4poBaHueM
ypoBHf, cepAeI{HbIX Tpo[oHI4HoB
corJIaIIIeHI4n ycTaHaBJIIBaeTcfl' ITp]la IIoBbIIxeHI4I4
rIpoIIeHTI4ns BepxHero
6olee, qeM B 10 pa: llo oTHo'[IeHHIo K ypoBH]o 99-ro
orHocr4TeJrbrrofo J[lNrrzra
y
rlaqlleHToB
C
HCXOAHO HOpMaJIbTIbIM ypoBHeM
rponoHl4Hr'r( <99-oro npr)ueHrl4n s)
6AI{H II3
Kpolre [oBbIIIIeH:I{t ypol}H{ rponoHl4HoB Aon)KeH Ha6n}OAaTbcfl
cneAyroqux [ppI3HaKOB :
6lorcaAa IHIIf;
- Hosrrir rrarorror.aqecKl4fi 3y6eq Qunu HoBaq
oKKJIrc3Htr IXyHTll
- aHfl4or.paouqecKl4 AOKyr\4eHTUpoBaHHaf,
vIV
HOBOfr
aprepr4rl;';
a
J
-
o6napyxteFrr{e HoBbrx oqafoB Hexr{3Hecnoco6uoro MI{OKapAa I4JIH HOBbIX
oqafoB HapyueHlz:t ABI{XeHI4q CTeHOK rIpU parJII4rrHblK MeTOAaX
Br{3yaJrl4l3 ALJI4I'4 M I4O B:apAa.
ltl.
METOAIbI,
.IIEIIEHNq
I
Ilolp(oAbl kr
0. K"rrunuqec Kaq rc"naccraQuKaurrfl
'Ia6nuua 1
TIPOIIEAyPbI
:
JKnaccradlvKar\vrfl
-
AI4AIHOCTIIKI{ \I
TI,IrIOB .ranQapxra
MI4OKapAa
IIESC/ACCF/A.HA/WHF, 2007 )
Tunu
1
run
XaparcreprrcrlrKa
C**rr*"tr - ""4upt,t MHoKapAa' cBt3aHsrtfr c
Ir3bj[3tsneHllel\4, tloBpeXAeHI{eNI, eposuefi klIII4
pa3pbIBOM,
AI4cceKIII{eu
aTepocKnepoT'I4qecr<ofi 6nquKn c pa3Burl4eu rport'r6o3a OAHoit' uttu
ylKyAIxeHHro
6onee KopotFrapHbrx apT]epuit, rrTo IpI{BO.{I4T
Mr4or(apAa rrJlr{ K sNa6orI,IZ Al4cr€ulbHolo pycna c
K
KpoBoaHadxenaq
rocIe,4y!grI4M HeKpo3oM KapAI{OMI4OIIHTOB.
qeM npll
llonpex4eHl4e MI4oKap[a c HeKpO3oM B yCnoBLIqX' IIHrIX,
*opo*rup"ot-I 6rf,Ie3HH cepAIIa, [pI4BoAtIIquX K: HapyrueHurc 6alalnca
*.i,4y norp,:dHocrbro MuoKapAa B KncnopoAe Lr ero ,4ocranxofi,
2
rul
Hanpr4Mep,
cocy'AoB,
CJre[CTBr4e 3HAOTeJrr4aJrbHoil 4rac,syHKIII4I4 KOpoHapHbIX
CrIAlMa KOjloHapHbIX COCy,IIOB, :',lr6oluu K(lpoHapHbIX
B
coc)'AoB, 'raxra-6pal.kr-aptrr}/..tlv,
aHeNII4I'r'
rrxarelruofi
fHtIOTeH3I4lI' fI4IIepTeH3Izu c HAIII4qI{EM VIIfil
uu IIX.
OTC\/TCTBVCM ft4
CepgeuHafl c.Mr3prb c npr43HaKaMH sosN4oxHoft rl[reMI4I'I ]{rroKapAa rr
npeArlonoxl4'renbHo HoBrIMI4 npH3HaKaMH I4IIIeN'IIII4 Ha 3Kf :arrul
BHOBT, Bo3HllK:uefi 61or<aAofi JIHfIf, B yc;loBl4flX KolAa cMepTb
Hac)Tytluna Ao Toro, KaK 6blni4 B3-f,TbI aHalII43bI KpoBI4 I4JII4 Ao' Toro
Kax: ruorJII4 IIOBbIcIrtTbr3.f, ypoBHI'I 6uoltapxep0B HeKpo3a MuoKApAa,
LInIl j jgAl(ry( (llyrlaflx, KorAa 6l{oMapKellbl He 6bIn}I onpel(eJleHbl'
IrlH$apxr MI{oKap.4a, cBt3aHHblfi c qpecKoXHbIM KrcpoHapHbIM
BMe[IaTeJIbc:fBoM, IIO CO|JIaIIIeHIZIO ycTaHaBJIUBaeTCtr tIpH
rleM B 5 pa: no
rrollbrrrleHnkl ypoBHf, cepAetIHbIX TponorII4HoB 6olee,
OTr{oUIeHI4Io K ypOBHrc 99-rO npOIIeHT}IJI-II BepxHefo oTHoCuTeJIbHoro
qeM Ha
Jrr4rwl4Ta :vrm4 LIpl4 rtOB;bIIueHI,lu ypOBHf TponOHHHa 6Olee,
20ot'o, ecJul olMeqaJlocb rIoBbIIrIeHI4e I{cXoAHoro ypOBFtfl IIpH ero
He.n.OCTaTOTIHTCOTI{,
3
ruu
4a
run
crer6lrnrtroM 3tF{ar{e:elpru; Vrv cHI{)I{eHI'Irr B AIrHaIv{rrKe. Kpolt': AI4HaMllKn
(]neAyroull4x
yp()BHq Tpo[oHHHOB AOnXeH Ha6nroAaTbcs oAIrH H3
npa:nar<on: 1)cul,trotulu HIueMI4I4 MI4OKap/la, 2)Honlte npI'I3HaKH
raurenuu Ha 3Kf r4rrrr HoBar 6nora4a JIHII| 3)allruorpaoiluecxu
AoKa3aHHoeHapyueHl4enpoXoAI{MocTHocHoBHbIXI(opoHapHbIX
corlyAoB r{nI.I B9TBeL"I 4) enpaxeHHoe 3aMeAneI{I4e KpoBoToKa I4JII4
sM6O.nHq5) o6irapyNieHlIe HoBbIX Or{arol} HeXI{3Heclloco6Horo
npw
MU:.OKApIA U:,nkI HoBbIX OqafoB HapylxeHHt AB]1llKeHHfl' CTeHOK
I{ rI H bI
X
Iv{
gTo A aX
B I4
3y aJI u 3 aL\vIL7 M 4
I I(9p43
MI4oKapAa, clafl3aHHrtfi c rporrt6o:ol,{ creHTa lr(l AaHHrIM
aHfr,torpa|un unn ayTotlcI,tu, rrpla yCTaHoBneHun laLt]ev'uvr H noAbeMa
wlun:.u cHr{}r(eHl4fl KapAI{€LIIHbHbIX6uoN,IapKepoB TaK,r{To6bI KaK
Mr4Hr,rMyM O[rICr 3HatIeHI4e 6UlO BbIIIIe 99-rO ][pOrIeHTHnt BepxHefo
Irlu{raprr
,lb rHn
ps@rlpeHTHOrO [peAena
:) TIITI
I,Iu(rapr<r Mr4oKapAa, cEi.f,3aHHbrfr c KopoHapHoIvI IxyHTI4poIlaHI4eM IIo
cofla[IeHrrro yr]TaHaBJIl4BaeTAfl fipl4 IIOBLIIIeHIIU ypOBHt CepAerlHbrx
TporroHr4Hoe 6olee, qel\4 B 10 pa3 no oTHoIIIeHIITo K ypol3Hlo 99-ro
npolleHTllnt Br3pXHefO OTHOCIITeJIbHO|O JII4M.I4Ta y IIatU4eHTOB C
r4cxOAHo HopManbHbIM ypoBHeM TpoIIoHI4Hr,r(<99-oro npoIIeHrIInt)
Kpor*,re noBbrmleHlzq ypOBHt TponoHHHoB Aonx(eH Ha6nloAa.Tbcq o,{I4H
r43 cJreAyIorIZX npu3HaKoB: 1) HoBbIfi naToJlorl,IqecKl4fi sy6eq Q uln
HoBa.fl 6noxa;1el IHII|', 2) aHrnolpaQu'recxu,4oKyMeHr.apoBaHHaq
OKK"Tro3uq IxyIITa VIIut HoBofi apTepHPI, 3) o6uapyNeHl4e HoBbIX
oqal-oB HeXI43Hec[oco6Horo MIloKapAa IUwr HoBbI)( oLIafoB
HapyllteHl4{ ,IBHX{eHI{f, CTeHOK rlpu pa3nur{Hblx MeToAaX
BId3:{ arrLl3
Ta6.rrwqa 2
-
arJryI
l\4I4
O
Kapl(a
K.rraccncptIKaIJLIfl. ocrTpofi cepAeqHofi ue4oc,raToqHocTl4
IIo Knlluu
(Killip T, Kim he!eJ,-Q:e7)
K.naccuQIrKauIrfl ocrpoii cepAeqHofi HeAocraroqHocrn IIo Kurrnr
(Killip T, Kin1q1llg J,j2q
Jleraruuocrr
XaparrepHcrI4Ka
Knacc
Her
cepAeqHol4
HeAOC)TaTOqHOCTH.
Braxurre
il
xpI4
nbl <50%
ICfOIIHbIX NOJICfi, III 'T<TU,
JIC| OI] HA' |I4TICPTCH3I{'I.
Braxurte xpl4nbl
III
Jrerorr.Hblx
6-8%
30%
>50Yo
nonefi. Orer 40%
JICfKI,]tX
IV
>500/0
[Llor<
Ir c yKa3a H It e M TH Ir a roc[rrraJlrr3a IIII lr
SncrperrHaq rocflrrra,rrrr3:ulrr,fl - naIII4eHT c OKC c [oAbeMoM cerMeHTa
ST ua 3Kf AOnxeH 6rrrr AocraB.reH B aHrrlorpa$u.recxy'ro na6oparopulo Ha croJl
KaTeTepu3ar\rLv, MHH)/-{ OTAeIeHr4e KapAI{OpeaHkIMirtIJkM VULId OTAeJIeHIIe
I I . Ilorca3aH
ilfl
A,rrfl f otcrllrraJl lr3a
HeorJro)KHofi rcapAuoJlol-t1
14
(I A).
12. ffepeu,eur ocHI)BHLIx
Meporpuqruii:
Ocuosurl{e ttccJIeAo,B?HIlfI
1. O6urufi atrarlrs K1soBI4
2.
rI lt
Onpege)JleHrIe rJlrot(o3bl
II
AOIOJIHI{T€JIbII['IX AHafHOCTIIq€CKHX
3. Onpeaer.eHl{e KPearI4HrIHa
4. Onpe4eJleulre Knl4lpeHca KpearHHrIHa
5. Onpe4eJteHPIe rpolloHl{Ha
6. Oupe4erterll{e AII'I
7. Oupe4elerrue CPIi
8. Onpe4eJIeIII4e ABt3
9. Onpe4erlel{He Ar{'Il3
1 0.Oupe4e:reHl'Ie lIT t4
.Onpeae.reHl4e Sra6pruuoreHa
xonecrepl'IHa
1 2.Onpe4e.reHue o6ulero
I 3. Onpeae.rleHl4e IIilHII
11
l4.OupeaereHHe JIilBn
1 5 . OupeaerleHue rpI/tr III4IIepI4l(oB
q/Harpu n
1 6. OnpeaeJleHI4 e xartl
1 7. O6uruir, auatruz Mor{ll
1 S.HccneAoBaHr{e ser III'19
BuC
19. Onpear3reHue M€tpKepoB BI4pycHbIX rerlarl{Tos
20. OupeA3neHl4e Ipyllrlbl KpoBI'I u pesyc-SaKropa
2l.MnrPoPeaKIIH.t{
22. Kur na. sfir\a rrll4c't
23.3Kf
Z|.Motturopl{Hr
3Kf
e 12 orBeAeHuqx
25.3XOKIL'
26. KopoH apoaHrr{orpa$rax
2J .P es'treH opraHoEr I'pyAHofi
rlerru
fouonnu'fer'IlHbIe u ccJIeAoBaHuq
1 . f:ruxeM:uqecKl4l"{ nPo$unl
2. f ttut<uFroBaHHblfi rt:uorlo6un
3. llepopatrrbHa{ npo6a c Harpy3Kofi rrrrorosofi
4. NT-proIlNP
5. D-4tlttleP
6. Onpe4e.lenrae MIB-KOK
7. Onpe4tlnenue MIHO
8. Onpe4eneHue Marlll{fl
g. Oupe4r:leHl{e KI4c.[orHo-ooHoBHoro cocro'xn'llfl
OuPe4r3[eHI{e rtltc uo6rana
1 1. Oupe4eJreHl4e alr'Qa-an'tu-ra3bl
12. Onpel[eneHl'le AC:T
13. Oupe;leneHl4e l{eror{Hofi Soc$ara:rt
I 4. OnpeTIeJieHI{e alrF)efalrl4ra rpou6oul4roB
15. 3Kf-recr c Sustuecrofi Harpy3Kofi (B3M/rpe4r'rralri)
1
0.
16. Crpec,c-3xoKf c 4o6Yrar4HHoM
/
17. nepQ; r:rrroHlafl' clllrHrl{rp'a$rax MI4oKapAa
18. KT, MPT. rI37
OO3I{T
1
3. fuaruocrrlqecKl{e K:PI{TePuu
1.3.1.
:
Xta.rro6u rr aHaMHe3i:
]FIa Hufilvul4
[zaruo: unQaprla MHoKapAa, KaK IIpaBHJIo, oCHOBbIBaeTcq
20 tvlnrryr u 6olee,
1otml;1ucKoMsopru r.py:t"ofi nrerxe, npoAonxulerlbHocrblo
6olu n
r{e Kynl4ponausufi np}IeM.oM HIITllornI'IqeppIHa' xapaKrepHa llppaAvai\vIfl'
Moryr 5rrrr
iltero, HHXHroto qeJllocrb n.uyio pyKy. V uero'ropblx naqlleHroB
"
I{eHee rgnl{q}rble cI{NIIlToMbI, KaK TorrrHora, pBorat, oAblrxKa. cla6octr,
6rteaer
oepArle6ueHr{e vrv noTep-r{ cosuaHl4s. B AHafHoc'fl4Ke eaxHofi
znSOpuaIII4t c) HAIttqLIV lztuleMurl€:cr<Ofi 6o;regnU CepAIIa B aHaMHe3e'
L3,2. @nsuKa.nbHoe o6cJ eAosaHHe:
O6cleAonaHr{e [aqrdeHToB c 6onbro
B rp]'AI,I BKnloqaer oMOTp rpyAHoI'I
khqur.u4ya[bHblx
KJTSTKI{, aycl(yJIbTaU}IFo \I I4:iMepeHI{e 9CC Lt l\A'
IIOAbeMoM cerMeTa S-f ue cyqec;TByeT' Ho y
Sr4:raranrHblx IIpI43HaKoIl IzIM c
HepBHofi
MHorr{x rauugH'roB Bo3iHr{Karor np[3HaKr{ aKTI4BaIIu[ cllMrlarl4rlecx:ofi
apTepuaJlbuas'
cHcTeMbI (6rte4uocrl, BbIpaXe)HHat IIoTnI4BocTb) YI nu6o
l{a6nioAaTbc-fl
flIfIOTeH3I4{, .nkI6O Hu3KOe IIynbcOBOe AaBJIeHI4e, TaK)Ke MOfyT
III 'rou cepAua I1
HepaBHoMepHocTb [yrb(ooBofi noffrbr, 6pa4nr<ap ALlfl', TaxvKapAl4s'
cTaHoBuTcq
XpHrIbI B HIZ1;(HI{X OTAenaX JISIKI4X. BaNnOfi Uenbl() OCMOTpa
paccnoeHl{e
ncrlroqeuue CC3 HelrilreMr{rrecKoft npupoAbl (:rnt6olux JrefKllx,
nepulKutpAgT, tlopoK cepAIIa)n Bo3l\{oXHbIX BI{ecepAerIHbIX
creHKH aoprbt,
3a6oneBauufi (nueBMOTOpaKC,
TIHeBMOHI4fl
'
IrJIeBpanbHbIfi BbInoT).
13.3. Jla6oparopHr,Ie uccJIeAoBAurrfli
BKIIotIaTb:
o6r{sar-erbHbrrl Nrr{HrrMyl\I nepBoHaqalbHbl.K aHaJIU3OB AOJIXeH
'IpoM6oIII4rbI'
TponoHI4H, MB KQ,K., OAIC, reMaToKpl{r, reMOrJIo6HH,
aI{arII43 KpoBI4 (EAK),
KoafynofpaMrv{a (ABC, ATITB, MHO), 6uoxunu'Iecx'fi
,n.*tpon"rrr (ranufi , tuttpuir', u a ruufi ), OAM'
IIoBbIUIeHI{e
Tponor,,ttu (T unu I). Y nauueHroB C tr4lvl. repEioHat{aJlbHoe
qacon c Mol\'!.eHTa BO3HI4KHOBeHI'I'1
ypoBHf Tpor{oHr.{HoB rrpor{cKoAI4'r B Ter{eHI{e -4
Mo'XeT COXpaFIflTbCt IO 3
ct{r\,{rlToMoB. lloerrrrrel{}Iblff ypOBeHb TpOTIOHI4HOB
flpu OKC Eil ST'
HeAenb H3-3rt 1lpoTeonla3a cog:par6l'eJlbl{oro a1[apaTa'
O6rtqgO ilpOXO'II{T B TeqeHHe
He3HaqHTeIIbHoe IIOBsI{IIeHI4e ypOBHfl TpOIIOHHHOI}
T 14
18-72 q. I(axnx-Ir'r5o cyrqec'IBeHilblx orIlI4LIHfi N'IextAy rponClHI{IIoN{
T'C}JIbKO Ha CaN{ofi perHueii cTail]/Itl'
TponoHI4HON{ I HeT. o6HtlpyxeHtle HeBO3IVIO)KHO
ilpt arp0Be[r3111414 BTo]lOrO aHaJln3a B TeLIeHHe 3 qacoB c N{oMeH'ra nOflBJieI{Ht
x 100%.
CHMTTTOMOB Lry.BcTBr.iTe.irr'Hocft' x I4M ilpH6nprxaeTefl
Ta6nuua 3 - IlnoxuMl4.lecKl4e M KCPbI H
(lneuraSu'ruo tIYu CTBI{TEJIb
Maprepn
I
Tb
MIiOKA
llepnufi
^a
Ifur<
Bo:nparqeHi.t
rroAbeM
IIOCJIE
e
TIOCJIE
I4M
K HopMe
124'l
72'l
I4M
MB-KOK
-f+
4rl
7
2ra
6-Ei q
24'r
4'a
24-48 u
5-21 cyr
3-4,1
24-36.r
5-1,4
cyr
Ha
Knuuuraet:rcuil auanu3 Kpoltt c ilo/{aqeroM Koruqecrea rpou6ouzron.
(Ht) u
rpoue rerreHuq fenapuHol,r onpeAe.]reHrre reuomo6nua (tr[b), feMoTol'ipl'Ira
lloAgrreT rt4c6a. rpOu6oqq1oB cne!,yeT OcyqeCTBJItTb e71eAHeBHO'
Euoxumttqecrcuil a)qaJ\u3 t(po6u BKIIOqaeT onpeAeneHl{e lKpeaTI{HHHa,
rsrlrpeHc Kpearr{Hr,rna, A.J[T, BbrcoKor{yBcrBlrrelrurrfi CF'E, rtlroKo3a' lHnu4ur'Ift
,rrranrp. Baxnrt onpeAenl{Ib cKopocrr r<ly6orlKoBofi Sunr'rpaql4u, KaI( ToJibKo 3To
rtT&HeT BO3MOXHbTM rrocJre nocTynn e]F'nfl. rIarlIIeHTa
flpHivrepHo
rrppiMepHo
y
20-3()% naqr,ieHroB c OKC
y raKoro xe
KoJruHecrBa riaur{errroB
I] CTaIIlt{OHap.
En S'f ycraHoBne[ ilva6er, H,
- HeAnalHocll4ponaIlHrtfi AI'raOer
3To
HJIH HapymeFlI4e ToJleFtaHTHocl'I{ K r.IIIoKo3e. CaxerpHrrfi gna6er
,r.ruur."nr,tfr npofH0clluqecruil $ar<rop cMepTHocTl{ cpeAu [aIJneHToe c OKC
Fn sT. funeprrrlrKelvrr4,r npr4 rrocTynneHulr HJIH n03x<e, BO BpeMq npe6rteaHul r
crarr[oHape, xB[rerc.tr BaxrHr;rru He3aBI'lcHN{blM ]\{apKepol\'I He6narotlpHf,THofo
HJrp{
nporHo3a ilpli OKC, He3aBHcr4N.{o or rofo, rBJiflercx JrI{ ilairneHT A}Ia(ierHKoIvI
qeNI
HeT, 14 N,tox(eT 6rilr, AaX(e 6Onee AocTOBepFILINI N{apKepoM pncKa,
AnarHocruporraHHb tfr, nvta6 et .
Ko a eyn o zp ar\4^4 a -- BKrrroq ae'r A9TB, |ITI4, s a6 przu:o reu A, MFIO.
3n e rcmp' rtn umbt - IIK:rIoqarcT KaJII4fi , ltatHufi , rrarpui't'
Iunuduttit cnercm:p (o6rqrail xonecrepLru, JIIIBfI, IIIIHII, rpurulurlepra4u) Y
onpeAeneHbl
BceX [aIII4eHToB npa [r]cTyIIJIeHI'Iu B CTaIII{OHap AOJIXHbI 6rrrr
pHOKa, BKJrH)qaf o6uuafi xoJlecTepI{H, XOnecTepIIH JII'I.IIOilpOTeHAOB
sar<roprr
Brtcoroii rrJlorHocrl{'
Hr,sxofi rrJrorr{ocrra (JIIllJlI), xonecrepuH nurlonporell.n,oB
-far
rar ypoBHll JI||HI
rpr,rrnqrlepllA6t, rnloKo3)/ B nJIa3Me KpoBH HaToqaK.
UOCJe uH$aprra
r4MerOT TeHAeHIIIIT K CTHLIXeHI4IO B TerIeHI4e nepllblx 4nefi
nocJle |00III{TaJIId3ATJxld'
Mr4OKapAa, Jryqllre Bcefo .a3Mepr4Tb HX KaK r\roxrHo paHbllre
Ta6nprqa 4
-
(JqenKa [O1:a3aTeneti JILI1IIAH9TS cIIeK-Tpa
JIuuuAr,t
;Hopuanrustii
ypoBeHb(rilvonu/r)
O6uufi XC
<50
II|IHil
<3,0
XC
]Ilenenoil ypoBeHb rIPu
jUEC u Cf(vuomh)
XC IITIBN
i
>1,0 y MyxrIHH, 21,2 Y Neuquu
TpuuuqepHiIbI
i
<1,5
flpu
norca3arerrrx
I\IIT >3 BnH,
K(DK
> 5 BIIIF{ orrr4eHslorc.a
r4Irv He
IIA3HAqATTC' CTATIIHbI.
OAM - HcxoAHo H rlo rroKa3aHu-sM
jlo u on n ureJr b [I LI e,r a 6o p aro p H ['I e recr['I :
fnurceuu,uecrcuit nooQunu -- rpu Ar{arHocrr{Ke oa)(apHoro 4ura6era (CA).
llnneprluKer\,I\urf nptl I.ocnHTarv3aL\ur4 flBJIflerc.fl BaIKI{bIM rlporHocruqecKHI\'{
rfaxropotr cMeprnocrr{ H cepAerrHofi seAocraroqHocrll Aaxe y nauHeHToB' He
crpaAaloqux c ax apHtttll gna6eroivt
Br,rcoKoLiyr3cTBI4TerbHltle v JIocTaroqHo cneqntlu'rrilte
N.{apKepbr, ucn orrb3yeMbrr3 A.rrr Bbrt Il lrer:.u^fl glrc $yHxuur{ r e Boro )KenyA()rI Ka.
lt{T-proEi,YP
D-dmtep,
L3.4. Hncrpynd eHTaJIbH ble rIcc,'IeAoBaHuq :
O6qsare.rrbHbrMrl r.rHcrpyN,reHTaJIbHbIMI4 HccJreIoBaHvrflMH npl4 OKC
.rrBJrrrorc_s 3Kl- (n reveHue 10 vruuyr nocne nepBr4qHoro t\{eAIIIII{HcKOro KoHraKra
- ;IMK), exorcqpduozpaqbun (3XOKf) - rraoxer noMorlb B ArrarHocrrrK:e B He-flcHbIX
cryrraqx, Ho He AonXHa 3aAep)KrrBaTb npoBeAeHLIe aHrl4orpa$uz.
-
truaruocrlrqecKute KpIITepuu 3Kf :
rroAbeM cerMeH'lta ST, uauepenurrfi B TorrKe J, n.qnyx cMexHblX orBeAeHI4.[x
B orBeAeHunxY2-\'3;
>0,25 ruB y Mylltrll4ll lo 40 :rer;
>0,2 raB,y MY)KquH craplxe 40 ner;
20,15 vB y x(eHIn,I4H B lpylux orBeAeHl4qx;
>0,1 nall (npu oroyrcrBr4lr rr{rreprpo$un .lIeBoI'o }KenyAorlxra (JIX) i'rnu
6noxaAlt reeofi H'o)KKrI nyr{Ka luca (JIHilf)) ;
npu HrrxHeM u.nrpapr<re MrzoKapAa rIoAbeM S'f B npaBr'IX rpy.{HbIX
orBeAerrrxx (v3 R-'V4R) -npr43HaK I4M upauof 0 xtenyAor{Ka;
lrlrleMuro
Aerrpecenrr cerMeHTa ST B orBeAellusx V1-V3 npeArlonaraer
MrroKap4a, oco6enuo nprt rroJIoxI4TeJIbHoM :y6iqe T, 14 lv{ox(er 6rrrr
rroArBepx(AeHa conyrcrByrculuM rIoAbeMoM ST >0,1 rraB B orBeAeHuxxYT-
v9.
PaculuQpoBr,la
3KI-
3arpyAHeHa B CJreAyrOrrIHx CJIyqaflX:
Blona.qa HoxeK nyrrKa l-uca (EHlIf): ilpl4 6rroraAe JIHII| HaJII{r{He
KoHKopAaHTHrf,fo IroAbr3Ma ce)rMeHTa ST (ro ecTb B oTBeAeHuqX c
rroJro)Kr{TeJrbHbrMrr QRS- orKJrc)HeHunl,ru) flBIrfleran OAHI{M kr3 LrHAI{KaropoB
pa3Br{Brxeroc.:r uusapKra Mr4oKap.qa. flpe4rr4yu]as,3KI't\{ox(er 6rtrr noJIe3Ha Ant
JIHIIf ocrpo Bo3HLlKIrrefi. BHonr Bo3HIrKIuat
),craHoBJr eHntr, fl.Brrflercfl. nu 6roxala
6loxaga, KaK rrpaBrrflo, qaule coilyTcTByeT OCTpO TeKyIl(:rr.ry uH$apK'Iy MlIOKapAa.
y [aur{eHToB C KJ]AH}rqecKHM:r4 npII3HaKaMrI I4IUeMnH MI4OKap.qa c BHOBb
Bo3HrrKrrrefi, vt;g no.qo3peHr{eM rra BHoBb Bo3HI{KlIryro 6noxaay JIIIllf, cneAyer
paccMoTperb BoIIpoc o rlpoBe paeHVvI penep$y:I{oHHofr repanl4l{.
Elora.la lIHlIf, K:aK npaBr4Jro, He nperlflrclB)'er l4HreplperalJ[kr rloAbeMa
ceruesra ST.
Xely.4o.rroertfiKapAl4ocTuMynqToplu0xeTTaKXe[oMeIIIaTb
pr MOXeT noTpe6oBaTb CpOqHyIo
plHTeplpe Tar\Vt4 I{3M€I{erHI4fi CerlvleHTa ST
Tepanuu'
anrratrpa6"o ,4nfl rroA'BrepxAeHl'rt Ar{arHo3 a vr Haqarr'uoli
noAbeMa
Orcyrcrane y natu4eHra c ocrpofi xopoHapnoit oKKllrosl4erfr
T, xOropble' KaK
Ha6nroAarcTof BbicoKIIe n ocTpoKoHer{Hble :y6qu
cefMeHTa
sT
ilpaBr4Jlo, npeAIIIeCTByIOll IIoA:beMy cerMeHTa
S'I,
IIejooXoAlIMo IIpoI'I3BecTtI
CefMeHTa sT'
C OXKJIIOSUefi
orcyrcrwle rroAb(3Ma cefMe,"tu sT MOXeT 6rrTb y IaIIUeHTOB
BeHO3HorO
,crr45aroqefi s,etsu Jleegii KopOHapHOfi aprepul{' OCTpbIlt rpolt6O3ol't
apTep1an' H'ecuorpr Ha
UyHTa r4rrvr IopaxeHIIeNt .tuon,i neBofi xopoHapnofi
3Kr B AOTIOJIHIITT:IIbHbIX vz-S
BbICOKyro Ar4ar.HocTHqe{lKylo qeHHoCTb' QIItTI',Ie
IIaIIIdeHTOII C OCrpofi oKKnro3Hefi
oTBeAeHrrflx He BCefAa noMofaeT BbuBnqTb
tloBTOpHOe CHttrue
3Kf
I',IJII4 MOHI4TOpI4H|
{Bjrtrorct ;roKa3aHI4eM 1infl 3KcrpeHHoro
KopoHapoaHrr{orpaSnuecroro
I{ccJIeAoBaHv|'-cIIeJIbIopeBacKyn'l^pI/l3aIJJryIMl4oKap/qa.
IrlsoluposaHHrrfi nHsapKr MI{oKapAa tua".ii creHKu
(uHxne-6a:allHrtfi)'
qacTo pa3BgBarouluficq BcJISACTBI{g ilopaxeHgtl o|uSaroulefi BSTBII neBofr
ttpoqBjl{Iott\ttitcs' ToJIbKo
KopoHapHofi apTepvr4 tI 3neKTpoKap.{Horpa$uuecru
rrlB B o'BeAe*'flx'V1-3' CJIe[]oT
r43onrrpoBaHH.fr 4.rrp.a,arefi ce.wenra STZ0,05
ST" B raKI4X cnyqaflx
Ha6nroAarb 14 n.r"iu KaK I4M c IIoAbeNIoM cerMeHret
V7-e oTBOAenlnflX'
qenecoo6pa3Ho cHqrb 3Kf B A9II6JIHI'IrSJI6HbIX 3aAHe-rpyAHbIX
r{To rro3BoJrr4T o6uapl,NUrt xapaKTepHbIX Anf, sltNse-6a3aJIbHOI'O lrusapxra
<40 ner)'
SD:O,OS naB (>0,1 rtlB y My:XTIHH
Mr4oKapAa,
roAbeM...o."ru
b6.rpy,nq"" crBoJra neBofi
xoprouapnofr aprepw'
CerMeHTa sT B
3rreKTpoKapArrofpaQuuecru npofBnf,IolIla{ct floAbe\4oM
orBeAeHlrflx
oru.al""" aVR v 4*upecclleii cerMeHTa ST B saAFIe-6oKoBbIXpycna vlru
KopoHapHofo
npeAnoJrafaeT MHO|OCOCyAIIOTOe [opaxeHl{e
B rex cJIyLIaflX' ecllkr y
o6crpyrquro reeoia KOPOHaPHOft aprepvt\ oco6eHHO
[aIII4eHTauMeIOTCgfeNIoAI4HalVIIrqecKI4eHapylxeHl'lt'
qKB qepe3 1 uac' a B
3Kf ne,o6xoAutr'ttl noBropl'Irb rIocJIe npoqeAypH
I{KB Heo6xoAnMO \4OHl{TOpHOe na6'nroAesue
TerreHue 24 q [ocJre ]repBI4qHOrO
npII KaX'{oM
3Kf B KapAr.{opeaHI{MaIII4oHHoIvl OTAeJIeHHI{, 3KI- perl'tcrpl{pyerct
TIoBTOpHOM B O3Hr{KHOBeHI4I',I CHMnroMoB'
|,{UarnocrHxa ocTpofo un$apxra
MMbI C AH|I{O
Hsx 3ilrlhceI alexrpoxap;t wo
Ta6nuqa
5-
Jlorcalurauun I Attaroltltn
3KT
OKKJIIO3UII
OSurrapHufr
llep'e4Hqs
nepe4nufi
HHCXOAflIIIAfl
un$aprr
apT(lpuq
npoKOI4MUUIbEi ee
sT t vtI,
V6,
aVl-ranr,rEJIH
tlf
MuoKapAa' ocHoBaHHa'[
I,{qCCKOH K
HA
que fr
cMepTHOCTE
Cuepruoc
TbB
,oh
TeqeHrre
30-AuesHas
1.9,6
rola
I
(%o)
25,6
nepnofi
cerlTalrbHofi
10
flporccuualrbHatr
Eonrurofr
sT t
vl- v6, I,
12,4
Ao
6onrurofi aVL
At{aI'oHaJII4, I{O
AI4CTaJIbHat ,IO
nepe.4urafr
uepnc,fi
cenralrHoft
llepe4uenepxyureuHuli
.{ucrartuax
Ao
6onrruofi
vrv fiepeAIIe- AI4afoHaJII4 l/.nvr
cauofi
Ao
6oroeofr
AI{AfOHATIU
Eonrlrofr
guxuttft
c
nopax(eHl'leM
rrpaBofo
xenyAoqKa,
flpox:cul,taJrbHe$npaBlefl BeHerrlla.s
vJrv
nn$apr<r
r0,2
sr t I, V5, V6
r4rrvr aVL,V5,
V6
ST
tll, Ill,
aVF 1 6,4
T4
JIEBAjT
Hr4X{enpI4BeAeH
kr3
HrIX: Vl, V3R,
V4R
V5, V6
R>SBV1,V2
ST 1 rolrxo II,
OKK:tosuq
.quclanrnofi
npanoft
nene.rHofi
III,
apTepuu
Be'fErI4
6,8
VTJTVI
Jlro6ofi
HI4XHC-
Huxnufr
v4
aprepuq
oru6arouraq
6oxosofi
u sal:Huil
HeSonturofr
sT t v1-
AVF
r4Irr
resofi
orra6aroureil
io.touu"o
I{a AaHHI'xGUSTO- t'
3xorcaPtduozPaQtun
Bleqe6rrltxyl{peN(Aelrw]flx,HeI4MeIo[IIHXBo3MoxHoc.l]bupoBoAIITb
3KcTpeHHyIoKopoHapoaHll4of]]a0"*o,AJIflpeIueHIIj{BollpocaonepeBoAe 14
noATBepAI{Tb AI4arHo3
raqueHTa B KJII4HI{KY, rAo eMy MoryT aHrllorpa$uuecxu
t{Kg, qelecoo6pa3Ho IIpoBecTI4 AByXMepHyIo
BbrrroJrHr4Tb tap"tuno.
cefMeHTapHble HapyIxeHI'Lf,
3xoKapAr{orpa$uio, ,,o3Bontrcqyrc BbIflBI4Tb
r{To pefuoHaJlbHl;Ie HapyuleHut
coKpaTr4Mocltr4 CTeHOT( MtroKapixa. vcranonrleHo'
B TeI{eIIHe HecKOJIbKI{X MI4HyT IIOCJIe
coKpaTI,IMOCTII MHOKap.4a BO3HIKaIOT
pa3Britrrfl HeKpo3a. ,{eyxrraepuax
ropouapnoii oKKJrro3a'r, To ecrb 3aAoJrro .qo
ecJIH oHa He 3aAepxuBaer
,*onupirorpaqnx BbrrroJiHfle'rc' ToJrbKo B Tex cJlyrlaflx'
CpoqHo BbIIIOJIHIITb 3KCTpeHHyto
lepeBoA 6Olr,soro lB KII{HI4X.y, fAe MOfyT
IIOMHHTL' qTO pefI4OHapHbIe
KOpOHapoarrftrofpasuro. Tar<lre seo6xoAuno
Hecrequdxlunu roJIbKO Anq
HapyllreHlIfl coKpaTrrMocTll CTeHOK MI4OKapAa
y IaIII4eHlroB c I4lxeMuefi MHoKapAa'
unQapr<ra MHoKap,qa, Ho MollyT 6ltrr
paHee uu$apr<ron :r'n:a
py6qonlrvr1 I43MSHSHI4gMI{ tIocJIe nepeHeceHHblx
11
HapyrreH
r4flML|
npoBoAI4Mocrtr.
BHyTpl4x(enyAorrKoBofi
l{nYxrraePHal
ro3Borqer AHafHocrlrpoBarb vlri'l
I4CKrrOrIarb TaKI4e
3rXOK?pAr4ofpaor4fl
aptepwu u
3;a6oneBaHl4f,, ICaK IIeplIKapAIIT, MaccuBHa.f, TpoM6o3M6oIHs neroqHoi\
paccnoeHr{r Bocxoprreii aoprbr, Koropble Moryr 6rtrr npuql'IHoii 6ol.n B rpyAHofi
npH
IilrerKe. Orcyrr;ru4e ilpr43HaKoB HapyrueHl4t tloABr{xHocrl4 creHKI'I MHoKapAa
prcKJrroqaer Bo3MoxHoclb Haluqux o6urupHoro
AByxMepHofi exor<apAuorpa$uu
uusapr<ra noronup4u. B in.tp."tt"t^ cl4ryallnux .{-ltt aHQ$epesqualruofi
leroquofi apreplIn
,IgarHocrr4Kr4 ocrporo paccJloeHtaifi aoprbl ra rpou6osNaSoJllau
ucnonb3yercfl KoMrlbrorepHat roMorp a$un.
'fa6nuUa
l\4
eTono B
B
6
14
3y
Peroueu4 ar\r4v
€l.q tI 3
|ro
npoBeAeHl4ro 3xoKapAHorpaor'u
v
Apyrr{x
aLIVtVl
PercoueuAautrH
flpr.r Aocraer!g_!3x494Ta B cralluoHa
B ocrpofi Saee, Korla AuarHo3 HeflceH'
Mo)r(er 6rtru rone3FIa Heor.IloxHat
llp"
ee
sxoKapArrorpraQur.
HeAOCTyIHOCTIT UnH HeyoeArrreJlbHocrr{
14 crofrrux coMIr€,HIafX, cneAyer
HeoTJtoxHyIo
paccMorperb
flocle ocrpofi da:rt
Bce rauueHTbl AonxHbI
npofiru
3xoKapAlrorpaQraro AJI'I oueHKI4 lla3Mepa
nusaprua
SYuxulzu JIeBoro
kr
XCNVIOIIKA B TIOKOC
Ecrn 3xoKapAlrorpa$zr HeBo3M()xHa, B
KAIIECTBE ANbTCPHITTI{BbI MOXHO
LlCUOrIb3OBaTr, MafHu'fHo-pe3oHaHcHyIO
TOMOfpa0I4K)
O IIJIII IOCJI€ BI'IIIIICKH
!.rr- naIIueI{ToB c N[Horococ]'AHcrblM
nopaxeHl4eN4 l1.Ir]1I B CJlyqatx' KofAa
paccMaTpLlBzrerQs. peBacKynflpv3arJldfl'
IIOKA3AHb]
cocyAoI!,
,4pyfl4x
Harpy3 orlrrlt e upo6bl I{III{ BrI3yanI43 a\krfl'
(uauprauep, c ucroJIb3oBaHI{eM crpeccuep$ysuoun:ofi cIIHHTIzoIPaSuu
M14OKapAa, crpecc-3xoKapAuOrpaQuu,
no3l{rpoHHo-3Ml4acuouuofr rou orpa$uu
unr4
MPT) Anfl oIIsHKlr ntueMr{Il
vr
xr43HecrIocoSuocrH.
Kounr
)r41ecKAfl,
l2
aHfr4ofpaor4r
He r4rpaer ponrr
rrp]a
pyrt4HHoM BeAeHHrr narlzeHron c OKC c
[onbeMoM celuenra Sl1
3.5. florca:a u vfl ailr, KoHcyJrbra qn u creqrraJrlrcro
Kapduoxupypz
onpe,{eneHr{e
xupyprurrecr<ollpenacKyn{pu3arlr4r{
B:
nora:alrlrfr
K
B paMKax KoJrJrerr4aJrbHoro
petrreHufl
(rcap4uonor * x:apAr4oxr4f)ypr * aHe,creguoJror + r4HTepBeHu,r.roHHbrfi xap4Honor).
3udorcpuuoJtoe - Ar4arHocr.KKa 14 JreqeHrre napyurenufi rJrrrKeMrrr{ecKoro
craryca, JreqeHHe oxr4peHru 14 Ap., o6yueune rlaqlreHTa [pr4HrrurraM
I(r4err4r{ecKoro r:^Ta:nlarr, [epeBoA Ha rer{eHue r{HcynuHoM KoporKoro 4eficreur
il ep eA nJr aH o B o r"r xupyp rl4tr e c ro fi p eB acKyn tpuzague it.
Heeponarnoroz Halrv-ur4e cI4MIIToMoB rtopaxe.Fru.f, roJIoBIIofo Mo3ra
(ocrprre HapyueHr.rf, M03roBolo rponoo6paueHr4q, npexoArrrlue HapylxeHIrr
N{o3roBoro KpoBoo6parqe:nur, xpor{HqecKue Sopvmr cocyAacrofi narorlorulr Mo3ra
ll Ap.).
- :aaJrkr.r'ue cuMrrroMoB perr{Horrararr (uo nor<a:ranuxw).
Aueuoxultypz Ar{arHoerr{Ka vr reqe6srre peKoMeHAar\Lrv
Orcynucm
arTepocKneporr4rlecKoM rr)paxeHr{14: nepu$eprzqecKl{x aprepr4fi
,fpyzue ysKue cnelluarucmw - rro IIoKa3aHI4tM.
1.3.6.
fu$QepeHIIHarrbI{srfi 4uarnos
lfa6nuqa 7
HeceDne
_____--!-:L
-
npl4
.
:
llu$$epeHrluanb:aafl Ar{arHocrrara OKC c ApyrHMI{ cepAeqHbIMrI
q H brML[
3aooJle
Bet
11
HVTflMU
rCepAe'IHuIe
JIero.rusIe
felrarorof
.MuoxapAnr
.[Iepuxap4rar
Tpou6oeM6orn-f, eerneil
Cepnoua4Ho-
leroqHofr aprepvlr
KJICTOI{HA' AHCMTI'
r.IqecKHe
IrIn$erpr<r JlerKoro
T'T4fl
.KaplNorravrorrulr4,
)poK cepArla lhiesNaoHHs
Kranasustfi nopo
Anuxartrnoe pacIxupeHr{e llneepnr
cep.4rIa llnesNloropaKc
BepxyrxKl{
(cunApou
Tar< ouy60)
)pTbI
Paccroesue aoprl
prbl
Aueepv:ua aoprr
cpTbI
Koaprraqkrfl aop"r
I"TI{PHbIE
I-lepebponacK)'rtl
sa6oreeaHlas
XenyAoq Ho-Krrur e9H bI€
lluu,:eoAHbre cIIa3MbI
flzsa
xenyAKa
ABeHaAIIarnnepcruo[
OproueguqecKlle
Lllefiuaq Al4cKorarl4t
u llepenou pe6ep
IIonpex4eIIre
K14IIJI.:U
BOCIIaJIeHI4e MbIIXU
llaHrpearur
XoreuucrHr
Pe6epnrtfi xougpur
t4. I{eru fleqeHlrq:
l3
Cnoenpe.lIeHHoe y(lrpaHeHl4e I4lrreMr4r4 c rrocneAyrorrlr4M npeAor,BpauleHueM
cepbe3Hblx 0c.lroxueuiafr, TaKIX KaK CMeprb, noB'ropHbre I4M
x
I{3
Heyfp o)K arc
rrlr4
v.
e apvTMtlu.
15. TarcruKa reqeHrrfl:
I 5.1. HeuelnxraNreHTo3rroe JreqeH ue:
llaqzeuraM co 3HutrII4TenbHbIM nopaxeHrreM JreBoro x{eJIyAor{KiI AorxeH
6rtrl rrponl4caFl nocreJlbHrtfi pexcuM Ao rex rrop, rroKa He 6y4yr oLIeHeHbr
pac[pocrpaHeHl{ocrb H T.f,xecrb rznQaprra MnoKap.ua, o qenbro Br,rrBJreHH-{
pauuefi cepAerlHofi ue4ocraroqHocTr Lr apLrrxruit. B ueocloxHeHHbrx cnyqarx
n:aIII4eHT MOX(er CHAeTb I] rrOCTeJrH yxe B rrepBbre AFrr4, noJrb3oBaTbcr KpecnoMTyaneroM z cal\,{ocro.sreJlbHo o6clyxunats ce6g, u caMocrorT'eJlbHo rrr4Tarbcfl.
Elcraearr naqHeHTbI 3a.rracryro Har{uHaror paHo (oco6euHo rraqueHTbr, y
Koropbrx 6ur nlrunreHeH paAuanbHufi 4ocryu).
Pexolreu,qyeMa Ar{era:
ynorpe6reirze trrrpoKoro cneKrpa npoAyKroB;
- KoHTpoJrb 3a xa.nopufinocrbK) rrLrrJJr4, no zs6exaHr4e oxr4peHu-f,;
- yBenl4r{erll4e uorpe:6reHIaa (rpyxroB r4 onorqefi, a raKxe rlenbrro3epHoBbrx
Kpyn 14 xlIe6a, pu6u (oc<l6euuo )Kr4pHbrx copron), rocrHoro N{rca 14
-
He)KrrpHbrx MoJIoqHbIX npoA)'KToB;
-
-
-
3aMeHIzTL H€ICbIxl€rHHbIe )I(I4pbI U TpaHC-XtI{pbI, MOHOHeHaCbIUIeHHbIMI4 Ll
IIOJIIIHeHiICbIIIIeHHLIMH )KlIpllMI{ II3 OBOIIIHbIX II MOpCKI4X HCTOTIHIIKOB, a
TaKx(e cH:r.I3I4Tb o6uee KoJrr4qecrBo xupoB (n: rorollblx MeHbrrre, r{eM oAHa
Tperb Ao.tIXHa 6rtrr Hacblu{eHnrrrrara) Ao MeHee 30oh ot o6rqero KoJrr4rrecrBa
norpe6nrreNrbrx r<arropHfi ;
yMeHbIxe)I{lIe uorpe6reuzr: coJrlr, [pr4 yBeJrr{r{eHrzr4 aprepr4aJrbHoro
AaBneHHrL EomuraHcrso nonyoa6puKaroB yr rorroBbrX 6nrol, coAepxHr
rroBbrrrreHsrrfi ypoBeHb coiur rr xnpoB coMHr4TeJrbHofo Kar{ecrBa;
a
HopManb.FrbrM crrnraercfl r4rrAeKc Maccbr rera (I4l\4T) MeHee 25 xrlwr"w
peKoMeH,[yer cHr.DreHr4e Beca npu I4MT 30 xr/v' z.ru 6olee, a raK xe rtpn
oKpy)KHocrr4 Talrurt 6oree 1(12 clr y My)Kqr4H trrrr 6o.lree 88 crr.r y xeHrrrr4H,
TaK KaK Cr{rl}KeHr{e BeCa MOXeT ynyqrxl4Tb MHOfrre, c.Bt3aHHbIe c oxr.rpeHneM
Sar<roprr pucKa.
15.2, MellrrcalreHTo3Hoe JreqeH rr€) :
Ta6nuqa 8 - P'exoMeHrarrIHZ Anfl KynupoBaHufl 6oresoro cr4HApoMa, oAbrrrrKn
rt yBcrBa rpeBofr,r y 6orsuux ocrpbnM raHQapxroM MHoKa na
PercoueHAaur,lH
Kracc'
l'poeeHs
a
J
2
C:
An
{ns o6e:6onuBaHr4fl noKa3aFrbr BHyrpr4BeHHoe I
BBe.{eH4e rHrpyeMbrx glr4e4.qoE:
Kncnopo4 rrpn
EH
cr{MrrroMos
Bo:iHHKHoBe.H:r^LT oAbrrxKu
or;rpofi cepAerrHofi ne40craroqHocrrr
ft4
f r4rroKcr4r.r co c r{r4xeHr4ervr s ao
f9
V
I
C]
vl
lio/o
IA
IT
It-I ryh
IIO'BJIC] IT4L1
Y
TAIII4
CHTOI] OqEHb
BbICOKOiI
LTpeBoxHocrr4 Ha3Haqaror rpaHKBktnrz3aropbr
n/n: nuyrpr.rBerrHo ; S aC)2,= caTypuprosauHrrfi HacbruleHurrii rzcnopoA.
l[,rn nyuupoBarHus 6otr^
rroKa3aHo ruTpyeMoe BBeAeHHe orruongon (1c)
MopQuu - ilpu npoAonxatourefic-f, 6onu 4-8 lrr Erle c AononHr4TenbHbrM
BBeIeHI4eu 2l',lr qepe3 KaxAbIe 5-15 ruun B 3aBgcr.rMoorr.{ or HHTeHcr{BHocrrl
6olenrrx oqyqeHrrfi go lrynnpoBarrr4r 6otu rlnkr rrorBneHr{rr no6oqnux e$$exron.
llo6o.rHrre a$Sercrbr or BBereHr{r lrop$una:
- ToIrIHora, pBora, frllloreH3vfl;" e 1paguxapgnei- r{ yrHereHpre [brxaHkrfl;
-
-
napaJlne-[bHo c onuol,IAaM[r An{ Mr4HHMrr3HpOBa.HHr TOrrrHOTbr Moryr
BBoAlrrbc)t nporuBopBorHble cpeAcrBa (ueroxlorpatyt{A 5- 1 0 mr e/n);
fr4froreH3r{r u6pitp|urcaprvs, o6rr.rHo orBeqaror Ha arpon}rH;
npl4 yrHr3TeHZI4 AbIXaHut rlBecrr4 HaJroKcoH (0,1-0,2lrr sle r(axAbre 15
MuHyT, npH iloKazaunxx);
AaHHbre npenapa'lbr BcerAa Aon)KHbr 6rrrr AoclynHbr,
flepnu'rnoe KopoHapHoe BMerrrareJrbcrBo oKcrpeHHar lrpecKox{Ha-fl
KarerepzsarJufl npla zHtlilpKre Mr4oKap,qa c rroAbeMOM cerMeHra ST rra 3Kf 6es
rlpeAlxecrnyrorqeit Qu6parIoJll4Tlrr{ecKofi repanw1 flBrrflelcf, [peArrorirr4TelrHofi
raxruxofi penepSysr4vr rrpr4 ycnoBran BbrrroJrHeHr{r B [peAenax ycrauoBJreHHbrx
BlpeMeHHbIX pa.:vIOK He3aBI4CI4Mo CrT TOro nOCTynaeT JII4 narlr4eHT B 6Onrnuqy
B.blnoJlHf,roqyrc IIKB. llcnu naIII4eHT nocrynaer B r{eHTp, He nunoluxrorqufi
rlKB, rpaHcnop'rupoBKa qepe3 cxo,pyrc noMorub e ra6oparopurc Karerepr43arJzrrl
AOnxHa rlpolr3lloAtlTcfl HeMeAneHrro. llpe4rror{Tr4TeJrbrrbre BpeMeHHbre paMKr4 or
nepBoro MeAuqrHcKoro rioHTaKTa Ao nepBr4r{Horo ql(B <90 nanu rz < 60 Mr4H rrpu
preHHeM nocryrtneul{u naul4eHTa {2 .racoe c MoMeHTa Bo3HlrKHoBeHr4.f, rcuMrrroMoB
sa6oresaHnfl tr,c6urupHoii soHofi nu$apr<ra.
llepnuvnoe r{KB qBJrrercr peKoMeHAyeMbrM Br.r,4oM penepfy:nouuofi
Teparrvr4, B cp,aBHeHuu c $u6pnrrorurH.Iecrofi repaulreft, ecJur BbrrorHrerc-s
o.urrrsofr xonaaH4ofi B rerleHl4e 120 MI4H or IIVMII (:i90 Mr4H nlpu paHHeM
fr,ocrrrJreHuu c 6r>tslrofi soHofi plrcxa uurenrnu)- IA.
llepnuvHoe r{KB iloKa3aHo y [aqr{eHroB c 'r.aNerofr ocrpofr cep4euuofi
HI3AOCTATOI{HOC'II4 HNH KAPAI4OfCI{HbIM IIIOKOM, KPOBE CNY9:ACB, KO|AA O)KHAACMA-f,
3alepxKa, cB.f,3ilHHas c q.KB,
CJIIIITIKoM BeJII{Ka )
HI]TIAJIA CI4MIITOIV{OS SA6OICBA]Ij^]afl
v
rrar\r4eHT
nocryrraer lpaHo flocJre
- IB.
KarrecrBe nepBztqHoro r{KB peKoN{eHlyerc-s creHrr4poBaHr.le (irexenu
ToJrbKo 6allouuarr aHrrronlacrnxa) - IA.
B
Acnupauru rpom(ia - IB.
Pexontesltyercn t,toIIoJIb3oBarb creHTbr, coo'rBercrByarrlue c.neAyro[Ir4M
,TEXHHI{CCKI4N{
YCNO BH,fl M
:
l5
Crenr KopoHapHbIfi
c JreKapcrBeHHLIM rIoKp['ITrIeM
Ea-rrnonopaclxupfleMblfi CTellT C neKapcTBeHHbIM IloKpbITI{eM 3BepOnIIMyc
Ha cIIc'IeMe Ao()raBKI4 eirrcrpofi cMeHbI AnlIuofi 143cv' Marepan
xo6alrr.rpoMoBbrit cnnaBl-605, roJruluHa c'IeHlKI,l 0,0032", Marepuan
6anroria - P"bu*. llpo$unr, ilpoxoxlteH]/lfl. 0,041 ". llporcuMan:bHblfi xla$r
0,031", AI{cTaJIbHbIt 0ii4".HouIIHaJIbHoe AaBJteHHe 8aru Anfl 2'25_2.75wxt, t0arrr,r Anfl.3.O-4.0urt. ,{arneHue pa3pblBa 18 aru. fltraua or B Ao
38ruu. fllrarr,rerpbl or 2.25 1,ct 4.0nvt.
2. MarepuilJr creFrra xo6allr-xponaonrtit crIJIaB L-60:i. Mareplral 6alloHa
Fulcrum. llor<ptrl cMecbro JreKapcTpBeHHOfO [peilapaTa 3oTiaponHMyc 14
Toryquua 1"ei4KpI 0,091u.r4 (0,0036")' Cucreua
nonr4Mepa
KaTeTepa
AocTaBKI,I .qlnnoft 140cv. pa3Mep npoKcI{MaJIbHorO ura$rla
0,69urr,r, AHCTaJrbr{ofo Urasra 0,91uu. HolrunalbHoe Aaene.F{Iae: 9 aTM.
15 aTM. [nfl
,{aueurae pa3pblBa 16 aTr{. Anr .4rraMeTpoB 2,25-3,5 MM,
creHra (t*t)
AlraMerpa +,0 uv. Pa:vrepu: AI{aMerp or 2.251o 4.00 vI Anvna
1.
-
gittinx.
-or8lo38.
'l'Olrqltua crelroK creHTa rrJrarurro-xpoMoerrfi cnJIaB.
0.0032", J[er<apcrBeHHoe noKpbrTr{e creHTa crocrol]T I{3 AByX rlonHMepoB I4
'fruulnua lonuMepHoro
neKapcTIleHHOro lpenapaTa 3BepOnIIMyc.
noKpblTrlq - 0,007 ruu. lIpoSI4JIb cTeHTa Ha cIIcTeMe AocTaBKIl - se 6olee
0.042,, (ln" creHra Ar4;aMerpoM 3 rrau). Marcuualrnufi AlraMerp
pacnparlneHsofi qqefiKr{ cre)HTa - He MeHee 5,7J nrvr (4nx creHTia Ar{aMerpoM
i,00 rr..ur'). ,{uave.rpbr creH'oB - or 2.251o 4.00 rr,'ul. .{luHa creHroB - or 8
.rro 38 MN{. HovunarbHoe AaBneHI4e - He MeIIee \2 aTM' llpe4e:nuoe
.[aBJreH]de - He MeHee 18 aru. llpo$unr KoFITITIKa 6al.noHa .qocraBntroqefr
cr4creMbr creH'ra - He 6onee 0,017". Pa6oqafi AnI{Ha 6alloHnoro Karerepa,
Ha KOTC,pOM CNIOE:TI,IpOBaH OTeHT - 744 cvt.
4. MarepHaJI creH'Ist: Ko6anbr-xpoMonufi cnlan' L-60'5. llaccusurle
noKpblllde : amOp cpnrrfi cltlr'Ixou-rap6l{A, aKTI{BHo e noKpbIT}Ie :
3. MareprraJr crerrra
-
6uo.4erpaa"py*utfi nolulaKruA (L-IIIIA, Poly-L-Lactic Acid, PLLA)
BKlloqalo ryufr, Ctrponl,IMyc. Tolulnua KapKaca cTeHTa HoMHHaJIbHbIM
npoSunr
Ar{aMerpov2,0-3,0 MM He 6onee 60 Hrxrt (0,0024"). Kpoccunr
creHra - 0.039"(Cl.9g4 urrl). [nnHa creHra:9,13,I.5,I8,22,26, 30 vvt.
Houuuanrnrrii A aaMerp cr eHroB : 2.25 2.5 2.7 5 3 .0 3 .5 4 .0 rulr' luarraerp
qacru(upoSunr BXoAa) - 0.017"(0'4318 uu)'
Ar4cranbHofi ropqeBofi
pa6oqafl [nkrHaKarerepa - 140 cu. HonrltHaJlblroe AaBJIeHI4e 8 aru.
1
1
1
1
1
Pacqersoe AaIlneHI4e pa3pI,IBa 6allosa 16 allt. [uauerp creHTa 2,25
rrpr4 AaBna:H:|ILr,8 AruocQep: 2.0 MM. AuaMerp crerlra2,25 MM npl4
AaBJIeHIIn l4 r\rturocQep: 2,43 tnttu.
wrvr
CreHr KopoHapsulii 6e:r ;rercapcrBeHHoro roKpl'ITUfl
1. Eannogopu.-"pxerrtrii CreHr Ha CI{CTeMe 6r,t,:rpofi AocTaBKH 143cttl.
Marepraar crerrra: HeMarHHTHbIfi xo5a.:mr-xpoMoBblfi cIIJraB L-605.
Marep,za-u 6ruuoua - Pebax. Toruluua crerIKI4:0.0032" (0.0813utu).
-v'
t6
{;' /-
[rzanrerp: or 2.0 Zto 4.0 nu. ,{nuua: or 8 Ao 28 ruu. flpo$I,IJIb creHra Ha
6allose 0.040" (creur 3.0x1 8rtarra). lIporxNeHHOcrE, pa6ouefi rloBepxHocru
6arrosa 3a Kpafl creHra (batrloon overhang) ue 6on<le 0.69uvr. I(ounlaunc:
HoMr4HaJbHoe AaBJreHHe (I.IBP) 9 atu., pacqerHoe AiIBneHr{e pa3pblBa (RBP)
16 arnl.
2. Marepuat crerrra xo6alrr-xpotr,tonsrfi cnJra.B L-605. Tolurptna s'aeirxu
0,091rrlu (0,003ti"). Culerta AocraBKII Alnsofi 14Ocrul. pa3Mep
3.
npoKcr4Mil,rlbHolo ura$ra Karerepa 0,69rrav, ,{HcralbHoro rua(lra 0,9lrtlrra.
HouuuarbHoe AaBneHr4e: 9 aru. faereuue pa:lpllBa i6 aru. [nfi;. [vaMerpoB
2,25-3,5 rrlnr, 15 arru. An{ Ar{aMerpa 4,0 rr,rnr. Pa:vepbr: AHaMerp Or 2.25 lo
4.00 u ArrLrHa cleH'ra (t"ru) - or 8 ao 38.
Marepu€rJr creHTa - HepxaBerorqat craJrb MapKrr 3ltiL Ha cllcreMe 6ucrpofi
AocraBKr4 4;rranclfi l45crtn. Hanu,aue M noKpbITHq Al4cr€ulbntoro uiaSra
(rpoue creHra'). fuzaitu cucreMbr Aoc'raBKH
rpexnerecrronufr
6allosulrii xarep. Toluluua creHKr{ creHTa, He Cionee 0,08 uvt. fiuzaim
creHTa --orKpbrrax sqefixa. Halrnqne HH3Koro rrpo$ulx 0,038" [Irfr creHTa
ArraMerpotr 3.0 vu. Hol,rlrHaJrbHoe AaBneHHe fian1qrH& 9 atm AJIfl AI'IaMerpa
4 rr,rvr H 10 atm Antt AI4aMe'IpoB or 2,0 4o 3,5 NIM; AaBJIeHHe Pa3p'riea 14 atm.
fuarvreql [poKc]r\4aJrbHoro uaSra-2,O Fr, AucranbHorc>-2,7 Fr ,.{uanaerpr,l:
or 2,0 Ao 4,0 f,itwta or B Ao 30 rnln'r.
fleperavrroe I{KB AonxHO orpaHnqr4Barbcfl, Iz:uSaprcr-cB-t3aHHofi, aprepwefi,
3a r{cKJrroqeHr4eM cnyqaeB KapArloreHHoro rq\uror<a H nepcllc'rupyloulefr uurevuu
ilocrre r{KB- IIa B.
Eclu BbrrroJrHrercs orrbrrHoM oleparopoM Iro nyqeBoMy Aocryrly, nyvenofr
r{eM 6e4peHnrrii- IIa B.
,(ocTyil AoJIXeFI 6rt15 ilpeAlor{TI4TeJIbHee,
Ecnu y ilarlgerlra orcyrcrrlyror rlporl4BonoKa3aHl,lf, K AJITITeJITHofr AATT
r[noxa:auue Anrr opanruofi aHTHKC]afyJTflrJkrv I,IJIII Bblcoxnii ptlct< KpoBrcrer{eHl4fl tlo
[rKaJie CRUSI\DE), lr oFr, rro-BrrAHMoMy, 6y4er BbIIroJiHtrb peKoMeHAaUI{u, creHT
c neKapcrBerlHbrM loKpbrrr4eM Aon)KeH 6rtrr rtpeAilotlTureJrbHee creHTa
MeraJrJlrrqecKolo 6es norprtrus- IIa A.
cne4yer: paccMorllerb pyrrlHHyro acnr4parlr4ro rpou,6a- IIa B.
Pyrranupe ucroJrb3oBaHr4e Ar.Icra-lIbHbIX 3arulITHbIX yclpoficrn He
peKoMeHAyercrl-
III
C.
Pyu4HHoe ucro.rrb3oBaHr4e
peKoMeHAlorC'r-
BAEK (V
III B.
HeueAleHHa{ a.nruorpaS.aa
c
uat-luelFlroB
6e: ruoxa) He
nepBl4'{uofr r{.KB peKoMeHAyerct y
laqrreHToB, poaHr4MrzpoBaHHbrx noc.rre ocTaHoBKI4 CepAU€t C npI{3HaKlaMU I',IM CII
ST na 3f- I B.
HevreAleHHa{ aHrr{orpaSrax c nepBuqHofi r{KB AonxHat paccMarpvBarbQs'
NOBbIIIICHI4'
\
rv\/r4-rvvr\vr
6eg Altor
If,CT?HOBKII UsPAIl4
,II]{AfHOOTI4IIECKOfO
cepAIIa \,vr
llOUJl€ UUla-UUIJI\.r1
y BbI)KI4BIIIr4X.
BbIxtl4BIIII4X. IIOCJIE
cerMeHra ST na 3KI-. Ho co 3rraqr4MblM rIoAo3peHI,IeM Hia reKyxlufi lan$aprcr- IIa
B.
TepauesrHqecKar rnnorepMHfl rroKa3aHo paHo IIocJIe peaHuMalll{u [pLI
ocraHoBKe cetr)AUa y narIHeHToB B KoMe HJII{ cocroflHzrr4 rrry6oxofi ce.uarlnra- IB.
t7
flepnuuttoeKopoH.apHoeBMeIIIaTeJI".]::-:lTI4MaJIbHaf,cTpaTeI.IIflJIeI{eHI4fl
repanuu' HaJrvltruv oIIbITHoI4
n
Sr^6pr'ruornnTn'qecKofi
KapAHO'OTOB I,I r<nzurHSHl'I{pOBaHHOf0 ''ep.On-3
KoMaHAbr r4HT3pBeHUI4oFIH'IX
cTaUuoHapa c pa:nu'rofi I4HTepBeHqHoHHoll
orAe:renuir KitpAlaopeal{uMaIII4ll,
qKB B KarlecrBe pyTI'IHHOfo
IiepBI4r{HOe
nporpauMOfi (2417), BLIloIIHflIOtqeIo
MI4Hyr or
MoxHo paHbllre (n reuenue 30-60
ST'KaK
CII
O'CC
MeroAa rruu".nru,noi
el:'zLfl raIII4eHTa (IB)'
qKB
MoMeHTa rlepnulllloro o{5paul
IIepBIlqHoro
[poqeAypbl
IIOCle
Teparln,'
PyrnHUax aHTLIKC)afyJIfl H' Hat
[pr4 rrpor""orronroui"r"'
HeIIoKa3aHa,3vI{cI{:JIIoqeHI{eMHeKoTopbIXKIIuuqecKlIXcutyll!:ailKo|Aa
Antr aHT'I4KOaIynflI\L,V (d[ra6pulltst*fl
r{MeroTc{ cfleurraJlbHl,Ie IIOKa:]aHH{
KJIaIIaHoB' rpou6a JI)I(', oTcpoqeHHoe
npeAoepAr{fr, Halluque MexaHI4rIecKI4X
BeHo3HoII
qex,,a Ar' creH,.a) uttu
'posI{JIaKTI4KI{
u3Brer{eHr4e :}aul[THorr)
^ru flocflereJlbl{oro pexl'Ma'
AJII{T.JIbH.I'.
rpe6yrcqlrx
y
naqr4eHroe,
rporurdosrnr6orrur
Ta6tuuag
I
BHrlHoM
re
- 4f: "lgqy6oruqecxar
PercoueHAalll{Iil
AnruarPeraHTHafl Treparrrrfl
IIJII{
PerorueHAyorctt acrIIlpI4H rlepopanbHo
n/n ( npu He Bo3rvIoxHCgIgJ4gIS:!
6loraropa
PerouenAy3Tclt tutt"u.rt""t
K
Afi@-peuelrropoB B AoIIOJIHeHI4e
:
acltlpl{Hy. Cne.qyro ru,I{e Bap}rgrrbl
Traratper
o
KlorIlI,uorPeJIE', KofAa rlpacyfpenb
r4lrr4
vfirvr Tl4B:afpelop HeAocTyrIHbI
BOfICTK&3&HbI
AsrunoaryrIlHTHa j;I TeParlutr
IrlnlerquoHHble alrll4Koary:rfl HTrI AoJIxHbI
qItB6rrrl ucuc,lb3 gEsg! rIpI4relDq{HeI"I
peKoueHAyercx 6olee' uev
Eunanupy,[I{H
uespar<uuoHl't
ponauurtfi tti?,p1,",
nnru6lrro Pary41ngion
SHorcanaPtaH Moxer
urra
ubl
IIb/IIIa
r
'Lt
qeM
tlpeAnor{T l4Te.iIbHbtNt,
n.SpuntlntoHllpoBaHsuft re uapgg
H-t6pu*utd oH I4p o B a:nnrtft ren apr{H
ucrroJlb3oBarl;ctr
Aon
xeH
y
[IaIII4eHTOB' He
6rananupyAtltt ulru
lonyqarcurl{}i.
3HoKcalap4!:
-IIe
@onAanaPIlH:YKc
c
peKOMeHAyerc{ AJrt
nepr4:H(lro YI(q
Irlcuoltlg,lBal{ue
14HOJIII3A
AO
r{KB
I
I nnauupYeMorr) nePBU
I oerouenAyerofl
.fa6nraua
10 [o:rr
,reperqHoNa LII|B
I
aHTI4afpeIaHTHat
tt
aHTI4KOafynqHTHaq repanul4 IIpII
Aogu aHruarrperaHTHr)u repafluu
--- A"* 150J00 tr nepoparllbHo
Y"Y*-'"^-- IrJII'I 80-150 ur e/n'
Y'uaPHax AU'
AcnnpuH
I tq"p"HeBo3M()x{eH, c [ocJIeAyIoIJ]eI4
I aa,n" nepopaJibu'fi npraeM
rouefi 4oaofi 75-100 U{498!
KronuAorpeJIb
o3bl aHTHKoaryrqHrlnori repaulllr
sls crPYfiHo, ecrll4 He [IilaHHpyloTcq
70-100
He$parql4on:up
nsru6uropbl rrll{Konporel4Ha IIb/II Ia'
osauHuft
50-60 Ea/rr n/n crpyfiHo c l{Ilfu6raropartu fnIIlKoIIporeI4Ha
fenapl{H
El/xr
Iltb/IIIa
KAIIEJIbHbIM
Fraealupy4urt
BBe.IIeHrrert 1,75 rrar/xr/qac 4,o
4 uilcoB rIocJIe rpoIIeAypbI,
KAK KJII{HI4IICCKU ONPABAAHHOC ICIICHUE'
ltr/xr/uac,
ransyarara 0,25 ur/'xr/qac r\loxer 6urr
)rMeHbrue HHafl Ao3a
rpoAonxeHa B Ter{eHue 4-I2 qaooB' KaK KIHHI{qCCKI4
Ilocne
rpeKpaq
ellfl' lrntpy:nra I,7 5
i ueo6xoAnvrafl.
@ u 6 p u u oJI Il 3
Ir
rr o cJr e Ay
lour lr e
BM
elrr areJr b crB a
penepoy:LIl4' B TeX ycJloBttflx'
@u6pnnoJrrr3 rrBJrseTcs Baxnofi crpareruefi
B I]peAeJIaX peKoMeHAyeMbIX
KorAa nepBl4tlHoe {KI] He MoXeT 6rtrr [poBeAel{o
c I4M cr sT. llpra orcyrcrBHl{ IlpoTt/IBOIIOTa:aui'tit
y
rrarlueHrorl
Tepalul4 Ha
neo6xogHrvro Har{aTb IIpOBeAeHI4e $u6puuoruruqecrofi B ATaIILIOHap
oco6esso ecJur rpaHOnoprr{poBKi}
.rlofocrrr{T&Jrr,HOM 3Ta[e (II a A),
ycnoButx:
safiN{er 6onee 30 rtl'tu, npu cneAyloqux
- 6 u' uo xpalfiHefr t\lepe ue
llpeMq OT gaqaJla aH|I4HO3HOrO npucTyna 4
cpoKoB
1.
Eclra
npeBbllxaet
72't;
0,1 mV, rar MI{HHMyM s 2-x
flX VIwr s 2-x oTBeAeHI{tX O'I xoueqsocreft
nOCJIeAOBaToJIbHbIX rpyAHbIX OTBeASHII
Ho)r(Krr rryqKa fuca (EJIHff) I4 Apyrux
rrJrr{ rrof,BJrf,ercfl HoB'fl 6nor<a4a reeofi
Z.
>
Ha 3I(f orMer{itercf, IIoAbeM cerMeHra ST'
BbIIueyKa3aIIHbIX H3MeHeHI{sx
3Kf (cu' crp' 7)'
xe cpoKl{ npll t?lKf rpr{3HaKax
Bee.qr:ntle rpovr6onnrlaKoB onpaB'qaHo B Te
l/fr\n (nrrcorue :y6urr It B npaBbIX [peKapAI{aJIbHbIX
r4crHHHOfO
3.
'ulrr..o
19
Aeltpecgl4fl cefMeHTa ST B oTBeAeHI4qX Vr-V+ c
"f).
HanpaBneHrIbIM BBepll ay6qo\a
4. @u6trruHorruTr,rqecKa{ Tepanr4r peKoMeHAyercrx B TerreHl4e 12 q or
orBeAeHH{x
Vr-Vu vI
noqBreHr4{ cnMrrroMoB, ecJrr,r ilepBr{qHoe r{KB r{eBo3Mtox(Ho npoBrocrrl B TeqeHue
90 uuHyr, rrpu Bo3Mc)xHocrr.{ BBeAeHuq Sn6puHolrr43% H B Ter{eHVe I20 MHHyr or
ilepBoro MeAHrIr{HcK()ro KoHTaKTa, ecJII4 Her npoTl4BorroKa3auuiL. lIpH no:4uefi
AocraBKe rraUHeHToEr (e qacrHocrrr IrocJIe 6 uacon) 6olee npeAilor{TI'ITeJIbHo
npoBeAeHrr() ilepBr4arFroro r{KB (n npolznoBec K SubpuuoJlrrruqecKofi repannu),
TaK rar< erpserr vr KJrr4HHqecKoe npeuMyilIecrBo Su6plrHolrv3a cHtaxarcrc-f, c
TeqeHHeM BpeMeHrI.
ITHOJII4:IUqCCI(OH TE
Ta6nuqa 1 I - llporuBonoKa3alr4fl. K
4.6corrortrsre
flpe4rr4yrqlre BHyTFruqepenHble KpoBopl3llvlflHvlfl rzlIkl laHc)'nbTbl HeI43BecTHofo
npoucxoxAeHl4t B nro6oe speM-r
ZureNrr.r.{e oxwfi. I{Hc}'nbr B np eAure creyru uue 6 x,{e cqq es
flonpex4er{He IJHII vrrv uoeoo6pa:oBaHr4t plrv arpl4oBeHrlplaKyupHble
TIODOKII
HeAasHqq oSuruprraq rpaBMa/ouepaqur/rpanua roJrollbl (n npe4utecrByloull4e
3 seAeru
Xteryloqllo-Klrrrreq]roe K BOTCqEHI,IE B TEI{EHI,IC NOCJIEAHE|O MEC'qA
BaeMocrlr (sa v cluroqerHueM MeHcrpyarI4I'I
ZseecrHoo Hapvuerlue c
Pacc:roeutre aoprbt
Paneune/rtpoKoJl, He noAAaloquecs, rIpHX?THro, 3o nocne.uHlae
H anp I4M q ?, 6vr9t9wl_ t t:tg", lro rra 6 alr s a-s nyr g u44
Oruocnre,'IbHLIe
,ro[t6e 6 vecsqr3B
afr pIIJletvIIM ecKilt aTAKA B npeAIxeCTB
ToaHsz
24
.uaca
JIf,l{THAfl
bHAfl AHTIIX:
eHHOcrb I{JII{ B TerleHae I ueAelu
nocle po,{oB
AprepuanbHa{ peQ'par<repr{afl rr4nepreH3rlt (czcrruuqecKoe allrepl,IanbHoe
AaBneHr4e >180 MM pr. ct. ulutu AuacroJll{qecKoe aprepl4anbH,ce AaBneHI4e
>110 mv lr. cr.)
Tqxeroe :la6orenaE:I4e net{eH}j
I4" S..tr^tgq!41tr{o Kap.qrIr
AKrueHar nerrrl,lqeoKafl. fl3Ba
r4T e nbIJ, irs. vrfir ^rpaB M I4p y ro rq at
HVIMAIfI4I
Ta6nuqa 12 - @u6pt HOII4TUqe0Katl'l'eparlut
Percouen,rauuu
Knacc
]/
rrporrrBoil9SsSqg4Hr
ilar-lr4eHToB
CCJII,I
o
a
@u6puuo[url4qecKil .f, Teparr4r peKoMeHAyerct B
TerIeHI4e z[ - 6 q. EIIe 6olee 12 \acos or Har{ara
CI4MIITOMOB
Vponeus
I
A
6eg
HCBO3MOXI{O
20
I{KB
IIpoBeAeHI4() rlepI]I4:qHOro
rolranlofi B
onuurofi
or
TerreHl4e 120 MI4HyT
fiepBoro
xeH:raKTa
p""t-rTot*"*" raqrleHra
MeAr{III{HCK9!9
IIp"
rrocJle rrotI]JreHI4q oI{MnroMoB)
ft--.:?::i:
c o6ruupunuvr
[plr
Teparuq
AuruarPoraHTHafl
ll6pltso.rll3e
6t't:rr
Ilepopanrrurrir. vtttu u/u u.tt"PI{H Aonxeu
BBCICH
KnouuAolllenb
AOTIOJIHCHI4E
rIOKa3aH
TepaIrrtl
AurunoarYrflHTHaq
0u6puuo'JrrI3e
AnruroalyJltul{t
FeKoMeHA)'ercs
ry)Ir
[auI{eHTaM co
JIer{eHI{Erx Sra6puuoJIrrrI4KaMI{ Ao
(ectu noxa:aHa)
rporleAyl) bI peBacx,yn"p" uu uu
B
vlfit B ToqeHr{e Bcero BpeMeHI4 upe6rtnauvfii
STEMI,
craul4oHitPe, Ao 821neil
AsrnroarYJItHTaMa Mo
3HorccanaPnH sls
BBeAeHI4()M (pexutvt
6rrrr:
c
ilocJieAylour{M U/r
yKa3aH nnNe)
(upe4no'rrI'ITeJIbHee'
roHrrpoBasurtft reII aPr{H
o
qeN{
fenapl{H
cKoppeKTl4poBausofi rlo Becy
aIrH blrr
ntttPPar\r{nvnrrLYvP*LLL'*"'
He
$p ar<ul4 o lt{tlp oB
Ha3Haqarlrct B Ao3e
sls crp'yfino v':wr KarIeJIbI{o (noA
KoHTpoireM
crpenroKunasoit,
e/s crPYfiH<l c
24'aaca
Ta6:ruua13l{oarrallTl{afperaurgofi:[laHTHKoafyllHruofiTepa\I4VIIpI4
6r.r6putttlill'I3e
I
Iorut sIIT'lIarpelaHTHolI
Te
21
---.r
Acnupuu
KlonuAorP':ltl
O3I'I AHTIIKOA
CraproBatl Ao3a 150-500
'75 rr,lrhesu u
bHo
-nqltrHofi TeParrIIII
HeQparcul'1c)I{rlpo
vr
ffiiiffiffi"i.
MaKcr4M\/'ton 4ooo
;;1"; ;;;;ililo'
13
EA, c nocneAyrott* s/e^ Ka''t"bHbIM
saHHufi rerlapun
*tTilty,
1000 r\rfrac B rerreHue 24-48
paza
qacoB. l{enenoe iqfgt 50-70 oeK I'1rIr{ Y 1'5-2'0
24
qeM rrcxoAHo I4 c KoHTporIeM Ha 3' 6' 12 u
Bbrrrre,
V naqueuros <75 ner:
I{
30 ul n/n crpyfiHo, qepe3 15 rurnnyr
3norcauaP'ltrt
Aa^rlee
1vr/r<r
,r/*nur,ose12qacoBlloBbIrIlrcKI4I43craul4oHapa'
lleperte ABe Ao3bI He
MaKcrlMaJrbHo B'reqeHge 8 4Ue[.
rti"
Aonx{HbI rIPeBbIIxarl 100
V naquenroe >75 ner:
0'75 nr/rr'
B\e 6oruoca Her; Har{arb c nepeofi n/r '4o:u
n/x Ao3'
MaKcI4Myu 75 ur AJIfl rIepBbIX AByx
ul/tr'lun'
Y uaqlleuroB c KnlrpeHcoNr KpearuHtrla'<30I paz u 24
BBoA{Tot
He3aIlI{cLIMo or uorpua'u, u/r< loslr
Ao:ofi 2'5 r'lr n/r<
ffi" *" O**., c noc;leAytorr1efi
ElbIrII{cKr{ I'I3 craul{oHapa'
1
@o"4uttullltuYr<c*
pa3 B AeHb, ,qo 8 ,qnefi LInI{ Ao
(upto
rrToKldHa3e)
24 -tacoe or Har{ara npncrvna (lA)
ffi##ffit;k"*A-@
r
p ow6 o
tt',;::;:::T;:ffi1ffi
o rrp e n ap ar p acrB op{ror n 1 0 0 pu"ruopil xJIopI4Aa Harpnx) no cxeMe
il (up e4n apr4r
6/o
0,9
200 rr,rn Ar4arvrrrrvrponauHofi BoAbgn,
e
JrbH
<5oruoc*nn$y:ral;'>..{o:alperaparalur/r<r*uttt'"nu(noue6oneel00rtlr):
30
uHSy3rtfl' 0,75 rtr/rr Maccbl rera sa
6oruocno BBoAr4rcfl 15 ^nr; ,ro.n.iy,ou1ar
ur/xr (uo ne 6olee 35 ur) sra 60 rvruH (o6u1ax
vruu (uo r.e 6olee 50 rrr), 3areM 0,5
ilpoAonxllleJlbHocm nHQystrv - I'5 u)'kltru
(
60IIpI4 Macce TeJIa 60 :rr, 35 lrr npra
Teuercmeruta3a- BHy.tpI,IBeHHo 30 rnrr
) *'
80-90 *' 5Cr nr rpI'I M&rcce rerla 90
70 rr, 40 ur npra 7rJ-80 ri; 45 *. npra
" 5 - 10 cer' Y'{Urrtnag 6olee
BBOAI4TCfl B IlI4Ae 6olroca' B Ter{eHIIe
rpe6yeuafl .4O3a
AJIIITeJIbHrtfrnepuoAIIon)/BbIBeAeHu{I43opraHl43ManpeflapaTI4cllonb3yeTcflB
r{To oco6euH'o }['c6uo [pI4 AOfOCnI{TaJIbHoM
sI4AO o4*oopu"o"o 60ruoca',
rporr6olr rzuce. Vlna
1500000 ME' sa 30-60 MUH B
B
sl}_
cs,
Ao3e
BIloAI4r
CrnpenmoKwla3L oh pacTBopa xnopull?l' HAT?LTA' Illacro oTMeqaeTc's
0,g
KOJrrrqecTBe
He6olHuoM
pear<qnfi' HeJllgq BBO'{I4Tb
pasBr4TIIe flrrloTel{3l4H, ocTpblx annepfzqecKHx
rIoBToPHo (Yro'rH
nlb
aHaMHe3 )'
IIKB IIOKa3aHa BceM
flerpeno:na B cTaIIHoHap' rAe IIpOB6AII'rCff
[aqueHl'aM rlocJre
QudpnuoJrrl3a'
..
nsolu:
Ta6tvua 14 - BueuraE)irbcrBa rlocne Qubp
,qfg [ol(a3aHo rIeMeAneHHo nPH I
HeorrtoNnoel
A
t66
rnaa
rr4
('SOX
$ra6Pitro
HeICIIgIIIHOC;'
Mi4HYre)
cHI{xeHrIe c(lrygg1qlT sa 60-fi
Heotloxno':: IIKB [oKa3itHo B
cnyqae
165,
I
B
165
I
A
167
I
A
168-
IIa
A
172
I4IIreMuI4
peurrAlrBlrp)1rouefi
Orrcnrosuu IIOCJIe
AOKa3aTeJIbo'rTBax rloB:topHofi
r4lrr4
rrrQ4l
- - ^ l---A'-Y'lrn
rrrJw
IIEDBHqHOfC _x9llglllii"r I L' \, YrulJlrrvJ
Heor:roxnal {
aHrllOrpasux
c
uenbro
noKa3 aHa y
rocneAyrorI efi penacr(yJltpl43alll{Il
c
IIAIIHEHTOB
cepAer{Hol4
HeAocTaTOtll IIOC btu/ llr\Jr\\rryr
AnruorPaS rrfl c
---=----;
nocneAyroue[
Ilenbro
peBacKyntFl i43aIJatl (,;nrsauHoli
aprepuu)
c
ran$apKToM
t7r
noKa3aHa Irocler ycnelxHofo
!94 Onrnltallttroe BpetMt aHruorPaSuu \nfl
craSulurulx [aul4e].ITOB rlocJIe ycIeIXHOfO
rusuca
3-")- Lt '1Cl\,4
qKB rocrre Su6PuuoJru3lrca
neo6xo4ul'to BbIrIorIHtrb
B
ilpeAeJlax
OT
(Sapruar<oI{HBa3IrBHa;{ crparerufl)
3 q A0 24 r{ fl()cJle YcnelxHo
[peKparqeHl4eM 6oresoro
(c
cpu6puu,olrr43trca
cerMenra ST
rz cHI4xeHI{eM rIoAbeI\Ia
utr4poua/;llacrorrsopra B rpyAHofi r<leme
IIpoBeAeHHOfO
na
3Kf) (I A).
qKB He
C$OprtupoBaHHbIM
peKoMeHAOBaHO IIaqueHTaM C IIOJIHOCTbIO
Cl{MtlroMon/npu:HaKoB
uri$apruo", r"o*upAa c ay6qoM Q 6ee npo4onxarcU?txcfl
y'LIacTKoB MZ:OKapAa B 3oHe
ugreMr{ll I4JII{ 6es npII3HaKOu
^"'"ttnocoSUOCTI4
noBpexAeHvI'|',Tlp:utj.ocTynJleu:!"Ie.Ie6uoeyIr'peXAeHI{eIIo3Xe24'lcMoMeHTa
ga6oresanun (III B)'
yr'n
Bo3Hr{KHoBeHrrfl
IIKB nepeA BbIIIIICKOI4 I43
llr6upaTeJlbrloe
Tar<lnl [arIr4eHTaM fl0Ka3ano
npoBoKaIIIIOHHbIX upo6ax (crpecccTaur4oHapa nplr fIoJIO)I(I4',IeJIbHbIX
(I
r4HAyrlupt<tttofi uureMHI{ MI{oKapAa) B)'
/.J
i
I
il
;;;'{-fi"ii"l
f t'i,."i**,tu.Li'r;t*"ofr
;;tu''i[,,J;l',]HU ill}'*'ila
ffiilj
i,'
I
I
l;re,rttto'r rrrtr'-lr'ttll
'i:: .J{}
H
rrporro,urrtnii
|1nrr:'1
riKli
lletT.rrroxrF,ril
grr6pinroiur
Il?ililellltr
liil:1i!!P2i lctlllf itlll'JIL)Jll ll() iiliJ!ll cty
'i
{t! t!'puolo
')il-,
t,.t".,.'" -l\),!'tilit r(ril;Bii'c'l1' lo rtlll""1
\rt':lrJili,l atsOl r' tltrl' irrlr i l Vt''
j'tltilll'
\J4-lfilrt'll(iilti\l K)iJjlf,fJ$
lL+ it,r:f6,i,' 4l{xli},''l !i
'' 13pcrll rtn
|
.
,"'r;,r,,;ittrtii
"a-
i \1(.
r,u,ulroii rrril'1rr'1 i \ll
l.
lllil] " 'ri]'rK1dtri1' !rlti1]|rlo'
il(lJ(uil tifll irt'l'rllil [i'1"INl:
BeAeHVe LI cTpaTerI{I4
Pracyuox 1. ,[orocuI4TaJIbHOe II BHyTpurocIIHIaJbu{J
MeAIIIII4HcKofo 'KoHTaKTa
B Teqe HI4e 24 qacoB oT llepBor.o
penellr|y:uu
cpe4ra [aq[eH'foB,
co6brrn,
c
r{epe3 HecKoJIbKO AHeff IIOCJIe ocTpol'o
y
rHSapKroM MHoKapAa' ToJIbKo re IraqI{eHTbI'
AOCTCIBJIeHHbIX
aanefurenHbr;
KoTopbIXoTMel{aeTcqpeIII4AI{BI4pyIoqaflcTeHoKapi[I{flyIIwI
lrrrreMvTfl''} v
"ol't"ll-T1::::l
AoKyMeHrrIpoBaHHaf, ocTaroqHa{
MHOKapAa npl4 HeI4HBa3I4BHOI4
3OHbI
6olsurofi
x(Il3HeCilOCO6HOATb
[pI'I
pacaMarpuBarbcfl' Fnfl peBacKynflpv3allrkr
Br43yaJrr,13 ar\rlvr) MO.fyT
aprepul4'
oKKnroAHpo BaHHofi I'1HoapKrHOfi
qKB MOXer 6urr
paccMorpeHa Ant
qaCOB
B CTaUI{OHap B Ter{eHHe 12-24
cTa6r.rnbHbtx naIIHeHToB, AocTaBneHHbIX
nocrre ro{I}JIeHuq cuMrroMoB (IIb B)'
penepsy:r4oHHa.r repanvIfl. c repBI4rIHbIM
TepanI4H
,{Oerr aHTI4i}fpefaHTHOfi kI €IHT}IKOafyn{HTHOii
TaSnuqa 15
B
cr,rrvaul4qX 6es
Eer pene
HOHIIOii TE
an no3a 150-500
Acnrapus
75 rtr/lenr ue
KlonuAorPeJIb
Ees penePOYsuoHHeIL re
HeSparulIoHr{P
OBAHHbIfr
ferlaprrH
fo^* *n
dosu, KaK
ur
n
uc
QudpuuonulmuqecKou
mepanueit
4000
60 El/xr BHyrpI4BeHHo crpyfiuo c MaKct4M'yMoM
12
EA, c rlocnelynull{M n/s ralrelbHblM BBeAeHI'IeM
Edru c MaKcI4Ml'ofgMJ)0q-EjI/qac n reqt)Htre 24-48
.\^
LA
50-70 cer< vlrr4B 1,5-2:"'0 paza
24
I{EM UCXOAHO LI C KOIITPOJICM HA 3' 6' I'2 U
aqrg'
;"*B" IJeJJI"o.
BbIIIIE,
SuorcauaPu
Taxem Mce dosa, ** " , rPu1Puruonumuqecxoil
mepanueit
V uaquenloe (75 rer:
1 vr/i<r
lI
30 rtr e/'n crpyfHo, r{epe3 15 unrlyr Aanee
n/r raxAr,re 12 qacos Ao BrITITIOKH I'13 craur{oHapa'
Ilepnrte ABe Ao3bI He
MaKcI4MaJIbHo B reileHlle 8 anefi'
rtr''
AoJrxHbI nPeBbIIIrarr 100
V uarlraenlos )75 Jier:
B\B 6omoca Her; Har{arb
c
nepnofi n/tc 'qo:lt 0'75
rIlK Ao3'
MaKcI4Myu 75 vrr Ant nepBbIX AByx
(30
rranhtun'
Y naquenroB c KnI4peHcoM KpearrrHllHa
n/r AogH BBoAflTctt pa: e
He3aBI4cI4Mo or
ur/rt,
I
"orpuatu,
24'nca.
@oH4auaPlIHYKc
O"w ** u-'
fr"*;tt
mepanueit
2,5 wrr e/n Solroc,
pa3 B AeHb, AO
c
tp'a1puuonum:uqecxoit
rocJleAyroulefi 4o:ofi' 2,5 l'rr n/x 1
8 .usefi urvr Ao BbIrIlrcKI4 v3
cTauploHapa.
oH
Alrrvp:a:rra Bo BTopuqriofi npoQulaKTI4Ke'
ponb
AOKa3aHHyIo
Y.{Urrtnaq
repannU
y Bcex .'uq"tn1os co STEIVII' [lr AJII{TeJIbHofi
AonXeH I{cIIoIIb3o BaTbcfl'
(70-100 rur)' finofiHax allTl4arperaHrHafl
r4cronb3ylo1cfl o6gqgo HI{3KI49 Ao3bI '
a 6rolcaropauu pelle)IIropoB AA@
IIaIII4eHTaIvt co sTE'MI'
(xnonu4o.1'.nu"n" ruxarpenop), peKoMeHAyeTcfl
I{KB (lo 12 rvrecaqee). ,[o
]"j]:::3
KoTopbIM IIpoBeAeHo IIepBI4IiHoe
repailr{fl, xoNl6uHaqnr
acnIIpHHa
pe3ynbTaToBIlpoAoJI)KaIoUII4XcqBHacTo'-]IeeBpeM'I4ccJieAoBaHV\|,
aHrltalperaursofr reparuu
peKoMeHAyeMafl npoAonxKreJlbHoclrb AeoiiHofi
MI4HI4MyN{ON{ B OAI{H Mectq [nfl'laLryeHTOB'
cocTaBJrfl et'9-12 nrecqqeB, CO CTpO;I4M
cTeHT A [IecTb MeotueB B cnyqae
KOTOpbTM :/cTaHoBneH foJIOMeTaJIJII{qecr<ufi
IJaxso uporaHsOpMr4poBarb
ycraHoBKr4 creHra c neKapcrBeHHbrM noKpbrrr4eM.
rEs6erarr npexAeBpeMeHHoro
rauueHToB 14 r{x epauefi o neodxoAnMocrrr
np eKp
auel{I4fl 4nofi uofi aHTllarperaurno ft
flaqaenrarl
co ST'EMI v c
Tep arl I4Ir'
sr'r6pullsqueit rpeAcepAl{fi'
v
c
IIOCJI9
aHTI{KOaf'/nflHTOB
neo6xo4ral{ocTbro [OCTOflHH(f,fo I4CIIOJI63OBAHVIfl'
>-2
IIIKaJIe TCHADS' o]IpeAenf,eTcf,
IIo
I{KB
oIIeHKe
[pI4
[ecnr'r
nepBr,rrrHol'o
<<rpofiuax Tepanl4fl))'' corleTArlzrg acilvpvHa'
peKoMeHAyeTctt
6an:ron)],
p.q.ntopou AAO v ilepopanbHblx aHTI{KOaIyJI{HTOB' unfl
aHrafoHr,rcToB
OBt3aHHbIX c $ra6ptulflr\t7r4
yMeHbIXeFtlIfl rporrt6oON[6oill4qecKux ocloxuenufi'
pl{cKa rpon't6o3a cTeFITa'Y naUueHToB
ilpeAcepA trb. u AIITI cBeA eHufl' K MIlHI{MyMy
cosTEI\4lcIOKa3aHI4eIvlAntI4CIIOJIb3OBAHaI:I'aHTIIKOalryJIqHTOB',vc
CTeHTOB
npeAloqegTb yCTaHOBKy
seo6xoAuNlocrblo ycraHoBKH creHroB' cneAye1
K MI4HI4MyMy
6es neKupcTBeHHOfO IIOKpbITIIt, T.K. 3TO MOX'eT cBecTI4
25
[poAonXuTeJIbHocTbTpofiHofi,Tepa||v|v|:v^'c[eAoBaTeIIbHo'cHI43I4Tbpl{cK
urtru6uropH
pe3Bztrvtfl, KpollorerreE[f"
,na11A.rf.T noenr
rrpeAnorITI4TeJIbHo
rrperraparbl'
facrpolrporeKTrrBHble
[auIIeHTaNI c x(enyAoIlHo-KI{[IeqHbIMl{
Ha3HaaII4Tb
IpoToHHofi nrltr,tnrr, cJIeAyeT
KpoBoreqeHI4r{MI'IBaHaMH:::.J-trpraHurrrqvrvrMHoxeorBaQarcroponpucKa
orHocqrot noxulojl Bo3pacr'
KoropbrM
K
eHil?r,
Bo3Hr,rKHo Be].Irrfl. KpoBorer{
I,IJII{ Hec,IepoI{AHbIX
aHTHKoafyIlf,HToB' cTepo}'{lloB
oAHoBpeMeHttOe [pI,I1\,IeHeHI{e
npoTIIBoBocI]aJ]I4TeJIbHbIx[peIapaToB,BToMIII,IOJIeBI,IOOKI4XAo3ac||I4pl1rH:a,V
rau$HuraposaHurHelicobacterpylori'
c n*oiinofi ar
^u
PolrIIOBbIXaHTI4Koafyn'.HToBBcoI{eTaH]'Iy|Q4aofiuofiaHTl4afpefaHTHol{
cratrr4' o6cyN4eHur'
Ha
HI43K.I4
repauueft
"o oe cHr{xeHr4e cMeprHocrl'' Bb'flBlelrHoe rIpI4 'pI4NI.H.HI4I4
rlo3BoJlqer
cyuecrreH.
ac,,upr4HoN{ u KJIortIlAorpeJreM'
c
\ruvr
cor{era
B
a6arta
Ao3br prrBap,f,Kc
peKoMeHAoBaTberyxor',t6I,IHauI4IooTAeJIbHbIMtpynllaMIIaqI4eH:toBcHI{3KHM
STEMI
pucKoM Kpol3oTer{ eH.trvT'
r{us' 6eta-6nrlraropaMl4 IIocJIe
"rJf";;;t
,rpo6"r*nt"n. srEMI ocrilorcn
Jleqe
IlOKa3aJIo
flpeur,lyutecrBa AJII{TeJlbHOfo
IIpIIMeHeHI{e 5r:ra-6loKaropoB
llepopanLHOe
xopolxo r{3I}ecTHbI.
pu*rnaa^ B/s r4croJrb3o BaH'e Sera-6"IoKaropoB
oQ$ercrraBHocrb.
I{JII4 c
BbrcoKyro
[plr3lraKaMu rl4rlore*3vr4
KJIIIHI'Iq..K,.M'
c
[porl{Borrolia3arlo [aIrueHTaM
pansee r{Qrrorrb3oBaHr4e Moxer 6rrrr
ue4ocr€rroqHocrbro.
gacrofinofr cep.qeuHOfi
cBfl3aHocyllepeuuofinollrsOfiynaIIueHToBcFtll3KI{MypoBHeMpl{cKaIl
B 6or*rur4HcrBe cnyqaeB ctrl4Taercq
cta6uttuza\11r4
feMoA'HaMnr.na&, cra6u*sr"'*aHToB.
6era-6noraropa,Mr4 rrocJre
,"pur"o
HaqrrHarb
oilpaBAaHHbrNr
uepopurrnrtfr rIpI4eM
Ha3HaqI{Tb
cneAyer
cocro{Hl'It nauueHTa, rIpI4qeM
rperapara,L::
;:ffi;:X:,"r';i;.rbcn
BceM rrilrri4eHraM
c ocrpsru''$apKroM
xon:ecrepn'a. 3ro JrerreHl'Ie AoIIxHo
KoHueHTp
or
MLroKapAa, He3aBr{cr4Mo
'*r4
TalK' KaK 3T'O yBe,'ut{I.BaeT
nocTyIIneHI{I'I
rlpu
xe
cpa3y
6'rl HattaTO
Ilpl4Bepx{e]]HocTbIIaIII4eHTOBKJIeqeH}IIonocJleBbIIIllcKI4'tIpI{qeMHa3HaI{aTb
cneAyeTC:TaTIIHbIBBbIcoKIlXAo3aX'TaKK{IKST0npI4BoAI4l]KpaHHeMyId
pe3yJlbTary ll'enrro rteqeHufl
IloJIOXc4TenbHOMy
ycrofivr.rnclvy KJII{HI{qecKoM}'
gBJIfleTcflAocTI{XeHuf,KoHIleHTpaWV*on..'Lpluua,n[Hil.<
I4HTeHoLIBHocrI4 crarl4HaMlr AonxHo
Husrofi
^teparrvr4
I4cuorlsoBaHrre
c TI.BbIIIT.HHbII\^ pI4cKoM Bo3Hr{KHoBeHtlfl'
paccMarpr{BaTbc{ y rralrlleIIT.B
JIroAt{, rlalrlreHTbl
crarr4HoB (naupra^,rep, [oxnnbre
orrp""*u
es$erroB
no6oqnru
pa3BrrrueM
HeAocraror{Hocrlro, c npeAbIAy'uI{M
iloqe.lHclfi
urr4
rer{eHoquofi
c
rIJ'" npll Hi'wrrlk,Ll elrcoroft
IIpI4MeHeHI4f,
oT
:QQer<ron
no6oqgtr:<
'TaTI4HOB
corlyrcrByrcruefirepanuu)'
npe[apa'aMlr
c
uruuMo4eficrnux
4-6
Bepo{THo.r"^
KpoBI{ oIIeAyeT npoBecTl4 Uepea
JI''III{AOB
ypoBHq
}1
floeropnoe oIIpeAeJIeHI4e
JIl4 IreJIeBbIe ypoBHI4'
Aocrl4rHyrbl
oIIeHr{Tb
Toro"lroSrt
HeAenb rlrfcJle OKC' AJIfl
orarl{HoB cneAyer
ilonyr{eHufl pe3ynbraroB Ao3y
rlocrle
Teparrlrtr;
6esouacuocrb
crarI4HOB B
cKoppeKlrnpo"uri.
v
naqraeHToB
c
I43Becrsofi senepeHoclrMo0Tbro
rrro6ofrAtJ3e,rreo6xoAnMopaccMoTpeTbBo3MoxHocTbJIeI{eHnq33eTl4uu6ou.
PyuzHHoeI,{cIIoJIE,3oBaH[IeHI4TpaToBrIpI4STEM|IHeoKa3aJIo
IIoJIoXHT.eJIbHofoBI|lIflHII'fl.IIacocToflH44eIIaqI4eHToB'IlIuo:rofiIIpHquHeuX
26
[pEMeHeHI{eHepeKoMeHAyeTcq.BrryrpraBeHHoeIIpHMeHeHI4eHI4q)aToBMo)I(eT
[auI'IeHToB c aprepl4arlbHor4
y
Qa:n
BpeMq
6urr rlole3ltbrM Bo
l-t'u ycnoBlrl]i orcyrcrBl4fl
'ot'pofi
usru6uropoB
rr4[epreHgueii v'nv cep4eunoil ".loar-oqHocrbro'
r4Jrr{ r{c[oJrb3oBaHr{s'
xelyAor{Kl
rrpaBoro
uu, uu,oapKra
rr4rroreH3
socsoauu.,,,pu,u,.5u[peAluec].uy'^".48qac0B'BocTpylovlcraSurrluyro
oasy,HIITpaIbIocTaloTc'ueHIIbIMIlnpe[apaTaMl4AIqKoHTpon,j{cI4MIlToMoB
'
Irc;florlb3oBaHr'Ie 6era-6noxaTopoB'
--^ ^..yrbnn^*q?ar{o I4c
nporl4BorroKa3aHo
KoropblM
IlaquenraM,
5o:reggu JIerKl{x' MoIyr
o6crpyrrusHoft
xpoHuqecrcofi
oco6enno rrl)a HaJrr{rrr4u
6rtrrHa3Ha!:eHbIaHTafoHI{cTI'IKaJIbuI4''tITo'BJI,{el]c'tpa3yMHbIMpeuleHueMAnq
rI x HbI
( nno)
e p^r e ur
f
lg
d';
nu6poca (:< 40%) vrwr
$parcul4l4
Ha3Haqarbcti raurreHraM
c
ocrpon
ilaur4eHraM
"po"o'"oficneAyer paccMorperb An' Bcex raur4eHroB
IIocJl9
ffiH.#H,'r"".
o6gsarerbHo y rlaui{eHToB
- r^rrarr'p r,{lr
r'^ r+e
^^IIPl4MeHvnvrv
rpI{r49H9rI49
oe
E
^'
cepAerlF-o-4
aTepOCKnep'J3OM AJII{TelbHOe
yrrrrtr cnTenI4aJIbHbIM- AilBJloHI4eM' uca6es caxapHo
MI c- HoPManbHbI\4 -a
-vrrvrvJ'^Vq^---- ft ruc$ynrutl
6eg cu
}Ks uvr
lr xe
UJII'I
CneAyeT
creHoKapAllll
;;;'
a
o
ffii"nffi:i':iffiHffiffiH}l'*-:1e
c ;;G"t"er"r
c
1'i::l:::::::[ ffi #1";l""ll'Ty;
ffi?"##;li"r
ffi *'*:l;.il:i.iid1,'ry:;#;ip3f:H..*,:rux;x;
-frrr6][{TOpLI A[IO,
HeAOCTaTOqI{OCTII.
ffiffi #""#
;il"%o,l'"to
"t' +ffi
uu"
tT":
c
aKaMI4
lirII4HI4r{e c KI{r\'Iu np I43H
]v
"
ca3 40oh'
opunu"efi nH6p'r
n.lottutot"ott'n "t^'^t
6r'nl lpaccMOTpeHO Y
aJrbAOCTepoHa MOXier
Ha.:'aqeuue Snorar.poe
STEMI c OiJilr;;t'u"'6Po'u r{ro ypoBeHb KpeartrHvr*a
ilaqueHro'
cepAerrHoz
"o'nt ;;; auaS.rool, ilPH ycJroBl{t4'
y
r'lr<r'lo m'lt (2''0 r'rr/al)
"
rrryx.Il4rn
y
.<zzrMxMonrh (2,5 ur/4r)
"-]r'177
cocraBi4r
nonnropr{Hf ypoBHfl
pe*nflpH'fi
Heo6xoArrM
*.-rne/r.
ip
xoHrrl?rH, . n-r"'.
HeAocraron"o.*l
KpoBrl'
KaJII,lfl B CTJBOpoTKe
MeAHKaMeHTbr'
H ap xomu q e c Kue aH &ry 2 emw<u
B aMII' 1% 1 ul
- MopQraHa rI{ApoxJIopI4'4
cP e o c tnoa
Tp ou 1onumuHe cKue
Alsrenla:a 1Sn' 50 tt1'
e cP e d cm 6 a
AumumP tt.u 6 o mu'a e cKLt
1
Euea;ruPYAI{H* 250 rr'lr - Sl'
Octtosnlle
nl' 0'6 ul' lvn
3"o*.unui"n -np"q-*o6nr 0'3
HumPamat
-
HlrrPornl{qepllH ra6' 0'5vr
uit
HrrrPorrll4uepl4H aMtI"' 10
Kalrc' 40ur
H:,ocop6uA uosoHl4rpar
Eema-6r'oKamoqbt
raprparra6'25 xrc' 50
Meronponon
5 trln
MeronPonon raPTPar aMrI'
ur
27
v:
,,
'-,
,.
r...
.?IuzuSumoPu '4[I@
ul' 25 ur
c XE'I upra
Kanronll ut 6,25 trlr' 12'5
rrorre'r{p narr'eHTal,t
laqueH:
Ha3HaareHr{e
(upe4iloqrrrreJlbHo
3o$eno n putl, T'5 1'tr
CKO< ')0 rrnlr/vnu;
AumuazPe?aHmbt
_
m6.75 rr,', 150
Aueru'calr4rrr.rfloBaf, Kr{cJrora
-
nollPurul
TrlrarPenop ra5' 90 r''lr
ur. Ha'ranrHaq
Ao3a 500
ur
6ea
Tun onunud enru're c rcue
c P e o cm
6
a
w
AroPnitcr arvrr ra6' 40
MeAI{KaMeHTbI
ea
Zr*u*P o, 6 omu'a e c xu e cP e d c m
feuaPau P-P alu 5000E'.[./n'rn Sn'
crpateruu)
oorru"tui;;" 2'5 wr (upm HeI{HBa3I4sHofi
[,ono.lruuTeJlbHLte
HumPamat
Kanc' 20 ur
- nro.t'P lu1;iv:nurpar a3po3' Ao3a
- HlocoPlu1 Aurl:arpar
Eema-6noK6'moPbt
t'r
KaPe<:4tlnorr 6'25 ur' 25
Aumazouuc'zxbt Kanbrlufl
[\untwazeM Karic' 90ur
BePanavurrra6' 40 ur
Irlueu|umo7tut AII@
PartulPun ra6' 10 tur
Au m a z o ull c' tn bt p
e L! e
nm o p
o
6
QH
zlt o m eu s uu a - I
BalcaPras ra6 80 rtar' 160
I
tr'tr
AumuaePe''lHtnbt
-
ur
KlotruAorperb ra6'75 rulr' 300
I
a
frmonunu it e nruq e c rcue cP e o cm
Poal'nacrarl{H ra5' 10 ur
Halcrcos P-P aff un'nexuufi 1 run/400
urr
1 ltn
Arponran P-P4nr uulenilufi 0'10%
Apal arrn'
MelorlonpaMl4Aa rl4llpoxno PV[aMoHorI4
To{'rlronau ra6' 50 v:r
I
tr'ln
ra6' 5 ur
Araesenau arun' 2 un
Aua'senala
0 un
/{o(iYrarvriln* 40 r'lr/5
CntlPouoraKroH ra6' 25 rnr
PutlaPot<ca6as 10 ur
LIu zuSum oP bt nP
o m ou o e o
il
n0 Mnbt
40 rtr
3:ol'tenpasol ruaoQr'tJlll3ar aun'
llaaronPasor ra6'' 40 vr
28
3:olreupason ra5' 40 rlr
p-p 200 rul' 400 tr'tn
Harprar xrloplrA 0'goh
200 trll' 400 nan
!,ercrptlr a 5ohp-p
*JlerapcrBeHHbre cpeAcrBa'
He
t"p::i:lL-ipoBaHHbIe B
eno: (flpuKa3
rro pa3perleH'lo rr& paaoe'fi
flpuruevaHrre:
pecuydnuxe l(a3axcraH, BBe3eHHbre
rpeAerlbHblx IreH Ha reKapcrBeHHble
(od
yrBepxAeHrrrr
xsg03
pK
Jz.Iz
or 27
M3
cpeAcTBa3aKyIIaeMI,IeBpaMKaXfapaHTl{poBaHHolooSleua6ecnlarrrou
roMoulu sa 20Il\ r'oA>)'
,f*"u""croli
15.3. fPYrue' euAbl JIeqeHI{fl:
15.4.XupypurqecKoeBMeuIaTeJIbcTBo:rhenxTr)MapTep?
llpone4enuel{KBHaHecBt3aHHbIxcun$apKTlf,MaprepuqxBocTpolr
cr4Tyaw4vl,KaKfIpaBI'Ilo'HepeKoMeHAyeTcfl''u"tnnKxo[peAeJIbHbIXqeHZeM
rraIIlIeHTor} c npoAoJr}I(aroqeficq
y
Ll
tuoKoM'
KapAr{oreHHbIM
cux nop
cryr{aeB c
BI{HOBHO|O cocyAa' ['o
Il]leAnonalaeN{olo
oTKpbITI{{
uureuuefi IIocJIe
HeycTaHoB.IeHaoIITI4MaJIbHa'cTpaTefl4flBeAeFIIlfIIilIII4eHToBc|cSTEMIc
MHofococy.ullcTblMIIopaXeHneM,KoTopbleIlepeHecnnIIepBI,IqHOeI{KBHa
uusaprr-cessaHHofiapTep}ll4Bocipofi$aseIIpI4CoXpr&H{IoU]eMcfl
axeHrII4'
MHO| ooocy,nJ4CTOM fiop
wsI|ceXBo3MoxHbIXcrpareruii.IaueBce|or4a[onb3yloTc{ABe:
toltlt<o rlpl4
KoHcepBaruBsstfrrIoAxoA-t""t'o""':"-?:SMMeAI'lKaMeHro3I{ofrrepanuu
gKB n peBacKynspr{3auraefi Apyrrrx aprepllfi'
upoSax;
r4rrreMr{I4 B []itoBoKalruoHHblx
r{Irrr
AoKa3areJrbcrB
HarrrqvryrcrrMrrroMoB
a I4crIrcJIb3oBaHHe]vI r{KB vr.'r
locJre repEirdr{Horo
[oAxoA uo:r'annoii peBacK)/Jlqpu3auuu
IIKB', 3aqaCTyIO IIOCJI.
KopoHapHororrryHTllpoBAHtlfl.HecB{3aI{HbIXcrauQapKTOMaprepuit'qepe3
IIOCJI. ,,epB'rtHofo
HeAenb
vlwr
pe3epBa
HecKOJrbKo
C'feHo3a nyTeM I43MepeHnr Qpar<uI4OH.HOIO
^nefi
Tflx{ecTl4
noArBepxr l\eHr4fl.
BKIIror{at
Mynbrl{Al.tq"'in"ttupuHir noAXoA'
quaro
neo6xo,4uu
KpoBoToKa.
KapAr{onoruqecKyro KoMaHAy
corrlacl4ejlT,xlTunorou
,1
uH$oprr'*lpoBaHHOe
coorBercrBy}orqee
ilpoBeAeHr4e aHrr{orrlacrllK]rl
np'
HeBo3MoxHo
'KBftpoxoAlIMOCTlI
yCnOBI4Il coxpaHeHIIt
[pI4
AKIII
[oKa3aHo IlpoBeAeHI4e
ueoSxo'4uuo BpeMf, Anfl
KoporlapH ofi' aprepuul-. t'n'
uuQapr<r-:iasuculn{oil
pyKI4 xl4pypfl4qecrofi KOMaIIAbI'
nepeAar{r.r narlHeHra B
AKIII
MOXer 6rtrr
IoKa3aHoIIaIII4eHTaMc'KapAuore'TlyIlIoKoIvlnpnHeBo3MoXHocTI4
BbIIIoJIHeFtu'aHfI4oIIJIacTI{Kt,I..,0"9KB--lBcnyqa'XBo3HI4KHoBeHIifl
r{KB .
I{KB,
,,pr4 npoBeAeHl4r{
TexHr4r{ecr(prx ocJroxneriufi
c
c HeyAaI{HbIM
[aIII4eHTc)B
y
HeAoc,IoBepHa
qKB, u
|Io:rlsa AKIII
a]IfI{oilJIacTI4]KI4 npu
ueuoAJIeXaIquX
apTepnfi,
oKKJIIo3I4(:fr ropouapHblx
IIKIB' TaK KaK n 6OlruruHaTBe
CI{MIITOMOB IIOCJIe
pespaKTepHLIX
HaJrr4uura
lpr4
3TI4Xc'ryqaeBpeaJrlr3alrHtxr{pypfl4qecrofipenepsy:ulruorpe6yer
c Oilepa t\uefi , BbIc oKI4e.
AJII4TeJIbEiof
o
Bp eM
eill^,
a
pv|cKk.^,
cB'3 aHHbIe
29
,/,
1s.s.
orKa3 or
o6pa:a x,{3Hr4 BKrrroqaror
Tf,,Ll#;il'ffi:ffi#1";ll##H;
coBeTbI o,IHocI{TeJIbHo
apTepltaJlbHofo AaI}[eHn,I,
l{ I{eaTKI{fi xourponb
KypeHI4g
a*rleHocri4' Xorq :a
sn:rauecxofi
Beca, a raK
r]paqr{ o6urefi
Auerbr r{ KoHl,porrb
":^;;;;eHI'Ie
rraur4eHT.n 6ylyr: orBeqarb
fpyrrrrbr
srofi
ecJILI 6y'uyr
Aonrccpor{Ho. BeAeH[e
r[aHcc)B Ha ]leaJII43aIr]IIor'
bo*rue
6yav}"0n"'iu
Toro'
[paKTr{Kr4 ,
crarrrroHape' l(porte
r
'rvrMepbr
rrarlr4eHToB
Haqarbr Bo BpeMfl npe6'eauure*r4t.o6paea }Krr3Hr4 r(onx(Hbr 6'r:r o6tgcnenrt
u BaxHocrb rr3MeH
lper{Myurecrla
|4IIpeAJIoxerIbIIIaqueHTyroroprtfi'BJlfleTctrK[loqeBbIMIIrpoKoMAo
HeJIerKo u3Menvrrb' a ]leaJll{3auvfl Y
BbIrI[cKI4. O,nnar<o xll3HeHHutt "p"uu'qKl{
flBJItIIorcg Aonfocpor{Hol.
uu u,"t I{3M.H.HI4flMr4
uadnrcgeuue
noc,,eAyrouloe
cileqHaJII4cTaMI4
saAa.Iefi.B:rovtoTHouIeHuI,l'TecHoecoTpyAHHqecTB()Me)(AyKetpAl4onofoM14
MeAr{ur{HcKI4MI4 ceorpaMu'
rrpaKTr4Kr4,
flBIqeTCt
o.urefi
BpaaroM
$raeraorepa''eBT.Ml4
AUeTOnofaMI4'
pea6uttural\)4r4) sapN,rauenTaMl,'
KpuTI4r{e cKI4
B
ax{HbrN{'
Orrcas or KYPeHur
qTo
yKypqlqfiXfIaIII4eHToBcocrprrrr,rKoporrapurrrr,rCraH4.porntorr,t(oKC)
raql4eHTaMr{'
c'HeKypturl4Mt{
pa3a r{arqe- ,,o cpaBHeHl{ro.
BcrpeqaeTcJr B ABa
Kyp elnfl" B uccleAoBaHl4qx
,porpo*0"*"irlcorra e$$eKre
roBopr4r o .rnilo*'
BbIfiBJIeHo,.n'o-'uu".","i6pocranrul4eKypI4Tb'CHII3IIJIIIcBoto|OMepTHocTbIIo
Mep Yr)
cpaBHeHl4rocTeMI{'KToIIpoAonXI4nKypI{Tb.o.rKasoTKypeHl{flgBJIf,eTcfl
utrlo$ranaKTl4qecKl{x
BTopr,rqHbrx
Bcex
rc3
3roro'
nara6oree oQsercr'BHbrM
Bce ycuttttit Anfl Aocrt.xeHllflSpocu$
npeA[pr4HtrTb
[o3ToMy, neodxo4ulro
paSotiuroe B rlo\{otrll4-:.3u"tttu*
M.ALI'LIHT*u*
Arq
I4Aealrs'r,r
KypiITbflBJ1fl.e.tcfl.To'qToIIaIII4eHTbIHeKyp'TBoBpeMfiocrpoftsmlroI4M,aTaK
eogoSHOeJIeHI{e KypeHI4t
qacTbIM
oAnaro
-'"
14
^U"'"'"'
xe B rrepnoA BbI3AOpoBJieHI',Ifl'
tIOCTOflHHa{ noAAepxKa
ueoSxo,4ultrt
raur4eHTaNrr4 rrocJle ""rrr"rnof
MoNe'r 6rtrr rIoJIe3ItbIM l{croJlb3oBa*ve
p"u6'in^'a\r4vr'
r{TO
KoHcyrrbruur"'u-L.p""o
EHno AOKa3aHO'
11 aHTl{AenpecoaHroB'
3aMeHr4Ter.eil lrr.ffio
rtnu'6y,rpo"p"oHa
6egouac'gbll'{
"nutr'pefi "un""o
6rrrr rlll{Hflr
nvpt"""-*n*t"
lrc'oJrb3oriaHl4e HI4KOTI4HOUU',^
oI4M. fltrrororOil
A"
*
OTKa3a o.I'
L";:;;ffi: #;"
:
1
. p al,tlo u arlbH
o
py Ko Bo AcrB
e c5 axartst'tp
oB
y
1111114r1fi
IaqueHTOB
C
6onlsuqefr'
o''o np. s ran ar(rr4Kr4 p eKo\{eHAv
er
:
aHHo e rII{TaHIre ;
Z.*or''ponbKaJlopl4firrccrrnpoAyKToeeollg6e)KrlHl4eoxl'lperrl{t;
Ir osoqe[, a raKxe IreJIbHo3epHOBbIx
spyrcroB
notp.6.o.nrax
3. yu,,n"i.*r".
Kp\/r.pu6rr(oco6eHuoxI4pHbIXcoproB)'nocrnoroMJ{caI'{HexupHbIX
MoHoHeHacr'IilIeHHbIMIr
-. Hl""J;i:" "n"if;li"'n"u'" xupbl'
rI
[oIII4HeHacbIIIIeHHbI'MllXHpaMIII43oBolIlHbD(I{MopcKIZtXI4OTOIIHI{KOB'a
I\[eHbIIre' qeM oAHa
roropblx
(r'rl
xl4poB
Tal(xe cHl{3rrrb o5u{ee Korut{ecrBo
O6qero r{llcrla
or
30%
MeHee
rperb AonxHa 6srTb, HacbrlIleHnrr"")
ncrPe5rieHuq
KaroPtau'
30
apTepIraJIbHoI{
coJrr{ nprr cotyrcrr3yroutefi
norpe6reuux
5. orpaullEeHr4e
seAOCraror{HOcTI4
rr4rreprc)l{ \rv vcepAerlHofi
r6neuofi y [arrr4eH:ToB a oI4M.
ypo"n"'
Y#i#tffi ri)*""2s
Beca rlpl4
cHi{xeHlle
14 peK-oMeHAyer
",".3iltJ;x*fu'*a::::1ffi'#ryili:'ff
Kr/Nl2e Kaqec'rBe orITI4MaJIbHoI'o
Beca Moxer ynyqrll4Tb
I4MT30r<r/l,r-ralu5olee'aTaK}I(ellpuonpy*'o..,u',-"u6olee102ctr,ty
y xeHulrrH' TaK KaK cHl4xeHl.e
cu
Myxr{rrH ranu 6olee 88
MHofI,Ie,cBf,:}aHHblecoxIIpeHI{eMsarropr-rpl{cKa.f.elrrreMeEiee'rre6rtlo
ycTaHoBneHo'I{TocHuxeHll"u".u.u*noce6ecHl4xael]ypoBeHbc\,{epTHoOTl{.
(rr) : pocr (rt'r2)
tt*l
IrlnAei<c Maccbl
"tc
QllsuqecKatr aKTIIBHocrb
Ant pea6u:luraUnoHHblx
AaBHo l4cronrcyeTcrr
Ile.IeSrraq $uer<yngypu-Y^t
rrro perynlPHrte sraaurlecKl{e
ycraHoBJreHo'
6mlo
Tarxe
or,irr,t.
qenefi rrocrr3
c .oIacHbIMu [nfl
y[paXHeHI4't[pl{Hocf,TYnYu'.n".nuu".",,*.-,.,'cra6ralrrrofiIABC,y
t{yBcTBo TpeB{f,f L4, cBfl3a'Hoe
yMeHblIIlITb
cI{JIax' PeKoMeHAyerct
naIIueHToB :)To Mo)I(eT
yBepeHHocrr' B cBol{x
flol}brcurb
I{
r4flNrv)
B Ter{eHI4e
xr{3Hr4 ea6oneeaH
yr'repeunofi r4rr{TeHcr4BHoc'rl.
aepoduru
Bbrrlol'eHr{3 ylpaxHeHr4fl
K CHI{)K.HI4IO ypoBHfl
TpI4AIIaTI4NII{HyT'IIorcpaliuefiMepe,IlflTbpa3I}HeAe[Io.KaxArrfrIuaI
yIIpaxHeH""
ltounocTl{
yBennqeHr{Jl III,IKOBOfi
rIpI4rIrrH u
pucKa cMeprHocTl4 Bcex
n"un*o:ne
'-'p"uou"t
8-14o/o'
KoHrpon;i;.*::":"#.ilffi ff #rr4neproH_r1et'J*:H_:,^_y;;r"^i;il'
(6era-
xopo[to KoHTponnpoBarbcfl. '(Daprr'raKoreparrr4fl
K I43MeHeHI,Io
6lor<aroprt.uuruSuroprt,tno_'"n^EP,A6loxaropsrpeue[ITopoB
,,ocJle oI4M' B lIotloJIHeHI4e
AaBJreHrre Aonx(HO
peKoMeHA)'a*
$u:lluecrofi
uorpe6leuux coJII4' yBel'qeHlleqenefi'
(cuuNeHrae
TarNe
)rir{3Hl{
3TLIK
o6pa.a
-trr L4cHr4x{eHHe neca) obr,'Ho rroMofaer ,'ocrur{b
aHrr4oreHanna),
aKTr4BHoc
MoXeTuouagoSltTbcflAoIIo:iIH[TeJIbHafineKapcTBeHHa,{TepaIIIu.
(D n s n q e
cil
aq
i"T::]ff ?H*up plrcKa noBTopHoro
oB
v
aHHar g ra: nue
cK
a
arpy3Ka cn o c o 6 crB oB arl
ranQapr'a' PacrultpeHl'Ie
H
cHru(eHr{ro cMeprHocrr4
o6teua
ABI4faTe[])HofopeXI{MarreoSxoAuuopaccMaTpltBaTbIIHAlIBHAyaJIbHoAnq
or 6y*r,au"t rleBoro xeJlyAorrKa'
Ka)r(Aoro rrarlueHTa
B
,uu"*oat"
no3TOMy
ilpoBeAerruoirpenacKyllflpu3al\'|VuKoHTpo[qcep,n.eqHolopI4TMa.[rrurelrur,ifr
BOCIIpI{III4Mae'Icfl oTpI{qaTelbHO'
IlpaBI4iIo'
KaK
oTIIycK IIO Solleeuu'
su:uuecrux
oT JIefK.I4x no yMepeHHblxMOXeT
6rtrr
nooUIp{Tb
cneAyeT
aKTI4BHOC'I]b
"u,'o,,'.",.
BbIIII{CKI4' cer<cyaJlbHatl
IIOCJIe
K $u:uuecxltl't
ynpaNHeHrarl
ecJrrr nporr3otuJla a*afiTarryfl
paHbrrre,
Ha ATIHHHbI.
sogo6HoBrre'a
rlpor}'JlKr4 Ha Bo3Ayxe
orpaHur{I4Tb
Bo3MoxlrocTsM. Heo6xoAulro
ocra-Toqr{ofi raureu'- vrrvr 4UCsyurut'
,,pr{
ueAenb
4_6
paccroflrr""-u ,a.neHr4e
JIeBoro xenyAoqKa'
31
pea6nJrIrraIIHrr'
CraquonapHaq trporpaMlra
:tofAa', KOrAa
[ltxnu*lo,o6ollrrorococTaBJlfleTcfl:|{:HIiy7I\v'I.yaJIbHafl,npo|paMMa
JIeqeHI4e H)'.)KHO HaI{I4HaTb
pea6ranrar
aI$14. BoccrauoBIITeJIbHOe
6omuofrHa}I'oAI4Tc{eIIIeBfIocTeJII4,p.,yn"p,,u'.ilaccl4BHbleABI4xeHI4flB
arpobu^'
cycTaBaxK()HeIIHocTeil'o-"-]*1,.nbHbleyIIpaXHeHr4'I[o3BoIqT6ollHouy
rar Mbr[rearHafl cna6ocrr, MbllrreqHaq
ras6eNarr TaKrrx ocJroxHeHufi,
\p'
n.|'|/ ivrnvratttlt| 6Olrglrx I4N4
14 pea6v"nuratJ:z.n
rer{eHuq
otrl{MaJlbHofo
3aAa'ra.N'{u craul4ouapnoro
r4 JrerreHr4e ociroxH euui',llo.Tr{xeHr4e
rrpeAylpexAeHr4e
,BJrsrorcfl
-oaro"""", c'a6uttuza*I KIIt4HI{qecKI4x' na6oparopHblx Y
'IaKOfo ypoBHl sllauuecrou
Ans 6ol*r.ro
AOCTI4XeHue
AaHHbIX'
ce6q'' [oAH[Marbct
r4HCTpyMeHTil[bHbrx
,,pr{ n.,ropi" o" r,ror 6'o6cny'Ncuearl
6o*soro,
aKTr,rBHocru
xu to 2-3 rl'r s 2-3 [pl4elta'
ua 1 eraN' cf,Beprrrarb [poryn
nt"tt'"" l' pea6unu'.al\v1'vr 6olrgltx
cTall'ollapHoro
Ilenb
MecrHoro
Irlrorc,Baq
TIHeBMOHI4VT vt
pea6v,rurar\tnvr
B orAeJreHr4e
r{eM
loAroroBKa r{x K nepeBoAi
ll'rlpaBrqlor He paHee_
Ha
AOJIerrI4BaHUe
caHaropl{r.
r{epe3 30
KapAr4orrofrlqecKofo
urrQapKTe MI{'K ap*a,,u
qepe3 20 wteilllpu MeIIKooIIafOBou
lrrefi
''pI4
*"';","ililTJ"1t1ll:.'lflT:t#lb3vtorcn-9:11"'-f
acileKTbl.
(Diasl4qecKas
Apouon'* ai^g;g.j
3aBr{cr{Mo..rr4 0T K,,acca
Krlaccaux;nifr
3uurcl^xorloru'Iecxuii
Hurruaenofi' A'M'
p"u{'^'^'uu^^ pu'pu6J'u"u I'@' BblrloJlHqlorcfl B
p"u5^n^rarruoHHbre Mepolrpn flr't1lfl
Nrr{oKap,'a' Pasru'rarcr
KrrlFrr{qecxofi rqxert" trr$uplira
fffi
il[trt;;?oxeHbl:pT1:l:.:"::n-:',1,(NrerKoor{aroenn'
rqxecTb
qi{pKy;upusrfi' Bepxyuequltft)'
KpynHoor{u.o"ofi, cy6euoxapAl{anbHblfi'
ocnoxueu'ft,
rl4rleproH
pa3AeneHHbrx
ut|, caxapHoro
4
3 fp),rrrbr, "Oipuat, HarI4tIUe apTepl{axbHoll
_Ha
AI4aO
era'
ccuQllKauufl ocJlo'KHeunfi
:
I . O<:"ryoxHeHufl I -it zPYnnat
K.rra
l.lli]13i.,ffi1ili::;:::
u
uS apKTa MuoKa pAa :
1
6nor<aAa
uudraPr<ra MI4oKaPAa
1
3. arp.tloneHTplrKyJl flpftafl,6nor<aAa
4. cun Yco vax 6PaguKaPAI4fl
cr,
c)'urecrBoBaBrua'
Ao
pa3Bv'rvn
cr, npu 3aAIIeM uuQapr<re MI{oKapAa
He Bblure
5. nen,ocrarorlHocrb KpoBoo6pauleunq
creH o Kap Aurl{q e aKr{I{
6 . Iletrl4KaPAr'rr 3 rI I'I
7. 6norcaAa HoxeK nyqKa lvca
I cr'
2. t)c"nocrcHeHufl 2-it 'zPynnar:
(ruuoreu:ur)
1. petpner<ropur'rfi uron
nn(rapKre MHoKapAa'
6rior<aAa 1 ct'' npl4 3aAHerr'r
2. ar1>woseHrpl'lKynf,pHat
MI4oKapAa
1 cr., rlpu [epeAHeM uu$apr<re
Slor<aAa
aTl)lIoBeH'p"*yn"p,,u"
SloraArt HoxeK II)'qKa f uca'
r4ItrLr
Hasolle
a^
3.uapoxc?t3NlalbHbleHapyueHuqpI4TNIa,3al{cKIIc|qeHI4eMxenyAollKonofi
ilapoKclt:lualurofi Taxi{KttpAr{I{
(ra'a)
1 er*pacr4crorrbr B MrrHv'rv, vt
i i^,1#Jili:ff#:t:fi"'?donee
[oJII4TotIHafl,)14(ulu),pynnouu",ra(rarru)pu*,n""(<<RuaT>),4nurenruar(o
e c fl 3 rII43 OAbI
ustu rracro no BTOpf, ro lqu
Ter{ eH}I rl t u6 nlo aa uul')
IIA cra4t'ttl
6. neAocrilror{Hocrr rponoo6paqeHlrr
7
. CunaPoru,[PeccJIePa
3.
iil;liffff,""offiilfi"u"
O0ul'rprrln)
rr{nepreH
Al{acrc
JII4"t""ot
Af
zur
(cvrc'rorr?rqecKoe
AA 200 *^aprcr'
1
OcnnrcHeHutr III ePYnnu:
TeIIeHI,ie urr$apxr;a MIIoKapAa
VJIV[ponoHfI4poBaHHoe
e
l. peqra4aBl4pyrolqu
cMeprl{
2. cocrortHue KJII4Hu'recKofr
6lora4a
3. nonnas arpl4oBeHTpuKylqpuar
MI4oKapAa'
1 ct., npu ilepeAHeM uu$apr:re
i.
4. arpuoa.rrrp^yn ^pnui6nbxala
cepAua
5. ocrPa;a aHeBPI43Ma
opraHax
6. rpoll(ioaltSoluil B pa3nnLiHbix
lloK
7 . ucrue-trufi rapAl4ofeHHblll
8. orer JrerKI4x
aulenur, p e Spatcr epH aq K JIer{eHI4'ro
KpoBoobp
neAoc:.ruro.n"o.rb
9.
1 0. rPol'r6o3HAoKaPArrr
KpoBoreqeHl4e
1 1 . xeny'AorrHo-Kr{[Ier{Hoe
[apoKcl43MaJibHa{ rax[KapAnfl
1 2. Nenl'AoqKoBatr
ocJloxHeHufi'2 r'pyrl^IJ,.tt"
13. co'r,:r alr4eAByx rl6o"Iee
cpoKoB
rpaKTuqecKl4 He yAnll:H{ror
fpyrrrlbl
l-fi'
Ocloxgenr'rr
He rlpenflrcr"ylt npoBeAeHulo
fpynnbl
z-n
n^i
rn"
o.non
pea6rarur a]vrv.
ocloNse]Hus' 3-it'
paclxl4peHlrt
pea6uturatJr4yT, HO TeMIIbI
pexuMa
',UOntAnfloT'
v| rpe6yrcr
[poBeAeHI4Io pea6utmra|\L|'I
npel[flTcTuyo,
fpynllbl 3I{aq[TeJIbHo
MeAI4KaMeI{TO3HOf
o Jler{eHl',rq'
Cpo-rraaKTlIBI{3aI]J4II,ullpofpaMMyp,??":vITaII^v|npoBoAflTB3aBI{cI4MocTI4
pexr{Ma 6o*uoro uuQapr<roM MiroKapAa
or KJracca rqxeorr.r. rlpu p.curvp'eHLrvr
cocroflHl{eM'
neo6xoAulvt KoHTpoJIb 3a efo
Ha Qu3nqecKylo Harpy3Ky
aAeKsaruoii peaKrruu 6olsHO[0,
flonarareJrtr
'n"'H;;1;l::#T[:ffTffi'""
ilocJre Heo AO 20 vui^, Ilve.rra
3 Mr4HvrbI
Bbrcore Harpy3Krr 14 B rrepBne
A/{ - ua
AO 6-8 vt'tu' cllcTOJIHrIecKofo
o"ou""" -
20-40M\IpTcT'Al4acTonl4"""no.oAA-Ha10-20,MI\{pTcTIltocpaBHeHuloc
ucxoAHbII{U BerI4r{I4 HaMI4'
r{ec Ha 10 tuun' cHI4xeHI{e
qac'toTbl ilynbca ne 6olee
I4JI!I yMeHbrrreHl4e
He 6o'nee'IeNa Ha 10 MMPrcr.
cr,rcroJll{qecKoro
Af
JJ
ArrgoI]'eHKI4$yHrruoHaIIbHbIXBo3MoxHocrefi6onrrroro'IlepeHeculefo
Hafpy3oK npI{MeH'IoT
$u:tz.'ecrl4x
o''"*-bHbIX
raHQapr<r Ml4o](ap'qa, "-uu,6opu
rpoBoAuuoft o6rtqHo ua Lr'zr-ir AeHr'
(B3M),
CpoKI4
recr paHr.r ""#p.or.rp"ra
BblcoKoro KJIacca Tfl)KecTH
vI
oclclxneunfi
I{AIII4qvvl
6oresHu. flpa
ua 3 -4 \Ii's"
aKTI,IBI{3auI{u yArll4Hqrorcs
EonrucNly[peAlafaeTcqBbIIIoIIHeHlleueupeprteHoficTyneHl{aTou
no:pacrarouleliisu:r,ruecrofiHafpy3KII.Ha.{aJbHafl,MoUIHoc.|bHa|py3KI{
50 Br:' 3 cryreHb - 100 Br'
cryneHb
2
cryuenl,
1
cocraBJg er i'.5 Br ,,O 3 MI''HYT'bI' llpo6y neo6xoAur'to
.tv"tn"
raNAofi
flpo^Onxr4rerrbHocrb
r{cc' pILtl IIp]a IIOflBJIeHUI4
lrpE AOCTI'I}KeHI4I4 CySuarcuuallsofi
ilpeKpaTr{Tb
cTeHoKapAI{I{'
An" IlpeKparq e'vrfl' npI4CTyn
1 rrr*'r u 6onee' roBbI[IeHIre
uureMr4r{ecKoro Tr4rra H:a
sr
cerMeHra
cMeureHr.e
10-20 MMprcr'
ur'rprcr' IIJII{ ero cHI{xeHI'Ie na
200
cucrorur{""u.,r.o'ifr
u BHyrpl4}KenyAor{KoBol{
14 Hapyueuufi arpuoBeHrpl4Ky:'puoft
aprarnrufi
pa3Br{rr4e
[oKiBaHI4eM
[pr43HaKoB, ttBJIflIOUIUXCq
o*."
un
ono
ffi "#o
"^
:?y
:^u#n
#" "il.Ji. #' d;;rilnd'"'#,
","
3KcrpeHHoI{
oKa3aHl4fl
ueo6xo4llMr,IM Anfl
o
u. o.
alnapaTou ]4BJI, KapAI{OCTI4NIynf,TOpoM'
"
JIeKapcTBeHHstMI4 IIpe[apelTaMI4'
,'ealeHl'If, Ha
BoccraHollureJlbHoro
MaJI6IX
Anq 'ouur#""" eS$errunHocrn
Ha3Harra* slt:l',ruecKl4^e TpeHI4poBKI4
u.n..oo6purno
craur{o'ap"o",lrurr"
cyTKI4 HApfl'Ay c
3-8
Ha
3CIIaHAepoB
I4CfIoJIb3OBaHI4eM
Mbr[reqHbrx
fpylln c
TpeHupyrcuy}o
fI4MHacTIlKr N91'' a TaKXe
neqe6sofi
ylpax(senufr
KOMrrJreKcor,{
Ao3l4poBaHllyrc
v
3alfr^rvfl' Ha BeJrorpeHaxepax'
"oa"6y
qacrora
@usl].qecxueTpeHI,lpoBKI{MaJIbIXMbIIIIeqHbIXlpyilIlnpoBoAflTcflIloA
neqe6noii
Qu:rcynb:typbl'
MeroAI4CTa
pyKoBoAcrrloN{ 14 KOHrponeM
Kaxr,bre 5 unuy'r' Brtuolnenue
o[peAemrorcf,
AA
u
."npu^.n"#
cepAeqHbr"
ynpaxHerrlrftcrre,4yeTIIpeKpaTI{TbllpuyBen-uqeHuucI4cToJII4IIecK:ofoAArra40
r{CC na 30 yA B MIIH'
15 MMprcr''
MMprcr, On,utton"'nttnoto na
MbIIIIeqHbIX rpyIIII npoBoAf,TCfl
(Dragr,r.Iecrue TpeHI'IpoBKI{ MaJrbIX
arrtlsHOCTII'
ocBoeHus'II cTyrIeHI4 dlUar4Uecrofi
exeAHeBHO B TerIeHI4e IlepuoAa
flpranepeBoAeHaIIIcrylleHbaKrI{BHOClrUHapflAyc$u:uuecrnt'au
lo
pa3pelleHa AO3IlpoBaI{Hat xoAr6a
fpyllfl
MbIUferIHbIX
MaJIbIx
TpeHr,rpoBx,aMr4
KopHAopy.flocle[epeBoAaHaIIIcTyIIeHb,KO|Aa6olr,useOCB()I4JII4xo4r6yno
Kopl4Aopy,IlpoBolII4Tafl'BSMBuen{Xollpe[eJleHl4flIZtHAI4BI4Ayalruofi
Ha 3ToM 3Tarle'
ilepeHocl{n,o"i Sraar'ruecxux Harpy3oK
MaKcHMaJIbHoro MaKOHMaJIbHOI{
oIIeIIUBaeTcfl IIO
TolepanrHocTb
r
$nst',r'recrofi HaIpy3Ke
MoIrIHocrIroceoeHHofiHarpy3Kr{,trptrKoroprrfirlotBlrJrlacbrIpI'{3HaKI4
paZa B HeAeJIIo
Ha Beno3proMeTpe rtpoBoAflTcX3
TpenraponKlI
q
eAbI'
HenepeHorlt4MoCTu.
He paHee 'IeM qepes 1'5 IIocJle
r{epe3 Aelrb, u ,rapuofi fIo:IoBI{He AHq'
fpyn'' - 2 paza s
rpeHupoBKI'I MaIIbIx MbrtueqHblx
r{
xtar6a
Ao3r{poBa.lHa.fl
HeAenro.
ir^^f' rrnnrnaM.MT-r dusuqecrt{x
cocTaBHafl IIacT-b llpofpaM]Mbl $usuuecri
xoA's6a
*9{"-6'
!,o:lr,rponaHHa{
sTaIIe' PaccroqHl4e [pI{ Ao3l4poBassofi
cTaIIroHapHoM
Ha
TpeHr4poE,oK
rraounocril 50 Br
MOIIIHOCT u' fIpunopofoBofi
noporonofi
ypoBHeM
onpeAenr eTcs
34
3-6 rpneMoB' npu
#.:,i:t#;J
"p"-"-:lTu.t:.
Dr - - ':::;: -,,r...,r,,ir*aercf
;"''i.?j'
14 Ha IV
l:,?ff:';lHTiX;'.:'"'
rlpoAonxa(
5orusnt"t rpoArlaraercq
reofi il;ffi
:li'"Tffi
i;
Kortnnt:rcc Qn:uuecruax
JL',
MOrrrHOCTrl BbIIUe
";:;#; ;;;,
s"r";::#;
CTeTIeHI',I
TpeHI4poBoK
\Hana.
H?p 0'
;;r,,ro ro BbrrrucKr{ r43 cral*Ic
uuQaPrcmou
IlpomueonoKa3UHufldnnQusw|ecKuxmpeHupo7ox'y1onuuutx
"vuorcaPda:
1. CrenoraPAuqfloKofl
IIE n IIIcr
2. HeAocra-roqHocrb KpoBoospaueuuq
3
.
HeAocrarotll{ocrb
BupaxeHHafl AbIXaTeJibHafl
4.Bl,rcoxoeA!.(cucrolilqecKoeA!.nuure180MMpTcT'AuacToII4IIecKoe
Bbtlrle I 20 rrlrrlPrcr;
Tena
5. IlleuureHHafl TeMrleparypa
6. Clj3 Bblrle 25 r'ltvt/'t
7 . OcrPufi rPor't6o$ne6rar
8. gacra{ 3Kcrpacl4crorll4t
III cr
g. Ar,p"o"L*"p"nyn"1lHas 5lot<ala II ra
f r'ic a I4 Meplrarerlb Han apurMl4f,
1 0 E no r<a;; ;;;t;
.
"ytnu
rrcr4xotorrrqecKo
Bonrmoe 3Har{eHr{e [pr{Aaercfl
fi'
pea6ut'"ra.ur4vr
6o:*urx
rauQapitroviMI,loKapAaHacTaIIl{oHapHoM3.falle.|Ictlxolofl4qecKylo
a[eBT'
t'urlflIor Bp arl KapAl'lonor' rlcuxorep
pe a6uluralll4lo o'yutt
Craclleltapea6HrrurallHoHHblxMep,BoccTaHoBI4Te[bHoeJIeqeHI{eJ
-rur1"o"up.' paccMaTpI4BaIoT'C{ t\ KaK Haqzulo BTOpI4r{HOU
[poBoAr4MOe B
OcyUecrBJIeHue pea6unuraql{oHHhIx
t"o*pOu'^
ranQapi<ra
npoQranaK:ir{KH
KoHrpoJll4pyercfl BpaqoM'
raH$ap*oM
Mepoflpus:liali s craul{oHape
pea6rznur ar,w 6Ol*r'x
3aAZr.raN,rra CaHaTOpHOfo
"turu'
MpIoKapAa
'IBJltIoTCg:
pa6orocnoco6nor;ru
- BocsraHoBJIeHI4e Sn:uueci<oit
pea'.arrcal!],j.f
- IIcu oxoJIOfI4qecK afl'
xI{3HI',I
K AaJlbHefiurefi caMo0Toflrelbrrofi
no,ur,oToBKa
-
lI
IIpoI43BOACTBeHHO}I
Ae{renbHoCTll'
B()TAeIIeHIIepea6ux|4.taI\v|VcaHaTopl,leBnepeBoAflTcfldolrHlrecI-I[
aAernraIJVrVr ux r IV
ga6olesa HI4fl' npl4 yAoBneTBop""tnu"ofi
KJraccaMr{ Tfl}r(ecTl{
.'""'fr,J1"Tilffi?ff.;:#;;1;"r"
Ha caHar)pHoM srarre r4cnonb3verc{
tp"t"po-uot{Hafl xo4r6a rlo
xo4r6a'
re.{e6Haq rr4MHacrl{Ka, oo'"pouunJ' r{HTeHcLTBI{ocru suau'ecKllx Harpy3oK'
yBe[[qeHr{eM
KJraccoB
JrecrHr{rlo c rrocrerreHHbrM
yr{eroM
olpeAenflror c
odre*,r (ruauuecrcr4x Harpy3oK
QyuxqraoHaJIbHbIX
nH0apxra
nnnrhf,r nar{'rlrKlr uu$aprra
- ----,-^x
upoQu'rraK'TIIKII
r{acTb nropuuuofi
Bcex
Pea6nnraralll4oHHaf,
Ba:KHa Ant'III{KBI4Aa'I4I4
(nocrcraq"orrupru"--p"uatn^iaquq)
Mr,roKap,n,a
rlcltoNUeHUfr' [nfr
ransaprra MI{OKapAa vr efo
nepeHeceHllofo
uuQapxrorut
nocle4crnufr
He3arpoHn"ll
B
BerqecrB
tawvr odnesa
Tf:::tll,""t
pucrta)
l4EC.
HopMan':
tITo BaXHo Anq ilpeAyIIpeXAeHUr (CUUXeH."fl'
qacTi{ copAeqHofi ntHurqr,I'
(Jlgul'l
vr3 eaxueilurux
ransapxra B 6yayqeN{.
Bo3Mor{Hocrr4 rroBTopHoro
rranpaelerruilnropuuuofiuposunaKTl{Kl4clia6unu:laW|flaTepocKnepo3a(n
qacTHocTI4,K.opoHapHbIXcocyAoe)v|Bo3MoxHoeAocTl{XeHueo6paruoro
ar ep o c KJIe p 03 a'
cr en ertu) Kop oH apHoro
rureHl{t
eu
Mr4.KapAa
p a3Bvrvfl.(yv
v, peaSittr4raqr'r4 ranQap*ra
;;;;;r;
3rarra
caHaropHoe
frocre caHaropHoro
vr r43 orauuoHapa (rav' rAe
r4Jrr4 HerrocpoAcTBeHHo
rrocJre BbrrrrrcK
KapAl4ocKnepo3oM
6onrrrofi nocruuQapK'tHbIM
Bpar{aJrerreHrre H€' upoeo.{rlnocr)
A,nc''aHcepl43rauuro
ocyulecrBrl{rculero
-'io
B
,,ocrynaer rroA ua6*o4enue
Ha6*',4eut're Bpaqa-K€IpAI4oJIora
rnt
KapAr{oJror".rarno, raSunere
TeparreBTa ,oJrr{KJr'rHr{Kr{
rroJrr{KJrr4Hr4Klr
(ru5o Kap',[Uonofa
t13
nonuKJrr4Hr{Kr4 r4Jru KapAl4tororuqecKoro
rap,uuororur{ecrofi
ert6panuoro
cneqr4aJrr{3rrr)otsaHHofi
I{acrora npave6uoro KoHrpon{ tI KoppeKIIuLI vr BHar{are
Bpaalolvl
Auc[aHcepa.t.
onpeAenflIoTct [eqa,,tnM
pexr{Ma
pea6ururarraoHHoro
IloBTop{rcTcflBcpeAHeMlpmBHeAenIo'3aTeM1pa:s2HeItenH'aI{epez3-rl
IIpoBOAI{TCfl
Mecf,IIa(uosr,txo4e6orrruo,o"upa6ory)uBTel{eHlleilepBofofoAia-npl{MepHo
IIOCIe rttlr$aprcra MI4OKapAa
foAy
nTOpoM
Ha
HeAeJIu.
1 pas e 3-,I
1 pas s 2-3 Mectqa"
rlaqg
KoHTponb o,,IeHb r4'ar4Byr1yaJrbHo,
;','
Bcefo
uy
..
r
TeqeHI{e
(n ":'ATII4TOJTbHLIM
vrna",,'iy;;
oaoop
::yT:io
T:;,,?r.:1"';ilnH
Hn :
oAHOBpeMellHbIM
cpeAc'rB' HarrpaBJIeHo
cleqr{aJrbHbrx leKapcrBe]:rHbrx
nepr4oAe
nocrcrarrpr.HapHoM
crl{Myrll4pytorqr{xperaparrrB-Hblenpoqeccblu"'p'utut'"1-Y::T:e'AalorBbIcoKI4I4
Bo3Bpara 6olrsltx r IPYAY'
ypo"t""
vrBafl'nucoxufi
o6ycnon'n
leqe6uufi :rQ$er<r,
qacToTbl IIOBTOpHbIX ransapxlroB MUoKapAa'
cHIII(eHI.e
a TaKXe ,,ocTOBepHOe
6ollnrtx uu$aprrou
JIerIe H.4PT 14 pea6uiv"a*rv
B
ycnexaM
CeroAHr 6naro,4apq
o4
rpyAocnocofinoro Bo3pacra'
Mr4oKapAa .r
rpyAy Bo3Bpaulir*or." 65-g0
6onru'x
i?f;ffJ:;|'l-dffi#"r:
I]EMI
repauus Sl'E
Penoues lauI{u
.
co STEMI
u
Aonx(HbI
6bITb BOBJIeqeHbI B
B BeAeHHI4
V itaNAoitr, 6onun"ubl' yr{acreyroueil
lB co STEMI, AonxeH 6rtrr rporoKon
[auneHTOB
)auIeHI'Irc
Per<orterL
KypeHlrf'
ly.t."
o.rE\/IT
O^i4qecKaq
-
-
Pea6u:rtlral{:'z.fl
- ^ iJ I t:rvu
6olurru< U(J
u6ort"tuPttas Tepanllfl (75-c
AnrurPou
,"urr".nn HnsKoii Ao3bI acnnpuua
IICIIOJIb3OB
Ha Heo[peAeJIeHrIOe BpeMt
n
100 rurl, loKa3aHa
nocle S
raM c He[epeHocHMOCTbro acTMpVIHa
Ilaquesr:av
B
L
iloKa3artoo
lluvlNrsrl
r
ra Ao'Irocpor{Has
I
Yponeur,
(b)
B
I
c
I
B
I
A
I
B
lKnacc
(a)
AKrueHb.:t nyptunbllrlrKl{
fIOJIYTII4T])r KOHClJIbTaur{to'
iloII
it' cravuu
pawrn ocrpofi, roAocrpo
VTTATTT,{TTNINI4.]I{
36
Y
fUM MIIHIIMYMOIvI Anfl:
o rIaqlteHTOB co OTeHTOM 6es noi<Pblrl4{-1
Mectq
o I&TII4OHTOB co oTeHTON{ c IIeKapcrBeHHbIM
rroKFYrueM - 0 MecqqeB
rleBoro **yA?:Y
narlueuroB c tpotsotoM
6strr
aHTl4Koary.o"tt*'u" Tepa[I'i:q AonxHa
*tt"Uu'
rls 3
Ha3HarreHa K?4I\nI4glllgJIuI
ffir---.*"
u M e H e H alo
rp
'Y.r!^v^---
."
rI ep o p arl b tt"t*-
($u6puu:4t1r4fi'
::-t i:,::""
IUKaJIO
>2 vrrv
MexaHr4r{eJKI{1 rlpore3oB
6snl
-;
K
"
"
- -3tt
fIO
rIPeAcePAIrI{
igerns2'vAsc
.rIoJI)I(HbI
t--
-.rporr4Mt{ rroKa3aH}{flMl{
I{arII4r{I{e
rlauaua)
oHIi
K
I{aroJIb3oBaHbI B AorlorIHeHI{e
aHrlrrpoM6ouurS!994
Eclra
rpeSyercr rPofinar
'Y"--'^-"
l:IaIIueHTaM 'r'l-l€uy\trv'.r
'rePartlrr'
urrt"rPot6oruqecras aHTl4arperasrrroil
rou6unulloBaHI4e 4eofiuofi
TepaIII4I414oAT,HaIIpuMep'IIocJIe co
y IIaIILIeHTOB
r4MlJIaHTirqI4I{ creHTOB
x OAT' AJII4TenbHoclb
repanl4l{
4eoftnofi aHrl4rpoM6ouurapnofi
cHuxeHr4fl'
oon*"u (irrrr MI4HI4MI{3rrpoBaHa Anq
crporI4MII [oKa3aH vflMvr
vaKa KpoBorerrel{vl['
pI{cKoM
orAenrrrur" ,rutrueHToB c HIl3KrrNr
ble Iro nyrr arc:
Kp o Borer{ eHufl, Korop
V
KJIOIII4AOIpelb' Ha3Har{eHHe
i:.i"p
nugxoli
-
:: :
AO3bI
pa3a n 4eur) Moxer
;;;.p*.i6u"'u(2'5 ur ABa
6rtrr
,[,noftHa;t aHTI4arPeraHTHat
Tepanl4q AOnxHa
foAa y rIaIIl{eHTOB
co STIIMI,
6rtlo
npoAon)Karbcfl n re'IeHlae
KoroPbIM
creHTUp0BaHVe.
KTI{BHA{
T
1
r{e
IlPoBeAeHo
rrvrfl, usrtlSuro
IIa
uorrauu AoJIxHa Sutrl Ha3HaqeHa
pI4CKOM KpoBoTer{eHr{fl B
"pG""""fi
IIaqI{eHTaM C; BbIcoKrIM
ffi;;;-;.;,;
noltyrreHus AsofiHofi
"peMeHI4
aucsynru!-eu.
ft. cneAyel Ha3Harrarb slr, 6era-6not<aroPbIY
r4lrv cePAeuuofi
[auI4eHTOB c fI{[oTeH3I4eVt
HalouraK y
Orrp.4.n.llue JIIriluAHoro npo$u:rx
6nrn
Bcex [aIII4eHToB co STEMI Aon)KHo
rrocJle I4x
lpoll3BeAoHo KaK MoxHo 6ucrpee
IOCTYIIIEIILIq.
Pexolteng)/eTcs Harrarb
vlnr
[poAonxI{TL
Cpa3y xe IIocJle
npl4eM BblcoKI4X AO3 CTaTI4HOB
(;o STEMI 6e:r
rrocryrlne'd,vrfl' y BCex [auI4eHTOB
B aHaMHe3e
nporl{Bon oKasauufi I4nI4 orcyrcrBru
He3aBI4CllMO O',r
HeIIepeHocrlMOCTI4 CTaTI4HOB,
BoHaqarbHoro@
flo"top".r. Ir3MepeHI{e ypoBHfl xonecrepl'IHa
Anfl
II|IHII rporl3BoAtl'tcfl' Ka)I(AbIe 4-6 ne'qelb
qeJIeBOfo
ItIa
TOro, q16, ySeAI'ITbcq B AOCTI{XeHI{I4
vDoBH{ < 1.8 l'lrtonrl'l (79 ltilll)'
xeJlyAorlKa,
c
-:axa
HbIM
AT4A6CTOM ]1*N]1l_ C
38
EPA,
r$apxrou uuorapAa '
areJIbHO BaJICapraH'
xeJlar
BI
qBLflIOTCS
rofr nHrr6l4ropaM AnO ArIt
amrePHaruttoj
c cepAe'{Hofi HeAocrarorrHocrblo
laurleHT0B c
)rr4qecKofi 4rac$Ynxuraefi JIX,
VIjIl
CLICT'f,JI
)r4 HeirepeHoci4Mocl
oco6eHHo n'Pu
u
usru6uropoB
AIIO.
llar
BceM
ltlurra6uroPsl,r AII@ AonxHbI Ha3Harlarbc{
rIpI4 ycnoBrrl4 oTcy'tcTBlls
IIauueHTaM
IIPOTHBOIIO](
l\
]B
HanplrMep.'
anbAocTepoHa,
Anrarograc'trbl
c Qpai<III4eu
SrIJIepeHoH, rIoKa3aHbI nalll4eHlav
ceP4euuofi
c
}oh,
nu6poca
=
HeAOCTarott rHocrbro vrv a caxapHblM 4raa6erotvt'
yc. roBIrI{ orcyTcrBl4t no're'ruofi
HeAOCTaror IHo crLI I4nI4 run epKq44glvl4ll'-
rprl
rr 6esonacuocTll
16. I4ugulcaropsr OssercruBHocTH JleqeHufl
MeToAoB
B TIPOTOKOJIE:
trUAIHOCTU]KII IT JICIIEHUfl' OfIIICAHHbIX
IIeqeHI,Iq 6o,'rHlrx
Ta6rr'ua 1?, _ Kpra Tep*es$ercrunHocTl4 BoccTaHoBLITeJIbHofo B *tul::-Ti:]:
upo0unr
KapArronorlrrrecKoro tr KapAlloxupyprl{qecKoro
yqpexAeHr4r{
orAeneHr4f,)l pea6unutar\r4v lreue6no-upo$nnanrr4r{ecKnx
oe 1-8
oIIeHI{Baro' c'g TTO KOM rJIeKc\/ IIpI{3Ha
3naqtlrelr,n Vriyuureuue
N KPVTTE PT,TI
oe
Ee:
IIepeN{eH
ylyqrueHl4e
Krttaru II{ecKafl
KJIACC]l4aSraxaqur
1
I
2
llepexo4
B
llepexo4
YxyAnesue
B
,I[rauauuru
HCT
flepexo4
6oree
TqxerL'tfi
6onee
6oree
T'x{CC 't'14
lemt.rfr
rerxnfr
cocTo. frHr4fl.
KJIACC.
Knacc.
Coxparienne
I rlacca
Coxpanenne
I ruacca
Vcs,ezra
Vpexeuue
f{uuauut<u
VqaueHIae
rrpHcrylloB,
IIET
Id.TYI
Cren KapAIrfl
KJIACC
BO3HI4KHOBEH
Yrxxelenue
VE
npl4crynoB
nplrcTyrloB
Ha 6olrtuue
3
HAKIl
43H
IIpu:
:qHofi
cepAl
AO'
14cqesrIa
Hafpy3Klr
VlraesuunnPt
cb
,[nnauuxra
Yseru'Iurtrcb
F{CT
HeAO STATOI{HOCT
V
39
Pesylrr
4
IlepexoA
-t
c6-
TECTA
focrnr
I
l
flepexoA
^l
OoJIee
n .{uuauuru
rerxufi
nen<ufi
KIIACC
Knacc.
>500u
CoxpaueHne
j
HET'
l
llepexo4
6olee
lsxelnfr
ICJIACC.
I rlacca
lfi
.tlepeno4 na I,{ocruxeuu Aoctnxenne' | /locruNeuu
IV III crYrIeHI4
Ie
VII V-VI
E
ABnI'areJIrsofi
CTyIIOHU 1 CT'/rIOHI4
cTyrIeFII{
yrafl.
CTEIIEH'&TO"tIbH,
rruofi
ABI{f&Tt
BHIf CTI,I
AKTI4BH
I
OoJIee
Ml{HyrH rJ h
xoAr6oj
5
B
K
eHly
MOMCH'
ABI4rareJIbHo Il- Aeurarelsu
ABr.IfareJIbH
it'
ofi
AKTI,IBHOCTI{
I oI4
aKrIIBHocrl4 i axl4eHegfu:vL.
t,ICI:H.
BbITI?IC]
Yuesruresue
VeeruqeHlae Vseru'reHlle f-\nnaunxu
pa IITHOCTb
Tolepa
KQU :uqecrofr He MeHee, HE MEHEE, IIET
I
AKTIIBI{OCTI4
6
y3Ke
Hafpy3
AurraM. r,rrca 3Kf
qeM HiI
1
qeM Ha
1
crynenr (no cryrleHb (lro
AaHHbIM
AaHHbIM
Hafpy3orlHbi
Hafpy3orrHbl
x reclon)
x recron)
3Kf
3Kf
,[unauuru
cra6u:lrrra
cra6ulrrra
Hr3T
VTV
I1-.ITTL
IIOJIO)I(HTEJIb
TEJIbHA{
Hafl.
AI,IHAMI4KA
fiuuaal{lI,lKA
3xoXKrl
napaMeTpoB
YnyuureHne
napaMerpoB
3xoKf
SxoKf
Vryuureuue
afl ntrHIM.uKa
IIOJIOXI4
Ar4HaMI{Ka_
8
Orpuqarelrri
f[uuauuxll
OrpuqarelrH
HET
Afl, trI1'I]^A}'{Id.KA
rrporoKoJrA
,,I. oprAHrr3AIII4OHHbIE ACrrEKTbr BrIEAp EHr4fl
1,7.
:
CnucoK pa3pa6orqurcoB uporoKoJ'Ia:
HI4I4 KapAHonorLII4
1. Eeprun6aee C.O. - A.M.H.' upocpeccop, AI{peKrop
vI
eHHrlx 6onegHeii'
3aMecrurenb AI4peKropaLJJzW[ xapAtaolorvl414
flxyrryc6eKosa f.A. -- A.M.H.,
BHy'rPeHHrax 5onesHeia'
orAena KapAI4onofI{I{ HIn4
Myc;ar arrveBa A.T. K.M.H., p)'KOBOAI{renb
Kap,Iuono rw 14 BHyrpel{Htlx 6one:ueii'
uayuHrtft coTpyAHI{K oTAeJIa KapAI4onorI4lI
BHYI:P
2.
3.
4. ToxlacyHoBa C.B.
-
unaAruufr
tMVIKapAI,lonot:'|fnvlBlJyTpeHHux6olesrreit.
5.Mexe6eKoBaA.M.-MnaAIIIufiuayuurrficor.pyAHI{KoTAenaKapAIIonofI4H
IMwKapAI,Io[o|L*IuBHyTpeHHt4x6oJlesHeti.
18. Peueni3eHTbl:
1. A6ceprroBa C.P.
-
KapAl'Ionor M3 PK'
AoKrop MeAIlUI4HcKI4x HayK, friasHHfi
40
llepecuorp nporoKona
19. YrcasaHue ycloBIril nepecMoTpa rpoToKo"Ia:
npl4 nocrynJIeHI4I{ EtoBbIX AaHH'IX
trrefl*r""pa*a, qeu 1 pro u 5 net, ln6o
3a6o'IrQB,,H."flt cocroqHl',Ifl' ',rlrkr
,,o Ar4arHocl]I{Ke H irerreH'ro cooTBeTcrBylolqefo
npor43BoA
cHHApoMa.
20. CnucoK I{crIoJrb3oBaHHoii luleparypbl
:
l.AlropruruJIeqeHI{focTpofoKopoHapHorocI,IHApoMacocrofirult
Srccueprn,rro coBera M3 PK or 8
sr
inpotonon
rroAbeMoM ceruesra
nHBaPn 2013 r. Nr 1)'
BeAeHI4ro ocrporo
2. Pexoue H;ia1izrv EOK
rIoAbc)MoM cerMeHra ST- 2012'
ro
3.
Eone:rila cepAua
un$aprra
MI4oKaPAa c
vr cocylloB. Pyrono4crno EnpoueficK(flo o6ulecrsa
Moct<sa' 12011 r"
KapAptonotoe, <<feorap-Me4raa>> '
MHOKAp/t}r' Enponefir:roe o6ruecTBo
4. perol,re llFArltlvrrlo peBacKynf,pl{3aqnH
KaPAIIorIoroe 2010'
A1
TI