Благодир Б.В. Эхокардиография

1. @I43I4TIECKI4E T4 TEXHI4ITECKI,IE OCHOBbI
9XOKAP.III4OTPA(DUN
3nyrc npeAcraBJrrer co6ofi rore6anu.{ yupyrofi cpeAbr
nepl4oAlIqecKoro clKarLrfl
TaK
14
p€l3prxelF.ufl.
14
B
Qopve
ee
3nyr Mox(er Bo3HzKarb KaK n ra:oaofi,
)KLIAKocrHoit uttu rnep4ofi cpeAe pI He Mox(er paclpocrpaHrrbcr
B BaKyyMe.
zcroqnzK
3ByKa Sopn'rzpyer lpoAonbHyro BoJrHy, Koropar LrMeer orrpeAeneHHyro
cKopocrb (c), uacrory (f)
u
AnuHy BoJIHrI (1,), upz.reM cKopocrb pacrpocrpaHeHr4t
ynbTpasByKa B CpeAe onpeAeJrreTcr cooTHorrreHzeM:
c=fxlu
3ayxonrre rone6aHu.{, HaxoArnrr{ec.rr
JruMLrrupyrorcr .racrorofi B cpeAHevr
Ar4arr€BoH cy)Kaercr.
unSpasnyxa,
a
3nyronue
or
B
rrpeAenax cJrhrrrrkrMocTz qeroBeKoM
20
fq. C nospacroM eror
Ao 20 fq orHocrrcr K o6tacru
cBbrrrre 20 000 Iq Bxo.{_rrr B
rcore6aHz.f,
rcore6aH[q qacrorofi
to
20 000
yJrbrpa3ByKoBort Aua rra3oH.
9acrora -
9To Kor'rqecrBo rroJrH'rx
1
rore6anzfi yrpyrofi cpe4u sa 1 cery'4y:
eer
Bpenrn
Puc'
l'
fpaburc, omo6pacrcant4uil 3anucutvtocmb ttqcmomut rcone6auuil
seyrca om 6peMeHu.
crcopocrb paclpocrpaHeHrrq yJrbrpa3By*a 3aBr4cLrr or cpeAbr, n rcoropofi
oH paclpocrpaHterafl 14 3Ta BeJILI%LTHa onpeAenrerc-rr [oHrrzeM aKycr[rrecrcHfi
rfMrleAaHc (arycrz'recKoe conporl4Bnenze).
npeAcraBJr-rrer
TIJIOTHOCTb.
Arcycrz.re
crcuit
LrMrrenaHc
co60fi rpoLr3BeAeHLre cKopocrr4 3ByKa B ynpyrofi cpeAe Ha ee
ConpeueHHbre
,IILI
AfHOCTI4 qECKI4E
npn6opsr
yJrbTpa3ByKoBbre
ornarndpoBaHbr Ha cKopocrb pacnpocrpaHeHLrr ynbrpa3ByKoBofi eoJrHrr 1540
rvr/c.
YnrrpasnyKoBa-fl BoJIHa He nepeHocLrr qacrr4rlbr,
a
Jrlrrrrb Bbl3brBaer I4x
cMeIIIeHI4e B npOCTpaHCTBe Ha AOII,I HaHOMeTpa, npn 9TOM ynbTpa3ByKoBar
BOJTHa
nepeHocur 3Hepfr.rrc, pacnpeAer-s-s ee no [yTr4 pacnpocTpall]leHns.. B y"urrpa3ByKe
aHeprnq orrpeAenf,ercs aKycrz.{ecrofi MorrlHocrbro u Ao3rrpyercfl KaK Brlcvt2.
B npoqecce cBoero pacnpocrpaHeHlrr rrprl B3auuo4eficrnkrLr c qacrurlaMr4 ynpyrofi
cpeAbl ynbrpa3ByKoBa-fl BoJrHa rropo)KAaer
rprr Qusuuecrczx eSSeKTa, Korophre
LrfparoT Ba)KHyro ponb B ynbTpa3ByKoBor4 Ar4afHocTr,rKe, a nMeHHo:
1. OrpaxeHue
2.
llpenoMneHkre
3. 3aryxauue (ocra6nenze)
OrpaxceHrle
- ero csoftcrBo ynbrpa3B
Ka orpax{arbcr Ha rpaHr4rle AByx cpeA,
I,IMeIoqvx pa:uufi aKycrr4rrecxuit r4M reAaHc.
Vron orpalKeHnr
paBeH yrny
rraAeHzr (puc.2).
Brr4erruor ABa BLrAa orpa)KeHLrrr:
.
.
llpruoe
lraS$ysnoe
llprrr,roe orpaxeHr4e (specular reflection) nusrrnaror
rroBepxHocTr4
(4r,raQparvra, creHKa MorreBoro
6oruuze
nysrrpr). 3rz
v
rnaAKHe
rroBepxHocrkr
orpax{arcT ynbrpa3ByK rroAo6uo seprany, oro6poKaercq ronbKo exo, BepHyBrrreect
B AarquK no rp-rrMofi. llprnao
cnr{ae
orpaxaerct
[eprreHArrKynrpHocrlr xoAa
TOJIbKO 3XO, BepHyBIXeeCt
nyqa
oTHocrrTeJrbHo
no npxuofi e
nccre4yeuoft
noBepxHocru (puc.2).
\t'. ,"'t
"rtr'
lt
+
l
Puc. 2. Ilpnuoe ompaJrceHue ynbmpa3syrca (om 6onuruux u znadrcux nonepxHocmeil).
Conperraeuuue AnarHocrr4rrecKue
yJrbrpa3ByKoBbre
npn6opur
orrcaludpoBaHbr Ha cKopocrb pacnpocrpaHe Hkrfl y nb'tpasnyronofi BoJrHbr L540
lr.lc.
Ynrrpa:eyKoBat BoJIHa He nepeHocI4T tlacrr4llbr, a Jrlrrrrb Bbr3brBaer vrx
cMeIIeHI4e B IIpOCTpaHCTBe Ha AOII/I HaHOMeTpA, frpLr 3TOM ynbTpa3ByKoBar BOnHa
nepeHocl4r oHeprl4ro, pacrpeAerrs.fl. ee no rryrkr pacnpocrpaHeHr4fl. B y.nurpa3ByKe
3Heprnq ortpeAen-f,ercq aKycrzqecxofi MorrlHocrbro u Ao3upyercq KaK Br/crvr2.
B upoqecce cBoero pacrpocrpaHeHr4rr rrpkr B3avlro4eficraukr c rracrtrr\aMkr ynpyrofi
cpeAbl ynbrpa3ByKoBaq BoJrHa nopo)r(Aaer
rpr{ Qusuuecrzx e$$eKTa, Koropbre
I4rparor Barrcrryro ponb B ynbrpa3nyronofi Ar'rarHocrr4Ke, a LrMeHHo:
1. OrpaxeHr4e
2.
llpenoMJreHLre
3. 3aryxanze (ocla6neuze)
- sro csoftcrBo ynbrpa3ByKa orpax{arbcfl Ha lpaHr4rle AByx cpeA,
pa:urrfi aKycrurrecxuir zMrreAaHc. Yrol orpalKeHur paBeH yrny
OrpaxceHrle
I,IMerorrIHX
rra5.eHun
(puc.2).
Bu4ernor
ABa BLrAa orpareHprr:
.
llpsuoe
.
Az$Qy3Hoe
llprrvroe orpall(eHl4e (specular reflection) nusrrnaror 6olrruue vr
roBepxHocrr,r (4zaQparl,ra, creHKa MorreBoro
nysupr). 3rz
rnaAKr4e
rroBepxHocrr4
orpaxarcT ynbrpa3ByK noAo6no eeprcany, oro6paxaercfl, ToJrbKo sxo, BepHyBrxeect
B AarqI4K
ilo np.f,Mofi. llpxrr,ro orpa)Kaercr roJrbKo oxo, BepHyBrxeecf, no npxlrofi
cnyqae [epneHALIKyupHocTLI XoAa nyqa
OTHocI4TeJIbHo llccne4yeuOfi
roBepxHocru (puc.2).
\\
/,
\-t/
e
It
tl
?l
Puc. 2. Ifpntnoe ompac{eHue yrbmpa3syrca (om 6onuutux u znadrcux nonepxHocmeu).
[zQSy:noe
orpa]KeHr4e
-
MHo)KecrBeHHhre
sKpaHe' BosHzrarcT npr4 orpaxeHzrr
BHyrpI4 opraHoB
LIJII4
TKaHefi.
or
He6omruux
14
BLrrLrM Ha
v rnaAKlrx nonepxnocrefr
3rz noBepxHocrz Moryr 6urr .ryrb
ynbrp€BByra' O6pa3yroquec.f, He6orblrrve
pa3Hble cropoHhr (pzc. 3).
exo, Korophre Mbr
MeHbrue .qnvHbr
MHo)KecrBeHHbre gxo pa3nerarorc.f, B
3ru se6onrlu4e oxo Sopuzpyror
HerroBropvrurrft y3op
KaxAofo opfaHa.
Puc. 3. Irpauoe ompqrrceHue (cneea)u due$ysuoe ompquceHue
(cnpqsq).
3aryxanue
-
yMeHbrIreHI'Ie LIHTeHcI4BHocrz (norep.a aMnJrr{TyAu)
yn4p€BDyKoM.
l4'teucuBHocrb ynbrpa3ByKoBbrx
cpeAe'
B <<u4eanbHhrx>>
yMeH'ruaerc{ ,,o Mepe pacnpocrp aHeHufl
cpeAax 3ByKoBoe AaBneHr4e (anannzry4a) cnrzNaercr
cqer paBHoMepHoro cHprlKelc^r4fl
<<pearrbHbrx>>
BoJrH
gHepfr4r4 Jrr{rrrb
3a
Ha pacnpocrpaHeHLre BoJrH,
cr4creMax HeKoropble BoJrHbI paccezBaro-tcfl
u nornoruarorcfl.
B
B
krlrll
oTpaxaroTcr.
flpuHqun sxoKapArrorpaenu ocHoBaH
HA
aH€urI43e oTpax{eHHbrx
ynbrp€l3ByKoBhrx BoJIH. Tarczv o6pasou, oxoKapAr4orpa$uvecKar
Ar,rarHocrrrKa
nocrpoeHa na SynAaMeHr€LnbHoM csoficree yJrbrpa3ByKa orpaxeHrlr4
or lpaHr4rl
cpeA' LIMOTIIUX pa3Hoe aKycrl4qecKoe conporl4BJreHze.
Atts
reHepaIII4I4 ynbrp€l3ByKoBhlx BoJrH
B ynbrpa3Byronoi
ALrarHocrr4Ke
rrpI4MeHtIOT CneIII4anbHbIe rrbe3oSJreKTpr4qecKlre SJreMeHTbI
- TaK H€BbIBaeMbIe
nbe3oKpl4cr€rllnbl. Bnepnrre Irbe3ooJleKTpzrrecKrafi eQ6exr
61111
roAY 6pars'Iwu Kropz B
ooHappKLIJIr4,
qro npz
Ml4Hep€Lnorzqecxofi na6oparopzz.
4eQopMaIII4I4 HeKorophlx Kpr4cr€rJrJroB Ha
orKpbrr B lgg0
oura
zx
rroBepxHocrrr
oopa3yerct sneKTpu\ecxuir sapflA. fo4ou Iro3)Ke zMr4 6rrn orr<pbrr
o6parnufi a$Qexr - rIoA 4eficrnzeM gneKTpr4rrecKoro rroJrr KpLrcraJrnhr
4e$opuzpoBarbc-fl. ouzcanHrre ceoficrea nonyqznu Ha3BaHr4e
6
BnepBhre
14 or?rcaH
HarrLrH€urr4
<<npxuoft>>
HA
refi
IHbI
,fl8
30p
<<o6paururfi>> rlbe3ogJleKTpprqecKue
eS$erru, a
KpLrcrannbr
c
orrr4caHHbrMr4
cBofi crBaMI4 nonyquJll{ Ha3BaHLre <<Irbe3ogJIeKTpLIKoB>>.
Bce ynrrpa3ByKoBble rlpl46opbr reHepr4pyror
BOJIHbT
rIpV
TIOMOITIU CIIeqVarrbHOfO AaTqLrKa.
rIbe3oKpI4cr€UIJIoB
traIIpIeHTa.
llepe4
r4 rrpr4HrrMaror yJrbrp€BByKoBbre
,.{arvzrc coAep)KLrT MHo)r(ecrBo
Ha KoHTaKTHofi [oBepxHocT?I, conpr4Kacaroqefic.rr c
TeJroM
[be3oSJreMeHTaMLr pacflonox{eHa crreqz€urbHa-s aKycrr4qecKat
irlrH3a, Koropat Sorcycrapyer reHepzpyeMbre rrbe3ooJreMeHTaMlr ynbrp€BByKoBbre
BONHbI.
Ff
[tn
oxoKapAl{orpaQzz ucrtonb3yrcrc.{ ynbrpa3ByKoBbre AurLrkrKvr co
cneqzalrnofi Qa:uponannofi peurerxofi (pzc. 5). B SaszponaHHbrx AarqlrKax
paclonaraercq or 64 3neMeHroB vr 6onee. llput crporo rrocneAoBareJrbHoM
oM.
no:6yx4euuz orAeJlbHbrx rrbe3ooJreMeHToB pe3ynbrlrpyrorqufi ynbrpuBByxonofi
B orrpeAeneHHoM ceKTope noA yrnoM
UIB
-Ty.I Moxter orKJloHrrrbcr roJrbKo
r3a
rpaAycoB. OruoAa AarqzKr4 Anr sxoKapAr4orpaQuz uonyqLrrrkr eule oAHo Ha3BaHr4e
irB
- ceKTopHbre.
90
WV
IbIX
wKa
n=8
{uq
LIKE
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380
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@ asup o e au
H
a2 p e ute mrca.
nb%ogreMeuma, A
-
p qc non o )rc e H bt 6
oduo
it
nn o
c
Ko
c
mu. Ka crcd w[t
dnuuy (nodteu), p
- pqccmonuue uecrcdy qeHmpaJvtu
g - paccmonuue uecrdy nbe3o?neMeHmcr.t tu (waz) e - wupuHa
nbe3oereMeHm ulvteem: w
nbe3ogreMeHmol,
II u e s o e n e M e Hmbt
-
anepmypa (o6u4aa dnuua) nbe3ogteMeHmo*, n
Anepmypy MoJtcHo paccqLtmamb
rcarc
A
-
qLtcno nbesogleMeHmo*.
- p x tt.
Puc.
6. @asupoeauuotil damqurc dnn exorcapduozpafiuu.
Puc.7. Ifpuuqun ceKmopHo?o cKaHuponauun QasupoBoHHbtM damqurcou. Vnumpasayrcoeoil nyvoK
c noMou4bto sneKmpoHuKu nepeMeu4qemct no ceKmopy utupuuoit 90" c oduuarcoeoil cKopocmuo
u qacmomoil rcadpoa oKono 25 e cercyndy.
9acrora KaApoB
o6ycnannl4Baer BpeMeHHyro p€Bperuaroqyro ctroco6Hocrb
ynbrpa3ByKoBoro annapara. llocrcoltt<y
rpv
oxoKapALtorpa$zu krccneAyrorc-rr
TIoABLIx(HbIe crpyKTypbl, 9To rrMeer
6olruroe 3HaqeHze - r{eM B;r[re qacrora
KaApoB ynbTpa3ByKoBoro allllapara, TeM 6olee roqHyro Ar4arHocrzqecKyro
zn0opnrallI4to [onyqaer I4ccneAoBareJrb. ConpeueuHbre froJrHocrbro sJreKTpoHHbre
AarrIIzKz 6laro4apr nap€unenurofi o6pa6orr<e AaHHbrx Ha ynbrpa3Byr<onofi
-IrJ*
8-l
n-laT$opMe MOryT 3HaqZTeJIbHo rIoBbICIlTb r{aCTOTy KaApOB, KOTopaq MOXeT
r{eloBeqecKl4fi fJIa3 He MoXeT
cocTaBnqTb 6olee 100 KaApoB/c. llocxollt<y
t-rrc-te.IlllTb
raKyro qacrory, Infl IroBbIIrIeHI4t TOr{HOCTI4
I4CCJIeAOBAH:/lfr
nprr\IeHqeTc{ pexuM <IIpoKpyTKpI>> c 6olee HI43Kofi qacToTofi KaApoB, Hanpl4Mep'
rrpr r
Hccn
eAo BaHuI4
)
pefypf
auvlv
t4T
H
a KJrarlaHax c epAua'
BIIJI6I I,I3OBPAXEHIIfr B SXOKAPAIIOIPA6I4I4
\I-pexuu.
M-pexuvr oro6pa)Kaer rpaQuKl4
ABI4)KeHHI
crpyKryp cepAIIa' qepe3 Koropble
trpoxolHT ynbTpa3ByKoBofi ny.I ToJIbKO OT OAHOIO
nyq
v--rbTpa3ByKoBofi
u
HenoABI,IXeH
IIbe3OgJreMeHTa. T'e'
pelllcTpl4pyer npoAonbHble nepeMeuleHl4q
!-Tp)'Kryp cepAIIa, rpoxoAtulux qepe3 Hero'
Ilpewwyugecm7q
M-pecrcutta
BblcoKas BpeMeHHaf,
vI [pocrpaHcTBeHHaq
pa3perxarcql4 e croco6uocru.
- rrJrocKocTb cKaH]o.pOBA}JI1'fl. AODKHa llpoxoAl',lTb
Eclu cepAIIe B IpyAHofi rlerre pacIIoJIolKeHo IIoA
H e d o c mamKu M -pe ilc uJVa
cTporo nepreHAl,lKy1apHo.
\T--roM K rroBepxHocrr{ Aarr{r.IKa (nanpurr,rep, BeprLIK€uIbHoe rloJlox{eHr4e cepAIIa),
ro
6y.Uer
trpnreHr4Tb M-pex{uM HeBo3MoXHo, T.K. cpe3 M-pexrarvra B AaHHOM cnyqae
trpOXOAI4Tb <<IIo KOCOfi IIHI4hI>>
VI 3TO npI{BeAeT K 3aBbIIIIeHI4IO I4CTI4HHbIX
-.IlmefiHbrx pa3MepoB crpyKryp cepAIIa.
nyqoK
cmblo
,rc\0
/\f,
HOCTb
nL
i.r
i
'\.-,./ \
35Ao
..30ltlK fn
rrIOTCf
rcroTa
rcKyro
)HHbre
?i:.8. Ilpuuqun
Bdotu nyua coqeputanm
nocmpoeHun uso6patreuun e M-petcuue. Cxauupynu\uii rxyq noKa3aH cuueil tuuueil'
deutceuue: CIDI{
-;tezopodxa, IIMCK
-
cmeHKa npa1ozo tre,tydovrca,
IIH{
-
no,'tocmb npalozo tcenydoarca,
- nepednnn cmsopKa MumpanbHozo rcqanaHa, 3CMK - sadunn
zadunn cmeHKa re|ozo crenydovrca. Cnpaea rno1patceuat
KOBOfi
MH{II - uetrtreaydouxoean
cmnopKa MumpMbHozo KranaHa' 3CJI)K
yKa3aHHde cmpyKmypbl e
M-petrcuue'
-
B-pexcnnn
B-pexravr 9ro
noryqeHr4e ynbrpa3ByKoBbrx z:o6paxenufi pa3pe3oB
(ceueunfi ) cepAua, cAenaHHbrx npr4 noMorqz ynbrpa3Byronofi rrJrocKocrr,r.
B-pexzlur errle Ha3brBaror
B B-pexulae B
<<pexfl4M cpe3oB>>
(pzc. 9).
nocrpoeHlrz zso6paxenur r4Meer 3HarreHr4e e$Qerr
orpDKeHul. OrpaxeHue or rpaHI4II cpeA c 6onrurofi pasHzqefi
lo
aKycruqecKoMy
I4MrIeAaHcy (rponr-vruorap4) Aaer qerKoe ra:o6paxeHue Ha gKpaHe. O4naro,
[prlcyTcrBue, HaIrpI4Mep, B MLIoKapAe MenKr{x crpyKTyp, cor43Mepr4Mbrx c 4lznofi
BoJIHbI nopo)KAaer
eooerr
pacceuBa]Hhrfl..
llocr<onbry yJrbrpa3ByK paccerrBaerct
xaoruqHo Bo Bcex HanpaBneHr4flx, gro [pr4BoAr4T K rrorBJreHr,rro speckles-uryua
3
-
epHzcroro uso 6pa xleHvrfl' Koropoe He tBJlterc-a oro 6p a)r{eHr{eM TeKcrypbr rKaHr4.
Puc.9. trIso6pacrceuue cepdqa e B-pecrcuue, npodonuHoe napacmepHanbHoe ceqeHue.
Bropan rapMoHrrKa.
Kor4a ynbrpa3Byr<orofi nyq A crzraer rpaHzrlbr cpeA c
pa3HhrM
aKycrLIqecKI4M corIporI4BJIeHLreM, OH OTpaxaergfl, B Br{Ae ynbrpa3ByKoBbrx BoJrH c
pa3nLIrIHbIMI4 rapMoHI4KaMI4.
cI{rHaJI Hecer
llepnax rapMoHLrKa, vfirvr HarzsHrrfi ynbrp€]3Byxonofi
B ceoe ocHoBHyIo Avar ocrr{qecKyro nHoopvraqvro,
oAHaKo oH
noABepxeH 3HaqHTerbHoMy BJrLrrHkrro yJrbrpasByKoBbrx apre$arror. Bolrrue
zHQopvraqll?I 3anox(eHo
fapMoHr{Kax.
10
n ycrofiur{Bbrx r
ap:reSaKraMlr nropofi,
rperrefi
14 T.A.
I4cuonrgoBalne pe)Kr4Ma eropofi rapMoHr,IKI4 (THI) no3BoJlter rlonyqrrrb
pe3oB
5o-ree <<qlrcryro>> Lr qerKyro KaprnHKy. llpznaeueHue pelKLIMa aropofi rapMoHtlKl{
tro3BoJurer nyqrue Bu3yarru3upoBarb KoHrypbr eHAoKapAa
(puc. 11). OAnaro
H)7{HO IIOMHI4Tb O TOM, qTO pe}Kr4rr,r nrOpofi IapMoHI4KI,I 3aBbrruaeT nllHefinrre
rSerr
pa:rrepu!
)KOMy
HaKO,
rnuofi
aerct
/Ma
-
AHId.
Puc.
ll.
Cpaeueuue uso6pacrceuuil cepdqa 6es ucnon*olaHut mxaueeoii zapMoHuKu (cneoa)
u c nput4eHeHueM THI (cnpaea). Roumypur eudorcapda eutznndnm uemqe s pnrcuMe mxaueeoil
?op.rtoHuKu, oduarco dnn usuepeuuil ueo6xoduuo ucnonbso*amb HamurHoe uso6pacrceuue.
-Irnarrn.recrcnfi Alrarra3oH
Ynrrpa:ayxoaofi Aarrrr4K rrocJre upeo6paeyer ynbrpa3ByKoBble cI,IrH€urbI B
l]el\-rpruecKl4e r,rMrrynbcbr, KoTopbre LrMercT pa3Hylo cTeIIeHb
I4HTeHCHBHOCTI4.
Ilcro.usrrfi elerrpuqecrufi clrrHaJr, nocrynarcqufi e [epBpItIHbIfi 6nor o6pa6orrz
1--Ibrp€BByKOBOfO alnapara
r4Meer
ar{reHcrrBHocrlr rop.rrAKa I2O
A6 (lx106)
ro a\frJrprryAe. ,{na roro
nvrle.aM'rrtecrzfi
r4 r.rMeer
Ar4ana3oH cpe4Hefi
Aocraroqno 6omruofi pas6poc
rrro6br HlrBenr4poBarb 3Ty HeoAHopoAHocrb rrpl4MeH-f,ercs
13HbIM
-rorapuQuwteaKafl KoMnpeccvfl. cvrHalra, B pe3yJrbrare qero crJla)IolBaercf, ero
OJIH
{eo-lHopoAHocrb Ao ypoBHq rpuMepno 50
C
Koeofi
(o
oH
)JIbIIIE
W T.A.
;-poro Mox(er BocnplrHqrb 3purenrnrrfi
A6 (11256). I,Inrenuo 256
aHaJtur3arop qenoBera.
orreHKoB
r{eu BbIIrre crelleHb
ro\mpeccr,rkt, TeM Br{3yanbHo 6omruero KaqecrBa nonyqaercf,
Ha
gKpaHe
no6paxeHr4e r4ccJreAyeMbrx crpyKryp.
T.r. ne r<ax4rrfi
qenoBeK cnoco6eH Bocnpr4Hr4Marb sce 256 orreHKoB ceporo
B cpeAHeM Mbr Bocrrpr{Hr4Maer ue 6oree 30-40 orreHKoB
or cBerJlo-6eloro
4o
repHoro), crerreHb KoMrrpeccvvr cvrHara (yponeHb AI4HaMI4qecKoro AraauasoHa)
KaxAbrfi uccneAoBaTeJrb noA6r{paeT
<<froA
cBo[
rJIa3>>
[I 3Ta BeJTIIqI'IHa He SBJI.f,eTCt
TIOCTO'HHOfi.
3. noil[JTEPOBCKA-fl SXOKAPruOTPAOT4fl
,{onuneposcrzfi pexuM ([-pexzrvr) oro6paxaer
HarIpaBJIeHpIe
u
cKopocrb
ABUX{eHLrS TOTOKOB KpOBLT LrJrLr TKaHeBbIX CTpyKTyp cepAIIa Ha ocHoBe aIIuIkI3a
qacrorbl orpax{eHHofi ynmpasnyronoft BoJIHrI.
SSSerr ,,{onnnepa
BnepBbre
6ul orlrcaH B 19 BeKe ancrpuficruu $zsurorvr
Xpuuuanou I4oraHHoM,{onunep
llpunquu
o6rerros
ovt.
AorrnJrepa orrr4cbrBaer Qenorr,reHbl,
lpoucxoAsrq[e rlpu
orHocnreJrbHo HerroABrrx(Horo rIpkIeMHLIKa.
Tar,
ABLIXeHITLI
HaxoA.acb Ha
xene3HoAopoxnofi craHrIVLr XpncruaH ,{ouunep o6napyxzn pztrnllque
roH€urbHocrLT
ryAKa upu6unarorlero vr y6rinarorqero
craHrluu. T.e. cau Xpucruan,{ouunep
u3AaIorILIfi
6ul
c
)Kene3HoAopoxnofi
neuoABtIxcHbIM npI4eMHLTKoM, a rloe3A,
BbIrIoJIHtn ponb rIoABLIxHoro o6rerra.
ry4ru
Paccuorpuvr rpvr BapvraHTa 4ruxeunfi o6rercra (Soprr,rennrre
3JIeMeHTbr
rcpoen) orH oc r4Te JrbHo HerroABlrxHoro yJlbrp a3ByKoBoro AarrILIKa, ycraHoBneHHoro
Ha noBepxHocTlr TeJra naIILIeHTa.
Ecnu
LT3
o6terr
Heno.IIBLIXeH orHocvreJrbHo Aarr{I{Ka, To
Hero ynbrpa3Byronofi BoJrHbr paBHa qacrore orpax(eHHoft
o6rerta ynbTp€BByronofi
or
rlacrora orrlpaBJlennofi
or
HerIoABLDKHoro
BoJIHrI. CAnura qacToT He IIpoI4cXoAlIr.
Ecnu o6rerr ABkrlr(ercr no HarrpaBJIeHLrIo K AaTTILIKY, :ro qacrora orpaxenHofi
o6rerra ynbrpa3Byronofi BoJIHII 6y4er 6olrrue qacrorbl,
ABlrx(yulerocr
ornpaBnennofi Ha o6rerr AarqLrKorr4. BosHLIKaer nono)KLtrenrnrrfi cABI4r qacror
yJrbrpa3ByKoBbrx role6anufi
Ecnu o6terr
ABr4I{yrlerocf,
B
orrrpaBnennofi na
.
<<y6eraer>>
ooparHoM
o6rerr
oT AaTrII4Ka, TO !IaCTOTa OTpalKeHHOLl OT
HanpaBneHLTLI o6terra MeHbIrIe qacrorbl,
qacror.
AarrrlrKoru. BognzKaer orpl{IlarenbHblit c4r,ut
3nas cKopocrb ynbrpa3Byroeofi BoJrHbr (c), a B ynbrpa3nyroeoft ALIarHocrLIKe 3ra
BerLrrrlrHa nocro-sHHar. 14 paBHa 1540
----i 12
\_
I
vlc,
6azoBylo qacrory ynbrpa3ByKoBoro
cf,rrrana(O, reHeprpyeMyro ynbTpa3ByKoBbrM AaTquKoM, a TaKXe BeJILIqLIHy CABUfa
qacror (40, MoxHo paccqr4Tarb c K ofi cKopocrbrc LIccJIeAyeMbIfi o6rerr
K
upu6luxaercfl.
AarquKy, twt6o yqurflercfl
or Hero rlo
coorBercrnyroqefi
Qoprr,ryne:
)ocrb
v =r/zc x flAf , rA€
ilrvr3a
v
Bce
iIIKOM
(EHI4KI
tHa
AorrurepoBcKLre pexerMbr rro3BoJrtror saSurcupoBarb roJIbKo
(no xoAy ynbrp€t3ByKoBoro rty'ra) r LIM
renocrynHbr rrolepeqHbre ABLDKeHLrfl.. 3ro .flsrserc.f, ocHoBHbrM ofpaH?ITIeHLIeM
roex AonnnepoBcKLrx pe)KLrMoB u uo6y4zno K co3AaHLI HeAorIrIJIepoBcKLIX
nlnAonbHbre ABLrx(eHLrs o6rerroe
reroroB
rvtl{ve
- cKopocrr o6rerra
Lr3) reHLr-fl ABr4xeHZfi, o
roropux 6yAer cKa3aHo qyrb
rIo3AHee.
flouul,ro groro olpaHlrqeHzfl, cyqecrBeHHblM, Ho
KoHTponupyeMbrM
rxHofi
re{ocrarKoM flBrrflercs. 3aBLrcLTMocrb AorrlnepoBcKtlx zauepeHzfi
IOe3A,
DcrreAoBaHnfl.
aporc [o
llocrolrry
or
yrna
HeBo3Mox(Ho pac[onoxLTrb yJlbrpa3ByKoBofi Aar.aurc
noToKy qacTLrrl
B cocyAax, To
r{3MepeHLIe CKOpOCTU KpOBOTOKa
ICHTbI
lI)EcxoAr4T rroA yrnoM Me)KAy ycTaHoBneHHbIM Ha rloBepxHocTll TeJIa AaTTILIKOM
HHOfO
-rfi)poM
HalpaBneHlrq rroroKa KpoBLr
GnoHeHr{e
onkr
cbrBaercr QopvryroZ
OHHOfi
KHOfO
K
HeMy. Tarc Ha3blBaeMoe yrnoBoe
:
Voopp=VxcosctrAe
Yq-r:uepeHHaq cKopocrb
KpoBoroKa, V
MexAy BeKTOpOM rrOrOKa
-
ucrunniur cKopocrb KpoBoroKa, coso
KpOBr,r K HanpaBneHr,rro
yrnoBoe orKJroHeHI4e
-
pacllpocTpalleHldf yJIbTpa3ByKOBOrO Jryqa
EHHOfi
B ureanrHoM cnyqae krcrtrnHar cKopocrb
]TOTbI,
{acToT
tmJr paBeH 0
- npu oroM cosOo =
tEoBbrM orKJroHeHuenr 90o,
,vt
oT
-If,Mbr
'oT.
IIaI(OIO
KOBOTO
1. Ecnz )Ke
cos9Oo
HarIpaBJIeHLTe
[onfreHa, ecrvl
nyqa 6yAer uoA
= 0. zuenno rlosToMy Ao[[nepoBcKze
- rpv
ABVr>KeHUe
yMHoxeHI4LI cKopocTv Ha HoJIb MbI He nonyqLIM HLIqero
-
ABIIX(eHLI', XOT.fl QarcrZueCKLI OHO eCTb.
Bnu.4y
tKE 3TA
ro
KpoBoroKa 6y4er
He MOfyT 3apeflrcTprrpoBaTb [oleperrHbre IIOTOK]I KpOBLMVT
cepAqa
cToTbI,
11
roro, qro
x
AonnnepoBcKLIe pe)KI{Mbr {BJItIorc-l yfoJI3aBucLIMbrMLI,
ynbTpa3ByKoBbIX
B
anlaparax upeAycMorpeH percrrM yrJroBorl
vrnonas KoppeKlu4{ zc,,oJlb3yerc.fl ToJrbKo [pu
cocyAax vr HLIKO|Aa He npr4MeH-rrerc.n npv
LtccneAoB aH.rr4 KpoBoroKa B
uccneAoB a-H:[I.a BHyrprrcepAeqHbrx
uoroxoe! Jr'o6a'- pyqHa'f, KoppeKl{z
fl
yrna [pLr r4ccneAoBaHr{u KJrarra'oB cepArra
IIpr,IBeAeT K noJryqeHrrro HeAOCTOBepHbtx
AaHr{btx.
flpu
upoBeAeHr4r4 Ao[[nepoBcKr4x r{caireAoBarrnft ynbrpa3Byrcoeovr
a*apar
rlo3BoJlter AotlrlJlepoecxllfi cABLIT rlacror MexAy qacrorofi creHepvpoeaHHofi
yJlbrp€l3Byrconofi eorHofi Id orpoKenuofi or ABuDryrrlerocr o6ter:ra upeo6pasoBarb
B aKycrLTqecKLIe cpIrH€LIIhI.
Tar rar
cABLrr
qacror BcerAa HaxoALrrcr B npeAeJrax
cJIbTIIILIMOCTLI TIeJIOBeKOM, TO frO,IBJIfleTCfl BO3MO)KHOCTb OTIeHLTBaTb HaLrBbICUIne
cKopocrLI KpoBoroKa rro cJIhIIrrkTMoMy aKycrLrqecKoMy crtHaJry.
Tarzu
o6pasou,
ayALloczrH€trl, rcoroprtfi reHepupylor Akr:naM:zKu ynbrpa3ByKoBoro arrnaputa
flBIrflercfl 3ByKoBbIM
LIHATKaTOpOM CABLrfa
rracror, a He
aH€urofoM
aycKynbTaTnBHbrx 3ByKOB.
9eu urzpe
OJIbIITTLIT
Auana3oH
rlacror, TeM 6onee
r4ccneAoBareJlb. Ilenr
<<rpyoee>>
LI xecrqe
-
yxe
<<uqrrufi>>
r{ MenoALrqnrrfi
ckrrH€ur
ALrala3oH qacror, TeM aKycrzqecrzfi ckrfH€ur
rrotBJllterct raK H€l3brBaeMHfi <<cevcrr,;rtluit>> nenpzxrnrrfi
3ByK.
OcHonnrre AorlrJrepoBcKrle pe)KrrMbr, [prrMenqeMbre B 3xoKap4uorpaeuH
Ir o cm on ruH o I on H o I un d o n nJt ep o zp a e un -
o
6osHaqaerc-fl
rar cw-4orrrnep.
[anuaq a66peBuarypa o6rqenpuHflTaLr zMeer oALrHaKoBoe o6osHaqeHlre
Ha Bcex
BhrrrycKaeMbrx ynbrp€l3ByKoBbrx npu6opax.
flpn
rocrotHHoBoJlHoBofi 4ouureporpa$zz oAr4H Lr3 gJreMeHToB AarquKa
paooraer Ha LT3nfreHI4e ynbrp€l3ByKoBbrx BoJrH (uocronruo reHepLTpyer
ylrrpasnyr), a nropofi gJIeMeHT AarqlrKa rrocrorHHo pa6oraer B pexuMe
IpLIeMHVKa orpax(eHHblx ynbrp€r3ByKoBbrx
pa6oraror nocrotHHo
u
cI4HXpoHHo.
xole6anufi. O6a orLrx
llocronrxy rtpv
gJreMeHra
[ocro.f,HHonorHosofi
Aorlnneporpa$zz peruIcrpl{pyerc.f, Bce cKopocrLr Bcex o6rerros, rrorraAarotur4x no
I
xoAY Jr)Ara, To [poLTcxoArrr cyMMarlvr Bcex
cropocrefi or nylenofi Ao
I
gToM BhrqJreHzrb orAenbHbre crreKTpbr rroroKa npuqeJrbHo
I
MaKcLIM€LIIruofi,
[pI{
)KA B
HeBO3MO)I(HO.
IHbIX
3atrOJrHeHnurr,r
W-sa groro
crreKTp KpoBoToKa oKa3brBaeTcr rroJrHocrbro
(puc. 1 3).
PAIIA
rapar
HHOfi
)BATb
[enax
CIIILIE
il3oM,
apara
IOIOM
{IH€tII
hrc. 13. CnexmpozpcmtMa
KpoaomoKa qep% aopmarbHbtil rcnanau (cnercmp Huzrce uzonuuuu)
aopmcwbHott pezypzumaquu (cnercmp uad usonuuueil) e CW-donrutepe.
IfH€UI
THbIfi
Ervruy.rrrcHo-BoJrHoBafl Aorrr.neporpaQrq (PW-lorrrJrep).
rQuH
rep.
BCEX
flpn
LI
CTIOJIb3OBAHI4I,,
yronoft
cr4rH€ur
npyer
)KI{ME
zcxoAnr
MrrynbcHo-BonHoBofi
or
AarqLTKa
Jra, KoTopbrr4 oAHoBpeMeHHo flBrrfleTcfl
. llpz
fIILIKA
kr
AonnneporpaSuu
or oAHoro eAuHcrBeHHoro
u feHeparopoM
yirbTp€r3ByKa Lr eFo
LrMrrynbcHo-eorHosofi Aonrneporpa$uu rponcxoALrr
, a LrMrryJrbclJas. feHeparlur ynbrp€BByKa
-
He
oH ucrrycKaeTcr Ha oobeKT B
orlpeAeneHHbrx r{Mnynbcon (<<uauer>). I4svrepeHlre cKopocrlr KpoBoroKa npLr
lpo[cxoALTT
B orrpeAeneHHofi TorrKe raK Ha3brBaeMoM KoHTponbHoM
B ouu.Ize or
rrocrorHHoBoJrHoeofi Aorrnneporpa$uu AanHuft pe)KLrM r4Meer
VIEHTA
rosofi
IitX IIO
,ii Ao
EJIbHO
uMoe
EHHOM
rpaMMa
rrpeuMyrrlecrBo
f{acrKe. flp"
r4ccneAoBaTb cKopocTb KpoBoToKa
r,rMrrynbcHo-BonHoBofi
KpoBoToKa oTrlrqaeTcr
Aorrrneporpa$uu
Ha3bIBaeMOfO
H€rrruqLreM
bHoro oKHD> - HeoKparxennoft o6lacrz crreKrpa
(puc.l4).
Crcopocrr Hafircnucra
BITeTCS OrpaHrIrIeHLIeM Nrf. rIpLIMeHeHI4t
AorueporpaQulr B 3xoKapAplorpa|^ . flocrcolrry a PW-
r4MrrynbcHo-BoJrHoBofi
AorrrrJrepe ynbTp€BByKoBbre clrfHuurbr rroAaroTct KOpoTKLIMII UIM[ynbcaMLI c
To rrpu
onpeAenessoft ra4epxrofi,
yMeHbrrraerct nopof
p
yBenl4qeHuu rrry6unrr
ef LI cTp ar\kru cKopocrll KpoBoroKa.
Cropocrr o6rerra, Koropar flpeBbrrxaer orlpeAenennrrfi rropor,
<<cKopocrb HafireLrcro>.
llpu
reHepupyeMbrx yJIbrp€L3ByKoBbIX
pzna rrpeBbrrrrarb qacrory
Ha3blBaerc-fl
oroM nopor cKopocrrI B I,IMrlynbcHo-eorHoeofi
TeopeMor4 c9MrInLlpoBaIJIds:
OIIIICbIBAETC'
AorrrneporpaQzra
LI3MepeHIIJI
qacTora
role6anufi Aonxua, rro uenrruei Mepe, B ABa
role6anzft 4nzxyuqeroc.f, o6lercra.
llpe,qen Hafirsucra MoxHo orlpeAenzrb Iro $opvryle:
V=C2x(8fxd),rAe
v-cKopocrtHafircstacra,c-cKopocrbynbrpa3ryna,f-qacroraynbrpa3ByKa,d-rty6una,Haroropofi
pacnonoxeH KoHTponbHrlfi o6reu.
Puc. 14. Ilomox qepu Mump(ubHatil rcnanau e PW-donnnepe. B cucmoruvecKoM nuKe eudua
Heo
Kp au,t
eHH
afl
u
ac
mb
c
ne Kmp
a (yrca s au a c mp e n x au u )
I&cxogt uz Sopvrynrr upeAena Hafirnucra, MoxHo paccqLTTarb na rarcofi
uy6une pacrronoxoaufl KoHTponbHoro o6reua 6yaer Aocrllrarbct npeAen
Hafirsucra:
Cropocrr AllarHocrllqecKoro ynbrpa3ByKa
exoKapAzorpa$uu
- 2 Mfq, d -
1540 vr/c. qacrora
rny6zHa cKaHl{poBaHvrfl (4onycrzu, 8 cnr).
B
FICHI{f,
Orcrola:
r PW-
\- = (1540v1c)2 / (8x2000000fq x 0.08rr,r/c) = 1,85
MI4
T.e. na rny6rane KoHTponbHoro 8
C
peHufl
cna
vr/c
npe4en cKopocrr'r KpoBoroKa, roroprrfi Moxer
6rtru 3aperrrcrpl4poBaH l4MrrynbcHo-BoJrHoBbrM AorrnnepoM cocraBr4T 1,85 u/c.
flpu
creHo3ax KnaIIaHoB cKopocru KpoBoroKa cyqecrBeHHo Bbrrrre, nooroMy
]aeTcs
-llrl
HOBOfi
:rocrorHHoBoJrHoBofi 4onnnep.
oueHKI{ MaKcrrMaJlbHbrx cKopocreZ rponoroKa B 3Tr4x cnyqarx npr4MeHrerct
ICTOTa
B
ABA
oropoft
Puc. 15. @euo.meu ucKaJrceHun (aliasing) e PW-donnnepe. 3a nuKoM E mpaucuumparbHozo nomoKa
pezucmpupyemct nomoK pezypzumaquu (uutrce usottuuuu), Ho nocKoJtbKy cKopocmb nomoKo
:c?rpzumaquu npelbnt aem npeden Hailrceucma, nomoK ucKctilceHHo omo1pactcaemcn uad usonuuueil.
Yneluqurb perplcrpl4pyeMbre cKopocrr,r KpoBoroKa MoxHo, rroBbrrrrar qacrory
:rrBToPeHI4f, I{MnynbcoB
(HPRF).
llp"
yBenkrr{eHr4u
qacrorbr
noBropeHr4t
-vrryJbcon e 1,5 pa3a rpeAen Hafirevrera, r.e. Ao 2,78 vrlc.
iuoHa
Kor4a Aocrl{raercf, npeAen Hafiretrcra, To Bo3HHKaer $eHoMeH erafiguHra
rliasing) unra $euoMeH I4cKalKeHu-f,. @euouen gnafi3krHra 3aKJrrcqaerafl B ToM, qro
f
[oIIaBIxLIe B rrrKaJly CKopoCTI4 KpoBoToKa oTO6paXarOTC-fl Ha ApyroM ee yqaCTKe
KAKOfi
;xt-.
rpeAen
OTA
B
15).
I{neronaq AorrreporpaQnr
I-fneronax Aorlnneporpa$ut tBr-sercr p€r3HoBrrAHocrbro rrMrrynbcHosorHosofi
AorlnneporpaSuu, ToJIbKo npu groM r4cnonb3yercr He oALrH, a MHoxecrBo
KoHTponbHbIX o6tenron, Koropbre
orpa r4qeHbr gonofi onpoca.
llp"
qneronofi
Aorlrneporpa$zz BMecro rpaSrara cKopocrr4 (cuer<rporpaMMbr rponorora)
ynbrpa3Byronofi ailnapar oro6paxaer qBeroM HarrpaBneHr4e KpoBoroKa
uzotulJueit Aorl[nepoBcKoro crreKTpa, urLr rroroK K Aarqr4Ky
KpacHbIMLI orreHKaMlr, a rroA Il3oJrusueit LrJrr4
or AarqlrKa
-
(HaA
oKparxLrBaercfl,
cvrnuuu orrenrauu).
B pexrarvre IlBeroBoro Aorrflnepa cKopocrr4 KpoBoEoKa orrpeAeJrrrrorcr raruKe B BLrAe
onpeAeneHHblx oTTeHKoB KpacHofo VUWI CVrIJefO rlBera, lrTO pefnaMeHTr,rpyercs
qneroaofi rura-uofi (pzc. 16).
Puc. 16. IUrcana crcopocmeilqsemonozo donnnepa.
Ifpeden crcopocmeil, sbtcmarneuuutil Ha utKane cocmaznflem om +26,6 do -26,6 cu/c
Coomeemcm*eHHo, cKopocmu KponomoKo, npu1nucrcanu4uect
6y
dym
o Kp
awus amb cn
Kp a cH o - Jrc e Jt mbt
Tar< KaK qneronofi Aorlnnep
BoJIHoBoro, To Ha Hero 4eficreyror
M unu
c uH e - ? ony 6
wu
q6
e
K nepxHeMy npedeny
matvtu.
fl rrflercfl pa3HoBr4AHocrbro
re x{e caMbre
LrMrrynbcHo-
orpaHr4qeHvtfl., a zMeHHo rrpeAen
z eSQeKr LIcKaiI(eHvrs.. B cryvae qneronofi AorrrneporpaSnz eQQercr
I4cKax{eHkI-s 6y4er BbIDI.f,Aerb KaK <<necrprrfi> vrru <<ruo3azqsufi>> rroroK c
Hafircszcra
0
r4pro3oBbrMkr OTTeHKaMLI.
,{nr roro qro6u
rIoBbIcrITb npeAen perlTcrpr4pyeMbrx B rIBeroBoM Aonnnepe
cKopocrefi, neo6xoAl4Mo yMeHbrlrurb pa3Mep 3oHhr olpoca, T.e. yMeHbrrrr.rrb
r4Mrrynbc oB, yrr acrByro
qv x
B nocrpoeHLr r'r
rlBeronofi Aorrllneporp
aMMbr.
qr4cJro
Cxopocrr Hafireucra v s$Qerr ucKalKeHkrr krrpalor
Ba)ICHyro
IIHOBOLI
KlJrurrecrseHHofi gxoKapArrorpaQzu AnA oTIeHKLI crelreHu creHo3oB
r)KecTBO
(pacuer nnoqaAlr orBepcrlrt) u o6reMa peryprurarJvrv.
ponb
B
KJIaTIaHoB
teroBofi
BOTOKa)
ia
(HaA
wBaeTcfl.
rrKaMLT).
) B BrrAe
rpyerct
Puc. 17. 3QQercm ucKcorceHufl (aliasing)
n
s
peJrctnte q6emo6oeo donnnepa npu KapmupoaaHul't
xrxa -vumpct"tuuoil pezypzumaquu. B nonocmu relozo npedcepdun peeucmpupyemcn <<necmpatitr> unu
<MO3AUqHblU>> nOmOK.
6 cu/c
Txaneeaq AorrrrJreporpaQrq
'
Tranenas AonrneporpaSzr (TDI)
npedeny
cKopocrLT
ABLDK9HII.S.
-
oro AornnepoBcKllft pex<I,lM, Koropblfi
TKaHeBbrx crpyKTyp cepAIIa
HacrpofiKlr annapura (upnrvrenarorct Qunrrpu,
rynbcHo-
Buepnue cr4rH€urbr
or
aa apreQaKTbr
) rrpeAeJl
nonf{eHHbre AaHHbre
Bo crIpLT
tx)flBrreHlrevr quSpoBofi ynbrpa3ByKoBofi TexHI,IKLI
e
<<orceKaloulue>>
B 196l r.,
Mr4oKap4a 6sutu non1^reHbl
14
[pLI rloMolqz
oAHaKo ux
HLIM€trIrIcb cKerrI4qecKLI.
1990 roAy BrlepBbre 6bln
eQSercr
MeroA pefkr cTparlLr
TIOTOK
14
cKopqcrel4 ABLIx{eHut MI4OKapAa.
C
flolo6no
rpaALrrlr4oHnoft AonnneporpaQzu BbrAentrcr rlBeroBofi rraHesofr
scrufi pex{LrM (TDI-Color) pkrc. 18 v
rcufi pexuvr (TDI-PW)
-
I4MrIynbcHo-BoJIHoBofi
puc. 19.
TxaHesofi Aorrrrnepoecrcufi MeroA rro3BoJr.f,er perl4crpllpoBarb roJIbKo
bre
HI,IEM.
ABvDKeIJvrfl.
crpyKTyp cepArla,
u
eror
Sarr
flBrrflercs. ero
Hecnaorpa Bce HaAexAhr' Korophre Bo3Jrar€urLrcb Ha qneronofi
rraneeofi
Aon'Ineposcrcufi pe)KI4M, ABax{eHue crpyKTyp cepArla B 3ToM pexLrMe
oK€r3€urocb
JILIITTb
xpacznoft r<apruHrcoft. oqenvlrr HapyrrreHLre noramnofi
coKparkrMocrkr
MLrOKapAa B STOM pe)Kr4Me HeBO3MO)KHO.
B
orJrllque
or
IlBeroBofo TKaHeBoro Aorrlnepa, uMuyJrbcHo-BoJrnonofi
rranesofi Aonlnep npoqHo BoIrreJI B Krr4HLrqecKyro npaKTrrKy
u Ha ceronH,r
cocraBJl'f,er ocHoBy OIIeHKH AvracronLFlecKofi
SyHrqzz cepArla. Kpolae Toro,
rIoMoIrII4 TKaHeBoro I4MnynbcHo-BoJIHoBoro
AonrrJrepa 14 cr4Hxpo11Lrca\uu
[prr
c 3Kf
MO)KHO
nonyqurb I{eHHhIe lapaMerpbl,
KOTOpbre ucrroJrb3yrorcr
B
apr4TMOJrOfLrLr
4nx 6olee roq'ofi nacrpofirkr BpeMeHz 3aAepxKLr B pa6ore LrMrrJraHTr4pyeMhrx
zcKyccrBeHHhrx no4zreleft pLrrMa,
qro oco6enuo
BaxHo
pe
cr4
HXpoHr4 3r4pyrcu1efi
npu
repanzz.
Puc' 18' IJeemoaoil mrcaueeoil donrutepoecrcuil pecrcutt.
eeemou rcodupyemcn deutrceuue
qHamoMultecKux cmpyKmyp cepdrya:
KpacHbtM qnemoM rcodupyemcn deurceuue
cuHuM qoemoM _ deucrceuue om damqurca.
L-L
rc
damqurcv.
AHEBOI{
13€uIOCb
NMOCTI,I
IIHOBOLI
)efoAHt
ro, [pLI
c 3Kf
tOJIOTI4Ll
pyeMbIX
rp14
Puc.
19.
I,Iunynacuo-eonuoeoil mrcaueeoil donnnepoecrcuil pecrcunr. Koumponauatf,t o6tent
e o6nacmu ramepcubHoeo MumparbHoeo Korbqa. Ha cnercmpozpctMJvte omo6pacrcaemcfl mpu
- oduu nonocrcumenauatil (nurc Sm) u dea omput4amenbHbtx (Em u Am). I'Iudexc <<m)> nocre
?ennoil udeumuQurcaquu nuKo6 o3Haqaem npusepuceHHocmb noKosametteil x mrcaueeouy donnnepy
,rar(a
(m-myocardium).
4. AHATOMT4fl V (DZr3IIOJrOrr4fl CEPAIIA
Cepaqe Mo)KHo npeAcraBurb B BuAe AByxcropoHHero Hacoca, pa6oraloqero
2417
.3ror
Hacoc Mox{Ho pa3AenrlTb Ha rrpaByro u neByrc roJIoBLIHbI.
Ilpanoe cepArle accoqu poBaHo c clrcreMofi reroqHoro
.ueoKcLIfeHLIpoBaHH€uI KpOFb
AenoHllpyeTct
KpoBb Bo3Bpalqaercf, K IIpaBoMy CepAIIy
B
BeHO3HOM KOnneKTOpe.
qepe3
BeHo3HyIo cncreMy.
V
HIl3KOe AaBJIeHIle,
oTAeJIbI IMeIOT HII3KOe COIpOTI{BJIeHIIe
pacrBopeHHoro KLIcJIopoAa (SatOz)
,uilceHue
mquKy,
KpoBoo6paIrIeHI4rI.
rarxe
cHuXeHa r4 cocraBJl-ler
75Vo. Hacoc npaBoro cepArla HarHeraer KpoBb B JIerKLIe, rAe npoLTcxoAkIT
COz
*
Oz (<<ynraeepc€rJrbHbrfi o6uenurrfi nynrcr>>). KzcnoPoA
c BAoXoM,
AOM
a yrneKllcnblfi rul3 BbIBoAvrTafl. c
e JIeTKI{e
BblAoxorvr. O6oraIIIeHHiUI
KpoBb npoAoJlxaeT ABLIraTbcs. B rteroqHofi rponeHocHofi cLTcTeMe
14
f, Ha ypoBHe refoqHblx BeH, KOTOpbIe nepeAaloT ee B JreBoe cepAqe.
Jlenoe cepAqe accoqnupoBaHo
c
cLrcreMHbIM KpoBoo6palrleHueM. Jlesrre
cepArla rroJrrraroT HacbrrrleHHyro KLIcnopoAoM KpoBb vr3 JIeforIHoLI
cLIcreMbI
Lr [epeKaqkIBalor ee ro cocyAaM clrcreMHoro
orcczrenupoBaHHa-f, KpoBb
KpoBoo6parrleHr4rr.
nocryuaer Ko BceM opraHaM vr
TKaHTM qepe3
aprepil€ubHylo czcreMy. Jlenrre orAeJrbr cepArla rMeror BbrcoKoe
AaBJreHrre n
BbrcoKoe co[porrlBJreHrle, KOHrIeHTpar\Lrfl. pacrBopeHHoro KlrcnopoAa raK)r(e
BblcoKas: HopMarrbHar SatO2 cocraBJrfler
=98Vo. flocle yrvuru3arlkrLt KtrcJropoAa
TKaHIMII' AeoKcLIreHupoBaHHas KpoBb rrocryrraer B BeHo3nrrfi ronneKTop kr rIkrKJr
HaqLTHaeTCt 3aHOBO.
Cep4qe B cocrotHLIl4 BhluonH.lrb cBolr 3aralrv, onuparcb Ha cerb cocyAoB,
KOTOpbre
rpaHcloprLTpyror KpoBb K HeMy
14
OT HefO
no BceMy opraHz3My.
Cyqecrnyer MHo)KecrBo cocyAoB, Ho Mox(Ho BbrAeJrlrrb 3
ocHoBHbre
KaTefopLrr4:
o
Apmepuu
Ran
Beruot
[ocranrca Kr.rcnopoAa u rrr4TareJrbnbrx BerrlecrB
bt
K TKaHTM
opfaHrr3Ma
YIanenrae CO2unpoAyKroB o6uena ng rraHefi
opraHv3Ma
Puc. 20. Hopuutuuaz KoHqeHmpaqun pacmsopeHHozo rcucnopoda s Kalvtepax cepdqa
(cneea) u daeneuue (cnpaea).
22
rrleHut.
qepe3
Cocy.uncraq c[creMa
l.
Aprep:zra
EHI|E II
-
Torcras
TAKXE
repeHocrr KpoBb or cepArla. Crenra aprepllfi ouroczreJrbHo
v o6laAaer gracrLlqecKllMt4 ceoficttauu, o6ecnequsaq
Heo6xo,4rauoe AaBneHLIe
B cucreMe co3Aalorct ycJIoBLIt An{
KpoBpl. Aprepur'r cucreMHoro
:nopoAa
aHreporpaAHolo (nnepea)
14 UI4KJI
rponoo6parrleHLrf, o6naAaror 6onrurefi ycrofi.rznocrblo
ABLDICeHLIT
K AaBneHr4ro
B
cpaBHeHlrr4 c cocyAaMu JrefoqHofo rponoo6pa[IeHLIq.
ocyAoB,
2. Apreprara nepepacnpeAensrorc{ Ha 6oree
MeJIKI4e cocyAbl, Ha3bIBaeMbIe
aprepuonaMLI.
HOBHbIE
3- Apreplronbr rrepepacnpeAelsrcT KpoBb elqe A€rnblue
-
B cerb MeJlbqauluux
cocyAoB, Ha3bIBaeMbIX KaIrLIJInf,paMI4.
E;rotc-cxeMa cepAeqHococyAucroft crlcreMbl
G
C
nctema KpoBoo6paqeHxR
ncreu uoe KpoBooOPa qeH[e
-at
*C
a
I
a
[lpaeoe
celAqe
l
El
t)]
EI
=i';
o
o
N
I
-o
E
.EFT
7-J
fleroquoe KpoBooOpaqeH ne
so
E
a
F
zS(
x(D
C'
is
t
A
E
a
o
-
a
-oa
E
cepdqa
=
P
uc.
2
l.
Enorc-cxeua
c
epd euuococyducmoit cucmeMbt.
IrrIeHLI'.
t
qepe3
CocyAucras cncreMa
l. Aprepvv -
nepeHocrr KpoBb
cepAIIa. Crenra aprepufi orHocureJrbHo
gracrLIrIecKIaMI{ ceofictnauu, o6ecnequeag
14 o6raAaer
IEHIE II
ToJlcra-fl
.
neo6xo.urauoe AaBJreHLre
TaKXe
or
B clrcTeMe
co3AaroTcr ycJIoBLIt Anfl
cnopoAa
aHrepolpaAHoro (nnepe4) ABLDK9HLT.I KpoBLI. Aprepuu cllcreMHoro
I PI ULIKJI
rponoo6parrleHur o6naAaror 6onrurefi ycrofi.runocrblo
K
AaBJIeHLTTO B
cpaBHeHZr4 c cocyAaMH JIefOqHOfo rponoo6pa[IeHLIs.
)ocyAoB,
2- Aprepuz nepepaclpeAenrrorcs Ha 6oree MeJIKue cocyAbl,
Ha3bIBaeMbIe
apTepuonaMl,I.
CHOBHbIC
3-
AprepLToJrbr rrepepacnpeAemror KpoBb elrle AaJIbrue
-
B cerb uenrqafiurzx
cocyAoB, Ha3bIBaeMbIX KaTILIJIJI'paMI{.
E.non-cxeMa cepAeqHococyAucrofi clrcreMbl
Gncrema KpoBoo6paqeHxf,
[lpaeoe
Ibece cepAqe
C
noeu
rl
'l
cepAL{e
Hoe KpoBoo6pau{eHue
j
_
l
f
-o_
J
-**-
Eq)
E
Et
s
rD
rn', { }
.:
LEFT
y u r'
:
E
a
i
AI
F
zS(
xo
:::::-
{'=F
C'
-<-
t.J
A
o
t
E
cepdqa
=
fleroqHoe KPoBooOPaqeH!4e
P
uc.
2
l.
Enox- cxeua cepdeuuococyducmoit cucmeMbt.
4'
Karmttn-'phl coeALrH''rcTcfl c BeHyJraMLr.
crenr<a KarrzruurpoB oqeH6 ToHKa{,
ocyulecrBJr'f,er o6uen KI4aJIopoA
a u rruraTeJrbHb,^ BerrlecrB (aprepzanrnrrft
KOHeq r<arwnapoe), a TaKXe
o6vreu CO, u npoAyKTOB N'era60rzs^aa
(neuosnrrfi roneq Kalunn poB).
5' Benyn.r
coeAr4H-rrrorc-f,, o6pazyt6onee
KpylHbre Be'br.
6. Benrr Hecyr
KpoB6 no HalpaBJreHr4ro K cepArly.
aprepuan'rofi He
TaKa-{ ToJlcra-f,.
C
eHxa BeH B cpaBHeHkrLr c
B orser Ha cHr4}Ke H.'e Lrru noBhrrrreHLre
rzApocTarl4qecKoro
AaBneHzt B BeHosHofi czcreMe, BeHa Mo)KeT
KaK JrerKo
claAarbcfl', TaK U pacrJnpflTbc-f,,
KyMynupyfl60*urofi
o6reu
ffo.noxenue cepArla B rpyAHoft x.nerrce.
,{m nyvruero rroHLrMaHuflrroJroxeHzr cepArla
3arloMHLrrb cneAyrouFo repMLrHonorr4ro
(puc. 22).
B
KpoBr4.
rpyAHofi rnerre neo6xonzuo
EoroEol
Er|I
0sroeaH[e
E
at
sr
Et
o
IF
$
a
CL
C]
.E
o-
tr
torcean
,.,i.'
v'
Hmn
Puc. 22. Ilonocrceuue cepdqa e
zpyduoit
KrxemKe.
TOHKat,
ANbHbIfi
iorusNra
fleHukI c
bIIIIEHLIC
lK JICfKO
o flepe4nsq (neurpalurax) qacrb reJla
o 3aAnst (4opcanrna-r) vacrb reJla
o Borogafl.-B cropoHy or cpeAllHsoit'ttuttuu
. MeAzalb]erAfl.- nO HaIIpaBJIeHI4IO K cpeAllHttoit ttnltuu
o HuxH.st - ro HanpaBneHrrlo B cropoHy Hor uaqueHTa
. Bepxnqr (6asanrHafl) - rro HarrpaBJIeHLIIo K roJIoBe uaULIeHTa
. flporcuM€UrbHat - HeA€IJIeKo OT KaKOTO-JIU6O trtecra
o [racrzrnb:aafl.- AuuIeKo or KaKoro-tu6o Mecra
Ocnosrrsaflcb Ha erofi TepMuHonofkrn, BepxHt.fl rlacrb cepAIIa [peAcraBJreHa
(rcHOBaHueM, opLIeHTLIpoBaHHbIM K3aAH
)XO,IILlMO
vI
BnpaBo. HzXnss qagTb CepAIIa
trpeAcTaBJIeHa BepxylxKofi , opuenTllpoBaHHoft rnepeALI
11
BJIeBo'
IlepnnapA rr creHKa cePArIa.
Cep4qe IIOKpbITo IIepLIKapAOM 5orceoi
ETT
3aIIOJIHSHH6IM 1CI{AKOCT6IO MSIIIKSM'
or uHQerqufi u TpaBM. flepurap,U ) IacrByer B
fleprarap.U
r43arJr4rr ocnosHofi 3a1avru cepAIIa - pa6orrr ero KaK Hacoca'
i4 3aulLtulaer
e1.o
AByXCnOftHbIM graCTUqecKLIM MeIUKOM
r43 coe.urIHrlTenbHofi
TKaHLI'
HHbIM )IOI.IIKOCTbIO.
o
o
Hapyxnrrfi nucroK IIepIIKapAa- Qra6posnrrfi uepnKapA
Bnyrpennnfi
Jrr4croK
rr
pr,rKapAa
- cepo3nrrfi uepuKapA.
Cocrour
ug
AByx
CJIOEB:
1. llapzeralnrufi
cJrofi romufi cJlofi, rloKpblBarouryflr Sv6posnufi
neplrKapA.
2.
Bu('I\epangrrrfi clofi
-
rpunex(kTr K Hapyxnofi noBepxHocrl4 cepAIIa.
3ro
caurrfi Hapyngbrir ctroit creHKZ cepAIIa. Bzcqepanurrrfi clofi nepuKapAa =
srruKapA.
B
rIoJIocrLI
rreprrKapAa, pac1loJloxeHHofi MeXAy Bllcqep€ilbHblM
cJrorMll UaXbAlrrca npo3paqHas
LI
)KLIAKOCTb, KoTOpat
pyeTct ceposnofi o6ouoqrofi. XzArocru 4eficrByer KaK cMtBKa Bo BpeMt
CI4CTOJIbI
50
LI AuraaTonbl cepArla. O6H.rHo e roJrocrlr
neplrKapAa coAepx(urcfl
1
0_30_
rvrn )Kr4.rlKocrrr.
Crenrca cepArla cocrorrr rr3 Tpex crroeB (puc.23):
HKA
cepAqa
ftpoenufi
n€pllElpA6
nepu[apfl
Puc.23. Cmpoeuue cmeHKu cepdqa.
3uzrcap4
LI
- BHerrrHLrit c,oit creHKr4 cepAqa. rlorpunaer
paclpocrpaHtercfl Ha KpylHhre cocyAhl. fiwmercs
rroBepxHocr' cepArla
BI4crIepEUrbHbrM cJroeM
cepo3Hofo nepr4KapAa.
Mzoxap4
-
rleHTp€urHrrfi cnofi creHKz cepArla, cocro,rqn
fi. us nnoruoft
Narrure'rHofi TKaHu' flpe4crarneH nolepeqHorroJrocarhrM'r
MbrrrreqHhrMLr
$ulpu''',a'u c
coKparl'TeJrbHbrMr4 3JreMeHTaMz
u
Ha3brBarorc,
uzo$z6purrraMn.
o 3n4or<ap4 rourufi crofi
gHAorenLr.fl,
coeAr4HLrreJrbHo-TKanofi <<[oAcrr{JrKe>.
rcoroprrfi paclonaraerc,
Tosxzfi cnofi,
Ha
rroKpbrBaroqzfi
KaMephI cepAIIa, KJIarIaHhI, xopAhr, [arrLrnJrrpHbre
Mhrrxrlhr.
Karvreprr cepArla, KJrarraHsr rr cocyAbr.
cep4qe cocroLIT vI3 qerblpex KaMep, qerbrpex
cocyAoB' KOTOpbre BnaAarcT LI BbIXOATT
KOJrJreKTOpbr
26
Haruefo opraHkr3Ma.
r43
KJrarraHoB
Hefo. llpe4cep AuL
-
vr MHoxecrBa
caMhre KpyrrHbre
r 10-30-
Ilpe4cep.uur
rBJurrorcr HarroJrHfleMbrMn KaMepaM[ cepAIIa. llpanoe
trpeAcepAr4e rroJrlqaeT AeoKclrreHzpoBaHrryro KpoBb oT TeJra, JreBoe rrpeAcepAhe
E
-
cncreMbr reroqHoro rcponoo6parrleHkrr. Ilpe4cep4rax uMeror npLIAaroK,
Ercryrraron\vfi 3a ero rrpeAenbr (yurr6)
u
rro3BoJrrer yBenuqlrrb nnoulaAb
n<)BepxHocrv1 a rarcKe
fracrByer B coKparrleHlrv. llpe4cep4r4fl. pacnoltararorc.f, B
repxnefi qacru cepArla (ocnonaHze). flo:zqvr rpeAcepguir BepxH-f,s, orKJIoHeHa
I
HarrpaBJreHuur K3aAr4
vr BnpaBo. flpe4cep4zx paso6qenrr
Me)KrpeAcepAnofi
B rIeHTpe roropofi vr eerc-tr oB€rJrbHoe orBepcrLre. OsanrHoe
orBepcrLre 3To <<rpoxoA>> Mex4y AByMr rpeAcepAuflMn. zueer BDKHoe
repercpo,qrofi,
henra
FPAqA
saqeHlle upu QeranbHoM
GlaBnrrr oB€rnbHyro f,MKy.
Xe.nyqourcn
lpooHbrf
elevrr4
tpuKapA
rcponoo6parrleHr4rr
rr <€aKpbrBaercr> nocne po)KAeHLIt,
flBJrf,rorc.n HacocHbrMrr KaMepaMrr cepArla.
upanufi )KenyAoqeK noJryrraer KpoBb
Hvrtr BbrrurrrKr{Baer
Lr3
flpz
npaBoro npeAcep4un, anpu
ee B neroqHyro aprepr4ro. Jlesrrfi )KenyAoqeK
npvr
I4I4 [OnyqaeT KpOBb pI3 JIeBOTO IIpeACepALUI, BbIT€UIKLIBa' IIOpqvrc
B aopry Bo
BpeM.rr coKparrleHur. Xeny4ourra paso6rqenu
,4ovroeofi [eperopo4rofi, Koropafl flBrrflercfl, HeorbeMJreuofi crenrofi
)KelyAorrKa.
B
nesoM )KenyAoqKe BbrAeJrrK)T qerbrpe creHKLt
, revr>Kr'flfl. Lr [eperopoAorrHa-f,.
no:rnofi
AOqKOB,
IqHbIMI4
BAIOTC.'I
KperrrTor K BepXHeLr
MarncrpaJrbHbre cocyAbr
-
-
rrepeAH-a-a,
Marzcrp€urbHbre cocyAbr, BbrxoAf,Iqkre
qACTVT )KenyAOrrKOB Lr
uI3
HeCyT KpOBb OT CepAIIa.
TpaHcnoprLrpyror KpoBb K cepAr{y LI or cepAIIa
2q.
B upaeoe
upeAcepAr4e BnaAaror
3 cocyAa - B BepxHroro qacrb rpeAcepAnt
BepxHf,t rIoJIa[ BeHa, e AzxHroro qacrb
rrpeAcepAlre BrraAaer KopoHapHufi cvrrtyc,
-
HLrx.Hg.g.
roroprrfi
rIoJIat BeHa. Tarxe s
flBlrflercs. KoJrJreKTopoM
reHLTpoBannofi KpoBrr caMoro cepArla.
B JIeBoe rlpeAcepAue BnaAaer 4 nero.rHrre BeHbr (JIB4), Koropbre Hecyr
reHLIpoBaHHyrc KpoBb
LT3
crrcreMbr JreroqHoro KpoBoo6paqenzr.
BepxHnn
Cnpaea
Cneea
H
Hf,F
Puc. 24. Kaaeput cepdqa u MazucmpcrrbHbte cocydau
14: npanoro )KenyAorrKa BbIXoAr4T reroqH€ur aprepns, Koropar Ae1rvrcflHa
ABe
BerBr4
-
cI4CTeMe
rrpaByro neroqHyro aprepr4ro, Hecyqyrc KpoBb B czcreMy K cocyAzcrofi
npaBofo nefKofo Lr neByro neforrHyro apTepr4ro, Hecynlyrc KpoBb
K
cocyAr4crofi cracreue JreBoro JrerKofo.
I4s reeoro )KenyAoqKa BrIXoAIaT aopra, Koropar rpaHcnoprlrpyer KpoBb rro
cLr
creMHoMy KpoBoo6paqenzro.
KlanaHu cepAIIa. gerrrpe
KJIarraHa o6ecne.rzBaror oAHoHanpasreHHrrfi
(aHreporpa4uufi) ToK KpoBZ. B sanuclrMocrLr or ux pacnonox eHLrfl nrr4erxror 2
ocHoBHbre
rpl4
28
rpynnbl KJIaTIaHoB
npeAcepAHo-xenyAorrKoBbre (vrzrpanrHufi
Kycru 4a-uruufi ) v nonynyHHble (aopranrn stir
vr
rynbMoHalg6rfi ), puc . 25 .
vr
a:l!i1tn:
ralfnt+:
ililnbf,roHotbtibtil
neBa
I
-.: : TanbH
br
ir NranoH
Puc. 25. Knanauut cepdqa.
1
.
-
C.ryeeq
IlpegcepAHo-)KeJryAoqKoBbre
6ud c6orcy, cnpasa
KJIATIAHbI
-
aud csepxy.
(vrurparbHbrfi
TpHKyCrIrAaJrbHbrfi) pacnoJro)KeHbr Mex{Ay npeAcepAr4flMlvr
Cnpaea Me)KAy
lIlI u IIX
r4
*r
xenyAoqKaMr.r.
pacnoJroxreH rpr4Kycrrr4A€LrrbHbrfi KJrarraH.
3ro
B cpanneHm e Mr4Tp€urbHbrM KJrarraHoM
pacnono)Ken 6ruxe K BepxyrxKe. Creea MexAy JIII u JIX pacnono)KeH
caMblfi KpyrrHblfi KJIaIIaH cepAqa.
Ha ABe
-l14crofi
poBb
K
vurparuHrrfi
3arpurrtfi
qBrqIOTCfl
oBb flo
ICHHbIfi
-IflIOT 2
HbIfi
t5.
KJranaH.
3ro
eAr4HcrBennrrfi KJrarraH c AByM-s crBopKaMr,r.
Mr{TpaJrbHbrfi KnarraH HarroMr4Haer cMafinr4K. AB-rcrauausr
AHaCTOJTT{qeCKH
:3 - rranaHbl I4Meror
Mr{,
T.
K. OTKpbrBarOTCq BO BpeMr ALraCTOJrbr.
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o llnornoe n
:
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K KoropoMy Kpen.f,rc.q
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K crnopraM
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14
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flanutlspHbre Mbrrrrrlbr qBr-flrorc-fl
KJranaHa r.r cTeHKaMI,r xenyAolrKoB
nocpeAHZKaMr4 MexAy crBopKaMv
Pacnonoxetre
AopranuHurl rnanau
Bepx
npaBoe
ropoftepilre
3axpurr
Cnpaaa
Cnesa
n.
flJ,nr"nranbHbl
Bepxyura
3aamg
3axpurr
3axpurr
Orxpurr
Orxprrr
Puc. 26. Rnanauu cepdqa, ux pacnoroiceHue e cepdqe, Hauv,reHonctHue cmsopoK 6
ampuo
6e
HmpuKynnpHbtx u nonyryHuil e nonynyuHbtx Kr anaH ox.
2. IlottystynHbre
KJra[aHbr
(aopra.nrHbrfi v
paclono)KeHbl Me)I(Ay xenyAoqKaMz
Lr MarLTcrparrbHbrMLr
rryJrbMoHa;rrHrrfi)
cocyAaMLr. Cnpana
IIX H JIA pacnoJrox(eH rlynbMoH€urrurrfi KJrarraH. Cnesa vrex4y IX
u Ao pac[onoxeH aopralrHufi KJrarraH. rlo.ny;rynnure KJrarraHbr
Mex(Ay
qBrqrorcfl crrcroJrlrqecKrlMrl, T.K. OTKpbrBarorct Bo BpeMs cllcroJrbl.
llonynyuHble KJralaHbr I4MeIor KapMaHbr, oKpy)KeHhr KoJrbrIoM. llorynynurre
KJralraHbr MeHblrre, .{eM AB-KnalaHbr.
E--.
- .!:
bHocTb B3arrMoAeficTB[fl KaMep, KJrarraHoB u MafrrcTpaJrbHbrx
cocyAoB cepArla oTHocrrTeJrbHo KpoBoToKa.
r6
+\.
(
I
(
I
15
\7
Bepxnrx norrar{
10.
11.
12.
13.
14.
15.
16.
Jleroqubre BeHbr X4 (nB)
Jlesoe rpeAcep,4r.re (n|I)
Nf.urpurcnrIfi KrranaH (MK)
JlessIft xenyAoqeK (JIX)
BeHa
(BIIB)
(HIIB)
2. Hzxnsr noJrar BeHa
3. Ilpanoe npeAcepAlre (IIII)
4. Tpurycura4anrurul KnaraH (TK)
5. flpanrrfi xenyAotreK (IIX)
6. flymuonamnrrfi KnaraH (lIK)
7. Jlero.nrrrft crnon (JIC)
8. flpanar neroqHar aprepvs GInA)
9. Jlesar reroqHar aprepnfl. (nnA)
,n
{
1.
Aopramnrrft rnaraH (AK)
Aopra (Ao)
Bersz Ayrr4 aoprbr (BUA, rreBiur OCA,
npaBar nKA)
\---
17.
Hucxolsqa:{ aopra u ee BerBpr
K6
2T.
II o cn e d o 6 am e nbH o cmb B 3 outvto d eilc m eun KqMep, Kr an aH o 6 u Mazuc mp ar bHbtx
co
cyd
o
e
cepoqa omHocumerbHo KpoqomoKa.
U|bHbrfi)
Paccuorpuvr
bHo KpoBoroKa (puc. 27).
. Cnpaea
xcAy
JIX
rrocneAoBaTeJrbHocrb B3aLTMoAeitcrB,ufl, cTpyKTyp cepArla
Bepxnra roraq
BeHa
(BIIB)
[oras BeHa flBJrfleTcfl
]IAIIAHbI
Bepxnax
)LICTOJIbI.
oT BepxHefi uoroezHbr TeJra
rnyHHbre
C6pacunaer KpoBb
3ro
B BepxHroro
o.reHb KoporKlrfi
crnol,
KonneKTopoM AeoKcLTreHLrpoBaHHofi KpoBr{
qacrb npaBoro rrpeAcepAlrt
AnLrHofi oKoJro 64-76 rvtvr
Hrncnqq rroJrafl BeHa (HIIB)
Fluxn-f,s rlora.f, BeHa flBlrflercfl KoJrJreKTopoM AeoKckrreHrlpoBaHHofi KpoBr4 or
Hr4x(Hefi [oJroBtrHbr reJra
HIIB
u 6prorunofi nonocru
co[poBo)KAaer aopry, pacrroJro)KeHa clpaBa
IIO3BOHOIIHLTKA
or :nee u cuepeAkr or
o
EecraxueB KnarraH
-
pacnonox(eH B coycrbe Mexqy
Seranruoro KpoBoo6pauqeHr4t eBcraxlreB
KJrarraH
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HIIB z
xopouo
lIlI. B nepzo4
p€BBLrr vr
vrpaer
lIfI u oB€LrrbHoe orBepcrr4e.
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qro cquraercs HopManrsofi naxo4rcofi.
a
Hopnranruwir 4uacrorLrqecKuir. 4uawerp FfIA 12-23 vrw.
(II[)
3. Ilpanoe rpeAcepAue
a
'
,{annenze
B rrpaBoM rrpeAcepAlrlr B
HopMe2-8 MM pr.cr.
Carypaqzt O2n HopMe =75Vo
CeTI, Xuapu - H€BBaHa B llecrb Bpaqa Xnapu. Sro su6pr4oHuurbHbrfi ocraror,
roroprrfi He BblrorH.f,er nzrarofi Synrqun u flBrrsercfl Hopnranruofi
uaxo4rofi. O6rr.{Ho npeAcraBJreHa cer.rarofi crpyrrypofi B rrpeAenax
u
rlpaBol-o npeAcepALrfl
noABlrxHofi rraeu6paHbr
o fIfI
' lIlI
B HerrocpeAcreeHHofi
nonyqaer KpoBb or B[IB, HIIB
r4
o6lacu
floror
3xoKf B BLr.rIe ronrofi
6rusocru or HIIB
KopoHapHoro c'rHyca.
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MeHbIrIe, rreM B BeHax.
o
Mox{er na6nrc4arbcfl Ha
crpeMLITc g
ery Qasy AaBneHr4e e lIlI
uz o6lacrLI BbrcoKofo .rIaBJIeHI,IrI
B
Hz3Koro ilaBJreHprfl
KoponapHrrfi ckrHyc -
4. TpnrcycrrrAaJrbnufi
KoJrJreKTop BeHo3Hofi
czcreubr caMoro cepArla
KJrarraH
. PacuoJro)KeH crrpaBa, Me)KAy lIfI n IIX
o $ cpaBHeHLILI c MrITp€uIbHbrM KJrarraHoM, TK 6onrure v LrMeer 6onee roHKr4e
l
crBopKLr, pacnoJro)KeH qyrb
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o cocrorar vr3 Tpex crBopoK
3ar{Hrr
rrepeAHrr-fl,
u
MeAlr€urbHa_rr
(ueNxelyAovxonax)
HopnaanrHar nnorlaAb orBep crvrfl 7 -9
cwr2
Hoprraa-rrrHar cKopocrb KpoBoroKa qepe3
TK 30-70 cna/c
llpanrrfi x{eryAorreK
fIfI
ser-serct caMofi uepe4nefi rcauepofi
rpy4ttnofi
'.
ra
1/
cepAu a
u pacno.rraraercr
cpa3y 3a
repr4oA
o B
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.'pcrlle.
cpaBHeHkrlr
c JIxt ronrqlrHa creHoK 14 pa3Mepbl
(romuzna creHKu Ao 5'MM, o6reru ao 32 rran)
o
)xoKf,
HopM€rJrbHoe AaBJreHue
B rrpaBoM x{enyAorlKe 15-30 MM pr.cr. (uuroeoe
cLrcTofllaqecroe) / 2-8
nrrvr
pT.cr. (ronevnoe ALlacTonuvecroe)
Ilpanufi r(eryAorleK
LIMeeT
uprlHoctqufi rparcr
npunocxulufi TpaKT BKJrroqaer
rpynrlbr MbrlIerIHbIX
LI
BblHoctqnfi rparr
TK vr Kpecr-HaKpecr pacrloJloxteHHble
BOJTOKOH, KOTOpbIe
a
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a
BbrHocrulufi
CTATOK,
BKJrroqaer B ce6fl rrpocrpaHcrBo B BI{AO BopoHKrr nepeA
rparr
IIynbMOH€uIbHbIM KJIaIIaHOM LI
anrnoft
o
lepexoArlT 3a HI4M B fleroqHblfi creor
)eAeJrax
a
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ronrofi
rloJrocrpl MeHbIIre
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cKorrJreHr4e MbllueqHbrx BoJIoKoH, rlepeceKaer
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rrpaBoro x(enyAoqKa.
HoprvranrH€ul
ee
lIlI
IEHLT'I B
carypa\us.o2
B IrpaBoM
xenyAorlKe =75Vo
6. Ily.rrurvroHaJrbHblft rstauan
o IIK
c npanofi cropoHbr
pacnonoxeH
Mex(Ay rIpaBbIM x{enyAorlKoM
Lr
nerorrHofi aprepzefi
o flynruonalurrrfi
KJrarraH kTMeer
tr JreBoe 3aAHee. llorrylynns
fIK
rplr nonyIryHLrfl: rlepeAHee, npaBoe 3aAHee
3HaqLITerbHo roHblrre, lIeM
y
aopraJlbHoro
KJIAIIAHA
TOHKUE
HoplaanrHafl cKopocrb qepe3 IIK 60-90
Hopl,ranrHa{ [noulaAb
T€LIIbHA'
crra/c
OTBep CTvIs.cOCTaBJIf,eT He MeHee
2
Ctut2
! Jleroqnaq aprepnq
Hoprr,ranrHoe AaBneHrre e
JIA 15-30
MM
pr.cr. (cucrolzqecKoe)
| 4-12 wttvr
pr. cT. ALIacToJILIqeCKOe
Crsor rero.rHofi aprep:rrz AeJrr,rrcr
Ha neByrc rteroqHylo aprepvro
neroqHyrc aprepurc
pa3y 3a
Jlenoe rpeAcepAl{e
JIII pacuoJro)KeHo
Ha 3aAHefi rloBepxHocrrl cepAIIa
u npaByro
JIfI Heunoro roHbrrre
o
CreHrca
o
HoprvramHoe AaBneHLre B
a
Hoprraanrnufi o6reu JIII Ao 34
o
Jlesoe
B cpaBH e:rtr4Lr c npaBbrM npeAcepAr4eM
IIII2-I2
MM
pr.cr.
urr,/w2
npr4AaroK yruKo. Vumo yBenuqzBaer
rroBepxHocrb JIII vr yqacrByer B ero coKparlrMocrr.r. llpu HeKoropbrx
ga6oreeaHvIflx, KorAa yBenlrrrkrBaercfl JIII v reprercr
ero HopMElJrbHa.rr
LrMeer
npeAcepAze
KoHTpaKrr'rJrbHocrb (Qz6pznnflr\vfl npe4cep4ufi, nazrparuuufi
crenos),
B
ylxKe JI|I $opvrkrpyrorcfl rpou6rr, Koropbre HeAocrynHbr Blr3yaJru3arrkru npvr
TpaHcTopaKaIIbHoM LICCIeAOBaHLTIz,
xopoIuo
HO
Br4AHbr
rrpLr
qpe3nLr qeBoAHoM trc cneAoB aHkru.
9.
Mnrpa.nrnrrfi
KJrarraH
a
MK pacuoJro)r{eH
a
HopnranrHas rrnoulaAb orBeperr4fl cocraBJr_rrer 4-6
a
HopvranrHa-rr cKopocrb qepe3
o
MK
crreBa, Mex(Ay
JIII
ra
JIX
ctvtz
MK 60-130 cvr/c
uvreer pa3BLIrufi no4rauannrrfi annapar
-
xopAbr Lr rarrkrlrnrpHbre
MbIIuII6I
.
flanznn.f,pHbre Mbrrrrrlbr Kperrf,Tcf, K creHKe
lalunnrpHbrx
.
Mhrrrrrlbr
3arpurrrfi MK
JIX. B
HopMe zMeerc.rr ABe
- nepe4He6 oKo Bar r4 3aAHeM e AvranrHafl
Qopnarzpyer Kaprr4Hy <<cuaftlrrKa>>
o MK r4MeeT ABe cTBopKLr
-
Ilepei;lHflfl Lr 3aTH'rfl
10. Jlenrrfi xce.iryAo.rerc
o
Llnaeer Sopn'ry yceqeHHoro gJIJII4rrcouAa Lr
creHKr4, Korop€u npprMepHo
B2
cocrozr
pa3a ToJrrqe,
r43
rrJrornofi
qeM creHKa
urlleqHofi
lIX.
Tara.s
MbllrretrHat Macca Heo6xo.4uua lrnfl co3AaHr'I.'I AocTaTorrHofo ypoBHt
KrlHerr4qecrofi oHeprLrr4
KpoBtr,
uocryuarolqeft B
cr,rcreMHoe
KpoBooopaqeHLre
Hoprr,rarrHax ronrqzna
creHKr4
MX|I u
salHeir (rpannlrHee
JIX cocraBJrrer 6-10 una.
Hopvranurrfi o6tenr JIX 50-100 nrn
;34
-
szxne6orconofi)
B JIX
Hoprvraruoe AaBneHLre
ALracr o nvrirecKoe
o llo
rvrvr
pr. cr.
c [paBbrM x(enyAoqKou, JIX
r,rMeer
rryrb [pLIToKa LI rlyrb
orroKa.
KOTOpbTX
)MAIIbHAJI
B
12
pr.cr. I
llyrr rrpkrroKa rc JIX cocraBJrf,er KoJrbrlo MK, crBopKLI MK u
xopAbr. llyru orroKa vr3 JIX cocraBr-fler rrepeAHrlt crBopKa MK Lr
ILIIII4BACT
eHo3),
aH€urorlrr.r
3-
ckrcroJlllqecKoe 100-140 MM
Melcx(enyAorrKoBa.f, neperopoAKa.
o
HopvraJrb:rrat caryparl?rr KucnopoAa B JIX
vuv
npvr
11.
r
npr4
o
AK pacuoJroxeH
a
KopeHr aoprbr flBIrflercfl
Aopra;rrHrrfi
cJreBa
vreX4y
JIX u Ao
<<AoMoM>>
lns AK. Hopnaanrnrrfi pa:uep KopHt
rvtvr.
rplr lonynyHzr: [paBoe KopoHapHoe,
LrMeer
98Vo
KJrarraH
aoprbr B KoHrIe Ar4acronbr 20-37
o AK
cocrasrser
neBoe KopoHapHoe u
EeKOpOHapHOe
1) Kaxgoe
IrnrpHbre
noJryJryHr4e aecoqrrlpoBano
KapMaHorroAooHbre cTpyKTypbr,
a
cvrHycovr BanscansBbr
-
rlMeer
KoTopbre pacnono)KeHbr HaA aopTuurbHblM
KJIAIIAHOM
]TCr nBe
2) flpaaoe
KopoHapHoe ronynyHLre HarIpaBJIeHo
KopoHapHofi aprepzu
B
cropoHy
rrpaBolr
(IIKA)
3) Jleeoe KopoHapHoe ronynyHue HarlpaBneHo B cropoHy
KopoHapHofi aprepzz
(nKA)
4) HeropoHapHoe nonynyHr4e He accorlkrlrpoBaHo
nrreqHoII
aprepuefi
l.
B qenrpe cno6o4noro Kpar
Taxa-fl
ypoBHf,
tcTeMHoe
resofi
HLr
c o4nofi roponapuoft
Kax(Aoro rronynyHur ecrb ne6omruofi yaeror,
rcoroprrfi o6ecne.rzBaer rrJrorHoe 3aKpbrrr4e AK. 3rer y3enKLI Ha3blBalorct
ApanqueBbrMr{.
flpz yronqeHLru
apaHrlzeBbrx y3enKoB KJIaITaH 3aKpblBaerct
He rroJrHocTbro, qTo [pkrBoAr4T K perypruraIJvlu.
iorosofi)
klnorya Ha nonynyHvflx AK uvrerorcr roHKLre BoJrocLTcrbre Hapocrbl rlo
KparM. Onz na:rrBarorc-s HapocraMra Jlanr6na Lr rox(e MoryT npvBoALITb
peryprLrrarJkrkr. Bogvroxnocrr xkrpyprLrqecKoro reqeHLrr
ALrcKyrlrpyercr.
Ao cnx
K
rlop
o
PacxoxAeHze nonylynzft AK
MaKCZM€LrrbHoe paccTorHr4e MelKAy
lonynyHzrMr4 B Haq€ure cr4cToJrhr. KOrAa r4x pacxoxAeHze
MaKCLrM€LJTEHOe Lr
AK pacKpbrr MaKckrMuurrHo. B HopMe pacxoxAeHLre uonynynzfi
AK
cocraBJrrer 15-26 ww
o
o
flnorqaAb orBepcrkrrAK s HopMe He MeHee
2
cv?
cropocrb KpoBoroKaqepe3 AK s HopMe 100-170
cu/cerc.
12. Aopra
'
oxczreHLrpoBaHHar KpoBb nrr6pacrrBaerc,
zs
locryrlaer B aopry. Aopra Aaer
JIX, npoxoAzr
qepe3
AK z
BerBr4, Korophre AocTaBn.rrror
oKcl4reHkIpoBaHHyrc KpoBb K cepAIIy,
foJroBe, nepxuefi rroJroBr4He reJra,
BHyrpeHHr4M opraHaM Lr Hzxsefi [oJroBr{He
TeJra.
Ao
- <<Marb Bcex aprepzfi>>
Becr
opraHLI3M
[oryqaer KzcnopoA Lr frrrrareJrbHhre
BeulecrBa qepe3 cerb
apr epui1 aprepr4on Lr Karrr4JrJrrpoB
I
I
'
HoprraarbHoe AaBneHLre
B aopre: cr4cronzqecKoe
100_140 MM
pr.cr. /
Ir4acronuqecKoe 60_90 MM pr.cr.
' Ao Aenlrrc-rr Ha 4 cerMeHra (pzc. 2g): BocxoA.,rq afl, aopra, Alrs aoprbr,
HLr
C
XOA.rrq
afl aopT a u a6 AOtvtuH€urbHa, aopTa.
BocxoAqrqaq aopra
-
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HaquHaercr or AK z 3aKaHrrLrB aercflHa ypoBHe
aluroro
lepBhre ABe BerBI{ Ao
crBoJra
orxo4tr or BocxoArrrlefi aoprrr
crBoJrbr KopoHapHbrx
aprepuir
KOpOHapHbIe aprepvLl CO3Aaror
rperzfi Kpyr xpoaoo6p an\eHufl-
ckrcTeMa
KopoHapHoro KpoBoo6parqenz_a
KOpOHapHbre
aprepuu 6epyr
HaqEUro
or
MZOKapA nonyqaer KpoBo cHa6Nenze
cLrHyca
Ba*ca*se
or KopoHapHbrx apr epuit, Korophre
IPOXOA.flT IIO BHCIIIHCfi UONCPXHOCTI4
CCPAIIA qEPE3 CLICTEMY KAIILIJIJI-f,POB,
IlpoxoA.f, rrlr4x B MLrOKapAe
3
Me)KAy
:l
'
T€IIIBHOE I4
i.,
.L
rnnir AK
h^^-^^--.----
pe: AK
,
i
Ilpasan manan
r.r
KOpOHapHaf
aDTeorfr
CTABJUIIOT
l{ranan
Jhm
FCpHapHfi
aprepnfr
mHe reJla,
epe3 cerb
mprbl
L"
'.J
r pr.cr. I
ptti
fa aoprbl,
apre
Puc.28. Aopma, ee omdenu u ee Bem6u.
KaxAas KopoHapH
afl. apTepvfl.
KpoBocHa6xaer orpeAeneHHblfi yqacroK
oepAIIa. KoponapHble aprePllu Aonx{HbI
|oHapHbrx
yAoBneTBoptTb rloTpe6HocTb MLIoKap1aB KllcnopoAe. Ecnu noTpe6HocTb He
yAoBJreTBopterct AocTaBKofi, nosuraraeT ullreMuf, MuoKapAa. flpu ocTpof
TCTCMA
3aKyr op Ke Kop o H apHofi aprep vI4 p
ropTbl
-
uMeer @opty
apKv1.
a3BvIB
aerc.fl uH 0 apKr MI{ o Kap Aa.
Or 4yru aoprbl orxoArr
Tp?I KpyrHblx BerBkI:
6paxzqeQ€rnbHbrfi crBoJI
ropbre
tJl.f,poB,
JreBafl,
o6qas
coHHuuI aprepnfl'
reBaq noAKrlotlvrrrHag. apr epvrfl
MexAy JreBofi IIKA vr apTepgraJrbHbrM npoToKoM
KoM. Oua rtau6oJlee IIoABep)KeHa
p ac
H€l3bIBaeTC.f,
cno eHV Io (4rac cercq
W
aopTbI)
.
HucxoAqrrlafl aopra
-
Harll4Haerct HenocpeAcrBeHHo
noAKnroqzqnoft aprepzefi
Ayruaoprhr sa renofi
.
13. A6aovruHaJrbHafl aopra
r4.ot
or
-
HarryrHaercr HerrocpeAcrBeHHo 3a 4za$parvrofi
aoprbr orxoArr MHoxecrBeHHhre BerBr4 K BHyrpeHHr4M opraHaM, a
3aBeprxaerc.f, oHa pa3AeneHr4eM Ha rroAB3AorlHbre apreplrz, Korophre
KpoBocHa6xaror HLrxHr4e KoHeqHocrr4.
1
5. Aprep Lrkr AenflTcfl Ha aprepr.ronbr.
16. AprepzoJlbl AenflTafl Ha KarruJrJrrpbr, B Koropbrx npoucxoAr4T rasoo6N,reH
z
o6uen rrr4TarenbHbrx BerrlecrB.
r7 . Kanuttntpbl nepexoAtr B BeHynhr, Koropbre co6zparor
AeoKcr4reHr4poBaHHyro
KpoBb
18. Benynbr rrepexoArr B BeHbr.
19. Benu repexoArr B noJrbre BeHbr.
20.
llolue BeHbr BrraAaror B rrpaBoe [peAcepALre.
KPYI 3AMKHYJICfl!
38
@usllororllq cepAe'urofi AeflTeJrbHocrlr'
JICBOLI
cepArla, KaK Hacoca, BbrAeJrflror qeTbrpe ocHoBHrre sasq:
ilrMo14
a
I4sosorloMtlrlecKoro coKpalqeuufl'
,a
o
Cucrolrt
a
I4sosorloMl4rlecKoro paccJla6reHlls
,I[uacrolu
f,EH
II
.
Oasa rl3oBoJrrcMurlecKoro corcpalrleHrrfl
.
}BAHH\rK)
Puc. 29. @asa u3olotttoMuqecKozo coKpat4eHun. O1osuaqeuun: V - o6ueu Kpo*u s
KaMepac, P 4aeneuue 6
KctJvtepaJc, T
I4soeorroMuqecKoe coKparrleHr4e
. Bce KJIaIIaHbI
-mont4uuauuorcapda.'
(IVCT) npeAllrecrByer
3aEpbITbI. O6rervr KpoBLt
HerlocpeAcrBeHHo
B x(eJryAoqKax
ra.recrufi).,{annenne n xelyAoqKax Hapacraer.
IIocTo{HHbII4
2. (DasacrrcroJrbr.
Puc. 30. @asa cucmzlbt.
cncro.ra
-
3To nrr6poc KpoBrr r{3 cepArla B aopry u JreroqHyro
aprepurc.
Brr6poc Haql4Haercr c BepxyrrrKr4 cepArla, Koropa, 3aKpyrrzBaerc,
uo .racoeofi
crpenKe K ocHoBaHkIIo cepAIIa, Koropoe 3aKpyqzrBaercfl
nporLrB .racoeofr crpenKr4.
Kar< ToJIbKO raBneHLIe B X{enyAorrKax lpeBbrrrraer
AaBneHr4e B Ao 14 JIA,
orKpblBalorct nonynyHHble KJIalaHbI 14 KpoBb nrr6pacrrBaerc{
B Marr4crp€urbHhre
cocyrbr (pzc' 30)' llpz cHzlKeHI4I4 AaBneHr4r B xenyAoqKax,
[onynyHHbre KJrarraHbr
3aKpblBalorc'fl' Moprenr 3aKpbITIrq rloJryJryHHbrx
KJra[aHoB co3Aaer II roH
cepArIa.
40
-1 EronoJrloMrrqecKoe paccla6lenue'
rprepEr0.
tracoBoft
cTpenKr4.
J V
JIA,
puc.
TparrbHbre
3l.
V
@asa u3o7olroMuuecKozo poccna6neuun. O6osuaueuun:
K(Lr,tepax, P -daeneuue s Ka lepax, T
-
- o6reu Kpoqu
s
monuluua uuorcapda'
) KJIAIIAHbI
T II
ToH
thta
R3oBoJrIoMIIrIecKofo paccJla6leHuq IIpeAIIrecTByeT AllacToJre'
B ary sa"y
Bce KJrarraHbr 3aKprrru (puc.31).O6rerra KpoBLl
(V) ocraercr
3a cqeT
ETo{HHrrNr (ugOsOlIOMLIrIecruvr). Xeny4OveK HaIII4HaeT paCKpyqI4BaTbCq
3-Tl{Ilecrofi rsru, co3AaHHofi
upra 3aKpyqllBa:atIvl n Qasy clIcToJIbI'
TrorlKax naAaer. .{anneuue B rlpeAcepAllrx pacrer'
,{auenue
n
4. f,uacrota.
Puc. 32. @asa duacmorbr.
luacrona oro repzoA paccna6rreHzrfl (pnc.32).
1. o*prrBarorc-fl [peAcepAHo-x{eJryAoqKoBbre
KJrarraHbr,
B pe3ynbrare
rrero
xenyAor{Kl4 HaIILIHaTOT HalroJlHrrbcr KpoBbro (rcpoer Lr3 lpe4cep4rafi
nocrylaer
B
xeJryAovrz).
2- Bo BpeMrI pannefi ALIacronbl AaBneHr4e s JIX HLr3Koe r{ }r(eJryAovrcu 6ucrpo
HarorHqrorcfl KpoBbro. 3ro Sasa 6ucrporo HarroJrHeHus. B ery
sasy JIX
HarroJrH-rretcs=75Vo. B sro BpeMfl Bo3HrrKaer rlr ron.
3' Kar ronbKo AaBneHI4e B )KenyAorrKax
TITO TIPLIBOALIT
K
npeAcepqLrflx ypaBHoBerrrr{Baercr,
TOPMO)KCHZIO KPOBOTOKA.
rroJrHoro paccna6n eHufl .
42
14
3rO
OUSU AVACTA3LICA,
UJILI
nte
Af,acroJrbl rlponcxoArrr cr,rcrona npeAcepguir (0a3a upe4cep4Hofi
), roropar o6ecue.{zBaer or 10 ao 30Vo sano,[HeHLrs xenyAoqKoB.
rrorBJreHwo ey6qa
P na 3Kf. B sTor
MoMeHT Mor(er
IV roH y B3pocnbrx npu rrarorrorlrn (y 4erefi - nopua!).
KpoBLr B gTor MoMeHT Hur3brBaerc-f, KoHeqHo-ALracroJrlrqecKzM
EpoBLI B xenyAoqKax Bo3pacraer
-
(KAO).
3aKpbrBarorcfl AB-rc.nananrr
;mrBJrflercfl f ron.
rle[qun QusnoJrorr{n ABrrxeH rrfl MrroKapAa
mry F.Torrent-Guasp d coasr. Brr4nznynlr coBpeMeHHyro KoHrlerquro
C.onpeuenHafl
KoH
cqpAeqHofi urrruqrr n Qopnre eAznofi 3aKpfreHnofi cnzpalrvtvlrvr
lonoca 6eper cBoe
aoprbr.
3ra
HaqaJro
JreHTbr.
or rero.rHofi apre vrv Lr 3aKaHqr4Baercfl y
clzp€urb r4Meer ABa
rILrKJroM. Ba"ganrHHfi qzrcn
H€BBAHHbIMLI OA3AIIbHbIM
BLrrKa,
cocror{T
r43
PI
rrpaBofo rr JreBofo cefMeHToB
igtaBrleH cao6o4nuMu creHKaMLr npaBoro Lr JreBoro )cenyAorrror. Bropofi
-
Bepxytrreqnrrft cocrolrr rr3 BocxoA.rrulero
6asanrHoro
Lr
Hr4cxoryrrlero cerMeHTon (puc.
IILIKJIa paCnOJrO)KeHbr rrepneHALtKynrpHo
oflroarcT IlpaByro
AJTLTHHOIT OCr4
v neByro cTopoHbr kr rroJrHocTbro BepxyruKy
HaupaueHlle BoJIoKoH anrrKtrrrbHoro rlrrKJra coorBercrByer 4lznHofi ocz
taTe qefo
c rrpekrMyrrlecrBeHHo rocoft opLreHTarlnefi eororoH.
)eAcepALrfi
r 6rrcrpo
Sa:y
nX
TILIBACTC-f,,
vIca, uJrn
Puc. 33. Vematpe cezMeHma cepdeuuoit Mwraqu co?nqcHo meopuu norocbt.
B reopzz rroJrocbr BhrAenrrcT
Tpr4
o Czcrona
o [nacrota
o [uac.rasuc
Cucro.na
Harrr4Haercfl Sa:ofi
r{eHTpocrp eMLrreJrbHoe cy)r(eHr4
sa:rr
cepAeqHoro qLrKJra:
KoMrrpecczu, BO BpeM.f, roropofi npor4cxoALrT
e BoJroKoH 6asanrHoro r{r4 Kna.,IIane
e cneAyer
$asa
kr3rHalJLrf' Korop€u cBr3aHa c coKpaqeHr.reM
HkrcxoArrrlero cerMeHTa nolocrr. llpz
STOM OCHOBaHze x(enyAoqKoB
ABrDKercr [porr4B .racosofi crpeJrKr4, B pe3yJrbTaTe
rlefo lpoucxoAkrr
cKpyqzBaHr4e x{enyAoqKoB
reroqHyro aprepuro (pnc. 34).
puc. 34. CxeMamuue
cKoe usofipatrceuu
cmpenKe u gepxyutKu npomu? uacoso
pacKpyqusaH
{nacro.na
BKJrroqaer B
ce6r 4ne
AeKoMnpecaLrr4 [por4cxoALrT Haq
loJrochr, qTo [pLrBOAr4T K BparrleH
BCaCbTBaHA' KpoBb aKTT4BHO
IOCTy
U
z3rHaHLre KpoBr4
B aopry Lr
LrBarll.dfl,
XeIyAOqKOB 3a CrreT OKOHrraTeJrbHOfO CO4paIrIeHLIr{ BOCXOA-SIqeIO
TITA.
oA Araacra?nca BKlroqaer $agy orropoxHeHuflkt coKpalqeHvrr^ npeAcepAutrt u
Byer cocroq Hrllo rloJrHoro paccJra6.rIeHllq rroJrocbl
rpozcxoALrT
teAyer $asa
xocrr. flpu
pe3ynbraTe
B aopry
Lr
o6pasovr,
M
rroKapAa.
[o reopuz Tronocbr KJrroqeBbrM flBIrl.ercfl crIUpaJIeBLIAHoe
vre cep4eunofi Mbrrrrrlbr,
A clrcroJrbr vr
a raKxe ee cKpf{uBaHLIe
LT
pacKpfrvrBaHvre
ALracronbr coorBercrBeHHo. Corpaqenue
ercr [pocrpaHcrBennofi opLreHTarlueit u
rIoJIocbI
HanpaBneHueM ABLIx(eHI{t ee
cerMeHToB, npuqeM cerMeHTbr yHrrK€rnbHbr SynrcqzoHarlbHo,
rvqecKu.
flpz
qro
B
Ho
He
uaroJrorLrkr cnLTpzrrreBr4Hafl Soprraa rrocrerreHHo cMeHrlerct
3HarrlrreJrbHo cHlrx(aer e$SerrnnHocrb coKpaIrIeHkIrI
vr
br cepAeqHoro au6poca.
5. OCHOBbI IEMOruIHAMIIKI4
Cucro.uuqecKaq Qynrcqur
cuoco6nocru cepArla eQQerrneno
nrr6pacueau KpoBb B cucrervrHrrfi vr nero.IHrrfi KpoBoroK, a rarcKe
rrpuAaBarr raxAofi rropqnlr KpoBLr, rrocryrrarculefi e MarkTcrpuurbHble cocyAbl
AocraroqHoro 3arraca KLrHerlrqecrofi gHeprlrrr, T.K. Bc.s gHepru.l KpoBoroKa
q)arlrrcr
Ha npeoAoJreHr4e nepu$ epzqecKoro co
cyAlrcroro corrpo rkrBIrenur^.
Cnuxesze cncroJrlr.recrofi Synrqzz Bo3HuKaer rrpu
KapAlr€rJrbHofi uaroJrorrru
, uacoBou
nat
(B) u
MHoTLIX BapkIaHTax
:
O APTEPI4AJIbHA' |I4TIE,PTEH3VIA
.WC
. 3CH
o KMII u Ap.
x. B
Qasy
CETMCHTA
e. B Qa:y
}
IIOJIHOTO
flp"
cHltx(eHLrn cucroJruqecrcofi
Synrquu rtorBr-f,ercr pflA
Koropbre [pLrHnro BbrAenrrb B <<cr4HApoM M€rrroro nrr6poca>:
Eonr
B
upeKapAnamHofi o6tacru
OArrnma npz Qu:z.recrofi Harpy3Ke Lr Aaxre B rroKoe
llepz$
epkrrrecKLr
e oreKrr
crrMrrroMoB,
lloesrrueHHa-s yroMJrreMocrb, cna6ocrt
2' [uacro;rlrqecKas Qynrcqua - cnoco6Hocrb xeryAoqKoB HalorHqrbc,
KpoBbro.
luacr o tuqe cKat $ynxqzr orrucblBaercr
cJreAyroqr{MLr Sz:zonorv qec
Kr4
Mr4
fIOHfl'TI4flMLI:
.
.
eJracrLTqHocrb KaMepbr
(xeny4ovra / Nely4ourcon)
rroAarJrr4Bocrb KaMepbr (xeny4oura / xerry4ovxon)
lnacrotuqecKa-fl
4zcsyurqzr
HarroJrHrrbcr KpoBbro
necnoco6Hocrb cepArla aAeKBarHo
B oasy Anacronbr. czcrorzqecKa.fl Qynrcqzx npkr
I43onzpoBaHnofi Ahracr o np[Iecrofi 4zc
Qynrrlr4rz He crpaAaer ! KnuHzqecKLr e
rlpolfiBneHkrt AkracroJlLIqecKofi 4zcQynKIILII{ colpoBoxAarorc-s
[orBJreHzeM
rrpr43HaKOB <(Cr'rHApoMa M€UrOfO ru6poco>
rrp
eArrrecrByer llo.f,
BJre
Hr4ro cu
.
[uacl.o.IluqecKa_f, 4ZCQyHXqrar
crorzrre crofi 4z c Qynr<qzra.
cucro.nuqec*aq rr AnacroJrrrqec*afl eynrcqur 3aBrrcrr or pqAa
I
rrapaMeTpoB:
yTonnleHr4 e cTeHKLr XenyAorrKoB
t.
ti
ri
[]
xapaKTep ABr{x{eHr4r cTeHoK )KenyAorrKoB
pa3Mep xenyAorrKoB
KoHeqHo- Akraar o rruqecKoe AaBneHkr e
(KAA)
Paruepu rroJrocrefi ceprua - rroKa3areJrb ero pa6orrr
1.
B uop^ae )KenyAo'KLI cepAIIa paBHoMepHo
KoHrleHTpr4rrecKr{ yMeHbrrrarorc.{ B
pa3Mepax Bo BpeM_fl crIcToJrhr.
2.
B
B
3.
nopnae )KenyAoqKz cepArla paBHoMepHo 3KcrleHTpzqecKkr
yBenr4rrr4Barorc,
pa3Mepax Bo BpeMr Ar4acToJrbr.
flpz
sxoKapAkIorpaSzvecKoM rrccneAoBaHLrv Anfl Lr3MepeH'r-rr nonocrefi
cepArla cyqecrByer
MHO)KeCTBO CUOCO6OB, KoTopbre
ycnoBHo
MOXHO
p€BAenurs ua 2 lpynrrbr:
Lr3MepeHue
lznefinbrx pa3MepoB
sXOBOnrOMerpLrfl
-
r{3MepeHlre o6reMoe (pacvernrrM MeroAoM r4Jrz npz
noMorqv rpexMepHoro zccJre4onanzr)
46
lan.re Hrre B rroJrocTflx cepArla
KOIIEIIHO|O
.IILI
ACTOJILIqCC KO|O AaBneHIdfl B rrpaBOM Lr JTeBOM )KenyAOqKaX
Cheueru yKopoqeHur MbrrrreqHoro BoJroKHa
Cheneru,r
pacrtxeHllt MhrlrleqHoro
D cxarllf,
KaMepbr
rEDmaer B
aAe
Krlkr.r tlp
)'BJICHLICM
cQynrcqzr
gSxoA*tMo
oe
BoJroKHa
-
3aBuctrr
or
KoJrLrqecrBa KpoBr,r
Bo BpeMr clrcroJrbr. rlenr 6onuunfi o6reu
KaMepy, TeM
6olrruee yKopoqeHLle MbrrrrerrHoro
BoJroKHa
An.{ ee Lr3rHaHlr.f,.
ALracroJrkrqecKoe AaBneHze
IDK u JIX MoxrHo onpeAenurb
ItmKy KpoBH qep e3 aTpzoBeHTpr4KynspHbre KJralaHbr.
Toro .no6H yAoBnerBopr4Tb uorpe6nocrr reJra B
rro
KkrcnopoAe rrpLl
Hafpy3Ke cepArle Aonx{Ho zHrencuQuqLrpoBarb
cBoro pa6ory.
Ha KoropoM cepAqe pa6oraer B OrrpeAeneHHbrlr cepAeqHbrlr
PCAA
KpoBr4
yAapuufr o6repr cepArla (VO). VO saszclrr or KAA. YO
-
TILTKJT,
ero o6revr
xoroprrfi nrr6pacrrBaer cepArle B aopry Bo BpeMr cLrcroJru. B nopnae YO
70-100 MJr. 9ena 6qnrrue KAO, reM 6olrrue
yO (npu ycnoBprLr
KoHrpaKTralrHocrz).
Cep.ueunufi nuldpoc (CB)
-
Bax{Hbrfi uorcasareJrb,
roropufi oro6paxaer
cepAIIe cnoco6no yAoBnerBoplrrb norpe6Hocu
CB s IroKoe oro6paxaer
tr€uoTc,t B
<<cKoJrbKo
Cepqevnufi nnAerc (ClI)
reJla
tonocreft
MOXHO
-
B rroKoe
cocraBJrrer 7-8 t/wprrr.
oro6paxaer CB c norpaBrofi na nnoqaAb
(ltrIT). CI4 onpeAeJurer rlrrr
reMoALrHaMLrKz
(eyrunerzuecrzfi,
zuecruft , rilrrepKlrHerzuecrzfi ).
@opuy.nu Arq pacqera ocHoBH brx rroKa3are.nefi reproA rrHaMrrKr.r
VO = K.4O-KCO
CB=YOxqCC
uM \pu
Hyxuo)), o CB upu Harpy3Ke
cepArle Mo)Ker o6ecuequrr Bo3pacraroque uorpe6nocrz
nofi r<poez. B noprrae CB
mBaloTct
opraHrrcMa
CkI= CB
/lIlIT
:
Cnoco6nocrb cepAqa yBenurrrrBarb CB 3aBLrcur or pflAa
B3ar4MocB_rr3aHHbrx
Qaxropon:
llpe4Harpy3Kr4
flocruarpy3KLr
ZuorpouHoro pe3epBa
.
XpoHorponHorope3epBa
TIPEAHAIPY3KA
llpe4uarppKy onpeAenrrcr cneAyrorlze
1.
o6ren'r unu
AaBrreHI4e
KaMepbr 3aBucvrr
2.
KpoBz n
rroKa3 arenr,r
:
JIX B KoHr{e ALracronbr, T.K. creleHb
or KoJrzqecrBa KpoBr4,
KOTOpOe e Hefi
a}KarLrfl
HaxoAzrcr.
3aron (Dpanxa-CrapnzHra (oruoureuue AnprHa-Hanprxenze). ge1,r
6onrrue
KpoBn nocrylr4no B )KenyAoqeK B Ar4acrony (npe4Halpy3Ka),
reu
60muras
cvra c)Karufl
Hy)KHa
4nx nrr6poca groro o6renaa. Yeerz.reHue
pacr-sxeHr'rr BoJroKHa yBenr4qr4Baer
pacTrHyn, TeM Cr4nbHee
ero HalprxeHHOCTb. <veu
crerreHr4
60nbure
OT.II?H€D>.
3- LrurepB€Lrr-cqenJreHHoe orHorueHr4e. rlena 6om're
uMnyn6caMr4, TeM 6olrure coKparzMocrb. Hanpnuep,
r'rHTepB€Ln MelKAy
rrpr4 xenyAo.{rcoeofi
oKcrpacr4crorrrrr4 (pzc. 35).
nror\EFqtr poBgH fre
416opmeroe
coxpqule]tEe
Puc.
35. IrocmerccmpecrcmorrttecKan naysa cosdaem
ycnoeun dnn ysenuqeHu,
npe duazpysKu
48
-
no
cmgKcmpacucmoruqe
cKo e nomeHqupou aHue.
:B'3AHH
4. CropocrHo-cr,rJroBoe orHorrreHvre -.reNr 6onrrrafl culra neo6xoAzMa AJrt
rrr6poca
KpoBLT
Bo BpeM.rr clrcroJrbr, TeM MeAneHHee cKopocrb yKopoqeHnt
xhlmeqHoro BonoKHa.
5. [Ipe4Harpy3Ka yBenuquBaercs. npu nro6ofi neperppKe KaMep o6reuou.
flprvznu:
EranaHHa{ peryprr4Tar\r4t rloroK
:arprnufi
B o6parnou HarIpaBneHkILI
KJIarIaH, rcoropufi He 3aKpbrBaerc .AoDKHIIM o6pasorr,r.
,{eQercr Me)rcKeny.qo.monofi neperopoarcu
Tb CX(ATLI'
qepe3
(AMXII) -
Me)rcKenyAotlKoBoe
coo6qenze. Bognuraer o6reMHar [eperpy3Ka rlpaBoro )KenyAoqKa.
,{eQerr Me)KrrpeAcepAnofi reperopoAKkt
r 6olrrue
coo6ulenue
6onuua.f,
- Bo3HuKaer
(ryI|I|I)
neperpy3ra o6leuoM rlpaBoro rlpeAcep4us.
Orrprrrrrfi aprepuamnufi nporoK - rrepelpysra
CTEIICHU
Me)KrlpeAcepAHoe
o6reNIoM JIeBoro
xenyAoqKa.
6onrrue
IleperpysKa o6reMoM rrp[BoAur K rraroJroruqecKoMy rIoBbI rreHrl Io
II peA
Harpy3Kll r rlTO rrpoqB;qeTcfl AIIJIaTaII uefi CoorBeTCTByIOq
Me)KAy
14x
KaMep.
Ioqrosofi
TIOCTHAIPY3KA
flocrnarpy3Ka
clrcroJrbr.
3ro
-
conporLIBJIeHlIe, Koropoe Aonx(Ho npeoAonerb cepArle
couporlrBJreHr4e Mo)I(er Bo3HnKarb KaK B CaMOM CepAIIe, TaK
xeHLrr{ Bcefo aprepu€lJrbHofo pycna.
flpurvunrr:
l- AprepuarrbHan rt4rrepreHsux (CA[ >140 uu Hg, AAA >90 naru Hg)
2.
-tLcig
lle|.re
Jlero.rHas rlrrepreH3lrr
3. Aopranrnrrfi
(CAIA >30 uu Hg)
creHo3, rlynbMoHanrnrrfi creHo
Vne.nt,rqeH ue rrocrHa rpy3Krr Ha3brBaercs [eperpys rcoft Aa BJreHrreM
rrpofl BJrfl eTcfl yroJruleHr{eM MrroKapAa.
HW
r4H O TP O rIHA-fl
@yHKur,rfl
- orHocllTcs K cLlre coKpaIIIeHL.I.fl, vrrn
cLIJIe
cx.arkrs.
B
14
xP oHoTPOTTHA-fl @yHKrIr4q
HAXOIT4TC' rIOA KOHTPONEM BCfETATZBHOfi HCPBHOfi
XponorporrHafl Qynrcqun
- croco6Hocrr
BO3paCTarOuIr4e naera6olzrrecKr4e
CLICTCM
cepArla pearlrpoBarb
lorpe6nocru. BHC peafzpyer
uera6olzrlecKl4e uorpe6Hocrz Lr oKil3brBaer BrrvrflH7re Ha cepneq
AerTenbHocTb, fnaAKyro MycKynaTypy u )KeJre3hr.
CzunaruqecKa.r HC
-
yBenzquBaer VCC.
llapacunrnarLrqecKas HC
-
yMeHbrxaer
r{cc
qepe3 6nyx4aroqzfi nepn.
cEPAErrHhrrz rlr4Kn
ilpe4craBrqer co6ofi coBorcyrrHocrb sreKTprqecrcofi
11
MexaHr{.recKofi
aKTIBHOCTTT CepArla.
Cep4euurrfi qI'IKJr, a TaKXe B3ar4MocB.rr3b oneKTpr4rrecrofi
n
MexaHkrqecK
aKTLrBHocrLr cepArla [peAcraBJreHbr ua pvrc. 36.
1. Kournerc
QRS orpaxaer
oneKrpr4qecKyro
czcrony
xeryAoqK
(Aenorrplr3arluro xely4ovlcon).
2. Lrzoso.lroMr'rrecKoe coKparr{eHlre HarrkrHaercq, Kor.qa 3aKaHqLr
MexaHl4qecKafl AuacroJla. Bce 4 KJraIraHa 3aKpbrrbr, rrooroMy o6rervr
MeHf,ercr. ,{anneuze e JIxt pe3Ko Bo3pacraer.
3. IVCT
3aKaHqllBaercs KaK ToJrbKo AaBneHLre B
JIX
upeahrrrraer AaBneHr4e
B
Ao.
4. Mexanl4'ecKat cl'croJla
xenyAotlKoB HaqHH aerefl, KaK ToJrbKo orKpbrBarorc,
lonynyHHhle KJlarraurt. Kponb nocrynaer B aopry
MaKCr4 M€UrbHO
z
creHKr4 )KenyAoqKoB
yronrqarorcs.,,{aue nrae B }KenyAorrKax pe3Ko rraAaer.
5. 3y6eq T orpaxaer
eneKTpLtqecKylo Ar4acrony xenyAorrKoB Lr coorBercrByer
rpoqe c cy penonrpu 3ar\uv.
6. IVRT HaquHaerc-{ KaK ToJrbKo
r(eryAotlt<os. Bce
4
aerafl MexaHr4qecKa.f, cr4croJra
wtanatta 3aKphlTbr, vI )KenyAoqeK pacKpyqLrBaercr
crrer snacrzqecr<ofi Tflfu.
50
3aKaHqr4B
lauenze
B )KenyAoqKax pe3Ko naAaer.
3a
7.
cucTeMhr.
LrpoBaTb
allrpyer
cep
MexaHvrqecKafl Apracrona Hav'unaercr, KaK ToJrbKo 3aKaHqlrBaercfl IVRT.
Orrprrnarorcr
)Ke[yAoqKo B,
AB-rlauanrr u
ALr ac T
A3LIC
t- 3y6eq P Ha 3Kf
Ha'tuHaercfl,
n np eA C ep AIJafl
<<
rr
oAKarrKD>
6ucrpoe
HarroJIHeHne
.
coorBercrByer ckrcroJre npe4cep4nfi (<<npe4cepAnas
uo4rcaura>).
K oroH'raHLIIo MexaHkIrlecKoit Ituacro.nrr JIX
LrMeer MaKcLrM€lJrrnrrft
o6reu.
CTO CTEHK}I MAKCI{M€IIIbHO TOHKLIE.
fi nepn.
MexanLr.IecKat Allacrona )KenyAoqKoB 3aKar{rlllBaerct,
AaBneHue
B xeny4ovrcai fipenrruraer AaBneHLre B
MoMeHT 3aKpbrBarorcs Al|-KnarraHbr.
nqecrcoft
xaHnqecK
KenyAoqKo
AHII
o6reu
{ABJIEHUC B
q)hrBaroTc.'I
elyAoqK
)T.
rBeTcTByeT
I
CZCTOJIA
IBaeTcr 3a
KaK TOJIbKO
rrpeAcepAr{.flx,
B
STOT
tr
G
s
E
a,
o
o
I
t
tr o
ET
E o
F h
o o tr
o
oE aIt x
tT
a
t
q
R
E
E
$,t
II
f.g
E.E i
giI
itt
T
0Kr
Hgrarx.rgcnan
|.Hteicft:rf,
flx
lio8
TH€CTS'IA
f,6
AK
ftftK
Mil(N
A
l(pnrm
GTONA
1a
Hrrf, EFEl.E
I rox
It
rox
lll
rox
lV rox
Puc' 36' Cepdeuuutil t4urtt. Bsauuoclt3b oneKmpuqecrcoil u MexaHwtecrc
ti axmueHocmu cepd4a.
52
oltLr
B rxoxap4uorpa@uz raso6paxeHLrfl cepArla non1..{ r Lr3 coorBercrByroullrx
Elm <<oKoH>>. TaK KaK cepAIIe oKpylKeHo cTpyKrypaMz c BbrcoKr4M
6. ME TOAT4KA 9XOKAPAT4OTPA
conpoTkrBJIeHLIeM, a I4MeHHO JrefKkrMLr Lr KOCTHbTMLT CTpyKTypaMLr
E rpyArlHofi. Tarranr o6pasou, o6sop cepArla orKpbrBaercfl.vr3
-
ne6olrmzx
oKoH, qepe3 Koropbre ynbrpa3ByK cuoco6en npoHLrKHyrb
K
cepAIIa cBepxy ero HaArpyAr4HH€ur o6lacrt, crepeALr
rrpoMe)KyrKkr, cHlr3y
cy6rcocralblrrafl o6lacrr. lpt
qepe3 y3Kr{e uexpe6epHhre rrpoMexyrKlr vclonb3yrorct
prlrr4 BeKTopHbre AarrrkrKur, Koropble l4Meror ne6onrurylo
rloBepxHocrb,
AJUI
Ho
o6ecne.{vBaK)T IxLIpoKoe AalrbHee rIoJIe
Toro, uro6rr cepArle rroJrHocrbro Brrvc€Llocb B ynbrpa3Byronofi
ny'{.
Jauunq B sxoKapquorpaQ[rr 3To He craHAapr rrono)KeHprr
AartruKa Ha
IpyAHOI4 KJIeTKT4 IIaIILreHTa, a TaKOe IIOJIOI(eHIe AaTrUIKa, KOTOpOe
creg/IaprHoe nso6paxeHrre cepArla
B ucruoqllTeJlbHbrx cnyqarx
AJUI nyq rue
fi nzeyan
B
3aBrlcr4Mocrz
or
nu6pannoro
AorrycKaercfl. lonyqeHLre HecraHAaprHbrx
Lr3arlLrv o rp eA en e HHbrx
crpyKryp
3xoKapAlrorpaQzz 4nx nohyreHufl. n:o6paxenzfi cepArla ucuon*yrcr
ocrl
-
rpoAonbHyro u ronepeqHyo (pzc. 38).
XaxAbrfi AarquK B yJIbrp€BByKoBoM npr,r6ope LrMeer MerKy B BrlAe
.xaHaBKLIn (puc. 37), rtu6o
<<HaceqKr,r>> vrlrvr
<(BbreMKLr>>
ne6olrruoro cBeroAvroqa. [auuax
troK€l3brBaeT HarrpaBJr eHze ynbTp €r3ByKoBoro
:mu cepoqa.
ABe
Jrr{a, ef o rrJro cKocTb.
Puc' 37' Bercmopuuril dam'turc dnn exorcapduozpasuu. Ha pyrconmrce
damuuKq u4eemcfl,
<<6breMKCt>>,
Komopa'n yKasbtsaem HanpasleHue mocKocmu ynbmprcTyrcoeoit
BonHbr.
I
i)a€arr FiarHl, tlc.Frririil
trffrtAr{}M
n0nJft
.Jprf H
.1.,p1i,
k
flg;rsrr gr r to
i;rapts
p
aJlt
!l
I
l
I
n pr b?p
r1p*a{epAFP
Bof*ttxEqi!]t1r
I trJtr{OR
:i: l:1
0r
Puc' 38' ocuoeuute ocu cKqHuposeHut s oxoKapduozpafuuu. Hanpaeue dam,tux
noryHarom npodonuuute uso6pacrceuun cepdqa,
llnocr<ocrr cpe3a, HarIpaBneHHa{
ro3BoJrreT
ronr{r4rb
t
.
'/'
_ nonepeuHue.
nap€LnnenbHo Anr4HHofi
rrpoAoJrbHbre ceqeHr4_rr (pzc. 3 g).
'\
I
{
54
K IeBOMy
K npasoMy nneuy,
ocv
cepArla
'mcfl
,-ig.Irpodonuuuecp%bt(ceueuun),nonyllaevblenpuHanpqcreHuuynbmpa3gyKoqougonHbr
bI,
napannerbHo dnuuuoil ocu cePdqa.
AByxKaMepHoe (2C)
- JIeBbIe KaMepbI
rpexKaMepHoe (3C) - JIX, Ao c AK r4 r{acrb rlpaBoro
r{erbrpexKaMepHoe (4C) - Bce KaMepbI cepAIIa
r-nruKaMepHoe (5C)
flrocrocrb
:.
r{r4Tb
xenyAor{Ka
- JIX, IIII, AK, uacrb II,K z lIlI
cpe3a, iloA npqMbrM yrnoM
K
AnI4HHofi
ocu cepAIIa rlo3BoJlter
[onepeqHbre cerreHvrs. HapzBnI4r{HbIX ypoBHtx (pzc. 40).
l.l
r,
1.'.
,ty nneqy,
cepArla
SAX AFEX
:0. IlonepeqHbte cp%u (ceqeHufl), noryqaer4bre npu HanpasneHuu yrbmpaseyrcoeoit
nepneudurcynnpuo
:,_
-
-
rc
dnuuuoit ocu cepd4a (ttemrca damqurca
K
le6o.L4y rueuy).
fl{rr ceqeHr4fi, nonyqaeMbrx rrpr4 cKaHr4poBaHvrv cepAIIa B nepneHAI4KyntpHoLI
r---:iofi ocu rIJIocKocrI4:
'
-
6o.rtHbt
Ea:anrHoM (SAX BASE)
K
.
o
Cpe4rzHHoM (SAX
MID)
BepxyueqHoM (SAX APEX)
{ocrynu B sxoKaptuorpa$nu
[nx roro 'rro6rr cAenarb Bo3MoxHbrM
crpyKTypaMz
c
rzccJreAoBaHr4e cepAr{a, oKpyxeHHOr(
BbrcoKI4M aKycrI4qecKLIM conporr4BJreHr4eM,
HecKonbKo aKycrr4r{ecKr.rx oKoH, Unkr
Aoarynoe (prac. 41).
56
14cIIonb3yrol
. Taxoe rIoJIo)KeHue npe4norrrkrrenbHee rrpr4 exoKapALrorpaQmu, TaK KaK
ElBoJrrer rroBbrcLrrb gxoKoMJraeHTHocrb (upurepxeHHocrb rlaqrreHTa K
oBaHr4ro Lr KSHTaKT
y)KeHHOfO
tronb3yroT
y ero
co clequ€rnlrcroM), a raKxe
3HarILITeJIbHo
ynpoilIaer
oneparunnofi perro3lrrlplu. Pasnu.rHue rIoJIo)KeHLIt [aqrleHTa
bHo crequ€ulrcra, roropufi BbIrIoJIHter gxoKapAl{orpaQuuecKoe
rroKa3aHbr Ha pI,Ic. 42.Ilolo (eHue naqLIeHTa cJIeBa oT cneqzalrlrcra
TarcKe <<fIoJro)I(eHueM KJILIHzTz Mefi
o>>.
Puc.42. Ilonotrceuue nauueHma omHocumerbHo cnequo.ttucma Bo 6peMn
KoZo uccledoeauUn. CneeA
il
<<tuttlHttKu
,tli,
Meilo), cnpaaa
-
-
naqweHm Clesa Om cnequqnucma (nottoilCeHue
naqueHm cnposa om cnequarucmq.
Srorca pauorpaQnqecKrre Aocryrrbr rr rroJryqaeMble uso6paxeH l{fl cepAIIa
O}KHOCTI4
'IOXEH14C
AOBAHLIE.
bHoro u
mfi..
[tn
amnoro)
A
JICBOM
IIIIIOM
K
:s Jreeofi
Kar yxe
ve
yrroMlrHulJrocb Bbrrrre, rro3Lrrlzrr
ynbrp€BByKoBofo
AaTrrLrKa Ha
KOTOpOe Aaer
craHAaprHbIe
B gxoKapAl4orpaQrau
-
3To raKoe
TPYAHOU
noBepxHocTLI
r43O6paxeHkTt
KJIeTKI'I
cepAIIa An[
yrculefo Aocryra.
B ra6n. 1 upe4craBJleHbl
, KOTOpbre llonyqarcT
Lr3
AOCTyTI, TIOJIO)KeHI4e AaTqLIKa
cooTBeTcTByroqzx AocryrloB.
u
ceqeHLIt (cpe3bl
.
.
fleaui rparl
yrnoM
rpyAt4Hbt
K sagHer4
e
4 r,llp. nog
no8epxHocru cepAqa
llapacrepHarbHar AnilH Has ocs (LAX)
llapacrepHanbHan kopofta ocb
aopTanbHoro KranaHa, Ha ypoBr€
(na
ypoBHe
Ml4TpanbHorc)
KranaHa, Ha ypoBHe nanHnIfipHbtx Mblrutl, Ha
ypoBHe BepxyuJKx)
Anuranuxurri
Bepxyuxa, TunH'{Hoe pacnonoxeHhe
- e o6nacru Bepxyuer{Horc Tonr.tKa,
yron cKaHl|poBaHnr BBepx vl
MelHanbH0
Bepxyueurce
Bepxyuevxoe
Bepxyuevnoe
Bepxyuernoe
4-x rcar,lepnoe (4C)
5 xar,,reptoe (5C)
2-x xar'leptoe (2C)
3-x rar'lepxoe
(3C)- annxanuat
npogonbHae ocu (Apical LAX)
f'l,on
CyOxocranuturil
orpocTxoM
MeqeBuAHbtM
B
rurmrefi qacru rpyAt4Hbt, MocKocrb
cKaHHpOBaHHg
BBepx
no
HanpaBneHhn KcepAqy
C!6rocransxoe no xoporroli ocu
H[xxcn nonai
BeHa
A$gor'luxanuxaR aopra
Cynpacrepxanunar
Clnpacrepnanrxurfi
Gy6nocranunoe 4-x xarrlepxoe (Subcotal 4C)
EbtpesKa.
pacnonoxeHHas HaA rpyAt4Hofi, yron .
cKaHHpoBaHt4F HasaA, HaBcrpeqy .
Clnpacrepx anbHaF AJI4H Har ocb
Cynpacrepx anbHar KoporKas ocb
Ayre a0prbl
Tafu. l- focmynut, ucnorxbsyeMbte G sxoKapduozpaQuu, nono)lceHue damrtuKa Ha no4epxHocmlt
zpyduoit KrremKu u nonyqqeMbre cpe3bt epdtla.
Mrr
rloApo6Ho paccMorpkrM oco6eHHocrr4 [onyrreHrls coorBercTByrolrr4x
cetreHr4fi kr HayqkrMcfl r4\eHTzszqzpoBarb coorBercrByroqve crpyKrypbr
cepAua
Ha ero I43o6pax{eHvlflx, Ho Anfl Haq€ula Heo6xoAr.rMo 3anoMHr4Tb oco6eHHocrr4
v3o'palKeH:Z'fl B B-pexuve ilpv npoBeAeHr4r4 oxoKapALrorpa6r{rrecKoro
14ccJIenoBaHr4fl.
B-pexcurvr
o
O6pasoBaH coBoKyrlHocrbro 6emrx, qepHbrx
u
cepbrx (pa:urre orreHKZ)
nr4Kcenefi
t
t
Oro6poKaer
I43MeHeHI4e
B
pexzMe peanbHoro BpeMeHrr
CoeoKynHocrb nuKcenefi Aaer I{3o6paxeHr4e cepArla 14
crpyKryp
VmrpasnyKoBofi nyr{
o
o
58
nonoxeHLrfl nzrKcenefi
Cnepe
Iu :nasa1
CnepeAZ BBepx
B
B-pexzlre
HarrpaBneH:
npr4ner-aronrr4x
t
v't.A., nogroMy crpyKTypbr, Koropbre HaxoAqrcq 6rrl]Ke
rc
uepe4nefi (nenrpa.nrnofi) rloBepxHocrrr reJra Ha sKpaHe rtoqBrflrorcq
ypoBHe
EnbHOrO
ilrq,
Cnepe AV BHvr3
BBepxy r.rso6paxeHr{fl (puc. 43).
Ha
)xHOCmu
ryroIII14x
cepArla
Puc. 43. trIso1pacrceHue Ha oKpaHe npu1opa so 6peMt uccnedoeauut.
)HHOCTLI
flpu
{ecKoro
uccleAoBaHI4I,I cepAIIa Anq rronyqenarfl KarrecrBeHHbrx zro6paxe:nnit u
rrlmeKTHbIX LI3Mepeuuir, ocb ynbrpa3ByKoBoro nyqa neo6xo4zMo oprreHrr4poBarb
trrmro noA np-tMbIM yrJIoM K r,rccneAyeMbrM crpyKrypal,r (pzc. 44).3to
renxz)
ryBl{no
I
ocHoBHoe
KaK B ynbrpzl3Byronofi ALIarHocrLIKe B rIeJroM, TaKu B 3xoKapAuorpaSvlr
qacrHocrl4. Zuenno cKaHkIpoBalue noA np-rrMbrM yrnoM
K
zccle4yeuofi
)MEHKI
EtrlTrype IIo3BOnteT rlonyql{Tb rrerKr4e KoHTypbr Lr fpaHr4rlbr,
ilorr{r4x
ryi}ElrKaror 6laro4apr eQSeKry rrprMoro orpaKeHr4-rr. Vnrrpa:nyronofi npu6op
KoTopbre
EsRHo rroJlaraer, qro ynbrpa3ByK, Koroprrfi ou reHepnpyer, Bo3Bpanlaercr rroA
IF[\tbrM yfnoM.
Puc' 44. Halpanneurle trnocKocrvl ocvB 3aBr4cr{Mocrz or
.qocryrra. Bnepxy
cylpacTepHaJIbHOM AoCTyne' ClpaBa
-
-
IIpI4 aIII'IKIUIbHOM AOCT)IIe, CJIeBa LI CHr{3y
rrpLr
-
rrprl
3nzracrpanrHonl (cy6rocrilJrbHoM) 4ocryne.
Zccne4onaHue noA yrnoM
90
rpaAycoB
OTHOCr{TeJrbHo r4ccneAyeMbrx
cTpyKTyp Ha3brBaeTcr <<oceBbrM 14 ccneAoBaHLreM>, krIIV <<UCCneAoBaHI4eM
Ha ocu>).
(<on uxis>> r4ccneAoBaHueM (pzc.
45).
Puc' 45' oceeoe u sHeoce^oe uccnedoeauun cepdqa. IrpodoLrcHoe
napacmepHaJxbHoe ceqeHrle.
Cneea
60
-
uccnedoeeHue <on axis>, cnpasa
-
rrccJ,te o,aHue <oJJ.axis>.
(,.on
Ocenoe
ESpaxenue,
axis>>) uccneAoBaHvre
Aaer
KOTOpOe HaXOAT{TC' <<Ha OCH>>,
rexHrrrrecKrr
LlAeaJIbHoe
T.K. CepArIe nepneHAr{KynflpHo
hocenoe (<off axis>>) uccJreAoBaHue Aaer rexHr4qecKr4 orpaHrlrreHHoe
, T.K. cepAIIe He
laqveHTa
-lTt-rlgHl{tr
Lr AaTqr,rKa,
reprreHAlrKynrpHo AarrrnKy. Heo6xo4zMbr
a TaK)rce [p?rMeHeHue HecTaHAapTHbrx AocTynoB
<<on axls>>.
Tarwr o6pasovr, rplr
upoBeAeHr{Lr 3xoKapA?rorpaQzuecKoro nccJreAoBaHnfl
fnrv[o 4o6uearscr raKoro
6ulo
,
y
- rpLr
m3y - npu
HA OCV)
axis>.
B
noJrylraeMoe
nporr{BHoM cnyqae, ecrtr npene6peqb sruM
vl wcKa3Lrr peanbHbre pa3Mephr
5tr
ocll, .rto6u
crpyKTypu cepryta 6ylyr pasMbrrbrMa Lr oro sHaqnrerbHo 3arpy4Hnr
B
ocz! 3ro
ccneAyeM
TCM
<<on
HarrpaBJreHr4r
cepArla.
rnaBHoe rrpaBzno crequ€rnvcra
Ilopr4orc roryqeHnfl rrccJreAoBaHnv
[oryvenue zso6paxeHufi cepArla (crau4apr
s
ce6s
6
rro
yirbrpa3Byr<onofi
cepA rla.
ronyqeHLrt zso6paxenufi)
uocneAoBareJrbHbrx rrraroB. Pae6eperr,r rrorrraroBo rroprAoK
fl cepArla.
[Ia rax4oM ruare
LrccneAoBaHvrfl BbrAeJrrK)T:
l-
flonoxeHlre AarqLrKa (nosuuus).
2-
HanpaBJreHlre oclr cKaHrlpoBaHvrfl (uerrcu na
3.
Ce'{eHI4e, Koropoe
4aruzre)
nonf{aercfl n 4anHofi rro3
rrr4r4 r4 HanpaBlreHvru ocLr
cKaHr4poBaH?Ifl:.
oKarue KaMepbr BkrAHbr na zso6pa:xeHurv
oKaxne
o
oe ceveHue.
KJrarraHbr Br4AHbr Ha
zso6paxeHuLr
Karcpre c ocyAlrcrbre crpyKrypbr BLrAHbr na zs o6p a)KeHULr
oKarvre creHKr4 JreBoro )KenyAotrKa
Br,rAHbr
ua ueo6pa)KeHtru
froloxen"e Aarrrr.r*a:
f ruar.
cJreBa or rpyALrH st, y 4vrexpe6e
pre
ocr
(puc. 46).
cr(aHrrpoBaH[q: upoAonbHa.rr (uerrca
Aarqr,rKa HalpaBJreHa B cropo
lpaBoro ureua). ocr cxaHprpoBaH4fl rrapalnenbHo
AnLrHsofi ocz cepArla.
Ceqenue
-
rpoAonbHoe rapacrepH€urbHoe (LAX).
Puc. 46. LAX. fiamuurc e 4 uecrpe6ept)e, .I4emKct
K npasoMy nneqy.
Puc. 47. Ifpodonuuoe napacmepHeJ,rbHoe ceHeHlte
(LAX).
Cmaudapmuoe
62
us
o1pacrceHue cmpyKmyp cepdt4a.
l.
BnsyaJrrr3tlpyeMble KaMeprl (puc. 47)z
o rlacrr [paBoro
cropoHy
.
o
)KenyAorrKa (nporccuvralurufi orAen BblHoctulero
rparta)
gacrr JreBoro xenyAor{Ka
(ocnona:rtne v cpeAI4HHbIfi yponenr)
Jlesoe rpeAcepALTe
2. BuryaJIII3IIpyeMbIe
arpuoBeHTplrKylspnHfi )
KJIaIIaHrI: uurpalrnrtfi KJIaIIaH
(nenufi
- ero repeAH-rrr v 3a4H.flfl. CTBOpKII.
3. BnsyaJrrr3rrpyeMbre cocyAbr:
KopeHb aoprbl B rlpoAonrnofi ocu (<4oM Ans
aopT€IJIbHoro ruanaHa>>), HLlcXoAtlIas aopTa
u
xoponapHrtfi cI4Hyc
B
[onepeqHol4 ocl4.
4. BuryaJrr{3llpyeMble cTeHKII: MexxenyAorlKoBat [eperopoAKa
uuxne6oKoBaq creHKa.
II
Iloloxen14e AaTrIuKa:
cJIeBa
ruar.
or fpyAI4HbI, Ha 1-2 rvrexpe6epra Bbrlue LAX'
Ocr crcaH[poBauuq: [poAonbHar (ruerra
AaTqI4Ka HanpaBJreHa
K
npaBoMy
nneuy).
Ceqenue
rpoAonbHoe napacrepHaJlbHoe BocxoAtlllefi aoprbl (LAX
Bocx.aoprbl).
Puc. 48. Ilpodonuuoe napqcmepHarbHoe ceqeHue (I-4X)
eocxodnt4eil aopmut
- LAX 6ocx.aopmbt.
Burya"uH3rrpyeMbre cocyAbr:
7-10
MM
eocxo4xrqeft aoprbr
B
npoAonbHoM
ceqeHzLr.
III
lro.noxcenrre AarrrnKa: cneBa
urar.
or rpyAr4Hhr, B rro3rrrlr4z LAX (4 naexpe6epre
cJreBa
or rpy4zuu).
Ocr
cKaH[poBaHrrfl: norreperrHa.fl (laema AarqzKa HalpaBneHa K
JreBOMy
uevy).
Ceqenlrq
- noneperrHbre [apacrepH€urbHhre.
Tperuit rrrar rro3BoJrrer nonyrrarb 4 cerreHr4.f, Ha rpex
CoorsercrBeHHo,
IIIa
-
ypoBHrx
cepAr{a.
III urar LrMeer 4 no4urara:
nolepeqHoe ceqeHr4e qepe3 ocHoBaHr4e cepArla Ha ypoBHe
aopTanbHofo
KJIATIAHA
1116
-
rorepeqHoe cerreHne qepe3 ocHoBaHLre cepArla Ha ypoBHe
Mr4rp'lJrbHoro
KJIAIIAHA
III' -
''onepeqHoe
ceqeHl'e qepe3 cpeALrHHbrfi or4en Ha ypoBHe rrarLrJrJrrpHhrx
Mhrrxq.
IIIr - rorepeqHoe
ceqeHLre qepe3 BepxyrrrKy cepArla.
llolepevnhre ceqeHI4t cepAl{a TaKxte Ha3brBaK)r <raproQeJrbHbrMLr
rrLrfrcaMr,r>).
Puc. 49. Ironep euuute c eueHutt c epdqa HanoMuH aK)m <
rcapmo$ erbHbte urncbt
64
>>.
IIIa nar.
poAon6HoM
Ilo.noxeurre AarqrrKa:
cJreBa
or rpyAl4Hrr, 4 uexpe6epre (rarc LAX).
Ocs cKaH[poBaHuq: nolepeqHas
K
(rraerrca AarquKa HarlpaBneHa
neBoMy
meuy).
Ceqenue
- noneperrHoe
Ha ypoBHe aopr€urbHoro KJraIraHa
(SAX AK).
expe6epre
K
neBoMy
t
cepAr{a.
)T€LIIbHOfO
P€LnbHofo
Ll:rrrpHhrx
?uc. 50. SAX AK. Cmaudapmuoe uso6pacrceuue cepdqa s nonepeqHoM napacmepHarbHou
ceqeHuu Ha ypo8He aopmaabHozo KrqnaHa.
l.
,fI{>.
Bnsyarrrr3rlpyeMble KaMepbI (pIac.
50): 9acm rpaBoro
xenyAorlKa
(nrruocxrqzfi rparr), JreBoe npeAcepAr4e, rlpaBoe rlpeAcepAue
2. BnsyaJru3r{pyeMbre KJrarraHbr: aopramurrfi
B louepeuuofi ocLI,
rrynbMoH€Lnrnrrfi B npoAonrnofi ocu.
3. BnsyaJrrr3r{pyeMbre cocyAbr: flerorrHaq aprepvs.
B upo4onrnoft
ocr4,
Hr{cxoA-fl[Iar aopra B rloflepeqnofi octl
{.
BusyaJrrr3r{pyeMbre creHKrr:
[paBoro xteryAoqKa,
MexnpeAcepAHa-s
nepefopoAKa.
1116
mar.
llcroirceru{e AarrrrrKa: cneBa or rpyAr,rHrr, 4 uexpe6epre (rcar LAX).
Oes cnanupoBaHrrq: nonepe-rleafl., rrJrocKocrb cKaHl4poBaHprfl,
i{e nepeMeqaq
Aarrrr4K
or
noJro)KeHlrr
BHI43
or LAX AK.
IIIa [rara, orKroH.leM
rlJrocKocrb
cKaHl4poBaHufl BHI{3 (py.{Ky Aarrrr4Ka cJrera [oAHr{MaeM BBepx,
rrpv
oroM
IrJrocKocrb ynbrpa3ByKoBoro nyqa cnycKaercr nuzs).
Ceqenne
-
ronepeqHoe Ha ypoBHe Mlrrp€LnbHoro KJrarraHa (SAX MK).
Puc. 51. SAX MR. Cmaudapmuoe uso6paJ{eHue cepdqa s nonepeqHoM nqpacmepHaflbHoM
ceqeHuu Ha ypogHe MumpanbHozo KranaHa.
1. Bnrya.nu3HpyeMbre KaMepbr
(pzc. 51): nenrrfi xenyAor{eK, r{acrb npaBoro
I(enyAoqKa.
2. Busya.nn3rpyeMbre KJrarraHbr : Mr4Tp€Lnruuft , BLIA cBepxy.
lIIn ruar.
lro.noxeHr.re AarqrrKa: cJreBa or lpyALrHrr, 4 uexpe6epre (rar< LAX).
Ocr crcaH[poBaHrrq: nolepeqHalr, lnocKocrb
He nepeMelrlat
AarrrI'IK
or [oro)KeHzq
cKaHrIpoBaHVfl BHI43 (py.{Ky AarqLIKa
cKaHr4p oBaHr4fl BHr43
1116 rrrafa, orKroH-seM nJrocKocrb
cnera
noAHr4MaeM BBepx,
nJrocKocrb ynbrp€r3ByKoBoro nyqa c[ycKaerc.a nnus).
66
r.
or LAX MK.
npr4 groM
rpv
3TOM
ceqenue
-
roreper{Hoe Ha ypoBHe rrarLrJrJrrpHbrx Mbrrxq (sAX IrM).
Puc. 52' SAX
IIM. Cmaudapmuoe
uso6pauceHz,te cepdqa s nonepeqHoM napqcmepHanbHoM
ceqeHuu Ha ypogHe nanunn.fpHbtx Mbtutq.
1. Bnryarrrr3rrpyeMble KaMeprr (pzc. 52): nenrrfi xenyAoqeK, rracrb rrpaBoro
IbHOM
x(enyAorrKa.
2. BnsyaJrn3rrpyeMbre KJrarraHbr:
KJrarraHa
tpaBOrO
lanunnqpHbre
Iloroxeru{e AarrruKa:
cJreBa
urar.
or lpyAr.rHrr, 4 naexpe6epre (r<ar LAX).
Ocr crcaHrlpoBaHrlq: [onepeltHas' rnocKocrb
|Ie rrepeMelrlat AarqvK or
]KOCTE
3TOM
Mr4Tp€IJrbHOfO
(ua yponne 4 u 8 .racax quQep6nura).
IIIr
K MK.
Mhrrxrlbr
:EaHHpOBaHVrfl BHr43
noroxeHr4-{
cKaHr4poBaHLrl- BHr43
IIIg rrara,
or LAX lIM.
orKJroHf,eM rrJrocKocrb
(pyqr<y AarquKa cnefa rroAHr4MaeM BBepX, r1p11 sTOM
ynbrpa3ByKoBoro nyqa cnycKaercx nuus).
=rocKocrb
Ceqenne - noneperrHoe Ha ypoBHe Bepxyrlrrcz (SAX APEX).
Puc. 53. SAX APEX. Cmaudapmuoe uso1paJrceHue cepdqa 6 nonepeuHoM napacmepHqnbHoM
ceqeHuu Ha ypoBHe Bepxyu,tKu.
1. BnryaJII'r3HpyeMbIe KaMepu (prac. 53): nenufi xeny4oqeK, rracrb
npaBoro
)KenyAorrKa.
2. BuzyaJru3npyeMbre creHrcr{: [epeAHqr,
HknK:nfl.fl,,
ooKoBat
nepefopoAoqHar.
lV ruar.
1. Ilo.rroxceHlre AarrluKa: arlaKuurbHoe oKHo B
rrpoeKrlr4r4 BepxymerrHoro
rorrr{Ka,5 uexpe6epbe. (puc. 54).
2.
Ocs cKaHlrpoBaHuq: npoAonbHax (napanJreJrbHo 4rzuuofi ocz cep4qa).
3.
Ce.renkrfl
-
rrpoAonbHbre arrr,rK€urbHbre.
Tperzfi urar rro3BoJrser noJryqarb
4 ce'aeuus cepArla. CoorsercreeHHo, IV
zMeer 4 uolurara:
IVa
68
-
rrerbrpexKaMepHoe ceuenrae (4C)
- rurrrrKaMepHoe (5C)
-rpexKaMepHoe (3C)
-.rtsyxKaMepHoe (2C)
51' Irotocrceuue dam'turca dna nonyqeHut onuKenbHbtx cp%o6. Irlsnyvant4at
nosepxHocmb
q pa3Meu4aemcn
uao sepxywevHbtM morvKoM (e nopue y MyctcquH
-
nod cocxou).
IVa ruar.
L
?pHcubHOM
llo;ronceHlre AaTrr[Ka: alr4KanbHoe oKHo
B rrpoeKrlzu BepxyueqHoro
mnqKa, 5 nrexpe6epbe. (puc. 54).
L Ocr cKaHrlpoBaHrrfl: [poAonbHar (napanneJrbHo
b rrpaBoro
Attu:nnofi. ocr4 cepArla).
Merrca AarqlrKa oplreHTLrpoBaHa BJreBo.
3. Ceqenr.re
- arruK€urbHoe
qerrbrpexKaMepHoe.
meqHofo
ua).
IV
urar
Puc. 5 5. 4C. AnuxanbHoe ttemwpexKa"r,repH oe ceq eHtrc.
1. BnsyaJrrr3rrpyeMbre KaMepbr (przc.
55): reesrfi
xenyAorreK,
Jre
rrpeAcepAr{e, rrpHHoaflu\krr4 rpaKr npaBoro xenyAoqKa, lpaBoe rrpeAcepAr4e.
2. Buty aJr rr3r{ pyeM bre KJra rra Hbr : Mrarparuurrfi Lr rpr,r Kycuz4amuufi
3. BnryaJrrt3r.tpyeMble creHKn: npaBoro r{eryAoqKa,
.
Mex{x{eJryAorrKoBat
neperopo4ra, 6oxoBaq, Mexrrpe.4cepAHas reperopoAKa.
IV6 urar.
1. ffo.noxeHlre AarrI[Ka:
anI'IK€uIbHoe oKHo
B npoeKrIVZ BepxyueqHoro
rorrr{Ka, 5 vrexpe6epbe. (puc. 54).
2.
Ocu cKaHHpoBaHuq: npoAonbHaq (napannerbHo
Mema AarqplKa opzeHTI.IpoBaHa
BJreBo.
Ocr
Anr4Hnofi
ocz
cep4qa).
cKaHr4poBaHLrfl rroAHlrMaror
cJIerKa BBepx (py.my AarqlrKa onycrr4Tb cJrerKa nnu:).
3. CeqeHue
- arrr4K€urbHoe
rsrr4KaMepHoe (5C).
Puc. 55. 5C. AnuxanbHoe ntmuKat4epHoe
1. Bnsya.rru3rlpyeMbre KaMepbr (prac.
ceqeHue.
55): nenufi xeny4oqeK, qacrb
qacrb
npeAcepALrrr, npunocxrqufi TpaKT npaBofo x{enyAorrKa,
JreBoro
npaBofo
rrpeAcepAr4s, KopeHb aopTbr.
) Bnryanu3rr
pyeMbr e KJra[aH br : Mr4Tpanurrfi
3. Bnrya;rn3HpyeMbre
14
aopraJrbHrrfi
creHKrr: npaBoro )KenyAoqKa,
neperopo4ra, 6or<oBar, MexlpeAcepAHar neperopoAKa.
70 -l
.
Me)KxenyAor{KoBas
K,
neBoe
IVs Iuar.
tcepALre.
L
lIoqKoBat
ToJITIKa'
llo.rroxceHlre AaTrr[Ka: aILIK€uIbHoe oKHo B IIpoeKIIlIu BepxylrelIHoro
5 rraexpe6epbe. (Puc. 54).
Ocr cKaHrpoBaHufl: IlpoAonbHat (napanneJlbHo Alunnofi ocLI cepAIIa)'
Merra
TIIeqHofo
craHvpoBaHv]fl' TaKafl' x(e' KaK
AaTqLIKa OpUeHTLIpOBaHa BJIeBo. OCr
Ho MeTKy AaTqLIKa [oBopaqLTBaIoT
s 4C'
na 10-11 'racos qzSep6laTa IIo qacoBoll
srpenKe.
Ce.renue
- a[rrK€urbHoe
rpexKaMepHoe
(3C).Ero eule Ha3bIBaIor <<arLIK€LIIrnufi
LAX>> 143-3a cxoxtecrLT c rlapacrepH€ulbHblu
Puc.
l.
LAX'
56. 3C. AnurcanbHoe mpexKcuwepHoe cetleHue (<<anurcanuuwil LAX>).
BnsyaJrrl3llpyeMble KaMepbI (pnc.
56): lenufi x{elyAoqeK,
JIeBoe
rrpeAcepAr4e, rracrb npl4Hoc-f,ulero rpaKTa upaBofo xenyAorlKa, KopeHb
aopTbr.
)qKoBa.'I
2.
Bttzy
aJIII3
H
pyeM ble KJIar
a H bI
: Mllrpalrnufi
14
aopT€rnbnrrfi
.
IVr urar.
1. Ifo.roxenrre Aarq[Ka: arrkrKarrbHoe oKHo
B rrpoeKrlr4ra
BepxyueqHo
roJrrrKa, 5 rr,rexpe6epbe. (puc. 54).
2. Ocs cKanlrpoBaHrrfl:
Merra
rpoAonbHas (napalnenbHo Anr4Huofi ocz cep4qa).
AarqLIKa opI4eHTI4poBaHa BBepx.
Ocr cranupoBaHvrfl orKJroHrror
3C, nosopaqvrBafl MerKy Aarqr4Ka rro qacoBofi crpenKe Ha ypoBHe 12 qaco
qrz$ep6nara.
3. Ceqenre -
arrr4K€LrrbHoe AByxKaMepHoe
(2C).
Puc. 57. 2C. Anurcanunoe deyxrcatwepHoe ceqeHue.
1. BusyaJrn3rrpyeMbre KaMepbr (pzc. 57): resHfi
r(enyAorreK,
npeAcepAr4e
2. Buzy
3.
aJr
r{3r{pyeM bre
KJr a
traH br :
B nryaJrn3 u pyeM bre creHK
rr:
Mzrpalrnufi
Hr4>KHflr kr
.
[eperopoAorrHar.
IIIAf.
f.
ilo.noxreHrre Aarrrnna: cy6rocr€urbHoe (pzc. 58).
2.
O
cs cKaHrrpoBaHr{fl : rrpoAonbHa-fl, rorepeqHbre
3. Ce.renvfl -
cy6rocra-rbHhre no Anr4HHofi z
roporrofi
oc.f,M.
1IIIEqHOIO
cepArla).
)IUIIOT
OT
12,racos
Puc.
58. Ilonocrceuue damraurca dnn nonyueuun cy6rcocmanbHbtx ceqeuuil.
rrrar rro3BoJr.rrer rron1nrarb 5 ce.reHlrfi cep.uua u 2 ceqenvt corlyrcrByloqux
(nzxnefi uonofi
BeHbI vI a14oMuHanbHofi
aopru). CoorsercTBeHHo, V
EMeer 7 uoluraroe:
- cy6Kocr€LllbHoe qerblpexKaMepHoe ce.{eHue (4C)
- cy6KocrzulbHoe ronepeqHoe Ha ypoBHe BepxyrxKz
(SAX APEX Subcostal)
(SAX ilM
-
cy6xocruurbHoe roneperrHoe Ha ypoBHe rIanI4nJItpHbIX MbIIuq
-
cy6rocr€urbHoe norepeqHoe Ha ypoBHe MLTTpurJIbHoro KJIaraHa (SAX MK
-
cy6rcocr€urbHoe nonepeqHoe Ha ypoBHe aopr€rnbHoro KJlarana
-
cy6rocr€ulbHoe ceqeHlle sIaxHefi
- cy6rocr€ulbHoe
c
uolofi
(SAX AK
BeHbr
erleHlre a6Aorr,rprn anrnofi aoprbl
Cy6xocra-rrbHbre florrepeqHbre ceqeHlrr rrcrroJlb3yrorct B ToM cJr)qae, ecJIV He
[onyqprrb r43o6pa)KeHl{rl B rlapacrepHurllbHoM Aocryne. Hanpzuep, y
B c xpoHr4qec
KLI
MLI o6
crpyrruBHbIMLI sa6oreea
lnvrflvrvr JIerKIax.
fVa ruar.
1. ffo.noxcenrre AarrrrKa: cy6rcocr€urbHoe (pzc. 5g.t.
2. Ocs cKaHrrpoBaHrlfl: rlpoAonbHar (uapannenbHo AnaHHofi ocu
cepAr{a
Merxa Aarqr4Ka oprreHTlrpoBaHa BlpaBo.
3.
CeqeHue
- cy6xocrEurbHoe qerbrpexKaMepHoe.
P
1.
uc. 5 9. Cy6rcocmanbHoe qemwpexK&\,repHoe
Burya.nu3r{pyeMbre KaMepbr
npeA cepAr.re, rpr4Ho c
2.
'l /l
B HSya.n
c
eqeHue.
(pzc. 59): resrrfi )KeJryAoqeK, JreBoe
rpaKT np aBof o xenyAoqKa, rrpaBo e rrp eA cepAHe.
'.t4uir
n 3 rr pye M br e KJr a r a H br : Mr.rrpa-nluufi TpLr Kyclu4alruufi
.
,
IV6-a rrarr.
l. ffo.nonceHre
AarrrrKa: cy6rocr€urbHoe (pzc. 58).
2. Ocr cKaHHpoBaHnq: rorepeqHax. llonopor
Aar.{r4Ka
sa 60-90 rpa4ycon or
cy6rocralsnoir 4C.
3.
CeqeHlafl
-
rrolepeqHrre cy6xocr€urbHbre.
Puc. 60. Cy6rcocmaabHoe nonepeqHoe ceveHue Ho yponHe nanut ttpHbtx
MbnaL!.
flo4nzuaa rrJrocKocrb cKaHLrpoBaHuflBBepx lonrraeM KoporKze oc]r
Ha
o BepxyrxKlr
O IIM
.MK
.AK
ceqeHlr.f, cxoAHhr c napacTepH€urbHbrMz ceqeHr4rMr4
bHbre ceqeHr4r
npz XOEJI.
ro Koporxofi oca (SAX).
IVe ruar.
1. ffoloaceHre AarrrrKa: cy6rocr€urbHoe (puc. 58).
2.
Ocr crcannpoBaHrrfl : rrpoAon
3. CeqeHlrq
- [poAonbHoe
bHafl.
nzxnefi uolofi
BeHbr.
Puc. 61. CydrcocmanbHoe ceqeHue uucrcueil nonoil 6eHu.
1. BHsya;ru3npyeMbre KaMepbr (pzc. 61):
.racu rrpaBofo npeAcepALrr.
2. Busya.nn3rrpyeMbre cocyAbr: Hvr>I(H'ifl rroJrat BCHA U ICqEHOI{HbIE
rrpoAoJrbHofi ocz.
I
76
BCHbI IIo
lVa urar.
1. Ifo"rroxeHrre AarrruKa: cy6rocr€urbHoe (prac. 58), JreBee
or
cpe4znnoi
TIT4HI'I}I.
2. Ocu crcaru poBaHr{fl : rrpoAon bHafl,. Merr<a Aarqr4Ka opueHTl{pyercq BBepx.
3. CeqeHuq
I{bI fIO
- npoAonbHoe
a64ourauamnofi aoprbr.
Puc. 62. Cy1rcocmanbHoe ceqeHue a6douuuanuuoti aopmu.
1.
Bnsya.nu3rrpyeMbre cocyAbr: a64ouznarbHafl aopra
npeAcraBJrrer co6ofi rpy6.raroe o6pasonanze
cTeHKaMrz r'r fr4fro- aHSxofeHHbrM rrpocBeToM.
rlo rpoAolurofr ocz
c
rI{rIepgxofeHHbIMI4
VI ruar.
1.
).
floroxen ue uarquKa: cyrpacrepHanrnoe (pzc.
63).
Ocr crcaHr{poBaHrrs: nporon lHafl.
3. CeqeHtlq
-
[poAonbHoe Ayrvaoprbr.
(-
lDn
,
:.F
d!
Gr,F
E,@
t,m
Puc. 6 3. Cynpacmepuanuuutil docmyn.
Puc. 64. CynpacmepHar,tbHoe ceqeHlte.
1.
Blrsyann:rrpyeMbre cocyAbr:
/1yra aoprbr
14 Hr4cxoA
flxlafl aopra B rrpoloJrbHoM
ceqeHzz. Jlero.rHa_rr aprepu_tr B rorepeqHoM
ceqeHuu (puc.64).
78
7. KOJII4ITBCTBEHHA-fl
SXOKAP.IUOIPA AVA
0IEHKA ITOTOCTI{ JIBBOT O XEJTyAOTTKA
B Hacrosqee BpeMr M-pexr4M Anr LT3MepeHr4r pa3Mepa JIxt I4crlonb3yerct
perKe. I4s upo4oJrbHoro napacrepH€urbHoro cer{eHut rtonyqarcT cpe3
!-poBHe KoHrIoB crBopoK
srporo
f
MK. llnocKocrb
neprreHAlrKyJrrpHo za4lnefi, creHKe
EprrlKanbHoe rroJrox{eHr4e cepArla
re
cpe3a
B
rpyAHofi
M-pexuua
M-pexuua
Ha
Aon)KHa npoxoAI4Tb
nX. Eclu 3To HeBo3Mo)KHo
rrerre), ro zavrepenprfl r M-pexuvre
rrpoBoAvrTcfl..
B xouqe Ar.racronbr rrcMep.serc.s KoHerrHo-Al4acronzqecrrafi pa3Mep
.F!r- 65. I'Isuepeuue
MP
JIX
(prac. 65).
s M-petrcuue us npodonuHozo napacmepHalbHozo ceqeHu.r. I'Isuepeuue
npoeodumcn Ha yposHe Hquara sy6qa q(R)
3I{f
Peuavrenr E3Meperrltfi e KAP n M-pexrrMe:
'HOM
Bce
L
Cpe: rpoxoAl4r qepe3 KoHIIII crnopor MK
2.
Cpes Aonx{eH npoxoAl,ITb crporo neprIeHALIKyntpHo
3.
I4snaepeHr4e
KAP crporo
B KoHIIe Al4acronbl
IlpeurvryuecrBa:
l. Brrcoroe
BpeMeHHoe pa3pelxeHlle
2. Bocnpoz3BoAlrMocrb
3. MuoxecrBo ouy6nuroBaHHbrx AaHHrIX
r sa4nefi
creHKe
OrpaHnveHrre:
7. 3asncuMocrb or oclr
2. Moxer
npLrMeHflrbcflroJrbKo Ha HopMa*uofi
$opue
JIX
Ecttu He yAaercr opr4eHrupoBarb nyv M_pexr.rMa cTpofo nepleHAr4KynrpHo
saAHefi creHKrr
JIX,
AonycKaerc_f, r43MepeHze
KAP u3
rrpoAonbHoro
rrapacrepH€urbHoro ceqeHr4.f, n B_pexzue (pzc. 66).
Puc' 66' I'Isuepeuue
MP
e B-pecrcuue us npodonuHozo nqpqcmepHanbHozo
ceqeHun.
Per.nauenr [3MepeHufi n B-pexlrrvre:
1. Zsvrepenufl
Ha ypoBHe KoHrIoB
crnopor MK
2'
LrzvepeHLrfl AoJrlI(HbI npoxoAl4Tb crporo [epneHArzKynrpHo
3.
I4auepeHue KAP crporo B KoHrIe Ar{acronbr
rc
sa4Hefr creHKe
4' Katunephr paclonararor or uapyxuofi rroBepxHocru MXII,
u3MepeHr4_f,
nepprKapAou (roneuna.f, roqra)
IIpeHrvryulecrBa:
1. HesaezcrrMocrb or loJrox
eHLrfl
cepArla n rpy4Hofi KJrerKe
OrpaHuveHrre:
80
1. Hzsrca.f,
BpeMeHHaf, pzBperuarorla.f,
2. MoNer
rrpr4MeHrrbcr roJrbKo Ha HopMuurbHofi
Qopnae JIX
cnoco6uoct
3aKaHrrr4B€I,
f,e odbeMa JreBoro zKeryAorrKa
oco6o orMerLrrb, qro Sopvryna Tefixonrqa
xeryAoqKa - ero ucropufl oxoKapAprorpa$uz.
rrynf,p
V = k * D3-
OJIbH
llo Tefixonbrly pacqer
6u -
Anfl, olpeAeneHLrt oobeMa
ocHoBa Bcex oAHoMepnbrx pacqeroB
o6renron JI)K zrrleer nz4:
+K{f)
<<KAO>
= 17 t (2,4
<<KCO>
= [7 | (2,4 +KCP3) ] x KCP3
pa3Mep oALIH, LI oH Aaer
l x Knp3
o6reu. Ho na caMoM .rlene oro
JrLrrrrb
o6reua.
o6repra JreBoro 2rceryAorrKa rro A ByxMepnofi exorcapArrorpaMMe
paccqr4TaTb
o6reu JIX neo6xoAkrMo LrcrroJrb3oBarb roJrbKo AByxMepHyro
apoAHoM raft4e
rro LBMepeHurM o6renra JIX pernaMeHTLrpyercr 2
pacqeTa:
Mero.q Bullet
Mero.q Simpson
o6reua JIX no MeroAy Bullet
memoda Bullet:
r43
AByx reoMerpzqecKlrx crpyKryp (puc.67):
p
pa
Puc. 67. Modenu uemoda Bullet
u
pacttem o6teua JDI(.
Puc. 68. I'Isuepeuue dnuuut JIII{ e qembtpexKa^t tepHoM ceHeHuu ezo naot4adu
e
nonepeqHoM ceqeHuu Hq yposHe nanunnnpHblx Mbtruq.
MeroAlrrca:
1. ,{nunHafl. ocb (L) - prs Bepxyme.{Hoi TIo3HIIVLI
2. llnorqalr (A) - r43 nollepeqHoro ceqeHll-f, Ha ypoBHe
V=5xAxLl6
IlpeurvryuecrBa MeroAa Bullet:
rlacrn.rno yqurrbrBaer Qopir,ry JIxt
Orpann.reHrrfl MeroAa Bullet:
o
at
BepxyrrrKa AonxHa iIerKo BvrcyaJrvr3l4poBarbct
o
Orcyrcrnze rpy6ux I,I3MeHenufi Sopl,rr JIX
a
OrpanzueHHocrb HopMarl,IBnofi
6
asrr B rIonyntIII4I4
rIarII4JrJrspHbIX Mblrxq
o6repra rro MeroAy Simpson
IIKA:
Jleerrfi x(enyAoqeK Aenr,rrcr Ha
crorrKy ALrcKoB (prac. 69)
3a4aua
-
KoppeKrno o6necrz
JI}It
HTbr
-
oAHorrnaHosHfi
Simpson
u 6uttanosrrfi MeroA pacqera
- caurrfi ro.rHrrfi LI3 AByxMepHbrx cnoco6on
6oree KoppeKrHofi
o6ao4KLT KoHrypa
Tb aAarrrlreHHft
pacqera o6rerr,ra JIX.
JIX rro oHAoKapAy
peKoMeHAyeMcf,
rolopafisunr.
trIIIrl
Puc. 69. I'Isuepeuue o6teua JI)I{ uemodou Simpson.
orMerurb. qro
aHaJrvr3
o6reua JIX z efo
Hyxuo npoBoAlrrb He rro a6comouruv
LrJrLr
ero o6renaa (KAO), a neo6xoAtrMo
rroBepxHocrr.r reJra (BSA
-
3HaqeHrlsrra
lznefi Horo pa3Mepa
HOpMLrpOBaTb 3Tl1 rroKa3aTeJrr4 K
body surface arca).
b reJra paccqLrrbrBaercs uo Qopvryne
KoHeqHo-nuacToJrkrqecKofo
!ro6ya:
BSA = (Weig[10,+zs x Heighto,tzs) x0,0071g4, r4e
Weigh
B
-
Bec n
rr, Height - pocr n cu
ynbrpa3ByKoBbrx
anIIapaTax
aBToMarLIqecKLI, ecJILI
Aaunrlir
paccqr4TbrBaeTct
IIOKUI3ATENb
B Haqalre vccneAoBaltrr n npz6op
BBecrLr
pocr Lt Bec
NAULICHTA.
nJIX(
Ouenrca
n KCO)
VnaepeHu
bIe
OTKJIOHEH
UA
t5r-174
Wz ra6lzqrr
ZHAEKCLIPOBAHHbIX
I2I-I3O
BLrAHo, qro
UOrASArErrEfi
rrpLrMeHeHr{e
ZHAEKCA
K4r z K!o.
3HaqeHI{t pa3MepoB
orIeHKe pa3MepoB
KAP (I4ITF) U
(I4KAO) yMeHbxraer reHAepHyrc 3aBzcLrMocrb
sHa'reHzfi
B
I4HAEKCA K,4O
B orJrLrqve or
a6comorHrrx
Kporrae Tofo, npLrMeHeHVe LrHAeKcoB no3Bor.f,er yqLrrbrBarb
JIX B 3aB[cLIMocrLI or
naqueHra pocroM, cKaxeM, 160 cu n BecoM 60
3HaqLIreJIbHo orJlLTrlarbct
KoHcrrlTyrlzv naqueHTa. Tarc, y
rr
3HaqeHz,
Kp
n
K[o 6ylyr
or raKoBbIX y [aqueHTa pocrorvr 190 cM v BecoM 110 rr.
flpzueneHLTe kIHAeKcoB Aaer Bo3Mo)I{Hocrb orreHlrrb pa3Meprr
JIX LrHAuBuAy€urbHo
Ant KaxAoro rIaIIkIeHTa LI [o3BoJrser zs6exarb 3aBbrrrreHHhrx oueHoK.
OTIEHKA MI4OKAPAA JTEBOTO )rGJIyAOrrKA
IuneprpoQun -
nX
yBenl4qeHkIe MhrlueqHoft uaccrr, Bo3HkrKarouefi n oTBer
Ha
rroBbrrrreHkr e Harpy3Klr.
Cyrqecrnyer HecKoJrbKo rlrrroB reoMerpkru JIX:
70. HopuanbHat ?eoMempufl JDI(. LIudeKc
a HopMe, morurruHa MuoKctpdo 6 Hopwe.
o
)KEHH
te
HeHLLfl
;l
RIP
Puc.7l.
RouqeumpuqecKqfl zunepmpoQun JIII{. Irludercc MP e HopMe, mont4uHa uuorcapda
oolburc HopMbt.
7
l0
0
JD{(
:Ao
IhIX
Puc. 72. SrccqeumpwtecKctt zunepmpoQun JIII{. Irludercc MP 1onaute HopMbt, morrr4uHa
uuorcapda 6 HopMe.
IATE
,Y
Br{AHo Lr3 pkrc. 70-72, TonIr{LTHa MuoKapAa He rBJrrerc.fl rrarorHoMoHLrrrHbrM
4yr
Kf.
rHO
efo fr4reprpoouu. Tak, JIX
Eapr4c.
TI,xorx
Ha
puc. 72 rrc Macce nepeBecrrr ADKe JDK
ronrqlrHa MrroKapAa y Her.o HopManbH€ur.
Tarnu o6pasou, Ant
oueHKI4 reoMerpuv
JIX
neo6xoAr4Mo rrcrroJrb3oBarb rpkr
IIOKA3ATEJUI:
o
.
.
Zn4ercc Maccbr Mr,roKapAa
ZnAercc [enepo
ZHAerc K,4P
Pac.rer Maccbr MLroKapAa Bo3Mox(eH AByMr cnoco6aMLr:
r
o
KonseHr{LtoHHbrfi uero4 n M-pexzue
Pac.rer Maccbr MzoKapAa a B-pexzrvre
KoneeHquoHHrrfi MeroA pacqera Maccbr Mr{oKapAa
Merogura:
1. Irlcnolrsyror M-pexuu
2.
3.
Ce.reHrae
- KoporKar ocb Ha ypoBHe rrarrr4nJrrpHbrx
Mbrrrrq
Cpes M-pe)KI4Ma AoJIIKeH rlpoxoAt4Tb Me)KAy roJroBKaMV rrarrktJrJrrpHhrx Mbrrrrq
crporo neprreHAzKyrrf,pHo
r
sa4Hefi creHKe
lloKasarerz, neo6xoAl4Mble Arr pacqera Maccrr
JIX (pzc. 73).
Mt4oKapAa KoHBeHrIr4oHHbrM MeroAoM:
1. lzanrerp JIxt s Al{acrorly (ero ne roxAecrBeHHo KAP!) Ha ypoBHe sy6qa Q 3Kf
2.
TorqraHa
3.
To,rrquna 3CnX
MXII
B
AvacroJry
B Ar,racrony
(Dopnyna AJrr pacqera Maccbr Mr4oKapAa:
MM = 0.8 x 1,04x t(M)IflI + JIXa + 3CJIX{)3-JIXA3] + 0.6, r4e
MXII - ToJrrrlr4Ha Mex)r(eJryAorrKoBofi
JIXa - pa3Mep JIX s Ar4acrorry
3CJIX
-
ToJrrrlktHa za1wefr creHKr.r
ueperopoAKr4 B Ar4acroiry
JIX s Ar{acroJry
Puc. T3.CeqeHue dnn nonyueuun uso6pacrceHut 6 M-pexuue
dna pacuema Moccbt uuorcapda KoHleHquoHuwu uemodou.
*:_
86
IlpeuuyuqecrBa MeroAa:
a
oof aTcTBo onyoJII4KoBaHHbIX
AaHHEIX
a
rloKa3aHa rrpofHocTl{rlecKat 3HarlI4Mocrb
a
ro.{Hrrfi npr4 aprepuanurofi rvnepreH3vrvr
v aop r€uIbHoM
creHose (Qopua
JIX ne usueruercr)
.
llpocrora Ans
cKpLrHLIHra
f,elocrarnn:
VI:
.
3aBLrcrrMocrb
Kf
or
reoMerpuqecKofi Soprr,rr
JIX
(yceqeHnrtfi oJIJILIIc, rrpLl
KOTOpOM COOTHOrrreHLre CTOpOH
2:I)
a
3aBr4CLrMOCTb OT OCr4 K€lllt4nepa
(yron 90 rpaaycon!!!)
a
Sopuyna
Ky6a
no6as. ouru6ra
r{3MepeHr,r.rr 3HaqureJlbHo
zcKaxaer
KOppeKTHOCTb pacqeTa
a
flepeoqen vrBaer Maccy
o
Heroqnrr
JIX (:anrruraer)
fi npu acc r4Merpkr
rrHbrx
rLT
neprpo
Q
uax
LI
u3MeHenuu
Q
oprvru
JIX
?ecqer Maccbr MrroKapAa rlJraH[Merp[qecKrrM MeroAoM
llerolrKa:
1. tr{cnonb3yror B-pexuvr
2.
Ce.reHvrfl.
-
anrlK€rrrbHoe qerbrpexKaMepHoe
u lro Kopomofi ocr
Ha ypoBHe
Ilallunn_flpHbrx Mbrruq
flranuuerpprqecKlrfi vreroA pacrrera Maccbl MI4oKapAa (puc. 74)
rpoMo3AKuir.
u
pe€urpr3oBaH He
JIX
6onee
Bo Bcex ynbrpa3ByKoBblx arlaparax. On roqnee
E)EBeHrIr,lOHHOfO MerOAa pacqera MaCCbI MI4OKapAa.
IlpenrvryqecrBa MeroAa :
o
Mo>lcHo rrpr4MeHrrb Ha v3MeHeHHofi Sopvre
a
6olee BbrcoKafl ToqHocrb
METO.IIE
He,rocrarKrr MeroAa:
.
fponao3AKocrb MeroAa
JIX
BBkrAy cHlrx{eHr{r rrorperrrHocrll
npu ry6uqecKoM
o
qETKA'
o
c na6 afl . H oPM arI4B Hafl' 6 a3a
o
HeAOCTaTOqHOCTb rlporHo3Hbrx AaHHbIX
BI'I3YAJILI3 ATTYTfl KOHTYP OB
P u c. 7 4. tr4su ep
e
Hue, o u
o,
**
"apd
a
rut
auuu e mpuq
ec
KuM u e mo
d
ou'
AmeAr-Az
LV tvlaes (AL) = 1'og
tt t& An {a+d*t} I - tsl. A, (a+d} l}
t - cpe4u-at roJIIrIIlHa creHKLI
Ouenrca Maccbl MrroKaPAa
JIX
Xemuunst
MyN't4Hll
Hopva
MXIl,
MM
3CJ]X,
MM
MM. r
6-10
HesHaqur.
OTKJIOHEHI4JI
Bupaxeuurte
Yuepennrte
Hopua
OTKJTOHCHI4'
OTKIOHCHU-fl
;_l -;;;l
;-r -;;1
Hegnaqrat.
YlrepeHuue
Brrpaxennrte
OTKJIOHCHII'
OTKJIOHCHI{'
OTKIOHEHUS
10-12
l3-15
>15
M-Pexnrvt
6-10
I 1-13
r4-r6
>16
6-9
10-12
13-15
>15
88-224
225-258
259-29'.2
>292
6'7-162
163-186
t87-2lO
>210
49-115
n6-131
132-148
>148
43-95
96-108
ro9-12r
>727
>254
66-150
l5r-7r'7
172-193
>193
>130
44-88
89-100
101-l 12
>t lz
R-nexutl
MM, r
I4MM,
rlu2
llpu
96-200
201-227
a--n8-zs4
50-102
103-1 16
I 17-130
He a6colrornrre
oqeHKe Maccbr M[OKapAa Heo6xoAI4MO TaK]I{e oIIeHLIBaTb
[aIII4eHTa'
a I{HAeKC5I c yueTOM IlHApIBLIAyanbHOft rOsCrUTyIIrau
3HaqeHLIs,
8s-
*i
|
OruocnreJrbHafl ToJrrrlrr Ha creHKH
OrnocureJrbHafl ToJIIru{Ha creHKrr (OTC, r{HAeKc
[enepo)
rroprtft
yroHbrxeH orHocr4TeJrbHo
orpax{aer HacKoJrbKo MrroKapA yronrqeH
rxKperHoro
pa3Mepa
Lrrrvr
rroKa3areJrb,
JIX.
OTC = (3CJIX x2) lKnP
hpuanrHoe 3Haqenue OTC <0142
BapnaHrbr r.r3MeHenufi Mr.roKapAa
JIEBOIO )I(EIYAOIIKA
IIMM
OTC
I4KIP
***!v
Hopua
Konqenrpr4 rrecKoe
peMoAenvpoBaHr{e
*"*<t
Kouqenrpr{qecKat
runeprpo$ux
3rcqenrpr4rrecK€ur
runeprpo$ua 6es
l)
I.r4nuta\vv
3r<cqenrpHqecKat
rr4rreprpo$ut c
Antlm;ra\nefi,
OiltEHKA fIOJIOCTI,I JIEBOTO TIPEACEP TIf,fl
X*repeHrq r[HefiHbrM MeroAoM (M-pexnnr n B-pexnvr)
lfgro,ulrna:
Ibrrepenue npoBoA urcfl. B rrpoAonbHoM napacrepH€urbHoM ceqeHLrlr
'
'
nepeAuesa4uufi pasMep Ll3Meprercfl, Ha ypoBHe aopr€urbHbrx cr'tHycoB
I43MepeHI{e npoBoAI,ITc.f,
KNAIIAHA
B MoMeHT 3aKpbrrbrx tolylynufi
aopr€LnbHof(
l
I
7
;
Puc.75. tr4suepeuue pa3Mepa JIII
e M-pecrcuue.
IlpeurvryuecrBa:
.
ilrrfl M-pexnua: BbrcoKar
BpeMeHHarI pa3pemaloqa{ cnoco6Hocrb
14
HaKorIJIeHHat HopM arprBnafl. 6 a3a
o [nx B-pexuua:
MoxrHo crporo rrepneHAlrKynqpHo opueHTllpoBarb KaJILInep
orHoclrreJrbHo 3a.uHefi crenru
JIII
HeAocrarKrr:
o Pasldep oAI4H, a Qurypa HenpaBuJlrnaq!!!
o r{alle yBenLTqeHve JreBoro pa3Mepa [poucxoAllT
rlpoAonbHoM HaTIpaBJIeHLI
.J
eo--i
lI
He B rloueper{HoM, a
B
Puc. 76. Irlsuepeuue pa3Mepa JIII{ e B-petrcuue.
lI r v e pen u e JIII
ro
aJr
ro prrrMy
<<rrJro
rrlaA b-AJr
r{ Ha>>
nep
Puc.77.tr4suepeuue
77. tr4suepeuue oo6
6teua JI II no anzopumMy
<
nn
ou4adu - dnuu
a
>>.
\Iero4nrca:
.
crrJraficrzHr rrnoqaAr4
ocyqecTBJrreTcr <<oT
MLrTpanbHofo KJIarraHa, Ha crBopKr4
KoJrbrla
MK ne <<3arroJr3arb>>
!
Ao
KOJIbIIa>>
.
LI3MEPEHI4E ANI4HHOfi OCU
III
r43MepeHHrx, Ao nJrocKocrr{ Konbrla
-
NE|OIIHbIE BEHbI HC YIIACTBYrcT
B
MK.
XocrouncrBa:
o
[o3BoJrrer rorrHo orIeHVTb HerrpaBlrJrbHyro 0opry neBoro npeAcepAl4s
oTpaooTaHHbre nporHo3Hbre KpLITepI4I,I
I4svre
peru e JreBoro rr peAcepA nq MeroAoM ArrcKoB
Irlsrr,reperize
o6reua JreBoro npeAcepAlrr MeroAoM
AI4cKoB nau6olee
npeAnor{Tr4TeJlbHo, TaK KaK MeHbIue Bcefo Ha nonyqeHHbre pe3ynbTaTbr oKa3bIBaeT
Blrvrfllrtvre Sopnaa.
Merolnrca:
.
Or<onrypr4Bale.ne rroJrocrr,r JreBoro [peAcepAr4-tr ocyqecrBJlf,erct <(or KoJrbua
Ao Konbrla>> MI,ITp€ilbHoro KJraIIaHa, Ha crBopKIa
MK
He <<3arloJrgam>>!
IocrolrHcrBa:
.
He 3aBr4cvrt or Sopvru JIeBoro rIpeAcepAI{rI.
Puc. TS.WsuepeHue o1aeua JIII
92
a B-pecrcuue
uemodou ducxoe.
't
I
I
JIEBOfO tI
AJIbHbIE 3HAIIEHUq
I
nepeAHe3aAHero
(nrnr/ru2)
o6reua (anropnrrr,r
IIIaAb-Anr{Ha>> ), ttll yt'
o6reua
19,4-35,2
(preroa
18,1-30,9
17,9-32,3
n). u.r/u2
orIeHKe pa3MepoB JreBof o rrpeAcepAnfl. ucrro rb3yloT HE AOCONIOTHbIE 3HAIIEHLI'
TeJrefi, a vx LIHAeKcbI.
HKA AOPTbI
aopTbr rrpoBoALrTcr
B
rrpoAonbHoM rrapacTepH€ulbHoM
ceqeHLTI4
BB-
(puc.79).
hc-
79.I,IsuepeHut aopmbt, zde I
carq)co6 Banacanuee, 3
-
-
duauemp
Konbqo aopmarbHoeo KJtanaHa, 2
Ha
-
duauemp Ha yposHe
yponHe cuuo-my1ynnpHozo coqreHeHufl, 4
npoKculvtottbHozo omd ena
eo
cxodnu4eil aopmat
-
duantemp
Crau4aprHo npI4 pyrznnofi oxoKapAr4orpa$zra ueo6xo4raMo r43Mep.f,rb aopry Ha
ypoBHe cr4HycoB Banrcamee.
Hop^'ranrHble rloKa3areJlu pa3Mepa aoprbr HaxoAf,Tcr B 3aBrrcr4Mocrr4 or
Bo3pacra
nnoqaAr4 Terra
vr
olpeAeJrreTcf, rro HoMorpaMMe:
Children and adolescents
Adults 20-39 years
4.2o
2.8
g
2.4
(!
y=1.92+0.74x
SEE = 0,24
SEE = 0.37
4.4r
P < .0005
o
.:(!
y=$,97+1.12r
r = 0,71
;3.2
E
Adults >40 years
r = 0.40
P<
0005
3.8
3.4
b z.o
3,0
3 r.e
2.6
3.6
3.2
o
o
2.8
6 t.,
0.4 0.8 ,1.2 1.6 2.0
1.6 2.A
1.6 2.0
2.4
2.4
Body $urface Anea (m2)
OTIEHKA IIPABOTO X{EJIyIOTIKA
llpaerrfi xenyroqeK B
orJrrrqr4e
or
neBoro
r4Meer
pflA
nropSonorr4qecKr4x
oco6ennocrefi:
1. @opuy npaBoro )KenyAorrKa HeBo3Mo)KHo Brrr{carb Hr4 B
oAHy
feoMeTprrqecKyro MoAenb
2- fIpaasrfi NenyAover 6ecQopMeHHhrit u
<<taccr4BHo pacnnacraH>> Ha JreBoM
)KenyIoqKe
3. flpanrrfi xeny4or{eK LrMeer ABa rpaKTa - ,rplrHocrqnfi u BbrHocr[ruir (s
JreBoM x{enyAor{Ke BbrAenrror rryrb npr4ToKa
14
nyrb orroxa)
14
B cessz c
oco6eHnocrflMvr, co3Aarorcs onpeAeJreHHbre npo6nev6r B orIeHKe
pa3MepoB npaBoro x{enyAoqKa. C yueroM Toro, qro
B HeM BbrAen.rrror
sTI4MLI
npznoc.aqzfi
Lt
BblHoctrqzfi rparrbr, oIIeHKa npoBoALrrefl rro zx pa3MepaM B
orAenbHocrrr.
Ilpnrorc K rrpaBoMy )r(eJryAovrcy (prac. g0):
Puc' 80' Itlsuepeuun npuHocnlt4ezo mpaKma npa6o?o trcenydourca,
zde RVDI
crcenydourca Ha yposHe Konbqa mpurgtcnudanbHozo KranaHa,
a RVD2
-
-
duattemp npa6o?o
duauemp npa1ozo
tcenydourca e ezo cpedueil mpemu
Orrorc r{3 rrpaBoro )r(eJryAoqKa (pzc. g1):
ry
peHuz
'
6btH o c.nu4e 2o mparcma
npaeom
npoKcutwaruuoti qacmu 7btHocztt4ezo mpaKma npa*ozo crcenydourca
s npooonbHoM
nqpacmepHarbHoM CeqeHuu uttu nesoM napacmepHarbHoM
ceqeHztu no KopomKoit ocu Ha yposHe
AK' Rvor Distal - duauemp
ducmanuuozo omdena 6uHoctu4e?o mpaKma npa*ozo ucenyoottKa.
llpezvryrqecrBa pa3AeJlbHofi oqenr<n npaBoro )KenyA qKa flrzHefinrrrrr MeroAoM
B
pe)Kr4Me:
o laer 6olrurue npeAcraBrreHvrfl o pa3Mepax npaBoro
cocTo{HLrr [pr4Hocrqefo
o llpz
r,r
BblHocsqefo
xorr 6u
yBenuqeHr4r4
oAHoro
xrenyAor{Ka c yqeTor
TaKToB
pa3Mepa
yBenr{qeHr.{e
rrpaBorc
x(enyAoqKa (npzHocxulero I4JII,I BbrHocf,rrlero rpaKTa r4Jrr4 Bcero rrpaBofo
x(enyAoqKa)
o
Oqeura roJrbKo a6coruorHbrx 3Harleuui1 uu1eKcbl He npr,IMeH-f,rorct.
OrIeHrca rrJrorrlaArr rrpaBoro r(eryAorrKa
IlpenrvryqecrBa:
Bocnpoz3BoAr4Moe
Lr
JrerKoe r.r3MepeHrde
HeAocrarrcu:
o
cJro)KHo Aocrr4rrb qerKoro zso6paxenz.q ceo6oAnofi
a
rpa6erynrpuocrr
a
HerorrHocrb
IIX
crenrz
IIX
B orIeHKe r{crrrHHbrx pa3MepoB IIxt
(ne4ooqeura
vli.H
uepeoqenr<a)
llnonlaAr npaBoro
xenyAoqKa r43Mep.rreTcq
B
arrzKaJrbHoM qeTbrpexKaMepHoM
ceqeHr'ru, npr4 STOM orIeHr4BaeTCq ToJrbKo rrpr4Hoc{qzfi
rparr npaBoro xenyAorrKa
(puc.82).
floprvr
a.n uH
bre 3HarreH rrfl pa3
M
epo B
llaparuerp
RVDI.
rr
pa
Boro ]KeJryAorr Ka
HopvranrHoe
vrvr
3HarreHr4 e
25-4r
RVD2. vru
RVOT B rrpoAonbHoM rrapacrepHilrbHoM
19-35
20-30
CCqEHI4KI. MM
96
RVOT B cerreHlrv no Koporrcofi ocu Ha ypoBHe
AK, uu
RVOT distal, uu
[uacrotuirecKar nnoqaAb lIX, cM'
2I-35
Myx.rzuu
Xenurzuu
r0-24
8-20
17-27
TO\l
rof0
rofo
P u c. 8 2. tr4su ep
eH
ue
rco u e
qu o - d u a
cm
on uq
e
crcu{t nn
u
o u4 a d
np ae o z o crc e ny d ourca.
?IJIVI
Ouenrca roJrrrluHbr rrpaBoro r(eryAorrKa
Jrs
oqenKI4 TonIrII4Hbr creHKr4 npaBor-o xenyAorrKa r4crronrcyror cy6KocranbHoe
{oM
-tqeHl4e.
IIKA
BeHrry
roro, rrro creHKa npaBoro )KenyAor{Ka roHKaf,, r43MepeHl4s
rpoBoAzrb Ha yBenr4qeHHoM uao6paxeunu (ZOOM)
pzc. 83.
-
-IocronncrBa:
Jlerr<o
crr
14
3M
epeHr4r Lr ero
He-rocrarrcn:
o u3Mepflercfl ToJrbKo
oAr4H
Bo
clpor4 3BoAr4Mo crb
lranefiurrfi noragarenr
a
Bropax rapMoHr4Ka Mo)Ker 3aBbrcr,rrb ronrqr{Hy crenrta
a
Croxnocrr,r c yronrueHr{eM rrepzKapAa
a
Her rpzreplreB
aHoMzrrrbHo roHKoro vzor<ap4a
IIX
IIX
olszareJrbHo
Puc. 83. tr4suepeuue monuluHbt
Kpurepzz HopMbI
flpz
cmeHKr.t npaaozo crcenydourca.
ToJrIrII4HbI creHKrI rlpaBoro x{enyAoqKa
- or 1 Ao 5 nru.
ynenprqe:nurpr roJrrrlr4Hbr creHKr4 rrpaBoro x(enyAotlKa cBbIIrIe
5 nru cyAtr
runeprpo$uu npaeoro xenyAoqKa.
OTIBHKA frPABOf O TTPEACEP Akrfl
Arq
orIeHKr4 pa3MepoB rlpaBoro rpeAcepAlat
r4crroJrb3yloT
arII4KzLIIbHoe
qerbrpexKaMepHoe ceqeHlle.
lonycraercs
Ar4aMerpbr
TOJIbKO
14
orIeHKa KaK uo rzHeftHbIM pa3MepaM (npo4onr rrstit
nnoulaAb rrpaBoro rlpeAceprvrr.), TaK
rro €rnrop IITMy
14
u nonepeunrrfi
o6reu npaBoro npeAcepAr4r
<<rIJrOIrIaAb-AJII'IHa>>.
HoDMaJrbHbIe 3HaqeHlrfl pa3MepoB trpaBot'o ilpeltcepAnrl
llapal,rerp
ZnAerc npoAonbHoro
22-28
ArraMerpa , vrM/M'
I4nAerc rtonepetlHoro
r6-22
I
AlraMerpa , rrnv.lw2
i
flnoulaAr npaBoro
<19
rrpeAcepAvrfl., cM'
O6levr rpaBoro
rrpeAcepAr{r,
:--ts
MJr
xtenurznu
Mvxqranrr
18-32
r5-27
-
Puc. 84. I,Isuepeuue npodonuuozo duauempa u nnou4adu npaaozo npedcepdun.
IbI14
lfl.
-
Puc. 85. Irlsuepeuue naouladu npalozo npedcepdun no anzopumMy <nnou4adu-dnuua>> u Qopuyna
dnn pacvema ezo
o6teua.
OIIE HI{A CI4C T ONrI.IE CK
OcHonHafl 3aAarra
Ofi O rrrrr \ZI]/^NEB OI O XE JIYAOIIKA
[plr
orIeHKe conparrrMocrrf JreBoro r(eryAotrKa _
orleHrrrb
crrJry cepAeqHofi urrurqbr KocBeHHbrM
MeronoM.
o
o
oqenra crerreHLr yKopoqeHkr.f, MhrrrreqHoro BoJroKHa
oqenra cKopocrr4 yKoporr e'UsMblrrreqHoro BOJTOKHa
oqeH rca
(Dparcqna nrr6poca
crerre'r y*oporreHrrfl
MbrrrrerrHoro BoJroKHa
-
BrIepBhIe rpeAnox{zJr ee ucrroJrb3o
Barb vrBhrBeJr 6opruryry
Ar's pacqera l43Bec**rfi KapALIonor EpaynnanbA.
zvrenno c Hero Haqzuracb orroxa
(<rroKJroHe Hvrfl>>
Spaxqzz nrr6po ca cpeAr4 KapAzonoroB.
(DB=(KAO-KCO)x100/MO
ff panu;la Arrfl r{3MepeHrrfl
eparcqnu nrr6poca :
1' llsnaepe*ufl u pacqer [poBoAr4Tc-[ crporo
ce.IeHla.s
2'
a
B
B-pexzrvre,
arLrK€urbHbre
!
M-peN?rM AJrflpacqera
Qpaxquz nrr6poca He LrcrroJrb3yerc,
J. B
epxyrura cepArla AoDr{Ha qerKo
B;z3y
uru3LrpoBarbc,
4. Kopper<ruoe LrcMepeHLre KAO u
KCO n B_iexzrvre
Oqenlca Qpat
rtrnrn
nrr6poca
Vuepeunrre
BrrpaNenrnre
OTKJIOHCHV{
Hegnaqr,rr.
Ynrepennrre
OTKJIOHEHI4f,
BrrpaNenrmre
OTKJIOHEHT4'
OTKJIOHEHII'
OTKIOHEHU,I
OrleHrca cKopocrrr rroAbeMa BHyTprrxeryAorrrcoBof
o AaBJreHrrfl
Ectu
r43Mepr4Tb BpeMr,
BHyTpzx(enyAoqKoBofo AaBJreHnfl
3A
KOTOpOe [poucxoALrT
rroBhrrrreHLre
MOMeHT CI4CTOJIbI, AOCTaTOqHofo
/{IIfl
orKpbITLIt [onyJlyHI4fi aopralbHoro
KJIa aHa z arr6poca KpoBkr B aopTy,
B
Mo]r(Ho
orleHr4
f-
1oo
Tb Cr4ny c oKp arrleHLu JreBof o xenyAoqKa.
KA
Bpervrx IroBblrxeHkrfl AaBIreHr{r B rronocrz
JIX lprMorrpolopqlroHaJrbHo cvre
cavofi cepAeqHofi tr,lrrurqu. lauurrfi rroKa3areJrb MolKHo
II{Tb
Ir\-TeM rIpI4 3oHAupoBaHLru rIoJIocrI,I
kr3Mepr4Tb LrHBa3rrBHbrM
JIxt. Ho y Hac ecrb Bo3Mo)KHocrb
orleHr4Tb 3To
3peMt rIpI4 [oMoIrIV gxoKapAl4orpaQvIu. E4zucrneHHoe ycnoBrze
1g1arkrrrue
\arrpanbHofi peryprvrrar\uu (cu. pzc. 86).
)Myny
9troxa
slg
bHbIC
Puc. 86. ustwepeuue cKopo cmu nodtetta auympurcenyd oqKonozo
MeroA ruca l{3MepeHnq cKopocrn rroAbeMa
B
d
aene Hun.
Hyrplr}KeryAorr KoBoro
Aa BJreH
uq
1. llpzvreHrercr nocro-rrHHoBoJrHoBofi (CW) Aorrnnep
)HI4E
2. IIyt CW Aonnnepa Aonx{eH rrpoxoAlrrb rrepe3 rroroK uurpa6nofi
Anfl
pefypfr{TarJkrvr
xtHO
3. orpanuqllTerbHa-l
MerKa AonxHa HaxoAr4Tc-rr rroA rroroKoM peryprr4T arJprv.
Cym MeroAa Il3MepeHrrs cKopocrr4 rroAbeMa BHyrpr4)KenyAoqKoBoro
-
AaBn eHufl
oIIeHZTb BpeMt, 3a KOTOpOe npoucxoALrr r43MeHeHr{e
fpaAr4eHTa AaBneHLrfl
C
ypoBHr 4
MO)rCeM
rvrrvr
pr.cT. Ao ypoBHs 36
paccqlrTaTb
TOJTbKO
l,rrvr
pT.cr., T.K. MeroAoM gxoKap4norpaqnu
rpaALreHT AaBJIeHI4t, a He LI3MepLITb
efo
aocoJIIoT
3HaqeHLI-f,.
Marcuuanrnrrfi fpaAr{eHT AaBneHur
paccqLTrblBaercq rro ypaBHeHI4Io
Eepuylwt:
P=4xV2,rAe
P
-
uarcIIM€UIbHbIfi. rpagueHT AaBneHur (n'rvr pr.br.),
V
-
uarccl4MalbHaq
KpoBoroKa.
Ha stoNl nocrpoeHa
JroFr{Ka MeroAa:
Oupe4enrrcr ToqKy repeceqeHl4rl noToKa MI4Tp€[IbHofi peryprelTaIlvu
ypoBHe 1 Ir,/c (4 vrvr pr.cr.) vI Ha ypoBHe 3
vlc (36 vru pr.cr.). ,{alee usu
BpeMf, Mex(Ay STI4MpI TOTIKaMLI.
Tarraru o6pasou, MbI nonfraeM 3HaIIeHI4e
orpp6ae!
- T (npeur) -
r.e., IIoKa3aTeJrb,
3a KaKoe BpeMr (dT) rpaalreHr AaBneHLIt Bblpoc c ypoBHt 4 rvrnr pr.cr'
36 vtvt pr.cr.
dP
= (36 uvr pr.cr.)
-
(4 vrvr pr.cr.)
-
32 MM pr.cr. CIeAoeareJIbHo' dP .se;ls
KoHcraHTofi, neo6xoAtrMo roJrbKo Lr3MepLITb BpeM-f,, 3a Koropoe rpaALIeHT AaBJIeHtrl
Hapacraer c 4 MM pr.cr. Ao 36 MM pr.cr.
I4cnorueyr ero
3Haqe:nlu'e
u QoPuYnY:
dP/dT =3217
Mbr rroJrvqaeM 3Harlenue dP/dT.
floragarem dP/dT {BJrrercr caMbrM TorrHbIM
B
3xoKap4uorpaQ[rl AJrfl oIleHKIr
coKpaTrlMocTrr JreBof o }|(eJIyAoqKa.
Kpzrepuu
oIIeHKLI dP/dT
>1200 MM
1
pr.cr./c - nopvrarbHaq coKparl{Mocrb
000- 1 200 l,rvr pr.cr./c
800-1000 MM pr.cr./c
<800
MM
pr.cr.lc
-
-
-
He3HarrvreJlbHoe cHLDKeHLTe coKparllMocrl4
yvrepeHHoe cHI4xteHLIe coKparuMocrll
YwpuKeHHoe cHLDKeHpIe coKparLIMocrLI
Eclz y [arlkreHTa uMeercr
MurpaJrbHafl. peryprLITarJnfl.kI yA€ulocb paccqLlTarb
3Tor rroKa3areJrb, To coKparlrMocrb
r
I
141
LV-
JIX
neo6xoALIMo rIpoBoALITb LIMeHHo rro HeMy,
I4 MbI
)THBIC
.fzDKe
eclrupaccqllrana Qparqzx eu6poca. T.e. rpu pacqere dP/dT Qpaxquefi
Bbr6poca Mbr rrpeHe6peraervr.
Cypporarnu fi rroKa3areJrb
orleH Krr
-
OcHosHaq upo6leua oxoKapAr,rorpaQura
cETyarll4-tr, KorAa
)OCTE
conparuMocrl{ JreBoro r(eryAoq Ka
KaqecrBo Bl43y€ilu3arJvrv.9acro 6Heaer
He yAaercq qerKo nonyqlITb uso6paxeuze cepAIIa
c.-reAcrBr4e, r43Mepr4rr
o6reubr JreBoro x(enyAorlKa
z
Qparquro eH6poca.
u
KaK
B erux
c-Tr{arx orleHr,lTb coKpaTlrMocTb Mo)KHo kr IIo cyppofaTHoMy IroKa3aTeJIro
\crrp
o - c e nrall b u o
fi
Zsuepzrr gTor
tHa
I.f,IOT
€Ln b H
ceu
ap ar\r4vr (EP
SS).
noKa3areJrb oqeHb
npocro. Atts ororo
Llcnonb3yercq
rrpoAonbHoe napacrepHaJrbHoe ceqeHr4e ra M-pexuvr, rrpuqeM cpes M-pe)Ifl4Ma
-loJrx{eH rrpoxoAl4Tb rlepe3 KoHIIbI cTBOp OK MI4Tpan bHOf O KJIarIaHa.
klzvrepr^r- paccrof,Hr4e
pufi
'. Ao
or
rrr4Ka pacKpbrrl4f, MI4TpanbHoro KJIarIaHa Ao
Mex)KenyAo.rroeofi reperopoAKrI, ronyqaeM 3HaveHI4e EPSS (puc. 87).
Cyrr 3Toro cnoco6a orleHKlr coKpar?rMocrll nxt ITQfl
EPSS, TeM AaJrbrxe crBopKa Mr4Tp€urbHoro KJIarIaHa
tlufl
rreperopo AKu vr reu
6olrrue pa3Mep nonocrrr
.{eNa
or
6omlue
Mex)KeJlyAo'Iroeofi
JreBoro xenyAorlKa vr rrlax.e cI4JIa ero
coKpauleHr4s.
Puc. 87. tr4suepeuue MumparbH
Oqenrca coKparrrMocrrl
(
JIX
o
no EPSS:
8 vrvr - HopMaJrbHafl. coKparl4Mocrr
JIX
-
3HarIeHI4e
cenmarbuoil cenapaquu ( E P S S ).
8-12 vrv
- yMepeHHoe cHr,rxeHr4e coKparkrMocru JIX
>I2 wtvt - 3Haqr'rreJrbHoe cHI4)KeHr.Ie coKparzN,rocrz JIX
!
florcasarem EPSS peKoMeHAyerct LI3Meprrb BcerAa B HarraJre r4ccneAoB aHvrs,
qroobr r4Merb npeAcraBneHr,re o coKparr4Mocrr4 JIX z ero
sopvre.
Tax, ecru EPSS < 8 vrvr, ro Mbr o)KLrAaeM HopM€urbHyro
Qparqzrc nrr6p oca u
neerrfi x(enyAoqeK zMeer HeLI3MeHeHHyro Sopry (yceuenHoro gJrJrkrrrca). Ecnz npz
raKl4x 3HaqeHLTtx EPSS I43MepeHHax
Sparqza err6poca cocraBnqer MeHe e 55Vo,
ro
Bcefo oHa HeKoppeKTHo r43MepeHa vr Heo6xo4zuo npoBecrlr
ee
Bepo-f,THee
IToBTOpHOe kr3MepeHlre.
B czryaqlrr4, KorAa rpafine 3arpyAHeHa
coKparr4Mocrb, r4cnonb3yror rzMeHso EpSS.
<<r43-3a
3arpyAHr4relruofi
Bvr3yankrcarJnvr
coKparr4Mocrr4 JIx{ tponoAr4nacb no EpSS
Br43y
anu3arlvfl u neo6xorkrMo oueHkrrb
B sarrroqeHr4e
pacqer @B
- HopManbHas
neo6xo4zMo yKa3arb
HeBo3Mo)KeH. OrIeHra
coKparr4Mo crb
JIX>.
Oqenrca coKparrlMocrr{ JreBoro r(eryAorrKa rro rroKa3areJrro ero r.no6a.nrnofi
4
eQopvra q uu (r.no6a.rr r n u
fi rpoA oJr b Hurfi strain
JreBoro )r(eJryAorrKa).
Oqenra 4e0opvra\uv Lr cKopocrkr 4eQopvrarllrkr MrloKapAa BrrepBhre 6uno
HaxoAr4T sce 6omruee npr4MeHeHrre B KJrr4Hr4qecrofi rrpaKTr4Ke.
Ha cero4nxurrzfi
AeHb orIeHKa rno6anrnoro
)KenyAoqKa Aaer BDKHyIO unQopvrallzrc
npoAonbHoro strain neBoro
o uo6amnofi <cor<parr4reJrbHofi crane>>
JreBofo x{enyAoqKa.
Oqenxa rno6alrnoro rpoAonbHolo strain rpe6yer clequanu3rrpoBaHHoro
rporpaMMHoro o6ecne'reHl4rl, rlooroMy AaHHafl
QyHrqzx npzcyrcrByer Ha Bcex
ynbrp a3ByKoBbrx upra6 op ax.
Hopvra GLSLV 3aBrrcrrr or AuarHocrrrrrecKofi cr.rcrepr rr :
. GE >I8Vo
. Siemens >73Vo
o Philips >I4Vo
o Mylab >l3Vo
t04
f
o
Toshiba>157o
V ocralrHblx npou3BoAzTenefi ynrrpa:ByKoBbrx npz6opon Mo)Ker nprrcyrcrBoBarb
Qynrqzx Strain/Strain Rate, Ho oHa He HopMLrpyercr!
tca u
rlpLr
b,
ro
ee
ILITb
raTb
HKA
Oq eurca zno1anuuo zo npodonuuozo
Strain n eeozoieny6 sqKq ( GLS yy
1.
OIIEHITAATIACTOTI,ITIECKOIZ(DYHKIIIIIdJIFjBOIOXEJIYNOqKA.
luacrotuqecKat Synrcqna (A@) - croco6Hocrb
)KenyAoqKoB HarroJrH flTbcfl
KpoBbrc.
)ro
te>>
B
noprrae Sopua rpaHcML'TpanbHoro A'racrorr,rrecKoro noroKa npeAcraBJrrer
co6ofi ABa [IaKa E u A; rtepnrrfi krs Hrrx coorBercrByer 6rrcrporry
.III4aCTOJII{qeCKOMy HarlonHeHr{ro
lfo
EX
.III4aCTOJrr4 qe c
KoMy HarroJrHeH prro
uru
lzacrolraqecKa-s Qyurqzr
MexaHr.rqecKkrx ceofi
crs
Mr4
JreBofo xenyAoqKa,
cr4
croJre
JIxt
oKapAa.
Jr
eBo f
3aBr4cvr'r
nropoft
MeAneHHOMy
o np eAc epAr4s.
or
paccna6n eHkrfl MLroKapAa u
Xnacro.nuqecKoe HarroJrHeHue JDff
II
I
Qasa
[ercovrnpecclrq, BcacbrBaHrre
Qara
<<rlpe4 cepA Haq
rr
oAKaq Ka>>
\
I
Puc. S9.CocmanHbte Qasut duacmonut renozo crcenydourca.
feuo4Iananrzqecr<ofi xapaKTepucrzxofi Ar,racronr{.recrofi QyHrqraz {BJrrercs
pacT_rrxr4Mo cTb Mr4oKapAa.
llsMeHeHr.rq MrrrpaJrbHoro KpoBoroKa rrpu HapyrreHnn
\,/
f:
flcen4ouopManu3auur
3
HOPMA
:
106
aue4rena
peJraKc
arlr4t
Ap
'{nr
oqenKlr Arracroru.re crofi Synrqn n neo6xo4zrvro
:
ncrronb3oBarb rKaHesoft Aonlnepoecrzfi pe)Kr4M
3HaTb ypoBeHb AaBJreHr4fl HalorHeHz_f,
3Harb o6reu neBoro npeAcepAr4t
.
3Harb BpeMrr 3aMeAneHH{ TpaHcMr4Tp€rnbHofo KpoBoroKa
flpu ucnoJIb3oBaHLII4 TKaHeBoro
ABLr>KeH:afl narep€LrrbHoro
Ao[[nepoBcKoro pex(vMa oupeAerqrcr Em
Konbrla Mr4Tp€rnbHoro KJrarraHa
(pzc. 25). Ecttu Em
MeHbrxe 10 crra/c - ALracronrrqecKaf, 4racQynrcqur.
florasarenr E/Em orp DKaer
o
r
o
E/Em S8 - nopnr€urbHoe AaBJreHue HarorHeHlrs
E/Em 9-I2
E/Em >12
IIp"
noJr?r(eH
B
-
yMepeHHoe rroBbrrrreHr4e AaBJrelr'ufl HarroJrHeHr4t
pe3Koe IroBhrrrreHlre AaBneHr4r HarroJrHeHlrt
AuacroJrn.recnofi 4ucQynrcqu[ r{HAercc o6reMa JreBoro rrpeAcepAlrq
6urr
He MeHee
34 rvilrv2
apzanrrr Ar.racronuqe crofi
1.
2.
yp o BeHb AaBneHufl, HarroJrHeHLrr.
4rac
Qynrqzu
:
{uacronrqecKafl 4ucQyHrcqna L crerreHr:
.
E/Em <8
o
EIA< 0.8
o
Tdec >220 MceK
[nacroJrrrrecKar 4ucQyHKrlrq 2 creneHr.r:
E/Em 9-12
E/A 0.8-1,5
Tdec 150-220 MceK
3. .{uacroJrrrqecKaa 4ucQyHKrlrq 3 creueHu:
ElEm>12
EIA>2,0
Tdec <150 MceK
Puc. 90. PW-TDI donnnep. Oqeurca cKopocmu deuJrceuut ramepanbHozo Konbqa Mumpatb-.
KranaHa. Ifepeutil ompuqqmenuuutil nurc - Em.
OUEHKA COKPATT4MO CTU ITPABOIO
XEIytrOrrR
Pac.rer RIMP (Tei).
fitn
pacuera RIMP (Tei) npaBoro x(enyAorrKa Heo6xoAr4Mo 14 crroJrb3oBarb
:
1. PW 4onunep
2. AnzranrHoe
qerbrpexKaMepHoe cer{eHr4e
Jleeoe napacrepHaJrbHoe cerreHr,re no ropomoil ocr'r Ha ypoBHe aopTa-.rbi:ir:
KJIANAHA
Puc. 9l.tr4suepeHue TCO u ET dnn pacqema RIMP (Tei) npaeozo trcenydourca.
r08
Pacqer RIMP (Tei) cocroplr r{3 AByx rlraroB:
I [rar:
o6reu PW
B arrprKaJrbHoM rreTbrpeXKaMepHOM cerIeHuLI KoHTpOJIbnufi
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JIeqeHHr, Mo)Ker pa3Br,ITbct
nuxopaAKa.
nopuaJlbHo orKpbIToM KJrarraHe KpoBb ABrDKerc{ qepe3 Hero or KaMepbr K
KaMepe B BI4Ae opfaHz3oBaHHofo napa6orurrecKoro rloroKa (nal,runapHoe rerreHrze
rcponu). Jlauuuapnrrfi noroK kIMeer cn xHyro cnoLrcryro crpyKTypy, cKopocrb
KpoBoroKa MaKcr4MarrbHafl B ero rleHrpe (puc.94).
Puc.
94 -
Hopuanuuutil opzauusoeauuutil ( nauuu apuutil ) nomorc qep%
Kn
anaH. Maxcuuanau an
cKopocmb KpogomoKa 6 qeHmpe nomoKa.
llp"
cy)KeHI4I4
orBepcrl4t reprercf, opraHr43oBaHHocrb rroroKa, u
oH
craHoBLITc-[ Ae3opfaHl43oBaHurtvr
(ryp6ylenruuM). B pe3ynbrare creHo3a pacrer
AaBneHI'Ie BHyTpI4 KaMepbI
kr
Bo3Hr4KaeT neperpy3Ka AaBneHrreM u
coorBercrnyoqzfi ynbrpa3Byxonofi rrarrepH neperpy3Kz
flp)icd|rrefibH@
Jnc,TanbHat
isRlepa
KtMepr
AaBneHzevr (prac. 95).
Puc. 95. Ilomorc qepes cmeHosupoeauuutti KranaH. B nporccuuanuuoit
6o3HuKaem nammepH nepezpysKu daeneuueu
KaMepe o6pasye
m
cn
3oH
ac
d
e
-
KcLrvtepe
(neped cmeuosou)
KoHqeHmpuqecKat zunepmpofuun. B ducmanuuoit
sopzauusoBaHHbtM ( myp6yn eumuuu ) nomorcou.
B cnyrae HeAocraroqHocrll
Lr rroToK KpoBLr
KJrarraHa
repf,ercr ero
3arrr4pareJrbH€rr
Qy"*tl"r,
c BbrcoKofi cKopocTbro Bo3BparqaeTcfl. B KaMepy, B pe3ynbTaTe qe
pa3BlrBaercr repefpy3Ka AaBJreHLreM
u
coorBercreyroulufi ynbrp€BByK
rrarrepH reperpy3rz o6reuou (pnc. 96).
fl
hmanumc
anbffn
K8
KAm€pe
Puc. 96. Ilomorc vep% Hecocmotmenauutti KrqnaH. B nporccuuanauoil Kcuwepe 6o3HuKqem
nqmmepunepezpy3urdgercuuelrL-
ee dunsmar4un
c desopzautnolquublu (trryp6yneumuatu)
nomorcou.
Krauannuft crenog.
KlanaHnrrfi creno 3 pa3BvrBaercr BcJreAcrBLr e yronrrleHlrr crBopoK, cpa
ero
KoMrrccyp vrrur HapyrrreHueM vrx rroABrDKHocrLr.
Lr3MeHeHLTfl.
3rz
rvropQororr4qec
npvrBoluT K Bo3Hr4KHoBeHUro lperrfrcrBr4r KpoBoroKy. KnaraHH
creHo3 oK€l3brBaeT BIrLrflIJne Ha KpoBoToK B Tpex ypoBrrf,x:
o
.
.
flporcrarvrzrrrbHee creHo3a (uepe4
ruaranou)
Ha yponne creHo3a (n carvrou rnauane)
,{ucranrnee creHo3a (nocle rlauana)
flporccuuaJrbHee creHo3a rrpozcxoAr4T loBbrrrreHkre
rrpoKcrrM€urrnofi KaMepe,
qro
rrpLrBoAzr
K
AaBneHlrrr
rroBbrrrreHlrro [ocrHalp
llocrnarpy3Ka 9To AonoJIHLrreJrbHoe conporlrBJreHkre, lporzB Koroporo cep
Aonx(Ho coKparrlarbcr. Yeeru.reHze nocrHafpy3KkT Ha KaMepy npLrBoAkrr
rurreprpo$uu ee creHKLr. Haupzrvrep, aopr€urrnrrfi creHo3 co3Aaer rroBbrrue
Harpy3Ky Ha JreBbrkr xenyAoqeK, qTo rrprrBoAlrr
K efo
KoHrIeHTp
rurleprpof^ . Ilevr rrxeJree creHo3, TeM Bbrrrre [ocrHarpy3Ka vr Bbrpa)Ke
rrrreprpo$w* llpz
creHo3e AB-xnanaHoB npeAcepAlrr necnoco6
B pe3ynbTaTe qelo
KOMrreHCrrpoBaTb yBenr4rreHr4e nocTHarpy3Krl,
3
aKoH @p anra- CrapnI4 Hra I4 npov cxoAHT [r4nur a\vrx npe4c
Ha yponue creHo3a npor4cxoArzT uporra6 crBopoK
ep,4ur ft
pe€uI,I3yeTct
.
KJIaIraHa Bo BpeMt ero
orKpbITI,It BcneAcrBlre roto, r{To IroBbrrrleHHoe AaBneHI4e B npoKcl4ualruofi KaMepe
npr4BoAr4T
K
<<B3Ayrlrro>>
crBopoK Knanana. VroJrIrIeHLIe, K€IJIIIIrIHo3 LI cpaqeHprfl'
yMeHbrrraror nnoqaAb orBepcrus. VNaeHbrrreHl4e rlnoulaApl
cHn)rceHzro cepAeqHoro
orBepcrllt IpLIBoAIIT
eu6poca. Arq KoMrIeHcaIIuz cHnlKerrr4fl'
K
cepAeqHoro
nrr6poca cKopocrb KpoBoroKa yBenuquBaerct.
,{ncralrnue eQQexrrr creHo3a
craHoBr,rrcx ryp6yJreHTHbrM,
KpoBoToKa
vr
a
Ae3opraHn3ar\vfl, IroroKa.
lloror
AaBJreHrre yMeHbrrraercq. YserlaqeHlae cKopocrl4
Ae3opfaHLI3oBaHHOCTb IIOTOKa MO)KHO BbUIBIITb
C
IIOMOIIIbK)
rlBeroBoro Aonlnepa B BlrAe Mo3auqHoro necrporo rloroKa. K xpacHblM LI cLTHLIM
ero HarrpaBneHlle rrpl4MelxlaBalorcq Apyrl4e IIBera
(xelrufi, cBerJro-rotyiofi u 3eJreHbrfi). lleu rqxteree creHo3, TeM BbIpDI(eHee
froroKaM, oro6paxaroqnM
ryp6yneurHocrb rroroKa. VuenrureHlre [oroKa ALIcr€uIbHee creHo3a npLIBoAIIT K
cHr4)r(eHLIIo AaBreHr,rs. Veerr.rqeHHoe AaBJIeHrre [poKcrlMaJrbHee creHo3a *r
yMeHbrrreHHoe AaBJreH[e AncTaJrbHee cTeHo3a co3AaeT IpaAIIeHT AaBJIeHIIfl
(PG) B MoMeHT orKpblToro KJrarIaHa.
flp" orcyrcrBI4u
rerreHI4-f, creHo3 KJrarIaHa oKa3blBaer Blrvrflrllde
cepAerrHococyALTcryK) cl4creMy. Hanpuvrep
MnrpanrHufi
HapyrxeHr4e oTToKa
AaBneHHfl
B
Ha
Bcro
:
creHo3
ro [efoqHbrM BeHaM -> nefoqHafl fI4IIepTeH3VIfl. -> yBell4r{eHl'Ie
npaBbIX oTAenax
pacrrxeHurq KoJrbrla TK -> Ardnara\ufl cl4creMbl eepxnefi LI HI,IxtHefi nonofi seH.
[utararyus BIIB
rrpuBoAr.rr K Bo3HtrKHoBeHkrro xapaKrepHoro nepraQepuqecKoro
rrpr43HaKa Mr4Tp€rnbHoFo creHo3a B BLrAe
leqeHr4 rrpl4BoArrT K BO3HI{KHOBeHUTO
AaBJreHr{r B BeHax Hr{mH
na6yxurux urefinrrx BeH. futwaguLr
aCIJI1rTA,
x KoHeqHocrefi
Bo npenrr axoKapAlrorpa$vuecKoro
-
a
BeH
IIOBbIIIIeHI'Ie fI4ApOCTaTLTqeCKOfO
K kIX uepHQepuqecKl4M oreKaM.
r4ccneAoBa:nufl. neo6xo4Ial{o o6.ssareJlbHo
[onyquTb feMoAl4HaMr4rrecKr4e rrapaMeTpbl, oTHoctluuec,fl K OTeHOTI4TIeCKOH 3OHe:
.
o
o
e
o
Marczrvra-ubHafl.cKopocrb KpoBoroKa
Cpe4nxx cKopocrb KpoBoroKa
MarccuuzurrHrrfi rpaAr4eHT AaBnoavrfl
CpeAnufi rpa4ueHr AaBneHur
llnorqaAb orBepcrufl
KJrarraHa
llnoIqa4r orBepcrl4r{ paccqurhlBaercr c rroMorr{bro AorrrJrepoBcKkrx MeroAoB.
Bce pacuerhl 3€uIo)KeHbI B ynbrp€l3ByKoBoM npz6ope, u 3a1a-ua vccneAoB aterrfl
3aKJlloqaerc-f, B rIpaBLInbHoM Lr3Mepenvrv coorBercrByrcrqux rroK€Bareteitu BBoAa
vx B npz6op. Ilocne BBoAa uoxasarerefi
npz6op [potr3BeAer neo6xo4zurre
pacqeTbr.
Cyqecrnyer
HecKoJIbKo cuoco6os
Anr orleHKrr
KJrarraHoB B AonnnepoBcKoM
pexr4Me:
o flo apevreHLr nonycna1a rpaALreHra AaBneHnx (pHT)
. llo yparHeHLrro HerpepbrBHoro rroroKa (yHlI)
e MeroA oIIeHKz rlpoKclTMzursofi r43ocKopocrnofi noBepxHocrz (PISA)
rnrrfi rpaA rreHT Aa BJreHrrn (PGmax).
Marczualrnrrfi lpaAr{eHr 1aBnoaufl r,r3Mep[rb rrprMo rrpv rroMorqt4
gxoKapAlrorpa$uu HeBo3Mo)KHo, oAHaKo ecrb trerKat 3aBUTCLTMOCTb Me)KAy
Marccn
pra.n
cKopocrbro KpoBoroKa
vr PGmax. Ory
3aBkrclrMocrb
orrlrcbrBaeT npocToe
ypaBHeHlre BepHyruz:
Pgmax =4x(V)2, rae
V
[ttx
-
uaxclrM€rlbHa.{ cKopocrb KpoBoroKa Ha KJrarraHe.
LI3MepeHLIt MaKcr4M€urrHoft cKopocrr4 KpoBoroKa
B cnyqae
creHo3a
KJIarIaHa neo6xo4zMo LIcrIoJIb3oBarb rrocrorHHoBoJrHoBofi 4onnnep (CW).
Vnrrpaseyrconofi upz6op aBroMarlrqecKlr oro6paxaer pgmax npll
tr3MepeHur{ MaKcLr Malrnoft cKopo crkr KpoBoroKa.
YcratrosreHo, qro Haprrtyquryro Koppenf,quro c Karerepusaqnefi cepArla Aaer
LI3MepeHLIe cpeAHero rpaALIeHTa AaBneHzx (Pgmean), r.r<. MaKcrrMarrbHafl cKopocrb
-
3To MrHoBeHHoe MaKcLIM€uIbHoe AaBneHkre.
[lt
Lr3MepeHlrr cpeAHero rpaAueHTa
AaBreHkI.s neo6xo4zlrao rpaccl'TpoBarb Becb rroroK.
118
llpu
rpaccupoBKe rroroKa
rrpr46op BbrqrrcJrf,er cpeAHrorc cKopocrb KpoBoroKa (Vmean).
ypaBHeHue Eepnynnn
cpe,quufi
us cpe4ueft
IpaALT eHT AaBneHLITI
Llcuonrsyt npocroe
cKopocrl,I KpoBoroKa MoxHo orlpeAenurb
:
Pgmean = 4 x(Vmean)Z, r1e
Vmean
-
cpeAHtt cKopocrb KpoBoroKa Ha KJIarIaHe.
Vpanneurle HenpepblBHoro rloroKa.
B ocnose
[prrHrluua HerrpepbrBHocrrr IroroKa JIex[T TeopeMa coxpaHeHlIt
Maccbr. Couacno gToMy [pkTHrlrruy Ha
14
rr
ortxeHLTLI ecefi
rpy6rz [poreKaer oALIH
Tor xe o6reu KpoBkr BHe 3aBrrct4Mocrll or ALIaMerpa ee [onepeqHoro cerleHlIf,.
O6revr KpoBoroKa paccqvrrbrBaercr KaK Irpo?I3BeAeHI4e
TIJIoITIaAI,I rlorrepeqHoro
cerreHur cocyAa Ha cpeAHroro cKdpocrb KpoBoroKa B sToM
HaqaJre
rpy6rz u s rro6oM ee fracrKe o6reu
xe yqacrKe,
KpoBLI, uporeKarculefi
rIpI4qeM
s
B
eAI4HLIqy
BpeMeHr4 oAuHaKoB:
A1 x
Vl = !r2 xY2 (puc.26)
v1
t
I
I
I
"1
Puc. gT.Vpaeueuue HenpepunHocmu nomorca (VHII).
Sl
xvl
52 = Sl
Ha ocHoBe reopeMbl
= 52 xv2
xvI /v2
ueupepupHocrll IroroKa ucrronmyt coorBeTcrByloqee
)ipaBHeHLIe, MO)I(HO paCCqLTTaTb:
o
Benprqr,rHy yAapHofo
o6reua KpoBLI (rar
npol,I3BeAeHkle
[noqaAII
cKopocTll
oTroKa u3 JreBoro xeJryAorlKa Ha LlHTefp€uI nunefinofi
IIyTII
- vTI
s
rIyrLI orroKa)
o
.
AB-orBepcrl{q
llnoulaAb MLrTp€UrbHofo KJIaIIaHa IIpI{ CyxeHLILI JIeBOro
flnoulaAr aopT€urbHofo oTBepaTVf.IIpu aopT€ulbHoM cTeHo3e
rITo paccquTaHHble no YHII IIJI9IIIaAI4
HeO6xO.UIIM9 II9MHIIT6 o ToM,
r
KJIaIIaHHbIx
OTBepcTLIt' KoTopiLs
ornepcrufi [peAcTaBJuroT co6ofi eQseruunnyro IIJIOUIaAb
eS0errunuofi
oT IICTI4HHOfi aHaTOMLIT{ecrofi, rrpl4qeM cOoTHoIIIeHue
oTJrr4qaeTc{
<roeQSuqIIeHT KOHTpaKIIVTVI>> t
flnorllaAlr K aHaToMLrqecKofi o6ogHaqaeTct KaK
o6paaovt' paccql4TaHHa.l uo YHII
Bcer.IIa cocTaBlseT 3HaIIeHIIe MeHbluee 1' Taruu
BeJlv]q141annoqaAuoTBepcT|4sBceIAaMeHbIIIe'IIeMI4cTI4HHafl'aHaToMLIqecKaI
lnOUIaAb. Tatr,
62
to
[pI{ MLITpUIJI5H9M CTeHO3e 9TO COoTHOIxeHLIe
MOXeT cOCTaBISTb OT
87Vo.
(PISA)
IlporccnrvraJrbHafl rl3ocKopocrHaq rloBepxHocrr
MacCbI B 3aKpbITOfi CuCreue' 3m
AsIsetCs.cJIeACTBI4eM 3aKoHa o coXpaHeHuLI
qepe3 Mecra cyxeHl4ft' B o6rqeM BLIAe IIpf,
o.trr4H u3 MeToAoB oIIeHKu IIoToKa
IIoBepxHocrII (PISA) y11pouleHllo
orIeHKe IIpoKcI4MzuIbHofi I43ocKopocrHofi
K Mecry cyxeHlls n Qopue
rrplrHuMaeTcf,, uTo KpoBb ABI4xeTct rro HarIpaBneHLIIo
KOHrIeHTprrqecKLrx
lonycoep paBHofi cKopocTll. corlacno
HerrpepbrBHocTt4 IIpou3BeAeHIIe IIoBepXHocTlI
IIpI4HIILTIIy
[onycQeprr Ha cKopocTb B
sToE
oco6eHHo BaxteH IIpu OIIeHKe
nonycoepe paBHo rrJrorrlaAu orBepcrlls. MeroA PISA
@r
apvrHa KJIalaHaX. TaK, ecJILI LI3BecTeH pa1vryc IIoJIycQepbI
(v1) - pI4C' 98', m
cKopocrb ABuxeHLls qacrr4q Ha IIOBepxHocrLI llonycoepbl
TfxCecTLr peryprl,IT
MOXHO paccquTarb:
1. MovrenrHblfi rloroK peryprlrrallr4l4 (Q)
Q- Znx Rf x V1
2.
O6'sev PerYPrlIr arJvru (Vreg)
Vreg = 2n x R2 x VTI, r4e
vTI -
T{epe3 cyxeHHoe oTBepcTue B
LrHTerpan JIuHefiHofi CKOpOCTI4
CW-.qouuepe (V2)
\
\,' j
om6epcmuen4 dnn pacuemot no
Puc.98. Modenu nonycfuepw, o6pa3yw4eilcn neped cyiceHHbtM
PISA
3
.
3SQer<rIlBHyro nnoilIaAb orBepcrlrq peryprll r ar\vwt
(3lIO)
SIIO=Q/Vmax,rqe
v max -
M
aKc LrM aIrbHafl. c Kop o c Tb p
e
f yp f LI T aIJVII4,
p ac cqvlT
aHHAfl B
CW Aonlnepe qepe3 rloroK peryprllralJvru'
9.
SXOKAPru4OIPAOI/FIECKA-fl AL{A[ HOCTI4KA MIITPAJIbHbIX
rroPoKoB CEPTIA
MI4TPAJTbHbIfr CTEHO3.
Srno"noruq MnrpaJrbHoro creHo3a:
PesNdarlasNt
,{erenepau{BHblfi (ranrqranoa)
Kortrtarenosrr
BPox4ennuft
OnYxolu
flaranaroMllq MI{TpaJrbHoro creHo3a :
flopaxeul4e roJIbKo KoMl4ccyp - 307o
flopaxerule roJIbKo crBopoK - I5Va
flopaxeul4e rorrbKo xoPA
o
-
I0%
Kou6uHI4poBaHHoe ropa)KeHl4e
- 45Vo
IlaroQusrroJrorrlfl MurpaJrbHoro creHo3a:
.
o
o
Cyxenue orBepcrlrt
Ycroper*rerpaHcMl4Tp€LnbHoro KpoBoroKa
floerrrueHr4e rpaHcMprrp€rJrbHoro rpaALIeHTa flosrrrueHue AaBneHpIq B JIeBoM
np eAcepA?II4, JIeroqHbIX BeHaX U
o
KaITLIJTJT
flpA){
floerrrrreHr,re AaBneHLrr B JleroqHofi, aprepuu
OrIeH rca
vropQop.torrl[
M
rrrpaJl bHoro KJrarIa Ha :
Oqenra cocro{HLrr crBopoK MLTTp€trrbHoro
cTpyKTyp rrpoBoAlrTcr
KJIarIaHa
B rrpoAoJrbHoM napacTepH€ulbHoM
vr
rIoAKnalaHHbD(
ceqeHvl4 vr
JIeBoM
napacrepH€urbHoM cerreHr{n no Koporrcofi ocu Ha ypoBHe MrlTpzurbHoro KJrarIaHa.
flarrepnoM rroBbllrlennofi exoreHHocrll npu
sxoKapAkI orpaQuuecKoM
I{CCJIeAOBAHVIV _f,BIteTC{ 3XO|eHHOCTb KOJIbIIa MLTTp€UIbHOIO KJIAIIa}JA
r4lM
Qra6posHrrfi uepzrap4. B Hoprue 3xoreHHocrb crBopoK MLTTpiuIbHoro KJIarIaHa
HecKoJIbKO BbIIIIe MLIOKapAa, HO MeHbIIIe, rIeM MLITp€rnbHOfO Konbllakrnr4
Qu6posnoro repuKap4a.
llpu
rr,rurp€rlrbHoM creHo3e Bo3Hr{Kaer rIoBbIIrIeHLIe gxoreHHocrLI crBopoK
MkrrpanbHoro KJrarraHa Ao rpKocrLr Qu6posHoro rlepl4Kapl.a. Tarxe MoxtHo
na6mo4arr
npLr3HaKLr K€urbrllrHo3a B ocHoBanvrr4
crBopoK.
Kalrqzfi o6laAaer
BbrcoKLrM aKycTLlqecKLrM COrrpoTprBJreHIreM, yJIbTpa3ByK He IIpOHI4KaeT qepe3
K€urbrllrHlrpoBaHHbre crpyKTypbr, B pe3ynbrare orMeqaerct xapaKrepHuft npu3HaK B
BLrAe apreQarcra <<aKycrplrlecKat reHb>>.
Kpovre orIeHKLr rr,ropQonoruLr Mlrrp€ulbHoro KJIarIaHa, npoBoAl4Tcfl. aHalrkr3
ABkrx(eHrrfi
ero crBopoK. llpu uurp€rrrbHoM creHo3e orMeqaerc{
cuequ$urrecKoro rrpu3HaKa
- <rapyceHlre>>
tIotBJIeHLIe
uepe4neft crBopKLI MulrpaJlbHoro
KrrarlaHa (puc. 100).
OrIeH na crerreH n creHo3a JreBoro arprloBeHTprl KyJrqpH oro
1. lllanuuerpzrrecKoe
u3MepeHrre rrJroqaALI JIeBoro AB-oreepcrvfl.
pexflrMe He Lrcnonb3yerc{ vr33a
uurpalrHuft
r22
orBepcrrlfl
ero
B B-
[pocrpaHcreeHHofi oco6ennocrur:
KJrarraH LrMeer BopoHKoo6pasnyro Qopnry
z
onpeAenllTb
B
nolepeqHoM ceqeHvIvI, Ha KaKoM ypoBHe rlporrren cpe3 rlo KopoTKoft ocl4,
HeBo3Mo)KHo.
,I[oso6Ho qacro Ha6nloAaerct
r4crr,rHHofi rnoulaAlr.
3aBbIIrreHI,Ie
B nacrosqee AorrycKaercq
krlrv 3aHLDI{€HI'I9
rlJlaHuMerpkTqecrcufi pacqer
nnoqaAr4 JreBoro AB-oraep erkrfl rrpr4 ycnoBI4I4 I4crIoJIb3oBaHLI-f, npl4llerlrsofi
3D exorap4uorpa$zu.
Puc. 99. Jleeoe napacmepHatrbHoe ceqeHue
no opomrcoil
ocu Ha yposHe MumpatlbHozo tLtanoHa.
Vmonu4euue, no7btuteHHoe oxozeHHocmu u ozpaHuqeHue pacKpbtmuf Mump&\bHo?o KIanaHa'
Puc.
100.
Ifpodonuuoe napacmepHal,rbHoe ceqeHue. <Ilapyceuue> nepedueil cmeoprcu MK.
2. Ocnoea orIeHKr4 rrxecrr4 creHo3a
-
AorlrrnepoBcKa{ sxoKapALIorya$ut
Onpege.rreHne cpeAHero rpaAI{eHTa AaBJreHlrfl.
,{nx oqenKr4 TDKecru
[oKa3areJrb
,{nx
Mr4Tp€LJrbHoro creHo3a HeoSxoAL{Mo Ll3Mep.flrr
- cpeAHufi, rpayueHT
saxHrrfi
AaBneHLI{.
nsvrepeHvrfl, gToro rroKa3areJrr r4crroJlb3ylor rocrosHHoBoJrHoBofi
(CW,4ouunep).
4onulep
llonyueunrrfi noroK
vr3onvrllvru
<<BI4cI4r B
Har{aJII4,
Ha cneKrpolpaMMe oKoHrypr4Baror no npaBr4Jry <<or
Lr3olrvrHnefi saroH.rvtlrv>>, Aaxe ecJII4 cneKTpotpaMMa
Bo3Ayxen (pzc. 101).
llpz
Qz6pr4nnilJkru rrpeAcepAuirpaccuurbrBaror
cpeAHee apuQuerraqecKoe 3HaqeHI4e groro noKa3are
Puc.
lnx
l0l.
rq e 4-6
KoMrrJreKcax.
Pacqem cpeduezo epadueuma daeneuun mpaHcMump(LtbHozo nomoKa.
pac.rera PHT vcronb3yerc-fl pe)Kr4M rrocro.rrHHoBoJrHoBoro (CW)
Aorlrnepa.
Iyr
CW lonnnepa Aonx{eH pacceKarb rpaHcMkrrpanbHbrfi noror<, npu
3TOM OfpaHI,IrrI4TeJIbHas MeTKa AOnX(Ha HaXOAr4TbCr nOA MI4Tp€UrbHbrM KJraIraHOM, B
rronocTr4 JreBofo [peAcepAlrq.
Ha annapare aKTLIBLIpyercr pacrrer PHT (o6rruno HaxoArrrcr B
pacr{eroB MLITp€rnbHoro KJrarlaua).
llepnrrfi
MeHK)
r<alranep ycraHaBJrr4Baercq Ha BepruIlHe
TpaHcMI4Tp€uIbHOfO IIOTOKa, r'r OnyCKarOT KacarenbHylo Ao TaK Ha3brBaeMofo
<<o6prrno>
(pzc. 102). Ha
er<pane ynbrpa3ByKoBoro
arrapara
rro,rrBr,rrcr 3Har{eHr4e
PHT.
Puc. 102. Pqcqem PHT no
r24
mp aH cMump aIbH oMy
nomoky.
I4cnomsyx npocryro Qoptryrry,
Mo)KHo paccql,ITarb rlJro IrIaAb JIeBoro AB - ornep
crvrfll
MVA =220|PHT
IlpenvryuecrBa MeroAa:
llpocrora pacr{era
HelocrarKr{ MeroAa:
.
MeroA pacqera rrnoqaAra JreBoro AB-oreeparkrfl uo PHT pa6oraer roJIbKo rIpI4
cy)KeHZI4 ero rInoqaALI MeHe e
o Hlrsras
I
cvt2.
Bocnpolr3BoAplMocrb
MeroAa
AoTIoJIHI{Telrnrrfi
ruK
Ha
c[eKTporpaMMe [oroKa irepe3 urarpamnufi KJraIraH co3Aaer rpyAHocrll
B
KoppeKrHoM pacqere PHT
Ecnpr Ml4rpanbHrrfi creno3 corlpoBoxAaercs $u6punn srJuefi npeAcepAuit'
-
Heo6xoAltMo z3MepurrPHT s4-6 KoM[IIeKcaX vI BbIcqI4TaTb cpeAHee
apraQrraeruqecKoe.
Pacqer rJrorrlaArr JreBoro AB-oreepcruq
rroroKa
ypaBHeHuro HerlpepblBHoro
(YHII)
Pac.{er nnorlaAlr uo
Maccbr.
[o
ftx
YHII ocHoBaH na $uerauecKoM
pacvera rrnoulalvr AB-orBepcrl,I-f, no
3aKoHe coxpaHeHllq
VHII ueo6xo4zMo BblnoJluurs
3
IIIAFA:
Ha 1 ruare
B rrpoAoJrbHoM rrapacrepH€urbHoM ceqeHLII,I
Ar4aMerp rryrra orroKa JreBoro )KenyAorrKa
(LAX) LI3Meptror
or nepe4neft crBopKLI MIaTpaJIbHoro
KnarraHa Ao Me)ruKeryAotlKonofi neperopoAKl4 (prac. 103).
Puc. 103. tr4suepeuue duauempa nymu ommoKa
u3
ne*ozo crcenydourca. Ceqeuue I'AX, peJrcull
yqenuqeHufl Ha ypogHe KOpHfl aopmbt.
Ha 2 [rare r4crronb3yror ]rMnynbcHoBoJlHoeofi Aorlnnep, KoHTponbnrtfi o6rena
YCTaHaBJTVBA9TCfl B nyTLI OTTOKa JIeBOTO )KenyAoqKa B aIILIKUIIbHOM
qerbrpexKaMepHoM cer{eHr4r4
(4c).llocre
3HaqeHHe I4Hrefp€Lna rrutteirarofi
oKoHrypI4BaHvrA crleKrpa noryrraeM
cropocrz (VTI)
-
przc.
104.
Puc. 104. trIsuepeuue uHme?pqla nuueiluoil cKopocmu 6 nymu ommoKa leaozo crcenydourca.
Ha 3 [rare r4crron*yror nocroqHHoBorHosofi Aon[nep. 3ror
nonf{eHrrro cneKrpa
p.nfl r,r3MepeHr4q
PHT.
llpz
zcnoJIb3oBaHI4Iz
[Iar I4AeHTuqeH
VHII
Anq pacrrera
nnoqaAr4 JreBoro AB-ornepcrBr4fl rd3Mep rcr I4Hrerparr' llulueiruofi cr<opocrlr (VTI)
rpaHcMr4rparrbHoro rroroKa (pzc. 105).
lanee no Qopuyne paccqurblBaror nnoqaAb reeoroAB-ornepcrur:
NIVA = (0,785 x Dno2 x VTIuo) / VTIurc, r4e
IVTVA- nnoqaAb JreBoro AB-ornepcrvfl, Dno
)KenyAoqKa,
VTIno z VTIvm
orroKa JreBofo xenyAorrKa
t26
vr
-
ArlaMerp nyrl4 orroKa
- r,rHrelpiurrr runefinofi
143
neBoro
cr<opocrl4 KpoBoroKa B nyrll
TpaHcMzTp€ulbHoro rroroKa cooTBeTcTBeHHo.
Puc. 105. tr4suepeuue uHme?pqra nuueiluoil cKopocmu i4umparxbHozo NtanaHa e CW
donnaepe.
IlpeuvryqecrBa MeroAa:
o Brrcoxas creneHb rorrHocrr4 B cpaBHeHr4r4 c PHT
He4ocrarKrr MeroAa:
o fponroeAKocrb pacr{era
o Heo6xoAl,rMo MaKcr,rM€rlbHo
roqHo
r43Mepr4Tb Ar4aMerp
[yrr4 orroxa JIX,
An-{ groro I43MepeHr4,rr nyqure ilpoBoAr4Tb B pexfl,rMe yBenr4qeHvrs. (ZOOM).
Pacqer rrJrorrlaAu JreBoro AB-oreepcrrq ro
rpoKcrrMa.nrofi
rr3ocKopocrHofi noBepxHocru (PISA)
MeroA PISA ocHoBaH raKx(e ua Su:zuecKoM 3aKoHe coxpaHeHnflMaeebr.
Heo6xo4IaMo orMerl,rrb, qro pacrrer no PISA He 3arrox{eH B oxoKap4raorpaQrr
cpeAHefo KJracca, noSToMy IIaJruI{ue pacqeTa STofo noKa3aTelrfl flBIIfleTcfl
I4HAIlKaropoM ypoBHq ynbrpa3eyrconofi ALrarHocrz.recrofi cr4creMbr.
llpu
nrzrpilllbHoM creHo3e Bo3HzKaer SeuonreH rrpoKcr4M€urbHoro ycKopeHr,rt
rloroKa qepe3 cy)KeHHoe AB-ornep crvre, uro Sopir,rupyer coorBercrByroqyrc
ynbrpa3ByKoByro KaprlrHy B rIBeroBoM Aorrnnepe (pzc. 106).
Puc.]06.PISAua]wumpa]IbHoMKIanaHeuu3^4epeHueeepaouyca.
BbIIIOJIHI4Tb
AB-oTBepcTLtfl IIO PISA Heo6xoAI4MO
,II,nr pacuera rrJIOIqaAI4
mara:
HalulaleonpeAenfioTpa[VycPISA-paccTo'H[eAol{3ocKopocrrrofr
Irv]Fivrpr (puc'
KoTOp€u cooTBeTcTByeT 6elo-xelToiLvnunteJlTo-Iony6ofi
fpaHurlbr,
106).
rpanuqe' flpu
orrpeAenf,Ior CKopocrb B Ll3ocKopocfirofi
(ecln
aBToMaTI4qecKI{ oro6pasraT ee 3HaqeHI4e
r43MepeHu upap1yca PISA anlapaT
uarcer pacqeroB annapara)'
pacqer PISA 3rurolr{eH B KapAuoJlolrqecKufi
Ha|rrafe
Ha3IIIaleBIIocTo'HHoBoJIHoBoMAoIInJIepe[onyqaloTcIIeKTpofpaMMy
cKopocTb
:npaecrn:aTblBaloT MaKcI4MaJIbHyIo
KpoBoToKa qepe3 MuTpaJIbHufi rnauan
KpoBoroKa (Prac. 101).
PacqerUIouIaAlIJIeBofoAB-oreepcTvIg.[poll3BoAv1T)fl,uosoprvryne:
MVA= (6,28r12'VH) / Vmax'
t
rAe
fpaHuue
cKopocrb Hafirsucra (cropocrb Bll3ocKopocrnofi
-pawryc PISA, Vn KpoBoToKa
uorora), vmax - MaKcuM€uIbHaq cKopocTb TpaHcMIITptuIbHofo
ouEHKA CTEIIEHI4 TflXECTn MI4TPAJIbHOIO CTEHO3A
I
r,6-2,0
1,1-1,5
PGmean, MM PT.cr.
MT4TPAJIbHAfl TTEAOCTATOITHOCTb
Sruolorlrfl Ml{Tpalrnofi neAocraroqHocrrr
'flpolanc
.PeeNdarugNl
.I4EC
.
Irln0erquonnrrfi sHAoKaPArIr
t KapAuotvtvarrurvrLr
.
KalrquHo3 MllTpuulbHoro
KoJIbIIa
.KonnareHo3bl
.
Bolegnz coeArmtlTelrnoft
TKaHI4
'TpaeNIH
'Ouyxonn
t BpoxAeHHbIe aHoM€tllllr4
MopQoQyHKrlrroHaJrbHbre
. (Du6pos, KuuIbIILIHos,
. Ornocurenuras
[u
c
[pIIqI|Hbl MlrTpaJlbnofi neAocTaToqHocTlr
4e
QopMaIIns KJIarIaHa
MH
Qynr \vrfl' rranvrnn.rp HIIX Mbrrul
PacrqxeHue KonbIIa
.
[o6 anovnrre o6pa:
oBankrfl Ha KJrarraHe
. flpora6zpoBaHue crBopoK
oB
onraro fi\aflcfl. crBopKa
Pasprrnrr crBopoK
Pasprrnrr xopA
Pasprrnu lanr4nnrpHbrx Mbrrrrq
IlaroQnuloJrorufl xpoHnqecrcofi MrrrpaJrbHofi neAocrarorrHocrrr
oBosnpar KpoBLr s JIII
oHarpysxa o6reuorra. {aereHl4e
.
ft
urertrHar
eQ QeKTr4 BH€ur
o,{erouueHcaqz{
B
B
JIX u JIII
Hoprr,r€rrrbHoe,
MOcruxen
KoMneHcarlzrr
peynbrare
cHLDK
eHufl coKparLrMocrlr
IlaroQusrroJrorrrfl ocrpofi MrrrpaJrbHofi neAocrarorrHocrrl
.Bnegauuufi aosnpar
oflosrrmeHue
. Jlero.rHar
rLr
AaBJIeHLTA
flo
orIeHKy.
n
JIII
JIII z JIX rprr coxpaneHuvr
HopM€urbHrrx o6reuon
nepreH3r4t
BrrpaxenHocrb
KoJrLrqecrBeHHbrMLr
KpoBLr s
MLTTp€IJIbHofi
uerolauz
peryprv rarJvru Mo)KHo orleHlrrb roJrbKo
!
qneroBoMy Aorunepy Mo)I(Ho npoBecrn Jrlrrrrb opLreHTr4poBoqHyro
Puc. 107. Mumpanuuaa uedocmamottHocmb 6 Lllemosow donnnepolcKoJvr
pntclnvte.
<
If ecmputil
nomorc > pe?ypzumoquu
c
eud emen bcmsyem
o mncrcenoti
cmeneHu gupailc eHHocmu.
Puc. 108. Mumpanunan ruedocmamoqHocmb 6 qsemonou donnneposcKoM peucuMe.
?rccqeumpuuuutit nomorc u e QQ
flp u
rrxenofi
MI4Tp €LnbHofi
ercm
Koaudut.
peryp rr4T arJtru n oqrlr BcerAa
SKcIIeHTpI{tIHbIfi IIoroK B IIBeroBoM AonnnepoBcKoM pexflrMe
-
p err4
crp r4pyerct
npu oroM crpyt
pefypfl,ITar\LTLr, KaK npaBI4JIO, HalpaBJreHa BAonb creHKr4 JreBofo ilpelcep!.vrfl
AaeT xapaKTepHylo <<neTJIro>> c LIHBepcuefi
kr
qnera y [poTt4BonoJro)KHofi crenr<rz.
Sror eQQerr
H€BbrBaercr <<eSQeKToM KoaH4rr>>
Lr
cBr4AerenbcrByer B noJlb3y
r.sxerofi Mr4rp€rnbHofi HeAocrarorlHocrz (pzc. 108).
Pacqer o6reua peryprrrrarlrr no ypaBnennrb nenpeprrnHoro rloroKa
lpt
(yHII)
pacuera o6reua rvrzrpanrnofi peryprnTar\Lrvr Heo6xoAzMo BbllroJrlnur:o 4
-
rrrara. Ce.reHze Anfl LT3Mepenuft
I nar -
u3MepeHLre AlraMerpa
2 llrar
kr3MepeHlre LrHrerpana
-
)KeJryAorrK
rryrll orroKa JreBoro x(eflyAoqKa
rznefiHofi cKopocrkl (VTI) B rlyrl4 orroKa
a npn rIoMouII4 PW Aounnepa
rrrar
3
(uex4y
BepxyuerlHoe IrtrLIKaMepHoe.
<<TorrKaMz>>
4
rrrar
uzrpalrnrrfi
u3MepeHLIe ArlaMerpa KonbIIa MkITpanbHoro
KperlneHut crBopoK MllTp€rnrnoro rlauana)
-
kr3MepeHue LrHTerp€rna
KJrarraH npkr rroMorqv
rnnefiHofi cropocrLT rloroKa rI
PW Aounnepa (ronrponrnufi
o6reru
HaA CTBOpKaMLI MTITpUIJIbHO|O KnalaHa).
Pacqer o6reua peryprulTarrvtr npoBoAlrrc-tr ro Qopvryne:
V
rAe
Dur -
-
(0,785 x Dvrrc2 x VT[vrrc)-(0,7q5 x Dno2
AnaMerp Konbrla MLrrp€rJrbHoro KJrarana, VTIuK
cKopocrr4 qepe3 MrrrpaJrbHufi rcranau, Dno
LrHTelp
Cyrr
ulJr
MeroAa pacrrera
KpoBLt,
qepe3"
roropuft lorrril
Lr3
uHTerpal lznefinofi
MLIrpamnufi
o6reua MkrrpaJrbHofi perypr
resrrfi
-
ArraMerp rIyrLI orroKa
lznefi nofi cKopocrlr KpoBoroKa
o6rervr KpoBLr, rcoroprrfi ror€rlr s
o6reu
-
x VTIuo),
rarJuvr
JIX, VTIno
KJrarraH.
- MbI BbIqLIcr-f,eM
)KeJryAoqer (renaa qacrb Soprvrynu) u
JreBoro )KeJryAoqKa B aopry. Pasnzqa
grrlx
o6reuoe u6yger cocraBJr-f,rr o6reu MLrrpaJrbHofi peryprvrrarlvrvr (<<rarofi o6rena
KpoBLI HeAorryrqrn
6olrruofi rpyr
rcp
onoo6paqenrar)
.
Pac.rer SfIO u o6revra peryprrrraqrn no PISA
llpu
rrazrpartrnofi peryprLrrarJurv raKxe KaK
Bo3HuKaer eQQeru rpoKcrrM€urbHoro ycKopeHLrrr
Lr npr,r MLITp€uIbHoM
crpyz
-
creHo3e
PISA, roJIbKo B cnf{ae
-
JIeBO|O X{eJIyAOqKa
\{r4TparrbHofi neAocTaToirHocrra <<rpra6oK>> HaIIpaBJIeH B CTOpOHy
(upra MlrTpanbHoM cTeHo3e
flpn
-
B
HaIIpaBJIeH
IIoJIocTb JIeBoro npe4cepAux)'
racuoIIb3oBaHI4I{ MeroAa PISA B oIIeHKe r{x{ecTLI
uurpalrnofi
He
[[oIUaAI4 orBep cTVfl
AocraToqHo cTI4 np o I43B9A vITc fl. p acqeT eQ S errunHofi
p
f yp f lrr a\Lrr4
e
(
SIIO)
I4 06 b eM a p e ryp rLI r ar\vr4.
1
ruar. Irlsuepenvre pa[vryca PISA
2
tsnr.Zsr'repeHr4e cKopocrra
npr4 H3MepeHIrLI
Hafirsvcra (anrolraruqecKl'I oro6pasur npra6op
Pa vYaaPISA)
peryprvlTal\Vu
3 ruar. I4:vrepenue MaKcllvalrnofi cKopocr?I MIlTp€LnbHofi
B
rrocrof,HHoBoJlHoBorvr (CW) Aorlrnepe
4 uar.-
I4suepeHlre r4Hrerpiila lunefinofi cKopocrl4 Ml,IrpaJrbHofr peryprvrarlvrr4
P
acqer
e
S$
e
rrunuofi nl ouIaAI4 orBep crvrfl' (3lIO)
SIIO
o 6r
e
-
rvr M LrTp aJrb Ho
eS
Q
(6,28 x
fi
p
e
p e ryprl4 r
a\w:
R2 x VH) /Vmax
ryp u4T arlvrvr p ac cqLIrbI
eruunnofi uloulaAll orBep
B
ae T c
q
I43
crvrfl':.
MRV=?IIOxVTlvtr
Vena Contracta
MrrpaJnnoft peryprrrrallru
Vena contracta (VC)
-
3ro caMoe y3Koe Mecro IIoroKa peryplLIral\vIvI
B
srofo yqacrKa'
rIBeroBoM Aorrrnepe (puc. 16). Ilpou3BoAktrct II3MepeHI4e IIII4pHHbI
Puc. 109. I'lsuepeuue vena contracta
OIIEHKA
Tfl111E CTL1
MI4TPAJI6HOfr PEII/P1IITAIIIII4
I
1.
9xoKAprurorpAozrm,cKA.g AT4ATHOCTT4KA AOprAnbHhD(
rroPoKoB CEP4IA
AOPTAJIbIfiTIT CTEHO3
Srno.norrq AC
.
I44LTorrarkrqecrcuit K€urbuLrHo3
{nyuonylyuHufi
aopr€LJrbHufi rclanaH
PesN4arusNa
IfaroQusrorornq AC
VueHrureHkre nnorlaArr orBep crLrt
flo err rue HLr e c r4 cro Jr
14
q e c Koro naB rreHr4s.
e
JIX
Yserr.r.renr4e rpaHcaoprurJrbHoro lpaArreHTa
Veerz.reHr{e cKopocrr4 rfpoBoroKa
lleperpy:ra JIX
AaBneHr4 eM
Coxpanenve HopMzrnbHbrx yO, MO, KAA
,{erouueHcar\vrfl rrpr4cHLrxeHkrucoKparlrMocrLr
Bapzanrrr
r34
rvropQo.nornn
AK
Normal
Rheumatic
Calcific
Bicuspid
A.tr" olleHKrr rqrrcecrlr aopraJrbHoro creHo3a
rrcrroJrb3yercq
AorrrrJrepoecK[ fi pe?KrrM.
Cpe4nnfi rpaAreHT AaBJreHrrfl
Z:uepenv e cpeAHero lp aALI eHTa AaBJreHvq rrpoBoArr
(Cw) Aorfrnepe rryreM oKolrrypzBaHufl rroroKa nepe3
u3o ITLIHVILI AO rrcOnLT
B rrocro.rrHHoBoJrHoBoM
aoprasrcruuitKJrarraH <<or
IJLIVD> .
Zarvrepenze cpeAHero IpaAueHTa AaBrroaufl He rrpoBo Anrcfl,, ecJrLr cKopocrb Ha
aopr€urbHoM KJIaIraHe He npeBbrrxaer 200 crvr/c
- B eroM cJr)4rae orcyrcrByer
aopr€rnbHrrfi crenos. Ecrlr MaKcLIM€urbHas. cKopocrb KpoBoroKa Ha aopr€urbHoM
KJranaHe rlpeBbllrraer 200 crr,r/c neo6xoAkrMo
s o6ssareJrbHoM
rrop.f,AKe Lr3Meprrrb
cpe4uzft lpaALreHr AaBneHVr.
Pac'rer rrJroIrIaArI aopraJrbHoro orBepcrrrfl rro ypaBHeHrrro HerrpepbrBHoro
troroKa
(YHII)
I ruar. Zsuepenve LrHTerp€ura JrlrHeft:aoir cKopocrlr
(VTI) KpoBoroKa
qepe3
aopr€urbHufi ruauaH s CW Aorrnnepe.
2 nar.ZsnaepenLre ALraMerpa rryrLr orroKa
3 ruar. Zsvrepenue prHTerpara
r.rs
JreBoro x{elyAoqKa.
IrLrHefiHofi cKopocrtr KpoBoroKa
orroKa JreBoro xeJryAonKa B pW
Aorrlnepe
(VTI) B rryrr4
(rconrpolrrrrfi
o6reu
ycTaHaBnuBaeTcfl B rryTE oTTOKa).
Pacqer rrJroulaAr4 aopr€rJrbHoro orBep
arLrfl.:
AVA= (0,785 x Dno2 x VTIuo) / VTIarc,
Dno
rle
- AI{aMerp nyrll orroKa, VTIno - uHTerpan nranefinoft cKopocrr4 K oBoroKa B nyrr4 orroK4
VTIarc - IrHTerpan nzsefinoft cKopocrr4 KpoBoroKa Ha aoprurnbHoM KJrarraHe.
OrIeHrca crerreHu rfl?Kecrlr ao
bHofo cTeHo3a
YrvrepenHufi
PGmean, MM pr.cr.
llnorqa4r AK,
cnr
AOPTAJIbHA-fl HE,IIO
C
TATOTIHO
C
Tb
Sruo.noruq aopralunofi HeAocrarorrHocrrr
flaronorzr
KJrarraHa
- Llguotarn.recxufi
KaJrbrILrHo3 Ha o6brqHoM Lrnu
AByXCTBOpqaTOM KJrarraHe
- PesNrarzgNr
- LluQerqnonnrrft gHAoKapAr.rr
- llponauc
AK
llarolorrzr aoprbr
- Arepocrnepos
- BoresHz coeAr{HLrrenrsofi
TKaHLT
- Bocuaru4TeJrbHhre ga6olenaHn lt aoprbr
IraroQusrroJrorrrfl aopraJrbHofi He4ocrarorrHocrrr
o
Bo:npar KpoBrl s JDK
Veertl,rqeHue nu6poca B aopry
Harpy:ra o6reltolt
o
[utaragus,
r{
I4
AaBneHIleM
rllrleprpo$zx JIX
llpz Hopl,ralrnofi coKparl{Mocrn - KIA
HopM€ulbHoe.
,{e rcouueHc aIILr-fl p €L3BuBaercs no3AHo, rrpu c HLIXeHTILI
c
oKp arI4 vrocrra
!
[uarHocTuKa aopralrHofi HeAocTaToqHocTlr ocyqecTBIqeTcq
rr o
Mo rrlb
Io Ao rI rlJreposcKofi sxoKapArrorpaQuu.
AopranrHrrfi rlanaH
H
- eAlrHcrseHHrrfr
KIIarraH cepAIIa, Ha KoropoM BHopMe
e AOn)KHa pef ucTpl4p oBarbct pe fyp f I{T alJvrfl .
Iloror
aopranbHofi peryprvrar\vru Bbrrr-flAl,Ir B BLIAe I4HBepcLIu IIBera
rIBeroBoM AonnnepoBcKoM pexr,rMe (r<pacHrrfi
uoror), nu6o <uecrprrfi
3Har{r4TeJrurofi Bbrpaxe Hocrlr aopr€LrrbHofi ne4ocrarorlHocru (puc.
1
B
rloroK>> IIpr4
10).
Puc. I10. Ilomorc aopmarbHoil pezypzumat4uu 6 qsemosoM Oonruxepe.
Bpetrn rroJrycrraAa rpaAr{eHTa AaBJreHnq rloroKa aopraJrbHofi peryprnTaunl|
(PHT)
I4svrep e ura e
PHT aopr€urbH ofi p erypr
gxoKapAlrorpaQuueclcufi oroKoJr
Lrr arrypr
Lr
BXoAI4r B MllHrlMalrnrrfi
cny)KHT ocHoeofi Korl4qecrseHHofi oIIeHKI4
T{)Kecrr4 aopranbHofi ueAocraroqHocrl4.
[nr
zenre peHLTs.
PHT aopr€urbHofi peryprvrrar\Lrrr Lrcnonrcyrcr CW Aorrrnep.
Ylrrpasnyrosofi ny^r AoJrxeH rrpoxo4rTb qepe3 rroroK aopr€rnbHofi peryprvrrar\vvr
(pzc. 20,21).
Pac.rer rrJrorrlaAr orBepcrrrfl peryprrrrarl
rr
MeroAoM PISA
1. ruar. I4snrepenvepa4Lryca PISA
2. ruar. Onpe4ereHlre cKopocrr4 Hafirezcra
3. ruar. I4svreperu4e MaKclruamnofi cKopocrlr aopr€rnbHofi peryprvrrarJuu s CW
AOrrnnepe
3fIOaH
-
SIIOan - (6128 , 12 t Vn) / Vmax, r4e
eSQerrvrBnas, rnoqaAb orBepcrLTr peryprLTTarJvrvr, r -pa1uyc PISA, Vn
- cKopocrr Hafirnzcta,
Vmax
-
MaKclrM€rrrbHarcKopocrb aopranrHofi
pefypfzrar\uu
Ecnu u3Mepumo VTI aopmerbHoil pezypzumequu, Mo)tcHo paccvumqmao6ueu
aopmcmbHoil p eeypzumaquu :
VaH = SIIOan x VTfaH, r4e
- o6teu aopr€urbHofi perypr vrrarJvru, SlIOaH - Q Q err vrBlaafl rrnoulaAb
orBepcrl{t aopr€lJlbttofi peryprvrar\w, VTIan - LrHTerpurJr rytrefinofi cKopocrr4
Van
o
aopr€ur b Ho fi p e ryp r ur arJurkr
Oqenrca crerreH rr
aopraJrbHofi peryprrrra
rl u
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rlapanrerp
.IIerrcaq
YruepenHan
Tqr(eraq
PHT. MceK
>500
200-500
<200
3lIO.
<0.1
0.1-0.29
>0.3
<30
30-59
>60
cvrz
Vau, nar
12.
rqlrecr[
SXOrpAOr4qECKA_g ATIATHOCTT,TKA Tpr4KyCrIr4AAnbHbrx
froPoKoB CEPATIA
TPnKy Crrr4AAJlbrrbrr,r
c
TErro 3
Sruolorrlfl TprrKycrlrlAaJrbHoro creHola :
.Penuarugu
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.
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SxorpaQ[rlecKrle [prl3HaKrt rprtKycrllrAaJr bHoro creHo3a
:
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. Orpanz.{eHlre rIoABkDKHocrLT crBopoK
.,{zacrorn.recKufi uporu6
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[.nr
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neo6xoAllMo H3Meprrrb cpe4nufi rpaArreHT AaBJreHrIfl Ha rprlKyc[rlAaJrbHoM
KIIAIIAHE.
3na.ruMrrfi cpe4Hrafi rpa4uenr AaBJreHLrr cocraBJlser 6oree 7 ulr pr.cr.
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o
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flBIrflercfl. cJreAcrBZeM npox4ennofi rraroJlorrlkt
co
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KJIAIIAHA.
o
llpzo6pereHHar HeAocrarorrHocrb rpllKycurlA€ulbHoro KJIarIaHa.
PeeNaarz.re cKoe rropaxeHne crBopoK KJIarIaHa.
ZuQerquonssrfi eHAoKapAkIr.
Tporvr6oeM6oru-fl rero.rHofi apreplrra.
flponauc rpkrKycluAzulbHoro KJIauaHa.
a
K ap qnn o
o
Tpanvra cepArla.
ugrtstir
c
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oPerporpaAnrrfi KpoBoroK s HzxHefi uorofi
14
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oflnoulaAr qnerHofi crpyr4 > ll3 nroulaAra lIfI
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-
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PACTIE T AABJIE HKIfl, B JIET OIIHOI4
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ac.rer
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fi, apr epuu
14
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30
rvrnr
pr.cr.
Ecnpr conocraBlrrb ero
c cucreMHbrM cr{crorLIqecKnM
AaBneHI4eM, To
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cKr.rx MeroAoB p acqera AaBneHUA
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-
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MM
pacuupena 6olee 25 vru
LI He
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Oqenna crerleH[ leroqnofi rlrrlepreH3rlrl
III
crenens
IV crenenr
(ynrepennan)
(nupaxennan)
(rrxce.uan)
s0-70
70-110
>1L0
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II creuenr
(neura.rur.)
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1
3.
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iAl -l-
:
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- lnyxgzcKoBbre (St.-Jude)
-
-
Poccuficxrafi analor 3MI4KC
Poccuficrcnir aHulrror
MEru4HK
oEuonporesrr
- fovrorpaQr
-
fereporpa$r
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Starr-Edwards.
3ru uporesH 6rrrz paspa6oraHbr
croJrerla.a (pzc. 111).
B nacro-sqee
HKJrarype Ha3brBarorcs
B 60-x
ro4ax rpourrloro
BpeMrr LrMrrJraHTarIrLrr AaHHbrx npore3oB
He frp olr3 Bo Akrr c s. u3ra BbrcoKoro rrucra ocJroxHeH
uit u lpaALr eHToB
AaBneHkr4 Koropbre co3Aaer 4annrrft BLrA rrpore3oB.
Puc. I I
l.
IUapoeute npom%bl muna Starr-Edwards
OAnoAucKoBbre (Bjork-Shitey) rpore3br
OAnoAucKoBbIe rlpore3bl HarraJrvr rrMrrJraHTr4poBarb c KoHrIa
60-x ro4on
npournoro croJlerllfluLrcrlorb3oB€rlrvcb BrrJrorb Ao cepeAlrHHbrx 90-x ro4on.
laHnue npore3bl cocrotJlll z3 Konbrla, K KoropoMy KpeluJrr{cb
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ABr4xeHr4e eAlrHcrBennrrfi ALTcK (prac.
B upeAenax
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Koropbrx
coBepru€1;1
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rrpr4 vrx [pzMeHeHlru
raKxe Bo3HlrKiuro MHoro ocnoxnenzfi.
B nacrosulee BpeMt oAHoAkrcKoBbre npore36r
141
La-
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He LrMrrJraHTrrpyrcTcr,
v
Puc. I12. Oduoducrconde tLtanaHHbte npom%u munq Bjork-Shiley. Pasnuquute KoHcmpyKmunHue
uoduQurcaquu o du o d uc Koswx npome
3o
6.
{nyxgncKoBbre rrpore3br (St.Jude Medical)
Mex4ynap oAHafl a6lpeyuarypa repeBoA rcr
,{annufi
BI4A
(<CB.f,roro Zy4u>>.
rlporeson (puc. 113) uMrrJraHrrzpyercr
ro
ceroAH sltttuir AeHb
Bo MHorI4x MeAI4III4HcKzx IIeHTpax no BceMy Mr4py.B Hacro-flrrlee BpeMs BhrrrynleHo
MHOX{e CTBO rvro4z Q
urca\uit AaHHoro KJraraHHof o
pacnpocrpaHeHHar MoAenb eroro rpore3a
rrp ore3
a. B poc c ulr
- MEAI4IiX.
Puc. I I3. ,[elncducrcosbte l{J'tanaHHbte npom%bt muna St.Jude Medical. Pasnuuuarc
KoH
cmpyKmueuut
e
uo d uQurcaquu
d
eyxduc
rco e wx
npom%
o
s.
,{annrrfi TLII npore3oB co3Aaer HauMeHbrrree conporr{BJreHr4e KpoBoroKy
cpeALr Bcex r4cKyccrBeHHbrx KnarraHoB (n cpaeHeHr4kr c uapoBbrMr.r u
oAHOAT4C KOBbrMr,r
upore:a nau).
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oB pasHrte no3I4IIuLI AonxHbr I4MnJraHTr{poBarbc{ ToJrbKo oALrHaKoBbre
r43
|
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rrpore3oB
.Jfto6ofi npore3 co3Aaer 6omruee
conporr4BJleHl4e KpoBoroKy, rreM
ecrecrBeHnrrfi rnanan (nro6ofi racryccreeHHrrfi
KJIaTIaH
- oro creHo3, Ho nyqrue
lrMerb He3HarlnTenrnrrfi creHo3, co3AaBaeMrrfi zcryccrBeHHbrM KnarIaHoM, qeM
co6creeHnrrfi rsxenrrfi rlauannrrfi creHo3 krrrtrrflxe.Ilyrc HeAocraroqHocrr).
.llppr
r4MrrJraHTarluu LrcKyccrBeHHbrx KJrarIaHoB Ilenb
-
ycraHoBl{Tb npore3
MaKcr4M€urbHoro p€BMepa, oco6enso y Aerefi
oBuonpore:rr orrr4qarorcq
orpaHlrqeHHbrM cpoKoM
MeHbrrrr4M corlporl{BJleHueM KpoBoroKy, Ho
cnyx6u (ne 6onee 10 ner)
oHa ucrcyccrBeHHoM KJranaHe AonycKaercfl peryprl,lTa\us. I
TaK Ha3bIBaeMa-S
KoHcrpyKquefi
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Korop€ul
efo
cHLDKeIlIdfl. pLICKa rpOMOO3a KJIaIIaHa.
Ocroxcenuq ncKyccrBeHHblx KJrarIaHoB
1.
llapanpore3Has. Qncryna
<<npope3brBaercq>>
npu
cocTotHlre.
qacrb rrrBoB - QopnrupyrcTct [apaKnanaHHble rIoroKI4 KpoBI4 B
rIBeroBoM Aorrnnepe.
Tarrura [pu napanpore3Hblx $ucrynax
-
oIIeHKa ALIHaMI4KI4
nonocrefi. Ecnpr B Ar4HaMLrKe Her yBenuqeHus. o6'setvta IloJlocrefi
Q
zcryna
p acrleHkr
KoropoM
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rar
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-
napanpore3Haf,
.
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cocroqHr4e,
Koropoe rpof,Bnqerct coorBercrnyoulefi ruznur<ofr ocrpol
cepAeuuofi
2.
HeAOCTaTOqHOCTI'I
U nppIBOAI4T K pe3KOMy IrOBbIrrreHLrrO rpaAVreHToB AaBreHr4q Ha
r4cKyccrBeHHoM KnarlaHe.
3.
Tarrura
-
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Zn$ercquonnrrfi 3HAoKapAI,IT I4cKyccrBeHHoro KJIaraHa. 3ro raK)I{e
ypreHTHoe cocTo.f,HkIe c
BcJreAcrBr4r4
KJILIHLIKOLI
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ocrpo14
kr
cep4e.trofi
nuxopa,4rcofi.
HeAocrarorrHocrla
llpoxuxercr pe3KrIM
noBbrrrreHHeM fpaALIeHToB AaBneHus Ha I,ICKycCTBeHHOM KJIarIaHe.
4.
KJIAIAHA.
llaHuvc. 3ro r-flxeJloe ocJroxHeHLIe, Bbr3BaHHoe <<3aKJTI4HLIBaHI'IeM>>
Taxzu o6pasou, nro6oe
3Harrr4TeJrbHoe rroBbrrrreHne fpaALreHToB AaBne1vr;-
yKa3brBaer Ha ero 4ucQynrcquro.
O6uleupzHtrblx HopMarLIBoB rlo {paALreHTaM AaBJrelvfl. Ha ncKyccrBeHHbrx
KJIarIaHax
BLTAOB
Her
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rrpoTe3oB KJrarraHoB.
3a
uHI.krBn[yzulbrryrc HopMy nplrHlrMaercr rpaArreHT
LIcKyccrBeHHoM KJIarIaHe, Lr3MepeHennrrfi
LlccneAoBaHvrlr
cpa3y IrocJIe
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rtpu
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cpaBHI4BaIOTCt BCe [OCneAyIOrrIkre LT3MepeHLrr rpaALreHToB AaBJreHVrs. B
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o6H'IHo B BbIIrvcHoM grluKpl{3e
y
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c
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lpaAkreHTa AaBJreHufl.
-c
neit u Heo6xorzuo
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EclH Bo3HI4KJIa ckrryar\vrfl, KorAa HeBo3Mo)KHo rroJr) rLrrb
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Taonuuen:
MurpanrHa.f, rro3lrqurr
Tzu nporeea
Marcuualrnrrfi
Aopranrnafl.no3urlvrfl
Marcuuanrnrrfi
rpaALr eHT
AaBJIeHLIT, MM pT.CT.
AABJT9HI1Ifl, MM pT.CT.
Starr-Edwards
14,6
38,6
Bojork-Shiley
10,7
23,8
St.Jude Medical
10,0
26,5
L3.9XOKAPIr4OI PAOTIqE
C
KA.fl AT4AIH
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c
r4MeHeM
I4nre 34nepa
rlHxeHepa rocnl,Iranr Kapra Xenruyra fepua (urne4cr<rafi ropo4 Jlynae)
roAY
u
s
u
1953
ypoBeHb rexHl{qecKl,rx Bo3MoxHocreft Toro BpeMeHr4 noApa3yMeBturo
[opoKoB cepArla. Hurro v3
I4ccneAoBarerefi Toro BpeMeHr{ He rrpeArronar€ur, rrro gxoKapALrorpa$zuecra.a
npr4MeHeHze MeroAa
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Ar4arHocrr4Kr,r
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Mepe coBeprrreHcrBoBaHl{rl ynbrpa3Byrconofi annaparypbr r{ coBeprxeHcrBoBaHueM
MeToALIKI4 l4ccneAoBantrfl MeroA gxoKapAr4orpaQzrz craHoBrrJrcr
qyBcTBLrTeJrbH
e
Bce roqHee
vr
e B BbrrBJIe HULr rIrUeMr4 r{ MZOKapAa.
IIpu ItBC [aroreHerurrecKz
3Harrr4Mbr Jrr4rrrb
rponoo6parleHprfl, Koropble nplzBoArr
K
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n 1935 roAy R. Tennant z C. Wiggers
gKcrIepI4MeHT€urbHo orMeqzurr4 rrorBneHr4e
Hapynenzfi noranurofi coKparzMocrr4
creHoK JreBoro x{enyAor{Ka npu lepex(arvkr KopoHapnofr aprepzz.
Cuzxesze KopoHapHoro KpoBoroKa conpoBoxrAaercr Hapy[reHrzeM
pa3nLIqHbIX 3BeHbeB SynrqnoHtrpoBaHvrfl cepArla cBf,3aHHbrx c norpe6neHr4eM
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qro
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pacrraAaercf, Ao aAeHo3LrHa, Koropbrit, cruwtytrkrpyfl
a-peqerropbr aQQepenrHbrx HepBHbrx oxonqanzfi B
BbI3bIBaer aHrI,IHo3Hyro
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or
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z BeAyr r< ru6enr,r
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BeprllrHy afic6epra, B ocHoBaHvrvr Koroporo Jre)Kar
Bo3HLIKIIrr4e kr3.ea
cnnxennofi
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OAHaro uo4o6nar rocneAoBareJrbHocrr Synrql4oHa[bHo-nropQonortr{ecKllx
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o cHo
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nopax{eHlle OcHoBHbIX
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Harrvqr4e creHo3a ocHoBHbIX aprepuit rre MeHee 50
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6ortrurprncree cnyqaeB JroK€LrrbHoe Hapy[reHLIe coKparLIMocrLI creHoK
cepArla (acr.rneprur) nosnuxaer rrocne HapyueHvrfl uepQysuz MI,IoKapAa, Ho Ao
rrorBJreHLrr
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Aenpeccr4q cerMeHra ST. Taruvr o6pasovr, HapyureHlle JloK€ulruofi coKparl4Mocrz
MuoKapAa rBJrrercfl oAHr4M us Hau6onee paHHlrx [pLI3HaKoB IlIrreMI{u MLToKapAa.
Ocruoea oxoxapduozpaQuuecxoil duazruocmuxu
n o KsJtbHo
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fr co xp amuM
o
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yrroMlrHanocb paHee, B HopMe 3HAoKapA B MoMeHT coBeprxaer
paBHoMepHoe ABTDKeHLTe KHyTpLr, B CTOpOHy IIOJIOCTI4 JIeBO|O XeJIyAOqKa.
Brr4elrror Hapy[reHr4{ noranrnofi coKparLIMocrl{ paslzunofi
Bbrpa)KeHHocrr4 (prac. lI4):
funoxuttes
-
crerleHkI
clrcroruqecKoe yronrrleHr4e Mr4oKapAa MeHee 30Vo. Auulzry4a
ABLDKeHU.f, Mr4 OKapAa CHDKeHa.
Axuues
-
cLrcroJrr4qecKoe yronrrleHkre He 6onee
I}Vo. Atuunury4a
ABpDKeHr4s.
MLIHKIM€UIbHA'..
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v
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fb
t
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Puc. I14. Tunut uapyuteuutt norcanuuoti coKpcrmuMocmu uuorcapda.
Cne4yer orMerl4Tb, sro npl4 orIeHKe
JroKEUrbHofi coKparkrMocrLr MLroKapAa Mbr
Mo)KeM Ha6nlo.4arb
2
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npn
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flpu
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<<rro\TflraBarbcfl>> UHTaKTH6TMA COCeAHUMA QetMeHTaMLI,
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B
AB][IIKeH]zfl, OTBJreKafl
HarraHarorrlero exoKapAaorpaQacra co3raBafl
aJlJrro3aro co6creenaoro rBn)KeHufl.
Heo6xornwo o'paaqarr BHaMaHne aMeHHo Ha
cLrcroruqecKoe yronare*,ne
wuorcap4a!
KOPOHAPIIOE KPOBOOEPAIUEHTIE
Koponapnoe rponoo6parrleHkre
ro
rpaBy H€l3brBaroT <<TpeTbLIM KpyfoM
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BpeM-[ CZCTOJIbI XenyAoqKoB CepArIa
Aaxe B rroKoe y qenoBeKa
KopoHapHhle aprepun nor
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pr. cr. Zrvrenno orr{
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15. Cxeua KopoHopHozo Kpo*ocHa6crceuun.
Kpacuutu qnemow o1osuaveua npanqfl
KopoHapHan qpmeput.
Oco6enHocrLI
cTpoeHuf, cepArla
pr efo KopoHapHolo
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HaLIMeHOBAHLTS, CTeHOK
JreBoro xenyAoqKa.
B 2006 roAy EnponeficK€ul
accoqua\LrA KapAlroBacKynspHbrx z:o6paxeszfi
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flo erofi
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npoAoJrbHoM cpe3e Mox(Ho pa3AenLrrr na 3 ycnoBHbrx ypoBHr:
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Cne4yer oco6o orMerLIrb, tlro c 2006 roAa Bce oxoKap4raorpaSzqecKlre o6rqecrsa
Bcefo Mvrpa orK€t3ELIIVcb or repMI4Ha <<HLIxHrq creHKa>>, roroprrfi ttpoqHo
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Ha pnc. 116 npe4craBJleHa cxeMa AeneHr{r
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lo
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KoJrr4rlecreeHHoft orIeHKe JIeBoro xenyAotrKa.
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A.B.
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or erofi MoAenr4 Bbr3brB€uro
orKJIoHeHVe ocLr cepAIIa
c
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= V4>>, To r4Meronlee Mecro
orlpeAeneHl4lo JroK€LJII43arIprr4 ranQapr<ra Mr4oKapAa.
cr€urKl4Barbc-[
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to
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lop0)KeHl4fi vtHorapAa rlpu IIIF,C orAaH Blr3y€ur'r3r4pyroqr{M MeroAzKau
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cepAIIa He y4aercfl, 3To co3AaBano rpyAHocrkr rrpv zcrroJrb3oBaqwr I7-tu
cerMeHTHofi
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all models
1, basal alte.r6!
3
3
4
5
7.
ill€ro$*ptal I
ba6rl
basal rrferor
basal :rferola:ei-al
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basal
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Puc. I17. ,[eneuue JI]I{ ua cezMeHmbt. IlpedcmaeneHue
cezMeHmHa.n Moderb, cnpasa
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l8-mu
13. apcalan,er:or
14 apcal en:Eroseptsl
15. apcal rrleroeepiel
16, apeal i:rferror
17. aplcal inferolateral
antenor
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15. a ieal infenor
mid r.rferoeeptal
10 mid rnfenor
11 rnid irferela:eral
arr rr:rla:'ergl 12
i
B
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kr 18-rr,r cerMeHTHar MoAenb npv MarHr,rrHo-pe3oHaHcHoM
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3xoKapAl4orpaok1kI,
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B
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or
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arrr4K€rrbHbrfi ypoBeHb.
Paccl,rorpl4M JIoKEL[I43aqI4Io creHoK JreBoro xenyAorrKa Ha AaHHofi MoAenLr
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12'aacoe
3 \aca
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15
OrnocureJlbHo raKoro paclpeAelreuns'
He
BO3HrrKaeT TpyAHocrel'r
B
HAI4 MEHOB AHPTV CC IMEHTOB.
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rrepeAHefi
rreperopoAorrHofi creHKaMu (10.racoa quQep6nara). CoorBercrBeHHo,
r4
AaHHbrfi cerMeHT
6y4er
LrMeHoBarbc-fl
KaK <<rlepeAHe-leperopoAoqHblfi Ha
6asanrHoM ypoBHe>>.
VInu, K rrplrMepy, 12 cerMeHr pacrono)KeH Ha cpeALIHHoM ypoBHe (cpe4nrafi
Kpyr) Ha rpaHLrrle Mex{Ay t2
v 3 qacaMI4 (uepe4nefi
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vl
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4
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sa 12,3,6 u 9 'racax.
CooreercrBeHHo, BepxyueqHbre cerMeHTbI 13,14,15,16 I4MeHyrorc-l
KaK
<Bepxyue.rHrrfi uepe4nrafi>>, <<Bepxyrue.rHrrfi [eperopo.4ovnrrfi>>, <<BepxylueqnHfi
nuxnufi>>
I4 <<Bepxyrue.rHrrfi
ilrg-
rroHr4MaHr4r
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rofo, Ha KaKZe
ceqeHu.a cepAIIa lpoequpytorct
cooTBeTcTByroqze cTeHKr,l JIeBoro XenyAoalKa, IIoMoXer pzc. 118.
Two chamber
anterlor
lnferlor
Long axis
Four chamber
Two chambar
Puc. I18. IlpoequpoeaHue cezMeumoe JDI( Ha coomaemcmrynu,rue ceqeHLs cepd4a.
Tar, nepeAHe-neperopoAo'Hble z nzxne6oKoBbre
cerMeHTbr JroqzpyrcTc,
B
npoAoJrbHoM rrapacTepHuurbHoM ceqeHlrr4.
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kr
repe4ne6oKoBhre
cerMeHThr B
ankrKzurbHoM
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cerMeHTbr
AB)D(KaMepHoM ceqeHr4Lr.
He cnyuafrno
u
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KpoBocHa6xenuevr cepArla (pzc. 1 19).
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D
RGA
FCA or CX
I.AD
l".AD sr CX
CX
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Puc' I 19' Ceasu uecrcdy apmeputMu, Kpo,ocHa6crcatou4turtu
cepdqe tt coomeemcm^ynu4uMu
cezMeHmoJvtu Jtesozo crcenydouxa.
o6osua'aeuun: RCA
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nepeduna uucxodnt4aa apmeput, cx ozu6arctl4a2
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-
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cerMeHTbr
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nepe4Hefi nucxo4xulefr
A nor <<rloJlocarble>> cerMeHTbr Moryr KpoBocHa6xarrc.s r43 p€BHbrx
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AotronHLITeJIbHo zMeerc,
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. OB e 3D real-time
. dP/dT
. GLSLV
. EPSS
1
KAPAI4
O
4. KAPAI4 OMI4 OTIA TI4I,I
MI,IOIIA TI/JI - s a6 or e n aHvrn Mr4 oK apA a,
Mbrrxqa crpyKTypHo vr QyHrquoH€rrrbHo z3MeHeHa
B
IIpLr KOTOpbrx cepAerrHat
oTcyTcTBI4e IIaTOJTO|I,II4
KopoHapHhrx aprepuir, aprepzanHrofi rr4rrepreH3Lrr4 u nopax(eHr4rr KJrafraHHofo
aIInapaTa.
KIAC
CI4
OI4KAIII4'[ KAPAI,I O MII OIIA TI4fr
I. [utararlnoHHaq KMrI
o Ll4uortarLrqecKat
o Cevrefina.s
o Bzpycna_a
o I4nanryno4eQzqLrrHafl
o
TorcuqecKar (n r..r. alxorolrHar)
2. lnneprpoQuuecKan KMII
3. Pecrpr{KTrrBHaq KMrr
4. ApnrrvroreHHafl
rrpaBo?KeJryAorr KoBafl KapA rroMnorrarrrfl
I
l
r57
5. Her.naccnQnqnpoBannas KMrI
6. CueqnQnuecrcne KapAtroMnonarrrrr
.
o
o
I4rueur4qecKarr
KnauanHas
KMII
KMII
fuuepreH3kTBH€ur
KMn
7. BocuaJrrreJrbHaq
o
o
o
KMII
Bone:nr 9araca
BZi[-rapArroMkrorrarvrfl.
SnrepoBLrpycHtur, aAeHoBr{py cHafl , rlLtroMeralroBr{pycH€ur
8. Mera6orrqecKue
KMII
.
TzpeororccnqecK€ur
.
llpz rzuorvpeo3e
o llpu ne4ocraroqHocrlr
.
KMII
Kopbr HaAloqeqHuKoB
llpuQeoxpoMorlrlroMe
[na6eruuecK€ur
llpz revoxpoMaro3e
llpz 6on*Hrx
.
.
flpz
HaKonneHLrs
HapyrueHLrr4 rrvrranur (6epz-6epu, KBaprrzoprcop)
flpu aneurul
9. KapAnoMrrorrarrrfl
rrp[ crrcreMHrrx sa6oreBaHrrflx
. CKB
o Vserxosrria nepuaprepnvrr
.PA
Cruepo4epMLr{
,{epnaaroMLT
.
o
o3rrr
Caprcoz4os
Jlefirogrr
10. MuruerrHbre 4ucrpoQnn
.
MbrrueqHuur
gucrpo$utr{roruena
I
rl
I
I
:i
:
il
O
MLIOTOHI4TICCKAf, MbITEIIH€UI AI4CTPOOI4'
11. HepnHo-MbrruerrHbre sa6oreeaH[q
o
uraKcu;r Qpu\pafixa
o
czHApoM Hyan
O
JICHTI,I|KTHO3
12. Atrcprr{rrecKrre rr roKcrrqecKrre
.
aIIKOfOIbHa_f,
O
KATCXOJIAMI4HOBA'
.
.
aHTpaqLIKnLrHOBa{
ryqeBat
13. Iloc"rrepoAoBaq
Ar4nA TArIr4 OHHA_fl KApnr4 oMr4 orrA
AKMII -
Ttrfl
sa6oreBaHvre, xapaKrepll3yroqeecr pacrrr4peHlreM JreBoro
uyu o6oux
xenyAorrKoB cepAIIa pr HapyrreHlreM Lrx coKparLrrelrnofi
Qynxqzz, rrpuY.uHa
Koropblx Bo MHorkIX'cnyqatx He -f,cHa Lrru cB.rr3aHa c ceuefiHo-reHerlrqecKLtMlr Lr
LtMMyHoJIorLIqecKLIMz Sarcropavz, xponzvecrcofi
alrcoronr ofi
BOcIIELIII4TeJIbH6IM IIpOqeCCoM
Apyfr{Mrr Sarroparr,rz (BO3).
Bl{pycHofi upzpoI.br
Lr
[rpr4HqTbrE Kpr4T Epurrl AKMrr
1. vnenzqeHve KapAkroropaKanbHoro LrHAeKca
oB rrl
E
peHTreHoJlorl4qecKoro zc cJre AoBaHprfr Ao
2.
LTHToKcLTKaUnefi.
Benkr
qznrr
no
.rIaHHbrM
6one e 0, 5 0- 0, 5 5
YeeruqeHLre KAP 6olee 27 yMw2
3. CnzxeHze
KoHrpaKrLIJIbHoro pe3epBa
JIX
naeHe
e 40-45Vo
(Manolio)
4. orcyrcrBue ropoHapnofi 6oresuz, ropoKoB cepArla, aprepnanrnofi
neroqHofr rzrrepreH3Lr
TIAT O OI43T4
O
JIO f]I,/.A
u
14
IIPU AI4NATAUII OHH
1. VnrerrrrrreHLIe KorlIqecrBa
O rZ
NNNU
ronHorleHHo
QyHrquoHr4pyroqux
KapAI4oMLr oqLrToB
15t
2.
PacrtupeHr4e KaMep cepAua
3. KouueHcaropHoe noAAep)KaHvre MOK 3a cqer MexaHr43Ma @panxaCrapruur a v yBentrqeHur r{C C
4. floeHueHr{e
-
A.n
prrrlrAHocrr4 Mr{oKapAa
nre;rrH rr fi nepu oA rco nr uen ca u u u
r4 cHraxeHr4e
MOK
5. Czcrorl4qecKa-fl Lr Avracro.[r4rrecKar cepAeqHa.f, HeAocraroqHocrb. Cpe4nrr
Bbr)KprBaeMocrb rrpr,r AeKoMneHcarlkrra
K
JII'THIITTE
C
KI4E
O O PMbI
1. Bocuanr4reJrbHaf, KMII
2
.
VIvwtyH
o Jro
rr4rre
c
- 5 ler
AI4IA TAIII4
O
HH OTT NVTU
(r<aprrana Mr4oKapAnra rrpr4 1uoncuvr)
rar (qzroro Kcr4qecraq T-rzla
So qurapHax)
3. HefiporyMopuurbHaf, (nopenraneSpzn, npe4cep4nufi yarpuiryperuqecrzfi
IIeIITI4A, peHr,rH, eU4OrelUn)
4.
CeMeirHar-
. AKMII c oAHoBpeueHnofi MbrrrreqHofi 4zcrpoSueir
o lOseHlalrbHafl, AKMil c 6ucrponporpeccupyroqt4M
x
a
w
i,
ToJIbKo
reqeHr4eM (crpa4aror
uvxqunrr)
J
o IKMII c cerMeHrapnofi rurroKrlHesraefi JIxt
. {KMII c paHHr4Mr4 nporBJreHnflv^u HapyrxeHutyoz6ylr4Mocrr4 Mr4oKapAa
. AKMII B eorreraHkrkr c paHHefi nefipoceHcopHofi ryroyxocrblo
SXOAr{AIHO
C
TrrKA AT4IATATIT,TOHHOR KMfr
M-PEXI4M (puc.
.
.
.
o
o
o
.
r
I
-
159
120):
CnuxeHr4e coKparr4Mocrr4
MXII u zagyeit creHKLr
[raccznxponnr JIX 6onee 60 vrcer
Veerr4r{eHr4e EPSS (20 nrna = (DB 30Vo)
Mzorapa JIX
Veerr4qeHze
He yronrrleH
I4qP
YeerzqeHrae I,IMMJIX
OTC ve:e'ee 0.42
Puc. 120. M-pecrcuu npu
IKMII.
- zunoKuHes WKII
B-PEII{IIM (pnc. I2I):
Cneea
o
.
.
.
u sadne6orcoeoti cmeurcu JIX{, 3HaqumerbHoe ygenwteuue EPSS.
l[apoBpr4Han Sopua
JIX
VeerzqeHLre LIKAO
CnraxeHr4e coKparrrMocrz
JIX
VserI4qeHLIe cHarlara JreBbrx orAeJroB, 3areM rrpaBoro lpeAcepAlrq
Sunane
- Bcex ronocrefi JI)K
Puc. 12l. B-pecrcuu npu
160
Cpes ua yporHe KoHttuKos cmsopoK MumpaJrbHozo KrranaHa.
IKMII.
Anurcanuuoe LtembrpexKaMepHoe ceqeHue.
kr
Puc. 122. B-pecrctm. Ilonepeuuoe ceueHue
xapaKmepHan dnn
IKMII
Ha
yporHe MumpqrbHozo KtranaHa. Om-ueqaemca
<dopsanusaqut>> MumparbHozo wranaHq
-
cMeu4eHue e?o K sadueil
cmeurce JIII{.
D.PEXI4M:
o
floarrureHr4e
.
CnuxeHr4e dP/dT
.
o
B
o
.
o
CnnA
E/A>2
Em <10
crvr/c
YvrenbrueHLre
ElEm
VvrenbrrreHue DecT <150 MceK
llpzsuaKll JIo)KHoro aopr€rrrbHoro creHo3a (us-sa cHkrx(eHlrq coKparrrMocrr,r
JIX ner rroJrHoro
pacKpbrrr4x
AK)
II4TIEPTPO@I4IIECKAfl KAPAI,IOMI,IOIIATILfl ,
IKMII -
sa6oreeaHvIe, xapaKrepLr3yroqeecr rLrneprpo$zefi creHoK JreBoro uJutrn
rlpaBofo x(enyAotlKon, o6rruHo acl4MMerpzunofi,
14,
KaK rrpaBlrJro, BoBneKarculefi
Mx{fl
wHo, 1995
9acrora BcrperraeMocrz
M:X = l:2
16l
l__
B
rronynr ryuu
2Vo
a
upuuuna 50vo cweprHocrr4
o
Mzr<poc xorll4qecKll
K JIA C CN (D I4KAUI4^fl
-
B MonoAoM Bo3pacre
I
E
IKMII
o
flepeAnufi or4etMIKII
o
3aAnze cefMeHTst2%o
o
3aAHzfi
.
JlarepalrHbre cerMenrrt
.
Auzranrnrrfi cerues.t
orlel
NDI{JI
IKMfI
C
95Vo
g3Vo
9Vo
4Vo
lVo
Cuvrvrerprrrnaq rurepr po$ur
M OAI4HAMUqE
xaorlrqHhre KoporKLr e uzo Sz6pLrJrJrbr
rI4 raHTcKkI e
1. Acuurvrerprrqnaq rrreprpoenr
2.
KA-fl KJIA
S Vo
C CI4
OI4KAUII]f, IKMII
:
c o6crpyKTnBHbrM KoMrroHeHToM
o
noKo_fl (rpaALreHr AaBneHLrs
o
JIATEHTHA' (TPA4IACUT AABNCHLIC S
a
cpeAr4HHo-)KenyAoqKoBar o6crpyxqu.r
IKMII
(ao 33 rer)
s
IIO >30 rvrnr pr.cr.)
IIO >30 VrVr PT.CT. [PI4 TIPOBOKAIII4LI)
6er o6crpyKTrrBHoro KoMrroHeHTa
vcJroBr4q
Infl Bo3Hr4KHOBEHr4.fl OBCTpyKrIwr B rryrrr
OTTOKA
NX
l'
fzueprpo0rax 6a:anrurrx cerMeHros IVDKII
u3rHalIuf
2'
-
npr4BoAar K 3aMenJreHzro
KpoBLr
HapyrueHLIe crpyKTyphl MLITpanbHoro KJralaHa BMecre
c
crpyKTypawtu, 6onee KacaeMhle cocoqKoBhrMLr MbrrlrlaMpr
crBopKaMz
COC
no.qKJrarraHHhrMr4
u
u3MeHeHH6rMLr
MK
TABHbIE IIAC TI4 OE C TPYKTI4BHOIO KOMIIOHEHTA
IIPI4
IKMII
c o6crpyrcquefi
1. sAM-OeHoMeH (czcronzqecKoe cMerrleHze BnepeA ncMK)
2. VlaenrlreHLre uolocru JIxt
3. llpexaeBpeMeHHoe 3aKpblrne AK
Puc. 123. M-pecrcuu. Cpez uepes KoHttuKu cmsopoK MR. SAM-Qeuoueu npu
o6c
mpyrcmu*HbtM
Ko Mno
He
|KMII
c
Hm o 14.
SAM-QeHoMeH
Czcrorz.recKoe cMerrleHLre IICMK (systolic anterior motion). llepe,4rut crBopKa
MK
crraeularcb BrrepeA Bo BpeMq clrcroJlbl co3Aaer nper-f,TcrBze KpoBoroKy
nnaroo6pa3Hoe
KJTI4HI4IIE
C
ABkTx(eHLIe
IICMK
MXII
n M-pexurvre (puc. 123).
KA-g KAP TI4HA
o
Cunro[€LIIbHbIecocrotHl4t
o
O4urura
O
flperap4u€urbHble
o
o
BAonb
3a cqer AllacronI4.Iecrcofi
6o
4zcSynrqzz
nu
HapyureHlls pLITMa
BnegauHaf, cMeprb B MoJIoAoM Bo3pacre
KPT4TEPITLkIIUIOIIATI4IIECKOIOIPOIIECCAIIPI4IKMII
. llpn acprMMerpuqnofi
nu6o vronrueHlae
MX|I
rLrrreprpoQuz
MXII
orHolrleHze MXfA3CJDK >1.8,
6onee 27 vrw
. llpu cuMMerplrqnofi rlrneprpoQuu JIX ToJIIIILIHa MI4oKapAa 6onee 20 vru rrpLT3
HaK
I.IAI1IOTTAWTqeC KOf O
npoqecc a
KPI4TEPVItrIXNPYPTI4ITECKOfr OECTPYKUI4I4TIPI4IKMfI
VserzqeHvre rpa4kreHTa AaBJIeHvrflB nyrll orroKa zs
6o.nee 50 vrrvr
r63
-l
l_
pr.cr.
JIX
-
15.
3AEOJIEBAHA'I fIEPI4KAPNA
1.
IIEPI4KAPNZT
llepurcapArrr
BO
C
I€UIEHI'I E
BI4
-
ero Qz6pI'IHo3Hoe, cepo3Hoe, ruofinoe rrJrr{ reMoppafzqecKoe
CIICP ELIIbHO
rO V
ilAP]'.,E'TUUIbHO f O JII4CTKOB NEPT{ KAPAA.
Irto6as rlaroJlorLIqecKat )KzAKocrb B rronocrr4 rrepr4KapAa
cneAcrBrreM peaKlluvr lrkrarKoB nepkrKapla
r4
flBrrflerefl
orrpeAerrflercfl KaK nepr4KapALtr.
flepurcapA B HopMe
TolrqzHa nepr4KapAa
-
MeHee 4 nrvr
Korz'recrBo xLrAKocrr4
[auenue
B rroJrocrr4
[ep'rKapAa
-
Ao g0 un
B rroJrocrr{ nepr4KapAa:
B Cr.rcTony 1 una pT.cT.
B
Alracrony -3 uvr pr.cr.
K.naccuQ[Karlnq reprrKapAr.rroB
1. LlHQercqnoHHbre
. Bzpycnrre (KorcaKr4, KpacHyxa, Kopb, Baprrrlenna, reprrec, rerrarr4T
'
er
Barcrepu€ulbHble (luenlao-, MeHr4Hfo-, roHoKoKKoBbre, TpenoHeMa,
6oppenzos,
xnaMvr4krfl, ry6epr<yne:
z 4p.)
fpra6ronrre (rcan4z4a, rr4crorrJr€BMa r4 Ap.)
a
).
llapasrarapnrre (exzHoKoKK, ToKcorrn€Bua
ra
r.n.)
lepnrcapA'Tbr rrpfi cncreMHbrx ayror{MMyHHbrx ga6orenaHuqx
. CKB
'PA
"
Anxzlo3lrpyroqr4fi cnou4zlrzr
. CzcreuHrrfi cr<lepo:
. lepuaroMr4o3r4T
. flepzaprepvu't
. CznAponr Pefirepa
. HacneA
r64
r.A.)
c
rBeHH a-s cp eAr43 eMHoMopcKa,
nr4
xop aAKa
3. IlepunapArrrbr rr ?r(HAKocrb B rreprrKapAe rlpn sa6oreeaHrqx oKpy)Kaloqux
opfaHoB
. PaHnufi uocrraHQaprruufi repuKapArar (nepnrre 3 AHq)
a
. 3nracrenoKapAurrlqecrufi replIKapAI'I r
fll
(3
-7 anefi )
. flogAruft nocrranQaprcrnuir reprrKapAllT
-
cl,IHAporr,r
[peccJlepa (no 6
rvrecsqee)
. MuorapAur
. Anespz3Ma aoprbl
.I4H0apru JrerKoro
. flHeslvroHu-s
. BoresHlr nuueBoAa
.
fuAponepuKapA IIpI,I HeAocTaToqHocTIl KpoBoo6paqenza
. IlapaneorrJracrllrlecrufi repuKapAnr
4. IIe purca pAIrTbI
II
pII A llcMera6ol u.recKllx paccrpofi cTBax
'Ypeuus
. Mzrce.[eua
3,
. Eolegul AAuccona
. [ua6 eru.re crzfi KeroaIILlAo3
. Xorecrepoloeuft repLIKapAI,rr
5. BepervreHHocrb
6. TpanvrarrqecKrre [epnKapArITbI
. llponHraroqve rpaBMbr
. Henpoul{Kaloulue rpaBMbI
. flocleolepaqlloHHble repuKapALITbI
7. Heon.rracrnrrecKaq 6oresHb rleprrKapAa
. flepeu'rHble olyxonl4
. Broppt.rHbre MeracrarurlecKlle on)rxonll
. KapqznoMa JlerKrrx
. Apyrne oryxoJlr4
I
8. IllnonarrrrrecKrrfi nepllrcaPAur
flo npervreHlr pa3BI{Tuq sa6oreBaHrIq
" OCTPbI%L -
to 6 ne4em
. [OnOCTPbIfr
- Ao 6 MecqlreB
. XPOHI4TIECKI4IZ - 6oree 6 Mecrqes
or43lIKAJIbHbrE AAHHbIE
. PacurupeHl4e fpaHlru cepAIIa
. Bepxyrue.rHsrfi ToJrqoK:ua6o
He onpeAeJltercf,,
ln6o cla6o
na,'Ibrll{pyerc-fl
. Tourr cepAUa [purJIyIIreHbI
. L[yu rpeHl4t
nepI4KaPAa
SXOAI4ATHO CTTTKA frE PIIKAPATIT OB
flolvrcolnqecTBeHHas orIeHKa BbrrroTa n M-pexuue (ASE)
OueHKa no celapalll4r{ nI4crKoB
. <10 MM - ne6olrmoe KoruqecrBo
.
10-20 MM
. >20
MM
-
yMepeHHoe KoJII4qecrBo
- 6o;mruoe KoJrI4rIecrBo
. >20 MM + rrprr3HaKr4
cAaBneHvJ{
- oileHb 6olrruoe
KoJrllqecrBo
KolnqecrBeHHas oueHKa Bblrlora n B'pexnue
nr;_ KoJrr{qecrBessofi
oUeHKr4 BbrrroTa
B B-pexuue
I4crIoJIb3yroT arILrKiUIbHoe
IICTbIPEXKAMCPHOC CCIICHIIC.
pacqer o6reNroe JreBoro xeryAorrKa npor.r3BoI'vrrcfl no arlfopl4TMy
<<rIJIOIrIaAb-AJrI4Ha>>
(puc 124).
P
uc. I 2 4. Anuxan
uu
o
e q emdp
exKcLM epH o
e
c
Kpacuutit KoHmyp - pacqem o6'aetwa eceeo cepdqa (euecme c npaluM
Cuuuii KoHmvp -
r66
eq eHu e'
u
readM crcenydourcauu
-
pacuem o6t e,ua no KoHmypy nepuxapda BMecme c 6dnomo-\4 ("RtrO")'
"KCO").
<KCO>> -
o6teu Bcero cePAIIa
..KAO, - o6reu rro repllKapAy BMecre c BbIrIoroM
<YO> - o6revr Bblrlora
Ko.nn.recrBeHHaq oIleHKa Bblrlora n B-pexuue
CyulecrnyeT anbrepHaTplBHrrfi vreroA pacrreTa o6reua BbIIIoTa n B-pexuMe IIo
pa3Mepa nepuKapAa B npoAoJIbHoM
Sopl,ryne c I4crIoJIb3oBaHLIeM rlepeAHe3aAHero
rrapacrepHaJlbHoM ceqeHl4ll (puc. 125).
Puc. 125. Pacqem II3PII e npodonuuoM napacmepHatbHon4 ceqeHlru npu nepuKapdume.
flepe4nesa4wuir pa3Mep nepr{KapAa rrcMep-sror <<or rrepuKapAa Ao
BMecre c Bbrrrorou
z cepArleu. Pacqer o6reua BbIIIora rIpoBoALIrct no
Vuepnrc.
Vuepur
-
(0,8 x
II3PII -
. BHsAopoBJIeHLIe
.
KoncrpkrKTrlBHbrfi neprarapAzr
. TavrnonaAa cepArla
2. TAMIIOHAAA CEPAIIA
. PaccnarlBaroqa-fl aHeBppr3Ma aoprbr
. Yperfllsecxufi repuKapAr4T
. Ty6epry;resHbrfi repr4KapAprr
l
r67
Sopnayne:
0,6)3, r4e
- o6revr Bbrrrora, lIP3n - repeAHesa4luuir
[4cxoAu rreprKapAnTa
rIepLIKapAa>>
pa3Mep repl4KapAa.
I HeonJracrlrrrecKufi uepuxap4zr
. I44uonarra.rec rzfi
nepr4 KapALr
r
9xoKI Kprrrepnrr raMrroHaAbr
'Koua6I4poBaHI4e [paBoro, pex{e neBoro rrpeAcepAr4r B KoHrIe Ar4acronbr
(puc. 126).
. Kolla6zpoBaHze frpaBoro, pe)Ke JreBoro x(enyAoqKa
B
paHHeit guactote
. PacruupeHrre HIIB z orcyrcrBr{e ee ana$aHuflHa B.uoxe
' BrrpaxeHHafl peaKl{ut
rpaHcMl4TpaJrbHoro
v
TpaHcrpr{Kycrrr4A€LnbHoro
rroroKoB na Qasrr AhrxaHr4r >30Vo
'
<<fllasaroqee cepArle>
rIoKA3AHIrfl K rrEpr4KApAr4OrIE
HTE
3y
. TavrnonaAa cepArla
, feuoueprzKapA
. fnofinrrfi nepzrap4ur
. [zaruocrr4qecKue rlenr4
Puc. I 2 6. Anurcanuuoe qemdpexKaJvrepH oe c eqeHue. Konna1upolaHue npq6 o?o
nped c epdun
(yrcasauo cmpenrcoil).
168
---1
t(
1.
KoHCTptrKTEBT[rfr
frE
prrrApAnr
9rno.norf,fl KoEgrpEr(TnBHof o rrep[KapArrra
. Ty6eprynes
'VpeIvrrlq
. Bzpycnrrfi uepurcap$VT
. Wuotaru.recKufi repu
KapALt
r
. fHofinufi uepzrap4zr
.
P
a4ua\uoHHrrfi repr{KapAur
' llocle ouepaqufi
SxoKI [prr
Ha cepArle
KoHcrprrKTrrBHoM rrepnKapAr{Te
. flosHueHr4e gxoreHHocrLr nepr4KapAa
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