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220.Клиническая физиология кровообращения №3 2014

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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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Klinicheskaya Fiziologiya Krovoobrashcheniya
?????????????
??????-???????????? ??????
??????? ???? ??? ? ???????
??????? ? 2004 ?.
Clinical Physiology
of Circulation
Peer Reviewed Scientific Practical Journal
Published once in three months
Founded in 2004
3 ?2014
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??????-??????????? ???????, ??????????? ? ?????????? ?????????
? ????????????? ??? ????????????? ???????? ??????????? ???????????
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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
Л??б?кзбн╦ к ка??збн╦
НиеГЛ ╚ГЯККО ко. д.Г. е?мшнб??╩
Цк?блак? л? ка??збн╦рмш? ?б?збн╦лсрз╦
Юя ? 03847 сз 25.01.2001 ?.
грб т???? а??к?бл?. Гк с?л?
??рз╦ ?зс?с ка??лк? лб осйбз ╥?з╦
а?лбрбл? ? т?о?з╦ мсот╦?зб??
нк╥с ?срт?ска?б?бл? н?╥?о
ртсрс╥со ╥ба т?б????кзбн╦лс?с
ткр╦обллс?с ??а?б╞блк? ка??збн?
Из?бзрз?бллсрз╦ а? ?срзс?б?лсрз╦
клыс?о??кк, рс?б?й??бхр?
? ?бмн?ол?? о?зб?к?н??,
лбршз ?бмн?ос??збнк
д??бр ?б??м?кк
119049, Есрм??, Цблклрмкх т?., 8
ГЯККО ко. д.Г. е?мшнб??,
Из?бн клзбннбмзш?н╦лсх
рс╥рз?бллсрзк
Мбнбысл ?б??м?кк (499) 236-92-87
Н?мр (499) 236-99-76, 236-92-87
E-mail: izdinsob@yandex.ru
http: //www.bakulev.ru
К?к?бзбн╦рз?с с ?б?крз???кк р?б?рз??
о?ррс?сх клыс?о??кк ХЮ ? 77-16885
сз 24.11.2003 ?.
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?.?. ???????? (???. ???????? ?????????)
???????????? ?????
?.?. ?????, ?.?. ?????,
?.?. ???????, ?.?. ???????
А??. ?б??м?кбх Й??кслс?? г.Ш.
Мбн. (499) 236-92-87
Цкзб??зш?л?х ?б??мзс?,
мс??бмзс?
длзслс?? Ю.г.
Editor-in-Chief L.A. BOCKERIA
Дсот╦?зб?л?? ?б?рзм?
к ???ык?брм?? с╥??╥сзм?
о?зб?к?н?
Editorial Board
Е?з?бб?? ж.Г., Кн?╞ И.г.
Гсоб? тс?ткр?л ? тб??з╦ 29.09.2014
Нс?о?з 60в88 1/8
Хб?. н. 11,0
Л?.-ка?. н. 10,78
Лрн. тб?. н. 9,85
Изтб??з?лс
? ГЯККО ко. д.Г. е?мшнб??
119049, Есрм??, Цблклрмкх т?., 8
збн. (499) 236-92-87
Днклк?брм?? ыкакснс?к?
м?с?сс╥???блк?
2014. ? 3. 1?88
ISSN 1814?6910
Мк??й 500 ?ма.
Хс?ткрлсх кл?бмр 84549
T.B. Averina, A.V. Gavrilenko,
D.Sh. Gazizova, S.V. Gorbachevskiy,
M.V. Zatevakhina,
G.V. Lobacheva (Assistant Editor),
R.M. Muratov (Assistant Editor),
E.S. Nikitin, N.O. Sokol?skaya,
M.V. Shumilina (Assistant Editor)
Editorial Council
V.A. Bykov, V.A. Lishchuk,
L.A. Piruzyan, K.V. Sudakov
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????
??????????
CONTENTS
??????
Reviews
5
???????????? ??????
Samsonov? N.N., Samuilova D.Sh., Klimovich L.G.,
Plyushch M.G., Kozar E.F. Strategy laboratory diagnosis in cardiac surgery
Original Articles
????????? ?.?., ???????? ?.?., ??????? ?.?.,
??????????? ?.?., ??????????? ?.?., ????????? ?.?., ??????? ?.?., ?????????? ?.?., ?????? ?.?., ??????? ?.?. ??????????????? ? ??????????????????? ??????? ? ?? ??????????
? ???????????? ??????????? ????????????
?????????? ? ?????? ?????????????????
???????
12
Samuilova D.Sh., Lobacheva G.V., Rakhimov A.A.,
Kolesnikova E.A., Samorodskaya I.V., Borovkova U.L.,
Linenko O.N., Rogal?skaya E.A., Skopin I.I.,
Bockeria L.A. ?yperlactatemia in patients cardiac
surgery ?nd its correlation with subsequent changes
in laboratory parameters in the early postoperative
period
?????????? ?.?., ??????????? ?.?., ??????? ?.?., ???????? ?.?., ??????? ?.?. ????????????????? ???????????? ??? ?????????????? ????????????? ?????? ????????? ? ????????? ? ??????????????? ?????????????
? ?????????????? ??????? ??????? ???????????? ????????? ??? ????????? ??????????
????? ?????????
23
Zatevakhina M.V., Farzutdinov A.F., Rakhimov A.A.,
Lobacheva G.V., Alshibaya M.M. Intraoperative
hemodynamics in left ventricular geometric reconstruction combined with coronary artery bypass
grafting using high thoracic epidural anesthesia as
a basic component of general anesthesia
??????? ?.?., ?????????? ?.?., ??????? ?.?.,
???????????? ?.?., ?????????? ?.?., ??????????? ?.?., ??????? ?.?. ????????? ????? ? ???????????? ?????? ? ?????? ?????????????????
??????? ? ????? ????? ???????? ????????????? ???????????? ??? ????????? ?????????
D-???????????? ????????????? ???????
34
Isakova E.N., Kalinicheva Yu.B., Shvetsova E.A.,
Zaynetdinova E.K., Gornostaev A.A., Chernogrivov A.E., Bazylev V.V. Cardiac rhythm and conduction heart system disturbances in the early postoperative period in patients after the operation of arterial
switch in different types of D-transposition of the
great arteries
??????? ?.?., ???????? ?.?., ????????? ?.?.,
?????????? ?.?., ???????? ?.?. ? ??????? ?
?????????????? ?????????????? ????????????
??????????????? ??????? ? ?????
42
Bockeria L.A., Abramova M.F., Stepanova I.A.,
Novoselova S.N., Shumilina M.V. To a question of
standardization of ultrasonic researches of brachiocephalic vessels at children
??????????? ?????????? ??????????????, ? 3, 2014
????????? ?.?., ????????? ?.?., ???????? ?.?.,
???? ?.?., ????? ?.?. ????????? ????????????
??????????? ? ??????????????
3
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
4
??????????
???????? ?.?., ????????-??????? ?.?., ?????? ?.?., ??????? ?.?., ??????? ?.?., ??????? ?.?., ???????????? ?.?., ???????? ?.?. ??????????????? ????????? ?????? ?????? ???
?????????? ?????????? ?????? ??????? ? ??????? ?? ????????????????
51
Ozolin?sh A.A., Radenska-Lopovok S.G., Darvish N.A., Eseneev M.F., Mollaev E.B., Valieva R.R.,
Dzhangveladze T.N., Gvetadze I.A. Morphological
changes and the reasons of progression of deformation in the wall of the internal carotid artery
??????? ?.?., ??????? ?.?., ???????? ?.?., ???????????? ?.?., ?????????? ?.?., ???????? ?.?.,
?????? ?.?. ???????? ??????? ????????? ?????????? ?? ?????? ???????? ? ?????????
57
Bockeria L.A., Bockeria O.L., Novikova S.P.,
Salokhedinova R.R., Nikolashina L.N., Shustrova O.V., Sivtsev V.S. Studying the properties of the
film compositions with gelatin and colchicine
????????
Methods
??????? ?.?., ?????? ?.?., ???????? ?.?.,
????? ?.?., ????????? ?.?. ??????????????
???????? ? ????? ?????? ??????????? ????????????????? ??????????? ? ?????? ????????????????? ??????? ? ?????????????? ???????
67
Lomidze S.V., Nekhaev I.V., Mazurina O.G., Sytov A.V., Zhuzhginova O.V. Pathological syndromes,
and the choice of method invasive hemodynamic
monitoring in the early postoperative period in cancer patients
???????? ?.?., ????? ?.?., ??????? ?.?., ??????????? ?.?. ???-??????????????? ?????????
? ???????????????????? ?????????
71
Lobacheva G.V., Popov D.A., Rakhimov A.A.,
Kolesnikova E.A. Ventilator-associated pneumonia
in the cardiac intensive care unit
??????????? ?????????? ??????????????, ? 3, 2014
??????? ?????????
Brief Reports
?????????? ?.?., ????????? ?.?., ??????????? ?.?., ???????? ?.?. ?????????????????? ???
????? ??????? ????????? ??????? ????? ???
??????? ???????????? ????? ????????? ?????????????
76
Tkhagapsova M.M., Chigogidze N.A., Papitashvili V.G., Shogenova S.R. Endoprosthesis as a method
of treatment of abdominal aortic aneurysm with a
high operative risk open intervention
??????? ??? ???????
82
Rules for authors
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????
5
??????
╘ ????????? ???????, 2014
??? 616.12-089-07
????????? ???????????? ??????????? ? ??????????????
?.?. ?????????, ?.?. ?????????, ?.?. ????????, ?.?. ????, ?.?. ?????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩
(???????? ? ???????? ??? ? ???? ?.?. ???????),
?????????? ?????, 135, ??????, 121552, ?????????? ?????????
????????? ??????? ??????????, ?????? ???. ????, ?????????, ???????????? ?????? ???????????
???????????? ???????????;
????????? ????? ??????????, ?????? ????. ????, ???????????? ???????-?????????????
???????????;
???????? ??????? ???????????, ?????? ????. ????, ??. ????. ????.; e-mail: climov@inbox.ru;
???? ?????? ???????????, ???????? ????. ????, ???????????? ????????????? ???????????;
????? ????? ?????????, ???????????? ??????????? ????????-???????????
??????????? ??????? ??????????? ???????????? ??????????? ? ??????? ????????? ? ??????????
???????? ?? ?????? ?????? ????????????? ???????. ?????????? ??????? ???????? ?????????????
????????? ?? ???????? ? ????? ??????????????? ??????????? ??????????. ?????? ???????? ????????? ??????????? ? ???????? ??????? ?????????????? ? ??????????????? ?????????. ????????
??????? ?????? ??????????? ??????????????? ??????????, ???????????? ??????????????? ? ???????? ? ????????? ????????????????? ???????. ??????????? ???? ????????????, ???????????
? ????????-??????.
???????? ?????: ????????????? ???????, ???????, ????????????, ???????????? ???????????
???????, ?????????? ???????, ??????????????.
STRATEGY LABORATORY DIAGNOSIS IN CARDIAC SURGERY
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Samsonov? Natal?ya Nikolaevna, MD, DM, Professor, Chief of Department of Clinical Laboratory Diagnostics;
Samuilova Daniya Shavketovna, Dr. of Biol., Chief of Clinical Biochemistry Laboratory;
Klimovich Lyudmila Grigor?evna, Dr. of Biol., Chief Research Associate;
Plyushch Marina Grigor?evna, PhD in Biol. Sci., Chief of Biochemistry Laboratory;
Kozar Elena Fedorovna, Chief of Laboratory of Express Diagnostics
The article deals with the modern laboratory diagnostics in clinical cardiac and vascular surgery at the various stages of
hospital stay. Attaches great importance to laboratory screening before surgery in terms of predicting cardiac events.
Particular attention is paid to the diagnosis and monitoring of treatment of thrombotic and hemorrhagic disorders.
Reflected how early diagnosis of life-threatening complications multiple organ failure and infection in the immediate postoperative period. Submitted the range of investigations carried out in express mode.
Key words: biochemic markers, thrombosis, hemorrhage, laboratory diagnosis sepsis, monitoring therapy, cardiosurgery.
???????????? ??????????? ???????? ????
?? ??????? ???? ? ????????? ???????????
????????????? ? ???????????????? ?????????? ????????????????? ??????? ? ????????? ?????- ? ???????????????????? ???????. ??????? ?????? ??????????? ???????
? ??????????? ?????????? ???????????,
??????????? ??? ????????? ?????????? ????????-?????????? ???????????, ?????? ??-
?????, ??????????????? ??????? ??????????????? ????????, ??????????? ????? ???????? ??????????????? ?????????? ? ?????
?????? ???????????????? ??????? ? ???????? ??? ?????????????.
? ????????? ??????????? ??????????? ??????????? ????? ????? ???????????? ??????????, ?????????? ?? ??????????? ???????????? ???????? ? ????????. ?????? ?? ???
??????????? ?????????? ??????????????, ? 3, 2014
N.N. Samsonov?, D.Sh. Samuilova, L.G. Klimovich, M.G. Plyushch, E.F. Kozar
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2014
6
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??? ???? ??????? ????????? ? ??????????
????????.
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????????????????? ??????? ? ?????????
????? ?????????????? ???????? ??????, ????????? ?????????? ??????? ? ???????????
???????????? [1?3]. ???????? ??????????
???????????? ???????? ?????????????? ?????????? ? ????????? ? ?????? ?????????
???????? ????? ???????? ??????????? ???????????? [4, 5].
? ??????????? ???????? ???????? ??????
?????? ??????????? ????????????, ???????,
???????? ?????????????????? ????????????????? ???????????, ??????? ???????????
?????, ??????????????? ?????????? [6?9].
??????????? ???????????? ???????????? ??????? ????? ? ??????? ??????- ???
????????? (?????????????? ??????????
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??????? ???????????? ? ?????, ???????????
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? ???????????? ????????????????? ????????? ?????????????? ? ?? ????????????? ??????????? ? ???????????????? ???????, ???????? ??????????? ? ??????? ??????????
? ????????? ???????????? [10?12].
???????????? ????????? ??????? ? ?????????? ??????????? ??????????? ?????????????? ?/?????????????? ?-I, ??????????? (?) ???????? ?????? ???????????????
????????? ?????????????. ??????? ???????
?????????? ????? ???????? ?????????????
? ?????????? ?????????????? ? / ?????????????? ?-I (R=0,79; ? < 0,0001). ? 40,5% ????????????? ??????? ?????????? ????????? ???????????? ???????????? (?). ?? ?????? ????? ???????????? (2000 ??????
? ???), ? 50% ??????? ?????????? ????????? ???? ????????? ????????? ??????.
? 13,9% ??????? ???????? ??????? ??????????????????? ? ??????????? ?????? ??????????? ?? 7,6 ?? 12,5 ?????/? ?/??? ?????-
??????????????? ? ??????????? ????????????? ?? 2,8 ?? 13,9 ?????/? [13].
???????????? ??????????? ????????
???????? (??) ???????????? ???????????????? ???????????????? ??????????, ??????????? ? ??? ????????: ??????????? (???,
?????????? ????? ? (????-?)), ??????????
????????? (?????????, ??????????????), ?????????? ??????????? (????????????????
(???), ????????????????? (???)), ???????? (????????? T, I, ??-??, ?????, ??????????? ?????? ??????? (H-FABP),
????????), ??????????????? ???????????
(????????????????? ?????? ?-???? (BNP),
???????? ?????????????????? ?????? 15
(GDF-15), ??????????? ???????? ST2). ???
??????? ?????????? ?????????? ???????
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?????? ???????? ???????? ? ????????? ??????????????. ╚??????? ??????????╩ ??????????? ???????? ????????????????????
?????????, ??????? ???????? ????????? ?????????? ?????????????? ?????????????
??? ??????? ??????????????? ???????????????? [14, 15].
???? ??????? ??????????? ????? ???????
BNP, ?????????????? ??????? (?? NYHA),
??????? ????? ? 72 ??????? ? ????????
???????? ??????, ?????????? ? ?????????
?????????????? ???????? ?? (??????? ??????? 45,0 ╠ 13,0 ???). ??????????, ??? ??????? BNP, ??? ??????? ?????????? ???????
???? ????????? ???????????????, ??????????
????? 984 ??/?? [1]. ? ????????????? ??????? ?????? ?????? ? ?????????? ????????
?????? ??????? BNP ?? ???????? ?????
486,2 ??/?? ? ??????? ???????????? ????????????? ???????? ??????????? ??????????:
?????? ????????? ??????????????? ? ???????????? ????????? ????? ? ?????? ????????????????? ???????. ? ????????? ? ???
??????? BNP ?? ???????? ????? 116,74 ??/??
?????????? ????????????? ???????? ??????????? ?????????? ? ???????????? ????????? ????? ? ?????? ????????????????? ??????? ????? ???????????????? ???????? [3].
??????????? ?????? ????????????????
? ?????????? ? BNP ? ??????? ? ?????? ?????????? ????????? ? ????????? ???????????????? ???? ?????????????? ??????????????? ??????????, ???????? ?????????
???? ????????-?????????? ???????????, ?????????? ?? ?????? ?????????????? [15].
??????? ?????????????????????????? ??????????? ?2 (??-???2) ????????????? ??-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
?????? ??????? ???????????????? ??????????????????? ??????. ?????? ???????????
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? ╚?????????????????????╩ ?????????, ??????????? ? ??????????? ?? ?? [16].
????? ??????????????? ???????? ?????? ??? ???????? ????????? ???????????????
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??????????? ?? ?????? ????????? ????????
?????, ????? ??????? ???????? ? C-???????????? ???????? ??????????????? [17].
? ????????? ? ????????????? ? ????????? ????? ???????? ????????? ??????????????? ????????? ????????-3. ?????????? ???
?????? ????????????? ? ??????? ????????
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???????? ??????????????? ?????? ?????????, ??? ?????????????? ??????????? ??????????? ? ????????? ??????????????
??????? ?????? [18].
???? ?? ???????? ???? ? ???????? ????????-?????????? ???????????, ? ??? ?????
? ?????????? ???, ???????? ?????????? ?????????, ??????? ???????? ? ?????????
???????? ??????????? ??????, ?????????????????, ???????????. ?? ??????????? ???????????? ??????? ??? ?? ??????????????
????? ? 36% ??????? ?????????? ???????
?????????? ??????????? ?????????? ??????? ???????, ? 56% ??????? ? ??????? ??????? ?????????? ?????????? ????????????
? ? 77% ? ?????? ?????????? ??????????
????????????. ? 37% ??????? ????????
??????? ?????????? ????????? ???????
? ? 90% ? ??????? ???????????? ????????????? ????????. ?????? ????????????????? ?????? ????? ???????????????? ???????? ????? ???????????????? ??????????
?????? ?????????? ??????????? ?????????.
???????????? ?????? ??????????????, ????????? ?????????? ????????????, ?????????? ?????????? ????????????, ???????
??? ??????????? ? ???????, ????????????? ?????????, ? ????????????, ?????????
??????? ? ??????????? ????????? ? ????????????? ???????????? ??????????? ??????,
??????????? ?? ????????????? ???????, ????????? ??????? ????????? ? ??????????
????? ?????????????? ??????????. ????????????? ???????? ?????????? ?????????
????????? ? ??????????? ?? ??????? ???????????????? ? ???????????? ??????? ???????????. ????????? ??????? ????????? ?????-
7
?????? ????? ?????????????? ???????, ???
???????????? ????????????? ??????? ??????????????? ??????????????? ??????? ???
?? ????????? [5, 19].
?????? ???????? ???????????? ??????
????????? ?? ???????????? ? ?????????????? ?????? ???????. ??? ?????? ???? ?????????? ???????????? ????????-????????????, ??????????????? ????????????? ?????????? ? ????????? ???????? ???????
?????, ???????????????? ???????????, ?????? ?????, ?????????, ???????? ??????????????, ??????????? ???????????? ???????
?????.
?????????????? ??????? ?????????? ?????? ??????? ?????? (??, ??2, ???2) ???????? ??????? ?????? ? ?????????? ??????????? ???????????? (????- ? ????????????????, ????????- ? ?????????????, ?????????
??????????) ??? ????????????? ??????
????????? ??????????? ?????????, ???????????? ??????????? ?????, ?????? ????????? ? ????? ? ???????? ???????? ?????????
??????????? ?????????? (SO2), ????? ???????????? ????????? ? ????? (ct ?2), ???????? ????????????? (p50). ????? ?????????? ????????????? ??????????? ?????? ?
?????? ???????? ?????????????? ??????????? ????????????????? ??????????. ????????? ? ?????????? ?????? ??????? ???????????? ?????, ??????, ?????, ???????, ???????, ?????????? ? ?????????? ?????????
???????? ?????? ??????? ????????? ???????? ?? ????? ????? ?????. ????? ???????????? ??????????? ??????????? ???????????, ??????????? ???????? ????? 10 ? ????????????? ???????????? ????? 20 ???????????
?? ????? ????? [20].
????????? ????????? ???????? ????????????? ???????????????? ??????????? ???????????? ? ???????????????? ???????.
?????? ???????? ??????? ?????????????
?????????? ??????????? ???????????? ? ???????? ????????? ?????, ? ??????? ?????
? ??????? ?????? ?????????????????? ?
??????????? ?????? ???????????? ???????
?????, ??? ????????????, ????????? ?? ???????????? ???????? ???????????, ??????????? ???????????, ?????????? ???????????, ?????????? ? ???????? ??????????? [20].
? ????????????????? ??????? ?????????
???????????????????? ??????? ?????????
?????? ??????????????? ????????????????
??????? ?? ????????? ?????????, ???????????? ???????????? ????????????? ? ???????
??????????? ?????????? ??????????????, ? 3, 2014
??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2014
8
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???????????????????? ???????????. ? ??????
??????????? ? ???????? ? ???????? ??????
???????????????? ??????????? ??????????? ?????????? ??????. ???????????? ???????????? ???????????? ??????????????, ?????????????? ? ??????????????? ????????
? (FV Leiden), ???????? ???????????? ??????????????? ? ????????? ? ? S, ???????????? III, ? ????? ?????? ??????????? ????????
?????, ????????????, D-??????, ???????
??? ???????????, ??????? ? ????????? ???????/?????? IV ???????????.
?????? ?????????? ??????????????????
??????? ??????? ? ???????? ????????? ???????????? ???????????????. ????????, ???
??? ??????????? ? ???????? ????????????
??????? ? ????? ? ???????????? ?????????
??????? ? ????????? ??????? ??? ????????.
??????? ???????????? ? ???????? ? ?????????????? ???????????????????????, ???????????? ????????? ? ??????????? ?????????? ?????????????. ?????????? ???????????? ????? ?????? ??? ????? ? ???
????????, ??? ? ????? ???????? ??????????
?? III ?????????? 49,4 ╠ 10,7%, ????? 3 ? ?????
???????? 57,3 ╠ 25,7%, ???????? ? ?????????????? 43,2 ╠ 9,9 ? 52,8 ╠ 14,0%. ?????????
?????? ???????????? ???????????? ???????????? ?????????????? ?????????? ? ????????????????? ???????. ? ??????? 2012 ?.
??? ?????????? ???????? ?????? ?? III
316 ????? ? ??? (?? ??? 270 ? ?? 6 ???) ????
????????? ?????????????? ??????? ?????????? ????????????? ?? III [21].
? ???????????? ?????? ???????????? ????????? ??????????? ??????????? ?????????? ?????????????? ?????????? ??????????
????????????? ???? ? ??????????? ???? ??,
????, ?????????? ???????????, ???????
? ????????? ???????/PF4; ????????? ???????????????? ? ??????????? ???, ????,
???????? ?, D-??????, ????????????; ?????????????? ? ???????????? ????????? ? ????????? ??????????; ?????????????? ? ??????????? ?????????? ????????????, ?????????? ?????????? ???????????? 1 ????,
????????????, ????????????, ???????????.
????????? ??????????? ?????????????????? ??????? ? ??????????????????? ??????? ???????? ?????? ??????????? ?????
(???). ??????? ???????????? ????????
??? ?????? ????? ???????, ??? ????????????? ??????????-??????????????? ????????? NGAL; ?????, ??????????? ?????? ??????? ??????????? ???? L-FABP,
??-18, NAG ? N-?????? b-D-???????????????; ???????? ?. ??????? ??????????????
??????????-???????????????? ??????????
?????????? ? ??????? ? ??? ? ?????????
???? ????? ?????????????? ??????????????,
????? ??? ????????? ?????????? ??????????
????????? ??????????? ???????. ???? ??????????? ????????, ????????????? ? ???????? ?? ?????????????????? ????? 120 ???.
?????? ??????????? uNGAL, ??????????,
????????, ?????????????? ????????? ?????
2, 4 ? 24 ? ????? ????????. ? 24 ???????
? ????????????? ?? ????? 150 ??? ????? 2 ?
?????????? ????????? ?????? uNGAL ? 2?6
???, ???? ?????? ?????????? ? ?????? ?????
24 ?. ? 8 ?? ??? ?? 2?3-? ???? ???????????
???, 6 ??????? ????????????? ?????????? ?????????????????? ?????????????? ??????? [8].
???????? ? ? ?????, ???????????????
??????????????? ????????, ??????????
?????? ????? ?????, ????? 100% ???????.
???????? ? ???????? ???????? ????????????? ??? ?????? ??????????????? ????????? ????? ?? ????????? ? ??????? ?????????? ? ????? ? ????????? ???????? ??????????. ? ?????????? ???????????? ? ??????
???????????? ???????, ??????????? ?? ????????????? ??????? ?? ?????? ?????????
??????????? ?????? ??????? ?????, ????????, ??? ? ?????? ????????? ? ??????? ??????? ????????? ? ?? ???????? ? 75% ???????
? ????????????????? ??????? ?????????
??? [22].
?????? ???????? ??????????? ??? ???????? ????? S100. ?? ??????????? ????????????, ??????????? ? ????? ??????, ????????
??????????????? ?????????? ? ????????????????? ??????? ?????????????? ???????
??????? ????? S100 ? ????? (?? 0,9 ???/?).
?????????? ?????? ????? S100 ? ???????
? ??????? ???????? ?????? ?????????????
?????? ???????? ????? ? ??????? ??? ????????? ?? ??????? ? ???????????????????
??????? ?????. ??????? ??????? ? ??????? ????? 2,0 ?????/? ?????? ???????????????
???????? ?????? ???????? ????? (???????????????? 83%, ????????????? 67%). ????????? ?????? ????? S100 ????? 1,4 ???/?
? ??????? ???????? ???????? ?????? ????????? ? ???????? ????? ? ?????? ????????????????? ??????? (???????????????? 93%,
????????????? 95%) [9]. ? ?????? ????????? ????????????, ??????? ???????? ??????????????? ?????????? ?????? BNP ? ???????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????
????????? ????? ????? ?????????????
?????? ????? ????????? ?????????? ? ?????????. ???????? ?????????????? ??????????? ????? ???????? ??????????, ??????????????? ? ?????????? ?????????? ???????????? [6].
?????????? ??????????? ????? (??????????????, ??????????????, ?????????????,
???????????? ???????????) ?????????? ?????????????? ??????? ???????????? ????????????. ?????????? ???????????? ???????????? ?? ???? ????????????? ?????
???????????? ??????????, ??????????? ??????????????? ? ??????????????? ??????????? ???????? ???????? ?????? ??????????????? ????????? ??????? ? ?????? ????????, ???????? ???????????????? ??????
????????-?????????? ??????????? ? ?? ??????????, ??????? ????????? ???????????
?????????, ?????????????? ?????????????? ????? ?? ????????????? ??????? ? ??????? ??????????? ???????? ????????????????? ??????????. ??? ??????????? ???????????????? ? ????????? ???????? ??????
? ???????????????? ????????? ? ????????????????? ?????? ??????????? ????????????
????? ??????????? ?????? ???????? ????????? ? ????????????.
??????????
1.
2.
3.
4.
5.
6.
??????? ?.?., ?????? ?.?., ??? ?.?., ????????? ?.?.,
???? ?.?., ????????? ?.?. ? ??. ??????????? ????????
????????? ?????????????????? ??????? ? ??????? ? ???????? ???????? ?????? ? ????????? ??????????????
???????? ????????. ??????? ? ????????-?????????? ????????. 2011; 2: 40?2.
???? ?.?., ???????? ?.?., ???????? ?.?., ??????????? ?.?., ????????? ?.?. ???????? ?????? ?????????????????? ??????? ?-???? ??? ????????????? ??????? ????????? ? ???????? ?????. ??????????? ??????????
??????????????. 2010; 3: 62?5.
???????? ?.?., ????? ?.?., ????????? ?.?., ???? ?.?.,
????????? ?.?., ?????? ?.?. ???????? ????????????????? ?????? ? ??????????? ???????? ?????????? ?????
???????? ????????? ????????? ??????? ?????? ? ???????????????? ????????. ??????????? ?????????? ??????????????. 2011; 2: 50?6.
???????? ?.?., ????????? ?.?., ?????????? ?.?.,
???????? ?.?., ????????? ?.?., ????????? ?.?. ?????????????? ????????? ???????? ?? ?????? ????????
??????????????? ?????????????? ? ?????? ????????????????? ??????? ??? ????????? ????????? ??????????? ????????????. ??????????? ?????????? ??????. 2010;
4: 42?7.
???????? ?.?., ?????????? ?.?., ????????? ?.?.,
???????? ?.?. ???????????? ?????? ??????????????
?????????? ? ????????? ? ????????????? ????????????
??????????? ?????? ?? ? ????? ????????. ???????????
?????????? ??????????????. 2010; 3: 57?62.
?????????? ?.?., ???? ?.?., ????????? ?.?., ???????? ?.?., ???????????? ?.?., ???????? ?.?. ? ??.
??????????? ??????? ?????????? ? ??????????? ???????????-??????????? ?????????? ? ??????????????-
??????????? ?????????? ??????????????, ? 3, 2014
? ??? ? ??????????????-??????????????
????????? ? ????? ???????? ??????????????? ?????????? ????? ?????????????? ??????? ? ???????? ?????????????? ?????????????? [23].
??-???????? ????????? ??????? ??????????????, ??????????????? ????????????? ???????? ?????????? ??????????????? ?????? (????), ??????????????? ?
?????????????? ??????????? ??????????
???????? ?????? ???????, ???????????
??????????? ?????????? ????????? ???????????.
? ?????? ??????????? ??????? ? ????
?????? ??????????: ??????????? ??????
?????, ????????????? ????????????, ??????
????????-????????? ? ???????? ??????? ?????, ??????????? ?????????-?????????????
????????, ?????? ?????????, ???????????????, ???????????, ??????????????????
??????, ?????? ????????????????? ???????,
?????????????? ??????? ??????????? ?????.
????????, ??????? ??????????? ??????????, ???????? ????????????? ??????????
?/??? ?????????? ?????? ?? ????????.
??? ?????? ??????????? ???????, ????????
? ???????? ??????? ????????? ????????????
????????????????? ????????? IL-1, -6, -8,
??????? ??????? ??????? (TNF-?) ? ????????????????????? ????????? ? IL-4, -10.
? ????? ?????? ??????????? ????????????? ?????????? ? ?????? ???????? ?????
??????????? ?????????? ? ?????????? ??????????? (???-????). ??? ?????? ? ???????????????? ? ??????? ??????-II ????????
??????????????? ???????? ??????????? ???
???????. ???????????? ??????? ?????????
? ??? ???? ???????????? ??? ?????? ?????????? ??????????? ? ??????????? ??????????? ?????????? ??? ???????????
??????????? ??????? ?????????? ???????
????????? ? ???????????-???????????? ???????????? ????? ???????????????????
???????? [24].
????? ???????? ??? ??????????? ??????? ???????? ????????? (sCD14-ST). ? ??????
????????? ???????????? sCD14-ST ? ??????? ? ?????????????? ???????? ??????
?????? ? ??????? ??????? ?-???????????
?????, ??????????????? ? ??????? ????????? ? ?????????????? ???????????? ????.
???????????? ???????? ????????? ???????? ??????? ? ?????????? ?????? ???????????? ?????????? ? ????????????????
?????? [25].
9
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
10
7.
8.
9.
10.
11.
12.
13.
14.
??????????? ?????????? ??????????????, ? 3, 2014
15.
16.
17.
18.
19.
20.
21.
??????
??? ??????? ? ????????? ???????????????????? ???????. ????????? ????? ??. ?.?. ???????? ????. 2013;
14 (3): 108.
????????? ?.?., ???????? ?.?., ??????????? ?.?., ???????? ?.?., ????? ?.?., ??????? ?.?. ? ??. ??????????? ? ????????? ????????????????????? ??????????
? ??????????????????? ??????? ? ?????? ????????????????? ???????. ?????????????? ? ??????????????.
2010; 5: 56?9.
???? ?.?., ??????????? ?.?., ??????? ?.?., ???????? ?.?., ???????????? ?.?. ????????????? ??????????-??????????????? ????????? ? ?????? ?????? ??????? ??????????? ????? ????? ???????? ???????? ??
?????? ? ???????. ????????? ????? ??. ?.?. ????????
????. 2012; 13 (3): 53?9.
??????? ?.?., ???????? ?.?., ??????? ?.?., ????????? ?.?., ????? ?.?. ??????????? ???????????? ????????????? ???????? ?????? ???????? ? ?????????
????? ??? ????????? ?? ??????? ? ???????????????????
??????? ?????. ??????????? ?????????? ??????????????.
2012; 4: 10?4.
???????? ?.?., ????????? ?.?. ???????????? ??????????? ?????????. ????????? ????? ??. ?.?. ????????
???? (??????????). 2012; 3: 122.
?????? ?.?., ???????? ?.?., ????????? ?.?., ???????? ?.?. ???????????? ??????????? ???????? ??????????? ????? ? ????????? ? ???????? ????????? ? ?????????? ????????. ??????? ? ????????-?????????? ????????.
2010; 2: 49?53.
????????? ?.?., ???????? ?.?., ?????????? ?.?., ???????? ?.?. ????????????? ??????????????? ??????????????? ??????? VII ? ??????????????. ???????, ????????
? ????????. 2011; 4: 41?7.
??????? ?.?., ????????? ?.?., ????????? ?.?., ??????????? ?.?., ??????? ?.?., ????????? ?.?. ??????????
???????????? ????????????? ???????????? ???????, ???????????? ?? ????????????? ??????? ???. ???????????
?????????? ??????????????. 2012; 3: 50?6.
??????? ?.?. ?? ???? ? ?????? ??????????? ????????-?????????? ???????: ?????????????? ?????? ? ???????????????????? ?????????. ???????????. 2011; 1: 30?6.
Morrow D.A., Sabatine M.S., Brennan M.-L., de Lemos J.A.,
Murphy S.A., Ruff Ch.T. et al. Concurrent evaluation of novel
cardiac biomarkers in acute coronary syndrome: myeloperoxidase and soluble CD40 ligand and the risk of recurrent
ischaemic events in TACTICS-TIMI. Eur. Heart J. 2008;
29 (9): 1096?102.
Lund J. et al. Circulating pregnancy-associated plasma protein A predicts outcome in patients with acute coronary
syndrome but no troponin I elevation. Circulation. 2008; 108:
1924?6.
Berliner D. et al. Copeptin in heart failure: associations with
clinical characteristics and prognosis: ESC congress. Munich;
2012.
Ravi V. Shah et al. Galectin-3, cardiac structure and function, and long-term mortality in patients with acutely
decompensated heart failure. Eur. J. Heart Fail. 2010; 12:
826?32.
?????????? ?.?., ????????? ?.?., ????????? ?.?.,
???????? ?.?., ???? ?.?., ???????? ?.?. ? ??. ?????????-????????? ????????? ????????? ? ????????? ?????????????? ????? ? ?????????? ???????? ??????????????
?????????? ? ?????? ????????????????? ??????? ?
??????? ??? ????? ???????? ???????????????? ????????????: ????????? 5 ????????????? ???????????
╚??????????? ??????????????? ? ???????????? ? ????????-?????????? ????????╩. 2?4 ??????? 2011 ?. ??????.
?.; 2011: 77?8.
????????? ?.?., ????????? ?.?., ???? ?.?., ???????? ?.?., ????? ?.?., ????? ?.?. ? ??. ???????????? ?????? ???????????? ? ??????? ????????-?????????? ???????? (??????????????, ?????????????, ????????????).
?.: ????? ??. ?.?. ???????? ????; 2012.
???????? ?.?. ??????????????? ? ??????? ??????????????: ???. ... ?-?? ???. ????. ?.; 2012.
22.
23.
24.
25.
??????? ?.?., ????????? ?.?., ???? ?.?. ???????? ?
? ?????? ??????? ????? ? ??????? ? ?????????? ??????????? ?????? ?????. ????????? ????? ??. ?.?. ???????? ????. 2010; 11 (6) (??????????). 215.
??????? ?.?., ???????? ?.?., ???? ?.?., ????????? ?.?., ????????? ?.?. ??????????????? ???????? ???????? ????????? ??????????????? ? ???????? ???????? ?????????? ????? ????????? ?????????? ???????
?????? ? ???????? ?????????????? ??????????????. ??????????? ?????????? ??????????????. 2012; 2: 38?43.
??????????? ?.?., ??????? ?.?., ????? ?.?., ???????? ?.?., ????????? ?.?., ????? ?.?., ???? ?.?. ????????????? ?????????? ??????????? ???????????? ? ?????????????????? ???????????? ? ? ???????????
??????? ???????????-??????????? ?????????? ? ??????????????????? ???????. ??????? ?????????????? ? ??????????????. 2009; 6: 27?34.
????? ?.?., ???? ?.?., ???????? ?.?., ??????? ?.?.,
???????????? ?.?., ??????????? ?.?. ??????????
?????? sCD14-ST (??????????) ? ???????????????? ??????? ? ??????????????????? ???????. ?????????????? ?
??????????????. 2013; 3: 30?5.
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Murphy S.A., Ruff Ch.T. et al. Concurrent evaluation of novel
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ischaemic events in TACTICS-TIMI. Eur. Heart J. 2008;
29 (9): 1096?102.
Lund J. et al. Circulating pregnancy-associated plasma protein
A predicts outcome in patients with acute coronary syndrome
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clinical characteristics and prognosis: ESC congress. Munich;
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and long-term mortality in patients with acutely decompensated heart failure. Eur. J. Heart Fail. 2010; 12: 826?32.
11
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
12
???????????? ??????
???????????? ??????
╘ ????????? ???????, 2014
??? 616.12-089.168.1-06:616-008.9
??????????????? ? ??????????????????? ??????? ? ?? ??????????
? ???????????? ??????????? ???????????? ??????????
? ?????? ????????????????? ???????
?.?. ?????????, ?.?. ????????, ?.?. ???????, ?.?. ???????????, ?.?. ???????????,
?.?. ?????????, ?.?. ???????, ?.?. ??????????, ?.?. ??????, ?.?. ???????
??????????? ?????????? ??????????????, ? 3, 2014
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩
(???????? ? ???????? ??? ? ???? ?.?. ???????),
?????????? ?????, 135, ??????, 121552, ?????????? ?????????
????????? ????? ??????????, ?????? ????. ????, ?????????? ???????-????????????? ????????????;
e-mail: d.samuilova@gmail.com;
???????? ?????? ??????????, ?????? ???. ????, ?????????, ??????????? ?????????? ??????????
? ??????????? ???????;
??????? ???????? ?????????????, ???????? ???. ????, ?????????? ?????????? ??????????????
? ??????????;
??????????? ????????? ?????????????, ????????????-????????????;
C?????????? ????? ????????????, ?????? ???. ????, ?????????;
????????? ?????? ??????????, ???? ??????????? ???????????? ???????????;
??????? ????? ??????????, ???? ??????????? ???????????? ???????????;
?????????? ????????? ???????????, ???? ??????????? ???????????? ???????????;
?????? ???? ????????, ?????? ???. ????, ?????????, ???????? ????????? ?????????? ? ??????????
???????? ????? ??. ?.?. ????????;
??????? ??? ?????????, ?????? ???. ????, ?????????, ???????? ??? ? ????, ???????? ?????
??. ?.?. ????????
???? ???????????? ? ??????? ??????????? ??????????????? ? ??????????? ????????????
???????????, ?????????? ???????? ??????????? ?? ?????? ?????? ?????????????????? ???????.
???????? ? ??????. ? ??????????????? ???????????? ???????? 103 ????????, ??????? ?????????
???????? ?? ?????? ? ????????????? ???????????????.
??????????. ? ?????? ????????????????? ??????? ? ??????????? ?? ??????? ???????????????
??????????? ????????? ????????? ????????????? ??????????? ?????. ??? ???????
? ???????????????? ???? ?????????? ?????? ????????????? ??????? ???????? ??????????,
????????????????????????, ??????????????????????, ???????, ????????, ?????? ???????? ?????
? ?????????.
??????????. ?????????? ???????????? ???????????? ??????????????? ? ???????? ??????????
????????????? ????????? ?????????? ?????, ??????, ??????????? ?????? ????????????? ??????
? ?????????????? ? ??????? ? ????????????????.
??????????????? ???????? ????? ?? ???????? ???????, ??????????????? ? ??????? ?????
??????????? ????????????????? ??????????. ???????????? ?????????? ????? ???? ????????????
? ???????? ????????, ?????????????????? ? ????????????? ????????? ???????.
???????? ?????: ???????????????; ????????????? ??????????????; ???????????? ?????????.
?YPERLACTATEMIA IN PATIENTS CARDIAC SURGERY ?ND ITS CORRELATION WITH SUBSEQUENT
CHANGES IN LABORATORY PARAMETERS IN THE EARLY POSTOPERATIVE PERIOD
D.Sh. Samuilova, G.V. Lobacheva, A.A. Rakhimov, E.A. Kolesnikova, I.V. Samorodskaya,
U.L. Borovkova, O.N. Linenko, E.A. Rogal?skaya, I.I. Skopin, L.A. Bockeria
A.N. Bakoulev Scientific Center for Cardiovascular Surgery,
Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Samuilova Daniya Shavketovna, Dr. of Biol., Chief of Clinical Biochemical Laboratory;
Lobacheva Galina Vasil?evna, MD, DM, Professor, Chief of Departament of Resuscitation and Intensive Therapy;
Rakhimov Abduvali Abdurozakovich, MD, PhD, Chief of Departament of Anesthesiology and Resuscitation;
Kolesnikova Ekaterina Aleksandrovna, Anesthesiologist-Intensivist;
Samorodskaya Irina Vladimirovna, MD, DM, Professor;
Borovkova Ul?yana Leonidovna, Physician Clinical Laboratory Diagnostics;
Linenko Ol?ga Nikolaevna, Physician Clinical Laboratory Diagnostics;
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
13
Rogal?skaya Ekaterina Anatol?evna, Physician Clinical Laboratory Diagnostics;
Skopin Ivan Ivanovich, MD, DM, Professor, Director of Institute of Coronary and Vascular Surgery of A.N. Bakoulev SCCS;
Bockeria Leo Antonovich, MD, DM, Professor, Academician of Russian Academy of Sciences and Russian Academy of Medical
Sciences, Director of A.N. Bakoulev SCCS
????????
??????? ?????????????????? ???????
? ??????????????????? ??????? ?? ??????
??????? ?? ???????????? ???????????????????? ???????????, ????????, ?????? ???????? ?? ????????????-???????????????
???????????, ??????? ????????????? ????????? ?????????, ???????????? ????????
?? ????? ?????????????? ????????, ????????????? ??????????? ? ????????? ???????????? ?????????.
?????? ??????? ?????? ?? ?????????
?????????? ????? ????????? ?? ????? ?????????????? ??????? ????????-?????????? ?????????.
???????????? ????????? ??????????
? ??????????????????? ??????? ??????????????? ? ???????? ????? ???????? ?????????
????????????????? ??????????, ??????????? ? ???????????? ???????????????. ????? ?? ?????? ???????????? ???????????
????????????????? ?????????? ????????
??????? ??????? ??????? [1, 2].
???????? ?? ?? ??? ?????? ? ???????? ??????? ???????????? ???????? ????????? ?????? ???????????? ??? ????? ???, ????????
??????????????? ?? ??? ??? ????????? ? ????? ? ??????? ???????? ?? ?????????????.
???? ?????? ???????????? ? ??????? ??????????? ??????????????? ? ???????????
???????????? ??????????, ?????????? ???????? ??????????? ?? ?????? ?????? ?????????????????? ???????.
???????? ? ??????
???????????????? ???????????? ?????????? ? 103 ??????????????????? ???????
(27 ??????, 76 ??????). ??????? ????????? ???????? ? ??????? 62 ???? (95% ??
57?66,3 ????). ???? ??????? ???? ????????? ???????? ? ???????? ?????????????? ?????????????? (??). ? 36 ??????? ???????????????? ???????????? ????????? ? 8 ???????
?? 8 ?????? 2012 ?., ? 41 ?????? ? ? 6 ?? 21 ??????? 2014 ?.
?????????? ??????? ??????? ? ??????????? ? ???????? ?????????????? ??????? ? ??????? ? ? ??????? 12 ? ????? ???????????
???????? ?? ???????????? ? ????????? ?????????? ? ??????????? ??????? (????),
?? ??????????? ABL 800 Flex (Radiometr,
Copenh?gen, ?????). ??????? ?????? ?????,
?????????, ????????, ??????????, ??????????, ?????????????????????? (???), ???????????????????????? (???), ????? ??????? ?? ????????, ??? ??????????? ? ?????
9 ? ????? ??????????? ? ????, ????? 1 ???
????? ???????? ?????????? ?? ????????????? ??????????? Architect c4000 (Abbot).
???????????? ?????? ???????????? ? ??????????? ?? ????????????? ?????- ? ?????????????????? ?????? ???????. ? 1-? ??????
????? 23 ???????? ? ??????? ???????,
?? ??????????? 3,0 ?????/?, 2-? ??????
????????? 29 ????????? ? ??????? ??????? ??
3,1 ?? 8,0 ?????/?, ? 3-? ?????? ????? 25 ????????? ? ??????? ??????? ????? 8,0 ?????/?.
?????????????? ???? ???????????? 4-?
??????, ? ??????? ???????? 26 ?????????
? ????????? ???????, ??????????????? ????????????? ? 22 ??????? 2012 ?. ?? 3 ?????
2014 ?. ??????? ??????? ? ??? ?????????
? ???????? ?? 6,7 ?? 28,0 ?????/?. ?? ???????? ? ???? ?????????????? ????????????
?????????? ????????????? ???????? ???????????? ???????? ?? ???? (? > 0,8 ? ? > 0,25
??????????????).
?????? ?????????? ? ??????? ????????? SPSS (?????? 20.0.01). ??? ?????????????? ??????????? ?????????????? ???????
??????????? ?????????? ??????????????, ? 3, 2014
Objective of the research ? to estimate correlation between hyperlactatemia and changes in laboratory parameters
reflecting multiple organ failure in the early stages of the postoperative period.
Material and methods. The authors retrospectively examined 103 patients undergoing cardiac surgery with cardiopulmonary bypass.
Results. Various changes in blood biochemical parameters were observed in patients in early stages of the postoperative
period. These changes depended on level of hyperlactatemia. High level of creatinine, aspartate aminotransferase,
alanine aminotransferase, amylase, urea and low level of protein and albumin were characteristics for the patients with high
level of hyperlactatemia.
Conclusion. Our results indicate that biochemical signs of renal dysfunction, liver failure, damage of pancreatic cells and
cardiomyocytes are most pronounced in patients with hyperlactatemia.
Hyperlactatemia is one of the warning signs of possible postoperative complications forthcoming. Screening laboratory
tests could be used to predict and/or evaluate the beginning of serious problems.
Key words: hyp?rlactatemia; cardiopulmonary bypass; biochemical parameters.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
14
???????????? ??????
30
16,9
25
????????????????? ??????
????????????????? ??????
20
11,9
15
5,3
10
5
0
2,5
8,7
2,1
3,4
1-? ??????
2-? ??????
5,6
3-? ??????
4-? ??????
???. 1. ????????????????? ? ????????????????? ???????????? ?????? ??????? (?????/?) ? ????????? ???????
???????. ???????????? ???????? ????????????? ??????? (? = 0,0001)
250
??, ???
202,9
200
????????? ?????, ???
158,4
150
100
138,7
114,7
89,4
81,7
72,8
88,1
50
0
1-? ??????
2-? ??????
3-? ??????
4-? ??????
??????????? ?????????? ??????????????, ? 3, 2014
???. 2. ???????????? ?? ? ????????? ????? ? ????????? ??????? ???????. ???????????? ???????? ?? ???????????? ??
????????????? ??????? ??? ????????? 1-? ? 4-? (p < 0,0001), 2-? ? 4-? (? = 0,015) ????? ???????
???????? (?) ? 95% ????????????? ????????. ??? ???????????? ??????????? ? ???????
? ??????? ????????????? ????????. ????????? ?????????????? ??????????? ? ???????
???????, ?????????????? ? ??????????? ??
?????? ???????, ????????? ??? ????????
????????????? ????? ? ????????? ?? ????????????? ????????? ?????????. ??????????? ?????????? ????????? ? ?????????????? ???????? ?????????? ?? ????????. ?????????????? ???????? ????????? ?????????
??? ?????? ? < 0,05.
??????????
????????????????? ??????? ???????
? ???? ??????? ???????? ????????????????? (???. 1). ? ??????? 1-? ?????? ???????????? ????????????????? ??????? ??????? ? ??????? ???????? 2,5 ?????/? (95% ??
2,2?2,7 ?????/?); ?? 2-? ? 3-? ??????? ?
5,3 ?????/? (95% ?? 4,7?5,9 ?????/?)
? 11,9 ?????/? (95% ?? 10,8?13,0 ?????/?)
??????????????. ? ?????? ??????? ? ????????? ??????? ???????????? ??????? ????????? 16,9 ?????/? (95% ?? 14,5?18,6 ?????/?).
???????? ?????????? ?? ??????????????? ? ??????? 4-? ??????, ? ??????? ??? ????????? 202,9 ??? (95% ?? 158,2?247,7 ???),
???????? ??????????????? ?? ???? ? 1-?
?????? ? 114,7 ??? (95% ?? 97,1?132,4 ???)
(???. 2).
??????? ????????? ?????????????? ??????????? ????? ????????????????? ???????
??????? ? ????????????? ?? (r = 0,45;
? = 0,001).
?? ???? ???????? ???????????? ???????? ?? ????????????????? ????????? ?????
(? > 0,9).
????? ?????? ??????? ??????? ??????????? ??????? ? ??????? ? ????????? ??????? ? 23,7% (95% ?? 21,4?25,9%), ?????
??????? ? ? ??????? 1-? ?????? ? 28,3%
(95% ?? 26,7?29,9%) (???. 3).
???????? ?? ?? ??? ?? ?????? ??????????? ????????????? ???????? ????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
29
28
27
26
25
24
23
22
21
15
28,3
25,4
25,2
23,7
1-? ??????
2-? ??????
3-? ??????
4-? ??????
???. 3. ??????????? ???????? ??????????? (%) ?? ????????????????? ?????; ? = 0,002 ??? ????????? 1-? ? 4-? ?????
???????
400
350
1-? ??????
100
2-? ??????
300
250
100
200
150
70,9
78,4
3-? ??????
4-? ??????
100
100
50
65,8
66,8
100
75,3
82,1
78,9
83,5
0
?? ????????
???????????
? ????
????? 9 ?
????? ??????????? ? ????
???. 4. ???????? ?????? ????? (%) ? ?????? ????????????????? ???????. ?? ????? ??????????? ? ???? ? = 0,0001 ???
????????? ??????????? 4-? ? 1-? ????? ???????. ????? 9 ? ????? ?????? ?? ???????????? ? = 0,003 ??? ????????? 4-?,
2-? ? 3-? ????? ???????; ? = 0,0001 ??? ????????? 4-? ? 1-? ????? ???????
400
1-? ??????
100
2-? ??????
300
250
100
200
150
76,2
81,3
3-? ??????
4-? ??????
100
100
50
66,9
72,6
100
74,6
79,2
78,4
81,6
0
?? ????????
???????????
? ????
????? 9 ?
????? ??????????? ? ????
???. 5. ???????? ?????? ????????? (%) ? ?????? ????????????????? ???????. ???????? ????????????? ??????? ?????
1-? ? 4-? ???????? ??????? ??? ??????????? ? ???? ? ????? 9 ? ????? ?????? ?? ???????????? (? = 0,001 ? ? = 0,007
??????????????)
???????? ?????? ????? 1-? ? 4-? ???????? ???????, ??????? ????????????? ????????????????? ???????? ??????????? ????? 24% ?? 2-? ? 3-? ??????? ???? ??????????? ???? ?? ????????? ? 1-? ???????
? ????????? 31 ? 36% ??????? ??????????????.
? ??????? ? ????????? ??????? ?????? ?????????? ??????? ? 46% ???????, ? ? ???????
1-? ?????? ? ??????????? ????, ? 3,8% ???????. ??????? ????????????? ????????? ?????????????? ??????????? ????? ????????-
????????? ??????? ??????????? ? ????????????????? ??????? ??????? (r = ?0,47;
? = 0,001).
????????? ????????????? ???????????
? ?????? ????????????????? ??????? ???????????? ???????????? ???????????????
????????, ????????? ?? 100%.
? ???? ??????? ???????????????? ???????? ?????? ?????? ????? ? ????????? ?????
???????? ???????????? ?????????????? ??
???????????? (???. 4, 5).
??????????? ?????????? ??????????????, ? 3, 2014
350
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2014
16
???????????? ??????
??????????? ???????? ?????? ?????
? ????????? ??? ??????????? ? ???? ??
???????????? ???????? ????? ???????????
? ?????? ??????? ? ????????? ???????. ????? ?? 34% ??????? ?????? ????? ? ?? 33%
??????? ????????? ? ??????? ? ?????????
??????? ????????? ???? ???????????????
??? ??????????? ? ????. ??????? ?????
???????? 48,0 ?/? (95% ?? 43,7?52,3 ?/?),
??????? ????????? ? 28,6 ?/? (95% ??
26,1?31,1 ?/?). ? 46% ??????? ??? ??????
?? ???????????? ??????? ?????? ?????
?????????? ?? 23 ?? 48 ?/?, ????????? ? ?? 13
?? 29 ?/?.
? ??????? 3-? ?????? ??? ???????????
? ???? ???????????????? ???????? ??????
????? ???????????? ??????????????? ? ??????? ?? 29%, ??? ????????? 52,8 ?/? (95% ??
50?55,5 ?/?), ?? ? 36% ??????? ??????? ?????? ????? ????????? ? ???????? ?? 42 ?? 49 ?/?.
??????? ????????? ???????? ?? 24%, ??? ??????????????? ?????? ??????? ?????,
?? ? 28% ??????? ??? ???????????? ????
????? ?????? ? ?? 24 ?? 28 ?/?.
? ??????? 2-? ?????? ?????????? ??????
????? ? ????????? ??? ??????????? ? ????,
???????? ?? ??????? ?????? ?? ????????????????? ?????, ?????????? ?? ???????????
? ?? ??????????? ? ??????? 3-? ??????. ?????? ? 27% ??????? ???? ?????????? ??????
?????????????? ???????? ?????? ????? ?
?? 36 ?? 49 ?/? ? ? 20% ??????? ????????? ?
?? 20 ?? 29 ?/?.
? 1-? ?????? ??????? ?????? ???????? ?????? ????? ? ????????? ????????????????
???? ? 1 (4,3%) ??????. ?????????? ?????
? ????????? ????????? 45 ? 28 ?/? ??????????????.
?? ???? ???????? ??????????? ????? 9 ?
????? ??????????? ? ???? ????????????
?????? ????? ? ????????? ? ??????? 1-?, 2-? ?
3-? ????? ?????????? ? ????????????? ??????????? ? ?????? ???????? ?????. ? ???????
4-? ?????? ?? ?????? ????? ?????????? ??????? ???????????? ????? ?? ??????????, ???????? 48,7 ?/? (95% ?? 44,9?52,6 ?/?). ??? ????
??????? ????????? ????????? ?? 31,0 ?/?
(95% ?? 28,3?33,7 ?/?). ?????? ? 42% ??????? ??????? ????? ? ? 25% ??????? ??????? ????????? ?????????? ????? ??????? ? ?? 28 ??
48 ?/? ? ?? 17 ?? 29 ?/? ??????????????.
??????? ????????? ?????????????? ??????????? ????? ????????????????? ???????
???????????, ??????? ????? ? ????????? ??
????? ??????????? ? ???? (r = 0,55; r = 0,50
??????????????, ? = 0,001).
???????? ?????????? ?????? ????????
??????????????? ? ?????????????? ?????????????? ??????????? ????? ? ????????????????? ??????? ? ??????????????????? ???????
(???. 6). ???????? ??????????? ???? ??????
???????? ??????? ? ??????? 4-? ??????.
??? ????? 9 ? ????? ??????????? ? ???? ?????????? ???????? ? ??? ???????? ?? 48%,
??? ????????? ? ??????? 9,7 ?????/? (95%
?? 8,7?10,6 ?????/?), ? ????? ????? ?????
???????? ? ?? 122%, ???????? 14,5 ?????/?
(95% ?? 12,7?16,3 ?????/?). ??????????
???? ?????? ???????? ?????????? ? ???????
1-? ??????: ? 1-? ??? ????? ???????? ?? ????????? ? ??????? ?? 10,4 ?????/? (95% ??
8,8?11,9 ?????/?). ??????? ?????? ???????-
800
1-? ??????
700
222
600
3-? ??????
500
148
400
2-? ??????
100
122
100
93
300
200
100
93
100
93
100
118
190
4-? ??????
194
128
120
171
????? 9 ? ?????
??????????? ? ????
1-? ??? ?/?
0
?? ????????
???????????
? ????
???. 6. ???????? ?????? ???????? (%). ?? ????? ??????????? ? ???? ? = 0,018 ??? ????????? 1-? ? 3-? ?????, ? = 0,006
??? ????????? 1-? ? 4-? ????? ???????. ????? 9 ? ????? ??????????? ? ???? ? = 0,015 ??? ????????? 1-? ? 3-? ?????
???????, ? = 0,032 ??? ????????? 1-? ? 4-? ????? ???????. ????? ????? ????? ???????? ? = 0,002 ??? ????????? 1-? ?
3-? ?????, ? = 0,036 ??? ????????? 1-? ? 4-? ????? ???????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
600
17
1-? ??????
500
225
3-? ??????
178
400
161
4-? ??????
100
118
124
129
100
113
121
139
100
104
103
100
300
100
2-? ??????
200
100
0
?? ????????
???????????
? ????
????? 9 ? ?????
??????????? ? ????
1-? ??? ?/?
???????, ?? ????????????? ???????? ?????
????? ?????- ? ????????????????? ??????? ??????? ? ????????????? ????????
? ??????? ????? 9 ? ????? ???????????
? ???? (r = 0,31, ? = 0,002 ? r = 0,30, ? = 0,003
??????????????).
?????????? ?????????? ? ??????? 1-?
?????? ?? ??? ??????? ?????????? ?????????? ?? ????? ?????? ? ?? ??????????? ? ??????????????. ????? ??? ? ?????? ???????
??????????? ???????????? ????????? ???
???????????? (???. 7). ???????? ??? ???????? ??????? ? ????????? ???????, ? ???????
??? ??? ??????????? ? ???? ??????? ?????????? ?? 61% ???????? ??????????????, ???????? 153,6 ??????/? (95% ??
140,7?166,6 ??????/?) ? ????????? ????????????? ?? ??????????? ?????? ??????????.
? 1-? ??? ????? ???????? ??????? ?????????? ?? 124% ???????? ????????????????
? ???????? 214,0 ??????/? (95% ?? 187,5?
240,5 ??????/?), ??? ????????? ?? ???????
????????? ???????? ???????.
???????? ?? ?????????????? ??????????
?????? ?????????? ???????????? ???????
??????? ?????, ??? ?????????? ??????? ???????????? ??????????????? ????? ????????????????? ?? ????????? ?????????? ????? ? ??????? 2-? ? 3-? ?????. ? 1-? ??? ?????
???????? ??????? ?????????? ?? 2-? ?????? ???????? 129,6 ??????/? (95% ?? 110?
149 ??????/?, ? 3-? ?????? ? 140,7 ??????/?
(95% ?? 124,2?157,1 ??????/?).
??????? ????????? ?????????????? ??????????? ????? ???????????? ????????-
????????? ??????? ??????? ? ????????????? ?????????? ?? ????? ??????????? ??????? ? ????, ????? 9 ? ????? ?????? ??????? ?? ???????????? ? ? 1-? ??? ?????
???????? (r = 0,40; r = 0,45; r = 0,43 ??????????????, ? = 0,001). ???????? ??????? ?????????????? ????? ????? ????????????
????????? ?????? ???????, ?????????????????? ? ????????? ???? ????? ????????,
? ??????? ?????????? ????? 9 ? ????? ??????????? ??????? ? ???? ? ? 1-? ??? ?????
???????? (r = 0,67; r = 0,61 ??????????????,
? = 0,001).
????? ??????? ?????????? ?????? ? ????
??????? ????? ????????, ?? ?? ???? ????????????? ???????? ???????????? ????????
?? ??? ??????? ?????????? (???. 8). ???????
??????, ?? ????????????? ???????? ?????????????? ??????????? ????? ????????????????? ??????? ??????? ? ??????? ?????????? ????? 9 ? ????? ??????????? ? ????
(r = 0,34; ? = 0,007).
??? ??????????? ?? ????????????
? ???? ???????????????? ????????????
????????? ?????????? ??? ? ?????? ??????? ? ????????? ??????? (???. 9). ?????????? ??? ????????? 104,4 ?/? (95% ??
75,8?132,9 ?/?). ????? 9 ? ?????????? ???????? ? 8 ??? ????????? ??????????????,
???????? 201,3 ?/? (95% ?? 135,6?267,0 ?/?).
?????????? ??? ????? 9 ? ????? ???????????
? ???? ? ??????? 1-? ?????? ?????????
59,7 ?/? (95% ?? 50,7?68,7 ?/?), 2-? ?????? ? 82,9 ?/? (95% ?? 67,8?98 ?/?), 3-?
?????? ? 103,8 ?/? (95% ?? 74,8?132,8 ?/?).
??????????? ?????????? ??????????????, ? 3, 2014
???. 7. ???????? ?????? ?????????? (%). ? ?????? ????????????????? ??????? ? = 0,006 ??? ????????? 1-? ? 3-?,
? < 0,0001 ??? ????????? 1-? ? 4-?, ? = 0,025 ??? ????????? 2-? ? 3-?, ? < 0,0001 ??? ????????? 2-? ? 4-?, ? = 0,019
??? ????????? 3-? ? 4-? ????? ???????. ????? 9 ? ????? ??????????? ? ???? ???????? ????????????? ??????? ?????
1-? ? 3-? (? = 0,006), 1-? ? 4-? (? < 0,0001), 2-? ? 3-? (? = 0,025), 2-? ? 4-? (? < 0,0001), 3-? ? 4-? (? = 0,019) ????????
???????. ? 1-? ??? ????? ???????? ???????? ????????????? ??????? ????? ????? ???????? (? < 0,01), ?? ???????????
1-? ? 2-? (? = 0,083), 2-? ? 3-? (? = 1,000) ????? ???????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
18
???????????? ??????
1000
900
274
800
246
700
1-? ??????
2-? ??????
600
500
400
195
209
224
196
100
100
100
0
3-? ??????
4-? ??????
100
300
200
276
206
100
?? ????????
???????????
? ????
????? 9 ?
????? ??????????? ? ????
???. 8. ???????? ?????? ?????? ?????????? (%) ? ??????? ? ????????? ???????? ??????????. ??????? ?????????? ??
??? ??????? ?????????? ?? ???? ????????????? ???????? ???????? ????? ????????: ? > 0,89 ??? ??????????? ? ????,
? > 0,07 ????? 9 ? ????? ??????????? ? ????
1800
1600
1400
805
1200
1-? ??????
1000
2-? ??????
3-? ??????
418
800
4-? ??????
305
600
238
400
??????????? ?????????? ??????????????, ? 3, 2014
200
0
100
100
100
100
?? ????????
302
207
183
217
???????????
? ????
????? 9 ?
????? ??????????? ? ????
???. 9. ???????? ?????????? ??? (%). ???????? ????????????? ??????? ??? ??????????? ? ???? ????? 1-? ? 4-?
(? = 0,002), 2-? ? 4-? (?<0,005) ???????? ???????. ????? 9 ? ????? ??????????? ? ???? ? < 0,001 ??? ?????????
4-? ?????? ? 1-?, 2-? ? 3-? ???????? ???????
???????? ????????? ?????????????? ??????????? ?????????? ??? ?? ?????? ??????????? ????????? ? ???? ? ????? 9 ????? ????? ?????? ?? ???????????? ? ?????- ? ????????????????? ??????? ??????? (r = 0,44
? r = 0,51; r = 0,48 ? r = 0,58 ??????????????;
? = 0,001).
?????????????? ?????? ???????, ??? ???
??????????? ?? ???????????? ? ????
? ??????? 1-? ?????? ???????? ???, ??????????? 107 ?/? ? ? 3 ???? ??????????? ??????? ?????? ?????, ??????????????? ?????? ? 1 (4,3%) ???????? (???. 10).
? ??????? 2-? ?????? ?????????? ????????,
??????????? ????? ??? ? 3 ???? ???????????????? ??????? ? ??????????? ?? 118 ??
69
70
60
50
40
40
30
20,6
20
10
4,3
0
1-? ??????
(107 E/?)
2-? ??????
3-? ??????
(118?154 E/?) (107?393 E/?)
4-? ??????
(102?701 E/?)
???. 10. ??????? ????????????? (%) ??????? ????????
??? ??? ??????????? ? ????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
19
700
600
1-? ??????
382
500
2-? ??????
400
3-? ??????
100
300
4-? ??????
111
100
145
200
91
100
71
90
100
76
81
?? ????????
???????????
? ????
????? 9 ?
????? ??????????? ? ????
100
0
???. 11. ???????? ??? (%) ? ??????? ? ????????? ???????? ??????????: ? < 0,05 ??? ????????? 4-? ? 1-?, 2-? ? 3-? ???????? ??????? ????? 9 ? ????? ??????????? ? ????
23
25
20
15
8
10
5
4,3
3,4
1-? ??????
(47 E/?)
2-? ??????
(77 E/?)
0
3-? ??????
(100?493 E/?)
4-? ??????
(122?719 E/?)
154 ?/?, ??????????????? ? 21% ???????.
? 40% ??????? 3-? ?????? ????????????
???????? ?????????? ??? ?????????? ? ???????? ?? 107 ?? 393 ?/?, ? ? 69% ??????? 4-?
?????? ? ?? 102 ?? 701 ?/?.
? ?????????? ????????? ??????? ???????? ??? ?? ????? ??????????? ? ????
? ??????? ????????? ????? ?? ???? ???????? ????????????? ???????? ????????
(???. 11), ?????? ????? 9 ? ????? ??????
?? ???????????? ? ??????? 4-? ?????? ???????????????? ????????????? ???????? ????????? ?????????? ???????? ?? 106,8 ?/?
(95% ?? 37,3?176,4 ?/?). ??? ???? ????????
??? ? 1-? ?????? ??????? ????????? 28,2 ?/?
(95% ?? 24?32,3 ?/?), ?? 2-? ? 31,0 ?/?
(95% ?? 25,4?36,6 ?/?), ? 3-? ? 50,3 ?/?
(95% ?? 12,9?87,8 ?/?).
??????? ??????, ?? ????????????? ???????? ????? ?????????????????? ?????? ??????? ? ??????? ??? ????? 9 ? ????? ??????????? ? ???? (r = 0,36; ? = 0,001).
??? ?????????????? ??????? ??????????, ??? ??????? ???????? ??? ????? ?????-
??? ??????????? ????? (???. 12). ???, ????? 9 ?
????? ?????? ?? ???????????? ?????? ? 1 ???????? ?? 1-? ?????? ???????????? ?????????? ???????? ??????????????? 47 ?/?, ???,
???????? ?? ????????? ???????????? ??????????????? ?????? ????? ? 2 ????, ????????????? ????????? ??????? ?????? ?????.
?? 2-? ?????? ? 1 (3,4%) ???????? ??????????
??? ??????????? ???????????? ??????????????? ?????? ? 1,9 ???? ? ???????? ????????????? ???????? ? ???? ?????? ? 77 ?/?.
? 3-? ?????? ? 2 (8,0%) ??????? ??????????
???????? ????????? 100 ? 493 ?/?. ???????
????????, ??? ? ???? 2 ????????? ??????????
??????? ???? ????????????????? ???
? ???????????????? ???????. ? ???????
4-? ?????? (? ????????? ???????) ???????
????????????? ??????? ???????? ??? (??
122 ?? 719 ?/?) ????????? 23%, ?????? ? ????
???? ????????? 4-? ?????? ??????????????
?????????? ?????????? ??? ???????????????
??????????.
? ??????? ? ??????? ??????? ???????
???????????????? ???????? ??????????
??????????? ?????????? ??????????????, ? 3, 2014
???. 12. ??????? ???????????? ???????? ?????????? ??? (%) ????? 9 ? ????? ??????????? ? ???? ? ??????? ? ????????? ???????? ??????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
20
???????????? ??????
1800
1-? ??????
1600
2-? ??????
1400
3-? ??????
819
4-? ??????
1200
1000
800
492
600
400
200
0
100
100
100
100
284
?? ????????
1-? ??? ?/?
195
???. 13. ????????? ?????????? ?????-??????? ????? ???????? ???????????? ?????????????? ???????? (%); ? = 0,025
??? ????????? 1-? ? 4-?, ? = 0,05 ??? ????????? 2-? ? 4-? ????? ???????
60
53
50
41,7
40
30
20
10
9
9
1-? ??????
(175 E/?)
2-? ??????
(337 E/?)
??????????? ?????????? ??????????????, ? 3, 2014
0
3-? ??????
(386?967 E/?)
4-? ??????
(372?1720 E/?)
???. 14. ??????? ????????????? (%) ???????? ???????, ????? ??? ? 3 ???? ??????????? ??????? ??????? ?????, ?
??????? ? ????????? ???????? ??????????
????????????? ???????? ??????????? ?????? ????????????? ?????? (???. 13). ? 1-? ???
????? ???????? ?????????? ??????? ? 1-? ?????? ??????? ????????? 111,6 ?/? (95% ??
79,4?143,8 ?/?), ?? 2-? ? 142,0 ?/? (95% ??
80,7?203,4 ?/?), ? 3-? ? 328,8 ?/? (95% ??
126,3?531,4 ?/?), ? 4-? ? 475,5 ?/? (95% ??
239,5?711,5 ?/?).
??????? ??????, ?? ????????????? ???????? ?????????????? ????? ????????????????? ?????????? ??????? ? ????????????????? ??????? ??????? (r = 0,35; ? = 0,011).
???????? ??????? ??????? ??????????
??????? ??????????? ???? ??????????
? ??????? 3-? ? 4-? ????? (???. 14).
???????????? ?????????????? ????????
?????????? ??????? ? ??????? 1-? ?????? ??
????????? 175 ?/?. ?? 2-? ?????? ???????????? ?????????? ????????, ??????????????? 3-???????? ?????????? ????????
??????? ?????, ????????? 337 ?/? ? ???????-
???? ? 9,0% ???????, ? ??????? 3-? ??????
? 41,7% ??????? ???? ?????????? ??????????
?? 386 ?? 967 ?/?, ? ? 4-? ?????? ? 53% ??????? ? ?? 372 ?? 1720 ?/?.
??????????
??????????? ?????? ??????? ????????????
??? ?????? ???????????? ??????????? ?????? ? ?????? ????????? ???????, ??????????? ? ??????????? ?????????. ???????
??????? ??????? ????????? ? ??????????
????? ????????? ?????????? ? ???????????????? ?????? [3?6].
??????? ???????? ????????, ??? ???????
??????? ???? ? ???????, ????????????? ???
?????? ??????????? ????? 24% [7], ? ??????
? ?????????????????? ?? [8].
????????????? Cell-Saver ?? ?????? ????????? ??????? ??????????? ???????? ??????????? ?? ????? ????????. ?????? ??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ????? ? ????????? ??? ???????????
????????? ?? ???????????? ? ???? ????????????, ????????, ???????? ????????????
??????????? ?? ????? ????????. ????? ????,
??? ???? ?????????? ???????? ??????????
??????????? ? ?????? ??????? ?????, ?????????? ??????? ??????????????? ??????????, ??? ?????????? ???? ????????? ????????????????? ??????????.
?????? ?????? ? ????????? ??????? ????????????? ? ?????????????? ??????????.
?? ????? ??????, ????????????? ???????? ?????????? ?????, ??????, ???????????
?????? ????????????? ??????, ?????????????? ???? ??????? ? ????????????????. ??????????? ???????? ????? ?????????? ????? ???????? ?? ?????? ???????? ?????? ???????? ???????????????.
??????? ???????? ?????? ???????? ??????????????? ????? ???????? ?? ?????? ?????????? ?? 5 ?? 30% [9?11]. ???? ????????
?????? ???????? ??????????????? ?????????
? ????????????? ?? [12], ???????????????? ??????? ?????????? [13], ???????? ??????????? [14?16].
??? ????????????? ??????????? ???????????? ?????? ?????????? ?????????? ??????????????? ?? ?????? ?? ?????????? ?????????? ???????????? ???????? ????, ?????
????? ????????? ????????? ???????? ???????????? ??????????????? ??????. ???????
?????????? ????? ?? ???????? ?? ???????
??????? ??????? ?????, ?? ????????????
?????????? ???????????????? ???????????? (?? 25?50% ? ?????) ???????????????
? ????????? ??????????? ???????? ???????. ???? ?????????????? ?????????? ???????????? ?????????? ??????? ? ?????? ???????? ?????? ???????? ??????????????? ?????????? ?? ???????????????? ???????
????? [17]. ????????? ?? ??????? ?????
? ???????, ?????????? ???????? ?? ??????,
??????? ? ??????? ???????????? [18].
?? ????? ??????, ? 2 ??????? 1-? ?????? (8,7% ???????) ? ?????? ??????? ???????
??? ??????????? ? ???? ??????? ?????????? ????????? ?? 23 ? 61% ???????????? ??????????????? ????????, ?????? ? ???????
???????? ???????????? ?????????? ????????? ??????? ?????? ????? ??? ?? ????????. ?? ????? ??????????? ??????? ?? ???????????? ? ???? ??????? ??????? ????????? ?????? ?????????? ?? 25?60%
???????????? ??????????????? ????????????? ?? 20 ?? 25% ? ??????????? ?? ???????
21
???????????????. ? ??????? ? ????????? ??????? ? 73% ??????? ??????? ?????????? ???
??????????? ? ???? ????????? ?? 25?120%
???????????? ???????????????, ?? ???????????? ??????? ?????? ?????.
?? ????? ?? ????????? ?????????? ?????? ??????????? ? ????? ?????????? ??????????? ? ?????? ?????, ??? ?????????? ?? ?????????? ?????? ?????????? ?? ???? ???????? ???????. ?? ????? ??????, ????? 9 ?
????? ??????????? ? ???? ??????? ????????? ? ???????? ?????? ?????????? ? ??????? ? ??????? ???????, ?? ???????????
3,0 ?????/?, ? ? ????????? ??????? ??? ?????????? ???????????. ??????? ?????? ????????? ?????????? ?/??? ??????????? ?????????? ?????? ? ??????? ? ????????????????.
????? ????, ? ???????????? ???? ????????,
??? ????????????? ????????? ??????????
???????? ? ???????? ???????? ??????????????? ????????? ? ?????????? ???????????? ????????????? ?????? ????????? [19],
??? ????? ?????????????? ??????????
????????????? ???????? ?????????? ???
?????????? ??????????? ? ?????????? ? ?????? ???????? ???????????? ??????????.
????????? ???????? ? ??? ??? ???? ???????
?????????????? ????????? ????????????????,
????????? ?????????? ??????? [20, 21].
?????????? ????????????????????????,
?????? ?? ?????? ???????? ???????????
????????? ?????, ?????????? ? ???? ??????????????????? ??????? ????? ????????.
?? ????? ??????, ????? ??????? ????????
?????????? ???????? ???? ???????????????? ? ??????? ? ?????????? ????????????????, ???, ????????, ??????? ? ????????????
??????? ?? ????????????????? ?????.
?????????, ??? ??????????????? ??????
???????? ????????????? ? ????????, ? ?????????? ? ??? ???? ?? ????? ??????? ?????????? ????? ???????? ?? ??????, ??? ???????????, ?? ?????? ?????? ???????, ? 0,4?27%
??????? ? ??????? ? ????????? ?????? ??????????, ????? ??? ??????????? ?????, ??????
???????? ???????????????, ?????????-???????? ???????????? [22?24].
? ??????????????????? ??????? ? ??????
????????????????? ??????? ???????????
???????? ??????????? ????? ?????????????
? ????? ? ???????? ? ??????????????. ????
????????????? ????????? ???????, ???????
??????? ? 3 ???? ????????? ??????? ??????
?????, ????? ???? ??????? ? ??????????????? ????????? [24].
??????????? ?????????? ??????????????, ? 3, 2014
???????????? ??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
22
???????????? ??????
?? ????? ??????, ? ??????? ? ???????
???????, ?? ??????????? ? ???????????????? ??????? 3 ?????/?, ?? ? ????? ?????? ??
???? ??????????????? ??????? ???????? ???????. ? ??????? ? ???????????????? ? 48% ??????? ??????? ??????? ? 1-? ??? ????? ????????
????? ??? ? 3 ???? ???????? ??????????????
?????????? ? ? 2,5?17 ??? ? ??????? ??????
???????? ?????. ???????????? ????????
?????????? ? ??????? ? ????????? ???????.
10.
11.
12.
13.
14.
??????????
?????????? ???????????? ????????????
???????????????, ??? ????????????? ???????? ?????????? ?????, ??????, ???????????
?????? ????????????? ?????? ? ?????????????? ???????? ???????? ? ??????? ? ????????????????.
??? ??????????? ??????????????? ???????? ????? ?? ???????? ???????, ??????????????? ? ??????? ????? ??????????? ????????????????? ?????????? ? ?????????
? ???????????? ???????????????, ? ???????????? ?????????? ????? ???? ????????????
? ???????? ???????? ?????? ?????????????
????????? ???????.
??????????
??????????? ?????????? ??????????????, ? 3, 2014
1.
2.
3.
4.
5.
6.
7.
8.
9.
Jansen T.C., van Bommel J., Woodward R., Mulder P.G., Bakker J.A. Association between blood lactate levels. Sequential
organ failure assessment subcores, and 28-day mortality during
early and late intensive care unit stay: a retrospective observational study. Crit. Care Med. 2009; 37 (8): 2369?74.
Badreldin A.M., Doerr F., Brehm B.R., Abul-Dahab M.,
Lehmann T., Bayer O. et al. Mortality prediction after cardiac surgery: blood lactate is indispensible. Thorac. Cardiovasc. Surg.
2013; 61 (8): 708?17.
Hajjar L.A., Almeida J.P., Fukushima J.T., Rhodes A., Vincent J.L., Osawa E.A., Galas F.R. High lactate levels are predictors of major complications after cardiac surgery. J. Thorac.
Cardiovasc. Surg. 2013; 146 (2): 455?60.
Jabarri A., Banihashem N., Alijanpour E., Vafaey H.R., Alereza H., Rabiee S.M. Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method. Caspian.
J. Intern. Med. 2013; 4 (2): 662?6.
Kogan A., Preisman S., Bar A., Stemic L., Lavee J., Malachy A.
et al. The impact of hyperlactatemia on postoperative outcome
after adult cardiac surgery. J. Anesth. 2012; 26 (2): 174?8.
??????? ?.?., ??????????? ?.?., ????????? ?.?., ????????? ?.?. ???????????????? ? ????????????? ??????????
??????? ?????????????????? ??????? ? ??????????????????? ??????? (??????????????? ????????????). ???????????
?????????? ??????????????. 2012; 4: 25?30.
Habib R.H., Zacharias A., Schwann T.A., Riordan C.J., Durham S.J., Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be
changed? J. Thorac. Cardiovasc. Surg. 2003; 125 (6): 1438?50.
Ranucci M., Isgro? G., Romitti F., Mele S., Biagioli B., Giomarelli P. Anaerobic metabolism during cardiopulmonary bypass:
predictive value of carbon dioxide derived parameters. Ann.
Thorac. Surg. 2006; 81 (6): 2189?95.
Moguel-GonzАlez B., Wasung-de-Lay M., Tella-Vega P., Riquelme-Mc-Loughlin C., Villa A.R.,Madero M., Gamba G. Acute
kidney injury in cardiac surgery. Rev. Invest. Clin. 2013; 65 (6):
467?75.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
D?Onofrio A., Cruz D., Bolgan I., Auriemma S., Cresce G.D.,
Fabbri A., Ronco C. RIFLE criteria for cardiac surgery-associated acute kidney injury: risk factors and outcomes. Congest. Heart
Fail. 2010; 16 (Suppl. 1): S32?6.
Dasta J.F., Kane-Gill S.L., Durtschi A.J., Pathac D.S., Kellum J.A. Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. Nephrol. Dial. Transplant. 2008; 23: 1970?4.
Kumar A.B., Suneja M., Bayman E.O., Wiede G.D., Tarasi M.
Association between postoperative acute kidney injury and duration of cardiopulmonary bypass: a meta-analysis. J. Cardiothorac.
Vasc. Anesth. 2012; 26 (1): 64?9.
Roh G.U., Lee J.W., Nam S.B., Lee J., Choi J.R., Shim Y.H. Incidence and risk factors of acute kidney injury after thoracic aortic
surgery for acute dissection. Ann. Thorac. Surg. 2012; 94 (3): 766?71.
De Somer F., Mulholland J.W., Bryan M.R., Aloisio T., Van
Nooten G.J., Ranucci M. O2 delivery and CO2 production during
cardiopulmonary bypass as determinants of acute kidney injury:
time for a goal-directed perfusion management? Crit. Care. 2011;
15 (4): R192.
Huybregts P.A., de Vroege R., Jansen E.K., van Schijndel A.W.,
Christiaans H.M., van Oeveren W. The association of hemodilution and transfusion of red blood cells with biochemical markers
of splanchnic and renal injury during cardiopulmonary bypass.
Anesth. Analg. 2009; 109: 331?9.
Karkouti K., Beattie W.S., Wijeysundera D.N., Rao V., Chan C.,
Dattilo K.M. et al. Hemodilution during cardiopulmonary bypass
is an independent risk factor for acute renal failure in adult cardiac
surgery. J. Thorac. Cardiovasc. Surg. 2005; 129: 391?400.
Liotta M., Olsson D., Sartipy U., Holzmann M.J. Minimal
changes in postoperative creatinine values and early and late mortality and cardiovascular events after coronary artery bypass grafting. Am. J. Cardiol. 2014; 113 (1): 70?5.
Mao H., Katz N., Ariyanon W., Blanca-Martos L., Ady?belli Z.,Giuliani A. et al. Cardiac surgery-associated acute kidney
injury. Cardiorenal Med. 2013; 3 (3): 178?99.
Hanssen S.J., Lubbers T., Hodin C.M., Princen F.W., Buurman W.A., Jacobs M.J. Hemolysis results in impaired intestinal
microcirculation and intestinal epithelial cell injury. World J.
Gastroenterol. 2011; 17 (2): 213?8.
Mebazaa A., Pitsis A.A., Rudiger A., Toller W., Longrois D.,
Ricksten S.E. et al. Clinical review: practical recommendations
on the management of perioperative heart failure in cardiac surgery. Crit. Care. 2010; 14 (2): 201.
Tritapepe L., De Santis V., Vitale D., Guarracino F., Pellegrini F.,
Pietropaoli P., Singer M. Levosimendan pre-treatment improves
outcomes in patients undergoing coronary artery bypass graft surgery. Br. J. Anaesth. 2009; 102 (2): 198?204.
Perez A., Ito H., Farivar R.S., Cohn L.H., Byrne J.G., Rawn J.D.
et al. Risk factors and outcomes of pancreatitis after open heart
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FernАndez-del Castillo C., Harringer W., Warshaw A.L., Viahakes G.J., Koski G., Zaslavsky A.M. et al. Risk factors and outcomes of pancreatitis after open heart surgery. Am. J. Surg. 1991;
325: 382?7.
Chung J.W., Ryu S.H., Jo J.H., Park J.Y., Lee S., Park S.W. et al.
Clinical implications and risk factors of acute pancreatitis after
cardiac valve surgery. J. Med. Yonsei. 2013; 54 (1): 154?9.
References
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2.
3.
4.
Jansen T.C., van Bommel J., Woodward R., Mulder P.G., Bakker J.A. Association between blood lactate levels. Sequential
organ failure assessment subcores, and 28-day mortality during
early and late intensive care unit stay: a retrospective observational study. Crit. Care Med. 2009; 37 (8): 2369?74.
Badreldin A.M., Doerr F., Brehm B.R., Abul-Dahab M.,
Lehmann T., Bayer O. et al. Mortality prediction after cardiac surgery: blood lactate is indispensible. Thorac. Cardiovasc. Surg.
2013; 61 (8): 708?17.
Hajjar L.A., Almeida J.P., Fukushima J.T., Rhodes A., Vincent J.L., Osawa E.A., Galas F.R. High lactate levels are predictors of major complications after cardiac surgery. J. Thorac.
Cardiovasc. Surg. 2013; 146 (2): 455?60.
Jabarri A., Banihashem N., Alijanpour E., Vafaey H.R., Alereza H., Rabiee S.M. Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method. Caspian.
J. Intern. Med. 2013; 4 (2): 662?6.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Kogan A., Preisman S., Bar A., Stemic L., Lavee J., Malachy A.
et al. The impact of hyperlactatemia on postoperative outcome
after adult cardiac surgery. J. Anesth. 2012; 26 (2): 174?8.
Bockeria L.A., Samorodskaya I.V., Samuilova D.Sh., Borovkova U.L. Hematologic and biochemical predictors of postoperative course in cardiosurgical patients (retrospective study).
Klinicheskaya fiziologiya krovoobrashcheniya. 2012; 4: 25?30.
Habib R.H., Zacharias A., Schwann T.A., Riordan C.J., Durham S.J., Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be
changed? J. Thorac. Cardiovasc. Surg. 2003; 125 (6): 1438?50.
Ranucci M., Isgro? G., Romitti F., Mele S., Biagioli B., Giomarelli P. Anaerobic metabolism during cardiopulmonary bypass:
predictive value of carbon dioxide derived parameters. Ann.
Thorac. Surg. 2006; 81 (6): 2189?95.
Moguel-GonzАlez B., Wasung-de-Lay M., Tella-Vega P., RiquelmeMc-Loughlin C., Villa A.R.,Madero M., Gamba G. Acute kidney
injury in cardiac surgery. Rev. Invest. Clin. 2013; 65 (6): 467?75.
D?Onofrio A., Cruz D., Bolgan I., Auriemma S., Cresce G.D.,
Fabbri A., Ronco C. RIFLE criteria for cardiac surgery-associated acute kidney injury: risk factors and outcomes. Congest. Heart
Fail. 2010; 16 (Suppl. 1): S32?6.
Dasta J.F., Kane-Gill S.L., Durtschi A.J., Pathac D.S., Kellum J.A. Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. Nephrol. Dial. Transplant. 2008; 23: 1970?4.
Kumar A.B., Suneja M., Bayman E.O., Wiede G.D., Tarasi M.
Association between postoperative acute kidney injury and duration of cardiopulmonary bypass: a meta-analysis. J. Cardiothorac.
Vasc. Anesth. 2012; 26 (1): 64?9.
Roh G.U., Lee J.W., Nam S.B., Lee J., Choi J.R., Shim Y.H.
Incidence and risk factors of acute kidney injury after thoracic
aortic surgery for acute dissection. Ann. Thorac. Surg. 2012; 94
(3): 766?71.
De Somer F., Mulholland J.W., Bryan M.R., Aloisio T., Van
Nooten G.J., Ranucci M. O2 delivery and CO2 production during
cardiopulmonary bypass as determinants of acute kidney injury:
time for a goal-directed perfusion management? Crit. Care. 2011;
15 (4): R192.
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Huybregts P.A., de Vroege R., Jansen E.K., van Schijndel A.W.,
Christiaans H.M., van Oeveren W. The association of hemodilution and transfusion of red blood cells with biochemical markers
of splanchnic and renal injury during cardiopulmonary bypass.
Anesth. Analg. 2009; 109: 331?9.
Karkouti K., Beattie W.S., Wijeysundera D.N., Rao V., Chan C.,
Dattilo K.M. et al. Hemodilution during cardiopulmonary bypass
is an independent risk factor for acute renal failure in adult cardiac
surgery. J. Thorac. Cardiovasc. Surg. 2005; 129: 391?400.
Liotta M., Olsson D., Sartipy U., Holzmann M.J. Minimal
changes in postoperative creatinine values and early and late mortality and cardiovascular events after coronary artery bypass grafting. Am. J. Cardiol. 2014; 113 (1): 70?5.
Mao H., Katz N., Ariyanon W., Blanca-Martos L., Ady?belli Z.,Giuliani A. et al. Cardiac surgery-associated acute kidney
injury. Cardiorenal Med. 2013; 3 (3): 178?99.
Hanssen S.J., Lubbers T., Hodin C.M., Princen F.W., Buurman W.A., Jacobs M.J. Hemolysis results in impaired intestinal
microcirculation and intestinal epithelial cell injury. World J.
Gastroenterol. 2011; 17 (2): 213?8.
Mebazaa A., Pitsis A.A., Rudiger A., Toller W., Longrois D.,
Ricksten S.E. et al. Clinical review: practical recommendations
on the management of perioperative heart failure in cardiac surgery. Crit. Care. 2010; 14 (2): 201.
Tritapepe L., De Santis V., Vitale D., Guarracino F., Pellegrini F.,
Pietropaoli P., Singer M. Levosimendan pre-treatment improves
outcomes in patients undergoing coronary artery bypass graft surgery. Br. J. Anaesth. 2009; 102 (2): 198?204.
Perez A., Ito H., Farivar R.S., Cohn L.H., Byrne J.G., Rawn J.D.
et al. Risk factors and outcomes of pancreatitis after open heart
surgery. Am. J. Surg. 2005; 190: 401?5.
FernАndez-del Castillo C., Harringer W., Warshaw A.L., Viahakes
G.J., Koski G., Zaslavsky A.M. et al. Risk factors and outcomes
of pancreatitis after open heart surgery. Am. J. Surg. 1991; 325:
382?7.
Chung J.W., Ryu S.H., Jo J.H., Park J.Y., Lee S., Park S.W. et al.
Clinical implications and risk factors of acute pancreatitis after
cardiac valve surgery. J. Med. Yonsei. 2013; 54 (1): 154?9.
╘ ????????? ???????, 2014
??? 616.124.2-089.844:616.132.2-089.819.5:617-089.5
????????????????? ???????????? ??? ??????????????
????????????? ?????? ????????? ? ????????? ? ???????????????
????????????? ? ?????????????? ??????? ??????? ????????????
????????? ??? ????????? ?????????? ????? ?????????
?.?. ??????????, ?.?. ???????????, ?.?. ???????, ?.?. ????????, ?.?. ???????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????), ?????????? ?????, 135, ??????, 121552, ?????????? ?????????
?????????? ?????? ?????????, ???????? ???. ????, ??. ????. ????., ??????? ???????????? ?????????
??????????????-??????????; e-mail: ma-z@mail.ru;
??????????? ????? ??????????, ????-????????????;
??????? ???????? ?????????????, ???????? ???. ????, ?????????? ?????????? ??????????????-??????????;
???????? ?????? ??????????, ?????? ???. ????, ?????????, ?????????? ?????????? ??????????
? ??????????? ???????;
??????? ?????? ??????????, ?????? ???. ????, ?????????, ?????????? ?????????? ??????????????
??????? ??????????? ??????? ??????
???? ???????????? ? ???????? ????????????????? ???????????? ??? ??????????????
????????????? ?????? ????????? (????) ? ????????? ? ??????????????? ????????????? (???) ???
????????????? ??????? ??????? ???????????? ????????? (????) ??? ????????? ?????????? ?????
????????? (??).
??????????? ?????????? ??????????????, ? 3, 2014
????????? 30.05.2014
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
24
???????????? ??????
???????? ? ??????. ? ????????? ?????????????? ??????? ??????????? ??????? ?????? (???)
????? ??? 70 ????????? ????????? ???? ?? ???? ? ??? ? ???????? ?????????????? ?????????????? (??) ? ???????????????? ????????????. ? ???????????? ????? 53 ????????, ?? ??? 41 ???????
? 12 ??????. ??? ??????????? ???? ????????? ?? ??? ?????? ? ??????????? ?? ???? ?????????:
???????? ?????? ????????? 30 (56,6%) ?????????, ? ??????? ? ???????? ????????? ??????????
????????? ???????????? ???? (??+????), ??????????? ?????? ? 23 (43,4%) ???????? ? ????????????
????????????????? ????? ?????????? (???).
??????????. ????????? ? ????? ????????? ??????? ??? ???????????????? ???? ??? ????
?? ???? ? ????????? ? ??? ? ???????? ?? ?????????????? ????????? ????????????? ?????? ?????????? ?????? ? ??????????? ????????????????? ???????????? ? ?????. ?? ???? ??????
????????????????? ??????? ????????????? ???????????? ? ???????? ?????? ????????? ??????????? ???? ? ???? ????? ??????????, ??? ? ??????????? ??????, ?? ???? ?????????? ?????????????????? ??????. ? ??????????? ?????? ???????? ????????? ?????????????? ????????????, ?????????????
????? ?????? ??????????????? ? ???????????? (???????????????? ????????? ?????????????? ?
????) ?????????. ?? ?????? ???????????, ?????????????? ???????????????? ???????, ??????????
? ????????????????? ?????????? ??????? ? ????????? ?????????? ? ??????????? ??????? (????)
???????? ????????????? ??????????? ??????? ? ?????? ????????? ???????? ??????.
??????????. ?? ?????????? ????? ?????????????????? ??????? ? ???????? ?????? ??????????????
?????????? ??????????? ? ?????????????? ????????????, ?????????? ????????? ?????????? ?????.
???????? ????????? ? ???????? ???????? ? ???????? ??????? ? ??? ????????????. ??????? ?????
??????????? ??????? ?????????? ??????????, ????????????? ???????????? ? ???????????, ???
???????? ?? ???????? ?????????????? ????????, ???????????? ????????????????? ?????????????
?????????? ?????? ? ?????? ??????? ?????????? ? ????.
???????? ?????: ???????????? ? ?????????; ????????????????? ?????? ?????????????
??????????????; ?????????? ????????????? ?????????; ?????????????? ??????????? ???????
??????; ????????? ?????? ?????????.
INTRAOPERATIVE HEMODYNAMICS IN LEFT VENTRICULAR GEOMETRIC RECONSTRUCTION
COMBINED WITH CORONARY ARTERY BYPASS GRAFTING USING HIGH THORACIC EPIDURAL
ANESTHESIA AS A BASIC COMPONENT OF GENERAL ANESTHESIA
M.V. Zatevakhina, A.F. Farzutdinov, A.A. Rakhimov, G.V. Lobacheva, M.M. Alshibaya
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
??????????? ?????????? ??????????????, ? 3, 2014
Zatevakhina Marina Vadimovna, MD, PhD, Chief Research Associate, Scientific Head of Department of Anesthesiology
and Intensive Care;
Farzutdinov Artur Fargatovich, Anesthesiologist;
Rakhimov Abduvali Abdurozakovich, MD, PhD, Chief of Department of Anesthesiology and Intensive Care;
Lobacheva Galina Vasil?evna, MD, DM, Professor, Chief of Department of Intensive Care;
Alshibaya Mikhail Mikhaylovich, MD, DM, Professor, Chief of Department of Surgical Treatment of Ischemic Heart Disease
Objective ? to examine the intraoperative hemodynamics in left ventricular geometric reconstruction in conjunction
with coronary artery bypass grafting (CABG) using high thoracic epidural anesthesia (HTEA) as the main component of
general anesthesia (GA).
Material and methods. In the Department of surgical ischemic heart disease (IHD) treatment in more than 70 patients
underwent a left ventricular geometric reconstruction (Dor procedure) and CABG in conditions of extracorporeal circulation (EC) and pharmaco-cold cardioplegia. The study included 53 patients: 41 men and 12 women. All examined patients
were divided into 2 groups depending on the type of anesthesia. The main study group contained 30 (56.6%) patients, who
received HTEA (GA + HTEA) as the principal component of anesthesia, and the control group was composed of 23 (43.4%)
patients who received a classical multicomponent general anesthesia (MGA).
Results. The inclusion of HTEA in anesthesia schemes for patients with IHD during left ventricular geometric reconstruction (Dor procedure) in combination with CABG in conditions of artificial blood circulation has increased the efficiency of
the ventricles and optimized intraoperative hemodynamics in general. At all stages of the perioperative period hemodynamic efficiency in the main study group was significantly higher and more stable than in the control group, caused by an
increased heart performance. In the control group a progressive instability of hemodynamics was observed, requiring
more powerful medicinal and mechanical (intraaortical ballon contrapulsation) support.
A statistically reliable difference in the time of anesthesia recovery, recovery of autonomous respiration and extubation, as well
as the patients' stay duration in the resuscitation department has been observed in favour of patients in the main study group.
Conclusion. During the intraoperative period in core group established an adequate central and peripheral hemodynamics, the absence of acute heart failure main rhythm. A tendency to reduce the pressure in pulmonary artery and its stabilization. Could also significantly reduce the number of hypnotic drugs, narcotic analgesics and neuromuscular blocking
agents that affect the speed of recovery of consciousness, duration after the operating artificial pulmonary ventilation and
the total time of stay in the intensive care department.
Key words: hemodynamics and anesthesia; intraoperating evaluation of the efficiency of the blood circulation; physiology of the peridural anesthesia; cardiosurgery of ischemic disease of the heart; left ventricular aneurysm.
????????
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? ????????? ?????????????? ??????? ???
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??????? ??????????? ??????? ??????, ??????????????? ??????????????, ?????????????? ????????? ?? ??? ??????????, ??????
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???? ??????????? 53 ???????? (41 ???????
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(43,4%) ???????? ? ???????????? ????????????????? ????? ?????????? (???).
???????? ???????-??????????????? ?????????? ??????? ????? ????? ????????????
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??????? ??????? ????????? ????????? ????? ??????? ????????? ??????????????-?????????????? ? ?????? ??????? ?????????
?????????? ? ?????? ???? ????????? ??? ????????????? ????????????? ?????????? ???????? ????? ?????????, ?????? ?? ????????
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???????????????????? ??????? ??????? ??????? ???????????? ????????? (????) [5, 6].
??????????????? ???????? ??????? ????????????? ????????? (??) ? ???? ?????? ???????? [6, 7, 9?13]. ??? ???????? ????????
??????? ?????? ? ???????????? ???????????????????? [3?5, 8]. ?????? ??????????? ??
?????????? ? ??????? ??? ???????? ?????????????? ????????????? ?????? ?????????
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9.
10.
11.
12.
13.
References
1.
2.
3.
4.
5.
6.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
??????? ?.?., ????????? ?.?., ?????? ?.?. ???????????????? ????????: ?????????? ??????? ? ???? ????????. ?????? ???. 1999; 6: 102?12.
??????????? ?.?., ??????? ?.?. (???.). ????????-?????????? ????????. ?.: ????????; 1996.
????????? ?.?. ??????????? (???????????? ? ??????????) ????????? ? ?????????? ? ??????? ? ??????? ???????????-??????????????????? ??????: ???????. ???. ?
?-?? ???. ????. ???; 1993.
????????? ?.?., ????????? ?.?., ??????? ?.?. ????????????????? ???????????? ? ???????????? ?????????
??? ?????????? ????????????. ????????. 1998; 5: 13?7.
??????? ?.?., ?????????? ?.?., ?????? ?.?., ??????? ?.?.
??????????? ????????? ? ??????????????. ??????? ??????????? ???????. 2006; 4: 37?42.
?????????? ?.?., ????????? ?.?., ?????? ?.?. ????????????? ?????????????? ??????????? ? ???????????????? ??????? ??????? ??????? ???????????? ?????????
??? ?????????????? ???????????????? ???????? ?? ?????? ?????? ?????????????? ??????????? ????????.
??????? ??????????? ???????. 2012; 3: 29?35.
??????????? ?.?. ????????? ? ????????? ????????????. ???; 2000.
?????????? ?.?., ???????? ?.?., ?????? ?.?. ???????
?????????? ??????????? ?????????. ??????????? ?????????? ??????????????. 2009; 2: 30?4.
Chen G.Z., Zhonghua Yi Xue Za Zhi. Effects of high thoracic
epidural anesthesia on ventricular remodeling and ??pression
of beta-adrenoreceptor in rats with heart failure induced by
acute myocardial infarction. Article in Chinese. 2009; 89 (47):
3366?70.
Jakobsen C.J. et al. High epidural analgesia improves left ventricular function in patients with ischemic heart. Acta
Anestesiol. Scand. 2009; 53 (5): 559?64.
Jakobsen C.J. et al. High thoracic epidural analgesia improves
cardiac performance in cardiac surgery patients. J. Cardio-Thorac. Vasc. Anesth. 2012; 26 (6): 1039?47.
Bromage P.K. The physiology and pharmacology of epidural
blockage. Clin. Anesth. 1971; 7 (3): 45?61.
Wu S., Zhonghua Yi Xue Za Zhi. Clinical observation of high
thoracic epidural anesthesia therapy for patients with congestive heart failure secondary to ischemic cardiomiopathy.
Article in Chinese. 2007; 87 (25): 1752?4.
7.
8.
9.
10.
11.
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13.
Bockeria L.A., Berishvili I.I., Sigaev I.Yu. Revascularization of
the myocardium: the changeling is near and way of development. Annaly hirurgii. 1999; 6: 102?12 (in Russian).
Burakovskiy V.I., Bockeria L.A. (eds.). Cardiovascular surgery.
Moscow: Meditsina; 1996 (in Russian).
Borovskikh N.A. Regional (spinal and epidural) anesthesia and
analgesia in patients with high operating-anesthesiological
risk. Dr. med. sci. Thesis in Diss. St. Petersburg; 1993 (in
Russian).
Kornienko A.N., Ivanchenko V.I., Kirtaev A.G. Multicomponent intravenose and epidural anesthesia with a coronary bypass. Khirurgiya. 1998; 5: 13?7 (in Russian).
Votyakov A.L., Zatevakhina M.V., Davoyan T.A., Sukhanov S.G.
Regional anesthesia in heart surgery. Vestnik intensivnoy terapii.
2006; 4: 37?42 (in Russian).
Zatevakhina M.V., Merzlyakov V.Yu., Davoyan T.A. The comparative characteristic of the standard and modified the procedures of high thoracic epidural anesthesia with off-pump
revascularization myocardial on the basis of the evaluation of
the contracting myocardial ability. Vestnik intensivnoy terapii.
2012; 3: 29?35 (in Russian).
Lebedinskiy K.M. Anesthesia and systemic hemodynamics.
St. Petersburg; 2000 (in Russian).
Diasamidze K.E, Khinchagov D.Ya., Omonov S.Kh. History of the application of regional anesthesia. Klinicheskaya fiziologiya krovoobrashcheniya. 2009; 2: 30?4 (in Russian).
Chen G.Z., Zhonghua Yi Xue Za Zhi. Effects of high thoracic
epidural anesthesia on ventricular remodeling and ??pression
of beta-adrenoreceptor in rats with heart failure induced by
acute myocardial infarction. Article in Chinese. 2009; 89 (47):
3366?70.
Jakobsen C.J. et al. High epidural analgesia improves left ventricular function in patients with ischemic heart. Acta
Anestesiol. Scand. 2009; 53 (5): 559?64.
Jakobsen C.J. et al. High thoracic epidural analgesia improves
cardiac performance in cardiac surgery patients. J. Cardio-Thorac. Vasc. Anesth. 2012; 26 (6): 1039?47.
Bromage P.K. The physiology and pharmacology of epidural
blockage. Clin. Anesth. 1971; 7 (3): 45?61.
Wu S., Zhonghua Yi Xue Za Zhi. Clinical observation of high
thoracic epidural anesthesia therapy for patients with congestive heart failure secondary to ischemic cardiomiopathy.
Article in Chinese. 2007; 87 (25): 1752?4.
????????? 30.05.2014
??????????? ?????????? ??????????????, ? 3, 2014
????????? ????????????? ? ? ????? ? ????????????? ?? ????? ?????????? ??????? ???????. ? 1 (3,3%) ???????? ????????? ????
? ????? ? ??, ?? ????????????? ???????????????? ??????????. ?????? ?????????? ??
????????. ? ?????? ??? ???? ????????????
? 82,3% ??????? ? ? ????? ? ??????? ????????? ????????????????. ??????? ? ????? ??????? ?? ????.
6. ????? ?????????? ? ???? ?????????
??????????? ?????? (???) ????? ?????????
?????, ??????????? ?? ??????? ????????? ???????? ??????. ??? ???? ??????????? ???????????????? ?????????????? ???? ? ?????????????? ???????? ????????????????
????????? ??? ??????? ????????????? ????????? ???????????????.
7. ???????? ???? ????? ???????? ????????????? ???????????? ?? ???? ?????????? ????? ????????????????? ??????????
(? ?????????????? ?????? ?? ?? ???????),
?????????? ?????????? ???????????? ???
????????? ????????????, ? ????? ?????????? ?????? ?????????? ??????? ? ????
? ? ????? ? ??????????.
33
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
34
???????????? ??????
╘ ????????? ???????, 2014
??? 616.12-007-053.1-052-089.168.1-06:616.12-008.318
????????? ????? ? ???????????? ?????? ? ??????
????????????????? ??????? ? ????? ????? ????????
????????????? ???????????? ??? ????????? ?????????
D-???????????? ????????????? ???????
?.?. ???????, ?.?. ??????????, ?.?. ???????, ?.?. ????????????,
?.?. ??????????, ?.?. ???????????, ?.?. ???????
??????????? ?????????? ??????????????, ? 3, 2014
???? ╚??????????? ????? ????????-?????????? ????????╩ ???????????? ??????????????? ??,
??. ???????, 6, ?????, 440071, ?????????? ?????????
??????? ????????? ??????????, ????????????-????????????; e-mail: D.E.N.doc@yandex.ru;
?????????? ???? ?????????, ???????? ???. ????, ?????????;
??????? ????? ???????????, ????????????-????????????;
???????????? ????? ?????????, ????????????-????????????;
?????????? ????????? ?????????????, ?????????? ?????????? ??????????????-??????????;
??????????? ??????? ??????????, ?????? ???. ????, ?????????? ??????????????????? ?????????? ?4;
??????? ??????? ???????????, ?????? ???. ????, ??????? ????
???? ???????????? ? ???????? ??????? ? ??????????? ????????????? ????????? ????? ?
???????????? ? ????? ????? ???????? ????????????? ????????????, ? ????? ?????? ?? ??????? ??
?????????? ???????????? ???????.
???????? ? ??????. ? ???????????? ???????? 103 ???????? ? ?????????? ??????? ????????????
????????????? ???????, ????????????? ? 2010?2014 ??. ? ?????? ?????? ????? 33 ???????? ?
??????????? ????? ?????? ? ????????????. ??????? ???????? ????????? 17,7 ??? (?? 1 ?? 94 ????),
??????? ????? ???? ? 3,42 ?? (?? 2,5 ?? 5,6 ??). ?????? ?????? ?????????? 70 ?????????, ? ???????
????????? ????? ?? ????????. ??????? ???????? ????????? 10,6 ??? (?? 1 ?? 79 ????), ???????
????? ???? ? ???? ?????? ???? 3,5 ?? (?? 2,48 ?? 4,6 ??).
???????????????? ????????? ??????? ????? ????????????? ???????: ???????, ???, ???????,
??????? ???????????? ? ????????? ?? ????????, ???????? ??????? ??????????????? ???????????
(????) ? ????????????? ???? ?????, ??????? ?????????? ????????, ????????????????? ?????????????? ?????????????? ? ????????? ?????, ??????? ????????? ???????? (Aristotel Score), ???????
???????, ??????? ???????, ?????????? ????? ????? ????????, ????????????? ??????? ??????????????. ???????, ??????????? ?????????? ?????????, ???? ??????????? ???????????????
???????????? ? ??????? ?????????????? ?????????????? ?????????????? ???????.
??????????. ??????? ????????????? ????????? ????? ????????? 32,0% (33 ??????), ???????????? ?
91,3% (94 ????????). ???????? ????????????????? ??????????? ????? ????????? ????????????
????????????? ??????? ???????? ? 39,4% (13 ???????). ??????? ?? ??????? ????????????? ?????????
??????? ???????????? ?????????? ? ??????????????????? ??????? III ??????? ? ?? 6 (18,2%) ???????.
????????? ????? (?? 6% ???????) ????????? ????? ???? ???????????? ??????????? ???????????,
?????? ??????????? ??????????????? ? JET-??????? ???????????, ??????? ? 1 (3,0%) ?????? ???????
? ??????????? ??????????. ? 1 (3,0%) ?????? ? ???????? ????????? ??????????? ??????????.
???????????? ???????? ????????? ????? ? ?????? ????????????????? ??????? ???????: ???????
???????? ????????????? ???????? (??) ?? ???????? (? = 0,001, 95% ?? [76,6?93,6], OR 0,847),
?????????? ???????? ???? (? = 0,05, 95% ?? [95,8?101,4], OR 9,860), ??????? ??????? ??????
????????? ????? ???????? (? = 0,002, 95% ?? [85,6?96,4], OR 0,908).
??????????. ??????? ???????? ????????? ????? ?????? ????? ???????? ?????????????
???????????? ????????? 32,0%. ???????? ????????????????? ??????????? ????? ?????????
???????????? ????????????? ??????? ????????? ? 39,4% ???????. ????????????? ?????????
???????????? ???????? ????????? ????? ???????: ??????? ???????? ?? ?? ????????, ??????????
???????? ????, ???????? ??????? ??????? ?????? ????????? ????? ????????.
???????? ?????: ????????? ????? ? ????????????; ???????????? ????????????; ????????????????? ??????.
CARDIAC RHYTHM AND CONDUCTION HEART SYSTEM DISTURBANCES
IN THE EARLY POSTOPERATIVE PERIOD IN PATIENTS AFTER THE OPERATION
OF ARTERIAL SWITCH IN DIFFERENT TYPES OF D-TRANSPOSITION OF THE GREAT ARTERIES
E.N. Isakova, Yu.B. Kalinicheva, E.A. Shvetsova, E.K. Zaynetdinova,
A.A. Gornostaev, A.E. Chernogrivov, V.V. Bazylev
Federal Center of Cardiovascular Surgery, Ministry of Health of the RF, ul. Stasova, 6, Penza, 440071, Russian Federation
Isakova Ekaterina Nikolaevna, Anesthesiologist-Intensivist;
Kalinicheva Yuliya Borisovna, MD, PhD, Cardiologist;
Shvetsova Elena Anatol?evna, Anesthesiologist-Intensivist;
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
35
Zaynetdinova El?za Kasimovna, Anesthesiologist-Intensivist;
Gornostaev Aleksandr Aleksandrovich, Chief of Department of Anesthesiology and Intensive Care;
Chernogrivov Aleksey Evgen?evich, MD, DM, Chief of Department of Cardiac Surgery ?4;
Bazylev Vladlen Vladlenovich, MD, DM, Head Physician
????????
???????????? ???????????? (??) ???????? ????? ?? ???????? ???????????????? ??????????? ???????????? ??? ????????????
????????????? ??????? ? ????? ? ?????? ???????????????. ????? ?????????????????
????????? ?????????? ????? ??? ????????
????????????? ???????????? ??????? ????,
??? ??? ???????? ????????????????? ?????????, ? ????? ? ??????????? ????????????????? ??????????? ? ???? ????????????
????????? ???? [1]. ??? ?? ????? ?????? ????????? ???????? ????? ?? ???????? ????????, ???????? ?? ??????? ??????? ?????????????????? ??????? [2]. ?????????????????
????????? ?????????? ????? ???????? ?????? ???????????? ?????????? ??????????????, ? ???? ??????? ?????????? ???????? ???????????? ????? ?????? ?????????
???????????????, ??? ????? ???????? ? ?????????? ?????? ??? ??????? ???????? ?????
?????????? ????????? ? ??????????????
????????? [3]. ???????????? ?????? ????????????????? ??????? ????????? ??????
???????, ?????? ????? ????, ??????? ????????????????? ?? ? ????????? ?????, ???????
??????? ????????? ???????????? ????????????? [2, 4, 5]. ????????? ???????????????, ?????????????? ? ????????????? ?????????,
?????????? ??????????????, ??????????
????????? ??????????????? ??????????,
? ????????? ?????????????, ? ????? ????
? ???????????? ???????? ?????????????????? ? ???????? ????????? ????? ????????? ?? ?????????? ??????? ?????????????????? ??????? [2, 4?6].
????? ?????????? ???????????? ???????
???????? ??????? ? ?????? ?????????????
????????? ????? ? ???????????? ? ????? ????? ???????? ????????????? ????????????,
? ????? ?????? ?? ??????? ?? ?????????? ???????????? ???????.
???????? ? ??????
?????? ????????????. ? ???????????????
???????????? ???????? 103 ???????? ? ?????????? ??????? ???????????? ????????????? ???????, ????????????? ? ?????
?. ????? ?? ?????? ? ?????? 2010 ?. ?? ????
2014 ?. ???? ????????? ???????? ????????????? ????????????, ??? ?????????????, ???
? ? ????????? ? ????????? ??????? ??????????????? ??????????? (????) ? ?????????????? ???? ?????. ????????? ??????????
??????? ??????????? ???????????? ?????
????? (???????? ???????).
? ??????????? ?? ??????? ??? ??????????
????????? ????? ? ???????????? ???????????? ??? ?????? ???????. ? 1-? ?????? ???? ???????? 33 ???????? ? ??????????????? ????????? ??????????? ????? ??????
??????????? ?????????? ??????????????, ? 3, 2014
Objective ? to investigate variability and predictors of cardiac rhythm and conduction heart system disturbances in the
early postoperative period in patients after the operation of arterial switch in different types of D-transposition of the great
arteries.
Material and methods. 103 patients with different forms of transposition of the great arteries were included in the study.
Operation of arterial switch was made for the period from 2010 to 2014. 33 patients with arrhythmias after surgery were
included in the first group. Mean age was 17.7 days (from 1 to 94 days), mean weight was 3.4 kg (from 2.5 to 5.6 kg).
70 patients without cardiac rhythm disturbances were included in the second group. Mean age was 10.6 days (from 1 to
79 days), mean weight was 3.5 kg (from 2.5 to 4.6 kg).
The following factors of cardiac arrhythmias development have been analyzed: age, body weight, diagnosis, infusion of
vazaprostan and saturation level before the operation, the accompanying plastic ventricular septum defect and reconstruction of the aortic arch, the presence of coronary anomalies, the time of cardiopulmonary bypass and aortic crossclamping, Aristotel Score, lactate level in the postoperative period, inotropic score and administration of levosimendan.
Factors having significant differences between groups were evaluated by univariant logistic regression analysis.
Results. Total rate of cardiac rhythm disturbance was 32.0% (33 cases in 103 patients). The survival rate amounted
to 91.3% (94 patients). The most common was ventricular premature contractions high degrees ? 39.4% (13 cases),
ventricular tachycardia was registered in 18.2% (6 cases) and atria-ventricular block III ? in 18.2% (6 cases). Atrial tachycardia, atrial premature contractions, JET-tachycardia were registered in 6% cases. Ventricular fibrillation and atrial fibrillation were developed in 3.0% (1 case) consequently. Predictors of cardiac rhythm disturbances in the early postoperative period were: mean arterial blood pressure before surgery (p=0.001, 95% CI [76,6?93,6], OR 0,847), plastic
correction of ventricular septum defect (p=0.05 and 95% CI [95,8?101,4], OR 9,860), ejection fraction of the left ventricle after surgery (p=0.002, 95% CI [85,6?96,4], OR 0,908).
Conclusion. Total rate of cardiac rhythm disturbance after arterial switch was 32.0%. The most common was ventricular
premature contractions high degrees ? 39.4%. Predictors of cardiac rhythm disturbances in the early postoperative period were: mean arterial blood pressure before surgery, plastic correction of ventricular septum defect, ejection fraction of
the left ventricle after surgery.
Key words: cardiac rhythm and conduction heart system disturbances; arterial switch; postoperative period.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2014
36
???????????? ??????
(???) ? ???????????? ????? ???????? ??
? ?????? ????????????????? ???????. ??????? ???????? ????????? 17,7 ??? (?? 1 ?? 94
????), ??????? ????? ???? ? 3,42 ?? (?? 2,5 ??
5,6 ??). ?????? ?????? ?????????? 70 ?????????, ? ??????? ????????? ????? ?? ????????.
??????? ???????? ????????? 10,6 ??? (?? 1 ??
79 ????), ??????? ????? ???? ? ???? ??????
???? 3,5 ?? (?? 2,48 ?? 4,6 ??).
?????????????? ????????? ? ??????
??????????? ????????. ????? ??????????????
????????? ?? ??????? ???????????? ? ??????? 1. ??? ???????? ????? ??????????
?????? ?????? ? ???????????? ????????????? ??????? (???), ? ??? ????? ??????? ?
59 ?????????, ??? ? ????????? ? ????
(??????? ???????? ?????????????) ?
33 ???????, ??? ? ????????? ? ???? ? ??????????? ????? ? 9 ?????????, ??? ? ????????? ?? ???????? ???????? ??????? ?
2 ???????. ???? ????????? ?????????
??????????? ?????????????: ?????????????
???????????? ???????????? ? ? 59 ???????,
???????????? ???????????? ? ?????????
? ????????? ??????? ??????????????? ???????????, ? ??? ????? ????????? ????????
????????????? ? ? 33 ?????????, ???????????? ???????????? ? ????????? ? ?????????????? ???? ????? ? ? 9 ???????, ????????????
???????????? ? ????????? ???? ? ??????????? ??????? ???????? ??????? ? ? 2 ?????????. ??????????????????? ???????????
???????? ?????????????? ???????? ????????? ? ??????? ?????????. ????????????? ?????????????? ????????? ? ?????? ??????????? ??? ????????? ?????????? ?? ????????
HL-20 (MAQUET, Germany). ?????????????
???? ????????? ? ?????????????? ????????-
??? ???????????? ????????. ?? ? ????? ?????? ?? ?????????? ????????????? ?????.
??? ?????? ???????? ???? ????????? ??????????? ?????????????? ???????????? ????????? ╚?????????╩ (????????). ? ???? ????????? ????????? ???????????????? ????????????????.
?????? ????????????. ? ???? ?????????
?????????????? ?????????? ??????????????? ??? ? ????????? ??????????, ??? ???
?????????? ????? ????????. ?????????? ???????? ???????? ?????? ??????? ???????????? ?? ??????? IntelliVue MP-70 (Philips,
Germany). ??? ????????? ????????? ?????
???????????????? 12-????????? ??????????????????? ?? 6/12-????????? ?????????????????? SHILLER AT-101 (Switzerland).
?? ????????? ????? ?????? ?????????
????? ?????????? ?? ????? ???????????,
??????? ? ??????????????? ??????????
??????, ??????? ???????? ???????????????
???????? [1]. ??????????????? ??????????
????????? ??????? ????????? (?????????
??????????? ?????????????, ??-??????? 1 ??.,
??????? ????? ????? ????) ?? ???????????.
??????????? ? ???????????? ??????????????
????????????? ??? ??????? ???????????????
?????????? ????? 10 ? ??????. JET-?????????? ????????????????? ??? ??????? ?????
?????????? ?????????? ??????? ? ??-??????????? ? ????? ????????? ?????? ??????????. ??????????? ?????????? ????????????????? ??? ??????? ?????????? ? ????????????? 1:1, ????? ??? ????????????
?????????? ? ??? ?????????? ? ????????
???????????. ??? ??????????? ??????????
?????????? ?????????? ? ?????? ??????????? ? ??????????? ????? ??? 2:1.
??????? 1
????? ?????????????? ????????? ????????? ???????
1-? ?????? (n = 33)
2-? ?????? (n = 70)
??????????
p
?╠m /n (%)
??????? ????? (???????), ???
95% ??
?╠m / n (%)
10,6
95% ??
17,7
4,3?21,6
????? ???? (???????), ??
3,42╠0,63
3,2?3,75
??????? ???
23 (69,7)
52,6?82,6
50 (71,4)
59,9?80,6
0,06
????? ????????????? (?? 28 ???? ?????)
27 (81,8)
65,6?91,4
60 (85,7)
75,6?92,0
0,259
3,5╠0,46
1,2?16
0,05
3,25?3,95
0,796
?? ?? ?? ???????? (???????), %
74,9╠6,8
72,4?77,3
72,5╠6,5
70,9?74,0
0,100
??????? ?? ?? ???????? (???????), ?? ??. ??.
46,8╠7,9
43,8?49,5
50,5╠7,8
48,6?52,3
0,034
??? ?? ????????, ??/???
150,4╠14,9
150,6╠22,9
??????? ????????? ????????? (???????), %
79,6╠14,1
72,2?87,4
68,9?85,0
0,193
??????? ????????????
19 (59,3)
76,3?99,1
51 (72,8)
63,3?80,5
0,03
2,6╠2,5
1,7?3,4
4,4╠4,2
3,3?5,4
0,111
??????? ??????? (???????), ?????/?
78╠17,1
0,593
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
?????????????? ?????????? ????? ?????
?????????? ????????? ????? ???????? ??????????? ????? ?????? ?????????, ??????????????????? ???? ??? ??-??????? ????????? ???????, ??? ??????????? ??????????
????????? ??????????????????????? ? 28
(27,1%) ??????? (95% ?? [19,5?36,4]). ????????? ??????????????????????? ????????? ? ??????? ???????? ?????? EDP 20/B
SingleChamber ╚Biotronik╩ (Germany). ?????????? ????????? ???? ????????????? ? 16
(15,5%) ????????? (95% ?? [9,7?23,7]) ?? ??????? ????????? ????????. ?????? ??????
?? ???? ???????? ? ????????????. ? 12 (11,6%)
??????? (95% ?? [6,7?19,2]) ???????????
???? ? ??????????? ???????? ?? ?????????????, ??? ??????????? ??????????? ???????????????? ? ????. ????????? ???? ????????????? ? 8 (7,7%) ??????? (95% ?? [3,9?14,5]),
? 4 (3,8%) ??????? (95% ?? [1,5?9,5]) ??? ????????????? ?????????? ???. ??????????
??????????????????????? ??????????????
? ??????? ?????? ╚St. Jude╩ VerityAdxXLSR ?
? 3 ???????, ?????? ╚Medtronic╩ SensiaDR ?
? 1 ??????.
??? ???????? ?????? ???????????????
?????????? ????????? ???????? ????? ????????????? ???????: ???????, ???, ???????,
??????? ????????????, ??????? ????????? ??
????????, ????????????? ???????? ????
? ????????????? ???? ?????, ??????? ?????????? ????????, ????????????????? ??
? ????????? ?????, ??????? ????????? ???????? (Aristotel Score), ??????? ???????, ??????? ??????? ?????? ?????????, ??????????
????? ????? ???????? (Inotropic Score ? IS),
????????????? ??????? ??????????????.
??????? ?? ??????? ??????????????????
??????? ??????????? ?? ?????????????????
????????????? ?????????? ?????? (???),
???????????? ?????????? ? ????????? ?????????? ? ??????????, ?????? ???????????.
?????????? ????? ?????????????? ??
??????????? ???????: IS = ???? ???????? в 1+
+???? ?????????? в1+???? ?????????? в100+
+ ???? ????????????? в 100 [7].
??????????? ??????? ?????? ?????????
?????????? ?????. ??? ????????????? ??????????????? ???????? ????????? ????? ??????????? ????????? ?????????????? ? ????????????? ?????????, ??????????????? ??????????????? ???????. ??????? ?????????
????? ??????????? ? ???????????? ? ?????????????? ?????????? ?? ????????????? ? ????????????? ?????????????? ??????? [8].
37
????????? ? ?????????? ??????????? ??????????????? ?????????? ??????????? ???????????? ???????? ???????? 1% ???????? ???
? ?????????? ? ???? 0,05 ??/?? ????? ????.
JET-?????????? ????????????? ??????????? ?? 35?35,5 ╟?, ????????? ??? ????????????????, ???????????? ????????? ?????????? ? ???? ????????? (5 ??/?? ?? 60 ???)
? ??????????? ??????????????? ???????????? ???????? ?????????????? ???? ?????????? (0,5 ??/??/?).
????????? ? ????????? ???? ???? ?????????? ??? ???????? ?????? ??? ????????????
?????????? ? ????? ???????????? ?????????? ?????. ??????????? ?????????? ? ?????????? ?????????? ????????????? ???????? 2 ???/??.
??????????. ?????????? ????? ???? ?????? ? ??????? ????????? Microsoft Office
Exell. ????????? ?????????????? ??????
??????????? ? ?????????????? ?????? ???????????? ??????????? Statistica 8.0 StatSoft
(StatSoft, Inc. Tulsa, USA). ??????? ????????
???????????? ? ???? ?╠m.
??? ??????? ?????????? ??????????? ?????? ?????? ????????????? ???????????????????? ????????, ??????????? ?????????? ??
??????????? ????????????. ??? ??????????
????????????? ?????? ????????????? ??????????? ?????????. ??? ?????????? ????????? ??????????? ????????????? ??????????? ????????????????? ?????? ?????????????? ????????? (???????????, ???? ?2).
???????, ??????????? ?????????? ?????????, ???? ??????????? ???????????????
???????????? ? ??????? ??????????????
?????????????? ?????????????? ???????. ???????? ????????? ???????????? ??? ????????? ???????? ? < 0,05 ??? ?????? ??????????????? ??????.
??????????
??? ????????????? ??????? ????????? ????????? ??????? ???? ????? (??. ??????? 1)
???? ???????? ??????????? ??????? ?? ????????? ???????????: ??????? ?????????
(? 1-? ?????? ??????? ????? ??? ??????), ???????????? ??????? ? ???, ???? ? ?????????? ???? ????? (? 1-? ??????), ??????? ???????? ????????????? ???????? (????? ??????
? ????????? 1-? ??????) ? ??????? ?????????? ???????????? (???? ????????????? ? ????????? 2-? ??????). ?? ?????? ???????????????? ???????????, ????? ??? ????? ????,
??????????? ?????????? ??????????????, ? 3, 2014
???????????? ??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
38
???????????? ??????
??????? 2
???????? ??????????
????????????? ? ??????? ?????????????????? ??????? ? ??????? ???? ?????
1-? ?????? (n = 33)
2-? ?????? (n = 70)
??????????
p
?╠m /n (%)
???????????? ??, ???
?? ? ???????? ??????????
10 (30)
95,9╠33,0
?????????????? ????? ???????????
4 (12,1)
???????? ????
????????????? ???? ?????
95% ??
159,6╠48,1
17,3?47,3
24 (34,2)
0,379
24,2?45,9
87,9╠28,8
4,8?27,3
239,2╠70,0
16 (48,4)
?╠m / n (%)
2 (2,8)
0,188
0,8?9,8
0,06
29,3?51,7
0,05
246,8╠70,2
32,5?64,7
28 (40)
0,91
0,443
5 (15,1)
6,6?30,9
4 (5,7)
2,2?13,8
0,037
Aristotel Score
14,4╠3,78
13,0?15,7
12,9╠3,0
12,1?13,6
0,034
?? ????? ???????? (???????), %
51,5╠14,3
46,0?56,1
61,9╠12,6
58,8?64,9
0,004
??????? ???????
????? ???????? (???????), ?????/?
3,7╠1,95
3,0?4,3
4,4╠3,0
3,6?5,1
0,451
??????? ?????????
12 (36,3)
22,2?53,3
17 (24,3)
15,7?35,5
0,641
??????? ????????? ?????????, %
97,9╠2,1
97,2?98,7
98,5╠1,5
98,1?98,8
0,556
Inotropic Score
28,6╠18,0
22,2?34,9
21,4╠10,3
18,9?23,8
0,163
17 (51,5)
35,2?67,5
20 (28,5)
19,3?40,0
??????? ?????????????? (????? ???????)
??????????? ?????????? ??????????????, ? 3, 2014
166,3╠47,8
???????????? ????????? ?????, ???
????? ?????????????????
???????? (???????), ???
95% ??
???????????? ??? (???????), ?
117╠100,4
?????????? ? ????, ?????-????
11,9╠9,1
???, ????? ????????????? ?????, ???????
??????? ?????? ?????????, ???, ??????? ????????? ?????????, ??????? ??????? ?????,
??????????? ???????? ????? ???????? ??
????. ?????????? ????????, ??? ?? ????????
???????? ????????? ????? ?? ???????????????? ?? ? ?????? ???????? ????? ?????.
????????????? ?????? ??????????? ????????????? ??????? (????. 2) ?????? ?????????? ????? ??????? ??????? ????????? ????????????? ?????????????, ??????????? ??
????? Aristotel Score, ? ????????? 1-? ??????
(? = 0,034), ? ??? ????? ? ????????? ????
(? = 0,05) ? ?????????????? ???? ?????
(? = 0,037). ? ?? ?? ????? ?? ???????? ??????????? ??????? ????? ???????? ?? ?????
???????????, ??? ???????????? ??, ?????????? ?????????? ?? ????? ??, ????????????????? ????????? ?????, ???????? ?????????????? ????????? ???????????? ? ????????????????? ????????.
??? ??????? ??????? ??????????????????
??????? ??????????? ?????????? ????? ?????? ??????? ??????? ?????? ????????? ? ????????? 1-? ?????? (? = 0,004). ????? ????,
?????????? ??????? ????? ????????? ? 1-?
?????? ???????? ????????????????? ??????? ?????????????? (? = 0,025). ?? ???? ???????? ??????????? ???????? ????? ??????-
136,9╠131,4
8,6?15,1
10,7╠6,0
0,025
0,162
9,2?12,1
0,625
?? ?? ?????? ??????? ????? ????? ????????,
?????? ????????? ?????????, ???????????
?????, ? ????? ?? ????, ????????? ??? ???????
???????.
??? ??????? ????????? ????? ? ???????????? ???? ???????????????? ?? ????????
? 33 ????????? ? ?????? ?????????????????
???????. ??????? ????????????? ??????????????? ???????? ????????? ?????, ?? ?????
??????, ????????? 32,0%.
?????? ?????????? ??? ??????????? ??
???????. ???????? ????????????????? ??????????? ????? ????????? ????????????
????????????? (???) ??????? ???????? ?
39,4% ??????? (n = 13). ??????? ?? ???????
????????????? ????????? ??????? ???????????? ?????????? (??) ? ??????????????????? (??) ??????? 3 ??. ? ?? 6 ??????? (??
18,2%). ????????? ????? (?? 6% ???????) ????????? ????? ???? ???????????? ??????????? ??????????? (??), ?????? ???????????
??????????????? (???) ? JET-??????? ???????????, ??????? ? 1 (3,0%) ?????? ???????
? ??????????? ?????????? (??). ? 1 (3,0%)
?????? ? ???????? ????????? ???????????
??????????.
?????? ??????? ????????? ????? ??????
??? ????????? ????????? ?????????????
????????? ??? ???????? ??????? ??????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
%
39
39
40
35
30
25
18
20
18
15
10
6
6
6
5
3
3
??
??
0
??
JET
??
??-???????
???
???
?????? ??????????????? ???????? ????????? ????? ?????? ????? ???????? ????????????? ????????????
??????? 3
??????????
???????
????? ????
??????? ???
??????? ????????? ????????? ?? ????????
??????? ?? ?? ????????
?????????? ???????????? ?? ????????
???????????? ??
???????????? ????????? ?????
?????????? ?????????? ?? ????? ??
???????? ????
????????????? ???? ?????
?????????? ????????
Aristotel Score
?? ?? ????? ????????
??????? ??????? ????? ????????
?????????? ?????
??????? ??????????????
???????????? ???
???????????? ?????????? ? ????
???????????
???????????? ??????????????
???. ??? ????????? ??????? ??? ????? ????
????? ????????? ?????????? ????? ???? ???????? ???????????? ???????????? ???????????? ??????????????, ? ??????? ????????????? ???????????? ? ????????? ? ?????????
??????? ??????????????? ??????????? ???
?????????????? ???? ????? ???????????
??????????? ?????? ????????????? ??? ??
???????? ?????????????? ??????.
?????????? ?????????????? ?????????????? ?????????????? ???????, ????????????
? ????? ????????? ????????? ???????????
???????? ????????? ?????, ????????????
? ??????? 3. ???? ?????????? ????? ?????????? ???????? ???????, ??? ??????? ???????? ?? ?? ???????? (? = 0,001, 95% ??
[76,6?93,6], OR 0,847), ?????????? ????????
???? (? = 0,05, 95% ?? [95,8?101,4], OR
?
0,176
0,81
0,77
0,97
0,001
0,36
0,27
0,24
0,73
0,05
0,67
0,66
0,37
0,002
0,08
0,06
0,80
0,57
0,59
0,91
0,17
95% ??
OR
98,7?107,6
21,7?33,1
21,9?309,9
95,6?104,7
76,6?93,6
32,6?204,2
96,5?101,0
98,2?107,2
18,2?33,1
95,8?101,4
3,9?80,8
34,7?52,1
86,5?146,7
85,6?96,4
60,1?103,6
99,5?115,9
25,1?58,7
99,3?100,7
88,7?123,1
41,1?584,8
88,1?107,3
1,030
0,847
0,825
1,001
0,847
2,581
0,987
1,026
0,775
9,860
0,564
1,344
1,127
0,908
0,789
1,074
1,215
1,020
1,045
4,901
0,972
9,860), ? ????? ??????? ??????? ?????? ????????? ????? ???????? (? = 0,002, 95% ??
[85,6?96,4], OR 0,908). ??? ???? ??????? ?????????? ????????, ????????????? ????
?????, ???????????? ?? ? ????????? ?????
?? ????? ?????????? ????????? ??????? ??
???????? ????????? ?????. ??????? ?????????????? ???? ? ????????? ???????????????,
?????????? ?? ?????? ?? ???????? ?????????
????? ? ????? (? = 0,8), ?????? ???????? ??????? ???????? ??????????? ????????? ???
?? 1,5% (95% ?? [25,1?58,7], OR 1,215).
???????? ?? ?? ??? ????? ???? ?? ?????????
??????????? ??????????? ????????? ???
(? = 0,81), ?????? ??? ?? ?????????? ?? 1 ??
????????? ??????????? ????????????? ??????????????? ???????? ??? ?? 18% (95% ??
[21,7?33,1], OR 0,847).
??????????? ?????????? ??????????????, ? 3, 2014
?????????? ???????? ????????? ????? ????? ????????
(?????????? ?????????????? ?????????????? ?????????????? ???????)
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2014
40
???????????? ??????
????????????????? ????????? ????? ????? ?? ??????? ??????????? ?????????????
????????? ?????????? ????? (?=0,24), ?????? ??? ?????????? ??????? ?????? ???????? ?? 1 ??? ???? ????????????? ??? ?????????? ?? 2,6% (95% ?? [98,2?107,2], OR 1,026).
??????? ?????????? ???????? ??????????? ???? ????????? ??? ?? 4,4% (? = 0,66,
95% ?? [34,7?52,1], OR 1,344). ?????????
?????? ????????? ????????????? ?????????????, ???????????? ?? ????? Aristotel Score,
?? 1 ??????????? ???? ????????????? ??????? ?? 2,7% (? = 0,37, 95% ?? [86,5?146,7],
OR 1,127), ? ?????????? Inotropic Score ?? 1
???????? ? ??????????? ????? ??? ?? 7,4%
(? = 0,06, 95% ?? [99,5?115,9], OR 1,074).
??????? ??????? ????? ???????? ?? ????? ???
?? ???? ???? ???????? ?????, ?? ????? ??????????????? ??? ??????????????? ????????
????????? ??????????????? ? ??????????????? ??????? ????????????? ??? (? = 0,08,
95% ?? [60,1?103,6], OR 0,789).
???????? ? ??????? ??????????????????
??????? ??????????? ?? ????????? ???????????: ????????????????? ??? ? ?? ????
???????? ??????????? ???????? (? = 0,57),
???????????? ?????????? ? ???? (? = 0,59)
? ? ?????????? (? = 0,17) ? ????? ?? ????????
??????????? ????????. ?????? ??? ????????????? ??? ????????????????? ??? ????????????? ?? 2% (95% ?? [99,3?100,7],
OR 1,020), ? ?????????? ????, ???????????
? ????, ? ?? 4,5% (95% ?? [88,7?123,1],
OR 1,045).
???????????? ????????? 91,3% (94 ????????). ??????????? ?? ??????? ?????????? ??
??????????? ? ????????? ? 1-? ?????? 3 (2,9%)
??????, ?? 2-? ?????? ? 6 (5,8%) ???????
(? = 0,101). ?????????? ????????, ??? ????????? ???????, ????????? ? ??????????? ????? ??????, ???????????????? ?? ????.
??????????
?? ?????????? ??????? ????????? ?????
?????? ????????? ???? ?????????? ?? ??????? ?? ??????? ??????? ??????????????????
???????, ? ????? ??????? ??????????? ?????
????????? ?????????? ??????? ?????? [3].
?????? ???????????? ???????? ????????????? ?????????? ???????????? ? ?????? ???????, ??????????? ????????? ?????????
??? ????? ????????? ?????????? ???????
??????. ??????????????? ???????????????
???, ??????????? ? ?????? ? ??????? ??-
??????????????? ??????? ????? ????????? ??? ? ????? [9, 10] ? ?? ????????? ?????????????? ???? [10, 11], ?????? ??????????????? ???????? ? ?????? ?????? ??? [5],
???????????? ???? ??? (? ?????????, JET??????????) ? ??????????? ?? ???? ?????????????? ????????????? [11].
???????????? ?????? ???????????? ??????? ????????????? ??????? ????? ???????? ? ???????? ?? ?????????????. ???, ???????? J. Delaney et al. (2006 ?.), ??????? ?????????? ? 15,0% ???????, ?? J.-P. Pfammatter
et al. (2002 ?.) ? ? 27,0%, ?? E. Valsangiacomo
et al. (2002 ?.) ? ? 48,0% ????????? [4, 5, 10].
? ????? ???????????? ?? ??????? ?????????
32,0%. ?.?. ??????? ????????, ??? ? ????????? ??????????? ????????? ????????? ????????? ????????????????? ???????, ? ????????? ?????????? ????? ?????????????????
?????? ??????, ????????????? ???????????
???????????? ?????????? ??????? ??????
[13]. ? ????????? ????????????????? ??????? ?????????? ???????????? ????????? ????????????? ???????????, ? ?? ?? ????? ????????? ???? ?????????? ?????????? ????????? ???? [9, 13, 14].
?? ?????? ?.?. ???????, ???????? ??????? ??????????? ????? ????? ?????????
??? ? ????? ???????? ???????????? ??????? (?? 36,0% ???????). ?? ???????? ???????????? ??????? ??????? ?????, ? ????? ?????????? ??????????? ?????? ????????????????? ?? ? ????????? ????? [9]. ? ?? ?? ?????
?? ??????????? ???????????? ???? ???????
???? ????????, ???, ????????, ????? ??????
??????? ???????? ??????????? ???????? ????????? ????? [2, 4, 6, 10]. ?? ????????? ??????? ?????????? ???? ??????????? ??????? ??
??????? ??????????? ??????????? ????????
??? ????? ????????.
???????????? ???????? ?????????????
???????????? ????? ????????? ????????????
???????????? ? ????? ?????? ???????? ????????????????? ??? ?????? ????????
[15]. ???????? ????? ?????????????? ????????? ???????????, ??? ??????? ? ??????? ????????? ???? ??? ???????? ???????????? ????????????. ??? ?? ???????? ???? ????????? ??? ???? ??????????? ??????????, ???
???????????? ??????????? ?????????? ?????
? 96,0% ?????????, ????? ??? ??? ????????
???????????? ???????????? ? ? 74,0% ????????? [1, 16]. ?? ?????? ?.?. ????????? (2011 ?.),
????????? ?????????? ????????? ???? ?????
???????? ????????????? ???????????? ? ??-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
???????? ??????? 3 ??. ? ?? 6 (18,2%) ???????.
????????? ????? (?? 6% ???????) ?????????
????? ???? ???????????? ??????????? ???????????, ?????? ??????????? ??????????????? ? JET-??????? ???????????, ??????? ? 1
(3,0%) ?????? ??????? ? ??????????? ??????????. ? 1 (3,0%) ?????? ? ???????? ????????? ??????????? ??????????.
????????????? ????????? ????????????
???????? ????????? ????? ?????? ???????:
??????? ???????? ?? ?? ????????, ?????????? ???????? ?????????????? ????, ???????? ??????? ??????? ?????? ????????? ????? ????????.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
??????????
??????????? ???? ???????????? ????????? ???????, ??? ??????? ???????? ??????????????? ???????? ????????? ????? ??????
????? ???????? ????????????? ????????????
?? ?????? ????????? ???? ???????????? ????????????? ??????? ????????? 32,0%. ???????? ????????????????? ??????????? ????? ????????? ???????????? ?????????????
??????? ???????? ? 39,4% (13 ???????). ??????? ?? ??????? ????????????? ????? ??????? ???????????? ?????????? ? ???????????-
12.
13.
14.
15.
16.
Rhodes L.A., Keane J.F. et al. Arrhythmias and intracardiac
conduction after arterial switch operation. J. Thorac.
Cardiovasc. Surg. 1995; 109: 303?10.
Rekawek J., Kansy ?., Miszczak-Knecht ?. et al. Risk factors
for cardiac arrhythmias in children with congenital heart
disease after surgical intervention in the early postoperative
period. J. Thorac. Cardiovasc. Surg. 2007; 133: 900?4.
Yueh-Tze L., Lee J., Wentzel G. Postoperative arrhythmia.
Curr. Op. Cardiol. 2003; 18: 73?8.
Delaney J., Moltedo J., Dziuraet J. et al. Early postoperative
arrhythmias after pediatric cardiac surgery. J. Thorac. Cardiovasc. Surg. 2006; 131: 1296?300.
Valsangiacomo E., Schmid ?., Schupbach R. et al. Early postoperative arrhythmias after cardiac operation in children. Ann.
Thorac. Surg. 2002; 74: 792?6.
Hoffman T.M., Wernovsky G., Wieand T.S. et al.The incidence
of arrhythmias in a pediatric cardiac intensive care unit.
Pediatr. Cardiol. 2002; 23: 598?604.
Wernovsky G., Mayer J.E. Jr, Jonas R.A. et al. Factors influencing early and late outcome of the arterial switch operation
for transposition of the great arteries. J. Thorac. Cardiovasc.
Surg. 1995; 109: 289?302.
HRS/EHRA/APHRS Expert Consensus Statement on the
Diagnosis and Management of Patients with Inherited Primary
Arrhythmia Syndromes. Heart Rhytm. 2013; 10 (12).
??????? ?.?., ????????? ?.?., ???????? ?.?., ????? ?.?.
????????? ????? ?????? ? ???????????? ? ?????? ????????????????? ??????? ????? ????????????? ????????? ?????????? ??????? ?????? ? ????? ??????? ????????. ?????? ???????????. 2012; 1: 24?32.
Pfammatter J.-P., Wagner ?., Berdat?t ?. et al. Procedural factors associated with early postoperative arrhythmias after
repair of congenital heart defects. J. Thorac. Cardiovasc. Surg.
2002; 123: 258?62.
Dodge-Khatami A., Miller ?., Anderson R. et al. Impact of
junctional ectopic tachycardia on postoperative morbidity following repair of congenital heart defects. Eur. J. Cardiothorac.
Surg. 2002; 21: 255?9.
???????? ?.?. ??????? ? ????? ????? ????????????? ????????? ?????????? ??????? ?????? ? ???????? ?????????????? ??????????????. ??????; 2011.
??????? ?.?. ????- ? ????????????????? ??????? ? ?????: ??????? ?????????????, ??????? ? ???????. ?????? ???????????. 2005; 1: 25?35.
??????? ?.?. ???????????????? ??????? ?????? ? ?????: ??.-???. ????????????. ?.: ????? ??. ?.?. ???????? ????; 2009.
Sarris G.E., Chatzis A.C. et al. The arterial switch operation
in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart
Surgeons Association. J. Thorac. Cardiovasc. Surg. 2006; 132:
633?9.
Moss A.J. Risk of mortality in patients with potentially malignant arrhythmias. J. Ambul. Monitor. 1989; 2: 15?9.
??????????? ?????????? ??????????????, ? 3, 2014
??????? ? ?????????????? ???? ????? ??? ???
??? ??????????? ? 40,0% ??????? [12], ??? ????????? ? ????????????? ? ??????? ?????????????? ??????????? ? ???????????????
?????????? ? ?????????????? ??????????????????, ? ????? ? ?????????????? ?? ??????????? ???????? [1]. ?????? ? ????? ???????????? ????? ????????? ????????????????
?? ????, ??? ?? ????? ??????? ? ??????????? ????????? ????????, ??? ?????????????? ????????????????? ????????.
???? ???? ???????? ??????????? ??????????? ???????? ????????? ?????????? ?????
??? ?????????? ???????? ????, ??? ??????????? ? ???????????? ??????? ? ????????? ???????????? ?????????????, ??????????? ?? ????? Aristotel Scor ??? ?????????
??? [2, 4].
?? ????? ??????, ????????? ???????
??????? ?????? ????????? ?????? ????? ??
???????? ???????? ???????? ???????? ????????????????? ???????. ?????????? ?????????????????? ??????? ? ????? ?? ???????? ?????????? ???????, ??????? ?????????
?????????? ????????? ??????????? ???????? ????????? ?????. ?????????? ????????????? ????????? ???????? ?????????? ?????????????? ??????? ????????, ??? ??????? ???? ???????? ?????? ??????????.
???????, ??????? ????????? ????????????????? ??? ?? ??????????? ? ???????????,
??????????? ??????????? ?? ????????????
???, ?????????? ? ???? ? ??????????.
J. Rekawek et al. (2007 ?.) ???????? ? ?????
??????????????? ??????? ???, ??????????
? ???? ? ????? ??????? ?????? ???????????
??? ???????? ??? [2]. ? ????? ????????????
?? ???????? ??????????? ??????????? ??????? ??? ?????????? ??? ? ?????????????
?????????? ???, ?????????? ? ???? ? ?????????? ???????? ? ??????????.
41
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
42
???????????? ??????
References
1.
2.
3.
4.
5.
6.
7.
8.
Rhodes L.A., Keane J.F. et al. Arrhythmias and intracardiac
conduction after arterial switch operation. J. Thorac.
Cardiovasc. Surg. 1995; 109: 303?10.
Rekawek J., Kansy ?., Miszczak-Knecht ?. et al. Risk
factors for cardiac arrhythmias in children with congenital
heart disease after surgical intervention in the early postoperative period. J. Thorac. Cardiovasc. Surg. 2007; 133:
900?4.
Yueh-Tze L., Lee J., Wentzel G. Postoperative arrhythmia.
Curr. Op. Cardiol. 2003; 18: 73?8.
Delaney J., Moltedo J., Dziuraet J. et al. Early postoperative
arrhythmias after pediatric cardiac surgery. J. Thorac. Cardiovasc. Surg. 2006; 131: 1296?300.
Valsangiacomo E., Schmid ?., Schupbach R. et al. Early postoperative arrhythmias after cardiac operation in children. Ann.
Thorac. Surg. 2002; 74: 792?6.
Hoffman T.M., Wernovsky G., Wieand T.S. et al.The incidence
of arrhythmias in a pediatric cardiac intensive care unit.
Pediatr. Cardiol. 2002; 23: 598?604.
Wernovsky G., Mayer J.E. Jr, Jonas R.A. et al. Factors influencing early and late outcome of the arterial switch operation
for transposition of the great arteries. J. Thorac. Cardiovasc.
Surg. 1995; 109: 289?302.
HRS/EHRA/APHRS Expert Consensus Statement on the
Diagnosis and Management of Patients with Inherited Primary
Arrhythmia Syndromes. Heart Rhytm. 2013; 10 (12).
9.
10.
11.
12.
13.
14.
15.
16.
Bockeria L.A., Zelenikin M.A., Golukhova E.Z., Batov S.M.
Disorders of heart rhythm and conduction in the early postoperative period after surgical correction of congenital heart
defects in children of early age. Annaly aritmologii. 2012; 1:
24?32 (in Russian).
Pfammatter J.-P., Wagner ?., Berdat?t ?. et al. Procedural factors associated with early postoperative arrhythmias after
repair of congenital heart defects. J. Thorac. Cardiovasc. Surg.
2002; 123: 258?62.
Dodge-Khatami A., Miller ?., Anderson R. et al. Impact of
junctional ectopic tachycardia on postoperative morbidity following repair of congenital heart defects. Eur. J. Cardiothorac.
Surg. 2002; 21: 255?9.
Sabirov? D.R. Arrhythmia in children after surgical correction
of congenital heart defects in extracorporeal circulation.
Kazan; 2011 (in Russian).
Bockeria O.L. Peri- and postoperative arrhythmias in children:
causes, treatment approaches. Annaly aritmologii. 2005; 1:
25?35 (in Russian).
Bockeria O. L. Perioperative arrhythmias in children: Educational-methodical recommendations. Moscow; 2009 (in Russian).
Sarris G.E., Chatzis A.C. et al. The arterial switch operation in
Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons
Association. J. Thorac. Cardiovasc. Surg. 2006; 132: 633?9.
Moss A.J. Risk of mortality in patients with potentially malignant arrhythmias. J. Ambul. Monitor. 1989; 2: 15?9.
????????? 30.05.2014
╘ ????????? ???????, 2014
??????????? ?????????? ??????????????, ? 3, 2014
??? 616.132.5-053.2-073.431.1:006
? ??????? ? ?????????????? ?????????????? ????????????
??????????????? ??????? ? ?????
?.?. ??????? 1, ?.?. ???????? 2, ?.?. ????????? 2, ?.?. ?????????? 2, ?.?. ???????? 1
1 ?????
╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????), ?????????? ?????, 135, ??????, 121552, ?????????? ?????????;
2 ???? ??? ╚?????????? ???????????? ????????????????? ??????????? ??????????? ??. ?.?. ????????╩
???????????? ??????????????? ??, ??. ?????????????, 1, ??????, 117997, ?????????? ?????????
??????? ??? ?????????, ?????? ???. ????, ?????????, ???????? ??? ? ????, ????????;
???????? ?????? ?????????, ???????? ???. ????, ?????????? ???????????? ??????????????????
????????? ???????? ????????; e-mail: de_mar@bk.ru;
????????? ????? ??????????, c?. ????. ????.;
?????????? ???????? ??????????, c?. ????. ????.;
???????? ????????? ????????????, ?????? ???. ????, ?????????? ??????? ?????????????? ????????????
????????-?????????? ? ???????? ?????????
? ??????? 15 ??? ????????? ???????????? ????? 6000 ????? ? ???????? ?? 1 ???? ?? 18 ???. ?????????? ???????? ?????????? ???????????? ? ?????????????????? ????????????, ??????????? ?????????? ???????????? ??????????????? ??????? ? ????? ????????? ?????????? ?????. ???????? ???????? ?????????? ???????? ???????????? ??? ???????? ?????????????? ? ??????????? ?????????.
??? ??????????? ?????????????? ????????????, ?????????? ? ??????? ????????, ???????? ???????????????? ? ????????? ????????? ?????????? ? ????????????????? ????????? ??????????????
???????????? ??????????????? ??????? (???????????????? ??????????????, ????????????????
??????????/??????????? ????????????, ?????????????? ?????????? ????????????). ? ?????? ???????????? ?????????? ?????????????? ???????????? ??????? ???????? ????????????? ??????
???????? ???????????? ??????????????? ???????, ???????????? ? ????? ??. ?.?. ????????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
43
???????? ?????: ????, ???????????? ? ?????????????????? ????????????, ????????? ?????????????? ???????????? ??????????????? ???????.
TO A QUESTION OF STANDARDIZATION OF ULTRASONIC RESEARCHES
OF BRACHIOCEPHALIC VESSELS AT CHILDREN
L.A. Bockeria 1, M.F. Abramova 2, I.A. Stepanova 2, S.N. Novoselova 2, M.V. Shumilina 1
1 A.N. Bakoulev Scientific Center for Cardiovascular Surgery,
Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;
2 N.I. Pirogov Russian National Research Medical University, Ministry of Health of the RF,
ul. Ostrovityanova, 1, Moscow, 117997, Russian Federation
Bockeria Leo Antonovich, MD, DM, Professor, Academician of Russian Academy of Sciences and Russian Academy of Medical
Sciences, Director;
Abramova Marina Fedorovna, MD, PhD, Chief of Laboratory of Cerebrovascular Disease of Childhood;
Stepanova Irina Alekseevna, Senior Research Associate;
Novoselova Svetlana Nikolaevna, Senior Research Associate;
Shumilina Margarita Vladimirovna, MD, DM, Chief of Band Ultrasound Cardiovascular and Organ Pathology
? ????????? ????? ??????? ??????????
?????????? ? ?????????????????? ?????????? (?? ?????????????? ?? ?????????) ? ????????? ???????? ????????. ????????????? ?????????? ?????? ?? ??????? ?????????, ???
? ????? ?? ?????? ?????? ????? (?????????????), ??? ? ? ??? ???????? ????????. ???????
??????????, ??????? ?????????, ?????????
????????? ?? ??, ??? ????????? ??????????
???????????? ?????????? ????????? ?????????? ? ??????? [1?4]. ????????, ??-?? ????,
??? ?? ??????????? ???? ??? ????????????,
????????? ? ??????????????? ????????????
?? ?????????? ????????? ???????? ????????,
?? ?????????? ???????? ?????????, ???????
? ???????????? ?? ?????? ????. ???????
????????? ????????????, ? ??????? ?????????????? ?????????? ???? ? ??????????
???????? ??? ??????????? ╚????????╩ (?????? 20?30 ???????? ??????????), ???? ? ??????? ???????? ????????? [5, 6]. ?? ? ?????
? ???????? 1 ???? ? 18 ??? ?? ????? ???? ?????????? ????????? ?????????, ? ???? ????????? ?????????? ???????? ?????????? ?? ?????????? ? ?????????????????? ????????
??????? ? ????? ???????? ?????????? ????????? ?? ???????? ???????? [4, 6, 7].
? ?? ?? ????? ???????????? ?????????
? ???????? ???????????? ????????? (??????????????? ?????? ????????? ?????????
??????????????, ? ??????????? ???????????????? ????????????, ??????? ????????-
???????? ?????? ?? ???????????? ? ?????????? ??????) ?????? ? ??????????????? ???????? ? ????????? ? ?????????? ???????? ????????? (???????????? ? ??????????????????), ??? ??????? ? ????????? ??????????
???????? ????? ??????????? ??????????????? ? ??????????? ????????? [8, 9].
?.?. ?????? (1996 ?.) ???????: ╚???????????? ??????????????? ?????????????????
?????????? ? ???????? ?????????? ???????????? ?????????? ??????? ????? ????????
???????????? ???????????????? ? ?? ?????? ???????? ????????? ?????? ????????
???????╩ [4].
?? ???? ??????????? ??????? ?????????
??????????? ???????? ? ??????? 15 ???
(2000?2014 ??.) ????????? ???????????? ?????
6000 ????? ? ???????? ?? 1 ???? ?? 18 ???. ?????????? ???????? ?????????? ????????????
? ?????????????????? ????????????, ? ?????
??????????? ?????????? ???????????? ??????????????? ??????? ? ????? ?????????
?????????? ?????. ???????? ???????? ?????????? ???????? ???????????? ??? ????????
?????????????? ? ??????????? ?????????
[10?12].
?????????? ??????????? ?????? ?????????????? ???????????? ????????????? ? ??????????????????? ????????? ? ?????, ???????? ?????? ????????? ???????????????
? ???????????? ??????????? ???????, ??
?????? ? ?????? ? ????????????? ????????
??????????? ?????????? ??????????????, ? 3, 2014
Within 15 years the examination of more than 6000 children aged from 1 till 18 years old is conducted. The main indicators
of cerebral and extra cerebral hemodynamics, features of carrying out of brachiocephalic vessels researches at children
of various age groups are defined. Value of age distinctions of hemodynamics for development of functional and clinical
violations is revealed. ?rotocols of brachiocephalic vessels ultrasonic researches are offered and improved. The most
informative uniform protocol of brachiocephalic system research is taken on a basis of protocols of ultrasonic researches
in SCCS named after A.N. Bakulev.
Key words: children, cerebral and extra cerebral hemodynamics, protocol of brachiocephalic vessels ultrasonic
examination.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2014
44
???????????? ??????
???????????????? ? ????????? ????????? ??
???? ???????????? ?????????? ????????????. ??-??????, ??? ??? ??????????, ???????????? ????????? ? ???????????? ╚?????╩
????????? ???????? ????????, ? ????????????
??? ????? (??? ?????????? ???? ╚?????╩
? ?????????? ???????), ????????? ??????????, ?????????????? ????, ??????????? ???????? ?????????, ? ??????????? ??????????????, ?????????????? ╚???????, ?????????╩ ?????????? ????????????. ? ??????
???????????? (? ??????????????????? ? ??????? 15 ???) ?????????? ?????????????? ???????????? ? ????? (???????????????? ?????????????? (????), ???????????????? ??????????/??????????? ???????????? (????),
?????????????? ?????????? ????????????
(????)) ???? ???????? ?????????????
?????? ???????? ???????????? ??????????????? ???????, ???????????? ? ?????
??. ?.?. ???????? [13, 14].
? ????? ?????? ????? ?????????????? (??)
???? ???????? ╚??????╩ ?????????, ?? ??????? ??????? ???????????? ?????? ╚???????????????? ???????╩, ???????????, ??? ????? ???? ?????????? ????????????? ???????????? ????????????. ?????? ????
? ???? ????????? ????????? ???????????
??????????? ??????? (?-?????), ????????
??????? ?????? (? ?????? ????????? ?????????????? ???????????? ? ???) ? ????????
(D-?????). ?????? ?????????? ????????????
????? ??????????, ??? ? ????????? ?????
??????????? ???????????? ?????????? ??
????????? ?????????????? ????????????
(????, ????). ╚?????? ????????? ????????????? ?????? ??????????????? ???????????? ??? ?????? ????????? ?????????????? ????? ? ??????????? ????? ??????????╩ [13].
???? ???????????? ??????????, ??? ?????
???? ????? ???????????? ??? ????????????
?????, ???????? ???????? ???????? (?? 1 ????
?? 7 ???), ??? ??? ???????????? ????????
?????? ???????, ??? ????, ? ?? ????????
????????????? ?????? (????????? ? ???????
? ?????????) ??-?? ???????????? (??? ????
????????????? ?????????? ???????? ???????????? ?????????? ???????????? ????????
?????, ????? ???????, ?????????? ?????
??? ??? ??????????????? ????????????),
???????? ??????? ? ?????? ????????, ?????
????, ???????? ??????? ??????? ????????
???????? ??????????? ?????: ??????? ??????
? ???? ??????. ????? ???????, ? ????? ?????-
??????? ??????????????? ??????? ?????????? ???????? ? ???????????? ??????? ????????? ????? ???????? ?????????????? ???????????????? ?????????????? (???? ??? ????),
?????? ?????????? ?????? ???????? ?????????? ??? ??????????? ?????????? ???????.
??? ??? ???????? ????????????? ?????????
? ??????? ??????????????? ?????????????
??????? ?? ????????? ??????????? ????????????, ?????????? ??????? ? ????? ?????? ???????????, ????????????? ????? ????????????? ????????????? ????????? ???????? ????????? ?? ?? ????? ??????? ???????????
(?????????????? ??????? ??????????????
??????????????). ??? ?????? ????? ?????????? ????????? ??? ????????? ???????????? ????????????? (? ????? ?????????? ?????
?????????? ?????? ???????????? ?????????
??????????? ????????????? ?????????). ? ?????? ???????????? ?????????? ????????
??????????????? ?????? ? ????????? ??????????? ????????? (????????? ?????????? ????????, ???????? ??????? ???????, ???????
????? ???????? ???????? ??????) [13].
? ????? ? ???????????? ???????? ???????????? ??????? ????????? ????? ????????
???? (????. 1) ? ???? (????. 2) ?? ??????????? ???????? ??????? ??????????? ????????: ????????????? ? ?????????? ????????
??????? ???????? ??????? (???), ???????? ???????? ??????? (???); ??????????????????????? ????????: ?????? ???????? ??????? (???), ???????? ??????? (??), ???????????????? ??????? ??????????? ???????
(??), ? ????? ???????????? ????????????
???????? ??? ?????: ??????? ????????? ??????, ???? ??????, ??????????? ???????.
?????????????? ?????? ??????????? ????????????? ????????? ????????? ??????????????? ??????????? ???????????? ????????????? ???????? ????????? (Vs), ???????????? ???????? ?????????????? ????????
????????? (Vd), ???????? ??????????????????? ????????????? ? ??????? ?????????
???????? (PI=(Vs?Vd)/Vm), ??????? ????????????? ??????? (RI=(Vs?Vd)/Vs). ??? ?????????????? ?????? ??????????? ????????? ????????? ????????????? ????????????
???????? ????????? (Vmax), ???????????????
???? ????????.
? ?????????? ?????????? ????????? ? ???
????????? (?????????????????, ?????????????????, ????????????????), ? ????? ????????? ?????? ?????????? ?????? (???????????????, ???????????????, ??????????????).
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
45
?????????? 1
??????????? ?????????? ??????????????, ? 3, 2014
??????????????? ????????? ?????????? ??????????????? ?????? ??????
??????????? ??????? ????????? ??????????? ????????
???????????? ??????????????? ?????? ??????
??????????????-??????????????? ?????
??????????????? ?????????
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46
???????????? ??????
?????????? 2
??????????? ?????????? ??????????????, ? 3, 2014
??????????????? ????????? ?????????? ??????????????? ?????? ??????
??????????? ??????? ????????? ??????????? ????????
???????????? ??????????????? ?????? ??????
??????????????-??????????????? ?????
??????????????? ?????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????, ??? ??? ?????? ?????????????? ??????????????? ?????????? ????? ???
????????? ?????????????????? ?????? ??????????????? ??????? (???) ??????????
????????? ????? [15].
? ????? ??? ????????? ?????????? ????????? ????? (???????????? ? ????????) ?????????? ????????? ? ???????? ??????????.
?? ???????????? ??????, ??? ????????????
????????????? ?????????? ???? ??????????,
???????? ? ????? ???????? ????????, ??? ???
?????????? ????????? ????? ?????????????
?????????? ???????, ????????????? ?????????? ??????????? ???????????? ? ?. ?.
??? ???????????? ??????? ?????? ?????? ?????????, ??????? ???? ? ???? ???????? ? ?????????????? ????????? ?? ?????
??? ?? ??????, ? ????????? ???????? ???
???????, ? ???? ????????????? ?? ??????? ???????? (??? ??, ????? ??????? ????? ?? ?????
? ????).
??????? ???????????????? ??????? (???????, ???) ?????????? ????? ??????????? ╚?????????????? ????╩: ????????????, ???????????, ?????????????.
???????, ??? ???????????? ???????? ???
????? ?????????? ????? ??????????????????
?????????????? ???? ? ??????? ????? ?????????? ?????, ?? ??????? 56 ?? (??????
???????? ?????) ? 65 ?? (???? ??????) ??
???????? R.W. Baumgartner [16]. ?? ?????
???????????, ???? ?????? ?????? ??? ???????????? ? ??????? ????????? ??????, ? ????
??????, ?? ?????? ╚??????????╩ ????????? ?????????, ?? ???????? ?????? (?? ????????? ? ???????? ????? ??????? ??????????
?????????).
??? ???????????? ???????????? ??????
? ???????????????? ????? (╚??????╩) ?????????? ?????? ??????? ??? ???????????????? ?????????? ???????????? ???? ????????? ???????????? ?????? [17]. ??? ????????? ???????? ????????? ?????????????
???????????? ? ???????? ????? ? ?????????????? ??????????? ????. ???? ?????????? ???????????????? ??? ????? ?????????????? ????? ??????????, ????- ? ??????????????????? ?????. ????????????
???????? ??????????? ?????????? ??????????????? ???? ? ????? ?? 7 ???, ? ????? ?????????? (??? ? ???????????????) ? ????? 7 ???.
???????? ? ?????????? ?????????? ?????????????? ?????? ?????????? ? ????? ? ???????? ?? 7 ??? ???????? ???????????? ? ???????????? [12].
47
????????? ?????????? ??? ?????????????? ????????????? ????????? ??? ? ?????
? ???????? ????? ? ????????, ? ????????. ??????? ??????????? ???????????? ?????? ????????????????? ??????? ? ????? ??????????????? ?????????? ????????????? (?????????? 3). ??????????????? ???????? ?????????????? (??? ????????) ????????????
??????? ??? ????? ?????? ??????? (???)
?????????? ?????????????? ? ????????? ????????? ? ??????????? ?? ??????????? ? ?????.
??????? ????? ? ╚?????????? ??????????╩
??? ?????????? ?? ??????? ╚????????????╩
? ??????? ???????? ??????????? ?????, ???????? ?? ????????? ????????? ???????????
? ????????. ?????????? ?????????, ??? ? ??????????? ?????????????? ??????????? ???
?????????? ???? ????? ?????? ???? ???????
???????, ??????? ??????? ? ????????? ????? ??? ???????? ?????????.
???????????????? ?????????? ????????
??? ??? ?????????? ?????? ??????? (???)
(? ????????? ???????? ????????) ???????????
?? ??????????? ????????? (??????????? ???
????????????) ?? ??????????? ????????, ? ?????? ???????? ???????? ???????? ?????????
(???). ?????? ??????? ????????? ? ???????
?????????? ??????????????? (??? ?????????????????) ????? ?????? ??????? ????? ??????????? ???? ? ???????? (? ????????? ? ??????? ??????????? ????????? ??????????????
? ?????? ?????, ? ??????????? ?????). ? ????? ?????????? ?????????? ??? (??? ????????????? ??????????????? ?????????????) ??
??????????? ? ???????? ?????? 10?12 ??? ??-??
????????? ?????? ?????????? ??????? (? ???
????? ????????? ??????????? ?????), ???
????? ??????????? ????????? ????????????????? ???????????? ??? ??????? ??? ???????????. ??????? ??? ???????????? ?????????????????? ?????? ???????????????
??????? ? ????? ???????????????? ????? ??????????? ????????????, ??????????? ??????????????? ??????? ??????? ? ??????? ????????? ????????? ??????-????? (???). ?????????? ???????????????? ? ??????? ????????
??????????????? ?????????? ???????????
??????? ?? ?????? ???????? ???????? ???????? ??????? ?? ??????? ????????? ?? ???????
?????? ? ????????????????? ???????, ? ????
?????? ???????????????? ???????? ???? ???
????, ??? ??? ?????????? ??????????? ??????
???????????????????? ??????? (??? ???????????? ? ?-??????) ?? ??????????? ???????
?? ? ????? ???????? ??????.
??????????? ?????????? ??????????????, ? 3, 2014
???????????? ??????
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?????????? 3
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??????????????? ????????? ?????????? ??????????????? ?????? ??????
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??????????????? ?????????
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???????????? ??????
???????? ??????????????? ??????????, ???????, ????????? (???????? ????? ???????????
? ?????), ? ?????? ?????????? ????????? ?????????? ????????????????? ???? (????????? ?????????), ??????????????? ??????????,
? ????????? ????? ? ???? ????? ??????????
????????? (???????? ??????? ??? ?????? ??
?2, ?????????? ???????). ???????????? 3-??
???????? ? ????? ????? ???? ?????????? ??-??
????????? ???????????? ????????? ? ???????? ?????? ???????, ? ????? ??-?? ???????
???????-??????????? ???????? (????? ??????????? ? ????????? ???????? ????????).
??????????
?????????? ???????????? ? ?????????
???????? ???????? ?? ??????????? ????????
? ???????????????? ??????? (????, ????).
??? ??????????? ???, ??? ? ????? ????????
?????????????? ? ?????????? ??????? ????????? ????????????????? ?????? (?????????
? ???????? ? ?????). ??? ????????? ??????????????? ???????? (???? ????????) ?????????? (?????????? ??? ????? 10?15%
? ???????? ??????????????? ?????????????
????? 10%, ?????????? ???? ??????? ?? ???????????????? ?????? ? ??.) ?? ??????
????? ?? ??????????? ?????????? ???????????? ????????????????? ??????? (?????????????? ?????????? ? ??????????? ????????????).
?????? ?? ???????????? ?????- ? ?????????????????? ??????? ??????????????? ??????? ?????????? ???????????? ? ??????????????? ?????????, ? ????????? ? ?????????? ???????? ???????????????? ?????????
(????????????, ????????), ?????? ? ???????????? ????????? (????????????????,
?????????????????), ???? ????????? (??????? RI, PI), ???????? ??????? (???, ???????,
????????) ? ????? ??????? ? ???????????????? ?????????? ??? ??? ???? ?????????. ????? ?????????? ??????? ???????????? ??????????, ????????? ? ?????? ??????????????? ? ???????????? ???????????.
????? ???????, ??? ???????????? ????????? ???????????? ??????????????? ???????????? ??????????????? ????????????
? ??????? ???????? (????/????, ?????
????) ??????????????? ?????????????? ??????? ????? ????? ??????? ???????? ??? ????????? ????????? ?????????? ????????? (??
????????????? ?? ????????????? ????????
??????????).
??????????? ?????????? ??????????????, ? 3, 2014
?????????????? ????? ? ??????????
??????? ??????????? ?? ?????? ? ???????????
????????? ??????????????? ????????????
??????????????? ??????? ? ????? ??? ????????????. ?? ?????? ??????, ??? ????? ?????????? ???????? ? ???????? ????????????
??? ??????????????, ??? ?????????? ?? ??????? ?????????? ?????????-???????? ?????
(??? ?????? ?? ??????? ??????). ??????????
???????? ????? ???? ????????? ???? ? ????? ?? 10?12 ???. ??? ???????????? ???????????? ????? ?????? ?????????? ????? ?????????? ?????????????? ???????? ??????????
???? ? ???? (? ?????? ?????? ??????????
?????????-???????? ????? ? ????? ? ?????????? ???????).
??????????, ?????? ???? ? ???? ???????? ????????????? ??? ?????????? ??????
?????????????? ???? ? ????? ? ?? ?????????
? ???????????? ??? ???????? ?????????, ??
????? ??????????? ??? ?????????? ? ??????? ???????? ??-?? ?????????? ??????? ????????????, ?????????????? ??????????? ??
??? ???????, ????????????? ??????? ? ??????????? ??? ????? ???????? (??. ????. 1, 3).
?????????????? ???????????? ??? ???????????? ???? ????? ? ??? ??????? ????
????????? ??????? ??????? ???????? ? ???????????? ????????, ????????, ????? ? ?????????????????? ???????, ??????? ????????? ????????? ??? (? ??????????? ??????
? ?? ???? ??????) (??. ????. 3).
???????????? ??????? ??? ? ??????????,
??? ? ? ?????????? ???????? ???? ??????????? ???????? ????? ????????? ??????????
?????????. ? ????????? ????? ??????????
?????? ?? ????????? ??????????? ????????????? ? ??????? ????????. ??????? ??? ??????????? ???????? ??? ??? ??? ? ?????
??????? ????????? ??????? ??????? (?? ???????? ? ?? ??????? ?????????), ???????? ????????? ? ??????? ??????????? ?????????????
(??????? ???- ? ????????????????? ???????)
[5, 6, 13] (??. ????. 3).
? ????? ???? ??????????? ??????????????
????????? ???? ???????. ? ?????? ?? ????????? ???????? ??????????? ????? ?????????,
???? ????????? (????? ?????????????? ??????? ?????? ????? ? ????), ?????????? ?? ?????
???, ???????????????? ??????????????
? ????????? ???????? ??????????????? ??????? [18, 19].
???????? ?? ??????????? ???????? ??????????? ?? ???? ????????? (?? ???????????). ?? ????? ? ????? ?????????? ?????????
49
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
50
???????????? ??????
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
??????????? ?????????? ??????????????, ? 3, 2014
14.
15.
16.
17.
18.
19.
??????? ?.?. ??????? ??????????. ?.; 1984.
?????? ?.?. ?????????? ??????????? ??????? ???????.
?????? ????????; 1992.
Bode H. Pediatric application of transcranial Doppler sonography. Wien; N.Y.: Springer-Verlag; 1988: 108.
?????? ?.?. ????????? ?????????????? ? ??????? ????????. ?.; 1978: 128.
????? ?.?., ???????? ?.?., ?????? ?.?. ????????????
???????????? ?????????????????? ??????????? ? ?????.
???????? ??????????? ????????. 2000; 3: 179?84.
???????? ?.?., ????? ?.?. ????????? ????????? ?????????????? ??? ?????????????? ????????? ??????????
?????? ???????. ??????????????? ??????. 2007; 2: 8?11.
??????? ?.?. ??????????? ?? ??????????? ?????????????? ?????????????? ? ??????? ??????????. ???; 1995.
???????????? ?.?. ???????? ???????????????? ????????? ????????? ?????. ?.: ????????; 1989.
??????? ?.?., ?????????? ?.?., ???????? ?.?. ????????? ????????????? ????????? ?????????????? ? ??????? ? ????????-?????????? ??????????. ?.: ?????
??. ?.?. ???????? ????; 2003.
???????? ?.?., ?????????? ?.?., ???????? ?.?. ??????
????????? ????????????????? ? ???????????????? ???????????? ? ?????????? ??????? ? ???????? ?????. ????????? VI ??????????? ????????? ╚??????????? ?????????? ? ????????? ? ??????? ????????╩. ?.; 2007.
???????? ?.?. ?????????????? ?????? ??????????? ?????????? ????????? ????????? ?????. ? ??.: ???????? ?.?. (???.) ??????????? ??????? ??????????. ?.: ????????; 2008.
Abramova M., Stepanova I., Novoselova S. Cerebral venous
outflow in children?s age. The normal indicators, pathology
and diagnostics. 18th meeting of the European Society of
Neurosonology and Cerebral Hemodynamics (ESNCH) and
third meeting of Cerebral Autoregulation Network (CARNet).
Porto, Portugal, May 24?27; 2013.
???????? ?.?. ????? ??????? ?????? ???? ????????
? ?????????? ?? ?????????????? ??????????? ?????????
??????????????? ???????. ??????????? ?????????? ??????????????. 2009; 4: 5?15.
???????? ?.?. ?????????????? ?????????????? ???????????? ? ????? (?????? ??????????). ????????????? ??????? ??????????? ╚????????-2011╩ ? ??????????????
? ???????????? ????????????. ?????????? ??????? ???????????????. 4?7 ???????? 2011 ?. ?????-?????????.
???????? ?.?., ???????????? ?.?., ?????????? ?.?.,
???????? ?.?. ??????????? ? ?????????????? ?????????????????? ????????? ? ?????. ??????????????? ???????. ??????????? ?????????? ??????????????. 2009; 3: 51?9.
Baumgartner R.W., Nirkko A.C., MЭri R.M., GЖnner F.
Transoccipital power-based color-coded duplex sonography
of cerebral sinuses and veins. Stroke. 1997; 28: 1319?23.
???????? ?.?., ??????? ?.?., ????????? ?.?., ?????? ?.?. ?????? ???????????? ??????? ????????? ?????.
?????? ?? ??????????? ? 2454936 ?? 25 ????? 2011 ?.
???????? ?.?., ???????? ?.?. ?????????????? ?????????? ???????????? ? ??????????? ??????????? ????????????????? ???????? ?????????? ?????? ??????? ? ?????. ?????????????? ????????????. 2009; 6 (3): 80?3.
Abramova M., Shurupova N., Novoselova S., Stepanova I.,
Nesterovsky Y., Shayunova S. Internal carotid arteries deformation at children: classification, clinical characteristics,
hemodynamic disturbances. 15th Meeting of the European
society of neurosonology and cerebral hemodynamics. May
22?25, Madrid, 2010.
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Burtsev E.M. Violation of brain blood circulation at young age.
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Smirnova Yu.V., Shul?ts T.E. Disturbances of cerebral hemodynamics in pathological deformation internal carotid arteries.
Nevrologicheskiy zhurnal. 2007; 2: 8?11 (in Russian).
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Berdichevskiy M.Yu. Venous dyscirculation pathology of the
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venous cerebral blood circulation at patients with cardiovascular pathology. Moscow; 2003 (in Russian).
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age aspects in healthy children. Materials VI of the Russian
congress "Modern technologies in pediatric and children's surgery". Moscow; 2007 (in Russian).
Abramova M.F. Ultrasonic methods of diagnostics of vascular
disorders of a brain. In: Petrukhin A.S. (ed.) Clinical children's
neurology. Moscow: Meditsina; 2008 (in Russian).
Abramova M., Stepanova I., Novoselova S. Cerebral venous
outflow in children?s age. The normal indicators, pathology
and diagnostics. 18th meeting of the European Society of
Neurosonology and Cerebral Hemodynamics (ESNCH) and
third meeting of Cerebral Autoregulation Network (CARNet).
Porto, Portugal, May 24?27; 2013.
Shumilina M.V. What questions have to be reflected in summary on ultrasonic diagnostics of pathology of brachiocephalic vessels? Klinicheskaya fiziologiya krovoobrashcheniya. 2009;
4: 5?15 (in Russian).
Abramova M.F. Standartisation of ultrasonic researches in
children (the draft of the conclusion). The International scientific conference "Angiodop-2011" ? a neyrosonologiya and
cerebral hemodynamics. Topical issues of an angionevrology.
4?7 September, 2011. St. Petersburg (in Russian).
Abramova M.F., Nesterovskiy Yu.E., Novoselova S.N.,
Shurupova N.S. Structural and funcional cerebrovascular
disturbances in children. Neurological aspect. Klinicheskaya fiziologiya krovoobrashcheniya. 2009; 3: 51?9
(in Russian).
Baumgartner R.W., Nirkko A.C., MЭri R.M., GЖnner F.
Transoccipital power-based color-coded duplex sonography
of cerebral sinuses and veins. Stroke. 1997; 28: 1319?23.
Abramova M.F., Shayunova S.V., Stepanova I.A., Ivleva S.A.
Method of visualization of cerebral vessels. Patent for invention ? 2454936, 25.03. 2011 (in Russian).
Abramova M.F., Shurupova N.S. Duplex sonography and
clinical peculiarities extracranial abnormalities of internal
carotid arteries at children. Pediatricheskaya farmakologiya.
2009; 6 (3): 80?3 (in Russian).
Abramova M., Shurupova N., Novoselova S., Stepanova I.,
Nesterovsky Y., Shayunova S. Internal carotid arteries deformation at children: classification, clinical characteristics,
hemodynamic disturbances. 15th Meeting of the European
society of neurosonology and cerebral hemodynamics. May
22?25, Madrid, 2010.
????????? 30.05.2014
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
51
╘ ????????? ???????, 2014
??? 616.133.3-007.24
??????????????? ????????? ?????? ?????? ??? ??????????
?????????? ?????? ??????? ? ??????? ?? ????????????????
?.?. ???????? 1, ?.?. ????????-??????? 2, ?.?. ?????? 1, ?.?. ??????? 1,
?.?. ??????? 1, ?.?. ??????? 1, ?.?. ???????????? 1, ?.?. ???????? 1
1 ?????
╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????), ?????????? ?????, 135, ??????, 121552, ?????????? ?????????;
2 ????? ╚??????-????????????????? ???????? ???????????? ??. ?.?. ?????????╩ (???????? ?
???????? ??? ?.?. ???????), ????????? ?????, 34?, ??????, 115522, ?????????? ?????????
???? ???????????? ? ???????? ?????????? ?????? ?????????? ?????? ??????? (???) ? ??????? ?
??????????????? ??????????? ???.
???????? ? ??????. ?????? ???????????? ???????? ?????????? ?????? ??????? 7 ??????? ?????
???????? ?? ?????????????? ?????????.
??????????. ? 2 (28,5%) ??????? ?????? ??????? ????? ?????????? ??????????????? ????????. ? 3
(42,8%) ??????? ???? ???????? ??????????????? ?????????, ??????????? ??? ?????????? ???????.
?????????? ??????????????? ????????? ??????? ????? ????? ? 2 (28,5%) ???????.
??????????. ????? ????????????, ??? ????????? ??????????????? ????????? ????? ???????? ??
???????? ???????, ???????????? ??????? ? ????????? ???????? ???????????, ? ????? ????
??????????. ?????????????? ? ?????????????? ????????, ??-????????, ??? ??????????, ???
????? ?????????????? ???????????????? ??????? ? ??? ?????????? ????? ???????????. ????????
??????????? ??????? ?????????? ??????????????? ???????? ???? ?????????? ??????? ?
??????????? ???????????????? ?????????? ???????????? ??????????? ???????? ??????. ???
????????????? ?????? ????????????? ?????????? ?????????? ???????????? ? ??????????????
?????? ?????????? ? ??????? ???????.
???????? ?????: ?????? ???????, ????????? ?????????? ?????? ???????, ???????????????
?????????, ????????.
MORPHOLOGICAL CHANGES AND THE REASONS OF PROGRESSION OF DEFORMATION
IN THE WALL OF THE INTERNAL CAROTID ARTERY
A.A. Ozolin?sh 1, S.G. Radenska-Lopovok 2, N.A. Darvish 1, M.F. Eseneev 1,
E.B. Mollaev 1, R.R. Valieva 1, T.N. Dzhangveladze 1, I.A. Gvetadze 1
1 A.N.
2 V.A.
Bakoulev Scientific Center for Cardiovascular Surgery, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;
Nasonova Research Institute of Rheumatology, Kashirskoe shosse, 34A, Moscow, 115522, Russian Federation
Ozolin?sh Artur Arturovich, Junior Research Associate, Cardiovascular Surgeon;
Radenska-Lopovok Stefka Gospodinovna, MD, DM, Professor, Chief of Laboratory of Morphogenesis Rheumatic Diseases;
Darvish Nidal Ahmetovich, MD, PhD, Senior Research Associate, Cardiovascular Surgeon;
Eseneev Mussa Feliksovich, Junior Research Associate, Cardiovascular Surgeon;
Mollaev El?murza Biysoltanovich, Junior Research Associate, Cardiovascular Surgeon;
Valieva Ramilya Rafikovna, Junior Research Associate, Cardiologist;
Dzhangveladze Tamara Nodarievna, Junior Research Associate, Ultrasonic Diagnostics Physician;
Gvetadze Irakliy Avtandilovich, Junior Research Associate
Objective ? to study the morphology of the wall of the internal carotid artery in patients with pathological tortuosity of the
internal carotid artery.
Material and methods. The study examined surgical material internal carotid artery 7 patients after resection of pathological tortuosity of the internal carotid artery.
Results. Two patients (28,5%) carotid artery had normal histological structure. In 3 (42,8%) cases were identified
morphological changes characteristic of lipomathosis. The expressed morphological changes artery occurred
in 2 (28,5%) cases.
??????????? ?????????? ??????????????, ? 3, 2014
???????? ????? ?????????, ??. ????. ????., ????????-?????????? ??????; e-mail: 1512@li.ru;
????????-??????? ?????? ????????????, ?????? ???. ????, ?????????, ?????????? ????????????
??????????? ????????????? ???????????;
?????? ????? ?????????, ???????? ???. ????, c?. ????. ????., ????????-?????????? ??????;
??????? ????? ??????????, ??. ????. ????., ????????-?????????? ??????;
??????? ???????? ?????????????, ??. ????. ????., ????????-?????????? ??????;
??????? ?????? ?????????, ??. ????. ????., ?????????;
???????????? ?????? ??????????, ??. ????. ????., ???? ?????????????? ???????????;
???????? ??????? ????????????, ??. ????. ????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
52
???????????? ??????
Conclusion. We can assume that different morphological changes may be age-dependent patients, the characteristics of
the course and at different stages of the disease, type of deformation. Dystrophic and sclerotic processes, apparently
moreintense, the more unfavorable hemodynamic conditions and the more long-time exposure. Fixation of the surrounding tissues due to the sclerotic process crumple zones artery and the impact of hemodynamic overload promotes the formation of inflection of the vessel. However, to confirm these assumptions, it is necessary to further study the data of the
morphology in comparison with data of radiological methods.
Key words: carotid artery, deformations of internal carotid artery, morphological changes, resection.
??????????? ?????????? ??????????????, ? 3, 2014
????????
???????? ?? ????????? ? ????????
?????????? ?? ?????????????????? ???????????, ??? ???????? ????? ?? ???????? ?????????? ??????? ???????????????, ????????
??????? ??????????????????, ??????? ??????????? ? ??????? ????????????? ??????? ? ????????? ????????? ????? [1].
???????????? ????????? ? ????????????? ?????????? ??? ?????????????? ?????????? ?????????? ?????? ??????? (???),
? ?????????? ? ????????????? ??????? ?????????. ??????????? ??????????? ??????
?????????? ?????? ??????????? ???? ????????? ? ?????, ?? ????????? ??????, ? ???
? ?????? ??? ?????. ????? ????????????? ?????????? ??? ????? ?????? ? ??????????
???????. ? ??????? ?????????????? ????????? ? ????????? ????????????? ??????? ?????? ???????? ??????? ????????? ?????????????? ? ???????????? ????????? ? ??????
???????? ?? ???????????? ? ??????? ????????? ???? [2]. ?? ????????????? ???????? ?????? ?????????????? ????????? ?????????????? ??????, ????????? ??????? ? ?????????????? ???????-????????? ?????? [3,
4], ??? ??????????????? ? ??????????? ?????????????? ????????????? ???????.
???????? ??????? ????????? ? ?????????
????????? ? ????????? ???, ??? ??????????????? ???????????? ??????? ???? ???????? ???????????? [5]. ????? ?????? ??????
??????????????? ??? ?????????? ????????????? ?????????, ??? ? ??????????? ?????,
?????????? ???????????, ??????????, ????????, ?????????, ????????????, ?????????? ??????? ????? [5].
???????????????? ???????????? ????
?????? [6, 7] ????????? ? ??????????? ??????? ??????? ??????????????? ????????????.
? ??????? ?? ????????????? ???????? ???,
? ??????? ????????? ????? ????????? ????????????? ??????? ????? ?? ???????, ??????
?????????? ??????? ????????? ??????????????? ????????? [8].
?????????? ?????? [9?12], ??? ???????????????? ?????????? ???????????? ??????
???????? ? ???????? ?????????????? ??????-
??? ? ????????????? ??????? vasa vasorum.
??? ????? ? ????????? ??????? ? ??????????? ???????????? ? ????????????? ????????? ???.
?????? ????????? ?????????? ??? ??????????????? ????????? (???????????????????? ??? ?????????????? ?????????) ????????????? ????????????? ??????????? ???????????? ???? ?????????.
???????? ? ??????
?????? ???????????? ???????? ??? 7
??????? ? ???????? ?? 27 ?? 64 ???. ????????
??????????? ? 10% ???????? ????????????
?????????, ??????????????? ? ???????? ? ??????? ????????? ???????????????? ????????. ??? ????????? ???????? ????????????
??????? ?????????????? ? ???????. ????????? ???????????? ??????? ????????? ?? ??????????? ??????? ????????????? ?? ?????????, ? ????????? ???????????? ??????? ?
?? ??????????? ??????? ????????, ?????????
??????????? ? ??????????? 200.
??????????
? 2 (28,5%) ?????? 27 ? 53 ??? ?????????????? ?????? ??????? ????? ?????????? ??????????????? ????????. ????????? ??? ??????, ??? ?????????????? ?????????. Vasa
vasorum ???? ???????????? ?????????????
???????? ??? ?????????????? ?????????.
???????????? ??????? ?????????? ??????
???????????? ? ????????-??????? ????
(???. 1, ?). ?????????????? ?????????? ? ???????? ???????????? ???????? ???????????
????? (???. 1, ?).
? 3 (42,8%) ??????? ???? ???????? ??????????????? ?????????, ??????????? ???
?????????? ???????. ??????? ???????? ?????????? ?????? ???? ????????. ????????????
??????? ??????????? ? ????????????????
??????. ???? ????? ????? ????????? ??????? ? ??????? ?????????? ???????? ?????? ?
????????? (???. 2, ?). ??? ??????? ????????????? ? ???? ????? ????? ?????????? ???????????? ???????????? ???????, ????????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
?
53
?
???. 1. ???????? ?????? ?????????? ?????? ??????? (?????), ?????????:
?
?
???. 2. ???????? ?????? ?????????? ??????
???????, ??????????, ?????????:
?
??? ?? ?? ??????????. ??????? ???????? ???????????? ????????????? ???????????
?????? vasa vasorum ? ????????? ??????????
(???. 2, ?). ?????????? ???????????? ??????-
? ? ? ??????? ???????? ????? ????????? ???????,
??????????????? ??????? ??????, ????????????
??????? ???????? ?????; ??????? ????????????? ??
???-??????, в 200; ? ? ????????????? ???????????? ? ????????? vasa vasorum; ??????? ?????????????? ? ???????, в 200; ? ? ?????????? ????????????
???????? ???????????, ???????? ???????? ???????????????; ??????? ????????, в 200
?? ??????? ????????????? ??? ?????????? ??
?????????????. ???????? ???????????? ???????? ?????????????? ???? ?? ?????????
???????? ?????????? ?????? (???. 2, ?).
??????????? ?????????? ??????????????, ? 3, 2014
? ? ???????????? ??????? ????????-???????? ?????; ??????? ????????????? ?? ???-??????, в 200; ? ? ?????????? ? ????????
???????? ??????????? ?????; ??????? ?????????????? ? ???????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
54
???????????? ??????
?????????? ??????????????? ?????????
??????? ????? ????? ? 2 (28,5%) ??????? ?
? 58-??????? ??????? ? 64-?????? ???????.
?????????? ?????? ???? ????? ???????? ? ????? ? ????????????? ???????????????????
??????. ?????????? ????????? ??????? ? ????? ??????? (???. 3). ?????? ? ???? ???? ????? ????????? ???????? ?????????? ????????
?????? ? ?????????. ???????????? ???????
??????? ???????????????, ????????????
? ?????? ????. ?????????? ???????????? ????? ??????? ? ????????? ???????????????.
???????????? ???????? ?????????????.
??????????? ?????????? ??????????????, ? 3, 2014
??????????
????? ??????????????????? ????????????, ??????????? ???????? ??????, ????????? ? ???????, ????????. ??????? ????????
?? ?????- ? ????????????????? ???????????? ????????? ??? ???????? ?.?. ?????????? ? ?????. [11, 12]. ???????? ?????????
??????????????? ? ??????????????? ???????????? ?????????????? ???????? ?????? ???????. ???????????? ????????? ? ???????????? ???????? ??????????? ????????? ? ????????? ??????? ????? ??? ??????? ???????
????????? ???????? ? ???????????? ????????, ? ????? ????????? ?????? ???????.
?.?. ?????? ???????? ?????? ???????????????? ???????????? ?????????????
?????????, ?? ??????????? ??????? ????
???????????, ??? ?? ???? ??????????????
?????????? ??????? ???????? ??????????
?????? ??? ?????? ???????? ?????????
? ??????? ? 1,5 ???? ?????????? ?? ???? ?????????????? ?????????? [13].
?????? ???????? ?????????? ? ?????????????? ??????? ???? ?????? ??????? ?? ??????? ? ????? ???????? ??????. ?????????
????? ????????????? ???????? ? ??????????? ?? ??????? ????????????. ? ??????????,
??? ???????, ???????????? ??????, ?????
?????????? ?? ????? ???????? ??????, ??????? ?????????? ??????? ? ????????? ?????????. ? ??????? ???????, ???????? ???
?????? ?????, ?????????? ??????? ??? ???????? ?? ???? ??????????? ??????????? ?????????? ??????. ? ???? ?????? ??????????
?????? ????????? ??????????? ?????????? ??
???? ???? ?? ?????, ? ?? ??????? ???????? ?????? ??? ???? ?????? [11?16]. ? ?????????
??????? ??????? ?????????????? ? ???????
??????? ??????? ?????, ?????? ???? ? ????????????? ???????? [14, 16].
???. 3. ???????? ?????? ?????????? ?????? ???????,
??????????????, ?????????. ??????????????? ????????? ??????? ? ????? ???????. ??????? ??????????????
? ???????, в 200
?????????????? ?????- ? ???????????????? ???????? ??????? ??? ????? ?????????? ?????? ?????? ????????? ???, ??? ?????
? ??????? ???????? ??? ?????????????? ??????. ?????????? ???????? ??????? ? ????????? ????????? ???????? ?? ?????? ? ??????? ????????, ?? ? ??????????? ????? ??????
??????? ? ??????????? ????????????????
?????????. ? ????? ?????????? ?????????
???????? IV ????. ? ????? ????? ??????????
???????? ????????? ????????????????? ???????????????????, ????????? ????????????, ????????????, ??????? ??????????????
(? ???????? ???????? III ????). ??????????
???????????? ???????? ???? ????????????,
??????? ????????????, ??????????? ??? ???? ?????????????????. ??????????? ????????????? ????????????????? ? ?????????????? ??????, ??????????? ???????? (????????? ????????????). ??? ??????????????
????????? ?????????? ???????????? ???????? ? ????? ?????? ???????? ???????? ????????? ????????? ? ???????????????????
? ?????? ??????? ? ????????? ?????? ?? ????? ????????????? ??????????? [11?16].
??? ??????? ?????? ??? ??????????? ????????? ???????????? ?????? ?????????? ????????? ??? ???????, ???????? ???? ???????
????? ? ?????????? ???????????? [11?16].
?? ?????? ?.?. ?????????? [16], ??????
??????? ???????????? ??????? ???????? ???????? ??????? ? ?????? ????????? ????? ? ???????? ??????????? ?????????, ???????? ???
????????????? ?????????????? ??????????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
? ???? ????????????, ??????????? ? ????????? ???????????, ?????????? ??????????
???????? ?.?. ???????? ? ?????., ? ?????
?.?. ?????????? ? ?????. [17, 18].
?.?. ?????? ? ?????. ???????? ?????? ??
???????????? 29 ?????????? ???, ?????????? ??? ?????????? ???????? ???????? ???
? ??????????? ????? ? ?????. ?????? ????????, ??? ? ??????????? ????? ???????
(21 ?? 29) ??????????? ?????????? ??????,
?????? ?? ???? ?????????? ??????? (?? 16 ???,
16?40 ??? ? ?????? 40 ???). ???????? ?????????? ??????? ????????, ? ?????????, ?? ????
?????????? ??????????????? ??????????,
????????? ??????????????? ????????????
???????, ????????? ???????????? ???????
? ????????? ?? ?????????????????? ????????? ??????. ? 3 ?? 10 ??????? ??????
40 ??? ?????????? ???????????? ? ?????? ????????, ???????????? ? ??????????. ? ?????
?????????? ?????????? ??????????? ??????????????? ?????????? ?????? ???????,
??????????????? ?? ?????????? ????????
???????? ? ???????????? ??????????????
???????. ?????????????? ?????????????????? ?????????? ? ?????????????????
???? ? ??????? ???????? ?????????? ? 7 ???????, ???? ? ?????? 16?40 ???, ??? ???????
?? ??????????????? (????????? ?????? ?????????????). ????? ?? ?????? ???????????
? 2 ??????? ?????. ? 1 ?????? ? ??????? ????????? ??????????? ?????????????????? ????,
??? ?????? ??????????? ??? ?????? ??????
???? ??????? ??? ??????????????? ??????????, ?? ????????, ??? vasa vasorum ? ???? ?????? ?? ???? ????????.
? 3 ??????? ???????? ?????? ????????????? ?????????, ?????? ?? ????????? ? ?????????????? ? ???????????. ?????? ????????????, ??? ???????? ?? ????????????? ?????
????????????? ??????? ?? ????? ???????? ??????. ? ????? ?? ???? 3 ??????? ??????? ???????? ??????????????? ? ???? ?????????
?????????????? ??????, ?? ????????? ????? ?????. ?????? ???????, ??? ? ??????????
? ???? ????? ?????? ??????????? ????????????? ?????????. ? ?????? ?????????? ? ??????? ???????? ???????? ??? ??????? ???????? ???? ???? ????????? ? ?????????? ?????
????, ? ??????? ????? ????????? ???????????? ???????? ????. ? ??????? ?????? ??????
?????? ?????? ? ???? ?????????? ???????????? ????????, ????????????? ? ???????,
????????? ?? ??????? ???? ? ???????????
??????? ??????.
55
?????? ???????? ????????????? ?????????????? ????????? ??? ?????????????? ????????? ???, ? ??? ??? ???? ??????? ??? ??????????? ??????????? ?? ???? ??????????
???????. ??? ???? ?????????? ? ?????? ?????? ? ??????????? ??????????????? ???????, ?????????????? ???????????? ???????
????????? ??? ?????, ??? ???????????????
? ?????????? ????????? ????????. ? ????????? ????????? ?????? ??????????? ?????
?????????? ? ????????????? ?????? ?? ??????
????????? ????????? ? ???????? ????????????? ????????. ????????????? ???? ????????? ?? ?????? ?????? ???????? ??????????????, ?? ? ??????????? ??????????? ???????? ?????????????, ????????????? ????????
? ????????????. ?????? ??????? ????????? ??? ??????????, ??? ? ?????????????
???????? ????????????? ?????????????? ????????? ???, ?? ????????? ? ???? ????????????? ???????????????????? ???????? ? ?????????? ?????? ? ??????? ? ?????????? ??
?????? [17].
?.?. ???????? ? ?????. ???????? ??????
???????????? ?????????????? ???????? ??????? ? ???? ??????????: ?????????????? ????????? ???????????? ??????? ? ?????????????? ?????????????? ? ???????????????
?????????? ???????????? ????????, ???????? ?????????? ????? ? ???????????? ?????????????? ??????. ?????? ????????????
?????????? ????? ?????????????? ?????????? ??????????????? ?????? ????? ? ?????????? ???????????????????? ????????? [18].
??????????
? ???? ??????? ? ????????? ???????? ????????, ? ????? ? ????????? ?????????? ????????? ???????? ???? ???????? ??????????
???????? ???????. ????? ????????????, ???
????????? ??????????????? ????????? ????? ???????? ?? ???????? ???????, ???????????? ??????? ? ????????? ???????? ???????????, ? ????? ???? ??????????. ?????? ? ?????????? ????????? ??????? ???? ????????
?????????????? ?????????, ??????? ? ???????
???????? ???????????????????? ???????? ?
?? ?????????? ?? ??????????????. ??? ??
?????? ??????? ????? ?????? ????????????
??????? ? ???????? ?????? ??????. ?????????????? ? ?????????????? ????????, ??-????????, ??? ??????????, ??? ????? ?????????????? ???????????????? ??????? ? ??? ?????????? ????? ???????????. ??????????????
??????????? ?????????? ??????????????, ? 3, 2014
???????????? ??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
56
???????????? ??????
????????? ???????????? ?????? ??????????
? ?????????? ???????????? ????????, ???????????? ????????? ??? ???? ?????? ? ??????????????? ?????. ???????? ???????????
??????? ?????????? ??????????????? ???????? ???? ?????????? ??????? ? ???????????
???????????????? ?????????? ????????????
??????????? ???????? ??????. ??? ????????????? ???? ????????????? ?????????? ?????????? ???????????? ? ?????????????? ?????? ?????????? ? ??????? ???????.
??????????
1.
2.
3.
4.
5.
6.
7.
??????????? ?????????? ??????????????, ? 3, 2014
8.
9.
10.
11.
12.
13.
14.
15.
16.
??????? ?.?., ??????? ?.?. ????????-?????????? ???????? ? 2011. ??????? ? ?????????? ???????? ???????
?????????????? (?????????). ??????? ? ????????-?????????? ????????. 2012; 6: 35?7.
????????? ?.?., ?????? ?.?., ????????? ?.?. ???? ????????? ?????????? ?????? ? ??????????? ??????? ? ????????????? ???????? ???????? ???????. ????? ?????????. 1972; 6: 28?33.
Weibel J., Fields W.S. Tortuosity, coiling and kinking of the
internal carotid artery. I. Etiology and radiographic anatomy.
Neurology. 1965; 15: 7?18.
Weibel J., Fields W.S. Tortuosity, coiling and kinking of the internal carotid artery. II. Relationship of morphological variation
to cerebrovascular insufficiency. Neurology. 1965; 15: 462?8.
???????? ?.?., ??????? ?.?., ???????? ?.?., ?????????? ?.?., ??????? ?.?., ???????? ?.?. ? ??. ????????? ?????????????????? ?????? ?????????? ??????
???????. ????? ?????????????? ?????????? ??????? ? ????????-?????????? ????????. 2013; 1: 27?32.
???????? ?.?., ?????????? ?.?., ????????? ?.?. ? ?????????? ? ?????????? ????????? ????????? ?????????????? ??? ????????? ?????? ? ??????????? ???????.
????? ?????????. 1962; 8: 18?26.
???????? ?.?., ?????????? ?.?., ????????? ?.?., ???????? ?.?. ?????????????? ???????? ????????? ????????? ??????????????. ?.; 1975.
????????? ?.?., ??????? ?.?. ?????????????? ????????.
?.: ??????; 1953: 57?68.
?????????? ?.?., ???????? ?.?., ??????????? ?.?. ??????????????? ?????????????? ?????????????? ?????????
? ????????? ??????????????? ???????. ?????????? ???????? ????????????????? ? ??????????? ?????????.
??????; 1987: 279?81.
?????????? ?.?., ???????? ?.?. ??????????????? ????????? ?????? ?????? ? ??????????? ??????? ??? ??
?????????????? ????????? ? ??????. ????? ?????????.
1990; 52 (10): 53?8.
???????? ?.?., ?????????? ?.?., ?????????? ?.?. ????????? ?????????? ?????? ??????? ??? ?? ?????????????
??????? ? ?? ??????????? ????????. ????????. 1989; 9:
47?51.
???????? ?.?., ?????????? ?.?., ???????? ?.?. ???????? ? ???????? ?????????????? ????????? ? ?????? ?????????? ?????? ???????. ??????????? ??????: ???????
?????. ?????? 1. ?.-??; 1995: 177?9.
?????? ?.?. ????????????? ??????? ?????????????? ????????? ?????? ???????: ???. ... ????. ???. ????. ?????;
1999.
????????? ?.?., ????? ?.?. ?????????? ??????????????
????????? ????????????????? ???????. ?????????? ? ?????????? ???????? (??????????). 1998; 2: 28.
???????? ?.?., ????? ?.?., ???????? ?.?., ???????? ?.?.
??????????? ? ??????? ?????????????? ????????? ?????? ???????. ?????????? ? ?????????? ????????. 2001; 7 (2):
93?103.
????????? ?.?., ?????? ?.?. ???? ????????? ????????? ?
??????????????????? ???????? ????????????? ???????
?????? ? ?????????? ????????? ????????? ???????????-
17.
18.
???. ? ??.: ????? ?????? ? ??????????, ??????? ? ??????? ??????? ? ??????????? ???????????: ??????
????????. ???????; 1977: 23?6.
?????? ?.?., ????? ?.?., ??????? ?.?. ?????????????
??????? ?????????????? ????????? ?????????? ??????
???????. ???????: ???-?? ????; 2003: 39.
???????? ?.?., ??????? ?.?. ?????????????? ?????????? ?????????? ?????? ? ??????????? ???????. ?.:
???-?? ??? (??); 2005.
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Disease and congenital malformations of the circulatory system (the end). Grudnaya i serdechno-sosudistaya khirurgiya.
2012; 6: 35?7 (in Russian).
Vereshchagin N.V., Levina G.Ya., Stepanova V.G. Role of the
excesses of the internal carotid and vertebral arteries in the case
of thrombosis of cerebral vascular. Arkhiv patologii. 1972; 6:
28?33 (in Russian).
Weibel J., Fields W.S. Tortuosity, coiling and kinking of the
internal carotid artery. I. Etiology and radiographic anatomy.
Neurology. 1965; 15: 7?18.
Weibel J., Fields W.S. Tortuosity, coiling and kinking of the internal carotid artery. II. Relationship of morphological variation
to cerebrovascular insufficiency. Neurology. 1965; 15: 462?8.
Arakelyan V.S., Gamzaev N.R., Gidaspov N.A., Kolesnikov Ya.G., Barykin Yu.S., Shumilina M.V. et al. Extracranial
internal carotid artery aneurysm. A trick of abnormal tortuosity? Grudnaya i serdechno-sosudistaya khirurgiya. 2013; 1:
27?32 (in Russian).
Koltover A.N., Lyudkovskaya I.G., Vereshchagin N.V. To the
pathogenesis and morphology of violations of cerebral circulation in lesions of the carotid and vertebral arteries. Arkhiv
patologii. 1962; 8: 18?26 (in Russian).
Koltover A.N., Lyudkovskaya I.G., Vereshchagin N.V., Morgunov V.A. Pathologic anatomy violations of cerebral circulation. ?oscow; 1975 (in Russian).
Abrikosov A.I., Strukov A.I. Pathological anatomy. Moscow:
Medgiz; 1953: 57?68 (in Russian).
Matskevichus Z.K., Paulyukas P.A., Tamuleytene M.G.
Histological characteristics of resected bending and twisting
brachiocephalic arteries. Actual problems of experimental and
clinical pathology. Kaunas; 1987: 279?81 (in Russian).
Matskevichus Z.K., Paulyukas P.A. Morphological changes
of the wall of the carotid and vertebral arteries in their pathological excesses and hinges. Arkhiv patologii. 1990; 52 (10):
53?8 (in Russian).
Paulyukas P.A., Matskevichus Z.K., Barkauskas E.?. Change
the internal carotid artery with the CE loop bends and their
clinical significance. Khirurgiya. 1989; 9: 47?51 (in Russian).
Paulyukas P.A., Laurikenas K.V., Streykus L.K. Problems in
surgery pathological kinks and loops of internal carotid arteries. Polenov's readings: Scientific works. Issue 1. St. Petersburg; 1995: 177?9 (in Russian).
Katkov A.I. Surgical treatment of pathological tortuosity
of the carotid arteries: MD, PhD med. sci. Diss. Perm; 1999
(in Russian).
Nikonenko T.N., Gubka V.A. Morphogenesis pathological tortuosity of the extracranial arteries. Angiologiya i sosudistaya
khirurgiya (Suppl.). 1998; 2: 28 (in Russian).
Kazanchyan P.O., Popov V.A., Gaponova E.V., Rudakova T.V.
Diagnosis and treatment of pathological tortuosity of the
carotid arteries. Angiologiya i sosudistaya khirurgiya. 2001;
7 (2): 93?103 (in Russian).
Vereshchagin N.V., Levina G.Ya. Role of combination of kinks
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Shoykhet Ya.N., Khorev N.G., Kulikov V.P. Surgical treatment of pathological tortuosity of the internal carotid artery.
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Kazanchyan P.O., Valikov E.A. Pathological deformation
of the internal carotid and vertebral arteries. Moscow; 2005
(in Russian).
????????? 30.05.2014
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
57
╘ ????????? ???????, 2014
??? 577.1:[665.931.7+547.944.6]
???????? ??????? ????????? ??????????
?? ?????? ???????? ? ?????????
?.?. ???????, ?.?. ???????, ?.?. ????????, ?.?. ????????????,
?.?. ??????????, ?.?. ????????, ?.?. ??????
??????? ??? ?????????, ?????? ???. ????, ?????????, ???????? ??? ? ????, ????????;
??????? ????? ??????????, ?????? ???. ????, ?????????, ??. ????. ????.;
???????? ???????? ????????, ?????? ????. ????, ?????????, ?????????? ???????????? ?????
? ?????????? ?????????? ??? ????????-?????????? ????????; e-mail: spnovikova@bakulev.ru;
???????????? ?????? ?????????, ???????? ????. ????, ??. ????. ????.;
?????????? ?????? ??????????, ??????? ????????;
???????? ?????? ??????????, ????. ????.;
?????? ??????? ??????????, ????????
???? ???????????? ? ??????? ??????????? ???????? ????????? ?????????? ?? ?????? ??????????
????????????????? ???????? ? ???????? ? ?????????.
???????? ? ??????. ??? ????????? ????????? ?????????? ???????????? ????????? ??????? ?
???????, ? ???????? ???????????? ????????? ???????? ? ???????? ????????????? ?????????????
? ?????????????????????? ?????????? ? ????????, ????????????? ? ????????, ????????? ????? ?
?????????? ????????.
????????? ??????????? ?????????????? ????????? ??????????, ????? ?? ???????????????
??????????, ????????? ????????? ?? ??????????, ??????? ????????????.
??????????. ???????? ???????? ??????????? ?????????? ??????????? ????????? ?? ??????????
????????????????? ? ?????????? ?????????. ????????, ??????? ????????? ????????????
????????? ?????????? ? ?????? 30 ??? ? ?????????? ?? 65 ?? 75% ????????? ? ??????????? ?? ???
?????????? ? ??????????. ?????????? ? ????????? ?????????? ????????? ?????????? ??
?????????, ? ????????? ??????????? ?? 18%. ??????????????? ?????????? ????????? ??????????
? ?????????? ???????? ???????. ???????????? ??????????? ?????????? ????????????? ?????????
?? 8% ? ????????? ?????? ???????? ? ?????????? ?? 15%.
??????????. ???????? ??????????? ????????? ?????????? ?? ?????? ???????? ? ???????????????? ?????????? ? ?????? ???????????? ? ??????? ?? ??????-?????????? ? ?????????????????? ????????. ?????????? ?????????? ??????????????? ???????????????? ??????????
?????????, ????????????? ??????? ??????????????? ??????????, ????? ??????????? ????????
???????????? ???????.
???????? ????? ?????????? ???????????? ????????? ?????????? ?? ????????? ?????????? ??????,
? ?????? 30 ???. ?????????????????? ????????? ????????? ? ????? ?????, ?????????? ? ??????,
?????????????? ?? ???? ??????????? ????????????????? ????????? ???????? ? ??????????. ?????
????????????, ??? ??????????????? ?????? ?????????? ?????????? ????? ???? ?????? ?? ???????
? ??????????? ?????????? ?????????, ??????? ? ??????????????????? ??? ????????? ? ????? ?????,
? ??? ????? ? ?? ???? ????????????? ?????????. ?? ??? ????????????? ???????? ???????? ???
?????????? ????????????? ????????????? ????????? ?????????? ? ???????????? ?? ????????.
???????? ?????: ????????? ??????????, ???????, ????????, ??????????????? ??????????,
???????????? ????????.
STUDYING THE PROPERTIES OF THE FILM COMPOSITIONS WITH GELATIN AND COLCHICINE
L.A. Bockeria, O.L. Bockeria, S.P. Novikova, R.R. Salokhedinova,
L.N. Nikolashina, O.V. Shustrova, V.S. Sivtsev
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Bockeria Leo Antonovich, MD, DM, Professor, Academician of Russian Academy of Sciences and Russian Academy
of Medical Sciences, Director;
Bockeria Ol?ga Leonidovna, MD, DM, Professor, Chief Research Associate;
Novikova Svetlana Petrovna, Dr. of Biol., Professor, Chief of Laboratory of Chemistry and Technology of Materials
for Cardiovascular Surgery;
Salokhedinova Regina Rushanovna, PhD in Econ. Sci., Junior Research Associate;
Nikolashina Lyubov' Nikolaevna, Leading Technologist;
Shustrova Oksana Vital'evna, Research Associate;
Sivtsev Vasiliy Stepanovich, Postgraduate
??????????? ?????????? ??????????????, ? 3, 2014
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????), ?????????? ?????, 135, ??????, 121552, ?????????? ?????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
58
???????????? ??????
??????????? ?????????? ??????????????, ? 3, 2014
Objective ? to assess the possibility of creating a film compositions based on natural biodegradable polymer ? gelatin and
colchicine.
Material and methods. To obtain film compositions using natural polymer ? gelatin. As the biologically active substance ? herbal drug with anti-inflammatory properties ? colchicine, a plasticizer ? glycerin, a crosslinking agent ? glutaraldehyde.
Evaluated: the strength characteristics of film compositions, the timing of their hydrolytic degradation, desorption of
colchicine compositions, sterilization effect.
Results. Shows a linear dependence of the amount allocated from the amount of the immobilized colchicine. Active rapid
release unbound colchicine occurs in the first 30 minutes ? released from 65 to 75% colchicine depending on its amount
in the composition. Adding to the film composition colchicine loosens its structure ? the strength is reduced by 18%.
Hydrolytic degradation film compositions with colchicine is faster. Sterilization increases the amount of liberated colchicine
at 8% and hardens gelatin film with colchicine at 15%.
Conclusion. The possibility of obtaining compositions based on gelatin-immobilized colchicine in different proportions.
Studied their physico-chemical, physico-mechanical properties. The received compositions have the prolonged allocation
of colchicine, adjustable terms of the hydrolytic destruction, necessary complex of mechanical properties. The bulk of the
injected unbound colchicine released from the film compositions quickly in the first 30 minutes. The prolonged release of
colchicine in small doses as shown in the work provided by the remaining biodegradable gelatin complex with colchicine.
It can be assumed that the therapeutic effect of the compositions can be associated not so much with the amount of
injected colchicine as a prolongation of its isolation in small doses including and biodegradation of the complex. It is
advisable to pay attention in further biological studies film compositions in experiments on animals.
Key words: film compositions, gelatin, colchicine, hudrolytic destruction, mechanical properties.
????????
? ????????? ????? ????? ?? ????????
???????????????? ????????????? ???? ? ???????? ???????? ?????????? ?????????
??????????, ???????????? ? ???????? ???????
???????? ????????????? ?????????? (??).
???????? ????????? ???????????? ?????????? ?????????? ?????????? ? ?????????????? ??????????? ? ???? ?????? [1?6]:
? ??????? ??????????????? ?????? ???
????? ????? ????????????? ???????;
? ?????????? ??????? ?????????? ????????????, ????????? ???????? ????????? ??
???? ???????? ???? ????????? ?????????????? ???????? ?? 10?20 ??? ?? ??????????????? ????;
? ??????? ?????? ????????????? ??????????;
? ???????????? ???????????????? ???????? ????????????????? ??;
? ???????????? ???????? ??;
? ???????? ? ??????????;
? ?????????? ??????? ? ?????? ???????.
????????????? ?????? ????? ????? ?? ?????? ???????? ?????????? ? ??? ????????????
? ??????? ?????????????? ??????????? ?????????, ?????? ????????, ?? ? ?????????? ?
? ???????? ?????????? ???????? ? ?????????
?????????? ? ????????????? ??????? ????????????? ??? ???????????? ???????? ?????????? ????? ????????????? ???????? [2?9].
?????????????? ???????? ?????????
?????????? ???????????? ??????-??????????? ???????????????? ?????????? ????????-????????, ????????????????? ? ?????????? ?????? ???????????? ?????????
??????????, ? ????? ????????????? ?????????? ????????? ??????????.
? ??????? ??? ?????? ??? ??????? ?????????????? ????? ???? ?? ?????????? ? ????????
?????????? ????????????? ? ???????? (?),
??????? ??????? ??????? ?????????? ? ?????? ???????? ????????? ?????????. ? ???????? ?? ?????? ???????? ?????????????
???????, ????, ?????, ??????, ???????????
? ????????????, ?????????????, ???????????, ???????????, ????????????, ??????????????????? [2?7].
??????????? ?????????? ??????? ?????????? ? ? ????????, ???????? ? ???????? ???????? ??????????? ???????, ?????????????? ? ?????? (??????? ??????????? ???????,
??????????????????? ???????), ? ????? ????????? ?????????????? ??????? ???? ??????? ? ??????????????????, ?????????????,
??????? ????????????? ?????????? [10?13].
??????? ????? ?????????? ????? ???????? ??????????? ????????????? ??? ???????
? ???????.
??????? ? ????????? ???????, ???????????? ????? ????? ???????? ??????? ????????? ?????????????. ???????? ??????? ?????
?????????? ?????????? ????????? ?????????
? ??????? ??????????? ?????????. ???????? ?????? ??? ???????????? ???????? ?????? ????? ???????? ???????? ?????, ?????,
?????? ??????????? ???????????? (???????
????, ??????) ? ?????????, ?? ???? ????????
????? ???????? ? ????????? ? ????? ???????????????.
??????? ????? ?????????? ??????????
? ?????????????? ??????. ????? ??????
? ??? ?????? ?????? ????, ???????, ????, ????????, ????, ??????? ??, ?????- ? ????????????? ? ???????, ??????, ??????, ?????,
??????, ??????. ?????????????? ??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????? 18 ???????????, ????? ??????? ?????? (26?31%), ?????? (15?18%), ?????????????? (13?15%), ???????????? ???????
(11?12%), ????????????? ??????? (6?7%),
?????? (8?11%), ??????? (8?9%).
????? ??????? ???????? ????? ??????? ???????? ????? ??? ??????-??????????, ???????????????, ?????????????? ????????, ???
????????????????, ?????????????, ?????????????????, ??????????? ? ?????????????,
?????????? ?? ??????????? ???????, ???????
?????????????? ???????????, ?????????????????, ??????? ?????????????, ??????????????? ????????, ??????????? ?????????????
???????? ??????????? ???????????? ??????, ??????? ??????????? ???????????, ??????? ?????????? ??????? (? ?????? ????? ?
????????????? ?????, ? ???????? ? ?????????????), ????????????? ?? ??????? ?????????????? ?????????? [1?3].
??????? ????? ??????? ??????????? ??????? ?? ????????? ? ????????????? ?????????, ? ?????????? ???? ???? ??????? ?????
??????? ??????? ???????? ??? ????????????? ??????????.
?????????? ??????? ?????? ? ????????
???????? ???? ??????????? ????????????
???? ??????? ??? ???????? ?????????????
????????? ?????????? ? ????????? ?????????? ??? ???????????? ???? ??????????.
????? ?? ???????? ????? ?????????????,
??????? ?????????? ????? ????????????? ???????????? ???????? ???????? ???????, ???????, ? ???? ???????, ???????? ? ?????? ????
????????? ??????????, ????? ??????????
????? ????????. ???????? ????????? ???????? ? ???????? ????? ????????? ? ?????? ?? ??????????. ? ????? ?????? ??????????? ?????
????????? ????????? ???????? ? ???????
???????. ? ?????????????? ?????? (post-surgical adhesions, postoperative pericardial adhesions) ????? ???????? ????????? ????????????????? ???????????, ?????????????
???? ????????? ????????, ???????????? ??????????? ??? ??????? ????? ?????????
14?15%, ? ? ????????? ??????? ? 43% [14].
???????? ????????? ?????? ? ????????
???????????? ????????? ????????:
1) ????????????? ? ??????? ???????????,
?????????? ????????? ????????, ??????????
????????? ????????????, ?????????? ????????????????? ???????, ?????????? ??????,
????? ??????? ?????????, ?????????? ?????????? ??? ???????????????? ?? ?????
????????: ????????? ?????, ???????, ???????
59
? ????????, ????????? ????????? ????????,
??????, ????????? ????????? ??? (???????????? ????????, ????? ? ?. ?.) ? ??????????
????????? (?????, ???) ? ??.;
2) ??????????????? ? ?????????? ????????????? ??????????: ??????????????, ???????????????, ??????????????, ????????????,
????????????????????? ?????????? ? ??.;
3) ???????????????????? ? ??????????,
???????-, ?????????????, ????????????, ?????????, ??, ?????????????? ??????? ? ?. ?.;
4) ?????????, ??????????? ??????? ???????????, ? ???????? ?????????????? ??????? ? ????, ????????, ??????, ????????, ?????, ?????, ??????, ????????, ???????.
???????? ?? ?????????????? ????????????, ? ????????? ????? ?? ??? ?????? ???????? ???? ??? ??????????? ????????????? ????????????? ? ?????????????? ???????????
?????. ?????? ?????????? ?????????? ????????? ??? ??????????, ??? ??????????
??????????????? ?????? ????? ??????????
?????????? ???????????????? ╚?????????╩
???????, ?????????????? ????????? ? ?????????? ?????????????? ????????????. ???????? ???????????? ??? ???? ????? ?????????? ?????????? ? ???? ?????? ?? ?????? ????? ?????????????? ????????? ?????????,
??? ???????, ????????, ???????, ??????????????????? [7?9, 15?17].
??? ????????, ? ?????????????? ????????
??????? ? ???? ?? ?????????? ???????????.
?????? ???????????? ?????? ???????, ???
? ???????? ???????? ???????????? ????????????????????? ???????? ????? ??????????? ???????? ????????????? ?????????????, ??????????? ????????? ? ????????
(???) [18?20].
???????? ???????? ?????? ????????????????????? ?????????? ? ???????????????? ????????????? ???????? [21]. ????????????? ??????????? ? ?????????? ????????? ????????: ???????, ??????? ???????,
???????? ????????????????? ?????????. ????????? ????????????? ?? ?????????????
????????? ? ??? ???????????, ????????????????? ????????, ???????? ????? ? ??????,
??????????, ???????????. ???????? ????????????? ???????????? ???????????, ???????? ???? ????????? ?????????? ??????? ?????? ? ?????? ???????? ? ???????, ?????????
???????????????? ???????????. ?????? ???
??????????? ????????????? ?????? ?? ????????????? ?????????? ? ???????????? ????????? ??? ???????????? ???? ???????????.
??????????? ?????????? ??????????????, ? 3, 2014
???????????? ??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
60
???????????? ??????
??????????? ?????????? ??????????????, ? 3, 2014
?????????????????????? ???????? ????????
????????? ??? ??????? ???? ??????????? ??
????? ??? ?? ?????? [22].
??????? ????????, ??? ???????? ????????
??????????????? ??????????, ??????????
????????? ?? ?????? ? ????????? ????????
???????, ???????? ?? ??????? ?????????????????? ??????, ??? ???????? ????? ?? ?????? ??????????? ??? ???????? ??????????.
??? ????????????? ????? ????????? ?????????? ????????? ????? ??? ???????? ? ?????????????? ? ??????? ?????????????? ???????????, ????????????? ??????????? (? ?????????, ???????? ???????????????) ? ??.
???????????, ??? ????????? ?????? ????????? ????????? ??? ????? 0,5 ??/?? ? ?????. ??
???? ???????? ??????, ????? ??????????? ?????????, ????????? ? ?????????? ??????, ??????????? ? ??? ??????? ????? ? 0,28 ??/?? [23].
?????????? ????????? ????? ?????????
???????????? ?????????? ? ??????????? ???
???????????? ???? ???????????, ???? ??? ???????????? ? ????????? ?????. ?? ???? ? ????
?????? ????????? ??????? ????????????.
???????? ??????????? ????????? ? ?????????? ?????????? ??????? ?????? ?????? ???????? ?? ???? ????????????? ????????? ? ????????? ?????????? ? ???????????
??? ????????????????? ?????????.
???? ????? ?????? ? ??????? ??????????? ???????? ????????? ?????????? ??
?????? ???????? ? ?????????.
???????? ? ??????
??? ????????? ?????????? ????????????
?????????????????? ????????? ???????
??????? (???????????????, ????? ?-13,
???? 11293-89 ╚???????. ??????????? ???????╩, ???????????? ??? ╚???????╩, ?. ???????, ??????? ?? ╚?????????╩ ???????).
?????????? ???????? ? ???? ?????? ??????? ?????? ?? ??????? ???????? ???????? ?
???????????? 5%. ??????? ???????? ?? ???????????????? ????????, ?????? ??? ????????? ??????????? 36?72 ?. ??? ????????????? ???????? ???????????? ???????????????? ????. ??????? ?? ?????????? ?????????
5,2?6,2. ??? ???????????? ????????????
?????? ???????? 2в3 ??, ???????? 100 ???,
????? ???????? 0,07 ? ? ?????????? ? ?????????? 0,05; 0,09; 0,14; 0,32; 0,5 ??.
? ???????? ?????????????? ?????????????????????? ????????? ???????????? ???????? ?
????????. ???????? ??????? ? ?????????
??????????? ? ????? ???????? ???????? ???????? (0,7; 1,3; 2,0; 4,5; 7,0 ?? ??? / ? ?).
? ???????? ?????????????? ????????????
???????? ? ??????????? ??????? : ???????? = 1 : (0,6 В 0,4).
?????????? ??????????????? ????????? ??????? ? ?????????? ?????????? (??)
(???????????? Panreac, ???????). ??? ??????? ? ????? ?????????, ??????????? ?? ?????
???????:?? = 50:1. ????? ??????????? ???????:?? ??????? ?? ?????? ????? ??????????? ???????????? ??? ???????? ???????????
?? ??????-???????????? ? ??????-?????????? ?????????.
???? ????????? ??????-??????????, ??????-???????????? ???????????? ??????????:
? ????????? ????????? ?? ??????????
????????? ????????????????????? (??????????????? Shimadzu UV-1240);
? ????? ??????????????? ??????????
????????? ?? ????????? ???? ??? ???????????? ???????? ? ??????????????? ????????
pH=3 ??? ??????????? 37 ╟? ?? ???????????
????????;
? ?????????, ???????????? ?????????? ? ???????? ?????????? ?????????? ??? ??????????? 25 ╟? ? ???????? ????????? 10 ??/???
?? ????????????? ????????? ?????? Zwick/
Roell BZ2.5/TN1S;
? ??????? ??????? ???????????? (?????
???????) ?? ???????? ?????????????? ??????????.
?????????????? ????????? ??????????? ???????????? ??????????? ? ?????? ????????????? (??????????, ??????????) ???????????
????? ??????????? ????????????? ????????
??? (X = X ╠ ?X ???), ??? ???? ????????? ?????
??? ?????????????? ???????? ????????? (X )
? ?????????????????? ?????? ???????? (???),
???????????? ????????? ??? ???????? ????????????? (P). ????????????? ?????????
??? ??????????? ??????? ??? ???????? ?????
???????????? ?? ??????? ????????? ?? ????????:
? ?
X ? X >> ?1?1?? + ?2?2?? ,
?1 ?2
X ? X << ?1?1?? + ?2?2?? ,
?1 ?2
X 1? X 2 ?1?1?? + ?2?2?? .
??????????
?????? ????????? ????????? ?? ??????????.
???????? ????? ???????? ?????????? ?????
??? ????? ????? 245 ??. ?? ??????? 1 ???????????? ????????????? ?????? ?????????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
61
?????????? ?????????, ??
1,4
1,2
1,0
0,8
0,6
0,4
0,2
0,0
0,002
0,004
0,006
0,008
0,01
0,012
0,014
???. 1. ????????????? ??????
?????????
????????????, ??/??
100
70
60
50
40
0,5 ?
30
2?
20
40 ?
10
0
0
1
2
3
4
5
6
7
?????????? ?????????? ?????????, ??/? ?
90
80
70
0,7 ??
1,3 ??
60
2,0 ??
4,5 ??
50
7,0 ??
40
0
0,5
1
1,5
2
?????????????????, ?
?
?????????? ????????????? ???, ??/? ?
?
?????????? ????????????? ???, %
?????????? ????????????? ???, %
80
?
8
0,7 ??
7
1,3 ??
6
2,0 ??
5
4,5 ??
7,0 ??
4
3
2
1
0
0
0,5
1
1,5
?????????????????, ?
2
???. 2. ????????? ????????? ?? ?????????? ?? ?????? ????????:
? ? ? %, ? ??????????? ?? ?????????? ?????????? ????????? ? ??????????; ? ? ? %, ? ??????????? ?? ????????????????? ???????????? ???????? ? ??????????????? ????????; ? ? ? ??/? ?, ? ??????????? ?? ????????????????? ???????????? ???????? ? ??????????????? ????????
??? ?????? ????????? ????????? ?? ????????? ??????????, ?????????? ?????? ?????????? ????? ?????????, ???? ???????????,
??? ???????? ??? ????????? ???? ? ??????
?????? ? ?? ???????? ? ??????????? ????????? min 0,7 ? max 7,0 ?? / ? ? ?? 30 ??? ??
?????????? ?????????? 65?75% ?????????
? ??????????? ?? ?????????? ??????????, ?????
???????? ????????? ???????????, ????? 2 ?
?????????? 10?7%, ????? 40 ? ? 4,3?1,5%
(???. 2, ?). ?????????? ?? ?????????? ????????? ? ?????????? ????????? ????????? ???
? ??????????????? ??????? ????? 1 ? ?????????? ????? ???????? (???. 2, ?, ?). ?????-
??????????? ?????????? ??????????????, ? 3, 2014
0
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
62
???????????? ??????
????????? ?????, %
?????????? ???????? ? ???????????????
??????? ??????? ?????????? ?????????, ?????????? ?????, ????? ????????????? ???????????. ? ???????? ? ?????????? ??????????????? ?????????? ???????? ??????? ? ?????????? 27╠3 ???, ??? ???????? ????????? ?
33╠3 ??? (P < 0,95; n = 5). ???????? ????????
? ???????? ?????????? ?????????? ??????
??????????? ????? 20 ??? (???. 3).
???????????? ??????-???????????? ????????????? ????????? ??????????. ???????
????? ???? ???? ??????????? ???????????
??????-???????????? ?????????????? ?????????? ????????? ??????????: ????????? ?
?? ????? 1 ???, ???????????? ? ?? ?????
60%. ????? ????????? ????????????? ??????????????? ??????????? ? ??????????.
????????? ?????????? ? ??????????
????? ???????????? ????????? ?? 18% ??????, ??? ??? ?????????, ???????????? ??????
?? 10%, ?? ??? ?????????????? ???????? ???
???? ? ??????????? ???????? (n = 5, P = 0,95)
(???. 4).
300
???????
250
??????? + ????????
200
150
100
50
???. 3. ?????????? ?????????? ?????????????????? ????????? ?????????? ?? ?????? ???????? ? ??????????????? ???????? (??=3, t=37 ╟C)
0
0
5
10
15
20
?????, ???
25
30
35
1,8
80
1,43
68
70
61
????????????, %
1,17
?????????, ???
??????????? ?????????? ??????????????, ? 3, 2014
?????? ?????????????????? ????????? ?????? ?????? (n = 5, P < 0,95).
?????????????? ????????? ?????? ????????? ???? ????????????? ?????? ??????????
(?????????????) ??????????? ? ?????????
??????? (??. ??????? 2, ?): ???????????? ???????? ???????? ????? ???????? 0,7 ? 1,3 ??
??? / ? ?; 1,3 ? 2,0 ?? ??? / ? ?; 0,7 ? 4,5 ??
??? / ? ?; 0,7 ? 7,0 ?? ??? / ? ?; 4,5 ? 2,0 ??
??? / ? ?; 7,0 ? 2,0 ?? ??? / ? ?. ??? ???????? ????? ????????: 1,3 ? 4,5 ?? ??? / ? ?;
1,3 ? 7,0 ?? ??? / ? ?; 4,5 ? 7,0 ?? ??? / ? ?;
0,7 ? 2,0 ?? ??? / ? ?.
????? ????????????, ??? ???????? ????????? ????? ??????????? ?? ??????? ??????????? ??? ? ??????????, ??????? ??????????????????? ??? ?????????.
?????? ??????????????? ?????????? ??????????. ??? ?????? ??????????????? ?????????? ????????? ?????????? (??? ??????
????????????) ???? ???????????, ??? ?????????? ????????? ? ????? ????????? ?????????? ????????? ?????????? ???????. ???
1,2
0,6
60
50
40
30
20
10
0
0
1
2
1
2
???. 4. ??????? ????????? ?? ??????????? ?????????????? ?????????? ????????? ?????????? ?? ?????? ????????:
1 ? ???????; 2 ? ??????? + ???????? (7 ?? ??? / ? ?)
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????
63
?????????? ????????????? ???, %
100
90
80
70
???????????? ???????
60
?????????? ???????
50
40
30
20
10
0
0
0,5
1
1,5
?????????????????, ?
2
???. 5. ??????? ???????????? ?? ????????? ????????? (7,0 ?? ??? / ? ?)
??????? ???????????? ?? ??????????? ?????????????? ????????? ??????????
?? ?????? ???????? ? ???????? ? ?????????? (7,0 ?? ??? / ? ?)
??????
????????????
?????????, ???
????????????, %
???????
??
?????
1,32╠0,24
1,43╠0,19
73,82╠2,13
68,00╠1,00
???????+????????
??
?????
1,02╠0,08
1,17╠0,10
65,00╠2,00
61,00╠1,00
??????? ???????????? ?? ???????? ?????????????? ??????????. ???????????, ??? ???????????? ?????? ??????? ??????????? ?????????? ????????????? ?????????: ?? 2 ? ??
?????????? ?????? ?????????? 91╠2% ?????????, ?? ???????????? ? 83╠2% (P < 0,95;
n = 5) (???. 5).
??? ?????? ??????????? ?????????????
????????, ??? ???????????? ?????????????
?????? ?? ????????? ? ???????????? ??????
?? ?????? ???????? ? ???????? ? ??????????
(??. ???????), ?? ? ????????? ??????? ????????? ????? ????????? ? ????????, ? ?????????? ???? ????? ???????????? ?????????? ?????? ????????? ? ?? 8%.
??????????
?????? ?????????? ???????, ??? ????????
?????????? ???????? ??????? ? ???????
? ???????????? ????????????? (???????)
? ??????????????? (??????? ???????, ???????? ????????????????? ?????????) ???????????. ????????? ????????????? ?? ????????????? ????????? ? ??? ???????????, ????????????????? ????????, ???????? ?????
? ??????, ??????????, ??????????? [18?24].
?????? ???????? ???????? ??????????????? ??????????, ?????????? ????????? ??
?????? ? ????????? ???????? ???????, ???
???????? ????? ?? ?????? ??????????? ???
???????? ??????????. ? ????? ????????
??????????? ????????? ??????? ???????? ???????? ?? ??????????? ????????????? ???
? ????? ?????.
?????? ????? ??? ????????????? ?????????? ? ????????? ????? ?????????? ????????? ??????? ??????????????? [5, 21, 24, 25].
? ???? ????? ???????????? ???????????????? ??????????? ????????????? ?????????
? ?????? ?????, ????? ????, ??? ?????????
??????? ??????????? ???????? ?????? ????????????? ????? ? ??????? ??? [21]. ? ?????
? ???? ?????????? ??????? ???????? ????????
????? ????????????? ??????????, ???????
????????? ????????? ????????? ?????? ?????? ? ???????????????. ????? ????? ????????, ???? ???????? ??????? ? ?????????
?????????? ?? ?????? ????????? ???????????????? ????????? ? ????????????? ??????? ????????????, ???????? ????????.
? ?????? ?????? ????????? ?????? ??????????? ????????? ????????? ??????????
?? ?????? ???????? ? ????????? ???????????
?????????. ???? ???????? ??????????
? ??????????, ???????? ? ??????? ? ?????????? ?? 0,05 ?? 0,5 ?? ? ?????????? ???????
(2 в3 ??), ?? ???? ?? 0,7 ?? 7,0 ?? ??? / ? ?.
??????????? ?????????? ??????????????, ? 3, 2014
? ? ? ? ? ? ? ? ? ? . ???????????? ??????? ???????? ?? 5 ???????? (P = 0,95).
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
64
???????????? ??????
?????????? ????????????? ???, ??/? ?
7
6
5
?????????? ?????????????
??? ?? 3 ?
4
?????????????? 100% ????????? ???, ?? ?? ???????????
3
2
1
0
0
1
2
3
4
5
6
7
?????????? ?????????? ???, ??/? ?
??????????? ?????????? ??????????????, ? 3, 2014
???. 6. ?????????? ???????????????? ????????? ? ??????????? ?? ??????????, ?????????? ? ???????
??????????????? ????? ??? ??????????? ?????????? ????????? ????????? 0,5 ??/?? [18].
? ????? ? ???????????? ????????? ??????????? ???????? ?????????? ? ??????? ????????????? ? ? ????????? ?????, ??? ???????, ?? ????????????. ????????? ???????, ??????????? ? ?????? ??????, ???????????????
??? ?????????? ??????????, ???????? ???????? ? 5?50 ??? ?????? ??????????????? ????.
??????????????, ??? ????? ???? ?????????
? ??????????? ??????? ????????? ? ??? ???????? ???????????????? ????????? ????? ????
????????? ? ?????? ?????????? ??? ???????????? ???? ??????????? ? ??????????.
?????????????? ?????????? ??????????
?????????? ?????????? ? ? ???????? ?????????? ???????? ??? ???????????? ????????
????????? ????? ????????????? ????????????, ? ???????? ? ???????? ????????????????????? ???????? ? ???? ?????????.
???????? ????????? ????????? ?? ?????????? ?????????? ????????? ??????????
????????? ?????????????? ???????? ?????????. ??????????? ???????? ??????????? ?????????? ????????????? ????????? ?? ?????????? ?????????? ? ??????? (???. 6).
???????? ????? ???????????? ?????????
?????????? ????? 0,5 ? ???????? ????????
? ??????????????? ???????? (65?75%) (??.
??????? 2). ????? 1 ? ???????? ????????? ????? ??????????? (???. 7), ?????????????? ???????????????? ????????? ? ? 40 ? ? ??????
???????? 16?20% ?????????. ????? ????????????, ??? ???????? ???????? ????????
? ????????? ? ?????????????????? ??? ????-
????? ????? ?????????????? ? ?????????????
????????? ??????????. ??????? ????? ????????? ?? ????? ?????????, ? ?????? ?????????????????? ??? ?????????. ??????? ? ??????????? ????????????? in vivo ?? ??????
????????????? ????????? ?????????????
??????????? ???????? ??????? ????? ???.
??? ????????????? ????????????? ?????????? ?????????? ????????? ??????????
?? ?????? ???????? ? ????????? ??????????
??? ???????????? ?????????????????????
???????? ?????????? ???????????? in vitro
? in vivo.
??????????
? ???????????? ???????? ??????????? ????????? ?????????? ?? ?????? ????????
? ???????????????? ?????????? ? ??????
???????????? ? ??????? ?? ??????-??????????, ??????-???????????? ????????. ?????????? ?????????? ??????????????? ???????????????? ?????????? ?????????, ????????????? ??????? ???????????????
??????????, ????? ??????????? ????????
???????????? ???????.
???????? ????? ?????????? ????????????
????????? ?????????? ?? ????????? ?????????? ??????, ? ?????? 30 ???. ?????????????????? ????????? ????????? ? ????? ?????, ?????????? ? ??????, ?????????????? ??
???? ??????????? ????????????????? ????????? ???????? ? ??????????. ????? ????????????, ??? ??????????????? ?????? ?????????? ?????????? ????? ???? ?????? ??
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
?????????? ??????????? ???, %
???????????? ??????
100
0,7 ?? ???/? ?
90
1,3 ?? ???/? ?
80
2,0 ?? ???/? ?
70
4,5 ?? ???/? ?
60
7,0 ?? ???/? ?
65
50
40
30
20
10
0
0
0,5
1
1,5
2
40
?????????????????, ?
?????????? ??????????? ???, ??/? ?
?
8
0,7 ??
7
1,3 ??
2,0 ??
6
4,5 ??
7,0 ??
5
4
3
2
1
0
0
?
0,5
1
1,5
?????????????????, ?
2
2,5
??????? ? ??????????? ?????????? ?????????, ??????? ? ??????????????????? ??? ????????? ? ????? ?????, ? ??? ????? ?? ????
????????????? ?????????, ??? ???????????
???????? ??????????? ?????????. ?? ???
????????????? ???????? ???????? ??? ?????????? ????????????? ????????????? ????????? ?????????? ? ???????????? ?? ????????.
??????????
1.
2.
3.
4.
5.
?????????? ?.?. ?????????? ??????? ? ?????????????? ?????????????? ???????????? ???????? ??????????. ?????????????. 2011; 4 (2): 9?19.
??????? ?.?. ??????????????????? ??????? ?????????
???????? ? ???????? ????????????? ?????????? ? ???? ??????????? ??????. ???????????????? ?????. 2011; 5: 53?7.
????? ?.?. ?????????? ??????? ?????????? ????????????? ??????????? ?????? ? ??????? ? ??????????? ????????: ???????. ???. ? ????. ???. ????. ???; 2004.
???????? ?.?., ??????? ?.?. ????????????? ??????
????????????????? ????????, ?????? ???????????? ?
?????? ?? ??????????. ?????? RU, 02445074 ?1; 2010.
??????? ?.?., ????? ?.?., ???????? ?.?., ????????? ?.?., ??????? ?.?. ??????????????? ??????????. ?????? RU, 2192846; 2002.
6.
7.
8.
9.
10.
11.
12.
13.
?????? ?.?. ? ??. ?????? ????????? ????????????? ??????????. ?????? RU, 2155071; 2000.
??????? ?.?., ???????? ?.?. ???????????????? ???????????? ?????????? ?????????? ? ???????????? ????????? ?????????? (????????). ?????? RU, 2519103; 2014.
Yoshioka I., Saiki Y., Sakuma K., Iguchi A., Moriya T., Ikada Y., Tabayashi K. Bioabsorbable gelatin sheets latticed with
polyglycolic acid can eliminate pericardial adhesion. Ann.
Thorac. Surg. 2007; 84: 864?70.
Tsujimoto H., Tanzawa A., Matoba M., Hashimoto A., Suzuki S., Morita S. et al. The anti-adhesive effect of thermally
cross-linked gelatin film and its influence on the intestinal
anastomosis in canine models. J. Biomed. Mater. Research.
Part B: Applied Biomaterials. 2013; 101 (1): 99?109.
??????? ?.?., ???????? ?.?. ??????? ??????????? ??????? ? ??????????????????? ??????? ? ???????????????????, ?????????????? ?????????? ? ??????? ????????????? ???????????. ????????? ????? ??. ?.?. ???????? ????. 2008; 9 (4): 5?20.
???????? ?.?., ?????? ?.?., ???????????? ?.?., ????? ?.?., ??????? ?.?. ??????????? ?????? ???????????? ??????? ??????????? ??????? ╚??????╩ ??? ?????????? ?????? ????????. ??????????? ??????????
??????????????. 2011; 1: 76?81.
??????? ?.?., ???????? ?.?., ?????? ?.?., ???????? ?.?. ?????? ????????? ????????????? ???????????
?????????????? ??????????? ???????, ?????????????? ? ??????. ?????? RU, 2462273; 2012.
???????? ?.?., ???????????? ?.?., ?????? ?.?., ?????????? ?.?., ??????? ?.?. ?????? ??????-????????????
??????????? ?????????? ??????????????, ? 3, 2014
???. 7. ?????????? ?????????, ?????????? ? ????????? ?????????? ????? ???????? ? ??????????????? ????????, ? %
(?) ? ?? ??? / ? ? (?)
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
66
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
??????????? ?????????? ??????????????, ? 3, 2014
24.
25.
???????????? ??????
? ??????????? ????????????? ???????? ??????????? ???????. ??????? ? ????????-?????????? ????????. 2012; 4:
27?33.
?????????? ?.?., ???????? ?.?., ????????? ?.?. ????????????????? ?????? ? ??????????????: ???????? ?
???????. ????????? ?????????????? ? ??????????????.
2011; 1: 100?4.
Sakuma K., Iguchi A., Ikada Y., Tabayashi K. Closure of the
pericardium using synthetic bioabsorbable polymers. Ann.
Thorac. Surg. 2005; 80: 1835?40.
Bel A., Kachatryan L., Bruneval P., Peyrard S., Gagnieu C.,
Fabiani J.N. et al. A new absorbable collagen membrane to
reduce adhesions in cardiac surgery. Interact. CardioVasc.
Thorac. Surg. 2010; 10(2): 213?6.
Zhou J., Liwski R.S., Elson C., Lee T.D. Reduction in postsurgical adhesion formation after cardiac surgery by application of N,O-carboxymethyl chitosan. J. Thorac. Cardiovasc.
Surg. 2010; 140 (4): 801?6.
Imazio M., Belli R., Brucato A., Ferrazzi P., Patrini D.,
Martinelli L. et al. Rationale and design of the colchicine for
Prevention of the Post-pericardiotomy Syndrome and Postoperative Atrial Fibrillation (COPPS-2 trial): a randomized,
placebo-controlled, multicenter study on the use of colchicine
for the primary prevention of the postpericardiotomy syndrome, postoperative effusions, and postoperative atrial fibrillation. Am. Heart J. 2013; 166 (1): 13?9.
Mack D.R., Cahoon W.D. Jr, Lowe D.K. Colchicine for the
primary prevention of the postpericardiotomy syndrome. Ann.
Pharmacother. 2011; 45 (6):803?6.
Kuo I.F., Pearson G.J., Koshman S.L. Colchicine for the primary and secondary prevention of pericarditis: an update. Ann.
Pharmacother. 2009; 43 (12): 2075?81.
?????????? ?.?., ???????? ?.?. ???????? ? ???????????? ? ????? ? ???????. ????? ?? ??????? ??????????? ????????????. 2010; 2: 25?9.
Deftereos S., Giannopoulos G., Papoutsidakis N., Panagopoulou V., Kossyvakis Ch., Raisakis K. et al. Colchicine and
the heart: pushing the envelope. J. Am. Coll. Cardiol. 2013; 62
(20): 1817?25.
Little A., Tung D., Truong C., Lapinsky S., Burry L.
Colchicine overdose with coingestion of nonsteroidal antiinflammatory drugs. CJEM. 2014; 16 (3): 252?6.
Gradus-Pizlo I., Wilensky R.L., March K.L., Fineberg N.,
Michaels M., Sandusky G.E. et al. Local delivery of
biodegradable microparticles containing colchicine or a
colchicine analogue: effects on restenosis and implications for
catheter-based drug delivery. J. Am. Coll. Cardiol. 1995; 26 (6):
1549?57.
??????? ?.?. ???????????? ??????????? ??????????
???. ????????? ????????????????? ???????? ? ????????.
2002; ?????????? 4: 8?14.
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Novikova S.P., Loseva S.V., Salokhedinova R.R., Popov D.A.,
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A method of processing synthetic textile implantable medical
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Novikova S.P., Salokhedinova R.R., Loseva S.V., Nikolashina L.N., Levkina A.Yu. Analysis of mechanical and structural
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Bel A., Kachatryan L., Bruneval P., Peyrard S., Gagnieu C.,
Fabiani J.N. et al. A new absorbable collagen membrane to
reduce adhesions in cardiac surgery. Interact. CardioVasc.
Thorac. Surg. 2010; 10(2): 213?6.
Zhou J., Liwski R.S., Elson C., Lee T.D. Reduction in postsurgical adhesion formation after cardiac surgery by application of N,O-carboxymethyl chitosan. J. Thorac. Cardiovasc.
Surg. 2010; 140 (4): 801?6.
Imazio M., Belli R., Brucato A., Ferrazzi P., Patrini D.,
Martinelli L. et al. Rationale and design of the colchicine for
Prevention of the Post-pericardiotomy Syndrome and Postoperative Atrial Fibrillation (COPPS-2 trial): a randomized,
placebo-controlled, multicenter study on the use of colchicine
for the primary prevention of the postpericardiotomy syndrome, postoperative effusions, and postoperative atrial fibrillation. Am. Heart J. 2013; 166 (1): 13?9.
Mack D.R., Cahoon W.D. Jr, Lowe D.K. Colchicine for the
primary prevention of the postpericardiotomy syndrome. Ann.
Pharmacother. 2011; 45 (6):803?6.
Kuo I.F., Pearson G.J., Koshman S.L. Colchicine for the primary and secondary prevention of pericarditis: an update. Ann.
Pharmacother. 2009; 43 (12): 2075?81.
Alekberova Z.S., Barskova V.G. Colchicine in rheumatology ?
yesterday and today. Will there be a tomorrow? Sovremennaya
revmatologiya. 2010; 2: 25?9 (in Russian).
Deftereos S., Giannopoulos G., Papoutsidakis N., Panagopoulou V., Kossyvakis Ch., Raisakis K. et al. Colchicine and
the heart: pushing the envelope. J. Am. Coll. Cardiol. 2013; 62
(20): 1817?25.
Little A., Tung D., Truong C., Lapinsky S., Burry L.
Colchicine overdose with coingestion of nonsteroidal antiinflammatory drugs. CJEM. 2014; 16 (3): 252?6.
Gradus-Pizlo I., Wilensky R.L., March K.L., Fineberg N.,
Michaels M., Sandusky G.E. et al. Local delivery of biodegradable microparticles containing colchicine or a colchicine analogue: effects on restenosis and implications for catheter-based
drug delivery. J. Am. Coll. Cardiol. 1995; 26 (6): 1549?57.
Epshteyn O.I. Regulatory capabilities ultra-low doses. Byulleten' eksperimental?noy biologii i meditsiny. 2002; Appendix 4:
8?14 (in Russian).
????????? 19.09.2014
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????
67
????????
╘ ????????? ???????, 2014
??? 616-052-006-008.6-089.168.1-047.36
?????????????? ???????? ? ????? ?????? ???????????
????????????????? ??????????? ? ?????? ?????????????????
??????? ? ?????????????? ???????
?.?. ???????, ?.?. ??????, ?.?. ????????, ?.?. ?????, ?.?. ?????????
????? ╚?????????? ?????????????? ??????? ????? ??. ?.?. ???????╩,
????????? ?????, 23, ??????, 115478, ?????????? ?????????
PATHOLOGICAL SYNDROMES, AND THE CHOICE OF METHOD INVASIVE HEMODYNAMIC
MONITORING IN THE EARLY POSTOPERATIVE PERIOD IN CANCER PATIENTS
S.V. Lomidze, I.V. Nekhaev, O.G. Mazurina, A.V. Sytov, O.V. Zhuzhginova
N.N. Blokhin Russian Cancer Scientific Center, Kashirskoe shosse, 23, Moscow, 115478, Russian Federation
Lomidze Sof?ya Valer?evna, MD, PhD, Senior Research Associate;
Nekhaev Igor? Vladimirovich, MD, DM, Chief of Department of Intensive Care ? 1;
Mazurina Ol?ga Georgievna, MD, DM, Leading Research Associate;
Sytov Aleksandr Viktorovich, MD, PhD, Senior Research Associate;
Zhuzhginova Ol?ga Viktorovna, Physician
Patients after extended and multiorgan surgery for malignancy are at high risk group of postoperative morbidity and mortality. Capillary leak syndrome, acute lung injury, low cardiac output syndrome are major pathological syndromes developing in the early postoperative period in these patients. Positive results of treatment can be achieved using stroke volume
variation, cardiac output, mean arterial pressure, cardiac preload volume and extravascular lung water as the key parameters of hemodynamic monitoring. This feature provides a technology PCCO (pulse contour cardiac output) combining
arterial pulse contour analysis algorithm and transpulmonary thermodilution.
Key words: multiorgan resection, extended surgery for malignancy; en bloc resection for esophageal cancer; early postoperative complications.
? ????????? ????? ?????????? ? ????????
???? ??????????? ????????? ???????????
? ??????????????? ??????????? ????????????? ? ??????? ? ??????? ??????? ???
??????-???????????????? ? ???????????
?????? ????. ??????????????? ??????? ????????, ??????????????????? ??????? ? ??-
???????? ? ?????????? ??????? ????????????? ??????? ????? ?? ?????? ?????????? ???
????????? ???????? ??????????????. ? ???????????? ? ???????????? ??????????????
????????? ????? ????????????? ?????????????
???????? ???????? ??? ???????? ????? ????
??????? ??????? (??????? ? ???????????
??????????? ?????????? ??????????????, ? 3, 2014
??????? ????? ??????????, ???????? ???. ????, c?. ????. ????.; e-mail: svlomidze@rambler.ru;
?????? ????? ????????????, ?????? ???. ????, ?????????? ?????????? ?????????? ? ???????????
??????? ? 1;
???????? ????? ??????????, ?????? ???. ????, ???. ????. ????.;
????? ????????? ??????????, ???????? ???. ????., c?. ????. ????.;
????????? ????? ??????????, ????
???????? ????? ??????????? ? ??????????????? ????????????? ???????????? ?? ??????
??????????????? ??????????????? ?????????? ?????? ???????? ????? ???????? ?????????????????
?????????? ? ???????????. ??????? ??????????? ??????, ?????? ??????????? ??????, ???????
?????? ?????????? ??????? ? ???????? ?????????????? ????????, ????????????? ? ??????
????????????????? ??????? ? ?????? ????????? ???????. ????????????? ?????????? ??????? ?????
???? ?????????? ??? ????????????? ?????????????? ???????? ??????, ?????????? ???????,
???????? ????????????? ????????, ???????? ??????????? ???????????? ? ????????????? ????
?????? ? ???????? ???????? ?????????? ????????????????? ???????????. ????? ???????????
????????????? ?????????? ???? (pulse contour cardiac output), ?????????? ???????? ??????? ?????
???????????? ????????? ????? ? ????? ?????????????????? ????????????.
???????? ?????: ??????????? ? ??????????????? ????????????? ????????????? ? ?????????,
???????? ???????? ?????? ?????? ?? ?????? ????, ?????? ????????????????? ??????????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2014
68
????????
? ??????? ??????? ??????? ? ?????, ??????
????? ???? ? ??.) ? ??????????? ?????????????? ? ??????? ? (???) ??????? ???????.
????????, ??? ??? ??????? ????? ???????
? ????????????? ???????? ???????????? ???????? ??? ????????, ??? ??????? ???? ????????????? ? ??? ???? ??????????? ?????????? [1].
???????? ????????????? ?????????????
????? ?????????????? ?????????? ????????????? ? 60?700% ??? (? 20% ?????????,
??? 300 ??????? ? ???, ?? ?????? ???? ? 1
???? ??. ?.?. ???????). ? ???? ?????????
????????????????? ??????? ?????????? ??????? ???????????? ??????, ???????????
??????????????, ?????????? ??????????? ??????????, ????????? ????????????
??????????? ? ?????????? ? ??? ???????????? (??????????????? ???, ?????? ???????
?????????????????? ????????????????? ???????????) ????????????????? ?????? ???????????? ???????? ???????? ??????????
? ? ?????? ??????? ? ??????? ???????????
?????? (???) ??? ??? ??????? ??????? ? ??????? ?????????????? ????????-????????
(????). ????????, ??? ???, ??????????,
????????? ???????????, ?????????????????
??????????, ??????? ???, ???????? ??????
? ?????? ?????????? ???????? ?????????
????????? ????? ???????? ???/????,
??? ??????? ?????????? ??????????? ??????????????????? ???????? ?? ??????? ??????????? ????????? ? ??????????? ??????????? ??? ?????????????. ???????? ?? ???????? ????? ???? ????????? ??????????
?????????? ???????? ????? ??????????
??????????? ?????????????? ? ???????
???????, ????? ??????????? ???????, ???
?????????????? ???????, ?????????? ??????????? ? ??????????????? ????????,
?????????? ?????? ?????? ????? ????????
???/????. ??????? ????????, ??? ???????
????????????????? ???????? ???????? ?
??????????? ??????????? ??????????? ????????? ?????????, ? ??????????? ?????????
???????? ??????? ??????????? ????? ???????? ?????????? ? ????? ???????????????
??? ?????? ? ?????????????? ?????? ╚???????? ??????????? ??????╩ [2, 3].
?????? ?????????? ??????????????, ???
?????? ????????????? ???????????????, ? ???
??? ???? ??????? (?? ????? ?????????? ???????????? ?????????? ?? ???????? ????) ????? ???? ???????? ? ???? ???????, ?????????? ??????????? ? ??????????????? ???-
???????? ?????????????. ?????? ?????????
??????, ??????????? ?? ????? ????????, ????? ??? ?????? ????????? ???????????, ??????? ??????? ??????? ? ?????? ?? ????? ????????, ??????? ????????? ? ??????, ??????
????????????? ??????????????? ????? ??????????? ? ? ?????? ????????????????? ???????. ????????, ????? ???????????? ????????
???????? ? ??????????? ???????????????
?????????? ?????? ???????? ?? ???????????
????? ? ?????????? ???????? ???????????? [4].
????????????? ????????? ?????????? ????
???????????? ???????????? ????? ????? ????????? ???????? ?????????????? ???????,
?? ?????????????? ? ??????? ????????????????? ????? ? ????? ? ???????????? ?????
?????????-???????? ??????.
??? ???????, ?????? ????????????? ???????????????, ??????????? ? ?????? ???? ????? ??????????? ????????, ??????? ? ????????? ????????????? ??????????? [4]. ??????? ??????????? ???????????, ???????? ??
?????????? ????????? ??????????? ???????, ?????????? ?????? ???????? ?? ??????????? ?????, ? ??????????? ??????????? ??
?????? ???????? ????????????, ?? ? ????????????????? [4, 5]. ????????? ????????????????? ????? ????? ????: ?????????? ????????? ????????????? ??????????? ????? ?
╚??????? ??????????? ??????╩ (???????????? ???????), ???????? ?????????-????????????? ???????? ?????? ????? (??????????????? ?????????????? ???????), ?????????
???????????? ??????????? ?????????? ??????????????, ?????????? ???????????????
??? ????????? ???? ??????.
??? ??? ???? ????????, ?????????? ???????? ???????? ???? ????????????????? ???????????? ?????? ?? ???? ???/????, ???
?????????????? ????. ?????????????? ??????????? ????????????????? ?????? ? ?????
????????? ????????????? ???????????, ????????????? ?? ???? ╚???????? ???????????
??????╩ ? ?????????? ???????? ????????????,
????? ???????? ? ????????? ????????????.
????????????? ??????? ???? ??????? ?????????? ??????????????, ?????????????
? ?????????????? ??????? ????? ??????????? ? ??????????????? ????????????? ????????????, ? ?????? ??????? ??????? ?? ??????????? ?????? ???????????? ?? ??????
? ????????? ???????????????? ? ?????????
??????????? ????????, ??? ??????? ????????????? ?????????? ??????? ???????????
????????????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????? ???????????? ????????? ???????? (???), ???????? ???????????? ????????
??????? (????), ?????????? ??????? (C?)
??? ?????? ???????? ??????????? ???????? ???????????? ????????? ???????????
???, ????????, ????? ??????????? ????????????? ? ?????????????? ??????? [6]. ?????? ?? ???? ??????????? ?????????????
??????? ? ???????? ???/???? ? ???? ????????? [7] ?? ????? ???????????? ? ??????????????? ????? ???????, ??????????? ???
?????? ???????? ???????????, ? ??????????? ???????? ????????, ??? ???????? ? ? ??????? ?????? ??????? [6, 8]. ????????????
????????????, ? ??????? ?? ?????????? ????? ????? ????????? ?????????? (???
? ????) ? ????????????? ???????????????
????? ?????? [9, 10].
? ??????? ?? ?????????? ????????????? ???? ?????? (????), ??????????? ??? ??????
?????? ?????????????????? ????????????,
???????????? ??????? ???????????? (???
? ????) ?? ????? ??????? ?????????? ????????? ??????? ??????? ????????? ? ????????
??????????? ????????????? ??????? [8, 11].
?? ?????????? ????????, ??? ? ??????? ?? ?????? ????????? (??), ???????????? ??????
????????? (??) ?????? ?? ???????????? ???
???????? ???????? ????????. ? ????? ? ??????? ????????????? ?? ?????????? ??? ?????? ?? ?????? ?????????????? ?????? ????????? ??????????????? ?????????? ??? ??????,
?? ???? ???????????? (???) [12]. ??? ????????
???????? ????, ??, ?????? ??????, ??? ????????????? ????????? ????????? ????????
? ?? ????????? ? ????????? ????????????????? ???????? ? ???????? ?????????? (???),
??????? ?????????? ?????? ??????. ??? ?????????????? ????? ?????? (???/????)
??? ?????????? ?????????? ?????????? ????????????? ???????? ????? ????????? ??????????? ????? ? ??????????? ?????????
???? ? ???????? ? ???????? ??????? (???) ?
╚???? ??? ?????? ????????╩ [13].
????? ???????, ??? ????????????? ???????????????? ???????? ?? ?? ??????? ????????? ??? ? ???? ? ????? ?? ??????????
?????? ??????? ?? ??? ???, ???? ?? ?????????? ????????????????? ???????????????, ? ????? ? ????????????????. ????? ?????????????????? ???????? ????????? ????????? ??????????????? ??? ?????????????? ?????
?????? (????) ??????? ? ??????? ????????????????? ?? ? ??????? ????????? ???????????? (???????? ??????????? ??? ????),
69
??? ???????? ? ??????? ?????????? ??, ??????????????? ?????? ??????????????? ??????????? ?, ??? ?????????, ???????? ?????????? ?? ? ???????? ?? [14].
????????? ???????? ?????? (???????)
?????????? ??????? ???????? ????? ?? ???????? ????? ??????????? ??????? ? ?????? ????????????????? ??????? ? ??????????????? ????????? ?????????????? ??????? [4].
??????? ??????????? ?? ???? ?????????????
?????? ????????? ???????? ? ???????? ????????????? ???????????????? ????????, ? ?????
????? ???? ?????????? ??????????? ??? ?????????????? ???????????. ????????? ???????? ???????? ? ???? ???????? ????? ?? ???????? ? ?????????? ????????? ???????? ? ??,
? ?????????? ?????????? ???????????, ???????????, ? ????? ????? ??????, ????????
????? ?????????????????? ????????????
(????), ????????????? ? ???????? ??????????? PiCCOplus ? PiCCO2 (Pulsion Medical
Systems, ????????). ????? ???? ?????????
???????????? ??????? ???????? ????????
??????????? ???????????? ? ????, ? ?????
??????? ????????????? ???????? ???????.
??????????????? ?????????? ???????????? ? ?????????? ???????? ??????????????
????? ? ????????????? ????? ????? ????
??????????? ??????? ???????????? ?? ???
?????? ??????, ??? ????? ????? ???????????? ???????? ? ????? ? ????????????????
???????? ?????? ?????? ?? ???? ?????????
???????? [15].
?????????????? ????? ?? ???????????
???????? ???????? ????? ????????? ?????????????? ???????? ?????? ??? ???????????
??????????? ?? ??????? ??????? ???????
????????? ????? (PiCCOplus ? PiCCO2). ??????? PiCCO2 ????????? ????? ??????????
?????????? ????????? ??????????? ????????
?????, ???????? ? ??????????? ?????????,
??? ???? ??????????? ? ?????? ?????????
??????? ?????? ?????? ? ?????????????
??????????? ????????? ?? ? ?????? ? ??????? ??????????? ??????????????? ??????????? ??????? ????????????? ??????????
???????.
??????????
1.
2.
3.
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285?90.
Fishel R.S., Are C., Barbul A. Vessel injury and capillary leak.
Crit. Care Med. 2003; 31: S502?11.
Webb A.R. Capillary leak, pathogenesis and treatment. Minerva Anestesiol. 2000; 66: 255?63.
??????????? ?????????? ??????????????, ? 3, 2014
????????
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of patients with sepsis or septic shock. J. Crit. Care. 1999; 14:
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thermodilution. Acta Anaesthesiol. Scand. 2006; 50: 1044?9.
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??????? ?.?., ????? ?.?. ?????????? ?????????? ???????????? ? ??????????? ??????? ? ??????????????.
???????????; 2008.
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3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
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????????? 30.05.2014
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????
71
╘ ????????? ???????, 2014
??? 616.24-002-089.87
???-??????????????? ?????????
? ???????????????????? ?????????
?.?. ????????, ?.?. ?????, ?.?. ???????, ?.?. ???????????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????), ?????????? ?????, 135, ??????, 121552, ?????????? ?????????
???????? ?????? ??????????, ?????? ???. ????, ?????????, ?????????? ?????????? ??????????
? ??????????? ???????;
????? ??????? ?????????????, ???????? ???. ????, ???????????? ???????????;
??????? ???????? ?????????????, ???????? ???. ????, ?????????? ?????????? ??????????????
? ??????????;
??????????? ????????? ?????????????, ????????????-????????????
???????? ?????? ???????????? ?????? ?? ??????? ??????? ????????? ? ???-????????????????
??????????? ? ???????????????????? ?????????. ???????????? ???????? ???????????????? ?
???????? ???????????, ??????? ????????? ????????? ??????? ???-??????????????? ?????????.
????????, ??? ??? ???????????? ??????? ?????????? ??? ??????????? ??????? ??????????
?????????? ??????????????????, ??? ? ?????????? ??????????????????? ???????????. ? ?????
???????? ?????????? ???????????? ??????? ?????????????????? ???????????? ??????? ?????????????? ?????????????, ??????? ???? ??????????? ?????????? ???????? ???????????? ??????????
????????? ? ???????????? ????. ????????? ????????????? ???????? ????? ???-???????????????
????????? ? ??????????????????? ?????????.
???????? ?????: ???-??????????????? ?????????, ??????????????????, ??????????????????
??????????, ??????????.
VENTILATOR-ASSOCIATED PNEUMONIA IN THE CARDIAC INTENSIVE CARE UNIT
G.V. Lobacheva, D.A. Popov, A.A. Rakhimov, E.A. Kolesnikova
Lobacheva Galina Vasil?evna, MD, DM, Professor, Chief of Department of Resuscitation and Intensive Therapy;
Popov Dmitriy Aleksandrovich, MD, PhD, Chief of Laboratory;
Rakhimov Abduvali Abdurozakovich, MD, PhD, Chief of Department of Anesthesiology and Resuscitation;
Kolesnikova Ekaterina Aleksandrovna, Anesthesiologist-Intensivist
The analysis of published data on the treatment strategy of patients with ventilator-associated pneumonia in intensive care
unit. Recommended range of preventive and therapeutic interventions that reduce the frequency of ventilator-associated
pneumonia. It is shown that effective treatment is necessary to make the most rapid appointment of adequate antibiotic
therapy, and conduct microbiological monitoring. In order to reduce the systemic toxic effects of antibiotic treatment with
inhaled antibiotics proposed which allow to ensure the delivery of sufficient quantities of the preparation in infectious focus.
Held stratification of risk factors ventilator-associated pneumonia in patients undergoing cardiac surgery.
Key words: ventilator-associated pneumonia, antibiotic therapy, microbiological monitoring, polymyxin.
????????
???????????? ???????? ???????????? ????? ????????? ??????????? ????????. ???????? ????? ??? ??????????? ? ?????????? ?????????? ? ??????????? ??????? (????),
??? ??????????????? ???????? ???????
???????, ????? ??????????? ? ???????????
????????? ? ??????????? ? ????????????????? ?????????? ???????. ?? ??????
?????????????? ???????????? EPIC II
(European Prevalence of Infection in Intensive
Care), ??????? ????????????? ?????????????
???????? ? ???? ?????????? 51%, ??????
? 64% ??????? ???? ???????????? ? ??????????? ????? [1].
???????? ????? ??????????? ???????? ??????? ??? ??????????? ??????????????? ?
????????????? ?????????? ?????? (???).
?? ????? ???? ??? ???????? ??????????????? ?????????? ??? ???????? ? ?????????
? ????????? ???? ??????????, ? ??? ?????
???-??????????????? ????????? (???).
?? ?????? J. Hortal et al. (2009 ?.), ???????
???????? ??????? ?????????? ????? ???????? ?? ???????? ?????? ?????????? 5,7%
? ????? ?????????? (?? 45,9%) ? ???????,
??????????? ?????????? ??????????????, ? 3, 2014
A.N. Bakoulev Scientific Center for Cardiovascular Surgery,
Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
72
????????
??????????? ?? ??? ????? 2 ???. ?????????
????? ????????: ??????? ?????? 70 ???, ??????????????, ???????????? ???, ?????????????? ??????????????, ???????????, ?????????? ????????, ????????????????? ??????????
????????? ? ?????????????? ???????? ??
?????? [2]. ??????????? ??? ??? ????????? ??
20 ?? 50% ? ????? ????????? 70% ??? ??????? ?????????????????? ???????????? [3].
????? ???????, ??????????? ? ????????????????? ????????????????, ??????????????? ? ???????? ???????? ? ????????? ???
???????? ????????? ???????? ?????????
??????????? ??????????????????? ????????.
??????????? ?????????? ??????????????, ? 3, 2014
????????? ? ????????????
???????? ??? ?????????? ??? ??????????, ??? ? ?????????? ?????, ?????????
? ????? ?????????. ? ?????????, ??????? ??????????????? ?????? ???????? ???????????? ???????? ?????? ??????????? ????? ??
????????????? ???????? ? ???????? ???????. ?????????????? ?????? ??????????,
????????? ?????????????? ? ?????????????? ????????????, ???????????? ?????????.
??????????? ???????? ????? ???? ??????????? ??????????? ?????, ? ???????????
?????????? ??????????????? ??????????
? ??????????? ????. ???????????? ????????
????? ???? ???????????? ??????????????????? ?????? ? ???????? ??? ??????? ??? ????????? ?????????? ?????? ???????? ? ???????????, ???????? ??? ?????? ??????? ???
??? ????????? ????????????? ???????????
???????????????. ??????? ????? ?????????
?? ???????? ?????? ???? ??????????? ?????????????, ?????????? ? ?????????????
????????????? ??????????????? ?? ?????????-????????? ?????? [4].
?????????? ??? ??????????????? ???????????? ???????????????? ???????????, ????? ??? ??????????? ????????? ?????????
????? ??????? (35?45╟), ?????????? ????????? ???????????, ??????????????? ? ?????????????? ????????????, ?????????????
??? ??????? ??????????????????? ?????? ???????? ??????, ???????????? ??????????
?????? [5]. ?????????? ???????? ???????????
??????, ???????????? ???????????? ?????????? ??????. ????? ?? ????????? ????????
???????????? ??? ???????? ??????????
??????????? ??????? ?????????? ? ?????????????? ????????? ? ?????????????? ????????????.
???????????? ??????? ??????????????
???????? ??? ? ????????????? ??????? ?
??????????? ??????? ?????????? ????????.
????????, ???????????? ???????? ????????
? ???????????, ????????????? ?????????????? ? ????? ???????? ? ????????????? [6], ?
??? ??? ???????? ????????? ????? ????????
???????????? ??????????, ? ??? ?????
?????????.
????? ?????????? ???? ????????????? ????????????? ??????? ? ?????????? ???????????? ?????????? ????????? ??? ?????????.
???????????
??? ????????????? ???????? ??? ?????????? ??????? ??? ??????? ???? ?? ????????? ?????????: ????????? ????? 38 ╟? ???
?????????? ????? 36 ╟?, ?????????? ?????
15?109/? ??? ?????????? ????? 3?109/?,
??????? ???????? ??????? ?? ?????? ??????????? ?????, ???????? ???????????? ???????????, ????????? ???????????? ??
?????????????? [7]. ??????????? ?????????? ??? ?????? ?????????: ?? ???????????? ??????? ??????? ??????????? ?? ???????
?????? ???????, ??????????????? ??????????? ?????. ???, ??????? ??????? ?????
???? ? ??????? ?? ??? ? ? ?????????? ?????????, ?????????? ??????????? ???? ? ?????? ?????????? ???????? ??????????????,
? ????????????? ??????????? ?????????????
????????? ???????? ?? ????????? ??????????
??????????? ??? ??????????? ?????????
???????? ??????? [8]. ????? ????, ?????????????????? ??????? ??? ???? ?????? ????????? (????????????? ????????-???????, ?????????, ????????????? ???? ??????, ????????????? ???????? ??????? ? ??.) ?????
???????? ???????????? ? ?????? ?????????,
? ????????.
?????? ????? ?? ???? ????????? ??????????? ????????? ???????? ?????????????
????? ?? ?????????????? (???), ??????? ???????? ??????????? ??? ???????????? ??????? ????????????? ????????, ? ????? ??????? ????????????? ?????????? ???????.
? ???????????????-??????????????? ?????
???????? ????????????? ? ?????? ???????????, ? ????????? ??????????? ?????? ????????????? IL-1? ? IL-8 ? ??????????????????
?????? [9].
?? ????????? ????? ????????????? ???????????? ????? ????????-??????????? ??????????? ?? ?????? ??????????? ?????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????
? ???????? ?? ?????. ??? ????????? ??????
(? ???????? ????????) ???????????????? ???
????????? ?????????? ????????????.
??????????? ???
??????????? ?????????????? ?????? ???????????? ??????????? ???????????????? ? ?????? ??????? ? ?????????? ????????.
?????? ?????? ? ????????? ????? ????????????????? ??????? ???????????? ?????????? ???.
?? ????? ??????, ? ?????? ? ??????
2013 ?. ?? ?????? 2014 ?. ? ????????? ???????????? ??? ???????? ???????????????? ???????? Kl. pneumonia (31%), Acinetobacter baumannii (24%), Ps. aeruginosa (14%), Stenotrophomonas maltophilia (10%).
? ???????????? ? ???????????? ??????????????? ?? ??? ?????????, ??????????? ??
???, ??????? ? ???????????? ??????????????. ??? ?????????? ?????? ?????????,
??????????? ? ?????? 72 ? ???, ??????????? ??????????????? ?????????? ?????????? ????????????? ????????? (??????????, ??????????? ???????, ??????????
? ??.), ??????? ?????????????? ??????????? ????. ? ????????? ??????? ???, ????????????? ??? ?????????? ????? 7 ???, ????-
73
??? ???? ???????? ?????? ??? ????????????
?????? [10]. ??? ??????? ????????? ??? ?????? ??????????? ?????? ?????????????????? ? ?????????? ?????????? ??? ????????????? ????????????? ??? ?????? ???
? ??????????, ???????? ? ????????? ╚??????????╩ ???????????? ??????????, ? ???
???????.
?????? ? ??? ??????? ????????, ???, ?? ?????? ???? ???????, ????????? ???? ????????????? ??? ?? ?????? ? ??????? ?????
???????????? ??????????? ???????? [11, 12],
???????? ??? ???????? ?????????, ?????????? ??? ??????? ?????????? ???????????,
???????? ? ????????????????? ???????.
??? ???? ???? ??? ?????? ???????? ????????? ?? ???????????? ????????? ?????? ?????????? ???? ???????????? ??????????.
????????????? ???????
??? ??????? ?????????????? ????????
???????? ???? ?????? ?????????? ???????????? (??. ???????). ??????? ??????????
? ???? ??????? ??????????. ?????? ???????? ???????????? ? ?? ?????????? ? ???????????? (????????????????? ????????????????? ????????), ??? ???????? ? ???????????? ?????????? ??????????.
???????????
Klebsiella pneumoniae ? ??????
?????????????? ? ?????????? ????-????????
???????????? ???????
??????????????, ?????????? ? ????????????
????????? ??????
????????, ????????? ???
?????????
?????????????? ???????
???????????/?????????? (??????????? ????????????? ??????? ?????? ? ???? ??????? ????????????)
?????????? ? ??????????? ╠ ???????? ????????????
Pseudomonas aeruginosa
???????? ??? ?????????
????????????/??????????
??????????
?????????? ?, ???????? (???
???????????? ? ?????? ??????????)
???????
?????????????
??????????????
????????
Acinetobacter spp.
???????? ??? ?????????
???????????/??????????
?????????? ?, ???????? (???
???????????? ? ?????? ??????????)
??????????/?????????? (???????
????)
????????
Staphylococcus aureus MS
??????????/??????????
????????????/??????????
????????????/??????????
????????????? I?II ?????????
??????????????
??????????? (??? ???????
?????????)
??????????
Staphylococcus aureus MR
??????????
?????????
??????????????
??????????
??????????? ?????????? ??????????????, ? 3, 2014
?????? ??????????? ??????? ???-??????????????? ?????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2014
74
????????
??????????? ???????? ???????????? ????? ???? ? ???????????? ??????? ???????????? ????? ?? ??????????? (??????????????)
??????????, ??? ???????? ?????????? ???
??????? ???????? ??????????? ?????. ???
????????? ??????? ??????? ????????????
????????? ? ????? ???????? ??? ??????????? ????? ???????? ????????? ????????????? ???????. ????????????? ??????? ?????
???? ????? ???????????? ??? ? ??????? ??
??? (? ??????? ?????????????????? ? ?????? ????????????), ??? ? ? ???????, ??????????? ?? ??????????????? ??????? [13, 14].
? ????????? ????? ???????? ?????????? ?
(????????) ? ??? ?????????????? ?????????? ? ?????????? ? ? ??? ???????????????
????????.
?????????? ???????????? ????????? ??????????? ??????? ??? ??? ??????????????
?????????? ??????????, ??????? ????????
?????????????????? ????????? ? ???????????? ???????????? ?????????. ? ?????????????? ????????????????? ????????????????????? ????????????, ? ???????
????? 200 ????????? ? ???????? ? ???-??????????????? ??????????, ????????, ???
?????????? ?????????????? ? ???????????
??????? ????????? ????????? ????????????
??? ? 22,5 ?? 16 ??? (? = 0,049), ? ????? ?????????? ????????? ? ? 15,5 ?? 10 ???
(? = 0,011) [15].
??? ?????????? ?????????????????? ?????????? ???????? ?????? ???????? ?? ?????????? ?????????? ??????? ???????????
? ???????? ??????????, ??? ???????????? ????????????? ???????.
??????????
??? ??????? ??????? ??????? ? ???????????? ??????????, ???????? ? ????????
????????? ??????????, ??????? ???????????
?????? ????????? ?????????? ??????????????????, ??? ??? ??? ???????? ???????????
???????? ??? ?????????? ?????????????? ?????? [16, 17].
? ????? ??????????? ???????????? ??????? ??? ?????????? ???????????? ???????
? ????????????? ?????????? ????? ??????????? ????????? ?????? ?????????? ??????????????????? ???????????.
?????? ????? ? ??????? ????????????
????????? ???????? ????????????? ??????????????????, ??????? ???? ???????????
?????????? ???????? ???????????? ??????????
????????? ? ???????????? ???? ??? ??????????? ?????????? ???????????? ???????.
??? ???? ???????? ????, ??????????
????????? ??????? ?????????? ??? ? ????????? ??????????????, ??? ? ???????????????? ????????????. ??, ?? ??? ??????, ???
?????????? ??? ??? ?????? ???? ?????????? ???????? ????????, ????????? ????????????????? ?????????????. ??? ???????
? ?????? ???????? ? ??????????????? ?????????? ????????? ????????????? ? ??????????? ???????, ? ????????? S. marcescens,
B. cepacia, ?????????????.
????, ? ???????? ? ????????????? ???
????????????????? ???????, ????????????
?? ???, ??????? ?????????? ??? ? ????????
? ???????? ?????. ??? ???????????? ? ??????? ??? ?????????? ????????? ?????????
???????:
1) ?????? ??????????? ???????????? ??????????, ????????????? ???????????;
2) ?????????? ?????? ???????? ? ??????????? ? ???? (?????? ? ?????????? ?????
? ????????? ???????????? ??? ?????????);
3) ??????????? ?????? ?????????? ??????????? ?? ????????? ?????? ??????????
??????????????????? ???????????;
4) ?????????? ?????????? ??????? ??????????? ? ???????? ?????????? ? ??????????
????????????? ??????? (? ?????? ?????????????);
5) ??????????? ????????? ?????????
????? ??????? ? ?? 45╟;
6) ??????? ??????? ?? ??????????????????? ?????? ???????????? ?????????? ??? ???????? ????????, ????????????? ??????????
?????????;
7) ??????? ? ????????? ??????? ???, ????? ??????????, ???????????? ??????? ??????????????? ????????????;
8) ??????????? ?????????????? ????????????;
9) ???????? ?? ?????????? ?????? ???
??????????? ??????????? ??? ????????????
? ????????? ????????;
10) ?????????? ???????????? ??? ??????? ??????????????????? ?????? ? ?????????? ???????????.
??????????-??????????????? ?????????
????? ????????? ? ??????? ? ??????????? ?????????, ??????? ?????????? ???????? ??????? ???????? ?????? 70 ???, ??????? ?????
?????????? ? ???????????? ????????, ?????
????????? ??????????? ? ??????????????,
??????? ? ???????? ????????. ??????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
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~oz P. Incidence and risk factors for ventilatorBouza E., Mun
associated pneumonia after major heart surgery. Intensive Care
Med. 2009; 35(9): 1518?25.
Tejerina E., Frutos-Vivar F., Restrepo M.I., Anzueto A.,
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Conway Morris A., Kefala K., Wilkinson T.S., Moncayo-Nieto O.L., Dhaliwal K., Farrell L. et al. Diagnostic importance of
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???????????? ?.?., ????? ?.?., ????????? ?.?. ????????????????? ???????? ? ??????????????: ??????????? ????????? ???????? ? ???????????. ??????? ? ????????-?????????? ????????. 2004; 4: 54?9.
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2009; 302 (21): 2323?9.
Hortal J., Giannella M., PИrez M.J., Barrio J.M., Desco M.,
~oz P. Incidence and risk factors for ventilatorBouza E., Mun
associated pneumonia after major heart surgery. Intensive Care
Med. 2009; 35(9): 1518?25.
Tejerina E., Frutos-Vivar F., Restrepo M.I., Anzueto A.,
Abroug F., Palizas F. et al. Internacional Mechanical
Ventilation Study Group. Incidence, risk factors, and outcome
of ventilator-associated pneumonia. J. Crit. Care. 2006; 21:
56?65.
Gatt M., Reddy B.S., MacFie J. Review article: bacterial
translocation in the critically ill ? evidence and methods of
prevention. Aliment. Pharmacol. Ther. 2007; 25 (7): 741?57.
Koenig S.M., Truwit J.D. Ventilator-associated pneumonia:
diagnosis, treatment, and prevention. Clin. Microbiol. Rev.
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Levy J.H., Tanaka K.A., Steiner M.E. Evaluation and management of bleeding during cardiac surgery. Curr. Hematol.
Rep. 2005; 4 (5): 368?72.
American Thoracic Society. Guidelines for the management of
adults with hospital-acquired, ventilator-associated, and
healthcare-associated pneumonia. Am. J. Respir. Crit. Care
Med. 2005; 171: 388?416.
Butler K.L., Sinclair K.E., Henderson V.J., McKinney G.,
Mesidor D.A., Katon-Benitez I., Weaver W.L. The chest radiograph in critically ill surgical patients is inaccurate in predicting ventilator-associated pneumonia. Am. Surg. 1999; 65:
805?10.
Conway Morris A., Kefala K., Wilkinson T.S., Moncayo-Nieto O.L., Dhaliwal K., Farrell L. et al. Diagnostic importance of
pulmonary interleukin-1{beta} and interleukin-8 in ventilatorassociated pneumonia. Thorax. 2010; 65 (3): 201?7.
Beloborodova N.V., Popov D.A., Bachinskaya E.N. Postoperative infection in cardiac surgery: state of the art and prospects. Grudnaya i serdechno-sosudistaya khirurgiya. 2004; 4:
54?9 (in Russian).
Gastmeier P., Sohr D., Geffers C., RЭden H., Vonberg R.P.,
Welte T. Early- and late-onset pneumonia: is this still a useful
classification? Antimicrob. Agents Chemother. 2009; 53 (7):
2714?8.
Giantsou E., Liratzopoulos N., Efraimidou E., Panopoulou M.,
Alepopoulou E., Kartali-Ktenidou S. et al. Both early-onset
and late-onset ventilator-associated pneumonia are caused
mainly by potentially multiresistant bacteria. Intensive Care
Med. 2005; 31 (11): 1488?94.
Lee S.Y., Lee J.W., Jeong D.C., Chung S.Y., Chung D.S.,
Kang J.H. Multidrug-resistant Acinetobacter meningitis in a
3-year-old boy treated with i.v. colistin. Pediatr. Int. 2008;
50 (4): 584?5.
Rosanova M., Epelbaum C., Noman A., Villasboas M.,
Alvarez V., Berberian G. et al. Use of colistin in a pediatric burn unit in Argentina. J. Burn. Care Res. 2009; 30 (4):
612?5.
Giamarellos-Bourboulis E.J., Peche?re J.C., Routsi C.,
Plachouras D., Kollias S., Raftogiannis M. et al. Effect of clarithromycin in patients with sepsis and ventilator-associated
pneumonia. Clin. Infect. Dis. 2008; 46 (8): 1157?64.
Leal-Noval S.R., Marquez-Vacaro J.A., Garcia-Curiel A.,
Camacho-Larana P., Rincon-Ferrari M.D., OrdonezFernandez A. et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit. Care Med. 2000; 28 (4): 935?40.
Pineda L.A., Saliba R.G., El Solh A.A. Effect of oral decontamination with chlorhexidine on the incidence of nosocomial
pneumonia: a meta-analysis. Crit. Care. 2006; 10 (1): R35.
????????? 30.05.2014
??????????? ?????????? ??????????????, ? 3, 2014
????????????? ?????? ???????? ????????
??????????????? ?????????????? ????? ?????????????? ???????????? ?????????? ? ????? ?????????????? ????????? ???????????
???????.
75
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
76
??????? ?????????
??????? ?????????
╘ ????????? ???????, 2014
??? 616.136-007.64-089.819.5
?????????????????? ??? ????? ??????? ????????? ??????? ?????
??? ??????? ???????????? ????? ????????? ?????????????
?.?. ??????????, ?.?. ?????????, ?.?. ???????????, ?.?. ????????
????? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????), ?????????? ?????, 135, ??????, 121552, ?????????? ?????????
?????????? ?????? ???????????, ????????; e-mail: mthagapsova@mail.ru;
????????? ??????? ????????????, ???????? ???. ????, ?????????? ?????????? ?????????????????????,
?????????????????????? ??????? ???????????? ? ??????? ? ????????? ???????? ??????????;
??????????? ??????? ??????????, ????. ????.;
???????? ??????? ??????????, ????????
??????????? ?????? ????????? ???????????????? ??????? ????????? ??????? ????? (???????????? ??????? ?????????????????? ????? 72 ??) ? ???????? ???????? ? ??????? ?????? ???????? ????????? (?????? ?????????, ???????), ??????????? ? ??????????????? ?????????? ??? ????????
????????????? ?????????????. ???????? ? ?????????????? ????? ????? ??? ????????????? ?????????????? ?????????????????? ?????-????? ? ????????? ?? ??????????? ???????. ????????????????? ? ????????????????? ??????? ????????? ??? ??????????. ??? ??????????? ???????????????? ???????????? ?????????? ? 3D-?????????????? ????? 3 ??? ????????? ?????????? ?? ????????.
???????? ?????: ??????????????????, ????????? ??????? ?????, ?????-?????.
ENDOPROSTHESIS AS A METHOD OF TREATMENT OF ABDOMINAL AORTIC ANEURYSM
WITH A HIGH OPERATIVE RISK OPEN INTERVENTION
M.M. Tkhagapsova, N.A. Chigogidze, V.G. Papitashvili, S.R. Shogenova
??????????? ?????????? ??????????????, ? 3, 2014
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Tkhagapsova Marina Mukharbievna, Postgraduate;
Chigogidze Nikolay Avtandilovich, MD, PhD, Chief of Department of Endovascular, Electrophysiological Methods of Investigation
and Treatment and Testing of New Technologies;
Papitashvili Vasiliy Georgievich, Research Associate;
Shogenova Sataney Ruslanovna, Postgraduate
This article presents a case of successful endovascular treatment of abdominal aortic aneurysm (maximum diameter of
the aneurysmal sac 72 mm) in elderly patients with a high risk of developing fatal (ruptured aneurysm, thrombosis), cardiac and neurological complications after open surgery. Patient in the infrarenal aorta was implanted self-extracting bifurcation stent graft with the transition to the iliac segment. Intraoperative and postoperative period was uneventful. When
control multislice computed tomography with 3D-reconstruction of 3 months revealed no signs of endoleaks.
Key words: endoprosthetic replacement, abdominal aorta aneurysm, stent-graft.
????????
????????? ???????? ?????? ?????
(???) ? ???????????????? ?? ???? ???? ???????????, ??????? ???????? 10-? ????? ?????
?????? ?????????? ? ???????? ??????? [1].
???????? ?????? ??????????? ??????? ??????? ??? ???????? ????? ?? ?????????????
? ??????????? ?????????? ????????. ??? ??????? ??? ? ??????????????????? ? ?????????????????? ??????????? ???????????, ???
? ? ?????????? ????? ?????????? ???????
??? ?????? ????????? [2].
???????? ?????? ? ??????? ??????????????
??????? ???????? ???????? ?????? ?????
???? ???????? ???????, ??????? ? ???????-
?? ??????? ????? ? ?????????? ????????????? ? ?????????? ?????????????????????? ??????????????? ?? ??????? ?????
? ??????????? ??????? ???????????????,
????????????????? ? ????????? ????????.
?????? ╚??????? ??????????╩ ??????? ???
? ? ????????? ????? ???????? ????????????
???????????????? ???????? ? ???????? ????????? ? ??????????????? ????? [3]. ??????
? ??? ??????????? ???? ????? ???????? ???????? ???????????? ??-???????? ?????????? ??????, ? ????? ?????? ??? ????????? 7,5%
[4]. ??? ????????????? ????????????? ???????? ? ????????????????? ????????????????
??????? ??????? ???.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ???????? ???????????????? ?????? ??????? ???????? ??????? ????? ????? ??????? 1985 ?., ????? ????????? ?.?. ???????? ??????? ? ???? ???????? ?????????????????? ?????????????? ??? ? ????????,
??????????? ??????????????? ???????????
????? ? ?????????? ????????? [5]. ? ????????? ????? ??? ???????? ??????????????????
????? ??? ??? ???????????? ?????????????? ?????-?????, ????????? ?? ????????
?????? ? ????????????????? ?????.
? ????? ?????? ??????????? ?????? ????????? ???????????????? ??????? ?????????
??????? ????? ? ???????? ???????? ? ??????? ???????????? ?????? ?????????????
????????? ?????????????.
???????? ??????
??????? 72 ??? ???????? ? ??????? ? ???????? ?? ??????? ????????? ? ??????, ????
? ?????????? ??????? ??? ?????? ? ????????,
????????????? ? ??????? ???????, ????????? ????????????? ???????? (??) ?? 170/100 ??
??. ??. (??????????? ? ?? 130/80 ?? ??. ??.).
??????? ????????? ??????? ????? ???
????????? ? 2001 ?. ?? ?????? ??????????????? ???????????? ??????? ???????. ???????????? ??????? ????? ?? ??? ?????? ????????? 37 ??. ???????? ???? ????????????? ???????????? ??????????. ???? ? ??????????
???????, ?? ???? ????????, ????????? 2 ???
?????. ??? ???????????? ?? ????? ?????????? ????????????? ??????? ??? ? ???????????
?? ???????? ?? ?????? ??????????????? ???????????? ???????????? (????) ?? 72 ??,
??? ????????? ???????.
?? ?????? ??????????????????? (???):
???? ?????? ?????????, ? ??? 62 ??/???.
????????????? ??? ?????? ????????? ?????.
??????? ???????? ????? ????? ????? ?????
????. ???????? ??????? ?????? ????? ?????
????. ????????? ???????? ?????? ?????????
(??).
?? ?????? ????????????????????? (?????)
????????????: ??????????????????? ????????? ???????????, ??????????? ???????? ?
?????????? ?????. ????????? ?????????
??????????. ???????????? ??????????? ??.
???????? ?????????????? ????? 146 ??, ???????? ????????????? ????? 56 ??, ???????
??????? ?? 61%.
?? ?????? ???? ??????????????? ???????: ?????? ?????? ???????????? ???????
25?30%. ?????? ? ????? ?????? ???????????
77
??????? 40?45%, ????????????????? ????
? ??????? ?????? ? ?-????????? ? 1 ????????.
?????? ?????? ?????? ????? ?????? ???????
20?25%, ?????????? ? 30?35%. ?????? ? ????? ?????? ?????????? ?????? ???????
40?45% (? ?????????? ???????????? ??????????????????? ??????). ?????? ?????? ????? ????? ?????? ??????? 15?20%, ?????????? ? 30?35%. ?????? ? ????? ????? ?????????? ?????? ??????? 30?35%. ╚?????╩
??????? ????? ??????????? ???????.
?? ?????? ????????-??????????? ?????????? (???) ????????? ?????: ? ???????? ?????? ???????? ???? ??????? ???? ????????
????? ???????? ?? 4 ??, ????????, ?????????? ?????????. ?????????? ? ???????? ???????????? ????????????.
?? ????????? ?????, ????????, ???????????? ??????? ? ??????????? ???????????-???????????????? ??????? ???????????? ???????? ??? ????????? ??????????? ???????: ????????????. ????????? ??????? ?????.
??????????? ??????? ??????. ???????????
?????????? II ??. ???????????? ??????????? 3 ??????, 2 ???????, ???? ???????. ??????????? ????????? ??????????????? 1 ??. (??
NYHA). ?????????????????? ???????. ??????????? ?????? ????? 3 ??????, ??????????????? ? ?????????????????? ????????,
??????????????. ??????????? ????????????? ??????? ????????? ????????? ?????????????? ? ???????? ?????? ??????? ???????? ??????? ?? 2002 ? 2007 ??. ????????????, ?????????-???????-????????????
?????. ?????????????? ???????????, ?????????. ???????????? ????????????. ??????????? ???????. ??????????? ?????????.
?? ?????? ???????????????? ???????????? ?????????? (????) ? 3D-??????????????
??????? ????? ? ?? ?????? (???. 1, ?) ?? 39 ??
???? ????? ?????? ???????? ??????? ?? ?????????? 71 ??, ? ???????????????? ??????????? ?? ?????????? ?????, ????????????
????????????????? ?????????? ??????????????? ?????? ??????? ????? (???????????? ???????? ?????? ????? 63 в65 ??, ?????? ???????? ????? ?? ???? ?????? 393в52 ??).
?????? ??????? ????? ???????????? ?????????, ? ??????? ????????????????????
???????? ? ?????????????? ??????? ??????????, ??????????? ???????????? ?????????? ????? ??????? ???????????????? ?
???????????? ?????? ?? 15?18 ?? ?? ??????
?????????????????? ?????????? ?????. ?????? ??????? ????? ?? ??????????????
??????????? ?????????? ??????????????, ? 3, 2014
??????? ?????????
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???. 1. ??? ??????? ?????:
?
? ? ????-??????????? ? 3D-?????????????? ??????? ????? ?? ???????? (??????????????? ?????????????? ???, ???????????? ??????? ????????? 67 ??); ? ? ??????????????????? ??????????? ?? ?????????????????? (???????-?????? ????????, ??????????????? ?????????????? ???);
? ? ??????????????????? ??????????? ????? ?????????????????? (???????-?????? ????????, ?????-????? ????????? ????????? ? ??????? ?????,
? ?????? ? ? ?????? ? ????? ???, ???????????????? ??????????, ????????? ??????, ??? ????????? ??????????); ? ? ???? ? 3D-?????????????? ??????? ????? ????? 3 ??? ????? ?????????????????? (????????????? ????? ??????????? ?????????? ?? 9 ?? ???? ?????? ?????? ????????
???????, ?????????? ?????? ??????????? ? ????? ??????????? ????????, ????????????? ???????????? ???????? ?? ??????? ??????????? ???)
?????? ???????? 31 ??, ?? ?????? ????? ???????? ?????? (??) ? 25 ?? (????? ?? 7 ??, ? ????? ??????????????? ?????? ???? ??????????), ?? ?????? ??????? ?????????? ???????
(???) ? 23 в24 ?? (????? ??? ?? 8 ??), ??
?????? ?????? ???????? ??????? ? 22в23 ??
(????? ?????? ???????? ??????? 9 ??, ????? ?
8 ??), ? ?????????????? ?????? ??????????????? ????????????????? ?????????? ?????, ??????? ????? ???????????? ????????
?????. ?? ?????? ?????????? ??????? ?????
????? ???????????? ?????, ???????? 29 ??.
?????? ??????????? ??????? (?????, ???????? ? ??????????) ? ????? ?????? ???????? ???????????? ???????? ? ???????????????? ??????????? ? ??????? ?????-
??????????????? ????????. ????? ?????
??????????? ??????? (???) ???????? ??????, ???????? 13 в11 ??, ?????? ??? ?????
??????, ???????? ? ????? 19 ??, ????? 17 ??,
? ??????????? ??????????? ?? 21 ??.
?? ??????? 2 ???????? ????? ????????
??????? ????????? ??? ??????? ?????-??????
??? ??????? ??????? ? ???: ??????? ?????
? ???? ????????????? ??????????? (?), ??????? ????? ?? 15 ?? ?????????? ???? ????????????? ??????????? (b), ????? ????????????? ????? (?), ???????????? ???????
????????? (d), ??????????? ??????? ?????????? ????? (??? ?? ???????) (f), ???????
?????? (g) ? ????? (h) ????? ???????????
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????????????????? ?????? ? ????? ???
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o
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????????????? ???????????, ??
28
c ????? ????????????? ?????, ??
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?? ?????????? ?????, ??
100+10
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????? (??? ?? ???????), ??
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??????????? ??????? ??? ??????? ?????-?????? (????????? ? ??????)
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15
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???????, ??
10
j ??????? ????? ???????? ??????????? ???????, ??
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k ?????????? ?? ?????? ???????? ???????
?? ?????? ?????????? ??????????? ???????, ??
110+70
l ?????????? ?? ?????? ???????? ???????
?? ????? ?????????? ??????????? ???????, ??
110+40
m ?????????? ???????? ?????? ???????????
???????, ??
n ?????????? ???????? ????? ???????????
???????, ??
o ???? ?????? ????????????? ?????, ╟
20
?????? ???????? 28,5 ?? в 14,5 ?? в 18 ?? ? ??????????? ?????? ???;
? ?????????? ?????????? ?? ????? ???
? ?????????? ??????? ???????????;
? ????? ??????? ?????????? ?? ???????
??? ???????? ????????????????? ??????
?????-?????? ? ????? ???;
? ?????????? ???????????? ??????? ??
???????? ?????????? ? ????? ??? (??????????? 12 F);
? ?????????? ?? ?????????? ????????????????? ?????? ??????????? ????????
14,5 ?? в 12 ?? ? ?????????????? ? ???????
??????????????????? ????? ? ??????? ???????? ?????? ? ?? ?????????????? ? ???????
? ????? ???;
? ???????????????? ????????????? ????????: ????????????? ???? ?????-??????,
??????? ?????????? ???????, ??????????
???? ????????????????? ?????? ? ?????????? ???? ???????? ??????;
? ?????????? ??????????? ???????????
(??????????????? ?????? ?????????? ??????????? ? ??????? ????? ? ??????? ? ??????
? ????? ???, ???????????????? ??????????,
??????????? ?????????? ??????????????, ? 3, 2014
????? ??????????????? ????????? ??????????? ?????????? ??????????????????, ????????? ????. ? ??????? ??????????? ?????????????? ?????? ???????? ?????-??????.
??? ???????????? ?????????? ???? ???????? ?????? ? ????? ????? ????????? ??????? (???). ????? ??? ???????? ??????????????? ????, ??????? ???????:
? ??????? ?????? ??? ?? ?????? ??????????? (??????????? 6 F);
? ????? ??????? ?????????? ? ??????
??? ?? ???????????????? ??????? Pigtail, ?????????? ??????????? ??????? ????? ? ???????????? ?????? ?????????? ???????? ??????? ? ????????????? ???????????? ??????????????? ?????? ????? (???.1, ?);
? ????? ??????? ?????????? ?? ???????
??? ???????? ???????? ?????? ??????????????? ?????-?????? ? ?????? ???;
? ??????????? ????????????? ? 7500 ??;
? ??? ???????????? ????????? ??????? ? ?????????? ???????????? ???????
??????????????? ?????????;
? ?????????? ???????????? ??????? ??
???????? ?????????? ? ?????? ??? (??????????? 18 F);
? ??????????? ???????????????? ??????????? ? ??????? ????????????? ????? ????????? ? ??????? ??????????????????? ?????
? ?????????????? ???????? ?????? ?????-
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80
??????? ?????????
????????? ??????, ????????? ?????????? ??
????????) (???. 1, ?).
? ??????????, ????? ???????? ??????????? ? ?????????????, ???? ????????? ???????? ????????? ??????? ?????? ? ????? ? ?????????? ???????????? ???????. ????????
?????? ??? ??????????. ????? ???????????
???????? 300 ??. ?????? ????????????? ?????????????? ???????????? ???????? ??????? (350 ??/??) ???????? 200 ??.
?????- ? ????????????????? ???????
????????? ??? ??????????, ???? ?????????
???????? ?????????????? ???????, ?????????? ??? ????????? ????????? ??????????.
??? ??????????? ???? ? 3D-?????????????? ????? 3 ??? (???. 1, ?) ????????????? ????? ??????????? ?????????? ?? 9 ??
???? ?????? ?????? ???????? ???????, ?????????? ?????? ??????????? ? ????? ??????????? ????????, ????????????? ???????????? ???????? ?? ??????? ??????????? (? ??????? ?????????, ??????????? ????????????)
???, ??????? ?????? ??????, ??????, ????????
???????????????? ???.
??????????? ?????????? ??????????????, ? 3, 2014
??????????
??? ??????????? ??????, ?????? ? ??????? ?????????????? ????????????? ????????
??????????????? ????????? ???????? ??????
???. ???, ???? ??????? ??????? ?????????
????????? 5,5?5,9 ?? ?????????? 9,4%, ????????? 6,0?6,4 ?? ? ????? 10,2%, ?????????? ?????????? ???????? ????????? ?? 6,5 ??
6,9 ?? ???????? ???? ??????? ?? 19,1% ? ???,
? ????? 7,0 ?? ? ?? 32% [6].
?? ?????? ??????????? ????????????
??? ????????? ?????????? ????????? ?????????????????? ????? ????????????? ????? ?????????, ????? ?????? ???????? ????????? ????????????? ???????? ???????
? ??????? ?????????, ?????? ?????????? ??
????? 15 ?? [7]. ??????????? ??????????
??????? ????? ????????? ??????? ?? ????????? ???????? ??????????????? ??????????.
??? ??????????? ?????-???????, ??????????
FDA, ???????????? ??????? ?????????? 34 ??.
??? ???????? ????????????? ???????? ????????????? ?????????? ??????? ????? ??
10?20%. ????? ???????, ?????????? ??????? ????? ?????????, ??????? ????? ????
??????? ????????????? ? ??????? ??????????, ?????????? 30 ??. ???? ????? ?????????, ?????????? ????? ????? ????????????? ?????? ????????? ? ???? ????????
??????????? ?????? ? ?????????, ????? 60╟
?????? ????????????? ?????????????????
? ????????. ????? ? ????????????? ????????????????? ????????? ???????????? ???????
??? ??????????? ????????? ????? ?????????, ??????? ????? ?????????????? ??????????? ? ???????? ???????? ?????-??????.
????? ????, ?????? ???????? ???????? ?????????? ??????????? ??????? ? ?? ?????????, ??????? ????????, ????????? ? ??????? ????????. ??????? ????????? ? ??????????? ??????? ?????? ???? ?? ????? 8 ??,
? ?? ???????? ? ?? ????????? 90╟.
????? ????, ????????? ???????? ?????
???????????????? ??????? ??? ????????
?????????? ???????? ??????????????????
?????, ?? ??? ????????????? ???????? ????????????? ?????????????? ??????? ????????????, ? ????? ?????????????? ??????? ???
?????????? ??????????????? ???????? ???????? ??????????? ???????.
??????????
?????????? ????????? ??????? ? ???????
????????????? ??????????, ??? ??????? ???????????? ???????? ????????????? ????????? ? ??????? ?????? ???????? ????????? ??????????. ? ???? ??????? ?????????????? ??????? ??????? ?????????????? ????????
???????? ??????????????????. ?? ??????????? ???? ?????????? ? ??????? ????????? ????? ???????????????? ??????? ??? ? ?????????? ??????? ?????????? ?????????? ?? 0 ??
3,4%, ??? ??????????????? ? ????????????????
????????????? ??????? ?????? [8]. ????? ????,
??????????? ???????????? ???????? ???????????? ?????? ?????????????????? ? ????????? ? ????????? ?????????????? ???????? [9].
C ????? ????????????? ?????????? ?? ?????????? ?????-??????, ??? ??????????, ???????? ?????????? ? ???????? ??????????
???? ????????? ????? ??????????????????
?? ?????? ??? ???????? ?????????? ????
? ????????? ? ?????????? ????????????????? ????????, ? ????? ????? 3?6 ??? ? ??????????? ????.
??????????
1.
2.
Cowan J.A. Jr, Dimick J.B., Henke P.K., Rectenwald J.,
Stanley J.C., Upchurch G.R. Jr. Epidimiology of aortic
anevrysm repair in the United States from 1993 to 2003. Ann.
NY Acad. Sci. 2006; 1085: 1?10.
???????? ?. ?????????????? ????????? ???????
?????: ??????????? ??????? ? ?????? ???????. ????????? ????? ??. ?.?. ???????? ????. 2008; 9 (5): 50?7.
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??????? ?????????
4.
5.
6.
7.
8.
9.
???????? ?.?., ???????? ?., ????????? ?.?. ????????
???????? ???????? ??????? ?????. ????????? ?????
??. ?.?. ???????? ????. 2008; 9 (5): 44?9.
??????? ?.?., ??????? ?.?. ????????-?????????? ???????? ? 2010. ??????? ? ?????????? ???????? ???????
??????????????. ?.: ????? ??. ?.?. ???????? ????.
2011: 127.
Volodos N.L., Karpovich I.P., Troyan V.I. Clinical experience
of the use of self-fixing synthetic prostheses for remote endoprosthetics of the thoracic and the abdominal aorta and iliac
arteries through the femoral artery and as intraoperative
endoprosthesis for aorta reconstruction. Vasa Suppl. 1991; 33:
93?5.
Darling R.C., Messina C.R., Brewster D.C., Ottinger L.W.
Autopsy study of unoperated abdominal aortic aneurysms. The
case of early resection. Circulation. 1977; 56 (Suppl. 3): 161?4.
Adelman M.A., Rockman C.B., Lamparello P.J., Jacobowitz G.R., Tuerff S., Gagne P.J. et al. Endovascular abdominal
aortic aneurysm (AAA) repair since the FDA approval. Are we
going too far? J. Cardiovasc. Surg. (Torino). 2002; 43 (3): 359?67.
Saratzis A., Mohamed S. Endovascular abdominal aortic
aneurysm repair in the geriatric population. J. Geriatr. Cardiol.
2012; 9: 285?91.
Bush R.L., Johnson M.L., Hedayati N., Henderson W.G.,
Lin P.H., Lumsden A.B. Performance of endovascular abdominal aortic aneurysm repair in high-risk patients results
Veterans Affairs National Surgical Quality Improvement
Program. J. Vasc. Surg. 2007; 45 (2): 227?33.
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Cowan J.A. Jr, Dimick J.B., Henke P.K., Rectenwald J.,
Stanley J.C., Upchurch G.R. Jr. Epidimiology of aortic
anevrysm repair in the United States from 1993 to 2003. Ann.
NY Acad. Sci. 2006; 1085: 1?10.
2.
3.
4.
5.
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Shirinbek ?. Infrarenal abdominal aortic aneurysm: modern
tactics and treatment outcomes. B?ulleten' Nauchnogo ?sentra
Serdechno-Sosudistoy ?hirurgii imeni A.N. Bakuleva Rossiyskoy
Akademii Meditsinskikh Nauk. 2008; 9 (5): 50?7 (in Russian).
Arakel?an V.S., Shirinbek O., Chemurziev G.M. Evolution of
abdominal aortic aneurysm surgery. B?ulleten' Nauchnogo
?sentra Serdechno-Sosudistoy ?hirurgii imeni A.N. Bakuleva
Rossiyskoy Akademii Meditsinskikh Nauk. 2008; 9 (5): 44?9
(in Russian).
Bockeria L.A., Gudkova R.G. Cardiovascular Surgery ? 2010.
Disease and congenital malformations of the circulatory system. Moscow: A.N. Bakoulev Scientific Center for Cardiovascular Surgery; 2011: 127 (in Russian).
Volodos N.L., Karpovich I.P., Troyan V.I. Clinical experience
of the use of self-fixing synthetic prostheses for remote endoprosthetics of the thoracic and the abdominal aorta and iliac
arteries through the femoral artery and as intraoperative
endoprosthesis for aorta reconstruction. Vasa Suppl. 1991; 33:
93?5.
Darling R.C., Messina C.R., Brewster D.C., Ottinger L.W.
Autopsy study of unoperated abdominal aortic aneurysms. The
case of early resection. Circulation. 1977; 56 (Suppl. 3): 161?4.
Adelman M.A., Rockman C.B., Lamparello P.J., Jacobowitz G.R., Tuerff S., Gagne P.J. et al. Endovascular abdominal
aortic aneurysm (AAA) repair since the FDA approval. Are we
going too far? J. Cardiovasc. Surg. (Torino). 2002; 43 (3):
359?67.
Saratzis A., Mohamed S. Endovascular abdominal aortic
aneurysm repair in the geriatric population. J. Geriatr. Cardiol.
2012; 9: 285?91.
Bush R.L., Johnson M.L., Hedayati N., Henderson W.G.,
Lin P.H., Lumsden A.B. Performance of endovascular abdominal aortic aneurysm repair in high-risk patients results
Veterans Affairs National Surgical Quality Improvement
Program. J. Vasc. Surg. 2007; 45 (2): 227?33.
????????? 04.07.2014
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3.
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?????? ?????? ????????? ????????? ???????.
1. ???????????? ?????. ?????? ?????? ????? ???? ???????????? ? ??????????????
??????????? ???????????? ?? ??????????, ?? ???????? ??????? ?????? (? ??????? ???????),
? ??????????? ??????? ? ?????????? ???????????. ? ??????????? ??????? ???????, ???????? ??
?????? ???????????????.
?????? ?????? ???? ????????? ????? ????????.
?????? ?????????? ? ???????? ??????, ???????????? ? ???? ???????? ??? ????????????
? ???? ???????.
???????? ????????? ?? ????? ????? ????????? ? ????????????? ???????? ??????. ?????
??????????? ?????? ????????? ????? ??????????? ?????????????? (???????????????) ????????
??????.
2. ?????? ??????????? ? ???????? ? ?????????? ? ???????????? ??????????? ???????????
??????. ?? ??????????? ????? ?????? ?? ???????????.
3. ?????? ?????? ???? ?????????? ??????? Times New Roman ??? Arial, ?????? ?????? 12,
? ??????? ?????????? ????? ????????, ???? ??????? 3 ??.
4. ????? ?????????, ???????? ? ????????????? ?????? ?? ?????? ????????? 15 ???.
(??????? ???????????, ??????? ? ?????? ??????????), ???????????? ???????????? ? 12 ???.,
???????? ? 3 ???.
5. ????????? ???? ?????? ?????????:
1) ??????? ? ???????? ??????;
2) ???????? ??????;
3) ?????? ???????????? ??????????, ? ??????? ???????? ?????, ? ???????????? ??????,
? ???????????? ????????? ????????????? ??????????????;
4) ?????? ???????? ????? ??????????, ??????? ??????.
???? ??????? ?????????, ? ?????? ??????? ? ???????????????? ?????????? ????????????? ???????? ??????. ???? ??? ?????? ?????? ???????? ? ????? ??????????, ????????? ?????
?????? ??????? ?????? ???????? ?? ?????.
?????? ???? ?????????? ?????? ???? ??????????? ??? ?? ???????, ??? ? ?? ??????????
?????. ??????? ??????? ????????????? ????????????????? ??? ??, ??? ? ?????????? ???????????, ??? ?? ??????? BGN (Board of Geographic Names), ??. ???? http://www.translit.ru. ? ????????? ???????????(??) ?????, ????? ??? ?????? ?????????? ???????? ?????????? ???????
????????????.
5) ???? ??????????? ?????????????? ???????? ? ?????? ??????, ??????????? ??? ????????? ??????? ? ?????????? ??????? ???????? ???????????: ?.?.?. ????????? ?? ???????
????? ? ? ??????????????, ??????? ???????, ??????, ?????????, ?-mail ??????????? ??????.
??????? ?????????? ?????:
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?????? ????? ?? ?????
1????
??? ╚????????? ??????????????? ??????????? ???????????╩ ???????????? ??????????????? ??,
??. ??????, 40, ???????, 656038, ?????????? ?????????;
2???? ??? ╚???????????? ??????????????? ??????????? ???????????
??. ????. ?.?. ?????-??????????╩ ???????????? ??????????????? ??,
??. ????????? ?????????, 1, ??????????, 660022, ?????????? ?????????
??????? ???????? ????????, ?????? ???. ????, ?????????, ?????????? ????????
??????????????, ?????????????? ? ?????????????? ???????????; e-mail: kulikov57@mail.ru;
???????? ????????? ??????????, ???????? ???. ????, ????????? ??????? ??????????????,
?????????????? ? ?????????????? ???????????;
?????????? ???????? ????????, ?????? ???. ????, ?????????, ?????????? ???????? ???????
???????????
V.P. Kulikov1, M.L. Dicheskul1, S.I. Zhestovskaya2
INFORMATIVITY OF DOPPLEROGRAPHIC EVALUATION OF CEREBRAL VENOUS REACTIVITY
IN DIFFERENT TYPES OF DISTURBANCES OF VENOUS BLOOD OUTFLOW FROM THE BRAIN
1Altai
6. ?????????? ???? ?????????? ???????????? ?????? ?????? ???? ?????????: ??????, ???????? ?????, ??????? ????????, ?????????? ????????? ??????? ? ??????? ?????????
??????, ? ?????? ?????????? ????????????, ???????? ? ??????, ?????????? ? ??????????, ?????? ?? ??????? ??? ??????????, ?????? ???????????? ??????????.
???????? ???????????? ?????? ???? ??????? ????? ?????, ??? ????? ?? ????? ????? ????
?????????????.
??? ?????????? ? ?????? ????????????????? ????? ??????? ????????????????? ╚?????????
?????????? ????? ? ?????????????? ????????????????? ????????╩. ?????? ????, ???? ? ?????????? ?????????????? ???????? ?????? ??????????? ?????? ????????? ??????????? ???
?????????? ??????????? ???????? ?????? ????????????? ? ?????? ??????????? ????????.
????????? ?????? ?????? ???? ?????, ??????, ??? ??????? ???????????? ???????? ? ??????????. ???????????? ??????? ???????? ????? ? ??????????? ??????, ??????????? ?????????? ????????????, ?????? ??? ??????? ???????????? ????????.
????? ???????, ???????? ?? ?????????? ???????? ???????? ?????????? ??? ????????????, ???????? ??????? ????????, ??????????, ????????? ?????????????, ??????, ????????????,
???????? ??? ??????????? ????????, ??????????? ? ??????.
7. ?????????. ??? ??????? ? ??????????? ?????? ???? ?????? ??????????, ?? ????????? (??? ???????, ??? ? ?????????) ?????? ??????????????? ╚?????????????????? ??????? ??????????? ????????╩ (? 3-? ?., ??? ???. ????. ?.?. ???????????).
????????????? ????????? ?????? ???? ????????? ?????? ? ????????????? ??????????????? ?????????, ??????? ????????????? ???????, ????? ? ?????? ????????????? ?????????? ????????? ???????? ???????? ??????????, ?????????????????? ? ?????? (? ????????????
? ?????????????-????????? ???????? ╚??????-?????????╩ ? ??????????????? ?????? ????????????? ???????).
??????????? ?????????? ??????????????, ? 3, 2014
State Medical University, Ministry of Health of the RF,
prospect Lenina, 40, Barnaul, 656038, Russian Federation;
2Prof. V.F. Voyno-Yasenetskiy Krasnoyarsk State Medical University, Ministry of Health of the RF,
ul. Partizana Zheleznyaka, 1, Krasnoyarsk, 660022, Russian Federation
Kulikov Vladimir Pavlovich, MD, DM, Professor, Chief of Chair of Pathophysiology, Functional and Ultrasound
Diagnostics;
Dicheskul Margarita Leonidovna, MD, PhD, Assistant of Chair of Pathophysiology, Functional and Ultrasound
Diagnostics;
Zhestovskaya Svetlana Ivanovna, MD, DM, Professor, Chief of Chair of Beam Diagnostics
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2014
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??????????, ????? ??????????? ??? ???????? ??????????? ??????????????? ????????????? ????????????? ??????????? ????????? ? ???????? (Mendelian Inheritance in Men,
??. http://ncbi.nlm.nih.gov/Omim).
???????? ??????????????? ?????? ???? ???????? ? ???????????? ? ╚?????????????????
???????? ??????????? ????????╩ (? 3-? ?., ??? ???. ????. ?.?. ???????????) ??? ?? ???????
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???? ?????? ??????????? ? ??? ??????, ???? ??? ?? ???? ?? ???????? ??????; ????? ??? ??????????? ?????????? ?????? ????????????? ????????? ? ??? ??????, ???? ??? ?????????? ???????? ??? ???????????? ??????? ? ????? ?????? ?????? ??????.
?????????? ???????? ????????????? ? ????????????????? ??????????. ???????????? ???????? ????? ??????????? ? ?????? ????????????? ????????, ?????? ?????????, ???????, ??????? ??????????? ???????????? ??????, ? ????? ??????, ???????, ?? ?????? ??????, ?????
???????????? ????????.
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? ?????? ?????????? ?????? ??????? ???????? ??????? ?????????????? ???????????,
??? ???????? ?????????? ???????????? ????????, ? ?? ????????? ?????.
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????? ?????? ?????????? ?????? ???????????? ??????????? ?????????? (??????? ????????, ?? ??????? ????????? ?/??? ???????????? ?????????), ?? ?? ?????? ???? ?????
100?250 ????.
???????? ????? ?????? ????? ????? ? ??????? ? ?? ?????? ??????????? ????? ??????,
??????? ?????????????? ???????????? ??? ?????? ?????? ? ????.
9. ?????????? ? ????????. ? ?????? ??? ??????????? (??????????, ?????, ?????????, ??????? ? ?. ?.) ????????? ?????????. ?? ??? ??????? ? ?????? ?????? ???? ???? ??????. ??????? ?????? ????????????? ??????????????? ????? ??????, ? ??????? ??? ???????????
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??????????????? ?????? ? ?????? ? ??????????? ?????? ???? ?????????? ?????????????.
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??????????? ???????? (Uniform Requirements for Manuscripts Submitted to Biomedical Journals).
?????????? ???????? ???????????? ?????????? ? ??????? ?????????? ???????? ??????? ????,
??? ?????????? ?????????? ????? ?????? ??? ?????? ??????? ???????????? ?? ??????? ? ???????????, ? ??????? ??? ????????.
? ???????????? ??????? ??????????? ??????????? ?? ????? 25 ??????????, ? ??????? ?????????? ? ?? ????? 50, ? ??????? ? ?????? ?????????? ? ?? 15. ???????????? ?????? ????????? ??????
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????????????????? ???????? ?????: ?????(?), ????????, ????? (??? ??????), ????? ????????? ? ???????? ????????????; ????? ????? ? ??????? ? ??? ???????. ???? ?????? ?????? ??
????? ?? ?????: ??????, ???????? ?????, ????? ????? ???????? ╚? ??.:╩ ??? ╚In:╩ ? ???????(?) ??????(??) ??? ?????????(??), ????? ???????? ????? ? ???????? ??????.
????????????????? ???????? ?????? ?? ???????: ?????(?), ???????? ??????, ???????? ???????, ???, ???, ? ??????? ????? ???????, ????? ????????? ????? ?????? ? ????????? ???????
???????????.
??? ????????? ?????????? ?? 6 ??????? ???????????? ??????????? ???, ??? ???????
????????? ??????????? ? 6 ?????? ??????? ╚? ??.╩, ? ??????????? ╚et al.╩; ???? ? ???????? ??????? ???? ????????? ?????????, ????? ??????? ??????? ??????? ╚???.╩, ? ??????????? ╚ed.╩.
?? ????? ????????, ??????????? ?????????? ????? ????????????? ?????? ???????????,
??? Web of Science ? Scopus, ????????????????? ?????? (References) ?????? ? ???????????? ????
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??????? ??? ???????
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?????? ? ?????????????? ?????? ???????? ?? ?????? ?? ????? ?????????, ?? ? ????????? (????????? ?????????). ??????? ?????? ?????? ?????? ?????? ?????? ?????????? ? ???? ?????????:
???? ?? ????? ????????? (????????????? ????????? ? ??????????, ???????????? ? ?????????), ??? ???? ??????? ?????, ? ????????? ?????? ??? ?? ?????? ?????????? (References)
? ????????? ???????? ??? Scopus ? ?????? ?????????? ??? ??????, ???????? ? ??? ??? ????????? ??????????, ?????????? ?? ????, ??????? ?? ????? ??? ???????????. ???? ? ?????? ????
?????? ?? ??????????? ??????????, ??? ????????? ??????????? ? ??????, ??????????? ? ????????? ????????.
? ????????? ???????? ??? ????????????? ?????????? ????????? ????????? ????????? ????????????????? ??????: ?????(?) (??????????????), ??????? ???????? ????? ??? ?????? ?? ?????????? ????, ???????? ????????? (??????????????), ???????? ?????? ? ???????? ???????,
???????? ?? ???? ?????? ? ??????? (in Russian).
??????????? ?????????? ??????????????, ? 3, 2014
?????????? ?????????? ?????? ? ?????????????? ???????
?????????????? ?????????????? ? ???????????
?? ????? http://www.translit.ru ????? ????????? ??????????????? ?????????? ?????????????? ???????? ?????? ? ????????. ????????? ????? ???????.
1. ?????? ? ????????? Translit.ru. ???????? ??????? ?????????????? BGN (Board of
Geographic Names). ????????? ? ??????????? ???? ???? ????? ????????????, ????? ????????
????? ??? ??????, ?? ??????? ????? ? ???????? ?????? ╚? ????????╩.
2. ???????? ??????????????????? ????? ? ??????????? ?????? References.
3. ????????? ? ??????? ??????????? Google ??? ???????? ?????????, ????? ??????? (???????? ?????, ??????, ????????????? ? ?. ?.) ?? ?????????? ????, ????????? ??? ? ??????????? ??????. ???????, ??????????, ??????? ??????????????, ??????? ?????? ????? ?????????? ???????? ????????, ??????????? ?????????? ????.
4. ?????????? ???????? ? ????????? ? ??????????, ???????? ? ???????????? ? ?????????
?????????. ??? ???? ?????????? ???????? ????? ??????? (Moscow) ?, ????????, ?????? ????????? ??????????? ????????.
5. ? ????? ?????? ? ??????? ??????? ??????????? (in Russian). ?????? ??????.
??????? ?????????????? ????????????? ?????????? ??????????
??? ????????????? ????? ??????
?????? ?? ???????:
Belushkina N.N., Khomyakova T.N., Khomyakov Yu.N. Diseases associated with dysregulation of
programmed cell death. Molekulyarnaya meditsina. 2012; 2: 3?10 (in Russian).
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economic optimization of hydrofracturing design. Neftyanoe khozyaistvo. 2008; 11: 54?7 (in Russian).
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??????????? ?????????? ??????????????, ? 3, 2014
??????? ?????????? ?????? ?? ?????????? ??? ????????????? ????? ??????
?????? ?? ???????:
??????? ?.?., ?????????? ?.?., ????? ?.?., ??????? ?.?., ????? ?.?., ??????? ?.?. ? ??. ??????????????? ??????????? ????????? ??? ?????????????? ??????????? ???????? ?. ??????? ???????????. 2012; 1: 45?8.
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?????????? ?.?. ???????-????????????? ? ??????????????? ????????? ?????? ? ??????? ? ??????????? ?????????????: ???????. ???. ... ?-?? ???. ????. ?.; 2008.
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??????????????? ?????? ╚? ????????? ???????? ????????? ?????????? ???? ? 2009 ????╩.
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????? ????? ??????????????? ?? ???????????? ????????????????? ??????.
??????????? ?????????? ??????????????, ? 3, 2014
?????? ??????? ?????????? ???????? ??????? ?? ??????: 119049, ??????, ????????? ??-?,
?. 8, ????. 18, ???????????? ????? ??. ?.?. ????????, ???????? ??????? ╚???????????
?????????? ??????????????╩; e-mail: izdinsob@yandex.ru; ???./????: 8 (499) 236-92-87.
??? ????????? ????????? ?????? ?????? ??????????????? ?? ?????.
????? ?? ?????????? ????????? ?? ?????????.
?? ?? ??????? ????????? ? ??????, ????
? ?????????? ??????? ??? ?????? ? ????????,
????????????? ? ??????? ???????, ????????? ????????????? ???????? (??) ?? 170/100 ??
??. ??. (??????????? ? ?? 130/80 ?? ??. ??.).
??????? ????????? ??????? ????? ???
????????? ? 2001 ?. ?? ?????? ??????????????? ???????????? ??????? ???????. ???????????? ??????? ????? ?? ??? ?????? ????????? 37 ??. ???????? ???? ????????????? ???????????? ??????????. ???? ? ??????????
???????, ?? ???? ????????, ????????? 2 ???
?????. ??? ???????????? ?? ????? ?????????? ????????????? ??????? ??? ? ???????????
?? ???????? ?? ?????? ??????????????? ???????????? ???????????? (????) ?? 72 ??,
??? ????????? ???????.
?? ?????? ??????????????????? (???):
???? ?????? ?????????, ? ??? 62 ??/???.
????????????? ??? ?????? ????????? ?????.
??????? ???????? ????? ????? ????? ?????
????. ???????? ??????? ?????? ????? ?????
????. ????????? ???????? ?????? ?????????
(??).
?? ?????? ????????????????????? (?????)
????????????: ??????????????????? ????????? ???????????, ??????????? ???????? ?
?????????? ?????. ????????? ?????????
??????????. ???????????? ??????????? ??.
???????? ?????????????? ????? 146 ??, ???????? ????????????? ????? 56 ??, ???????
??????? ?? 61%.
?? ?????? ???? ??????????????? ???????: ?????? ?????? ???????????? ???????
25?30%. ?????? ? ????? ?????? ???????????
77
??????? 40?45%, ????????????????? ????
? ??????? ?????? ? ?-????????? ? 1 ????????.
?????? ?????? ?????? ????? ?????? ???????
20?25%, ?????????? ? 30?35%. ?????? ? ????? ?????? ?????????? ?????? ???????
40?45% (? ?????????? ???????????? ??????????????????? ??????). ?????? ?????? ????? ????? ?????? ??????? 15?20%, ?????????? ? 30?35%. ?????? ? ????? ????? ?????????? ?????? ??????? 30?35%. ╚?????╩
??????? ????? ??????????? ???????.
?? ?????? ????????-??????????? ?????????? (???) ????????? ?????: ? ???????? ?????? ???????? ???? ??????? ???? ????????
????? ???????? ?? 4 ??, ????????, ?????????? ?????????. ?????????? ? ???????? ???????????? ????????????.
?? ????????? ?????, ????????, ???????????? ??????? ? ??????????? ???????????-???????????????? ??????? ???????????? ???????? ??? ????????? ??????????? ???????: ????????????. ????????? ??????? ?????.
??????????? ??????? ??????. ???????????
?????????? II ??. ???????????? ??????????? 3 ??????, 2 ???????, ???? ???????. ??????????? ????????? ??????????????? 1 ??. (??
NYHA). ?????????????????? ???????. ??????????? ?????? ????? 3 ??????, ??????????????? ? ?????????????????? ????????,
??????????????. ??????????? ????????????? ??????? ????????? ????????? ?????????????? ? ???????? ?????? ??????? ???????? ??????? ?? 2002 ? 2007 ??. ????????????, ?????????-???????-????????????
?????. ?????????????? ???????????, ?????????. ???????????? ????????????. ??????????? ???????. ??????????? ?????????.
?? ?????? ???????????????? ???????????? ?????????? (????) ? 3D-??????????????
??????? ????? ? ?? ?????? (???. 1, ?) ?? 39 ??
???? ????? ?????? ???????? ??????? ?? ?????????? 71 ??, ? ???????????????? ??????????? ?? ?????????? ?????, ????????????
????????????????? ?????????? ??????????????? ?????? ??????? ????? (???????????? ???????? ?????? ????? 63 в65 ??, ?????? ???????? ????? ?? ???? ?????? 393в52 ??).
?????? ??????? ????? ???????????? ?????????, ? ??????? ????????????????????
???????? ? ?????????????? ??????? ??????????, ??????????? ???????????? ?????????? ????? ??????? ???????????????? ?
???????????? ?????? ?? 15?18 ?? ?? ??????
?????????????????? ?????????? ?????. ?????? ??????? ????? ?? ??????????????
??????????? ?????????? ??????????????, ? 3, 2014
??????? ?????????
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???. 1. ??? ??????? ?????:
?
? ? ????-??????????? ? 3D-?????????????? ??????? ????? ?? ???????? (??????????????? ?????????????? ???, ???????????? ??????? ????????? 67 ??); ? ? ??????????????????? ??????????? ?? ?????????????????? (???????-?????? ????????, ??????????????? ?????????????? ???);
? ? ??????????????????? ??????????? ????? ?????????????????? (???????-?????? ????????, ?????-????? ????????? ????????? ? ??????? ?????,
? ?????? ? ? ?????? ? ????? ???, ???????????????? ??????????, ????????? ??????, ??? ????????? ??????????); ? ? ???? ? 3D-?????????????? ??????? ????? ????? 3 ??? ????? ?????????????????? (????????????? ????? ??????????? ?????????? ?? 9 ?? ???? ?????? ?????? ????????
???????, ?????????? ?????? ??????????? ? ????? ??????????? ????????, ????????????? ???????????? ???????? ?? ??????? ??????????? ???)
?????? ???????? 31 ??, ?? ?????? ????? ???????? ?????? (??) ? 25 ?? (????? ?? 7 ??, ? ????? ??????????????? ?????? ???? ??????????), ?? ?????? ??????? ?????????? ???????
(???) ? 23 в24 ?? (????? ??? ?? 8 ??), ??
?????? ?????? ???????? ??????? ? 22в23 ??
(????? ?????? ???????? ??????? 9 ??, ????? ?
8 ??), ? ?????????????? ?????? ??????????????? ????????????????? ?????????? ?????, ??????? ????? ???????????? ????????
?????. ?? ?????? ?????????? ??????? ?????
????? ???????????? ?????, ???????? 29 ??.
?????? ??????????? ??????? (?????, ???????? ? ??????????) ? ????? ?????? ???????? ???????????? ???????? ? ???????????????? ??????????? ? ??????? ?????-
??????????????? ????????. ????? ?????
??????????? ??????? (???) ???????? ??????, ???????? 13 в11 ??, ?????? ??? ?????
??????, ???????? ? ????? 19 ??, ????? 17 ??,
? ??????????? ??????????? ?? 21 ??.
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????????? (d), ??????????? ??????? ?????????? ????? (??? ?? ???????) (f), ???????
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????????????????? ?????? ? ????? ???
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????? (??? ?? ???????), ??
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? ?????????? ?????????? ?? ????? ???
? ?????????? ??????? ???????????;
? ????? ??????? ?????????? ?? ???????
??? ???????? ????????????????? ??????
?????-?????? ? ????? ???;
? ?????????? ???????????? ??????? ??
???????? ?????????? ? ????? ??? (??????????? 12 F);
? ?????????? ?? ?????????? ????????????????? ?????? ??????????? ????????
14,5 ?? в 12 ?? ? ?????????????? ? ???????
??????????????????? ????? ? ??????? ???????? ?????? ? ?? ?????????????? ? ???????
? ????? ???;
? ???????????????? ????????????? ????????: ????????????? ???? ?????-??????,
??????? ?????????? ???????, ??????????
???? ????????????????? ?????? ? ?????????? ???? ???????? ??????;
? ?????????? ??????????? ???????????
(??????????????? ?????? ?????????? ??????????? ? ??????? ????? ? ??????? ? ??????
? ????? ???, ???????????????? ??????????,
??????????? ?????????? ??????????????, ? 3, 2014
????? ??????????????? ????????? ??????????? ?????????? ??????????????????, ????????? ????. ? ??????? ??????????? ?????????????? ?????? ???????? ?????-??????.
??? ???????????? ?????????? ???? ???????? ?????? ? ????? ????? ????????? ??????? (???). ????? ??? ???????? ??????????????? ????, ??????? ???????:
? ??????? ?????? ??? ?? ?????? ??????????? (??????????? 6 F);
? ????? ??????? ?????????? ? ??????
??? ?? ???????????????? ??????? Pigtail, ?????????? ??????????? ??????? ????? ? ???????????? ?????? ?????????? ???????? ??????? ? ????????????? ???????????? ??????????????? ?????? ????? (???.1, ?);
? ????? ??????? ?????????? ?? ???????
??? ???????? ???????? ?????? ??????????????? ?????-?????? ? ?????? ???;
? ??????????? ????????????? ? 7500 ??;
? ??? ???????????? ????????? ??????? ? ?????????? ???????????? ???????
??????????????? ?????????;
? ?????????? ???????????? ??????? ??
???????? ?????????? ? ?????? ??? (??????????? 18 F);
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????????) (???. 1, ?).
? ??????????, ????? ???????? ??????????? ? ?????????????, ???? ????????? ???????? ????????? ??????? ?????? ? ????? ? ?????????? ???????????? ???????. ????????
?????? ??? ??????????. ????? ???????????
???????? 300 ??. ?????? ????????????? ?????????????? ???????????? ???????? ??????? (350 ??/??) ???????? 200 ??.
?????- ? ????????????????? ???????
????????? ??? ??????????, ???? ?????????
???????? ?????????????? ???????, ?????????? ??? ????????? ????????? ??????????.
??? ??????????? ???? ? 3D-?????????????? ????? 3 ??? (???. 1, ?) ????????????? ????? ??????????? ?????????? ?? 9 ??
???? ?????? ?????? ???????? ???????, ?????????? ?????? ??????????? ? ????? ??????????? ????????, ????????????? ???????????? ???????? ?? ??????? ??????????? (? ??????? ?????????, ??????????? ????????????)
???, ??????? ?????? ??????, ??????, ????????
???????????????? ???.
??????????? ?????????? ??????????????, ? 3, 2014
??????????
??? ??????????? ??????, ?????? ? ??????? ?????????????? ????????????? ????????
??????????????? ????????? ???????? ??????
???. ???, ???? ??????? ??????? ?????????
????????? 5,5?5,9 ?? ?????????? 9,4%, ????????? 6,0?6,4 ?? ? ????? 10,2%, ?????????? ?????????? ???????? ????????? ?? 6,5 ??
6,9 ?? ???????? ???? ??????? ?? 19,1% ? ???,
? ????? 7,0 ?? ? ?? 32% [6].
?? ?????? ??????????? ????????????
??? ????????? ?????????? ????????? ?????????????????? ????? ????????????? ????? ?????????, ????? ?????? ???????? ????????? ????????????? ???????? ???????
? ??????? ?????????, ?????? ?????????? ??
????? 15 ?? [7]. ??????????? ??????????
??????? ????? ????????? ??????? ?? ????????? ???????? ??????????????? ??????????.
??? ??????????? ?????-???????, ??????????
FDA, ???????????? ??????? ?????????? 34 ??.
??? ???????? ????????????? ???????? ????????????? ?????????? ??????? ????? ??
10?20%. ????? ???????, ?????????? ??????? ????? ?????????, ??????? ????? ????
??????? ????????????? ? ??????? ??????????, ?????????? 30 ??. ???? ????? ?????????, ?????????? ????? ????? ????????????? ?????? ????????? ? ???? ????????
??????????? ?????? ? ?????????, ????? 60╟
?????? ????????????? ?????????????????
? ????????. ????? ? ????????????? ????????????????? ????????? ???????????? ???????
??? ??????????? ????????? ????? ?????????, ??????? ????? ?????????????? ??????????? ? ???????? ???????? ?????-??????.
????? ????, ?????? ???????? ???????? ?????????? ??????????? ??????? ? ?? ?????????, ??????? ????????, ????????? ? ??????? ????????. ??????? ????????? ? ??????????? ??????? ?????? ???? ?? ????? 8 ??,
? ?? ???????? ? ?? ????????? 90╟.
????? ????, ????????? ???????? ?????
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?????, ?? ??? ????????????? ???????? ????????????? ?????????????? ??????? ????????????, ? ????? ?????????????? ??????? ???
?????????? ??????????????? ???????? ???????? ??????????? ???????.
??????????
?????????? ????????? ??????? ? ???????
????????????? ??????????, ??? ??????? ???????????? ???????? ????????????? ????????? ? ??????? ?????? ???????? ????????? ??????????. ? ???? ??????? ?????????????? ??????? ??????? ?????????????? ????????
???????? ??????????????????. ?? ??????????? ???? ?????????? ? ??????? ????????? ????? ???????????????? ??????? ??? ? ?????????? ??????? ?????????? ?????????? ?? 0 ??
3,4%, ??? ??????????????? ? ????????????????
????????????? ??????? ?????? [8]. ????? ????,
??????????? ???????????? ???????? ???????????? ?????? ?????????????????? ? ????????? ? ????????? ?????????????? ???????? [9].
C ????? ????????????? ?????????? ?? ?????????? ?????-??????, ??? ??????????, ???????? ?????????? ? ???????? ??????????
???? ????????? ????? ??????????????????
?? ?????? ??? ???????? ?????????? ????
? ????????? ? ?????????? ????????????????? ????????, ? ????? ????? 3?6 ??? ? ??????????? ????.
??????????
1.
2.
Cowan J.A. Jr, Dimick J.B., Henke P.K., Rectenwald J.,
Stanley J.C., Upchurch G.R. Jr. Epidimiology of aortic
anevrysm repair in the United States from 1993 to 2003. Ann.
NY Acad. Sci. 2006; 1085: 1?10.
???????? ?. ?????????????? ????????? ???????
?????: ??????????? ??????? ? ?????? ???????. ????????? ????? ??. ?.?. ???????? ????. 2008; 9 (5): 50?7.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ?????????
4.
5.
6.
7.
8.
9.
???????? ?.?., ???????? ?., ????????? ?.?. ????????
???????? ???????? ??????? ?????. ????????? ?????
??. ?.?. ???????? ????. 2008; 9 (5): 44?9.
??????? ?.?., ??????? ?.?. ????????-?????????? ???????? ? 2010. ??????? ? ?????????? ???????? ???????
??????????????. ?.: ????? ??. ?.?. ???????? ????.
2011: 127.
Volodos N.L., Karpovich I.P., Troyan V.I. Clinical experience
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arteries through the femoral artery and as intraoperative
endoprosthesis for aorta reconstruction. Vasa Suppl. 1991; 33:
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Darling R.C., Messina C.R., Brewster D.C., Ottinger L.W.
Autopsy study of unoperated abdominal aortic aneurysms. The
case of early resection. Circulation. 1977; 56 (Suppl. 3): 161?4.
Adelman M.A., Rockman C.B., Lamparello P.J., Jacobowitz G.R., Tuerff S., Gagne P.J. et al. Endovascular abdominal
aortic aneurysm (AAA) repair since the FDA approval. Are we
going too far? J. Cardiovasc. Surg. (Torino). 2002; 43 (3): 359?67.
Saratzis A., Mohamed S. Endovascular abdominal aortic
aneurysm repair in the geriatric population. J. Geriatr. Cardiol.
2012; 9: 285?91.
Bush R.L., Johnson M.L., Hedayati N., Henderson W.G.,
Lin P.H., Lumsden A.B. Performance of endovascular abdominal aortic aneurysm repair in high-risk patients results
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Arakel?an V.S., Shirinbek O., Chemurziev G.M. Evolution of
abdominal aortic aneurysm surgery. B?ulleten' Nauchnogo
?sentra Serdechno-Sosudistoy ?hirurgii imeni A.N. Bakuleva
Rossiyskoy Akademii Meditsinskikh Nauk. 2008; 9 (5): 44?9
(in Russian).
Bockeria L.A., Gudkova R.G. Cardiovascular Surgery ? 2010.
Disease and congenital malformations of the circulatory system. Moscow: A.N. Bakoulev Scientific Center for Cardiovascular Surgery; 2011: 127 (in Russian).
Volodos N.L., Karpovich I.P., Troyan V.I. Clinical experience
of the use of self-fixing synthetic prostheses for remote endoprosthetics of the thoracic and the abdominal aorta and iliac
arteries through the femoral artery and as intraoperative
endoprosthesis for aorta reconstruction. Vasa Suppl. 1991; 33:
93?5.
Darling R.C., Messina C.R., Brewster D.C., Ottinger L.W.
Autopsy study of unoperated abdominal aortic aneurysms. The
case of early resection. Circulation. 1977; 56 (Suppl. 3): 161?4.
Adelman M.A., Rockman C.B., Lamparello P.J., Jacobowitz G.R., Tuerff S., Gagne P.J. et al. Endovascular abdominal
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Saratzis A., Mohamed S. Endovascular abdominal aortic
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????????? 04.07.2014
??????????? ?????????? ??????????????, ? 3, 2014
3.
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?????? ?????? ????????? ????????? ???????.
1. ???????????? ?????. ?????? ?????? ????? ???? ???????????? ? ??????????????
??????????? ???????????? ?? ??????????, ?? ???????? ??????? ?????? (? ??????? ???????),
? ??????????? ??????? ? ?????????? ???????????. ? ??????????? ??????? ???????, ???????? ??
?????? ???????????????.
?????? ?????? ???? ????????? ????? ????????.
?????? ?????????? ? ???????? ??????, ???????????? ? ???? ???????? ??? ????????????
? ???? ???????.
???????? ????????? ?? ????? ????? ????????? ? ????????????? ???????? ??????. ?????
??????????? ?????? ????????? ????? ??????????? ?????????????? (???????????????) ????????
??????.
2. ?????? ??????????? ? ???????? ? ?????????? ? ???????????? ??????????? ???????????
??????. ?? ??????????? ????? ?????? ?? ???????????.
3. ?????? ?????? ???? ?????????? ??????? Times New Roman ??? Arial, ?????? ?????? 12,
? ??????? ?????????? ????? ????????, ???? ??????? 3 ??.
4. ????? ?????????, ???????? ? ????????????? ?????? ?? ?????? ????????? 15 ???.
(??????? ???????????, ??????? ? ?????? ??????????), ???????????? ???????????? ? 12 ???.,
???????? ? 3 ???.
5. ????????? ???? ?????? ?????????:
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2) ???????? ??????;
3) ?????? ???????????? ??????????, ? ??????? ???????? ?????, ? ???????????? ??????,
? ???????????? ????????? ????????????? ??????????????;
4) ?????? ???????? ????? ??????????, ??????? ??????.
???? ??????? ?????????, ? ?????? ??????? ? ???????????????? ?????????? ????????????? ???????? ??????. ???? ??? ?????? ?????? ???????? ? ????? ??????????, ????????? ?????
?????? ??????? ?????? ???????? ?? ?????.
?????? ???? ?????????? ?????? ???? ??????????? ??? ?? ???????, ??? ? ?? ??????????
?????. ??????? ??????? ????????????? ????????????????? ??? ??, ??? ? ?????????? ???????????, ??? ?? ??????? BGN (Board of Geographic Names), ??. ???? http://www.translit.ru. ? ????????? ???????????(??) ?????, ????? ??? ?????? ?????????? ???????? ?????????? ???????
????????????.
5) ???? ??????????? ?????????????? ???????? ? ?????? ??????, ??????????? ??? ????????? ??????? ? ?????????? ??????? ???????? ???????????: ?.?.?. ????????? ?? ???????
????? ? ? ??????????????, ??????? ???????, ??????, ?????????, ?-mail ??????????? ??????.
??????? ?????????? ?????:
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??????????????? ??????????????????? ?????? ????????????
???????? ???????????? ??? ????????? ????????? ?????????
?????? ????? ?? ?????
1????
??? ╚????????? ??????????????? ??????????? ???????????╩ ???????????? ??????????????? ??,
??. ??????, 40, ???????, 656038, ?????????? ?????????;
2???? ??? ╚???????????? ??????????????? ??????????? ???????????
??. ????. ?.?. ?????-??????????╩ ???????????? ??????????????? ??,
??. ????????? ?????????, 1, ??????????, 660022, ?????????? ?????????
??????? ???????? ????????, ?????? ???. ????, ?????????, ?????????? ????????
??????????????, ?????????????? ? ?????????????? ???????????; e-mail: kulikov57@mail.ru;
???????? ????????? ??????????, ???????? ???. ????, ????????? ??????? ??????????????,
?????????????? ? ?????????????? ???????????;
?????????? ???????? ????????, ?????? ???. ????, ?????????, ?????????? ???????? ???????
???????????
V.P. Kulikov1, M.L. Dicheskul1, S.I. Zhestovskaya2
INFORMATIVITY OF DOPPLEROGRAPHIC EVALUATION OF CEREBRAL VENOUS REACTIVITY
IN DIFFERENT TYPES OF DISTURBANCES OF VENOUS BLOOD OUTFLOW FROM THE BRAIN
1Altai
6. ?????????? ???? ?????????? ???????????? ?????? ?????? ???? ?????????: ??????, ???????? ?????, ??????? ????????, ?????????? ????????? ??????? ? ??????? ?????????
??????, ? ?????? ?????????? ????????????, ???????? ? ??????, ?????????? ? ??????????, ?????? ?? ??????? ??? ??????????, ?????? ???????????? ??????????.
???????? ???????????? ?????? ???? ??????? ????? ?????, ??? ????? ?? ????? ????? ????
?????????????.
??? ?????????? ? ?????? ????????????????? ????? ??????? ????????????????? ╚?????????
?????????? ????? ? ?????????????? ????????????????? ????????╩. ?????? ????, ???? ? ?????????? ?????????????? ???????? ?????? ??????????? ?????? ????????? ??????????? ???
?????????? ??????????? ???????? ?????? ????????????? ? ?????? ??????????? ????????.
????????? ?????? ?????? ???? ?????, ??????, ??? ??????? ???????????? ???????? ? ??????????. ???????????? ??????? ???????? ????? ? ??????????? ??????, ??????????? ?????????? ????????????, ?????? ??? ??????? ???????????? ????????.
????? ???????, ???????? ?? ?????????? ???????? ???????? ?????????? ??? ????????????, ???????? ??????? ????????, ??????????, ????????? ?????????????, ??????, ????????????,
???????? ??? ??????????? ????????, ??????????? ? ??????.
7. ?????????. ??? ??????? ? ??????????? ?????? ???? ?????? ??????????, ?? ????????? (??? ???????, ??? ? ?????????) ?????? ??????????????? ╚?????????????????? ??????? ??????????? ????????╩ (? 3-? ?., ??? ???. ????. ?.?. ???????????).
????????????? ????????? ?????? ???? ????????? ?????? ? ????????????? ??????????????? ?????????, ??????? ????????????? ???????, ????? ? ?????? ????????????? ?????????? ????????? ???????? ???????? ??????????, ?????????????????? ? ?????? (? ????????????
? ?????????????-????????? ???????? ╚??????-?????????╩ ? ??????????????? ?????? ????????????? ???????).
??????????? ?????????? ??????????????, ? 3, 2014
State Medical University, Ministry of Health of the RF,
prospect Lenina, 40, Barnaul, 656038, Russian Federation;
2Prof. V.F. Voyno-Yasenetskiy Krasnoyarsk State Medical University, Ministry of Health of the RF,
ul. Partizana Zheleznyaka, 1, Krasnoyarsk, 660022, Russian Federation
Kulikov Vladimir Pavlovich, MD, DM, Professor, Chief of Chair of Pathophysiology, Functional and Ultrasound
Diagnostics;
Dicheskul Margarita Leonidovna, MD, PhD, Assistant of Chair of Pathophysiology, Functional and Ultrasound
Diagnostics;
Zhestovskaya Svetlana Ivanovna, MD, DM, Professor, Chief of Chair of Beam Diagnostics
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2014
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??????????, ????? ????????? ????????? ??????????????? ????????? Enzyme Classification.
??????????, ????? ??????????? ??? ???????? ??????????? ??????????????? ????????????? ????????????? ??????????? ????????? ? ???????? (Mendelian Inheritance in Men,
??. http://ncbi.nlm.nih.gov/Omim).
???????? ??????????????? ?????? ???? ???????? ? ???????????? ? ╚?????????????????
???????? ??????????? ????????╩ (? 3-? ?., ??? ???. ????. ?.?. ???????????) ??? ?? ???????
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???? ?????? ??????????? ? ??? ??????, ???? ??? ?? ???? ?? ???????? ??????; ????? ??? ??????????? ?????????? ?????? ????????????? ????????? ? ??? ??????, ???? ??? ?????????? ???????? ??? ???????????? ??????? ? ????? ?????? ?????? ??????.
?????????? ???????? ????????????? ? ????????????????? ??????????. ???????????? ???????? ????? ??????????? ? ?????? ????????????? ????????, ?????? ?????????, ???????, ??????? ??????????? ???????????? ??????, ? ????? ??????, ???????, ?? ?????? ??????, ?????
???????????? ????????.
? ?????? ?????????? ?????? ?? ?????? ??????????? ????????, ???????????? ? ????????.
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? ?????? ?????????? ?????? ??????? ???????? ??????? ?????????????? ???????????,
??? ???????? ?????????? ???????????? ????????, ? ?? ????????? ?????.
?????????? ? ???????? ???????????, ????? ???????????????????, ????????? ? ?????????????? ??????? ??? ???? ?? ??????????? ? ??????????? ??? ?????? ???????????? ? ????????? ??????.
????? ?????? ?????????? ?????? ???????????? ??????????? ?????????? (??????? ????????, ?? ??????? ????????? ?/??? ???????????? ?????????), ?? ?? ?????? ???? ?????
100?250 ????.
???????? ????? ?????? ????? ????? ? ??????? ? ?? ?????? ??????????? ????? ??????,
??????? ?????????????? ???????????? ??? ?????? ?????? ? ????.
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jpg, ?? ??????????? ????, ???????? ??? ????????, ????? ?????????? ??????????? ???????? ? ???
?????????.
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?????????.
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? ??????????.
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?????? ?? ????????. ?????????? ???? ? ???????? ?? ???????????. ??? ????? ? ???????? ??????
??????????????? ?????? ? ?????? ? ??????????? ?????? ???? ?????????? ?????????????.
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??????????? ???????? (Uniform Requirements for Manuscripts Submitted to Biomedical Journals).
?????????? ???????? ???????????? ?????????? ? ??????? ?????????? ???????? ??????? ????,
??? ?????????? ?????????? ????? ?????? ??? ?????? ??????? ???????????? ?? ??????? ? ???????????, ? ??????? ??? ????????.
? ???????????? ??????? ??????????? ??????????? ?? ????? 25 ??????????, ? ??????? ?????????? ? ?? ????? 50, ? ??????? ? ?????? ?????????? ? ?? 15. ???????????? ?????? ????????? ??????
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????????????????? ???????? ?????: ?????(?), ????????, ????? (??? ??????), ????? ????????? ? ???????? ????????????; ????? ????? ? ??????? ? ??? ???????. ???? ?????? ?????? ??
????? ?? ?????: ??????, ???????? ?????, ????? ????? ???????? ╚? ??.:╩ ??? ╚In:╩ ? ???????(?) ??????(??) ??? ?????????(??), ????? ???????? ????? ? ???????? ??????.
????????????????? ???????? ?????? ?? ???????: ?????(?), ???????? ??????, ???????? ???????, ???, ???, ? ??????? ????? ???????, ????? ????????? ????? ?????? ? ????????? ???????
???????????.
??? ????????? ?????????? ?? 6 ??????? ???????????? ??????????? ???, ??? ???????
????????? ??????????? ? 6 ?????? ??????? ╚? ??.╩, ? ??????????? ╚et al.╩; ???? ? ???????? ??????? ???? ????????? ?????????, ????? ??????? ??????? ??????? ╚???.╩, ? ??????????? ╚ed.╩.
?? ????? ????????, ??????????? ?????????? ????? ????????????? ?????? ???????????,
??? Web of Science ? Scopus, ????????????????? ?????? (References) ?????? ? ???????????? ????
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??????? ??? ???????
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?????? ? ?????????????? ?????? ???????? ?? ?????? ?? ????? ?????????, ?? ? ????????? (????????? ?????????). ??????? ?????? ?????? ?????? ?????? ?????? ?????????? ? ???? ?????????:
???? ?? ????? ????????? (????????????? ????????? ? ??????????, ???????????? ? ?????????), ??? ???? ??????? ?????, ? ????????? ?????? ??? ?? ?????? ?????????? (References)
? ????????? ???????? ??? Scopus ? ?????? ?????????? ??? ??????, ???????? ? ??? ??? ????????? ??????????, ?????????? ?? ????, ??????? ?? ????? ??? ???????????. ???? ? ?????? ????
?????? ?? ??????????? ??????????, ??? ????????? ??????????? ? ??????, ??????????? ? ????????? ????????.
? ????????? ???????? ??? ????????????? ?????????? ????????? ????????? ????????? ????????????????? ??????: ?????(?) (??????????????), ??????? ???????? ????? ??? ?????? ?? ?????????? ????, ???????? ????????? (??????????????), ???????? ?????? ? ???????? ???????,
???????? ?? ???? ?????? ? ??????? (in Russian).
??????????? ?????????? ??????????????, ? 3, 2014
?????????? ?????????? ?????? ? ?????????????? ???????
?????????????? ?????????????? ? ???????????
?? ????? http://www.translit.ru ????? ????????? ??????????????? ?????????? ?????????????? ???????? ?????? ? ????????. ????????? ????? ?????
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