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84.Клиническая физиология кровообращения №3 2013

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Klinicheskaya Fiziologiya Krovoobrashcheniya
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??????? ? 2004 ?.
Clinical Physiology
of Circulation
Peer Reviewed Scientific Practical Journal
Published once in three months
Founded in 2004
3 ?2013
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Л??б?кзбн╦ к ка??збн╦ НиеЛ
╚ГЯККО ко. д.Г. е?мшнб??╩ ЙдЕГ
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?? ЙдЕГ,
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?б ?б??мзс??,
мс??бмзс??
длзслс?? Ю.г., Дк?кнблмс д.Е.
Дсот╦?зб?л?? ?б?рзм?
к ???ык?брм?? с╥??╥сзм?
о?зб?к?н?
Гбтс?с?кл? Е.г., Кн?╞ И.г.,
Осо?мс?? ж.М.
Гсоб? тс?ткр?л ? тб??з╦ 21.10.2013
Нс?о?з 60в88 1/8
Хб?. н. 10,50
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Изтб??з?лс
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119049, Есрм??, Цблклрмкх т?., 8
збн. (499) 236-92-87
Днклк?брм?? ыкакснс?к?
м?с?сс╥???блк?
2013. ? 3. 1?84
ISSN 1814?6910
Мк??й 500 ?ма.
Хс?ткрлсх кл?бмр 84549
Editor-in-Chief L.A. BOCKERIA
Editorial Board
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?????╩
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CONTENTS
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? ????????-?????????? ??????????.
????????? ?????-????????
??????? ?.?., ???????? ?.?., ?????????? ?.?.
??????????????? ??????????????????? ?????? ???????????? ???????? ???????????? ???
????????? ????????? ????????? ?????? ?????
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???????? ?.?. ???????????? ???????? ????????. ??????? ?????, ?????????, ??????????? ?
??????? ????????. ??????????? ??????? ????????? ? ???????????? ????????
???????-???????? ?.?., ?????? ?.?., ????? ?.?.,
???????? ?.?., ????????? ?.?., ?????? ?.?. ????????? ???????????? ???????? ????????????
? ??????? ??????????????? ?????????????? ?
?????????????????? ???????? ???????????????? ? ???????? ????????????????? ???????
??????? ?.?., ?????????? ?.?., ????????? ?.?.,
?????? ?.?., ??????? ?.?., ??????? ?.?., ???????? ?.?. ?????? ???????? ???????????????????? ????????? ???????????????? ???????????? ?????????? ? ????????-???????????
?????????? ? ??????????? ??????????????????
????????, ?????????? ???????????? ????????
?????????
Cerebral Venous Circulation
Disturbances in Patients
with Cardiovascular Pathology.
Workshop Materials
Shumilina M.V. Venous circulation disturbances in
patients with cardiovascular pathology
5
Kulikov V.P., Dicheskul M.L., Zhestovskaya S.I.
Informativity of dopplerographic evaluation of
cerebral venous reactivity in different types of disturbances of venous blood outflow from the brain
17
22
Abramova M.F. Cerebral venous blood flow.
Concepts of normality, pathology and diagnosis in
childhood. Particularities of management of
patients in the outpatient setting
28
Kolotik-Kameneva O.Yu., Belova L.A., Mashin V.V.,
Abramova V.V., Saprygina L.V., Burtsev S.V.
Condition of cerebral venous hemodynamics in
patients with hypertonic encephalopathy with constitutional venous insufficiency in the process of
neuroprotective therapy
Semenov S.E., Moldavskaya I.V., Kovalenko A.V.,
Khromov A.A., Khromova A.N., Zhuchkova E.A.,
Shatokhina M.G. Evaluation of routine topo-morphometric criteria of multispiral computed tomography and magnetic resonance imaging in the diagnosis of nonhemorrhagic stroke, caused by cerebral
venous thrombosis
37
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??????? ?.?., ??????? ?.?. ?????????????? ?????????? ? ?????????? ??????????? ?????????
?????????????? ??? ??????????? ??????????
Reviews
46
Bockeria L.A., Taskina V.Yu. Endothelial dysfunction in the pathogenesis of disorders of cerebral circulation in atrial fibrillation
??????????? ?????????? ??????????????, ? 3, 2013
???????? ?.?. ????????? ????????? ?????????????? ? ????????? ? ????????-??????????
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3
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
4
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?????? ?.?., ??????? ?.?., ???????? ?.?. ??????????? ??????????????? ?????? ?????????
??? ?????????? ?????????? ????? ??????????
??????? ?? ????????? ??????
Clinical Physiology
of the Heart
Rogova T.V., Bockeria L.A., Aslanidis I.P. Ischemic
left ventricular remodeling in anomalous origin of
the left coronary artery from the pulmonary trunk
57
??????????? ??????????
???????????? ??????????????
???????? ?.?., ???????? ?.?., ?????????? ?.?.,
??????? ?.?., ???????? ?.?., ?????????? ?.?.,
????????? ?.?., ?????????? ?.?. ???????????
?????? ??????? ???????????? ??????????????? ?????: ???????? ???????? ??? ????????????? ? ?????? ????????
??????? ?.?., ???????? ?.?., ????????? ?.?.,
??????? ?.?., ?????????? ?.?., ?????????? E.?.
????????????? ?????? ??????????????? ????????????? ????????? ??????? ??????? ???????????? ??????????????? ???????
Clinical Physiology
of Regional Blood Flow
Arakelyan V.S., Gidaspov N.A., Kolesnikov Ya.G.,
Gamzaev N.R., Shumilina M.V., Bortnikova N.V.,
Bukatsello R.G., Golovinova E.V. Critical artery
stenosis of a single functioning kidney: open surgery
or stenting ? what is the difference?
65
71
??????????? ?????????? ??????????????, ? 3, 2013
??????? ?????????
Bockeria L.A., Aslanidis I.P., Makarenko V.N.,
Getsadze G.G., Serguladze T.N., Dvalishvili E.R.
Comparative evaluation of the diagnostic efficiency
of different radiological methods of the examination
of brachiocephalic arteries
Brief Reports
??????? ?.?., ??????? ?.?., ??????? ?.?., ???????? ?.?. ????????????? ??????? ??????????
??????? ??????????????? ???????
76
Mollaev E.B., Eseneev M.F., Valieva R.R., Gvetadze I.A.
Surgical treatment of tandem stenosis of the brachiocephalic arteries
????? ??????? ??? ???????
80
New rules for authors
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5
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????????? ?????-????????
╘ ?.?. ????????, 2013
??? 612.134-005:616.1
????????? ????????? ?????????????? ? ?????????
? ????????-?????????? ??????????
?.?. ????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????) ????, ?????????? ?????, 135, ??????, 121552, ?????????? ?????????
???????? ????????? ????????????, ?????? ???. ????, ?????????? ??????? ??-???????????? ?????????????????? ? ???????? ?????????; e-mail: shumilinamv@yandex.ru
????????? ????????? ?????? ????? ???????? ???????? ?????? ? ??????????? ???? ????????? ????????? ?????????????? (????????, ???????????????? ?????????????, ??????? ?
??.), ?????????????????? ? ????????????? ???????????? ???????????, ???????? ???????????, ????????? ????, ? ????????? ???????? ??????????? ????????. ????????? ?????????
?????? ????? ???? ???????????: 1) ??????????? ????????????????? ??? ??????????? ????????? ???; 2) ????????? ????????????????? ??? ?????????? ??????????? ?????????? ????????? ??????; 3) ?????????????? ?????????????????.
???????? ?????: ????????? ????????? ??????; ???????? ????; ????????? ?????????
??????????????; ????????; ???????????? ???????????; ???????? ???????????; ????????
????????.
VENOUS CIRCULATION DISTURBANCES IN PATIENTS WITH CARDIOVASCULAR PATHOLOGY
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences,
Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Shumilina Margarita Vladimirovna, MD, Chief of Group for Diagnostic Ultrasonography of Cardiovascular and Organ
Pathology
Venous outflow impairment can lead to development of acute and chronic cerebral circulation disorders (stroke, discirculatory encephalopathy, migraine and others), cerebral ischemic and renovascular arterial hypertension, venous angina, ocular pathology including normal tension glaucoma.
Venous outflow impairment can be caused by: 1) regional venous hypertension in the presence of
regional venous pathology; 2) systemic venous hypertension in the presence of disorders of venous
outflow central mechanisms; 3) functional venous hypertension.
Key words: venous outflow impairment; headache; cerebral circulation disorders; glaucoma; arterial hypertension; venous angina; venous pressure.
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??????????? ??????????????? ????????????? ???????, ? ??????????? ??????????????. ??????????? ?????????? ????????? ????????????, ???????? ??????? ??????????????????? ? ???????? ???????? [1].
??? ?????? ???????? ?????? ?????? ????????????? ?????? ???????????? ????????? ? ??????????????? ????????? ??????-
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M.V. Shumilina
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??????????? ?????????? ??????????????, ? 3, 2013
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? ???????-????????????? ?????? [7]. ? 1951 ?.
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????????? ?????? [6]:
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???. 4. ???????????? ??????????????? ?????????? ??? ?????????? ????????? ?????? ?? ??????? ????????????????
?????????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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9
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? 39 ????????? ????? ??????????????? ????????? ???????? ?????????????? ???????????
(????) ??????????? ??????????? Amplatzer
(ASO). ?????????, ??? ??????? ???????? ? ????????? ? ???? ????????? 82%, ?? ??? ???????
?????????? ? 27% ?????????. ???????? ???????? ???? ??????? ????? ???????? ????
?????? ? 1 (7,7%) ???????? (p>0,05), ? ? 1 ???????? ???, ????????, ?????????. ? ????????? ? ????????? ? 94,9% ??????? ???????? ?????????? ????????? (?? ??? ????????? ????????? ?????? ? 91%) [17].
? 2010 ?. ?? ????? ? ??????????? ????????? ?????????????? ???????????? ??????????????? ??????? ????????? ?????????
???????? ? ???????? ???? (?????? ??
? 2480149). ?????????? ?????? ???????????????, ??? ?? ????? ????????? ??????? ????????????? ??? (???????????) ????????
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? ????????? ???? ?? ????? ???????, ???
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? 97% ??????? ?????????????? ????????? ????????? ??????, ???????????????? ????????? ?????? ?? ???????????? ??????, ??????? ????? (???. 6).
????????????? ????? ?? ???????????
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???. 6. ?????????? ???????????? ? ???????? ????????????? ????????? ? ????? ??????????? ???????. ????? ?
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??????? ? ???????? ?. ? ????????? ??????????? ????????
??????????? ?????????? ??????????????, ? 3, 2013
???. 5. ???????????? ??????????? ????????? ????????? ????? ??? ?????????? ????????? ?????? ?? ??????? ??
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2013
10
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? ??????????? ???????????? ??????, ??? ???????? ???????? ????? ???????? ????????? ????? (???. 7).
?????????? ????????, ??? ??? ????????? ????? ????? ?????????? ??????????????
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????????? ?????? ????????? ??????????? ????????????? ??????????? ? ?????????? ????????? ????????? ?????? (??? ?????????? ???????? ???????????) [18], ???????????? ???????? ? [19]. ??? ?????????
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[20, 21]. ??? ?????????????? ?????????? ????????-?????????? ??????? ???????? ?????
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?? ??? ????????? ????? ?????????? ?????????????????, ? ??? ????? ????????????. ????
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??????????????? [22?28].
?? ?????? ???? ???????, ??????? ????????? ??? ??????? ????????? ??????, ??????
??????? ?????? ????? ????? ??????????? ??
????? ? ??????? ?????? [29, 30]:
1) ???? ??????, ????????? ??????????????? ? ??????? ??????, ? ??? ????????? ????, ????????????? ?? ???????? ???????????
??????? ????????? ? ????????? ??????????????? ? ??????? ??????? ??????????;
2) ???? ??????, ????????? ? ????????
?????;
3) ???? ????????????????, ??? ??????????????? ????, ? ???????????? ????? ?????
????????? ???????? ??????, ??????? ?? ?????????? ?? ??????????? ??????, ? ?????????? ?? ??????????, ??????? ????? ? ??????? ?????????? ? ??????????.
? ?????? ???????? ?????? ???? ??? ??????, ??? ? ?????, ? ????? ? ??? ???????? ????
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????? ???? ??????? ???????? ?? 30% ????
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????? (???????????)
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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????? ????????? ?????? ????????? ??????????: ????? ???????? ????? ????????
56?60% ?????? ?????????? ?????????? ?????, ? ?????? ???? ?????????? ? ??????? ?????? 40% [31, 32].
????????? ???????? ? ???????? ??????
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? ???????? ?? ???? ???????? ??????????
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?????? ? ????????, ?????????? ???? ??????????? ???????? ????????, ????????? ????????? ???????????? ? ??????????? ????????????? ????????? ? ?????? [33].
?????? ????????????????? ??????????????? ????????? ??? ????????? ??????????
?????? ??????? ??????. ??????? ???? ?????????? ? ??????? ??????? ????????? ? ???????? ??????? ??? ? ?????? (???????? ???????,
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????????? ???????, ???????????, ?????????), ? ?????????? ???? ??????????? ???????? ???????? ????? ?????? ? ???????????
????????? [34, 35].
? ????? ????????????? ?? ??????? ????????, ??? ??????? ???????? ? ???????? ??????
???????? ?????????????? ?????????????? ?????? ????? ?? ???????? ?????? ?????????
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??? ????????????? ?? ????? ??????? ? ??????????? ?? ????? ???????? [37, 38]. ????????
????? ???????? ?????? ?????????? ????????????, ?????????????? ? ????????? ?????????????? ???????, ? ????????? ? ??????????? ????????, ??????? ?????????, ????????,
??? ????????? ??????. ????? ?? ???? ?????????? ?????????? ????????, ?????????? ????????? ???????????? [39].
11
? ???????????? ?? ??????? ????? ????????? ???????? ?? ???????? ????? ? ???? ???????? ?????? ???????? ? ???????? ?????????? ???????? ???????? ?????? ?? ?????????? ????????? ??? ???????. ????? 2?3 ?, ???
???????, ???? ????? ?????????, ?????? ?????? ?????? ?????????? ? ??????? ?????? ??????? ????????? ?? ?????? 1?2,5 ?? ??????????? ????? ????????????, ????? ?????????????? ?? ?????????? ?? ??? ???????????
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???? [39].
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? ?????? ??????? ?????? ????? ????????? [40].
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??????? ????????? ? ?????? ??????? ??????????????? ??????????? [41].
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????????? ????????? ????????????? ??????????????
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??????????? ?????????? ??????????????, ? 3, 2013
12
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?.?. ?????, ??.?. ????? (1995 ?.) [40].
????? ? ???????? ? ?????? ????????????
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??????? ???????????????? ? ???????? ????????? ?????? [39].
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? 60%, ?????? ??????????????? ???? ? ? 100
? 93%, ????? ??????????? ???? ? ? 100 ? 95%,
?????? ???? ?? ? ? 83 ? 41%, ????? ??????????? ???? ? ? 35 ? 26% ??????? ??????????????
[42]. ???????????? ???, ????????? ??????????????? ? ??????? ??????, ? ??? ?????????
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??????.
? ????????? ???? ????????? ??????, ??????????? ???????????? ????????????? ????????? ??????????? ??? ????????? ??, ????????? ????????? ?????? [43]. ??? ???????? ???????-???????????????? ??????????
?????????????? ???????? ???????????
(???) ?.?. ??????? ? ?????. ???????? ??? ???????? ?? ???????:
1. ????????????????? ??? ???????????????. ??????? ???? ?????? ????????????????? ???????????? ???????? ?????????
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?? ??? ???? ???????? ?????????? ?? ???.
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??????????? ? ???????????? ?????????????. ???????? ???????????? ???????? ???????? ??? ?????? ????????? ??????????
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? ??? ?????????? ? ????? ?? 20?30 ?? ???. ??.,
??????? ????? ?????????????? ? ??????????? ????????? ?????????? ???????? ? ???????? ????? ??????????? ????? ? ??????;
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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????, ???????? ?? ????????? ????????????? ????????;
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160?170 ?? ???. ??.;
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? ?????. (2003 ?.) ????????, ??? ??? ??????-
??? ?? ????????? ????????? ??????, ???????? ???????, ????????? ?????? ? ???????????? ??????????? ????????????? ????? ???????? ? ???????? ?????? ???????? [43].
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??????), ???????? ???????? ????, ????????????????, ??????? ? ??????? ?????????????
? ?????????? ????????? [17].
???????? ????? ???????? ???? ???? ????? ????? ???? ???????????? ?? ???????????????????? ??? ?????????????????? ??????????? (???. 8).
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?? 75?90╟. ??? ?????????? ???????? ???????????????????? ???? ???????? ??????. ???-
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????????? ????????? ????????????? ??????????????
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??????????? ?????????? ??????????????, ? 3, 2013
14
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??????? ???????? ??? ?? 2 ?? ?? ????????
? ?????? ????? ???? (???) ? ????? ?????????? 4?5 ??. ??? ???????? ???????????, ??????? ??????????? ??? ?????????? ????, ? ?????????????????? ??????? ??? ??????????? ??
1 ?? ? ?????. ?????????? ???????? ????????,
??????? ????? ?????????? ??? ???, ????? ????? ?? ? ??? ????? 3 ?? ??. ??.,
??? ?????????? ???? ???????? ???????? ?????
4 ?? ??. c?.
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??? ????? ??????????? ? ???? ????????????
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?????? ?????????????, ?? ? ????????? ????????. ????????? ?? ?????? ???? ????????
? ??????????? ????? ??????? ???????? ? ??????????? ? ??? ?????????????? ?????????????.
???? ????????? ??????? ????????????
?????? ????????? ???????? ????????? ???????? ??? ?????????????? ??????????????
? ??????????? ??? ????????? ? ???????????
???????? ??? (?????? ?? ? 2480149).
???????? ???????? ????? ???????? ? ????????, ???????????? ? ????????? ???? ?? ?????, ? ??????????? ????, ? ??????? ?????????????? ??????????????. ??????? ?????? ?????????? ? ?????????????? ????????? ??
???????. ?? ????? ??????????? ???????
?????????????? ??????? (??????? 12 ??).
?????????????? ?????? ????????????? ?? ???????? ??????? ? ???????? ????, ??? ????????
?? ????, ????? ??????? ????? ???????????????
????. ??????? ????? ????????? ????????? ????????? ? ???????????? ????????????? ???????-
??. ? ???????? ???????? ???? ????????????? ????? ? ???????? ????????, ?? 1 ?? ??????????
??? ?? 1 ?? ??????????? ?? (???. 9).
?????? ??? ?????????????? ????????
???????? ?? ??????????. ??? ???? ????? ?????????, ??? ?????????????? ?????? ??????????
??? ?????, ???? ????????? ???????? ?????????
??? ???????? ????? ? ??????? ????? ?? ???????
?????????. ?????? ?????? ???????? ? ???????
???????? ????????? ?????????, ? ????????
??? ???????????? ??? ??????????????. ?????? ?????? ????????????? ????, ??????? ????????? ??? ??????????????? ????????? ????????, ? ????????? ??? ????? ?????????? ???????? ?????????? ??????? ????????? ?????.
??? ?????????? ??????? ???? ??? ??????
???????? ????? ?????????? ??? ?????????????? ????? ????? ?????? ???????? ???.
??????????, ??? ?????????????? ??????
?????????? ??? ?????, ?????????? ?????????????? ???????, ??????????? ? ????????? ??????????, ?? ???????? 50?60 ?? ??. ??.
????? ????? ???????? ???????? ?????? ??
???????. ??? ???????? ???????? ? ???????
?? ???????? ????????? ???????? ? ???? ???
?????????????? ?????????????? ??????????
???????? ???.
?????? ????????? ????????? ???? ??? ???????????? ??????? ????????????? ????????
????????? ????????, ????????????? ?? ?????????. ? ????? ???????? ????????? ????????
?? ???????? ???? 18?23 ?? ??. ??. ??? ????????????? ??????? ????????? ???????? ??
???????? ????, ?????????? ????????????
????????, ? ?????????? ???????????? ????????? ????????, ??????????? ????????????
?????????? ????????, ??????? ??????????? ????????? 4,5.
?????????????
??????
???. 9. ????? ????????? ????????? ???????? ? ????????
???? ? ??????? ??????????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????? ????, ?????????? ???????????,
??? ???????? ??????? ???????? ?? ????? ????? ? ??????????? ??????????? ???????????????? ?????? ??????, ??? ????????????.
? ??? ?????????? ?????????? ???????? ?????????? ???????? ???? ????????? ?????????
?????? ? ???????????? ?????????, ??? ???
??? ????? ?????????? ??????????, ? ??????,
???????????????? ???????.
24.
25.
26.
27.
28.
29.
30.
31.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
???????? ?.?., ????????? ?.?. ?????????. ?.: ???????????; 2002.
???????? ?.?., ???????? ?.?., ????????? ?.?. ??? ?? ????? ??????????????? ???????? ?????????? ???????????
?????????? ??????????????. 2011; 3: 40?4.
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??????????? ?.?. ???????????? ?? ?????????? ????????? ?????. ?.; 1876.
????????? ?.?. ???????????? ????????? ??????????????
? ?????. ?.: ??????; 1963.
??????? ?.?. ????????????? ???????? ??????????? ??????? ????? ????????? ? ????? ? ?? ????? ? ???????? ???????. ? ??.: ????????? ?????????????? ??? ?????????? ????????? ?????. ?.; 1956: 254?71.
??????????? ?.?. ?????????? ????? ? ?????. ?.; 1951.
???????????? ?.?. ???????? ???????????????? ????????? ????????? ?????. ?.: ????????; 1989.
???? ?.?., ???????? ?.?. ????????????????? ?????????????? ???????????. ??????: ???????????? ??????????
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??????? ?.?., ???????? ?.?., ???????? ?.?. ? ??. ???????-???????????????? ??????????? ?????????????????
??????? ? ????????? ? ??????????? ???????? ?????? ? ?
????????????? ??????????? ?????????. ???????????
?????????? ??????????????. 2011; 2: 61?8.
??????? ?.?. ???????? ???????? ? ???????? ???????????????. ?. ????????: ???????????? ????????????? ??????????????? ??????????? ????????; 2003: 98.
??????? ?.?., ?????????? ?.?., ???????? ?.?. ? ??. ??????????? ???????????? ???????????? ? ???????? ????????? ? ????????? ???????? ?????????????? ???????????.
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?????? ?.?. ???????? ???. ?.: ????????; 1974.
????????? ?.?. ???????? ??????????? ???????. ?.: ????????; 1970.
???????? ?.?. ???????? ??????? ???????? ? ??????????
? ?????????. ??????? ?????????. 1926; 39.
???????? ?.?. ???????? ????????: ? ??.: ??????? ??????
??????????? ????????????? ??????????????? ???????
?????????????? ???????????? ?????????. ?.; 1939; 3.
32.
33.
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15
????????? ?.?. ???????? ??????? ????????. ?.; 1947.
????????? ?.?. ?????? ???????. ?.: ????????; 1971.
??????? ?.?. ???? ?????????? ????????. ????? ????????, ?????????? ? ???????????. 1941; 28 (1): 3?37.
????? ?.?., ????? ?.?., ????????? ?.?. ??????????? ?????? ?????? ? ????? ? ?????????. ?.; 1954.
???????? ?.?. ???????? ??????????????. ?.: ????????;
1979: 202.
?????????? ?.?. ???? ?????? ? ???????? ?? ????????.
? ??.: ????? 2-? ?????????? ??????????? ????????,
??????????, ???????????. ???????; 1958: 193?4.
????? ?.?. ?????? ??????????? ???????? ??????: ??????? ???????. ???. 2-?, ???. ????????; 1999: 62.
?????? ?.?. ????????? ?????????? ??????? ? ?????????
???????? ?????????? ??????????? ??????: ???. ... ?-??
???. ????. ?.; 1956.
?????????? ?.?. ???? ?????????? ??????? ? ??????????
??????????? ????????? ???????????????. ????????? ????.
1963; 3: 81?3.
???????? ?.?., ??? ?.?., ??????? ?.?. ????????? ??????????????? ???????? ??????? ??? ??????????? ???????????? ??????. ??????. 2009; 8 (1): 28?31.
??????? ?.?., ??????? ?.?., ???????? ?.?. ? ??. ??????????? ???????? ???????? ? ?????? ??????? ?????? ? ????????? ????????????????? ??????? ? ?????????, ?????????? ????????????? ? ???????? ??????????????
?????????????? (????????????????? ???????????????
? ??????? ??????????????, ?????? ?? ????????). ??????????? ?????????? ??????????????. 2011; 2: 78?81.
???????? ?., ?????? ?., ???? ?. ?????????????? ???????. ?.: ????????; 1967.
???????? ?.?. ??????????? ? ??????????????? ????
?????????? ? ????????? ?????. ??????????????? ??????
????. 1985; 71 (4): 510?6.
??????? ?.?. ??????????? ????????? ?????? ?? ??????????? ??????. ?????????????? ? ?????????? ???????? ???????? ??????? ????????. ?.: 1969; 139.
???????? ?.?. ??????????? ??????. ?.: ????????; 1990.
???????? ?.?. ??????????????? ????????? ? ??????
??? ????????? ????????? ??????. ??????? ????????
??. ?.?. ???????. 1964; 2: 33?40.
???? ?.?., ???? ??.?. ?????????? ? ?????????????? ???????? ???????. ?.: ????????; 1995.
Gold F.L., Bache R.J. et al. Transmural right ventricular blood
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??????? ?.?., ????????? ?.?., ?????????? ?.?. ? ??. ????????????????? ???????????? ?????? ??????????? ???
?? ??????????? ??????????? ?????????? ???????? ??????? ??????. ??????? ? ????????-?????????? ????????. 2010;
3: 21.
??????? ?.?. (???.) ???????? ??????????. ?. ????????:
???????????? ????????????? ??????????????? ??????????? ????????; 2003: 6?13.
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╘ ????????? ???????, 2013
??? 616.831:612.134]-005-073.432.19
??????????????? ??????????????????? ?????? ????????????
???????? ???????????? ??? ????????? ????????? ?????????
?????? ????? ?? ?????
?.?. ???????1, ?.?. ????????1, ?.?. ??????????2
1????
??????? ???????? ????????, ?????? ???. ????, ?????????, ?????????? ???????? ??????????????,
?????????????? ? ?????????????? ???????????; e-mail: kulikov57@mail.ru;
???????? ????????? ??????????, ???????? ???. ????, ????????? ??????? ??????????????, ??????????????
? ?????????????? ???????????;
?????????? ???????? ????????, ?????? ???. ????, ?????????, ?????????? ???????? ??????? ???????????
???? ???????????? ? ???????? ???????? ? ???????????? ???????? ??????? ?? ???????????????? ? ??????????????? ??????????? ? ????????? ? ????????????? ? ????????-????????????? ?????????? ???????????? ???????? ?????????????.
???????? ? ??????. ???????? ?????????? ???????????? ???? ????????? ? 35 ?????????
? ?????? ???????-???????? ??????? ? ????????????? ????????? ???????? ?????????????
(?????? ???), ? 30 ????????? ? ?????????? ??????? ?????? ????????????, ????????? ??????????? ??????? ? ????????-????????????? ????????? ???????? ????????????? (??????
???), ? 45 ???????????? ??? ????????? ???????? ????????????? (?????? ????????). ??????? ??????? ???????? ????????? (Vmean, ??/?) ?? ????? ? ???????????? ? ?????????? ????
??????? ? ??????? ???????? ??????? (???) ? ????????? ???? (??), ? ????? ? ??????????? ??????? (??) ? ??????????? ???? (??). ??? ?????? ??????? ????????? ?? ????? ????????? ?????? ???????????? (??) ??? ????????? Vmean ??? ????? ? ????????? ???????? Vmean.
??????????. ??? ??????????? Vmean ?? ? Vmean ??? ?????????????, ?? ? ???????? ???????? ??????? ???? ??????? ??????, ????? ??? ? ??????? ??? ? ??? ??????????????? ??????? ???????????? Vmean ?? ???????????. ??????? ????????? ????????? ?? ???????? ?????????????????
???????????? ????????? Vmean ?? ? Vmean ???, ?? ??????????? ?????? ???, ??? ???????? ??????? ???? ?????? ????????????. ?? ???? ??????? ??? ??????????? Vmean ?? ?????????? ?? ??????????, ? Vmean ?? ???????????, ?????? ? ?????? ??? ??????? Vmean ?? ??? ??????. ???????
Vmean ?? ??? ???????? ? ???????? ?? ???? ??????? ????????????????? ?????????? ?????????,
????? ??? Vmean ?? ? ???????????? ????????? ??????? ?? ??????????, ?? ??????????? ??????
???, ??? Vmean ?? ???????????.
??????. 1. ??????? ????????? ? ????????? ???? ? ???????? ??? ?????? ? ???????????? ? ?????????? ?????????????? ? ???????? ????????? ? ??????? ???????? ???????, ?? ??????????? ?? ?? ???????????? ??? ??????????? ? ?? ??????????? ? ??? ??? ?????????. 2. ???????
????????? ? ??????????? ??????? ? ??????????? ???? ??? ?????? ? ???????????? ? ?????????? ? ???????? ???????????????, ??? ?????????? ??????????? ????????????? ????????? ??
??????????? ? ????????? ????????? ??? ?????????. 3. ??? ????????????? ???????? ???????? ????????????? ??????? ????????? ? ????????? ???? ??????? ??? ???????????, ?? ??????????? ??? ???????????? ??????? ? ?????????. 4. ??????? ???????? ????????? ? ???????????
??????? ?? ??????????? ??? ????????????? ???????? ???????? ????????????? ??????, ???
? ????????, ? ??? ????????-????????????? ???????? ???????? ???????? ????????? ? ????????? ??????, ??? ? ????????.
???????? ?????: ???????? ??????????????; ???????????? ???????? ?????????????;
?????????????????? ????????????; ???????????; ????????.
INFORMATIVITY OF DOPPLEROGRAPHIC EVALUATION OF CEREBRAL VENOUS REACTIVITY
IN DIFFERENT TYPES OF DISTURBANCES OF VENOUS BLOOD OUTFLOW FROM THE BRAIN
V.P. Kulikov1, M.L. Dicheskul1, S.I. Zhestovskaya2
1Altai
State Medical University, Ministry of Health of the Russian Federation,
prospect Lenina, 40, Barnaul, 656038, Russian Federation;
2Prof. V.F. Voyno-Yasenetskiy Krasnoyarsk State Medical University, Ministry of Health
of the Russian Federation, ul. Partizana Zheleznyaka, 1, Krasnoyarsk, 660022, Russian Federation
??????????? ?????????? ??????????????, ? 3, 2013
??? ╚????????? ??????????????? ??????????? ???????????╩
???????????? ??????????????? ?????????? ?????????,
??. ??????, 40, ???????, 656038, ?????????? ?????????;
2???? ??? ╚???????????? ??????????????? ??????????? ???????????
??. ????. ?.?. ?????-??????????╩ ???????????? ??????????????? ?????????? ?????????,
??. ????????? ?????????, 1, ??????????, 660022, ?????????? ?????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
18
????????? ????????? ????????????? ??????????????
??????????? ?????????? ??????????????, ? 3, 2013
Kulikov Vladimir Pavlovich, MD, Professor, Head of the Chair of Pathophysiology, Functional and Ultrasound Diagnostics;
Dicheskul Margarita Leonidovna, Cand. Med. Sci., Assistant of the Chair of Pathophysiology, Functional and
Ultrasound Diagnostics;
Zhestovskaya Svetlana Ivanovna, MD, Professor, Head of the Chair of X-ray Diagnostics
Objective. To compare venous and arterial cerebral response to hypercapnic and orthostatic impact
in patients presented with dystonic and congestive-hypoxic variants of cerebral venous insufficiency.
Material and methods. Color duplex scanning was performed at 35 patients presented with mild
head injury, i.e. dystonic variant of venous insufficiency (MHI group); at 30 patients presented with
cervical spine pathology, vertebral artery syndrome, i.e. congestive-hypoxic variant of venous insufficiency (CSP group); at 45 volunteers without symptoms of venous circulatory failure (control normal group). Response of mean blood velocity (Vmean, cm/sec) to tests with hypercapnia and
orthostasis was investigated in middle cerebral artery (MCA) and basal vein (BV) as well as in vertebral artery (VA) and vertebral vein (VV). In order to measure blood flow response to tests the index of
reactivity (IR) was calculated as Vmean-under test to initial value-Vmean ratio.
Results. In the presence of hypercapnia Vmean BV and Vmean MCA were increasing but in normal group
venous response was significantly greater while in CSP group and MHI group the arteriovenous
responsive indexes Vmean did not differ. Cerebral circulation response to orthostasis was characterized by comparable decreasing Vmean BV and Vmean MCA, to the exclusion of MHI group in which venous
response was greater than arterial one. In all groups in the presence of hypercapnia Vmean VV did not
changed positively, and Vmean VA increased, but in MHI group the increase of Vmean VA was less. In all
groups response of Vmean VV when transferring to orthostasis was characterized by manifested
increase, while Vmean VA in upright standing posture did not change significantly, to the exclusion of
CSP group in which Vmean VA decreased.
Conclusion. 1. In normal group circulation response in basal vein using tests with hypercapnia and
orthostasis is unidirectional with circulation response in middle cerebral artery but it is more manifested under hypercapnia and did not differ from it under orthostatic test.
2. In normal group circulation response in vertebral artery and vertebral vein under tests with hypercapnia and orthostasis is of different directions and manifested in increasing of arterial circulation in
response to hypercapnia and venous circulation under orthostatic test.
3. In the presence of dystonic variant of venous insufficiency circulation response in basal vein
decreased under hypercapnia but prevailed over arterial response under orthostasis.
4. Circulation velocity increase in vertebral artery in response to hypercapnia in the presence of dystonic variant of venous insufficiency was less in comparison with normal group and in case of congestive-hypoxic variant the circulation velocity under orthostasis is slower in comparison with normal
group.
Key words: cerebral circulation; cerebral venous insufficiency; cerebrovascular response; hypercapnia; orthostasis.
????????
?? ???????? ???????? ????????????????
??????????? ?????? ????????????? ? ????????? ?????????, ? ??? ????? ???????????????
???????????? [1]. ?????? ???????????? ???????????? ???????? ??????? ????????? ?????
????????????? ???????????? ??????????.
??? ???? ????????, ??? ??? ????????? ????????? ?????? ?????????? ????????????
???????? ??????? ? ???????????? ???????????? ??????, ???????? ????????????????
????????, ? ???????? ???????? ????????????? ??????? ????????? ?????????????? [2].
? 1991 ?. R. Aaslid ? ?????. ??? ??????????
???????????????? ?????????????? ???????
???????? ??????????? ??????????? ????????? ? ?????? ?????? [3]. ???????, ? 1996 ?.,
J.M. Valdueza ? ?????., ????????? ????????
???????????????? ?????????? ????????????,
???????????????? ?????? ? ???????? ???????? ????????? ? ?????????????? ? ????????? ????? (??) [4]. ?? ?????? ?????? ?????-
??? ??????? ????? ??????? ?????????? ????????. ??????? ???????? ???????????????
???????????? ???????? ??? ? ???????, ?????????? ??????? ?? ???????, ? ??? ????? ? ??????????? ?? ???????? ? ????, ???????????
?????????? ???????? ??????????? ?????????
? ???????????????? ????? ? ??????? [5, 6].
?????? ? ??? ???????????? ?????? ?? ????????????? ?????????????? ?????? ??? ??????
??????? ????????? ????????? ????? ??????????????? ? ?????????????? ???????? ???????? ???????????? ???????? ????????????
??????????.
????????, ??? ??? ??????????????? ?????
??????????? ???????? ???????? ?????????
(???) ? ????????? ????????? ????????? ????????? ????????? ? ?????? ?????? ?????,
? ??? ????????????? ??? ?? ????????? ?????????, ? ??? ????????????????? ?????????????? ??????????? ????????? ?????????
????????? ??????????? [7, 8]. ????????????
??????? ???????? ??????? ????? ?? ?????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
?????? ????? ????? ???? ?????????????
??? ??????????? ???????? ?????????????.
????????, ??? ??? ?????????????? ????????? ????? ??? ???????? ??????????? ?????????? ???????? ??????, ? ????? ???????
?????????? ?????????? ??????? ????????
???????? ????????????.
???????? ????????????? ?.?. ????????????? (1989 ?.), ??????? ??? ???????? ???????? ?????????????: ?????????????
? ????????-????????????? [9]. ???????????? ???????? ????????????? ???? ????????
??????????? ???????????, ??????????
? ????????? ????????? ??????, ? ?? ??????????????? ????????????. ??????????????? ??????????? ????????? ???? ???????
?????? ?? ??????? ??????????????? ? ???????????????? ?????????????, ??? ?????????? ???????? [1, 10, 11]. ??-????????
??????????? ???????? ? ??????????? ??????? ????????? ? ????????????? ?????????
?? ?????????????? ?????, ??? ?? ????????? ? ?????? ???? ???????????????? ??????????????????? ?????????????? ?????????????. ????? ????????? ?????? ???? ????????? ???????? ? ???????????? ????????
??????? ?? ???????????????? ? ??????????????? ??????????? ? ????????? ? ????????????? ? ????????-????????????? ????????????????? ?????????? ???????????? ???????? ?????????????.
???????? ? ??????
???????? ?????????? ???????????? ??????????????? ??????? ???? ????????? ? 35 ????????? (?? ??? 15 ?????? ? 20 ??????
? ???????? 26╠6 ???) ? ?????? ???????-???????? ??????? (?????? ???) ? 30 ????????? (??
??? 17 ?????? ? 13 ?????? ? ????????
36╠13,5 ????) ? ?????????? ??????? ??????
???????????? ? ???????????? ????????????, ???????????? ??? ???????? ??????????? ??????? (?????? ???). ?????? ????????? ???? ??????? ? ????? ? ???, ??? ??? ????? ?????????????? ?????????? ????????
???????????? ?????????????? ?? ?????????????? ? ????????-?????????????? ????????.
??? ????????? ???? ??????????? 45 ???????????? (25 ?????? ? 20 ?????? ? ????????
32╠12 ???) ??? ????????? ???????? ????????????? (?????? ????????). ??? ?????????
???????????? ???????????? ??????????????? ????????, ? ???? ???????????? ???? ???????? ????????? ????????? ?????????? ???????????????? ???????????? ????????????.
19
???????????? ????????? ??? ??????
?????????????? ??????? Vivid-3 Pro (GE,
???). ????????? ????????? ? ???????????????? ??????? ??????? ????????? ???????????? ???????? ? ???????? 2,5?3,6 ???,
??? ?????? ????????????????? ??????? ???????????? ???????? ?????? 6?10 ???.
??? ?????????? ???????????? ???? ??????????? ??????????? ?????????? ?? ???????
???????, ???????? ????? ? ????????? ????
????????????. ??????? ????????? ? ????????????? ????????? ?? ????????????????
? ??????????????? ????? ???? ??????? ??
???????????????? ?????? ? ????????? ????
? ??????? ???????? ??????? (???), ? ??
????????????????? ?????? ? ? ??????????? ???? (??) ? ??????????? ??????? (??).
?????????????? ??????????? ?? ???????
???????????? ???????? ????????? (Vmean,
??/?). ?? ???? ??????? ????????? ??????????? ? ?????? ? ????? ???????, ? ???????????? ????????, ? ?????? ? ??????? ?????????????? ???????????. ?????????????
???????? ?????????? ?? ?????? ?5??6 ???????? ??????.
??? ???????? ??????????? ? ??????????? ????????? ??2 ? ???????????? ???????
(PetCO2) ?? ?????? ????? 6% ????????????
??????????? ?????? ╚????????╩ (??????)
[12]. ??? ???????? ??????? ????????? ?? ???????? ????????? ???????????????? ????? ???????. ?????????? ????????? ????????? ? ????????? ???????? ????, ????? ??????? ?????????????? ???????? ?????????
????. ???????????? ????????? ?????????
????????????? ????? 1 ??? ????? ?????????
???????? ? ???????????? ????????? [13].
?????? ??????? ?????????? ?? ??? ?????????????? ????? ???? ????????? ????? ??????? ??????? ???????????? (??, ???. ??). ????????? ????????? ?????????? ????????? ??
???? ?????????????? ????? ? ??? ????????? ????????.
?????????????? ????????? ? ?????? ?????????? ?????? ????????? ? ??????? ??????????????? ?????? Statsoft Statistica 6.0 for
Windows. ???????????? ?????????? ??? ?????????????? ?????? ???????????? ? ???? ????????
???????? ? ???????????? ?????????? (?╠SD).
??? ??????? ????????? ??????????? ?? ?????????????? ????? ???????????? ????????
??????????, ??? ????????? ???????????, ?????????? ? ???????, ? ???????? ???????????????? ? ???????????. ??????? ?????????????? ?????????? ??????? ??????? ? < 0,05.
??????????? ?????????? ??????????????, ? 3, 2013
????????? ????????? ????????????? ??????????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
20
????????? ????????? ????????????? ??????????????
??????????? ?????????? ??????????????, ? 3, 2013
?????????? ? ??????????
???????????????? ???????. ??? ???????????????? ????? ?? ???? ??????? ???? ???????????????? ?????????? ??????? ??? ??? ? ????????? ????, ??? ? ??????? ???????? ???????.
? ??????????? ?????? ??????? ??????? ???
? ?? ??? ??????? ? 100% ???????, ? ? ??? ?
? 92% ???????, ? ?????? ??? ??????????????
? 94 ? 76% ???????, ? ? ?????? ??? ? ????? ??????? ??????? ??? ??????????? ? 87% ???????.
???????? ??????? ??2 ?? ???????????? ????????, ?????? ??????? ??? ? ??? ???? ????????. ??????????????? ??????? ??????????? ???????? ??????? ? ????????, ?????????? ?? ???????? ???????? ???????????,
????????? ???????? ????????, ?????????? ??????? ???????? ???????? ???????? ??????????
?????????????? ? ?????????? ????????? ????????? [14]. ???????? ????????-????????????
???????? ???????? ???????? ? ??????? ??????,
??????????? ??????????? ???????????????
???????? ? ?????????? ???????? ?????????
??????, ??? ?? ? ?????????. ?????? ???????
??????? ???????? ????????? ? ????????? ????
? ????????? ? ??? ??? ??????? ??????, ???
? ??????????? ??????, ??? ?????????????????
? ???????? ????????? ??????? ?? ???????????
? ?????? ??????.
??? ????????? ??????? ?????????????
? ????????? ????? ?? ??????????? ?? ??????????? ??????? ???????????? (??) ? ??
? ???. ? ??????????? ?????? ???????? ??????? ???????????? ?? ???????????? ???????????? (???? = 1,49╠0,3; ????? = 1,37╠0,4
??? ?<0,05), ????? ??? ? ?????? ??? (???? =
=1,30╠0,3; ????? = 1,37╠0,4) ? ?????? ???
(???? = 1,30╠0,3; ????? = 1,32╠0,3) ?????????????? ???????? ?? ??????? ???????? ???????????? ? ???????? ??????? ??? ?? ????.
??????????????? ????? ??????????????
????????? ??????? ??? ? ????????? ????
? ??????? ???????? ???????, ??? ???? ??????????? ??? ? ??????????? ?????? (80 ? 62% ??????? ??????????????), ???
? ? ????? ??????????? ??????? (75?80%
? 70% ??????? ??????????????). ????????
? ???????????? ????????? ????????????????? ???????? ????? ? ??????? ???????? ???????? ??? ????????? ???? ??????? ????????
? ?????????? ??????? ????? ? ????? ? ????????????? ???????? ? ???? ????? ? ?????? ????????. ??? ????????? ?????????? ???????????, ???, ? ???? ???????, ???????? ? ????????? ????????? ????????????, ??????????
?????? ?????????????? ???????, ??????? ????????????? ???????? ? ?????????????? ??????? ????? ? ?????. ?????????? ????????????? ????????? ?????? ??? ????????? ??????????? ??????????? ????????????? ???????.
????????? ? ????????? ????????????? ?????
?????? ???????????? ???????? ?????????????? ?????????? ????? ???????????? ? ???????? ???????? ??????????.
??? ????????????? ??????? ???????????????? ??????? ? ?? ? ??? ???? ???????????, ??? ??????? ???????? ??????? ???
? ??????????? ?????? (???? = 0,89╠0,2;
????? = 0,92╠0,1) ? ?????? ??? (???? =
= 0,87╠0,2; ????? = 0,84╠0,2) ?? ???????????, ????? ??? ? ????????? ?????? ??? ???????? ??????? ???????????? ?? ???????????? ???????????? (?? ?? = 0,86╠0,2;
????? = 0,92╠0,1 ??? ?<0,05), ??? ????????????????? ? ????????? ???????????? ????????? ????????????? ????????? ??????.
????????????????? ???????. ??? ???????????????? ????? ??????? ??? ? ???????????
??????? ??????????? ? 75,5% ???????? ?????????? ? ? 81% ????????? ?????? ???, ?????
??? ? ?????? ??? ? ?????? ? ???????? ?????????. ? ??????????? ???? ??????? ??? ???
??????????? ?????????? ?? ?????????? ??
???? ???????, ??? ??? ? ???????? ??????????
??? ???????????, ? ? ?????? ???????? ?
???????????. ???????? ??????? ??? ? ????????????? ??????? ?? ??????????? ????? ??????????? ??????? (???? = 1,25╠0,3; ???? =
=1,09╠0,5) ? ??????? ??? (???? = 1,29╠0,3;
???? = 1,12╠0,5), ????? ??? ? ?????????
? ??? ??????? ??????? ??? ? ???????????
??????? ??? ????????????? ??????, ?? ? ??????????? ???? ?? ?????????? ?? ?????????
? ?????????? ???? ?????? ????? (???? =
=1,06╠0,3; ???? = 1,09╠0,4).
??????? ?????????????? ????????? ????????? ??? ???????? ? ???????? ????????????????? ?????????? ????????? ??????? ???,
??????? ?????????? ? 92?94% ??????? ? ?????? ??????, ????? ??? ? ??????????? ???????
??????? ???????? ????????? ? ????????????
????????? ??????? ?? ??????????, ?? ??????????? ?????? ???, ??? ? ???????????
????????? (69%) ??? ???????????. ???????
???????????? ????????????? ??????? ?? ????? ? ?????????? ?? ??????????? ????? ??????????? ??????? (???? = 1,04╠0,2; ???? =
=3,11╠1,5) ? ??????? ??? (???? = 0,99╠0,3;
???? = 2,93╠2,4). ? ?????? ??? ????????
??????? ???????? ??????? (2,89╠1,7) ????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????? ????????? ????????????? ??????????????
9.
10.
11.
??????
1. ??????? ????????? ? ????????? ????
? ???????? ?????????? ??? ?????? ? ???????????? ? ?????????? ?????????????? ? ????????
????????? ? ??????? ???????? ???????, ?? ??????????? ?? ?? ???????????? ??? ???????????
? ?? ??????????? ? ??? ??? ?????????.
2. ??????? ????????? ? ??????????? ??????? ? ??????????? ???? ??? ?????? ? ???????????? ? ?????????? ? ???????? ???????????????, ??? ?????????? ??????????? ?????????????
????????? (??? ?????????? ????????? ?? ??????? ?????????) ?? ??????????? ? ???????????
????????? ????????? (??? ?????????? ????????? ?? ??????? ?????????????) ??? ?????????.
3. ??? ????????????? ???????? ????????
????????????? ??????? ????????? ? ????????? ???? ??????? ??? ???????????, ?? ??????????? ??? ???????????? ??????? ? ?????????.
4. ??????? ???????? ????????? ? ?? ???
?????? ? ???????????? ??? ?????????????
???????? ???????? ????????????? ??????,
??? ? ????????, ? ??? ????????-????????????? ???????? ???????? ???????? ?????????
? ????????? ??????, ??? ? ????????.
12.
13.
14.
References
1.
2.
3.
4.
5.
6.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
??????? ?.?., ?????????? ?.?., ???????? ?.?. ????????? ????????????? ????????? ?????????????? ? ???????
? ????????-?????????? ?????????? (???????? ????, ??????, ??????????????). ?.: ??????? ????? ????????-?????????? ???????? ??. ?.?. ???????? ?????????? ???????? ??????????? ????; 2003.
???????? ?.?., ????????? ?.?. ??????????? ?????????????? ??????????? ????????? ????????? ??????. ??????????? ?????????? ??????????????. 2009; 3: 21?9.
Aaslid R., Newell D.W., Stooss R., Sorteberg W., Lindegaard K.F.
Assessment of cerebral autoregulation dynamics from simultaneous arterial and venous transcranial Doppler recordings in
humans. Stroke. 1991; 22 (9): 1148?54.
Valdueza J.M., Schmierer K., Mehraein S., Einhaupl K. Assessment of normal flow velocity in basal cerebral veins. Stroke.
1996; 27 (7): 1221?5.
Schreiber S.J., Stolz E., Valdueza J.M. Transcranial ultrasonography of cerebral veins and sinuses [review]. Eur. J. Ultrasound.
2002; 12 (16): 59?72.
Stolz E., Kaps M., Kern A., Babacan S.S., Dorndorf W. Transcranial color-coded duplex sonography of intracranial veins
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Stroke. 1999; 30 (5): 1070?5.
???????? ?.?., ???????? ?.?. ???????????? ?????? ????????? ?????????????? ?????, ??????????????? ? ??????????????????? ???????? ??????????? ??? ????????????.
??????????? ?????????? ??????????????. 2009; 3: 5?15.
Mosso M., Schmid-Priscoveanu A., Straumann D., Baumgartner R.W. Absence of gravity-dependent modulation of straight
sinus flow velocity in healthy humans. Ultrasound Med. Biol.
2008; 34 (5): 726?9.
???????????? ?.?. ???????? ???????????????? ????????? ????????? ?????. ?.: ????????; 1989.
?????? ?.?., ????? ?.?., ??????? ?.?., ????? ?.?. ??????????????? ?????????????: ???????-???????????????? ???????, ?????????????, ???????????. ?????????:
??????????? ??????????????? ???????????; 2010.
???????? ?.?., ??? ?.?., ?????? ?.?., ??????? ?.?. ?????? ???????? ???????????? ? ????????? ? ?????????????? ??????????? ????????????? ??????? ??? ?? ?????? ??????????????? ????????????. ??????????????
? ?????????????? ???????????. 2002; 4: 60?5.
??????? ?.?., ???????? ?.?., ?????? ?.?. ?????????????
?????????? ? ???????????????? ????????? ? ????????????
???????????? ??????????? ????????? ????? ? ????????????. ??????? ????????????????? ????????. 2008; 2: 59?61.
????????? ?.?. ??????????. ?????? ???????? ???????.
?.: ?????; 2010. Available at: http://md-portal. ru/catalog/stat/1330_stat.html
Ringelstein E.B., Sievers C., Ecker S., Schneider P.A., Otis S.M.
Noninvasive assessment of CO2-induced cerebral vasomotor
response in normal individuals and patients with internal
carotid artery occlusions. Stroke. 1988; 19 (8): 963?9.
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Bockeria L.A., Buziashvili Yu.I., Shumilina M.V. Cerebral
venous circulation insufficiency in patients with cardiovascular
pathology (headache, ischemia, arteriosclerosis). Moscow:
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of
Russian Academy of Medical Sciences; 2003 (in Russian).
Shumilina M.V., Gorbunova E.V. Complex diagnostic ultrasonography of venous outflow failure. Klinicheskaya Fiziologiya
Krovoobrashcheniya. 2009; 3: 21?9 (in Russian).
Aaslid R., Newell D.W., Stooss R., Sorteberg W., Lindegaard K.F.
Assessment of cerebral autoregulation dynamics from simultaneous arterial and venous transcranial Doppler recordings in
humans. Stroke. 1991; 22 (9): 1148?54.
Valdueza J.M., Schmierer K., Mehraein S., Einhaupl K. Assessment of normal flow velocity in basal cerebral veins. Stroke.
1996; 27 (7): 1221?5.
Schreiber S.J., Stolz E., Valdueza J.M. Transcranial ultrasonography of cerebral veins and sinuses [review]. Eur. J. Ultrasound.
2002; 12 (16): 59?72.
Stolz E., Kaps M., Kern A., Babacan S.S., Dorndorf W. Transcranial color-coded duplex sonography of intracranial veins
and sinuses in adults: reference data from 130 volunteers.
Stroke. 1999; 30 (5): 1070?5.
Shakhnovich A.R., Shakhnovich V.A. Non-invasive evaluation of
cerebral venous circulation, liquor dynamics and craniovertebral
dimensional ratios in the presence of hydrocephalus. Klinicheskaya Fiziologiya Krovoobrashcheniya. 2009; 3: 5?15 (in Russian).
Mosso M., Schmid-Priscoveanu A., Straumann D., Baumgartner R.W. Absence of gravity-dependent modulation of straight
sinus flow velocity in healthy humans. Ultrasound Med. Biol.
2008; 34 (5): 726?9.
Berdichevskiy M.Ya. Cerebral venous insufficiency. Moscow:
Meditsina; 1989 (in Russian).
Belova L.A., Mashin V.V., Nikitin Yu.M., Belov V.G. Hypertonic
encephalopathy: clinical-pathogenic subtypes, classification, diagnostics. Ul?yanovsk: Ul?yanovsk. Gos. Univ.; 2010 (in Russian).
Kuntsevich G.I., Dan V.N., Timina I.E., Burtseva E.A.
Assessment of venous hemodynamics in patients presented
with occlusive lesions of main cervical arteries according to
ultrasound diagnostics. Ul?trazvukovaya i Funktsional?naya
Diagnostika. 2002; 4: 60?5 (in Russian).
Kulikov V.P., Bespalov A.G., Yakushev N.N. Efficacy of training
with hypercapnic hypoxia in rehabilitation of cerebral
ischemic injury under experiment. Vestnik Vosstanovitel?noy
Meditsiny. 2008; 2: 59?61 (in Russian).
Nikiforov A.S. Neurology. Complete defining dictionary.
Moscow: EKSMO; 2010. Available at: http://md-portal.
ru/catalog/stat/1330_stat.html
Ringelstein E.B., Sievers C., Ecker S., Schneider P.A., Otis S.M.
Noninvasive assessment of CO2-induced cerebral vasomotor
response in normal individuals and patients with internal
carotid artery occlusions. Stroke. 1988; 19 (8): 963?9.
????????? 05.09.2013
??????????? ?????????? ??????????????, ? 3, 2013
??????????? ? ???? ? ???? ?????? ???????,
?????? ???? (0,96╠0,4) ??? ??????????
??????, ??? ? ??????????? ??????, ??? ????????????????? ? ????????? ????????????
???????????????? ??????? ? ????????? ???????????? ????? ? ????????????? ????????.
21
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
22
????????? ????????? ????????????? ??????????????
╘ ?.?. ????????, 2013
??? 616.831: 612.134-053.2-07-08
???????????? ???????? ????????. ??????? ?????, ?????????,
??????????? ? ??????? ????????. ??????????? ??????? ?????????
? ???????????? ????????
?.?. ????????
???? ??? ╚?????????? ???????????? ????????????????? ??????????? ???????????
??. ?.?. ????????╩ ???????????? ??????????????? ?????????? ?????????,
??. ?????????????, 1, ??????, 117997, ?????????? ?????????
???????? ?????? ?????????, ???????? ???. ????, ?????????? ???????????? ??????????????????
????????? ???????? ????????; e-mail: de_mar@bk.ru
????????? ???????????? ???????? ???????????? ?????? ???????? ???? ? ???????? ?????????? ????????? ?????, ?? ??? ????????? ?? ???????? ??? ???????????? ?????? ????????????? ??? ?????????? ???????? ? ?????????????? ?????????? ??????????? ???????.
?????????? ? ????????? (??????? ???????????????? ??????????????) ?????????? ???????????? ???????? ???????? ????????? ?? ???????? ????? ?????: ??????? ????????? ??????,
???? ??????, ??????????? ???????, ??????? ????? ? ????? ????????? ?????????? ????? ? ??
1,5 ???? ?? 18 ???. ???????????? ?????????? ???????????? ???????????? ???? ?????????
? ???????? ??????????????? ????? ? ??? ?????????????? ?????????. ????????? ????????????? ???????????? ???? ??????????, ????- ? ??????????????????? ? ???????????????? ???
????????? ???????? ????????.
???????? ?????: ???????????? ???????? ????????????; ????; ???????????????? ?????????????? ??????????????; ?????????????? (???????????) ?????.
CEREBRAL VENOUS BLOOD FLOW. CONCEPTS OF NORMALITY, PATHOLOGY AND DIAGNOSIS
IN CHILDHOOD. PARTICULARITIES OF MANAGEMENT OF PATIENTS IN THE OUTPATIENT SETTING
M.F. Abramova
??????????? ?????????? ??????????????, ? 3, 2013
N.I. Pirogov Russian National Research Medical University,
ul. Ostrovityanova, 1, Moscow, 117997, Russian Federation
Abramova Marina Fedorovna, Cand. Med. Sci., Head of Laboratory of Child Cerebrovascular Disorders
Disturbances of cerebral venous hemodynamics define development of vascular pathology of a
brain in many respects. However directed by the diagnosis and subsequent treatment these disturbances are not considered.
The absence of diagnostics algorithm and norms of cerebral venous blood flow limits the possibility
of timely therapy at children.
The data of a blood flow velocity (maximum linear) in deep cerebral veins of a brain: in straight
venous sinus, great cerebral vein of Galen and sinuses cavernous in children in different age groups
from 1,5 to 18 years are defined and added by Transcranial Doppler and Color-Coded Duplex (TCD,
TCCD).The research of parameters of a cerebral hemodynamics was carried out in the conditions of
functional rest and after dynamic tests. We suggest modified tests in children: Valsalva?s test,
orthostasis test and head-down tilting (anti-orthostasis test). Comparison of classical and modified
functional tests has been done.
Key words: cerebral venous hemodynamics; children; transcranial Doppler; functional (dynamic) tests.
???????????? ??????? ??? ????????????
?????????? ????????? ?????????? ? ???????
? ????????? ????????. ??? ? ????????? ????????????? ???????? (?? ??????????? ????????????? ???????? ?? ???????????? ??????????? ? ??????? ???????????? ?????????),
? ??????? ???????????? ???????? ??????????? ????? (??????????, ???????? ????????
??????????????? ???????), ? ???????-???????? ?????? (? ?? ?????????????). ????????
??????? ??????????? (??????????????, ???????????????), ????????? ????? ???????
? ???????????? ????????? ???????? ???????????? ?????????? ? ????????????? ???-
????????????? ???? ??? ?????????????? ??
????????. ?? ???????????? ?????????????
????????? ? ??????????? ??????? ????????????? ???????? ???????????? ???????, ??????
??? ? ????????? ???????? ????????, ??? ? ? ?????. ? ???? ??????????? ????????????? ?????
???? ??????? ?????????? ?????? ????????????, ?? ???????? ????????? ?????????????
????????? ??????????? ?? ???? ?????? ?????????? ? ????? ? ??????????? ??????????????
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? ?????? ?????????????? ????????? ????????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??? ╚?????╩ ? ???????? ?????????, ? ?????
??????????? ???? ╚?????╩ ? ??????? ????????. ??? ??? ╚??╩ ?? ????????? ??????????
??????? ???????? ??????????? ??? ????????? ?????????? ???????? ? ??????????? ╚??????????╩ ?????????? ??? ????????????? ????????? ????????? (???????? ??????, ???????????? ??????? ? ?. ?.) [1?3].
???????? ??????? ????? ???????????? ????? ???????????????????? ??????????????
????, ??????????? ? ??????? ?????????????? ????????, ?????????????? ???????????
? ???????????? ????????? ?????????. ?? ???????????? ???????? ?????????????? ????????? ??????? ?????????? ??????? ??????????
????????: ?????????????? ????????? ??????, ????????????? ???????? ???????????
???????? ??????? ??????, ??? ?????, ? ?????
??????? ???????? ?????????????? ???????
???????? ??? ?????, ? ??? ????? ???????? ?
????????, ?? ??????? ?????????????? ???????????? ????? ???????? ????? ?? ???????
?????? [4?7].
?????? ???????????????? ????????????????? ??????????? ????????? ?????? ? ??????????????? ???????? ??????????? ?? ????? ??????????? ??????????, ??? ?????, ?????????, ???? ?? ??????? ????????????,
?????, ?????, ?????, ???????? ?????? ? ???????? [4].
??? ????????? ???????? ???????? ??????? ? ?????????? ???????? ?????? ???????????? ???, ????????? ? ??????, ??????????? ??? ???? ???????? ??????? ????? (???????? ????? ? ???????? ????????????? ??????,
?????????? ? ???????????), ? ????? ?????????? ?????? ???????? ?????????? ?????? ?????????? ?????????? ?????? ???????? ?????,
??? ???????? ? ??????????? ?????????????
????????? ??????. ??????????? ??????????
????????? ????????? ?????? ??????? ???????? ????????????-??????????? [4, 6?11].
???????? ?? ???????? ???? ??????????,
?????????????? ????????? ???????????? ???????? ???????????? ?? ???????? ??? ???????????? ?????? ????????????? ??? ?????????? ???????? ? ?????????????? ??????????
??????????? ???????.
???????????? ???????? ????????? ? ????? ?????????? ??????????? ??? ??, ??? ? ????????? ???????? ????????, ?? ??????? ????????? ???????? ???????? ?/??? ??? ?????????? ?????, ?????????, ??????? ?????
?????????? ?????? ??? ???????? ?????
????????. ? ???????? ????????? ?????????
23
???????? ???? (? 60%), ???? ????????????
?????????, ? ???????-???????? ? ??????????
????????, ? ??????????? ?? ??????? ??????,
??????????????? (69%) ? ???????? ? ??????
????, ? ????? ????? ????? (17%), ?????????? ???????? (14%). ???????? ???????? ????, ??????????????? ??????, ? ??????????? ??????????? ????????? ??????? ??????????? ? 25% ????? ? ╚?????????╩ ?????????
??????.
??? ??????? ????? ?? ??????????????
(? ???????? ?? 1 ???? ?? 16 ??? ? 10?16% ?????)
?????????? ???????? ???????? ???????????
????? ????????, ??? ??? ? ╚????????╩ ???????? ???? ????? ?????????????? ?????? ???
?????????? ????????, ??????? ?? ??????????????. ????????? ????? ?????? ? ???????? ??????? ? ?????????? ??????? ???????????? ╚????????╩, ????? ?? ????? ??????? ??? ???????? ???. ?????? ???? ????????
???????? ???? ??????? ?????? ??? ????????
?????????. ? ???????? ? ????? ?????????
? ???????? ?????????????? ? ????????????? ????????? ???????????????, ?????????? ????????????? ??????? ??????? [12, 13].
??? ? ?????? ? ????, ?????????? ????????????, ? ??? ????? ??????????????? ???????? ??????? ??????, ????????? ??????, ??????? (43%), ????? ????? ??????? ? ????????
?????. ?????????? ?????????? ??????, ????????, ??????????? ???????? ???? ? ??????????????. ??? ???????????? ???????? ????????? ???????? ??????? (????????) ????????????, ??????????.
? ????? ????? ?????????? ????????? ?????????? ???????????? ????????? (???????,
?????????, ???????????, ???????????? ?????????) ??? ?????????? ? ??????????. ???????? ??????????? ????????????? ????????????? ????????? ?? ????????? ????????????? ??????? ? ???????????? ????????,
???????? ?????? ??????-??????, ???????
????????? ??????????? ??????-????? [15].
??????????? ???????????? ??????? ????????? ???????? ????????? ?????????????? ????? ? 67% ????? ?? 1,5 ???? ?? 16 ??? (??
??? ? 47% ? ?????????? ???????) [16].
??? ????????? ???????? ????????????
??? ? ????????? ??????? ????? ?? ??????????? ?????????? [17].
?? ???? ??????? ???????????? ???????????? ???????????? ? ????? ? ???????? ?? 1 ????
?????????????? ???????????????? ?????????????? (????) ?????? ???????????? ???????
??? ??????????? ???????????? ?????????????
??????????? ?????????? ??????????????, ? 3, 2013
????????? ????????? ????????????? ??????????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2013
24
????????? ????????? ????????????? ??????????????
? ????????? ????????? ?????????, ? ?????
?????????????? ??? ?????????????? ?????????. ??????????, ????????? ??? ??????????
? ???????????? ???????? ????? ???? ?? ??????? ??????????? ??????? ? ?? ????????? ?????????????? ??????? ?? ????????????? ????????? ??????? [18, 20].
??????????? ?????????????? ????????
?????????? ??????? ???????? ??? ?????????? ???? ? ???????????? ??????? (???????), ??????? ?? ╚?????????╩ ?????? ???????????? [16, 19, 20].
??? ???????? ???????? ????????? ?????
?????????? ???????? ??????????? ???????????? ??????????????? ???????, ???????
????????????????, ??????? ???????????? ????? ?????????? (?? ???????) ????????????,
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? ???? ?? ??? ???????? ?? ?????? ???????????? ??-?? ????????????? ?????????? ?????????????? ???? [21].
? ??????????, ????????????? ??? ??????????? ????????? ????????? ???????????? ???????? ???????????? ? ??????? ???????????
????????? ???????? ????????? ??????????? ?????????????? ????????: ????? ????????????, ??????, ??????????, ???????????????
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? ????????????? ??? ?????????? ?? ???????
???????? ?????. ╚?????╩, ╚????╩, ╚?????
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? ?????????? ?????????????? ??????????
?????????, ?? ? ????????? ??????????????????? ???? ???? ?????????? ??? [22?24].
??? ???????, ??? ?????????? ?????????????? (???????????) ???? ??????????????
?????????? ?????????????? ?? ?????? ?? ???????????? ???????? ??????? ????? ? ??????? ?????? (sinus rectuscerebri).
?????? ?????????? ???????????????? ????? ? ????????? ??????????, ??? ??? ????????
??????? ? ???????? ? ?????????????? ????????? ???????? ?????????? ???????, ???????? ? ??????? ????????, ??? ???????? ? ????????? ??????????? ????????????. ????????, ??? ? ?????????? ?? ??????????? ??????
╚?????╩ ??? ???????????? ????????? ????????? ??? ?????????? ????? ??????????
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???????? ? ??????
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3 ?? 18 ???. ?????????????? ???????????? ??????? ????????? ????? ??????????? ? ??????? ?????????????? ??????????? ╚????????╩ (??? ╚?????╩, ??????????) ? ???????-400 (╚??????????╩, ??????) ??
??????????? ???????? ? ?????????????? ??????????? ?????? ? ????????????????? ????? ? ???????? ????????? 2 ???. ????????????
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?????? ???????????? ???????? ???????? ?????????.
??????????
? 2004?2008 ??. ???? ??????????, ? ? ????????? ????? ????????? ?????????? ???????????? ???????? ???????? ?????????
(???) ?? ???????? ????? ?????: ???????
????????? ??????, ???? ??????, ??????????? ???????, ??????? ????? ? ????? ????????? ?????????? ????? [25, 26]. ????????????? ????? ?? ?????????? ??????? (3?5,
5?7, 7?10, 10?12, 12?14, 14?18 ???) ??????????????? ???????????????? ????????????? ?.?. ?????????, ???????????? ? 1906 ?.
[27, 28].
???????? ?????????? ?????? (????. 1),
?????????? ???????? ????????? ?????? ???????????????? ? ???? ???????? ? ??????-
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??????????????? ? ??????????????????? ??????; ??-?, -?, -?? ? ???????????? ???????? ???????? ????????? ? ???? ?????? ???
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?????????? ?????? ? ?????) ? ??????? ???????? ??????????????? (?????????? ???????? ????????? ?? ???????? ????? ????? ????????????? ?????????? ??????, ?? ???????
?????????? ? ??????????????????? ????????). ??? ???? ?????? ???????? ????? ????????? ???????????? ???????? ?????????
(?????????? ???????? ????????? ?? ???????? ????? ????? ????? ???????? ? ?? ????????????? ?????????? ??????, ???????
?????????? ? ??????????????????? ?????
????????).
???????? ????????? ?????????? ??????????????? ???? ? ?????, ???? ?????????????
?????????? ???????????????? ???? ?????????? ? ????? ?? 7 ???, ????????????????
???? ?????????? ? ??????????????? ???? ?
????? ?????? 7 ??? (????. 2).
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
??????????
1.
2.
3.
4.
5.
??????? ?.?. ??????????? ????????? ????????? ?????????????? ? ????????????? ??????????? ? ????? ?????????
???????? ? ????????????? ???????????????: ???????.
???. ? ????. ???. ????. ???????; 1994.
??????? ?.?., ???????? ?.?. ???????? ???????? ? ?????????????? ??????????????? ????????????? ?????????
? ?????. ?????????????? ??????????????????? ??????????? ?????????? ???????????. ?.?. ???????, ?.?. ???????? (???.). ?.: ?????; 2004.
???????? ?.?., ?????????? ?.?. ???????? ????????
????????? ????????? ????????? ????????????? ??????????????. ????????? ???????? ?????? ????????-?????????? ???????? ??. ?.?. ???????? ?????????? ???????? ??????????? ????. 2005; 6 (2): 141?50.
????????? ?.?. ???????????? ????????? ??????????????
? ?????. ?.: ????????; 1963.
??????? ?.?., ??????? ?.?. ?????????????? ???????????
??????????? ??????. ?.: ????????; 1986.
17.
18.
19.
20.
21.
???????????? ?.?. ???????? ???????????????? ????????? ????????? ?????. ?.: ????????; 1989.
???????? ?.?. ????????? ????????? ?????????????
?????????????? ? ????????? ? ????????-?????????? ??????????: ???. ? ?-?? ???. ????. ?.; 2003.
?????? ?.?., ?????? ?.?., ?????????? ?.?. ? ??. ? ????????? ???????????? ?????????????? ??????? ? ?????? ????????? ????????? ?????????? ???????????? ????????????. ?????? ?????????????? ? ??????????. 1981; 2: 65?8.
?????? ?.?. ?????????? ??????????? ??????? ???????.
?????? ????????; 1992.
?????? ?.?., ???????? ?.?. ??????????? ???????????
? ???????? ??????????? ????????????????? ?????????????? ??????????? ? ?????. ?????? ??????????????
? ??????????. 1997; 1: 13?5.
???????? ?.?., ???????? ?.?. ??????? ?????? ? ???????
? ?????. ??????????? ??? ??????. ?. 1. ?.: ????????; 1987:
94?9.
Abramova M., Stepanova I., Shayunova S. Headaches and
cerebrovascular venous haemodynamic dysfunction at children: The 1st Global Congress for Consensus in Pediatrics &
Child Health. Paris, February 17?20, 2011.
???????? ?.?., ????????? ?.?. ???????-??????????????? ??????????? ??????????????? ????????? ? ?????.
??????????? ?????????? ??????????????. 2012; 4: 59?63.
???????? ?., ????????? ?., ??????? ?., ????????? ?.,
??????? ?., ?????? ?. ?????????????????? ?????? ????? ????????? ????? ? ???????????? ?????. 27 ??????????? ???????? ?????????????? ??????????. 11?15 ???
2011. ??????????? ?????? ?????????????? ??????????.
2011; 4: 27?8.
Abramova M., Stepanova I., Novoselova S. Cerebral haemodynamics features with ocular pathology refraction at children.
Diagnostics capabilities: International Conference in Early
Disease Detections and Prevention (EDDP 2010). Munich,
February 25?28, 2010.
???????? ?.?., ?????????? ?.?. ??????????? ???????????? ???????????? ??? ????????????? ????????. ? ??.:
??????????? ?????? ?????????????? ??????????? ??????????? ??????, ??????? ? ?????????? ???????. ?.; 1996:
106?7.
???????? ?.?., ????????? ?.?., ????????? ?.?. ????????
???? ? ??????????? ???????????? ???????? ? ?????.
?????????????? ???????????. 2011; 3: 12?4.
Bode H. Pediatric application of transcranial Doppler sonography. Wien; N.Y.: Springer-Verlad; 1988: 108.
???????? ?.?. ?????????????? ?????????????? ???????????? ? ????? (?????? ??????????): ????????? ????????????? ??????? ??????????? ╚???????? ? 2011╩ ?
?????????????? ? ???????????? ????????????. ?????????? ??????? ???????????????. ????? ??????????????
???????????. ?????-?????????, 4?7 ????????, 2011.
??????? ?.?., ???????? ?.?. ?????????????? ????????????? ??????????? ?????????? ???????????. ?.: ?????;
2004.
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.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
22.
23.
24.
25.
26.
27
28.
??????? ?.?., ??????? ?.?., ??????? ?.?. ???????????? ???????????? ??????? ??? ?????????. ???????????????
? ????????????? ????????. 2001; 35 (1): 41?6.
??????????? ?.?. ??????? ??????????? ? ????????????
???????????? ?? ????? ????????? ????????? ? ????????
???. ?????????? ????????. 2008; 34 (5): 117?22.
???????? ?.?. ???????? ??????????????. ?.: ????????;
1979.
???????? ?.?. ?????????????? ?????? ??????????? ?????????? ????????? ????????? ?????. ? ??.: ???????? ?.?.
(???.) ??????????? ??????? ??????????. ?.: ????????;
2008.
???????? ?.?., ?????????? ?.?., ???????? ?.?. ?????? ????????? ????????????????? ? ???????????????? ???????????? ? ?????????? ??????? ? ???????? ?????: ????????? VI ??????????? ????????? ╚??????????? ??????????
? ????????? ? ??????? ????????╩. ??????; 2007: 25?6.
???????? ?.?. ??????????? ???????? ????????. ???.;
1906.
????????? ?.?., ???????? ?.?. ?????? ????????, ?????????? ? ??????? ????? ? ??????????. ?.: ????????; 2007.
12.
13.
14.
15.
16.
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Burtsev E.M., Maletskaya E.V. Clinic features and criteria of
diagnostic of benign intracranial hypertensia in children.
Zhurnal Nevropatologii i Psikhiatrii. 1997; 1: 13?5 (in Russian).
Belokon? N.A., Kuberger M.A. Heart trouble and vessels in children.The management for doctors. Moscow: Meditsina; 1987;
1: 94?9 (in Russian).
17.
18.
19.
20.
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23.
24.
25.
26.
27.
28.
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Abramova M., Stepanova I., Shayunova S. Headaches and
cerebrovascular venous hemodynamic dysfunction at children:
The 1st Global Congress for Consensus in Pediatrics & Child
Health. Paris, February 17?20, 2011.
Abramova M.F., Stepanova I.A. Clinic and diagnostic
features of brachiocephalic pathology in children. Klinicheskaya Fiziologiya Krovoobrashcheniya. 2012; 4: 59?63
(in Russian).
Abramova M., Rakhmanova I., Shayunova S., Stepanova I.,
Ishanova Yu., Ivleva S. Cerebrovascular risk factor of hearing
impairment at prematurely born children. 27 European
Pediatric Neurology Congress (EPNS). 11?15 May, 2011.
Evropeyskiy Zhurnal Pediatricheskoy Nevrologii. 2011; 4: 27?8
(in Russian).
Abramova M., Stepanova I., Novoselova S. Cerebral hemodynamics features with ocular pathology refraction at children.
Diagnostic capabilities: International Conference in Early
Disease Detections and Prevention (EDDP 2010). Munich,
February 25?28, 2010.
Shumilina M.V., Spiridonov A.A. Cerebral hemodynamics features at a cefalgia syndrome. In: Modern methods of ultrasonic diagnostics of diseases of heart, vessels and an internal.
Moscow; 1996: 106?7 (in Russian).
Abramova M.F., Stepanova I.A., Duminskaya M.V. Headaches
and structural cerebral anomalies at children. Funktsional?naya
Diagnostika. 2011; 3: 12?4 (in Russian).
Bode H. Pediatric application of transcranial Doppler sonography. Wien; N.Y.: Springer-Verlad; 1988: 108.
Abramova M.F. Standardization of ultrasonic researches at
children (draft of conclusion): International scientific conference "Angiodop-2011" ? neurosonology and cerebral hemodynamics. St. Petersburg, 4?7 September, 2011 (in Russian).
Nikitin Yu.M., Trukhanov A.I. Ultrasonic Doppler diagnostics
of vascular diseases. Moscow: Vidar; 2004 (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.
Osadchiy L.I., Balueva T.V., Sergeev I.V. Reactivity of arterial
system at orthostasis. Aviakosmicheskaya i Ekologicheskaya
Meditsina. 2001; 35 (1): 41?6 (in Russian).
Zabolotskikh N.V. Reactions of central and cerebral haemodynamics during active orthostasis at healthy people. Fiziologiya
Cheloveka. 2008; 34 (5): 117?22 (in Russian).
Tkachenko B.I. Venous blood circulation. Leningrad:
Meditsina; 1979 (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.F., Novoselova S.N., Petrukhin A.S. Assessment of
a condition of extracranial and intracranial hemodynamic in
aspect age in healthy children: Materials of VI Russian congress "Modern technologies in pediatrics and children's surgery". Moscow; 2007: 25?6 (in Russian).
Gundobin N.P. Features of children's age. St. Petersburg; 1906
(in Russian).
Obreimova N.I., Petrukhin A.S. Anatomy, physiology and
hygiene bases of children and teenagers. Moscow: Akademiya;
2007 (in Russian).
????????? 05.09.2013
??????????? ?????????? ??????????????, ? 3, 2013
????????? ????????? ????????????? ??????????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
28
????????? ????????? ????????????? ??????????????
╘ ????????? ???????, 2013
??? 616.831:612.134:616.14-008.64-085
????????? ???????????? ???????? ???????????? ? ???????
??????????????? ?????????????? ? ??????????????????
???????? ????????????????
? ???????? ????????????????? ???????
??????????? ?????????? ??????????????, ? 3, 2013
?.?. ???????-????????, ?.?. ??????, ?.?. ?????, ?.?. ????????,
?.?. ?????????, ?.?. ??????
????? ??? ╚??????????? ??????????????? ???????????╩, ??. ???? ????????, 42,
?????????, 432017, ?????????? ?????????
???????-???????? ????? ???????, ????????, ????-????????; e-mail: olessyakolotik@yandex.ru;
?????? ??????? ???????????, ?????? ???. ????, ??????, ????????? ??????? ??????????,
?????????????, ???????????? ? ???;
????? ?????? ????????????, ?????? ???. ????, ?????????, ?????????? ???????? ??????????,
?????????????, ???????????? ? ???;
???????? ??????? ????????????, ????????, ????-????????;
????????? ?????? ????????????, ????????, ????-????????;
?????? ?????? ????????????, ????????
???? ???????????? ? ??????? ????????? ???????????? ???????? ???????????? ? ???????
??????????????? ?????????????? (??) ? ?????????????????? ???????? ????????????????
(???) ? ???????? ????????????????? ??????? ?????????? ?????????? ? ???? 380 ?? ? ??
2 ???????? 2 ???? ? ???? ? ??????? 25 ????.
???????? ? ??????. ??????????? 140 ??????? ??????????????? ?????????????? I?III ??.
? ?????????????????? ???????? ????????????????, ??????? ??????? ???????? 46,7╠7,7 ????.
??????? ???????? ?????? ???????? ?????????? ? ???? 380 ?? ? ?? 2 ???????? 2 ???? ? ????
?? ???? ??????????? ???????? ???????, 30 ??????? ?????? ????????? ? ?????? ???????? ???????. ??? ???????????? ??????????? ?????????? ???????????? ???????????????? ? ????????????????? ???????? ???????, ????? ? ??????????????? ?????????, ????? ??????????,
?????????????? ??????????? ????? ?? ???????? D. Celermajer.
??????????. ? ???? ????????? ? ?? ? ??? ??? ?????????????? ???????????? ???????? ???????? ???????? ?????????????, ??????? ??????????? ????? ?????? ????? ???????????.
??????????. ?????????? ??????????? ???????? ??????? ?????????????. ??????????
? ???? ???????????? ?????????? ????????? ????????????? ?????????? ? ??????????? ??????? ??????? ??????????????? ?????????????? ? ?????????????????? ???????? ???????????????? ?? ???? ??????? ???????????.
???????? ?????: ?????????????? ?????? ?????; ??????????; ??????????????? ?????????????; ???????????? ???????? ?????????????.
CONDITION OF CEREBRAL VENOUS HEMODYNAMICS IN PATIENTS WITH HYPERTONIC
ENCEPHALOPATHY WITH CONSTITUTIONAL VENOUS INSUFFICIENCY IN THE PROCESS
OF NEUROPROTECTIVE THERAPY
O.Yu. Kolotik-Kameneva, L.A. Belova, V.V. Mashin, V.V. Abramova, L.V. Saprygina, S.V. Burtsev
Ul?yanovsk State University, ul. L?va Tolstogo, 42, Ul?yanovsk, 432017, Russian Federation
Kolotik-Kameneva Olesya Yur?evna, Post-graduate Student, Neurologist; e-mail: olessyakolotik@yandex.ru;
Belova Lyudmila Anatol?evna, MD, Professor;
Mashin Victor Vladimirovich, MD, Professor, Head of the Department of neurology, neurosurgery,
physical therapy and medical physical culture;
Abramova Valeriya Vladimirovna, Post-graduate Student, Neurologist;
Saprygina Larisa Vladimirovna, Post-graduate Student, Neurologist;
Burtsev Sergey Vladimirovich, Post-graduate Student
Objective. To study of condition of cerebral venous haemodynamics in patients with hypertensive
encephalopathy (HE) with constitutional venous insufficiency (CVI) in the course of neuroprotective
therapy by a ?ytoflavin in a dose of 380 mg on 2 tablets 2 times ? day of 25 days.
Material and methods. We examined 140 patients with constitutional venous insufficiency, suffering
from hypertensive encephalopathy of I?III stages, middle age 46,7 ╠ 7,7 years. Patients of the main
group received the basic therapy and ?ytoflavin in a dose of 380 mg on 2 tablets 2 times in day of 25
day, the 30 patients of the parallel group received only standard basic therapy. Ultrasound duplex
scanning of intracranial and ekstracranial venous, test with ortostatical loading, Valsalva's test, ultrasonic test by D. Celermajer technique were used in the study.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????? ????????? ????????????? ??????????????
29
????????
??????? ?????????????????? ? ?????????, ????????? ??????????? ? ??????? ?????????????????? ???????????, ?????????? ???????? ????????? ????????????? ?????????, ?????????? ????????? ??????? ? ????
?????????? ??????????? ???????? [1, 2].
???????? ???? ??????????? ????????????
? ?????????? ????????? ? ?????? ???????????
???????, ??????? ?????????????? ????? ???????? ????? ?? ???????? ?????? ????????,
???????????? ??? ??????? [3]. ???????? ???????????? ????????? ???? ?? ?????? ?????????????? ????????? ?????????? ?????????
?????, ??????????? ?????????? ????????
??????? ?????????? ????????????????
????????? ? ????????? [4]. ???????? ???????????? ???????????????? ????? ? ?????????
???????????? ??????????? ?????????? ???????? ???????????????, ? ????? ????????????? ????????????? ???????????? ???????
??????? ? ????????????, ?????????? ???????? ?????? ???? ????????? ??? ?????????????, ??? ? ????????? ??????????? ?????????
????????? ? ???????? ??????????? ???? ?????????????????? ??????????? [5]. ? ???? ????? ???????? ???? ???????????? ????????
????????????? ? ???????? ? ???????????????? ?????????????, ? ??? ????? ??? ???????????? ??????????? [6?9]. ?????? ????????,
??? ?? ????????? ???????? ????????????
????????? ??????? ?????????? ? ????????????? ??????? [5, 10]. ?????????? ????
???????????, ??????????????????? ???????
? ???????? ???????? ????????????? [5, 9,
11]. ??????? ???????????????? ?????? ??????????????? ????????????? (??), ? ???????? ???????? ?????? ???? ?????????????????? ???????? ??????????????? (???) [12].
???????? ?????????? ?????????? ????????,
???????????? ??????????? ? ?????????????
????????????? ? ???????????? ????????????? ????????? ?????? [13]. ?????????? ????????? ????????????? ????????? ?????,
? ??????? ???????? ????????????? ??????????????? ??? ????????? ????????? ?????????????? ??????? ? ???????????? ??????????????? ??? ???????????? ??????????? ???????, ? ??????????? ????????? ????????????
????????? ╚?????????╩ ? ????????? ????????? ????????????? ???????? ????? [13].
? ?????? ??????? ???????????????? ???????? ??????? ? ?????????? ????? ????? (85%),
??????? ????????? ???????????? ????????
???????????? ?? ??????????? ??????? ??????????? ? ??? ??????? ?????????? ????????
?????? ?????? ??????????? ??????? ???????
??????? ? ???????????? ???????? ??????????????.
????????? ????? ????????????, ?????????? ??????????? ???????? ??????????????? ?????? ??????????? ? ??????? ?? ?????????. ?????? ????? ?? ???????? ??????????????? ??????? ????????? ????????????
???????? ????????????? ?? ???????????.
??????????? ? ??????? ???????, ? ???????
??????? ???????? ????????? ??????, ???????
???????? ????? ?????? ?????????????? ??????????, ??????????? ???????? ????? [12].
? ?? ?? ????? ?????????? ?????????, ??? ????????? ???????????????, ???????????
??? ?????????? ????????????? ????????
????????, ????? ? ??????????????? ???????? ? ???????????, ??? ??????? ??????????
???????, ?????????? ????????????? ?????
? ????????? ???????? ?????????, ????????
?? ??????????, ?????????????? ??????????
????????? ????? ? ????????????? ????????
????? [12, 14].
????? ?? ????? ?????????? ???????? ????????????? ???????????????? ??????????,
?????????????? ????? ??????????? ??????????? ?????????? ?? ????????? ? ?????? ??????????? ???????????: ???????? ??????? ? ???? Na, N-?????????????????????????, ????????? ? ???? ??????????? ?
??????????? ? ????????????. ??????????
????????? ? ????? ??????, ???????? ????????????? ?????? ?? ???????? ????????????????? ? ??????, ?????? ???????????? ???????????? ??????? ? ???????? ?????????? ?????? ???????????? ??????????????????
? ???????? ?????? [15].
????? ?????? ???????????? ???????? ???????? ????????? ???????????? ???????? ???????????? ??????? ??????????????? ?????????????? ? ?????????????????? ????????
???????????????? ? ???????? ???????????-
??????????? ?????????? ??????????????, ? 3, 2013
Results. All patients with HE with CVI had signs of stagnation of venous blood by ultrasound duplex
scanning which decreased after ?ytoflavin's course reception.
Conclusion. Cytoflavin showed high efficacy. The results received during research allow recommend to use ?ytoflavin in complex therapy of patients by hypertensive encephalopathy with constitutional venous insufficiency already for all stages of a disease.
Key words: functional reserve of a brain; cytoflavin; hypertensive encephalopathy; cerebral venous insufficiency.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
30
????????? ????????? ????????????? ??????????????
?????? ??????? ?????????? ?????????? ? ???? 380 ?? (?? 2 ???????? 2 ???? ? ???? ? ???????
25 ????).
??????????? ?????????? ??????????????, ? 3, 2013
???????? ? ??????
??????????? 140 ????????? ? ?? I?III ??.
? ???, ?? ??? 38 (27,14%) ?????? ? ????????
?? 39 ?? 72 ??? (??????? ??????? 44,5╠8,5 ????) ? 102 (72,86%) ??????? ? ???????? ?? 39
?? 73 ??? (??????? ??????? 48,8╠7,4 ????).
??????? ??????? ???? ??????? ????????
46,7╠7,7 ????. ??????? ?? ? ?????? ??????????? ????????????? ? ???????????? ? ?????????????? ?? ?????????? ???? (1985 ?.).
?????????? ??? ????????: ??????? ?????,
????????????? ???????? ???????????? ?????????????? (??????????? ???? ?? ?????,
???????? ╚??????? ???????╩, ╚?????? ?????????╩, ╚????? ? ??????╩), ??????? ?????????? ???????? ??????????? ????????
????????? (?????????? ?????????? ? ??????? ??? ?????? ???????????, ????????, ??????????, ?????????? ?????????? ??? ????????), ???????? ╚????????╩ ??????? [12, 16,
17]. ?????????????? ???????? ?? ? ???? ????????????? ???? ?? ????????????? ?????
5 ??? (7,3╠4,77 ????).
?????????? ?????????? ????????: ??????? ???????????? ???????????, ??????? ????? ?? ????? ???????? ????????? ?????????
????????? ??????????????, ??????? ????????????, ???????????, ???????????, ????????????????, ??????????????, ????????????
???????????, ???????????? ??????? ? ??????
??? ????????????????? ??????? ?? 1 ????, ????????????, ????????, ????? ?????? ??????????????? ??? ?????????? ?????????? ? ??????? ????????? 3 ???.
??????? ??????????????? ??????? ????????? ?? ??? ??????. ???????? 1-? ??????
(n=74) ???????? ?????????? ? 1-? ?? 25-? ???
???????????? ? ???? 2 ???????? 2 ???? ? ????
?? ???? ??????????? ???????? ??????? (???????? ??????, ??), ???????? 2-? ??????
(n=66) ???????? ??????????? ???????? ??????? (?????? ?????????, ??). ?????? ????????
(??) ????????? 30 ??????????? ???????? ???????????, ???????????? ?? ???? ? ????????.
????????? ???????????????? ? ????????????????? ???????????? ???????? ????????????. ???????????????? ???? ????????? (??), ??????? ??????? ????????????????? ??????????? ???????????? (????)
? ??????? ?????????????? ???????? Viamo
SSA-640A (Toshiba, ??????) ????????? ???-
????? ? ??????????? ???????? 2,5 ???. ????????? ???????? ? ???????? ???????? ?????????. ??? ???????? ???????????? ???
????????? ????????? ????? ? ??????????????? ????????? ?? ??????????????? ?? 60?80╟.
????????????????? ?????????? ??????? ???? (???) ? ??????????? ???? (??) ????????? ? ??????? ?????????????? ???????? Viamo
SSA-640A (Toshiba, ??????) ???????? ???????? ? ??????????? ???????? 7,5 ??? ? ????????? ???????? ???? ?? ?????. ??????? ???????? ? ???????? ???????? ?????????. ??? ?????? ???????????? ? ?????????? ???????? ??
?????? ????????? ???????? ???????? ╚???????
???????╩. ??? ?????? ????????? ????????
??? ???????????? ????? ??????????.
?????????????????? ??????? ?????????
????????? ? ??????? ?????????????? ??????????? ????? ?? ???????? D. Celermajer
(1992 ?.) ? ????????????? ?????????????? ????????????? ???????? ???????.
??? ????????? ???????????? ????????????
??????????????? ????????, ? ???? ???????????? ???? ???????? ????????? ?????????
??????????.
?????????????? ????????? ????????? ? ??????? ?????????? ????????? ?????????? 8.0
? ??????????? ???????? ????????????? (?),
???????? ??????????????? (??), ???????????? ?????????? (SD). ? ??????????? ?? ????
????????????? ?????????????? ??????????????? ??? ????????????????? ?????? ??????????????? ???????. ?????????? ????????????
??? M? (SD). ? ?????? ?????? ?????????????? ???????? ??????????? ?????????????
???????? ??????????, ??? ???????? ????????? ?????????? ????????????????? U-???????? ???????????. ????????????? ????????? ????????? ???????? ??? ?????? ??????????? ????? 95% (p < 0,05).
??????????
???????? ???????? ???? ??????? ???????????? ? ??????? ????????? ????????????????? ????????? ?????. ??? ????? ??????? ???????? ? ??????????? ????????? ?????? ???
???????? ?????????????? ?????????, ?????????? ? ????????? ???????????? ???. ??????? ?????? ?? ?????????????? ???????????? ???????? ???????? [18]. ?????????? ???????????? ??????????? ????????? ?? ??
???????????? ? ??????? 1.
?? ?????? ??????? ?????????? ????????????? ???????? ???????? ??????? ??????????? ??? ?? ????? ????????? ? ???? ???????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????? ????????? ????????????? ??????????????
31
??????? 1
?????????? ??? ?? ?? ? ???????? ????????????????? ???????
Vmax (??/?), Me (SD)
??
??????????
I ??.
II ??.
Vmin (??/?), Me (SD)
??
III ??.
I ??.
II ??.
??
III ??.
I ??.
II ??.
??
III ??.
I ??.
II ??.
III ??.
?? ???????
13,5 (4,1)* 13,4 (4,7)* 13,3 (4,0)* 13,2 (4,1)* 13,0 (4,3)* 13,1 (4,9)* 9,3 (2,9)* 9,1 (2,3)*
9,1 (3,1)* 9,2 (2,5)* 9,1 (2,8)*
? ????????
16,1 (3,3) 16,0 (2,7) 16,0 (3,6) 13,3 (3,5)* 13,6 (3,3)* 13,3 (3,0)* 12,3 (2,7) 12,2 (2,6)
12,4 (2,9) 10,9 (3,0)* 10,2 (2,5)* 10,0 (2,5)*
??
16,0 (4,1)
9,0 (2,4)*
12,8 (4,1)
?? ? ??? ?? ????????? ? ???????????? ?????????? (p<0,001). ?????? ? ???????? ??????? ?????????? ?? ????? ??????????? ? ???????????? ??.
??????????? ???????? ??????????????????? ??????????? ?? ?????? ??????? ?? ????????? ??????????????????? ???????, ???????
???????????? ????????????? ???????? ??????? [19]. ???????????? ?? ??????? ? ?????
? ??????????. ????????, ??? ???????????????
????? ???????? ? ????????? ?????????? ????????? ????????????? ????????? ?????????????? ? ???????????????? ??????????????
???????????? ???????, ????????? ??? ? ?????????? ???????? ??????????????? ??????????? ?????????????. ? ????? ???????? ???????????? ?? ???????? ????????????? ???????????? ???????????? ??????? [9, 12, 20].
?????? ???????????? ??? ????????? ???????????? ? ???????? 2, 3.
? 1-? ??? ?????????? ???????? ?????????
?? ? ????? ?????????? ????? ? ?????????? ??
?????????? (??. ??????? 2, 3).
? ????????, ?? 25-? ??? ??????????, ? ???????? ?????? ??????????? ?????????????
???????? ???????? (p<0,002) ???? ?????????? ??????????? ? ????????? ?? ?????????
? ???????? ?????????? ??? ???? ??????? ???????????.
? ?????? ????????? ?? 25-? ??? ?????????? ?????????? Vmax ? Vmin ?????????? ??????????? (??. ??????? 3).
??? ?????? ????????????? ????????? ?????????? ? ????????? ???????????? ??? ????????? ??? ????????? ??????? ?? ? ???
???????? ?????????????? ????? ???????? ????? ?????????? (??. ???????).
???????? ??????? ????????????? ????????? ??? ???? ??????? ???????????.
???????? ????? ?? ??????? ?????? ???????? ? ??? ? ??. ? ???? ????????? ? ?? ? ???
???????? ??????? ????????? ???????????????. ??? ???? ??????????? ??? ??????????
????????? ???????? ? ???? ?? ?????????? ???
???????????? (25%), ??? ? ????????? ??????????????? (75% ???????). ? 4 (2,9%) ?????????
??????? 2
?????????? ????????? ?? ???? ????????? ? ????? ?? ???? ? ??????????????? ?????????
? ???????? ? ???????? ??????
Vmax (??/?), Me (SD)
?? ???????
??????????
I ??.
II ??.
Vmin (??/?), Me (SD)
? ????????
III ??.
I ??.
II ??.
16,1 (3,3) 16,0 (2,7)
?? ???????
III ??.
I ??.
16,0 (3,6)
II ??.
? ????????
III ??.
I ??.
II ??.
III ??.
???
13,5 (4,1) 13,4 (4,7) 13,3 (4,0)
9,3 (2,9)
9,1 (2,3)
9,1 (3,1)
12,3 (2,7) 12,2 (2,6) 12,4 (2,9)
????????
12,9 (3,4) 12,9 (3,1) 12,9 (3,5) 13,1 (3,0)* 13,5 (3,2)* 13,3 (3,1)* 9,1 (2,8)
9,0 (2,9)
9,1 (2,6)
7,6 (2,5)* 7,3 (2,6)*
7,2 (2,5)*
*p<0,05 ? ????????????? ???????? ???????? ?? ????????? ? ???????? ????????????.
??????? 3
?????????? ????????? ?? ???? ????????? ? ????? ?? ???? ? ??????????????? ?????????
? ???????? ? ?????? ?????????
Vmax (??/?), Me (SD)
?? ???????
??????????
I ??.
II ??.
Vmin (??/?), Me (SD)
? ????????
III ??.
I ??.
II ??.
?? ???????
III ??.
I ??.
? ????????
II ??.
III ??.
I ??.
II ??.
III ??.
???
13,2 (4,1) 13,0 (4,3) 13,1 (4,9)
13,3 (3,5) 13,6 (3,3)
13,3 (3,0)
9,2 (2,5)
9,1 (2,8)
9,0 (2,4)
10,9 (3,0) 10,2 (2,5) 10,0 (2,5)
????????
12,5 (3,5) 12,6 (3,2) 12,5 (3,4)
12,0 (3,0) 12,5 (2,9)
12,4 (3,1)
9,2 (2,7)
9,0 (3,0)
9,1 (2,9)
10,0 (3,0) 10,7 (2,9) 10,3 (2,9)
??????????? ?????????? ??????????????, ? 3, 2013
*p<0,05 ? ????????????? ???????? ???????? ?? ????????? ? ??.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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????????? ????????? ????????????? ??????????????
3
2
1
0
-1
-2
-3
2
4
6
8
10
12
14
16
18
20
22
24
2
4
6
8
10
12
14
16
18
20
22
24
?????? ??: 2
?????? ??: 1
3
2
1
0
-1
-2
-3
2
4
6
8
10
12
14
16
18
20
22
24
??????????? ?????????? ??????????????, ? 3, 2013
?????? ??: 3
????? ???????? ????? ??????????
???????? ??????? ???? ?????? ??????????
???????? ???. ??? ???????????? ???
? 7,8% ??????? ?? I ??., ? 9,8% ?????????
? ?? II ??. ? 7,9% ??????????? ? ?? III ??. ??????????? ???????????, ???????????? ? ?????????. ????????? ??????????????? ??????
?????????????? ???????? ? 42% ?????????.
? 39 (27,9%) ??????? ???????? ????????????????? (??????? ??????????? ??????? ???
?????? 2/3 ??????? ??????????? ???????
???) ? ????? (??????? ??????????? ???????
??? ? ??? ?????) ???? [5, 10, 21].
?????????? ?????????? ????????? ?? ???
???????????? ? ??????? 4.
?? ?????? ??????? ?????????? Vmax ? Vmed
??? ???? ??????? ?? ???? ????????????? ???-
???? ???? (p<0,02), ??? ? ??. ?? 25-? ??? ??????? ? ??????, ?????????? ??????????,
????? ??????????? ? ???????????? ?????????? (??. ??????? 4).
???????? ?????? ???????? ???????????
????????? ?? ??? ? ??????? ?? (????. 5).
?????????? Vvolmax ?? ??? ? ????? ??????? ??? ?? I?III ??. ????????????? ???????
???? ???? (p<0,007) ??????????? ????????. ? ???????? ???????? ?????????? ?????????? ???????? ?????? ????? ??????????? ? ???????? ? ??. ???????? ????????
? ?????? ????????? ?? ???????? (??. ??????? 5).
????????, ??? ???????? ???????? ??????????? ? ???????? ???????? ???, ? ????? ?? ??
??????? 4
?????????? ??? ?? ??? ? ??????? ?? ? ????????
Vmax (??/?), Me (SD)
Vmed (??/?), Me (SD)
??????????
??
??
24,6 (15,2)*
16,9 (11,9)*
17,2 (10,4)*
29,4 (16,7)*
19,5 (10,3)*
19,4 (10,8)*
34,1 (16,3)*
19,8 (10,1)*
19,5 (11)*
??
??
?? I ??.
24,6 (16,3)*
?? II ??.
29,6 (14,3)*
?? III ??.
33,9 (15,4)*
??? ?? ???????
??? ? ????????
?? I ??.
41,7 (18,1)
31,6 (15,0)*
21,8 (9,3)
17,5 (9,9) *
?? II ??.
44,3 (19,6)
30,6 (12,7)*
20,2 (9,1)
19,2 (11,1)*
?? III ??.
44,6 (20,4)
39,47 (14,4)*
22,36 (9,7)
19,0 (9,5)*
??? ??
49,4 (20,7)
*p<0,05 ? ????????????? ???????? ???????? ??? ????????? ? ??.
23,8 (6,1)
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
33
????????? ????????? ????????????? ??????????????
??????? 5
?????????? ???????? ???????? ????????? ?? ??? ? ??????? ?? ? ????????
Vvolmax (??/???), Me (SD)
??????????
??
???????? ???????? ????????? ?? ???????
?? I ??.
?? II ??.
?? III ??.
???????? ???????? ????????? ? ????????
?? I ??.
?? II ??.
?? III ??.
???????? ???????? ????????? ??
*p<0,05 ? ????????????? ???????? ???????? ?? ????????? ? ??.
??
424,6 (164,9)*
423,9 (107,3)*
416,7 (131,8)*
423,2 (119,9)*
421,9 (158,4)*
421,1 (128,2)*
547,33 (137,7)
552,7 (143,9)
521,1 (136,6)
438,3 (118,9)*
433,7 (128,9)*
424,5 (140,7)*
523,9 (112,6)
? ?????????????? ????????? ? ???????? ???
?????? ?????????? 5?9% [9, 10, 22]. ? ???????????? ?? ???????????? ? ??????? ?? I ??. ?
? 94,1% ???????, ? ??????? ?? II ??. ? ? 96,1%
? ?? III ??. ? ? 86,8% ???????.
?????????? ?????????? ????????? ?? ??
???????????? ? ??????? 6.
??? ???? ??????? ?? ? ??? ???????? ???????? ????????? (p<0,04) ?? ?? ?? ????????? ? ?? (??. ??????? 6). ?????? ?? 25-? ???
??????? ? ?? ???????? ???????? ???????????
??? ? I?III ??. ?? ? ???.
???????? ?????? ???????? ???????????
????????? ?? ?? ? ??????? ?? (????. 7).
??????? 6
?????????? ??? ?? ?? ? ??????? ?? ? ????????
??
??
Vmin (??/?), M? (SD)
??
Vmed (??/?), M? (SD)
??
??? ?? ???????
?? I ??.
20,4 (17,5)*
20,1 (16,9)*
13,6 (4,7)*
13,6 (4,0)*
?? II ??.
20,5 (15,8)*
20,5 (15,4)*
15,6 (6,3)*
15,8 (6,7)*
?? III ??.
20,4 (16,7)*
20,8 (17,1)*
16,2 (2,5)*
16,4 (2,3)*
??? ? ????????
?? I ??.
15,2 (17,7)
19,4 (16,0)*
7,5 (3,5)
13,2 (3,0)*
?? II ??.
15,1 (15,4)
20,1 (15,0)*
7,3 (2,8)
15,7 (2,1)*
?? III ??.
15,3 (15,7)
20,4 (16,5)*
8,1 (1,3)
16,6 (1,9)*
??? ??
16,5 (0,2)
9,73 (0,5)
* p<0,05 ? ????????????? ???????? ???????? ??? ????????? ? ??.
??
??
31,6 (11,6)*
32,8 (11,5)*
33,5 (9,1)*
33,0 (11,1)*
34,0 (10,7)*
34,1 (8,1)*
20,8 (8,4)
32,3 (8,4)*
24,9 (12,3)
32,6 (14,1)*
26,7 (8,5)
32,2 (9,7)*
24,6 (10,6)
??????? 7
?????????? ???????? ???????? ????????? ?? ?? ? ??????? ?? ? ????????
??????????
???????? ???????? ?????????
?? ???????
?? I ??.
?? II ??.
?? III ??.
????????
???????? ????????? ? ????????
?? I ??.
?? II ??.
?? III ??.
???????? ???????? ????????? ??
Vvolmed (??/???), Me (SD)
Vvolmax (??/???), Me (SD)
??
??
??
13,1 (6,1)*
11,4 (4,8)*
14,5(9,0)*
13,4 (5,8)*
11,7 (5,1)*
14,0(9,3)*
24,6 (18,6)*
26,8 (28,9)*
22,8(4,4)*
24,0 (18,0)*
26,6 (29,0)*
22,5(4,9)*
7,7 (1,3)*
7,3 (1,4)*
7,8(1,1)*
7,4 (1,7)*
7,9 (1,3)*
7,8(1,5)*
11,4 (6,4)*
10,3 (3,8)*
13,8 (9,2)*
11,9 (7,1)*
11,7 (3,0)*
13,9 (9,7)*
22,5 (18,7)*
24,7 (28,3)*
22,0 (13,8)*
23,2 (18,3)*
25,1 (28,5)*
22,1 (13,1)*
7,6 (1,2)*
7,5 (1,3)*
7,6 (1,2)*
7,3 (1,9)*
7,6 (1,5)*
7,7 (1,3)*
7,2 (0,3)
* p<0,05 ? ????????????? ???????? ???????? ?? ????????? ? ??.
??
Vvolmin (??/???), Me (SD)
19,5 (0,2)
??
??
4,1 (0,02)
??????????? ?????????? ??????????????, ? 3, 2013
Vmax (??/?), M? (SD)
??????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
34
????????? ????????? ????????????? ??????????????
??????? 8
?????????? ?????????? ???????????????? ???????
Wilks Lambda
Partial Lambda
p
RI ?? ????????
0,55
0,93
0,003
RI ?? ???
0,54
0,94
0,008
Vmin ?? ????????
0,55
0,93
0,004
??????????
TAVmax ?? ????????
0,54
0,94
0,009
TAVmax ?? ???
0,54
0,94
0,006
Vmin ???
0,53
0,95
0,02
Vmin ?? ???
0,25
0,86
0,00001
TAVmax ???
0,22
0,94
0,02
? ? ? ? ? ? ? ? ? ?. RI ? ?????? ??????????????, TAV ? ??????????? ???????????? ????????.
??????? 9
?????????? ?????????????????? ????????????? ? ???????????
?? ?????? ?? ? ???????? ? ???????? ??????
?????????????????? ?????????????
??????????
?? I ??. ? ???, M? (SD) ?? II ??. ? ???, M? (SD) ?? III ??. ? ???, M? (SD)
?? ???????
??
??
7,9 (1,5)*
7,5 (1,7)*
6,3 (1,6)*
6,1 (1,3)*
6,1 (1,9)*
6,4 (1,6)*
??, M? (SD)
13,5 (1,0)
13,5 (1,0)
??????????? ?????????? ??????????????, ? 3, 2013
? ????????
??
11,3 (1,4)*#
7,2 (1,8)*
6,9 (2,2)*
13,6 (1,1)
??
8,1 (1,2)*
7,0 (1,4)*
6,3 (1,7)*
13,6 (1,1)
*p<0,05 ? ????????????? ???????? ???????? ?? ????????? ? ??, #?<0,05 ? ????????????? ???????? ???????? ??? ????????? ?
????????.
?????????? Vvolmax, Vvolmin ? Vvolmed ?? ??
????????????? ??????? ???? ???? (p<0,05),
??? ? ?? ??? ???? ??????? ?? (??. ??????? 7),
?????? ?? 25-? ??? ???????? ????????? ? ??
????????.
??? ?????? ????????????? ??????????
??????????? ?? ???????? ????????? ???????????? ???????????? ???????? ?????????
??????????????? ?????? (????. 8). ??????????? ?????????? ????????????? ??????????? ? ????????? ?????? ? ???????????? ??,
???????? ?????????? ??????????? ?? ? ???.
? ?????? ?????????? ?????????????? ?????????? ? ???????? ????????????? ????????? ?????? [13, 17] ????????? ?????? ???????
????????? ??? ????????? ??????? ?? ? ???
? ???????? (????. 9).
?????????????????? ????????????? (????)
???? ??????? ??? ???? ??????? ?? ? ??? ??
????????? ? ??????? ???????? (p<0,01). ? ???????? ??????? ? ?? ??? I ??. ?? ? ??? ?????????? ????????????? ???????? ????????? ??????????? ???? (p<0,009), ?????? ??? ?? ???????? ??????????? (??. ??????? 9).
??????????
????????? ???????? ???????????? ??????????? ??? ?? ????????????????, ??? ? ??
????????????????? ?????? ??? ?? I ??. ??
? ???. ?? ???????????????? ?????? ???????? ???????? ??????????? ??? ?? ??, ???
??????? ? ???????????? ????????? ???????.
???????????? ?? ??????? ? ????? ? ??????????. ? 1-? ??? ?????????? ???????? ????????? ?? ? ????? ??????????????? ????????
?? ??????????. ??? ??????????????? ? ??????? ????????? ??????? ? ???????? ???????
????? ? ????????? ???????????? ???????????????? ???, ?? ?????????????? ????????????.
? ????? ???????????? ?????????????????? ?????? ??????????? ???????? ????????
??? ? ?? ?????????? ????????. ??????????
????????? ????????? ?????? ?? ????????????? ????? ???????? ????????? ????????? ??
??? ??? ???????????? ???????? ? ????????? ???? ?? ????? ? ???????? ????????? ??
??, ??? ??????????????? ? ????????? ?? ???
?????????????? ????? ?????? ??? ?????????????? ???????? ??????. ???????? ????????????? ????????? ?????????? ? ?????????
???????????????? ? ????????????????? ???????? ????????????, ??? ???????????
? ?????????? ???????? ?????????? ??????????? ?? ?? ?? ??????????? ????????, ????????? ???????????? ??, ?????????? ??????
?? ??? ? ????????? ????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????????? ??????? ??????? ?????????? ?????????? ?? ????????? ????????????
??? ????????? ???????????? ??????????????
??????? ???????? ????? ?????????? ?? ????
??????? ?? ? ???. ????????, ??? ????????
????????????????? ??????? ?? ?????? ?????????? ???????, ????? ?????? ??????? ?, ????? ???????, ????????????? ?????????????
?????????? [12].
???????? ???? ?????????? ?????????
? ?????????? ?????????? ??????????? ????????? ?????, ????????????? ??????? ???????
???????????? ?? ??????? ????????? ??????
? I ??. ?? ? ???, ?????????? ?????????? ????????? ?????????? ??? ??? ?????? ????????? ???????????.
9.
10.
11.
12.
13.
??????????
14.
?????????? ? ???? ???????????? ?????????? ????????? ????????????? ?????????????
??????????? ? ??????????? ??????? ??????? ??????????????? ?????????????? ? ?????????????????? ???????? ???????????????? ?? ???? ??????? ???????????.
15.
16.
17.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
????????? ?.?., ?????????? ?.?., ????????? ?.?. ? ??. ?????????????????? ???????????. ??? ????????? ???????
???????????? ??? ????????? ???????????? ???????????? ????????. Consilium Medicum. ??????????. ?????????????????? ???????????. 2007; 9 (2): 4?10.
??????? ?.?., ???????? ?.?., ????? ?.?. ? ??. ???????????
????????????? ??????????? ??? ???????????????? ????????????? ? ??????????? ?????? ????? (??????????
??????????????? ?????????????????? ????????????).
??????? ?????-????????????? ??????????????? ??????????? ???????? ??. ?.?. ?????????. 2005; 3: 7?14.
Van Laar P.J., van der Grond J., Bremmer J.P., Klijn C.J.M.,
Hendrikse J. Assessment of the contribution of the external
carotid artery to brain perfusion in patients with internal
carotid artery occlusion. Stroke. 2008; 1: 39.
??????? ?.?., ???????? ?.?., ???????? ?.?., ???????? ?.?.,
???????? ?.?., ???????? ?.?. ? ??. ?????????????? ??????????? ?????????? ???????????: ??????????? ??? ??????.
??????? ?.?. (???.). 1-? ???. ?.: ?????; 2007.
??????? ?.?., ?????????? ?.?., ???????? ?.?. ????????? ????????????? ????????? ?????????????? ? ???????
? ????????-?????????? ?????????? (???????? ????, ??????, ??????????????). ?.: ??????? ????? ????????-?????????? ???????? ??. ?.?. ???????? ?????????? ????????
??????????? ????; 2003.
?????? ?.?., ??????? ?.?., ????? ?.?., ????? ?.?. ?????????? ????????? ???????????? ??????????????? ???????????? ?????????? ??????? ????????? ????? ??? ??????????????? ?????????????. SonAce-International. 2011; 1:
16?8.
???????? ?.?., ??? ?.?., ?????? ?.?., ??????? ?.?. ?????? ???????? ???????????? ? ????????? ? ?????????????? ??????????? ????????????? ??????? ??? ?? ?????? ??????????????? ????????????. ?????????????? ?
?????????????? ???????????. 2002; 4: 60?5.
???????? ?.?., ???????? ?.?., ???-?????????? ?.?., ??????? ?.?. ???? ????????????????? ??????????? ???????????? ? ?????? ????????? ????????? ? ???????? ?????????
????? ? ???????????? ????? ? ??????? ? ?????????? ???????????????????? ???????????. ? ??.: ???????????
?????????? ? ???????????? ?????? ???????????. ????-
18.
19.
20.
21.
22.
35
?????????? ?????????????????. ????????? ?.?., ??????? ?.?. (???.). ?.: ???-???; 2000: 150?4.
???????? ?.?., ???????? ?.?. ???????????? ?????? ????????? ?????????????? ?????, ??????????????? ?
??????????????????? ???????? ??????????? ??? ????????????. ??????????? ?????????? ??????????????.
2009; 3: 5?16.
???????? ?.?., ????????? ?.?. ??????????? ?????????????? ??????????? ????????? ????????? ??????. ??????????? ?????????? ??????????????. 2009; 3: 21?9.
?????? ?.?. ? ??????????? ???????????? ????????? ?????????????? ?????: ????????? VIII ??????????????
?????? ??????????. ??????; 2001: 299.
?????? ?.?., ????? ?.?., ???????-???????? ?.?., ?????? ?.?., ?????? ?.?., ??????????? ?.?., ???????? ?.?.
????????????? ??????????? ? ??????? ? ??????????????? ?????????????? ? ?????????????????? ????????
????????????????. ?????? ?????????? ? ??????????
??. ?.?. ?????????. 2012; 8: 21?6.
Henry-Feugeas M.C., Koskas P. Cerebral vascular aging:
extending the concept of pulse wave encephalopathy through
capillaries to the cerebral veins. Chinese Medical Journal. 2012;
125 (7): 1303?9.
???? ?.?. ????????????? ???????? ? ???????????????.
?.: ????????; 1984.
????????? ?.?., ???????? ?.?., ?????? ?.?. ????????????????? ?????????? ???????? ??????? ? ??????????? ??
?????????? ? ???????: ??????? ??????. ???????? ?.?.
(???.). ???; 6?20.
?????? ?.?., ????? ?.?., ??????? ?.?., ????? ?.?. ??????????????? ?????????????: ???????-???????????????? ???????, ?????????????, ???????????. ?????????:
2010.
?????? ?.?., ???????? ?.?., ????? ?.?., ?????? ?.?., ???????-???????? ?.?., ???????? ?.?., ????????? ?.?.. ????????? ?????????????? ??????? ? ??????? ??????????????? ?????????????? ? ???????? ??????????????????
???????. ??????????? ?????????? ??????????????. 2012; 4:
63?8.
???????? ?.?., ??????? ?.?. ???????? ???????????????
????????? ??????????????. ?????????. 2007; 2: 18?21.
????????? ?.?., ???????? ?.?., ????????? ?.?. ? ???????? ?????? ??????????????????? ??????? ??? ??????????????????? ????????? ?????? ???????. ?????? ?????????? ? ?????????? ??. ?.?. ?????????. 1999; 2: 57?64.
???????? ?.?., ??????? ?.?. ???????????? ? ????????
???????? ???????????? ? ?????? ??????? ?????????? ????????? ?????. ?????? ?????????? ? ?????????? ??. ?.?. ?????????. 2011; 11: 65?8.
???????? ?.?. ??????????? ?????????????? ??????????? ????????? ?????????????? ???????. ?.: ???????
????? ????????-?????????? ???????? ??. ?.?. ????????
?????????? ???????? ??????????? ????; 2012.
????? ?.?., ????? ?.?. ???????????????? ??????????
???????????? ? ??????????? ???????. ???????????
?????????? ? ???????????? ?????? ???????????. ??????????, ?????????????????: ??????? ??????? ??????.
????????? ?.?., ??????? ?.?. (???.). ?.: ???-???; 2000:
158?62.
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problem of an assessment of a ?erebrovas?ular reserve at atherosclerotic defeat ?arotids. Zhurnal nevrologii i psichiatrii imeni
S.S. Korsakova. 1999; 2: 57?64 (in Russian).
Dicheskul M.L., Kulikov V.P. Arterial and venous brain reactivity in the sharp period of concussion of a brain. Zhurnal
nevrologii i psichiatrii imeni S.S. Korsakova. 2011; 11: 65?8 (in
Russian).
Shumilina M.V. Complex ultrasonic diagnostics of pathology
of peripheral vessels. Moscow; 2012 (in Russian).
Lelyuk V.G., Lelyuk S.E. Transcranial duplex scanning in modern clinic. Modern invasive and noninvasive methods of diagnostics. Ultrasound, electrophysiology: ?ol. sc. tr. Eds
Sandrikov V.A., Mit?kov V.V. ?oscow: Air-?rt; 2000; 158?62
(in Russian).
??????????? ?????????? ??????????????, ? 3, 2013
????????? 05.09.2013
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????? ????????? ????????????? ??????????????
37
╘ ????????? ???????, 2013
??? [616.831-005.1:616.14-005.6]-073.756.8:681.31
?????? ???????? ???????????????????? ?????????
???????????????? ???????????? ??????????
? ????????-??????????? ?????????? ? ???????????
?????????????????? ????????,
?????????? ???????????? ???????? ?????????
?.?. ???????1, ?.?. ??????????1, ?.?. ?????????1, ?.?. ??????1, ?.?. ???????1,
?.?. ???????1, ?.?. ????????2
1????
??????? ????????? ??????????, ?????? ???. ????, ?????????? ??????? ???????????
????????-?????????? ???????????; e-mail: sts63@list.ru;
?????????? ????? ??????????, ????. ????.;
????????? ?????? ????????????, ?????? ???. ????, ?????????, ???. ????. ????.;
?????? ????? ?????????????, ????. ????.;
??????? ???? ??????????, ????. ????.;
??????? ????? ?????????????, ??. ????. ????.;
???????? ????? ???????????, ?????????? ?????????? ???????-???????????????? ??????
?????????????? ????????? ????????????? ?????? ??. ?.?. ????????
??????????? ????????? ??? ????????????? ????????? ?????????????????? ???????? ???????
?????????? ???????????????? ? ???????????? ??????? ??? ???????????????? ???????????? ?????????? (????) ? ????????-??????????? ?????????? (???). ? ?? ?? ????? ???????????? ? ????????????? ????????? ???????????? ????????????? ?? ??????? ? ?????? ??????????????? ???????????, ??????? ????????????????? ?? ???????? ?????????????? ????
?, ? ?????? ??????, ?????????????? ???. ???????????? ???????????? ?????????? ??????????????? ?????????? ? ?????????? ????? ???????? ??- ? ??-?????????, ??? ????????????
? ???????????????? ?????, ???????????, ???????????? ????? ? ??????? ????? ????????.
???? ???? ????????? ? ???????????????? ??????????? ????????? ? ????????????? ????????? ???????? ???????????? ?? ????????? ??????????? ? ?????????? ???????????? ????????
??? ????????????? ????????? ???????? ? ???????????? ??????????? ??????? ????-??????????? ? ???????????? ??, ??-??????????? ? ???????????? ???. ???, ?????? ???????????
??-?????????????????? ?2WI ??? ???????? ??????? ?????????, ????????? ??? ?????? ??????????? ? DWI ? ?????? CBV ??? ???????????? ??, ??????????? ????????? ????????? ??????? ????????. ??????????? ????????? ???????? ╚???????╩ ? ???????-?????????? ???????
? ???????? ??? ???????? ???????? ?????????????, ??????????? ? ???????????? ?????????
???????, ? ????? ? ?????????? ???? ? ?????????? ?????? ??? ???????? ??????? ????????????? ? ??????? ????????? ???????, ?????????? ??? ????? ??? ??????-???? ????????????? ????????. ????? ????? ??? ???????? ???????? ? ??????? ?? ????????????? ???? ????????????.
???????? ?????: ???????????? ???????? ???????; ???????; ???????? ??????.
EVALUATION OF ROUTINE TOPO-MORPHOMETRIC CRITERIA OF MULTISPIRAL COMPUTED
TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF NONHEMORRHAGIC
STROKE, CAUSED BY CEREBRAL VENOUS THROMBOSIS
S.E. Semenov1, I.V. Moldavskaya1, A.V. Kovalenko1, A.A. Khromov1, A.N. Khromova1,
E.A. Zhuchkova1, M.G. Shatokhina2
1Research
Institute for Complex Issues of Cardiovascular Diseases, Siberian Branch
of the Russian Academy of Medical Sciences, Sosnovyy bul?var, 6, Kemerovo, 650002, Russian Federation;
2S.M. Berezin Treatment and Diagnostic Center of International Biologic Systems Institute,
ul. Volgogradskaya, 37, Kemerovo, 650056, Russian Federation
Semenov Stanislav Evgen?evich, MD, Head of Diagnostic Department;
Moldavskaya Irina Valer?evna, Researcher;
Kovalenko Andrey Vladimirovich, MD, Professor, Leading Researcher;
Khromov Anton Aleksandrovich, Researcher;
Khromova Anna Nikolaevna, Researcher;
Zhuchkova Elena Aleksandrovna, Junior Researcher;
Shatokhina Mariya Gennad?evna, Head of MRI Department
??????????? ?????????? ??????????????, ? 3, 2013
╚??? ??????????? ??????? ????????-?????????? ???????????╩ ?? ????,
???????? ?-?, 6, ????????, 650002, ?????????? ?????????;
2???????-??????????????? ????? ?????????????? ????????? ????????????? ??????
??. ?.?. ????????, ??. ?????????????, 37, ????????, 650056, ?????????? ?????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
38
????????? ????????? ????????????? ??????????????
??????????? ?????????? ??????????????, ? 3, 2013
The determination of venous or arterial genesis of insult demands angiographic and perfusion CT- and
MR-methods. In this time, the national and international recommendations limit the neurovisualization
only routine MSCT and conventional MRI for reducing lose time for revascularization window. This
investigation does assessment of significant and reliable symptoms of routine MSCT and MRI such as
hyperdense and hyperintensive vessels, location, measurement and shape of insult focus. The role
these symptoms in venous or arterial insult differential diagnostics was determine by statistic correlation between their and other contrast verified dates of MSCT-, MR-angiography, perfusion CT and diffusion MRI. Such the measurement insult focus on T2WI with MRI is high estimate like strong correlative between DWI on MRI and CBV-mapping on perfusion CT which are validity final cerebrum infarct
size markers. The typical locations for venous insult are shown: 1) parietal and occipital lobes, cerebellum in superior saggital or lateral (transverse/sigmoid) sinuses thrombosis cases; 2) corpus callosum and thalami in inferior saggital and straight sinuses/internal veins thrombosis cases. There are
irregular shape and non-arterial vascular territory does different between venous from arterial insult.
Key words: cerebral venous sinus thrombosis; stroke; venous ischemia.
????????
???????????? ???????? ???????? ?????????????? ? 22?30% ??????? [1]. ? ?????????????, ??????, ????????? ? ???????? ???????,
??????????? ╚???????????? ???????????
?????????????????? ????????????╩ ? ?????????????, ?? ?????? ??????, ? 0?5% ??????? ???? ????????? [2?4], ? ???????? ????????????? American Heart Association/American
Stroke Association (AHA/ASA) ? ? 0,5?1% ????
????????? [5]. ? 3% ??????? ???????? ??? ???????? ???????????? ???????? ???????
(???), ??????? ??? ??????????? ? ????????
???????? ?????????? (?????????? ???? ?????,
???? ??????, ?????? ?????) ???????? ? ???????? ?????? ???????? ? ????????? ????????
? 16% ??????? [5]. ???????????? ????????????? ?????????? ????????? ????????? ????? ?.?. ?????? (1975 ?.) ??? ?????????? ???????????? ???????? ??????????? ?? ??????????? ??????????????? ????????: ╚????????
???? ? ??????, ??????? ???? ? ?????? ??????╩. ??? ???? ?????????? ? ??????? ????????????? ????????? ???????? ????????????
?? ???????????? ????? ???????? ????????
? ????????-????????????? ??????? ?? ?????
??? ? ???????? ??????? [6].
???????? ???????????? ? ?????????
????????? ?????? ??????????????? ????????? ???????? ???????? ?????????????? ???????????? ?????????? (??) ?????? ? ? ????????????????? ? ????????? ???????
37?60% [7, 8] ? ?? 2?3-? ??? ? ?? 83?92% [9,
10], ??????? ? ????????? ? ??????????? ???????? ???????? ????????????? ?????????? ??????????? ???????? [11], ? ????? ???????????-?????????? ??????????? ??? ????????-??????????? ?????????? (???),
??????? ╚???????????????????╩ ????????? ?????? ?????? ???????????? ????????? ????????? ????? [12]. ??? ?????????????
????????????? ? ????????????? ????????
???????? ? ??????????????? ???????? ?????-
??????? ???????????? ??????? (??? ???
????) ??????? ???????? ????????????????
? ????????????? ??? ?????????? ?? ? ?????? ???? ????? ?????? ???????? ? ?? 96 ? 98%
?????????????? [13, 14].
???????? ???????, ????????? ?? ????????????? ????????????, ??????, ????????????
???????????????, ?? ?????????????? ??????????????? ??????????? ??????? ??????? ????????, ??? ????????, ??? ?????????? ????????
??????? ? ???????????? ??????. ?????? ???
???? ????? ????????? ???????? [6]. ????????
?? ??????? ??? ????????????? ???????????? ????? ╚????? ?????╩ ? ?????????? ??? ???????????????, ??? ? ???????????????, ??? ?????????????? ?????? ??????? ??????????? ????? ??????????? ? 0,3 ?? 2% ?? ???????? ?????? ? 3 ???
??? ???????????? ??????????????? ??????????????? ????? [15].
???????? ??? ????, ??? ?? ?????????? ??????? ? ???????? ???????????? ??????? ? ????????? ?? ????????????? ??????? ??????
??? ???????????? ????????? ?????? ????????
?? [16] ? ? ???? ??? ????? ???????????? ???
?????????? ????? ?????????????? ??? ???
?????????? ???????????????? ? ???????????? ??????????? ???????, ????? ?????????
?????? ??????? ??????????? ???????? ????
??????????? ? ???????? ?????? ????????? ???????? ? ????????? ? ??????? ????????????
????????, ??? ???????? ????? ????????????
? ???????? ???????????????? ?? (????)
? ??? ??????????????? ????????? ?? ????????? ???????????????? ??????? ? ?????????????? ??????????? ???????.
???????? ? ??????
????????????????? ??????? ?????????
? ????????????? ?????????? ? ?????????????? ?????????????? (?????????????????????? ? ????????-?????????????? ????????)
????????? ????????? ???????? ???????? ??
?????? ? 2008 ?? 2012 ?. ??????? ????????? ??
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??? ?????. ? ?????? ????? ????? 36 ????????? ? ????????? ╚??????? ?????, ?????????
????????? ??? ?????, ???????????╩, ?????????? ???????????? ? ???????????????? ???????????? ??????? ? ?????? ??? ???? ??????? ?????????????? ? ????? ???????????
????????????????? ??? ???????????, ???
? ??????????????? ????????? ????? ???????
???????????. ?? ??????????? ??????????????? ????? ???????????? ??? ????????? ??????????? ???? ??????????? ? ??????????????? ??????? ???????????? ??? ??????????
??????, ?????????????, ?????. ? ????????????? ????? ????? 33 ???????? ? ???????????????? ??????? ????????????????? ????????? (??), ????????? ???????????? ???????? ????????? (???), ? ?????? ?????????
(33 ????????) ? ???????????? ???????????
????????? (??), ?????????? ? ????????????
?????????? ?????? ?? ???? ???? ╚??????????? ???????????????? ?????????╩, ???????
???? ???????????????? ? ???? ???????????
??? ????????? ? ?????????????? ???????
????????. ??? ????????? ???????????? ??? ??
???????? ????????????? ???? ??????????????? ????????. ???????????? ???? ???????? ????????? ????????? ?????????.
??????????? ???????? ??????????? ???????? ????????????????? ?? ???? ???????
? ??? ????????-????????????? ????????????
? ??????? ?????????? ??????. ????????????????? ???????? ???????? (??c???????????)
???? ????????? ?????, ???, ????-??????????? (?????) ???????????????? ???????
(c ???????? ????????? ???????????? ???????? ? ????????????? ???? 320?370 ??/??) ? ??????? 40 ??? ????? ??????????? (??????????? ?? ????????? ? LightSpeedTMVCT 64),
??? ????????? ?????, ??? ???????????????? ??????? ? ?????? 24 ? ??????????? (?????? ??????) (??????????? ?? ????????????? ????????? Excel?rt Vantage 1,5T Toshiba).
???????? ???????? ????????? ??-???????????? ????????? ????? ????????????? ? ???????????: kV=140, mAS=160, ??????? ?????
5 ??, ????? ??????? ?????? 2 ?, ????? ???????????? 60 ?. ????????????????? ??????????? ? ???????? ????? 0,625 ?? ? ? ?????????? MPR, MIP, VR ?? ??????? ???????
Workstation Volume Share 4. ????????? ???
??????????? ?? ?????????? ???????????:
kV=80, mAS=200, ??????? ????? 5 ??, ?????
??????? ?????? 1 ?, ?????? 4 ??, ????? ???????????? 70 ?, ?????? ?????? 11╟, ????? ???????????? ???????? 40 ??, ???????? ????????
39
???????????? ???????? 4,5 ??/?. ?????????????? ?????? ? ?????????? ??????? ????
???????? (cerebral blood flow ? CBF, cerebral
blood volume ? CBV, mean transit time ? MTT)
??????????? ?? ??????? ??????? Workstation
Volume Share 4 ? ????????? Perfusion 4.
????? ??????????? ? ???????????: kV=120,
mAS=300, ??????? ????? 0,625 ??, ?????
??????? ?????? 0,4 ? ? ╚???????????╩ ????
????????????, ? ????????????? ???????
? ???, ? ????????? ??????? ???????????? ????? ????????? ????????????? ???????? ???????????? ???????? ?? ????????? 4?5 ??/? ??
??????? 1 ??/?? ????? ???? ? ??????? ??????????????? ?????-????????? Nemoto A300
(CoeurMedical, USA).
????????? ??-????????????:
1) T1WI ? ???????????? ?????????:
TR=630 ??, TE=17 ??, FA=90╟, ???????
224в320 ????????, ??????? ????? 5 ??, ?????????? ?????? ? 23;
2) T2WI ? ?????????? ?????????: TR=
=4300 ??, TE=105 ??, FA=90╟, ???????
256в320 ????????, ??????? ????? 6 ??, ?????????? ?????? ? 20;
3) FLAIR (fluid attenuated inversion recovery ? ?????????????????? ╚???????????????????????╩ ? ??????????? ??????? ?? ????????? ????????) ? ?????????? ?????????:
TR=10000 ??, TE=105 ??, FA=90╟, TI (inversion recovery ? ????? ????????) 2500 ??, ??????? 192в320 ????????, ??????? ????? 6 ??,
?????????? ?????? ? 20;
4) DWI+ADC (diffusion-weighted image ?
???????????-?????????? ??????????? +
+apparent diffusion coefficient ? ???????? ??????????? ????????) ? ?????????? ?????????: TR=5300 ??, TE=120 ??, FA=90╟, ??????? 192в128 ????????, ??????? ????? 5 ??; ?????????? ?????? ? 22;
5) 3D-ToF (time of flight ? ??????????????
???????????) ?? ??????????? ?????????:
TR=32 ??, ??=8 ??, FA=20╟, ??????? ?????
1,2 ??, ????????? ?????? 15?30%, FoV=
= 192в256, ?????????? ?????? ? 72.
???? ???????????? ??????? ????? (? ??2),
??? ??????? ? ???????????. ??????? ?????
???? ???????? ?? ?????????? ????????????
??? ???? ? ??? ? ????? ?? ???????? ????? ????? ????????? ??- ? ??-???????? ? ????????? ?????????? ? ?????????? ????????
??????? ?????????.
?????????????? ????????? ???????????
????????? ? ??????? ??????? Microsoft
Excel Windows (???????? ╘2004 Microsoft
??????????? ?????????? ??????????????, ? 3, 2013
????????? ????????? ????????????? ??????????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
40
????????? ????????? ????????????? ??????????????
??????????? ?????????? ??????????????, ? 3, 2013
Corporation X10-60270) ? Statistica 6.0 (???????? ╘2010 Statsoft AXXR003E608729FAN10 ??
31.03.2010). ??? ??????? ???????????????
????????? ?????????? ??????????? ? ???????????? ????????, ????????? ???????
?????????????? ????????, ??????????? ??????????, ????????????? ????????. ? ??????? ???????? ???????????? ???????????
???????????? ???????????? ?????????????
?????????????? ??????????? ???????????
?????????????. ??? ?????? ????????? ????????? ? ???????????? ??????? ????????????? ???????? ??????. ??? ???????????? ???????????? ????????????? ??????????? ? ???
????????? ????????? ? ???? ????????????
??????? ????????????? ???????????????
t-???????? ?????????, ??? ?????? ????????
? ???????????? ??????? ?????????????? ??????????????? ???????? ? ?????????????
??????, ? ??????????? ?????????? ???????
? ?????????????? ???????? ?????????? ?????????? ??????? (LSD). ? ?????? ?????????????? ???????????? ????????????? ??????????? ????????????? ????????????????? ???????? ????????????????. ??? ???????
???????????? ??????????? ????????? ??????? ????????????? ? ?????????? ????????
??????? ?2. ??? ??????????? ????? ????? ??????????????? ???????????? ?????????????
?????????????? ?????? ????????. ???????
???????? ??????????? ??? ?<0,05.
??????????
??????? ????????????? ?????? ??? ???????? ???? ??????? ???? ??? ?? ? 54,5%
??????? (???. 1, ?), ??? ?? ? ? 30,3% ???????.
??? ?????????????? ??? ? ?2WI ? ???????? ?????????????? ???????? ???????, ? ????? ?????????? ? ????????????? ?????? ????-
????? ???????????????? ?????? (?? ????????? ? ????????????? ???????????) ? ????
???????????? ?????????? ??????? ??????
(???. 1, ?).
? ?????? ?? ?????? ???????????? ???????? ??????? ????????? ? ???????? ?????????? ????? ????????? ???????????: ??????
?????? ???? ??? ???????? ???????? ????????????? ?????? (???) ? ? 2 (2,89%) ???????,
?????-???????? ??????? ??? ???????? ???
? ???????? ??? ? ? 3 (4,34%), ?????? ???????? ???? ??? ???????? ??? ?/??? ???????
????????????? ?????? (???) ? ? 6 (8,69%),
?????? ??????? ??? ???????? ??? ? ??????? ?????? (??), ? ????? ?????????? ??? ????? ? ? 7 (10,14%), ??????????? ??????? (??
?????? ???????) ? ? 4 (5,79%), ???????-???????? ??????? ??? ???????? ??? ? ??,
? ????? ?????????? ??? ????? ? ? 2 (2,89%),
?????? ??????? ??????????? ???? ??? ???????? ??? ? ? 6 (8,69%), ???????-?????????? ??????? ??? ???????? ???, ???
? ???????????? ?????? ? ? 12 (17,38%), ???????-?????????? ??????? (? ???????????????? ?????????? ??????????? ????) +
???????? ??? ???????? ??? ? ???????????? ?????? ? ? 2 (2,89%), ?????? ???????? ???? ? ? 1 (1,44%), ?????? ?????????? ???? ???
???????? ??? ?/??? ???????????? ?????? ?
? 8 (11,6%), ?????? ???????? ??? ????????
???????????? ?????? ? ? 7 (10,14%), ?????????? ???? + ???????? ??? ???????? ???????????? ?????? ? ? 3 (4,34%) ???????. ????? ????, ??????????????? 2 ????????? ????????,
???????????? ? ????????? ????? ??????????
??????? ??? ? ????? ?????? ? ?????????????
????????? ??????????, ?????????? ???????
??? ? ???????????? ?????? ?? ?????? ??????.
??? ???? ????????? ????????? ?? ??????-
???. 1. ???????????? ??????
? ???????? ??????????????
???????? ??????? ?? ?????????? ??????:
?
?
? ? ??????? ??????????? ??????
? ???? ???????? ?????????????
?????? ??? ????; ? ? ??????
???????????? ?????? ? ???? ???????? ??????? ? ?2WI ??? ???
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
? ???????????????? ????????????? ???????? ???????? ?? ????.
????????????? ??????????? ?????????
??? ?? ?????????? ???????? ????????, ??????? ?? ??????? ??????????? ?????????
? ?????? ????, ????? ?????? ???????????????? ????? ??? ????????????, ?? ???? ?????????? ???????????? ??? ???????? ??????????? ????????? ╚????????????╩ ????????.
?????? ? ??????? ? ?? ╚???????╩ ??? ?? ???????????????, ? ??????????? ???????????? ???????. ?????????? ??? ??????, ?????????????? ?? ????? ?????????. ? ??????
?????? ? ???????????? ?????? ? ?????? ? ?????-???????? ???????? ??? ???????? ???????? ? ??????? ?????? ???????? ?????????????
?????? ????? 5 (7,2%) ?????????; ?? ??????
??????, ? ???????????? ? ???????? ? ?????????? ????? (??????????????? ???????????????), ???????? ? ?????? ??? ???????? ??????
????? ???, ??????????? ??????? ? ?????????? ??????? ???, ? 40 (58%) ?????????
? ? ?????? ??????, ? ???????????? ?????????
? ??????? ??????????? ???? ? ????????????
???????? ??? ???????? ??????? ????????????? ? ??????? ???????, ? ????? ?????????? ???
?????, ????? 24 (34,8%) ????????. ? ??????
?? ??????????? ????? ????????? ??? ???????? ??????? ???????? ??????? (???) ???? ?????? ? ???????? ???? ? ? 5 (15,15%) ???????; ? ???????-???????? ??????? ?
? 9 (27,27%), ? ??????? ????????? ????? (?????-???????-???????? ????) ? ? 6 (18,18%),
? ??????????? ??????? (? ????????????????
?????????? ???????? ? ?????????? ????) ?
? 3 (9%) ???????, ??? ???????? ????????
???????? ??????? (???): ? ?????-????????
??????? ? ? 4 (12,12%), ??? ???????? ??????
???????? ??????? (???): ? ?????????? ???? ? ? 2 (6%) ???????. ??????????????? 3 ?????????? ???????? ??????????? ??????? ? 2
????????? ????????. ??????? ?????????
??????????? ??????? (?? ?????? ???????????
?????, ?? ? ???????? ? ?????????? ????),
? ????? ?????? ? ?????? (?????-????????)
??????? ?? ??????????? ??? ?? ? ??.
???????? ???????, ??? ???????, ?? ??????????? ? ????????? ??? ????????????? ???????? ????? ╚????????????╩ ?????????,
?? ????????? ????????????? ?????????? ????? ???????????????? ??????? ╚?????????╩
????????????? ??????? ?????????? ?????
[17]. ? ??????????? ??????????? ???????
(? 62 ?? 69 ? ? 90%) ????? ?????? ?? ???? ????????????, ? ??????? ? ????????? ? ?????-
41
????, ?? ╚??????????????╩ ?????? ??????.
???? ? 7 ??????? ???????? ????????????
?????? ??????? ?????? ??: ? 3 ??????? ???????? ? ?????? ???? ??? ???????? ????????
??????? ???????? ????????????? ?????? ? ????????? ? ????????? ???????? ???, ? 1 ??????
?? ? ?????????? ???? ??? ???????? ????????
????????????? ? ??????????? ???????, ? ????? ? 3 ??????? ????????? ??????????? ?????.
?????? ??????? ???????? ? ??????????? ??????? ????? ??? ??? ???????????????? ???????????, ??? ?????? ???? ??????? ?? ??????? ???
?? ? ???????? ??? ? ?????? ???? ???????,
? ????? ?? ?? ? ???????? ??? ? ????? ??????
? ??????????? ?? ??? ??????????? ? ?????????? ?????. ?????? ?????????? ??????????
?????????????? ?????- ? ???-???????
????????? ??????? ????? ????? ? ??? ??? ?????????? ???????????? ????????. ??????? ????????????? ?? ?? ???????????? ????????
??, ? ????? ?? ?2WI, FLAIR ??? ??? ? ??????????? ??????????? ??????? ?????? ? ??????. ?????????? ? ╚??????????╩ ???????? ????? ??? ???? ??????????? ?? DWI ??-?? ???????? ??????? ??????? ??????????? ? ?? ?1WI
?????????? ?????? ????????????? ????? ???????? ? ????????????? ?????????? ??????,
??????? ??????? ?????? ??????????????????
??? ????????????? ???????????? ????????.
?? ?????? ?BV ??? ??? (???. 2) ????????
??????? ????? ??? ?? ????????? ?? 1,82 ??
16,48 (??????? ???????? 6,56╠3,94) ??2,
??? ?? ? ?? 1,5 ?? 32,57 (9,53╠9,44) ??2.
?? ???? ?? ?????? ??????????? ????????
(?>0,05), ?? ? ???? ??????? ???????? ??? ??
?????? ? ???????????? ??????????, ??? ?????? ????? ???????? ????????????? ??? ??????????????? ?????????????. ?????????? ????????????? ??????????? ???????? ????? ??
? ?? ? ????????? ??????? ????? ????????
???????? ? ??? ?????????? ?? ????????????
? ????????? ??????????????????? ??? ?
?2WI, FLAIR, DWI, ADC (???. 3). ???????
???????? ??????? ????? ????????? ??? ????????? ? ???? ??????????????????? ???
? ??????? ??????? ??????????? ? ??????? ??
? ?? ?? ????????? ? ?????????? ?? ?????
CBV, ? ??? ???? ????????? ? ???????? ??????? ????????? ?????????? ???????? ?? ???????? ? ?????? ?? ???????????: S ?2WI (??2) ?
?? 2,33 ?? 16,89 (? ??????? 7,13╠3,78) ??? ??,
?? 0,5 ?? 24,59 (? ??????? 7,12╠6,82) ??? ??;
S FLAIR (??2) ? ?? 0,79 ?? 17,54 (? ???????
6,87╠3,94) ??? ??, ?? 0,5 ?? 23,95 (? ???????
5,89╠5,91) ??? ??; S DWI (??2) ? ?? 2,67 ??
??????????? ?????????? ??????????????, ? 3, 2013
????????? ????????? ????????????? ??????????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
42
????????? ????????? ????????????? ??????????????
?
?
???. 2. ???????? ?????????? ??????????? ??? ??? ? ???? ????? ????????? ???????? ?????? ?????????? ???? (ROI 3) ??
??????:
??????????? ?????????? ??????????????, ? 3, 2013
? ? CBF; ? ? CBV
?
?
?
?
???. 3. ???????????? ????? ?? ? ???????????? ? ?????? ?????????? ????:
? ? ???????? ????????? ?? ?????????? ????? ??? ???????? ??; ? ? ????????? ??-??????? ?? ?????????? ?2WI; ? ? ?????????
??-??????? ?? ?????????? ????? ?? FLAIR; ? ? ????????? ??-??????? ?? ?????????? DWI
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
16,74 (? ??????? 7,16╠3,88) ??? ??, ?? 1,67 ??
30,33 (? ??????? 8,31╠7,75) ??? ??; S ADC
(??2) ? ?? 2,37 ?? 14,37 (? ??????? 6,35╠3,71)
??? ??, ?? 1,25 ?? 34,4 (? ??????? 7,53╠7,63)
??? ??.
?? ???? ??????????? ??????? ????? ???????? ?????? ?????????? ???????? ?????????????? ????????????? ?? ????????
????????. ? ????? ??????????? ????????
?????????? ??? ?????????? ????????? ??????? ????????? ??????????????????? ???
?? ??????????? ???????? ?? ??????????, ??????? ????? ????????, ??????????? ?????
r?0,4, ?? ???? ???????, ??????? ? ?????? ???
?<0,05. ???, ??????????? ???????? ?????????????? ?????? ? ????????? ????????? ??????? ???????? [18] ?????????? ??????? ????????? ?? ????? ?BV (S CBV, ??2) ??? ????
(? ??????? ???????? ???? ?? ???????????)
????? ???????????? (r=0,95) ? ????????
????? ?? DWI ??-??????????? (S DWI, ??2),
???????? ????? ??? ???????????? ???????????? ???????? (S ADC, ??2) ? r=0,83
? ???????? ????? ??? ?????????? ?2WI-?????????????????? (S T2WI, ??2) ? r=0,86,
? ????? ?????? ???????????? (r=0,56) ? ???????? ????????? ?? ????????????? ??????????? FLAIR-???????????? (S FLAIR, ??2).
??????? ????? ?????????, ?????????? ??
?2WI-?????????????????? (S T2, ??2), ??????? ??????????? ??? ??????????? ? ??????
? ??????? ????????? ???? ???, ????? ????
????? ????????????? (r=0,87) ? ????????
????? ?? DWI ??-??????????? (S DWI, ??2)
? ? ???????? ????????? ?? ???????????
FLAIR-???????????? (S FLAIR, ??2) ?
r=0,85, ?????? ????????????? (r=0,73) ? ???????? ????? ??? ???????????? ???????????? ???????? (S ADC, ??2). ?????? ?????????? (r=0,9) ???????? ????? ????????????
S DWI (??2) ? S ADC (??2), ?? ???? ????? ????????? ?? ???????????? ?????????? ???????? ? ?????????????? ???????????? ????????. ??????? ?? ???? ?????????? (r=0,62) ???????? ????? S DWI (??2) ? S FLAIR (??2),
?????? ? ????? S FLAIR (??2) ? S CBV (??2)
(r=0,56) ? S ADC (??2) (r=0,43).
??????????
??????????? ????????? ???, ??? ? ?????? ???????????? ?????????????? ????????,
???????? ??????? ????????????? ?????? ???
???????? ?? [4, 19]. ?? ?????? ??????????,
??? ???????????? ???????? ???? ???????
??????????? ? ???????? ?? 25% ??????? ? ????-
43
????? ? ?? ? ?? 50% ? ? ??????? ? ?????? ?????????? ????????? ?????????????? ? ???????? ??? ? ?????? ????? [20]. ?? ?????
??????, ??? ??? ? ?????? ????? ???? ??????? ????? ?????????? ????? ??? ? 50%, ? ???
??????????? ?? ???????? ??-????????????
????? ??????????????? ? ???, ????? ?????
???????????. ??? ?????????????? ???
? ?2WI ? ???????? ?????????????? ???????
?????? ????????? ???????????????? ??????
? ????????????? ?????????? ??????? ??????
[17], ??, ??????? ?????????? ??????? ???????????????? ??? ? ?????????? ??????, ????
??????? ????? ??????????????? ? ?????? ?????????????, ??? ??? ?????????? ? ??? ?????????????? ????????, ?????????? ? ????????????? ?????????? ??????.
?????????, ??? ???????? ???????? ?????????? ?? ???????????? ??????? ?????????
? ╚???????????╩ ???????????? ? ???? ?????.
??????????? ????????? ????? ????? ??? ???????? ????????? ??????????? ?????????
[6, 21]: ??? ???????? ?????????? ??? ? ????
???????? ? ???????? ??????????? ??????
? ???????? ?????, ?????????? ??? ? ?????????? ??????????? ???? ?????, ??????????
??? ? ???????? ???? ? ??????????????? ?????
?????????? ????, ???? ???? ? ?????? ?????? ???????? ? ???????????? ?????? ???????? ?????, ?????????? ??? ? ???????? ??????
???????? ????, ???????????????? ??????
?????? ????. ??? ????????? ??? ??????? ?????? ???????? ? 62% ??????? ??????????
? ??????? ????????? ????????, ? 60% ? ? ???????? ??????? ?????? ???????? ?????????
? ?????? ? ??????? ? ?????????? ??????????
??????????, ????????????, ???????? ?????,
???????? [22]. ?? ?????? ????????????
ISCVT, ???????? ????? ???????????? ???????
???????????? ????? ? 62% ???????, ????? ?
?????????? ?????? ? 41?45% ? ?????? ?????
?? ??????? ????????????? ????? ???????? ???????? ????????? ? ???????????? ???? ? 18
? 17% ??????????????. ?? ????????? ????? ??
??????? ????????? ? ?????????? ??????? ???? [5, 23]. ????????, ??? ? ??????????, ?????
???? ???????. ? ??????????? ??????????????? ????????? ???????? ?????? ???????????? ???????????, ????????? ??? ?????????
????????? ??????????? ????????????? ?????????????? [6]. ??? ????????????? ????????
╚?????????? ????????╩ ????? ????????? ???????? ? ???????? ????????????????? ??????
???? ???????? ???????? ???? ?????????:
???????-?????????? ??????? ? ???????? ???
??????????? ?????????? ??????????????, ? 3, 2013
????????? ????????? ????????????? ??????????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2013
44
????????? ????????? ????????????? ??????????????
???????? ???????? ?????????????, ??????????? ? ???????????? ????????? ??????? (58%)
? ?????????? ???? ? ?????????? ????? ? ???
???????? ??????? ????????????? ? ???????
????????? ???????, ?????????? ??? ?????
(35%).
????? ?? ??????? ??????????????? ????????? ???????? ???????? ????????? ?????????
????????? ? ???????? ???????? ??????????????? ???????? ?????, ?????? ???? ????????? ????????? ?? ???????? ??-???????????
?????????????? ? ???????????? ????????.
??? ????????????? ???????????? ???????? ????????????? ?????????? ????? ??? ?????????
????????? ????? ?? ??????? ???????????????? ?????????. ???, ???????? ? ???????? ???
????? ?????????????? ?????, ? ?????????
??? ? ??? ? ???????????, ? ??????? ??????????? ???????? ? ????????? ????? ?????
?????????? ????????, ?? ?????? ???? ????? ??
?? ???????. ?? ???????? ???????? ????? ????????? ???????: ????? ? ?? 5 ?? 15 ?? ? ????????, ??????? ? ?? 16 ?? 30 ??, ??????? ? ??
31 ?? 70 ??, ???????? ? ?? 71 ?? 100 ?? [24,
25]. ????????? ????????????, ??? ?????? ???????? ???????? ????? ????????????? ?????
CBV ??? ??/???-???????? ? DWI ? ??? ???,
?????????? ???????? ????????? ??????? ???????? (?????????? ?.?., 2011), ? ?????????
??-??????? ? ?2-?? ? FLAIR ? ??????????????? ???? ??????????? ? ?????? 24 ? ? 80%
???????. ?? ???????????? ?????? [18] ? ???????? ??????? ?????????? ??????? ????? ??
????? ?BV ??? ???? ? ???????? ????? ?? DWI
??? ???. ?????? ????????, ?? ??? ??????,
????? ?????? ?????????? ??????? ????? ??
T2WI ??? ??? ? ?????????? ????????????,
??? ??????????????? ? ??????? ?????????? ??????????? ????? ??????????????, ?? ??????????????? ?????????????????? ?2WI ? ???????? ???. ????????, ??? ?2WI ???????? ???-????
?????????? ?????? ???????????? ?????? ??????? ????? ????????.
?????? ??????? ? ???????? ??? ????????
???????? ?????????????, ??????????? ? ???????????? ????????? ???????, ? ????? ?????????? ???? ? ?????????? ?????? ??? ???????? ??????? ????????????? ? ??????? ????????? ???????, ?????????? ??? ????? ???
??????-???? ????????????? ????????, ???????????? ????? ?????. ??????????????????
?2WI ??? ?????????????? ??? ????? ???????????? ??? ???????? ??????? ?????????
??? ????????, ??? ??? ??? ?????? ??????????? ? DWI ? ?????? CBV ??? ???, ??????????? ????????? ????????? ??????? ????????.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
??????????
???????? ????????????? ? ???????????
???????? ???? ? ??? ??? ?????????? ??????????? ???????, ????????????? ??????????? ???????????? ?????????? ????? ????????? ??????????? ???????? ? ????????????
???????? ??????? ?????????????????? ???????? ?? ????????? ???? ???????? ????????
?????????. ? ?? ????? ????? ????????
??????? ????????????? ?????? ??? ????????
??, ???????? ??????????? ? ???????-????-
16.
17.
18.
19.
?????? ?.?. ???????: ???????? ? ??????????. ?.: ?????.
??? ? ???????????; 2010.
Canha~o P., Ferro J.M., Lindgren A.G. ISCVT Investigators.
Causes and predictors of death in cerebral venous thrombosis.
Stroke. 2005; 36: 1720?5.
Bousser M.G., Ferro J.M. Cerebral venous thrombosis: an
update. Lancet Neurol. 2007; 6: 162?70.
Palena L.M., Toni F., Piscitelli V. et al. CT Diagnosis of cerebral venous thrombosis: importance of the first examination for
fast treatment. Neuroradiology J. 2009; 22: 137?49.
Saposnik G., Barinagarrementeria F., Brown R.D. et al. Diagnosis
and management of cerebral venous thrombosis: A statement for
healthcare professionals from the American Heart Association /American Stroke Association. Stroke. 2011; 42:
1158?92.
??????? ?.?. ???????? ?????????????? ??????? ? ???.
?.: ????????; 1975.
Wardlaw J.M., Dorman P.J., Lewis S.C. Can stroke physicians
and neurologists identify signs of early cerebral infarction on
CT? J. Neurol. Neurosurg. Psychiatry. 1999; 67: 651?3.
Warwick J.H., Barber P.A., Hill M.D. et al. Use of the Alberta
Stroke Program Early CT Score (ASPECTS) for assessing CT
scans in patients with acute stroke. Am. J. Neuroradiol. 2001;
22: 1534?42.
Rasmussen D. Computed tomography in prognostic stroke
evaluation. Stroke. 1994; 23: 506?10.
Von Kummer R., Allen K.L., Holle R. et al. Acute stroke: usefulness of early CT findings before thrombolytic therapy.
Radiology. 1995; 205: 327?33.
Masdeu J.C., Irimia P., Asenbaum S. et al. EFNS guideline on
neuroimaging in acute stroke. Report of an EFNS task force.
European J. Neuroradiol. 2006; 13 (12): 1271?83.
????????? ?.?., ?????? ?.?. ??????????????? ???????????????. ?.: ???????? ?.?.; 2006.
KЖnig M., Klotz E., Luka B. et al. Perfusion CT of the Brain:
Diagnostic approach for early detection of ischemic. Stroke.
1998; 209: 85?93.
Wintermark M., Sesay M., Barbier E. et al. Comparative overview
of brain perfusion imaging techniques. Stroke. 2005; 36: 83?99.
Semenov S., Moldavskaya I., Shatokhina M., Semenov A.,
Barbarash L. How to distinguish between venous and arterial
strokes and why? Neuroradiology Journal. 2011; 24 (2):
289?99.
???? ? 52600.5-2008. ???????? ??????? ???????. ???????. ???????????? ???????? ?????????? ?????????.
?.: ??????????????; 2009.
????????? ?.?. (???.). ??????? ??????????? ? ??????? ??????????? ?????? ? ???: ???????????? ???????????.
?.: ??????-?????; 2013.
?????????? ?.?. ??????????? ??????? ????????: ????????????????????? ?????????: ???????. ???. ? ?-?? ???.
????. ?.; 2011.
??????? ?.?., ?????????? ?.?., ??????? ?.?., ???????? ?.?. ???????? ??- ? ??-???????????????? ??????????? ????????? ? ????????????? ????????. ??????????? ????????????. 2010; 6: 41?9.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
20.
21.
22.
23.
24.
25.
Tomsick T.A., Brott T.G., Chambers A.A. et al. Hyperdense
middle cerebral artery sign on CT: efficacy in detecting middle
cerebral artery thrombosis. Am. J. Neuroradiol. 1990; 11:
473?7.
Vuia O. Intracerebral angioarchitectonic venous territories.
Rev. Roum. Neurol. 1966; 3: 235.
Ehlers H., Courville C.B. Thrombosis of internal cerebral veins
in infancy and childhood. J. Pediatr. 1936; 8: 600.
Ferro J.M., Canha~o P., Stam J. et al. ISCVT Investigators.
Prognosis of cerebral vein and dural sinus thrombosis: results
of the International Study on Cerebral Vein and Dural Sinus
Thrombosis (ISCVT). Stroke. 2004; 35: 664?70.
Skriver E.B., Olsen T.S., Herning M. Cause of cerebral infarction in the carotid territory: it is relation to the size and location of the infarct and to the underling vascular lesion. Stroke.
1985; 16 (3): 459?66.
Savoiardo M. CT scanning. Stroke: Pathophysiology.
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Bousser M.G., Ferro J.M. Cerebral venous thrombosis: an
update. Lancet Neurol. 2007; 6: 162?70.
Palena L.M., Toni F., Piscitelli V. et al. CT diagnosis of cerebral
venous thrombosis: importance of the first examination for fast
treatment. Neuroradiology J. 2009; 22: 137?9.
Saposnik G., Barinagarrementeria F., Brown R.D. et al.
Diagnosis and management of cerebral venous thrombosis: a
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Heart Association/American Stroke Association. Stroke. 2011;
42: 1158?92.
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CT? J. Neurol. Neurosurg. Psychiatry. 1999; 67: 651?3.
Warwick J.H., Barber P.A., Hill M.D. et al. Use of the Alberta
Stroke Program Early CT Score (ASPECTS) for assessing CT
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45
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Moscow: Andreeva T.M.; 2006 (in Russian).
KЖnig M., Klotz E., Luka B. et al. Perfusion CT of the Brain:
diagnostic approach for early detection of ischemic. Stroke.
1998; 209: 85?93.
Wintermark M., Sesay M., Barbier E. et al. Comparative overview
of brain perfusion imaging techniques. Stroke. 2005; 36: 83?99.
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Barbarash L. How to distinguish between venous and arterial
strokes and why? Neuroradiology Journal. 2011; 24 (2):
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Vuia O. Intracerebral angioarchitectonic venous territories.
Rev. Roum. Neurol. 1966; 3: 235.
Ehlers H., Courville C.B. Thrombosis of internal cerebral veins
in infancy and childhood. J. Pediatr. 1936; 8: 600.
Ferro J.M., Canha~o P., Stam J. et al. ISCVT Investigators.
Prognosis of cerebral vein and dural sinus thrombosis: results
of the International Study on Cerebral Vein and Dural Sinus
Thrombosis (ISCVT). Stroke. 2004; 35: 664?70.
Skriver E.B., Olsen T.S., Herning M. Cause of cerebral infarction in the carotid territory: it is relation to the size and location of the infarct and to the underling vascular lesion. Stroke.
1985; 16 (3): 459?66.
Savoiardo M. CT scanning. Stroke: Pathophysiology. Diagnosis
and Management. NY.: Churchill Livingstone; 1986.
????????? 05.09.2013
??????????? ?????????? ??????????????, ? 3, 2013
????????? ????????? ????????????? ??????????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
46
??????
??????
╘ ?.?. ???????, ?.?. ???????, 2013
??? 616.831-005:611-018.74-008:616.125-008.313.2
?????????????? ?????????? ? ?????????? ???????????
????????? ?????????????? ??? ??????????? ??????????
?.?. ???????, ?.?. ???????
??????????? ?????????? ??????????????, ? 3, 2013
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ?
???????? ??? ? ???? ?.?. ???????) ????, ?????????? ?????, 135, ??????, 121552,
?????????? ?????????
??????? ??? ?????????, ?????? ???. ????, ?????????, ???????? ??? ? ????, ????????;
??????? ??????? ???????, ???? ??-???????????, ????????; e-mail: vareni4ek@gmail.com
??????????? ?????????? (??) ??????????? ????????????? ??? ???????? ?????? ?????
??????????? ????????? ??????????????. ?????????????????? ?????????? ??? ?? ? ???????? ????????????? ? ???????????? ??????????????. ??????????? ????? ?????????? ????????????????? ? ???????????? ????????? ????? ? ????????? ??????? ???????????? ????????, ????????, ????? ?????????????? ? ?????????????? ?? ????????? ???????????????
? ?????????????? ?????????? ?? ?????? ????????????? ????? ?????????? ????.
?????????? ?????????, ?????????? ???? ??? ????? ?????????, ?????????? ??? ?????????
???????????? ? ?????????? ? ?????? ?????????? ??????? ????????? ???????????, ??????????
??? ??????????. ????????????? ? ??????????? ?????????? ???????? ????????????? ?????????? ????????? ? ???????????? ????? ?????????? ???? ????? ????????? ??????????
?????????, ??????? ???????????? ????????? ???????? ????? ? ??????????? ??????????
??????. ?????????? ??????????? ????? ???????, ????????, ????? ????????? ? ?????????????? ? ??????????? ????????????? ?????????????? ??????????, ????????? ? ??????????
? ????????? ?????? ?????. ???????????? ?????? ?????????? ????? ???????? ?????????????????? ?????????, ??? ????????????? ? ????????????? ????????? ???????? ??????????? ?????
?????????? ????????????????? ? ????????? ??????????? ??????? ???????????? ????????.
?????????????? ????? ? ???????? ?????????????? ?????????? ? ???????????? ????? ?????????? ??????? ??? ?? ????? ??????? ???????????? ? ???????????????? ?? ???? ??????????? ?? ????????????? ????????? ?????.
???????? ?? ????????????? ?????????????? ????????????? ??? ?? ?????????????? ?????????? ?? ?????? ???????? ????????????, ??? ????????????? ??? ??? ????????? ? ???????????? ?????????????. ??? ??????????? ???, ??? ????????????? ????? ???????????? ??
?????? ???? ?? ???? ??????????? ? ????? ?????? ??????????? ??????????? ??????????
???????, ?????? ?? ??????? ????? ????????????? ???????????, ?????? ????????? ????????
??????? ?????????, ?????????? ?? ??????? ??? ?????????? ?????????? ????? ???????????
??????????. ????? ????, ??????????????? ????????? ????????????? ? ??????? ???????
????????????? ?????????????? ?????????? ? ?????????????????? ????? ??? ?? ??? ????
?????????????.
??? ??? ??????? ????????????? ??????????? ??????????????? ????????????. ??????? ???????????, ??? ????? ????????????, ??-??????, ?????? ?????????? ????????? ? ????????????? ?????????????? ???????????? ??????????, ? ??-??????, ????????? ?? ??????, ?????????????? ??????????? ??????????? ?????????????? ????????? ????????? ?????? ?? ??????
???????? ????????????. ?????????? ??? ???? ?????????? ????? ????? ???????????? ???
????????? ? ??????????? ??????? ????????? ? ?? ???????????????? ??????????, ??????????? ??? ????????? ?????????????? ??????????.
???????? ?????: ???????????? ????????? ??????????????; ??????????? ??????????; ?????????????? ??????????.
ENDOTHELIAL DYSFUNCTION IN THE PATHOGENESIS OF DISORDERS OF CEREBRAL CIRCULATION
IN ATRIAL FIBRILLATION
L.A. Bockeria, V.Yu. Taskina
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences, Rublevskoe shosse,
135, Moscow, 121552, Russian Federation
Bockeria Leo Antonovich, MD, Professor, Academician of the Russian Academy of Sciences and Russian Academy of
Medical Sciences, Director;
Taskina Varvara Yur?evna, Doctor of Ultrasonic Diagnostics, Post-Graduate Student
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????
47
????????
??????????? ?????????? (??) ??????????? ? ????? ????????? ? ???????? 1?2% ? ????????? ????? ???????????????? ?????? ??????????????? ??????????? [1]. ???????????
???????? ?? ???????????? ??? ?? ?????????? ???????? ?? ???????? ?????, ????????????? ????? ????????????? ???????? ? ???????? ????????????? ? ?????????? ????????
[2], ??? ? ?????????? ????????, ?????????
?????? ????? ? ?????????? ?????? ???????????? ???????? ? ????????????????? ????????? ??????????????? [3?5]. ??????? ??????????? ????????? ? ????????? ? ??????????????? ?? ?????????? ? ??????? 5% ? ???,
??? ? 2?7 ??? ??????, ??? ? ????????? ??? ??
[4]. ????????, ??? ?????? ?????? ?????? ??????????????? ??????? ?????????? ??????
? ???????? ? ?? [6].
?????????????????? ?????????? ??? ??
? ???????? ????????????? ? ???????? ??????????? ???????, ???????????? ? ?????
?????????? [1]. ?????? ? ????????? ???????
??????????? ???????? ????? ????? ??????????????? ? ????????????????? ???????????, ?????????????? ? ?????????? ??????????? ????????? ? ???????? ???????? ???????
?? ???? ???????? ??? ?? ?????????? ????-
??????? ???????????? [7]. ?????? ????? ?????????, ??? ??????????? ????? ??????????
????????????????? ? ???????????? ????????? ????? ? ????????? ??????? ????????????
???????? ????? ?????????????? ?????????????? ?? ????????? ??????????????? [8]
? ?????????????? ?????????? ?? ?????? ????????????? ????? ?????????? ????.
? ????????? ?????? ??????????? ?????????? ????????? ??????? ????????? ? ???????? ???????????? ??? ??????? ????? ??????????? ??? ?? ??????????? ?????????????????? ??????????, ?? ???????????????
? ???????????? ??????????????, ? ?????
??????????? ???????? ? ???????????? ???????? ? ??????????? ? ??????? ??????????????
??????????.
???? ????????? ? ???????????
????????????????? ??????????,
????????? ??????? ? ???????????
?????????? ?????????
????????? ???????????? ????? ??????????? ????? ?????????????????? ??????, ??????????? ??????? ???????????, ????????????? ?????? ? ??????? ??????. ? ????????
?? ??????? ????? ????? ????????? ??????????
??????????? ?????????? ??????????????, ? 3, 2013
Atrial fibrillation is traditionally considered as a significant factor of cerebral blood flow dysfunction.
Cerebrovascular complications at atrial fibrillation are generally associated with cardiogenic
thrombembolia. Abnormalities of microcirculation and endothelial dysfunction at the level of final link
of the vascular tree, accompanying the atrial fibrillation, may further increase the risk of local clotting in cerebral miscrovessels with the progression of clinical findings of ischaemic stroke.
Endothelium dysfunction, caused by these or those factors, is detected at various diseases and
states and always worsens the course of the primary disease, promoting its complications. Slow
blood flow, which furthers increase of blood viscosity and increase of shear stress appear to be the
reason of the progressing endothelial dysfunction in the final link of the vascular tree in addition to
atrial fibrillation. Continuous impact of such factor may lead to overstress and further decompensation of compensatory mechanisms, related to products and effects of NO. Increase of protrombothic state will be the result of such abnormality, which in addition to the cerebral blood flow, shall mean
increase of the risk of local clotting with the progression of clinical findings of ischaemic stroke. Nonregular and impact with different amplitudes concerning its strength on endothelial cells of the pulse
wave may make an additional contribution into progression of endothelial dysfunction in the final link
of the vascular tree at atrial fibrillation
Despite the theoretical grounds of existence of endothelial dysfunction at the level of tissual miscrovessels at atrial fibrillation, such an assumption shall be confirmed in practice. It is explained by
the fact that the investigations concerning this subject, conducted before, were not correct from the
point of view of the selected cohort of subject matter patients, many of which had coexisting diseases that could easily damage endothelial function, notwithstanding the presence or absence of
atrial fibrillation itself. Apart from this, diagnostic potential of the methods of confirmation of
endothelial dysfunction in a miscrocirculatory course at atrial fibrillation, applied in the past year, was
obviously not sufficient.
The current situation with clarification of significance of endothelial dysfunction in the mechanisms
of cerebrovascular complications at atrial fibrillation necessitates continuation of appropriate
research. One should note, that such investigations, first of all, should include patients with exceptional essential atrial fibrillation, and, secondly, shall be supported by the methods, providing the
most objective characteristics of endothelial state right at the level of tissual microvessels. The information received in such a way, may become a basis for inclusion of cytoprotectants, applied for correction of endothelial dysfunction into comprehensive treatment of patients with atrial fibrillation.
Key words: disorders of cerebral circulation; atrial fibrillation; endothelial dysfunction.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2013
48
??????
???????? 1,7?1,8 ??, ??? ??????????? ? ?????? ??????, ? ????? ??????? ?????????????? ???????? ????????? 900 ?2 [9]. ?? ??????????? ?????????????? [9, 10], ????????? ?
??? ???????? ??????????? ?????, ???????
???????? ??????? ? ????????? ?????????????? ???????????? ???????? ??????????,
?????????????? ??????????? ????????????? ?????????? ????? ??????????????????
??????????, ???????????? ? ?????????:
? ?????? ??????? (?????????????/???????????????);
? ????????? ????????? ? ????????????
(?????? ? ????????????? ???????? ???????
? ????????? ??????????? ? ???????????);
? ???????????? ?????????? (?????????
???- ? ????????????????????? ????????,
??????????? ??????? ??????????);
? ??????????????? ??????? (??????/????????????? ???????? ????????????).
????????? ????????????????? ????????????, ?????????????? ??????????, ???????? ????? ????? (NO), ????????????, ?????????????? ????????????????? ?????? (EDHF),
? ????? ????????????????? ?????? ?-????.
? ????????????????? ??????????????? ????????????? ??????? ?????????-1, ???????????-II,
?????????? ?2, 20-????????????????????????? ??????? (20-HETE), ????????????? F2?
? ?????????? ?????????? ?????????. ? ????????? ????????? ???????? ???? ?????? ?????????????? ?? ????????? ?????????? ???????????? ? ?? ??????????, ?????? ???????????,
NO, ????????????, ?????????? ?2, ?? ???????????? ?????????? ?????? ?????????? ????????? ?- ? ?-??????????, ????????????
??????? ???????-1 (ICAM-1) ? ??????????
????????? ??????? ???????-1 (VCAM-1). ????????? ???????????? ?????????, ????????????? ? ?????????, ???????? ??????????
?????????????? ?????? ????? (VEGF), ? ????? ?????? ????? ????????????.
? ????????? ??????????????? ????????? ????? ????? ?????????? ??????? ????????? ????????? ????????? NO ??? ??????????? ??????? ? ????????? ?????????. ?????
????? ?????????? ?? ????????????? ????? ????? L-???????? NO-???????? [11]. ? ???????
NO ????????? ????? ???????????, ????????????? NO-?????????? ??????? ??????????????. ??? ??????????? ??????????????
???????????? ????? ????? ?????????? ??????????????? ?????????????? ??????, ???
???????? ? ?????????? ???????????? ???????????? ??????????????????? (?-???).
???????????? ??????????? ?-??? ? ???????? ?????????? ?????? ?????????? ?? ??????????, ?????????????? ?????????????? [9].
? ????? ?????????? ????????, ???, ??????
?????????????, ????? ????? ????????? ????????? ??????? [10, 12]:
? ?????????? ????????????? ?????? ?????? ???????????? ??????????;
? ?????????? ??????? ??????????, ??????????????? ???????? ??????????;
? ????????? ? ????????? ???????????????
?????????? ??????, ??????????? ???????????? ??????? ???????????? ?????????;
? ????????? ??????? ? ????????? ???????????, ??????????? ????????????????????
?????????????? ???????? ???????;
? ????????? ????????? ?????????????
?????? ????????? ? ???????? ??????????
???????????? ??????? ???? ???????, ??????????? ??????????????? ??????.
? ??????????????? ???????? ?????????
NO ? ?????? ???????????? ??????????????
???????? ?????? ??????????????, ??? ????????? ???????????? ????????????? ???????
??? ?????????? ??????????? ????????????????? ??????????.
??? ??????????? ????????? ????????
????????? ????? ???????????, ??????????????? ? ????? ??????????? ??????? ?????????-????????? ?????????. ??? ???? ? ??????
????????? ?????????? ??????????, ?????????????? ?????????? ????????????? ? ????????????? ???????? ??????????????????
? ?????????????????? ????????? [9, 10]. ????? ????????, ??? ????????????? ?? ??? ???
???? ???????? ?????????????? ??????????
?????? ?????????????? ??????????? ???????? ?????? ????? ??-?? ????????????? ????????? ????? ???????? ??? ????????? ??? ?????????????? [11, 12]. ????????????? ?? ?????????????? ?????????? ?????? ????? ???
? ?????????? NO-????????? ????????? ????????? ??????, ??? ????? ????? ????????? ???????????????? ??????? ? ????????? ??????????? ???? ??????? ?????????, ? ??????? ???
??????? ? ???? ?? ???????? ???????? ?????????????? ? ??????????? ????? ???????.
?????????? ????????? ???????????? ???
????? ????????? ???????????? ? ??????????.
???, ? ?????????? ????? ????? ?????????
? ???, ??? ????????? ??????????????? ????????? ????????? ????? ????? ????? ???:
? ???????????? ??????????? [13];
? ??????????? ????????? ??????????????? [14, 15];
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????
???, ?????????? ? ???????? ????????????
??????????? ? ???????? ????????, ? 60?70%
??????? ?????????? ? ??????????????? ????????? ???????? ???????? ???????, ?? ???? ??
????????????? ? ???????????????????????.
?????? ????????, ??? ? ????? ??????? ?????????? ?????????? ????????????????? ?????
??????? ?????? ?????????? ?????????, ??????? ???????????? ?? ??????? ?????????
???????? ??? ?????????????????????? ??????????????? ????????? ???????? ???????,
??????????????? ? ??????? ??? ??? ???????????????? ???????????? [31]. ????? ????,
?? ?????? ????????? ????????????, ????????? ???????????????? ??????? ?????????
???????? ??????????? ??????????? ??????????? ?????? ? ????????????? ?????????????? ? ??????? ? ??????????? ????????? ???????????????? II ? III ?????????????? ??????? ?? NYHA [15].
????????????? ?????????? ???????????? ????? ?????? ? ???, ??? ??????????????
?????????? ????? ???? ?? ?????? ??????????,
?? ? ??????????? ???????? ????? ????????
????????-?????????? ???????????, ? ????????? ????????????? ? ???, ? ????? ????????? ??
?????????? ??????????? ????????????? ???
?????????? ????????? ?????????????? ??????????, ???????????????? ???????? ??????? ??????????? ???????? ??? ????????????? ???????? [32].
??????????? ?????????? ??? ???????
?????????????? ??????????
? ?????? ????? ?????????????????
? ???????????? ????? ?????????? ????
????????????? ? ?? ????????? ???????? ?????????? ????????? ? ????????????
????? ?????????? ???? ????? ????????? ?????????? ?????????, ??????? ????????????
????????? ???????? ????? ? ???????????
?????????? ?????? [33]. ????????? ?????????? ?????? ?????????? ???????????????
? ???????????? ??????? ??? ????????? ???????? ????????? ? ????? ??????? ????????
? ????????????? ????????? ? ???????????
???????????? ????????? ? ??????? ?????????.
?????????? ?????????? ?????? ????????
????????? ??????????? ? ????????? ???? ???????? ??????????????? ? ?????? ????? NO.
??? ???????? ??????? ????????????? NO
????? ????? ????????? ?????????????? ??
??????????? ? ???????? ??????? ? ?????????
??????????? ????????????? ????????. ?????? ?????? ?????????, ??? ??????? ?????????
??????????? ?????????? ??????????????, ? 3, 2013
? ??????????? ??????? ?????? [16, 17];
? ?????????????????? ????????? [6];
? ???????????? ????? ? ?????? ??????????? ???????????? ?????? [18];
? ??????????????????? ?? ???? ?????????????, ??????????????? ???????? [19, 20];
? ???????? ??????? [21];
? ???????????? ????? [22] ? ?????? [23];
? ???????????? ???????????? [24];
? ???????????? [25];
? ??????????????? ?????????? [26];
? ??????????????? ???????? [27];
? ? ??????? ???????? [28].
????????????????? ?????????? ?????????, ??????????????? ???????????? ?????????? ?????????, ? ??????????? ?? ????????? ????????? ??????????? ????? ?????????
[10, 29]:
? ???????????????? ????????? (???????????? ?????????? ??????, ??????????? ??????????? ????????? ?????);
? ??????????? ????????;
? ????????-??????????? ???????????;
? ??????????????????;
? ????????????????????;
? ?????????? ? ?????????? ????????????.
????? ?? ?? ???? ???????????????? ??????? ????????? ??????????? ???????????????? ?????????, ??? ????????????? ?????????? ?????? ?????????? ??????? ?????????
???????????, ?????????? ??? ??????????.
???, ??? ???????? ??????? ?????????????
?????????? ????????? ????????????? ? ????????????????? ????????????? ?????- ? ??????????????? [21]. ??? ????????? ????????????? ?????????????? ??? ?????????? ????????? ??????????? ??????????? ??????????
??????????, ???? ????? ??????????????
? ?????? [17] ? ???????? ????? [6].
??????????? ???????? ??? ????, ??? ? ????
??????? ?????????????? ?????????? ?????
?????????????? ? ??????, ??????????????
??????????? ???????????? ???????????,
? ??????? ???????????? ?? ???????????. ???,
??????? ????????? ? ??????????? ????????? ????????? ??????????????? ?????????
????????? ??? ?? ????????? ????????? ???????????????????? ????????? ??????? ? ???????????? ???. ??? ???? ? ??? ? ????????????????? ?????????????? ??????????? ??????????? ???????????????? ??????????? ? ???
??????????? ????? ???????, ??? ?????????????? ??? ??????????????? ?????????????
?????????? ?? ?????? ?????????? [30]. ?????
???????? ????, ??? ??????? ?????????? ????-
49
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2013
50
??????
?????? ????????? ????????? NO ????? ?????
? ?????????????? ? ??????????? ????????????? ??????????, ?????????????? ???????
?????? ?????. ?????? ????????, ??? ?? ????????
??? ?????????? ????? ?? ??? ????? ?????????
? ???????????? ??????????????? ? ????????
?????????????????? ?????????. ????????, ???
????? ?????????? ????? ?????????????? ???????? ?????????? ?????????????????, ??? ????????????? ? ????????????? ????????? ?????
????????? ??????????? ? ??????????? ?????
??????????? ?????????, ?? ????????? ? ???????????? ??? ?? ?????????????? ????????????? ?????????????.
????? ????? ????????????, ??? ?????????????? ????? ? ???????? ??????????????
?????????? ??? ?? ????? ??????? ???????????? ? ???????????????? ?? ???? ??????????? ?? ????????????? ????????? ?????, ???
??????????? ???????????? ? ????????????? ?? ???? ???????????? ?????????? ? ??????????? ???????? ?????? ??? ??. ???????????? ???? ????????? ?????????? (?, ???
?????????, ???????????? ????????? ????????? ?????) ??? ?? ??????????????? ??????????? ?????????? R?R ? ????????? ??????????? ????????? ???????????? ??????????, ???? ???????? ??????? ? ???, ???
??????????????? (??????) ??????????? ????????? ??????????? ?????????? [34].
? ???, ? ??????? ?? ?????????? ? ???????
?????????????, ?????????? ????????? ?????????? ??????? ?? ????????? ?????????, ??????????? ?????????????? ?????????? ????? ???? ??????? ? ????????? ????????, ??????????????? ??? ??? ??, ??? ? ??? ????
???????????. ?? ????? ???????, ??? ??? ???????? ??????? ?? ??????? ????????? ??????
?? ?????????????? ?????????? ???????????
?????? ??? ? ????????????? (??????????????) ??, ?? ???????????? ? ??????-????
??????? ?????????????, ?????????? ?????
????????????? ?????????????? ??????????. ???? ???????? ?? ????? ?????? ????????? ??????????, ?? ????? ??????? ????????, ???
? ?????????? ???? ??????????? ?????????
? ??????? ?????? ????????????? ?? ??
??????? ?????????. ??? ??????? ? ???, ??? ??
???? ??????????? ????????????? ?? ????
????? ?? ? ?????????????? ??????????? ??
?????? [8, 35] ?? ???????????? ???? ??????????? ?????? ?????????? ? ??????????????
??. ???? ?? ???????? ????????????? ???,
??? ?????????? ????? ??????? ? ??, ? ???
????? ? ?????, ??????? ????? ?????????????
???????????, ????????? ????????? ??????????????? ?????????? ??????? ?? ??????? ?????????. ????????, ??? ??? ????? ??????
?????????? ??????? ?????????? ??????????, ?????? ??????, ?? ????????? ?????? ? ??????? ??????????? ??????? ?? ????????? ????????? ??????? ?? ? ??? ?????? ????.
?? ??????????????? ???????, ??? ?? ??????????? ???? ??????? ?? ?? ??????? ????????? ???????? ???????????, ??? ??? ?? ???
??? ?? ???? ????????? ???? ?? ?????? ???????-?????? ??????????? ???????????? ????????? ?????????????? ??????? ? ???????
?????? ? ?????????????? ??.
?????? ???????????
?????????????? ??????????
? ?????????? ??????? ?????????? ????? ??????? ??????????? ?????????????? ??????????, ?????????? ?? ????????? ?????????.
???, ??????? ? ???????? ?????????? ????????? ????? ???? ???????????? ? ???????
????????????? ???????????????? ???????,
????????????????? ?????? ???????? ?????????? ??????? ??? ?????????? ???????????
???? ?? ????????? ???????. ? ???????? ?????
???????? ????? ???? ???????????? [36]:
? ???????????? ????????? ???????????
???????;
? ????????? ? ???????? ???????????;
? ???????? ???????;
? ????????????????? ????? (????? ?????
? ????????????? ? ???????????).
??? ?????????? ??????????? ???? ???????????? ?????????:
? ???????? ????????? ? ????????? ?????????? ????? (? ??????? ??????????????
??? ???????? ????????????? ??????????);
? ???????? ???????????? ?????? (? ??????? ??-????????? ??????????? ??????);
? ?????? ??????????? ????? ????, ????
????? ?????? (? ??????? ??????????????
????????? ???????????).
???????? ???????????????? ??????? ???
?????? ???????????????? ??????? ????????? ???????? ?????????????? ??????????? ????? ? ??????????? ???????? ???????.
??? ?? ?????????? ?????????? ???????? ??????? ???????? ?????????, ???????? ? ??????? ??????????? ?? ????????, ???????????
????????????? ???????? ???????????? ???????? ?? 30?50 ?? ??. ??. ?????????? ???????? ??????? ???????????? ?? 1 ?? 5 ???, ????? ????
?????????? ?? ??????? ???????????? ? ??????
??????????? ??????????, ???????????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
????????? ???? ???????? ??????, ???? ?????????? ??????????? ?????????, ??????????? ??
?????? ???????? ??????? ??? ? ?????????? ???? ????????? ??????. ????????, ??? ?????????? ?????????????????? ????????? ????????
???????? ? ??????????? ?????? ?????, ??????? ???????????? ???????????????? ??????
? ???????????? ??????????? ???????? ????????? [36].
??????????? ??????? ??? ?????????? ??????????? ?????, ????????????????? ????????????? ????????? (????? 20% ?? ?????????
??????) ???????? ?????????? ???????????
?????????, ????????? ?? ??????? ?????????
???????????????? ??????? ?????????, ????????????? ? ????????????? ??????????? NO
? ?????? ???????????????. ?? ???? ?? ??????????????? ? ????????????? ?????????? ???????? ???????? ??????? ? ???? ?????????? ?????????????????? ?????????, ??????? ? ?????
??? ?????????? ??????????? ????? ??????
????????? 10% ?? ????????? ????????.
?? ????????????????? ????, ??????????????? ?????????-????????? ?????????????, ???? ????? ????????? ???????? ? ?????????????? ?????????? ???????????? ???
??????????, ??????? ????? ????????????
????????? ???????????? ????????? ??????????? NO, ?????????????, EDHF ? ??????????? ????????? ?????????????. ?????????-??????????? ????????? ???????????
????????? ? ??????? ???? ? ??????????????? ? ??????????????, ??????? ????????
?????????? ?????? ?????, ???????????? ????? ??????????? ?????????????????? ?????????????? ?????? ???????? ??????. ??????? ?? ???????? ???????? ????????????????? ??????????, ???????? ? ???? ?????
?????????????, ??????? ????? ??????????
????? ????????? ? ??????? ???????? ????????????? ?????????? ??? ??????????????? ?????????????? ??????????????.
?????? ?????? ? ?????? ???????????????
????????? ????????? ??????? ? ????????????? ????????????? ???????, ???????????
?????????? ? ????? ????? ???????? ??????????? NO ? ?????? ?????????????? ???????????? ?????????? [9].
??? ????????? ???????/?????????? ?????????????? ?????????? ????? ???? ????????? ? ???????????????? ??????, ??????????
?? ?????????? ?????? ????????? ??????????????????? ????? ? ????????? ??????????????? ? ??? ?????????. ???????? ???????????? ??? ????? ???????, ??? ???????, ??????
51
?????????????????? ????? ?????????? ??????????? ? ????????? ???? [8].
????????? ?????? ????????? ?? ??????????? ????????????? ?????????????? ?????????? ?? ?????? ?????????????? ???????
??????????? ????????????? ? ????? ???????????????? ?????????????? [16, 37].
????????? ??????????? [38, 39] ??? ????????? ????????? ????????? ?????????? ?????
??????????? ????????? ?????????? ? ?????,
????????? ????????????????? (???), ?? ??
??????, ???????? ???????? ??????????????
??????????. ??? ??? ???????? ?????????
????????? ? ????? ? ??????????, ??????????? ??????????????? ?????, ?? ???? ???????? ???????????????? ?????? ????????????
???????, ??? ???????? ????????? ?? 24 ? ?? 30
?? 300 ?? ????????? (??? ???????? ????????? ????????? ?? 20 ?? 200 ???/???). ?????????? ?????????????, ??? ??? ?? ??????
???????? ???????? ?????????? ? ?????????????? ??????? ?????, ?? ? ????? ???????? ???????????? ????????????????? ?????????
???????????? ? ????????? ? ???? ???????
?????????? ????? ???????? ?????????? ???
????? ??????? ????? ???????????, ? ????????? ??? ???????? ???????, ???????????? ???????????, ???, ?????????????? ????????
? ????????? ???????????????.
?????????? ??????????????, ??? ? ???????
? ?? ?? ????? ???????????? ????????????
???????? ? ??????????? ?????????????? ?????????? ?? ???????? ???? ???? ????????????
???? ??? ??????. ???? ?? ??? ??????????????
???????????????? (????????????????????????) ?????? ????????? ???????????????????
????? ?????????? ??????????? [8], ? ?????? ?
?????????? ?????????????? ?????? ?????????
???????? ???????? ??????? ? ???? ??????????
?????????????????? ?????????, ?? ???? ?????
Celermajer [35].
??????? ????????, ??? ??? ???? ?????? ????? ???? ????? ??????????. ???, ????????, ???
???????????????? ?????????? ?????? ??????????????? ?????? ???????? ? ??? ??? ???? ???? ?????????? ?????????????? ??? ???????
??????????? ???????. ????? ????, ?????????? ? ??????? ??????????? ?????? ? ????????? ??????????????? ??????????? ???????
? ?? ??????????? ???????? ????????????????? ???????, ?????? ?? ??????? ????? ????????? ???????????. ? ????? ?????????? ????????????????? ???????????? ? ??????? ??????
????? ?????? ????????????????? ? ???????
????????????? ?????? ???????? [8].
??????????? ?????????? ??????????????, ? 3, 2013
??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2013
52
??????
??????????? ?? ???????????? ?????
Celermajer, ????????????????? ?????????????? ???????????? ????????? ???????? ???????? ??????? ????? ?? ?????????? ?????????
? ??????? ??????? ?????????, ???????? ????????? ?????????? ? ????????? ?????????????? ??????? ?? ?????? ????????????
??????? ???????, ?? ?? ? ?????????????????? ?????. ????? ??? ????????, ??? ??? ????? ???????? ?????????? ?????????????????
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?????????? ? ????????? ????????? ??????
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[6]. ?? ????? ???????, ??? ??? ??????????? ?????????????? ?????????? ?? ?????? ??????????????????? ????? ? ??????? ???????
???????? ??????, ??????????? ?????????
?? ???????????? ? ???????? ????????????
???????? ????????, ? ?????? ??????????????? ???????? ? ?????????? ???????? ???????????? ? ?????? ??? ??? ???? ???????????
????.
????? ???????, ?????? ? ????????????
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?????????? ? ??????? ? ?? ? ???????????? ????? ?????????? ??????? ??? ??? ???????? ????????, ????????? ??????????????
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????? ??????????? ??????????, ?? ??????????? ???????? ????????????? ??????????? ??????????.
??????????? ????????, ??? ????????????
??????? ????????????? ????????????? ???????? ??????????????? ?????????????? ?????????????? (?????), ?????????????????
????????????? ?????????????? ????????, ?????????? ?? ??????? 20?25 ???, ???????
???????????? ??????????? ????????? ???????????????? ?????????, ???????????? ? ?????????????????? ????? [36]. ??????? ????????????, ??? ?????????? ????? ??? ??????
?????????? ????????? ? ???????????? ????????? ???? ??? ?????????? ??????????? ????? ? ??????????? ???????? ??????? ?????
????????? ?????? ? ????????? NO-?????????
???????????????? ??????? ????????? ??
?????? ????????????? ????? ?????????? ???????. ??? ?? ???????? ????? ???? ?????????
? ??? ?????? ?????????????? ??????? ?? ???????????????? ??????? ????????? ??????????????? ? ????????????? ??????? ???????
??, ? ????????? ?????????? ??????????????
??????? (??) ???????? ??? ? ??????????????? ???????? ╚???????? III╩. ????? ????, ??-
????????, ?????????? ? ??????? ??????????? ????? ? ??????? ??????????? ?????????????? ? ?????????????? ?????, ????? ????????? ???????? ? ??? ???????? ???????
? ?????????????? ?????????? ?????????
? ?? ???????????????? ???????, ??????????? ??? ????????? ?????????? ?????????.
????????, ??????, ??? ????????? ? ??????????? ??????????? ? ??????? ? ?? ?????????????? ?????????? ? ???????????? ????? ?????????? ???? ?? ?????? ????? ? ?????????? ???????? ??????? ? ??????? ?????????
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??????? ????????? ?????? ?????????? ???????? ??? ???? ??? ????? ??????????? ???????
??????????, ???????, ??????????, ? ??????????? ??????????? ????????? [38]. ??? ????????, ???, ????????, ??? ???????? ??????? ?? ?????????? ?????????????? ?????????? ??????
????? ????????? ?????????? ???????? ????????, ??? ???????????? ??????????? ??????????? ?? ? ???????? ??????????? ????????,
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?????? ????????, ??? ? ??????? ? ?? ?????????? ?????????? ??????? ????????? ?????? ??????? ?????? ????? ??????????? ???????????????? ???????, ?????????????? ?????????? ????????? ????. ????? ???????,
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??????????? ??????????? ?????????) ? ???????????? ??????????? ????????? ?????.
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??????????? ?????????? ??? ??? ???? ??????????? (????????, ????????????? ??? ???????? ??????? ??? ???????????? ??? ??),
?????????? ???????, ??? ??? ??????????????
??????? ????????? ??????? ????? ???? ??????? ????????, ??????????? ?????????????? ?????????? ??????? ?? ?????????.
???, ? ????????????????? ?????????,
????????? ???????? ?????????????? ????????? ????????? ??? ????? ?????? ?????????????????? ????????????, ??????????? ??????? ???????????? ??????? (????? ?? ???????
?????????, ????? ????????? ?????????????,
??????????? ???????????? ?????????? ????), ?????????? ?????????? ????????, ??????????? ??????? ? ??????????????? ????????? [14].
??????????????? ????????? ?????????????? ?????????? ??????????????? ?????????? ???????????????? ?????????? ????????? ????????????????? ?????.
? ?????????? ??????? ???????? ?????
??????? ??????? ?? ?????????????? ????????? ????????? ?????????? ????????, ???????
?????? ???? ??????????????? ? ???????????
??????? ?????? ????????-?????????? ??????????? [16], ???????????? ???????????? ????????? [40] ? ?????????? ????????? ???????
II ???? [41]. ??????? ???????? ???????? ?????? ??????????? ? ??????? ?????????????
?????? ?????????, ??????????? ?? ??????????? ????????? ? ??????????? ??????????????, ??????? ? ??????? ?????????????
????? ????????, ????????? ?????????? ??????? ? ???????? ??????????? ?????????????
? ?????????. ????? ??????? ???????? ?????
?????????????? ?? ?????????????? ?????????? ?????????????? NO-??????? (NOS),
??????? ?????????? ?? ??????????, ??????????????? ?? ???? ?????????????????? ??????????. ??????????? ?????????? NOS ???????? ? ????????? ????????? ?????? ?????,
?? ???? ???????? ?????????????? ?????????
????????????? ??????????????? ?????????
?? ??????????? ??????????? ?????????.
? ?????? ???????-????????????????? ????????????? ???? ????????, ??? ??????? ???????????? ?????????????? ????????? ??????? ?????????, ???????? ????????????????
? ??????????????? ?????????, ???????????? ?????? ?? ??????? ?????????, ?????? ?????????? ????????? ??????????? ? ???????????
??????? ???????????. ? ?????????? ???????? ???????? ????? ??????? ?? ???????????
????????? ??????????????????? ???????? ??
53
?????????????? ?????? ?????????? ??????
? ???????????? ????????????????????? ? ?????????????????? ???????, ?????????????? ???????????? ??????????????????? ?????? [42]. ?????????? ???????? ? ???????????
??????? ??????? ??????????? ???????? ??????????? ???????? ???????????? ?????????
? ????????????? ???????? ????????? ?????????? ????????, ??? ??????? ? ?? ???????????? ???????? ?? ?????????, ??????? ???????????? ????????? ??? ????????????????????
? ???????? ? ???????????? ???????????? ??????????????????? ?????? [43].
?????? ???????? ? ??? ??? ???? ???? ?????????? ????????????? ?????? ?? ?????????? ??????? ????????? ??? ??????????? ??????? ??? ? ?????????? ????????-??????????? ????????????? ????? ?????????:
? ?????????, ?????????? ?-?????????
?????? ??????, ? ????????? [44], ?????????
[35];
? ??????? ?????? ????? L-??????? [45];
? ??????????????? ???????? ? ? ? [46];
? ???????? ??????? [47];
? ?????????? ??? ? ????????? ?????????? ???????????? II [16];
? ?-??????????????? ? ????????? [48],
?????????? [49];
? ????????? ?????????? ? ??????????
[50];
? ?????????, ???????, ????????????,
?????????, ????????? ?????? [26].
????????????? ? ??????????? ???????
? ?? ?????????? ??????????????, ??? ???
???? ????????? ???? ?? ??????????? ????????? ????????????, ????? ???????????????? ????? ???????????? ???????????????
? ?????? ?? ?????????????. ?? ?????? ???
??????? ? ???, ??? ??? ?? ??? ???????????
??? ???? ??????????? ???????? ?????????????? ?????????? ??? ???????? ??????? ??
? ??? ?????? ????, ?? ???? ? ??????? ??????
? ?????????????? ??. ??????? ??? ??? ???????????, ??? ??????????? ? ??????? ???????????? ????????? ?????????????? ???????
? ??????? ? ?? [8, 35], ?????? ??????, ?? ????????? ???????? ??????????? ??????????
?? ??????? ???????. ??? ??????????? ???, ???
?? ???? ????? ????????????? ????????? ???????? ???? ?? ?? ???? ????????? ?????????????????? ????????? (???????????? ???????????, ????????? ???????????????), ????????? ????????? ?????????? ??????? ??
????????? ????????? ?????????? ?? ???????
??? ?????????? ?????????? ????? ??.
??????????? ?????????? ??????????????, ? 3, 2013
??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
54
??????
??????????
??????????? ?????? ?????????? ???????,
??? ???????????? ????????????? ? ???????
?? ?? ????????? ??????????? (???????????????????) ????????? ? ??????????????
??????? ? ???????????? ????? ??????????
??????? ????????? ? ?????????. ????????,
??? ???????????? ???????????????? ??????? ????????? ?? ?????? ???????? ???????????? ? ??????? ?????? ? ??????????????
?? ????? ?????? ????? ??????? ?????????
??????? ??????????? ??????????????????
??????????, ??????????? ???????? ??
? ??? ????????????? (??????) ????. ?????????? ??? ???? ?????????? ????? ????? ???????????? ??? ????????? ? ??????????? ??????? ????????? ? ?? ????????????????
?????????? ???????? ??????? ????????, ??????????? ??? ????????? ??????????????
??????????.
??????????
1.
2.
3.
??????????? ?????????? ??????????????, ? 3, 2013
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??????? ?.?., ??????????? ?.?., ??????????? ?.?., ???????? ?.?. ??????????? ? ?????????-???????????????
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? ??????? ??????? ? ???????????? ????????. ?????????
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Vrachebnaya praktika. 2003; 4: 5?10 (in Russian).
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??????????? ?????????? ??????????????, ? 3, 2013
??????
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??????
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??????????? ?????????? ??????????????, ? 3, 2013
????????? 16.07.2013
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????
57
??????????? ?????????? ??????
╘ ????????? ???????, 2013
??? 616.124.2-005.4-089.844:616.132.2-003.2:616.131
??????????? ??????????????? ?????? ????????? ??? ??????????
?????????? ????? ?????????? ??????? ?? ????????? ??????
?.?. ??????, ?.?. ???????, ?.?. ????????
?????? ??????? ????????????, ???????? ???. ????, ??????????? ??????????? ??????????
???????????????? ???????? ????????????? ? ????? ??????? ???? ????? ? ???; e-mail: orhn@yandex.ru;
??????? ??? ?????????, ?????? ???. ????, ?????????, ???????? ??? ? ????, ????????;
???????? ??????? ????????, ?????? ???. ????, ?????????, ?????????? ??????? ??????? ???????????
???? ???????????? ? ???????? ?????? ? ??????? ???????????? ??????????????? ??????
????????? (??) ??? ?????????? ?????????? ????? ?????????? ??????? (?????) ??? ????????? ????? ???????????, ??? ??????? ?? ???????????? ????????? ??????????????? ? ?????????? ?????????????? ???????.
???????? ? ??????. ??????????? 111 ????????? ? ?????. ???????????? ??????????
??????: 1-? < 1 ????, 2-? ? 1?3 ????, 3-? > 3 ???. ?????, ???-???????????? ????????? ???? ?????????, ???????????? ??????????????? ? 26 ????????? (?? ??? 21 ???????? 1-? ??????), ???????????????? ???????????? ? 92 ????????? (?? ??? 39 ????????? 1-?, 13 ? 2-?, 40 ? 3-?
?????), ?????????????? ?????? ??????????? ? 60 ????????? (?? ??? 37 ????????? 1-?, 23 ?
3-? ?????). ?????????????? ????????? ?????? ??????????? ? ?????????????? ????????
?icrosoft Excel 2000 ? Statistica 6.0 (Stat-Soft, 2001).
??????????. ?????????? ??????? ???????????? ??????????????? ?? ?????????? ? 1-? ?????????? ??????. ?????? ???????????? ??????????????? ????????? ?????????? ??????? ??????? ???????????? ??????????? ???????? ?? (25,24╠10,34%), ???????????? ??????????????? ??: ??? > 200 ??/?2, ?????? ???????? ?????????????? ???????????, ??????????
????????????????? ?????????. ??????? ?????? ?? ? ???????? ?????? ???????? ????? ???????? ????????? ???????????????, ???????, ????????????? ????. ???????? ? ???????????
??? ?? > 150 ??/?2, ?? < 35% ????????? ?????? ???????? ?????????????? ?????.
??????????. ??????? ????? ?????????? ????????????? ???????? ????????? ? ?????????
??????????, ???????? ? ?????????????? ????? ??????????. ?????? ?????????????? ?????????? ?????? ?????? ??-, ?????- ? ?????????????????? ???????, ?????????? ?????????????
????????? ??????.
???????? ?????: ?????????? ?????????? ????? ?????????? ???????; ??????????? ??????????????? ?????? ?????????; ??????????????? ???????.
ISCHEMIC LEFT VENTRICULAR REMODELING IN ANOMALOUS ORIGIN OF THE LEFT CORONARY
ARTERY FROM THE PULMONARY TRUNK
T.V. Rogova, L.A. Bo?keria, I.P. Aslanidis
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences,
Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Rogova Tat?yana Vladimirovna, Cand. Med. Sci., Deputy Head of the Department of Reconstructive Surgery
Newborns and Infants with Congenital Heart Disease;
Bockeria Leo Antonovich, MD, Professor, Academician of the Russian Academy of Sciences and Russian Academy
of Medical Sciences, Director;
Aslanidis Irakliy Pavlovich, MD, Professor, Head of Nuclear Diagnostics
Objective. Study of the causes and extent of ischemic left ventricular remodeling in the anomalous
discharge of the left coronary artery in different types of the disease, its effect on the severity of
heart failure and results of surgical treatment.
Material and methods. We examined 111 patients with ALCAPA. The age groups considered:
I < 1 year; II ? between 1 and 3 years; III > 3 years. Echocardiography, ECG studies performed
in all patients, Holter monitoring conducted 26 patients (21 patients I group), angiographic
study of 92 patients (I group ? 39 patients, II ? 13 patients, III ? 40 patients), radionuclide diagnostics methods ? 60 patients (I group ? 37 patients, III ? 23). Statistical data processing was performed with the use of programs such as Microsoft Excel 2000 and Statistica 6.0 (Stat-Soft, 2001).
??????????? ?????????? ??????????????, ? 3, 2013
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????) ????, ?????????? ?????, 135, ??????, 121552, ?????????? ?????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
58
??????????? ?????????? ??????
??????????? ?????????? ??????????????, ? 3, 2013
Results. According to the data of clinical and instrumental examination, the highest degree of
ischemic LV remodeling was defined in the first age group. Weak intercoronary collateral vessels
determines the large myocardial ischemic injury of LV (25.24╠10.34%), which determines the severity of LV remodeling LVDI > 200 ml/m2, sharp decrease in contractility, increase of dysfunctional segments number. The large size of the left ventricle into the became a risk factor for congestive heart
failure, arrhythmias, cardio shock. Patients with increase of LVDI > 150 ml/m2, EF < 35% constituted the group of the high surgical risk.
Conclusions. A large part of the affected myocardium ischemia is in a state of hibernation and could
recover after reperfusion. This makes to look for methods of pre-, intra- and postoperative treatment, which could be an alternative to heart transplantation.
Key words: anomalous origin of the left coronary artery; ischemic left ventricular remodeling; hibernating myocardiaum.
??????? ????????? ??????????????? (??)
????????????? ? 4-??????? ???????????? ????? ??????????? ?? ????????? ? ????????????
?????????? ???????? ????? ? ??????????????? ??? ???????, ??????????? ? ??????????
????????? ?????????????? ????????? ??????,
????????? ???????????????? ?????????
? ?????????????? ????? ???????? ????????????? ??????? ?????????? ?????????????
? ?????????????? ?????????? [1]. ???? ?? ???????? ?????? ?????? ???????? ???????????
?? (XCH) ? ??????????? ??????????????
(????), ??????? ????? ????? ???????????????
???????, ??? ????????????? ? ????????????????. ??????? ??????? ? ??? ?? ????????????
??? ???????? ????? ?? ????? ???????????????.
?????????????, ???????????? ????????? ????????? ????????? ?????? ?????????
(??) ? ????????? ?? ???????? ? ??????????
????????? ???????????? ??? ???????????
??????? ?????? (???), ?????????? ???????????? ??????? ╚???????????????╩ ??????, ????????? H. White ? 1987 ?., ??? ???????????
??????????-?????????????? ????????? ????????? ?? ???? ??????????? ? ??????? [2, 3].
?????????? ??????? ??? ???????? ???????
??????????? ???????????? ? ???????????????? ?????? ?? ??????? ??, ????????
??? ???????? ?????????? ?????????? ?????
?????????? ??????? (?????) ?? ?????????
?????? [4]. ??????????????? ??????? ?????????????? ???????? ??????? ????? ????????
???????? ? ???????? ???????? ????????
?????? ?????????, ??? ?????? ? ??????????. ??????????? ???????? ?? ???? ???????? ??????????????? ????????? ????? ????????? ?????? ? ????? ?????????? ???????.
????????????? ?????????????? ????????
???????????? ?????? (???????????? ???),
? ?????????? ???????? ???????????? ???????? ? ??????????? ╚????????????╩ ? ?????????? ???????? ???????? ?? ????? ????????? (???????? ???) [4, 5]. ???????? ???????? ???????? ???????????.
????? ?? ????????, ???????????? ?????????????? ????????, ???????? ???????????
?????. ? ???? ?? 85% ?????????? ??????????? ????? ?????????? ? ???????? ??, ?? ????????? ????? ????? ?????? ????????????
????????????? ?? ????? ??????? ?? [5]. ????????????? ?????? ?????? ? ????????????????? ?????, ?????????? ? ????????????,
??????????? ???????? ?? ????? ?????? ??????? ??????????? ?? ????. ?????? ?????????????? ??????????? ???? ?????????????????? ??????. ?????????????????? ??????
??? ????????????? ??????? ?????? ????????? ???????? ?????????????? ??????? ???????????????????? ????????? [6]. ??????????? ? ?????? ?????????????? ???????? ????????? ????????????? ??, ??? ?????????
[7]. ?? ?????? ?????? ???????, ??????????
???????????? ????? ???????? ????????? ???
???????????? ????????? ??? ??????? ??????????? ???? [8, 9]. ?????? ????????????
????????? ???????? ?????? ? ??????? ???????????? ??????????????? ?? ??? ?????
??? ????????? ????? ???????????, ??? ??????? ?? ???????????? ????????? ??????????????? ? ?????????? ?????????????? ???????.
???????? ? ??????
???????? ?????? ???????-???????????????? ?????? ???????????? 111 ????????? ? ?????????? ??????????? ????? ?????????? ??????? ?? ????????? ??????. ??????? ??????? ????????? ?? ?????? ????????
???????? 5,09╠3,09 ????, ??????? ??? ?
18,54╠7,97 ??, ????????? ???? 35, ??? ????????? 33%. ??? ??????????? ????????????
????????? ???? ??????????? ????????????
?????? ?????????? ? ??????????? ?? ???????? ?????????: 1-? ? ?? 1 ???? ????? (48 ?????????, ??????? ??????? 6,9╠2,7 ???, ???????
??? 5,9╠1,2 ??), 2-? ? ?? 1 ???? ?? 3 ??? (16 ?????????, 2,4╠0,9 ????, 13,3╠2,9 ??), 3-? ?
?????? 3 ??? (47 ?????????, 12,46╠8,25 ????,
38,27╠20,8 ??).
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
???????????? ??????????? ? 1-? ??????
????????? ??????????? ????? 3 ??? ?????,
?????? ? 2 ??????? ? ????? 1 ???. ??????????
?????? ????????????? ??? ?????????? ???????? (? ??????????? ????????). ??? ????????? ????????????? ??? ????????????? ???????????? ??????? ?????? ?? ?????? ???
??????????????, ??? ?????????????? ?????????? ?????????, ???????????? ???????.
?????? ? 5 ????????? ??????? ???? ????? ??????? ????? ????????? ????????. ? ????????? 1-? ?????? ? 46% ??????? ???? ????????
? ??????????? ???????????? ?????????????????? ???????? ? ?????? ???? (15 ?????????) ??? ??? ???????????? ??????????? ??????? (7 ?????????). ? ????????? ????? ????????? ???????????? ?? ?????????. ?? ??
????? ? ?????????? ????????? ??????????.
? ??????? ????????? ?? 10 ??? ?? ??????????? ?????? ?? ????????? ????????????,
?????? ??? ?????????? ????????, ????? ???
? ???????? ????? 15 ??? ?????????? ???? ? ??????? ?????? ? ????????? ???????????? ???
??????? ??? ????????, ??? ??????????? ? ????????????? ??????? [10, 11]. ? 3-? ?????? 12
(25%) ????????? ????? ???????????? ??????? ╚??????????????? ??????????? ???????╩,
3 ?? ??? ????????? ?????????????? ??????????? ???????, ? 1 ? ????????????????, ??????
??? ?? ??? ????????? ??????? ?????.
???????? ????????? ??????? ??????????? ????? ??????? ???????????????????? ???????????? (?????), ??????????? ??????????
?? ?????? ??????? ????????????? ??????????? ????? ?????????? ??????? ? ?????????????? ????????? ???????? ??. ????? ? ??????????????? ????????? ???? ?????????.
???????????? ??????????????? ????????? 26
(?? ??? 21 ???????? 1-? ??????), ???????????????? ???????????? ? 92 (1-? ?????? ? 39,
2-? ? 13, 3-? ? 40 ?????????), ??????????????
?????? ??????????? ? 60 (1-? ?????? ? 37,
3-? ? 23 ????????).
??????????
???????? ?????? ??????? ? ??? ?????????, ??? ?????-??????????? ??????????????? ?????????? ??????? ????????? ?? ???????????? ??????????????? ??????????
????????? ??????????????? ?????? (???)
?? (??) ? ??????? ??????????? ???? (BSA)
(?2) ? ??? (??/?2). ?? ???????? ? 1-? ?????? ????????? ??????? ???????? ??? ?? ????????? 211,73╠65,01, ?? 2-? ?????? ?
92,76╠41,12, ? 3-? ?????? ? 83,74╠35,97 ??/?2
59
(p<0,001). ??????? ??????? ?????? ?????????
?????????????? ????????? ???????: 1-? ?????? ? 33,65╠9,08%, 2-? ?????? ? 50,87╠11,97%,
3-? ?????? ? 59,23╠9,88% (p<0,001).
? 60% ????????? 1-? ?????? ??????? ???????? ?? 2? ? 3 ???????, 5 ?? ??? ?????????
? ???????????????? ?????????, 3 ? ? ????????????? ?????????? ?????? ?? ????????
? ????? ? ???????? ?????????. ????????? ??????????????? ??????????????? ??? ????????????????, ? ????????? ?????????? ??????, ????????? ??????, ???????? ??????? ??
??????????? ?????????????? ????????????.
? 62% ????????? 2-? ?????? ????????????????? ?? 2? ???????, ? ????????? ? 1 ???????
??. ???????? 3-? ?????? ????? ????????
?? 2? ??????? ? 13% ???????, ? 1 ????????
?????????? ?? 2? ???????.
???????? ????? ??????????? ????????? ??
??? ???????? ??? ?????????? ????? ????????????????? (??? ????? 150 ??/?2), ??? ?????????? ??? ????????? 1-? ?????? (???????????? ???): ??????????? ????? 0,035'' ????? Q ? 75%, ?????? ???????? ST ????? 2 ?? ?
65%, ?????????? QTc (????? 0,44 ?) ? 38% ?????????. ????? ??? ?? 2-? ? 3-? ??????? ??????????? ????????? ?? ??? ???????????????? ?????. ???????????? ???????????????
????????? ??????? ?????? ???????? ST ????? ??? ?? 2 ?? ?? ????? ???????? ????????,
????????????????? ??????????????? ??????????? ????? 190 ??/???, ? 5 ?????????
1-? ??????, ???????????? ????????????
?????????? ? ? 6 ????????? 1-? ??????
? 1 ???????? 3-? ??????. ????????? ?????
????????????? ? ????????? ? ??????????
??????????? ??????? ?????? ?????????,
??? ????????: 1-? ?????? ? 205╠59,15,
3-? ?????? ? 128 ??/?2, ??? ??????????? ????????? ?????????? ?????????? (40?50 ??/?2).
?? ?? ????? ? ?????????? ??????? ??????????????? ?? ? ????? ???????? ??????? ???
?????.
?????? ?????????????? ??????????? ??????? ?????????? ??????????????? ?? ?????????? ?????? ?? (???) ? ????? ????????????
?? ?????????? (r = 0,132, p = 0,218). ????????
?? ???????? ?????????? ? ?????????? ?? ??
?????. ?????? ?????????? ?????? ??????????? ??????? ??? ?????? ?????????? Z score
?????? ??? ???????? ?????? 3 ? 2 ?????????
1-? ?????? (??? Z score ?? 3,06 ??? ???????? 419 ??/?2, ??? 5,32 ? 118 ??/?2) ? ? 2 ????????? 3-? ?????? (Z score ?? 4,0 ??? ???
100 ??/?2, 3,06 ? ??? 66 ??/?2). ???????? Z score
??????????? ?????????? ??????????????, ? 3, 2013
??????????? ?????????? ??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2013
60
??????????? ?????????? ??????
??????????? ??????? ? ????????? 2?3 ????????
? 8 ????????? 1-? ? ? 2 ????????? 2-? ?????. ?????? ????????????? ????????????? ??????
????? ???????? ?????? ?????????? ????????
Z score ??????????? ??????? ? 1-? ?????? ????????? (p <0,001), ?? ???????? 1,6╠0,9. ?????????
??????? ? ?????????? ???? ?? ???????.
???? ????????? ?????? ??????????????
????????? ?????? ????????? ?? ?????????????????????? (???) ????????? ? ?????????
? ??????? ??????? ?????? ?? ???????? ??????? ? ?? 1 ?? 5 ?????? ?? ???? ?????????? ??????? ??????????. ????? ??????? ???????????:
??? ??????????? ?????????, ????????????
?????? ? ??, ???????????? ???????????????
?????????, ???????? ????????? ??, ????????????????? ???????? ??, ??????????????? ??????????? ???????, ?????????? ?????? ??. ????? ?? ??????????? ????? (?)
? ???????? ????????? ??????????: 1-?
?????? ? 16,34╠3,85, 2-? ? 9,92╠3,42, 3-? ?
6,75╠2,42 ????? (p < 0,001). ??? ?????? ?,
??? ???? ??????? ?????????????? ????????? ??.
?? ???? ??????? ??????????????? ??????????? ?????? ??? ??????????? ?????????,
??? ???????? ?????????????? ??????????
??? ?????? ??????, ????? ??? ???????????
????????? ??????? ? 5 ???????. ????? ?????
? ???????? ??????? ?? ???????? ??????? ?????????? ??? ? 1-? ?????? ????????? ?
3,36╠0,9 ?????, ?? 2-? ?????? ?? ????????
2,08╠0,86, ? 3-? ? 1,28╠0,55 ????? (p<0,001).
?????????????? ???????? ?? ???????? ?????? ?????????? ??????? ? ????? ??? ???????? ??????? ? 1-? ?????? ????????? ?
2,63╠0,63 ????? (?????? ????????? ? 64%),
?? 2-? ?????? ? 1,92╠0,86 ????? (?????? ????????? ? 30%), ? 3-? ?????? ? 1,25╠0,5 ?????
(?????? ????????? ? 2%) (p<0,001). ???????????? ?????????? ????????????????? ????????? ?? ????? ???????? ? 1-? ?????? ?????????. ??? ??????? ??????????????? ??????????? ??????? ?? ???????? ???????????
??????? ?? ???????. ?????????? ??????????
?????? ?????? ????????? ???????? ? ?????
1-? ?????????? ??????.
?????????? ?????????? ?, ?????????? ???
???-????????????, ? ???????? ???, ??????????? ??? ?????-????????????, ?? ??????? ??????????? ?????????? ?????? ?? (???)
?? ??????? ?????????????? ????????? ??
(????? ?????? ??? ???) (r = 0,731, p<0,001).
?????????? ?????????????? ???????? ????????? ?????????????? ??????????? ??????-
?? ??, ????????? ??????????????? ?????????
(?????????? ?????????? ??????) ?????????????? ????????? ?? ?? (r = 0,644, p<0,001).
? ?????????? ????????? ??????? ??? ???????
? ????? ???? ?? ???????.
?????? ???????????? ?? ????????????
??? ??????? ?????? ? ??????? ????????????
????????? ?? ? ??????????? ?? ????? ??????, ???????? ??????????????? ?? ? ??????????? ?? ??????? ? ??????? ????????????
?????????. ???????????????? ????????
??????????? ???? ? ??????? ?????????????? ???????, ??????? ????????? ????????????? ? ??????????? ??????? ????????????????????????? ????????? ???????? ??
?????? ??????????? ??????????????. ??
????????? ???????????? ? ????????????????????? ?????????? (???) ????????.
????????????????? ?????? ??????? ???????? (??) ????????? ? 99mTc-???????????, ??????? ???????? ???????? ??????????? ??????? ????????, ????????? ??????? ?? (S ??)
? ??????? ?????????? ??????????????????
(???). ?????? ???????????????? ????????
? ??????? ?? ???????????? ??????? ??? ??
??????? 18F-???, ??????? ???????? ????????
??????????? ???????. ???????? ????????????? F. Haas (2001 ?.), ???????, ??? ?????????? 18F-??? ? ?????????? ??????????????
??????? ???????? ???????? ????????? ?? ?????????? ?? ???????????????? [12].
???????? ???????????? ????????????
? 99m??-??????????? ? ????? ???? ?????????
60 ????????? ???? ?????: ?????? ? ? ???????? ??????? ???? ????? (n=37); ?????? ? ? ???????? ?????? 3 ??? (n=23). ??????? ??????????? ??????? ???????? (S ??) ?? ???????
?? ?????????: ? ?????? ? ? 25,24╠10,34%,
? ?????? ? ? 16╠8,57% (p<0,001). S ?? ??????? ????????????? (r = 0,823, p<0,001) ? ???????? ?????????????? ????????? ?? (?)
(??. ???????). ?????? ????????? ? ???? ????????? ??????????? ??????????????? ???????? (91%) ? ?????????????? (86%) ?????? ??. ? 84% ??????? ????????? ????????
???????????????? ?? ??????? ???????? ??.
???? ??????? ???????? ???????? ? ???????? ????? ??????????????? ???????????
(29%) ? ???????????? ?????? ?? (32%). ??????????? ?? ?? ?????? ?????? ?? ??????????? ?????? ? 2 ??????? ?????? ? ? ?????????? ? ????????? ????????? ???????????
???????? ??. ? ????? ????????? ???????
????? ??? ??????????? ?????????. ???????????? ?????? ??????????????? ? ????? ???-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??? ????????? ?????????????? ?????? ??,
???? ? ?????????????????????, ???????????, ???????????? ???????? ??. ? ?????????????? ??????? ??????? ???????????? ?????? ?????? ?? [13?15]. ??????? ????? ?????????? ??? ??? ?? ?????? ??????
???????? ????????????????? ? ?????????????? ????????. ????????? ????????? ???????????? ?????????? ???? 50, ?????????
?????? ??????????? ???????. ??????? ?????????? ???????????? ?????????? ??? 99m??
?? ??????? ?????????: ? ? 35,68╠11,78; ? ?
48,43╠17,58 (p<0,001), ?????????? ?? ???????? ?? ???? ?????????? (r = 0, 214).
??????????? ??????????? ??????? ? ??????? ??????? ???????? ? 18F-??? ???? ????????? 36 ????????? ?? ???? ? 17 ?????????
?????? 3 ???. ?????? ???? ???? ????? ???????? ??????? ??????? ??????? ?????????????
??? ???????????????? (???????????????
???????) ? ?????? ????????? ??????? ????
????? (97%), ? ????????? ?????? 3 ??? ??????????????? ??????? ? 53% ???????. ???????
???????????????? ???????? ???? ??????
? ????????? ??????? ???? ????? (?????? ? ?
25,6╠9,3% ?? ??????? ??, ?????? ? ?
17,5╠13,4% ?? ??????? ??; p = 0,04). ? ??
?? ????? ????????????? ???????????????
??????? ? 36% ????????? ?????? ? ? 35%
????????? ?????? ?, ? ????????? ????????? ??????????? ??????????? ??????? ?????????: ????????? ????????? ? ???????????????? ???????? ? ????, ???????????
? ?????. ???????? ????????? ???????? ??
??????? ???? ?????????? ? ????????? ??????? ???? ????? ? ????? ??????? ???????
(?????? ? ? 42% ?????????, S = 11,5╠3,3%
?? ??; ?????? ? ? 24% ?????????, S =
=9,24╠4,2% ?? ??, p=0,036). ??????? ????????????? ?????????????? ????????? ????????? ?? ? ??? ??????? ?????? ? ????? ??????
3 ??? (?????? ?: 11% ?????????, S = 11,1╠4,9%
?? ??; ?????? ?: 47% ?????????, S =
=16,3╠8,6% ?? ??; p<0,001).
?? ???????????????? ??????? ?????????? ??????????? ??????? ??????????? ???
?????? ??????? ???????????? ??????????????? ?? (?????, ???, ?????????????? ??????) ? ????????? ????? ? ? ?, ??????? ????????? ??? ????????? ???????????? (??.
???????).
?????? ???????????? ???????????????
????????? ?? ???????? ?????? ??????????
??????? ? ????? ? ????????? ?????? ? ???????? ? ???????? ?????? ???????????? ??????????? ??, ? ??? ??????????????? ??????? ??????? ????????. ?????????? ?????
??????????? ????????????? ?????????? ????????????????? ????????? ??, ????????
?????????????? ?????? ?? (??????? ?????????? ?????? ??), ??? ?????? ?? ????? ?????????? ????? ???-??????. ??? ???????????
????????? ??????????? ?? ??????????? ?????
???????? ?????????? ???????? ????? ?????????????? ??????? ???? ??????????? ?????????. ?? ???????? ??????????? ???????? ? ??
??????? ?????????? ??????????????? ? ??????????? ?? ?????? ???????????? ?????????
??. ??? ???? ???????????-??????????????
?????? ??????????????? ? ??????? ??????
??????????????? ???????? ?? ? ?????????
?????? ?, ??????? ??????? ????????? ????????? ????????. ??????? ??????????????
????????? ???????? ?? ?????? ? ?????????
?????? ?. ?? ?? ??????? ??????????? ??????? ?????????? ??????????????? ?? ??????
? ??????? ????????? ????????.
? ????? ?????????? ???? ???????????
108 ?????????: 46 ? ??????? ???? ?????, 15 ?
? ???????? ?? 1 ???? ?? 3 ???, 47 ? ?????? 3 ???.
???????? ?????????????? ?????????????
??????? ????????? ? 98 ???????, ?????????
????? ?????????? ??????? ? ? 10 ???????.
??? ????????? ????????? ?????? ????????
?????????????? ?????????? ?????? ???????????? ????????? ???????? ?? ??? ?????
?? ?????? ???????????????, ????????????????? (????? ????????????? ?? ???? ??????????
??????? ??????????) ? ???????????-??????????????? ????????????
??????
???,
??/?2
??? ???,
?????
??,
?????
????.
????.,
?????
? (n=36)
218,5╠64,9 1,23╠0,47 2,63╠0,63 3,16╠1,05
? (n=17)
83,49╠26,3 1,05╠0,32
p
<0,001
0,160
???,
???????
????. ??,
?????
?
??,
S ??.
S ?/?
S ??,
?????
?????,
?????,
% S ?? ?????????
(%) S ?? (%) S ??
1,9╠0,96
2,29╠0,69 16,78╠2,7 25,24╠10,34
97%
11,5╠3,3
11,1╠4,9
1,25╠0,5
0,5╠0,64
1,4╠1,14
0,95╠0,35 6,84╠2,48
53%
9,24╠4,2
16,3╠8,6
<0,001
<0,001
0,102
0,038
0,007
<0,001
<0,001
16╠8,57
0,002
? ? ? ? ? ? ? ? ? ?. ??? ? ???????? ?????????????? ?????? ??; ??? ??? ? ??? ??????????? ?????????; ?? ? ???????????? ??????????????? ?????????; ????. ????. ? ????????????????? ???????? ??; ??? ? ??????????????? ??????????? ???????; ????.
?? ? ?????????? ?????? ?????????; ? ? ????? ?????????????????????? ??????; S ?? ? ??????? ??????? ????????; ?? ? ??????????????? ???????; S ??. ????? ? ??????? ????????? ?????; S ?/? ????? ? ??????? ?????????????? ?????.
??????????? ?????????? ??????????????, ? 3, 2013
61
??????????? ?????????? ??????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2013
62
??????????? ?????????? ??????
?????? ????????? ????????? ? 5 ?????????
(3 ? ???????? ??????? ????), ??????????????
??????????? ??????? ? ? 4 ????????? (???
?????? 1 ????), ???????? ?? ? ? 8 ?????????,
????????? ?????????? ???????????? ? 14 ????????? (9 ??????? ? ? ?????? ??????? ????
?????). ? ????? ??????? ???? ????? ? 2 ??????? ??????????? ?????????????? ???????????
??????? ? ????????? ?????????????????
??????? ? ????? ? ??????????? ?????????
??. ??????????? ???? ????? ????????
???? ?????????? ? 6 ????????? (4 ? ???????? ??????? ????).
????????, ??? ? ??????????? ????????????? ?.?. ??????? ? ?.?. ????????? ???????? ??????????? ???????????? ?????? ???????????????? CD 133+ ???????? ??????? ???????? ? ????????? ? ??????????? ????????
?????? ??? ??????????????????? ??? ???????????? ???????? [16, 17], ?? ????????????
??????????????? ?????? ? ??????? ?????
??? ???????????? ?????????????? ??? ????????? ????????????????? ????????? ? ??????????????? ????????, ??????????? ?????????? ????. ???????? CD 133+ ??? ???????????
??????? ?? ????? ???????? ????????? ? 10
???????: ? 5 ????????? 1-?, 3 ????????? 2-?
? 2 ????????? 3-? ?????. ??? ??????????????? ????????????? ??? ????????? ? 4 ???????
? ????????? 1-? ??????, ??????????? ? ??????????? ????????? (????????????? ??????
??????? ? 3 ???????). ?? ???????????? ?????? ?????????? ? ????????? ? ??????????
?????????? ??, ????? ??????????? ????????? ? ???????? ?????????????? ?????????????? ???????????? ????????????? ????. ????? ?????????????? ??????? ?????????????
?????? ?????? ??????? ?????? ?????????
?????????? ???????????? ???????????? ??????? ???????????? ???????????, ??????? ????????? ?? ???? ?????? ?????????? 11% (12
?????????, ?? ??? 10 ????????? ? ??????? ???? ?????).
?????? ???????-???????????????? ??????? ???????????? 10 ????????? 1-? ??????
??????????, ??? ??? ??? ???? ?????? 6 ???,
? ????????? ??????????, ?????????? ??????????? ???????????????? ??: ??? ??????????? ????? 200 ??/?2, ?? ?? ?????????
30,5╠4,83%. ??? ???? ??????????????? ??????????? ??????? ?? ???? ???????? (????????? ?? 1,5 ?? 2 ???????). ???-?????? ???? ????????? ??????????????? ? ????????????????
?????????? ???????? ??: ??????????????
???????? ????? ???????, ????? ? ????????
??????? ?? ?????????? ?????????, ????????
??????? 4 ? ????? ?????????. ???????? ?? ???? ???????? ???????????? ???????????????
???????? ??????? ???????????? ?????????
?? ? ????? 25% (? ??????? 26,57╠8,79%, ? ????? ?????? ? 41%), ??????????????? ???????
??????? ???????????????? ????????, ????????? ??????? ?????????????? ?????????.
??????? ????? ??????? ????????? ?????????
????????? ????????? 5╠6,56% ?? ???????
??: ? 7 ????????? ?????????????? ?????? ??
???? ????????, ????? ??? ? 3 ????????? ???
????????? ?????????????? 15, 12 ? 8% ?? ??????? ??. ?????????????????? ??????????
??????????? ??????????? 4 ?????????.
?? ???????? ?????????? ????????? ??????? ??????? ?????? ????????? (?35%) ???
???, ??????????? 150 ??/?2, ????????
? 34 ????????? 1-? ??????, ??? ????????? 71%
?? ?? ???????????. ??????????? ?????????
????????????????? ??????????? ????? ????????? ? ????? ?????????? ??????????? ???????????????? ?? ???????? ?????? ??????? ????? (29%), ??? ??????? ???????? ??????? ╚?????? ???????? ??????????????
?????╩, ? ???????????? ?????????????? ??????? ???????.
??????????
??????? ??????????? ??????? ?? ??????????????? ???????????? ??????? ??????.
??? ???????????? ???????, ?? ??????
M. Friedberg (2009 ?.), ????????????????
???????? ??????? ??? ???????????? ???
?????????? ?????? ???????? [18]. C????????? ?? ?????? ???? ????? ??? ????????,
?? ?????? H. Wesselhoeft (1968 ?.), ??????????
88% [11]. ???????? ????? ????????? ??????
? ??????? ???????? ???????? ??????????????
?????? ??? ?????????? ???????? ? ???? ??????????? ???? ??? ????????? ?????. ??????
?????????? ????, ?? ?????? S. Gunaydin
(1997 ?.), ? ??????????????? ?????????? ??????????????? ???? ??? ?????????? ????????? ?? ??? [19].
?????? ???????????? ??????? ? ????????????? ??????? ?????? ???????? ??????? ???????? ????????, ????? ???????? ????????????
?? ?????? ????????? ?????????? ???????,
?? ? ??????????-?????????????? ?????????? ???????? ??. ?????? ???????? ??????
??????????? ??? ??? ? ???????? ?????????
[9, 20, 21], ?? ?? ????? ?????? ????????? ???
?????. ??? ??? ???? ??????, ??? ????? ??????????? ????? ?????? ? ????????? ????-
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????
??????????
??????? ???????????? ???????????????
?? ??? ????? ?????????? ??????? ?????????????????????? ????????? ?????????, ???????? ??????????? ?? ?????? ???? ?????. ??????????? ???????????? ??????????? ???????? ????????? ??????????, ??? ??????? ????? ???
????????? ? ????????? ?????????? ? ????????
? ?????????????? ????? ??????????. ?????????????? ?????????? ????? ???????? ????????????? ??????? ??? ??????? ?????? ???????
?????? ????????? ????? ?????????????? ????????? ????????? ? ?????????? ???????????.
??????????
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
??????? ?.?., ??????? ?.?. ??????? ? ?????????? ???????? ??????? ??????????????. ?.: ????? ??. ?.?. ???????? ????; 2004.
??????? ?.?., ?????? ?.?., ????? ?.?., ??????? ?.?. ????????? ?????? ????????? ? ?? ???????? ? ?????????? ????????? ???????????? ??? ?????????????? ?????????
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?????? ?.?., ??????? ?.?., ??????? ?.?., ???????? ?.?.,
???????????? ?.?., ??????????? ?.?. ??????????????
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??????? ?.?., ???????? ?.?., ?????????? ?.?., ????????? ?.?., ????????? ?.?. ??????????? ????????????
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??????????? ?????????? ??????????????, ? 3, 2013
????? ?????????? ?????? ???????? ?????????
???????? ? ?????????? (╚?????? ???????╩),
??? ??????? ???????? ?????????????? ???????????? ????? ?????????? [22].
?????? ???????????? ???????????? ???????? ??? ?????? ?????? ??????????? ????????, ???????????? ? ???????? ??? ?????,
???????? ?? ??????? ??????????????? ??
? ?????? ?????????? ??????? ?????????. ???????? ??????? ?????????? ???????? ???????? ???? ? ????????? ??????? ???? ?????.
?????? ???????????? ??????????????? ????????? ?? ???????? ?????? ?????????? ??????? ? ????? ??? ???????????? ????? ?????? ????? ??????? ?????? ??????????? ?????????. ???????????? ???????, ???????????
????? ???????????????? ??????? ?????????????? ??????? ??????, ?????????? ???????
????? ???????????? ??????????? ??, ???????????? ? ??????? ??????? ????????.
? 98% ????????? ??????? ???? ????? ??????????? ??????????????? ????? 3 ???. ???????????? ??????????????? ?? ???????????
? ?????????? ?????????? ????????????????? ?????????, ????????? ???????????????
??????? ??, ???????? ?????????????? ??????????? ????????. ??????? ?????? ??
? ???????? ???? ??????????????? ????????
???????? ??????? ????????? ???????????????, ??????? ???????? ???????. ???????????
??????? ?????????? ??????????????? ?? ?????????? ?????? ?? ???? ?? ???????. ?????
70% ????????? ??????? ???? ????? ? ?????
????? ??????? ??????? ????????? ???????????????, ???????? ?????????????? ??????
?? ????? 150 ??/?2 ??? ???????? ???????
??????? ?? ???? 35% ? ????????? ??????
??????????? ?????????????? ?????.
?????????? ??????????????? ?? ??????????? ???????? ???? ????????????????
???????????????, ????????? ?????, ????????????? ????, ??????? ???????? ????? ????????????? ? ?????????????????? ???????
?????????. ?????? ??????????? ???????????? ??????????? ??????? ????????? ????????, ???, ???????? ?? ????????? ???????????????? ????????, ??????? ????? ????????
? ???? ??????? ???????? ????????? ? ????????? ?????????? ? ???????? ? ?????????????? ????? ??????????. ?????? ?????????????? ?????????? ?????? ?????? ??-, ?????? ?????????????????? ???????, ?????????? ????????????? ????????? ??????, ??? ????????? ? ?????????? ????????????????
?? ??? ?????.
63
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
64
15.
16.
17.
18.
19.
20.
21.
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??????????? ?????????? ??????
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??????? ?.?., ???????? ?.?., ???????? ?.?. ? ??. ?????
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??????????? ?????????? ??????????????, ? 3, 2013
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Frapier J.M., Leclercq F., Bodino M., Chaptal P.A. Malignant
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Wesselhoeft H., Fawcett J.S., Johnson A.L. Anomalous origin of
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Haas F., Jannen L., Heinzmann U. Ischemically compromised
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Yamagishi M., Shuntoh K., Shinkawa T., Hisaoka T., Ogawa M.,
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Bockeria L.A., Golukhova ?.Z., Eremeeva M.V. et al. New
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(in Russian).
Eremeeva M.V., Golukhova E.Z., Bockeria L.A. Endogenous
angiogenesis activation in ischemic heart disease patient: different methods of myocardial revascularization of strategies for
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myocardial necrosis. Circulation. 1995; 91 (7): 2043?8.
Sutton M. St. J. Quantitative 2D echocardiography is major
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Rahimtoola S.H., Dilsizian V., Kramer C.M. et al. Chronic
ischemic left ventricular dysfunction: from pathophysiology to
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Cardiol. Cardiovasc. Imag. 2008; 7: 536?55.
Brown J.W., Ruzmetov M., Parent J., Rodefeld M., Turrentine M.
Does the degree of preoperative mitral regurgitation predict
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the pulmonary artery? J. Thorac. Cardiovasc. Surg. 2008; 136:
743?8.
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??????????? ?????? ??????? ???????????? ??????????????? ?????:
???????? ???????? ??? ????????????? ? ?????? ????????
?.?. ????????, ?.?. ????????, ?.?. ??????????, ?.?. ???????, ?.?. ????????,
?.?. ??????????, ?.?. ?????????, ?.?. ??????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????) ????, ?????????? ?????, 135, ??????, 121552, ?????????? ?????????
???????? ??????? ?????????, ?????? ???. ????, ?????????, ???????????? ????????? ????????
???????????? ?????????; e-mail: valeryarakelyan@hotmail.com;
???????? ?????? ?????????, ???????? ???. ????, ????. ????.;
?????????? ?? ???????????, ??????????? ?????????;
??????? ????? ?????????, ???????? ???. ????, ??????????? ???????????? ?? ???????? ??????;
???????? ????????? ????????????, ?????? ???. ????, ???????????? ?????? ?????????????? ????????????
????????-?????????? ? ???????? ?????????;
?????????? ??????? ????????????, ????. ????.;
????????? ????? ???????????, ???????? ???. ????, ????. ????.;
?????????? ??????? ??????????, ??????????? ?????????
? ?????? ??????????? ???? ???????? ????????????? ???????????????? ???????? ???????
??? ??????????????????? ????????? ? ???????? ? ???????????? ??????????????? ??????.
??????????????? ??????????? ??????????? ??????? ? ??????????? ? ??????? ???????????????????? ??????? ???????? ???????, ????????? ? ???????????????? ???????? ???????, ? ????? ???????? ?????? ?????? ????????????????.
???????? ?????: ?????? ???????? ???????; ???????????? ?????; ????????????? ????????????????.
V.S. Arakelyan, N.A. Gidaspov, Ya.G. Kolesnikov, N.R. Gamzaev, M.V. Shumilina, N.V. Bortnikova,
R.G. Bukatsello, E.V. Golovinova
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences, Rublevskoe shosse,
135, Moscow, 121552, Russian Federation
Arakelyan Valeriy Sergeevich, MD, Professor, Head of Department of Surgery Arterial Pathology;
Gidaspov Nikita Andreevich, Cand. Med. Sci., Researcher;
Kolesnikov Yan Gennad'evich, Clinical Intern;
Gamzaev Nazim Ragimovich, Cand. Med. Sci., Deputy Head of Medical Work;
Shumilina Margarita Vladimirovna, MD, Head of the Group of Ultrasonic Research Cardiovascular and Organ
Pathology;
Bortnikova Natal?ya Vladimirovna, Researcher;
Bukatsello Roman Gennad?evich, Cand. Med. Sci., Researcher;
Golovinova Evgeniya Viktorovna, Clinical Intern
A case of successful surgical RA revascularization in a patient presenting with renal artery stenosis
secondary to atherosclerosis and a single functioning kidney is reported. Current strategies in the
diagnosis and treatment of atherosclerotic renal artery stenosis, indications for renal artery revascularization and a choice algorithm for revascularization techniques are identified.
Key words: renal artery stenosis; single kidney; surgical revascularization.
????????
?????? ???????? ??????? ? ???????????????? ? ??????? ?????????? ???????????????????? ????????. ???????? ?????????????
?????????????????? ?????????????, ?????
6,8% ????????? ?????? 65 ??? ???????? ???-
??? ???????????? [1]. ??? ??????? ??????????? ?????????? ????? ????? ? ?????????? ????? ??????????????????? ?????????? ?????? ??????? ????????. ????? 50% ?????????
? ????????????? ?????????? ??????? ?????? ??????????? ? ?????, ? ????? ??? ? ????-
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CRITICAL ARTERY STENOSIS OF A SINGLE FUNCTIONING KIDNEY: OPEN SURGERY OR STENTING ?
WHAT IS THE DIFFERENCE?
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?????? ??????? ????? ????? ??????????????? ???????? ?????? ???????? ??????? [2].
?? ???????? ??????????? ???????????
??????: ??? ???????????? ??????? 73% ????????? ???????? ? ??????? 7 ??? [3]. ???????
????? ? ??????? 2 ??? ??????????? ? 97% ????????? ? ????? ??????? ? ?????????????
??????????, ????????? ?? 82% ? ? ?????????
? ???????????? ?????????? ? ????????????
?????? ?? 45% ? ? ????????? ? ????????????
?????? [4].
? ??????? ?????????? ??????????? ????????? ????????? ? ????????????? ???????
???????????????????? ??????? ???????? ??????? (????) ? ????????? ? ????????????
?????? [5]. ? ????????? ????? ??????????????? ????????? ??????????? ????????? ???????? ??????????? ????????????? ??? ????? ???????????????? ???????? ???????? ???????. ????? ??? ?????? ?? ???????? ???
????, ??? ??? ???????????, ??? ? ??????????? ?????? ? ???????? ???????, ???? ???
??????????? ?????? ?????????, ? 15% ??????? ?????????????? ?????????? ? ??? ???? ?????????? ???????? ??????? [6]. ??????
???????? ??? ?????????????? ???????????
??? ??????? ? ???????? ???????????? ?????. ?? ?????? ??????????? ????????? ??????????? ?????? ??? ?????? ????????????
?????????????? ?????? ????????????????
???????? ???????.
??????????? ?????????? ??????????????, ? 3, 2013
??????????? ??????
? ? ? ? ? ? ? ?., 56 ???, ???????? ? ???????
? ???????? ??: ????????? ?????????????
????????, ??????????? ?? 270/120 ?? ??. ??.
(???????? ?? ????? ???? ????????????? ?????????? ? ???????????? ???????????????
????????????), ??????????????, ????????
????, ????? ????????.
???????: ??????? ???? ??????? ? ???????
????????? 3 ???, ????? ??????? ???? ???????????????? ????????? ???? ????????????? ????????. ?????????? ?? ????? ??????????, ????????? 6 ??? ????????? ??????? ????????????? ???????, ?? ????? ?
????????????. ????????? ???????? ???????????? ??????????? ???????? ? ??? 2012 ?.
(????????? ?? ?? 270/120 ?? ??. ??.). ??????? ????????? ?? ????? ??????? ? ???? ??
?????????? 36 ???, ? ??????? ?????????
4 ??? ?? ?????. ? 2009 ?. ??????? ??????? ??????????????? ?? ?????? ??????-???????? ???????.
??????????? ??????: ??? ????????????.
?? ?????? ???????????-????????????????? ???????????? ???????????????? ? ???????? ?? ????????.
??? ??????? ???????? ?? ????????????
╚??????????? ?? ???????? ??????? ???????????????? ???????? ??????? ??? ??????????? ????????????╩ [7]. ???????? ??????? ???????????, ? ???????? ????????????? ???????????? ??? ????????????? ??????? ??
???????????? ??? ????? ? ??????????????
?????????? ???????????? ???????? ???????,
???????? ???????? ???????? ????.
????? ????? ?????????? ?????. ??????????? 2 ??. ??????? ????????. ???????: ????? ? 78 ??, ?????? ? 36 ??, ??????? ????????? ? 6 ??. ?????? ????? ?????????? ?????.
??????????? 2,4 ??. ??????? ????????????
????????. ???????: ????? ? 106 ??, ?????? ?
65 ??, ??????? ????????? ? 12 ??. ??????? ? 9 ??. ???????????: ?????????.
???????? ???????: ??????? ???????????
???????? ?????? ???????? ??????? 2,1 ??, ??????? ?????????? ? 5 ??. ???????? ????????
????????? (???, ?????????????/??????????????/???????) ?? ?????????????? ?????? ?????? ???????? ??????? ? 157/43/73 ??/?,
?I = 1,6 (???????), ?? ???????????? ??????? ? 46/10/24 ??/?, RI = 1,6 (???????); ???????? ?? ?????????????? ?????? ????? ???????? ??????? ?? ???????????, ?? ????????????
??????? ? 60/13/38 ??/?, RI = 0,53 (??????).
??????????: ??????????? ????????????
???????????? ??????. ???????????. ?????
????? ??????????? ????????? ? ????????.
?????? ?????? ???????? ??????? 60?65%.
? ???????? ??????????? ????????????????? ???????????? ??????????? [7] ???????????? ?????????? ??- ??? ??-???????????.
??????? ???????? ? ???????????? ??-????????????????? ????????????, ????????????
???????????.
??????????: ??-??????? ???????? ?????
???????? ???????, ?????????? ????? ?????
? ????????. ????????? ?????? ???????? ??????? ? ????????? ???????? ?? ????????.
?????????? ???????????? ???????? ??????
????? ? ????? ??? (???. 1, 2).
??? ???????????????? ?????? ???????
????? ?????????????? ?????????????????.
??????????: ?????? ? ????????? ??????? ????????? ??????????????? ?????????????
??????? ?????. ????????? ?????????????????????? ????????? ?????????????, ?? ????
?????????? ??????? ?????. ????? ? ????????????????? ?????.
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??????? ??????? ????. ???????? ???????
????? ?? ?????? ?????? ???????? ???????.
?????? ???????? ??????? ? ?????????????
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??????. ????? ???????? ???????? ????? ??????????? ?????? ?? ?????? ???????? ???????,
???????? ???????? ???????. ????????? ?????????? ?? ??????????? ?????? ????? ?? ??????
???????? ???????. ????????? ??????????????? ??????????????? ?? ???????? ???????.
??????????????????? ?????? ????????? ???????. ??????????????? ????????? ????? ??????????? ???????? ???? ???????????????? ????? 6/0?13 ??. ????? ????????. ????????? ? ????????? ?????? ???????? ???????
??????????, ??????????? ? ?????? ???????
??????, ????????? ????? ??? ??????????????
????????. ????? ??? ??????????. ?????????
? ???? ????? ????????, ???????, ? ??????????? ???????? ???????? ? ?????? ???????????
??????? ? ??????????? ????????????. ???????? ???????????? ???????.
????????????????? ?????? ?????????????, ??????? ??????? ? ??????????????????
????????? ?? 7-? ???.
???????????????? ????? ??????????
? ?????? ????????????????? ??????? ? ??????? ??? ???????? ??????? (??????? ????????? ?????????, ????????? ??????? ?? ????????), ??????????? ????? ??????????? ??????? ? ???????? (????. 1).
???. 1. ???????????????? ??-??????????? ?????? ??????? ?????, 3D-?????????????. ??????????????? ????????? ? ????????? ??????????????? ?????? ???????
?????, ??????????????? ?????????? ???????? ??????
??????? ?????????? ???????. ????? ???????? ??????? ??
???????????????, ???????????? ????????? ??????????????? ???????? ???????? ?????? ?????? ???????? ???????. ???????? ?? ???? ???????? ???????????? ???????
? ??????? ?????? ?????? ?????
??????? ???????????: ???????????????
????????????. ???????? ????? ???????? ???????, ????????????????? ????? ?????.
???????? ?????? ?????? ???????? ???????.
????????????? ???????????, ???????????????
???????????? ??????????? III ??., ???? ????????-?????????? ?????????? (???) ????? ???????. ??????????? ??????? ????? II?III ??.
???????? 10 ???????? 2012 ?.: ????????????????????????? ??????????? ?????? ?? ??-
???. 2. ???????????? ?????????? ??????? ??????? ??????? ? ?????? ???? ? ?????????????????:
?
? ? 3D-?????????????, ???????????? ?????????? ?????????? ???????-?????????? ??????? ?????? ?????, ??????? ??????????? ?
???????? ??????, ????? ????? ???????? ?? ????????; ? ? ??????????? ????, ???????? ??????????
???????? ????? ?????, ???????????????? ?? ???????-??????????
??????? ?? ????????
?
??????? 1
???????? ????????? ???????? ??????????? ?????????? (???)
???
?? Cockroft?Gault, ??/???
?? MDRD Study Prediction Equation, ??/???/1,73 ?2
?? CKD-EPI, ??/???/1,73 ?2
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10.09.2012
11.09.2012
14.09.2012
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??????????? ?????????? ???????????? ??????????????
???????????? ?? ???????: ????????????????? ????????? ???????? ????? ???, ??????? ??????????????? ???? ????????, ????????????????? ???????, ?????????? ??????????
??????? (???), ?-????????????????, ???????????? ?????????? ????????????-2 I ????
(???), ???????????? ? ??? ?????, ? ????? ???????? ??????????????? ????????????? ???????? ? ???????? ????? 2 ???.
??????????? ?????????? ??????????????, ? 3, 2013
??????????
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???? ????? ???? ???????? (?? ????? 5 ?? ??
????? ???????? ??????? ?? ?????? ????????????????? ????????????), ??????????, ????????? ??? ?? ?????????????? ????????
???? ????? ???????? ???????. ????????
? 90% ??????? ???? ???????????? ? ?????
? ????????????? ????? ??????, ????? ?????
?????? ??????????? ????????????? ????? [8].
???????????????? ?????????? ??????? ???????????? ?? ????????? ??????? ???????????
??????????, ??????? ??????? ?? ????????
????? 50%, ???????? ?????????????? ????????? ???????? ????? 20 ? ???????? ????????? ? ????? 10 ?? ??. ??.
?????????? ????????????? ????, ???????????? Safian&Madder. ???????? ??????
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????????????? ?????? ? ?????? ??? ????????? ?????? ?????????, ??????? ??????? ???????????? ?????? ?? ????????????????.
??????? ??????????? ???????? ????????
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??? ??????? ?????????? ???????????? ?????:
?????????????? ??????? ? ????????????????.
?????????????? ??????? ????????????? ????????????????? ? ????????? ??????????????? (???) ???????. ????????????????,
? ???? ???????, ?????????????? ?? ??????????????? ? ?????????????.
??? ???????? ??????? ? ?????????? ???????????????? ?????????? ????????? ????-
??????????? ??????????? ????????????? ?????????????? ????? (???????? ???????????
????????? ?????????????? ??????????? ??????). ????? ??????????? ????? ????????????? ? ??????, ???, ????????, ???? ??? ????????? ?????. ???? ???? ????????? ?????? ?????????????????? ????????????? ???????????
(???) ????? ????????? ? ????, ? ????? ???????? ??????? ??????????? ???????????? ??????????? ????? ???????? ??????????????????? ????????. ?????? ?? ???????????????, ??? ???????? ? ???? ?????? ????????
??? [10].
???????? ?????????? ??????????? [2, 11],
??????? ????? ????????? ??? ?????????? ??????? ??????? ????????? ? ???? ????? ?????????? ???????????? ???????????? ?? ??????????? ? ??????? ?????? ?????????. ????????? ? ??????????????????? ?????????
? ???? ?????????? ???????????? ??????????
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?????? ??????? ???????????????? ????????
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(???. 3), ? ? ??????????? ???????????? ???????? ??????????? [11] ? ? ???? ??????? (????. 2).
??????????? ? ?????????????? ???????
???? ????????: ??????????? ??????????
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(????????????? ???????? ??????? ??????
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????? I/B) ? ????????? ???? ? ?????????????? ????????????? ?????????? ????????????? (????? I/C) [2].
? ?????????????? ??????????????? ???????? ?????????: ?????????? ???????, ???????????? ????????????? ?????????????? ????????????? (???, ???, ??????, ????),
??????? ?????, ?????????? ????????? ????????? ?????, ??????????? ????? 1 ?/???,
???????? ??????????? ?????.
?????? ? ?????????? ? ????????????????
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?? ??????? ?????????? ?????????????????
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NITER, RAVE, STAR, ASTRAL, CORAL.
╚???????╩ ???????????? ? STAR, ASTRAL
? CORAL ?????????????????? ?????????? ??????? ???????????????? ????????????? ?
????????????? ?? ????????? ? ??? ? ????????? ???????????? ???????????, ???????
?????, ??????? ????????-?????????? ???????.
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*?????????????? ????? ? ????? ? ????????? ???????? ????? 7 ??.
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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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????????? ????????????? ??????? ???????? ??????? ????? ???????????????
??? ????? ??????? ? ????????? ? ???????????? ????????? ????????? ????????????????
??? ????????? ?????? ?????? ??? ????????? ????????????? ??????? ?????? ?????????
IIb
C
IIb
C
????????????
??????????????? ???????
??????????????? ???????
?????????????, ???????????????? ?? ??????????????, ????? ??????????????? ??? ?????
??????? ??? ????? ??? 60% ?????????? ????
? ?????? ?????????? ????????????? ????????? ???? ????????????? ????????? ?????????
??????????????
????????????? ???????
??????????? ?????????? ??????????????, ? 3, 2013
????????????? ??????? ????? ??????????????? ??? ????? ??????? ??????? ???????? ???????
? ?????????, ??????? ??????????? ????????????? ?? ??????? ?????, ????????? ?? ???????
????????? ???????? ??????? ? ????? ??????????? ??????? ???????????????? ???????
?? ??????????? ???? ??????? ???? ????
??? (RAOOD), ? ??????? ╚head-to-head╩
???????????? ??????????????? ? ????????
???????? ????????????? ???????? ???????.
? ?????? ??? ?? ???? ?????????? ???????
? ??????? ???????, ?? ??????????? ?????????? ?????-????, ??????????? ? ??????????
(18 ? ??? ???????? ?????? 10 ? ??? ????????? ????????????? ?? ??????????????) [12].
????? ? ???????? ??????????? ???? ???????? ????????????? ???????? ????????????? ????????? ????????????? ????? ??????????????? ???????????? ???????? ???????????
(21%, 95% CI 9?33%, ? = 0,001) ? ??????????
??????? ????? (34%, 95% CI 18?54%,
? = 0,001) [13]. ????? ????? ??????? ?? ???????? ??????? ??????????? ????????? ? ??????
? ????????? ????? ????????????? ???????
???????????? ??????????????? ?????
(87 ╠ 6%) ? ??????? 5 ??? [14].
???????? ?????????????? ?????, ??????? ????????? ???? ? ?????? ?? ?????????????, ??? ?????? ????? ? ?????? ?????????????? ??????? ???? ? ??????? ???????????
???????? ? ???????? ???????? ?????????
?????????? ????????.
??????
1. ??????? ????????? ? ???? ??????
???? ??????????? ? ?????? ???????? ???.
2. ????????? ?? ???????????????? ???????? ??????? ?????? ????????? ??????????.
3. ??????? ?????? ??? ??????? ???? ???????? ?????????? ???????????????? ????????????? ?? ?????????????? ???????? ???????.
4. ????????????? ???????????????? ?????
???? ???????????? ? ??????? ???????????
????????? ? ???????, ??????? ??????? ??????????????? ????, ???? ? ????????? ? ??????? ??????.
??????????/References
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2.
3.
4.
5.
6.
7.
8.
Hansen K.J., Edwards M.S., Craven T.E. et al. Prevalence of
renovascular disease in the elderly: a population-based study.
J. Vasc. Surg. 2002; 36: 443?51.
Hirsch A.T., Haskal Z.J., Hertzer N.R. et al. ACC/AHA 2005
guidelines for the management of patients with peripheral arterial disease. J. Am. Coll. Cardiol. 2006; 47: 1239?312.
Zierler R.E., Bergelin R.O., Davidson R.C. et al. A prospective
study of disease progression in patients with atherosclerotic
renal artery stenosis. Am. J. Hypertens. 1996; 9: 1055?61.
Connolly J.O., Higgins R.M., Walters H.L. et al. Presentation,
clinical features and outcome in different patterns of atherosclerotic renovascular disease. Q. J. Med. 1994; 87: 413?21.
Reilly J.M., Ruhin B.G., Thompson R.W. et al. Revascularization of the solitary kidney: A challenging problem in a high risk
population. Surgery. 1996; 120 (4): 732?6; discussion 736?7.
Sahin S., Cims?it C., Andac? N., Baltaciog?lu F., Tug?lular S.,
Akog?lu E. Renal artery stenting in solitary functioning kidneys:
technical and clinical results. Eur. J. Radiol. 2006; 57 (1):
131?7.
Rundback J.H., Sacks D., Kent K.C. et al. Guidelines for the
reporting of renal artery revascularization in clinical trials.
J. Vasc. Int. 2003; 14: 477?92.
Mukherjee D. Renal artery stenosis: who to screen and how to
treat? ACC Curr. J. Rev. 2003; 12: 70?5.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ???????????? ??????????????
9.
10.
11.
Safian R.D., Madder R.D. Refining the approach to renal
artery revascularization. J. Am. Coll. Cardiol. Intv. 2009; 2:
161?74.
Textor S., Lerman L., McKusick M. The uncertain value of
renal artery intervention: where are we now? J. Am. Coll.
Cardiol. Intv. 2009; 2: 175?82.
Tendera M., Aboyans V., Bartelink M.-L. et al. ESC Guidelines
on the diagnosis and treatment of peripheral artery diseases.
Eur. Heart J. 2011; 32: 2851?906.
12.
13.
14.
71
Balzer K.M., Pfeiffer T., Rossbach S. et al. Prospective randomized trial of operative vs interventional treatment for renal
artery ostial occlusive disease. J. Vasc. Surg. 2009; 49: 667?74.
Abela R., Ivanova S., Lidder S. et al. An analysis comparing
open surgical and endovascular treatment of atherosclerotic
renal artery stenosis. Eur. J. Vasc. Surg. 2009; 38: 666?75.
Davies M.G., Saad W.E., Bismuth J.X. et al. Endovascular
revascularization of renal artery stenosis in the solitary functioning kidney. J. Vasc. Surg. 2009; 49: 953?60.
????????? 21.05.2013
╘ ????????? ???????, 2013
??? 616.132.5-073.75-036.8
????????????? ?????? ??????????????? ????????????? ?????????
??????? ??????? ???????????? ??????????????? ???????
?.?. ???????, ?.?. ????????, ?.?. ?????????, ?.?. ???????, ?.?. ??????????,
E.?. ??????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????) ????, ?????????? ?????, 135, ??????, 121552, ?????????? ?????????
???? ???????????? ? ????????????? ?????? ??????????????? ????????????? ?????????
??????? ??????? ???????????? ??????????? ???????? ??????? ??????????? ? ??????????????????? ?????????: ??????????? ?????????????? ??????????? (???), ???????????? ??????????????? ??????????? (???) ? ?????????????? ????????-??????????? ???????????????
??????????? (???) ??? ??????????? ???????? ??????? ??????????? ? ???????????????????
?????????.
???????? ? ??????. ????????? 441 (100%) ???????????????? ????????????, ?? ??? ??? ?
391 (88,7%), ??? ? ?????????????? ??? ? 50 (11,3%) ????????????. ??????????????? ???????? ??????????? ?????????????? ???????????, ??? ? ?????????????? ??? ????????????
????????, ?????????????? ??? ????????? ???????????????? ??????????? ?????????, ? ??????? ??????????? ????? ????????????, ??? ??????????? ??????? ???????????? ???????
75?99% ??? ?????????? ?????? ? ??????????? ???????.
??????????. ???????? ?????????? ??????????? ??????????????? ????????????? ???? ???????????? ??????? ???????????, ??????????? ???????? ??????? ???????????????? ???
??????????????????? ???????? ???????????? ??????????? ???????? ?? 10,1%, ??????? ????????????? ? ?? 6,1% ? ??????? ??????????? ???????????? ? ?? 5,5%. ??? ????????? ?????
??????????? ??????????????? ???????? ???, ??? ? ?????????????? ??? ???????????, ???
?????????? ?????? ????????????????, ????????????? ? ??????????? ???????????? ???????? 97,6, 93,7 ? 84,7% ??????????????.
??????????. ?????????????? ?????????? ???????????? ? ??? ? ???????? ?????????????? ?
????????????? ?????? ???????????? ?????-????????????? ????????? ???????????????
??????? (???). ??? ????????????? ??? ???????????? ??????????? ???????? ? ???????? ???
??? ????????? ??????????? ?????? ????????????? ??????????????????? ??????. ?????????????? ??? ??????? ???????????? ??? ???????? ?? ??????????? ?????????.
???????? ?????: ???????????? ??????????; ?????????????? ????????-??????????? ?????????? ????????? ?????; ??????????? ?????????????? ??????????? ???????????????
???????.
??????????? ?????????? ??????????????, ? 3, 2013
??????? ??? ?????????, ?????? ???. ????, ?????????, ???????? ??? ? ????, ????????;
???????? ??????? ????????, ?????? ???. ????, ?????????, ?????????? ??????? ??????? ???????????;
????????? ???????? ??????????, ?????? ???. ????, ?????????, ?????????? ???????????????????????
???????;
??????? ???? ?????????, ????-???????????;
?????????? ??????? ??????????, ???????? ???. ????, ???? ?????????????? ???????????;
e-mail: serguladze74@mail.ru;
?????????? ????????? ??????????, ??. ????. ????.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
72
??????????? ?????????? ???????????? ??????????????
COMPARATIVE EVALUATION OF THE DIAGNOSTIC EFFICIENCY OF DIFFERENT RADIOLOGICAL
METHODS OF THE EXAMINATION OF BRACHIOCEPHALIC ARTERIES
L.A. Bockeria, I.P. Aslanidis, V.N. Makarenko, G.G. Getsadze,T.N. Serguladze, E.R. Dvalishvili
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences,
Rublevskoe Shosse, 135, Moscow, 121552, Russian Federation
Bockeria Leo Antonovich, MD, Professor, Academician of the Russian Academy of Sciences and Russian Academy
of Medical Sciences, Director;
Aslanidis Irakliy Pavlovich, MD, Professor, Head of the Department of Nuclear Diagnostics;
Makarenko Vladimir Nikolaevich, MD, Professor, Head of X-ray Diagnostic Department;
Getsadze Gela Guramovich, Radiologist;
Serguladze Tinatin Nodarievna, Cand. Med. Sci., Doctor of Ultrasonic Diagnostics;
Dvalishvili Ekaterina Ramazievna, Junior Researcher
Objective. The purpose of this study is a comparative evaluation of the diagnostic efficacy of different radial methods of examination critical stenosis of the carotid arteries and vertebrobazillary pools:
digital subtraction angiography (DSA), computed tomographic angiography (CTA) and magnetic
resonance angiography (MRA).
Material and methods. In A.N. Bakoulev Scientific Center for Cardiovascular Surgery of the
Russian Academy of Medical Sciences was held 441 (100%) of the angiographic studies which DSA
391 (88,7%), CTA and unenhanced MRA ? 50 (11.3%) research. Comparative characteristics of the
diagnostic value of DSA, CTA and unenhanced MRA analyzed using methods developed for testing
interpreting in medical settings by means of a triple scheme qualifications, in determining the degree
of critical stenoses 75?99% for the internal carotid and vertebral arteries.
Results. On the basis of the generalized parameters of the diagnostic efficiency of all methods used
angiography is the decrease of the index of sensitivity to vertebrobazillary pool relatively CP (carotid pool)
10.1%, specificity index by 6.1% and index positive statements by 5.5%. When comparing the general
indicators of the diagnostic value of DSA, CTA and unenhaced MRA, it is established that the generalized
index of sensitivity, specificity and positive statements was 97.6, 93.7 and 84.7% respectively.
Conclusion. Ultrasound Duplex Scanning with DSA remains the most sensitive and informative
method of visualization occlusive diseases brachiocephalic artery (BCA). CT angiography is recommended for the study of critical stenosis and occlusions of the BCA for clarification of localization
highly located atherosclerotic plaques. Unenhanced magnetic resonance imaging angiography
should be used if you are allergic to contrast agents.
Key words: computed tomography and unenhanced magnetic resonance imaging of the brain, digital
subtraction angiography of the brachiocephalic artery.
??????????? ?????????? ??????????????, ? 3, 2013
????????
? ????????? ????? ??? ???????????? ????????? ??????????????? ??????? ? ?????????? ?????? ????????? ????? ?????? ?
??????????? ?????????????? ????????????
(???) ? ???????????? ??????????????? ???????????? (???) ??? ???? ???????????? ????? ????????-??????????? ???????????????
??????????? (???), ??????? ????????? ???????? ??????????? ??????? ??? ????????????? ??????????????????? ??????? [1].
????? ????? ????????? ? ???????? ?????????????? ??????? ???????????? ?????????? ?????? ? ??????????? ???????, ??????????? ????? ????????????? ??????????????. ??? ????????? ????? ???????
??????????? ??? ?????????? ??? ???????
??????????? ?????? ??????????? ????????,
?????????? ????????? [1]. ? ????? ??????
??? ? ????????? ??????????? ????????? ??
??????????????.
???????? ? ??????
???????? TOF (???????? ???, ?????????? ?? ??????? ╚????????╩) ? 3D PC ????????? ???????? ????????? ?????? ??????.
? ????? ???????????? ?? ?????????
????????????? ?????? ??????????????? ????????????? ????? ??????? ????????????
??????????? ???????? ??????? ??????????? ? ??????????????????? ?????????, ???
???, ??? ? ???. ??? ??????????? ?? ??????????? ??????? ???????????? ????? ??????????? ???????? ???????? ??????????? ??
??????? ? ?? ????????. ???????? ?????? ????????????? ??????????? 441 (100%) ????????????????? ????????????, ?? ???????
??? ? 391 (88,7%), ??? ? ??????????????
??? ? 50 (11,3%) ????????????. ? 12 ??????? ???? ????? ????????? ???????????? ?
???-???????????? ???. ????????????? ??????????? ??? ? ??? ??????????? ?? ????????? ???????? ????????????? ???????? ?
???????? ??????????????? ???????? ?????????? ? ??????? ?????????, ???????????
?????????, ????????? ??????????? [2]. ??????????? ??? ???????? ????? ???????????
??????????? ???????????????? ? ????????????? ???????? ????????????? ?????? ???????? ???????. ???????? ?????? ? ????? ?
????? ???????? ???????????? ???????? ????????? ????????? ??????? ?????????? ???????????? ??????? [3].
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ???????????? ??????????????
?
?
73
?
???. 1. ??????????? ??????????????? ???????, ??????????? ?????? 90% ????? ??? (? ); ??-??????????? ???????????
??????? ? ??????????? ???????? (? ) ? ??-??????????? ??? (?)
???. 2. ?????????? ???? ??? ? ?????? ????????? ????????????: ??????????????? ??????????? ?????? ??????????
?????? ???????
??? ??????????? ??????? ?????????
2,6 ╠ 0,21 ?? ? ??????????????? ?????????
???? ???????? ??????? ??? 75?85%, ? ?????????? ????????? ? ??????? 85?99%.
??????????
? ??????? ???????????? ?????? ?????????????? ????????? ? ??????????? ????? ???????????? ??????????? ???, ??? ? ??? ???
??????? ??????????? ? ???????????????????
????????? (?? ? ???) ? ???????? ???????
???????? ???????? ?????????????, ???????????????? ? ???????? ??????????? ???????????? ? ???????????? ???????? ??????? 2:1
??? ??????? ??????? 75?85% ? 85?99%.
??? ????????? ??????????? ??????????????? ???????? ??? ??????? ?? ? ??? ???????
???, ??? ???????? ???? ???????????????
? ? ??????? ????????? 5,2% (P = 0,002), ? ???
?????????????? ??? ??????? ??????????
????????? ? 21,1%. ?????? ?????????????
??? ??? ?????????? ?? 4,6%, ??? ??? ? ??
7,8%, ? ??? ?????????????? ??? ? ?? 5,9%.
??????????? ?????????? ??????????????, ? 3, 2013
??? ?????? ???????? ???????????, ?????????? ??? ???, ??? ? ??????????????
???, ??????????? ???????? ??????????? ?
?????, ??????? ????????????? ??????? ?? ???????, ?????????? ??????? ?? ??? ? ???????
??????????. ?????? ?????? ???????????? ???? ?????? ?? ?????????????. ??????????????? ???????? ???, ??? ? ??????????????
??? ??? ????????? ??????? ? ????????????? ???????? ??? ???????????? ????????, ?????????????? ??? ????????? ???????????????? ??????????? ?????????, ? ???????
??????????? ????? ???????????? [3].
??? ????????? ???? ???????, ???????????? ??? ??????????? ???????? ? ?????????? ?????????? ?????? ??????? (???), ? ????? ??? ??????? ????????????? ? ????? ??????????????????? ??????, ???????????
???????? ????? ????????????, ??????? ????????????? ? ?????? ?????? ??????? ???? ??????????? ?????????. ?????????? ??????????????? ??????????? ???????????? (????)
?????????????? ? ???????? ?????????.
? ??????? ??????????? ????? ???????????? ??????????? ??????????? ?????????? ?
??????????? ????????? ????? ? ??????????????? ?????????, ? ????? ???????????? ??????????????? ?????????? ??????? ????????????? ╚??╩ ? ╚??????╩, ?????? ?? ??????? ??????????????? ?? ?????, ? ????? ???????:
??????? ? ?????? ????????????? ?????? [3].
????????????? ?????????????? ??????????? ???, ??? ? ?????????????? ??? ??????????? ??? ??????????? ??????? ??????????? ???????? 75?99% ??? ?????????? ??????
? ??????????? ???????.
??? ??? ????????? 5,6 ╠ 0,35 ?? ? ??????????????? ????????? ???? ???????? ??????? 75?85%, ? ?????????? ????????? ?
??????? 85?99%.
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
74
??????????? ?????????? ???????????? ??????????????
??????? ?????????????, ???????????????? ? ???????? ??????????? ????????????
??? ??????? ??????????? ? ??????????????????? ?????????
?????????? ???????
??????????? ?????????? ??????????????, ? 3, 2013
????? ???????????
??????
??? ??????? ???
??? (n = 391)
????????????????
?????????????
??????????? ????????????
99,4%
98,7%
100%
93,6%
94,1%
100%
96,5%
96,4%
100%
??? (n = 31)
????????????????
?????????????
??????????? ????????????
96,1%
91,7%
100%
91,5%
83,8%
96,5%
93,8%
87,8%
98,3%
??? (n = 19)
????????????????
?????????????
??????????? ????????????
93,6%
86,4%
89,8%
72,5%
80,5%
82,3%
84,6%
83,5%
86,1%
?????? ??????????? ???????????? ?????????? ?????????????? ?? 0, 3,5 ? 7,5%.
?? ???????? 3, 4 ???????????? ????????
???????? ???????? ??????????????? ????????, ?????????? ??? ???, ??? ? ?????????????? ???.
?????? ?????????? ??????????? ??????????????? ????????????? ???? ????????????
??????? ??????????? ??????? ???????? ??????? ???????????????? ??? ??? ???????????? ?? ?? 10,1%, ??????? ????????????? ? ??
6,1% ? ??????? ??????????? ???????????? ?
?? 5,5% (??. ??????? 3).
??? ??????????? ??????????????? ????????????? ???, ??? ? ?????????????? ???
???? ???????????? ?????????? ???????,
??????? ???????????? ????? ??????? ???????? ????????????????, ????????????? ? ??????????? ???????????? ??? ??????? ??????
????????????.
15
??? ??????? ??
??????? ????????
??+???
%
??? ????????? ????? ??????????? ??????????????? ???????? ???, ??? ? ?????????????? ??? ???????????, ??? ??????????
?????? ????????????????, ????????????? ?
??????????? ???????????? ???????? 97,6,
93,7 ? 84,7% ??????????????.
??? ??????? ??????????? ???????????? ???????? ??? ???????? ??????? ??????????
????? ??????? ???, ?????????????? ??? ?
???. ?????? ???????? ??? ??????????? ?
?????????????? ???????? ????? ????????????, ??????? ????????????? ? ?????? ??????
??????? ???? ??????????? ?????????.
??? ???????? ??? ?? ?????? ???, ???
? ?????????????? ??? ?? ???? ??????? ???????????????? ? ????????????? ?????????
100%.
??? ???? ??????? ???????????? ???????
?????? ?????????????? ????? ????? ???????????? ??????????????? ???????? (P = 0,06,
100
%
97,6
95
93,7
10,1
10
90
6,1
5,5
84,7
85
5
80
0
75
?????? ????????????????
?????? ?????????????
?????? ??????????? ????????????
???. 3. ???????? ????????? ???????? ???????????????
???????? ??? ??????? ?? ? ??? ??? ???? ??????? ???????????
???
???
???
???. 4. ????????????? ?????????????? ???????????????
??????????????? ????????? ??????? ???????????? ??????? ?? ? ???
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ???????????? ??????????????
?????????? ??? ? ???, ??? ?????? ????????????? ????????? ??? ??????????? ????????????? ? ????? ???????????????????
??????.
??????????
1.
2.
??????????
??????????????? ???????? ??? ??? ????????? ????????? ????????????? ???????,
??????????????? ???????? ????, ????????
????? ??????? ? ?????????? 97,6%. ?????????? ?????? ??????????????? ??????????????? ??? ??? ?????????? 93,7%, ??? ?????????????? ??? ? 84,7%. ??????? ?????? ?????????????? ????? ????????????? ???????????
??? ????????? ????? ??????????? ??? ??????? ??????? ????????.
???? ???????????, ??? ???? ? ??? ???????? ???????? ?????????????? ? ????????????? ??????? ???????????? ?????-????????????? ????????? ???. ??? ????????????? ??? ???????????? ??????????? ????????
? ???????? ???, ??? ????????? ???????????
?????? ????????????? ???. ?????????????? ??? ??????? ???????????? ??? ????????
?? ??????????? ?????????. ?????? ?? ?????-
3.
??????? ?.?., ????????? ?.?., ?????????? ?.?. ??-???????????? ?????? ? ??????? ? ??????? ? ??????????? ???????? ????????-?????????? ??????? ? ????????????
?????????? ????? ????????. ??????? ? ????????-?????????? ????????. 2008; 2: 8?13.
??????? ?.?. ??????????????????????? ? ?????????????? ?????????? ???????????? ??????? ????????? ?????.
? ??.: ??????? ?.?., ???????? ?.?., ?????? ?.?. ?????? ???????????????; ?.?. ??????? (???.). ?.: ?????????;
2005: 162?87.
????????? ?.?., ?????????? ?.?., ????????? ?.?., ??????? ?.?. ????????????? ????????? ???????????-??????????????? ???????????, ????????-??????????? ??????????? ? ??????????? ?????????????? ???????????
??? ??????????? ??????? ??????????????? ????????
???????? ?????????? ?????? ???????. ?????? ??????????? ? ????????????????? ??????????. 2008; 3 (2): 19?24.
References
1.
2.
3.
Bockeria L.A., Makarenko V.N., Yurpol?skaya L.A. CT scan
heart and vascular patients with congenital defects of the cardiovascular system in follow-up after surgery. Grudnaya i
serdechno-sosudistaya khirurgiya. 2008; 2: 8?13 (in Russian).
Nikitin Yu.M., Angiographic and ultrasonic technologies of
visualization of the cerebral vessels. In: Nikitin Yu.M.,
Chechetkin A.O., Lagoda O.V. Essays angioneurology. Ed.
Z.A. Suslina. Moscow: Atmosfera; 2005: 162?87 (in Russian).
Davydenko I.S., Crotenkova M.V., Konovalov R.N.,
Piradov M.A. Prospective comparison of the computed-tomographic angiography, magnetic resonance angiography and
digital subtracktion angiography to determine the extent of
hemodynamically significant stenosis of the internal carotid
artery. Annaly klinicheskoy i eksperimental?noy nevrologii. 2008;
3 (2): 19?24 (in Russian).
????????? 03.07.2013
??????????? ?????????? ??????????????, ? 3, 2013
Rs = 0,481) ??? ??????? ?? ? ???. ????????
???????? ???????? ???????? ??? ???????????? ?? ? ??????? ?? 7,4%, ??? ??????????
????????????? ?????? ??????????? ????????????? ??????????? ??? ????????? ?????
??????????? ??? ??????? ??????? ????????.
?????????? ???????? ??????????? ??????
???? ???????? ??? ??????? ???????????????? ??? ?????????????? ???, ??????? ????????? 21,1%.
75
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
76
??????? ?????????
??????? ?????????
╘ ????????? ???????, 2013
??? 616.132.5-007.271-089
????????????? ??????? ?????????? ???????
??????????????? ???????
?.?. ???????, ?.?. ???????, ?.?. ???????, ?.?. ????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????) ????, ?????????? ?????, 135, ??????, 121552, ?????????? ?????????
??????? ???????? ?????????????, ??. ????. ????.; ?-mail: meb86@list.ru;
??????? ????? ??????????, ??. ????. ????.;
??????? ?????? ?????????, ????-?????????;
???????? ??????? ????????????, ??. ????. ????.
??????????? ?????? ????????? ?????????????? ??????? ? ???????? ? ????????? ????????
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SURGICAL TREATMENT OF TANDEM STENOSIS OF THE BRACHIOCEPHALIC ARTERIES
E.B. Mollaev, M.F. Eseneev, R.R. Valieva, I.A. Gvetadze
??????????? ?????????? ??????????????, ? 3, 2013
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences,
Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Mollaev El?murza Biysoltanovich, Junior Researcher;
Eseneev Mussa Feliksovich, Junior Researcher;
Valieva Ramilya Rafikovna, Cardiologist;
Gvetadze Irakliy Avtandilovich, Junior Researcher
In a brief report describes a case of successful surgical treatment of a patient with tandem stenosis
of the internal carotid artery.
Key words: tandem stenosis; carotid artery; carotid endarterectomy.
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Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
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????????? ??????? ???? ? ????????????? ????????? ???????????????? ???????.
??????????
1.
2.
3.
4.
5.
6.
??????? ?.?., ??????? ?.?. ????????-?????????? ???????? ? 2010. ??????? ? ?????????? ???????? ???????
??????????????. ?.: ??????? ????? ????????-?????????? ???????? ??. ?.?. ???????? ?????????? ????????
??????????? ????; 2011.
????????? ?.?. ??????????? ? ?????????? ??????????
???????? ????????. ???????? ?????. 2004; 4: 10?2.
?????????? ?.?. ??????????????????? ?????????? ????????????? ????????? ??????? ?????????? ???????
? ????????????????????? ?????: ???. ? ?-?? ???. ????.
?.; 1996.
?????????? ?.?., ?????? ?.?. ??????????? ???????
????? ????????????. ??????? ??????????? ??????. 2003;
11 (12): 691?5.
????????? ?.?., ????????? ?.?., ?????? ?.?., ???????? ?.?. ??????????? ??????? ??????? ???????????
????????. ??????? ???????. 2005; 2: 26?31.
??????? ?.?., ?????????????? ?.?., ?????? ?.?., ?????? ?.?., ?????????? ?.?. ??????????? ??????? ? ??????????? ? ?????????????? ??????? ???????????????
??????? ? ??????? ??????????? ???????? ??????. ??????? ?????????? ???????? ??????????? ????. 2012; 10: 4?11.
References
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6.
Bockeria L.A., Gudkova R.G. Cardiovascular Surgery ? 2010.
Disease and congenital malformations of the circulatory system. Moscow: Nauchnyy Tsentr Serdechno-Sosudistoy
Khirurgii imeni A.N. Bakuleva Rossiyskoy Akademii
Meditsinskikh Nauk; 2011 (in Russian).
Skvortsova V.I. Medical and social significance of the problem of
stroke. Kachestvo zhizni. 2004; 4: 10?2 (in Russian).
Dobzhanskiy N.V. Associated atherosclerotic carotid occlusive
arterial disease of the brain and microrevascularization. Dr.
med. sci. Diss. Moscow; 1996 (in Russian).
Pokrovskiy A.V., Kiyashko V.A. The ischemic stroke can be prevented. Russkiy meditsinskiy zhurnal. 2003; 11 (12): 691?5 (in
Russian).
Dzhibladze D.N., Krasnikov A.V., Lagoda O.V., Barkhatov D.Yu. Asymptomatic carotid artery stenosis. Nervnye
bolezni. 2005; 2: 26?31 (in Russian).
Bockeria L.A., Pirtskhalaishvili Z.K., Sigaev I.Yu., Darvish N.A.,
Serguladze T.N. Current approaches to diagnosis and surgical
treatment of brachiocephalic arteries in patients with coronary
heart disease. Vestnik Rossiyskoy akademii meditsinskikh nauk.
2012; 10: 4?11 (in Russian).
????????? 30.09.2013
??????????? ?????????? ??????????????, ? 3, 2013
?? ????? ????????? ????????? ??????????
?? ?????? ?????????? ?????????: ?????? ????????? ? 62%, ??????? ? 64%.
????????????????? ??????? ?????????????, ???????????? ??????????, ??????????????? ???????????? ???. ?????? ??????????? ?????? ????????? ????? ?? ?????? ??????????? ????????-??????????? ??????????
????????? ????? ?? ????????. ? ????????????????? ??????? ??????? ???????? ????????? ????????????, ???????? ???? ? ????, ?????????? ???????? ????? ? ??????????????.
??????? ??????? ?? 8-? ??? ? ?????????????????? ?????????. ??? ?????????? ???????????? ??????????????? ??????????? ???????????? ?? ???????????? ????? ? ?????
2 ??? ????? ???????? ???? ?????????????
????????? ?????????, ?????????? ?????????? ?????????? ? ???????? ?????.
79
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
80
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???????.
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?????? ?????? ???? ????????? ????? ????????.
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?????? ????????? ????? ??????????? ?????????????? (???????????????) ???????? ??????.
2. ?????? ??????????? ? ???????? ? ?????????? ? ???????????? ??????????? ??????????? ??????. ??
??????????? ????? ?????? ?? ???????????.
3. ?????? ?????? ???? ?????????? ??????? Times New Roman ??? Arial, ?????? ?????? 12, ? ??????? ?????????? ????? ????????, ???? ??????? 3 ??.
4. ????? ?????????, ???????? ? ????????????? ?????? ?? ?????? ????????? 15 ? (??????? ???????????, ??????? ? ?????? ??????????), ???????????? ???????????? ? 12 ?, ???????? ? 3 ?.
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??????? ???????, ??????, ?????????, ?-mail ??????????? ??????.
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??????? ???????? ????????, ?????? ???. ????, ?????????, ?????????? ???????? ??????????????,
?????????????? ? ?????????????? ???????????; e-mail: kulikov57@mail.ru;
???????? ????????? ??????????, ???????? ???. ????, ????????? ??????? ??????????????, ??????????????
? ?????????????? ???????????;
?????????? ???????? ????????, ?????? ???. ????, ?????????, ?????????? ???????? ??????? ???????????
* ????? ??????? ??? ??????? ???????? ?? ??????? ????????? 2013 ?.
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81
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. ?????????? ???? ?????????? ???????????? ?????? ?????? ???? ?????????: ??????,
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???????? ? ????????????? ???????? ?????????? ?????????. ????????? ?????? ?????? ???? ???????????? ?? ??????? ? ?????????? ?????.
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??????????.
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State Medical University, Ministry of Health of the Russian Federation,
prospect Lenina, 40, Barnaul, 656038, Russian Federation;
2Prof. V.F. Voyno-Yasenetskiy Krasnoyarsk State Medical University, Ministry of Health
of the Russian Federation, ul. Partizana Zheleznyaka, 1, Krasnoyarsk, 660022, Russia
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?????????????? ? ?????????????? ???????╩ ?????????????? ???????? ?????????? ??????????? ???????? (Uniform Requirements for Manuscripts Submitted to Biomedical Journals). ?????????? ???????? ???????????? ?????????? ? ??????? ?????????? ???????? ??????? ????, ??? ?????????? ?????????? ?????
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? ???????????? ??????? ??????????? ??????????? ?? ????? 25 ??????????, ? ??????? ?????????? ? ?? ????? 50, ? ??????? ? ?????? ?????????? ? ?? 15. ???????????? ?????? ????????? ?????? ????????????????
????? ?????????? ?? ????????? 5 ???.
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?????? ?? ???????????????? ?????? ?? ???????????.
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???????? ????????????; ????? ????? ? ??????? ? ??? ???????. ???? ?????? ?????? ?? ????? ?? ?????:
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????????????????? ???????? ?????? ?? ???????: ?????(?), ???????? ??????, ???????? ???????, ???,
???, ? ??????? ????? ???????, ????? ????????? ????? ?????? ? ????????? ??????? ???????????.
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??????????? ? 6 ?????? ??????? ╚? ??.╩, ? ??????????? ╚et al.╩; ???? ? ???????? ??????? ???? ????????? ?????????, ????? ??????? ??????? ??????? ╚???.╩, ? ??????????? ╚ed.╩.
?? ????? ????????, ??????????? ?????????? ????? ????????????? ?????? ???????????, ???
Web of Science ? Scopus, ????????????????? ?????? (References) ?????? ? ???????????? ???? ?????? ?
?????????????? ?????? ???????? ?? ?????? ?? ????? ?????????, ?? ? ????????? (????????? ?????????). ??????? ?????? ?????? ?????? ?????? ?????? ?????????? ? ???? ?????????: ???? ?? ?????
????????? (????????????? ????????? ? ??????????, ???????????? ? ?????????), ??? ???? ??????? ?????, ? ????????? ?????? ??? ?? ?????? ?????????? (References) ? ????????? ???????? ???
Scopus ? ?????? ?????????? ??? ??????, ???????? ? ??? ??? ????????? ??????????, ?????????? ??
????, ??????? ?? ????? ??? ???????????. ???? ? ?????? ???? ?????? ?? ??????????? ??????????,
??? ????????? ??????????? ? ??????, ??????????? ? ????????? ????????.
? ????????? ???????? ??? ????????????? ?????????? ????????? ????????? ????????? ?????????????????
??????: ?????(?) (??????????????), ??????? ???????? ????? ??? ?????? ?? ?????????? ????, ???????? ????????? (??????????????), ???????? ?????? ? ???????? ???????, ???????? ?? ???? ?????? ? ??????? (in Russian).
?????????? ?????????? ?????? ? ?????????????? ??????? ?????????????? ?????????????? ? ???????????
?? ????? http://www.translit.ru ????? ????????? ??????????????? ?????????? ?????????????? ???????? ?????? ? ????????. ????????? ????? ???????.
1. ?????? ? ????????? Translit.ru. ???????? ??????? ?????????????? BGN (Board of Geographic
Names). ????????? ? ??????????? ???? ???? ????? ????????????, ????? ???????? ????? ??? ??????, ??
??????? ????? ? ???????? ?????? ╚? ????????╩.
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??????? ?????????????? ????????????? ?????????? ??????????
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??? ????????? ????????? ?????? ?????? ??????????????? ?? ?????.
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?? ? ????????????
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??????? ?.?. ??????????????????????? ? ?????????????? ?????????? ???????????? ??????? ????????? ?????.
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??? ??????????? ??????? ??????????????? ????????
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??????????? ?????????? ??????????????, ? 3, 2013
Rs = 0,481) ??? ??????? ?? ? ???. ????????
???????? ???????? ???????? ??? ???????????? ?? ? ??????? ?? 7,4%, ??? ??????????
????????????? ?????? ??????????? ????????????? ??????????? ??? ????????? ?????
??????????? ??? ??????? ??????? ????????.
?????????? ???????? ??????????? ??????
???? ???????? ??? ??????? ???????????????? ??? ?????????????? ???, ??????? ????????? 21,1%.
75
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??????? ?????????
??????? ?????????
╘ ????????? ???????, 2013
??? 616.132.5-007.271-089
????????????? ??????? ?????????? ???????
??????????????? ???????
?.?. ???????, ?.?. ???????, ?.?. ???????, ?.?. ????????
???? ╚??????? ????? ????????-?????????? ???????? ??. ?.?. ????????╩ (???????? ? ???????? ???
? ???? ?.?. ???????) ????, ?????????? ?????, 135, ??????, 121552, ?????????? ?????????
??????? ???????? ?????????????, ??. ????. ????.; ?-mail: meb86@list.ru;
??????? ????? ??????????, ??. ????. ????.;
??????? ?????? ?????????, ????-?????????;
???????? ??????? ????????????, ??. ????. ????.
??????????? ?????? ????????? ?????????????? ??????? ? ???????? ? ????????? ????????
?????????? ?????? ???????.
???????? ?????: ????????? ??????; ?????? ???????; ?????????? ???????????????.
SURGICAL TREATMENT OF TANDEM STENOSIS OF THE BRACHIOCEPHALIC ARTERIES
E.B. Mollaev, M.F. Eseneev, R.R. Valieva, I.A. Gvetadze
??????????? ?????????? ??????????????, ? 3, 2013
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences,
Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Mollaev El?murza Biysoltanovich, Junior Researcher;
Eseneev Mussa Feliksovich, Junior Researcher;
Valieva Ramilya Rafikovna, Cardiologist;
Gvetadze Irakliy Avtandilovich, Junior Researcher
In a brief report describes a case of successful surgical treatment of a patient with tandem stenosis
of the internal carotid artery.
Key words: tandem stenosis; carotid artery; carotid endarterectomy.
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????? ?????? ?????????? ? ????????????? ????????? ?????? ?? ?????? ????? ?????
???????? ???????? ????? ?????? ?????????
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[1]. ???????? ????????????? ????????????
???????? ???????? ??????????????????? ????????? ???????, ??????????????? ????????
???? [2, 3]. ??????? ????????????? ??????????????????? ?????? ? ??????????? ??
??????????? ???????? ??????: ??????????
?????? ??????? ? 80%, ???????????? ??????? ? 10?15%, ??????????????? ????? ? ????? ????? ?????? ??????? ? 5?10% [4].
????????? ??????????????? ??????? ??
?????? ???????, ??? ??????????????????, ???
? ????????????????? ?????????, ??????????
??????????????????, ??? ??????????, ?????????. ??????? ????????????? ?????????
????????? ?? ????? ??????, ?????? ????? ???????? ????? ??????? ???? ???????? ??????? ????????? ????????? ??????????????,
? ????? ????????????? ??????????????? ?????????? ??? ????????? ? ?????????????
???????????????.
?????? ?????? ??????????, ??? ?????????? ??????????????? ??????????????? ???
????????? ??????????? ??????? ??????????
?????? ???????, ????? ??????????? ????????? ????????????? ?????????? ?????? ???????
?? ?????????????????? ?????? (???? ?????
??? ??????????? ? ??????, ???? ? ? ??????? ?1
? ?1 ?????????????? ???????? ? ??????? ???????? ???????) ? ???????? ??????? ??????? ??
????? ??? ?? 50% ?? ????????? ????????. ???
???????? ???????? ????? ???????? ?????????? ?????? ??????? (???) ????? ??????????
???????????????. ? ???? ??????? ??????????????? ???????????? ??????? ????????????
????????? ??????????????????????? ??????????????? [5].
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?????? ????????? ?????????????? ???????
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?????? ? ?????????? ????? ?????? ???????
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???????? ?1.
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???????? ? ?????? ???????????, ??????????????, ????????? ????????????? ????????,
?????? ??? ????????? ?????????? ????????.
??????? ???????? ???????????? ????????????
????? 40 ???, ????????????? ??????? ???????? ?????????. ? 1991 ?. ??????? ?????? ????????? ????????? ?????????????? ? ?????????? ???? ? ???????????????? ??????????.
? 2004 ?. ? ????????? ????????? ?????????
?????????????? ?? ???? ????????????????
????? ? ?????????????? ??????????????? ??????????. ??? ?????????? ????????-??????????? ?????????? ????????? ????? ???????? ????????????? ???????? ?????????
???????? ????? ????????????????? ?????????, ????????? ???????????? ??????? ? ??????? ????????? ?????????????? ????????????. ??? ???????????? ? ??? 2013 ?. ????????
??????????????? ???????? ??????????????????? ????????? ?????? ???????, ? ????? ?
??? ??????? ??? ????????? ? ?????????????????? ?????????.
???????? ????????? ?????????????? ?????????? ???????????? ??????????????? ???????, ??? ??????? ??????? ?????? ? ???????
?????????? ????? ??? ?? 65?70% ? ????????? ?? ???, ? ???????????? ???????? ???????? ?? 85% ? ????????? ?????????? ????????? ?? 320 ??/?, ? ????? ?????? ?????? ???
? ??????? ?????????? ?? 55% ? ????????? ??
??? ? ?? 65% ? ????????? ?????????? ????????? ?? 175 ??/?.
?? ?????? ??????????? ??????- ? ???????????????? ??????? ??????????????? ??????? ???????? ????????? ????????? ?????
??? ?? ??????????, ? ???????, ?????????
?????????, ?????????? ?????? ??? ? ?????????? ???????????? ????????????? ??????, ??????? ????? ??????? ???????? ???????
? ????????????? ????? ?? ????? ?? 60% ? ?????? ??? ? ????????????? ????? ? ??????? ????????? ?? 55?60%. ???????????????? ???????? ?????? ??? ??? ????????????. ??????
??????????? ??????? ?????? ??? ?????? ????? ? ?????? ??????. ???????? ? ?????? ???????? ??????? ??? ???????????? (???. 1).
??? ?????????? ???????????????? ????? ?????? ? ?????????? ????? ??? ??? ????????? ???????????????? ??????????????
???????? ???????? ????????? ????????? ??
50% (???. 2). ?? ???? ????????? ?? ?????????? 2 ??? ??????????? ?????????? ????????
?? ????.
? ????? ?????? ? ???????? ?????????
????????? ? ???????????????? ??????? ?????? ? ??????? ???????? ????????????
??????? ????????? ??????????????? ???????. ??? ????? ?????????? ???????? ??????????????? ???????????, ?????????? ? ????
?????????????? ?????????? ????????????
??????????????? ???????, ???????????????? ??????????????, ??????????????
?????, ????????-??????????? ??????????,
???????????? ?????????? ????????? ?????, ??????????? ??????????????? ???????
???. 1. ??????????? ????????????????? ???????? ??? ?
?????? ????????. ???????? ?????? ?????? ??????? ???????? ???????
???. 2. ???????????????? ?????????????? ??????? ???????? ??????? (??????? ?1) ?? ???? ?????????? ???????????????? ????? ?????? ? ?????????? ????? ???
???????? ??????
??????????? ?????????? ??????????????, ? 3, 2013
??????? ?????????
Copyright ??? ╚??? ╚??????╩ & ??? ╚A???????? K????-C?????╩
??????????? ?????????? ??????????????, ? 3, 2013
78
??????? ?????????
(? ????????????????? ??????????), ? ????????? ??????? ????????-??????????? ???????????, ? ????? ???????????????????,
???????????????, ??????????????, ??????????????, ??? ??????? ????????? ?????
? ???????????? ???????????????, ?????
????, ?????? ?????? ???????????? ????????????, ? ??? ????? ???????? ?????? ? ????????????? [6]. ???? ???????? ??? ?????????? ??? ??????????? ????? ? ????????? ?????????????? ????????????? ? ?????? ?????????
?????? ? ????? ?????????? ??????????? ????????????? ??????????????? ? ???????????????? ?????????? ? ?????- ? ????????????????? ???????.
??? ?????? ??????????? ???????? ?????
???? ????????? ???????????????????, ???????????????, ? ????? ?????????????? (???????????? ? ????????????).
?? ?????? ???????????????????: ????
?????????, ????????????? ??? ?????? ????????? ?????, ??? 67 ??/???. ????????? ?????? ???????? ?? ????????.
?? ?????? ???????????????: ?????? ??????? ?????????? 38в46 ??, ?????? ? 39в48 ??,
?????: ??????? 3,7 ??, ?????? ? ???????????
???????. ????? ?????????: ???????? ????????????? ????? 60 ??, ??????? ????? 81 ??,
???????? ?????????????? ????? 142 ??,
??????? ??????? 58%. ??? ??????????? ??
????????. ?????? ?????????: ????????? ????????????? ???????? 29 ?? ??. ??. ??????????
??????: ??????? ????????? ???????. ????????
???????? ???????????? ? 10 ?? ??. ??. ???????????? I ??. ?????????? ??????: ?????? ?????????? ?????? 34 ??. ???????????? I ??.
??????????????? ??????: ???????????? I ??.
??????? ?? ?????????, ??????????????
??????? ??????????????????.
?? ?????? ??????????????: ?????? ???
??????????????, ????? ?????????????, ????? ???????? ???????. ???????? ??????????????? ????? ?? ?????? ?????????? ????????? ????? ????? ?????????? ???????
????????????, ? ????????????? ?????????
??????????. ?? ??????? ??????? ????? ? ?????????? ????? ???????? ???????????????
????? ?????? 65?70%, ???? ? ??????????
????? ? ?????? ???????. ???????????? ?????
?????????????, ?? ???????. ????????? ??????? ????????? ??????????? ????????????
?????, ????????? ?????? ? ?????????????
????? ?? 30?60%. ?????? ?????????? ???????
??????, ?????? ? ????? ?? 60?65%, ?? ╚????╩
????????? ????????????, ? ?????????????
????????? ?????????? ?? ????????? ?? ?????????, ? ?????????? ?? ?????, ?????? ?????
???????????, ?????????? ?????????????????
?????????? ?????????? ????? ?????????
????? 10 ??. ???????????? ?????, ?????? ??????????????? ????? ?????????.
?? ????????? ?????, ???????? ???????????, ?????? ???????????????? ??????? ???????????? ????????? ???????: ????????????;
?????? ????? ?????????? ?????? ???????; ????????? ????? ????????????? ??????? ????????? ????????? ?????????????? ? ????????
????? ??????? ???????? ??????? ? ?????????????? ??????????? (1991, 2004 ??.); ???????????????? ????????????? III ??.; ??????????? ??????? ??????; ??????????? ??????????
II ??; ???????????? ??????????? III ??., ????
4; ??????????????? ?????????????? I ??.;
??????????? ???????????, ??? ??????????;
????????????? ???????.
??????? ??? ????????????????? ?????????? ????????, ???????????. ? ?????? ??????????? ????????? ?????????? ???????,
??????????????????? ?????????? ??????????? ????? ???? ????????????? ???????????
?????????? ?????????, ????????????????
???????? ?? ?????? ????? ?? ????????, ???????? ?????????? ?????? ?????? ?????????? ???????????????.
??????? ?????????? ??????? ?????? ??????? ???????? ?????????? ??? ??????????
??????????????????????? ???????????????
?????? ?????? [3], ?????? ? ????? ? ????????????? ????????????????? ??????? ?????
?????????? ??? ? ??????? ???????? ???????, ?????????????????? ??????????? ???????? ? ?????? ???????? ???????, ???????
?????????????? ????, ?????????????????,
?????????? ??????????????? ????? ????
???????
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