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2009

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onepaijHH npoxe3HpoBaHHfl KOJICHHOFO cycxasa npe/uiojiaraeT o6si3a-

xeiibHoe HcnojibaoBaHHe cnenHaiibHbix MCTO^OB yMCHbineHHa o6i>eMa KpoBonoxepH, coxpaHe-

HH3 co6cTBCHHOH KpoBH nanHCHxa H cHtDKCHHa ero noxpeSHocxH B Tpanc(|>y3nax KOMnoHen-

TOB ^OHOpcKOH KpOBH. Bo BpeMa BMeuiaxejibcxBa 3XH 3a£aHH MO5KHO peiuHTb, oncpHpya «no;i

>KryxoM», 03113x0 nocjie CHHTHS TypnHKexa, ^H(})4)y3Hoe KpoBOxeneHHe HS noBpeayjenHbDC

ycHJiHBaeTca H npoaoJDKaeTCfl eme B xeneHHe HecKOJibKHx nacoB. OAHOH H3 ocHOBHbix

T3KOH KpOBOTOHHBOCTH aBJIflCTCfl aKTHBaUHa 4>H6pHHOJIH3a_ riepBHHHO 3T3

HOCHT KOMneHcaTopntm xapaxxep H aBJiaerca OTBCTHOH na nOBbnneHHe

noTCHUHana KpOBH B 3one noBpe^aeHH^ Txanefi, oAHaxo BCJie^cTBue 3HaHHTenbHoro nocxyn-

JieHHa B KpOBB U.HTOKHHOB H 3pyTHX BCmCCTB, IIpSMO HJIH OnOCpCflOBaHHO yCHJIHBaiOmHX

ueccbi npoxeoJiH3a, axTHBai^Hfl njiaaMHHorena MOMCCT cxaxb iipe3MepHofl,

OKOH^axejiBHOMy reMocxasy. V no/^aBJiaiomero 6ojibniHHCXBa 6o;ibHbix xaxaa

HC HMeex cucxeMHoro xapaxxepa H oxMeHaexca TOJILKO B pane, ojinaKO 3xox 4>axx ne

ex ee xjiHHH^ecKoe 3naHeHHe. ITocjieonepaiiHOHHafl KpoBonoxepa, BKJiiOHaiomafl cKpbixbie no-

xepH (B BHZie reMaTOM) H asHbie (no apenajKy), no oSteMy B 3 -5 pas npeBbnnaex nnxpaone-

noxepio KpOBH, Be/m K pasBHxuro ranoBOJieMHH, aHCMHH, HapynieHHaM reMoan-

, noBbimeHHio noxpeSnocxH B reMOXpanctJ)y3Hflx, ^xo B KOHCHHOM nxore, yxy^maex

nepHO^a H pe3yiibxaxbi jienejHM^B -I^CJIOM.

3XH o6cxoaxe:ibcxBa, jieKapcxseHHbie cpe^cxBa, 6noKHpyiontHe n36uxoifflBiH

(J)n6pHHOJin3, Moryx Sbixb nojiesHbi ana yMCHLmeiraa o6teMa KpoBonoxepH. B MnpoBoii KJIH-

HH^ecKOH npaKXHKe ^Jia 3XHX uejien Hcnojn>3yiox xpn npenapaxa: anpoxHHHH, SHCHJIOH-

aMHHOKanpOHOByK) KHCJioxy H xpaneKcaMOByio KHCJioxy. B ne^aBHCM cHCTCMaxH^ecKOM 06-

30pe accoiinaijHH Koxpana, BKJUOHHBineM ^aHHbie 21 1 paimoMii3HpOBaHHbix KOHxpojinpyeMbix

HcnbrraHHH (20 78 1 ynacTHHx) OXMCHCHO, HXO HHrnSuxopbi <JtH6pHHonH3a SHannxejitHO

yMCHbmaiox o6i.eM KpoBonoxepn H noxpeSnocxb SojibHbix B reMoxpanccJiysHflx, npH SXOM HX

HcnoJibsosaHHe He conpOBOMc/iaexca ysejiHHeHHeM HHCJia xpOM6oxirtiecxHx ocjioacHeHHii H

cMepxejibHbix HCXO^OB. B cpaBHHxejibHbix HCCJieflOBaHHax SXHX npenapaxoB Hexoxopbie npe-

HMymecxsa 6buin OTMeneHbi y anpoxHHHHa, o/inaKo cxaxncxn^ecKH sna^HMbiMH OHH oxasa-

Jincb xojibKo RJIX onpeAeJieHHoii rpynnbi KapAHoxupyprH^ecKHx 6oju>Hbix c BWCOKHM PHCKOM.

B ocxajibHbix oSnacxax xHpyprHH /(ocxosepHbix OXJIHHHH no a^eKXHBHocxH xpaneKcaMOBon

KHCJioxbi H anpoxHHHHa ne BbiHBJieHO, npH 3XOM, oflHaxo ycxanoBJieHO, HXO no anxn^HSpHHo-

nHXHHecKOH aKXHBHOCXH xpaHCKcaMOBaa KHCJioxa 3iiaiiHxejibHO npesocxo^HX 3ncHJion-

aMHHOKanpOHOByio KHCJioxy. TaKHM o6pa3OM, ynnxbisaa OXJIHHHJI B CXOHMOCXH npenapaxos,

no noKa3aTejiK> «nena - 3{J)<J)eKT» Hcnojib3OBaHne TpaneKcaMOBon KHCJIOTBI npn onepauHax

KOJiennoro cycrasa MOXCT 6biTb Han6ojiee nepcneKTHBHbiM.

TpaneKcaMOBon KHCJIOTM npn onepanHax npoxesHpoBanHa KOJieHHoro

cycTaBa

OneHKa 3(|)(jjeKTHBHocTH H SesonacHOCTH TpaHeKcaMOBOH KHCJIOTLI KaK cpe^cTBa Kpo-

Bec6epeaceniDi npn npoTe3npoBaHHH KOJieHHoro cycTasa nposo/nuiacb He Menee HCM B 13

npOCnCKTHBHblX paH£OMH3HpOBaHHbIX HCCJie^OBaHHaX, 9 H3 HHX - flBJMIOTCa JIBOHHblMH CJIC-

nbiMH, 4 - OTKpbrrbiMH.

B HCCJieflOBaiiHH Hippala H coaBT. (1995) 29 nairneHTOB, KOTOpbiM npoTe3HpOBanHe

KOJieHHoro cycTasa BbmojinaJiH «no/i ^<ryTOM» B ycjiOBHHX cnnHaJibHOH anecTesHH, 6buiH

panAOMH3HposaHHO pacnpe^ejieHbi B ABC rpynnbi: noJiy^mBiniix 33 2-5 MHH ̂ o cnaTHfl xypHH-

B/B 1 5 MF/KT TpaneKcaMOBOH KHCJIOTLI HJIH nJiane6o. OiteHHsajiH o6i,eM KpOBonoTepn BO

H nocjie onepannH, a TaK^ce o6m.ee HHCJIO 403 jjoHOpCKOH KposH, nepejinxoe 3a BpeMa

. VcTaHOBJieHO, HTO o6beM HHTpaonepaaHOHiioii KpOBonoTepH ne H3MeHHJica ( 428 ±

254 MJI H 415 ± 244 MJI), o^HaKO nocjie onepaann B nanaTC npo6yayieHHa (127 ± 95 MJI H 576

± 245 MJI, p^Q.QOl) H B XHpygriraecKOM oT/ienenHH (293 ± 200 MAH 558 ± 293 MJi,_p<0.01) B

rpynne c ipaneKcaMOBOH KHCJIOTOH o6T>eM apenaacHbix noTepb 6bui /locTOBepno Menbine. Ro-

TpeSHOCTb B TpaHC^jySHH JIOHOpCKHX 3pHTpOUHTCOZiepacamHX Cpe^ (HB < 100 T/JI ) TO^CC GblJia

^ocTOBepHo MCHbine (1.5 ± 1.3 e/i. H 3.3 ± 1.8 en., p < 0.005) npn Hcnonb3OBaHHH TpaneKca-

MOBOH KHciioTbi. Y AByx 6ojn,Hbix B rpynne nnane6o nocjie onepan,HH pasBHJincb TpOM6o3M-

6ojiH^ecKHe ociioacHeHHfl (B O^HOM Ha6jnoAeHHH - TpOM6"o3 rjry6oKnx BCH rojienn, B O^HOM -

TpOM6o3M6oJIH3 MCJIKHX BeTBCH JICrOHHOH apTepHH HCpC3 HCCKOJH.KO He^eJIb HOCJie BbinHCKH

^OMOH), B rpynne c TpaHeKcaMOBOH KHCJIOTOH Taicnx ocjioacHCHHH He 6buio (see 6ojQ.Hbie B

o6enx rpynnax nojiy^anH 3HOKcanapHH no 40 Mr, HaHHHaa c senepa nepea onepauHCH H SBTCM

^O BbHIHCKH HJIH nOJfflOH aKTHBH33n,HH).

Benoni G. H coaBT. (1996) H3y4ajin BJIH^HHC TpaHeKcaMOBOH KHCJIOTSI na KpoBonoTepio

H noTpe6nocTb B reMOTpaHc^ysH^x B nponecce paH^OMH3HpOBainioro ABOHHOFO cjienoro HC-

cjieflOBaiiHa H JieneHHa 86 n^neHTOB, TOJKC onepHpoBannbix « no^ 2cryTOM» B ycjioBHax pe-

rHonapHOH anecTesHH. TpaneKcaMOByio KHCJiOTy B AOSC 10 MF/KT HJIH ^JIa^e6o BBO^HJIH nesa-

£OJiro nepe/i cnarHeM TypHHKCTa H noBTopHJiH BBe^eHHe ^iepe3 3 naca B TOH IKQ ^O3e. Cpe^Haa

cyMMapnaa KpOBonoTeps cocTaBHiia 730 ± 280 MJI B rpynne c TpaneKcaMOBon KHCJIOTOH H

1410±480 MJI B rpynne nJiaueGo (p< 0.001). HHCJIO reMOTpaHC(})y3HH, a TaK^ce ^IHCJIO

4

KOTOpbiM nepejiHBajiH ^onopcKne spHxpounxbi yMeHbuiHJiocb B 3 pasa ( 8/43 H 24/43, p< 0.01).

3TOM BepOHXHOCXb XpOM6o3M6oJIHH6CKHX OCJ1O5KH6HHH H6 H3MeHHJiaCb.

B 1997 ro,ay Hippala H coaBT. BbinojiHHJiH .uonojiHHxejibnoe Hccjie/ioBaHHe B anajio-

FHHHOH no cocxasy, oSteny BMemaxejibcxBa H Bn^y anecxesHH rpynne GojibHbix, ojxnaKO c

6OJlbUIHM MHCJ10M HdlblTyeMblX (77) H 6oJIbUieH fl03OH XpaHCKCaMOBOH KHCJIOTbl (15 MF/KT

nepe,a. CH^THCM xypnHKcxa H ,aonojiHHxejibHMMH SojuocaMH no 10 MF/KF Hepes 3 H 6 nacos)

TOPO, Hxo6bi xo^nee onpeaejiHXb 3(|>4>eKXHBHocxb H 6e3onacHocTb npenapaxa. H B 3TOM

xpaneKcaMOBaa KHCJioxa ^ocxoBepHO yMenbmajia oSmnii o6"beM KpoBonoxepn (689 ±

289 MJI H 1509 ± 643 MJI, p < 0.0001), cHH^caoia HHCJIO reMoxpaHC(|)y3HH (1.0 ± 1.2 eji. npoxHB

3.1 ± 1.6 e/i., p< 0.0001) H Koira^ecxBO nannenxos, Koxopbai SXH reMoxpanc^ysHH noxpeSo-

Bajmcb (17/39 H 34/38, p < 0.00003). YsenHMeHHe flO3bi TpaHeKcaMOBOH KHCJIOXM ne npHsejio,

no /laHHbiM asxopoB, K noBbnneHHio pncxa xpoM6o3M6ojiHMecKHX OCJIOJKHCHHH. Ha 4)OHe npo-

cnenH^HqecKOH npo^HJiaKXHKH snoxcanapHHOM, y ^syx SoJibHbrx B rpynne c xpa-

tcHCJioxoH (na 12 H 18 ^CHb nocjie onepanHH) H y 4syx nouHenxoB B rpynne njia-

(nepes 2 H 4 He^eJiH nocjie onepauHH) pa3BHJica xpOMGos rjiy6oKHX BCH HHaaieH KOHCH-

HOCXH, noAXBepHcaeHHbiH npH (f)Jie6orpa$HH. Oana naunenxKa B rpynne njianeSo Bnesanno

Ha 15-e cyxKH nocjie onepaunn na (|)OHe MaccHBHOH T3J1A.

B Mccjie^oBaHHH Jansen A.J. H coasx.(1999) xpaneKcaMOByio KHCJioxy BBOZIHJIH BHyx-

no 1 5 MF/KF HenocpeflcxBeHHO nepe^ HananoM onepauHH H nepe3 8 nacos B xenenne 3

cyxoK nocjie onepai(HH. Asxopbi OXMCXHJIH, ^xo npHMeneHHe npenapax conpoBO>KJxajiocb ox-

HexjmBbiM KpoBecSeperaioHiHM 34>4>eKX H He BJIHSJIO na ^acxoxy xpoMSoxn^ecicHX ocjioacne-

HHH. Cpe/nran oSteM nocJieonepan,HOHHon noxepuKpoBH CHHSHJICJI c 1419± 607 £0 678 ±352

MJI, p< 0.001), yMeHbinHJiocb Tmcjio SoJiBHbrx, nyamaiomHxcfl B reMoxpaHC(J>y3Hax ( 2 H3 21

npoxHB 13 H3 21, p< 0.001). B rpynne c xpaneKcaMOBOH KHCJIOXOH KJiHHHHecKHX npH3HaKOB

xpOM6o3M6ojiHHecKnx ocjio^CHeiiHH He BbiHBJieno, B rpynne njianeSo xpoiw6o3 rjiy6oKHX sen

pa3BHJICH y 2 6oJIbHbIX, OflHOKO CXaXHCXHHeCKH 3XH OTJlHHHa 6bIJIH HCflOCXOBepHbl (p^0.23).

B HCCJieaoBaHHH Ellis M H coasx (2001) maBHOH uejibio 6buio lisy^eHHe oco6eHHo-

CXCH peaKnHH CHCxeMbi reMocxasa H (JmSpHHOjnoa na BbmojmeHHe 3H/ioiipoxe3HpOBaHHa KO-

neHHoro cycxasa «no^ acryxoM» H onpe^ejienHe BOSMO^CHOCXH KoppeKHHH BbiaBJieHHbrx HJIH

oacHflaeMbix H3MeneHHH CBOHCXB Kposw c noMombio xpaneKcaMOBOH KHCJIOXBI. B paHflOMH3H-

pOBaimoe npocneKXHBHoe HccneAOBaiiHe BKjnoneHO 20 naunenxoB, Koxopbie GBIJIH pa3^ejieHbi

na 2 rpynnbi: nojiyHasumx xpaneKcaMOByrc) KHCJioxy HJIH njianeSo. TpaneKcaMOByio xncjioxy

BBO^HJIH B ^03C 15 MP/KF nepe^ CHflXHCM XypHHKCXa, a 3axeM B BH;ie HH4>y3HH CO CKOpOCXbK)

B xeneHHC 12 nacoB. Asxopb! He BBISBIIJIH 3HaTiHMbix OTJIHHHH Meacny rpynnaMH B

noKasaxejieH KOHHeHxpamiH D-^HMepa H aKXHBHOCTH (JjnGpHHonHXH^ecKOH cncxe-

Mbl H C^eJiaJIH BblBOfl O TOM, HTO TpaHCKCaMOBaa KHCJ1OT3 B HCCJie/iyCMOH JJ.03Q HC BJIHJieX H3

cHcxeMHbie H3MeHeHH3 reMOCxasa. OjxnaKO, KaK H B £pyrnx Hccjie/ioBaHHiix, npHMCHCHHe npe-

napaxa HMCJIO KJIHHHHCCKHH 34><|>eKx: oSteivia reMoxpaHc4>y3HH B nocneonepauHOHHOM nepno-

RQ ^OCTOBepHO CHH3HJIC3 (p < 0.02).

B 2001 ro^y Engel H coaBT. ony6jiHKOBajin pesyjibxaxw paHaoMH3npoBaHHoro HCCJIC-

AOBaHHa, uenbio xoxoporo 6buio H3yHCHHe AHHaMHKH noKasaxejieii reMOCxaaa H 4>H6pHHO^H3a

B 3one onepaijHH H oueHKa BJiHSHna xpaneKcaMOBOH KHCJIOXBI na 3xn noKasaxejiH H o&teM Kpo-

BonoxepH. B HCcneAOBauHe 6bino BKinoieHO 24 naijHeHxa, 12-TH H3 Koxopbix eo BpeMH onepa-

HHH BHyXpHBCHHO BBCJ1H 1 5 MF/KX XpaHeKCaMOBOH KHCJIOTBI, a 33XCM HepC3 3 Haca nOBXOpHJIH

BsezieHHe B AO3e 10 MF/KT. OcxajibHbie 6ojiSHbie HOJiyHHJiH HJiaue6o. BCCM naiineHTaM B

peHHyio seny onepHpOBaHHoit KOHCTXHOCXH ycxanaBJiKBajra Kaxexep, nepes Koxopbiii

cHaxHCM xypHHKexa, a 3axeM nepes 5,10,30,60 120 MHH H nepes cyxKH 6pajiH KpoBb AIM 6no-

XHMHHCCKHX aHajiH3OB. B o6eHx rpynnax aBxopaMH oxMenena 3HaimMaa aKXHsamia npoueccos

rCMOKOaryjlflUHH H (J)H6pHHOJIH3a B KpOBH H3 6eApeHHOH BCHbl. TIpH 3XOM, K3K H B HpCflbmy-

Hccjie^oBaHHH, BseaeHHe. TpaneKcaMgBOH KHCJIOTH He BJinaJio na cxeneHb_3XHX H3Mene-

HHH. Bojiee xoro, asTopti ne oxMexHixa H flocxoBepnoro yMeHbineHHfl oGteMa KpoBonoxepn H

reMoxpaHC(J)y3HH npn Hcnonb3OBaHHH HHrnSHXOpOB ({)H6pHHOJiH3a. E^HHcxBennbiM

3HaHHMbiM oxjin^HCM cxajio yMeHbineHHe tfflcjia SojibHbix, KOXOpBiM noxpeSo-

Banacb reMOXpaHC(|>y3H5L B rpynne c xpaneKcaMOBOH KHCJIOXOH HH o/inoMy HS 12 6ojibHbix

KpoBb He nepejinsajiH. B rpynne njianeSo reMOTpanc^iysHH noxpeSoBanHCb (npH CHHaceHHH

Ht Menee 27%) 3 namienxaM.

B HCCJieaosaHHH Tanaka H coasx. (2001) 99 naqnenxoB, nepenecuinx 3H£onpoxe3Hpo-

KoneHHoro cycxasa 6buiH pasziejienbi na 4 rpynnbi: 1) rpynny nnane6o; 2) rpynny no-

xpaneKcaMOByro KHCJioxy OAHOKpaxno nepea onepaHHefi B ̂ ose 20 MF/KX; 3) xpynny,

npenapax B flose 10 MF/KX ^o onepaunn H 10 MF/KF nepezi CHHXHCM xypHHKexa; H

4) - nojxyTXHBHiHX 20 MF/KF xpaneKcaMOBOH KHCJIOTLI nepe/i cnaxneM xypHHKexa. KpOBecSepe-

raiomHH 3(|)4)eKx xpaneKcaMOBOH KHCJioxbi asxopbi onpe^enajm c y^iexoM ne XOJH>KO

noxepb KPOBH, HO H paccHHXbisaa oS^eM CKpbixoH KpOBonoxepn no noKa3axejno

HOFO CHH^eHHJi KOHueHxpauHH reMor^o6HHa B nocjieonepauHOHHOM nepHozie. KpoMe xoxo,

npenejieniifl qacxoxbi 6eccHMnxoMHbrx xpOM6o3M6onHHecKHx ocjio^neHHH BCCM 6o^b-

nocjie onepauHH BbinonnsjiH H3oxonHyro 4>Jie6orpa4>Hio H cuHHXHrpa^Hio JICFKHX. KaK

noKa3aJiH pesyjibxaxbi HccjieflOBaHHH, cyMMapnbiH oSieM KposonoxepH B rpynnax 6oJibHbrx.,

6

TpaneKcaMOByio KHCJIOXY 6bui ^ocxosepHo MCHbuie, HCM B rpynne onaueSo (785

H 1470 MJI cooxsexcxBeHHO, p < 0.01). HaiiMeHbinaa KposonoTepa (211 MJI HHXpaonepanHOH-

HO H 528 MJI - nocjie onepanHH) oxMe^ena B rpynne GojibHbrx, noJiy^HBiuHx xpaneKcaMOByro

KHCJioxy jjo onepanHH H nepeA CHMXHCM xypHHKexa, xoxa 3XH OXJIH^HS He HMCJTH cxaxncxH^ie-

CKH 3HaHHMbiH xapaKxep. He Sbxno BbMBJieHO AOCxoeepHbix OXJIHHHH Meac^y rpynnaMH nauH-

CHXOB, nojry^aBniHX xpaneKcaMOByK) KHCJioxy B pasJiHHHbix peiKHMax H no o6i>eMy reMO-

XpaHC(J>y3HH H HHCJiy 6oJIbHbK, Hy^CaaBUIHXCSI B nepejIHBaHHH AOHOpCKHX 3pHXpOUHXCOAep-

>KamHX cpezj. B xoace BpeMa Bee rpynnti oxjin^ajincb no SXHM noKasaxejuiM ox rpynnbi

eaxoB, noJiy^HBuinx njiaueSo (B cpe^neM no 2 ejj.icpoBH (p < 0.01) 6biJio nepejinxo

H3 26 nauHenxoB 3XOH rpynnbi). HH y O^HOXO H3 o6cjie4OBaHHbix 6ojn>Hbxx aBxopbi ne

J1H KJlHHH^ieCICHX HpH3HaKOB TpOMSoSMdOJIH^CCKHX OCJIOaCHCHHH . HpH HCnOJlb3OBaHHH (|>Jie6o-

rpa4)HH ^acxoxa xpOM6o30B oxasajiacb aoBOJibHO BHCOKOH, HO ona ne sasncejia OT npHMene-

HRfl TpaneKcaMOBOH KHCJioxbi H cc ^O3bi. V 12 H3 26 nanHCHxoB (46%) KOHxpojibHOH rpynnbi,

y 1 1 H3 24 (46%), nojiy^HBinHx npenapax ;̂o onepauHH, y 10 H3 22 (45%), noJiytraBuiHx npe-

napax #0 H BO speMa onepanHH, y 13 H3 27 (48%) GojibHbix, KOXOpbiM npenapax BBO^HJIH

XOJH>KO HHxpaonepannoHHo, pesyjibxaxw 4>jie6orpa<|iHH oKasajincb nojiosoixejibHbiMH. Hpn

3XOM, O,ZJHaKO, CKaHHpOBaHHC J1CFKHX HC BblSBHJIO CHenH^HHeCKHX H3MeHCHHH HH y OAHOFO

6ojibHoro.

B Hccjie^oBaHHH, npOBe/ieHHOM Veien M. H coasx. (2002), y^acxBOBajio 30 nannenxoB,

onepHpoBaHHbix na KOJICHHOM cycxase «no^ HcryxoM» B ycjiOBHax cnHnajibnoH anecxesHH H

pacnpeAejieHHbix cJiy^aKHLiM o6pa30M B rpynny njiaueSo Hjra B rpynny nojiyHHsmnx xpaneK-

caMOByio KHCJioxy. B aaHHOM HCCJieAOsaHHH asxopbi BBOJXHJIH npenapax B jiose 1 0 MF/KF na 3a-

KjnoifflxejibHOM 3xane onepanHH H B XOH ace jxose nepes 3 ^aca. Ha scex sxanax JieneHHH Kpo-

Bonoxepa B rpynne 6ojn>Hbrx, nojxyHHsniHX xpaneKcaMOByio KHCJioxy, Sbuia ziocxoBepHo nnace,

qeM B rpynne non3^4HBmHx njianeGo. B pesyjitraxe cyMMapnaa KpoBonoxepa cocxaBHJia 409.7

± 174.9 MJI H 761.7 ± 313.1 MJI cooxeexcTBeHno (p <0.001), npn oxcyxcxBHH flocxosepHbix ox-

JIHHHH Meac/ry rpynnaMH no noKasaxeJiSM reMOKoaryjiauHH. HH o^LHOMy nauneHxy B rpynne c

xpaneKcaMOBOH KHCJIOXOH ne noxpeSoBajmcb reMoxpaHC(J)y3HH B nocJieonepannoHHOM nepno-

fle, B rpynne c ixnaneSo xaKHx 6ojn>Hbix 6buio 13%.

cxeMy BBe^eHHa xpaneKcaMOBOH KHCJTOTbi Hcnojib30BanH Good H co-

asx. (2003) npH BbinonneHKH npoxe3npOBaHHa KOJiennoro cycxasa 53 6ojn>HbiM ocxeoapxpo-

3OM. B JIBOHHOM cjienoM HccjiejioBaHHH, 24 nanHCHxa nojiy^HJiH njianeSo, a 27 - xpaHCKcaMO-

Byio KHCJioxy (10 MF/KF nenocpe^cxBeiiHo nepe^ cnaxHeM xypHHKexa H nepe3 3 naca). KpoBO-

noxepio paccHHXbiBajiH c ynexoM cnnaceHHM KOHuenxpauHH HB na 5 ^enb nocjie onepauMH. Ho

7

3TOH rpynnbi Hccjie/iOBaTejieH npHMeHenne TpaneKcaMOBoH KHCJIOTM npireejio K noo

roeepHOMy yMCHbnieHHio o6teMa Apena^KHbrx noxepb: 845 (523-990) MJI H 385 (331-586) MJI

cooTBeTCTBCHHo(p<0.001). naimeHTti B rpynne miaue6o nojryHHJin B cpeAHCM 2 (0-2) efl., a

nauHCHTbi c TpaneKcaMOBOH KHCJIOTOH - 0 (0—0) CA. JXOHOpcKon KPOBH (p<0.001). PacneTHaa

KpoBonorepa cocrasHJia cooTBercTBeHHo 1426 (1135-1977) MJI n 1045 (792-1292) MJI

(p<0.001). V AByx nauHenTOB B Ka^KAon rpynne pa3BHjica nocjieonepauHOHHbiH

TpOM6o3 FJiySOKHX BCH HH^CHHX

CpejiH Hccjie/xoBaHHn no 3(J)4>eKTHBHocTH TpaneKcaMOBOH KHCJiOTbi npH onepauiDrx Ha

KOJICHHOM cycxase ppa nccJie^oBanHH Zohar E. H coasT. (2004) npHBJieKaioT oco6oe BHHMa-

HHC. B ojniOM H3 HHX aBTOpbi cpaBHHBaim AeMcTBHe TpaneKcaMOBOH KHCJIOTM ne c miane6o -

3(^(J)eKTaMH, a C MeTO/IOM OCTpOH HOpMOBOJieMHHCCKOH reMOflHJUOnHH (OHT) — OTHOCHTCJIbHO

pacnpocrpaHeHHOH MeroAHKon KpOBecSepeaceHHa B opToneAHH. B aannoM npocneicraBHOM

paHAOMH3HpOBaHHOM HccjieAOBaHHH y^acTBOBajio 40 nainieHTOB, pasaeneHHbix Ha ABC rpyn-

nbi. OAHOH rpynne ^a^HeHTOB B TeneHHe 30 MHH nepe/t CHHTHCM TypHHKexa npoBOAHJin Bnyr-

HH(J)y3HK) TpaHCKCaMOBOH KHCJIOTbl B AO3C 1 5 MF/KT, 3aTCM HH(J>y3HK) npOAOJlXCaJlH B

12 H3COB C nOCTOHHHOH CKOpOCTbK) 10 MF/KF/HaC. Bo BTOpOH Fpynne nailHCHTOB, H6-

nepeA na^ajioM aHecresHH H onepanHH nposoAHJiH 3aFOTOBKy ayroKposH B

o6-bCMe, o6ecneHHBaiomeM cHH^ceHne Ht AO 28% c oAHOBpeMeHHtiM saMeineHHCM KPOBH pac-

TBOPOM PHHrepa-JIaKTaTa. B KOHUC onepauHH BCK> ayroKpoBb BO3BpamajiH nauHCHxy. rioKa3a-

HH6M K FeMOTpaHC(J)y3H«M AOHOpCKOH KpOBH C^HTaJIH CHHHCeHHe Ht HHKC 27. fijlX OUCHKH

TpOMSOTHHCCKOH OHaCHOCTH T3KHX MCTOAHK BCCM GoJIbHbIM nepCA BbDlHCKOH BbmOJIHaJlH

AonnJieporpa(J)Hio BCH, a B Te'qeHHe 3-x MecatieB oTCJieaoiBajra pasBHTne CHMnTOMaTHHecKHX

TpOM6O3M6oJIHHeCKHX OCJIOXKHCHKH. KaK yCTaHOBHJIH aBTOpbl HCCJlCAOBaHHa, npH HCnOJlb30-

BaHHH OHT, HecMoxpa Ha SHaHHTejibHbrii (843 ±289 MJI) o6i>eM ayTOTpancc^ysHH,

Ht B nepBtie rpoe cyroK nocjie onepaunn 6buia AocTosepno HH^ce, qeM npn

TpaHCKCaMOBOH KHCJIOTbl, MTO npHBCJTO K HajmHHIO AOCTOBCpHOH (p< 0.0008) pa3HHqbI B

eMax H ^acToxe TpaHC(|)y3HH AOHOPCKHX 3pHTpou,HTCOflep)KanLHx cpeA- B rpynne c OHT 13

nauHCHTaM, HyacAaBniHMca B reMOTpaHc4>y3Hax, GbiJio nepejiHTO 19 efl. AOHopcKOH Kposn, B TO

BpeMa KaK B rpynne c TpaHCKcaMOBoH KHCJIOTOH TOJQ.KO 2 naunenTaM npOBOznuiH reMorpaHC-

c[)y3Hio (no 2 CA. KaagxoMy). /^ocTOBepHbrx OTOTIHHH no nacTOTe BenosHbix TpoM6o30B aBTOpbi

ne o6napyaauiH, B TeneHHe 3 Mecanes nocne onepauHH TpoM6o3 BCH HH^CHCH KOHCHHOCTH pas-

BHJica y OAHOFO SojibHoro H3 rpyniiH OHF. Ho 3aKJnoHeHHK> asTOpos, npH onepannax TOTajib-

HOFO 3HAonpore3HpoBaHHa KOJICHHOFO cycTasa npHMeHenne TpaHeKcaMOBofi KHCJIOTM HMCCT

8

npeHMymecxBa nepea OHF, cB>naHHbie uspoaxHO c 6onee Sjiaxcnpii^xiibiM cocxoanneM reMO-

H yMCHbtueHHeM norpe6nocxH B nepejiHBanHax ^OHOpcKOH

B apyroM nccjie^oBaHHH, Zohar E. H coasx. (2004) cpaBHHBajiH 3(J)(|)eKXHBiiocxb H

6e3onacnocxb xpaneKcaMOBOH KHCJIOXM, BBO.OHMOH BHyxpHBenno HJIH per os. 80 nannenxoB

6bLJiH pa3#eJieHbi na 4 rpynnbi: B I-H xpynne xpaneKcaMOByio KHCJioxy BBOAHJIH B BH,ne HH(|)y-

3HH B xeneHHe B flose 15 MF/KX B xe^eHne 30 MHH nepezj CHSXHCM xypHHKexa, a 3axeM B BH^,C

HHc|>y3HH co CKOpocxbio 10 MX/KX/H B xeHCHHe 12 ^acoB. Bo 2-H xpynne nepBOHanajibnoe BBe-

/leHne 6buio xaKHM we, o/znaKo B/B nH(|>y3HJi npeKpantanacb qepe3 2 ^aca nocne onepan.HH (x.e.

npn nepeeoAe Sonbnoxo H3 najiaxti npo6y Centra), a ^epes 6 H 12 ^acos naiiHeHTaM BHyxpb

eme no 1 x xpaneKcaMOBOH KHCJioxbL B 3-H xpynne sa 60 MHH ̂ o onepanun SoJibHbie

BHyipb 1 r TpaneKcaMOBOH KHCJIOXLI H xaKyw )Ke aosy nepes Kaaypbie 6 nacoB B xe^e-

HHC 18 nacoB. 4-a xpynna 6bUia KOHTpojibHOH. Bce 6o;ibHbie 6bum onepnpoBaHbi B ycjiosnax

o6meH anecxesHH H see noiry^ajiH anoKcanapHH no 40 Mr/^enb pjw npo^HJiaKTHKH xpOM6o3M-

6ojiHHecKHX ocjioacHeHHH. /^peHaaaibie noxepn B xeneHne nepsbrx 12 ^acoe nocjie onepauHH

MaKCHMajibHbiM B KonxpojibHOH rpynne (249 ±130 MJI), HO ̂ ocxoBepHo OHH OXJIH-

XOJIBKO or noxepi. B xpynnax, r^e xpaneKcaMOByK) KHCJioxy BBOflHJiH BHyxpHBCHHO

(121 ± 81 MJI H 1 1 0 ± 38 MJI), B xo BpeMfl Kax npH npHeMe npenapara BnyrpB, ero BJIRSIHIW na

XCMH H o6i.eM KposonoxepH He BbWBHJiH (231 ± 138 MJI). Asxopbi csasbmaiox 3xn oxjiHHHa c

^apMaKOJiorH^ecKHMH cBoflcxBaMH npenapaxa, fleficxBHe Koxoporo npH npHCMe BHyxpb ^oc-

xHxaex CBOCXO MaxcHMyMa nepe3 2 naca H K 3xany cnaxna xypHHKexa (x.e.K MOMenxy MaKCH-

aKXHsanHH (J)H6pHHOJiH3a) yace OKasbreaexca He^ocxaxo^HbiM. Cjie^yex oxMexnxb o/i-

no BCCM ocxanbHbiM cpasnuBaeivibiM noKasarejiHM (o6i>eM ApenaacHbix noxepb, g&-

xeMaxoxpHxa, noxpe6HOCXb B reMOTpaHC(f>y3Hax H ^HCJIO 6ojn,Hbix, nyjK/taioTxrHxca B

xpanc4)y3Hax) nepes 12 nacos nocjie onepaunn H B nocjiejryioineM, see xpH xpynnbi nanneH-

XOB, nojry^HBinHX xpaneKcaMOByK) Kncjioxy ^ocxosepHo oxjnnajiHCb ox KonxpojibHOH, npn

3TOM oxjintfflfl yace ne 3aBHcejni ox pe^KHMa npneMa npenapara.

Alvaxez J.C. H coasx. (2007) H3yHajiH 3(J>i{)eKXbi xpaneKcaMOBofi KHCJioxbi B

npH onepaitHax npore3HpOBaHHa KOJICHHOXO cycxasa npHMenaiiHCb H ^pyxne

. B flBoimoe cjienoe Hccjie^osanHe asjopBi BKJno^Hjm 95 nan.HeHXOB, H3 HHX

46-xH BO BpeMa onepauHH 6buio SOJIIOCHO BBe^eHO 10 MX/KX npenapaxa, a 3axeM BBe^eHHe

xpaHeKcaMOBOH KHCJIOXBI Sbuio npOAOJi^eno B BHAC BHyxpHBenHOH HH(j>y3HH co CKopocxbro 1

. ripn jieneHHH 33 nan,neHxoB (34.7%) npHMenajiHCb AonojmnxejibHbie Mexo^bi Kpo-

: 3aroxoBKa ayxoKposH (12), peKOM6HHanxHbiH 3pHxpono3xnn (6), npenapaxbi

acejie3a (15), cncxeMbi fljia peHH(j>y3HH /ipeHawHbix noxept (100%). 06-beM KposonoxepH asxc-

pbi paccHHTbiBajiH c yneroM CKPKTTKTX noTcph no KOHHCHTpauHK HE Ha 4-c CVTKK nGCJicone-

pauHOHHoro nepHozia. O6mHH o&teM KpoBonoTepn B rpynne c TpaHeKcaMOBOH KHCJIOTOH co-

1301 ±621 MJI, B KOHTpojie 1744 ± 804 MJI (p < 0.05). ToiibKO ^ayM naHHCHTaM H3 no-

TpaHeKcaMOByio KHCJiory (4%) H 36 (73%) - B KOHTpojie, HOTpe6oBajiacb peHH^y-

KpOBH H3 flpCHaaCHtlX CHCTCM (p < 0.0001). TpOM603M6oJIHHeCKHX OCJ1OKHCHHH aBTOpbl HC

OTMCTHJ1H.

Molloy D.O. H coaBT. (2007) HaynajiM B npocneKTHBHOM panjioMH3npoBaHHOM oTKpbi-

TOM HCCJie/IOBaHHH KJIHHHHeCKHe pe3yJIbT3TbI HHTpaOHepaUHOHHOrO BBe^eHHfl TpaHCKCaMOBOH

KHCJIOTbl B flO3C 500 MT ( 33 5 MHH AO CHHTH3 TypHHKCTa) C HOCJie^yiOmHM nOBTOpHbIM BBQRQ-

HHCM iepe3 3 naca. ABTOpbi OTMCTHJIH He6ojibmoe, HO CTaTHCTHHecKH 3HaHHMoe (p= 0.041)

yMeHbmeHHe o6i>eMa pacneTHOH KpOBonoTepn 1225 MJI ( 580 - 2027 MJI) H 1415 MJI ( 801 -

2319).

TaKHM o6pa3OM, K nacTOHmeMy BPCMCHH B MHpe BbinojineHo

HHH, cBH/zerejibCTByiomHx o TOM, HTO njiaHOBoe Hcnojib3OsaHHe TpaHeKcaMOBOH KHCJIOTbl npn

onepannax npoTe3HpOBaHHH KOJiennoro cycTasa o6ecneHHBaer cTaTHCTHHCCKH 3HaHHMbra Kpo-

BecSeperaiomHH 34)4)eKT5 no3BOJiaeT yMeHbuiHTb o6beM ApeHaaoibix noTepb H noTpeSnocTb

B nepesHBanHH flOHOpCKHX apHTpoHHTCo^epacaniHX cpe^i- TIpn STOM 6ojibmHHCTBO

H aBJiaiOTca He6ojibinHMH no o&beMy H oneHb pe^KO BionoHaioT 6oJiee 100

eHTOB. 3ro onenb Baacnoe o6cTOHTejibCTBO, nocKOJibKy no saKonaM cTaTHCTHKH, HHCJIO ncnbi-

TyeMbix onpeAenaeTca Heo6xoAHMOCTbK> AocTOBepno noflTBep^HTb Him OTBeprayrb OTJiH^na

Meacay rpynnaMH. He6oJibinoe HHCJIO HaSjnoACHHH B 3THX HCCJie,noBaHHsx cBH^erejibCTByer o

TOM, HTO KpOBec6eperaK>mHH 3$c[)eKT TpaneKcaMOBOH KHCJIOTM SbiCTpo CTanoBHTca

HblM H CTaTHCTHHCCKH

He Menee sa>KHbiMH AJIS npaKTHHecKoro Hcnojtt3OBaHHa TpaHeKcaMOBOH KHCJIOTM npn

3H£onpOTe3HpoBaHHH KOJieHHoro cycxasa HBJiaiOTcs H HeKOTopbie ^pyrne 3aKJnoHeHH«, KOTO-

pbie MOJKHO c^ejiaTb, anajiH3Hpyfl peayjibTaTbi STHX Hccjie^OBaHHH, 1 1 H3 KOTopbix 6buiH

B Mexa-aHajiH3 Zufferey P. H coasT.(2006). KaK oTMenaioT asTopu Mexa- aHajiH3a,

B KaaoiOM HccjieflosaHHn Hcnoju>3OBajiacb cBoa opnrHHajibHaa cxeMa BBe^eHHa

KHCJIOTbl. HanpHMep, BO BpeM# onepanHH 71033 cocTasjiajra OT 10 #o 135

Mr/KT. Eme Menbuie 4O3a npenapaTa 6bina B 6onee no3/meM Hccjie^OBaaHH (Molloy D.O. H co-

aBT., 2007), HO B STOM cjiy^ae 34>4>eKTHBHocTb npenapaTa OKasanacb nnace, neM B npe/nnecT-

Byiomnx ncnbiTaHHHX. Pa3^HHHbiM 6biJi H cpoK iipHMeneHHa npenapaTa. ^o onepauHH ero na-

3HaHajiH pe/iKO, H TaKa^ MeTO^HKa ce6a He onpaB/iana. HanSojiee jiorn^HbiM H 3(|)4)eKTHBHt.iM

10

cnoco6 BBeaeHwa npenapaxa Henocpe^cxBeHHO nepe.ii cnaxHcM xypnuKera, x.e. B

MOMCHT MaKCHMajibHOH aKTHBH3au.HM 4>H6piiHOJiH3a. FIpH 3XOM noBxopHbie 6ojnocHbie BHyx-

pHBCHHbie BBezieHHfl npenapaxa B xeneHHe 3 -6 qacoB H 4aace 3-x cyxoK, ero Hcnojib30BaHHe B

BH,ae .gJIHXeJILHOH, 4O 12 qaCOB, nOCXOUHHOH HH(J>y3HH HJIH npHCM XpaHCKCaMOBOH KHCJIOXbl

Biiyxpb npaKXH^ecKH ne pasjunajiHCb no CBoervty 3(f)4)eKxy.

Cjiejxyex oxMexwxb xaxace, HXO asxopbi npHMenajiw xpaHeKcaMOByro KHcnoxy npH npo-

onepaunH B ycjiofinax KaK pernoHapHoii, xaK H o6meM anecxesHu, conexajiH ee Ha-

c npHMenenneM ^pyxnx MCXOAOB KpOBec6epeaceHna H c HcnoJibsoBaHHeM jiJia npo-

osMSojra^ecKHx ocjio^caenHH HHSKOMOJieKynapHbix renapHHOB B nepHone-

pau;HOHHOM nepnofle H He OXMCXHJIH KaKHX-JiH6o cssisaHHLix c SXHMH oScxoaxejibcxBaMH oco-

6eHHOCxeH jtencxBHa npenapaxa. He 6bino BbiflBJieHO BJIH^HHS TpaneKcaMOBOH KHCJIOTM na

^acxoxy nociieonepanHOHHbix xpOM6o3M6oJiniiecKHx ocno^oieHHH, o/piaKo B aaHHOM cjrynae

He6ojibmoe HHCJIO BKjuoneHHbix B Hccjie^OBanHe nauHenxos HMCJIO H oxpHuaxejibHbie MOMCH-

XH, nocKOJU,Ky ana onpe/iejieHiM 6e3onacnocxii npenapaxa xaKoro HHCJia Ha6jnofleHHH HBHO

. B onpe/iejieHHOH cxenenH 3xox npoSeji ycrpanaex CHCxeMaTHHecKHH oSsop ac-

Koxpana (2007), no aaHHbiM Koxopoxo, npHMeneHne HHraSuxopoB (J)H6pHHOjffl3a ne

noBbinieHHCM HHCJia xpoMSoxHHecKHx jicno^cHeHHH. Ho^- sepoaxno, Sojiee

XOHHO na 3xox Bonpoc MO5KHO 6y/jex oxBexnxb no oKOHHaHHio Hccjie^oBaHna CRASH-2

(Clinical Randomisation of tranexamic acid in Significant Haemorrhage) Koxopoe npo^ojmaex-

cfl B nacxoaniee Bpeivtii. B nexo njiaHnpyK>x BKJiiOHHXb 20000 nocxpaAasmnx c xpasMOH H Kpo-

BoxeneHHeM. K Mapxy 2008 ro^a B 3x0 KCCJieAOBanne 6buio BKjnoneHo OKOJIO 6000 naixnenxoB

H na 3XOM sxane KaKoro-Jin6o 3HaHHMoro noBbmieHiia qacxoxbi TpOM6oxHHecKHX

ne Sbuio.

TOKHM o6pa3OM, npHMCHCHiie xpaneKcaMOBOH KHCJioxbi npn onepamiax 3H,nonpoTe3H-

KOJieHHoro cycxasa MOHCHO paccMaxpHBaxb KaK nepcneKXHBHbffl cnocoS yMeHbinenna

KpoBonoxepn H CHH>KeHHfl noxpeSnocxn 6ojn,Hbix B xpaHc4)y3nax aoHOpCKofi KpoBH. B na-

cxoamee BpeMs 3xn nepcneKXHBbl cxanH 6ojiee peajibHbiMH H jjjis acHxejien Haniefi cTpanti, xax

KaK c 2007 rojja xpaneKcaMOBaa KHCJioxa (TpaneKcaM, «MMP-OAPM») npoH3BO^nxca B Poc-

CHH H paspemeaa jjjis KjmHHHecKoro Hcnojn>3OBanHa. O^eHKa 3(J)(J)eKXHBHOCTH H 6e3onacHO-

CXH 3xoro npenapaxa npn npoxesnpoBaHHH KOJieHHoro cycxasa cxana OCHOBHOH ueju.io namexo

1 1TpaneKcajvia npH npoTesHposaHHH KOJiennoro cycxasa.

B npocneKXHBiiOM oxKpbixoM HccneflOBaHHH ynacxBOBajiH 40 nauneHxoB cxapme 20 jiex

(ASA I HJIH II), KoxopuM 6bmo Bbmojmeiio nnaHOBoe npoxe3HpOBaHHe KOJICHHOFO cycxasa.

KpwxepHflMH HCKjnoHeHHii 6buin: Bpoac^eimbie KoaryjionaxHH, Beno3Hbie xpoM6o3bi HJIH xpoM-

6o3M6ojiHs jieroHHOH apxepHH B anaMnese, npneM acxrapHna HJIH necxepoHjxHbix npoxHBOBoc-

npenapaxoB B xeHemie 3-x AHefl nepe/i onepanneH. B COOXBCTCXBHH c 3aaaHaMH

6ojibHbie 6buiH paHjjoMH3HpOBaHHo pacnpe^ejienbi B 2 rpynnbi (xaSn.l). KaK

BH/IHO H3 xa6ji.I, rpynnbi 6buiH conocxaBHMbl no sospacxy, pocxy, Becy, cxenenH anecxe3HOJio-

rHnecKoro pHCKa, npo^ojiHCHxeju,HOCXH o^epa^HH. B nepson rpynne BO BpeMa onepauHH, ne-

nocpe/icxBeHHo nepe^ cuaxneM xypnnicexa 6ojibHi>iM BHYXPHBCHHO BBO^H^H TpaneKcaM B AOSC

15 MF/KT. Bo Bxopoii rpynne TpaneKcaM ne BBOZIHJIH.

CpaBHHTejibHaa xapaxxepncxHRa rpynn naiineHTos1

MHCJIO SojibHbix,Cpe^HHH Bospacx, JiexCpejtHHH pocx, CMCpC/IHHH BCC, KT

ASA I / 11, aSc.HHCJioBpCMfl OliepaUHH, MHH

06-bCM HHXpaOHepa^HOHHOH KpOBOHOXepH, MJI

nocjieonepainioHHbie noxepH no Apena^caM, MJIO6l>eM HH{J>y3HH, MJI

TpaHCKcaMOBajiKHCJIOXa

2063 ±6163 ±973± 89/11121±20140±70234±1411485± 170

KoHXpOJIB

2062 ±7168±774 ± 108/121 1 1± 26139±60556±430(p=0.003)1462±250

BenepoM HaKanyHe onepanHH BCCM GojibHbiM HasHanajiH no/iKoacHo 0,3 MJI

na AJW npo4)HJiaKXHKH TpOMSoaMSoJiH^ecKHx ocjioacHeHHH. IloBxopHyio HHT>eKiiHK> npenapaxa

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B xeneHHe 14 AHCH. 3a 30 MHH ̂ o onepaitHH BHyxpHMbnneifflo BBO^HJIH 5 -7,5 Mr MH/jasoJiaMa

(npeMeAHKan;Ha). HnztyKUHio anecxesHH npOBO^HJin npono(|)OJiOM ( 1,5 Mr KT—1), (J>eHxaHHJioM

(3-4 MKT/KT), 3CMeponoM (0,5 - 0,7 MF/KT) na (})OHe caMOCXoaxejibHoro fluxaHHa nannenxoM

nepe3 jinneByK) Macxy 100% KHCJIOPO.HOM. /^Jia nozmepacaHHfl anecxe3HH HcnojibsosajiH ceBOfJ)-

juopan H 6ojnocHbie HHT>eKHHH 4>eHxaHHJia. B ycJIOBHax oSmen anecxesHH 6ojn>HbiM 6buxH BW-

nojmeHbi cxanflapXHbie onepaxHBHbie BMemaxejibCXBa nepBHHHoro njianoBoro npoxesHpOBaHHH

KOJiennoro cycxasa c HaBHrainieH. Bee BMemaxejibCXBa npeAnoJiarajiH Hcnojn>3OsaHHe xypHH-

Kexa c AaBJieHHCM 250 MM px.cx. Ha 3aKjnoTmxejn,HOM 3xane onepanHH, xypHHKex cnHMajiH,

ocymecxBJiajiH AonojiHHxejibHbm reMocxas DJieKxpoKoaryiwuHeH, ycxanaBJiHBajiH /ipenaac,

pany, HaKJia^bisaJiH ^aBflmyio noBa3Ky. Hocne OKOHHaHHa onepauHH nannenxoB ne-

12

B najiaTy npo6y>K£,eHHH, rjis KOHXpojiKposaJiK oSmee cocxosHHe, ox^enseMoe no

H npOAOjiacajin JieneHHe. l\o onepauHH, ^epes 6 H 18 nacoB nocjie ee OKOHnaHHs, a

3axeM OKezmeBHO KOHXpojmpOBajiH noKasaTejiH KOHuenxpauHH reMorno6HHa, reMaxoKpHxa,

KoaryjiorpaMMbi. CuioKeHHe KOHqeHTpauHH reMorjioSnHa MCHCC 80 r/ji cmrrajra noKasanneM K

reMoxpaHC(J»y:jHH- T^Jia 6oJibHbix c conyxcxsyiomeH HBC, a xaioKe RJIX nauneHXOB c BO3HHKniH-

MH nocne onepauHH 3KT npH3HaK3MH napyraenHH nep(J>y3HH HJIH xpo<J)HKH MHOKap^a, HHMCHCH

flonycxHMOH rpanHuefi AJIH nepejiHBanna zionopCKHX 3pHXpouHxcoAepacairj,HX cpefl CHHxajiH

KOHuenxpauHio reMoruoSHHa 100 r/Ji. CxaxncxuHecKyio o6pa6oxKy ^anntix npoBoanjin c no-

MOIULIO naxexoB nporpaMM Microsoft Office Excel 2003 H Statistica 6.0. fljix npH3HaxoB c Hop-

pacnpe/iejieHHeM paccnuxbisajiH cpeflnee 3Ha*ieHHe M n cxan^apxHoe oxiciioHeHHe s;

npH3HaKOB c HHBIM pacnpeflejieHHCM — Me^nany Me, BepxHUH H HHSKHHH KBapXHJin (UQ;

LQ).

Bo BpeMfl onepamiH o6teM KposonoxepH 6tui MHHHMajibHbiM (140±70 MJI H 139±60

MJI), irro 6kmo oSycjiOBJieno xexHHKOH BLinojraeHHfl BMeiiiaxejibcxBa, H He 3aBnceji ox

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13

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14

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no HCHOJIHCHHIO cxeMy BBe^eHHa xpaneKcaMOBOH KHCJIOTBI, Bbi6pas speMa ( nepea CHHXHCM

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(1995).

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15

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