Update In Anaesthesia ɝɢɩɟɪɩɨɥɹɪɢɡɚɰɢɸ. ɗɬɨ ɭɦɟɧɶɲɚɟɬ ɩɪɨɜɨɞɢɦɨɫɬɶ
ɬɤɚɧɟɣ, ɞɨ ɬɟɯ ɩɨɪ,ɩɨɤɚ ɫɩɨɧɬɚɧɧɨ ɧɟ ɛɭɞɟɬ ɞɨɫɬɢɝ-ɧɭɬ ɭɪɨɜɟɧɶ ɩɨɪɨɝɨɜɨɝɨ ɩɨɬɟɧɰɢɚɥɚ,ɱɬɨ ɩɪɢɜɨɞɢɬ ɤ ɫɧɢɠɟɧɢɸ ɑɋɋ. ȼɧɭɬɪɟɧɧɹɹ ɱɚɫɬɨɬɚ ɋȺ ɭɡɥɚ ɨɤɨɥɨ 100 ɭɞ/ɦɢɧ,ɨɞɧɚɤɨ,ɜɥɢɹɧɢɟ ɜɚɝɭɫɚ ɫɧɢɠɚɟɬ ɟɟ ɞɨ 70 ɭɞ/ɦɢɧ.
Ɋɟɮɪɚɤɬɟɪɧɵɣ ɩɟɪɢɨɞ
ȼɨ ɜɪɟɦɹ ɚɛɫɨɥɸɬɧɨɝɨ ɪɟɮɪɚɤɬɟɪɧɨɝɨ ɩɟɪɢɨɞɚ (ȺɊɉ) (ɪɢɫɭɧɨɤ 1) ɤɥɟɬɤɚ ɩɨɥɧɨɫɬɶɸ ɧɟɜɨɡɛɭɞɢɦɚ.ɉɪɢ ɫɥɟ-ɞɭɸɳɟɦ ɞɚɥɟɟ ɨɬɧɨɫɢɬɟɥɶɧɨɦ ɪɟɮɪɚɤɬɟɪɧɨɦ ɩɟɪɢɨɞɟ (ɈɊɉ) ɜɨɡɛɭɞɢɦɨɫɬɶ ɩɨɫɬɟɩɟɧɧɨ ɜɨɫɫɬɚɧɚɜɥɢɜɚɟɬɫɹ. ɋɜɟɪɯɦɚɤɫɢɦɚɥɶɧɵɟ ɫɬɢɦɭɥɵ ɦɨɝɭɬ ɩɪɟɜɪɚɳɚɬɶ ȺɊɉ ɜ ɈɊɉ.ɗɬɨɬ ȺɊɉ,ɬɟɦ ɧɟ ɦɟɧɟɟ,ɢɦɟɟɬ ɦɟɧɶɲɢɟ ɫɤɨɪɨɫɬɶ ɞɟɩɨɥɹɪɢɡɚɰɢɢ, ɚɦɩɥɢɬɭɞɭ ɢ ɩɪɨɞɨɥɠɢ-ɬɟɥɶɧɨɫɬɶ ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɧɨɪɦɚɥɶɧɵɦ ɪɟɮɪɚɤɬɟɪ-ɧɵɦ ɩɟɪɢɨɞɨɦ.ȼ ɫɜɹɡɢ ɫ ɷɬɢɦ,ɫɨɤɪɚɳɟɧɢɟ, ɩɪɨɢɡɜɟ-ɞɟɧɧɨɟ ɜɨ ɜɪɟɦɹ ɬɚɤɨɝɨ ɩɟɪɢɨɞɚ,ɫɥɚɛɟɟ.ɉɢɤ ɦɵɲɟɱ-ɧɨɝɨ ɧɚɩɪɹɠɟɧɢɹ ɩɪɢɯɨɞɢɬɫɹ ɧɚ ɨɤɨɧɱɚɧɢɟ ȺɊɉ. Ʉ ɤɨɧɰɭ ɈɊɉ ɦɵɲɰɚ ɧɚɩɨɥɨɜɢɧɭ ɪɚɫɫɥɚɛɥɟɧɚ. Ⱦɥɢ-ɬɟɥɶɧɵɣ ɪɟɮɪɚɤɬɟɪɧɵɣ ɩɟɪɢɨɞ ɡɚɳɢɳɚɟɬ ɠɟɥɭɞɨɱɤɢ ɨɬ ɫɥɢɲɤɨɦ ɛɵɫɬɪɨɝɨ ɩɨɜɬɨɪɧɨɝɨ ɜɨɡɛɭɠɞɟɧɢɹ, ɤɨ-ɬɨɪɨɟ ɧɚɞɨɥɝɨ ɧɚɪɭɲɚɟɬ ɢɯ ɫɩɨɫɨɛɧɨɫɬɶ ɤ ɪɚɫɫɥɚɛɥɟ-ɧɢɸ,ɜɨ ɜɪɟɦɹ ɤɨɬɨɪɨɝɨ ɨɧɢ ɧɚɩɨɥɧɹɸɬɫɹ ɤɪɨɜɶɸ.ȼ ɨɬɥɢɱɢɟ ɨɬ ɫɤɟɥɟɬɧɨɣ ɦɭɫɤɭɥɚɬɭɪɵ, ɞɜɚ ɫɨɤɪɚɳɟɧɢɹ ɧɟ ɦɨɝɭɬ ɫɭɦɦɢɪɨɜɚɬɶɫɹ ɢ ɜɵɡɜɚɬɶ ɬɟɬɚɧɢɱɟɫɤɨɟ ɫɨ-ɤɪɚɳɟɧɢɟ.
ɋȿɊȾȿɑɇɕɃ ɐɂɄɅ
ɋɟɪɞɟɱɧɵɣ ɰɢɤɥ – ɷɬɨ ɫɨɨɬɧɨɲɟɧɢɟ ɦɟɠɞɭ ɷɥɟɤɬɪɢ-ɱɟɫɤɢɦ,ɦɟɯɚɧɢɱɟɫɤɢɦ (ɞɚɜɥɟɧɢɟ ɢ ɨɛɴɟɦ) ɢ ɤɥɚɩɚɧ-ɧɵɦ ɤɨɦɩɨɧɟɧɬɚɦɢ ɞɟɹɬɟɥɶɧɨɫɬɢ ɫɟɪɞɰɚ, ɩɪɟɞɫɬɚɜ-ɥɹɸɳɢɣ ɫɨɛɨɣ ɢɯ ɢɡɦɟɧɟɧɢɟ ɜ ɬɟɱɟɧɢɟ ɨɞɧɨɝɨ ɩɨɥ-ɧɨɝɨ ɫɟɪɞɟɱɩɨɥ-ɧɨɝɨ ɫɨɤɪɚɳɟɧɢɹ.
ɉɚɫɫɢɜɧɨɟ ɧɚɩɨɥɧɟɧɢɟ (ɪɚɧɧɹɹ ɞɢɚɫɬɨɥɚ)
ɉɪɟɞɫɟɪɞɢɹ ɢ ɠɟɥɭɞɨɱɤɢ ɪɚɫɫɥɚɛɥɟɧɵ, ɜɟɧɬɪɢɤɭɥɹɪ-ɧɨɟ ɞɚɜɥɟɧɢɟ ɪɚɜɧɨ ɧɭɥɸ. Ⱥɬɪɢɨɜɟɧɬɪɢɤɭɥɹɪɧɵɟ (AV)ɤɥɚɩɚɧɵ ɨɬɤɪɵɬɵ,ɩɨɥɭɥɭɧɧɵɟ ɤɥɚɩɚɧɵ ɡɚɤɪɵ-ɬɵ.Ʉɪɨɜɶ ɬɟɱɟɬ ɢɡ ɤɪɭɩɧɵɯ ɜɟɧ ɜ ɩɪɟɞɫɟɪɞɢɹ ɢ ɠɟɥɭ-ɞɨɱɤɢ (ɢɡ ɨɛɥɚɫɬɢ ɜɵɫɨɤɨɝɨ ɞɚɜɥɟɧɢɹ ɜ ɨɛɥɚɫɬɶ ɧɢɡ-ɤɨɝɨ). Ɉɤɨɥɨ 80% ɧɚɩɨɥɧɟɧɢɹ ɠɟɥɭɞɨɱɤɨɜ ɩɪɨɢɫɯɨ-ɞɢɬ ɜɨ ɜɪɟɦɹ ɷɬɨɣ ɮɚɡɵ.
ɋɨɤɪɚɳɟɧɢɟ ɩɪɟɞɫɟɪɞɢɣ (ɩɨɡɞɧɹɹ ɞɢɚɫɬɨɥɚ)
ȼɨɥɧɚ ɞɟɩɨɥɹɪɢɡɚɰɢɢ,ɧɚɱɢɧɚɸɳɚɹɫɹ ɜ ɫɢɧɨɚɬɪɢɚɥɶ-ɧɨɦ (ɋȺ)ɭɡɥɟ,ɪɚɫɩɪɨɫɬɪɚɧɹɟɬɫɹ ɧɚ ɨɛɚ ɩɪɟɞɫɟɪɞɢɹ ɢ ɞɨɫɬɢɝɚɟɬ AV ɭɡɥɚ. ɗɬɨɦɭ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɩɨɹɜɥɟɧɢɟ ɧɚ ɗɄȽ ɡɭɛɰɚ Ɋ. ɉɪɟɞɫɟɪɞɢɹ ɫɨɤɪɚɳɚɸɬɫɹ, ɪɚɫɬɟɬ ɜɧɭɬɪɢɩɪɟɞɫɟɪɞɧɨɟ ɞɚɜɥɟɧɢɟ, ɷɬɨ ɜɵɡɵɜɚɟɬ ɩɨɹɜɥɟ-ɧɢɟ ɜɨɥɧɵ «ɚ»ɧɚ ɤɪɢɜɨɣ ɐȼȾ.
Ʉɪɨɜɶ ɩɪɨɞɨɥɠɚɟɬ ɩɨɫɬɭɩɚɬɶ ɜ ɠɟɥɭɞɨɱɤɢ, ɜɟɧɬɪɢɤɭ-ɥɹɪɧɨɟ ɞɚɜɥɟɧɢɟ ɫɥɟɝɤɚ ɩɨɜɵɲɚɟɬɫɹ.ȼɤɥɚɞ ɩɪɟɞɫɟɪ-ɞɢɣ ɜ ɧɚɩɨɥɧɟɧɢɟ ɠɟɥɭɞɨɱɤɨɜ ɜɨɡɪɚɫɬɚɟɬ,ɤɨɝɞɚ ɭɜɟ-ɥɢɱɢɜɚɟɬɫɹ ɑɋɋ,ɩɪɨɢɫɯɨɞɢɬ ɭɤɨɪɨɱɟɧɢɟ ɞɢɚɫɬɨɥɵ ɢ ɜɪɟɦɟɧɢ ɞɢɚɫɬɨɥɢɱɟɫɤɨɝɨ ɧɚɩɨɥɧɟɧɢɹ. ȼɟɧɬɪɢɤɭɥɹɪ-ɧɵɣ ɨɛɴɟɦ (ɄȾɈ) – ɨɛɴɟɦ ɤɪɨɜɢ ɜ ɠɟɥɭɞɨɱɤɟ ɜ ɤɨɧ-ɰɟ ɞɢɚɫɬɨɥɵ. ȼɨ ɜɪɟɦɹ ɷɬɨɣ ɮɚɡɵ ɪɟɝɢɫɬɪɢɪɭɟɬɫɹ ɧɚɢɦɟɧɶɲɟɟ ɡɧɚɱɟɧɢɟ ȺȾ.
ɂɡɨɦɟɬɪɢɱɟɫɤɨɟ ɫɨɤɪɚɳɟɧɢɟ ɠɟɥɭɞɨɱɤɨɜ (ɪɚɧɧɹɹ ɞɢɚɫɬɨɥɚ)
ɉɨɬɟɧɰɢɚɥ ɞɟɣɫɬɜɢɹ ɩɪɨɯɨɞɢɬ ɱɟɪɟɡ AV ɭɡɟɥ ɤ ɩɭɱɤɭ Ƚɢɫɚ,ɱɟɪɟɡ ɨɛɚ ɠɟɥɭɞɨɱɤɚ ɢ ɜɵɡɵɜɚɟɬ ɢɯ ɞɟɩɨɥɹɪɢ-ɡɚɰɢɸ. ɇɚ ɗɄȽ ɷɬɨɦɭ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɤɨɦɩɥɟɤɫ QRS.
ɋɨɤɪɚɳɟɧɢɟ ɠɟɥɭɞɨɱɤɚ ɜɵɡɵɜɚɟɬ ɛɵɫɬɪɵɣ ɩɨɞɴɟɦ
ɜɟɧɬɪɢɤɭɥɹɪɧɨɝɨ ɞɚɜɥɟɧɢɹ, AV ɤɥɚɩɚɧ ɡɚɤɪɵɜɚɟɬɫɹ (ɩɟɪɜɵɣ ɬɨɧ ɫɟɪɞɰɚ),ɤɚɤ ɬɨɥɶɤɨ ɞɚɜɥɟɧɢɟ ɜ ɠɟɥɭɞɨɱ-ɤɟ ɩɪɟɜɵɫɢɬ ɞɚɜɥɟɧɢɟ ɜ ɩɪɟɞɫɟɪɞɢɢ. ɗɬɨɬ ɦɟɯɚɧɢɡɦ ɬɚɤɠɟ ɩɪɟɩɹɬɫɬɜɭɟɬ ɨɛɪɚɬɧɨɦɭ ɬɨɤɭ ɤɪɨɜɢ ɜ ɩɪɟɞɫɟɪ-ɞɢɟ.Ⱦɚɜɥɟɧɢɟ ɜ ɠɟɥɭɞɨɱɤɟ ɡɧɚɱɢɬɟɥɶɧɨ ɩɨɜɵɲɚɟɬɫɹ, ɩɪɢ ɷɬɨɦ ɢɡɦɟɧɟɧɢɹ ɨɛɴɟɦɚ ɠɟɥɭɞɨɱɤɚ ɧɟ ɩɪɨɢɫɯɨ-ɞɢɬ.ȼɨ ɜɪɟɦɹ ɧɚɱɚɥɶɧɨɣ ɮɚɡɵ ɫɨɤɪɚɳɟɧɢɹ ɠɟɥɭɞɨɱ-ɤɨɜ ɞɚɜɥɟɧɢɟ ɜ ɧɢɯ ɦɟɧɶɲɟ,ɱɟɦ ɜ ɥɟɝɨɱɧɨɣ ɚɪɬɟɪɢɢ ɢ ɚɨɪɬɟ,ɤɥɚɩɚɧɵ,ɩɨ ɤɨɬɨɪɵɦ ɩɪɨɢɫɯɨɞɢɬ ɨɛɪɚɬɧɵɣ ɬɨɤ ɤɪɨɜɢ,ɡɚɤɪɵɬɵ,ɨɛɴɟɦ ɠɟɥɭɞɨɱɤɚ ɧɟ ɢɡɦɟɧɹɟɬɫɹ.
ȼɨɡɪɚɫɬɚɸɳɟɟ ɞɚɜɥɟɧɢɟ ɜɵɡɵɜɚɟɬ ɜɵɩɹɱɢɜɚɧɢɟ ɫɬɜɨ -ɪɨɤ AV ɤɥɚɩɚɧɚ ɜ ɫɬɨɪɨɧɭ ɩɪɟɞɫɟɪɞɢɹ,ɱɬɨ ɩɪɢɜɨɞɢɬ ɤ ɦɚɥɨɣ ɜɨɥɧɟ ɫɨɤɪɚɳɟɧɢɹ ɩɪɟɞɫɟɪɞɢɹ – «ɫ»ɜɨɥɧɚ ɧɚ ɤɪɢɜɨɣ ɐȼȾ.
ɂɡɝɧɚɧɢɟ (ɫɢɫɬɨɥɚ)
Ʉɨɝɞɚ ɞɚɜɥɟɧɢɟ ɜ ɠɟɥɭɞɨɱɤɟ ɩɪɟɜɵɫɢɬ ɞɚɜɥɟɧɢɟ ɜ ɚɨɪɬɟ, ɨɬɤɪɵɜɚɟɬɫɹ ɩɨɥɭɥɭɧɧɵɣ ɤɥɚɩɚɧ. ɉɪɢɛɥɢɡɢ-ɬɟɥɶɧɨ 2/3 ɤɪɨɜɢ,ɧɚɯɨɞɹɳɟɣɫɹ ɜ ɠɟɥɭɞɨɱɤɟ, ɢɡɝɨɧɹ-ɟɬɫɹ ɜ ɚɪɬɟɪɢɢ.ɋɧɚɱɚɥɚ ɜ ɚɪɬɟɪɢɹɯ ɫɤɨɪɨɫɬɶ ɩɨɬɨɤɚ ɜɵɫɨɤɚ (ɮɚɡɚ ɛɵɫɬɪɨɝɨ ɢɡɝɧɚɧɢɹ), ɨɞɧɚɤɨ ɫɨ ɜɪɟɦɟ-ɧɟɦ ɨɧɚ ɭɦɟɧɶɲɚɟɬɫɹ (ɮɚɡɚ ɦɟɞɥɟɧɧɨɝɨ ɢɡɝɧɚɧɢɹ).
ɍɞɚɪɧɵɣ ɨɛɴɟɦ (ɍɈ)–ɨɛɴɟɦ ɤɪɨɜɢ,ɜɵɛɪɚɫɵɜɚɟɦɵɣ ɠɟɥɭɞɨɱɤɨɦ ɡɚ ɨɞɧɨ ɫɨɤɪɚɳɟɧɢɟ.
Ɏɪɚɤɰɢɹ ɢɡɝɧɚɧɢɹ (Ɏɂ)–ɨɬɧɨɲɟɧɢɟ ɍɈ/ɄȾɈ. Ⱥɪɬɟ-ɪɢɚɥɶɧɨɟ ɞɚɜɥɟɧɢɟ ɞɨɫɬɢɝɚɟɬ ɜɵɫɲɟɣ ɬɨɱɤɢ – ɫɢɫɬɨ-ɥɢɱɟɫɤɨɟ ȺȾ (ȺȾɫɢɫɬ.). ȼ ɬɟɱɟɧɢɟ 2/3 ɫɢɫɬɨɥɵ, ɩɟɪɟɞ ɬɟɦ,ɤɚɤ AV ɤɥɚɩɚɧ ɫɧɨɜɚ ɨɬɤɪɨɟɬɫɹ,ɩɪɨɢɫɯɨɞɢɬ ɩɨ-ɜɵɲɟɧɢɟ ȺȾ ɤɚɤ ɪɟɡɭɥɶɬɚɬ ɩɪɢɬɨɤɚ ɤɪɨɜɢ ɢɡ ɜɟɧ – ɜɨɥɧɚ «v» ɧɚ ɤɪɢɜɨɣ ɐȼȾ. Ⱥɤɬɢɜɧɨɟ ɫɨɤɪɚɳɟɧɢɟ ɩɪɟɤɪɚɳɚɟɬɫɹ ɜɨ ɜɪɟɦɹ ɜɬɨɪɨɣ ɩɨɥɨɜɢɧɵ ɮɚɡɵ ɢɡɝɧɚ-ɧɢɹ. ȼ ɷɬɨ ɜɪɟɦɹ ɩɪɨɢɫɯɨɞɢɬ ɪɟɩɨɥɹɪɢɡɚɰɢɹ ɦɵɲɰɵ ɩɪɟɞɫɟɪɞɢɹ, ɱɬɨ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɩɨɹɜɥɟɧɢɸ ɧɚ ɗɄȽ ɡɭɛɰɚ Ɍ. Ⱦɚɜɥɟɧɢɟ ɜ ɠɟɥɭɞɨɱɤɟ ɜɨ ɜɪɟɦɹ ɮɚɡɵ ɦɟɞ-ɥɟɧɧɨɝɨ ɢɡɝɧɚɧɢɹ ɧɟɫɤɨɥɶɤɨ ɦɟɧɶɲɟ ɞɚɜɥɟɧɢɹ ɜ ɚɪɬɟ-ɪɢɹɯ, ɧɨ ɤɪɨɜɶ ɩɪɨɞɨɥɠɚɟɬ ɩɨɫɬɭɩɚɬɶ ɢɡ ɠɟɥɭɞɨɱɤɚ ɩɨ ɢɧɟɪɰɢɢ.ȼ ɤɨɧɟɱɧɨɦ ɫɱɟɬɟ,ɧɚ ɤɨɪɨɬɤɨɟ ɜɪɟɦɹ ɩɨ-ɬɨɤ ɦɟɧɹɟɬ ɧɚɩɪɚɜɥɟɧɢɟ,ɜɵɡɵɜɚɹ ɡɚɤɪɵɬɢɟ ɤɥɚɩɚɧɨɜ ɫɟɪɞɰɚ ɢ ɧɟɛɨɥɶɲɨɟ ɩɨɜɵɲɟɧɢɟ ɚɨɪɬɚɥɶɧɨɝɨ ɞɚɜɥɟ-ɧɢɹ – ɞɢɤɪɨɬɢɱɟɫɤɢɣ ɡɭɛɟɰ ɧɚ ɗɄȽ.
ɂɡɨɦɟɬɪɢɱɟɫɤɨɟ ɪɚɫɫɥɚɛɥɟɧɢɟ (ɪɚɧɧɹɹ ɞɢɚɫɬɨɥɚ) ɀɟɥɭɞɨɱɤɢ ɪɚɫɫɥɚɛɥɹɸɬɫɹ, ɞɚɜɥɟɧɢɟ ɜ ɧɢɯ ɩɚɞɚɟɬ ɧɢɠɟ ɚɪɬɟɪɢɚɥɶɧɨɝɨ,ɱɬɨ ɩɪɢɜɨɞɢɬ ɤ ɡɚɤɪɵɬɢɸ ɩɨɥɭ-ɥɭɧɧɨɝɨ ɤɥɚɩɚɧɚ (ɜɬɨɪɨɣ ɬɨɧ ɫɟɪɞɰɚ). ȼɟɧɬɪɢɤɭɥɹɪ-ɧɨɟ ɞɚɜɥɟɧɢɟ ɩɚɞɚɟɬ ɩɪɢ ɧɟɢɡɦɟɧɧɨɦ ɨɛɴɟɦɟ ɠɟɥɭ-ɞɨɱɤɚ. Ʉɨɝɞɚ ɞɚɜɥɟɧɢɟ ɜ ɠɟɥɭɞɨɱɤɟ ɩɚɞɚɟɬ ɧɢɠɟ ɩɪɟɞɫɟɪɞɧɨɝɨ, AV ɤɥɚɩɚɧ ɨɬɤɪɵɜɚɟɬɫɹ,ɢ ɰɢɤɥ ɧɚɱɢ-ɧɚɟɬɫɹ ɫɧɨɜɚ.
ɉɢɤ «x» ɧɚ ɤɪɢɜɨɣ ɐȼȾ ɹɜɥɹɟɬɫɹ ɫɥɟɞɫɬɜɢɟɦ ɪɚɫ-ɫɥɚɛɥɟɧɢɹ ɩɪɟɞɫɟɪɞɢɣ ɢ ɧɢɫɯɨɞɹɳɟɝɨ ɫɦɟɳɟɧɢɹ ɬɪɢ -ɤɭɫɩɢɞɚɥɶɧɨɝɨ ɤɥɚɩɚɧɚ ɜɨ ɜɪɟɦɹ ɫɢɫɬɨɥɵ ɠɟɥɭɞɨɱ-ɤɨɜ.
ɉɢɤ «y» ɧɚ ɤɪɢɜɨɣ ɐȼȾ ɩɨɹɜɥɹɟɬɫɹ ɜ ɪɟɡɭɥɶɬɚɬɟ ɬɨ-ɝɨ,ɱɬɨ ɤɪɨɜɶ ɢɡ ɩɪɟɞɫɟɪɞɢɹ ɱɟɪɟɡ ɨɬɤɪɵɬɵɣ ɬɪɢɤɭɫ-ɩɢɞɚɥɶɧɵɣ ɤɥɚɩɚɧ ɩɨɫɬɭɩɚɟɬ ɜ ɠɟɥɭɞɨɱɟɤ.
ɉɟɬɥɹ ɞɚɜɥɟɧɢɟ-ɨɛɴɟɦ
Ɉɩɢɫɵɜɚɟɬ ɫɨɛɵɬɢɹ ɫɟɪɞɟɱɧɨɝɨ ɰɢɤɥɚ ɩɪɨɬɢɜ ɱɚɫɨ-ɜɨɣ ɫɬɪɟɥɤɢ:
A. Ɉɤɨɧɱɚɧɢɟ ɞɢɚɫɬɨɥɵ;
B. Ɉɬɤɪɵɬɢɟ ɚɨɪɬɚɥɶɧɨɝɨ ɤɥɚɩɚɧɚ;
C. Ɂɚɤɪɵɬɢɟ ɚɨɪɬɚɥɶɧɨɝɨ ɤɥɚɩɚɧɚ;
D. Ɉɬɤɪɵɬɢɟ ɦɢɬɪɚɥɶɧɨɝɨ ɤɥɚɩɚɧɚ.
ɄȾɈ ɢ ɤɨɧɟɱɧɵɣ ɫɢɫɬɨɥɢɱɟɫɤɢɣ ɨɛɴɟɦ (ɄɋɈ) ɩɪɟɞ-ɫɬɚɜɥɟɧɵ ɬɨɱɤɚɦɢ Ⱥ ɢ ɋ, ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ. ɉɥɨɳɚɞɶ ɩɨɞ ɩɟɬɥɟɣ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɭɞɚɪɧɭɸ ɪɚɛɨɬɭ (ɞɚɜ-ɥɟɧɢɟ × ɨɛɴɟɦ).
Ʉɪɢɜɚɹ ɞɚɜɥɟɧɢɟ-ɨɛɴɟɦ ɜ ɞɢɚɫɬɨɥɭ ɢɡɧɚɱɚɥɶɧɨ ɛɨɥɟɟ ɩɥɨɫɤɚɹ,ɨɬɪɚɠɚɹ ɬɨ,ɱɬɨ ɛɨɥɶɲɨɣ ɩɨɞɴɟɦ ɨɛɴɟɦɚ ɦɨ-ɠɟɬ ɫɨɩɪɨɜɨɠɞɚɬɶɫɹ ɧɟɛɨɥɶɲɢɦ ɩɨɞɴɟɦɨɦ ɞɚɜɥɟɧɢɹ.
Ɉɞɧɚɤɨ, ɫ ɭɜɟɥɢɱɟɧɢɟɦ ɧɚɩɨɥɧɟɧɢɹ, ɠɟɥɭɞɨɱɤɢ ɫɬɚ-ɧɨɜɹɬɫɹ ɦɟɧɟɟ ɪɚɫɬɹɠɢɦɵɦɢ,ɱɬɨ ɩɪɨɫɥɟɠɢɜɚɟɬɫɹ ɩɨ ɪɟɡɤɨɦɭ ɩɨɞɴɟɦɭ ɞɢɚɫɬɨɥɢɱɟɫɤɨɣ ɤɪɢɜɨɣ ɩɪɢ ɛɨɥɶ-ɲɢɯ ɜɧɭɬɪɢɠɟɥɭɞɨɱɤɨɜɵɯ ɨɛɴɟɦɚɯ.
Ʉɨɪɨɧɚɪɧɨɟ ɤɪɨɜɨɨɛɪɚɳɟɧɢɟ
ɋɟɪɞɰɟ ɤɪɨɜɨɫɧɚɛɠɚɟɬɫɹ ɢɡ ɩɪɚɜɨɣ ɢ ɥɟɜɨɣ ɤɨɪɨɧɚɪ-ɧɵɯ ɚɪɬɟɪɢɣ. Ɉɧɢ ɪɚɡɞɟɥɶɧɨ ɨɬɯɨɞɹɬ ɨɬ ɫɢɧɭɫɚ ɚɨɪ-ɬɵ,ɜ ɦɟɫɬɟ ɜɨɡɧɢɤɧɨɜɟɧɢɹ ɜɨɫɯɨɞɹɳɟɣ ɚɨɪɬɵ,ɦɟɠɞɭ ɩɪɚɜɨɣ ɢ ɥɟɜɨɣ ɫɬɜɨɪɤɚɦɢ ɚɨɪɬɚɥɶɧɨɝɨ ɤɥɚɩɚɧɚ. ɉɪɚ-ɜɚɹ ɤɨɪɨɧɚɪɧɚɹ ɚɪɬɟɪɢɹ (ɉɄȺ)ɢɞɟɬ ɩɪɹɦɨ ɦɟɠɞɭ ɥɟ-ɝɨɱɧɵɦ ɫɬɜɨɥɨɦ ɢ ɩɪɚɜɵɦ ɩɪɟɞɫɟɪɞɢɟɦ ɤ ɚɬɪɢɨɜɟɧ-ɬɪɢɤɭɥɹɪɧɨɣ ɛɨɪɨɡɞɟ. Ʉɨɝɞɚ ɨɧɚ ɫɩɭɫɤɚɟɬɫɹ ɩɨ ɧɢɠ-ɧɟɦɭ ɤɪɚɸ ɫɟɪɞɰɚ, ɨɧɚ ɞɟɥɢɬɫɹ ɧɚ ɡɚɞɧɸɸ ɧɢɫɯɨɞɹ-ɳɭɸ (ɦɟɠɠɟɥɭɞɨɱɤɨɜɭɸ) ɢ ɩɪɚɜɭɸ ɤɪɚɟɜɭɸ ɜɟɬɜɢ.
Ʌɟɜɚɹ ɤɨɪɨɧɚɪɧɚɹ ɚɪɬɟɪɢɹ (ɅɄȺ) ɢɞɟɬ ɡɚ ɥɟɝɨɱɧɵɦ ɫɬɜɨɥɨɦ ɢ ɤɩɟɪɟɞɢ ɦɟɠɞɭ ɧɢɦ ɢ ɥɟɜɵɦ ɩɪɟɞɫɟɪɞɢɟɦ.
Ɉɧɚ ɞɟɥɢɬɫɹ ɧɚ ɨɝɢɛɚɸɳɭɸ,ɥɟɜɭɸ ɤɪɚɟɜɭɸ ɢ ɩɟɪɟɞ-ɧɸɸ ɜɟɬɜɢ, ɚɧɚɫɬɨɦɨɡɢɪɭɸɳɢɟ ɦɟɠɞɭ ɩɪɚɜɨɣ ɢ ɥɟ-ɜɨɣ ɧɢɫɯɨɞɹɳɢɦɢ ɜɟɬɜɹɦɢ. ɋɥɟɞɭɟɬ ɨɬɦɟɬɢɬɶ, ɱɬɨ ɩɪɢ ɨɤɤɥɸɡɢɢ ɨɞɧɨɣ ɫɬɨɪɨɧɵ ɤɨɪɨɧɚɪɧɨɝɨ ɤɪɨɜɨɨɛ-ɪɚɳɟɧɢɹ ɩɟɪɮɭɡɢɹ ɫɟɪɞɰɚ ɧɟ ɦɨɠɟɬ ɩɨɞɞɟɪɠɢɜɚɬɶɫɹ ɧɚ ɞɨɥɠɧɨɦ ɭɪɨɜɧɟ.
ɅɄȺ ɤɪɨɜɨɫɧɚɛɠɚɟɬ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɥɟɜɵɣ ɠɟɥɭ-ɞɨɱɟɤ, ɩɟɪɟɝɨɪɨɞɤɭ ɢ ɥɟɜɨɟ ɩɪɟɞɫɟɪɞɢɟ.ɉɄȺ ɤɪɨɜɨ-ɫɧɚɛɠɚɟɬ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɩɪɚɜɵɣ ɠɟɥɭɞɨɱɟɤ ɢ ɩɪɚɜɨɟ ɩɪɟɞɫɟɪɞɢɟ, ɫɢɧɨɚɬɪɢɚɥɶɧɵɣ ɭɡɟɥ (ɜ 60%) ɢ AVɭɡɟɥ (ɜ 80%). Ɍɢɩ ɤɪɨɜɨɫɧɚɛɠɟɧɢɹ ɫɟɪɞɰɚ ɨɩɪɟ-ɞɟɥɹɟɬɫɹ ɚɪɬɟɪɢɟɣ, ɨɛɪɚɡɭɸɳɟɣ ɡɚɞɧɸɸ ɧɢɫɯɨɞɹ-ɳɭɸ ɜɟɬɜɶ ɢ ɤɪɨɜɨɫɧɚɛɠɚɸɧɢɫɯɨɞɹ-ɳɭɸ ɡɚɞɧɸɸ ɧɢɠɧɸɸ ɫɬɟɧɤɭ ɥɟɜɨɝɨ ɠɟɥɭɞɨɱɤɚ ɢ AV ɭɡɟɥ. «ɉɪɚɜɵɣ» ɬɢɩ (ɉɄȺ) ɤɪɨɜɨɫɧɚɛɠɟɧɢɹ ɜɫɬɪɟɱɚɟɬɫɹ ɭ 70% ɥɸɞɟɣ.
«Ʌɟɜɵɣ»ɬɢɩ (ɅɄȺ)ɤɪɨɜɨɫɧɚɛɠɟɧɢɹ – ɭ 20% ɥɸɞɟɣ, ɚ ɬɢɩ, ɩɪɢ ɤɨɬɨɪɨɦ ɨɛɟ ɚɪɬɟɪɢɢ ɢɝɪɚɸɬ ɪɚɜɧɨɡɧɚɱ-ɧɭɸ ɪɨɥɶ – ɭ 10%.
ȼɟɧɨɡɧɵɣ ɨɬɬɨɤ
ɉɪɨɢɫɯɨɞɢɬ ɱɟɪɟɡ ɤɨɪɨɧɚɪɧɵɣ ɫɢɧɭɫ ɢ ɩɟɪɟɞɧɸɸ ɜɟ-ɧɭ ɫɟɪɞɰɚ. ɂ ɫɢɧɭɫ, ɢ ɜɟɧɚ ɨɬɤɪɵɜɚɸɬɫɹ ɜ ɩɪɚɜɨɟ
ɩɪɟɞɫɟɪɞɢɟ. ɇɟɤɨɬɨɪɨɟ ɤɨɥɢɱɟɫɬɜɨ ɤɪɨɜɢ ɩɨɫɬɭɩɚɟɬ ɩɪɹɦɨ ɜ ɤɚɦɟɪɵ ɫɟɪɞɰɚ ɱɟɪɟɡ Ɍɟɛɟɡɢɟɜɵ ɜɟɧɵ ɢ ɦɟɥ-ɤɢɟ ɜɟɧɭɥɵ.ȼɟɧɨɡɧɚɹ ɤɪɨɜɶ,ɩɨɫɬɭɩɚɹ ɜ ɥɟɜɵɟ ɨɬɞɟ-ɥɵ ɫɟɪɞɰɚ, ɜɵɡɵɜɚɟɬ ɧɟɛɨɥɶɲɨɟ ɭɦɟɧɶɲɟɧɢɟ ɫɨɞɟɪ-ɠɚɧɢɹ Ɉ2ɜ ɚɪɬɟɪɢɚɥɶɧɨɣ ɤɪɨɜɢ.
Ʉɨɧɬɪɨɥɶ ɤɨɪɨɧɚɪɧɨɝɨ ɤɪɨɜɨɨɛɪɚɳɟɧɢɹ
ȼ ɫɨɫɬɨɹɧɢɢ ɩɨɤɨɹ ɫɟɪɞɰɟ ɩɨɬɪɟɛɥɹɟɬ ɨɤɨɥɨ 5% ɋȼ.
Ʉɨɪɨɧɚɪɧɵɣ ɤɪɨɜɨɬɨɤ ɫɨɫɬɚɜɥɹɟɬ 250 ɦɥ/ɦɢɧ. ɉɨ ɫɪɚɜɧɟɧɢɸ ɫ ɞɪɭɝɢɦɢ ɬɤɚɧɹɦɢ (35%), ɷɤɫɬɪɚɤɰɢɹ ɦɢɨɤɚɪɞɨɦ ɤɢɫɥɨɪɨɞɚ ɜɟɫɶɦɚ ɡɧɚɱɢɬɟɥɶɧɚ (65%). Ɉɞ-ɧɚɤɨ ɦɢɨɤɚɪɞ ɧɟ ɦɨɠɟɬ ɤɨɦɩɟɧɫɢɪɨɜɚɬɶ ɫɧɢɠɟɧɢɟ ɤɪɨɜɨɬɨɤɚ ɩɭɬɟɦ ɭɜɟɥɢɱɟɧɢɹ ɷɤɫɬɪɚɤɰɢɢ ɤɢɫɥɨɪɨɞɚ ɢɡ ɝɟɦɨɝɥɨɛɢɧɚ. Ʌɸɛɨɟ ɭɜɟɥɢɱɟɧɢɟ ɩɨɬɪɟɛɧɨɫɬɢ ɦɢɨɤɚɪɞɚ ɜ ɤɢɫɥɨɪɨɞɟ ɞɨɥɠɧɨ ɫɨɩɪɨɜɨɠɞɚɬɶɫɹ ɩɨɜɵ-ɲɟɧɢɟɦ ɤɪɨɜɨɬɨɤɚ ɜ ɤɨɪɨɧɚɪɧɵɯ ɚɪɬɟɪɢɹɯ.
Ʉɨɪɨɧɚɪɧɵɣ ɤɪɨɜɨɬɨɤ ɡɚɜɢɫɢɬ ɨɬ ɬɪɟɯ ɨɫɧɨɜɧɵɯ ɮɚɤ-ɬɨɪɨɜ:
1. Ɇɟɯɚɧɢɱɟɫɤɢɣ, ɜ ɨɫɧɨɜɧɨɦ ɧɚɪɭɠɧɚɹ ɤɨɦɩɪɟɫɫɢɹ ɢ ɩɟɪɮɭɡɢɨɧɧɨɟ ɞɚɜɥɟɧɢɟ;
2. Ɇɟɬɚɛɨɥɢɱɟɫɤɢɣ;
3. ɇɟɪɜɧɵɣ.
Ʉɨɦɩɪɟɫɫɢɹ ɤɨɪɨɧɚɪɧɵɯ ɚɪɬɟɪɢɣ ɢ ɤɪɨɜɨɬɨɤ
ɍɧɢɤɚɥɶɧɨɫɬɶ ɤɨɪɨɧɚɪɧɨɝɨ ɤɪɨɜɨɬɨɤɚ ɫɨɫɬɨɢɬ ɜ ɬɨɦ, ɱɬɨ ɨɧ ɩɪɟɤɪɚɳɚɟɬɫɹ ɜɨ ɜɪɟɦɹ ɫɢɫɬɨɥɵ (ɦɟɯɚɧɢɱɟɫ-ɤɚɹ ɤɨɦɩɪɟɫɫɢɹ ɫɨɫɭɞɨɜ ɫɨɤɪɚɳɚɸɳɢɦɫɹ ɦɢɨɤɚɪ-ɞɨɦ). Ɍɨɤ ɤɪɨɜɢ ɩɨ ɤɨɪɨɧɚɪɧɵɦ ɚɪɬɟɪɢɹɦ ɩɪɨɢɫɯɨ-ɞɢɬ ɜɨ ɜɪɟɦɹ ɞɢɚɫɬɨɥɵ,ɤɨɝɞɚ ɫɟɪɞɟɱɧɚɹ ɦɵɲɰɚ ɪɚɫ-ɫɥɚɛɥɟɧɚ ɢ ɧɟ ɫɠɢɦɚɟɬ ɫɨɫɭɞɵ.Ʉɪɨɜɨɬɨɤ ɜ ɉɄȺ, ɧɚ-ɩɪɨɬɢɜ,ɜɵɲɟ ɜɨ ɜɪɟɦɹ ɫɢɫɬɨɥɵ. ɗɬɨ ɫɜɹɡɚɧɨ ɫ ɬɟɦ , ɱɬɨ ɩɪɢɪɨɫɬ ɞɜɢɠɭɳɟɝɨ ɞɚɜɥɟɧɢɹ ɜ ɚɨɪɬɟ (ɫ 80 ɞɨ 120 ɦɦ ɪɬ.ɫɬ.)ɩɪɟɜɵɲɚɟɬ ɩɪɨɬɢɜɨɩɨɫɬɚɜɥɟɧɧɵɣ ɟɦɭ ɫɢɫɬɨɥɢɱɟɫɤɢɣ ɝɪɚɞɢɟɧɬ ɞɚɜɥɟɧɢɹ ɜ ɩɪɚɜɨɦ ɠɟɥɭɞɨɱ-ɤɟ (ɫ 0 ɞɨ 25 ɦɦ ɪɬ.ɫɬ.).
Ɉɤɨɥɨ 80% ɨɛɳɟɝɨ ɤɨɪɨɧɚɪɧɨɝɨ ɤɪɨɜɨɬɨɤɚ ɩɪɨɢɫɯɨ-ɞɢɬ ɜ ɞɢɚɫɬɨɥɭ.Ⱦɢɚɫɬɨɥɢɱɟɫɤɨɟ ɚɨɪɬɚɥɶɧɨɟ ɞɚɜɥɟɧɢɟ ɫɨɡɞɚɟɬ ɩɟɪɜɢɱɧɭɸ ɞɟɬɟɪɦɢɧɚɧɬɭ ɞɥɹ ɜɨɡɧɢɤɧɨɜɟɧɢɹ ɝɪɚɞɢɟɧɬɚ ɞɚɜɥɟɧɢɹ ɤɨɪɨɧɚɪɧɨɝɨ ɤɪɨɜɨɬɨɤɚ. Ʉɨɪɨ-ɧɚɪɧɨɟ ɩɟɪɮɭɡɢɨɧɧɨɟ ɞɚɜɥɟɧɢɟ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɪɚɡɧɨɫɬɶ ɞɢɚɫɬɨɥɢɱɟɫɤɨɝɨ ȺȾ ɢ ɄȾɈɅɀ (ɤɨɧɟɱɧɨ-ɞɢɚɫɬɨɥɢɱɟɫɤɢɣ ɨɛɴɟɦ ɥɟɜɨɝɨ ɠɟɥɭɞɨɱɤɚ). ɍɜɟɥɢɱɟ-ɧɢɟ ɑɋɋ, ɤɨɬɨɪɨɟ ɭɤɨɪɚɱɢɜɚɟɬ ɜɪɟɦɹ ɞɢɚɫɬɨɥɵ ɞɥɹ ɤɨɪɨɧɚɪɧɨɝɨ ɤɪɨɜɨɬɨɤɚ, ɜɟɪɨɹɬɧɨ, ɭɜɟɥɢɱɢɬ ɩɨɬɪɟɛ -Ɋɢɫɭɧɨɤ 2. ɉɨɬɟɧɰɢɚɥɵ ɞɟɣɫɬɜɢɹ ɫɢɧɨɚɬɪɢɚɥɶɧɨɝɨ ɭɡɥɚ Ɋɢɫɭɧɨɤ 3. ɗɬɚɩɵ ɢ ɫɬɚɞɢɢ ɦɢɨɤɚɪɞɢɚɥɶɧɨɝɨ ɰɢɤɥɚ
ɂɡ: Guyton AC. Textbook of Medical Physiology, 8th edition
© 1991. ɋ ɪɚɡɪɟɲɟɧɢɹ Elsevier.
Update In Anaesthesia
ɥɟɧɢɟ ɤɢɫɥɨɪɨɞɚ ɛɨɥɶɲɟ, ɱɟɦ ɩɨɞɴɟɦ ȺȾ, ɤɨɬɨɪɨɟ ɜɨɡɦɟɫɬɢɬ ɩɨɜɵɲɟɧɧɭɸ ɩɨɬɪɟɛɧɨɫɬɶ ɜ ɤɢɫɥɨɪɨɞɟ ɭɜɟɥɢɱɟɧɢɟɦ ɤɨɪɨɧɚɪɧɨɝɨ ɤɪɨɜɨɬɨɤɚ, ɡɚɜɢɫɢɦɵɦ ɨɬ ɞɚɜɥɟɧɢɹ.Ɇɢɨɤɚɪɞ ɪɟɝɭɥɢɪɭɟɬ ɤɨɪɨɧɚɪɧɵɣ ɤɪɨɜɨɬɨɤ (ɚɭɬɨɪɟɝɭɥɹɰɢɹ) ɩɪɢ ɩɟɪɮɭɡɢɨɧɧɨɦ ɞɚɜɥɟɧɢɢ ɨɬ 50
ɞɨ 150 ɦɦ ɪɬ.ɫɬ.ȼ ɷɬɨɦ ɞɢɚɩɚɡɨɧɟ ɤɪɨɜɨɬɨɤ ɡɚɜɢɫɢɦ ɨɬ ɞɚɜɥɟɧɢɹ. Ⱥɭɬɨɪɟɝɭɥɹɰɢɹ ɟɫɬɶ ɪɟɡɭɥɶɬɚɬ ɜɡɚɢɦɨ-ɞɟɣɫɬɜɢɹ ɦɢɨɝɟɧɧɨɝɨ ɢ ɦɟɬɚɛɨɥɢɱɟɫɤɨɝɨ ɦɟɯɚɧɢɡ-ɦɨɜ.
Ɇɟɬɚɛɨɥɢɱɟɫɤɢɟ ɮɚɤɬɨɪɵ
Ȼɥɢɡɤɢɟ ɨɬɧɨɲɟɧɢɹ ɦɟɠɞɭ ɤɨɪɨɧɚɪɧɵɦ ɤɪɨɜɨɬɨɤɨɦ ɢ ɩɨɬɪɟɛɥɟɧɢɟɦ ɦɢɨɤɚɪɞɨɦ ɤɢɫɥɨɪɨɞɚ ɭɤɚɡɵɜɚɟɬ ɧɚ ɬɨ, ɱɬɨ ɨɞɢɧ ɢɥɢ ɧɟɫɤɨɥɶɤɨ ɩɪɨɞɭɤɬɨɜ ɦɟɬɚɛɨɥɢɡɦɚ ɦɨɝɭɬ ɜɵɡɵɜɚɬɶ ɤɨɪɨɧɚɪɧɭɸ ɜɚɡɨɞɢɥɚɬɚɰɢɸ. Ƚɢɩɨɤ-ɫɢɹ ɢ ɚɞɟɧɨɡɢɧ – ɩɨɬɟɧɰɢɚɥɶɧɵɟ ɤɨɪɨɧɚɪɧɵɟ ɜɚɡɨɞɢ-ɥɚɬɚɬɨɪɵ. ɋɪɟɞɢ ɞɪɭɝɢɯ ɮɚɤɬɨɪɨɜ, ɤɨɬɨɪɵɟ ɦɨɝɭɬ ɜɵɡɵɜɚɬɶ ɜɚɡɨɞɢɥɚɬɚɰɢɸ ɤɨɪɨɧɚɪɧɵɯ ɫɨɫɭɞɨɜ, ɜɵɞɟ-ɥɹɸɬ ɊɋɈ2,ɇ+,Ʉ+,ɥɚɤɬɚɬ ɢ ɩɪɨɫɬɚɝɥɚɧɞɢɧɵ.ȼ ɧɨɪ-ɦɚɥɶɧɵɯ ɭɫɥɨɜɢɹɯ ɢɡɦɟɧɟɧɢɹ ɤɪɨɜɨɬɨɤɚ, ɜɨɡɧɢɤɚɸ-ɳɢɟ ɢɡ-ɡɚ ɢɡɦɟɧɟɧɢɹ ɬɨɧɭɫɚ (ɫɨɩɪɨɬɢɜɥɟɧɢɹ) ɤɨɪɨ-ɧɚɪɧɵɯ ɚɪɬɟɪɢɣ, ɹɜɥɹɸɬɫɹ ɨɬɜɟɬɨɦ ɧɚ ɦɟɬɚɛɨɥɢɱɟ-ɫɤɢɟ ɩɨɬɪɟɛɧɨɫɬɢ.
ɇɟɪɜɧɵɟ ɮɚɤɬɨɪɵ
Ʉɨɪɨɧɚɪɧɵɟ ɚɪɬɟɪɢɨɥɵ ɫɨɞɟɪɠɚɬ Į1-ɚɞɪɟɧɟɪɝɢɱɟɫɤɢɟ ɪɟɰɟɩɬɨɪɵ,ɨɬɜɟɬɫɬɜɟɧɧɵɟ ɡɚ ɜɚɡɨɤɨɧɫɬɪɢɤɰɢɸ,ɢ ȕ2 -ɚɞɪɟɧɟɪɝɢɱɟɫɤɢɟ ɪɟɰɟɩɬɨɪɵ, ɨɬɜɟɬɫɬɜɟɧɧɵɟ ɡɚ ɜɚɡɨ-ɞɢɥɚɬɚɰɢɸ. ɋɢɦɩɚɬɢɱɟɫɤɚɹ ɫɬɢɦɭɥɹɰɢɹ ɭɫɢɥɢɜɚɟɬ ɤɨɪɨɧɚɪɧɵɣ ɤɪɨɜɨɬɨɤ ɢɡ-ɡɚ ɩɨɜɵɲɟɧɢɹ ɦɟɬɚɛɨɥɢɱɟ-ɫɤɢɯ ɩɨɬɪɟɛɧɨɫɬɟɣ ɢ ɩɪɟɨɛɥɚɞɚɧɢɹ ɚɤɬɢɜɚɰɢɢ ȕ2 -ɚɞɪɟɧɟɪɝɢɱɟɫɤɢɯ ɪɟɰɟɩɬɨɪɨɜ.
Ⱦɥɹ ɞɚɥɶɧɟɣɲɟɝɨ ɱɬɟɧɢɹ
1. Guyton AC. Textbook of Medical Physiology, 10th edition. Philadelphia. WB Saunders Company.
2. Smith JJ, Kampine JP et al. Circulatory Physiology – The Essentials 3rd edition. Baltimore. Williams and Wilkins.
3. Berne RM, Levy MN. Cardiovascular Physiology, 8th edition, Missouri. Mosby.
4. Levick JP. An Introduction to Cardiovascular Physi-ology, Oxford. Butterworth-Heinemann Ltd.
Ɋɢɫɭɧɨɤ 4A. ɉɟɬɥɹ ɞɚɜɥɟɧɢɟ-ɨɛɴɟɦ Ʌɀ (ɩɨɤɚɡɵɜɚɟɬ ɨɛɴɟɦ Ʌɀ ɢ ɢɡɦɟɧɟɧɢɹ ɞɚɜɥɟɧɢɹ ɜɨ ɜɪɟɦɹ ɨɞɧɨɝɨ ɫɟɪ-ɞɟɱɧɨɝɨ ɫɨɤɪɚɳɟɧɢɹ ɭ ɜɡɪɨɫɥɨɝɨ ɱɟɥɨɜɟɤɚ ɜ ɩɨɤɨɟ) ɂɡ: Smith JJ, Kampine JP et al. Circulatory Physiology – The Es-sentials 3rd edition. ɋ ɪɚɡɪɟɲɟɧɢɹ Lippincott, Williams & Wil-kins.
Ɋɢɫɭɧɨɤ 4B. ɉɟɬɥɹ ɞɚɜɥɟɧɢɟ-ɨɛɴɟɦ ɜɨ ɜɪɟɦɹ ɫɨɤɪɚɳɟ-ɧɢɹ ɢ ɪɚɫɬɹɠɟɫɨɤɪɚɳɟ-ɧɢɹ ɠɟɥɭɞɨɱɤɚ,ɢ ɮɚɤɬɨɪɨɜ,ɢɡɦɟɧɹɸɳɢɯ ɧɚɩɨɥɧɟɧɢɟ ɢɥɢ ɜɵɛɪɨɫ ɠɟɥɭɞɨɱɤɚ (ɐȼȾ, ɩɨɫɬɧɚɝɪɭɡ-ɤɚ)
ɂɡ: Aaronson PI, Ward PT, The Cardiovascular system at a glance, 1st edition. ɋ ɪɚɡɪɟɲɟɧɢɹ Blackwell Publishing Ltd.