Тромбоз. Геморрагии

1.

¶ucceuu+upoæa++oe
æ+ywpucocygucwoe
cæepw.æa+ue upoæu
Aneuca+gp M. Tunaua+oæ
bauuupcuun rocygapcwæe++9n
ueguyu+cuun y+uæepcuwew,
ua$egpa na6opawop+on
guar+ocwuuu NMO

2.

unasue++.e $auwop.
cæepw.æa+ue
wpou6oyuwap+.e $auwop.
a+wuuoaryne+w.
cucweua $u6pu+onusa
7euocmas
Tuuepuoaryneyue
HOPMA
Tuuouoaryneyue
PABHOBECNE (6ana+c)

3.

cucweua $u6pu+onusa
unasue++.e
$auwop.
wpou6oyuwap+.e
a+wuuoaryne+w.
$auwop.
Tuuepuoaryneyue
HOPMA
¶NCbAuAHC
Tuuouoaryneyue

4.

unasue++.e $auwop.
wpou6oyuwap+.e $auwop.
a+wuuoaryne+w.
cucweua
• uoæpeuge+ue s+gowenue
$u6pu+onusa
Tuuepuoaryneyue
HOPMA
¶NCbAuAHC
Tuuouoaryneyue

5.

Tuuepuoaryneyue
HOPMA
Tuuouoaryneyue

6.

¶uccemu+upoæa++oe
æ+ywpucocygucwoe
cæepw/æa+ue ıpoæu - cnegcwæme upesuep+ou
(uawonormuec›ou)
a›wmæaymm
cmcweu8
reuocwasa.
uaccmæ+oe um›powpou6oo6pasoæa+me
ms68wou+oe uowpe6ne+me unasue++8x upo- m
a+wm›oaryne+w+8x Øa›wopoæ m wpou6oymwoæ
a›wmæayme Øm6pm+onmsa
›poæowoumæocwa (æo II – III Øasax)

7.

K f l A C C E 8 E K A ] E ª ¶BC
MO XAPAKTEPV TEfEHHÆ
1. OCTPOE ¶BC, æınDuae mon+ue+oc+yD øopmy
uaccuønae 6ecmpy1yue opsanoø u m1aneu (uonmwpaæu8,
wpaæuawmu+8e xmpyprmuec›me æuemawenacwæa, ›pamcm+gpou, ocwp8u æ+ywpmcocygmcw8u reuonms, wpa+cØysmm
+ecoæuecwmuou m"cwapou" ›poæm),
wewen8e unØe1yuonno-cenmu¬ec1ue ta6oneøanue,
a1yuepc1ae namonosue (su6onme o›onounog+8um æogaum,
ceucmc, pa++ee owcnou›a unaye+w8, rmuowo+muec›me ›poæoweue+me mgp.),
ocmp;e ompaønenue (›mcnow8, yenoum, suem+8e eg8 mgp.),
uo1 mmepuunanan;e cocmoenue.
6/cwpoe patæuwue, ocwpae uonuopra++ae +egocwawou+ocwa,
wewen/e remopparuu.

8.

K f l A C C E 8 E K A ] E ª ¶BC
MO XAPAKTEPV TEfEHHÆ
2. MO¶OCTPOE ¶BC
øocnanumenan;e u uuuyno1ounne1cn;e npoyecc;,
reuopparmuec›me æac›ynmw8,
xponu¬ec1uu seuonut, ypeume, reuonmwm›o-ypeumuec›mu
cm+gpou,
not6nue secmot;, su6ena nno6a,
memenae namonosue ne¬enu (yuppot mgp. )
me+ee
æ/pawe++/e ınu+uuecı u e u na6opawop+/e
upoeæne+ue uo cpaæ+e+uD c ocwp/m ¶BC.

9.

K f l A C C E 8 E K A ] E ª ¶BC
MO XAPAKTEPV TEfEHHÆ
3. XPOHE1ECKOE
¶ BC,
peyuguæupyDyue ø o p m /
æınDuae
nawe+w+/e
u
tno1a¬ecmøenn;e noøoo6patoøanue (pa› ner›oro, uoue›, upocwaw8, ueue+m) mxponu¬ec1ue neu1ot;,
xponu¬ec1ae cep6e¬nae m nerou+o-cepgeu+ae ne6ocmamo¬nocma,
caxapn;u
6ua6em,
amepoc1nepot,
sunepmonu¬ec1ae
6onetna,
uaccmæ+8u 1onma1m 1poøu c ¬ymepo6n;uu noøepxnocmeuu
upm s›cwpa›opuopana+8x upoyegypax (reuogmanms, reuocop6yme, mc›yccwæe++oe ›poæoo6paye+me m gp.).
gnuwena+/u uepuog ruuepıoaryneyuu u ruueparperayuu
wpom6oyuwoæ, 6eccumuwom+oe weue+ue, uacwo o6+apywuæaewce nu+a na6opawop+/mu wecwamu.

10.

K f l A C C E 8 E K A ] E ª ¶BC
MO 8A3AM
1.FEMEPKOAFVflª]EOHHAª c wpou6oo6pasoæa+meu
2.FEMEP- FEMOKOAFVflª]EOHHAª c ›oarynouawmeu mwpou6oymwouawmeu uowpe6ne+me
3.FEMOKOAFVflª]EOHHAª c uawonormuec›ou
a›wm- æaymeu Øm6pm+onmsa mnm 6es +ee
4.ECXO¶ (æoccwa+oæne+me mnm cuepwa)

11.

M P E 1 E H ª MEPBE1HOFO TPOMbOObPA5OBAHEª:
A. MACCEBHOE MOMA¶AHEE B KPOBOTOK
TPOMbOMflACTEH-MO¶ObHªX B E ] E C T B E5 TKAHEM
b. MACCEBHªE MOBPEK¶EHEª 5 H ¶ O T E f l E ª
upeumyyecwæe++ae aıwuæayue æ+e++ero uywu cæepw/æa+ue,
uaye ocwp/u unu uogocwp/u xapaıwep ¶BC.
B. MOªBflEHEE "KOHTAKTHOM MOBEPXHOCTE"
bOfl@HOM M f l O ] A ¶ E
upeumyyecwæe++ae aıwuæayue æ+ywpe++ero uywu cæepw/æa+ue,
uaye uogocwpoe unu xpo+uuecıoe weue+ue ¶BC.
F. FEMEPAKTEBA]Eª TPOMbO]ETOB – æo æcex cnyuaex.

12.

MATOFEHE5 ¶BC:
ruuepıoaryneyue + ruuepuowpe6ne+ue + ruuepøu6pu+onut
Tyuopana+9n
upoweas+9n "æsp9æ"
Tuuepwpou6u+euue
upesuep+oe o6pasoæa+ue
$u6pu+a (uuupowpou69)
MOuNOPTAHHAª
HE¶OCTATO1HOCTb
Auwuæayue $u6pu+onusa,
gerpagayue $u6pu+a,
$u6pu+ore+a,
unasue++9x 6enuoæ
upesuep+oe uowpe6ne+ue
a+wuuoaryne+woæ,
$auwopoæ cæepw9æa+ue,
wpou6oyuwoæ
Hauoune+ue M¶0 u M¶$,
+apyue+ue uonuuepusayuu $u6pu+a
TEMOPPATN1ECKNN CNH¶POM

13.

¶EAFHOCTEKA ¶ B C
Hanu¬ue øotuomnou npu¬un; ¶BC
+ 1nunu¬ec1ue npoeønenue
+ na6opamopn;e 6ann;e

14.

KflEHE1ECKEE MPOªBflEHEª ¶ B C
MOflEOPFAHHAª HE¶OCTATO1HOCT@
c +apy+e+uem øy+ıyuu wut+e++o æaw+/x opra+oæ:
nes1ux (æ+esau+o pasæmæaDyeece uacwoe +esØØe›wmæ+oe g8xa+me, yma+os, xpmu8, m+Øap›w8 mawene›was8, owe› ner›mx),
no¬e1 (c+mwe+me gmypesa æunowa go a+ypmm, 6eno› mspmwpoymw8 æ uoue, upm xpo+muec›ou weue+mm - ›peawm+m+eume),
na6no¬e¬nu1oø (ocwpae +egocwawou+ocwa c uoæwop+8um
uage+meum A ¶ mrmuornm›eumeu),
sonoønoso motsa (sawopuowe++ocwa, sarpywe++ocwa uayme+woæ,
mmeumuec›me m+cynaw8),
ne¬enu (6onm æ upaæou upegpe6epae, cmuuwou8 ymwonmsa,
rmuep6mnmpy6m+eume),
meny6o¬no-1uue¬noso mpa1ma (uapes, pasæmwme ocwp8x esæ),
1omu
(upauop+ocwa,
cmuuewpmu+8e
uepmØepmuec›me
+e›pos8).

15.

Ocmpoe ¶BC, ¶BC-cun6pou
mnomecmøenn9e semoppasuu æ uecwax m+ae›ymu,
uanauaymm, +mwe ua+wew8 gne msuepe+me A¶, æ ownormx uacwex wena;
6numenanoe unu noømopnoe 1poøome¬enue ms uecw
upo›ona ›owm (uanay8, no›weæou crm6), ›poæowoumæocwa
ouepaymo++8x pa+ mcepos+8x o6onoue›;
mamo¬n9e 1poøome¬enue (æo æpeue pogoæ, uocne
a6opwa), +ecæepw8æaeuocwa mnmunoxae cæepw8æaeuocwa
æ8we›aDyeu ›poæm.
nocoø9e u meny6o¬no-1uue¬n9e 1poøome¬enue,
nputna1u opsannou ne6ocmamo¬nocmu (c+mwe+me
gmypesa mgp.).

16.

Mo6ocmpoe ¶BC
Cmuuwou8 oc+oæ+ou 6ones+m
+ mpom6ot/cune1u æuecwax æe+euy+›ymu mm+ae›ymu
+ napyuenue mu1poçup1yneçuu æ opra+ax (sarpywe++ocwa,
6ecuo›oucwæo, cwpax, c+mwe+me gmypesa, owe›m, 6eno› m
ymnm+gp8 æuoue).
Xponu¬ec1oe ¶BC
Cmuuwou8 oc+oæ+oro sa6oneæa+me + ø9pamennae sunep1oasyneçue 1poøu. Heuowmæmpoæa++8e u+owecwæe++8e
wpou6os8 æe+, æosuow+8 uewexmm, cm+e›m, ›poæoweue+me ms
+oca mgece+ æcouewa+mm c wpou6osaum.

17.

flAbOPATOPHAª ¶EAFHOCTEKA ¶ B C
Pesynawaw8 na6opawop+8x mccnegoæa+mu gonw+8 oye+mæawace wona›o
c yuewou ›nm+muec›ou ›apwm+8!
1.Peaıyuu, y ı a t / æ a D y u e +a aıwuæayuD cæepw/æa+ue (P8MK, 8uA).
2.Peaıyuu, y ı a t / æ a D y u e +a uowpe6ne+ue ø aıwopoæ cæepw/æa+ue (Øm6pm+ore+, AT III,
AfTB, MTB, TB- wona›o æ gm+aum›e !).
3.Peaıyuu, y ı a t / æ a D y u e +a aıwuæayuD øu6pu+onuta (D-gmuep8, M ¶ 8 + M¶Ø,8uA).
4. Knewou+/e mapıep/ ¶BC (›onmuecwæo wpou6oymwoæ mmx cuo+wa++ae arperayme, mmsoymwos m
Øparue+wayme spmwpoymwoæ).

18.

flAbOPATOPHªM CKPEHEHF ¶BC
Bpeme cæepw/æa+ue ıpoæu (I Øasa – wpou6mpoæa+me
mrn8 mnm oue+a 68cwpoe cæepw8æa+me, II-III Øas8 crycwo› p8xn8u, o6pasyewce uegne++o mnm +e o6pasyewce coæceu).
Konuuecwæo wpom6oyuwoæ, ıo+ye+wpayue øu6pu+ore+a ægu+amuıe – æI Øase +opuana+8e mnm yæenmue+8, æo II-III Øasax yue+amaDwce (<1,5 r/n - rmuoØm6pm+ore+eume, <0,5 r/n – aØm6pm+ore+eume). Oupegene+me uowew 68wa sawpyg+e+o.
A1TB, MTB (MO) æI Øase ¶BC y›opaumæaDwce, æo IIIII Øasax - ygnm+eDwce (rmuepuowpe6ne+me).
P8MK – yæenmumæaDwce.

19.

¶OMOflHETEfl@HªE T E C T ª :
Pacwæopum/e øu6pu+-mo+omep/ (P8MK), øu6pu+oueuwug A (reuarrnDwm+ayme) - uo›asawena a›wmæaymm
Øm6pm+ore+esa.
8parme+w/ upowpom6u+a 1+2, ›ouune›c wpom6u+a+wuwpom6u+ (T-AT) – uo›asawenm a›wmæaymm wpou6m+ore+esa, æ wou umcne ›ouue+cmpoæa++ou.
Kouune›c unatmu+-a+wuunatmu+ (P-AP) - uo›asawena
a›wmæaymm Øm6pm+onmsa, æ wou umcne ›ouue+cmpoæa++ou.
Tpom6oyuwap+/u øaıwop 4 (PF4), -wpom6orno6ynu+ uo›asawenm a›wmæaymm wpou6oymwoæ.
Pewpaıyue crycwıa – uo›asawena Øy+›ymm wpou6oymwoæ.

20.

MO¶TBEPK¶AŒ]EE TECTª:
Mpogyıw/ gerpagayuu øu6pu+a ow (+) go (+++) - nawe›cwecw M¶8+M¶Ø, swa+onoæ8u, -+aØwonoæ8u, upowaum+cynaØaw+8u wecw8, wecw c›nemæa+me cwaØmno›o››oæ.
D-gumep ow +auana ¶BC. Ogm+ ms +am6onee +agew+8x uo›asaweneu a›wmæaymm Øm6pm+onmsa.
Tpom6u+oæoe æpeme . 3aæmcmw ow ypoæ+e Øm6pm+ore+a,
M ¶ 8 , reuapm+a. Bapma+w - peuwmnas+oe æpeue.
A+wuwpom6u+ III – ypoæe+a m a›wmæ+ocwa. Baw+8u uo›asawena pesepæoæ a+wm›oaryne+w+ou cmcweu8 m æosuow+ocwm
reuapm+owepaumm. + Mpoweu+/ C u S .
8u6pu+onuwuuecıae aıwuæ+ocwa ıpoæu (nmsmc syrno6ynm+oæ mnm crycw›a yena+ou ›poæm, XIIa-saæmcmu8u Øm6pm+onms, cwpeuwo›m+as+8u wecw); +o ıo+ye+wpayue unatmu+ore+a (rmuepuowpe6ne+me).
8parme+wayue spuwpoyuwoæ, +utoyuwot.

21.

Mouasawenu
uoarynorpauu9
Tpou6oyuw.
Cwaguu ¶ B C
I
II
III
N
N
N
-
N
N
-
N
-
N
N
AT III
N
P8MK + M ¶ 8
+
N
A1TB
MTB (MO)
TB
8u6pu+ore+
D-guuep
0
+++

22.

flE1EHEE ¶ B C
Heuegne++oe +aupaæne+me 6ona+oro æ pea+muaymo++oe owgene+me, upmæneue+me wpa+cØysmonoroæ m cueymanmcwoæ uo uawonormm reuocwasa.
b8cwpeumee ycwpa+e+me upmum+ ¶ BC (neue+me oc+oæ+oro sa6oneæa+me).
Pea+muaymo++8e uepoupmewme: 6opa6a c mo›ou m
+apyme+meum Øy+›ymu wms+e++o æaw+8x opra+oæ,
uoggepwa+me
æog+o-sne›wponmw+oro,
›mcnow+oyenou+oro 6ana+ca mw.g.
Koppe›yme +apyme++oro reuocwasa.

23.

flE1EHEE ¶ B Cæ I øate
Heuwpanmsayme a›wmæmpoæa++8x Øa›wopoæ cæepw8æa+me,
c+mwe+me a›wmæ+ocwm wpou6oymwoæ, æoccwa+oæne+me a›wmæ+ocwmAT III, ynyume+me peonormuec›mx cæoucwæ ›poæm.
1. Henapun (mnm HMF) go 50.000 ME æ cyw›m. Ecnm ›poæa
"cæepw8æaewce æ mrne" - +euegne++oe ææege+me reuapm+a.
2.Cøemetauopomennae nnatua go 600-800 un/cyw.
3.¶etaspesanm;: acumpm+ 0,5 r, unaæm›c 75 ur/cyw.
4. Mpenapam;, yny¬uaαyue peonosu¬ec1ue cøoucmøa
1poøu: wpe+wan 100 u r æ/æ; ›ypa+wmn uo 100-300 u r 3 p/cyw,
seuo6unαyue (peouonmrnD›m+, 5% rnD›osa, Ømspacwæop).
5.51cmpa1opnopanan;e uemo6; (unasuaØepes).
Monumopuns ne¬enue: rmueparperaymm wpou6oymwoæ, cgæmr
uapauewpoæ ›oarynorpauu8 go +opu8 / yuepe++ou rmuo›oaryneymm, a›wmæ+ocwm AT III, cweue+m wpou6m+eumm, ›yumpoæa+me cnagw-Øe+oue+a.

24.

flE1EHEE ¶ B Cæo II øate
Bocuon+e+me +exæaw›m Øa›wopoæ cæepw8æa+me m AT III,
"pas6no›mpoæ›a" um›poymp›yneymm æmo›oæ8x opra+ax, uoggepwa+me wms+e++8x Øy+›ymu opra+msua.
1.Cøemetauopomennae nnatua go 2000 un/cyw m6onee.
2. Henapun æo Øna›o+ c unasuou mnmæ+auane ›awgou wpa+cØysmm æ uan8x gosax – 2500-5000 ME. HMH.
3. "Peonosu¬ec1ue" npenapam;, seuo6unαyue: wpe+wan, ›ypa+wmn, peouonmrnD›m+, 5% rnD›osa, Ømspacwæop m w.g.
4. Ansuonpome1mop;: gmym+o+ 2-4 un 2 p/cyw æ/æ.
5. Mpeuapaw8 c anmuo1cu6anmn;u 6eucmøueu:
a›woæerm+ 10 un æ/æ, æmwaum+ C mw.g.
6.Mnatuotauena (unasuaØepes + 600-1000 un C3M).
Monumopuns ne¬enue: upm6nmwe+me › +opue uapauewpoæ
›oarynorpauu8, æwou umcne AT III mØm6pm+ore+a, c+mwe+me
ypoæ+e D-gmuepoæ, P8MK mM¶8.

25.

flE1EHEE ¶ B C æ IIIøate
Bocuon+e+me geØmymwa Øa›wopoæ cæepw8æa+me m wpou6oymwoæ, +euwpanmsayme "upoweas+oro æsp8æa" m uawonormuec›oro
Øm6pm+onmsa, pea+muaymo++8e uep8.
1.Cøemetauopomennae nnatua – cwpyu+8e wpa+cØysmm go
2-3 n/cyw. Mpm›poæoweue+mex reuapm+ +e upmue+eewce.
2.Tpou6o1onyenmpam – upm ›onmuecwæe wpou6oymwoæ ue+ee
(20-25)·109/n m yæenmue+mm gnmwena+ocwm ›poæoweue+me 6onee ueu æ2-3 pasa uo cpaæ+e+mD c +opuou.
3. Mpm rmuepØm6pm+onmse - 6onauue 6 o t ; anmunpomeat (wpacmnon, ›o+wpm›an æ/æ go 300.000-500.000 E¶/cyw).
4.Mnatuotauena (unasuaØepes + C3M), +ms›ouone›ynep+8e
ge›cwpa+8 (peouonmrnD›m+), ansuonpome1mop;, anmuo1cu6anmn;e npenapam;.
5.Mecmnae ocmanoø1a 1poøome¬enue ›oaryneymeu m uepeæes›ou cocygoæ, wauuo+mpoæa+meu pa+, upmue+e+meu uecw+8x reuocwawmuec›mx cpegcwæ.

26.

flE1EHEE ¶ B C æIII øate
Monumopuns ne¬enue: cgæmr uo›asaweneu ›oarynorpauu8 go yuepe++ou rmuo›oaryneymm mnm +opu8, æospacwa+me ›onmuecwæa m a›wmæ+ocwm wpou6oymwoæ, yæenmue+me ›o+ye+wpaymm Øm6pm+ore+a, Øa›wopoæ cæepw8æa+me ma+wm›oaryne+woæ, +opuanmsayme uo›asaweneu Øm6pm+onmsa, c+mwe+me ypoæ+e D-gmuepoæ, P8MK m M¶8.

27.

¶BC æXEPVPFEE
Mpuuu+/: uonmwpaæu8, oworm, 6onamme opwouegmuec›me
ouepaymm (+a waso6egpe++8x cycwaæax), gnmwena+8e ouepaymm+a ›mmeu+m›e, ueue+m mw.g. (uaccmæ+oe uocwyune+me Ø.III
æ ›poæowo›). Xmpyprmuec›me æuemawenacwæa +a opra+ax,
6oraw8x a›wmæawopaum unasum+a (uaw›a, ner›me, upocwawa,
pancreas) => rmuepØm6pm+onms.
Mpoeæne+ue ¶BC: nocneonepaçuonnae mpom6oØunue.
H+Øap›w umo›apga, mmeumuec›me m+cynaw8, uonmopra++ae
+egocwawou+ocwa (uopawe+me ner›mx, uoue›, ronoæ+oro uosra,
cepgeu+o-cocygmcwou cmcweu8, ›mmeu+m›a, ›owm m gp. Kpoæoweue+mems ouepaymo++8x pa+, reuawou8.
Mpoøunaıwuıa uocneouepayuo++/x wpom6otoæ: Øpa›cmuapm+ (ogm+ mupmy) sa 2-3 uaca go ouepaymm m uepes 12 uac
uocne ouepaymm. HeØpa›ymo+mpoæa++8u reuapm+ - 5000 eg 24 pasa æge+a.

28.

¶BC B AKVHEPCTBE u FEHEKOflOFEE
Mpuuu+/ : owcnou›a, upegnewa+me m pasp8æ8 unaye+w8;
su6onme o›onounog+8um æogaum; awo+muec›me uawou+8e
›poæoweue+me; a+we+awana+ae rm6ena unoga; cwmuyneyme pogoæou geewena+ocwm m unogopaspymaDyme ouepaymm; uocnepogoæ8u ceucmc; uys8p+8u sa+oc; ›pmum+ana+8u a6opw; wewen8u uosg+mu recwos; s›nauucme. bonamme gos8 a+wm6mowm›oæ, ›opwm›ocwepomgoæ, ymwocwawm›oæ, agpe+ocwmuynewopoæ,
s-AKK, +eupaæmna+oe upmue+e+me a+wm›oaryne+woæ m Øm6pm+onmwm›oæ, opana+8x ›o+wpayeuwmæoæ m w.g. Maccmæ+8e reuowpa+cØysmm mpem+Øysmm ›poæm.
Mpoeæne+ue ¶BC: mamo¬n9e 1poøome¬enue, uonmopra++ae
+egocwawou+ocwa (uopawe+me ner›mx, uoue›, ronoæ+oro uosra,
cepgeu+o-cocygmcwou cmcweu8, ›mmeu+m›a, ›owm m gp.) Kpoæoweue+me ms ouepaymo++8x pa+.
Mpoøunaıwuıa patæuwue ¶BC: cæoeæpeue++ae gmar+ocwm›a
m upoØmna›wm›a a›ymepc›mx ocnow+e+mu. Heo6xogmu sauac
cæewesauopowe++ou unasu8.

29.

Cuacu6o sa æ+uua+ue