¢ерапия/Кардиология/Инфаркт... · created date: 8/26/2013 4:19:17 pm
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ll Ap.).Orcynucm - :aaJrkr.r'ue cuMrrroMoB perr{Horrararr (uo nor<a:ranuxw).
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llaqzeuraM co 3HutrII4TenbHbIM nopaxeHrreM JreBoro x{eJIyAor{KiI AorxeH6rtrl rrponl4caFl nocreJlbHrtfi pexcuM Ao rex rrop, rroKa He 6y4yr oLIeHeHbrpac[pocrpaHeHl{ocrb H T.f,xecrb rznQaprra MnoKap.ua, o qenbro Br,rrBJreHH-{pauuefi cepAerlHofi ue4ocraroqHocTr Lr apLrrxruit. B ueocloxHeHHbrx cnyqarxn:aIII4eHT MOX(er CHAeTb I] rrOCTeJrH yxe B rrepBbre AFrr4, noJrb3oBaTbcr KpecnoM-TyaneroM z cal\,{ocro.sreJlbHo o6clyxunats ce6g, u caMocrorT'eJlbHo rrr4Tarbcfl.Elcraearr naqHeHTbI 3a.rracryro Har{uHaror paHo (oco6euHo rraqueHTbr, yKoropbrx 6ur nlrunreHeH paAuanbHufi 4ocryu).
Pexolreu,qyeMa Ar{era:
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norpe6nrreNrbrx r<arropHfi ;
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Sar<roprr pucKa.
15.2, MellrrcalreHTo3Hoe JreqeH rr€) :
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2 aJ
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l[,rn nyuupoBarHus 6otr^ rroKa3aHo ruTpyeMoe BBeAeHHe orruongon (1c)MopQuu - ilpu npoAonxatourefic-f, 6onu 4-8 lrr Erle c AononHr4TenbHbrM
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llo6o.rHrre a$Sercrbr or BBereHr{r lrop$una:- ToIrIHora, pBora, frllloreH3vfl;" e 1paguxapgnei- r{ yrHereHpre [brxaHkrfl;- napaJlne-[bHo c onuol,IAaM[r An{ Mr4HHMrr3HpOBa.HHr TOrrrHOTbr Moryr
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- npl4 yrHr3TeHZI4 AbIXaHut rlBecrr4 HaJroKcoH (0,1-0,2lrr sle r(axAbre 15MuHyT, npH iloKazaunxx);
- AaHHbre npenapa'lbr BcerAa Aon)KHbr 6rrrr AoclynHbr,
flepnu'rnoe KopoHapHoe BMerrrareJrbcrBo oKcrpeHHar lrpecKox{Ha-flKarerepzsarJufl npla zHtlilpKre Mr4oKap,qa c rroAbeMOM cerMeHra ST rra 3Kf 6esrlpeAlxecrnyrorqeit Qu6parIoJll4Tlrr{ecKofi repanw1 flBrrflelcf, [peArrorirr4TelrHofiraxruxofi penepSysr4vr rrpr4 ycnoBran BbrrroJrHeHr{r B [peAenax ycrauoBJreHHbrxBlpeMeHHbIX pa.:vIOK He3aBI4CI4Mo CrT TOro nOCTynaeT JII4 narlr4eHT B 6OnrnuqyB.blnoJlHf,roqyrc IIKB. llcnu naIII4eHT nocrynaer B r{eHTp, He nunoluxrorqufirlKB, rpaHcnop'rupoBKa qepe3 cxo,pyrc noMorub e ra6oparopurc Karerepr43arJzrrlAOnxHa rlpolr3lloAtlTcfl HeMeAneHrro. llpe4rror{Tr4TeJrbrrbre BpeMeHHbre paMKr4 ornepBoro MeAuqrHcKoro rioHTaKTa Ao nepBr4r{Horo ql(B <90 nanu rz < 60 Mr4H rrpupreHHeM nocryrtneul{u naul4eHTa {2 .racoe c MoMeHTa Bo3HlrKHoBeHr4.f, rcuMrrroMoB
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llepnuvHoe r{KB iloKa3aHo y [aqr{eHroB c 'r.aNerofr ocrpofr cep4euuofiHI3AOCTATOI{HOC'II4 HNH KAPAI4OfCI{HbIM IIIOKOM, KPOBE CNY9:ACB, KO|AA O)KHAACMA-f,
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Acnupauru rpom(ia - IB.
Pexontesltyercn t,toIIoJIb3oBarb creHTbr, coo'rBercrByarrlue c.neAyro[Ir4M,TEXHHI{CCKI4N{
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Ha cIIc'IeMe Ao()raBKI4 eirrcrpofi cMeHbI AnlIuofi 143cv' Marepan
xo6alrr.rpoMoBbrit cnnaBl-605, roJruluHa c'IeHlKI,l 0,0032", Marepuan
6anroria - P"bu*. llpo$unr, ilpoxoxlteH]/lfl. 0,041 ". llporcuMan:bHblfi xla$r
0,031", AI{cTaJIbHbIt 0ii4".HouIIHaJIbHoe AaBJteHHe 8aru Anfl 2'25-
2.75wxt, t0arrr,r Anfl.3.O-4.0urt. ,{arneHue pa3pblBa _- 18 aru. fltraua or B Ao
38ruu. fllrarr,rerpbl or 2.25 1,ct 4.0nvt.
MarepuilJr creFrra xo6allr-xponaonrtit crIJIaB L-60:i. Mareplral 6alloHa -Fulcrum. llor<ptrl cMecbro JreKapcTpBeHHOfO [peilapaTa 3oTiaponHMyc 14
nonr4Mepa gittinx. Toryquua 1"ei4KpI 0,091u.r4 (0,0036")' Cucreua
AocTaBKI,I .qlnnoft 140cv. pa3Mep npoKcI{MaJIbHorO ura$rla KaTeTepa
0,69urr,r, AHCTaJrbr{ofo Urasra 0,91uu. HolrunalbHoe Aaene.F{Iae: 9 aTM.
,{aueurae pa3pblBa 16 aTr{. Anr .4rraMeTpoB 2,25-3,5 MM, 15 aTM. [nflAlraMerpa +,0 uv. Pa:vrepu: AI{aMerp or 2.251o 4.00 vI Anvna creHra (t*t)
-or8lo38.3. MareprraJr crerrra - rrJrarurro-xpoMoerrfi cnJIaB. 'l'Olrqltua crelroK creHTa -
0.0032", J[er<apcrBeHHoe noKpbrTr{e creHTa crocrol]T I{3 AByX rlonHMepoB I4
neKapcTIleHHOro lpenapaTa 3BepOnIIMyc. 'fruulnua lonuMepHoro
noKpblTrlq - 0,007 ruu. lIpoSI4JIb cTeHTa Ha cIIcTeMe AocTaBKIl - se 6olee
0.042,, (ln" creHra Ar4;aMerpoM 3 rrau). Marcuualrnufi AlraMerp
pacnparlneHsofi qqefiKr{ cre)HTa - He MeHee 5,7J nrvr (4nx creHTia Ar{aMerpoM
i,00 rr..ur'). ,{uave.rpbr creH'oB - or 2.251o 4.00 rr,'ul. .{luHa creHroB - or 8
.rro 38 MN{. HovunarbHoe AaBneHI4e - He MeIIee \2 aTM' llpe4e:nuoe
.[aBJreH]de - He MeHee 18 aru. llpo$unr KoFITITIKa 6al.noHa .qocraBntroqefr
cr4creMbr creH'ra - He 6onee 0,017". Pa6oqafi AnI{Ha 6alloHnoro Karerepa,
Ha KOTC,pOM CNIOE:TI,IpOBaH OTeHT - 744 cvt.
4. MarepHaJI creH'Ist: Ko6anbr-xpoMonufi cnlan' L-60'5. llaccusurle
noKpblllde : amOp cpnrrfi cltlr'Ixou-rap6l{A, aKTI{BHo e noKpbIT}Ie :
6uo.4erpaa"py*utfi nolulaKruA (L-IIIIA, Poly-L-Lactic Acid, PLLA)
BKlloqalo ryufr, Ctrponl,IMyc. Tolulnua KapKaca cTeHTa HoMHHaJIbHbIM
Ar{aMerpov2,0-3,0 MM He 6onee 60 Hrxrt (0,0024"). Kpoccunr npoSunr
creHra - 0.039"(Cl.9g4 urrl). [nnHa creHra:9,13,I.5,I8,22,26, 30 vvt.
Houuuanrnrrii A aaMerp cr eHroB : 2.25 1 2.5 1 2.7 5 1 3 .0 1 3 .5 1 4 .0 rulr' luarraerp
Ar4cranbHofi ropqeBofi qacru(upoSunr BXoAa) - 0.017"(0'4318 uu)'pa6oqafl [nkrHaKarerepa - 140 cu. HonrltHaJlblroe AaBJIeHI4e 8 aru.
Pacqersoe AaIlneHI4e pa3pI,IBa 6allosa 16 allt. [uauerp creHTa 2,25 wrvr
rrpr4 AaBna:H:|ILr,8 AruocQep: 2.0 MM. AuaMerp crerlra2,25 MM npl4
AaBJIeHIIn l4 r\rturocQep: 2,43 tnttu.
CreHr KopoHapsulii 6e:r ;rercapcrBeHHoro roKpl'ITUfl
1. Eannogopu.-"pxerrtrii CreHr Ha CI{CTeMe 6r,t,:rpofi AocTaBKH 143cttl.
Marepraar crerrra: HeMarHHTHbIfi xo5a.:mr-xpoMoBblfi cIIJraB L-605.
Marep,za-u 6ruuoua - Pebax. Toruluua crerIKI4:0.0032" (0.0813utu).
-v' t6
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[rzanrerp: or 2.0 Zto 4.0 nu. ,{nuua: or 8 Ao 28 ruu. flpo$I,IJIb creHra Ha
6allose 0.040" (creur 3.0x1 8rtarra). lIporxNeHHOcrE, pa6ouefi rloBepxHocru
6arrosa 3a Kpafl creHra (batrloon overhang) ue 6on<le 0.69uvr. I(ounlaunc:HoMr4HaJbHoe AaBJreHHe (I.IBP) 9 atu., pacqerHoe AiIBneHr{e pa3pblBa (RBP)
16 arnl.2. Marepuat crerrra xo6alrr-xpotr,tonsrfi cnJra.B L-605. Tolurptna s'aeirxu
0,091rrlu (0,003ti"). Culerta AocraBKII Alnsofi 14Ocrul. pa3Mep
npoKcr4Mil,rlbHolo ura$ra Karerepa 0,69rrav, ,{HcralbHoro rua(lra 0,9lrtlrra.
HouuuarbHoe AaBneHr4e: 9 aru. faereuue pa:lpllBa i6 aru. [nfi;. [vaMerpoB2,25-3,5 rrlnr, 15 arru. An{ Ar{aMerpa 4,0 rr,rnr. Pa:vepbr: AHaMerp Or 2.25 lo4.00 u ArrLrHa cleH'ra (t"ru) - or 8 ao 38.
3. Marepu€rJr creHTa - HepxaBerorqat craJrb MapKrr 3ltiL Ha cllcreMe 6ucrpofi
AocraBKr4 4;rranclfi l45crtn. Hanu,aue M noKpbITHq Al4cr€ulbntoro uiaSra
(rpoue creHra'). fuzaitu cucreMbr Aoc'raBKH rpexnerecrronufr6allosulrii xarep. Toluluua creHKr{ creHTa, He Cionee 0,08 uvt. fiuzaimcreHTa --orKpbrrax sqefixa. Halrnqne HH3Koro rrpo$ulx 0,038" [Irfr creHTa
ArraMerpotr 3.0 vu. Hol,rlrHaJrbHoe AaBneHHe fian1qrH& 9 atm AJIfl AI'IaMerpa
4 rr,rvr H 10 atm Antt AI4aMe'IpoB or 2,0 4o 3,5 NIM; AaBJIeHHe Pa3p'riea 14 atm.
fuarvreql [poKc]r\4aJrbHoro uaSra-2,O Fr, AucranbHorc>-2,7 Fr ,.{uanaerpr,l:
or 2,0 Ao 4,0 f,itwta or B Ao 30 rnln'r.
fleperavrroe I{KB AonxHO orpaHnqr4Barbcfl, Iz:uSaprcr-cB-t3aHHofi, aprepwefi,
3a r{cKJrroqeHr4eM cnyqaeB KapArloreHHoro rq\uror<a H nepcllc'rupyloulefr uurevuu
ilocrre r{KB- IIa B.Eclu BbrrroJrHrercs orrbrrHoM oleparopoM Iro nyqeBoMy Aocryrly, nyvenofr
,(ocTyil AoJIXeFI 6rt15 ilpeAlor{TI4TeJIbHee, r{eM 6e4peHnrrii- IIa B.
Ecnu y ilarlgerlra orcyrcrrlyror rlporl4BonoKa3aHl,lf, K AJITITeJITHofr AATTr[noxa:auue Anrr opanruofi aHTHKC]afyJTflrJkrv I,IJIII Bblcoxnii ptlct< KpoBrcrer{eHl4fl tlo
[rKaJie CRUSI\DE), lr oFr, rro-BrrAHMoMy, 6y4er BbIIroJiHtrb peKoMeHAaUI{u, creHT
c neKapcrBerlHbrM loKpbrrr4eM Aon)KeH 6rtrr rtpeAilotlTureJrbHee creHTa
MeraJrJlrrqecKolo 6es norprtrus- IIa A.cne4yer: paccMorllerb pyrrlHHyro acnr4parlr4ro rpou,6a- IIa B.
Pyrranupe ucroJrb3oBaHr4e Ar.Icra-lIbHbIX 3arulITHbIX yclpoficrn He
peKoMeHAyercrl- III C.
Pyu4HHoe ucro.rrb3oBaHr4e BAEK (V uat-luelFlroB 6e: ruoxa) He
peKoMeHAlorC'r- III B.HeueAleHHa{ a.nruorpaS.aa c nepBl4'{uofr r{.KB peKoMeHAyerct y
laqrreHToB, poaHr4MrzpoBaHHbrx noc.rre ocTaHoBKI4 CepAU€t C npI{3HaKlaMU I',IM CIIST na 3f- I B.
HevreAleHHa{ aHrr{orpaSrax c nepBuqHofi r{KB AonxHat paccMarpvBarbQs'
BbIxtl4BIIII4X. IIOCJIE If,CT?HOBKII cepAIIa 6eg ,II]{AfHOOTI4IIECKOfO NOBbIIIICHI4'y BbI)KI4BIIIr4X. llOUJl€ UUla-UUIJI\.r1 UsPAIl4 \,vr Altor rv\/r4-rvvr\vr \
cerMeHra ST na 3KI-. Ho co 3rraqr4MblM rIoAo3peHI,IeM Hia reKyxlufi lan$aprcr- IIa
B.TepauesrHqecKar rnnorepMHfl rroKa3aHo paHo IIocJIe peaHuMalll{u [pLI
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