, 30 % 40%, 6%,,,, (CIP).2002/. :, ISBN R6-54 CIP (2003) (2002 ) : : ( 800

Transcription

1 CHINESE YEARBOOK OF SURGERY

2 , 30 % 40%, 6%,,,, (CIP).2002/. :, ISBN R6-54 CIP (2003) (2002 ) : : ( ) : / 16 : : ISBN / R224 : ( )

3 2002 ) () () ()

4 ,, 1983, 20 ( ), , , 30% 40%, 6%,,,,,,,,, ( * ),, :, :

5 1 1 1 ( ) 1 ( ) 2 3 ( ) 3 ( ) 4 7 ( ) 7 ( ) 8 11 ( ) 11 ( ) ( ) 13 ( ) ( ) 39 ( ) 40 ( ) 40 ( ) ( ) 42 ( ) ( ) 44 ( ) 44 ( ) 45 ( ) 45 ( ) ( ) 54 ( ) ( ) 58 ( ) ( ) 78 ( ) 78 ( ) 79 ( ) ( ) 80 ( ) 81 ( ) ( ) 82 ( ) 82 ( )

6 2 (2002 ) ( ) 95 ( ) 96 ( ) 98 ( ) 98 ( ) 99 ( ) ( ) 100 ( ) 102 ( ) 103 ( ) 104 ( ) 104 ( ) ( ) 105 ( ) 105 ( ) ( ) 107 ( ) 107 ( ) ARDS 108 ( ) ( ) 126 ( ) 126 ( ) 126 ( ) 127 ( ) ( ) 129 ( ) 129 ( ) 130 ( ) 131 ( ) ( ) 143 ( ) ( ) 172 ( ) 173 ( ) 173 ( ) 174 ( ) 175 ( ) 176 ( ) 176 ( ) 176 ( ) 176 ( ) 177 ( ) ( ) 178 ( ) 181 ( ) 183 ( ) 184

7 3 ( ) ( ) 184 ( ) 184 ( ) 185 ( ) 185 ( ) 185 ( ) 185 ( ) ( ) 205 ( ) ( ) 207 ( ) ( ) 227 ( ) ( ) 235 ( ) 236 ( ) 237 ( ) 240 ( ) ( ) 241 ( ) 241 ( ) ( ) 261 ( ) 263 ( ) 264 ( ) 265 ( ) ( ) 271 ( ) ( ) 283 ( ) 284 ( ) 285 ( ) ( ) 285 ( ) 285 ( ) 286 ( ) 286 ( ) 286 ( )

8 4 (2002 ) ( ) 300 ( ) 300 ( ) 300 ( ) ( ) 301 ( ) 303 ( ) ( ) 304 ( ) 304 ( ) ( ) 305 ( ) 306 ( ) 307 ( ) 307 ( ) ( HNPCC) 307 ( ) 308 ( ) 308 ( ) 309 ( ) 310 ( ) 310 ( ) 311 ( ) 311 ( ) 311 ( ) 311 ( ) 312 ( ) ( ) 312 ( ) 313 ( ) 313 ( ) ( ) 313 ( ) 313 ( ) 314 ( ) ( ) 315 ( ) 315 ( ) 315 ( ) 315 ( ) 316 ( ) 316 ( ) 316 ( ) ( ) 316 ( ) 317 ( ) ( ) 337 ( ) 338 ( ) 339 ( ) ( ) 340 ( ) ( ) 352 ( ) 353 ( ) 354 ( ) 355 ( ) 355 ( ) ( ) 356 ( ) 357 ( ) 357 ( ) 358 ( ) 358 ( ) 358 ( ) ( ) 359 ( ) 359 ( ) 360 ( ) 360 ( ) 361

9 5 ( ) 361 ( ) ( ) 363 ( ) 364 ( ) ( ) 385 ( ) 387 ( ) ( ) 389 ( ) ( ) 396 ( ) ( ) 397 ( ) ( ) 397 ( ) 397 ( ) 398 ( ) ( ) 398 ( ) 398 ( ) 399 ( ) 399 ( ) 399 ( ) 399 ( ) ( ) 416 ( ) 416 ( ) 417 ( ) 417 ( ) 418 ( ) 419 ( ) 419 ( ) 419 ( ) 419 ( ) ( ) 423 ( ) 426 ( ) 428 ( ) 429 ( ) 429 ( ) 430 ( ) 430 ( ) ( ) 432 ( ) 433 ( ) ( ) 459 ( ) ( ) 466 ( ) 471 ( ) ( ) ( PSA) 472 ( ) 473 ( ) 475

10 6 (2002 ) 477 ( ) 477 ( ) ( ) 479 ( ) ( ) 480 ( ) ( ) 505 ( ) 506 ( ) 506 ( ) 506 ( ) 507 ( ) 508 ( ) 508 ( ) ( ) 513 ( ) 513 ( ) 514 ( ) 515 ( ) 515 ( ) 517 ( ) 518 ( ) 519 ( ) 519 ( ) 523 ( ) ( ) 524 ( ) 526 ( ) ( ) 527 ( ) 528 ( ) ( ) 532 ( ) 535 ( ) 535 ( ) 537 ( ) 539 ( ) 540 ( ) 540 ( ) 540 ( ) 541 ( ) 541 ( ) 541 ( ) 542 ( ) ( ) 543 ( ) 544 ( ) ( ) 546 ( ) ( ) 546 ( ) 546 ( ) 547 ( ) 548 ( ) 548 ( ) 549 ( )

11 1 330, 138, 41. 8% ; 15, 4. 5% ( ) [ 1 ] SD, 5 ( 45 min 90 min 180 min), -( -EP ) ( NO ) ( NOS),, -E PNO NOS,NO -EP, NOS NO -EP, ;, (inos) NO -EP [ 2 ], inos ( AG ) 0. 5 h 2 h 4 h AG ( MAP ), AG ET TNF- IL-6 IL-8 NO,AG h (85. 7% % ) ( 50% % ) AG inos, NO, cnos,, [ 3 ] SD,, NOS, ( ASMC) ; NO ( L- Arg) ( AG) ; L- Arg AG, 24 h, NOS L-Arg ASMC, ASMC ; AG ASMC, L- Arg AG 24 h ASMC inos NO,ASMC,, AG 24 h 50%, NO, [ 4] ( SOD ) ( GSH-PX), ( MDA ) ( P0. 05 ), [ 5 ] ( MAP )5. 3 k Pa( 40 mmh g ), 60 min, MAP kpa( 80 mmh g) 30 min, ( PO2 ) ( PCO 2 ) ( p H ) ( [ HCO3 - ] ), PO2 0 kpa ; PCO 2,, ( ) kpa [ ( ) mmh g ] ( P < 0. 01) ; [ H CO3 - ] 30 min ( ) mmol/ L ( P < ), ( ) mmol/ L ( P < ) ; p H ( P < 0. 01) PO2 ( ) kpa[ ( ) mm Hg ], PCO 2 ( ) k Pa [ ( ) mm Hg ] ( P < ), [ HCO 3 - ] ( ) mmol/ L ( P < 0. 01),p H ( P < ) PO 2 PCO 2 p H, [ 6 ] -, 1 3 d, ( 10 mg/ L, 100

12 2 (2002 ) mg L) ( P TX ) ( CTX), M HC- T NF- M HC-, T NF- ; PTX, MHC-TNF- ;CTX PTX G - T NF-, [7 ] * ( pinacidil ) ( PC), Western A2 (cpla2 ) PC 70 ( HSP70 ) PC cpla 2 ( C ) ; HSP70,24 h, C pinacidil HSP70 PLA 2, [ 8 ],, : 75 g/ L MAP, CVP,,; 20 ml/ min 1 h MAP 89 %, ;, 15 % min MAP,Na + Cl -, 12 d 20 ml/ min 15 % ( ml/ kg)75 g/ L,, Na + Cl - 12 d [ 9] * Wistar, 0. 9 % NaCl ( NS ) 7. 5 % NaCl( HS) 5. 0% NaCl-3. 5% NaAc[ -( H AS) ],, : NS, HSA HS ( P < ), ( P < 0. 05) ; HS, HSA ( P < ), 24 h, HS HSA HS, [ 10], ( LR ) (polyh b) + ( GSH ) 120 g/ L poly H b + GSH LR ;120 g/ L poly H b + GSH,, 45 min poly H b, polyh b 120 g/ L poly H b + GSH ( ) [ 11] 110 NO, NO ( P < ), ( P < 0. 05) ; NO Hb ( P < 0. 05) ( P < ) ( P < 0. 01), ( P < ), ( P > ) NO [ 12 ] 7. 5 % ( HSL) 30,3 HSL, 27 HSL 15 min, 1020 ;24 HSL 15 min, 80 ml/ 30 min;na + Cl - 9 mmol/ L 5 mmol/ L, K mmol/ L,1 d HSL, HSL, [ 13 ] 7. 5% 250 ml 56, 41 ( % ), 7. 5 %, 7. 5 %,,,, [ 14] ( HSD) LR, HSD,,, [ 15 ] 143 (ICU ) ( ED) ( H TS) ED ( CPR) ; 24 h, H TS CPR, 1 h CPR, H TS, ;,

13 3 ( ) [ 16 ], ( PTX) PTX D- ( P < ),,, NO PTX, NO [ 17 ] ( KC) ( Gln),, KC Gln ( ) mol/ L ( ) % ( ) mol/ KC; 10 mg/ L, Gln ( ) mol/ L ( ) % ( ) mol/ KC Gln KC, LPS KC Gln [ 18 ], ( Gln) ( PN) TPN, Gln Gln PN DNA AT P SOD GSH siga T PN, ( MDA ) T PN ( P < 0. 05) Gln, ( GSH ) [19 ], -1 ( E T-1) NO, 3 h ET-1NO, 24 h ; NO, E T- 1 ; NO, E T-1 ; ET-1, NO ET-1 NO NO E T-1 ; ET-1 NO [20 ] 27 (LPO) NO SOD LPO 77. 8% % LPO ( P < ) ; NO 0 3 ( P < 0. 01) ; SOD ( P < 0. 05) LPO NO SOD,, SIRS, NO,,,SIRS MODS [ 21] *,, ; ( BCAA ) h, 24 h ; ( AAA ) ;BCAA/ AAA 2 h, 6 h ; ALT AST ( P < ), 6 h ; T NF- IL-6 ( P < ), T NF- 2 h, IL-6 12 h [ 22] ( CLP ),,CLP 2 h, ;, ;, ( P < ),,,, [ 23], ( PAF ) TNF IL-8, PAF T NF IL-8, ; PAF W EB 2170,PAF T NF IL-8 ; WEB 2170 PAF T NF IL-8, PAF MODS [ 24 ] RT- PCR mrna, 3 h 12 h T NF- IL-1 IL-6, IL-4 12 h ; 12 h [ 25]

14 4 (2002 ), / MODS,,, [ 26 ] * SD, IL-10, + ( 1 h 3 h U IL-10) ( 3 h U IL-10 ) 3 9 h TNF- IL-1 IL-6 CLP +,, + IL-10 ( T NF- IL-1 IL-6),,+ [ 27 ], 10 mg/ L ( T 3 )1. 5 ml/ kg, T 3,24 h ( P < 0. 05), FT3 FT4 TSH ( P < ), [ 28 ] E. col i DNA, DNA ( SIRS ) E. coli DNA, LD 50 = mg/ kg; 30 mg/ kg E. col i DNA 60 Co ; DNA DNA CT DNA ( 0/ 10 ) DNA SIRS,, DNA, DNA [ 29 ] *, B( SEB) SEB, 2 6 h ng/ g ng/ g, P < ; ( MPO), U/ g, P < 0. 05; T NF- IFN- ( P < 0. 05), SEB SEB SEB, TNF- IFN-,, [ 30 ],, ( k Pa), 2 h,, ; 6 h, 2 mg/ kg 2 24 h - SIRS, ; ALT AST 1 ; 2 h 3 ; ; 39. 6%, %, 23. 5%, [ 31] 80, C ( CRP ), CR P ESR WBC, CR P WBC ESR CRP [ 32 ] CRP d 48 ; 3 d ; 5 d 36 ; 7 d 36, 4, CR P,, 7 d, [ 33 ] ELISA ( SAA ) CRP IL-6, 30, SAA CRP IL-6 ( P < 0. 01) ; SAA IL-6 ( P < 0. 01),CRP, SAA/ CRP ( P < ) SAA CR P IL-6, SAA IL-6 SAA/ CR P ( ) [ 34 ] ( IR), 10%, ; RT- PCR ( INSR) 4 ( GLUT 4 )

15 5 IR, ( P < )RT- PCR,, GLU T 4 mr- NA ( P < 0. 05),I NSR mrna IR ( IMGU ),, GLU T 4 [ 35 ] ; 78 ( ) 78 B ; T, CD 4, CD 4 / CD 8 ; WBC ; CR P PGE2 -EP ( P < ) ; ( % ) ; ( % ) (24. 32% ) ( P < ),,, [ 36] HP, 36 ( R VEF ) (R VWS) (E) ( A ) ( E/ A) ( Dte) ( RVSWI) ( RCWI),, RCWI RVSWI R VEF E/ A Dte R VWS ;, RCWI R VSWI RVEF E/ A Dte, RVWS ;, R VEF RVWS, RCWI RVSWI E/ A Dte, ;,,,,, [ 37] ( GH ),20 GH, 10 d, GH -1 (IGF-1) -3 C-, 24 h GH, IGF-1, [38 ] * 557 G ( % ),,, 3 ; G ( % ), : G - 3 ;G + ; [ 39] 158, NCCLS 184, :, ; 1994 [ 40 ] ,18, ; G +, 74 % 98% ; G -,18 [ 41 ] W HONET , 1 314,, 44. 6% ; 4. 3 % ; G % %, [ 42],, > 2 h,( P < 0. 05) [ 43],,,,, [44 ] %, 20% ;, ; WBC WBC ( P < 0. 05) ;, ; ( P < 0. 05) [45 ] 11

16 6 (2002 ), ; G -,,, [46 ] 10, % % % % 8. 69% % ; ; 5 MODS,,, [47 ] 1 196, [48 ] PCR PCR, T T ( T T V ) 223 T TV 96 (43. 1 % ) ;22 T TV-DNA, 14 ( 63. 6% ), T T V- DNA 100 % ;1 T TV, [ 49 ] ( SICU ) 181 ( NI), 9. 81% ; ( % )( % ) (9. 32 % ) ;,,,, % ;, SICU NI,,, [50 ] , G - ; G - (90. 7 % ) ( % ) (77. 9% ) ( 62. 5% ) ; G + ( 97 % ) [ 51 ] SICU 31 SICU G -, (90 % ), ( 50 % ) ; 2 ( 19 % ), 66. 7% ; ( 9. 6% ) SICU [ 52 ] SICU ( AAD ) 35 AAD, ; APA- AAD, AAD [ 53],149 ( > 3 d ), 1 1,,,, [ 54 ] 2 g, 8 h 2 g, ( 16 U/ d) (1. 0 g/ d),, 37 d %, % ; %, % [ 55],,, : ; ; [ 56 ] :,,,, [ 57],, ; 2 h, [ 58 ], ( CRS), : CRS ; ( > 1 ) PN, CRS [59 ] ( PICU ) 26, 1020 mg/ ( kgd),, 431( 11 7 ) d, 100 % 5 d 6 7 ( 23. 1% ), 4 4, %, 2 11, 6, 9,

17 7 5. 4% 1, 3. 8 % [ 60 ] , 14, 72 : T AT 1 2 U, 2 8 U ; 2. 5 mg, mg; mg/ kg;, 7 10 d: 41,, % [ 61] 44 18, 14, 12 : 39, d2, 3 [ 62] 34, 21, 5, 6 1 7,,, ( ), IL-2 [63 64 ] ( NFA T ) 1 ( AP-1) DNA IL-2 : NFA T AP-1 DNA, 4 d, 41 % 49%, IL-2 IL-2 mrna NFA T AP-1 IL-2 [ 65] -kappa B( NF-B) DNA NF-B P65 NF-B DNA NF-B P d NF-B DNA NF-B P65 SIRS [ 66 ] Bax Bcl-2 :,,, Bax, Bcl-2 ;, Bcl-2, Bax Bcl-2 [67 ], ( GC) ( GR), GC, 4 h, 24 h ; GR,12 h,24 h ; AL T GR, GC ;,, GR ; AL T, GC, GR GR [ 68], ( E ) ( NE) : E NE 30 min , 1 3 h, , 6 h, ,24 h ( 2 ms ), ,,, 30 5 min ( ),,6 12 h E NE ;,, [ 69 ],, 20 cm, kpa, %, 5. 12, 1. 3, 18 % 100 k Pa [ 70] 4 : ( C ) ( H ) ( L ) ( M ) ( p Hi)D-, ;72 h, ( DAO) 72 h M p Hi H

18 8 (2002 ) L P < 0. 01) ; H L ( P < 0. 01) ;48 h 72 h D- M H ( P < ) ;,M ; M DAO ;M H L ( P < 0. 05),,, - [ 71] C57BL/ 6 ( 171 ) BALB/ C (159 ) C57BL/ 6, BALB/ C ;,, ( ), [72 ],,, [73 ],,, [ 74 ], ;,, [ 75] 18 ( A ) ( B ) FT 3 ( C ), ( FT 3 ) B MAP A, CVP A, T (ctnt) A,FT3 A, MAP B,CVP B, F T 3,, ; T 3 [ 76 ] ( 6-keto- PGF- ) B 2 ( TXB 2 ),,, [ 77 ], 53. 3%, 6 h 70. 6% %, 66. 7%, 23. 3%,, 70. 6% 64. 7%, [78 ],1 h, ;, 3 7, ET TNF ( P < ),,,, [ 79 ] :, ; 25 min ( 4 h, 1/ 2 ) 45 min; 24 h, h ; ( ) [ 80] ( 36 ), IL-12,, IL-12 ( P < ) [ 81] -

19 9 -end ) ( PMNs ) CD 18 CD54 : 24 h ( P < ), -end,, 72 h ; 24 h ISS20 ISS < 20 ( P < 0. 01) PMNs CD 18 CD 54 ( P < 0. 01) ; 3 d, ISS20 ISS < 20 ( P < ) -end PMNs,, [82 ] * 41, ,, MODS, MODS ( P < P < 0. 01), [ 83 ] 40 ( TM ), : T M, TM, ; TM APACH E ISS,, ( FDP ) ; T M, T M > 40 g/ L, 77. 8% ( 14/ 18 ), % (17/ 22 ), % ( 14/ 19 ) T M, [ 84] (CAMs ) (LD)( LAF ) CD 18 1 ( sicam-1 ) 1 ( svcam-1), MODS, MODS ( P < ) CAMs MODS, [ 85 ] p H ( p Hi) p Hi d ; 68, 35, 33 ; 7. 35, p Hi > %, ph i ( % ) ( P < 0. 01) ;7. 30,p Hi > p Hi7. 30 ( 27. 3% % ) ( P < 0. 01) p Hi, p Hi7. 35 ; p Hi7. 30, [ 86] IC U 32, 2 5 d, 4 6 d, 2046 d,, : - ; ; [87 ] ,, [ 88 ] ( SCL-90 ),, ( PTSD ) PTSD SCL-90, PTSD, SCL-90 [ 89], ( P < ),,, [90 ] * : ( TS) ( P HI) ( GCS) ( ISS) ( TRISS RTS ) ASCOT ( ICISS),, ( AUC) ; 78%, ;

20 10 (2002 ) ( Ps ), [ 91 ] GCS ( RTS ) ( APAC H E) GCSRTSAPACH E, ; Logistic, GSC, RTS GSC ; APAC H E GSC, [ 92 ] ( PT T ), ( ISS ) ( PTI), PTI ISS,, ( P < ) ; ISS %, PTI %, 10%, ( P > ) ; P TI ISS, PTI ISS, P TI ISS, ISS PTI 20 16, P T T PTI ISS [ 93 ] ( ISS) ISS ( RFISS ) R FISS AIS AIS ( R FISS = A1 2 + A2 + A3 ) ISS RF ISS, R FISS,, RF ISS ISS ( P < 0. 01), RFISS, ISS [ 94 ] 227, ( AIS-85 ) ISS GCS, ISS : GCS %, > %, ( P < 0. 01) ;, 4 5 P < 0. 01; ISS, ISS P < ICU,GCS ISS 3, : GSC8 ICU ; GCS > 8,> 3 ICU ; < 3 ISS, 21 ICU [95 ] 65, 15, 50 62, 3,,,, [ 96 ] 56, 15 ; 18 ; ( ) 23 23, 26, 7 38, 82. 1%, 17. 9% ; 21, 5 ; 2, 5 ;, [ 97 ] % ; % ;49, 3, [ 98] , 16, 34 ; 87, 16, 9 106, 4 ; 6 : ;,,, ;, [ 99 ] 76, 59, 17, : 8, 5, MODS 4, [ 100 ] , AIS90 ISS, ISS16 ; ( P < 0. 05), ISS 50, ;MODS 6. 3%, 0 % ; ICU [ 101 ] 165 ISS > 16,, %,

21 11 B CT 3 90 % 21, 29 ISS = 41. 6, ( P < 0. 01), B CT,,, ISS > 40 [ 102 ] 379, ;, ;,,,,, [103 ] 46, 41, 76,5 37, 9,,, [104 ] 53, 17 :, ;,, ;,, ;,, ;,, ;, [ 105] 122 ISS 16 :, ; 3 :; ; [ 106 ] 36 ISS > 25VICO( ventilation, infusion, control bleeding,organ) 32, 4, VICO [ 107 ] 86 MODS Marshall 6 6, MODS MODS, MODS,, [ 108 ] 1996, 4 295, 2 976, 46. 0/ h , [ 109 ], %, 46. 6%, [ 110 ] 270, (5 8, 13 ) ; : ; ; ;, ( ) [ 111 ] ( Gln) ( GH ) 8 d ( PN ) ( P < 0. 05) ; Gln GH ; Gln + PN ( P < 0. 05), GH Gln + PN, Gln, PN [ 112 ] Gln 23 SD 80%, 3 : ; ( T PN ) TPN ; Gln TPN + Gln 8 : ;, Gln ( P < 0. 05) ; TPN ( V H ) ( MT ) VH ; T PN V HMT,

22 12 (2002 ) CD) MT ; Gln VH CD MT T PN MT :, Gln T PN 80 %,,, ; T PN, ; Gln T PN, ; Gln [ 113] T PN ( AP) : AP,, TPN 1 d,no, ;5 d NO ; AP ; T PN [ 114 ] 13, A( T PN) 7, B( T PN + ) 6, T PN 1,, A,B AST ( P < ), C- ( P < ), A, B, A,B, TPN, [115 ], S- - L- ( SAMet) T PN SAMet 80 mg/ ( kgd) : + TPN,, STBA GGT AKP, ; + T PN + SAMet + T PN, ST- BA GGT ALT AKP,,T PN SAMet TPN [ 116] (CLP), T PN A E C TPN AE C,,,, T CD 3 + CD 4 + CD 4 + / CD 8 + T PN A E C [ 117 ] :, 1 cm 12 cm,pepti-2000 ( EN ) ( EF ), ( CONT ),, 15 d EF, 18 EN ( P < 0. 05) ; 9 EN CONT ( P < ),EF CONT, EF EN CONT ( P < 0. 01) DNA IGF-1 mrna, CONT ( P < ) [ 118] TPN,,, T PN ( ) [ 119 ] 30 60,,, - [ g/ ( kgd ) ], Gln, /, 6 d, Gln,, [ 120 ] - ( Ala- Gln) T PN T PN 15, :( TLC) ( P < 0. 05) ; ( H b) ( Alb); ( POF ) Ala-Gln T PN T LC, POF, [ 121 ] * (BCAA ) 40 ( BCAA ) ( ),2, 6 d,, 12 h : 2 d, ;, ;,

23 13 BCAA [ 122] * 8 T PN > 4, TPN + S- - L-( SAMe), SAMe 500 mg,, 2, 4 - ( P < ), ( P < ),, SAMe T PN [123 ] * ( LCT ) ( MCT ) 24 6, 50 % MCT LCT MCT,,, MCT LCT, 50 % MCT, [ 124 ] ( rhgh ) 71 ( rhgh + ) 34 ( )37 : 5 d,, 9 ; IgG IgA IgM,,,9 ; (17. 6 % ) ( ) d, rhgh,,, [ 125] 16 4 rhgh rhgh,,,,,, [ 126 ] * rhgh 45 : 30, rhgh 15 ( ), rhgh 48 h rhgh, 8 U/ d, 7 d: CD3 CD4 CD8 NK CD4/ CD8, ;rhgh 4, 8 ;rh- GH CD 4 CD 4 / CD 8, 8 CD 4 NK CD 4 / CD 8 ; 10 d, 12 ( 40. 0% ), rhgh 1 ( 6. 7% ) rhgh,,, [ 127 ] ( PN ) 29 PN,, 57 d PN, [ 128] d,, ( L) ( M ), 6 h, L M,(L/ M) 20 L/ M , ,, P < 0. 05,, [ 129] ( 29 ) ( ) ; cm, ( ) cm ; 15 ; ( ) d,, 1 21,18 ; 2 8,4,,, ( ) [ 130 ] : LPS LPS LPS 9. 0 mg/ kg6. 0 mg/ kg LPS,,;,, ; LPS [ 131 ] T NF

24 14 (2002 ) IAI) MODS,T NF TNF IL-6,,,,,, 3-,,TNF IAI MODS, [ 132] * PCR-SSP, 37 MODS H LA-DRB1 MODS H LA-DRB1 * 1501 DRB1 * 1502 DR2 + MODS IL-10 DR2 - MODS, MODS H LA- DRB1 * 1501 DRB1 * 1502 [133 ] * T NF-mR NA T NF- IL-6 T NF-mR NA, T NF- IL-6, INF- IL-6 [134 ] * ( MPO ), ( PMN ) PMN,, ( ) [135 ] 31 MODS, 10, %, 87, % : ; ; ; ; ;, MODS [ 136 ] 353 SIRS MODS SIRS MODS SIRS MODS SIRS ;,, 27. 5% ;,, SIRS, MODS, SIRS MODS ; SIRS MODS,, MODS [ 137 ] 30,, MODS MODS,, 93. 3% Matsuno [138 ] B, 1, IL-6 ( ) 1,., 2001, 21 (2 ) : 66 2,., 2001, 10 (5 ) : 323 3,., 2000, 16 (11 ) : ,., 2001, 22 ( 7) : 724 5,., 2001, 17 (3 ) : 169 6,., 2000, 22 (11 ) : *,., 2001, 17 ( 4) : 232 8,., 2001, 17 (2 ) : *,., 2001, 18 (4 ) :333 10,., 2000, 16 (12 ) : ,., 2000, 9( 6 ) : ,., 2001, 10 (1 ) : 44 13,., 2001, 24 (9 ) : 46 14,., 2001, 21 (4 ) : ,., 2001, 30 ( 3) : ,., 2000, 16 (11 ) : ,., 2001, 8( 3 ) : ,., 2001, 8 ( 1) : 5 19,., 2001, 17 (3 ) : ,., 2001, 7 ( 5) : *,., 2001, 39 ( 8) : ,., 2000, 9( 6 ) : ,., 2001, 30 ( 3) : ,., 2001, 16 (2 ) : ,., 2001, 81 (15 ) : *,., 2000, 21 (6 ) :364 27,., 2000, 17 (6 ) : ,., 2001, 23 (4 ) : *,., 2001, 18 (3 ) :228 30,., 2001, 13 ( 5) : ,., 2000, 21 ( 6) : , 2001, 21 ( 2) : ,., 2001, 23 ( 2) : 73

25 15 4,., 2001, 16 (1 ) :41 35,., 2001, 11 ( 4) : ,., 2001, 10 (3 ) :179 37,., 2001, 8 (1 ) : 4 38 *,., 2001, 16 (5 ) : ,., 2001, 11 ( 3) : ,., 2001,9 ( 3 ) : ,., 2001, 16 (4 ) :231 42,., 2001, 11 ( 3) : ,., 2001, 11 ( 3) : ,., 2001,28 ( 3) : ,., 2001, 11 ( 3) : ,., 2001, 11 ( 4) : ,., 2001, 11 ( 4) : ,., 2001, 11 ( 4) : ,., 2001, 21 (4 ) :209 50,., 2000, 5 (4 ) : ,., 2001, 11 ( 3) : ,., 2001, 11 ( 3) : ,., 2001, 11 ( 4) : ,., 2001, 30 ( 2) : ,., 2001, 22 ( 5) : ,., 2001, 16 (7 ) : , 2001, 12 ( 8) : ,., 2000, 20 (11 ) : ,., 2001, 10 (3 ) :161 60,., 2001, 35 (1 ) :77 61., 2001, 23 ( 5) : ,., 2000,6 ( 6 ) : ,., 2001, 26( 2 ) : 92 64,., 2000, 22 (11 ) : ,., 2001, 13 ( 7) : ,., 2001, 13 ( 7) : ,., 2001, 10 (5 ) :314 68,., 2001,17 ( 5) : ,., 2001,21 ( 10 ) : ,., 2000, 22 ( 5) : ,., 2001,17 ( 5) : ,., 2001, 22 (1 ) :21 73,., 2001,17 ( 7) : ,., 2001, 13 ( 7) : ,., 2001,17 ( 6) : ,., 2000,16 ( 11 ) : ,., 2001, 23 (2 ) :166 78,., 2001,17 ( 10 ) : ,., 2001, 13 ( 7) : ,., 2001,21 ( 6) : ,., 2000, 29 ( 6) : *,., 2001, 39 ( 9) : ,., 2001,17 ( 7) : ,., 2000, 38 (10 ) : ,., 2001, 17 (9 ) : ,., 2001, 21 (4 ) : , 2001, 17 (7 ) :425 88,., 2001, 22 (19 ) : ,., 2001, 17 (7 ) : *,., 2001, 17 ( 3) : ,., 2001, 17 (3 ) : ,., 2001, 17 (3 ) : ,., 2001, 17 (5 ) : , 2001, 17 (1 ) :48 95,., 2001, 16 (9 ) : ,., 2001, 10 (5 ) : ,., 2001, 21 ( 1) : , 2001, 21 ( 2) : ,., 2001, 17 (10 ) : ,., 2001, 20 (4 ) : ,., 2001, 16 (9 ) : ,., 2001, 13 ( 2) : ,., 2001, 10 (2 ) : ,., 2001, 31 (4 ) : , 2001, 21 ( 1) : ,., 2000, 22 ( 6) : ,., 2001, 22 ( 8) : ,., 2001, 36 (1 ) : ,., 2001, 36 (5 ) : , 2001, 23 ( 4) : ,., 2001, 21 (2 ) : ,., 2001, 8( 1 ) : ,., 2000, 7( 4 ) : ,., 2001, 13 ( 1 ) : ,., 2001, 8( 2 ) : ,., 2000, 7( 4 ) : ,., 2001, 8( 1 ) : ,., 2001, 26 ( 2 ) : ,., 2000, 22 ( 5) : ,., 2001, 8( 4 ) : *,., 2001, 4 ( 2) : *,., 2000, 15 (12 ) : *,., 2001, 39 ( 9) : ,., 2000, 7( 4 ) : ,., 2000, 22 ( 5) : *,., 2001, 16 (6 ) : ,., 2000, 29 (12 ) : ,., 2000, 8 ( 6) : ,., 2000, 7( 4 ) : ,., 2000, 9( 6 ) : ,., 2001, 8( 2 ) : *,., 2000, 16 ( 11 ) : *,., 2001, 18 (1 ) :60

26 16 (2002 ) 34 *,., 2001, 23 (8 ) : ,., 2001, 10 (1 ) :17 136,., 2001, 30 ( 4) : ,., 2001,21 ( 9) : M at suno,., 2001, 36 ( 3 ) : A 2 [, 2001,17( 4) :232], : 90 ( N,10 ) ( C,40 ) ( PC,40 ) PC 25 g/ kg 2, 30 min,, 24h Western A 2 ( cpla 2 ), PC cp- LA 2, C,, cpla 2 60 ( C, 30 ) ( PC, 30 ), PC ( ), h, Western 70 ( HSP70 ), C, PC HSP70, 24 h,48 h 72 h, HSP70 PLA 2 ( ), PLA2, PLA2,,, HSP70, PLA 2 HSP70, PLA 2,,, - [,2001,18( 4 ) : 333] 3 : 0.9 % NaCl ( NS ) 7.5 % NaCl ( HS) 5.0% NaCl-3.5% NaAc ( H SA),, 4 ml/ kg NSHSHSA,5 min 90 min, : NS, HSA H R, MAP LVSPd p/ dt, HS, HSA ; HSA ph BE-ECFBE-BSBC H CO 3 -, HS, HSA HCO3 - ; HSA 24 h, HS, HSA HS,, HSA,,HS [, 2001, 39( 8) :638],, h 5, 8, ( ALT ) ( AST ) T NF- IL-6 : ( BCAA ) h, 24 h ; ;, ( AAA ), 2 6 h ; 12 h ; ;BCAA/ AAA 2 6 h ; 3-,, AL T AST, 6 h TNF- IL-6, h,,,, ;,;,,

27 17, MODS,,,,, ( ) 10 [,2000, 21 (6 ) : 364 ] 10( IL-10), 48 SD 4, 12 1 ;2 ( CLP ) ; 3 1 h IL U, CL P 3 h IL U ; 4, 3 h IL U 2 3 h 9 h, IL-1 IL-6TNF-, 1 IL-1 IL-6 TNF- ; 2 CLP IL-1 IL-6 T NF-,, ;3 4 2,, 3 4 : IL-10,,,, MODS, TNF IL-1 IL-6 IL-10 T NF IL-1 IL-6, IL-10,, IL-10 B [, 2001,18( 3) :228] ( ), B( SEB) Wistar 56 SEB 4, ;, 24 h ; 24 h ; SEB, SEB 2D 1 4 mg/ kg, 2 6 h SEB ( MPO ) T NF- IFN- : SEB, 2 6 h ng/ g ng/ g, P < 0. 01; MPO, U/ g, P < 0. 05; T NF- IFN- ( P < 0. 05), SEB SEB SEB ( ng/ g ) ; MPO 2 6 h 65. 6% % ; T NF- IFN-,: SEB, SEB TNF- IFN-,,,,,, B, [,2001,16( 5) :286 ], ( 557 ) G - G + G ( 71. 4% ),( % ), (9. 6 % ), 3 G ( % ), (7. 8 % )

28 18 (2002 ) 7. 7% ) ( 5. 4% ) 3 G - 3 ( ) 3 ( ), ; G +, ;,,,,, ( ),,,,, [, 2001, 39( 9) :690], ( ISS) 41 3 : 10 ( ISS < 16), 16 (16ISS < 25 ), 15 (ISS25), : ( 3 d ),,ISS MODS 3 d, MODS, MODS, nmol/ L % :,MODS,,, MODS MODS,,, -, MODS, [, 2001, 17 ( 3) :138] : 583 ;907 ; 365 ( TS ) ( P HI ) ( GCS ) ( ISS) ( TRISS RTS ) ASCOT ( ICISS),, ( AUC ) ; 78 % ;, ; ; ( Ps ),, ICISS ASCOT, GCS,,,,,, [, 2001, 4 ( 2) :94 ] 40 :[10. 3 % ( BCAA),20 ] (10. 4 % 18,20 ) 2, 6 d,,,12 h 7 d 24 h, 1 d 7,, :,

29 19,2 d,, BCAA,,,, ( ),,,, BCAA, S- - L- [, 2000, 15 ( 12) : 746 ] S- - L- 8 TPN, T PN S- - L-,500 mg,, 2, 4 -, B, S- - L-, 14,3 4 ;,24 ; 24 6,B,,,,, S- - L-,, T PN,, TPN, 8. 6 % 84%, T PN, T PN, S- - L-T PN,, T PN [,2001,39( 9) :694 ] ( LCT ) ( MCT ) 24 6,, 50 % MCT LCT : MCT,,6 d, MCT LCT, MCT LCT, MCT MCT LCT, MCT MCT,,,,,, MCT, LCT T PN, ( LCT ),, LCT ( MCT ),, MCT LCT [, 2001, 16 ( 6) :362] 45 : 30, ( rhgh ) 15 ( ), rhgh 48 h rh- GH, 8 U/ d, 7 d 4 8 CD 3 CD 4 CD 8 NK, : CD 3 CD 4 CD 8 NK CD 4 / CD 8, ; rh- GH 4, 8 ; rhgh CD 4 CD 4 / CD 8,8 CD 4 NK CD 4 / CD 8, CD3 CD8 ; 10 d, 12 ( 40. 0% ), rhgh 1

30 20 (2002 ) 6. 7% ) rhgh,,, ( ),,,, rhgh,,,, HLA-DRB1 [, 2000, 16 ( 11 ) : 663 ] H LA-DRB1 37 MODS [ISS 1641, ( ) ], 52 - H LA-DRB1, 10 : MODS H LA-DRB1 * 1501DRB1 * 1502 ; DR2 + MODS IL- 10 DR2 - MODS ; DR2 + MODS DR2 - MODS HLA-DRB1,MODS H LA-DRB1 * 1501 DRB1 * 1502, MODS T NF- IL-6 H LA-DR H LA-DR MODS H LA-DR 10 DR2 + MODS IL-10 H LA-DR MODS [, 2001, 18( 1) :60 ] ( ALI) 24 3 :, ( RT- PCR ) ( TNF-) 6 :T NF-mRNA :,, ( P < ) ; T NF- IL-6 : ( ) ng/ L ( ) ng/ L, ( ) ng/ L ( ) ng/ L, ( P < ) T NF- IL-6 ALI, ALI,, ALI, TNF- IL-6 ( ALI ),,,, ALI T NF-mR NA IL-6 PMN [, 2001,23 ( 8) :999 ] ( ALI) ( MPO ), ALI ( PMN ) :, MPO ; MPO :, PMN ;, PMN, PMN,, ALI, ALI PMN, PMN,,,,,,

31 21 293, 101, 34. 5% ; 19, 6. 5% [ 1 ] , 80 % ( 50% ) 14, 25, 28 3 (7. 5 % ),6, [2 ] 162,: ;,,,,,,, [3 ] :, ; ; ; ; :,, [4 ] > 50% TBSA 1 127,, > 70% TBSA, [ 5 ] : ; ; ;,,, [ 6 ] * [ 7 ] 76 ( ict ) ict, ict, ict ( 90. 0% ), ( % ),, [ 8 ] , 10 : ; ; ; PE EP ; [ 9 ] 155 ( ) h, ( ) h459, 24, %, ( ) 9. 6% [ 10 ] V : ; ; [ 11 ]

32 22 (2002 ), [12 ] 4 8,, [ 13 ] V/ m, 554 ma, : 137 ma/ cm 2,21 ma/ cm , 5, d [ 14],, Schwann DNA,, ; Schwann DNA 3 d ; Schwann DNA Schwann, [15 ] ( inos) 1 ( ET-1 ) mrna ( CK ) inos mrna 28 h,ck E T-1 mr NA 2 h inos mrna [ 16 ] 20,, 56 [ 17 ] 3 H, - ( Kd) TNF- IL-1 - ( -MSH ) KPV TNF- IL-1 -MSH KPV [ 18] h 25 ( ADM ) ( ET ), ADM E T, ; ADM 12 h,, 48 h ; E T 6 h,, 48 h ; E T ADM 6 h,, 6 h ET ADM [ 19] * 30,,,, [ 20 ] 126 > 30 % 48 h ( BD ),BD BD 48 h BD,48 h BD,16 24 h, 48 h BD ; 48 h BD, 416 h BD TBSA ; BD,416 h BD [ 21] * , ( SIRS ), [ 22] *,,,,,,,,,,, ( Na mmol/ L ),

33 23 23 ] 40% TBSA 48 h, ( C 2 H 4 C 2 H 6 ) A2 C4 [ 24 ] h, 12 h,, 24 h [ 25 ] (LPS) LPS, LPS [ 26 ] L- ( PMN ) ( PMEC), PMN L- L- PMN PMEC L- PMEC L- PMN PMEC [ 27] PMN -1( ICAM-1) PMN CD 11b / CD h BALF MPO, mr NA, PMN CD 11b / CD 18 PMN ICAM-1 PMN CD11b/ CD18 [ 28 ] ( NO) ( NOS) NO NO 2 - / NO 3 -, NOS L-NAME inos ( AG ), L-NAME ;NOS, L-NAME AG ; inos,, L-NAME AG ;, AG, L-NAME inos NO [ 29 ] 3 H-TdR, ( EBPS ) PMN ( EC), EC PMN PMN EC EC 3 H-TdR EBPS EC PMN, EC PMN, EC, EBPS EC [ 30], ( EDS), VE-, EDS,, EDS [ 31] *, 90 s,, 1 h,,,, ; [32 ] ( NO ) NO, NO [ 33 ] ( [ Ca 2 + ] i) [ Ca 2 + ]i [ 34] ( mtnos ) 30% TBSA, h, Ca 2 + ( [Ca 2 + ] m ) c mtnos [ Ca 2 + ] m mtnos, [ 35 ] Wistar 30% TBSA,, c-fos c-myc mrna c-fos c-myc, c-fos c-myc mrna

34 24 (2002 ) 36 ], [ 37 ] 40% TBSA,,, [ 38 ] 30 %, ICAM-1TNF-mR NA MPO ICAM-1 T NF- mr NA 4 h,8 24 h 96 h ; 96 h 7 d ; MPO 96 h, 7 d, [ 39 ] * -, -, SOD, MDA,, C -, C [ 40 ] ( TR H ) TRH, [ 41 ] TNF IL-6 IL-8 TNF IL-6 IL-8, ( 45 ), ;, IL-6 [ 42] ( ST F ),, ; ST F TNF- IL-1 ST F, [43 ] * [ 12 ml, 500 ml 100 mg 50 mg50 mg ], LPS Th1/ Th2,,,, Th1 48 h [ 44 ] 12 % TBSA T 3 d, ; IL-12 p35 p40 ;, ; T IFN- IL-4 [ 45 ] *, bp 20, 4,, [ 46], ( M) C ( PLC) ( DAG ) Ca 2 + C ( PKC) PKC M TNF M - C M TNF [ 47 ] rhgh IGF-1 ( M ) CD 14 rhgh IGF-1 MCD 14 mrna,, rhgh ( 40 g/ ml) IGF-1 M T NF IL-6 rhgh IGF-1, MCD14 M,,0. 2 mg/ ( kg d) rhgh, M [ 48] CD 3A K, CD3A K, T CD 4,CD 8, CD 4 / CD 8 2, T, NK CD 3A K,, [ 49 ] ( M), M 120 h M, ( ACP ), IL-15 mrna, T NF-mR NA ; [ mg/

35 25 kg d) ]5 d, M ACP,IL- 15 mr NA, TNF-mRNA, ; [ 2. 5 ml/ ( kg d),1 ml 100 mg 100 mg ] 5 d, ACP, IL-5 mr NA, T NF-mRNA, M, [ 50 ] T NK T NK, [ 51] 7,,,,, 4 ( IL-1 IL-6 IL-8 T NF-) ;, IL-1 IL-6 ; 4,, MODS, [ 52 ] * 30 % TBSA, TNFNO E T MDA, ;, ( ) T NF NO E T MDA ( 6 h ) SOD,, 24 h SOD,,,, [ 53 ], %,,,, [54 ] * , G + (52. 17% ) 3,G - ( % ) , , ( MRSA ) 85%, , [ 55 ] , 45 - ( ESBLs ),, -B 45 ESBLs 38, ESBLs 84. 4% [56 ], 504,MRSA 58, 43, MRSA DNA PCR % ( 22/ 41 ) MRSA, 5 MR- SA ;19,3 MRSA, M RSA ; 43 9 MRSA,2 MRSA ; 193 MRSA 13 MRSA DNA PCR, MRSA [ 57 ] 5,,, 10 [58 ] % ;, 30 % 1997 [ 59] * 17 (, 5 d ) (, 1015 d ), 17,

36 26 (2002 ), [60 ] G - ( ) 4 [ ( IMP ) ( CT Z) ( PFX) ( AMN ) ] 4, IMP, CTZ PFX, AMN CTZ > PFX > IMP > AMN ; 0. 5 MIC > 1 MIC > 5 MIC > 10 MIC; 8 h > 6 h > 4 h > 2 h ; ( IMP ), [ 61 ] 30 %,18 IL-18 mrna,, IL-18 mr NA I FN- FasL SOD IL-18 [ 62 ] ( ) JM109 LPS [ 63 ] * ,, ;,, ;,, 89 (54. 9% ), 65 ( 40. 1% ), 8 (5% ), [ 64 ] ( 10% ), ,, ( ) d; , ( ) d; ,(), ( ) d [ 65] 15,, [ 66 ] 13,, 3 [67 ], 119 ( ) % ( ) % ( ) %, ;,, ( ) % ( ) %,,, 19,,,,,,,,, [ 68] *, ( hegf),, ;, [ 69 ] SD- Ag,,,, [ 70 ] ph p H, bfgf [ 71 ],, 200 mg/ kg, [ 72], (110 5 / cm 2 ), 3 d ( / cm 2 ),,

37 27,, [73 ] *,, ( HF-ADM ), BALB/ c-nu ( ), 6 h,, ; 3 d, H F- ADM IL-6 IL-8 TGF- 1 ;,,, [ 74],,, -, [ 75 ] * c-fos c-myc bfgf, C 3 ; c-fos ; C [ 76 ] 3, 128 : [ 77 ] 61 8 ( PCNA ),, [ 78 ] 1,,,, [ 79] CTLA4Ig, SD 1, CT LA4Ig Wistar, CT LA4Ig, CT LA4Ig 7 d, CT LA4Ig [ 80] CT LA4Ig, ( DC ),, DC T ; CT LA4Ig-rA dv DC, DC CD 40 CD 80 CT LA4Ig DC T T, IL-2 ; CTLA4Ig DC CD 80 CT LA4Ig T [ 81 ] *, S-( GSTdecorin) 1 ( TGF- 1 ) GST-decorin TGF- 1, [ 82] 8 h, NF-B, NF-1 50%, DNA RT- PCR, 1 2 mr NA 56% 59% NF-B, NF-1, [83 ] DNA DNA,

38 28 (2002 ) [ 84 ] * ( MODS), 70 % 29, 84. 8% MODS, Goris MODS , MODS MODS, MODS MODS ( r = ) ( nmol/ L) MODS % % % 89. 9% MODS MODS [ 85 ] s, 30%, ( MOF ),48 h,, MOF [86 ] ( TNFR) TNFR1 TNFR2, TNF-, TNF- [ 87] ( ITF ) ITF, 1 ITF,, 7 d 4%, LPS,( PCNA), IT F LPS, PCNA ITF [88 ] 30% 60 % 10 %30% 39, ( Gln,20 ) Gln 0. 5 g/ kg, 7 d,, DAO, C,, [89 ] 30 %, ( SDD ) IL-18 IFN-mR NA,8 h, 24 h, SDD IL-18 IFN-mRNA ; SDD IL- 18 mr NA [ 90] 1( HMG-1 )mrna, HMG-1, 24 h, 72 h / ( rbpi 21 ), HMG-1 mrna, HMG-1 mr NA, HMG-1 mrna HMG-1, HMG-1 [ 91 ] SD 30 %, 9 h, Na + -K + - ATP Ca 2 + -Mg ATP,, ( NO ), NO [ 92] * 1, 30 % TBSA, (20 ng/ ( kgmin), 600 g/ d, 4 d),,,, ( T NF- IL-6 IL-8 ), [93 ] 8, ( REE) 6 ( IL-6) 8 ( IL-8) ( TNF- ) ( LPS ), RE E,REE ; IL-6 IL-8T NF- LPS,, REE IL-6

39 29 TNF- LPS, [94 ] % 35 % REE ( ) kj/ ( kgd) REE 127 ( ) kj/ ( kgd), REE [ 95 ], ( CGRP ) 30 % TBSA Wistar, ( EF,30 ) ( EPN, 30 ), EF EPN ;CGRP, EF CGRP 72 h EPN ; CGRP, EF h EPN ; CGRP, CGRP, CGRP, CG RP [ 96 ] * 24 rhgh, rhgh rhgh, 2,1, 03 d 4 7 d 8 14 d % % % rhgh, 100 % 50 % 0 % rhgh, rhgh, 2 rhgh [97 ], T NF-, 3 d T NF- 6 d 10 d, TNF-,,, [98 ] ( glutamine, Gln ) [ 99 ],, [ 100 ] MCT/ LCT LCT MCT/ LCT LCT,,,, [ 101 ],,,,,, 1,., 2001, 17 (9 ) : 876 2,., 2001, 26 ( 2 ) : 152 3,., 2001, 13 ( 7) : 436 4,., 2001, 17 (2 ) : 93 5,., 2001, 16 (10 ) : *,., 2001, 23 (4 ) :390 7,., 2001, 27 (8 ) : 591 8,., 2001, 23 (3 ) : 358 9,., 2001, 17 (1 ) : 18 10,., 2001, 17 (2 ) : 88 11,., 2001, 17 (2 ) : ,., 2000, 16 (6 ) : ,., 2001, 16 (6 ) : ,., 2001, 17 (5 ) : ,., 2000, 16 (6 ) : ,., 2000, 40 ( 21 ) :16 17,., 2001, 23 (5 ) : ,., 2001, 17 (5 ) : *,., 2001, 22 (2 ) :115 20,.,2000, 20( 6 ) : *,., 2001, 23 (2 ) : *,., 2001, 17 ( 5) : ,., 2001, 17 (5 ) : ,., 2001, 21 (3 ) : ,., 2001, 17 (3 ) : ,., 2001, 17 (4 ) : ,., 2001, 26 ( 5 ) : ,., 2001, 17 (7 ) : ,., 2001, 22 (17 ) : 1607

40 30 (2002 ) 0,., 2001, 23 (2 ) : *,., 2001, 17 ( 5) : ,., 2001,17 ( 5) : ,., 2001, 18 (3 ) :255 34,., 2001, 17 ( 7) : ,., 2001,17 ( 1) : 42 36,., 2001, 23 (4 ) :393 37,., 2001, 23 (1 ) :69 38,., 2001, 26( 7 ) : *,., 2001, 17 ( 1) : 46 40,., 2001, 36 (2 ) :111 41,., 2000, 9( 6 ) : ,., 2001,17 ( 3) : *,., 2001, 17 ( 3) : ,., 2001,17 ( 4) : *,., 2001, 17 ( (5 ) :295 46,., 2000,38 ( 11 ) : ,., 2001,17 ( 3) : ,., 2001,17 ( 3) : ,., 2001,17 ( 3) : ,., 2001,17 ( 5) : ,., 2001,81 ( 15 ) : *,., 2001, 23 (1 ) : 39 53,., 2000,8 ( 6 ) : *,., 2001, 17 ( 2) : 80 55,., 2001,17 ( 2) : 83 56,., 2001,17 ( 2) : 88 57,., 2000, 21 (4 ) :276 58,., 2001, 13 ( 5) : *,., 2000, 20 (6 ) : ,., 2001,17 ( 2) : 75 61,., 2001, 10 (2 ) :93 62,., 2000, 21 (5 ) : *,., 2001, 39 ( 9) : ,., 2001, 15( 3 ) : ,., 2000, 22 (12 ) : ,., 2001,17 ( 1) : 60 67,., 2000,38 ( 10 ) : *,., 2001, 17 ( 1) : 22 69,., 2001, 24 (3 ) :258 70,., 2001, 36 (4 ) :297 71,., 2000, 25( 6 ) : ,., 2001,17 ( 2) : *,., 2001, 17 ( 4) : ,., 2001,17 ( 5) : *,., 2001, 39 ( 9) : ,., 2001,17 ( 6) : ,., 2001, 23 (7 ) :844 78,., 2001, 13 ( 7) : ,., 2001, 23 (7 ) :759 80,., 2001, 23 (7 ) : *,., 2001, 17 ( 6) : ,., 2001, 17 (1 ) : 36 83,., 2001, 17 (4 ) : *,., 2001, 17 ( 3) : ,., 2001, 22 (3 ) : ,., 2001, 21 (1 ) : 1 87,., 2000, 22 (11 ) : ,., 2001, 8( 4 ) : ,., 2001, 9 ( 3) : ,., 2001, 39 (2 ) : ,., 2000, 20 (11 ) : *,., 2001, 39 ( 7) : ,., 2001, 17 (2 ) : 96 94,., 2001, 23 ( 4) : ,., 2001, 17 (4 ) : *,., 2001, 17 ( 4) : ,., 2001, 17 (3 ) : ,., 2001, 17 (4 ) : ,., 2001, 17 (4 ) : ,., 2001, 23 (8 ) : ,., 2001, 8( 3 ) : 157 [, 2001, 23 ( 4 ) : 390 ], 15, A B ( 5 min), A 24 h ;B, 1 h ( 250 ml) h, 24 h,, : PaO2,B PaO2, 26 h, 24 h ;,, / ;,, /

41 31, ( ),,,,,,,, ( ) [, 2001, 22 (2 ) : 115] ,, ; ;, ; :30 ( 372 ) %, ( 27 21) %, ( ) kg ( ) ml, ( ) ml,,,,,,,,,,,,,,,,, x 1 x 2 x 3,,,, [,2001,23( 2) :217 ] 42, , 8 788, 3 780, < 50% TBSA ( % ), > 50 % TSBA ( 8. 97% ), 50% 69 % TBSA 619, 70% 89 % TBSA 306, > 90% TBSA 202, 3, 1 ( , ) 2( , ) 3( , ) 3,, 1 2,3,, ( SIR ),,,,,,,,,,,

42 32 (2002 ),,, ( ) [, 2001, 17 (5 ) : 263],, % 20 %, A ( 174 mmol/ L, 17 ) B ( 130 mmol/ L, 18 ) 15 d / p H,, A 3 d B 2030 ml ;5 d A B,, B ; A 5 d, B ; / ; A B,,,,, ;,,,,, ( Na mmol/ L ) +,,, 24 h 24 h,, 24 h,,,,, [,2001,17 (5 ) :272], SD ( 6 ) ( 8 ) ( 20 ), 30% TBSA,,,, 90 s,, 3 h,, ( 7 ) 1 h,,, 4 /, ; ;,,,,,,,,, - [, 2001, 17 ( 1 ) : 46] - Wistar 56,

43 33 0 % TBSA, (8 ) (16, Parkland, 2 )C ( 16, C ) - (16, -) 1,, h ( SOD ) ( MDA ), : SOD, MDA, -, SOD, MDA,, C :,- ; - C,, ( ),,, ( SOD),, SOD, 20 90, C, ( MT ) C MT C LPS Th1/ Th2 [, 2001, 17 (3) :177] LPS Th1/ Th2 SD 78, ( 6 ) ( A ) ( B ) A B 30% TBSA, A 1% 2 ml/ kg,b, 12 ml [ 100 ml() 50 mg 50 mg/ 500 ml ],, LPS IL-1 IL-1 IL-6 TNF- IL-8 IL-2 IFN- IL-4 IL-10 LPS IL-1 IL-4 IL-10, IL-6TNF- IL-8 IL-2 IFN- A L PS, IL-1 IL-6 IL-4 (6 h ) B ( 12 h ),,,,, Th1,,,,, ( ) [,2001,17 (5 ) :295] F344 35% TBSA,, 4 h 37, RNA mrna, PCR-select cdna,, pgem- T, 20,,,, 20, -mr NA ; ;,, B CD9 4,, F344,

44 34 (2002 ),,,, T,,, ) ( ) [, 2001, 23 ( 1 ) : 39 ] Wistar 130, 30% TBSA ( n = 10) ( n = 50 ) ( n = 50,) ( n = 20, 6 h ) h ( T NF ) ( NO ) ( ET ) ( MDA ) ( SOD ) T NF NO E T MDA, ;, T NFNOET MDA SOD,, 24 h SOD,,,,,,, 1, 48 h ; 6 h,,,,, ( ) [,2001,17 (2 ) :80] , , 1999 G + ( % ) 3 ( P < 0. 01),G - ( % ) 3 ( P < 0. 01) ( P < 0. 01), ( P < 0. 01),( M RSA ) 85%, ( P < 0. 01), ESBS ;90 ; 90, M RSA,,,,,,,,,,,,, MRSA, ;, [,2000, 20 (6 ) : 549] 17 ( EUS ) ( TUC), 17,

45 35 ( P > 0. 05),,,,, 5 d,,,,, 5 d, ( ), ( 5 d) ( 14 d),,,,,,,,,,,,,,, ;,,,,,,, [, 2001, 39( 9) :708], , 3,,,, ( 10 1, 201 ),,,,, 89 ( 54. 9% ), 65 ( % ), 8 (5 % ),,, ( ) 26 47,,,,,, 15,,,,,, hegf [,2001,17( 1) : 22 ], ( hegf ),, ( ) 48, 1 d, 5 cm5 cm 0. 6 mm 4 cm4 cm 4, +, ,,, ;, ( hegf ), hegf

46 36 (2002 ) EGF hegf ( ) - [,2001, 17 (4 ) : 231],, ( H F- ADM )ELISA ( RIA) IL-6 IL-8TGF- 1 BALB/ c- nu ( ), 6 h,, ; 3 d, HF-ADM IL-6 IL-8TGF- 1 ;,,,,,,,,,,, IL-6 IL-8 TGF-, 3 [, 2001,39( 9) :714 ] c-fos c-myc bfgf, C Wistar 188, 30 % TBSA, ( n = 8) ( n = 36) c-fos ( n = 36 ) bfgf ( n = 36) C ( H7 )( n = 36) C ( ) ( n = 36 ) (3 6 h, d), ( RT-PCR ) c-fos c-myc bfgf,, c-fos, bfgf, cmyc, 3 h 1 d 3 d ; c-fos 3, c-myc bfgf 80% 85 % H7 cfos bfgf, c-myc 6 h ; H 7, c-myc 6 h, c-fos bfgf : 3 ; c-fos ; C,, c-myc, c-fos c-jun AP-1,, ( ) 1 [, 2001,17( 6) :330] S- ( GST-decorin ) ( T GF- 1 ), RT-PCR ( decorin ) cdna, pgex4t-1, JM109, GSTdecorin

47 GST-decorin, ( MT T ) ; 2 mg/ L TGF GST-decorin,,, mrna, GSTdecorin ; 2 mg/ L TGF- 1 mrna, GST-decorin TGF- 1 decorin,, decorin TGF- 1 GST-decorin TGF- 1, ( ) TGF- TGF-,, :,,, T GF-, TGF- 2, TGF- 3 TGF- ( ) [, 2001, 17 (3 ) : 142] ( MODS ), 70 % 29, 84. 8%, MODS, Goris MODS, 35,, MODS, , MODS MODS ( P < ), MODS MODS ( r = ), (35. 0 nmol/ L), MODS 81. 1% % % % MODS, MODS, MODS MODS, MODS, MODS,,,,,, ( ) [,2001,39 (7 ) :548],, 1, 30 % TBSA, [20 ng/ ( kgmin), 600 g/ d, 4 d] ( REE) ( TNF-) IL-6 IL-8, :, REE,, REE ( ) J/ ( h m) ;, INF- IL-6 IL-8, RE E ;,,, ;, ;, 3-,, ( TNF- IL-6 IL-8 ),

48 38 (2002 ) ),,,,,,,, [, 2001, 17 (4 ) : 204] 24 ( rhgh ), rhgh, rhgh, rh- GH,, 2, 1, 03 d 47 d 814 d % % % rhgh, 100% 50% 0 rhgh, rhgh rhgh, rhgh,,,, 2, rhgh, 2 rhgh,,, rhgh 2,,,,,,,, ( )

49 39 310, 114, 36. 8% ; 16, 5. 1% ( ), 1971, 11 [ 1], (2223 d) ( GAG )( H A ) GAG HA, 3 d GAG H A 7, GAG H A H A, [ 2] 24,,,, ; 7 d [ 3 ] *,, ELISA, IgG, IgG ;IgG ; 2 IgG ;IgG, [4 ] 6 ( K ) 6 ( HS) 6 1 : HS,K,, Bax/ Bcl-2 ; 1,, HS K, Bax/ Bcl-2 K,, H S, [57] : ;, ; [8 ], ( DC), DC ( H LA )-DR CD 1a, HS HLA-DR CD 1a HLA-DR + DC CD 1a + DC ; 3 d 7 d, HS HLA-DR + DC CD1a + DC HL A-DR CD 1a, HS K ; H LA-DR CD1a HS [ 9 ] 100 U 15,,, - ( P < ),, [10 ] 57 E 2 ( PGE 2 )

50 40 (2002 ) 24 h, PGE 2 mrna PGE2 [11 ] 3T3,, [12 ] SD, A B C D, 5, 1 4,4 7,7 10, X, 6 Gy, , X 7 d, 713, 1 ( ),,, [13 ] ( PGA ), 37 PGA, 10 d,,,,, 10 d, ( ) %, ( ) g/ ( cm 2 min ), PGA + [14 ],, 3 d,,,,,,,,,, [ 15 ] * ( 1 ) (2 ) (3 ) ( 4 ), 2 4, 10, HLA-1 involucrin Laminin 4, [16 ], Pluronic F127, / ml,, / ml,,, ;,,, / ml ( ), [ 17 ] 10 ( 20 ), :, ( ) cm, ( ) cm, ( ) cm, ( ) mm ;, ;,,;, [18 ] 30 8,,,, 3/ 4, 8 cm [ 19] 15 15,,,, 1. 0 mm [ 20] * 20 40,, : T cm,,

51 41 T 8, 68 ( ) [ 21 ] * -, E 1 ( PGE 1 ) 32 4, : PGE1 -, D, PGE1 PGE 1 [22 ] 9, 20, 15, 5, 2, ;20, ; 48,, [ 23 ], 18 SD 3 : 12, :,,, [24 ] 12, ( bfgf ), 7 d, : bfgf, : bfgf 125 AU,250 AU, bfgf,, [ 25 ] 7 7, ( 10 % ),, 130% 180 %, [26 ] 4 3,, :,,, [ 27],,, 30 g/ L 80 g/ L,,, ;, [ 28 ] ( 24 ) 11, 1, 1, 2, 4,3,0. 53, [ 29] ,98, 6. 23%, 5, %, [ 30 ] *,, 3, 15, 23 cm11 cm, 10 cm6 cm, , [ 31 ],,, cm17 cm,, [32 ],,,,, 4, [ 33 ],

52 42 (2002 ), 12 cm7 cm, 5 cm5 cm,, [ 34 ] 160, 10,6. 3 % 10 cm14 cm 12 cm18 cm,, 1, ( ), [35 ] - X,,, Ti +,100 m T i + [ 36] MS-1,15 1, mm,, 3,, [ 37 ] CT,, 45, 5 %, %, [ 38] 59, 2 cm, 0. 6 cm,0. 8 cm,16,4 V- Y,, [39 ] * ( medpor) 6, medpor,, 3 1,, medpor [40 ] 56, medpor , %, 1 1, medpor, [41 ] 34,,, 0.55,, ( ), [ 42 ] [ ( ) mm ], [ ( ) mm] ;11 ( ) 14, 10 6, 13,,, [ 43 ] 34, 7, 6 2,, [44 ] 10, 5, 5, 13,,,,, 20% 40 %,, [ 45] 5,, cm13. 5 cm, 9 cm11 cm, [ 46 ],, 18,,,,, [ 47] 13, 1, 3, 1, cm1. 2 cm10. 0 cm5. 0 cm, 58 cm,10 6

53 43 2,,,, [48 ] 30,, 12, 1. 0 cm1. 5 cm, 3. 5 cm2. 5 cm, 1,, 11, 2 4,, [ 49 ],, 3,, [ 50],, 7, 4. 0 cm2. 4 cm, 2. 0 cm1. 8 cm, 12,,, Medpor, [ 51 ] * 12,, Medpor, 312,,, [52 ] :, Millard C,, 50, 112, [ 53], :, ;,, M + T, 12,,, [ 54] Millard,,, 30, 3 3, , [ 55 ] ( 210 ) 15,, 100 %, 8 618,,, [ 56 ],12,,,12, 612, [ 57] 22,, 20, 2 ;,,, [ 58 ],,, 8 cm7 cm, 4 cm3 cm, 57 d, 23 47, ,,, [59 ],,,, 63 69, 1, 128,, [ 60],, 10 14,,3. 0 cm2. 5 cm, 2. 0 cm 1. 5 cm,, [ 61 ] * 16, :, 8 ;, 6,, [62 ]

54 44 (2002 ), 6,,, [ 63] 5,, 6 1,, 12 S 2,6 S2 ( + ),1 S3, [64 65 ], 7 16, [ 66 ], 6,,,,,,,, [ 67] 10, 23, [ 68 ], 4, 2, 10 cm12 cm12 cm35 cm,, 9 [69 ] 126, 1,, 1, 3,,,, [ 70] ( ) 8, 3, 11,, [ 71],, 16, 3 2,, [ 72],, ;,,, 33, 51, 20 80, 20,, 100, ( ),, [ 73],,,, SMAS 100,, [ 74], 10,,, [75 ] * 62, 30,,, [ 76 ],, SMAS ;, SMAS 48, 37, 8, 3 ;, A (BOTOX ) [ 77] * 1 000, 1. 5 ml 5 U BOT OX, 36, , 3, [ 78] XH, 32, 7 15 d,,13, ( ), [ 79 ] *

55 45, 28 56, [ 80],,, ,, [81 ] * 20,,,,, 204, 2 2, 40 [ 82 ] CO2 495, 30, 15, 39, 60, [83 ] * 7,,,,, 79, ,,, [ 84 ] 18, 5,, [85 ] 536,,,, [ 86],, ; 26, ( ),, [ 87 ],, 150,, mm, [ 88 ], ; ; 68 ;, [8991 ] , [ 92 ] 49,, 39, ( ), 20 [ 93] *,,,, 17 34, ,,, [94 ],, [95 ],,, 29, [ 96 ], ,3 4 1, [ 97 ], 24 cm,, 8 15,,, ( ), [ 98 ] *, 10 ml, 2,1,

56 46 (2002 ) 4, 35, %, % 1, 1 [ ] (),, :,, ; ( r = 0/ 0) h, 0, [101 ], 16, ml, ;,,, [102105],,, 1 294,,, [ 106 ],, [107 ] 1 ( 18 cm24 cm), H b,,: [ ] VPW 532 nm 126, 34, 286,, [ 111] *,,,, 35, 36,,, [112 ], 8, [ ], : ( 9. 36/ min ) ; 99m Tc-Dextrand ; :TGF- 1 ; ; mrna TGF- 1, mrna ( ) 1,., 2001, 17 (1 ) : 31 2,., 2001, 17 (4 ) : *,., 2001, 17 (1 ) :28 4,., 2001, 17 (5 ) : 279 5,., 2001, 17 (2 ) : 93 6,., 2001, 7 ( 2) : 83 7,., 2001, 17 (2 ) : 96 8,., 2001, 17 (5 ) : 282 9,., 2000, 6 ( 6) : ,.,2001, 12( 1 ) : 35 11,., 2000, 6 ( 6) : ,.,2000, 11( 6 ) : ,.,2001, 15( 2 ) : ,.,2001, 15( 2 ) : *,., 2001, 17 (4 ) :230 16,., 2001, 17 (5 ) : ,., 2001, 17 (5 ) : ,., 2001, 19 ( 1) : 38 19,.,2001, 7 (4 ) : *,., 2001, 15( 2 ) : *,., 2001, 7 (5 ) : ,., 2001, 17 (2 ) : ,.,2000, 11( 6 ) : ,., 2001, 22 (15 ) : ,., 2001, 7 ( 1) : 4 26,., 2001, 7 ( 1) : 13 27,., 2001, 7 ( 1) : 10 28,., 2001, 25 ( 8) : 700

57 47 9,., 2001, 7 ( 1) : 7 30 *,., 2000, 14 (6 ) : ,., 2001, 17 (5 ) :264 32,., 2001, 17 (5 ) :261 33,., 2001, 17 (2 ) :72 34,., 2001, 15( 4 ) : ,., 2001, 17 (4 ) :236 36,., 2001, 17 (2 ) :90 37,., 2001, 17 (2 ) :80 38,., 2001, 17 (2 ) : *,., 2000, 11 (6 ) : ,., 2001, 12( 1 ) : 19 41,., 2001, 17 (5 ) :294 42,., 2001, 17 (3 ) :161 43,., 2001, 7 (5 ) : ,., 2000, 16 (6 ) :340 45,., 2001, 17 (5 ) :318 46,., 2000, 6 ( 6) : ,., 2001, 15( 1 ) : 36 48,., 2001, 7 ( 2) : 74 49,., 2001, 17 (2 ) :69 50,., 2001, 17 (5 ) : *,., 2001, 17 (5 ) : ,., 2001, 17 (5 ) :292 53,., 2001, 21 (4 ) :282 54,., 2001, 17 (1 ) :48 55,., 2001,39 ( 5) : ,., 2001, 15( 1 ) : 64 57,., 2001, 17 (3 ) :146 58,., 2001, 15( 4 ) : ,., 2001, 17 (2 ) :78 60,., 2001, 17 (5 ) : *,., 2001, 17 (4 ) : ,., 2001, 17 (2 ) :75 63,., 2001, 12( 4 ) : ,., 2000, 16 (6 ) :368 65,., 2001, 12( 2 ) : 79 66,., 2001, 17 (4 ) :212 67,., 2001, 17 (4 ) :209 68,., 2001,39 ( 4) : ,., 2001, 24 (3 ) :170 70,., 2001, 17 (3 ) :170 71,., 2001, 17 (3 ) :144 72,., 2000, 14( 6 ) : ,., 2000, 16 (6 ) :336 74,., 2001, 12( 4 ) : *,., 2001, 12 (1 ) : 2 76.,2001, 12( 1 ) : *., 2001, 12( 4 ) : ,., 2001, 12( 1 ) : *,., 2001, 12( 2 ) : 86 80,.,2000, 11( 6 ) : *,., 2000, 6 ( 6) : ,., 2001, 7 ( 2) : *,., 2001, 12( 2 ) : 82 84,.,2001, 12( 4 ) : , 2001, 12( 4 ) : ,.,2001, 12( 4 ) : ,.,2000, 11( 6 ) : ,., 2001, 17 (5 ) : ,.,2000, 11( 6 ) : ,.,2000, 11( 6 ) : ,.,2001, 7 (4 ) :211 92,., 2001, 17 (3 ) : *,., 2001, 17 (1 ) :40 94,., 2000, 16 (6 ) : ,., 2001, 17 (4 ) : ,.,2001, 12( 2 ) : 66 97,., 2001, 17 (4 ) : *,., 2001, 12( 2 ) : 69 99,.,2001, 12( 2 ) : ,.,2001, 12( 2 ) : ,.,2000, 11( 6 ) : ,.,2001, 12( 2 ) : ,.,2001, 12( 1 ) : ,.,2001, 12( 2 ) : ,.,2000, 11( 6 ) : ,.,2001, 15( 1 ) : ,., 2001, 17 (1 ) : ,.,2000, 11( 6 ) : ,.,2001, 12( 3 ) : ,., 2001, 17 (1 ) : *,., 2001, 12( 1 ) : ,., 2001, 17 (5 ) : ,.,2000, 20( 6 ) : ,., 2000, 16 (6 ) : 354 IgG [,2001,17 (1) :28], IgG 1. 5 cm, 6-0,, IgG, ELISA,

58 48 (2002 ) 2328 d), IgG, IgG ( P < 0. 01) ;( 16 d) IgG ( d ), 1 2 ( P < ), ; 2 IgG ( P < ), ; IgG,,,, IgG,,, ( ) 1971 Burrington, IgG, :, [,2001, 17 (4 ) : 230 ] 48, 4, cm 1. 5 cm, ( 1, n = 10) ( 2, n = 10 ) ( 3, n = 10) ( 4, n = 10 ),, ,, ( 2 4 ), 10 d, HLA-1 involucrin,involucrin,, Laminin 4,,,,, [,2001,15( 2) : 86] 20 40, 4,,,, T cm,,,, T 68, :, ; 6 7 8, T 68,,, 68,,,,, T 68, E 1 [, 2001, 7 ( 5 ) : 258 ] E 1 ( PGE 1 ) - 3 cm5 cm, 6 h, - 32 Wistar 4 : A ; B PGE 1 ;C PGE1 ;D,, ( LDH )

59 49 D CD) ( MDA ), E 1 - ( P < 0. 01), - D ( P < ), ( P < 0. 05) E 1 E1 E 1 -,, PGE 1, - ( ), -, PGE 1 - PGE1 PGE1, [, 2000, 14( 6) :350] 1994, 18 3, 15 ;,,,, 0. 5 cm,,,,,, 2 4 cm23 cm11 cm, 10 cm 6 cm, 3 2,,,,,,,, 1975 Daniel, ( ),,,,,,,,, 6 [, 2000, 11 (6 ) :281] ( medpor ) , 6, 4, 2 4, 2,,, 5 cm 6 cm,9 cm10 cm, ( ) Medpor,, Medpor,, Medpor,,,, 3 1, Medpor, Medpor, : ; ; ; X CTM RI,,,,,,, Medpor [, 2001, 17 ( 5 ) :297 ] Medpor, Medpor : ; Medpor, 2 cm, 58 cm (4,8, 633 ),,,,,

60 50 (2002 ), 312,, : ; ; ; ; ( ),,, Medpor,,,, [,2001,17(4 ) : 201 ] 16 -,, X,24 : ; 1999, 14 ( 8, 6 ), 9, 3, 2,,,,,,, [, 2001, 12 (1) :2], 4,,, cm30,,,, 62, 2255, 12, 7, 22,10,11 10, 1, ( 90. 4% ) 5 ( 8% ),, d, 10 d,, ,,,, ;, ; SMAS-,,,, A 1 000[,2001,12(4 ) : 179 ] ( BOT OX),, 1. 5 ml 55 U,, 1 ml,18, BOTOX 24 h,,, 36, 1025 U ; 34, 1020 U ; 2 3,712 U1996, 1 000, 235, 380, 350, 35, 36, 610,1,3, ( BOTOX), BOT OX -

61 51, 36 :,, ( ) [,2001,12 (2 ) : 86 ], 28, 56, 3 : ; 3 6 ; 10 20,, 72, 20, 10, H E ; : ( ) ;,,,,,,,,,,, [,2000,6 (6) :284] 20, 1 mm, 23,, 3 10 mm,,,,,,, 15 mm, 12 mm, , 204, 5, ;2 2,, 40,,,,,,,,,,, [, 2001, 12( 2) :82] 7,,,, -,, ;,,,,,,,,,,, , 79, 65, 624,, 50 %, > 70%,,,,,