,,,,,,,,,,,,,,,,,,,,,,, 2007 12
1 19 ( F Nightingal) 1854 1856,, 42%, 38, 2%,, 70,, ICU,,,,,,,,,,, 50,,, 1957 1962 1974 ( ), 1980 1982 3 10,, 1983, 1983 1985 1986 1992, 6 :,,, ICU,,,,
2,,,,,,,,,, ICU,,,,, :, ( ) :,, ( BLS) ( BTLS) BLS BTLS :,, 90,,,
3,,,,,,,,,,,,,,,,,,,,,,,,,,,,
4,, 1,,,,,, 2,,,,, 3,,,, 4,,,,,,, 5,,, 6,, 1 2,,,, 3,,, 4,, 5,, 6, > 90% 7,, 8, 9, 10,,
5,,, 1987 10000, 53 5%,, 42 7% 32 3%, 69 4 %, 4 6%, 2 7% 1993 1814, 81 64%, 13 89%, 10%, 1 65 %,,,,,,,,,,, 1990 10, 21636, 4414,, ( ) 1 20 50 70 50,,,,,,,,
6,,,,,,,,, 2 20 80,,, 3 20 80 90,, 120, 1998, 70 2000, ( ) 1 60 1968, 1973,, 911 2., 911, 3,, ;,,,, 3. 70,, 4 : ICU ( ) 1977, ICU, 000,, 4. 1956,, Crara Claude Berard, Mollaret ICU, 1965 15,,,,, ( )
7, : ( ) :,, 10%, < 5%,,, 90%, ( ),,,, ( ),, ( ) 3 ( ) ; ( ) ( ) EMSS ; ( ), ( ) ( ),, ( ),,,,,,, : ( ),,,,,,,,,,,,,,,, ( ) 120,
8, ( ) ( ), ( ), ( ), ( ),,, 24 ( ),,,,,,,,,,, ( ),,,,,,,,,,,,,,,,,,, ( ),,,, 1. 5 2 1 2, 1, :
9,,,, ( ) 1.,,, 1 ; 3, 10 15 20 2., 3.,, 4.,,, ( ),,,, 1 : / ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; 2 ( ) ( 1) : : ; ; ; ; ; ; ; ; ; ; ; ; ; ; : ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; 20% ; ; 10% ; 5 % ; ; 50% ; 25 % ; 10% ( 2 ) : ( 30ml ) ;, : ( 3 ) : ; ; ( 4 ) : ; ; ; ; ; ( 5 ) : ; ; ; ; ; ; ; 1 # ; ; ; ; ; ( 6 ) :,,,,,,, ( ),
10, : 1. 2. 3. 4., :,, ( ),,,,,, :,,, 1. ( 1 ) :,,,, ( 2 ) :, ( 3 ) : ( 4 ) :,,, ( 5 ) :,,,,,, 2. ( 1 ) : ( 2 ) : ( 3 ) :,,
11 ( 4 ) :,, ( 5 ) :,, ( 6 ) :,, 3.,,, /, 4.,,,,, 5.,,,, 6., 7.,, 8. ( 1 ) :,, ( 2 ) :,,, : :, :,, :,, ( ),, 1.,, :,, 2.,,,,,, 3.,,,,,,,,
12,, ( ) 1. ( 1 ) :,, : 1 ) :,,,,,,, 2 ) :,,,,,, 3 ) :,,,,,,, ( 2 ) :,, 1 ) :, 2 ) :,,,,,, 3 ) :,,,, 4 ) :,, 2., ( 1 ) :,,, ( 2) :,,,, :,,, ( 3 ) :,,,,,,,,,
13 ( 4 ) :,,,,,,,, ( )
14,,,,,,,, X,,,,,,,,,,, ( ),, ( ), ; ;, ( ),, 20m 2,, ( ), ( ), ( ),,,, 2, 24m 2,,,, :,,,,
15,, 5% 20 %,,, ( ) 12 m 2 1 : 70% 2 5%, 1, 1 1 2 : 3 : 120 150, 15 20 1 ( ) 3,,, ( ),, 1,,, ( ),, ( ),, 1,,, 2, 3 ( ) ( ) 1. ( 1 ),,, ( 2 ),,,, ( 3 ),,, ( 4 ),,,
16,,,, ( 5 ),,, ( 6 ), 2. ( 1 ) ( 2 ),,, ( 3 ),,, ( 4 ),, ( 5 ),, ( 6 ), > 90 % ( 7 ),, ( 8 ), ( 9 ), ( 10),, ( ) ( ) 1. ( ) ( 1 ), ( 2 ),,, ( 3 ),, ( 4 ),, ( 5 ), ( 6 ),, ( 7 ) ( 8 ),, 2. ( )
17 ( 1 ) ( 2 ),, ( 3 ),,,,, ( 4 ),, ( 5 ),,,, ( 6 ),,,, ( 7 ) ( 8 ) 3. ( 1 ) 24, ( 2 ),, ( T P Bp ),,, ( 3 ) 6, ( 4 ),,,,, ( 5 ),,,,, ( 6 ), ( ),, 4 ( 1 ) ( 2 ), ( 3 ), ( ),,,, ( 4 ), ( 5 ),,
18 ( 6), ( ),, ( 7 ),, 5. ( 1 ), ;,, ; ( 2 ),,,, ( 3 ),,,, ( 4 ),,,,,, ( 5 ),,, ICU ( 6 ) 6. ( 1 ) ( 2 ),, ( 3 ), ( 4 ),,,,, ( 5 ),, :, ( 6 ), ( 7 ), ( 8 ), ( 9 ) ( 10),, ( 11),, 7. ( 1 ), ( 2 ),,,
19 ( 3 ),,,,, ( 4 ),,, ( 5 ) 3 5,,,, 8. ( 1 ) 1 ( 2 ),,,, ( 3 ),,,, ( 4),, ( ), ( 5), ( ), 9. ( 1 ),, ( 2 ),, ( 3 ),, ( 4 ),, ( 5 ),, 10. ( 1 ), ( 2 ), ( 3 ) 11. ( 1 ), ( 2 ) ( 3 ),,
20 ( 4 ), ( 5 ) ( ) : ( ) ; ( ) ; ( ) ( ), :,,,,,, : ( ) 1,,, 2, 3,,,,, 4, 5,, ( ) 1 ( 1 ) ( 2 ) ( 3 ) ( 4 ), ( ) 38 ( 5 ) ( 6 ) : ( 7 ) : ( 8 )
21 ( 9 ), ( 10) ( 11) 2 ( 1 ) ( 2 ),, ( 3 ) ( ) ( 4 ), 3 ( 1 ) : ( 2 ) : ( 3 ) : ( 4 ) : ( 5 ) 4, : ( 1 ) ( 2 ) ( 3 ) 5 ( 1 ) : ( 2 ) ( 3 ) : ( 4 ) 6 7 ( )
22,,, ( ),,,,,,,,,,,, 5 10 min,,,,, ( ) 1 SOAP Larry Weed SOAP, : 4 S( Subjective ) : O( Objective ) : A( Assess ) : P( Plan ) : SOAP,,
23 2 PQRST, PQRST, 5, 5, P( Provokes, ) :??? Q( Quality, ) :?? R( Radiates, ) :?? S( Severity, ) :? 1 10,? T( Time, ) :???? ( ) 1 ( 1 ) :,,,, ( 2 ) :,,, ( 3 ) : ( 4 ) :,,, ( 5 ) :, ;,,, ( 6 ) :, 2 ( 1 ) : ( 2 ) : ( 3 ) : AVPU,, ( 4 ) : ( 5 ) 1 ), 2 ) 3 ), 4 ), 5 ),
24 3,, :,,,,,,,,, :,, 36,, :, :,,,, 1.,,, 2.,, 3.,, 4. ( ),,,,,,, ( ) 1,,? 2, 3, ;,,, ;,
25 4 5:,, ( ),,,,,,,,, ( ) 1,,,,,, ;,, ;,, ;,, ;, ;, 2,, ;, ;,,,, ;, 3 4 5, ;, ;, : 6, ;, ;, ;, ; 7, ;, ; ; 8,,,
26 9,,, 10 ( Glasgow), 15, 14, 7, 3 ( ),,,,,,,,, ( ) 1 2 3 4 5 6 7,, ;, ; ( ) 1 : 2:, 3 :,, 4, ( ) 1, 2, 3 4 5, 6
27 7 ( ),,, ( ),,,,,,, :,,, :,,,,, :, ; :,,,, X :,,,,,, ( ),,,,,,,,,, ( ) 1 2 3,
28 4 5 6 ( ) 1 2 ( ) 1, 2 3 ( ),,,,, ;,, ; ; ; ( ) ( ),, ( ),,,,,,, ( ),,,,,, ;,,,,,,,, 1,, ; ;,
29, 2 ; ; ; ;,,,, 3 ; 1 2 ; 4 ; ;, 5 ( 1 ), ( 2 ) ( 3 ) 6 7, ;, ; 8, ; ; ;, 9, : ( 1 ) :, ( 2 ) : ( 3 ) :,,,, 10, ;,, ; ( )
30,,,,, ( ) ( ) 1 2 3,,,,, ( ), ( ),, 1, - 2,
31,,, 3, ( ),,,, 4, ( ) 1 X,, 2,, 1, 2,, ( ),, : ( ), ( ), 1. 33 kpa( 10 mmhg) (,, ),, 15 20 min ( ), 45min, 15min,, ( ) ( 10 20ml /min 6 8ml / min ) 30% 40%,, 20, 70% 80%,, 20% 30%,,,,, 95% 5ml,, 20% 40%,, ( ) 5 10mg,, 15, 2 3 ( ) 20 40 mg, 2, 10, 3 4, 4 1,, ( ), (
32 ), : 12. 5 25 g/ min,, 50 100 g / min, 100mmHg,, 4 8 : 10 g / min, 10 1, 5 10 g / min, 50 100 g/ min, ( ) 0. 4 0. 8 mg, 2 0. 2 0. 4mg 24 ( ), 0. 25g 25% 40 ml, ( ),, 300 500ml, ( ),,,, ( ),,, ( ) 1,,,,, ( ),,,,,,,, 2 ;, ;, 3.,,,,, ( ) 1,,,, 2,,,,
33 3,, : < 40 / min > 130 / min; ; ; 4,,,,,,,, 5,,,,,,,,, :,,, ; ; 24, 7 10,, : :, 1,,, ;,, 2, ( ),,,,,, ( ) ; ( ) ; -,
34 O 2 CO 2, / ( ),,,, O 2 CO 2 ( ) 4L/ min, 5L / min, ( V) / ( Q) = 0. 8, V /Q > 0. 8,, V / Q < 0. 8, O 2 CO 2, / O 2, CO 2 ( ) -,,,, 1 /20,, ( ), 1 2 3 4 5 6 ( ) 1 ( 1) :, 30ml / ( min kg), 6 :, ;, ;, ( 2 ) : ( 3 ) : PaO 2, ( ),
35, ( -, Cheyne-Stokes respiration) (, Biot) ( 4 ) :,, DIC ( 5 ) :,, ( 6 ) :,,,, ( 7 ) : 2 ( 1 ) :,,, ( 2 ), H + K +, K +, H + Na +, K + Cl _, + ( 3 ) :,,,,,,,,, ( 4 ) : < 15 %, 0. 13kPa( 1mmHg), 2L, ( ) 1, PaO 2 PaCO 2 < 7 98kPa ( 60mmHg), PaCO 2 < 7 98kPa( 60mmHg) ; PaCO 2 > 6 67kPa ( 50mmHg) > 6 67 kpa( 50mmHg), ph, PaCO 2 ph, ; PaCO 2 ph < 7. 35, 2,,, ( VC) ( FVC) 1 ( FEV 1 ) ( PEF),, 3 X CT /, ( ) : 1,,,,
36 2 ( PaO 2 ) 8kPa, ( PaCO 2 ) 6. 7 kpa : 1, 2 1, 2 3 4 5 6,, CO 2,, : ( ),,,,,,,,,, ( ),,, ( ),, ( ) ( membrane lung),,,, ( ) ( ), ARDS,,, ( ),,,
37,, ICU,,, ( MODS) ( ) 1, 2,, 3,,,,,, 4,, 5, 6, 7 8,, ( ) 1,,, ( 1 ) :,,,,,,, ( 2 ) ( ) :,,,,, ( 3 ) :,, 30 60,, ( 4 ) :,, 12,,, ( 5 ) :, 2,,,, 3, 24 500ml,,,,
38,, 4,,,,,,, 5 ( ),,, 6, 7,,,,,,,,,, 1 2,, ;,,,,,,,,,,,, 15, 8,, 9,,,,,,,,,, ;,,,,, ;,,, 10,,,,,,,,,, 160 480 U, 16 24 U,, 11,, CO 2,, ph < 7. 20,
39 5%,, PaCO 2,,, 12.,,,,,,,,,,,, 13,,,,,,,,,, ;, ;, ;,,,, ( acute renal failure),,,,, 40% 50% 10,,, ( ) ;, 3 : ( ) 1,, : ( ) ( ) ( ) ( ),,,,
40,,, 2 ; ; ; ;,, 3,,,,,,,,,, ( ), : 1,,,,,,,, 2,,,,,,, 3,,, 50 %,, -,,,,,,,,,, -, A 2 4,,,,,, ( ) :
41 1 ( 1 ) : ; ( ), ( ), ( ), 3 ( ) ( 2 ) : 2, ( 1 ) : ( 40% ) ( ) ( 2 ) : 25% 26%, ( 3 ) : 90%, ( 4 ) : 25%, DIC ( 5 ) :, 3 ( ), ( ) ( ) ( ),, 1 12, 6 62 400 ml 17ml, 50ml, 50 100ml, < 1. 018, > 40 mmol / L, < 350mOsm /kg, Cr / Cr < 20, / < 1 1, FE-Na > 20%,, ( 1 ) : ( 2 ) : H +, 3 4 : ( Kussamaul) ( 3 ) 1 ) :,,,,, 0. 7mmol / L, :,,,,,,,, T, Q-T, S- T, P-R,
42 2 ) : 130mmol /L, : ; ;, ;,,, 3 ) :, 60% 80%,,,,,,,,, 4 ) :,, 3mmol / L,, 5 ) :,,,,,,,, 30 % 70%, ARF 2, 500ml, 1500 2000ml,,,,, 2 3,, 3 5 60,,, 25% 50 %,, : > 500ml / < 1 1,,, ( ) 1 + + +, ( ),, ( 1. 010 1. 015), ( > 30mmol / dl), 2, 10. 0 10 9 20. 0 10 9 /L,,,, ph
43 3 X : :, : 4 B, 5, 1 2 3 4 5 ( ),,,,,,,,, ( ) 1,,, ATP A C, ATP-MgCl 2 ATP ARF,,,, 2,,,,,, 30 60 500 1000ml, 30ml 2, 0. 49 kpa( 5cmH 2 O) 0. 98kPa( 10cmH 2 O), 3 :,,
44,,,,,, CVP CVP < 17ml, 20% 100 200ml, 30ml 2, 4 8 1 1, 1,, CVP,, :,,,,, ATN,, 200 500 mg,, 2, 200mg,,,,, 250 mg, 4,,,, ( 1 ) :, Graziani ( 1984) 24, 3 g / kg 10 15 mg / kg, 19 6 24 11 7ml 85 15ml : 10 20mg 500mg 100 200ml 1, 2 4 ( 2 ) :,,, ( 40 80mg) 40, 95 %,, 10 20mg ( 3 ) :,,, ( 4 ) :,,, 8ng /kg, 654-2( 10 20mg) ( 90mg) ( 1g) ( ),,,
45 1 > 1045kJ, 100 g, < 0. 6 g/ kg, 1 /3 1 /2,, 2,, 1 ( ) 300 500ml 1 1. 2ml / kg: ( 1 ) 0. 3 0. 5 kg, 140 150mmol / L,, ( 2 ), < 140mmol /L,,, ( 3 ) > 1kg, > 145mmol /L,,, 3 ( 1 ) :,,,, : 10 % 20ml, 5% 200ml, 10% 500ml 12 U 4 6, ( 2 ) :,,, ( 3 ) :,,,,, HCO - 3 15mmol / L, 5%, 100ml,,,,, 10% 10 20ml ( 4 ) :,,, 30ml, 3 4,, 5,,, 6, 80 100g /L,
46, ( ), 7,,, : ; ; ;, ( ),,, 2 500ml /d,,,,,,, ( ),, ( ) 1,, 2,, 0. 55 0. 6g, 1. 0 1. 2 g;, ;, 1 2g 3 ( 1 ), 1 ( 2 ) 1 ( 3 ) 1, 2 2 1 ( 4 ),,,,, ( 5 ), 4, ( ) 1,,,, 2,,,
47 3, 24,,, 1,, : 0. 2 0. 5kg 130mmol /L( 130mEq / L), > 1kPa ( 10cmH 2 O), 4,,,, 5,,,,, ( ) 1,,,,,, 2,,,,, 5. 5 mmol / L,,, 3,,, 4,,,, 5,,, ( ) 1 ( 1 ) 1 ),,,, 2 ) : EKG ( / ) Na + K + Cl - Ca 2 + P 3-3 ) :, - -
48 4 ),, 5 ) 6 ) ( 2 ) 1 ) 1 2 ),, 3 ) : ( ),,, 4 ), ( ) 5 ),,, 6 ),, 7 ),, ( 3 ) 1 ), 2 ) K + Na + Cl 3 ),, 4 ) 8, 5 ), 6 ) 7 ),, 1g, 50%, 146J / kg 8 ) 2 ( 1) : : 1 1 1 1 1 1 1 1, : 2 6 6 6 4 4, 1 1 50 ml 1 2 1 1 1, 1 1 1 1000ml 2 3 2% 50ml 1 10ml 1 5 ml 1 ( 2 ) 1 ),,
49 2 ) 3 ) 4 ), ( 3 ) 1 ) 2 ) 3 ) 4 ) 1 /3,,,,, 5 ), ( 4 ) 1 ), 2 ),, 3 ), 1000 2000ml, 4 6, 30 60,, 4 ) 5 ) 6 ), 7 ) 37 38,, 8 ) 24, 9 ) 10),, 11), 12),,,,,, ( )
50 ( acute liver failure, ALF),,, ( fulminant hepatic failure, FHF) ( subfulminant hepatic failure, SHF) ALF, 80%,, 60% ALF,,, : : ALF,, ( ) FHF SHF : 10 2, 2 FHF, 2 SHF; 8 : FHF SHF, : ALF,,,, ( ) 1,, ( HAV) ( HBV) ( HEV), ( HCMV) Epstein-Barr( EB) ( HSV) ( Coxs. V) B ( ECHO) 2 AHF,,, ( ) AHF AHF ( paracetamol) ( phenytoin), ( halothane) ( dichlorpropane ) AHF 3 AHF :, ;, 4, MSOF, ATP,, ATP 17. 2%, 43. 4%, MSOF, MSOF
51 5 AHF :, Wilson Budd-Chiari ( ),,,,, ( ), ( ), 2 1. AHF,,,, 2 AHF 3 50 % 80%,,, 4 DIC,, 5 ALF,, ALF, 6 ( ) 1 2, 171 mo1 / L 17 mo1 / L,,,, 3 : :,, < 2. 22mmol / L :,, < 2mmol / L 4,, 5,, ALF DIC DIC, > 15, < 1. 25g /L, < 50 10 9 / L
52 ( ) 1, 20% 30 %, : -, ;, ; ; ;, 2 ( 1 ) : 80 10 9 /L, 57 10 9 /L 98 10 9 / L, ADP, : ; ; ( 2 ) :,,,, 2h,,,,, ( 3) /,, : ; ; 3 : ; ; ; Kupffer 4,, ; HF, 5 ( ABD),, ph HF,,,,, ( ),
53 ( triple acidbase disorder, TABD) HF ABD 6 40%, < 2. 2mmol / L,,,, 7,,, ( ) :, ; ;,, K ;,,, : ; 1, 2 4,,, 5 10,, 1 2 3 4 5, : ;,, ; ; ; ; ; DIC ; ( ), 5026 6702KJ,,,, 1500ml1000 1200 ml 3 5,, ( ) : 3 10 6 U,, 7 10 10mg /kg,, 7, 5mg / kg, 18 21
54 ( ) - ( G-T), : 1 2mg, 10 20U 10% 500ml, 1, 10 14 ( ) BCAA /AAA( ),, : 6-520, 250 500ml, 10%, 14-800, ( ) ;,,,,,,,, ( ),, 20mg 10 %, 10 60,, 10 15mg, 1 5 10mg, 3 5,,, ( ) E( PGE), camp / cgmp,,, : PGE 1 50 150 g, 10% 250 500ml, 2 3, 10 30, ( ), ( ),,, 3 5,,,,, 4 8g, 2 ( ) ( ) ( ) ( ) ( ) ;, ; H 2 ( ),, 1 654-2 40 80mg 250 500mg, 1 2 0. 6 1. 2mg, 1 2 654-2 2 1mg /kg, 2,, 1 2,,
55, 3 5 8mg/ kg, 300mg,, DIC, 4,,, 10 25g,,, 5, 1, 5 10ml / kg ( ),,,,,,, 1500 ml ; ( 29 % 33% ) ; 10 30 ( 0. 8kPa), ;,, ;, 1 2g /kg, 4 6 1 ( ) ( VIP),, ( VIP),, ARDS PEEP, 10% 250 ml 10mg( 20mg) A-V, ( ),,,,, ( ) - Wilson,, ( ) 1974,,,,,,,, ( ), 1d 1 2L ( 5L), 1, 2 5 Pa, ( ),,,,,,
56,,,,, AHF ( ) AHF,,,, ( ) ( ) 1, 2,,,,, 3,, 420 840KJ 4 ( 10mg / ) ( 25mg /, 60 ),, 1%, 5,, 6 ( ) 1, GPT,,,,, 2 ( 1 ) :, 4, 1 2, 15 20 g/ d -,,,,, ( 2 ) ( G-I) :,, 1mg 10U, 10 % 250 500 ml, 1 2,, ( 3 ) :,, 1. 0g /, ( ) 1. 0 1. 5 g/ d, ( 4 ) : ;
57,,,, 50ml 1 2,,, ;, 1,,,, 2,,, 3 ( )
58 : 36 8, 37 1, 37 5,, 1, ( ), 1,, 2 ( ) 1 2 3 4 ( ) ( ) 5,,,,,,,,, ( ), ; ;
59 ;, ;,, ;, ;, ;, ;, ;,, :, 10,, 10,, ( ),, 1,,, 2, 3,,,, 4, 5,,, 6 ( ) 1, ;, ;, 2,, 3 X 4, O B CT 5,,,, 6,,,,
60, ( 1 ) :,,, 2 3,, 4 6,, ( 2 ) :,, 2 3, ( 3) : ( ),,,,,,, ( 4 ),,, 1, 2, 3, 4, ( ),,,, ( ) 1., ( 1 ) : 39,,, ( 2 ) : 39 5, 1 ) :,, ;, 25% 35 % 100 200ml, 30,, ;,,,,,,,
61,,,, 39, 2 ) : 32 34,,, 3 ) : 40, 4 100 150ml, 2 ( 1 ) :, ;, ;, ( 2 ) :, 2mg /( kg ),, ( ) ( ),, ( ), ( ),,, ;,, ( ),,,, ( ) 1,, 5 1,,, 2,, 3,,, ( ),, 12552kJ( 3000kcal) ;, 3000 ml,,
62 ( ), ; ( ) ;, ;,,, ;, ;, ;,,, ( ), 3,,,, ;,,, ;,,, ( ) 1 ( 1 ) : ( 2 ) : 2,,,,, ( ) 1 2. 3., Adams - Stokes,, 4. 5.
63 ( ),,, CO ; ; ;,, ; ( ),,, ( ) ;,,, ;,, ( ), ;, ( ) ;, ;, ( ) ; ;, ;,,, ;, ; ; ( ) 1,, 2,,, 3 CT 1, 2 3,,,,
64 ( ),, 50% 80 100ml,, 2 4 ( 5 75 g/20ml) 10% 500 ml, ; 5g 100ml, 1,,,, ( ) 1,,,, 2,, 3, C A 4,,, 5, 20% ( DXM), ICP 15mmHg,,, PaCO 2,, 30 35mmHg, 15mmHg 6,, 7,,, 24 8, 9 10, 11, 12 13, 0. 1 0. 2g, ;, 10mg,,,, ( ) 1,,,,,,, 2 2, 48
65,,,, 3,,,, ( ) 1,,,,,,,,, 2,,, 3, ( 1 ),,,,,,, ( 2 ),,, ( 3 ),, 4, 5 2 L/ min,, ;,,, ( ) ( hemoptysis),,,,,,
66, 100,,,, 1, 2, ; ;, 3 4 ; : ( < 100ml / d ) ( 100 500ml / d) ( > 500 ml / d),, : 24 600ml 500ml ( ), 40,,,,,, ( ),,, ( ), : 1.,,,, X 2. ( 38 ), 3., 4,,,,
67 ( ) 1., 2. X X, X 3.,, 1 2, 1 2 3 4 ( ) 1,,,, 5 10mg 2,,,,, 3 ( 1 ) :, 5 10U 25% 20 40ml q8 h, 10 20U 5% 250ml, ( 2 ) 6- : 6 8g 5% 500ml,,, ( 3 ) : 100mg 25% 40ml, 2 ( 4 ) : -,, 5% 250 500ml 10 20 mg ( 5 ) : K 1 20mgq6h ; 5 10mg q6h; 0. 25 0. 75g q6h 4,
68, 100 200ml,, ( ) 1,,,,,,,,,,,,,,,,,, 2,,, 3,, ( ) ( ) 600 1500ml, 1 2 1 4 : 24 500ml; 12 600ml ; 200ml 24 ; : ;, ( ),,,,,,, 30% 1, ;,, ;,,,,, 2 ( 1 ),,, 45,, ( 2 ), ( ),, ( ),,,, ( 3 ) ( FiO 2 30% 40% ),,, ; ;,, ;
69 ( ) ;, 12. 0 13. 3 kpa,, ; ; ; ( ) 1,,,, 2,, ( ),, ;, ;, ( ) 1.,,,, 2.,, 3.,,,, 4.,,, 5,, ( ) 1, 2,,,,,,, 3, 4,,,, ;,,,,,,,,,
70, ( ) ( syncope),,, -, ( ),,,,,,,, ( ),,,,,,,,, ( 15 ),,, ( ) 1 X, 2 3, 4 CT, 1
71 2 3 ( ),,,,, ( ),,,,,, 25mg 2 3 10 20mg, 1 ; ( ) 1 ; 2 ;, ;,, ( ), ; ;, ;, 180 40,,,,,,,,,,,, ( ) ( headache),,,,
72 ; ; ; ( ) 1 ;,,, ;, ; ; 2 ; ; 3 4, ;,, ; 5, -, ( ), ( ), ;, CT X 1 2, 3 4 ( ), ; ;, ( ),, ( )
73 1,, 0. 2 0. 5g, ( A P C) 0. 5 1. 0g, 25mg, 3,,, 100 200mg, 3, ; 60 100mg 30 60mg, 3, ; 60mg 15 30 mg 50mg, 2 2. 5 5mg, ; 5 10mg, 5 10mg, 3, 50 100mg, 3, 3 : 1 2, 0 5 1 0 25 0. 5mg, 5 - : 2 12mg; 0. 5 1mg, 3 ; 2 4 mg, 3 : 15 25mg 10 35 mg, 3 : 10 30mg, 3 ; 2 5mg0 035 0. 075mg, 3 4 ( ), 20% 25% 250ml,, 4 6 1, 50% 60ml 10 20mg, 10 % 500ml, 1 ( ), ( ), ( ) ( ) 1,, 15 30,,, 20% 250 ml,, 2,, 3,, ( ) ( ) 1 ;, ;, ; 2,,,,, 3,,, 250ml
74 30min ;, ;, ;,, 1,, 2, 3 :, 4, 5,, ( ) ( dyspnea),,,,, ( ) 3 :,, ;,, ;,, ( ) 1 2,,,,, ;,, ;
75 ; ; ( ) 3 ;, : ; ( ),, ( ),,,,, ( ),,,,,,,,, X,,, ( ) 1 2 3 1 2,,,, ( ),,,,,,,,, X,, ( ) 1. ;, 2,,, 2
76 1,,, 3 : :,,, 7,,, 1 2 1 3 :,, 1 2,,,, 4,,, 5,,, ( ) 1,,,,,, 2,, 1 2L /min, 24% 30%,,, 1,,,, 2, 3 ( ) ( )
77 ( cardiac arrest),,,, ( ), 4,,,, 1, 24 1 6, 45 75, 1 13 19%, 14 21 30% 80% 90 %,, 80% ( 4: 1 ), 45 75 ( 7: 1) 2, 11 % 17%,,,, 3 20, 2. 4,,,,,, 4, 40% 5
78, 80%, ( Q - T ), 81% : :,, ; :, 50g, 50% ; : LDL - C, ; : ; : ; :, ; :,, ; :, 20 31 13 ; :, ; :,, 3 : ( ) ; QRS,, 200 400 /, ;,, ( ),,, ( ),, QRS-T, 20 30 3,, ( ) 75%, Q-T 5%, ( )
79 1.,,,,, 10 2.,,, 20 30 3., 4. 5., 30 6., 30 60 ( ) 3 :,, ;, ; ; :,, ; ; 10, ;,,, ; 5,,,, ( ) ( basic life support, BLS),,, BLS :, ( A), ( B), ( C), ( CPR) ABC 1 ( ),,,, ( ), 2 ( 1 ) 1 ) :,,,,,,, 2 ) :,,,, ( 2 ) :,,,, 2 800 1000mL,,,,,, 1 5
80 2 s( 1 0 1 5s),,,,,,,,, 100%,, ( 3) :,, ( 4 ) :,, ( 5 ) ( ) ( 6 ) - ( ) ( 7 ) ( 8 ) :, (, ), 3,,,,, :,,,, ;,,,,,, ;,,, ( 1 ) 1 ),, 10, 2 ),,, 3 ) :,,,, 1 /3, 4 ),,,,,,, 3 4cm,,,,, 80 100, 6 7 11kPa,, ;,,,,
81, ;, ;, ( 2 ) :,,,,, :,, ; ;,, ;, ; ( ) ;,,,,,,, 5,, 1 5,, 15 2,,, -,,, b, ( ) ( advenced life support, ALS) BLS,,,, 1,, 12 15, 1 2 2, 16, T,,, 3 4,, ;, ; ; ( 1 )
82 1 ) :,, 2 ) :, 1 2 10 20 ml,, : ;, 3 ) :,,,,,, :,,, ( 2 ) 1 ) : - ( ) - ( ) ( ) -,,,,, ; -,,,,,,, 1, 2,,,,,, 5 1mg,,, 5 2 5mg, 0 1 0 2mg /kg 2 ) :,,,, 1mg /kg, 1 4mg/, 225mg 3 ) :,,,,, 0 5 1mg, 5 1, 60 / 4 ) :,,,
83, : 5 10mg/ kg,,, 15 30 10mg / kg, 30mg/ kg 5 ) :, -,,,, 6 ) 5% :, ph, 10 :,, 5%,,,,,,, 1985 CPR ( ECC), CPR-ECC,,, :, 0 5 1 mmol / kg( 5% 100ml = 60mmol) ; ph,, 10 1 /2, 2 3 300ml,, 7 ) :,,,,,, 0 01 mg / kg, 8 ) : 1mg, 1 mg 5%, 2 g 9 ) :,,, Ca 2 +, Ca 2 +, Ca 2 +, Ca 2 + 200, Ca 2 +,, A 2,,,,,, :,,, 10) :,,,,,,,, 20 30,, 60, ( ), 1,, 11) : 5
84,,,,, 98%,,, -,,,, :,,,,,,,,,, 3 5, 5 10Ws ( ) ( prolonged life support, PLS) 1 2 %, 15%, 20% 25 %,,, 10,, 15, 3 24, 8,,,,, ( reflow damage),,,, : ( 1 ) :,,,,, EAA,, : :, ; :,, ; : 24h 30 32, 28 ; :, 24h 1,, ( 2 ) :, 10 6 /6 7 kpa ( 80 /50mmHg),, 3 5 20% 250ml, 20 40 mg 30mg,,,,
85 ( 3 ) : 200 600mg /d 100 400mg/ d,,,,,,, ( 4 ) :,,,,,,, 30 60, 24 2 % 5mg / kg, 2mg/ kg ( 2 4 mg),, 30mg /kg 7mg / kg,, : ; ; ( 5 ) :,,,,, ( 6 ) :,,,,, ATP,,,, : 0 075 0 15mg /kg 20 40mg, 3 : 120mg, 6 : 10 20mg, 6 ( 7 ) :, ;,, 5 10 mg,, 4 6 1, 3 5 ( 8 ) :, C E Q 10 2,,, ; ;, ;,, 20 40 mg 5% 100ml,, ( 2 10 g /kg, ; > 10 g / kg, ; > 20 g / kg,, 100 200mg 5 10mg,,,,,,,,, CVP
86 (, ), : 20mg 5% 100ml,, 5 20 g / min; 5mg 5% 100ml,, 5 200 g /min 3, 2 5mg 5% 100ml,, 20 100 g / min CO 2 3,, 48 72h,,,,, 3 33 4kpa( 25 30mmHg),,, ph, FiO 2 50% 13 3 kpa ( 100mmHg),, ( SIMV), 4,,,,, 5,,,,,,,, 6,, 7,,,,, ( ) 1 ( 1 ) ( 2 ), ( 3 ) ( 4 ) 2 ( 1 ) :, ( 2 ) : ( 3 ) 12,, ( ), 12,
87,,, : 1 ABC,,,, 2, 3, (,,, ) 4, : ( ) ; ; 5,, 6, ;, ;,,, ; 7,, ; ( 27 ) ; ; ; ; ; ; ; ;,,,,,,,,,, -,,,,,
88 ( acute myocardial infarction, AMI),,, 50 > 300 /10, 70 < 200 /10 35 84 71, 22 ; 80, 45, 0. 2 0. 6, ( 90% ), > 75%, 1,,, 1,,,, 1 2,, 6 8,,,,,,,,,,,,,,,,, ( dp / dt),
89,,,, ( ),,,,,,, Killip : ; ; ; ( ),, ( ) 1,,,,,,,, 2,,,,,,,,,,,, 3, 24 48,, 38, 4, 5 75% 95 %, 1 2, 24,,,, 6, 10 7kPa ( 80mmHg),,,,,, ( < 20ml / h),,, 1, 20%,, ( 40% ),
90 7 32% 48%,,, ( ) 1,,,, ;, ;, 2, 38, 1 2 ; ; ;, ;, ;, ;, ; 1 % 20 % 1 3,, 1 3, 1 2, ( ) 1 ( 1 ) :,, 75% 90%,,,, 2 3, ( 2 ) : ( CK) 3, CK - MB, CK - MB, 4 8, CK - MB, 24, 3, CK - MB CK CK - MM 3 CK - MM 1, CK - MB, ( GOT) 6 12, 24 48, 3 6 ( LDH) 8 12, 2 3, 1 2 ( PK), ( 3 ) :, 5 40, 83 ; 4, 24,,,,,, 2 : Q QS ST, T,, T :, 2, 5% 15 %, :,,,,
91 Q, QRS ST T,,,, 3, 4,,, 5 9 9m 131 20 1 42, 6 ( LPs) LPs 28% 58 %,,, 7 ( MRI ), ( ), : 1,, 1 2 2, ST 3 1, 4 2,,, 5 10 %,,,, ( ) 1 3 2, ( 1 ) ( 2 ) Q ( ) ST-T ( 3 ), 2 ( 1 ), : 2 6 Q > 0. 03 s + Q / R > 1 /3; 2 6 Q > 0. 04s; avlq > 0. 04s + R > 3mm; Q > 0. 04s( avf Q ) ; avfq > 0. 04s; 2 QS 6 RS R ; V 1 4 V 1 5 V 1 6 ( 2) ( ),,
92 1 2, 3 4 5 ( ),, AMI,,, ( ) 1 ICU,,,,,,,,, ICU 3 5,, Swan - Ganz 2,,,,,,,, 3,,,,,,,,,, 24 48,,, 4,,,,,,,,,
93 5 3,, 6,, 2. 5mg, 3 4, 5 10 mg,,,, 7,,,, 2 8 mg( 3 5 ml ), 1mg,, 5 10, 12,,, 100 200, 15, 1 2,, 0. 05 0. 1mg,,, 500ml 50 100mg, 25 50mg, 0 6mg,, -,, ( ) 3 6,,,,, 1 : 30 6, ST 0. 1mV, 75,,, 12 ( 3-3) : 10, 10 ;, ;, ;, > 24kPa ( 180 mmhg), > 14. 7 kpa( 110 mmhg) ; 10 ; 1 ; > 65,, ( 1) ( Streptokinase SK) : SK c,,, 50 100 U 5% 100ml, 30 60, 10 U, 24 25mg, ( 2. 5 5mg),, 0. 2
94 0. 5 mg, SK2 U, 2000 4000U, 30 90 2000 U30 60, ST,, 1 ( 2) ( Urokinase UK) :, SK 50 100 U, 60 6000U 1 0 5 1 ( 3 ) ( rtpa) :, SK 0. 375 mg / kg, 45 0. 75mg / kg, 90 ( SCUPA), - ( APSAC) 50% 75%,, 15% 35 %, 1 PTCA 2 ( PTCA) 20% 52 %,,,,,,, 3 : PTCA ; ( ) ; ( ),,, 1, 4 6, :,, 2 2. 4kPa,,,, ;, 2kPa( 2 2. 4kPa ),, 2 -, AMI 4 12, ( ), ( CPK, CK-MB ),,, 60, 14. 6kPa, 3 250 500ml, 7 14 4 6ml 80 160mg 12 30ml,
95 4 ( GIK),,, AMI C( 3 4 g) A( 50 100 U) ( 0. 2 0. 6g) B 6 ( 50 100mg), 1 5 ( 150 mg / kg) ( 500IU / kg, 6hl, 4 ), ( 20mg, 4hl ) AMI,, ( ), 1,, ( 1 ) :,, 40 5% 10%, > 18cmH 2 O, > 15 18 mmhg,, ( 2 ) :,,, 5% 100ml 10 30mg ( ) 10 30 mg 0. 5 1mg ( 3 ) :,,, 5% 100ml 5 10mg 1mg10 20mg ( 4) : 5%,, 2 90%, 72,,,,, ( 1 ),, 50 100mg, 5 10, 1 3 mg, ; 150 200mg, 250 500mg, 100 200mg, 6 1 ( 2 ),, ( 200 300J) 1 ( 3 ) 50, 50 60, 0 3 0. 5mg, 5 10, 2mg 0 25g 1 mg 300 500ml,, ( 4),, ( 5) - ( 24 )
96, 3, ( 1 ) 24 ( 2 ) 24 ( 3 ), 1 /3 1 /2, ( 4 ),,, ( 5 ), ( 6 ), 4 ( 1 ) :, AMI2 10,, 40 60 mg, 1, 6 8, ( 2) : AMI,, ( 3) : AMI 1 2,, ( ),, ( 4 ) : 10% 30%, Q, 2 /3 ST 1 X, ( 5 ) : AMI, 1, 24,,, ( 6 ) : AMI 2% 10%,,, 1 2 ( 7 ) :,, ( ) 3 4,,, ( ),,,,, 2 4,
97,, 30% 15% 10%, 1,,, ( ) 1, 2,, 3, ; ;, ; 2 3,,,,,, ; 4 8,,, ; 7 12,, 4,,,, 5,,, ;,,, ( ),,, ECG, 6,, ( ),,, : 1. 0 5 1, 4 6, 1 2 12kPa( 90mmHg),,,,,,,,,,, 2. ( CCU),,,,,,
98 : 5 ; ; ; R T,,,,,, 3.,,,,, 0. 6 mg,,, 4.,,,,,,,,,,, 5., 37 38. 5, 3, 1,, 6.,, 7. 1 2,,, 8.,,,,,, X 9. 2 2,,,, X,,,,,,, ; 1, 2 3,,, 4,, 5,,
99,, 60 100 / ( ), ( cardiac arrhythmia),,, :,, ; : ; : ; ; ; :, ( ) 1 2, ( ) ( ) 1 2,,,, 3,,,,, ( ) 1 ; ; ; ; 2 ( 1 ) : ( ) ; ;
100 ( 2) : ( ) ; ( ) ; ; ( ) 1 2 ; ; ; 3, ( ), : ; ; ;,, ( ) 1. ; ( 1 ) ( PST) :, 3 : ; ;, ;,,,, 150 220 /min,,,, ( 2 ) :, > 100bpm, 2, 6,,,,,,,,,,,, :, 140 160 ( 3 ) :,,,,,
101, :, 2 1,, 150 ; 4 1 3 1, 75 100,,, ( 4 ) :, 350 600,, 110 160,,,,,, ( ) :,,,, : 100 160,,,, ( 5 ) :,,,, :, : : :,,,,, : :, : : :,, RonT TDP Q-T,,,,,,,,,, 2. :,,, :
102 ( ), ( 1 ) :,, 60 70,,, :,,,,,, - : 50,, ;,,,, ( 2 ) : :, - ( 3 ) : :, - ( 4 ) :,,, AMI ( ) : :, :, ( ) :,,, ( ) :,, 1 :,,, -, 20 40,, ( ), 1. ( 1 ) : 3, ( 8-1 ) 1 ) : : 3 3 P, 140 250 / min( 160 220 / min),, P -P > 0. 12s QRS,, QRS, 85%,,
103 p -R 2 1 3 2 4 3,, ST-T, 2 ) ( ) : : 3 3,, 160 220 / min QRS-T, QRS P, P ( P -R < 0. 12s R-P < 0. 20s( 8-2) 8-1 8-2 3 ) : : 100 250 / min P 3 P -P, -P P -R, > 0. 12s, ( 2 ) : 3, 6 : 1 ) 3, QRS, > 0 12s, T 2 ) 130 200 / min, 3 ) 4 ), ( 3 ) : :
104 1 ) P, 240 400 F ), QRS F 2 ) P, 350 600 f, ( 8-3) 8-3 ( 4 ) : : 1 ) : 250, QRS ST-T 2 ) : 250 500, QRS T, 2. ( 1 ) : : 1 ), 40 50 / min, 2 ), 3 ) ( - ) 4 ) ( 2 ) 1 ), P-QRS-T 2 ) P-P 3 ), ( ) ( 8-4) 8-4 3 P-QRS-T 1. 84S P-QRS-T, P-P
105 0. 8 S 4 QRS ( 3) : QRS,,,, : 1 ) P-QRS-T,,, ( 8-5) 2 ) QRS,, P ; f 3 ) ( 4 ) : ( ),,, 1 ) :,, P-R, P QRS P-R,, P-R, P-R :, P-R > 0. 20 s P-R P-R P-R 0. 20 s,, P-R 0. 04 s P-R P-R,, QRS, QRS ( 8-6) 8-5,, 2 ) :,, : ( ) ( ) :, : P-R, R-R,
106 8-6 P,, P QRS P-R ( ) P R-R R-R R-R, R-R ( 8-7 ) 8-7,, QRS, : P, P-R, P R-R, R-R 3 2 4 3 P-R ( 8-8) 3 ) ( ) :, ( ), : P QRS, > P-P < R-R, QRS 30 60 ( 8-9 ) 8-8 ( ),,,
107 8-9,,,,,, 1 2 3 4,, ( ) 1 ( 1 ) ( 2 ), ( 3 ), 5mg 10 20 ml, 20mg ( 4 ) 0. 4mg, ( 5 ) ( ATP) 20mg, 3 5 ( 6 ) : ( 7 ) : 2 ( 1 ), ( 2 ) : 50 100 mg, 1 2, 5 10 50mg, 2 3, 1 4 mg / min 250mg 20 40ml,
108 ( 3 ) : ( 4 ),,,, 3 ( 1 ) : ( 2 ) 1 ) :,, 2 ) 1 1,,,, 3 ) : ( ) ( 3 ) :,, ( 4 ) : 4 ( 1 ) :,, ( 2 ) : 0. 4mg 50% 20 ml,, 2 4 0. 2 0. 4mg, 24 1. 2mg : 60 80, 90 100 0. 25 mg, 1 2 ( ) 10mg, 3, 60mg, 3,,, ( 3 ) 1 ) : :, 0. 1 g, 2,, 0. 2g, 2 1, 5 ( ) 1 2,, 0. 3g, 0. 4g, 2g 0. 2 0. 3g, 3 2,,,, 120,, QRS 25%, Q-T,, : 0. 2 g 3, 5 7, 0. 1 0. 2g, 1 2 : 5mg 40 80mg, 3, 40mg, 1 2 2 ) :, 90%, 100 200ws 1 3, 100 %, 50 70ws,
109,, ( 4 ) : ( 55 %, 50mm) ; 5 ; ; ; ; ; ;, :, 70 80 5 ( 1 ) :,,,,,,,,,, AMI,, ( 2 ) :,, 150 360 ws, 1, 1 1,,, 1 1000 0 5ml, 40ml,,,,,,,,, ( 3 ) 1 ) : 250 mg CAD, CAD 2 ) : Ic,, Na +, 0 1 0 2g 5% 200ml, 2 5mg, 24 0 3g; 50mg, 1 2, 3 ) :,,, AMI 4 ) :,,, 0 6 1 2g, 3, 1 2 0 2 0 6g 5 ) : Ic,, 0 1 0 2g, 6 8 1 1 0 1 0 2g, 3 0 9g : 1 1 1 5 mg / kg,,
110 0 35g ( 4 ) :,, ( ) 1 ( 1 ) :, -,, 1 ) : 15 30 mg, 3 2 ) : 0 3 0 6mg, 3 3 ) : 25mg, 3 4 ) : 10mg, 3 5 ) : 300 400mg, 10 20ml, 1, 7 10 6 ) : 25mg 300ml, 1, 30,,, ( 2 ) : : 1 ), 2 ) - 3 ) 4 ),, ;,, - 2 3 4 ( 1 ) :, ;,, ( 2 ) 1 ) :, ; AMI, ;, 2 ) : AVB: 50,,,,,,
111 AVB: 40, AVB,,, 5 10mg, 4 6 1, 0. 2mg 1mg 5 % 250ml, 0. 1mg,, 60 70 0. 3 0. 6mg 25mg, 3 4, ; 0. 5 1 mg,,,,,,, 3 ) : 10 20mg, 3 10 20 mg 10% 500ml 4 ) : ( ATP) 20 40 mg A100u C15 30mg C2 5g, 7 14 5 ) :, 25mg, 3, 3. 5 3. 9 mmol / L 6 ) ( 11 2% ) :, 60 100 ml 7 ) : 600 800mg 5 % 10% 500ml, 7 10 ( 3 ) :,,,, ( ) 1,,,,,,,,, 2, 3,,,, 4, 5,,,,,,,,,,,,, ( ) 1,,,,
112,, 2,,,,,, 1 4mg /min,, 50 150 mg, 5 10min, 300mg,,,,, 12 /8 kpa 60 / min 3,,,, 4,,, 1.,, 2.,, 3.,, 4. ( 1 ),, ( 2 ),, ( ), ;, ( 3 ),,, ( 4 ), ( 5 ) ( )
113,, 17. 33kPa, :,,, ( ), 90%,,,, ( ) 1 ( ), ( ) 2, ( celebral blood flow, CBF) CBF 50ml /100g,,,, ;,,,, ( MAP) 21. 3kPa( 160mmHg) 8. 0 9 3kPa( 60 70mmHg),, 16. 0 21. 3 kpa( 120 160mmHg),,, ( breakthrough), 18. 7 kpa( 140mmHg), ( ), 1% 2% -
114, 40 50 3 2 -, 30 60, ( ) 1,,,,,,,, 33. 3kPa, 18. 7 kpa,, > 180mg / L 5 23% 2., : ;,, ;,,, 3. :,, ; ; ;, ;, ;, > 16. 9 kpa( 130mmHg),, 1, 2,, 3,, 4 5 ( ) 1,, 2,,, 3,, 2h ( 1h ), 21. 3 24. 0kPa( 25 % ) 2 6h 21. 3 /13. 3kPa, 48 h
115 20. 0 21. 3kPa /12. 0 13. 3kPa 4,,, 5,, ( ) 1. : ( 1) :, 50 400 g,, 1, ( 2 ) :,, : 25 mg 500 ml, ( 3 ) ( diazoxide) :, 1, 3 5, 30, 6 12, 200 300 mg, 2 ( 4 ) : 5mg,, 5mg 20 mg,, ( 5 ) :,, 75 150mg, ( 6 ) :, 0. 5 1mg,, 1. 5 2, 3 4, 6 24 ( 7 ) :, 1,, ; 5-HT,,,,,,,,, 25mg 10 ml,, 5min, 25mg 10 min 50mg 250ml 5%,,, ( ),,,,, ( 8 ) :,,,,, 2 10 g / kg min ( 9 ) :,,,
116,, 25 100 mg, 1 3 20 30 BUN ( 10) :,, 1 2, 0. 5 mg, 1mg, 2, 3 20mg ( 11) : 1, 25 50mg, 25 mg, 2 ( 12) 25% : 10 ml, ; 25% 10ml, 10% 20ml ( 13) :, 50mg, 50mg 100mg, 10% 500 ml,,, 2.,,,, ( ) 1, 30,,,, 2, 2 4 3 ;, ; ; 4 5, 6,, 2 1, ( ) 1,,,,,, ;,,, 2,,,, ;
117,, 3,,, 4, ( ) 1.,, 2.,, 3.,,,,,, 4., 5.,, 6. 7.,, HDL- C O 2, ; ; ( ),,,,,,,, ( ) : 1, 2 3,,,, 4 5,, ( ) 10 20ml,,,,
118 0,,,,,,,,,,, 100 200 ml,,,,,, 10 12mmHg( 1. 3 1. 6kPa ),,,,,,,,,,,,, 10 mmhg( 1. 33kPa),, ( ),,,,, ( ) 1,,,,,,,,, 2,,,,,,, ( Kussmaul ),,, ( ) 1, ST-T QRS,, 2 X,, X 3,,,,, 4,,, 1
119 2 3 ( ) 1, 30 mmhg,, 2,,,, ( ) 1,, 2,, : ( 1 ) : 1 cm,, ( 2 ) : 2 3cm, 3, ( ),,,,,,,,,,,,, ;,,, ( ),,,,,, ( ),,,, 1,,,, 2,,,, X,, 3,,
120,,,,, 4,,, ( ) 1.,, 2., 3.,, 100ml,,,, 0 5 1. 0mg,,,,,,,, 1.,,, 2.,, 3.,,, ( ) 1 2 3-4 5
121 6 7,, ) ( ) 1 ( 1) ( ) ( ( 2 ) ( 3 ) ( 4 ), < 40 / ( 5 ) > 4 ( R - R ) ( 6 ) 2 ( 1 ), < 40 / ( 2 ) 3 ( 3 ) - ( 4 ), ( 5 ) ( ) ( 6 ) ( ) 1, 2,, 75% 2, 3 4, 5, ( ) 1 ( 1 ) :, ( ), L J 0 5cm, ;, ;, 4 5V,,, ( 2 )
122 1 ), ( ) 2 ) X 3 ) 4 ) 2 ( 1) ( ), ( 2 ), ( 3 ), ( 0. 5 1. 0V) ( 4 ), ( 5 ) ( 6 ), ( ),,,, ( ), 70 ma ( ),,,,, 50 100mg,, : DVI, ; VDD DDD,,,, ( ) ( ),,,,,,,, ( ),,,,, ( ) 1, 24
123,,, X 1,,, ( ),,,,,,,,, ( ) 1,,,,,,,,,,,,,,,,,,,,,,,,,,,, 2 3,, 1, 3,,,,,, 4 6, 30 ( ),, 1 12, 2 X,, 3 : P QRS, ( 1 ) :,, 3%,, ( 2 ) :, ( ) ( 3 ) : P-R, AVB ; DDD,
124, 20 % ; ST-T,,, T, ST,, ( 4 ) : DDD VVI SS,, 2 5mV,,, ( 5 ) :,, 7 20, 448 72,,, 24,, -,, 5 5 7,,,, 6,,, 7 500 g, 6,,,,,,,,,, 1 8, 12,, 4, ;,, :,,, 3 5 9 3 5,,,,, : : ; ; ; ; X 10, 3 7 7 10 11,, 2 3,, 7,, 12,,, 13VVI, 5 7, 1
125,,,,,,, 14, 15 16,,,,,,,,,,,,,,,, 1,,, X,,, 2,,,,, ;, 3,,,,,,, 4,,,,,, 5,,, 6,,, : R
126, ( ) 1, 2( 1 2 ), 3,, 4 1 1 ( ) 1, 2 ( ) 3 4 5,, ( ) ( ) 1,,, 2,, 1 2 3, 2 4, 5, P 1 2 12, R 3 15 30mg,,, 4, 250 300 150 200, 150 200, 80 100, 100,
127 5,, 10 15 1,,, 2 1 2,,,, 3,, 4,,,
128,, 8% 20% ( 800 1200ml ),, ( massive hemor - rhage of the upper alimentary tract),, 10% 20 %,,, :,, : ( ) 1 ( 1 ) :,, ( 2 ) :, ( 3) ( Mallory - Weiss ) :,,,,, 2 ( 1 ) :, 10% 20%,,,,,,,, ( 2 ) :,, ( 3 ) : Budd-Chiari ) 3 ( 1 ) :, 5000, 438, 8 44% ; 1597, 30 76 %, 41 2%,,,
129,,,,,, ( 2 ) :,,, 15% 30%, Menguy 22% 30% ( ) ( 3) :,, ; ( 4 ) : ( 5 ) :,,,,,,, 4 ( ) ( ) 1,,,,,,,,, 2, ( ),, PTCD, 3,,,, ( hemobilia) 4,, ( ) ( ), ( DIC ),, ( ),
130,,,,, ; ;, ;, ;, ; ( ),, : : ; ;,, :, :, :, ;,, : 40,, ( ) 1,,,,,,,,,,,,,,,,,,,,,, 2 10. 7kPa( 80mmHg), 90, 1500ml ; 8kPa( 60mmHg), 110, 2000ml, 300 500ml, 3, 1,,, 39 40,,
131 ( ) 1, 4,, 2 X X,, X ( 50 % ),,, X, 3, 12 24,,, 80 % 90%,, Mallory-Weiss, 4,,,,,,,, 5 130 cm,,, 6 8,, 5% 20ml, 4, 6,,,,,, 7 99m Tc 0. 5ml / min,, 9 9m Tc 24 h,,,, ( ) 1, X,, B CT
132 2 : 5ml,,, 50 100ml,,,,, ( 1 ) :, < 400ml,, 1, > 400ml, > 800 1200ml,,,, 2000 ml ( 2 ) :,,,,, ;,,,, ( ), 100 120, 800 1600ml;,, 1600ml,,,,,,, ( 3 ) :,, 800ml ( 20 % ),,, 800 1600ml ( 20 % 40% ), 9. 33 10. 66kPa( 70 80 mmhg),, 1600 2000ml( 40% 50% ), 6. 67 9. 33kPa( 50 70mmHg), 2000 ml, = ( / ) ( mm- Hg) 0. 58, = 1, 800 1200ml( 20% 30% ), > 1, 1200 2000ml( 30% 50% ) ( 4 ) :,,, 32,,, 7g, 1200ml ;, 2 3, 15. 0 10 9 / L;,, 0. 015 I ( 5 ) :,, 1 2, 3 4,,,,,, > 133 mol / L, > 14. 28mmol / L, 1000ml 3,,,,
133,,,,,, 0. 49 kpa,,,,,, ; 48, :,,,,,,,,, 6 12 4 ( 1 ), 1000 ml 20% ( 2 ), 3. 99 kpa( 30mmHg), 100ml, > 110 / ( 3 ) Hb 7 g, RBC < 200 RBC 28% ( 4 ) 1,, 2,, 3,, ( ) 1,,,,,, 2,, 3,,, ( ),,,,,,,,,, : ; 12 kpa
134 ( 90mmHg) ( 25 % ) ; 70 g/ L 25%,, ( ) 1 200 300 ml, 5 33 6 67kPa( 40 50mmHg),,, 100 150ml, 4 0 6 6 kpa( 30 50mmHg), 70% 90% 12 24,,, 24,,,, 8 mm,,,, 2 ( 1 ) :, 8 mg 150ml, ( 2 ) : H 2, 0. 6g 20 40 mg, 1 2, 40mg 1 2 3. -, : 10 20 U 50 % 20ml 12 24, 4 1 10 20 U 5% 200ml, 0 5 1, 6 1,,, 0 15U, 20, 0 30U, 20, 10, 30 4, 4 48 4,,,, 20 180mg, 2,, 25% 5 10 mg 5% 10% 250 500 ml 5,, 1. 5 2, 25% 35%, 12. 5% 16. 7%,, 70% 87 % 100 g, 25 g; 0. 6mg/ d,
135 14,, : 250 g, 250 g /h, 90% 6,,,,, ( ),,, 80%,,,,, 7., ( TIPS),, 10% - 20 % ( ),,, ( ) 1,, 2,,, ( ),,,,,,,,,, 1.,, : 10% 15% ( 400 600 ml) : 20% 25% ( 800 1200ml),,,,, 100 / min, 12 13. 3kPa, : 30 % 40% ( 1200 1600ml),,,, 100 120 / min : 40 % 50% ( 1600 2000ml),,,,,, 120 140 / min, 2. :,, 48, ( CVP)
136, 0. 49kPa, 3. 15 30, 2,,, 4. ( 1 ) :,, ( 2 ),, ( 3 ),,, ( 4 ),,, ( ), : 1. 24,, 2., 3.,, 4.,, 5.,,,, 6. 24,, 20 30ml,,, 7., 8. 72, ( ) 1., 5 48, 10. 7 kpa,,, 654-2 10mg, 10mg 2.,, 30 60, 4 6,,,, 36 48, BUN,,
137 ( ) 1,, 2, 400ml,, ;,,,,,, 3,,, ;,, ;, 4,,, 7. 1mmol / L,, 17. 9mmol / L, 5 4 1 24 ;, 1,, 2,,,, 3,,, 4,,
138 ( disseminated intravascular coagulation, DIC),,,, DIC, ( ), DIC 3l% 43%, ;, ;, ;, ( ) DIC 24% 34 %, ( ) ( ) DIC l% 15%,,, ( ) DIC 4% 12%, ( ) DIC 4% 8%,, ( ), DIC,,,,,,,,, ;, X,,, (
139 ),,,,,, ( ) DIC 1 ( 1 ) :,, a, a ( 2 ) :, ( CICA), CICA Walsh,, a,, DIC 2,,,,,, 3 ADP,,, DIC ADP, TXA 2 4 4,,, ( ) DIC 1 DIC ( 1 ) DIC : : a,,,, -, ( 2 ) :,,, CICA, a, a 2 DIC,,,,, DIC,,, DIC, DIC 3 DIC,, DIC
140 4 DIC,,,, 5 : ( 1 ),,,, DIC DIC ( 2 ), -, ( 3 ),, DIC ( ) DIC,, ( ) ( ), ( ) DIC,,, C, DIC,,,, 2 -,, 2 -,,,, ( ) DIC,, a ( ) ( FDP),,, FDP, FDP, ( ), DIC 3 : 1 1 2,, 2,,, 3,, DIC ( ) DIC 3 :
141 1, ( ) :, ; ; ; 3P ( FDP ) ; 2 : ; ; ; ; 3P ( FDP ) ;, 3, :,, 3P ( ),, ( ) DIC DIC 1. 84 % 95%,,,, DIC :,, 2. 30 % 80%,,, FDP,,,,, 3,, 4, ( ) 3 : 1 < 10 10 9 /L 2 3, 3, 2g / L,,, DIC,,, 1. 5g /L,,, 4 ( 3P) ( ) ( FDP) 20 mg / L
142 5 2% 6 : ( AT ) ; : C/ R: Ag ; - ( -TG) ; ) ( ) DIC (, 1999 1 DlC, 2 ; ;, ; 3 ( 1 ) : < 100 10 9 / L ( < 50 10 9 /L) : - TG, PF 4, TXB 2, GMP - 140 < 1. 5g /L( < 1. 0g /L, < 1. 8 g/ L) > 4. 0g /L( 3P, FDP > 20mg/ L( > 60mg/ L), D - ( ) PT 3 ( > 5 ) AT - < 60% ( ), PC PLG < 200mg /L : C < 50% ( ) ET - l > 80ng / L, TM 2 ( 2 ) : F 1 + 2 TAT FPA ; TF ( ) TFPI ; SFMC ; PAP ( ) DIC 1 DIC 2 :, ;, ; ; 3 :, PT 3 APTT 5 ; : -TG, PF 4, TXB 2, GMP - 140; : F 1 + 2, TAT, FPA, SFMC; : AT -, PC : ET - 1, TM ( ) DIC 1. < 50 10 9 / L ; 2 < 1. 5g /L ; 3 3P FDP > 20mg /La D - ; 4. PT 3, ; 5 > 10 % ; 6 < 15 mm / h; 7 2
143 1, 2, 3, DIC ( ) DIC ( ) DIC, 1 ( 1 ) : DIC DIC DIC DIC ( 2) : DIC,, 24,,, ( < 0. 5 g / ml), ( 3 ) :, 24 6000 12000U( 50 100mg) 10000 150000U( 80 120mg) 5% 10% ;,, 2 3, 5 7, DIC,,,,, :,,,, DIC, ( ),,,, 2( LMWH) X a LMWH X a LMWH DIC DIC X a,, ( 4 1 ), 1 1, LMWH : : 50 100U /kg, 2, 5 10 : 200 U /kg, 2, 5 8, Xa, 4 5 APTT
144, 3 AT - C( rhapc) TM TFPI TF X a ( DX9065) ( FOY) ( ) DIC DIC, ( 1 ) : DIC, DIC DIC : 400 600mg,, 100 200mg 100 ml, 4 6 1, 24 600 1000mg ( 2 ) : 0. 5 1. 0g, 3 ( 3 ) : 500 1000ml, ( 4) : DIC : AT 1500 1725 U, 1 500 1500U ( 5 ) ( ticlopidine) :, ADP DIC, DIC : 250mg,, 2, 5 7 500mg /d, 200ml,, 1, 3 5 ( ),, DIC APTT, ( < lg / L), ( ) DIC, ( ) DIC,, ( ),,,,,,, ( ) 1., DIC, ( ), 2,,, DIC,,, 0 1%,
145, 3,,,,,,,, ( ) DIC, : :,, :, 1 1000 : 1 5000 :,,
146 ( cerebrovascular disease, CVD), 10%,, 50% 70%,, 1986 1990, 109. 7 217 /10, 719 745. 6 /10, 116 141. 8 /10 ; : 1. 3 1. 7 1, 45, 65, 75 45 54 5 8 ( ) :, 24 ( TIA), 24 ; ; ;, ; ( 1986) CVD 12 ( 11-1) 11-1 ( 1986, ) 1 2 3 4 ( - ) 1 2 3 4 1 2 - ( cerebral thrombosis),,,,,
147,,,,,,,,,,,,,,,,,, 6, 12 24h,,,,,,,,, ( lacunar infarction),,,, ( ischemic penumbra),,, ( ), : 29%, 43%, 2 /3, 5%, 7%, 7%, 9% ( ) 1,, ( < 6h) 2,, 48, 3.,, 3 ( )
148 1, -,,, 2.,,,, CT : :,,,,,, ; :,,,,, ; Gerstmann ( ),, ; :,, ( Heubner ), ( ), ( ), ( ) 1 /3,, 2 3, ; 60 %, 80% 20% ( ) 1 /3,, 2 3, ;, 95 % 50, 65 74 1%,, 60%, 80% 20% 1, 25% 45 %, 2 ( 1 ) :,,,,
149 Horner ( 2 ) :,, 70% 80% 1 ) :,, ; ; ;, 2 ) :,, Broca ( ) ( ) ; Wemicke, 3 ) :, ;, ; ( 3 ) :,,,,,,, ( 4 ) :,,,, ;, ; ( 5 ) - :,, ( 6 ) :,,,,,,, Horner, ( 7 ) :,, ( 37 % 14% 10% 16% 10% ) ; ( ),,,, 1 ) :,,, 2 ) :, 3 ) :, 4 ) - :,
150, ( ) 1,, 2 CT 24 CT, 24 48,, CT 3 MRI, MR, T 1, T 2 CT, MRI,,, 95% MRI MRI, T 1, T 2 MRI 4 DSA MBA, Moyamoya 5 6 ( SPECT) 7 ( TCD), ( ) 50, TIA ;, ;,, ;, ; CT MRI 1, 2, 3, 4,,,,, ( ),,,,,,,,,, 1,,,,
151,, 20 /12kPa,, 2, ( 29 3kpa),,,, 3,,,,, 20 % 125 250ml, 2 4 /, 7 10, 10 20mg, 3 5, 7 10% 4, 20% 30%,,,, 24 48,, 706 5 :,,,,,,,,,,,,, 6,, 4 8 min,, ( time - window), : ( 1 ) ( UK) :,, 6 30 U 250ml, 1, 5, ( 2 ) ( SK) :, : 20 50 U 100 ml, 30 5 10 U,, 12 5,,, 2mg ( 3) ( t-pa) :,,,, ;, ; t-pa
152,,,,, 7,, ( 1 ) : 4000 6000U 12500 25000U 10% 500 1000ml,, 1, 1 2 ( 2 ) :, 1 200 300mg, 50 100mg, 20% 30%, ( ) 15 30,, ( 3 ) : 1 4 6mg, 2 4mg ( 4 ) :,, 1 3mg / kg, 10,, 8. ( 1 ) :,,, 30 % 33%, ( ), 500 1000 ml, 7 14 706, 500 1000ml, 7 14, 250 400ml, 30% 33% ( 2 ) : : 3 : 1 1 ) : 30mg, 2 3,, 60 90mg 5% 500ml, 2 ) : 50 100mg 3, 200 300mg 5% 250 ml, 30 50, 1, 2 3 3 ) 5% : 200 400 ml, 60, 1, 2 4 ) : 10mg, 3, 5 ) : 60 mg,, 15 6 ) : 0. 3 0. 6mg 5% 10 % 300 500ml, 1, 10, 7 ) : 25%,,
153,, 1ml, 3, 5,,,, 8 ) : 0. 1g, 3 4 ; 25mg, 3 ; 5 mg, 1 ;,, 200 400 mg, 3 4 ; 5 mg, 3, ; 2 4ml, 2, 9.,, 10,,,,,,, : : : 30mg, 3 ; 25mg, 3 ; 30mg, 3 : ; : E A;, ( ) 1. ( CDPC) CDPC, 0. 5 0. 75g, 10 14 18, 89%, 2. ( Duxil),,,,,, : : 1 2 :,, CT,,, 80% 3.,, 1mg, 3, 1. 5 2 mg 4. ( ),,, 5-,, 2mg, 3 3 6 95 8%, 88%,, 5. ( Cerebrolysin),, : 10 30ml 250 ml 5%, 60 120 10 20,, 8
154 10 6. 2 1. 5 2, 1, 10 7.,,, 8.,,,, 9. 150 200ml,,,, 1, 5, 1,, 10., 11 706 PSS Svate- 3,,,, ( ),,,, 24 48,, 3. 4.,,,, 5.,,,,,,, ( ) 1.,,, 2.,,, 3.,, 4.,,
155, 1,,,,, 2,,, 3,,,, ( cerebral embolism),,,,, 50% ; ; ;,,,, 10 %,,,,,,,,, 50 % 60%,,,, ;, ( ),,,
156 ( ),,,, ( ),, 12 48, ;,,,,,, ( ) 1,, 2 CT 24 48 CT 3, T 1 W, T 2 W 4 ( SPECT) 5 TCD 6 7,, 8, : ; ;, ( ) 1,, 2 ( 1 ) :,,, ;, 50% 40 ml,, 4 20 mg,, 2 3 25 mg, 3 ( 2 ) :
157,,,,,, ( 3 ) : ( 4 ) :, ( 5 ) : A C 10% ( 6 ) :, 90 % 5 10ml, 5 % 1000ml, 1, 3,,, 2 5, 2, 10, ( ),,, ( ), 0. 1g, 3, ( ) 1.,,, 2.,,, ( ) 1., 2.,, 3. ( 1 ),,,,,,, ( 2 ),,,,,,,,,
158,, ( ) 1.,,, 2.,,,,,,,,,,,,,, ( cerebral hemorrhage), 20% 30%,,,,,,,, 80%, - ( ) ; ( ),, 20%,,,,,, ( ),,
159,, ( ) 50,,, :,,, ;, : 1, 60%,, 60%,, : ( 1 ) :, 30ml,,, : 1 ) 2 ) 3 ) 4 ) 5 ) ( 2 ) :,, 30 160ml, : 1 ) 2 ),, 3 ),, 4 ) 5 ) 6 ), 7 ),,, 8 ),,,, 2, 15%, 11 80, : 25%,
160,,, ;, 65%,,, ;,, 10% 3, 5% 10%,,, :,,,,,,,,,,, 4,,,,,,,, 5, Weber ;,, 6, 7, 1 2,,, 24 ( ) 1, 86% 90%, 15%,,,, 2 3 2 16 %, 38 % 3 CT CT,,,,,, ( ) 50,,,,,
161, CT : 1. 2., 3. 4. 5. 6. CT 1 2, 3 4 5,,,, ( ),,,, ( ),, 15 30 ( ),,,,, ( ) 4,, 8 2, 4,, ( ) ( ),,, ( ),,,,,, 0 5 mg 25% 5 10ml ( )
162 20% 250ml( 20 40 ), 6 8 1, 10% 500ml, 1 2, 5 10mg, 5 7,,,,,,,, ( ),,, 0 4g, 1 2 6- ( ) 1 2,,, 1500 2000ml,,, 1 2,,,, ( ),, ( ),, ( ) CT,,,, CT,,, ( ),,, ( ) 1,, 4 6,,,,,,,,,,,, 2,, 3, 3, 3 4,,, 2500 ml, 5g,,,,
163 ( ) 1.,,,,, 2.,,,, 3.,,, 4.,,,,,, 5., 6., ( ) 1,,,,,, 2,, 50 %,, 3,, 2 4L, 4, 5,,,, 6,,,,,,,,,,,,,,,,,,
164 ( subarachnoid hemorrhage, SAH ),,,,, 31 /10, 4 /10, 57% : ( ) ( moyamoya),,,,,,,,, ;, SAH, 4 12,, ( ),, ; ; ; ;, ( ),,,,,,,, ;,,,
165 ( ) 1 1 /3, 1 /4,,, 2,,, ;, 2 3,,, 1 2, 3,, 3, 4 CT,, 5 MRI, 6,,,, 10%,,, ( DSA), 7,,, 8, T QT U,, 1 2,,, 3, 4,,, 5,,,,,,, ( ),,,
166,,, ( ) 3 3,,, : 1. 6 - ( EACA) 12 24g 5% 1000ml, 6g 25% 40ml, 8 18g 5% 500 1000ml 2. ( PAMBA) 400 800mg 5% 500 1000ml 3 ( AMCHA) EACA 8 10, 6g 5 % 400 ml, 2, 30 40U, 3,, ( ) 2 3 ( ),,,, 20% 250ml 50% 60ml 40mg, 6 20% 40 60ml, 2, 2 3 50% 100ml, 3 20% 200ml, 20% 200ml 25% 10%, ( ),, 1. 30mg 10 mg, 3 2mg 0. 5g 5% 500ml, 10 20, 2. ( ), C B 6 ( ),, 1.,,,,, 2., ( 60 ),,
167 3., - - ( ) 1, 4 6, 6, 1 2,, 2,,, 3., ( ) 1.,,,,,,,,, 2.,,,, ( ) 1.,,,,,,,,,,,,,,,, 1 2.,,,,, 3.,, 1 5000 2,,,,,, ( ) 1.,,,, 2,
168 2.,,,,,,, 5 10ml, 4 ( ) 1.,,, 2., ( ) 3.,,, 2 3, 1, 1,, ( ),,, 4., 400 800 ml 5. 6., 7. 8 8.,,, 9., 10. 11., ( ) 1.,, 15 30, 2., 3., 4., 1 2, 1 1 2 2 3,,,,
169 > 3 75mmol /L, : ( ) 4 16 16,,, : :, ;,, :,, ( ), : : :, : : : :,,,,,,,,
170, ( ),, ( ), 12 24 13 1 I, 1,, : 1, 39 40, 2,,,, 3, 160 /min,,,,,,, 4,,, 10, 5, 6,,,, 7,, ( ) 1 ; 2 T 3 T 4 ; 3 ; ( ),,,,,,,, :, 39, ;, 120 / min; ;,
171, T 4 TSH ( ) ( ) 1, 2, 3, 4 ( ),,, 600mg, 1, 20mg, 4 6 1,,, T 4 T 3, 1,, 30 60, 20 40 6 1 ( ) : 1 - ( ) 20 80 mg, 4 6 1, 1 mg, 5, 2, 1mg, 6 1, ;,, 100 200 mg, 24 ( ) 1 2, 30 60, 6 6 8 5 10 ; 0 5 1 0g, 8, 24 2 3g,, 3 7 ( ),,, T 4 T 3,, 200 400mg( 15 30mg), 2mg, 6 1 ( ),, C B A ATP,, ( ), 300 500ml,, RBC, 6 12 1
172 ( ) 1.,,,, 50 100mg, 25 50mg, 0. 3 0. 6mg,, 6 12 1, 2. 3.,, T 4 T 3,,,, ( ) 1, 2, 3,,,, 4,,,, 5,, ( ) 1,, 15 30, 2,,,,,, 3,,,,,, 4,,,,,,, 5,,,, ;,,,,
173 6,, B 6,,,, 7,,,,,,,,,,, 3 5g, 5% 1000 1500ml, 100ml 0. 3g, 1g, 40, 8,,,, 9,,,,,, 1,,,,, 2,,,, 3 T 3 T 4 4,, 5, 6 ( adrenal crisis) ( acute adrenal insufficiency),, : ( ) ( ) - -,,,
174 ( ) ( ),,, ( ) ( ), ( ),,,,,,,,,,,,,,,,,,,,,, 1,,,,, 2 3,, 1 2, 1, 2, 3, 4, 5,
175 6,,, 1 2,, ( ) 100mg, 100mg,, 10mg, 300 500mg, 5 30mg, 50mg,, 36 48 ( ), 5%,,,,, ( ),,, ( ), ; ; DIC, ( ),,,, ( ) 1 2, 2 3L/ min 3 4,, ( ) 1,, 2.,,, 3.,, 24, 4.,,
176 1.,,,,,,, 2.,,,,, 1,,, 200 300 mg, 3.,,,, 1 2,,,,,,, ( ) 1 2 3, 4 5, 6, 7,, ( ),,,,,,,
177 ( ), ( ) 1.,, 2. : ( 1 ),,,,, ( 2 ) :,,, 40, ( 3 ) :,, 4.,,, 26 30, ( 5 ) :,,, ( 6 ) :,, ( 7 ) :,,,, ( 8) ( ) :,,, 1, 2 3
178 ( ) 50 % 40 80ml,, 5%, 20 40 50%,,, ( ),,, 10 20mg, < 300mg, ( ),,,, 6 30 45mg, T 3, 6 25 g, T 4 0. 2 0. 4mg, 1 ( ),, ( ),,,, ( ), ( ) 1,, 2, 3, ( ) 1,,, 2.,, 24, 1.,, 2.
179,,,,, ( ), : ( ) ; ; ( ) ; ; ( ) ; ( ) ; ( ) ; ( ),,,,,, 6,,,,,,,,,,, ( ), 2 3.,, 2., 3., ( 1 ),,,,,, ( 2 ),,,, 50% 40 60ml,, ( 3 ) ( Addison, ),,
180 ( 4 ),,,, 1,, ( 5 ),, 10%,, ( 6 ), ( ) 1 2 < 2 8mmol /L 3 : 1, 2 ( ), 50 % 50 100ml, 50 %, 5% 10%,, 100mg 1 2mg,,,, 20%, 10g ( ),,, ( ) 1,,,,, 2.,,,,,,,
181,,,, ( ) 1.,,,,, 2.,, 12 48, 3,,,,,,,,, ; ; ( diabatiac ketoacidosis), ( ),,,,, ( ),,,, ( ),, -,,,,, -,,,,, ( ) A,
182, ( -),, ( ),,,,,,,,,,,,,,,,,,, ( ),,,, 2, 3-,,, ( ),,,,,,, ( ),,,, ( ), 30 40,, ( ),, ;, Kussmaul, ( ) ; ;, ;, ; ( ) 1, 16. 5 29. 75 mmol / L 2 8. 6mmol /L 3 ph < 7. 20, CO 2 CP < 13. 47mmol / L; 4 5 6 ( ),,, Kussmal,,, CO 2,
183 1 2, ( ) 0 9%, 0 1U / kg, 13. 9mmol / L ( 250mg /dl), 1 2U, 12, ( ) ; > 155mmol /L, 0 45%, 13. 9mmol /L( 250mg/ dl) 5%,, 2 4 1000 2000ml,, 3000 5000ml,, ( ),,, 500ml, 10% 10 15ml;, > 40 ml / h, < 30 ml / h, ;, ( ),,,, ph < 7. 1,,, ph,, ph < 7. 1, CO 2 < 90mmol / L, 5% 2 5ml /kg ( ) 1, 2,, 3 :,, BUN, 4,,,, ( ) 1,, 30,,
184 2,,,, 3.,,,, ;,, 4.,,,,,, 2% 3% ( ), 1 % 4%, 5. 24 6. 30,, ( ) 1.,, 2., 3.,, 4.,, 5.,,,,,,, ;, 6.,,, ;,,,,,,,, 24,,,,, 1 2L, 24% 28% 1., 2., 3., 4.,, 5., 6.,
185 ( nonketotic hyperosmolar coma), ;,,,,,,,, ( ),,, ( ) 1., :,,,,,,,,,,, 2.,,,, 3., ( ) 1 33. 3mmol / L( 600mg% ) 2 150 mmol /L,, 3 350 mmol /L( 350 mosm / kgh 2 O) 4, 5, 8. 21 31. 06 mmol / L 6, 7,,,, ( ) 1.
186 ( 1 ) 2 /3 ( 2 ) ( 3 ) > 33. 6mmol / L, > 145 mmol /L, > 350mOsm / L ( 4 ), : ( 1) ( 4), 2.,,,,,,,, ( ) ( 0. 45% NaCl), 330mOsm / L,, 3000 8000ml, 5000ml,, 8 12 1 /3 4, 1000ml,,,,,,,, ( ),,, 1000 ml 3g, 4 6 50ml, 24 4 6 g,,,,,, CO 2 CP 11. 23mmol /L, 1. 5%,, ( ), 4 6 U/ ( ),,,
187 ( ) ( ),,,,,,,,,,,,, ;,
188 ( heat illness), : ( heat cramp),, ( heat stroke), ( heat syncope ) ( ) ( heat stroke),, ( exertional heat stroke) ( nonexertional or clasic heat stroke) ; ( 35 ),,,,,, 37, 35, ; 35,,,,,,,,, Purkinje ;
189 ( ) ( ) 1,,,, 37 5 2, 38. 5,, 3,,, ( 1 ) : 40 42, DIC, ( 2 ) :,,,,, ( 3 ) :,,,, ( 4 ) :,, ( ) 1 ( 15 20) 10 9 / L,, 2, 3, 4 ( ),,, 1 2 3,
190 4 ( ),, ( ) 1 ( 1 ) :,,, 4 5%,,, 15 45,, 32 33,, 38,, ( 2) :, 25 50mg 5% 500ml, 25mg 25mg 5 % 100 200ml, 10 20 2, 1,, 38, 2 5%,, 3, 0. 3 % 4,, 5 10mg, 0. 1 0. 2g, 10 % 20ml 6,, 5 % 30% 6 8 DIC ( ) 1,, 2.,,,,, 10 1,,
191,,, 22 25 3.,,, ;, ;,, ; 15 25 ; 4 5% 500 1000 ml ; 38,,, 4 5. ( ) 1, 38, 2,,,, 5 %,, 3,,,,,,, 4,,,,,,, 5 6. ;,, 7.,,,,,,,, ( drowning), ( neardrowning)
192 ( ) ( ) ( ),,,,,,,, 2 ( ),,,,,,,,,, ( ) 3. 5%,,,,,,,,,, 70% ( ),, ( ),,,,, ;,,,,,,,,,,,,,,, 48 72
193 ( ) 1 ph 2, 3,,, ( ) 1 2,, 3 4, 5 6: 1 2, 3 4 ( ) 1,,,,,,,,, 2, 3,,, X ( ) 1,, 50 %, 60mmHg,,,,, 1 3mg,,,,, 2 ( CVP)
194,,, 3 5% ;,,,,, 4, 5 ; ARDS PEEP;,,, ( ),, 32 33,, < 31, 44,,,,, ( ) 1.,, ;,,,, 2,,,,,,, 5% 150 200ml,, 3,,, ( ),,,,,,,,,,,, ( IPPV) ( PEEP),,,,,
195 ( current flow) ( ) ( electrical injury), ( 380 V) ( > 1000 V) (, 10000 V 30 A) 300, 1879, 60%, 30%, ICU,,,,,, 8 12mA, 20mA, 50 ma, 100mA,, 300 1200mA,,, 40 50, 2000 4000,,,,,,,, 10 9 V, A, 0. 01 0. 1s,,,, ( ) ( ) 1
196,, 0. 5 2cm,,,,,,, :,,,,, 2,,,,,,,,,, 3 24 48, ( ) ( ) 1, 2 X 3 ( ) 1 2 ;,, ; 3, 1 2 3 :,,, ( ) 1,, ( 1 ) :,,,,,
197, ( 2 ) :,,,, 2,,,,,,,,,,,,,,,, 5% 100 200ml,, ( 1 1. 5 g) ( 3 6 mg) ( 8 16mg), 15 30 1,,, ( ), ( ICU),,,,,,, ( TAT) ( ),,,, ( ) 1,,,,,,, 2 3, ( ) 1,, 2, 3, 4,,, 2000ml, 40 60 ml 5,,, 1 2 1 2 ml,, 4 1
198,, ( ), ;,,,,,,,,,, 1,, 2,,,,
199,,, ( ) 1,, 2,,, ( ) 1 2 3, 4,,, ( ) 1,,, 2, 3,,, 4, ; ; 5( )
200,, ( ) :,,,,, :, ( ),,,,,,,,,,,,, ( ),,, : ; ; ; ; : ; ; ( ) ( ), ;, 1, 2 3,, 4 5 6 7, 8, 9
201 ( ) 1, 3% 5% 3% 5%, 2,,,, 3 ( 1 ) :, 2% 4%, 0 2 % 1% 3 4, 5mg, ( 2 ) :, 6, 1 5000 20000 2%,,, ( 3 ) : 20 30g ( ),, 6 2,, 4 ( 1 ) :,, 20% ( 2 ) :,, ( 3 ) :,,, ( 4 ) : ( ) 1 ( 1) : 1%,,,, ( 2 ) : 1 5000, ( 3 ) :, ( 4 ) :
202 ( 5 ) : 2% 5%,, ( 6 ) : 2 1 15 ml 200 ml, 2 : ;, : :, ( ),,,,, ;,, ;, 10 20mg, ; 0 1 0. 2g, ; ;,,, ;,, 3, (, ) ; ( ) ;, ( ),,,, ( ) 1,,, 2,,,, 3,,, 2 4L 4 3 5,,, ( ),,, : 1,
203 ;, ;,,, 2,,, 3,, 4,,,,,, : ;, ;, ; ;, ;, Na + K + Cl _ CVP ( ) ; ;,,,,, ( ),,,, ( ),,,, ( ),,,,, ( ),,,,,,,,,,, ( 3911 ) ( 1605)
204 ( ),,,,, :, ( ), 6 12,, 1, ;, 2, ( ), 3,,,,, 4,, : ( 1 ) :,, 50% 70 % ( 2 ) :,, 30% 50% ( 3 ) :, 30%,, ;, ; 1mg 50% 20ml, ;, ( ) 1 100% ;, 2,,, ;, ( ),
205,,,,, ; 1, 2, 3, PaO 2 12. 6 13. 3kPa, SaO 2 > 97%, PaCO 2 4. 7 6. 0 kpa 4 5 :, 24h, ;,, 3 7 ( ),,,,,,, ( ),,, 1% 5%, 2%,,, 6,,,, 24,,,,,,,, : 20,, 11 4,,,,, 50cm,,,, 300 500ml,,, 25 30,, 15000 20000 ml,,,
206 12 24, 2 4, 2000 ml ( ) ( 30 60g),,,,,, ( ) 1, ; ;, : 1 2mg,, 1 2 2 5 mg, 15 20 1 5 10mg, 10 15 1,,,,,, 140,,,,,,,, ( 0. 03 0. 05mg/ kg ), : ; ; ;,,, (, ) 2,, 3 5,, 3 ( 1 ) : 1 /2 1, 1 2 2 3, 1 /2 1, 60 %, 1, 2, 1 2, ( 2 ) : 0. 25 0. 5 g, 0. 5 0. 75g, 0. 75 1g, 1 /2 2 1 ( 3 ) : 0. 4g, 0. 8 1. 2 g, 1. 2 1. 6g, ( 4 ) : 0. 125 0. 25g, 0. 5g, 0 5 0 75g, 1 /2 2 1 3 ( ) 1,,, 2, 3,,, 4, 5,,,,
207 6, 7 8,, ( ), : 1 ; ; ; : 400 ml,,, 400ml 2 4, 400ml,,, 2 ( ),,,,,,,,,,, ( ),,,,,, :,,,,, 0. 9 4. 5 mg,,,,,,,, ( ) 1 ( 1 ), 6, 48,, ( 2 ),,, ( 3) 4%,, ( 3911 1059 1605 ) ( ), 32 38,,
208 5000 10000ml,, ( 4 ),, ( 5 ),, 2 ( 1 ),,,, 3 7, ( 2 ),, 3 ( 1 ) 3,, ( 2 ) 2 3, ( 3 ),,, ( ) 1 2, 2% 3 2% ( ) 1 5000 ( ), 4,,,,,,, 5,, 6,, 7, 8,,,, ( ) 1,,,, ;,,,,,,,
209 2,, ;,,,,, 3,, 20 % 200 400 ml 40 60mg 25% 4,,,,, 5,,,, 38 5,,,,, 6,,,,,, 7,,,, 8.,,,, 9.,,, 7, ( ), : 1,,,,,,,,,,,, ( 2 ),,, ( 3 ),,,,,,,
210 1,,,,,,,,,,,,,,, 60%, 2, 2 3,,, 3,,, ( carbon monoxide) : ; ; ; ; ; ;,,,,, ;,, ( ) ( ) 1, 2, ( ) ( ), 3,,,, 4,
211 4 : :,,,,, ( ), > 50%,, 5 ( ), 2 60, : : ; : ; : ; :, ( ), 10% 30% ; 30% 40% ; 40% CT : ( ) 1., ( Hbco),,, 2. ( 1 ) :, ( 2 ) : : 1 ) ; 2 ), 10 % ( 3 ) :,,, 30% ( 4 ) : : 1 ) ; 2 ) : ; ; ; ; ;, 50% ( 5) ( ), 2 60, : 1 ) ; 2 ) ; 3 ) ( ) ; 4 ), CT,
212 ( ),,, 1, 2 3 4, :,,,, ( ),,,,, ( ) 5% CO 2 COHb, CO, CO COHb 4 ; 30 40, 3 20,,, 95% 100%,, ( ) 20 % 250ml, 8 12 1, 5mg, B 1 B 6 C, ATP, C, A,, ( ), ;,,,, 50mg 50mg 100mg, 5% 500ml, 1 /3, 0. 3 0. 6mg, ;,, ( AET) - ( ),,,,,,, ( ) 1,,,
213, 2, ;, 3, 4 ; 4 5, ( ) 1,, 2,,,,,, 3,,,,, ; ; ;,,,, 4 : :, 6 8 :, 3 6 :, 2 3 :, 2,, ( ),, ( ), ;, 5 g, 3g,, 5 6,, 15,,
214,,,,,,,,,,,,, ( ) ( ) 1,,,, 2,,,,,, 3 10 20,, -,,,,,,,,,,,, ( ) ;, ; ( ) 1. 2.,, 3. 4. : 4 ( ), 1 2 3, 4
215, ( ),,,,,,,,, ( ) 1 1 5000, 10000ml, 50 % 60ml 2,,,,, 4% 5% 100 200ml, ( ),,,,,,,,,,, :, 48 1 1 50 100 ml 500 ml, 3 5 50mg,,, 2, 3 3 6 mg 6ml, 1 0ml,, 4 30 50mg,, 1,, 5 1mg, 15, ( ),,,,, ( ) 1,,,,, 2., 3.,
216 4. 5.,,,, ( ) 1., 2.,,,,,,,,, 1,,,, 10 % 15%, 40% 60 %, 10% 15%, 2% 5%,,,, ( ) ( ) : 1,,,,,, 2,,, 3,,,,,,,, ( ) 1 2 3, 4,
217 5 6 ( ), 1, 2 3 1,,,,, 2,,, 1%, 3,, 25 50mg, 4 1%, 5, 50 % 80 ml 16U, B 1 B 6 100mg, 2 6, 20mg 0. 5 g 7 20% 10% 8 : 15g,,, 1 3 3 5,,, 9, ( ) 1.,,, 10mg 2., 20%,,, 3., 5%, 4.,,
218 ( ) 1,,,, 2,,, 3,,,,,,,,, ( ),,,,,,,, ( ),,,,, 2 72, 4 12 ( ) 1 ( 1 ) :,,,,, 7 8,, 39 40, ( 2 ) :,,,,
219, ( 3 ) :,,,,,, 10 14 ( 4 ) :,, ( 5 ) :, ;, 1 40,, 2. 6 12,, 5 6, 20,,, 37. 5 39. 5,, 2 4, 3.,, 3, ( 1 ) : 2, 30, 10 12,,, 1 2, 3 4 ( 2 ) :, 30 2, 1 2 ( 3 ) : 4., 2 4, :,,,,,,, 3 4,,,, 1 2 5., 3 5,,, 2 2, 12 72,,,,, 4 10,,, ; 3 10,,, ( ),,
220 ( ) 1, 2, ( ),,, ( ) 1,, ( 1 ) :,, ( 2 ) : 0. 5mg, 654-2 10mg,, 5% 10% 500 1000ml,, 4mg 25 mg, 3 ( 3 ) : ; ; ; 2,, ( 1 ) :, 24,, 5 U 10 U ( 2 ) : 4 5%, 1 4000 ( 3 ), ( ) 1.,,,, 2.,,,, 3.,,, 4., ( ),,
221,,, ( ) 1,,,, 2,,,,,,,,,,,,,,, 3,,,, 6 10,, 1000 2000U,,,
222 ( head injury) 15% 20%,,,,, ( scalp injury) ( skull injury) ( brain injury),, 1 ( ) :,, 20,, ; ( ) :,,, 6,, ; ( ) :,,, 6,,, 2 Glasgow 13 15, 9 12, 3 8 15-1 15-1 Glasgow 4 5 6 3 4 5 2 3 4 1 2 3 1 2 1
223 1 :, ; : ; :, ;,, 2 :, ; :, ;, ; 3,,,, ( ),,,,,,,,,,,,,,,,,,, ( ),,,,,, ; ; ; ( ) 1. ( 1 ) : ( 2 ) : 3,, 1 ) :,,,,,,,, X 2 ) :,,,,,,
224,,,, 3 ) :,,, ( 3 ) :,, ;, ( ),,,, ( 4 ) :,,, 2.,,, ( 1 ) :,,, ( 2 ) : 3,,, 1 ) :,,, 2 ) :,, ;, 3 ) :, 4 ) :,,,,,,, ;,, 3.,,,,,,, 1, 4.
225 ( 1 ) : 1 % 3%,,,,, 1 ) 2 ),,,, 3 ) ( ) - - ( ) 2 3, 6 12,,,, 4 ),,,,,, ( 2 ) : 3%,,, 1 ) 2 ),,,,,, CT ( 3 ) : 1% 2%,,,,,,,,,,,, ( 4 ) :,,,,,,,,,, CT ( 5 ) : ( ), ( ) ( ) 1 ),, 2 ),, 3 ), 5. 30, 2,,
226 6 12, 12,,,,,,,,,,,,, CT 6.,,,,,, ( 1 ),,,, ( 2 ),,, X,, CT, ( ) 1 X, 2 CT CT, 3,, ( ), 1,, 2,, 3 4 5 ( ) 1,, 2 72,,, 2mm,,,,,
227, 3 ( 1 ) :,, ( 2) :, 12,,,,,,,,,,, 4 1 2 5, ( ) 1,, 2 1cm,, ;, ; ;,,, 3,,,,,,,,,,,,, ( ) 7 10, 24 48,,,,,,, ( ) 1,,,,,,,,,,,,,, 2,,,,,, CT,
228,, 3,,, 4,,,,,, CT,,,,, 5, ( ) 1,,,,,,,,,, 1500ml,,,, 2 ( 1 ) : 50%, 20% ( 2 ) : 5 7, 1500 2000ml ( 3 ) :, ( 4 ) :,,, ( 5 ) :,, 3 10ml 1, 1g 10% 500ml, 1 1 g 10g 10% 500ml, 1, ATP A C 4,, 33 35,,, 1 ( 50 mg, 50mg, 100mg), 1 /2,, 1 /3 1 /2, 20,,,,,, 4 6, 3 5,, 37,,, 5,
229 6 7,, CT,,,,,, ( ) 1 :,, : ;, ;, ; ;, 2 :,,,, ( ) 1,,,, 2,,,, 3,,, 4, 5,,,,,,,,,,,,,,,, ( ) 1.,, 15 30,,,,, 2.,,, 1000 1500ml, 500 800ml,, 2000ml,, 15 30,,,,,,,
230,,, 3. ;,,,,,,, 1 2L,,, ( ) 4.,,, 39 40,,,,, 5.,, 40 60,, 20% 250ml 24 6.,, 7.,,,,,,,,,, 3,,,, 8.,,,,, 1%,, ( 3g 5% 100ml) 9.,,,,, ( ) 1. 5 10,,,,,,, ( 1 ) :, ( 2 ) : ( 3 ) :
231,,,, ( 4 ) :,,,,, 2.,,,,,, 3.,,,,,, 4,,,, ;,,,,,,,, ( ) 1,,,, 2,, 39 40, 35 ( 1 ) :, 1, 6 7 %, 33, 35% ;, 1, 55%, 33, 1 /3, ( 2 ) 1 ) : 2 ) :,, 3 5 1 3 ) : 4 25 30 ml, 5 10, ( 3 ) 1 ) : ( 2 4 ), 37, 2 ) :,, 28,
232 32 3 ) :, ( ), 3 7, 2 3, 48 4 ),,,, ATP, 5 ) :,,, 24 1 2,, 0. 5 1mg,, 3, ( ) ;, 20 % 250 500 ml, 12. 5ml,, 4,,,, 5,,,, 6,,,, 7 ( 1 ) :,,,, 3 5, 30,,,, ( 2 ) :,,,,, 1 2,,,,, ( 3 ) :,, ( 4 ) :,,, 8, ;,,, 10 15 cm,,,,,,,, 3 7, 24,
233, U, 1.,, ( ), 2.,,,,, 3.,,,,,,,,,,, - 0. 79 0 98kPa( - 8-10cmH 2 O),,,, :, ;,,, ( chest trauma, thoracic trauma) 1 /4, ( thoracic - abdominalinjury), ( ),,
234 ( blast injury of lung) ( ) ( ) ( ),,, ( ),,, ( ),,, ( ) : 1. ( 1 ) :,,,,, ( 2 ) : ;, ;,, ; ( ),, ;, ( 3 ) X :, X,,,, X,,,, 4 6, 2. : 3,,, ( ),,, 3 ( pneumothorax),,, : ( 1 ) :, 30%, ;, ;,,,,, X,
235 ( 2 ) :,, X ; ( 3 ) :,,,, X,,, 4., 500 ml,, X 500 1000ml,,,, 1000ml,,,,,,,,, X 5.,, ( 1 ) :,,,,,, ( 2 ) :,,,,,,,,,,,, 6.,,,,,,,,,,,,,,,,,, X :,, X,
236 : :, ( ) 1 X, X 2,,,,,,, ( ), 1, 2 3, 4 5 6 7, ( ) 1,, 2, 3 ( ), : ; ; ; ; ; ; ( ) 1, 2.,, 3,,, 4,,,, 1
237 500 ;, 5,, 6,, 7.,, 3 5 L/ min,, 8,,,, ( 1 ) :,, 15 30, 1 2, 4 ( 2 ) :,,,,,,,,,,,,,, ( 3 ) :,,,,, 1 1. 5 kg, ( 4 ) :,,,,,,,,,,, ( 5 ) :,,,,,,, ( 6 ) :,,,, (,,,, ) ( 7 ) :,,,,,,,,,
238,,,,,,, ( 8 ) :,,,,,, 6,,,,,,,,,,,,,,,, 24, 1 2, 2 4, 7,, 8,,,,,, ( ) 1,,,,, :,,,, ( 1 ), :,,,, 1 2,,,, ( 2 ) : :,,,,,,,,, : 1 2, ( ) ( 3) :,
239 ;,,,,,, 2 24 50ml, 10ml,,,, X, :,,,,,, 1,, 2, 3,,, 4,, 5, 0 4% 2. 0 % ; 50%,, ;, ; 10%,,,,,,,,,,, ;,
240,,, ( ) ( ) 1, ;, ;, 2 3 4,, 5.,,,,,,,,,, 6,,,,,,, 7,,,,,,,,,, 8,,,, ( ) 1.,, 2. X,,,
241 X,, X ( ),,, 50ml, X,,,,, 3. B, 4. CT, ( ), CT, 5., 6.,, 90%,,,,, 17 18 0. 1 ml,,, 20 30ml,,,,,,,, :, 20 30cm, 1000ml( 10 20ml / kg),, : ( 25ml 1000 ml ) ; ; 100000 / ml 500 / ml; 100,, ( ),,,,,,,,,,, ;,,,,,,,
242,,,,,,,,,,,, ( ) 1, 2, 3 4, 5 6 7, ( ),,,,,,,, ; ( ) 1 : ; 90mmHg 100 / ; ; ;, ( 1 ) :, ;, ( 2 ) :, ( 3 ) : ( 4 ) :, ( 5 ) :, 2 : ( 1 ) ( 2 ) ( 3 ) ( 4 )
243 ( 5 ), ( ),,, ;,,, ( ) 1,,,, 2, 3 :,, 4 : ; ; ;, ; ;,,,,, 5 :,,,,,,, ( ) ( ),, 1 ( 1 ) :,, ( 2 ) :,,, ( 3 ),,, ( 4 ),,, ( 5 ) : 2,,
244, ( 1 ) :,,,,, ( 2 ) : 1 3, 38 5,,,, 100,,,, ( 3 ) :,, 48 72,,,,,, 6 7 ( 4 ) :, T,, :, : a.,, b., c. ( 50 55cm),, d.,,,,, 30 50ml e., 24,, 2 3,,, f.,,,, 30,, T :, a.,,,,, b.,,, ;, c., ( ),, d.,, e. T,,,,,,,, 48, : a. :,,,, b. ( ) :,,, c. :,,
245,,,,,,,, d. : 48 3 5,, 5, 5 7,, 10 12 5 ) : :,,,, 2 3,,,,,,,,,,, :,, 24, 1 2,,,,,,,,,, 6 ) :,,,,,, ;,, :,, 2 3,,,, ( ), 7 ), ( 3 ) :,,,, 1 ) :,,,,,,,,,,,,,,,, 2 ) :,,,,
246 3 5,,,,,, 1., 2,,, 3.,, 4.,,,, 20 %,,, ( ), : 1 2 3, 4 5,,, ;, ;, ( ) : 1,,,,, 2,, ( ), ( ),
247,, 1 0 1, 3 10 1, :, ; ;,,,,,, 4 2,,,,, ( ) ( ) 1,,,,,, 2 ( Brawn - Segurad ), 3,,, 4, 3 6 ( ) 1, 3 4 5, 4,,, 1 2 3 4,, 4 5,,,,,,,,, 20 50,, 100%,,,,, ;,, : ; ;
248 ; 2,,, : 2 3,,,,,,,,,,, 4 6,, - ( ),, 1,,, 3000ml,, 3,,,,,,,, ( ) 1 ( 1 ) :, ( 2 ) : ( 3 ) :,, 2 ( 1 ) X :,,, ( 2 ) :,,, ( 3 ) : CT, ( ),,, X, 1
249 2 3 4 5 6 7 8 9 10 ( ),,,,,,,,,,,, 3 4,,,,,,, 1 2,,,,,,, ( ),,,,,,, 1 ( 1 ) :,,,, ;,,, ;, ;,,,,,,, ( 2 ) 1 ) :,,,,,,
250,,,,,, 2 ) :,, 15, 12,, 3 ) :,, Mean 1, 4 ) :,, 5 ) :,,,, Faden ( 1 ) ( 4 ), 6 ) :,,, 7 ) : 2, 2, 5, ( ),,,, 8 ) - :,, -,, 15, 9 ) ( DMSO) :,,, DMSO,,,,,,,,, 10) : - 6-2 ( 1 ) :, ;, ;, ;, ;
251 ( 2 ) : ;, ; X CT, ( 3 ) : ; ; ( 4 ) :, ;, ( 5 ) : ;, 3,,, ( 1 ) :,,,,,,,, ( 2 ) :,,,, ( 3 ) :, 2,,,,,,,,,,,, ( 4 ) :,,,,, ( 5 ) :,,,,,, ( ),,,,, ( ),,,,,,,, ( ),,,,,,
252,,, ( ),,,,,,,,,,,,, ( ) : : 1,,, 2, ( 1 6000 ),, > 1500ml,, 3, 2 4 6,,, ( ) 40, : ; ;, ( ),,,, 2 3,,,,,,,,,,,,,,,, ( ) 1,, 2 3,,, 2,, 3, ( ) 1,, 4,,, 2 2 3,,,,, ( )
253 1,, 2,, 3,, 4,,, 5, 33 23, 3 /7, :, ( 15-1), 1 2, ;,,,,,,,,,,,, 1 2 1,,,,,,,,,,,,,,,,,,,,,,,,,,,, ( ),,, ;,
254 15-1,, ;, ;, ( ) 1 ; ; 2 ; ; ; 3,, ( ) 1. 1 /2,,
255 2. 1 /2,,,, 3., ( ), ( ) 1,,,,,,, 2, ( 1 ) 1 ) 1 2 :,, 1 3, 2 ) :, 3 7,, :, 4 5, ;,,,,,, ;,,, ;,,,,,, 6 7 ;,,,,,, :, : : :, : :, :, ( 2 ) : 1 10, 80 %,,,,
256 ( 3 ) :, 10 5,,, ( ) X, CT CT,, CT, MRI MRI, 1 2 3 4 5 6 7,,,,,,,,, ( ),, 2 3,,,,,,, ( ),,, 1, Minerva 3,, Minerva 1 2 2 4 2,,, 6 6 8,, 6,,
257,,, 3, Minerva 3,, 4 ( 1 ) :, 3,,,, ( 2 ) :, 3 6 ( 3 ) :,, 1 ( 4 ) :,, 2 3 ( 5 ) :, 10kg, X,,,, 2 3 kg, 6 8, ( 6 ) :, 3 4 ( 7 ) :, 4 6 ( ) 1,,,, 1 2,, 2, 3,,,, ( ),,,,,,,, X CT MRI,,,,, :,,,, ( ) 1
258 2.,,,, 3.,,,,,, 4.,, 5.,,,,,,,, 6.,, ( ) 1.,,,,,,, 2., 3.,,,,, 2 3,, ( 1 ) :,, ( 2 ) :,,,, ( 3 ) : 2,,,,, ( 4 ) :,,,, 1,, 2,, 3,, 4,,, 5,
259 ( ),,,,,,,,,,,,,, ( fracture of pelvis),,,,,,,, ( ; ), ( ),,,, ( ), ( ),, ( ),,, ; ; ( 15-2 ) ( ) ( ) 1 ( 1 ) :, ( 2 ) : ( 3 ) :,
260 15-2 2 ( 1 ) : ( 2 ) :, ( 3 ) :, 3 ( 1 ) :, 1000ml,, ( 2 ) :,,, ( 3 ) :,,,, ( 4 ) :, ;, ; 1
261 5 ;, ; ;, ( 5 ) : ( ),,,, ( ) ( ), X,,, ;,,, 1 24 2 3 4 5 6 ( ),,,,, 1 /2,,,,,,, ( ),, ( ) 1, 4 5 2 1 2, ;, ;, 3, 3 4,, 6 8,
262,, 3 6,,, ( ) 1. 2.,,,,, 3.,, 4.,, 5.,, 2 3 6.,,,,, ( ) 1., ( 1 ),,, ( 2 ),, ( 3 ) 2 ( 1 ), ( 2 ),, ( 3 ), ( 4 ), 3 ( 1 ), ( 2 ),, ( 3 ),, 4 ( 1 ) ( 2 ), ( 3 ) 5, ( ),,,,,
263 ( ) 1,, 2 1 2, 3 3 4, 4, 6 8,, 12 1,, 2,,,,,, 3,,,,,,,,,,,,,,, ( ),,,,,,,,,,, ( ),,,,,
264,,,,,,,,,,,,,,, ( ),, ( ) 1,,, 2,,, 24 ( ) 1, 1. 020, 60 mmol /L 0. 333mmol / L,,, 1. 010,, 60mmol / L, 0. 1665mmol / L, / 10 1, / 20 1, 2 :,, 3,,, 4 ( ) 1 ( 1 ) 5, ( 2 ) ( 3 ), 44. 3 88. 5 mol / L( 0. 5 1mg /dl)
265 ( 4 ) 1. 010, 40mmol /L, 350 mmol /L ( 5 ), ph 2 ( 1 ) :,, 1. 020,,,,, 30 500ml,,, ( 2 ) :,, 1 2 3, 4, ( ), ;, 1,,,, 2, 3, 4,, 5, 6, 8 g 1000 2000ml,,,,, 5% 150ml ( ),,, ;,,,, 1% 80 100 ml, 1, 3 4ml / kg, 24 ( 1500ml),, ( ), 5% 100 200ml, 20% 250ml, 320mg