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ivnpocpeocop Ka^ BOJlbHROA OTHCT o paiij|oivni3npoBaiiiiOM cpaBiiHTCJibiioivi npHMeiieiiini rpancKcaMOBOH KHCJIOTI>I («TpaneKcaM») H 3nCHJlOH-aiVIHHOKanpOHOBOM KHCJIOTbl flJIH JICHeilHII JlCrOMHblX y oojibiibiv ry6epKyjic3OM.

OTHCT o paiij|oivni3npoBaiiiiOM cpaBiiHTCJibiioivi ...tranexam.ru/docs/Otchet_lechenie_legochnyh_tuberkulez.pdf · BpCMSI POCCHH OXHOCHXCfl K 22-M C'lpEHaM C C3MOH BblCOKOH 3a6oJieBaeMOCXbK)

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Page 1: OTHCT o paiij|oivni3npoBaiiiiOM cpaBiiHTCJibiioivi ...tranexam.ru/docs/Otchet_lechenie_legochnyh_tuberkulez.pdf · BpCMSI POCCHH OXHOCHXCfl K 22-M C'lpEHaM C C3MOH BblCOKOH 3a6oJieBaeMOCXbK)

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3nCHJlOH-aiVIHHOKanpOHOBOM KHCJIOTbl flJIH JICHeilHII JlCrOMHblX

y oojibi ibiv ry6epKyjic3OM.

Page 2: OTHCT o paiij|oivni3npoBaiiiiOM cpaBiiHTCJibiioivi ...tranexam.ru/docs/Otchet_lechenie_legochnyh_tuberkulez.pdf · BpCMSI POCCHH OXHOCHXCfl K 22-M C'lpEHaM C C3MOH BblCOKOH 3a6oJieBaeMOCXbK)

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6biTb paBHOMepno OKpamena B po3OBO-KpacnbiH HBCT, 6biTb KPOBHHHCTO-neHHCTOH, p^caBoro HJIH ^ejiTo-KopHHiieuoro usera. B SojibiuHHCTBeKpoBoxapKaHte BbisbiBaexcfl zuiane/jesHbiM BLIXO^OM apuxpouHTOB usKpOBCHOCHoro pycua npH BOSpacTaiiHH ^aBJieHMa B cocyzie, na (Jjone

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Ty6epKyne3 - o^na H3 jipcBiieHiiiMxTaK,Ty6epKyjie3Hoe nopa}KeHHe no3BOiiKOB 6buio HanneHO yB rpeqHH Ty6epKyjie3 Hasbinajin phtisis HJIH «HCTomeHHe», «naxoTKa». OT3ioro cjiosa npOHCxoAHT H coBpcMciiiioc nasBaHHe HayKH, H3ynaioineHxy6epKyjie3 - 4)TH3HaxpHJi; a cnenHajiHCTw, H3yHaiom,He ry6epKyjie3,(J)TH3HaTpaMH. B XVII - XVIII BCKax, B nepHo/i yp6aHH3auHH H pe3Koro pa3BHTHanpOMbiiiuieHHOCTH, 3a6ojieBacMoc'ib Ty6epKyjie30M npno6pejia B EsponexapaKiep 3nHjieMHH. B 1 650 ro/*y 20% cMepTefi cpezin >KHTejiew AHFJIHH HVsjibca 6biJio o6ycjTOBJieno Ty6epKyjie3OM. B nepBOH nojroBHHe XX3a6ojieBaeMOCTb Ty6epKy;ie3OM B pa3BHTbix cipanax crajia cHM>KaTbHa OTCyTCTBHC 3(})4)eKTHBHbIX MCTO/lOB JICHCIIHa, HTO 6bIJlO o6yCJTOBJlCHO

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B POCCHH ncurbeM 3a6ojiciiacMocTH Ty6cpKy;ie3OM Hanajica B 1991H ^ocxiir MaKCHMajibHoro siianciiMa - 83 ^ejioucKa Ha 100 Tbic HacejieHna - B

Page 4: OTHCT o paiij|oivni3npoBaiiiiOM cpaBiiHTCJibiioivi ...tranexam.ru/docs/Otchet_lechenie_legochnyh_tuberkulez.pdf · BpCMSI POCCHH OXHOCHXCfl K 22-M C'lpEHaM C C3MOH BblCOKOH 3a6oJieBaeMOCXbK)

BpCMSI POCCHH OXHOCHXCfl K 22-M C'lpEHaM C C3MOH BblCOKOH 3a6oJieBaeMOCXbK)

xy6epKyjie3OM. PHCK saGojiexb cymecxBemio lasucHT ox B03pacxao. Cpc/in HH<j)HUHpOBaHHbix 3a6ojieBaeMOCXb xy6epKyjie3OM

BbicoKa B JOHOUICCKOM H MOJIO/IOM B03pacxe. V /KCHIUHH Go/ibiiiHHCXBOcnynaeB saGojieBaHHa npuxo^Hxoi na B03pacx ox 25 40 34 jiex, B 3XOM BO3pacxeHcenmHHbi Gojreiox name MJOKHMH.

B CBJI3H c BbicoKOH pacirpocxpaHeiiiiocxwo xy6epKyjie3a B HameMcxpane npo6i:eMa KpoBoxeneoHH H KpoBoxapKaHHj* y GojibHbix xyGepxyjiesoMoco6eHHO aKxyajibHa. reMocxaxH4ecKaa xepanun neroHHbix KpoBoxeneHHHHBJisexca Heoxx>eMJieMOH nacxbio KOMiuieKciiOH naxoreHexHHecKOH xepanwH, rjieOCHOBHOH KOMnOHCHX - Me^HKa.\ieHXO3HOe CIIM>KCHHe ^aBJieHHM B MaJIOM H

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B pa3BHXHH jieroHiibix KpoBOTeneiiMH H KpOBOxapKaHHH y 6ojibHbixxy6epKyjie3OM onpeziejieanoc snaneHHe npH^aexcn cHcxeMe cseprbiBaHHaH 4)H6pHHOJTH3a. H3BCCTHO, HTO TKailh JICFKOrO COZiep^CMX BblCOKOaKXHBHblH

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(f)H6pHHOJTIX3a (II. C. Py-CCHKHH, 1973). CKJIOHHOCXb K JierOMHbIM

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npoxpoivi6HHa nenenbio, a xaK >KC 4>aK'ropa XareMana (1961), A. M. MaKHHCKMH,F. C. A3H3OB (1972) 6ojibiiie ripM;iaBaJin snaneHHsi 4)yHKUMOHajibHOHHC^OCXaXOMHOCXH XpOMGoilHTOB, KOTOpafl XapaKXCpMSOBaJiaCb CHH>KeHHeM

xpoivi6o njiacxMHOMHoro (J)aKxopa. ^pyrMC anxopbi (H. M. PsaeB, A. H.MaKHHCKHH, 1970; JI. B. Xy;i3HK, 1978) ycxaiioBMJTH cHH^CHne aKXHBHOcxn XIII4>aKxopa, BCJie^cxBHe Hero crycxoK ()iH6pHHa o6pa30BbiBaexc5i 6bicxpo, HOocxaexca pbixjibiM 113-33 tie/iocxaxKa aKTMBHocxn XIII (J>aKxopa njia3Mbi((J)H6pHHa3bi), Koxopbifi yKpciuisicx ero cxpyKxypy. F. B. CyxblpHHa (1967), Brnn,Beraon (1967); A. B. LLIeMcxoB (1968); H. M. OoMHHeBa (1974) B 6ojibiiiHHCXBe

HauuiM 4)H6pnHOJiHXHHecKyio aKXHBiiocxb njia3Mbi B MOMCHX neroHHbixH KpOBoxapKaiiHii uoBbiiiieniiOH. TxaHb jierKoro

6ojibiuoe KOJIMHCCXBO aKTHBaxopa npo<}>H6pHHOJiH3HHa, MecxHoKoxoporo MO^cex npHBecxw K pac rBopcuHio 4}H6pHHOBoro crycxKa,o6pa3OBaBmeroc$i na MCCTC noBpe>K;icunoro cocy^a, BCJie/icxBue HeroBO3HMKHyXb KpOBOXeHeilliC. McXO;jH H3 3TOrO, F. C. HCBepOB (1967) H3y4HJl

(j)H6pHHOJIHXH4eCKyK> aKTHBIIOCTb MOKpOTbl MCXO^OM ({)H6pHHOBbIX HJieHOK H

HaiUeJI, HXO 4)K6pHHOJTHXHHeCKa5l aKXHBHOCXb MOKpOXbl y 6oJl!>LlIHHCXBa 6oJTbHbIX

c KpoBoxapKaniieivi Bbicoxaa H B concxaiiHH c ^pyrHMH 4)aKxopaMH co3aaexnpe/inocbijiKH A^a 4JiHxejibiioro KpOBoxapKaiiMM. flajiee JI. B. Xy,U3HK, B. M.CH6Hp>TKOB, JI. A. VcaMCBa (1971), conoc'raBnaa nojiynenHbieHCCJieZl,OBaHHH 4)H6pHIIOjrHXHMCCKOH aKXHBHOCXH IIJia3MbI H MOKpOXbl,

ycTaHOBHJiH, HXO y 6ojibiibix xy6epKyjie3OM jierKHx iiaGjii4)M6pHHOJlMXHHeCKOH aKXHBHOCTH HJiaSMbl M MOKpOXbl. OcoGeHHO OHH Bblpa>KeHbI

npH ^ecxpyKXHBHOM xy6epKyjie3c, OCJIO>KIICHHOM JieroHHbiM KpOBoxeneHHCM HKpOBoxapKaubCM. JI. B. Xy;i3HK (1977) cnHxaex, qxo B naxoreH63e jieroHHbix

Page 5: OTHCT o paiij|oivni3npoBaiiiiOM cpaBiiHTCJibiioivi ...tranexam.ru/docs/Otchet_lechenie_legochnyh_tuberkulez.pdf · BpCMSI POCCHH OXHOCHXCfl K 22-M C'lpEHaM C C3MOH BblCOKOH 3a6oJieBaeMOCXbK)

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B KOMnJieKCHOM JICHeHHH JlCFOHHblX KpOBOTeH6HHH H KpOBOXapKaHHH

npH Ty6epKyjie3e Heo6xoziHMo ynnxbraaxb jiamibie KoarynorpaMMbi HxpoM6o3JiacxorpaMMbi, xaK KaK npn BBejieiiHH c reMOcxaxunecKOH nejibio XOJILKOKoaryji^HxoB (xjiopucxbiH KanuuHH, BHKacoJi H up.) ne yHHXbiBaexcn (J)H3HOJiorHHnpouecca CBepxbiBanHH KPOBH, oco6einiocxH 4)apMaKOJiorHHecKoro AeHCTBMHKoarynaHTOB H naTorenes Jicroniibix KpOBOTeneiiMH H KpoBOxapKaHHH. HCXOAH M3MexaHMSMa ^opMiipOBaHHa crycTKa, HX oc'ranoBKa .uojmHa npOBO/inxbOi HexojibKo KoaryjiaHTaMH, HO M HHrwGHTOpaMH (j)H6pHHOjiM3a (cHHxexHHecKneaMHHOKHCJIOXbl — 3HCHJIOIiaMHHOKaHpOlIOBaM,

aMHHOMexHJiUHKoreKcaHKap6onoBasi; H uemecTBa >KHBOXHoro M pacxHxejibHoronpOHCxo^c/ieHHa - Tpacujioii, najioji, HiiHnpoJi, Koirrpn-Kaji, iinrHxpHJi) - JI. B.Xyfl3HK(1977).

npencxaBJiaex HHxepec UOSMO^KHOCTB 6bicxpOH H acjxfjeKXHBHOHocxanoBKH KpOBOxeneHMH H3 JierKMX c HcriojibsoBaiineM oxenecxBeHHoroaHXH(J)H6pHHOjiHXHHecKoro npenapaxa xpaHCKcaMOBOH KHCJIOXBI «TpaneKcaM», BKanecxBe KOMnoneHxa KOMnJieKcuoH xepanHH.

TpaneKcaMOBaa KHCjioxa (TpaneKcaM) - o6na^aexAHTH(J)H6pHHOJTMTHHeCKHM, IlpOTMBOaJlJlCprMMeCKHM, IIpOXHBOBOCnaJlHXeJlbHblM

^eHCXBHCM. TpaHCKcaMOBasi KHCJiora HiirHGnpyex aKXHBaxopbi nuasMHHorena Hnjia3MHHa H noflaBJiMex o6pa3OBaiiHe KHHHHOB M /ipyrnx nenxn^OB, yMacxByioujHxB BocnajiHxejibHbix H ajxncprHLiecKHX peaKunsix.

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xpOM6oij,HxapHbix npoGoK B noBpoiuicinihix cocyziax. DoziaBJieHMe (J)H6pHHOJiH3aocHosaHO na KOHKypenxHOM xopMO>KeiiHsi HJia3MHiioreHaKXHBHpyiomero4>epMeHxa H yrnexenHH o6pa3OBaHHH njiasMHua. HpHMeHeHHe xpaneKcaMOBOHKHCJlOXbl OCOGeilHO 3^^CKTHBHO IlpH HaXOJlOrHHCCKHX COCTO3HHHX C

XapaKxepIi3yK)lHHXC)l (JmGpHIIOJIMXHHeCKOH aKXHBHOCXH B KpOBH H XK3H5IX, B XOM

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1 rpynna -rpai-ieKcaM

N=30

II rpynna -KOHTpOJIb

N=30

J\O J I C H C H M M

CHH^CCH %

Hopivia %

OoBbiiueH %

Me^Hana (KBapxnjiH)

40%

60%

0

33,78

(24,9-41,5)

38%

62%

0

35,4(33,7-36,1)

Hepes 24 naca

CHH^CCH %

Hopivia %

ROBLIIUeH %

Me^Hana (KBapxHJin)

50

50

0

31,9(21,3-42,5)

65.5%

33,5

0

27,2(25,7-30,1)

OueHKa M3MeiienMH 3a 24 naca

CHM^eHHe 3a 24 naca

(% Ha6jTIO^eHHH)

CHH^ceHHe sa 24 naca B a6c.3Han - Meanana (KBapTHJin)

CHH>KeHHe 3a 24 naca

B % OT HCXO^H. 3naH.

70,3

5(1 ,5-7 ,45)

14,5

(5,0-21,2)

90

7,7(5,6-8,6)

22,7(15,7-23,8)

MeHee Bwpaxceiiiioc CHH^KCHHC ypoBiia reMaxoKpHTa Ha cj)OHe npnervia

npenapaxa TpaneKcaM, no cpaBiieitHio c rpyiinoii IFICHJIOH aMMHOKanpOHOBOH

KHCJTOXbl.

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Ta6jiHna 3. HoicasaxejiH MHO

MHO

HopMa 0,800- 1,1 40

I rpynna-xpaiieKcaM

N-30

II rpynna -KOHXpOJIb

N-30

}[o JICHCHHM

CHH^CCH %

Hopiua %

HoBbiineH %

Me/mana (KBapxMJin)

-

20

80

1,26

(1,08-1,59)

-

20

80

100,6(1,08-1,59)

Hcpes 24 naca

CHH)KeH %

Hopiua %

HoBbiineH %

Me^HaHa (KBapxHJiH)

7,1

75

17,9

1,28(0,93-1,87)

40

50

10

1,10(0,78-1,51)

OueHKa H3MeHeiiHH 3a 24 Haca

CniDKeHne 3a 24 Haca

(% Ha6jIK),ZieHHH)

CHH^KCHHC 3a 24 Haca B a6c3Han - Meanana (KBapTHJiii)

CHH^eHHe 3a 24 Haca

B % OX HCXOZIH 3HaH

89,3

6,6(2,4-13,9)

6,7(2,25-13,4)

100

8,25(6-13,4)

8,31(6,2-14)

MHO (MOKAyHapozjHoc nopMajiH30BanHoe oxnomeHHe) - xecx,no3BOjmomHM HanGojiee TOHIIO O U C H M i b pcsyjibxaxbi npoxpoiviGHHOBoroH HH^eKca, H cJie^OBaxejibiio, COCTOMIIHC cBCpXHBaioincM CHCTeivibi KpOBH. BHacxoittuee Bpeivia MHO JIBJIHCXCH «3OJioxbiM CTanjiapxoM» B ouenKe3(^(J3eKTHBHOCXH H 6e3onacnocxH JICHCIIMH.

KaK BH^HO H3 xa6jiHiibi, ua (J)onc JICHCHHJI TpaneKcaMOM PHCKxpOM6oxHHecKHx ocjio>KiieiiHM (no ; iauifbiM MHO) ne Bbipa^en, HXO

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no4XBep>K,aaex jinxepaxypiibicxpanexcaMOBOH KHCJIOTLI.

o oe^onacnocxH

Ta6jiHua 4.1 IoKa3axejiH

TpOM6oiiHXbi

HopMa 180-320

I rpynna -rpancKcaM

N=30

II rpynna -KOHXpOJlb

N=30

l\O J IC4CI IHM

CHH^CCH %

HopMa %

HoBbimeH %

Me^Hana (KBapxHJin)

53,6

42,9

3,6

316,09(154-520)

51,4

48,6

-

280,8(179-360)

Hepes 24 naca

CHH^eH %

HopMa %

HoBbimeH %

Me^naHa (KBapxiuiw)

53,6

39,3

7,1

323,45(177-510)

30

50

20

234(169-263)

OueHKa M 3 M C I I C H M M 3a 24 Haca

CnH)KeHHe 3a 24 naca

(% Ha6jiio^eHHH)

CHH>KeHHe 3a 24 Haca B a6c3nan - Me^wana (KBapxHJin)

CHHacenne 3a 24 Haca

B % OX HCXO^H 3HaH

71,6

6,55 (-8,5)- (23)

5,8(~3,9)-(13,5)

40

-5,5

(-49)- (30)

-4,2

(-22,9) -(11, 5)

Ha 4»one npneMa npenapaxa oxMCscubi pa3nonanpaBJieHHbie H3MeHenn»

noKasarejieii. Bo BxopoM (anciuiOH-aMHHOKanpOHOBaa Kncjioxa) rpynne B

OXMCHCHO He6ojibixioe yBejiMHennc ypoBiui c GOJIMIIHM pasGpocoM, B OCHOBHOH -

He6ojibiuoe cHH^KCHHe napaivicxpa, TO>KC c GojibmviM pa36pocoM.

10

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Ta6jmua 5. IIoKasaTenH AHTB

AMTB

HopMa 28-43

I rpynna -TpariCKcaM

N-30

II rpynna -KOHTpOJlb

N-30

1(0 J ICHCHHM

CHIDKCH %

HopMa %

HoBbimeH %

Me^Mana (KBapTHjra)

64,3

35,7

-

27,82(19,3-29,7)

68,5

41,5

-

25,05(23,2-27,6)

Hcpe3 24 naca

CHPDKCH %

HopMa %

noBbimeH %

MejiHana (KBapTHJin)

42,9

60,1

-

27,59(24-30,6)

70

30

-

27,4

(21,5-28,7)

qacTHHiioe TpOM6onnacTHHOBoe BpeMa HJIM AHTB3xo BpeMJi, sa KOTOpoe oGpasycTCJi crycroK KpoBH nocjre npiicoe^HHeHHa K

xjiopM^a Kajibuna H ^pyrnx peareiiTOB. AHTB - naii6ojieenoKa3aTeJib cBepTbmacMOCTH KPOBH, onpe^ensieMbiM npH

cHCTeMbi reMOcrasa. Mcxo;_ino HHSKHC 3HaneHHH riapaMexpOB Bo6enx rpynnax neMHoro no^pocjm na (})oiic

B rpynne nauneHTOB, nojiyqaiimnx jieneiiHe TpaneKcaMOM, HoprviajiM3auHsireMocxasa B TeneiiHe cyTOK BcrpenaeTca y 6ojibmero nncjia 6o^bHbix.

1 1

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1. 3(J)4)eKTHBHOCTb TpaHeKcaMa B KOMmieKCHOH xepanHH jieroHHbixKpoBoxenemiH cymecxBCHHO Bbime, HCM y anciijioH-aMHHOKanpoHOBOH KHCJIOTW,KaK no ^aHHtiM KJiHHHHecKoro Ha6jiK>fleHHa, xaK H no /jaimbiM AHTB.

2. EesonacHocxb xpaneiccaMa o6ycnoBJiena Kax OXCVXCXBHCM BJIHHHHH HaTpOM6oo6pa3OBanHe, xaK H sa CHCT 6ojiee 6bicxpOH HopMajiHsaijHH reiuocxasa ,HTO 6bijio noKa3aHO B

3. HpenapaT TpaneKcaivi B KOMnjieKCHOH repanHH jieronHbixaBJiHCTca npenapaxoM BbiGopa, nosBOJisnomHM Ha^e^KHO H 6e3onacno ocxaHOBMTbjieroHHoe

4. HpHMeHeHHe npenapaxa TpaneKcaM coKpamaex nacxoxy onepaxuBHorojieroHHbix

Jlnxepaxypa1. Andersson L, Nilsson IM, Nilehn J-E, et al. Experimental and clinical studies onAMCA, the antifibrinolytically active isomer of p-aminomethyl cyclohexanecarboxylic acid. Scand J Haemal 1965;2:230-47.2. Bartholomew JR, Salgia R, Bell WR. Control of bleeding in patients withimmune and nonimmune thrombocytopenia with aminocaproic acid. Ann InternMedl989; 149:1959-1961.3. Can drugs reduce surgical blood loss? (editorial) Lancet 1988; 1:55-56.4. Coulter A., Kelland J., Long A. the management of menorragia. Effectivehealth Care Bull. 1995; 9: 1-14.5. Kobrinsky NL., Israels ED, Gerrard JM et al. Shortening of bleeding time by 1-deamino-8-D-arginine vasopressin in various bleeding disorders. Lancet 1984;1:1145-1148.6. Mannucci PM, Vicente V, Alberca I et al. Intravenous and subcutaneousadministration of desmopressin (DDAVP) to hemophiliacs: pharmacokinetics andfactor VIII responses. Thromb Haemost 1987; 58:1037-1039.7. Melander B, Gliniecki G, Granstrand B, et al. Biochemistry and toxicology ofAmikapron*:the antifibrinolytically active isomer of AMCHA (a comparativestudy with eaminocaproic acid). Acta Pharmacol Toxicol 1965;22:340-52.8. Okamoto S, Okamoto U. Amino-rnethyl-cyclohexane-carboxylic acid:AMCHA. A new portent inhibitor of the fibrinolysis. Keio J Med 1962;! 1:105-15.

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Med 1989; 149:1959-1961.3. Can drugs reduce surgical blood loss? (editorial) Lancet 1988; 1:55-56.4. Coulter A. , Kelland J., Long A. the management of menorragia. Effectivehealth Care Bull. 1995; 9: 1-14.5. Kobrinsky NL., Israels ED, Gerrard JM et al. Shortening of bleeding time by 1-deamino-8-D-arginine vasopressin in various bleeding disorders. Lancet 1984;1:1145-1148.6. Mannucci PM, Vicente V, Alberca I et al. Intravenous and subcutaneousadministration of desmopressin (DDAVP) to hemophiliacs: pharmacokinetics andfactor VIII responses. Thromb Hacmost 1987; 58:1037-1039.7. Melander B, Gliniecki G, Granstrand B, ct al. Biochemistry and toxicology ofAmikapron*:the antifibrinolytically active isomer of AMCHA (a comparativestudy with eaminocaproic acid). Acta Pharmacol Toxicol 1965;22:340-52.8. Okamoto S, Okamoto U. Amino-rnethyl-cyclohexane-carboxylic acid:AMCHA. A new portent inhibitor of the fibrinolysis. Keio J Med 1962;! 1:105-15.

13