Post on 30-Apr-2019
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o npOBe^eHHM KJinHHHecKoro HCCJie,aoBaHns:
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jpaHCKcaMOBOH KHCJiorbi H Hajiponapiraa
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2009
2
onepaijHH npoxe3HpoBaHHfl KOJICHHOFO cycxasa npe/uiojiaraeT o6si3a-
xeiibHoe HcnojibaoBaHHe cnenHaiibHbix MCTO^OB yMCHbineHHa o6i>eMa KpoBonoxepH, coxpaHe-
HH3 co6cTBCHHOH KpoBH nanHCHxa H cHtDKCHHa ero noxpeSHocxH B Tpanc(|>y3nax KOMnoHen-
TOB ^OHOpcKOH KpOBH. Bo BpeMa BMeuiaxejibcxBa 3XH 3a£aHH MO5KHO peiuHTb, oncpHpya «no;i
>KryxoM», 03113x0 nocjie CHHTHS TypnHKexa, ^H(})4)y3Hoe KpoBOxeneHHe HS noBpeayjenHbDC
ycHJiHBaeTca H npoaoJDKaeTCfl eme B xeneHHe HecKOJibKHx nacoB. OAHOH H3 ocHOBHbix
T3KOH KpOBOTOHHBOCTH aBJIflCTCfl aKTHBaUHa 4>H6pHHOJIH3a_ riepBHHHO 3T3
HOCHT KOMneHcaTopntm xapaxxep H aBJiaerca OTBCTHOH na nOBbnneHHe
noTCHUHana KpOBH B 3one noBpe^aeHH^ Txanefi, oAHaxo BCJie^cTBue 3HaHHTenbHoro nocxyn-
JieHHa B KpOBB U.HTOKHHOB H 3pyTHX BCmCCTB, IIpSMO HJIH OnOCpCflOBaHHO yCHJIHBaiOmHX
ueccbi npoxeoJiH3a, axTHBai^Hfl njiaaMHHorena MOMCCT cxaxb iipe3MepHofl,
OKOH^axejiBHOMy reMocxasy. V no/^aBJiaiomero 6ojibniHHCXBa 6o;ibHbix xaxaa
HC HMeex cucxeMHoro xapaxxepa H oxMeHaexca TOJILKO B pane, ojinaKO 3xox 4>axx ne
ex ee xjiHHH^ecKoe 3naHeHHe. ITocjieonepaiiHOHHafl KpoBonoxepa, BKJiiOHaiomafl cKpbixbie no-
xepH (B BHZie reMaTOM) H asHbie (no apenajKy), no oSteMy B 3 -5 pas npeBbnnaex nnxpaone-
noxepio KpOBH, Be/m K pasBHxuro ranoBOJieMHH, aHCMHH, HapynieHHaM reMoan-
, noBbimeHHio noxpeSnocxH B reMOXpanctJ)y3Hflx, ^xo B KOHCHHOM nxore, yxy^maex
nepHO^a H pe3yiibxaxbi jienejHM^B -I^CJIOM.
3XH o6cxoaxe:ibcxBa, jieKapcxseHHbie cpe^cxBa, 6noKHpyiontHe n36uxoifflBiH
(J)n6pHHOJin3, Moryx Sbixb nojiesHbi ana yMCHLmeiraa o6teMa KpoBonoxepH. B MnpoBoii KJIH-
HH^ecKOH npaKXHKe ^Jia 3XHX uejien Hcnojn>3yiox xpn npenapaxa: anpoxHHHH, SHCHJIOH-
aMHHOKanpOHOByK) KHCJioxy H xpaneKcaMOByio KHCJioxy. B ne^aBHCM cHCTCMaxH^ecKOM 06-
30pe accoiinaijHH Koxpana, BKJUOHHBineM ^aHHbie 21 1 paimoMii3HpOBaHHbix KOHxpojinpyeMbix
HcnbrraHHH (20 78 1 ynacTHHx) OXMCHCHO, HXO HHrnSuxopbi <JtH6pHHonH3a SHannxejitHO
yMCHbmaiox o6i.eM KpoBonoxepn H noxpeSnocxb SojibHbix B reMoxpanccJiysHflx, npH SXOM HX
HcnoJibsosaHHe He conpOBOMc/iaexca ysejiHHeHHeM HHCJia xpOM6oxirtiecxHx ocjioacHeHHii H
cMepxejibHbix HCXO^OB. B cpaBHHxejibHbix HCCJieflOBaHHax SXHX npenapaxoB Hexoxopbie npe-
HMymecxsa 6buin OTMeneHbi y anpoxHHHHa, o/inaKo cxaxncxn^ecKH sna^HMbiMH OHH oxasa-
Jincb xojibKo RJIX onpeAeJieHHoii rpynnbi KapAHoxupyprH^ecKHx 6oju>Hbix c BWCOKHM PHCKOM.
B ocxajibHbix oSnacxax xHpyprHH /(ocxosepHbix OXJIHHHH no a^eKXHBHocxH xpaneKcaMOBon
KHCJioxbi H anpoxHHHHa ne BbiHBJieHO, npH 3XOM, oflHaxo ycxanoBJieHO, HXO no anxn^HSpHHo-
nHXHHecKOH aKXHBHOCXH xpaHCKcaMOBaa KHCJioxa 3iiaiiHxejibHO npesocxo^HX 3ncHJion-
aMHHOKanpOHOByio KHCJioxy. TaKHM o6pa3OM, ynnxbisaa OXJIHHHJI B CXOHMOCXH npenapaxos,
no noKa3aTejiK> «nena - 3{J)<J)eKT» Hcnojib3OBaHne TpaneKcaMOBon KHCJIOTBI npn onepauHax
KOJiennoro cycrasa MOXCT 6biTb Han6ojiee nepcneKTHBHbiM.
TpaneKcaMOBon KHCJIOTM npn onepanHax npoxesHpoBanHa KOJieHHoro
cycTaBa
OneHKa 3(|)(jjeKTHBHocTH H SesonacHOCTH TpaHeKcaMOBOH KHCJIOTLI KaK cpe^cTBa Kpo-
Bec6epeaceniDi npn npoTe3npoBaHHH KOJieHHoro cycTasa nposo/nuiacb He Menee HCM B 13
npOCnCKTHBHblX paH£OMH3HpOBaHHbIX HCCJie^OBaHHaX, 9 H3 HHX - flBJMIOTCa JIBOHHblMH CJIC-
nbiMH, 4 - OTKpbrrbiMH.
B HCCJieflOBaiiHH Hippala H coaBT. (1995) 29 nairneHTOB, KOTOpbiM npoTe3HpOBanHe
KOJieHHoro cycTasa BbmojinaJiH «no/i ^<ryTOM» B ycjiOBHHX cnnHaJibHOH anecTesHH, 6buiH
panAOMH3HposaHHO pacnpe^ejieHbi B ABC rpynnbi: noJiy^mBiniix 33 2-5 MHH ̂ o cnaTHfl xypHH-
B/B 1 5 MF/KT TpaneKcaMOBOH KHCJIOTLI HJIH nJiane6o. OiteHHsajiH o6i,eM KpOBonoTepn BO
H nocjie onepannH, a TaK^ce o6m.ee HHCJIO 403 jjoHOpCKOH KposH, nepejinxoe 3a BpeMa
. VcTaHOBJieHO, HTO o6beM HHTpaonepaaHOHiioii KpOBonoTepH ne H3MeHHJica ( 428 ±
254 MJI H 415 ± 244 MJI), o^HaKO nocjie onepaann B nanaTC npo6yayieHHa (127 ± 95 MJI H 576
± 245 MJI, p^Q.QOl) H B XHpygriraecKOM oT/ienenHH (293 ± 200 MAH 558 ± 293 MJi,_p<0.01) B
rpynne c ipaneKcaMOBOH KHCJIOTOH o6T>eM apenaacHbix noTepb 6bui /locTOBepno Menbine. Ro-
TpeSHOCTb B TpaHC^jySHH JIOHOpCKHX 3pHTpOUHTCOZiepacamHX Cpe^ (HB < 100 T/JI ) TO^CC GblJia
^ocTOBepHo MCHbine (1.5 ± 1.3 e/i. H 3.3 ± 1.8 en., p < 0.005) npn Hcnonb3OBaHHH TpaneKca-
MOBOH KHciioTbi. Y AByx 6ojn,Hbix B rpynne nnane6o nocjie onepan,HH pasBHJincb TpOM6o3M-
6ojiH^ecKHe ociioacHeHHfl (B O^HOM Ha6jnoAeHHH - TpOM6"o3 rjry6oKnx BCH rojienn, B O^HOM -
TpOM6o3M6oJIH3 MCJIKHX BeTBCH JICrOHHOH apTepHH HCpC3 HCCKOJH.KO He^eJIb HOCJie BbinHCKH
^OMOH), B rpynne c TpaHeKcaMOBOH KHCJIOTOH Taicnx ocjioacHCHHH He 6buio (see 6ojQ.Hbie B
o6enx rpynnax nojiy^anH 3HOKcanapHH no 40 Mr, HaHHHaa c senepa nepea onepauHCH H SBTCM
^O BbHIHCKH HJIH nOJfflOH aKTHBH33n,HH).
Benoni G. H coaBT. (1996) H3y4ajin BJIH^HHC TpaHeKcaMOBOH KHCJIOTSI na KpoBonoTepio
H noTpe6nocTb B reMOTpaHc^ysH^x B nponecce paH^OMH3HpOBainioro ABOHHOFO cjienoro HC-
cjieflOBaiiHa H JieneHHa 86 n^neHTOB, TOJKC onepHpoBannbix « no^ 2cryTOM» B ycjioBHax pe-
rHonapHOH anecTesHH. TpaneKcaMOByio KHCJiOTy B AOSC 10 MF/KT HJIH ^JIa^e6o BBO^HJIH nesa-
£OJiro nepe/i cnarHeM TypHHKCTa H noBTopHJiH BBe^eHHe ^iepe3 3 naca B TOH IKQ ^O3e. Cpe^Haa
cyMMapnaa KpOBonoTeps cocTaBHiia 730 ± 280 MJI B rpynne c TpaneKcaMOBon KHCJIOTOH H
1410±480 MJI B rpynne nJiaueGo (p< 0.001). HHCJIO reMOTpaHC(})y3HH, a TaK^ce ^IHCJIO
4
KOTOpbiM nepejiHBajiH ^onopcKne spHxpounxbi yMeHbuiHJiocb B 3 pasa ( 8/43 H 24/43, p< 0.01).
3TOM BepOHXHOCXb XpOM6o3M6oJIHH6CKHX OCJ1O5KH6HHH H6 H3MeHHJiaCb.
B 1997 ro,ay Hippala H coaBT. BbinojiHHJiH .uonojiHHxejibnoe Hccjie/ioBaHHe B anajio-
FHHHOH no cocxasy, oSteny BMemaxejibcxBa H Bn^y anecxesHH rpynne GojibHbix, ojxnaKO c
6OJlbUIHM MHCJ10M HdlblTyeMblX (77) H 6oJIbUieH fl03OH XpaHCKCaMOBOH KHCJIOTbl (15 MF/KT
nepe,a. CH^THCM xypnHKcxa H ,aonojiHHxejibHMMH SojuocaMH no 10 MF/KF Hepes 3 H 6 nacos)
TOPO, Hxo6bi xo^nee onpeaejiHXb 3(|>4>eKXHBHocxb H 6e3onacHocTb npenapaxa. H B 3TOM
xpaneKcaMOBaa KHCJioxa ^ocxoBepHO yMenbmajia oSmnii o6"beM KpoBonoxepn (689 ±
289 MJI H 1509 ± 643 MJI, p < 0.0001), cHH^caoia HHCJIO reMoxpaHC(|)y3HH (1.0 ± 1.2 eji. npoxHB
3.1 ± 1.6 e/i., p< 0.0001) H Koira^ecxBO nannenxos, Koxopbai SXH reMoxpanc^ysHH noxpeSo-
Bajmcb (17/39 H 34/38, p < 0.00003). YsenHMeHHe flO3bi TpaHeKcaMOBOH KHCJIOXM ne npHsejio,
no /laHHbiM asxopoB, K noBbnneHHio pncxa xpoM6o3M6ojiHMecKHX OCJIOJKHCHHH. Ha 4)OHe npo-
cnenH^HqecKOH npo^HJiaKXHKH snoxcanapHHOM, y ^syx SoJibHbrx B rpynne c xpa-
tcHCJioxoH (na 12 H 18 ^CHb nocjie onepanHH) H y 4syx nouHenxoB B rpynne njia-
(nepes 2 H 4 He^eJiH nocjie onepauHH) pa3BHJica xpOMGos rjiy6oKHX BCH HHaaieH KOHCH-
HOCXH, noAXBepHcaeHHbiH npH (f)Jie6orpa$HH. Oana naunenxKa B rpynne njianeSo Bnesanno
Ha 15-e cyxKH nocjie onepaunn na (|)OHe MaccHBHOH T3J1A.
B Mccjie^oBaHHH Jansen A.J. H coasx.(1999) xpaneKcaMOByio KHCJioxy BBOZIHJIH BHyx-
no 1 5 MF/KF HenocpeflcxBeHHO nepe^ HananoM onepauHH H nepe3 8 nacos B xenenne 3
cyxoK nocjie onepai(HH. Asxopbi OXMCXHJIH, ^xo npHMeneHHe npenapax conpoBO>KJxajiocb ox-
HexjmBbiM KpoBecSeperaioHiHM 34>4>eKX H He BJIHSJIO na ^acxoxy xpoMSoxn^ecicHX ocjioacne-
HHH. Cpe/nran oSteM nocJieonepan,HOHHon noxepuKpoBH CHHSHJICJI c 1419± 607 £0 678 ±352
MJI, p< 0.001), yMeHbinHJiocb Tmcjio SoJiBHbrx, nyamaiomHxcfl B reMoxpaHC(J>y3Hax ( 2 H3 21
npoxHB 13 H3 21, p< 0.001). B rpynne c xpaneKcaMOBOH KHCJIOXOH KJiHHHHecKHX npH3HaKOB
xpOM6o3M6ojiHHecKnx ocjio^CHeiiHH He BbiHBJieno, B rpynne njianeSo xpoiw6o3 rjiy6oKHX sen
pa3BHJICH y 2 6oJIbHbIX, OflHOKO CXaXHCXHHeCKH 3XH OTJlHHHa 6bIJIH HCflOCXOBepHbl (p^0.23).
B HCCJieaoBaHHH Ellis M H coasx (2001) maBHOH uejibio 6buio lisy^eHHe oco6eHHo-
CXCH peaKnHH CHCxeMbi reMocxasa H (JmSpHHOjnoa na BbmojmeHHe 3H/ioiipoxe3HpOBaHHa KO-
neHHoro cycxasa «no^ acryxoM» H onpe^ejienHe BOSMO^CHOCXH KoppeKHHH BbiaBJieHHbrx HJIH
oacHflaeMbix H3MeneHHH CBOHCXB Kposw c noMombio xpaneKcaMOBOH KHCJIOXBI. B paHflOMH3H-
pOBaimoe npocneKXHBHoe HccneAOBaiiHe BKjnoneHO 20 naunenxoB, Koxopbie GBIJIH pa3^ejieHbi
na 2 rpynnbi: nojiyHasumx xpaneKcaMOByrc) KHCJioxy HJIH njianeSo. TpaneKcaMOByio xncjioxy
BBO^HJIH B ^03C 15 MP/KF nepe^ CHflXHCM XypHHKCXa, a 3axeM B BH;ie HH4>y3HH CO CKOpOCXbK)
B xeneHHC 12 nacoB. Asxopb! He BBISBIIJIH 3HaTiHMbix OTJIHHHH Meacny rpynnaMH B
noKasaxejieH KOHHeHxpamiH D-^HMepa H aKXHBHOCTH (JjnGpHHonHXH^ecKOH cncxe-
Mbl H C^eJiaJIH BblBOfl O TOM, HTO TpaHCKCaMOBaa KHCJ1OT3 B HCCJie/iyCMOH JJ.03Q HC BJIHJieX H3
cHcxeMHbie H3MeHeHH3 reMOCxasa. OjxnaKO, KaK H B £pyrnx Hccjie/ioBaHHiix, npHMCHCHHe npe-
napaxa HMCJIO KJIHHHHCCKHH 34><|>eKx: oSteivia reMoxpaHc4>y3HH B nocneonepauHOHHOM nepno-
RQ ^OCTOBepHO CHH3HJIC3 (p < 0.02).
B 2001 ro^y Engel H coaBT. ony6jiHKOBajin pesyjibxaxw paHaoMH3npoBaHHoro HCCJIC-
AOBaHHa, uenbio xoxoporo 6buio H3yHCHHe AHHaMHKH noKasaxejieii reMOCxaaa H 4>H6pHHO^H3a
B 3one onepaijHH H oueHKa BJiHSHna xpaneKcaMOBOH KHCJIOXBI na 3xn noKasaxejiH H o&teM Kpo-
BonoxepH. B HCcneAOBauHe 6bino BKinoieHO 24 naijHeHxa, 12-TH H3 Koxopbix eo BpeMH onepa-
HHH BHyXpHBCHHO BBCJ1H 1 5 MF/KX XpaHeKCaMOBOH KHCJIOTBI, a 33XCM HepC3 3 Haca nOBXOpHJIH
BsezieHHe B AO3e 10 MF/KT. OcxajibHbie 6ojiSHbie HOJiyHHJiH HJiaue6o. BCCM naiineHTaM B
peHHyio seny onepHpOBaHHoit KOHCTXHOCXH ycxanaBJiKBajra Kaxexep, nepes Koxopbiii
cHaxHCM xypHHKexa, a 3axeM nepes 5,10,30,60 120 MHH H nepes cyxKH 6pajiH KpoBb AIM 6no-
XHMHHCCKHX aHajiH3OB. B o6eHx rpynnax aBxopaMH oxMenena 3HaimMaa aKXHsamia npoueccos
rCMOKOaryjlflUHH H (J)H6pHHOJIH3a B KpOBH H3 6eApeHHOH BCHbl. TIpH 3XOM, K3K H B HpCflbmy-
Hccjie^oBaHHH, BseaeHHe. TpaneKcaMgBOH KHCJIOTH He BJinaJio na cxeneHb_3XHX H3Mene-
HHH. Bojiee xoro, asTopti ne oxMexHixa H flocxoBepnoro yMeHbineHHfl oGteMa KpoBonoxepn H
reMoxpaHC(J)y3HH npn Hcnonb3OBaHHH HHrnSHXOpOB ({)H6pHHOJiH3a. E^HHcxBennbiM
3HaHHMbiM oxjin^HCM cxajio yMeHbineHHe tfflcjia SojibHbix, KOXOpBiM noxpeSo-
Banacb reMOXpaHC(|>y3H5L B rpynne c xpaneKcaMOBOH KHCJIOXOH HH o/inoMy HS 12 6ojibHbix
KpoBb He nepejinsajiH. B rpynne njianeSo reMOTpanc^iysHH noxpeSoBanHCb (npH CHHaceHHH
Ht Menee 27%) 3 namienxaM.
B HCCJieaosaHHH Tanaka H coasx. (2001) 99 naqnenxoB, nepenecuinx 3H£onpoxe3Hpo-
KoneHHoro cycxasa 6buiH pasziejienbi na 4 rpynnbi: 1) rpynny nnane6o; 2) rpynny no-
xpaneKcaMOByro KHCJioxy OAHOKpaxno nepea onepaHHefi B ̂ ose 20 MF/KX; 3) xpynny,
npenapax B flose 10 MF/KX ^o onepaunn H 10 MF/KF nepezi CHHXHCM xypHHKexa; H
4) - nojxyTXHBHiHX 20 MF/KF xpaneKcaMOBOH KHCJIOTLI nepe/i cnaxneM xypHHKexa. KpOBecSepe-
raiomHH 3(|)4)eKx xpaneKcaMOBOH KHCJioxbi asxopbi onpe^enajm c y^iexoM ne XOJH>KO
noxepb KPOBH, HO H paccHHXbisaa oS^eM CKpbixoH KpOBonoxepn no noKa3axejno
HOFO CHH^eHHJi KOHueHxpauHH reMor^o6HHa B nocjieonepauHOHHOM nepHozie. KpoMe xoxo,
npenejieniifl qacxoxbi 6eccHMnxoMHbrx xpOM6o3M6onHHecKHx ocjio^neHHH BCCM 6o^b-
nocjie onepauHH BbinonnsjiH H3oxonHyro 4>Jie6orpa4>Hio H cuHHXHrpa^Hio JICFKHX. KaK
noKa3aJiH pesyjibxaxbi HccjieflOBaHHH, cyMMapnbiH oSieM KposonoxepH B rpynnax 6oJibHbrx.,
6
TpaneKcaMOByio KHCJIOXY 6bui ^ocxosepHo MCHbuie, HCM B rpynne onaueSo (785
H 1470 MJI cooxsexcxBeHHO, p < 0.01). HaiiMeHbinaa KposonoTepa (211 MJI HHXpaonepanHOH-
HO H 528 MJI - nocjie onepanHH) oxMe^ena B rpynne GojibHbrx, noJiy^HBiuHx xpaneKcaMOByro
KHCJioxy jjo onepanHH H nepeA CHMXHCM xypHHKexa, xoxa 3XH OXJIH^HS He HMCJTH cxaxncxH^ie-
CKH 3HaHHMbiH xapaKxep. He Sbxno BbMBJieHO AOCxoeepHbix OXJIHHHH Meac^y rpynnaMH nauH-
CHXOB, nojry^aBniHX xpaneKcaMOByK) KHCJioxy B pasJiHHHbix peiKHMax H no o6i>eMy reMO-
XpaHC(J>y3HH H HHCJiy 6oJIbHbK, Hy^CaaBUIHXCSI B nepejIHBaHHH AOHOpCKHX 3pHXpOUHXCOAep-
>KamHX cpezj. B xoace BpeMa Bee rpynnti oxjin^ajincb no SXHM noKasaxejuiM ox rpynnbi
eaxoB, noJiy^HBuinx njiaueSo (B cpe^neM no 2 ejj.icpoBH (p < 0.01) 6biJio nepejinxo
H3 26 nauHenxoB 3XOH rpynnbi). HH y O^HOXO H3 o6cjie4OBaHHbix 6ojn>Hbxx aBxopbi ne
J1H KJlHHH^ieCICHX HpH3HaKOB TpOMSoSMdOJIH^CCKHX OCJIOaCHCHHH . HpH HCnOJlb3OBaHHH (|>Jie6o-
rpa4)HH ^acxoxa xpOM6o30B oxasajiacb aoBOJibHO BHCOKOH, HO ona ne sasncejia OT npHMene-
HRfl TpaneKcaMOBOH KHCJioxbi H cc ^O3bi. V 12 H3 26 nanHCHxoB (46%) KOHxpojibHOH rpynnbi,
y 1 1 H3 24 (46%), nojiy^HBinHx npenapax ;̂o onepauHH, y 10 H3 22 (45%), noJiytraBuiHx npe-
napax #0 H BO speMa onepanHH, y 13 H3 27 (48%) GojibHbix, KOXOpbiM npenapax BBO^HJIH
XOJH>KO HHxpaonepannoHHo, pesyjibxaxw 4>jie6orpa<|iHH oKasajincb nojiosoixejibHbiMH. Hpn
3XOM, O,ZJHaKO, CKaHHpOBaHHC J1CFKHX HC BblSBHJIO CHenH^HHeCKHX H3MeHCHHH HH y OAHOFO
6ojibHoro.
B Hccjie^oBaHHH, npOBe/ieHHOM Veien M. H coasx. (2002), y^acxBOBajio 30 nannenxoB,
onepHpoBaHHbix na KOJICHHOM cycxase «no^ HcryxoM» B ycjiOBHax cnHnajibnoH anecxesHH H
pacnpeAejieHHbix cJiy^aKHLiM o6pa30M B rpynny njiaueSo Hjra B rpynny nojiyHHsmnx xpaneK-
caMOByio KHCJioxy. B aaHHOM HCCJieAOsaHHH asxopbi BBOJXHJIH npenapax B jiose 1 0 MF/KF na 3a-
KjnoifflxejibHOM 3xane onepanHH H B XOH ace jxose nepes 3 ^aca. Ha scex sxanax JieneHHH Kpo-
Bonoxepa B rpynne 6ojn>Hbrx, nojxyHHsniHX xpaneKcaMOByio KHCJioxy, Sbuia ziocxoBepHo nnace,
qeM B rpynne non3^4HBmHx njianeGo. B pesyjitraxe cyMMapnaa KpoBonoxepa cocxaBHJia 409.7
± 174.9 MJI H 761.7 ± 313.1 MJI cooxeexcTBeHno (p <0.001), npn oxcyxcxBHH flocxosepHbix ox-
JIHHHH Meac/ry rpynnaMH no noKasaxeJiSM reMOKoaryjiauHH. HH o^LHOMy nauneHxy B rpynne c
xpaneKcaMOBOH KHCJIOXOH ne noxpeSoBajmcb reMoxpaHC(J)y3HH B nocJieonepannoHHOM nepno-
fle, B rpynne c ixnaneSo xaKHx 6ojn>Hbix 6buio 13%.
cxeMy BBe^eHHa xpaneKcaMOBOH KHCJTOTbi Hcnojib30BanH Good H co-
asx. (2003) npH BbinonneHKH npoxe3npOBaHHa KOJiennoro cycxasa 53 6ojn>HbiM ocxeoapxpo-
3OM. B JIBOHHOM cjienoM HccjiejioBaHHH, 24 nanHCHxa nojiy^HJiH njianeSo, a 27 - xpaHCKcaMO-
Byio KHCJioxy (10 MF/KF nenocpe^cxBeiiHo nepe^ cnaxHeM xypHHKexa H nepe3 3 naca). KpoBO-
noxepio paccHHXbiBajiH c ynexoM cnnaceHHM KOHuenxpauHH HB na 5 ^enb nocjie onepauMH. Ho
7
3TOH rpynnbi Hccjie/iOBaTejieH npHMeHenne TpaneKcaMOBoH KHCJIOTM npireejio K noo
roeepHOMy yMCHbnieHHio o6teMa Apena^KHbrx noxepb: 845 (523-990) MJI H 385 (331-586) MJI
cooTBeTCTBCHHo(p<0.001). naimeHTti B rpynne miaue6o nojryHHJin B cpeAHCM 2 (0-2) efl., a
nauHCHTbi c TpaneKcaMOBOH KHCJIOTOH - 0 (0—0) CA. JXOHOpcKon KPOBH (p<0.001). PacneTHaa
KpoBonorepa cocrasHJia cooTBercTBeHHo 1426 (1135-1977) MJI n 1045 (792-1292) MJI
(p<0.001). V AByx nauHenTOB B Ka^KAon rpynne pa3BHjica nocjieonepauHOHHbiH
TpOM6o3 FJiySOKHX BCH HH^CHHX
CpejiH Hccjie/xoBaHHn no 3(J)4>eKTHBHocTH TpaneKcaMOBOH KHCJiOTbi npH onepauiDrx Ha
KOJICHHOM cycxase ppa nccJie^oBanHH Zohar E. H coasT. (2004) npHBJieKaioT oco6oe BHHMa-
HHC. B ojniOM H3 HHX aBTOpbi cpaBHHBaim AeMcTBHe TpaneKcaMOBOH KHCJIOTM ne c miane6o -
3(^(J)eKTaMH, a C MeTO/IOM OCTpOH HOpMOBOJieMHHCCKOH reMOflHJUOnHH (OHT) — OTHOCHTCJIbHO
pacnpocrpaHeHHOH MeroAHKon KpOBecSepeaceHHa B opToneAHH. B aannoM npocneicraBHOM
paHAOMH3HpOBaHHOM HccjieAOBaHHH y^acTBOBajio 40 nainieHTOB, pasaeneHHbix Ha ABC rpyn-
nbi. OAHOH rpynne ^a^HeHTOB B TeneHHe 30 MHH nepe/t CHHTHCM TypHHKexa npoBOAHJin Bnyr-
HH(J)y3HK) TpaHCKCaMOBOH KHCJIOTbl B AO3C 1 5 MF/KT, 3aTCM HH(J>y3HK) npOAOJlXCaJlH B
12 H3COB C nOCTOHHHOH CKOpOCTbK) 10 MF/KF/HaC. Bo BTOpOH Fpynne nailHCHTOB, H6-
nepeA na^ajioM aHecresHH H onepanHH nposoAHJiH 3aFOTOBKy ayroKposH B
o6-bCMe, o6ecneHHBaiomeM cHH^ceHne Ht AO 28% c oAHOBpeMeHHtiM saMeineHHCM KPOBH pac-
TBOPOM PHHrepa-JIaKTaTa. B KOHUC onepauHH BCK> ayroKpoBb BO3BpamajiH nauHCHxy. rioKa3a-
HH6M K FeMOTpaHC(J)y3H«M AOHOpCKOH KpOBH C^HTaJIH CHHHCeHHe Ht HHKC 27. fijlX OUCHKH
TpOMSOTHHCCKOH OHaCHOCTH T3KHX MCTOAHK BCCM GoJIbHbIM nepCA BbDlHCKOH BbmOJIHaJlH
AonnJieporpa(J)Hio BCH, a B Te'qeHHe 3-x MecatieB oTCJieaoiBajra pasBHTne CHMnTOMaTHHecKHX
TpOM6O3M6oJIHHeCKHX OCJIOXKHCHKH. KaK yCTaHOBHJIH aBTOpbl HCCJlCAOBaHHa, npH HCnOJlb30-
BaHHH OHT, HecMoxpa Ha SHaHHTejibHbrii (843 ±289 MJI) o6i>eM ayTOTpancc^ysHH,
Ht B nepBtie rpoe cyroK nocjie onepaunn 6buia AocTosepno HH^ce, qeM npn
TpaHCKCaMOBOH KHCJIOTbl, MTO npHBCJTO K HajmHHIO AOCTOBCpHOH (p< 0.0008) pa3HHqbI B
eMax H ^acToxe TpaHC(|)y3HH AOHOPCKHX 3pHTpou,HTCOflep)KanLHx cpeA- B rpynne c OHT 13
nauHCHTaM, HyacAaBniHMca B reMOTpaHc4>y3Hax, GbiJio nepejiHTO 19 efl. AOHopcKOH Kposn, B TO
BpeMa KaK B rpynne c TpaHCKcaMOBoH KHCJIOTOH TOJQ.KO 2 naunenTaM npOBOznuiH reMorpaHC-
c[)y3Hio (no 2 CA. KaagxoMy). /^ocTOBepHbrx OTOTIHHH no nacTOTe BenosHbix TpoM6o30B aBTOpbi
ne o6napyaauiH, B TeneHHe 3 Mecanes nocne onepauHH TpoM6o3 BCH HH^CHCH KOHCHHOCTH pas-
BHJica y OAHOFO SojibHoro H3 rpyniiH OHF. Ho 3aKJnoHeHHK> asTOpos, npH onepannax TOTajib-
HOFO 3HAonpore3HpoBaHHa KOJICHHOFO cycTasa npHMeHenne TpaHeKcaMOBofi KHCJIOTM HMCCT
8
npeHMymecxBa nepea OHF, cB>naHHbie uspoaxHO c 6onee Sjiaxcnpii^xiibiM cocxoanneM reMO-
H yMCHbtueHHeM norpe6nocxH B nepejiHBanHax ^OHOpcKOH
B apyroM nccjie^oBaHHH, Zohar E. H coasx. (2004) cpaBHHBajiH 3(J)(|)eKXHBiiocxb H
6e3onacnocxb xpaneKcaMOBOH KHCJIOXM, BBO.OHMOH BHyxpHBenno HJIH per os. 80 nannenxoB
6bLJiH pa3#eJieHbi na 4 rpynnbi: B I-H xpynne xpaneKcaMOByio KHCJioxy BBOAHJIH B BH,ne HH(|)y-
3HH B xeneHHe B flose 15 MF/KX B xe^eHne 30 MHH nepezj CHSXHCM xypHHKexa, a 3axeM B BH^,C
HHc|>y3HH co CKOpocxbio 10 MX/KX/H B xeHCHHe 12 ^acoB. Bo 2-H xpynne nepBOHanajibnoe BBe-
/leHne 6buio xaKHM we, o/znaKo B/B nH(|>y3HJi npeKpantanacb qepe3 2 ^aca nocne onepan.HH (x.e.
npn nepeeoAe Sonbnoxo H3 najiaxti npo6y Centra), a ^epes 6 H 12 ^acos naiiHeHTaM BHyxpb
eme no 1 x xpaneKcaMOBOH KHCJioxbL B 3-H xpynne sa 60 MHH ̂ o onepanun SoJibHbie
BHyipb 1 r TpaneKcaMOBOH KHCJIOXLI H xaKyw )Ke aosy nepes Kaaypbie 6 nacoB B xe^e-
HHC 18 nacoB. 4-a xpynna 6bUia KOHTpojibHOH. Bce 6o;ibHbie 6bum onepnpoBaHbi B ycjiosnax
o6meH anecxesHH H see noiry^ajiH anoKcanapHH no 40 Mr/^enb pjw npo^HJiaKTHKH xpOM6o3M-
6ojiHHecKHX ocjioacHeHHH. /^peHaaaibie noxepn B xeneHne nepsbrx 12 ^acoe nocjie onepauHH
MaKCHMajibHbiM B KonxpojibHOH rpynne (249 ±130 MJI), HO ̂ ocxoBepHo OHH OXJIH-
XOJIBKO or noxepi. B xpynnax, r^e xpaneKcaMOByK) KHCJioxy BBOflHJiH BHyxpHBCHHO
(121 ± 81 MJI H 1 1 0 ± 38 MJI), B xo BpeMfl Kax npH npHeMe npenapara BnyrpB, ero BJIRSIHIW na
XCMH H o6i.eM KposonoxepH He BbWBHJiH (231 ± 138 MJI). Asxopbi csasbmaiox 3xn oxjiHHHa c
^apMaKOJiorH^ecKHMH cBoflcxBaMH npenapaxa, fleficxBHe Koxoporo npH npHCMe BHyxpb ^oc-
xHxaex CBOCXO MaxcHMyMa nepe3 2 naca H K 3xany cnaxna xypHHKexa (x.e.K MOMenxy MaKCH-
aKXHsanHH (J)H6pHHOJiH3a) yace OKasbreaexca He^ocxaxo^HbiM. Cjie^yex oxMexnxb o/i-
no BCCM ocxanbHbiM cpasnuBaeivibiM noKasarejiHM (o6i>eM ApenaacHbix noxepb, g&-
xeMaxoxpHxa, noxpe6HOCXb B reMOTpaHC(f>y3Hax H ^HCJIO 6ojn,Hbix, nyjK/taioTxrHxca B
xpanc4)y3Hax) nepes 12 nacos nocjie onepaunn H B nocjiejryioineM, see xpH xpynnbi nanneH-
XOB, nojry^HBinHX xpaneKcaMOByK) Kncjioxy ^ocxosepHo oxjnnajiHCb ox KonxpojibHOH, npn
3TOM oxjintfflfl yace ne 3aBHcejni ox pe^KHMa npneMa npenapara.
Alvaxez J.C. H coasx. (2007) H3yHajiH 3(J>i{)eKXbi xpaneKcaMOBofi KHCJioxbi B
npH onepaitHax npore3HpOBaHHa KOJICHHOXO cycxasa npHMenaiiHCb H ^pyxne
. B flBoimoe cjienoe Hccjie^osanHe asjopBi BKJno^Hjm 95 nan.HeHXOB, H3 HHX
46-xH BO BpeMa onepauHH 6buio SOJIIOCHO BBe^eHO 10 MX/KX npenapaxa, a 3axeM BBe^eHHe
xpaHeKcaMOBOH KHCJIOXBI Sbuio npOAOJi^eno B BHAC BHyxpHBenHOH HH(j>y3HH co CKopocxbro 1
. ripn jieneHHH 33 nan,neHxoB (34.7%) npHMenajiHCb AonojmnxejibHbie Mexo^bi Kpo-
: 3aroxoBKa ayxoKposH (12), peKOM6HHanxHbiH 3pHxpono3xnn (6), npenapaxbi
acejie3a (15), cncxeMbi fljia peHH(j>y3HH /ipeHawHbix noxept (100%). 06-beM KposonoxepH asxc-
pbi paccHHTbiBajiH c yneroM CKPKTTKTX noTcph no KOHHCHTpauHK HE Ha 4-c CVTKK nGCJicone-
pauHOHHoro nepHozia. O6mHH o&teM KpoBonoTepn B rpynne c TpaHeKcaMOBOH KHCJIOTOH co-
1301 ±621 MJI, B KOHTpojie 1744 ± 804 MJI (p < 0.05). ToiibKO ^ayM naHHCHTaM H3 no-
TpaHeKcaMOByio KHCJiory (4%) H 36 (73%) - B KOHTpojie, HOTpe6oBajiacb peHH^y-
KpOBH H3 flpCHaaCHtlX CHCTCM (p < 0.0001). TpOM603M6oJIHHeCKHX OCJ1OKHCHHH aBTOpbl HC
OTMCTHJ1H.
Molloy D.O. H coaBT. (2007) HaynajiM B npocneKTHBHOM panjioMH3npoBaHHOM oTKpbi-
TOM HCCJie/IOBaHHH KJIHHHHeCKHe pe3yJIbT3TbI HHTpaOHepaUHOHHOrO BBe^eHHfl TpaHCKCaMOBOH
KHCJIOTbl B flO3C 500 MT ( 33 5 MHH AO CHHTH3 TypHHKCTa) C HOCJie^yiOmHM nOBTOpHbIM BBQRQ-
HHCM iepe3 3 naca. ABTOpbi OTMCTHJIH He6ojibmoe, HO CTaTHCTHHecKH 3HaHHMoe (p= 0.041)
yMeHbmeHHe o6i>eMa pacneTHOH KpOBonoTepn 1225 MJI ( 580 - 2027 MJI) H 1415 MJI ( 801 -
2319).
TaKHM o6pa3OM, K nacTOHmeMy BPCMCHH B MHpe BbinojineHo
HHH, cBH/zerejibCTByiomHx o TOM, HTO njiaHOBoe Hcnojib3OsaHHe TpaHeKcaMOBOH KHCJIOTbl npn
onepannax npoTe3HpOBaHHH KOJiennoro cycTasa o6ecneHHBaer cTaTHCTHHCCKH 3HaHHMbra Kpo-
BecSeperaiomHH 34)4)eKT5 no3BOJiaeT yMeHbuiHTb o6beM ApeHaaoibix noTepb H noTpeSnocTb
B nepesHBanHH flOHOpCKHX apHTpoHHTCo^epacaniHX cpe^i- TIpn STOM 6ojibmHHCTBO
H aBJiaiOTca He6ojibinHMH no o&beMy H oneHb pe^KO BionoHaioT 6oJiee 100
eHTOB. 3ro onenb Baacnoe o6cTOHTejibCTBO, nocKOJibKy no saKonaM cTaTHCTHKH, HHCJIO ncnbi-
TyeMbix onpeAenaeTca Heo6xoAHMOCTbK> AocTOBepno noflTBep^HTb Him OTBeprayrb OTJiH^na
Meacay rpynnaMH. He6oJibinoe HHCJIO HaSjnoACHHH B 3THX HCCJie,noBaHHsx cBH^erejibCTByer o
TOM, HTO KpOBec6eperaK>mHH 3$c[)eKT TpaneKcaMOBOH KHCJIOTM SbiCTpo CTanoBHTca
HblM H CTaTHCTHHCCKH
He Menee sa>KHbiMH AJIS npaKTHHecKoro Hcnojtt3OBaHHa TpaHeKcaMOBOH KHCJIOTM npn
3H£onpOTe3HpoBaHHH KOJieHHoro cycxasa HBJiaiOTcs H HeKOTopbie ^pyrne 3aKJnoHeHH«, KOTO-
pbie MOJKHO c^ejiaTb, anajiH3Hpyfl peayjibTaTbi STHX Hccjie^OBaHHH, 1 1 H3 KOTopbix 6buiH
B Mexa-aHajiH3 Zufferey P. H coasT.(2006). KaK oTMenaioT asTopu Mexa- aHajiH3a,
B KaaoiOM HccjieflosaHHn Hcnoju>3OBajiacb cBoa opnrHHajibHaa cxeMa BBe^eHHa
KHCJIOTbl. HanpHMep, BO BpeM# onepanHH 71033 cocTasjiajra OT 10 #o 135
Mr/KT. Eme Menbuie 4O3a npenapaTa 6bina B 6onee no3/meM Hccjie^OBaaHH (Molloy D.O. H co-
aBT., 2007), HO B STOM cjiy^ae 34>4>eKTHBHocTb npenapaTa OKasanacb nnace, neM B npe/nnecT-
Byiomnx ncnbiTaHHHX. Pa3^HHHbiM 6biJi H cpoK iipHMeneHHa npenapaTa. ^o onepauHH ero na-
3HaHajiH pe/iKO, H TaKa^ MeTO^HKa ce6a He onpaB/iana. HanSojiee jiorn^HbiM H 3(|)4)eKTHBHt.iM
10
cnoco6 BBeaeHwa npenapaxa Henocpe^cxBeHHO nepe.ii cnaxHcM xypnuKera, x.e. B
MOMCHT MaKCHMajibHOH aKTHBH3au.HM 4>H6piiHOJiH3a. FIpH 3XOM noBxopHbie 6ojnocHbie BHyx-
pHBCHHbie BBezieHHfl npenapaxa B xeneHHe 3 -6 qacoB H 4aace 3-x cyxoK, ero Hcnojib30BaHHe B
BH,ae .gJIHXeJILHOH, 4O 12 qaCOB, nOCXOUHHOH HH(J>y3HH HJIH npHCM XpaHCKCaMOBOH KHCJIOXbl
Biiyxpb npaKXH^ecKH ne pasjunajiHCb no CBoervty 3(f)4)eKxy.
Cjiejxyex oxMexwxb xaxace, HXO asxopbi npHMenajiw xpaHeKcaMOByro KHcnoxy npH npo-
onepaunH B ycjiofinax KaK pernoHapHoii, xaK H o6meM anecxesHu, conexajiH ee Ha-
c npHMenenneM ^pyxnx MCXOAOB KpOBec6epeaceHna H c HcnoJibsoBaHHeM jiJia npo-
osMSojra^ecKHx ocjio^caenHH HHSKOMOJieKynapHbix renapHHOB B nepHone-
pau;HOHHOM nepnofle H He OXMCXHJIH KaKHX-JiH6o cssisaHHLix c SXHMH oScxoaxejibcxBaMH oco-
6eHHOCxeH jtencxBHa npenapaxa. He 6bino BbiflBJieHO BJIH^HHS TpaneKcaMOBOH KHCJIOTM na
^acxoxy nociieonepanHOHHbix xpOM6o3M6oJiniiecKHx ocno^oieHHH, o/piaKo B aaHHOM cjrynae
He6ojibmoe HHCJIO BKjuoneHHbix B Hccjie^OBanHe nauHenxos HMCJIO H oxpHuaxejibHbie MOMCH-
XH, nocKOJU,Ky ana onpe/iejieHiM 6e3onacnocxii npenapaxa xaKoro HHCJia Ha6jnofleHHH HBHO
. B onpe/iejieHHOH cxenenH 3xox npoSeji ycrpanaex CHCxeMaTHHecKHH oSsop ac-
Koxpana (2007), no aaHHbiM Koxopoxo, npHMeneHne HHraSuxopoB (J)H6pHHOjffl3a ne
noBbinieHHCM HHCJia xpoMSoxHHecKHx jicno^cHeHHH. Ho^- sepoaxno, Sojiee
XOHHO na 3xox Bonpoc MO5KHO 6y/jex oxBexnxb no oKOHHaHHio Hccjie^oBaHna CRASH-2
(Clinical Randomisation of tranexamic acid in Significant Haemorrhage) Koxopoe npo^ojmaex-
cfl B nacxoaniee Bpeivtii. B nexo njiaHnpyK>x BKJiiOHHXb 20000 nocxpaAasmnx c xpasMOH H Kpo-
BoxeneHHeM. K Mapxy 2008 ro^a B 3x0 KCCJieAOBanne 6buio BKjnoneHo OKOJIO 6000 naixnenxoB
H na 3XOM sxane KaKoro-Jin6o 3HaHHMoro noBbmieHiia qacxoxbi TpOM6oxHHecKHX
ne Sbuio.
TOKHM o6pa3OM, npHMCHCHiie xpaneKcaMOBOH KHCJioxbi npn onepamiax 3H,nonpoTe3H-
KOJieHHoro cycxasa MOHCHO paccMaxpHBaxb KaK nepcneKXHBHbffl cnocoS yMeHbinenna
KpoBonoxepn H CHH>KeHHfl noxpeSnocxn 6ojn,Hbix B xpaHc4)y3nax aoHOpCKofi KpoBH. B na-
cxoamee BpeMs 3xn nepcneKXHBbl cxanH 6ojiee peajibHbiMH H jjjis acHxejien Haniefi cTpanti, xax
KaK c 2007 rojja xpaneKcaMOBaa KHCJioxa (TpaneKcaM, «MMP-OAPM») npoH3BO^nxca B Poc-
CHH H paspemeaa jjjis KjmHHHecKoro Hcnojn>3OBanHa. O^eHKa 3(J)(J)eKXHBHOCTH H 6e3onacHO-
CXH 3xoro npenapaxa npn npoxesnpoBaHHH KOJieHHoro cycxasa cxana OCHOBHOH ueju.io namexo
1 1TpaneKcajvia npH npoTesHposaHHH KOJiennoro cycxasa.
B npocneKXHBiiOM oxKpbixoM HccneflOBaHHH ynacxBOBajiH 40 nauneHxoB cxapme 20 jiex
(ASA I HJIH II), KoxopuM 6bmo Bbmojmeiio nnaHOBoe npoxe3HpOBaHHe KOJICHHOFO cycxasa.
KpwxepHflMH HCKjnoHeHHii 6buin: Bpoac^eimbie KoaryjionaxHH, Beno3Hbie xpoM6o3bi HJIH xpoM-
6o3M6ojiHs jieroHHOH apxepHH B anaMnese, npneM acxrapHna HJIH necxepoHjxHbix npoxHBOBoc-
npenapaxoB B xeHemie 3-x AHefl nepe/i onepanneH. B COOXBCTCXBHH c 3aaaHaMH
6ojibHbie 6buiH paHjjoMH3HpOBaHHo pacnpe^ejienbi B 2 rpynnbi (xaSn.l). KaK
BH/IHO H3 xa6ji.I, rpynnbi 6buiH conocxaBHMbl no sospacxy, pocxy, Becy, cxenenH anecxe3HOJio-
rHnecKoro pHCKa, npo^ojiHCHxeju,HOCXH o^epa^HH. B nepson rpynne BO BpeMa onepauHH, ne-
nocpe/icxBeHHo nepe^ cuaxneM xypnnicexa 6ojibHi>iM BHYXPHBCHHO BBO^H^H TpaneKcaM B AOSC
15 MF/KT. Bo Bxopoii rpynne TpaneKcaM ne BBOZIHJIH.
CpaBHHTejibHaa xapaxxepncxHRa rpynn naiineHTos1
MHCJIO SojibHbix,Cpe^HHH Bospacx, JiexCpejtHHH pocx, CMCpC/IHHH BCC, KT
ASA I / 11, aSc.HHCJioBpCMfl OliepaUHH, MHH
06-bCM HHXpaOHepa^HOHHOH KpOBOHOXepH, MJI
nocjieonepainioHHbie noxepH no Apena^caM, MJIO6l>eM HH{J>y3HH, MJI
TpaHCKcaMOBajiKHCJIOXa
2063 ±6163 ±973± 89/11121±20140±70234±1411485± 170
KoHXpOJIB
2062 ±7168±774 ± 108/121 1 1± 26139±60556±430(p=0.003)1462±250
BenepoM HaKanyHe onepanHH BCCM GojibHbiM HasHanajiH no/iKoacHo 0,3 MJI
na AJW npo4)HJiaKXHKH TpOMSoaMSoJiH^ecKHx ocjioacHeHHH. IloBxopHyio HHT>eKiiHK> npenapaxa
SojibHbie nojryHajm nepe3 8-10 nac nocjie onepanHH, a 3axeM no 0,3 MJI BBO^HJIH nepes 12 nac
B xeneHHe 14 AHCH. 3a 30 MHH ̂ o onepaitHH BHyxpHMbnneifflo BBO^HJIH 5 -7,5 Mr MH/jasoJiaMa
(npeMeAHKan;Ha). HnztyKUHio anecxesHH npOBO^HJin npono(|)OJiOM ( 1,5 Mr KT—1), (J>eHxaHHJioM
(3-4 MKT/KT), 3CMeponoM (0,5 - 0,7 MF/KT) na (})OHe caMOCXoaxejibHoro fluxaHHa nannenxoM
nepe3 jinneByK) Macxy 100% KHCJIOPO.HOM. /^Jia nozmepacaHHfl anecxe3HH HcnojibsosajiH ceBOfJ)-
juopan H 6ojnocHbie HHT>eKHHH 4>eHxaHHJia. B ycJIOBHax oSmen anecxesHH 6ojn>HbiM 6buxH BW-
nojmeHbi cxanflapXHbie onepaxHBHbie BMemaxejibCXBa nepBHHHoro njianoBoro npoxesHpOBaHHH
KOJiennoro cycxasa c HaBHrainieH. Bee BMemaxejibCXBa npeAnoJiarajiH Hcnojn>3OsaHHe xypHH-
Kexa c AaBJieHHCM 250 MM px.cx. Ha 3aKjnoTmxejn,HOM 3xane onepanHH, xypHHKex cnHMajiH,
ocymecxBJiajiH AonojiHHxejibHbm reMocxas DJieKxpoKoaryiwuHeH, ycxanaBJiHBajiH /ipenaac,
pany, HaKJia^bisaJiH ^aBflmyio noBa3Ky. Hocne OKOHHaHHa onepauHH nannenxoB ne-
12
B najiaTy npo6y>K£,eHHH, rjis KOHXpojiKposaJiK oSmee cocxosHHe, ox^enseMoe no
H npOAOjiacajin JieneHHe. l\o onepauHH, ^epes 6 H 18 nacoB nocjie ee OKOHnaHHs, a
3axeM OKezmeBHO KOHXpojmpOBajiH noKasaTejiH KOHuenxpauHH reMorno6HHa, reMaxoKpHxa,
KoaryjiorpaMMbi. CuioKeHHe KOHqeHTpauHH reMorjioSnHa MCHCC 80 r/ji cmrrajra noKasanneM K
reMoxpaHC(J»y:jHH- T^Jia 6oJibHbix c conyxcxsyiomeH HBC, a xaioKe RJIX nauneHXOB c BO3HHKniH-
MH nocne onepauHH 3KT npH3HaK3MH napyraenHH nep(J>y3HH HJIH xpo<J)HKH MHOKap^a, HHMCHCH
flonycxHMOH rpanHuefi AJIH nepejiHBanna zionopCKHX 3pHXpouHxcoAepacairj,HX cpefl CHHxajiH
KOHuenxpauHio reMoruoSHHa 100 r/Ji. CxaxncxuHecKyio o6pa6oxKy ^anntix npoBoanjin c no-
MOIULIO naxexoB nporpaMM Microsoft Office Excel 2003 H Statistica 6.0. fljix npH3HaxoB c Hop-
pacnpe/iejieHHeM paccnuxbisajiH cpeflnee 3Ha*ieHHe M n cxan^apxHoe oxiciioHeHHe s;
npH3HaKOB c HHBIM pacnpeflejieHHCM — Me^nany Me, BepxHUH H HHSKHHH KBapXHJin (UQ;
LQ).
Bo BpeMfl onepamiH o6teM KposonoxepH 6tui MHHHMajibHbiM (140±70 MJI H 139±60
MJI), irro 6kmo oSycjiOBJieno xexHHKOH BLinojraeHHfl BMeiiiaxejibcxBa, H He 3aBnceji ox
HHJI xpaneKcaMOBOH KHCJIOXLJ. BMCCXC c XBM B 6jiHacaHineM nocjieonepaanoHHOM
o6i>eM oxflejiaeMOFo-no gpenaacaM ^HanHxenbno oxnuRajica MOK^y rpyHHaMim 6bui
BepHO (p=0.003) HH^ce B rpynne SojibHbix, nojiynHBiunx xpaHCKcaMOByio KHCJioxy (234
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neKcaMOBOH KHCJioxbi sa saioiiOHHxeJibHOM axane onepauHH upMBCJio K cxaxHcxunecKH 3Ha^H-
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cyxKH nocjie onepauHH p$m HccjiejjoBaxejieS ncnojibsoBajin ZUIH ouenKH H pac^exa cKpbiTofi
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BH cxanoBHxca paBHbiM npe^onepaiiHOHHOMy H, cjie/josaxejibHO, HSMeHenne KOHiieHxpaumi
B 3x0 speMa no3BOJiaex 6ojiee XOHHO onpe^ejmxb ero noxepio. Jfyix axoro B ana-
nccjie/tOBaHHax HcnojibsosajiH c^c'pMy-1^ Nadler H coasx.: Hbn~MTx(HbHCX-
Hb5)x0.001+Hbt ; r^e MT - Macca xejia, Hbn (r) - pac^exnaa noxepa reMorjio6HHa, HbHCX (r/Ji)
- KOHiteHTpaqHJi reMorjio6HHa nepej^ onepaiineH, Hbs (r/Ji) - KOHueHxpamw Ha 5-e cyxKH no-
cjie onepauHH, Hbt (r) - o6mee KOJIHHCCXBO nepejinxoro AonopcKoro reMorjioSuna H3 pacnexa
13
HXO 1 e/i- AOHopcKOH KpoBH co,nep)KHx 52 r reMomo6HHa. PacnexHaa Kposonoxepa 3axcM on-
no (jmpMyjie: KHp = 1000 x Hbn/ HbHCX.
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110±13
115±20
107 ±11
98 ±8
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0.415
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Hepes 6 nacos
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36,9 ± 5,9
31,2 ±4,0
28,7 ±-4,0
30,2 ± 3,8
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0.346
0^20
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Bonoxepa B rpynnax cocxaBHJia 1260 MJI (924; 1580) H 1821MJI (1348; 2156) (p= 0.001). Ta-
KHM o6pa30M, o^HOKpaxHoe BBe/ieHHe xpaHCKcaMOBOH KHCJioxbi B AO3e 1 5 r/ JT nepe^ cnaxHCM
xypHHKexa, npBsejio K .nocxosepHOMy CHH^KCHHIO ne XOJTLKO apeHa^cHbrx noxepb, HO H K
CKPLIXOH H cyMMapnofi KposonoxepH.
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Bec6epeaceHna aBJiaexca H3MCHeHne noxpeSnocxH naimenxoB B ^OHOpCKOtt KpoBH. B nauieM
HCCJieaoBaHHH HH o^HOMy H3 naHHeHxoB B o6eHx rpynnax reMoxpanc(J)y3HK> He npoBo/mnH.
BO3MO)KHO, 3XO CBfl3aHO C OXHOCHTCJIbHO BblCOKHM HCXOAHtIM ypOBHCM reMOIMIo6HHa (BbHUC
130 T/JI). riepejniBaHHe KPOBH xaKHM nanHenxaM npn njianoBLix onepamiax na KOJICHHOM cyc-
paccMaxpHBaexca KaK HCKrnoHeHHe H3 oSmero npaBHJia, xpeSyion^ee oxzienbHoro
Ka^ecxsa BbmoJineHHa onepaxHBHOro BMeuiaxejibcxBa.
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HH5KHHX KOHCHHOCTCH B npOUCCCe npOBe^CHHOrO HCCJICflOBaHHa He
14
BnejrpeHHe jnoSoro HOBOFO npenapaxa B cxanaapx Jienennfl xon HJIH HHOH rpynnbi na-
IXHCHXOB saBHCHX ox MHOFHX tj>aKxopoB. Bo-nepBbix, KOHCHHO, 3xox npenapar ziojDKen ynyn-
uiaxb pesyjibxaxbi jieneHHa, HTO jjoimno 6bixt noATBep^aeno c HOSHUHH «MCAHUHHH, OCHO-
BaHHOH Ha^oKa3axejibCTBax». Bo-sxopbrx, npHMeneHHe npenapaxa He .HOJDKIIO conpoBoac^aTb-
ca cepte3HbiMH no6oiiHbiMH 3(J)4)eKxaMH. B-xpexbnx, ero npHMCHCHHe ^OJI^CHO 6bixb OTHOCH-
TCJIbHO npOCXbIM, ^OCXyHHblM H OnpaB^aEHblM C KJlHHHKO-3KOHOMHHeCKHX nO3HUHH. yHHTbl-
eaa SXH npaBHJia, npn npoBe^enHH namero nccjieaoBatiHa Mbi HCnojibSOBanH caMyio npocxyro
no HCHOJIHCHHIO cxeMy BBe^eHHa xpaneKcaMOBOH KHCJIOTBI, Bbi6pas speMa ( nepea CHHXHCM
xypHHKexa), ^osy (no^xBep^HBinyro CBOIO 3(})4)eKXHBHocxb H 6e3onacHOCXb B npefliuecxByio-
HIHX HcnbixaHHHx) H KpaxHocxb (MHHHMaju>HO AOCTaxoHHyio) ZUM nony^eHHa 3<J)(J)eKxa. IIpH
3XOM Mbi XOHHO noBxopHJiH cxeMy, KOTopyio Hcnojib30Bajin B CBoefi pa6oxe Hippala H coasx.
(1995).
CpaBHeHHe nojiyMCHHbix pesyjibxaxoB noKasbmaex, HXO TpaneKcaM no CBOCH
XHBHOCTH H 6esonacHocxH HC ycxynaex 3apy6eacHbiM anajioraM, a ero Hcnojib30BaHHe npn
onepaijHax npoxesnpo Banna KOJieHHoro cycxasa MOKCT 6bixb peKOMen/joBaHo /uia
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xnpypr HMXI^ HM. H.H.IlHporoBa npotfieccop K).M.
aHecxe3HOJior-peaHHMaTOJior HMXLJ, HM. H.H.nnporoBa npo^eppop M.H.BaMaxHH
15
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