o. V1. K)pKOBCKVt
A. M. r P4IOK
KJ1li1HJ1lIECIG1E


C-4c
: npaKTKe
Bpa\.ia
t,
,
"


EJ>I< 53
1075
Y J{K 616 (035.5)
PeUeme/lT 33B. K34». KOCMCTO.10.-ii Ta peKO/lcrpYln. xipyprii rMAno, n3Y-
peaT )tep)l(3Blloi npcNii PtJ>. n-p Mea. /laYK. 111'0«1'. O. I. IIcpo6cCB
)tPYKYCTbCII 33 BI\lI3111111M: IOpKOf/C,m,i O. 11.. Ij'"IIIOK A. M. OOmCKJlIIIIII'IC-
C"IIC 3naJU"U.I B IIpa"'"TII"e BpaOja. M.: U,CllTp xrc. 1998.
Y KUlI)I(lIi 11311encno /lOpMaJlt.lli nOK33111'''" 3'U-aJlbIlOKnilfi'llllfX 3lfaniJiB
KpOHi. cC'li. "any. UI.1YlfKOBO/'0 1"3 nyo.aClfaJIbllOrO 8MiCT)'. MOKpOTlIIIIIII. cmill-
1f0MOJKOIiU. 1"':1.111111, 3 T3KO)l( CIIC1"CMIf rCfOCT3JY. OmlC3lfO tcnilfi'llfO-
;I'31110CTII'IIIC 3113'1CIIIIII MO)f(JIIfBIIX 3Mill Y pC3YllbTaT3X 311ani3iB, IIOIICHCIIO ;l.C-
JlKi lcpMinn 1"3 MC10.a11 nOCninJKCHb.
P03p3XOBaila Ifa Ncnn'lHIIX CCC1Cp T8 npaKTlIKYlO'lIIX IIiK3pio. Mo",c 6YTlI
BlfKOplfC1311a BlllUla.:taOjaMIf. CT)'nCIlTaMIl MCnlf'llflfX BYJiB.
B KllltrC IIplfOCilCHbi nOK3J31"Cml 06WCIUIIIIIIIOjCCKIIX alf31111J0B KpOOll, \IOOjIl,
KaJla. >KCnYlIOOjIlOIO M nyoncHanblloro co.nep>KlfMoro. MOKPOTbl. cmllllfOMo3ro.
BOii >KII.aKOCTH, a T3K>Ke CIICTeMbl n:MOCTa3a B HopNe. l1:1no)l(cliO tcnIllIllKO-
nIl3n.OCTlfOjCCKoe 3lfaOjelllU: B03MO)l(lfbiX 113NeHCllllii 0 pC3ynbT313X 311dJ1lfJOB,
p33bllCllelfbi IfCKOTopble TepM111II1 II MeTonbi IIccnellooallllll.
P3CC'IIIT3Ha 1f3 Ne1111.lIlHCKIIX ceCTCp If np3KTIIKYIOIIX op3'1eii. MO>KCT
6b1Tb IIClIonb30B3113 npenon30aTCnJlMli II crynClll"3MIf MenMUllIICKIIX OyJOB.
10
4108010000 - OOS
202 - 2000
&:306bJlM.
ISBN 966-575-187-5
@ IOpKOOCbKllii 0. I.,
rpllUIOK A. M.,
2000

O.II1.lOpKOBCKHH
A M. rp
KJ1l11HJ1lIECKVIE
B npaKTit1Ke
Bpa'ia
KTB
1"EXHIKA"
2000

COAEP>KAHE
Mamepuan iJnR KnuHuKo-na60pamopHblx uccneiJosaHuu ............................. 6
CCTEMA KPOB .............,......................................................................... 11
06l1tEKf1It1HIt14ECK\I1 AHAI1\113 KPOB\I1.................,.................................. 11
3pHTpOUI1Tbi (RBC)............. .........., ,..,...... ....................... ..., ,." ,...,...... ...... 12
PeTHtcyllOUI1TbI ....... ......... ............ ..... ................... ....... ..... ..................., 13
reMorllo611H (HGB) ........................,......................................................... 13
reMaTOKpl1T (HCT) ................................................................................... 15
Cpe.QHI1H 061>eM 3pHTpOUHTOB (MCV)...................................................... 16
Cpe.QHee COAep>KaHl1e reMom0611H8 B 3pHTpOUtlTe (MCH)..................... 16
Cpe.QHRR KOHueHTpaUHR reMom06I1H8 B 3ptITpoUtlTe (MCHC).................... 17
AHI130UHT03 3pl1TPOUtlTOB (RDW) ........... ................................................ 18
neHKOUtlTbl (WBC) ................................................................................... 1 B
HeHTpo4>l111bl.....,.....,....,....................................................................... 19
303HHo4>l111bl..........."...,......,.......................... ............. .................. ....... 21
68304>l1nbl ............................................................................................ 22
MOHOUHTbI ......... ........................ ...... ......... ...., ........................ ......... ...,.. 23
nl1M4>oUtlTbI . ............................ ............ .... ,.... ............., .....,.... ............... 23
TpoM60ul1TbI (PL T)..................,............................................................... 25
C03 ....... ......... ..... ...................,.. ........ ....... ........ ......................... .............. 26
KOCTHbl M03r (M\I1EnOrPAMMA).......................................................... 2B
n\l1McJ>A T\I14ECK\i1E Y3nbl (nIt1McJ>A,QEHOrPAMMA) ................................. 31
CCTEMA rEMOCTA3A .................",.,............................................,.......... 32
COCYA\I1CTO- TPOM60Lllt1T APHbl rEMOCTA3...................................... 36
Pe311CTeHTHOCTb Kanl11111RpOB ......... ............... .................., ............ ,.......... 37
BpeMR KpoBOTeHI1R ........... ...... .... .... ...... ...... ............ ,........................ .... 37
\I1cclle.QoB8Hl1e TpoM6oLlHTOB ,.... ...... ....... .... ................. ........................... 38
KOnl14eCTBO TpoM60uI1ToB........... ........ ....... ..... ............. ..... ..........,.,..... 38
A,Qre311BHOCTb TpoM60LlHTOB .........................,...............................,..... 39
Arper8L1I1R TpoM60LlI1TOB. ..... ................... ................. ........................... 40
cJ>8KTOp 3 TPOM60Lll1TOB ....................................................................... 40
cJ>aKTop 4 TPOM6oLll1TOB ....................................................................... 41
rEMOKOAfYnHLI\I10HHbl rEMOCT A3.. .................................... ...... ......... 41
BpeMR cBepTbiBaHI1R KpOBI1 (no nl1-Yamy) ...................,......................... 43
BpeMR peKanbLlI14>HKaLlI1H nn83MbI......................................................... 43
AKTI1Bl1pOBaHHoe BpeMI'I peK811bLlI14>I1K8L11111 nlla3MbI (ABP) -
KaOnMHoBoe BpeMR ...............................,..................................................... 44
AKTI1BI1POB8HHoe 48CTI14HOe TpoM60n1l8CTI1HoBoe
BpeMSI (A4TB) - KaOnI1H-Ke!PanI1HOBOe BpeMSI............................................ 44
AyroKoarynorpaMMa ........... ... .................. ...... ................... .......... ............. 45
nOTpe611eHl1e npoTpoM6HHa ................................................................... 47
AKTHBHOCTb 4>aKTopa VIII ........................................................................ 48
AKTI1BHOCTb 4>aKTopa IX .......................................................................... 48
AKTI1BHOCTb 4>aKTopa X.....................................................................,..... 48
AKTI1BHOCTb 4>aKTopa Xl.......................................................................... 49
AKTHBHOCTb 4>aKTopa XII ......................................................................... 49
npoTpOM611HoBoe BpeMI'I........... .............. .............. ............ ..... ........ ......... 49
3

AKTBHOCTb cpaKTOpa II............................................................................. 50
AKTBHOCTb cpaKTopa V..................................................................,......... 50
AKTI1BHOCTb .. cpaKTopaVIl......................................................................... 51
T pOM611HOBoe BpeMR.... ......... ..................... ..... .... ...... .......... .......... .... ....... 51
4>116p11HOreH A (cpaKTop I)......................................................................... 52
4>116pI1HOIlI1TI14eCKaS1 aKTI1BHOCTb (cnoHTaHHblH
3yrn06ynl1HoBblH 4>M6pMHOn'13) .................,................................................... 52
4>116p11Ha3a (cpaKTop XIII) ......................................................................... 53
PeTpaK4R KpoBRHero CryCTKa ................................................................. 54
npOAYKTbI AerpClAa1111 cp6pl1HOreHa (nA4» .......................................... 54
TOllepaHTHocTb nna3MbI K renapHY ........................................................ 55
CBo6oAHblH renapl1H '" .... ............ ......... .... ............, .........,.. ,............ ,..,...... 55
AHTTpOM6I1H III (AT III) ........................................................................... 55
npOTel1H C................................................................................................ 56
HcTpyMeHTallbHble MeTOAbl ................................................................... 56
T pOM6031laCTorpacpl1R ....... ................. ...... .......................................... 56
Koaryllorpacpl1R ." .... .... ......... .... ............ ... ..." ...... ... .,. ,......, ................... 57
OCHoBHble Tl1nbl KoaryllorpaMM .............................................................. 58
.-JCCI1EAOBAH.-JE MO'-lM ..,......................................................................... 59
4>3KO-XIi1M'-IEC XAPAKTEPCTKA ............................................ 60
KOIl4ecTBo M0411 B CyrK........................................................................ 60
OTHOCI1TellbHaR nllOTHOCTb M0411 (B yrpeHHeH nop41111) ......................... 62
'-IBeT ............... ..................... ..... .................... ... ....... ....... ........................... 63
np03pa4HocTb ....... ............. ..... .......... ...... ...... .................... ............ ........... 63
PeaK411R, pH ..............,.......,...... ..................." ....., ........... ...... .... ................ 64
DeIlOK ......... ....................... ....... .............. ....... ............... ............ ......... ....... 65
Caxap. ................ ............... ....... ................ ..... ...... ....... .................. ............ 66
KeToHoBble Tella ........................... ........... ....... ......................... ............ .... 66
nl1rMeHTHble Tella ... ...................... ....... .... ...... .... ....... .......................... ..... 67
BeU(ecTBa a30TI1CTOrO o6MeHa................................................................ 68
MO'-lEBOIiI OCA,QOK .........................................................................,.......... 70
3nTelll1allbHble K11eTKI1........... ........ ......... ................... ..... ............ .......... 71
I1eHKOI1Tbl ........ ...... ............... ... .__.... .__..... ................. ... .... ....................... 71
3pl1Tp04 11 TbI ...... ...... ............... ......... ............. ,.......,......... ...... ............... .... 72
I..\l1nHAPbl ........... ........ ........ ......... ........... ..... ............... ........ ...... .............. 72
5aKTepl111 . ......... ...... ......... ......... ..... ,......,....... ...... ......... ............................ 73
HeopraHI130BaHHblH O<:aAOK .................................................................... 74
KOll114eCTBeHHble MeTOAbl onpeAelleHI1S1 M04eBoro OCClAKa................... 75
CCIIE.D.OBAHE 4>YHKLt n04EK..................................................,...... 76
MCCI1EAOBAHME KAnA ............................................................................. 80
KOnpOIlOr4ECKE nOKA3A TEII ......................................................... 60
KOllH4ecTBo ............. .............. ........................ ............... ............................ 81
KOHCI1CTeH411R .... ...... ...................... ............... ......... ............. ...............,..... 81
'-IBeT . ................. ...... ......... ..... ........ ,.......... ........... ..... ......,................ ......... 82
3anax.............................................................................,.... ......... ............. 82
naTollor4eCKl1e npMec ....................................................................... B3
PeaK411R, pH ......... .............. ....,. ....... '" ......... ............................................. B3
CTepK06IlH............. .................................... ............ ... ....................,....... B3
CKpblTaR KPOBb ......... ............... ....................... .............,............................ 84
PaCTBOpl1MblH 6elloK ..... .... ..... ........ ................ .......................................... 84
4

MMKpOCKonMR Kana ................... .............. .... ....................... ...................... B4
f!Ha renbMMHTOB ...... ............... ............ .... .... ... ,....... ..........,..................... a6
MCCnEl\OBAHME )f(EJ1YA04HorO COAEP>KMMOrO ............................ a7
>KEIlYL104Hbllil COK ........ ....... .......... ..... .........,....................................... ..... a7
KoneCTBO )l(enY,QO'IHOrO COKa .............................................................. aa
(4BeT ........ ............... ...... .......... ............... .... ...... ....... ..... ................... ......... 68
3anax.... ...................................... ............. .....,................................... ... .... 88
CnM3b ........... ..... ... ..........................,........ ........., ,.....,......... ......,............... B8
MMKpocKonMR co,Qep)l(I1MOro.................... ................................. ,.............. aa
KMcnoTHocTb, pH ......................."..............,...................,......................... 89
nencliIH ...............................................................,.................................... 91
MccnEl\OBAHME AYOAEHAJ1bHOrO COAEP>IG1MOrO........................ 92
AYOL1EHAIlbHOE COL1EP>KIIIMOE ....,................,....................................... 92
Konlil'jecTBo )l(en'jlil ................... ........... ..... .............. ..... .................... ........ 93
nnoTHOCTb............. ................... .... ........ .... ................ .......... ...., ......... ........ 94
(4BeT ....... ............ ......... ....... .......... ... ... ................. ,.... .......... ....... ............... 904
npo3pa'jHocTb ....... .....,...... ..........., ...................... ................ ...... ,.............. 95
PeaKUIiIR, pH ................,...... ....... ....,....., ,............................................, ...... 95
6HJ1l1py6Ii1H ....... ...... ................................ ...................... ....................., ...... 95
>Ken'jHble KMcnOTbI... ........... .... ................. ................................................ 96
XoneCTeplilH ...... ...... ................ ......... ....... ...................... .... ............. ,..... .... 96
6enOK .... ............................... .... ................ ...............,...........................,.... 97
MMKpocKonlil'jecKoe Mccne,QOBaHlile ........,................................................ 97
MCCIlEl\OBAHME .. MOKPOTbl..............................................,................... 98
Konlil'jecTBo ............................................................................................. 98
XapaKTep MOKpoTbI...................,.....................,............................,........... 9a
MIiIKpocKonlil'feCKOe IiIccne,QOBaHlile .,.........................,.......................,..... 99
cnMHHOM03rOBAst >IG1AKOCTb......................................,..................... 101
(4BeT "..., ............. ...... ....................... ... ............. .............. .... ...... ................ 101
npo3pa'jHoCTb ....................... ....... ......... .................................. ................ 102
L1aBneHlile ...,....................... ................. .................................... ................ 102
nnoTHOCTb... .......... ....... ............................................... ............................ 102
(41i1T03 ..................... ...... .......... ................ ........................,.... .............. ...... 102
PeaKUIiIR .................................................................................................. 103
6enoK .....................,...............................................,................................ 103
rmoKo3a .................. ,........................ .................. ................................. .... 104
XnoPIiIAbI .....................................,................................. .......................... 104
CnucoK UCnOnb306BHHOU numepamypbl...................................................... 105

MaTepMan A11fl K11MHMKO-l1a6opaTOpHbIX
MCCneAOBaHMH
MaTcpHanOM n,nS! KnlflllfKO-na6opaTOpllblX HCCnC.nOBaHlfH MOryr
CnY>KIfTb pa3nJf'lllbfC 6HOnOrH'ICCKIfC >K1f.nKOCrH: KpOBb, ec KOMnO-
IICIiThf (nna3Ma. 3pHTpOLlJfTbf....). MO.,a. K3JI, >KCny.nO'IllbIH, naH-
KpCaTIf'ICCKH" COKH, >Ken'lb, CnfOHa, nHKBOp, cncpMa, nOT, BbmOTHblC
>KJUIKOCTIf (3KCCYJIaTbl, TpaIlCCYJIaTbl), KOHJIClicaT BblJIblXaCMoii Bna-
rH. a TaK>KC TKalib napCIIXltMaT0311blX opraHOB. non}"iaCMaS! cnoco-
60M 6HOnCH".
MaTcplf3JI }lJIS! Ifccnc.nOBmmlt HaJIO JIOCTaBnS!Tb B na60paTopHiO B
npc.ncnbJIO KOpOTKHC CpOKIf C conpOBo.nUTcnbllblM 6naIlKOM, B KOTO-
pOM YKa3b1B3fOTCS! cfIaMltnlfS!. HMS!. OT'ICCTBO 60nblloro, xapaKTcp Ma-
Teplt3JIa H JIaTa cro B3S!TIfSi. nCpC.,cHb IIco6xo.nHMbfX na60paTopHbJX
Hccnc.n.OBaHHH, oT.ncncHHc, npc.nnonaraCMblH JIUarH03.
Kp08b pCKOMCHJIYfOT 6paTb y 60nbHblx 113TOlllaK (CnyCTSI 12'1 no-
cnc npUCMa flJflllH). 06b1'1HO yrpOM (MC>K.1lY 7 U 9 'I), >KCnaTCRbHO .nO
$Jl31f'ICCKOH HarpY3KH H npOBc.n.CHHSI JIHamOCTif'lCCKHX npou'cJIYp.
nplt Hccnc.nOBalUlH KpOBH. nonY'ICIIIIOH IIC lIaTom3K, a TaK>KC
npH IICKOTOpblX Tlfn3X .nHcnHnonpoTelllletIIH B03MO>KCH BbfXO.n
JIItnCMIf'lCCKOH CbfBOpOTKH. B TaKOH CblBOpOTKC IIcnb3S1 onpc.ncnSlTb
pSl.l1. 6UOXUMU'ICCKHX nOK33aTcnCH (KpCaTlUIJUI, 06111HH 6cnoK,
TlmrmntCpHJIbl If .np.).
npJl B3S1THH KpOBU nyrcM nCHcnYHKI.lHII BpcMJI CJIaBJ1HBaHHJI co-
Cy.nOB >KryrOM .non>KHO 6blTb MHHHMaJ1bllbIM. 6onbHoH HC JIOn>KCH
C>KIIM3Tb H pa3>KHMaTb n3JIbLlbi PYKII. nOCKonbKY 3TO Bbl3blBaCT MC-
CTJlblii CTa] H rHnOKCHfO. a TaK>KC CJIBHrlf B pacnpc.ncnCHHH HCKOTO-
pblX BCmCCTB (xonCCTcpHH3, K3JlHSI, Halp"", K3JlbI.lHSI H .np.) MC>K.1lY
4>OpMCHHbIMU 3nCMCIITaMH KpOBH U cc >KHJIKOH '1aCTbfO.
nOnO>KClllfC Tcna naUUCIITa BnHS!CT Jla KOHUCHTpal.lUfO pSl.na KOM-
nOHCHTOB nna3Mbl. B 'IaCTHOCTIt o6ll.lcro 6CRKa, 3Jlb6YMHHa. KpcaTH-
HHHa, xoneCTCpHJla. K3JlbUHSI, ll.lCnOIIHOH 4>occflaTa3b1 H .np. YCTaHOB-
nCHO, 'ITO KOIIUCIITpaU\UI BCCX ncpC'IJlCJlCHHblX MCTa6onHTOB 3H3'1H-
TcnbHO nOBblwaCTCSI, ccnH 60nbJlOH Haxo.nUTCJl B nCpTHK3JlbHOM
nOnO>KClllfJI, H YMCHbwaCTCSI, ccnH B ropIl30HT3JlbHOM. B nOnO>KCHHIf
nC>Ka unlf CII.nSl 60nbHoii JIon>KCII lIaxo.nUTbCSI HC MCHCC 30 MUH .no
B]S!THSI KpOBH.
Bo 1I]6c>KaJlHC rCfOml3a KpOBl> cnc.nyCT 6paTb CYXHM rnnplfl.lCM,
CYXOH IImoii (o.nHopa30Boro nonb30BamfSl), B CyxyfO npo6lfpKY, B
CTCpHnl>JlbIX ycnoBlfSix. rCMOJlH3 3pH'rpOu,UTOB BO]MO>KCH B ycnoBII-
SIX BCIIOJliOrO 3aCTOSi. 3tlCprH'IIIOii 3cnHpaU\fIf KpOBH wnpHu,CM, npH
.nJllfTCnbIlOM coxpaHcHlfIf I.lCnbHOH KpOBH. .nciicTBHlf BO.nbl H JICTCp-
rCIITOB, BblCOKOH H HlI3Koii TCMncparypbl, BblCOKOCKOpOCTtlOrO U,CH-
6

TpmpympoBaHHR. .llnR npCJ10TBpamCHlIR BCncUHBaHHJI B3JITY1O KpOBb
MC.D)ICHUO nCpCHOCRT H3 IlmpHl..ta B np06Hp1CY.
DpH uCCnCJ10BaHl1H CHCTCMbl reMOCTaJ8 K B3HTHIO KpOBH npen'b-
RBnRIOT pM nononHHTcnbHblx TpC60BaHHit B :nOM cny.,ac HCnOJlb-
3YlOT HrIlY C lUHpOKHM npOCBeTOM, Jlyt{WC 6e3 wnpHua (nocncnHHH
npHMCIDIIOT npH B3$ITHH KpOBH Y ,lIeTCH. a TaK>KC y 60JlbHbiX C RBJlC-
HHRMH nmOTOHH", HaXOD,RWHXCR B TCpMHHaJlbHOM COCTORHHH).
KpOBb c06HpalOT B rpa,!{YHpOBaHHbIC UCHTpI,I(PY)l(HbIC np06HpKH, co-
,lIcp)l(am HC aHTHKoarynRHT-CTa6HJlH3aTOp, CBR3blBalOIl.lHH HOHH3HpO-
BaHHblH KaJlbUHH (3,8%-HbIH paCTBOp uHTpaTa HaTpHJI, 1,34%-HbIH
paCTBOp OKCaJlaTa HaTpHR). .llnR nonyt{CHUR npaBHJlbllblX PC3YJlbTa-
TOB Hc06xOAHMO npaBHnbHO C06nlO,lIaTb COOTHOWCHHJI OO'bCMOB
KpOBH H CTa6HJlH3aTOpa - 9: I. Hc pCKOMCHA)'eTCJI 6paTb KpOBb t{cpe3
KaTCTCp, TaK KaK cro nCpUO.D.Ht{CCKU npOMblBalOT rcnapUHOM H B cro
H3rH6ax TpaBMHpYIOTCJI OpMCHllbIC 3nCMcHTbI KpOBH. KO)l(Y ua,!{
MCCTOM npOKOJla (06blt{HO B nOKTCBOM crH6c) 06paoaTbiBalOT cnHp-
TOM. DOCKOJlbKY B npoucccc BBCJ1CHHR HrIlbl B npOCBCT cocY,lIa H3
npOKonOTOH KO)l(H, nOAKO)l(HOH KlICTt{aTKH, COCY.D.UCTOH CTCHKH B Hr-
ny nCpCMCll.laIOTCR TKaHCBaR )l(H.lI.KOCTb H 4)parMCHTbl TKaHCH, KOTO-
pblC B ,lIaJlbIlCHlllCM MOryr CYlllCCTBCIiHO nOBJUIRTb Ha KoarynonorH-
t{CCKHC TCCTbI, ncpBblC (nocnc HaJIO)l(CHHJI )KryTa H npOKona BCHbl Hr-
nOH) 0,5-1 Mn (OC06CHHO BblcTynHBwHc BHat{aJlC 5-6 KancnL)
BblTCKalOll.lCH KpOBH Hcnb3R Hcnonb30BaTb .D)IJI KoarynorpaMMbl. O.D.-
HaKO :ny nopuHIO KpOBH MO)l(HO npHMCHJlTb ,WUI BCCX ,lIpyrHX 6HO-
XHMII'iCCKHX HccncAoBaHHH. QT06bl HCKJlIO'iHTb BnHJlHUC Ha Koary-
nJll.{HIO nOCnC.D.CTBHH BCll03Horo 3aCTOJl, )l(CJlaTCnbHO 6paTb KpOBb 6C3
HaJIO)l(CHIfR >Kryra unn BO BpCMJI BblTCKaHHR KpOBH ua 2-3 C paccna-
6HTb )l(rYT. KpOBb AOn>KHa CTCKaTb no CTCHKC np06upKn ,lI0 MeTKIf.
Dp06npKY 3aKpblBalOT np06KoH H nnaBUblMH .D.BH)I(CHUJlMH HCCKonb-
KO pro ncpCBOpa'iHBalOT .lI.IIJI ncpcMcwHBaHHR KpOBII C aHTHKoary-
nJlHTOM (He 6empJLW8amb! He 6eneHII6amb!). BpCMJI MC)l()J.y B3RTHCM
KpOBIl H ee 06paooTKoH HC ,lIon)l(1I0 npcBblwaTb 30-40 MHH.
EcnH Tpc6ye-rcJI nonyt{HTb nn83MY, B np06HpKY 3apaHcc BJIlIBalOT
HnH BCbmalOT COOTBeTCTBYlOll.lHH 3HTHKoarynJlHT (nHMoHuoKHcnblH
HaTpHH, lUaBCJICBOKHCJIblH HaTpHH HJIH KaJlHH H .D.p.) ,WUI npeAoxpa-
nCHIfR KpOBH OT CBcpTblBaHIiJi. KpOBb C aHTHKoarymmToM ncpcMc-
WHBdlOT (6C3 BcncHHBaHIUI), 3aKpblBalOT np06HpKY KYCOt{KOM nOJIH-
3TlfJICHa H OCTaBillIlOT B lllTaTHBC Ha 20-25 MHH. HHTCHCHBHOC
BCTpJlXHBaHllc Bb13blBaCT rCMOJIH3 3pUTpOUHTOB, 'iTO HCKa)l(aeT MHO-
mc napaMcTpbl KoarynorpaMMbl. DO')TOMY nJla3Ma C npH3HaxaMH rc-
MOJIl133 HCnpHrOD,Ha JUlR AaHHoro HCCJIC,lIOBaHHJI.
DpH H3yt{CIIHH CHCTCMbl reMOCT83a KpOBb OOblt{HO cTa6IfJIH3H-
PYIOT pacTBopoM JIHMOHHOKHCJIOro lIaTpHJI, nOCKOJIbKY B UHTpaTHOH
KpOBH (nJla3Mc) JIy.,mc COXpallJlIOTCJI naOllJIbHbIC aKTOpbl CBCpTbl-
7

BaHJUI " TpOM60Ll1tTbl. OCIIOBHblC CBCnCH"JI 0 HaH60.nce "aCTO npH-
MCHJlCMblX aIlT"KoaryJlJlIITaX npltBCnCHbl H1t)f(C.
AIITInm81"ynAIIT
nOK818Tt'.'IH, onpc,unclIHIO KOTOPblX
MCUlaCT IICnOJlb1YCMl.lii alfTllKOarynAHT
rcnapllll..................... ......................
fcnapllHaT aMMOHMII. .............. ........ ..... AMMH8K. UlenO'lH811 cjJoccjJaTa1a (lUC1I)
renapllHaT H8Tf1III1. Ka.'IIIII...................... 3neKTpOnilTbl (K, Na)
3L1T A (3TllnellnllaMIIIITerpaYKcycllali KII-
cnoTa)........".........,..................... ..
3neKTpOnilTbi (K. Na, Cn), OCT8TO'lHbIH
a30T
<x-at.lIIna1a, nHnonpoTeHnbl
AMMltaK. <x-aMHna3a. lllC1l. pH KpOBII, Ca
UI1TJ>aT lIaTflIlIl. .................................
OKcanaT aMMOIIIIA......... ............... .......
.l1.nJl nonyqcHltJl CblBOpOTKH aHTHKoarynJlflT UC .n06aBJIJlIOT. .l1.oc-
TaBnCIIHblC B .na60paTopmo np06HpKH 3aKpbIBalOT BaTHOH np06KOH If
nOMCll\aIOT Ha 10-15 MHH B TcpMOCTaT ..lJ.]1J1 nporpcBaHHJI npH TCMnc-
parypc 37 0c. 3aTcM OCTOpO)f(HO npOBOIDIT npoBonoKoH "JI" CTCK-
.nJlIllIOH naJIO'lKOH no BHYT}JCHHHM CTCHKaM np06HpKH, 'IT06bl YCKO-
pHTb nonyqcHHc CbIBOpOTKH. nOcncllHlO1O CJ1JIBaIOT B LlCHTpH$)')I<-
HYIO np06Hpry, y.ncp)f(HBaJi CryCTOK CTCKJlJlIIIIOH naJIO'lKOH, If
LlCHTpH$yrHpYIOT. ECJlH CblBOPOTKY HanO non}"{HTb HCMC..lJ.]1CHHO, TO
KpoaL LlCHTpmtJympYJOT cpa3Y )f(C nocnc CC B3J1THJI. C'IHTaCTCJI, 'ITO
06"LCM Bbl.nC.nJlCMOH CblBOpOTKH COCTaBnJlCT npHMcpHO 1/3 B3J1TOrO
06"LCMa KpOBH (npH IICKOTOphlX naTOnOrH'ICCKHX COCTO"HHJlX CbIBO-
pOT1<H nOJI}"{acTCJI HaMHoro MCHbWC). CblBOPOTKY (.nc$H6pHHHPO-
BaHUYIO nna3MY) >KCnaTCJlbUO HCnOJlb30BaTb B .nCHb B3J1T"JI KpOBH.
Ecnlf )f(C JlCCJlc.nOBaJUIC OTKJla.nbIBaIOT }IO cnc.nYlOlllcro .nHJI, np06J1p-
KY C CbJBOpOTKOH 3aKpbIBalOT np06KoH H nOMCll\aJOT B XOJlO}IHnbHJlK,
R KOTOpOM XpaUJIT nplf TCMncparypc 4 0c.
.l1.JlJI JlCCnc.noBaIlHH C nOMOlUblO MHKpOl\teTOllOB KpOBb 6cpyr H3
naJlbLla, 3anOmUIJI CIO CnCllliaJIbHblC MHKponpo6HpKH, no.nHCCCHHbIC
K MCCry npoKona. nocnc CBcpTblBaHliJi KpOBH CrycTOK OTllC11J110T OT
CTCUOK npo6upKH TOIIKlfM 3anaJlHUhlM KanHJlJlJlpOM H LlCJITpH$yrH-
PYIOT Ha opnHllaplioH KJ1JtHlf<JCCKOH LlCHTpH$yre npH 2000 06/MHH B
TC<JCIUfC 15 MIllI. n011Y<JCllltylO CblBOPOTKY OTcaCblBalOT nacTcpoB-
cKoii nHnCTKOH H ncpcllocRT B .npymc 'IHCTbIC np06HpKH.
I)IIOXIIJI.IH'ICCKHC IICCJlCJlOR81ntH BbmOJlH"IOTC" KaK C nJl83MOH,
TaK H C CblBOpOTKOH KpOBU. OCIIOBHblM 61f0JlOm t lCCKHM MarepHaJlOM
..lJ.]1J1 IfCCJlc.nOBallltJl alITHBIIOCTH cf>epMcuToB " MCTa6onHTOB "BJI"eTCJI
Cb1BOpOTKa KpOBIf. Hc06xo.lJ.IIMO OTMCTHTb, 'ITO BCJlCnCTBHC BblncncHHJI
n npoLleccc CBcpTblBallHJI KpOBIf If peTpaKLlHH cryCTKa co.ncp)f(alllHXCJI
B TpOM60LlHTax 6HOJlOrn<JCCKH alITllBHblX BCll\CCTB, KOTOpblC MOryr
BJlH"Tb Ha $CpMCIITbl n1183Mbl KpOBH, B 6011bWHHCTBC CJI}"IaCB aKTHB-
HOCTb 3113HMOB CblBOpOTKIf npCBblwaCT TaKOBYJO nJl83Mb! KpOBH.
1)0JlCC Toro, npH JI"3HCC cocpCnOTO'lCIHlblX B cryCTKC 3PHTpOLlH-
TOB lIaXOnJUQHCC" B IUlX $epl\tellTbl ncpcxo.nJIT B CbIBOpOTK)' KpOBJI.
8

3THM 06'bRCHRCTCR, B '1aCTHOCTH, 60nce BblCOKaR aKTHBIIOCTb <l>cp-
MCHTOB (naKTaTllCrHJ1pOrCHa1bl, anaHHH-, acnapTaTaMlllloTpaHc4J c pa-
31>1. $PYKT03011If<!>oc$aTanbllonaJbl, KHcnOH <!>oc<!>aTa3bl, aprHHa3bl,
<!>oc<!>orCKCOlf30MCpa31>1 H JlPyrHx 3H3HMOB, COJlCp)l(allllfXCR B 3Ha'.JH-
TCnbllb1X KOnH'ICCTBaX B TpoM60UJiTax H 3pHTpOlUiTaX II OCB060)1(-
JlaJOIllHXCR H3 IIHX npH CBepTblBaHIIH !CpOBH) B CblBopOTKe, '1CM B
nna1Me KpOBH. n03TOMY JlnR OUCHKH aKTliBHOCTH nCpC'IIICnCIUlbIX
4>CpMCHTOB PCKOMCHJlYCTCR nonb30BaTbCJI nna3MOH.
COJlCp)l(aHHC 3JJeKTpOJJIITOB 60nce npaBHnbHO onpeJlCnRTb B
nna3MC KpOBH. nOCKonbKY KOHUCHTpaUHR HOHOB KaJUUI B 3PHTpOUH-
Tax HaMHoro npCBb1llIaeT TaKOBYJO B nna3Me KpOBH, OHH cnoc06HbI
Bb1XOJlHTb H3 3pHTpOUHTOB Jla)l(e '1epC3 HCnOBpe>KJlCHHYJO 060no'lK}'
('1CMY cnoc06CTBYIOT lIapymcHHR B HeH MCTa60nll'leCKIIX npOUCCCOB.
B '1aCTHOCnf A T<I>-H aKTllBlIOCTH, <!>YIIKUHoHHpoBaHHR K-Na lIaco-
ca). MCXOJlR H3 :noro onpCJ1enJlTb ypOBCHb KaJIHR B nna3MC CneJlyeT
lie n03>KC 45 MHII - 1 'I nocnc B3RTHR KpOBH.
Ecml JIJIR HCCnCJlOBaHHR HY)I(Hbl H cJIopMelillble :)JJCMeIiTLI KpOBH
II nna3Ma (KaK, lIanpHMep, npH onpCJlCnCIIHH aKTHBHOCTH auenfnXO-
nllH3cTcpaJb1 3pHTpOUHTOB H xonHH3cTcpaJbl nna3Mbl). TO nplf B3R-
TlfH KpOBH CnCJlYCT npCJlynpCJlHTb CC CBcpTbIBaHHC. np06HpKH.
npCJlHaJlla'ICHllbiC JIJIJI B3HTHR H xpaHeHlfJl KpOBH, npeJlBapHTenbHO
06pa6aTbIBaJOT paCTBopOM JJHMOHHOKlfcnoro If lllaBCneBOKHcnoro
HaTplfJl, Bb1CYlUlfBaJOT H Ha6HpaJOT B HHX KpOBb. 3aTCM KpOBb ueH-
TpH<!>yrlipYIOT B TC'ICHHC 5 MHH Ha KJ1HHlf'lCCKOH UC1rrp11<1>yrc THna
OnH-3 npH 3000 06b.UlH. nocnc 3Toro nna3MY OTcaCbIBaJOT. 3p11T-
POUHTbl OTMblBaJOT OT nna3Mbl oxna)!(JI.CHllblM H30TOIIH'ICCKHM pac-
TBOpOM HaTpHJI XnOpHJla H BHOBb IICCKonbKO pa3 UCIITpH<I>ympYloT,
Ka)l(JlblH pa3 YJlaJIRJI UCHTpIl4>yraT.
rCMOnlJ3l1pOBalUlblc CblBOPOTKY If nnaJMY HC pCKOMClIllYCTCJI IIC-
nonb30BaTb JlnJl aHaJIlI3a, 3a HCKJ1JO'ICHHCM pCJlKlfX cnY'taCB. TaK, I'C-
MOnJJ3aTbl ucnblloH KpOBII MO)l(IIO Hcnonb30BaTb npll onpCJlCnCHHH
aKTHBHOCTH <!>PYKT030MOII04>oc4>aTaJIbJlOna3bl, rmOK03bl H B HCKOTO-
pblX JlpyrHX TCCTax.
06bl'lHO CLiBOpOTl\:Y KpOBH xpallHT B XOnO.lUffibllHKe npH Q-4 0c.
.lI.onycKaCTcR xpaHcIIHc CblBOpoTKH B TC'IeIlHC MCCRua II 60nbllIC npH
ollllo!CpaTHOM ee JaMopa)l(llBaIlHH H OTI3HBaIlHH. BMCCTC C TCM H3BCCT-
HO, 'lTO aKTHBIIOCTh lllenO'lllOH 4>oc4>aTaJbl 60ncc CTa61tnblla (Ha npo-
TR)I(CHHH HCCKonbKHX cyrOK) npli KOMHallfOH TCMncpa1)'pc. B cnyqac
xpaHCIIHJI CblBOpOTKlf npH nOHH)I(CHHOH TCMncpa1)'pc (Q-4 °C) 'ICpC3
12-24 'I nOBblllJaCTCR aKTHBIIOCTb :noro <!>CPMCHTa. EcnH )l(C JlaHHblC 06
YCTOH'IHBOCTIf coclumclIHH (T.C. 06 H3MCIICIIHH aKTI1BHOCTIf 4>cpMcIITa)
B CblBOpoTKC (nnaJMc) KpOBH npH xpallcHHIl OTCyrCTBYIOT. pCKOMCIIJIy-
CTCJI npOB01lHTb allanlf3 TOT'laC nocne B3J1T1fJl KpOBIl.
9

.nnSi Onpe.n:CJICHHSI CO.n:Cp>KRHHSI JIa6HJ1LHbIX coenHllcHHH nJl60 aK-
THBHOCTIf pJUt3 $epMCfITOB (H3npHMCp, KHCnOH $oCct>3Ta3W) H)')kIlO
nOnL30BaTbCSI CBC)KCH HlIH nlfoct>HJ1H3HpOB3HHOH CLIBOpoTKOH. CLlBO-
poTKY', XpaHHBlU)'JOCSi npH Q-4 °C, npHMCWlTh JI)lJI3THX uerrCH HCJIL3S1.
DpH Hc06xoJJ.HMOCTH onpenCnCHHSI ct>oToJJa6HnLHbIX BCIUCCTB
()KCJJIIHWC nHrMCHThI, nOpct>HpHHLl, BHTaMHH B 12 , HCKOTOpLIC MCT3-
60nHTbi aMHHOKHCJJOT) 6HOnOrHIICCKHH M3TCpHaJI cnenyCT KaK MO>K-
HO 6MCTpCC H3np3BJUiTh B na60paTopHiO B 33TCMHCHHOH nocy.ll.c.
I1ccnC.lI.YCMblH MaTCpHaJI, KaK npaBllno, COXpaHJlIOT .lI.O OKOHllaHHSI
BCCX aHaJI1I30B, QTO n03BOnJiCT nOBTopHTb TOT HnH HHOH H3 HHX B
CJJYllac HC06XO.ll.HMOCTH.
DpH xpaHeHHH MO'IH Ha.IlO nOMHHTb, liTO npHcyrCTBYIOII1.He B
HeH 6aKTCpHH cnoc06Hbi BnJUlTb Ha CO.ll.cp>Ka1l.lHCCJI B HCM XHMHtJC-
CKHe COe.ll.HHCHHJI. Ih06w npCnOTBpaTHTb paJBHTHe MHKpOct>JJOpbl B
MOtJe, B HaH60JJbllIeH Mcpe CKaJMBalO1l.lCHCJI Ha pe3ynbTaTax 6aKTc-
pHOJJOrHtJCCKoro HccnCnOBaHHSI, aHaJIH3 MOtJH pCKOMCHJI.YIOT npOH3-
BO,!UiTb B CpOKH OT 30 MJIJ{ .lI.O 1,5 II nOCJJC BbI.ll.CnCHHSI. EcnH 3TO HC-
B03MO>KHO, MOtJY CJJC.lI.YCT nOJJ,KHCJJHTL H xpaHHTb B xononHnbHHKC
npH 4 °C (liTO n03BOJ1JlCT OTJIO>KHTb HCCJJCJJ,OBaHHC Ha 6 tJ nOCJJe c60-
pa). ,AmI nOJJ.KHCJJCHH1I HCnOJJb3}'JOT 60PHYlO KHCJJOl)' H3 pactJCTa
1,8 r Ha 100 Mn MOIIH. onycKaCTC1I npHMcHcHHC npyrnx KOHCCp-
BaHTOB. npaBna, MHorHe KOHCCpBaHTbI 3aTpynH1IIOT XHMHllCCKoe HC-
CJJCJJ,OBaHHC MOtJlf.
BbmOTIlble )KHAKOCTH c06HpalOT B CYXYIO IIHCT)'IO KOJJ6y. co-
,lJ.cp)KalU,YlO B KatJCCTBC 8HTHK08ryJ1JlHTa renapHH HJJH JIHMOHHOKHC-
JIM" HaTpHH.
Pe3YJlbTaTbi na60paTopHbiX aHaJ1H30B 3aHOCJlT B )f(j'pHaJ1. DpH
3TOM OTMCtJ81OT Bce np06M. Bbl3MBalOl..LIHC COMHCHHC.

. CCTEMA KPOB
KpOBh (sanguis) - >KH]{KaJl TKaHb opraHH3Ma, COCTOJlutaJl 1f3
nna3Mbi H B3BCmCJIIlbiX B HC" $OpMCHHblX 3nCMCHTOB, ocy"{eCT8-
nJllomaJl B oprallH3Mc TpalfcnopnlponaHHc xm.tJI'ICCKHX BClltCCTB
(8 T.tf. KHcnopOlla), 6naro.napJl KOTopoMyelO mrrcrpHpYIOTCR 6110XH-
M1f'JCCKlie npOLleCCbl, npOTCKalOlllHe 8 pa3mf'JHblX KneTKax H Me>K-
KnCTOtfHblX npOCTpaHCT8ax, a TaK>Ke 8blOomiRIOTCR 3aWHTIfb1C, pcry-
nJlTOplfblC H HCKOTOpblC .nPYrHC $YHKLlHII.
06U(EKl1It1HIt1"fECKIo1Ii1 AHA11M3 KPOaM
nOIt83aTCJlb
"
'"
3pHTp01UITbi (RBC), ><1O" 2 In
rCMorn061111 (HGB), rln
rCMaToKpllT (UeT). %
Cpe;!lIHH 06beM 3pHTpOItHTOB (MCV). MKM-'
Cpenllcc COnCp)l(aHHC rCMorn06HHa
B :JpIITpOUI1TC (MClI), nr
CpCD.IUIJI KOHItCIiTpaUIIJI I"CMorn061111B
B :JpHTpOUIITC (MClIC), %
AHI110UlIT01 :JpIlTpOUI1TOB (RDW). %
PCTHKYJlOUIiTbi. %
nCIiKOWlTbi (WBC). ><IO"/JI
TpoM60uHThI (PLn. ><10"ln
C03. M.l/q
I
I
HOpMa.lhHhle '1HaLlCH".
I
4-5,1
130-160
40-48
80-94
3.7-4,7
12{}-140
36-42
81-99
27-31
33-37
11.5-14.5
0.5-1.2
4-9
18{}-320
JleiiKouHTSp"S1I clJopMyns
1-10
2-15
nOKB13TeJlb
HciiTpoHnbl
nanOqKOJlD.CpHble
ccrMCHTOJUJ.CpHbIC
301Hllo$IInbi
1>a10Hnbl
MOHouIITbi
JJIIM0I11ITbi.
I HopManbllbic 1Ha'ICIIIIA
I % I ><10 9 111
1-6 0.04-0.3
45-72 2,0-5.5
0.5-5 0.02-0,3
0-1 0-0,065
3-11 0,09-0.6
19-37 1.2-3.0
MaTcpH8JI ,ztJIA HCCJlC;:t.ooaIlHA, BCH03HaR Ifnll KamUI1I1IpHM "pOBb.
11

3PIo1TPOLU,1Tbl (RBC)
M - (4,0 - 5.1) x IOu 1.'1
*- (3,7 -4,7) x IOu In
HOB6IlUeno:
t 3pmpCMHJI - a6conIOTHblH nCpBH'IflblH 3pHTpOLlHT03
t pcalCTIfBHblc 3pJl1l'0LlHT03bl, Bbl3BaflHblC rHnoKcHCH (8eHnm-
llR'luoHHaR HeoOemamO'IItOemb npu 6pOHXOJlei'OliHOil lIamoJ1ozuu.
epO:HCOeHltble u npuo6pemeHHble nop01m cepOllo, npe6b18aHlIe Ha
3Ha'illmenbHblX Bblcomax)
t BTOpH'lHblC 3pm-pol.UfT03bl, Bbl3BaHHb1C nOBblluCHfiOH npOJIyKLlHcH
3pm-pon03THHOB (zuopoHe<jJpo3 u nOllu,,:uem03 lro'le#(. H08006pa:J06aHlIR
nOlle#( u neileHU. CeMeUHblU o06poKa'leem8eHHhli'i 3pUmpOl-lUm03)
i 3pH1;pOJ.,tHT03bJ, CBJl3aHHbiC C H36bITKOM CTCpOHJ!OB B opraHH3MC
(Q(J.7t'311'b U CUHOpOM KywrlHi>a, <jJeoXpOJifOl/lilnOMa. zunepa/ibooeme-
pOTtU3M. Jle'lemle cmepouou.,m)
i OTHOCHTcnbHblC 3pwrpOLlHT03bl npH .ncrH.npaTaLlHH (CM. pa.J.ncn
FeMat1lOKpum)
HO""e"o:
! anCMHH (:HCene300e<jJUl/lImllaR. i'eMoJlUmUlieCKllR. zunotrJ1acmU'Ie-
CKaR, B 11-0e<jJ1Il/umHaR)
! oCTpaJi KpoBonoTcpH
! n03.nnHC CpOKH 6CpCMCHHOCTH
! XpOHH'lCCKHH BOCnaJImCnbHbJH npoLlccc
! rHncprH.npaTaLlHH
3pHTpOQHT (crytrocytus) - 6C3"bH.ncpnbIH cpOpMCHHblH 3nCMCHT
KpOBH. co.ncp)J(aIUHH rCMorno611H. OCHOBHOH cpYIIKLlHCH KOToporo
JlBnHCTCH TpaHcnOpTHpoBKa KHcnopo.na H yrncKHcnoro ra3a. 3pm-po-
lJ.HTbl COCTaBnHIOT ocnoBIlYIO Maccy cpOpMCHHblX 3nCMCHTOB KpOBH.
<]>0pMa .nBoHKOBOrJlYTOro .nHCKa o6CCnCI.fHBaeT MaKCHMaJIbHOC COOT-
HomCHHC n]JOUlMH nOBCpXHOCTH K o6"bcMy. nOM HMO }"faCTHJI B TKa-
HCBOM .nblxaHHH, 3pHTpOLlHTbi BbInOnHHIOT nHTaTcnbHYIO (.nOCTaBKa
nHTaTCJJbHbJX BCIUCCTB K KnCTKaM H TKaHHM), 3aIUHTH}'1O (cnoco6-
1I0CTb CBH3blBaTb TOKCHHbJ H ncpcnOCHTb Ha CBOCH nOBcpXHOCTH an-
TJlTCna) cpYHKLlJlH. KpOMC Toro, 3pJlTpOLlHTbJ (rcMorno6HH) o6ccnc-
'IHBaIOT nOlll1cp)J(aHHC KHcnOTHo-ocnoBHOro paBHOBCCHJI B KpoBH.
Co.ncp)J(aIUHCCH B 3pHTpOLlHTax cpCpMCflTbl KaTaJIH3HpYIOT )J(H3HCHHO
Ba)J(HbJC 6HOXHMHI.fCCKHC npOQCCCbl. 3pHTpOlJ.HTbJ npHHHMalOT }"fa-
crnc H B npOLlCCCC CBcpTbIBaHHH KpOBH. CpCIIHHJI np0.llOn)J(HTcnb-
HOCTb >KH3HH 3pUTpOUHTa 90-120 .lIHCH_ CTapblc 3pHTpOLluTbi pa.J-
pywalOTCH B l<J1eTKaX pCTHKyno3H.lIOTCnJlaJIbHOH CHCTCMbl, B OCHOB-
110M B CCnC3CHKe. Onpc.ncnCflHC 3pHTpOlJ.UTOB npOBO.llHT B CI.fCTlIOH
12

KaMCpc EIOpKCp3 C 11311CCCIIIIOH CCTKOii rOpJlCRa (pHC. I) H C nOMO-
lliblO C<JC'PUlKOB UJIH 311aJIH33TOpOB KJICTOK.
PeTMt<yJ10L4MTbl
0.5-1,2 %
(30-70) x 10 9 /11
n06b"ueIlO:
t cn1MymnuuI 3PI1Tpono'na (KpOfJOnOmepll. ze."0/1Il3, pemuKYJ701fll-
mapllblu KpU3 npu yel/elltllo.\t /le'ieUUU BrroerpurfllmllOli cweUUlI,
ocmpblu HeooemamoK Klle.lOpooa)
\
PHC. I. C'ICTlliUl K8Mepa 610pKepa H ce-rK8 rOplleB8
llOIlU;HCeIlO:
! yrHCTclIHc 3pllTpono333 (Ull1aemU'IeeKUe II ZW10lL'laCmU'reeK/le
alle.UUU, lle.1e'leWible BIl-oeqJlllflw/IIble aue.UUII, _"emaema"JbI paKa 6
Kocnlll)
PeTHKYJ10UHTbl (rcticulocytus) - HC3pcnbiC 3pltTpOUHTbI, y KO-
TOpblX CCTb OCT3TKH PHK (pH6oHYKnCHHoBbIX KHcnoT) B pH6oco-
M3X. PCTHKynouHT B TC'lCIUIC 2 .D.HCH OCTaCTCH B KpOBoo6p3lliCHHII,
nocnc Qcro, no MCpC YMCllbWCHHH PHK, CT3110BHTCH 3pCJlbiM
3PllTPOUIITOM.
rEMorn06MH (HGS)
III - 130-160 ,'h.
iK - 120-140."/11
l106b1U1eHO:
t nCpBH'lHbIC H BTOpH<JHbIC 3PHTpOUHT03bl
t OTtlOCHTCnbtlblH 3PHTpO/..lHT03 npH ,ncrHtl.paTaUHH
13

nOHJl:Hl'eHO:
! aHeMHH (:»ce.11e30oefjJW-/llnIHaR. i!e.\l0.71111111'1eCKaJl, ?lIIlOlI!lOemU'le-
CKaR. B l2-oefjJUljumHaR)
! oCTpaJi Iq)()BonoTCpJl (6 llep8ble C)71IKlI Kp080nomepli 1I3-3a C?)'II{ellllJl
Kp0811, 06yc.110R.'1eIlHO?0 60Rbllloii nomepeil .J/CIIOKOell1l1, 1.:ollljeHmpaljllJl
.'e.U02..w6lllla lie coom8emem8yem Kapmlllle llemllll1loii alle.MIIII)
! CKpblTble KpOBOTCIJCHHJI
! 3a6onCBaHHJI. conpOBO>KllaJOIUnCCJI Bbl-
pa>KCHHOH 3H.noreHHoH HHTOKCHKalUtcH (3.'10-
Ka'leCm8ellHble onYXO.1111 U ux ...,emacma3bl)
! nOpa>KeHlfJl KOCTHoro M03ra. nOIJeK H He-
KOTOpblX ,npynlx opraHoB
! reMo,nHnJOLlHJI (llO:»ClllUl aue.ullJl)
rCMorJlo6HH (haemoglobinum) - KpOBJI-
Hoif nHrMCHT, npc.ncTaB.nJlJ01l.\JlH co60if
CJlO>KHbIH 6cnOK. COCTOJllUHii In reMa U 6cnKa
rnoouHa. co.nep>KaIlUlHCJI B 3pmp0l1lITax. oc-
HOBJlaJI $YIlKUHJI Koroporo - ncpclIOC KUCJlO-
po.na OT ncnmx K TKaHJlM, a TaK>KC BbIBC.nCHHC
yrneKHcnoro ra3a 1f3 OpraHlf3Ma H pCl}'IDILlIDI
KHCnOTHO-OCHOBHOro COCTOJlHHJI.
B KpOBlf IJCnOBeKa HMCCTCJI IICCKonbKO
TlmOB reMornooHHa. B 3M6pHOH3nbIlOM ne-
pHO.nC o6HapY>KHBaIOTCJI $CT3nbHblH - HbF
(felus - nno.n). B3pOcnbJC - HbA. H HbA 2 (adultus - B3pOCnblii) I'CMO-
rn061IHbl. KOTOpblC HaXOlUlTCJI B KpOBH .nCTC" H nocnc pO>KllCHHR. K
KOIfUY ncpBoro ro.na )l(H3I1H B KpOBIf OCTaCTCJI B OCHOBHOM HbA , -
reJ\1Orno6HH B3pocnoro.
KOml.,cCTBO reMorno6HHa onpe.nenJleTCJI KonopuMcTpH'IeCKHM
MCTO.nOM npH nOM01l.\1f reMoMcTpa Caml (pHC. 2). o.nllaKO lUIJi TOIJ-
HblX xapaKTCpHCTHK reMorno6HHa (H3-3a cy61>CI\,IfBIIOCTH nepBoro)
pCKOMCHlU'CTCR npllMeHJlTb UHaHMerreMorno6HHOBblH MeTOD.
Pile I. rCMOMCTp CIIJIII
W' B nel'BI.IC 'IaCbI OCTpOH Kpo8onoTcI'li CTcnCIII, aHeMIIII. 113-38 6onbwoii nOTcpll
JIOtJlICOCTH. He RBJlIIC'TCII nOIC83aTe1leM Konll'leCTI18 nOTCpllHHOH KpOBH. B CBII311 C 3nlM
crenellb ICpoBOnoTepMpIUIHHH'ICCKIl MO)lCIIO onpeJlemlTb no tJ>oPMync Burri. '1f>:
Jl = K + IgWJf.
me K - KO)$$MuHellT, nl'M KpOBOTe'leHMIIX H3 )l(enYJlo'lHD-KI1Wc'IIIoro 1'p3KTa I( = 27.
npll nonOCTllblX ICpoBOTe'leHHIIX K = 33. npH paHeHHIIX KOlle'lHOCTCH K = 24. rpYlllIOH
lUIeTKH K = 22: lllJf -"WOKOBblH HHlIelCc" - OTHoweHlle 'IaCTOTbl nynbca IC BblCOTC
CIICTOml'leclCoro apTepllBnbllOrO n8BJ1CIIMli (MM pT CT.):
lllJf = PsIAJl.
JlollonllHTCJ1bHali none3HaR HHtJ>oPMaUHII. ItMeIOW311 KOCDCIIIIOC OTHOWClllle K H3Jla-
raeMoMY M8TeI'ItBnY.
14

CUlIellb KpOBOIIOTepH
CTCIICIt.. -poBO- ]1cIJ!lIlIltr
nOlcp" I.O.
nerKaA llo 3,0 D.o 100 D.o 3S D.o 20 D.o30
CPC:UIAA D.o 2,S D.o 80 D.o 2S D.o 30 D.o 45
TAJlleJ1U D.o 2,0 D.o SO D.020 .no 40 .no 60
Kpaiillc TAJKC-
naA MCHCC 2,0 MeHce SO Mellee 20 60nee 40 601lee 60
rEMATOKPHT(HCT)
)1 - 40-48 %
if' - 36-42 %
l106bllUellO:
r nCpBJI'IHLIC H BTOpnlfliLlc 3pIITpOLlHT03L1 (CM. p83.LleJI :Jpumpoqumbl)
t J1CrH.LlpaTaLlHH (3a60!le6aHltJI :JIC'lYOOliIlO-KUUle'lIlOZO IllpaKma, eo-
np060:JICOQlOUllleeR npOtPY1ltblA' nOItOeOAl, p80mou; OIlCl6em; 'lpe3-
Aleplloe nomoOmOelieltUe)
r YMCHbl11CIIHC 061>c1a uJlpKynHPYlOll.I. CH nna3Mbi (nepumoltum,
0:JICOZ08aR 60,'le3I1b)
llollu3ICello:
! aHCMHJI (CM. pa3J1Cn re."0'l06ulI)
! nOBbll11CHHC 061>CMa LlJlpKynHpYlOlllCH
coeyoucmaR II no.te'lHaR neoocmamo'IIIoemb.
ueUltoemu, zUllepnpomeulle,uuu)
! XpOIIH'ICCKIiH BOCnamlTCnbllblH npOLlccc. TpaBMbl. JlnJlTCnbllblii
nocTcnLHblH pC>KJlM. rOnOJ1almC, XPOHH'ICCK3jI rHncpa30TCMHJI, 011-
KOJIOrH'ICCKHC 3a60ncBaHlUi
! rCMoD:HnIOUHJI (6l1ympu6elltlOe 86eoellue :JICUOKOemu, «Je06ellHo Ilflu
CUU:JICeUUII tPYIIKIIUOlla'lbItOU elloc06110CIIIII llO'IeK)
n11a3MLI (cepoe.tlto-
lI030lme epoKII 6epe-
rClllaTOKpHT (hacmatokritos) - COOTHOl11CHHC 061>CMOB 3pIlTpO-
LlUTOB H nna3Mbi (061)CMHaJl !i>paKUHJI 3pllTpOLlJlTOB B LlCJlbnoH "po-
BU). fCMaToKpuT onpc.acnJleTCH UCHTpU!i>Y)\(HbIM MCro.LlOM. B COBpC-
MCHHblX rCMaTo11onllfCCKJlX ClfCTlfHKax nOK83aTCJIb rCMaToKpllTa Ifa-
Ille Bccro JlBJIJlCTCH paC'ieTHbiM napaMcTpOM. BbIBO'1.HMbIM H3
KOnH'iCCTBa 3pllTpOLlItTOB H ux 061>CMa.
Mal epH3J1 AJIR HCCJICAOoaIlHR. BCH03HaH IInJl KarnlJlJIHpH3jI
KpoBL c06HpaeTCH B reM3TOKpHTHLIH KanHl111Hp, 06pa6oT3lflfblif rc-
napHHoM.
15

CPE,QHMM 06bEM 3PMTPOMTOB (MCV)
'" - 80-94 "'1e",3
:iK - 81-99 "'K1I13
llOBbllueHO:
t MaKpOl.(HTapHLIC H Mcran06naCTHlfCCKHC aHCMHH (()et/Ju1Ium 6uma-
.MUHa BI2. t/Jollue80u KUe70nll>l)
i aHeMHH, KOTopLle MOryT cOnpOBO)f(JlaTbCJI MaKpoLlHTo30M (zeMo-
-"UmUlieCKUe aHeMUU, 60Jle311l1 nelieHU, .MUe.JlO()ucnllaemU'IeeKUe CUH-
()po.Mbl)
1l0pMO:
o HOpMOLlJfTapHblC aJfCMHH (anllaCmUlieCKUe aUeMUU, ZeAIOJlumU'Ie-
CKue aHeMUll, ze.MoZJl06uHOnamuu, aHeMUU noelle Kp060melieHuR)
o aJfCMHH, KOTopble MOryT conpoBo)!(JJ.aTLCJI JfOpMOLlHT030M (peze-
lIepamopuaR t/Ja3a :JICeJle30()eQJUllulillIOli aHe.MUU, MUe.no()uC1lJlacmu-
'1eeKUe CUII()pOA'bl)
II 011 U31ce1l0:
! MHKpoLlHTapnblc aHCMHH (:JICe.ne30()et/Jullumlible aHeMUU, mOllac-
ceMllll, eu()ep06JluCmU'IeeKUe uHe.41uu)
! aHCMHH, KOTOpblC MOryT cOnpOBO)f(JlaTLCJI MHKpOLlHT030M (ZeMO-
JlUmU'IeeKUe aueAIlIU. i'eAIOZJl06uHOllumuu)
CpeJ.lHHH ofh.eM 3PH1P0l1HTOB (mean corpuscular volumc) - HC-
nonL3yeTCJl J1JlJl xapaKTCpllCTHKH THna aHCMHH. npH nonCIfCTC 3pHT-
pOl.(HTOB MO>KHO nOCTpoHTb J<pHBYtO pacnpcn.enCHHJI no HX ,DHaMCT-
paM (KpnBaJi npaitc-}:l>Konca). CpcnnHH 06'bCM 3pJnpOLlHTOB MO>KHO
BLllfHCnJfTL no 4>opMync
MCV = HrxlO ,
RBC
rllc Hr- rCMaTOKpIlT, %; NBC - KOnH.,CCTBO 3pJfTpOLlHTOB, x 10 12 / n.
CPE,QHEE CO.QEP>KAHME rEMOrn06MHA B 3PMTPOMTE (MCH)
.
27-31 11.-
llOBblluellO:
i rHncpxpOMllblC allCMHIl (Ale?aJ10611aemUlieCKUe, llUpp03llelJeuu)
flOIlIl.HCeIlO:
! nmoxpOMHblC >KCnC30,Dc4>HllllTHLIC aHClIIlIH
! arlCMIIJI npll 3JIOKa<JCCTBCHtlbIX onyxoJUlx
Cpel1l1ee (:o.aep",a.IHe reMornoo.lHa B 3pmp0l1HTe (mcan cor-
puscular hcmoglobin) - n.nJl xapaKTCpHCTHK atlCMHH Hcnonb3YCTCJI
16

penKO. CpenHee conCp>KaUHe rCMorn06HHa B 3pIlTpOUJ1Te MO>KHO on-
peneJJHTb no 1J>0pMyne
MCH = Hb .
RBC
rnc Hb - reMorn06HH. r/n; RBC - KOnH'lCCTBO 3pUTpOLlHTOB. x 10 12 1n.
CPEJ1HfIfi KOHL&EHTPALtHFI rEMOrn05HHA B 3PHTPOL&HTE (MCHC)
33-37 %
20,4-22,9 MMonb In
l10661WeHo:
t rHncpxpoMHblC aHeMHJf (crjJepOllllm03. 08a70l1um03)
llOllU:HCeHo:
t rJfnOXpOMHblC aHeMJfJf (:HCeJle30iJetjJII1IIlmHble. euiJep06.nacmu'Ie-
CKue aHe.MUU, ma.:weceMllu)
CpeJJ.HRR KOHuellTpaUHR reMorJIo6HH8 B 3PHTJ)oUHTe (mean
corpuscular hemoglobin concentration) - onpenenJleT HaCblUlelfHOCTb
3pHTpOUHTOB reMorno6HlloM. CpenHlO1O KOHucHTpaUHIO reMorno6H-
Ha B 3pJfTpoUJfTe MO>KHO BbI'iHCnHTb no 1J>0pMyne
MCHC = Hbx 10 .
HI
rnc Hb - reMorn06HIf. rln; HI - reMaToKpHT. %.
m B 3H8'jHTCJlbHOH Mepe AI18r-HOCTHKY 8HeMliH ooner-'j8eT np8BHJJbHIUI Tp8KTOBK8
MopiJlonor-H'jecKHx 113MCHCHHH 3pI1TpOUMTOB.
nOKB38TeJlb JlCeJleJO- B'2-AecJIH-
AccJIIIUHTH8J1 UHTH8JI
rCMOr-nooHH 1 U U 1U
3pHTpOUHTbI -Ir 1 1 U1
1!BeT0BOH nOK838TCJlb 1 e e T
,ltH8MeTp 3pHTpOUHTOB 1 -Ir T n
Cpe.o.HHH ooJ.eM 3pHTpO'
UMTOB e l' T Tn
Co.o.epJK8HHe J"eMor-n06H-
HB B 3pKTpOUMTe 1 l' T ffT
KOHuempaUIIJlI"eMomo-
611H8 B 3pmpoUIne 1 e 1 1
PeTHlCynoWITbi e nT 1U !
npIlMe'j8I1Me. B T86nHue BBe.o.ellbi cne.o.YlOlUHe OO01H8'jeHHJI: e - nOK838Tenb
B HopMe; l' - HC1118'jIlTenbIiO n08b1WCH; T - nOBbiweH; n - 3118'jMTCJlb1i0 nOBbiweH;
TfT - pe3KO BblpaJKeliHoe nOBbiwellHe; -Ir - He1H8'jHTenbHO CHH>KeH; 1- CHHJlCeH;
U - 3H8'jHTenb1i0 CHIIJKeH; U 1 - pe1KO Bblp8)l(CHHoe CHII>KeHlle.
17

AHM30LU1T03 3PMTPOLIMTOB (RDW)
11.5-14,5 %
IltJ6blllle/lO:
T MaKpoUHTapHbIc aHCMlut
T MHCnO.1.UClmaCTlf'lCCKI'!C clfHnpoMbl
T MCTaCTa3bl uOBo06paJoBaHHH B KOCTHblH 1'.1031"
T }KCnC30nc4>uuHTHbIC aHCMllU
AHI130UlIT03 3plfTpOUHTOB (anisocytosis) - COCTORtmC, npl'! KO-
TOPOM onuoBpcMCUHO 06uapY}KUBaJOTcR 3pllTpOUUTbi p33.JIH'IUOH oe-
nIl'IHUbl. LluaMCTp 3pHTpOUHTOB KpOBH 3nopoBoro '1CnOBCKa paBcn
7-8 MKM. 3pHTpOLlHTbI C nHaMcTpoM MCUbllIC 6,5 MKM ua'JhIB3JOT
MHKpOLlifTar.m, 3 C nn3MCTpOM 60ncc 9 MKM - M3KpoLlHTaMH.
MCp3 pa3JIJI<m}! 3pHTpOUifTOB no 06'bCMY RDW (rcd cclI distribu-
tion width) nOnC'IHTbIB3CTCR no 4>opMync
RDW = SD x lO()% .
MCV
I"onc SD - CTaunapTHoc OTKJlOUCHHC 06'bCM8 3pm-pOUHTOB OT CpenHe-
ro 3Ha'lCHHR; MCV - cpcnHHH 06'bCM 3plf'rpOIlHTOB.
AUanOrH'IHYlo 4>YHKUHJO BbinOnHJlCT KPHB8}! npaHc-JJ.>KOIiCa
(CM. pa3.l!.Cn Cpeollllli 06beJlI 3plimpoIlWII08).
W I h Jlpynfll MOP<!>01l01 I/'IecKIIX H3NellCIIHii 3pHTpOUltTOB 311S'Ie1lMe IfIotCIOT:
noiiKHnO/JH"roJ - 1f8pYWCHIfe <l><>PMbl (nOABlIelflfe BbiTAIfYTblX, rpYWCBIlIblX,
CCpnOBI/.:tlfbIX, OBa.'1bHbIX. W8pOBI/.!HbI1l) 3pIfTpOUIfTOB;
TcnLua )l(0JI.1H. Konlo/Ja Ke60TB - OCT8TKIf Al\CPlfblX cy6c-ralluHii B 3pHTpoUHT3X,
nOABJlAIOTCA nplf 1f8npA1\\Clflllf "tplfrponO")J8 (.'e!IO.11l:J, "pORonomepR, B/:-de1J/IIIltmHDJI
t'He "ltR):
CiaJo<l>H.'Ilollall :H'pIfHCTOt'TI. - IIplf T3J18CCeMIUI. Bwl\e<!>lfuIfTlfoii aIfCMIIII;
MHIUCHeBH.:tHLIC 3PHTJlOUHTIoI - B KOTOpblX B /JellTpC npOCBeTnCIIHA HMCeTCA He-
60.llowoe 3aTCMllCllife (npil T8JlaCCeIotHlf);
")PltTJIOUHTIoI <l>pa"lcHTHpoBaHHiole - 06noMKIf 3plfTpoUlfTOB MJIII 3plfrpoUlITIol,
nOTCpJlBlIlIlC uenOCTllOCTb UifTOnn83Mbi (II 3Ha'ilfTenbllOM KOnlf'leC1Be npif .lI.BC-
ClfII.!pOMe, IfCKYCCTBCHIiOM KJl8naHC cepllua. "'MapWCBOM" I"eMOllI13e);
WHJOItHrlol (a...BHTo/JHrlol) - 3plfrpOUIfTioi C "'BOpcIfH'laTw,j"' KpaCM (apre<!>aKT
nplf nplII'OTOBlICIIIIII 1.UKa).
l1EiitKOLlMTbl (WBC)
(4-9) x 10 9 III
H06blu,ello (Jleii«ol{ullltJ:J):
t 6aKTCpnaJTbtfble HmpcKIlHH
t BocnanCHIfC H IICKp03 TKaHcH
t IIHTOKCHKaUWI
t 3JTOt<3I.fCCTBCtfHble HOBoo6pa30BatUUI
i nciiK03bI
t anJTcpnlH
J8

f pC3ynbTaT 11ciicTBIUI KOpTHKOCl"CpOH110B, allpCII3nHHa, rHCTaMHHa,
8UCTltJ1XOmma. "110B lIaCCKOMblX, 3H110TOKCnHOB, npCnapaTOB HanCp-
CT"HKH
llollu:WCIIO (.:lciil<onCIIUR):
!HCKOTOpbIC 68KTCpH3nbHbIC If B"PYCHbIC "H$CKLl11Ji
!J1CUCTBHC nCKapCTBCHHblX npCnapaTOB (c..11f>tjJamL7(Urrl(}08, aHa"b-
?emUK08, IlpOmU80c.."(}OP0:HCHf>lX, aHmumUpeOud1lhlX II (}p}'UX npe17a-
pam08)
! anna3HR If nmOnna3"R KOCTHoro M03ra
! MCTaCTa3bl HOBo06pa30BaHH" B KOCTHb1" M03r
! nOBpC>I<l1CHHC KOCTHoro M03ra XHMH'{CCKIIMU CpCllCTB8MH, ItH1 0-
CTaTl1K8MH
! HOHH3HPYlOUICC 06nY'lcIIHc
! nmcpcnnCHH3M (ncpBIf.,HbIH H BTOpH'IHbIH)
! anCHKCMH'IeCKHC $OpMbl neHK030B
! 8H8$H'1aKTII'ICCKIIH mOK
! KonnarCH03bl
! 60nC3Hb A.lUI.HCOHa-EHpMcpa
JleiiKoUHTbl (Icucocytus) - I<JICTKH KpOBH, 06pa3YlOlUUCCH B KO-
CTHOM M03rc H B nHM$aTl1'1CCKHX Y3nax. OCHOBHOIi $ym<UHCH nCH-
KOUHTOB HBnHCTCH 3alLlHTa oprallH3Ma OT 'I)')K1lblX AIUI ncro pa3nH'°I-
HblX areHTOB.
npH HOpM3nbHbIX ycnoBHRX B ncpH$cpH'ICCKOH KpOBH HaXOllHTCH
nHTb BH110B nCHKOUUTOB: nCHTpo$Hnbl, 303HIIO$HnI>I, 6a30$H.nbl, MO-
HOIlHTbl H nHM$ounTbI. XOTH COBOK)'nnOCTb BCCX nCHKOUHTOB 06pa-
3YCT CHCTCMY, K8)!(J1bIH nHJ1 H3 nHX caMOCTOHTcnCH H BbmonHHCT
CBOIO cnCUH$H'ICCKY'0 $YHKUHIO.
AH3nJ13 nCHKOLunOB cncnyCT llCnaTb HaTOlLlaK H nocnc KopOTKoro
OT11b1xa naIlHCHTa, nOTOMY '{TO nocnc $H3U'ICCKOrO nanpH)!(CUHH,
C.llbJ, npH 6CpCMCfIIIOCTH H npH CTpCCCC Ha6nlOllaCTCH 4Ju3HOnOnt'lC-
CI<HH pOCT HX KO.'1H'ICCTsa.
He.hpo4>Mnbl
nanO'lKOH.ltepHble l %, (0,04-0,3) X 10 9 In
CerTtleHTOIIlupHble 45-72 %, (2.0-5,5) x 10'In
OOBbllUCHO (Heimrpot/JuJ1eJ):
f 6aKTCpnanbHbtC HH$CKUHH (ccncuc. nepumoHum. a6C'II!CCbl, oc-
meo.trle.Ilum. IrllC8.UOIlUR, aHZUlia. CKapJlamuHa. xO.Ilepa. o. annelldu-
'Ium. o. XO.7c'Iliemllm, o. 17l1e.llOllerjJpum, mpo.u60que611m II dp.)
f BOCnancmrc JUJU HCKp03 TKaHCH (UHrjJapKm .uuoKapda. ullrjJapKm .7e2-
I<OCO. zallzpella. 06wupHhle O:JICOZU, ocmpall amaKa pe8.\#amUJ.IIla u dp.)
f nporpeccHPY lO 11I aR onyxonb C pacna,noM
19

i OCTpLiC H XpOHH'ICCKHC nCHK03LI, 3pHTpCMHJI, OCTCOMHCno4>H6p03
i HHTOKCIIKaUHJI 6,pe.JIWI, dua6emulieCKUU KemOaljud03. nodazpa.
:JK7Q.UlleWI6epeMeWlbIX. eWldpOM KywUHza)
i allCMHH (zeJltOJ1umUlieCKue. eoemORHue noeJle Kp060me'leIlWl)
i XpOIlH'ICCKHC 3a60nCBaHHJI KO>KH (:JKerjJOJ7UamU6I1blU dep_uamum.
IlCOpUa3, zepllemutjJopJllHblU dep.uamum)
i .npymc 3a60nCBaHHJI (y3eJ/K06blU nepuapmepuum. HeCneljurjJu'le-
eKuzi Jl36eWlblU KORum. xopeR)
i pC3ynLTaT .nCHCTBHJI KOpTHKOCTCpOH110B, a.npCHanHHa, rHCTaMHHa,
aUeTHnXOnHHa, Jl110B HaCCKOMLIX, 3H,lI,OTOKCHHOB, npcnapaTOB Hancp-
CTJlIIKH
i nOBbIlllCHHC KOHUCHTpaUHH yrncKHCJIOrO raJa
llOllU:HI:eHO (HeumpOnellUR):
! HCKOTOpbIC 6aKTCpHanLHbiC HU4>CKUHH (6pIOWHOli murjJ. napamu-
rjJbl. 1l0dOempblU 6oKnzepua.1bllblU 3HdoKapdum. my6epKYJle3, 6pY'4eJl-
lle3. dp. XpOlIUlieCKUe WlrjJeKIjUU)
! BHPYCHblC HH4>CKUHH (UlIrjJeKIjUOHHblU zenamum. zpunn. KOpb.
Kpacllyxa)
! HH4>CKUHH, Bbl3BaHHblC npOCTCHlllHMH, rpH6KaMH, pHKKeTCHJlMH
! .lI.CHCTBHC nCKapCTBCHHblX npcnapaTOB (cyJlbrjJaHUi1lUlUd08. OHOJlb-
zemUK08. IlpOmu60eyoopO:JICHblX, aHmumupeOlldHblX U dpyzux)
! anna3HJ1 H rHnOruIa3HJI KOCTHoro M03ra
! MeTaCTa3bl HOBo06pa30BaHHH B KOCTHblH M03r
! nOBpC)f{JJ;CHHC KOCTHoro M03ra XHMH.,CCKHMH Cpc.nCTBaMH, UHTO-
CTaTHKaMH
! HOHH3HPYlOll.ICC 06nY'lCHHC
! nOCTJm4>cKUHOHHbIC IICHTpOnCUHH
! rHncpcnnCHH3M (ncpBH'IHbIH H BTOpH.,HLlH)
1 anCHKCMH'ICCKHC 4>OpMbl JICHK030B
! aHa<pHJIaKTH'ICCKH" lllOK
! KOJInarCH03bl
! 60JIC3Hb A.zu:r.HcoHa-EHpMcpa
HeiiTpoeJ)HJ1LI (ncutrophilus) - HX OCHOBUaJI 4>YHKUHJI COCTOHT B
3all.lHTC opraHH3Ma OT 11H4>CKUHH, OCYll.lCCTBnJleTCJI OHa rnaBHblM 06-
pa30M C nOMOll.lblO <parouHTo3a. B KpOBIt npHCYTcTBYIOT CCrMCHTO-
JI.nCpHbIC HCHTpO<PHJIbl H OTHOCHTCJILHO Hc60JIblllOC KOJIH'ICCTBO na-
JIO'lKOJl.nCpUblX HCHTpo4>HnoB_
<1>H3HOnOm'lCCKHH pOCT KOJIH.,CCTBa HCHTp04>HJIOB OTMC.,aeTCJI no-
cnc <PH3H'lCCI<HX YCHnHH, nOCJIC CJIbI, BO BpCMJI 6CPCMCHHOCTH, npH
CTpCCCC.
W Jbt3rHOCTH'IecKoe 'J1t3'1eHMe HMelOT cnenylOwl1e K3'1eCTBeHlIl.le 1t3MelleHHII.
CnBHr BJlCBO - YBeml'leHlle B KpOBH nanO'lKOJlllepnblX HeiiTp()(jJltnoB, nOIlBJIeHHe Ne-
TIlMItCJIOUIITOB (101t1>lX, MHe.JIOUHTOB, npoMHCJlOWITOB) OTp3)K3CT TI!>KCCTb nUTOJlOrHOjCCKOro
20

npouecca. neiiKOIUrrapIIIIJI cj>opM)'na IIJMCIIIICTCR B OCHOBHOM Ja C'IeT CllBHra BJ1CBO. KOTO-
pblii MMeeT MecTO np" IIHKUIIRX. OTpaIL'CHIIR)(. f"eMaronOrll'fCCKIIX Ja60ncBaIIllR)(. nocne
KpOBOTe'lCHllii. Xllpypl"H'IecKlIX B\ICWarenbCTB. aHOMW1MH ncnLr-cpa-XLIO:m1.
l1H11eKC CllBIII"8 (HC) paCC'IHTLIB8eTCR no $opMync
HC= M1+JO+n .
C
r.l1e Mq - MHenOUIlTLI; JO - MeT8MlIcnOIITLI; n - n8JJO'IKOII.l1CpHble; C - CeI"MeIlTO-
JI.I1CpHblC.
B lIopMe HC '" 0,06.
npHJII8KH lIereHep8uHH lIe.hpo4lHlIOB - TOKCH'ICCK8R JCpIlHCTOCTL, TenLU8 J1e-
ne B UHTonn33Me. BaKY0nlIJ8UI1R Rllpa II UHTOnnaJMLI. nHKIIOJ Rllep. UHTOnHJ - HMeeT
MCCTO npH TJI>KenbiX IIHTOKCI1KaUI1RX. BLlpa)l(ellHOCTL :trHX HJMCllellllii JaBI1CHT OT TJI-
>KCCTH HHTOKCHKaUHH.
CaB HI' Bnp8BO - YBenM'ICHlle llonM Cel"MeHTOR11CpHblX rpaHynoUIlToB, KOTOpblH
npHHRTO paCUClIl1BaTL K8K npOJIBnellHe 118pyweHIIII CHHTC3a J1HK B OpraHH'3Me - HMe-
eT MeCTO npH lIacncllcTBCHHOii I"HncpcCI"MeHT8HH, MCI"BJ106naCTH'ICCKHX aHeMHJlX,
6one3HJlx ne'leHH H nO'ICK.
W I1l1lleKc ccrMCHT8UIII1 flelhpo$lInOB S paBCH KonH'ICCTBY Cel"MCHTOB B OllllOM Jlllpe
Helhpo$HJJ8.
B 1I0pMe S = 2,79.05.
303HHO<l>Hl1bl
OS%
(0,02-0,3) X 10' In
llOB""ueHO (OJUHOrpUJleJ):
f an.rrcprHH (6pOHXlI(1JlbHa.Jl acnlMa. eeHHaR JlUXOpaOKa. aJlJ/epzu'le-
CKUU oepMamum. omeK K8UHKe)
t HcncpeHoCHMOCTb nCKapCTB (aHmu6uomllK08. npenapamoe uooa.
aenupUHa. CYllbf/JaliUJ/aJlIUooe. XllopOnpOnaJIluoa. MemompeKcama.
npomu60cyoopO:J/CHblX epeoeme)
t napa3HTapHblc 3a60nCBaHH1I
f 60nC3J1H KpOBIf (oempblii lleUK03. XpOHUileCKUU MUeJlO.TleUK03. uc-
mUHHaR nOJlUlfUmeAIWl. JlI.Ltuj;ozpaHYJleMam03)
f '1CUlyH'IaTbI" nUUlaH, 3K3CMa
f HH!J>CKUHOHHbIC 3a60nCBaHHJI (CKapJlamUHa)
f ncpHo.n Bbl3.n0poBnCHHJI nocnc HH!J>CKUHOHHbJX 3a60nCBaHH"
t .npyrnc 3a60nCBaHHJI (Hecnelflif/JUlieCKUii R38emlblu KOllllm. 3HOO-
Kapoum JJef/Jq)Jlepa. Y3ellK06blu nepuapmepuum, xopeR)
llOHu:»cellO (30JUIIOnellIlR):
! OCTpblC HH!J>CKUHH (6plOumou muf/J. oU3eHmepllR. eeneue)
! TpaBMbl, O>KOrlf, xHpypnf'lccKHC BMCUlaTcnbcTBa, PO.nbl. 3KJ1aMn-
CHR, UlOK, !J>H3H'ICCKOC Hanp1l)f(CHHC
! pe3ynbTaT .nC"CTBWI KOPTHKOCTCPOH.nOB, a.npcHMHHa, HHKOTHHO-
BO" KHcnOTbl
21

303HIIOcltHJlLI (eosinophil us) JlBnJlIOTCJI KneTKaMH, c1tarOl.(HTH-
PYIOUlHMH KOMnneKCbl aHTlfreH-aHTlfTenO, rnaBHblM 06pa30M npel.(-
CT8BnCHHbiC HMMYllorn06ynHHoM E. OHH OTBCIJalOT Ha XCMOTaKCIf-
qeCKJlC $8KTOPbl, BbllIemlCMblC T}'LJllblMIf KnCTKaMH H 6a30$unaMH, a
T8K>Ke 118 KOMnnCKCbl 8HTHrCH-aHTlfTeno. J{cikTBIfC 303HHoclmnoB
aKTJfBIlO npOJlBnJleTCJI B CCHCH6HnH3JfpOBalfHbiX TK8HJlX. .ltJUI c}'T0IJ-
Horo pHTM8 xapaKTcplla $H3HOnOrnIJCCKaJl H3MCH'IHBOCTb KOnHIJCCT-
Ba 303HJI0$unOB. CaMblC BblCOKHC nOKa3aTcnH OTMCIJalOTCJI HOIJblO,
CaMbrC HH3KHC - l.(HCM.
6a3oclntnbl
0-1%
(0-0,065) x 10' In
n06bllliellO (6aJotjJWluR):
f 6onc3HH KpOBH (ocmjJblu JleUKOJ. Jo.]JoHUlieCKUU MuellOlleUKOJ, uc-
mUlti/OR 1I0_7l1l/"me \fUR, .7/LlltjJ02pallYJ7euOmOJ)
f XpOHlfIJCCKHC BocnamncnbHblC COCTOJlHHJI >KCny.noIJHO-KHUICIJHoro
TpaKTa, Jl3BeHHblH KonHT
f MJlKCClICMa
t XpOJUflJCCKHH CHHYCHT
f BCTpJlHM ocna, ocna
f annCprH.,CCKHe pcaKLlHH (Ha 68eOeHue '1Y:JICepOOIl020 6eJ1Ka. zunep-
'1Y8em8Ume.llbHOCl1Ib Ha IlIIU/y)
t rCMOnHTHIJCCKHC aHCMHH
t pC3ynbTaT .neifcTBHJI 3CTporCHOB, aHTHTHpCOHlIHblX npenapaTOB
f 60nC311b Xo.n>KKHHa
nOllU:HCeHO (6aJOnellUR):
! OCTpblC HH$CKLlHH
! nmcpnfpC03
! OBYnHLlHJI,6cpCMCHHOCTb
! CTpCCC
! pC3ynbTaT .nCHCTBJlJI KOpTHKOCTCpOH,AOB, CHH.npOM KYUIHHra
lJa30cltlfJlbl (basophilus) - I<1JCTKH KpOBH, rnaBH8J1 CPYHKLlHJI KO-
TOpblX 3al<1JIOIJaCTCJI B pcaKLlHJlX rHncplJYBCTBIfTcnbllOCTH HCMCJI,J1cn-
1I0ro THna (rHT). OIlH TaK>KC npHHHMalOT YIJ8CTHC B pCaKLlHJlX rn-
ncp"YBCTBHTcnbHOCTH 3aMCl1JICHHorO THna (r3T) IJCpC3 nHM$OLlHTLJ,
B BOCnanHTCnbllLlX, annCprH'lCCKHX peaKLlHJIX, B pcrynJlLlMH npOIlH-
LlaCMOCTH cOcy.nHCTOH CTCHKH.
22

MOHOMTbl
3-11 %
(0,09-0,6) x 10' In
llOBNweHO (MoHoqumm):
f HH<!>CKI.{HH (wujJeKijuoHHblU J\WHoHYKJIe03, 8upycHble, Zpu6Ko6ble,
pUKKemcu03Hble, npom030l1llble UlIf/JeK1IUU)
f nepHOJ1 BbI3J10pOBJIeHHlI nocne OCTpblX COCTOllHHH
f rpanyneMaTo3bl (my6epKYJle:J. cuf/JUJ/uc, 6p)'lIeJlJ1e3, capKouo03, R3-
8eHHblii KOllum, pezuOHa..1bHb/ii ::mmepum)
f 6one3HH KpOBH (oempblll lleuK03, XpOIlUlieCKUU JlfUe101euK03, 1U.M-
f/JozpaHYJ1ellam03, .1tUe.10npo.T/urjJepamu8Hblc 3a60J1e8aHuR 3JI0Ka'le-
cmeeHHblu 2UCmliOIjUm03)
f KonnarCH03bl
f XHPYprH"ICCKHC B/IICrnaTCnbCTBa
llOHU:HCellO (MoHOI(UmOneHuR):
! pC'3ynbTaT J1eiicTBHlI rnlOKoKopTHKOCTCpOH110B
! npH JfH<!>CKI.{HlIX C HCHTponcHHcH
! annaCTHIJCCKaJI aHeMHlI
MOIiOlUITbI (monocytus) - OTHOCJlTClI K CHCTeMe <!>aroI.{HTHpylO-
II.{HX MOHoHYKJIeapoB. OHH YJ1aJ1J1lOT H3 opraHH3Ma OTMHpalOlI.{He
KJIeTKH, OCTaTKH pa3pyrneHHbIx KJIeTOK, Jl.CH81)'pHpOB8HHbIH 6enoK,
68KTepHH H KOMnJIeKCbl 8UTHreH-aHTHTeno. KpoMe <!>aroI.{HT038 MO-
HOI.{HTbl BbmOnUlIlOT Ba)KHyIO ponb B HMM}'HHOM OTBCTe KJICTOK,
B3aHMollcHCTBYll C nHM<!>OI.{HTaMH.
III LE-K leTKH (KJlCTKII KpacHoH BOl1'1aIlKH, Kl1CTKI1 XaprpcHBca) - 3pCl1b1C rpa-
HY110UHTbI, 'tapa KOTOpblX OTTCCHCHbi K ncpH4>cpHH 4>aroUI1T1lpOBaHHblM IUtCpllbiM
BCWCCTBOM J1pyroH KJlCTKH; HMCCT MCCTO npl1 CKB (80 % 6011bHblX), pCBMaTOH.l1.-
HOM 8pTpHTC, OCTpOM rcn8THTC, CKl1CpOJ1CpMHH, nCKapcTBcHllblX BOn'l8HO'IIlOnO-
J106HblX CHH.I1.poM8X (npueAI npomuBocydoPO:HCHbiX npenapamoB, npoKaulla.uuoa,
Memu"1ootjJbI).
.nMMcI>OMTbl
19 - 37 %
(1,2-3,0) x 10' In
lloBNweHo (Jlu.,w,poqumOJ):
f BHPYCllbIC HII<!>eKl.{HH (zpunn, aoeH08upYCbl, umjJeKLllloHHbll1 AIOIIO-
HYIV1e03, oemphlr, BUpycHbl11 zenamum, ocmpblu uHf/JeKLluoHllblU 1UAI-
ljJOljUm03, KOIV11OlU, eempRHQR ocna, KOpb, KpacHyxa)
f 6one3HH KpOBH (ocmpb/u U XpOHUlieCKIIU muujJoJ1euK03bl, .1IaKpo:
2Jl06y.1wlemUl BaJ1bOeHcmpe.ta, Jlu.Mf/JoeapKo.1ta)
23

t nCBupycnblc UHt}JCKUmt (my6epKYlle3. ellrpWllle. .Ua1lRpWl. 6p101U-
/101; ""ifl), 6pYIJC,ue3. ollqmlepllR)
t TOKCOfIJJaJMOJ
t nmcpnlpCOH.ZU1JM
t JIcikTBHC nCKapCTBCllllb/X npcnapaTOD (aHa'lbZClIlIIK08. zpll3eo-
rPJl/lb61111O. i'a70llepIiOOlla II op.)
t OTiIOCllTCnbHblH nHMt}JOUHTOJ npH HciiTponcHHH
flOIlU:HCeIlO (J1UJ."rponeIlUR):
! naHU1tTOnCHIUI
t .ncikTBIIC KopnIKOCTCpOHlI.OB, HMMYHO.ncnpcccaHTon
t 3nOKaIJCCTBCHnbiC HOBoo6pa30BaHlUi
t HMMYHOn.Ct}JHUHTHbIC COCTOJlHHJI
t HOHII3HPYIOllICC H3nY1.JCHHC
t nOIJCIJHaJi HCllOCTaT01.JnOCTb, XpOHHIJCCKIIC 3a6onCBanHJI nC1.JCHH
t Hcn.OCTaTO'lHOCTb KpOBoo6pautCHHJI
JhflI4JOQ"Tbi (lymphocytus) - npe.nCTIlBJIJlIOT co60H rcTcporeH-
H)'IO nonynJlLlHIO KJleTOK. OHH 06paJYIOTCJI B KOCTHOM M03rc, aKTHBHO
t}JYHKUHOHllpyJOT B nHMt}JOHlI.HOH TKaHH. JIm.fCl>OUHTbl JlBJUlIOTCJI I.{CH-
TpaJIbHblM 3BCHOM B
cnCUHt}JHIJCCI<HX HM-
MynonOrHIJCCKHX pe-
aKUHJlX. Mx maBHaJI
t}JynKUJIJI - B }'3Ha-
BaHHH aHTHrCHa H
Y'IaCTHH B anCKBaT-
HOM HMMynonorn-
'ICCKOM OTBCTe opra-
HH3Ma. T-nHMt}JOUH-
Tbl H B-nHMt}JOUHTbl
B3aHMon.CHCTB}'JOT
n:pyr C .npyroM H C
.npyrHlltH KJleTKaMH opraHH3Ma. T -nHMt}JOUHTbl onpCllcnJlIOT KJIeTO'l-
HblH HMMyHHTCT, BbrnomUiIOT pcrynnopHblC H 3t}Jt}JCKTOpHbIC t}JYHK-
UHH. B-nHMt}JOUHTbl yqacTBYIOT B ryt.IOpaJIbIiOM IIMM)'HHTeTC, n.Ht}Jt}Je-
peHUHpYIOTCJI B nnaJMarn'leCKHC KJIeTKH, KOTOpblC B OTBCT Ha CTHMY-
nJlUHIO IJ}')KHMH aHTHrCllaMH BblllCJIJlIOT HMMynomo6ynHHbl.
B pC3ynbTaTc anCKBaTHoro OTBCTa Ha aHTJlrCHHYIO cTHMynJlUHIO
npOHcxon:HT YBcnH'ICHlfC KOnH'IeCTBa nHMt}JOUHTOB H nOJlBJIeHHe pe-
aKTHBHblX (aKTJIBHpOBaHHbIX) nHM$OI.{HTon. H3MeHCHHC COOTHowe-
HIIJI HCHTpo$HnOB H nHM$OLlHTOB B 3aBHCIIMOCTH OT B03paCTa 'Ieno-
BCKa npHBcn.CHO Ha pHC. 3.
24
%
60
50
410
30
20
10
o
o . AHII 1-2 roA8 . rOA8 B03P8CT
-Heih'po4JM11b1
- nMM4!oLtIfTW
PIIC. 3. H3MeHeHile COOTHoweHHR lIeihpOllmnoB
II nHMcpouMTOB B 3aBMCHMOCTI1 OT BO"JpacTa

W HHJICKC CnBHra nCiiKOUHTOB KpoBH (HC11K) IIC 3aBHCHT OT COnCp>K8I11UI nCnKOUII-
TOB B KpOBH H onpen.cnllCTCII no cl>opMync
IfCJ1K = :) + /j + H ,
M+.Tl
mc :) - 301I1HHnbl; /j - 6a1Ocj>lInbl; H - IfCKTpoqmnt.l; M - MOHOUHTbI: .fl- nHMeJIoUHTbI.
B 1f0pMC IIC11K - 1,96:t:OA4.
H3 npyrllx KnCTO'lllbIX 3nCMCHTOR 3118'1CHHC IIMCIOT cncnYIOIIIHC:
nna1MOUlfT (plasmocylus) - KJ1eTKa nllMcI>oHlllIoii TKaHII. nponYUllpy1OW8AIIMMY-
1I0rn06ynMHbl. Y 3,10pOBoro 'lcnORCKa nna3MOIIIITbi npl1cyrCTBYIOT B KOCTHOM M03rc H
B nI1McI>aTII'ICCKI1X TK811AX, pC>KC B ncpllcl>cpll'lCCKOii KpOBH nOABnAIOTCII B lIe60nb1lJOM
Konll'leCTHe (0,5-3 %) npll nlO60M IIlIcI>CKUlIOHIlOM H ROCnBnHTCnbllOM npouecce, BII-
PYCHblX HllcI>eKUI1J1X (Kpacllp:o. CKop70mUHO. KOph, KOK.7IOW. 6uPycHblii i!cnaml/m. o(}e-
1I06Up)'Chi. uHt/JeKI/IIOHHhlU .4toHOII."K.1eo3). onyxonJlx, CbIBOpoTO'lllOii 60nc31111, nna3MO-
HTOMe. KonnarClI03ax. nocnc 06nY'lcIIIIII;
npOMItCnOltl1T (promyelocylus) - KneTKa-npeJIlUeCTBeIlHIIK Mllel10UMTa. 06pa-
3ylOmaJlcJI H3 MHcn06nscTa:
"IItCnOUItT (myelocylus) - KJ1eTK8-npCJ1l11eCTBeHHHK MCT8MllenOUIITB. 06pS3YIO-
lJlaACII 113 npoMllenoUHTa;
MeT8MHenOUHT (melamyclocYlus) - KJ1eTKa-npeJJ.wecTBeIlHIIK rpallynoUI1T3, B03-
IIHKalOwaJl M3 MllenOUHTa:
nponlt'ltlJoulfT (prolymphocylus) - KJ1CTKa-npe.:!wccTBcIIIIHK JlIIMcI>OUIIT3. 06pa-
3YIOaACA 113 JIlIMcI>06naCTa.
W )),nil OUCIIKII CTenClII1 6aKTCpllBnblloii IIIITOKCMKaUlII1 H 3c1>lj>eKTHBliOCTH npOBO.:!II-
MOK allTll6aKTCpllBnblioit Tcpamm IIcnonb3YCTCA ncitKoulITapHblit IIHn.eKC IIIITOKCIIK8-
UIIH (11HI1) no JUI.Kanbcl>-KanMcI>y, KOTOpblii onpe.nCIUleTCII no cj>opMync
.TlIfJf = (4M1 +310 + 2fl + C)x(flu I) .
(M +.Tl)x(3+l)
rnc M1 - MlienOUllTbI: 10 - MeTaMllenOUI1TbI; fl - n8J10'lKOAJI.Cpllble; C - cerMCIITOAJI.ep-
IlblC; fl 1 - J1J131MaTH'leCKHe KJ1eTKH: M - MOIIOUIITbI; .Tl - nHMcj>oUHTbI: :) - 30111110qUtJIbl.
B HOpMC J1J1H = 0,3...1.5. Ecnll 11H" 60nblllc 1.5, TO ')TO CBIIn.CTcnbCTBYCT 06 IIIITOK-
CMKaUHII OpraH113Ma. a CBblwe 4...5 - 0 BblpaiKcHlloM 6SKTCpllBnbHOM KOMnOIlCllTC B
311.norcHHoii IIHTOKCIiKaUIlI1.
TPOM60lt\ltTbi (PL T)
(180-320) x 10 9 In
n06blUlellO:
r MHcnonponmpcpaHfBHblc npoucccbI (:JpumpeMIiJl. .,HueJ1oqm6p03)
r XpOHH'ICCKnC BocnamncnbHblC 3a6oncBalUfH (pee.,ltamOIiOlloe no-
pa:JICelllie cyemo606. Jl38eUlibiU KO,7um, my6epKJ'Jle3, oemeOAllIeJlUm,
I/uPp03 ne'lellu)
r 3nOKaIJCCTBCllllbiC Honoo6pa30nallHH (paK, llIU.ujJo,Ha, llWtf{jJozpa-
uY/leAranr03)
r KpOBOTCIJCHHH, rCMOmfTH'ICCKaH aUCMUSI
r nepHoll Bb13110pOBncHHH np" Merano6naCHIIJCCKHX aUCMHHX
r nocnc onepauHH
t COCTOHIUfC nocne cnnCH')KTOMHH
r nC'ICHHC KOpTHKOCTCpOH,LlaMIf
25
/

HOHU:JKeHO:
! HaCJICACTBeHHbJC TpOM601..lI1TOnCmUI, BblJBamlbJC CIIH>KCHHCM o6pa-
3OBallW1 'IpOM60l.lHTOB (6pO:HCOeHHaJl mpmt60l1llmOlleHWl, ClIHOPO,}f
YUCKOmma-OllOpU'Ia, CUHOpO,t EepHapa-CYJlbe, aIl0..,a.,7Wl f..JeouaKa-
Xuzaeu, CWtiJpo,t tlJaHKoHu, Kpacllyxa H080pO;HCOeHltbiX, zucmUOI.{ll-
m03)
! 60JIC3HH KpOBH (annaemUlieCKaR aHe.MllR, ,ueza706JlQemU'IeeKUe
alle,tfUU, !leUK03bl)
! nopIDKCHHC KOCTHOro M03m (.".,emacma3bl H08006pa306amtU. my-
6epKYJle3110e Il0pa:HCemle, UOHU3upY1OUlee 06..'lYlieHue)
! ApyrHC 3a60JICBaHHX (l.{UlC!lU'IeeKaJl mpmt6011l1mOlleHlIR. napo-
KCU3..Ua.,'lbllaJl 1I0'lHaJl zeU02.,W6lIHYPWl, ze,II0.7ItmllKo-ype.'llIlieCKUU
CUIIOpO,U. Il0'lC'IHaJl lIeOOCmamO'lHOcmb. 3a60,1eaa1lUJI Ile'leHlI. OIlY-
XO,llI eocyo06. ee,7C3ellKu, 3KJll1.MnCWl, ZUIlepmllpe03, ZUllomupe03)
! 1U1<l>CKUHH (811pyeHble, 6aKmeplla7bHble. pllKKemeU03bl, .Ua.,'lRpUR.
mOKCOIL7a3,U03, BJff..J-WUjJCK1IUR)
! 6CPCMCHHOCTb,MCHCTpyaUHH
! AcilcTBHc JICKapCTBCHHbIX npcnapaTOB (l.{UlllOcmamuK06, alla..'lbZe-
mUK08. alllllllzucma.,'IliHHblX cpeocm8, alllnu6ltomUK08. Ilcuxompon-
IlblX JleKapCm8, ouypemWW8. npom1l80CYOOpO:JICHblX cpeocm8, 6uma-
,milia K, pe3epllUHa. OUZOKCllIla. zenapUHa, HlimpOZllll.{epUHa. npeo-
HU3Q70Ha,3elllpO?eH06110p)
! AcilcTBHC aJIKOrOJIJl, TX)KCJIbJX MCTaJIJIOB
.1- TpOM60I.lHTOnCHHH, BbI3BaHilbIC nOBbJIlICHHbIM
TpOM60UHTOB (mpml60l{llmOnem''1eeKaJl Ilypnypa,
/JBC-ClIHOpO,II, Kp060me'lellllJl, ze.uOOUa/lU3)
TpOl\l60QHTbI - :no 6C3'bXACpHbIC KJICTKH AHaMCTpoM 2-4 MKM,
JlBJIXIOIl.IHCCX "ocKOJIKaI\W" UHTOlliIa3Mbi McraKapHoUHTOB KOCTHoro
M03m. OCHoBliax pOJIb TpOMOOUHTOB B opraHH3Mc - YlJaCTHC B ncp-
BHlJHOM rCMOCTa3C. B COCYAHCTOM PYCJIC TPOM6oUHTbi pacnOJIaralOT-
CJI BAOJIb CTCHOK COCYAOB, 8 MaJIOnOl1BH)KIIOM CJIOC nJIa3Mbl, 60raTOM
<l>H6pHflOrCIiOM. npOAOJI)KHTCJIbHOCTb )KH3I1H TpoM6ollHTOB 7-
10 AIICM. <I>n:mOJIOrH<JccKHC H3MCHCIIHH KOJIlftlCCTBa TpoM60uHToB B
TClJCHHC CyrOK COCTaBJIXIOT OKOJ10 10%. Y )KCHIl.IHH BO BpCMH MCHCT-
PyaUHM KOJIHlJCCTBO TpoM6ouITOB MO>KCT YMCHbIlIllTbCX Ha 25-50%.
nOTpC6JICHHCM
C'lInepen1eHU3,\f.
C03
M - 1-10 MM/'I
",-2-15 M..../'I
nOBbllUello (yeKopello):
t OCTpbIC H XpOHH<JCCKHC HII<l>CKL\HH
t BOCllaJICIIHC H HCKp03 TKalicH
26

1 3a60nCBallmi COenllllHTenLHOH TKaHIt
1 aHeMHH
1 60nCJHH no liCK
t WOK, TpaBMLJ, OnCpallHOHHLle BMcwaTenLCTBa
1 HIiTOKCHKaUHJI, OTpaBneHHJI XHMIt'JeCKHMH coenHHCIIHJlMH
1 JJlOKa'JcCTBeHHLle 1I0BOo6paJoBaHHJI
1 rHnepTHpCOJ,runoTHpc03
1 6epcMcHHOCTb, nocneponoBLlH nepHon, MeHCTpyallHH
t pCJynLTaT nei1cTBHJI neKapCTBCHHLIX npenapaTOB (;ItOpqJUII. .ue-
mrL!loofjJa, 8umlLUUII A. l1epOpaJIbHblX KOllmpal/enmu60fl)
llOIlU3ICeIlO (3llMeiJ.'1ello):
! 3pHTpOUHT03LI
! XpOHIt ' ICCK8JI HenOCTaTO'JHOCTb KpoBoo6palllcHIDI
! aHa(lmnaKTH'JccKHU WOK
C03 (C:KOpOCTh oc:e1l8HHH 3pHTpOItHTOO) - HeCnelllfH'JecKHH
nOKa33TcnL nHcnpoTCHHCMItH, cOnpOBO>K.lJ.aJOllteH npou:ecc 6onc31U1.
nOKa3aTcnL 'laCTO
HcnonL3YCTcJI ,WIJI cnc-
>KelUUI 3a TC'lCHHCM 3a-
6oncBallHJI. C03 no-
BLlWaCTCJI npH Hapywe-
IIHH H3HKO-XHMlf'JC-
CKHX CBOHCTB 060no'JKH
3pHTpOUJfTOB, BLI3BaH-
IIL1X YBCJIIf'ICHHCM co-
nCp>KaHIfJl H6pHHorcHa,
(l- Itnlt 13- rno6ynitHOB,
OTlICRLHLIX nltnHllOB, aJI-
KanOJOM.
06b1'mo C03 )'Bcm1-
'JHBaeTCJI HC cPaJY, a Ha
2-4-e cyn<H 3860ncBa- PMC 4. AllllapaT naH'IeHKOBa
HHJI. 11110rlla MaKCH-
MaJlLHOC }'Bcmf'JCHHC C03 Ha6monaCTCJI B Ha'Jane BLl3nopoBJICHIDI.
OcenaHHC 3plfTpOUHTOB npJlMO nponopUHOHanbHO Macce 3plfTp01llITOB
It 06parno nponOpLlItOHanbHO BJlJKOCTH nnaJMbL
C03 onpCnCnJlJOT B annapaTC naH'lCHKOBa (pltc. 4).
._r.-.<\--
 =:=;-;:=.. , - ---
" I----- .-....-
,.
"
'\-
f
f.
"
,.
ILI
,\
I

 -
m npH naronom'lecKllx COC'roIlHHIIX SblllCl1l11OT S TIinOS f"eMOrp3MM (no JT.H.MaJypy):
I) HeilTpocltH.'1LHO-:)()1HHoneHII'Irt:KHii - neHKOUIIT01, IIcHTpOcfl1lm1l1 (C.!I.Bllr snc-
so), nHMc!>oneHMR, MOIlOIIHTonCIlHlI, 8H'J0'JHHocflHnllIl (cencuc. nepflmOltUm, nltes..,o-
111111, pa" II r>p.);
2) HdITpocltHnLHO-:)()1MHocltHnbHwA - neHKoIIHTO'J. HeiiTpocflHnllR (C.!I.SHr Meso).
nllMcjloncHlIlI, MOHOUIlToneIlHR. :JQ1I1HOcl>IIJIIIR (.11L1Itf'o..paHy_eAfOm01. mJ'&p"y.e3 .e..-
"fiX. cKop.1a"'fI"o);
27

3) Helh'poneHH'Iec:KHii - neiiKonclIlIIl, HclhponcHlI1I (ncrcHcpaTMBHhlii cnRHr BncBo),
nHM4>oncHIIII (.1ID.1RpUR, Jleuw.'UuIIU03j:
4) nHAf4lam'lec:KHc H MOHOUlITapHblC pcaKUHH - neHKoUHT03, nHM$oUHTOJ. MOHO-
UMT03 (ulIf/JeKlluoHllble 3u6o.1eRulluR);
5) npoT030ilHblii - neHKoneHIIII. HeiirponcHHII (CJ1Bllr BncBo), nHM$onclIHII (."U1R-
PUR, .'leiiUIMQHUO:J).
M8TepH8J1 W1R HCCJ1ellOB8I1HR. KpOBb BCH03HaJl HnH KanHnnJlp-
HaJI. 6CpeTCII B np06HpKY. COl1Cp>KalllYfO 3.8%-lIbIH paCTBOp LlHTpaTa
(11JaCTb L{HTpaTa K 4 lJaCTJlM KpOBH).
KOCTHblH M03r (MME110rPAMMA)
nOKa38TeJ1b
HOpMSJlbHblC3HS'ICHHR
MHenOKaplIOUI1TbI, xI0 9 /n................................................. 50,0-250,0
MeraK8pHOUIITbl, x10 9 /n ................................................... 0,023-0.103
COOTHOlllellilC neHKouHTbI/3pIlTpOUHTbJ......................... 4/1
HHJ1eKC C03peBaHHII Heiirpo$HnoB ................................... 0,6-0.8
HHJ1CKC c03peB8HHII 3pHTp06nsCTOB................................. 0.8-0.9
6nsCTbJ. %.......................................................................... 0.1-1.1
MHen06n8cTbl. %............................................................... 0.2-1.7
npOMHenoUHTbI, % ............................................................ 0.5-8.0
HeiiTpo$Hnbllble, %:
MHenOUHTbI..................................................................... 4.5-16,0
MeTaMHenOuHTbI............................................................. 9.0-21.6
nanO'lKOlIllCpJlbIC............................................................ 14,0-33,0
cerMeHTOJlllepHble .......................................................... 13,0-27.0
303I1Ho$HnbHble, %:
Ml1enOUHTbI..................................................................... 0.5-4,0
MeT8MHenOuHTbI............................................................. 0,3-0.4
nanO'IKOlinepHble............................................................ 0.5-3.2
cerMeHTollllcpHbre .......................................................... 1.0-3.8
6a30$lInbHble, %:
MHenOuHTbl..................................................................... 0-1.5
cerMclITolillepHble .......................................................... 0--0.25
JIHM$OUI1TbJ. % ................................................................. 1.2-1/.5
MOHOUIITbl, %.................................................................... 0.25-2.0
nn83M8TH'IeCKlle KJleTKII. %.............................................. 0,1-1,0
PeTl1Kynllpllblc KJ1CTKII. % ................................................. 0.1-1.0
3pHrp06nacTbI (683o$lInbHble, nonHxpoM8To$«nbHbJe,
oKclI$HnbHble). %.............................................,................ 16.0-26.5
npoMeran06n8CTbI, Mcran06naCTbI 6830$MJ1bHble,
nonHxpoM8To$Hnbllblc, OKCI1$MJlbHble, % ....................... 0
m PC3ynbTaTbi J.ccne;J.OB8111111 COCT8B8 ncpll$cpll'leCKOii KpOBII He Bcerna B J10CT8-
TO'lHOH MCpC OTpaJKSIOT JI3MCIICHHII. npOHCXOllllllllle B oprallax KpOBC'TBOpCIIHII, Kap-
THH8 nYHKT8T8 KOCTIIOro M03r8 HMeeT 6onbwoc 3H8'1CHIIC npll p8JHbiX 4>opM8X reMO-
6n8CT030R II 811CMHH II n03BonliCT lie TonhKO yrO'iHIITb 4>oPMY 3a60J1cBaIlHII. 110 J' npa.
8HJIbilO Bbl6paTb COOTBCTCTBYIOHH KYpC TCp8nI1H.
OueHKY MllenorpaMMbl He06xolllIMO npo80llMTb B conOCTaBnellll1l C K8pTHHOH ne-
p"$epH'lccKOH KpOBH.
28

MeraKapHOHTbl
(0.023-0,103) xl0 9 /:1
flo6bllUeHo: MHcnonponH$cpaTHBHLlc npoucccbl, MCTaCTaJbl 3nOKa-
IJCCTBCHHblX HOBo06pa30BaHHH B KOCTHblH M03r.
flOHU:HCello: rHnonnaCTH.,CCKHC H annaCTH'ICCKHC HMMYHHblC H ay-
TOJIMMYHHblC npoucccbl. n}"{cBblc H UHTOCT3THIJCCKHC UHTonCIIHH.
COOTHOWeHHe neMKOHTbll 3pHTpOHTbl
4/1
fl06bllUellO: XpOHHIJCCKHH MHcnoncHK03, cy6ncHKCMHIJCCKHH MHC-
n03, nCHKCMOH.I1HblC pcaKUHH.
flollu:HCello: rCMoml3, KpoBOnOTCpJl, 3pHTpCMHJI, OCTpblH 3P"TpO-
MHcn03.
"'HAeKC c03peBaHHfI HeM'TpOct>HI10B (cooTHorncHHc npo-
MHcnOUHTOB. MHcnOUHTOB. MCTaMHcnOUHTOB K nanO'lKO- H CCrMCH-
TOJl.l1CpHblM HCHTpo$HnaM)
0.6-0,8
flo6bllUello: 6nacTHblH KPH3, XpOHH'ICCKHH MHcnoncHK03.
"'HAeKc c03peBaHHfI 3pM'Tpo6I1aCTOB (cOOTHOrnCHHC non"-
xpoMaTo$HJlbllblX H oKcH$HnbHbIx HopM06naCToB K 3pIITp06nacTaM,
npoHopMo6naCTaM H HopM06nacTaM)
0.,9
flOHU:HCello: B. r ,1l.C$HUHTHaJI aHCMHJI, "HC3<jJ$CKTHBHLlH" 3pHTpono-
33 npH rCMonH3C, KpOBonOTCpJl.
6naCTbi
0.1-1.1 %
fl06bllUellO 60ncc 20 %: OCTpI>lH nCHK03.
fl06b1IUeHO .110 20 %: OCTpblH nCHK03, MHCnOH,ll.HblC $OpMbl XPOHH-
'1CCKOrO ncilK03a, MHCnO.l1HCnnaCTH'ICCKIiH CIIII.I1pOM.
MMeno611aCTbi
0.2-1.7%
flo6bllUello 60ncc 20 %: 6naCTHblii KpH3, XpOlUl'ICCKHH MHcnoncHK03.
fl06b1IUellO .110 20 %: 6nacTHblii KPH3, XpOIUl'lCCKHH MHcnoncHK03.
MHCnO.l1HCnnaCTH'ICCKIiH CHH.I1pOM.
npOMMeI10MTbl
0.5-8.0%
H06bllUello: nCHKCMOH,ll.HblC pcaKUHH, XpOHH'ICCKHH MHcnoncHK03,
npoMHCnOmfTapllblH nCHK03.
nOHU:HCello: annaCTH'ICCKaJI aHCMWI, B pC3ynbTaTe .lI.CHCTBWI lU1TOCTa-
T"KOB. HOHH3lfpYlOlUcro H3JI}"fCHWI, HMM}'HHbIH arpaHynoUHTo3.
29

HeMTJ)O$Ml1bHble MMe11014MTbl
4,5-1 6,0 'fc
nOB61WeHo: nCHKCMOH.ltHbIC pCaKI1HH, XpOHH'JCCKH" MlicnoncHKo3.
cy6ncHKcMII'JCCKHH MIIcn03.
nOIIU3KeHo: annaclwlecKaJl 8I1CMIIR. 8 pe3ynbTaTC neiiCTBIDI llJfTOCTa-
THKOB, HOmBllpYfOll1erO H3J1Y'ICHIIJI, IfMMytUlblH arpaHynoUHT03.
HeMTJ)O$Ml1bHble MeTaMMe11014MTbl
9,0-21,6%
n06blweno: nCHKCMOH.ltHbIC pcaKUIUf. XpOHlI'JCCKHH MHenoncHKo3.
cy6nciiKcMH'JCCKIIH MHcn03.
nOllll.»cello: annaCTH'JeCKasi aHCMHJI, B pC3ynbTaTe nCHCTBIDI UJfTOCTa-
TIfKOB, HOHH'3l1pYlOlllero H3J1}"1CHII", IIMMytUlblH arpsllynOl.tIlT03.
HeMTpocl>Ml1bl nal1o-.KoJ\QepHble
14,0-33,0 %
n0661llleHo: JldiKCMOlIllHblC pcaKUHH. XpOIIH'leCKH" MHCJlOnCHK03,
cy6nciiKcMlf4CCKliH Mucn03. ClillDpOM "ncuIiBbIX" nCHKoUifTOB.
nOllll:Jlcello: SnnaCTlf'ICCKasi SUCMIISI, B pC3ynbTaTe nCHcTBHSI UlfTOCTa-
THKOB. HOIUl311PYIOUtcro I13J1}"1CJlHSI, HMMYHllblH srpauynoUHTo3.
HeMTJ)ocl>Ml1bl cerMeHToR,QepHble
13,0-27,0 %
n06blllleHo: nciiKcMoHDHblC pcaK1lIIH, XpOHII'JCCKIIH MHcnoncHKo3,
cy6nciiKC!\Hl4CCKUH Mlicn03, cHHnpoM "ncnHBblx" ndiKoUHTOB.
nOllll.»cl?no: annaCTHqCCKaSi aHcMH", B pC3ynbTaTc nCHcTBII" UHTO-
CTaTHKOB, lIolllnllpYfOlllcro H3n)"lcIUlSI. HMYll11blH arpanynoUIITo3.
303MH04>Ml1bl
0,5-4,0 %
n06blwello: anncprH4ccKlfC peaKuHH. rCJlbMlfHT03L1, 3JTOKa'JCCTBCH-
Hble onyxonH, OCTpblH neHKo3, XpOHH'JCCKIfH MIICJlOnciiK03, nIlMq,o-
rpaHyncMaTo3.
6a3ocl>Ml1bl
0-1,5 %
n0661Weno: 6a3oq,IIJlbHb1H neiiKo3, xpOImqCClmH MHCJlonCHK03,
3pHTpCMIISI.
lIMM4>oMTbl
1,2-11,5 %
n08hllllello: XPOllllqCCKIfH: JIIIMq,OJlCHK03, annaCTH'ICCI(asI 8HCMII",
MOHOMTbl
0.25-2.0 %
nOtJ""uel/(): XP0lnlqCCKlfe MJlCnOncHKo3. MlfcnOMOHOUIfTapUblH nCH-
K03. MOHOl1l1TapHblH nCHKo3. ry6cpKync3. ccnCHC,
30

nna3MaTHeCKHe K11eTKH
0,1-1,0 %
llo6bllliello 60ncc 20 %: IIIHCnOMHaJi 60nc311b.
llo6blwello .110 20 %: p,menOMllaJi 60ne311L, anm\CTlJ'iCCKM aHCMHJI,
HH<I>CKllHli, IIMMYIIIJLlH arpallynollHT03.
3pHTpo6naCTbi
16,0-26,5 %
llo6blluello: rCIIIOnllTlftlCCKaJl, nocTrcJ\JOppanltleCKaJl, <l>OnlfCBO.l1C-
4H111HTllaJi Ii B I2 -.I1Ct}>lillHTHaJi alle!\Um, OCTpLIH JplfTpOMllcn03.
llollu:Hcello: annaCTlf'iCCKaJl aHeM"JI, B pC3ynbTaTe LtCilcTBJUI. llIiTO-
CTaTHKOB. HOIIIBIIPYIOU(cro 1f3nY'iCIIIJJI, napluranLHaJi KpacHoKncTo'l-
HaJi anna311J1.
PaKOBble K11eTKH
MCTacTa3bl 3nOKa'iCCTBCIIHLIX onyxoncH
M"al'cpllan l{.rIH Hccnc.aOBaIiIfH. Ma3KH II rHCTOnOrH'ICCKlle npe-
napaTbl. nplll"OTOBnemJble 113 nYHKTaTOB KOCTHoro M03ra 113 rpy..rUfHbl
HnH n0.l1B3LtOWHOH KOCTH.
nMMcJ)ATM4ECKHE Y3nbl (nHMcJ)AAEHorPAMMA)
nO...818Te.nL, 'Y.
HOpIL'LHLI 1H8'1HII1I
RlfM<I>06!13CTbI ......................................................... 0,1-0.5
npoJlIINcfJouIlTbI..............,..........................,............. 65-80
RIINcfJOUIlTbI............................................................. 20-35
PeTlII(ynllpllbie IweI KII............................................. 0-0.8
n.lliUMaTH'ICCKltC KJICTKII......................................... 0,2-0.6
MaKpocfJarll.............................................................. 0.1-0.5
T Y'IlIble TKallCBblC KJlCTKIl ....................................... 0-0.1
RHnocfJarH ................................................................ 0-0.1
HCHTMllilbi .....................................,..................... 3-10
303I1Ho4IHilbI............................................................ 0-{).5
JIHMclJa.l1CHOrpa!\IJlI8 - JlBruleTCJI }).onOntIHTCnLHLlM MeTO}).OM HC-
cne}).OBaHHJI 3a60neBaHHH CHCTCMbl !<pOBH H 110KaJalla npH pJlllC 3a60ne-
BaHHH, conpoBO>K.ll.alOUJ,HXCJI yoenH'leHHCM nHMt}>aru"ccKHX yJ.I10B.
JlHJllclJOl(IIT03 - npll peaKTHBnLtX II Bllpycnblx (umjJeKl/ltOllllblii
.\IOIIo"Y'cle03. punll. aOell08ltpYCbI) nHM<l>a..o.CIUlTax.
HciiTpocIJllnc3 - npll npHMccH KpOBII, cncmf<l>H'ICCKOM BOCnaJIe-
HHH, npH OCTpOM HarHoeHIIH (IIeiimpocjJwlbHblli Oempu", - 2110U).
MSKpocIJarH - XpOnH.,eCKHif BOCnanHTCnbHLtif npo1(ccc.
m npH ItCCilC..10aaHHH iIIIMcfJaTlI'lCCKHX YlJJ08 NOryr 6blTb oOHapYJKCHbi lIaTOJlOl'II'le-
CKIIC 3i1eMCIITbi.
....paHYJle'fLi (3111IJe.1HOlt;IIfLiC ....ne..KH H ....neTKH nHpor-oBa-JlaHI x8Hca) -
IIplt Ty6epKYIlc1C, ilcnpc. 6pYUCililC1C. CmlJllilllcc. TYil"PCIH", CapKOMJ101C. 6onc1-
111\ Kpolfa II .lip.
31

KneT1CH 6epe10BcKOrO-WTepHGepra H XOn;oKKHHa - npll nIlMcJ!Orp8I1ync-
M8T01C.
OnYJlOJIeBloie 3JJeMeHTW - npll nllMlj>ocapKoMC (Jlu...ujJoIiUmapHou, .7u."t/J0IIJ/a-
MOllumapHou. npO.1W,cjJoIiUmap HO u. .RU.WtP06.7aCniHOU. UMAI)'H06J/aCmllOU), MeT3CT818X
3JlOK8'1ecTBeHHblX HOBo06pa1OBaHHH.
.l\pY1101 H .!I.eJIRII(Ht'CR HHTH MHueml1i 8KT1IHOMHUeTOB - Ha cJ!OHC rHOR npM aK.
11IHOMHK01C nIlMcJ!aTM'ICCKHX )'JJIOB.
MaTepHaJI./VI R HCCJJe.nOB8HHR, nYHIITaT JUlM$OY3na, H3 KOTOpO-
ro rOTOBHT M83KH HJ1H OTne'laTKH 6HonCHpOBaHifOrO nHM$OY3Jla.
CMCTEMA rEMOCTA3A
reMOCTaJ (haemostasis) - cOBoKynHoCTb $H3HonOrH'IeCKHX npo-
UecCOB, HanpaBnCHHblX Ha npe.nynpe>Kl1CHHe H OCTaHOBKY KpOBOTe-
'1eHH", a TalOKC nOA11Cp)f(aHHe )f(HllKOrO COCTOHHHH KpOBH,
m BbU1cnRIOT .QBa McxaHH3M8 OCTaIlOBKIl KpOBOTC'ICHIiR (pl1c. 5):
COC)'.QIICTO-TpOM60ulmlpHloIii (MHKpOQIIPK)'JI/ITOpllblH. nCpBII'IHblii) - 06ecnc'IlIeaey
RpeJ1)'npeJKJ.\cllllc II OCf8I1OBK)' KpOBOTe'lCIIHJI H3 MCJ1KHX KpOBeHOCHbiX COCY.QOB nyreM IIX
nCpBII'IHoro cn83Ma, IIa6yxallllR H a.areJIIH TpoM60J.tlfroB K MecT8M nOBpeJK.D.cllHR, a T8IOKC
nocnCJ1Y101lI)'IO 18K)'nopK)' KpOBOTO'I8lUHX COCY.QOB Brl'CniTaMIl TpoM60J.tlfroB:
I'eMOK08I)'nRUHoHHloIit (MaKpOQIIPK)'1UITOpHblH, IITOpIl'lHblii) - MHon>c1)'ncll'IIITbIH
cJlepMellT8T1lllllblH npouecc, B KOTOpoM )"I8CTBYeT MIIO)l(CCT!IO nn83M8TM'IecKHX. KJlCTO'I-
HbIX, TKallCBblX cJ!aKTopoa, B pe3ynbT8Te KOTOpOro co.Qep>KallUliicR B rlll83MC cJ!H6p1lHoreH
nO.llBepraeTCR nonHMepll18UIIII C 06pa1OBaHHCM CIlepTXOB cJ!H6pmla (TpoM60B), 18K)'1I0pll-
&aIOUU!X KpOBOTO'laWHC COCYllbI. OH, KaK npaaltJlo, Ha'lIlHIleTCR Ha OCHOBe nepBH'IHoro
reMOCTa38, cncJIYeT 18 1111101 II 06ecnC'IHB8CT OKOH'I8TenbH)'IO OCf8HOBKY KpOBOTe'leHHJI.
III CyecTByeT .QBa nyrH 3snYCKa CBCpTblB3HIIR KpoBII:
BHeWIlHii - JBnYCK8eTI:R nOCT)'nneHlleM B KpoBb 113 nOBpe)l(.llCHHblX TK8HCH M
nCiiKOQIITOB TKaHCBoro TpoM60nnaCTIlHa (cJ!aKTOp III), KOTOpblii npH B18MMO.QciiTBIlIi
C 4>SKTOpoM VII' M HOHaMH C8-- 06pa3yer aKTIlBaTOp cJ!aKTopa X, )"IaCTBYlOwcro B
KOMnneKce C cJ!8KTOpoM V H 4JaKTOpOM 3- "TpoM60uHToB (npompo.w6uHa3a) B npcBpa-
IUCHIII1 npoTpoM6mra B "TpoM6I1H;
BttylpeHHllii - Ha'iIlHaeTCR 15e3)"18C11U1 HOHOB C8+- C BKnIB8IUIM 4JaKTOp3 XII (KOH-
T8K1l10ro) npll KOHTaKTe C noeepxHOCTbJO mo6oro BeCCTBa, no CMa'lHB8eMOCTII UTnH-
'IalOerocR OT 3/UlOTeJlHJI (noBpeJKJ.\cHIUIJI COCYJlHCT8R CTeHK8, HMMYHHblC KOMnnCKCbI,
3/UlOTOKCI1HbI, 6aKTCpllaJIbHblC nHnollpoTCKl1bI H lIP. Bewecrsa). KOTOpblH B ll8JIbHeHWeM
BKnIBllpye-r cJ!aKTOpbl XI. IX, vrn C nocneJ1)'IOWCH BKnIBaQllcii 4JaKTOpa X (CM. pHC. 5).
<IlYHKUIIR cBepTblB810Wcii CHCTCMbI 3aKJIIO'I8CTCR B CBoeBpCMCIlHOM 06pa30BaHMH
cJ!1I6pI1118.
Dpouecc cBepT....BaHHIl KpoBH - K8CK8JI. nOCnC.!I.OB8TCnbHblX pe8KUHii, B KOropoM
8KTIIBI1311poB81111b1e cJ!CPMCHTbI npe.QbI.aywcii pe8KUHH cn)?KaT JI.IIR 8KTH83UHH nocnc-
.ay1OIIX cJ!SKTOPOB. MCX811H3M B18IIMO.QciiCTBIIR cJ!aKTOpOB CBcpTbiBaHIIH BCCbMa cnD-
)lCeH, 01111 .QeiicTBYIOT HC H30nllpoB811HO, 8 B KOMnneKCC C cJ!oc«I>onllnH.!I.OM (cJ!aKTop 3
. <IlaKTopLI CBCp-rblBoIHIIH KpOBIl - pHMCKIiC LlHcJ!Pbl.
-, cJ>8KTOpbl "TpOM6oUllTapHblC - apa6cKHc UIlcJ!Pbl.
32

"lpOM60UHTOB) H HOHaMH Ca+'. :hOT npouccc H306pa)ICaJOT B BIU{C KaCKIUlHD-
KOMnJlCKCHOii CXCMW CBCpTWBaHHII KpOBH (CM. pHC. 5).
m cI>aKTOpbl CBCpTblBaHHJI KpOBH:
I, !IIHfipHHoreH - rnHKonpoTeHJ1, Bblpa6aTblBae-rcli napcHxHMaT0311b1MH KJle-rKaMIl
nC'fCHH, npeBpall1aeTCli noli. B1IHIIIIIICM "lpoM6HHa B !IIH6pHH-MOHOMCP, KOTOpblii noml-
MCPH3YCTCII B !IIH6PIIH;
II, IlPO"l]lOMfillH - rJlI1Konpo-rcliJ1, IICaKTIIBllaH 4>opMa $CpiI:IlTa "lpoM611I1a. CHH-
Te3HpyeTCli B nC'fCHII npll Y'faCTHII BIlTaMIIHS K;
III, TlCaHcaLlii "I]IoMfionJiamlH - mlilonpoTCltJ1, Y'faCTBYlOwllii B OCIIOBIIOM B
MCCTIIOM rCMOCTS3C, npll KOIITSKTC C nJla3MCllllbiMil $SKTOpSMIl (VIla II CaU) cnOCD-
6eH aKTIIBHpoB8Tb $SKTOp X (BHCWJIIlii nyrb $OpMllpoBaIlI1J1 npOTpoMOIIHa3b1);
IV, lCaJlbl{Hii - Y'faCTBye-r B aKTlllldlll111 np011'OMOlllla3b1 II 06pa30BallllH "lpOM611-
Ha, B npocccc CBCpTblB3HHJI HC paCXOAYCTCJI;
V, IIpoalCl.lenepllH - Ac-rJl06YJIMII, 06pa3ycTcJI B nC'ICIIII, IIC06XO.IUIM Mil 06pa-
30BaHI1J1 npo-rpoM611l1a3bl;
VII, IlpolCOHBCpTIIH - npOTca3S, CIIIITC3I1PYCICA B nC'ICIlM IIpll Y'ISCTHII BII"laMIIHa
K, B aKTIIIIIIOii Ij>opMC BMeCTe C $SKTOpaMII III II IV aKTMBllpye-r cfJal\rop X;
VIII, aHTllrcMo!llllJlbllblii rnofiYJIIIII A - CJlO>KHbliiI"JIMKOllpOTCIIJ1, MCCTO CIIHTC-
3a TO'fIlO IIC YCTaIlOB1leHO, aKTIIBllpye-r o6pa30BaHllc "lpoM6onndCTt'Ha;
IX, BHTIlrelllo!llll;lbHLlH rn06'JlIIH B - $aKTop KpHCTMaca.I3..-rJl06ymlH, 06pa3ye-r-
CII B nC'Ictm, )"IaCTBye-r B 06pa30BaHI1I1 aKTIIBHoro TpoM60IUlaCTMHa (nporpoM611Ha"Jbl);
X, "I]I0Mfio"l]lonHH - $aKTop CllOspTa-npaY3pa. rJlIIKOllpOTCIIJ1, Bblpa6aTblBae-rcll
B nC'fCHII. Y'faCTBYCT B 06pa30BaHMII 11'oM611Ha;
XI, npeQWeCTBeHHHK nnB3Metllloro "I]IoMfionnaCTHlla - $aKTop P03CHT3JIIi.
rnHKonpOTCIIJ1, aKTIIBllpyCT $aKTop X;
XII, KOHTBICTHOii a"7HBaUHH - $aKTop XarcMaH8, aKTIIBaTOp nycKoBoii peaKU1I1I
CBCpTblBdlillA KpOBH II KlIIlHHOBOii CI1CTCMbl;
XIII, !IIHfipHHCTaIiHJIH3HpYIOIlIHii !IIa",.op - !IIH6pIIHa33, CTa6wI1I311PYCT $HOpHH
B npHcyrCTBl1H Ca-, KaT3JIMJllpye-r 11'ailcaMHHHpoBaHHc $1I6plllla;
fJ)aK'Top cI>neT'Icpa - IUla3McllllblH npcKaJJJlHKpCHH, aK1I1BHpye-r !IIaKTOpbl VII,
ve, nCpCBOlUiT KMHHHorCll1l KIIHttH;
fJ)a",.op cI>HTUJKepaJIbAa - KMlIilHOI CH, B aKHIBlloii $OpMC (KHHHII) aKTllllllpYC"I
!IIaKTop XI;
fJ)a",.op BHnne6paHQa - KOMIIOIICIIT ljIaKTopa VIII, Bblpa6aTblBae-rclI B 311!10TC-
JlHH, B KpOBOTOKC, COCAlIlIJlJlCb C KoarYJlJluHoHHOii 'f8CTblO. 06pa3YCT nOJllloucllllblii
$aKTop VIII (aHTHf'CMucjJIIJlbHblii rJlo6YJlIIII A).
BHyrpCHHHH JI BHCWHHH McxaHH3Mbi CBCpTblBaHiUl KpOBH B3aJlMO-
CBJ:l3aHbl C nOMOLUblO KaJIJIHKpCHH-KIIHHHOBOH CHCTCMbl, KOTOpIDI CTH- .
MynHpYl.'TCJ:I .paKTOpOM XlIa, II 8 CBOIO O'lCpCl1b alrmBHpYeT il>aKTOpbl
XI H VII, KOMnOHCHTbl BHYTpClIlICrO H BHCWIlCrO nym.
06pa30BaBUHlHCH B pC3ynbTaTc npoccca CBCpTbIBam1H CryCTOK
KpOBII'ICpC3 15-20 MHH Ha'lUHaCT COKpaLUaTbCJ:I H ynnoTHJ:lTbCJ:I. PCT-
paKHJ:I np0l10n>KaCTCH 01" 30 MHH l10 30 'I.
CBcpTblBaHHc KpOBH npIlBOl1HT K aKTI1BaHH npOl'HBOCBepTLI-
B810IlUIX I\leJ:8Hli31\IOB, KOTOpblC BlUlIO'IalOT nCpBH'IUblC anTJIKoary-
nJ:lHTbl (anTHTpOM6HH 111, rcnapHH, npOTCHIl C), CmITC3upYIOUUICCJ:I B
opraHU3MC Ii Bbll1CmllOlUnCCJI B KpOBOTOK C nOCTOJIIUIOH CKOpOCTblO,
H BTOpUtlHblC (npOl1YKTbll1erpallaHH <lmopIlHOreUa), o6pa"JYIOLUIICCJ:I
B npocccc CBepTbIBaHIIJ:I II .p1l6pHHonH3a.
33

BHEWHH MEXAH3M
IIclil'u.llblIIII!Yllb'C 061'UJU61lllUH COC)'OOB
-------------------.
. nOepe)I(,QeHHe TKaHH, .
. .
. CTeHOK COCYAOB .
---------i--------- '
._..________Jt.___________.
-- 1 --:: :::J ----j
AA ....
TKBH8SblH V "- t lla Ca B
L1J>OM6onn9CTH III + 
«
KonnareH.ooe.o.HHHTeflbHo- ...
TKaHHble CTpyKTYPbl
[::[
:>.
u
o
()
r-----------,
 renapMH ::::::.:
: AATHTpoM6HH III :
.._----------

C')
c
Bfl3KMH MeTaMopcp03. PeTpaKHfI TpOM6a ..
o
6enblH (TpOM60MTapHblH) TpoM6
.
npeBpallleHHe, BblAeneHHe, aKTHBHpOBaHHe
TOpMO>KeHHe AeHCTBHfI
-------41:
PHC. S. COBpeMellilali CXeMIt
O;O<;Y.il,IClo-1po..601unop",,," '-""O<;lllJ (c......a), ICacICailHO-KO>III1ICKCH...ii

BHYTPEHH MEXAH3M
p.-.-----------
: KOHT8KTH8S1 :
: nOeepXHOCTb .
1____----------,
a
I'J
a
-&
._--------------.
l1ponrpo.u611llUJO
t/J. CmlOopnra-l1poppa
npoTpoM6I1H II
a
I'J
D
.g.
-
-
l1el'Bu'/IIblli "pOCliblii mpo.u6
--.
Q>opMBHHble + CblBO poT Ka + \ cJlI16 p I1H I I
3J1BMeHTbI L
CblBOpoTK 8.-J
D
I'J
D
.g.
>
-
TpeTbSl $paKIII1S1
OKOH'IaTeI1bHbIH (KpaCHblM) TpoM6
J'eM0CT333 (110 HB3110BY E. n.):
npoucc.; CsepTblS31111R !CpOSU (cnpa8Q) H IIJ>OTIIBOCBCpTbllI3lOWIIC IoICXaHH3NW

O.ll.HOnpCMCHlfO co CBCpTblBalOUlCH aKTHBHpYCTCJI H cf»H6pHHOJlU-
.......CCK3H CIICTCM3, KOTOpaJi CPYHI<UltOHaJlbHO HanpaBJJCHa Ha eCTC-
CTOClllfblii nH3HC «pH6pHUa, 06pa3YIOU.lerOCJI B npOl.(CCCe reM0CTa3a.
Olla 01<J1101JaCT: J1JJa3MHHOrCH, npCBp81U810lUHHCJI no.n .nCi:fcTBHCM 8K-
TlIB8TOpOB B npOTCHII33Y - nn83MHII, CnOC06HblH p8CUlCIIJIJITb cpH6-
pHil, «p H6 pmiOrCH, TpoM6HH, npoTpoM6HH; TKaHCBblH aKTHBaTOp
nJla3MHHOrCHa; npOaKTHBaTOp nna3MHIIOreJla; Kltlla3bl (CTpenroI<HHa-
3a, ypOKHUa3a); HHrH6HTOpbl nna3MHHa H cro aKTHBaTopOB.
B COOpCMCHHOH CXCMC CBcpTbIBaJlH" KpOBH Bbl.ncnJlIOT IJCTblpC ee
cpa3bl (CM. pHC. 5):
I IJIU3 (5-7 ftiHIl) - np01pOM6HJla3006pa30B8HHC (KoHmaKmHo-
KQ.1.:llIKperlll-Kuliu IIKaeKaOllaJl aKmuear/Wl);
II 1J1333 (2-5 c) - TpoM6Hlloo6pa30Ba.iHc;
III 1J1333 (2-5 c) - «pH6pHHoo6pa30B8HHC;
IV 1J1333 (55-85 MIlIl) - nocTKOarynJll.(HOHJlaJI (06pa30eaHue ze-
.11lOemamll'leCKIi nOllllOI/ellllOZO czycmKa).
CJ TCXHJIK3 B:JIIIIIII II 06pa60TKII- KpOBII .111111 IICCneLlOB8HHII rCM0CT838 H:J.IIO)f(eHB 80
BBC.IIelllllf.
COCYACTO-TPOM60L&"TAPHbIM rEMOCTA3
nOKa:JaTcnb
Hopla"I"HblC :JHB'tCHHII
Pe3HCTCIf UlOC"[b K8mtnnllpoB:
CHMnTOM HIIKa (KO)f(eBIIHKOIl3) ...................................... OrcyrCTBHe If:JMeHeHHH
CIIMIIJOM )1(J'YTa
(KOII'lanOBCKon>-P)'r.menll-Jlce.llc) ................................... MClfee 10 nCTexHii
68110'111311 npOO3 (I-ICCTcp083) ............................................ MCHce 20 neTexMii
BpCMII KPOBOTC'leHIIII. MIIII:
1I0.QyKC .......................................................,...................... 2-4
no AiillH .............................,..............................................2.5-7
KOnH'IeCTBo:
'lpoM6U1UfroB, x I09tn........................................................ 180-320
MMKpOllJlaCTIiHOK, % .......................................................... 2-15
1I0pMO"I poM60uHToB, % ..................................................... 84-92
MaKponnaCTHIIOK, % .......................................................... I-II
MeraTpOM60uIIlOB, % ........................................................ 0-1
AJU"nllIlIlOCTb TpON60uHT08, %............................................ 25-55
ArperaUHII TpOM60uHTOB, %..................................................55-145
<J>3KTOp 3 TpoM60uIITOB, %.................................................... 40-98
<J>anop 4 'lpoM60llHToB, %.................................................... 40-85
36

PE3""CTEHTHOCTb KAn""nnstPOB
l106bllUellD JIOMKOCmb KDnUJlJlRp06:
f HH$CKUHOHHO-TOKCHIJCCKOC B0311CHCTBHC (eeIlCUC, CblllllOU mup,
Uop.)
f C-rHnOBHTaMHH03
f 3HllOKpHHHblC lIapYlllcnml r-"eltempyal/Wl, namOJlOi!U'leCKUU 1G1U-
MaKe)
f HapYlllCHHC $YHKLlHH TpOM601lHTOB (mpoM60l/umOneHUU, mpOA'-
60l/umollamuu)
f JJ,BC-CHHllpOM
f ncpCll03HpOBKa aHTHKoarymlHToB HcnpRMoro .nCHCTBHR
f .nC$HLlHT $aKTOpOB npOTpOM6HHOBoro KOMnJlCKCa (VII. X. V. II)
DpH HapYlUCHHIf HOpMaJ1l.Horo COCTORHHR CTCHOK KanmInJIpOB
nocnc MCXaHHIJCCKOrO B03.nCHCTBHJI H BCH03noro 3aCTOR nOBLllllaeTCJI
HX nOMKOCTL.
CHMnTOM ILlHnK8 (KO)KeBHHKOB8) - npH lUlinKC CKJlaLlKH KO)f(H
no.n KJlIOIJHLlCH npH HapYlllCIIHH pC3HCTCIITIIOCHI KanHnnRpOB Ha
MCCTC IllHnKa nORBnJlIOTCR nCTCXIHt H KpOBonO.J.TCKH.
CHMnTOM )KryT3 (KOIIIJaJlOBCKoro-PYMnCJIH-.TlcCIIC) - npH no-
BLllUCHIHt .naBnCHHR B TOIIOMCTpC lIa nncIJc 110 80 MM pT.CT. B TCIJC-
HHC 5 MHH Ha npClInJlC"ILC B 2 CM OT nOKTCBOH RMKIt B Kpyrc lIHaMeTpoM
2.5 CM Y 31I0poBLIX mOlIcH nCTCXJ1H HC 06pa3YIOTcR (WIH 06pa3YeTCR HC
60ncc 10 - 110 1 MM B .nHaMCTpC).
63110'lllaSi npo6a (HcCTcpoBa) - OCHOBaHa Ha C03.naHHH OTpH-
LlaTcnLHoro .naBlICIIHR B KIOBCTax lIHaMCTpOM 1,5 CM. HaKJIa.LlbIBaC-
MLIX nOlI KnlOtlHuaMH 11m.. na ncpClIHc-BHyrpCHHCH nOBcpXHOCTH
npc.nnnCIJLJI. Y 31I0pOBLIX mOlIC" 3a 3 MHn npH pa3pC)f(CHHH ]J.O
300 MM pT.CT. nORBnJlCTCR 110 20 McnKHX nCTcxHH.
np06bl Koxa II rccca - 3aKllIO"I8IOTCR B onpclIcncHHH KpOBO-
no.nTCKOB B MCCTax BHyrpHMLllUC"IHLIX nOlIKO)\(HLIX HlI"LCKLlHH.
BPEMst KPOBOTEYEH""st
2-4 1111111 (no j.Q'KC)
2,5-7 IIUlH (no AnBH)
l106bllUellO:
f TpoM60LlHToncHHH (lIae.7eocm8eHHble, lL\wYHltble, aJ1JlepZU'IeCKlle,
uHpeKlluoHHo-mOKeU'IeeKUe, npll 3a6011e8aHWlX Kp06U, l/Upp03e ne-
'lellU, uHfjJeKl/IIOHHblX 3a60'le8aIflIRX) - CM. pa31Icn TpOJu60l.#Umbl
f TpoM6orCMopparH"CCKHC CHHllpOMLI (Kp060melieHUR C i!unopu6-
pUIIOZeHeA'UeU, )JBC-CUHOpO.U)
f lIC$HI!HT $aKTopa VII
f pe3ynLTaT lICHCTBWI rcnapHHa. canHLlHnaTOB. J1C3af1>craTOB
37

t II3MCIICIJIIJI cocYJlIlCTOii CTeHKIt (C-ZUn0611ll,aMUH03. AfIIKpOaIlZUO-
110m 1111)
nOIlU1!1l0:
! 06bl'iHO BcnClIcTBItC TCXHJI'iCCKOii OWlt6KH
! nOBbIWCIUf3J1 CnaCTH'iCCKaJl cnoco6HOCTh ncpmpCpH'iCCKHX Ka-
m1nJIJlpOB
Rpel\lR "'''P0BOTe'leHUR - JTO Bpct.lJI. KOTOpoe npoXOIlJfT C MOMCRTa H3Hece-
Hml CTIlH,ll3pTIIOii paHbl KOil<lI (rny6l1Hoii IIC MCHec 3 MM) 110 MOMCRTa npeKpa-
UlcmUI BbITCJ<aIUIJI "'1>OBII, onpcllCJ1J1CMOrO Ka)J<,!J.blC 30 C nyreM npHlmaD.b1B3HHR
lIonOCKH )JInbTpOBaJ1bHOii 6)'M3rn.
no A\'Ie - np" npoKone KOH'lIIKa nanbu.a 1m" MO'IKH YX3.
no Aii8J1 - 113 nepcnHcii nOBcpxHOCTH npCllnnC'IbJl B ycnoBHJlx 1I0Bbl-
UICIIHOJ'O naBJICIIIIJI (40 MM pT.CT. B MaH>KeTC H:! nnc'Ic).
ill IJPCMR KpOIlOTC'!CHIIJI Jl8JJJlCTCJI rCCTOM, C nOMOWblO KOToporo OlleHHBaeTcJl nep-
BM'!lIbl" re"'OCTIn. BpeMJI KpOBOTe'!ellHJI XBpaKTepll:JYCT 4>YIIKuliollanbHYIO BIITIIBHOCTb
1poM60UlITOB II KarmnmlpOB H lie 3aBIlCliT OT npoueccoB Cllepl"b1BaHHJI !CpoBII.
TeeT ToncpsII....IIOCTII K aCllllp""' (no KBIIKY) - nocne nplteMa aCIIHplllla npeMJI
KpOBOTC'ICIIII" IIC IInlCIIJlCTCJI IInll YJlnllllJlCTCJI He 60nec '1eM B 1.5 paJa. 31"0 BpeMJI
nonllu"o: IIpll I"CMo4>lInllll A II B. KoarynonsTMII, 6one:JlIM 4>011 BllJlJle6pallJ18, IIpli
Jle'lCIIIIII Canll1l1maT3MII.
ccnOBAHETPOM60UTOB
KOn..eCTBO TPOM6oUHTOB
(186-320) X 109/J1
n0661lUI!1I0:
i MllcnonponmpCpaTlfBHblC npOllcccbl (3pumpe,uuR. .uUeJlOQJU6p03)
t XpOHH.,CCJ<IIC BocnaJUfTCnbHblC 3a6onCBallllJl (pee.MamouoHoe no-
pa:HceHue c)'ema806, R38ellHblii KO.7111", nJy6ep"J'.,7e3. oemeo.uue7U1Il.
l/lIPP03 "e'leltu)
t 3noKa'lccTBClfllblC lIoBoo6pa30BaHHJI (paK. llLLMtjJOAta. llU.UfjJOi!pa-
"YJ7e.\/Qm03)
t KpOBOTC'iCIIIIJI. rCt.lOnIlTH'.CCKall allCMnJl
l' ncpHOll BbI3.nopOBnCHHJI "PH Mcrano6nacTHI.fCCKliX allCMHJlX
t nocnc oncpallllii
t COCTOJlHlfC nocnc CnnCIUKTOMHII
t nCI.fCUHC KOpTHKOCTCpOlfllaMH
nOIlU3KeIlO:
! 113CnClICTBCIIIILlC TpOM60wrroncHJ.fIf. Bbl3B8IJHbIC CHmKCHHCM o6pa-
30n31UIJI TpOMOolllfTOB (6pO:J/CoellllaR mpo.",60Ljumo1leHWl. CUIt0POA' Yu-
CKOIJII"a-070pU'IO, ClmOpml Eepllapa-CY7be. aHa4la.7Wl l.JeoliaKa-
XiIi!GClI, CllIIopau tJ>aItKOIiU. Kpaellyxa H060pO:J/COeHHblX, ZlIcmUOl/um03)
- 38

! 6onC3HH KpOBH (alLwemlllleeKaR al/e."UR, ..\fe?aJl06;1CmUlleCKue
al/eAtUU, llei"iK03bl)
! nOpa)f(eHHC KOCTlloro M03ra (JllemaCma3bl 1I0600upa308aHUU, my-
6epKYlle311Oe nOpaJICeHue. UOIIU3upYIO/.4ee 06,1Y'lellue)
! .npyrHe 3a6onCBaHHH (IIU101U'IeCKaR mpo.\I001lllmOnellWl, na-
pOKCU3.\IQ.,ibIlOR HO'lHOR ZeIl02..1OUllHypUR, ze.\I0.lumllKO-JpeIlUlieCKUU
CUHOPO,U, nO'leliHOR lteOOCmamO'lHOCmb, 3a60.1e6aHUR ne'leHlI, ony-
XO.iU eoeY006. cerze3eltKU, '.J1(.1a.",ncWl, zunepmupeo.J, 2unomupe03)
! HHcl>CKLlHH (6upYCl/ble, uaKmepU(Lrzbllble. pllKKemeU03bl, .11(L1RptlR.
n1OKC01L1a3.\I03, BI1l[-Ul/(fteKI(Wl)
! 6cpeMeHHOCTb,MCHCTpyaLlHH
! .nei1cTBHe neKapCTBCHHblX npenapaTOB (1lumocmamUK08, aHaJlb2e-
mUK08. al/mU2uema.MwmblX epeoem6, all1nllUUOmUK06. ncuxompon-
HbIX .rzeKapcm8, ouypemuK08, npomu60CYOOPO:JICllblX cpeocm6, 8uma-
MUI/a K. pe3epnUHa, OUZOKCUHa. zenapUHa. HUmpOZ/lUlIepUHa, npeo-
HU3QjIOIW, 3cmpozeH06 U op.)
! .nCHCTBHC anKorOnJl, TH)f(CnbIX MCTannOB
! TpOM60l.lHTOnCHHH, BbI3BaIlHbIC nOBbllllCHHblM
TpoM6oLl.rrOB (mpo,,,60llllmOneHUlieCKOR nypnypa,
/JBC-eUHOpo,U, Kp060meliel/lJR, ze.\IoouaJllIJ)
ncrrpc6nCHHCM
zunepen;1eHU3.M,
Q CrpYKTYpa TpoM60uHToB orpaiKaCT CTcnellb IIX 3penOCTM.
TpOM601.1HTBpllaH lJIoPMYJla:
MHKpOnJlaCTHIIKH (1-1,5 MKM) - CTapble;
HopMOTpOM60HTbI (1,5-3 PoIKM) - 3peJlblC;
MaKponnaCTHIIKH (3,5-5 MKM) - IOHble;
..elaTpOM60LlHTbI (6- 10 MKM).
C,:.\BMI" BJlCBO - nOBbiwellllC 'iHCJl3 IOllblX «I><>PM (MaKpon.lacTHlloK) - IIOBbiwell-
11M pcrCllcpaUMH KOCTHoro M03111 (KpOf/o'lOmepR, .?e.I/01UmUlieCKUU IipU3. .1elir;o3. nOC1e
cn.1eH3IinJo.UUU).
CBBMI" BopaBO - 6onbwoe 'illcno crapblx ct>oPM (MMKpOnnaCTHHOK) - IIPH HaCJlen.-
CTBCHllbiX II CMMnTOMaTH'iCCKHX TpOM6aCTCHH1Ix, y 60nbHbut paKOM, LlHPPO'JC nC'iellH,
orpaBnCIIIIH 6eH30noM, npH CIlIln.pOPolC BHCKOrra-OI1...1pM'ia H .np.
MCI"aTpOM6oUHTbI - "PH TpOM60llHc-rpo4JHM licpHapa-CYl1be, 60neJHH MCH-
XelTnJiHa.
A.Are3HBHOCTb 'TpOM60L4HTOB
25-55 %
II06b1IUeHO:
i HWCMH1.JCCKaH 6onC3Hb ccp.nn:a
i nocnconcpaLlHoHHbIH H nocnepo.noBblH ncpHo.n
IIoHu3ICeHo:
! TpOM6oLlHTonaTHH (60.1e3Ifb ifJOIf BIL'L!le6paHOu)
! HapYlllcHHC arperaLlHoHHbIX tPYHKLlHH TpOM60UHTOB (mpoM6a-
cmeHWl rJlaHlIMaHHa-Hei!el'U, ypeJlIWl, 1euK03bl)
39

! a<lm6pHllorCIICMIIR
! MltrplfPYIOU{JfH TpoM60<lmc6ltT
AnrCJU8110CTb TpOM601111T08 (pCTCIIUItR) (adhaesio, retentio) _
IIX CnCUmpll"lCCKOC CBOHCTBO npllmmaTb K IJ)')KCpO.llHOH nOBepXIIO-
CTH. nOBpe)f(.llCHIIOH COCY.lIUCTOH CTellKC, JJCHKOUHTaM. Onpe.lleJJRCTCR
113MCHCHIICM KOJJH"ICCTBa TpoM6oUIITOB nOCJJe npOXO)f(.llCHIIR 'lepe3
CTall.llapTHYJO KOJJOIIKY C !J>ItJJbTpOM.
MaTCpUaJl .lIJiR IICCJlC.l{08aHHR. UIITpaTHaR nna3Ma.
ArperaLlHJI TpOM6oLlHTOB
55-145 %
CnOltlllQllllaR azpezaquR:
r pe3KaR aKTllBaUHJI CBcpTblBalUiR KpOBU (.llBC-C1IHOpO,U, mpoJlt603bl)
r caxapublH .lIUa6CT, 3TCpOCKJJCp03, HapymcHllC M03rOBoro II KOpO-
Haplloro KpOBoo6p a lllCIIHR
r rllncpmmonpoTCIIIICMIIR
HOP)'Ult!ltbl6Ce napa.ut!mpbl azpezaqllll:
! TpoM6acTcHifR rJJallUMaHa, 3CCeHUHaJIbHaR aTpoM6011HTOnaTHJl
II Tuna
OlllCJ'IIICIII6yelll BnlOpOR BOJllta azpezaquu:
! TpoM6oUHTonaTHII (6011e3Hb cpOH BWl.J1e6paHoa, JltaKpOl/umapHQR
mpo.,,601/umoouempocpllJl 5epHapa-CJ'lbe)
ArperaUHR TpOM6oUHTOO (agregatio) - CBOHCTBO TpoM60l1HTOB
06"bC.lIHlUlTbCR (CKJ1CifBaTbCR) .lIPyr C .lI.PyroM C 06pa30BaHHCM arpera-
TOB. OnpC.lICJIRCTCR BH3yanbHo llJIII 4)OTOMCTpH"ICCKHM cnoco60M npH
.lI.00aBJICHIIH K nJJa3MC, 60raTOH TpoM6oUHTaMII. pa31lH'lHblX BCllleCTB,
aKTUBlfpYIOllllIX arperaUllJO (a.llpCHanltlf. AJ.{<I>, TpOM6HH, pIlCTOMH-
UIIII H .lip.)
ill AlpelllullR C pllCI'OMHUHHOM - npo6a lIa BblRBJJelllle cjJaKropa BI\Jl1Je6paJuuL Hapy.
WCHIIC PlfCTOMHuHH-arperaUHH Ha6nIO.aaeTCR "P" 6one3HH cJIoH BHJ1IJe6pa1t.l13 KIIH 1pOM-
6oUIlTO!UfC1"JXl4tHH &:pHapa-Cynbe (Hem peIlellmopa p/lcmo."U'lUH06OU azpe,zu'lUU).
Manpll8JI .l{JlSI HCCJlC.l{OB8HHSI. EoraTaR TpOM60UHTaMH I1H1p3T-
HaR nJJa3Ma.
q,aKTOp 3 TpoM6oLlMTOB
40-98 %
n(Jltllt!Ha aKmUBHocmb:
! TpoM6oUHToneHHII. TpoM6oUliTOnaTHH
cJ>aKTop 3 TpoMfioUHTOB - TpOM60uIfTspHbIH ("IaCTH'lHLlH)
TpoM60nJIacTIIII. AKTHBHOCTb !J>sKTOpa 3 TpOM6oLlHTOB onpe.lle.1l1fCTCH
40

no cpaBIICHmo aKTHBHpOBaHHoro BpeMelll1 peKMbuH4>IIKaumf 60ra-
TOH H 6CJ1HOH TpoM60unaMH nna3Mbl.
ManpHaJl .II.JlA IICCJleJJ.OBaIIifA. bOraTa1l It 6Clllla1l TpOM6oUIITa-
MH UHTpaTlla1l nJ1aJMa,
cJ)aKTOp 4 TpOM6oL4MTOB
40 - 8S %
nOSbllUellQ QKmUSIIllcmb (speMR YKopO'lello):
f )J.BC-CHHJl.pOM, TpoM60Jbl
f aTCpOCKJ1CpOJ
nOllUJlCellQ QKmUSIIOClllb (spe.ftfR ydJlUIICItO):
! TpoM6oUHTonaTHH
! nocne npHcr.ra acnHpHHa, 6ynUlHolla, nanaBepuHa, a.npeH06J10Ka-
TOpOB
C])aKTop 4 TpOM601tHTOB - aHTHrenapHHoBblH $aKTop. AKTHB-
HOCTb 4>aKTopa 4 TpoM60UHTOB onpellen1lCTCJI no YKopO.,eHI1IO YpOM-
6HlloBoro BpeMcHH renapHHH3HpoBaHHoH nJ1a3Mbl npH J106aBnCHHH
HccnellyeMoH TpoM6oUHTapHoH B3BeCH_
MaTtpHaJi .lI.JlA HCCJle.ll.OBaIlHR. B3Becb HcnblTyeMblx TpOM6o-
UHTOB.
rEMOKOArYl1f1L,tHOHHbl&lt rEMOCT A3
nOlca:UlTeJlb
HOpMlUlbHble
)H.'UHHII
nepsaR r/Ja:Ja - 06pa:JoflaHue npompo.u6uHa:Jbl
BpCMII CBcpTbleaHMII KpOBU (no JlH-YaHT)'). Mlm:
B IICCHnllKOHOBOH np06l1pKc ...............................................................5-7
B cHnHKoHoBOH np06HpKc ...................................................................15-25
HIIJlCKC KOIIT3KTHOH aKTHBaUMH .............................................................1.7-3
BpCMII peKanbLlHcIIHKauliH nna3MbI, c.........,............................................60-120
AKTHBHpOBaHlloc (KBonHHoBOe) BpeMIi
peKanbLlHcIIHKBuHH (ABP). C ...................................................................50-70
AKTHBHpoeaHHoe 'IaCTH'IHoe TpOM60nnBCTHHoBoe
(KBonHH-KccllanHHoBOe) apeMJI (A'ITB), c .............................................35
AyroKoarynorpaMMa (HB 10 MHH), c...................................................... 7-10
no-rpe6nclIHc npoTpOM6ulla. % ............................................................. 75-125
AKTHBIIOCTb. 'Yo:
ljIaKTopa vln .......................................................................................50-200
cflaKTopa IX ..........................................................................................50-200
cIIaKTopa X ...........................................................................................60-130
lj>aKTopa XI ..........................................................................................65-135
lj>aKTopa XII ........................................................................................65-150
41

BmopaR t/x1:m - 06pa:sottaltue mpo.Jt6I11fQ
flpOl-poM611JIOBOC BpCMJ!, C ......................__........................................ 15-17
flpOTpOM6KIIOBblH IIII;lCKC, % ............................................................ 80-110
AKTIIBIIOCTb. %:
lj>aKTopa II ....................................................................................... 60-150
lj>aKTopa V....................................................................................... 60-150
lj>aJ..opa VII ................................_..................................................65-135
TpembJ/ tjJa3Q - OOpa306QHUe tjJu6puHa
TpOM611110BOC BpeMJ!, c....................... ...................._......................... 10-20
cI>H6pllHorcli A (lj>aKTOp I), rln ........................................................... 2-4
cI>1t6pllll, rln ........................................................................................ 7-8
l.JemBepmlUl tjJU3Q - nOCmKOQ.?YJIJII4UOHHlUI
cI>ItGpIlIlOJIHTH'ICCKaJl aKTMBHOCTb
(cno1l131111LJH :}yrn06YlllllloBblH Ij>H6pHllonH3), MMII ......................... 120-240
C ..pem OKHH33033BHCHMblH nH3HC :}yrn06ynHHoBOro
crycTKII, MIIH ....................................................................................... 5-13
cI>1t6pHlla1a (lj>aKTOp XIII), C (%) .......................................................50-100 (70-130)
PerpaKHJI KpoBIiHoro cryCTKa. 0/. .............. ......................................45-65
flpo.!1YKTbI J1Cl"p3JUIUHH Ij>H6pHHol-eHa (fUlcI>). ..rln ..........................l1o 5
n3paKodryJIJIHOIIHbIC TeCTbl: 3T3110JIOBblH,
npOla\IHllcYJlblj>aTtIl.IH. 13-lIaljrronoBblH .................,........................... OrpHuaTenbHblc
A"IIlIlKOQ.?y.VlHmf>/
ToncpallnlOCTb nna3Mbi K n:napHHY, MHH ......................................... 6-13
CBo60!UlblH rellapHH. C ....................................................................... 8-12
AIITHTpOM6ltH III, rln (%) .................................................................. O,3...{1,42 (75-125)
a-MaKpo/"J106ynHH, f-ln ............................ ......................................... J,S-4
flporclIlI C. MI-In ................................................................................. OKono J
Koal'YJlOrpaMMa cndraCTCJI H3 pa3nH':lHblX TCCTOB, KOnH'leCTBO
KOTOpblX MCHJlCTCJI 8 3aBHCHMOCTH OT LlcnCH H 3a.uall HCCne,IIOBa-
11ll".
B CB"3H C 3THM pa3nH'laIOT: nOJJHylO KoarYJJOrpaMMY, BKJJIO-
'ldlO1l{YIO pC3ynbTaTbl BCCX B03MO)f(HbIX KoarYJJOnOrHIlCCKHX Tec-
TOB, H COKpalllCHHYIO KoarYJJOrpaMMY, COCTO"1l{YIO H3 ,lIaHHbIX
60nbWHHCTBa YHH«PHLlHpOBaHHbIX TCCTOB; OT,AeJJbHblC TCCTbl I<oa-
rynorpaMMbJ.
COKpalQeHH8a KoaryJlorpaMMa BKJIlOllaCT: BpetdJl CBepTWBaHHJI
KpOBH, ayrOI<OaryJJorp3MMY (COKPallleHHbIH BapHaHT 6-10 MHH),
ABP (aKTHBHpOBaIlHOe BpeMR pCKaJU.LlH<}>HK8LlHH nna3MLI), AqTB
(KaOnJ1H- K etPan H HOBOe BpeMR), npoTpoM6HHOBblH HH,neKC, TpOM6H-
HOBOC BpCMJI, «pH6pHHorCH, qm6pHHOJJHTHIlCCKYIO aKTHBHOCTb,
AT-III (8HTHTpOM6HH III), CB060.l{HLIH renapHH.
42

BPEMSf CBEPTblBAHHfl KPOBM (no I1M-YAMTY)
5-7 IIIHH (B HeCRJlHKOHOBOii npofiHpKe)
15-25 IIIHII (B CHJlHKOHOBOH npofiHpKe)
YOJlUllellO:
i TpoM601.l1fTOnanm (oeqJll11llm qJaKmOpa 3 mpoA,601,WII08)
i nocTreMOppanf'fecKHe aHCMHH
i .ne$m.(HT $aKTopoB CsepThIBaHHJI KpOBH (qm6pllllOzella. VIII. IX.
XI. XII)
i H36blTOK aHTHKoarymlHToB (zenapulI, aJIIlllllnpOA,6,11l III, IIPOOYK-
mb' oezpaOatlltrl ljJu6pullozella)
HecBepmblBullul! "POBU:
x. - a$H6pHHOrCJlCMHJI (coOep.JICalllle ljJII6pullozeHa IlU:HCe / dll)
BpeMH cBepTLlB81111A KpOBH - 3TO BpeMJI C MOMCHTa B3J1THR
KpOBU H3 KpOBcllocHoro cocy.na .no MOMCHTa ee cBepTblBamuJ. 0110
onpcncmlCTCH aKTHBHOCTbIO nna3MeHllbiX $aKTOpoB. TpoM6oUHTOB,
COCTOHHHCM COcy.nHCTOH CTCHIrn.
TeeT HBJlHCTCR OpHeHTHpoBO'fllbIM nOKaJaTe.nCM MHorOKaCKa.nHO-
ro $cpMeHTaTHBHOro npouecca, B pe3ynbTaTC KOTOpOro pacTBopH-
AfblH $HopuHoreH nepexo.nHT B HcpacTBOpHMblH 4>HopHH.
m KHaCKC I.:oHT8KTHOii """THB""HH (1,7-3,0) - COOTl.oweIiMC BpeMenll CBepThlIl3-
111111 KpOBIi no 1111- Y aHT)' B CMnHKoHOBOH H IICClinlUCOflOBOK np06l1pKaX..
H08",lUeH: H8pywella KOHT8KTII8JI aKTHBall"JI (HedocmamoK r/JuKmopo8 XazeAfaHa.
(/>1em'lepa. (/>uml4:JICepa.1bda). H36wrolt 3HT11ltoarynJlHTOB (zenop'fII U dp.), lIapyweHllc
TpoM60nnaCTHHoo6paJoIl3HHII, Hap)'WCHIiC 4»)'HKUHI' Rel/eIiH (e.woq,II.IlJlu. zunor/Ju6-
PllHOZ(!He.IIUU) .
HOHu_ell - npe,1TpOMOOTliI/CCKoe COCTOJlIIHe (mllepfwozy.1RI4/101fIlaR r/Ja7a OBC-
c.tlldpo.lla).
M8TepH8J1 }:tJlH HCCJle}:tOBaIiHA. L{HTpaTHaJI nnaJMa.
BPEMJI PEKAf1bltMCI>MMM nnA3MbI
60-120 C
flOIlWU4I!HO:
l' .ne$HUHT $aKTOpOB CBcpTblBaHHH (KpoA,e VJI, XllI)
l' "lpOM601UlTOneHHJI (HeooCmamO'IllOC11lb rjJaKmopa J mpo.,60llum08)
l' HaJIH'lHe aHTHKoarynHIlTOB (zenapuH. aHmllmpoA,61111 11/, IIpO-
oYlanbl oezpaoaqullljJu6pllllozeHa)
flolluJlCello:
! mnepKoarynHUHH (mpoJJ/603bl, P,BC-CUHOpOM, 3pUmpol411m03)
.
nOKD'J8TCnb OTC)'TCTB)'CT.
43

BpCMH pCK8JJLQ H 4mK8QHH "JJ83M'" - BpCMJi CBCpTblBaHHJi KpO-
BH nocnc 06aBnCHHJi K HC" OnTHMaJJbHOrO KOnHqCCTBa xnopa
KaJJbUHJi.
MaTCpH8JJ J1J1J1 HCCJ1CJ10B8HHH. UHTpaTHaJi nna3Ma.
AKTBPOBAHHOE BPEMR PEKAI1bUCZ>KAU (ABP) _
KOaJIHHOBoe BpeMH
50-70 c
l106bllUellO:
i e<l>HUHT cfJaKTOpOB CBCpTbIBaHHJI (KpoMe VII, VIII)
i TpoM6oQHTOnCHHR (HeooemamOliHOemb ifJaKmopa 3 mpoAt6olJlIm08)
i HaJJHqHC aHTHKoaryJJJlHTOB (zenaplllI, aHmumpo...t61111 III, npooYK-
mbl oe?paoalJuu ifJu6pullozella)
llOHU:1Kello:
! rHncpKoarynJiUHR (mpoM603bl.I(BC-euHopOAt, 3pump O lJ Um0 3)
AKTHBlfPOB8HHoe opeMA peK8JJLQHc!»HK8QHH "Jl83M'"
BpeMJi CBcpTblBaHHJI KpOBH nocne o6aBnCHHJi K He" onTHMaJJbHO-
ro KOnHqeCTBa xnopHa KaJJbQHJI B ycnoBHJlX CTaapTH3aUHH
KaonHHOM.
M8TepH8JJ MR HCCJJeJ10B8HHH. QHTpaTHaJl nna3Ma.
AKTJiIBPOBAHHOE
'jACTM4HOE TPOM60nJ1AClliIHOBOE BPEMR (A4TB) _
K80JIHH-KeIj)8J1HIIOBOC BpCMH
35-45 C
YiJnullellO:
i rCMocfJHnHH (A - oeifJulJum ifJaKmopa VIII. B - oeifJuljum ifJaKmo-
pa IX, C - iJeifJulJum ifJaKmopa Xl)
i 6one3Hb cfJOH BHJIne6paHa
i C<l>HUHT pyrnx <l>aKTOpOB BHyrpeHHero McxallH3Ma CBepTbIBaHHJI
KpOBH
1 HaJJHtme aHTHKoarynJIBTOB (zenapull. altmumpoM6uII Ill, npooYK-
mbl oezpaoaquu tjJU6puHozeHa)
i J{BC-CHHPOM
1 60ne3Hlf neqeHH (lJUPP03, :JfCUp06aJl iJuempoifJWl)
YKopOilello:
! nOBblmCHHWI CBcpTblBaCMOCTb KpOBH
! HapymcHa TeXHHKa B3JiTHJi KpOBH (nonaiJaHue mKaHe60ZO mpoJU-
60nTJaemuua 6 npo6upkY)
44

KaOJlHH-Ke!JIwIHHoBoe BpCI\IR - nOKaJaTeJIb BHY1'I't:IIIICH aKTHBa-
UHH ctJaKTOpa X nocnc MaKCUMaJIbHOH aKTI1Bal.{HH ctJaKTopoB XII 11 XI.
OHO 3aBHCHT OT COll.cp>KaHHJI B KpOBH ctJaKTOpOB II, V, VIII, IX, X, XI,
XII H ctJu6pHHorCHa H HC 3aBHCHT OT KOnU'ICCTBa TpOM60I.{HTOB.
DpH YJ.J.lIHHCHHH A lJTB, ccnH lI.06aBnCHHC 1O%-HOH nOHopCKOH
nna3Mbl 1I0pMaJIII3YeT A lITB, TO :no YKa3blBaCT Ha ncctJUI.{HT nnaJ-
MCHllblX ctJaKTOpOB CBcpTbIBaIlH; npH HaJIH<JI1H I1HrH6HTopOB CBCp-
Tbl8aHH KpOBU KOppCKI.{H HC npOHCXOll.HT.
MaTepHan AJiH HccneAooallHH. I..{MTpaTHaJI nnaJMa.
AYTOKOAfYnOrPAMMA
A = 15,4:i:2,9 % T I = 3,7:i:O,2 MHH III-IT = 2,I:i:O,1
MA = 100:i:I,1 % Tz = 10 MHH
Ihucy68.LiH.. M"H
I Bpe... CBep'rblll4H"",C I
K08I)'II.IIHOH""
8KTH8HOCTb. %
2
4
6
8
10
20
30
40
50
60
17-50
8-25
8-14
7-11
7-10
7-14
10-18
10-22
12-52
12-32
20-73
54-105
82-105
93-108
93-108
82-108
70-100
59-100
54-88
41-88
AYTOKoaryJlRLlHOHHblH TeCT (AKT) - Hccnc,aOBaHHC BpCMCHH
PCKaJIbI.{H4>HKaLlHH nna3Mbi npH lI.06aBnCIIHH rCMonH3aT-KaJIbLlUCBOH
CMCCH (rKC) lIa 2, 4, 6, 8, 10, 20, 30, 40, 50, 6O-H MHllyrax OT MO-
MCHTa npHrOTOBJICHII rKC (pliC. 6).
.l1.aHllblc ayroKoarynJlI.{HOIIHOro TCCTa no Ta6nH<JHblM lI.aHHblM ne-
pCBO.lVlT B npoLlcHTHbie nOKa3aTCnH ayroI<OaryIlJlHOHHOH aKTHBHO-
CTH H Bbl<Jcp'lHBalOT ayroKoarynorpaMMY (PHC. 1). no KOTOpoH onpe-
lI.CIlJIIOT CnClI.)'IOlllHc napaMCTpbl:
A - CBcpTblBalOlllYIO aKTHBHOCTb Ha 2-A MHHyre. A = 15,4:t2,9 %;
MA - MaxCHMaJIbl1)'lO CBCpTblBalOlll)'IO aKTHBHOCTb, MA = 100:1:1,1 %;
TI - BpeMJllI.OCTH>KCHHJI nonOBHllbi MA, T. = 3.1%0,2 MHH; T 2 - Bpe-
MJI lI.OCTH>KCIUI MaKCHMaJIbHOH aKTHBHOCTH, T 2 = 10 MHH; HUT-
IUI,aCI<C HllaKl HBal.{lIH TpoM60lUlaCTHHa H TpOM6HHa,
JlJIT =
= 2, l:tO. I.
A Ita 60 - Ii MItHytt HHl(y6aWtH
MA
<4S

C)
Ii
E
CD
Q.
E80
i

::a

..,



CD
CD
::a
E
go
CD

a:

.
.%
tliiCmeUtl.HmumpOM6uH8 III U ntII
runo-
KOa2ynRqUR
reM unUR
30H8 cm86unt.Hoii H081: :nRqUU
MaHCUMBn,.",.Sf 8ranU8HOCml>
npompoM6uHB3&I
HOPMO-
Hoil2ynRquSf
......__________------ ___---e
runep-
Hoa2ynSfquSf
2" 6 8 10 20 30 +D 50 50
apeM" UHKY6aj.CUU
2eMonU3lIII'I-Hant.LlutJeou cMecu, MUH
PIIC 6. AYToKo8rynRHoHHblii TeCT B HOpMC (3awTPHxOB8HH8R o6nacn). npll
rHno- H nmepnpoTpoM6HH006pa30BaHHH
Il
AYTOKoaryJlOrpaMMa OTpa>KaCT COCTOJlHlle II KIIHCTIIKY npo-
KoarynJlIlHOHlloro II aHTIIKoarymUtllOHHorO 3BeHbeB CBcpTblBalOllteH
CHCTCMLl J<poBIf.
BOCX01UIIltaJI «aCTb ICpHBOH ayroKoarynorpaMMLl nOKaJblBaCT Ha-
paCTaHlle II M8KCIIM8JlbHYIO aKTIIBHOCTh TpoM6onnaCTIIHa II TpOM611-

tOO 1i
.A
e

0

CD
::J

 11
:;50
:r 
'2
III
CD
:a
E
i A
0 -..........
U
0 2 to .,,20 JO 1,0 50 60 AfUH
PHC. 7. AyroK08l)'norptIMM8 " ee napaMeTpbl
46

Ha npH CTaIl.napTH'3HpOB3tIlfOH KOHTaKTHOH H 41oc4K>llHml.nHOH aKTII-
BaUHH CBcpTbIBaHHJI.
no HHCXO.nJlIUCH 'laCTH KpHBOH CY.lI.JIT 0 CKOpOCTH H UIITCHCHB-
HOCTH HllaKTHBaUHH TpOM6HHa B PC3YllbTaTC cro COp6UHH H3 41H6-
pHlfC (3HTHTpOM6HH I), BllHJUlHH MC.lI.1lCIIHO..nCHCTBYIOIUHX aIfTH-
TpOM6HlfOB III. IV II npo.nYKTOB 41H6pHHollH3a (aHTHTpoM611I1a III.
HnH n)J.<I».
CII"3ICeHue naplL"emp06 60cxodRIeu '4a,'mu I<PUlJOU
r,rollu3ICellbl A U MA, ydnuHeHo T, U T 1 ):
! llCq,HUHT $aKTOpOB npoTpoM61t11a3006pa30BalUlJl (XII. Xl, lX, VlIl,
a mOK:HCe X. VillI)
! 1136bITOK 6bICTpO.nCHCTBYtOIUHX aHTHKoarymmToB (zel/OpllH II op.)
o.
Kpymoe CHU3KellUe HucxodR".eu '4QClnU I<PU60U (yBeJIII'4ellUe
HilT):
! JlOBbllllClfllC co.nep>KdIlHJI MCJIJICHHO.nCHCTBytOIUIIX aHTIITpOM611-
HOB
! aKTHBaUHJI q,H6pliHOllH3a
W AYTOKoarYl1orpaMMa 1l0CT)'nHa H npOCTa B BbIJ1011HeHIIII. ee pC1ynbTaTLI 10'1/1101 II
BbICOKOBOCIlPOII'JBO.:!IIMbL Ha pe1Yl11011lTW TCCTa BJlHJlIOT pe3KMe 111MellClmR I'CMaTOK-
pHTHOI'O lIoKa1aTCl1R H COllCpJKallHJI B KpoBIi 3PHTpOllllTOB. no COKpaw.CHIlOMY HapllaH-
"I)' KOIITpO IIIPYCTCR aKTIIBHOCTb liB 6, 8, 10-" Hnli TOl1bKO 118 10-" lIlIIyre.
J]..ruI KOIITpOl1J1 18 nC'ICIIHCM rcnapMIION ltOCT8TO'OIO ItCC./ICAOlJaTb MA fillWb /13 10."
Mllllyre. lIJUIlllISrHOCTHKH reMo4>lUlHH - lIa 10. 20. 30-1i MH/lyr&X, .will BblJlBJlClillJi nmep-
K031)'1IJIWtlt - HS 4, 6, 8, 10 H 60-" MHIlyr&X.
ManpHaJI nJiH HCCJleltOB8HHH. l.{H1-p8THaJl KpOBb.
nOTPE6l1EHME npOTPOM6MHA
75-125 %
IloIIU3ICello:
! rCtOqmllHH (A - oefjJu"llll1l fjJaKmopa VlIl. B - oefjJullllnr fjJaKI1l0pa
IX, C - oeq;II"111111 q;aKmopa Xl)
! .nCq,HUHT q,aKTOpOB II. V. X
! H311H'lHC 311THKoarymllITOB (zellapllli. ollmunrpoAf6uII Ill. /lpOOYK-
mbl oezpaOllljll" ifJu6pLlllozella)
nOTpC6Jlelllle "pm pOl\16HII8 - COOTHOlllCIfHC npO"IpOMOHHoBoro
BpelllcHH CblBOpoTKII KpOBJI 6onbHoro C npotpOM6HHOBLIM BpeMCHCM
nJIallllbl .nOHOpa.
IIpH HapywcHlU1 o6pa30BallllJl npoTpoM6HHaJLI l1pOTpoM6H11 HC
nOllHOCTblO npcBpaIUaCTCJI B TpoM6uH H B 6on"woM KORH'lCCT8C oc-
47

T8CTCJI B CbIBOpOTKC. Do KOnHIjCCTBY OCTaBWCrOCJI npoTpoM6H1i8 cy-
WIT 0 npoTpoM6UH8J006paJOBaIlHH.
MaTepltaJi .I:tJIH HCCJlC.nOB8IfHR. Cb!BOpOTKa.
AKTHBHOCTb Cl>AKTOPA VIII
50-200 %
llOllllJICella:
! !'cMoqmnlIJl A
! 60J1CJllb q,01l Bnnnc6paH.na
! npHcyrcTBltc cncLlHllmljecKltx 8HTltTeJl K q,aKTopy VIII
! )J.BC-CIIII.npOM
AKTlIBItOC"l"b sK'"lopa VIII onpc.neJlJleTCJI KoppeKLlHeH AtJTB
cy6CTpaTHOH nna3Mbi (nna3Mbl 6onbHoro rCMoq,HJmCH, COllep>KalLleH
Bce q,8KTOpbJ o6pa30BaHHJI TpoM60KHHa3bl, KpOMC q,8KTOpa VIII) npH
.no6aBncmm pa3BcllcHHOH nna3MbI 60nblloro.
MSTcplfsJI .I:tJIH IfCCJlC,ltOBaltlfH. U,HTpaTHaJi nna3Ma.
AKTHBHOCTb Cl>AKTOPA IX
50-200 %
llolluJlCella:
! rCMoqmnHJI B (6011e3Hb Kpuem.uaea)
! nCljeIlO.,HO-KJleTOIjHaJI Hc.nOCTaTO.,HOCTb
! 6onc311b r owe
! lIeq,poTHljeCKHH CHHllpoM
AKTlIBIIOCfb sKTopa IX onpc.nCJ1J1eTCJI KOppcKLlHeH AtJTB
cy6CTpaTHOH nn83Mb! (nJ183Mb! 6onbHoro rCMoq,HnllcH, cOJJ.ep>KalllCH
Bce q,aKTOpb! 06pa30B8HHJI TpoM6oKHH8Jbl, KpoMe q,aKTopa IX) npn
J106aBneHHH p83Be.nellHoH nna3Mbi 60nblloro.
MSTcpHaJI .l:tJlSI IfCCJlCJJ.OBSIlIfH. U,m paTHaJI nna3Ma.
AKTHBHOCTb Cl>AKTOPA X
60-130 %
n OIlU31Cella:
! BpO>KlleHHb!H .neq,HLlHT q,aKTopa X (60nc3Hb CnoapTa-OpaY3pa)
! 3MIIJ10Hll03
! 3aooneBalUlJl nCIjCHH
! 3JIOKd'ICCTBCHHbIC onyxonH nOljeK If H3J1nO'le'lIlHKOB
! nmOBHT3MHH03 K
! J1eHc rBHe q,YHrHLlHlloB
48

AKTHBHOCTb "'8"Op8 X onpc.ncn1leTC1I KOppCKUHCH npOTpOM-
6HHOBOrO BpCMCHH nna3Mbi 6onbHoro npH .lI.06aBnCIIHH cy6CTpaTa
cpaKTopa X.
MaTepHaJI AJIR HCCJleAOB8HHH. UHTpaTHaSi nJla3Ma.
AKTMBHOCTb CZ>AKTOPA XI
65-135 %
llOHU3ICella:
! rCMOcpHnHSI C
AKTHBllOCTb "'8KTOpa XI onpC.nCnSlCTCSI KOppCKUHCH BpCMCHH
pCKanbLlHllmKaUlfH nna3Mbl, nHUICHHOH <l>aKTOpa XI. npH .n06aBnCHHII
K HCH JIJla3MbI 60nbHOrO.
J\laTepllan AJIR HCCJJC.nOBaIlHH. l{UTpalt1ID1 nna3Ma.
AKTMBHOCTb CZ>AKTOPA XII
65-150 %
llOIlU3ICeHa:
! BpO>K.llCIIHbIH ACcpHUHT <l>aKTopa XII (6011e3I1b Xae"'aHa)
AKTIlBIIOCTb 4taKTOpa XII onpc.ncnSleTCSI KOppcKllUCH BpCMCHH
peKanbUHI!>HKaUHH nna3Mbl, nHUIeHHOH cpaKTOpa XII, npH .no6aBne-
HHH K HeH nna3Mbl 60nbHOrO.
M8Tepll8JJ AJIR HCCJJeAOBaIlHH. l{HTpaTHaSi nna3Ma.
npOTPOM6i-1HOBOE BPEMS1
15-17 c
npo1])oMfillHOBblii HIli!.eKC (nu) 80 - 110 %
Y6eJ1UllellO (n06b1WeHUe flN):
f BpO>K.llCHHaJi rHnonpOTpOM6HHCMIDI
f .necpHUHT cpaKTOpOB II, V, VII, X
f XpOHH'ICCKI1C 3a6oneBatlIDI nC'ICHH, MeXaHH"ICCKaSi )J(cJITYXa
f XpOHH'ICCKHH naHKpCaTl1T
f AecpHUHT BHTaMHHa K
f J].BC-CHItapOM (n030Hue emaouu)
f rHno-, .n Hc lJm6pHHOrCtlCMH1I
f HanH'IHe aHTHKoarynJlHTOB (enapuH. allmumpo\l6uH /II, npOOYK-
mbl oepaOal/11ll qm6puIl0.?ella)
YKopOllellO (CIIU3ICellue llH):
! COCTOJlHHe nmcpKoarynSlLlHH, TpOM603
49

! nOBbIlUCHH8J1 alCTHBHOCTb $aKTOp8 VII (mpa6Afa. IIeKpo3)
! 3nOKa'iCCTBCHHbIC HOBOo6paJOBaHIDI
! B nCpHOlt pOltOB, y 6CpCMCHHbiX
npOlpOllt6HHOBOe (YpOM6oIlJlaCTHHOBOe) BpeP,IH - nOKaJ3Tenb
BHCWHCH CUCTCMbl aKTHBaLlHH npoTpoM6HH8 B ycnoBHJlX H36bITKa
TKaliCBOrO TpOM60nnaCTlIHa H Ca 2 +. QHO 3aBHCHT OT nna3MCHHbIX
4>aKTOpOB II, V, VII, X H 4>H6pIlHOrCHa.
W JI.n1l HeKJIIO'ICIIIIII 3aUltCItMOCTH or aKTIIBHOCTil IIcnonb30BallllOl"0 "IpOM60IlJJaCmHa
nporpoM611110Boe BpCMII npC.l\Cl'aBnIlCTCIi KaK npo"J1KlMfiHHOBblli IIHaCKe (nlf):
nJ>OIpOM611110Boe BpCMJI naUIICIiTa
nl1 = xlOO%.
nporpoN6H 1I0Boe Bpe11I OOHopB
nporpoM611110BOC upeMIi WlipOKO npliMCHlieTCli Mil KOlirponli 38 nC'IClllleM 81ITH-
Koal'YJIIIIITaMil IIcnpliMoro .aeiicr8HII.
J\taTcpllan ltnH IICCneAOBaIliIH. U.mpaTllaSl nnaJMa.
AKU1BHOCTb CPAKTOPA II
60-150 %
nO/flu/celia:
! BpmKltClfHblH ltCcpllUHT $aKTopa II
! 3a60nCBaHlUi nC'iCHH
! nmOBHTaMHII03 K
! CHCTCMllaH KpaCliaSl BOnqaHKa
AKTlIBHOC1'b $aKTopa II onpC.1I.CnHCTCH KOppCKLlItCH npOTpOM-
611110Boro BpCMCHIl nna3Mbi 60nbHoro npH .ZI.06aBnCHHIl cy6CTpaT8
$aKTopa II.
Ma'I"CpIl8JI IUut IICCJIC1{08811I1H. UHTpaTlI8S1 nna3Ma.
AKTBHOCTb CPAKTOPA V
60-150 %
nOli u:ncella:
! BpO>K.ZI.CIIHblii .ZI.c$HLlHT $aKTopa V (Ilapaze.AwprurlR)
! :moonCBalUiH nC'iCIiH
! n100811 \"aMHH03 K
! lIaJlH.,HC IIHnl6uTopOB )alCTopa V
A.........IBIIOC-I b $aKTopa V onpc,nCJUlCTCg npoTpoM6HHOBbiM BpC-
McnCM cy6CTpaTHOii nna3MbJ C ,nC$HLlHTOM $aKTopa V npH pa3BC,nc-
IUlIl nna3Moii 6onblloro.
ManpHaJI A.'UI 'SCCJle.aOB8HH1I. Qmpa1118J1 nJl83M8.
50

AKTMBHOCTb Cl>AKTOPA VII
65-135 %
n ollu:»cella:
J. BpO)KJJ,eHHhlH .ne$HltHT $SIITOpS VII (60Jle3Hb A"eKcalli)epaj
! 3s6onCBSHHJI ne<IeHH
! rHnOBHTaMHH03 K
! npHMCHCHHe SlteTHJTCaJIHUHnOBOH KHCnOTbI
AKTIIBHOCTL cJIaKTOpa VII onpe.nenJleTCJI npOTpOM6HHOBb1M
BpeMCHeM cy6CTpaTHOH nn83Mbl C .nC$HltHTOM $aKTopa VII npH pa3-
BC.nCHHH nna31110H 60nbHoro.
MaTepH8J1 .nJlR RCCJle.nOB8I1HR. I..brrpaTluul nn83Ma 6e3 TpOM60-
ltHTOB.
TPOM6MHOBOE BPEMft
10-20 c
Y6eJlU'leIlO:
t rHno$H6pHlforCHCMHJI (npu KOlllfellmpalfuu tjJu6pullozellQ ftfellb-
we I z/Jl)
t 3s6onCBalfHJI nC<ICIfIf (zellanlllm, lfUpp03)
1 .l{BC-CHH.npoM
t HaJIH'IHC ItHrH6HTopOB CBepTblBaHHJI KpOBH (zellapulI, QmnllmpOM-
6UH Ill, npodYKmbl i)eZpai)olfuu fjJu6pullo<eHa)
H'lQ:JMQ lie C6epm616QemCR:
x .nHC-. rnno41H6pHHOreHCMHJl
x HaJ1H'.mc tlllrH6HTopoB CBepTbIBSHHJI KpOBH (zelJopuII. allnrumpo.u-
6uII III, "pooYKmbl oezpaoaijuu fjJu6pullozella)
x MOHOKJIOHaJ1bHbIC raMManaTHH
YMeHblUeHO:
! rHncp$H6pHHOrCHCMHJl,napanpoTCHHCMHJl
Tpol\l6HHOBOe BpCMR - nOK83aTCnb ncpcxo.na $lf6pHlforcna B
$H6pHH. BpCMJI o6pa30BaHHJI cryCTKa I1J183MhI npH .no6aBJICIIHH K
HC" H36b1TKa CTaH.napTHOro paCTBOpa TJxUot6HHa. QHO 388HCHT OT
KOHUcHTpauHH $H6pHHorcHa H npoucCCOB ero nonHMcpll3aUHH II HC
3aBHCHT OT McxalfH3Ma alITHBaUHH npoTpOM6HHa.
MaTepHBJI J),JIR HCCJle.nOBaHHR. l.{HTpaTHaJI nna3Ma.
51

4IM6PMHOrEH A (4IAKTOP I)
2-4 r/Jl
n06b1lUello:
i OCTpocpa30Bbie peaKUHH (80ena.7umellbHblu U HeKpOmUlieCKlIU npo-
'lecc, JlWWpaOKa, wlq;eKl/1I0Illtble 60Jle3HU, mpa6Mbl, O:HCOZU, 06wup-
IIble XUpypZll'leeKUe 6,lteWameJlbem6a)
i .llHlJJcpY3Hble 60ne3HH COe.llHHHTcnbHoH TKaHH
i OCTpblH HHcpapKT MHOKap.lla
i 60nc31U1 rIO<JeK (ltecjJpumbl, ze.uo.7umuKo-ypeJIfu'/ecKlIu eUHopoM)
i napOKCH3MaJlbHWI HO<JHa1l reMorn06HHypHJI
i nY<JeBWI 60ne3Hb
i 3nOKa"lCCTBeHHble lIoBo06pa30BaHHJI
i cpH3HonOrH.,ecKH (AteItCmpyal/IIJl, 6epe.ueHHocmb)
nOllll3l€ello:
! HaCnC.llCTBeHHblH .llCcpHUHT IJJH6pHHoreHa
! rIe.,eHO<JHO-KJlCTO<JHa1l He.llOCTaTO<JHOCTb (lJUPP03 llelieHU, ocmpaR
:HCeJlmaR oue/cjJWl, ompalL7ellue zenamompolll/blAtU ROaMU)
! nOBblweHH nOTpe6neHHe cpH6pHHoreHa (JJBC-eUItOpOM, co-
emORHlIe nOClle Kp060me'leHWl, mpa6J.fbl, o:HCoza)
! nOpa)f(eHHe KOCTHoro M03ra (JleUK03bl, A,emaema3bl onyxoJleu)
! WOKOBble COCT01IHH1I
! KaxeKclUI. llHHra
! ,ABC-CHlU1pOM (n03oltue cmaouu)
! TJI)f(enblH TOKCHK03 6epeMeHHbix
! .lleHCTBHe TpoM60nnacTH<JccKHX BeU(eCTB (3MeUltblU YKYc, 3.w60JlWl
oKo.70nllOOlfblAfU 600(UfU)
! .lleifcTBHe HeKoTopblX nCKapCTBeHHbIx Cpe.llCTB (cjJeH06ap6umaJl,
ypoKuHa3a, empenmoKuHa3a)
f1>H6pHItOreH A - cpaKTop I CBCpTbIBaHH1I KpOBH, Bblpa6aTblBaCT-
C1I rIapellXHMaT03HbiMII KJlCTKaMH rIe<JeHH (2-5 r/cyr). nO.ll .lleHCTBH-
CM TpoM6HHa npeBpaU(aCTC1I B HepaCTBopHMblH 6enoK - cpH6pHH. oc-
HOBHOH cy6c-rpaT TpoM6a. KpoBoTe<JeHIUI npH rHrIocpH6pHHoreHeMHH
I!H)f(e I r/n HHOr.lla 06ycJloBneHbi TOJlbKO He.l{OCTaTKOM ctIH6pHHoreHa.
MaTepHaJi .llnR HCCJleJl,OBaHHR. I..{HTpaTHWI nna3Ma.
4IM6PMHOnMTMECKAR AKTMBHOCTb
(cnoHT8HHLlH 3yrno6ynHHoBblH 4»HfipHHOJlH3)
12.....240 MHH
YO/lUHeHUe .puce,," (tjJU6pUHtJ/IU YZHemeH):
i rHrIO-, annaCTH<JeCKHe rIpoeccbI KpoBCTBopeHIUI
i reMOpparH.,ecKHH BacKynHT
i TpoM603
52

COI<jJQU(eHue BpeMeHU (t/JU6PUHOJlU:l QKmUBUpOBQH):
! ,lU3C-CHH.l1pOM
! nC'ICHO'IHO-KnCTO'maH HC.nOCTaTO'lHOCTb (l/UPP03 ne'lellll, oem paR
:JICe.nmllll oucmpoq;Wl)
! xHpyprn'lccKHC BMC11IarenbCTBa (Ha opzallOX, 60zambiX mpoJ,f6o-
KUHa30U, - JleZKUe, ftf032, .PoIamKa, npocmama)
! aKymcpcKHe ocnmKHCHHH
! 11I0K, CTpCCCOBbJC COCTOHHHH, rHnOKCHH. aLlH.n03, clJH3H'ICCKHC Ha-
rpY3KH
C])H6pHHOJlUTHIJeCK8H 8KTHBHOCTb nJl83Mbl, OCB060>K.llCHHOH
OT HHrH6HTopOB, - BpCMH. Hc06xo.llHMOe JI)IH nonHoro paCTBopCIIHJI
crycTKa. YCTaHOBJ1CHHOe no nH3HCY 3yrn06ynHHoBoH clJpaKLlHH.
3yrn06ynHHoBM clJpaKLlHH nonyqacTcH nyrcM LlCHTpHclJyrHpoBa-
HIDI LlHTpaTHOH nn33Mbl H CO.nCp)l{HT clJH6pHHorCH, nn33MHHoreH,
Dn33MHH, npoTpoM6HH H .npyrHc $aKTOpbl CBcpTblBalOll!CH CHCTCMbl.
BpCMH clJH6pHHonH3a 3aBHCHT OT KOnH'ICCTBa clJH6pHHorCHa,
Dn33MHHa, aKTHBaTOpOB nn33MHHoreHa.
m CrpelITOKHH8JO:J8BHCll\lblH nH:JHC 3yrno6ynHHoBol"O CI)'CTK8 (5-13 MHH) -
nH:JHC 3yrn06ymtHoBOH cl>P8KUIIH nRa:JMbI npH n06aeneHHH cTpcnToKHH83LI. Onpenc-
JIJleT ypoBCHb nna:JMMlloreHa.
YlIJIlIlICHHC BpCMCIIII- YMCHbWCHHC ypOBHJI nna:JMIIIIOI"CHa.
M8TepHaJI AJiH HCCJle.llOB8HHH. I..{HTpaTHaH nn33Ma.
G)6PHHA3A (G)AKTOP XIII)
SIOO c
7130 %
Y8eJlUIleHO (CHU:JKeHUe aKmUBlIocmu):
f BpO>K.llCHHblH .llCclJHLlHT clJaKTopa XIII (6o.1e3l1b JJalw-JJopal/a)
f 3a60nCBaHHJI netICHH (zenamum, l/Upp03)
f paK C MCTaCT33aMH B nCtICHb
f ,[{BC-CHH.llpOM
f nytICBM 60nC3Hb, ccnCHc, TH>KCnbIC oncpaLlHH
f MHCn0J1CHK03
YMeliblUeliO (n06bllUellue QKmU6110cmu):
! 60nbWOH 06'bCM nn33MOTpaHcclJY3HH
C])H6pHH83a - clJaKTOp XIII, clJCPMCHT, npHHHMalOll!HH ytIaCTHC B
06pa30BaHHH $H6pHHOBOro crycTKa. AKTHBHOCTb 4>H6pHHa3bJ onpc-
.nCJUlCTCH BpCMCHCM nH3Hca 4>H6pHHoBoro crycTKa OKC8..I1aTOM MOtIC-
BHHbl npH .n06aBncHHH MOHOHO.n.OYKCYCHOH KHcnOTbl.
M8TepHaJI JI,JIH HCCJle.n.oB8HHH. I..{HTpaTHM nn33Ma.
53

PETPAKUMs:I KPOmIHorO CryCTKA
4S%
nOBbllUeHO:
j nmCpclJu6pHilorCIICMHJI
j aHCMHR
llollu:HCello:
! TpOM60UHTOnCHHR
! 3pHTpCMHJI, YBCmf'lCIUfC rCMaTOKpHTa
! 6oJIc3Hb BCpJIbroljla
! rCMOpparH'leCKaR 8JlCHKHJI <J>paHKa
Pe-rpBKQHR KpOBHllOrO CI)'Cnc8 - 6HOnOrH'lCCKHH npouccc. CO-
CTOJllUHH H3 ynnoTHcHHR IIIITCH clJH6puila C nOCnC.lI)'lOlUliM 01?K8THCM
CbIBOpOTKH. CTCnCHb pCTpaKUHH Bblpa)!(aCTCR OTIIOIllCHUCM 06"bCMa
BblCn"BIllCHCR CblBOpOTKH K 06"bCMY B3J1TOH KpOBH:
no Ea.rryc - B np06upKC - 45 - 65 %;
no TOKallTHHcy - 78 %;
MHKpOMCTO - 77 %.
MaTepH8J1 JlR HCCJlC.ltOBaHHR. BCH03HaR KpOBL.
npO.QYKTbl.QErpAAAL\........ Q)....6P....HOrEHA (n,QCII)
110 S M..ln
0611apY:HCUBalOnlCR:
j J{BC- CHI -I.l1pOM
j MaCCUBHblH TpoM603
j ncro'lHaJi 3M60nHR, HllclJaplCT MHOKap.lta
j 3nOKa'lCCTBCHHble HOBo06pa30BallHR, neHK03bl
T nOIJC'lllaJl HC.llOCTaTO'lHOCTb
T nocnconcpaUHotfllblH nCpHO.l1
j nC'lCIIHC clJu6pHHOmITU'leCKHMH CpC.l1CTBaMH (empellm01<LlHa3a.
ypoKlIHa3a. aKm1l8amopbl II,7a3.,uuHOZelta)
j 3a6oncnaHHR nC'lCIiH
npOlQ'h.'TLI }J,CI]>M3QHH c!1II6plUlorclI3 (clJparMCHTbI D. E, X, Y;
PKM<J> - pacTBopuMblC KOMIUlCKCbI MOHOMepoB 4>u6pHlla; clJH6pHHO-
rCH B - KOMnnCKCbl clJHoPUlI-MOHOMcpa C cpH6pHliOrelloM) - BCIl.lCCTBa,
06pa3}'1OlUHccJI B opraHH3MC npH aJ\"TIfBalUtH CHCTeMbl IjJH6pHllonHJa.
W napaKoarynllUHolIHwe TeCTW (OTpHUaTeJlLHwe) - 3TalionOBblii, npOTaMHH-
cynblfJaTHblil, -HaIfJTonoBblii II .np. IIB.'IIIIOTCII nonYKOnH'leCTBCHllblMIl MeTo.aaMM onpe-
nenellllll nponYKTOB net"pll.l1ftUllll c}lII6pHHoreH8.
M8np"aJi JJ.JlR IICCJ.eJJ.OB8HHR. CBC>KaJI CblBopoTKa C 06aBJIe-
HIiJiMIf HHruOHTOpoB c1JH6pHHonHJa ('rpoM6HH, TpacHnon H .l1p.).
54

TonEPAHTHOCTb nnA3Mbl K rEnAPMHY
6-13 MHH
l106h1UleUQ (Jueuee 6 MUH):
t Jl.ecpm..tHT aHTIITpoM6HHa III
t CKJIOHHOCTb K TpoM603aM
T ccpJl.etUlaJI HeJJ.OCTaTO'iHOCTb
t nocneOnCpal.tHOHllblH nepHOJJ.
TOJlCpallTHOCTb nJla3Mbi K renapHHY - BpeMJI peKaJIbl.tHcpHKa-
l.tHH nna3Mbi npH JJ.o6aBneHHH He60nbWHX JJ.03 renapHHa.
MaTepH8JI AllII HCCJ1eOBaHHIl. UHTpaTHaJI nn83Ma.
CB060AHblH rEnAPMH
8-12 c
Y6i!.flUllello:
t aHacpHJJaKTHtICCKHH, nOCrrpaHCcpY3HOHHblH WOK
t JJ.IICPCP}'3HbIC 6one3HH COe.n:HHHTem,HOH TKaHH
t neHK03Ll
t n)"lCBaJI 6one3Hb
reOapHH (heparinum) - nOJIHcaxapHJI:, CHHTe3HpyeMblH T)'tIHblMH
KJICTKaMH, eCTCCTBCHHLlH npoTHBOCBepTbiBaJOll.tHH cpaKTOp KpOBH,
TOpM03JIl.I.lHH npeBpalL{eHHe npo-rpoM6HHa B TpoM6HH, cpH6pHHoreHa
B cpH6pHH H YMCHbwalOl.I.IHH aKTHBHOCTb TpoM6HHa.
BpeMII HHrH6HpoBaHHil aKTHBHOCTH cB060Alloro renapHHa
onpe.n:CJUleTCJI H3MeHCHHeM TpOM6uIIOBOro BpeMeHH npH JJ.06aBJJeHHH
TonYH.n:HHOBoro CHHcro.
MaTepHaJl Mil HCCJ1CAOBaHHII. UHTpaTHaJI nna3Ma.
H0661U1eH:
t BHPYCHLdi renaTHT
t npHMelleHHe aHa6onH'ieCKHX npenapaTOB
t HaKonneHHe n..Q<I> - mrrOJIOm'lCCKHX aHTHTpOM6HHOB
HOHU3IN!H:
! Hacnc.n:CTBeHHLle B03BpaTHLIC TpoM6o:n..r6oJIJIH
! ..QBC-CHH.n:POM, Koarynomnwi nOTpc6ncIIHJI
! 6onC3HH netICHH
! caxapHLlH Jl.Ha6er
AHTMTPOM6MH III (AT III)
75-125 %
0,3-0,42 ./n
55

! OCTpblH nallKpCaTHT
! nocnCOnCpaLlHOllllblH nCpHOlt
! BTOpaJi nOnOBlflla 6CpCMCIIIIOCTH, pOltbl, nOCnCpOltOBblH nCpHOlt
! npOltOJ1>KHTCnbHOC npllMCHCIIHC KOpTHKOCTCpOllltOB, nCpOpaJIbHblX
npOTHB03aqaTOtHlbiX CpCltCTB
! nCQCIIHC 60nblUHMH JI03aMH rCnapHlla
AHTHTpOJ\l6HH III - <X2-rn06YJ1HII, CHIITC3HPYCMblH B 31f,lJ.OTCnHH
H KnCTKaX nCQCIIII, OCIIOBHOH nm13MCHHbIH Ko<l>aKTOp renapHHa, HH-
rH6HTOp CCpHIIOBblX npOTCa3.
AKTHBIIOCTb 811THTpOM6Hlla III onpCltCnJlCTCJI BpcMcHeM CBCp-
TblBallliJi <l>H6pllHorclla npH CMCWHBallHH ltc<l>H6pHHHpoBa1lHoH
nna3Mbi co CTaHllapTHblM KOnH.,CCTBOM TpoM6Hlla.
MaTepllaJIlt.lJH IICCJleJJ.OB8I1HH. I..brrpaTHaJi nna3Ma.
npOTEHH C
OKono 1 fllrln
llOHU:HCeHO:
! TpoM603M60J1I1I1,TpoM60<l>nc6HTM
! 3a60nCBallllJl nC.,CHII (8l1pyeHblu zenanrllm, l/Upp03 nelieHu)
! nC<JCIIHC aHTarOHHCTaMH BHTaMHlla K
! .l{BC-CHHllpOM, KoarynonaTHJI nOTpc6ncHHJI
! OCTpblC ndiK03b1
! caxapHblH ltlla6eT
npOTel1H C - rnHKonpoTcHH, BHTaMHH K-3aBHCHMaJi npOTc83a,
HHaKTHBHpYCT <l>aKTOpbl Va H VIIl:Ka, pacmcnJUlJl HX.
MaTepH8J1 JJ.nH HCCJleJJ.OB8HHH. UIiTpaTllaJi nna3Ma.
HHCTPYMEHTAnbHblE METOAbi
.l{nJi ItCCnCltOBaHIiJi CBcpTblBalOll.(cH CIICTCMbl KpOBH npliMcIDIIOT
TpoM603naCTorpa<l>bI H KoarynorpacPbl.
Hcnonb30BallHc npH60poB, perHcTpllpYIOIl.(HX npoLlcccbl reMO-
KoarynJlLlI1H, n03B0J1J1eT 3Ha<JHTcnbHO YMCllbWHTb oWH6KH, B03HH-
KalOll.(HC npH ltPymx MeTOltax HCCJ1CltOBaHHJI.
TpoM603nacTorpa4>MR
TpOM603J18CTOI"patIJHH - OCHOBalla Ha rpa<l>HQCCKOH pemcTpa-
Lllllt H3MCHCIIHH BJl3KOCTH B <l>H6pHH-TpoM60LlHTapHOH CTpYKTYPc
KpOBH, npoHcXOlUlILlCH B npoLlcccC ec CBCpTbIBaHIIJI.
TpOFItfi03J18CTOrp8MflI8 (PHC. 8) OTpIDKaCT TpH <l>a3b1 CBCpTblBa-
tntJl KpOBII:
56

I clJaJa - R (4-10 MUll) - BpCMJI peaKUHH (06pa30Ba1lHC TpoM60-
KHlla3bl), XapaKTeplf3YCTCJI OTpC3KOM npJlMOH OT Ha<JaJIa 3anUCU .nO
paCWHpCHUJI B I MM;
R
PlfC 8. TpoM603nacTorpaMMa

'It:
1
PMC. 9. KoarynorpaMM8
II clJaJa - K (5-8 MUH) - BpCMJI 06pa30Ba1lHJI crycTKa (CKOpOCTb
06pa30BamlJl TpoM6HHa), onpc.ncnJlCTCJI no paCCTOJlHHIO OT paCWH-
pCnHJI KpHBOH B I MM.nO pacWHpCIIHJI B 20 Mill;
III clJaJa - 06pa30BaHHC )H6pmla. xapaKTCpH3YCTCJI lIIaKCHMaJIbHOH
atrulHl)'.nOH KpIfBOH - M A (46--66 MM). oTpIDKae-r «I>ynKUHOnaJIbH)'lO
cnoc06HOCTb TpOM60lUffoB, KOnH.,CCTBO H Ka<JCCTBO «I>H6pHHorcHa.
MaKCHMaJIbHaJI 3naClll.,HOCTb cryCTKa - E (80 - 180) paCC<JHTbiBaeTCJI
no «I>opM)'nc
E - lOOxM A
JOO-M A
runepl<oaZY_1RI(UR - YKOPO"ICHHC R. K H YBcnH<JCHHC M A .
runol<oaYJlRI(UR - Y.lJ.1IHHCHHC R. K H YMCHbWCHHC M A .
Koarynorpa4>MR
K081")'JlOrpacIJHH - pcrHCTpauml H3MCnCHHJI 3nClITponpOBo.nHO-
CTH KpOBH B npoucccc ce CBcpTblBaHHJI.
KoarYJlOrpaMMa (pHC. 9) pcrHcTpHpye-r:
57

lIa1JaJIO npOl.lCCCa CSepTbJBaHHJI !CpOBH T, (100-280 c); KOHCQ
npoecca CBCpTblSaHHJI KpoBH T 2 (320--600 c); CKOpocTb CBCpTbIBa-
IIHJI Ha I-H MHHyrC VI (0.2-1,3), Ha 2-H MHHyre V 2 (0,3-1,2), Ha
3-H MHHyre V 3 (0, I-I ,0); Ha'iaJIO peTpaKLlHH H qm6pHHonH3a
T3 (360-780 c); CKOpOCTb pCTpaKLlHH H I}>H6pmlOnH3a 3a 5 MHH
V p (0,01-0,06); IU1OTHOCTb cryCTKa no MHIUlMaJIbHOH ar.mnHTyAc
Ao (0,1-0,7), no aMnmrl)'Ac 'lepC3 10 MHHyr nocne Ha'iaJIa pCTpaK-
ltHH H I}>H6pHIIOnH3a AP<b (0,3-1,1); BCnHqHHY rCMaToKpHTa no MaK-
CHMaJIbHOH aMIU1HT)'AC AM (3,3-4, I).
no H3MCIICHHIO cfx>PMbr KoarynorpaMMbl MO>KHO CYAHTb 0 TOM,
KaKaH l}>a3a CBcpTblBaHHJI KpOBH HapymcHa.
OCHOBHblE nmbl KOArY110rPAMM
(no E.n.I1BaHoBY)
I-if THn - CHJDKCHHC aHTHKoarynHHTIlbJX CBOHCTB KpoBH - ncp-
BaJI HCACJUI nocnconepaLlHoHHoro ncpHoAa (OC06CHHO Y 60nbllblx
CTapmc 35 neT " C rHoHHo-CCnnl'fCCKJlMH ocnmKHcHiUlMH), Y HCKO-
TOpbJX pmKCHHlt, Y CTpa.z:taIOWHx I1EC, rnnCpTOHH'iCCKOH 60nc3HblO,
I}>nc60Tp0M6030M.
2-if THn - rnnepKoarynJlUHJI - npeATpOM603bl H pa3BHBWHCCJI
TpoM603bl (TpOM603M60nHH nCrO'fHOH aprepHH, OCTpLIH apTCpHaJIb-
HbIH TpoM603 HH>KHHX KOHCqHOCTCH, liHl}>apKT MHoKapAa), rHncpKoa-
ryJIJILlHOHllaJlI}>a3a .l1:BC-cHH.ztpoMa.
3-ii THn - pC3KaJI AcnpcccHJI I}>H6pHHonJf3a H pa3BHBalOlI.{aJlCJI
TpOM60HCMHH lIa I}>OIlC rHncpl}>H6pHHorcHcMHH.
4-n THn - rnncpKoarynJlltHOHHaJI $a3a .l1:BC-CHH.L\pOMa C npH3Ha-
KaMH rnnepKoaryJIJILlHH B I «p3.3c.
5-ii THn - OCTpaJI npH06peTCHHaJI rnnO<lJH6pmlOreHCMHJI C non-
IILIM pacCTpoHCTBOM 1}>3.3 CBepThIBalutJl ITpH .l1:BC-CHH.L\POMC.
6-ii THn - rnnoKoarynHltHJI - rCMol}>HnIDI, COCTOJIHIDI, npH KOTO-
pblX BCAeTCJI nC<JCHHC rcnapHHoM B J10CTaTOqHbIX A03ax.
7-ii THn - Bpo)fQJ,CHHbIH HCJ10CTaTOK l}>aKTOpOB CBCpTblBallHJI II,
V, VII HJIH X C napCHXJlMaT03HbiM nopIDKcHHCM nC'lCHH, K-
rHnoBHTaMHH03, nCQCHHC HCnpJlMblMH aHTHKoarymIHTaMH.
8-ii THn - rHnoKoarynJlLlHJI C pC3KOH aKTHBaLlHCH f}>H6pHHonH-
3a (6onc3HH KpOBH, mOK, nCQCHHc I}>H6pHHOnHTHQCCKHMH npcna-
paTaMH).
9.ii THn - rHnoKoarynJlQIDI BCJJCACTBHC HapYWCHIDI pCTpaKLlHH
cryCTKa H3-3a CHH>KCHHJI B HCM KOnH1JCCTBa TpoM60ltHTOB HJ1H HX
«PYHKltHOHaJJbHOH HCnOnHOI.{CHHOCTH - TpoM6oLlHTonCHHH (60nC3Hb
KIIH CHH,apoM Bcpnbrol}>a) H TpoM6oLtHTonaTHH (THna TpOM6aCTCIIHH
rnaHI.{MaHa) Bpo)fQJ,CHHbJC H npH06pc-reHHblc (ypCMHQCCKHC, npH 6o
nC3ID1X nC'lCHH, KpoBH, paKC H J1p.)
58

nOKa1aTenH OCHOBHblX THnOB KOaryJlOrpaM1l1 (no E. n. "B8HORY)
T CCTW
9-1
Bpe.." CIICpTIoUIIII'"JI KpOIII'
(no nH-Yaiity). ...""
II HCCMnllKOIIOIlOil npo-
611pKe S-1 4 3 6 5 14 35 9 5 8
II CIlJUIKOHOIIC" I1pOOllpKe 15-25 5 4 12 (, 32 85 18 14 19
A'lTB (!CIOnIlN-
Kecj!anHHolloc llpeM"). C 35-45 21 20 40 30 fi() 58 52 38 32
Ayro"oarynOl'Pa"M8. c:
Ha 6-" "HHyre &-14 9 7 9 8 14 26 14 12 II
H8 8-iI _Hyre 1-11 6 6 9 1 13 23 10 9 8
Ha 10-" ""Hyre 1-10 5 6 8 1 12 21 10 8 8
npOYpO..6HHOlllolii Hl\.!1eKC 0.8-1,1 0.85 1.0 0.85 0.1 0.6 0,85 0.35 0.85 0.8
<1>1I6pllHorcH A. rln 2-4 1.8 2.2 3.8 1.2 005 2.5 2.8 3.2 3.6
<1>M61'1II10'-':N B ++ +++ + +++ ++++
TpoM6MHOBOe lII'e..". C 10-20 10 8 15 II 25 18 19 20 17
AHTIITpO..6.111 111. C 19-69 14 12 6.! 18 10 50 55 68 52
ToncpaHTIlOCYIo 'ma:J>llol K
renapHHY, MHH 6-13 6 3 12 10 30 35 11 15 18
CIIOIrr8HllloIii cj!1I6pIlIlOJlH % 10--20 12 0 2 28 8 12 16 65 10
<bU6pltHOflIlTII'IecK8J1 iUCTIIB-
HOCTb. "1M" 120--240 170 450 600 140 400 200 140 40 156
<1>1I6pHHaJa, C 50-100 85 140 80 55 45 30 55 45 40
PetpalCUIIJI crycnca. % 45-6S 6S 85 15 70 S5 6S 60 58 25
reM8Toq)OlT. % 36-48 48 50 43 35 30 40 30 40 38
npcmllolHHOBU npo6a + ++
3nulOnOBall Ilpo6a ++
npll'le'lalllle. <1>1161"11101-':11 B (II IlPYu,c I1Jl<1» olll'c.ncnJllOrCJI 110.1) KOJU''ICCTBCHIlIoIMH
MeTO".'13.I\III. pcJynbTarLi KOI0pblX 0601H8 1 1a1OTca 4':+».
CCI1EAOBAHE MO'-l
1\10"18 (urina) - 6HOnOr1t'leCKa» >l<U,u,KOCTh, B COCTaBe KOTOpOM 113
OpraHH3Ma BbIBO,u,JlTCJI KOHe'lHblC npO,u,YKTbl 06Mel1a BeIl.lCCTB_ M01.la
o6pa3yeTcJI nyTeM 4>HnbTpaUHH nna'3MbJ KpOBlf B nOI.{C'IHbTX Kny6o'l-
Kax II OOpaTHOrO BcaCblBaHIIJI 60nbUJIII1CTBa paCTBOpeHHblX B IICM
BCll1eCTB II BOll.bJ B KaHaJ1bU8X.
aJ COCTaR "0'111 "O)l(CT ..ellJITbCIi B 3aB.iCIIMOCTII OT BbmMToii )l(1ID,KOCTK II ynorpe6-
!1"eMOIt nlllllll, aT lj>'I1"'IeCKO"O II HepBHD-nCIIXII'IecKoro COCTO"IIII".
M8Tep1t8J1 UJIH HCCJ1eUOB8ItMIl. Moqa Y'l'ellHcro c6opa.
59

<<P1013Io1KO-XIo1MIo1LJECKAfI XAPAKTEPIo1CTIo1KA
DOK8UTeJJb HOpMllJlbHblC 3H8'1CHHR
KOnH'ICCTBO MO'I11 B CyrKH, MJI ...........................,.................... 800-1500
OTHOClfTCnbHali nnOTHOCTb B yrpClIIlCH nopUMH, rln ............. 1015-1025
Lloer ......................................................................................... ConOMCHHD-JKenTblH
Dp03pa'lHOCTb .......................................................................... npo3pa'iliall
PeaKUltli .................................................................................... HCHrp3nbHOli
HJlH cna60KllcnaJI
6enoK, r/cyr .,........................................................................... OTcyrCTByer
MnM CnCltbl (O,025-O,1)
Caxap, rln ................................................................................. OTcyrCToyer
IInM cnCltbi (O,03-O,05)
KCTOIiOBblC Tena, Mr/cyr .......................................................... OrCyrCTBYIOT (<SO)
nHrMcuTHblC Tens. Mr/cyr ....................................................... OrCyrcTBYIOT «6)
BCUlccTBa 330THCTOro 06McHa, MMonwcyr: ........................... 400-1200
MO'lCBHII3, r/cyr .................................................................... 20--35
MO'lCBali KHcnOT3, r/cyr ....................................................... 0.27-0,80
KpcaTHHHlI, r/cyr:
Mil MYJK'IHH ...................................................................... 1-2
Mil JKCHUlIIII ...................................................................... 0.5-1.6
KpcaTHIi. r/cyr ...................................................................... OrcyrcTByer
HHltHKaH. MKMomJcyr .......................................................... 40--60
aMMllaK, r/cyr .......................................................................0.6-1,3
KOIWNECTBO MOYM B CYTKM
800-1500 MJI
,ZJ:nype3 (diuresis) - Bbl.l(CneHHC MO'JH 3a e.nHHHl()' BpeMCHH. Pa3JIH-
'JalOT CyrO'JHbIH .nH)'pC3, .nHCBHOH (c 9.00.n0 21.00), HO<lHOH (c 21.00
.no 9.00 yrpa), 'JaCOBOH H T..n. OrnollicHHe AHCBHOrO .nH)'pe3a K HO<JHO-
MY paBHo 3 : I. Konu<JccTBO MOtIU B yrpeHHCH nopUUH B HopMe 100-
300 MJI.
l106bllUeno - 60Jlee 1800 Mll/cym (noJluYPuJI -polyuria):
f ynOl-pe6neHHc 6onbllloro KonH<JCCTBa )l(H,L(KOCTH (Hep6Hoe 6036y-
3ICoeHue, 3a60.7eeaHUR zunomaJ/lUtyca)
f OCMOTH<JCCKIDI nonHypHJI (eaxapHblu oua6em, u36btnlOliHOe no-
mpe6JleHUe co.1eu HampuR, lUIUHOKUCJlOm, Z/lIOK03bl, .MO'le6U1tbl, .uaH-
numO,"la, napeHmepaJ/bHoe numaHue, XpOHU'IeCKQJl nO'le'lHQJl Heooc-
mamO'lHOcmb)
f HecaxapHblH ,nHa6eT blemnpaJ/bHblu - 3a6011e6a1lUR zunorjJU3a,
netjJpozellHblli - 3a6011e8aHuR nO'leK) .
f HccpponaTHJI (noCJle lIapK03a, 8mOPQJl nOJl06UlIa 6epeJIlellllOCmu,
nOCJle MeHempYal-/uu, nep8U'IHblU aJ/boocmepOHU3."" zunepnapamupe-
OOU3At)
t B nepHO.n CXO)l(l(eHHJI OTeKOB (ocmpblu nUeJlOHefjJpum, XpOHU'Ie-
CKQJl nO'le'lHQJl HeoOemamO'lJIOCmb)
60

f npHCM ,ZmypCTHKOB
f aMHJIOH.l103. CapKOH.l103. MHCnOMHa" 60JIC3Hb
f CTCH03 nO'iC'iHOH apTepHH. nCpCCa.llKa nO'iKH. .llHypeTH'ieCKaJI cfJa3a
oCTporo KanaJIbllCBOro HCKp03a
f pC3ynbTaT .llCHCTBH" HCKOTOpblX npCnapaTOB (KOcjJeUHa, npenapa-
m06 HanepemRHKli, 3maliO/la, Qlle'1UL1elL1Il11l,;7080ii KUeJlOmbl, /Iwmm,
zunoz,7I1Ke.UII3I1pYIOUIUX Ilpellapam06)
11011 U3ICeIlO - Mellee 500 JlulIcym (011 UZYpWI - oUg uria):
! cfJH3HonOrH'iCCKaJI (ozpaHUlieHUe numbe80ZO pe:JICUMa, 061UlbHoe
norneHue 8 :HCapK)l1O nozooy)
! 3a6onCBaHH" nO'iCK (IIecjJpumbl, HecjJp03bl, 80CnaJIUmeJlbllble npo-
lIeccbl 6 nO'lelilloii ,rapeIlXWtfe)
! nOBbzrnCHHa" nOTCp" >KH.llKOCTH (nOHoe, p60ma, Kp080nomepR,
06Ulupllble O:HCOZU, 06pa306alllle omeK06, mpae.Mbl :HCU80ma, KUUle'l-
HaR lIenpoxOOUMoemb U op.)
! .llCHCTBJIC HC$pOTOKCH'iCCKJlX BCu.tCCTB (e6UHlla, .MblUlbRKa. 6UC-
.Myrna, 3mU;7eIlZ.7UKO/IR, lleKapcm8eHllblX npenapam08)
! HapyrncHHc OTIOKa MO'iH ('1aCmUIJHaR 06mypaIJUJI MO'le6bl800R-
U/UX nymeii KaA",e.', onYXOllblO)
AIIYPUR - anuria - (nOlllloe npeKpaU(ellue 6bloeneHWI MOIIU):
x nO)fCHa" - 3KCKpeTOpHaJI (lIaJ1U'Iue npenRmcm6Wl K MO'leOmOe/le-
HUIO - 06mypaIJUR .\f0'le6bI600RU/UX nymeii KlL'I.",e,f. onYXOJlblO)
X HCTHHHaJI - CCKpCTopHa" (HapYUleHue AtO'Ie8blOeJlUme/lbllOii rpYHK-
IIUU nOlJeK - oempaR nO'lelillaR lIeOOemamOliHOemb. mJl:HCeJlble cjJop-
Jlfbl oempozo ZllO.\fepYllOllecjJpumaj
MIIIKr
80
70
60
50
40
30
20
10
o
MJ1
1200
1000
800
600
400
200
o
3 6 9 12 16 Bo3pacT
3 7 30 1
AHri
- MnlKr M8CCb1
-cyr<NHbIM AM}'P83
neT
Puc. 10. BLI,!!,eneHHe MO'iH B pB3JlH'iHlole B03paCTHbie
lIepHollbi
m HWYPIUI (ihuriB) - 33,nep*Ka BIol./I.eneHHJI MO'iH. Kor1l8 60nbHOH He B COCYOJlHHH
onopo*HHl'b MO'ieBOH nY3b1Pb. BClJIe'iaerCJI IIPH nOpBJl(eHHJlIl c:nHHHoro 1II03ra Y 6onb-
HIoIIl, H81l0nJlWHIlCli B 6c:cco3HBTenbHOM COCTOIIHHH.
61

HIlJo."1J'P IIR (nycturia) - npc06nan.aHHe HO'IIiO/'O IDtypC33 Ilan. JlHeBHbIM. lIa6nlOJl3e"R:1I
"pIt XPOHII'ICCKOii nO'le'lHoii Ite.lI.OCTaTO'IHOCTH II Hapywellllll cepne'luoii D.CllTeJtbllOCTH
nOJlna"HYPHR (pollskiuria) - Y'laeIlHC MO'lCIICnyCIC3HlI1I (cBb/We 6 pa] B CyrKM)
06b1'1llo CO'lCT3CTCli C nonHypHeii.
.lI.oJlaJo.'1I) pilI! (dolakiuria) - 'Iacrae MO'leHcnYCKallHC Man..,NH nOpUHJlMH.
.lI.H]),PHR (dysuria) - 06ee Ha]BaHHC pacCTpoiicTB MO'leHcnycKSHHJI; 6onc3Hell-
Hoe MO'lCllcnYCKSHHe, npH Bocna.IJCIIHII MO'lCBblBOJlJlHX nyreii.
Y B1pocJlOrO ].lIOpOBO/'O 'ICnOBCKa. HaXOJVIWC/"OCJI Ha 06b1'1HOM nMweBOM pCJKHMC.
Bo.na COCTaBnllCT 2/J MaCCbJ TCJJa. PerynllUHJI BOIDtOrO 06MeHa OCYCCTBJ1IICTCJI C no-
MOWblO aHTHlIHYpCTII'ICCKOro ropMoHa 3nCKTponHTIl0/'O OCTaBa. 6anaHc BOllbl B op/'a-
IIM]Ne (nOCTynnCHHC H BblBeD.eHIIC) COCTaBJlIICT 1.'>-3.0 n. BOJ13 nOCTynsCT c nHnCAI _
0.5-1.7 JI, C nHweii - 0,8-1,0 n. HCKoropoe KOnH'ICCTBO BO.lI.., 06pa3YCTCJI 311D.0/'eHHO. B
pc3ynbTaTc 6HOXHMH'ICCKMX npoLlcccoB. BblBOD.HTCJI BO.lla nO'IKaMH. KHWC'IHHKOM.
ncrKHMH, 'Iepe1 KOJK)'.
Cyro'lJ\blii lIllYpC1 Konc6ncTcli B npcD.cnsx HOpMb' H COCTaBnJlCT 60-80 % OT KO-
nH'ICCTB3 BblnHTOii JK11J1ICOCTH. nOlC8'18TenH 8b1J1CnCHHII MO'IH 8 pa1JlH'IHblC 801pacTllblC
ncpHOllbl npCD.CT8snCHbI Ha pllC. 10.
l10661U1ellQ -601lbUie /015 VII (zullepcmeuJ'PuR):
i npll HapaCTaHHH OTCKoa (oempblu 2/loMepYJlOHeppUm, He()ocma-
mO'IIlOCmb Kpo8006paU4eIlIlR)
i 60nbumc 3KcTpapCHaJIbHblC nOTcpH >KHllKOCTH (noHoc, p80ma,
Kp080nomepR, 06wupHble O:HC02U, 06pa308alllle omeK08, mpae.Mbl
:HCU60ma, KUWelillaJ/ lIenpOXO()ILlfoemb U op.)
i nOJlBnCHHC a MO'IC 6onbllJOro KOnH'ICCTBa rn1OK03bl, 6enK3, nc-
K3pCTB " HX MCTa6onHTOB (3,3o/C'O 6e/IKa 8 "'fOlie
n08bllllaem ee onllloellme.7bHYIO fI./IOmltoemb lIa
0,001 )
i npH BaenCHHH M3HHHTOJla HlIH nCKcTpafla,
peHTreHoKoHTp3CTIiblX BCmCCTB
i TOKCHK03 6epeMeHHbix
nOHUmellQ - MeUbUie /015 VII (<,unocmellY-
PUJI): t
! ocTpOC nOp8>KCHHe nO'le'lHbIX KaHaJIbLteB
! Hecax3pHblH nHa6eT
! XpOHH'ICCK8J1 nO'le'lH8JI HCll0CT3TO'lHOCTb
! 3J10K3'1CCTBCHH3J1 rHncpTCH3HJI
. ,
OTHOCHTEJ1bHMI nnOTHOCTb MOYH
(B YTPEHHEH nOPUHH)
1015-1025 rln
OTHOCHTenLH8R nnOTHOCTL MOIJH npo-
nOpLtHOHaJIbHa KOHlleHTp3UHH p8CTBOpCHHbiX B
HeH Bcw.eCTB (opraHH'ICCKHX coenHHcHHH H
PIIC. II. YpOMCTp 3neKTpOnHTOB) H OTp3>KaCT KOHlleHTpaUHOH-
62

HYIO cnoC06110CTh nO'JCK. Y 3)10pOBOrO 'JcnOBeKa OHa 3aBJlCJlT 01'
MHorux ycnoBUH. HO B OCHOBHOM 01' CyrO'JIIOro )1uypC3a - 'JCM BLllllC
)1UYPC3. TeM IIHJKC OTlIOCHTCnbH3J1 nnOTHOCTb MO'JH. KOTOpaJi H3MC-
pJlCTCJI C nOMOlUblO ypOMCTpa (PHC. II).
Q Y JlIOpOBbiX mOlleii cYMMa lIepBLlx lIBYX UII$p cyrO'lHOrO 1I11ypCJa It nocnellllllX
lIBYX UM$p OTIlOCIITCJILIIOii IIJIO"CIIOCTII IO'l1l 06b1'1lh) COCTdBnReT 30. HanpllMep. ecnH
CyrO'lHblii 1I11YPCJ -1100 Mn, OTIlOCllTenbllaR nnOTHOCTb - 1019 rln, TO
11 + 19 = 30.
m IbocTCIIYPIiR (isoslhenuria) - BbilieneHIlC MO'IIl C nOCTORHHblM JHa'lCHHCM OT1IOCH-
TcnbHoii IIJIOTHOCTII, paBllblMH 1I0KaJaTCJJRMH nnOTitOCTH 6eJ6eJIKOBOH 'IaCTIl 11J13J"bl
KpOBM (OTHocMTCnbllaR 1IJI0ruOCTb ncpBII.lltoii 1010'111 - 1010-1011 TIn) CBIIJtCTCnbc-rBY-
CT 0 nonHoii nOTCpe KOIlUClllpaUHOllltoii $YIIKUIIII nO'ICK.
!..tBET
COJIOI\ICIIIIO-JKeJIl blH
TeI\IIIO-iKe.rJTbIU - 60nblllaJi KOIIUCIITpaUHJI KpaCJllUHX BClUCCTB
(06pa306al/ue omeK06. I/ol/oe, p60ma, Kp060l/0mepR. 06UlUpl/ble
0:JIC02U. eepOelil/aR l/eooemW1l0'lllOemb).
CBeTJIO-iKeJnaH, BOJlHHUCTaH - MaJlaJi KOIIUCIITpaUHJI KpaCJllUUX
BCWCCTB (caxapl/blii. I/eeuxapl/blli ollCl6em).
TeMllo-6YPbIU - ypo6unUHorCII)'pHJI (2e.llIOYUmu'/eeKaR al/e.ll/UR).
qepublH - McnaHHH (,lIe,7QI/OeapKOMa), rCMorn06HUYPHJI (ocm-
paR 2e.lltORumU'IeeKaR I/O'/Ka).
I.(BeT "IIHBa" - 3eJICIlOBaTo-6YPblH - 6ltnuPy6HuypHJI, ypo6J1-
nHHorCHypHJI (napel/XUMam03lWR :JICe.ymyxa).
3CJICIlOBaTO-iKeJ1TbIU - 6wmpy6mtypHJI (.\lexaHIt'leeKaR :JICeJ/myxa).
KpaCHblH - MaKporCMarypHJI - CBC>KaJl KpOBb (nO'leliI/UR KO.'lItKa.
ltllljJapKm nO'/k'lt).
"l\1HCllbIX nO\IOeB" - MaKporCMaTypJlJl - H3MCHCllllaJi KpOHb
(ocmpblii HeljJpum).
l.(BeT 1\I0'lH 3aBHCHT 01' CO)1Cp)KaHHJI 8 lIeH nHrMCHTOB (ypOXPO-
Ma, yp06Hmma, nop<Jmpmta) H TCCHO CBJl3aH C ec nnOTHOCTblO. 011
U3MCHJlCTCJI npH npHcMc pa3JJH'JHblx BCWCCTB, B TOM 'Ulcnc H nCKap-
CTBCHHblX (,utl/donltpltl/a, pu60qHa8lil/a, .uemlt.yeI/080li el/llU, 1U1Il,e-
6blX I/pOOYKm06: C6e101bl, .UOpK06U u dp.)
np03PA\.fHOCTb
np03pa'iHaH
nOl\f)'TlICIIHe 06ycnOBJ1CHO 60nblllHM KOJIH'ICCTBOM nCHKOUHTOB,
6aKTCpUH. 3U1nCJIllaJlbHblX KJICTOK, cnn3H, Bbma)1CHI1CM B OCa)10K
COnCH.
63
-

PEAKL{S'I.PH
IleiiTp8J1bll8R IIJlII CJl860KHCJl8R
pH = 5,0... 7,0
n06blUIellue pH (pH> 7)
t MeTa60nH'ICCKHH 11 pCCnHpaTOpllblH aJlKaJlOJ
t nO'lC'illblH KallaJIbUCBblH aJlKaJl03
t 6aKTCpl1aJ1bHOC pa3JIO>KCHHC MO'iCBHllbl
t nocnc npHCMa nHiUH, npH BCrCTapHallCKOH ,llHeTC
t nmCpKaJlHCMHH
t XpOIlH'iCCKaH nO'iCllllaH IIC,llOCTaTO'lHOCTb
t 13 pC3ynbTaTc ,llCHCTBHJI UH'rpaTa HaTpHJI, 6HKap60llaTOB, a,llpClla-
nHHa,aJlb,llOCTCpOHa
Cllu:»cellue pH (pH < 5)
! MeTa60nH'iCCKHH H pccnHpaTopllblH aUM03
! ,llHeTa C BblCOKIfM cO,llCp>KaIlHCM MJlCHOrO 6cnKa
! rHnOKaJlHCMHH
! 06C3BO>KHBaHlfe
! nHXOpa,llKa
! caxapHblH ,llHa6eT
! B pC3ynbTaTc ,llCHCTBHH aCKop6HHOBOH KHcnOTbl, KOpTHKoTponHHa,
xnopH,lla aMMOJUlJI
PesKUIIR 1\10"111 (pH) 3aBHCHT OT KOnH'iCCTBa CB060,llllb1X BO,llO-
pO,llHblX IfOHOB H+, 06pa3YlOlUHxCJI 13 pC3ynbTaTc ,llHCCOUII3L\1111 opra-
HH'iCCKHX H HcOpraHH'iCCKIfX KHcnOT, KOTOpblC B03HHKalOT 130 BpCMJI
KaTa60JIH'iCCKHX npoucccOB B opraHH3Mc.
110Hbi H+ ,llHCTaJlbHOH '1aCTblO nO'lC'iHOrO KallaJIbua BbUICJIJlIOT-
CJI 13 MO'iY, r,llC B OCHOBHOM CBJl3b1BaIOTCH C 6y<!JCpllblMil oCllona-
HHJlMH, H TonbKO Hc60JIbWaJl HX 'iaCTb BbIBO,llHTCJI C MO'iOH 13 CBO-
60.llll0M BH,llC.
B 06b1'illbIX YCJIOBWIX MO'la cJIa60KHcmul. B 3aBHClfMOCTH OT PC>KH-
Ma nHTaIlHJI pH COCTaBJUJeT OT 4,0 ,llO 8,0. MJtCHaJI H 60raTaJI 6eJIKOM
,llHe-ra 06ycnaBnHBaeT KHcnylO peaKUHIO MO'iH, Bcre-rapHallcKWI - lUe-
nO'iHYIO.
113MCIICIIHJI pH MO'i1l 3aBHCHT OT pH KpOBH:
npH aLlH,l103aX MO'ia HMeeT KHcnylO pcaKLlHIO;
npH aJlKaJl03aX - lUeno'IHYIO.
PacXmKllCI1IIC :nHX nOKa3aTcncH npOHCXO,llHT npH XpOlllf'iCCKHX
nOpa>KCHHHX KaHaJlbUCB nO'lCK: 13 KpOBH Ha6JIIO,ll3CTCH nmcpxJIop-
HblH aUH,ll03, a peaKLlHH MO'i1f lUCJIO'iH3JI.
CCKpCUIfH 1f0HOO H <!JHJlfOnOnl'iCCKH, ,llnH 1I0ltllCp>KallHH HOHHO-
ro paBIIOBCCHJI, YBCJIH'iHBaCTCH npH rHI10KaJlHCMHH.
64

6EflOK
OTCYTCTBYCT UJIU CJlC.abl
(0,025-0,1 '-/CYT)
flpOmeUH)'PUR roteilZuria:
1 <l>H3I1onOrH'ICCKaR (opmoemamUlieCKGR, lZepeoxJ7a:HCiJelllle. nOc.1e
1108blWe1l1wii qIll311'leeKOllllazPY3Kll)
1 KJIy6o<JKoBaR (Z70./epy.70lle1}pllm, iJeiiem6ue umjJeKljllOllllblX II aJ1-
llepc'll'leeKliX fjJaKn1Op06, ZlinepmOIll(.teeKaJl 6o.W311b, i)eKOt1lellealjllR
cepiJelilloii iJeRme.1bIlOCI1l11)
1 KaHaJIbL{eBaR (a.U1L10uiJ03, oempblii KaHClllblje6blii lteKp03, llHmep-
cmUlllla.1bllblii lIefjJpllm, ell1lfJpo.f (/JaIlKOllll)
1 npepeHaJIbHaR lUlIe.70.,maR 60.e3Hb, lIeKpO.1 _Hblwe'i1lOii mKaHlI,
Ze.M0J1U1 3pumpOllllm06)
1 nOCTpeHaJIbHaR (npllljllCmllmax, ypempllma.t, KO_blZllmax)
W B nO'lC'IlIhlX KJly60'lKaX 3a cYTlm IjJHm,I1'yeTCJI OKono 5 r 6cnKa, rnaBHblM 06pa-
30M - 8nb6YMIIHa. 6naroJlapJl BblCOKOii pea6cop6UIIII. 60nce 99 % em BII081> nocryna-
eT B Kp08b, C MO'loii ya3nJleTCJI MeHee 100 MI-tcyr. TaKlle Koml'lCCTB3 IIC 06H3PY)l(II-
U310TCJI npll IICnOJlb30B3HIIII MeTO..'lOB, IIpaKTlIKyeMbix B HaCTOJIlUeC BpeMJI Jl360pa-
TOpllOii 11M3moCTIIKoii. .lLnJl 1jJ1I3110nOrll'leCKOii npoTcHllypHl1 X3paKTepil0 COACp)l(3Hlle
6enK3 IIIl)I(e, '1eM 0,3 rln.
npH nOBblllleHOM COACp)l(3HHM 6enK3 B MO'IC H>BOpJlT 0 n3ronorH'ICCKoii npOTCIlIlY-
pHil, KOTOp8JIIIO npCMMYIUCCTBClIIlOMY McxaHII3MY B01111tKHOBCHHJI n0.l\Pa:menJleTCJI Ha:
KJJ'60'lKOBYIO - CBJl3allllYIO C nOBblWCIIHOii IIpOHHU3eMOCTbIO nO'lC'IHblX KJlY-
60'IKOB. 06H3pY)l(CHile 6enKOB C OTHOCMTenbllO 6onbUloii MoncKynJlpHOii M3CCOH CBH-
ACTenbCTByeT 06 OTCyrCTBHH 113611p3TcnbliocTII nO'le'lHOrO IjJMnbTp3 II BbIp3)1(ellliOM
ero 1I0paJKellllll;
K8H8J1L1tCBYIO - cBJI'.IallllYIO C IIccnoco6110CTbIO K3118nbUeB pe36cop611pOBaTb
6cnKII, npoUieAwllc '1CpC3 HCM.lMClleHllbIH rno\lepynJlpllblH IjJllnb"l1':
npCpCH8JILHYlO - CBJlJ3HHYlO C YCllneHlIl>lM paCII3lJ,OM 6eJlK3 TK3tlCii, liP" BbICO-
Koii KOilUCHTpaUMIIII1I3KoMoncKynJlpllom6cnKa B l1a3MC (6cnoK 6CHC-.Ll)l(OIlC3. MMor-
n06II11, I cMonI061111);
noc"I]JcH3J1bHYIO - IIpll nOpa)l(CIIIIII MO'ICBbIBOlJ,JlIUIIX IIYTCH II nonOBblX opr3HoB.
npOTel1l1YPIlJl JlB'IJlCTCJI '13CTbIM HCCllcUlI(j)l!'1ecKIIM CIIMnTOMOM 113TOJI0I Mil 110-
'1CK. P33J!II'I31OT tlCM3CCIIBHYlO (noTCpJllJ,O 3 r/cYT) H MaccMBHYIO (CBbIWC 3 r/cYT) IIpO-
TellllyplllO. npM nO'le'lHoii npOTcMHypMII 6enoK 06HapY)l(IIBaeTCJI K3K B J)HCBHOii. TaK II
HO'ItlOii MO'le.
IIpoTCHHYPHJI '1aCTO CO'lCT3eTCJI C UI1nllHlJ,ypMCii, 1pHTpOWlrypMCii. nciiKOUIITYPIICH.
EMOK ECHc-.llJl\OHCa - Hl1.1KoMoncKynJlpHblii 6cnoK, 0611ap}'JK1I83CTCR 8 MO'IC npM
3110Ka'lCCIUCIIHbIX H08006p330BallllJlX 8 cnY'Iac J)I1CIjJYIIKUMII j3-KJleTOK (MllenOMH3R
601le.lllb).
MHOI"'lo6ml'pHH -1I8n1l'llle MMorn061U13 B MO'IC - 8031111KaCT npll KOllltCHTp3UHH
cro 8 nJla3MC UbllllC 0,15 rln (lIaC1l',kmfleIlHh/e 3a{jo.'L'flUHIIR .IIbJ/U//. .IIbJlUe'<lIh/e HeKpO'
3'>1. mpafU'bJ .lIhllllI/. 'L'C cbllme.7hllaR IlUlellIlR. c)eucmfllle ompUfI.1HlOlqllX (1('IIIeCnrl1).
rCIUIJI061111)PHH - nOJlBnClIlIC B MO'IC C80601tHOrO rCMorno61ma 8 PC1YJlbTaTe
ero nOHbllllCHIIR B n1l31MC KpOBl1 J)O 1,2 rln (;>ello.lIl3 "3pUmpOIj/lllwfI).
65

CAXAP
\...
T:molw:JypUJI - glucosuria:
i <pH3l1onorH'lccKasl (npll empeccax, npllC.Ale n06blweHHbiX KOJ/Il-
'1Cem6 J!i'.,;1e60iJ06 Y RloiJeu nO:JIC11J1020 803paema)
i BHCnO'-lC'lHaR (eaxapllblli iJua6em, nallKpeamum, iJUrjJrjJY311ble no-
pa:JICellUJI ne'lel/u. paK noiJ:JICeJ/}liJOliIIOU :JICe1e3bl, 2unepmUpe(J3, 60-
J7e311b J1l1eIlKo-KYUlul/.!a, rjJCOXpo.MO'-lumoJlta, 2unepmupe03, aKpmle-
iYL1UR. '1epenI/0-.u03i'08ble mpmufbl. uHcYRbmbl, ompa611eHue OKel/()OJIJ
)'J1epoiJa, ,uoprjJue,\!, LWPO(POpJ\IOJ\/)
i pCHa.ru,lIaR (nO'lelil/bIU iJIla6em, XpOHUlieCKUe HerjJpumbl, ocmpQJl
llO'le'lIIQJl l/eOOC/1Jal1lO'lIIOC/1Jb, 6cpc,UeHifOC/1Jb, ompa6J1eHue rjJoerjJo-
PO,\!, l/eKOmOpbWU lleKapC1I16eHllblJlfU npenapamaMu)
r JIIOK033 - BClllCCTBO C BblCOKHM nO'IC'-IHbIM noporoM Bbl.L\CJIe-
UHR. nO'-lC'UlbIM nopor BblJJ.CJICHHR - KOHucHTpaUHR BCllleCTBa B KpO-
BH, npcBblllIclIHC KOTOpOM BC.nCT K npcKpallcHHIO cro pca6cop6UHH B
KaHanbuax.
OTCYTCT8YCT HJIH CJICJJ.bl
(0,03-0,05 r/n)
bJ rJlIOK03ypHH - YBenH'leHlle KOHueHTpaUMM rmOKOJbl B MO'le - npH:
rMI/CpJ"J/HKCMMM (1/0'lC'IlIbIH I/opor 8.8-9,9 MMomJn), KOTopali MO)l(eT OblTb CBIIJa-
IIa c paJJIM'IIIbIMMIj>HJMOnOnt'lCCKIIMM It IIal'OnOrM'IeCKltMH npoucccaMM;
npM IIOpMaJlbllOM ypOBIIC rmOKOJbl B KpOBM, '1TO CBIIJaHO C HapYlIIcHIICM pea6-
cop6uIIII rmOKOJbl B KallaJIbuaX nO'lKIi (1I0'/C'/Hblii oua6cm).
KETOHOBblE TEI1A
OTCYTCT8YlOT
(1\ICHbWC 50 I\n'/cYT)
KemOHJPUJI - ketonuria:
i caxapublM .L\Ha6CT (lIeKmmellellpo6aIlHblu)
i rHncpKCTOHCMH'-ICCKaR KOMa
i Hcc6anaHcBpoBaHHoc nHTaHBC (i'oJ/oiJaHue; iJuema, Hanpa6J7eI/HaR
Ha eHU:JICeHlle JltaCebl me,1Q; ynompe6J/eHue npeuMYUleem8eHHO 6CR-
K0801i U ,J/ClipHOU Illltl.lll; Ue1011O'ICHUe U3 numaHUR yo1e60iJ06)
i rHncpnpoJJ.YKUHR KOpTHKOCTCpOHJJ:OB (onyxoJ/b nepeiJHeu iJO:lU 2U-
norjJIl3a U;1U HaOnO'leliHUK06)
i 6onc3Hb rHpKe
i .nH3CHTCpHR, TOKCHK03bl B .nCTCKOM B03paCTC (a'-lenIOHe.MU'IeeKaR
p6oma)
KCTOHOBblC TCJI3 - npo.nYKTbl HcnonHoro OKHCJICHHR nHnHJOB H
6cnKoB. B COCTaB KCTOHOBblX TCJI BXO!VIT j3-oKcHMaCJIRHaR KIfCJ10Ta,
66

aLlCTOYKCYCHaH KHCnOTa H aLlCTOH. KCTOHOBbIC TCna CHHTC3Up)'JOTCH
B nC<ICHH.
OnpCD,CnClmC KCTOHOBblX TCJ1 Ba)l(HO npH CaXapHOM .n:Ha6cTC -
D,J1H D,HamOCTHKH MCTa60J1H'lCCKOH D,CKOMnCHCaLlHH, KOppCKIUtH JIHC-
TLI H MCD,HKaMCHT03HOH TCpanHH.
nHrMEHTHblE TEnA
OTCYTCTBYIOT
(McHce 6 I\lr/cYT)
IlOpt/JUPllllYPUJI - porphyrinuria:
t ncpBu<IHaH noplfJupHH - HaCnC;tCTBCHHaH (60Re31/b nOltmepa -
3pumpono:Jnlll'leck'aR nopqJllpUR, ne'leHO'IItaJ/ nop£jJupWl, ypoKonpo-
nop£jJupuR)
t BTopu<lIIaH noplfJupHH - CHMnTOMaTH'fCCKaH (alte,ILlU, UIt£jJapKm
,ltUOKapOa, pe8.MamU)JII, ompa8ReHue mOKCU'WeKUItU 6eUfecmHa.uu,
IluPp03 ne'lellu)
EUJIIlPy6unypuJI - bilirubinuria:
t nOBblUlcllliLIH pacna;t rCMorno6ulla (zeA-lO,mmU'IeeKaJl aHelllR, no-
llUllume,miR, paeeaebl6aHue AIQCCUHHbLX zeMamo,u)
t MCXaHU'lCCKaH )l(cnryxa, HHIfJCKLlUH 6UJ1UapHOH CUCTCMbl
t HapymcHHc IfJYHKLlHH nC'lCHU (6upyeHblu zenamum, XpOl/lilieCKUU
zenamum, IIUpp03 ne'leHu)
t B PC3YJ1LTaTC .n:CHCTBHH TOKCH'lCCKHX BClllCCTB (UJ1KO?01lR, opi!altu-
'1eCKUX eoeolmeHuu, UlI<f1eKlfU01tHbIX mOKeuHo6)
t BTOpH</liaH nC'lCI/O'lHaH Hc,nOCTaTO'lHOCTb (cepOe'lltaR Heooema-
mO'IIIOCl1lb, on)'xo.1u ne'le1/u)
1 YBCJ1H'lCHHC o6pa30nallHH CTcpKo6unmiorcHa B )l(CnYD,O'lHO-KU-
mC'll/OM TpaKTC (lL1el.lm, Ko,mm, 06empYKlfllJl KIIlUe'lIlUKa)
EUJ1HPy6HII (bilirubinum) - OCHOBHOH KOIIC'lIlLIH MCTa6oJ1lrr nop-
IfJ"pHIIOB, BblJ{CJlHCMblH H3 oprallH3Ma. Erumpy6uH B KpOBH (lla 3/4)
npHcYTcTBYCT B CBo6oD,IIOM BH,llC - IIcKollblOrHpoBallllLlH (B co-
C,llHHCHHH C aJIb6YMHIIOM). CBo6oD,HbIH 6HnHpy6HII HC pacTnopHcT-
CH B BOD,C H HC nOHnnHCTCH B MO'lC. B nC'lCHH 011 KOllblOrHpycT -
COCD,HIIHCTCH C rnlOKypoHOBOH KHCJ10TOH H B 3TOM BHD,C BbID,CnHCT-
CH C )l(Cn'lblO B )l(cnYD.O'lHO-KHUlC'lllbIH TpaKT. CBH3allilLIH 6rumpy-
6HH pacTBopHM B BO,nC H npu noporoBoH KOIILlcIITpaLlHu B KpOBU
60JICC 34 MKMOJlb/JI BblD,CnHCTCH nO'lKaMH.
B )l(Cn'lCBbIBOD.HIllHX nyrHx 6HJ1/lpy6HH BOCCTaHaBnHBaCTCH AU
ypo6HJIHHOrCHa H nocTynaCT B KHUlC'lHHK, rD,C npco6pa3YCTCH B
CTcpKo6HnHllorCH. Hc601lbUiaH <taCTb CTCpK06HJ1HIIOrClla nOBTopHO
pca6cop6HPYCTCli B TonCTOH KHmKC B 06111HH KpOBOTOK H BbIBO,1lHTCH
67
-

C MOtlOH. Yp06HmmOrell B IIC'3Ha'lHTeJIbHOM KOJIH'leCTBC - B )f(CJItre-
BbIBOJUIll(HX nynrx H B TOIIKOH KHWKC - BcaCbIBaCTCj[ H no nopTanb-
1I0H CHCTCMC nocTynaCT B netJCHb, OTKY.lla BHOBb BbIBO.llHTCj[ C )f(CJI-
'lbro. B 1I0pMC yp06HJIHHOrCH C MOtIO" HC BbI.lICJIIJCTCj[.
BEECTBA A30T'-1CTOro 06MEHA
6--17 I"/cYT o6ll1cl"o 830T8
400-1200 I\IMOJlb/CYT
llo6blUleHo:
i pacna.ll 6CJIKOB TKaHCH
i .lIHa6cT
i paccacbIBaHHC 3KccY.llaTOB
i nOBblWCHHoe cO.llCp)f(aHHe 6CJIKa B nHTaHHH
i XpOHH'ICCKOC oTpaBJIeliHe <jJOC<jJOPOM
i JIHXOpa,l{Ka
ffollu3lcellO:
! 3a60JICBaJIHC nCtJCIIH (amporjJuJI, l{lIpp03 ne'lellll, ?enamum)
! 3a60JICBaHHC nO'lCK (lIeqJpUmbl)
! 3a6oJICBaHHC CCP.llCtJHO-COCY.llHCTOH CHCTCMbl
OOIUH" aJOT MOIfH - C}'MMa BCCX aJOTCOn;ep)f(aIl(HX COC.lIHHCHHii,
HaXOJlIJIl(HXCH B MOI.JC. K BCIl(CCTBaM a30THCToro 06MeHa OTHOCj[TCj[ _
MOlfeOHHa, MOIfCBaH KHCJJOTa, KpCaTlIHHH, KpcalHH, HH.lIHKall,
aMMHaK, aMHIIOKHCJJOTbI H .lIpyrHc BeU{eCTBa.
MO'leBHH3 (o6pa3YCTCj[ B nC'ICHH npH 06C33apa)f(HBa11HH aM-
MHaKa, OCHOBHOH KOHC'lHblH npO.llYKT 06Mcna 6CJIKOB. COCTaBJIj[CT
80-90 % OT KOJIH'ICCTBa npoJJ.YKTon al0THcTOro 06MCHa)
20-35 IlcYT
flo6blluello: pacna,l{ 6CJIKOB TKaHcH. nOBblwcHHOC COJlCp)f(aHHC
6CJIK3 B nHTaIlHH, JIHXOpaLlKa, 3JIOKaI.JCCTBCHH3IJ aHcMHj[, oTpaWlcHHc
(OC<jJOpOM, B PC3YJIbTaTC .lIciicTBHj[ npOH3BoLlHbrx canHl.{HJIOBOH KH-
CJIOTbl.
llollu3ICeHo: OCTp3IJ aTpo<jJHj[, UHPp03 nC'ICHH. rCnaTHT, ypCMHH,
3a6oJICBaHHIJ nO'lCK. aUH.lI03.
MO'leB3J1 KHCnOT3 (KonctlHblii npOLl)'KT o6Mcna nypHHoBblX
oCHoBaHHH (coCTaBHoH l.JaCTH HYKJICHHOBblX KHCJIOT»
0.27-0,80 r/C)'T
llo6blUlelio (runcPYPHKYPHH): JICiiK03b1. HCTHHllaj[ nomluHTc-
MHIJ, YCHJICHHblH pacna.n: TKaHcH, XHMHoTCpanHIJ, 60JIblllOC KOJIH-
IfCCTBO nypJlHOB B nHlUC, Hapymclmc pca6cop6uHlI MOI.JCBOH KH-
CJIOTbI B nOI.JC'lHbIX KaHaJIbI{3X (60JIC311b BHJIbCOlla, CHHLlpOM cI>3H-
KOlm).
68

llOIlUJlCellO (nmOypHKYPHJI): rnOMCPYJIOHC4>PHT, nOJIarpa, aMH-
JIOH;J.03 nO"lCK, npOrpCCCI1pYIOIuaJl MblIlIC'inaJi JIHCTpoqmJl, OTpaBJIC-
HHC COJIJlMH TJI)I(CJIblX MCTanJIOB, anKOrOJIH3M.
KpeaTMHMH (06pa3YCTCJI npH npCBpalltCIIHH KpCaTHlla, OJIIIH H3
KOHC'iHbIX npOJIYKTOB a30nfCTOrO 06MCHa. HCnOJIb3YCTCJI JIJUI OllCII-
KH 4>YHKUHOllaJlbIlOro COCTOJlHHJI nO'iCK (np06a Pc6cpra»
1\1- 1-2 I-Icy..
)I( - 0,5-1,6 (-Ic)"T
llo6bllUello (nmcpKpcaTHHHHYPHJI): TpaBMbl MbIIlIll, CHHJJ.pOM
CJIaBJICHHJI TKallcH, TJI)I(CJIaJl MbIIlIC'iHaJi pa60Ta, JIHXOpaJIKa,
60JIbllIOC KOJIH'iCCTBO MJlCHOH mfUlH, 3a6oJICBallHC nC'iCIUI, nHCB-
MOIIHJI.
llollllJICellO (mnoKpcaTHHHHypHJI): nporpcccHBllaJi MbIIlIC"IHaJi
JIHCTp04>HJI, MHOnanlJl, MH0311T, MHOrJIo6HHYPHJI, nO'iC'illaJi IICJJ.OCTa-
TO'iIlOCTb, XpOIlH'iCCKHH HCqJpHT C YPCMHCH, JICrCIICpaUHJI nO'iCK,
JICHKCMHJI, cTaplfccKHH BOlpacl.
KpeaTMH (COJICp)l(HTCJI B MblIlIuax (MHoKapJIc). B MOqC Kpca-
THH nOJlBJIJlCTCJI npH lIapYllIcHHH npouccca cro npCBpalltCIIHJI
B KpcaTHHHH (npH KOHUCHTpaUHH B nJIa3MC KpOBH CBblllIC
120 MKMOJIb/JI»
o'('cy (C"..ByeT
llo6bllUello (KpcanmypHJI): nporpcccHBHaJi MbIllICqnaJi D.HCTpO-
4>HJI, MHOnaTHJI, MH03HT, nOpa)l(CHHC nCqCHlf, 3a60JICBanml lIaJIno-
qCqllHKOB, aKpoMcI'anHJI, HH4>CKI{HOHHbIC 3a60JICBamlJl, roJIOJIaHHC,
nHCBMOnHJI, 3a)l(HBJICHHC 06umpHblx nCpCJIOMOB, ynoTpC6JICHHC
60JIbllIOrO KOJIHtlCCTRa MJlCHOH nl1lltH, Y JIHU CTap'lCCKoro BmpacTa,
npH nOJIOBOM c03pcBaHHH, npH nCD.OCTaTKC aCKop6HHOBOH KIfCJIOTbI
H TOKo<jJcpOJIa.
HAMKaH (KOIICtlllbIH npOll.YKT npcBpamCHlIJI TpHnTo<}Jana. 06-
pa3ycTCJI B nClfCHH npH 06c33apaiKHBamflf mU"loJIa)
40-60 MK\lOJII./CYT
llo6blulello: pa3JIOiKCIIHC 6CJ1KOB B OpraHH3l\1C (onyxomI, a6c-
UCCCbl, 6POIIx03KTa3HH), nOBblllICHI1C npoucccOB rHHCHHJI B KH-
lliCqlll1KC (KHIlIC'illaJl Hcnpoxo;J.HMOCTb, 3anopbI), nocJIconcpa-
UHOllllblH nCpHOJl.
llollUJICello: lIapYllIclIHC 3KCKpCTOpHOH <}JYHKrum notICK (HC<}J-
PHT, ar.mJ10HD.03, Ty6cPKYJIC3 nOtIcK), YMCHbIlICHI1C KJ1y60 t IKOBOH
qmJ1bTpallHH (lIapYIlICIIHC KpOBo06panlCHHJI, ]lCKOMnCHCallHJI ccp-
JICtmOH JICJlTCJ1bIlOCTH, 60JIbllIHC nOTcpH iKH]lKOCTH - JIJ1HTCJ1blIbIH
nOHoc, HCYKpoTHMaJi pBoTa, KpoBoTelfCHlIJl, O)l(OrH), 3a60ncBallHc
netlcnH.
69
-

C MOqOH. Yp06HnHHOrCH B HCJHaqHTCnbuOM KOnHqCCTBC - B >KCnqC-
BbIBO.n.RIl(HX nyux H B TOHKOH KHUJKC - BCaCblBaCTCR H no nOpTaJIb-
HOH CHCTCMC nOCTynacT B nCqCHb. OTKy.na BHOBb BbIBO.nHTCR C >Kcn-
t/bJO. B 1I0pMC ypo6HnHllOrCH C MOt/OI1 HC Bbl.ncnRCTCR.
BEECTBA A30THCTOro 05MEHA
6-17 r"/c)'T o6mcro 8JOra
400-J200 I\II\IOJlb/cYT
l106bllUello:
i pacna.n. 6CJ1KOB TKaHcH
i ltHa6cT
i paccacMBaHHc3Kccy.naToB
i nOBblIuclIHOC CO.ncp>KaHHC 6CJIKa B mnaHHH
i XPOIIHqCCKOC o'I'paBJ1CHHC «pOC«POPOM
i JIHXopa.n,Ka
llOlIU:HCello:
! 3a60JICBaHHC nCqCI-IH (ampOljJuR. 1.jIlPP03 nelJellll, ?enamllm)
! 3a60ncBaHHc noqCK (lIerjJpllmbl)
! 3a60ncBaHHc CCp.aCqHO-COCy,nHCTOH CHCTCMbl
0611(H" a30T MO'IH - cYMMa BCCX aJOTco,nep>KaUUfX COC.nHHCHHii,
Haxo,n.llLUHXCR B MOqC. K BCU!CCTBaM a30THCToro 06McHa OTHOCRTCR _
MOlfcBHHa, MOlfCBaH KHCJIOTa, KpCaT"HHH, KpeaTHH, HH.nHKaH,
aMMHaK, aMHlloKHCJJOTLI H .n.pyn1c BCIl(eCTBa.
MO'feBHHa (o6pa3YCTcR B nCqCHH npH 06CJ3apa>KHBaHHH aM-
MuaKa, OCHOBHOH KOHCqHblii npOltYKT 06McHa 6cnKoB. COCTaBJIRCT
80-90 % OT KOJIHqCCna npo.nYKTOB al0THcTOro 06McHa)
20-35 rlC)'T
llo6blUlello: pacna.n, 6cnKOB TKaI-lCI1, nOBblUJCHHOC co,ncp>KaHHC
6cnKa B nHTauHH. nHxOpa.nKa, 3nOKaqCCTBCHHaR aHCMHJI, o'I'paBJICHHC
«pOC«POPOM, B pC3ynbTaTC ltCiiCTBH.II npOH3Bo,nHb/X CaJIHl{HJ10BOii KH-
CJIOTb/.
llOHU:HCello: oC'I'paR a-rpoqnlR, l\lIpp03 nCqCHH, rcnaTHT, ypCMHR,
3a60JICBaHH.II nOqCK, al{u.n03.
MO'feBafi KMcnoTa (KOHCqHb/H npo.aYKT 06McHa nypHHoBblX
oCBoBaHHH (cocTaBHoH qaCTH HYKncHHoBb/X KHCJ10T»
0,27-0,80 rlcyr
llo6bllUello (nmepYPUKYPHR): nCHK03bl, HCTHUHaR nOnHl{HTC-
MHJI, YCHJICHHblH pacna.n. TKaHcii, XHMHoTcpanuR, 60nbUloc KonH-
qCCTRO nypmiOB R nMLUc, uapymclIMc pca6cop6uHlf MOqCBOii KH-
cnOTb/ B nOqcqllblX KallaJIbl\ax (60nc3Hb BHnbcoHa, CHH.npOM <Dau-
KOHH ).
68

lllJllu:»cello (mnOypHKypHH): rnOMCPYJIOHCcppHT, nOJlarpa, aMH-
nOHJ103 nO'lCK, npOrpCCClipYIOUlaH MblUIC'IHaH JlHCrpOcpHH, OrpaBJIC-
HHC COJIHMH THJKCJIblX MCTaJIJIOB, aJIKOrOJIH3M.
KpeaTMHMH (06paJYCTCH npH npCBpaU.lCHHIi KpCaTHUa, OJlllU H3
KOIlC'IHbIX npO.ilYKT08 a30TlICTOrO 06MCHa. I1cnOJIb3YCTCH JlJUI OQCH-
KH IPYHKUl10llaJlbilOrO COCTOHHHH nO'ICK (np06a Pc6cpra»
M -1-2 r/cYT
)K - 0,5-1,6 r/cYT
llo6blule1lo (rnncpKpcannnmypllH): Tpa8Mbl MbllliLl. CHlIJlpOM
C;J.a8nCIII1H TKaIlcH, TH)KCJIaH MblWC'IIIaH pa60Ta, nliXOpaJlKa,
60nbilloc KOJII1'1CCTBO MHCHOH nHllll1, 3a60JICBaIlliC nC'ICIIlI, nHCB-
MOHliH.
llollu:»cello (nmoKpcaTlIIIHIIypllH): nporpcCCI-IBUaH MbIWC'IUaH
.n.Hcrpol}Jl1!1, MHOnaTlIH, MU03HT, MHOrn0611Hypl1H, nO'lC'IIIaH I1CllOCTa-
TO'IHOCTb, XPOHWICCKHH HCq>pI1T C YPCMI1CH, JlCrCIICpaQlIH nO'lCK,
JICHKCMI1H, crap'IccKUH B03pacT.
KpeaTMH (COllCpJKI1TCH B Mblwuax (MI10Kap.ac). B MO'IC KpCa-
Hili nOHBJIHCTCH IIPH lIapymcmm npoQCCCa cro npCBpall\CHI1H
B KpcaTlIIUIII (UpH KOIIQCIITpaQl1l1 B nna3MC KpOBH CBblmc
120 MKMO!lb/n»
OTCYTCTByeT
llo6hllUello (KpCaTl1l1ypHH): nporpcccliBlJaH MbIWC'IHaH JlllCTpO-
qmH, MHonaTHH, MlI0311T, nOpaJKCIIHC nC'ICIIH, 3a60ncBaHliH Ha.n.no-
'IC'IHHKOB, aKpOMCraJIlIH, HIIcpCKllHOlillblC 3a601lCBallHH, r01l011aHHC,
nHCBMOHHH, 3a>KHBJICHHC 06mHpllblx nCpCJIOMOB, ynoTpc6JICIIHC
60JIbWOro K01lH'ICCTBa MHCHOH nHllH, y JIHQ CTap'lCcKor'o B03pacTa,
npH n01l0BOM c03pcBaHlU1, npu HCJlOCTaTKC aCKop6liHOBOH KHCJIOTbl
H TOKocpcpona.
HAMKaH (KOIIC'IHbIH npollYKT npcBpalllCHH!I TpunTmllaHa. 06-
pa3ycTcH B nC'ICIiH npH 06C33apa)f(UBaJnfl1 HHJlOna)
40 MK:\IOJlb/cYT
Il06blluellO: pa3nO>KCIIHC 6cnKOB B Opram!3MC (onyxoJII1, a6c-
QCCCbI, 6pOHXOJKTa3HH), nOBblWCIIHC npOQCCCOB rHUCHI1H B KI1-
UlC'IHIiKC (KIiWC'IHaH IIcnpOXO;J.HMOCTb, 3anopbl), noc1Iconcpa-
QHOHHblH IICpHO!l.
lltJIlU:»celw: lIapywclIUC 3KCKpCTOpHOH tPYHKIUHI nO'lCK (HCqJ-
pur, aMH1IOUJl03, Ty6cPKYJIC3 nO'lCK), YMCHblIlCHIiC KJIy60'lKOBOH
qmJIbTpaQHH (liapywclIl1c KpoB006pall\CHHH, JlCKOMnCHcaQUH ccp-
!lCLIHOH .lI.CHTCJIbllOCTH, 60nbUlHc nOTcpH >KHJ1KOCTI1 - JlJII1TCJlbHblH
nOHOC, IICYKpoTHMaH pBoTa, KpOROTC'ICHIiH. O>Koru), 3a60nCBaHI1C
nC'ICIII1.
69
-

AMMMaK (npO.l{)'KT ,nC3aMI1HHpOBaHllil aMIfiIOKHCJIOT, a30THCTbIX
OCIlOBallHH)
0,6--1,3 r/cYl"
llo6bllUello: 3a60JIeBallmi nCI.JCHI1 (aTpo<p"}1, Lll1pp03 nel.JCIII1, aJI-
KOrOJTH3M, ne'ICIIOl.Jlla}l KOMa), "llJOKOBa}l nCI.JClIb" (O)KOrOBa}l 60-
JJC3I1b, 06llJHpIIa}l TpaBMa, OTpaBJTCHI1C <pOC<pOPOM 11 MbIllJb}lKOM. nc-
pCmmalll1C HCCOBMCCTI1MOH KpOBH), HaCJJC.lI.CTBCHHbIC 3a60JTCBaHI1}1,
CB}l3aIIHbIC C HapymcHHcM CHHTC3a MOI.JCBI1Hbl.
MOYEBO OCA,/J,OK
MOI.JCBOH OCa,T:\OK 6bIBaCT ,T:\BYX BI1,T:\OB:
0pI'aHH30BaHHbiu (pHC. 12) - <pOpMcHHble 3JTCMCHTbi KpOBIf
3PHTpOl{HTbI H JTeHKOLlHTbI, 3nHTCJJI1aJIbHblC KJTCTKH H LlI1JTI1I1,UpbI;
ueopl'aHHJOBaHHblu - COJTIf 11 Kp"CTaJlmi'ICCKle 06pa30BaHH}I.
:.. 4
r.! 2l';  ,_
 /'\", iI J: ..
(:) . )
Q- 3 .,.. '- @f,
 (i) "'1'U
  ,.
f.- . ;'.'
'.; (.)  t
{ -'f"'\
.. ":.V 1U
..p..; ,:.: .  "-
 ;,.'.;,  (' 1 (t).}-.
 . t,.. Po:. J r.-. ", utA',
1." t ... '" \:..\1 "" .....so
,t. .1.:_:.-. '.
.,' 0 '. . · ', :"'
., ".., .  '"
;: 3  "':'" .  r;:." . . 0
. J- - v' . ",'
.." C!: . ..'b t ..>. v. " -....  .
.,.- '  .., '. ." ,
t  ....... O:!:';:
4a   
\,,) . r-. N'.', <': 2 "
"\..,)".1'1
---
 ,;-..-?--- 4e
a 6
PIIC. 12. Op' alU130BallHblH OC3.10K MO'I1l npll pa3.111'1I1b1X COCTOHIII1HX:
a (6c3 HO\fCpa - OCailKa IIer; I - IIO.IHM0M>lIblii ""liTe lItii: 2 - "P" 'POIIIII:
.1- nnOCtOU1 '}mnc.u1ii: 4 - IC"K()UUn): 6 (1 -")pJIIpOllltll.l; 2 - JI-HKUlUfrbl;;l IJO"iCLf-
HhlU "Jlllt '"CJudi; 4a WUlilH!J.pbl nlamtH08blC: 46 -1CpIIltCThlC; 46 BOCICOBHllHLJe)
nOl,3J3.C..b HOp'.3..bIlLlC ]n3'.ennH
3nMTenHaJlLllblC KJICTKII ..................................__.0--3 B 1I0lle 3peHuH
JIeHKuIIHTbl:
JJ.1U' \fY)f('IHH .....................................................0--2 8 nonc 3pCHH"
JJ.]I" JKCII1111 ..........................__........................\-3 B nOlle 3pCHHH
3pl1TpOUHTbI ....................................................... EiUllIIl'IlIblC B IIpcn3paTC
UI1JII1HJlpbl ...........................................................OTCyrCTBYIOT
CnH3b ................................................................... OTcyrcTBye-r
I>dKTCpHII .............................................__.............. OTCyrCTBYIOT (IIC 60Jlcc 50 000 B \ Mn)
Hcopl 31111"IORaHIILIH oca.10K
npll KIICJ.oij pCaKnMlI........................................ MO'IeBaJl KHcnOTd. yp3TbI. OKCaJlaTbl
nplllllClJO'lliOH pCaKIII1I1................................... A'IOp<jJIILIC <jJoc<jJa I 1,1. MO"CKMCJ1blii
aMMOHI1H. TpllllcnL<jJoc<jJal"b1
70

MaTCpllaJ1 }{JIH IICCJJC.lJ.OBaHIlH. Ha,aOCa.aO'lHaji )!(H,aKOCTb rrocne
QCIITpHlpympoBaHHjI yrpclIHcii MO'IIf.
3m1TEnAl1bHbIE KI1ETK
0-3 B none 3peHIIH
3nHTCJ1HH pa3,aCJljl10T Ha 1IJ10CKHH, ncpCXO}{HblH H nOIJClJllblH.
0J10CKIIH 31111J"CJIIiH HnH rrorra,aaCT B MO'IY H3 BJlaranHlua If Ha-
PY)!(lIbIX nonOBblX opraHoB 11 6onbllloro ,aHarHOCTI1'ICCKoro 3Ha'lCIH1j1
HC HMeCT HnH npl1 BocnanCHliH ypCTPbl Y MY)!('1HH.
OCPCXOJJ.Hbllt 3nHTCJllfH - 3nHTCJIHii MO'leBOrO rrY3blPjl, MO'IC-
TO'lHHKOB, nO'le'lHbiX noxaHOK: rrpH QHcTHTax, nHenHTax, HOBoo6pa-
30BaHWIX MO'leBblBo,aHIl{HX nYTcii.
OO.,ClJllbIH 3nllTCJlIIH - 3nl1TCJ1IiH KallanbQeB nO'lCK: npl1 Bocna-
J1I1TCJ1bHOM npoQCCCC B KaHanbuax nO'lCK, ,aercllcpaTHBHoM H3MCHC-
HliB B nO'IC'IHOH TKaIiH.
I1EiilKOUTbl
M - 0-2 B none JpeHHH
)K - 1-3 B none JpeHHH
l106blUtellO {-'lCUlwu,umYPuR}:
i HC<t>PHTbl (nlle. r lO1lerppllm, lI1lmepen1l1llUa1bHblu 1lerppum, 80.1'10-
HO'lHbIU HerfiplIm, my6epK)'-7e3 nO'lcK)
i rnOMcpYJ10HC<t>pHT (1LL'rpOljllmYPIIR)
i QHCTHT, ypCTPHT, nHcnHT, npOCTaTiiT
i IIC<t>P03bl, HCQJpOCKJ1Cp03bl
i nHxopa,aKa. HHTCHCHBHaji QHI3H'IccKajl lIarpY3Ka
i I1pl1 ,aCiiCTBHH TOKCH'ICCKI1X BCIJ.{CCTB (0I1IlU/ILLL1111ta, KaH{ LI1I1l I'lHa,
aCllllpll1la, J1C60()0Ilbl, ZCpOlIHO, CO/leu :JICC.1C3a)
JlCHKOUllilPIiH (Icucocyturia) - C0J1Cp}KaHl1C nciiKOUHTOB B MO-
'Ie 60nee 5 - 6 B nOJIC 3pCIIIUI - npll3HaK nO'ITIi BCCX 3a6oncBaIlHii
nO'lCK 11 MO'ICBbIBO,aHIJ.{IIX nyrcii. EcnH KOJ1I1'ICCTRO J1diKOUlITOB B
nonc 3pCHHH npcBbIwacT 60. TO roBOpjlT 0 nl1ypl1l1 (pyuria).
W ,lJ.B)"XCTaK3HI13M npofia: JleiiKuuMlypnll B ncpBoii nopuml (pyuria initialis)
ypCTpllT. npOCTanlT; 80 8TUpoii - BOCnaJIClIIlC MO'ICBOrO nY3blpll, JlOXanOK, nO'ICK.
TpCXCTaKaHHaH np06a: noclIc MaCC3iK3 npOCT3Tbl. nepe,l C60POM TpCTbeii nop-
Ulill (pyurid lerrninalis) - npOCT3T1IT.
lI.JlII 8blllBJlCIIIIII CKpbITOH nciiKOllHTYPMlI 6bUla npCJlnO)l(CHa npC,!\IIHJO.l01l0-
BaM np06a - YTPOM Y 60nbHoro MccnellYIOT IICPBYIO noplllllO MO'ln, nocnc :noro
BIlYTpHIICllno BBO;J,IIT 30 Mr npc IMlnOJlOlla 113 10 Mn !jJn3HonOrn'lCCKOrO paCTBopa.
3aTCM HCCneJlYIOT nocncllYIOllll1C TPM nopUHH MO'III, C06pa'IIlbiC C '1aCOBbIM MHTep-
BanOM.
np'l HaJIH'I'1li "CKpbI10ii" IO"e8()ii MII4>CKIUIII JICHIWUllrypll1l .'10:1)1(11.\ Yllcm''1I1-
RaTbCII II 2 II fiOJICC pa3.
71
-

3PMTPOLWITbi
C".HIIHllllbIC B npenapan
l106bllliellO (eJ.'amJ'pUR):
t pCHaJlbUa)/ (.!..70.uepYJ101/e<fJpum, oempaR nO'le'lIlQJl lIei)oemamo'l-
lIoemb, mpa8.ua, wupapl\m 1l0'IKli, my6epK}'.J1e3 11O'IKII)
t He".OCTaTo'mOCTb KpOBOo6pall{eHH)/ C Bblpa}!(eUHblMH 3aCTOnHbIMH
)/BJICHH)/MH
t TpaBMa MOIICBbIBO"')/Il!HX nyren, MOIICKaMCHHa)/ 60JIC3Ub
t 3JIOKallCCTBCHHbIe uOBoo6pa30aaHH)/ MOIICBbIB0".)/II1HX nyren
t I1HCTHT, YPCTPHT, nHCJIHT, runcpTpO!l>H)/ npOCTaTbi
t npH J1CHCTBHH TOKCHlleCKHX BCIl!CCTB (nelllllILL7'l//H06, CY7bpa1lU-
llQ..I/Ui)06, peHmzellOKOHmpaCm1/blX epei)em6, allmUKOaZ}'.,1J/ltn106, ae-
IlUpUlla, U1/i)o.femalIW/G)
rCJ\la-rypHH (hacmaturia) - nO)/RJIeliHe JpHTpOunTOB B MOIIC. Pa3-
lIHllalOT J\laKpOI'CMa-rypIIlO (KOr.l1a KpOBn B MO'IC TaK 1\1II0ro, liTO olla
BbBblBaC'r H3MCHCHnc UBCTa MOlin H BH.L\Ua Ha rnaJ) H J\lHKpOrCJ\la-
TYPHIO (eClIH JpnTpOUHTbl 06uapY}!(HBaIOTC)/ MIiKpOCKOnH'ICCKH).
m TPCXCT3K3HH3R IIpofi3:
ncpBaH nopllllH - KpOBb M3 YPeTpbl;
rpCTbH noplll'" - KpOBb 113 MO'ICBoro ny Jhlpll;
"CMaTYP"H BO BCCX nopUHHX MO'JII - KpOHb 113 nO'JCK.
UMIIMHAPbl
OTCYTCTBYIOT
Pa3ml i ialOT rHallHIIOBblC, JCpIlHCTbIC, BOCKOBlfj{lIbIC U HJInH .I1Pbl.
ECJIn HX npmIaMC}!(HOCTb HC RbJ3bIBaCT COMHCIIII)/ - .'1CHKOQHTap-
IILle, 3pllTpOQlll'apHblC, 3111lTCJlHaJIblible.
rUll.J1UII06ble:
t Bce 3a6oJICBaHH)/ nOIlCK, COnpOBO)f():\aIOIl!HCC)/ KJIy60IlKORoii: npo-
TCI.fHYPHCii: (Z70-\/epY1OHe<fJpum, i)euem6ue umjJeK1IUOllllhiX U aiL1ep-
ZUlieCKliX <fJaKmopo8, ZlmepmOllli'leCKQJl 6o.7e3Hb, i)eKu.uneHemIUJ/
eepiJe'lHoii i)eJ/me..7bHOcmu)
t OClpblM nHCJIOHcIjJPHT. HccppOnaTH)/ 6CpCMCHIIbIX
t HOBo06pa30BaUH)/ nOlleK
t Ty6cpKYlIe3 nOlleK H MOIICBbIBO.l1)/Il!HX nyrcM
t JIHXOpa.L\Ka
t OTpaBJICIIHC COJI)/MH T)/}!(CJIblX MCTaJlJIOR
t IjJH3HOJIOrHIICCKa)/ (1Il/meIlCU8HQJl tPlI3l1'1eeKaJ/ lIa<'pY3Ka, IIpll pa-
60me 6 :JICapI\O,'1 IVULUame, none K}'l1aIlW/ 6 XO,70i)IIUli 60i)e)
t JICIICIUfC ,rmypCTIiKal\lH
72

3ep"ucmble:
T aKTUBHblii rJIOMcpynoHCq,pUT, ua6CTlf'jCCKall nC<j>pOnaTUlI
T nucnOnC<j>pUT
t aMUnOU.!I.03
T 3nOKa'{CCTBCHIIaH fUIICpTCn3UlI
T OTpaBnCHHC TlI)KCnbIMU MCTa.J1naMU
t JIHXOpaKa, UHTCHCHBHall .pU3H1.fCCKall HarpY3Ka
BOCK06UOllble:
t n01.fC1.fllall IIC;{OCTaT01.fIlOCTb
T aMUnOH.!I.03
JIeiiKOI{Umapllble:
T HlnCpCTUQUa.J1bnO-KaHa.J1bUCBOC nOpa)KCHUC II0lJCK (nlle.1OIlerPPllm,
60.1'1aIlO'l1lhllllle(jJpllm)
3pUmpOI{UmapHble:
T naTOnOfUlI KJly60lJKOB (J1OAlCPYJ1OIlerjJpWn)
T HlHpapKT II0lJKU, TpOM603 nOlJClJnOH BCHbl
T 3nOKalJCCTBCnilaH fUnCpTCHJlU1
T nOOCTpbl" 6aKTCpUa.J1bHbIH 'JHOKapll.UT, nOnUapTCpUUT
3"UmC.i1Ua.1bHble:
T OCTpbIH IIC<j>p03 nOlJClJHblX KaHa.J1bLJ,CB
T Bupycnblc 3a6onCBaHJUI
T aMUnOU!I,03
T OTpaBnCHIIC TlI)KCnbIMU MCTa.J1naMH. CanUQUnaTaMU, :nUnCHrJIU-
KOnCM
IJ.HJlltII.!I.pbl (cylindrus) - 6CnKOBbiC o6paJOnallJl1I, lie BCTpC'lalO-
IUI1CClI B M01.fC 3;{OPOBOro 'IcnORCKa. OIlU 06paJYlOTclI B Kana.J1bl{aX
Hc<j>pOHa U HMCIOT l.(ummpU1.fCCKYIO .pOPMY (noBropHIOT <j>OPMY Ka-
Ha.J1bQCB).
III UJlmIH!lpOH,lhl - 06pa:!OBallllll. noxmKHC lIa rMa.'IHHOUble IIHJ1HHilpbl. C'II1T310T,
'ITO OHM 06pa"JYIOTCIIIU cn":!11 1\ MorYT BCTpC'JaTbCII B "OpliIJ1hHOii MO'IC.
6AKTEPn1
He 60.'Iee 50 000 B 1 !\IJI
EUKmepll)'pllR:
T boncc 50 000 MHKpo6HbiX KnCTOK B I Mn MO'IJI YKa3bIBaCT lIa na-
nH'IHC BOCllanHTcnbilOfO npoLl,ccca
73

HEoprAH30BAHHbl OCA,QOK
I'tfOiKeT 6blTb
Heopl'amI:JOBaIIllMii OCa.l:{OK (plfC. 13) COCTOlfT 1f3 COnCH H KPH-
CTMnH'lCCKlfX 06pa30BaJlHii, BCTPC'IaIOU{HXC1I B 1I0pMMbliOH H naTO-
nOrn'lCCKOH MO'IC.
HCOpraHIf30BallHblH oca,aOK IIC HMCCT 60nbUloro KJlHHH'ICCKOro 3Ha-
'lCHIUI, TaK KaK O'lCllb 'IaCTO 3aBHCHT OT xapaKTcpa nJITb1l H nHTaHWI.
..r D  f"
() 1.:1-J f3  ] J.....
(} . . )\  "'V'
oQ .;:-
B vo:; J/
a
lJ
. *- j,t
.....J . 11
6
(4
y ;; C'('
" '1i
#, \k,
, t(. ('J 1
2 -' ('" ( ....
t "tl ...
f) r" "0
t '--
---- ............
110 '-.
<1
...

.\...
.. ;,C-
3
6
PHC. 13. Heopl aHI130BallHhiH oca,aOK:
a - KHcnOH MO'iH C OKCa.IaT3MH; 6 - KHCJIOii MOIIH C ypaT3MIf: II _ me IOI.JHOH MOIIIt
(1 TPIIIICJI.<j>OC<!>aTbJ; 2 - Moe""c'I.lii a"Mollllii: 3 - IIJBec....)
MO'lCBaH KHCnOTa - npl-f KI-fCnOH pca KI{1-f I-f, nocne npo.n.on)J(J1-
TcnbHOH <PIf3H'ICCKOH HarpY3KH, npl-f ynoTpc6ncmIH I-fCKmO'mTcnbIiO
M1ICIIOH mlllIH, npH MO'lCKHCnblX J1HaTC3ax, nCHKOJaX, npH npHMCHC-
HHH uHrocTaTHKOB, JlHXopa.n.O'lHblX COCT01l1l1-f1lX. rnnOBOJlC:\-IHH (no-
HOCLI, pBOTa, 'IpCJMCpIIa1l nOTJlJmOCTb).
"Ypal'LI - npl-f KHcnoii pcaKLlHH, y 60nbHbiX no.n.arpOH, npH 3J10-
Ka'lCCTBCHHbIX onYXOJl1lX, npH npHMCHCHI-fH IUITOCTaTHKOB, 06ump-
HblX O>lwrax, JIIfXOpa1l0'lHblX COCT01lHIi1lX, rHIlOBOJICMHlI (nOIlOCbJ.
pBora, 'lpC3l\ICpHa1l nOTJII1BOCTb). nO'lctllloii IIC,10CraTO'lHOCTIi.
OKCaJIaTLI - npH KHcnOH pcaKUHH, npH ;lI-fCTC, CO):{Cp)J(all.{CH Ka-
nYCTY, pcnCIII,; npli T1I)J(cnblX XpOIlI-f'lCCKIIX 3a6oncnaHlf1lX nO'lCK,
,aHa6cTC. HapYUlCHlIH 06MCII3 KMbUIf1l. OTpaBJlCHli1f :1TJlnCllrmfKO-
nCM, PC3CKI\IIH TOIIKOH KIfLUKIf.
AMOP<PllbiC cJ>occJ>aTLI - npl-f ll.{CnO'IHOH pcaKIUIH, nplf <PPYKTO-
DoH lIIfCTC, 110m'OM CT01lllHIf MO'H!, IUICTIITC.
MOIICKIIC.'lblii ai\lMollllii - npH u(CnO''''OH pCaKI{IfIf, npl! I..{IICTH-
TC C aMl\Hfa'lHbIM 6pO)J(ClllfCM B MO'ICBOM nYJblpc.
74

TpHneJ1LcJloccJlaTLI - npH IlJ,CJlO'fHOH pCaKUHH, npH 06HJlbHOM
npHCMC paCTIlTCJlbHOH nmUH, MHIICpaJIbHOH BO.AbI, npH .AOJlrOM CTOH-
HliH MO'fH, npH UHCTHTax.
XOJ1eCTepHIIOBLle - npH TH:>KCJlOH HIICKUHH MO'fCBbIX nyrCH,
HC$pHTC, aMHJlOH.AHOii H JlHnOH.AHOH .AHCTpO$Hli nO'fCK, HOBoo6pa-
30BaHHHX, a6clcccc nO'fCK.
lJ,HCTHlloBLIe - npH LlHCTHHypHH H roMOLlHCTHlIypHH.
reMaTOH.AH" - npH KpOBOTC'fCHHHX H3 MO'fCBbIBO.AHWHX nyrci1
(MO'fCKaMCHHaH 60JlC3Hb, HOBoo6pa30BaHHH MO'fCBOro nY3bIPH H no-
'fCK. a6cuccc nO'fCK. npOCTaTbI).
KOIWI"IECTBEHHbIE METOAbl
OnPEAEI1EHlI1fl MO"lEBOro OCAAKA
KOJ1H"ICCTBCIIHLlC MCTO)lLl n03BOJlHIOT onpC.ACJlHTb TO'fHOC KO-
JIH'fCCTBO JlCHKOUHTOB, 3pHTpOHHTOR H IHmm.n;pOB, BbIJICnCIIHbIX C
MO'fOH. 3TO OC06ClIII0 Ba:>KIIO JUIH .AHanIOCTHKH 3a60nCBaHHH nOIICK.
,nHlIaMH'fCCKOrO Ha6mOllCHHH 3a ero TC'fCHHCM H KOHTponH 3a npOBO-
,nHMbIM nC'fCHHCM, OC06CHHO npH CKpbITOM, XpOHIi'fCCKOM HJIH BHJIO-
TCKYWCM xapaKTCpc.
ill Onpen.eJlclilic npOBon.liTCI! C nOMolUblO c'!eTHOH KaMepbl (fOpl!eBa - 06'beM
0,9 MKJI liJlI1 <I>YKc-P03eH ranI! - 3,2 MKJI).
MeTOA A,q,q"'ca-KaKOOCKOrO - OCHORaH Ha onpC.ACnCHHH $op-
MCHHblX 3nCMCHTOB B CyrO'fHOM KOnH'fCCTBC MO'fH.
33 CYTKH
,nO 2,5x I 0 6 JICHKOIHTOB,
)1.0 ] ,5x Hl' 3pHTpOUIiTOB,
,nO 2x 10 4 l1HnHHilpOB
HC.l.\OCT'dTOK MCTO.n;a - JUIHTCJIbHOC RpCMH c60pa Ii XpaHCHHH MOlm
MeTOA He.,,,,nopeHKO - OCHORaH lIa onpc):\cncmili KnCTO'fllbIX
3nCMCIITOB B I Mn CRCjKCC06p31I1I0H MO'!H.
,nO 2000 nCHKoUHTOB,
.AO I 000 'pHTpOlHTOR R I MJI,
UHJIlIlWPbI OTCyrCTBYIOT
MeTOA AM6YP>Ke - OClIOB31I n3 nO.AC'fCTC KJICro'fllbIX 3nCMCHTOB
B MO'fC, coopaHHOH 33 3 'I, C nCpCC'fCTOM Ha MHH)'THbIH llHypC3.
.AO 2000 JICMKOU1ITOD,
JO I 000 3pHTpOlIITOR R I MHII,
UHnHIwpbl OTCyrCTBYIOT

JJ.ml OUCIIKH q,YHKUHOHanbHoro COCTOllllHlI nOlJCK HCnOnb3YIOTClI
CnC,lJ.YlOlllHC llapaMCTpbl:
nOKa3aTCnH KOIlUCHTpaUHOllllOH CnOC06HOCTH (np06bl 3U.IHlIlIKO-
20, (])o.%ZapOa);
HCCnC,lJ.OBaIlHC 6HOXHMHlJCCKOrO COCTaBa KpOBH H HCKOTOpblX CC
q,H3HlJCCKHX CBOHCTB (a3017108blOe/1Ume.bllaJ/.. 20.\leOemamll'leCIWR II
3HOOKpllllHllJl l/JYIIKlIUU);
HCCnCJI,OBaHHC q,H3HKO-XHMHlJCCKHX CBOHCTB MO'IH H CC 6110XI1MH'IC-
CKoro COCTaBa (CM. pa3;lcn cJ>U3l1KO-XUMll'leCifUe e8oiicm611 ,UO'lll);
napllHanbllblC 1I0Ka3aTcnH ,lJ.ClITCnbIiOCTH nOqCK (K7lIpeHC, Ilpo6a
Pe6epza).
npo6a 3MMHMKoro - onpC.1J.cnllCT cnOC06110CTb nO'IKI1 KOII-
UClnpHpOBaTb H BbIBO,lJ.HTb MOqy B ycnOBHlIX 06bllJIIOro BO,lJ.HOrO 11
mnUCBoro pC>KHMa, CC
npHcnoc06nCIIHC K cy-
TOlJHblM Konc6alll1l1M
>KHJI,KOCTH (pHC. 14), no-
CTynalOlllcH B opraHH3M.
OHa q,H3HOnOrnqlla H
npOCTa no TCXHHKC npo-
BCJlCIIHlI. JJ.JTlI onpc,lJ.C-
nCHHlI cyrOlJHOrO ,lJ.HYPC-
3a MO'l)' c06HpalOT nop-
IlHlIMH qCPC3 Ka>K,abiC 3 'I,
H3MCplll0T cc KOnHlJCCT-
BO H OTHocl1TcnbllYIO
PIIC 14. KOJIC6allJlc KOnll'lCCIHa 11 OTI10CI1TCnb- nnOTlIocTb, nO,lJ.C'-lI1Tbl-
lIoii nnOTIIOCTIl MO'III B TC'ICI1I1C CyrOK nalOT CyrO'/Hbl", ,lJ.IICB-
110" H 1/0'1110" ,lJ.HypC3
11 011lHOcllme.'lbIlWI 1L70m-
CCJlE,QOBAHE Q)YHKlt nO"lEK
un
400
300
200
100
o
6
9 12 15 18 21 24 3
-----KOnM'IeCTBO,un
-nnOTHOCTb. rln
r/n
1025
1020
1015
1010
1005
(CM. pa3,lJ.Cnh/ KOJ1U'leC11leO ,'oIOliU 6 C)17/KIl
HOemb ,UO'lIl).
Y JJl.OpOBOro qCnOBCKa CyrOlJHblH J1HypC3 Konc6JTCTClI B Ilpccnax
HOpMbl, IIHCBHO" npco6na.ll.aCT 1IaJI, HOql/bIM B COOTHOIlICIIHH 3: I. B
OT.1J.CnbHbIX nOpUHlIX MJlHHManbllblC Konc6allHlI nnOTHOCTH COCTaB-
nlll0T IIC MCHCC 10 r/n H Konc6aHHlI KOnHqCCTBa 40-300 Mn. DpH
3TOM qCM 60nblliC 3TH KOJTc6aIllUI. TCM BbilliC aJlanTaUHOllllall cno-
C06HOCTb nO'ICK. npH BOnnClJClIl1H B naTOnOrHlJCCKHii npouccc no-
qC'-lllblX KJly60'IKon lIapymacTclI 06pa30BaHI1C nCpBH'/HOH MOql1 (ru-
nOCTCllypHlI B COlJCTallHH C onHrypHcH - pHC, 15, a). npH nOTcpc Ka-
lIanbuaMH nO'IKH cnoC061/0CTH KOIl/lCHTpHpOBaTb MOlJY (mo-
CTCHypHlI - pHC. 15, 6) OTHOCHTcnbllM IlJIOTHOCTb nOCJTC,lJ.HCH MClIlI-
CTClI B Y3KHX npc,lJ.cnax (101O-1011 r/n). npC06na,lJ.allHC HOqHOro
76

Jl.HypC33 H3.Ll .LlHeBHbIM HBnHeTCH p3mUlM npH3H3KOM nO'ICtJHOH He-
.LlOCT3TOtJHOCTH.
np06bl C2>onbrapAa (np063 H3 pa"3Be,/leHHe H H3 KOHueHTp3-
UHIO) - n03BOnHeT BbIHBHTb H3H60ncc p3HHHC H3pYllIeHHH KOHUeH-
Tp3UHOIIIIOH <PYHKUHH nOtJCK.
Mn r/n Mn r/n
250 1020 250 1020
200 200
150 1015 1015
 150
100 1010 100 1010
50 50
0 1005 0 1005
6 9 12 15 18 21 24 3 6 912151821243
a 6
PI1C. 15. CyrO'lHblH .1J.HypC3 npH npcIIMyuICC"fnCIUlOM nOpaJICCHl1II:
a - KJ1y60'lKOB; fi -' KaHa.lbCB
npo6a Ha paJBeAeHMe - BO,/llI3JI <PYHKUHOHMbHlliI np063, Bbl-
nonHHeTCH H3TOIl\3K nocJlc OnOpO)l(HeHHH MotJCBoro nY"3bIPH. l)onbHoH
B TCtJCHHC 30 MHH BblI1HB3CT BO,/lbI B p3CtJeTC 20 Mn H3 I Kr M3CCbI Te-
na. 3aTeM, OCT3B3JICb B nOCTCJIH, B TetJCHHC 4 tJ K3JKJ1,bIC 30 MHH C06H-
p3eT MOtJy. Y 3J1.0pOBOro tJenOBeKa B TCqCHHC 4 tJ BbIBO,/lHTCH He Me-
Hee 75 % BbInHTOH )l(H,lIi:OCTH. M3KCHMMbHoe ec KOnW-ICCTBO npH-
XO,/lHTCH Ha BTOPYIO-TpCTblO nopuHIo (JJ,0 300 Mn), OTHOCHTcnbIl3H
nnOTHOCTb MOtJH na,/laeT .110 1001-1003 r/n. npH OTHocHTcnbHoH
nnOTHOCTH 1005-1010 r/n - H30CTCHypHH. I)onee 1010 r/n - rnncp-
CTCHypHH (CM. p3"3JJ,eJllJ.rlOnllwemb MO'lU).
npo6a Ha KOHeHTpaHIO - MO)l(CT npOBOJ.1HTbCH tJepe3 4 'i nocnc
BOJl.HOH Ha'l'Y"3KH. 6onbIloMY JJ,alOT 06cJI. 6c"3 )l(HJl.KOCTH, H OH BCCb JJ,eHb
,/lOjJ>KCH nHTaTbCH BCYXOWITI(Y. MOIIa c06Hp3CTcH K3JKJ1,bIC 2 tJ B TCtJC-
HHe 8 'I. B HOpMC OH3 Bbl.LleIDIeTCH Bce }'MCHbllI3IOIUHMHCH nopUIDIMH
(JJ,0 40 MJI) C nocrcneIllIblM )'BenmeHHeM OTHOCHTCJlbHOH nnOTHOCTH II:O
1025-1035 r/n. DpH OTIIOCHTCnbHoH nnOTHOCTH 1015-1016 r/n - H3-
tJMbHlliI nO'IC'IHlliI HCJ.lOCT3TO'iHOCTb, nHenoHccppHT, ry6ynonaTIIH. DpH
OTHOCHTCJlbHOH nnOTHOCTH 1010-1012 r/n- H30CTCHypIDI.
ru npOTI1BOnOKaJaHllRMH A-IR npOBcnCIIHR np06 c1>OJlbrap;ta RBJlRIOTCR: nO'le'maR
He.nOCTaTO'lHOCTb. HecjJpOTH'ICCKI1H ClIlI!lpOM, ocrpaR 11 XpOHM'ICCK3R IIenOCTaTO'lHOCTb
KpoBoo6palllCI1IIR.
ccneAoBaHMe aJOTOBblAel1MTenbHoH cJ>YHK'-'MM BKnlO'I3-
eT B CC6H onpCJl.CJlCIHIC COJJ,Cp)l(3I1HH B KpOBH OCTaTotJlloro 330Ta H
cro KOMnOHCHTOB (MO'ICBHHbI, MotJeBoH KHcnOTbI, KpcaTHHHHa, HII-
77

.1IJIKaHa). HOpMaJIbHaJi KOHltCHTpaltHJI HC6CJlKOBblX a30THCTbIX KOM-
nOHCHTOB B KpOBH COCTaBJIJlCT 14-28 MMOJlb/JI, IIJlH 0,2-0,4 r/JI. rH-
ncpa30TCMIIJI (noBbIllJCHIIC OCTaTo'moro a30Ta) nOJ\pa3J\CJlJleTCJI H8
npOi:IYKltHOHHYfO H PCTCHltHOHHYfO. KOTOpaJi B CBOfO O'lCpCJ\b MO>KCT
6b1Tb nO'lc'1II0H H BHCnO'lC'lHoii.
Pen'IIL\HOIiHaH I"ImCpaJOTeMHH JlBJllICTClI CJICJ\CTBHCM HCJ\OCT8-
TO'lHOro Bb/JICJICHHlI C MO'IOH 830TCOJ\CP>K8IIUIX BCIUCCTB npH IlOp-
MaJIbHOM HX nOCTynncHHII B KpOBb.
nO'lC'IliaH 06YCJlOBJICH8 CHH>KCHHCM BbIJ\CJIHTCJIbHOH qJ}'HKlt HH
nO'lCK H onpcJ\CJUlCTClI CTcnCHbiO nOpIDKCHHJI HC(POH8. YpOBCHb OCTa-
TO'lHOrO a30Ta nOBbIllIaCTCH B OCHOBHOM 3a C'lCT MO'lCBHHbi. BCTpc'la-
eTClI npH mOMcPYJIOHccppHTax, nHCJIOHccppHTax, aMHJIOHJ\03C H ry6cp-
KYJICJC no'lCK. Dpu OCTpOH II XpoHu'lecKoH nO'lC'iHOH nCJ\OCTaTO'lHO-
CTH aJOTCMUlI MO>KCT J\OCTHraTb 100-200 MMOJIb/JI H BblIlIC.
BlienO'le'lHaH B03HHKaeT BCJICJ\CTBHC HapymcnHJI OTIOKa MO'lH
no MO'lCBbIBOJ\JlIUIIM nyrllM, napYllIcHHlI rCMOJ\HHaMHKH C nOCJIC-
J\YfOU1HM CHU>KCIIUCM KJIy60'lKOBOH cpHJIbTpaJIHH. BCTpC'laCTCJI npH
CJ\aBJICHHH MO'lCBblBO.1VlIUHX nyrcH onyxOJIbfO, rHncpTpoqmpoBaH-
HOH npc.cTaTCJIbHOH >KCJIC30H; npH CCPJ\C'lHO-COCYJ\HCTOH J\CKOM-
nCHcallHH; 06C3BO>KHB8HHH opraHH3M8 (npOlpY3Hble nOHoebl U HeYK-
pOmu.uaR peoma, O.J/C02U, mpa8,UamUlieCKui'i UlOK, eaxapl/blU oua6em
U op.). A30TCMlliI npCBblllIacT HOPMY B 2-3 pa3a.
npOllYKuHoHHaH rHncpa30TeMHH pa3BHBacrCH npH nOBbIIlICH-
HOM nOCTynncHHH npoJ\YKTOB a30THcTOro 06McHa B KpOBb KaK npo-
JlBJlCHHC TKaHCBoro pacnaJ\a. A30TCMHJI 06YCJIOBJICHa nOBblllICHHCM
cOJ\cp>KaHHJI aMHIIOKHCJIOT, MO'lCBOH KHCJlOTbI, KpcaTHHHHa npH Ma-
JIOH3MCHCHHOM ypOBHC MO'ICBHHbl. BCTpc'laeTClI npH OCTpblX H xpo-
HIf'lCCKHX HHcpCKltHlIX. ccnCHCC. BblCOKHX JlHXopaJ\Kax, 061lIHpHbIX
paHCIIHlIX, nopa>KCHI1I1 nC'lCHI1, nOJ\>KCJIYJ\O'UlOH >KCJIC3bl. 3JIOKa'lCCT-
BCHllbIX HOBo06pa30BaHHlIX, JIY'lCBOH 60JIC3HH. a TaK>KC npH pC3KOM
nOBblllICHHH KaTa60JIH3Ma B PC3YJIbTaTC npUMCHCHHlI CTCpOHJ\OB, npH
THpCOTOKCHK03C.
(:J KOHUcliTpaUMJI JlIO'le6UII'" B Kp08M COCTaBnJleT 2.5-8.3 \lMomJn, OKono 50 % oc-
TaTO'ItlOrO a3OTa. Olla xapaKTcpH3YCT COCTOJlIIHC 6eJIKOBOro OOMCHa. MO'leBHHo06pa-
30BaTcnbHYIO cj!YHKUHIO ne'leHH, BblJ\cnHTcnbHYIO c!>YHKUI1IO nO'IeK. OT ypOBIiJi MO'lC-
BHllbI B KpOBH B 3Ha'IIITeJlbHOii Mepc 3aBliCHT pCTeHUHOHllaJi rHncpa30 remJl.
YBCnl1'1CHHC KOllueHTpaUHH UIIOUKDHD KpOBI1 Ha6nlOJ\3CTCJI npH HlnCHCHcj!I1I(a-
IIHH npOUCCCOB rllHCH11I1 B KI1U1KaX, pcTeHIUIOHIIOii mncp330TeMI111 H 'Ialue eccro C8H-
J\CTcnbCTBYCT 0 TJlJKCnoi! nO'le'lHoii IICJ\OCTaTO'lIiOCTH.
nOBblWCHIiC ypOBIiJi KpeDmUHUIID B KpOBH 1131100ncc J\OCTOBCpIiO OTp3JK3Cl'
IICIIOCT3TO'lHOCTb a30TOBblIlcnHTenbHoii cj!YHKUlIH nO'lCK H HMceT 60nbllloe 3113'1C-
liMe npl1 onpCJ\cnCIIIIH CTenCIiH nO'lc'IlIoii HCJ\OC1'3TO'IilOCTII. Fro KOll1tCHTpalUIJI B
KpOBIi o6paTiIO nponop1I0I13nbll3 Kntlpellcy. .l{BYKp3T1lOe nOBbllnCHHe ypOBHH
KpC3TMHMII3 B KpOBH conpoBQ)K,13CTCH CnH)I(eHllCM Kny6o'lKOBOii cj!HnbTp a lllll1
lIa50%.
78

cCl1eAOBaHMe rOMeOCTa1\1eCKOM 4>YHKMM BKJlIO'iaCT B
cc6j1 onpCJJ:CJIeHHC 3nCKTpOnHTHoro COCTaBa nna3Mbl KpOBH. OpH 3..160-
nCBaHHjlX nO'iCK COJJ:CP)!(dHHC 3nCKTponHTOB IHMCIUlCTCjI B pC3ynbTaTC
HapYIllCIIHjI MCXallH3Ma HX 06Mcna. OCTpM nO'iCllHaji IICJJ:OCTaTO'i-
HOCTb, XpOHH'iCCKHH HC<PPHT, nHcnOHc<pPHT xapaJ<TCpH3)1OTCSI nmcp-
HaTpHCMHCH, nmcpKanHCMHCH H mncpxnopcMHCH. OOCTOjillCTBO KOH-
llCHTpaL.lHH BO.n;0POLUlbIX HOHOB, HOHOB 6y<pCpHb1X CHCTCM onpCJJ:cnjllOT
KHCnOTIIO-lI.lCnO'iIlOH roMCOCTa3 (CM. pa3JJ:cn PeaKI.IW/ ItO'lU).
KnMpeHc (clcarancc) - 06"bCM nna3Mbi KpOBH, KOTOpblH, npoxo-
JJ:j1 'iCpC3 nO'iKH 3..1 onpCJJ:cnCHIIOC BpCMSI (I MHII), nonHOCTblO O'iH-
lllaCTCSI OT Toro lInli lIHOrO BCmCCTBa. O'iHlllCHliC OT BcmCCTBa ocy-
mCCTBnSlCTCSI nyrcM <plInbTpallHlI B Kny60'iKaX (KpeaTHHHH, THO-
cynb<p aT HaTpUSI, HHynllH), nyrcM CCKpCUHlI B KaHaJlbUaX
(nCHlillunnllH, CTpcnTOMlIUHH, npcnapaTbI HOJJ:a) Hnll nyrcM liX CO'iC-
TaHlISl.
KI1y60"KooaR <l>lIInbTpaMR
90-140 MJI/MHH
llo6blWellQ (60ncc 140 MnIMlIlI): paHHHc 3Tanbl caxapHoro JJ:lIa6CTa,
runcpToHlI'ICCKOH 60nc3HlI, HC<ppOTlI'iCCKOro ClIHJJ:poMa.
llOllu:HCella (50-15 MJIhnlH): nOllC'lHaSi IIC'!OCTaTO'iHOCTb OT KOM-
nCHclipoBaHHoH JJ:O cy6KoMncHcHpoDaHHoH CTaJJ:HlI.
llollu:HCella (MCHCC 15 MJI/MUH): JJ:CKOMncHcupOBallllaSi nO'iC'iHaSi HC-
JJ:OCTaTO'iHOCTb.
Kny60'iKOBaJi <plInbTpaUliji paCC'iliTblBaCTCjI no <popMync
C
(/J = --.M.. x Jl
C M'
K
rJJ:c C M - KOHllcHTpaUHSI B MO'iC npo<punbTpoDalllloro BcmCCTBa; C K -
KOHllclITpaUHSI <plinbTpYlOlUcrocSi BCll.\CCTBa B KpOBH; PM - 06'bCM
MO'iH, BblJJ:cnSlCMOH 3..1 MHHyry.
npo6a Pe6epra - Hccnc.n;OBaimC <pHJlbTpaWiH no 3HJJ:orCHII0M)'
KpCaTHHHny. Opll npone.aCHHH npo6bl Pc6cpra c06HpaeTCSI MO'ia 3..1 CYIl<H
Ii Bbl'iHCJUlCTCjI MHH)'THbrn JJ:HYPC3, onpeJJ:CJISlCTCSI KOHucmpaUl\j1 KpCaTH-
HliHa B KpOBli 1I B MO'iC. 00 BbIll1CnpllBCJJ:eHHOH <popM)'nc paCC'iIITbIBaeTCSI
KJIy6o'iKOBaSl <pHJlbTpaUIDI. OpllHHMaeTCSI, 'iro COJJ:cp)!(aImc KpcaTHHlIHa B
nna3Me KpOBH H B KJIy6o'iKOBOM <pHJlbTpaTC O,il.HllaKOBO. 00 H3MCHeHlIIO
ero KOHLl.ClnpaLl.HH nocnc npOXO>K.L\CHHSI 'iepe3 KaHanbllbI MO:>KHO onpeJJ:C-
nlITb npol.lCHT pea6cop611poBaHHOH BOJJ:bl (KaHanbueBYIO pea6cop6Ul\1O).
KallaJIbUCBaSi pea6cop6uuSi paCC'iHTbIBaCTCJI no <popMyne
(/J-/J
R=--.M..xlOO.
(/J
rJJ:c (]J - Kny60'iKOBaSi IpHnbTpaUHSI; PM - 06'bCM MO'iH, DbUI.CnSlCMOH
'Ja MHHyry.
79

KaHanbeoaJl pea6cop6MJI
98-99 %
l106blUlella: nmOBOnCMH1.JCCKHC COCTOHHml.
llOIlUJlCeHa: lIapYlllemiC 4>YIIKQHH KallaflbQCB (nHcnollc4>pHT, HII-
TCPCTHQHaflbllblH IICc!>PHT, npHMcllclIHC .'U1ypCTl1KOB, n01.JC'maH HC-
)J,OCTaT01.JHOCTb ).
i>1CCIlE.QOBAHi>1E KAnA
KaJI (faeces, copros)
Moe npH )J,c4>eKaQHH.
CO)J,cp)f(HMOe TOJrCTOH KHlllKH, Bbl)J,enJle-
m HCJlbJR 'IOCTaBJlIITb KaJ1lU1l1 l1eCJlCJJ.OBalll1l1 noeJIC KJlIIJMbl: noeJle npliCMa MCJJ.IIKa-
MCIITOR. RbIJblBalOWIiX cjJYHKUIiOIlaJ1bllble I1JMCIICIIMR >KCJlYlIO'lIlD-KII11IC'I1I0I'O rpaK ra 11
MeHRIOUlliX xapaKTep KaJla (6CJlJla.lIOllllbl, nHJlOKapmm3. IIpCllapaTOB JKeJleJa, BI1cMyra,
6apIIII, BBeJJ.CIII1I1 eBc'Icii, KaCTOpooOlO 111111 RaJCJlI1HOROrO Maella).
Mal"CpHaJl }lJlH HCCJlC}lOBaliltH. CBC)f(HH Kafl )J,OCTaBnHfOT B na-
60paTOpmO B CYXOH. 1.JHCTOH nocy)J,c IIC n03)f(e, 'leM 1.JepC3 8-12 q no-
ClIC cro Bbl!\CnCIIHH.
Konp0110rW'JECKE nOKAJA TEI1
nOKBJBTC11b
1I0pMaJlLHbiC ]HB'ICHHR
KOnH'IeCTBO]a eyrKIi. r/cYT .................................................... 100-250
KOllcllcTelluI111 ......................................................................... OcjJOPMqCHHblii
llBC r ............ ........ ................. ..................... ....... ................ ........ KOpl1'lIICSblii
3anax ........................................................................................ KaJ10BbIH, IICpCJKIIH
naTOnOrll'leCKlle npl1MeCIl
(KpOBb. e1111"Jb. I Hoii. flapB]IITbl) .............................................. OreyrCTBYIOT
XI1MM'ICCKHC eBOHCTsa:
peaKIIIIII (pll) ........................................................................ HeiiTpaJ1bHaR
CTCpK06I1JUIH. Mr/cyr ........................................................... 75-350
cKpwTall KpOSb ...................................__................................. OreyrcTByeT
paCTBopllMblii 6enoK ............................................................. OrcyrcToyel
MMKpOCKOIIIIII:
MbJWC'IlIbIC BonOKlla ............................................................. OTeyrcTBYIOT
eOeil.MIII1TenbHaR TKaHb ...................,.................................... OrCyrCTBYeT
HciiTpaJ1bHblii >Kl1p ................................................................ OrcyrcTByeT
>Kl1pHbJe KlIcnOTbJ ................................................................. OrcYTcrBYIOT
Mbilla ..................................................................................... Ile]Ha'lHTenbHoe
KOnM'ICC1BO
paCTII rCnbllBJI KJleT'Ial Ka ...................................................... B paJllblX KO.ql1'1CCTBax
KpaXMaJI ................................................................................ OTCYTCTOYeT
HO.1ocjJl11bHall cjJnopa ............................................................ OreyrCTBycT
JlCHKOl.llllbl ............................................................................ EJJ.IIIUI'IlIbJC II npcnapaTe
80

KonMECTBO
100-250 r/cYT
n06b1lUeHO:
i npH HapYlllcHHH nocrynncHHSI >KCn'lH, Hc,nOCTaTO'lHOCTH no,n>KC-
ny.no'iHoif >KCnC3bl, HapYlllcHHH ncpcBapHBauHSI B TOHKOif KHlllKC
(6pooU'lbHaJl U 2HWlOCmHOJl oueneneUJl)
i npH YCHncHHH ncpHCTanbTHKH
i npH HapYlllcHHH BcaCblBaUHSI (xpOHUlieCKUii 3Hmepum)
nOHu3ICeHo:
! npH 3anopax
)(OJlH..eCTBo 3KCKpCMCUTOB 3aBHCHT OT xapaKTcpa H omcMa nH-
lll.H. Quo YBcnH'IHBaCTCH npH ynoTpc6ncuHH 60raToif KJlCT'IaTKoif
pacTHTcnbuoif nHlll.H H YMcublllaCTcSI npH npHcMc ncrKoycBoSlCMblX
npo,nYKTOB.
(;] 3anop (constipatio, obstipatio) - 3aMelUlCHHoe, 3aTpYlUICIIHoe HJlH CHCTeMaTH'ie-
CKH HC.QOCT8TO'iIiOe onopOJKHeHHe KHWe'iIlHKa, lUIHTenLII3JI 33.QepJKKa CTyna (60nee
.QBYX cyrOK). 011 6L1Baer:
OpI"BHH'IeCKHII - npH MeXaHH'ieCKOM npenllTCTBHH (cy.JlCel/ue npOC8ema 8CJ/eocm-
8ue onyxoJ/u, cpaU/el/uii. py6tj08; npu al/O,\/GJ/WIX pa38umUR - ..uei'acuz'lfa. Mei'aKOJ/OH,
oU8epmuKY,7umbl);
+YHKIIHOHBJlLHLlH - 8J\HMeHTapHLIe (ynompe6J/el/ue ,7ei'Koyc80J/e.\/oii nuU/u),
HeBporeHHLle (amOHU'leCKUe, cnaCmU'leCKUe), TOKCH'JeCKl1e H .lip. npH'iHHLI.
KOHCMCTEHLlM
ocIJopMJleHl1 hlH
nJlOTHLIH HJlH "oBe..HH" K8JJ - CTCH03 HJlH cna3M TonCToif
KHlllKH, npH 3anopax.
KawHueo6pa3HhiH - YCKOPCHHaSI 3BaK}'aQHH H3 ToncToif KHlllKH,
npH KonHTC C nOHocoM, 6po,nHnbHoif ,nHcncnCHH.
MaJeBHJJ;HLIH - npH HapYlllcHHH CCKpCIUIH no,n>KCny,nO'lHOH >KC-
nC3bl, OTCyrCTBHH nocrynncHHSI >KCn.,H.
)l(HJJ;KHH - HCJJ;OCTaTO'lHOC ncpcBapHBaHHc B TOHKOH KHlllKC
(2HlLWemHOJl oucneneUJl, YCKopeHHOJl 36aKya1JUJl) H ToncToH KHlllKC
(no8b1UleHHOJl ceKpelJUJl 6 mOllemOM KUUleliHUKe).
neHHCTLIH - npH 6po,nHnblloif ,nHcncnCHH.
"rOpOXOBOro cyna" - npH 6plOillHOM TH$C.
"PHCOBoro OTBapa" - npH xoncpc.
«J>opMa H KOIICHCTeHUHH Kana 3aBHCHT OT co,ncp>KaHHH BO,nbl.
DpH CMClllaHHoif nHlll.C Bo,na COCTaBJIHCT 75-80 % HCnpa>KHeHHH, Ha
OCTaTKH nHlll.eBblX Macc, 3nHTCnHaJlbHblC KJlCTKH, non16111Hc MHK-
p06HblC Tcna npHxo,nHTCSI 20-25 %.
40- 7J
81

I:} nOlloc(diarrhoea) - 'IaCTbIH JKHllKI1H cryn - IIBJllleTCIi npH311aKOM 3360JleB3HHII
KI1We'lHlIK3 011 MOJKeT 6blTb IIH«!>eKUI10Il1l0rO, TOKCM'IeCKoro, 311110KpHIIIIOrO, annep-
rJI'ICCKOrO, IICpBIIOrO npOIlCXOJlCllellllli. B OCIIOBe MCX311H3M3 nOHOCOB nCJKH1 Hapywc-
IIlfe MOTOpHOH M CCKpe-rOpHOH «!>YIIKUHI1 Kl1llJe'lHHK3.
LlBET
KOpH'llleBLlH
.LJ:erreo6pa31lblH - npH KpOBOTC'lCHmIX H3 BCPXHHX OT,aCnOB >KC-
ny,aOIJHO-KHIlICIJHOrO TpaKTa; ynOlpc6nCHliC CMOpO,aliHbI, IJCpHliKIi,
npliCM BlicMyra.
TeMIlO-KOpH'llleBbIH - npli 3anOpaX, HC,aOCTaTOIJHOCTIi >Kcny-
,aOIJHOro nHlCBapCHliJl, KOmnC, rHliJIOCTHOH ,aHCnCnClili, MJlCHOH
,alieTC.
CBCTlIO-KOpH'llleBbIH - npH YCKOPCHHOH 3BaK)'aI.{HIi li3 TOnCTOH
KliIlIKH, npH paCTHTCnbHOH ,aHCTC.
KpaCHOBaTblH - npH KOnHTC C H3'bH3BnCHHJlMH.
3elleHLlH - npH cO,aCp>KaHHIi 6linHpy6wJa, 6HnHBCp,aHHa, npH
nOBbIIliCHHOH ncpHCTanbTHKC.
CBeTlIO-)I(e.JJTbIH - npH Hc,aOCTaTOIJHOCTIi no,a>KCny,aOIJHOH >KC-
nC3bl, npH Hc,aOCTaTOIJHOCTIi ncpCBapHBaHHJI B TOJICTOH KHIlIKC, 6po-
,aHJIbHOH ,aHcncnCHH.
CepOBaTo-6e.JJbIH - aXOnHIJCCKHH Kan npH HcnOCT)'nnCHHH >KCJI-
'lH B KHIlICIJHliK.
I(BeT 3KCKpCMCHTOB onpc,acmlCTCJI npHcyrcTBHCM CTcpKo6Hnli-
Ha H HMCCT KOpHIJnCBbIH OTTcnOK. Ha BCT Kana B 3HaIJHTCnbHOH
MCpC BJIHJlCT xapaKTCp nHWH, ynoTpc6nCHliC HCKOTOpbIX nCKapCTB
(CAI. 8b/we).
3AnAX
Ka1l0BLlH, lIepe3KHH
rllHlIOCTHblH - npH rHHnOCTIIOH ,alicncnCHH, Hc,aocTaTOIJHOCTH
>KCJIy,aOIJHOrO nHwcBapCHHJI, KonHTC C 3anopOM, MOTOpHbIX pac-
CTpOHCTBax KliIlICIJHHKa.
3110BOHHbIH - npH HapyrncHHH CCKpCLlHH no,a>KCJIy,aOIJHOH >KC-
nC3bI, OTCyrCTBHIi nOCTynncHliJi >KCnIJIi, rHncpCCKpCLlliH TonCTOH
KHIlIKH.
KHClIblH - npH 6po,alinbHOH ,aHcncncliH.
MaC1ISlllOH KHClIOTbl - npH YCKOPCHHOH 3BaKyaLlHH" H3 TonCTOH
KHIlIKH.
XapaKTep 1anaxa HCnpa>KHCHHH 3aBHCHT OT KOnHIJCCTBa TaKHX
apOMaTHIJCCKHX BCWCCTB, KaK CKaTon, HH,aon, clJCHOJI H ,ap., o6pa-
3YlOWHXCJI B pC3ynbTaTc ncpcBapHBaHHJI nHWH.
82

nAT0110rMECKME nPMMECM
KpOBL, CJlH3L, rIlOU, lIap83HTLI
OTCYTCTBYIOT
KpOBL - nOJlBJUICTCJI npH HapYWCHHH llCJIOCTHOCTH CJIH3HCTOH
060JIO'-lKH )f(CJIY.lI.O'-lHO-KHWC'-IHOro TpaKT:i.
rHOU - 06HapY)f(HBaCTCJI npH .lI.H3CHTCpHH, Jl3BCHHOM KOJIHTC,
pacna.n.c onYXOJIH TOJICTOH KHWKH.
CJlH3L - npH Bbl.ll.CJICIIHH H3 BCPXHHX OT.lI.CJIOB CJ1H3b ncpCMcwaHa
C KaJIOM, H3 HH)/(HHX - JIC)f(HT Ha nOBcpXHOCTH HCnpa)/(HCHHH.
napa3Hl'LI - BH3YaJIbHO MOryI' 6b1Th 06Hapy>KCHbl aCKapH.lI.bI. OCT-
pHllbl, BJIaCOmaB, 06PblBKH H OT.lI.CJIbHblC '1JICIIHKH nCHTO'-lHbIX '1CpnCH.
II) npHMCCH B Kanc MOryr nOIlB!IIITbCllllpM HapYWCHl1H ncpcaapMBaHlI1I 111111111:
JlIICHTOpeR (Iientonhoca) - lIanl1'1HC B K3J1C KpY"llbIX K)'CO'lKOB HCllepeBapeHHOH 1111-
U1H (npH Bblp3)KCIIHOH HC.'IOCTaTO'IHOCTII JKCnY110'lHoro II lIalll(pcanl'lCCKoro IIMWCBapc-
HIIII);
"peSTopCR (crcatorrhoea) - H3J1I1'1I1C B HCllpaJKHCHHIIX '1aCTHU IIcncpCBapCHHoro
MJlCa (MbIWC'IHblX BonOKOII IIPH MIIKPOCKOIIHI1);
CTeSTopeR (stcatorrhoea) - 6onbwoc COl1CpJKaHHC B K3J1C JKMpa.
PEAKUMs:I,PH
HeiiTpaJlLH8H
CJl86oU{enO'l1l8H - npH HC.lI.OCTaTO'-lHOM ncpCBapHBamUl B TOH-
KOH KHWKC.
eJlO'-lHaH - npH HC.lI.OCTaTO'lHOCTH )/(CnY.lI.O'-lHOrO ncpCBapHBa-
HH", HapYlI1CHHH CCKpCl{HH nO.ll.)f(CnY.lI.O'-lHOH )f(CJIC3bl, rHncpCCKpCl{HH
>KCnC3 TonCTOH KHWKH, npH KonHTax, 3anopax.
Pe3KoU{eJlO'-lHaH - npH rflHJ10CTHOH JI.HCnCnCHH.
Pe3KOKHCJl8H - npH 6pOJI.HnbHOH .lI.HcnCnCHH.
CTEPK06Ml1MH
75 - 350 Mlky-r
llo6bllUelIO (zunepxoJlurtecI<Uu KaJI):
t rCMOnHTH'-ICCKCUI aHCMH"
t YCHJICHHOC )f(CJI'ICOTJI.CJ1CHHC
lloHu:»ceHo (axoJlurtecKuii KaJI):
! o6T)'pal!HOHHa" )f(cJITyxa, XOJ1aHrHT
! 3a6oJICBaHHJI nC'-ICHH
IiUJlupy6ulI:
t nOBblWCHHaJi MOTopHKa, YCKopcHHa" 3BaKyal{HJI H3 KHWKH
t nO.ll.aBnCHHC MHKpo4>nopbl KHWC'-IHHKa ((hUme,7bllblli npue,H allnlll-
6uomwW8 U eYJ1bcjJaHLl.1lLuu006)
83

Q npolla WMHlITa. .l(;T1I YCTaHOeneHHII HaJJH'I1I1I IInll OTCyrCTBHII crepK06HnHHa MC-
nOnb3YeTCli peaKI(HR C cyncMoii. KaJJOBaJI 3MynbcHli B 7,5 %-HOM pacTBope cyneMbi
npH HaJJH'IHH cTepK06HnHHa CTaHOBH"IT1i p030BOH Hnll KpacHoH, a B npMcyrcTBHH 61t-
nltpy6HHa - 3eneHOH.
.l(;T1I TO'lHOrO onpelleneHMII KOnll'leCTBa CTCpK06MnMlta npMMeHlleTcli cneKTpO-
CKOnH'IeCKHH MeTOllMccnellOBaHHII.
III K034t4tHI(HCHT AJvIepa (I: 10 - 1 :30) - COOTHoweHHe yp06HnHwCTepK06MnHH:
YBenM'IIIBaeTCIi 110 1:5 - 3: I npM nOpa)KeHIIII napeHXIIMbi ne'leHII;
YMCHbWaeTCII.no 1:300 - I: I 000 npH reMOnHTH'ICCKOH aHeMHH.
CKPblTAR KPOBb
OTCYTCTByn
llpucymcmByem:
f KpOBOTC<JCHHH H3 >KenY,lJ.O<JHO-KHllIC<JHOrO -rpaKTa
t KpOBOTC<JeHHc H3 BCPXHHX ,lJ.blXaTCnbHblx nyrcH (npu 3aZllamb/6a-
HUU «p08U)
f pacna.u. onyxoneH :>KKT
l:l npolla rperepceHa. npM HaJJII'IHH IIaJKC HC3Ha'lIlTenbIiOro KOnll'lCCTBa KpOBII B
KaJJe npll .n06aBneHIIII paCTBopa lIeH311J{HHa B YKCYCHOH KHcn<rre B Te'leliHe 2 MIIH no-
IIBnlleTCIi CIIHe-3eneHoe oKpawIIBaHHe. PeaKuIIII OCHOBaHa Ha CBOHCTBe OKCII1183bl rc-
Morn0611Ha OTluennllTb OT nepeKIICII Bo.nopo.na aToMapHblH KllcnOpO,ll, KOTOpblH 113MC-
HlieT oKpacKY 6eH311I1I1H8. JJ.0 npoBe.neHHII npo6bl 6onbHoH B Te'lCHlle rpex J1HeH .non-
)KeH nonY'IaTb .nMery 6e3 Mllca II PbI6b1. TaK KaK llOnO)KMTenbHblH pe3ynbTaT MOJKeT
6b1Tb 06ycnoencH HaJJII'IlIeM B Kane MbiWe'lHblX BOnOKOH.
PACTBOPMMblH 6EI10K
OTCYTCTByeT
llOR8JlRemCR:
t rHHnOCTHaH ,lJ.HCnCnCHH
f KonHT, nOBblllICIIHaH CCKpeUHH >KenC3 TOnCTOH KHWKH
f KpOBOTC<JCHHH
m npolla TpH6yne-BHwHRKoBa. no.n B03I1eHCTBlleM KIIcnOT 6enOK IInH MYUIIH Koa-
rynllpYeT II Bblll8IIaeT B OC8IlOK, 8IlCop611PYx 'IaCTIIUbl Kana 113 npllrOTOBneHHOH
3MynbCIIII. PeaKUIIII oueHIIBaeTCIi no CTeneHII npOCBeTneHIIII JKIIMKOCTII.
MMKPOCKonMfI KAnA
MHKpOCKonHH Kana n03BonHCT .lJ.CTaJIbHCC H3)"1HTb xapaKTCp na-
TonorH<JCCKHX npHMCCCH B HCnpa>KHCHHHX. 06HapY>KCHHC 3nCMCHToB
nHIl.\CBOrO npOHCXO>K.1l.CHHH ,lJ.aCT npe,lJ.CTaBneHHe 0 CTcnCHH ncpCBa-
pHBaCMOCTH nHIl.\H (pHC. 16).
m .l(;Tx MI1KpOCKOnMII O.nHOBpCMCHHO roTOBRT HeCKonbKO npcnapaTOB:
lIaTIIBHblH npenapaT;
C paCTBOpOM JllOronli - Ha npllCyrcTBlle KpaXMana II HOIlo4>lInbHoH 4>nopbl;
C MeTHJlCHOBbiM CIIIIIIM - Mil 0611apY)KeHIIII )KllpHblX KIIcnOT, MbIJI II HeiiTpaJJbHD-
rOJKMpa;
84

C rnHUepHHOM - llJIR 06HapY)I(eHHJI RHII renbMHHTOB;
C CY.lIaHOM III - llJIR .lIHljlljlepeHuHaMM HeihpaJIbHOrO )l(Hpa.
MblmelJHble BOJlOKHa - BbUIBmnOTCR B 60nblllOM KOnH'leCTBe
H3-3a HCJ10CTaTO'lIlOro nepeBapHBaHHR 6enKOB npH aXHnHH, aHal(HJ1-
HOM COCTORHHH, oCna6nellHH naHKpeaTH'leCKoro nCpeBaplmamill,
YCHneHHH nCpHCTaJlbTHKH KHIlIC'lHHKa.
ill B HenepcsapeHHblX MblWC'IHblX BonoKHax RCHO BblpaJKeHa nOnepc'lHWI HC'Icp'leH-
HOCTb (B nepesapeHHblX BOROKliax 1I0nepe'lIIWi HC'Iep'leHHOCTb He COXpaIlJlCTCJI).
CoeJJ.HHHTeJlbHOTK3HHble BOJlOKH3 - HaXOJ1RTCR B KaJlC npH HC-
J10CTaTOIJHOCTH >KenYJ10IJHOrO nepeBapHBaHHR (CHH>KeHHe KOnHIJeCT-
Ba HnH OTcyrcTBHe CBO-
60J1HOH COnRHOH KHcnOTbI 5
B >KenYJ1Ke) H npH $YHK-
l(HOHaJlbHOH HCJ10CTaTOIJ-
HOCTH n0J1>KCnYJ10IJHOH
>KCne3bI.
HeHTpaJIbHblH amp -
nORBnRCTCR B HCnpa>KHe-
IIHRX npH HeJ10CTaTO'lHOM
nocTynncHHH naHKpcaTH-
IJeCKOH nHna3bI, >Ken'lH,
HeJ10CTaTO'lHOM nepeBa-
pHBaHHH B TOHKOH KHIlIKe.
(II OKpaWHBaCTCR cy.aaHOM III
B RpKO-OpaH)I(eBbIH UBCT.
PHC. 16. HaTHBHblH npenapaT KaJla:
1 - MbIWC'IHblC BOllOKHa HcncpcBapcHHblc; 6 - nepcBa-
peHHblC; 2 - >Kl1pHblC KIlCIIOTbl; 3 - Mblna: 4 - Kan 111
Jl(Hpa; 5 - lUIC'NaTICa HcncpcBapHMa.; 8 - IIcpcBap"M8JI;
7 - .D.CTpHT; 9 - COC.D.I1HHTCllbH8JI TKaHb
jKHpHble KHCJlOTbl H
MblJl3 - COJ1ep>KaTCR npH
YMellblllCHHH nocTynne-
HHR B KHllIeIJHHK >KCnIJH, HapYllleHHH CeKpel(HH n0J1>KenYJ10'lHOH >Ke-
ne3bI, 6p0J1HnbIlOH J1HCnCnCHH.
KpaXM3J1 - npH CHH>KeHHH aMHnOnHTHIJeCKOH $YHKl(HH nO,lJ)l(e-
nYJ10IJHOH >Kene3bI HlIH YCKopeHHOH ncpHCTanbTHKe KHIlICIJHHKa.
(II B npHcyrcTBHH paCTBopa JIlOronR KpaXMaJI. B 33BIICIIMOC'IM OT CTIIlIHM lIepcBapH-
BallHR, npM06pe-rae-r IjIHoneroBYIO, KpaclIYIO, )l(enTYIO WI" C"1I101O oKpacKY.
HOJJ.OcJIHJlbH3H cJlJlOp3 - OTMeIJaeTCR np" HeJ10CTaTO'lHOCTH >Ke-
nYJ10IJIlOro nHmeBapeHHR, lIapYllIeHHH CeKpel(HH n0J1>KenYJ10'lHOH
>Kene3bI, HCJ10CTaTOIJHOCTH nepeBapHBaHHR B TOHKOH KHIlIKe, YCKO-
peHHOH nCpHCTaJlbTHKe.

SlMUA rEIlbMHTOB
OTCYTCTBYIOT
06Hap)')KeHHe JUll.( renLMHHTOB JlBJIJleTCJI Ba)KHLIM 3neMeHTOM
MHKpOCKOnHIJeCKOrO Hccne,uOBaHHJI Kana (pHC, 17).
m 06HapyJKeHHe npoBOlVlT B HaTMBHOM MaJKe, OCBeTneHHOM 50 o/...lIblM paCTBOpoM rnH-
epHHa. XopowHe pe:!ynbTIlTbI npM MHKpOCKonMH l1aer MeTOli TOnCToro MaJKa no KSTO.
JJ,JUI KOHueH1palVlH IIHU renbMMHTOB B npenapaTe npHMeHlleTCli MeTOlI o6oraweHMJI no Ks-
Jl8HTapRII, OCHOBallHblH Ha BCnnbITHMIIHU renbMHHTOB B HaCbIeIlHOM pacTBOpe HMTpaTii
lIaTpMJI, MMelOwero 60nee BblCOK)'1O OTHOCKreJJbHYIO nnOTHOCTb, WlH MeTOli KpaCHJlbHH-
KOBa C npHMeHeHHeM l1erepreHTOB, npH KOTOpoM nOlll1eHCTBHeM nOBepXHOCTHD-aKTHBllbIX
BeweCTB IIHua renbMMHTOB OCe060Ji(./l1llOTC1i OT cj>eKaJIHH H KOlWeHTpUPYIOTCIi B OC3.iI.Ke
, I .....:::;.. .
. .......\
: ... If'
8 · ,- b:"J
..
. I. t&..
._
1 2 3 4 6
- .
I ".
,.. 
7  9 11
8
12
13
14
PMC 17. RHua rnHCTOB:
1 - B118Cornaaa: 2 - 8HKIUIOCTOMbI: 3 - OC"t]JHUbI: 4 - cH6wpcKOA JIByycn<H: S - nee-
HOHOii JIBYYCTKH: 6 - WHpoKOro nctrrea: 7 - K8pJlHKOBOro ucnHJI: 8 - 'UCHHKH He-
BOOpyJKCHHOro ucnHJI; 9 - lliio HCBOOp)"KCHHOro ucnHJI: 10- 'VleHH"" BOOp}'>KCHHO-
ro uenHII: II -lIii IIoopy1KCHHOro uenHJI; 12, 13, 14 HIS - lliiue 8CK8p1tll
86

IfICCJlE.QOBAHIflE >KEflY.QOYHOrO
CO.QEP>KIJIMOrO
jl(eJIyoIlHLlii COK (succus gastricus) - CCKpCT TPy6<JaTbIX >KCnC3,
paCnOnO>KCHHbIX B CJIH3HCTOM >KCJIY.D;Ka. )l(cnY.D;O<JHbIM COK COCTOHT
H3 MHOro<JHCJICHHbIX OpraHHIICCKHX H HCOpraHHtJCCKHX COC.D;HHCHHM,
cnOC06CTB)'IOIllHX npOl.{cccy nHI.l{CBapCHHH.
MaTepHaJi JIH HCCJleOBaHHH. )l(Cny.D;O<JHOC CO.n:Cp>KHMOC Ha-
TOmaK, npH O.D;HOMOMCHTHOM H3BnCtJCHHH H npH <!>paKQHOHHOM 30H-
.n:HpOBaHHH.
>KEnYAOYHbl COK
nOK838Tenb
HOpM8JJbHble
3H8'1eHHII
KonH'JeCTSO, n/cyr ...........................................................................2-3
I..{seT .................................................................................................DeCliSeTHblii
3anax................................................................................................OrcyrCTSye-r
KHcnOTHocTL (pH) ...........................................................................1,6-2
CnI13L................................................................................................He60m,woe
KonH'JeCTBO
MHKpocKonHII JKenYJ\o'JHoro cOJ\epJKHMOrO ...................................HenepesapeHH3JI
KJleT'IaTKa
nOK838reJlH aceJlYllo'lHOii ceKpeUHH
CCKpCIIHII >KcnYJ1K8
nOK83IITCJ1L nocne cy6MaK- MaKCH.
H8TOll.18K 6aJaJlLHaR np06Horo CHMaJ1b- MaJlLHLdi
:J881P8K8 HblHTecT TCCT
061>eM )f(enYJ\o'Jlloro COKa, Mn 5-40 50-100 50--100 100-140 180-220
061U3JI KHcnOTHOCTL, MMomJn 6-8 40-60 40-60 80-100 100-120
CBo60J\H3JI conliHali KHcnOTa,
MMomJn 0 2()-40 2()-40 65-85 90-100
,l{e6I1T-'Jac conllHoii KHcnOTbI,
IIIMomJn 0 1,5-5,5 1,5--6,0 8-14 16-26
,l{e6I1T-'Jac cs06oJ\Hoii conllHoii
KHcnOTbI, MMomJn 0 1,()-4,O 1.()-4.5 6,5-12 16-24
,l{e6HT-'Jac nenCHHa, Mrln 0-21 1()-40 2()-40 50-90 90-160
87

-
KonMECTBO >KEl1YAOHOrO COKA
2 - 3 nlcYT
06"bCM >Kcny.no'lHoro CO.nCp>KHMOro naTOlllaK - 5-40 Mn.
fl06b1Ulello:
i nOBbllllCHHC CCKpCUI1H (R38ellllaR 60J7e3Hb, cunepalJUdllblU zaem-
pum, eUlldpo,,, 30/L1UHcepa-3lwueoHa)
i 3aMc.nnCHHC 3BaKYaJ..U1H (emouKuu ena3.M. emeH03 npu6pamlluKa,
0I1}'XO;7b :JICellydKa)
i pc$nCKTOpHOC YBcnH'IcHHc (o.xo;7elJUemUm, o.anneHdulJ um )
flOHU:HCeHO:
! CHH)I(CHHC CCKpCI..{HH
! YCKopclIHa$l 3BaKyaUH$I, HcnonHOC 3aKpbITHC npHBpaTHHKa
! npH BBC.nCHHH nCKapcTBcHHblX BClllCCTB (amponuHa, zaH2Jluo6J7o-
Kamop08, wleYlluHa, dUa3enCL\w)
....BET
6eCQBeTHLlH
lKeJlTOBaTO-3eJ1eHLlH - npH npHMccH >KCn'!H.
KopH'!HeBbIH - npH npo)J;on)l(HTCnbHoM npc6bIBaHHH KpOBH B
)l(cny.n KC .
KpOBb B BUlI.C IIP0)KUJlOK - B pC3ynbTaTc TpaBMbl cnH3HcToH,
npH I<pOBOTC'ICHH$lX H3 BCPXHHX .nblxaTcnbHblX nyrcH.
3AnAX
OTCYTCTByeT
rllHJlOCTHblH - npH 3aCTOC, CTCH03C, OTCyrCTBHH COn$lHOH KH-
cnOTbl, pacna.nc onyxonH, rHHCHHH 6enKoB.
cnM3b
He6oJlblUOC KOJlH'IeCTBO
fl06b1UleIlO:
i racTpHTbl, $I3BCIIHa$l 6onc3Hb
i nonHn03, paK
MMKPOCKonMSI COAEP>KMMOrO
MHKpOCKOnH'ICCKOC Hccnc.nOBaHHC >KCny.no'iHoro CO.ncp>KHMOrO
(pHC. 18) n03BOn$lCT non}"lHTb .nononHHTcnbHblC CBC.nCHH$I 0 COCTO$l-
HHH CJlH3HCTOH >Kcny.nKa.
88

Bcc :mCMCUTbl, nCTpc'IalO-
ll.{HCCH npH MHKpOCKOnHH, J/.C-
nHTCH Ha 3nCMCHTbi CnH3HCTOH,
OCTaTKH nHU{H H MHKpOOpra-
HH3Mbl.
OC06CHHO TU{aTCnbHO H3Y-
'1alOT COJ/.Cp>KHMOC nOpUHH Ha-
TOU{aK ,nnH 06HapY>KCUH}I B
HCH 3nCMCHTOB 3aCTOH H HO-
Bo06pa30BaHHH.
3acroHHblH )Ke.rIy,nO'lHbIH
COK - COLlCp>KJIT MOnO'lHYIO KH-
cnory, 06paJyroUlylOCH B pe-
3ynbTaTC >KH3HCJ/.CHTCJlbHOCTH
naJIO'lCK MOnO'lHOKHcnoro 6po-
>KCHWI HnH MCTa60nH3Ma HOBO-
06pa30BaHHH, H COnpOBO>KJJ.aCT-
CH nOHBITCHHCM paCTHTCJlbHOH
KJICT'IaTKH, >KHpa, nCHKOUJITOB,
3pHTpOUHTOB, capwm, J/.pO)!Qf(C-
BblX rpH6KOB, 3nJITCJlIDI.
ATHnH'IHbIC KJlCTKH - nOHnn}llOTCH B Ha'laJIbUOM :nanc MaJIHr-
HH3HpOBaHHOrO pOCTa, a.aCUOKapLlHHOMC, HOBo06pa30naUH}lX.
JIcHKone,ne3 (Icucopcdcsis) - onpCLlcnCHHC KOnH'ICCrna nCHKO-
LlHTOB B >KCnYLlO'lHOM COKC. B HOpMC OH panCH (0,2 - 0,3)x10 9 /n H
pC3KO yncnH'IHBaCTCH npH BocnanCHHH CnH3lfCTOH >KCnYJJ.Ka.
.. :
.:;
. '
- 1 f " i :.-1t "
t. _.. . I
. t! '. \', ;  "
\I\-. f: ' 6
.I;', . . "'."'.
_:,.." 5
..;.:}-
".') ,,: . 9
..... . .I.....
::!. i?;;"
.I <!:<:; ......, .
8 '" ,
4
3 .
t, .;\."
.. p  :.
r>
f'-",
4:..
. ....
.......
! .:
.,:;
./  h-.
. . 
\' .... r 7
10 '
PMC 18. CO!\epJKIIMOC )l(Cny.aK3 npM MI1K-
poCKOIIHII:
I - MloIllIeHLle BonOKHa; 2 - KpaxMMbHLlC
JCplla; 3 - KanenbKH "'Hpa: 4 - pac rHTcnbllaR
KIlCT'taTKa: 5 - MOCKHH 3nHTenHH li3 IIOnOCU1
pta; 6 - IIIln"HJ\PHccKHii 311HTC !Hi!; 7 - R..Jpa
nci!KoIIHToB; 8 - capHHbl: 9 - ,I.pO>K>KCBloIe
KJle.. K,,; J 0 - 118JIOKH MonOHOKHcnOI"O 6po.
)ICe"",.
KIo1CIlOTHOCTb, PH
pH 6313Jlbl13H =1,6...2
KHCJlOTIIOCTb )KCJI}'Jto"IHOro CO,nCP)KHI\IOI'O onpcJ\cn}lIOT no IfC-
cnCJJ.onaHlflO COn}lHOH KlfcnOTbl (HCI). KOHUCHTpaUlflO xnoplfcToBO-
JJ.OpO.lUIOH KHcnOTbI B MOMCHT 06pa30BaHH}I 0603Ha'la1OT KaK ncp-
Blf'mylO KHCJlOTHOCTb.
W npH HCCnCJlOB3HMM KMCJ10TOo6p8JYlOlI{cii tJI'HKIUIH 1KC.IY.ilK8 onpe.'{cnJlIOT 06-
YIO KHcnOTHOCTb, cBo6o.aHYIO H CBIIJ3HllYlO conliHYIO KMCJIOry, KIIcnOTHblH OCTaTOK.
CBo6o.aH8R CO:JRII8R KHCJIOT8 co.aep)l(HTCJI B )l(CJly.aKC R BMJJ.C JlMCCOUIIMPOB3H-
HblX HOHOB BOJlOpOJl3 H xJlopa. CBRJ8HHaH COJIHHaR KHC.10T3 H3XOJ\HTCII B )l(C;JY.i1Ke B
BII,1e He.aliccoUMMPOB31111blX MOJlcKyn Ii XMMM'leCKH CBIIJ311a C 6CJIK3MII.
0611131'1 KllcnOTHOCTb - CYMM3Pll311 KlIcnOTHOCTb BCCX KlIcnLIX pC3rclIToB. co-
.I1Cp)l(all1MXCII R )l(enYJlo'IHOM COKC (cB060.i1110ii II CBIIJaHHOH comlHOH KIICnOTbl, KHcnLIX
conCH. OpraIlM'ICCKIIX KMCJJOT - MOnO'IliOH, YKCYCHOH, MacnlllloH).
rUnepXJlOpZUOpUR (u16blmO.,Il0e Ku(.'rlOmoo6pU1IJ6UIlue):
t LlYOJ\CHanbHaH JIOKanHJaUI1}1 }l3Bbl
t mnCpaLlH.!UlbIH raCTpOJJ.Y0Jl.CHliT
l
89

i CHH.D.pOM 30JIJlHHrCpa-3nnHCOHa
i npH .D.CHCTBHH HCKOTOpbIX BCIllCCTB (zuema.MWla. ZJlIOKOKOpmu-
KOU008, KopeUHa, aJlKOZOJlfl, npenapam08 paY80JlbpUU)
runoXJlopZUOPUfl (yJlfeHbWeHue eOOep:HCallUfl HCI):
! Jl3BCHHaJi 60nC3Hb )KenY.D.Ka
! XpOHH':leCKHH rHnOaLtH.D.HbIH raCTpHT
! CHH.D.pOM nnaMMepa-BHHCOHa
Axll0PZUOPUfl (nOJlHOe omcymcm6ue COJlflllOU I<UCJlOmbl):
X .D.H4>4>Y3HbIH aTpo4>HQeCKHH raCTpHT
X HOBoo6pa30BaHHJI )Keny.D.Ka
X BI2-4>onHeBO-.D.e4>HLtIITHaJI aHeMHJI
X CHH.D.pOMbI BcpHcpa-MoppHCOHa, nnaMMepa-BHHCOHa
x HHTOKCHKaUHH,HH4>CKuHoHHMe3a6oneBaHHJI
AXWIUR (omcymcm6ue COllRHOU KUCJlOmbl U nenCUHa):
XX HOBoo6pa30BaHHJI >KenY.D.Ka
xx Btr4>onHeBO-.D.e4>HLtHTHaJI aHCMHJI
x HHTOKCHKaLtHH, HH4>eKLtHOHHbIC 3a6onCBaHHJI
III MOJlO'lH8R KHCJJOT8 - B HOpM3nbHOM JKenyltKe 06bI'IHbIMH MeTOll8MH He onpClle-
nlieTCIi (pc8KUI1I1 Ylj>lj>enbM8H8). YBenH'IHB8eTCIi npH 38CTOHHblX IIBneHl1l1X B JKenYllKe,
B pe3ynbTaTe p83MHOJKeHHJI n3nO'IeK MOnO'IHOKHCJ10rO 6pOJKeHHII B OTCyrCTBHH conll-
HOH KHCJJOTbJ, 8 TaKJKe B pe3ynbT8Te MeT86onH3M8 p8KOBbiX KJleTOK
(II 30HllOBbie MeTOllbi HCCJJellOB8HHR
OllHOMOMeHTHoe 30H.llHpOB8HHe - AllII 8H3n1138 6epeTcli OllH8 nopllHII JKCnYllO'l-
Horo CO.nepJKHMOrO, npHMeHlleTCIi TonCTblH 30Hll KYCCM8ynll.
p8KlIHOHHblii MeTO;J. - MHorOMOMeHTHoe 301l.L\HpOB8HHe TOIIKHM 30H.II.OM 3HH-
ropH8 118eT B03MOJKIIOCTb HccnenOB8Tb JKenYllO'lHYIO ceKpellHIO H8 p83HblX :n8n8X llell-
TcnbHOCTH JKcny llK8.
3neK1]lOMeTpH'IeCKHH MeTOll - HCCne.ll.OB8HHe KHcnOTHOCTI1 TOIIKI1M 30H.II.OM C
onHBOH H8 KOHue. B KOTOpylO BMOHTllpoB8HbI JneKTpOllbl.
cJ>p8KLtHOHHLlH MeTO,lJ, 30H.D.HpOB8HHH n03BOIDICT H3}"1IITb ceKpe-
LtHlO B TCQCHHC ,lVIHTenbHoro BpeMeHH H nOJI)":lHTb .D.aHHbIC 0 CC XapaK-
Tepe B CnO)KHOpe4>neKTOpHOH (OTBeT Ha MCXaHHQCCKHH pm.D.pa)KlITenb)
H HeHporyMOpaJIbHOH (pCaKLtIDI Ha 3HTCpaJIbHbIH H napeHTeparrbHMH
pm.D.pIDKlITenH) 4>max, B COOTBeTCTBHH C KOTOpbIMH BbI.D.eIDIIOT .D.Ba
3Tana 4>paKLtHOHHOro HCCne.D.OBaHHJI: 6maJIbHOH (OCHOBHOH) CeKpCLtHH;
nOCne.D.OBaTeJIbHOH (CTHMynHpoBaHHOH) CCKpCLtHH.
,Ami CTHM)'IDILtHH CeKpCUHH HCnOnb3YlOTCJI cnC.D.)'lOIllHe 3HTeparrb-
HbIC np06HbIC 3aBTpaKH: 1) no JlcnopcKoMY - 200 Mn KanyCTHoro COKa;
2) no ne-rpOBOH - 300 Mn 7 %-Horo KanycTHoro oTBapa; 3) no 3HM-
HHUKOMY - 300 MJI MJlCHOrO 6ynboHa; 4) no 3pMaHY - 300 Mn 5 %-
HOro pacTBopa aJIKOrOIDI; 5) no KaQy H KaJIbKY - 0,5 r Ko!}JcHHa Ha
300 Mn BO.D.bI.
90

113 napemepaJIbHblX CTHM)'mrropoB >Keny.nO'IHOH ceKperu m HCnOnb-
3yKYTCH: HHcynHH - 10 EJ{; npenapaThI raCTpHHa (nemaraCTpHH, TeTpa-
raCTpHH) - 0,6 Mr Ha 10 Kr MaCChi TeJIa; rnCTaMHH - 0,08 Mr Ha 10 Kr
MaCCbI Tena .DJUI nOJl)"leHIDI cy6MaKCHMaJIbHOH ceKpellHH HJIH - 0,32 Mr
Ha 10 Kr MaCCbI .DJUI MaKCHMaJlbHOH rnCTaMHHoBoH CTHM)'IDIllHH.
CeKpe-ropHaa aKTHBHOCTb - xapaKTepH3YeTCH '1aCOBbIM HanpH-
>KeHHeM (KonHqeCTBOM COKa, BbI.neneHHoro 3aqac).
KHCJ10TOo6pa3YlOwaa cnoco6HoCTb - KOnH'IeCTBO BbI.neneHHoH
commoH KHcnOTbI 3a e.nHHHllY BpeMcHH, pe6HT COIDIHOH KHcnOTbl.
J{e6HT conHHoH KHCnOTbJ, MMonbln, B TOH HnH HHOH nopllHH BbI-
'1HCnHeTCH no cpopMyne
n = VxC
1000 '
r.ne V - KOnH'IeCTBO COKa B nopllHH; C - KOHlleHTpallHH HCI unH
061l{aJI KHcnOTHOCTb.
(II J)enOHllOBLIe MeTOJ.\LI
Mcnonb30B8HHe MeTO.ll8 30HllHpoeaHHII npOTHBOnOK83BHO HCKOTOpblM 60nbHblM
(nopoKH, HWCMH'JCCK3JI 60ne3Hb Cep.llU8. rHnepTOHH'JCCK3JI 60nC3Hb, 8HeBpH3M8 80p-
Tbl, llCKOMneHCHpoB8HHble 3860neB8HHII nerKHX, CTCH03 nHeBO.lla, 6epeMcHHocTb). B
3THX CJI)"J3JlX .IlII1I H3Y'JeHHII ceKpCTopHoH YHKUHH JKCnY.IlK8 nonb3YlOTCli 6e330H.IlO-
BbIMH MeTO.IlaMH.
,llCCMOHllH8A npoli8 no CMH OCHOB8H8 H8 cnoc06l1ocTH JKenY.llo'Jlloro COK8 ne-
peB8pHBaTb KeTryT. nocne 38rn8TbIB8HI111 60nbllbiM pe3HIIOBoro MeWO'JK8 C MeTHneHO-
BbiM CHIII1M, 33TIlllyToro KeTryTOM. y 60nbHoro npOH3BO.1VIT 3860p MO'JH 'Jepe3 3, 5 H
20 'J. MHTCHCHBHoe OKp8wHB8HMe Bcex 'Ipex nopUHH CBl1.1leTenbCTBYeT 0 rnnepaulI.Il-
HOM COCTOIIHI1H, BTOpOH H tpeTbCH - 0 HOpMBnbHOH KHCnOTHOCTH, TonbKO 'IpeTheH - 0
rHnoxnoprH.IlpHM, MO'l8 He OKp8WMBaCTCli npH 8XnOprH.IlpHI1.
MeTOll HOHo06MCHHb.X CMon OCHOBaH Ha cnoc06HOCTI1 HOIIOB HH.Ill1K8ropa (HH3-
KOMoneKynllpHoro COC.Ill1HeHHlI, CBII33HHoro C HOHoo6MeHHOH CMonOH) 06MeHHBaTbCli
B JKenYAKe H8 TaKoe JKC KonH'JCCTBO BO.llOpOAHblX HOHOB conliliOH KMcnOTbi. npl1 3TOM
HHD.HK8TOp OCBo60JK.LlaCTCIi H3 CMonbl, BcaCblB8eTCli B KI1WC'JHHKe H Bbl.llenllCTCIi C MO-
'JOH. r.lle ero 06H8pY>KMB8IOT.
nEnCHH
o - 21 Mrln
l106blwellO:
t H3BeHHaJI 60ne3Hb
t rnnepTHpe03, nocnc BBe.neHHH AKTf
llOllu:HCello:
! aTOnH'IeCKHH raCTpHT
! 60nC3Hb A.rI.nHcoHa-EHpMepa
! rHnOTHpe03
! HHTOKCHKallHH, HHcpeKLlHOHHbIe 3a60neBaHHH
91

m 0 cjlepMCHT006p33YIOIUCH cjJYHKUl1M JKCnYllK3 (neml1'lecKoA aKTMBIlOCTH JKCnYllO'l-
1I0ro COKa) MOJKHO nonY'IHTb npCACT3BneHlle, onpeAeJ1I1B KOJ1M'ICCTBO yponcnCHHa B
MO'Ie. B 1I0pMC C MO'IOH BblAenJlCTCJI 0,4-1,0 Mr B CyrKH.
CCflEAOBAHEAYOAEHAnbHOrO
COAEP}f{MOrO
J],yo,..eH3J1blloe CO,..ep"'HI\toe (SUCCUS duodcnalis) - COJICP)l(J1-
MOC npOCBCTa "'BCHaJ1LlaTJ1nCpCTHOH KJ1111KJ1, CMCCb )l(Cn'lJ1, CCKpCTa
nOJ\)I(cnYJ10 t mOH )l(CnC3bl, J1BCHaJ1LlaTJ1nCpCTHOH KJ1111KJ1 J1 )l(cny-
J10'lHOrO COKa.
MaTCpHaJI }1J1H HCCJle,..OB3HHH. COJ1Cp)l(J1MOC J1BCHMLlaTJ1nCpCT-
HOH KJ1111KJ1 HaTOll\aK, J13BJIC'lCHHOC 30HJ1J1pOBaHJ1CM.
AYOAEHAnbHOECOAEP>KMOE
nOK3JaTenb I HOpM3.Jll.llblC 3H3'1CHHR
I lIopu",,"A" I nOPIlH" "B" I nopHH "C"
KOnM'IeCTBO, Mn 20-35 35-60
I1nOTHOCTb, rln 1007-1015 1016-1032 1007-1010
LlBeT 30noTHcTo- TeMHo- CBCTnD-
JKenTblH KOpM'IHeBbIH JKenTblH
Ilp03p3'1HOCTb np03p3'1H3J1
PCaKUI1J1, pH 7,0-8.0 6,5-7.3 7.5-8.2
6Mnl1py6l1H.MMonwn 0.51-1,03 1.71-3,42 0,17-0.34
)Kcn'lHble KI1CnOTbI. MMonwn 17,4-52,0 57.2-184,6 13,0-57,2
XonccTcpllll, MMonwn 1.3-2.8 5.2-15,6 1,1-3,1
Xon3TOXOJICC rcpIIIIOB..) H
KmcjJcjJlluHcHT 6,5-6.7 8,0 6.0-7,0
6C,10K, rln 4.5 1,4-2,7
31IHrenHH
JlCHKOUI1I bI
Cnl13b
Kp"LT3JJnbl X0J1CCTCpIl1l3
11 6MnHpy611113T3 K3JJbUIIII
,'tfUKpoCKOnUileCKOe UCC1eOOBQHUe
He3H3'1I1TCnbHoc KOnl1'lCCTBO
1-2
2-3
2-3
IIC3H3'1I1TCnblloe Konll'leCTRO
OrcyrCTRYIOT E"IIIII1'1I1b1C OTCyrCTBYIOT
(]) JVIII 113Y'lCIiHII AYOACII3J1bHOrO COACpJKHMOrO npHMcHIICTCIi IjJpaKltHOHHOC (nIlTI1-
lj>a3110c) 30HAHpoB3I1HC.
92

IIjIaJa (JKeJl'Ib 1I0pWtH "A" - collep)J(MMoc LlBCIla.rw.arnnepcrnoil KlfWKII- 20-35 MJI)-
OT MOMeHTa BBCliCHHII 30HlIa lIO BnHBaHIiJI xOnCUHCTOKMHCTH'ICCKOrO paCTBOpa BblllC-
nlieTCIi B Te'!CIIMC 20-30 MMH.
II 4>838 ()KCn'lM IICT) - cjJa3a 3aKpblTHli CcjJHHKTCpa OMH. OT BBCliCHHII paCTBOpa,
Bbl3bIBaIOCrO COKpaWCllHC JKCn'!lIoro nY3Wpli (CY1brfJomO ,IIOZHUR, i!1KJK03hl, nenmo-
HO. O.QUBKOf/Oi!O ."aCiU U Op.) - npOllOn)KHTCnbHOCTb 2-6 MHH, lIO nOIlBnCHHII B 30HlIC
HOeoH )KCn'!H.
III 4>838 ()KCn'!b H3 BHCnC'!CHO'!HbIX JKCn'!HWX npOTOKOB - 3-5 Mn) - nlITeHTHblH
nepMOli OT /Ia'!ana OTKpblTMII CcjJMHKTcpa OMH lIO nOIiBneHHII nY3blpHOH >Ken'!M. BpCMII
BblJ1.CnCHHII 3-4 MHH.
IV 4>838 (nOpl.lMIi "8" - nY3blpHali )Ken'!b - 35-60 Mn) - TCMHD-KOpH'!/Iesali >Kcn'lb
BbilIcnllCTCII B Te'!eHHe 20-30 MMH.
V 4>838 (nopUHII "C" - ne'!CHO'!H811 )Ken'!b) - BbilICnC/lHC CBeTnOH )Ken'!H, 38 20--
30 MM/I KOnH'IeCTBO npeBblwaCT nOpl.lMIO "8".
KOflM'-IECTBO >KEfl'-lM
nOpl.\HH "A"- 20-35 MJI
llo6bllUeHo:
t mncpccKpCUHH )f(Cn'fH
t xonc.nOX03KTa3HH
IIpepbl6ucmoe 6blde.neHue:
! rHncpTcH3HH ccl>HHKTCpa OMH (oyooeHum, KOHKpeMeHmbl, 3JlOKa-
'1eem6eHHble H08oo6pa306al/wz)
lloHu:»cello:
! paHHHc CTa,nHH xOnCUHCTHTa, rcnaTHTa, rcnaT03a
Omcymcm6ue:
X TH)f(CnbJC nOpa)f(CHH" nC'fCHH (8upyeHblu zenamum, /.fUPP03, :JICell-
mall ampol/mll, paK nelieHu)
X nHnopocna3M, ncpcKpY'fHBaHHC .nYO.nCHaJIbHOro 30H.na B )f(cny.nKc
nOpl.\HH "8" - 35-60 MJI
IIpepbl6ucmoe 6blde.nellue:
! Cna3M ccl>HHKTCpa, cna3M )f(en'fHoro nY3bJp"
llollu:»ceHo:
! )f(Cn'fHOKaMCHHaH 6onc3Hb, xonCUHCTHT
! cna3M ccl>HHKTcpa nY3bJpH
Omcymcm6ue:
x KaMHH nY3bJpHOrO npoToKa
x HOBoo6pa30BaHH" ronoBKH no.n)f(Cny.nO'fHOH )f(CnC3bJ, <1>aTcppoBa
COCKa
x CMopHBaHHe, cpaeHHe, aTpocl>HH )f(Cn'fHOrO nY3b1P"
93
-

nOPQHR "C"
Upepbl6ucmoe 6blOeJlellUe:
! Cna3M cqJHHlITCpa
! KaMIUI B 06ll\CM )KCJI'IHOM npOTOKC
OmcymCm6Ue:
x KaMHH o6ll\cro )KCJI'IHOrO npOTOKa
x HOBOo6pa30BaHHJI, OTCK roJIOBKH nOll)KCJIy,nO'IHOH )KCJIC3bI
x Cna3M C<j>HHKTCpa, OnYXOJIh <DaTcppoBa COCKa
nnOTHOCTb
nOPQHR "A"-1007-1015 rhl
fl06blmella:
i npH nocTynJICHHH )KCJI'IH nOpUHH "B" (ze.MOllUmU'IeeKaR aue-
.MUR)
flOllU3ICella:
 nOpa>KCHHC nC'ICHH (8upyeHblu zenamum, ,-/Upp03 ne'leHU)
 HapYIllCHHC nOCTyruJCHHJI >KCJI'!H B ,nBCHa,nuaTHncpCTHYIO KHIllKY
(3aKynopKa KOHKpe.MeHmOM, ena3.M epUHKmepa OiJiJu; onYXOllb, omeK
ZOl106KU noiJ:JICellyiJoliHOU :JICeJ/e3b1)
nOPQHR "B"-1016--1032 r/n
fl06bllUella:
t 3aCTOH )Kcn'lH (:JICe'lliHOKall'teHHaR 6011e3Hb, iJueKuHe3Wl :JICell'le8bl-
80iJRU/UX nymeu)
fl OllU3ICella:
 CHH)KCHHC KOHllCHTpm..tHOHHOH <j>YHKllHH )KCJI'IHOrO nY3bIPH
IIOPQHH "C"-I007-IOIO 1"ln
fl06blmeHa:
i npH rCMOJIHTH'ICCKOH >KCJITyXC
flOHU3ICella:
 nOHH)KCHHC CCKpCllHH 6HJIHpy6HHa (zenamumbl, ,-/Upp03)
UBET
nOPQHR "A" - 30noTHCTO-)f(enTbIH
TeMHO-)f(eJlTLlii - nocTynncHHc )KCn'lH nOpl(HH "B" (zeJ..tO.'lumu-
'1eeKaR ,1/CeJ/myxa).
94

CBeTJlO-eJlTbIH - IIOpa)KeHHe lIe'IeHH (6UpYCltbIU zenomum,
IIUPp03), HapYIllCHHC IIOCTYIIJIenml )KeJI'IH B .nBCHa,rJ,uaTHnepcrnylO
KHIllKY (3aK)lnOpKO KOItKpe-\teHmOM,. ena3M apUHKmepa Odou; ony-
XORb, omeK ZOJl06KU nooJICe.nYOOliHOU .J/CeJle3bl).
3eJleHOB3TblH - npH 3aCToe, HH<pCKU,HH.
nopUHH "8" - TeMHo-KopH'JHeBblH
6eJlOB3TblH - XpOHH'ICCKHH XOJIeu,HCTHT C aTpo<pHeH CJIH3HCTOH
)KeJI'IHOrO IIY3blpH.
qepHo-KOpH.,HeBbIH - IIPH 3acToe, HH<peKU,HH.
nOPQHH "c" - CBeTJIO-:HI:eJlTbIH
6eJlOB3TblH - nOpa)KeHHe lIe'leHH (8upyeHblii zenamliln, IJUpp03).
qepllo-KOpH'fHeBbIH - IIPH reMOJIHTH'ICCKOH )KCJITyxe.
np03PA4HOCTb
npOJp8'JH8H
lIoMymHeHue, 6blnaoeHue X/lOnbe6:
! nOpu,HH "A" - IIOBblUleHHaH KHCJIOTHOCTb )KeJIy.nO'IHoro cOKa,
.nY°D;eHHT
! nOpu,HH "8" - BOCnaJIeHHe )KeJI'IeBbIBOD;Hll.lHX n)'TCH, )KCJI'IHOrO
IIY3blPH
! nOpu,HH "C" - XOJIeUHCTOXOJIaHrHT, BOCnaJICHHe BH)'TpHIIC'ICHO'l-
HblX XO.L\OB
PEAKLtS1,PH
CJJ86omeJlO'JH8H
CHU:HCeIlUe pH, KUCJlaR peaKUR:
! IIOpU,HH "A", "8", "C" - npH BOClIaJlHTeJIbHOM npou,ecce B COOT-
BeTcTBYIOll.leM OT.L\eJIe )KeJI'IeBbIBOWill.lHX lI)'TeH
6nPY6H
nOPQHH "A" - 0,51 - 1,03 I\IMOJlb/Jl
nopUHH "8" - 1,71 - 3,42 Ml\lOJlb/Jl
nOPQHH "C" - 0,17 - 0,34 I\IMOJlb/Jl
l106blwellO:
i reMOJIHTH'IeCKaH )Kcmyxa, MaJlHpHH, lIepCmlBaHHe HeCORMeCTH-
MOH KpOBH
i 3HCMHH AMHcoHa-EHpMcpa
95
-

lloHU3ICello:
! nOpa)!(CHHC nCI.J:CHH (6upyeHblu 2enamum, lfUpp03)
! 06T)'paQHOHHM )!(cmyxa (3aKynOpKa KOHKpe.\feHmOM. ena3M
ajJUHKmepa Ooou; onyxo.'lb, omeK 20J108KU nOO:HCeJ/YOOliHOU :HCe.e3bl)
! aJIHMCHTapHaJi .l1HcTpOllmJl
! HcrCMOnHTH'-ICCKaJl BPO)!(lI.CHHM )!(cnryxa I THna (eulIopo.u KPU2-
i1epa-HaiiRpa)
>KEII4HbIE KMcnOTbl
nopUHH "A" - 17,4-52,0 MMOJlb/Jl
nOpU"H "B" - 57,2- 84,6 MMOJJb/JJ
nOpU"H "C" - 13.0-57,2 MMOJJb/JJ
llo8blwello:
t nOPQHJI "C" - nOBbllliCHHaJi CCKPCQHJI xonCBblX KHcnOT ncI.J:c-
HOI.J:llbIMM KJleTI<aMH (lIa'iOJ1bllaJl emaouR lIeOeJ10:HCHeHH020 xpo/tu'Ie-
eK020 K(L1bKy,e3/to2o xOi1elfuemuma)
II OllU3ICellO:
! CCKpCTOpHM HC..D.OCTaTOI.J:1I0CTb nC'-ICHOI.J:HbIX KJlCTOK (8upyeHblu
2enamum)
! KaJIbK)'nc3HblH xoncQHCTHT, naHKpCaTHT
XOIlECTEPMH
nOpltHH "A" -1.3-2,8 MMOJlb/JJ
nOpU"H "8" -5,2-15.6 MMOJJb/.'J
HOpUHH "C" -1.1-3.1 MMOJlb/Jl
llo8blweHo:
t )!(CnI.J:HOKaMCHHaJi 6one3Hb, XOnCQHCTHT, naHKpeaTHT
t rCMOnHTH'-ICCKM >KcJ1T)'xa
f caxapHblH .l1Ha6cT
llollu3ICello:
! nOpa)!(CHHJI neI.J:eHH (8upye/tblu 2enamum, lfUpp03, XpOllli'lCCKUe
3a6o;1e6aHuR)
! CIIH)!(CHHC KOHltCHTpaQHOHHOH «PYHKQHH )!(cn'-llforo nY3blpJl, OCT-
Pbl" xonCUHCTHT
! BTOpH'-IHbIC aHCMHH
! aJIHMCIITapHM .l1HCTpO«pJlJI
III XOJlaTOXOJlecrepHHoBLIH KO:JtJltJlHItHeHT (6,0--8,0) - COOTlloweHHe JlCeJI'IlIbiX
KMCJIOT H XOJICCTCpHHa: 3Ha'IIITeJIbll0 CIIMJKCH "pI! OCTpOM XOJIeIICTHTe H XpOHM'Ie-
CKOM naHKpeaTIITc; YMCPCHHO CHIIJlCell npH 33TJlJlCHOM Te'leHHH BHPYCIIOro renanrra;
HC3Ha'lHTeJIbHO CIIHJlCCII npM 06bl'lHOM Te'lCIIMH BHpycHoro renaTlfTa.
96

YMeHbWClIIlC KOHUeHTpaUHH )f(en'lllbiX KHCJIOT B )f(cn'lH C O.llllOBpCMCHHblM
nOBblWCHHCM CO.llCp>KaHHII XOnCCTCpMHa (CIIH)f(ClmC XOnaTOXOnCCTCpHIiOBOro KO-
J$«!>HUHCHTa) MOJKCT CBMJl.CTCnbCTBOBaTb 0 npc.apacnOnO)f(CHIiOCTH K )f(Cn'!HOKa-
MCHHOH 60neJIIH.
)KeJI'IHLlC "8MHH (concremcntum biliarc) 6b1BaIOT paJJlH'!HbIMH no COCTaBY H CO-
.IICp)f(aT BCC KOMnOHeHTbI )f(en'!H.
XonecrepHHoBLIe H CleW8"HLIC "8MHH 06paJYIOTCli npll CHH)f(CHIIH xonaTo-
xonCCTcpHIiOBoro KOJcjJcjJIIUIICIITa, Koma JKCn'!b replieT cnOC06HOCTb y.ncp)f(MBaTb XO-
nCCTcpHIi B paCTBOpe.
nH.-MCHTHLIC "8MHH 06paJYlOTCli npH nOBblWCHHOM nocrynncHHII B )f(Cn'!b 611-
nHpy6HHa (n06b1IUeHHblU ;>e..u01U3 3pllmpolillmo6J. OC06CHHO '!aCTO )f(Cn'!HbIC KaMIiM
06paJYlOTcli y MHorop0)f(aBWHX )f(CIIHH H IIPH IIpllMCHCHIIM BHyrpb ropMoHanbllblx
KOIiTpaUCnTHBHblX npCnapaTOB.
I
6EIlOK
nopllHH "8" - .ao 4,5 .-In
nopliltH "C" - 1,4-2,7 r/n
llo6blweHo:
t nopUlH1 "B", "c" - BOCnarrHTeJ1bHblH npouecc B COOTBCTCTBYIO-
meM OT.D.eJ1e )f{CJ1IJCBblBO.D.Il\HX n}'TCH
t OTpaBJ1eHHe MbIUlbJlKOM, arrKOrOJ1CM, I}>OCI}>OPOM
MHKPOCKOnHYECKOEHCCnEAOBAHHE
m MMKpocKonHIO )f(CJI'!H HCoOXOJlMMO npoBo.n1ITb cpaJY nocnc nOil}"lCHIIJI MarepHana.
JIeiiKOUIITbl - B nopUHu "A" nOBblUlalOTCJI npH J1Y0J1CHHTe, B
nopUHH "8" COBMeCTIiO C BbiCOKHM npH3MaTH'jeCKHM :mHTeJ1HeM
)f(eJ1IJHOrO nY3blpJl - npH XOJ1CUHCTHTC, BMCCTe C :mUTeJ1HeM )f(eJ1IJC-
BbIBO,lUlIl\HX n}'TCH - npH XOJ1aHrHTax.
303HHOUJlbl 06Hap)0KHBaIOTcJI npH rJ1HCTHbIX HIIBa.3HJlX, arrJ1cp-
rUlJeCKHX XOJ1aHrHTax, XOJ1CI{HCTHTax.
CJlH3b - B 60J1b1ll01\l KOJ1HlJeCTBe YKa3bIBaeT lIa BocnarrCHHC )f(CJ1-
1jCBbIBOLl.JlIl\HX n}'TCH, .i1YOlleHHT.
3mll'eJIHD - cO./ICp)I(aHHe KpynHbIx UHJ1HII.D.pHlJeCKHX KJ1eTOK C
K}'THKYJlOH H BopcHHKaMH nOBhIUlaeTCJI npH naTOJlOrHH .D.BeHa.D.uaTH-
nepcTHoH KHWKH, BbICOKHX npH3MaTHIJeCKHX peCIIHTlJaTbIX KJleTOK -
npH BocnarrCHHH )l(eJlIJHOrO nY3blpJl, KOJ1HlJeCTBO MeJ1KHX npH3MaTH-
1jeCKHX I<1ICTOK nelJCHO'IHblX X0J10B HJ1H BbICOKHX npH3MaTHIJeCKHX
(06mcro )l(CJ1IJHOro npoToKa) - npH XOJ1aHfHTe.
ATHnH1jllble KJleTKH - MO)f(HO BbUIBIITb npH 3J10KalJeCTBeHHblX
HOBoo6pa30BaHHx.
KpHcTaJlJlJ.l XOJleCTeplIHa II oHJlIIpy611HaTa Ka:lbUHH - nOB-
J1HIOTCJI npH H3MCHCHHH K0J1J10H.D.HOH cTa6HJ1bHOCTH )l(CJ1IJH, )l(CJ1IJHO-
KaMeHHOH 60J1C3HH.
97

napa3HTLI - BCTpCqalOTCJI BCrCTaTHBHbIC <l>OpMbl JUIM6J1Hif, Jlifl{a
rCJ1bMHHTOB (aeKapUO, nelieHOIJHOU lL1U KOLUa%eU o6yyemKu, lIUIJU-
HOK Y2pUljbl).
f,1CCI1E.QOBAHf,1E MOKPOTbl
MOIcpOTa (sputum) - naT0J10rHtJCCKHH CCKpeT ,abIxaTCJlbHbIX ny-
Tcif BMCCTC C OT,aCJlJlCMbIM HOCOrJ10TKH H nOJlOCTH pTa.
ill Y 3.110pOObiX nlOllcii MOKpOTa He Bbl.'\cnHCTCH. O.'\HaKO OHa nOHBnHCTCH Y npaKTI1'IC-
CKH 3.'\OpOObIX nlOJl.cii npH pa60Tc B 3anbIJICIIHOii aTMOccpcpC (0 waxTc. ac6ccTo80M
np0l13BOllCTBC H T.lI.); y nil!!. npocpccclIH KOTOpblX Tpe6ycT '.pC3Mcplloro lIanpHJKCIIMH
ronOCOBblX CBHJOK (ncBUbi. nClIal'orH. cTcKnollyobi. MY3b1KaHlbl, HrpalOlUHc Ha llYxO-
BblX HHCTpYMcHTax); y Kypl1nbHKoo.
MaTepHaJi ,anH HCCJle,aOBaHHH. MOKpOTa, Bbl,aCJ1CHHaJI npH 01'-
KaWJ1HBaHHH (HC CJllOlia H lie CJlH3b H3 HOCOrJIOTKH).
KOIWI'-IECTBO
CKyOHoe OmOtmRe.MOe:
i BOCnaJICHHC ,ablxaTCJlbHblX nyrcH (lwpWl2um, mpaxeum, oemphlu
6pOHXum)
i 6POHXHaJIbHajJ aCTMa
EOJlbUlOe KOJlUQeCm80:
ii HaJIH'UfC nOJIOCTCH B J1CrKlIX (a6eIWcc, 2aH2pella, my6epK)me3
.;1e2Kttx, 6pOHX03KmamUIJeeKaR 60J1e31lh)
XAPAKTEP MOKPOTbl
CJlH3HCTaH MOKpOTa (BjJ3KOif KOHCHCTCHI..{HH, 6CCI..{BeTHaJI, npc-
HMylltCC1'BCHHO H3 CJlH3H): npH OCTpOM 6pOHXHTC, 6pOIlXHaJIbHOH ac-
TMC, OCTpblX pccnHpaTopHbIX 3a6oJ1CBaHHjJx.
nlOHHaH I\fOKpOTa (nOJ1}')KH..lI:KaJI, 3CJlCHOBaTO->KCJ1TOro I..{BCTa):
npH a6CllCCCC J1CrKOrO, coo61ltalOIltcrocjJ C 6POHXOM,
CJlH3HCTO-rHoiiHaH (BjJ3KaJI, >KCJIToro HJlH 3CJlCHOrO llBeTa): npH
T}'6CPKYJ1C3C JICrKHX, XpOHHtJCCKHX 6pOHXHTax, 6pOllxonHCBMOHHH,
a6CllCCCC, raHrpcHC J1CrI<Oro.
KpOBaBaH I\fOKpOTa (npH J1CrotJHbIX KpOBOTCtJCHHJlX): npH 3J10-
KatJCCTBCIIIIblX HOBOo6p830BaIlHjJX, Ty6cpKync3c, HH<I>apKTc JICrKHX,
6pOHX03KTa3ax.
98

CJlH3HCTO-KpOBHHHCTaH (H3 CnH3H C npO)!(HnKaMH KpOBH): npH
nHCBMOH"H, 6pOHXOrCHHOM paKC, OCTpbIX pccnHpaTopHbIX 3a6onc-
BaHHJlX.
Cepo3HaH MOKpoTa ()!(H.aKaJI. nCHHcTa", 6ccUBCTHaJi - nna3Ma
KpOBH, nponoTcBIlICUI B npocBcT arIbBcon): npH OTCKC ncrKHX.
 npM CTOIIHMM MOKpOTa Ae11MTCIi Ha C110H pa311I1'JHOH KOHCHCTeHlum:
ABYXCJJOHHBH (HMJKHHH CJJOH - niDH, eepXHHH - cepo3H311 >KtILIKOCTb) - npH a6cecce;
"I]IexCJJoHHBH - rHOH, cepo.lH311 >KHl\KOCTb, HII.L\ KOropoH pacnonarae-rcll cnoH CJJH3H.
OCMO"l]l MOKpOTbi n03BonlieT 06HapY>KHTb .Qa>Ke npocTblM 1"n330M YaK Ha3blBae-
Mble cnMpanH KYPWMaH3, KYCO'lKH onyxonH nerKoro, cl1H6pMH03Hbie CryCTKH, rHOHHble
npOOKM, .QHcl1TepHHHble nneHKH, cnY'IaHHble HHOpO.QHbJe Tena.
MKPOCKOnH"IECKOE CCI1E,QOBAHE
"KpOCKOnHqCCKOC "CCnC.aOBaHHC MOKpOT npOBO.aHTC" B Ha-
THBHbIX H CnCUHarIbHO OKpallICHHbIX npCnapaTax. B lIaTHBHOM npc-
napaTC MO)!(1I0 o6l1apY)!(HTb 11'H rpynnbI 3nCMCHTOB: KJleTO'lHbIe,
BOJlOKHHCTbIe H KpHCTaJlJlH'IeCKHe.
KneTO.,Hble 311eMeHTbl
JIeuKoumbl - BCTpCqalOTCJI B m060H MOKpOTC. OC06CHHO MHOro
HX B rnOHHOH MOKpOTC (a6elfeee JleZKOZO, 6pOIIX03KmG.3bl, my6epKYlle3).
30"JUHOrjJUJlbl - npH arInCpmqCCKHX COCTOJlHHJlX (6pOIlXUaJ/bHaR
aemMa, 303UH0<pUJlbHbIU 6pOHxum, 3XUHOKOKK03 lleZKOZO).
3pumpoumbl - npH nCrOqHbIX KPOBOTCqCHHJlX.
3nUmeJlUaJlbilble K.JlemKU - UHnHH.aPHqCCKHH McpuaTcnbHH
3nHTCnHH .abIxaTCnbHblX nyrCH (6pOlIxumbl, 6pOIlXU{LbllaR GemMa,
3J/OKa'leemeeHllhle H06006pa306aHUR); nnOCKHH 3nHTCnHH (l1pUMeeb
eJIIOHbl).
AJlb6eOJ1RpHble ,'HaKporjJazu - npH nHCBMOIm"x, 6pOHXHTax, HII-
$apKTC ncrKoro H .ap.
OnYXOJle6ble KllemKU - npH 3J10KaqCCTBCHHbIX HOBOo6pa30BaHHSIX.
BonOKHMCTble 06pa30BaHMJI
3J1QCmUileeKue 60JlOKHQ - npH pacna.ac ncroqHOH TKaHH (my6ep-
KY,e3, a6elfeee. 2GII2pella, 3XUHOKOKK03. H06006pa308aHUR J/e2K020).
KOpOJlJl06UOilble 60JlOKHQ - 3naCmqHbiC BonOKHa, nOKpbITbIC CO-
IDIMH )!(HPHbIX KHcnOT - "pH XpOHW1CCKHX 3a6onCBaHH"X nCrKHX (Ka-
3e03l1bllJ my6epKYlle3).
06bl36eCm6JleHllble :JJlQCmUIIHble 60JlOKIlQ - 3nacruqHbIC BonOKHa,
npOnHTaHHbIC COIDIMH KarIbUH", B.acn"IOTCSI C MOKpOTOH npH pacna.n.c
06bI3BCCTBncHHoro yqacTKa nCrKoro.
t])U6PUH - np" I}m6pHHo3HOM 6pOHXHTC, Kpyn03HoH nHCBMOHHH,
-ry6CpK)'nC3c, aKTHHOMHK03C.
99
-

CnUPQJlU KyplUMaHa - 06paJYlOTCH npH HaJlH'lHH CJIH3H B cnaCTIl-
'leCKHX 6pOHXaX (6pOHXUaJ/bHaJl aem.\1O, onYXOJlb lle2KUX, eOG8JlU8GIO-
UjaJl 6pOHXU). 80 BpeMH KalilJICBOrO TOJI'lKa BH3KaJI CJIH3b Bbl6pacblBa-
CTCH B npOCBeT 60JIee KpynHoro 6POHXa, 3aKp}"lHBaJlCb CnHpaJIblO.
KpMCTannM.,eCKMe o6pa30BaHMJt
Kpucmaflilbl illapKo-JIeuoeHa - CBH3aHbJ C pacna,noM 303HHo<}m-
JIOB (6POItXUaJ/bltaJl aemMa, 303UltO(fJUJlbltbiU 6poHXum, 2HWlOemltble
nopa:JICeltUR J1e2KUX, lle20'lHaJl oeyyemKa).
KpUCmallJlbl ze.MamououHa - npH pacna,ne l"eMom06HHa B 6ec-
KHCJIOpOJ1HOH CpCJ1C npH pacna,nc JIero'lHOH TKaHH (a6elwee, 2all2pella,
H06oo6pa308GltUR lle2Ko2o).
Kpucma.1Jlbl xOflecmepuHa - 06Pa3}'1OTCH B nOJIOCTHX (my6epry-
lle3, H06oo6pa306aHUJI, a6elleeebl, 3XUHOKOKK03 lle2Kux) B pe3YJIbTaTC
pacnaJ1a )I<Hpa.
KpUCmOJlJlbl :HCUpHblX KUCJlOm - npH 3aCToe MOKpOTbl B nOJIOCTJIX
(my6epKyile3, a6ClJeee lle2K020, 6poHXo3Kma3bl).
ApyrMe 3neMeHTbi
llpo6Ku ,l(umpuxa - COCTOHT H3 J1CTpHTa, 6aKTCpHH, )I<HpHblX KH-
CJIOT. KaneneK )l(Hpa; nOHBJUllOTCH npH XpoHH'lCCKHX BOCnaJIHTeJIbHblX
npoLleccax C pacna,noM JICrO'lHOH TKaHH (6poHXo3Kma3bl, a6elleeebl.
2all?peliG ile2KUX).
Tempaoa 3pJlUXa - 06bI3BCCTBJICHHbIH J1CTpHT, 06bI3BCCTBJICHHbIC
3JIaCTH'lHbIC BOJIOKlla. KpHCTaJIJIbJ XOJICCTCpHHa H MHK06aKTCpHH ry-
6cpKYJIe3a - npH pacna,nc 06W3BCCTBJICHHOrO nCpBH'lHOrO ry6CPKY-
JIC3110ro O'lara.
llapa3umbl - 3JICMCHTbJ 3XHllOKOKKa (3XUlIOKOKK03), HHLla JIero'l-
1I0H J1BYYCTKH (nGpa20ltUMo3). JIH'IHHKH aCKapH.a (aeKapuo03),
rpU6bl - .np)'3bJ JIY'-lHCTOro rpH6Ka B rIlOMHO-KpOBHHHCTOH MOKpO-
TC (aKmUItO,\fUK03); .npo)l()I(Cno.ao6HwC rpH6bl B CJIH3HCTO-mOHHOH
MOKpoTe npH .J])IHTCJIbHOM JIC'lCHHH anTH6HoTHKaMH (KalloU0031taJl
nHe8.MOHUR).
6aKmepuu - 06Hap}')KHBaIOTCH B oKpalllcHHbIX MaJKax. 113 IIHX:
MHK06aKTepHH ry6CpK)'JIe3a - npH ry6CPKYJIC3C JIen<HX;
nnCBMOKOKKH - npH Kpyn03HOH nHCBMOHHH B CJIH3HCTO-KpOB-
HHCTOH MOKpOTC H npH XpOHH'lCCKOM 6POHXHTC;
CTpcnToKoKKH H cTd<}mnoKoKKH B rnOHHOH MOKpOTC - npH a6cLlcc-
cc JICrKoro. 6pOHXOJKTa3HH. 6POHXHTax H nnCBMOHHH;
.aHnJI06aLlHJIJIa <I>pH)J,JlcH,iJ.cpa - npH nnCBMOHHX;
JIenp0311blc MHK06aKTCpHH - npH JIcnpc.
g MHKpoopraHH3Mbi ner'le 06Hap}')KHTb npH Hcnonb30BaHI1M MeTOllOB HaKonneHHII-
cjJnoTaUHH M :}JJeKTpocjJope"Ja I1nl1 c nOMOIIIl>1O nlOMMHecueHTHoro MMlq)OCKOna
100

-
,[{nJl OlipCACnCIIIIJI B036YAIITCnJl II cro '1YBCTBIITcnbHOCTIl K 3HTII6110TMK3M
npOll3BOlll1TCJI nOCCB MOKpOTbI Ha nl1TaTCnbllblC CpCAbI. B COMHIITCJlbHblX cnY'l3J1X
B036Yll.IITCnJl MO>KIIO 06113PYJKMTb, npH6crnYB K 33p3JKCHMIO 3KcncpllMCHT3nbtlblX
>KIIBOTHbIX.
cnVlHHOM03rOBAfi >KVI.QKOCTb
CnHHHOM011'OBaH H.n;KOCTb (liquor ccrcbrospinalis) - )1<H)J.KaH
cpc.n;a, 3anOnHHIOw.aH nonOCTH cnHHHoro H ronOBHoro M03ra.
nOll:B3BTCJ1b
HOpManbtlMC3HB'ICHHH
I..{BCT ......................................................................................... 6ecuBCTtlaJl
np03pa'iIlOCTb .......................................................................... npo3pa'lHaJl
,[{aBnCHHe, MM BOA. CT.:
nC>Ka ...................................................................................... 150--200
CH.WI ......................................................................................300-400
nnOTHocTb, r/n ......................................................................... 1003-1()()8
I..{HT03 B 3 MK1I:
1I1OM6anbHaJI iKHAKOCTb ........................................................0--3
BCHl"pIlKYJIHpllaJl >KII!lKOCTb ................................................. 7-10
PeaKUMJI, pH ............................................................................. 7,35-7,8
6enoK, r/n:
1I1OM6anbUaJl >K11..1KOb ........................................................ 0,22-0.33
BCIITpllKynJlpllall JKI\JIKOCTb ................................................. 0,12--0,20
rnlOK03a. MMOJlbln ................................................................... 2.78-3.89
X!IOpl1.:1b1. MMonbln .................................................................. 120-128
MaTepHaJi .n;!IH HCCJle.n;OBaHHH. CnHHHoM03roBaH )KH.n;KOCTb, no-
nytJcHllaJI nYTcM nlOM6anhlloH nYHKLlHH HnH nYHK1um )KCny.n;O'lKOB
M03ra.
!..tBET
6ecUBCTHaH
KcaHToxpoMHblH - XpOHHtJccKaH cy6)J.ypaJIhHaH rCMaToMa, HH-
TpaCnHllaJlbHaJi OnYXOnb, KapLlHHOMaT03 M03rOBbiX 060nOtJcK, non-
HblH 6nOK npH rpbI)KC .QHCKa.
KpaCHblH - cy6apaXHOH.QaJlbHOC KpOBOH3JUlJlHHC, npHMcCb n}'Tc-
BOH KpOBH.
rHOHHblH - mOHHblH MCHHllrHT, BCKphlBlllHilcH a6CLlccC M03ra.
OnaJleCItHPYlOlltHH - T)'6CpKync3HbIH, 6aKTCpHdJIbHhlH MCHHH-
rHT; KapIU1HOMaT03 M03fOBb1X 060no'lcK.
101

np03PAHOCTb
np03pa'iHaH
nOMYTHeHHe - npH YBCnH'lCHHH cO.nCpJKaHH1I KJIeTO'lHbIX :mc-
MCHTOB - 3pmpOI.lHTOB, nCHKOLlHTOB, 3nHTCJmaJIbHbIX KJICTOK rum
npH HanH'.JHH 60nl,IlIOrO KOnH'lCCTBa MHKpoopraHH3MOB.
AABnEHME
JIe)Ka - 150-200 MM BO.n. CT.
CHL{H - 300 - 400 MM BOL{. CT.
Il06bllUellO:
i 06'bCMHbIH HHTpaKpaHHaJlbHbIH npOLlCCC (onyxo..7b, a6e'1eee, ey6-
oypaJlbHaJI ZeMamOJlW)
i 'lCpCnHo-Mo3roBM TpaBMa (ey6apaxHouoa..7blwe KP060U3/lWIHUe,
XpOHU'IeeKaJI ey6oypa..7bHaJI ZeMamOMa)
i BHyrpH'lepenHM HHq,CKLlHSI (my6epK}'lle3ublu, oempblu 6aKmepu-
aJlbllblU MeUUHzum. 6UPyeHaJI MeHuHZ03H'1erpa..7UmllaR UlIrpeK'1UR)
i nonHpa.n:HKynoHeBpHT rHHCHa-Eappe
i I-IHq,apKT M03ra
llollu3ICello:
! HHTpacnHHanbHM onyxonb
! XpOUH'"leCKM cy6.nypanbHM rCMaTOMa
nnOTHOCTb
1003-1008 rln
l106bllUella:
i BocnanCHHC M03rOBbiX o60nO'lCK
i TpaBMbI ronoBHoro M03ra
llollu3ICella:
! nf.npoLlcq,anHSI
UMT03
.IIOM6anLH8H )KH,lumCTL - 0-3 B 3 MKJI
BeHTpHKYJlHPH8H )KH,/J.KOCTL -7-10 B 3 MKJI
llo6b'lUeH (lUleoumo:J) - pleoeytosis:
i HHTpaKpaHHanbHbIH a6cLlccc, onyxonH M03ra, MCHHHrHTbI, HH-
q,apKT M03ra
i HCHTpoq,HnbHbIH (ZuouHble Jl-teHUIIZUmbl, npopbl8 a6e'1ecea 6 llUK-
60pHbie npoempaHem8a, nOllaOaHue e8e:J/Ceu Kp08U 8 llUK60P npu
onepa'1uRX Ha M03ze)
102

1 JIlIM$Ol.tllTapHblH (eepo3Hblii U my6epKY.'le3Hblii MeHUHzum, nOCJle-
onepalJuOIlHblU nepuoo nOCJle HeiipoxupYPZU'IeeKUX onepal/uii)
1 303l1Ho$lInbHbIH (ClJ1.J1epZU'IeeKUe eoemORHWl, 2J/UemHble UH8a3UU
ZOllOBHOZO ."'03ZQ - 3XUHOKOKK03, l/uemUl/epK03, ey6apaxHouolL1bHble
Kp080113.'lWlHUR, peaKmUBHble MeHllHzumbl)
1 aTHnll'lHbIC KnCTKlI (HoBoo6pa30BaHWl 060J10'leK, J.temaema3N pa-
Ka U MeJlaHOMbl)
I..{HT03 (cytosis) - KOJIlI'ICCTBO $OpMCHHbIX 3nCMCHTOB B cnllHHO-
M03roBOH )KH,[IKOCTli. llO,Z:\C'lCT UJIT03a Hco6xo,Z:\lIMO npOll3BO,Z:\JITb cpa-
3Y )KC noCJIC cc nOJI)"lCHlIJI, TaK KaK
$OpMCHHbIC 3nCMCHTbI npH CTOJlHlIli B
B npo6HpKC 6bICTpO paJpywaIOTCJI.
m .lJ.Byxnpo6HpO'lHSH npo6s:
Jpl1TpOUHTbl npel1MyecTBeHHO B nep-
eoi! np06HpKe - TpaBMa KpoBCHOCHblX cocy-
JJ.OB nYHKUMoHHoi! Mrnoi!;
O.iUltiaKOBOe KOnM'ICCTBO JpHTpOUHTOB B
np0611pKax (YBcnH'ICIIMC '1l1cna JpI1TpoUH-
TOB B nocnCJJ.YJOlIlHX np06HpKax) - cy6-
apaXHOHJJ.8J1bIlOC KpOBOIl3nI1I1I1HC.
.lJ.;JH 1I0JJ.C'ICT8 I.\HT03a nonb3YJOTCli
06bl'itiO KaMcpoi! <I>YKC-P03CIIT8J1I1. 061.CM I III
cc 16 6onbwI1x KB8JJ.paTOB (pl1c. 19) COCTaB-
nliCT 3,2 MM), nOJTOMY JJ.JIII YJJ.06CTBa Konl1- PHC. 19. CCTKa KaMcpbl <I>YKC-P03CIITaJlII
'iCCTBO cjJOpMCHllblX JnCMCIITOB onpC.<J.cnllJOT
B 3 MKn..lhJ1I TOro 'iT06bl y3HaTb I1MT03 B 1 MKJI, /lOnY'ICHHbli! PC3YJlbTaT IIc06xoJJ.HMO
pa3,lCmlTb tla 3,2. .lhJ1I onpcJJ.CiJCIIMIi cOllCp>KallHII cjJOpMCllllblX 3iJCMCilTOB Bin I1TOr
.llCJICIIHII tl14{O YMHO>KI1Tb Ha 10".
PEAKLlHSI
pH = 7,35...7,8
Dpll 3a6onCBaHnJlX nO'lTH HC MCHJlCTCJI.
6EI10K
JII011168J1bH8H )lCH.!I.KOCTb - 0,22-0,33 r/Jl
BeHTpuKYJlHpHaH )lCHiJ,KOCTb - 0,12-0,20 r/Jl
llo6blUleHo:
1 CCp03HbIC II rHOHHblC MCHlIHrllTbI
1 cy6apaXHOH,[\aJIbHOC KpOBOll3JIlIJlHlIC, XPOHH'ICCKaji cy6,Z:\ypaJIbHaji
rCMaTOMa
1 mnpaKpaHHaJIbHbIH a6cuccc, lIH$apKT M03ra
1 KapUliHOMaT03 M03roBbIX 060nO'lCK
1 onyxonH M03ra, 3 H UC$aJIHTbI
103

i nOmipaJXliKynoHeBpHT fliHeHa-Eappe
i HapyrneHHe LlI'lpK)'mll.lHH CnHHHoM03roBOH )l(HJj,KOCTH (eiJa8Ru-
Ballue enlllll1020 M032a. 2pbl:JICa oueKa)
i Hocne onepaUHH Ha M03re
g KO,111'1CCl BO 6cnKa B cnHHHOM03rOBoil JKH,IKOCTH onpCllcmnOT TeMM JKC MeTO!laMI1,
'1TO 11 B MO'IC.
rJlOfiYJlHHOBble peaKLlHH OCHOBaHbl lIa cnoc06HOCTI1 HCKOTOpblX paCTBopOB B
onpe.ncnCIIHblX KOHucHrpalll1l1X M36HpaTCJlbHO OCaJKlIaTb rno6ynllHbI cnl111110M03rOBoil
JKHllKOCTH:
pcaKLlHH naHnH - C HaCblwcHllblM paCTBopOM Kap60nOBoil KHcnoTbI;
pcaKUHH HOHHc-AneJ1bTa - C HaCblLUCHHblM paCTllopOM cynbl!>aTa aMMOIIMII;
peaKLlHR TaKaTa-Apa - C paCTBOpOM cyncMbI, npM TIOM M3MCIIIICTCli UBCT !j>YK-
CHH-cyncMoBoH CMCCH.
rfllOK03A
2,78-3,89 MI\IOJlb/.l
llo6bllUeHo:
i 3HllCcpaJIHTbI H onyxonH ronOBHoro M03ra
i COTpHceHHH ronOBHoro M03ra
i XOpCH, BO BpeMH npHcryna 3nHncnCHH
i mncprnHKeMHH (eaxapllblu iJua6em)
flOllU:HCello:
! BOCnaJICHHe M03rOBblX o60nO'IeK
! TY6epKyne3HblH MCHHHHIT
XJlOP\.1Abl
120-128 M\fGnbIJI
flo6bllUello:
i IHlleq)aJlHTbI H onyxonH ronOBHoro M03ra
i nO'le'lHaH H ccpJ{C'InaH neaoCTaTO'UlOCTb
flollu:HCello:
! MCIUlHrHTbI
! onyxonH ronOBHoro M03ra

--
cnMCOK MCnOnb30BAHHOM nMTEPATYPbl
I. Bopo6be6 n.A_ U iJp_ CnYTHI1K HHTepHHCTa: no na60paTOpliOH H ItHCTjJYMeHTanl.llOH
llHarHOCTHKe. - M.: HblOlll1aMeD., 1994. - 158 c.
2. tlOJ106 B.. MOp03060 B.. MOp/lUWe6CKOJi B. U iJp. KJlI1HHKD-llHarHOCTH'IeCKOe 311a-
'Ielll1e Jla60paTOpHblx nOKa3aTeneH. - M.: JIa6HHcjJopM, LlellT)), 1995. - 224 c.
3. /160H06 E.n. PYKOBOllCTBO no reMOCTa3HonorHH: HopManbHble H HapYlIJeHHble
IjJYIIKUHH CHCTeMbl reMOCTa3a, KnMHHKD-na6opaTopHali llHarHOCTHKa KpOBOTe'lCIII1H 11
,lJ,BC-CI1HllpoMa. - MH.: Eenapycb, 1991. - 302 c.
4. K016 B.r.. Ka.lfblWHUKOfi B.C JIa60paTopllalillHaniocTHKa xHpyprM'IecKMx 3a60ne-
BaHHH. - MH.: BblllJ. WK., 1993. - 185 c.
5. fl106uHO A.H. U iJp. KnHIIH'ICCKMe na60paTopHble HccnellOBaHHII. - M.: MellllulIHa,
1984. - 288 c.
6. flepeiJepuu B.r., X"e7e6cKuu 1O.r., KOHolue6o n.t!>. U C>p. KnI1HH'ICCKali oueHKa
6110XHMM'IeCKHX nOKa3aTcnCH npl13a60neBaHHllx BHyrpellllHx opralioB. - K.: 3ll0pOB'II,
1993. - 192 c.
7. CnpOHO'ltllIK na60paTopllbiX M IjJYHKUHoHanbHblx nOKa3aTeneH 311opoBoro 'Ienoee-
Ka:- M.: PS3BIITMe, 1992. - 28 c.
8. CJUpKUH A.A.. OKOpOKOfi A.H.. rOH'lOpUK /1./1. ,lJ,MsrnOCTH'IeCKHH CnpaBO'lHMK Tepa-
neOTa: KJ1HHH'IeCKMe CHMIlTOMbI, nporpaMMbl 06cnelloBaHMII 60nbHblx. HllTeplipeTaUHII
118HHblX. - Mil.: EeJlapycb. 1994. - 688 c.
9. 3H/lUK,mnedu'leCKUU cnOBapb MellHllHHCKI1X TepMlllloB: B 3-x T. I rn. pell. £.B.neT-
poBCKHH. - M.: MellHUIIHa. 1982.


.D.oBlu.KOBe BHJlaHHII
IOpKOBcbKHH Oncr IBaHOBH'I,
rpHIUOK AHaToniii MHXaiinOBH'I
3Ar A11bH0KI1IHI4HI AHA1113H
Y nPAKTHLU nlKAPSI
Poe. MOBOIO
PeJl8KTOp O.K. Apme,lIeHKo
O<j>opMJleHHII XYJlO)f(HHK8 B. 0. Fyp,1CeQ
XYJlo)f(HiH peJl8KTOp C B. AHHeHKoe
KOMn'IOTepH8 BepcTKa C(/). flo6YHel/b
KopcKTop H. M. MipoUIHU'IeHKO

ni.llnHCaHO.110 .ilPYKY 30.03.2000. tJ>opMaT 84xI08"n. nanip *CT-
HIIiI.N"2 I. rapHirypa Taii"c.l\pYK *er. YMOB. ..'lJJ}'K. apK. 5.88.
06n.-BI1.lI. apK. 5,93. THpa)l( 10000 npliM. JaM..N"2 0-73
Bl\ilaBHHT80 "TcxHiKa". 04053 K"iB. Byn. 06ccpS8TOpHa, 25.
CBi.llOIlT80 npo .IICp>K88HY percrpallilO }(2 02473145 Bill 22.12.95 p.
HartP}'K088HO Ita 6inoucpKiBCbKiii KIIH>KKOB;ii 4>a6pH;.
09117 6ina L(cpKBa. Byn. ncc Kyp6aca.4.

IOpKOBCKHH O.M., rpHIUOK A. M.
JO 75 06111CKflHHH'JeCKHe aHanH3bl B npaKTHKC Bpa1.Ja. - K.: TexHiKa,
2000. - 112 c.
ISBN 966-575-187-5
B KHHre npHBe.neHbI nOK8J8-renH 06ll1eKJIMIIH'ICCKMX 8HaJ1HJOB KpOBH, MO'!M,
Ka..3, )l(cny.nO'!HOI"O H .nyo.nellaJ1bHOI"O co.nepJKMMOI"O, MOKpOTbl. cnMHHOMOJro-
BOH )l(1I.nKOCTH, 8 T3K)I(e CHCTeMbI l"eMOCT3J3 B HOpMe. I-hnO)l(eHO KnHHIIKD-
M3I"HOCTH'!eCKOe 3H8'1eHHe BOJMO)l(lIblX H3MeHeHHH B peJynbT3r3X 8HaJ1MJOB,
p8JbJlCHeHbI HeKOTOpble TepMHHbl H MeTO.nbl HCCne.nOB3HHJI.
P3CC'lHT3H8 HB Me.nHUMHCKHX CeCTep H np3KTHKYIOU\HX Bp8'!eH. MOJKCT
6bITb HCnOnbJOB8H8 npenO.n3B3TCnJlMM H cry.neHT3MM MCllHLlI1HCKMX BYJOB.
10 4108010000-005 6eJ O(ibRBJI.
202 - 2000
66K 53

CMCTeMa KpOBM
nOKa3aTsnb
Ha emOll epa'lY!
3pMTPOLlMTbI (RBC), x10'2 /n
reMorn06MH (HGB). r/n
reMaTOKpMT (HCT), %
CpeAHMH 06beM 3pl1TpoMTOB (MCV). MKM 3
CpeAHee COAep>KaHMe reMorn06MHa
B 3pMTpoUMTe (MCH), nr
CpeAHRR KOHeHTpaM$I reMorn06MHa
B 3pMTpOMTe (MCHC), %
AHM30MT03 3pMTpoMTOB (RDW). %
PeTMKYnOMTbI, %
lleHKoMTbI (WBC), xl0 e /n
TpoM60MTbI (PLT). xl0 9 /n
C03, MM/'I
l1eMKoMTapHaSi opMyna
T
r
HOpM8nbHIbI8 3Ha'l8HMA
I
4-5,1
130--160
4o--4B
B0--94
3,7-4.7
120--140
36-42
BI-99
27-31
33-37
11,5-14,5
0,5-1,2
4-9
1 B0--320
1 10 2-15
I
I
nOk838Tenb
HopManbHb 8 3Ha...eHMA
% I x10"n
HeHTpoq,Mnbl
nanO'lKOSlAepHble
cerMeHTOSlAepHble
303MHOq,Mnbl
6a3oq,Mnbl
MOHOMTbI
IlIo1Mq,oTbI
nepOM.,HbiM reMOCTa3
n0K83aTenb
1-6
45-72
0,5-5
0--1
3-11
19-37
HOpUaJ1bHble 3Ha....HMJI
0,04-0,3
2,0--5.5
0.02-0,3
0--0,0065
0,09-0,6
12-30
Pe3MCTeHTHOCTb KanMnnSlpoB:
CMMnTOM MnKa (KO>KeBHMKoea) ....___...___............................. OrC'fTCTBMe M3MeHeHMH
CMMnTOM >KryYa
(KOH'IanOBcKoro-PyMnenR-lleeAe) ...................................... MeHee 10 neTexMH
6aHO'lHaSl npo6a (HecTepoea).............................................. MeHee 20 neTexMH
BpeMR KPOBOTe'leHMSI. MMH"
no AYKB ___..............................................................___...........2-4
no AHBM .............................................................................. 2,5-7
KonM'IeCTBO:
TpoM60I1TOB, x 10 9 1n ......................................................... IB0--320
MMKPOnnaCTMHoK. % ............................................................ 2-15
HopMoTpoM60MToB, %....................................................... B4-92
MaKPOnnacTMHoK. %..............___...........................................1-11
MeraTpoM60MToB. % ....................................:.................... 0--1
AAre3MBHocTb TpoM60MTOB. % .............................................. 25-55
ArperaMSI TpoM60MToB. %...........___...................................... 55-145
<l>aKTop 3 TpoM60ToB. %..........................................___....___.. 40--98
<l>aKTop 4 TpoM60UMTOB, % ......................................___............. 40-85
109

Ha en/Oll 8pa'lY!
Koaryl1orpaMMa
nOK838Tenb
HOpUanbHbKt 3H8'18HMA
nepeaR cjJa3a - 06pa308aHue npompoM6uH83b1
BpeMR CBepTblBa!;MR KPOBM (no IlM-YaHry), MMH:
B HeCMnMKOHOBOH npo6MpKe ............................................................. 5-7
B cMnMKoHOBOH npo6MpKe ................................................................. 15-25
H,AeKc KOHTaKTHOH aKTMBaMM ............................................................ 1,7-3
BpeMSI peKanbI1q,MKaMM nna3MbI. C................................................... 60--120
AKTMBMpoeaHHoe (KaonMHoBoe) BpeMSI peKanbMq,MKaIo1M (ABP), C.... 50--70
AKTMBMpoeaHHoe '1aCTM'IHoe TpoM60nnacTMHoBOB
(KaOnMH-Keq,anMHoeoe) BpeMSI (A4TB), C ............................................35-45
A'fTOKoarynorpaMMa (Ha 10 MMH). C..................................................... 7-10
nOTpe6neHMe npoTpoM6MHa. % ........................................................... 75-125
AKTMBHOCTb, %:
q,aKTopa VIII ..................................................................................... 50--200
q,aKTopa IX ....................................................................................... 50--200
q,aKTopa X........................................................................................ 60--130
qJaKTopa Xl....................................................................................... 65-135
qJaKTopa XII ......................................................................................65-150
BmopaR cjJa3a - 06pa308aHue mpoM6uH8
npoTpoM6MHoBoe BpeMR, C .................................................................. 15-17
npoTpoM6MHOBblH MH,AeKC, % ............................................................... Bo--ll0
AKTMBHOCTb, %:
q,aKTopa II ........................................................................................ 60--150
q,aKTopa V....................................................................................... 60--150
q,aKTopa VII ..................................................................................... 65-135
TpembR cjJa3a - 06pa308aHue cjJu6puHa
TpoM6MHOBoe BpeMSI. C ........................................................................ 10--20
Cl>M6pMHoreH A (q,aKTop I), rln .............................................................. 2-4
Cl>M6pMH, r/n ..........................................................................................7-8
lIemeepmaR cjJa3a - noCmKoazynRquoHHaR
Cl>M6pMHOnMTM'IeCKaSl aKTMBHOCTb
(cnoHTaHHblH 3yrn06ynMHoBblH q,M6pMHonM3), MMH .............................120--240
CTpemoKMHa303aBMcMMblH nM3MC 3yrn06ynMHoBoro
CryCTKa, MMH ......................................................................................... 5-13
Cl>M6pIo1Ha3a (q,aKTop XIII), C (%) ........................................................... 50--100 (70--130)
PeTpaKMSI KPOBRHOro cryCTKa. % ........................................................ 45-65
npoAYKTbI Aerp3A3MM q,M6pMHoreHa (I1,QCI», Mrln .............................. Ao 5
napaKoarynS1MoHHble TBCTbI: 3TaHonoBblH,
npoTaMMHcynbq,aTHbIH. !3-Haq,TonoBblH ............................................... OTpMaTenbHble
AHmuKoazynRHmbl
TonepaHTHOCTb nna3MbI K renapMHY. MMH ............................................ 6-13
CBo6oAHblH renapMH, C ........................................................................8-12
AHTMTpoM6MH III. r/n (%) ...................................................................... 0,3-0,42 (75-125)
a2-MaKporno6ynMH. r/n ......................................................................... 1,5-4
npoTeMH C, Mr/n .................................................................................. OKOno 1
110

Ha en/Oll epa'lY!
Mo.,a
nOK838Tenb
HopManbHble 3HaqeHMA
KOnlf'leCTBO MO'II1 B C'fTKI1, Mn .................................................. BOO-1500
OrHocmenbHaS1 nnOTHOCTb B 'fTpeHHeH nOpIo1I1, rln ................ 1015-1025
LlBeT .......................................................................................... ConOMeHHD-JKenTblH
npo3pa'lHOCTb ........................................................................... npo3pa'lHaS1
PeaKI1S1 .................................................................................... HeHrpanbHaS1
MnI1 cna60KMcnaS1
6enoK, r/cyr .............................................................................. OTc'fTCTByeT
I1nl1 cneAbi (0.025-0,1)
Caxap, rln ................................................................................. OrC'fTCTeyeT
I1nl1 cnep,bI (0,03-0,05)
KeToHoBbie Tena, Mr/C'fT ........................................................... OrC'fTCTBYIOT «50)
nl1rMeHTHble Tena. Mr/c'fT ......................................................... OTC'fTCTBYIOT «6)
BecTea a30TI1CToro o6MeHa. MMonWC'fT: ............................. 400--1200
MO'IeBI1Ha. r/C'fT .....................................................................20--35
MO'IeeaS1 Kl1cnoTa, r/c'fT ......................................................... O,27-o,BO
IQ)6aTI1HI1H. r/c'fT:
AflS1 MI1H ....................................................................... 1-2
AflS1 )l(eHI1H ...................................................................... 0,5-1,6
KpeaTI1H, r/c'fT ........................................................................ OTC'fTCTByeT
101H,AIo1KaH, MKMonwc'fT ............................................................ 40-60
aMMl1aK, r/c'fT ........................................................................ 0.6-1,3
MO.,eOOM OCaAOK
nOK838Tenb
HopManbHble 3Ha"teHMfI
3nl1Tenl1anbHble KfleTKM ........................... 0--3 B none 3peHI1R
lleHKoTbI:
AJlR MI1H ........................................... 0--2 e none 3peHIo1F1
AflR )l(eHI1H .......................................... 1-3 B none 3peHI1R
3pl1TPOU l1TbI ............................................. E,o,I1HI1'1Hble B npenapaTe
LlI1J111H,IWbl ................................................ OTC'fTCTBYIOT
Cnlo13b ........................................................ OTC'fTcTByeT
6aKTepl1101 .................................................. OTC'fTCTBYIOT (He 60nee 50 000 e 1 Mn)
HeopraHI130BaHHblH C>CaAOK:
nplo1 Klo1cnOH peaK1011o1 .............................. MO'leBaR KIo1cnOTa, ypaTbI, oKcanaTbi
npM eno'lHOH peaKMI1......................... AMopq,Hble q,ocq,aTbI, MO'leKI1CJ1b1H
aMMoHMH, TpMnenbq,ocq,aTbi

Ha cmOJl epa'lY!
>Kel1YAO.,Hoe COAep>KMMOe
nOKa3aTenb
HOpMal1bHbIG 3Ha"teHMA
KOnlNeCTBO. 11Ic'fT ..............................................................___....2-3
LlBeT ...........................................................................................6ecTHblH
3anax ......................................................................................... OrC'fTCTByeT
KMCflOTHOCTb (pH) ...................................................................... 1,6-2
CnM3b .........................................................................................He60nbwoe
KOnM'IeCTBO
MI1KpocKonl1S1 JKenYAO'IHoro COAepJKl1Moro ................................ HenepeeapeHHaS1
Kfle'NaTKa
nOKa3aTel1M >Kel1YAO.,HOM CeKpeMM
nO«a3aTeJ1b
MaKCM-
ManbHblM
TeCT
1 B0--220
100-120
20-40 20-40 65-B5 90-100
1,5-5,5 1,5-6,0 8-14 16-26
1,0--4,0 1.0--4,5 6,5-12 16-24
10--40 20--40 50--90 90--160
06beM JKenYAO'lHOro COKa. Mn
06aS1IG1CnOTHOCTb. MMomJn
Ceo60AHaS1 conS1HaS1 KI1CJ1OTa,
Mnwn 0
Ae611T-'lac conS1HoH IGICflOTbl,
MMonwn 0
Ae6I1T-'1ac CB060AHOH conS1HoH
KI1CflOTbI, MMonwn 0
Ae6I1T-'1ac nenCI1Ha, Mrln 0--21
AYOAeHal1bHoeCOAep>KMMOe
nOK83aTeJ1b I HopManbHbl8 3Ha"leHHfI
I nop"" "A" I nop"" "8" I nop"" "C.
KOnlf'lecTeo, Mn 20--35 35-60
r1nOTHOCTb. rln 1007-1015 1016-)032 1007-1010
LleeT 30nOTI1CTO- TeMHD- CBeTno-
JKenTblH KOpl1'1HeBbIH JKemblH
npo3pa'lHOCTb npo3pa'lHaS1
PeaKI1S1. pH 7,o-a,O 6,5-7,3 7,5-B,2
6l1nl1py6I1H, MMonwn 0,51-1.03 1.71-3.42 0,17--0.34
)f{en'lHble KI1CflOTbl, MMonwn 17,4-52,0 57,2-1B4,6 13.0--57,2
XonecTepl1H, MMonwn 1,3-2,8 5,2-15.6 1,1-3.1
XonaToxOneCTepl1HOBblH
K03<t>4>I1eHT 6,5-6.7 8,0 6,0--7,0
6enoK. rln 4,5 1,4-2,7
MUKpocKonU'IecKoe uccneiJoeaHue
3nl1Tenl1H
llej;iKOI1TbI
Cnl13b
Kpl1CTannbl xoneCTepl1Ha
11 6l1nl1py6Io1HaTa Kanblo1S1
He3Ha'lIo1TenbHoe KOnlNecTBo
1-2 2-3 2-3
He3Ha'lI1TenbHoe KOnlo1'1eCTBO
OrC'fTCTBytOT E,o,I1HIo1'1Hble
OTC'fTCTByIOT
112

KJIt1HW1ECKME
II
 c
B npaKTKe
Bpaa
J
i
' ];:XHiK8»