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2011 2011 2011 2011 2011
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CHARACTERISTICS OF A 24 HOUR RHYTHM OF BLOOD PRESSURE IN
PCHARACTERISTICS OF A 24 HOUR RHYTHM OF BLOOD PRESSURE IN
PCHARACTERISTICS OF A 24 HOUR RHYTHM OF BLOOD PRESSURE IN
PCHARACTERISTICS OF A 24 HOUR RHYTHM OF BLOOD PRESSURE IN
PCHARACTERISTICS OF A 24 HOUR RHYTHM OF BLOOD PRESSURE IN
PAAAAATIENTSTIENTSTIENTSTIENTSTIENTSWITH OR WITHOUT THE DIABETIC
NEPHROPWITH OR WITHOUT THE DIABETIC NEPHROPWITH OR WITHOUT THE
DIABETIC NEPHROPWITH OR WITHOUT THE DIABETIC NEPHROPWITH OR WITHOUT
THE DIABETIC NEPHROPAAAAATHYTHYTHYTHYTHY
Abdullaev Sh.S.Tashkent medical academy, Tashkent.
Uzbekistan
Aim.Aim.Aim.Aim.Aim. To elicit the peculiarities of 24 hour
profile of thearterial blood pressure and compare them
withechogeometrical parameters of the heart in patients with
IIIstage of CKD with or without the diabetic nephropathy.
Material and methods.Material and methods.Material and
methods.Material and methods.Material and methods. The trial
enrolled 25 patients (14males and 11 females) with CKD III stage
(by classifications ofNKF K/DOQI, 2002) with nephropathy of
different genesis:chronic glomerulonephritis 3 8 patients, chronic
pyelonephritis 4 patients, diabetic nephropathy 13 patients. The
averageages of patients were 368 years. All patients were
examinedfor clinical laboratory3biochemical tests. The functional
conditionof kidney valued by glomerular filtration rate (GFR) in
equationof MDRD (Modification of Diet in Renal Disease) and by
urinaryexcretion of albumin. Before beginning of treatments all
patientshad arterial hypertension. Herewith systolic arterial
pressure(SAP) has formed 158,312,4 mm Hg., diastolic arterial
pressure(DAP) 94,17,2 mm Hg. Patients were divided into two
groups(1 and 2). 13group has formed patients CKD with
diabeticnephropathy, the second group consists of patients CKD
withoutdiabetic nephropathy. The control group consists of
healthyvolunteers matched by sex and age. 24 hour monitoring of
bloodpressure was performed in device of KARDIOTECHNIKA34000AD
(Inkart, St. Petersburg) by oscillometric method with intervalof
the measurement 15/30 minutes day/night. Estimated theaverage
values a SAP, DAP, and night reduction degree of bloodpressure
(BP). Hypertension is considered if BP for day hoursformed
>140/90 mm Hg, for night 3 >120/70 mm Hg.
Intracardialhemodynamics and remodeling of left ventricle valued on
3mode echocardiography. The Results of the study is
processedstatistical with using of criterion t Stiyudent. The
Differencesconsidered to be reliable if p
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4
31% accordingly), average 47,21,05 years (0,05); mean level of
thyroxin in the I group was 7,81,13ng/ml and 7,21,01 ng/ml in the
II one (>0,05); meanthyrotropin level in the I and the II groups
were 0,0050,06 /ml 0,0040,01 /ml accordingly (>0,05).
Both groups didnt differ in thyroid gland hyperplasiadegree.
Average index of thyroid gland volume in the I groupwas 36,41,02
sm?, in the II group 3 38,031,06 sm? (>0,05).
Indices of duration from disease beginning (the
hospitalization date) to treatment beginning were
reliablydifferent in comparised groups: in the I group 3 8,30,4
month,in the II group 3 17,00,07 month (
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5
during 1,532,5 years. All patients had got diastolic
dysfunction,but they had not myocardial infarction in anamnesis.
Transmitralblood flow was less than 1.0 in according with results
(0,74 0,05, while maintaining contractile myocardium ability
(LVejection fraction, on average amounted to 66,7 2,03%).
Theaverage age of patients was 46,8 7,9 years. Verification ofthe
diagnosis of hypertension was performed according to
therecommendations Russian Medical Society of ArterialHypertension
and Russian Scientific Society of CardiologyDiagnosis and treatment
of hypertension, the third revision,2008. All patients from the
first day of hospitalization weredivided into two groups (A and B).
They did not differ in termsof mean BP. Standard base therapy was
in subgroup A (35patients): ?3blocker (Betaloc ZOK in the mean
daily dose 37.5mg, aldosterone antagonists (Spironolactone 75 mg /
day),diuretics (torasemidi in daily dose 5310 mg) was added
aliskiren(Rasilez , Novartis Pharma, Switzerland), 1503300 mg /
day,an average of 225 50 mg / day. Combination of aliskiren inthe
same daily dose (mean 180 36 mg / day) and losartan(Cozaar , MERCK
SHARP & DOHME BV, Switzerland) 50 mg/ day was added in base
therapy in subgroup B, submitted 24patients. On the tenth day of
hospitalization, all patientsreached target BP: 131 5 3 mmHg and
127 7,2 mmHg forthe subgroup A and subgroup B, respectively, p =
0,673.
Clinical monitoring of symptoms of CHF had surveyed allpatients:
dynamic control of blood pressure, daily diuresis,glomerular
filtration rate, and echocardiography performed onthe apparatus
Ultramarc37 ALT (USA), with the assessment ofsystolic and diastolic
heart function in the dynamics, taking intoaccount the results of
morphometry cameras heart andanalysis of transmitral blood flow to
the second day ofhospitalization, through 15318 day and through one
year.Following options of left ventricular diastolic dysfunction
wasdistinguishes on based of the ratios of the coefficients of
peakvelocities (E / A) transmitral flow:
1. Anomalous the value of E / A was less than 1,0;2. Pseudo the
value of E / A was in the range from 1,0
to 1,6;3. Restrictive the ratio E / A spectrogram was 2,0 or
more.We continued to titrate patients doses with control of
blood
pressure all 12 months. We controlled patients
tolerance,identify side effects of therapy and assessment of the
functionalclass of CHF on test 63minute walk, as well as monitoring
thelevels of blood creatinine and estimated glomerular
filtering,ECG record3rest.
Results: Results: Results: Results: Results: a comparative
analysis of diastolic function LV andidentification of options for
violations of diastolic function LV inpatients of both subgroups
revealed that on the second day of
hospitalization abnormal variant occurred respectively in62,4%
and 62,9% of patients subgroups A and B (p = 0,944),whereas by
15318 day of hospitalization (before discharge)showed a trend to an
increase in this cohort of patients in groupaliskiren therapy (p =
0,058), and a 123month study of theperiod 3 a statistically
significant preponderance of thesubgroup combination therapy (p =
0,048). Pseudo versionof the LV diastolic dysfunction was recorded
on the second dayof hospitalization in 37,6% and 37,1% of patients
respectivelyin groups A and B (p = 0,889) for 15318 days,
established atendency to increase the proportion of these patients
in thesubgroup A (p = 0,810), which persisted throughout the year(p
= 0,097). In addition, 15 to 18 days of hospitalization in
onepatient and a year later in two patients with group A therewas a
restrictive option left ventricular dysfunction, which isabsent in
patients with subgroup B. The study of dynamicchanges options
disorders diastolic filling in each patient in asubgroup of the
combined aliskiren and losartan treatmentrevealed the presence of
anomalous option Stability ispreserved within a specified time of
the study, 23 patients(65,6%), and the transformation of the
anomalous in thepseudo. There was only one patient (3,5%) at 15318
days ofhospitalization and continued during the year. In six
patients(18,3%) of the original pseudo version of
diastolicdysfunction in the combined therapy was replaced
byabnormal is a 15318 day hospital stay and was maintainedduring
the subsequent year. Four patients (12,2%) maintainedstable pseudo
version of the dysfunction on the second, 15318 days of
hospitalization and within 12 months of follow3up.
Conclusion:Conclusion:Conclusion:Conclusion:Conclusion:
Combination aliskiren and losartan therapyin patients with
refractory hypertension with chronic heartfailure to NYHA Class II
and III, leads to a statistically significantpredominance of
patients with prognostically more favorableabnormal type of LV
diastolic dysfunction after a year oftherapy. Along with this, in a
subgroup of the combined therapyshowed a tendency to increase the
number of patients withpseudonormal option dysfunction due to the
absence ofpathological evolution of the pseudonormal option in
therestrictive that occurred in the subgroup of
aliskirenmonotherapy. Study of the nature of the dynamic
changesoptions LV diastolic dysfunction in each patient in both
groupsshowed a statistically significant increase in the proportion
ofpatients with stable to maintain the anomalous option in
thesubgroup of combination therapy for a year (p = 0,043),coupled
with a significant decrease in its same number ofpatients the
transformation of anomalous in the pseudoversion of LV diastolic
dysfunction at 15318 days ofhospitalization and within 12 months of
observation (p
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6
and/or stenting of coronary arteries (CA). The
presence,character and size of perfusion defects were
estimated.
Results.Results.Results.Results.Results. The coronary
angioplasty resulted in a 76%decrease of mean size of transitory
ischemic zones. Thepresence of reversible perfusion defects after
operationcoexisted with the uncomlete revascularization in patients
withsignificant multivessel lesions.
In the long3term follow up (336 months and 132 years
afterendovascular treatment) the aggravation of
coronaryinsufficiency in patients with incomplete
revascularizationproceeded mainly due to an increase of the areas
of stabledisturbances of coronary microcirculation caused not only
byacute myocardial infarction but also by transformation of
transitory ischemic zones to the new stable perfusion defects.As
compared to the early terms in the later period (336
months after coronary angioplasty) in patients with
restenosisand stenosis de novo the mean size of transitory ischemic
zoneswas significantly increased and exceed preoperative level.
After132 years the appearance of new irreversible defects in
zonesperfused by recanalized CA in 6 of 11 patients was marked.
Themicrocirculation of the heart muscle in the group of
patientswithout restenosis not undergo remarkable changes.
Conclusion.Conclusion.Conclusion.Conclusion.Conclusion.
Myocardium perfusion scintigraphy withthallium3199 chloride allows
to evaluate objectively the resultsof endovascular treatment of CAD
and to diagnose therestenosis and stenosis de novo with high
sensitivity.
ADDITIONAL USE OF A REMOTE MONITADDITIONAL USE OF A REMOTE
MONITADDITIONAL USE OF A REMOTE MONITADDITIONAL USE OF A REMOTE
MONITADDITIONAL USE OF A REMOTE MONITORING SYSTEMORING SYSTEMORING
SYSTEMORING SYSTEMORING SYSTEM(CARELINK, MEDTRONIC) IN P(CARELINK,
MEDTRONIC) IN P(CARELINK, MEDTRONIC) IN P(CARELINK, MEDTRONIC) IN
P(CARELINK, MEDTRONIC) IN PAAAAATIENTS WITH LONG3TERM IMPLANTED
PTIENTS WITH LONG3TERM IMPLANTED PTIENTS WITH LONG3TERM IMPLANTED
PTIENTS WITH LONG3TERM IMPLANTED PTIENTS WITH LONG3TERM IMPLANTED
PACEMAKER,ACEMAKER,ACEMAKER,ACEMAKER,ACEMAKER,
ICD AND CRT DEVICESICD AND CRT DEVICESICD AND CRT DEVICESICD AND
CRT DEVICESICD AND CRT DEVICES
Ritter Yulia, Bastian DirkKlinikum Nrnberg Sd, Nrnberg,
Germany
BackgrBackgrBackgrBackgrBackground:ound:ound:ound:ound: The
number of patients fitted with new cardiacimplantable electronic
devices (CIED) with telemetry options willincrease particularly in
regions, where a long journey is necessaryfor follow up and if
there is favorable reimbursement. Howeverthere is not enough
systematic data available about additional postimplantation
equipment of long3term implanted CIED carriers withremote
monitoring to start a tele3cardiology network (TKN).
Aim: Aim: Aim: Aim: Aim: To change the follow up of long3term
implanted CIEDpatients from out3 patient care in a big cardiology
center toremote follow3up (RFU) with cardiology practices with
criticalanalysis of patient acceptance and use.
Patients and method: Patients and method: Patients and method:
Patients and method: Patients and method: The implantation center
initiatedthe setup of a TKN. The effort was deliberately kept to
aminimum. 586 non selected patients, that had been equippedwith a
CIED (Medtronic) in the years from 2002 to 2009 (meanage 70 13
years) were informed by letter about the possibilityof a voluntary
free retrospective equipment with CareLink inJune 2009. Two
seminars took place for both patients andcardiologists.
Results: Results: Results: Results: Results: Altogether 289/586
patients (49%) respondedto the letter (Fig 1). The patient response
was independent ofpatient age and implantation duration of the
CIED, however withdifferences between the device categories (fig.
2). 145/586patients (25%) were equipped with CareLink
(70/359pacemaker, 51/182 ICD, 22/43 CRT D, 2/2 implantable
looprecorders (ILR)). After 1.5 years, 79 of the 586 patients
thatwere addressed in the letters (13%) used the system actively(38
PM, 30 ICD, 10 CRT3 D, 1 ILR) (fig 3). Altogether, 448transmissions
(means 3.1/patient) were carried out in this timeperiod with 814
reported events, most frequently with CRTsystems.
Conclusion:Conclusion:Conclusion:Conclusion:Conclusion: If the
effort for the initiation is kept minimal,approx. 15% of the
attainable CIED carriers use the RFU in anindustrialized urban
region. The resulting ratio of effort andusefulness as well as
options for more efficient patientrecruitment need to be further
analyzed. In rural areas with alower doctor density and longer
patient journeys a higheracceptance is to be expected.
Fig. 3 Number of transmissionsfor each CIED3category after
1.5
years
Fig. 1 Patient response to the offer of free CareLinkequipment
(n=586) Fig. 2 Patient response for each CIED type
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7
INTERVENTIONAL LASER3ASSISTED EXTRACTION OF AN INFECTED TRAPPED
VENTRICULO3AINTERVENTIONAL LASER3ASSISTED EXTRACTION OF AN INFECTED
TRAPPED VENTRICULO3AINTERVENTIONAL LASER3ASSISTED EXTRACTION OF AN
INFECTED TRAPPED VENTRICULO3AINTERVENTIONAL LASER3ASSISTED
EXTRACTION OF AN INFECTED TRAPPED VENTRICULO3AINTERVENTIONAL
LASER3ASSISTED EXTRACTION OF AN INFECTED TRAPPED
VENTRICULO3ATRIALTRIALTRIALTRIALTRIALSHUNT BASED ON TECHNIQUES FOR
PSHUNT BASED ON TECHNIQUES FOR PSHUNT BASED ON TECHNIQUES FOR
PSHUNT BASED ON TECHNIQUES FOR PSHUNT BASED ON TECHNIQUES FOR
PACEMAKER LEAD EXPLANTACEMAKER LEAD EXPLANTACEMAKER LEAD
EXPLANTACEMAKER LEAD EXPLANTACEMAKER LEAD
EXPLANTAAAAATIONTIONTIONTIONTION
Ritter Yulia, Bastian Dirk.Klinikum Nrnberg Sd, Nrnberg,
Germany
Aim: Presentation of an alternative interventional methodfor
extraction of trapped infected (cerebro3) ventriculo3atrial(VA)
shunts.
Case: A 44 year old patient had undergone implantationof a
VA3shunt for treatment of a communicating hydrocephalus21 years
ago.
After two shunt revisions the patient developed ageneralized
infection with staphylococcus aureus. The cerebralventricular part
of the shunt could be extracted without anyproblem; the atrial part
however could not be removed bysimple traction due to extensive
endovascular adhesions.Operative removal was planned using
interventional means.
After opening the cervical implantation site we mobilizedthe end
of the persisting atrial catheter. A guide wire (Amplatzer0,035
inch, extra stiff) was introduced into the catheter
forstabilization and fixed with a solid thread at the end of
thecatheter (fig 2). Then a 14 Fr Excimer laser
sheath(Spectranetics, Colorado Springs, CO, US) was advanced
overthe catheter until the entry to the vein. With low dose
energyrelease, careful rotation, traction and counterpressure it
waspossible to advance the laser sheath under the clavicle (Fig.3).
Extensive local calcifications could be overcome by using a
mechanical sheath (13 Fr, evolution, Cook Vascular) (Fig
4).Adhesions in the superior vena cava (SVC) as well as in theright
atrium were loosened without any problems. Finally thewhole
remaining systems could be extracted in one piece (fig.5).
Discussion: The procedure is based on techniques andtechnologies
which are used for extraction of trapped cardiacpacemaker and ICD
electrodes. Necessary preconditions forthis interventional approach
include access to an extravascularend of the catheter, sufficient
catheter stability to traction andmanipulation and finally3 patency
of the catheter lumen. Itseems to be essential to stabilize the
catheter by introductionof a stiff guide3wire or a Lead Locking
Device. The stiffenedcatheter serves as guidance for the outer
sheath, whichdecreases the risk of perforation of the vessel wall
significantly.
Conclusion: The safe extraction of intravenous and
atrialVA3shunt catheters that have become adherent and trappeddue
to the long time since insertion is possible with the use
ofmodified techniques for explantation of pacemaker electrodes.This
interventional approach can be pursued in specializedcenters to
avoid the more invasive primarily vascular surgicalor even
cardiosurgical approach.
Fig. 1 Cervical x3ray showing the infected abandoned atrialpart
of the ventriculo3atrial shunt (*) and the contralateral
ventriculo3peritoneal shunt()
Fig. 2 Intraoperative site: the mobilized end of the VA3shunt(*)
with introduced and fixated guide wire (). Holding
sutures.
Fig. 3 Mobilization of the shunt by advancing the lasersheath
(*) down to the clavicle. stiff guide wire inside the
VA3shunt catheter ().
Fig. 4 After passing the stenosis under the clavicle with
thenonpowered sheath (*) further adhesions are being
loosened in the SVC. guide wire.
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8
Fig. 5 Completely removed system (cleaned): * extracted VA3shunt
catheter; guide wire for stabilization, fixed to theproximal end of
the shunt for traction with a firm suture ().
COMPCOMPCOMPCOMPCOMPARAARAARAARAARATIVE FEATIVE FEATIVE FEATIVE
FEATIVE FEATURES OF LIPID3METTURES OF LIPID3METTURES OF
LIPID3METTURES OF LIPID3METTURES OF LIPID3METABOLIC DISORDERSABOLIC
DISORDERSABOLIC DISORDERSABOLIC DISORDERSABOLIC DISORDERSAMONG
INDIGENOUS SMALL IN NUMBERS PEOPLE OF YAMONG INDIGENOUS SMALL IN
NUMBERS PEOPLE OF YAMONG INDIGENOUS SMALL IN NUMBERS PEOPLE OF
YAMONG INDIGENOUS SMALL IN NUMBERS PEOPLE OF YAMONG INDIGENOUS
SMALL IN NUMBERS PEOPLE OF YAKUTIA WITH ARTERIALAKUTIA WITH
ARTERIALAKUTIA WITH ARTERIALAKUTIA WITH ARTERIALAKUTIA WITH
ARTERIAL
HYPERTENSIONHYPERTENSIONHYPERTENSIONHYPERTENSIONHYPERTENSION
Sofronova S.I., Uvarova T.E., Voevoda M.I.,Yakut Scientific
Center of complex medical problems Siberian Branch of RAMS,
Yakutsk, Sakha Republic (Yakutia),
Research Institute of Therapy, Siberian Branch of RAMS,
Novosibirsk, Russia
Objective of the study: Objective of the study: Objective of the
study: Objective of the study: Objective of the study: To study the
peculiarities of lipid3metabolic disorders among indigenous people
of Yakutia withthe presence of arterial hypertension.
Materials and methods.Materials and methods.Materials and
methods.Materials and methods.Materials and methods. A set of
material for research iscollected in expedition conditions in
places of compactresidence of indigenous small in numbers people of
Yakutia inYuryung3Khaya Anabarskiy district (Dolgans), and.
EzhantsyUst3Maisky district (Evenks), while conducting
complexexamination.
Indigenous small in numbers people of Yakutia (EvenkS
andDolgans) of working age from 30 to 59 years who were dividedinto
2 groups were the object of the study. Dolgans and Evenkswith
hypertension (80 persons) made up the I, main group.Among them:
women 52 (65%), men 28 (35%). The averageage of patients was 44.38
0,82 yrs. II control group wasrepresented by the same ethnic groups
without hypertensionand other cardiovascular diseases according to
routineinspection and the absence of chronic disease in their
medicalhistory (106 persons). Among them: women (62,3%), men
40(37.7%). Average age 39.96 0.7 yrs. For hypertension wastaken BP
level 140/90 mmHg. (Russian recommendationsdeveloped by the
Committee of Experts All Russiancardiologist's Committee, 2004,
2009). HP I stage 17, HP IIstage 63. Those with secondary
symptomatic hypertensionof all forms of CHD are excluded.
Laboratory Methods include: identification of blood lipidprofile
(total cholesterol, triglyceride (TG),
LDL3cholesterol,HDL3cholesterol) and glucose level.
When estimating the frequency of the blood lipid profiledisorder
among the population we used Russianrecommendations III edition of
the Committee of Experts of AllRussian cardiologist's Committee
2007, drawn up taking intoaccount the recommendations of the III
European edition, 2003[Section atherosclerosis All Russian
cardiologist's Committee,2007; European guidelines on
cardiovascular disease preventionin clinical practice, 2003 ]. For
hypercholesterolemia (HCH) isaccepted cholesterol level 5.0 mmol/l
(190 mg/dL),hypercholesterolemia LDL, LDL3 cholesterol 3.0 mmol / l
(115mg / dl), hypoalphacholesterolemia (hypo33 cholesterolemia)3
HDL3cholesterol 1.0 mmol / l (40 mg / dL) among men and1.2 mmol / l
(46 mg / dL) among women. Hypertriglyceridemia(HTG) is considered
when the level of TG 1.7 mmol / l (150mg / dL).
According to the All Russian cardiologist's
Committeeclassification (2007) criterion of carbohydrate
metabolism
disorder is hyperglycemia (HG), fasting serum 6.1
mmol/l,impaired glucose tolerance (TGT) (plasma glucose 2
hoursafter TSH 7.8 mmol / l 11.1 mmol / l).
Statistical data processing was performed using standardmethods
of mathematical statistics, using SPSS softwarepackage (version
17.0). Differences were consideredstatistically significant at
p
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9
When comparing the frequency of Hypo33cholesterolemia in
hypertensive women and normotensivealmost the same increase in
these parameters in both groups(46.2% in Group I and 47.0% in group
II, p> 0,05) is noted. Onother indicators of lipid disorders in
women is a similar patternof overall performance. Thus,
hypercholesterolemia in GroupI in women made up 73.1% in control
39.4% (p
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10
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(42,3 46,8%). 3 53 , 45354 ., ( 44,3% 21,5%), 3 ( 7,3% 21,5%). ,
45354 : 53 3 ( 16,8% 5,0%) 3 ( 36,8% 62,2%).
: , 3 3. 3 , 3 53 , .
-
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. , 3 .
3 3 . ( Kendall) 3 3, , , , 3 , 3, , NT3pro3BNP.
: 3, , , , . 3 3 NT3pro3BNP (R=0.43), 3 (R= 30,37) (R=0,36). , 3
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-
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, 3, , ?3, . 3 3 83 . 2 3 ( 2009): , 3 , 2009 . 13 44 , Q (.Q)3 28
(64%), Q3 20 (36%), 17 (38,6%),3 27(61,4%). 2 3 39 , . Q324 (62%),
Q3 15 (38%), 24 3 (61,5%), 3 15 (38,5%).
3 3 334 ,.. . 1996398 .. 3 ALOKA SSD32000 () HITACHI EUB565A ()
3 3,5 , 3 . 3 3: (), () 3 () (), 3 () (), (EF) . 3 BIOSTAT 3 . 3
(M), 3 (m). 3 (t). p
-
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.., .. , ,
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3 3 .
: 42 (12 30 ) 24 67 . 20329 4 (10%), 30339 40349 11 (26%) ,
50359 9 (21%), 60 7 (17%). 30 (71%) (F40 F45),8 (19%) (, , 3 ) 4
.
: 3 , 30 (71%), 6 24 , 3 40349 50359 3. , 3 , () 18 (43%), 3 15
. : 3 3 3 (7%), 3 10 (24 %), 5 (12)%. , 3 10 (24%) , 3(7%) , 3
5(12%), 2(5%); 3 8(19%) , , 5(12%), 3 3(7 %); 3 . 3 9 (50%), 3 5
(7%). 3 : 15 (35%), 12(29)%, 3 2(4%), 3; 3 3, 4 (10 %), 33 , 6
(14%). , 3
, : 3 3 5(10%); 3 3 2 (5%), 3 32 (5 %); 3 3 3. 31 (74%) (3
1003120). , 3 3. 3 3 3 3. , , 3 3 3 . , 3 . 3 , 3 , . , . 3, , 3 ,
3 (3, ), 33. , 3 3 , 3 , 3, , 3 3 . , 3 . 3 , 3 , 3 .
3 3 3 3 3
.., .. , . ,
: 3 3 3 ().
: 64 3 , 40 55 ().
-
21
() 3 3 (NYHA) 63 () 3 : 13 30 II 23 3 34 III NYHA. 20 . 3 .
Solomon. 3 3 ?33 ().
: , II 3 28,5 %, III 42,3% (P
-
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(). 3 3 IBM PC/AT 3 ECXEL 6.0Windows395. : (MSD).
: 3 , 32, 4% 3 60 . ONOO3 3 3 3
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: 3 3 , .
.., .., .. 3
,
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. 3 3 () (56,4%). 3 , , 3 , 3 , 3 . 3 , 4059 , 29% 3 () , , 36
61 % . (,, , .) 3 (, , ). 3, , , 3 3 3. , 3 ., 3 3, , 3 . , . 3 3 ,
, 3 . 3 , 3 . 3 , , 33 , , ., 3 , 3
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3 (), () (). 3 (, 3, 3) 3 3 3, 4.12.78 .N1038/82 ( ..,1992) 3 .
3
-
23
"Stat Fa". 3 3 .
. , 3, 3 0,0020,0001 /3, 0,00120,0002 /3, 0,00010,00001 /3,
0,00010,0001 /3, 3. 3 2,1 3 (42,0% 20,0%,=0,05, ). 1,4 , 3 30%. : 3
( 2,7 ), ( 2,9 ) 3 ( 1,7 ), 3 59,0% , 3 ( 1,6 ). 3 61,0% , 3 3
10,0% (=0,002). 3 55,2% , 39,6%, 5,2%. 10,0% 3, 33 . 3 3
(4,10,2 2,10,3 ., =0,02, ). 3 (=0,0130,001). 3 3 3 3 (r=0,57,
=0,05), 3, (r=0,63, =0,03; r=0,59, =0,05,), 3, 3 (r=30,49, =0,04;
(r=30,66,=0,03, ).
. , 3 3 , 3 3, . 3 3,9 (=3,9). 3 3 3 , 3 . , 3 3 3 3 3.
33333
.., .., .., .. 3
,
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120 . , 70% 3 3. 3 3 (), 3 3 3.
3 3 3 3 3 3 () 3 3 3
106 5 10 . 42,711,2 .
. 70% , , , 3 3. 3 () 85,6%, (I.10) 71%, (I.20.00) 7,3 %, (I.20)
5,5 %, (I25.2) II 1,8 % (=0,05). 90,6 % 3 , 3 , , 3. , 3 () (5,51,0
/, =0,05) (3,20,8/, =0,05). 3
-
24
,, 3 1,3, 1,5 1,2 , 3 3 ( 3 , r=0,69, =0,04; , 3 ,r=0,71, =0,03;
r=0,79, =0,03, ).
, (3
, 3, , 3 3 3 1 ) 3 1,2 ( 3 1,2).
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. . . . . 303 19 44 ( 25,271 ) . , 3, T4 3 IMMULITE 2000. .
Statistica for Windows, 7.0, 3 .
. . . . . 3 3 5,741,14 / ( 2329 /). 3 3 587,6579,68 / ( :
29832350
/). 3 3 : 3,3035,20/ ( 3,3035,50 /) 4,0036,80 / 2 ( 7,80 /). 3
4,060,11 /, 2 5,710,13/. 2,140,18 / ( 0,434 /). 3 3 (10%) ( 4,56/),
3 . T4 11,90318,70 / ( 11,50322,70/), 15,210,43 /.
. . . . . , , 3 . 10% , 3 .
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: : : : : 3 .
. . . . . (I) 3 116 :75 (64,7%) 3 () 41 (35,3%) 3 () 3. 33 () 3
: (n=50) 3 () ; 3 (n=25) 3
3 3; C (n=14) 3 ( ) 3 , ; D (n=27) 3 ( ) 3 , , . 3 (II) 37 I3II
3 . 11,8 0,4 , 12,10,4. 3 6,60,4 6,90,6 .
Philips 11XE () 3 3 3
-
25
5 . 3 () Teiholz 3.
. . . . . 3 3 3 ( ,3375%, 325%), 3 (26,7%), 3 , (31,9%), (27,6%)
. , 3 4 (R=4,2 [1,315,02]). 3 () 3 (2,50,03 2,20,06,=0,000). :
87,83,4 77,92,2 (
-
26
(), 3 . 53 3. 2 : (n=24) 3 ( 9 3 +), 3 (n=18) . 3 2,535 /. .
28,98,6 ( 7 42 ). 3 6312 . , 3 : , , 3 (), , 3 , 3. 3 , , 3 6 3
.
::::: 3 : 3 16,7%, 53,8%, 3 3 (21,81,4/%) 61%, III II (21,32,04
17,23,17, =0,04, ), 3 3 . 3 3 (3,40,7/) 537 (2,20,9/). 89,7% 3 3
0,5 1,5/, (95,45,9 (=0,001). 537 (2,033,0). 9 3 3 ( +). 3
3 6. 3 , . 56%, 33,5%, 33% (=2,09); 53%, 26%, 9,9% . 3 19% ()
7,6% , 23% 20%, 3 68% 45% . 5,30,3 ( 2,50,02),+ 3,40,3 ( 2,350,07).
3 . , . 3 . 3 4,7% (, ), . 3 (=0,003). (=25,2329,9 42,3% , >30,0
31% ) 3 3 .
::::: 3 , , 3 3 . 3 3, 3. 3 3 .
.., .., .., ..3 3 ,
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::::: 3 . 3, 3 . 3 3. , 3 () 3
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3 , 3 3 .
: : : : : 3 .. , 3 , 3 . 3 3
-
27
(3). ( . 2010615687).
: : : : : .3 2010 . , 3 2028 3 . , 57,9% 3, 42,1% . 3 3 : 10,7%,
13%, 76,3% 3. , , 3: 7,5% , 13,2%, 79,3% . 3 3 , 3 . 3 62,3% .
3 3 . 3 61,%.
::::: 3 3 , 3 . 3 3 3. 3 . 3 3 3 .
.., .. ,
3 3 ,. ,
, 3 . 3 3 3 .
33 3 .
: 270 (129 141 ) 13 83 ( 45,30,9 ), 3 3, . 7 20 (n=22); 20329
(n=32); 30339 (n=38); 40349 (n=54); 50359(n=81); 60369 (n=27); 70
(n=16). 3 3 . 3 . () () 3 / (Sa) 3.
: : : : : 53 3 3
(), 17,00,98, 17,10,6, 18,82,6, 15,10,5,13,90,4, 13,90,4 11,80,8
/, (F=3,53; =0,002). 3 (), , , 43 . 3 10,50,7, 10,80,6, 15,22,3,
14,10,6, 15,40,5,16,20,8 16,31,1 /, (F=4,06;=0,0006). /
1,80,18,1,710,11, 1,320,07, 1,140,05, 0,970,04, 0,860,06 0,740,05
(F=21,14; =0,0000001). / 59% , 81% 94% . 3 3 S 3, 14,41,0315,20,6
/(F=0,18; =0,98). 3 (r=30,23; p=0,018), (r=0,26;p=0,02), /
(r=30,56; p=0,0001)
, 3 . 33 .
-
28
.., .. , 3
3 ,. ,
, 3 . , .
3 .
: : : : : 270 (129 141 ) 13 83 ( 45,30,9 ), 3 3. 7 3 20 (n=22);
20329 (n=32); 30339 (n=38); 40349 (n=54); 50359 (n=81);
60369(n=27); 70 (n=16). 3 3 : 3 (), (), 3 (/), (). 3 (). 3 (,
).
::::: 3 , 65,22,9, 69,52,3, 60,81,6, 54,91,4, 53,21,4,
51,12,1,48,22,3 /, (F=12,54; =0,0000001). / , 3 1,60,06, 1,640,06,
1,440,05, 1,380,04, 1,20,03,1,20,04, 1,10,09 / (F=14,7;
=0,0000001). 3
, 42,21,8348,44,5 / (F=1,32; =0,24). 3 3 , 162,77,3 178,64,4
(F=0,67; =0,67). 3 , 3 59,72,2, 52,91,9, 52,52,2, 52,81,8,
44,71,1,45,32,1 40,92,1 /, (F=9,27;=0,0000001). 3 3 49,21,6,
46,61,4, 45,01,7, 43,20,9,39,60,7 38,41,3 /, (F=10,3;=0,0000001). 3
3 (r=0,61; p=0,00001), 3 (r=30,42; p=0,0001) (r=0,34; p=0,002), /
(r=30,56; p=0,0001), 3 (r=30,46;p=0,0001), / (r=30,46; p=0,0001), 3
(r=30,38; p=0,0001) (r=30,42;p=0,0001).
, 3 , 33 , 3 3 . 3 .
NT3PROBNP NT3PROBNP NT3PROBNP NT3PROBNP NT3PROBNP
.., .., .. , . ,
: : : : : 3 (), , 3 () 3 , , 3 N3 3 (NT3proBNP), 3 .
: : : : : 3 NT3proBNP 33 .
::::: 3 52 38 3
() 14 ().::::: , 3
(), 3 () () 3 , NT3proBNP (MiniVidas, BioMerieux).
: : : : : NT3proBNP ( 3,
-
29
, NT3proBNP 3 ((r=0,383; p=0,001) 3 (%) (r=30,310; p=0,013).
>I . NT3proBNP 112/ 92% 50 % 3, 64%, 87%.
: N3
3 (NT3proBNP) 3 3 3 , 3 .
.., .., .. ,
. ,
: : : : : 3 3 .
: : : : : 84 3 II3III . 3 3 . 3 (1979) (1984) 3 (2000). 3 3 2 :
I 3 44 () II II 40 III. 3 I 46,95,35 52,476,03 II . 3 I 4,052,15 II
6,714,6 . 3 4 3 : 13 II (n=28); 23 3 II+ (n=16); 33 III (n=21) 43
III+ (n=19).
23 Humaclot3Duo (). : 3 3 () ; (3 ); ( 3 ); ( ); ( ); .
3 www.swpc.noaa.gov/alerts/archive;
www.forecast.izmiran.rssi.ru. 3 3 . .
3 3: 037 (30); 7325 (); 25 (). 3 . 3
() () .
IBM PC/AT biostatic for windows, 4,03. . 3 3 (t). .
: 3 II3III, , 13 23 3 3 30 . 3 8,5%; 7,5% 6,7% 23 (
-
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.., .., .. ,
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: : : : : 3 3 .
: : : : : 3 84 II3III . 3 3 . (1979) (1984) (2000). 3 2 3: I 44
3 () II II 40 III (. 1.). 4 3 : 13 3 II (n=28); 23 II+ (n=16); 333
III (n=21) 43 III+(n=19).
() 3 G.V. Born (1963), 23 3 Chronolog3440(). : 1 3 (); V1 (/); 3
( ).
3 www.swpc.noaa.gov/alerts/archive;
www.forecast.izmiran.rssi.ru. 3 3 . .
3 3: 037 (30); 7325 (); 25 (). 3 3 . 3 () () .
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-
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3 3 .
-
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.., .. , .,
. . . . . 3 3.
. . . . . 49 26 57 , 3 . , , 3 24 . 3 ().
. . . . . () (SDNN128,9 170,5 ; p=0,025), rMSSD (22,6 39,5 ;
p=0,000), NN50(3,8 13,3% ; p=0,000), %HF 3 (7% 21% ;p=0,000), 3 . 3
, (LF3 R=0,906, p=0,005; LF/HF3
R=0,790, p=0,034), . 3 SDNN (R=30,521,p=0,013), SDNN 10
(R=0,592, p=0,004).
3 pNN50 10 (R=0,472, p=0,031), pNN50 3 3 (R=0,449, p=0,031) 30
(R=0,590, p=0,005). 3 HRVti (R=30,691, p=0,001) 3 (R=30,481,
p=0,032), 3 HRVti 10 (R=0,468, p=0,037).
. . . . . 3 , 3 .
.., .., .., .. , . ,
c 3 , . 3 , 3 3. 3 .
. . . . . 72 II 28 60 . , 3 3 3, . 3 3: 15%, 15 30%, 30 80%, 3
80%.
..... (8613,0 7812,0 .; =0,020), (6131,6 4334,4%; =0,036), 3 (7
11,1%; =0,03). 3
30% 3 3 . 82% 3 (30%) 3 (p=0,0678), 59% ( 30%3 39%; =0,0001).
30% ( 42%, 21% 30%, p=0,0048). 30% 2 3 , 0 1 3 (=0,0014). 30%
(47%), 30(18%), (p=0,0067). (=0,0382), 3 (=0,0056).
. . . . . 3 , 3 , 3 .
-
33
33333 , ,, ,, ,, ,, ,
.. .. , ,
, . ,
: : : : : 3 () 3 3. 40% , 60% 50% . 3 () 33 , 3, 3 . 3 , 3, (),
, 3 , 3 3 , 3 80% ,
3 .
: : : : : 3 3 () 3 , ; 33 , ; . : 3 33 ; , 3 ; .
: : : : : 3 809 , 3263 546 25375 3 (. 1).
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-
34
, 321,6%, 313,5% 3 47,8%. 3 . 3, 322,4% 3 3 334,7%. : 347,8%, 3
32,9%
346,4% , 3 3 3 . , 3 3 . 3 .
.., .. 1 3 , 3 ,
.,
3 () 3 3 () [Aversa A. et al. 2005]. , 3 [Melman A.1995]. 3 53 [
.. .2003]. 3 3. 3 [ .. .2006].
R.Virag (2002) 3 , 3 3. 3 100 92% . 3 3 .. .(2005). 3 100 94,5%
3. 3 , .
: : : : : 3 () 3 3 3 .
: : : : : 78 3 (). 12
. 3 ( , , 3 , ). 3 3 3 (ZB). 3 () :
(D D)/D x 100% , D3
3;D3 3
3;:::::
2 : 1 (n=61) 2 (n=17). 62,2%, 13 23 12,5% 51,7% 3. 3 3 3 . 3 . 3
3 30%.
: : : : : , 3 . .
. ., . ., . ., . ., . . ,
, . ,
::::: 3 31, 3 / 3 .
: : : : : 3 3 (n=79) 1803250 , 6 , 3 . 3
-
35
: 1 0,1% ( 5 /) 3 0.5 ( ); 2 3 3 ; 3 3 ; 4 3 . 3 1,5 / 3 3. 33
10 , 2,5105 0,5 3 100 .
(132 3 ), . . 3.
3 3 70 ( 72 73 3 70), () 1 (31), . C 70 3 , 3 70 (Sigma) 3 3.
(Sigma), 53343333/ . , 31 3 3 Ultrospec34050 (LKB, ) (P.Z. CORMAY
(, ) BioconDiagnostik ()) , . , Biocon (). 16, 24, 72 .
3 3 (U) (W), 3 .
-
36
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.., .. . . .. ,
. ,
3 3 .
. . . . . 3 209 10311 3 . 16317 . 3 128 3 (), 3 30 . 3: ( 12) 33
( ). 3 3, .. ..(2002 .). , 3 ( , 3, ), 3 , , , 3 . 20 3 . . 3 3: ;
; ; 3 ; ; 3 ; . 3 Statistica 6.1 (StatSoft3Russia, . 2009).
..... 80% 3 3 . 3 : (21,6%), 3 (4%), (12%), (10%), (2%), (4%),
PQ (4%). 3 .
3 . 97% 3 ; 37% ; 33% ; 27% 3 ; 20% . , 7%. 3 3 3% .
3 3 3, .
, . 3 3 , 3 ( , 3). 3 .
3 , , 53 . 3 .
, 3 3 3 33 , .
, , : 47% , 32% 3 , 17% ,16% 3 .
50% 3 , 3 3 3 .
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..... 3 .
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33 , 3 . 3 , . 3, 3 , .
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-
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3 , , .
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. . . . . 3, , . 3 , () 110 . . 3 . 3 , (), () 3 (), 3 Logic 7
(General Electric, ,2008). (Vs), (Vd), 3 (Vmean), (PI), 3 (RI) 3 (
3 S\D). . 3 : 1 3. 3 4 2006 . 632. 2 20325% (KRKA) (Enalaprilat)
1,25 . 236 3 160/100 .. () 3 48 . 3 2 3 140/90... 1 20 3 2 12,5 (3)
(Hydrochlorothiazide). 2 3(Nifedipine) (LEK d.d.) 60 12,5 3. : 140
. . 90 . .; . 3 10314
..... 42 (21 21 ). 53 . 3 , 1 : 3
; ; ; 3 . 3 3 ; . 3: 3 ; 3 ; 33 .
, 2 3 : , 3 ; ; 3 ; 3 . 3, ; 33 . 3 : 3 ; , 3 . , 1 2. 3
(p=0,064). 3 3 3. 37 % 1 23% 2: 3 .
. . . . . , 3, 3 123 : 3 ; 3 3 , , 3 .
-
38
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3 12 , 3: 3XL 3. 3 37 % 1 23% 2: 3 .
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3 , , . ,
: : : : : sP sE 3 , 3 ().
: : : : : 41, 57,81,5 . . (, 3, ) 3 Vitalograph 6800 (Medical
GraphicsCorporation, ) 3 . : 7 (17,1%) , 3 (7,3%) 3 10 (24,4%) 3 .
3 , , , II. 3 , 3 : 3, 21(51,2%) , 20 (48,8%), 3. sP sE 3 3
(eBioscience) . 3 3 Statistica 6.0.
:::::
, , sP , (162,833,5 /., 113,558,9 /.=0,002), sE 3 (31,010,7 /.,
25,49,4 /.=0,082). 3 3, , , , sP 3 3 (r=30,88; =0,008), sE 3
(r=30,92; =0,002). , 3 3, 3 . sP 3 (r=30,59; =0,033) 3 (r=0,65;
=0,02), sE (r=30,63; =0,027) 3 (r=30,67; =0,011).
: : : : : , 3 , sP 3 ; 3 sE , , .
sP sE , sP sE , sP sE , sP sE , sP sE ,
.., .., .., . ., . ., .., .., .., ..
3 , . ,
: : : : : 3 sP sE , 3 (), 3 ().
: : : : : 41 , 3 57,81,5 . ,
7 (17,1%) 3, 3 (7,3%) 10 (24,4%) 3 . , 3 , 3, 3 21(51,2%) 20
(48,8%)
-
39
. 3 Vitalograph 6800 (MedicalGraphics Corporation, ). sP sE 3
(eBioscience) , 3 . 3 3 Statistica 6.0.
::::: sP 3 , 3 , 134,758,5 /, (211,272,5 / =0,000), (162,833,5
/) =0,01, 3 . sE
, , sE 39,38,5 /, (17,48,8 /)=0,000 (31,010,7/) =0,000. , , sP
sE 3 . 3 , , , .
::::: , 3 , 3 , 3 .
, , , , ,
.., .., .., . ., . ., .., .., ..
3 , . ,
: : : : : 3 (Dlco) () 2 , 3 ().
: : : : : 3 49 , 3 3 . 3 , I , 3 2 27 (55,1%) II 22 (44,9%). 3
6,41,5%. 3 (), 3 57,63,0 , 302,4/2. , 3 (II3III 3) , 3 Dlco. 3 . 9
. 3 Dlco 3 Vitalograph 6800
(Medical Graphics Corporation, ). Dlco 3 (Dlco cor). 3
Statistica 6.0.
: : : : : (I Dlco cor 76,25,6%, II Dlco cor 87,68,3%;=0,000), (I
3 Dlco cor 69,88,4%, II Dlco cor 74,57,6%;=0,048) Dlco cor , . 3
Dlco cor , (r=30,52; =0,007), Dlco .
: : : : : , , , Dlco cor, . 3 , 3 .
.., .., .., ..,.. , .. .
, . ,
::::: 3 () 3 () 3 ().
: : : : : 36 3 ( 58,39,2
) (). 3 25 ( 53,78,5 ). , , 3 , 3 . General Electric, (). 3
-
40
() 3 () . 13 , 23 .
: : : : : . 3 : >92/. rMSSD>41; >21/ rMSSD>46
3>21/ pNN100>2,1%. rMSSD, rMSSD, rMSSD,pNN100, pNN100, pNN100
, . 3 , SDNN, SDNNi, rMSSD, pNN50, pNN100. 3 4 ., , 3 .
. , 3 . 3 :
-
41
; . 3 .
::::: 3 . 3 2090(Medtronic, ), 3 . 3 3 33 . 3 ()
AcusonSV70(Siemens, ). 3 , 3 .
. 3 3 : , 3 , . 3 , 3 3 , .
: : : : : 3 . 3 3 3 , 3 , 3.
sP3 sE3 sP3 sE3 sP3 sE3 sP3 sE3 sP3 sE3 2, 2, 2, 2, 2,
.., .., .., .., .., .., .., ..
, . ,
::::: () 3s3 sE3 () , 3 () 3 ().
: : : : : 22 , 3 , 16 (72,7%), 6 (27,3%). 57,03,2 , 58,01,5 ,
57,03,5. 3 . : , 3, . 3 () 2 10 (45,5%), 5 (50%) 5 (50%), 3. 54,5%
(12 ). 3 3 3 () 6 (50%). 3 1 . (25%) , 3 73 3 . , 3 2 (17%). (8%)
3, 3. s3 s3 3 3 (eBioscience) , .
::::: s3 3 118,822,0 /, 3
3 156,529,0 / (=0,01), 146,9 21,0 /. , s3 :35,210,2 /, 3 :
18,811,0 /, (=0,0001). s3 . 3 2 , , s3 122,425,1 vs 118,829,1 /, 3
3 : 193,228,3 vs 127,420,0 / (=0,03). sE33 3, , : 44,49,7 vs
31,79,3/ (=0,02). 3 , 3 , , 3 : 24,915,1 vs 18,0 10,2 /;33,611,0 vs
25,19,6 /. 2 , 2 , 3 . , sP3 , 3 , 3 . , 3 , 3 sE33: 20,54,9 vs
11,65,5 / (=0,04); 31,1 4,1 vs 16,3 4,7/ (=0,04). 3 3 sP3
-
42
. sE3 . , sP3 , :212,569,5 vs 127,424,1 / (=0,04). 3 , . : 3 sE3
13 73
3, 24,912,6 vs 11,65,5(=0,04); 33,68,0 vs 16,34,7 (=0,04).
:::::1. 3
sE3 .
2. , 3 , .
::::: 33 339 (39), 3 : sP3 2 , .
: : : : : 29 , , 22 3 (75,9%), 7 (24,1%). 3 573,25 . 3 () 2 3 12
(41,4%). 3 (). 9, s33, 3 () 3, .
::::: 39 3 258,96197,64 /, 3 3: 52% 537,46375,15 /(=0,0004), 3
508,51431,97/. 3 2 : 2 , 39 3 , , :302,82165,78 vs 228,00216,81
(=0,07) 56%
(=0,004) 302,82165,78 vs 687,43463,61; 47,2% (=0,03):
228,00216,81 vs431,60320,72 /. 39, 13 , 2, , , : 687,43463,61 vs
431,60320,72, (=0,04). 73 , , 13 3 7,1% vs 3,5% (>0,05). , 3 73
39 54,7% (=0,06), , 45,3%(=0,03). 39 sP3, , 3 : R=0,62;p=0,02.
::::: 1.
3 39 3 .
2. , 3 3 , , , 3 3 39 , 73 3 .
3. 3 .
39 39 39 39 39 2 , 2 , 2 , 2 , 2 ,
.., .., .., .., .., .., .., ..
, . ,
39 ,39 ,39 ,39 ,39 ,
.., .., .., .., .., .., .., ..
, . ,
::::: 3 339 (39), : sP sE3 , 3 .
: : : : : 29 ,
, , 22 (75,9%), 7 (24,1%). 573,25 , 3 581,5 573,5. 3 20 (68%). 3
14 (70%).
-
43
3 8 (89%), (11%). : 3 , 3 1 (5%), 1 (5%), 3 1 (5%), , 4 4 (20%).
4 (20%) , 3 . , , 2 (10%), 3 1 (5%). , 3 , 3 6 (30%) 3 (). 9, s3
s33, 3 () , .
: : : : : 39 3 258,96197,64 /, 3 3: 52% 537,46375,15 /(=0,0004),
3 508,51431,97/. 3 39 , :285,06216,09 vs 176,9192,26 (>0,05) ,
42% (=0,02), 74% (=0,02): 490,13412,29 vs686,20477,85 / (>0,05).
, 73 , , 3 39 3. 3
9 3 : 240,42210,81 vs 300,15168,55 / (>0,05) 73 3 3 39 , ,
:553,12429,36 vs 502,64450,75 /; 522,47399,35 vs477,47522,26 /
(
-
44
6 (30%). 3 (). IL31240 () , 3 .
::::: 3 IL31240 3 ( 50 %), : 5,711,56 vs 11,42 8,00 /(=0,0001),
. 3 . , IL31240: 16,1412,04 vs 9,925,8 / (>0,05). 3 IL31240 ,
3
. , 3 , IL31240 7 3 3 , 3 .
: : : : : 3 IL31240 3 . , 3 , 3. 3 7 , , , , IL31240.
.. , . ,
3 3 , 3 , 3 3. 3 33 , , 3 .
::::: 3 3 3.
: : : : : 81 3 () 18 37, 15 18 35 20 . 3 , 33 , . () 3 () ; 3 ()
, 3 (L23L4).
. . . . . 3 3 . . 3
. 3 , 3 . 3 3, . , , 3 . 3 18320 , 21329 30337 . 3 , , . 3 3 , 3
, .
. . . . . 3 3 . 3 3 , , , 3, 3 . 3 3 , 3 , 3 , 3 .
-
45
, , , , ,
.., .., .., .., .., .. . .. ,
, ,. ,
..... 3 () 3 . 3 () 3 (), 3 , 3, 3.
: : : : : 3 If3 3 3 .
: : : : : 21 II3III 3 45 67 ( 58,95,32 ), 17 (81%) 4 (19%) , 3
10 . . 3 33 . 3 303 ( , . ) 3 3, 3 3 . 3 , , , , 3 . 33 2 . 3 13
(n=11) 5/ (, , ) 3 10 / (, , ). 23 (n=10) 5 /. 3 . 3 , 3 , , 3 , ,
3 (SDNN, RMSSD, TP). 3 ; .
: : : : : 3 , , , (89,6410,10 13 90,007,16 23 ), (9 ) . 3 : SDNN
13 21 (11,0331,0), 23 25 (13,5333,5). RMSSD TP. : HbA1c 8,621,96%,
5,721,14 / 3 5,961,91 /. 3 , . 3 3 (68,904,68 13 73,004,35 23;
=0,0430). 13 < 70 . 3 132 13 234 23, 3 . 3, 3 (SDNN, RMSSD, TP)
, 3 . 3 3. 3 3 3 , . 3 < 70 3 13 23 .
::::: , 3 5 / 10 / 3 3 3, .
.., .., .., .., .. , . ,
: : : : : 3 () 3 .
: : : : : 3
5 (, 3, , ) . 20359 . 87% 1320 , 531, 789 . 3
-
46
. 3 40,10,3 , 40,10,5 , 40,10,4 .
33 , ( , , ), , , 10312 . (), (), 3 ( ) ( ) CardioChekTM PA
(PTS).
:1. 3
III 3 2003 .
2. 3 94 , 80 (, 2007).
3. () > 5,6 / (IDF,2005).
3 STATISTICA 8.0. 3 3 3 (253 753 ).
() 5%. , 3 (2001).
::::: 42% ( 59%, 3 23%, p=0,001). (p=0,005). 3 , , , 3 , 3 ,
(=0,01).
:, 60% ( 37%, p=0,001); 77% ( 43%, p=0,001); 3 61 41% (
p=0,001); 58 30% 3 (p=0,001). 66% , 3 42% (=0,001).
::::: , 3 , 3 .
(IN VIVO) (IN VIVO) (IN VIVO) (IN VIVO) (IN VIVO)
.., .., .., .. , 3 . .. ,
. ,
..... in vivo 3 3 .
. . . . . (2) 3 , 3 , , , . 2 3 3, .. 3. 3 Clark. 3 2, 3, 3
Clark (+3 ). 44. 44 , 3. (PtcO2) 2 20%(), (PtcO2) 2 5315% ( 2 .
1315 ., 45360 . 2 (3
) .(SpO2 2, 90 . .; 703116 ..; 2 150 ..). , 3 , , . 3, 3 3, , in
vivo. 3. 3 , 3, 3 576. . 3 3, , 3 . 3 0.04 ; . 0.04 . 3, 3 , ,
3
-
47
. , , 3 3, , , , 3 . , 3, , , 3 : . , 3 3, , 3 , , ,, 3, 3 .
. . . . . 3 , , 3 , 3 . 3 3 , 3 .
. . . . . 3 , 3 , . 3 , 3 , 3 3; , , 3, ., , 3, 3 3 . 3 : ( 3 );
3; 3 ; 3 592 ( , ).
.., .., .., .., ..3 3 ,
, . ,
: : : : : 3 3 .
: : : : : 3 3 ( , . ). 200632010 . 141 . 3 8 . 336 . 3 : I , 3 3
91 3, II 42 , , 3 (44 ). 3 3 89% I 90,9% II . 3 604,3 I 61,24,8 II.
I 34,61,3, II 18,91,1 . 3 2008 . ( 2,5 /), , 3 3 () .
: : : : : 3 . 3 3 3, . 3
: 39 (42,9%) I 6 (13,6%) 3 II . , I ( 33 3) 9 (9,9%) , 3 ( 18 .)
19 (20,9%) 11(12,1%) . II : 3 3 (6,8%) 3(6,8%). 3 II 26 , 18 .
.
, 15 (16,5%) I , 8 (8,8%) 3, 7 (7,7%) . II 3 4 (9,1%) 3.
3 , II, , 3 , 3 (54,414,6%/ 42,713,9%/ ; =0,0034), (9,34,8
7,22,3 ; =0,043) 3 (3,81,2 3,21,3 ;=0,014).
::::: 3 3 . 3 3 .
-
48
.., .. 3 , . ,
3, 3 20 3 . , 3 3 3, .
: : : : : 3 3 3 .
: : : : : 24 3 2503350 . 3 . 3 (n = 6) 303 3 () , 120 . (n = 6)
15 3 303 3 n. vagus. (n = 6) 3 30 , 3 3, 5 5 , 53 . (n = 6)
n. vagus, 3 , . 3 Spike4.
::::: 3 3 . () 3 398%. 3 n.vagus 3 , 3 . 597% (
-
49
(>0,05). 435%. , n.vagus , 3 3 3597% (
-
50
(n=6). n. vagus 15 303 (n=6) (n=6) . 3 3 3 , 3 (), (), . ()
(253; 753 ). 3 (253; 753 3). 3 .
: : : : : 3 27 337 . , 4 9 , . 3 7 . 2 . 3 10 11 , 1 . . 3 4 6 .
;
42 207 . , 5 . , n.vagus. 3 3 . 17, 19 126 . , , 2 , . 3 96,0
(36,5; 277,5) , 3 3 0.0 (0.0;10.25) , 3 n. vagus 3 122.0
(74.25;177.0) , 3 8,5 (0,0;45,75) . 3 3 (0,05). 3 (>0,05).
: : : : : 3 3 n.vagus 3 , 3 .
.. , . ,
..... 3 .
::::: 3 (3 ) Pentaphylloides fruticosa (L). O. Schwarz, Rosaceae
,3 3 3.
: : : : : 3 2,53 , . 3 . 3 . , 0,125 / 1 ( ) 0,25 / 3 1 ( ). , ,
3 3 . 3 (), 3 (), ( ); ( 3 , 3 ) (
3 ) . 3 .
..... 3 0,25 / 3 (
-
51
3 .
. . . . . 3 3 , 3 ( ), , 33
, 3 , 3 3, 3.
,,,,,
. . . . .
. ., .. , . ,
33 , 3 . 3 3 (). .
. . . . . 3 , 3.
. . . . . 122 35 84 ( 52,00,7 ) 33 ( 3 () /(1999 ) () 3 ), 3 . 3
35 , 3 35 63 . 3 : I 35 60 ( 3 49,30,9 ) ; II 3 35 60 ( 46,81,3) ;
III 35 60 ( 49,71,1 ) ; IV 3 60 ( 62,61,1 ) ; 35 63 ( 48,21,3 ). ()
(n=60) () (n=15), . () 3 () 3, () 3 () 3 36. () 3 3 . 3 STATISTICA
6. m, , m . 3
3. t33 . 3
-
52
III (45,280,92), (
-
53
.., .., .., .., .., .. 3
, . ,
: : : : : 3 () 2 , 3 (). 3, .
: : : : : 3 , 3 () 2006 2009 . 3 2 (n=303), 3 I ( 57,40,61 ). 3
(II) 535 3, , 1, 2 ( 57,10,58 ). 3 , , , , . ; 33 : , (), 3 MDRD,
(3 0,033 /); 3 3 (); .
3 3 , 3 , 3 , (), 3 (), 3 (), 3 , , 3 3, .
3 STATISTICA 6.0. 3 3 3. , 3, , 253 753 3. 3 3. 3 2 . 3 . 3 25
/2) 81% I 79 % II (=0,85). 76% I 74,5% II (=0,4), 3 7,0 5,5% 3
(=0,35), . 3 (95% 87% , p
-
54
.., .. , . ,
, () 3 . 3 3 3, 3 .
::::: 3 , .
. . . . . 26 , 3 3 . 3. 26 3 34 . 800 2300 . 3. 12 3 . 14 33 . 3
() 3 3 5 . 3 9 . 3 , 3 0438 ( , 3, ). 3 3 V4M, Y, V6M, 3 . 3 . 3 3
Microsoft Excel 7,0.
..... 3 243 3 , 3 . 91,6% 3 , , 3 78,5%, 3. 33,3% 3
3 42,85% , 3 . , 3 , 3 . 3 , 2 8 (57,1%), 3 (25,0%). 3 , 50,0% 3
35,7% 3 3 3 , 3 (16 33 ). 3 . , 3 1 3 (8,3%) 3 (21,42%) . Qc , Qc ,
(438,5511,52 455,8820,91 , ). 3 8,32% 14,28% . 3 ST ( ) 3 .
. . . . . 3 3 3 , 3 . 3 II 3 , 3 . 3 , 3 3 .
3 3 3 3 3
.. , . ,
::::: 303 3 () 3 .
: : : : : 16 (. =38,158,25 )
. 6 (. = 44,0 10,49 ). 3 12 , , 3, . 3 1/. 3
-
55
63 () (). (): 1,87 0,29/, 5,831,39/, 3 29,14,18/, , 3 . (,
NOBEL3PHARMSANOAT) 45,837,71 /.
::::: 103 3 , , , 3. , 1 (43,6721,37, 62,2520,90, =0,065) 1/
(0,740,27 0,950,19, =0,059). 3 3 . , 3 () 3 25% ( =0,600.15/,
=0,750,14 /, =0,033), 3
3 7% ( 43,752.5%, 46,851,91%, =0,006). , 3 3 22% (142,2546,41.,
111,0036,77, =0.112) 3 19% ( 29,98,88, 24,322,44, =0,071). . , 1033
3 37% ( 273,6 106,34, 373,831,05.=0,010) () 3 , ( 21,251,89
18,01,63, . 26,253,09 21,01,15, =0,000).
, 303 3 3 , 3 .
.., .. , . ,
3 17% 65 12% . 3 , 3 3 . (), , 3 . 3 , 3 , , 3, .
3 ().
. . . . . 10 . , 3, 3 3.
. . . . . 3 () 3 . 3 7 ST V133, V1,2 QS, V3 QrS. 3 3: V1,2 3 QS,
ST , , V3 Q ST 3 (3+), 3 I 436 /( 030,5 /). 3 3 ,
. 3, . 1, 4 5 QRS . 2 3 , 3 , . 2 QRS 1 , 2. 3 3 , 3 QRS 4 . 2,3
QRS 3 , , . QRS , QRS . QRS 1, 2, 3 5 . 3 QRS 1 2,3, . 3 1 4 5 . 3
, 4 3 . 1,531,8 1,4,5 3 2 3 3 3 133. QRS3T . 1, 4 5 , 3 2,3. 3 QRS
: 1 0,2230,24 , 2 0,1130,15 , 3 0, 1430,18 , 4 0,2530,28 , 5
0,2130,25 . 3 ST , . , 3 , ; 3 QRS 2 3 3; QRS 1 ; QRS , 3 QRS3T;
ST
-
56
, ; 3 , , 3 333 . 1 . , 1,2 4 5 .
3 , 3 .
. . . . . , 3 , 3 3 .
2 2 2 2 2
.., .., .., .. 3
3 , . ,
() () 2 , , 3. 3 () ST, , . , 3 () 3 3.
: : : : : 3 ST (ST) 2 .
: : : : : 423 ST. . 3 77 (18,20%) . (346) .
: : : : : 3 () 45,45% (n=35) , 3 54,91% (n=190) (>0,05). 33
,
. 3 (69,57 vs 56,97 ; p=0,02), : 3 3 (42,86% vs 15,26%;
p=0,001), (21,95% vs 3,70%; p=0,0001), (11,90% vs 3,16%; p=0,04); 3
TIMI (5,0 vs 2,0; p>0,05), ; 3 40% (54,76% vs 20,0%; p
-
57
, , 3, ( ).
: : : : : 3 , 3 (p>0,05) : 28,57%, 30,53%.
, 3 : 52,38% 3 42,95% . , 3 3 3.
::::: 2 3 3 .
R3 R3 R3 R3 R3
.., .., .., .. 3
3 ,. 3,
33 . 3 3 ( RR3). 3 R3 . , 3 , ..., , 3 3 .
. . . . . 3 R3 3 ( R3wave trigger). 3 3 , 3 , , , . 3 R3 3. ,
:
1. o R3 . 3, 3 250 R3 . 3 3 RR3. 3 3 ( R3), 3 .
2. R3 3 3, 3
, , 3 R3.
3. 3 R3 , 3 , 3 ( ), .
4. , 3 , ( 3 ) 3 RR3. , , R3, 3, QRS3. , , 3 .
. . . . . 3 , , . 3 3 3 MicroCap 3 . .
. . . . . 3 R3 16 25. 3 R33 3 , . : 3 R3 3 (), 3 . : , 3
-
58
. 3
3 . 2010 . 3 . (3 ) 3 . 3 3 , 3 ( ) 3 , 3
. 3 3 , 3 . 3 , 3 28 .
. . . . . 3 3 R3 3 , 3 3 3 . 3 .
2 2 2 2 2
.., .., .., .. , . ,
3 () , 2 ().
3 81 , 30 , 51 3 . 3 8 1,5 3 . 3 () 3 Meditech 02/ ( Meditech,
).
3 3 2 3 ( () =329,1 2,9 .., () =324,00,7 ..,
-
59
61,61,5), 37 3 () 14 (). 3 3 54 3, 13, 73 14 3 . 14 (52,62,6),
40 (61,11,8): 30 10 . 3 12 3 3 (53,32,2), . () 3 3(). 323 () 313 ()
3 .
::::: 3 3 (1,310,11 /, 1,290,11, 1,500,18 1,900,13 /,
-
60
, 3 .
: : : : : 53 3 : Q3 31 , 3Q 22. 3 38 . 61,2 (41 12 ). 3 , , , .
3 sFas, sICAM31 (CD54) sICAM33 (CD50). 3 3 HLA I (sHLA3I). 3 : ( ),
. ELISA c . 3 3 Statsoft Statgraf.
: : : : : sFas. sFas 356,0 7,0 / ( m). sFas Q3 475,8 40,7 /. 20
13 32 .
sICAM31. 3 , 3 , . sICAM31 3 64,0 2,2 /. 3 30% (88,3 6,2 /).
sICAM31 Q3 3. 3Q 3 sICAM31. 3
3 Q33 3Q . sFas sICAM31. .
sICAM33. 3 sICAM33 353,6 7,3 /. Q3 364,926,6 /, 3Q 3 373,4 19,7
/. .
sHLA31. 3 sHLA3I 1021,5 156,8 /. Q3 sHLA3I 972,0 468,1 /, 3 3Q ,
1342,0973,1 /. HLA I 3 3 3 , CD833 . , 3 sHLA3I, 3 .
: : : : : sFas, , 3 ICAM31, , , 3 . 3 , , 3. 3 ( 4 ), 3 . , ,
.
.., .., .. ,
, . ,
() 3 3 (). 3 3 () .
: : : : : 3 , 3 , .
: : : : : 69 , 3 2 . : 51 ; ( ): 18 .
. , 3, 3 . 3. 1 3 50,66,2 , 3 25% 44,0 ; 75% 3 57 , 46,097,06,
25% 37,0 ; 75% 59 . 3 . , , 130 / 4,51012/. 33 32000 3 3,5 . 3
3
-
61
, 1980 . 3 (ASE). 3 .
3 STATISTICA 6,1 (StatSoftware, USA). 3 (3 3, , ). 3 3 <
0,05.
: : : : : 3 28 3 , 23 3 .
, 13 . , (P= 0,05). 13 10, 8%, (P=0,05). 3 13 0,20,12
(P=0,00035). 3 13 27%,(P=0,00002). 3 . (> 110/2) 74 (75%) ,
8(10%) 64(86%) . , 112,720,2/2 3 82,119,2/2, , (=0,00001). 3
(R=0,21; =0,00001), ( R= 3 0,19; =0,00035). 6 (8,1%), 5 (6,8%) 3 32
(43,2%). 3 . 3, 58,5% , 3 15,6% , 17,2 % 3 , 8,5% .
3 13 7 % ( r=0,32; =0,0009) 3 , 3. 3 13 23 , 7,3% (=0,03) . 3 13
10,72,7(=0,85). 3 3 () 13 4% (r=0,38;=0,02) . 3 (), 3 13 2%
(=0,05). / 3 13 4,9%(=0,00352). 3 (DT) 13 23 . 3 (IVRT ) 3 13
4%(=0,00007), , 3 . 72,6%. 3 13 23 : 56 (68,3%) 24(32,7%) .
::::: , , 3 , , . 3 33 3 , 3 . 33 . 3. 3 3 .
ST ST ST ST ST
.., .., .. ,
, . ,
33 3 () 18,5% 72,7% , 3 . 3 P, R , S, T ( R T V2), P, P3Q, QRS.
, 3 () 3 () , , 3 3
. () . 3 ST 3 .
::::: ST 3 .
::::: 98 . 51 , 29 , 18 33 .
-
62
. 3, , 3 130 / 4,51012/. 34 51 (66%) 125 / 115 /, 70/ 30/. 3 ,,
, VI. 3 () ArMaSoft . 200032004 Safe Heart System 24h 2.02. ST 3
3
1, 23 . 3 3 STATISTICA 6,1 (Stat Software, USA). 3 3. <
0,05.
: : : : : , 18,2% 3. ST(.1) , 3, , , (
-
63
.., .., .., .., .., .., .., .. , . ,
, . , , . ,
() 3 333 . 3 . 3 . , 3 3. , , 3 ( C3344T) .
. . . . . 3 3 ( C3344T) 3 .
. . . . . 226 I3III ( ) (149 77 ) 45 65 ( 3 55,95,8) I3IV NYHA.
3 () 63330% (). 3 136 (63 73 ) 45 65 ( 53,64,8 ) .
, , 3 3 , , 3 . 13 47 (20,8%) I , 23 96 (42,5%) II , 33 83
(36,7%) III3IV .
3 3 : (142 ) 3 (84 ) . 3 : 3, , , () .
( ) 3 3 C3344T. 33 .
. . . . . , , 3 , 3 / (34,5% 18,4%,
-
64
. . . . . , ,
. / C3344T . / .
.., .., .., .., .., .. , . ,
: : : : : 33 () 3 () () 3 .
: : : : : 55 3 (): G83A 3 (REN), M235T (AGT), I/D 33 (), A1166C
3 II 13 (AGTR1). , 3 . () I/D 3 . 3 . 3 , 3 . : 3 336 , . 3 5 . 15
. 3 150 . 3 3 EEEL, 32, BIOSTAT.
: : : : : 3 3 . G83A (=0,0005, ), (=0,01) G (=0,045) . 3 G83A 3.
3 . 3 32 , , 3 3. , 50% I/D . D3 DD 3 3 . 3 DD D3 , , 3 . , 3
3. 3 3 , 3 . 3. 3 . 16 , , 3 , , 3 3 . 4 . I/D , , 3 3 DD (p
-
65
, , , , ,
.., .., .., .., .. , ,
. ,
() 3, , 3 , 33 (CC) 2 ( 2). 3 , 3 . , , 3 . , 3 .
: : : : : , .
: : : : : . 3 . 17000 3 127. 3 :, , (), 3 , 3 : 2, (), 3 (),
.
3 Microsoft Office Excel 2007
STATISTICA 6.0 (StatSoft, USA). 3 3 2. 3
-
66
. 3 3 Microsoft Office Excel 2007 3 STATISTICA 6.0 (StatSoft,
USA). 3 , 3 . (ME) (253 753). 3 3 Kruskal3Wallis. 3
-
67
7
8
9
0
0
0
2. CHADS2 CHA2DS2VASc
3 CHADS2, 3
10% , CHA2DS2VASc 6%( 2).
2
35
21
4
0
0
0
0
0
0
0
1
2
3
4
5
6
7
8
9
CHADS2 (n = 29)
0
13
13
3
0
0
0
0
0
0
CHA2DS2VASc (n = 62)
::::: , 3 (n=73), CHADS2, 40% 3 3 . CHA2DS2VASc, , 85%
. 3 3 CHADS2 4 3 CHA2DS2VASc, 3 3 3 .
.., .., .. 3 , . ,
3 3 3 . , 3 , 3 . 3 3 3 , , 3 . 3 , 3 3 . , 3 3 . , 3 3 , 3
33 .
3 3 3 , 3 .
: : : : : 27 40369 , ( 58,51,3 ), 21 6 . ( 3 88,24,3 , 52,62,8 )
. , 13, 73 . 3 , 3 15 , . ; 3 ; . 3
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68
3 3. 3 Statistica 7.0, 3 3 .
: : : : : 3 9,07 /, 2,6 3, , 2,6 2,62 6,93. ., 4 1,23 4,81. . 3
: 60% 30% 3. .
3 . 3 3 3 2,42 9,45 . . 3 1,23 8,03 . . 3. 3 () . 1 334 3 2. 334
132 : 21%, 12% 3 3 16%, 20%.
7 . 13 54% 70%, 3 10%. , 3 3 .
3
3 . 3 , . 334 3 . . 3 3 3 . 13 , , . 3 , 3 , 3 . 3 3 .
, , 3 3 , , 3 , 3 , , . 3 , , .
:::::1.
3 , 3 .
2. , 3 3 , 3 .
3. , 3 , 3. 73 .
, , , , , , , , , ,
.., .., ..3 . .. , 3
. .. , . 3,
, , 3 3 64 3 18 65 3 . .. . 30 16, 31340 10 , 41350 14 ,51360 16
, 60 8 .
: : : : : , 3
(), , , , (CoHb). 3 .
, , 3 2, , 3 CoHb. 3 . I 3
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69
, II 2 30 37,5 % (9,375 % ), 31340 20 % (3,125 % ), 41350 14,28
%(3,125 % ), 51360 12,5 % (3,125 % ), 60 20 % (3,125 % ). I 4 (6,25
% ), I 3 II 4 (6,25 % ), > 2 2 (3,125 % ). 15,625 %. 3 () . 30 3
(III .. ) Rayan 50 % (12,5% ), 31340 0 %, 41350 57,14 % (12,5 %
),51360 50 % (12,5 % ), 60 100 % (12,5% ). 41350 60 2 3 3 . III ..
16 (25 % ), IVb .. 8 (12,5 % ), V .. 8 (12,5 % ). 50 %. 6 (9,375 %
) .. (3,125 % ) . () 3 : ( IV .. ), QT, 3 ().
100 % 3. 30 25 % (6,25 % ),31340 0%, 41350 42,857 % (9,375 % ),
51360 75% (18,75 % ), 60 50 % (6,25 % ). 40,625 % . 3 43,75 %
(21,875% ) 18,75 % I II .., , .. 68,75 % 3. () : 3 (> 100 ),
(> 1 ), , . 30 3 25 % (6,25 % ), 31340 20 % (3,125 % ),41350
57,14 % (12,5 % ), 51360 37,5 % (9,375 % ), 60 75 % (9,375 % ). ()
60 (3,125 % ). 4 (6,25 % ) 3 ( + ) 3
. 3 1 10 . 46,875 % . 3 30 62,5 %(15,625 % ), 31340 40 % (6,25 %
), 41350 28,57 % (6,25 % ), 51360 12,5 % (3,125 % ), 60 100% (12,5
% ). 3 60 2 3 () 3 (). 3, . 3 , 3 9 182 , , 40 , 3 , , ( ). 3 43,75
% . (, , 3, ) . 10 (15,625 %) 3 . 12 (18,75%) , 22 (34,375 %) ,
10(15,625 %) , 6 (9,375 %) 4 (6,25 %) 3. 4 (6,25%) 3 , 4 6 4 5 3 3
.
, 3 3, , 3 3 , , 3 , 3 .
.., .., .., .. , . ,
3 (). 3 . 203 ,
, , 3 .
3 ( ) ().
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70
: : : : : 26 (5 21 ), 63,95 +9,54, . 10,61+ 7,26 . 3 3 3 : 13
(n=14) 3 I3II, 23 (n=7) , 33 ( n=5) IV . 3 3 Vivid 3 Expert
(General Electric, ). (, ), 3 (, ) , 3 ( ,%) 3 (dS%). 3 ( , /) (/),
3 ( IVRT), 3 (), / 3 , Taniguhi K. . (2000). 3 3 ( ) Celermajer
D.S.et.al. (1992) c . 3 7 Vivid 3 Expert (General Electric, 3). , ,
3 . 3 200 . . 5 , , 30 . 60390 10% 3 . 3 . 3 3 (2007). , 3, , , 3,
. .
: : : : : I3IV
. I3II 48% , 68% , 3 100% . 3 .
3 13 101,8%, 3 9,81%. 3 23 , 86,19%, 3 8,47%. 33 3 3 6,4% 5,08%.
3 3: . , , 3 , 33 . 3 3 , . 3 (r= 30,75 p
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71
40 (RMS40)< 20 . 3 . 3 3 3 : RR 3, ; 3 NN (3 RR) (RMSSD), ;
NN50 RR, 50 (pNN50%); 3 (0,0030,04) very low frequency (VLF), 2;
(0,040,15 ) low frequency (LF),2; (0,150,4 ) high frequency (HF),
2.
. . . . . 3 . , . 3, 3, . 3 , 3 NN50% (9,62,3), RMSSD (26,81,7)
(16,31,6 33,72,1 , p
-
72
.., .., .., .., .. , . ,
. . . . . 3 , , .
. . . . . , .
. . . . . ( 3, 3 ) 3 3 . . ( ) 3 : 3 , , 3, . 3 . 3 3 . 3 , 3 ,
3 3. (3 ) , 3, . 3 , 3 3. 3 ( ), 3 , 3. 3 3 3 . 3 ( 3, ) 3 3 3 3 33
. , 2 ., 3 3 .
30 3 . 3
3 . 3 3 .
. . . . . 6 , 6 3 , 3 3 .
3 , , 3 , , .
, 3 , , , 3, . 3 , . . 3 3 . , 3 , 3 , 2 . , . , 3 3 . 3 . 3, ,
3 3 . , 3 ( ). , 3 3 . 3 , 3 , , 3 . , . 3, 3. , (, 3 ) , 3 .
70%
-
73
3 3 . 3 . 3 , 33 , , 3 , . , , 3, 3, 3 . 3
3 3 3 .
. . . . . , 3 3 3 3 .
, , , , ,
.., ., .. , .,
3 , 3 () (). 3 , , 3 , 3 , . , 3 33 13 , 3 .
. . . . . 48 , (40 , 8 ), 3 52,29,2 . 6 3 3 3, , .3 (3, Astra
Zeneka, ) 1003150 3 3 . , 3 3 , (, Sanofi Aventis, ).
..... 3 3 (147,712,1 136,910,8 ..; =0,000), 3 (137,417,0
123,012,2 ..; =0,000) (76,38,3 70,96,9 ..; =0,027), 3
(63,520,9 45,021,5%;=0,000) (77,328,7 55,229,5 %; =0,007). , 3 3
, 3 ( 135,98,3 128,86,8 ..; =0,001; 128,311,4 119,17,2 ..; =0,002).
3 3 , , 3 3: ( 131,5 6,1 151,15,2 ..; =0,000; 73,65,5 80,6 5,3
..;=0,001) ( 154,610,8 175,1 6,5 ..; =0,001; 85,64,0 91,14,9
..;=0,004), , 3 3 (1009,6 756,2 ; =0,001). 3 , (5,810,5 10,27,1%;
=0,024) (1010,2 14,67,7 %; =0,036). 3 (29 5,5%; =0,000) (23 57%;
=0,001).
. . . . . , , , . 3 .
33333
.., .., .. , . ,
3 3 , 3 .
3 3
3 () 3.
. . . . . 48 3 3 , 3 () (40 , 8 , 52,29,2 ). 3 3
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74
(3, Astrazeneka, 3) 503150 . 3 , 3 ().
. . . . . 2 :1 (22 ) 3 , 3, 2 (16 ) 3 . , 3, , 2 (SDNN 98,0813,2
ms 138,0230,7 ms ; =0,001; pNN503,493,4 % 4,453,7 % ; =0,05). 1 c 3
, 3 , , 3 , 3 , :SDNN 98,0813,2 105,5739,2 ms ;=0,003; pNN50
3,493,4 3,614,0% ;=0,02, rMSSD 20,717,3 25,58,1 ms ;=0,05; HF
69,1450,8 76,2646,0 ms2 ;=0,04; LF/HF 3,62,06 3,01,5 ; =0,01).
2 3 3 : SDANN 155,3564,2 178,5629,2 ms ; =0,02; rMSSD22,657,7
25,144,4 ms ; =0,03; VLF713,77379,13 980,91812,37 ms2 ;=0,005; HF
81,0156,5 98,0129,5 ms2 ;=0,005; LF/HF 4,11,6 3,31,5 ; =0,01).
3 3 , (SDNN 16 7 ms , p=0,001; SDANN 23 11ms , p=0,000; VLF 200
15 3, p=0,000; LF 110 8 , p=0,000; HF 17 7, p=0,001).
. . . . . , , 3 , 3 , 3 . , , 3 , , .
, , , , ,
.., .., .., .., .., .. 2 ,
. ,
3 . 3 3 , 33 .
, 3 3 3. , 3 , 3 33 , .
. . . . . 118 18 70 , 5 : (12 ), () (25 ), 3 () 1 (26 ), 3 233
(28 ), . 3 338/. , 3 , 3, 3 304. 3
, , 3 Vivid 3 Expert. 3 , 3 338/(, ), 3 , .
. . . . . 5,92 / + 1,21; 6,8 / + 1,18; 1 8,72 / + 3,45; 3 233
18,78 / + 11,07; 6,6 + 2,07;
3 3,31 / + 2,47; 5,16 / + 2,84; 1 6,1/ + 3,07; 233 7,39 / +
3,14; 5,38 + 2,18;
3 2,3 ./2 + 2,1; 3 2,7 ./ + 3,3; 1 2,9 ./2 + 3,1 ; 233 5,4 ./2 +
5,07; 3 2,7 ./2 + 2,07;
3 4,6 ./2 +1,93; 3 6,4 ./ + 3,6; 1 9,01 ./2 + 4,6; 233 13,4 ./2
+ 7,06; 6,2 ./2 + 5,2;
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75
( ) : 800/5; 1200 /5 ; 3 1 1224 /5; 3 233 3101/5; 860 /5;
.....1., 33
3 . 3 .
2. 3 3 3 .
3. 3 , , 3 3 3, 3 , 3 , 3 .
.., .., .. , . ,
3 , 3 3 3 . 3 .
3 3 3 .
. . . . . 3 , , 3, , 3 , . 42 1703320 , 3 . 3 3 40 / .
3 3 .
5 : 3, , 3 ( 40 /), , 0,844 / , 50 / 100 /.
18 , 3
( (), 3 ) 3 ( (), (), 3 ( ).
..... 3 3,6 (
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76
, 3 . , , 3 , . 3 80387 % 3