История болезни - Профессиональные болезни (остаточные явления вибрационной болезни)

˜a®a ae ©« c§ia ?§ ?®««Y?ae?? Medinfo
http://www.doktor.ru/medinfo
http://medinfo.home.ml.org
E-mail: [email protected]
or [email protected]
or [email protected]
FidoNet 2:5030/434 Andrey Novicov
˜?eY¬ aYaeYa ae § ? § – e-mail: [email protected]

‚ Medinfo ¤«i c a a ¬ i !®«ie i aaaa? i ?®««Y?ae?i ¬Y¤?ae?a??a
aYaeYa a®c, ?aa®a?© !®«Y§?, «?aYa aaae, ®!ac ie?a ?a®Fa ¬¬, aYaa®c.

‡ a®¤?aY http://www.doktor.ru – ˜aaa??© ¬Y¤?ae?a??© aYacYa ¤«i caYa!

‘?˜?’-˜…’…˜˜“˜?‘??? ??‘“„?˜‘’‚…˜˜??

?…„?–?˜‘??? ???„…??? ?¬.?.?.?…—˜???‚?

? aeY¤a ?a®aeYaa?® «iea !®«Y§Y©

‡ c.? aeY¤a®©: ?a®ae.‚.?.?aa ¬®®c
˜aY?®¤ c aY«i: aa. ….˜.?®«Ya®c

?‘’?˜?? ˜?‹…‡˜?.

˜®«i®©: x, 59 «Ya

„? F®§: ®a®c®Y § !®«Yc ?Y –
?aa a®ceY ic«Y?i c?!a ae?®®© !®«Y§? ®a «®? «i-
®© c?!a ae?? (cYFYa a?c®-aYa®a i ?®«?Yca®? a?i
cYaa?a ?®Yc®aaY©)

a®?aaaacaie?Y § !®«Yc ?i –
„caaa®a®?© ?®a«Y ae© Yca?a ?a®aeYaa?® «i®F®
FYY§ a® a?¦Y?Y¬ a«aa II aaY?Y?;
?§cY i !®«Y§i ¤cY ¤ae a??Yaaa®© ??e?? c
aa ¤?? aa!aY¬?aa??;
???Yaa®?cYa? i !®«Y§i I aa ¤??.

®a«®¦Y?i – Ya.

?aa a®a: aaa¤Ya 2542 0 Faa??e
«YcY!®F® ae ?a«iaYa
?a Yc ?.?.
‘a®? ?aa ae??: 9.02.- 18.02/1998F.

‘?! 97

– 2 –

˜?‘˜?˜’˜?? —?‘’?.

2” ¬?«?i 0: x
2?¬i: 0 x
2?acYaac®: 0 x
2‚®§a aa: 0 59 «Ya
2?Yaa® a !®ae: 0 ?a®ae?« ?a®a?© ‡?¬?®
2‡ ?¬ Y¬ i ¤®«¦®aai: 0 2 0®?Ya a®a ?®aY«i®©
2„®¬. ¤aYa: 0 F.‚e!®aF
2„ a ?®aaa?«Y?i: 0 22.01.97F.
2˜® ?a c«Y?i 0 ?!« aa®© !®«i?aeY©
2‘ ¤? F®§®¬ 0: ?aa a®ceY ic«Y?i c?!a ae?®®© !®«Y§?

‘?˜?’?˜˜?-????…˜?—…‘??? •?˜??’…˜?‘’??? ‚›˜?‹˜?…??‰ ˜?˜?’›.

˜a®aeYaa?i ?‹…˜?‹?™??, aa ¦ 7 «Ya ‘a¤®aaa®?aY«i®¬ § c®¤Y
F.‚e!®aF .
˜ !®a § ?«ic Yaai c a a?«Y?ec ?? aa «iea § ?«Y?®? ?Yc¬ a?cYa-
??¬ ¬®«®a?®¬, cYa®¬ 15?F, FYYa?aaie?¬ ?§?®c aa®aai c?!a ae?i. ‚®
caY¬i a !®ae ¤Ya¦?a ¬®«®a®? ¤ca¬i aa? ¬?, c cea¦¤Y®¬ ?®«®¦Y?? aY« .
˜ !®a Ya c § ?aeaea ?®¬YeY?ia ? ®a?aea®¬ c®§¤aaY. ‘?Yae.®¤Y¦¤ :
a®! , § e?aeY ®c??, !aY§Ya®ceY aa? c?aee, ?a?®«i§®c « Y¦Y¤Yc®, a?Y-
ae? «ieY aa? c?aee ¤«i a !®ae a ?aa®c?? ¬? c?!a ae?? Y ?a?®«i§®c «.
„Y©aacaie?Y ae ?a®ae: «®? «i i c?!a ae?i, ¬eeYc®Y ?ai¦Y?Y ?«YcYc®F®
?®ia ? aa?, aa a?cYa?®Y ?ai¦Y?Y, ea¬, ?§? i aY¬?Ya aaa c®§¤aa .
„«?aY«i®aai a !®cYF® ¤i – 8 c a®c a ?YaYaec®¬ ®!Y¤ c 1 c a. ˜ !®-
c i Y¤Y«i – 5 ¤Y© ?§ 7 ? «Y¤ aea. ?a?aa? 24 a !®c?a ¤i c F®¤a
?YaceY 5 «Ya, 30 a !®c?a ¤Y© c F®¤a ?®a«Y 5-a? «Ya cea«aF?. ‚ea®¤
?Ya?i a 55 «Ya.

˜a®aeYaa?i ˜“˜™??-—…??˜™??, aa ¦ 18 «Ya a ¬ ¦Y.
˜ !®a § ?«ic Yaai c ®!aa!ec ?? ?§«?eY© aa «? §a!?«®¬ ? ?®a«Y-
¤aieY¬ § cY? ?c ?? Ya®cea ?®cYaa®aaY© ?Yc¬ a?cYa??¬ ¬®«®a?®¬,
FYYa?aaie?¬ ?§?®c aa®aai c?!a ae?i. ?®«®a®? a a ¤?®©-§a!?«®¬, cY-
a®¬ 5 ?F, ?®¤?¬ Ya ¤® Y®!a®¤?¬®F® aa®ci, ¤«?aY«i® a¤Ya¦?c i cea¦-
¤Y®Y ?®«®¦Y?Y aY« . ˜ !®a Ya c § ?aeaea ?®¬YeY?ia, c aa®, c ¬Y¦-
¤®®¬ ?a®aaa aacY. ‘?Yae.®¤Y¦¤ : a®! , § e?aeY ®c??, a?Yae? «ieY
aa? c?aee ?a?®«i§®c « aYFa«ia®.
„Y©aacaie?Y ae ?a®ae: «®? «i i c?!a ae?i, ¬eeYc®Y ?ai¦Y?Y ®!eYY,
®a®!Y®, ?«YcYc®F® ?®ia ? aa?, aa a?cYa?®Y ?ai¦Y?Y, ea¬, ?§? i
aY¬?Ya aaa ®?aa¦ ieYF® c®§¤aa .
„«?aY«i®aai a !®cYF® ¤i – 8 c a®c a ?YaYaec®¬ ®!Y¤ c 1 c a, 5 a –
!®c?a ¤Y© c Y¤Y«i. ?a?aa? 30 a !®c?a ¤Y© c F®¤a. ‚ea®¤ ?Ya?i
a 55 «Ya.

˜˜?”…‘‘??˜?‹?˜›‰ ?˜??˜…‡.

1961 – 1968 FF – ?«Y? «ie??
1968 – 1973 FF – ?®¬?«Y?a®ce??
1973 – 1975 FF – aaa®? «ie??
1975 – 1993 FF – aa!e??-cY? e??
a 1993 ?® aa. caY¬i – ®?Ya a®a ?®aY«i®©

?a®c®© ac?a Ya ?a®aeYaa?i ?«Y? «ie?? .
‘ 1968F ?® 1975F ? a 1993F ?® aa. caY¬i – aa®©? i c aa?c i
aaa a aaa¤®a?®a®!®aa? (III Faa?? ?c «?¤®aa?).
.

– 3 –

†?‹?˜›.

_ 5˜ ¬®¬Ya ?®aaa?«Y?i:

– aiae?Y !®«? c ??aaia c ?®?®Y;
– ? aYaaY§?? cYaa?a ?®Yc®aaY© c® caY¬i a , § aa c«iieYY !®«i-
®F® ?a®ae? aiai, ceaiF?c ai aa?? ccYaa, ca® ?a?®a?a ®!«YFcY?Y;
– Yc®§¬®¦®aai ¤«?aY«i®F® ®eY?i c aa? a ai¦YaaY© >3 ?F;
– §i!?®aai ??aaY©, ®Y¬Y?Y c a®«®¤®© c®¤Y;
– !®«? c «®?aYcea ? «acY§ ?iaaea aaaa c a, aa?«?c ie?Yai ?a?
¤c?¦Y?ia;
– ®aae¦?a, Y?a?iaeY ®eaeY?i c i??F aaa «i®© ®!« aa?, c®§?? ie?Y
cYaY§ 3-4 c a ?®a«Y Y¤e, ®a¬Yc Ya ?®«®¦?aY«ie© iaeaeY?a 3 a ae?¤®c 0;

_ 5˜ ¬®¬Ya ®a¬®aa : . 0 ¦ «®!e aY ¦Y.

?˜??˜…‡ ‡?˜?‹…‚?˜??.

˜®«ie¬ ac?a Ya aY!i a 1968 F®¤ , ?®F¤ ?®a«Y 7 «Ya a !®ae ?«Y-
? «ie??®¬ aa «® aaa¤® aF?! ai ??aa? ? ¤Ya¦ ai ?Yc¬ a?cYa??© ¬®«®a®?,
a?§?« ai ?a®?§c®¤?aY«i®aai aaa¤ ; ?® ?a c«Y?i ?‘— § c®¤ ®!a«Y¤®-
c c ?!« aa®© ?«??cYa?®© !®«i?aeY (??˜) F.‹Y?Fa ¤ , F¤Y !e« aa-
a ®c«Y aci§i § !®«Yc ?i a ?a®aeYaa?Y©, ®?aY¤Y«Y III Faa?? ?c –
«?¤®aa?. ˜®«i®© !e« ?YaYcY¤Y a !®aa, Y aci§ ai a ?aa®c?? ¬?
c?!a ae??. ‚ ?®a«Y¤aie?Y 6 «Ya ?a®c®¤?«?ai ¤Y?c a i aYa ??i ? a  –
a®a®-?aa®aa®Y «YcY?Y, a®aa®i?Y a«ace?«®ai, aaa¤®a?®a®!®aai ?®«-
®aaii c®aaa ®c«Y , ? c 1975 F®¤a !®«i®© c®ci ?a?aaa??« ? a !®aY
a ?Yc¬ a?cYa??¬ ¬®«®a?®¬, FYYa?aaie?¬ c?!a ae?i, aYFa«ia® ?a®a®¤?«
?a®ae?« ?a?cYa??Y ®a¬®aae, !«i¤ «ai c ??˜ ?® ?®c®¤a ?®«?Yca®? a??
cYaa?a ?®Yc®aaY© ? ? ®aa a®c®F® ic«Y?i c?!a ae?®®© !®«Y§?,
?a?§ c «ai aaa¤®a?®a®!e¬. ‘ 1985 F®¤ !«i¤ Yaai c ?«???Y ?a®ae.
!®«Y§Y© ‘˜!???, ?a®c®¤?«®ai Ya?®«i?® ?aaa®c «YcY?i aYae?¤?c®c a ?a?-
¬YY?Y¬ ¬Y¤?? ¬Ya®§®F® ( a? §¬®«?a??,   «iFYa???, c?a ¬?e ),
ae?§?®aYa ?Yca?cYa?®F® ? a  a®a®-?aa®aa®F® «YcY?i, !®«i®© caY¬Y®
?YaYc®¤?«ai «YF??© aaa¤. ‚Ya®© 1992 F®¤ !®«i®© aa « ®eae ai
!eaaaai aa®¬«iY¬®aai aa?, Y®!ecai §i!?®aai ??aaY©, aa?«?«?ai !®«? c
®!« aa? aaaa c®c cYaa?a ?®Yc®aaY©, aa « ®eaa?¬ ¬eeYc i a« !®aai;
?®aaY?Y® ?a?a®Y¤??«?ai ?a?aaa?e ?®!Y«Y?i ? «iaeYc aa?, ®!e i aa®¬-
«iY¬®aai, a §¤a ¦?aY«i®aai. ‚® caY¬i ®cYaY¤®F® ®a?aa? a ¬®cacaac?Y
!®«i®F® a«ace?«®ai, ?® c®§ca eY?? a !®aa a?¬?a®¬e § !®«Yc ?i
aY§?® ?a®FaYaa?a®c «?, ?a?aaa?e ?®!Y«Y?i aa? ac aa?«?ai, !Ya?®?®?«?
F®«®c®?aa¦Y?i, aa « YacYa¤®© ?®a®¤? . ?aYii 1992 F®¤ ®a®c ??
aY§a«ia a®c ®!a«Y¤®c ?i c ??˜ !®«i®© ?®«ac?« III Faa??a ?c «?¤®aa?,
?aY?a a?« a !®aa c aa«®c?ia c?!a ae??. ‘ 1993 F®¤ a ¬®cacaac?Y ?®aaY-
?Y® a«ace Yaai, ? aYaaY§?? !Ya?®?®ia aY¦Y, ?acY§«? ?a?aaa?e ?®!Y«Y-
?i ? «iaeYc, ®eaeY?Y ¬eeYc®© a« !®aa?, a«ace?« ai aea?ae?® «i i
a?®a®!®aai aa?. ˜ ¤ e© ¬®¬Ya a®aa iiaai !®«? ??aaia c ?®?®Y, c
aaaa c a aa? ?a? ¤c?¦Y?ia, ? aYaaY§?? ?a? ®a« ¦¤Y??. ˜®aaa??« c ?«?-
??a ‘˜!??? ¤«i ?YaY®ac?¤YaY«iaac®c ?i Yaaa¤®a?®a®!®aa?.

– 4 –

?˜??˜…‡ †?‡˜?.

˜®¤?«ai c 1938 F®¤a c ??a®ca?®© ®!« aa?, a®a ? a §c?c «ai ®a-
¬ «i®, § ?®c?« 10 ?« aa®c aaY¤Y© e?®«e, ¤® 1960 F – aa®c i a«a¦!
c ai¤ a ‘/?, a 1961 F ?a®¦?c Ya c F.‚e!®aFY, c aYcY?Y 32 «Ya a !®a «
‘a¤®aaa®?aY«i®¬ § c®¤Y, ?Ya?®Ya II ? aYF®a?? a 1993 F®¤ , c
aa®ieYY caY¬i a !®a Ya c ?a®ae?« ?a®a?? F.‚e!®aF , aa«®c?i aaa¤ ®?-
a?¬ «ieY; ¦Y a, ?¬YYa ¤caa ¤YaY©, ca?®c, ®!Ya?YcY ®a¤Y«i®© ?c a-
a?a®©, ¦?cYa a ¦Y®© ? ae®¬, a¬®aaeYaa c aY¬iY ac?a Ya !« F®?a?ia®©,
¬ aYa? «i®Y ?®«®¦Y?Y a¤®c«Yac®a?aY«ie¬. ˜?a Yaai aYFa«ia®, ¤®aa –
a®c®, ®!a § ¦?§? F??®¤? ¬?ce©.

˜YaYYaneY § !®«Yc ?i. •a®?cYa??Y § !®«Yc ?i.
?˜‡ !®«YYa aY¤?®.
?§cY i !®«Y§i ¦Y«a¤? a 1991 F®¤ ;
???Yaa®?cYa? i !®«Y§i I aa ¤?? a 1986 F®¤ ;
•?aaaF?cYa??Y c¬Ye aY«iaac c aYcY?Y ¦?§? ®aa?ae Ya.

˜ a«Y¤aacY®aai.
‘® aa®a®e ®aae – Y?§cYaa ;
‘® aa®a®e ¬ aYa? – a«Y¤aacYe¬?, ®?®«®F?cYa??¬?, ai¦Y«e¬?
aa®?cYa??¬? § !®«Yc ?i¬? Y ®aiF®eY ;

‚aY¤eY ?a?cec??. ?aa?a 20 ? ??a®a c ¤Yi. ‚ ?a®e«®¬ – aYFa«ia®Y
a?®aaY!«Y?Y a §! c«Y®F® aYa?cYa?®F® a??aa a !®aY.

?««YaF®«®F?cYa??© ¬Y§.
?««YaF?cYa??Y aY ?ae?? c c?¤Y ?®¦®© ae??,?a?aaa?®c a¤aeii ?
®an?®c ®aa?ae Ya. ˜Y?YaY®a?¬®aai «Y? aaacYea ?aY? a a®c ®aa?ae Ya.

˜??¤Y¬?®«®F?cYa??© ¬Y§.
?Y? a?a®¬, aa!Ya?a«n§®¬ ? ¤aaF?¬? ?aeY?ae?®e¬?, c a®¬ c?a«Y
cYYa?cYa??¬?, § !®«Yc ?i¬? Y !®«Y«. ‚?— Y ?ae?ae?a®c . ?®a ?a a
?aeY?ae?®e¬? !®«ie¬? ®aa?ae Ya. ‘ !®«ie¬? ¦?c®ae¬? ?®a ?a ®aa?ae Ya.
‚ aYcY?? ¦?§? FY¬®aa aaea§?© Y ?a®c®¤?«®ai. ‡ ?®a«Y¤?Y 6 ¬Y-
aiaeYc ?eY?ae?© Y ¤Y« «®ai. ˜®a«Y¤?Y 6 ¬YaiaeYc § ?aY¤Y«e ®!« aa? Y
ceY§¦ «.
?¬YYaai a?«®®aai ? § ?®a ¬. ‘aa« ®ae®a¬«Ye©, ®!ec®F® aecYa ,
!Y§ ? a®«®F?cYa??a ?a?¬YaY©.

‘aa a®c®© ¬Y§.
„«?aY«i®aai !®«i?c®F® «?aa ?® ®a®c®¬a § !®«Yc ?i c aY?aeY¬
F®¤a – 15 ¤Y©, ¤«?aY«i®aai ?®a«Y¤YF® !®«i?c®F® «?aa – 15 ¤Y©.

?˜™?‰ ?‘??’˜.

‘®aa®i?Y a¤®c«Yac®a?aY«i®Y,a®§ ?Y ia®Y, ?®«®¦Y?Y ?a?c®Y.
’Y¬?Ya aaa aY« ®a¬ «i i.
’Y«®a«®¦Y?Y ?a c?«i®Y. ˜®aa 168 a¬, cYa 84 ?F, ®a¬®aaY?cY-
a??© a?? ?®aa?aaae??.
‘«?§?aaeY aa ? ¬iF?®F® n! a®§®c®F® aecYa , c?aaeY, c« ¦eY. ‡a-
!e c aa?c® aaa cYe, ? a ¤®a®§. ?§e? a®§®ce©, c« ¦e©, a ?®ai ®!«®-
¦Y !Y«e¬ «na®¬.
?®¦eY ?®?a®ce ®!ec®© ®?a a?? ? c« ¦®aa?, i« aa?ceY, c?aaeY.
’aaF®a a®aa Y. ?an?®c Ya. ?®¦eY ?®?a®ce ??aaY© a aa®ae?cYa??¬? ?§-
¬YY?i¬?.
?c®«®aY?Y a?a¤®Y. ‚®«®ae aaa?«eY, «®¬??Y. ˜®Fa? aa? a
aa®«eYe, ¤Yae®a¬?a®c e ?® a??a “c a®cea aaY?®«”, ®F a – ?®a ¦Ye
i??¤Ya¬®ae?a?i¬?.
.

– 5 –

˜®¤?®¦®-¦?a®c i ?«Yac a? cea ¦Y ?aYa?c®, Ya c®¬Ya® –
a ?§!ea®ce¬ ®a«®¦Y?Y¬ ¦?a ¦?c®aY.
˜Ya?aeYa?cYa??Y «?¬ae a?cYa??Y a§«e (?®¤cY«iaaeY, ian¬eY, eY©eY,
§ ae«®ceY, ?®¤¬eeYceY, «®?aYceY, ? a®ceY) Y acY«?cYe, !Y§!®«Y§Y-
eY, a ®?aa¦ ie?¬? a? i¬? ? ¬Y¦¤a a®!®© Y a? ie.
?eeYc i a?aaY¬ a §c?a ?® ¬a¦a?®¬a a??a, a¤®c«Yac®a?aY«i®, a®-
aa a®aa Y, !®«Y§Y®aa? ?a? ? «i? ae?? Ya, F??Yaaa®ae??, aa®ae??
®a¤Y«iea Faa?? ¬eeae Y ceic«Y®.
?Y¦ae « F®ceY aaaa ce ??aaY© ¤Yae®a¬?a®c e, ¤c?¦Y?i c® caYa aaa-
a c a cYaa?a ?®Yc®aaY© !®«Y§Ye, ®!eY¬ ¤c?¦Y?© ?®«e©. ‚ aaaa c a
?¦?a ?®Yc®aaY© ¤Yae®a¬ ae?© ? aaeY?© ¤c?¦Y?© Y ®! aa¦Y®.

?aa«Y¤®c ?Y aYa¤Yc®-a®aa¤?aa®© a?aaY¬e.

?aa¤ i ?«Ya? c ®!« aa? aYa¤ae Y ?§¬YY . “a?«Y?Y ?a«ia ae??
a®ea aaYa?© Y !«i¤ Yaai. ˜ !aa ?Y ? ?a«ia ae?i eY©ea cY ®a-
aaaaacaYa. ‚YaaaeYce© a®«c®? ? «i??aaYaai c V ¬Y¦aY!YaiY
l.medioclavicularis, ?«®e ¤ii 1 a¬, Ya?®«i?® aa?«Y. ‘Ya¤Yce©
a®«c®? Y ? «i??aaYaai. ˜??F aaa «i®© ?a«ia ae?? Ya. “?®e ciY ¬aa«e-
? iY” ®aaY ? cYaaae?Y aYa¤ae Y ? «i??aaYaai.
˜ a®«®F?cYa?®© ?a«ia ae?? Ya.˜a«ia ®¤? ?®ce© ®!Y?a aa? a,
a?a¬?ce©, a¤®c«Yac®a?aY«i®F® ?®«Y?i ? ?ai¦Y?i, ®!ec®© ae®a¬e.
— aa®a — 80 a¤/¬?. ‘®aa¤?aa i aaY? cY ?a«ia®c®© c®«e Y ? «i??-
aaYaai.

?a ?aee 2 0®a®a?aY«i®© aYa¤Yc®© aa?®aa?:
1˜a c i 0:IV ¬Y¦aY!YaiY- ?a ce© ?a © Faa¤?e.
III ¬Y¦aY!YaiY – 1.5 a¬ ? aa¦? ®a ?a c®F® ?a i Faa¤?e.
1‚Yaaii 0: III aY!a® ¬Y¦¤a l.sternalis ? l.parasternalis.
1‹Yc i 0: V ¬Y¦aY!YaiY – l. medioclavicularis sinistra.
IV ¬Y¦aY!YaiY – 1 a¬ ?aaa? ®a l.medioclavicularis
III ¬Y¦aY!YaiY – l.parasternalis

?a ?aee !a®«ia®© aYa¤Yc®© aa?®aa?:
1˜a c i 0: IV ¬Y¦aY!YaiY – «Yce© ?a © Faa¤?e
1‚Yaaii 0: IV aY!a® a ?a i Faa¤?e
1‹Yc i 0: V ¬Y¦aY!YaiY – 2 a¬ ?aaa? ®a «Yc®© Fa ?aee ®a®a?aY«i®©
aYa¤Yc®© aa?®aa?.

‘®aa¤?aae© ?ac®? Y cea®¤?a § ?aY¤Y«e Faa¤?e c I-¬ ? II-¬ ¬Y¦-
aY!Yaiia.

˜a? 2 0 aa?a«ia ae??: 2 0 a®e aYa¤ae iaeY, ?aeYa II a® ®aaY.
?a¬®c Ya.
?aaYa? «i®Y ¤ c«Y?Y: 160/100 ¬¬ aa aa.

?aa«Y¤®c ?Y ¤ea aY«i®© a?aaY¬e.

?aa¤ i ?«Ya? ?a c?«i®© ae®a¬e, a?¬¬Yaa?c i, ®!Y ?®«®c?e a c-
®¬Ya® ?a?c® ac aacaia c ?aY ¤ea ?i. ˜ ¤?«ic?ceY ? ?®¤?«ic?ceY
i¬?? a?¬¬Yaa?ceY, a®a®e® cea ¦YeY. ?Y¦an!YaeY ?a®¬Y¦aa?? a®a®e®
?®aaa?aaiaai, i« aa?ceY, !Y§!®«Y§YeY.
˜®a Y ¤Yae®a¬?a®c .„ea ?Y ac®!®¤®Y, a®c®Y, ®a¬ «i®© F«a!?-
e, a?a¬?c®Y. — aa®a ¤ea aY«iea ¤c?¦Y?© — 18 a § c ¬?aaa.
˜ «i? ae?i 2 0Faa¤®© ?«Ya?? !Y§!®«Y§Y i. ?aa¤ i ?«Ya? i« aa?c-
i. ?®«®a®c®Y ¤a®¦ ?Y ®¤? ?®c®Y a ®!Y?a aa®a® c a?¬¬Yaa?cea
ac aa? a.
.

– 6 –

˜a? 2 0 a®?®Fa ae?cYa?®© ?Ya?aaa??:

1?a ?aee ?a c®F® «nF?®F® 0:
– l. parasternalis: cYaa?© ?a © 6-F® aY!a .
– l. medioclavicularis: ?¦?© ?a © 6-F® aY!a
– l. axillaris anterior: 7-Y aY!a®
– l. axillaris media: 8-Y aY!a®
– l. axillaris posterior: 9-Y aY!a®
– l. scapularis: 10-Y aY!a®
– l. paravertebralis: ®aa?aae© ®aa®aa®? XI Faa¤®F® ?®§c®?

1?a ?aee «Yc®F® «nF?®F® 0:
– l. axillaris anterior: 7-Y aY!a®
– l. axillaris media: 9-Y aY!a®
– l. axillaris posterior: 9-Y aY!a®
– l. scapularis: 10-Y aY!a®
– l. paravertebralis: ®aa?aae© ®aa®aa®? XI Faa¤®F® ?®§c®?

‚Yaaae?? ®!®?a «nF??a a?YaY¤? 3 a¬ ceeY ?«ic?ae, a§ ¤? —
aa®cY VII eY©®F® ?®§c®? .
˜®¤c?¦®aai ?¦YF® ?a i ®!®?a «nF??a ?® l.axillaris media a®a-
a c«iYa 6 a¬.
??a? ?YaYeY©?®c ?®«Y© ?aY?F — 7 a¬ a?a c ? a«Yc .
‘?¬?a®¬ ?aYa!YaF ? ˜®aY¦Ya ®aa?ae aY«ie©.

˜a? 2 0aa c?aY«i®© ?Ya?aaa?? ¤ caY© ?®cYaa®aaii «nF??a ®?aY¤Y-
«iYaai iae© «nF®ce© §ca?, ®¤? ?®ce© c a?¬¬Yaa?cea ac aa? a Faa¤®©
?«Ya??.
˜a? 2 0 aa?a«ia ae?? ¤ caY© ?®cYaa®aaii «nF??a cea«ae?c Yaai cY§?-
?a«ia®Y ¤ea ?Y. ˜®!®cea ¤ea aY«iea ea¬®c Ya.

?aa«Y¤®c ?Y ??eYc a?aY«i®© a?aaY¬e.

‘«?§?aaeY a®a®c®© ?®«®aa? ? ¬iF?®F® n! a®§®ceY, c?aaeY, c« ¦eY.
‡a!e ¦Y«aeY, c aa?c®-aaa cYe, ?¦?Y eYaana?? a ac aa? ¬? ? a?®§®©
??F¬Ya ae??. ?§e? a®§®ce©, c« ¦e©, a ?®ai ®!«®¦Y !Y«e¬ «na®¬.
†?c®a ?a c?«i®© ae®a¬e, ?a?c® ac aacaYa c ?aY ¤ea ?i. ˜a?®?
Y ce?a?«e©, cYe Y a ae?aYe.
˜a? 2 0?®cYaa®aa®© ? «i? ae??: ¦?c®a ¬iF??©, !Y§!®«Y§Ye©.
˜a? F«a!®?®© ? «i? ae??: c «Yc®© ?®c§¤®e®© ®!« aa? ®?aY¤Y«iYaai
1a?F¬®c?¤ i ??e? 0 ?«®a®-i« aa?cYa?®© ?®a?aaYae??; !Y§!®«Y§Y i,
?®¤c?¦ i, a a®c®© ?®cYaa®aaii, Yaac e i.
c ?a c®© ?®c§¤®e®© ®!« aa? ? «i??aaYaai
1a«Y? i ??e? 0: !Y§!®«Y§Y i, ?®¤c?¦ i, a«YF? aac e i.
1?®?YaYc®-®!®¤®c i ??e? 0 ®!ec®© ?®-
a?aaYae??, ? «i??aaYaai aa®cY ?a?? , !Y§!®«§Y i.
1!®«ie i ?a?c?§ ¦Y«a¤? 0 ? «i??aaYaai c
c?¤Y c «?? a a®c®© ?®cYaa®aaii, a a?®«®¦Y®F® 2 a¬ ceeY ?a??
?® ®!Y aa®a®e ®a aaY¤Y© «??? aY«
1?a?ca a?? 0 Y ? «i??aaYaai
1?¦?© ?a © ?YcY? 0 Y ceaaa? Ya ?§ ?®¤
an!Ya®© ¤aF?, a®ce©, !Y§!®«Y§Ye©, a«YF? § ®aaaY. ˜ §¬Yae ?YcY?
?® ?aa«®ca – 8:8:10 a¬.
1aY«Y§n? 0 Y ? «i??aaYaai. ˜Ya?aa®a®
®?aY¤Y«iYaai ?® l. axillaris media a 9-F® aY!a .

?aa«Y¤®c ?Y ¬®cYcec®¤?aY«i®© a?aaY¬e.

?®¦eY ?®?a®ce c ?®ia?c®© ®!« aa? Y ?§¬YYe. ˜®c?? Y ? «i??-
aaiaai. ‘?¬?a®¬ ?®?®« c?c ?i ®aa?ae aY«ie© a ®!Y?a aa®a®.
?®cY?a?aa? ?Y Y § aaa¤Y®.
.

– 7 –

‹???‹?˜›‰ ‘’?’“‘.

??aa? c« ¦eY, ae? ®a?ceY; ? «iaee ?a?a?c«Ye, ¬Y¦ae « F®ceY
aaaa ce ¤Yae®a¬?a®c e; ?®¦ ? «iaeYc aa? Yi« aa?c i, a ¬®¦Yaac®¬
aaYe?, ®Fa? ¤Yae®a¬?a®c e ?® a??a c a®cea aaY?®«; ¬eeYc®-aaaa c®Y
cacaac® a®aa Y®, !®«Yc i cacaac?aY«i®aai aY§?® a?¦Y ?® a??a ?Ya-
c a®?. ‘?¬?a®¬ !Y«®F® ?ia cea ¦Y a« !® – c®aaa ®c«Y?Y ?aa®¤®F®
aecYa cYaY§ 10-12 aY?a¤, a?¬?a®¬ ˜ «i Y®acYa«?ce©.

˜˜…„‚?˜?’…‹?˜›‰ „???˜?‡.

?a®c®Y § !®«Yc ?Y –
?aa a®ceY ic«Y?i c?!a ae?®®© !®«Y§? – cYFYa a?c®-aYa®a i
?®«?Yca®? a?i cYaa?a ?®Yc®aaY©.
‘®?aaaacaie?Y § !®«Yc ?i –
?§cY i !®«Y§i ¤cY ¤ae a??Yaaa®© ??e??, F??Yaa®?cYa? i
!®«Y§i I aa ¤??.
?a«®¦Y?i – Ya.

˜‹?˜ ?˜‘‹…„?‚?˜??.

1. ?«??cYa??©   «?§ ?a®c?,
RW, ae®a¬ 50.
2. ?!e?©   «?§ ¬®c?.
3. ˜?®a?¬?cYa??©   «?§ ?a®c?.
4. ˜ ««YaaY§?®¬Yaa?i.
5. ?«iFY§?¬Yaa?i.
6. „? ¬®¬Yaa?i.
7. ? ??««ia®a?®??i.
8. ’Y?«®c?¤Y?Y.
9. •®«®¤®c i ?a®! .
10. ˜YaFY®Fa ae?i ??aaY©.
11. ˜YaFY®Fa ae?i eY©®F® ®a¤Y« ?®§c®®c?? .
12. ’® «i i a¤?®¬Yaa?i.
13. ?!§®a i aYaFY®Fa ae?i Faa¤®© ?«Ya??.
14. “«iaa §ca?®c®Y ?aa«Y¤®c ?Y ?YcY?, ?®cY?.
15. ˜«Y?aa®? a¤?®Fa ae?i.
16. ”?„‘.
17. ?®aa«ia ae?i Yca®? a®«®F .
18. ?®aa«ia ae?i ®a®« a?F®«®F .
19. ?®aa«ia ae?i ®aea «i¬®«®F .

– 8 –

˜…‡“‹?’?’› ?‘‘‹…„?‚?˜?‰ ? ‡??‹?—…˜?? ??˜‘“‹?’?˜’?‚.

?«??cYa??© «?§ ?a®c?.

Hb – 170 F/«
˜a?aa®ae?ae – 5.3 *10 512 0 F/«
–cYa®© ?®? § aY«i – 0.96
‹Y©?®ae?ae – 6.4 * 10 59 0 F/«
˜ «®c?? – 4%
‘YF¬Yae – 58%
˜®§?®ae?«e – 0%
‹?¬ae®ae?ae – 33%
?®®ae?ae – 5%
‘?˜ – 5 ¬¬/c a

?!e?© «?§ ¬®c? 2.

?®«?cYaac® – 100 ¬«
–cYa – acYa«®-¦n«ae©
˜a®§a c®aai – ?a®§a c i
“¤Y«ie© cYa – 1024
˜Y«®? – Ya
‘ a a – Ya
‹Y©ae®ae?ae – Y¤. c ?®«Y §aY?i

˜?®a?¬?cYa??© «?§ ?a®c?.

?!e?© !Y«®? – 74.7 F/«
?¬?« § – 5.2 F/«/c
?‹’ – 0.4
?‘’ – 0.33
?!e?© !?««?aa!? – 8.0 ¬?¬®«i/«
’?¬®«®c i ?a®! – 4 Y¤.
B-«??®?a®aY?¤ – 42 aa«.Y¤.
‘ a a – 5.2 ¬¬®«i/«
?®cYc? – 5.1 ¬¬®«i/«
?aY a?? – 0.08 ¬¬®«i/«
•®«YaaYa? ®!e?© – 5.2 ¬¬®«i/«
”?!a?®FY – 3 F/«

RW ®aa?ae aY«i .

”®a¬ N 50. ‚?— Y ?ae?ae?a®c .

? ??««ia®a?®??i.

”® !«Y¤®-a®§®ce© a«Yc , !«Y¤e© a?a c , ? ??««iae a?a c aa¦Y-
e, !«Y¤eY, a«Yc a ae?aYe, a¤«?Ye, ?§c?ae, ?®«?cYaac® c 1 ¬¬ c
®a¬Y; ®a¬YcY a¬YaYe© cY®§e© § aa®© a«Yc , a¬YaY®Y § ?aaaYc ?Y
? ??««ia®c a?a c ; ?a®c®a®? Ya §«?c?¬.
.

– 9 –

„? ¬®¬Yaa?i.

?a c i aa? – 20 ?F;
«Yc i aa? – 18 ?F;

_‡ ?«icY?Y: . ‘?¦Y?Y ¬eeYc®© a?«e ®!®?a aa?.

?«iFY§?¬Yaa?i.

?a c i aa? 1.3 1.5 1.5 1.15 0.85
«Yc i aa? 1.35 1.2 1.3 1.15 0.80

_‡ ?«icY?Y: . ˜Y§?®Y a?¦Y?Y !®«Yc®© cacaac?aY«i®aa? aa?.

‚?!a®aYaa?a®c ?Y.
———-T—————T——————–?
? ? ?a c i aa? ? «ec i aa? ?
? ?ae ? 4 II III IV 0 ? 4II III IV 0 ?
? +—————+——————–+
? 125 ? >3O >30 >30 ? >30 >30 >30 ?
? 250 ? >30 >30 >30 ? >30 >30 >30 ?
? 63 ? 30 >30 >30 ? >30 >30 30 ?
L———+—————+———————

_‡ ?«icY?Y: . ‚ea ¦Y®Y a?¦Y?Y c?!a ae?®®© cacaac?aY«i®aa?
caYa c aa®a a.

•®«®¤®c i ?a®! .

‘« !®?®«®¦?aY«i i: cYaY§ 3′ – ?®ic«Y?Y ®a¤Y«iea !Y«ea ?iaY.

?a¤?®Fa ¬¬ .

„! —-T—-T—-T—-T—-T—-?
0+—+—-+—-+—-+—-+—-+
10+—+—-+—-+—-+—-+—-+
20+—+—-+—-+—-+—-+—-?
30+—+—-+—-+—-+—-+—-?
40+—+—-+—-+—-+—-+—-+
50+—+—-+—-+—-+—-+—-+ ————-T———?
60+—+—-+—-+—-+—-+—-+ ? ?a c®Y aa® ? ?
70+—+—-+—-+—-+—-+—-+ +————+———+
80+—+—-+—-+—-+—-+—-+ ? «Yc®Y aa® ? ?
90+—+—-+—-+—-+—-+—-+ L————+———-
100L—+—-+—-+—-+—-+—-+–
250 500 1000 2000 4000 8000 ?ae

_‡ ?«icY?Y: . ˜®ceeY?Y ?®a®F c®a?a?ia?i cea®??a §ca?®cea c aa®a a
®!Y?a aa®a®. ‘?¦Y?Y c®a?a?ia?i aaY¤?a ? ?§??a §ca-
?®cea c aa®a a«Yc .
˜aY¤c a?aY«ie© ¤? F®§: ¤caaa®a®?© ?®a«Y ae© Yca?a
®a ¤«?aY«i®F® c®§¤Y©aac?i ea¬ .

– 10 –

˜YaFY®Fa ¬¬ ??aaY©.

” « F®ceY, ?iaaeY ? § ?iaaeY ?®aa? ¤Yae®a¬?a®c e, ¬®¦YaacY-
eY ®c F? ®aaY®a?«Ya®§ .

?!§®a i aYaFY®Fa ¬¬ Faa¤®© ?«Ya??.

˜ a®«®F?cYa??a aYY®!a §®c ?© Ya, ®aF e Faa¤®© ?«Ya?? !Y§
? a®«®F??.

˜«Y?aa®? a¤?®Fa ae?i.

˜?a¬ a?aa®ce©. _‡ ?«icY?Y .: ˜?a¬ a?aa®ce©. ?®acYeY
RR – 0.70″ ?a?§ ?? a ae?aY?i Fa ?ae c«Yc®.
RQ – 0.16″ ˜a®c®¤?¬®aai Y aaeY c® caYa
QRS – 0.08″ ®a¤Y« a aYa¤ae .
QT – 0.36″

—‘‘ – 80 a¤/¬?

˜§®ae F®F aaa®a?®??i.

‘«?§?aa i ??eYc®¤ ®!ec®F® aecYa .
‚ ¦Y«a¤?Y — a¬YaY®Y ?®«?cYaac® acYa«®© ¦?¤?®aa?. ‘?« ¤?? ¬iF-
??Y,«YF?® a a?a c«iiaai c®§¤aa®¬. ‘«?§?aa i ®!ec®F® aecYa a ac aa? ¬?
!«Y¤®-a®§®c®F®. ˜Ya?aa «ia?? ?a?c i.
‘«?§?aa i «a?®c?aee ¤cY ¤ae a??Yaaa®© ??e?? F??YaY¬?a®c ,
§ ¤Y© aaY?Y – ?§ei§c«Y?Y a«?§?aa®© 5¬¬ a 3¬¬, ¤® i§ce § ?®«Y®
ae?!a?®¬. “a®«eY?Y a?« ¤®? ?® ?Ya?aeYa?? i§cY®F® ¤YaeY?a ? ?®cYa-
FYae?i ? ?a i¬.
_‡ ?«icY?Y .: ?§cY®Y ?®a ¦Y?Y § ¤Y© aaY?? ¤cY ¤ae a??Yaaa®© ??e??
c ®!« aa? «a?®c?aee 5¬¬ a 3¬¬. ‚§ia ?aY? a a ¤«i F?aa®«®F?cYa?®F® ?aa«Y-
¤®c ?i.

“«iaa §ca?®c®Y ?aa«Y¤®c ?Y/ 2.02.1998F.

˜YcYi: ?a © a®ce©, ia®aaaa?aaa Y®¤®a®¤ i, ae?!a®§ c®a®a.
˜®¤¦Y«a¤®c i ¦Y«Y§ : Y acY«?cY , ?a © cYa??© a®ce©, ia®aaaa?aaa
®¤®a®¤ i.
˜a c i ?®c? : a §¬Ya 95 a 42 a¬,
?®aaa a®ce©, ? aYa?¬ ®¤®a®¤®© aaaa?aaae, Y a?«®aY ,
c eYc®-«®a ®ce© ?®¬?«Y?a Y a ae?aY,
?®?aY¬Yae – Ya
‹Yc i ?®c? : a §¬Ya 100 a 48 a¬,
?®aaa a®ce©, ? aYa?¬ ®¤®a®¤®© aaaa?aaae, Y a?«®aY ,
c eYc®-«®a ®ce© ?®¬?«Y?a a¬YaY® a ae?aY,
?®?aY¬Yae – Ya
_‡ ?«icY?Y: . caaaY?Y ®aF e !Y§ ? a®«®F??.

?®aa«ia ae?i Yca®? a®«®F .

11.02.1998F. † «®!e !®«? c ®!« aa? «®?aYc®F® aaaa c , §i!?®aai
??aaY©, ? aYaaY§?? cYaa?a ?®Yc®aaY©.
˜Yca®«®F?cYa??© aa aaa: —?˜ c ®a¬Y, F«a!®??Y aYae«Y?ae ®¦?c«Ye,
a c®¬YaeY a ®!Y?a aa®a®; ? a®«®F?cYa??a § ?®c Ya. ??aa? c« ¦eY,
ae? ®a?ceY, ?a®a« ¤eY; „?aa «i i F?? «FY§?i.
_‡ ?«icY?Y .: ‚YFYa a?c i ?®«?Yca®? a?i cYaa?a ?®Yc®aaY©.

– 11 –

?®aa«ia ae?i ®aea «i¬®«®F .

11.02.1998F. ?a¬®aa F« §®F® ¤ : ¤?a?? §a?aY«iea Yac®c a®§®-
ceY, cYa??Y, ®c F®c Ya. ‘®aa¤?aaeY ?§¬YY?i c ?aY¤Y« a c®§a aa®©
®a¬e.

?®aa«ia ae?i ®a®« a?F®«®F .

11.02.1998F. ˜?®a?®??i: ®a®ceY a®¤e ac®!®¤e, a«?§?aaeY ®a®cea
a®¤®c aa! aa®ae?ce. ‹ a?F®a?®??i: a«?§?aaeY caYa ®a¤Y«®c F«®a?? ®!ec-
®© ®?a a??, c?aaeY. ˜Y!eY ¬?¤ «?e Y acY«?cYe. ?a®a?®??i: –
aa¦e© a«aa®c®© ?a®a®¤ c?aae©, ! a ! i ?YaY?®? aYa®-a®§®c®F® aecY-
a , !«Yaaie i, cYa?® a §«?c?¬e ?a?®? ? acYa®c®© ?®aa, ?Yaae®a ae?© Ya,
aa!ae®cea ?§¬YY?© Ya. ”a?ae?® «i®Y ?aa«Y¤®c ?Y: a §F®c®aai aYci
a §«?c Ya ?a ce¬ aa®¬ a >6 ¬Yaa®c, «Yce¬ – a 4 ¬Yaa®c; eY?®aai aYci
a §«?c Ya ?a ce¬ aa®¬ a 4 ¬Yaa®c, «Yce¬ – a 1 ¬Yaa ; ?®«®¦?aY«ieY
®?eae ˜?Y, ”Y¤Ya?c?, a?®a®cY® c®a?a?ia?Y c ®?eaY ?c ! a , a?¬?a®¬
˜« F®cYeYa?®© ®aa?ae aY«ie© a ®!Y?a aa®a®.
_‡ ?«icY?Y: . ?®a«Y a i Y©a®aYa®a i aaF®aa®aai ¤caaa®a®ii,
!®«YY cea ¦Y a«Yc .

???˜—?’…‹?˜›‰ „???˜?‡.

3˜ ®a®c ?? ?a®ae. ¬Y§ ? a ?a a®-F?F?Y?cYa?®© a a ?aYa?aa?-
3?? ce?®«iY¬ea a !®a – 7 «Ya aa ¦ c ?a®aeYaa?? ?«Y? «ie?? , a !®a ieYF®
3a ?aa®c??®¬ «®? «i®© ?§?®c aa®a®© c?!a ae??;
3- 18 «Ya aa ¦ c ?a®aeYaa?? aa!e?? -cY? e?? , a !®-
3a ieYF® a ?aa®c??®¬ «®? «i®© ?§?®c aa®a®©
3c?!a ae??;
3- ¤®aa®cYa i aci§i a«aceY?i a®aa®i?i a ?aY?a –
3eY?Y¬ a !®ae a 0 3?aa®c?? ¬? c?!a ae??, ?®aaY?Y-
3®Y ?a®FaYaa?aaieYY aaa¤eY?Y ?® c®§ca eY?? ?
3a !®aY;

3˜ ®a®c ?? ceic«Y®F® a !®«i®F® 0 2a?¤a®¬ 3 2 cYFYa a?c®-aYa®a 3-
2®© Yca®? a?? 0 2cYaa?a ?®Yc®aaY© 3 (¦ 0 «®!e !®«i®F® aiae?Y !®«? c
??aaia 3 0c ?®?®Y, 3 0 3 0? aYaaY§?? 3 0cYaa?a 3 0?®Yc®aaY© c® caY¬i a ,
§ aa c«iieYY !®«i®F® ?a®ae? aiai, ceaiF?c ai aa?? ccYaa, ca® ?a?®a?a
®!«YFcY?Y, Yc®§¬®¦®aai ¤«?aY«i®F® ®eY?i c aa? a ai¦YaaY©, §i! 3-
?®aai ??aaY©, ®Y¬Y?Y c a®«®¤®© c®¤Y; ®!eY?a?c®Y a?¦Y?Y a ?a?«i 3-
®©, aY¬?Ya aaa®©, !®«Yc®© cacaac?aY«i®aa? ?® a??a ?Yac a®?, a?¦Y?Y
¬eeYc®© a?«e 3).

3˜ ®a®c ?? cea ¦Yea a?¤a®¬®c c ¬Y§Y § !®«Yc ?i:
3 0 «?c?Y 3 0c ¬Y§Y 3 0cea ¦Yea 3 0 F?®a? aa?cYa?®F® 3 0a?¤a®¬ 3 0(c aaeY
?a?aaa?e ?®!Y«Y?i ? «iaeYc, !®«Y§YeY ®eaeY?i c ? «iae a ?a? ®a« ¦-
¤Y??), a?¤a®¬ aYa®a®-¬®a®a®© ?®«?Yca®? a?? (!®«YceY aeY®¬Ye c
¬eeae a ? aaaa c a cYaa?a ?®Yc®aaY©, a aa ie i ¬eeYc i a« !®aai),
cYaa?!a«ia®F® a?¤a®¬ (®!e i aa®¬«iY¬®aai, F®«®c®?aa¦Y?i, a ?a?i),
a §c?ce?aai ?®aaY?Y® c® caY¬i a !®ae a ?aa®c??®¬ «®? «i®© c?!a ae??,
a!ec ie?a !Y§ «YcY?i ?a? ®aaecY ®a ®a®c®© a !®ae (®a?aa?, ?a®aeYaa?-
® «ie© aaa¤®c®© !®«i?ce© «?aa) ? 3 0 ae®Y «YcY?i a? §¬®«?a?? ¬?,
F F«?®!«®? a®a ¬? ? ?a®FaYaa?aaie?a 3 0?® c®§ca eY?? ? ®a®c®© a !®aY
? ?a?cY¤e?a !®«i®F® ? aa®©?®© 3 0aaa aY 3 0aaa¤®a?®a®!®aa? 3 0?® 3 0®a®c®©
?a®aeYaa??, a? §ec Ya 3 0 a¬YaY® 3 0 cea ¦YeY 3 0?a®ic«Y?i c?!a ae?®®©
!®«Y§? (II-III aaY?Yi) c ?a®e«®¬.
.

– 12 –

3˜ ®a®c ?? 0
aa®©?®F® cea ¦Y®F® a?¦Y?i c?!a ae?®®© cacaac?aY«i®aa?,
aa®©??a aa®ae?cYa??a aaeY?© 3 0( 3¤Yae®a¬ ae?i ? «iaeYc ? ¬Y¦ae « F®cea
3aaaa c®c, ®FaY© ?® a??a c a®cea aaY?®«, aaYe?e ?®¦? ? «iaeYc 0),
aa®©??a F?®¤?aa®?cYa??a ic«Y?© 3 0( 3?® ¤ e¬ ? ??««ia®a?®???,
3 a ?¦Y a« !®?®«®¦?aY«ieY a®«®¤®c i ?a®! , a?¬?a®¬ !Y«®F® ?ia 0) 3.

3˜ ®a®c ??
3ceic«Y®F® ?a? ®!a«Y¤®c ?? ®a®« a?F®«®F®¬ ?®a«Y a®© Y©a®aY-
3a®a®© aaF®aa®aa?,
3 «?c?i c a ?a a®-F?F?Y?cYa?®© a a ?aYa?aa??Y aa«®c?© aaa¤
3a? § ?i ea¬ ? ? ¤Y©aacaie?© caY¤e© ae ?a®a, 25 «Ya aa ¦ c a? § –
3ea ?a®aeYaa?ia,
3ce!®a®c®F® ?®ceeY?i ?®a®F®c c®a?a?ia?i cea®??a §ca?®cea c aa®a
3?® ¤ e¬ 0 3?®a®F®c®© a® «i®© a¤?®¬Yaa??,
3®aaaaaac?i c ¬Y§Y —?’, ?a®?a?? ae?©, c®a? «?aY«iea § !®«Yc –
3?©, ?a?c®¤ie?a ? a?¦Y?i a«aa , a ?¦Y ®aaaaaac?i ?a ®!eY?a?cea
3?a?§ ?®c, c a®¬ c?a«Y 0 3 ®aaaaaac?Y ?Yaae®a ae?© ! a ! ®© ?YaY?®??,
3 «?c?i c ¬Y§Y cYaa?!a«iaea a aaaa®©aac;

3˜ ®a®c ?? ¦ «®! ( 0 ®aae¦?a, Y?a?iaeY ®eaeY?i c i??F aa 3-
a «i®© ®!« aa?, c®§?? ie?Y cYaY§ 3-4 c a ?®a«Y Y¤e, ?®«®¦?aY«ie©
iaeaeY?a 3 a ae?¤®c), ae?!a®F aaa®¤a®¤Y®a?®??? (i§c § ¤Y© aaY?Y «a-
3?®c?aee, ?®?aea i ae?!a?®¬);

3˜ ®a®c ?? aa®©?®F® ?®ceeY®F® aaYa? «i®F® ¤ c«Y?i ¤®
3160/100 ¬¬ aa.aa., a ae?aY?i Fa ?ae c«Yc®, ?aeYa II a® ®aaY,
3®aaaaaac?Y ¤ ea § Y¤®aa a®c®aai ?a®c®®!a eY?i;

3¬®¦® ®?aY¤Y«?ai a®?aaaacaie?Y § !®«Yc ?i:

3„caaa®a®?© ?®a«Y ae© Yca?a ?a®aeYaa?® «i®F® FYY§ a® a?¦Y-
3?Y¬ a«aa II aaY?Y?, 0 3 i 0§cY i !®«Y§i 3 0¤cY ¤ae a??Yaaa®© 3 0??e?? c
aa ¤?? aa!aY¬?aa??; 3F 0??Yaa®?cYa? i !®«Y§i I aa ¤??.

3??®c aY«ie© 0 3¤ 0? F®§:
®a®c®Y § !®«Yc ?Y –
?aa a®ceY ic«Y?i c?!a ae?®®© !®«Y§? ®a «®? «i-
®© c?!a ae?? (cYFYa a?c®-aYa®a i ?®«?Yca®? a?i
cYaa?a ?®Yc®aaY©)
a®?aaaacaie?Y § !®«Yc ?i –
„caaa®a®?© ?®a«Y ae© Yca?a ?a®aeYaa?® «i®F®
FYY§ a® a?¦Y?Y¬ a«aa II aaY?Y?;
?§cY i !®«Y§i ¤cY ¤ae a??Yaaa®© ??e?? c
aa ¤?? aa!aY¬?aa??;
???Yaa®?cYa? i !®«Y§i I aa ¤??.
®a«®¦Y?i – Ya.
.

– 13 –

‹…—…˜?…

„?Ya , !®F a i !Y«? ¬?, aF«Yc®¤ ¬?, c?a ¬? ¬?, a ®Fa ?cY?Y¬
?®aaY!«Y?i ¦?a®c.

Rp: Thiamini bromidi 6% – 1.0
D.t.d. N 20
S. ‚c®¤?ai caaa?¬eeYc® ?® 1¬« Y¦Y¤Yc®.
#
Rp: Pyridoxini hidrochloridi 25% – 1.0
D.t.d. N 15
S. ‚c®¤?ai caaa?¬eeYc® ?® 1¬« cYaY§ ¤Yi.
#
Rp: 3 Sol.Cyanocobalamini 0.01% – 1.0
D.t.d. N 310 in amp.
S. ‚c®¤?ai caaa?¬eeYc® ?® 1¬« cYaY§ ¤Yi.
#
Rp: Acidi ascorbinici 5% – 1.0
D.t.d. N50
S. ‚c®¤?ai caaa?¬eeYc® ?® 3¬« Y¦Y¤Yc®.
#
Rp: 3Tab. 0Acidi nicotinici 0. 305
D.t.d. N 350
S. ‚aaai ?® 1 3a !«Ya?Y 2 a § c ¤Yi 0.

32. ?Yaa®Y «YcY?Y.

”?§?®aYa ?Yca?cYa?®Y «YcY?Y 3 – ?¬?«??a«ia ®!« aai ?«YcYc®F®,
3«®?aYc®F® aaaa c®c ? aaaa c®c ??aa? cYaa?a ?®Yc®aaY©,
3 ®!« aai ?«YcYc®F® aaaa c – 10 aY a®c cYaY§ ¤Yi;
3 ®!« aai «®?aYc®F® aaaa c – 10 aY a®c cYaY§ ¤Yi;
3 aaaa ce ??aaY© – 20 aY a®c Y¦Y¤Yc®.

33. 0 ‹YcY! i F?¬ aa?? , ¬ aa ¦, a ¬®¬ aa ¦.

3˜˜??˜?‡
˜®«i®© x, 59 «Ya, ?c «?¤ III Faa??e ?®
?a®ae.§ !®«Yc ?i, ?®aaa??« c ?«???a ?a®aeYaa?® «iea !®«Y§Y© ‘˜!???
22/01.1998 F®¤ a ¤? F®§®¬ ®aa a®ceY ic«Y?i c?!a ae?®®© !®«Y§? –
cYFYa a?c®-aYa®a i ?®«?Yca®? a?i cYaa?a ?®Yc®aaY© ¤«i ®cYaY¤®-
F® ?YaY®ac?¤YaY«iaac®c ?i a a ?aYa Yaaa¤®a?®a®!®aa?. ‚ aY§a«ia aY
?a®cY¤Y®F® ?®¬?«Y?a®F® ®!a«Y¤®c ?i ?®aa c«Y ¤? F®§:
®a®c®Y § !®«Yc ?Y – ?aa a®ceY ic«Y?i c?!a ae?®®© !®«Y§? ®a
«®? «i®© c?!a ae?? (cYFYa a?c®-aYa®a i ?®«?Yca®? a?i cYaa?a
?®Yc®aaY©),
a®?aaaacaie?Y § !®«Yc ?i – „caaa®a®?© ?®a«Y ae© Yca?a ?a®aeYaa?®-
«i®F® FYY§ a® a?¦Y?Y¬ a«aa II aaY?Y?; ?§cY i !®«Y§i ¤cY-
¤ae a??Yaaa®© ??e?? c aa ¤?? aa!?®¬?Ya ae??; ???Yaa®?cYa? i
!®«Y§i I aa ¤??,
®a«®¦Y?© ®a®c®F®/a®?aaaacaie?a § !®«Yc ?© Ya.
‚ aa ae?® aea aa«®c?ia ?a®cY¤Y ?aaa «YcY?i a ?a?¬YY?Y¬
®!eYa?aY?«iieY© ¬Y¤?? ¬Ya®§®© aYa ??? ? ¬Yaa®© ae?§?®aYa ??? a ?®«®-
¦?aY«ie¬ iaeaeY?a®¬. ˜®«i®© ce??a c a¤®c«Yac®a?aY«i®¬ a®aa®i??,
a¦¤ Yaai c ¤ «iY©eY¬ !«i¤Y??.

‡??‹?—…˜?… ? ?‘’?˜?? ˜?‹…‡˜?

˜®«i®© x, 59 «Ya, ®?Ya a®a ?®aY«i®© c
?a®ae?« ?a®a?? ‡?¬?®, a YY aa!e??-cY? e?? ‚e!®aFa?®F® ‘a¤®aaa®?aY«i-
®F® § c®¤ (‚‘‡), aa ¦ 18 «Ya, ?«Y? «ie?? ‚‘‡, aa ¦ 7 «Ya, a®¤?«ai
c ?«???Y a 22.01 ?® 18.02/1998F.
„? F®§: ®a®c®Y § !®«Yc ?Y –
?aa a®ceY ic«Y?i c?!a ae?®®© !®«Y§? ®a «®? «i-
®© c?!a ae?? (cYFYa a?c®-aYa®a i ?®«?Yca®? a?i
cYaa?a ?®Yc®aaY©)
a®?aaaacaie?Y § !®«Yc ?i –
„caaa®a®?© ?®a«Y ae© Yca?a ?a®aeYaa?® «i®F®
FYY§ a® a?¦Y?Y¬ a«aa II aaY?Y?;
?§cY i !®«Y§i ¤cY ¤ae a??Yaaa®© ??e?? c
aa ¤?? aa!aY¬?aa??;
???Yaa®?cYa? i !®«Y§i I aa ¤??.
®a«®¦Y?i – Ya.

‹ !®a a®aeY ¤ eY:
Hb – 170 F/«, ˜a?aa®ae?ae – 5.3 *10 512 0 F/«, –cYa®© ?®? § aY«i – 0.96
‹Y©?®ae?ae – 6.4 * 10 59 0 F/«, ‘?˜ – 5 ¬¬/c a
?!e?© !Y«®? – 74.7 F/«, ?¬?« § – 5.2 F/«/c
?‹’ – 0.4, ?‘’ – 0.33, ?!e?© !?««?aa!? – 8.0 ¬?¬®«i/«
’?¬®«®c i ?a®! – 4 Y¤., B-«??®?a®aY?¤ – 42 aa«.Y¤.,
‘ a a – 5.2 ¬¬®«i/«, ?®cYc? – 5.1 ¬¬®«i/«,
?aY a?? – 0.08 ¬¬®«i/«, •®«YaaYa? ®!e?© – 5.2 ¬¬®«i/«
RW ®aa?ae aY«i . ‚?— Y ?ae?ae?a®c .
? «?§ ¬®c? !Y§ ®a®!Y®aaY© 2.

?aaaa¬Ya «ieY ¤ eY:
? ??««ia®a?®??i: ”® !«Y¤®-a®§®ce© a«Yc , !«Y¤e© a?a c , ? ??««iae
a?a c aa¦Ye, !«Y¤eY, a«Yc a ae?aYe, a¤«?Ye, ?§c?ae, ?®«?cYaac®
c 1 ¬¬ c ®a¬Y; ®a¬YcY a¬YaYe© cY®§e© § aa®© a«Yc , a¬YaY®Y
§ ?aaaYc ?Y ? ??««ia®c a?a c ; ?a®c®a®? Ya §«?c?¬.

„? ¬®¬Yaa?i: ?a c i aa? – 20 ?F; «Yc i aa? – 18 ?F;

?«iFY§?¬Yaa?i. ?a c i aa? 1.3 1.5 1.5 1.15 0.85
«Yc i aa? 1.35 1.2 1.3 1.15 0.80
‚?!a®aYaa?a®c ?Y: cea ¦Y®Y a?¦Y?Y c?!a ae?®®© cacaac?aY«i®aa?
caYa c aa®a a.
•®«®¤®c i ?a®! : a« !®?®«®¦?aY«i i, cYaY§ 3′ – ?®ic«Y?Y ®a¤Y«iea
!Y«ea ?iaY.
?a¤?®¬Yaa?i: ˜®ceeY?Y ?®a®F c®a?a?ia?i cea®??a §ca?®cea c aa®a
c aa®aY 4000 ?ae a«Yc – 80 ¤˜, a?a c – 50¤˜.

˜§®ae F®F aaa®a?®??i: ‘«?§?aa i ??eYc®¤ ®!ec®F® aecYa . ‚ ¦Y«a¤?Y —
a¬YaY®Y ?®«?cYaac® acYa«®© ¦?¤?®aa?. ‘?« ¤?? ¬iF??Y,«YF?® a a?a c-
«iiaai c®§¤aa®¬. ‘«?§?aa i ®!ec®F® aecYa a ac aa? ¬? !«Y¤®-a®§®c®F®.
˜Ya?aa «ia?? ?a?c i. ‘«?§?aa i «a?®c?aee ¤cY ¤ae a??Yaaa®© ??e??
F??YaY¬?a®c , § ¤Y© aaY?Y – ?§ei§c«Y?Y a«?§?aa®© 5¬¬ a 3¬¬,
¤® i§ce § ?®«Y® ae?!a?®¬. “a®«eY?Y a?« ¤®? ?® ?Ya?aeYa?? i§cY®F®
¤YaeY?a ? ?®cYaFYae?i ? ?a i¬.

‡ ?«icY?i a?Yae? «?aa®c:
?®aa«ia ae?i ®aea «i¬®«®F : ¤?a?? §a?aY«iea Yac®c a®§®ceY, cYa??Y,
®c F®c Ya. ‘®aa¤?aaeY ?§¬YY?i c ?aY¤Y« a c®§a aa®© ®a¬e.

?®aa«ia ae?i ®a®« a?F®«®F : ®a®ceY a®¤e ac®!®¤e, a«?§?aaeY ®a®cea
a®¤®c aa! aa®ae?ce. a«?§?aaeY caYa ®a¤Y«®c F«®a?? ®!ec®© ®?a a??,c?a-
aeY. ˜Y!eY ¬?¤ «?e Y acY«?cYe. ˜ aa¦e© a«aa®c®© ?a®a®¤ c?aae©,
! a ! i ?YaY?®? aYa®-a®§®c®F® aecYa , !«Yaaie i, cYa?® a §«?c?¬e
?a?®? ? acYa®c®© ?®aa, ?Yaae®a ae?© Ya, aa!ae®cea ?§¬YY?© Ya.
”a?ae?® «i®Y ?aa«Y¤®c ?Y: a §F®c®aai aYci a §«?c Ya ?a ce¬ aa®¬
a >6 ¬Yaa®c, «Yce¬ – a 4 ¬Yaa®c; eY?®aai aYci a §«?c Ya ?a ce¬ aa®¬
a 4 ¬Yaa®c, «Yce¬ – a 1 ¬Yaa ; ?®«®¦?aY«ieY ®?eae ˜?Y, ”Y¤Ya?c?,
‡ ?«icY?Y: ?®a«Y a i Y©a®aYa®a i aaF®aa®aai ¤caaa®a®ii,
!®«YY cea ¦Y a«Yc .

˜Yca®«®F?cYa??© aa aaa: —?˜ c ®a¬Y, F«a!®??Y aYae«Y?ae ®¦?c«Ye,
a c®¬YaeY a ®!Y?a aa®a®; ? a®«®F?cYa??a § ?®c Ya. ??aa? c« ¦eY,
ae? ®a?ceY, ?a®a« ¤eY; „?aa «i i F?? «FY§?i. ‚YFYa a?c i ?®«?Yc-
a®? a?i cYaa?a ?®Yc®aaY©.

‡ ?«icY?Y: ˜ !«i¤ Yaai c ?«???Y a 1985 F®¤ , ? aa®ieY¬a
®!a«Y¤®c ?i a®aa iiaai ®aa a®ceY ic«Y?i c?!a ae?®®© !®«Y§?, c
?«???Y ?a®cY¤Y® «YcY?Y a Y?®a®ae¬ iaeaeY?a®¬.
˜®-?aY¦Y¬a ?a®a?c®?®? § a !®a , aci§ i a ?aa®c?? ¬? c?!-
a ae??, ae?§?cYa??¬ ?YaY ?ai¦Y?Y¬, ?YaY®a« ¦¤Y?Y¬, ea¬®¬.
˜a¦¤ Yaai c ¤ «iY©eY¬ ¤? ¬?cYa?®¬ !«i¤Y?? c ?«???Y ? a –
a®a®-?aa®aa®¬ «YcY??.

Нашли опечатку? Выделите и нажмите CTRL+Enter

История болезни – Профессиональные болезни (остаточные явления вибрационной болезни)