Литература - Патофизиология (ПАТОФИЗИОЛОГИЯ ПЕЧЕНИ)

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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!

?‡??˜ ˜®aa??
˜?‚?‘?˜?˜‘??‰ ?…„?–?˜‘??‰ ?˜‘’?’“’
??”…„˜? ˜?’?”?‡??‹????

“ ’ ‚ … ˜ † „ ? ?
‡ c. ? aeY¤a®© ? a®ae?§?®«®F??
?a®aeYaa®a ?.‚.…aeaY¬®c
“____” __________199___F.

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

˜?‡„…‹: ˜?’?”?‡??‹???? ?˜??˜?‚ ? ‘?‘’…?
’…??: ˜?’?”?‡??‹???? ˜…—…˜?

˜ §a !®a «: ¤®aeYa,
?.¬.. ”.”.??§a«?

?Ya®¤?cYa?®Y a? § ?Y aa-
cYa¦¤Y® § aY¤ ??
? aeY¤ae “___”______199__F.
?a®a®?®« N___

˜®c®a?!?aa?, 1995 F.
.

– 2 –

–…‹? ‡?˜?’??: ?§ac?ai ®!eai ia?®«®F?i ? ? a®FYY§ § !®«Yc ?© ?Y-
cY?, ?a?ae??e ¤? F®aa?cYa??a aea?ae?® «iea ?a®!
? ? a®FYYa?cYa?®© aYa ???.

˜® ®?®c ?? ?§acY?i aY¬e aaa¤Yae ¤®«¦e:

‡˜?’?: 1. ˜a?c?e, ¬Ya ?§¬e a §c?a?i ? ®a®ceY ?a®ic«Y?i ae?a®-
«?a?cYa?®F® a?¤a®¬ .
2. ?a®!Y®aa? ? a®FYY§ ? ¬Ya ?§¬ aea?ae?® «iea ?a®!
?a? a?¤a®¬Y ?YcY®c®© Y¤®aa a®c®aa?.
3. ˜a?c?e ? ®a®!Y®aa? ¬Ya ?§¬®c a §c?a?i ?¬¬a®c®a? –
«?aY«i®F® a?¤a®¬ .
4. ?Ya ?§¬e a §c?a?i ? ®a®ceY ?a®ic«Y?i a®«Yaa a?cYa-
?®F® a?¤a®¬ .
5. ˜a?®«®F?i, ? a®FYY§ FY? a?a®c ? ae?aa®§®c ?YcY?. ˜ a®-
FYY§ a?¤a®¬ ?®aa «i®© F??YaaY§??.
6. ?a®!Y®aa? ¬Ya ?§¬®c a §c?a?i ? ?®? § aY«? a?¤a®¬
aYFYYa ae?? ? ®?aa®«Yc®F® a®aa ?YcY?.
7. ?a®!Y®aa? ia?®«®F?? ? ? a®FYY§ ¦Y«aaa a ¤YaY©
(?Y¤.ae ?.).
8. ‘a®¬ a®«®F?cYa??Y ?a®ic«Y?i ?a? Y¤®aa a®c®aa? ?YcY-
?, ?a ? a®FYY§ (aa®¬.ae ?.).
“?…’?: „?aeaeYaYae?a®c ai ®a¤Y«ieY c?¤e ¦Y«aaa ?® ¤ e¬ ®?aY¤Y«Y-
?i ¦Y«cea ??F¬Ya®c c ?a®c? ? i?a?aYa a.
˜›’? ?‡˜????‹…˜˜›??: a ®!e?¬? ?a?ae?? ¬? ¤? F®aa??? ? aYa ???
§ !®«Yc ?© ?YcY?.

˜‹?˜ ? ˜?‘—…’ ‚˜…?…˜? ‡?˜?’??
1. ‚aaa??aY«i®Y a«®c® ?aY?®¤ c aY«i……………….5¬?
2. ?Ya®¤?cYa??Y ? ®aF ?§ ae?®eY a? § ?i
?aY?®¤ c aY«i ?® ?a®cY¤Y?i § ia?i…………….15¬?
3. ?®aa®«i aY®aYa?cYa?®© ?®¤F®a®c??
aaa¤Ya®c a ?®¬®eii ?®¬?iiaYaea
aYaa®c ? aaa®F® ®?a®a ……………………….45¬?
4. ‘ ¬®aa®iaY«i i a !®a aaa¤Ya®c
?®¤ aa?®c®¤aac®¬ ?aY?®¤ c aY«i,
®ae®a¬«Y?Y ?a®a®?®«®c………………………..130¬?
5. ?!aa¦¤Y?Y ?®«acYea aY§a«ia a®c………………15¬?
6. ‡ ?«ic?aY«i®Y a«®c® ?aY?®¤ c aY«i………………5¬?
___________________

– 3 –

?’???: 215 ¬?

??’…˜??‹?˜?-’…•˜?—…‘??… ?‘˜?™…˜?…
I. ?aaaa¬Yae ? ®!®aa¤®c ?Y:
1. ??¬®Fa ae ……………………………………. 1
2. ˜ec ¦®? ˜FY«i¬ …………………………… 1
3. ‘Yaae??? ……………………………………. 2
4. ˜a®!?®c i ¤®eYc? ……………………………. 1
5. ˜®¦?aee …………………………………….. 1
6. ˜?aeYa ……………………………………… 1
7. ‡ ¦?¬ ˜Y …………………………………. 2
8. ˜a« c?? ……………………………………. 15
9. ‘a ? c?? 50 ¬« …………………………… 2
10. ??a?ae 2 ¬« ……………………………….. 1
11. ‘Y?a¤®¬Ya ………………………………….. 1
12. ?¤a?ae?® i ? aae? ?«? i«Y?aa®aa?¬a«ia®a ……… 1

II. •?¬?cYa??Y aY ?a?ce ? ¬ aYa? «e:
1. †Y«ci …………………………………… 10 ¬«
2. ?§®a i ??a«®a ?®aeYaa?a®c i ………….. 30 ¬«
3. 0,2% a aac®a a®«i®© ??a«®ae ……………… 100 ¬«
4. ˜ aac®a ˜?FYa …………………………. 100 ¬«
5. 0,65% a aac®a a«®a?aa®F® aa?i …………… 100 ¬«

III. †?c®aeY:
1. ‹iFae?? ………………………………….. 4 ea

IV. ’ !«?aee:
1. ‘aY¬ ®!¬Y ¦Y«cea ??F¬Ya®c.
2. ‘®¤Ya¦ ?Y ¦Y«cea ??F¬Ya®c c ?a®c? ?a? a §«?cea ¦Y«aa-
a a (?® ’®¤®a®ca).
3. ˜ a?aY¤Y«Y?Y ?¤?? a®aea aeYa¬Ya®c c aa!?«Ya®cea ®!a –
§®c ?ia FY? a®ae?a®c.
4. ?Ya®¤e ?aa«Y¤®c ?i c FY? a®«®F??.
5. ˜ a«Y¤aacYeY ae®a¬e ¦Y«aa«.
6. ˜YcY®c®-??eYce© ?aaF®®!®a®a aa®!?«?®FY .

‚‘’“˜?’…‹?˜?… ‘‹?‚? ˜˜…˜?„?‚?’…‹?
‚ ?®a«Y¤?Y ¤c ¤Yaia?«Ya?i § c?aY«i® c®§a®a«® c?a«® !®«i-
ea a ®aaae¬? ? aa®?cYa??¬? § !®«Yc ?i¬? ?YcY?. ?? ceic«iiaai

– 4 –

c aci§? a i?aaaY¬ «ie¬? a®aa®i?i¬?: ?a? a®aa¤?aaea ? a aaa®ae a,
®aa c«Y?ia ? ®¦®F a, ?a? ?eY¬?? ¬?®? a¤ , ?®a«Y ®?Ya ae?©, a-
«Y¤aacY®© ? a®«®F?? ? a.¤. ˜ aaeY?i aea?ae?© ?YcY? ?a? a ¬ea
a §«?cea ? a®«®F?cYa??a a®aa®i?ia caYF¤ c a®© ?«? ?®© aaY?Y?
§ aa F?c ia !®«ie®© ?aaF ®!¬Yea, F®a¬® «iea ? FY¬®aa a?cYa??a
a aaaa®©aac. ˜a®ic«Y?i a §«?cea § !®«Yc ?© ?YcY? Yaaa c aY!Y
cYaae Ya?Yae?ae?c®aa?. ˜®ia®¬a c FY? a®«®F?? ®!eY?a?iae¬ ac?a –
Yaai a?¤a®¬e© ?a?ae?? ?« aa?ae?? ae?? § !®«Yc ?© ?YcY?. ?« aa?-
ae?? ae?i ?a®! ?YcY? a ?¦Y ?a®c®¤?aai ?® a?¤a®¬®¬a ?a?ae??a,
a.Y. ?® aae®aa? aaeY?©, ?®a®aeY ia? ?a®!e ®aa ¦ ia.

?…’?„?—…‘??… ? ?˜??˜?‡?–??˜˜›… “??‡?˜??
˜˜…˜?„?‚?’…‹? ˜? ˜˜?‚…„…˜?? ‡?˜?’??
˜aY?®¤ c aY«i ®!eiaiYa ?®ai¤®? ?a®cY¤Y?i § ia?i.
˜Yac i c aai c?«ic Ya c aY!i ?a®Fa ¬¬?a®c e© ?®aa®«i § –
?© aaa¤Ya®c ? aY®aYa?cYa??© ®?a®a.
‚a®a i c aai § ia?i – a ¬®aa®iaY«i i a !®a aaa¤Ya®c ?®¤
aa?®c®¤aac®¬ ?aY?®¤ c aY«i ? ®!aa¦¤Y?Y ?®«acYea aY§a«ia a®c.

??˜’˜?‹? ’…?˜…’?—…‘??‰ ˜?„??’?‚?? ‘’“„…˜’?‚
1. ˜a®Fa ¬¬?a®c e© ?®aa®«i (?a?«®¦Y?Y 1).
2. ˜YeY?Y § ¤ c (?a?«®¦Y?Y 2).
3. ??a®a ?® a«Y¤aie?¬ c®?a®a ¬:

‚?˜˜?‘› „‹? ˜?‚’?˜…˜??
1. ?!e i a a ?aYa?aa?? aea?ae?® «i®© ¬®aae®«®F?? ?YcY?.
2. ˜®«i ?YcY? c ?®¤¤Ya¦ ?? F®¬Y®aa § – ac aa?Y c ®!¬Y-
ea ?a®aeYaa a, ??eYc aY?i, FY¬®aa § ? ¤a.
3. ˜®«i ?YcY? c aeYa¬Ya®«®F?cYa?®¬ F®¬Y®aa §Y.
4. ˜®«i ?YcY? c ®!¬YY ¦Y«cea ??F¬Ya®c.
5. ?!¬Y !?«?aa!? c ®aF ?§¬Y.

‚?˜˜?‘› ? ‡?˜?’??
1. ?a®ceY c?¤e, ?a?c?e ? ¬Ya ?§¬e a §c?a?i ae?a®«?a?cYa?®F®
a?¤a®¬ . ?aeY? “”Ya¬Ya®c ?®caY¦¤Y?i”.
2. ?Y? a®¤Y?aYaa?ce© ? FY? aYaF?cYa??© a?¤a®¬e, ®a®!Y®aa?
? a®FYY§ ? ®a®ceY aea?ae?® «ieY ?a®!e.
3. ˜YcY®c i ?®¬ , c?¤e ? ®a®!Y®aa? ¬Ya ?§¬®c a §c?a?i.
4. ˜ a®FYY§ ? ?®a«Y¤aac?i ?¬¬a®c®a? «?aY«i®F® a?¤a®¬ .
5. ?Ya ?§¬e a §c?a?i ? ®a®ceY ?a®ic«Y?i a?¤a®¬ ?®aa «i®©

– 5 –

F??YaaY§??.
6. ˜ a®FYY§ a?¤a®¬ aYFYYa ae?? ? ®?aa®«Yc®F® a®aa ?YcY?,
YF® ?¤?? a®ae.
7. ˜a?c?e ? ¬Ya ?§¬e a §c?a?i a®«Yaa a?cYa?®F® a?¤a®¬ .
8. ?« aa?ae?? ae?i ¦Y«aaa, ®a®!Y®aa? ¬Ya ?§¬®c a §c?a?i.
9. ?§¬YY?Y a®¤Ya¦ ?Y ¦Y«cea ??F¬Ya®c c ?a®c?, ¬®cY ? aeY? –
«?ia ?a? a §«?cea c?¤ a ¦Y«aaa.
10. ?«??cYa?®Y § cY?Y ®a¤Y«iea c?¤®c ¦Y«aaa.

‘???‘’??’…‹?˜?? ˜?˜?’? ‘’“„…˜’?‚
˜?„ ˜“??‚?„‘’‚?? ˜˜…˜?„?‚?’…‹?

?˜›’ 1. ??aY¤Y«?ai c?¤ i?a?Ya?¬Ya «i®© ¦Y«aaa? a ?®¬®eii ? –
cYaacY®F® ®?aY¤Y«?i !?«?aa!? ?a®c? ?® ¤? §®aY ?ae??
‚ -¤Y-˜YaF .

˜?«?aa!? ?a? c§ ?¬®¤Y©aac?? a ¤? §®aY ?a?c®¬ ˜a«?a ¤ Ya a®-
§®c a®Y ®?a e?c ?Y. ˜Y ?ae?i ce?®«iYaai c ¤caa c a? a a: ?ai¬®©
? Y?ai¬®©.
_˜ai¬ i aY ?ae?i .: c ?a®!?a?a ?®¬Ye ia 1 ¬« aec®a®a?? ?a®c? ? ¤®! c-
«iia 2 ¬« ¤?aa?««?a®c ®© c®¤e ? 5 ? ?. ¤? §®aY ?a?c ˜a«?a
(˜Y ?a?c 1. ‘a«iae ?«®c®© ??a«®ae 0,2 F. + ?®aeYaa?a®c ®© a®-
«i®© ??a«®ae 3 F. + ¤?aa?««?a®c ®© c®¤e 200 ¬«; ˜Y ?a?c 2.
0,5% a aac®a §®a®??a«®F® aa?i. ˜YaY¤ ®?aY¤Y«Y?Y¬ a¬Ye?c ia
10 ¬« aY ?a?c 1 a 0,3 ¬« aY ?a?c 2).
…a«? a®§®c®Y ®?a e?c ?Y a §c?c Yaai c aYcY?Y ¬?aae – aY ?ae?i
?ai¬ i, !eaaa i. ˜ §c?a?Y ?®a®§®cY?i § ?aY¤Y« ¬? ®¤®© ¬?aae
®aeY?c ia ?ai¬ai aY ?ae?i ? ? § ¬Y¤«Yai.
_˜Y?ai¬ i aY ?ae?i .: c ?a®!?a?a ?®¬Ye ia 1 ¬« aec®a®a?? ?a®c?, 2 ¬«
96% ia ®« ? 5 ? ?. ¤? §®aY ?a?c ˜a«?a . ˜ §c?a?Y a®§®c®F® ®?-
a e?c ?i ®aeY?c Yaai ? ? Y?ai¬ i aY ?ae?i ‚ -¤Y-˜YaF .
?!aa¦¤Y?Y ?®«acYea aY§a«ia a®c.
? cYaacY i aY ?ae?i !?«?aa!? a ¤? §®aY ?a?c®¬ ˜a«?a
?a?¬YiYaai ¤«i 2¤? 0aeaeYaYae? «i®© ¤? F®aa??? ¦Y«aaa.
˜a? ia®¬ ?ai¬ i !eaaa i aY ?ae?i ac?¤YaY«iaacaYa ® F??Ya!?«?-
aa!?Y¬?? § acYa ?aY?¬aeYaacY® !?«?aa!?¤?F«i?aa®?¤ (?®¤?Y-
cY®c i ¦Y«aaa ), ?ai¬ i § ¬Y¤«Y i – § acYa ?aY?¬aeYaacY®
!?«?aa!?¬®®F«i?aa®?¤ (?YcY®c i ¦Y«aaa ), Y?ai¬ i aY ?ae?i
– § acYa Y?®iiF?a®c ®F® !?«?aa!? ( ¤?YcY®c i ¦Y«aaa ).

– 6 –

?˜›’ 2. ‚«?i?Y ¦Y«c? a?®a®aai ¤c?F aY«i®F® aYae«Y?a a «iFae-
??.
‹iFae?a ¤Y? ??a?aaia ? ?®¤cYe?c ia § ?¦ii cY«iaai ea –
a?cY. —YaY§ 5-10 ¬? ?®a«Y ¤Y? ??a ae?? « ??a «iFae?? ®?aa? ia c
0,2% a aac®a a®«i®© ??a«®ae. ??aY¤Y«iia caY¬i, cYaY§ ?®a®a®Y
c®§?? Ya ¤c?F aY«i i aY ?ae?i a §¤a ¦Y?Y ??a«®a®©. ˜®a«Y
Ya?®«i??a ?®ca®aea a §¤a ¦Y?© aaa c«?c ia aaY¤YY « aYa®Y
caY¬i aY ?ae??.
‚ «?¬ae a?cYa??© ¬Ye®? «iFae?? cc®¤ia 0,5-1,0 ¬« aeY«i®© ¦Y«-
c?. —YaY§ 15-20 ¬? ?®ca®aiia ®?ea a a §¤a ¦Y?Y¬ « ??? a®«i®©
??a«®a®©. “aa c«?c ia ?§¬YY?Y « aYa®F® caY¬Y? aYae«Y?a
?®a«Y ccY¤Y?i ¦Y«c?.
?!aa¦¤Y?Y ?®«acYea aY§a«ia a®c.
“¤«?Y?Y a?aea®F® caY¬Y? aYae«Y?a ?a? a §¤a ¦Y?? « ??? «i-
Fae?? a®«i®© ??a«®a®© aci§ ® a aY¬, ca® ¦Y«ci § ¬Y¤«iYa ?a®cY-
¤Y?i c®§!a¦¤Y?i ?® aY¤ «?e®¬a Yaca. „«i aYeY?i c®?a®a , ? –
? i c aai aYae«Y?a®a®© ¤aF? ?®a ¦Y ¦Y«cii, ?¤a?ae?®e¬ a®?®¬
a §¤a ¦ ia aeYaa «ie© ? ?Ya?aeYa?cYa??© ®aaY§?? ?YaYaY§ ®F® aY-
¤ «?e®F® Yac .

?˜›’ 3. ‚«?i?Y ¦Y«c? a?a¬ aYa¤Yc®© ¤YiaY«i®aa? «iFae??.

?!Y§¤c?¦Yai «iFae?a ae??a?aaia ¤®eYc?Y !aie?®¬ ?cYaaa,
ca?aec ia Faa¤ai ?«Ya?a ? ®! ¦ ia aYa¤aeY. ‚Yaaae?a aYa¤ae ?a?
?®¬®e? aYaae??? a®Y¤?iia a aec ¦?®¬ ˜FY«i¬ . ˜ «YaY ??¬®F-
a ae § ??aec ia a?a¬ ? ¬?«?aa¤a aYa¤Ycea a®?a eY?©. ‡ aY¬,
aYa¤aeY «iFae?? a ?®¬®eii ???Ya?? ®aia Ya?®«i?® ? ?Y«i ¦Y«c? c
a §«?cea ?®aeYaa ae?ia (1:10; 1:5; 1:2; aeY«iai ¦Y«ci). ˜®a«Y¤®-
c aY«i® § ??aec ia «YaY ??¬®Fa ae ?§¬YY?i aYa¤Yc®F® a?a¬
?a? a §ea a §cY¤Y?ia ¦Y«c?.
?!aa¦¤Y?Y ?®«acYea aY§a«ia a®c.
†Y«ci, a?¦ i ?a®cY¤Y?Y c®§!a¦¤Y?i ?® Yace¬ c®«®? ¬, ce-
§ec Ya a¬YieY?Y c aa®ae ? ¬?«?aa¤e aYa¤Ycea a®?a eY?©. ‘aY-
?Yi !a ¤?? a¤?? ?a ?®aae?® «i a §cY¤Y?i ¦Y«c?.

‡??‹?—?’…‹?˜?… ‘‹?‚? ˜˜…˜?„?‚?’…‹?
˜YcYi, c ?a?ae??Y, ?aY¤aa c«iYa a®!®© aeYaa «iai a?¬?cYa?ai
« !®a a®a?i ®aF ?§¬ , ca® ? ®?aY¤Y«iYa YY cY¤aeai a®«i c® ¬®-
F?a ¦?§Y®c ¦ea ?a®aeYaa a, ?a c«Yea ?®¤¤Ya¦ ?Y F®¬Y®a-
a § . ˜a®ic«Y?i a §«?cea § !®«Yc ?© ?YcY? ®aia, ? ? ?a c?«®,

– 7 –

Ya?Yae?ae?cYa??© a a ?aYa.
˜®ia®¬a, a®«i?® a®c®?a?®aai ?aa«Y¤®c ?© ?®§c®«iYa aYe ai
c®?a®ae ia?®«®F?? ? ®§®«®F?cYa?®© ?a? ¤«Y¦®aa? a®F® ?«? ?®F®
? a®«®F?cYa?®F® ?a®aeYaa , ?a?c®aa? YF® ? aea?ae?® «i®F® a®aa®-
i?i ?YcY?.

˜?‘—…’ ?˜„ (??’?‚˜?‘’?) ‘’“„…˜’?
˜? ‡?˜?’??
_________________________________________________________________
˜’?˜› ‡?˜?’?? | ‚˜…??| “˜?‚…˜? | ??‹-‚? ‘’“„…˜’?‚
| ¬? |“‘‚?…˜?? | ?a?c | ? aa?c
—————————————————————–
1. ‚aaa??aY«i®Y a«®c® | 5 | 1 | | 12
?aY?®¤ c aY«i | | | |
—————————————————————–
2. ?!eiaY?Y ?aY?®¤ c – | | | |
aY«Y¬ ?®ai¤? ?a®cY¤Y-| | | |
?i § ia?i, aeY«? ? | 5 | 1 | | 12
¬Ya®¤?cYa??Y a? § ?i | | | |
?a®cY¤Y?i i?a?Ya?¬Y-| | | |
a «i®© a !®ae | | | |
—————————————————————–
3. ?®aa®«i ?aa®¤®F® | | | |
aa®ci § ?© ?aaY¬: | | | |
– aYaa®c®F® ?®aa®«i | 20 | 1,2 | 12 |
– aaa®F® ®?a®a | 25 | 1,2 | 7 | 5
—————————————————————–
4. ˜a®cY¤Y?Y aaa¤Ya ¬? | | | |
i?a?Ya?¬Ya «i®© a – | 45 | | 12 |
!®ae ?®¤ aa?®c®¤aac®¬ | | | |
?aY?®¤ c aY«i | | | |
—————————————————————–
5. ?®aa®«i ?®Yc®F® | | | |
aa®ci § ?© aaa¤Y- | 10 | 2 | 12 |
a®c ?aaY¬ aYeY?i a?- | | | |
aa ae?®ea § ¤ c | | | |
—————————————————————–
6. ?!aa¦¤Y?Y ?®«acYea | 10 | 2 | 12 |
aY§a«ia a®c | | | |
—————————————————————–

– 8 –

˜« ?aaY¬e© ?®iaeae?ae?Ya ?®«Y§®F® ¤Y©aac?i a ac?aec Yaai ?®
ae®a¬a«Y:
?˜„=————–

F¤Y: – ?®«?cYaac® ?a?c® a !®a ie?a aaa¤Ya®c;
– ?a®¤®«¦?aY«i®aai caY¬Y? ?a?c®© a –
!®ae aaa¤Ya®c;
– ®!eYY ?®«?cYaac® aaa¤Ya®c;
– ®!e i ?a®¤®«¦?aY«i®aai § ia?i.

‹ ? ’ … ˜ ? ’ “ ˜ ?
?a®c i:
1. ˜ a®«®F?cYa? i ae?§?®«®F?i /?®¤ aY¤.?.„.?¤® ? ‹.?.?e?¬®-
c®©.-?.,?Y¤?ae? .-1980.
2. ˜ a®«®F?cY? i ae?§?®«®F?i /?®¤ aY¤. ?.„.?¤®,‚.‚.˜®c?ae?®-
F®-’®¬a?,1994/.
3. ‹Y?ae?? ?® ? a®ae?§?®«®F??.

„®?®«?aY«i i:
1. ‹Y©aYa ‘.?., ‹ ?aYc ˜.˜. ?cYa?? ?® ? a®ae?§?®«®F?? ®!¬Y
cYeYaac ? i¤®?a?®© a?aaY¬e. ?., 1967.
2. ˜®¤ ai ‡.?. ?«??cYa? i FY? a®«®F?i. ?., 1970.
3. ˜«iFYa ?.”. ?a®ce FY? a®«®F??. ˜., 1975.
4. ? «i?Ya? ˜.?., ‘®¬Y¤iYc ?.?. ? ¤a. ˜Y¤®aa a®c®aai ?Y-
cY?. ?., 1978.
5. ‹®F?®c ?.‘., ˜«®? ?.…., •a®?cYa??Y FY? a?ae ? ae?aa®§e
?YcY?, ?., 1987.
6. • § ®c ?.?. ”a?ae?® «i i ¤? F®aa?? !®«Y§Y© ?YcY?.
?., 1988.
7. ?a«aa?® ˜.?. ˜®«Y§? ?YcY? ? ?®cY?. ‘˜!., 1993.
.

?a®ceY ?®ia?i ? aY¬Y:
“˜?’?”?‡??‹???? ˜…—…˜?”.

˜a ?a?cYa?? «i!eY c?¤e ? a 4® 0«®F?? ?YcY? a a ?aYa?§aiaai a?a-
aY¬e¬? ?a®ic«Y?i¬?.˜ aaeY?Y aea?ae?© ?YcY? caYF¤ c a®© ?«?
?®© aaY?Y? § aa F?c Ya !®«ie®© ?aaF ®!¬Yea, F®a¬® «iea ?
a®¬ a?cYa??a a aaaa®©aac.˜a®ic«Y?i § !®«Yc ?© ?YcY? a a ?aYa?-
§aiaai Ya?Yae?ae?c®aaii.
‚ aci§? a ia?¬ ce¤Y«Y?Y ®a¤Y«iea c?¤®c ? a®«®F?? ?YcY?
?a®c®¤ia ?® aae®aa? aaeY?© FY? a®!?«? a®© a?aaY¬e ? ?® aea?-
ae?® «ie¬ ?a®! ¬, ?®a®aeY ia? aaeY?i ®aa ¦ ia – ?® a?¤a®¬®-
¬a ?a?ae??a.

1. –?’?‹?’?—…‘??‰ ‘?˜„˜??
) ae?a®a®?a?cYa??© ae?a®«?§;
!) ?¬¬a®ae?a®«?§;
c) F?¤a®aa a?cYa??© ae?a®«?§;
F) F??®?a?cYa??© ae?a®«?§;
¤) ®?aa®«Yce© ae?a®«?§;
Y) aaa??a?ce© ae?a®«?§.
?¤?? a®aeY aYaae a?¤a®¬ – ceic«Y?Y “aeYa¬Ya®c ?®caY¦¤Y-
?i” – ?«’, ?a’ (aa a ¬? §), « ?a a- ? F«aa ¬ a ¤YF?¤a®FY §.

2. ‘?˜„˜?? ˜…—…˜?—˜?‰ ˜…„?‘’?’?—˜?‘’?.
) ?aa? i (?YcY®c®?«Ya®c i)
!) ?YcY®c i iaeYae «®? a?i (?®aa®a?aaY¬ i iaeYae «®? a?i ?«?
¬¬? c i ?®¬ )
c) i«Y?aa®«?a i (F??®? «Y¬?cYa? i) ?®¬ .
?…˜?’?„…˜˜…‘‘?‚˜›‰ ‘?˜„˜?? (¬ « i ?YcY®c i Y¤®aa a®c®aai)
– ia® «i!eY aaeY?i aea?ae?© ?YcY? !Y§ iaeYae «®? a?©. ?…˜?’?˜-
??? – !®«ie i ?YcY®c i Y¤®aa a®c®aai – a a ?aYa?§aYaai a®aa®-
i?Y¬ aea?ae?® «i®© Y¤®aa a®c®aa? a iaeYae «®? a?Y©, a ?¦Y, c
aci§? a® a?¦Y?Y¬ ?a®¤a?ae?? ?a®?® Fa«ia®c, FY¬¬®a F?cYa??¬
a?¤a®¬®¬.
?¤?? a®ae ?YcY®c®© Y¤®aa a®c®aa? ¤Y«ia Faa§®ceY
?a®!e ? ?a®!e ®aeY?a a §«?cea ?®¬?®Ya®c ?a®c?.
˜ Faa§®ceY ?a®!e:
1) ce¤Y«?aY«i i (!a®¬aa«iae «Y?, ?¤®ae? )
2) ®!Y§caY¦?c ie i ( a???a?®c i, ?®aeY?®c i)
?aeY? a?aY§ ?a®?® Fa«ia®c ? a??® Fa«ia®c (ae?!a?®FY,

– 2 –

3. ?…‡…˜•???‹?˜?-‚?‘˜?‹?’…‹?˜›‰ ‘?˜„˜?? (?¬¬a®c®a? «?aY«i-
e©). ?¤?? a®ae – ®a ¤®ceY ?a®!e (a?¬®«®c i, aa«Y¬®c i), a®¤Ya-
¦ ?Y ?¬¬a®F«®!a«?®c.

4. ‘?˜„˜?? ˜?˜’???‚?‹?˜??? ?“˜’?˜?‚?˜?? (?®aa «i®© F??YaaY-
§??).
) ?®¤?YcY®ce© !«®? ( aaeY?i c®a®a®F® ?a®c®a®? );
!) caaa??YcY®ce© !«®? (¤?aeaea§eY § !®«Yc ?i ?YcY?);
c) ¤?®cYce© !«®? ( aaeY?Y ?a®c®a®? ?® ?YcY®ce¬ cY ¬)
?¤?? a®ae a?¤a®¬ – a®¤Ya¦ ?Y ¬¬? ? (60-70 ¬?¬®«i/«) ?
aeY®«®c (0,2-0,3 ¬F%).
5. ‘?˜„˜?? ˜?’?‹???—…‘??‰ ˜…?…˜…˜?–?? ? ?˜“•?‹…‚??? ˜?‘’?
˜…—…˜?.
?¤?? a®a a?¤a®¬ – -aeYa®?a®aY?.

6. •?‹…‘’?’?—…‘??‰ ‘?˜„˜??.
) ¦Y«aae i ae®a¬ ;
!) !Y§¦Y«aae i ae®a¬ .
?¤?? a®ae a?¤a®¬ – ®!e?© !?«?aa!? (8,5-20,5 ¬?¬®«i/« ?®
¬Ya®¤a ‚ -¤Y-˜YaF ) ? YF® aea ?ae??.
†…‹’“•? – ®?a e?c ?Y c ¦Y«ae© aecYa ?®¦?, a?«Ya ? a«?§?aaea
®!®«®cY?, ce§c ®Y ®a«®¦Y?Y¬ !?«?aa!? ca«Y¤aac?Y ?®?«Y?i
YF® c ?a®c?.
†Y«aaa ceic«iYaai ?a? aa®cY !?«?aa!? c ?« §¬Y 32,2
¬?¬®«i/« (2 ¬F%).
‹®¦ i ¦Y«aaa Y aci§ a F??Ya!?«?aa!?Y¬?Y©.
˜ ¤?®cYceY ¦Y«aaa? a §c?c iaai ?a? ?Yac?c®¬ aaeY?? ia?a-
a®?®i§ , § c?aY«i®¬ a a? ¤Y ia?aa®ae?a®c.“cY«?c?c Yaai ?aY?¬a-
eYaacY® Y?ai¬®© !?«?aa!?.˜a? ca®a?c®¬ aaeY?? cecY¤Y?i
!?«?aa!? acY«?c?c Yaai ? ?ai¬®© !?«?aa!?.
˜YcY®ceY ¦Y«aaa? aci§ e a ?®caY¦¤Y?Y¬ FY? a®ae?a®c.?®Faa
aae aiai a §eY §cYii ®!¬Y a a §c?a?Y¬ caaa??YcY®c®F® !?-
«Yaa § :
) ?§®«?a®c eY ?«? ?®¬!??a®c eY aaeY?i § ac a !?«?-
aa!? ca«Y¤aac?Y ?§?®F® aa®ci «?F ¤? (?a? F®«®¤ ??, ?®a«Y
ccY¤Y?i aYaFY?®aa aaea cYeYaac, !«®??aaie?a «?F ¤?);
!) aaeY?Y ca®¤ c i¤®?« §¬ a?cYa?ai aYai (c a? a †?«i!Y-

– 3 –

a );
c) aaeY?Y ?®eiF ae?? !?«?aa!? a F«i?aa®®c®© ??a«®a®©
(ae?§?®«®F?cYa? i ¦Y«aaa ®c®a®¦¤Yea ? ¦Y«aaa ?a?F-
«Ya-˜ © a ).
˜a? caYa ia?a c a? a a c ?a®c? acY«?c?c Yaai a®¤Ya¦ ?Y ac®-
!®¤®F® !?«?aa!? ? a¬Yie Yaai a®¤Ya¦ ?Y !?«?aa!? c ¦Y«c?.
˜®¤?YcY®ceY ¦Y«aaa? – a a ?aYa?§aiaai aaeY?Y¬ cecY¤Y?i
aci§ ®F® !?«?aa!? cYaY§ cY?YcY®ceY ¦Y«ceY ?a®a®??, ia®
cY¤Ya ? § ¤Ya¦?Y ? ®!a a®¬a § !a®aa.‘®?a®c®¦¤ iaai ?®ceeY?Y¬
¤ c«Y?i c® caaa??YcY®cea ¦Y«cea ?a®a®? a ? ?®?«Y?Y¬ !?«?-
aa!? c® caY¬ !?«? a®¬ ¤YaYcY ? aa®cY FY? a®ae?a .
˜YcY®ceY ? aYa?¬®a®§eY F??Ya!?«?aa!?Y¬??.
’?? †?«i!Ya .
‚ YY ®a®cY Y¤®aa a®c®aai F«i?aa®?«aa aaeYa §e, ca® ?a?c®-
¤?a ? Ya?®a®!®aa? FY? a®ae?a®c aac ?c ai Y?®eiF?a®c e© !?«?-
aa!? ?«? ?aYca e ai ¬®®F«i?aa®?¤ c ¤?F«i?aa®?¤.?a¬Yc Yaai
a ?¦Y ?®a ¦Y?Y a?aa®?¤ «iea ¬Y¬!a , ¤Yae?ae?a ae?a®?« §¬ a?cYa-
??a !Y«?®c ?YcY®c®©, aci§ec ie?a a®«Yae?«ieY ®aF ?cYa??Y ?®-
e.
’?? ?a?F«Ya-˜ © a .
1 a?? – c ®a®cY ?®«®Y ?«? c aa?c®Y ®aaaaaac?Y F«i?aa®?«a-
a aaeYa §e.?®eiF ae?i ¬??¬ «i , ¦Y«ci Y ®?a e?c Yaai, ®!a §ai-
e?©ai Y?®eiF?a®c e© !?«?aa!? ? ?«?c Yaai c a? ia ¬®§F ,
ce§ec i ?a®?a?? ae?i.
2 a?? – aci§ a Y§ c?aY«ie¬ ¤Yae?ae?a®¬ F«i?aa®?«aa aaeY-
a §e, aYcY?Y ¤®!a®? cYaacY®Y.˜a? ia®¬ ¦Y«ci a®aa iYa ®a¬ «i-
e© aecYa, ¦Y«aaa Y cea ¦Y .˜®a ¦Y?Y F®«®c®F® ¬®§F Y§ c?-
aY«i®Y.
’?? „ !? -„¦®a® .
˜®cee Yaai ?aY?¬aeYaacY® aci§ e© !?«?aa!?.”˜®«Y§i cYa-
®© ?YcY?” – Y aa®«i?® ¦Y«aaa ? ?®?«Y?Y !?«?aa!? , a?®«i?®
¬Y« ®§ ?YcY? § acYa ®!a §®c ?i ¬Y« ? c aci§? a ?§ca eY?Y¬
¬Ya !®«?§¬ ¤aY «? c FY? a®ae?a a.
’?? ˜®a®a – aY¬Y© i, aa®?cYa? i ?®eiF?a®c i F??Ya!?-
«?aa!?Y¬?i.”a?ae?? ?YcY? a®aa Ye, FY¬®«?§ Ya.˜a®ic«iYaai
?aYa¬?aa?aaieY© ¦Y«aaa®©.’YcY?Y ¤®!a®? cYaacY®Y.
.

˜a?«®¦Y?Y 2

‡?„?—? 1
˜®«i i 27 «Ya ?®aaa??« c ®a¤Y«Y?Y a ¦ «®! ¬? a« !®aai,
F®«®c®?aa¦Y?Y, aa®¬«iY¬®aai, ?®ceeY?Y aY¬?Ya aaae. ‡ 10 ¤Y©
¤® § !®«Yc ?i «Yc?« ai !®«ie?¬? ¤®§ ¬? a??a? ? a?®a!?®c®©
??a«®ae ?® ?®c®¤a ?˜‡.
˜a? ®!a«Y¤®c ?? ®! aa¦Y®: ?®¦ !«Y¤ i a «?¬®®¦Y«ae¬ ®aaY-
?®¬. ˜ «i? –
a®a® ®?aY¤Y«iYaai acY«?cY i ? a?«®aY i aY«Y§Y? , ?YcYi
2-3 a¬ ?¦Y aY!Ya®© ¤aF?.
? «?§ ?a®c?: Er – 2500000/¬?«, Hb – 80 F/«, aYa.- 15%. ˜®©-
??«®ae?a®§, ?§®ae?a®§, ?§®aa®¬?i. ?a¬®a?cYa? i aY§?aaYa®aai
ia?aa®ae?a®c Y ?§¬YY , L – 8000 4/ 0¬?«.
˜-0, ˜-5, ?-2, ˜-6, ‘-57, ‹-25, ?-5%.
‘ec®a®a? ?a®c? ?¬YYa ¦Y«a®c aai ®?a a?a, a®¤Ya¦ ?Y ac®!®¤-
®F® !?«?aa!? 10 ¬F% (®a¬ «i®Y a®¤Ya¦ ?Y 3,42-10,52 ¬?¬®«i/«
?«? 0,2-1,2 ¬F%).
˜®ceeY® a®¤Ya¦ ?Y ¦Y«Y§ c aec®a®a?Y; ¬®c ? ? « !®«i®©
?¬Yia aY¬ai ®?a a?a.
?®c – § c?aY«i® ??F¬Ya?a®c § acYa aa®!?«? . ˜?«?aa-
!? c ¬®cY ®aaaaaacaYa.
?a?a ¦Y?i ?¬Yia aeeYe© aY¬e© aecYa ca«Y¤aac?Y § c?-
aY«i®F® a®¤Ya¦ ?i aaYa?®!?«? .
‘®®a®eY?Y aaYa?®!?«? c ? «Y ? aa®!?«?®cea aY« c ¬®cY
400:1 (c ®a¬Y 10:1-20:1).
˜a® «?§?a®c c aY§a«ia ae ®!a«Y¤®c ?i, ®!eia?aY ? a®FYY§
¦Y«aaa? a !®«i®©.

‡?„?—? 2
†Ye? 54 «Ya § !®«Y« cY§ ?®. ˜®ic?«?ai !®«? c ?a c®¬
?®¤aY!Yai? ®cYi a?«ieY, aY¦ae?Y a ?aa ¤? ae?Y© c ?a c®Y ?«Yc®,
eYi, ?a cai «®? a?a. ˜Ya?®?®?« a®e®a , Ya?®«i?® a § ?®ca®ai-
« ai ac®a . ’Y¬?Ya aaa 37,8 4 0‘. ˜a?aaa? ?a??a®c «ai aY?«®¬ ?
a? §¬®«?a?cYa??¬? aaY¤aac ¬?.
—YaY§ ¬Yaiae ?a?aaa? ?®ca®a?«ai. ˜a®¤®«¦ «ai aa? ¤i. ˜®«? a®
aa?a «?, a® c®ci aa?«?c «?ai. ˜®«i i F®a??a «?§?a®c .
˜a? ®!a«Y¤®c ?? ®a¬Yc Yaai ®¦?aY?Y, ?a a®¬ a®§eY !«ie??
cYaa?a cY? a. ?®¦ , c?¤?¬eY a«?§?aaeY ¦Y«aaee. †?c®a c§¤aa,
?a? ?®cYaa®aa®© ? «i? ae?? !«i¤ Yaai ?ai¦Y?Y ?YaY¤Y© !aie-

– 2 –

®© aaY??, ®a®!Y® c ®!« aa? ?a c®F® ?®¤aY!Yaii, aY§? i !®«Y§-
Y®aai c ia®© ®!« aa?.
? «?§ ?a®c?: …r-4500000/¬?«, ˜c-140 F/«, aYa.-1%,
L-13000/¬?«.
˜-0, ˜-2, i-3, ?-9, a-62, ‹-20, ?-4%, ‘?˜-21 ¬¬/c a.
‚ ?a®c? ®?aY¤Y«iYaai aci§ e© !?«?aa!?, ¤ ie?© ?ai¬ai aY ?-
ae?i ?® ‚ -¤Y-˜YaFa (15 ¬F%).
?®c ?¬YYa ?®a?cYcai ®?a a?a a ia?®¦Y«a®© ?Y®©. ??aY¤Y«iYa-
ai aci§ e© (?ai¬®©) !?«?aa!?. “a®!?«?®cea aY« c ¬®cY Ya.
? « a®«?cY, aaYa?®!?«? ®aaaaaacaYa.
˜a® «?§?a®c c aY§a«ia ae ®!a«Y¤®c ?i, ®!eia?aY ? a®FYY§
¦Y«aaa? a !®«i®©.

˜˜??…—?˜?…: Ya«? ®!e?© !?«?aa!? aec®a®a?? Y ?aYcee Ya 4-6 ¬F%
(68.4-102.6 ¬?¬®«i/«) ®!aaa ae?® i ¦Y«aaa “Y?®« i”. ˜®« i
®!aaa ae?® i ¦Y«aaa a®?a®c®¦¤ Yaai F??Ya!?«?aa!?Y¬?Y© ceeY
8-10 ¬F% (136.8-171 ¬?¬®«i/«).

‡?„?—? 3
?a¦c? 37 «Ya, a !®c?©, aci§ a caY¤e¬ ?a®?§c®¤aac®¬ (ae®a-
ae®a). ˜®«ie¬ aY!i ac?a Ya c aYcY?? 2-a «Ya. ˜®a«Y¤?© ¬Yaiae
cacaacaYa aY!i aa¦Y. ˜Ya?®?®ia cacaac® ai¦Yaa? c ?a c®¬ ?®¤aY-
!Yai?, a?¦Y?Y ??Ya?a , F®aYci c® aaa, a®e®a , ®¤ee? , ?a®c®-
a®c?c®aai ¤YaY.
˜®«i®© aaY?cYa?®F® aY«®a«®¦Y?i. ?®¦ ? a«?§?aaeY ¦Y«aae-
eY. –cYa ?®¦? e aea ®c®-¦Y«ae© a ?a a®c ae¬ ®aaY?®¬, ?a c®¬
!Y¤aY ?a®c®?®¤aY?.
˜a? ? «i? ae?? ®?aY¤Y«iYaai ?a © ?YcY? 4-5 a¬ ?¦Y aY!Ya-
®© ¤aF?, a¬YaY® ?«®ae©, a«YF? !®«Y§Ye©. ‘Y«Y§Y? YaY§?®
acY«?cY .
? «?§ ?a®c?: …r-3500000/¬?«, ˜c-100 F/«, aYa.-1%,
Tr-17000/¬?«, L-4000/¬?«, ˜-0, ˜-2, i-0, ?-2, a-50, ‹-40, ?-6%,
‘?˜-28 ¬¬/c a.
‘?¦Y® a®¤Ya¦ ?Y ?a®aa®¬!? ? ®!eYF® !Y«? ?a®c?. ???®a®-
«YaaYa?Y¬?i. ˜a®¬aa«iae «Y®c i ?a®! a« !®?®«®¦?aY«i i.
‚ ¬®cY ®?aY¤Y«iYaai aci§ e© !?«?aa!?, ¦Y«ceY ??a«®ae.
‘®¤Ya¦ ?Y aa®!?«?®cea aY« a?¦Y®.
“¬YieY® ce¤Y«Y?Y aaYa?®!?«? a ? «®¬, ® ?®«®F® ®!YaaecY-
c?c ?i Y !«i¤ Yaai.
?!eia?aY c®§¬®¦e© ? a®FYY§ ¦Y«aaa? a !®«i®F®.

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