285 research outputs found
FORMATION OF STRATEGIES FOR THE DEVELOPMENT OF ENERGY COMPANIES
In a dynamically changing economic environment and external circumstances energy companies have forced to pay more attention to the searching for management solutions, aimed at their effective functioning. This diffcult task can be solving by forming a strategy for their development. For this purpose, the article presents the results of the studying of the main behavioural strategies of energy companies, the analysis of the business strategies of the dominant energy companies operating in the electricity and power marke
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Increased expression of matrix metalloproteinases and matrix degrading activity in vulnerable regions of human atherosclerotic plaques
Dysregulated extracellular matrix (ECM) metabolism may contribute to vascular remodeling during the development and complication of human atherosclerotic lesions. We investigated the expression of matrix metalloproteinases (MMPs), a family of enzymes that degrade ECM components in human atherosclerotic plaques (n = 30) and in uninvolved arterial specimens (n = 11). We studied members of all three MMP classes (interstitial collagenase, MMP-1; gelatinases, MMP-2 and MMP-9; and stromelysin, MMP-3) and their endogenous inhibitors (TIMPs 1 and 2) by immunocytochemistry, zymography, and immunoprecipitation. Normal arteries stained uniformly for 72-kD gelatinase and TIMPs. In contrast, plaques' shoulders and regions of foam cell accumulation displayed locally increased expression of 92-kD gelatinase, stromelysin, and interstitial collagenase. However, the mere presence of MMP does not establish their catalytic capacity, as the zymogens lack activity, and TIMPs may block activated MMPs. All plaque extracts contained activated forms of gelatinases determined zymographically and by degradation of 3H-collagen type IV. To test directly whether atheromata actually contain active matrix-degrading enzymes in situ, we devised a method which allows the detection and microscopic localization of MMP enzymatic activity directly in tissue sections. In situ zymography revealed gelatinolytic and caseinolytic activity in frozen sections of atherosclerotic but not of uninvolved arterial tissues. The MMP inhibitors, EDTA and 1,10-phenanthroline, as well as recombinant TIMP-1, reduced these activities which colocalized with regions of increased immunoreactive MMP expression, i.e., the shoulders, core, and microvasculature of the plaques. Focal overexpression of activated MMP may promote destabilization and complication of atherosclerotic plaques and provide novel targets for therapeutic intervention
Economic prospects of innovative technologies of in vitro cultivation of seedlings
Purpose: The article discusses the economic prospects of innovative technologies for planting material of forest trees. The results of the development of an organizational model of business processes of growing forest seedlings are given and the stages of reproduction technology are described, its competitive advantages are revealed. Structure/Methodology/Approach: The use of innovative technologies in reforestation and afforestation in Russia remains insufficiently developed. Promising methods of reforestation is the use of seedlings grown by cloning. Findings: The duration and cost for each stage of the forest seedling technology were determined. The technology of clonal micropropagation includes a combination of techniques, the choice of a donor plant and the preparation of the source material of the species. Practical implications: It has been established that the development and introduction of technological innovations into practice requires financial support, due to the high cost of growing seedlings of woody plants. The developed organizational model of the process of clonal micropropagation can be used in organizing the production of seedlings of woody plants in forest seed breeding centers. Originality/Value: The development of clonal breeding technologies for modern breeding and seed centers is promising, however, there are a few difficulties that impede the successful development of production and reduce the economic efficiency ofreforestation activities.peer-reviewe
The Use of Elements of the Technology of Critical Thinking for the Formation of Professional Competencies Among Students of Technical and Vocational Education
Π Π΄Π°Π½Π½ΠΎΠΉ ΡΡΠ°ΡΡΠ΅ ΡΠ°ΡΠΊΡΡΠ²Π°ΡΡΡΡ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π²Π½Π΅Π΄ΡΠ΅Π½ΠΈΡ ΡΠ»Π΅ΠΌΠ΅Π½ΡΠΎΠ² ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΊΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΌΡΡΠ»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΠΏΡΠ΅ΠΏΠΎΠ΄Π°Π²Π°Π½ΠΈΠΈ ΡΠΏΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΡ
Π΄ΠΈΡΡΠΈΠΏΠ»ΠΈΠ½ Π² ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΡΡ
ΡΠ΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈ ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΡ (Π’ΠΈΠΠ). Π Π°ΡΠΊΡΡΠ²Π°Π΅ΡΡΡ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΡ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΠΎΠΏΡΡΠ° ΠΏΡΠΈ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΠΊΠΎΠΌΠΏΠ΅ΡΠ΅Π½ΡΠ½ΠΎΡΡΠΈ ΡΡΡΠ΄Π΅Π½ΡΠΎΠ².The article raises the issue of vocational guidance of college students. The need for the formation of motivation of students through practical exercises, ensuring the development of interest in the chosen specialty, is revealed. An example of organizing and holding an event with the aim of increasing interest in the chosen profession among students majoring in Β«HairdressingΒ» is given
PUBLIC ADMINISTRATION OF THE PROVISION OF SOCIAL SERVICES IN UNITED TERRITORIAL SOCIETIES OF UKRAINE: ORGANIZATIONAL ASPECTS
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Cystatin C deficiency in human atherosclerosis and aortic aneurysms
The pathogenesis of atherosclerosis and abdominal aortic aneurysm involves breakdown of the elastic laminae. Elastolytic cysteine proteases, including cathepsins S and K, are overexpressed at sites of arterial elastin damage, but whether endogenous local inhibitors counterbalance these proteases is unknown. We show here that, whereas cystatin C is normally expressed in vascular wall smooth muscle cells (SMCs), this cysteine protease inhibitor is severely reduced in both atherosclerotic and aneurysmal aortic lesions. Furthermore, increased abdominal aortic diameter among 122 patients screened by ultrasonography correlated inversely with serum cystatin C levels. In vitro, cytokine-stimulated vascular SMCs secrete cathepsins, whose elastolytic activity could be blocked when cystatin C secretion was induced by treatment with TGF-Ξ²1. The findings highlight a potentially important role for imbalance between cysteine proteases and cystatin C in arterial wall remodeling and establish that cystatin C deficiency occurs in vascular disease
ΠΠ½Π°Π»ΠΈΠ· ΠΏΡΠΈΡΠΈΠ½ ΠΏΠΎΠ·Π΄Π½Π΅ΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π° Π»Π΅Π³ΠΊΠΈΡ
A pilot study was designed to analyze causes of late diagnosis of lung tuberculosis and late start of the specific therapy. Thirty-eight inpatients with proven infiltrative lung tuberculosis were randomly involved in the study; they were city and rural dwellers of different age. A special questionnaire was developed to determine reasons of late diagnosis. An analysis of results obtained has shown that 8 patients, or 21 % were diagnosed at a scheduled large frame photofluorography, 30 % of the late diagnosed patients were not aware of their disease, 25 % of the females and 64 % of the maleswere self-treated. Primary care therapeutists were blamed for the late diagnosis in 33 % of the patients while failed to perform necessary investigations; the delay was 2 to 11 months.ΠΡΠ»ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΏΠΈΠ»ΠΎΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠΎ Π°Π½Π°Π»ΠΈΠ·Ρ ΠΏΡΠΈΡΠΈΠ½ ΠΎΡΡΡΠΎΡΠΊΠΈ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π· Π»Π΅Π³ΠΊΠΈΡ
(Π’Π) ΠΈ Π½Π°ΡΠ°Π»Π° ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ. ΠΠ΅ΡΠΎΠ΄ΠΎΠΌ ΡΠ»ΡΡΠ°ΠΉΠ½ΠΎΠΉ Π²ΡΠ±ΠΎΡΠΊΠΈ Π±ΡΠ»ΠΎ Π²Π·ΡΡΠΎ 38 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½Π½ΡΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ ΠΈΠ½ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠ²Π½ΡΠΉ Π’Π, ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΠ²ΡΠΈΡ
ΠΊΡΡΡ ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ, ΠΆΠΈΡΠ΅Π»Π΅ΠΉ Π³ΠΎΡΠΎΠ΄ΡΠΊΠΎΠΉ ΠΈ ΡΠ΅Π»ΡΡΠΊΠΎΠΉ ΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ, ΡΠ°Π·Π»ΠΈΡΠ½ΠΎΠ³ΠΎ Π²ΠΎΠ·ΡΠ°ΡΡΠ°. ΠΠ»Ρ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈΡΠΈΠ½ ΠΎΡΡΡΠΎΡΠΊΠΈ Π±ΡΠ»Π° ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π° ΡΠΏΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π°Π½ΠΊΠ΅ΡΠ°. ΠΠ½Π°Π»ΠΈΠ· ΠΏΠΎΡΡΡΠ΅Π½Π½ΡΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΏΠΎΠΊΠ°Π·Π°Π», ΡΡΠΎ Ρ 8 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (21 %) ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡ Π±ΡΠ»Π° Π²ΡΡΠ²Π»Π΅Π½Π° ΠΏΡΠΈ ΠΏΠ»Π°Π½ΠΎΠ²ΠΎΠΉ ΠΠΠ€. 30 % ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΡΡΡΠΎΡΠΊΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° Π½Π΅ ΡΠ°ΡΠΏΠΎΠ»Π°Π³Π°ΡΡ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠ΅ΠΉ ΠΎ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π΅, 25 % ΠΆΠ΅Π½ΡΠΈΠ½ ΠΈ 64 % ΠΌΡΠΆΡΠΈΠ½ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΡΠ°ΠΌΠΎΠ»Π΅ΡΠ΅Π½ΠΈΠ΅. Π£ 33 % ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π½ΡΡ
ΠΎΡΡΡΠΎΡΠΊΠ° Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° ΠΈ Π½Π°ΡΠ°Π»Π° Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΡΠΎΠΈΠ·ΠΎΡΠ»Π° ΠΏΠΎ Π²ΠΈΠ½Π΅ ΡΡΠ°ΡΡΠΊΠΎΠ²ΠΎΠ³ΠΎ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠ°, ΠΈΠ·-Π·Π° Π½Π΅Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΌΠΈΠ½ΠΈΠΌΡΠΌΠ° ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π½Π° ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·, ΠΎΠ½Π° ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° ΠΎΡ 2 Π΄ΠΎ 11 ΠΌΠ΅ΡΡΡΠ΅Π²
ΠΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠ΅ΡΠ΅ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ½Π΅ΠΆΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠΊΡΠΎΠ²Π° β ΠΊΠ»ΡΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠ° Π·ΠΈΠΌΠ½ΠΈΡ Π±ΠΈΠΎΡΠΎΠΏΠΎΠ² ΠΊΠΎΠΏΡΡΠ½ΡΡ ΠΠ°Π»ΡΠ½Π΅Π³ΠΎ ΠΠΎΡΡΠΎΠΊΠ°
The properties of snow cover, one of the most important abiotic factors for survivability of animals (mainly hooves) in winter, are considered. To analyze possible consequences of this influence, it was necessary to develop a special parameterization of snow cover properties differing from those used in solving hydrometeorological problems. In this paper we present the biotopic approach to spatial and temporal modeling of the snow depth and structure at the mesoscale level. For this scale level, the main factor determining the snow cover depth and structure is the distribution of plant associations (the vegetation cover) on mountain slopes of different exposure and steepness. Our cartographic model of the vegetation cover was developed based on the results of decoding the hierarchical multispectral satellite images. Each combination of a vegetation type, exposure, and steepness of a slope has its own snow accumulation coefficient, which allows calculation of the snow depth in a particular biotope. We propose to analyze winter animal habitats using two parameters depending on the depth and structure of the snow cover: a passability and the food availability. Similarly to the map of plant associations exerting effect on snow cover, a map of plant communities of forage biotopes of specific animals has been built, and a certain snow depth was assigned to each type. The forage biotopes were ranked according to degree of availability and passability. The proposed approach was applied to modeling the passability and food availability for wild boar and red deer biotopes in the southern spurs of the Bureinsky range in the Russian Far East. The snow accumulation coefficients used in the model were obtained from field surveys carried out in 2016β2018 at 173 sites located on slopes of different exposure and steepness and within different types of plant communities. It has been established that a significant part of the favorable foraging territories of wild boar and deer overlap, that may cause the interspecific competition and increased load on forage biotopes during severe and snowy winters. The model also makes possible to introduce additional parameters such as the energy consumption per movement, composition and quantity of feeds.ΠΠΏΠΈΡΠ°Π½Ρ ΠΏΡΠΈΠ½ΡΠΈΠΏΡ Π±ΠΈΠΎΡΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Π° ΠΊ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π΅Π½Π½ΠΎ-Π²ΡΠ΅ΠΌΠ΅Π½Π½Γ³ΠΌΡ ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π²ΡΡΠΎΡΡ ΠΈ ΡΡΡΡΠΊΡΡΡΡ ΡΠ½Π΅ΠΆΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠΊΡΠΎΠ²Π° Π΄Π»Ρ Π°Π½Π°Π»ΠΈΠ·Π° Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊ Π·ΠΈΠΌΠ½ΠΈΡ
ΠΌΠ΅ΡΡΠΎΠΎΠ±ΠΈΡΠ°Π½ΠΈΠΉ ΠΆΠΈΠ²ΠΎΡΠ½ΡΡ
Π½Π° ΠΌΠ΅Π·ΠΎΠΌΠ°ΡΡΡΠ°Π±Π½ΠΎΠΌ ΡΡΠΎΠ²Π½Π΅. ΠΠ½Π°Π»ΠΈΠ· Π·ΠΈΠΌΠ½ΠΈΡ
ΠΌΠ΅ΡΡΠΎΠΎΠ±ΠΈΡΠ°Π½ΠΈΠΉ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½ΠΎ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΡΡ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ Π΄Π²ΡΡ
ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ², Π·Π°Π²ΠΈΡΡΡΠΈΡ
ΠΎΡ Π²ΡΡΠΎΡΡ ΠΈ ΡΡΡΡΠΊΡΡΡΡ ΡΠ½Π΅ΠΆΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠΊΡΠΎΠ²Π°: ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΠΈ ΠΈ Π΄ΠΎΡΡΡΠΏΠ½ΠΎΡΡΠΈ. ΠΠ° ΠΏΡΠΈΠΌΠ΅ΡΠ΅ Π»Π°Π½Π΄ΡΠ°ΡΡΠΎΠ² ΡΠΆΠ½ΡΡ
ΠΎΡΡΠΎΠ³ΠΎΠ² ΠΡΡΠ΅ΠΈΠ½ΡΠΊΠΎΠ³ΠΎ Ρ
ΡΠ΅Π±ΡΠ° ΠΠ°Π»ΡΠ½Π΅Π³ΠΎ ΠΠΎΡΡΠΎΠΊΠ° Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΡΡΠΎΡΡ ΡΠ½Π΅ΠΆΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠΊΡΠΎΠ²Π° Π΄Π»Ρ ΠΊΠΎΡΠΌΠΎΠ²ΡΡ
Π±ΠΈΠΎΡΠΎΠΏΠΎΠ² ΠΊΠ°Π±Π°Π½ΠΎΠ² ΠΈ Π±Π»Π°Π³ΠΎΡΠΎΠ΄Π½ΡΡ
ΠΎΠ»Π΅Π½Π΅ΠΉ. ΠΠ° ΠΎΡΠ½ΠΎΠ²Π΅ ΠΊΠΎΡΡΡΠΈΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ½Π΅Π³ΠΎΠ½Π°ΠΊΠΎΠΏΠ»Π΅Π½ΠΈΡ, ΠΏΠΎΠ»ΡΡΠ΅Π½Π½Ρx ΠΏΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌ ΠΏΠΎΠ»Π΅Π²ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, Ρ ΠΏΠΎΠΌΠΎΡΡΡ Π³Π΅ΠΎΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π° ΡΠΊΡΡΡΠ°ΠΏΠΎΠ»ΡΡΠΈΡ Π·Π½Π°ΡΠ΅Π½ΠΈΠΉ Π²ΡΡΠΎΡΡ ΡΠ½Π΅ΠΆΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠΊΡΠΎΠ²Π°, ΡΠ²ΠΎΠΉΡΡΠ²Π΅Π½Π½ΡΡ
ΠΊΠ°ΠΆΠ΄ΠΎΠΌΡ ΡΠΈΠΏΡ ΠΊΠΎΡΠΌΠΎΠ²ΠΎΠ³ΠΎ Π±ΠΈΠΎΡΠΎΠΏΠ°. ΠΠ»ΠΎΡΠ°Π΄ΠΈ ΠΊΠΎΡΠΌΠΎΠ²ΡΡ
Π±ΠΈΠΎΡΠΎΠΏΠΎΠ² ΠΊΠ°Π±Π°Π½Π° ΠΈ Π±Π»Π°Π³ΠΎΡΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΎΠ»Π΅Π½Ρ ΡΠ°Π½ΠΆΠΈΡΠΎΠ²Π°Π½Ρ Π½Π° Π΄ΠΎΡΡΡΠΏΠ½ΡΠ΅, ΡΡΡΠ΄Π½ΠΎΠ΄ΠΎΡΡΡΠΏΠ½ΡΠ΅ ΠΈ Π½Π΅Π΄ΠΎΡΡΡΠΏΠ½ΡΠ΅. ΠΠ½ΡΠΎΡΠΌΠ°ΡΠΈΡ ΠΎ ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΠΈ ΠΈ Π΄ΠΎΡΡΡΠΏΠ½ΠΎΡΡΠΈ ΠΏΠΈΡΠ΅Π²ΡΡ
ΡΠ΅ΡΡΡΡΠΎΠ² Π² Π·ΠΈΠΌΠ½ΠΈΠΉ ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»Π° ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π΅Π½Π½ΡΡ ΡΡΡΡΠΊΡΡΡΡ ΠΊΠΎΡΠΌΠΎΠ²ΡΡ
Π±ΠΈΠΎΡΠΎΠΏΠΎΠ², ΠΎΡΠ΅Π½ΠΈΡΡ ΠΈΡ
ΡΠ°Π·ΠΎΠ±ΡΡΠ½Π½ΠΎΡΡΡ ΠΈ ΠΏΡΠ΅Π΄ΠΏΠΎΠ»ΠΎΠΆΠΈΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΡΠ΅ ΠΏΡΡΠΈ Π·ΠΈΠΌΠ½ΠΈΡ
ΠΌΠΈΠ³ΡΠ°ΡΠΈΠΉ ΠΆΠΈΠ²ΠΎΡΠ½ΡΡ
ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
Π²ΠΈΠ΄ΠΎΠ²
Π‘ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ Π°ΡΠΏΠ΅ΠΊΡΡ ΠΠ‘ΠΠ’-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ
Introduction: The growing importance of the MSCT method in the case of acute massive pulmonary embolism forms new diagnostic directions Β β the determination of objective MSCT markers of right ventricular dysfunction and the search for new, previously ignored, MSCT parameters of angiographic severity of embolic load.The purpose of the study: to evaluate the prognostic role and predictivity of the results of MSCT angiopulmonography in the case of choosing a surgical method for the treatment of pulmonary embolism.Research objectives. Π’o analyze the influence of the volume of preserved peripheral arterial pulmonary blood flow on the results of surgical treatment of acute massive PE and the dependence of the average pressure in the pulmonary artery on the MSCT parameters.Materials and methods: this work examines the surgical approach to the treatment and possibilities of preoperative MSCT diagnosis of acute massive pulmonary embolism. The 7-year analysis included the analysis of more than 1,200 MSCT studies for acute massive pulmonary embolism. 147 patients were selected for surgical treatment and successfully operated on, the remaining patients received conservative therapy with dynamic MSCT observation. According to international classifiers, the analysis of classes and categories of intraoperative and postoperative complications of emergency surgical treatment was performed in comparison with the initial MSCT parameters of acute massive PE.Results. The smaller the number of segmental branches of the pulmonary artery is determined at the preoperative stage, the higher the risks of mortality and complications of emergency surgical treatment of acute massive PE (p<0,001). A direct relationship between the average pressure in the pulmonary artery and the MSCT parameter-the diameter of the unpaired vein (p<0,001) was confirmed. An increase in the number of visualized bronchial arteries corresponds to an increase in the average pressure in the pulmonary artery (p<0,05).Discussion. The lightning speed of the course of pulmonary embolism dictates an exceptional approach to the completeness of the diagnosis of the disease, and the change in treatment tactics due to the increasing demand for surgical methods of treatment changes the diagnostic approach to acute pulmonary embolism in general. The success of surgical treatment of PE directly depends on the completeness and speed of preoperative MSCT diagnostics, in particular, on the quality of analysis of intra-pulmonary and intracardiac hemodynamics.Conclusion: For acute massive PE with obstruction at the level of the trunk and / or main branches of the pulmonary artery, with a sharp and often uncontrolled progression of right ventricular failure, risk stratification in Β«real timeΒ» becomes the most relevant, the time factor becomes of paramount importance for determining treatment tactics. The inclusion of previously ignored MSCT parameters in the algorithm of preoperative diagnosis allows us to modify the algorithm of preoperative diagnosis, to form and introduce the concept of the reference MSCT status of a patient with acute massive PE.Β ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. Π ΠΎΡΡ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΠΈ ΠΌΠ΅ΡΠΎΠ΄Π° ΠΠ‘ΠΠ’ Π² ΡΠ»ΡΡΠ°Π΅ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ ΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΡΠΎΡΠΌΠΈΡΡΠ΅Ρ Π½ΠΎΠ²ΡΠ΅ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ β ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΎΠ±ΡΠ΅ΠΊΡΠΈΠ²Π½ΡΡ
ΠΠ‘ΠΠ’-ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΠΏΡΠ°Π²ΠΎΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ ΠΈ ΠΏΠΎΠΈΡΠΊ Π½ΠΎΠ²ΡΡ
, ΡΠ°Π½Π΅Π΅ Π½Π΅ ΡΡΠΈΡΡΠ²Π°Π΅ΠΌΡΡ
, ΠΠ‘ΠΠ’-ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² Π°Π½Π³ΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡΠΆΠ΅ΡΡΠΈ ΡΠΌΠ±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π½Π°Π³ΡΡΠ·ΠΊΠΈ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: ΠΎΡΠ΅Π½ΠΈΡΡ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠΎΠ»Ρ ΠΈ Β ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΠ‘ΠΠ’-Π°Π½Π³ΠΈΠΎΠΏΡΠ»ΡΠΌΠΎΠ½ΠΎΠ³ΡΠ°ΡΠΈΠΈ Π² Β ΡΠ»ΡΡΠ°Π΅ Π²ΡΠ±ΠΎΡΠ° Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄Π° Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ.Β ΠΠ°Π΄Π°ΡΠΈ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ Π²Π»ΠΈΡΠ½ΠΈΠ΅ ΠΎΠ±ΡΠ΅ΠΌΠ° ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π»Π΅Π³ΠΎΡΠ½ΠΎΠ³ΠΎ ΠΊΡΠΎΠ²ΠΎΡΠΎΠΊΠ° Π½Π° ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ Π’ΠΠΠ ΠΈ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΡ ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΎΡ ΠΠ‘ΠΠ’-ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ².ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ Β ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ°ΡΡΠΎΡΡΠ°Ρ ΡΠ°Π±ΠΎΡΠ° ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°Π΅Ρ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ ΠΊ Β Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΈ Β Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡΠΌ Π΄ΠΎΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΠ‘ΠΠ’-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ. 7-Π»Π΅ΡΠ½ΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· Π²ΠΊΠ»ΡΡΠΈΠ» Π°Π½Π°Π»ΠΈΠ· Π±ΠΎΠ»Π΅Π΅ 1200 ΠΠ‘ΠΠ’ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ. ΠΠ° Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΎΡΠΎΠ±ΡΠ°Π½ΠΎ ΠΈ ΡΡΠΏΠ΅ΡΠ½ΠΎ ΠΏΡΠΎΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½ΠΎ 147 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΎΡΡΠ°Π»ΡΠ½ΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ ΠΏΠΎΠ»ΡΡΠ°Π»ΠΈ ΠΊΠΎΠ½ΡΠ΅ΡΠ²Π°ΡΠΈΠ²Π½ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ Ρ Β Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΠ‘ΠΠ’-Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ΠΌ. Π‘ΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΌΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΡΠΌ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΎΡΠ°ΠΌ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ Π°Π½Π°Π»ΠΈΠ· ΠΊΠ»Π°ΡΡΠΎΠ² ΠΈ Β ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΉ ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΈ Β ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΡΠΊΡΡΡΠ΅Π½Π½ΠΎΠ³ΠΎ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π² ΡΠΎΠΏΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΠΈ Ρ ΠΈΡΡ
ΠΎΠ΄Π½ΡΠΌΠΈ ΠΠ‘ΠΠ’-ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠ°ΠΌΠΈ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ Π’ΠΠΠ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π§Π΅ΠΌ ΠΌΠ΅Π½ΡΡΠ΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΡΠ΅Π³ΠΌΠ΅Π½ΡΠ°ΡΠ½ΡΡ
Π²Π΅ΡΠ²Π΅ΠΉ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ΅ΡΡΡ Π½Π° Π΄ΠΎΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΡΡΠ°ΠΏΠ΅, ΡΠ΅ΠΌ Π²ΡΡΠ΅ ΡΠΈΡΠΊΠΈ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ
ΠΎΠ΄Π° ΠΈ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΡΠΊΡΡΡΠ΅Π½Π½ΠΎΠ³ΠΎ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ Π’ΠΠΠ (p<0,001). ΠΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½Π° ΠΏΡΡΠΌΠ°Ρ Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·Ρ ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΈ ΠΠ‘ΠΠ’-ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠ° β Π΄ΠΈΠ°ΠΌΠ΅ΡΡ Π½Π΅ΠΏΠ°ΡΠ½ΠΎΠΉ Π²Π΅Π½Ρ (p<0,001). Π£Π²Π΅Π»ΠΈΡΠ΅Π½ΠΈΡ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° Π²ΠΈΠ·ΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Π±ΡΠΎΠ½Ρ
ΠΈΠ°Π»ΡΠ½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠΉ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΠ΅Ρ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ Π² Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ (p<0,05).ΠΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅. ΠΠΎΠ»Π½ΠΈΠ΅Π½ΠΎΡΠ½ΠΎΡΡΡ ΡΠ΅ΡΠ΅Π½ΠΈΡ ΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ Π΄ΠΈΠΊΡΡΠ΅Ρ ΠΈΡΠΊΠ»ΡΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ ΠΊ ΠΏΠΎΠ»Π½ΠΎΡΠ΅ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, Π° ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π»Π΅ΡΠ΅Π±Π½ΠΎΠΉ ΡΠ°ΠΊΡΠΈΠΊΠΈ Π·Π° ΡΡΠ΅Ρ Π²ΠΎΠ·ΡΠ°ΡΡΠ°ΡΡΠ΅ΠΉ Π²ΠΎΡΡΡΠ΅Π±ΠΎΠ²Π°Π½Π½ΠΎΡΡΠΈ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ, ΠΌΠ΅Π½ΡΠ΅Ρ Π² ΡΠ΅Π»ΠΎΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ ΠΊ ΠΎΡΡΡΠΎΠΉ ΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ. Π£ΡΠΏΠ΅Ρ
Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π’ΠΠΠ Π½Π°ΠΏΡΡΠΌΡΡ Π·Π°Π²ΠΈΡΠΈΡ ΠΎΡ ΠΏΠΎΠ»Π½ΠΎΡΡ ΠΈ Π±ΡΡΡΡΠΎΡΡ Π΄ΠΎΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΠ‘ΠΠ’-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ, Π² ΡΠ°ΡΡΠ½ΠΎΡΡΠΈ ΠΎΡ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° Π°Π½Π°Π»ΠΈΠ·Π° Π²Π½ΡΡΡΠΈΠ»Π΅Π³ΠΎΡΠ½ΠΎΠΉ ΠΈ Π²Π½ΡΡΡΠΈΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ»Ρ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ Π’ΠΠΠ Ρ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠ΅ΠΉ Π½Π° ΡΡΠΎΠ²Π½Π΅ ΡΡΠ²ΠΎΠ»Π° ΠΈ/ΠΈΠ»ΠΈ Π³Π»Π°Π²Π½ΡΡ
Π²Π΅ΡΠ²Π΅ΠΉ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ, Ρ ΡΠ΅Π·ΠΊΠΈΠΌ ΠΈ ΡΠ°ΡΠ΅ Π½Π΅ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΡΠ΅ΠΌΡΠΌ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΏΡΠ°Π²ΠΎΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ ΡΡΡΠ°ΡΠΈΡΠΈΠΊΠ°ΡΠΈΡ ΡΠΈΡΠΊΠΎΠ² Π² ΡΠ΅ΠΆΠΈΠΌΠ΅ Β«ΡΠ΅Π°Π»ΡΠ½ΠΎΠ³ΠΎ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈΒ» ΡΡΠ°Π½ΠΎΠ²ΠΈΡΡΡ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎΠΉ, Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠΉ ΡΠ°ΠΊΡΠΎΡ ΠΏΡΠΈΠΎΠ±ΡΠ΅ΡΠ°Π΅Ρ ΠΏΠ΅ΡΠ²ΠΎΡΡΠ΅ΠΏΠ΅Π½Π½ΡΡ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΡ Π΄Π»Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ°ΠΊΡΠΈΠΊΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ. ΠΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ Π² Π°Π»Π³ΠΎΡΠΈΡΠΌ Π΄ΠΎΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΡΠ°Π½Π΅Π΅ Π½Π΅ ΡΡΠΈΡΡΠ²Π°Π΅ΠΌΡΡ
ΠΠ‘ΠΠ’-ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°ΡΡ Π°Π»Π³ΠΎΡΠΈΡΠΌ Π΄ΠΎΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ, ΡΡΠΎΡΠΌΠΈΡΠΎΠ²Π°ΡΡ ΠΈ Π²Π²Π΅ΡΡΠΈ ΠΏΠΎΠ½ΡΡΠΈΠ΅ ΠΎΠΏΠΎΡΠ½ΠΎΠ³ΠΎ ΠΠ‘ΠΠ’-ΡΡΠ°ΡΡΡΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Ρ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ Π’ΠΠΠ
ΠΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΏΠ΅ΡΠ΅Π³ΡΡΠ·ΠΊΠΈ ΠΏΡΠ°Π²ΡΡ ΠΊΠ°ΠΌΠ΅Ρ ΡΠ΅ΡΠ΄ΡΠ° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΠ΅ΠΉ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΠ’-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ
The study group included 147 patients at the stage of preparation for emergency surgical treatment of acute massive PE in the period from March 2012 to December 2019 inclusive. As CT indicators of overload of the right chambers of the heart, the usual CT indicators that do not require the use of expert β class computed tomographs were taken β they were the superior vena cava, inferior vena cava, unpaired vein; reflux of the contrast drug into the inferior vena cava; reflux of the contrast drug into the hepatic veins. In the course of the study, a comparative analysis of the average pressure in the pulmonary artery with the above CT indicators was performed. The most stable statistical relationship with the indicators of mean pressure in the pulmonary artery was demonstrated by CT parameters β the diameter of the unpaired vein and the reflux of the contrast agent into the hepatic veins. Based on the results of the work, a method for calculating the actual values of the average pressure in the pulmonary artery based on the CT parameter of the diameter of the unpaired vein is proposed.Π Π³ΡΡΠΏΠΏΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π²ΠΎΡΠ»ΠΎ 147 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π½Π° ΡΡΠ°ΠΏΠ΅ ΠΏΠΎΠ΄Π³ΠΎΡΠΎΠ²ΠΊΠΈ ΠΊ ΡΠΊΡΡΡΠ΅Π½Π½ΠΎΠΌΡ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌΡ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΡΡΡΠΎΠΉ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ (Π’ΠΠΠ) Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ ΠΌΠ°ΡΡΠ° 2012 Π³. ΠΏΠΎ Π΄Π΅ΠΊΠ°Π±ΡΡ 2019 Π³. Π²ΠΊΠ»ΡΡΠΈΡΠ΅Π»ΡΠ½ΠΎ. Π ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΠ’-ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΏΠ΅ΡΠ΅Π³ΡΡΠ·ΠΊΠΈ ΠΏΡΠ°Π²ΡΡ
ΠΊΠ°ΠΌΠ΅Ρ ΡΠ΅ΡΠ΄ΡΠ° Π²Π·ΡΡΡ ΠΎΠ±ΡΡΠ½ΡΠ΅ ΠΠ’-ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ, Π½Π΅ ΡΡΠ΅Π±ΡΡΡΠΈΠ΅ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½ΡΡ
ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΎΠ² ΡΠΊΡΠΏΠ΅ΡΡΠ½ΠΎΠ³ΠΎ ΠΊΠ»Π°ΡΡΠ°, ΠΈΠΌΠΈ ΡΡΠ°Π»ΠΈ Π²Π΅ΡΡ
Π½ΡΡ ΠΏΠΎΠ»Π°Ρ Π²Π΅Π½Π°, Π½ΠΈΠΆΠ½ΡΡ ΠΏΠΎΠ»Π°Ρ Π²Π΅Π½Π°, Π½Π΅ΠΏΠ°ΡΠ½Π°Ρ Π²Π΅Π½Π°; ΡΠ΅ΡΠ»ΡΠΊΡ ΠΊΠΎΠ½ΡΡΠ°ΡΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° Π² Π½ΠΈΠΆΠ½ΡΡ ΠΏΠΎΠ»ΡΡ Π²Π΅Π½Ρ; ΡΠ΅ΡΠ»ΡΠΊΡ ΠΊΠΎΠ½ΡΡΠ°ΡΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° Π² ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΡΠ΅ Π²Π΅Π½Ρ. Π Ρ
ΠΎΠ΄Π΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ Ρ Π²ΡΡΠ΅ΡΠΊΠ°Π·Π°Π½Π½ΡΠΌΠΈ ΠΠ’-ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌΠΈ. ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΡΡΠΎΠΉΡΠΈΠ²ΡΡ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΡΡ Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·Ρ Ρ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌΠΈ ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π»ΠΈ ΠΠ’-ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΡ β Π΄ΠΈΠ°ΠΌΠ΅ΡΡ Π½Π΅ΠΏΠ°ΡΠ½ΠΎΠΉ Π²Π΅Π½Ρ ΠΈ ΡΠ΅ΡΠ»ΡΠΊΡ ΠΊΠΎΠ½ΡΡΠ°ΡΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° Π² ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΡΠ΅ Π²Π΅Π½Ρ. ΠΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌ ΡΠ°Π±ΠΎΡΡ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Π° ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ° ΡΠ°ΡΡΠ΅ΡΠ° ΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π·Π½Π°ΡΠ΅Π½ΠΈΠΉ ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΠΠ’-ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠ° βΠ΄ΠΈΠ°ΠΌΠ΅ΡΡ Π½Π΅ΠΏΠ°ΡΠ½ΠΎΠΉ Π²Π΅Π½Ρβ
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