MakKormik_-_Bazovy_kurs_anesteziologa_2010


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Update in Anaesthesia,
Department of
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World Federation of Societies of Anaesthesiologists
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SPON
ORED
Y:
World Federation of Societies of Anaesthesiologists, 21 Portland Place, London, W1B 1PY, United Kingdom.
Tel: (+44) 20 7631 8880. Fax: (+44) 20 7631 8882. E-mail: wfsahg@anaesthesiologists.org
CORRE
PONDEN
E TO ED
TOR:
Dr. B. McCormick, Anaesthetics Department, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
E-mail: Bruce.McCormick@rdeft.nhs.uk
DISC
MER
World Anaesthesia takes all reasonable care to ensure that the information contained in Update is accurate. We cannot be held respon-
sible for any errors or omissions and take no responsibility for the consequences of error or for any loss or damage which may arise from
reliance on information contained.
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. . , . . \r, –. . \b, …. . …

\r
\f \r\n \t\b
Basic Sciences
   -  
­€ ‚ƒƒ
­€  „ƒ€
­€ ƒƒ ‚ƒ
ƒ ‚ ƒƒ
… ‚‚   ƒ
ƒƒ€ ƒ€ ƒ:   ƒƒ  
­€  † €
  ‚  ƒƒ, ƒ  ‚ƒ
­€ ‡‚  
­€ ‚
­€ 
­€ 
­‚ €, €ƒ   ˆ

\b


\r
\f \r\n \t\b
Basic Sciences
\n\n\t\b\n \b\b\r\b„
\n\n…\t-\b \b\n†
‚…\t \f…
E-mail: James.Rogers@nbt.nhs.uk
James Rogers
Consultant Anaesthetist,
Frenchay Hospital
Bristol BS16 1LE, UK
\n,  \r   
  ƒ\r€\t \b\r, -
\t  \r (  / SA) \b\r — -
\r \r-\r\t , \r‡-
  \r  \t \r\t \n
  . „ \r \n
 \t \r,  \b-
 \r\b , \b €
.  \r  \t
\b\r ‡  \b\r-
 ( / AV) \b\r, \r‡  ‡-
\t \f  \n, \t
 \b .  \b €\r
 \n–
, € \n-
  ƒ\r€\f \b\r 
\t  \r\t ‡
 \n
, € \n\n-
 € \b \r-
  ‡\r\b€, \b \r\r-
 0,2 \b\n \r  \b\r
 \r \b\r. \r -
    \n‚
 \b\r€\f \r, €,
  €,     €
\t  ‡\b \b \r — -
  .  \r \t -
 \r €\r \r‚, €
 \r\b€  \r \r\t \n‚\n.  ƒ
 \r   € \b‡-
  \b\r\n (\n\t ).
 ()
„\r\f \f\b -
 ‡\n \r, 
   ƒ\r€ \n, -
  . \b
\b
\r \t, \r
QRS

\r ‡\r\b€, \b
— -
\r ‡\r\b€.
 
— ƒ
ƒ\r\r\f€\t  -
\r ƒ\r€\f \r \n,
\n\t   \b \r
\t  \b € (\r
). • „ \r  €\b
  €\n \t,  ‡ ‡
\b\n  ‡ ,  
   \r\t -
 . …\r\n \r\n \f\b

€-\b  \r€ 
   \b\n, \b \b\f -
\f  \r\f€\f . 
  € \r\n\t, \r\f€\t \b\f,
\f   \r \b\r \f-
,  \r‚\t — \n\t \b\f, -
€\t \b   \n
\r  \f     -
\r€ . \r  
˜  \r\b \f-
\t \t \t,  \f\b 
 \b\f€\t ,    .
  \r\f €-\b\t
\n \f \r€\r ‡\b \r
\r \b\f \r\f  \r
\r\f \t .

   €\n   -
\r  \b  \r\b €, ‡ 
\n \r€   ‡\r\b€.
  \f \r \b \r -
\t  , \r \t -
\t \b\t, € \r ‡-
\r\b€. ™\r\b€  € \t \n\t
\r\t  €
   \b  \r\f€-
\b \b\f . ‹\n\t ‡\r\b-
€  €\b \b   -
\r, €\r  \r 
 ‡\r\b€, ƒ\b \f  \r.
Ž\n \r € -
\r\n\t    \t  ‡\r\b€-
 (€\n\t  \r\n\t \r\n)
 \r   (\r\n \r\f€\f \r
 \n). ­   \n‚€\n \r-
, \n  \b , 
‡ \r-\r\t  (\t\t\n)
 \t \n,  \r-
\b \b.




   \r-
    
\r€\n  (\r), €
‡  -
\r \t. •  ‡ \n
\b \f\r\n\f
\n   \r-
  \r-
 \b
-
\t  
\r   
. \n -
   -
   \r-
 \t
\b \t.
\b \b­€
World Federation of Societies of Anaesthesiologists
WFSA
\n \n\r\n  „ ‡  \b €\f
\n — ƒ    
\b
\b\t  \b  \t\b
( „,
pulseless
electrical activity
— PEA
,  \r  ƒ\f -
 \r\r  «ƒ\r€ -
». —
. 

‚
‚
€\n\t \n ( ) — ƒ  €\n
€\n \t (Ž )  \b\f ˜ ():
 =  × .
\r \b‡€\n  70 \f  \r\n €-
 Ž (š70 \b/)   (š70 \r) €\n\t \n
\r \r 5 \r/.
\f \f\b
— ƒ ,
\n\t  \r  \r ( 
). „ -
\r \r 2,5›4,0 \r//
Ž €\n \t (Ž ) \r
€\t \t \r \r -
\r\f \b\r (. \r\b\b )  ‡ -
     \f\t \t
\n. \r\b‡\t , \t\b € \b-
\n \n, ‡ Ž , \f  €
\n € \b\r\b -\f€
\n  \n‚ Ž .
\f   
\r  \r€\n
 — \f\b\t, \f\b\t  -
.
­\f  —
ƒ ˜ ‡\r\b€   -
\r\n (\r €-\r€\t ˜ — ).
\r€ \f\b   \n‚ .
 \f\b, \f\r\n ,   
\t ,  \n\t \r \r‡ \r,
\b\f\b \r, ˜ \b\r\b\t 
 \b \n \b. ‚ ‡\b  ‡-
\r\b€  \b\n ˜   
« \r\f»
(Starling)
, \n\t \f , €
ƒ\f  \n‚\n \r 
\t \r \n‚€\f \r, € \f€ -
\r  \b 1    \n \r\f.
   \b\r€   \r\t‚\f ‡
\n‚€\f \r € \b\r€ ƒ\f -
  \b\f ˜  € ‡,
\r \b, \b\n\t ˜ € ‡-
, , , ƒ   \r\b€ €\t
€.   \t Ž €\n\t \n-
 \b ‡ \n‚ \r ‡ \r-
\r\r \b\b ˜\b. \n \b -
\b \b   \r€\n \b
\r\t  —  \f  
\b\r\t \f\f ‚.  \r \r\b€ -
‡    € \r\b -
\b \t. … \b 1 ‡ \r 
\t \r \n‚\f \b €\t \f\b,
\b\t \b\f  .
­\b  —
ƒ \r, \n
\f   ‡\r\b€.    -
\r \r \f\b  \r\n\t ‡\r\b€ -
\b \r \b   \r‚
\b\f ,  \n 
\b \b\b\f\b \b\t
( ,
systemic
vascu
lar resistance — SVR
). \r \r
 \r  \r\r\n  —
€ ‚ \b,  \n‚ \r. 
\b \r \r\b €-
\t \t \t,  \f\b\r\b \b \f\r-
\t \b\b\r\b\n  \r , ,
 . \r   //
 \n \r\f ( \r€\n \b -
\f\b),   \b 2, \b -
‡ ,     \f\b.
 ‡\b \n \b\n \r 
\f\b\r\t \r\f \r  ‡.
 \b
\b  -
   \t -  \f\b.
\b\f \r, ƒ \r («») €\t
\n‚\n. …\r € \r  
 1.
‰ Š
(Starling)
‹

… \r   \r 
\t - Œ\t … (\r) -
 .  \t,  \r \t\t ‹‚ \r
\t \r… \t  .   \r…
 (

)     \r… \t,
 ‹‚   ,  \t…  \r 
  \r  Œ\t\t
 2.
\n\t  Œ\t  \r
Š  \t   \r 
 Œ\t.   \t  \r  Œ\t  \t-
,   ‹‚ (\r)   \t

\r
\f \r\n \t\b
Basic Sciences
\n €  . \b\r
-



 \r, \n‡-
  \n €\t,   \b -
. ‡\t ƒ \n\n \b\r\b\t
\r,   (ƒ, \f),  ‡
\n Ca
. , ‚ , -\r\n
 € \n ‡ .
€\n\t \n   
\r€  \f. \n 
‡\r\b€ \r‡ \n €\n  
\b \b.  ‡  ‡\b
  \n  ‡ \n   -
 €\t \f\b.  \r 
\t\t \f\b \n‚   \r \b-
, € ‡ \b\r€   -
\b\r\b \n\t  — \f\b\b  \n\t
‡\r\b€.  \r, \r‚   
\r\b ‡\r\b€\b  €\n\t \n .   -
€\t \f\b \r \n‚ \b -
€\t \t \n,  ‡ \b\r€ Ž
 €\f \n, \f \r €
\r€ \t \t.



‚ƒ


 ‡  ‡  \b
-\r \n \r \f\r\n \t\t.
\n\t   (\t  «\b-
\t ») ‡ \n   \t
\n \b\r \r \b\r\b , -
  \r.  € \n‚€\n \r, -
\n \r \t \b\n \r,
\r    \t \b\r\t :
‡ \r  \r   -
   \f\b\r\t €\t. „ ˜-
 , € ƒ\r€ \t  \r€\t
\n €  —  \f\b-
\r «\r\b». \r \r
\t  \b‚ \r\t \r€\n -
\r\f  \r€\t \n  \r\b\t
\f \t (  ), € ‡
\n‚€\n  \r ‡ -
\f \b\r. ­\n‚€\n \r \r€\n \b€
 \r€  € \t \r-
: \r‡\n  ‡\r\b€ \r -
‚\t €\t \t \r,   -
 — \r‚\t.
   €-
  € \f, € \r  \r‚\t €\t
\r \b\r  \t \r\n.  
ƒ \r,  €\b €\n \t,
\b \r\n\t \b\r — €\n\t \t\t-
  ( \f\r.
pace
› , , ‚\f 
make

. —
. 
), \t  
. \r \r\f \b\r -
   \r\n ƒ\r€\t -
  , € \r€  \t  .
 ƒ\r€\t \f\r  € -
\b\r\n\t \b\r  \r  ‡\r\b€ — € -
\r  \b, \b \b€ . „ 
‡  ‡\r\b€.  ‡
\t \n  ‡ \r  
 \b‡, €   
Ž . …,  ‡ \b\r\f
\b\r  \r  ‡\b 
 ‡\r\b€.  ƒ \r\b€ ‡\r\b€ \b\b -
  \t \t, \b\t  €\t,
€\r ‡, € \n€,  \r, 30›50 
 \b\b.
 \n \r , , ,  \f-
\r, \f\b \r €\b \r -
\r\f \b\r,  ƒ \r €\f ƒ\t\t
 ‡    \b\r\n\t \b\r.
„ \b‚   «\b\r\t ». Ž
\n €\n \t   \r-
 \f\t \t \n. €
 \t €  €-
 \n \r,  \t \f
 \b €\n  \f\b\n  (
).
\b\r  œ
- 
€  \b€,   \b\r€ \r\n -
€\n \t.
\r\b‡\t 
(n. vagus)
\b€\b  
\t,  ƒ \f \b\r \r€  \t
‡ Ž (). •\b\f€ ‚-
\r \f\b ‡ \b\r\t \r\b‡-
\f    \n‡\t . 
€,  ƒ\b \r‡ \f\b  
\b\r,  ‡ \n‡\t ‚, \r-
 \r\f \r \r ‡ \n‚ \f\r. 
\r\n \b\r ƒ \r\b‡\f  (-
€  )   \r-
\b. „  \n   \r, -
\r€ \r \t Ž  .
Ž €\n \t   
\n \r.   \t  \n -
 € \n (\b  \f\b) -
\n \r, €  ‡.   -
\r‡\n \n \n\f \r.   \n‚
  \b \r \r €-
\f , \r\f €\b \f ‡ €-
\f \n  \r. \b\f\t \n,  ‡-
 \r Ž \n‚, €,  €, ‡
\r   ‚. ‰\b\r ‡
\n € \r\f  .
  ‡ \t, € ‡ \r 
 €\t € \r \f\b ‡-
, \r \r \n‚ Ž , €
 \r \f, €\n  \r  \n-
 \b\t .  ‡ \r-
     \r €\f -
. „ , \n\t 
€\b \f‚
(Bainbridge)
, ‡ ˜ \n‡\b -
, \b \f   \r\t -
.  ƒ\t \b ‡ Ž ‡ \n \b-
 ˜ \f, €   \b \f .
Š\r ƒ    \r\f \b\r, -
\b  , \b\r€ Ž ,
, ƒ \r \r.
World Federation of Societies of Anaesthesiologists
WFSA
”\b\r\b  ‡ \r  Ž .
 \r, , , 
\r, \n‚  , €   \b\r-
€ Ž . ‹\n \n \r 
\t €\t €\t, \b\t   Ž ,
 €, ƒ   \r‚\b -
. \r \n \r  \r\n\t
\b\r,  ‡ \r \r\b €\n \t.
…, \r  \n\n \r €\f ƒ-
,  \n\n \r € \b.
ˆ  ƒ ‡  \b -
‡ \r\t \t, € 
\n \n‚ .   \b\r  -
, \n‚\t 1 ­, \r  -
\r \f\b \n‚ €\b . 
€ ƒ\f ‡  \b\r€ Ž , €\f 
\r\b€  \r \r. 
‡ \n\n €\b \b\r, € -
‡  .  \t\b
  \f\t \t \n 
\f\b \n \r  Ž . …, \n‚-
  CO
     -
€\f   , € ‡ \r\b‡
‡\n  \n\r\t €.




\b\n \f  \r-
  , \r\n, \r\r\n  \n. 
\r   \f  \n \r-
. \r\n — \b\n ‚\f \r  \n‚€-
\t \t, \r\t \f\b\r \f\n\t
  \r  \r\r \t.
\r\r\n   \f \r ƒ\r\r\n \r-
. †   €  
‡\b   . \n   
\r\r\n \t  \b.   \r\f
70% \t \b\r\b\t , \f   -
\r\n \b  \f 15% . \n ‡
\f \r \b —  \b  ‡ €-
  ‡ \f    \b,
,  €, \f € -
\b\r \n\n \b .


‚ ‡\b    \b-
\n (‡\b) \r \n
 \t
ƒ  —­ 
.   \f \b\r   
\b (Q) \r \r\b :
 \n \b   \n\t, 
\b\r\b\t   \b   
 . “ ,  -
\b\r  ‡  \n ƒ , 
 \r\r\b ‡\n\t  — \r‚ -
  \b \b   \n‡\n -
  .   \r,   
\r\r    
 €  \b \b,  €,  \f \b.
 — ƒ \t ‡ \n -
\r \b.   \t  
ƒ\n \r , \n‚ , 
   \b. “ , €
 (\b   \f\r\f \b) -
\b ‚ € \f. „
    « \r\n»
skimming

.
« \r». —
. 
).
 ‡  , € \n€ -
‡ \n‚ , \b -
\b \r  .





   \r\r \r -
\b \r,  \n\t \r ‡ -
, \r€ \f\b \f\b\r, \b\r\b
\f\n, ƒ\r\t-\n \n  \r\r\b
 \r.
\f \f\b\r   \b\r-
 €\t \t \t, \b\t
 \b\n,  \r\r. € \r
\b €\r  \f\b  € \r \f
\f  \r\b \n  -
\r\f\f \f, \n\t  € \f€\n
\n  \r\n \n. \n\t
 € \n\t €\t \b,
\r\t ‡ \b\n  \r\f -
 . …  \b -
\t €\t , \b\r 
 \t\b  \r€\n \b\n
\t\n (\b 3),   \r
  ‡, \n‚  ‚€  \f\b, \b 
€. €\t \b \n‚  \f-
\r, ,   ‡\r\f €, €
 3.
\n \t \t\r  -
\t    \r
  \t  \t\r \t \r 
  … ( \b \r…   \r)
\f\t‚„ \f \t ×  \f\b
\f × \t\b

\r
\f \r\n \t\b
Basic Sciences
\r  ‡   ‡ ‡-
\n \f. \t ƒ €\t \t
\n — , \r\b € \r-
\n.     ‡ \n 
\r\b\t ƒ  \b\r
œ-  \rƒ\f€ , 
ƒ ƒ \f€ \b\n \b\r \r\n
\n‚.  \n‚ \n‚€\f  — ‡\n\t
   (« \r \f») 
‡ €\t \f\b.
”\b\r\b \f\n,   \r 
\f-II, \r \n -
,  ,  \f,  \n €\f \r-
  €-\b\b \b  \t \b-
. …, ƒ\r\t-\n \n \f
‡\b \r  \f\b\r \f\f . „
 \r \b \b ƒ\r
\b, \r   . …, -
\r    (NO) \r \n -
\r.
 \f, \r   \r
,  K
 …
,   \r \n\n -
\r. „  \r ‡\n  -

\b
, , \f  \f\b\r-
\b   \b \r ‡ \t
\b \t  ‚ \f \b\f
\r.  €, \b\f\b\r \r ‡\t
 \f\f  €€\f .





 \r \r \r -
\r\b \r ‡ \t \b
\t.     \b\r\b\t -
 ,  \r \r (
ˆŠ.
\r\b€‚  \b \b -
\r \f\f .  \r\r €
ˆŠ.
‡ \n € \r\b :
†.
= …
‡…ˆ.
+ …
­‰Š.
/ 3,


ˆŠ.
—  \r \r; 
† “.
— -
\r€ \r; 
 ‹ž .
— \b\r \r (
‡\b \r€  \r€ ).
  \r \n  €\f
\n  \f \b\f \r (-
\f €\f \r \b)  ‡
  \r\f    (V = I × R):
†.
~  × ,


ˆŠ.
—  \r \r;  — €\n\t
\n; —  \b \r.
‡ , ,  \b‚ -
\f    \f\r, \b ‡
\b‚ \f . €  ‡ -
‡   \f   €
 \r. „  
 — \r\n -
 \r, \r‡\n   \b 
\b\f \n, \n  \n  -
\r \f. ‡ \r   \r\r -
\b\r   \b‚ 
\f\r, \b  \b \b. 
 €, ƒ   \n‚ €\f
\b, , \n‚ Ž  -
 (\r‡\r\n \n\t  \n\t
ƒ\n),  ‡   \r.
…, \n‚ \r\f \r -
\b\r\b \n,   \b\r -
€\t \b\r   \r\b‡\f
, € \n\n \r Ž  ‡ -
. €\t \b ‡ ‡, €
\r€  \t \r € \b.
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\n — \b\r  \f-II  \r-
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\r\b  ‡ \r€\f . 
      \b\r \r
‡.






  \n  \r
\t  .   ‡ \r-
\t  , \f   ‡ \b\f-
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\n.  \b\r, \r ‡ €-
\f \n   \r, € ‡-
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\b\f\t \n,  \n,   
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\b\b ‡,    -
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„ ‡    \b\r\n ,
\f \r \r  \n\r \b-
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„). ­\n  \r  -
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€ \r, ,  \r€ ‡\r\b-
€\n \t \r.  \n \n
\n  \f\b \n \b , 
  € ‡ \f \r\b€\t\f \b\f
  ƒ\t \f\b\n (\b!).
World Federation of Societies of Anaesthesiologists
WFSA
 1.
‹ \b, \r   \r  \t\t
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-\n,  \r\f \r 

   †‹ ‡ \n\n -
 €-\b\t \n. ‡ ˆ 
€  \r   †‹, \b \n\n-
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 €, ‡  \f \b-
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\b  €\b\r\n  \f\r\n \n -
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‡ €,   \r \r 
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†\b  € \n \r-
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\f, \n \f\b \n \r\n, € ‡-
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‡\n   \r\b‡ €\t \r\t‚\f
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  † ‡  \b\b\f\b ‚ -
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\n \r \n‚  \r  \f
\r . „ \r   
, \r\n  \r 1.

\r
\f \r\n \t\b
Basic Sciences
A. M. Campbell
Clinical Fellow in
Cardiothoracic
Anaesthesia,
The Heart Hospital,
University College
Hospitals
London W1G 8PH, UK
J. A. Hulf
Consultant Cardiothoracic
\n \t
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… \t \b-
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E-mail: Bruce.McCormick@rdeft.nhs.uk


‚ 



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\n  \r \t ‡\b
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 (š 250 ) €\r \r\r, €  
\r \t \r \r\t \n‚€\t -
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†‡\r†ˆ \b‰\f (\r‡Š\b\t 1)
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\r\n \r\n, €   € \n\b
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‡\f  —  \b \r; \f  — -
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World Federation of Societies of Anaesthesiologists
WFSA
 4 — \r\f \r
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\r .
\f  \f†ˆ \b‰\f (\r‡Š\b\t 2)
• \r \r \t\t (\r-
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\r\n \r \r \t\t.
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-\n, \r \b 4 \r \r\f\t, \r\b
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, \f \r \f ‡
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 ‡\r\b€  \r‚ \n\f \f
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  \r\r, \b \r \f
\r.  \r€  \r\t \b\b\r\b\n, 
  \n \b; ‡  -
‡  \r‡ € .

‚

€\n\t \r \b ‚ ‡\b
ƒ\r€\t, €\t (\r  ˜)  \r-
\t \r \r   €
\f \r\f €\f  (\b 3).
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(\r\n€€ ‡‡\b \n)
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\n\n  \r. … „ ƒ\b \b -
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\r  ‡\r\b€ \n \r  -
, \n \r (\n\t  ). „ -
 \b \b \b   .
\r  ‡\r\b€ €\r \n‚, 
 3.
Š  
Guyton AC. Textbook of Medical Physiology, 8
edition
© 1991. Š  Elsevier
 2.
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 )

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Basic Sciences
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™\r\b€ \r\r, \r   
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   ‡\r\b€ \r\r\n,  \r 
‡\r\b€ \r  \b\r. \b\r\n \r-
\n \n\n, \r\b\r\b\n \r\n \n\n. 
€  \b\n     ‡\r\b€ ( -
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(…)
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()
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()
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 4.
  –Œ\t \r \t
Œ\t    \t … \r 
\t  (  -
   \r)
Smith JJ, Kampine JP
et al.
Circulatory Physiology — The Essentials 3
rd
edition.
Š  Lippincott, Williams & Wilkins
World Federation of Societies of Anaesthesiologists
WFSA
\r.  ‡ ‡\r\b€ ‡
  \r, € ‡ \b\n  -
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 \r‚\t  \n \r \r, €
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\f\b\r \n\t  (\b\f\b\r)
  \b\f \r 50›150  . .
  \n  \r\n ƒ\f  \n\t
 5.
\n \t  \r …-
,  … \b, \t \r 
,   –Œ\t
Aaronson PI, Ward PT. The Cardiovascular system at a glance, 1
edition.
Š  Blackwell Publishing Ltd.
 6.
‡\t  

\r
\f \r\n \t\b
Basic Sciences
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( \b\f\b\r). ‰ \b\f\b\r \b-
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\f .
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 \r \r \b \r \f\b \n-
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, 
\r  \f\r\n.  \r\n \b\r ˜-
  \r \b\r\r \b (-
\r) \n \t, \b  
  \r€ .
\fˆ\r\b­\f†\f ‹\n\t\b\r†
\n \r\n ‡ Ÿ
-

\f
€
 \n, \n  , 
-\f€ \n, \b -
\r.  \r \b\r \f  
 €\t \b\r  \r-
 \r€      -
\b\r\t œ
-.  ƒ\r\n \b\r-
 \n\r , €  \r \n 
\n ƒ €\t 
  \r\n œ
-\r ( ‡-
 \r€\f )  \r 
\r \n\n  \b -
. “ , \n\t ƒ
€\t \b\r,  \f, \r€
 , ‡\r \r \n \b,
€   € € \r€
\f\b\r\n .



—



Guyton AC. Textbook of Medical Physiology, 10
edition. Philadelphia.
WB Saunders Company.
Smith JJ, Kampine JP
2.
et al.
Circulatory Physiology — The Essentials 3
edition. Baltimore. Williams and Wilkins.
Berne RM, Levy MN. Cardiovascular Physiology, 8
edition, Missouri.
Mosby.
Levick JP. An Introduction to Cardiovascular Physiology, Oxford.
4.
Butterworth-Heinemann Ltd.
World Federation of Societies of Anaesthesiologists
WFSA
‚\b\b\r\b
†‡\f\t\b
*E-mail: coolfred@btinternet.com

 \b \r\f — €-
 \n\f \f ‡\b \n-
\n \b  , \b\r\b\t
 \r\f.   ƒ € \b-
\r \r  \b\r \b\f\r\r\n\t
\f, \n\t  \f  \n.
™ \f €-
 \r  ƒ ƒ\f
   \b\r \r,    \r-
\f\n \b\r ‚\t \n.  -
 ƒ\r \r  \r‡\n
  \n,  ƒ
\f   \f\b \n \r\n  \b
 \b\r .   \r\f
\n — \r€\r ‡ \b\r
    .
ƒ ‚ƒ
\r   \f  \f-
 \r\t.    \n
\n\n\t \b   \n\r-
\n \b  €  \b\f
\r  \r\r ( ›5  H
O  -
 ),  ƒ  \b\r€-
  \f\b\t \r  € -
 \n‚ .   \n \r 
\r\r \r\f   
\f \b\r  \b ‚\t -
\n.
Š Ž\b\b\r\bˆ \f\r‰\n˜
\t \n‚\t, \f\b\t -
\r \b\f\b \r , -
, , \r \f. 
\r \t \n‚€-\b‡\r\b
\f\b ‡\b ‚\t  \f\b\t -
\r. \f  €\b
\n‚€\b €,  \r 
  €\n ,  \b‡\r-
\n\t . †\b \f\r\n
 (C
3›5
).    \b
   ‡ ‚\t \r-
   . \r  \b\r-
 \b‡\n ‡\n \n‚
(\b \n ‡\n-
  T
1›12
)  \f\r\t \n-
\r\t \b\b\r\b\t (\f\b-\r€€-
  \r€ \n‚\n). €,
\f\r\n \n‚\n \f €\b
\r \r‚  €\t \f\b \r \n-
\r\n \b‚.
  \t \n \n — -
\n\t , \n\t  ƒ\r€\t
€ \r\f   \f\b\t \r.  
\b\r \r, ,   -
€\t \f\b, \n  -
\n  €  \n‚ ‚\t -
  \b ‡\n \n‚. „ ‡
\f\b\n \n‚ \b€\b   \b‡-
 ( \r\r\n).
\f\r\n ™\n€ \r\f­Š €˜€ †–\n€
­ \f\b\r \n \r‡. 
\f  \r‡ \r \f\b\n \n-
\r\n  \r \f\r\f \f, -
€   \t \n-
\r\t . ˆ\f\b\r  
  \b\r  \t
\f\r, \b  .
„ \b \f\b\r ‡ \n \r
\r \b\r, \b 
\n \f\r\f \f.   \f \r-
 \f\b \n \b\r €\t \n-
,   .
\t \n\r\n\t  \r-
\f   €\f ‡\r\b€  -
  \b \f\b \t: \n
(\r)  ƒ\n (\r).
…\t\n  \f\b \b\r -
€,  ƒ\n \r  
\r   \n.  €
‡\n \r\n  
  : \t\n\t (\b\r ) 
€\t  (\f€.
pneumon

\r\f,
taxis
— \t, . —
. -

), \n\t  \b \r
\r\t \f\b\n \t.
ƒ
, \f\b\r\b 
\n, \r\f   , 
 \r.   \f\b\r \b\r-
 \r\n  \r\f-
\f \f, €\b\r\n  -
    \r.   €
Fred Roberts
Consultant Anaesthetist,
Royal Devon and Exeter
NHS Foundation Trust
Barrack Road
Exeter EX2 5DW, UK
Ian Kestin
Consultant Anaesthetist,
Derriford Hospital
Derriford Road
Crownhill PL6 8DH, UK
\n \t
ˆ  
…  -
 \r \b-
 \t .
  \t… \r-
 \r\t, -
 \t \b-
   \t
  \r \r-
 .
Š  -
   -
\t  
 \t… \t,
  -
  \r -
 .  
\r \r\t-
 \r  
, \r\t, \t
…,  -
  -
…, \r\t
\t \t, \t-
 \r -
\r  \t
\r\t  \t
  … 
.
 \f*, € ‹
\b \b­€

\r
\f \r\n \t\b
Basic Sciences
 H
(pH) \b \r \r-
\n \r CO
, \n\t   €
\fƒ\r€\t   \r\t  (
\r\b ‡  \f. —
. -

). „  \r€ \n\t \t
 \n€\b\r ‡  \r\n  PCO
\r\t  (PaCO
).  \f, \b\b
€ \n, \n \r\f-
   \b  \r\n \r. \r‚
€ ƒ € \t €\b\r
 ‡ \r\f \r O
,  -
\n ‡ \f\b   PaCO
. \n‡
\f,  \t O
-\n € 
\b, \r \n   \r\n €\t.
 ƒ   \r‚  ‡\r\t \f-
 — ‡ PaO
60  . . (8  ), -
,  \n \b‡ \b  \r-
‚\t \n (. ‡ \n \b\r). „ \r
‡   \b‚  -
\t PaCO
, € ‡    €\t \f-
, ‡\t \b\r 
\r\n  (€ \f-
 ‡ \r  \r  -
\r\t ‡   — HCO


‚ƒ
†–\n\f ™†\f \b“š\fŽ†
\r  ƒ\b (‡\t) \r\f  -
     \n \r\b
\r€\n \n, \r\n  \b 1.
\n\r\n\t ˜ (500 \r), \b‡\n\t  €-
\b \n\t  \b\b (14 \n\t  \b\b),  -
\b\n\t ˜ \n (7000 \r/):

V
— \b\n\t ˜ \r
(exhaled volume)
; f — €-
 \n; V
— \n\r\n\t ˜
(tidal volume)
…  \n\r\n\t ˜ \b€\b  \f-
, \r\b ƒ  ‡ \t \r‚
\f \n\n\t \f \f \n\r\n -
\r (17-\t  \r \r\f ).
ˆ\r‡\n \n‚ ƒ\f \b \n\r\n \b
\n\r \r‚ \b \b,  
 
«\n  
\n\n»
(V
). Š\f ˜ \r \r\r-
 2 \r/\f, € \r \r \r\f \r 150 \r,
   \b  \n\r\f ˜.
‚ € \n\r\f ˜, \r \b€-
\b  \f, \b‡  €\b \n-
, \r € ˜ \r\r\t -
\r (V
, \r\r 5000 \r/).
‰\b\r €  \r\f (‰Š)
\r \t  ˜ \b, \n\t -
  \r\f \r \t\f \n. ­, 
  , \r \b‚-
 \r\n \b \r ƒ\r€\f -
 \r\f  ‚\t \f \f\b\t \r-
,    \r \b \n‚.
‰\b\r €  ‡  \r-
‡  ,  ‡, , -
,     . \r \r\f -
\r ‰Š \r \n\t ,  \b 
\r\b €\n:
  ƒ ‰Š \r «\b»,  -
  \r, \b\t  ;
 ‡ ‰Š  \r \f
 \r\f, € ‡ \b‚ -
‚ \r  \r\f€\t \b;
\r ‰Š ‡ ‡ \r\f €
(« \n»),   (\n-
) \n\r\n \b\t, €   ‚\b.
\bŒ\r\b‰ \f\f  Œ\b \n ‰\b‡™
  \b \n\r\n \b\r\t ˜ \r\f
 \n ‰Š. Ž\n \b  ƒ\t €-
,  € \n\r ‡.  ƒ
\r\b€    \b \r, -
 ‡ \r\f    \b: -
\r \n\r\n \b\t  \r (-
\r\t) \r\f  \f\b\t \r.
„\n
\n\r\n \b\t \b
 \b \b  \n\r-
\n \b. …\r‚ € \r -
 \n\r\n \b \r‚\f \r (
6›7-\f )  \r  \n\f \f
\r, \f  \b\r \b-
\f  \b\b \r\f  \n.  \n‚
\r \r \b‡ \n\r\n \b-
\t, ,  ,   
\b\n \r\t \r\f.   \b
\n\r\n \b\t ‡ ‡, € \f ‡
\b\r\b€‚  \r\b€ \b\r€ \n\r\f \b\r
(\n‚ \f \r\t). “ \b‡
\n€ \n \n  ‚ , -
   \n \n\t ƒ ‡  \r-
.   \n‚ \b\r\r\f \r
 1.
’ Œ\t  \t…: \r
\t \r 
 (RV) —  Œ\t
(residual volume)
\f (IRV) —  Œ\t 
(inspiratory reserve volume)
\f (ERV) —  Œ\t 
(expiratory reserve volume)
ƒ’ (TLC) —  \t 
(total lung capacity)
ƒ (FRC) — \b  \t
(functional residual capacity)
‚ (VT) —  Œ\t/Œ\t 
(tidal volume)
“ƒ’ (VC) — … \t 
(vital capacity)
World Federation of Societies of Anaesthesiologists
WFSA
  \n \r‡\t‚  \r\r \n\r\n
\b \f\b , € \b\b\f\b\r \b, 
\r \b\r€  ƒ\f  
\r\b‡ €\t  €\t \f-
\r («\b‚ \r\b‚»)  \r\n \n-
\r\n \b.
\r„\n
(\f\r.
compliance
— \r) -
\b ‡ (  \b\r).
 \f € ƒ\f \r  \r
 \r  \r\f,   \f\b\t \r.
, \r   -
‚ \n ˜   \r (V/P) —
\n€  \r /  . .    \r\t \r\f
\r ‡,  \r \r \r\r \b
\r‚ \b\r.   \b\b‚ \r\t (-
 ‡ \n \r\f€\n\t )  -
\n \r \r\f. € \r\t -
    \n \r\f  \b \n‚ 
\b‚  ‡  \r\n \r \r\f. 
\f, \r  ˜ \r\f \n \r\t, 
ƒ € \r\t \b \n, -
 \r \r \t \r \r\f \r \f \r\f-
\f   \r \r\f \b (\b 2).
\r\t \b    €\r \r \r\f-
 (- \n, €\t  \n \r\r),
   \r \n ˜ (\r
\f\b\t \r   \r\n). …\r\b€‚, -
\r \n € \r\t \b‡
 ‡\b€\n \r\f€\n ˜.
\n“\b\n †–\n€
† \b \t,   \b  \f —
\r\t  \r \n\r\n \b\t, \r‚
\r \b \r \f \r -
‚ \n \r\t \n. \r
\b \f \b\b    ,  
\n,  ƒ , €  \f \r-
,   « \n»
(work of breathing,
WOB)
. \n‡   ‚ ƒ\f
\b    \r.
•  \r ƒ\r€ \r  -
\r \r\f ‡  ƒ\f,   -
 \r  \b \b \n, \r\b 
 ,    \r\b ƒ-
\f \b\t ƒ\r€\t \r\f€\t . …
€ \r\t ƒ\f \b \r  -
 \n \n  \r \r
\n\r\n \b\t   \n. …\r\b€‚ -
  \n ‡ \n \r  -
 \r «\r›˜» \r\f \n
\r\f \r (\b 3), \n\t \b, 
\n  \n \n \b   \n — ƒ
  
\b\b
.   \n-
   \n\r\n\t \r \b \r-
 \f\b\n, \f€\t \r\t.
  \n  \n\t €\t \b \r
\n  , € \n‚ \r\n .
„ \r \r   € -
\b\n \r\t, \f \n 
 \b \n  € \r \f
(\r\f) \n  \r \n \n\r
˜. …, \n  \n -
‡ \r\f (‡ \r\t)   -
 \n\r\f ˜ \n \f \r\f-
\t \t € \t \r\t,  ƒ,
\b‚ \b \n,    \n\b 
\b \n.
Š\r‹\n\t\n
  \r\t ‡ \r -
\n ‡,   \r
\r \r\b\r ‡  \b ‡-
. † ƒ ˜  \b\f\r-
\n \r ‡, \t  .
  ‡ \f ‡, 
\r \r \n\r, \r \b\r 
‡  \t \r\t.
 2.
‹ \r,  \t-
  \r    
  ƒ   \t    … -
  ( \r   ), , \t \t,
   \t, \t     , 
\r  …,  \r   \t\r
 3.
\f  \r \t\t
–Œ\t    

\r
\f \r\n \t\b
Basic Sciences
Š\r  ‡ €,   
   ‹\r \b  -
\r \r:
P = 2 × T / r,

ˆ — \r, T —  ‡, r — \b -
\n.  \r\b€  \b \n  ‡ (\b-
\n) ƒ \b \n\f\r  P = 4 × T / r. ( \r\r \r‚
 — \b  ‡  ‡ —
. 
 \r ‡, \n\r \r\r\b, ‡
  ‡, €   -
\n‚ \r  \r\r, €, € ‚
\r\r,  \n‚  \t \r. \b -
\r \t \r‡ \f ,
\n\n ƒ\r\r\n \r\r 2-\f
,  \r €\r  
‡ \r ‡ \n\r\t 
\r\r. \b, \t    -
\r (\r\r \r), \n \r\b-
 ‡\n ƒ\n:
‡ \b€ ‡  \r\f€\n \r\r
 \r\r\n, \r\b \r\n \f -
‡ \b\r€ \f \f€
\r\t  \r \r\r  \r\r;
\n‚ (\b\r\b€‚) \b\n\t \r\f€\t -
\r\t;
‡ \r \r\r ‚\f  
\b‚ \b € \f \r \b\n
«» ,  , \b‚  \r\r-
 \r\f€\t .
‹‹Š€ \t‡ \b\r\b \n
\b \r  \r\r\r\r\n
, € \n  \b\n\t -
 \f ‡\b \r\r\n   \r\f€-
\n , \f (50›100 
). ˆ
\r , € \f \b € \b
\r\r\r\r\b \b \r \t
ƒ\n\t  \n\n\t .    \r\f€-
\n \r\r     \r\r 
€ , \r\f  \b \r 0,75 \b-
\n. \r \r\f \b‚  O

\r\r   € \t  ƒ\f 
(0,25 .),  ƒ   \f
,
 \t \b\r \f. ‡  -
\r \r\f, ‡ \b‚ -
\b,  \b\r  ƒ\f   \n€-
 € \r \r\f \n  \r\f€\n
\r\r \r.   €\t -
\f\b, \f \n‚  \r\f€\f -
, ,   \f, .  ƒ
\b\r  ‡ \r\f \r\f \n
 \r  , ƒ\b 
   €\t \f\b \b
\f€.
 ‚ \b\f\r\r\f \f, \n\t  20  \n-
 \b\b € \r\r\r\r\b -
\b, \n‚\n \n  €\r ‚\t
 \r   \f    \r\r\n.
\f €˜€, Œ\f\r‹Š€  ›Š
 \r\t \r \r \r \f
\b€ \r\f\f \f\r \n \n €\t \r \b-
\r \r\f  \r  \b\f\r\r\n
\f  , \t  ƒ\b \b€\b.  -
\r\f€ \b\r   ,   \r
(V),  \b (Q)  \r\n  
\r\f,  ‚  \r \n, 
ƒ \r\n \r\n \r\f \r\b€ \r
\r‚\t ˜   \r  
 \b‚.
ˆ\r
€
 \r\f \f\r\n 
\r \r\t ‡. „ €, €  \r‡-
  \b \r  \r\n \r
\r\f \b  \b \f \r  \r\f€-
\t  (15  . ., \r 20  H
O)  \f-
€\f \r \r ‡, \n \f
\r \t  \b \r\f€\f \r
  \r\f\f ( 15  H
O).  \r\b€
 \b‚ \r\f, ,  € \r-
  \r\f€\t  \n€ \f€
 4.
\f\r  (V)  \r\b (Q) 
  \t 
 5.
\n    \r\b-
 ( V/Q)
\r\n‰\bŽ\b‘\b‡™ \r\n ˜\b\b­\b \b“š€‡\f€ Ž\f–\nŽ\n ‡\b\b\b-
›\f€ ‰\f €˜  Œ\f\r‹Š ‡ \f \n‰– Œ\b\r \b‡Œ\n\r‰\n\f‡€.
      ,  \t  \t 
 , \b \r… -
  \r\b \r   …  -
  \r    (\t \t,
   \r  ,  -
 \r\r \r  \r, \r -
  ,  . —
. 
26
World Federation of Societies of Anaesthesiologists
WFSA
\r,  \b\r €\f \b \r 
ƒ\t  \r\f \n \r€\r .
†\f \b \r  ƒ\t  ‡ ‡
 ‚ \r \f  \r\r, € -
   \b  \b 
   (\b 4).
ˆ\r
\n\f
 \r\f  
 \r \t \r \r\f\f  \b
\r\t  €\r\b \r\f  (\b ‰Š).
 \r\b \f, € \r\n \r\n   \t
\r\t \r \r\f \r‡, € -
\b‚, \r   \r‚  ˜
 €  \r. “ ,
 \r\f  \r \r\b€‚ \r\b. •
 \b\r\t,  \n  \b‚ 
 \r\f, €\r ‚ \n‡  -
‚ \r, ‡\r \b,  \r \f-

\n\f-„ƒ †
(V/Q)
 €\n \r ƒ\t \f
, \t € \r\f.
…\b‚ \r \r  \b
 \r\f ‡    ‚ V/Q
(\b 5).   \r\f\f  ‡\n ‚-
 V/Q  \b  \r \f, €
  \b ‡ \r  \r-
\t  (\f).   \b\r, € \r
  \f V/Q - ,  \r, ƒ
\b‚ ‡   € \n‚
FiO
, \b\r€,  , \b\r \r
 \b, \f \r \r\t \f -
\t .
…\b‚ ‚ V/Q € € -
   . „ \b\r\r ‡
‰Š, €   €  \r‡ \r\f -
\r \t \r\t. \b‚,  -
,   \r \r\f\n \b\r,  
  \r\n \r\n   \n\f\b
  ‡\t € \t.
  \r  \r\r\f -
  \t-\r  \b \r ƒ\r
\b‚ V/Q,  ƒ ‚ V/Q \b -
  € (¡). „  € 
\n‡\n \r „
,  
 € \n  \r
\r\f€  . \r
\f  ƒ,  ‡.
…,   \r\f\f, \n  \r\b-
 \r \n \r \b \n\r\n
\b\t, ‚ V/Q   \b\r  \n-
 
\n
.   \n  ƒ\t \n PO
 
\r€  \f € (40  . ., \r 5,3
 ). ˆ \n‡ \r \f-
,   ‡ \n \f \n‚-
 FiO
‡  \b 100%, \r\b \r ‚\b-
  \r\b€ \r. •‚ \r\b\n
\n \r\f\f  \f\b  \f, 
 \f\f\r \b‡ \r \n O
 -
\r\f€ € ˆ
. \r\t‚ \n‚ PaO
 ‡ \r  \f ‡ \r
 \r\t  (.
\r \n \n-

, . 29).
“ ,  \r\b€  ‚\b \b\r\b€-
‚ \f ‡ \r‚ \b \r
\r \r\f    -
\t ,    \n\r\n \b-
\t, \b \r\f,    \r -
 \r   \n\f \r‡\r\f
\r  \n\r\n \b, \n \r-
  \n\r\n \b\t  \r
\r\r\n \b€ \r\f.  \r\b ˜ -
\n \r \n   ‡-
  \f \b\r€  , 
\b ‡\n  ‡\r\n  \r
\r‚\t . Š\r  \b\r,  -
\n ‰Š  ‡ ˜ \n, \b‚-
  \r \n\r\n \b\t  
\n  \r.
\b\b \r\f€\t , \b‚-
\t \n‡ \f \r \f -
‚ V/Q \b  \t -
  , \r\b€ €\b \r,
 \r   € \r, -
\r \n \r\b€‚. „ , \n\t 
 «\f€ \r\f€ »
(‹, HPV),   \b€\n -
, \t\b  \r\r \b.   
ƒ \f ƒ ‹ ‡ -
\r  ,   € \f\r-
\n .

‚ƒ
\b\b \r ,  -
\n  \r  \b \b.
\r    ƒ \t
  \r\f \f\b\r \n.
\n \r\f€\t \t\f\t \f\b\r
\n€  \r  \r\b  -
\r:
\r \r\t \f\b\r,
\n\t \b,
ƒ\n\t \b.
…\t\n \r\b\t \n \n -
  \b\f €\t \r  \n\n -
\n\t , \n\t   \r€\n
\f\n  \n‚\n  ƒ\n \b.  \b
 \r \r\t \f\b\r  \f-
\b \r€\n \n   -
  \n \b.
“ \n‡™ ˜\f\r\n ™\bˆ \r\f­Š €˜
\r \r\t \f\b\r \n, -
 
\fΠ 
, \r‡  ‡\t
€ \r \f —  \r\f \f
(medulla
oblongata)
. „  \r€ «\n
\t\n», \n \n \r   , 
«ƒ\n \t\n», \b \r 
\b \n. „  \f\b\n \r ‡ 

\r
\f \r\n \t\b
Basic Sciences
 ‡ €\n\t \r€\t 
( \f\r.
pattern
— \r, \r. —
. .
) 
 \n. \n\t  ‡ \n  
\r \t .
‹‹\f\r\f†\f ŒŠ
\t\t \n 
•\n — ƒ \r, \n \f-
  € \b\r\n.  \r\f  
€\f ‡\r\b€ ( \r \f) , \f\b 
\r \f\t ‡ ( ­™), -
 \f\b\r\b \n. \r \r\t
‡ ‡ \n   
\r pH, \n\t ‡  
 (H
)  .
…\r € pH   \f -
\r 7,4, \b\r€ ƒ\f \r \r\b-
  \r€ \n  ‡ -
 H
. ‡ ‡ € 7,4 \r\b
 \r  . \r  €\f
‡\r\b€ \f\b  pH ­™.   ‡ pH
()  \f\r, , , 
\r\b€ €\f .   \r€\t 
­™  \r  \n\r\f
. \f\r\r\n\t \f \n \b\b  
 ­™  ‚  \b\b\t \r -
\t CO
   (HCO
  \n‚ PCO
  (,  
€\t \f\b)  \b\r€ -
\t CO
, H
 HCO
 \r. \f 
­™  «\r\b» \b   \f\r, -
 \r \b\r \n CO
 .  
‡ PCO
 (\f \r \f)
\r \r‡\n\t ƒ, €, ,
‡ \r  \r\b\t †‹  
.  \b\r \f\r ‡ -
\r \r \f \n  -
€ ‚\r.
\b\r \n 
\n  \r\n \r \r -
\t \r \b€, \n -
\n \r, \n \f  -
 \r  \b\f\r\r\f \f  \r\t
.   \n \r \f \r ‡-
\b \r  \f\b\r \n.  \r‡\n  -
 \b \t \t   \b‡\b 
\b   \r ‚. \r\n \r
\r‡\n  \b\f \n. †  -
\n \r \b  \n\r\n\t   \r-
,    \n\f\r€\f  (IX 
€-\f\n ),   \r\n \r — 
\r\b‡\b \b (X ). €, € \f\r\n
 \n \r € \b,
\r\r\b \f\b\r \n (« ‡\n -
»).
 \n \r\t \b\r  \n \r
  PO
 80  . . (10,6  ) \r PCO

\r 40  . . (5,3  ) \n\n \r  \n-
‡ \b\r \r. „ \f\n €
\f\b    \r  \r,
, \b   €  -
‡ \r \r \r  \n-
‚\t  CO
\r ‡\t -
 O
 \r\t .

… \n \f\b \n \r  \b\f \n
\f.  \n ‡ \r \b\r€ \f\r\b\b
 €\b \n (\f\r), €, ,
‡   €\r ‡\r\t €\t
\f\b. \b ƒ\r\f ‡, -
, -\b \b\f \r, ‡ \b
\n\n \f\r. \r€ ˜ -
\r   \r \f 
 \r\b . „  \b
\n  \f\r\b  \n
 \r \f.

 \r\f \r‡  \n , \b€-
\b  \f\b\r \n. ˆ\n, \r\f-
   , €  ‡ -
  \n\n ‚\r, ‡\b \n  €. 
ƒ\r€  \r\f  \f\b\t \r \r-
‡\n \n, \f\b  ‡. “€
\b ƒ \t    — €,
€  \f\b \b€  \r€\n \r\n
, \b€\n  \r\n ƒ\r-
\n \b\r. \b\b   ‡ (-
\r \r\f): ‡ \r\f  \f\b\t \r
  ‚ . „  €
  \b‡ \n€\b \f\b\b 
\f\n \n. …,   ˜ \r\f
\t\b \r‡\n\t \r. …\r‚ -
‡ ˜ \r\f ‡ \b\r -
\n ‡  \b\r  \r‡ . „
ƒ \f ‡ \r  \b\r 
\b \r\n, \n \n \n.  \n-
 \b  \b\b \r € \f  ‡,
   \r\f \r‚\f \r‡-
\r\f \r  \n\r\n \b (\f\r-
\n\t )  \b\r \n  
 \n «\n» \f, ‚ \f\r\b\t .
„ \r ‡ ‡ \f \r\b \r \b
‡\n \b ‡ \r ‡, \f \r\n
€\r\n  \f\b \b\r \r\t‚ \n-
.
  \b \r\f€\f \b\r ‡ \b\b
\n ‡.    \b\r (\b\r
\r, ,  €\t -
€)  \r \f\r.
†  ƒ    \n-
\r\n\t    \r\b‡\f .
‹‹\f\r\f†\f ŒŠ
„\n \n \r,   \n-
\r\f , \b   \f \f 
\f, ‡\n \n‚  \f\r\n
\n\r\n \n‚ ‚. \f \b
\f\r\n , \n\t \b  ‚
World Federation of Societies of Anaesthesiologists
WFSA
 \r \t \r\n   \f
. ­‡\n \n‚\n \b \f-
\n ‡\n ,  -
\t \f  \b  T
 T
. † \f-
\r\n \n‚ ‚ €  ‚\t\f
\r.  \r\n \b\r  \r
\t \n\t , \b\t \n‚€\t -
. \n    € \t
ƒ\r€ \t, \r\t ‡ \r\f.
\f \f \r ‡\b \r  \n.
‹ \r, ‡ ƒ\n \b
\n\r\f   \b C
,   ‡\r\t
\b \n.    ƒ  ‚\t\f
\r \f \f  \b \n‚ C
\n€ 
 \r\r\b \b.
\r\fŒ\n\r\n†  € \n\f‡\f  †–\n\f
\n \r\f,    \r
\r, \r  \n\r\f   \f-
,  ƒ  ƒ ‡ \n \b 
 \r. †\f\r\n  \n-
 ‡ \r  \n\r\n\t ,  
 ƒ \n \r ‚ \r 
\f\b\r \n. †\f\r\n  -
 \r   \r\f, €   -
\b‚ \r-\b\f ‚
 ‡ ƒ \f.  -
 \n €\r \t  \n.
 \r ƒ\n   \r\b€ -
  \b\r \b\f \b\f,    €  
€  \r\n\t \f \b-
 \n.   \b \b  \r\b -
 ‡  \r  \b\r -
\t ‡.
‚ƒ

‚

 ƒ
• \f\r \b \r\f   €-
 \f,  \b€\b   \r\f€
,  \n \r ‡\n \r
\r\b:
 \b () ,   -
 ‡ \b  \n\t ,
\r \f\b,
 \f-II  € \r
\f-I \f 
 ( ‰),
  ƒ\f\n ,  
\r  ,
\b€  \b  \b   -
\t IgA.


Galvin I, Drummond GB, Nirmalan M. Distribution of blood ”ow and
ventilation in the lung: gravity is not the only factor.
British Journal of
Anaesthesia
(2007);
: 420–428.

\r
\f \r\n \t\b
Basic Sciences
‚\b\b\r\b \f\t\f \b\r\f
* E-mail: Robert.Law@rsh.nhs.uk
Rob Law
Consultant Anaesthetist,
Royal Shrewsbury
Hospital
Mytton Oak Road
Shrewsbury SY3 8XQ, UK
Henry Bukwirwa
Consultant Anaesthetist,
Mbarara, Uganda
\n \t
‚ … -
 … \r
  \t\b
 \r 
\t,   \r
 … … \t-
 \r.
  \t-
  \t -
 
  
  (-
 \t\t).
‚ , \r-
\t,  \t, -
  , -
 \t 
 \r  \r-
 …
\t —  -
 \t\t.
  \r
\r \r-
 , -
 .  
  \t -
  
\t\t \t.
\f ’*, ­ †






ƒ

\r \r  \b, -
\n \n \n‚, ‡\t \r \f. 
\r \f\n   \r  \n-
\t \t (\r)  \b  \t
\t (\r). Š\r  \b
  \f,  \r ‡\f \f
(\r \r, €  P)
 \r,  \r \n \f,
\b    ‡ \b . \b
\r  \f  \b \r-
\n \r\t  \f, \r ƒ\b
.
‡ \b\r\b †ˆ \t\n‡\t\n
\r   \f\b 
\r \r \n\t  (\r-
)  \b € \n\r\n \b, ‚-
  \r\r\n \f, \r \b 
\r\b , \r\r\n , , 
\r\b (\b 1).  \r \r 
\f \r\f \b (7›11  .
., 1›1,5  )  , \n \r-
 \b\b\n  \r,
\n  \b ƒ\f. „
‡ \r\f \r O
—  \n-
\f \b    
\r\n\t . \b€ ‡
  \r\f€ €
,   ‡\t \b   -
 \r ‡ ‚ \r\f€\t
, , \f\r, \b‚-
 \r-\b\n ‚-
\t \r \b. …  \b ƒ
 \b  \f.
 \nŽ\b‡‹\f\r† ‰ \n ™‰\f\b †
\b () \b\f   
\b  \r \r 760  . . (1
 = 760  . . = 101  ). \b
‡ 21% \r, 78% ,  ‡
\r‚ \r€ 
, \f  \f\r.
\r,  \b \n \f-
 — \r  , ‚\n
, \r‡  \b, \r -
\b, \r. “ , \r
\r (ˆ
)  \b \b  \b
 \r 159  . . (21 / 100 × 760
159  . ., \r 21,2  ).   \b -
\b, \f \n\n\t \b \f -
,  \f  \b\r‡  
\n\r\n \b. \r‡ € -
\n  \n, . . \f, \n\t -
\n \r \r. “,  37 °C
\r \r  \n (P
)  -
 \r 47  . . (6,3  ).  
 € \r \n , ˆ
 
 \n \b   150  .
. (13,4  ), € ‡ \n € \r-
\b :
(760 – 47) × 21 / 100.
 1.
‹ 
  \b\b \r  \r 
\b \b­€
World Federation of Societies of Anaesthesiologists
WFSA
\r \r  \r\r \f (P
) -
‡ \r  \b\r «» \b\f\r\r\n \f-
, \b  \r\r\n  \r\f€\n \r\r.
‡ € P
‡ \n € 

 \t \t  
= FiO
– (PaCO
/ RQ),

— \r \r O
 \r\r; FiO
— -
 \n\f \r; PaCO
— \r \r
\b\f\r\r\f \f  \r\r; RQ — \n\r\n\t ƒ
(respiratory quotient)
— ‚ \b CO
 \r-
 O
(\n€ \r \r 0,8).
 \n ™‰\f\b  ‰ \t\r\b‰™
,   \b  \t, 
 ˆ
(32  . ., 4,3  )  \b  \r\f
 \r\f€\n . ‹\f€\n    -
 \r\f€\n \r\r, \b‡ \r-
\r\n. \r \b\b  \r\r — \n \n-
\f ˆ
(100  . ., 13  )  \r\r\n — \b
\f ˆ
(32  . ., 4,3  ).  \r \f
 \b  \r\f€\n   \r\n \r\n
  \r   \f.  \r «\r-
\f \r\f\f» ˆ
  \r\f€\n  \f\r \n -
 ˆ
 \r\r (P
).   \r€\n
 \r ƒ ‡\n  ˜ -

\t-   \t  ( -
\b)
. -\n, \t \r  ‚
\r-\b\n (V/Q) ‚\t (\b-
\r€ \f  \r ‚\b),  -\n
— \f€  \b € \r\r-
\r\r\b \b.
\t  \t\f\n\t\t- \b\t\t \t\t
 «\r \r\f» \r \n\r \n -
 \r ‡\b  \r\r,  
\b‡  \r\r\n \r\b€\r \n \b
€  €\f \n. “ ,  ƒ\t -
‡\t \r \r  \b 
  \r\f  (V/Q = 1).  -
‡\r, ƒ ‡ ‡  \r ,
 €   \b \r\f\f \b\b -
\r\n\t \r \b  \r (-
\b 2).  \b \r  \r\n \r
\r\f   ‡  \r  
\b‚, € \f\r\n    \t
\r\n ‡. \r\r\n, \r‡\n  
\f \r\f\f, \b\b  \b\r \r
\f «˜ » ( \b \b\r\t
€\t , ‰Š),    \r\b€‚ \r\b-
, \r\b  ˜   \b\r€ 
\r \r‚\t . „   -
\r \b\t     , € -
\f \r \f\r\t \n\r\t \n‚\t, -
\r‡\t  \r\f, €  ˜ \r
\r \n\t \r\t \r\n \r \r\f.
   ‡   \r\f 
\b\r\b€‚  \r,  \b,  \r\f
   . \r,  
\b‚ \r\f, \r \r\b€‚ \r\b-
, € ‡ (\t  ƒ\t -
\b \r  \f ,
\f  \r,  \b\b -
\n\t \r \b\r \f , V/Q �� 1).
 3.
Š\t \r   .     V/Q   \r\t
 —   ()   \t \r (\r)
 2.
 \b      -
 ( \r \r  ).
Š    
  \r\b

\r
\f \r\n \t\b
Basic Sciences
 \r\n  \b \n‚ ‡
\r (\t  ƒ\f 
\r \b\r\f€\t ‚\b  V/Q 1).   -
\r\n  \t\f  V/Q
\r\r\n  \b 3.
\f    \r\r  \f
  (‚\b, . \b 3), ‚ \r-
\b\n \r\r\n ( \n PO
 \r\r\t )
 \f\b  €\b \f
 \r \b\b\n \r\r   PO
 -
\r\r\t . „ ˜ , € \b\b
\t \r \r€ \r,  ‡
 \f\f\r (. \b  \f-
\f\r ‡).  \r \r O
 \r-
\t  (P
),  , \b ‡ \r-
\f \r O
 \r\r \f (P
 \r\f€ , \n \f\b \b\b-
\f\b\r \r\f€ ‚\b, 
\r, \b\r \r\f€\t , 
\r\f \r \n \r \b\n \b\t.
„\r \r\f€\t  \n\n \n‚ -
\r\f€\f \f .
­\b\b\f
\r \b\b  \r\r  \r\r\n 
 \n ˆ
 \r\r (P
)  P
„   \n,  \r 0,25 -
\b\n,    ‚, \f  
\b  \b  \r\f€\b \r\r\b.  
‡   \f\b \b€\b \r-
\r \r 0,75 \b\n (\b 4).
 \n \r\f, ‡   \r\b€, \r -
€\n\t \n  \r\r\n\t  \n-
 \n‚\n (\f\b),    
\r\r\t € \r \n \r\n
\r\t O
(\b 4). \r \r\f \f\b
‡ ‡ \r\r\r\r\t
\n, € \b  \b \r-
  ‚\b\b \r\r›\r\r (\b -
\b‚).  \t   ‡
  \r\r ‡   \n €\n
\r \r\t \f,   ,€\t -
\f\b \n\t  \r 
\b\n, €   \f (\b 4).
 \r\f \r \r‚ \n
‡ — \b\n \b‚ 
 €\t €\t \f,  \r€-
, ‡\r\b\t, \f ,   \r\f.
 \r\r\f \t\f  \t\r\n\f
\r  \f\f \r \r\f€\f
‚\b  \f  \r\f€\n \b-
\n \r     
 ‡ P
—   ‡ -
  \r \r\b\n . „  
 «\f€ \r\f€ » 
\r \r \r ‚\b.
\r\n‡Œ\b\r \t‡ \b\r\b \n \t\r\b‰™œ
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World Federation of Societies of Anaesthesiologists
WFSA
 5.
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World Federation of Societies of Anaesthesiologists
WFSA
• \r € ˆ
 ‚ \r-
\f€ ‚\b ‡ \n \r 
‡  € \n‚\t  \n-
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90›94%).



—



Nunn JF. Applied Respiratory Physiology (3
Edition). Butterworth•s 1987.
West JB. Respiratory Physiology (4
2.
Edition). Williams and Wilkins 1990.
World Federation of Societies of Anaesthesiologists
WFSA
\f\t \r\n\b\r \f\f
*E-mail: gja@arthurs40.freeserve.co.uk
G. J. Arthurs
Consultant Anaesthetist
Maelor Hospital
Wrexham LL13 7TD, UK
M. Sudhakar
Prince Charles Hospital
Merthyr Tyd˜l CF47 9DT, UK
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.  \n   \r\f \n-
  \r\n \f\f\r, \n\t -
\b \r ‡ \r  , -
 €\f \n \n  \b\r 
. \r \r\f \f\f\r
(HbR \r HbH) ‡, € \f\f (HbO
),
€ ‡  ‚ 
€€ ƒ\f
(Haldane)
, \n\t ˜  , €  
\b PCO
‡ \b\f\r\r\f \f  \f-
\t  \n‚, €  \f\t.
 \b\r  \r\n   ƒ-
\n  \b\f \n   -
\r\n \f\f\r  \r‚
\n‚ \b\r€\t \r. „ 
 \b\r \n  ƒ\n  \b \r,
€ ‡ \n    -
\f \b\b\r\f ˜ (MCV).   ‡
ƒ € \r\r\n \r\f ƒ 
  .
‰€†‰\n\f C
­\fŽ\b­ \b“\bŽ  Œ\r\b‘Ž “\f \t\nŽ
\f\r\r\n\t \f \n   \t\r-
\t ( \b\t ƒ\r€\f ) \r\t
\f\b (R›NH
)   \n
\t (\b 3):
R–NH
+ CO
= RNH–CO
\r \r‚ \r    CO
\b
 \r \r \f\b.   \t-
  \f\f\r   \f-
\f\r  \r€. \r\n\t \f\f\r
\r \n \r, \n\t ‡ ƒ-
 \n \n   \r\f€
€ pH, € ˜ \n ‡ 
\f  \r\n \f,  \r\t
\f\b\t \t \n \n H
. \r 30% CO
\f \f  \n\n\t \f\t ,
\b  \r\f    \f\f\r .
\r€ CO
, \f     -
\n \t, \r,    -
€   \f ‡\b ‡ CO

\r\t  \t . „ •ƒ\rƒ\t -
‡ \r€  ‡ CO
‡\b \f
\n  \r\n \f\f\r  -
 € PCO
. „ ƒ € \b\r\r
 \f\f\r \n \n   
\r\t  ˜  , € -
\r\n\t \f\f\r \b    CO
 3,5 
, € \f \r .
 \r€\n  \f\f\r  CO
, -
\b \b\f\r (CO)  \r\b \b. \f\r\r\n\t
\f \r\f \b    \f\f\r  -
 \t   \r  \r
\r, € \r.  \f\f\r 
 €  \f \r€ CO
 €-
 98% \r. …, \r\n\t \f\f\r,
 \f    œ-\t 
¢-,  \n \r  \r 
\r \r. ­ \b\f\r \r
\r \n\t   \f\f\r\b, € \r,
 \b \n \f    \f\f\r.






ƒ
  CO
    \b-
 1.   \t CO
 \t \b \b\f\r-
 \r. „   € \r 
\r,  \n  ƒ    \r€ 
 \f\n. \f\r \r (H
\b    H
 HCO
, €
  \n‚  ƒ   ƒ-
.     \n  \f\b -
 ƒ\n, \n   \n \t
€ \r€\b \b. \r ‡ -
\r ƒ\r\t\r   
 \n \r (Cl
), \b  \r\n.
†\n     \n -
\r\n \f\f\r. …\r€ \r\t \f\b\n
\r\n \f, \t \f \f\f\r,
€ \n‚ \f \b\b , €  ‡
\n € € \r.  
\b   ‡\t \r\f
 1.
\r    . \n -
 
World Federation of Societies of Anaesthesiologists
WFSA
‡ 38 \f\n   ‡  €-
\n  \f\f\r.  
\r\n \f\b    \f, -
\f   ‡\f  .   \n‚
\r  ‡\b \f\f\r  \r
\r\r,  ƒ \r \f\f\r -
€ \r€ \r\t \f\b\n. …
\b \t \r\n \r\n \f\b\n \r-
\r   \r\b, \f  \n 
\t\r\b \f\f\r, \n\t € -
\r \r \r€\n \t.




   ƒ
\n \r  \f\f\r \r\f€
 \r€ \f\n \f\b: 
\f  \r\b \n‚   ‡
(\b 4), € \r \t  €
€ 
(Bohr)
+ HbH
+ HCO
= HbO
O + CO
‡ \f\f\r \f -
   \r\b   \n CO
 HCO
‡   \r 
ƒ\r CO
(\b 2).

‚



 
 
  \b\f\r\r\f \f \b\r-
  ‡\b PaCO
(  . . \r  )  \r€-
 \b\f\r\r\f \f, \f   (\r) (-
\b 3). \r€ \f CO
 
\b     PCO
,   
  \f\f\r.  \r€ -
\f\f\r  €\r\t  \r -
\f\t \f\f\r   ‚\t  PCO
 \r \r CO
 ‚\t \t
 \r š46  . . (6,1  ),  \r-
\t  š40  . . (5,3  ).  ‡
 \t  \r\t  \r -
 520  480 \r/\r.   CO

\b \r \r\t\t \t   
\t  \f\f\r (O
Hb).
ˆ\b 4 \r\r\b \r€ ‡\b -
‡   \r  \b\f\r\r\f \f  
  \r\f \r.   -
‚ €, € ‡ CO
\n
‚  ‡ \f   \f -
\r\f \r.  ‡ \r 
\r \b,  \r  \f , \f -
 \r \n \f\f\r › \r ƒ\t €
\r €\r\n\t , \n\t  -
€\r\n \n‚ \f O








„…
ˆ\r€ ‡\b \r\t  \t 
\b\n  \b 5   \r 1. \n -
‡ CO
 \t \r\r\t  ‡-
  \f\f\r  \r\b,   \f
\n‡  .
  ƒ  \f
\t  \f\f\r 
(€€
 )
,  \f\n\t \f\f\r \n
\r‚ \r€ CO
   \f-
\n
(€€ ƒ\f )
. \n‡ \r
 \r\r \b\r   \b\r \r€\n
\t \r\b\r\n \f\f\r ( \r \r-
\n  ). “ , \f\f\r
\n‚ \r€ CO
, \f  \t
 (\b 4):
HbO
+ CO
O = HbH
+ HCO
‡ \r\b\r CO
, \b  ƒ,
\n‚ \b\r€ € \r -
    HCO
\r Cl
 \r,  \b\r€ ˜ ƒ-
, € ˜ \r \n € \f-
 \t ,   3% \n‚, € -
\r\t.     \r\t, \b 
‡ \r€ \r \n  HCO

‡  \r.
 2.
­\t  \t 
‡Š\b\t 3.
‚\t\t \r CO
  

\r
\f \r\n \t\b
Basic Sciences


pH 



 \r \r \f\f\r   \n-
‚ pH   0,03.   ‡ \b 
25% pH \n‚  0,007 (  PCO
).
Š\r PCO
\n‚  6  . . (0,8  ), € -
\b \t , 
‡ € pH  0,04. €\n\t ƒ ƒ
\t —  pH  0,033 ( 7,4  7,36).


ƒ



 \r\f€\n \r\r ƒ\n \n‡
, € ‡ \n‚  \f-
\f\r  \r\b.
\f\n\t \f\f\r \n ‚
\r€  , €   «\r»
 1.
\t  pH  \r        (1 \t\t = 22,32 \t)
\f 
  
\n\r    
   
\f ™\n€ \t\r\b‰™
7,4
7,36
–0,033
PCO
(\t\t . . /  )
40 / 5,3
46 / 6,1
+6,0 / +0,8
 … CO
(\t\t/ / \t/)
21,5 / 480
23,3 / 520
+1,8 / +40
 \nŽ\n
/
/
/
/
/
/
\f CO
1,2
1,4
+0,2
+5,0
„ 
0,0017
0,0020
+0,0003
€ 
24,4
26,2
+1,8
‹\t-CO



 …
25,6
27,6
+2,0
\r\r\b˜\n\r\n€ ‹\r\n\t˜€
/
/
/
/
/
/
\f CO
0,44
0,51
+0,07
€ 
5,88
130
5,92
132
+0,04
‹\t-CO
1,10
1,7
+0,6
+13
 \nŽ\f\n€ ‹\r\n\t˜€
/
/
/
/
/
/
\f CO
0,66
0,76
+0,1
€ 
13,42
300
14,41
320
+0,99
+20
 …  1  
21,5
480
23,3
520
+1,8
+40
 5.
\f\r    
  
 4.
‹  CO
\r\b\r\n,  ‡ PCO
 \f  \r 
 \b ƒ , «\r€-
» \r\b\r\b \f\f\r. \n \n \b‚
\t \b\b\r\n\t ˜ (MCV), € -
‡ ‡ \f.  
\f\f\r \f \r (ƒ ). 
\r \r\t    \r
\n‚,   ‡, €  \t.








‡\b \b\b  \f \b\r  \n
\r 200 \r \b\f\r\r\f \f, € \r ƒ\r-
\n \n 12›13 \r\t    \b.
  ‡  pH € \r\r  \r 4,5›8,0.
‡  pH = 4,0  €\t ‡ \n \n  \r
\r/\r  H
. “ ,  
3 \r €  \b ƒ \b  \r
World Federation of Societies of Anaesthesiologists
WFSA
\r‚\t \r  ƒ\r  . “ 
,  €\t \f\b \n \b\r\n \n   \b\r-
, \n  \f\b \n \n  CO



 ‡ CO
 \f, \r€ \n
, \r \r 120 \r, €  100 
\n‚ ‡ \r.   \b\r
ƒ  \r\t ‡ CO
  PCO
\b \r 3›6  . ./ (0,4›0,8  /).
 \t \n \n PCO
 \r\r-
 \f  \t : \r\r PCO

  40  46  . .,  PO
 \b\b  
105  . .  40  . .  \r, \b -
 \n  \f. Š\r \n\r
\f 100% \r, PO
 \r\r \b-
   \b 100  . .  ‡
\b  \b 100%  € \r \b.
‡\b \b\b  \r\r\f  \b
\f\r \r 250 \r O
c \n \r-
\n \n‚ PaCO
. \b 5 \b  
ƒ \f € \b \r‡  75  . .
(10  ), € \b ‡ \b
 pH.




‚
West JB. Respiratory Physiology, 7
Ed. Lippincott Williams & Wilkins,
2004.
Ganong WF. Review of Medical Physiology, 21
2.
Ed. Lange Medical Books,
2003.
Nunn JF. Respiratory Physiology, 5
Ed. Butterworth Heinemann, 1999.

\r
\f \r\n \t\b
Basic Sciences
ˆ   
\b \t\b…\n\n\t\n \f \r\n\t\b\n
* E-mail: lambpie10@hotmail.com
Lisa Hill
Specialist Registrar in
Anaesthesia,
Royal Oldham Hospital
Lancashire OL1 2JH, UK
Carl Gwinnutt
Consultant
Neuroanaesthetist,
Hope Hospital
Salford M6 8HD, UK
\n \t
Ž\r  -
  \r-
  
 \b-
 Œ\t, -
…  \t,
  \r\t-
 … (Š“).
 \t ,  
\t\r \t-
, …  \r-
   
 
\r,   \r
\r \r-
. ˆ \b -
 \t  
, \r
\t\t  
\r\t -
.
’ ‘*, ‹ ­



 \f\r\f \f  
, €    €-
 ‡ (‚) \r‚ €
\r‚\t  . „   ,
€ €  ƒ\f (“‰) \t\n
\n\n  € \r\r\f -
\r \b,   \f\r  -
\n \r,  ƒ ‡ \r-
 ƒ\f \r  \f 
\f€\n.  \r ƒ\f\n
\n \r, €   -
\n \r€\n ‡, \r -
\f\t   \b \n \r
(\n€  € 3›8 \b). “ ,
\r € \t  \r-
  \r\n ,  ‡ \b\r
\b \r  -
‡ \n\t \f\t .
­\f\t  (­)   
, \n ‡ \r  
‚ \f\b\n:
1)
\n, \b‚ \r -
\b \r,
2)
\n,  \b \f\n
\b.
  ‡ \n -
  
 \t ‹  –
­ 
(. ‡),  \n \r-
\n\t  ‡\t ‡
 \t  ( \n
… ‡) € \r€-
\b \b\b  \n €\n €-
. †    \b  ƒ
,  \b \r\r \r  -
 \r\n\t .
\r\n‰\f\f
\n­\f\nžŠ\n\fˆ €

£ˆ — \f \b \r; r — \b
\b; ¤ —  ; l — \r \b (-
\f \b); ¥ —  (3,14).
\f\t\b\b\r†\f ‹\n\t†  ˜‹\r†
­\f\t    \r
50 \r/100 \f/ (\b  20 \r/100 \f/
  \r  \f  70 \r/100 \f/
   ).
\t  \f \r\f \r
1400 \f, \r 2%  \t \n \r.
“ , \r‡ €, €
­ \r \r 700 \r/, \r 15%
 €\f \n  .
„ ‡ \n \r -
\r \f — 3,3 \r/100 \f/ (50 \r/
 \b), € \r 20%  -
\f \r \r  \f-
. \n\t \r \r\b€\r 
« \r \r \f»
cerebral metabolic rate for oxygen
— CMRO
).
„ \r \n‚    
    ƒ\r€-
\t  \n \f.



 
 \b \f\r\f \f   \f-
 \r\t ‡\b   ,
\r\b€‚\f  «\r \b-
 \r» (” , CPP).
ƒ
\n
\r \t  -
\f \r\f \r (
ˆŠ.
)  -
\f \f \f\f \r.  \r\t
\r € \r‡ , ƒ-
\b \f  \r  \b,  \f-
 \r\f€ \n \r —

„\r \n\r (\tˆ‰)
Ž­ = …
†.
– .
 \r \r ‡
\n €  \b \r€\f
  ¦ \b\r\f  ( ‡\b -
\r€  \r€ ).  
\r \r 90  . ., \f  Ž
€\r ‡ —   13  . .
Ž­ \t  \b\b \t  80  . \b.
€, € ”  \b  
\r\b€ \t , \r 
ˆŠ.
\r Ž.  \n\n \f-
, ‡ 
ˆŠ.
 ”  ( \r,
\b   ‡\r\n ‚ ‡ \b-
 ),     \b\f-
 \f \n‚ Ž, ‡ 
\b \b­€
Ž  \t =
‘ × ’ × r
World Federation of Societies of Anaesthesiologists
WFSA
 ‡ ”  (. ‡). “ ,  €-
 \n‚€\r\n  \n ‡ \r-
 € ‡ ”   \n‚ 
 ‚.  \n‚ ” ,  -
\r, \r \b\r \b\r€ 
ˆŠ.
, \f 
\r ‡ Ž €\r, \r€ \r-
\f€ \n, \b € \n
Ž.   \f\r \f,   -
 
ˆŠ.
(, €   . .), ­
 \n  ‚ \r 
” . „ ‡ \r\f \b, \r\b€‚\b
 «\b\f\b\r» (. ‡).

 
 

‚ƒ

 
­‡ \n\r €\n \n , \b€-
\b  ƒ \f\b\r :
1)
\r \f\r\f \f,
2)
 
3)
\b\f\b\r,
4)
\t\f\b\r\n \n.
ˆ\b \t \f\r\f \f \r ‡\n
, \b€\n \f \r  ­. \r€
\b (\r)   \b\r€ ˜-
   \f, €,   €, \n‚ Ž 
‡ ” . “ , € ‡, \b€\n
 \n‚, ‡ \r,  -
\f\b\r\b  \t.
\f\n“\b Ž ­\b \b‰\b­\b Ž\b­\n
† ­  \r € ‡
\b\f \b\f. ‹\r \r \f\r\r \n‚ -
\r€ \t \n \b\r \b-
 \n‚ ­   \n \b,
  (€   \n ‚-
 ›\r, \b 1).  \r\f, €
ƒ  \r\b \r -
\n \r€ ,  
, 
, 
, , ‡\b€\n \b
\f\r\r, \r   \r,   -
 \n ‡   (NO).
\b˜\f\r\n˜€ Š­ \f\t‡ \b­\b ­\n\n  \t‡ \b\r\b \n
  \r € \r\f \r-
 \r \r 
 \r\t 
(ˆ 
)  ­ \n € \r\t. 
\b\r \t   ˆ 
80  . . (10,6
 ) ­ € \b.   ‡
ƒ\t €, \b \r\f ‚ \r,
\r\t‚ \b\r€ ­  ‡\n.
…,  ˆ 
 20  . . (2,7  ) 
 ‡ €  —  ƒ -
\f \r   (\b
2)   \r\b€ \r\t‚\f ‡ PaCO
 -
\r  . „ ƒ\n \f\b\r\b \r‡\t
 \t \t . …€\r\n\t
\b\r — ‡ \r€\f € pH -
\f  € \n‚ ˆ 
.  \r\t‚ 
\t \b€\b  , \n, \r€-
 \b\r\n, \r\n \r\n.  \b\r, -
\f ‡  \b\r€\f
\r, \n\t \n\b  \r €\f -
\f .
“\b \r \r  \t  ˆ 
\b  ­.  \f \b‚
 \f\f    ˆ 
,  \n-
‡ \f   \r\b ƒ\b .
 \f\f    ˆ 
‡ \n \r \r    -
\n‚\n Ž, , \r €\f -
‡ \f\r\f \f. \r ‡
\b ˆ 
 \n\n  \f\n
\b (\b‚  \b),  \r\r, -
‡ ˜ \f\f   Ž.  \r
ˆ 
‡ \n€,  \n -
 ‡   €\b ‡ \f-
\f , \r   \r \b\f\r\b\r-
 ‚ \b€ \f. €, € 
\f \f  \r\b\t \r,
\t  \n‚ Ž. “ , \r
\f, €\n  \n‚ Ž, ˆ 

 ‡   \r \r
\b (35›40  . ., 4,7›5,3  ).    €\b-
\r  
‡ \n \b€  ‡-
\n \b€ \f\r\f \f.  €\b\r
\b  CO
‡ \b  \r\f\n
 1.
 \t… \t\t \t  -
 \r  \t\t (CMRO
).
\t  \t  
CMRO
\r \r 
 2.
   \fŠ

\r
\f \r\n \t\b
Basic Sciences
\f \r   ‡\r\n ‡ \f-
\r\f \f. ‡, €  \f\n \b 
\n€    \f\r\t -
 (\r  ‡ 1 ­),  €, ‡
\n \r \r \r Ž  \b -
\f   . \r \r \r  -
\b \r\n \b  \n€  \r€
\b\r \r \r.
­\f\t  \n‚  ‡ ˆ
‡ 50›55  . . (6,7  ), € \r -
 \r  \f\b    \b-
.  \t\b    \f,
\n\n \n‡    \n \r\b-
€ , €  €\n\t \r  -
 \r \b \f.  \f, \f
\t\b  \f\r\n‚€\b \b\b\r\b\b \f-
\n \b,   \f\r  ‡
\f  \r —  ƒ  ‡
\b\r \r.
Š\b\r\f­Š €˜€
\r\b \f\b  \n\t -
  \r€\n \b \r\f \r,
€ \f    \b\f\b\r.
\b\r \r \b\f\b\r — ” ,    . 
\f \r\f €\r (Ž 10  . .) ” 
 
ˆŠ.
€ \r  ­  \n 
”  60›160  . . (\b 4.). Ž \n‚ Ž, 
\r‚ ”  \b \r€  \f ,  -
 \r \b\r\b \r \f €. 
\b\f\b\r   \b   -
€\t \f\t  \r — \b ‡\n  -
\r \t (\r‡ \r‡  \r-
\b   \r).
\b\f\b\r,  \f, \r \f\n
, \b \f \r€  , € \f\r-
 \b\b\r\b \b     -
\n‚ ‡  \b,   ‡
 ‡, , \r\r.   -
‡ ‡\t \f\n \b\f\b\r \r\r-
 \b \f \b; ‡ ƒ\f \b
 \r\r \b    ­
  ‡ \f . … \t \f
\b\f\b\r  \n‡ \r-
. Š \n‚ ‡   \b, € \n-
‚ \r \n ‚ \b, 
 \n‚ ­  ‡ \fƒ\r€-
\f .   \b\f\b\r  
\r \f\b \n \r€\n  \r€
\n,  .   € \n, -
  \b, \b\f\b\r ‡ \r-
  \b \f  \r\n\t ˜ .
\b\f\b\r \r ‡ \n \b‚ 
\f \r\f€ , , \b -
  \b\r \f\r\f \f, \b\r\n
\r, \b\r \r € -
‡.   \f\n  -
  \b\f\b\r ‡ \t \r  €
‡ \r\b\t \n (. . \f\n
\b), \r \b , \r€\n 
\b\r \f\t  \b \f.  ƒ \r\b-
€ ­  \n  \r  \r‚
 \f  \f\b   \n‡\n
\f ­  ˜   \f\r \f.
\fˆ\r\b­ŠŽ\b\r\n ™†\f ‹\n\t\b\r†
\r€\r  \f\f 
  \r \r\t \f\b\r\t  -
\t \f\b\r \b\f \b.   €\t
\b\r  \f  ,
 \f\r\t \f  €  \t
\b\f\b\r .  € \n \n-
\n \r, € ‡ \f \r  -
 \f  \b\f ‡ (-
, \r  ).
\r\b‘\f ‹\n\t\b\r†
€\f\r  
 , \b \n\t  \f.
  ‡  ­  (. \b
\f— \b\t\r).  ƒ \r€  \t ‡-
 \r\t  . € \f,
  \f \r\b€‚\t \r ‡\b -
   \r\t  , -
\r \r 30%.
 4.
\n\t \t… \t \t
 \t \r\b\t \t.  
 \r  \t
\r
 3.
 \t… \t\t \t  \f
   O
 -
  ‹   \t. ™
\r\b \t   \r …
\f
… 50 \t\t . . (6,6  )
World Federation of Societies of Anaesthesiologists
WFSA
‚ 
 \r\f \r O
‡
  7%  1 ° ‡ \b\n \r  \r-
\r\r\n ‡ ­.   27 ° ­ \r -
 50%  \r\f.   20 ° ­ \b‡ 10% 
\r\f. ‡ CMRO
\r  ,
\n\t \f   \f\t 
\r\r\n\t  ‡\f ­  ‚€
‡\t, ,    \b-
\f .  \b\r -
 ­  Ž ‡. ‹€\b \f \n-
\r \r \r \r \n‚\f Ž,
 \n \r€ \r  -
\r \b\r\b€‚  \r.
 
­\f\t \r ‡  (‡),
 \r\r,  \r,  ­, Ž  ˜-
   \f\r \f, ‡ \f\b \n ‡\n.
 \b (\r) \r\b \r
‡ Ž \r €\f ‡ ­,
 ƒ     € \b\r.
 \n \r  \n € \r-
  \f\n \b\n; \r\b€  \n\n-
 ‡ ‡ \f\r\t \b\b\r\b\n \b-
\t ,   \r  \n‚
­. †, € \f  \n  (-
\r, \r) ‡ ‡  \t-
  \r€ , € ‡  
\n\b  «›\r». „ ƒ-
    \f\r\f -
. \r ‡ \n \b \b-
\t \f\r\t  ‡ ˆ 
 ‡\t
\f\n \n 30›34  . . (4,0›4,5  )  \n-
‡\f   \r\t ‚.



 
\b€ \r \r ‡\n -
\r\f€ \r —  \n \r 
” .   Ž \r\r  5  13  . . “
 ƒ \r \r   \r‡ \r,
 \b\r\b \b   Ž \n€ -
  \b‡\f \r\b\f .
\f\t\b\b\r†\f ‹\n\t†  ˜‹\r†
‡ €\t  \r€ \f (80%,
1400 \r),  (10%, 150 \r)  \f\b ‡-
 (10%, 150 \r).
 \r € — \f \b\b, ƒ\b \b-
\r€ ˜ \f  \n‚€\r\n -
 \r‡ \n  \b‚-
 \b\f (\f \r \r),  
\r\b€ \t \b\r€ Ž (\b 5). \r
\f €\n  ƒ \r, € \r\b

«\f \t\b»
(\r\t),  \r €-
\n  \r «
 \b\b»
, \r€,
 \r ( \r  -
\b  ˜).
\n \n \r€   
­™  \f\t \r, \n‚\b -
 ­™,  ‡  \n \b-
. „ \n \b‚ ‡\n\t ˜
‡\f €.



„
\f ‡ ( ­™) \r -
\t \r\b \r€\b \b, -
\b  ‡\r\b€  \b\r -
, \f \n\r  \b\t.
Š\t˜ ‡Œ\bŽ\b­\b‰\bˆ  \t\b‡
­€   € «\f\r€\t -
\r» («\r\b€») \f\r\f \f. …\t
\b\r\n\t  ­™ (1,007) \b‚ ƒ-
\n\t  \f  1,4 \f  47 \f ( ).
‚ \n ‡  \f  -
  \b \t\t, \b\r\r-
\n \r \b  ‡.
­™ €  \b‡\t -
\n \r € \r\t \n \t.
­™ ‡ \r \f\b\r  \n, -
\f   §ˆ.
­™ \r \b  \r\n
, \n    \f
 € \fƒ\r€\t .
 5.
‹  \nŽ‚ (\t 
  \t Œ\t)
\n\n 1Ÿ2
\b  \t\r\n.
     \r
\t\r  Œ\t   Œ\t \t,  \r -
 \nŽ‚ \t\t.
\n\n 3Ÿ4
\b  \t\r\n.
   \t\r \t-
\t …     \r \t\r 
Œ\t   \t  \nŽ‚.
    , Œ\t  \r \t\r
\t \r . ƒ    Š“,  \r
…\t\t —    .    …  Œ\t
 \t (\r, )     \t \t,
\r  \t\r\t  …\t
 1.
Š  \r\t  \r\t …-
 (Š“)
 \r\r \t \tƒ.
\n
\f\r
\n
\b‘\f‰\n (ŽŽ\b ™/ )
2,5–6,5
2,0–7,0
 œ\t\b\n* (ŽŽ\b ™/ )
3,0–5,0
2,5–4,5
\n\rˆ (ŽŽ\b ™/ )
136–148
144–152
\n ˆ (ŽŽ\b ™/ )
3,8–5,0
2,0–3,0
\n ™˜ˆ (ŽŽ\b ™/ )
2,2–2,6
1,1–1,3
 \b\r (ŽŽ\b ™/ )
95–105
123–128
\t\n\r“\b\n (ŽŽ\b ™/ )
24–32
24–32
\r\b\f (­/ )
60–80
0,2–0,4

\r
\f \r\n \t\b
Basic Sciences
\f ‡ \n\n  -
 0,3›0,4 \r/ (500 \r/\b)  \r\n
\r \n, \f  €\f ‡\r\b€.
 \b ­™  \b \r \r-
\n € \n \r\r\n, \r €\f \b-
\r \n\t  \n  \n
 € ƒ\r\r\n \r  «›
­™».  \r\t  \r\b \b  \fƒ-
\r€  („), \n\t ‡ ƒ-
\r\r\n \r, \n \b\f  \b\f  
\r\n \t, \b  \f\r-
\f \f  \t,   
\b\r.  ­™   ”  —  \f
‡ ‡ 70  . . € \r\r\r
\b‚ \b ­™, \r\b  
\f\n  \r\n \r ‡.
 \r \n ­™ \b\r\b   ‡-
\r\b€  \b\r , €\b
\b €\n ‡ € \r
ƒ\n.   ­™   €
\f\r\n    \f\b\r \b\t
\r€ ( \n \f\b\r). ‡\b\t \r\t
 \r  \r\t ­™  -
\t . \b \b\t \b\r ­™,  \f-
\b \r   \b  -
 \f\r.




‚
…
 




‚ƒ



‡\n\t   \b€\n 
(, \f, ­™) ‡ \b\r€ \t  
˜ (\r 2).


‚






  \n‚ Ž \b \r \f
‡  € \f   \t , €
\b \f \r , € \r€ 
\t  \f. Š  \b\r \f -
\r \f ‡ «\r» (\r \f\n
\b\b  \n \r \b\n \r\n).
‘\r  \b \r\f€ \n
, \r\n \n \r\n 
‡ \r\f   \f\r \f.
 \t\b \f
(\b\r -
\r)   ‡€ (\r €
\f) — \n\n \r€ III \n €-
\f\n  (‚ €   -
‡ (\r\r)  \r \f\r  
\b‡.
 ‚ ‚
€ \r‚ \n\r€-
  (\r\r \r). \r
 \r \f \n\n \r \b‚\f — \f-
,   \n Ž\t›  (-
€ \n).
­\f\b\t\f (\b€ \b) \t

, \f  \r  \r\t -
 \r\t \r  \r
\t \r  \n\t \t  \f.
‡ \r \t \f\t .
\bŒ\f„  ‚\t \t
\r\b€
  \r€ \r‚\f ˜ \r \n‚\f
\r  \t €\t . ­‡€ -
 ,   , € \n\n €-
\b  \t € \r \f.
 









 € ‡ \f\r\f \f 
   \n, ƒ  -
‡, \r   \f\n \n \n.
 \f\n‡ \n… \r„, „\r…
„\n ƒ\r „ „Š —
„‡ \n \r\r\n‡ ‡ -
 †.
 \r \f\b \n \n  
‡  \r  \b\r \f
( PaO
) \r , \b‚ \f\f -
 \r \f \r ‡ €-
\f \n,  ‡ , \n\n \n‚
Ž  ‡ ” .
 2.
Š,   \r 
   \r

\n \r \t
\r.
 \t   \t,
\b, , \r\t,
\r \b\r,
 \r ,
\t \f.
‡ \t.
„ \t
\n\r   , -
  \r \t\t.
‡    \r\t, \r\r,
 , \r\t, \r\r, \r.
\n    \r\t   ‚‹\n,
, \r…,  , \t -
 , \r…  \r\t \t \t, -
  \t \t
­\b.
 .
\r  \r-

 6.
 ,    \r\t-
 …
  \t \t \r   \r
 …. Š\r\t …   
\t \r,      
\r  .   \r \nŽ‚ , \r
  ,   
46
World Federation of Societies of Anaesthesiologists
WFSA
 3.
   … \r 
“  \r€   \r\b €\r-
\n :
)
‡  \n\r\n \b\t 
 ‚\t\f \r €  ,
)
‡ \f \n  \f,
)
‡ \f   ” .
 \r \b\r €\r\n \t -
 \r  \r\r\n -
\t, \r\n  ‡ Ž  ‡
\f ” . ­\n, \n \f\b \n \r-
\n \r ‡ Ž, \r\n  \b‚
˜ \f \r \r \b€\n -
 (\r 3).
Ž  \b\r€  \n
\b —   ,   -
\r \r \r (\b \r\n\t
\n\t \b). Ž-\f  -
‡ \b‚ \b\f\b\r ­,  ƒ -
‡  (  \t  \r -
)   \r \f\n \b  \n‚
\r\f .   € \b\r€
\r \f   \n‚ Ž  \r-
\t‚\b ‡ ”  —  €\n\t \b\f.
“ , \n‚ \f   -
\r  Ž.
 


 
\r  Ž  \r\b -
\b\r, \r \b‡\n\t ‡\r\b€\n\t ‡,
€ \b  \f ‡\r\b€-
 € \r‚   € ().
\f\r  \b  \r, -
\f   \r ‡. \b\r
‡ \r  ­™, € ‡ \n
ƒ\t \t, \r\t  ‡ Ž.
   Ž  \b 
\f-\r \r\f \b\t (, -
\f )   \f
(„
…\r „)
.  \f, ‡ \r
‹„\n‡ „
,    € -
€\t €    Ž.
…\r  Ž  \b \b, 
\t \n\t \n\t \n\t ,  \t  \t
\f ‡. \f \r\t \b‚, 
\t  \t  \n€  \n‚ \f.
 \f,   \r\t  \n‚
Ž \f\b \r \b\r€\n, \r\f€
\r\n.  1960 \f\b ‹\b\f
(Lundberg)
\r  
\r\n \r Ž, \n \r\b€\r  \r-
\n ,   . “   \r € ”  € \r-
\b  € Ž.
  ‡ \f  Ž \f
‡  \r€  ‡ 
ˆŠ.

\b,  \r ‡ ” :
\r\n\t, €\n\t  (‚\r \n \r\f 9›13
\r\r) — Ž š 20  . .;
  ‚\r \n \r\f ¨ 8 \r\r — Ž š 30
 . .






„ € \b \b, \r\b 
\r  \b \f \r‡ -
  \r€ \b. † \f ‡ ,
\r\b€ \r \t\n  \r€ \r
 \r\n .  \r‡ \r
 \b \f\b \n \r\n  -
   \r\t.  \n  
\f\b \n \r\n  \r€ \b\r  -
€\b \r  \b\r\r\f -
\f \b   Ž­“.  \r \r-
\n  € \n, ƒ\b \r
  \f€ \r.
† Ž  € ”  (\r € -
\r\b\n\t ).
† \b \f\f\r  \t \r\b-
 \t \n (S
, \n€ 65›75%). ‡
\r ‡\b \t \r  \f\r\b -
\f\b  CMRO
. … € S
\r ‡-
\n  \f\b \f.
“\r \r\f, \r
    \f\r \f 
 \r\n\t .
­\r —   ‡
\f\r\n, \b, \r, \f\r\r, \f\r\b
(\r€ \r).
 -ƒ \f ( „“) —
 \r €\t \n  \f\r
\f \r \n\r \r€\t .
\b\r   ­ \r \r€ 
\b\r   ­ \r 
\b\r   ­ \r \n
\f \r,  .
Š ( \t) 
\t … .
 / \b\t  …
 Œ\t.
­\r  NaCl  …
 Œ\t.
‚\t\r \t  -
… \r Œ\t
ˆ \t\t.
‡ :  \r\t,
\r\r, \r\t, ,
\r.
† \t  \t CMRO
Œ\t \t .
\n : \r… \r  \r-
\t  30° \t \t, \r\r…
   (, -
 ),   
 ‚‹\n,   \r, -
   (\t )
  … … -
…  \r 
 … Œ\t Š“ ( -
 \r)

\r
\f \r\n \t\b
Basic Sciences
‰\b\r \f- \f.
 , \n\t  € \b-
 —ª \r \r ­  \r-
 \f \f-\r (
133
•).
\r‡   (NIRS) -
\r\b \r  \f  \r\n
\r \f.
 

—



Rosner MJ, Daughton S. Cerebral perfusion pressure management in
head injury.
J Trauma
1990;
: 933–941.
Rosner MJ, Rosner SD, Johnson AH. Cerebral perfusion pressure: manage-
2.
ment protocol and clinical results.
J Neurosurg
1995;
: 949–962.
Cormio M
et al
. Elevated jugular venous oxygen saturation after severe
head injury.
J Neurosurg
1999;
: 9–15.
World Federation of Societies of Anaesthesiologists
WFSA
\n\n\f\b \t\f \t\n \t\f \b\n\f:
\t † \f\t\f\b\b \b \b\b\r\b\b
*E-mail: carl.gwinnutt@srht.nhs.uk
Oliver Pratt
Specialist Registrar,
Department of
Anaesthesia
Hope Hospital
Salford M6 8HD, UK
Carl Gwinnutt
Consultant,
Department of
Anaesthesia
Hope Hospital
Salford M6 8HD, UK
Sarah Bakewell
Consultant,
Gloucestershire Royal
Hospital
Great Western Road
Gloucester GL1 3NN, UK
\n \t
\n 
\t  
\r -
  -
   -
 \t. \n
\t  -
  -
\t  -
 \r 
 
 \b.
Š  
—   -
  -
,  
 
,  
 
\t 
, \t
, \t -
   -
   -
 ….
  , ‹ ­*  Š †

­\f \b \f  
\f-\r \r\f «»  
 \n \r\t \t \n
(”… ). …, \n  \r‡\n , €
 \b‡  \b \r \f,  
˜, \r , €  \r\b , \f
\r‚ ‡. „ \n \r\b-
  \r,  \b. 
ƒ  \f\b\r €  
\t \t \n — \f, \r
,   (… ). „ -
 \r\b \r‚ \f\n
 \f \b \r \r-
\r\n \n \r. „
 … ‡  €\r   \b
”… ,   € \n -
\t. „  ‡ \n \r
 €\t  €\t -
\r\n,  \b\r\n  \b\b\n
\r€. …\r\n ƒ\n \r-
 …    \t
 \r  , \r\r-
,  \r ‡\b €\b \r‡-
 \r\f€ .


‚
• …  \b-
  ƒ \r  € 
€\b \b\r  ”…   —
 \f,  ‡ \r\b€ -
  \n \r (€
\t    ”… ) 
\r\n \b\f, \n \r\n 
\r , \n\r\n ‡.
\f­\f\n‰\n€ \f\r‰\n€ ‡‡\fŽ\n
\n \t\n … € 
€\b \r\t \t -
  \f\b\r \n  \n\r\n
\r.   ƒ  \r
\n  \n -
\f \b  \b\f \n, \n \f ‡-
\b \r  \f\b\r Ž ,   \n\r\t
. \n \r \n€
\f ”…   \b\n -
\n ,   \r\b‡\t , 
‡ \t \r€\f \r \f
\r\t.    \n -
\n \r \n \b -
\f\b    € .
\r\b‘\f \b \f † ˜\f\r\n ™\bˆ \f\r‰\bˆ ‡‡\fŽ†
  \r \f\r\n\t -
\r, \t    ‡ \b-
 \b \b , \n\n
   \b\r.


‚
„  \t\r\n -
\n \r € -
€ €\n \f\n 
(\f\f\r\n \n), \n \r-
€  \n \f\f\r 
€\t €  €\n, \r
\f\f\r\n, \r. † ƒ -
\f\f\r\n \r \b ‡\r\n\t
ƒ  \f-‚.  ƒ -
 ‡ \n ‡ \r€ €
  (, ‚\r \r ).
 \n \r\n \r \r\b 
\r \f \f,   -
  \r‡\n — \r\b \n‚
\f\n , \r‡\n 
”… ,   €  \f\r\b.
…  €  \b-
\r\n \t  ƒ 
… \f\b \n \n\r\n  \r —
\b
 \b 

  \b \b 
 -
. „ \r\n   \b\b\n, 
 \b\r\n \r€.
 \r €\t \r … ‡
  « \n‡»,
\r  \r \b\r\t
\r\n \r\f€\t  -
 — « \r \b\f». \b\r
€-\b\t \n \n‡ 
\n‚ \r\n (\r‡\r\n\t -
\n\t ƒ)  €\n (\r‡\r\n\t -
\n\t ƒ) €\n \t,
€   \b\r€ €\f \n
 \r   ‡-
 ‡\n \f  \r\t \b\b\r\b-
.  \r\r\r \r \n‚ -
 ”…  \b\r \f
\b \b­€

\r
\f \r\n \t\b
Basic Sciences
\t.    \r€\t \r-
 (™“) ‡.
…, €   -
\n‚  \f ‚\t \r (\r-
€\t \f).   \r 
€-\b\t \n, € \r ‡-
 Ž  €\f \n  \r
  \r\b \b.  \r\r\r ‡-
  \n\r\t \n  ”… .

 



‚
 €\t,   €\t -
\r\n … \r\n \r\n \f-
\f\r\n \r, \n \b -
€   \f\f\r\n \r.
 \r, ,   \r\f \n,
    €  -
 ƒ\f \f. € \n
\n€ \f\b\b  \r,  
 
. \r‚ \f \r\b€ 
  \r … , \n,  \r, €
 \r‡\n ƒ\n. …, \r\b‡-
\t  \r Ž ,     €
\r \b€ €\n\t   \b\r -
. \t \n \r …  \n
\f\n, , ,  \r\n ‡\r\n, ‡
\n \n.
ŽŒ\n‘\f‡\t\n€ \f\r‰\n€ ‡‡\fŽ\n
  \t \b\r\t   ”… ,
€\t \r … \r  \t €.
\f\r €\f \r \r  -
 €\t €,  \r\f 
€\b \r\b  \r‚\t € \f ‡-
. “\r \t, \b \f\f\r\n
€ \r, \r‡\n  ‡\b€-
\r\r\t \r \f  \f \f
(\t \f)  \b  \f \f\b\f  \f
€\f  (T
).   \t \f,
ƒ \r \r\b  \r‚   -
 €\n \r\n \t ‚\n -
\r\n  (\t \f\t ‚) 
  € \f\f\r € \r\n -
\r\n  (\b 1). \f\r \r‚\t \t €-
 \f\b\n   \r\n €
(€ \f\f\r\n ), \r‡  -
 \r  ‚  \r -
    ‚\t\f \b  . 
€\t € \r \b  — -
 \b €\r \r\n \f\f\r-
\n \r, \n    -
\r\n    \n \r\n
\t (\b\n). \r \f\f\r\n -
\r \n€ \r\b  ƒ\n \f,  -
\n       \r-
   \r  \r — 
\b\f \b €\t  (. 5  \b 1).
“ , \f\f\r\n \r \r-
 ,  \f\f\r\n \n€ \r.
\n\r\n‡ŽŒ\n‘\f‡\t\n€ \f\r‰\n€ ‡‡\fŽ\n
 € \n \r 
”…   €-\f\n  \n .
\r\n \r \b €\r  €
\n €  \r \f. 
   III (\f\r\f\r\n\t), VII (\r\t),
IX (\n\f\r€\n\t)  XII (\r\b‡\t)  €-
\f\n . \r \r \r\b  \r -
  \f\f\r, \n,  \r, \r\f
 \r  \t\r\n \b\b — \r‡ 
ƒ\b \f\b. \r \f\f\r \f\b \n -
‚ \f\n (\r \n‚€\t \r€
‚€) \r ‡ \b €\n (€-
\t \b\n, \n \b\n).  \r€  -
€\f \r \f\t \t \n, -
€ \f\f\r\n \r €\r
\r, € \f\f\r\n.
 1.
‡\t \t\r  \t 
\r\t 
‹\r\nŽ \bŽ\f‘\f†:
1 — \t \b\b; 2 — \t \b\b-
; 3 — \t\r \b\b (\r ); 4 — \t-
\r \b\b (\r ); 5 — \t\r
\b\b,   \t \r    
\t\r \r; 6 — \t\r \b\b
 2.
‡\t   \t
World Federation of Societies of Anaesthesiologists
WFSA
\n \f\f\r\n \r \n 
\r\n ”…   \r\n \t \r-
\n  S
 \b \n \r€
\n, \n \r\b  \f\f\r, \r‡\n 
\t \r  ƒ\n \f.
Ž-\f\n \n III, VII  IX  \r 
 €   \r\n ‡\r,   
 \r\b‡\t  (X )  €-
 \r  \b, \r\f, ‡\r\b\b, \b -
\r\b ‚€  €€\b. \r\n (\n)
\r \b \n \r, € 
\b  \r\f \r €-
\t ‚, \t ‚, €\f \b\n  \f
\b\t \n (, ). 
\b\b … \r  \b 2.
\b\b ‡\b \b \r … -
€ \r€  \f \r€ €-
,  €, \r \r\f. ˆ\r€\n \n
 \f\b \n \r \r  \n‡
\t   €  -
€ \n \b\b. •‚\t \r\r\t
\r \r . \r\n\t \r -
 \n \f\r, \b\t  €-
 ƒ  \r ‡ (‚\r-
), € \r€  \t \r  
\r  \b \r€\n . Š\r
\r  \r, € \n -
€ \r, \b  \b (T
), \r
\r \f  \f \t, € -
‡ ‡ €\f \n  -
\f\b\t \f\t.  € -
  (\r\b‡\t )   \n
\t , €   \t
€\t \b\r  .
 



‚
\r \f €\n   \b\r-
\n  …  ‡\n ‚ -
,  \r \n  
‚  \t \t 
, \f \f\b\b \r  
ƒ\f \r \t \n.
   \r\b€ € \t\r\n -
\t, €\n ƒ\n … \n \t-
, \n \n‡ \t.
 \f\f\r\n \r €\f  -
€\f \r \b \r\r, -
‚ \f \r \n \n
(. ‡), \r  \f\n \f\f\r.
€ \f\f\r\n \r \f\r\n
 \f€.  \b -
\r    \r\b€ — \r.  -
\r,   \r   \f\b \r
 \b \b \f\b€\f   -
\t \r\n \r\r.  \f,
 ƒ  ƒ \t \b -
. „ \b\r \f\f\r\n \r
   , \r‡\n  \r
ƒ\f \f, — \n€  \r\n Ÿ- 
œ-. „ \b\r \b -
  € \f  \r -
€ \n €, \f -
  ƒ\f \t  \b€
 \n  .  
 1.
\n   \t     \t
„\t\t  \t\t\t ; ** \t  …\r\t \r…\t\t †.
‚
\n\r ƒ  \r
\f\r ƒ  \r
„ 
   
„ 
\f\r ˜\f
  ŽŠŠ
( š
Š… ŽŠŠ
„  š
( š
)Š…  
Š…  \r
   \r
\r\f\r
‹
‚
‚
\f†
‹
‚
\f­\t\f
\f 
†,    …
\f Š \b‘\b-\t›\f‘†ˆ \r\n\t
 \t
„ \t
Š \b›
\f \b
\f‘\f™
­
Š 
­
’\r
\b‘\t
Š 
\b‘\f‰\bˆ ŒŠ†\r™
\f š
Š \b›
\n\t\n
Š \t \t›
\f \t*
 \n
‚ 
Š  (\t),
„   …
 œ†\f \f \f†**
Š  ›
Š  

\r
\f \r\n \t\b
Basic Sciences
ƒ\f,   \r\r \r -
\r   ƒ \r-O-\r\n.
\n\t \r\b€\t  ‚ €\f \r
… \r \t  \f\f -
 €€. „ \r €  \n -
\b\r\n \rƒ\f€ \f\f\r\n -
€ \r \t \f. \b
\r €\t \n  \b -
€ \t  \r €\t \f\f\r-
\t €. “ , €€ -
\b \b — \f\f\r\n \r,
\n,  \b‡ \n\r , \n 
\r \r\r. “  \r \f-
\f  €€ \r  
 \n\t \f\n\t \f\f\r\t,  \r\f-
 \b\b\b \r\r\b \b -
 \r‚ € \r \b 
 \r.  \b, \n  € \r
€ ,  \r €€-
 €\r .
 € \f\f\r\n \r
\n‡ \r\r. \r‚ € ƒ
 \b\r\t \b\n ,
  \t  \r \f\r \t-
 \r\rƒ\t, \f 
€\t \r.
\r \r €\f ƒ \t-
\n \n  €\n 
\r-‚\t. \r ‡\f \r … \b\b
\r€\n \n .  \r-‚\t
, , ƒ\n \f,  -
, \b    \b\r\b\f .
„\n €\f \r … , \f\r\n -
, \n  -
€\f \r — \b\n , €\b-
\r\n  \r\r\b. Š  \r€
 \r \r \f\f\r\n €
\r, \b \n ‡\r\n. „ \r
\b \r\r  \r\b \t ƒ €-
 \b\n \n.


‚
\n\r   : Ÿ (\r)  œ
(). ‡\n\t  ƒ \r \r  \f\b-
\n: Ÿ
 ™‹\n-\r\f˜\fŒ\b\r† (¡)
\r-\n   G-

\n \n \r. † \t -
 € Gz \f\b\b G-  \r\b-C
 \n‡  \n‚  \r 
\r. \r\n  ƒ    -
\b‡, , ,  \f\r\t \b\b\r-
\b\n. ˆ\n Ÿ
- \n  
€ \b,  ƒ  \b\r -
  , \n‚ \f \b-
\f \r  \r 
   ‡ ‡\n \f («-
\r »). ˆ\n ƒ\f  \f\b \n
‡ \r\n  \n Ÿ
, Ÿ
 Ÿ
, € 
   \b\b\n    
\f\n.  \r Ÿ-  \n 
 \b\f \r€\f €   -
  ƒ\t .
 \r … Ÿ
-\n \r‡\n \f\r
\n   € \b.  \t-
\b € Gi \f\b\b G- , \f\b
\r\r\b, ‡  \r€-
\f ­‰  \r. \b\r ƒ 
‡ ‡ \n\n \t ƒ — 
\r\n \r, € \n\n \f\r
\n \r. \b\n\t \b\r ƒ ƒ
  \r (‡ \f\b\r) \r, 
‚\t ,  \b\r €\f .
 \f, Ÿ
-\n \r\n  \n
\r ”… —  €,  \r \f\r\b\f

(locus coeruleus)
  €\f ‡\r\b€. 
\r,  \r   \f\b\r\t  -
\r\b, \b\r\r\n   \n
.  \r\n Ÿ
- \n-
\n \r\f, \r  \f.   Ÿ
\n, Ÿ
-\n ‡ \f\b \n \r\n
 \n —   \r\b€  €\n.
\f\n-\r\f˜\fŒ\b\r† (¢)
„   ‡   \f\b -
\n \b\b, \n  -G.
\b\r ƒ  \n‚ 
\r\r\n, € \b\r€ 
­‰  \r ƒ\n \r. \b\b
 \f\r\n  œ-: œ
, œ
 œ
. …
\n\r  €\n\t ,  \f € \b
. ˆ\n œ
 œ
\f\r\n  
\r‡\n   (\r 85%). \n\b \r,
\f\r \b œ
-\n   «€-
\b» \b,  œ
—  «€\b», €, -
\r \r‚ \b\n.  \b\r œ-
\r €\t, \r\t —  ‡ -
\b\r  \r, € \n‡  -
  \r€  \b\r\t .
•‚  ƒ\f  \r €
 3.
\f\r  \t 
 \t
World Federation of Societies of Anaesthesiologists
WFSA
€,  \t € €
‡ \r   .
 \r€ \b\r \b\r œ
-
  \n‚ Ž  \r‡\r\b -
\b ƒ\b.  \n‚ \n‡  -
\f\r\b\r\n \r

   \b\r -
\f-\r\t \n. \b\r
- \n\n \r \f\r\n‚€\n
\r   , \r  \r-
\n \b\n \t (, \r \b\b-
\r\b, \r\f€ \b\r, \n \b\n)   -
\t  — \r‡\r\n -  \n\t
ƒ\n. ˆ\n  œ
\r‡\n  \r
‡\t   \b€\b  \f\b\r \r,
\r\b  \r€ ‡  \f.
ƒ‚ 

‚
„ \n \r  \b «\r-
\f» \f — ,    €
 ƒ\r\n \b\r (  \b 
  \b\b  \f. —
. -
). “  , \n \b , 

«\t»
, €  \b\r
\b —
«\b \t»
\t\b\b‰†\f \r\f˜\fŒ\b\r†
…\n \n \r \t -
\n \r\n, \n  \b\r \r\r
\r\f€    \r\b, € \n\n -
\r. „   \b\b 
 \f\n \f\f\r.   \r\r\n
, \r‡\n\t  \t \t
\r \t\n‚€\f , €
 ‡ \n \n,   
\n \b\b\n \r€   … .
Š‡\t\n\r\b‰†\f \r\f˜\fŒ\b\r†
­\b\n \n \b \r‚-
 ƒ,   \b\r -
€ \f\f\r\n \r.  
\n,  \n  G-  \r
   \b\b\n  \b\r\n -
\t  \n M
.   M
\r
 \r\n \r \r\t ‡\r\b  €
  . \n \b -
\n M
,  \n ‡ -
\r\n \n ƒ.   M
€
  \f\r\n‚€\n \r  ‚€-
  \b\r  \r\n ‡\r. ˆ\n
 M
\n\n \n‡ \r -
\f\n  €€    €-
\b \b\r,  M
, -\b, \n
\r\n ƒ\n.
‚‚
\f   \r\b -
\r\n \b  \r\t \b\f 
\t \n \f\r  \r\r \b-
 \r  \r \f. \n \r\f  \b‚-
 \b ƒ\t \n  \r‚ €
\r \r\f: \f \n, \n
     \t ,
\r\b \r \r\t \b\r  -
\n ,  €, \r \f\b\r -
€\t, \n\r\t  \r\t \t \r-
. …\n \r\n  \n
‡\r\r\n €\n ƒ\n  \f\b
\b \b,  ƒ ƒ\n  \b-
 (  \r\b€ \r \r\f€-
  \r  \t\n‚€\f \r).
… ‡   € \f\b
\b,  ‡ \r   -
,  \n\t ,  \t—
  \r€ , 
‡ «\r\f€\b » (\f-
\b ).  \r  \r €\n
\b ‡\r\f   €\r \b\r
‡\r\r\n ƒ\n \f   
\r.

\r
\f \r\n \t\b
Basic Sciences
‚\b\b\r\b \t\n†‰\n…\t
\n\b\t\n\t\b
‹ ˆ, ‹ ­*
* E-mail: carl.gwinutt@srht.nhs.uk
Clare Ackroyd
Specialist Registrar,
Department of
Anaesthesia
Derriford Hospital
Crownhill, Plymouth PL6
8DH, UK
Carl Gwinnutt
Consultant,
Department of
Anaesthesia, Hope
Hospital
Salford M6 8HD, UK
\b \f\r\n\f
\t -
  
\t  
\t 
\r, -
 \r -
 (\r\t…\t). ˆ
 
   -
\r -
  -
 \t.
‰   \b-
 \t-
  -
 
\t\t  -
\r \r
\t  -
  -
 \r,  …
 \r\t \r-
 \r -
,  
\t \t-
 \r.

‚


­\n \t\n \r\b \n‚€-
\b .  \r\f  \r
\r\f \f \f \f  
 (\n), \n, \f  \r-
\b  \f , \b €-
\r\b \b\b\r\b\b. “\r \t — \f
\r €  \b\r\n, -
‡\b \r .   -
\f 10›20 ;  \b‡\n
\r\t \r€\t,   -
\t € \r ª
(Schwann)
­\r \r€ \f \r \r,
 \r \b\r€  -
 \f \b\r,   -
€ \b\r\n \n\n — \n ˆ
(Ranvier)
, € € \r
\t. „  \b \n-
\t   \f \b\r
(€,
\n
).
‡\n\t \n\t \t (\t)
 \n  \r \n‚€\n \r-
, \b,  , \b\r-
 \b \b \b. \r€
\n‚€\n \r, ˜\n  \r
\t \t \n, ‡  ‚
 —   (€ €
\r€\r €\b \f\b\r -
, ,  \n‚ \f\r),  \r-
 \n€ (\r \f\b\n,  \b \n\t
€ \t\t — \n‚\n ).  
 ‡ \r \r\t \n‚\n 
\r‚  \t\n‚€  (…­ ),
\r\n ƒ\r\b   ƒ-
\r\f \f.
\f \n\t \t \f \n‚€-
\n \r,  \r   -
\n \r\t
(telodendria)
,  ƒ 
 ‡\f \r \b -
\r\n \b\r («\b\f\n» \r «\r\b-
\n»), \b  €\t  
\t \t \r\t. ­‡\b ƒ
  ‡\b \r-
\t \r\r 20 , \t 
«\b\f  »
\r
«\b \b 
„»
. †   \n \t-
 \r\r (•), \n\t
\b  \t  
\t \t \r.

 




­  \r \r
\n\r\t \r 
\r\n \n‚€\f \r.   \t 
 \r  \r\t   \r \r
3000 
.   \r  \f\r\b-
 \r  ‡ \f\t  -
€\n \r (\r\t). … \f \r
\r‡ \f €\r \n
\r\r\n  (1›10 \r), -
 ‡ \n\b \r 
(10
000›20
000   
). “ -
 € \r€\r\b
ƒ \n \t\n‚€\t -
€.  \r \t \t \r-
 ‡  \r\rƒ
(•„).
\r \n‚€\f \r \b\f -
\t \t \r  
€\t (\r\r\t)
\r.  ƒ  \r, \n\t
 \t \r, -
\b  \r \t, \n\t
 \r  \n‚, \b
\n‚€ .  €
 \r€   \f
\b\r\t \r\n \r  \n‚ 
  €\r\n\t \b\r, \b\n\t
€ .
ƒ



 ‚


\r\r \b  \r 
\rƒ- (\r-)  \r-
\t \r \n \t.  -
  • €  \r-
\r. \r- \b 
\b   \r\n -
€\t.  \r\r 50% \r \r-
  \r€\t ‡  
\t\t \n \f -
;  50% \b   • 
\r …­ .  \r \r‚ € \r
\b \b­€
World Federation of Societies of Anaesthesiologists
WFSA
\b  \f  \t  \r‚ \r‚ \f
€ \b  €.
•\r\r \b  
\r \n \t  \b \b‡ \b-
  \r \r  € \r-
€\f , \f \r\n \b\r\t.  -
\b\r \n\f     \r
…­  \n  ƒ\f .
 \r\r\n \f\b
\r\r  \n‚  \b\r .
 \n \r\b\r\n • \r 
\b\r \r\n \b\r\t,  ƒ ‡
\b\r ‡ \r 10
000 \r\b\r ƒ\f \t-
. \b\r\n \r •  \b€
\f\t-\t \n \f , 
ƒ   \r\b\r\n •   
). \r\n \r\n \b\r\n \r-
   \b    \f  \n-
‡ •. \r 1% \t \n\n-
  €\b \r \r\r, 
80% \f  \n‡    
(\r 20%) \r \t \b (-
\b) € . “€\n  ƒ €-
\t \f\b      
•  \b\r .
\n‡ •  €\b \r ‡
 \n\t  \r    
\n\t \b\r.  \n‡ \r-
\n \b\r, ‡ •,  
 ‡ \f\t \n -
\r \n‚€\t \r (MEPP —
miniature endplate
potentials
) \r\b\t 0,5›1,0 , \r\f€
\b \n  \b€\t.   \b\r-
 \f \b\r  \r\t  -
\r\n €\t \n \r‚ €\r \r-
\n \r P-, €   \r\r\b
\b\r \r \b \r. 
\t \r €\t -
\r\t \n    \r \b
 \r 100›300 \b\r  €\t
\t.   \r   €-
  \n‡, \r‡\n 
\r\n \r,  \r€  \t \n • 
€\b \r (ƒ).  -
 \r \r \t\n‚€\t \n,
€ \r \b\n  \r \t
(. ‡). … \b \b‚\n \b\r \n
\b \b\r\n  \f \b (\f\n\t  \n-
‡ •  ),  ƒ \b\n \b-
\n \f \b \r.  -
 \n\t \r\t ‡  \b ‡
10›60 ­ (\r\t)   € \t -
 \r\t \n \r ƒ\f ,
\n \f \t-\r\f \f
    .
ƒ‚

‚
ˆ\n €\t \n 
\t \t \r   €\b

\r
\n \r\r\n . … \f
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 \r‡  50 \r \r\r\n
. ‡\n\t \n\t  -
\r \t \r, \t   \r\n
\b˜, \b \r\b \b\b\b \b\f
\r\f \f  — \n
(\n\t \r). ˆ \r\f €\r 
 \b €\n \r-\b˜ (Ÿ), \t -
(œ), \t \f- (¢)  \t ƒ\r- (¬) \b˜\n.
 \r ƒ\r-\b˜\b  ¢-\b˜.
  ‡\f  ƒ \r, \t
 \n‚€\n \r, € \r\n\t \f.  -
     \r\t \r€\t
\n  , € \r‚ \f € \n\b-
  \r€ .
­\r\b\r\n • \n  €
\b€  Ÿ-\b˜,   \b\r, € 
\b˜\n \n,   -
\n , € \n
\f \r \f  1 \r\r\b\b. \r \r\f€-
 ‡  ,  \r€\b \r 
 ‚ ,   \f ƒ-
 \f   . „  \n\n -
\r,  ƒ  \r  
\r\n  ‚  \b‡  \b-
\b.   ‡ \f ›50  ( 
\r  ›80 ) \n \r-
\n \n \r\n, € \b\r€ 
\r  \b \r \t -
\t \r  50›100 .   € ƒ 
 1.
 
 2.
\t 

\r
\f \r\n \t\b
Basic Sciences
\b \r \t \n‚€\f \r, €
  . “ ,  \n\b-
  \r \f \b\r\r  \r€\r -
\f \b\r. \r\r\n\t   \r
 (\b\t€  \b‡).
  €\t \r \t \r-
 • \n \f\b \n ‡ \b‡\n 
\r \t\n‚€\f    ƒ \r\b€
  «ƒ€ \n» \r
 \r\n \b\r — «€-
 \n». „€ \n -
\f\b \n \t\n  \r \b€  \n‚€\n
\r  \n€ \b\b  \t €\r
\r€. …\r‚   \r-
 \b\f \t \r   €\t
. \n\n  ‡  ‡-
\f ‡ €\r\n \b\r€ €\r
ƒ€    \n‚€-
\n \r. „    \b\b\b, -
\b \r \r\f \r ( ¬-\b˜
\r\n ¢-\b˜\n), € \n \r
  \r\f€  \r\f€ \t.
 €,  \r€ \n‚\t €\b\r-
  \r\b \r  ‡-
\t —  \r\b.
 € \n, \r‡\n 
\r \r\n \b\r\t (\r\b), €-
   \r‡\r\t \t .  €
\n \t\n‚€\n  
\n •  ƒ  , € \n\n
\b\r \b \t  \b€
\n €\f ‡. „ \n \f\b
‡ \f \r   «», \n\t -
\r€  \r  \r 
•   \r\n, \n\t \r\b
\r.
ƒ


\n \b\r •  €\t \r \f
‡ ‡ €  € ƒ-
\f \b •- — \r \f 
‡ \f \r «\n\r€\r» \n‚€\t -
. „ \b\r \f  \f\r
•   \r    , 
 \r\r
ƒ\t (•„). \n\t
 \r\b\r\n •„   : \n\t —  \f\r\b-
\n   ƒ\n\t —   .
\r    \r\f  
\n\t ,  ƒ •„ \r\b  -
\b \n\t \r.  \r ƒ\f \r
\n\t
\n\t   \n\n\t \n\t
\f\r    (\b\b\t \r\n)
   \f  \n\r \t \b.
­‡   ƒ\f , \b\b, €
      \b\b -
\r \n‚ 10
000 \r\b\r \r\r.
 •„   \n‚€\n \r, 
  \r  ,   -
\r\n   \r\r\f\n \r, \n
 \r\t \t. \r\rƒ ‡
\n \b‡  €\t \r  \r
€ \r:   € -
 \r\r  € 1  \r \f \n‡-
. “ , \t € \r\r-
\n\t     \n\t ,
\r €\f \r\b \n \r, -
 \r\b   .
 3.
Š  \r
World Federation of Societies of Anaesthesiologists
WFSA
\t†\n \n† \f\t\b\f,
\t\f\b \b \f\r\b
* E-mail: danfreshwt@yahoo.co.uk
Daniel Freshwater-Turner
Registrar in Intensive Care
Medicine,
Royal Brisbane and
Women•s Hospital
Brisbane, Australia
Richard Green
Anaesthetic Specialist
Registrar,
Poole General Hospital
Poole, Dorset BH15 2JB
Bruce McCormick
Consultant Anaesthetist,
Royal Devon and Exeter
NHS Foundation Trust
Exeter, Devon EX2 5DW
\n \t
‚  (Na
  (K
) -
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\t 
  
\r -
. ˆ 
\t  -
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\r   -
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\r\t …-
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‚  -
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,  … \r-
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\t  \r-
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-
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‚ -œ*, \f ­, † \t
 





™  ƒ\r\r\n \r\n
 \r  () \f-
     € -
.  \r \r ‡\t € ,
\b‡\t ƒ\n, \r\r\r
(\b\r€) ‡ (†”™) \r€-
 \b \r,  \r ‡-
 († ™) \r\f ‡\b \r
\f,  \n \b.
 \b\b  \r, † ™  †”™ 
  ‡\b ƒ -
  \t \f € -
\r\t. †\r ‡  \r
\b ƒ\r\r\r\b (\r€\b)
‡ („”™).  \r€ \n -
\r 60%  \n \r \r\f €\r
(\t ˜ \n () = 42 \r  
70 \f).    \f ˜ -
  †”™ (28 \r)    —  „”™
(14 \r). \r \r€ ‡ -
‡ ‡ \n \r  † ™ ( €-
 — 10,5 \r)  \r\b ( € — 3,5
\r) (\b 1).
 ƒ\r\r\r\t ‡ ‡-
 ó\r‚ €  \f,  ƒ
 \f  † ™  \r .
…\t   \f\b  
€ \b \r\r, \f  \r\b-
 (\r ‡\n\t € \n\t
 \r€\t ‡)  -
 € \r\r\b \b. \r\b
 \r  \b 
\r  (\r-
  40 \f/\r  10 \f/\r -
)  \b\b  \b\r€ -
. “ \r \f \b‡
‡  \r  € €\f ƒ-
 \r\b.






˜ \b\t  \f ‡-
 \r‡ \b\r ‡\b -
  ,  ‡ \r\r\n
.  ‡\t ˜ ‡ \b
, \n  \f\b  ‡-
 ƒ\r, \r‡ €, 
\t\t , \r\b  
,   \r. … ,
€     ƒ\r\r ‡
  \n \r\f€ -
, ,    .
 1.
 \r     \t 70 
\b \b­€

\r
\f \r\n \t\b
Basic Sciences
‚ 
‚ƒ 


\r‡\n  \b †
\r\r\n \r \t , -
 \r \r\n \r\b\r\n, \n -
\b  \n   \n , 
ƒ\b \n  € \r\b\b
\b. …\r € \r\b\n \r\r-
 \r 0,9%  NaCl,  \f\r\n 
 • (ˆ\f \r). ‡ ƒ\r-
\r ( \r/\r), pH  \r (/\r) -
\n  \n  \r 1.
  \b  0,9%  
\r   • \n \r
  ˜ \r€\t ‡,  ƒ 
\b\b  
€  -
\f ˜,   250 \r   1000 \r -
.
 \f  \f\r\n (€\t
 «»  \t  ‡ -
 €) \r \f ‡ € €
 \r\n \n‚\n   «»,  -
 \r  . “ ,  \b-
\b   \r‚
€  -
€\r \f ˜ (  \r‚ 83 \r 
1000 \r \t ‡).
\b  \b †
\r\r\n ‡ \b\n \r\b\r\n, \n
\f\n  \r,   \n \r\b-
\r\n     . \r\r\n
 \f\b  € \r\b\n \n
 ƒ\b \b   \b\b-
 . ‡ ƒ\r\r (\r/\r),
pH  \r (/\r) \n \r €
\r\b\n \r\r \r\n  \r 2.
‡\t (\t , Gelofusine, Haemaccel)
\n \r\r\n \r \r, -
\r\b€\n  ‡\r, \n\t,   €, \n-
\r  \r\r\f.  \r\b\r  ‡-
\r \r  35
000 \r (\r,
\n.
 \r « \t \n», 
\n
 \b\f\r-12 (
), \n\t  \f 
\n 12). ™\r\n   \r\b\n 
\b\b \b\r  3 €  ƒ\b-
 €. \r€   
€\t 1 : 13
000. ™\r\n \f\b \n \r
 \b   \f\b\r \b ‡-
 \b   \r\r.
­\r\t (\t , \r\t-40, \r\t-70)
 \r \r, \b\n
 \n  \t \t
Leuconostoc
mesenteriodes
. ­\r\b\r  -40 -
\r 40
000 \r, -70 — 70
000 .  
\r\b\n  \b\f \b\r \b\r€ 
\b\r€  \r\b\r\n  \b  15 \b
 \r \t. \n  \t \r\b\r\t
\t ƒ\b € \b 
 , \f  \b\n \r\b\r\n -
  \b \b\r  € \r \t.
Ž \r\t  \r 
\r 1 : 4500.
\n  \r\b \r \r
˜ \b\f \b\r,  ‚\r  -
  €  \r ƒ-
\r€ \r‡\t  \b\r€ ˜
, ‡    \b‚ \f\f
  ƒ.  €\n ƒ -
 €€ € (\r \b-
 €€\n \r), \r  \b\r\n \n
   \f\b  \f\b\r.
 (\t , \r (), Hetastarch)
„ € \r\r\n  \b\b\b,
\b  \b\b\t \f\r\f,    \t
\r\b\r \f\r\n (� 90% \r). \r\n -
 \r\b\r\n  \t \r\b\r\t \t,  ƒ
\r\b\r\n \r\f  ( 50
000 ) ƒ-
\b €,  \r \b\n \f -
\r\b \f\r\b \f\r\n \t  \t
\r-\r\n  \r\b\r ‚\f , €-
\f \r €€\t ƒ.
\r€    € 
€\t 1 : 16
000. …€\r \b\b‚ \n-
  ‡ \b \r \b \r‚
˜; ‡    \r \b.
   \r‡ \n‚ 20 \r/\f (1500 \r/\b-
 \r \b‡€\n \f \r\r‡).
ˆ\r   \r \t
ˆ €\r€\f \r\b \r\b€  \r-
\n €\r \b   \r\b\t
 1.
Š   
 2.
Š   
\f  
HCO
‚\r
aCl 0,9%
154
154
308
 œ\t\b\n 5%
280
 œ\t\b\n 4%,
aCl 0,18%
255
\n‡‰\b\r
\n\rŽ\n\n
131
278
\f  
‚\r
\f \b‹Š
154
0,4
0,4
125
0,4
279
7,4
\fŽ\n˜\f ™
145
5,1
6,25
145
301
7,3
\f\t‡\r\n-70
287
3,5–7,0
 ™“ŠŽ 4,5%
100–160
100–160
270–300
6,4–7,4
World Federation of Societies of Anaesthesiologists
WFSA
\r\t \r \r \b‚  €
\t. Ž\r€\t \r\b \n\b  
4,5% (40›50 \f/\r)  20% (150›200 \f/\r)   0,9% -
  \r. “  \r\b-
 \r\r  € \r\r\f  \b
  \f\r\b\t \r  \r‚ \f
 (, ‡\f),  ‡  \t
 \b \t.


 
  
ˆ\r Na
 K
‡ \n \r
 \r‡ \r — \f  
 \n  \f   
\b\f\f, , ,  \b\f  \n -
 \f    \f. …\t -
\r \r\b  „”™, \f  
\f  \r \r 140 \r/\r, \f
 \n€ \f  \b \r \r 10
\r/\r. …, \r\t \r \r
\b\r€\n   \t, \r\r-
\t \r 150 \r/\r.  \r\b \b\r€\n\t
 \r \r‚ \n ,
\r\t  \r \n -
 \f. ‹‚ \r 1%  \f ‡
 \f   \r\b, \f \f -
 ‡  \b 3,5›4,5 \r/\r.
\r€  \t\b   ‡\b
\f\t \r †”™  \f\t  „”™.  -
 \b \b  \r\n \f\n -
\r\b\r\n, \f   \r \b\n \r\b\r 
‡\n €.  ƒ\b Na
 K
\f\b 
\r‚ € € \n \r.
 ‡ \f \r‚\b €  -
  \r \t  \r Na
  \r K
. \b\n \r \f\b  
, €  \n ‡ -
  \b \r  \n \b\f  \r  \f-
\t \r \t.    \n-
\t \f \t Na
 K
‡
 € \n Na
›“‰\n — \f
\r, \n\t \b   Na
 \r-
     K
\b \r.  €
 ƒ\f \r ‡ ‡ -
\r\n\t \n\t \r  — ƒ \r-
   \r‡\r\f  
\b‡\b  \r€\t \n.
  Na
›“‰\n, ‡\t -
\n \f\n \t,  \f \b-
\b \n \n \r \f ‡-
 Na


 

 ‡ ˜ \b\r\b\t \r\n -
\r ‡ \n \r \f,  
\n\t ˜ \r\n \n \r  -
\r\b \b \f. ˜ \r\n -
\r ˜\b „”™,    Na
\r \n
\r€\n ,   ‡ Na
 -
\f \r ˜\b „”™.
 \n \r\t  € \r  -
‡ \r Na
,    ƒ \f \r€-
 Na
,  \b  \f. \r\f€\n\t
\r \r\f \r \f \b
\n \r ‡ Na
(   ˜
\r\n) €.
\r‚ € \r\b\f € Na
(99,0›
99,5%) \b  \r\n €€\n -
\r  \r \r. „ € \f 
    ‡  \f\b . Š \r
\f\b \r \r‡ ‚ 0,5% \r\b-
\f Na
, \n\t \b  \r\n -
€€\n \r  \r\n \b€. †
ƒ \r‚\t ˜ \r \f\b \r -
‡ \t  \b, \r ƒ   -
. … \r ‡\b ‡\t  \n-
  \n \r \r€\n \f\n.
\b\rŽ\b†, Œ\b‰†›\nœ’\f \r\f\n“‡\b\r“˜œ \n\r€
ˆ\t\t
\n\n \f\r\b\r\n 
€.
\n‡ \b\r\b:
\n‚\n\t €\t \b,
‡ ˜ \r\n,
\r\n \f\r\n,   PGE
… \n\n \f \b\r\b\f ƒ 
‡\b Na
,  \r \r€\n 
-\f-\r\t \n.
‰\t\t\t-II
 \f \f \n‚    \n-
‡ .
  €, \b\r\b \n‡ \r-
.
\f-II ‡ \n‚ \b \n
\r\b€\n \r. „   \b\r€
 \r
 ,  , \n‚
€\f  ‡ \f€\f -
\r  , \b\b\r\n \r\r.
€\n ƒ \r \b\r -
 Na
 \r\n \r.
‰\r\t
\n\t \f, \n\n\n\t   -
€€.
‘\r €\n \b   \n
-\f-\r.
\t\b  \r\n \r\n  \r-
\n \b€ €, \n‚  Na

\n (\r‚ Na
, € \n).
\n‡ \r ‡ \b
\f\r\t.
‰\t\r \t (‰­),  \t\t-  \r\r\t
 \n\t \f \t \r \f, -
\t  \n \r \f\r\b.
\n‡ \f \f \f\b\r\b \b-
 \n :
\n \f\r\b, \r\b
 \r \r\n.  

\r
\f \r\n \t\b
Basic Sciences
\r ‡  € \n-
‚ \r ‡ \b .  \n‚
\r ‡ \n\n \r €\b-
 ‡‡\n;
\n  \n \r, €\b-
\r\n  ˜\b \b\r\b\t .
\r \n\n €\r \n‚-
  .
\n\t  (, \b\f€ -
‚\r) ‡ \n\n \n‡ .
\n\t \f \b\r\b \b 
\n  \r\n \b€, \b -
  €\b.
 \r‚\t  \n\n  Na
 ‡ \n \r \n‡.
\t\b  ‡ \t \n \f,
‡ € \r   Na
 \r\b€ \b   (\n\t
)  \r  -
 €\b, € \r \b\r€ \b-
  20 \r  \b.
\b\rŽ\b†, Œ\b‰†›\nœ’\f £\t‡\t\r\f˜œ \n\r€
\r\t \t\r   (, ANP)
\t \f, \t\b\t  \n-
‚\n ƒ.
…\r‚\t , \n\n\n\t \t -
     ‡ \r \f-
\r.
 \n‚ ƒ Na
(, \r\r, \n)
\b \b\r€  \r\b€\t \r-
  \r\n  Na
 \r\n
\r\n \b€ €.
† \n, € ‡\t ƒ \f\b \n-
 € \n, \n\n\n \f\r\b-

(\r \n  — BNP)


 
…\r‚ \n‚ \r\t 
\r ‡ € \n  ‡\b\f‡.
  \n‚  \r  \f
    ‡ € \n -
 \t €, ƒ\b \r‚ €
 \b\r€\n\t \b. \f € \n
\n \r  \f \r  ,
 \n‡  \r.
\n\t\b\r†, Š‡ ‰\nœ’\f Œ\b‡ŠŒ \f\f \t\n € ‰ \t \f\tŠ
\t\r\t
 € \n‚  Na
›“‰\n.
‰\t\t
  \b\r -.
‰\r\t
\n‡ \b\r\b    \n‚-
 \r\f \b \r.
pH 
  ‡ pH \n H
  \r\b. Š\r
\n‚ \b H
\b\r\r \r
\f€ \r (, \r),  -
\n \n   \r\b   
.  \r  \r -
\f€ \r (, HCl),  \f-
€ \n   € \b.  ƒ
\r\b€ \r \r‡\n \n \b\f\t  \r
‡ ƒ\r€\t \t\r,  
 \r€ K
\b \r \r‚, 
 € ƒ\f  \n€   . 
\r‡\t \b, \f  -
\n‚ pH, \r \n H
  
\n \r.
 \r  90% ‡ \f\r-
\f \r ƒ\b €,  ‚ €
€ ‚€.   90% \r\b\f \r
\b  €\r\n \r \r\n -
€€\n \r,  ƒ \r \r -
\n \r ‚\f  \f\r\f \r.
\r € €€\t ƒ K
\r\b
 \r\n €€\n \r  \r-
\n \b€.
 \t € €  Na
€ -
\r\n \r\n € \b \r Na
›“‰\n  \r\r\t  \r
,  , \b\r K
 \b\b\r\t
‡   \r. \n\t  \b\r-
 \r\n ƒ\r€ \f 
\b\t ‡ (  Na

\b  \b\b\f ).  \b, \f
    \r, K
›“‰ 
\t   \r € \n -
 \n K
 \n H
. „ ˜ \r€-
\t \r\r, € \t  \r\r \b-
\b  \r.
\n\t\b\r†, ‰\b \fˆ‡‰Šœ’\f \n Œ\b‘\f‘†ˆ ­\bŽ\f\b‡\n \t\n €
‰\r\t
 \n‚  Na
›“‰\n  \r-
\n €€\n \r  \r\n \b€-
.  \b \b\r\b \n
\b \r.
…
\t\b   ‡ \r\n €, €  \r-
. \n€ \r\b €€\t
11-œ-\f-\f\f\t,  
\n€ \r€ \f\r \n\t
 ‡ \n \f\b‡, € ‡ \r\b‡
€\t \f\r, \r\t  \r€
\n \f ( \b‚\f).
 \t \f\t  †\r (\t…\r\f 
\t\b\t\t \t)
 \n‚\n\t  «\n\n» \r  \b‡ ƒ-
\n  \r\n \n K
, \r\f€ \r-
\t‚  \n  \f\b .
€\t\t  pH
  H
 \r\t ‡.
\r\r \n‚  H
,  -
, ƒ K
.  \n\n -
\r‡\n ƒ\n.
World Federation of Societies of Anaesthesiologists
WFSA
­
 \n‚   ‡  \r\n
€€\n \r, \b\r€  \n \n\n-
 \r (  \n‚).
 \r\n \b ‡  K

\r\t \t € \r \r.
\r\t\f \b (\r, -
) \r\b  Na
 €\t €
\r\n €€\n \r  \r\n
\b€. “   Na
 \r\b  -
\r\n\t ƒ\r€\t \f \r\t
‡, \b\t \n K
, \r\t
\f \b ‡ ƒ \r.
\r \r \f \r-
    \r\b  Na

ƒ \r  \r\n \b€.

‚ 


   \f ‡ 
€  .
\b\rŽ\n ™\n€ \b‡Ž\b €\r\b‡™ ž Œ‡\f‰ \b­Œ\b\n\r\fŽ€
 \r ‚ , -
   \b\r€ \b\f 
\r\n (\b\r€ \r€ \r  \r).
Ž \f   \f\f\r
\r .
†‡\b\t\n€ \b‡Ž\b €\r\b‡™ ž \r\n‡ \b\t\n˜\b\n€
­Œ\b\n\r\fŽ€
  \r€  \r € -
\n , \n  \f\b \t €
\r€\b \b.
­\f ,   € \r ƒ\r,
\f\b   \r\b  \n\n \f€-
  \f \r.
   \b   \n  
€ \b\r \f\r  ‡ \t
\b \r,  ƒ   € \r-
€\b \b, \f\b \r\b  «»
\t \r\n .
 \n\t ƒ   \f -
  “ˆ - (“ˆ  — \b-
\r  \n. —
. .
), \f
\f\r (\r  \f\r\n)  -
  \b \b\r.
\t\n€ \b‡Ž\b €\r\b‡™ ž ‡\n€ ­Œ\b\n\r\fŽ€
† \f \f \r \f-
\r\n . \r\b ƒ 
\r \r€\t \b .
  \r\f  \t\f
    ,   \n,  -
  \r \n‡\n.
ˆ   ƒ\r\r  \n €
€ \r ‡\r\b€-‚€\n\t .
\n€ \n  \n  \r-
 \b \r \f€ ‡,   \r-
€, € \r \r -
\r.
 \r\n ‡  \r \b -
  €: \b  30 \r/\r \f 
€€\n , \f  \b \r 30
\r/\r \r\b  € \b‚
 \n €.
 \r\f  \t\f
…\r € € \b \f\r\n
\r\n.
­‡ \r \r‚ \n‚ \r -
‡ ˜ \b\r\b\t ,  ƒ 
  \r€ \r\t, \r€
\b .
…\r € € \f  — -
 \r \f€ -
.
…\r€ \f ‡ -
   \t  
(SIADH). \r  \f \f -
 \r€ \b €, \f, -
€€  \t ‡\r\n,  ‡ 
\b.
  \r\f  \t\f
•\b ‡\t   \n,  \n
 \r‚\t .
 \r  ‡   \f-
 \n‚.
 €\n \r ‡ \n\r
\n  \n€ € \r\f \f\b.

‚ 


  \r \r €-
\f \b\r \r  \f, \r (€\r-
 €)  \b\r €\f \b\r \n
 \f.    \r\b€  \f\t, ‡
 \r€\t \b .
Œ\b‰\b \fŽ‘\f‡\t\n€ ­Œ\f\r\n\r\fŽ€
    ,   \n, 
 \n \r \n‡.
­‡ \n \r  \b   €:
 3.
  \r\t
…  \rƒ  ( )
…  \rƒ 
(† )
‡\r \rƒ 
…   \rƒ 
€ 
‚\b \t
Š \b\r
 \t \r -
 
‹
\t 
\f
‚
…
 
\t
 
­\r\t
Š\t   ‡‚­
  \r\r
(   ‡‚­)
  \r\r
\n \r 
   \r -

‰  
\b \t
™

\r
\f \r\n \t\b
Basic Sciences
\b  30 \r/\r \r\b  -
€€\n €, \f  \b \r 30
\r/\r \f  \r\n \b‚.
\n \n \r  \f\b \r\b€ -
 \r€ ‡ \r   ,
\r      \r-
€ ‡.
\b\rŽ\b‰\b \fŽ‘\f‡\t\n€ ­Œ\f\r\n\r\fŽ€
  €€   \n.
­‡    \t \n
\r  \b\r €\b ‡‡\n, \r
\b ‡\n  \r\n \r\t.
Œ\f\r‰\b \fŽ‘\f‡\t\n€ ­Œ\f\r\n\r\fŽ€
…\r  ‡   €
\b\r \n  \f.
€ €\r ‡, € \b\f  
\f.

‚


\r   \b\r -
 \r \b \r \r, \r €,  \b\r-
 \f  \r  \f. †\f \n
€\n \f\b €.
\f\r\fŽ\f’\f\f \t\n € ‰Š\r™ \t \f\t
†\n \b\r (ƒ\f\f \r ƒ\f\f).
\f\n œ- (  ƒ\f-
\n \r\n \r ƒ\f\n\t \r\b\r).
  \r\r.
 \n‚ \b \r\f pH.
“’ˆ \f‹˜ \t\n € ‰ \b\r­\nŽ\f
­‡   \b\r \r ‡\f -
\b\r, \r \n‚\n .
Ž\n \r  \f\r, 
\r€ \r,  \r 
\r‡ \r  € \r\r\f -
: ƒ\b \r €  \b \r\t, -
 \r\f\r.
†\n€\n  \f\b \n €€\f \r -
€€\f ‡.
\t \t  ……:
  \b.
†\n \r.
†\n \f\r.
 €€\n\t \r\n\t ,  I  II.
€\t  — \f\r \n\n
€\t \b, \n\n\t \r\t.
ˆ — \f\r    \b\r
 \r  \n ,   \b\r
 H
 \n, \t  \r€\b
\r\r\b  \n‚ \b \r.
\f.
ˆ ‡\n ,   \n

(Bartter)
 \r
(Gitelman)
€\t \t \t  ……:
…€ \b\r.
†\n€ \r.
•€ .
‰\b\r\n ‡\r\b€-‚€\f .

‚ 

\r ‡   \b\r \n-
‚ \f \b \r  \f \r \f
 \r  \b\r€\f  
\r€.
Ž\f’\f\f \t\n € ‰\b ‰\f\t \f\b‘\b\f Œ\r\b‡\r\n‡‰\b
 — \n H
\b  \r, 
  K
 \b\r,   \f\f\r.
\r\b , €   € €-
  \f\r\b   \r.
† €\n \f\r —  -
\b\r \f Na
›“‰\n.
œ-\r\n — € \r \b \n‚-
 \r.
‰€ \b‡ — \r\t \n  -
\r\n \n‚  \b\r  .
 \b (\b\r\r). ‰

\b
\r
 \n\n \n \r  \r\n
\n‚  €\t ,  \r
  \r .   -
 ‡ \n ˜ \r\f \b
\r  1,0 \r/\r. Š\r \b  \b‡ 
\n\t \b \r,  ƒ\f ‡ 
€\n \r  \r\t -
.    \t \b\b\r\b\t
\n€\n \n \b‡ \r\r\n
  €\t \r ‡\n 
\n   \t 
\n‚€\n \r (ƒ€ -
\n).  \b  \r\n -
,    \n\n \n \r, €
€   \t \f\r.
“†\b‘\b\f Œ\b‡ŠŒ \f\f \t\n €
ˆ\b‚ \r,   \f\r,
\r \r   \f 
 \r\f€\t \r\f.
 4
  \r\t
…  \rƒ  ( )
…  \rƒ 
(† )
‡\r \rƒ 
…   \rƒ 
   \t

 \t
\r
 … \r
‚/
…

  (-
  \b
\b\t)
\t \r
  Na
 \r
Š\t ‹
Š\t ‹
\n \r , NaHCO
‚  \r\t \r -

World Federation of Societies of Anaesthesiologists
WFSA
…\r € \r\t‡ -
 \r € ‡\t €\t \f-
\r \b \f\r\n \r\n.
\n\rŠ›\f\f Œ\b‘\f‘\bˆ £\t‡\t\r\f˜
‡  \r\b€\t \r —
€€ € \r \r €-
\t €\t \f\r.
­\r € — ‡
  €\t €€\t -
€, \f€ \f\r-
 (€€\n\t \r\n\t ,  IV) \r
  ,   \f\n  ‰,
\f\n  \f-II \r -
\r.
\r\t\f \b (. \n‚).
 € ‡ € (  -
\r\n\t ), \n\n ‡ ƒ
\r  \r\n €€\n \r  -
\r\n \b€.
‡\f‰ \b­Œ\f\r\t\n \fŽ€
Ž € \r‡\f \n‚ \b \r.
…\r €   \f\r
in vitro
\r
\r\r ‡ \b  €
   .
  ‡ \r \b 
 €\r\n \n‚ \b \r\t
\r  \r  \r ƒ
\r   \r\f \r.







 \r \r \n‚ \r ‡ \r-
\f \b Na
\r K
 \f   -
  ƒ \t. …, € \t
\b Na
‡ \n \f\b  \r -
€\n , \r   
,  € \r .  \n
‡  \n  €\t €€\t -
€ \f\b  \r \f\r,
\n \r \r\n  ‡   -
€ \r €.   \f€\n,
€ €  ƒ\r\r, 
\n  \r\n \n \r\n \r\f€-
 \n \b‚   
 ƒ \t.
­‡ \r   \r‚ \n
 ƒ\r\r\n \b‚\t.   
‚    ˜   -
  \f , \b\f \r€,
 \r‡ \r\b\t .
\r\b€‰ \f€  Š‡\r\n\f\f ­Œ\b\n\r\fŽ
…\r    \r -
\r 135›145 \r/\r,  ‡   125
\r/\r \r \n‚  150 \r/\r €  
\r.   ‡ ‡ \r \n‚ ƒ -
\r  ‚, \r\f, \r  \b-
 .   Na
\r 160 \r/\r \r 
110 \r/\r  \b\f,   .
  ‡ \b   \r 
\b\r \b \r, \n\n  \b, €
\r  \r \r \f\r\f \f. \b\b
\r , \n‚  \r‡\t
\f \r  \r€:
ˆ  \f \f€\f 
\f\r\f \f \n‚ \b \r\n \r-
\n, ‡  \b, \b ‡\r\n ‡,
 \n, \b \t  \b   \f-
\t.
   \r , \r\f\r, -
  ‡\f \r \f\r\t \n 
 €\f \r\r  €
\n\t  \f.
…\t \r\b\n\t  \r, €  -
\t   \b\b \f\r  -
‚ \r€ .     -
\n \n  ‚  \f€
 ‚\t \f ( \r
 €  48 €)  €\t \f.
 \f€ ‡  ‚ \r€
ƒ \b \f\b \r\n.
­\f \r\r €, €  \f-
,  \r  (,  -
 \r ), ‡ \n -
€    \n ‡. \n
  \r‚  , \b \n
 \n \f,  ƒ  \r
\r ‡ \t  , 
\t  €.   \b -
  \f  2 \r/\r/€ €-
 \t  €\r ƒ \r€ 
‚\f .  \t \b 
  Na
� 135 \r/\r ‡ \n -
\t,    \r \r‡ \n \n\t,
\r \n \f ‚\r.
­\n \n\t  \r€  \b-
 /\r \f€\f  NaCl, 
ƒ  Na
\r\b ‡\n\t €.
‹€ €\t \f ‡ 
 \r€ \r \b .   \r€
 \b \n   10 \r/\r.
 \r ƒ\f   \r‡ \n
\f€ 1,5 \r/\r/€   \r € 8 \r/\r  \b-
.  \n €   
 12 \r/\r  \b.
  \r€ \n  \r‡ \f-
€ ‡. … \f\b\r\n\t \r\f€-
\t ;  ƒ\r\r  ‚\t
  ‡\n 12 €.  ‚ \r\f-
€\f \r€ ‡ \r €\b \f
      \b.  \b-
\b \r \r\f€\f \r€ €\t \f-
, , \b\b \r \r\n
\f\n  ( \n\n \b).
  \r\b€  \r€ \f\r -
€\r  \r‡ \n \f  
0,9%   \r. „ \b \n\t

\r
\f \r\n \t\b
Basic Sciences
\n , \n\t \b\r \r ‡\b -
  \t.    \f\r\t \r -
 \r \f€ \b\r ‡ 
\f, \f€ \b\r \r\t  €
\r\n \b. \b ‡ \f\b -
 \r\n  \t \f\b .
• \r \b\b‚  \b 
 €\t \f\t € \b\b-
, \b  ‡ \b 
\r\b € \r\n 
\r \r\n \b\f€ ‚\r.
‡\r\n\f\f ­Œ\f\r\n\r\fŽ
€\r    
˜ \b\r\b\t    0,9% -
 NaCl  €  \f\r, 
 € \f. “‡ 
\r €\b  ‡  \b .
\t  \n  \f ‡ \n -
€   \b   \r   \b-
, €  \r 60% \n \r.  \r\b€\n\t
€\n \b  \r‡ \n \b  -
 5%  \f\r\n,  ƒ \r \r\b-
€\f ˜ \r‡ \n   € \n
12›24 €,  ‚ €  € \r\b
24›36 €.  \r\b€ \f\r€\t \f-
 \r  \r \b\r \n ,
\r €\f \r\b \r\n \b \r \r
 \r\b€ \b €.
\r\b€‰ \f€ ­Œ\b\t\n \fŽ
\r€ \r \f\r 
  \r  \r. …\r\n\t \b-
 \r 3,5›4,5 \r/\r,  \b 3,0›3,5
\r/\r €  \r \t -
\t.   \b  3,0 \r/\r \r \r,
\b\r  \n. …‡ 2,5 \r/\r \f\b -
\r \n \n‚ (, \r -
 \b\r€   €\t \f\b), 
 \b  2,0 \r/\r  \t
\r€, \t  \f  \b‚ \n.
   \b\b\t \r\t -
\r\f   \n  \b\b
‡  \b \r  3,0 \r/\r.  \b -
  ‚€\t \r ,  €\t
€ \r \r‡\r\b€\t €-
 \n‚  \t ‡  \r‚\t \r
\b\t \f\r. €\r  „ \r
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(€
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\r.   ‡  \r \b
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20 \r/€,  ƒ \b \n\n\t -
\f €\t \r.
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5% (š 175 \r); ‡  3,0  2,0 \r/\r \f
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\r € €   \f,
\b \f ‡  \r 
.
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€. † \r, € \r‚ -
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T,  ‡ \r  \f\r\t -
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\b\f€ ‚\r  \r\n, -
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\n \r\n.
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\f\b  € \n, ƒ\b ‡ \r‚
\b\r€ \b \r, ‡ \r-
 -\r \t  „, \r‡ \r\b‡
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64
World Federation of Societies of Anaesthesiologists
WFSA
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\r, \r‚ €    \f-
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‡ \n‚ \b\t \r  \b\r.
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(Cochrane)
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—



Reynolds RM, Pad˜eld PL, Seckl JR. Disorders of sodium balance.
BMJ
2006;
332
: 702–705.
Mahoney BA, Smith WAD, Lo DS, Tsoi K, Tonelli M, Clase CM. Emergency
2.
interventions for hyperkalaemia.
The Cochrane Database of Systematic
Reviews
. 2006 Issue 2.

\r
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Basic Sciences
‚\b\b\r\b Š\t\b\t\t \b\n†
* E-mail: peter.farling@dnet.co.uk
P. A. Farling
Consultant,
Department of
Anaesthetics,
Royal Victoria Hospital
Belfast BT12 6BA, UK
M. E. McBrien
Consultant,
Department of
Anaesthetics,
Royal Victoria Hospital
Belfast BT12 6BA, UK
D. Breslin
Research Fellow,
Department of
Anaesthetics
The Queen•s University
Belfast BT9 7BL, UK
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World Federation of Societies of Anaesthesiologists
WFSA
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\f\r\f€\f ‚  \n, -
\r\n  \r\n. \n \b-
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1)
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2)
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3)
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4)
\f\n (\r\b\t  \r\r\b\r-
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5)
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