okklyuzionnie zabolevaniya vetvey dugi aorti

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ateroskleroz kafedra fakultetskoy i gospitalnoy xirurgii №1 okklyuzionnie zabolevaniya vetvey dugi aorti * naselenie respubliki uzbekistan kkr xorezm navoi buxara kashkadarya surxandarya fergana namangan andijan sirdarya djizak samarkand g.tashkent 29,775 mln. goskomstat,2013 deti 37,5% lyudi starshe 65 let 4,3% vozrast 18-65 let 58,2% zabolevaniya sistemi krovoobrasheniya na (100 000 naseleniya) 5065 5133 5464 ministerstvo respubliki uzbekistan 2012 v 2012 v uzbekistane zaregistrirovano 64400 isultov!!! (gafurov b.g., 2012) sootnoshenie ishemicheskix i gemorragicheskix insultov 4,8:1 gemorragicheskiy insult 17,3% (11140) ishemicheskiy insult 82,7% (53260) (gafurov b.g., 2012) prichini % vid porajeniya ateroskleroz 75-90 % patologicheskie deformatsii 11,6- 18,2% nespetsificheskiy aortoarteriit (bolezn takayasu) 7-12% fmd(fibromuskulyarnaya displaziya) ekstravazalnaya komressiya 1- 2% prichini porajeniya vetvey dugi aorti ekstra-intrakranialnie anastomozi naibolee chasto porajaetsya bifurkatsiya sonnix arteriy sootnoshenie porajeniy ekstra- i intrakranialnix sosudov gm sostavlyaet 2/1 (33% porajeniy btsa raspolagaetsya intrakranialno, v 67% sluchaev porajayutsya ekstrakranialnie sosudi gm). nevrologicheskiy status fizikalniy osmotr. uzdg s opredeleniem ob'ema i gemodinamicheskoy …

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iv st. xsmn (perenesenniy insult) po stepeni stenoza uslovno razlichayut - maliy stenoz (0-29%); - umerenniy (30-50%); - virajenniy (50-69%); - kriticheskiy (70-99%); - okklyuziyu (100%). klassifikatsiya nascet i ecst, razrabotannaya v xode randomizirovannix issledovaniy v ssha i evrope v 1991 godu): emboli from ulcerated plaque otlojenie lipidov v tolshe stenki arterii krovoizliyanie v tolshe blyashki stroenie neizmenennoy arterii mikroemboliya etapi razvitiya ateroskleroticheskix blyashek: tranzitor ishemik xurujida kuzatiladi: bosh ogrishi, bosh aylanishi ko'l va yuzninig ayrim joylarida sezgini buzilishi belgilari, afaziya. xarakat vazifasining buzilishi (xar xil darajali mono-gemiparez, mono-gemiplegiya). ko'rishni buzilishi (amavroz fugas - ko'z oldida pardani xosil bo'lishi, xar xil fotopsiya, bir yoki ikkala ko'zning kurish xususiyatini vaktinchalik yo'kolishi). bu belgilar bir necha dakikadan 24 soatgacha kuzatilishi mumkin. v 50% sluchayax okklyuziruyushie porajeniya braxitsefalnix vetvey dugi aorti protekayut asimptomno. pri asimptomnom techenii zabolevaniya bolnie jalob ne pred'yavlyayut, priznaki sosudisto-mozgovoy nedostatochnosti opredelyaetsya tolko lish vo vremya tshatelnogo osmotra. pri tranzitornoy …

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elnie rasstroystva (gemi- i monoparezi, paralichi, neredko s razvitie motornoy afazii). rasstroystva taktilnoy i bolevoy chuvstvitelnosti v polovine tela. osmotr bolnix pulsatsiya sheynix sosudov i sosudov konechnostey (otmechaetsya oslablenie ili otsutstvie pulsatsii. stenki sosudov stanovyatsya tverdimi, i pri izmerenii ad mojet otmechaetsya raznitsa (asimmetriya) v konechnostyax bolee 15 mm rt.st.). auskultatsiya braxiotsefalnix vetvey aorti dopplerografiya glaznichniy anastomoz proba matasa: nevrologicheskiy status lineynaya skorost krovotoka po sma pri tkd elektricheskaya aktivnost golovnogo mozga po eeg kontrol isxod perejatie dekompressiya ultrazvukovaya dopplerografiya dupleksnoe skanirovanie dupleksnoe skanirovanie geterogennaya blyashka tipi ateroskleroticheskix blyashek po dannim ultrazvukovie angioskanirovaniya 1. odnorodniy exonegativniy tip (myagkaya gomogennaya blyashka) 2. preobladayushe exonegativniy (geterogennaya blyashka). 3. preobladayushe exopozitivniy (geterogennaya blyashka) i tip ii tip iii tip iv tip v tip gomogennie blyashki klinicheski manifestiruyutsya v 22% 4. odnorodnaya exopozitivnaya (plotnaya gomogennaya blyashka). 5. kaltsinirovannaya blyashka. stenozi iz'yazvlennie blyashki issledovanie morfologicheskoy strukturi ateroskleroticheskix blyashek ultrazvukovoe dupleksnoe skanirovanie sonnix arteriy gistologicheskoe izuchenie …

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angiografiya rentgenkontrastnaya angiografiya spiralnaya kt-angiografiya spiralnaya kt-angiografiya spiralnie kt-angiogrammi pri ateroskleroticheskom stenoze vsa s petrifitsirovannimi ateroskleroticheskimi blyashkami intraoperatsionnaya angioskopiya sonnix arterii. pokazaniya k operatsii pri stenozax vsa 1) nerovnosti konturov vnutrenney sonnoy arterii pri nalichii tia v basseyne porajennoy arterii; 2) iz'yazvlennaya ateroskleroticheskaya blyashka, po dannim dupleksnom skanirovanii i angiografii. 3) stenoz vnutrenney sonnoy arterii bolee 70% ee prosveta; 4) peregib (kinking) obshey ili vnutrenney sonnoy arterii na storone, gde imeyutsya nevrologicheskie simptomi porajeniya; 5) stenoz bolee 50% pri nalichii embologennix blyashek – nalichie xotya bi odnogo epizoda tia opredeleniem prosveta embologennogo blyashka klassicheskaya karotidnaya endarterektom-iya (keae) s podshivaniem zaplati. eversionnaya keae rezektsiya s autovenoznim ili alloprote-zirovaniem vsa zakritie arteriotomicheskogo otverstiya neprerivnim shvom rev vmeshatelstva vidi operatsii pri stenoze vsa klassicheskaya karotidnaya endarterektomiya pokazaniya: nizkaya i kriticheskaya stepen tolerantnosti golovnogo mozga k ishemii pri diametre vsa bolee 6 mm plastiku vsa arteriotomicheskoe otverstie zakrivaetsya neprerivnim shvom etapi klassicheskoy karotidnoy endarterektomii: …

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arterii pri okklyuzii 1 portsii arterii protezirovanie braxiotsefalnogo stvola pri ego okklyuzii transpodklyuchichnaya trombendarterektomiya iz ustya pozvonochnoy arterii balonnaya angioplastika btss european heart journal 20014 pokazaniya k stentirovaniyu sonnix arteriy u asimptomnix patsientov pokazaniya stentirovanie sonnix arteriy u asimptomnix patsientov doljno vipolnyatsya tolko v visokospetsializirovannix tsentrax. oslojneniya posle stentirorvaniya (insult i letalnost ne doljni previshat 3%)!!! na osnovanii rezultatov privedennix issledovaniy ustanovleni pokazaniya k karotidnoy endarterektomii: u patsientov s asimptomnimi porajeniyami ili xronicheskim techeniem smn operatsiya pokazana pri gomogennix blyashkax, sujivayushix prosvet sosuda na 70 % i bolee, pri geterogennix i gipoexogennix, a takje iz'yazvlennix blyashkax — ot 60 % i bolee. * european heart journal pokazaniya k stentirovaniyu u simptomnix patsientov pokazaniya stentirovanie sonnix arteriy yavlyaetsya alternativoy karotidnoy endarterektomii u simptomnix patsientov s visokim perioperatsionnim riskom. pri vipolnenii stentirovaniya u dannoy kategorii bolnix (insult i smert ne doljni previshat 6%)!!! pri simptomnix porajeniyax (bolnie s tia ili posle insulta) …

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ateroskleroz kafedra fakultetskoy i gospitalnoy xirurgii №1 okklyuzionnie zabolevaniya vetvey dugi aorti * naselenie respubliki uzbekistan kkr xorezm navoi buxara kashkadarya surxandarya fergana namangan andijan sirdarya djizak samarkand g.tashkent 29,775 mln. goskomstat,2013 deti 37,5% lyudi starshe 65 let 4,3% vozrast 18-65 let 58,2% zabolevaniya sistemi krovoobrasheniya na (100 000 naseleniya) 5065 5133 5464 ministerstvo respubliki uzbekistan 2012 v 2012 v uzbekistane zaregistrirovano 64400 isultov!!! (gafurov b.g., 2012) sootnoshenie ishemicheskix i gemorragicheskix insultov 4,8:1 gemorragicheskiy insult 17,3% (11140) ishemicheskiy insult 82,7% (53260) (gafurov b.g., 2012) prichini % vid porajeniya ateroskleroz 75-90 % patologicheskie deformatsii 11,6- 18,2% nespetsificheskiy aortoarte...

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