Ahtmtmpeomflhbie cpeactba

Август 9, 2022

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Ahtmtmpeomflhbie cpeactba

Содержание

2. AHTMTMpeoHAHbie cpe^CTBa - K/iaccM()>MKaL^km 1. ymeiaKunne npoflyKi^MK) TTr afleHornno(t)M30M npenapaTbi MOfla (noflaB/iaKDinaa TepanMa) 2. YmeTaioiMMe CMHTe3
3. npenapaTbi MOflMflOB TupeociaTMHecKoe ^eMCTBue cbb33ho c neperpy3KOM K/ieTOK LU.MTOBM.fl.HOM >Ke/ie3bl MOflOM, npn KOTOpOM ero KOHU.eHTpaU.Mfl BHyTpM
4. npenapaTbi moamaob - apMaKo/iornMecKne a(t> eKTbi 1. B Ma/ibix A03ax (/v\eHee 1,5 Mr/cyi) Mo^n/ibi CTMMy/inpyK)T CMHTe3
5. npenapaTbi moahaob - (JjapMaKo/iornMecKkie 3(|>(t>eKTbl • TnpeocTaTMHecKMM 9 eKT HenpoAO/imme/ieH. Ko 2-8 He^e/ie Ha6/iK)AaeTc« c()eHO/v\eH «oTKa3a
6. npenapaTbi moamaob - npwv»eHeHne A. Ma/ibie aobw. ripuMeHAfOT BOcno/iHeHMfl Ae noma MOfla npn /leneHHM 9HAeMMHecKoro 306a.
7. ripenapaTbi moamaob - npMM6H6HM6 B. BoTibWMe A03bi. npuMeHAfOT no/iyneHUfl Obicrporo, ho KpaTKOBpeMeHHoro TMpeocTaTMHecKoro acJxfceKTa ripn c/ieAytoiu,mx
8. npenapaTbi moamaob - Heme/iaTe/ibHbie 3 eKTbi 1. Odpbie peaKUMM - B03HMKaK>T nepe3 HecKO/ibKO MMHyT noc/ie BBeAeHMfl
9. TnaMa30/i OTHOCMTCfl K npOM3BOAHblM TMOMOHeBMHbl. MexaHU3M deucmeun. no/iaratoT, hto Tna/v\a3o/i HapywaeT npou,ecc opraHM(j)MKaLJ1MM Mo/^a m KOHAeHcau,m/i
10. TnaMa30/i - ap/v»aKo/iorkmecKMe acj) TnaMa30/i OKa3biBaeTTMpeocTaTMHecKoe ^eMCTBue. CHM>KaeT ypoBeHb TupeoMAHbix topmohob m nepeBOflMT napneHTa c rnnepTnpeo30M
11. Tna/v\a30/i - noKa3aHH« KoHcepBaTMBHoe/leneHne TnpeoTOKCMK03a m B03Bpauj,eHMfl nau,neHTa k ayTMpeoM.a.HOMy coctoahmk). Cmn^poM TnpeoTOKCMK03a B03HMKaeT, KaK npaBM/io,
12. Tna/via30/i - noKa3aHnn KoHcepBaTMBHoe zieneHne TnpeoTOKCMK03a m B03BpameHMfl nau,neHTa k ayTMpeOM.fl.HOMy COCTOflHMK). CmH/^pOM TMpe0T0KCMK03a B03HMKaeT, KaK
13. Tna/via30/i - noKa3aHkin TnaMa30/i npMHnr/\aK)TTaK>Ke no cneu.ua/ibHbiM noKa3aHHAM: •/V1* nO^rOTOBKM naU,MeHTOB C flH(t>(|>y3HblM TOKCHHeCKHM 3060M h/ih
14. Tnan/ia30/i - no6oHHbie 3 eKTbi Ko>KHbie BbicbinaHMfl MHor^a conpoBOKAaioLAMecfl /lMxopaAKOM, BacKy/imaMM, apipa/irMRMM, /lM/vu^aAeHonaTMRMM. Xo/iecTaTMHecKa^ H rMnOTMpeOM^Hbie
15. TnaMa30/i - no6oMHbie 3 eKTbi ToKcunecKUM arpaHy/iou,MT03. floA B/in^Hne/v\ TnaM23o/ia MoweT HapywaTbCfl /ieMKono33 y 1 nau,neHTa
16. nporm/iTMoypaLjM/i flB/lfleTCfl npOM3BOAHblM TMOMOHeBUHbl. MexaHM3M fleMCTBHA. I1oao6ho TMa/v\a30/iy my 6/iOKMpyeT npou,ecc opraHucJjMKapMM flo^a, KOHfleHcapuM Ml/IT m
17. nponn/iTMoypaij^M/1 - noKa3aHkm nponn/iTMoypau,n/i npMMeHHK)T a/ih /leneHna TkipeOTOKCMHeCKHX COCTOBHMM nOA06lHO TkiaMa30/iy. my cnmaeTCa cpeACTBOM Bbi6opa npn
18. nponn/iTnoypanM/1 - noKa3aHkm nponn/iTMoypau)n/i npMMei-iafOT a/ih /leneHna TkipeOTOKCMMeCKklX C0CT051HMM n0A06lH0 TMaMa30yiy. my cnmaeTCa cpeflCTBOM Bbi6opa npn
19. nponM/iTMoypau^M/i - noi TupeoTOKCMHecKMM Kpn3. B/iaroflapa cnoco6HOCTM 6/iOKnpoBaTb nepn(|)epMHecKyK) KOHBepcnK) TMpOKCMHa my CHUTaeTCB CpeflCTBOM Bbl6opa A/lfl
20. nponn/iTnoypaun/1 - Heme/iaTesibHbie a eKTbi my xapaKTepHbi Te we Hewe/iaie/ibHbie acJx^eKTbi, hto m npM Mcno/ib30BaHMn Tna/via30/ia.
21. MHrn6mopbi TpaHcnopia moamaob b L14>K HeKOTopbie MOHOBa/ieHTHbie MOHbi, ruflpaTHaa (J)opivia KOTopbix no CBoeMy AnaMeipy noA,o6Ha ruApaTHOM
22. MHrn6mopbi TpaHcnopia moamaob b m>K PaHee MHrM6mopbi TpaHcnopia moamaob b >Ke/ie3y ujMpoKo npnMeHfl/iMCb b K/iMHunecKOM npaK’MKe
23. klonaHOBaa xnc/iOTa PeHTreHKOHTpacTHoe cpeACTBo, coAepwm 333 Mr 3/ieMeHTapHoro fioAa b 1 Ta6/ieTKe. MexaHM3M fleMCTBMB. no/iaraKDT, hto
24. MonaHOBaa Knc/iOTa OapivtaKO^omHecKMe 3 1. noflaB/iaeT KOHBepcnK) T4 b T3 b TKaHax neneHn, nonex, rnnocj)M3a m
25. MonaHOBaa Kuc/iota - npmvieHeHMe KJ • /leneHne rMnepTMpeoMAHbix coctoahhm. klonaHOByK) KMC/iOTy npMMeH^KDT, KaK npaBM/io, b AByx
26. PaAMOaKTMBHblM MOfl Moa MMeeT CTa6n/ibHbm M30Ton I 127, a TaKwe 4 paAnoaKTMBHbix M30Tona: • I 131
27. PaflMOaKTMBHbIM MOfl C TepaneBTMHecKMMM u,e/iflMM name Bcero ncno/ib3yKDT I 131, M3/iyHeHne KOToporo Ha 90% npeAcraB/ieHO 6eTa-HacTnu,aMM
28. PaflMOaKTMBHbIM MOfl - He>Ke/iaTe/lbHbie 3(t>())eKTbl B03MO>KHO pa3BMTMe OCTpbIX peaKU,MM Ha MOA y /lMU, c rnnepHyBCTBme/ibHOCTbK). Pa3BMTne
29. llpenapaTbi ropMOHOB noA>ne/iyAOHHOM x
30. dHflOKpMHHan nacTb nojpKenyflOHHOH Mene3bi noflJKe/iyflOHHafl «ene3a pacnono)KeHa 3a6pioiunHHc. SHflOKpMHHafl nacTb npeflCTas/ieHa ocipoBKaMn JlaHrepraHca-Co6oneBa. KOTopbie pacnonoweHbi npeMMymecTBeHHO
31. HmoKaroH flo/iMnenTM^Hbrn ropMOH - 29 a/v\MHOKnc/ioT. HmoKaroH othocmtca k runepr/iMKeMUHecKMM c^aKTopaM, Bbi3biBaeT yBe/iMHeHne r/iK)K03bi b kpobm,
32. nmoxaroH • MexaHkOM fleMCTBua aAeHM/iaTL],MK/ia3HbiM. 06lu,mm moroMfleMCTBua r/iK)KaroHa BB/iaeica ycM/ieHMe pacna,o,a r/inKoreHa b neneiHM npM y/v\eHbiueHMM
33. nmoxaroH ripenapaT ivifOKaroHa - rmoKareH noi • runor/iMKeMna, rnnomnKe/v>MMecKaa KOMa, • AnarHOCTMKM — noflaB/ieHne motopmkm opraHOB
34. noflwenyflOHHafl >Kene3a IIOAXf.\yAOiiiJB AceApia MHTeHCMBHOe OKMC/ieHMe l71K)K03bl B TK3HBX
35. MHcyjiHH (Insuline). MHcyjiHH HCJioBCKa - neooJibmoM 6c;iok c Mr=5.808 J\a, coctohiuhh H3 51 aMHHOKHCJioxbi. MHcyjiHH oSpaxyexca
36. Mexam/i3M ceKpei^MM i/mcy/ii/ma CocTOflHMe noKOw AKTMBaLIMfl KATlt)-KaHambi/ ^ U?KpblTbl / ©ATOf ATOl ‘K- K^-KaHa/ibi ^aKpbTTbl a\
37. Ulll U '. v ULM KoHMeHTpai4^.« MHcynvJHa B CbIBOpOTKe, Hf/MH O) “1
38. MexaHM3M AeftcTBua MHcy/iMHa klHcy/iHH AeMCTByeT Ha TpaHCMeM6paHHbie MHcy/iHHOBbie peuemopbi, pacno/iowGHHbie Ha noBepxHOCTH TKaHen mhujghgh (cKe/ieTHbie Mbiiui^bi,
39. 0M3MO/lOrMMeCKMe 3()>(t>eKTbl MHCY/1MH3 • Ochobhmm 34>4>eKTOM nHcy/iMHa AB/ifleTCfl ero B/iMBHue Ha TpaHcnopT r/iiOK03bi b K/ieTKH. Hepe3
40. 0M3MO/ionmecKne acJx^eKTbi MHcy/iMHa Yr/ieBOflHbm o6MeH: • TpaHCnOpT l71K)K03bl B MHCy/lHH03aBMCMMbie TK3HM • ycKopeHne yTM/iM3au,MM r/iK)K03bi b
41. B/iMAHue MHcy/iMHa Ha o6MeH Beu^ecTB b pa3/lMHHblX TKaHBX >Khpobom /innoreHe3 ^CMHTe3Tr 4/ 7lHnO/lH3 CMHTe3 >KMpHblX KMC/IOT
42. CaxapHbm Ana6eT - cocTo^Hne xpom/inecKOM rMnepr/ii/iKeMMM, o6yc/iOB/ieHHoe a6co/ifOTHbiM m/ih OTHOCMTe/lbHblM ^ecJWL^MTOM MHCy/IMHa M conpoBo>Klfl1aKDLij1eec?i HapyrneHMeM Bcex
43. CaxapHbm flna6eT
44. XapaxTepMCTMKii npenapaTOB mncy/iMHa • B MeflMU.MHCKOM npaKTMKG npMMeHflhOT 3 BMfla HHCy/lMHOB - rOBfl>KMM, CBMHOM, He/IOBeneCKMM. HHcy/iMH
45. XapaKTepucTHKM npenapaTOB MHcy/iMHa • KceHoreHHbie MHcy/iMHbi (roBAWMM, cbuhom) no/iynaKDT nyTeM 9KCTpaKU,MM KMC/lOTHO-CriMpTOBblM MeTO/JO/Vt npaKTMHeCKM TeM >ne
46. XapaKTepucTMKM npenapaTOB MHcy/iMHa KoMMepnecKne npenapaTbi MHcy/iMHa no^BepratoTcn flono/iHme/ibHOM oHMCTKe. Pa3/iMHaK)T 3 BMfla HHcy/iMHOB no CTeneHM ohmctkm:
47. MHcysiHH ne/ioBexa Cnoco6bi no/iyneHHfi: • riO/lHblM XMMMHeCKMM CMHTe30M; • no/iycMHTeTMHecKM/vi nyTeM; • reHHOMHMKeHepHbIM CMHTe30M. (lepBbiM cnocoG
48. AKTMBHOCTb fipenapaTOB MHCy/IMHa AKmueHocmb npenapamoe uhcv/iuho BbipawaioT 6M0/10mHeCKMMM MeTO/^aMM B Efl. 3a 1 Efl npMHMMaKDT T3KOe
49. HoMeHK/iaiypa npenapaTOB MHcy/imna B 3aBncnM0CTM ot fl/ime/ibHOCTM A6MCTBMB npenapaTbi MHcy/iMHa pa3A6/iBK)T Ha HecKO/ibKO rpynn: 1. MHcy/iMHbi
50. HHCy/lMHbl y/lbTpaKOpOTKOrO fleMCTBMfl /lM3npoMHcy/uiH (Lysproinsuline, Humalog). TpaAHAMOHHbm MHcy/iMH o6pa3yeT b pacTBope m noAKOKHOM K/ieTHaTKe reKcaMepHbie KOMn/ieKCbi,
51. klHCy/IMHbl y/lbTpaKOpOTKOrO AeMCTBMfl AcnapTMHcy/iMH (insuline aspart, NovoRapide). TaK>Ke BB/lfleTCB MOAH mj,HpOBaHHblM MHCy/lklHOM y^bipaKopoTKoro agmctbhb. no/iyneH nyieM
52. klHCy/lMHbl KOpOTKOro fleMCTBMfl npeflCTaB/iflHDT co6om pacTBop hmctoto MHcy/iMHa m/im MHCy/lMHa C He6o/lblUMM KO/lMHeCTBOM MOHM3npoBaHHoro u,MHKa. noc/ie
53. klHcysiMHbi cpeflHeM npoAO/imuTe/ibHOCTM fleiictbmh y/3/1 mhehma w-icy/i wna /],o6MBaK)TCH nyieM 3aMe£/ieHkm ero BcacbiBaHM^. ripn 3tom ncno/ib3yK)T
54. klHcy/iMHbi fl/ime/ibHoro AeficTBHfl • npe^CTaB/iflK)T KpMCTa/iyiMHecKyK) cycneH3MK) u,MHK-MHcy/iHHa. flyiMTe/ibHoe BpeMfl rah no/iyneHMfl 3tmx npenapaTOB ncno/ib30Ba/in roB^>KMv\
55. KOM6HHMpOBaHHbie MHCy/lMHbl • fl/ia yAo6dBa nau,neHTOB, KOTopbie no/ib3yK)Tca KOpOTKMM M npOflyieHHblM MHCy/IMHOM BbinyCK3K)T roTOBbie CMecu MHcy/iMHa
56. ripenapaTbi MHcy/iMHa siMweHHbie nuica flenctbmh • rnaprMHMHcy/iMH (Glargineinsuline). 1/lHcy/iMH c TpeMfl aaMeuj^eHMflMM b no/innenTMAHOM u,erm: i71mu,mh
57. flpenapaTbi MHcy/iMHa
58. noi OcHOBHbie noKa3aHMfl CBB3aHbi c H33HaneHneM MHcy/iMHa f\r\n /leneHna caxapHoro Ana6eTa: • HHcy/iMH3aBMCMMbm caxapHbiM A^a^eT (Ana6eT
59. Ocsio>KHeHkm mhcv/imhobom TeparmM 1. A/i/ieprunecKMe peaKunn Ha HHcy/iMH. Cefl3aHbi c npMcyTCTBMeM b npenapaTax MHcy/iMHa nocTopoHHMX npMMecefi,
60. Oc/io>KHeHMfl MHcy/iMHOBOM Teparmu 4. OeHOMGH «yipeHHeM 3apn». rnnepr/iMKeMMfl b paHHue yTpehhme nacbi (Me>KAy 5-8 nacaMM yTpa).
61. Oc/io>KHeHMfl MHcy/iMHOBOM Tepankiu ft. MHCy/lMHOpPBHCTPHTHOCTh (CHMWPHMP HyRCTRMTP/lhHOCTM TKRHPM K /^PMCTRUJO MHcy/iMHa m Heo6xoAMMOCTb yBe/iMHeHMB ero cyTOHHOM
62. /leKapcTBGHHbie cpe^cTBa, npMMeHfleMbie /yia TGpannn caxapHoro Ana6eia II Tuna
63. CaxapHbiM Aua6eT II Tuna - MeTa6o/iMHecKoe 3a6o/ieBaHne; xapaKTepn3yK)LiJ,eeca xpoHMHecKOM rkinepr/iMKeMMeM, pa3BMBaK)Lu,ePicfl b pe3y/ibTaie HapyrneHna B3aMMOfleMCTBHB MHCy/1
64. CaxapHbiM Ana6eT II Tuna - HapyweHne ymeBOAHoro o6ivieHa, Bbi3BaHHoe ripen My mecTBem-iOM MHCy/lMHOpe3MCTeHTHOCTbK> H OTHOCHTe/lbHOM MHCy/lMHOBOM
65. % 8 7 6 5 4 3 2 1 0 PemcTpupyeMafi u cpaKTMHecKan pacnpocTpaHeHHOCTb CA 2
66. MHCy/lbT HapymCMMC xpoBOo6pameMHfl M03ra, npMBOiifliyec k OTMMpaHMio era micro* Henponarnfl PaccTpOMcrea hcpbhom cucTeMw, cBfl3aMHt>ie c nopaxeHMeM
67. To/icraa KMLUKa flaioflorMMecKaw MMKpO^Opa BOBMOWHOe CHMWeHMe cenpei^MM mn*l p-OPMEHTMPOBAHHAfl MOflE/lb Cfl 2 TMnA 113BEHbEB nATOfEHE3A apymeHMe
68. CMHAPOM MHCySlMHOpe3MCTeHTHOCTM MHcy/iMHOpe3MCTeHTHOCTb - HapyrneHne peaKU,nn nHcy/iMHMyBCTBme/ibHbix TKaHePi Ha (J)H3no^ornHecKne KOHu.eHTpau.m/i MHcy/iHHa. Pa3BHBaeica nocieneHHo, b nepByK)
69. OaKTopbi pkiCKa pa3BUTkm caxapHoro Ana6eia II Tuna Bo3pacT 6o/iee 45 /ieT M36biTOHHafl Macca TG/ia m owmpghmg
70. npMHL^unbi TGpannn caxapHoro Aiia6eia II Tuna • AKTUBHoe BbmB/ieHne rpynn pucKa • M3MeHeHne o6pa3a >km3hm (nmaHne,
71. neseHneAnadeTa 2 Tuna -Med.Com
72. PeKOMeHAaijMM no M3imecKOM aKTMBHOCTM Pery/iapHaa OA npn Cfl 2 Tuna y/iyniuaeT KOMneHcauMK) ymeBOAHoro o6MeHa; noMoraeT CHM3MTb
73. PGKOMGHAaUMM nO aKTMBHOCTM Pcry/iapHafl OA npn Cfl 2 Tuna y/iynwaGT KOMriGHcaunK) ymeBOAHoro o6MGHa; noMoraeT CHM3MTb m
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Слайд 2

AHTMTMpeoHAHbie cpe^CTBa -
K/iaccM()>MKaL^km
1. ymeiaKunne npoflyKi^MK) TTr afleHornno(t)M30M
npenapaTbi MOfla (noflaB/iaKDinaa TepanMa)
2. YmeTaioiMMe

CMHTe3 TupeonflHbix ropMOHOB 4)o/i/iMKy/iaMM m>K
TkioaMMAbi: muoM030/i, nponu/imuoypauu/i;
3. HapyuiaioiMiie npoHMKHOBeHue nofla b 4>o/i/inKy/ibi m>K AHMOHHbie MHrn6nTopbi: Ka/iun nepxnopam;
4. PemreHKOHTpacTHbie cpeflCTBa: uonaHoeecw Kucnoma;
5. Pa3pyiuaK)LMMe K/ieTKM 4>o/i/iMKy/iOB LH>K PaMOaKTMBHblM MOfl (1131)

Слайд 3

npenapaTbi MOflMflOB
TupeociaTMHecKoe ^eMCTBue cbb33ho c neperpy3KOM K/ieTOK
LU.MTOBM.fl.HOM >Ke/ie3bl MOflOM, npn KOTOpOM

ero KOHU.eHTpaU.Mfl BHyTpM
K/ieTKM npeBbiiuaeT BHeK/ieTOHHyio 6o/iee ne/vi b 1.000 pa3. CnmaeTCB,
hto TupeocTaTMHecKoe A^MCTBue tio^a o6yc/ioB/ieHo:
• HapyuieHueM TpaHcnopia mo^maob b K/ieTKM lumtobmahom M• HapymeHneM KOH.qeHcau.MM Ml/IT m flMT, a TaKwe opraHMcjwKau.MM kio^a (acfx^eKT Wolff-Chaikoff);
• HapyweHMeM npoTeo/iM3a Tnpeor/io6y/iMHa m BbicBoOoHv^eHMfl T4 m T3 M3 TK3HM >Ke/ie3bl ((J>aKTMHeCKM, MO^M^bl - eflMHCTBeHHbie cpe^cTBa, KOTopbie nepBMHHO chmhokdt ceKpeu,MK> TMpeoMflHbix ropMOHOB >Ke/ie30M);
• noAaB/ieHMeM peaKu,MM >Ke/ie3bi Ha TTr (no/iara>OT, hto MOflMflbi HapyiuaKDT pa6oiy u,AMO m b pe3y/ibTaTe CMTHa/i ot peu,enTopoB TTr He nepe^aeTCB Ha acJxfceKTopHbie CMCTe/vibi).

Слайд 4

$npenapaTbi moamaob - apMaKo/iornMecKne a(t> eKTbi 1. B Ma/ibix A03ax (/v\eHee$

npenapaTbi moamaob - apMaKo/iornMecKne
a(t>eKTbi
1. B Ma/ibix A03ax (/v\eHee 1,5 Mr/cyi) Mo^n/ibi

CTMMy/inpyK)T CMHTe3 rop/vioHOB llIjMtobm/^hoJi >KG/ie30M, oco6eHHo y nau,neHTOB c runo-M ayTMpeOMAHbIMM COCTOflHMflMM.
2. B AOBax 6o/iee 6 Mr/cyT npoaB/iaeTCfl TupeocTaTMHecKMM 3(J)ct)eKT. Hana/io ^eMCTBHfl OTMenaeTCfl b TeneHMe 1-2 cyTOK. K 5-7 cyTKaM 3c()(t)eKT AOCTMraeT MaKcn/v\y/v\a: CHMwaeTCfl ceKpeu,MB m CMHTe3 TupeouAHbix ropMOHOB, yMeHbuuaeTCfl BacKy/iflpM3au,Mfl >Ke/ie3bi, ee pa3Mepbi. TKaHM >Ke/ie3bi ct3hobhtch MeHee HyBCTBMTe/ibHbi k MexaHMHeCKMM B03AeMCTBMflM.

Слайд 5

npenapaTbi moahaob - (JjapMaKo/iornMecKkie
3(|>(t>eKTbl
• TnpeocTaTMHecKMM 9eKT HenpoAO/imme/ieH. Ko 2-8 He^e/ie Ha6/iK)AaeTc«

c()eHO/v\eH «oTKa3a ih,mtobmahom >ne/ie3bi», Kor^a ee TKaHb nepecraeT OTBenaTb Ha TepanMKD BbicoKMMM A03aMM MOfla m rnnepTnpeonAHoe cocroflHMe B03HMKaeT BHOBb, Macro b 6o/iee Tfl>Ke/10M c{)Op/V\e. ripMHMHa yCKO/lb3aHMB >Ke/ie3bl MS-nOA
flemctbmjr mo^m/job HeacHa. llo/iaraioT, bto cBA3aH0 c TeM, hto b K/ieTKax M• C/ie^yeT noMHMTb, hto npenapaTbi moam^ob chumojot CKopocTb nor/ioLii.eHMB lu^mtobmahoh >Ke/ie30M pa/^MoaKTMbhoto Mo/^a, noaTOMy mx Mcno/ib3yKDT MHor/i.a npoc()M/iaKTMHecKM Rnn 3aLU,MTbi TK3HM >Ke/ie3bl OT pa/JMai^MOHHOrO nOBpe^eHMfl.

Слайд 6

npenapaTbi moamaob - npwv»eHeHne
A. Ma/ibie aobw. ripuMeHAfOT BOcno/iHeHMfl Aenoma MOfla npn

/leneHHM 9HAeMMHecKoro 306a. Bocno/iHeHne MOAHoro AeMAma ao^i>kho CTporo cooTBeTCTBoeaiD cyTOHHbiM HopMaM noTpe6/ieHMfl MOAa. B 1996 r. B03 yTBepAM/ia Hopr/ibi noTpe6/ieHMfl moas, AeMCTByromne u b HacTOfliu.ee BpeMfl.

CyTOHHaa noTpe6HOCTb b moama^x m ee BoccTaHOB/ieHne Ka/iMfl moahaom

Слайд 7

ripenapaTbi moamaob - npMM6H6HM6
B. BoTibWMe A03bi. npuMeHAfOT no/iyneHUfl Obicrporo, ho KpaTKOBpeMeHHoro

TMpeocTaTMHecKoro acJxfceKTa ripn c/ieAytoiu,mx CMTyau.Mflx:
• npeAonepau,MOHHafl noAroTOBKa nau,neHTOB k xnpyprnHecKOMy /leneHMio AM(j)(t)y3Horo TOKCMHecKoro 306a m/im tokcmhgckom aAeHOMbi lu,mtobmahom >Ke/ie3bi. Ha3HaHeHMeM moamaob xupypru AoOMBaKrrca yMeHbiiieHMR BacKy/iflpM3au,MM mene3b\, CHMweHMH ee HyBCTBMTe/ibHOCTM k MexaHMHecKMM B03AGMCTBMAM. T.e. TaKoe zieneHMe o6ecneHMBaeT CHMweHMe pMCKa KpOBOTeHGHMfl BO BpeMfl OnepaiJMM, P33BMTMA TMpeOTOKCMHeCKOrO KpM3a, BC/ieACTBMe Bbl6pOCa ropMOHOB M3 TpaBMMpOBaHHOM >Ke/ie3bl. 06blHHO npMMeHHHDT pacTBop /lK>ro/ifl, KOTopbiM Ha3HanaK)T 3a 7-10 AneM ao onepau,MM no 5 Kane/ib 2-3 pa3a b A^Hb.
• OKa3aHMe HeOT/lOWHOM nOMOUi,M npMTMpeOTOKCMHeCKOM KpM3e. BBOAflT BHyTpMBGHHO 10% paCTBOp MOAMA^ HaTpMfl no 10 M/l Ka>KAbie 8 HaCOB, /im6o pacTBop/lraro/ifl no 8-10 Kane/ib Ka>KAbie 6 nacoB BHyTpb.

Слайд 8

npenapaTbi moamaob - Heme/iaTe/ibHbie 3eKTbi
1. Odpbie peaKUMM - B03HMKaK>T nepe3 HecKO/ibKO

MMHyT noc/ie BBeAeHMfl MOAMAOB M CBfl3aHbl C MHAMBMAya/lbHOM HenepeHOCMMOCTbK) MOAa. npOJRB/lflKDTCfl OTeKOM ry6, BeK, ropiaHM (Bn/ioTb ao ackho noBbiiueHMe TeMnepaTypbi, /lMM^aAeHonaTMfl, yBe/iMneHne ypoBHfl 303mho4>m/iob b KpoBM, TpoM6oAmoneHMHecKafl nypnypa.
2. XpoHnnecKaa nepeA03npoBKa moas (moam3m). llepBbiMM CMMnTOMaMM MOAH3M3 flB/iflK)TCfl noaB/ieHMe HenpMflTHoro MeTa/i/iMHecKoro BKyca bo piy, >KMTca npM3HaKM, HanoMMHaKDiAne npocryAHoe 3a6o/ieBaHMe: HMxaHMe, Kaiue/lb C BblAe/ieHkieM C/1M3MCTOM MOKpOTbl, KOH-bJOHKTMBMT M npMnyX/lOCTb BeK. BecbMa xapaKTepHbiM flB/iaeTCfl OTeK, yBe/inneHne m 6o/ie3HeHHOCTb OKO/ioyiuHbix m noAHe/iHDCTHbix cyifOHHbix MKKT Macro OTMenaeTCH pa3BMTne Anapen.
3. MoAMAbi He/ib3fl npMMeHATb y 6epeMeHHbix, t.k. ohm npoHMKatOT nepe3 reMaTon/iameHTapHbm 6apbep m MoryT Bbi3BaTb pa3BMTMe 306a y pe6eHKa.

Слайд 9

$TnaMa30/i OTHOCMTCfl K npOM3BOAHblM TMOMOHeBMHbl. MexaHU3M deucmeun. no/iaratoT, hto Tna/v\a3o/i HapywaeT$

TnaMa30/i
OTHOCMTCfl K npOM3BOAHblM TMOMOHeBMHbl.
MexaHU3M deucmeun. no/iaratoT, hto Tna/v\a3o/i HapywaeT npou,ecc opraHM(j)MKaLJ1MM

Mo/^a m KOHAeHcau,m/i moatkpo3mhob b Ko/i/ion.o.e. Iloc/ie BBe/jeHUfl b opraHM3M Tnaiv\a30/i 3axBaTbiBaeTca TKai-mMM lAHTobmahom >Ke/ie3bi m CBfl3biBaeTCfl c reMOM nepoKCMAa3bi, CTa6n/iM3npyfl ero b OKHC/ieHHOM coctoahhm. Ilpn stom MOflnepoKCMAasa repaeT cnoco6Hocrb BocciaHaB/iMBaTb MOAMAbi m BK/IKDHaTb MOfl B OCTaTKM TMp03MHa.
Kpoivie Toro, noA B/iMflHMeM Tna/v\a30/ia HapyiuaeTca o6-beAHHehme M0H0M0ATMP03MH0B M AHM0ATMP03MH0B B MO/ieKy/lbl T3 M T4. 3TOT 3cJ>(t>eKT npoaB/iaeTCfl b A03ax 3HaHMTe/ibHO MeHbwi/ix, neM Te, hto noA,aB/iflK)T aKTMBHocTb MOAnepoKCMAa3bi. TaKMM o6pa30M, noA B/lMflHkieM TMa/V\a30/ia CMHTe3 HOBbIX TMpeOMAHbIX ropMOHOB npeKpaLU,aeTCfl. OAHaKO, BbiAe/ieHne ropMOHOB M3 >Ke/ie3bi npoAO/iwaeTCH ao Tex nop, noKa coxpaHflioTCfl 3anacbi paHee

Слайд 10

TnaMa30/i - ap/v»aKo/iorkmecKMe acj)<|)eKTbi
TnaMa30/i OKa3biBaeTTMpeocTaTMHecKoe ^eMCTBue. CHM>KaeT ypoBeHb TupeoMAHbix topmohob m

nepeBOflMT napneHTa c rnnepTnpeo30M b ayTupeoMAHoe cocTOBHue.
Tna/v\a30/i OKa3biBaeT c/ia6oe mvuv\yHOMOAy/inpyioiij,ee fleMCTBUe - OH CHMWaeT H36blTOMHO nOBblLLieHHyK) (J)yHKLl,HK) Th- /IHM(j)OU1MTOB M nOBbllUaeT M36blTOMHO CHkDKeHHytO (j)yHKU,MK) Ts-/lMM(t)OpHTOB y 6o/lbHblX AM(J)(J)y3Hbl/V\ TOKCMHeCKMM 3060M.

Слайд 11

$Tna/v\a30/i - noKa3aHH« KoHcepBaTMBHoe/leneHne TnpeoTOKCMK03a m B03Bpauj,eHMfl nau,neHTa k ayTMpeoM.a.HOMy coctoahmk).$

Tna/v\a30/i - noKa3aHH«
KoHcepBaTMBHoe/leneHne TnpeoTOKCMK03a m B03Bpauj,eHMfl nau,neHTa k ayTMpeoM.a.HOMy coctoahmk). Cmn^poM

TnpeoTOKCMK03a B03HMKaeT, KaK npaBM/io, ripn c/ie(4yK>w,Mx cocTOflHkmx:
• /Jucpcpy3Hbiu moKcunecKuu 306 (6o/ie3Hb rpeueca) - amo aymouMMyHHoe 3060/ieeoHue npu KomopoM e op2aHU3Me ebipa6ambieaiomcfi oHmumena k penenmopaM TTr Ha noeepxHocmu uu,umoeudHou mene3bi. Ilo ceoeu cmpyKmype amu aHmumupeoudHbie aHmumena HanoMUHaiom aKmueHbiu u,eHmp TTr u npu C6H3bieaHuu c peu,enmopaMU mene3bi eo3deucmeytom Ha nee nododHO eopMOHy 2unocf)U3a - ohu cmuN\ynupy\om poem cpo/i/iuKy/ioe, cuHme3 u cexpenuio T3 u T4, yeenuneHue pa3Mepoe >Ke/ie3bi. BecbMa xapaxmepHUM npu3HaxoM 6one3HU rpeueca noMUMo mupeomoKcuK03a nennemcn ocf)ma/ibMonamun. Ocpma/ibMonamun cabana c meM, nmo aHmumupeoudHbie aHmumena enumom Ha pei^enmopbi, pacno/ioyKeHHbie e mxaHu 2/ia3odeu2ame/ibHbix Mbiuiu, u pempoop6uma/ibHOu K/iemnamKU (mupoean mnaHb, ebicmu/i a toucan dHO 2na3Huu,bi). Hod enunHueM amux aHmume/i HavuHaemca cuHme3 2/iuK03aMUH02/iuKaH08 u pbixnou coeduHumenbHou mKOHU, Komopbie ne2K0 ydepynueaiom eody u nocmeneHHO ebima/iKueaiom 2/ia3Hoe b6/ioko - noaenaemcn nyve2/ia3ue, omen u npunyxnocmb eex.

Слайд 12

Tna/via30/i - noKa3aHnn
KoHcepBaTMBHoe zieneHne TnpeoTOKCMK03a m B03BpameHMfl nau,neHTa k ayTMpeOM.fl.HOMy COCTOflHMK).

CmH/^pOM TMpe0T0KCMK03a B03HMKaeT, KaK
npaBM/io, npM c/ielQyK>Lu1Mx coctoahmax:
• ToKcimecKCM adeHOMa mumoeudHou )Ke/ie3bi (y3/ioeou moKcunecKuu 306). Brno 3o6oneeoHue, npu KomopoM e mKctHHx m:e/ie3bi noaennemcn epynna 6btcmpopacmym,ux xnemox (y3en), xomopan nocmoHHHo ebipadambieaem T3 u T4 u He nodHUHaemca KOHmpo/iK) co cmopoHbi TTT eunocpU3a. T.e. He 3aeucuM0 om moeo, ecmb u/iu Hem TTr K/iemnu y3/ia nocmoRHHO cexpemupy- tom e npoeb mupeoudHbie eopMOHbi. OcHoeHoe om/iuHue moncuHecKou adeHOMbi om 6one3nu Tpeueca 30K/itoHaemcH e moM, nmo npu adeHOMe yee/iunueaemcn He ecn Me/ie3a, o mo/ibKO KaKan-nu6o ee nacmb. Kpo/we moeo, npu odeHOMe ui,umoeudHou mene3bi He Ho6/itodaemcn mupeomoKcune- ckou ocpma/ibMonamuu.

Слайд 13

$Tna/via30/i - noKa3aHkin TnaMa30/i npMHnr/\aK)TTaK>Ke no cneu.ua/ibHbiM noKa3aHHAM: •/V1* nO^rOTOBKM naU,MeHTOB$

Tna/via30/i - noKa3aHkin
TnaMa30/i npMHnr/\aK)TTaK>Ke no cneu.ua/ibHbiM noKa3aHHAM:
•/V1* nO^rOTOBKM naU,MeHTOB C flH(t>(|>y3HblM

TOKCHHeCKHM 3060M h/ih y3/ioBbiM 3o6om k xnpyprnHecKOMy zieneHHK). fle/io b tom, hto MexaHMnecKoe B03/3.eMCTBMe Ha >Ke/ie3y b npou,ecce onepau,HH MoweT npMBeCTM K KO/lOCCa/lbHOMy Bbl6pOCy mpMOHOB H Bbl3BaTb TMpeoTOKCMHecKMM KpM3. lloaTOMy b npoLjecce noAroTOBKM k onepau.nn nau,HeHTaM Ha3HaHarc>T THaMa30/i b TeneHHe 6 He^e/ib flo onepau,HH ^.ocTHHceHH^ ayTHpeoH^Horo coctoahha.
•fl/lfl OKa3aHHfl HeOT/IO>KHOH nOMOLU^M naU,HeHTy CTHpeOTOKCHHeCKHM KpH30M. TnaMa30/i He nsnneTCft npn 3tom cpe^cTBOM Bbi6opa, ho MoweT npHMeH^TbCH npn OTcyTCTBHH nponH/iTHoypau,H/ia. Bboaat THaMa30/i BHyipb no 40-60 Mr Kaw^bie 8 nacoB. Ec/ih nau,neHT HaxoAHTCH b KOMe mo>kho npn6emyTb k peKTa/ibHOMy BBe^eHH\o h/ih BBefleHHK) nepe3 Ha3oracTpa/ibHbiH 3qh/v

Слайд 14

Tnan/ia30/i - no6oHHbie 3eKTbi
Ko>KHbie BbicbinaHMfl MHor^a conpoBOKAaioLAMecfl /lMxopaAKOM, BacKy/imaMM, apipa/irMRMM, /lM/vu^aAeHonaTMRMM.
Xo/iecTaTMHecKa^

HrMnOTMpeOM^Hbie COCTOHHMR (Bn/lOTb ftO KOMbl).
3o6oreHHbm 3(j)(t)eKT. llpM /leneHMM TMa- Ma30/io/v\, HecMOTpa Ha AocTMweHMe 3yTnpeoM,qHoro coctorhmr, o6-beM lu,mtobmahom >Ke/ie3bi npo^o/iMoeT yse/iMHHBaTbCR. 9to cbr33ho c Te/v\, hto noA B/iMRHneiv\ Tna/v\a30/ia b MKe/ie3bl, pa3BMTMe B HGM COCyAOB M COeAMHMTe/IbHOM TKaHM. nOAaB/ieHMR 3o6oreHHoro ac^eKTa TMaMa30/ia noc/ie A^CTM>KeHMR ayTMpeo3a nau,MeHTy Ha3HanaK)T Ma/ibie A°3bi zieBOTMpoKCMHa. Ohm He cnoco0Hbi Bbi3BaTb rMnepTMpeo3, ho AOdaTOHHbi noAaB/ieHMR CMHTe3a TTf b rMnocJ)M3e.

Слайд 15

$TnaMa30/i - no6oMHbie 3 eKTbi ToKcunecKUM arpaHy/iou,MT03. floA B/in^Hne/v\ TnaM23o/ia MoweT$

TnaMa30/i - no6oMHbie 3<}>eKTbi
ToKcunecKUM arpaHy/iou,MT03. floA B/in^Hne/v\ TnaM23o/ia MoweT HapywaTbCfl /ieMKono33

y 1 nau,neHTa M3 Kaw^bix 500- 1.000. flaHHoe oc/io>KHeHMe Han6o/iee Macro B03HMKaeT y no>KM/ibix nau,neHTOB, npMHMMaKDLu,MX Tna/via30/i b R03e 6o/iee 40 Mr/cyT. ArpaHy/iou,MT03 oOpaTMM m npu oTMeHe TnaMa3o/ia KpoBeTBopeHMe BHOBb B03o6HOB/ifleTC^. Te/v\ He MeHee, HecBoeBpeMeHHO AMarHOCTMpoBaHHbiM arpaHy/iou,mo3 Mom npMBecTM k Tflwe/ibiM MH4)eKU,MOHHbiM oc/io>KHeHMflM. llpM /leneHMH TnaMa30/ia peKOMeHAyKDT KOHTpo/inpoBaTb nepncj)epMHecKyK) KpoBb 1-2 pa3a b Mecflu,.
Tna/v\a30/i Bbi3biBaeT nepeKpecTHyK) ceHCM6n/iM3au,MK) k .qpyrMM TMoaMMAaM. no3TOMy y nau,neHTOB c a/1/ieprnMecKHMM peaKU,nflMM Ha TMa/v\a3Q/i npMMeHeHMe nponn/iTMoypauIM/ia npoTMBonoKa3aHO.

Слайд 16

$nporm/iTMoypaLjM/i flB/lfleTCfl npOM3BOAHblM TMOMOHeBUHbl. MexaHM3M fleMCTBHA. I1oao6ho TMa/v\a30/iy my 6/iOKMpyeT npou,ecc$

nporm/iTMoypaLjM/i
flB/lfleTCfl npOM3BOAHblM TMOMOHeBUHbl.
MexaHM3M fleMCTBHA. I1oao6ho TMa/v\a30/iy my 6/iOKMpyeT npou,ecc opraHucJjMKapMM flo^a,

KOHfleHcapuM Ml/IT m fll/IT. B to >ne caMoe Bpe/v\a my HapywaGT pa6oiy f\ev\- o,qa3 nepn(j)epMHGCKMx tiohgm m npGAOTBpamaGT npou,6CC nGpM(j)GpMMGCKOM KOHBGpCMM T4 B T3. riOSTOMy riTY OC/ia6/iaGT B/IMflHMG TMGpOMflHblX TOpMOHOB Ha K/IGTKH-

MMLUGHM.

Слайд 17

nponn/iTMoypaij^M/1 - noKa3aHkm
nponn/iTMoypau,n/i npMMeHHK)T a/ih /leneHna
TkipeOTOKCMHeCKHX COCTOBHMM nOA06lHO TkiaMa30/iy. my cnmaeTCa

cpeACTBOM Bbi6opa npn KOHcepBaTWBHofi Tepannn Tnpe0T0KCHK03a y 6epeMeHHbix. riocKO/ibKy Tnaiv»a30/i zierKO npoHMKaeT nepe3 reMaion/iau,eHTapHbm 6apbep ero npn/v\eHeHne bo Bpe/wa 6epeMeHHOCTM MOweT npHBecTM k BHyTpnyTpo6HOiv\y noBpe>KAei-mio lu,mtobmahom >ne/ie3bi n/iOAa n pa3BMTMK) bpokaghhoto rnnoTnpeo3a. Bc/ieACTBne BbicoKoro CBa3biBaHna c 6e/waMM kpobm, nTY rmoxo npoHMKaGT Hepe3 n/iau,eHTy m b mo/ioko (v\aiepn m noaTOMy oTHocme/ibHO 6e3onaceH A-na npmv\eHeHMH y 6epe/v\eHHbix.

Слайд 18

nponn/iTnoypanM/1 - noKa3aHkm
nponn/iTMoypau)n/i npMMei-iafOT a/ih /leneHna
TkipeOTOKCMMeCKklX C0CT051HMM n0A06lH0 TMaMa30yiy. my cnmaeTCa

cpeflCTBOM Bbi6opa npn KOHcepBaTUBHofi Tepannn TnpeoTQKCHK03a y 6epeMeHHbix. nocKO/ibKy Tnaivia30/i zierKO npoHMKaeT nepe3 reMaion/iau,eHTapHbiM Gapbep ero npn/vieHeHne bo BpewH Gepe/vieHHOCTM iviomeT npHBeCTM K BHyTpkiyTpo6HOMy nOBpeMKfleHMK) LU,MTOBM,Z],HOM
>ne/ie3bi n/iOAa m pa3BmnK) Bpo>KAeHHoro rnnoTnpeo3a. Bc/ie/i,CTBMe BbicoKoro CBa3biBaHna c 6e/iKamm KpoBn, my n/ioxo npoHMKaeT nepe3 n/iau,eHTy m b mo/ioko Maiepn m noaioiviy oTHOcme/ibHo 6e3onaceH f\ila npMMeHeHMa y 6epe/v\eHHbix.

Слайд 19

nponM/iTMoypau^M/i - noi
TupeoTOKCMHecKMM Kpn3. B/iaroflapa cnoco6HOCTM 6/iOKnpoBaTb nepn(|)epMHecKyK) KOHBepcnK) TMpOKCMHa my

CHUTaeTCB CpeflCTBOM Bbl6opa A/lfl
npoBefleHUfl Tupeo- CTaTunecKOM TeparmM bo BpeMA Kpn3a. Ero c/ieflyeT npeAnonecrb BBe^eHUK) TnaMa30/ia.

Слайд 20

nponn/iTnoypaun/1 - Heme/iaTesibHbie aeKTbi
my xapaKTepHbi Te we Hewe/iaie/ibHbie acJx^eKTbi, hto m

npM Mcno/ib30BaHMn Tna/via30/ia.

Слайд 21

MHrn6mopbi TpaHcnopia moamaob b L14>K
HeKOTopbie MOHOBa/ieHTHbie MOHbi, ruflpaTHaa (J)opivia KOTopbix no

CBoeMy AnaMeipy noA,o6Ha ruApaTHOM (jjopMe MOAMAa, MoryT CBfBbiBaTb aKTMBHbie U,eHTpbl TpaHCnOpTepOB mmOBMflHOM >ne/ie3bi i/i HapywaTb TpaHcnopT MO^a M3 kpobm b anme/ikiM Mne/ie3bi B/ieneT 3a co6ofi CHMHMoflHbm TpaHcnopiep 6/iOKkipyHDT HmpaTbi, TkioUjUaHaTbi m nepx/iopaTbi, npuneM aKTMBHocTb nepx/iopaTOB ca/viaa BbicoKaa: = 1:30:300.

1 i c

Слайд 22

MHrn6mopbi TpaHcnopia moamaob b m>K
PaHee MHrM6mopbi TpaHcnopia moamaob b >Ke/ie3y ujMpoKo

npnMeHfl/iMCb b K/iMHunecKOM npaK’MKe npM /leneHMM rnnepTnpeo3a. B Hacroflinee BpeMfl, b cba3m C Cepbe3HblMM He>Ke/iaTe/lbHblMM a^^eKTaMM, KOTOpbie OHM Bbl3blBaK)T, 9TM cpeACTBa npaKTMnecKM He Mcno/ib3yK>TCfl:
• HMTpaTbi - BC/ieACTBMe c/ia6oro agmctbma Tpe6ytoT BBeAeHMfl bwcokmx A03, KOTopbie conpoBOH• TMOU,MaHaTbl - OK33blBaK)T He^pO-, HeMpO- M renaTOTOKCMHeCKOe AGMCTBMe.
• nepx/iopaTbi -nacTo Bbi3biBaK)T Tfl>Ke/ibie Heo6paTMMbie an/iacTMHecKyK) aHeMMK) m arpaHy/i0AMT03. HaM6o/iee Macro aHeMMfl pa3BMBaeTca npM Mcno/ib30BaHMM BbicoKMX A03 (6o/iee 2,0-3,0 r/cyi).
OAHaKO, c/ieAyeT o’MeTMTb, hto b noc/ieAHMe HecKO/ibKO nej MHTepec k npMMeHeHMfo nepx/iopaTOB bo3o6hobm/icm. HM3KMe A03bi nepx/iopaia Ka/iMM (750 Mr/cyT) peKOMeHAyfOT npMHMMaTb A^ifl zieneHMfl rMnepTMpeo3a, o6yc/ioB/ieHHoro
npMeMOM MOACOAep>KaiAero aHTMapMTMMnecKoro cpeACTBa aMMOAapoHa.

I liC

Слайд 23

klonaHOBaa xnc/iOTa
PeHTreHKOHTpacTHoe cpeACTBo, coAepwm 333 Mr 3/ieMeHTapHoro fioAa b 1 Ta6/ieTKe.

MexaHM3M fleMCTBMB. no/iaraKDT, hto
MonaHOBaa Kuc/ioia noflaB/iBeT aKTMBHOCTb AeMOfla3 nepncj)epMHecKMx TKaHePi m HapyujaeT TeM caMbiM KOHBepcnK) T4 b T3. KpoMe toto,
B03M0>KH0 3a CHeT BblCB060H

Слайд 24

MonaHOBaa Knc/iOTa
OapivtaKO^omHecKMe 31. noflaB/iaeT KOHBepcnK) T4 b T3 b TKaHax neneHn,

nonex, rnnocj)M3a m HepBHOM cucTeMbi b pe3yyibTaie aero, oc/ia6/iaeTca B03fleMCTBne T3 Ha pepemopbi sthx TKaHePi. 1/lHTepecHO, hto b OT/iMHkie ot APyux hoahaob PionaHOBaa KMC/ioia He HapyLuaei 3axBaT MOfla lu,mtobmahom a2. 3aAep>KMBaeT peHTreHOBCKoe M3/iyneHne m o6ecneHHBaei KOHTpacTMpoBaHMe iv\arKMx TKaHePi.

Слайд 25

MonaHOBaa Kuc/iota - npmvieHeHMe
KJ
• /leneHne rMnepTMpeoMAHbix coctoahhm. klonaHOByK) KMC/iOTy npMMeH^KDT, KaK

npaBM/io, b AByx c/iynaflx - npn HenepeHOCMMOCTM TMoaMUflOB, /im6o KaK BcnoMoraie^bHoe cpeACTBO npn /leneHMM
TMpeOTOKCMHGCKOrO KpM3a.
• npoBefleHMe peHTreHKOHTpacTHOM xo/ierpacJ)MM.

Слайд 26

PaAMOaKTMBHblM MOfl
Moa MMeeT CTa6n/ibHbm M30Ton I 127, a TaKwe 4 paAnoaKTMBHbix

M30Tona:
• I 131 - nepnoA no/iypacnaAa 8 A^en;
• I 123 - nepnoA no/iypacnaAa 13 nacoB;
• I 125 - nepnoA no/iypacnaAa 60 AHen;
• I 132 - nepnoA no/iypacnaAa 2 naca.

Слайд 27

PaflMOaKTMBHbIM MOfl
C TepaneBTMHecKMMM u,e/iflMM name Bcero ncno/ib3yKDT I 131, M3/iyHeHne KOToporo

Ha 90% npeAcraB/ieHO 6eTa-HacTnu,aMM h Ha 10% ra/viMa-ziynaMM. ripi/i BBe^eHMM b opraHM3M I 131 ObicTpo npoHMKaeT b TKaHb >Ke/ie3bi m aKKyMy/inpyeTC^ b c()o/i/iMKy/iax. llocKO/ibKy npoHMKaK)Lii,afl cnocoOHOCTb OeTa-nacTMU, Bcero 0,5-2 mm, to noA mx B/iMflHMeM npoMCXOAm noBpewAeHMe MCK/noHme/ibHO TKaHePi >Ke/ie3bi, OKpy>KaKDLiilMe >Ke/ie3y K/ieTKM (HanpMMep, napaiu.MTOBM/i.Hbie >Ke/ie3bi) ocTaKDTCfl HenoBpe^eHHbiMM.
5eTa-HaCTMU,bl Bbl3blBaKDT nMKH03 «AeP M HeKp03 K/ieTOK (f)0/l/lMKy/10B lUjHTObhahom >Ke/ie3bi c noc/ieAytoLAMM 3aMeLu,eHMeM ee tk3hm 4>n6po3HbiM py6u,OM. B pe3y/ibTaie KO/iMHecTBO >Ke/ie3MCTbix K/ieTOK yMeHbiuaeTCfl m CMHTe3 ropMOHOB oc/ia6eBaeT. BcJxJjeKT paAnoaKTMBHoro Mo^a pa3BMBaeTCfl Me/yieHHO m npoaB/iaeTCfl/inwb nepe3 1 Mecau, noc/ie BBeAeHMfl, AOCTMraa MaKCMMyMa k 3-My Mecmj,y.

Слайд 28

PaflMOaKTMBHbIM MOfl - He>Ke/iaTe/lbHbie 3(t>())eKTbl
B03MO>KHO pa3BMTMe OCTpbIX peaKU,MM Ha MOA y

/lMU, c rnnepHyBCTBme/ibHOCTbK).
Pa3BMTne /ieMK03a m paKa KO/iopeKTa/ibHOM 30Hbi. B noc/ieAHee BpeMfl neTKo noKa3aHO, hto zieneHMe paAnoaKTMBHbiM moaom He nOBblLUaeT PUCK pa3BMTMfl 3TMX COCTOflHkltf.
Pa3BMTne rnnoTnpeo3a. B nepBbin roA noc/ie npoBeAeHHoro zieneHHfl rnnoTnpeo3 pa3BMBaeTCfl y 6-15% nau,neHTOB, a b nocjieAyKDLii,eM euj,e y 2-3% nau,neHTOB e>KeroAHO.
PaAnoMOATeparma npoTMBonoKa3aHa ripn 6epeMeHHOCTM, t.k. I 131 MO>KeT 3axBaTbiBaTbc« >Ke/ie30M n/ioAa m npMBOAHTb k ee BHyipnyTpo6HOMy noBpe>t

Слайд 29

llpenapaTbi ropMOHOB noA>ne/iyAOHHOM x

Слайд 30

dHflOKpMHHan nacTb nojpKenyflOHHOH Mene3bi
noflJKe/iyflOHHafl «ene3a pacnono)KeHa 3a6pioiunHHc. SHflOKpMHHafl nacTb npeflCTas/ieHa ocipoBKaMn

JlaHrepraHca-Co6oneBa. KOTopbie pacnonoweHbi npeMMymecTBeHHO b 06/iacTH ee xBoaa - KOMnaicmbie K/ieTOHHbie rpynnu, ouiMHafomuecfl 6onee CBemoM OKpacKOM no cpaBHemiK) c ochobhom napaHXMMOM nofl)KenyflOHOM >xene3bi

OcTpoBKOBdM annapaT BK/iKwaeT:

Слайд 31

$HmoKaroH flo/iMnenTM^Hbrn ropMOH - 29 a/v\MHOKnc/ioT. HmoKaroH othocmtca k runepr/iMKeMUHecKMM c^aKTopaM,$

HmoKaroH
flo/iMnenTM^Hbrn ropMOH - 29 a/v\MHOKnc/ioT.
HmoKaroH othocmtca k runepr/iMKeMUHecKMM c^aKTopaM, Bbi3biBaeT yBe/iMHeHne

r/iK)K03bi b kpobm, maBHbiM o6pa3o/v\ 3a cneT pacna^a r/iMKoreHa b neneHM.
OpraHaMn wmueHflMM aB/iaeTCB neneHb, MMOKap#, >KnpoBaa TKaHb.
BMOCMHTe3 r/iKDKaroHa Kompo/ii/ipyeTCfl ypoBHeM r/iK)K03bi no npnHU.Mny o6paTHon cba3h. Ha CMHTe3 r/iKDKaroHa 0Ka3biBaeT B/IMflHMe MHCy/lklH, MHCy/lMHOnOA06HblM 4>aKTOp pocia.
CeKpeu,Ma ymeTaeTcn npne/vioM nmu.M - noBbiweHneM KOHU.eHTpaU.MM f/lh0K03bl, aMMHOKMC/lOT, WMpHbIX KMC/IOT.

I AC

Слайд 32

nmoxaroH
• MexaHkOM fleMCTBua aAeHM/iaTL],MK/ia3HbiM. 06lu,mm moroMfleMCTBua r/iK)KaroHa BB/iaeica ycM/ieHMe pacna,o,a r/inKoreHa

b neneiHM npM y/v\eHbiueHMM ero cMHTe3a. AKTMBHpyeT npou,eccbi rmoKOHeoreHe3a. 3to npMBOAHT k yBe/lMHeHMKD ypOBHfl r/IKDK03bl B KpOBM.
• AKTMBHpyeT /iMna3y — ziMno/iMTMMecKoe fleMCTBMe.
• YcM/iMBaeT npopeccbi KaTa6o/iM3Ma 6e/iKOB.
• Ha MMOKapfl OKa3biBaeT CM/ibHoe MHOTpormoe m xpoHOTponHoe AeMCTBMe, BC/ieACTBMe HaKormeHMa u,AMO. CTMMy/iMpyeT rvifOKaroHOBbie peu,eriTopbi b MMOKapAe m I1CC, cnoco6cTByeT BbiCBo6oH

i An

Слайд 33

nmoxaroH
ripenapaT ivifOKaroHa - rmoKareH noi• runor/iMKeMna, rnnomnKe/v>MMecKaa KOMa,
• AnarHOCTMKM — noflaB/ieHne

motopmkm opraHOB jKe/iyAOHHo-KmueHHoro TpaKTa npn npoBefleHnn o6c/ieAOBaHna /v>eTOAa/viM aHAOCKormM n paAnorpacfjM
npOTMBonoKa3aHna:
• runepr/iMKeMHa,
• c^eoxpoMapmoMa

Слайд 34

$noflwenyflOHHafl >Kene3a IIOAXf.\yAOiiiJB AceApia MHTeHCMBHOe OKMC/ieHMe l71K)K03bl B TK3HBX$

noflwenyflOHHafl >Kene3a
IIOAXf.\yAOiiiJB AceApia
MHTeHCMBHOe OKMC/ieHMe l71K)K03bl B TK3HBX

Слайд 35

$MHcyjiHH (Insuline). MHcyjiHH HCJioBCKa - neooJibmoM 6c;iok c Mr=5.808 J\a, coctohiuhh$

MHcyjiHH (Insuline). MHcyjiHH HCJioBCKa - neooJibmoM 6c;iok c Mr=5.808 J\a, coctohiuhh

H3 51 aMHHOKHCJioxbi. MHcyjiHH oSpaxyexca b b-KJieTKax no,o>KejiyzjOHHOH >KeJie3bi b BH^e npenpoHucyjiHua, xoxopbiH co^ep>KHT 110 aMHHOKHCJiOT. Elocjie Bbixo^a H3 '3H^ioiuia3Mai HHccKOH cem ot MOJieKyjibi OTmemraexcfl N-KOHueBOH CHraajibHbiH nenraa H3 24 aMHHOKHCjiox h o6pa3yeica npoHHcyjiHH. B komiijickcc lojibir/KH nyTeM npoxeo:iH3a H3 cepe^HHbi MOJieKyjibi npoHHcyjiHHa yaanaioxcH 4 ocHOBHbie aMHHOKHCJlOTbl H C-neiXTHA H3 3 1 aMHHOKHCJlOTbl. B HTOre, oopaayexcfl 2 uenn HHcyjiHHa - A-uenb m 21 aMHHOKHCJioxbi (co^epaoix ,HHcyjib(j)HOTyio CBJBb) h B-ucnb H3 30 aMHHOKnc.xox. Mc>K^y coGoh AhB uciih coeflHHflioxca 2 aHcy;ib({jiuiibiMH CBH3BMH. B /tajibiieHLueM b cexpexopHbix rpaiiyjiax b-iKe;ie3a HCJlOBCKa COflCpvKHX flO 8 Mr HHCyjlHHa, HXO npHMCpHO
cooxBexcxBvex 200 EH HHCvjiHHa.

Слайд 36

Mexam/i3M ceKpei^MM i/mcy/ii/ma
CocTOflHMe noKOw
AKTMBaLIMfl
KATlt)-KaHambi/ ^ U?KpblTbl / ©ATOf
ATOl
‘K-
K^-KaHa/ibi
^aKpbTTbl
a\ \-70 mB>^Ca2'-KaHa^bi

^
^ ^^ 33KpbJTbl ^

flna30KCMA (1pOM3BOAHWe A6no/iflpn3aunfl

Cy/lb(pOHM/1MOHeBMHbl

CeKpeunfl

MHcy/iMHa

Hm3KM ypOBeHb r/ll0K03bl

BbicoKnii ypOBeHb r/ii0K03bi

Слайд 37

Ulll U '. v ULM
KoHMeHTpai4^.« MHcynvJHa B CbIBOpOTKe, Hf/MH
O)
“1

Слайд 38

MexaHM3M AeftcTBua MHcy/iMHa
klHcy/iHH AeMCTByeT Ha TpaHCMeM6paHHbie MHcy/iHHOBbie peuemopbi, pacno/iowGHHbie Ha noBepxHOCTH

TKaHen mhujghgh (cKe/ieTHbie Mbiiui^bi, riGMGHb, wnpoBaa TKaHb) h aKTnsnpyGT sth peuemopbi.
MHcy/iHHOBbiH peuemop coAepwm 2 cy6beAMHHUbi: a-cy6beAHHH4y, KOTopaa pacno/ioweHa c shgwhgh CTOpOHbi MeM6paHbi h b-cy6beAHHH4y, KCTopaa npoujHBaeT MGM6paHy HacKB03b. npH CBB3biBaHHM MHcy/iHHa c pcu,GnTopaMH nponcxoAHT hx aKTHBauna, npH 3tom Mo/icKy/ibi peuemopoB o6beAMHflK)TCfl nonapHo h npno6peiaK3T Tnpo3HHKHHa3Hyio aKTHBHOdb (T.e. cnoco6HocTb 4>OC4>OpH/lHpOBaTb OCT3TKM THp03HHa B MOTieKy/iaX pflAa 6e/lKOB). AKTMBHpOBaHHbIM peuemop noABepraeTca ayTo4>ocopH/iHpoBaHHK) h b pe3y/ibTaie ero Tnpo3HHKMHa3Ha« aKTHBHOdb ycH/iHBaeicfl b a^cbtkh pa3. B Aa/ibHGHWGM cnma/i c peuemopa nepeAaeTCfl AayMa nyT«Mn:
1. HeMeA^eHHbiM oTBeT (pa3BHBaGTca Hepe3 HGCKO/ibKo mhhyt). CB«3aH c 4>oc4)opn/inpoBaHneM OCTaTKOB TMp03MHa B 6G/1KG IRS-2, KOTOpblH aKTHBHpyGT <}>0CaTHAH/lHH03HT0/l-3-KHHa3y (PI-3 KHHa3a). riOA B/IHBHHGM 3TOH KHHa3bl MO/16Ky/lbl 4>0C4>aTHAM;iHH03HT0/l 6n(j)OCaTa (PIP2) (J>OC(J)OpH/lHpyK>TCa AO 4>0C4>aTMAH/lMH03MT0/l TpH^OCtJjaTa (PIP3). PIP3 cKTMBHpyeT p«A npOTGMHKMHa3, KOTOpbie 8/lHBK)T Ha:
• P aKTHBHOdb TpaHCMGM6paHHblX TpaHCnopTGpOB (lHTaTG/lbHblX BGUi,GdB;
• P aKTHBHOdb BHyTpHK/IGTOMHbIX (j>GpMGHTOB MGTa6o/lH3Ma yr/IGBOAOB H WHpOB;
• P TpaHCKpHnu,HK> b aApe k/igtkh paAa reHOB.
2. 3aMeA/ieHHbiH otbgt (pa3BHBaeTca Mepe3 HecKo/ibKO Hacos). 06yc/iOB/ieH 4>ocopH/iHpoBaHHeM OdaTKOB THp03HH3 B MO/lGKy/lG IRS-1, KOTOpaa dHMy/lHpyGT MHTOrGH-aKTHBHpyGMbIG npOTGHHKHHa3bl (MAPK) h 3anycKaGT npoAGee pocTa k/igtok h chhtgsb AHK.

Слайд 39

0M3MO/lOrMMeCKMe 3()>(t>eKTbl MHCY/1MH3
• Ochobhmm 34>4>eKTOM nHcy/iMHa AB/ifleTCfl ero B/iMBHue Ha TpaHcnopT

r/iiOK03bi b K/ieTKH. Hepe3 Mew6paHy k/iotok r/i>0K03a npoMnwaoT nyTGM o6/ior<-ioMHoro TpaHcnopTa aa cmgt cnouna/ibMbix ncpoHOCMUKon -TpaHcnopTepos r/iK>K03bi GLUT. Pa3/iMHaK)T 5 bmaob 3thx TpaHcnopTepos, KOTopbie MoryT 6biTb o6beAHHeHbi b 3 ceMeficTBa:

• • GLUT-1,3,5 - TpaHcnopiepbi r/noK03bi b MHcy/iHHHe3aBncmvibie tk3hm. f\iin pa6oibi 3tmx TpaHcnopiepoB He
Tpe6yeTCfl MHcy/iMH. Ohm mmckjt wpaMHe BbicoKoe cpoactbo k r/iK>K03e (Km»l-2 mM) m o6ecneHMea»OT TpaHcnopT r/iK)K03b« b 3pnTpoi4MTti, HCMpoHbi M03ra, 3nMTe/iMM KMUjeMHMKa m noMex, n/iaueHTy.

• • GLUT-2 - TpaHcnopiep r/iK>K03bi b MHcy/iMHpery/iMpyKimMe TKaHM. Oh Tanwe He Tpe6yeT ppn CBoeM pa6oibi MHCy/lMHa M aKTMBMpyeTCfl TO/lbKO npM BbICOKMX KOHUeHTpau,M5IX r/lK5K03bl, T3K K3K MMCeT K HeM KpaMHe HM3KOe
cpoactbo (Km»15-20 mM). 06ecneMMBaeT TpaHcnopT r/iK)K03bi b K/ieTKM noA>«e/iyAOHh-OM >Ke/ie3bi m neneHM (T.e. b Te TKaHM, TAe mact CMHre3 m AerpaAauMB MHcy/iMHa). Oh npMHMMaeT ynacTMe b pery/imiMM ceKpeAMM MHcy/iMHa npM noBbimeHMM ypoBHfl rsiK>K03bi.
• • GLUT-4 - TpaHcnopTep m»OK03bi b MHcy/iMH3aBMCMMbie TKaHM. 9tot TpaHcnopTep MMeeT npoMewyTOHHoe cpoactbo k r/i»OK03e (Km»5 mM), ho b npMcyTCTBMM MHcy/iMHa ero cpoactbo k r/iK>K03e pe3KO noBbimaeTca m oh o6ecnenMBaeT 3axsaT rnK)K03bi K/ieTKaMM Mbiwu, aAnnoAMT3MM, neseHbio.
• noA B/iMBHMeM MHcy/iMHa npoMexoAHT nepeMeiAeHMe wo/ieKy/i GLUT-4 M3 uMTon/ia3Mbi K/ieTKM b ee Mew6paHy (yBe/iMHMBaeTCB ko/imh=ctbo wo/ieny/i nepeHOCHMKa b MewCpane), noBbiwaeTCB cpoactbo nepeHOCHMKa k
T/1KJK03C M OMO nOCTynOCT OnyTpb K/1CTKM. B MTOrC, KOHl^CMTpaUMfl ™»0K03bl O KpOOM nCHMWaCTCfl, a O K/1CTKC
B03pacTaeT.

Слайд 40

0M3MO/ionmecKne acJx^eKTbi MHcy/iMHa
Yr/ieBOflHbm o6MeH:
• TpaHCnOpT l71K)K03bl B MHCy/lHH03aBMCMMbie TK3HM
• ycKopeHne yTM/iM3au,MM

r/iK)K03bi b unK/ie KpeSca
• CTHMy/iflL^MB iviMKoreHe3a b neneHM m Mbnuu,ax
• TopMoweHMe r/iMKoreHO/iM3a
• TopMomeHne r/ifOKOHeoreHe3a >KnpoBOM o6MeH:
• noAa8/ieHne /inno/iM3a m KeioreHe3a
• pery/iBU,MB cm-rre3a ziunnAOB Be/iKOBbm o6fv»eH
• YcM/ieHne cnHTe3a npoieMHOB
B me/ioM fl/ifl nHcy/iMHa xapaKTepHo aHa6o/iMHecKoe ^eMCTBue Ha npou,eccbi o6MeHa 6e/iKOB; >KnpoB m yr/ieBOAOB (T.e. ycn/ieHne CHHTeTMHecKMx peaKi^MM) m aHTMKaTaSo/iHnecKMe acfx^eKTbi (TopMomeHkie pacna^a r/iHKoreHa m /imiimaob).

Слайд 41

B/iMAHue MHcy/iMHa Ha o6MeH Beu^ecTB b
pa3/lMHHblX TKaHBX
>Khpobom /innoreHe3 ^CMHTe3Tr
4/ 7lHnO/lH3 CMHTe3

>KMpHblX

KMC/IOT 4/ /inno/iM3

Слайд 42

CaxapHbm Ana6eT - cocTo^Hne xpom/inecKOM rMnepr/ii/iKeMMM, o6yc/iOB/ieHHoe a6co/ifOTHbiM m/ih OTHOCMTe/lbHblM ^ecJWL^MTOM

MHCy/IMHa M
conpoBo>Klfl1aKDLij1eec?i HapyrneHMeM Bcex
BMflOB o6MeHa BeLU,eCTB.

Слайд 43

CaxapHbm flna6eT

Слайд 44

XapaxTepMCTMKii npenapaTOB mncy/iMHa
• B MeflMU.MHCKOM npaKTMKG npMMeHflhOT 3 BMfla HHCy/lMHOB -

rOBfl>KMM, CBMHOM, He/IOBeneCKMM. HHcy/iMH 6biKa OT/iMHaeica ot MHcy^MHa He/ioBe«a Bcero 3 a/viMHOKMC/iOTaMM, Tor^a KaK MHcy/iMH CBMHbM — TO/IbKO OflHOM aMMHOKMC/lOTOM. B CBB3M C 3TMM MHCy/IMH CBMHbM 6o/iee TOMO/IOrMHeH mHcy/iMHy ne/iOBeKa m MeHee aHTMreHeH, neM mHcy/iMH 6biKa. B HacTOflLu,ee BpeMa bo Bcex pa3BMTbix CTpaHax He peKOMeHAOBaHO npMMeHaTb /leneHMH /imu, 6o/ibHbix Ana6eTOM TOBa>KbM MHCy/IMHbl.

Слайд 45

XapaKTepucTHKM npenapaTOB MHcy/iMHa
• KceHoreHHbie MHcy/iMHbi (roBAWMM, cbuhom) no/iynaKDT nyTeM 9KCTpaKU,MM KMC/lOTHO-CriMpTOBblM

MeTO/JO/Vt npaKTMHeCKM TeM >ne npMHU,nnoM, hto 6bi/i npe/yioweH 6o/iee 80 nei Ha3a£ BaHTMHroM m BecTOM b Topomo. OflHaKO, npou,ecc 3KCTpaKU,MM yCOBepiiieHCTBOBaH M BblXOA MHCy/lMHa cocTaB/i^eT 0,1 r Ha 1000,0 r TKaHM nofl>ne/iyflOHhom >Ke/ie3bi. no/iyneHHbiM 3KCTpaKT coflepwMT nepBOHana/ibHO 89-90% MHcy/iMHa, ocTa/ibHoe cocTaB/iflKDT npniV\ecn - npoMHcy/iMH, r/iKDKaroH, coMaTocraTMH, naHKpeaTMHecKMM no/innenTMA, BW"I. 9tm npMMecM ^e/iaiOT MHcy/iMH MMMyHoreHHbiM (Bbi3biBaK)T o6pa30BaHkie aHTme/i k He/v\y), chmmokdt ero 3(J>4)eKTMBHOCTb. OCHOBHOM BK/13/], B MMMyHOreHHOCTb BHOCMT npoMHcy/iMH, t.k. ero Mo/ieKy/ia co,o,ep>KMT C-nenTM#, BMAOCneU,M(t)MHHblM y Ka>KflOrO M3 >KMBOTHblX.

I c*>

Слайд 46

XapaKTepucTMKM npenapaTOB MHcy/iMHa
KoMMepnecKne npenapaTbi MHcy/iMHa no^BepratoTcn flono/iHme/ibHOM oHMCTKe. Pa3/iMHaK)T 3 BMfla

HHcy/iMHOB no CTeneHM ohmctkm:
• KpncTa/i/iM3QBaHHbie MHcy/iMHbi - ohmLu,akdt nyTeM MHOrOKpaTHOM peKpMCTa/l/lM3aU1MM M paCTBOpeHMB.
• MoHonnKQBbie MHcy/iMHbi - no/iyHaK)T nyTeM ohmctkm KpMCTa/i/iM30BaHHbix MHcy/iMHOB MeTO^OM re/ib-xpoMaTorpacj)MM. npM 3tom MHcy/iMH Bbixo^MT b BM^e Tpex nMKOB! A - CO^epWMT 3H/],OKpMHHbie M 3K30KpMHHbie nenTMflbi; B - coAepwMT npoMHcy/iMH; C - coAepwMT mhcy/imh.
• MOHOKOMnOHeHTHbie MHCV/IMHbl ~ MHOfOKPaTHO xpoMaTorpacj)MpoBaHHbie MHcy/iMHbi, nacTo c npMMeHeHMeM MOHOo6MeHHOM xpoMaTorpa4>MM m MeTo^a MO/ieKy/inpHbix CMT.

Слайд 47

MHcysiHH ne/ioBexa
Cnoco6bi no/iyneHHfi:
• riO/lHblM XMMMHeCKMM CMHTe30M;
• no/iycMHTeTMHecKM/vi nyTeM;
• reHHOMHMKeHepHbIM CMHTe30M.
(lepBbiM cnocoG

b HacTonmee BpeMH He npn/v\eHHK)TCH BBM/^y HeaKOHOMMHHOCTM no/iHoro CMHTe3a.
rio/iycMHTeTMHecKMM MHcy/iMH no/iynaioT M3 CBMHOTO nyTeM 4>epMeHTaTMBHOM 3aMeHbl aMMHOKMC/lOTbl a/iaHMHa b no/io>KeHMM 30 B-u,enM Ha TpeoHMH. B noc/ieflyioLneM no/iyneHHbiM MHcy/iMH no,o,BepraeTCfl xpoMaTorpa4)MMecKOM ommctkg. He^ocTaTKOM aioro MeTO,qa flB/lfleTCfl 3aBMCMMOCTb npOMSBO^CTBa MHcy/iMHa OT MCXOAHOTO Cbipbfl - CBMHOTO MHCy/IMHa.

Слайд 48

AKTMBHOCTb fipenapaTOB MHCy/IMHa
AKmueHocmb npenapamoe uhcv/iuho BbipawaioT 6M0/10mHeCKMMM MeTO/^aMM B Efl. 3a

1 Efl npMHMMaKDT T3KOe KO/lMHeCTBO MHCy/IMHa, KOTOpoe CHMMOGT KOHU.eHTpaU.MK) r/lK)K03bl B KpOBM y KpO/IMKa HaTOLU,aK Ha 45 Mr/,0,/1 M/1M Bbl3blBaeT rnnor/iMKeMMHecKne cy^oporM y MbiuieM. 1 E/], kmcy/ii/ma yTM/iM3npyeT oko/io 5,0 r r/iK)K03bi kpobm. 1 Mr MeM^yHapo/^Horo CTaHAapia MHcy/iMHa coAepmMT 24 Efl. flepBbie npenapaTbi coAep>Ka/in 1 Efl b m/i, coBpeMeHHbie KOMMepnecKMe npenapaTbi MHCy/lMHa BbinyCKaKDTCJR b BM^e 2 KOHU.eHTpaU.MM:
• U-40-co^epmaT 40 EA/m/i. TaKaa KOHU.eHTpau.km ncno/ib3yeTCfl npM BBe^eHUM MHcy/iMHa npM noMOLU,M oObiHHoro Lunpmi.a, a TaKM• U-100 - co^epMKMT 100 Efl/M/i. TaKaa KOHU.eHTpau.km Mcno/ib3yeTCfl npM BBe^eHMM MHcy/iMHa c noMOLU,bK) Lunpnu,a-

Слайд 49

HoMeHK/iaiypa npenapaTOB MHcy/imna
B 3aBncnM0CTM ot fl/ime/ibHOCTM A6MCTBMB npenapaTbi MHcy/iMHa pa3A6/iBK)T Ha

HecKO/ibKO rpynn:
1. MHcy/iMHbi y/ibTpaKopoTKoro AeMCTBMa;
2. MHcy/iMHbi KopoTKoro AeMCTBM^ (npocTbie MHcy/inHbi);
3. llpoA/ieHHbie MHcy/iMHbi (MHcy/iMHbi cpe^HeM A/ime/ibHocTM
AeMCTBMfl);
4. MHcy/iMHbi A/ime/ibHoro fleMCTBMfi;
5. CMeLUaHHbie MHCy/lMHbl (rOTOBbie CMeCM MHCy/lMHOB KopoTKoro m npo,fl/ieHHoro AeMCTBMfl);
6. MHcy/iMHbi, /lMLueHHbie nuKa a^mctbhh.

Слайд 50

HHCy/lMHbl y/lbTpaKOpOTKOrO fleMCTBMfl
/lM3npoMHcy/uiH (Lysproinsuline, Humalog). TpaAHAMOHHbm MHcy/iMH o6pa3yeT b pacTBope m

noAKOKHOM K/ieTHaTKe reKcaMepHbie KOMn/ieKCbi, KOTopbie HecKO/ibKO 3aMeA/i«K)T ero BcacbiBaHne b KpoBb. B /iM3npoMHcy/iMHe M3MeHeHa noc/ieAOBaie/ibHocTb aMMHOKMC/ioT b no/ioweHMflx 28 u 29 B-ueriM c -npo-/iu3- Ha -nu3-npo-. 3to M3MeHeHne He 3aiparnBaeT aKTMBHbm u,eHTp HHcy/iMHa, KOTopbiii B3anMOAeMCTByeT c peu,errropoM, ho b 300 pa3 CHMwaeT ero cnocodHocrb 4>opMnpoBaTb reKcaMepa m AHMepbi.
fleMCTBMe MHcy/iMHa /iM3npo HaHMHaeTCfl y>Ke nepe3 12-15 mmh, a MaKcmviyM 3eKTa npMXOAMTCB Ha 1-2 naca, c o6w,eM npoAO/iWMTe/ibHOCTbK) Ae^CTBna 3-4 h. Tanaa KMHeTMKa acjxJjeKTa npMBOAHT k 6o/iee 4>M3no/iornHecKOMy kohtpo/ik> nocmpaHAMa/ibHOM r/iMKeMnn m pewe Bbi3biBaeT mnor/iMKeMMHecKMe coctoahma Me>KAy npneMaMM nmu,n.
/lM3nponHcy/iMH c/ieAyeT BBOAmb HenocpeACTBeHHO nepeA ep,ov\ v\m cpa3y noc/ie Hee. 3to oc6eHHO yAo6HO y A^TeM, t.k. BBeAeHMe o6biHHoro MHcy/iMHa Tpe6yeT, HToObi ne/ioBeK Chen ciporo OTMepeHHoe hmc/io Ka/iopnM, ho anneTMT pedeHKa bo MHoroM 3aBMCMT ot ero HacTpoeHMB, Kanpn30B m poAme/iM He BcerAa MoryT y6eAMTb ero b hcoOxoammoctm cbecTb AO/i>KHoe KO/iMHecTBO nniun. /lM3ripOMHCy/lMH MOWHO BBeCTM riOC/ie eAbl, paCCHMTaB KO/lMHeCTBO Ka/IOpMM, KOTopbie no/iyHM/i pedeHOK.

Слайд 51

klHCy/IMHbl y/lbTpaKOpOTKOrO AeMCTBMfl
AcnapTMHcy/iMH (insuline aspart, NovoRapide).
TaK>Ke BB/lfleTCB MOAH<}>mj,HpOBaHHblM MHCy/lklHOM y^bipaKopoTKoro agmctbhb.

no/iyneH nyieM 3 a/vie me hub ociaTKa npo/iMHa Ha acnaparMHOByio KMC/iOTy b no/io>KeHMM 28 B-u,enM. Ero bboabt HenocpeACTBeHHO nepeA npneMOM nmu,n, npM stom yflaeTca Ao6nTbca 6o/iee BbipaweHHoro chh>kghmb nocmpaHAHa/ibHOM r/imOB: KapTpHA>KM no 1,5 m3m/i (100 Efl/zwi)

Слайд 52

klHCy/lMHbl KOpOTKOro fleMCTBMfl
npeflCTaB/iflHDT co6om pacTBop hmctoto MHcy/iMHa m/im MHCy/lMHa C He6o/lblUMM

KO/lMHeCTBOM MOHM3npoBaHHoro u,MHKa. noc/ie noAKOWHoro BBefleHna 3tm MHcy/iMHbi HaMUHaiOT AeMCTBOBaTb nepe3 0,5-1,0 h, MaKCMMyM mx agmctbmb npMxoAmca Ha 2-3 h m npoAO/i>KMTe/ibHOCTb rMnor/iMKeMM3MpyiOLu,ero AGmctbmb cocTaB/iaeT 6-8 nacoB. flpenapaTbi stow rpynnbi PB/iaKDTca MCTMHHbiMM pacTBopaMM, mx mo>kho BBOAHTb nOAKOWHO, BHyTpMMblLUeHHO M BHyTpMBeHHO. Ka« npaBM/io, b Ha3B3HMax npenapaTOB stom rpynnbi ^MrypupyiOT c/iOBa «panMA» m/im «pery/inp».

i r.d

Слайд 53

klHcysiMHbi cpeflHeM npoAO/imuTe/ibHOCTM fleiictbmh
y/3/1 mhehma w-icy/i wna /],o6MBaK)TCH nyieM 3aMe£/ieHkm ero
BcacbiBaHM^.

ripn 3tom ncno/ib3yK)T c/ie/]IyK)Lii1Me npenapaTbi MHcy/iMHa:
• CycneH3MK) aMopcj)Horo u,MHK-MHcy/inHa - co,a,ep>KMT MHcy/iMH c M36blTKOM MOHM3MpOBaHHOrO U,MHKa, KOTOpbIM CnOCo6cTByeT o6pa30BaHMK) /v\e/iKMX n/ioxopacTBopn/vibix KpucTa/i/ioB mhcy/iMha.
• CycneH3MK) M30(j)aHHoro MHcy/iMHa m/im MHcy/iMHa-NPH (neutral protamine Hagedorn) - coflepmm civiecb 3KBn/v\o/iHpHbix KO/innecTB MHcy/iMHa m ochobhoto 6e/iKa npcrraMMHa, KOTopbiM o6pa3yeTC MHCy/lMHOM n/lOXOpaCTBOpMMbIM KOMn/ieKC.
• CycneH3MK) npoTaMMH-u,HHK MHcy/iMHa - CMecb coAepwamaa MHCy/lMH M M36blTOK MOHM3MpOBaHHOrO Li,MHKa C npOTaMMHOM.
KaK npaBM/io, b Ha3BaHMflx npenapaTOB btom rpynnbi 4>MrypnpyK)T c/ioBa
«Tap(a1»/ «/ieHTe».

Слайд 54

klHcy/iMHbi fl/ime/ibHoro AeficTBHfl
• npe^CTaB/iflK)T KpMCTa/iyiMHecKyK) cycneH3MK) u,MHK-MHcy/iHHa.
flyiMTe/ibHoe BpeMfl rah no/iyneHMfl 3tmx

npenapaTOB ncno/ib30Ba/in roB^>KMv\ MHcy/iMH, t.k. b ero A-u,enn coAepwaTCfl 6o/iee rn1oIpo4)o6Hbie aMMHOKMC/ioTbi, neM y MHcy/iMHa CBMHbM m/im ne/ioBeKa (a/iaHMH m Ba/iMH) m oh HecKO/ibKO xywe pacTBopwvt. B 1986 r. cJ)Mp/v\a Novo Nordisk cos^a/ia npoA/ieHHbiki MHcy/iMH Ha ocHOBe MHcy/iMHa ne/ioBeKa. C/ieflyeT noMHMTb, hto cos^aHMe npenapaTa A/iMTe/ibHoro ^encTBHfl Ha ocHOBe cbmhoto MHcy/iMHa b HaCTOflLU.ee BpeMfl HeB03M0>KH0 M /lK)6yK) nonbITKy o6T>flBMTb npenapaT Ha ocHOBe CBMHoro MHcy/iMHa KaK npenapaT,q/iMTe/ibHoro AeMCTBM^ c/ie^yeT pacu,eHMBaTb KaK (J)a/ibCM(J)MKau1MK).
KaK npaBM/io, b Ha3BaHMflx npenapaTOB ,4/iMTe/ibHoro .u.eMCTBMfl npMcyTCTByeT (J)parMeHT «y/ibTpa».

Слайд 55

KOM6HHMpOBaHHbie MHCy/lMHbl
• fl/ia yAo6dBa nau,neHTOB, KOTopbie no/ib3yK)Tca KOpOTKMM M npOflyieHHblM MHCy/IMHOM

BbinyCK3K)T roTOBbie CMecu MHcy/iMHa KOpOTKoro AeMCTBua c NPH-MHcy/iMHOM b pa3/iMHHbix coneTaHMax 10/90, 20/80, 30/70, 40/60 m 50/50. Han6o/iee nony/iapHbiMM bb/ibk)tcb CMecu 20/80 (ncno/ib3yiOT /ikiu,a c MHCfl b 4>a3e nHcy^MHonoTpe6HocTn) n 30/70 (ncno/ib3yK)T nau,neHTbi c M3C/H npn pewuMe 2-KpaTHblX MH'beKU.Mki).

I -7^

Слайд 56

ripenapaTbi MHcy/iMHa siMweHHbie nuica flenctbmh
• rnaprMHMHcy/iMH (Glargineinsuline). 1/lHcy/iMH c TpeMfl aaMeuj^eHMflMM

b no/innenTMAHOM u,erm: i71mu,mh b no/io>KeHMM 21 A-u,enn m 1a1o6aBOHHbie ocraTKM apruHMHa b no/ioweHMi/i 31 m 32 B-u,enn. TaKoe 3a/v\euiIeHMe npMBOAMT K M3MeHeHMK) M303/ieKTpMHeCKOM TOHKM M paCTBOpMMOCTM MHCy/IMH3. l~lo CpaBHeHMK) C NPH MHcy/iMHaMM y r/iaprMHa Kpi/iBaa KOHu,eHTpau,i/m 6o/iee n/iocKaa m nuK AeMCTBMfi n/ioxo BbipaweH.
• 9tot MHcy/iMH peKOMeH/^yeTCfl npMMeHflTb ,0,/ifl MOAe/ikipoBaHHfl 6a3a/ibHOM ceKpeu,MM MHcy/iMHa y /imu, c UHTeHCMC^MUjUpOBaHHOM cxeMOM MHcy/iMHOTepannn.

Слайд 57

flpenapaTbi MHcy/iMHa

Слайд 58

$noi OcHOBHbie noKa3aHMfl CBB3aHbi c H33HaneHneM MHcy/iMHa f\r\n /leneHna caxapHoro Ana6eTa:$

noiOcHOBHbie noKa3aHMfl CBB3aHbi c H33HaneHneM MHcy/iMHa f\r\n

/leneHna caxapHoro
Ana6eTa:
• HHcy/iMH3aBMCMMbm caxapHbiM A^a^eT (Ana6eT | inna).
• /leneHne mnepr/iMKeMMHecKMx kom npn Ana^eie (KeToaAMAOTMHecKOM, mnepocMO/iapHOM, mnep/iaKTaAMAeMMHecKOM) - no aTOMy noKa3aHmo ncno/ib3yK)T To/ibKo npenapaTbi KopoTKoro agmctbh^, KOTopbie bboaat BHyTpMBeHHO M/1M BHyTpMMbILUeHHO.
• /leneHne MHcy/inHHe3aBncMMoro caxapHoro Ana6eTa b a3y MHCy/lMHOnOTpe6HOCTM (A^lUTe/lbHO 6o^eK)lAMe naU,HeHTbl C HeB03M0>KH0CTbK) KOHTpO/IMpOBaTb ypOBeHb r/IMKeMMM npM nOMOLAM AH^Tbl M nepopa/lbHblX cpeACTB).
• /leneHMe MHcy/iMHHe3aBMCMMoro caxapHoro AnaSeia y OepeMeHHbix.
• /leneHHe MHcy/iMHHe3aBMCMMoro caxapHoro Ana6eia bo BpeMfl nH^eKAMOHHbix 3a6o/ieaaHMM, npM Bbino/iHeHMM XMpyprMHecKMX BMeiuaTe/ibCTB.
MHorAa MHcy/iMH npMMeHBKDT a/i« zieneHHB coctobhmm He CBB3aHHbix c caxapHbiM
Ana6eTOM:
1) b cocTase Ka/iMM-no/iapM3yioiij,Mx cMecePi (cMecb 200 m/i 5-10% pacTBopa r/noK03bi,
40 m/i 4% pacTBopa x/iopMAa Ka/ibaha m 4-6 Efl MHcy/iMHa) npM zieneHMM apMTMMM m
rnnoKa/iMeMHki; 2) npn MHcy/inH-K0MaT03H0H TepannH y 6o/ibHbix LUH3Q({)peHHeH c

Слайд 59

Ocsio>KHeHkm mhcv/imhobom TeparmM
1. A/i/ieprunecKMe peaKunn Ha HHcy/iMH. Cefl3aHbi c npMcyTCTBMeM b

npenapaTax MHcy/iMHa nocTopoHHMX npMMecefi, o6naf\3\oiu,\AX aHTMreHHbiMM CBOMCTBaMM. He/ioBenecKMM MHcy/iMH KpaPtHe peAKo Bbi3biBaeT sto oc/io>KHeHMe. A/1/ieprnHecKne peaKu,MM npoflB/iflK>TCfl b BMAe 3yAa, ^eHna, cbirm b Mecrax MH'bGKLJ.MM. B Tfl>Ke/lblX C/iyHaflX B03M0>KH0 pa3BMTMe OTeKa KBMHKe, /iMM(J)aAGHonaTMM (yse/iMHeHHfl /iMM(J>aTHHecKMX y3/ioB) m aHac|)M/iaKTMHecKoro iiiOKa.
2. /lnnoAMCTpo4>MM - HapyiueHMe /innoreHe3a m nwnonma b noAKOWHOM K/ieinaTKe b 06/iacTM mhi^kamm MHcy/iMHa. npoflB/ifleTCfl /im6o nO/lHblM MCHe3HOBeHMeM K/ieTHaTKM (/innoaipo(})kfl) b BMAe yr/iy6/ieHMki Ha Kowe m/im ee pa3pacTaHneM b BMAe y3/ioB (/iMnorMnepTpo4)MM). fl/ifl mx npo4)M/iaKTMKM peKOMeHAyeTca nepMOAMHecKM MeHflTb Mecra MH"beKU,MM, He no/ib30BaTbCfl 3aTyn/ieHHblMM MfTiaMM M XO/lOAHbIM MHCy/lMHOM.
3. MHCy/lMHOBbie OTeKM - B03HMK3K)T B HaHa/ie /leneHMfl, CBfl3aHbl c npeKpaiAeHMeM no/iMypMM m yBe/iMHeHMeM o6-be/v»a BHyTpMK/ieTOHHOM >kmakoctm (t.k. yBe/iMHMBaeTca nociyn/ieHMe rynoK03bi b K/ieTKy m, c/ieAOBaie/ibHO, BHyTpMK/ieTOHHoe ocMOTMHecKoe Aae/ieHMe, KOTopoe o6ecneHMBaeTTOK BOAbi b K/ieTKy). 06bNHO npoxoAflT caMOCTOATe/ibHO.

Слайд 60

Oc/io>KHeHMfl MHcy/iMHOBOM Teparmu
4. OeHOMGH «yipeHHeM 3apn». rnnepr/iMKeMMfl b paHHue yTpehhme nacbi

(Me>KAy 5-8 nacaMM yTpa). 06yc/ioB/ieHa uupKaAnaHHbiMM pMTMaMM ceKpei^nn KOHTpm-icy/iflpHbix ropMOHOB - K0pTM30/ia M CIT, KOTOpbie Bbl3blBaJOT nOBbIWeHMe ypOBHfl l71K)K03bl, a TaKme HeAOdaTOHHOM npoAO/i>Kme/ibHOCTbK) AeMCTBMfl npoA/ieHHoro MHcy/iMHa, KOTopbm nau,MeHT bboamt nepeA y>KMHOM. fl/ia yMeHbweHMfl 3Toro act^eKTa c/ieAyeT nepeHecTM Ha 6o/iee no3AHee Bpe/vm BenepHtoK) MH-beKu.nK) npoA/ieHHoro MHcy/iMHa.
5. rnnor/iMK€MMHecKne coctohhmh m rnnoi7iMKeMMHecKafl KOMa. CBH3aHbi /im6o c npeBbiweHMeM A03bi bboahmoto MHcy/iMHa, /im6o c HapyiueHneM pe>KMMa MHcy/iMHOTepannn (BBeAeHMe MHcy/ikiHa 6e3 noc/ieAytounero npneMa nMLU,M, MHTeHCMBHbie (J)M3MHecKne Harpy3KM). XapaKTepn3yeTCfl noaB/ieHMeM nyBCTBa ro/ic>Aa, noT/iMBocTbK), ro/ioBOKpyweHMeM, ABoeHneM b r/ia3ax, 0He/v\eHneM ry6 m A3biKa. 3panKM y naAneHTa pe3KO pacwMpeHbi. B Tawe/ibix c/iynaflx B03HMKaKDT cyAopom MbiLLiu, c noc/ieAyK)LLi,HM pa3BMTneM KOMbi. rioMoiAb 3aK/iKDHaeTCfl b npMeivie BHyTpb 50,0-100,0 r caxapa, pacTBopeHHoro b Ten/ioM boag m/im nae, bo3mo>kho npn/vieHeHMe KOHcJ)eT, MeAa, sapeHbfl. Ec/im nauMeHT noiepa/i C03HaHMe Heo6xc>AMMO BBecm BHyTpuBeHHO 20-40 m/i 40% pacTBopa r/iK)K03bi m/im BTepeTb b ero AecHbi MeA (oh coAep>KMT (f)pyKT03y, KOTopaa xopoiuo Bcacbisaeicfl nepe3 c/iM3MCTyK) pia). >Ke/iaie/ibHO BBecTM oamh m KOHTpMHcy/iapHbix ropMOHOB - 0,5 m/i 0,1% pacTBopa
i nn

Слайд 61

Oc/io>KHeHMfl MHcy/iMHOBOM Tepankiu
ft. MHCy/lMHOpPBHCTPHTHOCTh (CHMWPHMP HyRCTRMTP/lhHOCTM TKRHPM K /^PMCTRUJO
MHcy/iMHa m Heo6xoAMMOCTb

yBe/iMHeHMB ero cyTOHHOM A03bi ao 100-200 Ef\). OCHOBHOM npMHMHOM MHCy/lMHOpe3MCTeHTHOCTM RB/lfleTCR Bbipa60TKa aHTMTe/1 K MHcy/iMHy m ero peu,enTopaM. Ham,e scero o6pa30BaHne aHTme/i Bbi3biBafOT KceHorehHbie MHcy/iMHbi, noaTOMy TaKMX naAnemoB HeoOxoAUMO nepeBecTM Ha He/ioBenecKkie MHcy/iMHbi. OAHaKO, MHcy/iMH ne/ioBeKa MOweT Bbi3BaTb
o6pa30BaHne aHTMTe/i. 9to CBfl33HO c TeM, hto oh pa3pywaeTCfl MHcy/iMHa30M noAKOM7. Cmhapom Commoa>km (xpoHMHecKaa nepeA03kipoBKa MHcy/iMHa). llpMMeHeHMe BbICOKMX A03 MHCy/lMHa Bbl3blBaeT BHaHa/ie rMnor/IMKeMMK), HO 3aTeM pe(()/ieKTOpHO pa3BMBaeicfl mnepr/iMKeMMfl (npoMexoAMT KOMneHcaTopHbiM Bbi6poc KOHTpHHcy/iBpHbix ropMOHOB - KopTM30/ia, aApeHa/iMHa, r/iK)KaroHa). OAHOBpeMeHHO, cTMMy/iMpyeTCR /iMno/iM3 m KeToreHe3, pa3BMBaeTca Keioai4MA03. Cmhapom npoaB/iaeTCR pe3KMMM KO/ie6aHMRMM ypoBHfl r/uoK03bi b kpobm BTeneHMe AHB, 3nM30AaMM TMnor/lMKeMMM, KeT0aU,MA030M M KeTOHypMeM 6e3 r/IKDKOaypMM, noBbiiueHMeM anneTMTa m yBe/inneHMeM Maccbi Te/ia HecMOTpa Ha Tawe/ioeTeneHMe AMa6eia. fl/ia ycipaHeHMB aToro CMHApowia Heo6xoAM/vio yivieHbiiiMTb A03y MHcy/iMHa.

Слайд 62

/leKapcTBGHHbie cpe^cTBa, npMMeHfleMbie /yia TGpannn
caxapHoro Ana6eia II Tuna

Слайд 63

CaxapHbiM Aua6eT II Tuna - MeTa6o/iMHecKoe 3a6o/ieBaHne; xapaKTepn3yK)LiJ,eeca xpoHMHecKOM rkinepr/iMKeMMeM,
pa3BMBaK)Lu,ePicfl b

pe3y/ibTaie HapyrneHna B3aMMOfleMCTBHB MHCy/1 MHa C K/ieTKaMM TKaHeki
(B03, 1999 toa).

Слайд 64

CaxapHbiM Ana6eT II Tuna - HapyweHne ymeBOAHoro o6ivieHa, Bbi3BaHHoe ripen My

mecTBem-iOM
MHCy/lMHOpe3MCTeHTHOCTbK> H OTHOCHTe/lbHOM MHCy/lMHOBOM HeAOCTaTOHHOCTbK) H/1H npenMymecTBeHHbi/vi HapyweHneM ceKpeu.nn MHCy/lMHa C MHCy/lHH0pe3MCTeHTH0CTbK) H/1H 6e3

Hee.

Слайд 65

%
8
7
6
5
4
3
2
1
0
PemcTpupyeMafi u cpaKTMHecKan pacnpocTpaHeHHOCTb CA 2 mna no so3pacTHbiM rpynnaM (PO)
/
Jr
30-39

40-49 50-59 60-69

B03paCT

■* perncTpupyewafl * tt>aKTMMecKafl

» or

Слайд 66

MHCy/lbT
HapymCMMC xpoBOo6pameMHfl M03ra, npMBOiifliyec k OTMMpaHMio era micro*
Henponarnfl
PaccTpOMcrea hcpbhom cucTeMw, cBfl3aMHt>ie

c
nopaxeHMeM xpcBewocMbix cocyAoa

HeM onaceH Ana6eT 2oro Tuna?
TeM, mto Aa*e npH npasH/ibHOH jieneHHH oh nporpeccHpyei! A ero pa3BHTHe npHBOAHT k pnjy Tfl*e;ieMUJMx oc/io>kh6hhh:

Слайд 67

To/icraa KMLUKa
flaioflorMMecKaw MMKpO^Opa BOBMOWHOe CHMWeHMe
cenpei^MM mn*l
p-OPMEHTMPOBAHHAfl MOflE/lb Cfl 2 TMnA
113BEHbEB

nATOfEHE3A

apymeHMe

MMMyHHOM pery/i«4Mn/ Bocna/ieHMe

(e/iyAOK/TOHKMM

KMLUeHHMK
tcKOpOCTM a6cop64MM r/l(0K03bl

■K/ieTKM

^yHKl^MH P*K/ieT0K IfViaCCbl (J-K/ieTOK iceKpei^MM MHCy/lMHa

i HHKpeTMHOBOrO

3^4>eKTa

Ae4>eKT a-wieTOK tr/iK)KaroH

rMflEPr/lMKEMMfl

flOHKM
tpea6cop6i^HM
MWK03N

CZ^rO/lOBHOM M03r

tanneTHTa
IcHMweHMeAonaMMHa t cMMnaTMMecKoro TOHyca

P63MCT6HTHOCTb K MHCy/lMHy

neneHb

AnpOAyK4MM r/lK)K03bl

MblLULfbl

inepHepMMecKOM yTH/1M3aAHH r/lK)K03bl

ir^HtopoBan

Слайд 68

CMHAPOM MHCySlMHOpe3MCTeHTHOCTM
MHcy/iMHOpe3MCTeHTHOCTb - HapyrneHne peaKU,nn nHcy/iMHMyBCTBme/ibHbix TKaHePi Ha (J)H3no^ornHecKne KOHu.eHTpau.m/i MHcy/iHHa.

Pa3BHBaeica nocieneHHo, b nepByK) cnepeAb b rieneHM m Mbiiuu.ax. To/ibKO Ha 4>OHe rnnepipo(})HM m rnnepn/ia3nn aAnnou,moB pa3BHBaeica COCTOaHHe MHCy/IMHOpe3MCTeHTHOCTM B >KMpOBOM TKaHH.
CaMa >KnpoBaa TKaHb 06/iaAaeT SHAOKpMHHbiMM m napaKpkiHHbiMH c|)yHKpMaMM. rnnepTpoc|)MpoBaHHbie aAnnou,mbi ceKpeTMpytOT B/iMHK>m,ne Ha MHcy/iMH BemecTBa: pmoKMHbi, zieriTMH, OHO a/ib^a. Ohm AGMCTBytOT Ha nepeHOCHMK GLUT-4, HapywatOT B3aMMOAeMCTBMe mhcy/imha c peu,enTopoiv\.

iiil

Слайд 69

OaKTopbi pkiCKa pa3BUTkm caxapHoro
Ana6eia II Tuna
Bo3pacT 6o/iee 45 /ieT
M36biTOHHafl Macca TG/ia

m owmpghmg (MMT donee 25 Kr/M2) CGMGMH bIM aHaMHG3
ripMBblH HO HM3K3B (j)M3MHGCKafl aKTMBHOCTb
HapyiUGHHaB MMKGMMfl HaTOlD,aK M/1M Ha pyiUGHHafl TO/IGpaHTHOCTb K I71KDK03G B aH3MHG3G
rGCTau,MOHHbiM caxapHbm py\edei M/iM poK^GHMG KpynHoro n/iofla b
aH3MHG3G
ApTGpna/lbHaB rMllGpTGH3MB
Xo/lGCTGpMH /IBn MGHGG 0,9 MMO/lb//l m/m/IH TpMr/lMU.GpM/l.OB 6o/1GG 2, 82 iv\Mo/ib//i
CMHAPOM n0/lMKMCT03HblX BMHHMKOB
Ha/iMHkie CGpAeHHO-cocyAMCTbix 3a6o/iGBaHMM

Слайд 70

npMHL^unbi TGpannn caxapHoro
Aiia6eia II Tuna
• AKTUBHoe BbmB/ieHne rpynn pucKa
• M3MeHeHne o6pa3a

>km3hm (nmaHne, 4)M3MHecKne Harpy3KM)
• MeAMKaMeHT03Haa TepanMfl

Слайд 71

neseHneAnadeTa 2 Tuna
-Med.Com

Слайд 72

PeKOMeHAaijMM no M3imecKOM
aKTMBHOCTM
Pery/iapHaa OA npn Cfl 2 Tuna y/iyniuaeT KOMneHcauMK) ymeBOAHoro

o6MeHa; noMoraeT CHM3MTb m noAAepwaTb Maccy iena, yMeHbumTb MHCy/lMHOpeBMCTeHTHOCTb, CTeneHb a6AOMMHa/lbHOrO OMKHpeHMfl, cnoco6cTByeT y/iyniueHUK) f\v\cnv\nv\f\eN\v\v\, noBbiweHMK) cepAenHO-COCyAMCTOM TpeHMpOBaHHOCTM
0A noA^MpaeTCfl MHAUBMAya/ibHo cyneTOM B03pacia 6o/ibHoro, oc/io>KHeHMM Cfl, conyTCTByjoiAnx 3a6o/ieBaHMM; a TaKwe nepeHOCMMocTM
PeKOMeHAOBaHbi aapo6Hbie 4)M3MHecKMe ynpawHeHMfl npoAO/i>KMTe/ibHOCTbK) 30-60 MMHyT, npeAnoHTme/ibHO eweAHeBHO, ho He MeHee 3 pa3 b HeAe/iio. CyMMapHas npoAO/i>KMTe/ibHOCTb - He MeHee 150 MMHyT b HeAe/iK).
y 6o/ibHbix Cf\ 2 TMna, no/iynaKDLAMx MHcy/iMH m/im nepopa/ibHbie caxapocHMMOJOiAMe npenapaTbi, CTHMy/iMpyKDiAMe ceKpeu,Mfo MHcy/iMHa, OA MOWeT Bbl3BaTb TMnor/lMKeMMK).

Слайд 73

PGKOMGHAaUMM nO aKTMBHOCTM
Pcry/iapHafl OA npn Cfl 2 Tuna y/iynwaGT KOMriGHcaunK) ymeBOAHoro

o6MGHa; noMoraeT CHM3MTb m noAAepwaTb Maccy iena, yMGHbiiiMTb MHCy/lMHOpG3MCTGHTHOCTb, CTGnGHb a6AOMMHa/lbHOrO 0>KMpeHMfl, cnoco6cTByGT y/iyniueHHK) f\v\cnv\n\Af\eN\v\v\, noBbiweHMK) cepAeHHO-COCyAMCTOM TpGHMpOBaHHOCTM
0A noASupaeTca MHAUBMAya/ibHo c yneTOM B03pacia 6o/ibHoro, 0C/10>KHGHMM Cfl, COnyTCTByHDIAMX 3a6o/lGBaHMM, a TaKMPGKOMeHAOBaHbi aapo6Hbie (J)M3MHecKMe ynpawHGHMfl
np0A0/l>KMT6/lbH0CTbK) 30-60 MMHyT, npGAnOHTMTG/lbHO 6>K6AHGBHO, HO HG MeHee 3 pa3 b HGAe/iio. Cy/viMapHaa npoAO/i>KMTe/ibHocTb - He mghgg 150 MMHyT B HGAe/lK).
y 6o/ibHbix Cfl 2 Tuna, no/iynajOLAHx MHcy/iMH v\nv\ nepopa/ibHbiG caxapocHMMOfoiAMG npcnapaTbi, CTMMy/iMpyfoiAMG cgkpgu,mk) MHcy/iMHa,

Слайд 74

Ahtmtmpeomflhbie cpeactba

Содержание

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