You are on page 1of 114

Advanced

Cardiac Life
Support:
Pocket Reference,
1994 edition
Ken Grauer, M.D., FAAFP
Professor,
Department of Community Health & Family Medicine;
Assistant Director,
Family Practice Residency Program
University of Florida, College of Medicine
Gainesvilfe, Florida;
Past ACLS National Affiliate Faculty
ACLS Affiliate Faculty for Florida
Dan Cavatlaro, REMT-P
Coordinator,
Center for Cardiopulmanary Research
All Children's Hospital
St. Petersburg, Florida
Past ACLS National Affiliate Faculty
Mosby
Lifeline
Mosby-Year Book
St. Louis, Baltimore. Berlin, Boston, Carlsbad,
Chicago, London, Madrid, Naples,
New York, Philadelphia, Sydney, Tokyo, Toronto

-

.
.
. . ..
, ..

1996

54.5
5
616-036.882+616-001.36-0086
. 1
5 . , . .
- . .
, . - .: , 1996 - 128 ., .


- ,
, -
.

; , ,

.
. .
.
,
.
, - ,
, .
.
54.5
ISBN 0-8151-3435-5 (.)
ISBN 5-88001-007-4 (.)
1994 by Meshy-Year Book, Inc.
A Meshy Lifeline imprint of
Meshy-Year Book, Inc.
,
, 1996.

.


7
. 9
9
10
- : 11
. 13
16
. 27


- :

I:
2: 92
3: 94
4: 96
98
5: , .
- . 102
- 103
6: 104
106
/ 107
7: 108

- -
112
- 119
: ,

, 122


30
- ,
.
:
,
,
.

.
.
,
,
, .
,
, .
,
.
(National Conference on Cakliopulmonary Resuscitation
and Emelgency Cardiac Care, 1992) J.A.M.A. (October 1992,
v.268, 16). 126 ,
,
(1974, 1980, 1986 .).

- ;


.
,
- ,
;
.
,
( )
, , ,
.
,
, .
- ( )
, ,
, ( )
.


.
,
- .

..
-


A -
-
-
/ -
-
-
-
WPW - --
- -
-
-
-
-

,

.
. 1994 .
- .

(), 1992 .

,
(
), .
,
.
,
,
.
.
- .
, .
Ken Grauer
Dan Cavallaro

Caller ., Cavallaro D. ACLS: certification preparation - vol. I (3rd Ed.), Meshy
Lifeline, St. Louis 1993.

Grauer K., Cavallaro D. ACLS: a comprehensive review - vol.II Old Ed.), Mosby
Lifeline, St. Louis, 1993.
Grauer K., Cavollaro D. ACLS: mega code review/study canl (2nd Ed.), Meshy
Lifeline, St. Louis, 1993.
Grauer K., CavoUaro D. ACLS teaching kit: an instructors' resource. The . V.
Meshy Company, St. Louis, 1990.
Grauer . A practical guide to ECG interpretation. Mosby Year Book, St. Louis,
1992.

- :
.

, ,
:
1) ();
2) (,
, ) (. , . 1).
,
, . ,
, ,
,
.

, .
.
, , ,
. ,
.
. -
, .


.
(. , . I):
- ;
- ;
- , .

( 2/3 ) - . , -
(510% ). ( 1/3)
. Wang . (1991), ,

T.
,
, . ,
,
. ,

, , ,
.
- ,
. ( )
,
. ,
: ,
, .

- . , . 1-6.

, , .
.
,
.
,
: 5-25%.
- , (
-
).

( )
(. ,
. I):
- ;
- ( );
- ;
- .

(. , . 4 5).

.
.

, ,
. ,
, - . , . 6.

,
. -

, .

.
:
1) ;
2)
3)
.
-
,
. .
1. .
2. .
3.
.
4. .
5. , (
).
6. , .
7.
.
, ,
.

.



- . , . 2.
- ,
. ,
.
.
, .
- ,
.
,
.
,
.
, , ,
.
,
.
,
- ,
20 .
,
, .
,
.

1.
- 200 .
( , ),
320 ,
(Weaver, 1982).
,
.

( )
, ,
.
- 200 300 . ( 300
)
.
, ,
- 360 .

1
2.
,
, ,
.
3.
- .

,
.
- 1 / (1 1:1000 10
1:10 000) - 3-5 )
- .
(2-2,5 ). ,
(. . 69-70,
73).
.
4.
(360 ).
1-4 ,
( 1-4 ),
.
.
.
5.
- .
/ - 1,5 / ( 75-100 ).
2 /.
/
2 /.
, , ,
, 10 .
,

- .

, .
.
, ,
2 / 15-30 , 30-60 . ,
,
.
6.


1-2 ,
. (360 ).
7.
,
, .

,
, ).
, :
( , ), , ,
(, ,
), ( ,
).
,
, (
) ,
, .
.
1-7
8.

( 15 . .),
.
(15 . . ),
. ,
, /
3-5 .
9.

,
. ,
, ,
.
10-15
(1 / /),
. ,
, .
, .
7,25 7,35. ,

7,15-7,20.
10.

, /
(1,5 /),
. .
,
;
.
, , , (Jaffe, 1993).
,
.
11.
.
, .

1-2 ,
, (360 )
.
( )
.
.
12.

(. ).


. 5
, / .
,
, /
; - 2 /.
.
.
(. , .
3)
,
,
, ,
.
12.
,
. , ,
, ,

;
.


, ,
, .
, ,
.
,
, .
- 1-2 / 1-2 .
, 5-10 .
12.
- .
,
.
,
10-15 .

- 5 / / .
(
), 500 .
, 1-2

. , /
10 / ; 3035 /.
2-6 ,


,
.
12. -
, / -
.

.
,
( ,

; , ).

-.
,
, .
/ 0,5-1,0 5 ;
( - 5 ).
b- (, ).

12.
III .

,
. ,
, Willialns . (1989 .),
,
.


. ;
(, ).
-
?
200 , ,
.
(
).
,
100 . (300
), -,
(, 1988).
, ,
( 300-360 ). ,

.
,

,
200
- .
, ?
.
200 ,

.
, 200
,
. ,

( ),
. 200 , 360 .
?

,
( ). ,
.
, ,
( ),
, :

.

.
, .
?
,
, .
,
(
) (Martin, 1986).
, ,
, (
) .

?

(Elms, 1983). ( 1-2 )

.

(
), ,
:
-
( , ) ;
- 100/;
- , ,
;
- ,
.
?

- , (
) .


. -
(
,
).
- ,
, ,
.
, , .
,
; :
1) ;
2) ,
,
;
3) (50-100 );
4) , , .
( )
.
.
,
. ,
( ) .
, ,
.
?
:
: , , ;
: , , ( ), ,
( ).
?

. ,
.
-
- 1 (1 1 : 1000 10 1:10 000);
3-5 .
, ,
. ,
. ,


( ) .
/ ?
250
, .
.
: (1 ) 250
5% / 15-30 /.
?
- :
1 = 1
1 = 1
1 = 1
- :
1 = 1
1 = 1 (1 1:1000 10
1:10 000)
- :
1 = 200
/ :
. 1 (1 ) 250 5% ,
30 / (2 /).
. 1 (1 ) 250 5%
, 30 / (2 /).
. 1 (1 ) 250 5% ,
15 / (1 /).
. 1 (1 ) 250
5% , 30 / (2 /).
. 1 (1 )
(1 1:1000 10 1:10 000) 250
5% , 30 / (1 /).
. 200 (1 ) 250 5% ,
15-30 / (2-5 //).
?

.
, .
, .
?
30
, ,

, .

- .

20 ,
. , , ,
20-30 :
- ;
- (
);
- ( );
- ( ).

,
?
. .
( ,
, ), ,
, .
;


.


( 30 ),
(. , .
4). , ( )
- .
,
:
(200 ).

.
,
,
,
.

.
. ,

, ,
R .
( ).
, ,
.
, , .
,
.
, , 90
. . ,
.
:
.
(140-170 -1).
,
, .
,
,
,

( ),

.
.
.
,
.
, (
) ,

.

, 2-5
.
, ,
( ).
, ,
.
100 .


.
(20 )
,
( 100 ).

, ,
(50 ).

, .
1.
-
. - 50-100 / ( 1-1,5 /),
2 /.
50-75 5-10 (
3 /, 225 ).

,
. ,

.
,
, (
2 /)
50-75 3
/.
2.
,
. 100
(, 5 ); ,
:
- 500-1000 ( - 17 /);
- ;
- ;
- QRS 50%.
- ,
500-1000 100 5% ,
20-30 / 30 ( 17 /).
,
2 /.

, (.
, . 4).
.

,
.
,

. -
- . , ,
, ,
( ).
, , /
, , . 500
50 5% 10 ,
( 1-2 /).
3.
,
.

, :
- , /
;
- ( ),
;
- (50 ),
100-200 .

,
( 100-200 ).
.

, :

- ;
- -;
- ;
- .
- ,
,
,
.
.
, , , -

, QRS
.
, , ,
QRS,
, .
-
?
1. .
2. .
. ,
.
, , .

. ,
- , .
?
. ,
.
,

,
. . , ,

( ; 90
. .).
, ?

QRS, ,
.

. ,
( ) ,
.
- ,
QRS .
( ,
).
,
, .
12 .

, .

, ,
.

QRS WPW,
.
- ,
.
, ,
.
QRS ,
.
,

.
,
?
- , .
, ,
,
, ,
.
, ?

,
( ,
, ).
, - , ,
.
, ?
R
,
,
. ,
; ,
,
.
,
, ,

( 200-360 ).
, ?

. ,
.

,
, ,
. .

, ,
.
,
.


.
(. , . 5) ,
.

, : ,
, .
, .
, ( 90 . .),
, ; .
1.

( ,
, ).
2.
.
, (
) ( ,
), ,
.
0,5 /.
3-5
0,04 /.
2.

,
,
.
2.


( )
( , ).

, .
- .
,
.
,
.

.
3.
,
, .

.
: 200
250 5% . 15-30 / (25 //). ( 20 //)
.

- ,
, . .
1.
2.
(1 /),
3-5 . ,
(2-2,5 ) .
.
-
.
,
,
.
,
.
,
, ,
(Sallaham, 1990; Paladis, 1992).
(

),
( )
.

3.
:
- ( ,
);
- (
, , );
- ( , ) .
4.
- . - (
) . , ,
(
).
- .
.
.
(. , . 5) ,
( ).
,
, .

. , ,
, ,
,
( )
QRS . ,
QRS (Smeven, 1989).
- . ,
( ),
,
.
- .
.
. , ,
, -
,
.

, .
, .


,
. ,
.
. 1 2
1 ( )
, .

. , , , -
. 2 II,
2 3

.

.

, .
1.
( )
.
, , 2
3 , ,
( 80-85 . .).
, 60
. ., .
2.
. 33,
, .
, / 0,5 3-5
0,04 /, ,

( 80 . .).
.
/ (1 ) ,
, .
( 1 ), , .

.
2.

- .

.
.
- .

( )
.

, .
,
,

,
.
,
. ,
.
,
, . ,
:
- (
, );
- ( ) ;
- (
, , );
- (
, ,
, ).
2.
,
,
(. . 35).
.
,
, . ,

, - ,
,
.
3.
-
,
.
.
,
, - -

. ( 2 //)
(
). (2-10 //)
- ,
( 10 //) - -
(); , 15-20 //
.
,
,
,
.
, .

.

, . ,

.

.
,
, ,
. , , (
1 /). (
2-10 /). , /
.
,
- . . 25.

, ,
, ,
.
,
, . ,
,
.
(, ), ,
, .
, ,
,
, .
, ,
.
1.

2.
(1 /, 3-5 ). ,
(2-2,5 ).
( ), .
3.
,
. ,
(Gonzalez, 1993).
- 1,0 /,
3-5 0,04 / ( 3 ).
4.
,
, .
,
.
, (
- ,
, ); , Cummins .
(1993),
.
5.
(
), , ,
,
.
6.
(250 / 1-2 )
,
, .
Viskin . (1993), 15 ,
(2-7 ) (2 ),
(
) 30 / 250
; 11
, 60
.
.
.
,

, ,
,
(Rothenbclg, 1993).
(
) .
, ,
.
, , ,
.
-
- ?
, ,
.
:
- ,

( );
- ,
.
,
: ?
- ,
.
- ,
.
.
, .
, ,
, ?
- :
,
. ,
. ,
.
?
.
,
. ; ,
. ,
,
.

?

,
. . ,

, ,
.
;
.
, ,
. , ,
, .
.
, .
, ,
, . ,
, ,
(Cummins, 1988).
?
: 1) ; 2) ; 3)
.


, , (
) .
( , ,
, ),

(. , . 6).
.
,
( , ,
). , .


.
,

, ,
, .
,
( 80 . .),
, .
,
.
1.
,
: .

( 100-200 ):
. -
, .
, ,
:
10-20 . , ,
( 200
).
(50-100 ).
.

( , ,
),
. ,
,
.
, QRS ,
.
QRS ,
.
.
,
, .
-
, ,
.
.

(-entry) . ,
-entry, .
, ,
. - .

1.
.
.
,
.
,
, , ,
( ),
, .

, .

.
, , 3-5
( ).
, .
.
,
( 10)
,
(, 1992).
,
,
. ,

, . ,

.
, .
, ,
, ,
, .
, ,
,
.
2.

.

(
10 ). .
(, ,
), .
- 6 ; / ( :
1-3 ). ,
.

1-2 , (12 ),
1-2 - , 12
( 6+12+12=30 ). ,
( /).

.
( /
),
(
).
, ,
, (
- 3 , - 6 ) (Reed, 1991). (3 )
, .
. , -
( ),
, ,
( ).
2.

: 90% ,
.
-
( 30 ),
( )
( / ,
).
- 2,5-5 ; / 2 ,
,
(23 ) ( 3-4 ).

.
/ ( 500-1000
5-10 )
, .

( 100 . .).
15-30 ,
(5-10 ),
,
.
, ,

.

QRS.

, /

(
), . , 80
/
8 .
3.
, ,
.
-,
.
,
(
), :
- , 0,125-0,25 ;
- , 0,25 ;
- , 1,0 .
4.

,
.
b- / -
, . ,
,
. , - /
( - 20 ),

.
/ .

( ), ,
.
,
( ,
): ,
;
,
.
(
) .


( ).

,
.

.
, ,
.
1.

, .
(
).

(, , . .).
(
) - ; ,
.
2.

, .
, T.

. .
-
.
2.
/
(. . 50-51).

/ -
, .
/ :
- (/
,
/ );
- ( );

- ( );
- ( , /
);
- (
);

- ;
- ( /,
, -,
);
- (, , );
- ( ,
);
- .
10%
.
, ,

( ),
.
,
, (
),
.
,

:
, . ,
( - ,

).
, ,
.
,
.
, .

/ .


.

, - .
/ ,
. ,
;
.
/
, . ,
,
.
,

.
1.

/ .
,
,
.
,
(0,25-0,5 /).
(0,125-0,25 / 2-6 );
0,75-1,5 .
, ,
,

/
.
,
(
),
( ).

,
.
,

.
(,
1991).
1.
/

/
.

,
. (

/ ,
; . . 46.)
/
,
.
1.
/
.
(Ellenbogen, 1992), :
- ;
- ;
- ;
-
.

( 3 ), 7 1-3 .

24 .
/
,

.

15-20 (0,25 /); / 2 .
15 , ,
/ 25 (0,35 /) .
,
.
- 10 /,
15 /. ,

(/ 10-15 )
(5 /). / 24 .
2. -
- -
(
). ,
, ,
. ( ) .
- /
( 20-30 ),


.
3.
/
(,
,
), .

.

, .

(20-50 ).
(200 ),
.
,
,
.
, , -
/ .
,
.

: (, ,
, , , , ) -
.
-
?
.
,
,
.

, .
.

.
. ,
, ,
:
, .

.
.

/
,
.
(
, / ),
, -,
/ .
, , ,
90% 1,
.
( )
?
, .
,
.
, ,
. ,
, .
(
) -.

?
?

; .

,
(50-100 ),
(20-50 ).
.
50-100 ,
.

Callaham ., Barton . Prediction of outcome of cardiopulmonary resuscitation from


end-tidal carton-dioxide concenration. Grit. Care Mad. 18:358-362, 1990
Cummins R. O., Austm D. The frequency of occult ventricular fibrillation
masquelading as a flat line in prehospital caldac arrest. Ann. Emerg. Med. 17:813817, 1988.
Cummins R. O., Graves J. R., Lareen M. P., Hallstrom A. P., Heame . R., CaibertyJ.,
Nicola R. M., Horan S. Out-of-hospital tlanscutaneous pacing by emergency medical
technicans in patients with asystolic cardiac arrest. N. Engl. J. Med. 328:1377-1382,
1993.

Ellenbogen . . Role of calcium antagonists for heart rate control in atrial


fibrillation. Am. J. Caldiol. 69:368-40B, 1992.
Enns J., Tween W. A., Donen N. Prehospital cardiac rhythm deteriolation in a system
providing only basic life support. Ann. Emelg. Med. 12:478-481, 1983.
Folk R. H., Leavitt J. I. Digoxin for atrial fibrmation: a drug whose time has gone?
Ann. Int. Med. 114:573-575, 1991.
Gonzalez E. R. Phannacologic controversies in CPR. Ann. Emelg. Med. 22(Part 2):
317-323, 1993.
Greene . O., Spodick D. H. Recognition and management oftorsades de pointes.
Heart Dis. and Stroke 1:383-390, 1992.
Kelber R. E., Martins J. ., Kienzle M. G., Constantin L., Olshansky ., Hopson R.,
Charirenmer F. Energy, current, and success in defibrillation and cardioversion:
clinical studies using an automated impedancebased method of energy adjustment.
Circulation 77:1038-1046, 1988.
Martin . G., Hawkins N. S., Weigel J. A., Rider D. E., Buckingham . D. Initial
treatment of ventricular fibrmation: defibrillation or drug therapy? Am. J. Emelg.
Med. 6:113-119, 1986.
Patadis N. A., Martm G. ., Goetting M. G., Rvels E. P., Feingold M., Nowak R. M.
Aortic pressure during human cardiac arrest: identification of pseudoelectromechanical dissocation. Chea 101:123-128, 1992.
Pomeroy P. R. Augmented carotid massage. Ann. Emelg. Med. 21:1169-1170, 1992.
Ramoska E. A., Spaler H. A., Wmter M., Borys D. A one-year evaluation of calcium
channel blacker overdoses: toxicity and treatment. Ann. Emelg. Med. 22:196-200,
1993.
Reed R., Falle J.L., O'Brien J. Untoward reaction to adenosine therapy for
supraventricutor tachycaRdia. Am. J. Emerg. Med. 9:566570, 1991.
Rothenberg M. A. Aminophylline reverses refractory bmdyasystolic arrest. ACLS
Alert 6:55-56, 1993.
Rothenberg M. A. More on aminophylline in cardac arrest. ACLS Alert 6:79-80,
1993.
Stueven H. A., AufaeAeide . P., Thakur R. K., Hargarten .., Vanags . Defining
electromechanical dissociation: morphologic presentation. Resuscitation 17:195-203,
1989.

Viskin S., Belhassen ., Rath A., Reicher M., Avertuch M., Shops D., Shatobye E.,
Laniado S. Ammophylline for bmdyasystolic cardac arrest refactory to atropine and
epinephrine. Ann. Int. Med. 118:279281, 1993.
Wang Y., Scheinmann M. M., Chien W. W., Cohen . J., Lesh M. D., Griffin J. .
Patients with supraventricular tachycardia presenting with aborted sudden death:
incidence, mechanism, and long-term follow-up. J. Am. Coil. Caldiol. 18:1711-1719,
1991.
Weaver W. D., Cobb L. A., Compass M. K., Hallstrom A. P. Ventricular defibrillation
- a comparative trial using 175-J and 320-J shocks. M. Engl. J. Med. 307:1101-1106,
1982.
Waliams M. L., Woelfel A., Casco W. E., Simpson R. J., Genes L. S., Foster J. R.
Intravenous amiodarone during prolonged resuscitation from cakliac arrest. Ann. Int.
Med. 110:839-842, 1989.
Woosley R.L., Chen Y., Freiman J.P., Galls R.A. Mechanism of the caldiotoxic
actions of terifenadme. J.A.M.A. 269:1532-1536, 1993.

- :

, ,
.
, .
J.A.M.A.

Emelgency rdi r committee and subcommittees. American Heart Association:


guidelines for canliopulmonaly resuscitation and emelgency Cannae care. JAMA.
268:2171-2295, 1992.
J.A.M.A., 268:2184, 1992
,
. ,

, .

,
,
.
, .
,
,
,
.

(
, , ,
),
,
.
,
, .
, - .
, , -
. , .


,
.
J.A.M.A., 268:2187, 1992
(
),
. ,
, .

,
.
(
) (
).

J.A.M.A. 268:2187-2191, 2194, 2197; 1992

(
, , ).
,
, ,
.
(
,
).
, 1,5-2 .

( ). ,
(
), ,
.
,
, ,
.
, .
, (. . 64-67).


( ),
.

, ,
(
).
( ,
).
, .

, (
, , ),
, .
, :
10-12 1 .
:
80-100 -1 ( 3,5-5
). ,
15:2.
, 2-3 .
:
15
, 2 .
,
, .
, 80100 -1,
5: 1 . 5 1,5-2 .
, ,

( ).
, .


,

(J.A.M.A. 268:2196, 1992). ,
.

, ,
,
(J.A.M.A. 268:2197, 1992).

( , ,
),
.

, , .
, (

),
.
, ,
, ( )
, .
- ,
. (
), , , .

, , ,
,
.
,
, ,
.
,
(Cummins, 1989).

JAMA. 268:2251-2252, 1992

- ,
(, ), ,
, , .
( 1 )
- ,
( ),
( ), (
), , .

, , .
- ,

(
- ).
- 6
. 6
, .
- ,
. (
1-1,5 ), ,

.


- .


(
).
,
. - 20 1 .
- .
,
( ), .
-
, (
),
.
- .
, -
.
- .
(
);
,
. - 1,5 2,5 ,
- 100/.
- 1-8
( )
. - 2,5 4 ,
- -1.
-
5:1 ,
. 1
2-3 .

J.A.M.A. 268:2190-2194. 1992



, , .
,
, , .
,

,
.

(, , ,
, , )
.
(
, )
.

. -
, ,
.
.
1. : ,
,
. ,
(
), .
2.
.
3. ,
;
.
4.
,
- . , ,
;
, (
, ).
,
, .

( )
. ,
,
. ,
.
:

-
,
;
- , .

, .
:
1. ;
2. ;
3.
;
4. ;
5. ,
.

, ,
.
,
.
,
, -
.

.

,
.

J.A.M.A. 268:2258, 1992

5 , 65% -
.

:
- , -
;

- , - .
,
, ;
- .

1. 5 ( ).
2. 5 (
),
( ).
- .
3. , . -

.
4. (
) . ,
.
.


- ,
, .
1. ( 5 ),
( . 65).
2. ,
.
3. , ,
(,
), (,
),
(5 ). , .
.

( ).
.
J.A.M.A. 268:2174, 1992

:
- I - , ( ).
- II - ,
.
- II - ( ,
).
- IIb - , , -,
( , ).
- III - ,
().


I, II .


JAMA. 268:2205, 2267: 1992
,
, , ,
2-2,5 (
/ ), - 10 .
:
- 10
;
- ;
- (
),
; .
, .

J.A.M.A. 268:2205, 1992

. 5%

, -
(Gonzalez, 1993).

Gonzalez . R. Phannacologic controvereies in CPS. Ann. Emelg. Med. 22 (Part


2):317-323, 1993.

JAMA. 268:2208, 1992


(I ) /
1 Mr (1 1:1000 10
1:10 000) 3-5 .

, . (IIb )
1 .
: (2-5 / ),
(1 , 3 , 5 / ) (0,1 / /
7 );
3-5 .

( ),
.
1 /; ( 2-10
/), .
.
,
(1 3-5 ,
200 /),
. ,
.
, ,
2-2,5 , / .
,
.

,
,- (Ornate, Am. Fain. Phys.,
):
. ,
, , -
, (Paradis, 1990; Gonzalez, 1991),
(1 /)
(Koscove, 1988; Martin, 1990; Gonzalez, 1991; Barton, 1991).

,
(Martin, 1990; Brown, 1992; Stall, 1992). ,
: ,
?
:
- ;
- ,
3-5 , (/ 3, 5 10-15 ,
100-200 /,
, ;
);
- ,
2-3 ;
, ;
- -
3-5- ;
- , , ;
- / ( ),
;
- ,
; .

, ,
. , ,
,
,
(Ornate, 1991; Ornate, Am. Faro. Phys., ;
Gmuer, 1993).


(Ornate, 1993).
,
( , )
, - .

Barton ., Callaham . High-dose epinephrine improves the return of


spontaneous cireldation rates in human victinls of Cannae arrest. Ann. Emelb. Med.
20:722-725, 1991.

Brown . G., Martin D. R., Pope P. E., Stueven H., Cummins R. O., Gonzoles
E., Jastremski M., and the Multi-Center High-Dose Epinephrine Group. A comparison
of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. N.
Engl. J. Med. 327:1051-1055, 1992.
Gonzalez E. R., Ornate J. P. The dose ofepinephrine during cardiopulmonaly
resuscitation m humans: what should it be? Ann. Pharmacother. 25:773-777, 1991.
Grauer . New trends m the pharmacologic management of caldiac arrest.
Am. Fain. Phys. In press.
Greuer . Rebuttal to ACLS update. Proc. Slalk & Office Tech. 6 (No. 5), 1993.
Koscover E. M., Paladis N. A. Successful resuscitation from caldac arrest using highdose epinephrine thetapy. J.A.M.A. 259:3031-3034, 1988.
Martin D., Woman H. A., Brown . G. Four case studies: high-dose epinephrine m
caldiac arrest. Ann. Emelg. Med. 19:322-326, 1990.
Ornate J. P. High-dose epmephrme during resuscitation: a word of caution. J.A.M.A.
265:1160-1161, 1991.
Omato J. P. Use of adrenelbic agonists during CPR in adults. Ann. Emelg. Med.
22(Part 2) 411-416, 1993.
Paradis N. A., Martin G. ., Rivere E. P., Goetting M. G., Appleton . J., Feingold
M., Nowak R. M. Coronary perfusion pressure and the retum of spontaneous
ciroulation m human caldiopulmonaly resuscitation. J.A.M.A. 263:1606-1613, 1990.
StieU I. G., Hebert P. C., Weitzman . N., Wells G. A., Raman A., Stark R. M.,
Higgmson L. A., Ahuga J., Diskinson G. E. High-dose epinephrine in adult caldiac
arrest. N. Engl. J. Med. 327:1045-1050, 1992.

JAMA. 268:2211, 1992
-

. ,
, .

. (I ),
,
(II ), (IIb ).
, (
)
(III ).

, c
(,
, ,
). - 1 / /,
10- ,
.

JAMA. 268:2217, 2208: 1992

.
.

(8-12
2-4 ).
(toreades de pointes).

.
1-2 ( 100 5% / 1-2
).
1-2 5-60 ,
0,5-1 / 24 .

JAMA. 268:2216-2219, 1992
(
) .
1.
(). ,
. -
,
.
2. .
,
,

.
3. : 200 , 200-300 ,
360 .
4.
:

- ;
- , ;
- ,
.
5. - 1 / 3-5
(1 ). , (IIb
), :
- (2-5 / 3-5 ),
- (1 , 3 , 5 / 3 ),
- (0,1 /, 7 , / 3-5 ).
6. 30-60
() ,
360 .

, ,
,
.
7. ,
. 30-60
360 . :
- , - .
(II ) (IIb ),
.
- / 1,5 /, 3-5
( - 3 /). -
. ,
,
.
2-4 /.
- / 5 /; 5 10
/, 5 ( 30-35
/). ,
.
- / 1-2 ( 1-2 ).
,
.

- / 30 / ( 17
/, 1,0-1,2 ).

( ).
II IIb
,
.
, ,
.
8. (. . 71-72).
9. IIb
, .
10. ,
.


.
, (. 1617, 27-28), B- (. 21); ,
-
, .

J.A.M.A. 268:2219-2220, 1992
1. () -
, ,
, ,
, .
- ,
.

. , ,
, ,
, (Callaham, 1990; Paladis,
1992). -.
2. ,
. , ,
( ).

3. - ( ), ,
, , , ,
( ),

. , , -
.
4. :
- (. . 69);
- , 1 / ( );
- ;
- ;
- ;
- ;
- (. . 71-72).
5. ,
.


, . ,
, ,
.
, , (
).
( )
, (. 34-36),
, 60/.

J.A.M.A. 268:2220-2221, 1992
1. ,
, , .
2. ,
.

- ,

,
.
- ,
,
.

; ,
.
- ,
,
IIb . ,
,
.
- .
,
,
.
.

) , .

, - ,
,
.
3. :
- , ,
;
- ;
- ;
- ;
- ( );
- ;
4. (. 69-70).

5. ,
.
, ( )
.
- 1 /, 35 0,04 /.
, ,
, . ,
,
. . ,
, , ,
. ,
, .


, (. . 39-40).

JAMA. 268:2220-2221, 1992
1. , .
2. 60 -1.
. ,
( ) 60/.
, 70 -1,
.
3.
:
- , 0,5-1,0 / (1 II );
- (1 );
- , / 5-20 // (III) );
- , / 2-10 / (IIb ).

. ,
/
(
).

4. .
, ,
(, ,
) (
).
5. :
- - 0,5-1,0
/; 3-5 ( 0,03
/, 2 ).
0,04 /,
3 ;
- ( 3 5 )
: ;
- , . ,
, ;
- (2
II 3 ) .
.
,
, ,

(/ Task , 1990).
, .
, 3
( );
- , , .


.
6.
:
-
1 ;

-
.
;
- .
.

. ,
;
/

(
)
.
7.
:
- ,
;
- - 2-5 //, 520 //;
-
,
, 1 /;
( 2-10 /) (. . 69-70).
8. .
( ),
,
.

. ,

IIb ( ).
III ().
9.
; , .

/ , ,

, ,
.

American College of Cardiology/American Heart Association task fore:


guidelines for the early management of patients with acute myocardial infarction
emulation 82:664-707, 1990.

JAMA. 268:2222-2226, 1992

1. .
, .
( , ,
), (
, ).
2.
,
. 150/
( ), ,
.
150/ .
:
- ;
- ;
-
; , ;
, .

:

- : 100 ,
200-300360 ;
- : 50 ,
100-200300-360 ;
- : 200 ,
300-360 .
, ,
, .
, ,
.
3. /
- ,
. ,
- ,
.

- /
, ( ),
, , ,
.
- - , ,
,
.
- / -
( ).

. , ,
(, ).
- /
:
- - (, , );
- ( ); -
30 ,
;
- ,
/ .
- ( )

.
4.
- ,
. ,
.
:
-
;
- : , ,
, , ,
(
), , ,
, ,
.
:

- : ,
( ),
;
- : ,
;
- : ;
- : ;
- : (
).
- , .
. ,
. :
- ,
( );
-
5-10 .
.
,
( );
-
;

- .
- , (
1-3 ) 6 /, 1-2
- 12 . (12 ) 1-2
( - 30 ). ,
,
QRS.
QRS ,
- . :
- , 1,0-1,5 / / ;
- / , 20-30 / (
17 /).
- QRS , ,
:

- .
- QRS , ,
:
- / 2,5-5 ( 2 );
- , ,
(2-3 ) ( 3-4 );
- (5-10 ) 15-30 ,
( ,
); ,
. (0,5-1 ,
/ ). 5-10
, .
,
;
- ,
,
-,

, ,
, ;
-
.

: -
(I ) ,
-
. , ,

, , ;
- , .
;
- ,
50-60% .
.
5.
QRS.

QRS , :
( ,

/ )
.
- ( , , )
.
. ,
,
QRS .
- -
; ,
.
- QRS (

/ WPW)
, .
WPW (
/
, ). ,
,
.
QRS ,
, ,
, WPW .
-


QRS.


QRS .

-
QRS, , .
,
, , .

- : / (1,0-1,5 /,
75-100 ), 5-10 - (0,5-0,75 /,
50-75 ).
- ,
2-4 /.
3 / (
225 ).

- QRS
( ):
- ( , );
/ 20-30 / ( 17 /);
- ;
- .

.


QRS.
,
(II ),
.

QRS.
- ( )
.
-
QRS , (
), .
-
20-30 /; :
1) ;
2) QRS 50%;
3) ;
4) (17 /, 1,2 ).
-

,
1-4 /.


QRS.
- (
) .
( ):

- (5-10 /)
8-10 ;
- , (5-10 /)
,
1-2 /;
-

- 30 //.

QRS.

- -
( R).

.
- , 160 -1,
, R .
-
150-160 -1.
- , , ,
,
.
6. .
- ,
QRS (. .
83-85), , .
- ( ).
- ,
, (
, ).

- , ,
( ), .
-
,
.
, (50-100

), (
- 100-200 ).
-
( 200 )
(20-50 ).
- -
, ,
12 .
, ,
. ,
QRS
( QRS
).
.
.

/ , ,
(. . 50).
,
(
).
-,
. - . . 50-51, 53.
- . . 45-46, 48, 50, 52-53. - . . 20.
.
( , QRS,
QT)
,

QRS. ,
.
- ( )
. ( )
(Annengol, 1989; Wesley, 1991). ,
,
, .
- ,
, .. ,
( ) re-entry.
WXT,
.

- / WPW.
, ( )
.
, -
, /
.
. ,
.
- ,
( , ),
/ .
,
.
QRS (,
1972; Hilleman, 1985).
- (4 /)
.
.
(, ,
), .
(1-2 /).
.
,
.
. ,
(. . 85) .
, ,
,
(Castle, 1984; Lucchesi, 1984).
QRS
, (. . 28-29), , ,
B-.
-. B-
,
, .
,
( ,
, ).

Annengol R. ., Draff J., Baennan . J., Swim S. Lack of effectiveness of lidocaine


for sustained, wide QRS complex tachycardia. Ann. Emerg. Med. 18:254-257, 1989.

Castle L. Therapy of ventricular tachycardia. Am. J. Cardiol. 54:26A33A, 1984.


Grauer . When 12 leads are better than one. A practical guide to ECG interpretation.
St. Louis, Meshy Year-Book, 1992.
Hilleman D. E., Mohiuddin S. M., Destache . J. Lidocaine-induced second degree
Mobitz II heart block. Drug InteH. elm. Pharm. 19:669673, 1985.
Lucchesi . R. Rationale of therapy in the patient with acute myocardial infarction
and life-threatening arrhythmias: a focus on bretylium. Am. J. Cardiol. 54:14A-19A,
1984.
Marriott J., Bieza . F. Alamung ventricular acceleration after lidocame
administration. Chest 61:682-683, 1972.
Wesley R. C., Resh W., Zimmennan D. Reconsidelations of the routine and
preferential use of lidocaine in the emergent treatment of ventricular arrhythmias.
Grit. Care Med. 19:1439-1444, 1991.
()

(. 4)
(. 2,3)
, , (. 5)
( )

(. 6)
'

/






-
-
- ,
-

1- - 200
2- - 300
3- - 360
, ,
.
,
2. ,
3. (1 / 3-5 )'.
-
4. (360 ) *
-
5. 1,5 / ( 75-100 ) / /
2 /
6. (360 )
7.
-
8.
9. (???)

10. / (1,5 /) (?)


11.
12.

1.
2. ;

3. / 50-100 ( )
2 /

. 3 1
,
, (2-2,5 )


I-II-o 2
12. ( ) 1-2 / 1-2 .
5-1 0 .
()
126.
5 / ( 350-500 ) / . 1-2
,
(360 ).
5 10 / /.
(360 ).
5 30-35 /.
, / (1-2
/).
()

12. - / (
, ).
/ 0,5-1,0 , ( 5 )
5,0 .
()
12.
- 150-500 / ( 5-1 0 ).
15-30 .
, / (20-50 ).

1. .
2. .
. / (50-100 )
2 /, .
()
.
.


,


I.
, ,
( ).
- 200 .

I. (100-200).


I.
50-100 ( 1-1,5 /) /. /
2 /. / 5075 ( 0,5-0,75 /) 5-10 (
3 /, 225 ).
2.
100 / 5 ( 17 /, 1 ).
0,5-1 ( 17 /) / 2030 / 30-60 .
, /
2 / (1-4 /).

3.
5-10 / / 10 .
, 1-2 /.
3. :
, ; - 50-100 .
()
3.
. -,
( 0,5-1,0 5 ,
5,0 ). - 1-2 / 1-2 .
5-10 .

QRS,
, .
,

AB


I.
()
1.
2.
(1 / 3-5 2-2,5
). .
3.
4. :
)
) ( )
1 / -5 ( 0,04 /, 2-3 )
) (?)
) (?)

1.
2.
(1 / 3-5 2-2,5
).

3.
1 / 3-5 ( 0,04 / 2-3 )
4. :
5. (?)
6. (?) - 250 / 1-2


I . -

2. ( - ) 0.1 / 3-5
( 0,04 /, 2-3 )
()
2 :
()
2.


- 1
- 2 I

- 2 II
- 3
-
,

3. " ": ,

-
. / 2-5 //,
20 //.
- .
(1 /),
2-10 /.
. 2
/, - 10 /.

:


, 100-200 .

12 ,
( )


1.

I . ( )
2. - 2,5-5 /, 5-10 ()
2. /

1
2. 6 / ( 1-3 ),
.
1-2 - 12 / .
1-2 - (12 ).
()
2.
2,5-5 / ( 2 ).
5-1 0 / ( 15-30 ).
.
( ).
3.
4.
-
- - /
- /

-
/ :


1..
.

1a.
0,25-0,5 /, 0.125-0.25 / 2-6 (
0,75-1 ,5 ) ()
1.
/ 2,5-5 , 5-10 .
1.
/ 0,25 / ( 15-20 ). 15
0,35 / ( 25 ). / 5-15 .
2. - - 0,5-) /
( 5 ) 5 .
3.
- 200 .
- 20-50 .


1
2
4
5 :
-
-
-
6

-
-

:
-
-
3



9

13
,

*
1

:
-
-
-

:
-
-
*I I



17


:
-
-
-


?



- , 1966 .,
torsade de pointes (. ).
QRS -
, (. ).
,
QRS .
,
.
(Greene Spolack, 1992).
,
QT ( ,
, ,
). (
-
QT), .
- - (
450)
:

-;

; - ;

1;
;

, (Woosley ,, 1993).
- , 12
QT ,
( , ,

, QT).
- (
).
- - ;
. (10%
) / (1-2 1-2 , 5-15 ) (50 / 2 ).
1-2
2-10 /.

-
,
.

-
,
. ,
,
, .
:
-
(
;
);
- ( ;
);
( ; );
- : , .
;
-.
.


1. ,
, , ,
.
2. , , .
3. , (
) .
4. , -
.
5. :
- ;
- 12 ;
- , ,
.

6. .
7. .
8. .
9. .
10.
, .
11.
.



,
. - .
- (0,5-1 / 5-10 )
, .
, , .
- ,
.
- ,
,
(Ramoska ., 1993).

, ,
.
/
. -
(. 6).
- 200 ,
50 .
-
, .


2-3 ; .
2-3 ,
(
).
-
3-4 - .
/ :
- , , ;
- , , ,
, ,
, .
- (, )
.
/ , -,
.

- (200-300 6-8 )
.
-
;
- / ( . . 29)
(500-750 6-8 );
- - , ,
.

.



.
:
- , ;
-

,
; -
, .
,
, :
( , ,
, , ) ,
. ,
,
(1-2- 45- ).
,
(1-3-7).

(1-2-6 1-3-6).
(8).
(9), .

(6-8-9-11). ,
(10-12).
,
, ,
(6-8-13-14).
8-9-10-12 8-9
11. (15),
(6-813-14-15-16).

(14-17-18).

(19).
(20).
:
- .
- ,
.
1. ,

( ,

, ).

2. -
, ,
- .
3. ,
, , : ,
, , , ,
(, , . .).
.
4.
- . , -
(J.A.M.A. 268:2266-2269, 1992).
5. -
.
.
.
6. ,
, - .
250-300/.
200 -1,

.
.
,
. ,
,
(Gillete, 1989). ( 15 )

, .

-
(JAMA. 268:2269, 1992). ,
, .
,
(Rfiyes .. 1992).
,
, ,
(Sllahar .. 1991; Porter .. 1983).
,

(Gillete, 1989).

- , 1 / /.
. - 12 .


: 1) , 2)
, ,

.
.
1. (0,01
/ /).
2.
( 10-20 , 0,1-0,2 / /); 3-5
(Goetting
Paladis, 1991).

( 1:10 000 1:1000
), , .
3. 3-5 .
4. ( ) .

- , / .
.
5. ( , )
(Spivey .. 1992).
,

/ . ,
/ (J.A.M.A. 268:2266-2267, 1992).

7 : ,
90 (J.A.M.A. 268: 2266-2267, 1992).

- / - 0,01 / (0,1 /
1:10 000). 3-5 .

- - 0,1 / (0,1 /, 1:1000).


3-5 .
10 , / (0,1 /
0,01 /).
10 (1:1000 1:10 000), -
(. .).

10
20
30

/

0,1 (1 - 1:10 000)
0,2 (2 - 1:10 000)
0, ( - 1:10 000)
1.0 /
( )

1 (1 p-pa 1:1000)
2 (2 p-pa 1:1000)
3 (3 p-pa 1:1000)
2-2,5 ( )


- / - 0,01 / (0,1 /,
1:10 000), . . , .
- - 0,1 / (0,1 /,
1:1000), - , .
- ( ) /,
- 0,1-0,2 / (0,1-0,2 /, 1:1000) - 3-5 .
- /
, (0,1 /, 0,1 /, 1:1000).
- 0,1 1,0 //.
(0,6 Mr ) 5% ,
100 .
/ 1 /, 0,1 //; ,
.

10

6 100
5%
12 100
5%
18 100
5%
1 250
5%

20
30

*
1 /
(0,1 //)
1 /
(0,1 //)
1 /
(0,1 //)
15-0 /
(1- 2 /)

**
10 /
10 /
10 /
10 /

* .
** , .

,
,
, - .

(J.A.M.A. 268: 2269, 1992).
/ - 0,02 /; 5 (
1,0 2,0 ).
- 0,1 . - 0,5
1,0 .

10
20
30

, /
0,2
0,4
0,6
0,5-1,0



,
.

- . . 38. , ,
,
, 20
// (J.A.M.A. 268:2270, 1992).
/ 2-20 //. (6
), 100 , 5% ,
; :
- 1 / 1,0 //;
- 2-5 / - 2-5 // ( );
- 20 / - 20 // ( ).

10
20

60 100
5%
120 100

-
*
2-5 /
(20-50 /)
2-5 /


20 /
20 /

30

5%
180 100
5%
200 250
5%

(40-100 /)
2-5 /
(60-150 /)
30 /
(400 /)

20 /

* .

-
, ,
. / - 1,0
/.
- 20-50 //.
120 (3 40 /) 97 5% ;
- 100 ; - 1,2 /.
- 1 // (20 //).
- 2,5 //.
* .

-
.
-
( , ).

- 2 / .
, ( 4 /)
(, ).
- 0,5 /
. .

10
20
30

:
1-, 2- -
20-40-40
40-80-80
60-120-120
200-300-360

5
10
15
50 200

Crespo S. G., Schofistall J. M., Fuhs L. R., Spivey W. H. Comparison of two doses of
endotlacheal epinephrine in cardiac anba model. Ann. Emerg. Med. 20:230, 1991.
Gillette P. . Advances m treatment of supraventricular tachydysrhythmias in
children. Mod. Cone. Cardiovasc. Dis. 58:37, 1989.
Goetting M. G., Paladis N. A. High-dose epinephrine improves outcome from
pediatric Cannae arrest. Ann. Emerg. Med. 20:22-26, 1991.
Porter C., Garson A., Colette P. . Velapanul: an effective calcium blocking agent for
pediatric patients. Pediatrics 71:748, 1983.
Reyes G., Stanton R., Galvis A. G. Adenosine in the treatment of paroxysmal
suplaventricular tachycardia in children. Ann. Emerg. Med. 21:1499-1501, 1992
Shahar E., Bamlay Z., Frand M. Velapanul in the treatment of paroxysmal
suplaventricular tachycardia in infants and children. J. Podia. 98:323, 1981.
Spivey W. H., Crespo S. G., Fuhs L. R., Schoffstall J. M. Plasma catecholamine levek
after intraosseous epinephrine administration in cardiac arrest model. Ann. Emerg.
Med. 21:127, 1992.

: 6 / ( 1-3 ),
. 1-2 12 / ; (
6+12+12=30 ). (3 ).
.
: ; :
- (1 / ).
- 3-5
, (/
3,5 10-15 ) ( 100-200
/ ).
- ( - 22,5 ),
.
- :
- 1 (1 1:1000 10
1:10 000) 250 5% .
- 1-2 / (15-30 /) 210 /.

- :
- 50 (50 1:1000) 250 5% .
- 30-60 / (100-200 /),
.
: 250 / ( 1-2 )
.
: 150-500 / ( 5-10 ), 15-30
.
: 0,5-1,0 /, 3-5
0,04 / ( 2-3 ). ( 1 ) -
, .
: 50-100 - ( ,
5-10 ). ,
.
- .
: 5 /, -
1-2 , . ,
10 /, 30-35 /.
- / . 1 250 5% , 15 /
(1 /).
- 500 50 5% /
10 , 1-2 /.
: 2,5-5 / 2 ;
(2-3 ) .
, 15-30 (5-10 ).
.
QRS,
b-.
: 0,25 / ( 15-20 ) / ; (
15 - 0,35 / ( 25 ).
3 , 1-3 .
- . 250 250 5% ,
10 / (10 /), 5-15 /.
: . ( 15-20
//) , .

- . 200 250 5% ,
15-30 / (2-5 //)
: - 100%. .
: 1,5 / ( 75-100 ).
, , ,
, (, ).
- 50-100 ( 1-1,5
/), 2 /. - / 50-75
5-10 ( 3 /, 225 ).
-

/ . 1 250 5% , 30 / (2 /);
1-4 /. . . 17-18, 19, 25, 28-29, 73, 84,
87-88, 117 . 2, 3, 4.

: 100 / (, 5 );
0,5-1 (
17 /). QRS .

- / . 1 250 5% , 30 / (2
/).
: 0,5-1,0 / ( 5 )
5 .
- (
, , , ,
).
: 1-2 / ( 1-2 ) 10% ,
5-10 .
(1-2 / 10-20
).
: 0,5-1,0 / ( 5-10 ).
,
.

-
-
-

-
-

:
, ,
.

(., , 1995).
, ,
(-), (
, ), .
, adenosine; .

, epinephrine; .
, alprazolam; , . ,
, ,
, aminophylline; , ,
. , ,
,
amiodarone hydrochloride; III. ,
,
, astemizole; .
, , , , , ,
, atenolol; b-, . , , , , , , , ,
, , , , , , ,
,
, atropine sulfate; .
, sodium bicarbonate;
, bretylium tosilate III. ,

, velapamil hydrochloride; ,
IV. , , , ,
, diazepam; , , ,
. , , , ,
, digoxin;
, ,

, disopltomide phosphate; I.
, , , ,
, diltiazem hydrochloride; . , ,
-, , , , , , ,
, dipyridamole; ,
, , , ,

dopamine hydrochloride; . ,
, isoproterenol; , . ,
, ,
, ipecac syrup; , calbamazepine;
. , , , , ,
, , ,
, ketoconazole; . ,

lidocaine hydrochloride; Ib.


. , ,
,
lolazepam; , ,
. , , , -

,
magnesium sulfate; , ,

, metoprolol; B-,
. , , , , ,
,
,
naloxone hydrochloride; . ,
,
norepinephrine bitartlate; -.
,
,
procainamide
hydrochloride;
,
,

I.

propafenone hydrochloride; 1. ,
,
, propmnolol; b-. , . ,
, -, , , -
, sotalol hydrochloride; b-,
II III. , , ,
, , ,
, theophyllin; ,
.
, , , , , , , ,
,
, terfenadine; .
, , , , , , ,
, triazolam; ,
. ,

/
, -trinloxazole; , .
-, , , , , ,
, , rfobo-, , , ,
.,
, ,
, flecainide acetate; I.
, fluconazole;
,
, quinuline; I. ,
,
, erythlomycin; , .
, , , , -, , ,
,
esmolol hydrochloride; b-,
II.


No 1
, .
- . .
. . . .
. .
. . . .
090070 29.12.93 15.08.95.
84108/32. No 1. . . 4
. . 15 000 . . 637
. 119048 , / 421
-
.
143000, . , . , 93


. .

, ., 252 .
,
.
,
, , ,
, ,
.
-
.
. . (.)


. . 832.

.
,
.
. ,
,
.
.
, ., 255 .

, .

.
. -
.

. , . , . , .

, ., 250 .
1971 .
.
( )
, .
:
; ,
; .
,
.
.
-
, ., 500 .
-
.
, .
, .
BIOSTAT .
,
.
. . , . , . . , . .
-
- 350 ., ., 2- .
500 .
, ,
.
( 500 ).

.
- .

.

,
1994-95 .
. . (347 .. 215 .)
ECHODATA 2.01 IBM PC
. . (, ., 255 .)
. (, ..
255 .)
. (, ., 204 .)
. .
(, ., 96 .. 212 .)
.()

(, ., 832 .)

. , . () - (,
., 150 .).
.

(...200.).



. . - (350 .. .,
2- )
: . (. .. 700 .)
. . . . . . .
(816 .. .)

1996 .
. ( . , .. 1200 .)
: () (, ., 600 .).

() (, .. 550 .).

() (, ., 800 .).

() (, .. 600 .).

()
(, ., 750 .).

. () (, ., 750 .).

()
(, ., 500 .)
. - (, ., 550 .)
. BIOSTAT 3.03 IBM PC

( ., 25),
- - ( ., 28).

. :
119048, , / 421, .
: (095) 1 12-85-36
/: (095) 246-32-39



: 119048 , / 421,
""
: (095) 112-85-36, 246-32-39

, . (347., 215 .)
, . (, ., 255 .)
. (, ., 255 .)
. (, ., 204 .)
. .
(, ., 96 ., 21 2 .)
, ()
(, ., 832 .)
, () -
(, ., 150 .)
. (, ., 200 .)
. -
. - (350 ., ., 2- .)
: . (, ., 700 .)
. . . . ...
832 .. 34 .
. - (, ., 550 .)
. BIOSTAT 3.03 ( IBM PC)
() (, ., 600 .)
() (, ., 550 .)
() (, ., 800 .)
() (, ., 600 .)
() (, ., 750 .)

. () (, ., 700 .)
. ( , , ., 1200 .)
. () (, ., 750 .)
()
(, ., 500 .)
... ........................... ....................................
.............. ...........................
.......................................................

You might also like