: -

...

2002


1. (. )

2.
(. )

19

3. (. )

37

4. (. )

57

5. (. )

75

6. (. )

86

7. TOY
(. )

100

8. (. )

113

9. (. )

123

10. (. )

134

11.
& (. )

142

1.
-

1.1.

,

,


.



(
).



,
. :
1)
(

).
2) ADP
( ADP

).
3)
(PGI2-- ).
4)
( ),
,

,


.
5)

..

, *

( C). **
6) ( ..)


.
7)

.


,
, ,

,
..,
.
,

(
)
,

( - ).

,
,
,
. ,
,
,

)
( )
, )
C
*

() ,
.
-

.
**
C
V VIII.

-.
1.2.

T
,
,

,
()
.

),

von
Willebrand (vWF) * .

,
.

(DP)


(,
, ).

,


,

, **
*

vWF


-
.
VIII.
**

,


, Ca++
.

ADP

2 (x2) *** (

),

( ,
).
,

(PF3),
.
,


,

.
2.
2.1.

(,
..).
(
)

,

.

(
)

***

2 (PGI2),

.

,
.
,

(TxA2, Ca++, ADP,

vWF, )
,
V, VIII XIII.

, , C,


.

.
2.2.

in vivo
,

,
.

:
1)


. ,
,


(
).

,

.
2)

,
, :
) , ,


,
VII, .
(
2300 )
.
)
,

1000
.
) C,
V (. 1)
VIII ,

. C
,
.
) S,
( 15 )
C.
) ,

100

C (. 1).
)
(issue Factor
Pathway nhibitor-TFPI).



VII
( VII)- .

. 1: ()- C (PC)-
S (PS). APC: PC. : .
.

) 2-,

, . *
3) , **
,


.

20 ,
1950
,


, , ,
.
*

, .




.
**

..
,
, ..

,
.

,
.
,
,
,

.

, ,
:

,
,
( ),
..

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

,

,

.
2.2.1.



* ( ), ,

,
,
(. 2). ,

,
,
. **

V, VIII,
,
,
.

,

[Lipoprotein()Lp()]
.


.



(t-PA)

-1
.
**


.

)

.
1)
.

)
(lasminogen Activators-PAs).

.


.
.
i) E :

(tissue Plasminogen Activator-tPA).

,
,
..


. ,
tPA, ,
(. 2).
tPA,

,
.
(u-PA).

.

.



.



.
,
, .

ii) :
- .

-
.

-,

. 2: . t-PA: . PAI-1:
. 2: . FDP:
.

2)
.
)

.
i)
A

.
,
.
50% .
ii)

(Plasminogen Activator InhibitorsPAI). -1, -2, -3
.
- -1:

- .
,
IL-1, , Lp()
..

,
, ..
t-PA.
- -2:
.
t-PA.
- PAI-3:
.
t-PA
.
- :

,
..
t-PA, ,
,
.
)
.

2- 2- * (. 2).
- 2-:

,
,
,
.
- 2-: t-PA,
,
- -.
3.
3.1.


, ,
.

,
,
(...).
3.2.

(
),


(

, ).
, , **

(


),
( ), ,
.

:
)
.
i) .


,

( )

. ***

(X, IX, VII),
.
ii) .

( )
VIII


(Christmas )

(
).


,
,

VIII
vWF,

VIII
**

1--,

1-,
C1-
.

.
***



.

10

. A
VIII ADH,

.
,

( ),

.
,

.



.
iii) ()
, : , V, XIII,
VII, X, XI,
.
)

,
:
i)

.
ii)

.
iii) 2- ( ).
) .
i) .
(
),

-
-
- -

. *



[
(ITP), AIDS, ,
..], (
,
-
(),

,
, ).


, (),
( 12 ..)
.

(

), ,
(

).
ii) .

, .

, vWF
(

Willebrand

, )
()
*

11

vWF ( BernardSoulier).
,

(b, III)
(
Glanzman)

.


( )

(
).
,
(
)

(
).
,
,

2.
3.3.



() *
. **
,
, ,
,

.

,
*** ( ),

,
.


(, , )

,

.
,
,
,

o
().
,

,


, ..,

,
- .



.

,

().



.

.
**

.

***

12

. 3: .

,

(CFII) C S.
,
,
(



),


. o
-,
.

,
19
,
,

, (

Virchow) (. 3).


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

.



.

[

13

( )
(
)], (
LDL, VLDL, LDL,
, ..),
(, , ..),
- ( ..), (CO,
..), .


,
,

.

*
,
.

, .


, . **


.

,
IL-1
*

.
**

, ..
.

,

,

(
)

- C.
(
) ***

.
, ,

(
),
.



,

.



( )

.
)

-
.


,
***

,
(PlateletDerived Growth Factor-PDGF-).


,


.


.

14

.


.
(
)

,


.


,

.





.

.
(
)

. *
2. .



,
-
.




.
*

,

,
.

,
.
( ,

)
.

,
,

.
3.
.



.
)

(
,
, ..)
( ),
.



, .
,

15

*
,
,
, , x2
c-,
.


,
PF-4, -

.
,

,
,

.
,
(cationic protein)

,
.

,


(digital ischemia)
.
)
.


,
.


,
,
*

( , ,
).



.


,
( )
,
.



** ..
,

.



(IL-1, )

.

(clearance) (

)
,

.


. ,
,

-

**

C,
.

16

.
(...) *




.

,

(, , ,
) .

...
(Disseminated
Intravascular Coagulation-D.I.C.)
,
,
.
...


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


( , , ).

...

. ,
*

,

(Fibrin Degradation Products-FDP)

(
)
,
.
,
,
V, VIII IX
.
...
, ,

,

..
.

... (, , )
,

. ...

, ...
,

. , , ,

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


,
.
, ,

17

, .

, ,
.

, ,
.
...
.

,
.

... ,

.
, ,


.
,
[ (
)]

,

(t-PA).

,

.

Berne M., Levy N.M. Physiology,

Fourth Edition, Mosby, 1998
- .
. ,
, ,
1999

Corrigan J.J. Studies in the

coagulation
and
fibrinolytic
systems in autoimmune disease.
Arch Intern Med 126: 324, 1970
Edgington T.R. Recognition coupled
responses of the monocyte:
Activation
of
coagulation
pathways. Nouv Rev Fr Hematol
25: 1, 1983
Friedman R.J., Burns E.R. Role of
platelet in the proliferative
response of the injured artery.
Prog. Hemost Thromb 4: 249,
1978
Guyton A.C., Hall J.E. Textbook of
Medical
Physiology.
enth
edition, W.B. Saunders Company,
2000
Kaufman C.E., McKee P.A. Essentials
of Pathophysiology. Little, Brown
and Company, 1996
Lee R.G., Bithell T.C., Foerster J.,
Athens
J.W.,
Lukens
J.N.
Wintrobes Clinical Hematology.
Lea and Febiger, Ninth edition,
1993
Lijnen H.R., Collen D. Congenital and
acquired
deficiencies
of
components of the fibrinolytic
system and their relation to
bleeding
or
thrombosis.
Fibrinolysis 3: 67, 1989
.

...
, 2, University
Studio Press, , 1998
Ross J.M., Mc Intire L.V. Molecular
mechanisms of mural thrombosis
under dynamic flow conditions,
News Physiol Sci, 10: 117, 1995
. . University Studio
Press, , 1992
Shattil S.J., Bennet J.S. Platelets and
their membranes in hemostasis:
physiology and pathophysiology,
Ann Intern Med, 94: 108, 1981
Stanley L. Schrier, Lawrence L.K.
Leung. Hematology V.I. Disorders

18

of hemostasis and coagulation,

1996
Stein J.H. Internal Medicine. Forth
edition, Mosby, 1994
Thomas D.P. Overview of venous
thrombogenesis. Semin Thromb
Hemost 14:1, 1988
Thomas E. Andreoli, J Clante Bennett,
Charles C.J. Carpenter, Fred
Plum, Lloyd H. Smith, gr: Cecils

Essentials of Medicine, Thired

edition, Vol 1, WB Saunders Co,
1996
Vander A.J., Sherman J.H., Luciano
D.S. Human Physiology. Mc
Graw-Hill, Inc. Sixth edition, 1990
Wintrobes Clinical Hematology. Lea
and Febiger, Ninth edition, Vol 2,
1993

19

1.

(
)
.

.


(

120 ,
7 , 10
). 1.1011
,
.



(,
, )

.

,
,

,





.

.
2.
, ,
.

,
,

(, ,
).

(2
CO2 ).
(4,5.106/mm3
5,5.106/mm3 )
,

,
:
, ,
,
,
.
2.1.

, ,

(colony
stimulating factors CSFs)

(, ).

20

.

(l-3, l-6, l-11 l-

12) , . (.
1)

. 1: .CFU-S , BFU-E (burst-forming

unit-erythroid), CFU-E (colony-forming unit-erythroid) ,
1 , 2-3 , 4 , 5
, 6 , 7 , -.

.
: 1)

( 2
), 2)
(,

),
3)

(

2 ).


-

-
().

10-15% .


.

2.

2
.
12-15
.

8-32
. 18

,
, 8-10
.

,

,

( ).

21

2.1.1.
.

,



.


.



:
Ca2+,
,
RNA,

- - ,

,

3 4.1.





.

,


,
.

DNA (

- ).

DNA,

.


( )
CFU-E
,


CFU-E

.



,
( 12, ,
C),
()
,
..

(
,

), (


).
2.2.

: 1)

( 2000
dyn/cm2)
. 2)
, ,



,
-

22

,
,

. 3)
( 3 )
(, , 4.1, 4.2, 4.9,
, ) (. 2) ,

. 2:

2-3 m,

7,2 m.




.

. - ., C- C.

2.3.

,

,
. ,


(.3):
1)
Embden-Meyerhoff
(90%) .
()

-,

( ,
)

.
2)
Rapoport-Luebering (

).
2,3- (2,3-DPG). 2,3-DPG
bA1,
b
2,
2 (

23

2
).

2,3-DPG
.
3)

NADPH
(
--)

,

(GSSG)
(GSH)
Hb,
.

. 3: . , PFK , G-6-PD
-6- , PK .

2.4.
98%

(b).
b

(, )
.


,

,

.
,



-
.

.

24

bA1 (2, 2) 97%,
HbF (2,
2) HbA2 (2, 2).
Hb

.
b ,

16 , 11,
.
,
b

.. 4 4,
.
b

(22, 22, 22).

b
.
2.5.
: 1)
2) .

5.106/mm3
6,4.106/mm3
(t)
54%.

.



b
.

,


-

1)
2)

.

:
(, , ),
( ,
), (, ),
( ,
12, , ),
( ),
, ,
, ,
.

.

.
( )

,


.

25

: 1)

, 2)


(

), 3)

2 ,
) 2,3DPG (
2 b) )

.



2.
, 2


, ,

.
,

,

.

,

.

, ,
, , .

,
, .
,
, ,
.
(, ),

.
2.6.

:
(),
b (t).

(. 4):
1)
(MCV-mean corpuscular volume).
MCV=80-95 fl,
MCV>95 fl
,
MCV<80 fl
.
2) b
(MCHC-mean
corpuscular haemoglobin concentration). MCHC=32-35
g/dl. <30 g/dl

b,
.
MCHC>35 g/dl
.
3) b

(MC-mean
corpuscular
haemoglobin). MCH=30
pg/cell.

26

. 4:

.


.

1/5



.
, , 3:1 4:1.
, 1%


()-
(1) ,

RNA,
.



().

().
=% . t /
t

()

( ).
,

,

,
(),


.
2.7.


.
.

:
1. :
)
(MCV-)
)
(MCV-)
)
(MCV-)

27

2. b
:
)

(MCHC-)
)

(MCHC-)
)

(MCHC-)


:
. :
1.-

:
)
- .
)
- 12,
.
)
-
.
2.-

.
. :
1)

.
2)

.
. .
1) .
2) .
3.
3.1.
3.1.1.

)


,

.

50 40 mg/Kg
. 28-31
mg/Kg ,
4-5 mg/Kg ,
12 mg/Kg

.
i.- .

,

,

.


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

.

.



(
), ,
, .

28

(..
)

, ,
.


.
-,
(,
.)

, .



.

4.500

.
,
,

.

(
),
, .

RNA

,
.
,

.


.
12 ng/ml
.

,
.

,


. , ,
, ,
, ,
.
ii.-
.

.

,
, .

(900 mg

)
.


,
,
.


:
, , , , . ,
,
,
.
,
,
.

29

,
,


.


.



.
)

12,
,

DNA.
,
,

:
,
,

( DNA)
DNA ,
RNA .


. RNA

.



(), .

,

,
.
1/3
.

:
, ,
t, Hb, MCV>120
fl MCH.

.

:




.
i.

12
().

12 :



.

12


.
12
,
(
)

.
.
12
2-5 mg
2 3
.
12


()

30

,
.

12. ,

12



.
(R- )

.
.

12.


.


.
R
.
-

,


.
12
( )

-
.



12
.

12 ..
,

( ),



R-

12.
ii.- .
,
,
.


.

.


.
,


(


).
3.1.2.

: )

, )

(,
,
) .
,
:
1.

, :
) ,

,
) ,
, , , -

31

.
.
2.-
( ).
3.2.

,
,


(, ,
)

(, , , , ).

,

, ()
(LDH) ,

,
,
,

,

.

,

.

.




.
1/10
1/20 ,
.

).

.
.

.

.


.



.
3.2.1.


: 1) : )
, ) , )

,
2)
b.
300
.

.

: ) b
2

2 ) b

(
)
().
i.- .
.

32

b. O

.
,

.
MCV,

,

.

- -
.

-
.

(. 1).
ii.- .


.


b.

b ( b)
( Heinz).

b
: 1)
2, (Hb
Chesapeake, Hb Yakima ..)

1.

/
-/

4
3

-/- --/

--/-

--/-/
-/
-/-

2
1
0

- ,

bH (
)

( Cooley)

33

2
( 2
).



. 2)

2 (Hb Kansas, Hb
Mande ..). 3)

(Fe++ Fe+++)
(HbM)
2 (HbM
Boston, HbM Saskatoon ..).

,
.


.

b

,
.
falciparum.

-

6
. bS ,
,
.

.


,

.

17 .
3.2.2.

(. 3).


.

-6 (G-6PD),
(), (),
(PFK) .
i.- G-6-PD. K
G-6-PD
NADPH.
GSSG GSG,

.
Hb
.
,

(

).
( )
,

. ,
Heinz,
.



.
ii.- . K
,

,

.

,
,

34

( ),
,
,
, Ca2+
.
,
.
iii.- .
.


.

.

.
2,3-DPG
.
iv.- PFK. PFK
: ,
, .

.
3.2.3.



.


,
, ,

.
:
,


(. 2).



4.1

,
( )
+-+.


: )


4.1, )


(
3).


.
( )


.
..
,

(
). , .

LCAT
(
),
.

.
3.2.4.

.
: 1)
- ( ,
) 2)

-

35

,
.

(CD59 DAFdecay accelerating factor-

)
.


.

,
.

.
3.2.5.-
1)
: )

(
karate) (
),
)
(

), )

(

), )
.

2)
: )
, )
( Penicillin, aMethyldopa).



.
3)
.

,
: )

,
)


, )

(, ..).
3.3. M
3.3.1.

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


.


24h48h. 24h



,
,
.
. 24h-48h

36

. 4 5
.


.

(
30-40%)
(
)
.

1:1.



4-5 .
3.3.2.

,
, . .

( ,
).

.

.
( ).
,
,
.

..,

..
, , 1991
.. . 1986
Ganong F. William. Review of
Medical Physiology. Seventeenth
edition, Appleton and Lange, 1995
Kaufman E. Chris. Essentials of
pathophysiology, First edition,
Little, Brown and Company,
Boston, New York, Toronto,
London, 1996
Richard G. Lee, Thomas C. Bithell,
Foerster John, Athens W. John,
Lukens N. John. Wintrobes
Clinical
Hematology.
Ninth
edition,
Lea
and
Febiger,
Philadelphia, London, 1993
Schiffman J. Fred. Hematologic
Pathophysiology,
LippincottRaven Publishers PhiladelphiaNew York, 2000

37

1. -

()
()
,


.


().

,

. , ()
140 mm Hg
(P) 90 mm
Hg.
140-149 mm Hg
< 90 mm Hg.

2-3

. 50%


.


1.

1.
/ *

1 ()
2 ()
3 ()

(mm Hg)
< 120
< 130
130 139

(mm Hg)
< 80
< 85
85 89

140 159
160 179
180

90 99
100 109
110

140
140 149

< 90
< 90

, .

* (NJC) 1997,
, , .
15-25%

.

28%
(
,

).

2.



.
() . ( + 2) / 3

38

: =
x R. . R.
Poiseuille: R.
= k . n L / r4, n =
, L = , r =

.





.

.



.

()
(v) ( = x v).

(
)
.

(
)
.

,

. ,

:
.


, ,
,
.


.

(.

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

, 4)
5)
.

,
.

,

.


(

)

.
2.1.

1


in vitro (

) in situ.


(renal
output curves).
( )

39

NaCl.
:
1) ( )


2)
NaCl.
( )


()
(..
) (. 2)

NaCl,

.

(.. 4, . 1)

( , . 1). In
vivo


( , . 1).

in situ
NaCl

. 1: NaCl
( ). = in situ, =
, E= invitro.

7-10 mm Hg.


NaCl
,
.

NaCl

.

40

NaCl .
,

NaCl 50

4-6 mm Hg, ,

NaCl

10 ,
50-60 mm Hg.
,
NaCl 150

17 mm Hg.

. 2:
1= , 2= ,
3= , 4= , 5=
(Guyton, 1981-).

3



NaCl.

NaCl.


.

NaCl.

(
NaCl)
(
NaCl
)

(salt-loading renal
function curve).

NaCl


NaCl.

41

1.

: 1)
/
(pressure range of
the renal output curve)

2)
(net rate of fluid intake).

. ,



.

. 3. NaCl .

(Guyton, 1995-).

2.2

( = x R.
).

,


.


-
: 1)

, 2)

42

( Bayliss),

.

,
, *

(. 4).

sec


.





-
.



. ..

-

. , ,



.





*

.
..




.

.




,
,
,
. ,

2%
5%

5%.

25-50%.

5%
30-57%.

,
..
,



,



.

,



Beriberi,
,

, ,
,
Paget.



.
,

43

. 4: .
.

,
NaCl
,


.

,

NaCl
)
().


, , .
,
,

2.1 2.2
.

110
mm Hg .
> 90 mm
Hg > 135-140 mm Hg.

150-170 mm
Hg 130 mm Hg
250 mm Hg.
3.

95%
,
.
() .

,

.


.
2
.

5% ,



.

44

. 5:
/ (Kaufman &McKee, 1996).

.
5
,

,

.

NaCl,
, ,
.

,

.




.
4.
()


.

()
70%
(
)
30%
.


6 mmHg.

, ,
( NaCl 9/).

, 4



(140 mm Hg).


: 1.-
70%

.



(

, . 2, 4). 2.-

5-6 .

45

2. .
.
.
1.

2.

3.
4.
5.

6.

(95%)
(5%)

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

Cushing, ,
, , ,
, , ,
, , , ,

, , Guillain-Barr,
, , ,
stress
( )
, , ,
, , Paget,
erieri

.



: 1.-
,

70%,
,
2040%.


( 30%)

( 13%)

. 2.-



.



. 3.-

:


.

46

(Bayliss) .

.



(
).

. 4.

: ) , )
, )

,
.



(

)
,
.

,


.




.



.
NaCl

,

NaCl 20%


.


NaCl



NaCl.

,
NaCl,

.
4.1.

(

)

.
.



.

,
,
.

.
,

.

47

, ,
, +, ..
. / . *

:
1.

.
2.

.
3. (..
) .
4.


,

.

.

.

.

,

(


, . 2,
3)

.

[ ()


]

.

4.2.

5.

:
, , 18 18-
,

.

*

.


.

(.. )
.
5.1.

48

( ).

.

.



(. 2,
3),

.





,



.

.




,


. , ,
,

,
.
:



,

.



,
.
5.2.

.

,
.


.

.
5.3.

,

Goldblatt


.
5.3.1
Goldblatt
, ,

,

,

49

.




.

.

,

( )
,

.

.


(. 2, 2).

Goldblatt :
,

.

Goldblatt




.

5.3.2. Goldblatt

,


.

(. 2, 2 3),


.

.

5.3.1.

- .

,




.

.

Goldblatt
.
5.3.3.



Goldblatt

50

,






.




. ,
Goldblatt ,




.

,
,

:
-




.

, ,
, (
).
6.

,

.

6.1.

.


.
55%
, ,
, .

,

,

.


Goldblatt.

.


,
,
,
.


.



,


(
55% ).
-

51

.

Goldblatt

.
6.2.

,

,

,
,

(. 2, 5)

.


.
6.3.


.

. 3

2
.

,



.
,
,
2-3

.






GABA- C1

100 mm Hg
160 mm Hg.


2
.




,





.


:

,
.

52

7.

,

.
Okamoto

1)
.
2) a+

.
3)

a+,




.
8.2.

8.

()

.
: ,

NaCl,

, (
), +
(stress).

,
,
( )
.




,
, .
8.1.

1)
,



.

25% ,
50%
25% .

.
2)


stress

.


.
3)

,

53

,
.


(renopressin)


.
4)


(water-logged vessels)
.
5)

.

,

,
,
.

.
8.3.

1)




, .
Na+-H+,
Na+

H+ ,

.


Na+-Ca2+
3-5 Na+
Ca2+ .

Na+ Ca2+
,
.
2)

Na+


Na+-K+-ATP
(digitalis-like factor).
(
Dahl .)
Na+,
,

Na+-K+,

, .
Na+-K+
(- , .)
Na+ ,

Na+-Ca2+,

Ca2+

(

deWardener

McGregor).
3)

, ,




.


,

, Na+
.
Ca2+-ATP
Na+-K+-ATP

54

+
Na Ca2+,

Na+-H+

Na+. Na+
Na+-H+ Na+K+-ATP.
4)

,

.


.

() ,

2 ()
,
D
.
,


.

K+ Mg2+ P Se Cu

,
Ca2+
: Ca2+


.

.

.
8.4.

(. 6).

.

: 1)


, 2)
.

NaCl
.

,


aCl.




.

55

. 6: (1=
, 2= ) (Guyton,1995-).

8.5.

:
1)

40-60%,
2)

(RBF)
11/2 ,
3)


2-4 ,
4)
(GFR)
,
5)

,
6)

40-60%,
7)
+
Na
.
8.6.

: 1)
2)
Na+

.

(
) : )

(, , ),
) [- (),
1- (), ()], )
(,
), )

Ca2+ (, ,
), )
- (), )
1
(, .).

(,
, ).
9.

, ,

56

.



,
,
,
.

.



,
.

( ),
( ), ( )
( ).
( >
130 mm Hg)


.

., .

. :

,
, 3 ., ,
1995

Berne R.M., Levy M.N.: Principles of

Physiology. London: The C.V.
Mosby Company, 1990
Bray J.J. et al: Lecture Notes on
Human Physiology, 3rd ed.
London: Blackwell Scientific
Publications, 1994
Guyton A.C. Textbook of Medical
Physiology. 6th ed., Philadelphia:
W.S. Saunders Company, 1981
Guyton A.C., Hall J.G. Textbook of
Medical Physiology. 8th ed.,
Philadelphia:
W.S.
Saunders
Company, 1995
Kaufman C.E., McKee P.A. Essentials
of Pathophysiology. London:
Little, Brown and Company, 1996
McPhee S.J., Lingappa V.R., Ganong
W.F., Lange J.D. Pathophysiology
of Disease. 1st ed., London:
Prentice Hall, Appleton and
Lange, 1995
.., ..
.
: ,
1984
. .(.
.). ,

,
:
University Studio Press, 1998

.:

, :
University Studio Press, 1992
Stergiou G.S., Thomopoulou G.C.,
Skeva Il., Mountokalakis T.D.
Prevalence, awareness, treatment
and control of hypertension in
Greece: The Didima Study. Am J
Hypertens 1999; 12: 959-65

.
(.
.).
, :

..
,
1998

57

1.
()


()




.

.
2.

, ,
,

.
2.1.

..
.


..


.




..
, , .

.
2.2. -

.


( ) (
).

.
.


.
2.3.

(forward-backward failure)

.





a


.

58

2.6.

2.4.

( )

(
) ..
.

*
( )

,

,
..
. , ..
.

(.. , ,
)

.
, ,
Paget,
Beri-Beri


.



.


Beri-Beri

.

2.5.

3.

()

3-20
/1.000 (30-130 /1.000 65
), 1-5
/1.000 (3244 /1.000
75 ).
80.000

15.000 .

(compliance or distensibility)

(V/).

(stiffness)



.

4.

:
)
i.-
( , )

59

ii.-
( , ),
iii.-
(
,
,

).
)
i.- : ,
ii.- :
,
,

,
,
).
)
: .


.


: )



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

(.. , .), )
stress, )
, ) .
5.

5.1.

(. )



, .

.

(wall tension)

, .

.

Laplace T = P . r / 2d T
, P
, r d
.

(impedance)
,
,


.

( )
(
)


.

,

.




.

60

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


: )
, )

. 1:

, )
,

(..
, ), )
2, Pco2, pH, )
, )
.
1




.

5.2.



2,
(wall stress: T = p .
r / 2d),
,
.
2
,

2

(net working time), .

.

2

.

61

5.3.



( )
()
Starling.
- Starling


,

Starling
(
).
Starling

: ) ( x)
(

)


,

(compliance) , )
( )

(= x

),

,



.

. 2: . A=
, = .

(cardiac
function
curve)

(. 2).

(.

... *

:
)
( ), ) , )
, )
, )
(
*

... = =

62

).

(.
...

) : )
( ), )
,
)

, )
(), )

).

Starling

,


.




.

(venous return)
...

(...)

(...):

= (... ...) /
...
...

. 2/3 ...

1/3

.
..
- ...

.

...

(venous return curve)
(vascular function curve).

...

,
...
... ( ~7 mmHg).

...
( )
(.. )

,
... (
) .
...


....
...
(. 3).

(. 4),
,
,


.


Guyton

(..
).

63

. 3: . 1=
, 2=, 1= , 2= .

5.4.


.
300400% (20-25 lt )
500-600% (30-35 lt ),

200%.
.


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


.




,
.


.

6.






:
1.-

-


,

( )

.
Frank-Starling

.
2.-


,
.

( )

64

. 4:

. 1=, 2=.

,

( ).

.


Laplace

.

( ) ,


( ).


,

, (
) .

,

,

.

,


.

,


.
:
3.

.
4.-
-


( )

.

,

65

.
,
stress

.
,


. ,
.





.






.




() Starling,


.

,

Starling (
) Starling

(
).
7.

7.1.

(. 1).

Starling

( ).

( )

.
,

,


.



.
7.2.



.

66

( Paget, ,
, ,

).

.


(
)
.




.
, ,
,



,

.

.
7.3.



.

.

.

,
,

.
()

.



7.4.


(
, ) (

).
.

.



,
,

67

.






.
7.5.


7.5.1.

: )
)


(. 5).





.

... 4 mm Hg
2 lt/min.
30 sec

(, *
*

,


.

, ...)


... 5 mm g
4lt/min.

100%
(...)
7 10 mm Hg.
30 sec
,


.

: )
)
,




... 6 mm Hg ...
12 mm
Hg +
.

().


:
1)

(
)
.


.
2)

-
.


N+-+
.

68

1.

(
)

()

(
)

:

= , = , = , =
, = , = , = ,
= , =/-

69

. 5:
(Guyton,1995-).

3)


+

.
4)
*
ADH

+

.

,
,
()
.



.
,

*

,
ADH

,

.

,
.

( 30-50%)
...


.

,
.

5-7

( ,
- * )
*

70

(c-fos, c-myc, cjun .)

.

, ,



(remodeling),

.
7.5.2.

,


,
,
,


.

.




. . 6



. ,

,


3 lt/min
.

-
,
.

...
30 sec 7
10,5 mm Hg




.
4 lt/min
... 5 mm Hg.
, ,

,

10,5 mm
Hg 13 mm Hg.





4,2 lt/min ... 7
mm Hg.


.
, ...

,
.

,


.


5 lt/min

71

. 6: .
.
= , 1=1 ,
, 2=2 , 4=4 , 6=6
, 8=8 (Guyton, 1995-).

.

:
,
,
,

.
:

C2+

.

)

Ca2+ )
-
(

-)
Ca2+.

.


1.


TNF-
(Tumor Necrosis Factor Alpha),

. TNF


,


,

(, , , ).

, .

TNF

NO,
.

( .. )

72

)
(
)

, .
7.5.3.






.

,
.

(.
). 1/10
.
,

< 45 mm Hg
.


<
80-90 mm Hg.

20 mm Hg

85%
.
7.6.

,

. .
13
mm Hg
17 mm Hg 13 mm Hg.




.

.


:

.
7.7.

,
.
:
- , ,
- , ,

73

: ,
,
,

(

) :
-
- , ,
Cheyne-Stokes
- , (

),

(


)
:
- , .
- ,
.
- , , .
8.



.

)
( )

.



.

.

(

)
.

(-)
(impedance)



,

.

.
, , 3 .,
1995
Bray J.J. et al. Lecture Notes on
Human Physiology, 3rd ed.
London: Blackmell Scientific
Publications, 1994
.
. : .
(. .)
19971998. : University
Studio Press, 1998
- .
, ,
, ,
1999
Guyton A.C. Textbook of Medical
Physiology. 6th ed. Philadelphia:
W.S. Saunders Company, 1981
Guyton A.C., Hall J.G. Textbook of
Medical Physiology. 8th ed.,
Philadelphia
W.S.
Saunders
Company, 1995
K .

.
:
. (. .)

1999-2000.
: University Studio
Press, 2000
.

. :
. (. .)

74

1997-1998.
, University Studio
Press, 1998
Kaufman C.E., McKee P.A. Essentials
of Pathophysiology. London:
Little, Brown and Company, 1996
. .
: University Studio
Press, 1991
Mc Phee S.J., Lingappa V.R., Ganong
W.F., Lange J.D. Pathophysiology
of Disease. 1st ed., London:

Prentice Hall, Appleton and

Lange, 1995
M .
( .. ).
. University Studio
Press, 1996
.
.
; : ..
(. .), 4

.
1999

75

(SHOCK)
.

H (shock),

100 .

.

.
,

,
.
,
,
,
,
,

.

:
1.

(Hypovolemic Shock)
2.

(Cardiogenic Shock)
3.

(Septic Shock)
4.

(Neyrogenic Shock)
5.

(Anaphylactic Shock)
,

,

.

,

.

.


,

.
1.

10%
:
)
,
,
,
,

,

-,

76

.
)
:
, ,
, ,
,

), , ,
, .

,
.



:
1.
15%
2.

15-30%
3.

30-40%
4.

>40%

30%,


,

,

.


,
-

.

30%,
,
.


.

>

40%,

60%,
.
,

,


.

,
25%
5-8%
.

,
.
, 10-20%
,

,
,


.
,

.
1.1.

,
, ,
,
( ),


.
H

, ,

77

.
, ( , ,

,
)
,

,

, .

,

(

),
.

(
<0,5 ml/h Kg ) ,

.
2.

, ).
)
.
2.-


.
) .
)
.
)
( ,
).
) .
) .
2.1.

1.- 90
mmHg 30 mmHg
.
2.-
:
) 30ml/h.
) .
) .
2.2.

,
:
1.- :
) ,

> 40%.
7%

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

,


, ,
, ,
, (<90
mmHg 30 mmHg


),
,

 1.
(.., mmHg)

.. > 30 mmHg
.. > 15 mmHg
.. < 15 mmHg
.. < 30 mmHg

0%
8%
37%
87%

> 80%.

3.

Gram Gram
, , ,
,
Gram
(),

. 6575%
Gram
50-75% ,
.

35-50%
.
10-20%
.
H
.

.
,

,

, ,
,
(
), ,

,


.

(AC).

,
,

.

,

,
(

 2.

1.

50%

. coli, Klebsiella, Proteus

Bacteroids

2.

Klebsiella, haemophilus,
pseudomonas,
E. coli

3.

,
,

E. coli,
bacteroides,
Klebsiella

4.

Bacteroides,
proteus,
pseudomonas,
streptococus

5.

,
,

Staph. Strep.
Acinetobacter
erwina
serratia

)
, 10%
.


.

VLDL, (very low
density lipoproteins), .




.

.



,

. F (Tumor
Necrosis Factor)
,
.
F
,

. F
,

,
2

80

,
,
,

-1. -1
,

,

.
,

, AF (Platelet Actvating
Factor),

,
,

,
.

,
,

.
ageman,


.

> 50% .
3.1.

.
>38,9 ,

.
,

.
4.



,
.

:
1.-
2.-
.
3.- , .
4.-
5.-
6.-


.

.
4.1.

.


,
.

81

(transection) ,


.

.

(Babinski) 3-4


.

.





.

> 3%.

5.

.
,
(penicillin)

, ( ,
.),
(, .).

,
, , ,
,
,
(, )

( ).

,
,
, 1 2
,
,

, ,
-

5.1.

,
,

.


,

-
.

.



.

,

82

.







,
,

.





.





.

, ,

.


:

,

,


.


. (2, CO2, ,).




48 .


,
.
- (


).

(ADH) ,


,

, , ,



.
(-)

.

,



,

83

.




.

()

(
).

,



.


,
,
( ).




(
)

.




.

,
.







10%
,
(
).


.
4,5
mEq/L,
.
4,5 8 mEq/L

33%
8 mEq/L 10%.

320
mEq/h
.


(


)
.
p
7,4

,
,

,
(

84

)

().


,
,

,
, ,
.

( BezoldJarisch).




, ,
,
,
,

.


.



, ,
,
p.

, (tubulorrhexis)



.

.
,

.





.

Barry A.Shapiro and al.Clinical

application of Blood Gases. 2th
Ed. Year book -medical publishers
Chicago-London.1977
-
:

(
, ).

1999.
Chris E.Kaufman.Patrick A.McKee.
Essentials
of
Pathophysiology.First Ed.Little,
Brown and Company. Boston
1996
Charles F.Carey and al. The
Washington manual of medical
therapeytics. 29th Ed.LippincottRaven.Philadelphia- New York
1998.
G. Tom Shires. Shock and related
problems.
Clinical
surgery
international. New York 1984

85

Goldberger Emanouel. A primer of

water, electrolyte and acid-base
syndromes. 5th Ed. Philadelphia
1975.
Hamilton Bailey. Demostration of
physical
signs
in
clinical
surgery.12th Ed.Johns Wright and
sons ltd.Bristol 1954.
Lawrence W.Way. Current Surgical
Diagnosis and Treatment. 10th
Ed.Appleton
and
Lange.
Norwalk,Connecticut 1994.

86

: i)
()

, ,

ii)
()

, ,
,
,
.

()
1. -


,

.


.

.


,
.
,

,

.
400 ml/
.
(renner, 1981),


, ,
.




.
,


0,5mg/dl/
BUN
(blood urea nitrogen) 10
mg/dl/. UN
,
,


. *



,
.
2.

I.
2.500
*

, ,
,
.
, ,
,
, ,
, , .

87

, 43%
,
9% , 26%
,
13%

9% .


.

)
)

()
.
(, )
(,

)

, ,

.
)
)
i)
ii)

)
)

,

,
, ,
, , ,

,
,
, ,

, ,

.
)
)

,
,

88

,
,
,

, .



.

, , ,
. 50-80%

, 5-10%
.

.

, ,
,

,
.
20%
,


,
.



10 300
,
.
,

,

.

2.1.
2.2.

:
)


)

,

,
,
.

89

. 95%
,

1-3

-.
.

,

.

.



,

,
.
,

.

,



.

.
2.3.

,

.

,
.
3.
3.1.

20-25%
.
,

(GFR) .
,
(RBF) (. 1)
,
,

,

. RBF
,
,

. RBF
20% ,

,

.
,


.

RBF, GFR
NaCl
(

).

NaCl

. RBF
GFR,
.
GFR
,

90

.
20%,

,
,




.

,

.
3.2.

:
RBF
( ) (. 1),
(. 1),

(. 1).

,
GFR.
-

.
3.3.

(.
1).
,
(feedback)
2
GFR.


.
,


.

.

,



.

. ()

91

-

***

. 1: . .
,
. .
,
. .
, (GFR)
. .

.

92

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.
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.

H2O, Na, K, Ca, P, ,

,
.


.


,

.


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. ,

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.
, ,

, ,
,
*

.

,

,
.
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,





.

.

,

(

).




,

,
.

93

,
.

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.


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.

-

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.
1980


.
,

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.
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.

%
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25
21
4
22

6.

6.1.

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L
/,

.

94

,

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.

,
,
,

.



.
,
,

:
=

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GFR,
,

,


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).
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,

,
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.



GFR.

,

GFR


.


.

,


GFR.

, .. 75%


+

.

GFR
,

.

GFR,

.
7.

95

,
.

7.1.
-

,
GFR

(. 2).

. 2: . Q= , = ,
RA= , RE= .

7.2.

7.2.1.

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1.010).

.


.

7.2.2.

,
99%

1%
.

GFR,

.
,



.

96

()

,
.
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,
3,5 5,1 meq/.
75 meq
, 70 meq

. ,

200 meq/.



.


.



. ,



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160 meq/. ,



,

,

( ).

,

,
,

.



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.
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,
2,7
4,5 mg/dl
1000 2000 mg/.
,
85%
.


(PTH)
.
A C


.

,
,
,
,
.
, GFR
20 ml/min,


PTH *

.
*

PTH
.

97

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800 mg,
160
.

, 50
mg/,


.

: i)
. ii)


.
iii)


.


.

.
7.2.6.

, pH
7,37 7,42




.


,

+.



14-16 meq/. pH

4,5-5,

,

.


* .


12 15 meq/,
,
.
7.2.7.

50-80 milimoles
,
.
,

,.

500-1000 milimoles
+

+
milimoles .
,
pH

, pH
6-8.
*

:
Ca2+103)6(OH)2

x(H3O )2x(PO4


( x
.
Ca:P
.
+

98

8.

: )
)
.
: 1)

, 2)
,

,
3)

,
,
,

4)

, ,
,
.
,

.
8.1. :

,
.

,
,
10

1-2
. -

. ,
,


.
8.2.
8.2.1.



.
,
.
,



,
, (GFR 40ml/min),

.

22
35%.

,


.
8.2.2.
GFR
40ml/min
--PTH D

D,

99

PTH .

PTH.


,
,

.



.

.
8.3.
8.3.1.

.
-
.
o

.
8.3.2.
.
8.4.

...
,

.

,


.

Guyton & Hall. Textbook of Medical

Physiology, 9th edt, Harcourt
Brace I.E., Saunders, 1996
Brenner & Rector. The Kidney, 6th ed.,
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Harisson. Principles of Internal
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Mountcastle. Medical Physiology,
Mosby, 1980
Kaufman, Chris E., McKee Patrick A.
Essentials of Pathophysiology,
Little, Brown and Company,
Boston New York Toronto,
London, 1996
Zellenock GB, D Allecy LG.:
Pathophysiology of ischemia and
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The C.V. Mosby Company 147158, 1990
Raskin N. Neurological aspects of
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3rd edition, 231-245, 1989

100

A.
1.

, ,
, ,

. ,
,

, ,



(. 1).

).


(..
), ,

. ,

, ,
, .

,



.

2.



,

.
2.1.



(.. ),
, *
(..
*

.

(Schmidt's syndrome),

, .

.
1:

2.2.
,

101

.

,

.


,

. ..
(
)
25()D3 1,25-()2D3





.

,
,

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. ,

,
,
.
2.3.

.
,

.



.

DNA
,


. ,
,


,

( ),

(
).

.
,
GH

GH

Pit-1. *
3.
**

,

.


( )
. ,

(LH, FSH, TSH, PRL, GH,

ACTH).
,

,

, , *

Pit-1

(,

)
.
**

(
).

102

, .



..



,
,
. * ..

.

**
,

. ,
,
(ACTH, FSH, LH, ADH, PTH, GH, PRL).

.
,


( ),

, ***
*

,
,
(
1,25()2D3,
).
**
.
***

ACTH, .
,
CRH,
ACTH
, ACTH
, .
Cushing

, .

,

.
,
,

. ..

. ,

,
.

,

.
,


, .


- ,

.
4.
-
1942 Albright


, (
).

( )
Gs ,
,

103

.


,

(
),

.


(..
).

. ,
ADH
. GnRH


(down regulation),

.



..

.

( )


,
.
() ,


. ,
,


,
.

.



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,

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,
(
).
,

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.


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.


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,

.

104

, .

,

GTP.

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,
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,

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),


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).
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.
)

..

,
.

,
,

.
)


..
, Cushing,

.

,

,
,
licorice ()
(nasal sprays).
6. ,

,
,
,
,

..


.

.
7.

,


(), *

105

.


,
(

). ,
TBG ()

,
(),
.



,

..
Cushing
,
,


.
8.
,
,
.

,
.
..
,

,
.


,
,
(
thyroid , , .

stimulating immunoglobulins). ,
,

.
,
,
,

.
9.

,
.

(
).
)

)
,
,

.
.
.


1.
1.1.

,
, ,

106

,
.
,
, ,

.
1.2.

.
()
.

,
.


,


.

,
C (
)
.


,
.




,

(Zucker rats)
. *
1.3.

-

.

Cushing,


,
. **
,

,
,

. ,

, 90%
,
Gushing 2%
. ,

,
.
1.4.

,

.

,
3,
.
TSH TRH
,
3

.
1.5.

,
,
**

Cushing
,
.

107

. ,
--
,
,

( )
,


.

,
.

1.6.


( * ),
,
.

,

.

,

LHRH.

,
(
),
. ,

,
.

,
.

1.7. -
-,
() ,
(GH). ,
,

.
24

(controls),

.
,
GH,
I (IGF-I C)
.
GH,
IGF-I
.

CRH .

,
.

,

, .
1.8. -

,
.

,
.
D ,

. .

108

2.

2.1.


,

.

,
.


,

. *

, **


,
.


.


,
,
,
.
2.2.


,

*

1689
Richard Morton,
17 .
. 4-6%
.
**

.

.
.

.

(
* LHRH)

,
. **
,

LHRH ,
FSH LH (
).
,
,

. ***
,

LH

.
LH LHRH,
,


.


,
.
2.3.

,
(GH). ,

,
*

LHRH,
,

...
**

LHRH.
***

10%
.

109

C (IGF-I),

GH.
IGF-I

, .

( )

,
(PRL).
TRH ,
PRL,

LHRH. TRH
PRL .

2.5.

.

,

Cushing.

( )
,
, ,

,
.

(
),
(
) . ,

** ,
ACTH CRH
. , CRH

, ACTH
.
CRH,
ACTH,

,
ACTH
.
CRH
,

.
,
,

,
( ).
,
.

, -

**

2.4.

,
.

4
, 3 ,
rT3 * .

,
-
.

3
,
(

), TSH
,

TRH.

rT3 reverse T3,

3.

110

-.
2.6.


/. *
, ,
,
.
3.
3.1.



Cushing (-Cushing ). **

,


,

.

, ,


,

.


.

,
, ,
,
,

.



,

,
,

, ,
cAMP
.


.


25%
,

.
3.3.



.

,

.
B

3.2.
*

.
**

.

., - ..
.
, .,
, 1996

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113

1.

()
,



.
o

-

.



.
80%


,


20%

.



, ,
.
2.

, .
:

(

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


.


.

.



.
:

, ,
,

.

,
,

.



Willis
.

-

-

114

.

,

,


.
Willis
.


.

-
.

-

-
,

.






.
3.

15%

2%
.

()
50-55ml/100g/min

,
.
.

( )



( ).


:
1)

. CO2, H+
O2,
.


.
CO2 pH:
CO2 () ,

,
()


.


+, ,

.
2: ,

,
, .

-

(CMRO2=3.2-4 mlO2/100gr/min). H

115

O2 ()

.
2) :







60-160 mm Hg.

( )
-
-


()
.

60
mm Hg


.
160 mm Hg,

,



.
3)
:

,


.

. :
i) :


.
ii)
:

.
iii) :


Ht, ,


.


-

-
(
)

CO2 (
).
4. -





.


(focal
ischemia) (global
ischemia).


,

116

.



.

.


.

.

,
,
.

(,
).



.



. -
-



.

(
,

).

(. 1).

. 1: .

117

:
: 1.-
. 2.-
3.-

.

,

.



,


.

,
,
.
,




.

,

(, ),

.
,
,
(Lacunar infarction).
,


.

,
.

,


.


,
,


.









.

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, )


)

.



.


,
C S,
,
,

118

.



.

( ).

.

, ,

.


,
,
,

(
)
( 1).

, , .
:



.
1.- (,

,
), 2.- (
) 3.- (
).
.
( )
.

.

1.

, ,

,
,
,

, ,
, ,
, ,

,
, ,
,

119

,

.


,

,
.
5.

,



.


2



.

(penumbra)
,



()

.

,

.


.






.





.

,
,


.



. , ,




,

DNA
200-600 kbp,




.


,

120

( 2).

.


,

,
, .

,

,




.

,


(
)

.




,

, pH
.

.


,


.

,


: (NMDA, AMPA,
)
G
,

,
,

.


Ca2+
,

,
.


NMDA
(excitotoxicity)



penumbra,



.



.
Ca2+




(,
,
)

121

Na+ / K+ - ATP
Ca+2 - ATP
Na+ , Cl- , H2O
Ca+2

Na+ / K+
Ca+2

pH

H+

NMDA, KA, AMPA

ATP
ADP, AMP

ATP
2

(VSCC)

H+

NADH, FADH
H+

c AMP

DAG

IP3

Ca+2

Ca+2

O2- , OH-

Ca+2

(AOCC + VSCC )

O2- , OH-

Ca+2

-

-

. 2:

.


,



, ,

.
,

,
,

.
:




.

,

,

.
24-96
.

122

.

, ,

,


.

Aminoff M.J. Clinical Neurology,

Appleton and Lange, 1996
Braddom R.L. Physical Medicine and
Rehabilitaion,
S.W.Saunders
Company, 1996
- .
, ,
1999
Cecil. Textbook of Medicine, W.B.
Saunders Company,19th ed, 1995
De Lisa J.E. Rehabilitation Medicine,
Lippincott Raven Philadelphia
NY, 1998
Guyton. , 8
, 1992

..,

..

,
3
, University Studio Press,
1996
Lindsay K.W., Bone I., Callander R.
Neurology and Neyrosurgery
Illustrated, Churchill Livingstone
,2nd ed, 1991
. ,
, 2000
Robbins S.L. Pathologic Basis of
Disease, 5th Ed, W.S. Saunders
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Walz W. Cerebral Ischemia-Molecular
and Cellular Pathophysiology,
Humana Press, 1999

123

1.


(1300-1500g).

,

, ,
.

,
.
,


. .




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(, , ). I
,


.

,

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,
.


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( Kuppfer),
.

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)
.

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.
().
.
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.
.
2.-
,
.
3.- (
).
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.
5.- .
6.
:
.
7.- .
8.- (, , ,
, ,
,
).
9.-

.
10.- (, ,
, , ,
,
).
11.- (,
, , ).
12.-
(, D, K), 12
(, ).

124

13.-
Kupffer.
14.-
.
2.
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)

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)



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.

2.2.

:
1.- .
2.- .
3.- .
4.- :

,

,

. ,


.
3.

3.1.

2.1.

:
1.- ,
2.- : ,
, ,
,
,
3.- :
(Amanita
Phaloides),

( )

(CCl4)
4.-
.

, B, C, D
95%

.

Epstein-Barr, ,
,
Coxcachie, ,
.


,
.

.
,

(
)
,
(.. , ).

125

,


.
:
,
,
.



.


.



.


.

.
3.2.




,

.
,
,

,


.

.

.



.

NADH ATP.



.






.




.

.



.
:
.

:

126

1.
.
2. .
3.
.
4. .
5.
.
6.
.
7.

.
8.

.
.


.
:
1.

.
2.
2.
3.

450

CCl4, ,


.
.
, ,
:
1. .
2.
.
3.
-

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, , , ,
.
4.

.
5. .
6.

.
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.


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.

127

.



:

. ().
. ().
. ().

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:
1.


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2.

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3.


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.

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,
,
, ,

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,



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

-
-
-
--

128

3.4.

,
,


.

.



.
,

,
.
4.

,

.


5 .
.
.
.
.
.

.
.


.
.
- .

:
4.1.

,
.
4.1.1.

-
.
,

,

.

,

.

129

.
4.1.2.


,

.

,

.



VLDL.

,
,

.


.

.

,
,
-

.




( )
...

4.1.3.





.





.


,

.
4.2.

,


. :
4.2.1.

,

,
-
.

( )

(..

).

.

130

,

:


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.


.
,

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.
,
.
(
,
).

,


(.. ).



.



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,

.



.

.

.

.



.
Gilbert


.



.




.



.
4.2.2.

.
( )
,
-450,


NADPH

.

131

,




.


, .

.



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.




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.

(.. )


.

, ..


.




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.
,

,



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.

,
,
.


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.
4.2.3.



,
12.




.

.
4.3.

,



. ,

132

.
,

.



.
4.4.

4.4.1.



kupffer

,



.
4.4.2.



,
.


,

.




.



.



.







.
4.4.3.
,

. ,

.

.



.






P450.

133

.
450

.



.
4.5.

,



.



.

,

. ,

.




.

Achord JL. Alcohol and the liver.

Scientific American Science and
Medicine, 16, 1995
Guyton A. ,
1992
Lee WM. Drug-induced hepatotoxicity.
N Engl J Med 333:1118, 1995
Lee WM. Acute liver failure. N Engl J
Med 329: 1862, 1993
.
,, 1996
.

,
, 1998

134

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135

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137

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139

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140

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2001
Cecil. ,
, 1996
aufman E.C., M.D., McKee A.P.,
M.D..
Essentials
of
Pathphysiology. Little, Brown and
Company, Boston, New York,
Toronto, London, 1996
.., ...
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1984
,
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, 1998
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141

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142

3.- .
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stress
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0
2000
3000
4000
5000
6000
7000
8000
10000
14000
19000

760
596
526
462
405
354
308
267
199
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143

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144

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145

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.


.
CO2
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30 mm Hg. 6500 m
20 mm Hg
pH 7.5.
(base excess, BE)

146

, ,
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)

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147

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140 g/ml ,


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5000 m
. 100 ml
15,5 g ,
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20 g ,

75% (
5000 m).

,

148

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pH
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149

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150

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3.


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10 m

.
30 m 4 (1+3)
.


.
,


Henry: V =
sP V , P
s

( ml.l-1.mmHg-1).
, (37o C), s=0,03ml.l1
.mmHg-1
vo2=0,03 . 100=3ml=0,13mM
: sco2=0,68ml.l-1.mmHg-1
sN2=0,015ml.l-1.mmHg-1
vco2=0,68.40=27,2ml=1,2mM,
vN2=0,015.570=8,55ml=0,38mM

PCO2
,

.
3.1.

,
.


.

O2=450 mm Hg (60%
)
,
.
(760 mm Hg)
8
, .


.
1,7-2 ,
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100%
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O2) ,


O2 (750-1130 mm Hg).
, O2
. , ,

151

.



O2.

300 mm Hg (40%
). O2

.


,
,

.
3.2.




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.

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50 m) .
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,

.

152

.
,

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100% 10 m .
(20% 2, 80% 2) , 50 m
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2 ). - ()
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3.5.


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11,9 atm (
130 m
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153

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HPNS


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trimix,

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650 m (. 3).
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.


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.



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,


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,


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.
3.7.

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,

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20 m

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20 . ,

(diving response).

,
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,
.

.
,

.

(.. )

.

154

(
). ,

.
,
50%.

.
,
,


.




.


O2
30-35 mm Hg

.
Pco2
Pco2 .

2 co2

. ,
,

. ,


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,

.


,
.


.

10 m
.

CO2.
,

.
Pco2


(break-point )

.

.
2

Pco2. ,

(break-point)

.

.
co2

,
, .


,
( 2)
.

155

Dejours P. Respiration, Chapter 9.

xford University Press, New
York, 1966
Guyton A. C. Textbook of medical
physiology, 7th edn, Chapters 44
and 45. Saunders, Philadelphia,
1986
Hurtado A.: Animals in high altitudes:
resident man. In: Dill D.B., ed.:
Handbook of Physiology. Sect. 4:
Adaptation on the environment.
Washington: Amer. Physiol. Soc.
1964
Lambertson C. J. In Medical
physiology, 14th edn, ed. V. B.
Mountcastle, Chapters 73 and 75.
Mosby, St Louis, 1980
Levitzky M. G. Pulmonary physiology,
3th edn, Chapter 11. McGrawHill, New York, 1991
Minors D. S. In Human physiology:
age, stress, and the environment,
2th edn, ed. R. M. Case and J. M.
Waterhouse, Chapters 7 and 8.
Oxford Science Publications.
Oxford, 1994
G.
W.:
Survival
of
Molnar
hypothermia by men immersed in
the ocean. J Amer. Med. Ass. 131,
1046, 1946
Nunn J. F. Nunns applied respiratory
physiology, 4th edn, Chapters 15
and 16. Butterworth-Heinemann,
Oxford, 1993
Slonim N. B. and Hamilton L. H.
Respiratory physiology, Chapter
17. Mosby, St Louis, 1987

156