, Mporoxon No24 EKCTPEHA MEJMYHA JIONOMOFA Y PASI BOJIIO Y FPYJJAX/ TOCTPOMY KOPOHAPHOMY CHHJPOMI/IH®APKTI MIOKAPAY (3 EMEBALIEt0 CETMEHTA ST) MpotoKon onucye nocnigosnicrs HagaHHA EMA Ha AorocnitansHoMy erani xBopAM 3 nif: o3po10 Ha IM, MeroWw yboro NpoTokony € KagaHHa MaKcuManbHo akicHoi EM] Ha qorocniranbHomy eTani XBOpMM 3 TOCTpuM KOpoHapHIM cmHApoM (TKC) a caMe: CBOEYaCHA AiarHOCTHKa MeAMYHM! Mw daxisyswn TKC/IM (3 eneBayiew CermenTa ST) y xBopux, HagaHHR i EM 3 MOMeHTY BCTaHOBNEHHR giarHo3y aG0 3BepHeHHA TaxOrO xBOpOrO 3a MeAUUHOIO AONOMOFOW AO MO: Mekry rocnitanisauii, Ta, y pasi HeoGxiqHocTi, cBde4acHOrO Ta AKicHOTO NpOBeAeHHA peaki- MauilaHinx 3axoaie. Mocaigosuicr» sukonanna npotoKoay 1. Ouinit Micue noaii. 2. Mepsuune spaxenia npo xsoporo/nocrpaxnanoro. 3. Mepsunnnit orasa, — ditime sziduo 3 Mpomoxotom Ne 3. Yeyuyti sarposmnei Ana aKHITTR 4, Mposectu xeranbue o6crexenns xsoporo. Caria spepuyri yeary: 4.1. Jas yrounennsa niarnosy auxonatit 12-Kanarbuy EKI * peaynbrari EK (nu HeoGxianocri) cain Hagicnarn sa inrepnperauti cpaxin- UsM 3a ONIOMOrO!O TeneMeTpH4HHX TeXHO.TOrIf + y pasi IM, ~ nosigomuri npo we siatinentia EMI] sinnosianoro nikypanbHoro saknany; + yci peaynsrarn EKM, aKi Gyn orpumani Ha sorocniranbHomy eran, ~ caizt 0- CTaBHTH Y NpHfimanbHe BizninenHs aiKapHi; + Mowitopuur EXT ¢ onaum 3 HaiiSinbus incbopmaruexix weronis aiarHocrHKn Tlopywiexb cepyesoro purMy, npoBizHocTi ra BHaBments iueMil MioKapsa; + 300THM npaBHOM € 3HaTTA MOKAsHHKiB 12-KaHanbHoi EK’ y nepusi 10 xe. ne- peGysanna Ha Micui nozii 21a xBopHx, B aKHX KasiBH osHaKH TKC; + nposegentia nocriiiHoro Kapaiomoxiropuary € GaxkaxuM. 42. Okciirenorepania Hie sacrocosyerbca pyTHlHo y XBOpHx 3 KC: + xBopi 3 roctps (inTeHicuBHuM) GoneM 8 rpyanili kniTui Ta niaosporo wa PKC ne ToTpe6ylors AoaTKOBOTO KHCHIO, AKUIO Y HHX He Mae O3HaK rinoKcli, sanLIKH 60 ostak cepuesol Henocraruocti (CH); + np naapunix osHaKax rinokcii, 3aMlUKH a6o o3Hak CH, ~ cain BAKopHcToByBa- tH 100% kncents 10KH He Syne MoxuIMBicTs BusHauiETH SpO,; + nicna sa6eanevenia Moxuiieocti BHgHaueHHa SpO,,— cain THTpyBarH noma4y KHCHIO lo ocarHeHHs pista SpO, = 94-95%, a 3a HaaBHOCTI y XBOpHX xpoHlis- Horo O6crpykTHBHOrO 3axBopioBaliHa nereHb (XO3II) no AocarHeHHs pisHiHO SpO, = 88-92%. 5. Heo6xinno natn xsopomy: Mpenapara Dosyeanna AUETUACARIMOBA Saxano 8 ra6nerosanilt opm Ges eneuiansnoro nokpurra vasanraysanbHa 1038150-300 mr per os a7Mpenapatn Aosyeanna knonigorpe. ao mnaiyeTsen | ano Bik ae 600 mr per os 73 AHTMKOATYNAHTH mn nN(a60 Ane. Loaaron wee Ea 6. Busnaunrn AT. Yrountra y xBoporo insbopmauiio mono BXHEAHHA HHIM NPOTAFOM OcTaHix 49 ro Topis docdoaiecrepasn (ue npenaparH, ski BHKOPHCTOBY!OTD NpH epeKTiineyig ii uii Ta nerenesifi rineprenaii): MCV. ‘+ saxwo Taki npenapatH npuiiMann, — NpoTHNOKasave BBeneHHs p tT i Nitponpeng Tig, — Heo6xidxo nepeiimu do n. 8. yooz0 Flpomoxony; ba + sxo npoTunoxasis 20 npifony Hirponpenapatia He Mae, — Heagyj2y. 5 timu do n. 7. yooeo Mpomoxony. pe 7. Tipw noxasunxy AT.,., > 90 MM pr.cr., BHpaxkeHoMy Gonbosomy CHHAPOMI Ta Bincyry i mporunoxasia: “- + aHeGomosarma poanosars 3 Hitpormiuepnny y TaGaeToBaHit opm agg opmi cnpeto cyninreanbHoro (0,4 mr/nosa) 3 intepBaiom 3-5 51, 3" Y + yBunanky sincytHocti edexry sia npuiiomy Hitporniuepuny, — peel petimu d0 n. 8. ysoeo Mpomoxony. 8._ ¥ pasi pesncresrruoro no nixysavni winporniuepiiom Gonto aG0 mporinox:\ 20-apx auavensa vitpatis: 81. Poarasiyri siKopuicrania HapKoTHuRH akanbreTHKia (nepeBary Mae -ii-pooate BeneHHA npenapaty fo ameHuleniia Gono a60 nlosBH noGiuHHx edpexrin + Mopsbiny riapoxtopia: 10 mr 8/8 a60 B/« (a posperentiansi30ToHis\ posur Hom Harpito xnopnny (0,9% ~ 20 man), upo6Ho 8 4-8 mr, Hacrynti ii: l,m 2 mr KoxkHi 5-15 xB. 10 3HMKHEHHA Gono; Tipu nenocratabomy ecpexri sin HapKoTHuHix aHanbreTHkis posrsiyti: + inehysito nitporninepuny: 10-20 mkr/xB 8/8 a6o B/K 3i SGinbueHHAM s103K a0 200 mkr/xe nia konTponem AT ta YC (20 mr possecti B isoToHiuHOMy possi Harpito xnopmay (0,9% — 200 ma), KoHueHTpania 100 mxr/s, wenaicr> indyaii cxnanae 2-4 Kp/xe, (max = 40 xp/xe)), indysito Mpumiusiote pH anwxenni AT.,, 10.90 MM pr. cr. a60 CAT wa 10-25% Bis, anartronaninx WP: 9. Tipu PKC enenauicto cermenra ST (STEMI 2a wansunx pecypeis i norpunanis wacosr Mex, noTpi6Ho posrnaryTH rocnitanisayiio xBoporo ana npogenenHis UKB Ta creHTy paw kopoxapHnx aprepiil y Bianosiqnomy sikyBanbHomy saknazi. Lle Mac essanepesHHit mp purer nepen tpomGoaitwuHow tepanticio, posraaHym™ 10. 3a Hemoxmeocri Buacuoi rocniranisauii xoporo ana nposexenua UKB, mposegeHia TpomGonituunioi Tepanii Ha aorocniranbHomy eran. 11. 3a HeoGxinnocti mpoxoucynbryitrect 3 KepiBHHkoM (cTapuiHM siKapeM). - J Ky HA 12. Merom tpavcnoprysanua Ta nyHKT npuaHauenns cnig o6upaTH 3 pospaxy#KY kanbui pecypcu MenMuHoi cuctemn, ee npodi 12.1, Tpatcnoprysanua ta rocniranizauia xsopux y signosinHuii crauionap, A i fi 1) aoniomore: vi axieul ta oGnamHania ana HananHa aKicHoi (cneuiaisoBaHol) 1070 + sinnosiane signinennia; + MoxkIMBicTE npoBezeHtia HeOOxiaHoro obcrexeHHA mo -“122. Thin 4ac tpancnopryeanna, i ~ KOHTponoBaTH Ta nepesipsTi OcHOBHi BiTanbHi NoKa3~ koxkwi 15 xB. ana xBopix y craGinbHoMy crani; * KONI 5x8. npH suits craky a60 ata xBopHx y HecraGinbHoMy crani. Baxknuso! 1. Mepen nposenenHsm nikysanHa cri Ia si6parn neraneui akanwes ra npoKoHcyneryearich 3 iano- BigHum cbaxiauem (3a noTpe6u). a anneal 2, Mposeaite cepio sanucie EKT, soKpema, Koni € aMina Kniniunoro CraHy xBoporo 3. Heo6xinvio ensHaunr noBuih cnucox npenaparia, aki NpMMae XBOPHA (wanpAKAa, f-6noKaTOpM, re alk eer eulesix KaHanie, Knovianky riapoxnopwA, AUFOKCHK, aHTHKoarynaHtn Ta npenaparn Aaa DMSBAHHA ePEKTAALHO! AUCyHKUIl a6O NereHeBOI rinepreHsli), LO OCOBAMBO BaKNKEO AA ni- kaps 6 NpHMIMansHoMy BigaineHHi 4. KpnTepil go nposeaenia Tpombonitwunol Tepanii “Alarnoa FKC 3 enesauicio cerwenra ST (STEMI), cBinolo a60 VMOSIpHO ceimo¥ 6noKaROW « TiBo! Mika nyuka Tica (BMHOKT), Ta paHimn aaneay (vac posBHTKy CAMnToMiE < 12 ron). SincyTHicTe YMOB Ana npoBeReHHa UKB y Mexax 120 xB, (nepLUI MeBWNHiN KONTAKT ~ 6ANOK). YunKarrre BBeneHHA HiTpaTia NauieHTaM 3 riroreNsieio, ocoBnHEO & NoEANAHAI 3 6paANKapAIeD, a Ta~ SOR RAIEHTEN 3 KiokHiM incbapKTOM Ta nigosporo Ha ibapkT NpaBOrO LinyHOMKA (niaOM cerMeHTY 015 wm y V3R-V4R). Takum xBopin noKazaHo npoBeAeHHA HaNeXHOT IMepyallaHOl Tepanil 6. 3a wansHocTi Taxikapall_ npw norpe6i cnia poarnanyru aacrocysaHHA f-GnoKaTopie per Os 2 HHaBKHX 03 (nicns craGini3auii craky xsoporo ta 3a sigcyTHocTi npoTunoKaaaHe): 5. Mpenaparu Doaysanna METONPONONY TAPTPAT 20 25 ur per os NPonPAHONONy rigPoxnopug 0 20 mr per os ATEHONON 0 50 mr per os 7. B6noxatopn 8/8 a60 B/k 3acTocoByioTEcA TinbkH 3a HaRBHOCTI Nokasi8 (TAKKO! rinepreHail Ta/360 Taxikapail) ta BiacytHocTi npoTunoxasie Npenaparn Dosysanna 5 wr 8/6 a60 8/x METONPONONY TAPTPAT KOM 510 xB, 20 HanexHoro ebexry 360 max nos 15 wr (15 Hn) 260 MaBanTamyeansHa n030:0,5ur/ur 8/8 860 8/« ‘nporaroM 1x8. EcMonony rigpoxnopug (005 ran/xr npn KonueHTpauil npenapary 10 Mr/s4n) cepenk ninrpwmyioua 2038: S0-200 mxr/Kr/x8, 8. Minuac s60py akamHesy y xBoporo cnin 38epHYTH yeary Hat 81. BeTakoBneHiia ToUHOro Yacy Big NouaTKy Kanany Gon 8 rpyaax Ta Horo TpHeanicte; 82 BctaHoBnenHa nepesiry, xapakTepy 6onio, Horo noxKanisauil Ta ippaniauil, 3a'saKy 3 cisMuHMM i NCMXOeMOUIMHHIM HaBaHTaKeHHAM; 83. BcTaHosneHHs, cnpoGu 3HATH Bin’ NPMNMHEHHSM HaBHTAKeHHA, NPVIOMOM HiTporniuepHKy (axnit peaynetar); 84. Un cxookisi Yel Hanaq Gono a60 3aayxn Ha Ti BiAYYTTA, WO BiHnKaNH paHiwie npH cbisHuHOMy HaBaHTaxKeHHi 3a NoKanisauiew Ta xapaKTepom; 85. BcTaHOBNeHHA nikapcEKHXx 3aCO6I8, Aki NPHIAMAE XBOPMM WOAeHHO; 86. JacyeaHHA nikapcekix 3aC06is, Aki XBOPUA NpMAHAB No NpHEyTTR Gpurann EMD; 87. 3'acysanHa nepeHeceHoro rocTporo IM, npoBeneHHs aopToKopoHapHoro WyHTyBaHHA (AKL) 860 KOpOHApHO! aHrionAACTHKN 8 MAHYOMy, HAABHICTe ‘bakTopis PUaHKY CepLeBO-cyAHHHMX Baxsopiosahs (Hanpvknan, apTepianbea rinepTeHsin, ToTIOHONaniHHS, uyKPORMi AiaGer, rinep= xonectepunemis); feuanoienan. fOPYUENYA PITHY ceo, i oroBa eOPOSe sey, ah aynony KBORGTeU Se sae hn a aero) ; nor etOD Ta6inbHocTi MiOKA| reat repent ant erponenice AT, Mh Oe cyan Pasay a wnant7© 210MM ATT ny rippOKMODMMY POMMNBION 2 NO2M 25-5 arya Qt 10. saiwactan noxaarnnia AT Ta 03H@KOK PCTAE Busenenns us noaKoROF 29. Nae, ikyBaHHe, eran aianoBiaHor niKy®2 ne) Sor napnTy MiOKBARY, TAK! AK: HYZOTa/Cnogy ae ‘i MBHMX aHTMATDETAHTIB: Npacyrpens cjorHOCh venencin); sanmuKa,sTP3Té 12. Bapto seepuyTi yeary He 8M ypaneua 032 60 mr 3 MOCHA duannesi ta akin naanyeTecs ‘90 wr asi Ha eH). jopucTaHi ansTepHa” nODICTEN Four IOMT) NENTEN 3 BIRCYHIM IynATON Oe operon ( abaHTEMYBANEH 2030 TBO MF 3 rochigyy) AE AYO eee 7 Ounce vicus N03 Tr ot Seales aT 3. Nepanwnna ornaa, “Tixainauia sarpeannenx ANA KUTTR CTAHi8 5, Alerancaniunnosa Kacnora - 6aNano y Ta6neTOBAHIh @opMi Ges cneulanbuor (G030 150 do 300 me) + knoninorpens “Postnanytn abruKoarynant | 6. AT, Npotunoxaan no nikyeanna nirporniuepniom? Hitpornivepus (enpen , an Het noe eyennesaronni 0-4 2/0030) 80 Nostopirn sinrepaanon 3 3-5 x8 3a ynoon Wo Ata 100Km Bren Beep SMeHWAnHce Gonnoni BinuyriA? 9. Posrnanyn | 1YTH nirTana rocniranisaull x80"? Leroy ARR NBESEREHn IKE 79 __STentypanns xoponapHnx aprepit 8, Haprown anansrevm bn NeotxiaHoct indie tepanin —— pon We rote earnest ee 1. Koncyner —* Koveynrauin xepiannma Ccrapuioro ions (Crapwioro niKapA)