Neyrokhirurgia-Grinberg-2010-pdf
.pdf27. |
22 |
.
, .
, , -
, " ".
: .
102
: o
6-14 ) 0,45
0,17
103
o ( ) 91%
104
( ):
o: -
,
, -
105,106
o-
107
, )
( )
, -
108-110. . 27-3. >50 -. , ( -
) ( -
) ( . 27-3).
. 27-3. -
|
|
|
|
( ) |
|
( |
|
|
) |
|
|
<120 |
<3 |
|
|
|
27. |
23 |
|
|
|
|
|
120-200 |
|
3-6 |
|
>200 |
|
>6 |
|
27.4.2.
3070% , ,
20-30%
18
-
- -
,
, . , -. -
; -
7% ,
7% , -18
-
: 3 111
6-8
, 17 )
12 -
,
3-4
, 10%
, -
( 9 )
27. |
24 |
;
-
( , )
-
( . . 27-4)
112,113 ( .
. 27-5) (
3)
-
114
, , -
T,
,
, -
T 3 ( -
)
( . )115; -
116
, -
: , 24 -
,
-
, 90
, ,
. 27-4. -
|
% - |
Hunt |
( |
Hess |
) |
1 |
22% |
2 |
33% |
3 |
52% |
4 |
53% |
5 |
74% |
27. |
25 |
. 27-5. 112
- |
|
|
|
|
||||
|
* |
|
|
- |
|
- |
||
|
|
|
|
|
- |
|
|
- |
Fisher |
|
|
|
|
|
|
- |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
) |
1 |
|
|
- |
11 |
2 |
|
2† |
0 |
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
||
2 |
|
|
7 |
3 |
|
0 |
0 |
|
|
- |
|
|
|
|
|
||
|
‡ <1 |
|
|
|
|
|
|
|
3 |
|
24 |
1 |
|
23 |
23 |
||
|
|
|
|
|
|
|
|
|
|
‡ >1 |
|
|
|
|
|
||
4 |
|
5 |
2 |
|
0 |
0 |
||
|
|
- |
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
- |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
§ |
|
|
|
|
|
||
* -
(
), 5
47 ; 1
†0, . 1 -
,
‡ ( -
, , ) §
27.4.3.
. , -
-
.
( , )
.
27. |
26 |
,
, . 27-6.
. 27-6.
1-8 |
|
( , - |
|
|
- |
|
|
|
|
|
- |
|
|
|
|
|
- |
|
|
, |
|
|
117,118 |
9-60 |
|
|
|
|
|
- , -
-
. -
( ,
, , - ).
:
:
A., -
91 ( . )
B., 92, 93
C.nervi vasorum ( -
)
1.( -
-
)
3.-
94
4.: , -
95
D.-
:
,
,
27. |
27 |
( -
)96
5.:
C.91
, :
4.: , -A2
5.}
27.4.4.
. ,
, . 27-7.
. ,
.764.
. 27-7. 119
4-20
( . )
27.4.5.
27. |
28 |
. . -
Wilkins120,121. ,
, -
.
-
. -
(
). ,
-
( )
. -
, .774).
A.:
1.*: -
, -
( . .770)
2.†: ETA-
ETA/B 122,123
C.§124,125: -
( . )
D.ICAM-1 † ( -
): III
-
2.: -
§ ( . )
3.: -
* ( . )
4.: -
‡126
127,128
27. |
29 |
2.-† -
129-132 (
48 ) -
133. -
132
B.: , -
134
6.:
A.* ( . .770)
B.NMDA (N- -D- )- †
1.Selfotel: NMDA- (
), -
, ,
. (
)135.
136.
137
2.Eliprodil
3.Cerestat
C.†
1.Tirilazad mesylate (Freedox®): 21- .
, -
6 138 ( -
3-4 , ; -
15 µ ). ,
, -
2.Nicaraven139
7.-
( -
)* ( . .769)
: , , -
‡, †, ( . .777)
, -
30-35% -
O2 (
, -
)
27. |
30 |
8.-
‡140,141
*, -
§ , ,
† ,
‡ ,
,
142,143, ,
, .
: ,
144,145, . -
( -
). 60-70% .
-
-
« », .
, . , -
, -
, , . -
, -
.
,
, -
. -
146, 147, -
148.
:
4., -
5.: , -
,
. -
27. |
31 |
, ,
,
:
1.(
)
A.T, , , -
B., 71
C.,
D.,
F.:
A., ,
;
( :
; -
-
, . .763)
B.O2, pO2 > 70 .
C.: , 30º
F.-
( -) ( ,
,
)
G.(Decadron®): 6 6
H.:
1., Hb/Hct
12
I.-
( . )
J.( . )