2 курс / Нормальная физиология / Торшин 2014
.pdfɪɢɱɟɫɤɢɟ ɫɨɫɭɞɵ ɪɚɫɲɢɪɹɸɬɫɹ, ɩɨɷɬɨɦɭ ɬɟɩɥɨɨɬɞɚɱɚ ɭɜɟɥɢɱɢɜɚɟɬɫɹ ɢ ɬɟɦɩɟɪɚɬɭɪɚ ɬɟɥɚ ɧɚɱɢɧɚɟɬ ɛɵɫɬɪɨ ɩɨɧɢɠɚɬɶɫɹ. ȼ III ɫɬɚɞɢɢ, ɞɟɤɨɦɩɟɧɫɚɰɢɢ, ɬɟɩɥɨɨɬɞɚɱɚ ɟɳɟ ɛɨɥɟɟ ɜɨɡɪɚɫɬɚɟɬ, ɚ ɬɟɩɥɨɩɪɨɞɭɤɰɢɹ ɫɧɢɠɚɟɬɫɹ, ɜɫɥɟɞɫɬɜɢɟ ɱɟɝɨ ɨɪɝɚɧɢɡɦ ɫɬɚɧɨɜɢɬɫɹ ɩɨɣɤɢɥɨɬɟɪɦɧɵɦ ɢ ɩɪɢɧɢɦɚɟɬ ɬɟɦɩɟɪɚɬɭɪɭ ɨɤɪɭɠɚɸɳɟɣ ɫɪɟɞɵ. ȼ ɷɬɨɬ ɩɟɪɢɨɞ ɫɧɢɠɚɟɬɫɹ ɚɤɬɢɜɧɨɫɬɶ ɐɇɋ ɢ ɜɨɡɧɢɤɚɟɬ ɫɨɧ, ɩɪɨɢɫɯɨɞɢɬ ɭɝɧɟɬɟɧɢɟ ɞɵɯɚɧɢɹ ɢ ɤɪɨɜɨɨɛɪɚɳɟɧɢɹ. ɂɫɤɭɫɫɬɜɟɧɧɭɸ ɝɢɩɨɬɟɪɦɢɸ ɢɫɩɨɥɶɡɭɸɬ ɩɪɢ ɩɪɨɜɟɞɟɧɢɢ ɧɟɤɨɬɨɪɵɯ ɨɩɟɪɚɰɢɣ ɞɥɹ ɩɨɜɵɲɟɧɢɹ ɪɟɡɢɫɬɟɧɬɧɨɫɬɢ ɨɪɝɚɧɢɡɦɚ ɤ ɧɟɞɨɫɬɚɬɤɭ ɤɢɫɥɨɪɨɞɚ ɢ ɭɦɟɧɶɲɟɧɢɹ ɞɨɡɵ ɧɟɨɛɯɨɞɢɦɵɯ ɞɥɹ ɨɩɟɪɚɰɢɢ ɧɚɪɤɨɬɢɱɟɫɤɢɯ ɫɪɟɞɫɬɜ.
ɉɪɨɬɢɜɨɩɨɥɨɠɧɨɟ ɫɨɫɬɨɹɧɢɟ ɨɪɝɚɧɢɡɦɚ, ɫɨɩɪɨɜɨɠɞɚɸɳɟɟɫɹ ɩɨɜɵɲɟɧɢɟɦ ɬɟɦɩɟɪɚɬɭɪɵ ɬɟɥɚ, – ɝɢɩɟɪɬɟɪɦɢɹ ɜɨɡɧɢɤɚɟɬ, ɤɨɝɞɚ ɢɧɬɟɧɫɢɜɧɨɫɬɶ ɬɟɩɥɨɩɪɨɞɭɤɰɢɢ ɩɪɟɜɵɲɚɟɬ ɫɩɨɫɨɛɧɨɫɬɶ ɨɪɝɚɧɢɡɦɚ ɨɬɞɚɜɚɬɶ ɬɟɩɥɨ. ɉɪɢ ɩɨɞɴɟɦɟ ɬɟɦɩɟɪɚɬɭɪɵ ɬɟɥɚ ɜ ɪɟɡɭɥɶɬɚɬɟ ɩɨɬɟɪɢ ɠɢɞɤɨɫɬɢ ɫ ɩɨɬɨɦ ɭɦɟɧɶɲɚɟɬɫɹ ɨɛɴɟɦ ɰɢɪɤɭɥɢɪɭɸɳɟɣ ɤɪɨɜɢ ɢ ɩɨɜɵɲɚɟɬɫɹ ɟɟ ɨɫɦɨɬɢɱɟɫɤɨɟ ɞɚɜɥɟɧɢɟ. Ɉɪɝɚɧɢɡɦ ɜ ɷɬɢɯ ɭɫɥɨɜɢɹɯ ɫɬɪɟɦɢɬɫɹ ɫɨɯɪɚɧɢɬɶ ɜɨɞɧɵɣ ɝɨɦɟɨɫɬɚɡ, ɞɚɠɟ ɟɫɥɢ ɷɬɨ ɢɞɟɬ ɜ ɭɳɟɪɛ ɬɟɪɦɨɪɟɝɭɥɹɬɨɪɧɵɦ ɪɟɚɤɰɢɹɦ, ɩɨɷɬɨɦɭ ɨɬɞɚɱɚ ɬɟɩɥɚ ɡɚ ɫɱɟɬ ɩɨɬɨɨɬɞɟɥɟɧɢɹ ɭɦɟɧɶɲɚɟɬɫɹ ɢ ɬɟɦɩɟɪɚɬɭɪɚ ɬɟɥɚ ɭɫɬɚɧɚɜɥɢɜɚɟɬɫɹ ɧɚ ɛɨɥɟɟ ɜɵɫɨɤɨɦ ɭɪɨɜɧɟ. Ɋɚɡɜɢɜɚɟɬɫɹ ɱɭɜɫɬɜɨ ɠɚɠɞɵ, ɭɦɟɧɶɲɚɟɬɫɹ ɞɢɭɪɟɡ. Ƚɢɩɟɪɬɟɪɦɢɹ ɧɚɢɛɨɥɟɟ ɥɟɝɤɨ ɪɚɡɜɢɜɚɟɬɫɹ ɜ ɭɫɥɨɜɢɹɯ ɞɟɣɫɬɜɢɹ ɧɚ ɨɪɝɚɧɢɡɦ ɜɧɟɲɧɟɣ ɬɟɦɩɟɪɚɬɭɪɵ, ɩɪɟɜɵɲɚɸɳɟɣ 37 ºɋ ɩɪɢ 100% ɜɥɚɠɧɨɫɬɢ ɜɨɡɞɭɯɚ, ɤɨɝɞɚ ɢɫɩɚɪɟɧɢɟ ɩɨɬɚ ɢɥɢ ɜɥɚɝɢ ɫ ɩɨɜɟɪɯɧɨɫɬɢ ɬɟɥɚ ɫɬɚɧɨɜɢɬɫɹ ɧɟɜɨɡɦɨɠɧɵɦ. ȼ ɫɥɭɱɚɟ ɩɪɨɞɨɥɠɢɬɟɥɶɧɨɣ ɝɢɩɟɪɬɟɪɦɢɢ ɦɨɠɟɬ ɜɨɡɧɢɤɧɭɬɶ ɬɟɩɥɨɜɨɣ ɭɞɚɪ. ɗɬɨ ɫɨɫɬɨɹɧɢɟ ɨɪɝɚɧɢɡɦɚ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɩɨɤɪɚɫɧɟɧɢɟɦ ɤɨɠɢ ɜ ɪɟɡɭɥɶɬɚɬɟ ɪɚɫɲɢɪɟɧɢɹ ɩɟɪɢɮɟɪɢɱɟɫɤɢɯ ɫɨɫɭɞɨɜ, ɨɬɫɭɬɫɬɜɢɟɦ ɩɨɬɨɨɬɞɟɥɟɧɢɹ, ɩɪɢɡɧɚɤɚɦɢ ɧɚɪɭɲɟɧɢɹ ɮɭɧɤɰɢɣ ɐɇɋ (ɧɚɪɭɲɟɧɢɟ ɨɪɢɟɧɬɚɰɢɢ, ɛɪɟɞ, ɫɭɞɨɪɨɝɢ). ȼ ɛɨɥɟɟ ɥɟɝɤɢɯ ɫɥɭɱɚɹɯ ɝɢɩɟɪɬɟɪɦɢɢ ɦɨɠɟɬ ɩɪɨɹɜɢɬɶɫɹ ɬɟɩɥɨɜɨɣ ɨɛɦɨɪɨɤ, ɤɨɝɞɚ ɜ ɪɟɡɭɥɶɬɚɬɟ ɪɟɡɤɨɝɨ ɪɚɫɲɢɪɟɧɢɹ ɩɟɪɢɮɟɪɢɱɟɫɤɢɯ ɫɨɫɭɞɨɜ ɩɪɨɢɫɯɨɞɢɬ ɩɚɞɟɧɢɟ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ.
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ȼ ɩɪɨɰɟɫɫɟ ɷɜɨɥɸɰɢɢ ɜɵɪɚɛɨɬɚɧɚ ɨɫɨɛɚɹ ɨɬɜɟɬɧɚɹ ɪɟɚɤɰɢɹ ɨɪɝɚɧɢɡɦɚ ɧɚ ɞɟɣɫɬɜɢɟ ɩɢɪɨɝɟɧɧɵɯ ɮɚɤɬɨɪɨɜ – ɥɢɯɨɪɚɞɤɚ (ɩɢɪɟɤɫɢɹ, ɠɚɪ, ɝɨɪɹɱɤɚ). Ɉɧɚ ɹɜɥɹɟɬɫɹ ɡɚɳɢɬɧɵɦ ɦɟɯɚɧɢɡɦɨɦ, ɧɚɩɪɚɜɥɟɧɧɵɦ ɩɪɨɬɢɜ ɜɢɪɭɫɨɜ, ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜ ɢ ɱɭɠɟɪɨɞɧɵɯ ɜɟɳɟɫɬɜ. ɉɨ ɫɬɟɩɟɧɢ ɩɨɞɴɟɦɚ ɬɟɦɩɟɪɚɬɭɪɵ ɪɚɡɥɢɱɚɸɬ: ɫɭɛɮɟɛɪɢɥɶɧɭɸ ɥɢɯɨɪɚɞɤɭ (ɩɨɜɵɲɟɧɢɟ ɬɟɦɩɟɪɚɬɭɪɵ ɞɨ 38 ºɋ), ɭɦɟɪɟɧɧɭɸ (38–39 ºɋ) ɢ ɱɪɟɡɦɟɪɧɭɸ (ɜɵɲɟ 41 ºɋ). Ʌɢɯɨɪɚɞɤɚ – ɷɬɨ ɫɨɫɬɨɹɧɢɟ ɨɪɝɚɧɢɡɦɚ, ɩɪɢ ɤɨɬɨɪɨɦ ɰɟɧɬɪ ɬɟɪɦɨɪɟɝɭɥɹɰɢɢ ɫɬɢɦɭɥɢɪɭɟɬ ɩɨɜɵɲɟɧɢɟ ɬɟɦɩɟɪɚɬɭɪɵ ɬɟɥɚ. ɗɬɨ ɞɨɫɬɢɝɚɟɬɫɹ ɩɟɪɟɫɬɪɚɢɜɚɧɢɟɦ ɦɟɯɚɧɢɡɦɚ «ɭɫɬɚɧɨɜɨɱɧɨɣ ɬɨɱɤɢ» ɧɚ ɛɨɥɟɟ ɜɵɫɨɤɭɸ, ɱɟɦ ɜ ɧɨɪɦɟ, ɬɟɦɩɟɪɚɬɭɪɭ ɪɟɝɭɥɹɰɢɢ. Ƚɪɭɩɩɚ ɧɟɣɪɨɧɨɜ, ɨɫɭɳɟɫɬɜɥɹɸɳɢɯ ɚɧɚɥɢɡ ɬɟɤɭɳɟɣ ɫɪɟɞɧɟɣ ɬɟɦɩɟɪɚɬɭɪɵ ɬɟɥɚ ɢ ɟɟ ɫɪɚɜɧɟɧɢɟ ɫ ɧɨɜɵɦ ɭɫɬɚɧɨɜɥɟɧɧɵɦ ɡɧɚɱɟɧɢɟɦ, ɜɨɫɩɪɢɧɢɦɚɟɬ ɧɨɪɦɚɥɶɧɭɸ ɬɟɦɩɟɪɚɬɭɪɭ ɹɞɪɚ ɬɟɥɚ ɤɚɤ ɧɢɡɤɭɸ. ȼɤɥɸɱɚɸɬɫɹ ɦɟɯɚɧɢɡɦɵ, ɚɤɬɢɜɢɡɢɪɭɸɳɢɟ ɬɟɩɥɨɩɪɨɞɭɤɰɢɸ (ɩɨɜɵɲɟɧɢɟ ɬɟɪɦɨɪɟɝɭɥɹɰɢɨɧɧɨɝɨ ɬɨɧɭɫɚ ɦɵɲɰ, ɦɵɲɟɱɧɚɹ ɞɪɨɠɶ) ɢ ɫɧɢɠɚɸɳɢɟ ɢɧɬɟɧɫɢɜɧɨɫɬɶ ɬɟɩɥɨɨɬɞɚɱɢ (ɫɭɠɟɧɢɟ ɫɨɫɭɞɨɜ ɩɨɜɟɪɯɧɨɫɬɢ ɬɟɥɚ, ɩɪɢɧɹɬɢɟ ɩɨɡɵ, ɭɦɟɧɶɲɚɸɳɟɣ ɩɥɨɳɚɞɶ ɫɨɩɪɢɤɨɫɧɨɜɟɧɢɹ ɩɨɜɟɪɯɧɨɫɬɢ ɬɟɥɚ ɫ ɜɧɟɲɧɟɣ ɫɪɟɞɨɣ). ɏɨɬɹ ɫɭɛɴɟɤɬɢɜɧɨ ɜ ɷɬɨ ɜɪɟɦɹ ɱɟɥɨɜɟɤ ɨɳɭɳɚɟɬ ɨɡɧɨɛ, ɧɚ ɫɚɦɨɦ ɞɟɥɟ ɬɟɦɩɟɪɚɬɭɪɚ ɬɟɥɚ ɩɨɜɵɲɚɟɬɫɹ ɢ ɜɫɤɨɪɟ ɞɨɫɬɢɝɚɟɬ ɧɨɜɨɝɨ, ɭɫɬɚɧɨɜɥɟɧɧɨɝɨ ɭɪɨɜɧɹ ɪɟɝɭɥɹɰɢɢ. ɋ ɷɬɨɝɨ ɦɨɦɟɧɬɚ ɧɚɱɢɧɚɟɬɫɹ ɭɪɚɜɧɨɜɟɲɢɜɚɧɢɟ ɩɪɨɰɟɫɫɨɜ ɜɵɪɚɛɨɬɤɢ ɢ ɨɬɞɚɱɢ ɬɟɩɥɚ. ȼ ɪɟɡɭɥɶɬɚɬɟ ɞɪɨɠɶ, ɤɚɤ ɨɞɢɧ ɢɡ ɧɚɢɛɨɥɟɟ ɷɮɮɟɤɬɢɜɧɵɯ ɫɩɨɫɨɛɨɜ ɬɟɩɥɨɩɪɨɞɭɤɰɢɢ, ɢɫɱɟɡɚɟɬ, ɪɚɫɲɢɪɹɸɬɫɹ ɩɨɜɟɪɯɧɨɫɬɧɵɟ ɫɨɫɭɞɵ, ɩɨɜɵɲɚɟɬɫɹ ɬɟɦɩɟɪɚɬɭɪɚ ɤɨɠɢ ɢ ɩɨɜɟɪɯɧɨɫɬɧɵɯ ɬɤɚɧɟɣ. Ʉɨɝɞɚ ɜ ɨɪɝɚɧɢɡɦɟ ɞɨɫɬɢɝɚɟɬɫɹ ɛɚɥɚɧɫ ɢɧɬɟɧɫɢɜɧɨɫɬɟɣ ɬɟɩɥɨɩɪɨɞɭɤɰɢɢ ɢ ɬɟɩɥɨɨɬɞɚɱɢ, ɜɨɡɧɢɤɚɟɬ ɨɳɭɳɟɧɢɟ ɬɟɩɥɚ ɢ ɢɫɱɟɡɚɟɬ ɨɡɧɨɛ.
ɉɟɪɟɯɨɞ «ɭɫɬɚɧɨɜɨɱɧɨɣ ɬɨɱɤɢ» ɧɚ ɛɨɥɟɟ ɜɵɫɨɤɢɣ ɭɪɨɜɟɧɶ ɩɪɨɢɫɯɨɞɢɬ ɜ ɪɟɡɭɥɶɬɚɬɟ ɞɟɣɫɬɜɢɹ ɧɚ ɫɨɨɬɜɟɬɫɬɜɭɸɳɭɸ ɝɪɭɩɩɭ ɧɟɣɪɨɧɨɜ ɩɪɟɨɩɬɢɱɟɫɤɨɣ ɨɛɥɚɫɬɢ ɝɢɩɨɬɚɥɚɦɭɫɚ ɩɢɪɨɝɟɧɨɜ – ɜɟɳɟɫɬɜ, ɜɵɡɵɜɚɸɳɢɯ ɩɨɞɴɟɦ ɬɟɦɩɟɪɚɬɭɪɵ ɬɟɥɚ. Ʉ ɧɢɦ ɨɬɧɨɫɹɬ: ɥɢɩɨɩɨɥɢɫɚɯɚɪɢɞɵ ɝɪɚɦɨɬɪɢɰɚɬɟɥɶɧɵɯ ɛɚɤɬɟɪɢɣ, ɛɟɥɤɨɜɵɟ ɷɤɡɨɬɨɤɫɢɧɵ, ɚɥɥɟɪɝɟɧɵ, ɤɨɦɩɥɟɤɫɵ ɚɧɬɢ- ɝɟɧ–ɚɧɬɢɬɟɥɨ, ɩɪɨɞɭɤɬɵ ɪɚɫɩɚɞɚ ɬɤɚɧɟɣ. ȼɫɟ ɨɧɢ ɫɚɦɢ ɧɟ
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ɫɩɨɫɨɛɧɵ ɜɵɡɵɜɚɬɶ ɥɢɯɨɪɚɞɤɭ. ɉɨɩɚɜ ɜ ɤɪɨɜɶ, ɨɧɢ ɚɤɬɢɜɢɪɭɸɬ ɜɵɫɜɨɛɨɠɞɟɧɢɟ ɢɡ ɥɟɣɤɨɰɢɬɨɜ ɷɧɞɨɝɟɧɧɵɯ ɩɢɪɨɝɟɧɨɜ. ȼɵɪɚɛɨɬɤɚ ɷɧɞɨɝɟɧɧɵɯ ɩɢɪɨɝɟɧɨɜ ɩɪɨɢɫɯɨɞɢɬ ɜ ɧɟɣɬɪɨɮɢɥɚɯ, ɷɨɡɢɧɨɮɢɥɚɯ, ɦɨɧɨɰɢɬɚɯ, ɝɢɫɬɢɨɰɢɬɚɯ, ɤɥɟɬɤɚɯ Ʉɭɩɮɟɪɚ. ɗɧɞɨɝɟɧɧɵɦɢ ɩɢɪɨɝɟɧɚɦɢ ɹɜɥɹɸɬɫɹ ɩɟɩɬɢɞɵ: ɢɧɬɟɪɥɟɣɤɢɧ-I ɜ ɮɨɪɦɚɯ D ɢ E, ɮɚɤɬɨɪ ɧɟɤɪɨɡɚ ɨɩɭɯɨɥɟɣ, ɢɧɬɟɪɥɟɣɤɢɧ-6, D-ɢɧɬɟɪɮɟɪɨɧ ɢ ɞɪ.
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Ƚ ɥ ɚ ɜ ɚ 12
ȼɕȾȿɅȿɇɂȿ. ɎɂɁɂɈɅɈȽɂə ɉɈɑȿɄ
ȼ ɩɪɨɰɟɫɫɟ ɠɢɡɧɟɞɟɹɬɟɥɶɧɨɫɬɢ ɜ ɨɪɝɚɧɢɡɦɟ ɱɟɥɨɜɟɤɚ ɨɛɪɚɡɭɸɬɫɹ ɡɧɚɱɢɬɟɥɶɧɵɟ ɤɨɥɢɱɟɫɬɜɚ ɩɪɨɞɭɤɬɨɜ ɨɛɦɟɧɚ, ɤɨɬɨɪɵɟ ɭɠɟ ɧɟ ɢɫɩɨɥɶɡɭɸɬɫɹ ɤɥɟɬɤɚɦɢ ɢ ɞɨɥɠɧɵ ɛɵɬɶ ɭɞɚɥɟɧɵ ɢɡ ɨɪɝɚɧɢɡɦɚ. Ʉɪɨɦɟ ɬɨɝɨ, ɨɪɝɚɧɢɡɦ ɞɨɥɠɟɧ ɛɵɬɶ ɨɫɜɨɛɨɠɞɟɧ ɨɬ ɬɨɤɫɢɱɧɵɯ ɢ ɱɭɠɟɪɨɞɧɵɯ ɜɟɳɟɫɬɜ, ɨɬ ɢɡɛɵɬɤɚ ɜɨɞɵ, ɫɨɥɟɣ, ɨɬ ɥɟɤɚɪɫɬɜɟɧɧɵɯ ɩɪɟɩɚɪɚɬɨɜ. ɂɧɨɝɞɚ ɩɪɨɰɟɫɫɚɦ ɜɵɞɟɥɟɧɢɹ ɩɪɟɞɲɟɫɬɜɭɟɬ ɨɛɟɡɜɪɟɠɢɜɚɧɢɟ ɬɨɤɫɢɱɟɫɤɢɯ ɜɟɳɟɫɬɜ, ɧɚɩɪɢɦɟɪ ɜ ɩɟɱɟɧɢ. Ɍɚɤɢɟ ɜɟɳɟɫɬɜɚ, ɤɚɤ ɮɟɧɨɥ, ɢɧɞɨɥ, ɫɤɚɬɨɥ, ɫɨɟɞɢɧɹɹɫɶ ɫ ɝɥɸɤɭɪɨɧɨɜɨɣ ɢ ɫɟɪɧɨɣ ɤɢɫɥɨɬɚɦɢ, ɩɪɟɜɪɚɳɚɸɬɫɹ ɜ ɦɟɧɟɟ ɜɪɟɞɧɵɟ ɜɟɳɟɫɬɜɚ.
Ɉɪɝɚɧɵ, ɜɵɩɨɥɧɹɸɳɢɟ ɜɵɞɟɥɢɬɟɥɶɧɵɟ ɮɭɧɤɰɢɢ, ɧɚɡɵ-
ɜɚɸɬɫɹ ɜɵɞɟɥɢɬɟɥɶɧɵɦɢ, ɢɥɢ ɷɤɫɤɪɟɬɨɪɧɵɦɢ. Ʉ ɧɢɦ ɨɬɧɨɫɹɬ ɩɨɱɤɢ, ɥɟɝɤɢɟ, ɤɨɠɭ, ɩɟɱɟɧɶ ɢ ɠɟɥɭɞɨɱɧɨ-ɤɢɲɟɱɧɵɣ ɬɪɚɤɬ.
Ƚɥɚɜɧɨɟ ɧɚɡɧɚɱɟɧɢɟ ɨɪɝɚɧɨɜ ɜɵɞɟɥɟɧɢɹ – ɷɬɨ ɩɨɞɞɟɪɠɚɧɢɟ ɩɨɫɬɨɹɧɫɬɜɚ ɜɧɭɬɪɟɧɧɟɣ ɫɪɟɞɵ ɨɪɝɚɧɢɡɦɚ. ɗɤɫɤɪɟɬɨɪɧɵɟ ɨɪɝɚɧɵ ɮɭɧɤɰɢɨɧɚɥɶɧɨ ɜɡɚɢɦɨɫɜɹɡɚɧɵ ɦɟɠɞɭ ɫɨɛɨɣ. ɋɞɜɢɝ ɮɭɧɤɰɢɨɧɚɥɶɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɨɞɧɨɝɨ ɢɡ ɷɬɢɯ ɨɪɝɚɧɨɜ ɦɟɧɹɟɬ ɚɤɬɢɜɧɨɫɬɶ ɞɪɭɝɨɝɨ. ɇɚɩɪɢɦɟɪ, ɩɪɢ ɢɡɛɵɬɨɱɧɨɦ ɜɵɜɟɞɟɧɢɢ ɠɢɞɤɨɫɬɢ ɱɟɪɟɡ ɤɨɠɭ ɩɪɢ ɜɵɫɨɤɨɣ ɬɟɦɩɟɪɚɬɭɪɟ ɫɧɢɠɚɟɬɫɹ ɨɛɴɟɦ ɞɢɭɪɟɡɚ. ɉɪɢ ɧɚɪɭɲɟɧɢɢ ɜɵɞɟɥɢɬɟɥɶɧɨɣ ɮɭɧɤɰɢɢ ɩɨɱɟɤ ɜɨɡɪɚɫɬɚɟɬ ɪɨɥɶ ɩɨɬɨɜɵɯ ɠɟɥɟɡ ɢ ɫɥɢɡɢɫɬɨɣ ɨɛɨɥɨɱɤɢ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɜ ɭɞɚɥɟɧɢɢ ɩɪɨɞɭɤɬɨɜ ɛɟɥɤɨɜɨɝɨ ɨɛɦɟɧɚ. ɇɚɪɭɲɟɧɢɟ ɩɪɨɰɟɫɫɨɜ ɜɵɞɟɥɟɧɢɹ ɧɟɢɡɛɟɠɧɨ ɜɟɞɟɬ ɤ ɩɨɹɜɥɟɧɢɸ ɩɚɬɨɥɨɝɢɱɟɫɤɢɯ ɫɞɜɢɝɨɜ ɝɨɦɟɨɫɬɚɡɚ ɜɩɥɨɬɶ ɞɨ ɝɢɛɟɥɢ ɨɪɝɚɧɢɡɦɚ.
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Ʌɟɝɤɢɟ ɢ ɜɟɪɯɧɢɟ ɞɵɯɚɬɟɥɶɧɵɟ ɩɭɬɢ ɭɞɚɥɹɸɬ ɢɡ ɨɪ-
ɝɚɧɢɡɦɚ ɭɝɥɟɤɢɫɥɵɣ ɝɚɡ ɢ ɜɨɞɭ. ȼ ɫɭɬɤɢ ɢɫɩɚɪɹɟɬɫɹ ɨɤɨɥɨ 400 ɦɥ ɜɨɞɵ. Ʉɪɨɦɟ ɬɨɝɨ, ɱɟɪɟɡ ɥɟɝɤɢɟ ɜɵɞɟɥɹɟɬɫɹ ɛɨɥɶɲɢɧɫɬɜɨ ɚɪɨɦɚɬɢɱɟɫɤɢɯ ɜɟɳɟɫɬɜ, ɧɚɩɪɢɦɟɪ, ɩɚɪɵ ɷɮɢɪɚ ɢ ɯɥɨɪɨɮɨɪɦɚ ɩɪɢ ɧɚɪɤɨɡɟ, ɫɢɜɭɲɧɵɟ ɦɚɫɥɚ ɩɪɢ ɚɥɤɨɝɨɥɶɧɨɦ ɨɩɶɹɧɟɧɢɢ. ȼ ɫɨɫɬɚɜɟ ɬɪɚɯɟɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ ɢɡ ɨɪɝɚɧɢɡɦɚ ɜɵɜɨɞɹɬɫɹ ɩɪɨɞɭɤɬɵ ɞɟɝɪɚɞɚɰɢɢ ɫɭɪɮɚɤɬɚɧɬɚ, IgȺ ɢ ɞɪ. ɉɪɢ ɧɚɪɭɲɟɧɢɢ ɜɵɞɟɥɢɬɟɥɶɧɨɣ ɮɭɧɤɰɢɢ ɩɨɱɟɤ ɱɟɪɟɡ ɫɥɢɡɢɫɬɭɸ ɨɛɨɥɨɱɤɭ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɧɚɱɢɧɚɟɬ ɜɵɞɟɥɹɬɶɫɹ ɦɨɱɟɜɢɧɚ, ɤɨɬɨɪɚɹ ɪɚɡɥɚɝɚɟɬɫɹ, ɨɩɪɟɞɟɥɹɹ ɫɨɨɬɜɟɬɫɬɜɭɸɳɢɣ ɡɚɩɚɯ ɚɦɦɢɚɤɚ ɢɡɨ ɪɬɚ. ɋɥɢɡɢɫɬɚɹ ɨɛɨɥɨɱɤɚ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɫɩɨɫɨɛɧɚ ɜɵɞɟɥɹɬɶ ɣɨɞ ɢɡ ɤɪɨɜɢ.
ɋɥɸɧɧɵɟ ɠɟɥɟɡɵ ɜɵɞɟɥɹɸɬ ɫɨɥɢ ɬɹɠɟɥɵɯ ɦɟɬɚɥɥɨɜ, ɧɟɤɨɬɨɪɵɟ ɥɟɤɚɪɫɬɜɚ, ɪɨɞɚɧɢɫɬɵɣ ɤɚɥɢɣ ɢ ɞɪ.
ɀɟɥɭɞɨɤ: ɜ ɫɨɫɬɚɜɟ ɠɟɥɭɞɨɱɧɨɝɨ ɫɨɤɚ ɜɵɜɨɞɹɬɫɹ ɤɨɧɟɱɧɵɟ ɩɪɨɞɭɤɬɵ ɦɟɬɚɛɨɥɢɡɦɚ (ɦɨɱɟɜɢɧɚ, ɦɨɱɟɜɚɹ ɤɢɫɥɨɬɚ), ɥɟɤɚɪɫɬɜɟɧɧɵɟ ɢ ɹɞɨɜɢɬɵɟ ɜɟɳɟɫɬɜɚ (ɪɬɭɬɶ, ɣɨɞ, ɫɚɥɢɰɢɥɨɜɚɹ ɤɢɫɥɨɬɚ, ɯɢɧɢɧ).
Ʉɢɲɟɱɧɢɤ ɜɵɜɨɞɢɬ ɫɨɥɢ ɬɹɠɟɥɵɯ ɦɟɬɚɥɥɨɜ, ɢɨɧɵ ɦɚɝɧɢɹ, ɤɚɥɶɰɢɹ (50% ɜɵɞɟɥɹɟɦɨɝɨ ɨɪɝɚɧɢɡɦɨɦ), ɜɨɞɭ; ɩɪɨɞɭɤɬɵ ɪɚɫɩɚɞɚ ɩɢɳɟɜɵɯ ɜɟɳɟɫɬɜ, ɤɨɬɨɪɵɟ ɧɟ ɩɨɞɜɟɪɝɥɢɫɶ ɜɫɚɫɵɜɚɧɢɸ ɜ ɤɪɨɜɶ, ɢ ɜɟɳɟɫɬɜ, ɩɨɫɬɭɩɢɜɲɢɯ ɜ ɩɪɨɫɜɟɬ ɤɢɲɟɱɧɢɤɚ ɫɨ ɫɥɸɧɨɣ, ɠɟɥɭɞɨɱɧɵɦ, ɩɨɞɠɟɥɭɞɨɱɧɵɦ ɫɨɤɚɦɢ, ɠɟɥɱɶɸ.
ɉɟɱɟɧɶ: ɜ ɫɨɫɬɚɜɟ ɠɟɥɱɢ ɷɤɫɤɪɟɬɢɪɭɸɬɫɹ ɛɢɥɢɪɭɛɢɧ ɢ ɩɪɨɞɭɤɬɵ ɟɝɨ ɩɪɟɜɪɚɳɟɧɢɹ ɜ ɤɢɲɟɱɧɢɤɟ, ɯɨɥɟɫɬɟɪɢɧ, ɠɟɥɱɧɵɟ ɤɢɫɥɨɬɵ, ɩɪɨɞɭɤɬɵ ɪɚɫɩɚɞɚ ɝɨɪɦɨɧɨɜ, ɥɟɤɚɪɫɬɜ, ɹɞɨɯɢɦɢɤɚɬɨɜ ɢ ɞɪ.
Ʉɨɠɚ ɨɫɭɳɟɫɬɜɥɹɟɬ ɜɵɞɟɥɢɬɟɥɶɧɭɸ ɮɭɧɤɰɢɸ ɡɚ ɫɱɟɬ ɞɟɹɬɟɥɶɧɨɫɬɢ ɩɨɬɨɜɵɯ ɢ, ɜ ɦɟɧɶɲɟɣ ɫɬɟɩɟɧɢ, ɫɚɥɶɧɵɯ ɠɟɥɟɡ. ɉɨɬɨɜɵɟ ɠɟɥɟɡɵ ɭɞɚɥɹɸɬ ɜɨɞɭ (ɜ ɨɛɵɱɧɵɯ ɭɫɥɨɜɢɹɯ 0,3– 1,0 ɥ ɜ ɫɭɬɤɢ; ɩɪɢ ɝɢɩɟɪɫɟɤɪɟɰɢɢ ɞɨ 10 ɥ ɜ ɫɭɬɤɢ), ɦɨɱɟɜɢɧɭ (5–10% ɜɵɞɟɥɹɟɦɨɝɨ ɨɪɝɚɧɢɡɦɨɦ ɤɨɥɢɱɟɫɬɜɚ), ɦɨɱɟɜɭɸ ɤɢɫɥɨɬɭ, ɤɪɟɚɬɢɧɢɧ, ɦɨɥɨɱɧɭɸ ɤɢɫɥɨɬɭ, ɫɨɥɢ ɳɟɥɨɱɧɵɯ ɦɟɬɚɥɥɨɜ, ɨɫɨɛɟɧɧɨ ɧɚɬɪɢɹ, ɨɪɝɚɧɢɱɟɫɤɢɟ ɜɟɳɟɫɬɜɚ, ɥɟɬɭɱɢɟ ɠɢɪɧɵɟ ɤɢɫɥɨɬɵ, ɦɢɤɪɨɷɥɟɦɟɧɬɵ, ɧɟɤɨɬɨɪɵɟ ɮɟɪɦɟɧɬɵ. ɋɚɥɶɧɵɟ ɠɟɥɟɡɵ ɡɚ ɫɭɬɤɢ ɜɵɞɟɥɹɸɬ ɨɤɨɥɨ 20 ɝ ɫɟɤɪɟɬɚ, 2/3 ɤɨɬɨ-
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ɪɨɝɨ ɫɨɫɬɚɜɥɹɟɬ ɜɨɞɚ ɢ 1/3 – ɯɨɥɟɫɬɟɪɢɧ, ɩɪɨɞɭɤɬɵ ɨɛɦɟɧɚ ɩɨɥɨɜɵɯ ɝɨɪɦɨɧɨɜ, ɤɨɪɬɢɤɨɫɬɟɪɨɢɞɵ, ɜɢɬɚɦɢɧɵ ɢ ɮɟɪɦɟɧɬɵ.
Ɉɫɧɨɜɧɵɦ ɨɪɝɚɧɨɦ ɜɵɞɟɥɟɧɢɹ ɹɜɥɹɸɬɫɹ ɩɨɱɤɢ.
Ɏɭɧɤɰɢɢ ɩɨɱɟɤ
ɉɨɱɤɢ ɜɵɩɨɥɧɹɸɬ ɜ ɨɪɝɚɧɢɡɦɟ ɦɧɨɝɨ ɮɭɧɤɰɢɣ. Ɉɞɧɢ ɢɡ ɧɢɯ ɩɪɹɦɨ ɢɥɢ ɤɨɫɜɟɧɧɨ ɫɜɹɡɚɧɵ ɫ ɩɪɨɰɟɫɫɚɦɢ ɜɵɞɟɥɟɧɢɹ, ɞɪɭɝɢɟ – ɧɟ ɢɦɟɸɬ ɬɚɤɨɣ ɫɜɹɡɢ.
ȼɵɞɟɥɢɬɟɥɶɧɚɹ, ɢɥɢ ɷɤɫɤɪɟɬɨɪɧɚɹ, ɮɭɧɤɰɢɹ. ɉɨɱɤɢ ɭɞɚɥɹɸɬ ɢɡ ɨɪɝɚɧɢɡɦɚ ɢɡɛɵɬɨɤ ɜɨɞɵ, ɧɟɨɪɝɚɧɢɱɟɫɤɢɯ ɢ ɨɪɝɚɧɢɱɟɫɤɢɯ ɜɟɳɟɫɬɜ, ɤɨɧɟɱɧɵɟ ɩɪɨɞɭɤɬɵ ɚɡɨɬɢɫɬɨɝɨ ɨɛɦɟɧɚ ɢ ɱɭɠɟɪɨɞɧɵɟ ɜɟɳɟɫɬɜɚ: ɦɨɱɟɜɢɧɭ, ɦɨɱɟɜɭɸ ɤɢɫɥɨɬɭ, ɤɪɟɚɬɢɧɢɧ, ɚɦɦɢɚɤ, ɥɟɤɚɪɫɬɜɟɧɧɵɟ ɩɪɟɩɚɪɚɬɵ.
Ɋɟɝɭɥɹɰɢɹ ɜɨɞɧɨɝɨ ɛɚɥɚɧɫɚ ɢ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ ɨɛɴɟɦɚ ɤɪɨɜɢ ɢ ɜɧɟɤɥɟɬɨɱɧɨɣ ɠɢɞɤɨɫɬɢ (ɜɨɥɸɦɨɪɟɝɭɥɹɰɢɹ) ɡɚ ɫɱɟɬ ɢɡɦɟɧɟɧɢɹ ɨɛɴɟɦɚ ɜɵɜɨɞɢɦɨɣ ɫ ɦɨɱɨɣ ɜɨɞɵ.
Ɋɟɝɭɥɹɰɢɹ ɢɨɧɧɨɝɨ ɫɨɫɬɚɜɚ ɠɢɞɤɨɫɬɟɣ ɜɧɭɬɪɟɧɧɟɣ ɫɪɟɞɵ ɢ ɢɨɧɧɨɝɨ ɛɚɥɚɧɫɚ ɨɪɝɚɧɢɡɦɚ ɩɭɬɟɦ ɢɡɛɢɪɚɬɟɥɶɧɨɣ ɷɤɫɤɪɟɰɢɢ ɢɨɧɨɜ ɫ ɦɨɱɨɣ (ɢɨɧɧɚɹ ɪɟɝɭɥɹɰɢɹ).
Ɋɟɝɭɥɹɰɢɹ ɩɨɫɬɨɹɧɫɬɜɚ ɨɫɦɨɬɢɱɟɫɤɨɝɨ ɞɚɜɥɟɧɢɹ
ɠɢɞɤɨɫɬɟɣ ɜɧɭɬɪɟɧɧɟɣ ɫɪɟɞɵ ɩɭɬɟɦ ɢɡɦɟɧɟɧɢɹ ɨɛɴɟɦɚ ɜɵɜɨɞɢɦɨɣ ɫ ɦɨɱɨɣ ɜɨɞɵ, ɚ ɬɚɤɠɟ ɤɨɥɢɱɟɫɬɜɚ ɜɵɜɨɞɢɦɵɯ ɨɫɦɨɬɢɱɟɫɤɢ ɚɤɬɢɜɧɵɯ ɜɟɳɟɫɬɜ: ɫɨɥɟɣ, ɦɨɱɟɜɢɧɵ, ɝɥɸɤɨɡɵ (ɨɫɦɨɪɟ-
ɝɭɥɹɰɢɹ).
Ɋɟɝɭɥɹɰɢɹ ɤɢɫɥɨɬɧɨ-ɨɫɧɨɜɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɩɭɬɟɦ ɷɤɫ-
ɤɪɟɰɢɢ ɜɨɞɨɪɨɞɧɵɯ ɢɨɧɨɜ, ɧɟɥɟɬɭɱɢɯ ɤɢɫɥɨɬ ɢ ɨɫɧɨɜɚɧɢɣ.
Ɉɛɪɚɡɨɜɚɧɢɟ ɢ ɜɵɞɟɥɟɧɢɟ ɜ ɤɪɨɜɨɬɨɤ ɮɢɡɢɨɥɨɝɢɱɟɫɤɢ ɚɤɬɢɜɧɵɯ ɜɟɳɟɫɬɜ: ɪɟɧɢɧɚ, ɷɪɢɬɪɨɩɨɷɬɢɧɚ, ɚɤɬɢɜɧɨɣ ɮɨɪɦɵ ɜɢɬɚɦɢɧɚ D, ɩɪɨɫɬɚɝɥɚɧɞɢɧɨɜ, ɛɪɚɞɢɤɢɧɢɧɨɜ, ɭɪɨɤɢɧɚɡɵ
(ɢɧɤɪɟɬɨɪɧɚɹ ɮɭɧɤɰɢɹ).
Ɋɟɝɭɥɹɰɢɹ ɭɪɨɜɧɹ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ ɩɭɬɟɦ ɜɧɭɬɪɟɧɧɟɣ ɫɟɤɪɟɰɢɢ ɪɟɧɢɧɚ, ɜɟɳɟɫɬɜ ɞɟɩɪɟɫɫɨɪɧɨɝɨ ɞɟɣɫɬɜɢɹ, ɷɤɫɤɪɟɰɢɢ ɧɚɬɪɢɹ ɢ ɜɨɞɵ, ɢɡɦɟɧɟɧɢɹ ɨɛɴɟɦɚ ɰɢɪɤɭɥɢɪɭɸɳɟɣ ɤɪɨɜɢ.
Ɋɟɝɭɥɹɰɢɹ ɷɪɢɬɪɨɩɨɷɡɚ ɩɭɬɟɦ ɜɧɭɬɪɟɧɧɟɣ ɫɟɤɪɟɰɢɢ ɝɭɦɨɪɚɥɶɧɨɝɨ ɪɟɝɭɥɹɬɨɪɚ ɷɪɢɬɪɨɩɨɷɬɢɧɚ.
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Ɋɟɝɭɥɹɰɢɹ ɝɟɦɨɫɬɚɡɚ ɩɭɬɟɦ ɨɛɪɚɡɨɜɚɧɢɹ ɝɭɦɨɪɚɥɶɧɵɯ ɪɟɝɭɥɹɬɨɪɨɜ ɫɜɟɪɬɵɜɚɧɢɹ ɤɪɨɜɢ ɢ ɮɢɛɪɢɧɨɥɢɡɚ – ɭɪɨɤɢɧɚɡɵ, ɬɪɨɦɛɨɩɥɚɫɬɢɧɚ, ɬɪɨɦɛɨɤɫɚɧɚ, ɚ ɬɚɤɠɟ ɭɱɚɫɬɢɹ ɜ ɨɛɦɟɧɟ ɮɢɡɢɨɥɨɝɢɱɟɫɤɨɝɨ ɚɧɬɢɤɨɚɝɭɥɹɧɬɚ ɝɟɩɚɪɢɧɚ.
ɍɱɚɫɬɢɟ ɜ ɨɛɦɟɧɟ ɛɟɥɤɨɜ, ɥɢɩɢɞɨɜ ɢ ɭɝɥɟɜɨɞɨɜ (ɦɟɬɚ-
ɛɨɥɢɱɟɫɤɚɹ ɮɭɧɤɰɢɹ).
Ɂɚɳɢɬɧɚɹ ɮɭɧɤɰɢɹ: ɭɞɚɥɟɧɢɟ ɢɡ ɜɧɭɬɪɟɧɧɟɣ ɫɪɟɞɵ ɨɪɝɚɧɢɡɦɚ ɱɭɠɟɪɨɞɧɵɯ, ɱɚɫɬɨ ɬɨɤɫɢɱɟɫɤɢɯ ɜɟɳɟɫɬɜ.
ɋɥɟɞɭɟɬ ɭɱɢɬɵɜɚɬɶ, ɱɬɨ ɩɪɢ ɪɚɡɥɢɱɧɵɯ ɩɚɬɨɥɨɝɢɱɟɫɤɢɯ ɫɨɫɬɨɹɧɢɹɯ ɜɵɞɟɥɟɧɢɟ ɥɟɤɚɪɫɬɜ ɱɟɪɟɡ ɩɨɱɤɢ ɢɧɨɝɞɚ ɫɭɳɟɫɬɜɟɧɧɨ ɧɚɪɭɲɚɟɬɫɹ, ɱɬɨ ɦɨɠɟɬ ɩɪɢɜɨɞɢɬɶ ɤ ɡɧɚɱɢɬɟɥɶɧɵɦ ɢɡɦɟɧɟɧɢɹɦ ɩɟɪɟɧɨɫɢɦɨɫɬɢ ɮɚɪɦɚɤɨɥɨɝɢɱɟɫɤɢɯ ɩɪɟɩɚɪɚɬɨɜ, ɜɵɡɵɜɚɹ ɫɟɪɶɟɡɧɵɟ ɩɨɛɨɱɧɵɟ ɷɮɮɟɤɬɵ ɜɩɥɨɬɶ ɞɨ ɨɬɪɚɜɥɟɧɢɣ.
Ɇɨɪɮɨɮɭɧɤɰɢɨɧɚɥɶɧɚɹ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚ ɩɨɱɟɤ
ɋɬɪɨɟɧɢɟ ɧɟɮɪɨɧɚ
ɉɨɱɤɚ ɫɨɫɬɨɢɬ ɢɡ ɞɜɭɯ ɫɥɨɟɜ: ɜɧɟɲɧɟɝɨ, ɫɨɫɬɚɜɥɹɸɳɟɝɨ ɤɨɪɤɨɜɨɟ ɜɟɳɟɫɬɜɨ, ɢ ɜɧɭɬɪɟɧɧɟɝɨ, ɨɛɪɚɡɭɸɳɟɝɨ ɦɨɡɝɨɜɨɟ ɜɟɳɟɫɬɜɨ. ȼ ɦɨɡɝɨɜɨɦ ɜɟɳɟɫɬɜɟ ɜɵɞɟɥɹɸɬ ɧɚɪɭɠɧɭɸ ɢ ɜɧɭɬɪɟɧɧɸɸ ɱɚɫɬɢ.
Ɉɫɧɨɜɧɨɣ ɫɬɪɭɤɬɭɪɧɨ-ɮɭɧɤɰɢɨɧɚɥɶɧɨɣ ɟɞɢɧɢɰɟɣ ɩɨɱɤɢ ɹɜɥɹɟɬɫɹ ɧɟɮɪɨɧ, ɜ ɤɨɬɨɪɨɦ ɩɪɨɢɫɯɨɞɢɬ ɨɛɪɚɡɨɜɚɧɢɟ ɦɨɱɢ. ȼ ɤɚɠɞɨɣ ɩɨɱɤɟ ɱɟɥɨɜɟɤɚ ɫɨɞɟɪɠɢɬɫɹ ɨɤɨɥɨ 1–1,3 ɦɥɧ. ɧɟɮɪɨɧɨɜ.
ɇɟɮɪɨɧ ɫɨɫɬɨɢɬ ɢɡ ɧɟɫɤɨɥɶɤɢɯ ɩɨɫɥɟɞɨɜɚɬɟɥɶɧɨ ɫɨɟɞɢɧɟɧɧɵɯ ɨɬɞɟɥɨɜ (ɪɢɫ. 12.1). ɇɚɱɢɧɚɟɬɫɹ ɧɟɮɪɨɧ ɫ ɩɨɱɟɱɧɨɝɨ (ɦɚɥɶɩɢɝɢɟɜɚ) ɬɟɥɶɰɚ, ɤɨɬɨɪɨɟ ɫɨɞɟɪɠɢɬ ɤɥɭɛɨɱɟɤ ɤɪɨɜɟɧɨɫɧɵɯ ɤɚɩɢɥɥɹɪɨɜ. Ʉɥɭɛɨɱɟɤ ɤɚɩɢɥɥɹɪɨɜ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɪɚɡɜɟɬɜɥɟɧɢɟ ɩɪɢɧɨɫɹɳɟɣ ɚɪɬɟɪɢɨɥɵ (vas afferens). Ʉɚɠɞɵɣ ɤɥɭɛɨɱɟɤ ɫɨɞɟɪɠɢɬ 30–50 ɤɚɩɢɥɥɹɪɧɵɯ ɩɟɬɟɥɶ, ɫɨɛɢɪɚɸɳɢɯɫɹ ɜ ɜɵɧɨɫɹɳɭɸ ɚɪɬɟɪɢɨɥɭ (vas efferens). ɋɧɚɪɭɠɢ ɤɥɭɛɨɱɟɤ ɩɨɤɪɵɬ ɞɜɭɯɫɥɨɣɧɨɣ ɤɚɩɫɭɥɨɣ ɒɭɦɥɹɧɫɤɨɝɨ–Ȼɨɭɦɟɧɚ. ȼɧɭɬɪɟɧɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ ɤɚɩɫɭɥɵ ɜɵɫɬɥɚɧɚ ɷɩɢɬɟɥɢɚɥɶɧɵɦɢ ɤɥɟɬɤɚɦɢ. ɇɚɪɭɠɧɵɣ, ɢɥɢ ɩɚɪɢɟɬɚɥɶɧɵɣ, ɥɢɫɬɨɤ ɤɚɩɫɭɥɵ ɫɨɫɬɨɢɬ ɢɡ ɛɚɡɚɥɶɧɨɣ ɦɟɦɛɪɚɧɵ, ɩɨɤɪɵɬɨɣ ɤɭɛɢɱɟɫɤɢɦɢ ɷɩɢɬɟ-
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ɥɢɚɥɶɧɵɦɢ ɤɥɟɬɤɚɦɢ, ɩɟɪɟɯɨɞɹɳɢɦɢ ɜ ɷɩɢɬɟɥɢɣ ɤɚɧɚɥɶɰɟɜ. Ɇɟɠɞɭ ɞɜɭɦɹ ɥɢɫɬɤɚɦɢ ɤɚɩɫɭɥɵ, ɪɚɫɩɨɥɨɠɟɧɧɵɦɢ ɜ ɜɢɞɟ ɱɚɲɢ, ɢɦɟɟɬɫɹ ɳɟɥɶ ɢɥɢ ɩɨɥɨɫɬɶ ɤɚɩɫɭɥɵ, ɩɟɪɟɯɨɞɹɳɚɹ ɜ ɩɪɨɫɜɟɬ ɩɪɨɤɫɢɦɚɥɶɧɨɝɨ ɤɚɧɚɥɶɰɚ.
Ɋɢɫ. 12.1. ɋɯɟɦɚ ɫɬɪɨɟɧɢɹ ɧɟɮɪɨɧɚ (ɩɨ ɋɦɢɬɭ):
1 – ɤɥɭɛɨɱɟɤ; 2 – ɩɪɨɤɫɢɦɚɥɶɧɵɣ ɤɚɧɚɥɟɰ; 3 – ɧɢɫɯɨɞɹɳɚɹ ɱɚɫɬɶ ɩɟɬɥɢ ɧɟɮɪɨɧɚ; 4 – ɜɨɫɯɨɞɹɳɚɹ ɱɚɫɬɶ ɩɟɬɥɢ ɧɟɮɪɨɧɚ; 5 – ɞɢɫɬɚɥɶɧɵɣ ɤɚɧɚɥɟɰ; 6 – ɫɨɛɢɪɚɬɟɥɶɧɚɹ ɬɪɭɛɤɚ
ɉɪɨɤɫɢɦɚɥɶɧɵɣ ɤɚɧɚɥɟɰ ɧɚɱɢɧɚɟɬɫɹ ɢɡɜɢɬɨɣ ɱɚɫɬɶɸ, ɤɨɬɨɪɚɹ ɩɟɪɟɯɨɞɢɬ ɜ ɩɪɹɦɭɸ ɱɚɫɬɶ ɤɚɧɚɥɶɰɚ. Ʉɥɟɬɤɢ ɩɪɨɤɫɢɦɚɥɶɧɨɝɨ ɤɚɧɚɥɶɰɚ ɢɦɟɸɬ ɳɟɬɨɱɧɭɸ ɤɚɟɦɤɭ ɢɡ ɦɢɤɪɨɜɨɪɫɢɧɨɤ, ɨɛɪɚɳɟɧɧɵɯ ɜ ɩɪɨɫɜɟɬ ɤɚɧɚɥɶɰɚ.
Ɂɚɬɟɦ ɫɥɟɞɭɟɬ ɬɨɧɤɢɣ ɫɟɝɦɟɧɬ, ɧɢɫɯɨɞɹɳɢɣ ɨɬɞɟɥ ɤɨɬɨɪɨɝɨ ɨɩɭɫɤɚɟɬɫɹ ɜ ɦɨɡɝɨɜɨɟ ɜɟɳɟɫɬɜɨ ɩɨɱɤɢ, ɩɨɜɨɪɚɱɢɜɚɟɬ ɧɚ 180 qɋ ɢ ɩɟɪɟɯɨɞɢɬ ɜ ɜɨɫɯɨɞɹɳɭɸ ɱɚɫɬɶ. ȿɝɨ ɫɬɟɧɤɢ ɩɨɤɪɵɬɵ ɩɥɨɫɤɢɦɢ ɷɩɢɬɟɥɢɚɥɶɧɵɦɢ ɤɥɟɬɤɚɦɢ.
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Ⱦɢɫɬɚɥɶɧɵɣ ɤɚɧɚɥɟɰ ɧɚɱɢɧɚɟɬɫɹ ɫ ɩɪɹɦɨɣ ɱɚɫɬɢ, ɤɨɬɨɪɚɹ ɩɨɞɧɢɦɚɟɬɫɹ ɞɨ ɭɪɨɜɧɹ ɤɥɭɛɨɱɤɚ ɫɜɨɟɝɨ ɠɟ ɧɟɮɪɨɧɚ, ɝɞɟ ɩɟɪɟɯɨɞɢɬ ɜ ɢɡɜɢɬɭɸ ɱɚɫɬɶ. ɗɬɨɬ ɨɬɞɟɥ ɤɚɧɚɥɶɰɚ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɜ ɤɨɪɟ ɩɨɱɤɢ ɢ ɨɛɹɡɚɬɟɥɶɧɨ ɫɨɩɪɢɤɚɫɚɟɬɫɹ ɫ ɩɨɥɸɫɨɦ ɤɥɭɛɨɱɤɚ ɦɟɠɞɭ ɩɪɢɧɨɫɹɳɟɣ ɢ ɜɵɧɨɫɹɳɟɣ ɚɪɬɟɪɢɨɥɚɦɢ ɜ ɨɛɥɚɫɬɢ ɩɥɨɬɧɨɝɨ ɩɹɬɧɚ (macula densa). ɉɪɹɦɵɟ ɨɬɞɟɥɵ ɩɪɨɤɫɢɦɚɥɶɧɨɝɨ ɢ ɞɢɫɬɚɥɶɧɨɝɨ ɤɚɧɚɥɶɰɟɜ ɜɦɟɫɬɟ ɫ ɬɨɧɤɢɦ ɫɟɝɦɟɧɬɨɦ ɨɛɪɚɡɭɸɬ ɩɟɬɥɸ Ƚɟɧɥɟ, ɢɥɢ ɩɟɬɥɸ ɧɟɮɪɨɧɚ. Ⱦɢɫɬɚɥɶɧɵɣ ɢɡɜɢɬɨɣ ɤɚɧɚɥɟɰ ɱɟɪɟɡ ɤɨɪɨɬɤɢɣ ɫɜɹɡɭɸɳɢɣ ɨɬɞɟɥ ɜɩɚɞɚɟɬ ɜ ɤɨɪɟ ɩɨɱɟɤ ɜ ɫɨɛɢɪɚɬɟɥɶɧɭɸ ɬɪɭɛɤɭ. ȼ ɨɞɧɭ ɫɨɛɢɪɚɬɟɥɶɧɭɸ ɬɪɭɛɤɭ ɜɩɚɞɚɸɬ ɧɟɫɤɨɥɶɤɨ ɤɚɧɚɥɶɰɟɜ ɨɬ ɪɚɡɧɵɯ ɧɟɮɪɨɧɨɜ. ɋɨɛɢɪɚɬɟɥɶɧɵɟ ɬɪɭɛɤɢ ɨɩɭɫɤɚɸɬɫɹ ɢɡ ɤɨɪɤɨɜɨɝɨ ɜɟɳɟɫɬɜɚ ɩɨɱɤɢ ɜ ɝɥɭɛɶ ɦɨɡɝɨɜɨɝɨ ɜɟɳɟɫɬɜɚ, ɫɥɢɜɚɸɬɫɹ ɜ ɜɵɜɨɞɧɵɟ ɩɪɨɬɨɤɢ ɢ ɨɬɤɪɵɜɚɸɬɫɹ ɜ ɩɨɥɨɫɬɢ ɩɨɱɟɱɧɨɣ ɥɨɯɚɧɤɢ. ɉɨɱɟɱɧɵɟ ɥɨɯɚɧɤɢ ɨɬɤɪɵɜɚɸɬɫɹ ɜ ɦɨɱɟɬɨɱɧɢɤɢ, ɤɨɬɨɪɵɟ ɜɩɚɞɚɸɬ ɜ ɦɨɱɟɜɨɣ ɩɭɡɵɪɶ.
Ɏɭɧɤɰɢɹ ɤɚɠɞɨɝɨ ɨɬɞɟɥɚ ɧɟɮɪɨɧɚ ɪɚɡɥɢɱɧɚ.
ɉɨ ɨɫɨɛɟɧɧɨɫɬɹɦ ɥɨɤɚɥɢɡɚɰɢɢ ɤɥɭɛɨɱɤɨɜ ɜ ɤɨɪɟ ɩɨɱɟɤ, ɫɬɪɨɟɧɢɹ ɤɚɧɚɥɶɰɟɜ ɢ ɤɪɨɜɨɫɧɚɛɠɟɧɢɹ ɪɚɡɥɢɱɚɸɬ 3 ɬɢɩɚ ɧɟɮɪɨɧɨɜ: ɫɭɩɟɪɮɢɰɢɚɥɶɧɵɟ, ɢɥɢ ɩɨɜɟɪɯɧɨɫɬɧɵɟ (20–30%), ɢɧɬɪɚɤɨɪɬɢɤɚɥɶɧɵɟ (60–70%) ɢ ɸɤɫɬɚɦɟɞɭɥɥɹɪɧɵɟ (10– 15%). ɉɟɪɜɵɟ ɞɜɚ ɬɢɩɚ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɜ ɤɨɪɤɨɜɨɦ ɫɥɨɟ ɩɨɱɟɤ. ȼɫɟ ɩɨɜɟɪɯɧɨɫɬɧɵɟ ɤɨɪɤɨɜɵɟ ɧɟɮɪɨɧɵ ɢɦɟɸɬ ɤɨɪɨɬɤɭɸ ɩɟɬɥɸ; ɢɧɬɪɚɤɨɪɬɢɤɚɥɶɧɵɟ ɧɟɮɪɨɧɵ ɦɨɝɭɬ ɢɦɟɬɶ ɢ ɤɨɪɨɬɤɭɸ ɢ ɞɥɢɧɧɭɸ ɩɟɬɥɸ. ɉɟɬɥɢ Ƚɟɧɥɟ ɷɬɢɯ ɧɟɮɪɨɧɨɜ ɨɩɭɫɤɚɸɬɫɹ ɜ ɦɨɡɝɨɜɨɟ ɜɟɳɟɫɬɜɨ ɧɚ ɧɟɛɨɥɶɲɭɸ ɝɥɭɛɢɧɭ. ɘɤɫɬɚɦɟɞɭɥɥɹɪɧɵɟ ɧɟɮɪɨɧɵ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɜ ɧɚɪɭɠɧɨɣ ɱɚɫɬɢ ɦɨɡɝɨɜɨɝɨ ɫɥɨɹ, ɚ ɢɯ ɞɥɢɧɧɵɟ ɩɟɬɥɢ ɩɪɨɧɢɤɚɸɬ ɜɨ ɜɧɭɬɪɟɧɧɢɣ ɨɬɞɟɥ ɦɨɡɝɨɜɨɝɨ ɜɟɳɟɫɬɜɚ. ɇɟɫɦɨɬɪɹ ɧɚ ɧɟɤɨɬɨɪɵɟ ɨɬɥɢɱɢɹ, ɩɪɢɧɰɢɩɢɚɥɶɧɚɹ ɫɯɟɦɚ ɫɬɪɨɟɧɢɹ ɢ ɮɭɧɤɰɢɨɧɢɪɨɜɚɧɢɹ ɧɟɮɪɨɧɨɜ ɨɞɢɧɚɤɨɜɚ.
ȼ ɦɨɱɟɨɛɪɚɡɨɜɚɧɢɢ ɝɥɚɜɧɭɸ ɪɨɥɶ ɢɝɪɚɸɬ ɤɨɪɤɨɜɵɟ ɧɟɮɪɨɧɵ. ɘɤɫɬɚɦɟɞɭɥɥɹɪɧɵɟ ɧɟɮɪɨɧɵ ɨɬɜɟɱɚɸɬ ɡɚ ɫɨɡɞɚɧɢɟ ɜɵɫɨɤɨɝɨ ɨɫɦɨɬɢɱɟɫɤɨɝɨ ɞɚɜɥɟɧɢɹ ɜ ɦɨɡɝɨɜɨɦ ɫɥɨɟ ɩɨɱɤɢ.
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Ʉɪɨɜɨɫɧɚɛɠɟɧɢɟ ɩɨɱɟɤ
Ƚɥɚɜɧɨɣ ɨɬɥɢɱɢɬɟɥɶɧɨɣ ɨɫɨɛɟɧɧɨɫɬɶɸ ɤɪɨɜɨɫɧɚɛɠɟɧɢɹ ɩɨɱɟɤ ɹɜɥɹɟɬɫɹ ɬɨ, ɱɬɨ ɤɪɨɜɶ ɢɫɩɨɥɶɡɭɟɬɫɹ ɧɟ ɬɨɥɶɤɨ ɞɥɹ ɬɪɨɮɢɤɢ ɨɪɝɚɧɚ, ɧɨ ɢ ɞɥɹ ɨɛɪɚɡɨɜɚɧɢɹ ɦɨɱɢ. ɗɬɨ ɜɨɡɦɨɠɧɨ ɛɥɚɝɨɞɚɪɹ ɞɜɨɣɧɨɣ ɫɟɬɢ ɤɚɩɢɥɥɹɪɨɜ. ɉɨɱɤɢ ɩɨɥɭɱɚɸɬ ɤɪɨɜɶ ɢɡ ɤɨɪɨɬɤɢɯ ɩɨɱɟɱɧɵɯ ɚɪɬɟɪɢɣ, ɤɨɬɨɪɵɟ ɨɬɯɨɞɹɬ ɨɬ ɛɪɸɲɧɨɝɨ ɨɬɞɟɥɚ ɚɨɪɬɵ. ȼ ɩɨɱɤɟ ɚɪɬɟɪɢɹ ɞɟɥɢɬɫɹ ɧɚ ɛɨɥɶɲɨɟ ɤɨɥɢɱɟɫɬɜɨ ɦɟɥɤɢɯ ɫɨɫɭɞɨɜ-ɚɪɬɟɪɢɨɥ, ɩɪɢɧɨɫɹɳɢɯ ɤɪɨɜɶ ɤ ɤɥɭɛɨɱɤɭ. ɉɪɢɧɨɫɹɳɚɹ (ɚɮɮɟɪɟɧɬɧɚɹ) ɚɪɬɟɪɢɨɥɚ ɜɯɨɞɢɬ ɜ ɤɥɭɛɨɱɟɤ ɢ ɪɚɫɩɚɞɚɟɬɫɹ ɧɚ ɤɚɩɢɥɥɹɪɵ (ɩɟɪɜɚɹ ɤɚɩɢɥɥɹɪɧɚɹ ɤɥɭɛɨɱɤɨɜɚɹ ɫɟɬɶ), ɤɨɬɨɪɵɟ, ɫɥɢɜɚɹɫɶ, ɨɛɪɚɡɭɸɬ ɜɵɧɨɫɹɳɭɸ (ɷɮɮɟɪɟɧɬɧɭɸ) ɚɪɬɟɪɢɨɥɭ. Ʉɚɩɢɥɥɹɪɵ ɤɥɭɛɨɱɤɨɜ ɜɵɩɨɥɧɹɸɬ ɬɨɥɶɤɨ ɮɭɧɤɰɢɸ ɦɨɱɟɨɛɪɚɡɨɜɚɧɢɹ, ɩɨɷɬɨɦɭ ɤɪɨɜɶ, ɜɵɯɨɞɹɳɚɹ ɢɡ ɤɚɩɫɭɥɵ, ɨɫɬɚɟɬɫɹ ɚɪɬɟɪɢɚɥɶɧɨɣ. Ⱦɢɚɦɟɬɪ ɩɪɢɧɨɫɹɳɟɣ ɚɪɬɟɪɢɨɥɵ ɩɨɱɬɢ ɜ 2 ɪɚɡɚ ɛɨɥɶɲɟ, ɱɟɦ ɜɵɧɨɫɹɳɟɣ, ɱɬɨ ɫɨɡɞɚɟɬ ɭɫɥɨɜɢɹ ɞɥɹ ɩɨɞɞɟɪɠɚɧɢɹ ɧɟɨɛɯɨɞɢɦɨɝɨ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ ɜ ɤɥɭɛɨɱɤɟ. Ɇɵɲɟɱɧɚɹ ɫɬɟɧɤɚ ɭ ɩɪɢɧɨɫɹɳɟɣ ɚɪɬɟɪɢɨɥɵ ɜɵɪɚɠɟɧɚ ɥɭɱɲɟ, ɱɟɦ ɭ ɜɵɧɨɫɹɳɟɣ. ɗɬɨ ɞɚɟɬ ɜɨɡɦɨɠɧɨɫɬɶ ɪɟɝɭɥɹɰɢɢ ɩɪɨɫɜɟɬɚ ɩɪɢɧɨɫɹɳɟɣ ɚɪɬɟɪɢɨɥɵ. ȼɵɧɨɫɹɳɚɹ ɚɪɬɟɪɢɨɥɚ ɜɧɨɜɶ ɪɚɫɩɚɞɚɟɬɫɹ ɧɚ ɫɟɬɶ ɤɚɩɢɥɥɹɪɨɜ ɜɨɤɪɭɝ ɩɪɨɤɫɢɦɚɥɶɧɵɯ ɢ ɞɢɫɬɚɥɶɧɵɯ ɤɚɧɚɥɶɰɟɜ (ɜɬɨɪɚɹ ɫɟɬɶ ɤɚɩɢɥɥɹɪɨɜ). ɗɬɢ ɤɚɩɢɥɥɹɪɵ ɜɵɩɨɥɧɹɸɬ ɨɛɦɟɧɧɭɸ ɮɭɧɤɰɢɸ. Ⱥɪɬɟɪɢɚɥɶɧɵɟ ɤɚɩɢɥɥɹɪɵ ɩɟɪɟɯɨɞɹɬ ɜ ɜɟɧɨɡɧɵɟ, ɤɨɬɨɪɵɟ, ɫɥɢɜɚɹɫɶ ɜ ɜɟɧɵ, ɨɬɞɚɸɬ ɤɪɨɜɶ ɜ ɧɢɠɧɸɸ ɩɨɥɭɸ ɜɟɧɭ. Ɉɫɨɛɟɧɧɨɫɬɶɸ ɤɪɨɜɨɫɧɚɛɠɟɧɢɹ ɸɤɫɬɚɦɟɞɭɥɥɹɪɧɨɝɨ ɧɟɮɪɨɧɚ ɹɜɥɹɟɬɫɹ ɬɨ, ɱɬɨ ɷɮɮɟɪɟɧɬɧɚɹ ɚɪɬɟɪɢɨɥɚ ɧɟ ɪɚɫɩɚɞɚɟɬɫɹ ɧɚ ɨɤɨɥɨɤɚɧɚɥɶɰɟɜɭɸ ɤɚɩɢɥɥɹɪɧɭɸ ɫɟɬɶ, ɚ ɨɛɪɚɡɭɟɬ ɩɪɹɦɵɟ ɫɨɫɭɞɵ, ɤɨɬɨɪɵɟ ɜɦɟɫɬɟ ɫ ɩɟɬɥɟɣ Ƚɟɧɥɟ ɫɩɭɫɤɚɸɬɫɹ ɜ ɦɨɡɝɨɜɨɟ ɜɟɳɟɫɬɜɨ ɩɨɱɤɢ, ɨɛɟɫɩɟɱɢɜɚɹ ɟɝɨ ɤɪɨɜɨɫɧɚɛɠɟɧɢɟ, ɚ ɬɚɤɠɟ ɭɱɚɫɬɜɭɸɬ ɜ ɨɫɦɨɬɢɱɟɫɤɨɦ ɤɨɧɰɟɧɬɪɢɪɨɜɚɧɢɢ ɦɨɱɢ.
ɑɟɪɟɡ ɫɨɫɭɞɵ ɩɨɱɤɢ ɜ 1 ɦɢɧ. ɩɪɨɯɨɞɢɬ ɨɤɨɥɨ 1/4 ɨɛɴɟɦɚ ɤɪɨɜɢ, ɜɵɛɪɚɫɵɜɚɟɦɨɝɨ ɫɟɪɞɰɟɦ ɜ ɚɨɪɬɭ. ɉɨɱɟɱɧɵɣ ɤɪɨɜɨɬɨɤ ɭɫɥɨɜɧɨ ɞɟɥɹɬ ɧɚ ɤɨɪɤɨɜɵɣ ɢ ɦɨɡɝɨɜɨɣ. ȼ ɮɢɡɢɨɥɨɝɢɱɟɫɤɢɯ ɭɫɥɨɜɢɹɯ 85–90% ɤɪɨɜɢ ɬɟɱɟɬ ɩɨ ɤɨɪɟ (ɨɛɥɚɫɬɶ, ɫɨɞɟɪɠɚɳɚɹ ɤɥɭɛɨɱɤɢ ɢ ɩɪɨɤɫɢɦɚɥɶɧɵɟ ɤɚɧɚɥɶɰɵ) ɢ 10–15% – ɜ ɦɨɡɝɨɜɨɦ ɫɥɨɟ. ɋɤɨɪɨɫɬɶ ɤɪɨɜɨɬɨɤɚ ɜ ɤɨɪɤɨɜɨɦ ɜɟɳɟɫɬɜɟ ɫɨɫɬɚɜɥɹ-
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