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Инфекционный аллергический миокардит критерии

Инфекционный аллергический миокардит критерии

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AA;54C5BAO 7=0G8<>ABL 15@5<5==>AB8 8 A>?@>2>640NI8E 55 ?@>F5AA>2 3>@<>=0;L=>9 ?5@5AB@>9:8, 0=5<88, :@>2>B5G5=89 4;O @0728B8O ?>A;5@>4>2>9 :0@48><8>?0B88. ;O @0728B8O =5>1E>48<> A>G5B0=85 <=>38E 87 MB8E D0:B>@>2. -B> ?>4B25@6405B 2KA:07K20=85: "# 3>;>40NI53> E@>=8G5A:>3> 0;:>3>;8:0, 70@060NI53>AO 28@CA>< >:A0:8 3 2 60@:>< 2;06=>< :;8<0B5, 1>;LH5 H0=A>2 =0 @0728B85 :0@48><8>?0B88, G5< C E>@>H> ?8B0NI53>AO =5?LNI53> G5;>25:0, :>=B0:B8@CNI53> A MB>9 65 8=D5:F859 2> 2@59 ?>3>4K 25A=>9" (J. Perloff, 1971. &8B. ?>: . . CE0@;O<>2, 1990). 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Ц"Ц2Ц4Ц├Ц┼Ц▄Ц░ЦлЦДД8ДFД╛ДФДХДЙДПД8Е:Е<Е>Е√Й≤Й╝Н╡Н╢Н╤НLРNРзСэСТТ╟Т╡ТхТУ(У░У═У╡УбУЙУ.ЖnЖpЖ╕Ж╙ЖдЖЙЖЛЖРЖТЖЖЖЬЖВRВVВ≤В╢В╤ВЭВЧВЬЬЬЬЬЬ>Ь@Ь\Ь^Ь`ЬbЬ·Ь═Ь╒ЬЬМЕМЕМЕМЬМЬМЬМЬМЬМЬМЬМжМгМгМжМЬМЬМЬМЬМЬМЬМЬМЬМЬМЬМЬгЬМЬМЬМЬМЬМгМгМгМгМЬМЬМЬМЬМhn#h/PCJaJmH sH hn#h/PCJOJQJaJh╥хCJaJhn#h/PCJaJhЦ╤CJaJNNРэСТ╡ТУЙУrЖЬЖRВ≤В╤В>Ь`Ь╒Ь(ЫvЫЙЪ╕%Е жЪ╕%яъжЪ╕%х█ бЪ╕%яъ╜Ъ╕%Н[ ≥Ъ╕%х█ ≥Ъ╕%х█ ≥Ъ╕%яъ≥Ъ╕%яъ≥Ъ╕%яъ╜Ъ╕%В╜┘Ъ╕%яъ┘Ъ╕%яъ┘Ъ╕%х█ ┘Ъ╕%яъ$ &Fdh1$7$8$H$a$gd%$ &FФdh1$7$8$H$a$gdЦ╤$└ dh1$7$8$H$`└ a$gdЦ╤$ &FЕdh1$7$8$H$a$gd%$ &FЕdh1$7$8$H$a$gdЦ╤$└дdh1$7$8$H$`└дa$gd%╒Ь╓Ь$Ы&Ы(ЫЫrЫtЫvЫxЫБЫДЫФЫХЫ:З<З>З@З├З┬З┼З▄ЗБЗДЗФЗХЗ·Ш═Ш·Щ═Щ╙Щ╟Щ╢Щ╦Щ╨Щ╪Щ.Ч0ЧDЧJЧNЧPЧTЧVЧДЧФЧНЧПЧPЪTЪюЪбЪФЙxzРЬrt▄▌°·═╒Ь8<>╗╙╛╝ ЬМЬМЬМЬМЬМЬМЬМЬМЬМЬМЬМЬМчМчМоМоМоМоМоМоМоМоМоМоМоМгМоМоМоМчМгМгМгМгМгМгМгМгМгМhлNPCJaJhn#h/PCJaJmH sH hn#h/PCJOJQJaJhn#h/PCJaJhЦ╤CJaJNvЫФЫ>З┼ЗФЗХЗ═ШбЪt▄═<╛   > n╨Рp!КЪ╕%яъКЪ╕%яъКЪ╕%яъКЪ╕%яъжЪ╕%В╜жЪ╕%Н[ жЪ╕%╦o%жЪ╕%аа жЪ╕%Н[ жЪ╕%сeбЪ╕%©;бЪ╕%х█ бЪ╕%яъбЪ╕%яъбЪ╕%яъбЪ╕%х█ жЪ╕%Е жЪ╕%Е жЪ╕%oъJ╜Ъ╕%'Op$└дdh1$7$8$H$`└дa$gdлNP$ 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nterobacteriaceae (E.coli, Klebsiella spp., Proteus spp., Enterobacter spp., Serratia spp. 8 4@.), P.aeruginosa (=> =5 ?@52>AE>48B B8:0@F8;;8=), =5D5@<5=B8@CNI8E 10:B5@89 - S.maltophilia, A?>@>>1@07CNI8E 8 =5A?>@>>1@07CNI8E, 2:;NG0O B.fragi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zlocillinum).!8=>=KF8;;8=0 =0B@8520O A>;L, !5:C@>?5=K?CA:05BAO 2 ?>@>H:5 4;O 8=J5:F89 2> D;0:>=0E ?> 0,5 3, 1,0 3, 2,0 3 8 4,0 3 @52>AE>48B :0@15=8F8;;8= ?> AB5?5=8 0=B8A8=53=>9=>9 0:B82=>AB8, => 459AB2C5B B>;L:> =0 =5:>B>@K5 HB0<<K P.aeruginosa, CAB>9G82K5 : :0@15=8F8;;8=C. :B825= ?@>B82 =5:>B>@KE :;51A85;;, A5@@0F89.5@8>4 ?>;C2K2545=8O >:>;> 1 G0A0.>:070=8O: A8=53=>9=0O 8=D5:F8O.!?>A>1 ?@8<5=5=8O: =CB@825==> :0?5;L=> <54;5==> 2 B5G5=85 70 30 <8=CB. 0AG5B ACB>G=>9 4>7K - 200-350 <3/:3 (2 A@54=5< 20 3/ACB), 22>48BAO 2 4-6 22545=89. >1>G=K5 O2;5=8O: 2>7<>6=> @0728B85 38?5@=0B@85<88 8 38?>:0;85<88 (2 1,0 3 A>45@68BAO 2,2 <<>;L =0B@8O), => >=8 >B<5G0NBAO @565, G5< ?@8 =07=0G5=88 :0@15=8F8;;8=0. 8?5@0F8;;8= (Piperacilinum). !8=>=8@>H:5 4;O 8=J5:F89 2> D;0:>=0E ?> 1,0 3, 2,0 3, 3,0 3 8 4,0 3 > A?5:B@C 0:B82=>AB8 AE>45= A 07;>F8;;8=><, => 1>;55 0:B825= ?@>B82 P . aeruginosa, E. coli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nterobacteriaceae (E.coli, Klebsiella spp., Proteus spp., Enterobacter spp., Serratia spp. 8 4@.);P.aeruginosa (=> =5 ?@52>AE>48B ?8?5@0F8;;8=); =5D5@<5=B8@CNI85 10:B5@88 - S.maltophilia; 0=0M@>1K: A?>@>>1@07CNI85 8 =5A?>@>>1@07CNI85, 2:;NG0O B.fragilis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efazolin). !8=>=8;, B>B0F5D, F57>;8=, F5D07>;8= 8:><54, F5D07>;8= "520, F5D07>;8=0 =0B@8520O A>;L, F5D0<578=)K?CA:05BAO 2> D;0:>=0E ?> 0,5 3, 1,0 3, 2,0 3 ?>@>H:0 4;O ?@83>B>2;5=8O @0AB2>@0 4;O 8=J5:F89.!?5:B@ ?@>B82><8:@>1=>9 0:B82=>AB8 2:;NG05B @0< (+) :>::8 - AB@5?B>:>::8, AB0D8;>:>::8 (2:;NG0O PRSA), @0< (-) ?0;>G:8 - E.coli, P.mirabilis (?> 0:B82=>AB8 2 >B=>H5=88 MB8E 2>71C48B5;59 F5D07>;8= CABC?05B F5D0;>A?>@8=0< II-IV ?>:>;5=89), 0=0M@>1K G0I5 2A53> CAB>9G82K. 5 459AB2C5B =0 MRSA, M=B5@>:>::8, ;8AB5@88, b-;0:B0<07>-?@>4CF8@CNI85 HB0<<K .influenzae, A8=53=>9=CN ?0;>G:C 8 4@.@8 ?0@5=B5@0;L=>< 22545=88 E>@>H> ?@>=8:05B 2 @07;8G=K5 >@30=K 8 B:0=8, => ?;>E> - G5@57 -, , 2 ?@54AB0B5;L=CN 65;57C. 05B AB018;L=K5 :>=F5=B@0F88 2 :@>28 8 <>G5 ?@8 22545=88 2-3 @070 2 ACB:8, B0: :0: T1/2 A>AB02;O5B ?>GB8 2 G.>:070=8O: AB@5?B>:>::>2K5 8 AB0D8;>:>::>2K5 8=D5:F88 :>68, AB59 8 ACAB02>2, ?5@8>?5@0F8>==0O 0=B818>B8:>?@>D8;0:B8:0.!?>A>1 ?@8<5=5=8O: ?0@5=B5@0;L=> 2=CB@825==> 8;8 2=CB@8 - ?> 1,0-2,0 3 :064K5 8 G, A F5;LN ?@>D8;0:B8:8 - 1,0-2,0 3 70 0,5 G 4> >?5@0F88 (5A;8 >?5@0F8O 4;8BAO 1>;55 4 G0A>2 =5>1E>48<> ?>2B>@=>5 2545=85).&5D0;>A?>@8=K II ?>:>;5=8O @0AH8@ONB A?5:B@ ?@>B82><8:@>1=>9 0:B82=>AB8 2 >B=>H5=88 3@0<>B@8F0B5;L=>9 D;>@K 8 C<5=LH0NB 0:B82=>ABL 2 >B=>H5=88 3@0> ;>68B5;L=>9. 0@5=B5@0;L=K5 F5D0;>A?>@8=K II ?>:>;5=8O&5DC@>:A8< (!efuroxim). !8=>=8F5D,; K?CA:05BAO 2> D;0:>=0E ?> 0,25 3, 0,75 3 8 1,5 3 ?>@>H:0 4;O ?@83>B>2;5=8O @0AB2>@0 4;O 8=J5:F89 2 2845 =0B@852>9 A>;8.!?5:B@ ?@>B82><8:@>1=>9 0:B82=>AB8: 1>;55 0:B825=, G5< F5D0;>A?>@8=K I ?>:>;5=8O, 2 >B=>H5=88 3@0<>B@8F0B5;L=KE 10:B5@89: . influenzae, . catarrhalis, E.coli, =5:>B>@KE HB0<<>2 :;51A85;;, ?@>B5O ( .mirabilis, P.vulgaris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efotaxim). !8=>=8@0=, ;8D>@0=, F5D>A8=, F5D>B0:A8< =0B@8520O A>;L. 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K?CA:05BAO 2> D;0:>=0E ?> 0,25 3, 0,5 3, 1,0 3 8 2,0 3 ?>@>H:0 4;O ?@83>B>2;5=8O @0AB2>@0 4;O 8=J5:F89. !?5:B@ ?@>B82><8:@>1=>9 0:B82=>AB8 - A8=53=>9=0O ?0;>G:0 8 4@C385 @0< (-) <8:@>>@30=872=K5 >B;8G8O >B F5D>B0:A8<0 70:;NG0NBAO 2 2KA>:>9 0:B82=>AB8 ?> >B=>H5=8N : P.aeruginosa, ?@52>AE>4OI59 0:B82=>ABL ?8?5@0F8;;8=0, 0<8=>3;8:>784>2 8 F8?@>D;>:A0F8=0, <5=LH0O 0:B82=>ABL 2 >B=>H5=88 3@0> ;>68B5;L=KE :>::>2 (AB0D8;>:>::>2, ?=52<>:>::>2), 1>;55 4;8B5;L=K9 "1/2 (2 G).>:070=8O: A8=53=>9=0O 8=D5:F8O, 2:;NG0O <5=8=38B, =>7>:><80;L=0O ?=52<>=8O, BO65;K5 2=51>;L=8G=K5 8 =>7>:><80;L=K5 8=D5:F88 <>G52K2>4OI8E ?CB59, 8=B@0014><8=0;L=K5 8 B07>2K5 8=D5:F88 (2 A>G5B0=88 A 0=B80=0M@>1=K<8 ?@5?0@0B0<8), =59B@>?5=8G5A:0O ;8E>@04:0. !?>A>1 ?@8<5=5=8O: ?0@5=B5@0;L=> 2=CB@825==> 8;8 2=CB@8 - 3,0-6,0 3/ACB 2 2-3 22545=8O (?@8 A8=53=>9=>9 8=D5:F88 3 @070 2 ACB:8); ?@8 <5=8=38B5 0,2 3/:3/ACB 2 3 22545=8O. &5D>?5@07>= (Cefoperazone). !8=>=8?5@01>;, 40@4C<, <54>F5D, F5D>184. 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K?CA:05BAO 2> D;0:>=0E ?> 2,0 3 ?>@>H:0 4;O ?@83>B>2;5=8O @0AB2>@0 4;O 8=DC789.><18=8@>20==K9 ?@5?0@0B 2:;NG0NI89 F5D>?5@07>=0 8 8=3818B>@>< b-;0:B0<07 AC;L10:B0< 2 A>>B=>H5=88 1:1, 548=AB25==K< 8=3818B>@>70I8I5==K9 F5D0;>A?>@8=.> A@02=5=8N A F5D>?5@07>=>< 7=0G8B5;L=> 1>;55 0:B825= ?@>B82 <8:@>>@30=87<>2, >1@07CNI8E b-;0:B0<07K - 3@0<>B@8F0B5;L=KE 10:B5@89 A5<59AB20 Enterobacteriaceae, 0F8=5B>10:B5@>2. >B;8G85 >B 4@C38E F5D0;>A?>@8=>2 E>@>H> 459AB2C5B =0 B.fragilis 8 4@C385 =5A?>@>>1@07CNI85 0=0M@>1K, ?>MB>9 ?>;>AB8 8 <0;>3> B070 <>65B ?@8<5=OBLAO 2 2845 <>=>B5@0?88. > 0:B82=>AB8 2 >B=>H5=88 A8=53=>9=>9 ?0;>G:8 A>>B25BAB2C5B F5D>?5@07>=C. > 4@C38< ?0@0<5B@0< =5 >B;8G05BAO >B F5D>?5@07>=0.>:070=8O: BO65;K5 2=51>;L=8G=K5 8 =>7>:><80;L=K5 (2 B>< G8A;5 A8=53=>9=K5) 8=D5:F88 25@E=8E 4KE0B5;L=KE ?CB59 ?@8 =5>1E>48<>AB8 ?0@5=B5@0;L=>3> 22545=8O, 2=51>;L=8G=0O 8 =>7>:><80;L=0O ?=52<>=8O, 01AF5AA ;53:>3>, >AB@K9 E>;5F8AB8B, E>;0=38B, >AB@K9 ?85;>=5D@8B, 8=B@0014><8=0;L=K5 8 B07>2K5 8=D5:F88, 8=D5:F88 :>68, AB59 8 ACAB02>2, =59B@>?5=8G5A:0O ;8E>@04:0, A5?A8A. !?>A>1 ?@8<5=5=8O: 2=CB@8 8 2=CB@825==> 4,0-8,0 3/ACB 2 2 22545=8O. &5D0;>A?>@8=K IV ?>:>;5=8O E0@0:B5@87CNBAO 1>;LH59, G5< 2A5 4@C385 F5D0;>A?>@8=K CAB>9G82>ABLN, : 459AB28N E@><>A><=KE 8 ?;07<84=KE 15B0-;0:B0<07. > A@02=5=8N A F5D0;>A?>@8=0<8 III ?>:>;5=8O 1>;55 0:B82=K ?@>B82 3@0> ;>68B5;L=KE :>::>2 (=> =5 459AB2CNB =0 MRSA 8 M=B5@>:>::8), 3@0<>B@8F0B5;L=KE 10:B5@89 A5<59AB20 Enterobacteriaceae 8 P.aeruginosa (2:;NG0O =5:>B>@K5 HB0<<K, @578AB5=B=K5 : F5DB07848< (Cefepime).!8=>=8< K?CA:05BAO 2> D;0:>=0E ?> 0,5 3, 1,0 3 8 2,0 3 ?>@>H:0 4;O ?@83>B>2;5=8O @0AB2>@0 4;O 8=J5:F89. !?5:B@ ?@>B82><8:@>1=>9 0:B82=>AB8: @0< (+) :>::8 - AB@5?B>:>::8, ?5=8F8;;8=>@578AB5=B=K5 ?=52<>:>::8), AB0D8;>:>::8 (:@><5 MRSA); @0< (-) :>::8 - N.gonorrhoeae, N.meningitidis, M.catarrhalis, 2:;NG0O 15B0 -;0:B0<07>>1@07CNI85 HB0<<K; @0< (-) ?0;>G:8 - A5<59AB2> Enterobacteriaceae (E.coli, Proteus spp., Klebsiella spp., Enterobacter spp., Serratia spp. 8 4@.), 2:;NG0O @O4 HB0<<>2, @578AB5=B=KE : F5D0;>A?>@8=0< III ?>:>;5=8O; H.influenzae, P.aeruginosa (2:;NG0O =5:>B>@K5 HB0<<K, @578AB5=B=K5 : F5DB078481K - ?@58 0=0M@>1=K5 :>::8 (?5?B>AB@5?B>:>::8 8 4@.). 5 459AB2C5B =0 M=B5@>:>::8, B.fragilis.@8 2=CB@825==>< 22545=88 E>@>H> @0A?@545;O5BAO 2 >@30=87<5, ?@>=8:05B G5@57 -. -:A:@5B8@C5BAO ?@58 2 =587<5=5==>< 2845 ?>G:0<8. "1/2 A>AB02;O5B >:>;> 2 G.>:070=8O: BO65;K5, 2 >A=>2=>< =>7>:><80;L=K5, 8=D5:F88, 2K720==K5 ?>;8@578AB5=B=>9 <8:@>D;>@>9, =>7>:><80;L=0O ?=52<>=8O; >A;>6=5==K5 8=D5:F88 <>G52K2>4OI8E ?CB59, 8=B@0014><8=0;L=K5 8 B07>2K5 8=D5:F88 (2 A>G5B0=88 A <5B@>=8407>;><); 8=D5:F88 :>68, AB59, ACAB02>2; A5?A8A, =59B@>?5=8G5A:0O ;8E>@04:0. !?>A>1 ?@8<5=5=8O: 2=CB@8 8 2=CB@825==> ?> 1-2 3 :064K5 12 G; ?@8 8=D5:F8OE, C3@>60NI8E 687=8, ?> 2 3 :064K5 8 G. 0@10?5=5<5NB AB@C:BC@=>5 AE>4AB2> A 4@C38<8 15B0 - ;0:B0<=K<8 0=B818>B8:0<8, => 2 >B;8G85 >B =8E E0@0:B5@87CNBAO 2KA>:>9 CAB>9G82>ABLN : 459AB28N 15B0-;0:B0<07 @0AH8@5==>3> A?5:B@0 459AB28O 8 1>;55 H8@>:8< A?5:B@>< 0:B82=>AB8, 2:;NG0O P.aeruginosa 8 =5A?>@>>1@07CNI85 0=0M@>1K. @C??0 :0@10?5=5<>2 2:;NG05B 8<8?5=5< 8 <5@>?5=5<, 459AB2CNI85 =0 <=>385 HB0<<K 3@0<>B@8F0B5;L=KE 10:B5@89, CAB>9G82KE : F5D0;>A?>@8=0< III-IV ?>:>;5=89. 0@10?5=5B=>H5=88 MRSA 8 B0:8E 3@0<>B@8F0B5;L=KE 10:B5@89, :0: B.cepacia 8 S.maltophilia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Источник: http://belmapo.by/downloads/cardiology/2010/kurs.d...

Инфекционный аллергический миокардит критерии

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