4 курс / Медицина катастроф / Алгоритмы_оказания_скорой_и_неотложной_медицинской_помощи
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ɉɪɢɥɨɠɟɧɢɟ |
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Ʉɪɢɬɟɪɢɢ ɨɰɟɧɤɢ ɧɨɜɨɪɨɠɞɟɧɧɨɝɨ ɩɨ ɲɤɚɥɟ Ⱥɩɝɚɪ |
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ɉɪɢɡɧɚɤ |
ɛɚɥɥɨɜ |
ɛɚɥɥ |
ɛɚɥɥɚ |
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ɑɋɋ |
0 |
Ɇɟɧɶɲɟ ɜ ɦɢɧɭɬɭ |
Ȼɨɥɶɲɟ ɜ ɦɢɧɭɬɭ |
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Ⱦɵɯɚɧɢɟ |
Ɉɬɫɭɬɫɬɜɭɟɬ |
Ȼɪɚɞɢɩɧɨɷ ɞɵɯɚɧɢɟ ɧɟɪɟɝɭɥɹɪɧɨɟ |
Ƚɪɨɦɤɢɣ ɤɪɢɤ ɢɥɢ ɪɟɝɭɥɹɪɧɨɟ |
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ɞɵɯɚɧɢɟ |
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Ɇɵɲɟɱɧɵɣ ɬɨɧɭɫ |
Ⱥɬɨɧɢɹ |
ɇɢɡɤɢɣ ɢɥɢ ɭɦɟɪɟɧɧɵɣ ɥɟɝɤɨɟ |
ɇɨɪɦɚɥɶɧɵɣ ɫ ɚɤɬɢɜɧɵɦɢ |
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ɫɝɢɛɚɧɢɟ ɤɨɧɟɱɧɨɫɬɟɣ |
ɞɜɢɠɟɧɢɹɦɢ |
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Ɋɟɚɤɰɢɹ ɧɚ |
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ɏɨɪɨɲɨ ɜɵɪɚɠɟɧɚ ɤɪɢɤ ɤɚɲɟɥɶ |
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ɮɚɪɢɧɝɟɚɥɶɧɵɣ |
Ɋɟɚɤɰɢɹ ɨɬɫɭɬɫɬɜɭɟɬ |
Ƚɪɢɦɚɫɚ |
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ɤɚɬɟɬɟɪ ɧɚ |
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ɱɢɯɚɧɢɟ ɝɪɨɦɤɢɣ ɩɥɚɱ |
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ɪɚɡɞɪɚɠɟɧɢɟ |
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ɐɜɟɬ ɤɨɠɢ |
Ȼɥɟɞɧɵɣ ɢɥɢ |
Ⱥɤɪɨɰɢɚɧɨɡ |
Ɋɨɡɨɜɵɣ |
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ɞɢɮɮɭɡɧɵɣ ɰɢɚɧɨɡ |
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Ɉɰɟɧɤɚ ɩɪɨɜɨɞɢɬɫɹ ɧɚ -ɣ ɢ -ɣ ɦɢɧɭɬɟ ɩɨɫɥɟ ɪɨɠɞɟɧɢɹ ɧɟɡɚɜɢɫɢɦɨ ɨɬ ɯɚɪɚɤɬɟɪɚ ɢ ɨɛɴɟɦɚ ɩɪɨɜɨɞɢɦɵɯ ɪɟɚɧɢɦɚɰɢɨɧɧɵɯ ɦɟɪɨɩɪɢɹɬɢɣ ȼ ɫɥɭɱɚɟ ɩɪɨɞɨɥɠɟɧɢɹ ɪɟɚɧɢɦɚɰɢɨɧɧɵɯ ɦɟɪɨɩɪɢɹɬɢɣ ɛɨɥɟɟ ɦɢɧɭɬ ɠɢɡɧɢ ɩɪɨɜɨɞɢɬɫɹ ɬɪɟɬɶɹ ɨɰɟɧɤɚ ɩɨ Ⱥɩɝɚɪ ɱɟɪɟɡ ɦɢɧɭɬ ɩɨɫɥɟ ɪɨɠɞɟɧɢɹ Ⱦɨ ɛɚɥɥɨɜ ɩɨ ɲɤɚɥɟ Ⱥɩɝɚɪ ɧɚ 1-ɣ ɦɢɧɭɬɟ ɠɢɡɧɢ – ɬɹɠɟɥɚɹ ɚɫɮɢɤɫɢɹ, ɩɪɨɜɨɞɹɬɫɹ ɪɟɚɧɢɦɚɰɢɨɧɧɵɟ ɦɟɪɨɩɪɢɹɬɢɹ
Ɉɬ ɞɨ ɛɚɥɥɨɜ ɧɚ 1-ɣ ɦɢɧɭɬɟ ɠɢɡɧɢ – ɫɨɫɬɨɹɧɢɟ ɬɹɠɟɥɨɟ ɩɪɨɜɨɞɹɬɫɹ ɞɨɩɨɥɧɢɬɟɥɶɧɵɟ ɥɟɱɟɛɧɵɟ ɦɟɪɨɩɪɢɹɬɢɹ ɫɦ ɉɪɢɥɨɠɟɧɢɟ Ɉɬ ɛɚɥɥɨɜ ɞɨ ɛɚɥɥɨɜ – ɫɨɫɬɨɹɧɢɟ ɭɞɨɜɥɟɬɜɨɪɢɬɟɥɶɧɨɟ.
ɉɪɢɡɧɚɤɢ ɠɢɜɨɪɨɠɞɟɧɧɨɫɬɢ
•ɋɚɦɨɫɬɨɹɬɟɥɶɧɨɟ ɞɵɯɚɧɢɟ
•ɋɟɪɞɰɟɛɢɟɧɢɟ
•ɉɭɥɶɫɚɰɢɹ ɩɭɩɨɜɢɧɵ
•ɉɪɨɢɡɜɨɥɶɧɨɟ ɞɜɢɠɟɧɢɟ ɦɵɲɰ
250
ɉɪɢɥɨɠɟɧɢɟ
Ⱥɥɝɨɪɢɬɦ ɩɟɪɜɢɱɧɨɣ ɪɟɚɧɢɦɚɰɢɢ ɧɨɜɨɪɨɠɞɟɧɧɨɝɨ ɩɪɢ ɪɨɠɞɟɧɢɢ
1. |
Ɋɨɠɞɟɧɢɟ ɨɰɟɧɤɚ ɜ ɬɟɱɟɧɢɟ - ɫɟɤ |
ȾȺ |
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Ⱦɨɧɨɲɟɧɧɵɣ" Ɇɵɲɟɱɧɵɣ ɬɨɧɭɫ ɯɨɪɨɲɢɣ" |
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Ⱦɵɲɢɬ ɢɥɢ ɤɪɢɱɢɬ" ȼɨɞɵ ɱɢɫɬɵɟ" |
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ɇȿɌ ɞɚɠɟ ɩɨ ɨɞɧɨɣ ɢɡ ɩɨɡɢɰɢɣ |
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Ɉɛɟɫɩɟɱɢɬɶ ɬɟɩɥɨ ɨɛɫɭɲɢɬɶ ɩɪɨɦɨɤɚɬɟɥɶɧɵɦɢ ɞɜɢɠɟɧɢɹɦɢ ɜɥɚɠɧɵɟ ɩɟɥɟɧɤɢ ɜɵɛɪɨɫɢɬɶɉɪɢɞɚɬɶ ɩɨɥɨɠɟɧɢɟ ɧɚ ɫɩɢɧɟ ɫɨ ɫɥɟɝɤɚ ɡɚɩɪɨɤɢɧɭɬɨɣ ɝɨɥɨɜɨɣɋɚɧɢɪɨɜɚɬɶ ɞɵɯɚɬɟɥɶɧɵɟ ɩɭɬɢ ɩɨ ɩɨɤɚɡɚɧɢɹɦɌɚɤɬɢɥɶɧɚɹ ɫɬɢɦɭɥɹɰɢɹ - ɫɟɤ
ɋɭɞɨɪɨɠɧɵɟ ɜɞɨɯɢ ɚɩɧɨɷ ɢɥɢ ɑɋɋ ɡɚ ɫɟɤ
ɉɪɨɜɟɞɟɧɢɟ ɂȼɅ ɱɟɪɟɡ ɦɚɫɤɭɩɪɢ ɧɚɥɢɱɢɢ ɩɨɩɵɬɨɤ ɞɵɯɚɧɢɹ ɑȾ - ɜ ɦɢɧ
ɑɋɋ 60 |
ɑɋɋ ɡɚ ɫɟɤ |
ɂɧɬɭɛɚɰɢɹ ɂȼɅ ɱɟɪɟɡ ɷɧɞɨɬɪɚɯɟɚɥɶɧɭɸ ɬɪɭɛɤɭ ɨɰɟɧɤɚ ɱɟɪɟɡ ɫɟɤɭɧɞ
Ɋɭɬɢɧɧɵɟ ɦɟɪɨɩɪɢɹɬɢɹ ɨɫɜɨɛɨɞɢɬɶ ɞɵɯɚɬɟɥɶɧɵɟ ɩɭɬɢ ɫɨɝɪɟɬɶ
Ⱦɵɯɚɧɢɟ ɪɟɝɭɥɹɪɧɨɟ ɑɋɋ ɉɟɪɫɢɫɬɢɪɭɸɳɢɣ ɰɢɚɧɨɡ ɛɨɥɟɟ - ɦɢɧ
Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ Fi O2 - 0.5
ɇɟɩɪɹɦɨɣ ɦɚɫɫɚɠ ɫɟɪɞɰɚ ɤɨɦɩɪɟɫɫɢɣ ɜ ɦɢɧ ɂȼɅ ɱɟɪɟɡ ɷɧɞɨɬɪɚɯɟɚɥɶɧɭɸ ɬɪɭɛɤɭ ɑɋɋ ɑȾ – 3/1.
Ɉɰɟɧɤɚ ɱɟɪɟɡ ɫɟɤ
ɉɪɢ ɨɬɫɭɬɫɬɜɢɢ ɷɮɮɟɤɬɚ ɨɬ ɚɞɟɤɜɚɬɧɨɣ ɂȼɅ ɢ ɧɟɩɪɹɦɨɝɨ ɦɚɫɫɚɠɚ ɫɟɪɞɰɚ - ɦɟɞɢɤɚɦɟɧɬɨɡɧɚɹ ɬɟɪɚɩɢɹ ɗɩɢɧɟɮɪɢɧ ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɢɥɢ ɜ ɤɨɫɬɧɨ ɉɪɢ ɧɟɜɨɡɦɨɠɧɨɫɬɢ ɨɛɟɫɩɟɱɟɧɢɹ ɭɤɚɡɚɧɧɨɝɨ ɩɭɬɢ ɜɜɟɞɟɧɢɹ ɗɩɢɧɟɮɪɢɧ ɦɝ ɤɝ ɷɧɞɨɬɪɚɯɟɚɥɶɧɨ Ɉɰɟɧɤɚ ɷɮɮɟɤɬɚ ɱɟɪɟɡ ɫɟɤ ɨɬ ɦɨɦɟɧɬɚ ɜɜɟɞɟɧɢɹ ɑɋɋ ɞɨɥɠɧɚ ɞɨɫɬɢɝɧɭɬɶ ɭɞ ɦɢɧ ɉɪɢ ɨɬɫɭɬɫɬɜɢɢ ɷɮɮɟɤɬɚ - ɩɨɜɬɨɪɢɬɶ ɜɜɟɞɟɧɢɟ
ɗɩɢɧɟɮɪɢɧɚ ɦɝ ɤɝ ɤɚɠɞɵɟ - ɦɢɧ
ɋɟɪɞɟɱɧɚɹ ɞɟɹɬɟɥɶɧɨɫɬɶ ɨɬɫɭɬɫɬɜɭɟɬ ! ɦɢɧ ɧɟɫɦɨɬɪɹ ɧɚ ɩɨɥɧɵɣ ɨɛɴɟɦ ɪɟɚɧɢɦɚɰɢɨɧɧɵɯ ɦɟɪɨɩɪɢɹɬɢɣ
ɉɪɟɤɪɚɬɢɬɶ ɪɟɚɧɢɦɚɰɢɨɧɧɭɸ ɩɨɦɨɳɶ
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ɇɚɱɚɥɶɧɵɟ ɩɚɪɚɦɟɬɪɵ ɂȼɅ ɭ ɧɨɜɨɪɨɠɞɟɧɧɵɯ |
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ɉɪɢɥɨɠɟɧɢɟ |
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ɉɚɬɨɥɨɝɢɹ |
Ɋinsp |
Peep |
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FiO2 |
Rate |
Ɍi (ɫɟɤ |
I : E |
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Flow |
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ɫɦ ɜɨɞ. ɫɬ |
(ɫɦ ɜɨɞ. |
ɫɬ |
(ɦɢɧ |
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ɥ ɦɢɧ |
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Ɋɟɫɩɢɪɚɬɨɪɧɵɣ ɞɢɫɬɪɟɫɫ |
20 - 25 |
4 - 5 |
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50 - 60 |
60 - 80 |
0,4 |
1:1 |
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4 - 6 |
ɫɢɧɞɪɨɦ ɊȾɋ |
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ɋɢɧɞɪɨɦ ɚɫɩɢɪɚɰɢɢ |
25 - 30 |
3 - 4 |
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60 - 80 |
40 - 60 |
0,4 |
1:2 |
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6 - 8 |
ɦɟɤɨɧɢɹ ɋȺɆ |
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ɉɧɟɜɦɨɧɢɹ |
20 - 25 |
3 - 4 |
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60 - 80 |
30 - 40 |
0,5 |
1:2 |
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4 - 6 |
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Ɉɬɟɤ ɥɟɝɤɢɯ |
20 - 25 |
4 - 6 |
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50 - 60 |
20 - 40 |
0,5 |
1:1,5 |
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4 - 6 |
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ɉɟɪɫɢɫɬɢɪɭɸɳɚɹ |
25 - 35 |
2 |
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100 |
60 - 120 |
0,3 |
1:2 |
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8 - 12 |
ɥɟɝɨɱɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ |
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ɉɅȽ |
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ɂɧɬɟɪɫɬɢɰɢɚɥɶɧɚɹ |
15 - 20 |
0 |
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60 - 80 |
60 - 120 |
0,2 |
1:2 |
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8 - 12 |
ɷɦɮɢɡɟɦɚ ɥɟɝɤɢɯ ɂɗɅ |
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Ⱥɩɧɨɷ ɧɟɞɨɧɨɲɟɧɧɵɯ |
14 - 18 |
2 |
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21 |
15 - 30 |
0,4 |
1:2 |
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4 - 6 |
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Ɉɛɨɡɧɚɱɟɧɢɹ
Ɋinsp - ɦɚɤɫɢɦɚɥɶɧɨɟ ɞɚɜɥɟɧɢɟ ɜ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɹɯ ɜɨ ɜɪɟɦɹ ɜɞɨɯɚ ɫɚɧɬɢɦɟɬɪɨɜ ɜɨɞɧɨɝɨ ɫɬɨɥɛɚ PEEP - ɩɨɥɨɠɢɬɟɥɶɧɨɟ ɞɚɜɥɟɧɢɟ ɜ ɤɨɧɰɟ ɜɵɞɨɯɚ
FiO2 - ɮɪɚɤɰɢɹ ɤɢɫɥɨɪɨɞɚ ɜɨ ɜɞɵɯɚɟɦɨɣ ɫɦɟɫɢ Rate - ɱɚɫɬɨɬɚ ɜɞɭɜɚɧɢɣ
Ɍi - ɜɪɟɦɹ ɜɞɨɯɚ
I : E - ɫɨɨɬɧɨɲɟɧɢɟ ɜɞɨɯɚ ɤ ɜɵɞɨɯɭ
Flow – ɩɨɬɨɤ Ɋɚɫɱɟɬ – ɥ ɯ ɦɚɫɫɚ ɬɟɥɚ ɪɟɛɟɧɤɚ ɜ ɤɝ
252
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ɉɪɢɥɨɠɟɧɢɟ |
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Ɏɢɡɢɨɥɨɝɢɱɟɫɤɢɟ ɜɨɡɪɚɫɬɧɵɟ ɧɨɪɦɵ ɭ ɞɟɬɟɣ ɜ ɩɨɤɨɟ |
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ȼɨɡɪɚɫɬ |
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Ɇɚɫɫɚ ɬɟɥɚ ɤɝ |
ɑȾȾ |
ɑɋɋ |
ȺȾ |
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ɇɨɜɨɪɨɠɞɟɧɧɵɟ |
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3,5 |
40 - 60 |
130 |
- 140 |
70/40 |
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ɦɟɫ |
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5 |
35 - 40 |
120 |
- 130 |
85/40 |
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ɦɟɫ |
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7 |
33 - 35 |
120 |
- 125 |
90/55 |
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ɝɨɞ |
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10 |
30 - 32 |
120 |
92/56 |
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ɝɨɞɚ |
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12 |
26 - 30 |
110 |
- 115 |
94/56 |
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ɝɨɞɚ |
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16 |
25 - 26 |
100 |
- 105 |
98/56 |
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ɥɟɬ |
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19 |
25 - 26 |
100 |
100/58 |
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ɥɟɬ |
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20 |
25 |
90 |
- 95 |
100/60 |
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ɥɟɬ |
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25 |
22 - 24 |
80 |
- 85 |
100/65 |
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ɥɟɬ |
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30 |
20 - 22 |
78 |
- 80 |
105/70 |
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ɥɟɬ |
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33 - 35 |
18 - 20 |
75 |
- 82 |
110/70 |
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ɥɟɬ |
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ɞɨ |
16 - 18 |
72 |
- 78 |
120/70 |
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ɋɪɟɞɧɟɟ ɜɨɡɪɚɫɬɧɨɟ ȺȾ ɞɥɹ ɞɟɬɟɣ ɜ ɜɨɡɪɚɫɬɟ ɨɬ ɝɨɞɚ ɞɨ ɥɟɬ ɋɢɫɬɨɥɢɱɟɫɤɨɟ ɜɨɡɪɚɫɬ ɜ ɝɨɞɚɯ ɯ Ⱦɢɚɫɬɨɥɢɱɟɫɤɨɟ ɜɨɡɪɚɫɬ ɜ ɝɨɞɚɯ
ȼɟɪɯɧɟɟ ɩɨɝɪɚɧɢɱɧɨɟ ɋɢɫɬɨɥɢɱɟɫɤɨɟ ɜɨɡɪɚɫɬ ɜ ɝɨɞɚɯ ɯ Ⱦɢɚɫɬɨɥɢɱɟɫɤɨɟ ɜɨɡɪɚɫɬ ɜ ɝɨɞɚɯ
ɇɢɠɧɟɟ ɩɨɝɪɚɧɢɱɧɨɟ ɋɢɫɬɨɥɢɱɟɫɤɨɟ ɜɨɡɪɚɫɬ ɜ ɝɨɞɚɯ ɯ Ⱦɢɚɫɬɨɥɢɱɟɫɤɨɟ ɜɨɡɪɚɫɬ ɜ ɝɨɞɚɯ
253
ɉɪɢɥɨɠɟɧɢɟ
ɉɪɨɦɵɜɚɧɢɟ ɠɟɥɭɞɤɚ ɭ ɞɟɬɟɣ
•ɉɪɢ ɩɪɨɦɵɜɚɧɢɢ ɠɟɥɭɞɤɚ ɭ ɞɟɬɟɣ ɢɫɩɨɥɶɡɭɸɬ ɩɟɪɨɪɚɥɶɧɨɟ ɢɥɢ ɬɪɚɧɫɧɚɡɚɥɶɧɨɟ ɜɜɟɞɟɧɢɟ ɡɨɧɞɚ ɞɢɚɦɟɬɪ ɤɨɬɨɪɨɝɨ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɧɚɪɭɠɧɨɦɭ ɧɨɫɨɜɨɦɭ ɨɬɜɟɪɫɬɢɸ Ⱦɥɹ ɩɪɨɦɵɜɚɧɢɹ ɢɫɩɨɥɶɡɭɟɬɫɹ ɩɢɬɶɟɜɚɹ ɜɨɞɚ ɤɨɦɮɨɪɬɧɨɣ ɬɟɦɩɟɪɚɬɭɪɵ ɬɟɦɩɟɪɚɬɭɪɚ ɠɟɥɭɞɤɚ
•ɋɤɨɪɨɫɬɶ ɜɜɟɞɟɧɢɹ ɠɢɞɤɨɫɬɢ ɡɚ ɦɢɧɭɬɵ ɪɚɡɨɜɵɣ ɨɛɴɟɦ ɜɵɜɟɞɟɧɢɟ ɫ ɬɚɤɨɣ ɠɟ ɫɤɨɪɨɫɬɶɸ ɰɢɤɥ ɜɜɟɞɟɧɢɟɜɵɜɟɞɟɧɢɟ ɧɟ ɛɨɥɟɟ ɦɢɧɭɬ
•Ʉɚɠɞɵɣ ɩɪɨɦɵɜɧɨɣ ɰɢɤɥ ɡɚɤɚɧɱɢɜɚɟɬɫɹ ɜɜɟɞɟɧɢɟɦ ɫɨɪɛɟɧɬɚ ɋɨɪɛɟɧɬ ɪɚɡɜɨɞɢɬɫɹ ɜ 1/2 ɪɚɡɨɜɨɝɨ ɨɛɴɟɦɚ
•ɉɪɢ ɢɫɩɨɥɶɡɨɜɚɧɢɢ ɝɚɫɬɪɚɥɶɧɵɯ ɫɨɪɛɟɧɬɨɜ ɩɟɪɨɪɚɥɶɧɚɹ ɬɟɪɚɩɢɹ ɧɟ ɩɪɨɜɨɞɢɬɫɹ
Ʉɨɥɢɱɟɫɬɜɨ ɪɚɡɨɜɵɯ ɨɛɴɟɦɨɜ ɠɢɞɤɨɫɬɢ ɧɚ ɨɞɢɧ ɩɪɨɦɵɜɧɨɣ ɰɢɤɥ
ɉɪɢ ɨɬɪɚɜɥɟɧɢɢ ɠɢɞɤɢɦ ɜɟɳɟɫɬɜɨɦ - 2 - ɪɚɡɨɜɵɯ ɨɛɴɟɦɚɉɪɢ ɨɬɪɚɜɥɟɧɢɢ ɪɚɫɬɢɬɟɥɶɧɵɦɢ ɜɟɳɟɫɬɜɚɦɢ ɬɚɛɥɟɬɢɪɨɜɚɧɧɵɦɢ ɮɨɪɦɚɦɢ ɥɟɤɚɪɫɬɜɟɧɧɵɯ ɜɟɳɟɫɬɜ ɞɪɭɝɢɦɢ ɜɟɳɟɫɬɜɚɦɢ ɬɜɟɪɞɨɝɨ ɯɚɪɚɤɬɟɪɚ - 3 - ɪɚɡɨɜɵɯ ɨɛɴɟɦɚ
Ɉɛɴɟɦ ɠɢɞɤɨɫɬɢ ɞɥɹ ɩɪɨɦɵɜɚɧɢɹ ɠɟɥɭɞɤɚ
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ȼɨɡɪɚɫɬ |
Ɋɚɡɨɜɵɣ ɨɛɴɟɦ ɦɥ |
Ɇɚɤɫɢɦɚɥɶɧɵɣ ɨɛɴɟɦ ɩɪɨɦɵɜɚɧɢɹ ɦɥ |
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ɇɨɜɨɪɨɠɞɟɧɧɵɟ |
10 - ɦɥ ɤɝ ɜɟɫɚ |
50 - 100 |
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ɧɟɞɟɥɹ ɠɢɡɧɢ |
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ɧɟɞɟɥɹ ɠɢɡɧɢ |
10 - ɦɥ ɤɝ ɜɟɫɚ |
50 - 100 |
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ɧɟɞɟɥɹ ɠɢɡɧɢ |
10 - ɦɥ ɤɝ ɜɟɫɚ |
100 |
- 150 |
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ɧɟɞɟɥɹ ɠɢɡɧɢ |
10 - ɦɥ ɤɝ ɜɟɫɚ |
150 |
- 200 |
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1 |
- ɦɟɫ |
60 – 90 |
200 |
- 250 |
3 |
- ɦɟɫ |
90 - 100 |
300 |
- 400 |
5 |
- ɦɟɫ |
100 - 110 |
400 |
- 500 |
7 |
- ɦɟɫ |
110 - 120 |
600 |
- 700 |
9 |
- ɦɟɫ |
120 - 150 |
800 |
- 900 |
2 |
- ɝɨɞɚ |
200 - 250 |
1000 |
- 1500 |
4 |
- ɥɟɬ |
300 - 350 |
1500 |
- 2000 |
6 |
- ɥɟɬ |
350 - 400 |
2500 |
- 3000 |
8 |
- ɥɟɬ |
400 - 450 |
3500 |
- 4000 |
12 - ɥɟɬ |
450 - 500 |
4000 |
- 4500 |
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254 |
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ɉɪɢɥɨɠɟɧɢɟ
Ɉɩɪɟɞɟɥɟɧɢɟ ɩɥɨɳɚɞɢ ɨɠɨɝɨɜ ɭ ɞɟɬɟɣ ɩɨ Lund ɢ Browder)
ȼɨɡɪɚɫɬ |
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0 |
ɝɨɞ |
ɥɟɬ |
ɥɟɬ |
ɥɟɬ |
Ɉɛɥɚɫɬɶ |
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ɉɨɥɨɜɢɧɚ ɝɨɥɨɜɵ |
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10% |
8,5% |
6,5% |
5% |
4% |
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ɒɟɹ ɡɚɞɧɹɹ ɩɟɪɟɞɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ |
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ɩɨ |
ɩɨ |
ɩɨ |
ɩɨ |
ɩɨ |
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ɉɟɪɟɞɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ ɝɪɭɞɧɨɣ ɤɥɟɬɤɢ ɠɢɜɨɬ |
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18% |
18% |
18% |
18% |
18% |
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Ɂɚɞɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ ɝɪɭɞɧɨɣ ɤɥɟɬɤɢ ɩɨɹɫɧɢɱɧɚɹ ɨɛɥɚɫɬɶ |
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11% |
11% |
11% |
11% |
11% |
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ɉɥɟɱɨ ɡɚɞɧɹɹ ɩɟɪɟɞɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ |
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ɩɨ |
ɩɨ |
ɩɨ |
ɩɨ |
ɩɨ |
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ɉɪɟɞɩɥɟɱɶɟ ɡɚɞɧɹɹ ɩɟɪɟɞɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ |
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ɩɨ |
ɩɨ |
ɩɨ |
ɩɨ |
ɩɨ |
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Ʉɢɫɬɶ ɡɚɞɧɹɹ ɩɟɪɟɞɧɹɹ ɩɨɜɟɪɯɧɨɫɬɶ |
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ɩɨ |
ɩɨ |
ɩɨ |
ɩɨ |
ɩɨ |
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Ʌɚɞɨɧɶ |
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1% |
1% |
1% |
1% |
1% |
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ɉɪɨɦɟɠɧɨɫɬɶ |
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1% |
1% |
1% |
1% |
1% |
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əɝɨɞɢɰɵ |
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ɩɨ |
ɩɨ |
ɩɨ |
ɩɨ |
ɩɨ |
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ɉɨɥɨɜɢɧɚ ɛɟɞɪɚ |
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2,75% |
3,25% |
4% |
4,5% |
4,75% |
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ɉɨɥɨɜɢɧɚ ɝɨɥɟɧɢ |
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2,25% |
2,5% |
2,75% |
3% |
3,25% |
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ɋɬɨɩɚ ɩɨɞɨɲɜɟɧɧɚɹ ɬɵɥɶɧɚɹ ɩɨɜɟɪɯɧɨɫɬɶ |
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1,25% |
1,25% |
1,25% |
1,25% |
1,25% |
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255 |
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ɒɤɚɥɵ ɞɥɹ ɨɰɟɧɤɢ ɢɧɬɟɧɫɢɜɧɨɫɬɢ ɛɨɥɢ |
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ɉɪɢɥɨɠɟɧɢɟ |
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ɇɭɦɟɪɨɥɨɝɢɱɟɫɤɚɹ ɨɰɟɧɨɱɧɚɹ ɲɤɚɥɚ ɇɈɒ |
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ɇɟɫɬɟɪɩɢɦɚɹ ɛɨɥɶ |
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ɇɟɬ ɛɨɥɢ |
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0 |
1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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7 |
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8 |
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9 |
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10 |
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ɰɢɮɪɵ ɜɵɪɚɠɚɸɬɫɹ ɜ ɩɪɨɰɟɧɬɚɯ ɟɞ |
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ȼɢɡɭɚɥɶɧɨ-ɚɧɚɥɨɝɨɜɚɹ ɲɤɚɥɚ ȼȺɒ |
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ɇɟɫɬɟɪɩɢɦɚɹ ɛɨɥɶ |
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ɇɟɬ ɛɨɥɢ |
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Ⱦɢɚɝɧɨɫɬɢɱɟɫɤɢɟ ɤɪɢɬɟɪɢɢ ɢɧɬɟɧɫɢɜɧɨɫɬɢ ɛɨɥɢ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɫɢɦɩɬɨɦɨɜ |
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ɂɧɬɟɧɫɢɜɧɨɫɬɶ |
ȼȺɒ |
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ɉɪɨɹɜɥɟɧɢɟ ɛɨɥɢ ɫɢɦɩɬɨɦɵ |
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Ɋɟɤɨɦɟɧɞɭɟɦɚɹ ɮɚɪɦɚɤɨɬɟɪɚɩɢɹ ɜ ɭɫɥɨɜɢɹɯ |
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ɛɨɥɟɜɨɝɨ |
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ɢɥɢ |
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ɞɨɝɨɫɩɢɬɚɥɶɧɨɝɨ ɷɬɚɩɚ |
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ɫɢɧɞɪɨɦɚ |
ɇɈɒ |
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Ȼɨɥɢ ɧɟɬ |
0 |
ɀɚɥɨɛ ɧɟɬ |
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Ȼɨɥɶɧɨɣ ɫɩɨɤɨɣɧɨ ɫɨɨɛɳɚɟɬ ɨ ɫɜɨɟɣ ɛɨɥɢ |
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- Ɇɟɬɚɦɢɡɨɥ ɧɚɬɪɢɹ ɦɝ ɜ ɜɟɧɧɨ ɢɥɢ |
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ɫɬɭɩɟɧɶ |
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ɤɨɬɨɪɚɹ ɯɨɪɨɲɨ ɤɭɩɢɪɭɟɬɫɹ ɧɚ - ɱɚɫɨɜ |
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- Ʉɟɬɨɪɨɥɚɤ ɦɝ ɜ ɦɵɲɟɱɧɨ ɢɥɢ |
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ɞɨ 40% |
ɩɚɪɚɰɟɬɚɦɨɥɨɦ ɚɧɚɥɶɝɢɧɨɦ ɢɥɢ ɫɪɟɞɧɢɦɢ ɞɨɡɚɦɢ |
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- Ɍɪɚɦɚɞɨɥ ɦɝ ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ* ɢɥɢ |
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ɫɥɚɛɚɹ ɛɨɥɶ |
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ɇɉȼɋ ɧɨɱɧɨɣ ɫɨɧ ɧɟ ɧɚɪɭɲɟɧ ɢɡ-ɡɚ ɛɨɥɢ |
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- Ɍɪɚɦɚɞɨɥ ɦɝ ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ* ɢ |
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ɉɚɪɚɰɟɬɚɦɨɥ - ɦɝ ɜɧɭɬɪɶ |
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ɫɬɭɩɟɧɶ |
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ɉɚɪɚɰɟɬɚɦɨɥ ɚɧɚɥɶɝɢɧ ɢɥɢ ɫɪɟɞɧɢɟ ɞɨɡɵ ɇɉȼɋ |
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- Ɍɪɚɦɚɞɨɥ ɦɝ ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ* ɢɥɢ |
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ɭɦɟɪɟɧɧɚɹ |
40-70% |
ɦɚɥɨɷɮɮɟɤɬɢɜɧɵ ɧɟ ɛɨɥɟɟ - ɱɚɫɨɜ ɧɨɱɧɨɣ ɫɨɧ |
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- Ɍɪɚɦɚɞɨɥ ɦɝ ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ* ɢ |
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ɛɨɥɶ |
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ɧɚɪɭɲɟɧ ɩɪɢɫɬɭɩɚɦɢ ɛɨɥɢ |
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ɉɚɪɚɰɟɬɚɦɨɥ - ɦɝ ɜɧɭɬɪɶ |
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ɫɬɭɩɟɧɶ |
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Ɍɪɚɦɚɞɨɥ ɜ ɤɨɦɛɢɧɚɰɢɢ ɫ ɩɚɪɚɰɟɬɚɦɨɥɨɦ ɢɥɢ |
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- Ɇɨɪɮɢɧ - ɦɝ ɜ ɜɟɧɧɨ ɢɥɢ ɜ ɦɵɲɟɱɧɨ* |
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ɛɨɥɟɟ |
ɚɧɚɥɶɝɢɧɨɦ ɢɥɢ ɇɉȼɋ – ɦɚɥɨɷɮɮɟɤɬɢɜɟɧ ɛɨɥɶ |
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ɫɢɥɶɧɚɹ ɛɨɥɶ |
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70% |
ɜɵɡɵɜɚɟɬ ɫɬɪɚɞɚɧɢɟ ɭ ɩɚɰɢɟɧɬɚ ɩɪɢ |
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ɜɨɫɩɨɦɢɧɚɧɢɢ ɨ ɧɟɣ ɧɚɪɭɲɚɟɬ ɟɝɨ ɧɨɱɧɨɣ ɫɨɧ |
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ɫɬɭɩɟɧɶ |
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Ȼɨɥɶɧɨɣ ɧɚ ɦɨɦɟɧɬ ɨɫɦɨɬɪɚ ɦɟɱɟɬɫɹ ɫɬɨɧɟɬ |
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100% |
ɫɬɪɚɞɚɟɬ ɨɬ ɫɢɥɶɧɟɣɲɟɣ ɛɨɥɢ ɩɪɢɧɢɦɚɟɬ |
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ɧɟɫɬɟɪɩɢɦɚɹ |
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ɜɵɧɭɠɞɟɧɧɨɟ ɩɨɥɨɠɟɧɢɟ |
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ɛɨɥɶ |
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ɇɟɨɛɯɨɞɢɦɚ ɧɟɨɬɥɨɠɧɚɹ ɩɨɦɨɳɶ |
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* ɉɪɟɞɩɨɱɬɢɬɟɥɶɧɵɦ ɩɭɬɟɦ ɜɜɟɞɟɧɢɹ ɩɪɟɩɚɪɚɬɨɜ ɹɜɥɹɟɬɫɹ ɜɧɭɬɪɢɜɟɧɧɵɣ
256
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ɉɪɢɥɨɠɟɧɢɟ |
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ɈɋɌɊȺə ȾɕɏȺɌȿɅɖɇȺə ɇȿȾɈɋɌȺɌɈɑɇɈɋɌɖ |
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ɩɨ Ʉɚɫɫɢɥɸ ȼ Ʌ ɝ |
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ɍɪɨɜɟɧɶ |
ɑȾȾ |
ɐɜɟɬ ɤɨɠɧɵɯ |
ɑɋɋ |
ȺȾ |
SpO2 ɧɚ ɮɨɧɟ |
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ɫɨɡɧɚɧɢɹ |
ɩɨɤɪɨɜɨɜ |
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ɨɤɫɢɝɟɧɨɬɟɪɚɩɢɢ |
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ɇɨɪɦɚ |
əɫɧɨɟ |
12 - 16 |
Ɉɛɵɱɧɨɣ ɨɤɪɚɫɤɢ |
ɇɨɪɦɚ |
ɇɨɪɦɚ |
96 - 99 |
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Ȼɥɟɞɧɨɫɬɶ |
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ɇɨɪɦɚ |
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ɈȾɇ I |
əɫɧɨɟ |
14 - 20 |
100 - 110 |
ɭɦɟɪɟɧɧɚɹ |
92 - 95 |
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ɭɦɟɪɟɧɧɵɣ ɰɢɚɧɨɡ |
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ɝɢɩɟɪɬɟɧɡɢɹ |
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Ɇɨɠɟɬ ɛɵɬɶ |
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ɍɦɟɪɟɧɧɚɹ |
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ɈȾɇ II |
ɜɨɡɛɭɠɞɟɧɢɟ |
20 - 30 |
ɐɢɚɧɨɡ |
110 - 120 |
90 - 92 |
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ɝɢɩɟɪɬɟɧɡɢɹ |
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ɚɝɪɟɫɫɢɜɧɨɫɬɶ |
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ɈȾɇ III |
ɋɩɭɬɚɧɧɨɫɬɶ |
30 - 40 |
ȼɵɪɚɠɟɧɧɵɣ |
120 - 140 |
Ƚɢɩɟɪɬɟɧɡɢɹ |
85 - 90 |
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ɨɝɥɭɲɟɧɢɟ |
ɰɢɚɧɨɡ |
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Ƚɢɩɨɤɫɢɱɟɫɤɚɹ |
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©Ɇɪɚɦɨɪɧɵɣ |
> 140 ɢɥɢ < 60, |
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ɈȾɇ IV |
ɤɨɦɚ ɫɭɞɨɪɨɝɢ |
> 40 |
ɜɨɡɦɨɠɧɚ |
Ƚɢɩɨɬɟɧɡɢɹ |
< 85 |
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ɰɢɚɧɨɡª |
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ɦɢɞɪɢɚɡ |
< 8 |
ɚɪɢɬɦɢɹ |
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257 |
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ɉɪɢɥɨɠɟɧɢɟ
ɒɤɚɥɚ ɨɰɟɧɤɢ ɜɟɪɨɹɬɧɨɫɬɢ ɌɗɅȺ (Revised Geneva Score)
ɉɪɢɡɧɚɤ |
Ȼɚɥɥɵ |
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ȼɨɡɪɚɫɬ ɫɬɚɪɲɟ ɥɟɬ |
+1 |
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Ɍɪɨɦɛɨɡ ɝɥɭɛɨɤɢɯ ɜɟɧ ɢɥɢ ɌɗɅȺ ɜ ɚɧɚɦɧɟɡɟ |
+3 |
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ɏɢɪɭɪɝɢɱɟɫɤɨɟ ɜɦɟɲɚɬɟɥɶɫɬɜɨ ɢɥɢ ɬɪɚɜɦɚ ɜ ɬɟɱɟɧɢɟ ɦɟɫɹɰɚ |
+2 |
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Ⱥɤɬɢɜɧɚɹ ɡɥɨɤɚɱɟɫɬɜɟɧɧɚɹ ɨɩɭɯɨɥɶ |
+2 |
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Ȼɨɥɶ ɜ ɨɞɧɨɣ ɧɨɝɟ |
+3 |
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Ʉɪɨɜɨɯɚɪɤɚɧɶɟ |
+2 |
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ɑɋɋ - ɜ ɦɢɧɭɬɭ |
+3 |
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ɑɋɋ ɛɨɥɟɟ ɜ ɦɢɧɭɬɭ |
+5 |
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Ȼɨɥɶ ɩɪɢ ɩɚɥɶɩɚɰɢɢ ɢɥɢ ɨɬɟɤ ɨɞɧɨɣ ɢɡ ɧɢɠɧɢɯ ɤɨɧɟɱɧɨɫɬɟɣ |
+4 |
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Ʉɥɢɧɢɱɟɫɤɚɹ ɜɟɪɨɹɬɧɨɫɬɶ |
ɋɭɦɦɚ ɛɚɥɥɨɜ |
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ɇɢɡɤɚɹ |
0 - 3 |
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ɋɪɟɞɧɹɹ |
4 - 10 |
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ȼɵɫɨɤɚɹ |
ɛɚɥɥɨɜ ɢ ɛɨɥɟɟ |
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258 |
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ɉɪɢɥɨɠɟɧɢɟ
ɒɤɚɥɚ ɨɰɟɧɤɢ ɤɥɢɧɢɱɟɫɤɨɝɨ ɫɨɫɬɨɹɧɢɹ ɛɨɥɶɧɨɝɨ ɏɋɇ ɒɈɄɋ ɜ ɦɨɞɢɮɢɤɚɰɢɢ Ɇɚɪɟɟɜɚ ȼ ɘ
ʋ |
ɉɪɢɡɧɚɤ |
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Ʉɨɥɢɱɟɫɬɜɨ ɛɚɥɨɜ |
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0 |
1 |
2 |
3 |
1 |
Ɉɞɵɲɤɚ |
ɧɟɬ |
ɩɪɢ ɧɚɝɪɭɡɤɟ |
ɜ ɩɨɤɨɟ |
- |
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2 |
ɂɡɦɟɧɢɥɫɹ ɥɢ ɡɚ |
ɧɟɬ |
ɭɜɟɥɢɱɢɥɫɹ |
- |
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ɩɨɫɥɟɞɧɸɸ ɧɟɞɟɥɸ ɜɟɫ |
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3 |
ɀɚɥɨɛɵ ɧɚ ɩɟɪɟɛɨɢ ɜ |
ɧɟɬ |
ɟɫɬɶ |
- |
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ɪɚɛɨɬɟ ɫɟɪɞɰɚ |
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4 |
ȼ ɤɚɤɨɦ ɩɨɥɨɠɟɧɢɢ |
ɝɨɪɢɡɨɧɬɚɥɶɧɨɦ |
ɫ ɩɪɢɩɨɞɧɹɬɵɦ |
ɫ ɩɪɢɩɨɞɧɹɬɵɦ ɝɨɥɨɜɧɵɦ |
ɫɢɞɹ |
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ɧɚɯɨɞɢɬɫɹ ɜ ɩɨɫɬɟɥɢ |
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ɝɨɥɨɜɧɵɦ ɤɨɧɰɨɦ |
ɤɨɧɰɨɦ ɩɨɞɭɲɤɢ ɩɥɸɫ |
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ɩɨɞɭɲɤɢ |
ɩɪɨɫɵɩɚɟɬɫɹ ɨɬ ɭɞɭɲɶɹ |
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5 |
ɇɚɛɭɯɲɢɟ ɲɟɣɧɵɟ ɜɟɧɵ |
ɧɟɬ |
ɥɟɠɚ |
ɫɬɨɹ |
- |
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6 |
ɏɪɢɩɵ ɜ ɥɟɝɤɢɯ |
ɧɟɬ |
ɧɢɠɧɢɟ ɨɬɞɟɥɵ ɞɨ |
ɞɨ ɥɨɩɚɬɨɤ ɞɨ |
ɧɚɞ ɜɫɟɣ |
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1/3) |
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ɩɨɜɟɪɯɧɨɫɬɶɸ |
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ɥɟɝɤɢɯ |
7 |
ɇɚɥɢɱɢɟ ɪɢɬɦɚ ɝɚɥɨɩɚ |
ɧɟɬ |
ɟɫɬɶ |
- |
- |
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8 |
ɉɟɱɟɧɶ |
ɧɟ ɭɜɟɥɢɱɟɧɚ |
ɭɜɟɥɢɱɟɧɚ ɞɨ ɫɦ |
ɭɜɟɥɢɱɟɧɚ ɛɨɥɟɟ ɫɦ |
- |
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9 |
Ɉɬɟɤɢ |
ɧɟɬ |
ɩɚɫɬɨɡɧɨɫɬɶ |
ɨɬɟɤɢ |
ɚɧɚɫɚɪɤɚ |
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10 |
ɍɪɨɜɟɧɶ ɋȺȾ |
> 120 |
100 - 120 |
< 100 |
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Ɇɚɤɫɢɦɚɥɶɧɨɟ ɤɨɥɢɱɟɫɬɜɨ |
ɛɚɥɥɨɜ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɬɟɪɦɢɧɚɥɶɧɨɣ ɫɟɪɞɟɱɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ ɛɚɥɥɨɜ - ɨɬɫɭɬɫɬɜɢɟ |
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ɤɥɢɧɢɱɟɫɤɢɯ ɩɪɢɡɧɚɤɨɜ ɋɇ ɉɨ ɤɥɚɫɫɢɮɢɤɚɰɢɢ 1<+$ (New York Heart Association ɛɨɥɶɧɵɟ ɫ ɎɄ ɫɟɪɞɟɱɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ ɞɨɥɠɧɵ ɢɦɟɬɶ ɛɚɥɥɨɜ ɫɨ II ɎɄ - ɨɬ ɞɨ ɛɚɥɥɨɜ ɫ III ɎɄ - ɨɬ ɞɨ ɛɚɥɥɨɜ ɫ IV ɎɄ - ɛɨɥɶɲɟ ɛɚɥɥɨɜ ɉɚɰɢɟɧɬɵ ɫ III - IV ɎɄ - ɩɨɞɥɟɠɚɬ ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ
259