Иммунопрофилактика инфекционных болезней

06w.111e np111H~"1nbl neYeHHSI 6onbHblX aHacl>HnaKTHYeCK"1M WOKOM:

1neLte6Hb1e 111 A111arHocn1YecK111e Meponp111sn111fl AOn>t<Hbl npoBO.LJ.lllTbCfl HeMe,LJ.neHHO, He3as111c111Mo oT npocp111nfl neYe6Horo yype>t<,LJ.eHvrn;

2 He,LJ.onycT111Ma TpaHcnopn1pOBKa 6onbHblX AO BblXOAa 1113 WOKa, HeOTnO>KHble MeponplllflTvrn cne,LJ.yeT OKa3blBaTb Ha MeCTe, O,LJ.HaKO 3aTeM, Aa>Ke np111 nerKolll cpopMe, 6onbHble AOn>KHbl Ha6moAaTbCfl s OTAeneH111111 peaH111Maw111111;

3Heo6XOA111MO MaKCl/1ManbHO 6blCTpO oweHl/1Tb CTeneHb npOXOA111MOCTlll ,LJ.b1xarenbHblX nyre111, noKa3aren111 BHewHero AblXaHl!lfl 111 reMoA111HaM111K111;

4lllHOrAa no >Klll3HeHHblM noKa3aHll1flM Heo6XOAll1Ma rpaxeoCTOMlllfl Ill

nepeBOA 6onb Haro Ha V1 Bfl;

5 np111 OCTaHOBKe AblXaHl/15'.l 111 Kposoo6paL.LJ.eH1!1fl ( MOnHll1eHOCHbl~

aHacp111naKTl11YeCKlll~ WOK) HeMeAneHHO np111cTyna10T K cepAeYHO-neroLtHO~

peaH111Maw111111;

66onbHOrO cneAyer ynO>Kll1Tb rop11130HTanbHO, npvmOAHflTb Hlll>KHl!le KOHe4HOCTll1, renno yKpblTb, o6no>Kl11Tb rpenKaMlll 111 nOCTOHHHO ,LJ.aBaTb KlllcnopoA;

7o6KonoTb Mecro 111HbeKw111111 0 ,3 -0 ,4 Mn 0,1% pacrsopa aApeHan111Ha r111Apoxnop111Aa (3n111Hecpp111Ha) 111 np111no>t<111Tb neA;

8pa3secr111 0,1-0,3 Mn 0,1 % pacrsopa a.o,peHan111Ha s 10 Mn 1113oroH111L.JecKoro pacraopa Harp111H xnop111Aa 111 BBOAll1Tb sHyrp111seHHO 5-10 M111H, np111 Heo6xoA111Mocr111 AOnonH111renbHO ssecr111 0,1-0,3 Mn 0,1 % pacrsopa aApeHan111Ha s 200-300 Mn 1113oroH111L.JecKoro pacrsopa Harp111H xnop111Aa

sHyrp111seHHO KanenbHO nosropHH sseAeHlllfl Ka>t<Ab1e 10-15 Ml!IH, HO L.Jro6b1

rntoKOKopr111Ko111,LJ.b1 ( IKC): npeAHlll3onoH AO 5- 10 Mr/Kr 111n111 r111ApOKOpTV130H

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Vl3 pacYera 7-10 Mr/Kr noerop~rn np111 Heo6XOAVIMOCTVI Ka>KJJ-ble 6 Y;

10BHyrp111seHHO crpyiitHo BBOAHT 250 Mil 5 % pacrsopa anb6yM1t1Ha 1tU1111 300 Mil HaTVIBHOLit nna3Mbl, a 3aTeM 1000 Mil nOAOrpeTblX AO TeMneparypbl Tena

conesb1x pacrsopos;

11np111 pa3BVITVIV1 oreKa nerKVIX, M03ra A03Y rn10K0Kopr1t1KOV1AOB HY>KHO ysenVIYVITb, B TO >Ke BpeMs:i AVlypeTVIKVI Ha cpoHe KonnanTOVIAHOro COCTOflHVlfl npOTVIBOnoKa3aHbl;

12np111 cyAopo>KHOM CVIHAPOMe, conposo>1<Aa10w_eMcfl CVIIlbHblM so36y>1<- ,o,eHV1eM, so3MO>KHo sse,o,eH111e sHyrp111seHHo 2,5-S Mr (1-2 Mn) Aponep111,o,ona;

13npVI HDKeflOM VI MOJlHVleHOCHOM aHacp111naKTW-leCKOM WOKe AJlfl 6b1crporo ysen111YeHV1fl OUK sHyrp111seHHO crpyiitHo BBOAHT 250 Mn 5 % pacrsopa anb6yMV1Ha VI 3aTeM rJ1IOK030-COJleBble pacrsopbl B KOilVIYeCTBe AO 3-6 n111rpos s cyrK111 Aflfl noMep>1<aHV1fl c111cron111YecKoro AA He H1t1>1<e 100 MM.pr.er;

14npvi 6poHxocna3Me ~ He3HaYvnenbHOiil aprep111anbHOiil r111noreH3VIVI BHyrp111seHHO BBOA~n 10 Mn 2,4 % pacrsopa 3ycp1t1n11111Ha 1.-1111.-1 V1Hran11L.1,1t10HHO canb6yraMon;

15aHTVlrV1CTaMV1HHble npenapaTbl BBOAHT BHYTPll1BeHHO, OAHaKO VIX

npV1MeHeHV1e orpaHVIYeHO B03MO>KHblM r111noreH3VIBHblM 3cpcpeKTOM. YKa3aHHblill BblWe anroplllTM BeAeHvrn 6onbHblX c aHacp111naKTV1YeCKVIM WOKOM

s nonHoM o6beMe Bb1nonHV1M s ycnos11rnx or,o,eneHVlfl peaH1t1Mau,111111 111n111 nanaTbl 111HT€HCVIBHOiil repan1t1111. 3aYaCTYIO >Ke VICXOA Tfl>KeJlblX nocrsaKL.1,VIHaJlbHblX OCilO>KHeHviill 3aBVICVIT OT nepsoiil ,o,ospaYe6Hoiil nOMO~VI, OKa3aHHOiil Ha ,D,OMY VIIlVI ,o,a>Ke 8 noneBblX ycnOBVIHX. ,lJ.Jlfl 3TOro anreYKa CKOpoiil noMOLLI_VI, peKOMeH- ,D,OBaHHafl Afls:I co3HarenbHblX po,o,t11rene111, ,o,on:>KHa coAep>KaTb rn101<opr1111<0111A, npenapar 3n1t1Hecpp111Ha (a,o,peHan111Ha r111,o,poxnop111,o,) vi 6b1crpo,o,eiilcrsy10w_ee aHTlt1flt1CTaMVIHHOe cpeACTBO 8 KannflX. noAKO>KHOe sse,o,eHVle 3nV1Hecpp1t1Ha y>Ke ycrapeno, T.K. 1113-3a CHVl>KeHVlfl KpOBOCHa6>1<eHV1s:I KO>KVI, MaKCll1MaJlbHafl KOHU,eHrpau.1t1fl s Kpos111 y Aereilt ,o,ocrviraercs:i Yepe3 34 MVIHYTbl, ror,o,a KaK no- cne s/ M sseAeHVlfl y>1<e Ha 8 M1t1Hyre.

3cpcpeKTVIBHblM lt1 y,o,o6HblM B 111cnonb30BaHVIVI npVI HeOTJlO>KHblX COCTOHHVIHX Ha AOfOCnVITaJlbHOM 3Tane rnlOKOKOpTVIKOlt1AOM flBJls:leTCfl npe,D,HV130H B cseYax ( PeKro,o,enbr 100/ RECTODELT 100). O,o,111H cynno311nop111iil co,o,ep>K111r 100 Mr npe,o,HV130Ha; scnoMorarenbHoe sew_ecrso - rsep,o,b1tl1 >KVlp. npenapar npviMeHHIOT AeTflM CTapwe 6 MeCflU,eB. npe,D,HVl30H - fJllOKOKOpTLllKOVIA, KOTOpbliil He COJJ,ep>KVIT cprop, npeAHa3HaYeH AJlfl CVICTeMHOro npt11MeHeHV1fl, 0611a,o,aer ,D,0303aBVICVIMblM 3cpcpeKTOM Ha Mera60J1Vl3M npaKTVILJeCKVI scex TKaHeiil. no CKOpOCTVI scaCblBaHVlfl B KpOBOTOK peKTaJlbHafl cpopMa rKC onepe>Kaer scaCblBaHVle ra6ner111posaHHblX cpopM . nocne sse,o,eH111fl npeAH11130H 6btCTpo Mera6on1113vipyercfl s npeAHVl3onoH. B o6w_eM npe,o,HVl30H ll1 npeAHVl3onoH s opraHVl3Me B3all1MHO npespaw_arbCH Apyr s Apyra, np111 3TOM 6onbwy10 YaCTb COCTaBnfleT npeAHVl30JlOH.

A6con10rHas:i 61110AoCTynHoCTb cynno3111rop111es PeKro,o,enbT 100 cocrasnf!eT

50

OKOJlO 29%'YTO no3BOJ1SleT 6e3 onaceHitii71 pacCYit!TblBaTb neAV1aTpw-1eCKitie A03bl npenapara . npenapaT Ha3HaYaeTC5l, KaK npas111no, OAll1H pa3 B CYTKV1, a ero A03111posaHV1e npaKTV1YeCKV1 yHV1BepcanbHO He3aBV1CV1MO or so3paaa V1 seca pe6eHKa. no TH>KeCT111 coCT05lHvrn, np111 3HaY111TeJ1bHOl71 Macce KpaTHOCTb BBeAeH111H Mo>KeT 6b1Tb ysenV1YeHa 111n111 Bb16paHa raKT111Ka coYeTaHV1H BHyrp111seHHoro 111 peKranbHoro nyr111 sseAeH111H IKC. PeKranbHOe np111MeHeH111e oco6eHHO peKoMeHAyercH ManeHbKll1M AeTHM, Kor,o,a BHYTPV1BeHHoe, BHYTPll1MblweYHoe V1nV1 opanbHOe sse,o,eHV!e IKC y AeTei71 C03Aaer cno>KHOCTll1 V1 AOnonHV1TenbHblV1 apecc.

TH>KenblMV1 c111creMHb1M111 anneprw-1ecK111M111 peaKu,111HM111 3aMeAneHHoro rvma HBnHIOTCH C111HApOM (Tv1BeHCa- ~>KOHCOHa V1 Cll1H,D,pOM nai7tena (TOKCll1Y€CKll1171

3n111,o,eMaJlbHbli71 HeKp0111!13). nocne,D,Hll1Vl OTJlW-laeTGl neTaJlbHOCTblO AO 50- 80%. XapaKrepHblM HBnHeTcH T5l>KenaH 3HAoreHHaH 111HTOKC111Kau,1115l, nopa>KeH111e KO>Kll1, cnl!13111CTblX Ill BHyrpeHHll1X opraHOB. neYeH111e npOBOA111TC5l B ycnOBlllHX peaH111MaU,lllOHHOro OTAeneHll15l : V1HT€HClllBHaH 111Hcpy31110HHa5l repan111H, 3KCTpaKopnopallbHble MeTOAbl ,D,eTOKCl!1KaU,1!11!1, IKC B BblCOKll1X ,D,03aX 111 AOnOJlHv1TeJlbHO MeCTHO B o6naCTlll 1113bH3BneH111il1 Ha KO>Ke Ill CJ11113111CTblX ( rna3a, MOYenonosa5l c111creMa), aHr1116aKrep111anbHaH repan111H w111p0Koro cneKrpa Ael!1CTBll15l.

np111 r111raHTCKOVl Kpanll1BHll1LJ,€ - OTeKe KB111HKe - OTeK pacnpOCTpaHH€TCSl Ha rny6oKO ne>Kall.tll1€ OTA€Jlbl KO>KVI ll1 nO,D,KO>KHOi7t KJl€TYaTKV1. AHrlllOH€BpOTV1Lj€(KV1171 OTeK KBlllHKe, KaK V1 Kpanll1BHV1LJ,a, Hap51AY c KO>Kei71 MO>KeT JlOKaJlVl30BaTbGl Ha cnll13111CTbl X o6onOYKax, HapywaH cpyHKU,llllO pa3JlW-IHblX opraHOB V1 Cll!CT€M. np111 OTeKe ropTaHl!1 B03MO>KHO 3aTpyAH€Hll1e AblXaHlllSl BnJlOTb AO accp111Kc111vi, np111 n0Kan1113au,111111 Ha cnll13111CTblX o6onoYKax Apyr111x opraHos - All13yp111YecK111e s:rnneH1t15l, c111MnTOMbl ocrporo racrpo3HTep111ra, HenpoxoA111Mocr111 Kll1W€'-IHl!1Ka.O TeK KB111HKe, KaK Ill Kpanll1BHll1U,a, A€P>Klll TCSl OT HeCKOJlbKlllX YaCOB AO HeCKOJlbKlllX cyTOK Ill 111CYe3aeT 6eccneAHO.

B cnyYas:ix oreKa ropraH111, a6,o,oM111HanbHoro C111HAPOMa np111 oreKe Ks111HKe BBOASH 0,5 Mfl 0,1 % paCTBOpa a,LJ.peHaJllllHa Ill 1 MJl 5 % pacrsopa 3cp€AP111Ha. noKa3aHbl rKC: r111,D,pOKOpT11130H, npe)J.Hll130Jl0H BHYTPll1BeHHO KanenbHO 111n111

BHYTPlllMblWeLtHO, npeAH11130H (PeKTOAeflbT 100) peKranbHO.

np111 OTeKaX KB111HKe C IlOKaJ11113a LJ,111€Vl B o6naCTlll ropTaHll1 )J.OnOJlHll1T€JlbHO rpe6yercH ,o,er111,o,parau,1110HHas:i repanvrn : 2 Mn na3111Kca Ha 20 Mn 20 % pacrsopa rnt0K03bl sHyrp111seHHo . np111 HapaaaH111111 accp111Kc111111 111 orcyrcrsL-1111 3cpcpeKra or nposo,LJ.111Mo111 repa n 111111 noKa3aHa rpaxeocroM111H.

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