Page 1 cTAHOBt{uIE 3A AI4 CEPTAIIUOHHI/.fr TPYA HA Ha /I

Page 1 cTAHOBt{uIE 3A AI4 CEPTAIIUOHHI/.fr TPYA HA Ha /I

cTAHOBt{uIE
3A
CEPTAIIUOHHI/.fr TPYA HA
/I-p Arasac AHrelon Aranacos ,,po,rs sa KopoHapflur aprepr{aJre,
Kaflrlr{eB cr(op rrpIa pucr(oBa crparn$urcaqaq Ha 6escu[{rrroMnr{
Jrrrqa u
flpu flaqtreHTr.r c rpbAna 6onrca 6es r{3Becrna noponapua 6o,recr
na
crpqero,,
AI4
Ha
za nptgo'ueaHe Ha Hayr{Hara z oopasoaareJlHa crefieH
,,gorcrop,
npoQeczouanHo HanpaB.,,reu ne 7.l. Me1Luurrla _ Haylila
,,Ka
B
cneqfiarHocr
pgIlo,.Iorllflr,
tfnes sa Hayquo xypu :flpoe. Ilnerana
Mapuxora Kr,rona, HKE, Co{ua
l. Arryalnocr
na
rpyra
3a xlrzarlqnara ctofinocr Ha KopouapHlr{ aprepnaJreH Kanur4eB cKop
(CACS - coronary artery calcium ,.o.i; np, acrMrroM,r,
naurre,ra HflMa
KolrceHcyc. Cranoeurla.ra ca ABy[oJr]oc]i:
or r<pafino Herarr4BHr.r (raro Hanpr,uep Xoaan4cr<ara rlKOJra, K'rero He
e
pa3pelrreHo lr3noJr3Banero My 3a ra3v r<areropr,ra nzqa).
AO CrlJrHO nOJrO)r(HTeJrHLr - 3a MHOrO go6para flporrocrrzqHa
croftuocr na
CACS npu 6e:crzunron*r u rut\a, oco6eno ,ar,
,rHTepMr4Ar,repeH pr{cK r4
"
Bb3MoxHocrra vpe: CACS Aa ce HanpaBlr per<lacusrariarlr,
,u pr"nu
flucepraquoriHrrrr rpy,q e [peAcraBeH ua 1 7g c:rpauzu]r
20 ra6tu\n u 63 $urypra. Er.l6araorpa$una
rr3TorrHr.rKa,
BKrrloqBa
or Kotzro 9 na xupunuqa u 363 Ha rraruluua.
Jlzreparypnaxr
14
e ouameAeH c
372
nureparypuw
o6:op
Ha[paBeH oT Ar{CepTaHTa JIOKA3BA MHOfO
sa4nr6oueno rro3uaBaHe Ha Havqrr.rre NOCTIIXCHIItr B Ta3n
o5:racr c
ge$unapaue Ha He- peilIeHII BT,[pOCtr, KOI4TO CA
H npeA[OCTaBKa 3a
rrpoBe)KAaHe Ha HacTofitrJoTo fipoyqBaHe.
1. Ifpu 6 e s c u.tt n m. o,u uu nu q a ;
- IIp, Jrr.rrlara c Hficlx K6M t4HrepMeAuepeH przcx (FRS 6_90/o\ nsrra
KOHCeHCyc oTHocHo rloKa3aHluTa.
- "Iluncsa Koucencyc orHocHo r43cJreABaHero
BI4coxopr.rcKoBr.r Kareroprl]r .uuqa
2.
llpu
6e: goxaaaua tr{BC.
cuM.nmouHu na4ueHm.u 6es useecmuq. !rIEC;
Ha CACS
npr4
- Hslaa
anropaTbM
KoHceHCyc orHocHo EKJlroqBaue.ro
,pu nalJ,re1T[re Cr,c cr.a6a;lHzl
sa
CACS B ..X14aI',lioc.f HqeH
6e: aora:aua l4EC.
cHM,T,ON,rarHxa
5) lle,.r n raaaqu
I-lelra e .acro $opruy,rrapaua.
,,[a ce upoyull Mrcroro Ha rl3cneABaHero 3a KopoHapeH aprepHa-rreH xa-,rqizia
ripl{ p}rcKoBara crpatlrr}axa\hf He 6escr4A4nror4H 14 JtUlrA C pa3.[].lqHa
pHCKOBa
xapa*Tepucrr4Ka 14 fipn crzMlrroMHr.i riauueHT, C fp'rHa 60:rxa
6ea ]43Becr,a
I{BC." KoHrp ern3npaHt ca 8 sana.ru.
!a ce ycraHoBa rrecrorara
Ha CACS:0 npu pa3rrzqHrire p,c*oBrr
Kareropz[, 6e:cielrnrouu u Jtu\a
2. {a ce onpe4enrl npeAcKa3Bairara crofiaocr sa cACS
3a Har,r{i4e Ha
o6crpyxrlmua KopoHapHa 6olecr.
J. [a ce ycraHoBu qecrorara ua pex.r:aca$zKarln, cnope.q
croiisocrure ua
CACS npa 6e:czlrnrolrsr4Te nurla c Hrrc:br x c r4HTepMeAnepeH prlcr .
4. [a ce zac,reABa AuarHoc'tvs*ara croiinocr Ha GACS 6escu^anroMHa
lurla 6es r43BecrHa trIBC: r,ana4a ,l Br,3pacrHr.r; c napo(cr43MarHo
flpe.qclpAHo MtxAeHe, 6esc rzvnrou uu gu a6 eruqa.
5. ,{a ce lrscregBa nperar(Tr{Buata crofiuocr ua cACS 3a Ha,-rraqrre
na l{EC
B cpaBHeHrre c EKI n nor<ofi u EKI crpec recr.
6. [a ce a*urLl3Lrpar $axropure BJrH{erq,, ua crofiuocrare na E[ c onreA
nocTzraHe peAyr(qa, Ha eKcfro3tlqu_,rTa Ha I4oHu3r4paqa pa!uaL\ufl .
Ocrana;rure ABe 3aAaqu 3Byrlar rBbpAe art6zquosuo 3a roBa HavqHo
1_
Ir3Cr'IeIBaHe.
Z:pa6oreane
Ha
AI,iarHocTHr{eH aJItOpl.tTbM
cHMnTOMHtt [aIdaeHTH 6es r.r:secrua tr4EC npega
o6pasH r.r v3c tre 2.Ba:nr4fl
3a
rIoBeAeHHe fipv
npoBexlaHero Ha Apyrr.l
{a ce norlpct4 r{operaqr'i, N.rexAy perucrp upaHure npoMeHa B neqeHaero,
qecToTaTa Ha npoBeAeHHTe
u pe TcTpHpaHr4Te CbpAeqHo
c:sloBa cr6wrus rrpe3 nepuoAa 'r3cneABalF.ufl
Ha fipocneAsBaue a Hararr]lero ua KAK.
3a ue,rure Ha Hayr'rHoro npoyqBaHe ca a3creABaHr.i 433 n ocLieroea.reJrl'4
raq[reHTr'r, [p]l Kor4To e rrpoBeAeHo KT a:c;re4aar.re Ha cbprJero. Eo,rur.,rre
ca
pa3AeneHlr Ha nBe fpynH:
Eegclrvnrousv n r\a c noHe eAr4H pr4cKoB saxrop, HacorreH 3a cKprHHHr.
3a KopoHapHa 6oaecr (n:225).
Cl.runrolrur
naqr.teHTr4
c r-pr,AHa 6olra
flo.ilo3ripaHo r.raJTr.rq[ero rra raKaBa (n:208
).
6e:t rr3Becrrra i4EC"
nplr t{oHt.o e
clnopell o6ruonpzerur e Kpurepwu e orltereHo Han,\irIe-i<.:'
Ltnu Jt,rTca.ra Ha
r e onpelereH Io_ro4uruHul pucK .]a norBa Ha
tr4EC c
npr4iraraHe'o ua Fra,ringha, Risk score (FRS).
nu\a,a c r 0-.oanure, pr"*
<6Yo ca xaa.crad;uuupaH, Karo Hr,c*opr.rc*oB
u. Ilpu 6_9o/o - pucrca, *-.'o"f ,.rrpo
Karo Hr4cr,i< Kr,M xHTepMeAi4epeH, a pu pucK l
O_20% - nuro ,nrapr"rr"p"r"
l laqaenrure c l 0-ro.qzxleH pucx >20yo
ce xtacu$ut1up",
Merogare Ha r{3cnelBaHe ca [peAcraBen[ no4po6ao
" ";";;;;;;.^"'
u ,tclo or
gevorpa$crara i, KJrrzr{Hq'a xapa( repr{c'tu.a
Ha r.r3cJreABaHzre laqa, EKf z
crpec EKI- 4o nogpo6uo on,caHara (oMrrrorr,pHa
rouorpa$rza: Kounrorsp
rouorpa(lcra KopoHaDHa anraornaf r_r c-!el oxpelc,laitc?o
i;a CACS ,cr
MeroAr.r*ara Ha Agatston. B 3aBr4cr,Mocr
or crofiuocrra ua GACS
KJrac,rrecKr.rre p@
I43CJICABAHL,TC
II4I]A
CC X,TACZQITqTPAT B C..HA OT CNCAHI,TC
KATC.OPI4H:
CACS:o,
CACS I-99, CACS 100-3St r bACS>400. rlpu ecsxo
KT u3creABaHe e
olpeAeleHa paAriaLIr4oHHaTa lo3a
Craracru.lecrl4Te MeroIt4 ca orITI,iMaJIHo no46paHa.
Te sxrlo.rear
AecKpr.lnrnBeH, BapnaUHoHeH a rpa(;aueu a*u-tri3l Tecr
Ha @Nurep,
Crro4rur u Apyrr4. Wzlpauuri L, uuropu crarr4cr r{ecKa t-Tecr Ha.
MeroAr4 My
rro3Bo:r{Bar ga o6pa6oru AaHHrrre, Kor4To e cr,6par
, ,, or.oufr, nu
nocTaBeHIlTe 3aI.AIq14.
3a o6pa6orxa Ha.qaHHHTe or flpoyrrBaHero, ctsr,p3aHo
c AnceprauuoHHara
pa6ora, e r43noJr3BaH
naxer IBM,
(Statistical Package for "rurr""rr""n,
".p"rrru ,u' SpiS f O.O.
Social Science)
r. Perv.nrarr
Pesy,rrarxre or npoyr{BaHero ca npeAcraBeHu ,cHo rz ca
vuoro go6pe
cra6turlu u $urypu.
Anroprr cpaBHrBa plicKoBara xapaxTeplrcraKa Ha yqacrHrzture B
oHarureAeHr.
EpoyqBaHeTO C Ta3H OT roJreMr4Te cTy
AUt4 KaTO yCTaHOB
acFia TeHAeHUA' 3a
'rBa
erHa no o6peueneHa c Kracflqecxure p@ non.,
r.r,repMeAriepeH przc* rronaAar lBe.rperr4
80/o
or
uscne4BaHr4Te ce r:racaorzuupar
r""l:;XhJil-i
rIffiXffi;
"r raKuBa c Hrc6K (FRS<6%)
Karo
unu
Br,rcoK pt4cK (FRS>20%), r.e. HerroKa3 aHu 3a
CACS cxpraurn.
npenop'Kt4Te sa ACC/AIIA. HeoqaxeaHo, orHocrrrerHr{rr
"nop.o
rrJr Ha .irr{uara
c
CACS:0 ce ora3Ba czrHa$r.rxaHruo Eo_BHCoK B Kareropt .qra
riHTepMeAr.{epeH
pncr( B cpaBHeHr4e c KaTeropHrTa Hr{c.r,K K1,M r.rHTepMeAr.repeH
pr4cK
rlorerpxlarar ce r'r3BecrH,Te Bpib3l(r.i Ha Karrur4eBl,r, c(op c r,on. tsb3pacr."
paca, pr{cr(oB14 Qar<ropu
B npoyreauarra
rz3creABa
{}r npeAr4rir}reuara cror;Hocr- na CACS rrpu
u nu\a o6i*raii,o He e r'pceHa (openaul, c a'rrorpaQrcxara
raro c,'reA o[peAerx flHe Ha cACS ne e [poBe)KraHa KTKA unrz
tr4KA. Aeroptr HaMHpa creAHr,Te 3aBnc,Mocrr,r: llpr.r lr.rqa:ra
c H[4cr,K r{.r,M
r.HTepr{eAaeper-i pr,c* CACS:0 ,i3*r}ortBa r"raJruqr4ero
Ha KOpOHapHa 60.necr..
6escuN4nrol4u
HaxoAKa, rr,fi
l{eeacora Bepor,Hoc', (' 17a/,,) 3a }raJ,{q,e na
o6c r.pyr<-r.rz,Ha r(oporaplra 6o,rec.r
t,.Ma pu CACS>,00. llpu CACS>I00 npl.r BC.KTJ
rperri ,iMa BeporrHoc.r. 3a
HarurTue rua cretlaza} 50ya.
fio*aro HerarrrB,ar.a
npeAcr(a3Ba,la crofisocr. (Hnc) :a EI{r- pErI
e
ro IIIC fi r{yBcrBr4renHocrra HM e AocroBepHo no_Hr4c(a r
:?!:!%,
or
ra3r4
rra
CACS recra. Ho ue rpx6na Ia ce za6paen. ee
r43cnegBaaero Ha CACS rrpu
6e:czvnronna Jrrrua e rporrlocraseH Mapxep, a He
Mero.{ AoKa3BaLq OI46C.
Klanu.luara no,rl3a or onpe4e!.IrHero Ha Ka!.-iuLieB , cxop
B npoyqBaHero,
npoBereHo or r-p AHre,Toe e per<,racnrplrx anlut
Ha r43c,rrelBaHu re r[ua. Or
I7I4I\aTA C HACT,K Kt,M AHTepMe
AilrepeiH pnCX 30o/o Ce nernecurhr;rr*hor D ,r^
Brrco*a pr.rcKoBa Kareropur. B rareropuxru
pex,racu$raqupar c'orBerHo 25yo, a B .ra3u
c Br4coK pucx
Bbnpocbr 3a Mrcroro sa CACS rrpH peKnacr{Oraxallaqra 5ok. Lrl ,Ioxaro
.
aHTepMeAIlepeH pI4cK rl3rJTexAa no-cKopo pe[reH,
To BCe oure He Bcr,r],.u
rrpr4eMaT 3a rroKa3aHo OlpeAenrHeTo My
Epr4 nr{ua c Hr.tcT,K pacK
. ,nr"pr"ord;;;;;_" ";
,u ,rulro
Crofinocrrre Ha CACS u ,poyruur*ro
.
Kope,,u4
par c arlruorpa$crcara
HAXOIKA, KATO JIIAICATA UA ITAK NPAKTATIECKI,T
I,I3KNIOqBA HANI,I]'ICTO gA Otr4EC
npu 6e:calrlroMHa nr4qa, npu CACS> 400 nepoaruocrra
oI4EC
nagxarp.,ra
a
50o%.
:a
Clope4 aBTopa, CACS recrrr Moxe Aa crryxr4 Karo
caoeo6paseH Su:r.r.tp,
i<ofiro 4a AaAe nocoxara 3a Apyru lraruocrt4 qHr4
TecroBe unu ofupaswu
E3CJreABaHrz
npa KoHKperHrz, 6o,reu. [-p Aure.iros npeAnara
anropr.rrtM 3a
noBeleHlre 'rrplr nallr4eHTrz c tptAHa 6olxa c HrrcKa
a yMepeHa rperecr
BeporrHocr 3a Haruque ua o6crpyi<ruBHa KopoHapua
6olecr.
Ho rosll anropllll,M. e rB.bpne cnopeH.
I
[I. Kpurlr.rufi
6e,.ler(rcH:
Br:Hl.tKsa rort,r.rHrlrr Bbirpoc:
cKpr4itr.rHr r7pr4 Jrr4tJa c Huclx prcr?
Brnpexrz, qe
L4Ma
ru
cMi,rc!!,I Aa ce npoBeir(la CACS
aBTopT,T 3arrIHTaBa re3a.ra
3a
no-roJr_gMara
rolr3a
,reSuuzpauero Ha Ka!.rrrr4eBrzq cKop, Jrr{rrHo a3 crra y6e4era. ,";;;;;;;;r*
14 OBTTAAflBAMC EXOK]- B C'BPCMCHHI4TE
II MOIAJIIIOCTI4 KAKTO U flMP BMCCTO
IIOAIaTaMe cBoHTe fla{I4eHTH Ha HeHyxHa, A.{ar(ap
u HefoJTrMa panLrauufl
EXOKI-
B I}ICCPTAUI,IO HE
harr'^i]n11."rvrt,
n^
rIc]I(A?2Te Ilr, 2, 'I3CICABAHE
wvl 1vr!j, r si!
lfl
or.
AA
"
TPYA HC BKJ'IIO.IBA C}BPCMEHI{I4TC
14 I jtouareu aHarlt43 ua JIK
Qyur<qul n
HaroBapeaHe Jlancara Ha rosn aHarr43 He rro3Bor,trBa
.4a ce
nocTrztHe Ao no-Il]aA{u zuroprrTbM na noBe.{eHtre.
norofi
z np
IV. flpunocure.
KATO 3HAIILTMI,I CA:
Korzro ripreMaM
or
.4riceprarlnoHHux rpy.q Ha aBropa
t. 3a ntpsrz nt r s Ebmapr4, e r43cneIBaHa porflra
ua CACS npra
pex:racrz(taraiu.{Ta Ha pajrrLlulu Kareroprra 6esczr4nrolau
u tu4ua: c
Ht4 cI,K K:sM [HTepMeAr{epeH pncK; c
r{HTepMeAr.lepeH pD cK; gua6eru4u
6e: u:eecrua tr4EC; nr,ragra H rro-Br,3pacrHu 6eaczunrou
HLl J7t4tla.
2.
n:sr n El,rrapm e ,r3crre,{BaHa A}rarHocrrrqHara crofrsoct
11 :T""
sa
CACS npz c,MnroMHt4 narJr.teHrr.r c rpbAHa 6o:rra 6e: u:eecrHa
I{EC.
I,lac,relnauara nonyJTaqru e c mupoK B63pacroB
Atana3oll c BIrcoK
oTHOCrrTereH Ifln Ha xeHr,rTe, c Hr4C6K
IO yMepeH pr.rcK, KOeTO [paBH
r{3cJrerBaHara rpyna noAxoAflrqa 3a or_leHKa Ha
npeArrKTr.rBsara
crofrsocr
3.
sa CACS.
llprz 6escur\anroNa'Lt lua c cACS:0 e HaJrr.{qe Mr4Hr4MaJrHa
Beporr'ocr
3a Har.niqrze Ha OL{BC., raro nogo6Ha Kopenaur4.s MexAy
CACS
a
aHruorpa$crara HaxoAKa e Lr3c,,reABaHa B eAi.rH l.r.r HH npoyr{BaHr.rr.
4. llorer,pN4aBa ce re3ara, 3aii.r{TaBaHa or Bce rroBeqe aBTopr{, qe
CACS
crpr4ar.rHrbr e Eoxa3ar{ npra 6escuvnroMnrl nurla crc
3! c ourea
pexlacrzSlixaqua Ha prrcKa, rofiro npa
4ua6erinqu o6r.r.rafiHo ce
5.
HaAIIeHTBa oT KJ'Iacl4rlecKIITe pucKoB14 MOAeJlIr.
E$exraenara Ao3a fionrz:uparqa pa va\fifl npu fi3cneABaHc
Ha CACS 6u
Morna Aa 6tge pe4yqapaHa qpe3 npHJraraHe Ha cr,orBerHH
TexHl4rrecKlr
npzfi otul.
v' Iryo'rulcarluure na Aucepraura, cBlp3aHa c reMara lra rucepraqr4.lrlr*x
rpyA ca 2 z 5rnrapcxu peqeH3upaHu cnucaur.Jrr ria(ro 14 6 uayunu
cao6urerrN;r (4
Ha 6urapcxri KapAuoJroraqau <f opyrrau u 2 ua Erponeficxu
rourpecu).
VI. 3AKJIIOqEHI4E
PeqenszpaHnfl'r Lt4cep-tar\r4oHeH TpyA na
4-p Arauac Anreroe AraHacos
Hocll M,ofo '.oKa3arercrBa B nor'I3a Ha R,ru'uq*ara 3Haqr.IMocr
Ha
4e$rzrutpauero Ha Kzurr1r4eBa, cKop: 3a prrcKoBa crparnsraxaqur, ,u
oarp"o"rrn"
Ha vHALrBLrAyurHr4s' ptlc.K,3a MorI4BLIpaHe Ha npoMeHrrre
B HarraHa Ha )Kr{Bor rl
Ha reparreBT,qeH [o.qxoA. Hauparenar:a KparaKa
HaMarfiBa crofiuoc*.a na
HayqHara pa:pa6orr<a Ha .(-p A.A.Arauacor,
'e Korro e lr3BbprrreHa c
LI3KJrroqr4Te.[Ha MeroArrLt'ocr rz [perlr43Hocr.
Ilpe^craBeHr.rrr rpyl orroBap,
rr3IIrJIo Ea KpI,ITepIrIzre 3a I ceprallr4 oHeH TpyI 3a
noulo6l;iaaHe rr2
'r\/.,uaro r.
o6pasonare-una creleH,,AoKTop".
Toea r\4a [o3Bon_rrBa Aa [peAJroxa Ha q:reHoBere Ha HayrrHoro
)Kypr4 [a
HracyBar noJroxlrrerHo 3a nprrcr,xraHe Ha
Aranac
A-p
Anreros Araru*o u,u
Hayrruara cteu.gE,,Aoirrop,,.
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24.01.2014