?????????? ??? ???????????? / ??????????????? ?????? ? ??????? / ? ??????????????? ???????? ???????????? ?????????? ? ??????????? ?????????? ? ??????? ????????? ????????, ?????????? ????????? ?????????? ?????????????.

Дата: 2009-06-09 21:54

? ??????????????? ???????? ???????????? ?????????? ? ??????????? ?????????? ? ??????? ????????? ????????, ?????????? ????????? ?????????? ?????????????.

??????????????? ???????? ??????????????? ???????????? ????????? ????? – ?????????? ???????????? ?????????? (??) ? ??????????? ?????????? (??), ??????????? ? ??????? ?????? ????????? ???????? ? ???????? ???????? ST (???ST), ???????????? ?????????? ??????????? ??????????? ????????????? (???), ???????? ?? ????????????. ????? ??????? ??? ???????? ????????? ?????? ?????? ?????????????????? ???????? ??????? ???????????? ???????????? APEX AMI.
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– ????????????? (pexelizumab) ??? ???????; ????????? ???????? ?????? – ?????????? ??????, ????????????? ????, ????????? ????????? ??????????????? ????? 30 ? 90 ?????.
??? ?????????? ??????? ????????? ???? ????????? ?? ??????: ??? ??/??; ? ?????????????????? ??/?? ? ????? ????? ?? ??? ????? ???; ? ??/?? ?? ????????? ??? (?????? ??/??); ??/??, ??????????? ????? ????????? ??? (??????? ??/??).
??????????????? ???????????? ??????? ???????????????? ? 329 (5,7%) ?????????? ????????????, ? 90% ??????? – ? ?????? 48 ????? ?? ?????? ???????????. ?????? ??/?? ???????? ? 205 ????????? (? 25 – ?? ?????? ????????????? ??????), ??????? ??/?? – ? 117 ??????? (? 70% ??????? – ? ?????? 48 ????? ???????????).
??????? ???????????? ???????, ??????????????? ? ????? ????? ??????????????, ?????????????? ??????????? ????? ??????? 90-??????? ???????????: 23,2% ?????? 3,6% ? ??? ??? ??/?? (????????????????? ????????? ?????? [???] – 3,63; 95% ????????????? ???????? [??] 2,59–5,09). ??? ???? ?????? ???? ???? ? ? ??? ? ?????? ??/?? (90-???????? ?????????? – 17,2%; ??? – 2,34; 95% ?? 1,44–3,80), ?, ????????, ? ??????? ? ??????? ??/?? (90-???????? ?????????? – 33,3%; ??? – 5,59; 95% ?? 3,71–8,43). ? ?????????????? ??????? ? ?????????? ?? ???????? ???????-??????????????? ? ???????????????? ???????? ?????????, ?????????? ?????????? ? ?????? ??/??, ?????????: ???????? ??? ????? ??? (0 ??????? ????????? ?? TIMI) (?? – 2,54; 95% ?? 1,93–4,47), ?????? ??????????? ?? (?? – 2,16; 95% ?? 1,58–2,93), ????????? ???????? ???????? ST (?? – 1,39 ?? ?????? 5 ?? ??????????; 95% ?? 1,19–1,63), ??????? ?????????? (?? – 0,88 ?? ?????? 10 ??/??? ??????????; 95% ?? 0,83–0,94), ????? ?? ??????? ???? I (?? – 1,88; 95% ?? 1,29–2,76), ????????????? ???????????? ???????? ??? ??????????? (?? – 0,92 ?? ?????? 10 ?? ??. ??. ??????????; 95% ?? 0,87–0,9, ????? ???? (?? – 1,16 ?? ?????? 10 ?? ??????????; 95% ?? 1,04–1,29) ? ??????? ????????? ?????????? ??? ??????????? ???? 70 ? ?????? (?? – 1,10 ?? ?????? 10 ?????? ? ??????; 95% ?? 1,01–1,20). ?????????, ?????????? ? ????????? ??????? ??/??, ???? ?????????: ????????????? ???????????? ???????? ??? ??????????? (?? – 0,83 ?? ?????? 10 ?? ??. ??. ??????????; 95% ?? 0,76–0,91), ??????????? ???????? ST ? ???????? ????? ??? ????? 70% ?? ????????? (?? – 3,17; 95% ?? 1,60–6,2, ??????? ????????? ?????????? ??? ??????????? ???? 70 ? ?????? (?? – 1,20 ?? ?????? 10 ?????? ? ??????; 95% ?? 1,08–1,33), ????????? ???????? ???????? ST ??? ??????????? (?? – 1,43 ?? ?????? 5 ?? ??????????; 95% ?? 1,14–1,79), ???????? ??? ????? ??? (?? – 2,12; 95% ?? 1,20–3,75), ??????? ????????? ?? ??? ????? ??? ?? ????? TIMI ????? 3 (?? – 2,09; 95% ?? 1,24–3,52) ? ?????????? ????-?????????? ? ?????? 24 ???? (?? – 0,52; 95% ?? 0,32–0,85).
???????? ??????????????? ???????????? ????????? ????? ? ??????? ???ST, ???????????? ?????????? ???, ??????? ? ?????????? ?????? ?????? ? ??????? ?????? 90 ?????, ? ??? ????? ????? ??? 2-??????? ??? ??????????? ??? ?????? ??/?? ? ????? ??? 5-??????? ??????????? ??? ??????? ??/??. ??????, ?????????? ? ??????? ??????????? ??/?? ? ?? ???????????, ??????? ???????? ????????? ???????? ?????, ????????? ????????????????? ?????????? ? ????????? ??????????? ???????, ???????? ?????? ??????????.
????????.
Mehta R.H., Starr A.Z., Lopes R.D. et al. for the APEX AMI Investigators. Incidence of and outcomes associated with ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention. JAMA. May 6, 2009;301(17):1779-1789.

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