??????????? ?????? ?????? - ??????? ? ????????????? ???? ?????????? ???????????????? ??????? ??? ?????? ???????? ????????. ???????????????? ??????? ??? ?????? ???????? ????????

????????????? ??????? ???????????? ??????? ?:
· ??????????????? ???????????? ?????????? ??????? ?????????? ?????? ? ??? ?????? ? ???????????? ???? ???????;
· ????????? ????? ???????? ????????? ??????????????? ?? ???? ?????????? ???????? ??????? ?????? ?????????;
· ?????????? ????????? ?????????;
· ????????? ??????? ??????????? ????????;
· ????????? ??????? ??????????? ??????? ? ????? ?????????;
· ?????????? ????????????? ???????????? ????????.

???????????? ??? ? ??????? ?????? «???????» ????? ?? ?????? ?????????? ????????? ???????? – ???????? ??????????? ?? 47% ??? ????????????? ????????? ? ??????????? ?????? ?? ????????? ? ??????????? ????????? ?????????? ???????????? (???). ? ???????? ??????????? ???, ???????? ?? ????????? ? ???, ??????? ???????????? ??????? ? ?????? ???, ?????????? ?????? ? ??????????????? ??????????. ?????? ??????? ???????, ??? ??? ???, ??? ? ??? ???, ? ?????? ????????? ??? ????? ???????? ???????????????? ??????????? ??????????? ?????. ??? ???? ?????????? ???? ???????????, ???? ????? ????????? ?? ?????? ????? ?, ????? ???????, ???????? ? ?????????? ? ???????? ??????????? ????????? ????????? ???????. ??? ???????? ??????????, ?? ? ?????? ?????????? ???????????? ??????? ??????? ????????? ? ??????? ???????? ?????????? 25-35%, ??? ??? ??? ????????????? – 30%. ? ???????????? ??? ??????? ??????? ?????????? ???????????? ??? ?? 80-? ?????? ????? ? 85% ??????? [15], ?????? ?? ???????????? – ? 54%, ? ??????????????? ???????? ???????? – 40%. ????????????? ?????????? ? ???????????? ??? ????????? ? ?? ??????????? ?????????????????. ???? ??????? ?? ???? ???? ?? ?????? ?? ????????????? ? ????? ? ?????????? ???, ? ??????? ??? ????? ?????? ?????? ??? ????????. ??? ???????????? ? ??? ????? ????????? ?? ??? ??????: ???????? ????? ?????????? ? ??????????? ???? ???????? ?????????; ????????? ????????? ??????????? ???????????????????? ???????; ?????????? ????????? ????????? ??? ? ???, ?? ??????? ??? ?????? ??????? ???????? ?????????????.
????????? ???????? ????????????? ???? ??????? ?????????? ???????? ???????? ???????? ???, ?? ????????? ???? ???? ??? ?????????? ?? ????????? ?????? ???????? ?????????? ? ??????????? ?????? ????? ?????????????? ???????. ? ?????????? ????????????? RAPID II, ?????? ARIAM ? ?????? ???? ??????????? ????????????? ? ???????????? ??????????? ???????? ??????????. ???, ? ???????????? ARIAM ????? 4615 ????????? ??????????? ? ??????? 30 ??? ????????? 6,43-7,15% ? ??????????? ?? ???????????? ???????? ????????? (??????? ????? ??? ?????????? ???????).
??????????? ???? ???????? ? ? ???????. ???, ? ?????? ?.?. ???????????? ??? ????????? ??????? ??? ? 463 ??????? ???????????, ??? ?????????? ???????? ????????????? (?? 30 ???) ? ?????????? (?? 60 ???) ???? ????? ?????????? ? ??????????? ?? ????????? ? ????? ?????????. ????????? ??? ???????? ???????? ??????????? ??? ?? ???????????? ?????, ??? ??? ?? ?? ???????????? ????????????? ???????? ?? ???????. ? ????? ? ???? ?????????? ????? ????????????? ???????? ??? ???????????? ????????? ?????????? ? ????????? ???????? ???????????? ??? ?????????? ???????? ?????? ?????????????. ????? ?????????? ???????? ???????????? (????????®). ??????? ????? ?????? ??????? ? ????????? ??????, ? ??????? ? 2003 ???? ??????? ?????? ???????????? ??? ????????.
????????® – ????????, ?????????? ?????-?????????? ?????, ????? ? 14 ??? ??????? ???????????????????? ? ? 80 ??? ??????? ???????????? ? ?????????? ????????? ?????????? ????????????, ??? ??????????. ???????????? ????? ??????????? ??????? ?????? ?????????????, ??? ?????? ????????? ??????????? ???????? ???????? (? ??????? 5-10 ?). ???????? ?????????? ? ???????????? ? ?????? ???? ???????? (?? 30 ?? ??? ????? ???? 60 ?? ? ?? ???????????? ???? 50 ?? ??? ????? ???? ????? 95 ??). ????????? ???????? ????? ????? ??????? ???????????? ? ??????? ? ?????????? ?????? ????, ? ?????? ??? ???????? ??????? ???????? ????????? ?? ????????? ?? ??????????? ??? ????? ??????, ???????? ? ?????????? ? ??????? ???????? ????? (??????? ? ?????? ???? ????? 67 ?? ? ?????? 75 ???) [17], ???? ???????? ??????? ??????? ?????????? ??? ?????? ????? ??? ??????????????? ????????????. ??????????? ????????????? ???????????? ??? ???????????? ? ?????????????? ??????????? ????????????? TIMI 10A, TIMI 10B, ASSENT-1-3; 3 PLUS, ENTIRE-TIMI 23 c ???????? 30 100 ???????. ???????? ?????? ? ???????? ????????? ?????????????? ??? ?? ??????? ? ????????. ? ??????? ????? ??????????????? ???????????? ????????? ? ???????? ? ???????.
? 2004 ???? ? ?. ??????? ?? ???? ????????? ?????????? ? ????????????????? ???????? ??. ?.?. ?????? ? ?????? ?????????????? ???????? ??????????? ???? ??????? ? ?????? ??????????????? ???????? ????????? ??????? ??? ???????? ??????????????? ???????????: ????????????, ? ?. ?. ?? ?????????????? ?????, ? ??? (????????? ????????????? ? ?????????????). ?? ??? ????? ????????? 345 ????????? ? ????????? ???, ??????? ????????? 112 ???, 66 ???????? ?????????? ????????????, 11 ?? ??? – ?? ?????????????? ?????. ????????? ????????? ??? ?? ?????????????? ?????, ?????????????? ?????????? ??? ?? ??? ???? ????????? ??????? ????? ??????????? ??? ??? ?? 5,3% – ? 14,8 ? 2004-? ?? 9,5% ? 2006 ????.
????????? ?????????? ??????????????? ?????? ??????? ???????? ?????????????? ??????? ?? ??????? ?????? ????????? ??: ??????? ????????? ? 2 ???? ?????? ????????? ? ??????? 6 ? ?? ?????? ???????????, ??? ????????? ??????????? ? 2 ???? ???? ????????? ??????????????? ?????? ??????? ???. ??? ???? ?? ???????? ?????? ???????? ???????????, ???????? ? ?????? ??????????????? ????????? (? 5,5 ?? 2,74%).
???????? ?????????? ? ???????, ?????????? ???, ??????????? ?????? ??????????? ?????????????, ?. ?. ??? ?????? ??????? ???????????? ???????? ?? ?????????? ????????, ??? ??????? ??????? ????????? ???????? ????? ????????? ? ??? ????????????? ???????. ??????????? ? ????? ????????? ?????????? 8,5%.
? ?????? 2006 ???? ???????? ???????? ?????????? ???????????? ?? ?????????????? ?????. ?????????? ????? ?????????, ? ??????? ?? ????????? (12 ???????), ????????? 0%. ???????? ??? ????????? ???????????? ??? ?????????? ?? 10%, ?????? ?? 13,5% ??????????? ???? ????????? ?????????? ????????????. ?? 2,3% ????????? ??????????? ??? ??? ? ??????? ?????? ?????. ?? 112 ???????, ??????? ????????? ???, ?????? 5 – 4,4%. ????? ???????, ??????? ?? ?????-???? ???????? (??????? ??????????????, ??????? ????????????????, ????? ???????? ?? ????? ???????????) ???????? ???????????? ???????, ?????????? ????????? 16,7%.
????? ???????, ????????? ????????????? ??????? ??????? ???, ?????? ??????????? ?? ???? ????, ???????????? ????????????? ???????? ??? ???????????, ??? ? ????????????? ?????????, ???????? ??????????????? ????????.

??????????
1. ????? ?.?., ???????? ?.?., ?????? ?.?. ? ??. ???????????????? ?????????? ????????????? ??? ?????? ???????? ????????. ???. ???. 1976; 48 (4): 8.
2. Gruppo Italiano per lo Studio della Streptochinasi nell'lnfarto Miocardica (GISSI): Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986; 1: 397-402.
3. Gruppo Italiano per lo Studio della Streptochinasi nell'infarto Miocardica (GISSI): Long-term effects of intravenous thrombolysis in acute myocardial infarction: final report of the GISSI study. Lancet 1987; 2: 871.
4. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17, 187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 2: 349-60.
5. Wilcox R.G., van der Lippe G., Olsson C.G. et al. for the ASSET (Anglo-Scandinavian Study of Early Thrombolysis) Study Group. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction: Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet 1988; 2: 525.
6. Wilcox R.G, von der Lippe G., Olsson C.G. et al. For the Anglo-Scandinavian Study of Early Thrombolysis. Effects of alteplase in acute myocardial infarction: 6-month results from the ASSET study: the Anglo-Scandinavian Study of Early Thrombolysis. Lancet 1990; 335: 1175.
7. AIMS Trial Study Group. Effect of intravenous APSAK on mortality after acute myocardial infarction: preliminary report of a placebo-controlled clinical trial: AIMS Trial study group. Lancet 1988; 1: 545.
8. AIMS Trial Study Group. Long-term effects of intravenous anistreptase in acute myocardial infarction: final report of the AIMS study. AIMS Trial Study Group. Lancet 1990; 335: 427.
9. Gruppo Italiano per lo Studio Della Sopravvivenza NelL'Infarto Miocardico. GISSI-2: A factorial randomized trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Lancet 1990; 336: 65-71.
10. The International Study Group. In-hospital mortality and clinical course of 20,891 patients with suspected acute myocardial infarction randomized between alteplase and streptokinase with or without heparin. Lancet 1990; 336: 71-5.
11. ISIS-3: a randomized comparison of streptokinase vs tissue plasminogen activator vs anistreptase and of aspirin plus heparin vs aspirin alone among 41299 cases of suspected acute myocardial infarction. Lancet l992; 339: 753-69.
12. The GUSTO Investigators. An international randomized trial comparing four thrombolitic strategies for acute myocardial infarction. N. Engl. J. Med., 1993; 329: 673-82.
13. Peto R. Aspirin after myocardial infarction. Lancet 1980, 1: 1172-3.
14. Antiplatelet trialist's collaboration: collaborative overview of randomized trials of antiplatelet therapy-I: Prevention of death, myocardial infarction and stroke by prolonged antiplatelet therapy invarious categories of patients. Br. Mod. J. 1994; 308: 81-106.
15. A randomized, blind trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet 1996, 348: 1329-39.

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