I\IIHICTSPCTBAAXOBbI 3NAPOY{

P3CITYEJIIKI EEJIAPYCb

MIIHI,ICTEPCTBO3.[pasooxPAHEHI{t

PECIryEJII{KI,I I;EJIAPY Cb

Ha ocHoBaHrd' rloroxeH[q o Mnuncrepcrre 3ApaBooxpaHeHr.r,Pecny6nzrz Ferapycr, yrBepxAeHHoro [ocraHoBJreHr.reM coseraMnuncrpon Pecuy6lnru Eenapycl or 2g orrr6ps 20ll r. Ns 1446 (OHeKorophrx Borrpocax Mnuucrepcrna 3ApaBooxpaHeHu, r,r Mep€x rropeaJ'rr43arllr[ Yra:a flpesu4e'ra pecny6nnru Eelapycr or I I anrycra 201 Ir. Ne 360D, c rleJrbro coBeprxeHcrBoBaHr4r oKa3a'r4, MeAr,rqr,rHcKofi noruoqurrarIHeHTaM c ocrphrM HapylreHileM Mo3roBoro rponoo6pauleuur,

IIPI4KA3bIBAIO:l. VrnepAnrr lIncrpyxqnrc no oKa3aHr,rro MeAr,rqr,rHcKofi nonrorqn[arlrreHTaM c ocrpbrM HapyrueHr,reM Mo3roBofo rporoo6parqenn.r(<lopoxuar xapru).2. Ha.raruHuraNa yupannenrafi (rnannrrx ynpaanenufi)

3APABOOXPAHCNTTT O6IACTH'IX UCTIOJIHI.ITCJI'H'IX KOMUTETOB, IIPEACEAATEJIIOKOMI,ITETA .'O 3APABOOXPAHEHV IO MNUCXOTO IOPOACKOIO II CTIOJIHATEJI'HOTOKoMl.rrera, pyKoBoAtrrenrNr pecuy6lunancrux opraHnsaquff3ApaBooxpaHeHr.rr, [o,4q]rHeHHhrx MuHr.rcrepcTBy 3ApaBooxpaHeHr.r,Pecuy6laxu Belapycr, o6ecnequrr:

3ArAA TIPIIKA3

r.Muncx

&/ olk,'ff N,

r.Mincx

06 yrBepxAeHar{ Ilucrpyrquu rooKa3aHr,rrc MeAr,rr_laucKofi uouorqu[aqrreHTaM c ocTpbrM Hapyr]eHlreMMoiroBoro xponoo6parrleHr.rt((l{opoxHar KapraD)

KOHTpOJIb 34 II0IIOJIHeHI,IeM rIoABeAotrIcTBeHHbIMI,I opraHI.I3aIIr4rMr43,qpaBooxpaHeHuf, HacTortqefo rrpr4Ka3a;

rrpeeMcrBeHHocrr, n pa6ore oprauasaqufioKa3al{uu MeIuUr{HcKofi noruorqu [arI[eHTaM cMo3roBoro rponoo6panlenr.ra (<lopoxuaa napru).3. Konrpolr 3e uc[oJrHeH\eM Hacrorrqerollepnoro 3aMeorr.rrerr Munncrpa fluuenu.ra n.JJ.

3ApaBooxpaHeHr.rr npEocrphrM HapyrueHr,reM

IIplIKa3a B O3JrO)KtrTb Ha

Muuncrp ft/n*"- B.A.Manamro

flpnnoxeuue IK IIDI,IK€BVMunucrepcrBa 3ApaBooxpaHeHHtPecuy6luxra Belabvcrot .{t1. t t-.2011" Ni 4 7

llucrpyrqza[o oKa3aHuro MeAr.rUI{HcKofi lououlz [auneHTaM

c ocrpbrM HapyrueHr,reM Mo3foBofo nporoo6pauleuur(<lopoxuar xapro)

I'IHcrpyr<qua no o*a3aHr4ro MeA'ut4 HcKofr noruoulu [aurreHTaM cocrpbrM HapyueHueM Mo3foBofo xpoaoo6paqeuzr (4alee _ OHMK)lpeAycMaTpr{Baer cneAyroqr4e ueJrr,r.

|JIABA IuEnr4 oKA3AHr,rr MEIT,TIITTHCKOTZ TIOMOIIZ IAULTEHTAM

C OHMKCrpareruvecKaq ueflb - o6ecne.reHr,re cHr,rxeH'r cMeprHocrr.r lr

I4HBaJ'rr.rAHocrn npu OHMK.

PCHTIEHO3HAOBACKYN'PH'IX XITPYPIUqECKI,IX BMEII]ATEJIbCTB (AArrEC _ P3XB)lo 2 5 0 npo uegyp/ I M r{J'tJr }roH uaceneuur/rog).

3. O6ecleqeuue AocrynHocrr.ruu0aprra ro.,loBrroro Mo3fa (aanee lIfM): yBenurreHne o6renros

AKTI,IBHOIO BHC.{PEHI,I'

rpona6o,urrauecxofi Tepanuv (4anee rnr) coBpeMeHHhrMlrJreKapcrBeHHbrMr.r cpeAorBaMu !'nfl, rpou6olu:nca.

4. Cnr.rNesue sa6oreeaeN4ocru OHMK 3a cr{ernepnuvuofr lr nroprzuuoil npoSu,raxruru.

TaKrl,r.IecrcLte ue,rrl:L ConepruencrBoBaHrze clrcreMbr 3Ta[HOfO OK€l3AHI,I'

MeAr4rIrzHcKo[ lovour,r nauHeHTaM c OHMK uocpeAcrBoM:focnr,ranr.r3au,r.r Bcex naur4eHToB B ocrpoM lep]roAe OHMK n

cneLIuaJu.t314poBaHHbre HeBponofI,Iqe0KI,Ie I,IHCynbTHbIe oTAeIIeHI,Ir;o6ecne.reH14s npoBeAeHxr uefipowrsyan Lrlar\uLr,

xrlpypruu 4rrflrpr unQaprcre(o6rqee qucro

coBpeMeHHbrx MeTOAOB JreqeHr,rt

2. Pazsurue clyx6u peHrreHo3uAoracxylapuofiAocrHXeHuq o6r,elra BMeurareJlbcrB, BbInoJrHqeMblxfoJroBHofo Mo3ra, aolocraBuMoto c erponeficrnu

3TArrbr oKA3AHr4r MEro4rIr4HCKOfr nOMOrUnIIAUI4EHTAM C OHMK

Srauu orca3aHr.rq MeAr{ur,tHcKoft nonoulr.r [aur{eHTaM c OHMK.Oxasauue MeAr,rqr,rHcKofi nouoqu [aulIeHTaM c OHMK

ocyulecrBnrercr B paMKax nocJreAoBareJrbHofo npoqecca: 4orocuuralrurrfi6omuuqun

orgelenze),

{orocnura.nsrrslfi tran :

1. OnasaHr.re nepnofi roMorqr4:l-fi urar: npu noAo3peHr.rr{ Ha OHMK seo6xo.qlruo

6pura4y cropofi MeAr.rqrrHcKofi uol,roqn (aaaee - CMD;2-il tuar: ynoxrrrb rraqueHTa Ha c[r4Hy Ha rBepAyro poBnyro

rroBepxHocrb !{ nprdnoAHrrb foJroBy Ha 30 rpa4ycon;3-i nar ocno6o4urr, urero or oAexrbl KJIr{ r{Hbrx rrpeAMeroB, Koropbre

Moryr ee cAaBnr4BaTb;

4-il uar: TrqarenbHo oqucrllTb poroByro [oJrocrb narlueHTa orpBorHbrx Macc' ecJ'r' 6sr,ra pnora, v yranurb cbeMHbre sy6Hrre nporesu (rpnuar'uuuu);

5-r urar: ecJr' rrauueHr HaxoAr4Tcr s 6eccosHareJrbHoM cocro{Hr,I[,ueo6xo4uuo noBepHyrb ero Ha 6ox, qro 6y4er cnoco6crsonarr6eclpenrrcrBeHHoMy BbrreKaHr4ro cJrroHbr Lr c'tv3r4 r.rs poroaofi uoJrocrr',npeAoTBpaTIrT I,tX nonaAaHl4e B AbIXaTeJIbHbre nyTr{:

6-i urar: yKpbrrb rraqueHra.llplr erou Heo6xoruuo:rrocrorHHo cneAr4Tr, 3a rrapaMerpaMr,r AbrxaHr4.s, cepArle6uel:lrfl Lr

aprepuaJrbHofo AaB!'reHar (aa,'ree _ AD;HE PA3PEIXATI, II'IT., XI,IAKOCT' IZNI IPI,IHTMATI rrrO6UC NCKAPCTBEHH'IE

cPeAcrBa;

''pu Harurrr'u npfi3HaKOB rCrvruuqecxoft cMeprv (ocrauoara cepArla,

AbrxaHr,rr H pacruupeHr4e rpauxor) npprcrynr,rrb K peaHr.rMarltroHHbrMMeponpurraflu (nenpanaonay Maccaxy cepArla, AlrxaHrrro (por B por> u gp.)Ao npue3Aa 6pura4u CMII a,ra BoccraHoBJreuu.a cep4ue6^in ri 1rr*ur

";He [btTaTbcr caMocTo.gTeIbHO npr,IBecTr,I [arlueHTa B CO3HaHue,t4cnonb3yr uaruarupHufi cntrpr rlJrr4 Apyrne neKapcrBeHHbre cpeAcrBa,oco6enHo [pr'r Hanuqur' cyAopof, TaK KaK BO'MOXHO yCyry6neure r-')KeCTr,rcocToflHl4q IaUI4eHTa u lpofpeccr{poBaHr.re uenpOrOrnVecrofiC},I MI]TOMATI4 KI4.

J

fJIABA 2

3Tarr, cratluoHapHbrt 3TaIr (npaenaHoe orAeJIeHI,IecIIequanLr3lrpoBaHHoe HeBponofuqecKoe I4HCynbTHOeItocrrocrI,tr,lJI rurtil gran.

CPOTIHO BbI3BATb

4

2. Oxa:anue nepeofi MeAr4ur4HcKoft nonaorqu:l-fi ruar: npu rroAo3petuu Ha OHMK ocyulecrBr{Tb cpovnrrfi rrr:on

6prara4u CMII;2-i4 uar: ynoxr4rb nautreHra Ha cnr.rHy Ha rBepAyro poBHyro

rroBepxHocrb 14 [pr4noAHrrb ronoBy ua 30 rpa4ycon;3-fi ruar: urueparu A!;4-fi ruar: KoppeKur{r A! * npoaoAr.rrc.rr ttpu CAA > 220 r"nvr. pr. cr.,

AAA > 120 r'lrrl. pr. cr.3. Oxarasue MeAr.rquHcKoi non,toulrz upu OHMK 6pr.rra4ofi CMII

ocyulecTBnreTcr B cooTBeTcTBI ,I C KJIIIHI,IqeCKT{MI{ IpOTOKOJIaMLI

Ar4aIHOCTr,rKrr I,I Jler{eHuq, a TaKXe ,{pyILIMr4 HOpMaTHBHbTMII IIpaBOBbIMr,r

AoKyMelrraMr.r, yrBepxAeHHbrMr,r MuHracrepcrnou 3ApaBooxpaHeHr{tPecny6-rraxu Belapycs, r,r BKJrroqaer:

I-14 [raf : r4crroJrb3oBaHrae ipelt4urepoM rro lpueMy r,r [epeAarreBbr3oBoB craHrlrtr (or4e,reHua) CMII npu rroAo3penr.u{ Ha OHMK, Bo BpeMsreJreQoHHoro orpoca, TecTa (Jrr4rlo-pyKa-peqb-BpeMrx

2-ir, war:. no nbre3Ay yroirHeHr4e 6plrralofi CMII npeueHlr Haq€urasa6o,'reaauur (y naqueura, poAcrBeHHr{Kon u gpyrnx rHq);

3-fr uaf : perr4crpauur 6pura4ofi CMn eJreKrpoKapAlrofpaMMbr,onpeAeneHue ypoBHr fJrroKo3br B KpoBlr, tr3MepeHue A!. IIpn rroBbrrrJeHHoMAA (CAA > 220 N,rM. pr.cr., AAA > 120 vu. pr.cr.) npr.rMeHrror JIC(xanronpu,r, ypanlatrlarr, xloura4rau). llp" aprepr{rL'rbHofi rHnoreust,tlr(cucroluuecrcoe A! rrraxe 90 MM. pr. cr.) - o6teru3aMecrr.rreJrbHrur reparrt(r[Apor<clrsruJ.rKpaxN{€rJr, pacrBop 4ercrpaua), npu orcyrcrnr.ru e<[Serra -noIraMuH:

4-[ ruar : uefi po lporexropHuur repalur. Lluratrt1wn Kr,rcnopoAa;5-i ruar: cuMnroMarurrecKar repa[ur *: rynuponanue rolonnofi 6olu,

no:6yx4euur, cy.qopor, nonropnofi pBorbr, fu[eprepMr{r,r cBbrrue 38fpaAycoB l]elscun.

6-fi urar: onpeAeneHr,re Aaaruefiureft TaKrnKrd BeAeHr{r naur{eHToB cOHMK c yrreroM KJtr4Hr,rtrecKr4x upornrteuufi ga6oaeaaHus, TtxecrucocTorHr,rt IIaur{eHTa :

npu Hanrrquu noxa:arrufi tr orcyrcrBrir4 nporr,rBorrora-:aHnfi 4nr TJITrun P3XB - ocyurecrBJreHr.re KoHraKra c AexypHbrM BpaqoM-HeBponoroMcrauuoHapa flocpeAcrBoM cpeAcrB cBr3vr, o6ecneqenr,re excrpeuuofiTpaHcnoprr,rpoBKrl (nocne npeABaprrreJrbHoro coo6ulenlrs B rrptreMHoeorAeJ'reHr,re craqr4oHapa o npeArronafaeMoM BpeMeHr.r upn6rrrna naqueura) n* ocyt4ecmanaemct 6 coom,emcm,uu c kr,uttwteckuvt npomoKoJtoj4 <,[uaeuocmuxa ure\eHue na4ue moc c gct6oneoauutLMu uepauofi cucme.^4bt (aspocnoe naceneuue)> (danee aK,tuu uq e c xui npomoxo.'t )

opfaHu3au14ro 34paBOOXpaHeHr,rr, OCHAIUEHHVIO anraparyporr AJI'IrPOBEAEHU' HCIPOBI{3YANU3A]']J.,U, OTACJIEHEEM PEAHI,IMAIII4I{ I{ IIHTEHCI.IBHOiTepanuU LI CneqUaJILI3I,IpOBaHHbIM HeBpOIOIUqeCKT,IM I,IHCyJIbTHbIMOTAEJIEHI,IEM, TT9 PEUIEHI,Ifl BONPOCA O NPOBEAEHI,II MEAHUHHCKOTO

BMeuaTenbcTBa; MeAr,rur,rHcK€ur rpaHcrropTr,rpoBKa rrarl[eHToB c OHMKocyulecTBnfercq B [pLIeMHOe OTAeJIeHLIe I{JII,I HerrOcpeACTBeHHo B

KpyrrocyroqHo pa6oraroqvfr Ka6r.rHer KT ulu MPT, unHyfl npveMHoeorAeJreHr{e, opfaHu3aqr{fi 3ApaBooxpaHeHr,rs, B crpyKType Koropbrx r,rMerorcscneuHanr43r.rpoBaHHoe HeBponoluqecKoe I,IHcyJIbTHoe OTAeneHr.Ie c nanaTorpeaHHMarlult H nHTeHC14BHOii TepanLIU, oTAeneHI,Ie aHecTe3I,IOJIOrlrr4 U

peaHuMauuli, Hefipox[pypfr{qecKoe orAeJreHr,re vrvr aHrr{ofpa(bHrrecKr.rfiKa6LrHer, Anr rpoBeAeuus TJIT r.rJrr4 P3XB npr OHMK;

npr4 rraJwrvvl4 nporr.{BorroKa3aHr,rf p.rfl TJIT r4rrv p3XBrpaHcnoprr,rpoBKa narlneHra c noAo3peHrreM Ha OHMK OCyUIeCTBnTeTCT B

OPI-AHU3AIIUrc 3APABOOXPAHEHI,Ifl, OKUI3bIBAIOIIIYIo MCAI,TqI,THCKYIO TIOMOIIIbnpu OHMK, B roM rrricne He BbrnoJrHrroqyro P3XB vnlr TJIT.

Craquouapltbrfi 3Tarr.B nprreMHoM orAeneHur,r BpaqoM-HeBporofoM ocyulecrBr.flercs:

eepu$Hnaqutl AuafHo3a OHMK (nxnrovar npoBeAeHr.re KT uln MPT),eu6op olrHuaruHofi cxeMbr Jreqeuur r.r Haq€uo ee [poBeAeHHr,onpeAeneHHe noxa:arrtfi Anq rocnHTar H3aryvu.

B ocrpoM lepuoAe OHMK naqneHra focnr.rraJrn3r,rpyror B

cnetluanr,r3rrpoBaur ro9 HeBponoruqecKoe r,rHcyJIbTHoe oTAeneuue c ualarolpeaHr.rMaqfiu 14 rzHTeHcr4Bnoft tepannu, orAeJleHr4e aHecre3r,toJrorlrr{ LI

peaH14Marlur{ rleHrpa./'rbHofi pafiouuof (uexpafiounoft, ropo4croft LUwr

o6racruofi ) opraHr43aur.rr4 3ApaBooxpaHeHr.rr.O6rsare,'Iruo BbIIroJlHeHue :

ra6oparopusrx r.rcc,re4onauuil: o6ulero aH€rJrlr3a KpoBrr !r Moqr{;feMaToKpLrTa; ypoBHr fJrror(o3bl, HaTpItt, KaIlufl, MatHIIq, KpeaTI4HI,IHa, KOK,MB-ltOK, D-guvepa, Qu6praHoreua B cbrBoporKe KpoBr,r; aKruBr{poBaHHofoqacrr4qHoro rpona6onrlacu{HoBofo BpeMeHr{ (AUTB); aKrxBr.rpoBauHoroBpeMeHr4 cBeprbrBarrnfl rpoeu (ABCK), xncloruo-uleJroqHoro 6ataruca una3oBoro cocTaBa r(poBH ;

I,IHCTpyMeHTanbHLIX ttCC,re4OOaUU[:fpyAr.rofi KneTKu; llo rroKiBaHr,trM

peHrreHorpalpulr3xoKapAr4orpaoI.ru;

opraHoBcyToqHoro

MP-anrr.rorpaQnu), naoopaTopHbrx AaHHbrxx TJIT r.r 3KcrpeHHorrly P3XB. TJIT 4olxna 6lrrrnonyqeHur AaHHbrx He[poaHfr,roBu3y urv3ar\vl4-

MoHl4Topr.rpoeaurar A!, cyroqHoro MoHrrropxponauus 3Kf .

llocre nonyqeHr.rr pe3yJrbraroB uefipoaHrnonn3yanvsa\uLr (KT-aHluorpaQnpr v vl

onpeAgJrgloTct IIoKa3aHI,ItHaqaTa ToTr{ac IIocJle

rrolrBepxlarorur4x nopaxeHrre aprepnfi rpoM6orr.rqecKoro xapaKrepa,rrcKJIIOr{eHr4r feMopparlrqecKotoNPOTI,IBONOK€BAHTfr K IPOBCAEHI,Irc TJIT.

I. BulconorexHoJroruqecKr{exrrpypf|,|qecKHe

IIHCyJTbTa upr4 oTcyTcTBr,r[

MeTOIbI JIeqeHIIfl. B TOM rtHCJte

BnyrpuaeHnufi cucreruHurfi rpou6ollr3r,rc Moxer rrpoBoAltrbcr BoBpeMeHHoM lrHTepBarre 4,5 qaca or Harr€ula 3a6oreBaHa.f, ToJrbKo B

oTAeJreHI,t{x aHecTe3ltoJrofHl4 Il peaHI,IMaIIXH I4JII4 traJIaTaX peAH']'i,llAlryrut Ll

I4HreHcuBHofr repail14H B opfaHu3ar_lr4qx 3ApaBooxpaHeHxr, r{MeroquxBO3MO)KllOCT[, npOBeAeHut Het4HBa3I,IBHOI UefipOaUfUOB[3yaJIIt3aIIUI{cocyAoB trren r{ fonoBHofo Mo3ra (KT-anrlrorpa$wu utlr MP-aHruorpaQun).flp, r{eBo3Moxtrocrr4 npoBeAeHr.rr ueftpoauruonw3yuxz.:;a\vw TJIT HenpoBoAr4rcr.

P3XB BHyrptrcocyAr4crar peKaHaJrx3arlur orrurcruponanuofiaprepr4lr B ocrpoM lepuoAe OHMK c [pr.rMeHeHr,reM MeroAr.rKlrBHyrp14cocyAHcroft rpovr6exroltllu (rurexauu.recroil rporu6ercrpaKrllrur n(uru) rpov6acnupaur.tu), 6al,rosuofi aHrr.rorrJracrr4Kr.r co creHrHpoBaHHeM.flepeuuc,reuuue ctoco6u 3HAoBacKyJrf,pnofi peraualu3ar\Lrr4 rrpr.rMeHf,rorctKaK CaMOCTOtTeJ'rr'Hbre MeTOAbr BoccTaHoBJI9HI'I' KpOBOTOKa, TaK r{ B

coqeraHurz c TJIT (o4nonpeuenno vrvr rrocJre nee). BrruorHeura.flnuyrpucocyAucroii rpon6errovuu He AonxHa nperrrrcrBoBarb vJvr3aAepxuBarr, npoBeAeHfie TJIT (npu Harul.lz':a noxasauufi r TJIT), a rapr(enpoBeAeHr,re TJIT He AonxHo 3aAep)o.rBarb ocyuecrBJreHr.reBHyrpLrcocyAr.rcrofi rpona63KToMr.rr4.

flaqueursr, noABepru[ecr TJIT, He AoJrxHbr flonyr{arb ACK, npanrueaHTr,rKoaryJrrruTbr, eapQaplru, PzY n r4Hrr4or,rTopbr TpoMoorlr,rToB

\rr4r(nolr,rAr.rH, KnonlrAorpen, TrrKarpenop, npa3yrper), urLr .qpynreaHTUKOafynqHTbIe u aHTr4arpefaHTHbre JIeKapcTBeHHbIe cpeAcTBa B Ter{eHLIenepBbrx 24 \acos nocne nporleAypbr.

Peruesue o npoBeAeHr,ru auyrpncocy4ucrofi TpOMO3KTOMLII4

npr,rHhMaeTcr upaue6uutrr,l KoHcHJrrryMoM c yqacTr.teM Bpaqa-HeBpoJloracI] erl H aJr rr3rrpo BaH H of o He Bpono tr4 qecKof o I,IHcyJrbTHoto oTAeJIeHr.rr, Bpar{a-peHTreHo3HAOBaCKynrpHOfO', xupypm Lr Bpar{a-aHecTe3I,IoJrof a-peaH HMaToJrrofa.

BHe gasucur\4ocrr.r or npoBoAr4Mofi TJIT, npu HurLr\rLrtr 3KcrpeuHbrxnora:launi rc P3XB u co6nroAeHr4r{ BpeMeHHoro r{HTepB€rJra (Ao 6 .racon orHaqaJra sa6o,'reeaHaq) naqraenr AocraBJrrercr B peHTfeH3HAoBacKynflpHoeorAereHze (aHrraorpaQr.rqecrnfi xa6uuer), rAe npoBoAlrrc.r qepe6paluarauruorpaQr.ra, yroqHqercr nug u o6reu Heo6xoAr,rMoro BMeruareJrbcrBa.

llaqueurav c uueMrzqecKr4M trHcyJrbroM, BbI3BaHHHtvr oxrutrosl4 efixpynuol apreplru B nepeAHr4x orAeJrax aprepr.r€urbHoro Kpym 6olrruoroMo3ra (BHyrpeusefi cousofi aprepuu BCA, cpe4He[ Mo3foBofi aprepr{HCMA s Ml u M2-cefMeHrax, nepegnefi Mo3roBofi aprepr{lr IIMA s A1 nA2-cerrrreHrax.), noKa3aHo 3HAOBaCKyrspHOe BMEIXATCJIbCTBO(rporra6sxcrpaxqrzl/rpou6acnuparlur) B TeqeHr.re 6 .lacon or HaqaJraBo3Hr4KHoBeHr.rr euMnroMoo. llpu Ar,rcceKrlr{lr u (um) creHo3npyrouleMarepocKnepo3e r.r orcyrcrBrrr4 auruorpaSlruecKoro e(pQerra oroHAoBacxyJlrpHofi Oa-rr,roHHofi 1urura\vrv, lro ycMorpeHr,rrc Bpar{apeHTfeH03HAOBaCKynqpHOfo xr.rpypm BbrrroJrHreTcr cTeHTr{poBaHr4eapreputr, rocJ're r{efo [aur4eHT Bo3Bparqaercq s 6ror (nanary) lluregcunsofiTepa rz H.

V nauneHroe c I,'I|M c 6lrcrpo o6pauruuu HeBpororuqecKr,rMgeQuquronr (<tralsrlr un$aprrou Mo3ra))), [epeHeceHHoir TVIA B TerreHr.renepBbrx 2 uepens npu lrlcunarepaJrbHoM BbrpaxeHnoM creuo3e3KcrpaKpaHrraJrbHofo orAena coHHbrx aprepni (70-99%) peKoMeHAyercsKaporr.rAHarr 3HAaprepoKrovraa (4alee K3A), ecJrr{ plrcK rrepuolepaqr.roHHofi3a6oreBaeMocrli H cMeprHocru cocraBJrrer MeHee 6% B ycnoBurxropo4cr<ofi (o6,racrnofi rrJrLI

3APABOOXPAHEHI,Ig.

pecuy6ruraucrofi) opraHr43arlLlH

llpu rrtrcu!'rareprurbHoM yMepeHHoM creH03e 3KcrpaKpaHr,rrrJrbHofoorAena coHHbrx aprepufi (50-69%) BrA oneparr.rBHofo BMerrrarelrcrna (K3Auru aHfuorrJracrt{Ka 14 creHTl,Ipoaauue) 3aBvcvrr or Bo3pacra Lr

conyrcrByrouux sa6o,'renauHfi .

Kaporu4ual 6a.,'uroHua.s aHrr,rorrJracrr.rKa co creHTr,rpoBaHr4eM rroKa3aHaKar( aJrbrepHarrzBa K3A rtpu [ncr,rJrarepanbHoM creHo3e3KcrpaKpaHr,r€urbHoro orAeJra coHuofi apTepr,ru > 70yo rrpr,r Her.rHBa3HBHofiBvr3yutv3a\uu vJrv > 50%o npu Br43yanrr3arltrr4 MeToAoM KaTeTepr.r3arluonnofiauruorpalpuu npu cpeAHeit uttu Hr,r3Kofi crerreHr.t plrcKa ocJro)KHenuft,cBr3aHHbtx c SHAOBaCKyntpHbIM BMeIIIaTeJIbCTBOM. A]J'' IOXI{JrbIXnaqueHroB (crapure 70 ,rer) npeAfloqrrrrelrHee K3A, 4la 6onee MoJroAbrxnauueHToB K3A er<nrana.,reHTHa 3HAoBacrylapuofi peBacKyJrrpu3arlulr.

flaqueuralr c uncunarepiltbHbrM BbrpaxeHHbrM creHo3oM (> 70%o) rrpuBbrpaxer-rHoM pncKe xupypfr4qecKofo BMerrraTeJlbcTBa uI [pr{ H€uruqvvpaAr,raquoHHoro crgHo3a r4nr.{ pecreHo3a rrocJre K3A, npu oKKJrro3r{r,rnporuBonoJroNuofi cosHoir aprepuu noKa3aHa onepautrr - Kaporr.rAHzur6alrosgar aHruoIIracrr4 Ka co creHTLIpoBaHI4eM.

flpra orcyrcrBr4tr nporuBoloxa^:anufi peBacKyJrrp[3auurc Heo6xo.U,rMoBbrnorHl,trb B TerleHr.re 2 uenets nocle OHMK.

flaqzenrart,t c OHMK Ha $oue uylrrnQoxalbHoro arepocKJrepo3a,caxapH o ro LL4a6er a, n o BTopHof o uexapAlroana6on r4qecKoro lluQaprra Mo3Fa,rtpu HenepeHocr4Mocrt4 ACK, oAHoKparHbrM unr[aprrou Mo3ra,pa3BuBrrrlrMcr Ha $one nocrorHHoro npuenaa ACK, a raKxe BceMnaur4eHraM, KoropbtM B pe3ynbrare sHAoBacKyJrrpHoro BMerxarelrcrna 6rtluMrrnaHT[poBaH cTeHT: KnOlr,rAorpeJr.

flaqneuran c cy6apaxuor,rA€rJrbHbrM KpoBor.r3Jrr,rrHneu (Aalee - CAK)fi3 pa3opBaBuelc.q naeurorqarofi aHenplr:Mbr AJrr npooularruKr4 rroBTopHoroKpoBoreqeHr4l qelecoo6pa3Ho BbrlonHeHne xupypruuecrofi ofleparlr4r,r B

TerleHl.{e 72 qacon or Haqana sa6oresaHHq, AJII rrero nau[eHTa nepeBoArr B

nelpoxupyprrqecKoe orAeJteHr.re ropo4crofi (o6nacrHoft) opraHr.r3arlr.rH3ApaBooxpaHeuHq. B HeipoxupypruqecKoM orAeJreHr.ru ocyqecrBJrrerctIIOAFOTOBKa H npoBeAeHr.re 3KcTpeHHbrx r,r oTcpoqeHHbrxueipoxrzpypr[qecKuX BMeruarenbcrB Iro noK€BaHr4rM, reqeHl{e naUueHToB cBHyTpUqepenHbrMr.r KpoBou3J'IuqHr4tMI'I HeTpaBMaTI4qeCKOIO reHe3a B

flocneonepauuoHHoM neplroAe vrru MeAr,rKaMeHTO3Has Tepa[Xr Aocra6ur nsarrr4lr cocrorHur (no couacoaaHrrro c rpavou-uefi poxupyproM/.

flpH nuroleuuu Nretrror,{aroft aHeBpr,r3Mbr r,rnu aprepr.roseHogHofiua,rrQoplraqw u rfl)Keerr{ cocrorHrrr, coorBercrByroqeft IV-V creneHqN,rno t-trK re Xaura-Xecca: MeAr4KaMeHTo3H€ur repaflus go cra6ulnsaqnucocrorHHr (lo couracoBaHlrrc c BpaqoM-Heftpoxupyproira) cofJracHoflocraHosreHurc or I utorts,2017 r. Ng55 MrEuucrepcrBa 3ApaBooxpalelvrflPecny6ruxrz Fe,rapycl <06 yrnepxaeHr,rr{ nporoKoJra lr{€lrHocrvKu 14

J'reqeHHr rrarlr4eHToB c HerpaBMaTr{qecKr.rMr4 BHyTpr.rMo3foBbIMr,rKpoBor.i 3nutH vrflMu>> .

llpu BbuB;rerrr.rH Hreurorqarofi aHeBpn3MbI Hnrl aprepr,toseHosHofiuaar$opuaqlaLt,,'ttrlnecrn cocrorHuq, coorBercrByroqeft I-II creleHsM rourxare XaHra-Xecca, nocne KoHcynbrarl[lr npaua-aefipoxr4pypm - [epeBoAn ueffpoxr.rpypruqecKoe orAeneHr.re PHIII] HeBponorr4r4 ll nefipoxupypruu.{nr xr4pypf r4qecKof o J'reqeHl4r.

Xr.rpypruuecroe JrerreHue

nl,reurarellcrna) rauueHTaM ruans$opuraqnanal.rocyuecrB,'rrercr roJ'rbKo n uefipoxr,rpyprur{ecKllx orAeneHl{.fx, B cocraBeKoropbrx ltMerorcr: orAeneHI,Ie lyueaof AI4afHocrI,IKI{, ocHaIIIeHHoe

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c cocyAr,rcTbrMr,r

3HAOBaCKyJrrpHhre

annaparypoii Anr npoBeAeuu.a KT u MPT, cnlrpaltuof KT-aurnorpaSnn,MP-auruorpaQuu; peurreHoleparlrroHHarr r{ coorBercrnyrouluf pacxo4HufizucrpyueHrapufi Anr npoBeAeHr,r.r Karerepr.r3arl[onsofi qepe6palruofiaHrr4orpalprrr{ v Bbtno,qHeHr,rr sHloBacKynrpHbrx onepaquf Ha 3Kcrpa- I,t

uurpaqepe6parbHbrx apreprrrx;Mr,rKpoxrrpypfHH

oIIepallHoHHEUI, ocHarqeHH€uI

apTepr{anbHbrxo6opyAonaHlrerra Lntl qepe6parIrnux

aHeBpu3M r.r aprepuoBeHo3Hbrx Marb$opMauufi (onepaqnounrrfi Mr.rKpocKo[,MnKpoxupypruqecrufr r,rHcrpyMeHrapafi, creunue r4 flocrorHHbre KJrr{rrcbrAnr cocyAoB uo:ra); peaHrrMarlr4oHHoe orAeneHr.re, rraJrarbr utru xoitxu rlt:-o6cryNueau ar rarlHeHroB ueiipoxlrpyprnqecKoro npo0nna.

II. MeAurcaneuro3HoeJreqeHrrellpr.r nexapauosu6oluqecrorra z (unn)

npoT14BOIlOKa3aHU'{Mtl K HEIIP'MbIMarlerr{J'tc aJrrr qr,r!'ro Bar K}r cJrora (4aaee - ACK).

Y narlr4eHToB

u e rcapAu oorra6ort4 r{ec KI,IM LHenepeHocrrMocru ACK,ACK - KnonuAofpen.

HeAannrai 3nr43oA ocrporo KopoHapHofo clrH.qpoMa, BbrrroJrHeHHoeqpecKoxHoe KopoHapHoe BMeruaTeJrbcTBo, a TaKXe o[eparlu_s3HAOBaCT(yr'rrpHoro cTeHrr,rpoBaHlrr 3KcTpaKpaHr.r€rJrbHbrx aprepr{I{[oxa3aHnfl x 4nofiHofi aHTr4arperaHruofi repalua: ACK B coqeraHr,r[ cKnonuAorpeJroM se 6olee 90 anefi c [ocJreAyrorqr.rM rrepexoAoM HaMOHOTepant4IO aHTuafpefaHTHbtM neKapcTBeHHbIM CpeACTBOM.

flpu BbrconoM pacKe xapAua,rrHofi eu6oluv ($u6pururrrrJurnpeAcepAr4il, rpoM6e reBoro npeAcepAr{r, rpaHcMypaJrbuorrr lru$aprreMI4oKapAa nepe4uefi creHKr,r AaBHocrbro lrenee 4 HeAeJrb, rpou6e JreBofoxelyAoqKa, r,rcKyccrBeHHLrx KJlanaHoB cepAIIa, peBMaTr,rqecKoM nopaxeHllllKJrarraHoB, I4fM s cor{eraHur,r c ocrpbrM TpaHcMypaJrburrlr r,rn(papxrouMHoKapAa lepe4uel creHKr4 c noAbeMoM cerMeHTa ST, 6e: npr,r3HaroB

$oprraupooaHrzr rporr.r6a reBoro xeJryAor{Ka, npu HaJflr-tuu [epe,qHe-BepxyuerrHoft axr.rueguu r4lLr AtrcK[He3r,rn, Ar4cceKrlra]r aprepuu,conpoBoxAaroqeics ZfM, usnecrubrx cocrorHr4.flx fr4nepKoaryuqnv) -aururporvr6orr4qecKr.{e cpeAcTBa:

aHrnxoarynrH'rbr HenprMoro 4eficrnu.r: eapQaplrH noA KoHTpoJreMMHO, ue,reBoft ypoueno MHO 2-3. KoHrpolr MHO: s reqeHr.re uepaux 5-74uefi noc,re H€BHaqeHHr e)r(eAHeBHo r,rJru qepe3 AeHb, 3areM l-2 paza vHeAenro; nocle cra6uJlr,r3arruu MHO na qeneBoM ypoBHe ocyuearBrqerctKor{rponb I pa: n 2-3 HeAeJrr4 B opfaHrl3arlun 3ApaBooxpaHeHr,rr,oKa3rrBarouryp MeAHrInHcKyro noMorrlr n au6ynaropHbrx ycJroBlrrx, troMecry rpoxhnauul (npe6unauur) narllreHra.

xap4noeu6oarzqecKoM ZfM caHTr.rKoatynrHTaM

c paHee [epeHeceHHbrMr,r rroBTopHbrMr,rI,I|M Ha Qone npreMa ACK, \pv

a raKxe npu la6oparopuofi pe3r,rcreHrHocrr,r K

flp, BbrcoKoM plrcKe xapguallHofi gru6oluu (uexlanauuaaQn6pr.r,rnrqrzr npeAcepAHfi, rpou6 JreBoro [peAcepAr4q, rpaucrrlypalrurrfiuu$apxr MuoKapAa nepe4ne[ocnoxHeHHbrfi rpov6ov JreBofo

creHKr,r AaBHocrbro MeHee 4 uegell,xeryAoqKa, UfM s coqeraur,rr{ c ocrpbrM

rpaHcMypanbHbrM r.rHqapKroM Mr,roKapAa nepe4uefi creHKu, ocJro)KHeHHbrM

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l0

rpoM6a neBofo xeJryAoqKa vrrr4 HapyrueHr.reMnoABr{xHocrr4 nepeAHefi v (unv) BepxyueqHofi o6lacrlr c ofpauuqeHr.{eM

$paxqun eu6poca JreBofo )KeryAorrKaKpoBoreqeHr.rft, B rov qficre npr4 cHr4xeHrar,r KJrr,rpeHca Kpearr{Hr,rna.qo 30-50u,rhruu:

aHrurpon6o'rhqecKue cpeAcrBa: nprnrofi nHru6urop rporra6uua -4a6nrarpaua 3rer(cnrrar vrru npauoi ranru6urop Sarropa Xapranaponca6au.

llaqneurarr,t c rapAuoertr6oJrr,rqecKnM HfM s coqeraHur{ c roponapHoft6o,'resurrc vna creurlrpoBaHr,reM KopoHapHbrx aptepuit Bo3Mo)r(Ha

xou6uuaqur oap$apr.tra u ACK npu ycnoBr4r4 orcyrcrBr,r{ B aHaMHe3e

yra:auuil Ha er,rcoKnfi prrcK rcpoaoreveuufi ue 6onee 90 Auefi crtocneAyrourr4M nepexoAoM Ha MoHorepalrlro aurnrponr6orIaqecKlrMJIeKapcTBeHHbrM CpeACTBOM.

Koppexqur A!: naqrzeHraM c naKyHapHbrM ZfM noxasas qeresofiypoBeHb AI <130/80 MM. pr. cr.; nprr BbrpDr(eHHoM creHo3r.rpyrculeMarepocKnepose 6paxnoue{aruHux aprepufi (>70%) - 140-150/90 MM. pr.cT.; nauueHTaM c caxapHbrMsa6oreeaHrzrMx noqeK - < 130/80150/90 MM. Dr. c'f.

Ar,ra6erou

flpu orcyrcrBr4r4 noKa3aHufi (lrnu) Hufiluvv [porr{BofloK€l3asnfi rTJIT, P3XB, uefipoxr.rpypruqecKoMy BMerrrareJrbcrBy npoBeAeHr,re

cr4MrroMarr4r{ecxoft repal nu corJracHo Klusuqecrovy npororony * :

KoppeKlll,tt AA c aocrr.rxeHlteM IIeJIeBrtx :nauenufi ;KynlrpoBaHrle rrcrrxoMoropHoro nos6yxgeunr, 6olenofo crrHApoMa,

fl,rneprepM?rII, cyAopoxHoFo cuHApoMa, rlrIIepTeH3r,roHHofo cr,rHApoMa,

necru6yrrpurrx uapyureuufi ;

ueft ponporerropHar repanr4r. LIsratnJus. Kr{c,'ropoAa.B opfaHr43arllrrx 3ApaBooxpaHeHns, He ocyulecrBJrflroulrx

HHrepBeHrIrroHHyro u Hefipoxllpyprr4qecKyro troMoulb, 06ecneqlrsaercqrpoBeAeHr4e KoMnr'reKca HeorJ.ro)Knbrx uepoupuarufi t,t zHreucusHofi

repan[r4 Ao cta6utuza\u].r cocrorHr,rr naulaeHTa c OHMK, c

Aa.,rruefiururu peueHrreM epaue6Horo KoHcr,rJrr,ryMa Borrpoca o [epeBoAe B

opraHu3aur4ro 3ApaBOOXpaHeHr.rf , ocyulecrBrqroqyrc P3XB,HeHpoxr{pypf r,rrrecKr4e BMe uareJrbcTBa.

Aaasuefturue leqe6uue v peaoLrJrr,rTaqHoHHbre MeponputTl,rfnpoBoArrcr B ycnoBr4rx orAereuufi pauueft pea6w.srurarynu opraHlrsaquft3ApaBooxpaHeHur FopoAcxoro, o6racrHoro, pecny6Jrr,rKaHcKoro ypoBHr.

* ocyulecmanaemct B coomBemcm+uu c KnuHuqecKu.rt npomoKonoM <fluazuocmuxa uteveHue natpeHmoa c ta6oiesaxun,uu uepauofi cucmeMd (ezpocnoe uaceneuue)>

MM, pT. CT.;

u (uru) xpoHuqecKr.rMlrB Bo3pacre >75 ner - 140190-

ll

flocrrocrura,rsrrrrfi oranAanrHeiuree ar{HaMuqecKoe na6ruoAenvle v JleqeHr,re nauueHTa c

OHMK ocynrecrBJrrercq Bpar{oM-HeBpoJroroM (npavou-repanenrou)opraH[3arlr4rr 3ApaBooxpaHeHl4t, oKul3blBalouyrc MeALIqLIHCKyIO IOMOIIIb B

aHr6y,raropuux ycJroBr.rrx, no Mecry [poxr.IBaHLIs (upe6nranur) naquenra.@yuxquu KoHrponr 3a opraHr,r3aqueft pea6nJrrlTaIIHI,I [aII[eHTa c

OHMK Bo3rafalorcl Ha aAMIIHI,Icrpauurc opraHl,I3aunl{ 3ApaBooxpaHenllt,oKa3brBarouyrc MeAr4r{r{HcKyto rloMolur n arrl6ylaTopHblx ycJIoBI,Ifx, [OMecry ero rpoxnBaHL{t (upe6unauur).

|JIABA IIII4HN}{KATOPbI KATIECTBA OKA3AHI4' MEAI4I_U4I{CKOIZ

IIOMOIUI4 IIAUI4EHTAM C OHMK PE|I4OHAhu4urcaropu pa:pa6orauu rrr npoBeAeHI,Is oIIeHKI,I

clrcTeMbI KoHTpoJ'r.s KaqecTBa MeAI,IqIIHCKOI4 TIOMOIqU npuBHyrpeHHero L\ \vnl1) BHeurHefo ay LuTa.

l. Arra6ynaropuuff eranI.1 VAensnsrfi Bec [au]ieHToB c

MenuunHcKat rroMoulb B coorBercTBl l a

nporor(onoM. Ideneeofi ypoBeHb: 6orce 95Yo.

1.2 floxa:are,rl cBoeBpeMeHHoro

MeAurlr{HcKofi novorqrto e nepnoA Ao 3(rzngur<arop KaqecrBa npo$r'uaxrlr.{ecrofi pa6oru). I-{elenofi yponenr: 70olo.

Pacqer: KoJtLIqecrBo raulreHToB c OHMK, K KoropblM 6Hra nrtssaHa

6prara4a CMil e cpoKr4 Ao 3 ,{acoa or Haqara 3a6oneBaHl'rt, K KoJII'IqecrBy

Bcex naqueHroe c OHMK, AocraBJIeHHbIX B cralluouap 6pr'rra4arr'rr'r CM[I.I-{erenof ypoBeHb: 1\oh w 6o,'ree (oqeuuBaerct IIo AaHHIIM craquonapon).

2. 3ran CMII2.1 Bperrlr or BbI3oBa 6pura.qu CMII ao KoHraKra c lauuenrov (30

Mr.{Hyr B fopoAe u 45 tr,tuHyr B LIHbIx HaceJIeHHbIX uyurrax). Ifelenofiyponeur:100%o.

Pac,rer: KoJruqecrBo naqlleHToB (n npoqeurax), upu6urue K KoropblM

6puraaofi CMII ocyurecrBJleHo He no3AHee 30 uranyr B fopoAe u 45 tuuuyr nr,rHbrx Hace,rrleHHbIX nyHKTaX nOCJIe pefl4crpauuu cpor{Hofo BbI3oBa c

noBoAoM (BHe3anHble HapyueHu.g ABI'IfaTeJIbHOfi artunnoct[>, cpeAI'I

rau[eHroB, Bbr3brBaBuux CMII lo AaHHoMy noBoAy.

2.2 Bpeul or nepBoro KoHraKra 6puraAu CMII c [auneHroM Ao

AocraBKr,r naqneHra B cralrl4oHap (60 ruranyt B ropo.{e u 75 unuyr B I'IHbIX

HaceJreHHbrx nyn r<rax). I{e,renofi ypoeenr : 1 00ol0.

B p€rMKax

npoBeAeH}lLI

OHMK, KoropblM oK€BaHa

geEcrnyrcrqnM KJII,IHI,IqeCKI{M

o6pauqennx [aIIneHToB 3aqacoB or HaqaJIa sa6oresaHzq

12

Pacqer: KoJrr,rqecrBo rraur4eHToB (r upoqeurax), 4ocraaleuHbrx B

craur4oHap B Ter{eHHe 60 lauHyr B fopoAe u 75 uuuyr B r,rHbrx HaceJreHHbrx

nyHKrax nocne nepBoFo noHraKTa c 6pura4ofi CM[I, cpegn Bcex naqlreHToB,

AocraBJreHHbrx B crarruoHap c [oAo3peHr{eM Ha OHMK.3. Craqrlonapubrfi 3ran

3.1 CnoenpelreuHocrb Ha[paBJreHr.rr B [ilrary u HTeHcr,rBHoft Tepaililv(IIPI4T) uru orAeJr e Hr.re aHecre3r4oJro f nrr lr peaHr.rMarlnrr (OAI4P).

Pacqer: KoJrnqecrBo naqueHToB (n a6coruoumrx 3HaqeHI,Itx vl

npoueurax), Koropbre lro rroKa3aHurM HanpaBneHH s lIPI,lT nnr,r OALIP socrpefiruelr lrepuoAe :a6o,resaHraq. I{elenofi ypoBeHb - 100%.

3.2 llpoeeAeHue KT uru.r MPT roroenoro Mo3ra B reqeHr4e I qaca orMOMeHTa nooTynneHr4r B CTaUr.rOHap.

Pac.rer: KoJllqecrBo rraqrreHToB c npr,r3HaKaMu OHMK (n a6conrorurrx3HaqeHurx 14 npoqeHrax), xoropurlr npoBeAeHo KT rarn MPT rorosHoroMo3ra B Ter{eHHe I qaca or MoMeHTa flocrynJleHr,rfl B craul,IoHap apeArr Bcex

rocrynlrBrur4x narlueHroB c OHMK. I{e,renofi ypoBeHb - 100%.3.3 llpone4enrae TJIT n,rn P3XB npu I,I|M.Pacqer: KoJrr4qecrBo rraqr{eHToB c I,IfM (a a6colrornbrx 3HaqeH[tx rI

rpoqenrax), Koropr,rM npoBeAeHhr TJIT vrv PSXB (n a6colroruux3HaqeHr.rrx u npoueHrax). I-{eneeoi ypoBeHb - l0%.

4. PeruouarlHbre noKa3areJII4

4.1 lloKasarenb cMeprHocru or OHMK 3a foA (ncero I4 B roM qLIcJIe

rpyAocnoco6uoro no:pacra).4.2 YAemnufi Bec Jrr,r[, rrepeHeclxl4x OHMK, [poIxeAIII]IX

crarllroHapubrfi eran pea6utu'raryuu,I-{eneeoii ypoBeHb: 80Yo W nLrU rpyAoc[oco6Hofo Bo3pacra.