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120

2-3

* II.

30

1. -

130
120

110

>, 100

90

80

X 70

60

40

-------- 2

---------98

3. ()
0 18 -

PQ
-
PQ. Q (R)
. PQ

.
PQ :
;
- , ;
- ;
- -.
PQ
. ,
80 , 120 -

31

150 1 (. 3, . 4).
PQ 100
, 90 101 .
, 140-150
, 160 - 2 8 170 8 9
. 10 180 .
3. PQ* ()
0 18 -
;

N
2

50

95

98

0 -7

257

80

80

101

120

120

1 . - 2 .

374

80

80

110

120

130

3-5 .

232

80

80

101

140

140

6 -12 .

318

80

90

110

140

150

1 -4

200

80

80

110

140

140

2-3

128

101

101

120

140

160

3 -4

188

101

101

120

156

160

4 -5

197

90

101

120

150

160

5-6

241

101

101

120

160

160

6-7

245

101

101

130

160

160

7 -8

426

101

101

120

160

160

8-9

330

101

110

129

160

170

9 -1 0

261

101

105

130

160

170

10-11

294

101

110

130

160

180

11-12

262

101

101

130

160

180

12-13

207

101

110

140

160

180

13-14

248

101

108

130

160

170

14-15

356

101

110

140

170

180

15-16

236

101

101

140

180

180

16-18

217

101

110

140

180

180

* PQ II.

32

1.
-

190

5 180
* 170
2
160
2- 150

! 140

130

120

110

I 100

90

80

70

-------- --------- 2

98

4. PQ ()
18 -


A. Davignon [2]. PQ,
, 30
.
10-12 , A. Davignon.
, PQ
. PQ
.

.

QRS
QRST
-
QRS, - () RS- ( S)
RT - .

33

QRS
Q
S, S R.
QRS
. QRS .
40-70 (. 4,
. 5). 40 60
. 70 101
16- ,
- 120 ,
[4]. QRS
.
4. QRS* ()
0 18 -
;

34

N
2

50

95

98

0 -7

260

40

40

60

60

70

1 . - 2 .

378

40

40

60

80

80

3 -5 .

237

40

50

60

80

80

6 -12 .

325

50

50

60

80

90

1-5

207

50

60

70

90

90

2 -3

135

50

60

70

90

101

3 -4

200

50

60

80

90

101

4-5

207

60

60

80

90

101

5-6

250

60

60

80

90

101

6-7

253

55

60

80

101

101

7 -8

433

60

60

80

101

101

8 -9

336

60

60

80

101

101

9 -1 0

267

60

60

80

101

101

10-11

309

60

60

80

101

101

11-12

278

60

60

80

101

101

12-13

214

60

60

80

101

101

1.
-

4 ()

N
2

50

95

98

13-14

263

60

60

80

101

101

14-15

364

60

60

80

101

112

15-16

240

40

60

80

101

101

16-18

221

40

40

80

101

120

* QRS V1.

-------- ...........5 --------- 95

5. QRS ()
0 18 -

QT
QT,
,
,
,
. QT
,

35

-
QT [5, 6].
QT [7].
Anttonen . (2007) 1966-2005 .

QT , 10 822 30
59 . , QTc ( 340 ) QTc
( 320 ) .
-
QT ,
.
, ,
,
QT ,
- , .


.

[6, 8].
QT
, 200 328 (. 5, . 6,
7).
6-8 , 290 400 .
8
.

100 . (128 )
, (80 ) - 2 3 (. 5, . 6, 7).
5. QT* QTc** ()
18 -
;

36

50

95

98

QT

QTc

QT

QTc

QT

QTc

QT

QTc

QT

QTc

0 -7

200

324

200

339

260

395

320

467

340

491

8 - 6 .

200

343

210

357

260

408

300

460

320

477

7 . - 1

210

328

220

346

260

389

320

446

350

463

2-3

240

349

260

361

300

410

360

448

360

458

1.
-

5 ()

95

50

98

QT

QTc

QT

QTc

QT

QTc

QT

QTc

QT

QTc

4-5

260

340

280

354

320

405

360

463

380

471

6-8

280

352

290

359

340

413

380

464

400

473

9-12

280

347

300

361

350

412

400

459

420

471

>13

300

335

300

354

355

401

400

450

400

465

* QT QTc V5.
** QTc QTc = QT / V RR ( 1).

430
420
410
400
390
380
2 370
360
350
1
340
g- 330
I 320
I 310
t 300
I 290
5 280
s 270
260
250
c l 240
C 230
220
210

200
190
180
0 7 .

8 .-6 . 7 . -1

2-3

4-5

6-8

9-12

>13

...... 5

- - 2

--------98

--------95

6. QT ()
18 -

37

-------

- - - - 2

-------- 98

7. QTc ()
18 -

,
QT ( = -0,85; < 0,05). 6
8
QT (
5 95 ). QT
2 98

QT . QT
( = -0,04).
6. QT* ()
;

<=60
61-70
71-80
81-90
91-100

38

2
330
320
300
300
280

5
340
320
320
300
280

50
380
370
360
340
330

95
440
420
400
380
360

98
440
440
400
400
380

1.
-

6 ()

101-110
111-120
121-130
131-140
141-150
151-160
161-170
171-180
181-190
>191

2
260
240
240
230
210
220
170
180
190
180

5
280
250
240
240
220
220
220
200
200
190

50
320
300
280
270
260
260
240
240
240
215

95
350
340
320
310
300
280
280
280
260
260

98
360
340
320
320
320
290
280
290
260
260

* QT V5.
450
440
430
420
410
4 00
390
s 380
370

a
gSE
s

5
S

340
330
320
310
300
290
280
270
260
250
240
230

Q- 220
c 210
200
190
180
170
160
150

, /

----------2

---------- 98

8- QT ()
-

39

QTc ( = -0,07;
< 0,05). ,
( = 0,13; <0,05). , QTc

QT ,
,
.
QTc (5 95 )
- 339-462 , 2
, 361 -449 . 4 ,
, 356-465
(. 6).

, ,
PQ, QRS, QT.
, .
QT, .
QT 1
.


,
QT .

QT, .
QT QTc 440
[5, 6, 8]. 2000 . P. Rijnbeek ,
QTc 450 [3]. ,
(5 95 )
QTc 13
. QTc 340
( ) 465 ( ).
QT
,
QT .
QT.


1. .., .., .., ..,
.., .., .., .., .., ..,
.., .., .., .., ..,

40

1.
-

.., ..
- / / / - 2009. 49, 10. - . 47-54.
2. Davignon A., Rautaharju P., Boisselle . Normal ECG standards for infants and children.
Pediatr Cardiol 1979/80; 1: 123-31.
3. Rijnbeek PR., Witsenburg ., Schrama E. New normal limits for the paediatric
electrocardiogram. European Heart Journal 2001; 22, 702-711.
4. Strong W., Downs ., Liebman J. The normal adolescent electrocardiogram. Am Heart
J. 1972 83: 115-128.
5. Schwartz P.J., Stramba-Badiale M. Prolongation of the QT interval and the sudden
infant death syndrome. N. Engl. J. Med. 1998; 338: 1709-14.
6. Pearl W. Effects of gender, age, and heart rate on QT intervals in children. Pediatr
Cardiol. 1996; 17: 135-136.
7. Giustetto C., Di Monte E, Wolpert C. Short QT syndrome: clinical findings and
diagnostic-therapeutic implications. European Heart Journal 2006; 27, 2440-2447.
8. Kligfield P., Gettes L.S., Bailey J. Recommendations for the Standardization and
Interpretation of the Electrocardiogram. Part I: The Electrocardiogram and Its Technology.
A Scientific Statement From the American Heart Association Electrocardiography
and Arrhythmias Committee, Council on Clinical Cardiology; the American College of
Cardiology Foundation; and the Heart Rhythm Society. Circulation 2007; 115: 1306-1324.

41

3.

() ,


.
.
.
,

[1].


QRS
[4].

().
( I ),
, (. 1).
( I )
- 0, - 180. ,
, +90, -90.
, , ,
[1, 4].

.

1.

42

1.
-


,
QRS
.
,
(. 2) [1].


QRS ,
. I III .


QRS. QRS
, .

+ 1

+III

+11

2. [1]
QRS

(. 2). (
)
I III .
.
. [4].

[1 ]
(. 3).
I III

43

.
.
.

I
-9 -8 -7 -6 -5 -4 -3 -2 -1 +1+24-3-+5+-6+7+8+9

-3 -8 -7 -6 -5 -4 -3 -2 -1 0+1+2+344+5+6+7+8-HJ

I
3. ( )



QRS I III .
. ,
(. [2]).



, .
[4]:

44

1.
-

1.
QRS ,
, .
2. RS, (R = S
R = Q + S), ,
.
, (
) ,
-
,
- .

( ) QRS I aVF-.

(. 4):
0 +90 (
);
0 -90 (
);
+90 +180 ( ,
/);
-90 -180 (
).

180

aVF J \_

+90
4. 4

.
QRS-
I aVF,
(. 5):
1 - 0 -30;
2 - +30 +69;

45

3456-

, () +70 +90;
+90 +120;
+120;
-30 -90.

1 aVF
1

__
Y
Y

_\_

5. 6
( [3])
,
30: 1 ,
,
QRS
, [5].
1. QRS

46

R S
(S+Q)
+

QRS
RS

+30

I II

aVR

III

+60

II

aVR

aVL

+90

aVF

aVL aVR

+ 120

III

aVL

aVR

+ 150

III

aVL

II

+ 180

aVR

aVF

1. -

1()
R S
(S+Q)
+

QRS
RS

aVR

aVF

1 1

aVL

III

II

aVL

III

aVR

-90

aVL aVR

aVF


[1-5] (. 6):
-

- +30 +69;

- + 70 + 90;

- 0 +29;

- -1 -90;

- +90 (
).

6.

47


:
RM> R, > R ,
III / aVL R S ;

R, > RM> Rm, aVF / III RS;
Rn> Rni > R,,
I / aVL RS;

I / aVL ( aVL aVR),
aVF, aVR, I II RS,
S III / aVF;
R
aVF / III ( aVR), RS -
I / II ( aVR), S - aVL / I.
,
( -20)
( +100) .
[1]. .. [2]
-30
+ 120.

:
- -30 +105;
- +105 180;
- 180 -90 (.. -
);
- -90 -30.



() , , ,
1-3 ,
[3]. 2 3 [3, 6].
2. ( )
0 -1 7 , = 2141 (* - Davignon . [6])

48

2%

0-1 *

+ 59

+ 135

+192

1-3 *

+ 64

+134

+197

5%

25%

50%

75%

95%

98%

1.
-

2 ()
5%

25%

50%

75%

95%

98%

2%

3-7 *

+77

+132

+ 187

7-30 *

+65

+110

+160

1-3 .*

+31

+75

+ 114

0-1

-2

+25

+55

+79

+90

+130

+ 164

1-2

-3

+30

+55

+71

+83

+90

+99

3-4

+7

+23

+60

+74

+83

+98

+104

5-7

+14

+60

+75

+84

+97

+102

8-11

+18

+60

+71

+82

+92

+ 104

12-15

+7,3

+60

+74

+83

+93

+99

16-17

-9

+11

+60

+76

+87

+97

+109

3. 0 -1 7 50% (2-98)%
( = 153 1 ) [3]
1 1 -2

3-4

5-7

8-11

12-15

70
(1-151)

66
(-11-91)

78
(10-100)

73
(-3-101)

73
(9-92)

73
(-12-99)

90
(20-146)

77
(-8-118)

76
(2-131)

75
(7-102)

71
(8-105)

74
(8-100)

16-17

81
(-25
-

111 )

74
(11-91)

-

( = 5277) .


1. .. . - ., 2000 395 .
2. ..
. - .: , 1983. - 368 .
3. .. . - .: -, 2006 - 544 .
4. .., .. . - .: , 1991 288 .
5. .., ..
. - .: , 1999. - 622 .
6. Davignon A., Rautaharyu P., Boisselle . Normal ECG standards for infants and
children. Ped Cardiology 1980; 1:123-131.

49


-
-

CL

--------

- - - - 2

---------98

.
18 -

.
0 18 -
;

50

50

95

98

0 -7

252

122

83

95"

120

160

169

8 - 6 .

601

80

36

44

80

119

130

6 . -1

529

65

18

29

65

97

120

1. -

()

62

20

66

450

63

6-8

1003

67

10

24

70

93

13

71

100

71

94

102

67

13-18

1068

CD

1051

9-12

323

4-5

2-3

CD

98
102

95
94

CNJ

50

CD

180
170
160
150
140
130
120
0 110

,' 100
1
*
S

>

90
80
70
60
50
40
30

20
10
0
-10

! < < < > ; ) < <

1 ^ $

55
00 ^S

'

--------

--------- 2

--------- 98

.
18 -

.
0 18 -
;

50

95

98

0-7

252

122

83

95

120

160

169

8 - .

376

86-

43

49

85

120

135

51

()

6 . - 1
1
2

98

71"

39

70

104

113

319

18

109

204

65

18

26

64

105

126

60

11

62

98

120
102

69

90

105

22

67

205

64

13

20

245

64

20

102

70

94

100

21

70

94

100

331

15

71

96

101

14

11

273

34

71

15

72

95

100

69

70

95

100

14

357

96

102

16

94

104

73

100

41

20

10

260

71

15

237

214

13

12

15

68

68

264
300

9
10

69


CD

10

00 00

68
66

249
423

6
7


00 00

197

CD

95

50

231

3 . - 6 .

52

72

16

214

68

20

1
QRS 1
,

(+) ()
1
-30

QRS III , (-) ()


17
19
12
13
14
15
16
18
7
8
9
10 | 11
4
5
6
3

-57

-70

-73

-78

-82

-83

-84

-85

-86

-86

-86

-86

-86

-87

-87

-87

-87

-87

-88

-30

-47

-60

-65

-70

-73

-77

-78

-79

-81

-82

-82

-83

-83

-84

-84

-85

-85

-85

+ 10

-8

-30

-41

-51

-60

-63

-67

-70

-72

-74

-77

-77

-78

-79

-79

-80

-81

-81

-81

+20

+8

-13

-30

-38

-47

-54

-60

-63

-66

-69

-71

-73

-74

-75

-75

-77

-78

-78

-79

+20

+7

-5

-18

-30

-38

-45

-51

-56

-60

-62

-65

-67

-69

-71

-72

-74

-74

-75

-75

+5

3
4
5
6

+22

+ 11

+2

-10

-19

-30

-36

-43

-49

-53

-57

-62

-62

-68

-68

-68

-70

-71

-72

-73

+23

+ 15

+5

-4

-13

-23

-30

-36

-42

-46

-51

-54

-57

-60

-62

-64

-66

-68

-69

-70

+24

+ 16

+ 10

+1

-7

-16

-22

-30

-35

-40

-45

-49

-52

-55

-58

-60

-62

-64

-65

-67

+24

+18

+ 11

+6

-3

-10

-17

-24

-30

-34

-39

-44

-47

-50

-53

-56

-58

-60

-61

-63

+1

-7

-13

-19

-24

-30

-35

-36

-42

-45

-49

-51

-54

-56

-58

-60

10

+25

+ 19

+ 13

+7

11

+25

+20

+ 15

+ 10

+4

-3

-9

-14

-20

-25

-30

-34

-38

-41

-44

-47

-50

-53

-5 4

-57

12

+26

+21

+ 16

+ 11

+6

-5

-11

-16

-21

-25

-30

-34

-37

-41

-43

-46

-49

-51

-53

13

+26

+22

+17

+ 12

+8

+3

-2

-7

-12

-17

-22

-26

-30

-33

-37

-40

-43

-45

-48

-50

14

+27

+22

+ 18

+ 14

+ 10

+5

+1

-5

-9

-14

-18

-22

-26

-30

-33

-37

-39

-42

-44

-47

15

+27

+23

+20

+ 15

+12

+7

+3

-3

-7

-11

-15

-19

-23

-26

-30

-33

-36

-39

-42

-44

16

+27

+24

+20

+ 16

+ 13

+8

+4

-6

-8

-12

-16

-19

-23

-26

-30

-33

-36

-39

-41

17

+27

+24

+20

+ 17

+13

+ 10

+6

+2

-2

-5

-9

-14

-17

-20

-24

-27

-30

-33

-36

-38

18

+27

+24

+21

+18

+ 15

+11

+8

+3

-4

-7

-11

-14

-18

-20

-24

-27

-30

-33

-35

19

+27

+25

+21

+ 18

+ 15

+ 12

+9

+5

+2

-2

-5

-9

-12

-15

-18

-22

-25

-27

-30

-32

20

+27

+25

+22

+ 19

+17

+ 13

+ 10

+6

+3

-3

-7

-11

-13

-16

-19

-22

-25

-27

-30

* .. . - .: , 1983. - 368 .

20

1.
-

QRS 1
,

(-)
()

QRS III , (+) ()


4
7
3
5
6
8
9
10
11
12
13
14
15
16
17
18
19

20

+95

+94

+94

+94

+93

+93

+93

+93

+93

+92

+ 180 + 150 + 130 + 120 + 112 + 109 + 106 + 102 +101 + 100 +99

+99

+98

+97

+97

+97

+96

+96

+95

+95

+ 170 + 168 + 150 + 130 +127 + 120 + 116 + 112 + 109 + 107 + 105 + 104 + 102 + 102 + 101 +100 +99

+99

+98

+98

-164 -179 + 163 +150 +139 + 131 + 124 + 120 + 115 + 113 + 110 + 109 +107 + 106 + 105 + 104 + 103 + 102 +101 +101

+120 + 110 + 105 + 102 +99

+98

+97

+96

+95

-161 -175 + 173 +161 + 150 + 140 + 134 + 128 + 124 +119 +117 + 114 + 112 + 110 + 109 +108 + 107 + 106 +105 +104

-158 -170 + 180 + 168 + 158 + 150 +142 + 136 + 129 + 125 + 122 + 120 + 117 + 115 + 113 +112 + 110 + 109 + 108 + 107

-158 -167 -175 + 175 + 166 + 157 +150 +143 +138 + 138 + 129 + 125 + 122 + 120 +117 + 116 + 114 + 113 + 112 + 110

-157 -164 -172 + 180 + 170 + 164 + 156 + 150 + 144 + 139 +134 +131 + 127 +124 +122 + 120 + 118 +116 + 115 + 113

-156 -162 -169 -177 +176 + 169 + 161 + 155 + 150 + 145 + 140 +136 +132 + 129 + 126 +124 + 122 + 120 + 118 + 117

10

-155 -161 -168 -174 + 180 + 173 + 167 + 160 + 155 + 150 + 145 + 141 +137 + 134 + 131 +128 + 126 + 124 + 122 +120

11

-155 -160 -165 -172 -177 + 177 + 171 + 165 + 160 +155 + 150 + 145 +141 + 142 + 135 + 132 + 130 + 127 +125 +123

12

-154 -160 -164 -169 -175 + 180 + 174 +169 +164 +159 + 154 + 150 + 146 + 142 + 139 + 136 + 133 + 131 + 132 + 127

13

-154 -160 -163 -168 -173 -178 +177 +172 + 167 + 163 + 158 + 154 + 150 + 146 +143 + 140 + 137 +134 + 132 + 130

14

-154 -158 -162 -167 -171 -175 + 180 + 175 + 170 + 168 +161 + 157 + 153 + 150 + 146 + 143 + 140 +138 + 135 + 133

15

-154 -157 -161 -165 -169 -174 -178 + 178 + 173 + 169 + 164 + 161 + 157 + 153 + 150 + 146 + 144 + 141 + 138 + 136

16

-153 -157 -161 -164 -168 -172 -179 + 180 + 176 + 172 + 168 + 164 +160 + 159 + 153 + 150 + 147 + 144 + 142 + 139

17

-153 -156 -159 -163 -166 -169 -173 -178 + 178 + 174 + 170 + 166 + 163 + 159 + 156 + 153 + 150 + 147 + 144 +142

18

-153 -156 -159 -162 -166 -169 -173 -177 + 180 + 176 + 172 + 169 + 166 +162 + 159 + 156 + 153 +150 + 147 + 145

19

-153 -155 -159 -162 -165 -168 -171 -175 -178 + 178 + 175 +171 + 168 + 165 + 162 +158 + 156 + 153 + 150 + 147

20

-153

-158 -160 -164 -167 -170 -173 -177 + 180 + 176 + 173 + 170 + 167 + 164 +161 + 158 + 155 + 152 + 150

* .. . - .: , 1983. - 368 .


QRS I
,


(+) ()

+60

+70

+75

+78

+81

+82

+83

+84

+85

+85

+86

+86

+86

+86

+87

+87

+87

+87

+87

+87

+50

+60

+67

+71

+74

+76

+78

+79

+80

+81

+82

+82

+83

+83

+84

+84

+84

+85

+85

+85

QRS III , (+) ()


2

10

11

12

13

14

15

16

17

18

19

20

+43

+54

+60

+65

+68

+71

+73

+75

+76

+77

+78

+79

+80

+81

+81

+82

+82

+82

+83

+83

+41

+50

+56

+60

+64

+67

+69

+71

+73

+74

+75

+76

+77

+78

+78

+79

+80

+80

+80

+80

+39

+46

+52

+57

+60

+63

+66

+68

+69

+71

+72

+73

+74

+75

+76

+77

+77

+78

+79

+79

+37

+44

+49

+53

+57

+60

+63

+65

+67

+68

+70

+71

+72

+73

+74

+75

+76

+76

+77

+77

+36

+42

+47

+51

+55

+57

+60

+62

+64

+66

+67

+69

+70

+71

+72

+73

+74

+75

+75

+76

+35

+41

+45

+49

+53

+55

+58

+60

+62

+64

+66

+67

+68

+69

+70

+71

+72

+73

+73

+73

+35

+40

+44

+47

+51

+53

+56

+58

+60

+62

+63

+65

+66

+67

+68

+69

+70

+71

+71

+72

10

+34

+39

+43

+46

+49

+52

+55

+57

+59

+60

+62

+63

+65

+66

+67

+68

+69

+70

+70

+71

11

+34

+38

+42

+45

+48

+50

+52

+55

+57

+59

+60

+62

+63

+64

+65

+66

+67

+68

+69

+70

12

+34

+38

+41

+44

+47

+49

+52

+53

+55

+57

+59

+60

+62

+63

+64

+65

+66

+67

+68

+68

13

+34

+38

+40

+43

+46

+48

+50

+52

+54

+56

+57

+59

+60

+61

+63

+64

+65

+65

+67

+67

14

+33

+37

+40

+42

+45

+47

+49

+51

+53

+54

+56

+58

+59

+60

+61

+62

+63

+64

15

+33

+36

+39

+41

+44

+46

+48

+50

+52

+53

+55

+56

+56

+59

+60

+61

16

+33

+36

+38

+41

+43

+45

+47

+49

+51

+52

+54

+55

+57

+58

17

+33

+35

+38

+40

+43

+45

+47

+49

+50

+51

+53

+54

18

+33

+35

+38

+40

+42

+44

+46

+47

+49

+50

19

+32

+35

+37

+39

+42

+43

+45

+47

20

+32

+35

+37

+39

+41

+43

.. . - .: , 1983. - 368 .

3
X
0

0)
S
S)

CD

?
0

S
1
S
I~1

S
Sc
s
3

1.

5
S
c

Sc

2
68

s
S

2.
..

-
,
,
. -
.

.

, , , ,
.
,
, ,
, , /
.
, , ,
, .
3-4- .
4- ,
- (
, , , , ) (, , .). , ,

56

2.

. 0,1-0,2 %
.

, ,
.
5-6-
. ()
. , 6
90-110 /, 9 - 140-170 /.

.
12
120 160 /. 110 /
, 100 / .
()
. 180 /
.
: - ( , ),
; -
(), - (), ;
- , (),
() [1 ,2 ]. ,
, (),
().

1.

. , Zaidi [3],
1-2%. Jeffrey . ,
250 [4].
,
. . , 5
3 7%, 28 1000
, 36%
[5].

2.
( )
.

57

( ,
; , , ; ; , PRKAG2). : ,
, ;
, , .
,
, ,
.
,
.
, , .

3.
.

, ,
, Willem Einthoven 1913 , , ,
().

().
.

,
, .

.
: -
2,5-6 - 5-8 .
:
;
;
;
.

, , -
- .

().
.

58

2.

, .
Pombos
method [6], -
.

.
, ,
-
- - [7].

,
,
, -
.

. ,
.
,
,
[8] : 10-14 , 20-24 , 32-34 ( - : 10-14, 18-22 32-34 ).

,
,
, ,
, ,
. , ,
,
. ,
, , .
, ,
, ,
,
.

4.


.
, (
) / .

59

.

.
/
,
, , .
: - ;
( , ,
); (), ,
, ,
( ,
10-20%, - 20-30%);
( ,
40-50%); ;
. ,

.
, ,
. ,
,
, , 50 %
( ), ,
.

4.1.


(,
) 180 / 80 /.

,
. ,

.
10 115
, ,
50,4% (58 ).
, ,
: 62,1% (36 ) -
, 20,7% (12 ) - ,

60

2.

8,6 % (5 ) - 8,6%
(5 ) - .
.

4.2.

.
,
, ,
(-) (-),
.
,
, ,
.

4.2.1.

.

, .

, ,
, 24-38% .
, .

:
, , , 250-320 / ( ,
- -).

, --,
.
: ,
.
--
:
, ,
,
, .
, - ( , - -).

61

()
() ( , -).
(
, -).
( , -).

4.2.2.

, .
.

:
- 150 280 /
( , - -)
.

200 / ( , - -).

. ,

, ,
.
, , , (
, -).

( , - -).

4.2.3.

, ,
,
.

:
, , , 230 /
( , - -).
( , -).
( , -).

62

2.

, ,
(
) ( , -).
( , -).

4.2.4.
, , .
:
(-).
, .
(
;
)
( , ,
).
:
100 / ( , - -).
( , -).
- ; - ( , -).
-
( , -).
-, , ( , -).

4.2.5.
.
.
.

4.3.



().

63

, ,
.
,
,
;

.

:
,
.

.
.
, ,

.

, ,
.
.
, .

, ,
, Ronn E.Tanel, Larry A. Rhodes [9].
1

64

0,5-1,0
/

100%


1,0-1,5 /

80-320 /

,


()

70%

3-6 /

,
,

QT

25-100%

2.

1()

50-100%

10-20%

40-180


QT

600
6

;
800 /

QT,


, ,

, FDA (, 2002),
2.
2



,




,
.
,

,,


.

,


.

, ,
,
,
,
,
,,
, ,
,

65

2 ()

, ,

.
,


,


,
, ,

:



.

2
.
,
, ,
, .

4.3.1.
,
, .
. ,

. ,
30
. ,
, [10].
,
,
.
.

, .
, , ,
, ,
,
[ 11].

66

2.

,
,
. ,
- 83,3% ( 30 36 ) 58,3% ( 7 12 ).
. , ,
,


, , ,
- --.

.


(-)
-. ,
, .


(
. . 250).

4.3.1.1.
, 3-5 . 0,00075
. .
1-2 /.
( ) ,
. 0,00025
( ) .
.

4.3.1.2.
5 ,
.
2 / .
2 /
.

67

, 7
.
.
.
: -
(, , , ); (
, , ); (
, -).
.

4.3.2.
- -.

.


. , , 80 .
5 .

. 5
.

4.3.3.

.
.
,
.
4 5
.
600 .
5 .
. 5
.

4.3.4.



,
.

68

2.

5.
,
, .

,
,
.
, ,
- .

.

, .

.
. ,
200 /, ,
.

.
,
, ,

.
,
, ,
.
,
,
.


1. .. . - .: , 2004. 400 .
2. .. . 2- ., . [. .] - .;
.: - , 2002. - . 22-29.
3. Zaidi Ali N., Ro Pamela S. Treatment of Fetal and Neonatal Arrhythmias.
4. Moak J.P. Supraventricular tachycardia in the neonate and infant / / Progress in
Pediatric Cardiology. - 2000. - 1 May, V. 11, Issue 1. - P. 25-38.

69

5. .
- : . ... . . . - ., 2003
6. Pombo, J.F. Troy, B.L. and Russel, R.O. Left ventrical volumes and ejection fractionis
by echocardiografphy. Circulation, 43, 480-90.
7. [ . .. ]. -1 - . - .: ,
, 2000. - . 61-63.
8.

:
. 28 2000 . 457;
- 28
2007 . 496.
9. R.E. Tanel and L.A. Rhodes. i //
: - [ . .
i .. ] [ .]. - . 28, 1, , 2001. - KniB:
, 2004. - . 227-248.
10.R.E. Tanel and L.A. Rhodes. i //
: - . - Knie: ,
2004. - . 229-230.
. PH. . .; .: , 2002. . 121.

70

. 3. : , ,

. 3.
:
, ,

.. , ..

1.
, ,


() () 95%
.
,
, , ,
. ()
.
.
, ,
.
.
,
,
.
-
,
,
-. , ,
, - , ,
-, , .

71

.
.
, 30 ,
, 30 .
,
.
() - (-). ,
.
-
,
.
QRS ,
.
.
220-300 /,
- 180-250 /.
200-250 / - 150200 / - .
-
:
I. :
1. :
- ( 30 )
- ( 30 )
2. :
-
- -
II. :
1. :
1. ().
2. .
3. .
2. :
1. () .
2. .
3. .
4. .
5. .
3. -:
1. :
-
-

72

. 3. : , ,

2. () -:
-
-
-
4. (
--, ):
1. - .
2. -
.
3. - .
4. - (
).


/ .
, , ()
, () , .
-
(reentry).
() ,
,
. ,

. .

(, ) .
.
()
, ..
, ,
.
.
()
() -.
-
, .

, .
II ( 1) III ( 2) .

73


, .. IV .
reentry () ,
(
). , (,
),
. , reentry,
. .


, ,
1 25000 1 250 [1, 2].
-
8-12 [3]. 50%
, , -, ,
, WPW [2-6]. , WPW
,
60-90% [4-6].
, 30% ,
. ,
. ,
, , 18
.
.

[7].
.
-
-, ..
--.

, 80% 1
65-70% - [5, 8]. ,
, - - 1323% [1, 5].
- 2 31%
.
() - 15% 1 , 10% 1 5 [5].
.
,

74

. 3. : , ,


.
,
WPW [9].
0,5% [10].

2.


.
, , ,
, .. ,
, .
, ,
.
,
.
, :
1. .
2. .
3. ,
.
4. .
:
1. .
2. 12 .
3. 12 ( )
.
4. .
5. ( ).
6. .
7. .

,
,
, .
,
.

,
.

75



.
.

.
.
, , .

.
, ,
, , ,
.

.

.
, , , ,
.
,
.
.

, , , , . ,
, ,
, ..

.
, .
,
, .
, - ,
, , ,
, , , , .
10-15% ,

.
WPW, ..
- .

( , )

76

. 3. : , ,

.
.

, ,
,
, ,
.

,
:
1. .
2. ,
.
3. ,
/ .
4. .
5. .
6. .

.

12 . ,
: WPW
PQ.
WPW ( PR, -,
QRS, ),
- . ,
WPW ,
,
. WPW -
.
,
- ,
.

.
.

(, ) -
, ..
.
,
.

77

.

, . ,
.

. ,
, - .
, .


( ).
.

1.


1.
/ , . ,
WPW,
, - - .
WPW .
, .

78

. 3. : , ,

,
RP-.

(. 2).
- ,
.

2.
QRS

:
1. QRS: QRS,
QRS.
2. : , .
3. QRS: - 1:1; 2:1 ..; -.
4. RP .
5. RP PR ,
: RP < P R, RP > P R RP
(. 3).

79

/ \

/ \

/ \

...Tp'R
RP

J \

P'J

\p

/ \l

RP<PR

P'J

RP
PR

P'J

\ P '

RP>PR

3. RP < P R RP > P R. RP
QRS . P R
QRS.
RP < P R RP -,
RP > P R - RP -
6. ( RR )
.
7.
.
8. (, ,
, , ).
10. : .
11. .

3.
()
,
, .
,
.

.
, 20-30 ,
, , .
160-220 /,
- 120-140 /.
- :
1. ( 95 - 98%
) (. 1).

80

. 3. : , ,

2.
.
3. QRS.
4. .
5. QRS .
1. (/ )
0 -1 7 ( . . [1 1 ] A. Davignon [1 2 ])
5%

25%

50%

75%

95%

98%

2%

1 *

94

122

155

1-3 *

91

124

158

3-7 *

90

128

166

7-30 *

106

148

182

1-3 .*

120

149

179

3-6 .*

105

142

185

6-12 .*

107

132

168

1-2

86

86

102

120

130

166

187

3-4

75

79

91

100

109

121

140

5-7

67

71

82

89

100

120

122

8-11

55

59

70

79

91

107

115

12-15

53

57

68

77

86

104

112

16-17

48

53

64

71

80

100

107

/
, , , ,
, , ,
. ,
, ,
1 9,6 / [13].
(,
, ), ,
(, , ).
,

.
- ,
, ,
, .
: ,

81

, .

.
/
.
, ..

.
:
1. .

.
2. ,
.
3. .
4. - (, .), ..
.

. , ,
, , . ,
, ,
. p-,
.
(), 1(-,
.
.
( reentry
, reentry )
. reentry
P. Barker . 1943 [14]. 1995 J.A. Gomes .
,
[15].
, 120 220 /,
, .
,
.
, [17].
:
1. .
. .
2. .

82

. 3. : , ,

3. .
4. , / .
,
, , (3-, . , ,
,
.
90-100%, :
-
[16,17].

4.

.
.


. ,
,
.
()
,
- .
,
-reentry. ,
,
.
.
. ,

, .
,
()
[18].

, ,
120-300 .
, QRS.
(. 4).

83

mm-

25 /

10mm/mV
BDS- 30 .

II

^JU 4

10 / V
BDS- 30

III
10 / V
BOS-.

_1___1__1
~--

Jl

axa

----- ' L,
4_^tuLL---vj

aVR
10 / V
BDS- 30 .
VI
10mm/mV
BDS- 30 .

~V

aVF
10 / V
BDS- 30 .

X a J_ajUvJL^v_Ju^---------------------------------------- a JL------------------------ 'vI^-a IuaX a ,

V1
10 / V
BDS- 30 .

-a---------- ^

V2

V4
10 / V
80S- 30 .

10 / V
BDS- 30
V3
10mm/mV
BOS- 30 .

y~--------- ~'~v

^
1/^VV------- v""^v

- IT---------~~v~ v

-----------

'I ^

TXTTX ^ Y^TXXX IP TT 0

V5
lOmm/mV
80S- 30 .
V6
10mm/mV
BOS- 30

Ne 31
. -

4. -
., 16 (25 / ). ,

() (
)
.

100 400 -
100250 /.
- (. 5):
1. , ,
.
2. PR-, - RR-.
3. .
()
, 250-450 .
F
(II, III,
aVF) (. 6). reentry.

84

. 3. : , ,

5. ()
., 7 (25 / ).
.
\

6. ., 16 , .
.
250 (FF 240 ),
II, III, aVF, V, .
-
70 /

85


- ,
() .
10-30% ,
.
.
,
.
.
,
, . ,
-
( )
reentry.
300-700 ,
f
(. 7).
- .
-
.
R i.S T

0 1 ~ (* 1 .-0 8 IO:3<>
I. I I . H I , aVR, a V I.. 11VI-

" H

':

50nm /s F t t t

p :M i
:M P .

E>F

^11 ):

_ I

]___ I

j-

llta jlfr

NAMK:
lOmm/mV

1 J *

cm

L :

I_

/\

FX 30 ( V O t - f M -

7. X ., 15 .
QRS.
f

86

. 3. : , ,


,
. ,
.. 1916 . ,
,
, ,
. ,
- ,
, .
,
.
,
-.

,
, , - III
. ,
, , ,

, ,
.
-.
- , -
1:1 .
, - 1:1,
- - -
WPW. II III
, . ,
- 2:1
.
- II I , PR
QRS,
. -
- II III
/ .


.
reentry,
/ .
.
,

87

. ,
,
.
.

/
IA, 1C III (, , ).
IA 1C
, -
.

.
,
.
1C III (, , , ).

, .
,
,
50-82% [19, 20]. 62%
5 150
/ [19].

,
: , , (3-.
p-.
,
,
.
IC III , , , .
( < 45%) ,
.


. 75-90%,
,
.

,
,
. -

88

. 3. : , ,

--------------------------------------------------------------------------------------------------------------- ,
[21].
()

.
. ,
IC (, )
,
- 1:1.
IC ,
-, , p-.
,
-: , p-, .
10 .

.
.
48 .
, .

/ .
,
3 ,
- .

5. -

- ()
- , reentry
.
- -
[22].
- ,
.
.
: ,
- -

89

, .
- , ,
(. 8).

8. .
() . -
, - , - , , - , -
(Tendor of Todaro), - , - ,
-
-
. -
- ,
.. .
() -

.
-
.
(slow-fast; -) - , 90% ,
, ,
.
RP < PR. QRS.
, 5-10% ,
(fast-slow; -) - ,

90

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.


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4.

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.

(, , )
(. 2).
,
.

,
[8].
,

. ,
. ,

17-37% [9, 10].

129


,
. ,
, 85 100%.
-99- (. 3).

2. [5].
2 .1 . -
( ):
) ;
)

2 .2 . ( -):
) - ;
)

130

4.

., .
, 2002

3.1 9 9 - [5]

, .
. 2002

3 .2 . 9 9 - - [5]


[11].

, -,
,
,
[12].
, ,
,
,
.
,
, ,
. ,
.

.
,
. ,
(
- . 2.2 ),
,
.
- 99 , ,
, ,
[13, 14].
,
(. 4).

4 .
,

132

4.

,
, ,
, ,
, . ,
, , ,
.
,

,

.

, .


, ,

.
(
) 30% .

2, ,
(22 - 76%), -
(23 - 79%).

. ,
.
2.


( = 29)


( = 29)

-1 1 / -1 8

- 21/ - 8

32,99,8

19,4+5,2

< 0 ,0 5

,
- 4

. -0

0,01

- 23

- 3

0,001

,
- 10
( = 0,0001)


- 7 ( = 0,05)

2 ( )


( = 29)


( = 29)

-22

-23

10

0,001

20

0,001

15

10

28

0,001

27

0,001

- reentry

0,01

. ,

482,522,7

560,9+12,5

<0,05

93,1%

93,1%

0,005
0,001
0,01



.
IgG

,
. ,
,
,
.

,
.
() ()
,
:
1. :
(4-100%, -100%);
(4-100%, -52%);
(4-63%, -98%);
(4-71%, -92%);

134

4.

-
(4-98%, -96%).
2. :
-
, (4-97%, -61%)
- \ ( 70%) (4-98%, - 74%);
- ( TV1-V3) (4-100%, -42%);
- (4-100%, -38%);
- (4-92%, -47%).
, ,
,
,
3.
3.

- .

-
lg
G ( 1:400 )

-
(
- )

-


(
-

)

-
-
(, -.,
)
-
(. )

-
/
/
-

,
: 4 ; 3 1 ; 2 4 .

,
,

. ,
,
. ,
.
(. 4),
.
4 .

: QRS V2 >120 (
)

-BP:

+/

-/

()

,
(, )

(,
)

(, )

(, )



. ,
(. 5),
,
,

.

136

4.

5.
,

, -
. ,
.
, ,

.

2.
,
,
.

(),
,
.

,
.

.
, 38-40% ,
,
2-5 Lown, 8%
[15, 16].

[16].
,
. , ,
70 . .
100%
88% ,
2-5 Lown
75%
,
. , -
100% , 75%
, 30% 100%

.
, - ,
.
,
, , ,
,
.
, ,
,

-.
,
,
.
,
( , , ),
(Commotio Cordis, ), (
, ).
,
- ,

138

4.

[17].
, ,
,
[18]. :
- QT;
- ;
- ;
- QT;
- ;
- .


.

. - , , , - . , , ,
, (, .),
( IA, IC, ill )
.
, , , ,
. , ,

.


.

. ,
,
,
. ,
, ,
-
. ,
[19-22].
, -
3% .
,
, ,
.

139


,
, , .
,
:
1. :
1.1. :
;
(, ).
1.2. :
;
;
;
.
2. :
2.1. ( < 30 .);
2.2. ( > 30 .).
3. :
3.1. ( QRS
RR):
;
;
( );
( ,
, ).
3.2. (
QRS -):
;
;
;
.

12 ,
,
, , .

140

4.

6. 12
( D. Kuchar).RAO - , LAO -
, LV apex - .
: 1 , 2 , 3 - , .
(RAO 30): - anterior, - m iddle, I - inferior
(, ).
(LAO 30): S - septal, - central, L - lateral ( ,
)

7.
( D. Kuchar), I, II, III, V4, aVR, aVL, V 1 , V4, V6 -
. + -
QRS (R > Q+S), 0 -
QRS (R = Q+S), - -
QRS (R<Q+S). - ,

141

1989 D. Kuchar et al. [23]



(. 6 ,7). 2006 .
. (.. , .. .)
-
[24] (. 8).
,
( ORS):
1) + 4 5 + 1 2 0 ; 2 ) Q R S V 1 - V 2 : Q S , r S R S ( R < S )

I
R/R s

Q S /rS


-
TK (, HCB)

I lepei
/-.

( , )

V I , V2

V I , V2
V
QS

R S / rS * *

Q S/rS*

,

, \.
.,

, /
-.


rs***

, ..,
HCB

R S V l> V2
R V 3 /R V 2< 2

. \.
.
,

V6

Rs

,
-

* V1 3 (. - 0, 680,18 );
** V1 2 9 (. - 4,550,79 )
*** V1 1,5 6 (. - 3,50,61 ).

8. -
( . .,
. .)

142

4.

,
.




()
70%
, , . -
,
.

( ).
;
-.
- :
1. QRS
2. ( +60 +120)
3. R aVF (R aVF > Rl)
4. QRS II aVF
5. QS rS - V1 - V2
6. R
7. RsR' - QRS V6

9.

143


( )
. 30% ,
. 1%
.


()
-
.

. .. .. ,
( ),
[25].
- :
1. QRS.
2. .
3. QRS
rsr', rSr , Rsr , RSR, (
).

10.
.
- .
,
.

144

4.

()

.
, .
,
QRS
(-). () ,
-. ,
, .

(. 5).

Cohen et al. 1972 . [26].
QRS. 1979 Zipes et al.

, QRS 120 140
, [27].
. Belhassen et al.
, [28].

: ,
, - ,
Belhassen.
5. -

90%

QRS

QRS

QRS
( 120 )


slow-fast ,


(-

)


(
)

145

5 ()

QRS

QRS

5%

QRS
( 120 )


,
-

5%

QRS
< 120


.

-

.
-.
,
(- ).
- :
1. () QRS.
2. QRS ( )
( ).
3. ( -110 -70,
).

.

IfVWVW

ay/YYYVVYYYYYVYVYYVYY^

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11.

146

4.

,
.
.
.

.
(IV ) 0,25%
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, , 2 . ,
30 ( ).
1-3 // 3 .

,
90%.

,
, , .
-
.
(
). ,
.
.
.
, ,
, .
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).
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, ; )
, ,
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. ,
.

147


, , , ,
.
1.
.

. , ,
, ,

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, , , . ,
,
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,
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,
.
2.

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.
,
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3.
. ,

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.
4.


(
, , ).
,
.

148

4.
....

.
,

.

, ,
(
), ,
,
, (
), , .
:
1.

, .

(. 1).
aVF, V1, V6.

( ), QT QTc,
QRS ( , ), (
).
2. -
-
.
(, , ,
) . 24-
,
, .
.
.

.
,
.
3.


( , );
.

149

-

(1 3-4 ),
, -
, -
.
,

(
, , ,
).
4.


. .
( ). ,

.
.

,
. ,
, (, b -)
(
)
.
5.


. ,
, , , , .
6.


,

,
( 36 ) , REVEAL.

.
7.

,
, , , , QT.

150

4.
.................


, . ,
, 30% QT 80 %

.
.
8. ()
, ,
. -
, .
9.
. ,
,
,
.
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(
).
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, ,
. , ,
, ,
.
3) .
. ,
, .




.
:
1. .
1. .
2. .
3. - .
4. .
.

.

151

,
. (-, )
,
.

,
, ..
.
.
.
,
(,
, ,
),
[29].

, , ,
,

. , , :
. ,
.

.
,
, , ,
[30].


,
.
, , 1 6
.



(
, ). ,
: ,
, .

152

4.

---------------------------------------------------------------------------------------------------------------------------------------------



.
1. 2% , 10%
1 - 2 (40 ) 1 (20 ). , 5-10
5% ( 0,9% NaCI, 5-10 ) - 0,5 -1 /.
, 1:1.
: 5-10 S
( , 3 /).
- 20-50 // (
, ).
2.
,

,
.
12:
, - - .
-
, :
, -
.
, 0,9%
.
0,5-1 /.

Mid-ctovicutar line

12.

153

3. () - III
1 5% - 3 (150 ). ,
( 5% ) 5-10 /
60 . 5-15 // .
,
,
.
4 . - (IV ) 0 ,2 5 %
1 2 (5 ). 0,1 / . (20
0,9% NaCI) , 2 . ,
30 ( ).

, .
!!
5.
, ,
,
.
6.
(, , )
- 0,01-0,02 / ( 0,2 /). ,
.
() - 0,5-1,5 /.
10 .



.

(, ),
, , ,
, ).
, ,

.
,
.

-
, . , ,

154

4.

,


.
,
3
[31],
,
.
, .
(, , , , , , ) -
, , ,
,
().
4 6
, 2 . (
).
:
1) :
(. 400 )
5 - 0,2 2
5 - 0,4 2
(. 200 , . 400 )
5 - 0,2 2
5 - 0,4 2
- (. 0,25 )
3- - 0,25 / 2
3 - 0,5-3 / 3
1-4
(. 0,25 ; 10% 50 100 )
1 - 5-10 (0,5-1 ) 2 ,
3- - 10-15 (1-1,5 ) 2
3-15 - 15-20 (1,5-2 ) 2
1-1,5
(. 400, 800, 1200 )
1-5 - 0,8 / 2 ,
5-16 - 0,8-1,8 / 2
1-1,5
(. 0,1 )
3 0,15 / 3 (7-14 ), 0,05 / 1

4 - 0,3 / ( 2-3 )
14-30

155

(. 0,25 )
8 - 0,45 / 3
8-14 - 0,75 /
14 - 0,75-1,5 /
14-21
2) (, , , ), ,
, ,
, ,
, .
( 0,1; 0,4 )
14 - 0,8-1,6 /
(. 0,025 , . 0,075 .)
8 - 0,075 / 3
8 - 0,075 - 0,15 /
1
( , )
5 - 1 (1/4 .) 2 ,
5-12 - 2 (1/2 .) 2
12 - 4 (1 .) 2
1-1,5
3) ( , , , , , ) ,
, ,
, .
(. 10 )
1-5 - 10 / 4
5-12 - 20 / 4
12 - 40 / 4
2-3
(. 125 )
- 250-375 / 1-2
2
4) -
, (
, , , , , Q [].
Q10 ()
1 1-3
() ( )
1-3 - 4-10 . 1
3-7 - 10-16 . 1
7 -1 2 - 16-20 . 1
12 - 20-60 . 1

156

4.

2-3
(. 250, 500 ; 5 250 )
12 - 500 / 2
12 - 500-10 / 2
2-3
() 20%
3 - 10 . 2
3-6 - 14 . 2-3
6-12 - 28-42 . 2-3
1
( 6,
), .
6 (, )
1-6 ( ) - 10-30 // 3
6-12 - 1-2. (1/2-1 ) 2-3
12 - 2 . (1 -2 ) 2-3
1
() -
. , , , .
(. 0,2 )
10-15 /
1 - 0,1 -0,2 / 3
1-5 - 0 , 1 -0,4 / 3
6-10 - 0,2-0,6 / 3
10 - 0 , 2 - 1 / 3
1-4

()

.
,
.
,
, ,
, ,
( b-) .
,
, - .

157

,
,
, ,
, .
,
, .

. , ,
. ,
, 1 -
.
(IC) - - , QT
. IA (,
); IC (, ) III (, )
.

.

.
1 ,
- ,
. . ,
,
.
.

b -. ,
, ,
.
.
5
. 5

.

.
.

158

4.

-----------------------------------------------------------------------------------------------------------------------------------------**

-
, , ( ).

, - . b- .
b -
b- , ,
, , , ,
. , ,
.

,
, , , - -Ill ,
, , -
.

( ,
),
, - I , , ,
( ).
b- .

.
(, ,)
-.
10, 40, 80 .
0,1% 1 5 (1 - 1 ).
4-6 .

- 4 / 8 /. 8
4 .
- 1-4 // 2 4 .
.

- .
,
.
25 , 50 , 100 .
0,05% - 10 (1 - 0,5 )
5-10 .
- 2-3 .
- 1-2 // 1-2 .

159

()
-.
, .
1-2 // 1-2 .
20 , 40 , 80 , 120 , 160 .
12-24 .
- 2-3 .

I
-
, .
. ,
.
(), , ()
.

() IA
- 5-10 / / 20-60 .
(/ 20-40 // ,
80 // ).

/-- , , b-, .

, QT, II-III , , .

. ,
.
. N - ,
. -,
, , .

(, .) IA
20 .
- 20 3 (3 ), 2030 /.

, - II , - II-III
, , .
.

160

4.

() IB
- 1 / /, 10-15
.
- / 20-50 // .
. ,
.
.

b-
.

. --,

WPW; -, .
.
.
, ,
, , - .
, .

(, , , ) IB .
,
QT .
50 ; 200 ; 360 .
10 (250 ).
- 2 / 3 (
5 /, 7-8 /.

, , - II-III ,
.

(, ) 1C
7-10-20 // 3-4 .
150 , 300 .
2-10 .
- 2-3 .

, b -, , ,
- .

,
, , , ,
-, ,
, , .

161


QRS 20% QT
.
.

1C
150-200 / 3 .
50 . 2,5% 2 (50 ).
:
- 0,25-1 / 20 0,9% - NaCI,
, 10
2,5 .
- 2,5-3 .
.
,
, , II - -Ill ,
, .

1C
( ) - 75-100 / 3 .
25 . 0,5% 2 .
1-1,2 .

, ,
, II - -Ill , .

1C
: 1 - 80-90 /1/ 2 ; - 100110 /1/ ( 200 /1/).
- 1-2 .

, , - II -
II-III , .

III

()

.
.
b - , . , ,
:
.
200 .

162

4.

5% 3 (150 ).
30-60 ,
180 .
- 1 0 - 1 5 // 1-2 1-3 .
2-6 // 1-2 1 .
, .
1. ( , QT QTc,
) - 3 4-6 , 1 .
2. - 1 3 .
3. , , , , , 1 3
.

, , , , , , , -,

, -,
, .

.
,
.
,
.

IV

.
.
, - ,
-
.


.
40 , 80 .
3-7 / / 4 .
- 1-3 .
2 (5 ).
: 0,1-0,3 // 1 , 5 /.

163

(
, , , ).

.
, , , , .

,
, , - 11-111 , ,
1 .


.
2 , 3-4 -
, 1 .
3- , 1 2-3 .
1,5-2 .
,
,
50%,
90% ( -).
,
, , .



, ,
-.


()

.
90%,
.

164

1982 ,
. Scheinman J. Gallagher


[32]. 80-
90- .
G. Van Hare 1990 [33].
.
, 5
,
(, ..),
, . 5 10
,
, .
10 .
(2009 .)
[34]. , .
I ( ):
1. ,
, ,
.
2. (bundle branch re-entry).
3. -,
, ,

. , ,
.
II ( ):
:
1. , , , ,
.
2. , , , ,
.
:

.
III ( ):
1. , .

().
,

165

.
,
. -
.

. -:
- 55-60, 50 ,
- 60-120 .
,
.
. , ,
80-95%, - 90%.
: (
, , ) (
- ,

[ ]. -
(- II! ).
.

-
-
,

.
80- .
1% .
, , ,
. -,
, ,

.
, 1 2 ,
25-75% ,

.

,
(), 2009 , ,

166

4.

()
() 2008 (. 6).
:
I: , /
(
).
IIA:
.
:
.
III: ,
/ ,
,
.
:
.
:
.
: ,
.
6.

IA


,
,
40% ,

1

IA

b -
QT,
,
1

1C

,
,
,
,

1

6 ()

168

IB

,
,
;

1

IC

b -
,

,
, 1

IC


(
)
.
, ,
,
, ,
1

IC



.

.

IB

,
,

, 30-35% ,
NYHA II III, ,

1

IB



\,

1

IB



\,

1

4.

-------------------------------------------------------------------------------------------------------------------------------------------
6 ( )


,
( < 35%),
,
1

,
,
.
,
,

1

-

QT, /
b-,
1



,
,
1


,
,

1


.
1962 . Lown
R- ,
, ,
.
R- ( 10-20 )
. , . ,
- . ,
( QRS),
- .
7.

169

7.

R-

200

25-50

-
,
,
, (. 13).
.
40
. 40 - .

. ;
- ,
( ) -
.
, . , ,
.


. ,
.
-
,
, ,
,
.
,
R-R, ,
, .
- ( ).

170

4.

13. -
4 ( Thierry , Katrien F, e t.a l.)
: (
200 ),
;
-
. ,
BURST - ,
10-30%,
, .
RAMP - ,
.
RAMP+ - .
,
, ,
, . ,
.
,

171

. , -

,
.
. P.S. Fischbach
. [36]
. ,

, .
-
. ,
. 20% 50% 2,5 .
, ,
, ,
,
.

,
. (
),
. , ,
b-, .

.
R,
,
.
,
.

. ,
, (
) .
6% [37] ,
.
. .
.
,
. .
.
.

172

4.

D. DeMaso et al. [38] A. Eicken et al. [39]


. , 12 44%
/ .
, 1
.


,
QRS .
, ,
.


.
QRS
,
(-70 +120).
, QT (. 14).
. Schwensen 1922 ,
[40]. ,
- [41 ],
[42].

( , ).

173



() -
. -
,
, ,
.
1975 D. Reid 1978 P. Coumel et at.
[43], ,
,
, /
. ,
.
(2005 .), - 67%
[44]. ,
10 30% .
20%
20 .
2001 -
, ,
2+ [45].

1. :
- ( ,
(RyR2.);
- (
(CASQ2).
2. .

2+ , . ()
,
.
:

.
8 . 40
30%
.
, , , U-.

174

4.

/

.
- ( 15):
1. QRS.
2.
( -70 +120).
3. 140-200 /.
4. QT.
I

fl

fl

III

(I
aVR

fl
aVL

fl

aVF

15.

:
.
-, ,
.

b -, ,
b - ( )
I III .
-:
() - 1-2 //
- 0,05 / /
- 0,5-1 //
- 1 - 2 //

175

:
(IA) - 5 / /
(1C) - 1 / /
(IC) - 5 / /
(III) - 5-7 / /
, 2 ,
.
, QT 25%,
, ,
. , 2-3 (.
).
- ()
,
, ,
.

, .
(- ) ,
,
.
.

.
2 3 ,
.
.



1966 F. Dessertene,

QT [46].
- Torsades de pointes,
- .
,
,
QRS,
,
- .
- 150 250 / (. 16).

176

4.


, ,
,
,
- .

16.
- :
1. QT, U
.
2.
( R , - ).
3. RR 200-400 .
4. QRS ( 120 ), .
5. QRS ,

.
6. QRS
.
7. .
8. AV-.
9. ,
RR.
10. ,
.

177


,
. :
QT, , ,
, -, , ,
(, , ),
.


.
(M gS04) 25%
25-50 /, , 1-2 .
5-10 (
- 2 ).

QT, :
.
QT (long QT syndrome - LQT) - , QT
;
torsade de pointes
, , .
QT .
~
, +, Na+ 2+
, 2+
.

QT QTc.

QT
QT
. 12 ,
QRS .
QT II , .. q
, V1, V3 V5.
. Lepeshkin
. Surawicz [47],
, (. 17).

178

4.

17. QT ( . Lepeshkin)
QTc
( QT), :

QTc = QT ( m c ) / a/ R R ( )

.
QT 8.
8.
QTc, ( . . [3 5 ])

QT

QT

<300

300-350

350-440

440-460

>460

< 3 00

300-350

350-450

460-470

> 4 70

, QTc .
QTc -, 0,05
, .
( ), QT
QRS.
JT. JT J ( S
ST) . JTc = 0,320,02 ,
- 0,34 .
QT QTc,
,
, ..
.
QT (95-98% 2-5%)
, - ,
QT [48].

P. Schwartz ,
- ,
[49]. 9
.
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180

4.


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181

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.
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182

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183

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1989 W. Timothy,
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.
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.
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184

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186

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187

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194

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.
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.
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.

201


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. - 2000. - 18. - . 57-58.

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- (2003). HCN1-4,
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211

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, QTc = 0,335-0,364 . - I, II, III, aVL, aVF,
V2-V6. ST - () V2-V5.
: , II (
, ) ( 5 ).

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, 37-67/ (RR ( )
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- I, II, III, aVF, V2-V6.

: : , II
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2.
.

()

/ . ,
. // . - 2010. - . 89, 3. - . 15-21.
3. . . .: , 1999. 230 .
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2 5 6

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LQT1/KCNQ1

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IKs

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/

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8.
--------------------------------------------------------------------------------------------------------------- ^

8. [35]
I. *

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.

[35].

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1. ..
/ .. , .. , .. .
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9.

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1. . , , / . . . ,
3 . - .: . - 1996 - 512 .
2. .., ..
. - .: - . .. , 1999. - 66 .
3.
..,

..,

..


QT / /
. - 2005. - 42 - . 50-56.
4. . . . . . - .:
. - 1996. - 728 .
5.

. - ., 2009. - . 89-96.
6. .. . - .: , 1 9 9 8 .-6 3 8 .
7. , . .. . - .:
, 2004. - 518 .
8. - . - .:
, 2 00 5 .- 972 .

3 1 4

9.

9. QT / . . .. . - .:
, 2001.
. .., ..
/ / . . .,
2005. - 2 - . 26-34
11. ..
. . . .
. . - 1998 - 42, 2. - . 35-42.
12. .. . - .: . - 1999,
230 .
13. ..
/ / .ru .- 2008. - 3 - . 25-32.
14. ACC/AHA/ESC guidelines for the management of patients with supraventricular
arrhythmias executive summary: a report of the American college of cardiology/American
heart association task force on practice guidelines and the European society of cardiology
committee for practice guidelines (writing committee to develop guidelines for the
management of patients with supraventricular arrhythmias) Developed in Collaboration
with NASPE-Heart Rhythm Society. Committee Members, Carina Blomstrdm-Lundqvist,
Melvin M. Scheinman, Etienne M. Aliot, Joseph S. Alpert, Hugh Calkins, A. John Camm,
W. Barton Campbell, David E. Haines, Karl H. Kuck et al. Journal of the American College
of Cardiology, Volume 42, Issue 8, 2003, p. 1493-1531.
15. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm
Abnormalities. A R eportofthe American Collegeof Cardiology/American Heart Association
Task Force on Practice. Guidelines (Writing Committee to Revise the ACC/AHA/NASPE
2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia
Devices). Journal of the American College of Cardiology. Vol. 51,N. 21, 2008, p .1-62.
16. American Heart Association/American College of Cardiology Foundation/Heart Rhythm
Society scientific statement on noninvasive risk stratification techniques for identifying
patients at risk for sudden cardiac death a scientific statement from the American
Heart Association Council on clinical cardiology committee on electrocardiography and
arrhythmias and council on epidemiology and prevention. Circulation 2008;118;14971518.
17. ACC/AHA/ESC2006Guidelinesformanagementofpatientswith Ventricular Arrhythmias
and the prevention of Sudden Cardiac Death. Circulation 2006; 114:e385-e484.
18. Moss A.J.,Schwartz P.J. 25th anniversary of the International Long-QT Syndrome
Registry: an ongoing quest to uncover the secrets of long-QT syndrome. Circulation.2005
Mar 8;111 (9): 1199-201.
19. Practical management of pediatric cardiac arrhythmias. Ed. by V L. Zeiggler,
PC.Gillette, 2001, 422p.
20. Priori S., Antzelevitch C. Inherited arrhythmogenic diseases. In: Sudden Cardiac
Death. Edited by Priori S., Zipes D.P. 2006.
21. Rautaharju P., Surawicz B., Gettes L. et al. AHA/ACCF/HRS Recommendations for the
Standardization and Interpretation of the Electrocardiogram Part IV: The ST Segment,

3 1 5

-----------------------------------------------------------------------------

and U Waves, and the QT Interval. J Am Coll Cardiol 2009; 53: 982-991.
22. Schwartz P.J., Priori S.G., Spazzolini C. et al. Genotype-phenotype correlation in the
long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation.
2 001;103:89-95.
23. Schwartz P.J. Idiopathic long QT syndrome: progress and questions. Am. Heart J.
1985;109: 399-411.
24. Schwartz P.J., LocatiE., Moss A. etal. Left cardiac sympathethic denervation in therapy
of congenital long QT syndrome. Circulation 1991; 84: 503-511.

316

10.

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. 1 - M ontaque ., 1982 (=29); 2 - Southall DP, 1980 (n=134); 3 - Southall D.P, 1981 (n=92);
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18

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. 1 - .., 2000 ( = 28), 2 - .., 2003 ( = 80), 3 - Southall D.P, 1981 ( = 92).

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. -
, , [9, 32].


.
,
[33]. ,
, :
Mean - RR-, , .
SDNN - RR-.
rMSSD - RR-.
pNN50 -
RR- 50 , %.
() , 2,
:
ULF - ( 0,003 )
VLF - (0,003-0,04 )
LF - (0,04-0,15 )
HF - (0,15-0,4 )

, (.
. 3, 4).
3.
( - , - )

3 3 2

M ean (.)

SDNN (.)

RMSSD (.)

pNN
50 (%)

3-5

0,546
0,6183

0,0116
0,01233

0,050
0,0473

13,4
15,1

0,6581

0,0511

0,05

0,6671

0,0471

0,043

0,6811

0,054

0,052

0,743
, 719

0,0551

0,056

10

0,753
0,7191

0,0551

0,057

11

0,762
0 ,7 3 3 1

0,058
0,053

0,062
0,053

21,3
19,73

33,4
24,43

10.

-------------------------------------------------------------------------------------------------------------------------------------------------------------
3 ()

Mean (.)

SDNN (.)

RMSSD (.)

pNN
5 0 (%)

12

0,754
0,712'

0,056
0,050'
0,064-0,0702

0,053
. 0,043'
0,064-0,0702

28-312
13,4
15,13

0,767
0,762'

0,058
0,0561

0,058'

0,772
0,757'

0,068
0,055'

0,066
0,050'

15

0,795'

0,0611

0,05'

16

0,819'

0,061'

0,057'

13

14

13,4
15,13

. 1 - . ., 2001 ( = 5400); 2 - W insley R. et al., 2003 (n = 12); 3 - ..,


2003 (n = 80).

4.
( - , - )

VLF ( 2)

2-5

LF ( 2)

HF ( 2)

6-143

0-1343

1149'

1106'

586'

1203'

1113'

538'

11191

1123'

678'

1289'

1287'

820'

10

1262'

1170'

728'

11

1335
1190'

1318
1061'

855'

12

1460
1559'

1139
964'
758-922

807
. 616'
920-13642

13

1702
1649'

1369
1399'

830
835'

14

1692
1468'

1446
994'

976
863'

15

2305
1358'

1472
1045'

704'

16

1808'

1277'

755'

. 1 - .. ., 2001; 2 - W insley R. et al., 2003; 3 - Martin G. et al., 1987.


[34].

rMSSD 350

[9].
RR- -
[9].
,
- SDNN, SDANN, SDNNi, pNN 50% [28].


,
.
12-
,
(. 17).

RRX@Crpo.ca /
16 13:54:13

sos

(1mV)

(1mV)

V,

A 10mm-

I I
____
.. .

I &.
QP* JT* , < *
17. 15 .
7 3 -7 5 /

,
QT ,
.

3 3 4

10.

10-12%
6-25% 6-10% [35].
,
.

-.
24-
.
- .
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,

, .
,
. 7 ,
- 30-40 .
REVIL, .

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,
.

( , ),
, ,
.


-
-
-
/ -
-
-
-
-


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report of the American College of Cardiology / American Heart Association Task force
on Assesement of dianostic and therapeutic cardivascular procedures (Commitee on
Pacemaker Implantation) J. Am. Coll. Cardiol. 1991; 18:1-13.
3 2 . O.O.,
// . . - 1997.- 6. - . 2125.
33.Task force of the European Society of Cardiology and the North American Society
of Pacing and Electrophysiology. Heart rate variability. Standards of measurements,
physiological interpretation, and clinical use. Circulation 1996; 93: 1043-1065.
34. Sosnowski ., Petelenz T. Heart rate variability. Is it influenced by disturbed sinoatrial
node function? J Electrocardiol.1995; 28(3): 245-51.
35.Linzer ., Pritchett E., Pontinen ., McCarty E., Divine G., Incremental diagnostic
yield of loop electrocardiogaphyc recorders in unexplained syncope. Am. J. Cardiol. 1990;
66:214-219.

11.



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G. Casten J. Marsh , 5
, 1958 , W. Weinberg
5
,
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.. ., 1972,1978).
.. (1960)
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3 8 5


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.
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,
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.

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52
( - 4 ). 1998

: 19964 134
.
0,7% (147 19964) . 0,05% (10 19964 )
(Hiramitsu S., Hiroe ., Uemura ., 1998).
2000 R.H. Pass .
22 1
6 ,
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, (Pass R.H., Trivedi K.R. et al., 2000).

( .., 1990; . ., .., .. ., 2003; . ., .. ., 2002;

3 8 6

12.

.., 2000; .., 2003; . ., .. ., 2004;


FerransV.J. et al., 1974; NishikavaT. e ta l., 1990; NishikavaT., Sekiguchi M. e ta l., 1990;
Patterson E. et al., 1998; Schowengerdt K.O., 1997; Yonesaka S. et al., 1996; Puig M.
et al., 2000; Uemura A. et al., 2001). -

. ,
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,
, 58 4 44
(

31 -).
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). .

7- ( .., .. ., 2002,2004).


(
) () ( .., ..
., 1983).
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(Bercu .
et al., 1964). 1951
( Larrey),
56 (Braimbridge M.V., 1964).
1956
. ,
2 ,
- 35 (Brooksby
I.A. et al., 1974; Jay W. et al., 1978).
, 260
(Brooksby I.A., 1974).
(Caves ..,
1973). :
Vim-Silverman, Menghini, Terry, Sutton .
Menghini
. 1964 . Bercu .
.
. -

3 8 7

( .. .,
1972).
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.
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1.
.
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3. .
4. () .
1962 S. S. Sakakkibara
.
,
(Sakakkibara S., S., 1962; .. ., 1972).
, ,
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.
Caves,

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.

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,

. 1973 .. Caves ., I.A. Brooksby (1974)
, 40 ,
. 1984 J.L. Anderson
W. Marshal ,
. ( .., 1989). ,
, ,
- , .
.
10% , 8% - ,
(Shirey . et al<, 1972;
.., .. ., 1972). J.B. OConnel ., -

3 8 8

12.

6739 ,
1,7% ,
0,42%, ,
( .., 1989). ..
1971
, ..
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.., 1973).
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,
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1974). ,
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1260 15.03.1999, 2173091 10.09.2001
),
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