?- 1984 ????? ????? ?????? ?? ??????? - PowerPoint PPT Presentation

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?- 1984 ????? ????? ?????? ?? ???????

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Title: Slide 1 Author: mamir Last modified by: residents_orl Created Date: 10/22/2005 10:40:16 AM Document presentation format: On-screen Show Company – PowerPoint PPT presentation

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Title: ?- 1984 ????? ????? ?????? ?? ???????


1
  • ????? ?? ????? ?????
  • ?"? ????? ???? ???

2
  • ?- 1984 ????? ????? ?????? ?? ??????? Newsweek
    ???? ??? ??????
  • One Aspirin a-day, will keep the devil away
    ????? ?"? ???????? ?????? ????????, ?????? ???
    ??????? ??????? ?????? ????? ?? ????? ?????.
  • ?????? "??????? ??? ????" ---gt ?????? ????????
    ???.

3
???? ??????? ???? , ????
  • ?? ???? ???? ???? ??
  • ???? ????? ?????
  • ?????? ?? ???? ?????? ??????, PVD, CVA ?? ????
    ???? TIA
  • ??????? ?? ?????? ??????? (?????, ??"?
    ??????????????? ?- glucose intolerance )
  • ????? ?????? ?? ????? ?? 3 ????? ???? ???? ??
    ?-5 ????? ???????

4
???????
  • ?????? ?????? ????? ?????
  • ??? ??? ?????? ????"? 30 ??????? ?????? ???????
  • ?? ??????? ???? ?????? ? 110 ?????? ????
  • ??? ????????? ????? ???????? ???? ????? ?????
    ???? ???????? ????? ??? ?? ??????? ?????? ?????
    ?? ????? ????? ??????? ??????? ????? ????

5
??? ????????....
  • ?????? ?? ??? ????? ????? ??????? ???? ?????? ??
    ??? ??? ?????? ?????? ????.
  • ??????? ??? ????? ?????? ????? ???? ????? ?????
    (Salix alba) ??? ??? ?????? ?? ????? ??? ???.
  • ????? ???????? (377-460 ???? ??????) ????? ??
    ????? ??? ??? ????? ??????? ???? ?? ???? ?????.
  • ???? ?-2 ????? ????? ????? ?????? ????? ??????
    ???? ????? ?????.
  • ??????? ?? ???? ?-18 ????? ?????? ???? ??????
    ????? ????? ?????? ????.

6
  • ???? 1828 ???? ??????? ?????? Buchner ?? ?????
    ?????? ?????? ????.
  • ?-1859 ????? ????? ??? Kolbe ????? ??????? ?????
    ???????? ???? ????? ???.
  • ???? 1876 ????? ?????? ??????? ??????? ????????
    ?????????? ?? ?????? ????????? ?????? ???? ????
    ?????? ?????? ????, ????? ??? ????? ?????.
  • ???? 1897 ????? ????? ??? ?????? ??????
    Eichengrun ??????? Bayer ?? ????? ?????? ??
    ?????? ????????? ----gt ???? ???????? ? 1899

7
????? ??????- ?????????
  • Archidonic acid

Aspirin
COX
Thromboxane A2
8
  • TX A2 ???? ????? ?"? ?????? ??????? ?????? ??????
    ?? ?????? ??? ?????? ???? ??? ????? ??? ???.
  • TX A2 ???? ???? ??????? ???????? ?"?

9
  • ????? ????? ? COX ?????? ? TX A2 ????? ??? ????
    ????????????
  • ????? ???????? ? 10 ???? ( ???? ??? ??????)
  • ???????? ?? ??????? ?? ????? ????? ? COX ??????
    ????? ?? ??????? ????? ?? ?????? ?????? (???????
    ??????? ?"? ???????, ????? ??????? ?- ADP)

10
???????-?????? ?????
  • ??????? ???? ?????? COX1 ?????? ?????? ???? ????
    ????? ????? ?? ??? ???? ?????? ?????? ??????.
  • ????? ???? ?????? ?????? (stroke ?????? ??????
    ????)
  • ?????? ??? ?? ???? ?? ????? ???????
  • ???????? ????????
  • Aspirin triad

11
Aspirin triad
  • ? 5-10 ??????? ???????? ??
  • ?????????????? ? ASA
  • ????????????? ??????
  • ??????? ??????

12
?????????????? ????????
  • ?????? ?????????????? ????? ?? ???????????, ?????
    ?????? ?????? ??????????????? ?"? ????????.
  • ?????? ????????? (?????????) ??????? ??
    ?????????????? ???????? ????? ????? ?? 96.2
    ??????? ??????? ?????? ? 70.8 ??????? ? 6.7
    ????????? ?????? ?????.

13
  • ??? ????? ?????? ?? ?????????????? ???????? ??
    ????? ?????? ? URT
  • ??? ??? ????? ?? ?? ??? ??????? ?? ???? ????
    (hypertrophic rhinosinusitis) ????? ??? ??????? ?
    Aspirin triad

14
?????? Thienopyridine
  • Ticlopidine Ticlidil
  • Clopidogrel Plavix
  • ?????? ?? ?????? ???????? ?? ????? ??? ?"? ADP
    ??? ??? ?????? ????? ???? ???? ??????? ADP ?"?
    ?????? ---gt ????? ?? ???? ????? ??????? ??????
    ???????????? IIb/IIIa ????? ???? ????????? ????
    ?????? ??????.
  • ?????? ????? ?? ???? ???? ?????? ?????? COX
  • ?????? ??? ?? ??????? ??????? ?????? ?????
    ???????? ?????? ??????? von-Willebrand ???? ?????
    ????? ??????

15
  • ??? ?????? ?????? ??? ?? ?????? ???? ???? ????
    ???? ????? ????? ??????.

16
?????? ?????
  • ??????? (?????? ?????? , ??? ?? ??????? ??????)
  • ????? ?? ??? ?? ????????? ???????????????
    (???? ?? ??????)

17
  • ?????? ????? ?????????? ?? ??????? ????? ?? 75
    ?"? ?????? ??? 325 ?"? ??????? ????? ????? ?????
    ?? ?????? ???? ???? ??????? ??? ??? ????? ????
    ????? ?????? ????? ?????? ?????? ????? ??????? (
    0.5 ????? 0.7 ??????)

18
NEJM 2005
  • ????? ?? 320 ????? ?? ??? ?? ????? ????? ?"?
    ??????? ?????? ?????? ???????. ???? ?????? ??????
    ?? ?????? ???? ???? ? HP ????? ???????? ????
    ??????. ????? ??? ????? ? 75 ?"? ??????,
    ?????? ? 80 ?"? ??????? ???????? 20 ?"? ??????
    ????. ??? ??????? ????? 12 ?????? ?????? ????? ??
    ?????? ????? ???? ???????

19
  • ????? ??? ?????? ?????? ?- 13 ????? ???????
    ??????? ????? ?????? ????? ???? ??? ??????
    ????????PPI (8.6 ????? 0.7 )
  • ?-3 ????? ?????? ??????? ??? ????? ???? ??????
    ?????? (?????? ????? ???? ????? ????? ???? ????)
    ?? ????? ?????? ??? ?????? ?????? ?? ?????? ??
    ??? ?????. ????? ??? ??? ??????? ???? ??????
    ?????? ?????? ????????

20
  • ???? 12 ?????? ?????? ????? ?????? ?????? ????
    ????, ??"?, ????? ??? ???????? ?? ????? 8
    ??? ?????? ??????? ????? 4 ?????? ????????

21
??????? ??? ??????
  • ??? ????? ????, ???? ????? ????? ????? ????"?
  • ???? ??????? ???? ?????? ??????

22
Dipyridamole
  • ????????
  • ????? ?????? ??????? ?? ????? ??????? ??? ???????
    ???? ?????? ?? ????? ???.
  • ????? ?? ADP ??? PDE ???? ???? ??????? ?? ????? .
  • ?????? ????? ????
  • ?????????? ????? ?? ????? ????? ?? ?????? , ?????
    ???? ?????? ?? ????? ??????

23
????? ??????? IIb/IIIa
  • ??????? ???????????? IIb/IIIa ??? ????? ????? ??
    ?????? ?????? , ???? ?????? ?????? ?- ADP ??
    ??????? ?????? ???? ????? ???? ???? ????????
    ????? ??? ??????? ????? ???????? ?? ??????.
  • ????? abciximab (???? ?????? ??) ???? ????? ?????
    ?????? ?? 90 ???????? ?????? ??? ??????, ???????
    ?????? ?????? ??? ??????
  • ????? ?????? ??????? ??? ??????? ( ??? ??????
    ?????? ?? ????? ????? ?????)

24
  • Eptifibatide ????? ????? ?????? ? 8 ?????? ?????
    ???? ?????? ?????? ?????????? ????? ??
    ????????????? ???? ???? ???????.
  • ??????? ?????? ?????? ????? ?? ????? ???????
    ?????????????? ?????....
  • ??? ????? ??????
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