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Рекомендации по интенсивной терапии нетравматического субарахноидального кровоизлияния (обзор литературы)
Рудник Е.Н., Белкин А.А. Рекомендации по интенсивной терапии нетравматического субарахноидального кровоизлияния (обзор литературы). Consilium Medicum. 2016; 18 (9): 22–26. DOI: 10.26442/2075-1753_2016.9.22-26
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Rudnik E.N., Belkin A.A. Guidelines for intensive care in non-traumatic subarachnoid haemorrhage cases (review). Consilium Medicum. 2016; 18 (9): 22–26. DOI: 10.26442/2075-1753_2016.9.22-26
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Аннотация
Субарахноидальное кровоизлияние (САК) является ургентным состоянием с высоким риском развития неблагоприятных исходов. Пациенты с САК требуют междисциплинарного подхода в решении вопросов диагностики, тактики ведения, сроков и способов окклюзии аневризмы, что предполагает лечение в специализированных нейрохирургических центрах с большим опытом лечения больных с САК. Основными задачами интенсивной терапии пациентов с САК являются профилактика и лечение вторичных ишемических повреждений головного мозга, которые обусловлены развитием церебрального ангиоспазма, и чей успех зависит от умелого применения комплексного мониторинга и контроля перфузионно-метаболического сопряжения. В представленном обзоре литературы изложены основные терапевтические стратегии интенсивной терапии данного неотложного состояния.
Ключевые слова: субарахноидальное кровоизлияние, церебральный ангиоспазм, внутричерепная гипертензия, отсроченный неврологический дефицит, антагонисты кальция, эуволемия.
Ключевые слова: субарахноидальное кровоизлияние, церебральный ангиоспазм, внутричерепная гипертензия, отсроченный неврологический дефицит, антагонисты кальция, эуволемия.
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Subarachnoid hemorrhage (SAH) is an urgent condition with a high risk of adverse outcomes. Patients with SAH require a multidisciplinary approach to solving problems of diagnosis, tactics, timing and methods of occlusion of the aneurysm, which involves treatment in a specialized neurosurgical centers with extensive experience in the treatment of patients with SAH. The main tasks of intensive care in patients with SAH are prevention and treatment of secondary ischemic brain injuries, which are caused by the development of cerebral vasospasm, and whose success depends on the skillful use of integrated monitoring and control of perfusion-metabolic coupling. In the present literature review outlines the main therapeutic strategy for intensive care of the emergency condition.
Key words: subarachnoid hemorrhage, cerebral vasospasm, intracranial hypertension, delayed neurological deficit, calcium antagonists, euvolemiya.
Key words: subarachnoid hemorrhage, cerebral vasospasm, intracranial hypertension, delayed neurological deficit, calcium antagonists, euvolemiya.
Полный текст
Список литературы
1. Wartenberg KE. Update on the Management of Subarachnoid Hemorrhage. Future Neurol 2013; 8 (2): 205–24.
2. Springborg JB, Frederiksen H-J, Eskesenand V, Olsen NV. Trends in monitoring patients with aneurysmal subarachnoid haemorrhage. Br J Anaesth 2005; 94 (3): 259–70.
3. Lee KH, Lukovits T, Friedman JA.“Triple-H” Therapy for Cerebral Vasospasm Following Subarachnoid Hemorrhage. Neurocrit Care 2006; 4: 68–76.
4. Jr. Connolly ES, Rabinstein AA, Carhuapoma JR et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2012; 43 (6): 1711–37.
5. Dhar R, Scalfani MT et al. Relationship Between Angiographic Vasospasm and Regional Hypoperfusion in Aneurysmal Subarachnoid Hemorrhage Stroke, published online April 5, 2012.
6. Schmidt JM, Rincon F et al. Cerebral infarction associated with acute subarachnoid hemorrhage. Neurocrit Care. Doi 10.1007/s12028-007-0003-2.
7. Juvela S. Minor leak before rupture of an intracranial aneurysm and subarachnoid hemorrhage of unknown etiology. Neurosurgery 1992; 30 (1): 7–11.
8. Claassen J, Bernardini GL, Kreiter K et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke 2001; 32 (9): 2012–20.
9. Diringer MN, Bleck TP, Hemphill III JC et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference. Neurocrit Care 2011; 15 (2): 211–40.
10. Yarlagadda S, Rajendran P, Jacob C. Cardiovascular Predictors of In-Patient Mortality Afte rSubarachnoid Hemorrhage. Neurocrit Care 2006; 5: 102–7.
11. Horowitz MB, Willet D, Keffer J. The use of cardiac troponin-I (cTnI) to determine the incidence of myocardial ischemia and injury in patients with aneurysmal and presumed aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 1998; 140: 87–93.
12. Hachinski VC, Smith KE, Silver MD et al. Acute myocardial and plasma catecholamine changes in experimental stroke. Stroke 1986; 17: 387–90.
13. Keyrouz SG, Diringer MN. Clinical review: Prevention and therapy of vasospasm in subarachnoid hemorrhage. Crit Care 2007; 11:220. Doi:10.1186/cc5958.
14. Allen GS, Ahn HS, Preziosi TJ et al. Cerebral arterial spasm – a controlled trial of nimodipine in patients with subarachnoid subarachnoid hemorrhage. N Engl J Med 1983; 308: 619–24.
15. Petruk KC, West M, Mohr G et al. Nimodipine treatment in poor-grade aneurysm patients. Results of a multicenter double-blind placebo-controlled trial. J Neurosurg 1988; 68: 505–17.
16. Van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain 2001; 124: 249–78.
17. Kassel NF, Torner JC, Jr. Haley EC, Adams HP. The international cooperative aneurysm study on the timing of surgery. Part I: Overall management results. J Neurosurg 1990; 73 (1): 18–36.
18. Ronan P, Killeen MB, Alvin I et al. Comparison of CT perfusion and digital subtraction angiography in the evaluation of delayed cerebral ischemia Acad Radiol 2011; 18 (9): 1094–100.
19. Enblad P, Persson L. Impact on clinical outcome of secondary brain insults during the neurointensive care of patients with subarachnoid haemorrhage: a pilot study.
J Neurol Neurosurg Psychiatry 1997; 62: 512–6.
20. Talacchi A. Sequential measurements of cerebral blood flow in the acute phase of subarachnoid hemorrhage. J Neurosurg Sci 1993; 37: 9–18.
21. Hayashi T, Suzuki A, Hatazawa J et al. Cerebral circulation and metabolism in the acute stage of subarachnoid hemorrhage. J Neurosurg 2000; 93: 1014–8.
22. Karibe H, Tominaga T, Sato K, Yoshimoto T. Decrease in intraoperative brain surface temperature in patients with subarachnoid haemorrhage. Acta Neurochir (Wien) 2001; 143: 9–14.
23. Ginsberg MD, Busto R. Combating hyperthermia in acute stroke: a significant clinical concern. Stroke 1998; 29: 529–34.
24. Nilsson OG, Brandt L, Ungerstedt U, Saveland H. Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 1999; 45: 1176–84.
25. Ungerstedt U, Rostami E. Microdialysis in neurointensive care. Curr Pharm Des 2004; 10: 2145–52.
26. Stahl N, Mellergard P, Hallstrom A et al. Intracerebral microdialysis and bedside biochemical analysis in patients with fatal traumatic brain lesions. Acta Anaesthesiol Scand 2001; 45: 97–85.
27. Mascia L, Fedorko L et al. The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage. Intensive Care Med 2003; 29: 1088–94.
28. Lewis SB, Wong ML, Bannan PE et al. Transcranial Doppler identification of changing autoregulatory thresholds after autoregulatory impairment. Neurosurgery 2001; 48: 369–75.
29. Feldman Z, Robertson CS. Monitoring of cerebral hemodynamics with jugular bulb catheters. Crit Care Clin 1997; 13: 51–77.
30. Oddo M, Schmidt JM, Carrera E et al. Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study. Crit Care Med 2008; 36 (12): 3233–8.
31. Mayberg TS, Lam AM. Jugular bulb oximetry for the monitoring of cerebral blood flow and metabolism. Neurosurg Clin N Am 1996; 7: 755–65.
32. Van Der Bilt IA, Hasan D, Vandertop WP et al. Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage: a metaanalysis. Neurology 2009; 72 (7): 635–42.
33. Wartenberg KE, Schmidt JM, Claassen J et al. Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med 2006; 34 (3): 617–23.
34. Kramer AH, Gurka MJ et al. Complications associated with anemia and blood transfusion in patients with aneurysmal subarachnoid hemorrhage. Crit Care Med 2008; 36 (7): 2070–5.
2. Springborg JB, Frederiksen H-J, Eskesenand V, Olsen NV. Trends in monitoring patients with aneurysmal subarachnoid haemorrhage. Br J Anaesth 2005; 94 (3): 259–70.
3. Lee KH, Lukovits T, Friedman JA.“Triple-H” Therapy for Cerebral Vasospasm Following Subarachnoid Hemorrhage. Neurocrit Care 2006; 4: 68–76.
4. Jr. Connolly ES, Rabinstein AA, Carhuapoma JR et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2012; 43 (6): 1711–37.
5. Dhar R, Scalfani MT et al. Relationship Between Angiographic Vasospasm and Regional Hypoperfusion in Aneurysmal Subarachnoid Hemorrhage Stroke, published online April 5, 2012.
6. Schmidt JM, Rincon F et al. Cerebral infarction associated with acute subarachnoid hemorrhage. Neurocrit Care. Doi 10.1007/s12028-007-0003-2.
7. Juvela S. Minor leak before rupture of an intracranial aneurysm and subarachnoid hemorrhage of unknown etiology. Neurosurgery 1992; 30 (1): 7–11.
8. Claassen J, Bernardini GL, Kreiter K et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke 2001; 32 (9): 2012–20.
9. Diringer MN, Bleck TP, Hemphill III JC et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference. Neurocrit Care 2011; 15 (2): 211–40.
10. Yarlagadda S, Rajendran P, Jacob C. Cardiovascular Predictors of In-Patient Mortality Afte rSubarachnoid Hemorrhage. Neurocrit Care 2006; 5: 102–7.
11. Horowitz MB, Willet D, Keffer J. The use of cardiac troponin-I (cTnI) to determine the incidence of myocardial ischemia and injury in patients with aneurysmal and presumed aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 1998; 140: 87–93.
12. Hachinski VC, Smith KE, Silver MD et al. Acute myocardial and plasma catecholamine changes in experimental stroke. Stroke 1986; 17: 387–90.
13. Keyrouz SG, Diringer MN. Clinical review: Prevention and therapy of vasospasm in subarachnoid hemorrhage. Crit Care 2007; 11:220. Doi:10.1186/cc5958.
14. Allen GS, Ahn HS, Preziosi TJ et al. Cerebral arterial spasm – a controlled trial of nimodipine in patients with subarachnoid subarachnoid hemorrhage. N Engl J Med 1983; 308: 619–24.
15. Petruk KC, West M, Mohr G et al. Nimodipine treatment in poor-grade aneurysm patients. Results of a multicenter double-blind placebo-controlled trial. J Neurosurg 1988; 68: 505–17.
16. Van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain 2001; 124: 249–78.
17. Kassel NF, Torner JC, Jr. Haley EC, Adams HP. The international cooperative aneurysm study on the timing of surgery. Part I: Overall management results. J Neurosurg 1990; 73 (1): 18–36.
18. Ronan P, Killeen MB, Alvin I et al. Comparison of CT perfusion and digital subtraction angiography in the evaluation of delayed cerebral ischemia Acad Radiol 2011; 18 (9): 1094–100.
19. Enblad P, Persson L. Impact on clinical outcome of secondary brain insults during the neurointensive care of patients with subarachnoid haemorrhage: a pilot study.
J Neurol Neurosurg Psychiatry 1997; 62: 512–6.
20. Talacchi A. Sequential measurements of cerebral blood flow in the acute phase of subarachnoid hemorrhage. J Neurosurg Sci 1993; 37: 9–18.
21. Hayashi T, Suzuki A, Hatazawa J et al. Cerebral circulation and metabolism in the acute stage of subarachnoid hemorrhage. J Neurosurg 2000; 93: 1014–8.
22. Karibe H, Tominaga T, Sato K, Yoshimoto T. Decrease in intraoperative brain surface temperature in patients with subarachnoid haemorrhage. Acta Neurochir (Wien) 2001; 143: 9–14.
23. Ginsberg MD, Busto R. Combating hyperthermia in acute stroke: a significant clinical concern. Stroke 1998; 29: 529–34.
24. Nilsson OG, Brandt L, Ungerstedt U, Saveland H. Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 1999; 45: 1176–84.
25. Ungerstedt U, Rostami E. Microdialysis in neurointensive care. Curr Pharm Des 2004; 10: 2145–52.
26. Stahl N, Mellergard P, Hallstrom A et al. Intracerebral microdialysis and bedside biochemical analysis in patients with fatal traumatic brain lesions. Acta Anaesthesiol Scand 2001; 45: 97–85.
27. Mascia L, Fedorko L et al. The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage. Intensive Care Med 2003; 29: 1088–94.
28. Lewis SB, Wong ML, Bannan PE et al. Transcranial Doppler identification of changing autoregulatory thresholds after autoregulatory impairment. Neurosurgery 2001; 48: 369–75.
29. Feldman Z, Robertson CS. Monitoring of cerebral hemodynamics with jugular bulb catheters. Crit Care Clin 1997; 13: 51–77.
30. Oddo M, Schmidt JM, Carrera E et al. Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study. Crit Care Med 2008; 36 (12): 3233–8.
31. Mayberg TS, Lam AM. Jugular bulb oximetry for the monitoring of cerebral blood flow and metabolism. Neurosurg Clin N Am 1996; 7: 755–65.
32. Van Der Bilt IA, Hasan D, Vandertop WP et al. Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage: a metaanalysis. Neurology 2009; 72 (7): 635–42.
33. Wartenberg KE, Schmidt JM, Claassen J et al. Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med 2006; 34 (3): 617–23.
34. Kramer AH, Gurka MJ et al. Complications associated with anemia and blood transfusion in patients with aneurysmal subarachnoid hemorrhage. Crit Care Med 2008; 36 (7): 2070–5.
________________________________________________
1. Wartenberg KE. Update on the Management of Subarachnoid Hemorrhage. Future Neurol 2013; 8 (2): 205–24.
2. Springborg JB, Frederiksen H-J, Eskesenand V, Olsen NV. Trends in monitoring patients with aneurysmal subarachnoid haemorrhage. Br J Anaesth 2005; 94 (3): 259–70.
3. Lee KH, Lukovits T, Friedman JA.“Triple-H” Therapy for Cerebral Vasospasm Following Subarachnoid Hemorrhage. Neurocrit Care 2006; 4: 68–76.
4. Jr. Connolly ES, Rabinstein AA, Carhuapoma JR et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2012; 43 (6): 1711–37.
5. Dhar R, Scalfani MT et al. Relationship Between Angiographic Vasospasm and Regional Hypoperfusion in Aneurysmal Subarachnoid Hemorrhage Stroke, published online April 5, 2012.
6. Schmidt JM, Rincon F et al. Cerebral infarction associated with acute subarachnoid hemorrhage. Neurocrit Care. Doi 10.1007/s12028-007-0003-2.
7. Juvela S. Minor leak before rupture of an intracranial aneurysm and subarachnoid hemorrhage of unknown etiology. Neurosurgery 1992; 30 (1): 7–11.
8. Claassen J, Bernardini GL, Kreiter K et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke 2001; 32 (9): 2012–20.
9. Diringer MN, Bleck TP, Hemphill III JC et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference. Neurocrit Care 2011; 15 (2): 211–40.
10. Yarlagadda S, Rajendran P, Jacob C. Cardiovascular Predictors of In-Patient Mortality Afte rSubarachnoid Hemorrhage. Neurocrit Care 2006; 5: 102–7.
11. Horowitz MB, Willet D, Keffer J. The use of cardiac troponin-I (cTnI) to determine the incidence of myocardial ischemia and injury in patients with aneurysmal and presumed aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 1998; 140: 87–93.
12. Hachinski VC, Smith KE, Silver MD et al. Acute myocardial and plasma catecholamine changes in experimental stroke. Stroke 1986; 17: 387–90.
13. Keyrouz SG, Diringer MN. Clinical review: Prevention and therapy of vasospasm in subarachnoid hemorrhage. Crit Care 2007; 11:220. Doi:10.1186/cc5958.
14. Allen GS, Ahn HS, Preziosi TJ et al. Cerebral arterial spasm – a controlled trial of nimodipine in patients with subarachnoid subarachnoid hemorrhage. N Engl J Med 1983; 308: 619–24.
15. Petruk KC, West M, Mohr G et al. Nimodipine treatment in poor-grade aneurysm patients. Results of a multicenter double-blind placebo-controlled trial. J Neurosurg 1988; 68: 505–17.
16. Van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain 2001; 124: 249–78.
17. Kassel NF, Torner JC, Jr. Haley EC, Adams HP. The international cooperative aneurysm study on the timing of surgery. Part I: Overall management results. J Neurosurg 1990; 73 (1): 18–36.
18. Ronan P, Killeen MB, Alvin I et al. Comparison of CT perfusion and digital subtraction angiography in the evaluation of delayed cerebral ischemia Acad Radiol 2011; 18 (9): 1094–100.
19. Enblad P, Persson L. Impact on clinical outcome of secondary brain insults during the neurointensive care of patients with subarachnoid haemorrhage: a pilot study.
J Neurol Neurosurg Psychiatry 1997; 62: 512–6.
20. Talacchi A. Sequential measurements of cerebral blood flow in the acute phase of subarachnoid hemorrhage. J Neurosurg Sci 1993; 37: 9–18.
21. Hayashi T, Suzuki A, Hatazawa J et al. Cerebral circulation and metabolism in the acute stage of subarachnoid hemorrhage. J Neurosurg 2000; 93: 1014–8.
22. Karibe H, Tominaga T, Sato K, Yoshimoto T. Decrease in intraoperative brain surface temperature in patients with subarachnoid haemorrhage. Acta Neurochir (Wien) 2001; 143: 9–14.
23. Ginsberg MD, Busto R. Combating hyperthermia in acute stroke: a significant clinical concern. Stroke 1998; 29: 529–34.
24. Nilsson OG, Brandt L, Ungerstedt U, Saveland H. Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 1999; 45: 1176–84.
25. Ungerstedt U, Rostami E. Microdialysis in neurointensive care. Curr Pharm Des 2004; 10: 2145–52.
26. Stahl N, Mellergard P, Hallstrom A et al. Intracerebral microdialysis and bedside biochemical analysis in patients with fatal traumatic brain lesions. Acta Anaesthesiol Scand 2001; 45: 97–85.
27. Mascia L, Fedorko L et al. The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage. Intensive Care Med 2003; 29: 1088–94.
28. Lewis SB, Wong ML, Bannan PE et al. Transcranial Doppler identification of changing autoregulatory thresholds after autoregulatory impairment. Neurosurgery 2001; 48: 369–75.
29. Feldman Z, Robertson CS. Monitoring of cerebral hemodynamics with jugular bulb catheters. Crit Care Clin 1997; 13: 51–77.
30. Oddo M, Schmidt JM, Carrera E et al. Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study. Crit Care Med 2008; 36 (12): 3233–8.
31. Mayberg TS, Lam AM. Jugular bulb oximetry for the monitoring of cerebral blood flow and metabolism. Neurosurg Clin N Am 1996; 7: 755–65.
32. Van Der Bilt IA, Hasan D, Vandertop WP et al. Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage: a metaanalysis. Neurology 2009; 72 (7): 635–42.
33. Wartenberg KE, Schmidt JM, Claassen J et al. Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med 2006; 34 (3): 617–23.
34. Kramer AH, Gurka MJ et al. Complications associated with anemia and blood transfusion in patients with aneurysmal subarachnoid hemorrhage. Crit Care Med 2008; 36 (7): 2070–5.
Авторы
Е.Н.Рудник*1, А.А.Белкин1,2
1 ФГБОУ ВО Уральский государственный медицинский университет Минздрава России. 620028, Россия, Екатеринбург, ул. Репина, д. 3;
2 АНО Клинический институт мозга. 623702, Россия, Екатеринбург, ул. Шиловская, д. 28/6
*erudnik@mail.ru
1 ФГБОУ ВО Уральский государственный медицинский университет Минздрава России. 620028, Россия, Екатеринбург, ул. Репина, д. 3;
2 АНО Клинический институт мозга. 623702, Россия, Екатеринбург, ул. Шиловская, д. 28/6
*erudnik@mail.ru
________________________________________________
E.N.Rudnik*1, A.A.Belkin1,2
1 Ural State Medical University of the Ministry of Health of the Russian Federation. 620028, Russian Federation, Yekaterinburg, ul. Repina, d. 3;
2 Сlinical Institute of Brain. 623702, Russian Federation, Yekaterinburg, ul. Shipilovskaia, d. 28/6
*erudnik@mail.ru
1 Ural State Medical University of the Ministry of Health of the Russian Federation. 620028, Russian Federation, Yekaterinburg, ul. Repina, d. 3;
2 Сlinical Institute of Brain. 623702, Russian Federation, Yekaterinburg, ul. Shipilovskaia, d. 28/6
*erudnik@mail.ru
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