Episodes of asthma during pregnancy – link with a viral infection and treatment approaches

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ɍȾɄ 616.248-06:618.2:616.98-08

Ɍ.Ⱥ.ɉɟɪɰɟɜɚ,

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Ƚɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ ɆɁ ɍɤɪɚɢɧɵ»

ɤɚɮɟɞɪɚ ɮɚɤɭɥɶɬɟɬɫɤɨɣ ɬɟɪɚɩɢɢ ɢ ɷɧɞɨɤɪɢɧɨɥɨɝɢɢ

(ɡɚɜ. – ɱɥɟɧ-ɤɨɪɪ.ɇȺɆɇ ɍɤɪɚɢɧɵ,ɞ.ɦɟɞ.ɧ., ɩɪɨɮ.Ɍ.Ⱥ.ɉɟɪɰɟɜɚ)

ɭɥ.Ȼɚɬɭɦɫɤɚɹ, 13, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49000, ɍɤɪɚɢɧɚ

SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine" chair of medicine and endocrinology

Batumskaya str., 13, Dnepropetrovsk, 49000, Ukraine e-mail: simmetrichno@gmail.com

Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ:ɛɪɨɧɯɢɚɥɶɧɚɹ ɚɫɬɦɚ,ɛɟɪɟɦɟɧɧɨɫɬɶ,ɛɚɡɢɫɧɚɹ ɬɟɪɚɩɢɹ,ɨɛɨɫɬɪɟɧɢɟ

Key words: asthma, pregnancy, basic therapy, exacerbation

Ɋɟɮɟɪɚɬ. ȿɩɿɡɨɞɢ ɛɪɨɧɯɿɚɥɶɧɨʀ ɚɫɬɦɢ ɩɪɢ ɜɚɝɿɬɧɨɫɬɿ – ɡɜ'ɹɡɨɤ ɡ ɜɿɪɭɫɧɨɸ ɿɧɮɟɤɰɿɽɸ ɬɚ ɩɿɞɯɨɞɢ ɞɨ

ɥɿɤɭɜɚɧɧɹ.ɉɟɪɰɟɜɚ Ɍ.Ɉ.,Ʉɿɪɟɽɜɚ Ɍ.ȼ.,Ʉɪɚɜɱɟɧɤɨ ɇ.Ʉ.Ȼɪɨɧɯɿɚɥɶɧɚ ɚɫɬɦɚ (ȻȺ) – ɧɚɣɛɿɥɶɲ ɩɨɲɢɪɟɧɟ ɡɚɯɜɨ

-ɪɸɜɚɧɧɹ ɞɢɯɚɥɶɧɨʀ ɫɢɫɬɟɦɢ ɭ ɜɚɝɿɬɧɢɯ, ɩɪɢ ɰɶɨɦɭ 20% ɜɚɝɿɬɧɢɯ ɩɟɪɟɧɨɫɹɬɶ ɡɚɝɨɫɬɪɟɧɧɹ ȻȺ ɪɿɡɧɨɝɨ ɫɬɭɩɟɧɹ

ɬɹɠɤɨɫɬɿ ɿ 5,8% ɡ ɧɢɯ ɩɨɬɪɟɛɭɸɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ. Ɇɟɬɚ ɞɨɫɥɿɞɠɟɧɧɹ: ɜɢɜɱɢɬɢ ɩɟɪɟɛɿɝ ȻȺ ɩɪɢ ɜɚɝɿɬɧɨɫɬɿ

ɲɥɹɯɨɦ ɜɢɡɧɚɱɟɧɧɹ ɤɥɿɧɿɤɨ-ɮɭɧɤɰɿɨɧɚɥɶɧɢɯ ɨɫɨɛɥɢɜɨɫɬɟɣ ɩɟɪɟɛɿɝɭ ɡɚɯɜɨɪɸɜɚɧɧɹ, ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɧɚɹɜɧɨɫɬɿ

ɡɚɝɨɫɬɪɟɧɶ ɬɚ ɩɪɢɯɢɥɶɧɨɫɬɿ ɞɨ ɛɚɡɢɫɧɨʀ ɬɟɪɚɩɿʀ (ȻɌ). Ɇɚɬɟɪɿɚɥɢ ɿ ɦɟɬɨɞɢ:ɭ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɨ ɜɤɥɸɱɟɧɨ 35

ɜɚɝɿɬɧɢɯ ɭ ɜɿɰɿ (Me± SD) 31±5,28 ɪɨɤɭ,ɬɟɪɦɿɧ ɜɚɝɿɬɧɨɫɬɿ 34±6,69 ɬɢɠɧɹ.ɉɪɨɜɟɞɟɧɨ ɚɧɚɥɿɡ ɚɧɚɦɧɟɫɬɢɱɧɢɯ ɿ

ɮɿɡɢɤɚɥɶɧɢɯ ɞɚɧɢɯ,ɫɩɿɪɨɦɟɬɪɿɹ,ɨɰɿɧɤɚ ɪɿɜɧɹ ɤɨɧɬɪɨɥɸ ȻȺ ɡɚ ɞɨɩɨɦɨɝɨɸ ɬɟɫɬɭ ɤɨɧɬɪɨɥɸ ȻȺ (Ⱥsthma ɋontrol

Ɍest). Ɋɟɡɭɥɶɬɚɬɢ:ɭ ɞɨɫɥɿɞɠɭɜɚɧɿɣ ɝɪɭɩɿ 71% ɜɚɝɿɬɧɢɯ ɩɟɪɟɧɟɫɥɢ ɡɚɝɨɫɬɪɟɧɧɹ ɪɿɡɧɨɝɨ ɫɬɭɩɟɧɹ ɬɹɠɤɨɫɬɿ,ɹɤɿ

ɪɨɡɜɢɜɚɥɢɫɹ ɧɚ ɬɥɿ ɫɢɦɩɬɨɦɿɜ ȽɊȼȱ. ɉɪɢ ɰɶɨɦɭ ɩɪɢɯɢɥɶɧɿɫɬɶ ɞɨ ȻɌ ɞɨ ɿ ɩɿɞ ɱɚɫ ɜɚɝɿɬɧɨɫɬɿ ɞɨɫɬɨɜɿɪɧɨ ɧɟ

ɜɿɞɪɿɡɧɹɥɢɫɹ. ȼɢɹɜɥɟɧɨ ɧɟɜɿɞɩɨɜɿɞɧɿɫɬɶ ȻɌ ɫɬɭɩɟɧɸ ɬɹɠɤɨɫɬɿ ɡɚɯɜɨɪɸɜɚɧɧɹ ɭ 25% ɠɿɧɨɤ ɡ ɥɟɝɤɢɦ ɿ 36% ɡ

ɫɪɟɞɧɶɨɬɹɠɤɢɦ ɩɟɪɟɛɿɝɨɦ ɚɫɬɦɢ.

Abstract. Episodes of asthma during pregnancy – link with a viral infection and treatment approaches. Pertseva T.A., Kireyeva T.V., Kravchenko N.K. Bronchial asthma (BA) is the most common respiratory disease in pregnancy. About 20% of pregnant women experience asthma exacerbations of varying severity, while 5.8 % of them require hospitalization. Objective: to study asthma course during pregnancy by determining clinical and functional cha-racteristics of the disease, taking into account presence of exacerbations and adherence to basic therapy (BT). Materials and methods: The study included 35 pregnant females (Me ± SD) aged 31±5,28 years, gestational age – 34±6,69 weeks. Anamnestic and physical data, spirometry and assessment of asthma control using Control Asthma Test were conducted. Results: In the study group 71% of pregnant women suffered from aggravation of varying severity developing on the background of symptoms of respiratory tract infection. Here with commitment to BT before and during pregnancy significantly did not differ. Inconsistency of BT to severity of the disease in 25% of women with mild and in 36% with moderate asthma course was detected.

Ȼɪɨɧɯɢɚɥɶɧɚɹ ɚɫɬɦɚ (ȻȺ) – ɧɚɢɛɨɥɟɟ ɪɚɫɩɪɨ -ɫɬɪɚɧɟɧɧɨɟ ɡɚɛɨɥɟɜɚɧɢɟ ɞɵɯɚɬɟɥɶɧɨɣ ɫɢɫɬɟɦɵ ɭ ɛɟɪɟɦɟɧɧɵɯ ɢ, ɩɨ ɞɚɧɧɵɦ ɪɚɡɧɵɯ ɢɫɫɥɟɞɨɜɚɧɢɣ, ɜɫɬɪɟɱɚɟɬɫɹ ɭ 8-13% ɠɟɧɳɢɧ [6, 7]. ɉɪɢ ɷɬɨɦ 20% ɛɟɪɟɦɟɧɧɵɯ ɩɟɪɟɧɨɫɹɬ ɨɛɨɫɬɪɟɧɢɹ ȻȺ ɪɚɡ -ɧɨɣ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ ɢ 5,8% ɢɡ ɧɢɯ ɬɪɟɛɭɸɬ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ [4, 10].

ɉɪɟɞɫɤɚɡɚɬɶ, ɤɚɤ ɢɡɦɟɧɢɬɫɹ ɬɟɱɟɧɢɟ ȻȺ ɧɚ ɮɨɧɟ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɧɚ ɫɟɝɨɞɧɹɲɧɟɣ ɞɟɧɶ ɧɟ -ɜɨɡɦɨɠɧɨ, ɩɨɫɤɨɥɶɤɭ ɨɫɨɛɟɧɧɨɫɬɢ ɮɢɡɢɨɥɨɝɢ -ɱɟɫɤɢɯ ɢɡɦɟɧɟɧɢɣ ɠɟɧɫɤɨɝɨ ɨɪɝɚɧɢɡɦɚ, ɜɥɢɹɸ -ɳɢɟ ɧɚ ɬɟɱɟɧɢɟ ɡɚɛɨɥɟɜɚɧɢɹ,ɟɳɟ ɧɟ ɢɡɭɱɟɧɵ.ɇɨ ɢɡɜɟɫɬɟɧ ɪɹɞ ɮɚɤɬɨɪɨɜ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɨɛɨɫɬɪɟ -ɧɢɹ ɭ ɷɬɨɣ ɝɪɭɩɩɵ ɛɨɥɶɧɵɯ. ɇɚɢɛɨɥɟɟ ɡɧɚɱɢ -ɦɵɦɢ ɹɜɥɹɸɬɫɹ: ɧɚɪɭɲɟɧɢɟ ɪɟɠɢɦɚ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɢ ɨɛɨɫɬɪɟɧɢɹ ɧɚ ɮɨɧɟ ɜɢɪɭɫɧɨɣ ɢɧ

-ɮɟɤɰɢɢ.Ɍɚɤ, Belanger K. et al., 2010 ɜɵɹɜɢɥɢ,ɱɬɨ ɢɡɦɟɧɟɧɢɟ ɬɟɱɟɧɢɹ ȻȺ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɞɨɫɬɨɜɟɪɧɨ ɫɜɹɡɚɧɨ ɫ ɬɹɠɟɫɬɶɸ ɡɚɛɨɥɟɜɚɧɢɹ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɫ ɩɪɢɜɟɪɠɟɧɧɨɫɬɶɸ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ. Ɍɟɦ ɧɟ ɦɟɧɟɟ, Chambers K., 2003 ɩɪɢ ɨɩɪɨɫɟ 500 ɠɟɧɳɢɧ ɞɟɬɨɪɨɞɧɨɝɨ ɜɨɡɪɚɫɬɚ ɫ ȻȺ ɜɵɹɜɢɥ,ɱɬɨ 82% ɪɟɫɩɨɧɞɟɧɬɨɜ ɨɛɟɫɩɨɤɨɟɧɵ ɜɨɡ -ɦɨɠɧɵɦ ɧɟɝɚɬɢɜɧɵɦ ɜɨɡɞɟɣɫɬɜɢɟɦ ɢɧɝɚɥɹɰɢɨɧ -ɧɵɯ ɫɬɟɪɨɢɞɨɜ (ɢ ȽɄɋ)ɧɚ ɩɥɨɞ,ɚ 36 % ɧɚɦɟɪɟɧɵ ɨɬɤɚɡɚɬɶɫɹ ɨɬ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɜɨ ɜɪɟɦɹ ɛɟ -ɪɟɦɟɧɧɨɫɬɢ [5].

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ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

ɛɟɪɟɦɟɧɧɵɯ ɫ ɬɹɠɟɥɵɦ ɨɛɨɫɬɪɟɧɢɟɦ ȻȺ ɫɜɹɡɵ -ɜɚɥɢ ɭɯɭɞɲɟɧɢɟ ɫɨɫɬɨɹɧɢɹ ɫ ɩɟɪɟɧɟɫɟɧɧɨɣ ɪɟɫ -ɩɢɪɚɬɨɪɧɨɣ ɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɟɣ [11].

ɐɟɥɶ ɢɫɫɥɟɞɨɜɚɧɢɹ – ɢɡɭɱɢɬɶ ɬɟɱɟɧɢɟ ȻȺ ɩɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɭɬɟɦ ɨɩɪɟɞɟɥɟɧɢɹ ɤɥɢɧɢɤɨ-ɮɭɧɤ -ɰɢɨɧɚɥɶɧɵɯ ɨɫɨɛɟɧɧɨɫɬɟɣ ɬɟɱɟɧɢɹ ɡɚɛɨɥɟɜɚɧɢɹ, ɫ ɭɱɟɬɨɦ ɧɚɥɢɱɢɹ ɨɛɨɫɬɪɟɧɢɣ ɢ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ (ȻɌ).

Ɂɚɞɚɱɢ:

1.ɉɪɨɚɧɚɥɢɡɢɪɨɜɚɬɶ ɧɚɥɢɱɢɟ ɢ ɫɬɟɩɟɧɶ ɬɹ -ɠɟɫɬɢ ɨɛɨɫɬɪɟɧɢɣ ɛɪɨɧɯɢɚɥɶɧɨɣ ɚɫɬɦɵ,ɢɯ ɫɜɹɡɶ cɢɧɮɟɤɰɢɟɣ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ.

2.Ɉɰɟɧɢɬɶ ɩɪɢɜɟɪɠɟɧɧɨɫɬɶ ɤ ɛɚɡɢɫɧɨɣ ɬɟ -ɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɭ ɠɟɧɳɢɧ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ɚɫɬɦɨɣ.

3.Ɉɰɟɧɢɬɶ ɭɪɨɜɟɧɶ ɤɨɧɬɪɨɥɹ ɜɨ ɜɪɟɦɹ ɛɟ -ɪɟɦɟɧɧɨɫɬɢ ɭ ɠɟɧɳɢɧ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ɢ ɢɧɬɟɪɦɢɬɬɢɪɭɸɳɟɣ ɚɫɬɦɨɣ.

Ⱦɢɡɚɣɧ ɢɫɫɥɟɞɨɜɚɧɢɹ:

ɗɬɚɩ 1. Ⱥɧɚɥɢɡ ɧɚɥɢɱɢɹ ɢ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ ɨɛɨɫɬɪɟɧɢɹ ɭ ɛɟɪɟɦɟɧɧɵɯ ɫ ȻȺ

ɂɫɤɥɸɱɟɧɵ (n=10) Ȼɟɪɟɦɟɧɧɵɟ ɫ ɨɛɨɫɬɪɟɧɢɟɦ ȻȺ

(n= 25)

Ƚɪɭɩɩɚ 1 ɥɟɝɤɨɟ

ɨɛɨɫɬɪɟɧɢɟ (n=8) Ƚɪɭɩɩɚ 2 ɨɛɨɫɬɪɟɧɢɟɫɪɟɞɧɟɣ ɬɹɠɟɫɬɢ (n=11)

Ƚɪɭɩɩɚ 3 ɬɹɠɟɥɨɟ ɨɛɨɫɬɪɟɧɢɟ (n=6)

Ȼɟɪɟɦɟɧɧɵɟ ɜɧɟ ɨɛɨɫɬɪɟɧɢɹ

ɗɬɚɩ 2. Ⱥɧɚɥɢɡ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ

ɂɫɤɥɸɱɟɧɵ (n=13) Ȼɟɪɟɦɟɧɧɵɟ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ȻȺ (n=22)

Ʌɟɝɤɚɹ (n=8; 36%)

ɋɪɟɞɧɟɣ ɬɹɠɟɫɬɢ (n=11; 50%)

Ɍɹɠɟɥɚɹ (n=3; 14%)

Ȼɟɪɟɦɟɧɧɵɟ ɫ ɢɧɬɟɪɦɢɬɬɢɪɭɸɳɟɣ ȻȺ (n=7); ɠɟɧɳɢɧɵ,ɤɨɬɨɪɵɦ ɞɢɚɝɧɨɡ ȻȺ ɜɵɫɬɚɜɥɟɧ ɜɩɟɪɜɵɟ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ (n=6)

ɗɬɚɩ 3. Ɉɰɟɧɤɚ ɭɪɨɜɧɹ ɤɨɧɬɪɨɥɹ ȻȺ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ

ɂɫɤɥɸɱɟɧɵ (n=6) Ȼɟɪɟɦɟɧɧɵɟ ɫ ɢɧɬɟɪɦɢɬɬɢɪɭɸɳɟɣ (n=7) ɢ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ȻȺ

(n=22)

ɀɟɧɳɢɧɵ,ɤɨɬɨɪɵɦ ɞɢɚɝɧɨɡ ȻȺ ɜɵɫɬɚɜɥɟɧ ɜɩɟɪɜɵɟ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ

ɆȺɌȿɊɂȺɅɕ ɂ ɆȿɌɈȾɕ ɂɋɋɅȿȾɈȼȺɇɂɃ

Ȼɵɥɨ ɨɛɫɥɟɞɨɜɚɧɨ 35 ɛɟɪɟɦɟɧɧɵɯ ɜ ɜɨɡɪɚɫɬɟ (Me±SD) 31 ± 5,28 ɝɨɞɚ,ɫɪɨɤ ɛɟɪɟɦɟɧɧɨɫɬɢ 34 ± 6,69ɧɟɞɟɥɢ. ɍ 29 ɠɟɧɳɢɧ ȻȺ ɛɵɥɚ ɭɫɬɚɧɨɜɥɟɧɚ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɭ 6 – ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɪɢ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ ɜ ɫɬɚɰɢɨɧɚɪ (n=2) ɢɥɢ ɨɬɞɟ -ɥɟɧɢɟ ɪɟɚɧɢɦɚɰɢɢ ɢ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ (ɈɊɂɌ) (n=4) ɫ ɜɵɪɚɠɟɧɧɵɦ ɛɪɨɧɯɨɨɛɫɬɪɭɤ -ɬɢɜɧɵɦ ɫɢɧɞɪɨɦɨɦ ɧɚ ɮɨɧɟ ɢɧɮɟɤɰɢɢ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ (ɨɫɬɪɵɣ ɪɢɧɨɮɚɪɢɧɝɢɬ, ɬɪɚɯɟɢɬ).Ⱥɧɚɥɢɡ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ɛɚɡɢɫɧɨɣ ɬɟ -ɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɪɨɜɨɞɢɥɫɹ ɫɪɟɞɢ ɠɟɧɳɢɧ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ȻȺ ɪɚɡɧɨɣ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ, ɩɨɥɭɱɚɜɲɢɯ ɜ ɤɚɱɟɫɬɜɟ ȻɌ ɢ ȽɄɋ. ɍ ɜɫɟɯ ɠɟɧɳɢɧ ɩɪɨɜɨɞɢɥɢɫɶ: ɚɧɚɥɢɡ ɚɧɚɦɧɟɫɬɢɱɟɫɤɢɯ ɢ ɮɢɡɢɤɚɥɶɧɵɯ ɞɚɧɧɵɯ, ɫɩɢɪɨ -ɦɟɬɪɢɹ,ɨɰɟɧɤɚ ɭɪɨɜɧɹ ɤɨɧɬɪɨɥɹ ȻȺ ɩɪɢ ɩɨɦɨɳɢ Ⱥsthma ɋontrolɌest (ȺɋɌ) [3, 9].

ɂɫɫɥɟɞɨɜɚɧɢɟ ɩɪɨɜɨɞɢɥɨɫɶ ɧɚ ɛɚɡɟ ɨɬɞɟɥɟɧɢɹ ɩɚɬɨɥɨɝɢɢ ɛɟɪɟɦɟɧɧɵɯ Ʉɍ ɈɄȻɆ ɢ ɞɢɚɝɧɨ

ɫɬɢɱɟɫɤɨɝɨ ɤɚɛɢɧɟɬɚ «ɋɩɢɪɨ»ɜ ɩɟɪɢɨɞ ɫ ɨɤɬɹɛɪɹ ɩɨ ɞɟɤɚɛɪɶ 2013 ɝɨɞɚ. ȼ ɢɫɫɥɟɞɨɜɚɧɢɟ ɜɤɥɸ -ɱɚɥɢɫɶ ɛɟɪɟɦɟɧɧɵɟ ɫ ȻȺ, ɩɨɫɬɭɩɢɜɲɢɟ ɧɚ ɫɬɚ -ɰɢɨɧɚɪɧɨɟ ɥɟɱɟɧɢɟ ɢɥɢ ɨɛɪɚɬɢɜɲɢɟɫɹ ɡɚ ɤɨɧ -ɫɭɥɶɬɚɰɢɟɣ ɩɭɥɶɦɨɧɨɥɨɝɚ ɜ ɤɚɛɢɧɟɬ «ɋɩɢɪɨ». Ɉɛɪɚɛɨɬɤɚ ɩɨɥɭɱɟɧɧɵɯ ɞɚɧɧɵɯ ɩɪɨɜɨɞɢɥɚɫɶ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɦɟɬɨɞɨɜ ɧɟɩɚɪɚɦɟɬɪɢɱɟɫɤɨɣ ɫɬɚɬɢɫɬɢɤɢ ɜ ɩɪɨɝɪɚɦɦɟ STATISTICA 6.0 [2].

ɊȿɁɍɅɖɌȺɌɕ ɂ ɂɏ ɈȻɋɍɀȾȿɇɂȿ

(3)

14/

Ɍɨɦ

XIX / 2

ȼ ɚɧɚɥɢɡ ɛɵɥɢ ɜɤɥɸɱɟɧɵ 25 ɠɟɧɳɢɧ, ɨɛɪɚɬɢɜɲɢɯɫɹ ɡɚ ɦɟɞɢɰɢɧɫɤɨɣ ɩɨɦɨɳɶɸ ɫ ɨɛɨɫɬɪɟɧɢɟɦ ȻȺ ɢ, ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɟɝɨ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ,ɪɚɡɞɟɥɟɧɵ ɧɚ ɬɪɢ ɝɪɭɩɩɵ (ɪɢɫ. 1):

Ƚɪɭɩɩɚ 1 (n=8) – ɥɟɝɤɨɟ ɨɛɨɫɬɪɟɧɢɟ, ɩɪɟɨɛ -ɥɚɞɚɥɢ ɛɟɪɟɦɟɧɧɵɟ ɫ ɥɟɝɤɢɦ ɬɟɱɟɧɢɟɦ ȻȺ (n=5 (63%)). Ⱦɢɚɝɧɨɡ ɜɵɫɬɚɜɥɹɥɫɹ ɩɪɢ ɧɚɥɢɱɢɢ ɭɜɟ -ɥɢɱɟɧɢɹ ɩɨɬɪɟɛɧɨɫɬɢ ɜ ȕ2-ɚɝɨɧɢɫɬɚɯ ɢ / ɢɥɢ ɩɨɹɜɥɟɧɢɢ ɧɨɱɧɵɯ ɫɢɦɩɬɨɦɨɜ. ɇɚ ɩɟɪɜɨɦ ɦɟɫɬɟ ɭ ɷɬɢɯ ɩɚɰɢɟɧɬɨɤ ɛɵɥɢ ɠɚɥɨɛɵ ɧɚ ɭɱɚɳɟɧɢɟ ɩɪɢɫɬɭɩɨɜ ɤɚɲɥɹ, ɩɪɨɯɨɞɢɜɲɢɯ ɩɨɫɥɟ ɞɨɩɨɥ -ɧɢɬɟɥɶɧɨɣ ɞɨɡɵ ȕ2-ɚɝɨɧɢɫɬɚ ɜ ɮɨɪɦɟ ɞɨɡɢ -ɪɨɜɚɧɧɨɝɨ ɚɷɪɨɡɨɥɶɧɨɝɨ ɢɧɝɚɥɹɬɨɪɚ ɢɥɢ ɱɟɪɟɡ ɧɟɛɭɥɚɣɡɟɪ ɧɚ ɮɨɧɟ ɧɨɪɦɚɥɶɧɵɯ ɩɨɤɚɡɚɬɟɥɟɣ ɎȼȾ ɢ ɫɚɬɭɪɚɰɢɢ. ɋɨɝɥɚɫɧɨ ɫɬɚɧɞɚɪɬɚɦ ɜɟɞɟɧɢɹ ɥɟɝɤɨɝɨ ɨɛɨɫɬɪɟɧɢɹ ȻȺ ɜɫɟ ɠɟɧɳɢɧɵ ɥɟɱɢɥɢɫɶ ɚɦɛɭɥɚɬɨɪɧɨ, ɱɟɬɵɪɟɦ ɛɨɥɶɧɵɦ ɛɵɥɚ ɩɪɨɜɟɞɟɧɚ ɤɨɪɪɟɤɰɢɹ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ.

Ƚɪɭɩɩɚ 2 (n=11) – ɨɛɨɫɬɪɟɧɢɟ ɫɪɟɞɧɟɣ ɬɹ -ɠɟɫɬɢ,ɩɪɟɨɛɥɚɞɚɥɢ ɩɚɰɢɟɧɬɤɢ ɫɨ ɫɪɟɞɧɟɬɹɠɟɥɨɣ ȻȺ (n=7 (64%)). Ⱦɢɚɝɧɨɡ ɜɵɫɬɚɜɥɹɥɫɹ ɩɪɢ ɧɚɥɢ -ɱɢɢ ɨɞɵɲɤɢ ɩɪɢ ɨɛɵɱɧɨɣ ɮɢɡɢɱɟɫɤɨɣ ɧɚɝɪɭɡɤɟ, ɭɱɚɳɟɧɢɹ ɷɩɢɡɨɞɨɜ ɫɜɢɫɬɹɳɟɝɨ ɞɵɯɚɧɢɹ ɢ ɧɚ -ɪɭɲɟɧɢɹ ɎȼȾ (ɨɛɴɟɦ ɮɨɪɫɢɪɨɜɚɧɧɨɝɨ ɜɵɞɨɯɚ ɡɚ ɩɟɪɜɭɸ ɫɟɤɭɧɞɭ (ɈɎȼ1) 78±1,2%).

ɇɚ ɦɨɦɟɧɬ ɩɨɫɬɭɩɥɟɧɢɹ ɜ ɫɬɚɰɢɨɧɚɪ ɫɚɬɭ -ɪɚɰɢɹ 95%, ɚɭɫɤɭɥɶɬɚɬɢɜɧɚɹ ɤɚɪɬɢɧɚ ɫɤɭɞɧɚɹ (ɟɞɢɧɢɱɧɵɟ ɫɭɯɢɟ ɯɪɢɩɵ), ɩɪɢ ɫɩɢɪɨɦɟɬɪɢɢ – ɭɦɟɪɟɧɧɵɟ ɧɚɪɭɲɟɧɢɹ ɎȼȾ ɩɨ ɨɛɫɬɪɭɤɬɢɜɧɨɦɭ ɬɢɩɭ. 9 ɛɟɪɟɦɟɧɧɵɯ (82%) ɢɦɟɥɢ ɤɥɢɧɢɱɟɫɤɢɟ ɩɪɨɹɜɥɟɧɢɹ ɢɧɮɟɤɰɢɢ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭ -ɬɟɣ, ɚ ɬɚɤɠɟ ɨɬɹɝɨɳɟɧɧɵɣ ɷɩɢɞɟɦɢɨɥɨɝɢɱɟɫɤɢɣ ɚɧɚɦɧɟɡ (ɤɨɧɬɚɤɬ ɫ ɛɨɥɶɧɵɦɢ ɨɫɬɪɵɦɢ ɪɟɫɩɢ -ɪɚɬɨɪɧɵɦɢ ɡɚɛɨɥɟɜɚɧɢɹɦɢ, ɜ ɨɫɧɨɜɧɨɦ ɱɥɟɧɚɦɢ ɫɟɦɶɢ). ɇɚɯɨɞɹɫɶ ɜ ɫɬɚɰɢɨɧɚɪɟ, ɜɫɟ ɠɟɧɳɢɧɵ ɩɨɥɭɱɚɥɢ ɧɟɨɛɯɨɞɢɦɭɸ ɞɨɡɢɪɨɜɤɭ ɛɚɡɢɫɧɵɯ ɩɪɟ -ɩɚɪɚɬɨɜ ɱɟɪɟɡ ɧɟɛɭɥɚɣɡɟɪ. Ⱦɜɭɦ ɛɟɪɟɦɟɧɧɵɦ ɞɢɚɝɧɨɡ ɛɵɥ ȻȺ ɜɵɫɬɚɜɥɟɧ ɜɩɟɪɜɵɟ, ɧɚɡɧɚɱɟɧɚ ɛɚɡɢɫɧɚɹ ɬɟɪɚɩɢɹ.

Ƚɪɭɩɩɚ 3 (n=6) – ɬɹɠɟɥɨɟ ɨɛɨɫɬɪɟɧɢɟ, ɩɪɟ -ɨɛɥɚɞɚɥɢ ɛɟɪɟɦɟɧɧɵɟ ɫ ɪɚɧɟɟ ɧɟ ɞɢɚɝɧɨɫɬɢɪɨ -ɜɚɧɧɨɣ ȻȺ (n=4 (67%)). ȼ 100% ɫɥɭɱɚɟɜ ɨɫɬɪɵɣ ɛɪɨɧɯɨɨɛɫɬɪɭɤɬɢɜɧɵɣ ɫɢɧɞɪɨɦ ɪɚɡɜɢɥɫɹ ɧɚ ɮɨɧɟ ɫɢɦɩɬɨɦɨɜ ɢɧɮɟɤɰɢɢ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭ -ɬɟɣ. ɇɚ ɦɨɦɟɧɬ ɩɨɫɬɭɩɥɟɧɢɹ ɫɚɬɭɪɚɰɢɹ 92-94%, ɩɪɢ ɧɨɪɦɟ ɞɥɹ ɛɟɪɟɦɟɧɧɵɯ 95%. ȼ ɤɥɢɧɢɱɟɫɤɨɣ ɤɚɪɬɢɧɟ ɧɚ ɩɟɪɜɨɦ ɦɟɫɬɟ ɛɵɥɢ: ɨɞɵɲɤɚ ɩɪɢ ɧɟɡɧɚɱɢɬɟɥɶɧɨɣ ɮɢɡɢɱɟɫɤɨɣ ɧɚɝɪɭɡɤɟ ɢ ɜ ɩɨɤɨɟ, ɧɚɪɭɲɟɧɢɟ ɫɧɚ, ɫɭɯɨɣ ɦɭɱɢɬɟɥɶɧɵɣ ɤɚɲɟɥɶ. Ⱥɭɫɤɭɥɶɬɚɬɢɜɧɨ ɧɚ ɦɨɦɟɧɬ ɩɨɫɬɭɩɥɟɧɢɹ – ɫɭɯɢɟ ɪɚɫɫɟɹɧɧɵɟ ɫɜɢɫɬɹɳɢɟ ɯɪɢɩɵ. ȼɫɟɦ ɠɟɧɳɢɧɚɦ ɩɪɨɜɨɞɢɥɚɫɶ ɫɬɚɧɞɚɪɬɧɚɹ ɬɟɪɚɩɢɹ: ɤɢɫɥɨɪɨɞ ɦɚ

-ɤɨɤɨɪɬɢɤɨɫɬɟɪɨɢɞɵ ɩɚɪɟɧɬɟɪɚɥɶɧɨ.ɋɪɟɞɧɹɹ ɞɥɢ -ɬɟɥɶɧɨɫɬɶ ɩɪɟɛɵɜɚɧɢɹ ɜ ɨɬɞɟɥɟɧɢɢ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ 5±1,2 ɫɭɬɨɤ. ɑɟɬɵɪɟɦ ɠɟɧɳɢɧɚɦ ɩɪɟɞ -ɜɚɪɢɬɟɥɶɧɵɣ ɞɢɚɝɧɨɡ – ɜɩɟɪɜɵɟ ɜɵɹɜɥɟɧɧɚɹ ȻȺ ɛɵɥ ɩɨɞɬɜɟɪɠɞɟɧ ɩɨ ɞɚɧɧɵɦɢ ɫɩɢɪɨɝɪɚɮɢɢ (ɈɎȼ1 76±1,2%, ɨɛɪɚɬɢɦɨɫɬɶ 21±1,8%), ɧɚɡɧɚ

-ɱɟɧɚ ɛɚɡɢɫɧɚɹ ɬɟɪɚɩɢɹ.ȼɢɪɭɫɨɥɨɝɢɱɟɫɤɢɟ ɢɫɫɥɟ -ɞɨɜɚɧɢɹ, ɩɪɨɜɟɞɟɧɧɵɟ ɭ ɜɫɟɯ ɠɟɧɳɢɧ ɝɪɭɩɩɵ 3, ɧɟ ɜɵɹɜɢɥɢ ɜɢɪɭɫɨɜ ɝɪɢɩɩɚ ɬɢɩɚ Ⱥ ɢɥɢ ȼ.

Ɋɢɫ. 1. Ɋɚɫɩɪɟɞɟɥɟɧɢɟ ɛɟɪɟɦɟɧɧɵɯ ɩɨ ɫɬɟɩɟɧɢ

ɬɹɠɟɫɬɢ ɨɛɨɫɬɪɟɧɢɣ ȻȺ

ɗɬɚɩ 2. Ⱥɧɚɥɢɡ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ɛɚɡɢɫ

-ɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ.

(4)

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

Ɋɢɫ. 2. ɉɪɢɜɟɪɠɟɧɧɨɫɬɶ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɭ ɠɟɧɳɢɧ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ȻȺ

ɗɬɚɩ 3. Ɉɰɟɧɤɚ ɭɪɨɜɧɹ ɤɨɧɬɪɨɥɹ ȻȺ ɜɨ ɜɪɟ

-ɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ.

ɇɚ ɬɪɟɬɶɟɦ ɷɬɚɩɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɜɵɹɜɥɟɧɨ,ɱɬɨ ɩɨɥɧɵɣ ɤɨɧɬɪɨɥɶ ɡɚɛɨɥɟɜɚɧɢɹ (ɛɚɥɥ ɩɨ ȺɋɌ 20) ɫɪɟɞɢ ɛɟɪɟɦɟɧɧɵɯ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ȻȺ ɛɵɥ ɞɨɫɬɢɝɧɭɬ ɬɨɥɶɤɨ ɭ ɬɪɟɯ ɠɟɧɳɢɧ ɫ ɥɟɝɤɢɦ ɢ ɭ ɞɜɭɯ – ɫɨ ɫɪɟɞɧɟɬɹɠɟɥɵɦ ɬɟɱɟɧɢɟɦ, ɩɪɨ

-ɞɨɥɠɚɜɲɢɯ ɩɪɢɟɦ ȻɌ ɜ ɩɨɥɧɨɦ ɨɛɴɟɦɟ. Ⱥɧɚɥɢɡ ɫɨɨɬɜɟɬɫɬɜɢɹ ɞɨɡɢɪɨɜɤɢ ɛɚɡɢɫɧɵɯ ɩɪɟɩɚɪɚɬɨɜ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ ȻȺ ɩɨɤɚɡɚɥ,ɱɬɨ ɧɟɞɨɫɬɚɬɨɱɧɭɸ ɞɨɡɢɪɨɜɤɭ ɛɚɡɢɫɧɨɝɨ ɩɪɟɩɚɪɚɬɚ ɜ ɝɪɭɩɩɟ ɥɟɝɤɨɣ ȻȺ ɩɨɥɭɱɚɥɢ ɞɜɨɟ ɛɨɥɶɧɵɯ (25%), ɚ ɜ ɝɪɭɩɩɟ ɫɪɟɞɧɟɬɹɠɟɥɨɣ ȻȺ – ɱɟɬɜɟɪɨ (36%), ɜ ɬɨ ɜɪɟɦɹ ɤɚɤ ɠɟɧɳɢɧɵ ɫ ɬɹɠɟɥɵɦ ɬɟɱɟɧɢɟɦ ȻȺ ɜ 100% ɫɥɭɱɚɟɜ ɩɨɥɭɱɚɥɢ ɞɨɫɬɚɬɨɱɧɭɸ ȻɌ (ɪɢɫ. 3).

Ɋɢɫ. 3. ɍɪɨɜɟɧɶ ɤɨɧɬɪɨɥɹ ɢ ɞɨɥɹ ɛɨɥɶɧɵɯ ɫ ɧɟɞɨɫɬɚɬɨɱɧɨɣ ɞɨɡɨɣ ɛɚɡɢɫɧɵɯ ɩɪɟɩɚɪɚɬɨɜ

ɫɪɟɞɢ ɛɟɪɟɦɟɧɧɵɯ ɫ ɥɟɝɤɨɣ ɢ ɫɪɟɞɧɟɬɹɠɟɥɨɣ ȻȺ

ɇɚɪɭɲɟɧɢɟ ɪɟɠɢɦɚ ȻɌ, ɚ ɬɚɤɠɟ ɷɩɢɡɨɞɵ ɪɟɫ -ɩɢɪɚɬɨɪɧɨɣ ɢɧɮɟɤɰɢɢ ɩɪɢɜɨɞɹɬ ɤ ɜɨɡɧɢɤɧɨɜɟ -ɧɢɸ ɧɟɫɤɨɥɶɤɢɯ ɨɛɨɫɬɪɟɧɢɣ ȻȺ ɜɨ ɜɪɟɦɹ ɛɟ -ɪɟɦɟɧɧɨɫɬɢ, ɱɬɨ ɛɭɞɟɬ ɩɨɤɚɡɚɧɨ ɧɚ ɫɥɟɞɭɸɳɟɦ ɤɥɢɧɢɱɟɫɤɨɦ ɩɪɢɦɟɪɟ.

Ȼɟɪɟɦɟɧɧɚɹ Ɍ., 31 ɝɨɞ, ɛɵɥɚ ɝɨɫɩɢɬɚɥɢɡɢɪɨ -ɜɚɧɚ ɜ ɨɬɞɟɥɟɧɢɟ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ ɫ ɞɢ

-ɚɝɧɨɡɨɦ: ɜɬɨɪɚɹ ɛɟɪɟɦɟɧɧɨɫɬɶ, 23 ɧɟɞɟɥɢ, ɛɪɨɧ -ɯɢɚɥɶɧɚɹ ɚɫɬɦɚ ɫɪɟɞɧɟɣ ɬɹɠɟɫɬɢ, ɧɟɤɨɧɬɪɨɥɢ -ɪɭɟɦɨɟ ɬɟɱɟɧɢɟ,ɬɹɠɟɥɨɟ ɨɛɨɫɬɪɟɧɢɟ,Ⱦɇ 1.

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Ɍɨɦ

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ɬɟɦɩɟɪɚɬɭɪɵ ɞɨ ɫɭɛɮɟɛɪɢɥɶɧɵɯ ɰɢɮɪ ɢ ɤɚɬɚ -ɪɚɥɶɧɵɯ ɹɜɥɟɧɢɣ ɭɫɢɥɢɥɚɫɶ ɨɞɵɲɤɚ ɢ ɭɱɚɫɬɢ -ɥɢɫɶ ɩɪɢɫɬɭɩɵ ɫɭɯɨɝɨ ɤɚɲɥɹ. ɉɪɢɟɦ ɜɟɧɬɨɥɢɧɚ ɱɟɪɟɡ ɧɟɛɭɥɚɣɡɟɪ ɞɨ 6 ɪɚɡ ɜ ɞɟɧɶ ɧɟ ɞɚɜɚɥ ɨɠɢ -ɞɚɟɦɨɝɨ ɤɥɢɧɢɱɟɫɤɨɝɨ ɷɮɮɟɤɬɚ.

ɇɚ ɦɨɦɟɧɬ ɩɨɫɬɭɩɥɟɧɢɹ ɜ ɨɬɞɟɥɟɧɢɟ ɢɧ -ɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ ɫɨɫɬɨɹɧɢɟ ɬɹɠɟɥɨɟ, t 37,6°ɋ, ɨɞɵɲɤɚ ɜ ɩɨɤɨɟ, ɫɚɬɭɪɚɰɢɹ 91%, ɱɚɫɬɨɬɚ ɞɵɯɚ -ɬɟɥɶɧɵɯ ɞɜɢɠɟɧɢɣ 28 ɜ ɦɢɧ.,ɬɚɯɢɤɚɪɞɢɹ (100 ɭɞ. ɜ ɦɢɧ.). ɇɚɞ ɥɟɝɤɢɦɢ ɜɵɫɥɭɲɢɜɚɟɬɫɹ ɛɨɥɶɲɨɟ ɤɨɥɢɱɟɫɬɜɨ ɫɭɯɢɯ ɫɜɢɫɬɹɳɢɯ ɯɪɢɩɨɜ. ȼ ɨɛɳɟɦ ɚɧɚɥɢɡɟ ɤɪɨɜɢ ɥɟɣɤɨɰɢɬɨɡ 10 Ɍ/ɥ ɢ ɥɢɦɮɨɩɟɧɢɹ 6%. Ɋɟɧɬɝɟɧ ɝɪɭɞɧɨɣ ɤɥɟɬɤɢ ɜ ɩɪɹɦɨɣ ɢ ɛɨɤɨɜɨɣ ɩɪɨɟɤɰɢɹɯ ɢɧɮɢɥɶɬɪɚɬɢɜɧɵɯ ɢɡɦɟɧɟɧɢɣ ɧɟ ɜɵɹɜɢɥ.

ɦɨɣ ɬɟɪɚɩɢɢ: ɤɢɫɥɨɪɨɞ ɦɚɫɨɱɧɵɦ ɫɩɨɫɨɛɨɦ (ɮɪɚɤɰɢɹ ɤɢɫɥɨɪɨɞɚ ɜɨ ɜɞɵɯɚɟɦɨɣ ɫɦɟɫɢ 40%), ɜɟɧɬɨɥɢɧ 2,5 ɦɝ ɢ ɩɭɥɶɦɢɤɨɪɬ 0,5 ɦɝ ɱɟɪɟɡ ɧɟ -ɛɭɥɚɣɡɟɪ, «Ɇɟɞɪɨɥ» 32 ɦɝ/ɫɭɬɤɢ, ɫɨɫɬɨɹɧɢɟ ɡɧɚ -ɱɢɬɟɥɶɧɨ ɭɥɭɱɲɢɥɨɫɶ. ɉɨɫɥɟ ɜɵɩɢɫɤɢ ɢɡ ɨɬɞɟ -ɥɟɧɢɹ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ ɩɪɨɜɟɞɟɧɵ ɫɩɢɪɨ -ɝɪɚɮɢɹ ɢ ɤɨɧɫɭɥɶɬɚɰɢɹ ɩɭɥɶɦɨɧɨɥɨɝɚ.ȼɵɫɬɚɜɥɟɧ ɞɢɚɝɧɨɡ: ɩɟɪɫɢɫɬɢɪɭɸɳɚɹ ȻȺ, ɫɪɟɞɧɟɣ ɬɹɠɟɫɬɢ, ɧɟɤɨɧɬɪɨɥɢɪɭɟɦɨɟ ɬɟɱɟɧɢɟ, ɭɦɟɪɟɧɧɵɟ ɧɚɪɭ -ɲɟɧɢɹ ɎȼȾ ɩɨ ɨɛɫɬɪɭɤɬɢɜɧɨɦɭ ɬɢɩɭ.ɇɚɡɧɚɱɟɧɚ ɬɟɪɚɩɢɹ: «ɋɢɦɛɢɤɨɪɬ ɬɭɪɛɭɯɚɣɥɟɪ» (ɛɭɞɟɫɨɧɢɞ 160 ɦɤɝ+ ɮɨɪɦɨɬɟɪɨɥ 4,5 ɦɤɝ) ɩɨ 1 ɜɞɨɯɭ ɞɜɚ ɪɚɡɚ ɜ ɞɟɧɶ ɢ ɜɟɧɬɨɥɢɧ ɩɨ ɬɪɟɛɨɜɚɧɢɸ.

Ɋɢɫ. 3. ɋɩɢɪɨɝɪɚɦɦɚ ɩɚɰɢɟɧɬɤɢ Ɍ.ɩɨɫɥɟ 5 ɞɧɟɣ ɩɪɟɛɵɜɚɧɢɹ ɜ ɨɬɞɟɥɟɧɢɢ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ

ȼ ɬɟɱɟɧɢɟ ɫɥɟɞɭɸɳɟɝɨ ɦɟɫɹɰɚ ɩɚɰɢɟɧɬɤɚ Ɍ. ɩɪɨɞɨɥɠɚɥɚ ɧɚɪɭɲɚɬɶ ɪɟɠɢɦ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɢ ɩɟɪɟɧɟɫɥɚ ɟɳɟ ɨɞɧɨ ɨɛɨɫɬɪɟɧɢɟ ɫɪɟɞɧɟɣ ɬɹɠɟɫɬɢ. Ɉɬ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ ɨɬɤɚɡɚɥɚɫɶ, ɥɟɱɢɥɚɫɶ ɚɦɛɭ -ɥɚɬɨɪɧɨ: ɜɟɧɬɨɥɢɧ 2,5 ɦɝ ɢ ɩɭɥɶɦɢɤɨɪɬ 0,5 ɦɝ ɱɟɪɟɡ ɧɟɛɭɥɚɣɡɟɪ 4 ɪɚɡɚ ɜ ɞɟɧɶ. ɇɚ ɫɟɞɶɦɨɣ ɞɟɧɶ ɬɟɪɚɩɢɢ ɧɚ ɮɨɧɟ ɡɧɚɱɢɬɟɥɶɧɨɝɨ ɭɥɭɱɲɟɧɢɹ ɫɨ -ɫɬɨɹɧɢɹ ɩɟɪɟɜɟɞɟɧɚ ɧɚ ɩɪɢɟɦ ɩɪɟɩɚɪɚɬɚ «ɋɢɦ -ɛɢɤɨɪɬ» ɜ ɩɪɟɠɧɟɣ ɞɨɡɢɪɨɜɤɟ. ɑɟɪɟɡ 2 ɧɟɞɟɥɢ ɩɨɫɥɟ ɩɟɪɟɧɟɫɟɧɧɨɝɨ ɨɛɨɫɬɪɟɧɢɹ, ɧɚ ɮɨɧɟ ɫɨ -ɛɥɸɞɟɧɢɹ ɬɟɪɚɩɢɢ ɩɨɤɚɡɚɬɟɥɢ ɎȼȾ ɡɧɚɱɢɬɟɥɶɧɨ ɭɥɭɱɲɢɥɢɫɶ (ɪɢɫ. 4).

Ⱦɚɥɶɧɟɣɲɟɟ ɧɚɛɥɸɞɟɧɢɟ ɩɨɤɚɡɚɥɨ, ɱɬɨ ɧɚ ɮɨɧɟ ɚɞɟɤɜɚɬɧɨɣ ɞɨɡɵ ɛɚɡɢɫɧɨɝɨ ɩɪɟɩɚɪɚɬɚ ɭ ɩɚɰɢɟɧɬɤɢ Ɍ.ɫ 28-ɣ ɧɟɞɟɥɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɧɟ ɛɵ -ɥɨ ɧɢ ɨɞɧɨɝɨ ɨɛɨɫɬɪɟɧɢɹ, ɤ 34-ɣ ɧɟɞɟɥɟ –

ɞɨɫɬɢɝɧɭɬ ɱɚɫɬɢɱɧɵɣ ɤɨɧɬɪɨɥɶ ɡɚɛɨɥɟɜɚɧɢɹ (ȺɋɌ 17 ɛɚɥɥɨɜ), ɡɧɚɱɢɬɟɥɶɧɨ ɭɥɭɱɲɢɥɚɫɶ ɎȼȾ (ɪɢɫ. 5).

Ɋɨɞɵ ɩɪɨɢɡɨɲɥɢ ɧɚ 38 ɧɟɞɟɥɟ ɛɟɪɟɦɟɧɧɨɫɬɢ ɠɢɜɨɣ ɞɟɜɨɱɤɨɣ,ɜɟɫ 3,300 ɝ,ɪɨɫɬ 50 ɫɦ.

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ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

Ɋɢɫ. 4. 1 – ɫɩɢɪɨɝɪɚɦɦɚ ɜɨ ɜɪɟɦɹ ɨɛɨɫɬɪɟɧɢɹ; 2 – ɫɩɢɪɨɝɪɚɦɦɚ ɱɟɪɟɡ ɞɜɟ ɧɟɞɟɥɢ

ɩɨɫɥɟ ɜɨɡɨɛɧɨɜɥɟɧɢɹ ɩɪɢɟɦɚ ɛɚɡɢɫɧɵɯ ɩɪɟɩɚɪɚɬɨɜ

ɋɥɟɞɭɟɬ ɨɬɦɟɬɢɬɶ,ɱɬɨ ɭ 17 (68%) ɛɟɪɟɦɟɧɧɵɯ ɨɛɨɫɬɪɟɧɢɟ ȻȺ ɩɪɨɬɟɤɚɥɨ ɧɚ ɮɨɧɟ ɫɢɦɩɬɨɦɨɜ ɢɧɮɟɤɰɢɢ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɪɚɡɧɨɣ ɫɬɟɩɟɧɢ ɜɵɪɚɠɟɧɧɨɫɬɢ. ɉɪɢ ɷɬɨɦ ɭ 70 % ɛɵɥ ɨɬɹɝɨɳɟɧɧɵɣ ɷɩɢɞɟɦɢɨɥɨɝɢɱɟɫɤɢɣ ɚɧɚɦɧɟɡ ɜ ɜɢɞɟ ɤɨɧɬɚɤɬɚ ɫ ɛɨɥɶɧɵɦɢ ɪɟɫɩɢɪɚɬɨɪɧɵɦɢ ɢɧ

-ɮɟɤɰɢɹɦɢ ɱɥɟɧɚɦɢ ɫɟɦɶɢ. ɇɢ ɨɞɧɚ ɛɟɪɟɦɟɧɧɚɹ, ɩɟɪɟɧɟɫɲɚɹ ɨɛɨɫɬɪɟɧɢɟ ȻȺ, ɢɥɢ ɱɥɟɧɵ ɟɟ ɫɟɦɶɢ ɧɟ ɛɵɥɢ ɜɚɤɰɢɧɢɪɨɜɚɧɵ ɨɬ ɝɪɢɩɩɚ. ɏɨɬɹ ɞɚɧɧɵɟ Rastogi D. et al., 2006 ɩɨɤɚɡɚɥɢ, ɱɬɨ ɜɚɤɰɢɧɚɰɢɹ ɩɪɨɬɢɜ ɝɪɢɩɩɚ ɫɪɟɞɢ ɛɟɪɟɦɟɧɧɵɯ ɫ ȻȺ ɫɧɢɠɚɟɬ ɪɢɫɤ ɨɛɨɫɬɪɟɧɢɣ ɧɚ 50% [12].

Ɋɢɫ. 5. ɋɩɢɪɨɝɪɚɦɦɚ ɧɚ 32-ɣ ɧɟɞɟɥɟ ɛɟɪɟɦɟɧɧɨɫɬɢ

ȼ ɦɟɬɚɚɧɚɥɢɡɟ Murphy V. E. et al., 2011 ɨɛɟ -ɫɩɨɤɨɟɧɧɨɫɬɶ ɠɟɧɳɢɧ ɨɬɧɨɫɢɬɟɥɶɧɨ ɛɟɡɨɩɚɫ -ɧɨɫɬɢ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɥɹ ɩɥɨɞɚ ɪɚɫɫɦɚɬɪɢ -ɜɚɟɬɫɹ ɤɚɤ ɨɫɧɨɜɧɚɹ ɩɪɢɱɢɧɚ ɫɧɢɠɟɧɢɹ ɩɪɢ -ɜɟɪɠɟɧɧɨɫɬɢ ɤ ɥɟɱɟɧɢɸ, ɨɞɧɚɤɨ ɜ ɧɚɲɟɦ ɢɫ -ɫɥɟɞɨɜɚɧɢɢ ɢɡɦɟɧɟɧɢɹ ɜ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ɛɚ -ɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ

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ȼɕȼɈȾɕ

1. 71% ɛɟɪɟɦɟɧɧɵɯ ɩɟɪɟɧɟɫɥɢ ɨɛɨɫɬɪɟɧɢɹ ɪɚɡ -ɧɨɣ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ, ɤɨɬɨɪɵɟ ɪɚɡɜɢɜɚɥɢɫɶ ɧɚ ɮɨɧɟ ɫɢɦɩɬɨɦɨɜ ɢɧɮɟɤɰɢɢ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ. ɗɬɨ ɟɳɟ ɪɚɡ ɩɨɞɱɟɪɤɢɜɚɟɬ ɪɨɥɶ ɪɟɫɩɢ -ɪɚɬɨɪɧɵɯ ɜɢɪɭɫɨɜ ɜ ɪɚɡɜɢɬɢɢ ɨɛɨɫɬɪɟɧɢɣ ɛɪɨɧ -ɯɢɚɥɶɧɨɣ ɚɫɬɦɵ ɢ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɩɪɨɜɟɞɟɧɢɹ ɫɩɟɰɢɮɢɱɟɫɤɨɣ ɩɪɨɮɢɥɚɤɬɢɤɢ (ɜɚɤɰɢɧɚɰɢɹ), ɟɫɥɢ ɫɟɡɨɧɧɨɟ ɩɨɜɵɲɟɧɢɟ ɭɪɨɜɧɹ ɡɚɛɨɥɟɜɚɟ -ɦɨɫɬɢ ɪɟɫɩɢɪɚɬɨɪɧɵɦɢ ɜɢɪɭɫɧɵɦɢ ɢɧɮɟɤɰɢɹɦɢ ɫɨɜɩɚɞɚɟɬ ɫɨ ɜɬɨɪɵɦ ɢɥɢ ɬɪɟɬɶɢɦ ɬɪɢɦɟɫɬɪɚɦɢ ɛɟɪɟɦɟɧɧɨɫɬɢ,ɨɫɨɛɟɧɧɨ ɭ ɠɟɧɳɢɧ ɫ ȻȺ.

2. ɉɨɥɭɱɟɧɵ ɞɚɧɧɵɟ ɨ ɬɨɦ, ɱɬɨ ɩɪɢɜɟɪɠɟɧ -ɧɨɫɬɶ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟ

-ɩɪɟɞɩɨɥɨɠɢɬɶ, ɱɬɨ ɩɪɢɜɟɪɠɟɧɧɨɫɬɶ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɟɟ ɫɨɨɬɜɟɬɫɬɜɢɟ ɫɬɟ -ɩɟɧɢ ɬɹɠɟɫɬɢ ɡɚɛɨɥɟɜɚɧɢɹ – ɫɩɨɫɨɛɫɬɜɭɸɬ ɞɨɫɬɢ -ɠɟɧɢɸ ɤɨɧɬɪɨɥɹ ȻȺ ɜ ɝɟɫɬɚɰɢɨɧɧɵɣ ɩɟɪɢɨɞ.

3. ɍɯɭɞɲɟɧɢɟ ɤɨɧɬɪɨɥɹ ȻȺ ɜɨ ɜɪɟɦɹ ɛɟɪɟ -ɦɟɧɧɨɫɬɢ ɦɨɠɟɬ ɛɵɬɶ ɨɛɭɫɥɨɜɥɟɧɨ ɧɟ ɬɨɥɶɤɨ ɧɚɪɭɲɟɧɢɟɦ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ, ɧɨ ɢ ɟɟ ɧɟɞɨɫɬɚ -ɬɨɱɧɨɫɬɶɸ,ɧɚ ɮɨɧɟ ɮɢɡɢɨɥɨɝɢɱɟɫɤɢɯ ɢɡɦɟɧɟɧɢɣ. ɗɬɨ ɝɨɜɨɪɢɬ ɨ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɤɨɧɬɪɨɥɹ ɬɟɱɟɧɢɹ ɡɚɛɨɥɟɜɚɧɢɹ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɩɪɨɫɬɵɯ ɢ ɞɨɫɬɭɩ -ɧɵɯ ɦɟɬɨɞɢɤ (ȺɋɌ ɢ ɫɩɢɪɨɦɟɬɪɢɹ) ɢ ɫɜɨɟɜɪɟ -ɦɟɧɧɨɣ ɤɨɧɫɭɥɶɬɚɰɢɢ ɩɭɥɶɦɨɧɨɥɨɝɚ ɞɥɹ ɩɟ -ɪɟɫɦɨɬɪɚ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ.

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1. ɉɟɪɰɟɜɚ Ɍ.Ⱥ.ɂɧɮɟɤɰɢɨɧɧɨɟ ɨɛɨɫɬɪɟɧɢɟ ɛɪɨɧ

-ɯɢɚɥɶɧɨɣ ɚɫɬɦɵ / Ɍ.Ⱥ. ɉɟɪɰɟɜɚ, ȼ.ȼ.Ⱦɦɢɬɪɟɱɟɧɤɨ // Ɂɞɨɪɨɜɶɟ ɍɤɪɚɢɧɵ. – 2010. – ɬɟɦɚɬɢɱɟɫɤɢɣ ɧɨɦɟɪ. – ɋ. 6.

2. Ɋɟɛɪɨɜɚ Ɉ.ɘ. ɋɬɚɬɢɫɬɢɱɟɫɤɢɣ ɚɧɚɥɢɡ ɦɟɞɢ -ɰɢɧɫɤɢɯ ɞɚɧɧɵɯ. ɉɪɢɦɟɧɟɧɢɟ ɩɚɤɟɬɚ ɩɪɢɤɥɚɞɧɵɯ ɩɪɨɝɪɚɦɦ STATISTICA / Ɉ.ɘ.Ɋɟɛɪɨɜɚ. – Ɇ.:Ɇɟɞɢɚ ɋɮɟɪɚ, 2002. – 312 ɫ.

3. Ɍɟɫɬ ɩɨ ɤɨɧɬɪɨɥɸ ɧɚɞ ɚɫɬɦɨɣ (ACT). Ƚɥɚɤ -ɫɨɋɦɢɬɄɥɹɣɧ, 2010 [ɗɥɟɤɬɪɨɧɧɵɣ ɪɟɫɭɪɫ]. – Ɋɟɠɢɦ ɞɨɫɬɭɩɚ: http://www.astmatest.ru /what_is_act.html.

4. Asthma morbidity during pregnancy can be pre-dicted by severity classification / M. Schatz, M.P. Dom-browski, R. Wise, [et al.] // J. Allergy. Clin. Immunol. – 2003. – Vol. 112. – P. 283.

5. Chambers K. Asthma education and outcomes for women of childbearing age / K. Chambers // Case Mana-ger. – 2003. – Vol. 14.– P. 58-61.

6. Effects of asthma severity, exacerbations and oral corticosteroids on perinatal outcomes / J.A. Namazy, V.E. Murphy, H. Powell [et al] // Eur. Respir. J. – 2013. – Vol. 41. – P. 1082-1090.

7. Enriquez R. Effect of maternal asthma and asthma control during pregnancy and perinatal outcomes / R. Enriquez, M.R. Griffen, K.N. Carroll [et al.] // J Allergy Clin. Immunol. – 2007. – Vol. 120. – P. 625-628.

8. Exacerbations of asthma and chronic obstructive pulmonary disease (COPD): focus on virus induced exa-cerbations / P. Mallia, M. Contoli, G. Caramori [et al.] // Curr. Pharm. Des. – 2007. – Vol. 13, N 1. – P. 73-97.

9. Global strategy for asthma menegment and pre-vention report 2013 [Internet]. – Available from: http://www.ginasthma.org.

10. Kwon H. L. Asthma prevalence among pregnant and childbearing-aged women in the United States: Esti-mates from National Health Surveys / H.L. Kwon, K. Belanger, M.B. Bracken // Ann. Epidemiology.– 2003. – Vol. 13.– P. 317-324.

11. Severe asthma exacerbations during pregnancy / V.E. Murphy, P. Gibson, P.I. Talbo [et al.] // Obstet Gy-necol.– 2005.– Vol. 106. – P. 1046-8.

12. T-helper type 2 polarization among asthmatics du-ring and following pregnancy / D. Rastogi, C. Wang, C. Len-dor [et al.] // Clin. Exp. Allergy. – 2006. – Vol. 36. – P. 892.

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1. Pertseva TA, Dmitrichenko VV. [Infectious exa-cerbation of asthma]. Zdorov'e Ukrainy. 2010;6. Russian. 2. Rebrova OY. [Statistical analysis of medical data. Application of software package STATISTICA]. Media Sfera, 2002;312. Russian.

3. Asthma Control Test (ACT) [Internet]. Glaxo-smithKline, 2010. Available from: http://www.astma-test.ru/what_is_act.html.

4. Schatz M, Dombrowski MP, Wise R. Asthma morbidity during pregnancy can be predicted by severity classification. J Allergy Clin Immunol. 2003;112:283.

5. Chambers K. Asthma education and outcomes for women of childbearing age. Case Manager 2003;14:58.

6. Namazy JA, Murphy VE, Powell H, Gibson PG, Chambers C, Schatz M. Effects of asthma severity, exa-cerbations and oral corticosteroids on perinatal outcomes. Eur Respir J 2013;41:1082–90.

7. Enriquez R, Griffen MR, Carroll KN, et al. Effect of maternal asthma and asthma control during pregnancy and perinatal outcomes. J Allergy Clin Immunol. 2007;120:625.

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ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

9. Global strategy for asthma management and pre-vention, report 2013 [Internet]. GINA, 2013. Available from: http://www.ginasthma.org.

10. Kwon HL, Belanger K, Bracken MB. Asthma prevalence among pregnant and childbearing-aged wo-men in the United States: Estimates from National Health Surveys. Annals of Epidemiology 2003;13:317–24.

11. Murphy VE, Gibson P, Talbot PI, et al. Severe asthma exacerbations during pregnancy. Obstet Gynecol 2005;106:1046.

12. Rastogi D, Wang C, Lendor C, et al. T-helper type 2 polarization among asthmatics during and fol-lowing pregnancy. Clin Exp Allergy. 2006;36:892.

ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ 13.03.2014

ɍȾɄ 616.24-002-036-08:615.33:330.133

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Ⱦɍ «ɇɚɰɿɨɧɚɥɶɧɢɣ ɿɧɫɬɢɬɭɬ ɮɬɢɡɿɚɬɪɿʀ ɿ ɩɭɥɶɦɨɧɨɥɨɝɿʀ

ɿɦ.Ɏ.Ƚ.əɧɨɜɫɶɤɨɝɨ ɇȺɆɇ ɍɤɪɚʀɧɢ»

ɜɭɥ.Ɇ.Ⱥɦɨɫɨɜɚ, 10, Ʉɢʀɜ, 03680, ɍɤɪɚʀɧɚ

SO “National institute of phthisiology and pulmonology named after F.G. Yanovsky, NAMS of Ukraine” M. Amosova str., 10, Kiev, 03680, Ukraine e-mail: dzublik@yahoo.com

Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɧɟɝɨɫɩɿɬɚɥɶɧɚ ɩɧɟɜɦɨɧɿɹ,ɚɧɬɢɛɿɨɬɢɤɢ,ɟɮɟɤɬɢɜɧɿɫɬɶ ɥɿɤɭɜɚɧɧɹ,ɜɚɪɬɿɫɬɶ

Key words: community-acquired pneumonia, antibiotics, effectiveness of treatment, cost

Ɋɟɮɟɪɚɬ. Ɉɩɬɢɦɢɡɚɰɢɹ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɨɣ ɬɟɪɚɩɢɢ ɛɨɥɶɧɵɯ ɜɧɟɛɨɥɶɧɢɱɧɨɣ ɩɧɟɜɦɨɧɢɟɣ ȱV ɤɥɢɧɢ

-ɱɟɫɤɨɣ ɝɪɭɩɩɵ. Ⱦɡɸɛɥɢɤ ə.Ⱥ. ɐɟɥɶ ɢɫɫɥɟɞɨɜɚɧɢɹ: ɢɡɭɱɟɧɢɟ ɤɥɢɧɢɱɟɫɤɨɣ ɢ ɷɤɨɧɨɦɢɱɟɫɤɨɣ ɷɮɮɟɤɬɢɜɧɨɫɬɢ

ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɧɧɵɯ ɪɟɠɢɦɨɜ ɷɦɩɢɪɢɱɟɫɤɨɣ ɫɬɭɩɟɧɱɚɬɨɣ ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɢ ɛɨɥɶɧɵɯ ɜɧɟɛɨɥɶɧɢɱɧɨɣ ɩɧɟɜɦɨɧɢɟɣ (ȼɉ) ȱV ɤɥɢɧɢɱɟɫɤɨɣ ɝɪɭɩɩɵ.Ɇɚɬɟɪɢɚɥɵ ɢ ɦɟɬɨɞɵ.ȼ ɢɫɫɥɟɞɨɜɚɧɢɟ ɜɤɥɸɱɢɥɢ 42 ɩɚɰɢɟɧɬɚ ɫ ȼɉ

ɬɹɠɟɥɨɝɨ ɬɟɱɟɧɢɹ ɛɟɡ ɧɚɥɢɱɢɹ ɮɚɤɬɨɪɨɜ ɪɢɫɤɚ ɢɧɮɢɰɢɪɨɜɚɧɢɹ P. aeruginosa, ɤɨɬɨɪɵɟ ɛɵɥɢ ɝɨɫɩɢɬɚɥɢ

-ɡɢɪɨɜɚɧɵ ɜ ɨɬɞɟɥɟɧɢɟ ɢɧɬɟɧɫɢɬɜɧɨɣ ɬɟɪɚɩɢɢ ɩɨ ɦɟɞɢɰɢɧɫɤɢɦ ɩɨɤɚɡɚɧɢɹɦ. ɉɚɰɢɟɧɬɵ ɞɚɧɧɨɣ ɝɪɭɩɩɵ ɛɵɥɢ

ɪɚɧɞɨɦɢɡɢɪɨɜɚɧɵ ɩɪɨɫɬɵɦ ɦɟɬɨɞɨɦ ɜ ɫɨɨɬɧɨɲɟɧɢɢ 1:1:1 ɜ ɬɪɢ ɩɨɞɝɪɭɩɩɵ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɢɫɩɨɥɶɡɨɜɚɧɧɵɯ

ɫɯɟɦ ɷɦɩɢɪɢɱɟɫɤɨɣ ɫɬɭɩɟɧɱɚɬɨɣ ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɢ: ɜɧɭɬɪɢɜɟɧɧɨɟ ɩɪɢɦɟɧɟɧɢɟ ɚɦɨɤɫɢɰɢɥɥɢɧɚ/ɤɥɚɜɭ

-ɥɚɧɚɬɚ,ɥɢɛɨ ɰɟɮɬɪɢɚɤɫɨɧɚ,ɥɢɛɨ ɷɪɬɚɩɟɧɟɦɚ ɜ ɤɨɦɛɢɧɚɰɢɢ ɫ ɚɡɢɬɪɨɦɢɰɢɧɨɦ.ɉɨɫɥɟ ɫɬɚɛɢɥɢɡɚɰɢɢ ɫɨɫɬɨɹɧɢɹ

ɛɨɥɶɧɨɝɨ ɱɟɪɟɡ 3–4 ɞɧɹ ɬɟɪɚɩɢɹ ɡɚɦɟɧɹɥɚɫɶ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ ɧɚ ɩɟɪɨɪɚɥɶɧɵɣ ɩɪɢɟɦ ɚɦɨɤɫɢɰɢɥɥɢɧɚ/ɤɥɚɜɭ

-ɥɚɧɚɬɚ, ɰɟɮɭɪɨɤɫɢɦɚ ɚɤɫɟɬɢɥɚ ɜ ɤɨɦɛɢɧɚɰɢɢ ɫ ɚɡɢɬɪɨɦɢɰɢɧɨɦ, ɥɢɛɨ ɩɟɪɨɪɚɥɶɧɭɸ ɦɨɧɨɬɟɪɚɩɢɸ ɥɟɜɨ

-ɮɥɨɤɫɚɰɢɧɨɦ.ɋɪɚɜɧɢɬɟɥɶɧɚɹ ɨɰɟɧɤɚ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɪɟɠɢɦɨɜ ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɢ ɩɪɨɜɨɞɢɥɚɫɶ ɩɨ ɤɥɢɧɢɤɨ

-ɥɚɛɨɪɚɬɨɪɧɵɦ ɢ ɮɚɪɦɚɤɨɷɤɨɧɨɦɢɱɟɫɤɢɦ ɩɨɤɚɡɚɬɟɥɹɦ. Ɋɟɡɭɥɶɬɚɬɵ. Ⱥɧɚɥɢɡ ɞɢɧɚɦɢɤɢ ɪɟɡɭɥɶɬɚɬɨɜ ɤɥɢɧɢɤɨ

-ɥɚɛɨɪɚɬɨɪɧɵɯ ɢ ɪɟɧɬɝɟɧɨɥɨɝɢɱɟɫɤɢɯ ɢɫɫɥɟɞɨɜɚɧɢɣ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ, ɱɬɨ ɩɪɨɜɟɞɟɧɧɚɹ ɷɦɩɢɪɢɱɟɫɤɚɹ

ɫɬɭɩɟɧɱɚɬɚɹ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɚɹ ɬɟɪɚɩɢɹ ɫɩɨɫɨɛɫɬɜɨɜɚɥɚ ɞɨɫɬɢɠɟɧɢɸ ɩɪɚɤɬɢɱɟɫɤɢ ɨɞɢɧɚɤɨɜɵɯ (ɪ>0,05)

ɩɨɡɢɬɢɜɧɵɯ ɪɟɡɭɥɶɬɚɬɨɜ ɜɨ ɜɫɟɯ ɩɨɞɝɪɭɩɩɚɯ: ɭ 78,6r11,0% ɛɨɥɶɧɵɯ 1-ɣ ɩɨɞɝɪɭɩɩɵ (ɜɵɡɞɨɪɨɜɥɟɧɢɟ – ɭ 28,6r12,1, ɭɥɭɱɲɟɧɢɟ – ɭ 49,4r13,2%), ɭ 71,4r12,1% ɛɨɥɶɧɵɯ 2-ɣ ɩɨɞɝɪɭɩɩɵ (ɜɵɡɞɨɪɨɜɥɟɧɢɟ ɢ ɭɥɭɱɲɟɧɢɟ – ɭ 35,7r 12,8%) ɢ ɭ 85,7r 9,4% ɛɨɥɶɧɵɯ 3-ɣ ɝɪɭɩɩɵ (ɜɵɡɞɨɪɨɜɥɟɧɢɟ ɢ ɭɥɭɱɲɟɧɢɟ ɭ 42,9r13,2%) (ɪ!0,05). ȼɵɜɨɞɵ.