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ȾɁ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɦɟɞɢɱɧɚ ɚɤɚɞɟɦɿɹ ɆɈɁ ɍɤɪɚʀɧɢ»
ɤɚɮɟɞɪɚ ɧɟɜɪɨɥɨɝɿʀ ɬɚ ɨɮɬɚɥɶɦɨɥɨɝɿʀ
(ɡɚɜ. – ɞ.ɦɟɞ.ɧ.Ɉ.ȼ.ɉɨɝɨɪɽɥɨɜ)
ɩɥ.ɀɨɜɬɧɟɜɚ, 14, Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤ, 49044, ɍɤɪɚʀɧɚ
SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine» Department of neurology and ophthalmology
Zhovtneva sq., 14, Dnipropetrovsk, 49044, Ukraine e-mail: [email protected]
Ʉɥɸɱɨɜɿ ɫɥɨɜɚ:ɫɭɛɬɟɧɬɨɪɿɚɥɶɧɢɣ ɿɲɟɦɿɱɧɢɣ ɿɧɮɚɪɤɬ ɦɨɡɤɭ,ɫɬɨɜɛɭɪɨɜɿ ɪɟɝɭɥɹɬɨɪɧɿ ɫɬɪɭɤɬɭɪɢ,ɩɟɪɟɛɿɝ
ɿɧɫɭɥɶɬɭ
Key words:subtentorial ischemic stroke, brain stem regulatory structure, stroke result
Ɋɟɮɟɪɚɬ. Ʉɪɢɬɟɪɢɢ ɞɢɚɝɧɨɫɬɢɤɢ ɫɨɫɬɨɹɧɢɹ ɦɨɪɮɨɥɨɝɢɱɟɫɤɢ ɪɚɫɩɪɟɞɟɥɟɧɧɵɯ ɫɬɜɨɥɨɜɵɯ ɪɟɝɭɥɹɬɨɪɧɵɯ
ɫɬɪɭɤɬɭɪ ɩɪɢ ɰɟɪɟɛɪɨɜɚɫɤɭɥɹɪɧɵɯ ɡɚɛɨɥɟɜɚɧɢɹɯ. ɉɨɝɨɪɟɥɨɜ Ⱥ.ȼ. ɉɪɨɜɟɞɟɧɨ ɤɥɢɧɢɤɨ
-ɧɟɣɪɨɮɢɡɢɨɥɨɝɢɱɟɫɤɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ 62 ɩɚɰɢɟɧɬɨɜ, ɤɨɬɨɪɵɟ ɩɟɪɟɧɨɫɢɥɢ ɫɭɛɬɟɧɬɨɪɢɚɥɶɧɵɣ ɢɲɟɦɢɱɟɫɤɢɣ
ɢɧɫɭɥɶɬ ɞɥɹ ɨɩɪɟɞɟɥɟɧɢɹ ɤɪɢɬɟɪɢɟɜ ɧɚɪɭɲɟɧɢɹ ɮɭɧɤɰɢɢ ɦɨɪɮɨɥɨɝɢɱɟɫɤɢ ɪɚɫɩɪɟɞɟɥɟɧɧɵɯ ɫɬɜɨɥɨɜɵɯ ɪɟɝɭɥɹɬɨɪɧɵɯ ɫɬɪɭɤɬɭɪ. ɍɫɬɚɧɨɜɥɟɧɨ, ɱɬɨ ɷɬɢ ɧɚɪɭɲɟɧɢɹ ɢɦɟɸɬ ɭɫɬɨɣɱɢɜɵɣ ɯɚɪɚɤɬɟɪ ɫ ɜɨɡɦɨɠɧɨɫɬɶɸ
ɪɟɝɪɟɫɫɚ ɢ ɜɥɢɹɸɬ ɧɚ ɬɟɱɟɧɢɟ ɢɧɫɭɥɶɬɚ.Ɉɬɦɟɱɟɧɨ ɜɥɢɹɧɢɟ ɬɚɤɢɯ ɧɚɪɭɲɟɧɢɣ ɧɚ ɭɪɨɜɧɢ ɫɨɡɧɚɧɢɹ,ɬɹɠɟɫɬɶ
ɫɨɫɬɨɹɧɢɹ, ɬɟɦɩɵ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ, ɭɪɨɜɟɧɶ ɚɫɬɟɧɢɢ, ɮɭɧɤɰɢɸ ɫɧɚ, ɨɬɦɟɱɟɧɵ ɩɪɨɹɜɥɟɧɢɹ ɰɟɪɟɛɪɨ
-ɤɚɪɞɢɚɥɶɧɨɝɨ ɫɢɧɞɪɨɦɚ, ɧɚɪɭɲɟɧɢɟ ɭɪɨɜɧɹ ɜɧɢɦɚɧɢɹ, ɪɟɚɤɰɢɢ ɨɪɢɟɧɬɢɪɨɜɚɧɢɹ, ɫɟɧɫɨɦɨɬɨɪɧɵɯ ɚɤɬɨɜ.
ɉɚɰɢɟɧɬɵ ɫ ɬɚɤɢɦɢ ɧɚɪɭɲɟɧɢɹɦɢ ɢɦɟɸɬ ɧɢɡɤɢɟ ɬɟɦɩɵ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɮɭɧɤɰɢɣ. ɇɟɣɪɨɮɢɡɢɨɥɨɝɢɱɟɫɤɢɦɢ
ɤɪɢɬɟɪɢɹɦɢ ɹɜɥɹɟɬɫɹ ɨɬɫɭɬɫɬɜɢɟ ɷɤɫɩɪɟɫɫɢɜɧɵɯ ɪɟɚɤɰɢɣ ɩɪɢ ɷɥɟɤɬɪɨɷɧɰɟɮɚɥɨɝɪɚɮɢɢ,ɫɧɢɠɟɧɢɟ ɟɟ ɨɛɳɟɝɨ
ɭɪɨɜɧɹ,ɧɟɫɬɨɣɤɨɫɬɶ ɪɢɬɦɨ-ɝɟɧɟɪɚɬɨɪɧɵɯ ɫɬɪɭɤɬɭɪ ɢ ɞɪɭɝɢɟ.
Abstract. Diagnostic criteria of the state of the distributed brain stem regulatory structures in cerebrovascular diseases. Pogorelov A.V. The clinical-neurophysiological study of 62 patients with history of subtentorial ischemic stroke was carried out in order to determine the criteria of dysfunction of morphologically distributed stem regulatory structures. It was revealed that these disorders are sustainable with the possibility of recourse and influence on the course of stroke. It was marked the influence of this disorders on the levels of consciousness, severity of state, recovery rate, asthenia level, sleep function. Manifestations of cerebral cardiac syndrome, impaired attention, orientation reaction, speed of sensomotoric acts are also marked. Patients with these disorders have low rates of recovery of functions. Neurophysiological criteria of these disorders are the lack of expressive reactions in electroencepha-lography, reduction of their overall level, instability of rhythm - generating structures and others.
ɐɟɪɟɛɪɨɜɚɫɤɭɥɹɪɧɿ ɡɚɯɜɨɪɸɜɚɧɧɹ (ɐȼɁ) ɬɚ ʀɯ
ɧɚɫɥɿɞɤɢ ɭ ɜɢɝɥɹɞɿ ɿɧɮɚɪɤɬɭ ɦɨɡɤɭ (ȱɆ) ɯɚɪɚɤɬɟ
-ɪɢɡɭɸɬɶɫɹ ɜɢɫɨɤɨɸ ɫɦɟɪɬɧɿɫɬɸ,ɜɢɫɨɤɢɦ «ɟɤɨɧɨ
-ɦɿɱɧɢɦ ɬɹɝɚɪɟɦ» ɿɧɫɭɥɶɬɭ, ɿɧɜɚɥɿɞɢɡɚɰɿɽɸ ɜɧɚ
-ɫɥɿɞɨɤ ɧɟɩɨɜɧɨɝɨ ɜɿɞɧɨɜɥɟɧɧɹ ɮɭɧɤɰɿɣ. ȼ ɍɤ
-ɪɚʀɧɿ ɡɚɪɟɽɫɬɪɨɜɚɧɨ ɩɨɧɚɞ 3 ɦɥɧ ɥɸɞɟɣ ɡ ɪɿɡɧɢɦɢ
ɮɨɪɦɚɦɢ ɫɭɞɢɧɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ ɝɨɥɨɜɧɨɝɨ ɦɨɡ
-ɤɭ,ɳɨ ɧɚ 100 ɬɢɫ.ɧɚɫɟɥɟɧɧɹ ɫɬɚɧɨɜɢɬɶ ɛɿɥɶɲɟ 8
ɬɢɫ., ɳɨɪɿɱɧɨ ɞɿɚɝɧɨɫɬɭɽɬɶɫɹ ɞɨ 100-120 ɬɢɫ.
ɿɧɫɭɥɶɬɿɜ [1, 6], ɩɪɢ ɰɶɨɦɭ ɨɞɧɢɦ ɡ ɜɚɠɥɢɜɢɯ
ɚɫɩɟɤɬɿɜ ɪɨɡɜɢɬɤɭ ȱɆ ɽ ɩɢɬɚɧɧɹ ɪɢɡɢɤɿɜ ɬɚ ɩɪɨ
-ɝɧɨɡɭ ɡɚɥɟɠɧɨ ɜɿɞ [2, 5, 9] ɧɚɹɜɧɨɫɬɿ ɞɢɡɪɟ
-ɝɭɥɹɬɨɪɧɢɯ ɫɬɚɧɿɜ, ɫɬɨɜɛɭɪɨɜɨʀ ɞɢɫɮɭɧɤɰɿʀ, ɳɨ
ɩɟɪɟɞɭɽ, ɫɭɩɪɨɜɨɞɠɭɽ, ɜɩɥɢɜɚɽ ɧɚ ɪɨɡɜɢɬɨɤ ɿ
ɩɟɪɟɛɿɝ ȱɆ ɿ ɜɢɫɜɿɬɥɟɧɨ ɜ ɧɟɞɨɫɬɚɬɧɶɨɦɭ ɨɛɫɹɡɿ.
Ɇɟɬɨɸ ɰɿɽʀ ɪɨɛɨɬɢ ɛɭɥɨ ɜɢɡɧɚɱɟɧɧɹ ɤɥɿɧɿɤɨ
-ɧɟɣɪɨɮɿɡɿɨɥɨɝɿɱɧɢɯ ɤɪɢɬɟɪɿʀɜ ɩɨɪɭɲɟɧɧɹ ɦɨɪɮɨ
-ɥɨɝɿɱɧɨ ɪɨɡɩɨɞɿɥɟɧɢɯ ɫɬɨɜɛɭɪɨɜɢɯ ɪɟɝɭɥɹɬɨɪɧɢɯ ɫɬɪɭɤɬɭɪ ɬɚ ʀɯ ɜɩɥɢɜɭ ɧɚ ɩɟɪɟɛɿɝ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨɝɨ ɩɟɪɿɨɞɭ ɿɧɮɚɪɤɬɭ ɦɨɡɤɭ.
ɆȺɌȿɊȱȺɅɂ ɌȺ ɆȿɌɈȾɂ ȾɈɋɅȱȾɀȿɇɖ ɉɪɨɜɟɞɟɧɨ ɤɥɿɧɿɤɨ-ɧɟɣɪɨɮɿɡɿɨɥɨɝɿɱɧɟ ɞɨɫɥɿɞ
-ɠɟɧɧɹ 62 ɩɚɰɿɽɧɬɿɜ ɜɿɤɨɦ ɜɿɞ 49 ɞɨ 60 ɪɨɤɿɜ (ɫɟɪɟɞɧɿɦ ɜɿɤɨɦ 58,3 ± 5,56) ɭ ɪɟɚɛɿɥɿɬɚɰɿɣɧɨɦɭ
ɩɟɪɿɨɞɿ ȱɆ (ɫɬɪɨɤɢ ɜɿɞ 21 ɞɨɛɢ ɞɨ 3 ɦɿɫɹɰɿɜ ɩɿɫɥɹ
ȱɆ), ɹɤɿ ɩɟɪɟɧɨɫɢɥɢ ɫɭɛɬɟɧɬɨɪɿɚɥɶɧɢɣ ȱɆ ɡ
ɯɚɪɚɤɬɟɪɢɫɬɢɤɚɦɢ ɡɚ ɲɤɚɥɨɸ NIHSS [4] ɜɿɞ 5 ɞɨ 14 ɛɚɥɿɜ. Ʉɨɧɬɪɨɥɶɧɿ ɡɧɚɱɟɧɧɹ ȿȿȽ ɨɬɪɢɦɚɧɿ ɭ
ɝɪɭɩɿ ɡ 31 ɞɨɫɥɿɞɠɟɧɨɝɨ ɛɟɡ ȱɆ. ɉɨɪɹɞ ɡ ɩɨɝɥɢɛ
41
14/
Ɍɨɦ
XIX / 4
ɦɚɝɧɿɬɧɨ-ɪɟɡɨɧɚɧɫɧɭ ɬɨɦɨɝɪɚɮɿɸ (ɆɊɌ),ɭɥɶɬɪɚ
-ɡɜɭɤɨɜɭ ɞɨɩɥɟɪɨɝɪɚɮɿɸ ɦɚɝɿɫɬɪɚɥɶɧɢɯ ɚɪɬɟɪɿɣ ɝɨɥɨɜɢ (ɍɁȾȽ ɆȺȽ),ɜɢɤɨɧɚɧɨ ɧɟɣɪɨɮɿɡɿɨɥɨɝɿɱɧɿ
ɞɨɫɥɿɞɠɟɧɧɹ.Ⱦɥɹ ɨɰɿɧɤɢ ɮɭɧɤɰɿɨɧɚɥɶɧɨɝɨ ɫɬɚɧɭ
ɫɤɥɚɞɧɢɯ ɧɟɣɪɨɧɚɥɶɧɢɯ ɫɬɪɭɤɬɭɪ ɛɭɥɚ ɫɬɜɨɪɟɧɚ ɦɟɬɨɞɢɤɚ, ɡɚ ɹɤɨɸ ɨɰɿɧɸɜɚɥɢɫɶ ɡɦɿɧɢ ɬɨɬɚɥɶɧɨʀ
ɩɨɬɭɠɧɨɫɬɿ ɫɩɟɤɬɪɭ ɟɥɟɤɬɪɨɟɧɰɟɮɚɥɨɝɪɚɦɢ ɜɧɚ
-ɫɥɿɞɨɤ ɪɢɬɦɿɱɧɨʀ ɮɨɬɨɫɬɢɦɭɥɹɰɿʀ, ɜɢɡɧɚɱɚɥɢɫɶ
ɦɚɤɫɢɦɭɦɢ (ɦɤȼ) ɧɚɪɨɫɬɚɧɧɹ ɩɨɬɭɠɧɨɫɬɿ ɬɚ
ɜɫɬɚɧɨɜɥɸɜɚɥɚɫɶ ɱɚɫɬɨɬɚ ɮɨɬɨɫɬɢɦɭɥɹɰɿʀ, ɹɤɚ
ɜɿɞɩɨɜɿɞɚɥɚ ɞɚɧɢɦ ɩɿɤɚɦ ɟɤɫɩɪɟɫɿʀ. ɇɚɞɚɥɿ ɜɢɹɜ
-ɥɟɧɚ «ɟɮɟɤɬɢɜɧɚ» ɱɚɫɬɨɬɚ ɡɚɫɬɨɫɨɜɭɜɚɥɚɫɶ ɩɪɢ
ɞɿɚɝɧɨɫɬɢɱɧɿɣ ɫɬɢɦɭɥɹɰɿʀ, ɳɨ ɜ ɝɪɭɩɿ ɤɨɧɬɪɨɥɸ
ɡɚɡɜɢɱɚɣ ɜɢɤɥɢɤɚɥɨ «ɡɚɫɜɨɽɧɧɹ» ɧɚɜ’ɹɡɚɧɢɯ ɪɢɬ
-ɦɿɜ ɪɿɡɧɨɝɨ ɫɬɭɩɟɧɹ ɜɢɪɚɠɟɧɨɫɬɿ, ɹɤɟ ɜɤɥɸɱɚɥɨ
ɹɤ ɞɪɟɣɮ ɱɚɫɬɨɬ ȿȿȽ, ɬɚɤ ɿ ɩɨɜɬɨɪɸɜɚɧɭ ɟɤɫ
-ɩɪɟɫɿɸ ɪɿɜɧɹ ɚɛɨ ɚɦɩɥɿɬɭɞɢ (ɦɤȼ) ȿȿȽ. Ɉɛɪɨɛɤɚ
ɨɬɪɢɦɚɧɢɯ ɞɚɧɢɯ ɩɪɨɜɨɞɢɥɚɫɶ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɜɢɦɨɝ ɨɩɪɚɰɸɜɚɧɧɹ ɦɟɞɢɤɨɛɿɨɥɨɝɿɱɧɨʀ ɿɧɮɨɪ
-ɦɚɰɿʀ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ ɦɟɬɨɞɿɜ ɛɿɨɫɬɚɬɢɫɬɢɤɢ [3]
ɡɚ ɞɨɩɨɦɨɝɨɸ ɩɚɤɟɬɿɜ ɩɪɨɝɪɚɦ Microsoft Office Excel-2003® (ʋ 74017-641-9475201-57075).
ɊȿɁɍɅɖɌȺɌɂ ɌȺ Ȳɏ ɈȻȽɈȼɈɊȿɇɇə
ɍ ɧɟɜɪɨɥɨɝɿɱɧɨɦɭ ɫɬɚɬɭɫɿ ɩɚɰɿɽɧɬɿɜ ɜɢɹɜɥɹɜɫɹ ɧɟɜɪɨɥɨɝɿɱɧɢɣ ɮɨɤɚɥɶɧɢɣ ɞɟɮɿɰɢɬ: ɜɟɪɯɧɶɨ
-ɫɬɨɜɛɭɪɨɜɨɝɨ ɪɿɜɧɹ (ɮɭɧɤɰɿʀ ɨɤɨɪɭɯɨɜɢɯ ɧɟɪɜɿɜ,
ɥɨɤɨɦɨɬɨɪɧɿ, ɜɟɫɬɢɛɭɥɹɪɧɿ, ɤɨɨɪɞɢɧɚɰɿɣɧɿ ɬɨɳɨ – ɭ 31 ɩɚɰɿɽɧɬɚ), ɧɢɠɧɶɨɫɬɨɜɛɭɪɨɜɨɝɨ (ɛɭɥɶɛɚɪ
-ɧɢɣ ɫɢɧɞɪɨɦ – ɭ 5), ɚɥɶɬɟɪɧɭɸɱɢɦɢ ɫɢɧɞɪɨɦɚɦɢ (11)ɬɚ ɿɡɨɥɶɨɜɚɧɢɦɢ ɡ ɩɿɪɚɦɿɞɧɢɦɢ (15). Ⱦɨ ɨɡɧɚɤ
ɩɨɪɭɲɟɧɧɹ ɪɟɝɭɥɹɬɨɪɧɢɯ ɫɬɨɜɛɭɪɨɜɢɯ ɫɬɪɭɤɬɭɪ,
ɳɨ ɛɭɥɢ ɜɢɹɜɥɟɧɿ ɭ ɩɚɰɿɽɧɬɿɜ, ɬɚ ɜɩɥɢɜ ɹɤɢɯ ɧɚ
ɩɨɪɭɲɟɧɧɹ ɜɢɳɢɯ ɦɨɡɤɨɜɢɯ ɮɭɧɤɰɿɣ, ɪɢɬɦɨɝɟ
-ɧɟɪɚɬɨɪɧɢɯ ɿ ɪɟɬɢɤɭɥɹɪɧɢɯ ɩɨɥɿɮɭɧɤɰɿɨɧɚɥɶɧɢɯ ɪɟɝɭɥɹɬɨɪɧɢɯ ɫɬɪɭɤɬɭɪ ɦɨɡɤɭ ɽ ɧɟɫɩɟɰɢɮɿɱɧɢɦ
[10], ɚɥɟ ɯɚɪɚɤɬɟɪɧɢɦ, ɡ ɤɥɿɧɿɤɨ-ɧɟɜɪɨɥɨɝɿɱɧɢɦɢ
ɬɚ ɧɟɣɪɨɮɿɡɿɨɥɨɝɿɱɧɢɦɢ ɜɿɞɩɨɜɿɞɧɨɫɬɹɦɢ ɿ ɜɤɥɸ
-ɱɚɜ ɬɚɤɿ ɤɥɿɧɿɱɧɿ ɫɢɦɩɬɨɦɢ, ɹɤ ɤɨɥɢɜɚɧɧɹ ɪɿɜɧɹ
ɫɜɿɞɨɦɨɫɬɿ, ɡɚɝɚɥɶɧɚ ɬɹɠɤɿɫɬɶ ɡɚɝɚɥɶɧɨɝɨ ɫɬɚɧɭ,
ɬɟɦɩɢ ɜɿɞɧɨɜɥɟɧɧɹ, ɪɿɜɟɧɶ ɚɫɬɟɧɿʀ, ɩɨɪɭɲɟɧɧɹ
ɮɭɧɤɰɿʀ ɫɧɭ, ɟɦɨɰɿɣɧɨɝɨ ɫɬɚɧɭ, ɬɟɪɦɨɪɟɝɭɥɹɰɿʀ,
ɩɪɨɹɜɢ ɰɟɪɟɛɪɨ-ɤɚɪɞɿɚɥɶɧɨɝɨ ɫɢɧɞɪɨɦɭ, ɩɨɪɭ
-ɲɟɧɧɹ ɪɿɜɧɹ ɭɜɚɝɢ, ɪɟɚɤɰɿɣ ɨɪɿɽɧɬɭɜɚɧɧɹ, ɲɜɢɞ
-ɤɨɫɬɿ ɫɟɧɫɨɦɨɬɨɪɧɢɯ ɚɤɬɿɜ ɧɚ ɿɧɬɚɤɬɧɿɣ ɫɬɨɪɨɧɿ ɬɿɥɚ [7, 8, 10].
Ⱦɨ ɧɟɣɪɨɮɿɡɿɨɥɨɝɿɱɧɢɯ ɨɡɧɚɤ ɬɚɤɢɯ ɩɨɪɭɲɟɧɶ ɧɚɥɟɠɚɬɶ ɡɚɝɚɥɶɧɢɣ ɪɿɜɟɧɶ ɫɩɨɧɬɚɧɧɨʀ ɚɤɬɢɜɧɨɫɬɿ ȿȿȽ, ɫɬɚɛɿɥɶɧɿɫɬɶ ɚɛɨ ɧɟɫɬɿɣɤɿɫɬɶ ɪɢɬɦɨ- ɝɟɧɟɪɚ
-ɬɨɪɧɢɯ ɫɬɪɭɤɬɭɪ, ɦɨɠɥɢɜɿɫɬɶ ɞɢɧɚɦɿɱɧɢɯ ɡɦɿɧ
ɚɤɬɢɜɧɨɫɬɿ ɦɨɡɤɭ,ɜɤɥɸɱɧɨ ɫɬɨɜɛɭɪɨɜɢɯ ɫɬɪɭɤɬɭɪ
ɿ ɤɿɪɤɨɜɨ-ɥɿɦɛɿɤɨ-ɪɟɬɢɤɭɥɹɪɧɨ ɩɨɜ’ɹɡɚɧɢɯ, ɹɤɿ
ɜɩɥɢɜɚɸɬɶ ɧɚ ɟɦɨɰɿɣɧɿ ɪɟɚɤɰɿʀ ɯɜɨɪɢɯ ɬɚ, ɦɨɠ
-ɥɢɜɨ,ɝɟɦɿɫɮɟɪɧɭ ɿɧɬɟɝɪɚɰɿɸ.
ɉɪɢ ɞɿɚɝɧɨɫɬɢɱɧɿɣ ɫɬɢɦɭɥɹɰɿʀ ɟɤɫɩɪɟɫɿɹ ɩɨ
-ɬɭɠɧɨɫɬɿ ȿȿȽ ɧɚ «ɟɮɟɤɬɢɜɧɿɣ» ɱɚɫɬɨɬɿ ɫɩɨɫɬɟ
-ɪɿɝɚɥɚɫɶ ɭ 21 ɚɛɨ 33,8% (ɬɚɛɥ.), ɩɚɰɿɽɧɬɢ ɡ ɧɟ
-ɜɢɡɧɚɱɟɧɨɸ ɚɛɨ ɜɿɞɫɭɬɧɿɫɬɸ ɬɚɤɨʀ ɪɟɚɤɰɿʀ ɦɚɥɢ ɩɟɪɟɜɚɠɧɨ ɫɩɥɨɳɟɧɿ ɬɢɩɢ ȿȿȽ, ɛɿɥɶɲ ɜɢɫɨɤɢɣ
ɛɚɥ ɡɚ ɲɤɚɥɨɸ NIHSS ɭ ɝɨɫɬɪɨɦɭ ɩɟɪɿɨɞɿ ȱɆ ɬɚ
ɩɨɜɿɥɶɧɿ ɬɟɦɩɢ ɜɿɞɧɨɜɥɟɧɧɹ ɩɨɪɭɲɟɧɢɯ ɮɭɧɤɰɿɣ.
Ɋɨɡɩɨɞɿɥ ɯɜɨɪɢɯ ɡ ȱɆ ɡɚ ɟɤɫɩɪɟɫɿɽɸ ɪɿɜɧɹ (ɦɤȼ)ɪɢɬɦɿɜ ȿȿȽ(n=21)
ɑɚɫɬɨɬɧɿ ɫɭɛɞɿɚɩɚɡɨɧɢ ȿȿȽ (Ƚɰ)ɩɪɢ ɮɨɬɨɫɬɢɦɭɥɹɰɿʀ ɩɟɪɟɦɿɧɧɢɦ ɪɢɬɦɨɦ
ɇɚɣɦɟɧɭɜɚɧɧɹ
8 9 10 11 12 13 14
n 5 6 6 2 1 1 0
Ɂ ɱɚɫɬɤɨɜɨ ɡɛɟɪɟɠɟɧɨɸD -
ɚɤɬɢɜɧɿɫɬɸ (n=21)
% 23,8 28,5 28,5 9,5 4,7 4,7 0
n 4 7 8 7 3 1 1
Ʉɨɧɬɪɨɥɶ (n=31)
% 12,9 22,5 25,8 22,5 9,6 3,2 3,2
Ɉɬɪɢɦɚɧɿ ɞɚɧɿ ɯɚɪɚɤɬɟɪɢɡɭɸɬɶ ɦɨɠɥɢɜɿɫɬɶ ɟɤɫɩɪɟɫɿʀ ɪɢɬɦɿɜ ȿȿȽ ɩɟɪɟɜɚɠɧɨ ɩɪɢ ɫɬɢɦɭɥɹɰɿʀ ɭ ɞɿɚɩɚɡɨɧɚɯ 8-10 Ƚɰ ɡɧɢɠɟɧɧɹ ɮɭɧɤɰɿɨɧɚɥɶɧɨʀ
ɚɤɬɢɜɧɨɫɬɿ ɪɨɡɩɨɞɿɥɟɧɢɯ ɭ ɫɬɨɜɛɭɪɿ ɦɨɡɤɭ ɪɟɬɢ
-ɤɭɥɹɪɧɢɯ ɫɬɪɭɤɬɭɪ. Ɍɚɤɨɠ ɜɢɹɜɥɟɧɨ ɮɟɧɨɦɟɧ
ɧɟɫɬɿɣɤɨɫɬɿ ɱɚɫɬɨɬɢ ɪɢɬɦɿɜ,ɫɩɨɧɬɚɧɧɢɣ «ɞɪɟɣɮ»,
ɩɨɪɭɲɟɧɧɹ ɦɨɞɭɥɹɰɿɣ ɪɢɬɦɭ ɬɚ ɧɿɜɟɥɸɜɚɧɧɹ ɤɪɚɧɿɨɬɨɩɿɱɧɢɯ ɨɫɨɛɥɢɜɨɫɬɟɣ. ɉɪɢ ɩɪɨɜɟɞɟɧɧɿ
ɚɤɬɢɜɚɰɿɣɧɢɯ ɩɪɨɛ ɬɨɪɩɿɞɧɢɯ ɜɿɞɝɭɤɿɜ (ɩɪɢ ɹɤɢɯ
ɧɟ ɫɩɨɫɬɟɪɿɝɚɥɚɫɶ ɟɤɫɩɪɟɫɿɹ ɚɤɬɢɜɧɨɫɬɿ) ɛɭɥɨ
ɞɨɫɬɨɜɿɪɧɨ ɛɿɥɶɲɟ ɩɨɪɿɜɧɹɧɨ ɡ ɤɨɧɬɪɨɥɟɦ ɡ ɜɢɫɨɤɢɦ ɪɿɜɧɟɦ ɫɬɚɬɢɫɬɢɱɧɨʀ ɜɿɪɨɝɿɞɧɨɫɬɿ
(p<0,001). ȼɫɬɚɧɨɜɥɟɧɿ ɤɨɪɟɥɹɰɿʀ ɧɟɣɪɨɧɚɥɶɧɢɯ
ɪɟɝɭɥɹɬɨɪɧɢɯ ɩɨɪɭɲɟɧɶ ɡ ɩɪɨɫɬɢɦ ɬɟɫɬɨɦ ɤɨ
-ɪɨɬɤɨɫɬɪɨɤɨɜɨʀ ɩɚɦ’ɹɬɿ ɧɚ ɜɩɿɡɧɚɜɚɧɧɹ ɚɛɫɬɪɚɤ
-ɬɧɢɯ ɮɿɝɭɪ ɡ ɩɨɦɿɪɧɢɦ ɫɬɭɩɟɧɟɦ ɡɜ’ɹɡɤɭ (r=0,32)
ɬɚ ɜɿɞ’ɽɦɧɢɦ ɡɧɚɤɨɦ. Ʉɨɪɟɥɹɰɿʀ ɡ ɿɧɞɟɤɫɨɦ
ɞɨɛɨɜɨʀ ɚɤɬɢɜɧɨɫɬɿ Ȼɚɪɬɟɥ [4] ɦɚɥɢ ɩɨɦɿɪɧɭ ɫɢɥɭ (0,35) ɡ ɩɨɡɢɬɢɜɧɢɦ ɡɧɚɤɨɦ. Ɍɚɤɢɦ ɱɢɧɨɦ, ɧɚ
ɩɿɞɫɬɚɜɿ ɚɧɚɥɿɡɭ ɨɬɪɢɦɚɧɢɯ ɞɚɧɢɯ ɦɨɠɥɢɜɨ ɭɡɚ
-ɝɚɥɶɧɢɬɢ, ɳɨ ɧɟɣɪɨɮɿɡɿɨɥɨɝɿɱɧɢɦɢ ɤɪɢɬɟɪɿɹɦɢ
ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
ɆȿȾɂɑɇȱ ɉȿɊɋɉȿɄɌɂȼɂ
42
ɫɩɨɧɬɚɧɧɨʀ ɚɤɬɢɜɧɨɫɬɿ ȿȿȽ, ɧɟɫɬɿɣɤɿɫɬɶ ɪɢɬɦɨ
-ɝɟɧɟɪɚɬɨɪɧɢɯ ɫɬɪɭɤɬɭɪ, ɤɪɚɧɿɨɬɨɩɧɿ ɧɟɜɿɞɩɨ
-ɜɿɞɧɨɫɬɿ ɚɥɶɮɚ ɚɤɬɢɜɧɨɫɬɿ ɛɟɡ ɮɨɤɚɥɶɧɢɯ ɡɦɿɧ,
ɩɨɪɭɲɟɧɧɹ ɦɨɞɭɥɹɰɿʀ ɪɢɬɦɭ ɬɚ ɡɪɨɛɢɬɢ ɬɚɤɿ ɜɢɫɧɨɜɤɢ.
ȼɂɋɇɈȼɄɂ
1. ɉɪɢ ȱɆ, ɩɨɪɹɞ ɡ ɥɨɤɚɥɶɧɢɦ ɧɟɜɪɨɥɨɝɿɱɧɢɦ
ɞɟɮɿɰɢɬɨɦ, ɜɢɧɢɤɚɽ ɩɨɪɭɲɟɧɧɹ ɮɭɧɤɰɿʀ ɪɨɡɩɨ
-ɞɿɥɟɧɢɯ ɪɟɝɭɥɹɬɨɪɧɢɯ ɫɬɪɭɤɬɭɪ ɫɬɨɜɛɭɪɚ ɦɨɡɤɭ.
ɐɿ ɩɨɪɭɲɟɧɧɹ ɦɚɸɬɶ ɫɬɚɥɢɣ ɯɚɪɚɤɬɟɪ ɡ ɦɨɠɥɢ
-ɜɿɫɬɸ ɪɟɝɪɟɫɭ ɬɚ ɜɩɥɢɜɚɸɬɶ ɧɚ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɜɚɝɨɦɢɯ ɫɢɦɩɬɨɦɿɜ ɿɧɫɭɥɶɬɭ.
2. Ʉɥɿɧɿɤɨ-ɧɟɜɪɨɥɨɝɿɱɧɿ ɨɡɧɚɤɢ ɩɨɪɭɲɟɧɧɹ ɪɟ
-ɝɭɥɹɬɨɪɧɢɯ ɪɟɬɢɤɭɥɹɪɧɢɯ ɫɬɪɭɤɬɭɪ ɩɨɥɹɝɚɸɬɶ ɭ ɩɨɪɭɲɟɧɧɹɯ ɪɿɜɧɹ ɫɜɿɞɨɦɨɫɬɿ, ɜɩɥɢɜɚɸɬɶ ɧɚ
ɡɚɝɚɥɶɧɭ ɬɹɠɤɿɫɬɶ ɫɬɚɧɭ, ɬɟɦɩɢ ɜɿɞɧɨɜɥɟɧɧɹ, ɪɿ
-ɜɟɧɶ ɚɫɬɟɧɿʀ,ɩɨɪɭɲɟɧɧɹ ɮɭɧɤɰɿʀ ɫɧɭ, ɟɦɨɰɿɣɧɨɝɨ
ɫɬɚɧɭ, ɬɟɪɦɨɪɟɝɭɥɹɰɿʀ, ɩɪɨɹɜɢ ɰɟɪɟɛɪɨ-ɤɚɪɞɿɚɥɶ
-ɧɨɝɨ ɫɢɧɞɪɨɦɭ, ɩɨɪɭɲɟɧɧɹ ɪɿɜɧɹ ɭɜɚɝɢ, ɪɟɚɤɰɿʀ
ɨɪɿɽɧɬɭɜɚɧɧɹ, ɲɜɢɞɤɿɫɬɶ ɫɟɧɫɨɦɨɬɨɪɧɢɯ ɚɤɬɿɜ.
ɉɚɰɿɽɧɬɢ ɡ ɛɿɥɶɲ ɜɢɪɚɠɟɧɢɦɢ ɨɡɧɚɤɚɦɢ ɞɢɡɪɟ
-ɝɭɥɹɬɨɪɧɢɯ ɩɨɪɭɲɟɧɶ ɦɚɸɬɶ ɛɿɥɶɲ ɧɢɡɶɤɿ ɬɟɦɩɢ ɜɿɞɧɨɜɥɟɧɧɹ ɮɭɧɤɰɿɣ ɩɪɢ ȱɆ.
3. ɇɟɣɪɨɮɿɡɿɨɥɨɝɿɱɧɢɦɢ ɤɪɢɬɟɪɿɹɦɢ ɬɚɤɢɯ ɩɨ
-ɪɭɲɟɧɶ ɽ ɜɿɞɫɭɬɧɿɫɬɶ ɟɤɫɩɪɟɫɢɜɧɢɯ ɪɟɚɤɰɿɣ ɐɇɋ,
ɡɧɢɠɟɧɧɹ ɡɚɝɚɥɶɧɨɝɨ ɪɿɜɧɹ ɫɩɨɧɬɚɧɧɨʀ ɚɤɬɢɜ
-ɧɨɫɬɿ ȿȿȽ, ɧɟɫɬɿɣɤɿɫɬɶ ɪɢɬɦɨ-ɝɟɧɟɪɚɬɨɪɧɢɯ
ɫɬɪɭɤɬɭɪ ɡɿ ɫɩɨɧɬɚɧɧɢɦ «ɞɪɟɣɮɨɦ ɱɚɫɬɨɬɢ»
ɪɢɬɦɭ, ɤɪɚɧɿɨɬɨɩɧɿ ɧɟɜɿɞɩɨɜɿɞɧɨɫɬɿ ɛɟɡ ɮɨɤɚɥɶ
-ɧɢɯ ɡɦɿɧ ɚɤɬɢɜɧɨɫɬɿ, ɩɨɪɭɲɟɧɧɹ ɦɨɞɭɥɹɰɿɣ
ɪɢɬɦɭ.
ɋ
ɋɉ
ɉɂ
ɂɋ
ɋɈ
Ɉ
Ʉ
Ʉ
Ʌȱ
Ʌ
ȱɌ
Ɍȿ
ȿɊ
ɊȺ
ȺɌ
Ɍɍ
ɍɊ
Ɋɂ
ɂ
1. ȼɿɧɢɱɭɤ ɋ.Ɇ.ɉɪɨɝɧɨɡɭɜɚɧɧɹ ɪɢɡɢɤɭ ɪɨɡɜɢɬɤɭɩɨɜɬɨɪɧɨɝɨ ɿɧɫɭɥɶɬɭ ɩɿɫɥɹ ɩɟɪɟɧɟɫɟɧɨʀ ɬɪɚɧɡɢɬɨɪɧɨʀ ɿɲɟɦɿɱɧɨʀ ɚɬɚɤɢ ɭ ɩɚɰɿɽɧɬɿɜ ɡ ɨɫɟɪɟɞɤɨɦ ɿɧɮɚɪɤɬɭ ɡɚ ɞɚɧɢɦɢ ɆɊɌ ɬɚ ɛɟɡ ɬɚɤɨɝɨ / ɋ.Ɇ.ȼɿɧɢɱɭɤ, Ɉ.ȯ. Ɏɚɪ-ɬɭɲɧɚ // ɍɤɪ.ɦɟɞ.ɱɚɫɨɩɢɫ. – 2009. – ʋ 5 (73). – ɋ. 53-57.
2. Ɂɨɡɭɥɹ ȱ.ɋ.ȿɩɿɞɟɦɿɨɥɨɝɿɹ ɰɟɪɟɛɪɨɜɚɫɤɭɥɹɪɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ ɜ ɍɤɪɚʀɧɿ / ȱ.ɋ.Ɂɨɡɭɥɹ,Ⱥ.ȱ.Ɂɨɡɭɥɹ // ɍɤɪ. ɦɟɞ.ɱɚɫɨɩɢɫ. – 2011. – ʋ 5 (85). –– C. 38-41.
3. Ɇɿɳɟɧɤɨ Ɍ.ɋ. Ʉɥɿɧɿɱɧɿ ɲɤɚɥɢ ɿ ɩɫɢɯɨɞɿɚɝɧɨ-ɫɬɢɱɧɿ ɬɟɫɬɢ ɜ ɞɿɚɝɧɨɫɬɢɰɿ ɫɭɞɢɧɧɢɯ ɡɚɯɜɨɪɸɜɚɧɶ ɝɨ-ɥɨɜɧɨɝɨ ɦɨɡɤɭ: ɦɟɬɨɞ. ɪɟɤɨɦɟɧɞɚɰɿʀ / Ɍ.ɋ. Ɇɿɳɟɧɤɨ, Ʌ.Ɏ. ɒɟɫɬɨɩɚɥɨɜɚ, Ɇ.Ⱥ. Ɍɪɿɳɢɧɫɶɤɚ – ɏɚɪɤɿɜ: ɇɚɭɤ. ɜɢɞɚɧɧɹ, 2008. – 3 ɫ.
4. ɉɚɪɮɟɧɨɜ ȼ.Ⱥ.Ɏɚɤɬɨɪɵ ɪɢɫɤɚ,ɬɟɱɟɧɢɟ ɢ ɜɬɨ-ɪɢɱɧɚɹ ɩɪɨɮɢɥɚɤɬɢɤɚ ɩɪɢ ɩɚɬɨɝɟɧɟɬɢɱɟɫɤɢɯ ɩɨɞɬɢɩɚɯ ɢɲɟɦɢɱɟɫɤɨɝɨ ɢɧɫɭɥɶɬɚ / ȼ.Ⱥ. ɉɚɪɮɟɧɨɜ, ɋ.ȿ. ɏɚɬɶ -ɤɨɜɚ, Ɇ.Ɇ. ȼɨɪɨɧɰɨɜ // ɇɟɜɪɨɥ. ɠɭɪɧɚɥ. – 2010. – ʋ 6. – ɋ. 16-20.
5. ɉɨɝɨɪɽɥɨɜ Ɉ.ȼ. Ⱦɿɚɝɧɨɫɬɢɱɧɚ ɡɧɚɱɭɳɿɫɬɶ ɡɨ-ɪɨɜɢɯ ɜɢɤɥɢɤɚɧɢɯ ɩɨɬɟɧɰɿɚɥɿɜ ɩɪɢ ɰɟɪɟɛɪɚɥɶɧɢɯ ɿɲɟ -ɦɿɱɧɢɯ ɩɨɪɭɲɟɧɧɹɯ ɜɧɚɫɥɿɞɨɤ ɰɟɪɟɛɪɚɥɶɧɨɝɨ ɚɬɟɪɨ -ɫɤɥɟɪɨɡɭ / Ɉ.ȼ.ɉɨɝɨɪɽɥɨɜ // Ɇɟɞɢɱɧɿ ɩɟɪɫɩɟɤɬɢɜɢ. – 2010. – Ɍ. 15, ʋ 2. – ɋ. 1-4.
6. Ɋɟɝɿɨɧɚɥɶɧɿ ɨɫɨɛɥɢɜɨɫɬɿ ɪɿɜɧɹ ɡɞɨɪɨɜ’ɹ ɧɚɪɨɞɭ ɍɤɪɚʀɧɢ. Ⱥɧɚɥɿɬɢɱɧɨ-ɫɬɚɬɢɫɬɢɱɧɢɣ ɩɨɫɿɛɧɢɤ. – Ʉ., 2011. – 165 ɫ.
7. Beissner F. Investigating the human brainstem with structural and functional MRI / F. Beissner, S. Baudrexel // Front Hum. Neurosci. – 2014. – Vol. 28, N 8. – P. 116.
8. Deistung A. High-resolution MR imaging of the human brainstem in vivo at 7 Tesla / A. Deistung // Front Hum. Neurosci. – 2013. – N 7. – P. 710.
9. Singh M.K. Stress Structures the Brain / M.K. Singh // Neuroscience. – 2012. – N 4. – P. 165.
10. Za J.H. Biostatistical Analysis / Jerrold H. Za. – Prentice Hall, 2010. – 944 p.
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