Применение прерывистой нормобарической гипоксии в лечении

ɉɪɢɦɟɧɟɧɢɟ ɩɪɟɪɵɜɢɫɬɨɣ ɧɨɪɦɨɛɚɪɢɱɟɫɤɨɣ
ɝɢɩɨɤɫɢɢ ɜ ɥɟɱɟɧɢɢ ɛɨɥɶɧɵɯ ɯɪɨɧɢɱɟɫɤɢɦɢ
ɨɛɫɬɪɭɤɬɢɜɧɵɦɢ ɡɚɛɨɥɟɜɚɧɢɹɦɢ ɥɟɝɤɢɯ ɜ
ɭɫɥɨɜɢɹɯ ɫɚɧɚɬɨɪɢɹ
ɋ.ɇ. Ⱥɯɦɚɬɨɜɚ, Ɂ.Ɇ. Ɏɚɞɢɧɚ, Ⱥ.Ƚ. Ʌɨɝɢɧɨɜ, ɂ.Ⱦ. Ɏɟɨɮɚɧɨɜɚ
ɂɡɭɱɚɥɨɫɶ ɜɥɢɹɧɢɟ ɩɪɟɪɵɜɢɫɬɨɣ ɧɨɪɦɨɛɚɪɢɱɟɫɤɨɣ ɝɢɩɨɤɫɢɢ ɩɪɢ ɜɞɵɯɚɧɢɢ ɝɢɩɨɤɫɢɱɟɫɤɨɣ ɝɚɡɨɜɨɣ ɫɦɟɫɢ ɫ 12% ɫɨɞɟɪɠɚɧɢɟɦ ɤɢɫɥɨɪɨɞɚ ɧɚ ɫɨɫɬɨɹɧɢɟ 58 ɛɨɥɶɧɵɯ ɯɪɨɧɢɱɟɫɤɢɦ ɨɛɫɬɪɭɤɬɢɜɧɵɦ ɛɪɨɧɯɢɬɨɦ ɢ ɛɪɨɧɯɢɚɥɶɧɨɣ ɚɫɬɦɨɣ. ȼɵɹɜɥɟɧɨ
ɭɥɭɱɲɟɧɢɟ ɤɥɢɧɢɱɟɫɤɨɝɨ ɫɨɫɬɨɹɧɢɹ ɛɨɥɶɧɵɯ, ɭɜɟɥɢɱɟɧɢɟ ɨɛɴɟɦɧɵɯ ɢ ɫɤɨɪɨɫɬɧɵɯ ɩɨɤɚɡɚɬɟɥɟɣ ɩɨ ɞɚɧɧɵɦ ɮɭɧɤɰɢɢ ɜɧɟɲɧɟɝɨ ɞɵɯɚɧɢɹ, ɩɪɢɪɨɫɬ ɩɨɪɨɝɨɜɨɣ ɦɨɳɧɨɫɬɢ ɧɚɝɪɭɡɤɢ, ɩɨɥɨɠɢɬɟɥɶɧɨɟ ɜɥɢɹɧɢɟ ɧɚ ɩɪɨɰɟɫɫɵ ɦɢɤɪɨɰɢɪɤɭɥɹɰɢɢ. Ɋɟɤɨɦɟɧɞɭɟɬɫɹ ɢɫɩɨɥɶɡɨɜɚɬɶ ɩɪɟɪɵɜɢɫɬɭɸ ɧɨɪɦɨɛɚɪɢɱɟɫɤɭɸ ɝɢɩɨɤɫɢɸ ɩɪɢ ɥɟɱɟɧɢɢ ɛɨɥɶɧɵɯ ɯɪɨɧɢɱɟɫɤɢɦɢ ɨɛɫɬɪɭɤɬɢɜɧɵɦɢ ɡɚɛɨɥɟɜɚɧɢɹɦɢ ɥɟɝɤɢɯ ɜ ɭɫɥɨɜɢɹɯ ɫɚɧɚɬɨɪɢɹ.
S.N. Akhmatova, Z.M. Fadina, A.G. Loginov, I.D. Feofanova
Intermittant normobaric hypoxia for treating patients with chronic obstructive lungs diseases at the sanatorium
Effect of intermittant normobaric hypoxia has been studied in 58 patients with chronic obstructive bronchitis and bronchial
asthma who inhaled gaseous mixture with 12% oxygen content. Clinical picture in these patients has been improved. We also
observed an increase in their volumetric and speed indexes during the examination of their external respiration function. These
patients demonstrated an increase in the loading threshold power, better microcirculation. Intermittent normobaric hypoxia is
recommended for treating patients with chronic obstructive lung diseases at the sanatorium regime.
Ʉɚɤ ɢɡɜɟɫɬɧɨ, ɜ ɩɨɫɥɟɞɧɢɟ ɝɨɞɵ ɜ ɧɚɲɟɣ ɫɬɪɚɧɟ ɢ ɡɚ
ɪɭɛɟɠɨɦ ɨɬɦɟɱɚɟɬɫɹ ɪɨɫɬ ɯɪɨɧɢɱɟɫɤɢɯ ɨɛɫɬɪɭɤɬɢɜɧɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɥɟɝɤɢɯ (ɏɈɁɅ) — ɯɪɨɧɢɱɟɫɤɨɝɨ ɨɛɫɬɪɭɤɬɢɜɧɨɝɨ ɛɪɨɧɯɢɬɚ ɢ ɛɪɨɧɯɢɚɥɶɧɨɣ ɚɫɬɦɵ (ɏɈȻ ɢ ȻȺ) — ɝɪɭɩɩɵ
ɛɨɥɟɡɧɟɣ, ɹɜɥɹɸɳɢɯɫɹ ɪɟɡɭɥɶɬɚɬɨɦ ɩɟɪɟɯɨɞɚ ɨɫɬɪɨɝɨ ɜɨɫɩɚɥɟɧɢɹ ɜ ɯɪɨɧɢɱɟɫɤɨɟ. Ɉɫɧɨɜɧɨɣ ɩɪɢɱɢɧɨɣ ɷɬɨɝɨ ɩɚɬɨɥɨɝɢɱɟɫɤɨɝɨ ɩɪɨɰɟɫɫɚ ɹɜɥɹɟɬɫɹ ɚɥɥɟɪɝɢɡɚɰɢɹ ɧɚɫɟɥɟɧɢɹ,
ɡɚɝɪɹɡɧɟɧɢɟ ɜɨɡɞɭɲɧɨɣ ɫɪɟɞɵ, ɜɧɟɞɪɟɧɢɟ ɯɢɦɢɢ ɜ ɫɟɥɶɫɤɨɟ ɯɨɡɹɣɫɬɜɨ ɢ ɛɵɬ, ɚ ɬɚɤɠɟ ɲɢɪɨɤɨɟ ɢɫɩɨɥɶɡɨɜɚɧɢɟ ɚɧɬɢɛɢɨɬɢɤɨɜ, ɜɚɤɰɢɧ ɢ ɞɪ. [1].
ɉɨɷɬɨɦɭ ɧɟ ɫɥɭɱɚɟɧ ɩɨɜɵɲɟɧɧɵɣ ɢɧɬɟɪɟɫ ɤ ɧɟɦɟɞɢɤɚɦɟɧɬɨɡɧɵɦ (ɧɚɬɭɪɚɥɶɧɵɦ) ɦɟɬɨɞɚɦ ɩɪɨɮɢɥɚɤɬɢɤɢ ɢ
ɥɟɱɟɧɢɹ ɏɈȻ ɢ ȻȺ. Ʉ ɧɢɦ ɦɨɠɧɨ ɨɬɧɟɫɬɢ ɩɪɟɠɞɟ ɜɫɟɝɨ
ɩɪɟɪɵɜɢɫɬɭɸ ɧɨɪɦɨɛɚɪɢɱɟɫɤɭɸ ɝɢɩɨɤɫɢɸ (ɉɇȽ) — ɩɪɢɪɨɞɧɵɣ ɫɬɢɦɭɥɹɬɨɪ ɧɟɫɩɟɰɢɮɢɱɟɫɤɨɣ ɪɟɡɢɫɬɟɧɬɧɨɫɬɢ ɨɪɝɚɧɢɡɦɚ ɱɟɥɨɜɟɤɚ (ɦɟɬɨɞ "Ƚɨɪɧɵɣ ɜɨɡɞɭɯ") [2].
ȼɵɫɨɤɚɹ ɷɮɮɟɤɬɢɜɧɨɫɬɶ ɉɇȽ ɨɛɭɫɥɨɜɥɟɧɚ ɨɩɬɢɦɚɥɶɧɵɦ ɫɨɱɟɬɚɧɢɟɦ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɵɯ ɪɟɚɤɰɢɣ ɨɫɧɨɜɧɵɯ ɫɢɫɬɟɦ ɨɪɝɚɧɢɡɦɚ ɧɚ ɞɨɡɢɪɨɜɚɧɧɭɸ ɝɢɩɨɤɫɢɸ ɫ ɞɨɥɝɨɜɪɟɦɟɧɧɨɣ ɚɞɚɩɬɚɰɢɟɣ — ɮɨɪɦɢɪɨɜɚɧɢɟɦ "ɫɬɪɭɤɬɭɪɧɨɝɨ
ɫɥɟɞɚ".
ȼ ɪɟɡɭɥɶɬɚɬɟ ɜɨɡɞɟɣɫɬɜɢɹ ɝɢɩɨɤɫɢɢ ɩɨɜɵɲɚɟɬɫɹ ɥɟɝɨɱɧɚɹ ɢ ɚɥɶɜɟɨɥɹɪɧɚɹ ɜɟɧɬɢɥɹɰɢɹ, ɭɜɟɥɢɱɢɜɚɟɬɫɹ ɥɟɝɨɱɧɵɣ ɤɪɨɜɨɬɨɤ, ɫɬɢɦɭɥɢɪɭɟɬɫɹ ɷɪɢɬɪɨɩɨɷɡ ɢ ɨɛɪɚɡɨɜɚɧɢɟ
ɝɟɦɨɝɥɨɛɢɧɚ ɜ ɷɪɢɬɪɨɰɢɬɚɯ, ɭɫɢɥɢɜɚɟɬɫɹ ɫɩɨɫɨɛɧɨɫɬɶ ɤɥɟɬɨɤ ɭɬɢɥɢɡɢɪɨɜɚɬɶ ɤɢɫɥɨɪɨɞ ɡɚ ɫɱɟɬ ɚɤɬɢɜɚɰɢɢ ɞɵɯɚɬɟɥɶɧɵɯ ɮɟɪɦɟɧɬɨɜ ɢ ɚɧɬɢɨɤɫɢɞɚɧɬɧɨɣ ɫɢɫɬɟɦɵ [3] .
ɐɟɥɶ ɞɚɧɧɨɣ ɪɚɛɨɬɵ — ɢɡɭɱɟɧɢɟ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɩɪɟɪɵɜɢɫɬɨɣ ɧɨɪɦɨɛɚɪɢɱɟɫɤɨɣ ɝɢɩɨɤɫɢɢ ɩɪɢ ɪɟɚɛɢɥɢɬɚɰɢɢ
ɛɨɥɶɧɵɯ ɯɪɨɧɢɱɟɫɤɢɦɢ ɨɛɫɬɪɭɤɬɢɜɧɵɦɢ ɡɚɛɨɥɟɜɚɧɢɹɦɢ
ɥɟɝɤɢɯ.
ȼ ɨɫɧɨɜɟ ɦɟɬɨɞɚ ɝɢɩɨɤɫɢɱɟɫɤɨɣ ɬɪɟɧɢɪɨɜɤɢ ɥɟɠɢɬ
ɱɟɪɟɞɨɜɚɧɢɟ ɞɵɯɚɧɢɹ ɝɚɡɨɜɨɣ ɫɦɟɫɶɸ ɫɨ ɫɧɢɠɟɧɧɵɦ ɫɨɞɟɪɠɚɧɢɟɦ ɤɢɫɥɨɪɨɞɚ ɢ ɞɵɯɚɧɢɹ ɚɬɦɨɫɮɟɪɧɵɦ ɜɨɡɞɭɯɨɦ
ɩɪɢ ɧɨɪɦɚɥɶɧɨɦ ɛɚɪɨɦɟɬɪɢɱɟɫɤɨɦ ɞɚɜɥɟɧɢɢ. ɇɚɦɢ ɢɫɩɨɥɶɡɨɜɚɥɚɫɶ ɨɬɟɱɟɫɬɜɟɧɧɚɹ 4-ɦɟɫɬɧɚɹ ɭɫɬɚɧɨɜɤɚ ɞɥɹ ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ ɫ ɢɧɞɢɜɢɞɭɚɥɶɧɵɦ ɡɚɞɚɧɢɟɦ ɢ ɢɧɞɟɤɫɚɰɢɟɣ ɩɪɨɝɪɚɦɦ
ɞɵɯɚɧɢɹ
"Ȼɢɨ-ɇɨɜɚ-204",
ɩɭɥɶɫɨɤɫɢɦɟɬɪɵ
"Ɉɤɫɢɲɚɬɬɥ" (ɋɒȺ). ɉɨɞ ɤɨɧɬɪɨɥɟɦ ɩɨɤɚɡɚɬɟɥɟɣ ɝɟɦɨɞɢɧɚɦɢɤɢ (ɱɚɫɬɨɬɚ ɫɟɪɞɟɱɧɵɯ ɫɨɤɪɚɳɟɧɢɣ, ɭɪɨɜɟɧɶ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ), ɧɚɫɵɳɟɧɢɹ ɚɪɬɟɪɢɚɥɶɧɨɣ ɤɪɨɜɢ ɤɢɫɥɨɪɨɞɨɦ ɢɧɞɢɜɢɞɭɚɥɶɧɨ ɩɨɞɛɢɪɚɥɫɹ ɨɞɢɧ ɢɡ ɱɟɬɵɪɟɯ
ɪɟɠɢɦɨɜ ɜɞɵɯɚɧɢɹ ɝɢɩɨɤɫɢɱɟɫɤɨɣ ɝɚɡɨɜɨɣ ɫɦɟɫɢ (ȽȽɋ) ɫ
ɫɨɞɟɪɠɚɧɢɟɦ ɤɢɫɥɨɪɨɞɚ 12%. Ɉɛɳɟɟ ɜɪɟɦɹ ɞɵɯɚɧɢɹ ȽȽɋ
ɩɨ I ɪɟɠɢɦɭ ɫɨɫɬɚɜɥɹɥɨ 12 ɦɢɧ, ɩɨ II — 18 ɦɢɧ, ɩɨ III —
24 ɦɢɧ, ɩɨ IV — 30 ɦɢɧ. ɋɨɨɬɜɟɬɫɬɜɟɧɧɨ ɷɬɨɦɭ, ɜɪɟɦɹ
ɞɵɯɚɧɢɹ ɚɬɦɨɫɮɟɪɧɵɦ ɜɨɡɞɭɯɨɦ ɩɪɢ ɩɟɪɟɜɨɞɟ ɫ I ɩɨ IV
ɪɟɠɢɦ ɫɧɢɠɚɥɨɫɶ. Ɉɫɧɨɜɧɵɦ ɤɪɢɬɟɪɢɟɦ ɚɞɟɤɜɚɬɧɨɫɬɢ ɪɟɠɢɦɚ ɬɪɟɧɢɪɨɜɤɢ ɫɥɭɠɢɥ ɭɪɨɜɟɧɶ ɧɚɫɵɳɟɧɢɹ ɚɪɬɟɪɢɚɥɶɧɨɣ ɤɪɨɜɢ ɤɢɫɥɨɪɨɞɨɦ, ɞɨɩɭɫɬɢɦɨɟ ɫɧɢɠɟɧɢɟ ɤɨɬɨɪɨɝɨ
ɫɨɫɬɚɜɥɹɥɨ 85% (ɩɪɢ ɧɨɪɦɟ 95-99%). Ⱦɥɢɬɟɥɶɧɨɫɬɶ ɫɟɚɧɫɚ
ɛɵɥɚ 60 ɦɢɧ, ɬɪɟɧɢɪɨɜɤɢ ɩɪɨɜɨɞɢɥɢɫɶ 5 ɪɚɡ ɜ ɧɟɞɟɥɸ ɤɨɪɨɬɤɢɦ ɤɭɪɫɨɦ — 13-15 ɩɪɨɰɟɞɭɪ.
Ɇɚɬɟɪɢɚɥ ɢ ɦɟɬɨɞɵ ɢɫɫɥɟɞɨɜɚɧɢɹ
Ɉɛɫɥɟɞɨɜɚɧɨ ɜ ɞɢɧɚɦɢɤɟ 58 ɩɚɰɢɟɧɬɨɜ (37 ɦɭɠɱɢɧ ɢ
21 ɠɟɧɳɢɧɚ), ɫɬɪɚɞɚɸɳɢɯ ɯɪɨɧɢɱɟɫɤɢɦ ɨɛɫɬɪɭɤɬɢɜɧɵɦ
ɛɪɨɧɯɢɬɨɦ (78,1%), ɛɪɨɧɯɢɚɥɶɧɨɣ ɚɫɬɦɨɣ (21,9%). ɋɪɟɞɧɢɣ ɜɨɡɪɚɫɬ ɫɨɫɬɚɜɢɥ 57,9 ± 3,0 ɝɨɞɚ, ɞɚɜɧɨɫɬɶ ɡɚɛɨɥɟɜɚɧɢɹ — 17,0 ± 0,83 ɝɨɞɚ; ɩɨ ɯɚɪɚɤɬɟɪɭ ɬɟɱɟɧɢɹ ɭɦɟɪɟɧɧɨ
ɪɟɰɢɞɢɜɢɪɭɸɳɚɹ ɮɨɪɦɚ ɛɵɥɚ ɭ 30 (51,8%) ɱɟɥɨɜɟɤ, ɱɚɫɬɨ
ɪɟɰɢɞɢɜɢɪɭɸɳɚɹ — ɭ 7 (12%), ɪɟɞɤɨ ɪɟɰɢɞɢɜɢɪɭɸɳɚɹ —
ɭ 21 (36,2%). ɋɭɛɴɟɤɬɢɜɧɵɟ ɢ ɨɛɴɟɤɬɢɜɧɵɟ ɫɢɦɩɬɨɦɵ ɡɚɛɨɥɟɜɚɧɢɹ ɫɨɨɬɜɟɬɫɬɜɨɜɚɥɢ ɬɹɠɟɫɬɢ ɧɚɪɭɲɟɧɢɣ ɜɟɧɬɢɥɹɰɢɢ. ɍ ɜɫɟɯ ɛɨɥɶɧɵɯ ɛɵɥ ɤɚɲɟɥɶ, ɜ ɨɫɧɨɜɧɨɦ, ɩɪɨɞɭɤɬɢɜɧɵɣ ɫɨ ɫɥɢɡɢɫɬɨɣ ɢɥɢ ɫɥɢɡɢɫɬɨ-ɝɧɨɣɧɨɣ ɦɨɤɪɨɬɨɣ.
Ȼɨɥɶɲɢɧɫɬɜɨ ɛɨɥɶɧɵɯ ɨɛɟɢɯ ɝɪɭɩɩ ɠɚɥɨɜɚɥɢɫɶ ɧɚ ɨɞɵɲɤɭ
ɩɪɢ ɮɢɡɢɱɟɫɤɨɣ ɧɚɝɪɭɡɤɟ (76,7%), ɡɚɬɪɭɞɧɟɧɧɨɟ ɞɵɯɚɧɢɟ
(46,4%). ɉɪɢɫɬɭɩɵ ɭɞɭɲɶɹ ɧɚɛɥɸɞɚɥɢɫɶ ɭ 21,1% ɛɨɥɶɧɵɯ.
ȼɫɟ ɛɨɥɶɧɵɟ ɩɨɥɭɱɚɥɢ ɤɨɦɩɥɟɤɫ ɥɟɱɟɛɧɵɯ ɦɟɪɨɩɪɢɹɬɢɣ, ɜɤɥɸɱɚɸɳɢɣ ɜ ɫɟɛɹ ɞɨɡɢɪɨɜɚɧɧɭɸ ɯɨɞɶɛɭ, ɞɪɟɧɢɪɭɸɳɢɟ ɫɬɚɬɢɱɟɫɤɢɟ ɢ ɞɢɧɚɦɢɱɟɫɤɢɟ ɞɵɯɚɬɟɥɶɧɵɟ ɭɩɪɚɠɧɟɧɢɹ ɫ ɭɞɥɢɧɟɧɢɟɦ ɜɵɞɨɯɚ, ɞɢɚɮɪɚɝɦɚɥɶɧɨɟ ɞɵɯɚɧɢɟ,
ɡɚɧɹɬɢɹ ɅȽ ɧɚ ɬɪɟɧɚɠɟɪɚɯ "Ⱦɚɜɢɞ", ɩɥɚɜɚɧɢɟ, ɪɟɮɥɟɤɬɨɪɧɨ-ɫɟɝɦɟɧɬɚɪɧɵɣ ɦɚɫɫɚɠ ɨɛɥɚɫɬɢ ɝɪɭɞɧɨɣ ɤɥɟɬɤɢ, ɪɚɡɥɢɱɧɵɟ ɦɟɬɨɞɵ ɮɢɡɢɨɥɟɱɟɧɢɹ, ɚ ɬɚɤɠɟ ɦɟɞɢɤɚɦɟɧɬɨɡɧɨɟ ɥɟɱɟɧɢɟ ɛɪɨɧɯɨɥɢɬɢɱɟɫɤɢɦɢ ɫɪɟɞɫɬɜɚɦɢ ɜ ɜɢɞɟ ɢɧɝɚɥɹɰɢɣ.
20 ɱɟɥɨɜɟɤ, ɩɨɥɭɱɚɜɲɢɯ ɜɟɫɶ ɤɨɦɩɥɟɤɫ ɥɟɱɟɛɧɵɯ ɦɟɪɨɩɪɢɹɬɢɣ, ɧɨ ɧɟ ɩɪɨɯɨɞɢɜɲɢɯ ɤɭɪɫ ɉɇȽ, ɫɨɫɬɚɜɢɥɢ ɤɨɧɬɪɨɥɶɧɭɸ ɝɪɭɩɩɭ.
ɋ ɰɟɥɶɸ ɜɵɹɜɥɟɧɢɹ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɥɟɱɟɧɢɹ ɚɧɚɥɢɡɢɪɨɜɚɥɢɫɶ ɩɨɤɚɡɚɬɟɥɢ ɰɟɧɬɪɚɥɶɧɨɣ ɢ ɩɟɪɢɮɟɪɢɱɟɫɤɨɣ ɝɟɦɨɞɢɧɚɦɢɤɢ (ɩɨɞɚɧɧɵɦ ɷɥɟɤɬɪɨɤɚɪɞɢɨɝɪɚɦɦɵ, ɜɟɥɨɷɪɝɨɦɟɬɪɢɱɟɫɤɨɣ ɩɪɨɛɵ, ɷɯɨɤɚɪɞɢɨɝɪɚɦɦɵ), ɩɚɪɚɦɟɬɪɵ ɮɭɧɤɰɢɢ
Ɍɚɛɥɢɰɚ
Ɉɛɴɟɦɧɵɟ ɫɤɨɪɨɫɬɢ
ɩɪɢ 25,
50 ɢ 75% ɤ ɨɛɉɨɤɚɡɚɬɟɥɢ ɮɭɧɤɰɢɢ ɜɧɟɲɧɟɝɨ ɞɵɯɚɧɢɹ ɞɨ ɢ ɩɨɫɥɟ ɥɟɱɟɧɢɹ (Ɇ ± m)
ɳɟɦɭ ɨɛɴɟɦɭ ɜɵɞɨɯɧɭɬɨɝɨ ɜɨɡɞɭɯɚ ɩɨɜɵɫɢɥɢɫɶ
Ⱦɨ ɥɟɱɟɧɢɹ
ɉɨɫɥɟ ɥɟɱɟɧɢɹ
ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ
ɧɚ 22,5,
ɉɨɤɚɡɚɬɟɥɢ
ɨɫɧɨɜɧɚɹ ɝɪɭɩɩɚ
ɤɨɧɬɪɨɥ. ɝɪɭɩɩɚ
ɨɫɧɨɜɧɚɹ ɝɪɭɩɩɚ
ɤɨɧɬɪɨɥ. ɝɪɭɩɩɚ 20,2 ɢ 21,8%. ɉɨ ɞɚɧɧɵɦ
81,1±3,1
82,3 ± 3,5
96,4 ± 4,2*
88,1 ± 2,9
ɀɢɡɧɟɧɧɚɹ ɟɦɤɨɫɬɶ ɥɟɝɤɢɯ
ɜɟɥɨɷɪɝɨɦɟɬɪɢɱɟɫɤɨɣ
62,1 ± 2,9
61,9 ± 3,2
75,5 ± 4,0*
70,2 ± 3,0
Ɉɛɴɟɦ ɮɨɪɫɢɪɨɜɚɧɧɨɝɨ
ɩɪɨɛɵ ɩɪɢɪɨɫɬ ɩɨɪɨɝɨɜɵɞɨɯɚ ɡɚ 1 ɫ
ɜɨɣ ɦɨɳɧɨɫɬɢ ɧɚɝɪɭɡɤɢ
ɋɤɨɪɨɫɬɶ ɩɨɬɨɤɚ ɜɨɡɞɭɯɚ ɩɪɢ
ɫɨɫɬɚɜɢɥ 14 ȼɬ (ɪ <
ɮɨɪɫɢɪɨɜɚɧɧɨɦ ɜɵɞɨɯɟ:
0,05). Ɉ ɩɨɥɭɱɟɧɢɢ ɬɪɟFEF75
41,4 ± 2,3
40,8 ± 2,7
53,4 ± 4,0*
47,6 ± 3,8
ɧɢɪɨɜɨɱɧɨɝɨ
ɷɮɮɟɤɬɚ
FEF50
35,2 ± 2,6
34,9 ± 3,2
44,1 ±2,8*
37,5 ± 2,9
ɦɨɠɧɨ ɫɭɞɢɬɶ ɢ ɩɨ ɫɧɢFEF25
38,1 ± 2,7
37,8 ± 2,9
48,7 +3,2*
42,0 ± 3,4
ɠɟɧɢɸ ɞɜɨɣɧɨɝɨ ɩɪɨɢɡɜɟɞɟɧɢɹ ɧɚ ɫɨɩɨɫɬɚɜɢɦɵɯ
* ɪ < 0,05
ɭɪɨɜɧɹɯ ɧɚɝɪɭɡɤɢ ɢ ɭɜɟɜɧɟɲɧɟɝɨ ɞɵɯɚɧɢɹ (ɎȼȾ), ɨɩɪɟɞɟɥɹɟɦɵɟ ɧɚ ɫɩɢɪɨɚɧɚɥɢɡɚɥɢɱɟɧɢɢ ɟɝɨ ɧɚ ɩɨɪɨɝɨɜɨɣ ɧɚɝɪɭɡɤɟ (ɧɚ 9 ɭɫɥ. ɟɞ.).
ɬɨɪɟ "Ɏɭɤɭɞɚ" (əɩɨɧɢɹ), ɩɪɨɰɟɫɫɵ ɦɢɤɪɨɰɢɪɤɭɥɹɰɢɢ — ɩɨ
ɋɧɢɠɟɧɢɟ ɩɪɨɰɟɧɬɚ ɚɝɪɟɝɚɰɢɢ ɬɪɨɦɛɨɰɢɬɨɜ ɧɚ 15%
ɫɬɟɩɟɧɢ ɚɝɪɟɝɚɰɢɨɧɧɨɣ ɫɩɨɫɨɛɧɨɫɬɢ ɬɪɨɦɛɨɰɢɬɨɜ, ɚ ɬɚɤɠɟ
ɢ ɭɜɟɥɢɱɟɧɢɟ ɞɟɡɚɝɪɟɝɚɰɢɢ ɧɚ 10% ɝɨɜɨɪɢɬ ɨ
ɪɟɝɪɟɫɫɢɹ ɤɥɢɧɢɱɟɫɤɢɯ ɫɢɦɩɬɨɦɨɜ ɢ ɭɪɨɜɟɧɶ ɮɢɡɢɱɟɫɤɨɣ
ɩɨɥɨɠɢɬɟɥɶɧɨɦ
ɜɥɢɹɧɢɢ
ɉɇȽ
ɧɚ
ɩɪɨɰɟɫɫɵ
ɚɤɬɢɜɧɨɫɬɢ.
ɦɢɤɪɨɰɢɪɤɭɥɹɰɢɢ.
ɉɨ ɞɚɜɧɨɫɬɢ ɡɚɛɨɥɟɜɚɧɢɹ, ɤɥɢɧɢɤɨ-ɚɧɚɦɧɟɫɬɢɱɟɫɤɢɦ
ȼ ɬɨ ɠɟ ɜɪɟɦɹ ɫɭɳɟɫɬɜɟɧɧɵɯ ɫɞɜɢɝɨɜ ɩɨɤɚɡɚɬɟɥɟɣ
ɞɚɧɧɵɦ, ɩɨɤɚɡɚɬɟɥɹɦ ɮɭɧɤɰɢɢ ɜɧɟɲɧɟɝɨ ɞɵɯɚɧɢɹ ɨɫɧɨɜɎȼȾ, ɚ ɬɚɤɠɟ ɢɡɦɟɧɟɧɢɣ ɩɨɪɨɝɨɜɨɣ ɦɨɳɧɨɫɬɢ ɧɚɝɪɭɡɤɢ ɢ
ɧɚɹ ɢ ɤɨɧɬɪɨɥɶɧɚɹ ɝɪɭɩɩɵ ɛɨɥɶɧɵɯ ɛɵɥɢ ɫɨɩɨɫɬɚɜɢɦɵ.
ɩɪɨɰɟɫɫɨɜ ɦɢɤɪɨɰɢɪɤɭɥɹɰɢɢ ɭ ɛɨɥɶɧɵɯ, ɧɟ ɩɨɥɭɱɚɜɲɢɯ
ɩɪɨɰɟɞɭɪɵ ɉɇȽ, ɧɟ ɜɵɹɜɥɟɧɨ, ɯɨɬɹ ɭ ɧɢɯ ɢ ɨɬɦɟɱɚɟɬɫɹ
Ɋɟɡɭɥɶɬɚɬɵ ɢɫɫɥɟɞɨɜɚɧɢɹ ɢ ɢɯ ɨɛɫɭɠɞɟɧɢɟ
ɧɟɤɨɬɨɪɚɹ ɩɨɥɨɠɢɬɟɥɶɧɚɹ ɞɢɧɚɦɢɤɚ ɤɥɢɧɢɱɟɫɤɢɯ ɫɢɦɩɬɨɉɨɫɥɟ ɩɪɨɜɟɞɟɧɧɨɝɨ ɥɟɱɟɧɢɹ ɭ ɜɫɟɯ ɛɨɥɶɧɵɯ ɨɬɦɟɱɟɧɚ
ɦɨɜ ɡɚɛɨɥɟɜɚɧɢɹ.
ɩɨɥɨɠɢɬɟɥɶɧɚɹ ɞɢɧɚɦɢɤɚ ɤɥɢɧɢɱɟɫɤɨɝɨ ɫɨɫɬɨɹɧɢɹ:
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɢɡɥɨɠɟɧɧɵɣ ɜɵɲɟ ɦɚɬɟɪɢɚɥ ɫɜɢɞɟɭɦɟɧɶɲɢɥɚɫɶ ɨɞɵɲɤɚ ɩɪɢ ɮɢɡɢɱɟɫɤɨɣ ɧɚɝɪɭɡɤɟ (89%),
ɬɟɥɶɫɬɜɭɟɬ ɨ ɩɨɥɨɠɢɬɟɥɶɧɨɦ ɷɮɮɟɤɬɟ ɩɪɨɰɟɞɭɪ ɩɪɟɪɵɜɢɫɩɪɢɫɬɭɩɵ ɭɞɭɲɶɹ (100%), ɤɚɲɟɥɶ (90%), ɫɭɛɴɟɤɬɢɜɧɨ ɭɥɭɱɬɨɣ ɧɨɪɦɨɛɚɪɢɱɟɫɤɨɣ ɝɢɩɨɤɫɢɢ ɧɚ ɤɥɢɧɢɤɨ-ɮɭɧɤɰɢɨɧɚɥɶɲɢɥɨɫɶ ɤɚɱɟɫɬɜɨ ɞɵɯɚɧɢɹ (100%), ɫɧɢɡɢɥɢɫɶ ɞɨɡɢɪɨɜɤɢ
ɧɨɟ ɫɨɫɬɨɹɧɢɟ ɛɨɥɶɧɵɯ ɏɈɁɅ, ɛɥɚɝɨɩɪɢɹɬɧɨɦ ɢɯ ɜɥɢɹɧɢɢ
ɛɪɨɧɯɨɥɢɬɢɱɟɫɤɢɯ ɫɪɟɞɫɬɜ. ɂɡɦɟɧɟɧɢɹ ɱɚɫɬɨɬɵ ɫɟɪɞɟɱɧɵɯ
ɧɚ ɮɭɧɤɰɢɸ ɜɧɟɲɧɟɝɨ ɞɵɯɚɧɢɹ, ɬɨɥɟɪɚɧɬɧɨɫɬɶ ɤ ɮɢɡɢɫɨɤɪɚɳɟɧɢɣ (ɑɋɋ) ɢ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ (ȺȾ) ɛɵɥɢ ɜ
ɱɟɫɤɨɣ ɧɚɝɪɭɡɤɟ, ɚ ɬɚɤɠɟ ɧɚ ɫɨɫɬɨɹɧɢɟ ɩɪɨɰɟɫɫɨɜ ɦɢɤɪɨɩɪɟɞɟɥɚɯ ɧɨɪɦɵ. ȼɨ ɜɪɟɦɹ ɞɵɯɚɧɢɹ ȽȽɋ ɨɬɦɟɱɚɥɨɫɶ ɧɟɰɢɪɤɭɥɹɰɢɢ.
ɡɧɚɱɢɬɟɥɶɧɨɟ ɭɜɟɥɢɱɟɧɢɟ ɑɋɋ, ɤɨɬɨɪɚɹ ɡɚɬɟɦ ɫɧɢɠɚɥɚɫɶ ɜ
Ɇɟɬɨɞɢɤɚ ɉɇȽ ɞɨɫɬɚɬɨɱɧɨ ɩɪɨɫɬɚ ɢ ɦɨɠɟɬ ɲɢɪɨɤɨ
ɩɟɪɢɨɞ ɩɚɭɡɵ ɨɬɞɵɯɚ, ɬ.ɟ. ɞɵɯɚɧɢɹ ɚɬɦɨɫɮɟɪɧɵɦ ɜɨɡɞɭɢɫɩɨɥɶɡɨɜɚɬɶɫɹ ɜ ɥɟɱɟɧɢɢ ɛɨɥɶɧɵɯ ɏɈɁɅ ɜ ɭɫɥɨɜɢɹɯ ɫɚɧɚɯɨɦ. ȼ ɫɪɟɞɧɟɦ ɡɚ ɜɪɟɦɹ ɨɞɧɨɣ ɩɪɨɰɟɞɭɪɵ ɜɵɹɜɥɟɧɨ ɭɪɟɬɨɪɢɹ.
ɠɟɧɢɟ ɑɋɋ ɫ 76,1 ɞɨ 71,5 ɭɞɚɪɚ ɜ ɦɢɧɭɬɭ. ɉɪɢ ɷɬɨɦ ɧɚɫɵɳɟɧɢɟ ɚɪɬɟɪɢɚɥɶɧɨɣ ɤɪɨɜɢ ɤɢɫɥɨɪɨɞɨɦ ɫɧɢɠɚɥɨɫɶ ɜ
Ʌɢɬɟɪɚɬɭɪɚ
ɫɪɟɞɧɟɦ ɫ 95% ɞɨ 85,3%. ȼ ɤɨɧɰɟ ɩɪɨɰɟɞɭɪɵ ɫɨɞɟɪɠɚɧɢɟ
/. Ɂɚɤɨɧɳɢɤɨɜ Ʉ. Ɏ. Ⱥɞɚɩɬɚɰɢɹ. Ƚɢɩɨɤɫɢɹ. Ɂɞɨɪɨɜɶɟ.
ɤɢɫɥɨɪɨɞɚ ɜɨɡɜɪɚɳɚɥɨɫɶ ɤ ɢɫɯɨɞɧɨɦɭ ɭɪɨɜɧɸ.
— Ɇ., 1996.
Ʉɪɨɦɟ ɬɨɝɨ, ɜɵɹɜɥɟɧɨ ɝɢɩɨɬɟɧɡɢɜɧɨɟ ɞɟɣɫɬɜɢɟ ɤɚɤ
2. Ɇɟɟɪɫɨɧ Ɏ.Ɂ., ɉɲɟɧɧɢɤɨɜɚ Ɇ.Ƚ. Ⱥɞɚɩɬɚɰɢɹ ɤ
ɨɞɧɨɝɨ ɫɟɚɧɫɚ ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ, ɬɚɤ ɢ ɜɫɟɝɨ ɤɭɪɫɚ ɜ ɰɟɥɨɦ.
ɫɬɪɟɫȼ ɫɪɟɞɧɟɦ ɫɢɫɬɨɥɢɱɟɫɤɨɟ ȺȾ ɜ ɪɟɡɭɥɶɬɚɬɟ ɥɟɱɟɧɢɹ ɫɧɢɡɢɫɨɪɧɵɦ ɫɢɬɭɚɰɢɹɦ ɢ ɮɢɡɢɱɟɫɤɢɦ ɧɚɝɪɭɡɤɚɦ.—
ɥɨɫɶ ɧɚ 18,6 ɦɦ ɪɬ. ɫɬ., ɞɢɚɫɬɨɥɢɱɟɫɤɨɟ — ɧɚ 5,9 ɦɦ ɪɬ. ɫɬ.,
Ɇ.: Ɇɟɞɢɰɢɧɚ, 1988.
ɱɬɨ ɦɨɠɧɨ ɨɛɴɹɫɧɢɬɶ, ɫɨɝɥɚɫɧɨ ɥɢɬɟɪɚɬɭɪɧɵɦ ɞɚɧɧɵɦ,
3. Ɇɟɟɪɫɨɧ Ɏ.Ɂ., Ɍɜɟɪɞɨɯɥɢɛ ȼ.ɉ., Ȼɨɟɜ ȼ.Ɇ., Ɏɪɨɥɨɜ
ɜɨɡɞɟɣɫɬɜɢɟɦ ɝɢɩɨɤɫɢɢ ɧɚ ɦɟɯɚɧɢɡɦɵ ɧɟɣɪɨɝɭɦɨ-ɪɚɥɶɧɨɣ
Ȼ.Ⱥ. // ȼ ɤɧ.: Ⱥɞɚɩɬɚɰɢɹ ɤ ɩɟɪɢɨɞɢɱɟɫɤɨɣ ɝɢɩɨɤɪɟɝɭɥɹɰɢɢ ɧɟɤɨɬɨɪɵɯ ɮɭɧɤɰɢɣ ɨɪɝɚɧɢɡɦɚ [4].
ɫɢɢ ɜ ɬɟɪɚɩɢɢ ɢ ɩɪɨɮɢɥɚɤɬɢɤɟ. / ɉɨɞ ɪɟɞ.
ɉɨ ɞɚɧɧɵɦ ɮɭɧɤɰɢɢ ɜɧɟɲɧɟɝɨ ɞɵɯɚɧɢɹ ɨɬɦɟɱɟɧɨ
Ɉ.Ƚ.Ƚɚ-ɡɟɧɤɨ. - Ɇ., 1989. - ɋ. 26-33.
ɞɨɫɬɨɜɟɪɧɨɟ ɭɥɭɱɲɟɧɢɟ ɨɛɴɟɦɧɵɯ ɢ ɫɤɨɪɨɫɬɧɵɯ ɩɨɤɚɡɚɬɟ4. Ɍɤɚɱɭɤ ȿ.ɇ., Ƚɨɪɛɚɱɟɧɤɨɜ Ⱥ.Ⱥ., Ʉɨɥɱɢɧɫɤɚɹ Ⱥ.Ɂ. //ȼ
ɥɟɣ (ɬɚɛɥɢɰɚ).
ɤɧ.: Ⱥɞɚɩɬɚɰɢɨɧɧɚɹ ɦɟɞɢɰɢɧɚ: ɦɟɯɚɧɢɡɦɵ ɢ
ɀɢɡɧɟɧɧɚɹ ɟɦɤɨɫɬɶ ɥɟɝɤɢɯ ɜ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɟ ɜɨɡɡɚɳɢɬɧɵɟ ɷɮɮɟɤɬɵ ɚɞɚɩɬɚɰɢɢ. — Ɇ., 1993. —
ɪɨɫɥɚ ɧɚ 15,9%, ɨɛɴɟɦ ɮɨɪɫɢɪɨɜɚɧɧɨɝɨ ɜɵɞɨɯɚ ɡɚ 1 ɫɟɤɭɧɋ. 303— 331.
ɞɭ - ɧɚ 17,7%.
ɂɦɩɭɥɶɫɧɚɹ ɝɢɩɨɤɫɢɹ ɜ ɤɨɦɩɥɟɤɫɧɨɣ ɬɟɪɚɩɢɢ
ɩɭɥɶɦɨɧɨɥɨɝɢɱɟɫɤɢɯ ɛɨɥɶɧɵɯ ɩɨɠɢɥɨɝɨ ɜɨɡɪɚɫɬɚ
ɘ. ɋ. Ʉɪɵɫɢɧ, ȼ. ɉ. ɋɢɥɶɜɟɫɬɪɨɜ, ȼ. ɇ. ɋɭɪɨɜɢɤɨɜ
Ȼɪɨɧɯɢɚɥɶɧɚɹ ɚɫɬɦɚ ɢ ɯɪɨɧɢɱɟɫɤɢɣ ɛɪɨɧɯɢɬ ɲɢɪɨɤɨ ɧɢɹ ɩɪɨɛɥɟɦɵ ɯɪɨɧɢɱɟɫɤɢɯ ɧɟɫɩɟɰɢɮɢɱɟɫɤɢɯ ɡɚɛɨɥɟɜɚɧɢɣ
ɪɚɫɩɪɨɫɬɪɚɧɟɧɵ ɢ ɡɚɧɢɦɚɸɬ ɨɞɧɨ ɢɡ ɩɟɪɜɵɯ ɦɟɫɬ ɫɪɟɞɢ ɥɟɝɤɢɯ (ɏɇɁɅ) ɞɢɤɬɭɟɬɫɹ ɬɚɤɠɟ ɧɟɭɤɥɨɧɧɵɦ ɪɨɫɬɨɦ ɪɚɫɩɪɢɱɢɧ ɡɚɛɨɥɟɜɚɟɦɨɫɬɢ ɢ ɫɦɟɪɬɢ. ɇɟɨɛɯɨɞɢɦɨɫɬɶ ɪɟɲɟ- ɯɨɞɨɜ ɧɚ ɥɟɱɟɧɢɟ ɢ ɪɟɚɛɢɥɢɬɚɰɢɸ ɷɬɢɯ ɛɨɥɶɧɵɯ. Ⱥɪɫɟɧɚɥ