Показания и противопоказания к резекциям печени по поводу

ÄççÄãõ ïàêìêÉàóÖëäéâ ÉÖèÄíéãéÉàà, 2003, ÚÓÏ 8, ‹ 1, Ò. 10–18
Ô˜Â̸
èÓ͇Á‡ÌËfl Ë ÔÓÚË‚ÓÔÓ͇Á‡ÌËfl Í ÂÁÂ͈ËflÏ Ô˜ÂÌË
ÔÓ ÔÓ‚Ó‰Û ÏÂÚ‡ÒÚ‡ÁÓ‚ ÍÓÎÓÂÍڇθÌÓ„Ó ‡Í‡.
ñÂÌÌÓÒÚ¸ Ù‡ÍÚÓÓ‚ ÔÓ„ÌÓÁ‡ Ë Ëı Í·ÒÒËÙË͇ˆËfl
û. à. è‡Ú˛ÚÍÓ,
à. Ç. 뇄‡È‰‡Í
éÚ‰ÂÎÂÌË ıËÛ„ËË ÓÔÛıÓÎÂÈ
Ô˜ÂÌË Ë ÔÓ‰ÊÂÎÛ‰Ó˜ÌÓÈ ÊÂÎÂÁ˚ êéçñ êÄåç
ËÏ. ç.ç. ÅÎÓıË̇ (‰Ë. –
‡Í‡‰. êÄåç å.à. ч‚˚‰Ó‚),
åÓÒÍ‚‡
è‰ÒÚ‡‚ÎÂÌ ÓÔ˚Ú Î˜ÂÌËfl 153 Ô‡ˆËÂÌÚÓ‚ Ò ÏÂÚ‡ÒÚ‡Á‡ÏË ÍÓÎÓÂÍڇθÌÓ„Ó ‡Í‡ ‚
Ô˜Â̸. ÇÒÂ„Ó ‚˚ÔÓÎÌÂÌ˚ 164 ÂÁÂ͈ËË Ô˜ÂÌË. èÓ˜ÚË ÔÓÎÓ‚ËÌÛ ËÁ ÌËı (47.5%) ÒÓÒÚ‡‚ËÎË Ó·¯ËÌ˚Â Ë Ô‰ÂθÌÓ Ó·¯ËÌ˚ ÓÔÂ‡ˆËË: ‡Ò¯ËÂÌ̇fl Ô‡‚ÓÒÚÓÓÌÌflfl
„ÂÏË„ÂÔ‡Ú˝ÍÚÓÏËfl (ÉÉù) – 17 (10.4%), ‡Ò¯ËÂÌ̇fl ΂ÓÒÚÓÓÌÌflfl ÉÉù – 1 (0.6%),
Ô‡‚ÓÒÚÓÓÌÌflfl ÉÉù – 50 (30.4%), ΂ÓÒÚÓÓÌÌflfl ÉÉù – 9 (5.4%). ç‡Ë·ÓΠ˜‡ÒÚ˚Ï
ÓÔÂ‡ÚË‚Ì˚Ï ‚ϯ‡ÚÂθÒÚ‚ÓÏ fl‚Ë·Ҹ Ô‡‚ÓÒÚÓÓÌÌflfl ÉÉù. Ä̇ÚÓÏ˘ÂÒÍË ÂÁÂ͈ËË ‚ Ô‰Â·ı ‰‚Ûı Ò„ÏÂÌÚÓ‚ ‚˚ÔÓÎÌÂÌ˚ 53 (32.2%) ·ÓθÌ˚Ï. ç‡̇ÚÓÏ˘ÂÒÍËÂ
ÂÁÂ͈ËË ÔÓËÁ‚‰ÂÌ˚ 33 (20.1%) ·ÓθÌ˚Ï. èÓÒÎÂÓÔÂ‡ˆËÓÌ̇fl ÎÂڇθÌÓÒÚ¸ ÒÓÒÚ‡‚Ë· 4.8%.
Ç „ÛÔÔ ·ÓθÌ˚ı Ò ËÁÓÎËÓ‚‡ÌÌ˚Ï ÔÓ‡ÊÂÌËÂÏ Ô˜ÂÌË 5-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸ ÒÓÒÚ‡‚Ë· 37.5 ± 7.1%, 10-ÎÂÚÌflfl – 18.5 ± 8.0%.
î‡ÍÚÓ˚, ÒÛ˘ÂÒÚ‚ÂÌÌÓ Ì ‚ÎËfl˛˘Ë ̇ ‚˚ÊË‚‡ÂÏÓÒÚ¸, ̇΢ˠÍÓÚÓ˚ı Ì Ò͇Á˚‚‡ÂÚÒfl ̇ ÓÚ‰‡ÎÂÌÌ˚ı ÂÁÛθڇڇı: ·ËÎÓ·‡ÌÓ ÔÓ‡ÊÂÌË (ÔË Ì‡Î˘ËË Ì ·ÓÎÂÂ
‰‚Ûı Ó˜‡„Ó‚), ‡ÁÏÂ ÒÓÎËÚ‡ÌÓ„Ó ÛÁ·, Ó·˙ÂÏ ÓÔÂ‡ÚË‚ÌÓ„Ó ‚ϯ‡ÚÂθÒÚ‚‡ (ÍÓÏÂ
‡Ò¯ËÂÌÌ˚ı ÉÉù Ë ÔË Òӷβ‰ÂÌËË ‡‰ÂÍ‚‡ÚÌÓ„Ó ÓÚÒÚÛÔ‡ ÓÚ ÓÔÛıÓÎË).
Å·„ÓÔËflÚÌ˚ ÔÓ„ÌÓÒÚ˘ÂÒÍË هÍÚÓ˚, ÔË Ì‡Î˘ËË ÍÓÚÓ˚ı ‚ÓÁÏÓÊÌÓ Ì‡‰ÂflÚ¸Òfl ̇ 5-ÎÂÚÌ˛˛ ‚˚ÊË‚‡ÂÏÓÒÚ¸ ·ÓΠ˜ÂÏ Û 40% ·ÓθÌ˚ı: ËÁÓÎËÓ‚‡ÌÌÓ ÔÓ‡ÊÂÌË Ô˜ÂÌË, ‡‰˙˛‚‡ÌÚ̇fl ıËÏËÓÚÂ‡ÔËfl, ÛÓ‚Â̸ êùÄ ‰Ó 100 Ì„/ÏÎ, ÛÓ‚Â̸ ˘ÂÎÓ˜ÌÓÈ ÙÓÒÙ‡Ú‡Á˚ ÏÂÌ 1000 Ö/Î, ÍÓ‚ÓÔÓÚÂfl ‰Ó 1000 ÏÎ, ÒÓÎËÚ‡Ì˚ ÛÁÎ˚ ‚ Ô˜ÂÌË, ‡ÒÒÚÓflÌË ÓÚ ÓÔÛıÓÎË ‰Ó Í‡fl ÂÁÂ͈ËË ·ÓΠ1 ÒÏ, ‡ÔÔÓÁˈËÓÌÌ˚È Ë
Òϯ‡ÌÌ˚È ÓÒÚ ÓÔÛıÓÎË, ÓÚÒÛÚÒÚ‚Ë ËÌ‚‡ÁËË ‚ ÒÓÒÛ‰˚, ̇΢ˠÙË·ÓÁÌÓÈ Í‡ÔÒÛÎ˚ Ë ÎËÏÙÓˉÌÓÈ ËÌÙËθÚ‡ˆËË ‚ÓÍÛ„ ÓÔÛıÓÎÂ‚Ó„Ó ÛÁ·.
ç··„ÓÔËflÚÌ˚ هÍÚÓ˚ Á̇˜ËÚÂθÌÓ ÛıÛ‰¯‡˛Ú ‚˚ÊË‚‡ÂÏÓÒÚ¸, ÌÓ Û ˝ÚËı
·ÓθÌ˚ı ÂÒÚ¸ ÔËÂÏÎÂχfl 3-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸, ˜ÚÓ ‰Â·ÂÚ Ô‰ÔÓ˜ÚËÚÂθÌ˚Ï
ıËÛ„˘ÂÒÍӠΘÂÌË ÔÂ‰ ‰Û„ËÏË ‚ˉ‡ÏË ÚÂ‡ÔËË. ä ÌËÏ ÓÚÌÓÒflÚÒfl: ÏÌÓÊÂÒÚ‚ÂÌÌ˚ ÛÁÎ˚ ‚ Ó‰ÌÓÈ ËÁ ‰ÓÎÂÈ Ô˜ÂÌË, ‡ÒÒÚÓflÌË ÓÚ ÓÔÛıÓÎË ‰Ó ÎËÌËË ÂÁÂ͈ËË
ÏÂÌ 1 ÒÏ, ËÌÙËθÚ‡ÚË‚Ì˚È ÓÒÚ ÓÔÛıÓÎË, ËÌ‚‡ÁËfl ‚ ÒÓÒÛ‰˚, ‚ÌÂÔ˜ÂÌÓ˜Ì˚ „ÂχÚÓ„ÂÌÌ˚Â Ë ÎËÏÙÓ„ÂÌÌ˚ ÏÂÚ‡ÒÚ‡Á˚, Ó·˙ÂÏ ÔÓ‡ÊÂÌËfl Ô˜ÂÌË, ÚÂ·Û˛˘ËÈ
‡Ò¯ËÂÌÌÓÈ ÉÉù, ÍÓ‚ÓÔÓÚÂfl ·ÓΠ2000 ÏÎ, ËÒÚËÌÌÓ ‚‡ÒÚ‡ÌË ÓÔÛıÓÎË ‚
ÒÓÒ‰ÌË ÒÚÛÍÚÛ˚.
î‡ÍÚÓ˚, ÔË ÍÓÚÓ˚ı ÂÁÂ͈Ëfl Ô˜ÂÌË ÌÂÓÔ‡‚‰‡Ì̇ ËÁ-Á‡ Í‡ÈÌ ÌÂÛ‰Ó‚ÎÂÚ‚ÓËÚÂθÌ˚ı ÓÚ‰‡ÎÂÌÌ˚ı ÂÁÛθڇÚÓ‚: Ô‡ÎΡÚË‚Ì˚ ‚ϯ‡ÚÂθÒÚ‚‡ Ò ÓÒÚ‡‚ÎÂÌËÂÏ ÓÔÛıÓ΂˚ı ÛÁÎÓ‚, ÏÌÓÊÂÒÚ‚ÂÌÌÓ ·ËÎÓ·‡ÌÓ ÔÓ‡ÊÂÌË Ô˜ÂÌË.
Indications and Contra-Indications
for Liver Resections in Colorectal Metastasis Patients.
Value and Classification of Prognostic Factors
Yu.I. Patyutko,
I.V. Sagaydak
Department of Liver and
Pancreatic Tumors Surgery,
N.N. Blokchin Russian
Oncological Scientific Center
of RAMSci (Dir. – Academician
of RAMSei M.I. Davidov),
Moscow
The experience of treatment of 153 patients with colorectal liver metastasis is presented in the
article. Total number of liver resections was 164. Hemihepatectomies accounted for almost
half of them (47.5%): extended right hemihepatectomy – 17 (10.4%), extended left hemihepatectomy – 1 (0.6%), right hemihepatectomy – 50 (30.4%), left hemihepatectomy 9 (5.4%).
The most frequent procedure had been performed was right hemihepatectomy. 53 (32.2%)
anatomical liver resection were made within the bounds of two segments. 33 patients underwent wedge liver resections. Operative morbidity was 4.8%.
5-year and 10-year survival rates of patients with separate liver lesion were 37.5 ± 7.1% and
18.5 = 8.0%, respectively.
The factos incidentally influencing on survival. Long-term results don’t depend on bilobar
involvement (at the most two lesions), size of solitary nodule and extent of surgical procedure
(except the extended hemihepatectomies with negative surgical margins).
10
Ô˜Â̸
èÄíûíäé, ëÄÉÄâÑÄä
The favorable prognostic factors. A 5-year survival of patients with presence of these factors is more than 40%. They are: separate liver lesion, adjuvant chemotherapy, CEA level
up to 100 ng/ml. AIPh level less than 1000 U/l, blood loss up to 1000 ml, solitary nodules
in liver, surgical margin more than 1 cm, apposite and mixed types of tumor growth,
absence of vascular invasion, fibrous capsule and lymphoid infiltration around the tumor.
The unfavorable prognostic factors. They worsen survival greatly, but the acceptable
3-year survival still exists, so surgical management should be preferred to other therapies.
They include: multiple nodules in one lobe, surgical margin less than 1 cm, infiltrative
type of tumor growth, vascular invasion, extrahepatic hematogenous and lymphogenous
metastasis, blood loss more than 2000 ml.
The factors depriving liver resection any value because of extremely unsatisfactory longterm results are palliative procedures with leaving tumor nodules, multiple bilobar lesion
and true involvement of neighboring structures.
ǂ‰ÂÌËÂ
è˜Â̸ – Ó‰ÌÓ ËÁ Ò‡Ï˚ı ˜‡ÒÚ˚ı ÏÂÒÚ ÏÂÚ‡ÒÚ‡ÁËÓ‚‡ÌËfl ·Óθ¯ËÌÒÚ‚‡ ÁÎÓ͇˜ÂÒÚ‚ÂÌÌ˚ı ÓÔÛıÓÎÂÈ. èÓ ÒÂ͈ËÓÌÌ˚Ï ‰‡ÌÌ˚Ï, ÒÂ‰Ë ‚ÒÂı ÛÏÂ¯Ëı
ÓÚ ‡Í‡ ‡Á΢Ì˚ı ÎÓ͇ÎËÁ‡ˆËÈ ‚ 41% ̇·Î˛‰ÂÌËÈ ÓÔ‰ÂÎflÎËÒ¸ ÏÂÚ‡ÒÚ‡Á˚ ‚ Ô˜Â̸ [14].
ç ÔÓÒΉÌ ÏÂÒÚÓ ‚ ˝ÚÓÏ fl‰Û Á‡ÌËχÂÚ ‡Í
ÚÓÎÒÚÓÈ Í˯ÍË. Ç êÓÒÒËË ‡ÍÓÏ ÔflÏÓÈ Ë Ó·Ó‰Ó˜ÌÓÈ Í˯ÍË ÂÊ„ӉÌÓ Á‡·Ó΂‡˛Ú 46 Ú˚Ò. ˜ÂÎÓ‚ÂÍ
[2]. Ç Ì‡¯ÂÈ ÒÚ‡Ì Ì ‚‰ÂÚÒfl Û˜ÂÚ‡ ˜‡ÒÚÓÚ˚ ‚˚fl‚ÎÂÌËfl ÏÂÚ‡ÒÚ‡Ú˘ÂÒÍÓ„Ó ‡Í‡ Ô˜ÂÌË. çÓ ÂÒÎË
Û˜ÂÒÚ¸ ‰‡ÌÌ˚ Á‡Û·ÂÊÌ˚ı ‡‚ÚÓÓ‚, ÚÓ Û ÚÂÚË
·ÓθÌ˚ı Ò ÍÓÎÓÂÍڇθÌ˚Ï ‡ÍÓÏ Ò‡ÁÛ ËÎË
‚ÔÓÒΉÒÚ‚ËË ·Û‰ÛÚ ÓÔ‰ÂÎflÚ¸Òfl ÏÂÚ‡ÒÚ‡Á˚ ‚ Ô˜Â̸ [4]. èÓ Ì‡¯ËÏ ÔËÏÂÌ˚Ï ÔÓ‰Ò˜ÂÚ‡Ï, ÂÊ„ӉÌÓ ÔÓ êÓÒÒËË ˝ÚÓÚ ÍÓÌÚËÌ„ÂÌÚ ÏÓÊÂÚ ÒÓÒÚ‡‚ÎflÚ¸ 15 Ú˚Ò. ˜ÂÎÓ‚ÂÍ.
èË ÍÓÎÓÂÍڇθÌÓÏ ‡Í ÒÓÎËÚ‡Ì˚È ÏÂÚ‡ÒÚ‡Á ‚ Ô˜Â̸ ÏÓÊÂÚ ·˚Ú¸ ‰ËÌÒÚ‚ÂÌÌ˚Ï ÔÓfl‚ÎÂÌËÂÏ ÔÓ„ÂÒÒËÓ‚‡ÌËfl ÓÔÛıÓÎÂ‚Ó„Ó Á‡·Ó΂‡ÌËfl
‚ Ú˜ÂÌË 1 – 2 ÎÂÚ. ùÚ‡ ÏÓ‰Âθ ÓÔÚËχθ̇ ‰Îfl
ıËÛ„˘ÂÒÍÓ„Ó Î˜ÂÌËfl. ÅÓθÌ˚Â Ò ËÁÓÎËÓ‚‡ÌÌ˚Ï ÔÓ‡ÊÂÌËÂÏ Ô˜ÂÌË fl‚Îfl˛ÚÒfl ÔÓÚÂ̈ˇθÌ˚ÏË Í‡Ì‰Ë‰‡Ú‡ÏË ‰Îfl ÓÔÂ‡ÚË‚ÌÓ„Ó Î˜ÂÌËfl.
é‰Ì‡ÍÓ ‰Ó ̇ÒÚÓfl˘Â„Ó ‚ÂÏÂÌË ÒÛ˘ÂÒÚ‚ÛÂÚ ÏÌÓ„Ó
ÒÔÓÌ˚ı ÏÓÏÂÌÚÓ‚ ‚ ÓÚ·Ó ·ÓθÌ˚ı ‰Îfl ıËÛ„˘ÂÒÍÓ„Ó Î˜ÂÌËfl.
å‡ÚÂË‡Î Ë ÏÂÚÓ‰˚
ïËÛ„˘ÂÒÍÓ ÓÚ‰ÂÎÂÌË ÓÔÛıÓÎÂÈ Ô˜ÂÌË Ë
ÔÓ‰ÊÂÎÛ‰Ó˜ÌÓÈ ÊÂÎÂÁ˚ êéçñ êÄåç ӷ·‰‡ÂÚ
ÓÔ˚ÚÓÏ ·ÓΠ430 ÂÁÂ͈ËÈ Ô˜ÂÌË. 164 ËÁ ˝ÚËı
ÓÔÂ‡ˆËÈ ÔÓËÁ‚‰ÂÌ˚ ÔÓ ÔÓ‚Ó‰Û ÏÂÚ‡ÒÚ‡ÁÓ‚ ÍÓÎÓÂÍڇθÌÓ„Ó ‡Í‡. ÇÒÂ„Ó ·˚ÎÓ 153 Ô‡ˆËÂÌÚ‡,
15 ËÁ ÌËı ‚˚ÔÓÎÌÂ̇ ÂÁÂ͈Ëfl Ô˜ÂÌË ÔÓ‚ÚÓÌÓ,
Ô˘ÂÏ 4 ÔÂ‚˘̇fl ÂÁÂ͈Ëfl Ô˜ÂÌË ÔÓËÁ‚‰Â̇
‚ ‰Û„Ëı ωˈËÌÒÍËı Û˜ÂʉÂÌËflı.
ì 155 ˜ÂÎÓ‚ÂÍ ‚ϯ‡ÚÂθÒÚ‚‡ ÌÓÒËÎË “‡‰Ë͇θÌ˚È” ı‡‡ÍÚÂ, Û ÓÒڇθÌ˚ı 9 ˜ÂÎÓ‚ÂÍ ÓÌË
·˚ÎË Ô‡ÎΡÚË‚Ì˚ÏË.
ᇠÔÓÒΉÌË „Ó‰˚ ̇ÏË ÓÔÂËÓ‚‡ÌÓ 7 ·ÓθÌ˚ı ÒÚ‡¯Â 70 ÎÂÚ, ‚ ÚÓÏ ˜ËÒÎÂ Û 5 ËÏÂÎË ÏÂÒÚÓ
Ó·¯ËÌ˚ ÂÁÂ͈ËË Ô˜ÂÌË: 1 ‡Ò¯ËÂÌ̇fl Ô‡ÄççÄãõ ïàêìêÉàóÖëäéâ ÉÖèÄíéãéÉàà ÚÓÏ 8
‚ÓÒÚÓÓÌÌflfl „ÂÏË„ÂÔ‡Ú˝ÍÚÓÏËfl (ÉÉù), 4 Ô‡‚ÓÒÚÓÓÌÌË ÉÉù Ë ÚÓθÍÓ 2 ÂÁÂ͈ËË Ô˜ÂÌË ‚ Ô‰Â·ı ‰‚Ûı Ò„ÏÂÌÚÓ‚.
Ç ÒÚÛÍÚÛ ÂÁÂ͈ËÈ Ô˜ÂÌË ÔÓ˜ÚË ÔÓÎÓ‚ËÌÛ
ÒÓÒÚ‡‚ËÎË ÉÉù (78 ÓÔÂ‡ˆËÈ, ËÎË 47.5%). Ç 17 ̇·Î˛‰ÂÌËflı ÔÓËÁ‚‰Â̇ ‡Ò¯ËÂÌ̇fl Ô‡‚ÓÒÚÓÓÌÌflfl ÉÉù, ˜ÚÓ ÒÓÒÚ‡‚ËÎÓ 10.4% Ó·˘Â„Ó ÍÓ΢ÂÒÚ‚‡ ̇·Î˛‰ÂÌËÈ. ä‡ÈÌ ‰ÍÓÈ Ë ÚÂıÌ˘ÂÒÍË
Ó˜Â̸ ÒÎÓÊÌÓÈ ÓÒÚ‡ÂÚÒfl ‡Ò¯ËÂÌ̇fl ΂ÓÒÚÓÓÌÌflfl ÉÉù, ÍÓÚÓ‡fl ÔÓËÁ‚‰Â̇ ‚ÒÂ„Ó 1 ·ÓθÌÓÏÛ, ˜ÚÓ ÒÓÒÚ‡‚ËÎÓ 0.6% Ó·˘Â„Ó ˜ËÒ· ÓÔÂ‡ˆËÈ.
ç‡Ë·ÓΠ˜‡ÒÚ˚Ï ÓÔÂ‡ÚË‚Ì˚Ï ÔÓÒÓ·ËÂÏ fl‚Ë·Ҹ Ô‡‚ÓÒÚÓÓÌÌflfl ÉÉù. ç‡ÏË ÓÔÂËÓ‚‡ÌÓ 50
(30.4%) ·ÓθÌ˚ı ‚ Ó·˙ÂÏ Ô‡‚ÓÒÚÓÓÌÌÂÈ ÉÉù.
ì‰ÂθÌ˚È ‚ÂÒ Î‚ÓÒÚÓÓÌÌËı ÉÉù Ó͇Á‡ÎÒfl Á̇˜ËÚÂθÌÓ ÏÂ̸¯Â – 9 (5.4%) ÓÔÂ‡ˆËÈ.
êÂÁÂ͈Ëfl Ô˜ÂÌË ‚ Ô‰Â·ı ‰‚Ûı-ÚÂı Ò„ÏÂÌÚÓ‚ ÔÓËÁ‚‰Â̇ 86 (52.4%) Ô‡ˆËÂÌÚ‡Ï. ÇÒ ˝ÚË
Ò„ÏÂÌÚ˝ÍÚÓÏËË Ï˚ ÛÒÎÓ‚ÌÓ Ó·˙‰ËÌËÎË ‚ „ÛÔÔÛ
“˝ÍÓÌÓÏÌ˚ı” ÂÁÂ͈ËÈ Ô˜ÂÌË. ëÂ‰Ë ÌËı Ò‡ÏÓÈ
˜‡ÒÚÓÈ ÓÒÚ‡ÂÚÒfl ΂ÓÒÚÓÓÌÌflfl ÎÓ·˝ÍÚÓÏËfl (22 ˜ÂÎÓ‚Â͇, ËÎË 13.4%). ëڇ̉‡ÚÌÓÈ ÂÁÂ͈ËÂÈ Ô˜ÂÌË Ú‡ÍÊ fl‚ÎflÂÚÒfl Ô‡‚ÓÒÚÓÓÌÌflfl ·ÚÂ‡Î¸Ì‡fl
ÎÓ·˝ÍÚÓÏËfl – 10(6.1%) ·ÓθÌ˚ı.
àÁÓÎËÓ‚‡Ì̇fl Ò„ÏÂÌÚ˝ÍÚÓÏËfl VIII ÔÓËÁ‚‰Â̇ ‚ 9 (5.4%) ̇·Î˛‰ÂÌËflı.
ÑÓÒÚ‡ÚÓ˜ÌÓ ˜‡ÒÚÓÈ ÓÔÂ‡ˆËÂÈ Òڇ· ÂÁÂ͈Ëfl
Ô˜ÂÌË ÔË ‡ÒÔÓÎÓÊÂÌËË ÓÔÛıÓÎË Ì‡ „‡Ìˈ IV
Ë V Ò„ÏÂÌÚÓ‚ – 12 (7.3%) ̇·Î˛‰ÂÌËÈ. éÔ‡ÒÌÓÒÚ¸
ÔÓ‰Ó·Ì˚ı ‚ϯ‡ÚÂθÒÚ‚ Á‡Íβ˜‡ÂÚÒfl ‚ ·ÎËÁÓÒÚË
Ò„ÏÂÌÚÓ‚ Í ‚ÓÓÚ‡Ï Ô˜ÂÌË, ˜ÚÓ ‰Â·ÂÚ ‚ÓÁÏÓÊÌÓÒÚ¸ ̇Û¯ÂÌËfl ÍÓ‚ÓÒ̇·ÊÂÌËfl ËÎË ÊÂΘÂÓÚÚÓ͇ ‡θÌÓÈ.
éÒڇθÌ˚ 33 (20%) ÂÁÂ͈ËË Ï˚ Ó·˙‰ËÌËÎË
‚ Ó‰ÌÛ „ÛÔÔÛ. ÅÓθ¯ËÌÒÚ‚Ó ËÁ ÌËı ÒÓÒÚ‡‚ËÎË ‡ÚËÔ˘Ì˚ ÂÁÂ͈ËË (̇̇ÚÓÏ˘ÂÒÍË ÂÁÂ͈ËË Ô˜ÂÌË). Ç ÔÓÒΉÌË „Ó‰˚ ‰‡ÌÌ˚È ÚËÔ ÂÁÂ͈ËË ËÒÔÓθÁÛÂÚÒfl Í‡ÈÌ ‰ÍÓ. ÇÂÒ¸ ÒÔÂÍÚ ÓÔÂ‡ˆËÈ
̇ Ô˜ÂÌË ÔË ÏÂÚ‡ÒÚ‡Ú˘ÂÒÍÓÏ ‡Í Ô‰ÒÚ‡‚ÎÂÌ
‚ Ú‡·Î. 1.
Ç Ì‡ÒÚÓfl˘Â ‚ÂÏfl ̇ÏË ÂÊ ‚˚ÔÓÎÌfl˛ÚÒfl
˝ÍÓÌÓÏÌ˚ ÂÁÂ͈ËË Ô˜ÂÌË, ÓÒÓ·ÂÌÌÓ ÔË ÔÓ‡ÊÂÌËË Ô‡‚ÓÈ ‰ÓÎË.
‹1
2003
11
Ô˜Â̸
èéäÄáÄçàü à èêéíàÇéèéäÄáÄçàü ä êÖáÖäñàüå èÖóÖçà
퇷Îˈ‡ 1. ï‡‡ÍÚÂËÒÚË͇ ‚˚ÔÓÎÌÂÌÌ˚ı ÓÔÂ‡ÚË‚Ì˚ı ‚ϯ‡ÚÂθÒÚ‚ ̇ Ô˜ÂÌË
鷢 ˜ËÒÎÓ
ãÂڇθÌÓÒÚ¸
Çˉ ‚ϯ‡ÚÂθÒÚ‚‡
‡·Ò.
%
‡·Ò.
%
ê‡Ò¯ËÂÌ̇fl Ô‡‚ÓÒÚÓÓÌÌflfl ÉÉù
17
10.4
2
11.7
ê‡Ò¯ËÂÌ̇fl ΂ÓÒÚÓÓÌÌflfl ÉÉù
1
0.6
–
–
50
30.4
5
10.1
9
5.4
–
–
ÇÒÂ„Ó Ó·¯ËÌ˚ı ÂÁÂ͈ËÈ
78
47.5
7
8.9
ã‚ÓÒÚÓÓÌÌflfl ÎÓ·˝ÍÚÓÏËfl
22
13.4
1
4.5
è‡‚ÓÒÚÓÓÌÌflfl ·ÚÂ‡Î¸Ì‡fl ÎÓ·˝ÍÚÓÏËfl
10
6.1
–
–
9
5.4
–
–
êÂÁÂ͈Ëfl IV–V Ò„ÏÂÌÚÓ‚
12
7.3
–
–
ÄÚËÔ˘Ì˚ ÂÁÂ͈ËË
33
20.1
–
–
ÇÒÂ„Ó ˝ÍÓÌÓÏÌ˚ı ÂÁÂ͈ËÈ
86
52.4
1
1.1
8
4.8
è‡‚ÓÒÚÓÓÌÌflfl ÉÉù
ã‚ÓÒÚÓÓÌÌflfl ÉÉù
êÂÁÂ͈Ëfl VIII Ò„ÏÂÌÚ‡
àÚÓ„Ó
164
Ç ÔÓÒÎÂÓÔÂ‡ˆËÓÌÌÓÏ ÔÂËӉ ÛÏÂÎË 8 (4.8%)
˜ÂÎÓ‚ÂÍ. ãÂڇθÌÓÒÚ¸ ‚˚¯Â ÒÂ‰Ë ·ÓθÌ˚ı, ÔÂÂÌÂÒ¯Ëı ÉÉù. èÓÒΠ˝ÍÓÌÓÏÌÓÈ ÂÁÂ͈ËË Ô˜ÂÌË
ÛÏÂ ÚÓθÍÓ 1 (1.1%) Ô‡ˆËÂÌÚ, ÚÓ„‰‡ Í‡Í ÔÓÒΠӷ¯ËÌ˚ı ÂÁÂ͈ËÈ – 7 (8.9%) ˜ÂÎÓ‚ÂÍ. èÓÒΠ‡Ò¯ËÂÌÌÓÈ ÉÉù ÛÏÂÎË 2 (11.7%) Ë ÔÓÒΠÔ‡‚ÓÒÚÓÓÌÌÂÈ ÉÉù – 5 (10.1%) ·ÓθÌ˚ı. ç‡Ë·ÓΠ˜‡ÒÚÓÈ Ô˘ËÌÓÈ ÔÓÒÎÂÓÔÂ‡ˆËÓÌÌÓÈ ÎÂڇθÌÓÒÚË
ÓÒÚ‡˛ÚÒfl ÓÒÎÓÊÌÂÌËfl, ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ Ò‚flÁ‡ÌÌ˚Â Ò ı‡‡ÍÚÂÓÏ ÓÔÂ‡ÚË‚ÌÓ„Ó ‚ϯ‡ÚÂθÒÚ‚‡.
éÚ‰‡ÎÂÌÌ˚ ÂÁÛθڇÚ˚ ·˚ÎË Ó·‡·ÓÚ‡Ì˚ ‚
··Ó‡ÚÓËË Ï‰ˈËÌÒÍÓÈ ÍË·ÂÌÂÚËÍË êéçñ
êÄåç Ò ÔÓÏÓ˘¸˛ ÔÓ„‡ÏÏ Ï‰ËÍÓ-·ËÓÎӄ˘ÂÒÍÓÈ ÒÚ‡ÚËÒÚËÍË ÄëíÄ Ì‡ èùÇå. Ç ÍÓÏÔÎÂÍÒ ËÒÒΉӂ‡ÌËfl ‚ıÓ‰ËÎË: 1) ÔÓ„‡Ïχ ÏÌÓ„ÓÏÂÌÓÈ
ÒÚ‡ÚËÒÚËÍË; 2) ÔÓ„‡Ïχ ‚˚ÊË‚‡ÂÏÓÒÚË ÓÌÍÓÎӄ˘ÂÒÍËı ·ÓθÌ˚ı ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ‡Á΢Ì˚ı
ÔËÁ̇ÍÓ‚.
ÑÓÒÚÓ‚ÂÌÓÒÚ¸ ‡Á΢ËÈ ‚ ̇¯ÂÏ ËÒÒΉӂ‡ÌËË
ÓÔ‰ÂÎfl·Ҹ Ò ÔÓÏÓ˘¸˛ ‰Ó‚ÂËÚÂθÌÓ„Ó ÍÓ˝ÙÙˈËÂÌÚ‡ t (ÍËÚÂËÈ ëÚ¸˛‰ÂÌÚ‡). ê‡Á΢Ëfl Ò˜ËÚ‡ÎËÒ¸ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚ÂÌ˚ÏË ÔË t > 2.0,
Ú.Â. Ò ÛÓ‚ÌÂÏ Á̇˜ËÏÓÒÚË p < 0.05 (95% ÚÓ˜ÌÓÒÚË).
Ç˚ÊË‚‡ÂÏÓÒÚ¸ ·ÓθÌ˚ı ‡ÒÒ˜ËÚ˚‚‡Î‡Ò¸ ÔÓ
Ú‡·Îˈ‡Ï ‰ÓÊËÚËfl (“Life-table”), ÔËÌflÚ˚ı åÂʉÛ̇Ó‰ÌÓÈ ‡ÒÒӈˇˆËÂÈ Á‰‡‚ÓÓı‡ÌÂÌËfl ‚ 1989 „.
‰Îfl ÓÌÍÓÎӄ˘ÂÒÍËı ·ÓθÌ˚ı.
èÓÒÎÂÊÂÌÌÓÒÚ¸ ·ÓθÌ˚ı ‚ ̇¯ÂÏ ËÒÒΉӂ‡ÌËË ÒÓÒÚ‡‚Ë· 94.3%.
êÂÁÛθڇÚ˚
Ç ËÒÒΉӂ‡ÌË ‚Íβ˜ÂÌÓ 232 Ô‡ˆËÂÌÚ‡, ̇ıӉ˂¯ËıÒfl ̇ ΘÂÌËË ‚ çàà äé êéçñ êÄåç
ËÏ. ç.ç. ÅÎÓıË̇ Ò 1985 ÔÓ 2002 „. ÔÓ ÔÓ‚Ó‰Û ÏÂÚ‡ÒÚ‡Ú˘ÂÒÍÓ„Ó ÔÓ‡ÊÂÌËfl Ô˜ÂÌË. ÇÒÂı ·ÓθÌ˚ı
12
100
Ï˚ ‡ÒÔ‰ÂÎËÎË Ì‡ 5 ÓÒÌÓ‚Ì˚ı „ÛÔÔ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ‚ˉ‡ ΘÂÌËfl.
Ç 1-˛ „ÛÔÔÛ ‚Íβ˜ÂÌ˚ ‚Ò 135 ·ÓθÌ˚ı, ÍÓÚÓ˚Ï ÔÓËÁ‚‰Â̇ ÔÂ‚˘̇fl ÂÁÂ͈Ëfl Ô˜ÂÌË
ÔÓ ÔÓ‚Ó‰Û ÏÂÚ‡ÒÚ‡ÁÓ‚ (114 Ò ËÁÓÎËÓ‚‡ÌÌ˚Ï ÔÓ‡ÊÂÌËÂÏ Ô˜ÂÌË Ë 21 Ò ÔÓ‡ÊÂÌËÂÏ Ô˜ÂÌË Ë ‚ÌÂÔ˜ÂÌÓ˜Ì˚ÏË ÏÂÚ‡ÒÚ‡Á‡ÏË).
ÇÓ 2-˛ „ÛÔÔÛ ‚Ó¯ÎÓ 114 ·ÓθÌ˚ı ÚÓθÍÓ Ò
ËÁÓÎËÓ‚‡ÌÌ˚Ï ÔÓ‡ÊÂÌËÂÏ Ô˜ÂÌË Ë ÔÓ‰‚Â„¯ËıÒfl ÂÁÂ͈ËË Ô˜ÂÌË ‡Á΢ÌÓ„Ó Ó·˙Âχ.
Ç 3-È „ÛÔÔ ·˚ÎÓ 9 Ô‡ˆËÂÌÚÓ‚, Û ÍÓÚÓ˚ı ÂÁÂ͈Ëfl Ô˜ÂÌË ÌÓÒË· Ô‡ÎΡÚË‚Ì˚È ı‡‡ÍÚÂ. Ç
‰‡ÌÌÓÈ „ÛÔÔÂ Û ·ÓθÌ˚ı ·˚ÎË ÓÒÚ‡‚ÎÂÌ˚ ÓÔ‰ÂÎflÂÏ˚ ÏÂÚ‡ÒÚ‡Á˚ ‚ ‰Û„Ëı Ó„‡Ì‡ı (΄ÍËÂ,
·˛¯Ë̇, ‚·„‡ÎˢÂ, Ô˜Â̸).
Ç 4-˛ „ÛÔÔÛ ‚Íβ˜ÂÌÓ 28 ÔÓÒÎÂÊÂÌÌ˚ı Ô‡ˆËÂÌÚÓ‚, Û ÍÓÚÓ˚ı ÔÓËÁ‚‰ÂÌÓ Û‰‡ÎÂÌË ÔÂ‚˘ÌÓ„Ó Ó˜‡„‡ ‚ ÚÓÎÒÚÓÈ Í˯ÍÂ. Ç Ô˜ÂÌË ÓÔ‰ÂÎflÎËÒ¸ ÒÓÎËÚ‡Ì˚ ËÎË Â‰ËÌ˘Ì˚ ÏÂÚ‡ÒÚ‡Á˚,
ÍÓÚÓ˚ ÏÓ„ÎË ·˚Ú¸ ÔÓ‰‚Â„ÌÛÚ˚ ıËÛ„˘ÂÒÍÓÏÛ ‚ÓÁ‰ÂÈÒڂ˲, ÌÓ ·ÓθÌ˚Ï ÔÓ ÚÓÈ ËÎË ËÌÓÈ Ô˘ËÌ ÔӂӉ˷Ҹ ÚÓθÍÓ ÒËÏÔÚÓχÚ˘ÂÒ͇fl ÚÂ‡ÔËfl.
Ç 5-˛ „ÛÔÔÛ ‚Ó¯ÂÎ 51 ˜ÂÎÓ‚ÂÍ. ì ˝ÚËı ·ÓθÌ˚ı Û‰‡ÎÂÌ ÔÂ‚˘Ì˚È Ó˜‡„ ‚ ÚÓÎÒÚÓÈ Í˯ÍÂ, ‚ Ëı
ΘÂÌËË ËÒÔÓθÁÓ‚‡ÎË ‡Á΢Ì˚ ÒıÂÏ˚ ıËÏËÓÚÂ‡ÔËË ÔÓ ÔÓ‚Ó‰Û ÒÓÎËÚ‡Ì˚ı Ë Â‰ËÌ˘Ì˚ı ÏÂÚ‡ÒÚ‡ÁÓ‚ ‚ Ô˜Â̸.
Ç˚ÊË‚‡ÂÏÓÒÚ¸ ‚ ˝ÚËı „ÛÔÔ‡ı Ô‰ÒÚ‡‚ÎÂ̇ ‚
Ú‡·Î. 2.
ç‡ËÎÛ˜¯‡fl 5-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸ ÓÚϘÂ̇
ÔË ıËÛ„˘ÂÒÍÓÏ Î˜ÂÌËË ËÁÓÎËÓ‚‡ÌÌÓ„Ó ÏÂÚ‡ÒÚ‡Ú˘ÂÒÍÓ„Ó ÔÓ‡ÊÂÌËfl Ô˜ÂÌË (37.5 ± 7.1%).
å‰ˇ̇ ‚˚ÊË‚‡ÂÏÓÒÚË ÒÓÒÚ‡‚Ë· 48.6 ± 0.7 ÏÂÒ.
ç‡ÏË Ôӂ‰ÂÌ ‡Ì‡ÎËÁ ·ÓΠ40 Ù‡ÍÚÓÓ‚, ÍÓÚÓ˚ ÏÓ„ÎË ËÏÂÚ¸ Á̇˜ÂÌË ‚ ÔÓ„ÌÓÁËÓ‚‡ÌËË
ÄççÄãõ ïàêìêÉàóÖëäéâ ÉÖèÄíéãéÉàà ÚÓÏ 8
‹1
2003
Ô˜Â̸
èÄíûíäé, ëÄÉÄâÑÄä
퇷Îˈ‡ 2. Ç˚ÊË‚‡ÂÏÓÒÚ¸ ·ÓθÌ˚ı ‡ÍÓÏ ÚÓÎÒÚÓÈ Í˯ÍË Ò ÏÂÚ‡ÒÚ‡Ú˘ÂÒÍËÏ ÔÓ‡ÊÂÌËÂÏ Ô˜ÂÌË ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ‚ˉ‡ ΘÂÌËfl
Çˉ ΘÂÌËfl
2 „Ó‰‡
3 „Ó‰‡
4 „Ó‰‡
5 ÎÂÚ
10 ÎÂÚ
å‰ˇ̇, ÏÂÒ
èÂ‚˘̇fl ÂÁÂ͈Ëfl Ô˜ÂÌË.
1-fl „ÛÔÔ‡, n = 135
61.4 ± 4.9
50.2 ± 5.3
46.3 ± 5.6
35.0 ± 6.5
15.3 ± 7.4
36.7 ± 2.3
êÂÁÂ͈Ëfl Ô˜ÂÌË ‡Á΢ÌÓ„Ó
Ó·˙Âχ. 2-fl „ÛÔÔ‡, n = 114
65.4 ± 5.2
52.8 ± 5.7
50.6 ± 6.0
37.5 ± 7.1
18.5 ± 8.0
48.6 ± 0.7
0
0
0
0
0
11.4 ± 0.9
ëËÏÔÚÓχÚ˘ÂÒ͇fl ÚÂ‡ÔËfl.
4-fl „ÛÔÔ‡, n = 28
18.4 ± 9.4
11.0 ± 8.0
11.0 ± 8.0
0
0
8.5 ± 1.2
ïËÏËÓÚÂ‡ÔËfl. 5-fl „ÛÔÔ‡, n = 51
25.5 ± 7.1
5.6 ± 3.8
2.8 ± 2.7
0
0
15.6 ± 0.9
è‡ÎΡÚË‚Ì˚ ‚ϯ‡ÚÂθÒÚ‚‡
̇ Ô˜ÂÌË. 3-fl „ÛÔÔ‡, n = 9
퇷Îˈ‡ 3. Ç˚ÊË‚‡ÂÏÓÒÚ¸ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ Ì‡Î˘Ëfl ·ËÎÓ·‡ÌÓ„Ó ÏÂÚ‡ÒÚ‡Ú˘ÂÒÍÓ„Ó ÔÓ‡ÊÂÌËfl Ô˜ÂÌË
1 „Ó‰
3 „Ó‰‡
4 „Ó‰‡
5 ÎÂÚ
óËÒÎÓ ‰ÓÎÂÈ
å‰ˇ̇, ÏÂÒ
%
1 (n = 114)
91.2 ± 2.8
50 ± 5.7
45.8 ± 6.0
34.7 ± 6.6
36.0 ± 5.6
2 Ò ‰‚ÛÏfl ÏÂÚ‡ÒÚ‡Á‡ÏË (n = 14)
91.7 ± 8.0
57.3 ± 8.0
57.3 ± 8.0
çÂÚ ‰‡ÌÌ˚ı
çÂÚ ‰‡ÌÌ˚ı
퇷Îˈ‡ 4. Ç˚ÊË‚‡ÂÏÓÒÚ¸ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ Ó·˙Âχ ‚ϯ‡ÚÂθÒÚ‚‡ Û ·ÓθÌ˚ı Ò ËÁÓÎËÓ‚‡ÌÌ˚Ï ÔÓ‡ÊÂÌËÂÏ
Ô˜ÂÌË
2 „Ó‰‡
3 „Ó‰‡
4 „Ó‰‡
5 ÎÂÚ
é·˙ÂÏ ÂÁÂ͈ËË Ô˜ÂÌË
å‰ˇ̇, ÏÂÒ
%
ÉÉù (n = 40)
66.3 ± 8.3
58.5 ± 9.0
58.5 ± 9.0
32.5 ± 10.9
51.9 ± 1.9
ê‡Ò¯ËÂÌ̇fl ÉÉù (n = 8)
50.0 ± 25.0
0
0
0
24.0 ± 6.0
ë„ÏÂÌÚ˝ÍÚÓÏËË (n = 42)
61.4 ± 8.7
43.8 ± 9.7
43.8 ± 9.7
43.8 ± 9.7
31.8 ± 4.5
ÄÚËÔ˘̇fl ÂÁÂ͈Ëfl (n = 24)
73.7 ± 10.1
66.0 ± 11.6
45.6 ± 14.4
45.6 ± 14.4
45.4 ± 6.8
Ú˜ÂÌËfl ÓÔÛıÓÎÂ‚Ó„Ó ÔÓˆÂÒÒ‡. àÁÛ˜ÂÌÌ˚ ÔËÁ̇ÍË ı‡‡ÍÚÂËÁÛ˛Ú ‡ÒÔÓÒÚ‡ÌÂÌÌÓÒÚ¸ ÔÂ‚˘ÌÓÈ ÓÔÛıÓÎË, ‡ÒÔÓÒÚ‡ÌÂÌÌÓÒÚ¸ Ó˜‡„Ó‚ ‚
Ô˜ÂÌË, ̇΢ˠ‚ÌÂÔ˜ÂÌÓ˜Ì˚ı ÏÂÚ‡ÒÚ‡ÁÓ‚,
‡‰ÂÍ‚‡ÚÌÓÒÚ¸ ‚˚ÔÓÎÌÂÌÌÓ„Ó ÓÔÂ‡ÚË‚ÌÓ„Ó ‚ϯ‡ÚÂθÒÚ‚‡, ·ËÓıËÏ˘ÂÒÍË ËÒÒΉӂ‡ÌËfl Ë ÔÓ͇Á‡ÚÂÎË ÛÓ‚Ìfl ÓÔÛıÓÎÂ‚Ó„Ó Ï‡ÍÂ‡ (êùÄ). ç‡ÏË
ËÁÛ˜ÂÌ˚ Ú‡ÍÊ ÌÂÍÓÚÓ˚ ÏÓÙÓÎӄ˘ÂÒÍËÂ
ÍËÚÂËË, ı‡‡ÍÚÂËÁÛ˛˘Ë ·ËÓÎӄ˘ÂÒÍË ÔËÁ̇ÍË ÓÔÛıÓÎË Ë Â‡ÍˆË˛ Ô˜ÂÌÓ˜ÌÓÈ Ô‡ÂÌıËÏ˚
̇ ÓÔÛıÓ΂˚È ÓÒÚ.
å˚ Ì ·Û‰ÂÏ ÔÓ‰Ó·ÌÓ ÓÒڇ̇‚ÎË‚‡Ú¸Òfl ̇
‚ÒÂı Ù‡ÍÚÓ‡ı ÔÓ„ÌÓÁ‡, ‡ Ô‰ÒÚ‡‚ËÏ ÚÓθÍÓ Ì‡Ë·ÓΠÒÔÓÌ˚ ËÎË Ï‡ÎÓËÁÛ˜ÂÌÌ˚Â.
Ç˚ÊË‚‡ÂÏÓÒÚ¸ ÔË ·ËÎÓ·‡ÌÓÏ ÔÓ‡ÊÂÌËË
ÓÚ‡ÊÂ̇ ‚ Ú‡·Î. 3. ÅÂÁÛÒÎÓ‚ÌÓ, ‚˚ÁÓ‚ÂÚ ÒÓÏÌÂÌË ÔÓÒÚÛÎ‡Ú Ó ÚÓÏ, ˜ÚÓ Ì‡Î˘Ë ·ËÎÓ·‡ÌÓ„Ó ÔÓ‡ÊÂÌËfl Ì ‚ÎËflÂÚ Ì‡ ÓÚ‰‡ÎÂÌÌ˚ ÂÁÛθڇÚ˚.
ÑÂÎÓ ‚ ÚÓÏ, ˜ÚÓ ˜¸ Ì ˉÂÚ Ó ÏÌÓÊÂÒÚ‚ÂÌÌ˚ı
ÏÂÚ‡ÒÚ‡Á‡ı Ò ÔÓ‡ÊÂÌËÂÏ Ó·ÂËı ‰ÓÎÂÈ. Ç ˝ÚÓÈ
„ÛÔÔ ÌÂÚ ‰‡Ê 2-ÎÂÚÌÂÈ ‚˚ÊË‚‡ÂÏÓÒÚË Ë ÓÔÂ‡ÄççÄãõ ïàêìêÉàóÖëäéâ ÉÖèÄíéãéÉàà ÚÓÏ 8
ˆËfl ÔË Ú‡ÍÓÈ ‡ÒÔÓÒÚ‡ÌÂÌÌÓÒÚË, Ò Ì‡¯ÂÈ ÚÓ˜ÍË ÁÂÌËfl, ÌÂÓÔ‡‚‰‡Ì̇. ì‰Ó‚ÎÂÚ‚ÓËÚÂθÌ˚Â
ÓÚ‰‡ÎÂÌÌ˚ ÂÁÛθڇÚ˚ ÓÚϘÂÌ˚ Û Ô‡ˆËÂÌÚÓ‚,
Ëϲ˘Ëı Ì ·ÓΠ2 Ó˜‡„Ó‚ ‚ ‡ÁÌ˚ı ‰ÓÎflı.
èÓÎÓ‚Ë̇ ËÁ 14 Ô‡ˆËÂÌÚÓ‚ Ò ·ËÎÓ·‡Ì˚Ï ÔÓ‡ÊÂÌËÂÏ Í Ì‡ÒÚÓfl˘ÂÏÛ ‚ÂÏÂÌË ÊË‚˚. ÑÓÒÚÓ‚ÂÌÓÈ ‡ÁÌˈ˚ ‚ ‚˚ÊË‚‡ÂÏÓÒÚË Ô‡ˆËÂÌÚÓ‚ Ò ÔÓ‡ÊÂÌËÂÏ Ó‰ÌÓÈ Ë ‰‚Ûı ‰ÓÎÂÈ Ì‡ÏË Ì ÔÓÎÛ˜ÂÌÓ.
ëÚÓθ ‚˚ÒÓÍËÈ ÔÓ͇Á‡ÚÂθ 4-ÎÂÚÌÂÈ ‚˚ÊË‚‡ÂÏÓÒÚË (57.3 ± 8.0%) ‚Ó ÏÌÓ„ÓÏ Ó·ÛÒÎÓ‚ÎÂÌ Ú˘‡ÚÂθÌ˚Ï ÓÚ·ÓÓÏ ·ÓθÌ˚ı ÔË ·ËÎÓ·‡ÌÓÏ ÔÓ‡ÊÂÌËË.
èÓ˜ÚË Û ÔÓÎÓ‚ËÌ˚ ·ÓθÌ˚ı ̇ÏË ÔÓËÁ‚‰Â̇
Ó·¯Ë̇fl ÂÁÂ͈Ëfl Ô˜ÂÌË (Ú‡·Î. 4).
ê‡ÁÌˈ‡ ÏÂÊ‰Û „ÛÔÔ‡ÏË ÉÉù, ‡Ì‡ÚÓÏ˘ÂÒÍËı Ë
‡ÚËÔ˘Ì˚ı ÂÁÂ͈ËÈ ÒÚ‡ÚËÒÚ˘ÂÒÍË Ì‰ÓÒÚÓ‚Â̇.
Ç˚ÊË‚‡ÂÏÓÒÚ¸ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ÍÓ‚ÓÔÓÚÂË
Ô‰ÒÚ‡‚ÎÂ̇ ‚ Ú‡·Î. 5.
èË ÍÓ‚ÓÔÓÚÂ ·ÓΠ2000 ÏÎ 5-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸ Ì Ô‚˚ÒË· 12.9 ± 8.0%, ˜ÚÓ ‰ÓÒÚÓ‚ÂÌÓ ÌËÊÂ, ˜ÂÏ ÔË ˝ÚÓÏ ÔÓ͇Á‡ÚÂΠÏÂÌÂÂ
‹1
2003
13
Ô˜Â̸
èéäÄáÄçàü à èêéíàÇéèéäÄáÄçàü ä êÖáÖäñàüå èÖóÖçà
퇷Îˈ‡ 5. Ç˚ÊË‚‡ÂÏÓÒÚ¸ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ÍÓ‚ÓÔÓÚÂË
1 „Ó‰
3 „Ó‰‡
4 „Ó‰‡
5 ÎÂÚ
äÓ‚ÓÔÓÚÂfl
å‰ˇ̇, ÏÂÒ
%
ÑÓ 1000 ÏÎ (n = 81)
éÚ 1100 ‰Ó 2000 ÏÎ (n = 34)
ÅÓÎÂÂ 2000 ÏÎ (n = 20)
91.5 ± 3.3
90 ± 5.4
84.2 ± 8.3
55.7 ± 7.0
52.1 ± 7.4
41.1 ± 9.0
50.3 ± 2.5
48.6
38.9 ± 12.2
35.0 ± 7.4*
25.8 ± 11.6*
12.9 ± 10.8*
21.7 ± 2.8*
48.6 ± 10.8
34.4 ± 12
* ê‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚Â̇ ÔË p < 0.05 ÔÓ Ò‡‚ÌÂÌ˲ Ò „ÛÔÔÓÈ ·ÓθÌ˚ı Ò ÍÓ‚ÓÔÓÚÂÂÈ ‰Ó 1 Î.
퇷Îˈ‡ 6. Ç˚ÊË‚‡ÂÏÓÒÚ¸ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ‡ÁÏÂ‡ ÒÓÎËÚ‡ÌÓ„Ó ÏÂÚ‡ÒÚ‡Á‡
1 „Ó‰
3 „Ó‰‡
4 „Ó‰‡
5 ÎÂÚ
ê‡ÁÏÂ ÒÓÎËÚ‡ÌÓ„Ó ÛÁ·
å‰ˇ̇, ÏÂÒ
%
ÑÓ 3 ÒÏ (n = 18)
93.7 ± 6.0
44.7 ± 14.4
44.7 ± 14.4
44.7 ± 14.4
29.7 ± 8.9
éÚ 3.1 ‰Ó 5 ÒÏ (n = 30)
96.4 ± 3.4
48.5 ± 10.6
32.3 ± 11.7
32.3 ± 11.7
35.3 ± 4.9
ÅÓÎÂÂ 5 ÒÏ (n = 40)
88.5 ± 5.3
61.8 ± 9.3
61.8 ± 9.3
47.3 ± 11.4
57.8 ± 7.8*
* ê‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚Â̇ ÔË p < 0.05 ÔÓ Ò‡‚ÌÂÌ˲ Ò „ÛÔÔÓÈ ·ÓθÌ˚ı Ò ÏÂÚ‡ÒÚ‡Á‡ÏË ‡ÁÏÂÓÏ ‰Ó 3 ÒÏ Ë ÓÚ 3
‰Ó 5 ÒÏ.
퇷Îˈ‡ 7. Ç˚ÊË‚‡ÂÏÓÒÚ¸ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ‚ˉ‡ ΘÂÌËfl
1 „Ó‰
3 „Ó‰‡
5 ÎÂÚ
Çˉ ΘÂÌËfl
å‰ˇ̇, ÏÂÒ
%
ïËÛ„˘ÂÒÍÓ (n = 46)
83.7 ± 5.6
37.2 ± 8.3
29.5 ± 8.1
28.1 ± 2.0
äÓÏ·ËÌËÓ‚‡ÌÌÓ (Ò ‡‰˙˛‚‡ÌÚÌÓÈ
ıËÏËÓÚÂ‡ÔËÂÈ) (n = 75)
96.8 ± 2.1
67.4 ± 7.1*
48.1 ± 12.6
58.8 ± 7.1*
* ê‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚Â̇ ÔË p < 0.05 ÔÓ Ò‡‚ÌÂÌ˲ Ò „ÛÔÔÓÈ ·ÓθÌ˚ı, ÍÓÚÓ˚Ï Ôӂ‰ÂÌÓ ıËÛ„˘ÂÒÍÓÂ
ΘÂÌËÂ.
2000 ÏÎ (p < 0.05). äÓ‚ÓÔÓÚÂfl ̇ÔflÏÛ˛ Ò‚flÁ‡Ì‡ Ò Ó·˙ÂÏÓÏ ÓÔÂ‡ÚË‚ÌÓ„Ó ‚ϯ‡ÚÂθÒÚ‚‡. ç‡
Ó·˙ÂÏ ÍÓ‚ÓÔÓÚÂË Ú‡ÍÊ ‚ÎËflÂÚ Á̇˜ËÚÂθÌÓÂ
ÍÓ΢ÂÒÚ‚Ó Ù‡ÍÚÓÓ‚ (Òԇ˜Ì˚È ÔÓˆÂÒÒ, Ò‚flÁ¸
ÓÔÛıÓÎË Ò ‚ÓÓÚ‡ÏË Ô˜ÂÌË, ÓÔ˚Ú ıËÛ„‡ Ë Ú.‰.).
LJÊÌÓÒÚ¸ ˝ÚÓ„Ó ÔÓ͇Á‡ÚÂÎfl ‚ÂҸχ ÛÒÎӂ̇. å˚
ıÓÚËÏ Ô˂Θ¸ ‚ÌËχÌË ÍÓÎ΄ Ë Í Ú‡ÍÓÏÛ ‡ÒÔÂÍÚÛ Á̇˜ËÚÂθÌÓÈ ÍÓ‚ÓÔÓÚÂË ÔË ÂÁÂ͈Ëflı
Ô˜ÂÌË.
Ä̇ÎËÁ ‚˚ÊË‚‡ÂÏÓÒÚË ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ‡ÁÏÂ‡ ÒÓÎËÚ‡ÌÓ„Ó ÏÂÚ‡ÒÚ‡Á‡ Û ·ÓθÌ˚ı Ò ËÁÓÎËÓ‚‡ÌÌ˚Ï ÔÓ‡ÊÂÌËÂÏ Ô˜ÂÌË Ô‰ÒÚ‡‚ÎÂÌ ‚
Ú‡·Î. 6.
ç‡ÏË Ì ÓÚϘÂÌÓ ‰ÓÒÚÓ‚ÂÌÓÈ ‡ÁÌˈ˚ ‚ ‚˚ÊË‚‡ÂÏÓÒÚË ÌË ‚ Ó‰ÌÓÈ ËÁ „ÛÔÔ ·ÓθÌ˚ı, ıÓÚfl
ωˇ̇ ‚˚ÊË‚‡ÂÏÓÒÚË ·˚· ̇˷Óθ¯ÂÈ Û ·ÓθÌ˚ı Ò Ó˜‡„‡ÏË ·ÓΠ5 ÒÏ Ë ‰ÓÒÚÓ‚ÂÌÓ ÓÚ΢‡Î‡Ò¸ ÓÚ ·ÓθÌ˚ı ‰‚Ûı ‰Û„Ëı „ÛÔÔ. ë Û˜ÂÚÓÏ ÚÓ„Ó, ˜ÚÓ Ë ‚˚ÊË‚‡ÂÏÓÒÚ¸ (ıÓÚfl Ë Ì‰ÓÒÚÓ‚ÂÌÓ)
·˚· ‚˚¯Â Û ·ÓθÌ˚ı Ò Ó˜‡„‡ÏË ·ÓΠ5 ÒÏ, ˝Ú‡
„ÛÔÔ‡ Ó͇Á‡Î‡Ò¸ Ò‡ÏÓÈ ·Î‡„ÓÔËflÚÌÓÈ. å˚ ¯ËÎË ‡ÁÓ·‡Ú¸Òfl Ò ‰‡ÌÌ˚Ï Ó·ÒÚÓflÚÂθÒÚ‚ÓÏ Ë
ÔÓ‚ÂÎË ‡Ì‡ÎËÁ Ó·˙Âχ ÓÔÂ‡ÚË‚Ì˚ı ‚ϯ‡14
ÚÂθÒÚ‚ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ‡ÁÏÂ‡ ÓÔÛıÓÎÂ‚Ó„Ó ÛÁ·. ì 36 ËÁ 40 Ô‡ˆËÂÌÚÓ‚, ÔÓ‰‚Â„¯ËıÒfl ÂÁÂ͈ËË
ÔÓ ÔÓ‚Ó‰Û ÒÓÎËÚ‡Ì˚ı ÏÂÚ‡ÒÚ‡ÁÓ‚ Ò ‡ÁÏÂÓÏ ·ÓΠ5 ÒÏ, ‚˚ÔÓÎÌÂ̇ Ó·¯Ë̇fl ÂÁÂ͈Ëfl Ô˜ÂÌË.
àÁ 30 ·ÓθÌ˚ı Ò ÒÓÎËÚ‡Ì˚ÏË ÛÁ·ÏË ÓÚ 3 ‰Ó 5 ÒÏ
Ó·¯Ë̇fl ÂÁÂ͈Ëfl ‚˚ÔÓÎÌÂ̇ ÚÓθÍÓ Û 4 Ô‡ˆËÂÌÚÓ‚. é·¯Ë̇fl ÂÁÂ͈Ëfl ÔË ÏÂÚ‡ÒÚ‡Á‡ı ‰Ó 3 ÒÏ
Ì ÔÓËÁ‚Ӊ˷Ҹ. èÓ˝ÚÓÏÛ Ô‡ÍÚ˘ÂÒÍË Ó‰Ë̇ÍÓ‚Û˛ ‚˚ÊË‚‡ÂÏÓÒÚ¸ ÔË ‡Á΢Ì˚ı ‡ÁÏÂ‡ı
ÓÔÛıÓÎÂ‚Ó„Ó ÛÁ· ÏÓÊÌÓ Ó·˙flÒÌËÚ¸ ‡‰ÂÍ‚‡ÚÌÓÒÚ¸˛ ÓÔÂ‡ÚË‚ÌÓ„Ó ‚ϯ‡ÚÂθÒÚ‚‡.
ä ıÓÓ¯ËÏ Ù‡ÍÚÓ‡Ï ÔÓ„ÌÓÁ‡ ÏÓÊÌÓ ÓÚÌÂÒÚË Ë Ôӂ‰ÂÌË ‡‰˙˛‚‡ÌÚÌÓÈ ıËÏËÓÚÂ‡ÔËË
(Ú‡·Î. 7).
èË ıËÛ„˘ÂÒÍÓÏ Ë ÍÓÏ·ËÌËÓ‚‡ÌÌÓÏ Î˜ÂÌËË (ÔÓÒÎÂÓÔÂ‡ˆËÓÌ̇fl ıËÏËÓÚÂ‡ÔËfl Ò ËÒÔÓθÁÓ‚‡ÌËÂÏ ÔÂÔ‡‡ÚÓ‚ 5-ÙÚÓÛ‡ˆË· Ë ÎÂÈÍÓ‚‡Ë̇. 1 ÍÛÒ „ËÓ̇ÌÓÈ ‚ÌÛÚˇÚÂˇθÌÓÈ
ıËÏËÓÚÂ‡ÔËË Ë 2 ÍÛÒ‡ ÒËÒÚÂÏÌÓÈ ıËÏËÓÚÂ‡ÔËË) 1-, 3- Ë 5-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸ ÒÓÒÚ‡‚Ë·
83.7 ± 5.6, 96.8 ± 2.1, 37.2 ± 8.3% Ë 67.4 ± 7.1,
29.5 ± 8.1 Ë 48.1 ± 12.6% ÒÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ. èÓÎÛ˜Â̇ ‰ÓÒÚÓ‚Â̇fl ‡ÁÌˈ‡ ‚ 3-ÎÂÚÌÂÈ ‚˚ÊË‚‡ÂÏÓÒÚË
ÄççÄãõ ïàêìêÉàóÖëäéâ ÉÖèÄíéãéÉàà ÚÓÏ 8
‹1
2003
Ô˜Â̸
èÄíûíäé, ëÄÉÄâÑÄä
퇷Îˈ‡ 8. Ç˚ÊË‚‡ÂÏÓÒÚ¸ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ı‡‡ÍÚÂ‡ ÓÒÚ‡ ÏÂÚ‡ÒÚ‡ÁÓ‚ ‚ Ô˜Â̸
1 „Ó‰
3 „Ó‰‡
4 „Ó‰‡
5 ÎÂÚ
ï‡‡ÍÚÂ ÓÒÚ‡
å‰ˇ̇, ÏÂÒ
%
ÄÔÔÓÁˈËÓÌÌ˚È (n = 21)
àÌÙËθÚ‡ÚË‚Ì˚È (n = 47)
ëϯ‡ÌÌ˚È (n = 15)
100
86 ± 5.2
92.5 ± 7.1
70.8 ± 12.5*
59.0 ± 15.0
59.0 ± 15.0
62.7 ± 1.8*
44.4 ± 8.1
44.4 ± 8.1
31.7 ± 13.2
22.4 ± 2.1
74.0 ± 13.0*
74.0 ± 13.0*
53.0 ± 20.1
çÂÚ ‰‡ÌÌ˚ı
* ê‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚Â̇ ÔË p < 0.05 ÔÓ Ò‡‚ÌÂÌ˲ Ò ·ÓθÌ˚ÏË Ò ËÌÙËθÚ‡ÚË‚Ì˚Ï ÓÒÚÓÏ.
퇷Îˈ‡ 9. Ç˚ÊË‚‡ÂÏÓÒÚ¸ ·ÓθÌ˚ı ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ Ì‡Î˘Ëfl ÙË·ÓÁÌÓÈ Í‡ÔÒÛÎ˚ ‚ÓÍÛ„ ÓÔÛıÓÎË
1 „Ó‰
3 „Ó‰‡
4 „Ó‰‡
5 ÎÂÚ
îË·ÓÁ̇fl ͇ÔÒÛ·
å‰ˇ̇, ÏÂÒ
%
éÚÒÛÚÒÚ‚ÛÂÚ (n = 58)
88.7 ± 4.3
54.7 ± 7.5
50 ± 8.2
31.8 ± 11.5
48.0 ± 12.6
ë··Ó ‚˚‡ÊÂ̇ (n = 10)
89.4 ± 10
65.6 ± 16.1
65.6 ± 16.1
65.6 ± 16.1
çÂÚ ‰‡ÌÌ˚ı
ìÏÂÂÌÌÓ ‚˚‡ÊÂ̇ (n = 7)
100
60 ± 22.0
60 ± 22.0
60 ± 22.0
çÂÚ ‰‡ÌÌ˚ı
êÂÁÍÓ ‚˚‡ÊÂ̇ (n = 8)
100
51.8 ± 24.8
51.8 ± 24.8
51.8 ± 24.8
çÂÚ ‰‡ÌÌ˚ı
95.5 ± 4.5
59.3 ± 12.2
59.3 ± 12.2
59.3 ± 10.2*
çÂÚ ‰‡ÌÌ˚ı
ÇÒÂ„Ó ·ÓθÌ˚ı Ò ÙË·ÓÁÌÓÈ
͇ÔÒÛÎÓÈ
* ê‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚Â̇ ÔË p < 0.05 ÔÓ Ò‡‚ÌÂÌ˲ Ò „ÛÔÔÓÈ ·ÓθÌ˚ı ·ÂÁ ÙË·ÓÁÌÓÈ Í‡ÔÒÛÎ˚.
퇷Îˈ‡ 10. Ç˚ÊË‚‡ÂÏÓÒÚ¸ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ÎËÏÙÓˉÌÓÈ ‡͈ËË Ú͇ÌÂÈ ‚ÓÍÛ„ ÓÔÛıÓÎË
1 „Ó‰
3 „Ó‰‡
4 „Ó‰‡
5 ÎÂÚ
ãËÏÙÓˉ̇fl ËÌÙËθÚ‡ˆËfl
å‰ˇ̇, ÏÂÒ
%
éÚÒÛÚÒÚ‚ÛÂÚ (n = 35)
87.6 ± 5.7
50.0 ± 9.7
43.3 ± 10.7
26.0 ± 11.3
36.1 ± 1.6
ë··Ó ‚˚‡ÊÂ̇ (n = 32)
93.1 ± 4.7
64.1 ± 9.6
64.1 ± 9.6
64.1 ± 9.6
çÂÚ ‰‡ÌÌ˚ı
ìÏÂÂÌÓ ‚˚‡ÊÂ̇ (n = 11)
90.5 ± 9.0
56.5 ± 9.0
56.5 ± 9.0
100
50.0 ± 35.3
50.0 ± 35.3
50.0 ± 35.3
36.0 ± 8.4
92.4 ± 4.2
58.0 ± 8.7
58.0 ± 8.7
58.0 ± 8.7*
çÂÚ ‰‡ÌÌ˚ı
êÂÁÍÓ ‚˚‡ÊÂ̇ (n = 5)
ÇÒÂ„Ó ·ÓθÌ˚ı Ò ÎËÏÙÓˉÌÓÈ
ËÌÙËθÚ‡ˆËÂÈ
çÂÚ ‰‡ÌÌ˚ı
* ê‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚Â̇ ÔË p < 0.05 ÔÓ Ò‡‚ÌÂÌ˲ Ò „ÛÔÔÓÈ ·ÓθÌ˚ı ·ÂÁ ÎËÏÙÓˉÌÓÈ ËÌÙËθÚ‡ˆËË ‚ÓÍÛ„
ÏÂÚ‡ÒÚ‡Ú˘ÂÒÍÓ„Ó ÛÁ·
Ë Ï‰ˇÌ ‚˚ÊË‚‡ÂÏÓÒÚË ÏÂÊ‰Û ‰‡ÌÌ˚ÏË „ÛÔÔ‡ÏË. àÁ Ô‰ÒÚ‡‚ÎÂÌÌ˚ı χÚÂˇÎÓ‚ Ә‚ˉÌÓ, ˜ÚÓ
‡‰˙˛‚‡ÌÚ̇fl ıËÏËÓÚÂ‡ÔËfl ÛÎÛ˜¯‡ÂÚ ÓÚ‰‡ÎÂÌÌ˚ ÂÁÛθڇÚ˚, Ô˘ÂÏ ÔË 3-ÎÂÚÌÂÈ ‚˚ÊË‚‡ÂÏÓÒÚË (ÍÓ„‰‡ „ÛÔÔ˚ ·Óθ¯Â Ë Ó¯Ë·Í‡ ÏÂ̸¯Â)
‡ÁÌˈ‡ Ó͇Á‡Î‡Ò¸ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚ÂÌÓÈ
(p < 0.05).
èӂ‰ÂÌ ‡Ì‡ÎËÁ ‚˚ÊË‚‡ÂÏÓÒÚË ‚ Á‡‚ËÒËÏÓÒÚË
ÓÚ ı‡‡ÍÚÂ‡ ÓÒÚ‡ ÏÂÚ‡ÒÚ‡ÁÓ‚ ‚ Ô˜Â̸ (Ú‡·Î. 8).
Ç˚‰ÂÎÂÌ˚ 3 „ÛÔÔ˚: ·ÓθÌ˚Â Ò ‡ÔÔÓÁˈËÓÌÌ˚Ï
ı‡‡ÍÚÂÓÏ ÓÒÚ‡, ·ÓθÌ˚Â Ò ËÌÙËθÚ‡ÚË‚Ì˚Ï
ı‡‡ÍÚÂÓÏ ÓÒÚ‡, ·ÓθÌ˚ ÒÓ Òϯ‡ÌÌ˚Ï ı‡‡ÍÚÂÓÏ ÓÒÚ‡.
ç‡Ë·ÓΠÔÓ͇Á‡ÚÂθ̇ 3-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸, ÍÓÚÓ‡fl Û ·ÓθÌ˚ı Ò ‡ÔÔÓÁˈËÓÌÌ˚Ï ı‡‡ÍÚÂÓÏ ÓÒÚ‡ ÒÓÒÚ‡‚Ë· 70.8 ± 12.5%, Ò ËÌÙËθÄççÄãõ ïàêìêÉàóÖëäéâ ÉÖèÄíéãéÉàà ÚÓÏ 8
Ú‡ÚË‚Ì˚Ï – 44.4 ± 8.1% Ë ÒÓ Òϯ‡ÌÌ˚Ï – 74.0 ±
± 13.0%. ê‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚Â̇ Û
·ÓθÌ˚ı Í‡Í Ò ‡ÔÔÓÁˈËÓÌÌ˚Ï, Ú‡Í Ë ÒÓ Òϯ‡ÌÌ˚Ï ı‡‡ÍÚÂÓÏ ÓÒÚ‡. í‡Í‡fl Ê ÚẨÂ̈Ëfl ÒÓı‡ÌË·Ҹ ‚ 4- Ë 5-ÎÂÚÌÂÈ ‚˚ÊË‚‡ÂÏÓÒÚË, ıÓÚfl
‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË Ì‰ÓÒÚÓ‚Â̇. ÑÓÒÚÓ‚Â̇
‡ÁÌˈ‡ ‚ ωˇÌ ‚˚ÊË‚‡ÂÏÓÒÚË.
ä ·Î‡„ÓÔËflÚÌ˚Ï ÔÓ„ÌÓÒÚ˘ÂÒÍËÏ Ù‡ÍÚÓ‡Ï
Ú‡ÍÊ ÓÚÌÓÒËÚÒfl ̇΢ˠÙË·ÓÁÌÓÈ Í‡ÔÒÛÎ˚ Ë
ÎËÏÙÓˉÌÓÈ ËÌÙËθÚ‡ˆËË ‚ÓÍÛ„ ÓÔÛıÓÎË
(Ú‡·Î. 9, 10).
àÁ Ô‰ÒÚ‡‚ÎÂÌÌ˚ı Ú‡·Îˈ Ә‚ˉÌÓ, ˜ÚÓ ÒÚÂÔÂ̸ ‚˚‡ÊÂÌÌÓÒÚË ˝ÚËı ‰‚Ûı ÔÓ͇Á‡ÚÂÎÂÈ ÌÂ
ËÏ· ÔË̈ËÔˇθÌÓ„Ó Á̇˜ÂÌËfl. ÅÂÁ ÙË·ÓÁÌÓÈ Í‡ÔÒÛÎ˚ Ë ÎËÏÙÓˉÌÓÈ ËÌÙËθÚ‡ˆËË 5-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸ ÒÓÒÚ‡‚Ë· 31.8 ± 11.5 Ë 26.0 ±
‹1
2003
15
Ô˜Â̸
èéäÄáÄçàü à èêéíàÇéèéäÄáÄçàü ä êÖáÖäñàüå èÖóÖçà
퇷Îˈ‡ 11. Ç˚ÊË‚‡ÂÏÓÒÚ¸ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ÍÓ΢ÂÒÚ‚‡ ÓÔÛıÓ΂˚ı ÛÁÎÓ‚ ‚ Ô˜ÂÌË
1 „Ó‰
3 „Ó‰‡
4 „Ó‰‡
5 ÎÂÚ
äÓ΢ÂÒÚ‚Ó ÛÁÎÓ‚
å‰ˇ̇, ÏÂÒ
%
ëÓÎËÚ‡Ì˚È (n = 88)
92.4 ± 3.0
53.1 ± 6.4
Ö‰ËÌ˘Ì˚ (n = 32)
92.9 ± 4.7
åÌÓÊÂÒÚ‚ÂÌÌ˚ (n = 15)
66.7 ± 13.6*
47.9 ± 6.7
40.8 ± 7.4
43.3 ± 10.1
51 ± 12.0
51.0 ± 12.0
17.0 ± 14.0
48.3 ± 0.6
26.7 ± 15.5
26.7 ± 15.5
8.8 ± 7.6*
17.0 ± 2.1*
* ê‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚Â̇ ÔË p < 0.05 ÔÓ Ò‡‚ÌÂÌ˲ Ò ·ÓθÌ˚ÏË Ò ÒÓÎËÚ‡Ì˚ÏË ÏÂÚ‡ÒÚ‡Á‡ÏË.
± 11.3%, ÔË Ì‡Î˘ËË ˝ÚËı ÔÓ͇Á‡ÚÂÎÂÈ – 59.3 ±
± 10.2 Ë 58.0 ± 8.7% ÒÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ. Ç Ó·ÂËı „ÛÔÔ‡ı ‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‰ÓÒÚÓ‚Â̇ (p < 0.05).
ä ıÓÓ¯ËÏ ÔÓ„ÌÓÒÚ˘ÂÒÍËÏ ÔËÁÌ‡Í‡Ï ÓÚÌÓÒËÚÒfl Ë ÓÚÒÛÚÒÚ‚Ë ËÌ‚‡ÁËË ÓÔÛıÓÎË ‚ ÒÓÒÛ‰˚. ÅÂÁ ËÌ‚‡ÁËË 5-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸ ÒÓÒÚ‡‚Ë· 48 ±
± 9.6%, Ò ËÌ‚‡ÁËÂÈ ‚ ÒÓÒÛ‰˚ – 23 ± 17.7%, ıÓÚfl ‡ÁÌˈ‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË Ì ‰ÓÒÚÓ‚Â̇. êÂÁÛθڇÚ˚
ΘÂÌËfl ·ÓθÌ˚ı Ò ÏÌÓÊÂÒÚ‚ÂÌÌ˚ÏË ÏÂÚ‡ÒÚ‡Á‡ÏË Ô‰ÒÚ‡‚ÎÂÌ˚ ‚ Ú‡·Î. 11. íË „Ó‰‡ ÔÓÊËÎË ÌÂ
·ÓΠ˜ÂÚ‚ÂÚË Ô‡ˆËÂÌÚÓ‚, ÔflÚ¸ ÎÂÚ 8.8 ± 7.6%,
˜ÚÓ ‰ÓÒÚÓ‚ÂÌÓ (p < 0.05) ÌËÊÂ, ˜ÂÏ ÔË ÒÓÎËÚ‡Ì˚ı Ë Â‰ËÌ˘Ì˚ı ÏÂÚ‡ÒÚ‡Á‡ı.
àÒÚËÌÌÓ ‚‡ÒÚ‡ÌË ÓÔÛıÓÎË ‚ ÒÓÒ‰ÌË ÒÚÛÍÚÛ˚ ‚ÒÚ˜‡ÂÚÒfl ‰ÍÓ. ó‡˘Â ÔÓ‡Ê‡˛ÚÒfl ‰Ë‡Ù‡„χ, Ô‡‚˚È Ì‡‰ÔӘ˜ÌËÍ, ÌËÊÌflfl ÔÓ·fl ‚Â̇,
ÚÓÌ͇fl Í˯͇. àÁ 13 ˜ÂÎÓ‚ÂÍ ˝ÚÓÈ „ÛÔÔ˚ 5 ÎÂÚ
Ì ÔÓÊËÎ ÌË Ó‰ËÌ ·ÓθÌÓÈ. 3-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸ ÒÓÒÚ‡‚Ë· 11.1 ± 10.0%. ÇÓ ‚ÂÏfl ÓÔÂ‡ˆËË
Ì ‚Ò„‰‡ ÏÓÊÌÓ ÓÔ‰ÂÎËÚ¸, ˜ÚÓ ËÏÂÂÚÒfl ËÒÚËÌÌÓ ‚‡ÒÚ‡ÌË ÓÔÛıÓÎË. éÚ͇Á˚‚‡Ú¸ ·ÓθÌÓÏÛ ‚
ÓÔÂ‡ˆËË ÔË ÔÓ‰ÓÁÂÌËË Ì‡ ‚ӂΘÂÌË ‚ ÓÔÛıÓ΂˚È ÔÓˆÂÒÒ ÒÓÒ‰ÌËı ÒÚÛÍÚÛ ÌÂÓÔ‡‚‰‡ÌÌÓ.
ç‡ ÔÓ„ÌÓÁ ‚ÎËflÂÚ Ë ‡‰Ë͇ÎËÁÏ ‚˚ÔÓÎÌÂÌÌÓ„Ó ‚ϯ‡ÚÂθÒÚ‚‡. í‡Í, ÔË ‡ÒÒÚÓflÌËË ÓÔÛıÓÎË
ÓÚ Í‡fl ÂÁÂ͈ËË ÏÂÌ 1 ÒÏ 3-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸ Ì Ô‚˚ÒË· 22.3 ± 8.7%.
èË ÔÓ‰ÓÁÂÌËË Ì‡ ÏÂÚ‡ÒÚ‡Á˚ ‚ ÎËÏÙÓÛÁÎ˚
ÔÓËÁ‚Ӊ˷Ҹ ÎËÏÙÓ‰ËÒÒÂ͈Ëfl „ÂÔ‡ÚÓ‰ÛÓ‰Â̇θÌÓÈ Ò‚flÁÍË. ì 12 ˜ÂÎÓ‚ÂÍ ÏÂÚ‡ÒÚ‡Ú˘ÂÒÍËÈ
ÔÓˆÂÒÒ ·˚Î ÔÓ‰Ú‚ÂʉÂÌ ÔË „ËÒÚÓÎӄ˘ÂÒÍÓÏ
ËÒÒΉӂ‡ÌËË. àÁ ÌËı ÚÓθÍÓ 1 Ô‡ˆËÂÌÚ͇ ÔÓÊË· ·ÓΠ2 ÎÂÚ. óÂÂÁ 25 ÏÂÒ ÔÓÒΠÂÁÂ͈ËË Ô˜ÂÌË Û Ì ‚˚fl‚ÎÂÌ˚ ÏÌÓÊÂÒÚ‚ÂÌÌ˚ ÏÂÚ‡ÒÚ‡Á˚ ‚
΄ÍËÂ. Ç Ú˜ÂÌË 3 ÎÂÚ ÂÈ ÏÌÓ„ÓÍ‡ÚÌÓ ÔӂӉ˷Ҹ ıËÏËÓÚÂ‡ÔËfl Ò ‚˚‡ÊÂÌÌ˚Ï ÚÂ‡Ô‚Ú˘ÂÒÍËÏ ˝ÙÙÂÍÚÓÏ. ÅÓθ̇fl ÛÏÂ· ÓÚ ÔÓ„ÂÒÒËÓ‚‡ÌËfl Á‡·Ó΂‡ÌËfl ˜ÂÂÁ 62 ÏÂÒ ÔÓÒΠ‚ϯ‡ÚÂθÒÚ‚‡ ̇ Ô˜ÂÌË. ÑÎËÚÂθ̇fl ‚˚ÊË‚‡ÂÏÓÒÚ¸ ‚
‰‡ÌÌÓÏ Ì‡·Î˛‰ÂÌËË Ó·ÛÒÎÓ‚ÎÂ̇ ‚ ÔÂ‚Û˛ Ó˜Â‰¸ ‚˚ÒÓÍÓÈ ˜Û‚ÒÚ‚ËÚÂθÌÓÒÚ¸˛ ÓÔÛıÓÎË Í ıËÏËÓÚÂ‡ÔËË.
àÁ 9 ˜ÂÎÓ‚ÂÍ Ò ‚ÌÂÔ˜ÂÌÓ˜Ì˚ÏË „ÂχÚÓ„ÂÌÌ˚ÏË ÏÂÚ‡ÒÚ‡Á‡ÏË ÚÓθÍÓ Û 4 ˝ÚÓ Ó˜‡„ ‚˚fl‚ÎÂÌ ÒËÌıÓÌÌÓ Ò ÏÂÚ‡ÒÚ‡ÁÓÏ ‚ Ô˜ÂÌË. çË Ó‰ËÌ ËÁ ÌËı ÌÂ
‰ÓÊËÎ ‰Ó 2 ÎÂÚ. èË ÏÂÚ‡ıÓÌÌ˚ı ÏÂÚ‡ÒÚ‡Á‡ı ‚ÒÂ
Ô‡ˆËÂÌÚ˚ ÊË‚˚, Ô˘ÂÏ Ò ÏÓÏÂÌÚ‡ ÂÁÂ͈ËË ÔÂ16
˜ÂÌË ÔÓ¯ÎÓ ·ÓΠ3 ÎÂÚ Û 4 ·ÓθÌ˚ı, ‡ 1 ËÁ ÌËı
ÔÓÊË· ·ÓΠ5 ÎÂÚ.
é·ÒÛʉÂÌËÂ
ë‰Ìflfl ÔÓ‰ÓÎÊËÚÂθÌÓÒÚ¸ ÊËÁÌË ·ÓθÌ˚ı Ò
ÏÂÚ‡ÒÚ‡Á‡ÏË ‚ Ô˜Â̸ ‡Í‡ ÚÓÎÒÚÓÈ Í˯ÍË ÒÓÒÚ‡‚ÎflÂÚ ÏÂÌ 2 ÎÂÚ. èÓÒΠıËÛ„˘ÂÒÍÓ„Ó Î˜ÂÌËfl
5-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸ ÍÓηÎÂÚÒfl ÓÚ 20 ‰Ó 40%.
ê‡ÁÌˈ‡ ‚ ‚˚ÊË‚‡ÂÏÓÒÚË ‚ Á̇˜ËÚÂθÌÓÈ ÒÚÂÔÂÌË
Ó·ÛÒÎÓ‚ÎÂ̇ ‡Á΢Ì˚ÏË ÍËÚÂËflÏË ÔË ÓÚ·ÓÂ
·ÓθÌ˚ı ‰Îfl ÂÁÂ͈ËË Ô˜ÂÌË. çÂÍÓÚÓ˚ ËÒÒΉӂ‡ÌËfl ‰‡˛Ú ÌÂÒÍÓθÍÓ ÎÛ˜¯Ë ÂÁÛθڇÚ˚, ÍÓÚÓ˚ ‰ÓÒÚË„‡˛Ú 51% 5-ÎÂÚÌÂÈ ‚˚ÊË‚‡ÂÏÓÒÚË
ÔË Ò‰ÌÂÈ ÔÓ‰ÓÎÊËÚÂθÌÓÒÚË ÊËÁÌË ÓÚ 26 ‰Ó
59 ÏÂÒflˆÂ‚ [11].
Ç Ì‡ÒÚÓfl˘Â ‚ÂÏfl ÒÛ˘ÂÒÚ‚ÛÂÚ ÌÂÒÍÓθÍÓ Ì‡Ë·ÓΠ˜‡ÒÚÓ ˆËÚËÛÂÏ˚ı ‡·ÓÚ ÔÓÒ‚fl˘ÂÌÌ˚ı
Ù‡ÍÚÓ‡Ï ÔÓ„ÌÓÁ‡ [5, 9, 10, 13, 16, 17]. Ç êÓÒÒËË
Î˯¸ ‰ËÌ˘Ì˚ ÍÎËÌËÍË ËÏÂ˛Ú ‰ÓÒÚ‡ÚÓ˜Ì˚È
χÚÂˇΠ‰Îfl Ôӂ‰ÂÌËfl ÒÚÓθ „ÎÛ·ÓÍÓ„Ó ‡Ì‡ÎËÁ‡ [1]. åÌÓ„Ë ·Î‡„ÓÔËflÚÌ˚ هÍÚÓ˚ ıÓÓ¯Ó
ËÁ‚ÂÒÚÌ˚: ËÁÓÎËÓ‚‡ÌÌÓ ÔÓ‡ÊÂÌË Ô˜ÂÌË,
ÛÓ‚Â̸ êùÄ ‰Ó 100 Ì„/ÏÎ, ÒÓÎËÚ‡Ì˚Â Ë Â‰ËÌ˘Ì˚ ÛÁÎ˚ ‚ Ô˜ÂÌË, ‡ÒÒÚÓflÌË ÓÚ ÓÔÛıÓÎË ‰Ó Í‡fl
ÂÁÂ͈ËË ·ÓΠ1 ÒÏ.
å˚ ‡Á‰ÂÎflÂÏ ÏÌÂÌË ·Óθ¯ËÌÒÚ‚‡ ‡‚ÚÓÓ‚ Ó
ÚÓÏ, ˜ÚÓ Ì‡Î˘Ë 3 Ë ·ÓΠÏÂÚ‡ÒÚ‡ÁÓ‚ fl‚ÎflÂÚÒfl
Ì··„ÓÔËflÚÌ˚Ï Ù‡ÍÚÓÓÏ [17], ÌÓ Ì Òӄ·ÒÌ˚,
˜ÚÓ 5-ÎÂÚÌÂÈ ‚˚ÊË‚‡ÂÏÓÒÚË ‚ ‰‡ÌÌÓÈ „ÛÔÔ ÌÂÚ
[6, 7]. é‰Ì‡ÍÓ ÌÂÍÓÚÓ˚ ‡·ÓÚ˚ ÔÓ͇Á˚‚‡˛Ú,
˜ÚÓ ÌÂÚ ‰ÓÒÚÓ‚ÂÌÓÈ ‡ÁÌˈ˚ ‚ ÔÓ‰ÓÎÊËÚÂθÌÓÒÚË ÊËÁÌË Ô‡ˆËÂÌÚÓ‚, Ëϲ˘Ëı ÚË Ë ·ÓΠÏÂÚ‡ÒÚ‡ÁÓ‚, ÔÓ Ò‡‚ÌÂÌ˲ Ò Ô‡ˆËÂÌÚ‡ÏË, Ëϲ˘ËÏË
ÒÓÎËÚ‡ÌÓ ÔÓ‡ÊÂÌË Ô˜ÂÌË [16].
чÊ ÔË Ú‡ÍÓÏ Ù‡ÍÚÓ ÔÓ„ÌÓÁ‡, Í‡Í ‡ÒÒÚÓflÌË ÓÚ ÓÔÛıÓÎË ‰Ó Í‡fl ÂÁÂ͈ËË, Óθ ÍÓÚÓÓ„Ó Ï‡ÎÓ ÓÒÔ‡Ë‚‡ÂÚÒfl, ÌÂÍÓÚÓ˚ ıËÛ„Ë ÓÔ‡‚‰˚‚‡˛Ú “‚˚ÎÛ˘Ë‚‡ÌË” ÓÔÛıÓÎË ËÁ Ô‡ÂÌıËÏ˚ Ô˜ÂÌË.
å˚ Ì ̇¯ÎË ‰ÓÒÚÓ‚ÂÌÓÈ ‡ÁÌˈ˚ ‚ ‚˚ÊË‚‡ÂÏÓÒÚË ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ Ó·˙Âχ ÂÁÂ͈ËË Ô˜ÂÌË. èË Ì·Óθ¯Ëı ÏÂÚ‡ÒÚ‡Á‡ı ‚ÓÁÏÓÊÌÓ ‚˚ÔÓÎÌÂÌË ˝ÍÓÌÓÏÌÓÈ ÂÁÂ͈ËË Ô˜ÂÌË Ò „‡ÌˈÂÈ ÂÂ
Ì ÏÂÌ 1 ÒÏ ÓÚ Í‡fl ÓÔÛıÓÎË. Ç˚·Ó Ó·˙Âχ
ÓÔÂ‡ÚË‚ÌÓ„Ó ‚ϯ‡ÚÂθÒÚ‚‡ ÓÔ‰ÂÎflÂÚÒfl ‡ÒÔÓÒÚ‡ÌÂÌÌÓÒÚ¸˛ ÓÔÛıÓÎÂ‚Ó„Ó ÔÓˆÂÒÒ‡. ñÂÎÂÒÓÓ·‡ÁÌÓÒÚ¸ ‚˚ÔÓÎÌÂÌËfl Ó·¯ËÌÓÈ ÂÁÂ͈ËË
ÄççÄãõ ïàêìêÉàóÖëäéâ ÉÖèÄíéãéÉàà ÚÓÏ 8
‹1
2003
Ô˜Â̸
èÄíûíäé, ëÄÉÄâÑÄä
Ô˜ÂÌË, ÍÓ„‰‡ ÚÂıÌ˘ÂÒÍË ‚ÓÁÏÓÊ̇ ˝ÍÓÌÓÏ̇fl
ÂÁÂ͈Ëfl, Ú·ÛÂÚ ‰ÓÔÓÎÌËÚÂθÌÓ„Ó ËÁÛ˜ÂÌËfl.
çÂÍÓÚÓ˚ ‡‚ÚÓ˚ ÔÓÎÌÓÒÚ¸˛ ÓÚ‚Â„‡˛Ú ˆÂÎÂÒÓÓ·‡ÁÌÓÒÚ¸ ıËÛ„˘ÂÒÍÓ„Ó ‚ϯ‡ÚÂθÒÚ‚‡
ÔË Ì‡Î˘ËË ‚ÌÂÔ˜ÂÌÓ˜Ì˚ı Ó˜‡„Ó‚ ÔË ÍÓÎÓÂÍڇθÌÓÏ ‡ÍÂ. ÑÛ„Ë ÛÚ‚Âʉ‡˛Ú, ˜ÚÓ Û Ì·Óθ¯ÓÈ „ÛÔÔ˚ Ô‡ˆËÂÌÚÓ‚ ̇΢ˠËÁÓÎËÓ‚‡ÌÌ˚ı
Ó˜‡„Ó‚ ‚ ΄ÍÓÏ, fl˘ÌËÍ Ì fl‚ÎflÂÚÒfl ÔÓÚË‚ÓÔÓ͇Á‡ÌËÂÏ Ë ‚ ͇˜ÂÒÚ‚Â ‡„ÛÏÂÌÚ‡ ‰ÂÏÓÌÒÚËÛ˛Ú
5-ÎÂÚÌ˛˛ ‚˚ÊË‚‡ÂÏÓÒÚ¸ [3, 15]. ç‡¯Ë ‰‡ÌÌ˚Â
ÔÓÁ‚ÓÎfl˛Ú Ò˜ËÚ‡Ú¸, ˜ÚÓ ÓÔÂ‡ÚË‚ÌӠΘÂÌË ÔË
ÒËÌıÓÌÌ˚ı ‚ÌÂÔ˜ÂÌÓ˜Ì˚ı ÌÂÛ‰‡ÎËÏ˚ı „ÂχÚÓ„ÂÌÌ˚ı ÏÂÚ‡ÒÚ‡Á‡ı ÌÂÓÔ‡‚‰‡ÌÌÓ. èË ‚ÓÁÏÓÊÌÓÒÚË Ëı Û‰‡ÎÂÌËfl ıËÛ„˘ÂÒÍÓ ‚ϯ‡ÚÂθÒÚ‚Ó
ÒÚ‡ÌÓ‚ËÚÒfl ˆÂÎÂÒÓÓ·‡ÁÌ˚Ï, Ú‡Í Í‡Í ‚ ˜‡ÒÚË Ì‡·Î˛‰ÂÌËÈ ÏÓÊÌÓ ‰Ó·ËÚ¸Òfl Á̇˜ËÚÂθÌÓ„Ó ÔÓ‰ÎÂÌËfl ÊËÁÌË.
êÂÁÂ͈Ëfl Ô˜ÂÌË Î˛·Ó„Ó Ó·˙Âχ ‰ÓÎÊ̇ ̇˜Ë̇ڸÒfl Ò ÎËÏÙÓ‰ËÒÒÂ͈ËË Â ‚ÓÓÚ Ò ÔÓÒÎÂ‰Û˛˘ËÏ Ú˘‡ÚÂθÌ˚Ï ÏÓÙÓÎӄ˘ÂÒÍËÏ ËÒÒΉӂ‡ÌËÂÏ Û‰‡ÎÂÌÌÓ„Ó ÍÓÏÔÎÂÍÒ‡. ç‡Î˘Ë ÎËÏÙÓ„ÂÌÌ˚ı ÏÂÚ‡ÒÚ‡ÁÓ‚ ‚ ӷ·ÒÚË „ÂÔ‡ÚÓ‰ÛÓ‰Â̇θÌÓÈ
Ò‚flÁÍË Á̇˜ËÚÂθÌÓ ÛıÛ‰¯‡ÂÚ ÔÓ„ÌÓÁ Á‡·Ó΂‡ÌËfl.
Ç ·Óθ¯ÓÏ ËÒÒΉӂ‡ÌËË [8] ̇ 1001 ÂÁÂÍˆË˛
Ô˜ÂÌË ‡‚ÚÓ˚ ‚˚‰ÂÎËÎË „ÛÔÔÛ Ô‡ˆËÂÌÚÓ‚ Ò Ì‡Ë·ÓΠ̷·„ÓÔËflÚÌ˚ÏË Ù‡ÍÚÓ‡ÏË ÔÓ„ÌÓÁ‡. ä
ÌËÏ ÓÚÌÂÒÂÌ˚: ‡ÁÏÂ ÓÔÛıÓÎË ·ÓΠ5 ÒÏ, ‚˚fl‚ÎÂÌË ÏÂÚ‡ÒÚ‡Á‡ ‚ Ô˜Â̸ ‚ Ú˜ÂÌË 12 ÏÂÒ ÔÓÒÎÂ
Û‰‡ÎÂÌËfl ÔÂ‚˘ÌÓÈ ÓÔÛıÓÎË, ·ÓΠ˜ÂÏ 1 ÏÂÚ‡ÒÚ‡Á ‚ Ô˜Â̸, ̇΢ˠÏÂÚ‡ÒÚ‡ÁÓ‚ ‚ ÎËÏÙÓÛÁ·ı
ÔÂ‚˘ÌÓ„Ó Ó˜‡„‡, ‰ÓÓÔÂ‡ˆËÓÌÌÓÈ ÛÓ‚Â̸ êùÄ
·ÓΠ200 Ì„/ÏÎ. é‰Ì‡ÍÓ ‡‚ÚÓ˚ ÔÓ͇Á‡ÎË, ˜ÚÓ Ì‡Î˘Ë ÚÓθÍÓ Ó‰ÌÓ„Ó ËÁ ÓÔËÒ‡ÌÌ˚ı ÔËÁ̇ÍÓ‚ ÌÂ
ÏÓÊÂÚ ·˚Ú¸ ÓÒÌÓ‚‡ÌËÂÏ ‰Îfl ÓÚ͇Á‡ ÓÚ ÓÔÂ‡ˆËË,
Ú‡Í Í‡Í ÔË ˝ÚËı ÔËÁ͇̇ı ‚ÓÁÏÓÊ̇ 5-ÎÂÚÌflfl
‚˚ÊË‚‡ÂÏÓÒÚ¸. ç‡ ÓÒÌÓ‚‡ÌËË ˝ÚËı ÔËÁ̇ÍÓ‚ ‡‚ÚÓÓÏ Ô‰ÎÓÊÂ̇ ¯Í‡Î‡ ÍÎËÌ˘ÂÒÍÓ„Ó ËÒ͇,
ÔÓÁ‚ÓÎfl˛˘‡fl ÒÔÓ„ÌÓÁËÓ‚‡Ú¸ ‰‡Î¸ÌÂȯ ژÂÌË ÓÔÛıÓÎÂ‚Ó„Ó ÔÓˆÂÒÒ‡. ä‡Ê‰˚È ÔËÁÌ‡Í Ò˜ËÚ‡ÂÚÒfl Í‡Í 1 Ó˜ÍÓ. èË Á̇˜ÂÌËË 2 ÂÁÂ͈Ëfl ˉ‡θ̇. èË Á̇˜ÂÌËË 3–4 ÔÓ„ÌÓÁ ÏÂÌ ·Î‡„ÓÔËflÚÂÌ, ÌÓ Ô‡ˆËÂÌÚ˚ ÌÛʉ‡˛ÚÒfl ‚ Ôӂ‰ÂÌËË
‡‰˙˛‚‡ÌÚÌÓÈ ıËÏËÓÚÂ‡ÔËË. ÑÎfl Á̇˜ÂÌËfl 5 ÌÂÚ
ÓÚ‰‡ÎÂÌÌÓÈ ‚˚ÊË‚‡ÂÏÓÒÚË [8].
ç ‚Ò„‰‡ ·ÓθÌ˚Â, ‰‡ÊÂ Ò Ì·Óθ¯ËÏË ÏÂÚ‡ÒÚ‡Á‡ÏË, ÏÓ„ÛÚ ÔÓÊËÚ¸ 3–5 ÎÂÚ. èÓ„ÂÒÒËÓ‚‡ÌË Á‡·Ó΂‡ÌËfl ̇ÒÚÛÔ‡ÂÚ ‚ ÍÓÓÚÍË ÒÓÍË ÔÓÒΠıËÛ„˘ÂÒÍÓ„Ó ‚ϯ‡ÚÂθÒÚ‚‡. ùÚÓ Á‡ÒÚ‡‚ÎflÂÚ ËÒ͇ڸ ÌÓ‚˚ هÍÚÓ˚, ı‡‡ÍÚÂËÁÛ˛˘ËÂ
·ËÓÎӄ˘ÂÒÍË ÓÒÓ·ÂÌÌÓÒÚË ÓÔÛıÓÎË. ç‡ÏË ÔÓÎÛ˜ÂÌ˚ ‰‡ÌÌ˚Â Ó ˆÂÌÌÓÒÚË Ú‡ÍËı ÏÓÙÓÎӄ˘ÂÒÍËı
ÍËÚÂË‚, Í‡Í Ì‡Î˘Ë ͇ÔÒÛÎ˚, ̇΢ˠÎËÏÙÓˉÌÓÈ ËÌÙËθÚ‡ˆËË ‚ÓÍÛ„ ÓÔÛıÓÎË, ı‡‡ÍÚÂ
ÓÒÚ‡ ÓÔÛıÓÎË, ËÌ‚‡ÁËfl ÓÔÛıÓÎË ‚ ÒÓÒÛ‰˚. ùÚÛ
ÚÓ˜ÍÛ ÁÂÌËfl ‡Á‰ÂÎfl˛Ú I. Nagashima Ë ÒÓ‡‚Ú. [12].
Ç Ëı ‡·ÓÚ ÔÓ͇Á‡Ì‡ Á‡‚ËÒËÏÓÒÚ¸ ÏÂÊ‰Û ‚˚ÊË‚‡ÂÏÓÒÚ¸˛ Ë ÏÓÙÓÎӄ˘ÂÒÍËÏË ı‡‡ÍÚÂËÒÚË͇ÏË ÓÔÛıÓÎÂ‚Ó„Ó ÔÓˆÂÒÒ‡.
ÄççÄãõ ïàêìêÉàóÖëäéâ ÉÖèÄíéãéÉàà 2
ÚÓÏ 8
á‡Íβ˜ÂÌËÂ
ë Û˜ÂÚÓÏ ÔÓÎÛ˜ÂÌÌ˚ı ̇ÏË ‰‡ÌÌ˚ı ‚Ò هÍÚÓ˚ ÔÓ„ÌÓÁ‡ ‰ÂÎflÚÒfl ̇ 4 ÓÒÌÓ‚Ì˚ „ÛÔÔ˚.
1. î‡ÍÚÓ˚, ÒÛ˘ÂÒÚ‚ÂÌÌÓ Ì ‚ÎËfl˛˘Ë ̇ ‚˚ÊË‚‡ÂÏÓÒÚ¸, Ëı ̇Î˘Ë Ì Ò͇Á˚‚‡ÂÚÒfl ̇ ÓÚ‰‡ÎÂÌÌ˚ı ÂÁÛθڇڇı. ùÚÓ ÔÓÎ, ‚ÓÁ‡ÒÚ, ÎÓ͇ÎËÁ‡ˆËfl ÔÂ‚˘ÌÓ„Ó Ó˜‡„‡, ÒÓÍ ‚˚fl‚ÎÂÌËfl ÏÂÚ‡ÒÚ‡Á‡
‚ Ô˜Â̸, ·ËÎÓ·‡ÌÓ ÔÓ‡ÊÂÌË ( ÔË Ì‡Î˘ËË ÌÂ
·ÓΠ‰‚Ûı Ó˜‡„Ó‚), ‡ÁÏÂ ÒÓÎËÚ‡ÌÓ„Ó ÛÁ·,
Ó·˙ÂÏ ÓÔÂ‡ÚË‚ÌÓ„Ó ‚ϯ‡ÚÂθÒÚ‚‡ (ÍÓÏ ‡Ò¯ËÂÌÌ˚ı ÉÉù Ë ÔË Òӷβ‰ÂÌËË ‡‰ÂÍ‚‡ÚÌÓ„Ó
‡ÒÒÚÓflÌËfl ÎËÌËË ÂÁÂ͈ËË ÓÚ ÓÔÛıÓÎË).
2. Å·„ÓÔËflÚÌ˚ ÔÓ„ÌÓÒÚ˘ÂÒÍË هÍÚÓ˚,
ÔË Ì‡Î˘ËË ÍÓÚÓ˚ı ‚ÓÁÏÓÊÌÓ Ì‡‰ÂflÚ¸Òfl ̇
5-ÎÂÚÌ˛˛ ‚˚ÊË‚‡ÂÏÓÒÚ¸ ·ÓΠ˜ÂÏ Û 40% ·ÓθÌ˚ı. ä ÌËÏ ÓÚÌÓÒflÚÒfl: ËÁÓÎËÓ‚‡ÌÌÓ ÔÓ‡ÊÂÌËÂ
Ô˜ÂÌË, ‡‰˙˛‚‡ÌÚ̇fl ıËÏËÓÚÂ‡ÔËfl, ÛÓ‚Â̸
êùÄ ‰Ó 100 Ì„/ÏÎ, ÛÓ‚Â̸ ˘ÂÎÓ˜ÌÓÈ ÙÓÒÙ‡Ú‡Á˚
ÏÂÌ 1000 Ö/Î, ÍÓ‚ÓÔÓÚÂfl ‰Ó 1000 ÏÎ, ÒÓÎËÚ‡Ì˚ ÛÁÎ˚ ‚ Ô˜ÂÌË, ‡ÒÒÚÓflÌË ÓÚ ÓÔÛıÓÎË ‰Ó Í‡fl
ÂÁÂ͈ËË ·ÓΠ1 ÒÏ, ‡ÔÔÓÁˈËÓÌÌ˚È Ë Òϯ‡ÌÌ˚È ÓÒÚ ÓÔÛıÓÎË, ÓÚÒÛÚÒÚ‚Ë ËÌ‚‡ÁËË ‚ ÒÓÒÛ‰˚,
̇΢ˠÙË·ÓÁÌÓÈ Í‡ÔÒÛÎ˚ Ë ÎËÏÙÓˉÌÓÈ ËÌÙËθÚ‡ˆËË ‚ÓÍÛ„ ÓÔÛıÓÎÂ‚Ó„Ó ÛÁ·.
3. ç··„ÓÔËflÚÌ˚ هÍÚÓ˚, Á̇˜ËÚÂθÌÓ
ÛıÛ‰¯‡˛˘Ë ‚˚ÊË‚‡ÂÏÓÒÚ¸, ÌÓ ‚ ‰‡ÌÌÓÈ „ÛÔÔÂ
·ÓθÌ˚ı ÂÒÚ¸ ÔËÂÏÎÂχfl 3-ÎÂÚÌflfl ‚˚ÊË‚‡ÂÏÓÒÚ¸, ˜ÚÓ ‰Â·ÂÚ Ô‰ÔÓ˜ÚËÚÂθÌ˚Ï ıËÛ„˘ÂÒÍӠΘÂÌË ÔÂ‰ ‰Û„ËÏË ‚ˉ‡ÏË ÚÂ‡ÔËË. ä
ÌËÏ ÓÚÌÓÒflÚÒfl: ÏÌÓÊÂÒÚ‚ÂÌÌ˚ ÛÁÎ˚ ‚ Ó‰ÌÓÈ ËÁ
‰ÓÎÂÈ Ô˜ÂÌË, ‡ÒÒÚÓflÌË ÓÚ ÓÔÛıÓÎË ‰Ó ÎËÌËË ÂÁÂ͈ËË ÏÂÌ 1 ÒÏ, ËÌÙËθÚ‡ÚË‚Ì˚È ÓÒÚ ÓÔÛıÓÎË, ËÌ‚‡ÁËfl ‚ ÒÓÒÛ‰˚, ‚ÌÂÔ˜ÂÌÓ˜Ì˚ „ÂχÚÓ„ÂÌÌ˚Â Ë ÎËÏÙÓ„ÂÌÌ˚ ÏÂÚ‡ÒÚ‡Á˚, Ó·˙ÂÏ ÔÓ‡ÊÂÌËfl Ô˜ÂÌË ÚÂ·Û˛˘ËÈ ‡Ò¯ËÂÌÌÓÈ ÉÉù,
ÍÓ‚ÓÔÓÚÂfl ·ÓΠ2000 ÏÎ, ÌËÁÍÓ‰ËÙÙÂÂ̈ËÓ‚‡ÌÌ˚È ‡Í, ËÒÚËÌÌÓ ‚‡ÒÚ‡ÌË ÓÔÛıÓÎË ‚ ÒÓÒ‰ÌË ÒÚÛÍÚÛ˚.
4. î‡ÍÚÓ˚, ÔË ÍÓÚÓ˚ı ÂÁÂ͈Ëfl Ô˜ÂÌË ÌÂÓÔ‡‚‰‡Ì̇ ËÁ-Á‡ Í‡ÈÌ ÌÂÛ‰Ó‚ÎÂÚ‚ÓËÚÂθÌ˚ı
ÓÚ‰‡ÎÂÌÌ˚ı ÂÁÛθڇÚÓ‚. Ç ˝ÚÓÈ „ÛÔÔ ‰Ó 2 ÎÂÚ
‰ÓÊË‚‡˛Ú ‰ËÌ˘Ì˚ ·ÓθÌ˚Â. ïËÛ„˘ÂÒÍÓÂ
ΘÂÌË Ì ËÏÂÂÚ ÔÂËÏÛ˘ÂÒÚ‚ ÔÂ‰ ıËÏËÓÚÂ‡ÔËÂÈ ËÎË ÒËÏÔÚÓχÚ˘ÂÒÍËÏ Î˜ÂÌËÂÏ – Ô‡ÎΡÚË‚Ì˚ ‚ϯ‡ÚÂθÒÚ‚‡ Ò ÓÒÚ‡‚ÎÂÌËÂÏ ÓÔÛıÓ΂˚ı ÛÁÎÓ‚, ÏÌÓÊÂÒÚ‚ÂÌÌÓ ·ËÎÓ·‡ÌÓ ÔÓ‡ÊÂÌË Ô˜ÂÌË.
åÂÚ‡ÒÚ‡Ú˘ÂÒÍÓ ÔÓ‡ÊÂÌË Ô˜ÂÌË – ˝ÚÓ ÔÓfl‚ÎÂÌË ‡ÒÔÓÒÚ‡ÌÂÌÌÓ„Ó ÓÔÛıÓÎÂ‚Ó„Ó ÔÓˆÂÒÒ‡. чڸ Ë̉˂ˉۇθÌ˚È ÔÓ„ÌÓÁ Ú˜ÂÌËfl ÓÔÛıÓÎÂ‚Ó„Ó ÔÓˆÂÒÒ‡ Ì‚ÓÁÏÓÊÌÓ. èÓ͇Á‡ÌËfl Ë
ÔÓÚË‚ÓÔÓ͇Á‡ÌËfl Í ÂÁÂ͈ËË Ô˜ÂÌË ÔË ÏÂÚ‡ÒÚ‡Ú˘ÂÒÍÓÏ ÔÓˆÂÒÒ ‚Ó ÏÌÓ„ÓÏ Á‡‚ËÒflÚ ÓÚ ÒÛ·˙ÂÍÚË‚ÌÓÈ ÚÓ˜ÍË ÁÂÌËfl ıËÛ„‡. è‰ÎÓÊÂÌ̇fl
̇ÏË Í·ÒÒËÙË͇ˆËfl ÔÓ„ÌÓÒÚ˘ÂÒÍËı Ù‡ÍÚÓÓ‚
ÏÓÊÂÚ ÔÓÁ‚ÓÎËÚ¸ ıËÛ„Û ÓÔ‰ÂÎËÚ¸ Ó·ÓÒÌÓ‚‡ÌÌÓÒÚ¸ ‚ϯ‡ÚÂθÒÚ‚‡ ‚ ÍÓÌÍÂÚÌÓÏ Ì‡·Î˛‰ÂÌËË
Ë ¯ËÚ¸, ËÏÂÂÚ ÎË ÓÔÂ‡ˆËfl ÔÂËÏÛ˘ÂÒÚ‚Ó ÔÂ‰ ‰Û„ËÏË ÏÂÚÓ‰‡ÏË Î˜ÂÌËfl.
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2003
17
Ô˜Â̸
èéäÄáÄçàü à èêéíàÇéèéäÄáÄçàü ä êÖáÖäñàüå èÖóÖçà
ëÔËÒÓÍ ÎËÚÂ‡ÚÛ˚
1. Ç˯Ì‚ÒÍËÈ Ç.Ä., äÛ·˚¯ÍËÌ Ç.Ä., 鉇˛Í í.ë.,
ÖÓÔÍËÌ è.Ç. Ë ÒÓ‡‚Ú. ïËÛ„˘ÂÒÍӠΘÂÌË ÏÂÚ‡ÒÚ‡ÁÓ‚ ÍÓÎÓÂÍڇθÌÓ„Ó ‡Í‡ ‚ Ô˜Â̸ // ÄÌ̇Î˚
ıË. „ÂÔ‡ÚÓÎ. 1998. í. 3. ‹ 1. ë. 13–18.
2. í‡ÔÂÁÌËÍÓ‚ ç.ç., ÄÍÒÂθ Ö.å. ëÚ‡ÚËÒÚË͇ ÁÎÓ͇˜ÂÒÚ‚ÂÌÌ˚ı ÌÓ‚ÓÓ·‡ÁÓ‚‡ÌËÈ ‚ êÓÒÒËË Ë ÒÚ‡Ì‡ı
ëçÉ (ëÓÒÚÓflÌË ÓÌÍÓÎӄ˘ÂÒÍÓÈ ÔÓÏÓ˘Ë, Á‡·Ó΂‡ÂÏÓÒÚ¸ Ë ÒÏÂÚÌÓÒÚ¸). å., 2001. ë. 99.
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ÄççÄãõ ïàêìêÉàóÖëäéâ ÉÖèÄíéãéÉàà ÚÓÏ 8
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