ЦИТОЛОГИЧЕСКОЕ ИССЛЕДОВАНИЕ ТРАХЕАЛЬНЫХ

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ǸșȖțȖȥȓȟȘȎȭ ȚȓȒȖȤȖțȎ
ɍȾɄ 616-053.3(078.5)
ȄǶȀǼǹǼDZǶȅdzǿǸǼdz ǶǿǿǹdzDzǼǰǮǻǶdz ȀǾǮȃdzǮǹȊǻȉȃ ǮǿǽǶǾǮȀǼǰ
ȁ DZǹȁǯǼǸǼ ǻdzDzǼǻǼȆdzǻǻȉȃ ǻǼǰǼǾǼǴDzdzǻǻȉȃ ǿ DzȉȃǮȀdzǹȊǻȉǺǶ
ǾǮǿǿȀǾǼǷǿȀǰǮǺǶ
ɇ. Ⱥ. ɒɢɥɨɜɚ1*, ɤɚɧɞɢɞɚɬ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤ,
Ɍ. ȼ. ɑɚɲɚ1, ɞɨɤɬɨɪ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤ,
Ɇ. Ⱥ. Ɋɨɞɢɧɚ1,
ȿ. ȼ. ɉɪɨɰɟɧɤɨ1, ɤɚɧɞɢɞɚɬ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤ,
Ⱥ. Ƚ. ɏɨɪɨɲɢɥɨɜɚ2, ɤɚɧɞɢɞɚɬ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤ
ɎȽȻɍ «ɂɜɚɧɨɜɫɤɢɣ ɧɚɭɱɧɨ-ɢɫɫɥɟɞɨɜɚɬɟɥɶɫɤɢɣ ɢɧɫɬɢɬɭɬ ɦɚɬɟɪɢɧɫɬɜɚ ɢ ɞɟɬɫɬɜɚ ɢɦ. ȼ. ɇ. Ƚɨɪɨɞɤɨɜɚ»
Ɇɢɧɡɞɪɚɜɚ Ɋɨɫɫɢɢ, 153045, Ɋɨɫɫɢɹ, ɝ. ɂɜɚɧɨɜɨ, ɭɥ. ɉɨɛɟɞɵ, ɞ. 20
2
Ⱦɟɩɚɪɬɚɦɟɧɬ ɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ ɂɜɚɧɨɜɫɤɨɣ ɨɛɥɚɫɬɢ, 153000, Ɋɨɫɫɢɹ, ɝ. ɂɜɚɧɨɜɨ, ɭɥ. Ȼɚɬɭɪɢɧɚ, ɞ. 8
1
ɊȿɁɘɆȿ ɉɪɨɜɟɞɟɧɨ ɢɫɫɥɟɞɨɜɚɧɢɟ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ 106 ɝɥɭɛɨɤɨ ɧɟɞɨɧɨɲɟɧɧɵɯ ɞɟɬɟɣ. ɉɨɤɚɡɚɧɨ,
ɱɬɨ ɭ ɞɟɬɟɣ ɫ ɜɪɨɠɞɟɧɧɨɣ ɩɧɟɜɦɨɧɢɟɣ ɷɧɞɨɩɭɥɶɦɨɧɚɥɶɧɚɹ ɰɢɬɨɝɪɚɦɦɚ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɧɚɥɢɱɢɟɦ ɛɚɤɬɟɪɢɚɥɶɧɨɣ ɢ ɜɢɪɭɫɧɨɣ ɮɥɨɪɵ, ɩɪɢɡɧɚɤɚɦɢ ɝɢɛɟɥɢ ɤɥɟɬɨɤ ɚɥɶɜɟɨɥɹɪɧɨɝɨ ɷɩɢɬɟɥɢɹ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɜ ɜɢɞɟ
ɧɟɤɪɨɛɢɨɡɚ ɢ ɧɟɤɪɨɡɚ, ɚ ɬɚɤɠɟ ɛɨɥɟɟ ɜɵɫɨɤɢɦ, ɱɟɦ ɩɪɢ ɪɟɫɩɢɪɚɬɨɪɧɨɦ ɞɢɫɬɪɟɫɫ-ɫɢɧɞɪɨɦɟ, ɫɪɟɞɧɢɦ ɤɨɥɢɱɟɫɬɜɨɦ ɩɨɥɢɦɨɪɮɧɨɹɞɟɪɧɵɯ ɥɟɣɤɨɰɢɬɨɜ. ɉɪɢ ɪɟɫɩɢɪɚɬɨɪɧɨɦ ɞɢɫɬɪɟɫɫ-ɫɢɧɞɪɨɦɟ ɜ ɰɢɬɨɝɪɚɦɦɟ ɱɢɫɥɨ
ɧɟɢɡɦɟɧɟɧɧɵɯ ɚɥɶɜɟɨɥɨɰɢɬɨɜ ɡɧɚɱɢɦɨ ɜɵɲɟ, ɱɟɦ ɩɪɢ ɩɧɟɜɦɨɧɢɢ, ɝɢɛɟɥɶ ɠɟ ɤɥɟɬɨɤ ɪɟɫɩɢɪɚɬɨɪɧɨɝɨ ɷɩɢɬɟɥɢɹ ɩɪɨɢɫɯɨɞɢɬ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɩɭɬɟɦ ɚɩɨɩɬɨɡɚ.
Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɝɥɭɛɨɤɨ ɧɟɞɨɧɨɲɟɧɧɵɟ ɞɟɬɢ, ɬɪɚɯɟɚɥɶɧɵɣ ɚɫɩɢɪɚɬ, ɪɟɫɩɢɪɚɬɨɪɧɵɣ ɞɢɫɬɪɟɫɫ ɫɢɧɞɪɨɦ,
ɩɧɟɜɦɨɧɢɹ.
* Ɉɬɜɟɬɫɬɜɟɧɧɵɣ ɡɚ ɩɟɪɟɩɢɫɤɭ (corresponding author): e-mail: shilova37@gmail.com.
ɂɡɭɱɟɧɢɟ ɤɨɥɢɱɟɫɬɜɟɧɧɨɝɨ ɢ ɤɚɱɟɫɬɜɟɧɧɨɝɨ ɤɥɟɬɨɱɧɨɝɨ ɫɨɫɬɚɜɚ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ ɹɜɥɹɟɬɫɹ ɞɨɩɨɥɧɢɬɟɥɶɧɵɦ ɷɤɫɩɪɟɫɫ-ɦɟɬɨɞɨɦ ɜ ɩɭɥɶɦɨɧɨɥɨɝɢɢ
[2, 3, 11, 12, 13]. ȿɝɨ ɩɪɢɦɟɧɟɧɢɟ ɨɫɨɛɟɧɧɨ ɚɤɬɭɚɥɶɧɨ ɩɪɢ ɨɬɫɭɬɫɬɜɢɢ ɱɟɬɤɢɯ ɤɥɢɧɢɤɨ-ɥɚɛɨɪɚɬɨɪɧɵɯ
ɢ ɪɟɧɬɝɟɧɨɝɪɚɮɢɱɟɫɤɢɯ ɩɪɢɡɧɚɤɨɜ ɡɚɛɨɥɟɜɚɧɢɹ,
ɩɨɡɜɨɥɹɸɳɢɯ ɩɪɨɜɟɫɬɢ ɞɢɚɝɧɨɫɬɢɤɭ ɞɵɯɚɬɟɥɶɧɵɯ
ɪɚɫɫɬɪɨɣɫɬɜ. Ȼɟɡɭɫɥɨɜɧɨ, ɫɨɜɪɟɦɟɧɧɚɹ ɦɟɞɢɰɢɧɚ
ɪɚɫɩɨɥɚɝɚɟɬ ɛɨɥɟɟ ɫɨɜɟɪɲɟɧɧɵɦɢ ɦɟɬɨɞɚɦɢ ɢɫɫɥɟɞɨɜɚɧɢɹ – ɰɢɬɨɫɩɢɧɨɜɵɦ ɢ ɷɥɟɤɬɪɨɧɧɨ-ɦɢɤɪɨ-
ɫɤɨɩɢɱɟɫɤɢɦ, ɩɨɡɜɨɥɹɸɳɢɦɢ ɬɨɱɧɨ ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɬɶ ɤɥɟɬɨɱɧɵɣ ɫɨɫɬɚɜ ɬɪɚɯɟɚɥɶɧɨɝɨ ɚɫɩɢɪɚɬɚ
[1, 4, 5, 9]. ɗɬɢ ɦɟɬɨɞɢɤɢ ɩɪɟɞɩɨɥɚɝɚɸɬ ɧɚɥɢɱɢɟ
ɞɨɪɨɝɨɫɬɨɹɳɟɝɨ ɦɟɞɢɰɢɧɫɤɨɝɨ ɨɛɨɪɭɞɨɜɚɧɢɹ ɢ ɪɟɚɤɬɢɜɨɜ ɞɥɹ ɮɢɤɫɚɰɢɢ ɧɚɬɢɜɧɨɝɨ ɦɚɬɟɪɢɚɥɚ, ɬɪɟɛɭɸɬ ɫɩɟɰɢɚɥɶɧɨɣ ɩɨɞɝɨɬɨɜɤɢ ɩɟɪɫɨɧɚɥɚ, ɜ ɫɜɹɡɢ ɫ
ɱɟɦ ɩɪɢɦɟɧɢɦɵ ɞɚɥɟɤɨ ɧɟ ɜ ɤɚɠɞɨɦ ɥɟɱɟɛɧɨɦ ɭɱɪɟɠɞɟɧɢɢ. ȼ ɰɟɥɹɯ ɭɞɟɲɟɜɥɟɧɢɹ ɢ ɭɩɪɨɳɟɧɢɹ ɢɫɫɥɟɞɨɜɚɧɢɹ ɦɵ ɩɪɟɞɥɚɝɚɟɦ ɨɛɪɚɬɢɬɶ ɜɧɢɦɚɧɢɟ ɧɚ
ɧɟɡɚɫɥɭɠɟɧɧɨ ɡɚɛɵɬɵɣ ɩɪɨɫɬɨɣ ɦɟɬɨɞ ɞɢɚɝɧɨɫɬɢɤɢ
Shilova N. A., Chasha T. V., Rodina M. A., Protsenko E. V., Khoroshilova A. G.
CYTOLOGIC EXAMINATION OF TRACHEAL ASPIRATES IN EXTREMELY PRETERM NEWBORNS
WITH RESPIRATORY DISORDERS
ABSTRACT Tracheal aspirates in extremely preterm infants were examined. It was demonstrated that endopulmonic cytogram in infants with congenital pneumonia was characterized by bacterial and viral Àora presence,
by alveolar epithelium cells destruction signs (predominantly necrobiosis and necrosis) and by higher average
quantity of polymorphonuclear leucocytes in comparison with respiratory distress syndrome. Unchanged number
of alveolocytes was signi¿cantly higher in cytogram in respiratory distress syndrome in comparison with pneumonia; respiratory epithelium cells were destructed by apoptosis predominantly.
Key words: extremely preterm infants, tracheal aspirate, respiratory distress syndrome, pneumonia.
Ɍ. 18, ʋ 4, 2013
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ȼɟɫɬɧɢɤ ɂɜɚɧɨɜɫɤɨɣ ɦɟɞɢɰɢɧɫɤɨɣ ɚɤɚɞɟɦɢɢ
ɥɟɝɨɱɧɨɣ ɩɚɬɨɥɨɝɢɢ – ɢɡɭɱɟɧɢɟ ɫɨɫɬɚɜɚ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ ɧɚ ɫɜɟɬɨɨɩɬɢɱɟɫɤɨɦ ɭɪɨɜɧɟ, ɤɨɬɨɪɨɟ ɜɵɩɨɥɧɢɦɨ ɜ ɥɸɛɵɯ ɭɫɥɨɜɢɹɯ. ȼ ɪɹɞɟ ɫɥɭɱɚɟɜ
ɪɟɡɭɥɶɬɚɬɵ ɷɬɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɦɨɝɭɬ ɨɤɚɡɚɬɶɫɹ
ɪɟɲɚɸɳɢɦɢ ɩɪɢ ɞɢɚɝɧɨɫɬɢɤɟ ɥɟɝɨɱɧɨɣ ɩɚɬɨɥɨɝɢɢ
(ɜ ɬɨɦ ɱɢɫɥɟ ɭ ɧɟɞɨɧɨɲɟɧɧɵɯ ɧɨɜɨɪɨɠɞɟɧɧɵɯ) ɢ
ɨɩɪɟɞɟɥɟɧɢɢ ɞɚɥɶɧɟɣɲɟɣ ɥɟɱɟɛɧɨɣ ɬɚɤɬɢɤɢ.
ɐɟɥɶɸ ɧɚɫɬɨɹɳɟɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɫɬɚɥɨ ɜɵɹɜɥɟɧɢɟ ɨɫɨɛɟɧɧɨɫɬɟɣ ɤɚɱɟɫɬɜɟɧɧɨɝɨ ɢ ɤɨɥɢɱɟɫɬɜɟɧɧɨɝɨ ɫɨɫɬɚɜɚ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ ɩɪɢ ɪɚɡɥɢɱɧɵɯ ɞɵɯɚɬɟɥɶɧɵɯ ɪɚɫɫɬɪɨɣɫɬɜɚɯ ɭ ɝɥɭɛɨɤɨ
ɧɟɞɨɧɨɲɟɧɧɵɯ ɧɨɜɨɪɨɠɞɟɧɧɵɯ.
ǺǮȀdzǾǶǮǹ Ƕ ǺdzȀǼDzȉ
ɉɪɨɜɟɞɟɧɨ ɰɢɬɨɥɨɝɢɱɟɫɤɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ ɭ 106 ɝɥɭɛɨɤɨ ɧɟɞɨɧɨɲɟɧɧɵɯ
ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɫ ɨɱɟɧɶ ɧɢɡɤɨɣ (1000–1499 ɝ) ɢ ɷɤɫɬɪɟɦɚɥɶɧɨ ɧɢɡɤɨɣ (ɦɟɧɟɟ 1000 ɝ) ɦɚɫɫɨɣ ɬɟɥɚ ɩɪɢ
ɪɨɠɞɟɧɢɢ, ɝɟɫɬɚɰɢɨɧɧɵɣ ɜɨɡɪɚɫɬ – ɦɟɧɟɟ 32 ɧɟɞɟɥɶ. ȼɫɟ ɞɟɬɢ ɜ ɪɚɧɧɟɦ ɧɟɨɧɚɬɚɥɶɧɨɦ ɩɟɪɢɨɞɟ
ɢɦɟɥɢ ɞɵɯɚɬɟɥɶɧɵɟ ɪɚɫɫɬɪɨɣɫɬɜɚ ɢ ɛɵɥɢ ɪɚɡɞɟɥɟɧɵ ɧɚ 3 ɝɪɭɩɩɵ. ȼ ɩɟɪɜɭɸ ɝɪɭɩɩɭ ɜɨɲɥɢ 14 ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɫ ɪɟɫɩɢɪɚɬɨɪɧɵɦ ɞɢɫɬɪɟɫɫ-ɫɢɧɞɪɨɦɨɦ
(ɊȾɋ), ɜɨ ɜɬɨɪɭɸ – 65 ɞɟɬɟɣ ɫ ɜɪɨɠɞɟɧɧɨɣ ɩɧɟɜɦɨɧɢɟɣ, ɜ ɬɪɟɬɶɸ – 27 ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɫ ɧɟɨɧɚɬɚɥɶɧɨɣ ɩɧɟɜɦɨɧɢɟɣ, ɪɚɡɜɢɜɲɟɣɫɹ ɧɚ ɮɨɧɟ ɊȾɋ.
Ⱦɥɹ ɰɢɬɨɥɨɝɢɱɟɫɤɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɪɨɢɡɜɨɞɢɥɫɹ ɡɚɛɨɪ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ ɧɚ ɬɪɟɬɶɢ ɫɭɬɤɢ
ɠɢɡɧɢ ɞɟɬɟɣ ɩɨ ɫɬɚɧɞɚɪɬɧɨɣ ɦɟɬɨɞɢɤɟ [10]. Ɇɚɡɤɢ
ɢɡ ɚɫɩɢɪɚɬɨɜ ɝɨɬɨɜɢɥɢ ɫɪɚɡɭ ɥɢɛɨ ɜ ɬɟɱɟɧɢɟ 1-ɝɨ
ɱɚɫɚ ɩɨɫɥɟ ɜɡɹɬɢɹ ɦɚɬɟɪɢɚɥɚ, ɩɨɫɤɨɥɶɤɭ ɷɬɨ ɹɜɥɹɟɬɫɹ ɧɟɩɪɟɦɟɧɧɵɦ ɭɫɥɨɜɢɟɦ ɫɨɜɩɚɞɟɧɢɹ (93,4%)
[9] ɩɨɥɭɱɟɧɧɵɯ ɪɟɡɭɥɶɬɚɬɨɜ ɫ ɪɟɡɭɥɶɬɚɬɚɦɢ ɨɰɟɧɤɢ ɰɢɬɨɫɩɢɧɨɜɵɯ ɩɪɟɩɚɪɚɬɨɜ, ɫɭɳɟɫɬɜɟɧɧɨ ɩɨɜɵɲɚɸɳɢɦ ɰɟɧɧɨɫɬɶ ɢɫɫɥɟɞɨɜɚɧɢɹ. ɉɪɟɩɚɪɚɬɵ
ɨɤɪɚɲɢɜɚɥɢ ɩɨ Ƚɪɚɦɭ ɢ ɝɟɦɚɬɨɤɫɢɥɢɧɨɦ-ɷɨɡɢɧɨɦ.
Ɉɰɟɧɤɚ ɫɨɫɬɚɜɚ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ ɜɤɥɸɱɚɥɚ ɩɨɞɫɱɟɬ ɷɩɢɬɟɥɢɚɥɶɧɵɯ ɤɥɟɬɨɤ (ɚɥɶɜɟɨɥɨɰɢɬɨɜ, ɤɥɟɬɨɤ ɪɟɫɧɢɬɱɚɬɨɝɨ ɷɩɢɬɟɥɢɹ), ɩɨɥɢɦɨɪɮɧɨɹɞɟɪɧɵɯ ɥɟɣɤɨɰɢɬɨɜ. Ɋɟɡɭɥɶɬɚɬ ɜɵɪɚɠɚɥɫɹ ɜ
ɩɪɨɰɟɧɬɚɯ ɩɪɢ ɫɩɥɨɲɧɨɦ ɚɧɚɥɢɡɟ 100 ɤɥɟɬɨɤ. ɂɫ-
ɫɥɟɞɨɜɚɧɢɟ ɩɪɨɜɨɞɢɥɨɫɶ ɧɚ ɫɜɟɬɨɜɨɦ ɦɢɤɪɨɫɤɨɩɟ «Micros» (Ⱥɜɫɬɪɢɹ) ɩɪɢ ɭɜɟɥɢɱɟɧɢɢ ɜ 1 000 ɪɚɡ.
ɋɬɚɬɢɫɬɢɱɟɫɤɭɸ ɨɛɪɚɛɨɬɤɭ ɪɟɡɭɥɶɬɚɬɨɜ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɪɨɜɨɞɢɥɢ ɫ ɩɨɦɨɳɶɸ ɩɪɨɝɪɚɦɦɵ Statistica 6.1. ɇɨɪɦɚɥɶɧɨɫɬɶ ɪɚɫɩɪɟɞɟɥɟɧɢɹ ɩɪɢɡɧɚɤɚ ɜ ɜɚɪɢɚɰɢɨɧɧɨɦ ɪɹɞɭ ɨɰɟɧɢɜɚɥɢ ɫ ɩɨɦɨɳɶɸ
ɤɪɢɬɟɪɢɹ Ʉɨɥɦɨɝɨɪɨɜɚ – ɋɦɢɪɧɨɜɚ. ɉɨɥɭɱɟɧɧɵɟ
ɞɚɧɧɵɟ ɩɨɞɱɢɧɹɥɢɫɶ ɡɚɤɨɧɭ ɧɨɪɦɚɥɶɧɨɝɨ ɪɚɫɩɪɟɞɟɥɟɧɢɹ ɢ ɛɵɥɢ ɩɪɟɞɫɬɚɜɥɟɧɵ ɜ ɜɢɞɟ ɫɪɟɞɧɟɝɨ
ɡɧɚɱɟɧɢɹ ɢ ɫɬɚɧɞɚɪɬɧɨɝɨ ɨɬɤɥɨɧɟɧɢɹ. ɉɪɢ ɫɪɚɜɧɟɧɢɢ ɤɨɥɢɱɟɫɬɜɟɧɧɵɯ ɩɪɢɡɧɚɤɨɜ ɞɜɭɯ ɫɨɜɨɤɭɩɧɨɫɬɟɣ ɢɫɩɨɥɶɡɨɜɚɥɢ ɤɪɢɬɟɪɢɣ ɋɬɶɸɞɟɧɬɚ. ɍɪɨɜɟɧɶ
ɫɬɚɬɢɫɬɢɱɟɫɤɨɣ ɡɧɚɱɢɦɨɫɬɢ – ɪ < 0,05 [8].
ǾdzǵȁǹȊȀǮȀȉ Ƕ ǼǯǿȁǴDzdzǻǶdz
ȼ ɦɚɡɤɚɯ ɭ ɞɟɬɟɣ ɜɫɟɯ ɝɪɭɩɩ ɜɵɹɜɥɟɧɵ ɚɥɶɜɟɨɥɨɰɢɬɵ ɜ ɫɨɫɬɨɹɧɢɢ ɞɢɫɬɪɨɮɢɢ: ɩɪɢ ɊȾɋ – 35,2%,
ɩɪɢ ɜɪɨɠɞɟɧɧɨɣ ɢ ɧɟɨɧɚɬɚɥɶɧɨɣ ɩɧɟɜɦɨɧɢɢ –
45,4 ɢ 42,6% ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ (ɬɚɛɥ. 1).
ɇɟɤɪɨɛɢɨɬɢɱɟɫɤɢɟ ɢ ɧɟɤɪɨɬɢɱɟɫɤɢɟ ɩɪɨɰɟɫɫɵ ɜ
ɤɥɟɬɤɚɯ ɚɥɶɜɟɨɥɹɪɧɨɝɨ ɷɩɢɬɟɥɢɹ ɢɦɟɥɢ ɡɧɚɱɢɦɨ ɛɨɥɶɲɢɣ ɭɞɟɥɶɧɵɣ ɜɟɫ ɭ ɞɟɬɟɣ ɫ ɜɪɨɠɞɟɧɧɨɣ
ɩɧɟɜɦɨɧɢɟɣ (30,1 ± 10,8%), ɱɟɦ ɭ ɧɨɜɨɪɨɠɞɟɧɧɵɯ
ɫ ɊȾɋ (14,6 ± 5,5%, ɪ < 0,05), ɱɬɨ ɨɛɭɫɥɨɜɥɟɧɨ
ɞɥɢɬɟɥɶɧɵɦ ɩɪɹɦɵɦ ɬɨɤɫɢɱɟɫɤɢɦ ɜɨɡɞɟɣɫɬɜɢɟɦ
ɩɪɨɞɭɤɬɨɜ ɠɢɡɧɟɞɟɹɬɟɥɶɧɨɫɬɢ ɜɢɪɭɫɨɜ ɢ ɛɚɤɬɟɪɢɚɥɶɧɨɣ ɮɥɨɪɵ, ɩɪɢɜɨɞɹɳɢɦ ɤ ɫɩɨɧɬɚɧɧɨɦɭ, ɧɟɤɨɧɬɪɨɥɢɪɭɟɦɨɦɭ ɨɦɟɪɬɜɥɟɧɢɸ ɤɥɟɬɨɤ.
ɐɢɬɨɥɨɝɢɱɟɫɤɚɹ ɤɚɪɬɢɧɚ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ
ɩɪɢ ɊȾɋ, ɜ ɨɬɥɢɱɢɟ ɨɬ ɬɚɤɨɜɨɣ ɩɪɢ ɜɪɨɠɞɟɧɧɨɣ
ɩɧɟɜɦɨɧɢɢ, ɯɚɪɚɤɬɟɪɢɡɨɜɚɥɚɫɶ ɫɬɚɬɢɫɬɢɱɟɫɤɢ
ɡɧɚɱɢɦɵɦ (p < 0,01) ɭɜɟɥɢɱɟɧɢɟɦ ɱɢɫɥɚ ɚɥɶɜɟɨɥɨɰɢɨɬɨɜ ɫ ɚɩɨɩɬɨɡɨɦ ɢ ɧɟɢɡɦɟɧɟɧɧɵɯ ɚɥɶɜɟɨɥɨɰɢɬɨɜ (ɬɚɛɥ. 1), ɱɬɨ, ɫ ɧɚɲɟɣ ɬɨɱɤɢ ɡɪɟɧɢɹ, ɫɥɟɞɭɟɬ ɪɚɫɰɟɧɢɜɚɬɶ ɤɚɤ ɪɟɡɭɥɶɬɚɬ ɫɚɦɨɪɟɝɭɥɹɰɢɢ
ɨɪɝɚɧɢɡɦɚ.
Ʉɥɟɬɤɢ ɪɟɫɧɢɬɱɚɬɨɝɨ ɷɩɢɬɟɥɢɹ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɨɛɧɚɪɭɠɢɜɚɥɢɫɶ ɭ ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɜɫɟɯ
ɝɪɭɩɩ ɛɨɥɟɟ ɱɟɦ ɜ ɩɨɥɨɜɢɧɟ ɫɥɭɱɚɟɜ (ɬɚɛɥ. 2). ɇɚ
ɫɜɟɬɨɨɩɬɢɱɟɫɤɨɦ ɭɪɨɜɧɟ ɜɵɹɜɥɟɧɨ, ɱɬɨ ɭɤɚɡɚɧ-
Ɍɚɛɥɢɰɚ 1. ɋɨɫɬɨɹɧɢɟ ɚɥɶɜɟɨɥɨɰɢɬɨɜ ɜ ɦɚɡɤɚɯ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ ɭ ɝɥɭɛɨɤɨ ɧɟɞɨɧɨɲɟɧɧɵɯ ɧɨɜɨɪɨɠɞɟɧɧɵɯ
ɫ ɞɵɯɚɬɟɥɶɧɵɦɢ ɧɚɪɭɲɟɧɢɹɦɢ
ɑɢɫɥɨ ɤɥɟɬɨɤ, %
ɉɨɤɚɡɚɬɟɥɢ
Ⱦɟɬɢ
ɫ ɊȾɋ
Ⱦɟɬɢ
ɫ ɜɪɨɠɞɟɧɧɨɣ ɩɧɟɜɦɨɧɢɟɣ
Ⱦɟɬɢ ɫ ɧɟɨɧɚɬɚɥɶɧɨɣ
ɩɧɟɜɦɨɧɢɟɣ ɧɚ ɮɨɧɟ ɊȾɋ
Ⱥɥɶɜɟɨɥɨɰɢɬɵ ɫ ɞɢɫɬɪɨɮɢɟɣ
35,2 ± 8,5
45,4 ± 19,8
42,6 ± 19,1
Ⱥɥɶɜɟɨɥɨɰɢɬɵ ɫ ɧɟɤɪɨɡɨɦ
14,6 ± 5,5
30,1 ± 10,8*
24,4 ± 12,1
Ⱥɥɶɜɟɨɥɨɰɢɬɵ ɫ ɚɩɨɩɬɨɡɨɦ
15,9 ± 7,4
4,9 ± 1,1**
9,6 ± 8,5
Ⱥɥɶɜɟɨɥɨɰɢɬɵ ɛɟɡ ɩɚɬɨɥɨɝɢɢ
34,3 ± 15,9
19,6 ± 13,1**
23,4 ± 14,1
ɉɪɢɦɟɱɚɧɢɟ. ɋɬɚɬɢɫɬɢɱɟɫɤɚɹ ɡɧɚɱɢɦɨɫɬɶ ɪɚɡɥɢɱɢɣ ɦɟɠɞɭ ɩɨɤɚɡɚɬɟɥɹɦɢ I ɢ II ɝɪɭɩɩ: * – p < 0,05, ** – p < 0,01.
22
Ɍɚɛɥɢɰɚ 2. ɋɨɫɬɨɹɧɢɟ ɤɥɟɬɨɤ ɪɟɫɧɢɬɱɚɬɨɝɨ ɷɩɢɬɟɥɢɹ ɜ ɦɚɡɤɚɯ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ
ɉɨɤɚɡɚɬɟɥɢ
ɑɚɫɬɨɬɚ ɜɫɬɪɟɱɚɟɦɨɫɬɢ ɤɥɟɬɨɤ ɜ ɦɚɡɤɟ, %
Ⱦɟɬɢ ɫ ɊȾɋ
Ⱦɟɬɢ ɫ ɜɪɨɠɞɟɧɧɨɣ
ɩɧɟɜɦɨɧɢɟɣ
Ⱦɟɬɢ ɫ ɧɟɨɧɚɬɚɥɶɧɨɣ
ɩɧɟɜɦɨɧɢɟɣ ɧɚ ɮɨɧɟ ɊȾɋ
53,8
51,0
68,2
95,5 ± 21,0
87,9 ± 19,6
72,3 ± 31,4
Ɋɟɫɧɢɬɱɚɬɵɣ ɷɩɢɬɟɥɢɣ ɫ ɧɟɤɪɨɡɨɦ, %
4,5 ± 1,6
12,1 ± 3,4*
10,9 ± 3,2**
Ɋɟɫɧɢɬɱɚɬɵɣ ɷɩɢɬɟɥɢɣ ɫ ɚɩɨɩɬɨɡɨɦ, %
0
0
16,8 ± 0,3
Ɋɟɫɧɢɬɱɚɬɵɣ ɷɩɢɬɟɥɢɣ ɫ ɞɢɫɬɪɨɮɢɟɣ, %
ɉɪɢɦɟɱɚɧɢɟ. ɋɬɚɬɢɫɬɢɱɟɫɤɚɹ ɡɧɚɱɢɦɨɫɬɶ ɪɚɡɥɢɱɢɣ ɦɟɠɞɭ ɩɨɤɚɡɚɬɟɥɹɦɢ (p < 0,01): * – I ɢ II ɝɪɭɩɩ, ** – I ɢ III ɝɪɭɩɩ.
ɧɵɟ ɤɥɟɬɤɢ ɯɚɪɚɤɬɟɪɢɡɨɜɚɥɢɫɶ ɞɟɫɬɪɭɤɰɢɟɣ ɪɟɫɧɢɱɟɤ ɢ ɧɚɯɨɞɢɥɢɫɶ ɛɨɥɶɲɟɣ ɱɚɫɬɶɸ ɜ ɫɨɫɬɨɹɧɢɢ
ɞɢɫɬɪɨɮɢɢ. ɇɟɤɪɨɬɢɱɟɫɤɢɟ ɩɪɨɰɟɫɫɵ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɡɧɚɱɢɦɨ ɱɚɳɟ ɧɚɛɥɸɞɚɥɢɫɶ ɭ ɞɟɬɟɣ ɫ ɜɪɨɠɞɟɧɧɨɣ ɢ ɧɟɨɧɚɬɚɥɶɧɨɣ ɩɧɟɜɦɨɧɢɟɣ, ɱɟɦ ɭ ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɫ ɊȾɋ.
ɬɨɜ ɢɡ ɝɪɭɩɩɵ ɫ ɜɪɨɠɞɟɧɧɨɣ (ɜ 7 ɫɥɭɱɚɹɯ – 14%) ɢ
ɧɟɨɧɚɬɚɥɶɧɨɣ (ɜ 5 ɫɥɭɱɚɹɯ – 18,5%) ɩɧɟɜɦɨɧɢɟɣ,
ɬɨɝɞɚ ɤɚɤ ɩɪɢ ɪɚɡɜɢɬɢɢ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ ɜ ɥɟɝɤɢɯ ɧɚ ɮɨɧɟ ɧɟɢɡɦɟɧɟɧɧɨɝɨ ɦɟɫɬɧɨɝɨ ɢɦɦɭɧɢɬɟɬɚ ɧɚɛɥɸɞɚɟɬɫɹ ɡɧɚɱɢɬɟɥɶɧɨɟ ɭɜɟɥɢɱɟɧɢɟ
ɤɨɥɢɱɟɫɬɜɚ ɭɤɚɡɚɧɧɵɯ ɤɥɟɬɨɤ [6].
Ⱥɧɚɥɢɡ ɫɨɞɟɪɠɚɧɢɹ ɩɨɥɢɦɨɪɮɧɨɹɞɟɪɧɵɯ ɥɟɣɤɨɰɢɬɨɜ ɜ ɦɚɡɤɚɯ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ ɩɪɨɜɨɞɢɥɫɹ ɩɭɬɟɦ ɩɨɞɫɱɟɬɚ ɫɪɟɞɧɟɝɨ ɤɨɥɢɱɟɫɬɜɚ ɥɟɣɤɨɰɢɬɨɜ ɜ ɩɨɥɟ ɡɪɟɧɢɹ (ɩɪɢ ɨɰɟɧɤɟ ɧɟ ɦɟɧɟɟ 10 ɩɨɥɟɣ
ɡɪɟɧɢɹ). ɉɪɢ ɷɬɨɦ ɛɵɥɨ ɜɵɹɜɥɟɧɨ ɡɧɚɱɢɦɨɟ ɩɨɜɵɲɟɧɢɟ ɫɪɟɞɧɟɝɨ ɤɨɥɢɱɟɫɬɜɚ ɥɟɣɤɨɰɢɬɨɜ ɜ ɩɨɥɟ
ɡɪɟɧɢɹ ɜ ɦɚɡɤɚɯ ɭ ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɫ ɜɪɨɠɞɟɧɧɨɣ ɢ
ɧɟɨɧɚɬɚɥɶɧɨɣ ɩɧɟɜɦɨɧɢɟɣ ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɞɟɬɶɦɢ ɫ ɊȾɋ (ɬɚɛɥ. 3).
ɍ ɜɫɟɯ ɞɟɬɟɣ ɢɡ ɝɪɭɩɩ ɫ ɜɪɨɠɞɟɧɧɨɣ ɢ ɧɟɨɧɚɬɚɥɶɧɨɣ ɩɧɟɜɦɨɧɢɟɣ ɜ ɦɚɡɤɚɯ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ, ɨɤɪɚɲɟɧɧɵɯ ɩɨ Ƚɪɚɦɭ, ɜ ɛɨɥɶɲɨɦ ɤɨɥɢɱɟɫɬɜɟ
ɩɪɢɫɭɬɫɬɜɨɜɚɥɚ ɛɚɤɬɟɪɢɚɥɶɧɚɹ ɮɥɨɪɚ (ɤɨɤɤɨɜɚɹ ɢ
ɩɚɥɨɱɤɨɜɚɹ). ɍ 5 ɞɟɬɟɣ ɜɵɹɜɥɟɧɵ ɨɤɨɥɨɹɞɟɪɧɵɟ
ɢɥɢ ɜɧɭɬɪɢɹɞɟɪɧɵɟ ɜɤɥɸɱɟɧɢɹ, ɩɨɡɜɨɥɹɸɳɢɟ ɡɚɩɨɞɨɡɪɢɬɶ ɜɢɪɭɫɧɭɸ ɢɧɮɟɤɰɢɸ. ɍ ɧɨɜɨɪɨɠɞɟɧɧɵɯ
ɫ ɊȾɋ ɥɢɲɶ ɜ 2 ɫɥɭɱɚɹɯ (14,3%) ɤɨɧɫɬɚɬɢɪɨɜɚɧɵ
ɟɞɢɧɢɱɧɵɟ ɤɨɤɤɢ ɜ ɦɚɡɤɚɯ.
ɉɨɥɭɱɟɧɧɵɟ ɞɚɧɧɵɟ ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɬ ɨ ɧɚɥɢɱɢɢ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ ɜ ɥɟɝɨɱɧɨɣ ɬɤɚɧɢ
ɭ ɞɟɬɟɣ ɫ ɩɧɟɜɦɨɧɢɟɣ. ɉɪɢ ɭɤɚɡɚɧɧɨɣ ɩɚɬɨɥɨɝɢɢ
ɥɟɣɤɨɰɢɬɵ, ɤɚɤ ɩɪɚɜɢɥɨ, ɧɚɯɨɞɢɥɢɫɶ ɜ ɫɨɫɬɨɹɧɢɢ
ɝɥɭɛɨɤɨɣ ɞɢɫɬɪɨɮɢɢ ɢɥɢ ɧɟɤɪɨɡɚ. ɉɪɢ ɜɪɨɠɞɟɧɧɨɣ ɩɧɟɜɦɨɧɢɢ ɛɨɥɶɲɚɹ ɱɚɫɬɶ (60%) ɥɟɣɤɨɰɢɬɨɜ
ɛɵɥɚ ɩɨɥɧɨɫɬɶɸ ɪɚɡɪɭɲɟɧɚ ɥɢɛɨ ɮɚɝɨɰɢɬɨɡ ɛɵɥ
ɧɟ ɡɚɜɟɪɲɟɧ, ɱɬɨ ɨɬɪɚɠɚɟɬ ɧɟɫɩɨɫɨɛɧɨɫɬɶ ɨɪɝɚɧɢɡɦɚ ɝɥɭɛɨɤɨ ɧɟɞɨɧɨɲɟɧɧɵɯ ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɨɬɜɟɱɚɬɶ ɩɨɥɧɨɰɟɧɧɨɣ ɥɟɣɤɨɰɢɬɚɪɧɨɣ ɪɟɚɤɰɢɟɣ ɧɚ
ɢɧɮɟɤɰɢɸ ɢ ɭɤɚɡɵɜɚɟɬ ɧɚ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶ ɤɥɟɬɨɱɧɨɝɨ ɢɦɦɭɧɢɬɟɬɚ ɜ ɥɟɝɤɢɯ, ɫɜɹɡɚɧɧɭɸ, ɜɟɪɨɹɬɧɨ, ɤɚɤ ɫ ɮɢɡɢɨɥɨɝɢɱɟɫɤɨɣ, ɬɚɤ ɢ ɫ ɩɚɬɨɥɨɝɢɱɟɫɤɨɣ
ɧɟɡɪɟɥɨɫɬɶɸ ɢɦɦɭɧɧɨɣ ɫɢɫɬɟɦɵ ɜɫɥɟɞɫɬɜɢɟ ɟɟ
ɞɢɫɯɪɨɧɧɨɝɨ ɪɚɡɜɢɬɢɹ ɜ ɭɫɥɨɜɢɹɯ ɜɧɭɬɪɢɭɬɪɨɛɧɨɝɨ ɢɧɮɢɰɢɪɨɜɚɧɢɹ [7]. ɉɨɞɬɜɟɪɠɞɟɧɢɟɦ ɷɬɨɝɨ
ɹɜɢɥɨɫɶ ɢ ɬɨ, ɱɬɨ ɥɢɦɮɨɰɢɬɵ ɢ ɦɚɤɪɨɮɚɝɢ ɨɛɧɚɪɭɠɢɜɚɥɢɫɶ ɥɢɲɶ ɜ ɟɞɢɧɢɱɧɵɯ ɦɚɡɤɚɯ ɭ ɩɚɰɢɟɧ-
ɍ ɞɟɬɟɣ ɫ ɬɹɠɟɥɵɦ ɬɟɱɟɧɢɟɦ ɜɪɨɠɞɟɧɧɨɣ ɩɧɟɜɦɨɧɢɢ, ɞɥɢɬɟɥɶɧɨ ɧɚɯɨɞɢɜɲɢɯɫɹ ɧɚ ɂȼɅ, ɬɪɚɯɟɚɥɶɧɵɣ ɫɦɵɜ ɫɨɫɬɨɹɥ ɢɡ ɤɥɟɬɨɱɧɨɝɨ ɞɟɬɪɢɬɚ,
ɩɥɚɫɬɨɜ ɫɥɭɳɟɧɧɵɯ ɚɥɶɜɟɨɥɨɰɢɬɨɜ ɢ ɷɩɢɬɟɥɢɚɥɶɧɵɯ ɤɥɟɬɨɤ ɛɪɨɧɯɨɜ. Ʉɥɟɬɤɢ ɪɟɫɩɢɪɚɬɨɪɧɨɝɨ
ɷɩɢɬɟɥɢɹ ɧɚɯɨɞɢɥɢɫɶ ɜ ɫɨɫɬɨɹɧɢɢ ɝɥɭɛɨɤɨɣ ɞɢɫɬɪɨɮɢɢ, ɧɟɤɪɨɛɢɨɡɚ ɢ ɧɟɤɪɨɡɚ, ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɨɜɚɥɨ ɨ ɞɥɢɬɟɥɶɧɨ ɫɭɳɟɫɬɜɭɸɳɟɦ ɜɨɫɩɚɥɢɬɟɥɶɧɨɦ ɩɪɨɰɟɫɫɟ ɜ ɥɟɝɨɱɧɨɣ ɬɤɚɧɢ ɢ ɫɬɟɧɤɟ
ɛɪɨɧɯɨɜ.
ǰȉǰǼDzȉ
1. ɐɢɬɨɥɨɝɢɱɟɫɤɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɬɪɚɯɟɚɥɶɧɵɯ
ɚɫɩɢɪɚɬɨɜ ɨɬɪɚɠɚɟɬ ɦɨɪɮɨɥɨɝɢɱɟɫɤɭɸ ɢ ɩɚɬɨɝɟɧɟɬɢɱɟɫɤɭɸ ɧɟɨɞɧɨɪɨɞɧɨɫɬɶ ɞɵɯɚɬɟɥɶɧɵɯ ɪɚɫɫɬɪɨɣɫɬɜ ɭ ɝɥɭɛɨɤɨ ɧɟɞɨɧɨɲɟɧɧɵɯ
ɞɟɬɟɣ.
Ɍɚɛɥɢɰɚ 3. ɋɨɞɟɪɠɚɧɢɟ ɩɨɥɢɦɨɪɮɧɨɹɞɟɪɧɵɯ ɥɟɣɤɨɰɢɬɨɜ ɜ ɦɚɡɤɚɯ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ
ɉɨɤɚɡɚɬɟɥɶ
ɋɪɟɞɧɟɟ ɤɨɥɢɱɟɫɬɜɨ ɜ ɩɨɥɟ ɡɪɟɧɢɹ
Ⱦɟɬɢ ɫ ɊȾɋ
Ⱦɟɬɢ ɫ ɜɪɨɠɞɟɧɧɨɣ
ɩɧɟɜɦɨɧɢɟɣ
Ⱦɟɬɢ ɫ ɧɟɨɧɚɬɚɥɶɧɨɣ
ɩɧɟɜɦɨɧɢɟɣ ɧɚ ɮɨɧɟ ɊȾɋ
1,4 ± 0,7
6,4 ± 4,7*
7,8 ± 5,7**
Ɋɚɡɪɭɲɟɧɧɵɟ ɥɟɣɤɨɰɢɬɵ, %
0
60,5*
57,2**
Ʌɟɣɤɨɰɢɬɵ ɫ ɧɟɡɚɜɟɪɲɟɧɧɵɦ ɮɚɝɨɰɢɬɨɡɨɦ, %
0
54,3*
56,1**
ɉɪɢɦɟɱɚɧɢɟ. ɋɬɚɬɢɫɬɢɱɟɫɤɚɹ ɡɧɚɱɢɦɨɫɬɶ ɪɚɡɥɢɱɢɣ ɦɟɠɞɭ ɩɨɤɚɡɚɬɟɥɹɦɢ (p < 0,01): * – I ɢ II ɝɪɭɩɩ, ** – I ɢ III ɝɪɭɩɩ.
Ɍ. 18, ʋ 4, 2013
ȼɟɫɬɧɢɤ ɂɜɚɧɨɜɫɤɨɣ ɦɟɞɢɰɢɧɫɤɨɣ ɚɤɚɞɟɦɢɢ
2. ɍ ɞɟɬɟɣ ɫ ɜɪɨɠɞɟɧɧɨɣ ɩɧɟɜɦɨɧɢɟɣ ɰɢɬɨɥɨɝɢɱɟɫɤɚɹ ɤɚɪɬɢɧɚ ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɧɚɥɢɱɢɟɦ ɛɚɤɬɟɪɢɚɥɶɧɨɣ ɢ ɜɢɪɭɫɧɨɣ
ɮɥɨɪɵ, ɩɪɢɡɧɚɤɚɦɢ ɝɢɛɟɥɢ ɤɥɟɬɨɤ ɚɥɶɜɟɨɥɹɪɧɨɝɨ ɷɩɢɬɟɥɢɹ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɜ ɜɢɞɟ ɧɟɤɪɨɛɢɨɡɚ ɢ ɧɟɤɪɨɡɚ, ɚ ɬɚɤɠɟ ɛóɥɶɲɢɦ, ɱɟɦ ɩɪɢ
ɪɟɫɩɢɪɚɬɨɪɧɨɦ ɞɢɫɬɪɟɫɫ-ɫɢɧɞɪɨɦɟ, ɫɪɟɞɧɢɦ
ɤɨɥɢɱɟɫɬɜɨɦ ɩɨɥɢɦɨɪɮɧɨɹɞɟɪɧɵɯ ɥɟɣɤɨɰɢɬɨɜ.
ɉɪɢ ɪɟɫɩɢɪɚɬɨɪɧɨɦ ɞɢɫɬɪɟɫɫ-ɫɢɧɞɪɨɦɟ ɜ ɰɢɬɨ-
23
ɝɪɚɦɦɟ ɱɢɫɥɨ ɧɟɢɡɦɟɧɟɧɧɵɯ ɚɥɶɜɟɨɥɨɰɢɬɨɜ
ɡɧɚɱɢɦɨ ɛɨɥɶɲɟ, ɱɟɦ ɩɪɢ ɩɧɟɜɦɨɧɢɢ; ɝɢɛɟɥɶ ɠɟ
ɤɥɟɬɨɤ ɪɟɫɩɢɪɚɬɨɪɧɨɝɨ ɷɩɢɬɟɥɢɹ ɨɫɭɳɟɫɬɜɥɹɟɬɫɹ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɩɭɬɟɦ ɚɩɨɩɬɨɡɚ.
3. ɍɤɚɡɚɧɧɵɟ ɨɫɨɛɟɧɧɨɫɬɢ ɤɥɟɬɨɱɧɨɝɨ ɫɨɫɬɚɜɚ
ɬɪɚɯɟɚɥɶɧɵɯ ɚɫɩɢɪɚɬɨɜ ɦɨɝɭɬ ɫɥɭɠɢɬɶ ɞɨɩɨɥɧɢɬɟɥɶɧɵɦ ɞɢɚɝɧɨɫɬɢɱɟɫɤɢɦ ɤɪɢɬɟɪɢɟɦ ɞɵɯɚɬɟɥɶɧɵɯ ɪɚɫɫɬɪɨɣɫɬɜ ɭ ɝɥɭɛɨɤɨ ɧɟɞɨɧɨɲɟɧɧɵɯ
ɞɟɬɟɣ.
ǹǶȀdzǾǮȀȁǾǮ
1. ȼɨɡɦɨɠɧɨɫɬɢ ɰɢɬɨɥɨɝɢɱɟɫɤɨɝɨ ɦɟɬɨɞɚ ɜ ɞɢɚɝɧɨɫɬɢɤɟ ɞɨɥɶɤɨɜɨɝɨ ɪɚɤɚ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ / ɇ. ɇ. ȼɨɥɱɟɧɤɨ [ɢ ɞɪ.] // ɇɨɜɨɫɬɢ ɤɥɢɧɢɱɟɫɤɨɣ ɰɢɬɨɥɨɝɢɢ Ɋɨɫɫɢɢ. – 2003. – Ɍ. 6, ʋ 1–2. – ɋ. 49–50.
2. Ⱦɢɚɝɧɨɫɬɢɱɟɫɤɢɣ ɛɪɨɧɯɨɚɥɶɜɟɨɥɹɪɧɵɣ ɥɚɜɚɠ (ɦɟɬɨɞɢɱɟɫɤɢɟ ɪɟɤɨɦɟɧɞɚɰɢɢ) / ɩɨɞ ɪɟɞ. Ⱥ. Ƚ. ɏɨɦɟɧɤɨ. – Ɇ., 1988.
3. Ʉɥɟɣɦɟɧɨɜɚ, ɇ. ȼ. Ɇɨɪɮɨɥɨɝɢɱɟɫɤɢɟ ɪɚɡɥɢɱɢɹ ɞɵɯɚɬɟɥɶɧɵɯ ɪɚɫɫɬɪɨɣɫɬɜ ɭ ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɞɟɬɟɣ ɜ
ɩɟɪɜɵɟ ɫɭɬɤɢ ɠɢɡɧɢ ɩɨ ɞɚɧɧɵɦ ɫɨɫɬɚɜɚ ɬɪɚɯɟɨɛɪɨɧɯɢɚɥɶɧɵɯ ɫɦɵɜɨɜ / ɇ. ȼ. Ʉɥɟɣɦɟɧɨɜɚ, Ⱥ. ɂ. Ʉɥɟɦɛɨɜɫɤɢɣ // Ⱥɪɯ. ɩɚɬɨɥɨɝɢɢ. – 1999. – Ɍ. 61, ʋ 4. –
ɋ. 31–35.
4. Ʉɥɢɧɢɤɨ-ɥɚɛɨɪɚɬɨɪɧɨɟ ɡɧɚɱɟɧɢɟ ɢɦɦɭɧɨɰɢɬɨɯɢɦɢɱɟɫɤɨɝɨ ɦɟɬɨɞɚ ɨɩɪɟɞɟɥɟɧɢɹ ɂɅ1 ɜ ɚɥɶɜɟɨɥɹɪɧɵɯ
ɦɚɤɪɨɮɚɝɚɯ ɜ ɨɰɟɧɤɟ ɞɨɫɬɢɠɟɧɢɹ ɤɨɧɬɪɨɥɹ ɧɚɞ
ɛɪɨɧɯɢɚɥɶɧɨɣ ɚɫɬɦɨɣ / ɋ. ɇ. ɉɨɫɩɟɥɨɜɚ [ɢ ɞɪ.] //
Ʉɥɢɧɢɱɟɫɤɚɹ ɥɚɛɨɪɚɬɨɪɧɚɹ ɞɢɚɝɧɨɫɬɢɤɚ. – 2011. –
ʋ 10. – ɋ. 9.
5. Ʉɨɦɩɥɟɤɫɧɵɟ ɥɚɛɨɪɚɬɨɪɧɵɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɪɢ ɩɪɨɮɟɫɫɢɨɧɚɥɶɧɵɯ ɡɚɛɨɥɟɜɚɧɢɹɯ ɨɪɝɚɧɨɜ ɞɵɯɚɧɢɹ
/ Ʌ. Ⱥ. ɂɜɚɧɨɜ [ɢ ɞɪ.] // ɉɭɥɶɦɨɧɨɥɨɝɢɹ. – 2008. –
ʋ 4. – ɋ. 26–28.
6. Ɉɫɨɛɟɧɧɨɫɬɢ ɢɦɦɭɧɧɨɝɨ ɨɬɜɟɬɚ ɫɥɢɡɢɫɬɵɯ ɨɛɨɥɨɱɟɤ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɭ ɧɟɞɨɧɨɲɟɧɧɵɯ ɞɟɬɟɣ
ɫ ɩɧɟɜɦɨɧɢɹɦɢ / Ɇ. ȼ. Ʉɭɲɧɚɪɟɜɚ [ɢ ɞɪ.] // ɉɟɞɢɚɬɪɢɹ. – 2002. – ʋ 1. – ɋ. 13–18.
7. ɉɟɪɟɬɹɬɤɨ, Ʌ. ɉ. Ɇɨɪɮɨɥɨɝɢɹ ɩɥɨɞɨɜ ɢ ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɫ ɷɤɫɬɪɟɦɚɥɶɧɨ ɧɢɡɤɨɣ ɦɚɫɫɨɣ ɬɟɥɚ / Ʌ. ɉ. ɉɟɪɟɬɹɬɤɨ, Ʌ. ȼ. Ʉɭɥɢɞɚ, ȿ. ȼ. ɉɪɨɰɟɧɤɨ. – ɂɜɚɧɨɜɨ : ɂɡɞɜɨ «ɂɜɚɧɨɜɨ», 2005. – 384 ɫ.
8. Ɋɟɛɪɨɜɚ, Ɉ. ɘ. ɋɬɚɬɢɫɬɢɱɟɫɤɢɣ ɚɧɚɥɢɡ ɦɟɞɢɰɢɧɫɤɢɯ ɞɚɧɧɵɯ. ɉɪɢɦɟɧɟɧɢɟ ɩɚɤɟɬɚ ɩɪɢɤɥɚɞɧɵɯ ɩɪɨɝɪɚɦɦ SɌAɌISTICA / Ɉ. ɘ. Ɋɟɛɪɨɜɚ. – 3-ɟ ɢɡɞ. – Ɇ. :
Ɇɟɞɢɚɋɮɟɪɚ, 2006. – 312 ɫ.
9. ɋɚɜɨɫɬɢɤɨɜɚ, Ɇ. ȼ. ɂɦɦɭɧɨɰɢɬɨɯɢɦɢɱɟɫɤɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɜ ɞɢɚɝɧɨɫɬɢɤɟ ɢ ɨɰɟɧɤɟ ɜɚɠɧɟɣɲɢɯ ɮɚɤɬɨɪɨɜ ɩɪɨɝɧɨɡɚ ɡɥɨɤɚɱɟɫɬɜɟɧɧɵɯ ɢ ɞɨɛɪɨɤɚɱɟɫɬɜɟɧɧɵɯ ɨɛɪɚɡɨɜɚɧɢɣ : ɚɜɬɨɪɟɮ. ɞɢɫ. ... ɤɚɧɞ. ɦɟɞ. ɧɚɭɤ /
Ɇ. ȼ. ɋɚɜɨɫɬɢɤɨɜɚ. – Ɇ., 2007.
10. Ɏɢɥɢɩɩɨɜ, ȼ. ɉ. Ȼɪɨɧɯɨɚɥɶɜɟɨɥɹɪɧɵɣ ɥɚɜɚɠ ɩɪɢ
ɞɢɮɮɭɡɧɵɯ ɩɨɪɚɠɟɧɢɹɯ ɥɟɝɤɢɯ / ȼ. ɉ. Ɏɢɥɢɩɩɨɜ. –
Ɇ. : Ɇɟɞɢɰɢɧɚ, 2006. – 80 ɫ.
11. ɑɢɱɚɯɨɜ, Ⱦ. Ⱥ. Ƚɢɞɪɨɤɨɪɬɢɡɨɧ ɢ ɮɭɪɨɫɟɦɢɞ ɜ ɥɟɱɟɧɢɢ ɛɪɨɧɯɨɥɟɝɨɱɧɨɣ ɞɢɫɩɥɚɡɢɢ ɭ ɧɟɞɨɧɨɲɟɧɧɵɯ
ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɫ ɧɢɡɤɨɣ ɢ ɷɤɫɬɪɟɦɚɥɶɧɨ ɧɢɡɤɨɣ
ɦɚɫɫɨɣ ɬɟɥɚ : ɚɜɬɨɪɟɮ. ɞɢɫ. ... ɤɚɧɞ. ɦɟɞ. ɧɚɭɤ /
Ⱦ. Ⱥ. ɑɢɱɚɯɨɜ. – ɋɉɛ., 2005. – 24 ɫ.
12. Lamellar body count and stable microbubble test on tracheal aspirates from infants for the diagnosis of respiratory distress syndrome / A. C. Vieira [et al.] // Pediatr.
Crit. Care Med. – 2012. – ʋ 13(2), mar. – P. 178–182.
13. Stumph, F. The Bronchoalveolar lavage to day /
F. Stumph // Chest. – 1981. – Vol. 3, ʋ 80. – P. 251–258.