№4• 2006 том 14 Ю.C. НЕБЫЛИЦИН ОСТРЫЙ ТРОМБОЗ

ʋ4x2006 iɬɨɦ 14
ɘɋ. ɇȿȻɕɅɂɐɂɇ
ÎÑÒÐÛÉ ÒÐÎÌÁÎÇ ÃËÓÁÎÊÈÕ ÂÅÍ ÍÈÆÍÈÕ ÊÎÍÅ×ÍÎÑÒÅÉ:
ÑÎÂÐÅÌÅÍÍÎÅ ÑÎÑÒÎßÍÈÅ ÏÐÎÁËÅÌÛ
ɍɈ «ȼɢɬɟɛɫɤɢɣɝɨɫɭɞɚɪɫɬɜɟɧɧɵɣɦɟɞɢɰɢɧɫɤɢɣɭɧɢɜɟɪɫɢɬɟɬ»,
ɊɟɫɩɭɛɥɢɤɚȻɟɥɚɪɭɫɶ
ȼɫɬɚɬɶɟɩɪɟɞɫɬɚɜɥɟɧɨɛɡɨɪɥɢɬɟɪɚɬɭɪɵɩɨɨɞɧɨɦɭɢɡɜɚɠɧɵɯɪɚɡɞɟɥɨɜɮɥɟɛɨɥɨɝɢɢ – ɞɢɚɝɧɨɫɬɢɤɟɢɥɟɱɟɧɢɸɨɫɬɪɨɝɨɬɪɨɦɛɨɡɚɝɥɭɛɨɤɢɯɜɟɧɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣ. Ⱦɚɧɧɚɹɩɪɨɛɥɟɦɚɜ
ɧɚɫɬɨɹɳɟɟɜɪɟɦɹɹɜɥɹɟɬɫɹ ɚɤɬɭɚɥɶɧɨɣɢɞɨɤɨɧɰɚ ɧɟɪɚɡɪɟɲɟɧɧɨɣ ɢɡɡɚɫɥɨɠɧɨɫɬɢ ɷɬɢɨɥɨɝɢɢ,
ɩɚɬɨɝɟɧɟɡɚɡɚɛɨɥɟɜɚɧɢɹ, ɪɚɡɧɨɨɛɪɚɡɢɹɤɥɢɧɢɱɟɫɤɢɯɩɪɨɹɜɥɟɧɢɣ, ɬɪɭɞɧɨɫɬɢɞɢɚɝɧɨɫɬɢɤɢɢɨɬɫɭɬɫɬɜɢɹɟɞɢɧɵɯɩɨɞɯɨɞɨɜɥɟɱɟɧɢɹ. ȼɪɚɛɨɬɟ ɢɡɥɚɝɚɸɬɫɹɫɨɜɪɟɦɟɧɧɵɟɧɚɭɱɧɵɟɞɚɧɧɵɟɨɛɷɩɢɞɟɦɢɨɥɨɝɢɢɡɚɛɨɥɟɜɚɧɢɹ, ɷɬɢɨɥɨɝɢɢɢɩɚɬɨɝɟɧɟɡɟɬɪɨɦɛɨɨɛɪɚɡɨɜɚɧɢɹɜɜɟɧɚɯ. ɉɪɟɞɫɬɚɜɥɟɧɨɛɡɨɪ
ɧɨɜɵɯɧɚɭɱɧɵɯɞɚɧɧɵɯɩɨɦɟɬɨɞɚɦɥɚɛɨɪɚɬɨɪɧɨɣ, ɢɧɫɬɪɭɦɟɧɬɚɥɶɧɨɣɞɢɚɝɧɨɫɬɢɤ, ɦɨɥɟɤɭɥɹɪɧɨɝɟɧɟɬɢɱɟɫɤɢɦɢɫɫɥɟɞɨɜɚɧɢɹɦ. Ɉɫɜɟɳɟɧɵɜɨɩɪɨɫɵɬɚɤɬɢɤɢɢɩɪɢɧɰɢɩɵɫɨɜɪɟɦɟɧɧɨɝɨɩɨɞɯɨɞɚɤ
ɥɟɱɟɧɢɸɨɫɬɪɨɝɨɬɪɨɦɛɨɡɚɝɥɭɛɨɤɢɯɜɟɧɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣ. Ɉɰɟɧɟɧɵɜɨɡɦɨɠɧɨɫɬɢɤɨɦɩɥɟɤɫɧɨɣɬɟɪɚɩɢɢɢɞɚɧɚɯɚɪɚɤɬɟɪɢɫɬɢɤɚɯɢɪɭɪɝɢɱɟɫɤɢɯɦɟɬɨɞɨɜ. Ɉɛɫɭɠɞɟɧɵɚɫɩɟɤɬɵɪɟɚɛɢɥɢɬɚɰɢɢ
ɩɚɰɢɟɧɬɨɜ, ɩɟɪɟɧɟɫɲɢɯɨɫɬɪɵɣɬɪɨɦɛɨɡɝɥɭɛɨɤɢɯɜɟɧɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣ. ȼɪɚɛɨɬɟɨɬɪɚɠɟɧɵ
ɫɨɜɪɟɦɟɧɧɵɟɩɚɬɨɝɟɧɟɬɢɱɟɫɤɢɟɩɨɞɯɨɞɵɩɪɨɮɢɥɚɤɬɢɤɢɡɚɛɨɥɟɜɚɧɢɹ.
The literature review on one of the most important sections of phlebology - diagnosing and treatment
of acute deep venous thrombosis of the lower extremities – is presented in the article. At present, the
given problem is an actual one and it hasn’t been completely solved because of etiology complexity,
disease pathogenesis, variety of clinical manifestations, difficulties in diagnosing and absence of a single
treatment approach. Modern scientific data on epidemiology of the disease, etiology and pathogenesis of
venous thrombogenesis are given in the article. The overview of new scientific data on the methods of
laboratory, instrumental diagnostics and molecular-genetic investigations is submitted in the article. The
problems of tactics and the principles of present-day approach to the treatment of acute deep venous
thrombosis of the lower extremities are illuminated. The possibilities of complex therapy are estimated
and characteristic of surgical methods is given. Rehabilitation aspects in the patients who have acute
deep venous thrombosis of the lower extremities are discussed. Modern pathogenic approaches to the
disease prevention are reflected in the research.
ɗɩɢɞɟɦɢɨɥɨɝɢɹ
ɉɨɞɚɧɧɵɦɷɩɢɞɟɦɢɨɥɨɝɢɱɟɫɤɢɯɢɫɫɥɟɞɨɜɚɧɢɣ ɱɚɫɬɨɬɚ ɬɪɨɦɛɨɡɨɜ ɝɥɭɛɨɤɢɯ ɜɟɧ
ɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣ (ɌȽȼ) ɜɨɛɳɟɣɩɨɩɭɥɹɰɢɢ ɟɠɟɝɨɞɧɨ ɫɨɫɬɚɜɥɹɟɬ ɨɤɨɥɨ 160 ɧɚ
100 000 ɫɱɚɫɬɨɬɨɣɮɚɬɚɥɶɧɨɣɬɪɨɦɛɨɷɦɛɨɥɢɢɥɟɝɨɱɧɨɣɚɪɬɟɪɢɢ (ɌɗɅȺ) 60 ɧɚ 100 000
ɧɚɫɟɥɟɧɢɹ [21]. ȼɋɒȺɫɨɝɥɚɫɧɨɨɮɢɰɢɚɥɶɧɨɣɫɬɚɬɢɫɬɢɤɟɌȽȼ, ɩɪɨɹɜɥɹɸɳɢɟɫɹɤɥɢ-
ɧɢɱɟɫɤɢɦɢ ɩɪɢɡɧɚɤɚɦɢ, ɨɛɧɚɪɭɠɢɜɚɸɬɫɹ
ɟɠɟɝɨɞɧɨ ɭ 260 000 ɱɟɥɨɜɟɤ: 84 ɜɩɟɪɜɵɟ
ɡɚɛɨɥɟɜɲɢɯ ɧɚ 100 000 ɧɚɫɟɥɟɧɢɹ [27]. ȼ
ɫɬɪɚɧɚɯ Ɂɚɩɚɞɧɨɣ ȿɜɪɨɩɵ, ɜ ɱɚɫɬɧɨɫɬɢ ɜ
Ⱦɚɧɢɢ, ɒɜɟɰɢɢ ɌȽȼɜɫɬɪɟɱɚɟɬɫɹɭ 1,87 –
3,13% ɧɚɫɟɥɟɧɢɹ [1, 24]. ȼɊɨɫɫɢɣɫɤɨɣɎɟɞɟɪɚɰɢɢɷɬɨɡɚɛɨɥɟɜɚɧɢɟɟɠɟɝɨɞɧɨɞɢɚɝɧɨɫɬɢɪɭɟɬɫɹɭ 240 000 ɱɟɥɨɜɟɤ [26]. Ȼɨɥɟɟ 25%
ɫɥɭɱɚɟɜɫɜɹɡɚɧɵɫɪɚɡɥɢɱɧɵɦɢɯɢɪɭɪɝɢɱɟɫɤɢɦɢɜɦɟɲɚɬɟɥɶɫɬɜɚɦɢ. ɉɨɫɥɟɬɪɚɜɦɚɬɨɥɨ107
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
ɝɢɱɟɫɤɢɯ ɨɩɟɪɚɰɢɣ ɨɧ ɞɢɚɝɧɨɫɬɢɪɭɟɬɫɹ ɭ
47%, ɭɪɨɥɨɝɢɱɟɫɤɢɯ – ɭ 34%, ɪɟɤɨɧɫɬɪɭɤɬɢɜɧɵɯɨɩɟɪɚɰɢɣɧɚɛɪɸɲɧɨɣɱɚɫɬɢɚɨɪɬɵɢɩɨɞɜɡɞɨɲɧɵɯɚɪɬɟɪɢɣɪɚɡɜɢɜɚɟɬɫɹɭ
20% ɛɨɥɶɧɵɯ. ɌȽȼɜɨɡɧɢɤɚɸɬɭ 35% ɨɩɟɪɢɪɨɜɚɧɧɵɯɛɨɥɶɧɵɯ ɜɜɨɡɪɚɫɬɟɞɨ 40 ɥɟɬ,
ɢɭ 65% ɜɜɨɡɪɚɫɬɟɨɬ 40 ɞɨ 70 ɥɟɬ. ɍɞɟɬɟɣ
ɌȽȼɜɫɬɪɟɱɚɟɬɫɹɪɟɠɟ. 50% ɌȽȼɜɨɡɧɢɤɚɸɬ ɭɠɟɧɳɢɧ ɜ ɜɨɡɪɚɫɬɟ ɞɨ 40 ɥɟɬ ɢ, ɤɚɤ
ɩɪɚɜɢɥɨ, ɨɧɢɫɜɹɡɚɧɵɫɛɟɪɟɦɟɧɧɨɫɬɶɸ. ɉɨ
ɨɛɨɛɳɟɧɧɵɦɞɚɧɧɵɦɦɢɪɨɜɨɣɥɢɬɟɪɚɬɭɪɵ,
ɧɚ 1000 ɪɨɞɨɜɩɪɢɯɨɞɢɬɫɹ 2-5 ɬɪɨɦɛɨɬɢɱɟɫɤɢɯɨɫɥɨɠɧɟɧɢɣ. ɉɨɞɚɧɧɵɦɆɟɠɞɭɧɚɪɨɞɧɨɝɨ ɤɨɧɫɟɧɫɭɫɚ ɩɨ ɩɪɨɮɢɥɚɤɬɢɤɟ ɌȽȼ ɢ
ɌɗɅȺ, ɱɚɫɬɨɬɚɨɛɧɚɪɭɠɟɧɢɹɌȽȼɩɪɢɡɚɛɨɥɟɜɚɧɢɹɯ ɬɟɪɚɩɟɜɬɢɱɟɫɤɨɝɨ ɢ ɧɟɜɪɨɥɨɝɢɱɟɫɤɨɝɨɩɪɨɮɢɥɹɫɨɫɬɚɜɥɹɟɬɩɪɢɢɧɫɭɥɶɬɟ
56%, ɢɧɮɚɪɤɬɟɦɢɨɤɚɪɞɚ – 22%, ɨɛɳɟɬɟɪɚɩɟɜɬɢɱɟɫɤɢɯɡɚɛɨɥɟɜɚɧɢɹɯ – 17%. ɑɚɫɬɨɬɚ
ɜɵɹɜɥɟɧɢɹ ɌȽȼ ɫɜɹɡɚɧɚ ɫ ɜɨɡɪɚɫɬɨɦ ɢ ɭ
ɛɨɥɶɧɵɯɬɟɪɚɩɟɜɬɢɱɟɫɤɨɝɨɩɪɨɮɢɥɹɫɬɚɪɲɟ
65 ɥɟɬɢɫɨɫɬɚɜɥɹɟɬ 9% [24]. ɌȽȼɨɩɚɫɟɧ
ɪɚɡɜɢɬɢɟɦɬɚɤɨɝɨɝɪɨɡɧɨɝɨɨɫɥɨɠɧɟɧɢɹɵ
ɤɚɤɌɗɅȺ. ɉɨɫɥɟɩɟɪɟɧɟɫɟɧɧɨɝɨɌȽȼɪɟɰɢɞɢɜɧɚɛɥɸɞɚɟɬɫɹɭ 21-34% ɩɚɰɢɟɧɬɨɜ, ɚɭ
15% ɨɧɩɪɢɜɨɞɢɬɤɌɗɅȺ [1]. Ɉɧɚɹɜɥɹɟɬɫɹ
ɩɪɢɱɢɧɨɣɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɣɥɟɬɚɥɶɧɨɫɬɢɜ 6 - 25% ɫɥɭɱɚɹɯ. ȼɫɬɪɭɤɬɭɪɟɥɟɬɚɥɶɧɨɫɬɢ ɯɢɪɭɪɝɢɱɟɫɤɢɯ ɫɬɚɰɢɨɧɚɪɨɜ ɌɗɅȺ
ɩɪɨɱɧɨɭɞɟɪɠɢɜɚɟɬ 2-3 ɦɟɫɬɨ.
ɌȽȼ ɹɜɥɹɟɬɫɹɩɪɢɱɢɧɨɣ ɪɚɡɜɢɬɢɹ ɩɨɫɬɬɪɨɦɛɨɮɥɟɛɢɬɢɱɟɫɤɨɣɛɨɥɟɡɧɢ, ɤɨɬɨɪɚɹ
ɱɚɳɟɜɫɟɝɨɩɪɨɹɜɥɹɟɬɫɹɱɟɪɟɡ 5-15 ɥɟɬ. ɊɚɡɜɢɬɢɟɟɟɡɚɜɢɫɢɬɨɬɥɨɤɚɥɢɡɚɰɢɢɌȽȼ. ɉɪɢ
ɞɢɫɬɚɥɶɧɨɣ ɥɨɤɚɥɢɡɚɰɢɢ (ɝɥɭɛɨɤɢɟ ɜɟɧɵ
ɝɨɥɟɧɢ) ɱɚɫɬɨɬɚɫɨɫɬɚɜɥɹɟɬ 25%, ɩɪɢɢɥɢɨɮɟɦɨɪɚɥɶɧɨɦ-90-98% [1].
ɗɬɢɨɥɨɝɢɹ
ɄɮɚɤɬɨɪɚɦɪɢɫɤɚɌȽȼɨɬɧɨɫɹɬɫɹ: ɜɨɡɪɚɫɬ, ɩɟɪɟɥɨɦɵ ɧɢɠɧɢɯ ɤɨɧɟɱɧɨɫɬɟɣ, ɩɨɥɢɬɪɚɜɦɚ, ɬɟɪɦɢɱɟɫɤɢɟɩɨɜɪɟɠɞɟɧɢɹ, ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶɤɪɨɜɨɨɛɪɚɳɟɧɢɹ II–III ɫɬɟɩɟɧɢ,
ɚɧɬɢɮɨɫɮɨɥɢɩɢɞɧɵɣɫɢɧɞɪɨɦ, ɢɲɟɦɢɱɟɫ108
ɤɚɹɛɨɥɟɡɧɶɫɟɪɞɰɚ, ɷɧɞɚɪɬɟɪɢɢɬ, ɜɚɫɤɭɥɢɬɵ, ɫɢɫɬɟɦɧɵɟɚɭɬɨɢɦɦɭɧɧɵɟɡɚɛɨɥɟɜɚɧɢɹ,
ɩɟɪɟɨɯɥɚɠɞɟɧɢɟ, ɩɟɪɟɩɚɞɵ ɬɟɦɩɟɪɚɬɭɪɵ,
ɨɛɟɡɜɨɠɢɜɚɧɢɟ, ɧɟɭɞɨɛɧɨɟ ɩɨɥɨɠɟɧɢɟ
ɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣɩɪɢɞɥɢɬɟɥɶɧɨɣɟɡɞɟ,
ɩɨɥɟɬɚɯɧɚɫɚɦɨɥɟɬɟ, ɜɢɪɭɫɧɵɟɢɛɚɤɬɟɪɢɚɥɶɧɵɟɢɧɮɟɤɰɢɢ, ɬɪɨɦɛɨɡɵɜɟɧɜɚɧɚɦɧɟɡɟ [12]. ɋɢɫɬɟɦɧɚɹɝɢɩɟɪɤɨɚɝɭɥɹɰɢɹɦɨɠɟɬ
ɪɚɡɜɢɬɶɫɹɩɪɢɛɨɥɶɲɢɯɨɩɟɪɚɬɢɜɧɵɯɜɦɟɲɚɬɟɥɶɫɬɜɚɯ, ɨɠɢɪɟɧɢɢ, ɡɥɨɤɚɱɟɫɬɜɟɧɧɵɯ
ɧɨɜɨɨɛɪɚɡɨɜɚɧɢɹɯ, ɛɟɪɟɦɟɧɧɨɫɬɢ, ɜɪɟɡɭɥɶɬɚɬɟɩɪɢɟɦɚɤɨɧɬɪɚɰɟɩɬɢɜɨɜ, ɷɫɬɪɨɝɟɧɬɟɪɚɩɢɢ, ɯɪɨɧɢɱɟɫɤɨɣɜɟɧɨɡɧɨɣɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ, ɬɪɚɜɦɚɯɫɨɫɭɞɨɜ, ɱɬɨɬɚɤɠɟɩɪɢɜɨɞɢɬ
ɤɌȽȼ. ɍɝɪɨɡɚɪɚɡɜɢɬɢɹɬɪɨɦɛɨɡɚɜɨɡɪɚɫɬɚɟɬɩɪɢɫɨɱɟɬɚɧɢɢɮɚɤɬɨɪɨɜɪɢɫɤɚ.
ɉɚɬɨɝɟɧɟɡ
ȼ ɪɚɡɜɢɬɢɢ ɌȽȼ ɢɦɟɸɬ ɡɧɚɱɟɧɢɟ ɬɪɢ
ɩɚɬɨɝɟɧɟɬɢɱɟɫɤɢɯ ɮɚɤɬɨɪɚ: ɩɨɜɪɟɠɞɟɧɢɟ
ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ, ɧɚɪɭɲɟɧɢɟ ɫɤɨɪɨɫɬɢ
ɤɪɨɜɨɬɨɤɚɢɫɨɫɬɚɜɚɩɪɨɬɟɤɚɸɳɟɣɤɪɨɜɢ.
ȼɟɧɨɡɧɵɟɬɪɨɦɛɵɮɨɪɦɢɪɭɸɬɫɹɜɭɫɥɨɜɢɹɯɦɟɞɥɟɧɧɨɝɨɤɪɨɜɨɬɨɤɚ. ȼɨɫɧɨɜɟɬɪɨɦɛɨɝɟɧɟɡɚɥɟɠɚɬɧɚɪɭɲɟɧɧɵɟɢɥɢɢɡɜɪɚɳɟɧɧɵɟ ɮɭɧɤɰɢɨɧɚɥɶɧɵɟɪɟɚɤɰɢɢɫɨɫɭɞɢɫɬɨɬɪɨɦɛɨɰɢɬɚɪɧɨɝɨɢɤɨɚɝɭɥɹɰɢɨɧɧɨɝɨɝɟɦɨɫɬɚɡɚ. ɂɡɭɱɟɧɢɟɦɨɥɟɤɭɥɹɪɧɵɯɦɟɯɚɧɢɡɦɨɜ
ɬɪɨɦɛɨɨɛɪɚɡɨɜɚɧɢɹɢɮɢɛɪɢɧɨɥɢɡɚɩɨɡɜɨɥɹɟɬɭɬɜɟɪɠɞɚɬɶ, ɱɬɨɫɭɳɟɫɬɜɭɸɬɞɟɮɟɤɬɵ
ɛɟɥɤɨɜ, ɤɨɬɨɪɵɟ ɨɩɪɟɞɟɥɹɸɬ ɧɚɥɢɱɢɟ ɢɫɬɢɧɧɨɣɬɪɨɦɛɨɮɢɥɢɢ. ɗɬɢɞɟɮɟɤɬɵɧɚɫɥɟɞɭɸɬɫɹ, ɚɡɧɚɱɢɬ, ɹɜɥɹɸɬɫɹɝɟɧɟɬɢɱɟɫɤɢɞɟɬɟɪɦɢɧɢɪɨɜɚɧɧɵɦɢ. ȼ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ
ɨɛɧɚɪɭɠɟɧɵ ɞɟɮɟɤɬɵ ɜ ɝɟɧɚɯ ɫɥɟɞɭɸɳɢɯ
ɮɚɤɬɨɪɨɜɫɜɟɪɬɵɜɚɧɢɹɤɪɨɜɢ, ɩɪɢɜɨɞɹɳɢɟ
ɤɧɚɫɥɟɞɫɬɜɟɧɧɵɦɬɪɨɦɛɨɮɢɥɢɹɦ: ɚɧɬɢɬɪɨɦɛɢɧ III, ɩɪɨɬɟɢɧɋ, ɩɪɨɬɟɢɧ S, ɤɨɮɚɤɬɨɪɝɟɩɚɪɢɧɚ II, ɮɢɛɪɢɧɨɝɟɧ, ɩɥɚɡɦɢɧɨɝɟɧ,
ɚɤɬɢɜɚɬɨɪɩɥɚɡɦɢɧɨɝɟɧɚ (t-ɊȺ), ɮɚɤɬɨɪɏɚɝɟɦɚɧɚ, ɮɚɤɬɨɪɵɬɪɨɦɛɨɰɢɬɨɜ, ɩɪɨɫɬɚɰɢɤɥɢɧ, ȺɊɋɪɟɡɢɫɬɟɧɬɧɨɫɬɶɮɚɤɬɨɪɚ V (ɜ 90%
ɫɥɭɱɚɟɜɦɭɬɚɰɢɹɚɪɝɢɧɢɧɚ-506 ɜ V ɮɚɤɬɨɪɟ
ɢɩɨɜɵɲɟɧɢɟɚɤɬɢɜɧɨɫɬɢɩɨɫɥɟɞɧɟɝɨɜɤɪɨ-
ʋ4x2006 iɬɨɦ 14
ɜɨɬɨɤɟ), ɝɢɩɟɪɦɨɧɨɰɢɫɬɟɢɧɟɦɢɹɩɪɢɨɛɧɚɪɭɠɟɧɢɢɝɟɧɟɬɢɱɟɫɤɨɝɨɞɟɮɟɤɬɚɜɫɨɞɟɪɠɚɧɢɢ ɮɟɪɦɟɧɬɚ ɰɢɫɬɚɬɢɧɝɫɢɧɬɟɬɚɡɵ [19,
25, 40]. ɋɨɱɟɬɚɧɢɟɞɟɮɟɤɬɨɜɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ
ɛɨɥɟɟɬɹɠɟɥɵɦɢɬɪɨɦɛɨɮɢɥɢɹɦɢ, ɱɟɦɨɞɢɧɨɱɧɵɟɞɟɮɟɤɬɵ [6]. ɇɟɦɚɥɨɜɚɠɧɨɟɡɧɚɱɟɧɢɟɜ ɪɚɡɜɢɬɢɢɬɪɨɦɛɨɡɨɜ ɢɝɪɚɟɬɫɨɫɬɨɹɧɢɟ ɫɨɫɭɞɢɫɬɨɝɨ ɷɧɞɨɬɟɥɢɹ. Ɉɧ ɨɛɥɚɞɚɟɬ
ɭɧɢɤɚɥɶɧɨɣɫɩɨɫɨɛɧɨɫɬɶɸɦɟɧɹɬɶɫɜɨɣɚɧɬɢɬɪɨɦɛɨɬɢɱɟɫɤɢɣ ɩɨɬɟɧɰɢɚɥ ɧɚ ɬɪɨɦɛɨɝɟɧɧɵɣ. Ɍɚɤɚɹɬɪɚɧɫɮɨɪɦɚɰɢɹɩɪɨɢɫɯɨɞɢɬ
ɩɪɢ ɝɢɩɨɤɫɢɢ, ɩɨɜɪɟɠɞɟɧɢɢɫɬɟɧɨɤɫɨɫɭɞɨɜɮɢɡɢɱɟɫɤɢɦɢɢɯɢɦɢɱɟɫɤɢɦɢɚɝɟɧɬɚɦɢ,
ɩɨɞɜɥɢɹɧɢɟɦɷɤɡɨ - ɢɷɧɞɨɬɨɤɫɢɧɨɜ, ɫɪɟɞɢɤɨɬɨɪɵɯɝɥɚɜɟɧɫɬɜɭɸɳɭɸɪɨɥɶɢɝɪɚɸɬ
ɦɟɞɢɚɬɨɪɵ ɜɨɫɩɚɥɟɧɢɹ (ɢɧɬɟɪɥɟɣɤɢɧɵ,
ɮɚɤɬɨɪɧɟɤɪɨɡɚɨɩɭɯɨɥɢɢ. ɬ. ɞ.), ɚɧɬɢɷɧɞɨɬɟɥɢɚɥɶɧɵɟɢɚɧɬɢɮɨɫɮɨɥɢɩɢɞɧɵɟɚɧɬɢɬɟɥɚ, ɚɬɚɤɠɟɤɥɟɬɨɱɧɵɟɢɩɥɚɡɦɟɧɧɵɟɩɪɨɬɟɚɡɵ (ɬɪɢɩɫɢɧ, ɬɪɨɦɛɢɧ) [4].
Ʉɥɚɫɫɢɮɢɤɚɰɢɹ
ȼɧɚɫɬɨɹɳɟɟɜɪɟɦɹɢɡɜɟɫɬɧɵ 23 ɤɥɚɫɫɢɮɢɤɚɰɢɢ ɨɫɬɪɨɝɨ ɬɪɨɦɛɨɡɚ. ȼɵɞɟɥɹɸɬ
ɨɫɬɪɭɸ, ɩɨɞɨɫɬɪɸ ɢ ɯɪɨɧɢɱɟɫɤɭɸ ɫɬɚɞɢɢ
ɌȽȼ (ɅɢɞɫɤɢɣȺɌ., 1958; Ⱥɥɟɤɫɟɟɜɉɉ.,
1967). ɉɨɦɧɟɧɢɸ ȼɋ. ɋɚɜɟɥɶɟɜɚ (1972),
ɨɫɬɪɚɹɫɬɚɞɢɹɞɥɢɬɶɫɹɨɬɧɟɫɤɨɥɶɤɢɯɞɧɟɣ
ɞɨ 1 ɦɟɫ. ȺȺ. ɒɚɥɢɦɨɜ, ɂɂ. ɋɭɯɚɪɟɜ
(1984) ɫɱɢɬɚɸɬ, ɱɬɨ ɩɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɶ
ɨɫɬɪɨɣɫɬɚɞɢɢ 7—14 ɞɧɟɣ, ɡɚɬɟɦɨɧɚɩɟɪɟɯɨɞɢɬɜɩɨɞɨɫɬɪɭɸ, ɢɱɟɪɟɡ 3 ɦɟɫ. ɧɚɱɢɧɚɟɬɫɹɯɪɨɧɢɱɟɫɤɚɹɫɬɚɞɢɹ.
ɇɚɢɛɨɥɶɲɟɟɩɪɢɡɧɚɧɢɟɩɨɥɭɱɢɥɚɤɥɚɫɫɢɮɢɤɚɰɢɹȼɋ. ɋɚɜɟɥɶɟɜɚɢɫɨɚɜɬ. (1972),
ɜɤɨɬɨɪɨɣɭɱɢɬɵɜɚɸɬɫɹɤɥɢɧɢɱɟɫɤɢɟɩɪɨɹɜɥɟɧɢɹ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɥɨɤɚɥɢɡɚɰɢɢ ɢ
ɩɪɨɬɹɠɟɧɧɨɫɬɢɬɪɨɦɛɚ [8].
1. ɉɨɥɨɤɚɥɢɡɚɰɢɢ: ɚ) ɬɪɨɦɛɨɡɦɚɝɢɫɬɪɚɥɶɧɵɯɜɟɧɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣ —ɧɢɠɧɢɣɫɟɝɦɟɧɬ; ɛ) ɬɪɨɦɛɨɡɧɚɪɭɠɧɨɣɢɨɛɳɟɣ
ɩɨɞɜɡɞɨɲɧɵɯɜɟɧ — ɫɪɟɞɧɢɣ ɫɟɝɦɟɧɬ; ɜ)
ɬɪɨɦɛɨɡ ɧɢɠɧɟɣ ɩɨɥɨɣ ɜɟɧɵ — ɜɟɪɯɧɢɣ
ɫɟɝɦɟɧɬ.
2. ɉɨ ɷɬɢɨɥɨɝɢɱɟɫɤɨɦɭ ɮɚɤɬɨɪɭ: ɩɟɪɜɢɱɧɵɣɢɜɪɨɠɞɟɧɧɵɣ.
3. ɉɨ ɤɥɢɧɢɱɟɫɤɨɦɭ ɬɟɱɟɧɢɸ: ɫɬɚɞɢɹ
ɤɨɦɩɟɧɫɚɰɢɢɢɫɬɚɞɢɹɞɟɤɨɦɩɟɧɫɚɰɢɢ.
ɇɟɫɦɨɬɪɹɧɚɛɨɥɶɲɨɟɤɨɥɢɱɟɫɬɜɨɩɪɟɞɥɚɝɚɟɦɵɯɤɥɚɫɫɢɮɢɤɚɰɢɣɌȽȼ, ɜɧɚɫɬɨɹɳɟɟ
ɜɪɟɦɹ ɧɟɬ ɟɞɢɧɨɣ, ɤɨɬɨɪɚɹ ɛɵɥɚ ɭɞɨɛɧɨɣ
ɞɥɹɩɪɚɤɬɢɱɟɫɤɨɝɨɩɪɢɦɟɧɟɧɢɹɢɹɜɥɹɥɚɫɶ
ɭɧɢɜɟɪɫɚɥɶɧɨɣ.
Ⱦɢɚɝɧɨɫɬɢɤɚ
Ⱥɤɬɭɚɥɶɧɨɣ ɩɪɨɛɥɟɦɨɣ ɫɨɜɪɟɦɟɧɧɨɣ
ɮɥɟɛɨɥɨɝɢɢɹɜɥɹɟɬɫɹ ɪɚɧɧɹɹɞɢɚɝɧɨɫɬɢɤɚ
ɌȽȼ. ȼ ɞɢɚɝɧɨɫɬɢɱɟɫɤɢɣ ɤɨɦɩɥɟɤɫ ɌȽȼ
ɜɤɥɸɱɚɸɬɫɹ: ɨɰɟɧɤɚɤɥɢɧɢɱɟɫɤɨɣɤɚɪɬɢɧɵ,
ɢɫɫɥɟɞɨɜɚɧɢɟɞɢɧɚɦɢɤɢɩɪɢɡɧɚɤɨɜɚɤɬɢɜɚɰɢɢɫɢɫɬɟɦɵɤɨɚɝɭɥɹɰɢɨɧɧɨɝɨɢɬɪɨɦɛɨɰɢɬɚɪɧɨɝɨɝɟɦɨɫɬɚɡɚ, ɮɥɟɛɨɝɪɚɮɢɹ, ɤɚɩɢɥɥɹɪɨɫɤɨɩɢɹ, ɬɟɪɦɨɝɪɚɮɢɹ, ɩɥɟɬɢɡɦɨɝɪɚɮɢɹ,
ɭɥɶɬɪɚɡɜɭɤɨɜɨɟɚɧɝɢɨɫɤɚɧɢɪɨɜɚɧɢɟɜȼ±ɪɟɠɢɦɟ, ɞɨɩɩɥɟɪɨɝɪɚɮɢɹ, ɞɭɩɥɟɤɫɧɨɟɢɬɪɢɩɥɟɤɫɧɨɟɚɧɝɢɨɫɤɚɧɢɪɨɜɚɧɢɟɫɢɫɩɨɥɶɡɨɜɚɧɢɟɦɪɟɠɢɦɨɜɰɜɟɬɨɜɨɝɨ, ɷɧɟɪɝɟɬɢɱɟɫɤɨɝɨ
ɤɚɪɬɢɪɨɜɚɧɢɹ ɤɪɨɜɨɬɨɤɚ, ɤɨɦɩɶɸɬɟɪɧɚɹ
ɬɨɦɨɝɪɚɮɢɹ, ɹɞɟɪɧɨɦɚɝɧɢɬɧɵɣɪɟɡɨɧɚɧɫ,
125
J-ɮɢɛɪɢɧɨɝɟɧɧɨɟ ɫɤɚɧɢɪɨɜɚɧɢɟ, ɢɡɭɱɟɧɢɟɝɟɧɟɬɢɱɟɫɤɢɯɞɟɮɟɤɬɨɜ.
ȼɟɞɭɳɢɦɡɜɟɧɨɦɜɞɢɚɝɧɨɫɬɢɤɟɌȽȼɧɚ
ɪɚɧɧɢɯɫɬɚɞɢɹɯɹɜɥɹɟɬɫɹɤɥɢɧɢɱɟɫɤɚɹɤɚɪɬɢɧɚ, ɤɨɬɨɪɚɹɛɭɞɟɬɡɚɜɢɫɟɬɶɨɬɜɢɞɚɬɪɨɦɛɚ, ɟɝɨ ɥɨɤɚɥɢɡɚɰɢɢɢ ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɨɫɬɢ, ɧɚɥɢɱɢɹɤɨɥɥɚɬɟɪɚɥɟɣ [15, 26]. ɈɫɧɨɜɧɵɦɢɤɥɢɧɢɱɟɫɤɢɦɢɫɢɦɩɬɨɦɚɦɢɌȽȼɹɜɥɹɸɬɫɹ: ɛɨɥɢɩɨɯɨɞɭɝɥɭɛɨɤɢɯɜɟɧ, ɪɚɫɩɢɪɚɸɳɢɟɛɨɥɢ, ɨɬɟɤɫɟɝɦɟɧɬɚɢɥɢɜɫɟɣɤɨɧɟɱɧɨɫɬɢ, ɰɢɚɧɨɡɤɨɠɧɵɯɩɨɤɪɨɜɨɜ, ɩɟɪɟɩɨɥɧɟɧɢɟɩɨɞɤɨɠɧɵɯɜɟɧ. ɇɚɢɛɨɥɟɟɢɧɮɨɪɦɚɬɢɜɧɵɦɢ ɹɜɥɹɸɬɫɹ: ɫɢɦɩɬɨɦ ɏɨɦɚɧɫɚ
ɜɫɬɪɟɱɚɟɬɫɹ ɜ 35%, ɫɢɦɩɬɨɦ Ʌɢɫɤɟɪɚ - ɜ
65%, ɫɢɦɩɬɨɦɅɭɜɟɥɹ - ɜ 40% ɫɥɭɱɚɟɜ [15].
ɇɢɨɞɢɧɢɡɤɥɢɧɢɱɟɫɤɢɯɩɪɢɡɧɚɤɨɜ, ɜɡɹɬɵɣ
ɜɨɬɞɟɥɶɧɨɫɬɢ, ɧɟɦɨɠɟɬɛɵɬɶɢɫɩɨɥɶɡɨɜɚɧ
ɢɡɨɥɢɪɨɜɚɧɨ, ɫɨɱɟɬɚɧɢɟɧɟɫɤɨɥɶɤɢɯɫɢɦɩɬɨɦɨɜɦɨɠɟɬɩɨɜɵɫɢɬɶɢɯɞɢɚɝɧɨɫɬɢɱɟɫɤɭɸ
109
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
ɰɟɧɧɨɫɬɶ. ɉɪɢɜɧɢɦɚɬɟɥɶɧɨɦɤɥɢɧɢɱɟɫɤɨɦ
ɨɛɫɥɟɞɨɜɚɧɢɢ ɞɢɚɝɧɨɡ ɦɨɠɟɬ ɛɵɬɶ ɭɫɬɚɧɨɜɥɟɧɜ 60% ɫɥɭɱɚɟɜ [15].
ɂɫɫɥɟɞɨɜɚɧɢɟɫɢɫɬɟɦɵɤɨɚɝɭɥɹɰɢɨɧɧɨɝɨɢɬɪɨɦɛɨɰɢɬɚɪɧɨɝɨɝɟɦɨɫɬɚɡɚɢɦɟɟɬɩɟɪɜɨɫɬɟɩɟɧɧɨɟɡɧɚɱɟɧɢɟɞɥɹɞɢɚɝɧɨɫɬɢɱɟɫɤɨɝɨɫɤɪɢɧɢɧɝɚɌȽȼɢɝɢɩɟɪɤɨɚɝɭɥɹɰɢɨɧɧɵɯ
ɬɪɨɦɛɨɮɢɥɢɣ, ɚɬɚɤɠɟɞɥɹɨɫɭɳɟɫɬɜɥɟɧɢɹ
ɦɨɧɢɬɨɪɢɧɝɚɡɚɫɨɫɬɨɹɧɢɟɦɝɟɦɨɤɨɚɝɭɥɹɰɢɨɧɧɵɯɦɟɯɚɧɢɡɦɨɜɩɪɢɩɪɨɜɟɞɟɧɢɢɚɧɬɢɬɪɨɦɛɨɬɢɱɟɫɤɨɣ ɬɟɪɚɩɢɢ. ɇɚɢɛɨɥɟɟ ɩɨɤɚɡɚɬɟɥɶɧɵɦɢɹɜɥɹɸɬɫɹɥɚɛɨɪɚɬɨɪɧɵɟɬɟɫɬɵ:
ȺɉɌȼ (ɚɤɬɢɜɢɪɨɜɚɧɧɨɟɩɚɪɰɢɚɥɶɧɨɟɬɪɨɦɛɨɩɥɚɫɬɢɧɨɜɨɟɜɪɟɦɹ), ȺȼɊ (ɚɤɬɢɜɢɪɨɜɚɧɧɨɟɜɪɟɦɹɪɟɤɚɥɶɰɢɮɢɤɚɰɢɢ), ȺɄɌ (ɚɭɬɨɤɨɚɝɭɥɹɰɢɨɧɧɵɣ ɬɟɫɬ), ɮɢɛɪɢɧɨɝɟɧ ɩɨ Ɋɭɬɛɟɪɝ, ɩɚɪɚɤɨɚɝɭɥɹɰɢɨɧɧɵɟɬɟɫɬɵ (ɩɪɨɬɚɦɢɧɨɜɵɣɢɷɬɚɧɨɥɨɜɵɣ) [17, 44]. Ɉɛɚɤɬɢɜɚɰɢɢɫɜɟɪɬɵɜɚɸɳɟɣɫɢɫɬɟɦɵɤɪɨɜɢɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬɩɨɜɵɲɟɧɢɟɜɩɥɚɡɦɟɦɚɪɤɟɪɨɜ
ɝɢɩɟɪɤɨɚɝɭɥɹɰɢɢ: ɉɊɎ (ɩɪɨɞɭɤɬɨɜɪɚɫɩɚɞɚ
ɮɢɛɪɢɧɨɝɟɧɚ), ɮɢɛɪɢɧɨɩɟɩɬɢɞɚ A, D-Dimer
ɩɪɨɞɭɤɬɨɜɪɚɫɩɚɞɚɩɟɪɟɤɪɟɫɬɧɨɫɜɹɡɚɧɧɨɝɨɮɢɛɪɢɧɚ), ɤɨɦɩɥɟɤɫɨɜ F1+2 (ɩɪɨɬɪɨɦɛɢɧɨɜɚɧɧɵɟɮɪɚɝɦɟɧɬɵ) ɢɌȺɌ (ɬɪɨɦɛɢɧ - ɚɧɬɢɬɪɨɦɛɢɧ III). Ɋɟɡɭɥɶɬɚɬɵ ɢɫɫɥɟɞɨɜɚɧɢɣ
ɩɨɤɚɡɵɜɚɸɬ, ɱɬɨɧɢɡɤɚɹɤɨɧɰɟɧɬɪɚɰɢɹ DD
ɜɩɥɚɡɦɟɦɨɠɟɬɛɵɬɶɨɫɧɨɜɚɧɢɟɦɞɥɹɢɫɤɥɸɱɟɧɢɹɌȽȼɭɩɚɰɢɟɧɬɨɜ, ɭɤɨɬɨɪɵɯɢɦɟɸɬɫɹ ɤɥɢɧɢɱɟɫɤɢɟɩɪɢɡɧɚɤɢ ɡɚɛɨɥɟɜɚɧɢɹ.
ɑɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ ɦɟɬɨɞɚ ɫɨɫɬɚɜɥɹɟɬ 92100%. DD-ɬɟɫɬɢɪɨɜɚɧɢɟɦɨɠɟɬɛɵɬɶɰɟɧɧɵɦɞɨɩɨɥɧɢɬɟɥɶɧɵɦɦɟɬɨɞɨɦɞɥɹɢɫɤɥɸɱɟɧɢɹɌȽȼɜɪɚɧɧɟɦɩɟɪɢɨɞɟ, ɚɬɚɤɠɟɩɪɢ
ɩɨɜɬɨɪɧɨɦ ɩɨɹɜɥɟɧɢɢ ɩɪɢɡɧɚɤɨɜ ɌȽȼ [9,
38, 48]. Ⱦɥɹɨɰɟɧɤɢɫɨɫɬɨɹɧɢɹɬɪɨɦɛɨɰɢɬɚɪɧɨɝɨɡɜɟɧɚɩɪɨɢɡɜɨɞɢɬɫɹ: ɩɨɞɫɱɟɬɤɨɥɢɱɟɫɬɜɚɬɪɨɦɛɨɰɢɬɨɜ, ɬɪɨɦɛɨɰɢɬɚɪɧɨɣɮɨɪɦɭɥɵ (ɩɨɡɜɨɥɹɟɬɞɚɬɶɤɚɱɟɫɬɜɟɧɧɭɸɯɚɪɚɤɬɟɪɢɫɬɢɤɭɤɪɨɜɹɧɵɯɩɥɚɫɬɢɧɨɤ, ɬɟ. ɩɪɨɰɟɧɬɧɨɟɫɨɨɬɧɨɲɟɧɢɟɪɚɡɥɢɱɧɵɯɤɥɚɫɫɨɜ), ɨɩɪɟɞɟɥɟɧɢɟɫɩɨɧɬɚɧɧɨɣɚɝɪɟɝɚɰɢɢɬɪɨɦɛɨɰɢɬɨɜɫȺȾɎɢɚɞɪɟɧɚɥɢɧɨɦ, ɦɨɪɮɨɮɭɧɤɰɢɨɧɚɥɶɧɭɸɨɰɟɧɤɭɜɧɭɬɪɢɫɨɫɭɞɢɫɬɨɣɚɤɬɢɜɚɰɢɢɬɪɨɦɛɨɰɢɬɨɜ [3, 22, 23].
110
ɄɨɧɬɪɚɫɬɧɚɹɮɥɟɛɨɝɪɚɮɢɹɹɜɥɹɟɬɫɹɢɧɮɨɪɦɚɬɢɜɧɵɦɬɟɫɬɨɦɢɞɟɧɬɢɮɢɤɚɰɢɢɌȽȼ.
ɉɪɢɦɟɧɟɧɢɟ ɤɨɧɬɪɚɫɬɢɪɨɜɚɧɢɹ ɝɥɭɛɨɤɨɣ
ɜɟɧɨɡɧɨɣ ɫɢɫɬɟɦɵ ɞɥɹ ɞɢɚɝɧɨɫɬɢɤɢ ɌȽȼ
ɫɬɚɥɨɨɝɪɚɧɢɱɟɧɧɵɦɩɨɫɥɟɲɢɪɨɤɨɝɨɜɧɟɞɪɟɧɢɹɜɩɪɚɤɬɢɤɭɭɥɶɬɪɚɡɜɭɤɨɜɨɝɨɦɟɬɨɞɚ
ɢɫɫɥɟɞɨɜɚɧɢɹ. ȼɧɚɫɬɨɹɳɟɟɜɪɟɦɹɢɫɩɨɥɶɡɭɟɬɫɹɪɟɬɪɨɝɪɚɞɧɚɹɢɥɢɨɤɚɜɚɝɪɚɮɢɹɧɢɠɧɟɣɩɨɥɨɣɢɩɨɞɜɡɞɨɲɧɵɯɜɟɧɫɰɟɥɶɸɨɩɪɟɞɟɥɟɧɢɹɩɪɨɤɫɢɦɚɥɶɧɨɣɝɪɚɧɢɰɵɬɪɨɦɛɨɡɚ [26].
Ʉɧɟɢɧɜɚɡɢɜɧɵɦɬɟɫɬɚɦɨɬɧɨɫɹɬɫɹɩɥɟɬɢɡɦɨɝɪɚɮɢɹ, ɭɥɶɬɪɚɡɜɭɤɨɜɨɟɚɧɝɢɨɫɤɚɧɢɪɨɜɚɧɢɟ, ɞɨɩɩɥɟɪɨɝɪɚɮɢɹ, ɞɭɩɥɟɤɫɧɨɟɢɬɪɢɩɥɟɤɫɧɨɟ ɫɤɚɧɢɪɨɜɚɧɢɟ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ
ɪɟɠɢɦɨɜɰɜɟɬɨɜɨɝɨ, ɷɧɟɪɝɟɬɢɱɟɫɤɨɝɨɤɚɪɬɢɪɨɜɚɧɢɹɤɪɨɜɨɬɨɤɚ, ɤɨɦɩɶɸɬɟɪɧɚɹɬɨɦɨɝɪɚɮɢɹɢɹɞɟɪɧɨɦɚɝɧɢɬɧɵɣɪɟɡɨɧɚɧɫ.
ɇɟɤɨɬɨɪɵɟɚɜɬɨɪɵɪɟɤɨɦɟɧɞɭɸɬɜɞɢɚɝɧɨɫɬɢɤɟɌȽȼɩɪɢɦɟɧɹɬɶɢɦɩɟɞɚɧɫɧɭɸ (ɂɉ)
ɢɬɟɧɡɢɨɦɟɬɪɢɱɟɫɤɭɸ (Ɍɉ) ɩɥɟɬɢɡɦɨɝɪɚɮɢɢ.
ɑɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶɂɉɩɪɢɩɪɨɤɫɢɦɚɥɶɧɨɦ
ɌȽȼ ɫɨɫɬɚɜɥɹɟɬ ɜ ɫɪɟɞɧɟɦ 94% (ɨɬ 87 ɞɨ
100%), ɚ ɫɩɟɰɢɮɢɱɧɨɫɬɶ - 95% (ɨɬ 91 ɞɨ
100%) [37]. ɑɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ ɦɟɬɨɞɚ ɩɪɢ
ɞɢɫɬɚɥɶɧɨɦɌȽȼɫɨɫɬɚɜɥɹɟɬ 20%, ɚɫɩɟɰɢɮɢɱɧɨɫɬɶɨɫɬɚɟɬɫɹɜɵɫɨɤɨɣ, ɧɚɭɪɨɜɧɟ 95%
[37, 42]. ɑɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶɌɉɫɨɫɬɚɜɥɹɟɬ 95100%, ɫɩɟɰɢɮɢɱɧɨɫɬɶ 80-100% [42].
ɍɥɶɬɪɚɡɜɭɤɨɜɨɟ ɚɧɝɢɨɫɤɚɧɢɪɨɜɚɧɢɟ ɜ
ȼ±ɪɟɠɢɦɟɨɬɥɢɱɚɟɬɥɟɝɤɨɫɬɶɜɵɩɨɥɧɟɧɢɹ,
ɲɢɪɨɤɚɹɞɨɫɬɭɩɧɨɫɬɶɢɜɨɡɦɨɠɧɨɫɬɶɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨɣɜɢɡɭɚɥɢɡɚɰɢɢɬɪɨɦɛɚ. ɇɚɢɛɨɥɟɟɬɨɱɧɵɦɢɩɪɨɫɬɵɦɤɪɢɬɟɪɢɟɦɧɚɥɢɱɢɹ
ɌȽȼɹɜɥɹɟɬɫɹɧɟɫɠɢɦɚɟɦɨɫɬɶɜɟɧɵɩɪɢɥɟɝɤɨɦ ɩɪɨɛɧɨɦ ɫɞɚɜɥɢɜɚɧɢɢ [36]. Ⱦɚɥɶɧɟɣɲɢɟɞɢɚɝɧɨɫɬɢɱɟɫɤɢɟɤɪɢɬɟɪɢɢɜɤɥɸɱɚɸɬ
ɜɢɡɭɚɥɢɡɚɰɢɸɬɪɨɦɛɚɢɨɬɫɭɬɫɬɜɢɟɪɚɫɲɢɪɟɧɢɹɜɟɧɵɩɪɢɦɚɧɟɜɪɟȼɚɥɶɫɚɥɶɜɚ. ɑɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ ɦɟɬɨɞɚɫɨɫɬɚɜɥɹɟɬ 97%, ɫɩɟɰɢɮɢɱɧɨɫɬɶ - 97% ɩɪɢ ɩɪɨɤɫɢɦɚɥɶɧɨɦ
ɬɪɨɦɛɨɡɟ [29, 31]. ɄɪɢɬɟɪɢɹɦɢɌȽȼɩɪɢɢɫɩɨɥɶɡɨɜɚɧɢɢɞɨɩɩɥɟɪɨɝɪɚɮɢɢɫɧɟɩɪɟɪɵɜɧɨɣɜɨɥɧɨɣɹɜɥɹɸɬɫɹɨɬɫɭɬɫɬɜɢɟɤɪɨɜɨɬɨɤɚ, ɧɟɩɪɟɪɵɜɧɵɣɤɪɨɜɨɬɨɤɛɟɡɮɚɡɧɨɫɬɢɜ
ʋ4x2006 iɬɨɦ 14
ɫɨɨɬɜɟɬɫɬɜɢɢɫɞɵɯɚɧɢɟɦ, ɚɬɚɤɠɟɨɬɫɭɬɫɬɜɢɟɢɥɢɧɟɡɧɚɱɢɬɟɥɶɧɨɫɬɶɭɫɢɥɟɧɢɹɤɪɨɜɨɬɨɤɚ ɩɪɢ ɞɢɫɬɚɥɶɧɨɣ ɤɨɦɩɪɟɫɫɢɢ ɢɥɢ
ɩɪɨɤɫɢɦɚɥɶɧɨɣɞɟɤɨɦɩɪɟɫɫɢɢ. Ⱦɭɩɥɟɤɫɧɨɟ
ɚɧɝɢɨɫɤɚɧɢɪɨɜɚɧɢɟ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ
ɤɨɦɛɢɧɚɰɢɸɢɦɩɭɥɶɫɧɵɯɫɢɫɬɟɦɞɨɩɩɥɟɪɨɜɫɤɨɝɨɦɟɬɨɞɚɫɞɜɭɯɦɟɪɧɵɦɢɡɨɛɪɚɠɟɧɢɟɦ ɜ ȼɪɟɠɢɦɟ. ɑɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ ɫɨɫɬɚɜɥɹɟɬɜɫɪɟɞɧɟɦ 93% (ɨɬ 87 ɞɨ 100%), ɚ
ɫɩɟɰɢɮɢɱɧɨɫɬɶ - 94% (78-100%) [10, 11, 13,
24, 48]. Ⱦɥɹɩɨɜɵɲɟɧɢɹɢɧɮɨɪɦɚɬɢɜɧɨɫɬɢ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɪɢɦɟɧɹɟɬɫɹ ɰɜɟɬɨɜɨɟ
ɞɨɩɩɥɟɪɨɜɫɤɨɟ ɤɚɪɬɢɪɨɜɚɧɢɟ ɢ ɰɜɟɬɨɜɨɟ
ɞɨɩɩɥɟɪɨɜɫɤɨɟɤɚɪɬɢɪɨɜɚɧɢɟɩɨɷɧɟɪɝɢɢ.
ɍɤɚɡɚɧɧɵɣɦɟɬɨɞɭɥɶɬɪɚɡɜɭɤɨɜɨɝɨɢɫɫɥɟɞɨɜɚɧɢɹɩɨɥɭɱɢɥɧɚɡɜɚɧɢɟɬɪɢɩɥɟɤɫɧɨɝɨɚɧɝɢɨɫɤɚɧɢɪɨɜɚɧɢɹ. Ⱦɚɧɧɵɣɪɟɠɢɦɢɫɩɨɥɶɡɭɸɬɩɪɢɢɫɫɥɟɞɨɜɚɧɢɢɜɟɧɦɚɥɨɝɨɤɚɥɢɛɪɚ. Ȼɥɚɝɨɞɚɪɹɬɨɱɧɨɫɬɢ, ɯɨɪɨɲɟɦɭɫɨɨɬɧɨɲɟɧɢɸɫɬɨɢɦɨɫɬɢɢɷɮɮɟɤɬɢɜɧɨɫɬɢ, ɚɬɚɤɠɟɩɪɨɫɬɨɬɟɭɥɶɬɪɚɡɜɭɤɨɜɨɟɢɫɫɥɟɞɨɜɚɧɢɟ
ɪɟɤɨɦɟɧɞɨɜɚɧɨɜɤɚɱɟɫɬɜɟɨɫɧɨɜɧɨɝɨɞɢɚɝɧɨɫɬɢɱɟɫɤɨɝɨɬɟɫɬɚ [41].
Ʉɨɦɩɶɸɬɟɪɧɚɹ ɬɨɦɨɝɪɚɮɢɹ ɹɜɥɹɟɬɫɹ
ɥɭɱɲɢɦ ɦɟɬɨɞɨɦ ɜɢɡɭɚɥɢɡɚɰɢɢ ɤɪɭɩɧɵɯ
ɜɟɧ, ɢɞɟɧɬɢɮɢɤɚɰɢɢ ɢɧɬɪɚɥɸɦɢɧɚɥɶɧɵɯ
ɬɪɨɦɛɨɜ [28]. ɋɨɡɞɚɧɢɟɢɡɨɛɪɚɠɟɧɢɣɝɥɭɛɨɤɢɯɜɟɧɧɢɠɧɢɯɤɨɧɟɱɧɨɫɬɟɣɢɬɚɡɨɜɵɯ
ɜɟɧ ɫ ɩɨɦɨɳɶɸ ɹɞɟɪɧɨɦɚɝɧɢɬɧɨɝɨ ɪɟɡɨɧɚɧɫɚɨɰɟɧɟɧɨɬɨɥɶɤɨɜɧɟɛɨɥɶɲɢɯɤɥɢɧɢɱɟɫɤɢɯɢɫɩɵɬɚɧɢɹɯ: ɫɨɨɛɳɚɟɬɫɹɨɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢɢɫɩɟɰɢɮɢɱɧɨɫɬɢɩɪɢɞɢɚɝɧɨɫɬɢɤɟ ɌȽȼ, ɪɚɜɧɵɯ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ 100 ɢ
96% [33, 34]. ȼɫɜɹɡɢɫɜɵɫɨɤɨɣɫɬɨɢɦɨɫɬɶɸɢɨɝɪɚɧɢɱɟɧɧɨɣɞɨɫɬɭɩɧɨɫɬɶɸɷɬɢɦɟɬɨɞɵ ɜ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɢɫɩɨɥɶɡɭɸɬɫɹ ɜ
ɢɫɤɥɸɱɢɬɟɥɶɧɵɯɫɥɭɱɚɹɯ [35].
125
J-ɮɢɛɪɢɧɨɝɟɧɧɨɟɫɤɚɧɢɪɨɜɚɧɢɟɹɜɥɹɟɬɫɹɢɧɜɚɡɢɜɧɵɦɬɟɫɬɨɦɌȽȼ. ȼɧɚɫɬɨɹɳɟɟɜɪɟɦɹɩɪɢɦɟɧɟɧɢɟɞɚɧɧɨɝɨɦɟɬɨɞɚɨɝɪɚɧɢɱɟɧɨ ɢɡɡɚ ɷɬɢɱɟɫɤɢɯ ɢ ɬɟɯɧɢɱɟɫɤɢɯ
ɩɪɨɛɥɟɦ, ɫɜɹɡɚɧɧɵɯ ɫ ɜɵɩɨɥɧɟɧɢɟɦ ɪɚɞɢɨɚɤɬɢɜɧɵɯɬɟɫɬɨɜ. ɑɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ IɎɋ ɩɪɢ ɞɢɫɬɚɥɶɧɨɦɌȽȼ ɝɨɥɟɧɢ ɫɨɫɬɚɜɥɹɟɬ 55% [32, 47].
ȼɩɨɫɥɟɞɧɟɟɜɪɟɦɹɜɫɟɛɨɥɶɲɟɟɡɧɚɱɟɧɢɟɩɪɢɨɛɪɟɬɚɸɬɝɟɧɟɬɢɱɟɫɤɢɟɢɫɫɥɟɞɨɜɚɧɢɹ. Ɉɧɢɩɨɡɜɨɥɹɸɬɜɵɹɜɢɬɶɧɚɫɥɟɞɫɬɜɟɧɧɵɟɞɟɮɟɤɬɵ, ɥɟɠɚɳɢɟɜɨɫɧɨɜɟɜɨɡɧɢɤɧɨɜɟɧɢɹɌȽȼ [19, 25].
Ʌɟɱɟɧɢɟ
ɉɨɞɨɡɪɟɧɢɟɧɚɌȽȼɹɜɥɹɟɬɫɹɚɛɫɨɥɸɬɧɵɦɩɨɤɚɡɚɧɢɟɦɤɫɪɨɱɧɨɣɝɨɫɩɢɬɚɥɢɡɚɰɢɢ
ɩɚɰɢɟɧɬɚɜɫɩɟɰɢɚɥɢɡɢɪɨɜɚɧɧɵɣɚɧɝɢɨɯɢɪɭɪɝɢɱɟɫɤɢɣɫɬɚɰɢɨɧɚɪɢɥɢɜɯɢɪɭɪɝɢɱɟɫɤɨɟɨɬɞɟɥɟɧɢɟ.
ȼ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɥɟɱɟɛɧɚɹ ɬɚɤɬɢɤɚ
ɌȽȼɧɟɫɬɚɧɞɚɪɬɢɡɢɪɨɜɚɧɚ.
Ʌɟɱɟɧɢɟɞɨɥɠɧɨɛɵɬɶɧɚɩɪɚɜɥɟɧɨɧɚ:
1) ɩɪɟɤɪɚɳɟɧɢɟɪɨɫɬɚɢɪɚɫɩɪɨɫɬɪɚɧɟɧɢɹ
ɬɪɨɦɛɚ;
2) ɩɪɟɞɨɬɜɪɚɳɟɧɢɟɌɗɅȺ;
3) ɧɟɞɨɩɭɳɟɧɢɟɩɪɨɝɪɟɫɫɢɪɨɜɚɧɢɹɨɬɟɤɚ
ɢɩɪɟɞɨɬɜɪɚɳɟɧɢɟɪɚɡɜɢɬɢɟɜɟɧɨɡɧɨɣɝɚɧɝɪɟɧɵ;
4) ɜɨɫɫɬɚɧɨɜɥɟɧɢɟɩɪɨɯɨɞɢɦɨɫɬɢɩɪɨɫɜɟɬɚɜɟɧɵ;
5) ɩɪɟɞɭɩɪɟɠɞɟɧɢɟɪɟɰɢɞɢɜɚɬɪɨɦɛɨɡɚ.
ɉɨɫɬɟɥɶɧɵɣɪɟɠɢɦɧɚɡɧɚɱɚɟɬɫɹ, ɩɨɤɚ
ɧɟ ɢɫɱɟɡɧɟɬ ɜɵɪɚɠɟɧɧɵɣ ɨɬɟɤ, ɧɟ ɛɭɞɟɬ
ɨɛɟɫɩɟɱɟɧɚɚɧɬɢɤɨɚɝɭɥɹɧɬɧɚɹɬɟɪɚɩɢɹɢɧɟ
ɢɫɤɥɸɱɟɧɮɥɨɬɢɪɭɸɳɢɣɬɪɨɦɛɨɡ [26]. ɗɥɚɫɬɢɱɟɫɤɚɹɤɨɦɩɪɟɫɫɢɹɩɪɨɜɨɞɢɬɫɹɨɬɫɬɨɩɵɞɨɩɚɯɨɜɨɣɫɤɥɚɞɤɢ. ɗɮɮɟɤɬɢɜɧɨɫɬɶɟɟ
ɩɨɜɵɲɚɟɬɫɹ, ɟɫɥɢ ɤɨɠɭ ɨɛɢɥɶɧɨ ɫɦɚɡɵɜɚɬɶɚɤɬɢɜɧɵɦɢɮɥɟɛɨɬɪɨɩɧɵɦɢɦɚɡɹɦɢ:
ɝɟɩɚɬɪɨɦɛɢɧ, ɥɢɨɬɨɧɝɟɥɶ, ɝɢɧɤɨɪɮɨɪɬ,
ɬɪɨɤɫɟɪɭɬɢɧ, ɜɟɧɢɬɚɧ [26]. ɇɨɪɦɨɜɨɥɟɦɢɱɟɫɤɚɹɝɟɦɨɞɢɥɸɰɢɹɩɪɨɜɨɞɢɬɫɹɫɰɟɥɶɸɢɡɦɟɧɟɧɢɹɫɨɫɬɚɜɚɤɪɨɜɢ, ɫɧɢɠɟɧɢɹ
ɟɟɜɹɡɤɨɫɬɢ.
Ʉɨɦɩɥɟɤɫɧɨɟɥɟɱɟɧɢɟɜɤɥɸɱɚɟɬ: ɚɧɬɢɤɨɚɝɭɥɹɧɬɵɩɪɹɦɨɝɨɢɧɟɩɪɹɦɨɝɨɞɟɣɫɬɜɢɹ,
ɚɧɬɢɚɝɪɟɝɚɧɬɵ, ɧɟɫɬɟɪɨɢɞɧɵɟɩɪɨɬɢɜɨɜɨɫɩɚɥɢɬɟɥɶɧɵɟɢɮɥɟɛɨɚɤɬɢɜɧɵɟɩɪɟɩɚɪɚɬɵ.
ɎɋȺɦɢɧɨɜ [8] ɭɤɚɡɵɜɚɟɬ ɧɚ ɷɮɮɟɤɬɢɜɧɨɫɬɶɩɪɢɦɟɧɟɧɢɹɚɧɬɤɨɚɝɭɥɹɧɬɧɨɮɢɛɪɢɧɨɥɢɬɢɱɟɫɤɨɣɬɟɪɚɩɢɢɜɤɨɦɩɥɟɤɫɟɫɝɢɞ111
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
ɪɨɤɨɪɬɢɡɨɧɨɦ, ɡɚɞɟɪɠɢɜɚɸɳɟɣ ɩɪɨɰɟɫɫɵ
ɮɢɛɪɨɡɚɢɮɥɟɛɨɫɤɥɟɪɨɡɚɜɫɬɟɧɤɟɡɚɬɪɨɦɛɢɪɨɜɚɧɧɨɝɨɭɱɚɫɬɤɚɜɟɧɵ. ȺɧɬɢɤɨɚɝɭɥɹɧɬɧɚɹɬɟɪɚɩɢɹɹɜɥɹɟɬɫɹɧɚɢɛɨɥɟɟɷɮɮɟɤɬɢɜɧɵɦɦɟɬɨɞɨɦɥɟɱɟɧɢɹɌȽȼ. ȼɩɟɪɜɵɟɱɚɫɵ
ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ ɛɨɥɶɧɵɯ ɌȽȼ ɧɚɡɧɚɱɚɸɬ
ɚɧɬɢɤɨɚɝɭɥɹɧɬɵɩɪɹɦɨɝɨɞɟɣɫɬɜɢɹ: ɝɟɩɚɪɢɧ
ɩɨ 10 ɬɵɫ. ȿȾɩɨɞɤɨɠɧɨ 4–6 ɪɚɡ ɜɫɭɬɤɢ.
Ⱦɥɹ ɞɨɫɬɢɠɟɧɢɹ ɦɚɤɫɢɦɚɥɶɧɨ ɛɵɫɬɪɨɝɨ
ɚɧɬɢɤɨɚɝɭɥɹɰɢɨɧɧɨɝɨɷɮɮɟɤɬɚɰɟɥɟɫɨɨɛɪɚɡɧɨɩɟɪɜɨɧɚɱɚɥɶɧɨɟɜɧɭɬɪɢɜɟɧɧɨɟɫɬɪɭɣɧɨɟ
ɜɜɟɞɟɧɢɟ 5000 ȿȾɝɟɩɚɪɢɧɚ, ɚɡɚɬɟɦɨɫɬɚɬɨɤɫɭɬɨɱɧɨɣɞɨɡɵɫɩɨɦɨɳɶɸɢɧɮɭɡɨɦɚɬɚ.
ɉɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɶɝɟɩɚɪɢɧɨɬɟɪɚɩɢɢɢɧɞɢɜɢɞɭɚɥɶɧɚɢɜɫɪɟɞɧɟɦɫɨɫɬɚɜɥɹɟɬ 7–10
ɫɭɬ. ɉɪɢɷɬɨɦɞɨɡɚɝɟɩɚɪɢɧɚɤɨɪɪɟɝɢɪɭɟɬɫɹ
ɫɭɱɟɬɨɦ ɜɪɟɦɟɧɧɵɯɩɨɤɚɡɚɬɟɥɟɣ ɫɜɟɪɬɵɜɚɧɢɹɤɪɨɜɢ (ɨɩɬɢɦɚɥɶɧɨɢɯɭɞɥɢɧɟɧɢɟɜ
1,5–2 ɪɚɡɚɨɬɧɨɪɦɵ), ɤɨɬɨɪɵɟɨɰɟɧɢɜɚɸɬɫɹɩɟɪɟɞɨɱɟɪɟɞɧɵɦɜɜɟɞɟɧɢɟɦɩɪɟɩɚɪɚɬɚ.
ȼɧɚɫɬɨɹɳɟɟɜɪɟɦɹɞɥɹɚɧɬɢɤɨɚɝɭɥɹɧɬɧɨɣ
ɬɟɪɚɩɢɢɌȽȼɲɢɪɨɤɨɢɫɩɨɥɶɡɭɸɬɧɢɡɤɨɦɨɥɟɤɭɥɹɪɧɵɟɝɟɩɚɪɢɧɵ (ɮɪɚɤɫɢɩɚɪɢɧ, ɤɥɟɤɫɚɧ, ɞɚɥɬɟɩɚɪɢɧ), ɤɨɬɨɪɵɟɞɟɣɫɬɜɭɸɬɧɚɏɚɮɚɤɬɨɪ. Ɉɧɢ ɜɜɨɞɹɬɫɹ 1–2 ɪɚɡɚ ɜ ɫɭɬɤɢ ɜ
ɞɨɡɢɪɨɜɤɟɫɭɱɟɬɨɦɦɚɫɫɵɬɟɥɚɨɬ 0,3 ɞɨ 0,8
ɦɥ. ɉɪɢ ɢɯɩɪɢɦɟɧɟɧɢɢ ɜɪɟɦɹ ɫɜɟɪɬɵɜɚɧɢɹɢȺɑɌȼɞɨɥɠɧɵɛɵɬɶɭɞɥɢɧɟɧɵɜ 1,2–
1,8 ɪɚɡɚ. Ɂɚ 3–4 ɞɧɹɞɨɩɪɟɞɩɨɥɚɝɚɟɦɨɣɨɬɦɟɧɵɩɪɹɦɵɯɚɧɬɢɤɨɚɝɭɥɹɧɬɨɜɧɟɨɛɯɨɞɢɦɨ
ɧɚɡɧɚɱɚɬɶ ɧɟɩɪɹɦɵɟ. ɂɯ ɷɮɮɟɤɬɢɜɧɚɹ ɫɭɬɨɱɧɚɹɞɨɡɚɤɨɧɬɪɨɥɢɪɭɟɬɫɹɩɨɭɪɨɜɧɸɢɧɞɟɤɫɚɩɪɨɬɪɨɦɛɢɧɚ, ɜɟɥɢɱɢɧɚɤɨɬɨɪɨɝɨɞɨɥɠɧɚɛɵɬɶɫɬɚɛɢɥɢɡɢɪɨɜɚɧɚɜɩɪɟɞɟɥɚɯ 45–
60%. ɉɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɶ ɩɪɢɟɦɚ ɧɟɩɪɹɦɵɯɚɧɬɢɤɨɚɝɭɥɹɧɬɨɜɨɛɵɱɧɨɫɨɫɬɚɜɥɹɟɬ 3–
6 ɦɟɫ., ɩɨɫɤɨɥɶɤɭɢɦɟɧɧɨɜɷɬɢɫɪɨɤɢɱɚɳɟ
ɜɫɟɝɨ ɧɚɛɥɸɞɚɸɬɫɹ ɪɟɰɢɞɢɜɵ ɌȽȼ. ɉɪɢ
ɬɪɨɦɛɨɮɢɥɢɱɟɫɤɢɯɫɨɫɬɨɹɧɢɹɯɬɟɪɚɩɢɹɧɟɩɪɹɦɵɦɢ ɚɧɬɢɤɨɚɝɭɥɹɧɬɚɦɢɞɨɥɠɧɚ ɛɵɬɶ
ɛɨɥɟɟɞɥɢɬɟɥɶɧɨɣ [1, 6, 23, 26].
Ɍɪɨɦɛɨɥɢɬɢɱɟɫɤɚɹɬɟɪɚɩɢɹɩɪɟɞɭɫɦɚɬɪɢɜɚɟɬɩɪɢɦɟɧɟɧɢɟɩɪɟɩɚɪɚɬɨɜ, ɚɤɬɢɜɢɡɢɪɭɸɳɢɯɷɧɞɨɝɟɧɧɵɣɮɢɛɪɢɧɨɥɢɡ (ɫɬɪɟɩɬɨɤɢɧɚɡɚ, ɭɪɨɤɢɧɚɡɚ, ɬɤɚɧɟɜɵɣ ɚɤɬɢɜɚɬɨɪ
112
ɩɥɚɡɦɢɧɨɝɟɧɚ). ȼɪɹɞɟɫɥɭɱɚɟɜɭɞɚɟɬɫɹɜɨɫɫɬɚɧɨɜɢɬɶɩɪɨɫɜɟɬɬɪɨɦɛɢɪɨɜɚɧɧɨɝɨɫɨɫɭɞɚ, ɫɨɯɪɚɧɢɬɶɧɟɢɡɦɟɧɟɧɧɭɸɢɧɬɢɦɭɢɜɟɧɨɡɧɵɟɤɥɚɩɚɧɵ [27]. Ɉɞɧɚɤɨɜɧɚɫɬɨɹɳɟɟ
ɜɪɟɦɹɜɨɩɪɨɫɨ ɩɪɢɦɟɧɟɧɢɢɬɪɨɦɛɨɥɢɬɢɱɟɫɤɨɣɬɟɪɚɩɢɢɹɜɥɹɟɬɫɹɞɢɫɤɭɬɚɛɟɥɶɧɵɦ,
ɬɚɤɤɚɤɨɧɚɦɨɠɟɬɩɪɢɜɟɫɬɢɤɮɪɚɝɦɟɧɬɚɰɢɢɬɪɨɦɛɚɢɌɗɅȺ. ɉɨɷɬɨɦɭ ɧɟɤɨɬɨɪɵɟ
ɚɜɬɨɪɵ [26] ɪɟɤɨɦɟɧɞɭɸɬ ɟɟ ɩɪɨɜɟɞɟɧɢɟ
ɩɨɫɥɟ ɢɦɩɥɚɧɬɚɰɢɢ ɫɴɟɦɧɨɝɨ ɢɥɢ ɩɨɫɬɨɹɧɧɨɝɨɤɚɜɚ±ɮɢɥɶɬɪɚ.
ȼɧɚɫɬɨɹɳɟɟɜɪɟɦɹɜɵɹɜɥɟɧɨɜɵɪɚɠɟɧɧɨɟ ɫɧɢɠɟɧɢɟ ɫɜɟɪɬɵɜɚɸɳɟɣ ɚɤɬɢɜɧɨɫɬɢ
ɤɪɨɜɢ ɩɨɞ ɜɨɡɞɟɣɫɬɜɢɟɦ ɨɡɨɧɨɬɟɪɚɩɢɢ,
ɩɪɨɜɨɞɢɦɨɣɜɜɢɞɟɢɧɮɭɡɢɣɨɡɨɧɢɪɨɜɚɧɧɨɝɨɮɢɡɢɨɥɨɝɢɱɟɫɤɨɝɨɪɚɫɬɜɨɪɚ [18]. Ɉɧɚ
ɬɚɤɠɟɩɪɢɜɨɞɢɬɤɭɥɭɱɲɟɧɢɸɮɭɧɤɰɢɨɧɚɥɶɧɵɯɯɚɪɚɤɬɟɪɢɫɬɢɤɬɪɨɦɛɨɰɢɬɨɜ – ɫɧɢɠɟɧɢɸɫɩɨɫɨɛɧɨɫɬɢɬɪɨɦɛɨɰɢɬɨɜɤɚɝɪɟɝɚɰɢɢ
ɧɚɮɨɧɟɭɜɟɥɢɱɟɧɢɹɢɯɤɨɥɢɱɟɫɬɜɚ.
ȼ ɤɨɦɩɥɟɤɫɧɨɟ ɥɟɱɟɧɢɟ ɌȽȼ ɜɯɨɞɹɬ
ɚɧɬɢɚɝɪɟɝɚɧɬɵ: ɚɰɟɬɢɥɫɚɥɢɰɢɥɨɜɚɹ ɤɢɫɥɨɬɚɩɨ 50 ɦɝɜɫɭɬɤɢ, ɬɢɤɥɨɩɢɞɢɧɩɨ 250
ɦɝ 2 ɪɚɡɚɜ ɫɭɬɤɢ, ɤɥɨɩɢɞɨɝɪɟɥɶ 75–100
ɦɝɜɫɭɬɤɢ [26]. ɇɟɫɩɟɰɢɮɢɱɟɫɤɢɟɩɪɨɬɢɜɨɜɨɫɩɚɥɢɬɟɥɶɧɵɟɫɪɟɞɫɬɜɚɧɚɡɧɚɱɚɸɬɫɹ
ɩɚɪɟɧɬɟɪɚɥɶɧɨɢɥɢɪɟɤɬɚɥɶɧɨ (ɜɫɜɟɱɚɯ)
ɫɰɟɥɶɸɫɧɢɠɟɧɢɹɜɨɫɩɚɥɢɬɟɥɶɧɨɣɪɟɚɤɰɢɢɫɨɫɬɨɪɨɧɵɜɟɧɨɡɧɨɣɫɬɟɧɤɢɢɛɨɥɟɜɨɝɨɫɢɧɞɪɨɦɚ. Ɉɞɧɨɜɪɟɦɟɧɧɨɧɚɡɧɚɱɚɸɬɫɹ ɮɥɟɛɨɚɤɬɢɜɧɵɟ ɩɪɟɩɚɪɚɬɵ (ɞɟɬɪɚɥɟɤɫ, ɷɫɤɭɡɚɧ, ɬɪɨɤɫɟɪɭɬɢɧ), ɤɨɬɨɪɵɟɭɥɭɱɲɚɸɬɜɟɧɨɡɧɵɣɢɥɢɦɮɚɬɢɱɟɫɤɢɣɨɬɬɨɤ,
ɭɦɟɧɶɲɚɸɬ ɩɪɨɧɢɰɚɟɦɨɫɬɶ ɤɚɩɢɥɥɹɪɨɜ,
ɩɨɜɵɲɚɸɬɬɨɧɭɫɫɬɟɧɨɤ, ɨɤɚɡɵɜɚɸɬɩɪɨɬɢɜɨɨɬɟɱɧɨɟɞɟɣɫɬɜɢɟ.
Ⱥɧɬɢɛɢɨɬɢɤɢ ɩɪɢ ɧɟɨɫɥɨɠɧɟɧɧɨɦ
ɌȽȼɧɟɩɪɢɦɟɧɹɸɬɫɹ. ɂɫɤɥɸɱɟɧɢɟɦɹɜɥɹɸɬɫɹɝɧɨɣɧɢɱɤɨɜɵɟɩɨɪɚɠɟɧɢɹɤɨɠɢɢ
ɩɚɰɢɟɧɬɵ ɫ ɜɵɫɨɤɢɦ ɪɢɫɤɨɦ ɫɟɩɬɢɱɟɫɤɢɯɨɫɥɨɠɧɟɧɢɣ (ɫɚɯɚɪɧɵɣɞɢɚɛɟɬ, ȼɂɑ
ɢɞɪ.) [26].
ȿɫɥɢɩɪɢɞɢɧɚɦɢɱɟɫɤɨɦɭɥɶɬɪɚɡɜɭɤɨɜɨɦ
ɢɫɫɥɟɞɨɜɚɧɢɢ ɢɥɢ ɩɨ ɞɚɧɧɵɦ ɢɥɢɨɤɚɜɚɝɪɚɮɢɢɢɦɟɸɬɫɹɫɢɦɩɬɨɦɵɩɪɨɝɪɟɫɫɢɪɨɜɚ-
ʋ4x2006 iɬɨɦ 14
ɧɢɹɬɪɨɦɛɚɜɩɪɨɤɫɢɦɚɥɶɧɨɦɧɚɩɪɚɜɥɟɧɢɢ
ɢɥɢɟɝɨɮɥɨɬɚɰɢɢ, ɩɨɤɚɡɚɧɵɯɢɪɭɪɝɢɱɟɫɤɢɟɦɟɬɨɞɵɥɟɱɟɧɢɹ: ɬɪɨɦɛɷɤɬɨɦɢɹ, ɩɥɢɤɚɰɢɹɩɨɞɜɡɞɨɲɧɵɯɢɧɢɠɧɟɣɩɨɥɨɣɜɟɧɵ
ɇɉȼ) ɜɵɲɟɦɟɫɬɚɬɪɨɦɛɚ, ɩɟɪɟɜɹɡɤɚɦɚɝɢɫɬɪɚɥɶɧɵɯɜɟɧ, ɭɫɬɚɧɨɜɤɚɫɴɟɦɧɨɝɨɢɥɢ
ɩɨɫɬɨɹɧɧɨɝɨɤɚɜɚɮɢɥɶɬɪɚ. Ɍɪɨɦɛɷɤɬɨɦɢɹ
ɷɮɮɟɤɬɢɜɧɚɜɫɥɭɱɚɹɯɪɚɧɨɞɢɚɝɧɨɫɬɢɪɨɜɚɧɧɵɯ (ɞɨ 7 ɫɭɬɨɤ) ɫɟɝɦɟɧɬɚɪɧɵɯ ɌȽȼ,
ɤɨɝɞɚ ɧɟɬ ɜɵɪɚɠɟɧɧɨɝɨ ɮɥɟɛɢɬɚ [46]. ɋ
ɰɟɥɶɸ ɭɦɟɧɶɲɟɧɢɹ ɱɚɫɬɨɬɵ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɯɪɟɬɪɨɦɛɨɡɨɜɩɪɟɞɥɨɠɟɧɨɧɚɤɥɚɞɵɜɚɬɶɜɪɟɦɟɧɧɭɸɚɪɬɟɪɢɨɜɟɧɨɡɧɭɸɮɢɫɬɭɥɭ, ɫɪɨɤɢɡɚɤɪɵɬɢɹɤɨɬɨɪɨɣɦɨɝɭɬɛɵɬɶ
ɨɬ 6 ɧɟɞɟɥɶɞɨ 6 ɦɟɫɹɰɟɜ [39]. ɉɥɢɤɚɰɢɹ
ɧɢɠɧɟɣ ɩɨɥɨɣ ɜɟɧɵ ɛɵɥɚ ɩɪɟɞɥɨɠɟɧɚ ɜ
1959 ɝ. F.C.Spenser ɢɫɨɚɜɬ. [35]. ȼɧɚɫɬɨɹɳɟɟɜɪɟɦɹɟɟɩɪɢɦɟɧɟɧɢɟɨɝɪɚɧɢɱɟɧɨɢɡ–
ɡɚ ɛɨɥɟɟ ɜɵɫɨɤɨɣ ɬɪɚɜɦɚɬɢɱɧɨɫɬɢɢ ɪɚɡɜɢɬɢɹɨɫɥɨɠɧɟɧɢɣɜɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ
ɩɟɪɢɨɞɟ. ɉɟɪɟɜɹɡɤɚ ɦɚɝɢɫɬɪɚɥɶɧɵɯ ɜɟɧ
ɩɪɨɢɡɜɨɞɢɬɫɹɬɚɤɠɟɩɪɢɪɚɡɜɢɬɢɢɮɥɨɬɢɪɭɸɳɟɝɨɬɪɨɦɛɚ. ȿɫɥɢɫɭɳɟɫɬɜɭɟɬɭɝɪɨɡɚ
ɪɚɡɜɢɬɢɹɮɥɟɛɢɬɚ, ɬɨɩɪɨɢɡɜɨɞɢɬɫɹɢɯɩɟɪɟɫɟɱɟɧɢɟ. ɉɟɪɟɜɹɡɤɚɨɛɳɟɣɩɨɞɜɡɞɨɲɧɨɣ
ɜɟɧɵɧɟɰɟɥɟɫɨɨɛɪɚɡɧɚ. Ʌɭɱɲɟɩɪɨɢɡɜɟɫɬɢ
ɟɟ ɩɥɢɤɚɰɢɸ [26]. ȼɪɟɦɟɧɧɚɹ ɢɦɩɥɚɧɬɚɰɢɹɤɚɜɚɮɢɥɶɬɪɚɩɪɨɢɡɜɨɞɢɬɫɹɦɨɥɨɞɵɦ
ɢ “ɫɨɯɪɚɧɧɵɦ” ɛɨɥɶɧɵɦɫɬɚɪɲɟɝɨɜɨɡɪɚɫɬɚ, ɧɟɨɬɹɝɨɳɟɧɧɵɦɝɟɦɚɬɨɥɨɝɢɱɟɫɤɢɦɢɢ
ɨɧɤɨɥɨɝɢɱɟɫɤɢɦɢɡɚɛɨɥɟɜɚɧɢɹɦɢɞɥɹɩɪɨɮɢɥɚɤɬɢɤɢɌɗɅȺɧɚɩɟɪɢɨɞ, ɤɨɝɞɚɜɟɪɨɹɬɧɨɫɬɶɟɝɨɜɨɡɧɢɤɧɨɜɟɧɢɹɧɚɢɛɨɥɟɟɜɵɫɨɤɚ: ɯɢɪɭɪɝɢɱɟɫɤɚɹɬɪɨɦɛɷɤɬɨɦɢɹɩɪɢɮɥɨɬɢɪɭɸɳɢɯɬɪɨɦɛɨɡɚɯɪɚɡɥɢɱɧɨɣɥɨɤɚɥɢɡɚɰɢɢ, ɪɟɝɢɨɧɚɪɧɚɹɬɪɨɦɛɨɥɢɬɢɱɟɫɤɚɹɬɟɪɚɩɢɹ. ɋɪɨɤɢɜɨɡɦɨɠɧɨɝɨɩɪɟɛɵɜɚɧɢɹɮɢɥɶɬɪɚɜɩɪɨɫɜɟɬɟɇɉȼ, ɩɨɞɚɧɧɵɦɥɢɬɟɪɚɬɭɪɵ, ɫɨɫɬɚɜɥɹɸɬɨɬ 10 ɞɧɟɣɞɨ 4 ɧɟɞɟɥɶ [20].
ɍɫɬɚɧɨɜɤɚɩɨɫɬɨɹɧɧɨɝɨɤɚɜɚɮɢɥɶɬɪɚɩɪɨɢɡɜɨɞɢɬɫɹɩɪɢɮɥɨɬɢɪɭɸɳɢɯɬɪɨɦɛɚɯɇɉȼ,
ɩɨɞɜɡɞɨɲɧɨɣɢɛɟɞɪɟɧɧɨɣɜɟɧ, ɨɫɥɨɠɧɟɧɧɵɯ ɢɥɢ ɧɟɨɫɥɨɠɧɟɧɧɵɯ ɌɗɅȺ; ɦɚɫɫɢɜɧɨɣ ɌɗɅȺ; ɩɨɜɬɨɪɧɨɣ ɌɗɅȺ, ɢɫɬɨɱɧɢɤ
ɤɨɬɨɪɨɣɧɟɭɫɬɚɧɨɜɥɟɧ [43].
Ɋɟɚɛɢɥɢɬɚɰɢɹ
Ʉɨɦɩɥɟɤɫɧɚɹ ɪɟɚɛɢɥɢɬɚɰɢɨɧɧɚɹɩɪɨɝɪɚɦɦɚɜɤɥɸɱɚɟɬ: ɩɪɨɮɢɥɚɤɬɢɤɭɪɟɰɢɞɢɜɚ
ɡɚɛɨɥɟɜɚɧɢɹ, ɤɨɦɩɟɧɫɚɰɢɸɜɟɧɨɡɧɨɝɨɨɬɬɨɤɚɢɩɪɟɞɨɬɜɪɚɳɟɧɢɟɩɪɨɝɪɟɫɫɢɪɨɜɚɧɢɹ
ɩɨɫɬɬɪɨɦɛɨɮɥɟɛɢɬɢɱɟɫɤɨɣɛɨɥɟɡɧɢ, ɫɨɰɢɚɥɶɧɭɸɚɞɚɩɬɚɰɢɸɩɚɰɢɟɧɬɚɫɫɨɯɪɚɧɟɧɢɟɦɢɦɩɪɢɜɵɱɧɨɝɨɭɪɨɜɧɹɤɚɱɟɫɬɜɚɠɢɡɧɢ
[5, 26]. Ʉɨɦɩɟɧɫɚɰɢɹɜɟɧɨɡɧɨɝɨɨɬɬɨɤɚɞɨɫɬɢɝɚɟɬɫɹ ɜɟɞɟɧɢɟɦɚɤɬɢɜɧɨɝɨɞɜɢɝɚɬɟɥɶɧɨɝɨɪɟɠɢɦɚɫɨɝɪɚɧɢɱɟɧɢɟɦɫɬɚɬɢɱɟɫɤɨɝɨ ɩɪɟɛɵɜɚɧɢɹ ɜ ɜɟɪɬɢɤɚɥɶɧɨɦ ɩɨɥɨɠɟɧɢɢ. ɗɬɨɨɩɪɟɞɟɥɹɟɬɧɟɨɛɯɨɞɢɦɨɫɬɶɩɪɢɦɟɧɟɧɢɹ ɷɥɚɫɬɢɱɟɫɤɨɣ ɤɨɦɩɪɟɫɫɢɢ. Ɋɚɫɩɪɨɫɬɪɚɧɟɧɢɟɬɪɨɦɛɚɧɚɇɉȼ, ɫɨɫɬɨɹɧɢɹ
ɩɨ ɫɥɟ ɢɦɩɥɚɧɬɚɰɢɢ ɤɚɜɚɮɢɥɶɬɪɚ ɢɥɢ
ɤɚɜɚɩɥɢɤɚɰɢɢ, ɜɵɡɵɜɚɸɳɢɟɮɥɟɛɨɝɢɩɟɪɬɟɧɡɢɸɜɨɛɟɢɯɤɨɧɟɱɧɨɫɬɹɯ, ɹɜɥɹɸɬɫɹɚɛɫɨɥɸɬɧɵɦ ɩɨɤɚɡɚɧɢɟɦ ɤ ɞɜɭɫɬɨɪɨɧɧɟɦɭ
ɷɥɚɫɬɢɱɟɫɤɨɦɭɛɚɧɞɚɠɭ [26]. ɉɪɢɩɪɨɜɟɞɟɧɢɢ ɚɦɛɭɥɚɬɨɪɧɨɝɨ ɥɟɱɟɧɢɹ ɩɨɞɛɢɪɚɸɬ
ɚɞɟɤɜɚɬɧɭɸɞɨɡɭɧɟɩɪɹɦɵɯɚɧɬɢɤɨɚɝɭɥɹɧɬɨɜ, ɤɨɬɨɪɭɸɫɥɟɞɭɟɬɤɨɪɪɢɝɢɪɨɜɚɬɶ. ɉɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɶ ɩɪɢɟɦɚɧɟɩɪɹɦɵɯ ɚɧɬɢɤɨɚɝɭɥɹɧɬɨɜɞɨɥɠɧɚɛɵɬɶɧɟɦɟɧɟɟ 3 ɦɟɫ.
ȼɚɠɧɵɦɦɨɦɟɧɬɨɦɚɧɬɢɤɨɚɝɭɥɹɧɬɧɨɣɬɟɪɚɩɢɢɫɥɟɞɭɟɬɩɪɢɡɧɚɬɶɫɬɚɛɢɥɶɧɵɣɭɪɨɜɟɧɶ ɝɢɩɨɤɨɚɝɭɥɹɰɢɢ. ɉɨɫɥɟɡɚɜɟɪɲɟɧɢɹ
ɩɪɢɟɦɚɧɟɩɪɹɦɵɯɚɧɬɢɤɨɚɝɭɥɹɧɬɨɜɩɥɚɧɢɪɭɟɬɫɹɩɪɨɝɪɚɦɦɚɦɟɞɢɤɚɦɟɧɬɨɡɧɨɝɨɥɟɱɟɧɢɹ, ɧɚɩɪɚɜɥɟɧɧɚɹɧɚɭɥɭɱɲɟɧɢɟɝɟɦɨɪɟɨɥɨɝɢɢ, ɦɢɤɪɨɰɢɪɤɭɥɹɰɢɢɢɥɢɦɮɚɬɢɱɟɫɤɨɝɨɨɬɬɨɤɚ. ɂɡɮɢɡɢɨɬɟɪɚɩɟɜɬɢɱɟɫɤɢɯɩɪɨɰɟɞɭɪ ɧɚɢɛɨɥɟɟ ɷɮɮɟɤɬɢɜɧɵɦ ɹɜɥɹɟɬɫɹ
ɜɨɡɞɟɣɫɬɜɢɟɦɚɝɧɢɬɧɵɦɩɨɥɟɦ [5].
ɉɪɨɮɢɥɚɤɬɢɤɚ
ɉɪɨɮɢɥɚɤɬɢɱɟɫɤɢɟɦɟɪɨɩɪɢɹɬɢɹɜɤɥɸɱɚɸɬ: ɜɵɹɜɥɟɧɢɟɮɚɤɬɨɪɨɜɪɢɫɤɚ, ɫɜɨɟɜɪɟɦɟɧɧɨɟɥɟɱɟɧɢɟɫɨɩɭɬɫɬɜɭɸɳɢɯɡɚɛɨɥɟɜɚɧɢɣ. ȼɵɞɟɥɹɸɬɦɟɬɨɞɵɩɪɨɮɢɥɚɤɬɢɤɢ: ɮɢɡɢɱɟɫɤɢɟɢɮɚɪɦɚɤɨɥɨɝɢɱɟɫɤɢɟ [1, 7, 26]. Ʉ
ɩɟɪɜɨɣ ɝɪɭɩɩɟ ɨɬɧɨɫɹɬɫɹ: ɜɨɡɜɵɲɟɧɧɨɟ
113
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
ɩɨɥɨɠɟɧɢɟɤɨɧɟɱɧɨɫɬɢɜɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɦ ɩɟɪɢɨɞɟ, ɚɤɬɢɜɧɵɟɢɩɚɫɫɢɜɧɵɟ ɞɜɢɠɟɧɢɹɤɨɧɟɱɧɨɫɬɢ, ɷɥɚɫɬɢɱɟɫɤɚɹɤɨɦɩɪɟɫɫɢɹ, ɩɪɟɪɵɜɢɫɬɚɹɩɧɟɜɦɨɤɨɦɩɪɟɫɫɢɹɧɢɠɧɢɯ ɤɨɧɟɱɧɨɫɬɟɣ ɫ ɩɨɦɨɳɶɸ ɧɟɫɤɨɥɶɤɢɯ
ɤɚɦɟɪ, ɩɧɟɜɦɨɦɚɫɫɚɠ, ɫɨɤɪɚɳɟɧɢɟɫɪɨɤɨɜ
ɩɨɫɬɟɥɶɧɨɝɨɪɟɠɢɦɚ [1, 7, 8, 26]. Ɇɟɞɢɤɚɦɟɧɬɨɡɧɚɹɬɟɪɚɩɢɹɜɤɥɸɱɚɟɬ: ɢɫɩɨɥɶɡɨɜɚɧɢɟ ɚɧɬɢɤɨɚɝɭɥɹɧɬɨɜ ɩɪɹɦɨɝɨ ɞɟɣɫɬɜɢɹ
ɧɢɡɤɨɦɨɥɟɤɭɥɹɪɧɵɣ ɝɟɩɚɪɢɧ - ɮɪɚɤɫɢɩɚɪɢɧ, ɧɟɮɪɚɤɰɢɨɧɢɪɨɜɚɧɧɵɣɝɟɩɚɪɢɧ), ɚɧɬɢɤɨɚɝɭɥɹɧɬɨɜɧɟɩɪɹɦɨɝɨɞɟɣɫɬɜɢɹ (ɜɚɪɮɚɪɢɧ), ɩɪɹɦɵɯ ɢɧɝɢɛɢɬɨɪɨɜ ɮɚɤɬɨɪɚ ɏɚ
ɮɨɧɞɚɩɚɪɢɧɭɤɫ), ɬɪɨɦɛɨɰɢɬɚɪɧɵɯɚɧɬɢɚɝɪɟɝɚɧɬɨɜ (ɩɪɟɩɚɪɚɬɵ ɚɰɟɬɢɥɫɚɥɢɰɢɥɨɜɨɣ
ɤɢɫɥɨɬɵ, ɢɧɝɢɛɢɬɨɪɨɜ ɬɪɨɦɛɨɰɢɬɚɪɧɵɯ
ɝɥɢɤɨɩɪɨɬɟɢɧɨɜɵɯɪɟɰɟɩɬɨɪɨɜ IIb/IIIa, ɫɢɧɬɟɬɢɱɟɫɤɢɟɩɪɨɫɬɚɝɥɚɧɞɢɧɵ) [2, 7].
ȼɵɜɨɞɵ
Ɉɛɨɛɳɚɹɜɫɟɜɵɲɟɢɡɥɨɠɟɧɧɨɟ, ɫɥɟɞɭɟɬɨɬɦɟɬɢɬɶ: ɜɧɚɫɬɨɹɳɟɟɜɪɟɦɹ ɜɨɩɪɨɫɵ
ɞɢɚɝɧɨɫɬɢɤɢ, ɥɟɱɟɧɢɹɢɩɪɨɮɢɥɚɤɬɢɤɢɨɫɬɪɵɯɬɪɨɦɛɨɡɨɜɝɥɭɛɨɤɢɯɜɟɧɚɤɬɢɜɧɨɪɚɡɪɚɛɚɬɵɜɚɸɬɫɹ. Ɉɞɧɚɤɨ ɩɪɢɯɨɞɢɬɫɹɤɨɧɫɬɚɬɢɪɨɜɚɬɶ, ɱɬɨɦɧɨɝɢɟɢɡɧɢɯɞɚɥɟɤɢɨɬɪɚɡɪɟɲɟɧɢɹ. Ⱥɧɚɥɢɡ ɥɢɬɟɪɚɬɭɪɧɵɯ ɞɚɧɧɵɯ
ɩɨɤɚɡɵɜɚɟɬɰɟɥɟɫɨɨɛɪɚɡɧɨɫɬɶɩɪɨɜɟɞɟɧɢɹ
ɞɚɥɶɧɟɣɲɢɯɢɫɫɥɟɞɨɜɚɧɢɣ, ɧɚɩɪɚɜɥɟɧɧɵɯ
ɧɚɪɚɡɪɚɛɨɬɤɭɧɨɜɵɯɞɢɚɝɧɨɫɬɢɱɟɫɤɢɯɦɟɬɨɞɨɜ, ɚɬɚɤɠɟ ɥɟɱɟɛɧɵɯɢɪɟɚɛɢɥɢɬɚɰɢɨɧɧɵɯɬɟɯɧɨɥɨɝɢɣ.
ɅɂɌȿɊȺɌɍɊȺ
1. Ȼɚɟɲɤɨ, Ⱥ. Ⱥ. ɉɨɫɥɟɨɩɟɪɚɰɢɨɧɧɵɣɬɪɨɦɛɨɡ ɝɥɭɛɨɤɢɯ ɜɟɧ ɧɢɠɧɢɯ ɤɨɧɟɱɧɨɫɬɟɣ ɢ
ɬɪɨɦɛɨɷɦɛɨɥɢɹ ɥɟɝɨɱɧɨɣ ɚɪɬɟɪɢɢ. / ȺȺ.
Ȼɚɟɲɤɨ.- Ɇ.,2000.- 136ɫ.
2. Ȼɚɟɲɤɨ, ȺȺ. ɉɪɨɮɢɥɚɤɬɢɤɚɬɪɨɦɛɨɷɦɛɨɥɢɢɥɟɝɨɱɧɨɣɚɪɬɟɪɢɢ // ȺȺ. Ȼɚɟɲɤɨ, ȺȺ.
Ɋɚɞɸɤɟɜɢɱ // ɏɢɪɭɪɝɢɹ. 2004.- ʋ12.- ɋ.67-69.
3. Ȼɚɥɭɞɚ, Ɇȼ. Ʌɚɛɨɪɚɬɨɪɧɵɟɦɟɬɨɞɵɢɫɫɥɟɞɨɜɚɧɢɹɫɢɫɬɟɦɵɝɟɦɨɫɬɚɡɚ / Ɇȼ. Ȼɚɥɭɞɚ. – ɋɚɪɚɬɨɜ, 1992.
114
4. Ȼɚɪɤɚɝɚɧ, Ɂɋ. Ɉɫɧɨɜɵɞɢɚɝɧɨɫɬɢɤɢɧɚɪɭɲɟɧɢɣɝɟɦɨɫɬɚɡɚ. / Ɂɋ. Ȼɚɪɤɚɝɚɧ, Ⱥɉ.
Ɇɨɦɨɬ. - Ɇ., 1999.-246 ɫ.
5. Ȼɨɝɚɱɟɜ, ȼɘ. Ʌɟɱɟɧɢɟɢɪɟɚɛɢɥɢɬɚɰɢɹ
ɛɨɥɶɧɵɯɬɪɨɦɛɨɡɨɦɝɥɭɛɨɤɢɯɜɟɧɧɢɠɧɢɯ
ɤɨɧɟɱɧɨɫɬɟɣ / ȼɘ. Ȼɨɝɚɱɟɜ, Ⱥɂ. Ʉɢɪɢɟɧɤɨ, Ɉȼ. Ƚɨɥɨɜɚɧɨɜɚ // Ɋɭɫɫɤɢɣɦɟɞɢɰɢɧɫɤɢɣɠɭɪɧɚɥ. – 1999. – ʋ 13.
6. ȼɚɜɢɥɨɜɚ, Ɍȼ. Ⱥɧɬɢɬɪɨɦɛɨɬɢɱɟɫɤɚɹɬɟɪɚɩɢɹɢɦɟɬɨɞɵɟɟɥɚɛɨɪɚɬɨɪɧɨɝɨɤɨɧɬɪɨɥɹ / Ɍȼ. ȼɚɜɢɥɨɜɚ // Ʉɥɢɧɢɱɟɫɤɚɹɥɚɛɨɪɚɬɨɪɧɚɹ ɞɢɚɝɧɨɫɬɢɤɚ. – 2004. – ʋ12. –
ɋ.21-32.
7. ȼɨɪɨɛɟɣ, Ⱥȼ. ɉɪɨɮɢɥɚɤɬɢɤɚɢɥɟɱɟɧɢɟ
ɬɪɨɦɛɨɷɦɛɨɥɢɱɟɫɤɢɯɨɫɥɨɠɧɟɧɢɣɜɯɢɪɭɪɝɢɱɟɫɤɨɣɩɪɚɤɬɢɤɟ / Ⱥȼ. ȼɨɪɨɛɟɣ // Ɇɟɞɢɰɢɧɫɤɚɹɩɚɧɨɪɚɦɚ. – 2006. – ʋ2.
8. Ƚɟɧɵɤ, ɋɇ. ɉɪɨɛɥɟɦɵ ɥɟɱɟɧɢɹ ɢ ɩɪɨɮɢɥɚɤɬɢɤɢɨɫɬɪɵɯɜɟɧɨɡɧɵɯɷɦɛɨɥɨɝɟɧɧɵɯ
ɬɪɨɦɛɨɡɨɜ. / ɋɇ. Ƚɟɧɵɤ, ɋɘȿɦɟɥɶɹɧɨɜ //
ɏɢɪɭɪɝɢɹ. – 1996. – ʋ2. – ɋ.138-140.
9. Ⱦɢɚɝɧɨɫɬɢɤɚɢɩɪɨɮɢɥɚɤɬɢɤɚɧɚɪɭɲɟɧɢɣ
ɫɢɫɬɟɦɵɝɟɦɨɫɬɚɡɚɭɛɨɥɶɧɵɯɫɨɡɥɨɤɚɱɟɫɬɜɟɧɧɵɦɢɧɨɜɨɨɛɪɚɡɨɜɚɧɢɹɦɢ / Ⱥȼ. Ɇɚɞɠɭɝɚ [ ɢɞɪ.] // Ʉɥɢɧɢɱɟɫɤɚɹɥɚɛɨɪɚɬɨɪɧɚɹ
ɞɢɚɝɧɨɫɬɢɤɚ. – 2001. – ʋ 10. - ɋ. 12-13.
10. Ɂɭɛɚɪɟɜ, ȺɊ. ɍɥɶɬɪɚɡɜɭɤɨɜɚɹɞɢɚɝɧɨɫɬɢɤɚ ɡɚɛɨɥɟɜɚɧɢɣ ɜɟɧ ɧɢɠɧɢɯ ɤɨɧɟɱɧɨɫɬɟɣ / ȺɊ. Ɂɭɛɚɪɟɜ, ȼɘ. Ȼɨɝɚɱɟɜ, ȼȼ. Ɇɢɬɶɤɨɜ. – Ɇ.: ȼɢɞɚɪ, 1999. – 104 ɫ.
11. Ɂɭɛɚɪɟɜ, ȺɊ. ɍɥɶɬɪɚɡɜɭɤɨɜɚɹɞɢɚɝɧɨɫɬɢɤɚ
ɡɚɛɨɥɟɜɚɧɢɣɜɟɧ ɧɢɠɧɢɯ ɤɨɧɟɱɧɨɫɬɟɣ. ɇɨɜɵɟɬɟɯɧɨɥɨɝɢɢ - ɧɨɜɵɟɜɨɡɦɨɠɧɨɫɬɢ / ȺɊɁɭɛɚɪɟɜ // ɉɭɥɶɦɨɧɨɥɨɝɢɹ. – 2000. – ʋ2. –
ɋ.48-55.
12. Ʉɟɦɩɛɟɥɥ, ɂȺ. ɊɭɤɨɜɨɞɫɬɜɨȻɪɢɬɚɧɫɤɨɝɨ ɬɨɪɚɤɚɥɶɧɨɝɨ ɨɛɳɟɫɬɜɚ ɩɨ ɜɟɞɟɧɢɸ
ɛɨɥɶɧɵɯɫɩɪɟɞɩɨɥɚɝɚɟɦɨɣɬɪɨɦɛɨɷɦɛɨɥɢɣ
ɥɟɝɨɱɧɵɯɚɪɬɟɪɢɣ / ɂȺɄɟɦɩɛɟɥɥ, ȺɎɟɧɧɟɪɬɢ, ȺɆɢɥɥɟɪ // ɉɭɥɶɦɨɧɨɥɨɝɢɹ. –
2005. – ʋ4. – ɋ.19-29.
13. Ʉɥɢɧɢɱɟɫɤɚɹɭɥɶɬɪɚɡɜɭɤɨɜɚɹɞɢɚɝɧɨɫɬɢɤɚ ɩɚɬɨɥɨɝɢɢ ɜɟɧ ɧɢɠɧɢɯ ɤɨɧɟɱɧɨɫɬɟɣ /
ɘȼ. ɇɨɜɢɤɨɜ [ ɢɞɪ.]; ɩɨɞɪɟɞɘȼ. ɇɨɜɢɤɨɜɚ. – Ʉɨɫɬɪɨɦɚ: ȾɢȺɪ. 1999. – 72 ɫ.
14. Ʉɨɡɥɨɜɚ, Ɍȼ. Ʉɨɧɬɪɨɥɶɚɧɬɢɤɨɚɝɭɥɹɧɬɧɨɣɬɟɪɚɩɢɢ: ɜɨɡɦɨɠɧɨɫɬɢ, ɩɪɨɛɥɟɦɵ, ɩɟɪ-
ʋ4x2006 iɬɨɦ 14
ɫɩɟɤɬɢɜɵ / Ɍȼ. Ʉɨɡɥɨɜɚ // Ʉɥɢɧɢɱɟɫɤɚɹɥɚɛɨɪɚɬɨɪɧɚɹ ɞɢɚɝɧɨɫɬɢɤɚ. – 2001. – ʋ9 ɋ.19-20.
15. Ɇɨɝɟɲ, Ƚɟɨɪɝɟ Ɍɪɨɦɛɨɡɵɢɷɦɛɨɥɢɢɩɪɢ
ɫɟɪɞɟɱɧɨɫɨɫɭɞɢɫɬɵɯɡɚɛɨɥɟɜɚɧɢɹɯ. / Ƚɟɨɪɝɟ
Ɇɨɝɟɲ. – Ȼɭɯɚɪɟɫɬ: 1979. – 450 ɫ.
16. Ɇɨɪɨɡɨɜ, ȺȺ. Ʉɥɢɧɢɤɚ, ɞɢɚɝɧɨɫɬɢɤɚ,
ɢ ɤɨɧɫɟɪɜɚɬɢɜɧɨɟ ɥɟɱɟɧɢɟ ɨɫɬɪɨɝɨ ɩɨɞɜɡɞɨɲɧɨɛɟɞɪɟɧɧɨɝɨɜɟɧɨɡɧɨɝɨɬɪɨɦɛɨɡɚ. /
ȺȺɆɨɪɨɡɨɜ, ɆɎɆɭɪɚɜɶɟɜ, ȿɆ. ɒɚɲɤɨɜɚ // ɏɢɪɭɪɝɢɹ. – 1987. – ʋ12. - ɋ.55-59.
17. ɇɨɡɞɪɚɱɟɜ, ɘɂ. Ⱥɤɬɭɚɥɶɧɵɟɩɪɨɛɥɟɦɵ
ɝɟɦɨɫɬɚɡɢɨɥɨɝɢɢ / ɘɂ. ɇɨɡɞɪɚɱɟɜ,
ȼɇ. ɂɥɶɢɧ. – Ɇ.: ɇɚɭɤɚ, 1981. – ɋ.356-362.
18. Ɉɤɪɭɬ, ɂȿ. Ʌɚɛɨɪɚɬɨɪɧɵɟ ɤɪɢɬɟɪɢɢ
ɨɰɟɧɤɢɝɢɩɨɤɨɚɝɭɥɹɰɢɨɧɧɨɝɨɷɮɮɟɤɬɚɨɡɨɧɨɬɟɪɚɩɢɢ. / ɂȿɈɤɪɭɬ, ɄɇɄɨɧɬɨɪɳɢɤɨɜɚ // Ʉɥɢɧɢɱɟɫɤɚɹɥɚɛɨɪɚɬɨɪɧɚɹɞɢɚɝɧɨɫɬɢɤɚ. – 2004. - ʋ9. - ɋ.72-73.
19. ɉɚɬɪɭɲɟɜ, Ʌɂ. ȼɨɡɦɨɠɧɨɫɬɢɫɨɜɪɟɦɟɧɧɵɯɦɟɬɨɞɨɜȾɇɄɞɢɚɝɧɨɫɬɢɤɢɬɪɨɦɛɨɡɨɜ
ɢɝɟɦɨɪɪɚɝɢɣ / Ʌɂɉɚɬɪɭɲɟɜ, ɌɎɄɨɜɚɥɟɧɤɨ // Ʉɥɢɧɢɱɟɫɤɚɹɥɚɛɨɪɚɬɨɪɧɚɹɞɢɚɝɧɨɫɬɢɤɚ. – 2001. – ʋ9. – ɋ.19.
20. ɉɪɨɤɭɛɨɜɫɤɢɣ, ȼɂ. ɗɧɞɨɜɚɫɤɭɥɹɪɧɚɹ
ɩɪɨɮɢɥɚɤɬɢɤɚ ɬɪɨɦɛɨɷɦɛɨɥɢɢ ɥɟɝɨɱɧɨɣ
ɚɪɬɟɪɢɢ / ȼɂ. ɉɪɨɤɭɛɨɜɫɤɢɣ, ȿȽ. əɛɥɨɤɨɜ
// ɋɛɨɪɧɢɤɧɚɭɱɧɵɯɬɪɭɞɨɜ / ɋɉɛ., 1992. –
ɋ. 69-78.
21. ɉɪɨɮɢɥɚɤɬɢɤɚɢɥɟɱɟɧɢɟɬɪɨɦɛɨɡɚɝɥɭɛɨɤɢɯɜɟɧ: ɭɱɟɛ.- ɦɟɬɨɞ. ɩɨɫɨɛɢɟ / ɚɜɬ.– ɫɨɫɬ:
ɆɌ. ȼɨɟɜɨɞɚ, ȺȺ. Ȼɚɟɲɤɨ – Ɇɢɧɫɤ : Ȼɟɥɩɪɢɧɬ, 2006. – 48 ɫ.
22. ɋɩɨɧɬɚɧɧɚɹɚɝɪɟɝɚɰɢɹ ɬɪɨɦɛɨɰɢɬɨɜɜ
ɨɰɟɧɤɟ ɪɢɫɤɚ ɬɪɨɦɛɨɝɟɧɧɵɯ ɨɫɥɨɠɧɟɧɢɣ
ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɝɨɩɟɪɢɨɞɚɩɪɢɪɚɤɟɥɟɝɤɨɝɨ / Ⱥɇ. Ⱥɮɚɧɚɫɶɟɜɚ [ ɢɞɪ.] // Ʉɥɢɧɢɱɟɫɤɚɹ ɥɚɛɨɪɚɬɨɪɧɚɹ ɞɢɚɝɧɨɫɬɢɤɚ. – 2003. –
ʋ 12. - ɋ. 42-43.
23. ɋɪɚɜɧɢɬɟɥɶɧɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟɬɪɨɦɛɨɰɢɬɨɜɡɞɨɪɨɜɵɯɥɢɰɫɢɫɩɨɥɶɡɨɜɚɧɢɟɦɫɜɟɬɨɜɨɣɦɢɤɪɨɫɤɨɩɢɢɢɩɪɨɬɨɱɧɨɝɨɫɱɟɬɱɢɤɚ «Cobas micros» / Ɏȼ. Ʉɨɪɨɛɨɜɚ [ ɢɞɪ.] //
Ʉɥɢɧɢɱɟɫɤɚɹɥɚɛɨɪɚɬɨɪɧɚɹɞɢɚɝɧɨɫɬɢɤɚ. –
2000. – ʋ 12. - ɋ. 46-49.
24. ɋɭɞɠɚɟɜɚ, ɋȽ. Ɍɪɨɦɛɨɷɦɛɨɥɢɹɥɟɝɨɱɧɨɣ
ɚɪɬɟɪɢɢ. / ɋȽ. ɋɭɞɠɚɟɜɚ. – Ɇɢɧɫɤ: Ȼɟɥɩɪɢɧɬ, 2004. – 128 ɫ.
25. Ɏɟɞɨɪɨɜ, ȼȾ. Ɉɫɬɪɵɣɜɟɧɨɡɧɵɣɬɪɨɦɛɨɡ: ɧɨɜɵɟ ɧɚɩɪɚɜɥɟɧɢɹ ɜ ɩɪɨɮɢɥɚɤɬɢɤɟ ɢ
ɥɟɱɟɧɢɢ. / ȼȾɎɟɞɨɪɨɜ, ɆɂɌɢɬɨɜɚ, ɉɎ.
Ƚɚɧɠɚ // ɏɢɪɭɪɝɢɹ. – 1998. – ʋ 12. – ɋ.60-63.
26. Ɏɥɟɛɨɥɨɝɢɹ: ɪɭɤɨɜɨɞɫɬɜɨɞɥɹɜɪɚɱɟɣ /
ȼɋ. ɋɚɜɟɥɶɟɜ [ɢɞɪ.]; ɩɨɞɪɟɞȼɋ. ɋɚɜɟɥɶɟɜɚ. - Ɇ.: Ɇɟɞɢɰɢɧɚ, 2001. – 664 ɫ.
27. Ant ithro mbot ic therapy for venous
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28. Bauer, A.R. Computed tomography diagnosis
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29. Cogo, A. Comparison of real-time Bmode
ultrasonography and Doppler ultrasound with
contrast venography in the diagnosis of venous
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A.W. Lensing, P. Prandoni // Thromb
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30. Comerona, A.J. Venous duplex imaging:
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31. Comparisom of ultrasound and blood pool
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32. Cruickshank, M.K. An evaluation of
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33. Deep venous thrombosis of extremities: role
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34. Detection of deep venous thrombosis:
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