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Â íàøè äíè, êàê è ïðåæäå, â îðãàíàõ óïðàâëåíèÿ ìåäèöèíñêîé ñëóæ-áîé ñèëîâûõ ñòðóêòóð è âåäîìñòâ, â âîèíñêèõ ÷àñòÿõ è ïîäðàçäåëåíèÿõ,â âîåííûõ ëå÷åáíî-ïðîôèëàêòè÷åñêèõ è ñàíèòàðíî-ýïèäåìèîëîãè÷å-ñêèõ ó÷ðåæäåíèÿõ, íàó÷íî-èññëåäîâàòåëüñêèõ èíñòèòóòàõ, â ó÷åáíûõàóäèòîðèÿõ è ëàáîðàòîðèÿõ äîáðîñîâåñòíî âûïîëíÿþò ñâîé âîèíñêèéè ïðîôåññèîíàëüíûé äîëã æåíùèíû-ìåäèêè. Îíè ïðèâíîñÿòâ äåÿòåëüíîñòü ìåäèöèíñêîé ñëóæáû àðìèè è ôëîòà ìèëîñåðäèåè ñîñòðàäàíèå, äîáðî è ðàäîñòü, òåïëî è óþò – âñå, ÷òî ïîìîãàåò ðàíåíûìè áîëüíûì âîçâðàòèòüñÿ â ñòðîé è ê òðóäó.

Ïóáëèêóÿ ôîòî ïîáåäèòåëüíèö ìåæäóíàðîäíûõ ñîðåâíîâàíèé2018 ã. ïî âîåííî-ìåäèöèíñêîìó ìíîãîáîðüþ, ìû æåëàåì êîëëåãàì-æåíùèíàì è âïðåäü îñòàâàòüñÿ òàêèìè æå îáàÿòåëüíûìè è ïðè-âëåêàòåëüíûìè, êàêèìè óâèäåë èõ êîððåñïîíäåíò ðåäàêöèè.

Ôîòî © Âîåí.-ìåä. æóðí.

Ðåäàêöèîííàÿ êîëëåãèÿ è ðåäàêöèîííûé ñîâåò «Âîåííî-ìåäèöèíñêîãî æóðíàëà»

ñåðäå÷íî ïîçäðàâëÿþò íàøèõ ÷èòàòåëüíèö ñ Ìåæäóíàðîäíûì æåíñêèì äíåì,

æåëàþò èì çäîðîâüÿ, ðàäîñòè è óñïåõîâ â äåëå îõðàíû çäîðîâüÿ âîèíîâ Ðîññèè

Æåíñêàÿ êîìàíäà Âîîðóæåííûõ Ñèë Ðîññèéñêîé Ôåäåðàöèè íà ìåæäóíàðîäíûõ ñîðåâíîâàíèÿõïî âîåííî-ìåäèöèíñêîìó ìíîãîáîðüþ 2018 ã. ïîñëå âðó÷åíèÿ ñåðòèôèêàòîâ «Êíèãè ðåêîðäîâ» (äîñòèæå-íèé) ÂÑ ÐÔ. Ñïðàâà íàëåâî: ñòàðøèé ëåéòåíàíò ìåäèöèíñêîé ñëóæáû Âèîëåòòà Êèñòåíü, ìëàäøèéñåðæàíò Ìàðèÿ Íè÷èïîðåíêî, ìëàäøèé ñåðæàíò Âèêòîðèÿ Êîðíåâà, åôðåéòîð Àðèíà Ïàñòóøåíêî.Â õîäå ñîðåâíîâàíèé ïðåäñòàâèòåëüíèöû Ðîññèè âûïîëíèëè êîìïëåêñíîå óïðàæíåíèå ïî ýâàêóàöèèóñëîâíî ðàíåíîãî ñ ïîëÿ áîÿ ñ ïðîõîæäåíèåì ïîëîñû ïðåïÿòñòâèé çà 9 ìèíóò è 21 ñåêóíäó, ÷òî ñòàëîðåêîðäîì ñðåäè æåíñêèõ êîìàíä çà âñå âðåìÿ ïðîâåäåíèÿ ìåæäóíàðîäíûõ ñîðåâíîâàíèé âîåííûõìåäèêîâ.

ISSN 0026-9050. Âîåí.-ìåä. æóðí. – 2019. – Ò. 340, ¹ 3. – Ñ. 1–96.

Ãàëåðåÿ Âîåííî-ìåäèöèíñêîãî æóðíàëàÕóäîæíèê Âàñèëèé Âåðåùàãèí: ñåðèÿ «Ðàíåíûé» (1901 ã.)

Âûäàþùèéñÿ ðóññêèé õóäîæíèê ÂàñèëèéÂàñèëüåâè÷ Âåðåùàãèí (1842–1904) íå ðàç îá-ðàùàëñÿ â òâîð÷åñòâå ê âîåííî-ìåäèöèíñêîéòåìàòèêå. Ñåáÿ îí íàçûâàë «õóäîæíèêîìâîåííûõ ñöåí», à íå áàòàëèñòîì. Â ñîáðàíèèÃîñóäàðñòâåííîé Òðåòüÿêîâñêîé ãàëåðåè õðà-íèòñÿ åãî ìàñøòàáíîå ïîëîòíî 1881 ã. «Ïîñëåàòàêè (ïåðåâÿçî÷íûé ïóíêò ïîä Ïëåâíîé)»,ñëóæàùåå ÿðêîé èëëþñòðàöèåé îðãàíèçàöèèïîìîùè ðàíåíûì â õîäå Ðóññêî-òóðåöêîé âîé-íû 1877–1878 ãã. Â ýòîì ïðîèçâåäåíèè õóäîæ-íèê åäâà ëè íå âïåðâûå èçîáðàçèë æåíùèí íàâîéíå, ïåðåä ñàìîîòâåðæåííîñòüþ êîòîðûõïðåêëîíÿëñÿ.

Âûïîëíåííàÿ õóäîæíèêîì â 1901 ã. ñåðèÿïîëîòåí èçîáðàæàåò ÷åòûðå ýïèçîäà èç æèçíèâîåííîãî ãîñïèòàëÿ: 1) «Â ãîñïèòàëå», 2) «Ïèñüìîê ìàòåðè», 3) «Ïèñüìî ïðåðâàíî» è 4) «Ïèñüìîîñòàëîñü íåîêîí÷åííûì». Ïåðâàÿ, òðåòüÿ è ÷åò-âåðòàÿ êàðòèíû íàõîäÿòñÿ â Íèêîëàåâñêîì õó-äîæåñòâåííîì ìóçåå èìåíè Â.Â.Âåðåùàãèíà(Óêðàèíà), âòîðàÿ – â Ðîññèè, â ßðîñëàâñêîìõóäîæåñòâåííîì ìóçåå.

Îáðàç óìèðàþùåãî ñîëäàòà, îáðàùàþùåãîìûñëåííûé âçîð ê ìàòåðè, îòëè÷àåòñÿ ãëóáîêèì òðàãèçìîì. Ñêîðáíûå ÷óâñòâà ñåñòðû ìèëî-ñåðäèÿ õóäîæíèê ñìîã ïåðåäàòü ÷åðåç âûðàæåíèå ëèöà äåâóøêè – òî ëàñêîâî âíèìàòåëüíîå,òî íàñòîðîæåííîå, òî ïðîíèêíóòîå ãîðåì. Ñêðîìíûå ãîñïèòàëüíûå êîñòþìû, ñòðîãàÿáîëüíè÷íàÿ îáñòàíîâêà íå çàäåðæèâàþò âíèìàíèÿ çðèòåëÿ, êîòîðîå ñîñðåäîòà÷èâàåòñÿíà äâóõ ïåðñîíàæàõ êàðòèíû. Â ôîðìå ñåñòðû ìèëîñåðäèÿ ïîçèðîâàëà æåíà õóäîæíèêàË.Â.Àíäðååâñêàÿ-Âåðåùàãèíà.

Êàðòèíû ñîçäàâàëèñü â õîäå ïóòåøåñòâèÿ õóäîæíèêà â 1901 ã. íà Ôèëèïïèíû è ñâÿçàíûñ òåìîé èñïàíî-àìåðèêàíñêîé âîéíû. Â Ðîññèè ýòè âåðåùàãèíñêèå ñþæåòû ïîëó÷èëèøèðîêóþ èçâåñòíîñòü áëàãîäàðÿ èçäàííîé Îáùèíîé ñâÿòîé Åâãåíèè â íà÷àëå Ðóññêî-ÿïîí-ñêîé âîéíû 1904–1905 ãã. ñåðèè îòêðûòûõ ïèñåì. Â íàøåé ôèëîêàðòè÷åñêîé êîëëåêöèèèìååòñÿ ïîëíûé êîìïëåêò èç ÷åòûðåõ îòêðûòîê.

Ì.Ï.

Â.Â.Âåðåùàãèí. Ïèñüìî îñòàëîñü íåîêîí÷åííûì.Õ. ì., 1901 ã. Íèêîëàåâñêèé õóäîæåñòâåííûéìóçåé èìåíè Â.Â.Âåðåùàãèíà, Óêðàèíà

Â.Â.Âåðåùàãèí. Ïèñüìî ïðåðâàíî.Àâòîòèïèÿ, 1904 ã. Îòêðûòêà,èçäàííàÿ Îáùèíîé ñâ. Åâãåíèè,ïî êàòàëîãó ¹ 967

Â.Â.Âåðåùàãèí. Ïèñüìî ê ìàòåðè.Îáëîæêà êàòàëîãà âûñòàâêè, 2015 ã.ßðîñëàâñêèé õóäîæåñòâåííûé ìóçåé

Â.Â.Âåðåùàãèí. Â ãîñïèòàëå.Àâòîòèïèÿ, 1904 ã. Îòêðûòêà,èçäàííàÿ Îáùèíîé ñâ. Åâãåíèè,ïî êàòàëîãó ¹ 965

Ïî÷òîâûé àäðåñ ðåäàêöèè:119160, Ìîñêâà,Ôðóíçåíñêàÿ íàáåðåæíàÿ, ä. 22,ðåäàêöèÿ «Âîåííî-ìåäèöèíñêîãîæóðíàëà»Òåë./ôàêñ (495) 656-33-41

Òåë. â Ñàíêò-Ïåòåðáóðãå+7(911) 149-01-43

ÅÆÅÌÅÑß×ÍÛÉÒÅÎÐÅÒÈ×ÅÑÊÈÉÈ ÍÀÓ×ÍÎ-ÏÐÀÊÒÈ×ÅÑÊÈÉÆÓÐÍÀËÌÈÍÈÑÒÅÐÑÒÂÀ ÎÁÎÐÎÍÛÐÎÑÑÈÉÑÊÎÉ ÔÅÄÅÐÀÖÈÈ

Ôóíêöèÿ ó÷ðåäèòåëÿ – Ãëàâíîåâîåííî-ìåäèöèíñêîå óïðàâëå-íèå ÌÎ ÐÔ

Non scholae, sed vitae discimus!

ÐÅÄÀÊÖÈÎÍÍÀßÊÎËËÅÃÈß:

Ì.Â.Ïîääóáíûé (ãëàâíûéðåäàêòîð)È.È.ÀçàðîâÀ.Í.ÁåëüñêèõÀ.Þ.ÂëàñîâË.Ë.Ãàëèí (çàìåñòèòåëüãëàâíîãî ðåäàêòîðà)Ñ.Â.ÄîëãèõÂ.Â.ÈâàíîâÎ.Â.Êàëà÷¸âÀ.À.ÊàëìûêîâÁ.Í.ÊîòèâÊ.Ý.ÊóâøèíîâÞ.Â.Ìèðîøíè÷åíêîÞ.Â.Îâ÷èííèêîâÍ.Í.ÐûæìàíÀ.Ã.ÑòàâèëàÄ.Â.ÒðèøêèíÀ.ß.ÔèñóíÂ.Í.ÖûãàíÀ.Ï.×óïðèíàÂ.Ê.ØàìðåéÀ.Ì.Øåëåïîâ

ÐÅÄÀÊÖÈÎÍÍÛÉÑÎÂÅÒ:

Èçäàåòñÿ ñ 1823 ãîäà

2019 * ÌÀÐÒ

Ò. 340 * ¹ 3

ÌÎÑÊÂÀÔÃÁÓ «ÐÈÖ «Êðàñíàÿ çâåçäà»Ìèíîáîðîíû Ðîññèè

Ï.Ã.Áðþñîâ (Ìîñêâà)À.À.Áóäêî (Ñ.-Ïåòåðáóðã)È.Þ.Áûêîâ (Ìîñêâà)Â.Â.Âàëåâñêèé (Ñ.-Ïåòåðáóðã)Ñ.Ô.Ãîí÷àðîâ (Ìîñêâà)Â.Â.Äîáðæàíñêèé (Ìîñêâà)À.Â.Åñèïîâ (Êðàñíîãîðñê)Ï.Å.Êðàéíþêîâ (Ìîñêâà)Å.Â.Êðþêîâ (Ìîñêâà)Þ.Â.Ëîáçèí (Ñ.-Ïåòåðáóðã)È.Ã.Ìîñÿãèí (Ñ.-Ïåòåðáóðã)Ý.À.Íå÷àåâ (Ìîñêâà)Ñ.Â.Ïàïêî (Ðîñòîâ-íà-Äîíó)Ï.Â.Ïèí÷óê (Ìîñêâà)Â.Á.Ñèìîíåíêî (Ìîñêâà)È.Ì.×èæ (Ìîñêâà)Â.Â.Øàïïî (Ìîñêâà)

Ìåäèêî-ïñèõîëîãè÷åñêàÿ ðåàáèëèòàöèÿâîåííîñëóæàùèõ, ïðîõîäÿùèõ âîåííóþñëóæáó â Àðêòè÷åñêîé çîíå Ðîññèè

Ïðàâîâîå ðåãóëèðîâàíèå òåëåìåäèöèíûâ ñèñòåìå çäðàâîîõðàíåíèÿÐîññèéñêîé Ôåäåðàöèè

Àëãîðèòì äèàãíîñòèêè áðîíõèàëüíîéàñòìû ó ãðàæäàí ïðèçûâíîãî âîçðàñòà

Îñîáåííîñòè ïñèõè÷åñêîãî çäîðîâüÿâîåííîñëóæàùèõ, ïðîõîäÿùèõâîåííóþ ñëóæáó â çàãëóáëåííûõêîìàíäíûõ ïóíêòàõ

Äåêîìïðåññèîííàÿ áîëåçíü ó ýêèïàæàñàìîëåòà è åå ïîñëåäñòâèÿ

Ïðèìåíåíèå ëàáîðàòîðíîé ýêñïðåññ-äèàãíîñòèêè â ìíîãîïðîôèëüíîììåäèöèíñêîì ñòàöèîíàðå è íà ýòàïàõýâàêóàöèè ïàöèåíòîâ

Ïåðâûé â Ðîññèè ó÷åáíî-ïðàêòè÷åñêèéêóðñ ïî âîåííî-ïîëåâîé õèðóðãèèè õèðóðãèè ïîâðåæäåíèé ÑÌÀÐÒ

© «Âîåííî-ìåäèöèíñêèé æóðíàë», 3’20192

ÑONTENTS

4

Ëå÷åáíî-ïðîôèëàêòè÷åñêèåâîïðîñû

Prophylaxis and treatment

Îðãàíèçàöèÿ ìåäèöèíñêîãîîáåñïå÷åíèÿ Âîîðóæåííûõ Ñèë

Organization of medical supportof the Armed Forces

15

30

Ãèãèåíà è ôèçèîëîãèÿâîåííîãî òðóäà

Military physiologyand hygiene

Àâèàöèîííàÿè âîåííî-ìîðñêàÿ ìåäèöèíà

Air and navy medicine

44

Ìåäèöèíà ýêñòðåìàëüíûõñèòóàöèé

Medicine of extremesituations

36

23

50

Äîëãèõ Ñ.Â., Ïîíîìàðåíêî Ã.Í., Áîáðîâ Ë.Ë.,Èùóê Â.Í., Ìåðçëèêèí À.Â. – Ìåäèêî-ïñèõîëîãè÷åñêàÿ ðåàáèëèòàöèÿ âîåííî-ñëóæàùèõ, ïðîõîäÿùèõ âîåííóþ ñëóæáóâ Àðêòè÷åñêîé çîíå Ðîññèè

Âåíãåðîâè÷ Í.Ã., Þäèí Ì.À., Êîíüøà-êîâ Þ.Î., ×åïóð Ñ.Â., Èâàíîâ È.Ì. –Âåðîÿòíîñòíàÿ ïðîãíîçíàÿ ìàòåìàòè-÷åñêàÿ ìîäåëü õðîíè÷åñêèõ ðåñïèðàòîð-íûõ ñîñòîÿíèé äëÿ ñíèæåíèÿ ðèñêà èí-âàëèäèçàöèè ïðè îòðàâëåíèè âåùåñòâà-ìè ïóëüìîíîòîêñè÷åñêîãî äåéñòâèÿ

Ìàðêåâè÷ Ï.Ñ., Àëåõíîâè÷ À.Â., Êèñëåí-êî À.Ì., Åñèïîâ À.À. – Ïðèìåíåíèå óëü-òðàôèîëåòîâîãî èçëó÷åíèÿ â ñîâðåìåí-íîé ìåäèöèíå (Îáçîð ëèòåðàòóðû)

Çàêðåâñêèé Þ.Í., Àðõàíãåëüñêèé Ä.À.,Áàëàõíîâ Ä.Î., Ëåìåøêî Ï.Í. – Àëãîðèòìäèàãíîñòèêè áðîíõèàëüíîé àñòìûó ãðàæäàí ïðèçûâíîãî âîçðàñòà

Àáðèòàëèí Å.Þ., Æîâíåð÷óê È.Þ., Æîâ-íåð÷óê Å.Â. – Îñîáåííîñòè ïñèõè÷åñêîãîçäîðîâüÿ âîåííîñëóæàùèõ, ïðîõîäÿùèõñëóæáó â çàãëóáëåííûõ êîìàíäíûõïóíêòàõ

Äâîðíèêîâ Ì.Â., Âîëîâèê Þ.À., Ìàòþ-øåâ Ò.Â. – Ïîó÷èòåëüíàÿ èñòîðèÿ îä-íîãî âûñîòíîãî ïîëåòà: äåêîìïðåññè-îííàÿ áîëåçíü ó ýêèïàæà ñàìîëåòàè åå ïîñëåäñòâèÿ

Markevich P.S., Alekhnovich A.V., Kislen-ko A.M., Esi pov A.A. – Use of ultravioletradiation in modern medicine (Literaturereview)

Zakrevskii Yu.N., Arkhangelskii D.A., Bala-khnov D.O., Lemeshko P.N. – Algorithm fordiagnosing bronchial asthma in citizens ofmilitary age

Dvornikov M.V., Volovik Yu.A., Matyushev T.V.– Instructive story of one high-altitudeflight: decompression sickness in an aircraftcrew and its consequences

Abritalin E.Yu., Zhovnerchuk I.Yu., Zhov-nerchuk E.V. – Peculiarities of the mentalhealth of servicemen serving in submergedcommand posts

Vengerovich N.G., Yudin M.A., Konsha-kov Yu.O., Chepur S.V., Ivanov I.M. – Pro-babilistic predictive mathematical model ofchronic respiratory conditions to reduce therisk of disability in case of poisoning withsubstances with a pulmonotoxic effect

Dolgikh S.V., Ponomarenko G.N., Bobrov L.L.,Ishchuk V.N., Merzlikin A.V. – Medical andpsychological rehabilitation of servicemenserving in the Arctic zone of Russia

Allamyarova N.V., Sanakoeva E.G. – Legalregulation of telemedicine in the health caresystem of the Russian Federation: stateand prospects for improvement

Àëëàìÿðîâà Í.Â., Ñàíàêîåâà Ý.Ã. – Ïðàâî-âîå ðåãóëèðîâàíèå òåëåìåäèöèíû â ñè-ñòåìå çäðàâîîõðàíåíèÿ ÐîññèéñêîéÔåäåðàöèè: ñîñòîÿíèå è ïåðñïåêòèâûñîâåðøåíñòâîâàíèÿ

«Âîåííî-ìåäèöèíñêèé æóðíàë», 3’2019 3

Êðàòêèå ñîîáùåíèÿ Brief reports59

87

Õðîíèêà Chronicle

90

Èç èñòîðèèâîåííîé ìåäèöèíû

From the historyof military medicine

Ëåíòà íîâîñòåé News feed 22,

29, 49,54, 89

55

Ïîäïèñàòüñÿ íà «Âîåííî-ìåäèöèíñêèé æóðíàë» ìîæíî ÷åðåç êàòàëîãè«Àãåíòñòâî Ðîñïå÷àòü» (èíäåêñ 70138) è «Îáúåäèíåííûé êàòàëîã

Ïðåññà Ðîññèè» (èíäåêñ 43986)

«Âîåííî-ìåäèöèíñêèé æóðíàë» âõîäèò â áàçó äàííûõ RSCI, âêëþ÷åí ÂÀÊ ÐÔâ ñïèñîê ðåöåíçèðóåìûõ íàó÷íûõ èçäàíèé, â êîòîðûõ äîëæíû áûòü îïóáëèêîâàíûîñíîâíûå íàó÷íûå ðåçóëüòàòû äèññåðòàöèé íà ñîèñêàíèå ó÷åíîé ñòåïåíè êàíäèäàòàè äîêòîðà íàóê

Âîåííàÿ ôàðìàöèÿè ìåäèöèíñêàÿ òåõíèêà

Military pharmacyand medical technique

Ñòåö Â.Â., Ëþáèìîâ Ì.Ä. – Ïðèìåíå-íèå ëàáîðàòîðíîé ýêñïðåññ-äèàãíîñòè-êè â ìíîãîïðîôèëüíîì ìåäèöèíñêîìñòàöèîíàðå è íà ýòàïàõ ýâàêóàöèè ïà-öèåíòîâ

Êðþêîâ Å.Â., Êîñòþ÷åíêî Î.Ì., Áîáû-ëåâ Â.À., Îâ÷èííèêîâà Ì.Á. – Ê 100-ëå-òèþ îòêðûòèÿ Ãîñóäàðñòâåííîé âûñ-øåé ìåäèöèíñêîé øêîëû â ñòåíàõÌîñêîâñêîãî âîåííîãî ãîñïèòàëÿ

Êîðíååâ À.Ã., Àìèíåâ Ð.Ì., Øåâëþê Í.Í.,Ëàíöîâ Å.Â. – À.Ä.Øàéêîâ – âîåííûéâðà÷, ó÷åíûé, ðåêòîð

74

Ìåøêîâ À.Â., Íåæèâîâ Ð.Í., Ãàëèê Â.Ï.,Ìóñàèëîâ Â.À. – Îòêðûòèå ãëàâíîãî ëå-÷åáíîãî êîðïóñà â Ôèëèàëå ¹ 1 3-ãîÖåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãîãîñïèòàëÿ èìåíè À.À.Âèøíåâñêîãî

Ñàìîõâàëîâ È.Ì., Ôîìèí Í.Ô., Ãîí÷à-ðîâ À.Â., Ðåâà Â.À., Ïåòðîâ À.Í., Êàñè-ìîâ Ð.Ð., Íîñîâ À.Ì., Êîñêèí Â.Ñ. – Ïåð-âûé â Ðîññèè ó÷åáíî-ïðàêòè÷åñêèéêóðñ ïî âîåííî-ïîëåâîé õèðóðãèèè õèðóðãèè ïîâðåæäåíèé ÑÌÀÐÒ

Meshkov A.V., Nezhivov R.N., Galik V.P., Musa-ilov V.A. – Opening of main medical buildingin the Branch N 1 of the A.A.Vishnevsky 3rdCentral Military Clinical Hospital of the Mi-nistry of Defense of the Russian Federation

Samokhvalov I.M., Fomin N.F., Goncharov A.V.,Reva V.A., Petrov A.N., Kasimov R.R.,Nosov A.M., Koskin V.S. – First trainingand practical course on field surgeryand trauma surgery «SMART» in Russia92

95

Kalinin P.A., Kovaleva T.V. – Experienceof organization of the first meeting of chiefand senior medical nurses of the AirborneForces

Êàëèíèí Ï.À., Êîâàë¸âà Ò.Â. – Îïûòïðîâåäåíèÿ ïåðâîãî ñáîðà ãëàâíûõè ñòàðøèõ ìåäèöèíñêèõ ñåñòåð Âîçäóø-íî-äåñàíòíûõ âîéñê

Kryukov E.V., Kostyuchenko O.M., Boby-lev V.A., Ovchinnikova M.B. – To the 100th

anniversary of the opening of the StateHigher Medical School in the MoscowMilitary Hospital

Korneev A.G., Aminev R.M., Shevlyuk N.N.,Lantsov E.V. – A.D.Shaikov – a militarydoctor, a scientist, a chancellor

Stets V.V., Lyubimov M.D. – Application oflaboratory express diagnostics in a multi-disciplinary medical hospital and at thestages of the evacuation of patients

«Âîåííî-ìåäèöèíñêèé æóðíàë», 3’20194

ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ

ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ [616-036.82/.85:159.9]-057.36(98)

Ìåäèêî-ïñèõîëîãè÷åñêàÿ ðåàáèëèòàöèÿâîåííîñëóæàùèõ, ïðîõîäÿùèõ âîåííóþ ñëóæáóâ Àðêòè÷åñêîé çîíå Ðîññèè

ÄÎËÃÈÕ Ñ.Â., êàíäèäàò ìåäèöèíñêèõ íàóê1

ÏÎÍÎÌÀÐÅÍÊÎ Ã.Í., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ïðîôåññîð,ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà2

ÁÎÁÐÎÂ Ë.Ë., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå2

ÈÙÓÊ Â.Í., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå2

ÌÅÐÇËÈÊÈÍ À.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû([email protected])2

1Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëåíèå ÌÎ ÐÔ, Ìîñêâà; 2Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿèì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã

Ïðèâåäåíû àíàëèç è ðåçóëüòàòû îáîáùåíèÿ îòå÷åñòâåííûõ íàó÷íûõ èññëåäîâàíèé, ïîñâÿùåííûõâîïðîñàì ñëóæåáíîé äåÿòåëüíîñòè âîåííîñëóæàùèõ è ãðàæäàíñêèõ ëèö â óñëîâèÿõ Àðêòèêè. Ïîêàçàíûïðîáëåìû îðãàíèçàöèè îõðàíû çäîðîâüÿ âîåííîñëóæàùèõ, ïðîõîäÿùèõ ñëóæáó â óñëîâèÿõ Àðêòè÷åñêîãîðåãèîíà. Óñòàíîâëåíî, ÷òî ó âîåííîñëóæàùèõ, âûïîëíÿâøèõ ó÷åáíî-áîåâûå çàäà÷è â Àðêòè÷åñêîéçîíå Ðîññèè, ïðåèìóùåñòâåííî (áîëåå 95% ñëó÷àåâ) âñòðå÷àþòñÿ ñëåäóþùèå âèäû ïñèõîôèçè÷åñêèõè íåâðîòè÷åñêèõ äåçàäàïòîçîâ – ñîìàòîôîðìíàÿ äèñôóíêöèÿ âåãåòàòèâíîé íåðâíîé ñèñòåìû,ïåðåóòîìëåíèå, îãðàíè÷åíèÿ äåÿòåëüíîñòè, âûçâàííûå ñíèæåíèåì èëè óòðàòîé òðóäîñïîñîáíîñòè.Ïîêàçàíà ðîëü ìåäèêî-ïñèõîëîãè÷åñêîé ðåàáèëèòàöèè êàê îäíîãî èç ýôôåêòèâíûõ ìåòîäîâïðîôèëàêòèêè è ëå÷åíèÿ äåçàäàïòèâíûõ ðàññòðîéñòâ ó âîåííîñëóæàùèõ. Ïðåäëîæåíû ìåòîäè÷åñêèåïîäõîäû ê îðãàíèçàöèè ìåäèêî-ïñèõîëîãè÷åñêîé ðåàáèëèòàöèè âîåííîñëóæàùèõ, âûïîëíÿâøèõó÷åáíî-áîåâûå çàäà÷è â Àðêòè÷åñêîé çîíå Ðîññèè, â ÷àñòíîñòè ðåêîìåíäàöèè ïî ïðèìåíåíèþêîððèãèðóþùèõ ìåòîäîâ â ñîîòâåòñòâèè ñ êëèíè÷åñêèìè õàðàêòåðèñòèêàìè ñèíäðîìîâ.

Ê ë þ ÷ å â û å ñ ë î â à: Àðêòèêà, Âîîðóæåííûå Ñèëû, âîåííîñëóæàùèå, âîåííî-ìåäèöèíñêèåîðãàíèçàöèè, ñàíàòîðíî-êóðîðòíûå îðãàíèçàöèè, ìåäèöèíñêàÿ ðåàáèëèòàöèÿ, ìåäèêî-ïñèõîëîãè÷åñêàÿðåàáèëèòàöèÿ.

Dolgikh S.V., Ponomarenko G.N., Bobrov L.L., Ishchuk V.N., Merzlikin A.V. – Medical and psychologicalrehabilitation of servicemen serving in the Arctic zone of Russia. The analysis and results of thegeneralization of domestic scientific research on the issues of service activities of military personnel andcivilians in the Arctic are given. The problems of the organization of the protection of the health ofservicemen serving in the Arctic region are shown. It has been established that military personnel performingcombat training tasks in the Arctic zone of Russia mainly (more than 95% of cases) have the followingtypes of psychophysical and neurotic disadaptosis – somatoform dysfunction of the autonomic nervoussystem, overwork, restrictions on activity caused by a decrease or disability. The role of medical andpsychological rehabilitation as one of the effective methods for the prevention and treatment of maladaptivedisorders in the military has been shown. Methodical approaches to the organization of medical andpsychological rehabilitation of servicemen performing training and combat tasks in the Arctic zone ofRussia, in particular, recommendations on the use of corrective methods in accordance with the clinicalcharacteristics of syndromes are proposed.

K e y w o r d s: Arctic, Armed Forces, military, military medical organizations, sanatorium and resortorganizations, medical rehabilitation, medical and psychological rehabilitation.

Àðêòèêà – òåððèòîðèÿ, çàíèìàþùàÿ ïðèìåðíî îäíó øåñòóþ ÷àñòü ïîâåðõ-

íîñòè çåìíîãî øàðà (îêîëî 3,1 ìëí êâ. êì).Äâå òðåòè ýòîé òåððèòîðèè çàíèìàåò

Ñåâåðíûé Ëåäîâèòûé îêåàí, áîëüøàÿ÷àñòü êîòîðîãî ïîêðûòà ëüäîì (ñðåäíÿÿòîëùèíà îêîëî 3 ì) è ìàëî ïðèãîäíàäëÿ ñóäîõîäñòâà. Ðîññèéñêàÿ Àðêòèêà –

15«Âîåííî-ìåäèöèíñêèé æóðíàë», 3’2019

ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË

Ëèòåðàòóðà

1. Î ñòàòóñå âîåííîñëóæàùèõ: Ôåäåðàëü-íûé çàêîí îò 27.05.1998 ã. ¹ 76-ÔÇ // Ñîáðà-íèå çàêîíîäàòåëüñòâà ÐÔ. – 1998, 1 èþíÿ. –¹ 22. – Ñò. 2331.

2. Î ñóõîïóòíûõ òåððèòîðèÿõ Àðêòè÷åñ-êîé çîíû Ðîññèéñêîé Ôåäåðàöèè: Óêàç Ïðå-çèäåíòà ÐÔ îò 02.05.2014 ã. ¹ 296 // Ñîáðà-íèå çàêîíîäàòåëüñòâà ÐÔ. – 2014, 5 ìàÿ. –¹ 18 (÷. I). – Ñò. 2136.

3. Îá óòâåðæäåíèè ãîñóäàðñòâåííîé ïðî-ãðàììû Ðîññèéñêîé Ôåäåðàöèè «Ñîöèàëüíî-ýêîíîìè÷åñêîå ðàçâèòèå Àðêòè÷åñêîé çîíûÐîññèéñêîé Ôåäåðàöèè»: Ïîñòàíîâëåíèå Ïðà-âèòåëüñòâà ÐÔ îò 21.04.2014 ã. ¹ 366 // Ñî-áðàíèå çàêîíîäàòåëüñòâà ÐÔ. – 2014, 5 ìàÿ. –¹ 18 (÷. IV). – Ñò. 2207.

4. Î ìåäèêî-ïñèõîëîãè÷åñêîé ðåàáèëèòà-öèè âîåííîñëóæàùèõ: ïðèêàç ìèíèñòðà îáî-ðîíû ÐÔ îò 27.01.2017 ã. ¹ 60 // Îôèöèàëü-íûé èíòåðíåò-ïîðòàë ïðàâîâîé èíôîðìàöèèhttp://www.pravo.gov.ru/ 06.03.2017.

5. Ãèãèåíà òðóäà: Ðóêîâîäñòâî ïî ãèãèåíè-÷åñêîé îöåíêå ôàêòîðîâ ðàáî÷åé ñðåäû è òðó-äîâîãî ïðîöåññà. Êðèòåðèè è êëàññèôèêàöèÿóñëîâèé òðóäà / Óòâ. Ãëàâíûì ãîñóäàðñòâåííûìñàíèòàðíûì âðà÷îì ÐÔ 29.07.2005 ã.Ð 2.2.2006-05.2.2. // Áþëë. íîðìàòèâíûõ è ìå-òîäè÷åñêèõ äîêóìåíòîâ Ãîññàíýïèäíàäçîðà. –2005. – ¹ 3. – 160 ñ.

6. Ãîí÷àðîâ Ñ.Â., Ðóìÿíöåâ Ð.À. Ìîðàëüíî-ïñèõîëîãè÷åñêîå îáåñïå÷åíèå ñîåäèíåíèé èâîèíñêèõ ÷àñòåé ñóõîïóòíûõ âîéñê â Àðêòè-êå // Âåñòíèê Ñèáèðñêîãî îòäåëåíèÿ Àêàäå-ìèè âîåííûõ íàóê. – 2014. – ¹ 25. – Ñ. 119.

7. Äåðÿïà Í.Ð., Ðÿáèíèí È.Ô. Àäàïòàöèÿ÷åëîâåêà â ïîëÿðíûõ ðàéîíàõ Çåìëè. – Ë.:Íàóêà, 1977. – 296 ñ.

8. Äåðÿïà Í.Ð., Äàâèäåíêî Â.È. Òåîðåòè÷å-ñêèå è ïðèêëàäíûå àñïåêòû ïðîáëåìû àäàï-òàöèè ÷åëîâåêà â Àíòàðêòèäå // Àíòàðêòèêà.– 1988. – ¹ 27. – Ñ. 203–218.

9. Äîâãóøà Â.Â., Êóäðèí È.Ä., Òèõîíîâ Ì.Í.Ââåäåíèå â âîåííóþ ýêîëîãèþ. – ÑÏá: ÂÌåäÀ,1995. – 496 ñ.

10. Êàçíà÷ååâ Â.Ï., Äåðÿïà Í.Ð., Ñîëîìà-òèí À.Ï. Ãåëèîãåîôèçè÷åñêèå ôàêòîðû è àäàï-òàöèÿ. – Ì.: Ìåäèöèíà, 1976. – 154 ñ.

11. Êàçíà÷ååâ Â.Ï. Êëèíè÷åñêèå àñïåêòûïîëÿðíîé ìåäèöèíû. – Ì.: Ìåäèöèíà, 1986. –208 ñ.

12. Íîâèêîâ Â.Ñ., Øóñòîâ Å.Á. Ïðîãíî-çèðîâàíèå ïåðåíîñèìîñòè ýêñòðåìàëüíûõâîçäåéñòâèé // Âåñòíèê îáðàçîâàíèÿ è ðàç-âèòèÿ íàóêè ÐÀÅÍ. – 2004. – ¹ 3. –Ñ. 43–49.

13. Íîâèêîâ Â.Ñ., Ñîðîêî Ñ.È. Ôèçèîëîãè-÷åñêèå îñíîâû æèçíåäåÿòåëüíîñòè ÷åëîâåêàâ ýêñòðåìàëüíûõ óñëîâèÿõ. – ÑÏá: Ïîëèòåõ-íèêà-ïðèíò, 2007. – 476 ñ.

14. Íîâèöêèé À.À. Ñèíäðîì õðîíè÷åñêîãîýêîëîãî-ïðîôåññèîíàëüíîãî ïåðåíàïðÿæåíèÿè ïðîáëåìû ñîõðàíåíèÿ çäîðîâüÿ ëè÷íîãîñîñòàâà â ïðîöåññå âîåííî-ïðîôåññèîíàëüíîéäåÿòåëüíîñòè // Òðóäû Âîåí.-ìåä. àêàä. – 1994.– Ò. 235. – Ñ. 8–17.

15. Ïîíîìàðåíêî Ã.Í. Ôèçè÷åñêèå ìåòîäûëå÷åíèÿ. – ÑÏá, 2011. – 328 ñ.

16. Ñîðîêî Ñ.È. Íåéðîôèçèîëîãè÷åñêèåìåõàíèçìû èíäèâèäóàëüíîé àäàïòàöèè ÷å-ëîâåêà â Àíòàðêòèäå. – Ë.: Íàóêà, 1984. –153 ñ.

17. Ôèçèîòåðàïèÿ: Íàöèîíàëüíîå ðóêî-âîäñòâî / Ïîä. ðåä. Ã.Í.Ïîíîìàðåíêî. – Ì.:ÃÝÎÒÀÐ-Ìåäèà, 2014. – 628 ñ.

18. Õàñíóëèí Â.È. Ââåäåíèå â ïîëÿðíóþìåäèöèíó. – Íîâîñèáèðñê: Èçä. ÑÎ ÐÀÌÍ,1998. – 320 ñ.

19. Õàñíóëèí Â.È., Ñîáàêèí À.Ê., Õàñíóëèí Ï.Â.,Áîéêî Å.Ð. Ïîäõîäû ê ðàéîíèðîâàíèþ òåððè-òîðèé Ðîññèè ïî óñëîâèÿì äèñêîìôîðòíîñòèîêðóæàþùåé ñðåäû äëÿ æèçíåäåÿòåëüíîñòèíàñåëåíèÿ // Áþëë. ÑÎ ÐÀÌÍ. – 2005. – ¹ 3(117). – Ñ. 106–111.

20. Ôèçè÷åñêàÿ è ðåàáèëèòàöèîííàÿ ìå-äèöèíà: Íàöèîíàëüíîå ðóêîâîäñòâî / Àññî-öèàöèÿ ìåä. îáùåñòâ ïî êà÷åñòâó, Ìåæðåãèîí.îáùåñòâ. îðã-öèÿ «Íàó÷íîå îáùåñòâî ôèçè-÷åñêîé è ðåàáèëèòàöèîííîé ìåäèöèíû» / Ïîäðåä. Ã.Í.Ïîíîìàðåíêî. – Ì.: ÃÝÎÒÀÐ-Ìåäèà,2016. – 685 ñ.

© Í.Â.ÀËËÀÌßÐÎÂÀ, Ý.Ã.ÑÀÍÀÊÎÅÂÀ, 2019ÓÄÊ [61:621.38]:34(470)

Ïðàâîâîå ðåãóëèðîâàíèå òåëåìåäèöèíûâ ñèñòåìå çäðàâîîõðàíåíèÿ ÐîññèéñêîéÔåäåðàöèè: ñîñòîÿíèå è ïåðñïåêòèâûñîâåðøåíñòâîâàíèÿ

ÀËËÀÌßÐÎÂÀ Í.Â., êàíäèäàò ìåäèöèíñêèõ íàóêÑÀÍÀÊÎÅÂÀ Ý.Ã., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû ([email protected])

Ôèëèàë Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà, Ìîñêâà



Çàêîíîäàòåëüñòâî â ñôåðå ýëåêòðîííîãî çäðàâîîõðàíåíèÿ, ïðèíÿòîå â 2017 ã., îòêðûâàåòïðèíöèïèàëüíî íîâûå âîçìîæíîñòè â ðàçâèòèè ìåäèöèíñêîé ïîìîùè ñ ïðèìåíåíèåì òåëåìåäèöèíñêèõòåõíîëîãèé. Â ñòàòüå ïðèâåäåí àíàëèç íîðìàòèâíûõ ïðàâîâûõ äîêóìåíòîâ, óñòàíàâëèâàþùèõ ïðàâîâûåðàìêè îêàçàíèÿ ìåäèöèíñêîé ïîìîùè ñ ïðèìåíåíèåì òåëåìåäèöèíñêèõ òåõíîëîãèé. Äàíà îöåíêàòåêóùåìó ñîñòîÿíèþ ïðàâîâîãî ðåãóëèðîâàíèÿ òåëåìåäèöèíû â Ðîññèè. Çàêîí î òåëåìåäèöèíå òðåáóåòêîððåêòèðîâêè è äîðàáîòêè ñóùåñòâóþùèõ íîðìàòèâíûõ àêòîâ, ïîðÿäêîâ, ñòàíäàðòîâ îêàçàíèÿìåäèöèíñêîé ïîìîùè ñ äåòàëüíîé ðåãëàìåíòàöèåé èíñòðóìåíòîâ è ñèòóàöèé èõ ïðèìåíåíèÿ.

Ê ë þ ÷ å â û å ñ ë î â à: òåëåìåäèöèíñêèå òåõíîëîãèè, öèôðîâàÿ ìåäèöèíà, ýëåêòðîííûéäîêóìåíòîîáîðîò.

Allamyarova N.V., Sanakoeva E.G. – Legal regulation of telemedicine in the health care system of theRussian Federation: state and prospects for improvement. The legislation in the field of e-health,adopted in 2017, opens fundamentally new opportunities in the development of medical care using telemedicinetechnologies. The article provides an analysis of regulatory legal documents that establish the legal frameworkfor the provision of medical care using telemedicine technologies. An assessment is made of the currentstate of telemedicine legal regulation in Russia. The law on telemedicine requires adjustment and refinementof existing regulations, procedures, standards of medical care with a detailed regulation of tools and situationsof their application.

K e y w o r d s: telemedicine technology, digital medicine, electronic document management.

Â íàñòîÿùåå âðåìÿ öèôðîâèçàöèÿ ñè- ñòåìû çäðàâîîõðàíåíèÿ ÿâëÿåòñÿ îä-

íèì èç ïðèîðèòåòíûõ ãîñóäàðñòâåííûõíàïðàâëåíèé. Ñ 1 ÿíâàðÿ 2018 ã. âñòóïèëèâ ñèëó ïîïðàâêè ê Ôåäåðàëüíîìó çàêîíóîò 21.11.2011 ã. ¹ 323-ÔÇ «Îá îñíîâàõîõðàíû çäîðîâüÿ ãðàæäàí â ÐîññèéñêîéÔåäåðàöèè», êîòîðûìè ðåãóëèðóþòñÿ íå-ñêîëüêî íàïðàâëåíèé: òåëåìåäèöèíà,ýëåêòðîííûé äîêóìåíòîîáîðîò â ìåäè-öèíñêîé îðãàíèçàöèè, ýëåêòðîííûå ðå-öåïòû, à òàêæå Åäèíàÿ ãîñóäàðñòâåííàÿèíôîðìàöèîííàÿ ñèñòåìà â ñôåðå çäðàâî-îõðàíåíèÿ (ÅÃÈÑÇ). Êàæäîå èç ýòèõ íà-ïðàâëåíèé çíà÷èòñÿ ñåãîäíÿ â ïîâåñòêåöèôðîâîé òðàíñôîðìàöèè ìåäèöèíñêîéïîìîùè íàñåëåíèþ, è äàëüíåéøåå ðàç-âèòèå öèôðîâèçàöèÿ ñôåðû îõðàíû çäî-ðîâüÿ áåç äîñòèæåíèÿ ïðîãðåññà âî âñåõ÷åòûðåõ óêàçàííûõ îáëàñòÿõ ïðàêòè÷åñ-êè íåâîçìîæíî [2].

Íîðìàòèâíîå ïðàâîâîå ðåãóëèðîâà-íèå öèôðîâèçàöèè çäðàâîîõðàíåíèÿ âÐîññèéñêîé Ôåäåðàöèè ñîñòîèò êàê èçíàöèîíàëüíûõ çàêîíîäàòåëüíûõ àêòîâ,èìåþùèõ îòíîøåíèå ê òåëåìåäèöèíå,íàöèîíàëüíûõ ïðîòîêîëîâ è ñòàíäàðòîâìåäèêî-ñàíèòàðíîé ïîìîùè, òàê è ìåæ-äóíàðîäíûõ è íàöèîíàëüíûõ èíæåíåð-íûõ òåëåêîììóíèêàöèîííûõ ñòàíäàðòîâ,äîêóìåíòîâ Âñåìèðíîé îðãàíèçàöèèçäðàâîîõðàíåíèÿ. Â Ðîññèéñêîé Ôåäåðà-öèè â íàñòîÿùåå âðåìÿ äåéñòâóåò íå-ñêîëüêî ôåäåðàëüíûõ çàêîíîâ, â ÷àñòíî-ñòè Ôåäåðàëüíûé çàêîí «Î âíåñåíèè èç-ìåíåíèé â îòäåëüíûå çàêîíîäàòåëüíûåàêòû Ðîññèéñêîé Ôåäåðàöèè ïî âîïðî-

ñàì ïðèìåíåíèÿ èíôîðìàöèîííûõ òåõ-íîëîãèé â ñôåðå îõðàíû çäîðîâüÿ» îò29.07.2017 ã. ¹ 242-ÔÇ (Çàêîí î òåëåìå-äèöèíå).

Çàêîíîì î òåëåìåäèöèíå â 2018 ã.ââåäåíî ëåãàëüíîå îïðåäåëåíèå òåëåìå-äèöèíñêèõ òåõíîëîãèé êàê«èíôîðìàöè-îííûõ òåõíîëîãèé, îáåñïå÷èâàþùèõ äè-ñòàíöèîííîå âçàèìîäåéñòâèå ìåäèöèí-ñêèõ ðàáîòíèêîâ ìåæäó ñîáîé, ñ ïàöèåí-òàìè è (èëè) èõ çàêîííûìè ïðåäñòàâè-òåëÿìè, èäåíòèôèêàöèþ è àóòåíòèôèêà-öèþ óêàçàííûõ ëèö, äîêóìåíòèðîâàíèåñîâåðøàåìûõ èìè äåéñòâèé ïðè ïðîâå-äåíèè êîíñèëèóìîâ, êîíñóëüòàöèé, äèñ-òàíöèîííîãî ìåäèöèíñêîãî íàáëþäåíèÿçà ñîñòîÿíèåì çäîðîâüÿ ïàöèåíòà» [8].

Òåëåìåäèöèíà êàê âñïîìîãàòåëüíîåíàïðàâëåíèå ìåäèöèíû îñíîâàíà íà ïðè-ìåíåíèè ñîâðåìåííûõ òåëåêîììóíèêà-öèîííûõ è èíôîðìàöèîííî-òåëåêîììó-íèêàöèîííûõ òåõíîëîãèé äëÿ îêàçàíèÿìåäèöèíñêîé ïîìîùè ïàöèåíòàì óäàëåí-íî, êîãäà ãåîãðàôè÷åñêîå ðàññòîÿíèåìåæäó ìåäèöèíñêèì ðàáîòíèêîì è ïà-öèåíòîì ÿâëÿåòñÿ êðèòè÷åñêèì ôàêòî-ðîì.

Çàêîí î òåëåìåäèöèíå ïðèíÿò íå êàêîòäåëüíûé çàêîíîäàòåëüíûé àêò, ïðè-çâàííûé ñàìîñòîÿòåëüíî ðåãóëèðîâàòüñôåðó òåëåìåäèöèíñêèõ òåõíîëîãèé, à êàêïðåäóñìàòðèâàþùèé âíåñåíèå èçìåíå-íèé â ðÿä äåéñòâóþùèõ çàêîíîâ, â ÷àñòíî-ñòè: Ôåäåðàëüíûé çàêîí îò 21.11.2011 ã.¹ 323-ÔÇ «Îá îñíîâàõ îõðàíû çäîðîâüÿãðàæäàí â Ðîññèéñêîé Ôåäåðàöèè»(Çàêîí ¹ 323-ÔÇ); Ôåäåðàëüíûé çàêîí




1. Âëàäçèìèðñêèé À.Â. Èñòîðèÿ òåëåìåäè-öèíû – ïåðâûå 150 ëåò // Æóðíàë òåëåìåäè-öèíû è ýëåêòðîííîãî çäðàâîîõðàíåíèÿ – Ðîñ-ñèÿ. – 2015. – ¹ 1. – Ñ. 10–18. URL: http://jtelemed.ru/article/istorija-telemediciny-pervye150-let/ (Äàòà îáðàùåíèÿ: 6 äåêàáðÿ 2018 ã.).

2. Êóñàéêî Ò.À. Öèôðîâîå çäðàâîîõðàíå-íèå – âàæíîå çâåíî â ðàçâèòèè öèôðîâîé ýêî-íîìèêè â Ðîññèè. Ýëåêòðîííûé ðåñóðñ http://council.gov.ru/events/news/98534. (Äàòà îáðàùå-íèÿ: 6 äåêàáðÿ 2018 ã.).

3. Ïèñüìî Ìèíçäðàâà Ðîññèè îò 9.04.2018 ã.¹ 18-2/0579 «Î ïîðÿäêå îðãàíèçàöèè è îêà-çàíèÿ ìåäèöèíñêîé ïîìîùè ñ ïðèìåíåíèåìòåëåìåäèöèíñêèõ òåõíîëîãèé». URL: http://www.garant.ru/products/i po/prime/doc/71842326/ (Äàòà îáðàùåíèÿ: 6 äåêàáðÿ 2018 ã.).

4. Ïîñòàíîâëåíèå Ïðàâèòåëüñòâà ÐÔ îò28.11.2011 ã. ¹ 977 «Î ôåäåðàëüíîé ãîñóäàð-ñòâåííîé èíôîðìàöèîííîé ñèñòåìå «Åäèíàÿñèñòåìà èäåíòèôèêàöèè è àóòåíòèôèêàöèè âèíôðàñòðóêòóðå, îáåñïå÷èâàþùåé èíôîðìàöè-îííî-òåõíîëîãè÷åñêîå âçàèìîäåéñòâèå èí-ôîðìàöèîííûõ ñèñòåì, èñïîëüçóåìûõ äëÿ ïðå-äîñòàâëåíèÿ ãîñóäàðñòâåííûõ è ìóíèöèïàëü-íûõ óñëóã â ýëåêòðîííîé ôîðìå». URL: http://www.consultant.ru/document/cons_doc_LAW_122455/ (Äàòà îáðàùåíèÿ: 6 äåêàáðÿ 2018 ã.).

5. Ïîñòàíîâëåíèå Ïðàâèòåëüñòâà ÐÔ îò12.04.2018 ã. ¹ 447 «Îá óòâåðæäåíèè Ïðàâèëâçàèìîäåéñòâèÿ èíûõ èíôîðìàöèîííûõ ñèñ-òåì, ïðåäíàçíà÷åííûõ äëÿ ñáîðà, õðàíåíèÿ,îáðàáîòêè è ïðåäîñòàâëåíèÿ èíôîðìàöèè,êàñàþùåéñÿ äåÿòåëüíîñòè ìåäèöèíñêèõ îðãà-

íèçàöèé è ïðåäîñòàâëÿåìûõ èìè óñëóã, ñ èí-ôîðìàöèîííûìè ñèñòåìàìè â ñôåðå çäðàâî-îõðàíåíèÿ è ìåäèöèíñêèìè îðãàíèçàöèÿìè».URL: http://www.consultant.ru/document/cons_doc_LAW_295787/ (Äàòà îáðàùåíèÿ:6 äåêàáðÿ 2018 ã.).

6. Ïîñòàíîâëåíèå Ïðàâèòåëüñòâà ÐÔ îò05.05.2018 ã. ¹ 555 «Î åäèíîé ãîñóäàðñòâåí-íîé èíôîðìàöèîííîé ñèñòåìå â ñôåðå çäðà-âîîõðàíåíèÿ». URL: http://www.consultant.ru/document/cons_doc_LAW_297474/ (Äàòà îáðà-ùåíèÿ: 6 äåêàáðÿ 2018 ã.).

7. Ïðèêàç Ìèíçäðàâà Ðîññèè îò 9.01.2018 ã.¹ 2í «Î âíåñåíèè èçìåíåíèé â ïðèêàçÌèíèñòåðñòâà çäðàâîîõðàíåíèÿ Ðîññèè îò15.12.2014 ã. ¹ 834í «Îá óòâåðæäåíèè óíèôè-öèðîâàííûõ ôîðì ìåäèöèíñêîé äîêóìåíòà-öèè, èñïîëüçóåìûõ â ìåäèöèíñêèõ îðãàíèçà-öèÿõ, îêàçûâàþùèõ ìåäèöèíñêóþ ïîìîùü âàìáóëàòîðíûõ óñëîâèÿõ, è ïîðÿäêîâ ïî èõ çà-ïîëíåíèþ» URL: http://www.consultant.ru/document/cons_doc_LAW_175963/ (Äàòà îáðà-ùåíèÿ: 6 äåêàáðÿ 2018 ã.).

8. Ôåäåðàëüíûé çàêîí «Î âíåñåíèè èçìå-íåíèé â îòäåëüíûå çàêîíîäàòåëüíûå àêòûÐîññèéñêîé Ôåäåðàöèè ïî âîïðîñàì ïðèìå-íåíèÿ èíôîðìàöèîííûõ òåõíîëîãèé â ñôåðåîõðàíû çäîðîâüÿ» îò 29.07.2017 ã. ¹ 242-ÔÇ.URL: http://www.consultant.ru/document/cons_doc_LAW_221184. (Äàòà îáðàùåíèÿ:6 äåêàáðÿ 2018 ã.).

9. Ôåäåðàëüíûé çàêîí «Îá îñíîâàõ îõðà-íû çäîðîâüÿ ãðàæäàí â Ðîññèéñêîé Ôåäåðà-öèè» îò 21.11.2011 ã. ¹ 323-ÔÇ. URL: http://www.consultant.ru/document/cons_doc_LAW_121895/ (Äàòà îáðàùåíèÿ: 6 äåêàáðÿ 2018 ã.).

Ë Å Í Ò À Í Î Â Î Ñ Ò Å É

Â 451-ì âîåííîì ãîñïèòàëå ðîññèéñêîé âîåííîé áàçû â Òàäæèêèñòàíå çà ãîä ïðîâåäåíîáîëåå 200 îïåðàöèé ñ èñïîëüçîâàíèåì íîâåéøåãî îáîðóäîâàíèÿ.

«Îïåðàöèè ñ èñïîëüçîâàíèåì ýíäîâèäåîõèðóðãè÷åñêîãî îáîðóäîâàíèÿ ïðîâîäÿòñÿ â òå÷åíèåïîëóòîðà ÷àñîâ, è ÷åðåç òðè äíÿ ïàöèåíòû âîçâðàùàþòñÿ â ñâîè ïîäðàçäåëåíèÿ, çà òåêóùèé ãîäìû ïðîâåëè áîëåå 200 îïåðàöèé íà íàøåì îáîðóäîâàíèè», – ñêàçàë íà÷àëüíèê õèðóðãè÷åñêîãîîòäåëåíèÿ ãîñïèòàëÿ ìàéîð ìåäèöèíñêîé ñëóæáû Äæàáðàèë Ìàãîìåäîâ.

Ïî åãî ñëîâàì, ïðèìåíåíèå äàííîãî ìåòîäà ëå÷åíèÿ ïîçâîëÿåò ðåçêî ñîêðàòèòü ñðîêãîñïèòàëèçàöèè, ñíèçèòü ïîòðåáíîñòè â ëåêàðñòâåííûõ ïðåïàðàòàõ è èñêëþ÷èòü ðèñê ðàñïðî-ñòðàíåíèÿ èíôåêöèè.

Êðîìå òîãî, äëÿ âûïîëíåíèÿ òàêèõ îïåðàöèé ðàíüøå âîåííîñëóæàùèõ ïðèõîäèëîñü òðàíñ-ïîðòèðîâàòü â ëå÷åáíûå çàâåäåíèÿ íà òåððèòîðèè Ðîññèéñêîé Ôåäåðàöèè.

Íîâîå çäàíèå 451-ãî âîåííîãî ãîñïèòàëÿ, îñíàùåííîå íîâåéøèì ìåäèöèíñêèì îáîðóäî-âàíèåì è ðàññ÷èòàííîå íà åæåãîäíîå ëå÷åíèå áîëåå 3000 ïàöèåíòîâ, ââåäåíî â ýêñïëóàòàöèþâåñíîé 2017 ã.

Äèñëîöèðîâàííàÿ â Òàäæèêèñòàíå 201-ÿ âîåííàÿ áàçà – êðóïíåéøèé âîåííûé îáúåêòÐîññèè çà åå ïðåäåëàìè. Ðàñïîëàãàåòñÿ â äâóõ ãîðîäàõ – Äóøàíáå è Áîõòàðå. Ñîãëàñíî ïîä-ïèñàííîìó â îêòÿáðå 2012 ã. ñîãëàøåíèþ, ñîåäèíåíèå áóäåò íàõîäèòüñÿ â Òàäæèêèñòàíåäî 2042 ãîäà.

Ïðåññ-ñëóæáà Öåíòðàëüíîãî âîåííîãî îêðóãà, 3 ÿíâàðÿ 2019 ã.https://function.mil.ru/news_page/country/more.htm?id=12210742@egNews

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ÌÅÄÈÖÈÍÀÝÊÑÒÐÅÌÀËÜÍÛÕ ÑÈÒÓÀÖÈÉ


© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ [616.2-002.2-02:615.917]-037

Âåðîÿòíîñòíàÿ ïðîãíîçíàÿ ìàòåìàòè÷åñêàÿìîäåëü õðîíè÷åñêèõ ðåñïèðàòîðíûõ ñîñòîÿíèéäëÿ ñíèæåíèÿ ðèñêà èíâàëèäèçàöèè ïðèîòðàâëåíèè âåùåñòâàìè ïóëüìîíîòîêñè÷åñêîãîäåéñòâèÿ

ÂÅÍÃÅÐÎÂÈ× Í.Ã., äîêòîð ìåäèöèíñêèõ íàóê, êàïèòàí ìåäèöèíñêîé ñëóæáû1

ÞÄÈÍ Ì.À., äîêòîð ìåäèöèíñêèõ íàóê, äîöåíò, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû([email protected])1

ÊÎÍÜØÀÊÎÂ Þ.Î., êàïèòàí ìåäèöèíñêîé ñëóæáû2

×ÅÏÓÐ Ñ.Â., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû ([email protected])1

ÈÂÀÍÎÂ È.Ì., êàíäèäàò ìåäèöèíñêèõ íàóê, ìàéîð ìåäèöèíñêîé ñëóæáû1

1Ãîñóäàðñòâåííûé íàó÷íî-èññëåäîâàòåëüñêèé èñïûòàòåëüíûé èíñòèòóò âîåííîé ìåäèöèíûÌÎ ÐÔ, Ñàíêò-Ïåòåðáóðã; 21602-é Âîåííûé êëèíè÷åñêèé ãîñïèòàëü, ã. Ðîñòîâ-íà-Äîíó

Íà ýêñïåðèìåíòàëüíîé ìîäåëè îòðàâëåíèÿ êðûñ ôîñãåíîì òÿæåëîé ñòåïåíè (îäíîêðàòíîåââåäåíèå â òîêñîäîçå 1 LÑt

50 – 3,92 ìã×ìèí/ë) èññëåäîâàíû ïîêàçàòåëè ðåñïèðàòîðíîé ñèñòåìû

è ãèñòîïàòîëîãè÷åñêèå èçìåíåíèÿ ïàðåíõèìû ëåãêèõ. Óñòàíîâëåíî, ÷òî ÷åðåç 45 ñóò ïîñëåâîçäåéñòâèÿ ôîñãåíîì ó ïîëîâèíû âûæèâøèõ æèâîòíûõ ôîðìèðóåòñÿ êîìïëåêñ ñòîéêèõôèçèîëîãè÷åñêèõ, ôóíêöèîíàëüíûõ è ñòðóêòóðíûõ èçìåíåíèé, ñèíäðîìîñõîäíûõ ñ õðîíè÷åñêèìðåñïèðàòîðíûì ñîñòîÿíèåì (J68.4 ÌÊÁ-10). Ìåòîäîì ìàòåìàòè÷åñêîãî àíàëèçà óñòàíîâëåíûîñíîâíûå íåçàâèñèìûå ïðåäèêòîðû èç ÷èñëà ëàáîðàòîðíî-ôóíêöèîíàëüíûõ ïîêàçàòåëåé â îñòðûéïåðèîä îòðàâëåíèÿ ïóëüìîíîòîêñèêàíòîì (6 ÷), íà îñíîâå êîòîðûõ ðàçðàáîòàíà ìîäåëüïðîãíîçèðîâàíèÿ âåðîÿòíîñòè ôîðìèðîâàíèÿ õðîíè÷åñêèõ ðåñïèðàòîðíûõ ñîñòîÿíèé óîòðàâëåííûõ æèâîòíûõ êàê ïîñëåäñòâèé îñòðîãî îòðàâëåíèÿ ôîñãåíîì òÿæåëîé ñòåïåíè.Ïîêàçàíî, ÷òî óâåëè÷åíèå êîíöåíòðàöèè ïðîäóêòîâ ïåðåêèñíîãî îêèñëåíèÿ ëèïèäîâ â ïëàçìåêðîâè íà 25% îïðåäåëÿåò âåðîÿòíîñòü âîçíèêíîâåíèÿ îòäàëåííûõ ïîñëåäñòâèé áîëåå ÷åì 0,95.Ïîëó÷åííàÿ ìàòåìàòè÷åñêàÿ ìîäåëü ïîçâîëÿò ñïðîãíîçèðîâàòü õàðàêòåðèñòèêè ïîòîêàïîðàæåííûõ, íóæäàþùèõñÿ â ñðåäñòâàõ ýêñòðåííîé ìåäèöèíñêîé ïðîôèëàêòèêè õðîíè÷åñêèõðåñïèðàòîðíûõ ñîñòîÿíèé ïðè îêàçàíèè ìåäèöèíñêîé ïîìîùè â îñòðûé ïåðèîä îòðàâëåíèÿïóëüìîíîòîêñèêàíòàìè.

Ê ë þ ÷ å â û å ñ ë î â à: ïóëüìîíîòîêñèêàíòû, ôîñãåí, àíòèîêñèäàíòíàÿ àêòèâíîñòü,õðîíè÷åñêîå ðåñïèðàòîðíîå ñîñòîÿíèå, ðåãðåññèîííûé àíàëèç.

Vengerovich N.G., Yudin M.A., Konshakov Yu.O., Chepur S.V., Ivanov I.M. – Probabilistic predictivemathematical model of chronic respiratory conditions to reduce the risk of disability in case of poisoningwith substances with a pulmonotoxic effect. In the experimental model of poisoning of rats with phosgeneof severe degree (single administration in Tox dose 1 of Lt

50 – 3.92 mg×min/l), the parameters of the

respiratory system and histopathological changes of the lung parenchyma were investigated. It was establishedthat 45 days after exposure to phosgene, half of the surviving animals formed a complex of persistentphysiological, functional, and structural changes in the syndrome of the syndrome and the chronic respiratorystate (J68.4 ICD-10). The main independent predictors from the number of laboratory and functionalparameters in the acute period of pulmonary toxicant poisoning (6 hours) were established by the methodof mathematical analysis, on the basis of which a model was developed to predict the likelihood of chronicrespiratory states in poisoned animals as consequences of severe phosgene poisoning. It is shown thatan increase in the concentration of lipid peroxidation products in the blood plasma by 25% determinesthe likelihood of late effects of more than 0.95. The obtained mathematical model will allow predictingthe characteristics of the flow of affected, in need of emergency medical prevention of chronic respiratoryconditions in the provision of medical care in the acute period of pulmonary toxicity poisoning.

K e y w o r d s: pulmonary toxicants, phosgene, antioxidant activity, chronic respiratory status, regressionanalysis.

29

ÌÅÄÈÖÈÍÀÝÊÑÒÐÅÌÀËÜÍÛÕ ÑÈÒÓÀÖÈÉ


Ïîëó÷åííûå â ðàáîòå ðåçóëüòàòûöåëåñîîáðàçíî èñïîëüçîâàòü ïðè èññëå-äîâàíèè ýôôåêòèâíîñòè ôàðìàêîëîãè-

÷åñêèõ ïðåïàðàòîâ, ïðèìåíÿåìûõ â îñò-ðûé ïåðèîä îòðàâëåíèÿ ïóëüìîíîòîêñè-êàíòàìè.


1. Àêèìîâ À.Ã., Ãàéäóê Ñ.Â., Õàëèìîâ Þ.Ø.è äð. Ìåäèöèíñêèå ïîñëåäñòâèÿ õèìè÷åñ-êèõ àâàðèé è êàòàñòðîô, ñîïðîâîæäàþùèõ-ñÿ âûáðîñîì õëîðà è àììèàêà // Ìàòå-ðèàëû 3-ãî Àçèàòñêî-Òèõîîêåàíñêîãî êîí-ãðåññà ïî âîåííîé ìåäèöèíå. – 2016. –Ñ. 98–99.

2. Áàøàðèí Â.À., Ãðåáåíþê À.Í., Ìàðêèçî-âà Í.Ô. è äð. Õèìè÷åñêèå âåùåñòâà êàê ïîðà-æàþùèé ôàêòîð ïîæàðîâ // Âîåí.-ìåä. æóðí.– 2015. – Ò. 336, ¹ 1. – Ñ. 22–28.

3. Ìåäèöèíñêàÿ òîêñèêîëîãèÿ. Íàöèî-íàëüíîå ðóêîâîäñòâî / Ïîä ðåä. Å.À.Ëóæ-íèêîâà // ÃÝÎÒÀÐ-Ìåäèà. – 2014. –928 ñ.

4. Ìåòîäè÷åñêèå ðåêîìåíäàöèè ïî òåðà-ïèè äûõàòåëüíîé íåäîñòàòî÷íîñòè ó ïîðàæåí-íûõ îòðàâëÿþùèìè è âûñîêîòîêñè÷íûìèâåùåñòâàìè íà ýòàïàõ ìåäèöèíñêîé ýâàêóà-

öèè: Ìåòîä. ðåêîì. óòâ. íà÷. ÃÂÌÓ ÌÎ ÐÔ . –Ì., 2016. – 55 ñ.

5. Àrmaments disarmament and internationalsecurity SIPRI Yearbook // Stockholm InternationalPeace Research Institute. – 2018. – 584 p.

6. Lee J.J., Miller J.A., Basu S. et al. Buildingpredictive in vitro pulmonary toxicity assays usinghigh-throughput imaging and artificial intelligence// Archives of Toxicology. – 2018. – Vol. 92, N 6.– P. 2055–2075.

7. Nadjafi M., Hamzeh S. Knowledge andAttitude of Iranian Red Crescent Society Volun-teers in Dealing with Chemical Attacks // Bulletinof Emergency And Trauma. – 2017. – Vol. 5, N 2.– P. 122–128.

8. Rea L., Parker R. Designing and conduc-ting research (4th Edition). – San Francisco:Jossey-Bass. – 2014. – 360 p.

9. The SAGE Encyclopedia of War: SocialScience Perspectives. – Tufts University, USA. –2017. – 2104 p.


Íà÷àëüíèê Ãëàâíîãî âîåííî-ìåäèöèí-ñêîãî óïðàâëåíèÿ Ìèíèñòåðñòâà îáîðîíûÐîññèéñêîé Ôåäåðàöèè Äìèòðèé Òðèøêèíïðîâåë â Çàëå óïðàâëåíèÿ èìåíè Ã.Ê.Æó-êîâà Íàöèîíàëüíîãî öåíòðà óïðàâëåíèÿîáîðîíîé ÐÔ ñåëåêòîðíîå ñîâåùàíèåñ ðóêîâîäÿùèì ñîñòàâîì ìåäèöèíñêîéñëóæáû Âîîðóæåííûõ Ñèë ÐÔ.

Â ìåðîïðèÿòèè ó÷àñòâîâàëè íà÷àëü-íèêè ìåäèöèíñêèõ ñëóæá âîåííûõ îêðó-ãîâ è ôëîòîâ, ðóêîâîäèòåëè öåíòðàëüíûõâîåííî-ìåäèöèíñêèõ îðãàíèçàöèé.

Ïîñëå âñòóïèòåëüíîãî ñëîâà íà÷àëü-íèêà ÃÂÌÓ ÌÎ ÐÔ äîêëàä îá èòîãàõ ðà-áîòû âîåííî-ìåäèöèíñêèõ îðãàíèçàöèé öåíòðàëüíîãî ïîä÷èíåíèÿ â ïåðèîä íîâîãîäíèõïðàçäíèêîâ è î ïëàíèðóåìûõ â òåêóùåì ãîäó ìåðîïðèÿòèÿõ ïî ñíèæåíèþ ñìåðòíîñòèâîåííîñëóæàùèõ îò çàáîëåâàíèé ïðåäñòàâèë âðèî íà÷àëüíèêà 1-ãî óïðàâëåíèÿ ÃÂÌÓ ÌÎ ÐÔïîëêîâíèê ìåäèöèíñêîé ñëóæáû Ñåðãåé Ñóøèëüíèêîâ.

Ðåçóëüòàòû ðàáîòû ìåäèöèíñêèõ ñëóæá âîåííûõ îêðóãîâ ïî îêàçàíèþ ìåäïîìîùèâ ïðàçäíè÷íûå äíè äîëîæèëè â ñâîèõ âûñòóïëåíèÿõ íà÷àëüíèêè ìåäèöèíñêèõ ñëóæáÞæíîãî è Öåíòðàëüíîãî âîåííûõ îêðóãîâ ïîëêîâíèêè ìåäèöèíñêîé ñëóæáû Ñåðãî Ïàïêîè Àíàòîëèé Êàëìûêîâ, à òàêæå âðèî íà÷àëüíèêîâ ìåäèöèíñêèõ ñëóæá Âîñòî÷íîãî, Çàïàäíîãîâîåííûõ îêðóãîâ è Ñåâåðíîãî ôëîòà ïîëêîâíèê ìåäèöèíñêîé ñëóæáû Àëåêñåé Âèíîãðàäîâ,ïîäïîëêîâíèêè ìåäèöèíñêîé ñëóæáû Èâàí Äîðîøêîâ è Ñåðãåé Êóçíåöîâ.

Èòîãè ñîâåùàíèÿ ïîäâåë â ñâîåì âûñòóïëåíèè íà÷àëüíèê ÃÂÌÓ ÌÎ ÐÔ Äìèòðèé Òðèø-êèí, óäåëèâøèé îñîáîå âíèìàíèå âåäåíèþ ïàöèåíòîâ ñ ïíåâìîíèÿìè, ñòðîãîìó ñîáëþäåíèþàëãîðèòìîâ ëå÷åíèÿ, ââåäåíèþ äîïîëíèòåëüíûõ íîðìàòèâîâ òåðàïèè ýòîé êàòåãîðèè áîëüíûõ.Îí ðàññêàçàë òàêæå î ïðåäñòîÿùèõ ìåðîïðèÿòèÿõ ñ ó÷àñòèåì ìåäèöèíñêîé ñëóæáû ÂÑ ÐÔ.

Äåïàðòàìåíò èíôîðìàöèè è ìàññîâûõ êîììóíèêàöèéÌèíèñòåðñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè, 16 ÿíâàðÿ 2019 ã.

https://function.mil.ru/news_page/country/more.htm?id=12212366@egNews


ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ

ÂÎÏÐÎÑÛ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ 615.831.4

Ïðèìåíåíèå óëüòðàôèîëåòîâîãî èçëó÷åíèÿâ ñîâðåìåííîé ìåäèöèíå (Îáçîð ëèòåðàòóðû)

ÌÀÐÊÅÂÈ× Ï.Ñ., êàíäèäàò ìåäèöèíñêèõ íàóê, ìàéîð ìåäèöèíñêîé ñëóæáû ([email protected])1

ÀËÅÕÍÎÂÈ× À.Â., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà2

ÊÈÑËÅÍÊÎ À.Ì., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

ÅÑÈÏÎÂ À.À. ([email protected])3

1Ôèëèàë ¹ 1 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. À.À.Âèøíåâñêîãî,ã. Êðàñíîãîðñê, Ìîñêîâñêàÿ îáëàñòü; 23-é Öåíòðàëüíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëüèì. À.À.Âèøíåâñêîãî, ã. Êðàñíîãîðñê, Ìîñêîâñêàÿ îáëàñòü; 3Ðîññèéñêàÿ ìåäèöèíñêàÿ àêàäåìèÿíåïðåðûâíîãî ïðîôåññèîíàëüíîãî îáðàçîâàíèÿ Ìèíçäðàâà Ðîññèè, Ìîñêâà

Â ñòàòüå ðàñêðûòû îñíîâíûå íàïðàâëåíèÿ è îáëàñòè ïðèìåíåíèÿ óëüòðàôèîëåòîâîãî îáëó÷åíèÿâ êëèíè÷åñêîé ïðàêòèêå. Îñîáîå ìåñòî óäåëåíî ìåõàíèçìàì áèîëîãè÷åñêîãî âîçäåéñòâèÿóëüòðàôèîëåòîâîãî èçëó÷åíèÿ, ëå÷åáíûì ýôôåêòàì, à òàêæå îñíîâíûì ïîêàçàíèÿì,ïðîòèâîïîêàçàíèÿì, îáîðóäîâàíèþ äëÿ èñïîëüçîâàíèÿ óêàçàííîãî ìåòîäà ëå÷åíèÿ â íàñòîÿùåå âðåìÿ.Óëüòðàôèîëåòîâîå îáëó÷åíèå âî âñåõ âîçìîæíûõ ìåòîäèêàõ è ñïîñîáàõ äîñòàâêè ê áèîëîãè÷åñêèìòêàíÿì èìååò âûñîêóþ çíà÷èìîñòü â ñîâðåìåííîé ïðàêòèêå, ýôôåêòèâíî ïðèìåíÿåòñÿâ áîëüøèíñòâå ðàçäåëîâ ìåäèöèíû – õèðóðãèè, óðîëîãèè, ãèíåêîëîãèè, äåðìàòîâåíåðîëîãèè,ïóëüìîíîëîãèè, êàðäèîëîãèè, îòîðèíîëàðèíãîëîãèè, ãåìàòîëîãèè, èììóíîëîãèè è ìíîãèõ äðóãèõ. Ýòîôîðìèðóåò îñíîâó äëÿ áîëåå øèðîêîãî âíåäðåíèÿ ÓÔ-èçëó÷åíèÿ, äàëüíåéøåãî ñîâåðøåíñòâîâàíèÿîáîðóäîâàíèÿ è ìåòîäèê åãî ïðèìåíåíèÿ â ïðàêòè÷åñêîé ìåäèöèíå.Ê ë þ ÷ å â û å ñ ë î â à: óëüòðàôèîëåòîâîå îáëó÷åíèå, ôîòîãåìîòåðàïèÿ, àóòîòðàíñôóçèÿîáëó÷åííîé óëüòðàôèîëåòîì êðîâè, ëå÷åáíûå ýôôåêòû, ïîêàçàíèÿ è ïðîòèâîïîêàçàíèÿ, àïïàðàòóðà.

Markevich P.S., Alekhnovich A.V., Kislenko A.M., Esi pov A.A. – Use of ultraviolet radiation inmodern medicine (Literature review). The article describes the main directions and areas of applicationof ultraviolet radiation in clinical practice. A special place is given to the mechanisms of biological effectsof ultraviolet radiation, therapeutic effects, as well as the main indications, contraindications, equi pment forthe use of this method of treatment at the present time. Ultraviolet radiation in all possible methods andmethods of delivery to biological tissues is of high importance in modern practice, effectively used in mostsections of medicine – surgery, urology, gynecology, dermatology, pulmonology, cardiology, otorhinolaryngology,hematology, immunology and many others. This forms the basis for a wider introduction of UV radiation,further improvement of equipment and methods of its application in practical medicine.K e y w o r d s: ultraviolet radiation, photohemotherapy, autotransfusion of blood irradiated with ultravioletradiation, therapeutic effects, indications and contraindications, equipment.

Óëüòðàôèîëåòîâîå èçëó÷åíèå (ÓÔ-èç-ëó÷åíèå) ïðåäñòàâëÿåò ñîáîé ÷àñòü

îïòè÷åñêîãî (ñâåòîâîãî) äèàïàçîíà ýëåê-òðîìàãíèòíûõ âîëí ñ äëèíîé âîëíû îò400 äî 180 íì. Â çàâèñèìîñòè îò äëèíûâîëíû ÓÔ-ñïåêòð óñëîâíî äåëÿò íà3 çîíû: îáëàñòü «À» – äëèííîâîëíîâîåÓÔ-èçëó÷åíèå (ÄÓÔ), 400–320 íì; îáëàñòü«Â» – ñðåäíåâîëíîâîå ÓÔ-èçëó÷åíèå (ÑÓÔ),320–280 íì; îáëàñòü «Ñ» – êîðîòêî-âîëíîâîå ÓÔ-èçëó÷åíèå (ÊÓÔ), 280–180 íì.Â ïîñëåäíèå ãîäû äîïîëíèòåëüíî èñ-

ïîëüçóþò ñåëåêòèâíóþ ÓÔ-òåðàïèþâ âèäå äàëüíåãî è áëèæíåãî ó÷àñòêîâîáëàñòè «À» – ÓÔ «À» 1 (400–340 íì),ÓÔ «À» 2 (340–320 íì) è óçêîïîëîñíóþ÷àñòü ñïåêòðà «Â» – 311 íì.

ÓÔ-ñïåêòð èçëó÷åíèÿ îïðåäåëÿåòáèîëîãè÷åñêîå äåéñòâèå íà îðãàíèçì. ÓÔ-ëó÷è ïðîíèêàþò â áèîëîãè÷åñêóþ òêàíüíà ãëóáèíó 0,1–1 ìì. Íàèìåíüøåé ïðî-íèöàåìîñòüþ îáëàäàåò êîðîòêîâîëíîâîå,íàèáîëüøåé – äëèííîâîëíîâîå èçëó÷å-íèå. Äëèííî- è ñðåäíåâîëíîâûå ÓÔ-ëó÷è


ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅÂÎÏÐÎÑÛ

Ë è ò å ð à ò ó ð à

1. Âåêøèí Í.Ë. Ôîòîíèêà áèîëîãè÷åñêèõñòðóêòóð. – Ïóùèíî: ÍÖÁÈ, 1988. – Ñ. 18–21.

2. Ãàâðèøåâà È.À., Äóòêåâè÷ È.Ã., Ïëåøà-êîâ Â.Ã., Êîëåñíèê Â.Ñ. Âëèÿíèå ðàçíûõ ìåòîäîâôîòîãåìîòåðàïèè íà ðåîëîãè÷åñêèå ñâîéñòâàêðîâè ó áîëüíûõ ñ ÈÁÑ // Âåñòíèê õèðóðãèèèì. Í.Í.Ãðåêîâà. – 2000. – Ò. 159, ¹ 2. – Ñ. 60–64.

3. Êàðàíäàøîâ Â.È., Ïåòóõîâ Å.Á. Óëüòðà-ôèîëåòîâîå îáëó÷åíèå êðîâè. – Ì.: Ìåäèöè-íà, 1997. – Ñ. 49–51.

4. Êîìàðîâà Ë.À., Êèðüÿíîâà Â.Â. Ïðèìåíå-íèå óëüòðàôèîëåòîâîãî èçëó÷åíèÿ â ôèçèî-òåðàïèè è êîñìåòîëîãèè. – ÑÏá: ÌÀÏÎ, 2006.– Ñ. 31–47.

5. Êîìàðîâà Ë.À., Åãîðîâà Ã.È. Ñî÷åòàííûåìåòîäû àïïàðàòíîé ôèçèîòåðàïèè è áàëüíåî-òåïëîëå÷åíèÿ. – ÑÏá: ÌÀÏÎ, 1994. – 222 ñ.

6. Ïîíîìàðåíêî Ã.Í. Ôèçè÷åñêèå ìåòîäûëå÷åíèÿ: Ñïðàâî÷íèê. – ÑÏá: ÂÌåäÀ, 2002. –299 ñ.

7. Ïðèìåíåíèå óëüòðàôèîëåòîâîãî èç-ëó÷åíèÿ äëÿ ïðîôèëàêòèêè è ëå÷åíèÿ çàáîëå-âàíèé ó äåòåé: Ìåòîä. ðåêîìåíäàöèè. – Ì.:Ìåäèöèíà, 1988. – 31 ñ.

8. Ñàìîéëîâà Ê.À. Äåéñòâèå óëüòðàôèîëå-òîâîé ðàäèàöèè íà êëåòêó. – Ë.: Èíòåðñòèëü,1997. – 106 ñ.

9. Ñåìåíêîâ Â.Ô. Èììóíîãåðîíòîëîãèÿ. –Ì.: Ìåäèöèíà, 2005. – Ñ. 18–26.

10. ÓÔ-èçëó÷åíèå è êîæà: ýôôåêòû, ïðî-áëåìû, ðåøåíèÿ. – Ì.: Èçäàò. äîì «Êîñìåòèêàè ìåäèöèíà», 2004. – 391 ñ.

11. Óøàêîâ À.À. Ñîâðåìåííàÿ ôèçèîòåðà-ïèÿ â êëèíè÷åñêîé ïðàêòèêå. – Ì.: ÀÍÌÈ,2002. – Ñ. 120–132.

12. Ôîòîòåðàïèÿ (ñâåòîëå÷åíèå): Ðóêîâîä-ñòâî äëÿ âðà÷åé / Â.È.Êàðàíäàøîâ, Å.Á.Ïåòó-õîâ, Â.Ñ.Çðîäíèêîâ / Ïîä ðåä. Í.Ð.Ïàëååâà. –Ì.: Ìåäèöèíà, 2001. – Ñ. 373–389.

13. Öóöîð Â.Á. Ëå÷åíèå àóòîêðîâüþ, îáëó-÷åííîé óëüòðàôèîëåòîâûìè ëó÷àìè, áîëüíûõ,ñòðàäàþùèõ ïàòîëîãè÷åñêèì êëèìàêñîì //Â êí.: Êâàíòîâàÿ ãåìîòåðàïèÿ. – Ñâåðäëîâñê,1981. – Ñ. 43–45.

14. Creed D. The photophysics and photo-chemistry of the near-UV absorbing amino acids.I. Tryptophan and its simple derivatives // Photo-chem. Photobiol. – 1984. – Vol. 39. – P. 537–562.

15. Fitzpatrick R.E., Rostan E.F. Double-blind, half-face study comparing topical vitaminC and vehicle for rejuvenation of photodamageText // Dermatol. Surg. – 2002. – N 3. – P. 231–236.

16. Giacomoni P.U., Gan D., Ingrassia M.Protection against indirect photodamage in humanskin and in living skin equivalents // SOFW-J. –2000. – Vol. 126, N 7. – P. 2–5.

17. Íåñkman Ì.,‚ Zogelmeier F., Konz B.Frequency of facial basal cell carcinoma does notcorrelate with site-specific UV almol exposure// Arch. Dermatol.– 2002. – Vol. 138. – P. 1494–1497.

18. Kato H. Photodynamic therapy forlung cancer A review of 19 years experience //J. Photochem. Photobiol. – 1998. – Vol. 42. –P. 96–98.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ 616.248-053.82-07

Àëãîðèòì äèàãíîñòèêè áðîíõèàëüíîé àñòìûó ãðàæäàí ïðèçûâíîãî âîçðàñòà

ÇÀÊÐÅÂÑÊÈÉ Þ.Í., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû([email protected])1

ÀÐÕÀÍÃÅËÜÑÊÈÉ Ä.À., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

ÁÀËÀÕÍÎÂ Ä.Î., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû ([email protected])2

ËÅÌÅØÊÎ Ï.Í., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

1Ìåäèöèíñêàÿ ñëóæáà Ñåâåðíîãî ôëîòà, ã. Ñåâåðîìîðñê, Ìóðìàíñêàÿ îáëàñòü; 21469-é Âîåííî-ìîðñêîé êëèíè÷åñêèé ãîñïèòàëü, ã. Ñåâåðîìîðñê, Ìóðìàíñêàÿ îáëàñòü

Íåñìîòðÿ íà íàëè÷èå ðàçëè÷íûõ ìåæäóíàðîäíûõ è ðîññèéñêèõ äîêóìåíòîâ, ðåãëàìåíòèðóþùèõâîïðîñû äèàãíîñòèêè áðîíõèàëüíîé àñòìû, â ïîâñåäíåâíîé ïðàêòèêå âðà÷è ïîñòîÿííî ñòàëêèâàþòñÿñî çíà÷èòåëüíîé ïðîáëåìîé ïðè ïîäòâåðæäåíèè èëè èñêëþ÷åíèè äàííîãî çàáîëåâàíèÿ ó ëèö ïðèçûâíîãîâîçðàñòà â ïåðèîä ïðîõîæäåíèÿ èìè ìåäèöèíñêîãî îñâèäåòåëüñòâîâàíèÿ. Ýòî ñâÿçàíî ñ îñîáåííîñòüþåñòåñòâåííîãî òå÷åíèÿ çàáîëåâàíèÿ â ïðèçûâíîì âîçðàñòå: ÷àñòûìè äëèòåëüíûìè ðåìèññèÿìè,ïðåîáëàäàíèåì ëåãêèõ ôîðì èëè áåññèìïòîìíîãî òå÷åíèÿ, íîðìàëüíûìè ïîêàçàòåëÿìè ôóíêöèèâíåøíåãî äûõàíèÿ â ôàçó ðåìèññèè. Ïîòðåáîâàëîñü ïåðåñìîòðåòü àëãîðèòì äèàãíîñòèêè àñòìûó ýòîé êàòåãîðèè ëèö âî èçáåæàíèå ïðèíÿòèÿ íåïðàâèëüíûõ ýêñïåðòíûõ ðåøåíèé. Ó÷òåíî, ÷òîñëóæáà â àðìèè, ñ ïîâûøåííûìè ôèçè÷åñêèìè è ýìîöèîíàëüíûìè íàãðóçêàìè, âîçäåéñòâèåì ðàçëè÷íûõíåáëàãîïðèÿòíûõ óñëîâèé âíåøíåé ñðåäû, ìîæåò ÿâèòüñÿ ôàêòîðîì êàê äåáþòà, òàê è îáîñòðåíèÿçàáîëåâàíèÿ. Îáðàùåíî âíèìàíèå íà íåîáõîäèìîñòü êîìïëåêñíîãî ïîäõîäà ïðè ïðîâåäåíèè



îáñëåäîâàíèÿ ïåðåä ïðèíÿòèåì ðåøåíèÿ îá îêîí÷àòåëüíîì âûíåñåíèè ìåäèöèíñêîãî çàêëþ÷åíèÿ.Ïðè ýòîì îáÿçàòåëüíû ñïåöèôè÷åñêîå àëëåðãîëîãè÷åñêîå îáñëåäîâàíèå, îöåíêà ñïèðîãðàôè÷åñêèõèññëåäîâàíèé, ïîñòàíîâêà òåñòîâ, íàïðàâëåííûõ íà ïîäòâåðæäåíèå ñîõðàíåííîé áðîíõèàëüíîéãèïåððåàêòèâíîñòè, à â ñïîðíûõ ñëó÷àÿõ – èíãàëÿöèîííûå ïðîáû ñ êëèíè÷åñêè çíà÷èìûì àëëåðãåíîì.

Ê ë þ ÷ å â û å ñ ë î â à: áðîíõèàëüíàÿ àñòìà, ïðèçûâíîé âîçðàñò, àëãîðèòì äèàãíîñòèêè.

Zakrevskii Yu.N., Arkhangelskii D.A., Balakhnov D.O., Lemeshko P.N. – Algorithm for diagnosingbronchial asthma in citizens of military age. Despite the presence of various international and Russiandocuments regulating the diagnosis of bronchial asthma, in everyday practice, doctors are constantey facea significant problem when confirming or excluding this disease in people of military age during theirmedical examination. This is due to the peculiarity of the natural course of the disease in military age:frequent long-term remissions, the predominance of mild or asymptomatic, normal indicators of respiratoryfunction in the remission phase. It was necessary to revise the algorithm for diagnosing asthma in thiscategory of persons in order to avoid making the wrong expert decisions. It has been taken into accountthat service in the army, with increased physical and emotional loads, exposure to various adverseenvironmental conditions can be a factor in both debut and exacerbation of the disease. Attention is drawnto the need for an integrated approach in conducting a survey before making a decision on the finalrendering of a medical opinion. At the same time, a specific allergological examination, evaluation ofspirographic studies, testing aimed at confirming the preserved bronchial hyperreactivity, and in controversialcases, inhalation tests with a clinically significant allergen are mandatory.K e y w o r d s: bronchial asthma, draft age, diagnostic algorithm.

Çà ïîñëåäíèå ãîäû ïðîèçîøëî çíà÷è- òåëüíîå óâåëè÷åíèå ïðåñòèæíîñòè

âîåííîé ñëóæáû ñðåäè ëèö ïðèçûâíîãîâîçðàñòà. È åñëè ñîâñåì íåäàâíî óñòàíîâ-ëåííûé äèàãíîç «áðîíõèàëüíàÿ àñòìà»(ÁÀ) íå îñòàâëÿë êàêîé-ëèáî âîçìîæ-íîñòè ïðîõîæäåíèÿ âîåííîé ñëóæáû,òî ñ ó÷åòîì âíåñåííûõ èçìåíåíèéîò 29.12.2017 ã. â Ôåäåðàëüíûé çàêîí«Î âîèíñêîé îáÿçàííîñòè è âîåííîéñëóæáå» ãðàæäàíå â âîçðàñòå îò 18 äî27 ëåò, ðàíåå ïðèçíàííûå îãðàíè÷åííîãîäíûìè ê âîåííîé ñëóæáå ïî ñîñòîÿ-íèþ çäîðîâüÿ, ïîëó÷èëè ïðàâî ïðîéòèïîâòîðíîå ìåäèöèíñêîå îñâèäåòåëü-ñòâîâàíèå [5].

Â õîäå ïðîâîäèìûõ îáñëåäîâàíèéâðà÷è ðåãóëÿðíî ñòàëêèâàþòñÿ ñ ïðîáëå-ìîé ïîäòâåðæäåíèÿ èëè èñêëþ÷åíèÿ çà-áîëåâàíèÿ, ÷òî ñâÿçàíî ñ îñîáåííîñòüþåãî åñòåñòâåííîãî òå÷åíèÿ: ÷àñòûå äëè-òåëüíûå ðåìèññèè, ïîäàâëÿþùåå ïðåîá-ëàäàíèå ëåãêèõ ôîðì, áåññèìïòîìíîå òå-÷åíèå è íîðìàëüíûå ïîêàçàòåëè ôóíê-öèè âíåøíåãî äûõàíèÿ â ôàçó ðåìèññèè[1, 2]. Â ñâÿçè ñ ýòèì ÷àùå âñåãî äèàãíîçâûñòàâëÿëñÿ «àíàìíåñòè÷åñêè», ïîä ëî-çóíãîì óñòîÿâøèõñÿ â ìåäèöèíñêîé ñðåäåâûðàæåíèé: «Äèàãíîç áðîíõèàëüíàÿ àñ-òìà ëåã÷å ïîñòàâèòü, ÷åì ñíÿòü» è «Âðà÷óëó÷øå îñòàâèòü íà ãðàæäàíêå ëèøíèéâçâîä çäîðîâûõ, ÷åì ïðîïóñòèòü îäíîãîàñòìàòèêà». Íè âîåííûå êîìèññàðèàòû, íèòåì áîëåå ãðàæäàí, ïðîõîäèâøèõ îáñëå-äîâàíèå, ýòî êîíå÷íî íå óñòðàèâàåò, ÷òî

òðåáóåò åùå ðàç ïåðåñìîòðåòü åäèíûéïîäõîä ê äèàãíîñòèêå äàííîãî çàáîëå-âàíèÿ ó þíîøåé ïðèçûâíîãî âîçðàñòàâî èçáåæàíèå â äàëüíåéøåì ïðèíÿòèÿíåïðàâèëüíîãî ýêñïåðòíîãî ðåøåíèÿ.

Ïðè ðåòðîñïåêòèâíîì àíàëèçå ïðî-âåäåííûõ ìåäèöèíñêèõ çàêëþ÷åíèé ìîæ-íî óñëîâíî ðàçäåëèòü ëèö, ïðèáûâàþùèõäëÿ ìåäèöèíñêîãî çàêëþ÷åíèÿ, íà íå-ñêîëüêî ãðóïï.

1. Èìåþùèå êëèíè÷åñêèå è àíàìíå-ñòè÷åñêèå äàííûå äëÿ ïîäòâåðæäåíèÿðàíåå âûñòàâëåííîãî äèàãíîçà ÁÀ, íî íàìîìåíò îáñëåäîâàíèÿ ÷óâñòâóþùèå ñåáÿçäîðîâûìè è íå ïðèíèìàþùèå ïðîäîë-æèòåëüíîå âðåìÿ (èíîãäà ìíîãîëåòíåå)áàçèñíîé òåðàïèè.

Ê ïîíÿòèþ «âûçäîðîâëåíèå» ïðè ÁÀñëåäóåò îòíîñèòüñÿ ñ áîëüøîé îñòîðîæ-íîñòüþ, ò. ê. äëèòåëüíàÿ êëèíè÷åñêàÿ ðå-ìèññèÿ ìîæåò íàðóøèòüñÿ ïîä âëèÿíè-åì ðàçëè÷íûõ ïðè÷èí â ëþáîå âðåìÿ. Ïðèïðîâåäåíèè äëèòåëüíûõ èññëåäîâàíèéáûëî óñòàíîâëåíî, ÷òî ñèìïòîìû ÁÀ èñ-÷åçàþò ó 30–50% äåòåé (îñîáåííî ìóæ-ñêîãî ïîëà) â ïóáåðòàòíûé ïåðèîä,íî ÷àñòî âíîâü âîçíèêàþò âî âçðîñëîéæèçíè [3]. Ýòî ñâÿçàíî ñî ñíèæåíèåìñïîñîáíîñòè â âîçðàñòå 14–20 ëåò ê ñèí-òåçó ñïåöèôè÷åñêèõ IgE è óìåíüøåíèåìãèïåððåàêòèâíîñòè áðîíõîâ.

2. Ëèöà ñ îòñóòñòâèåì ïî ðåçóëüòàòàìîöåíêè ïðåäñòàâëåííîé ìåäèöèíñêîé äî-êóìåíòàöèè è ñáîðà àíàìíåçà óáåäèòåëü-íûõ äàííûõ çà ïîñòàíîâêó ðàíåå äèàã-



ðåñïèðàòîðíûõ æàëîá ïðè êîíöåíòðàöèèìåòàõîëèíà ìåíåå 8 ìã/ìë. Â êà÷åñòâåêîíòðîëÿ ïðîâîäÿò èíãàëÿöèþ ôèçèî-ëîãè÷åñêîãî ðàñòâîðà.

Ïîñëåäíèì ýòàïîì â äèàãíîñòèêå ÁÀÿâëÿåòñÿ áðîíõîïðîâîêàöèîííûé òåñòñ àëëåðãåíàìè, ïîçâîëÿþùèé âåðèôèöè-ðîâàòü äèàãíîç ÁÀ äàæå â ñëó÷àÿõ ñòîéêîéðåìèññèè áîëåçíè ó ïàöèåíòîâ ñ âûÿâëåí-íîé ñïåöèôè÷åñêîé ãèïåð÷óâñòâèòåëüíî-ñòüþ ïðè àëëåðãîëîãè÷åñêîì îáñëåäîâàíèè[4]. Îí ïðîâîäèòñÿ â ñëó÷àå ìåäèöèíñêèõýêñïåðòèç ñòàöèîíàðíî ïîäãîòîâëåííûìâðà÷îì-àëëåðãîëîãîì è òîëüêî ïðè ñòðî-ãèõ óñëîâèÿõ: íàëè÷èå óêàçàíèé íà àëëåð-ãè÷åñêóþ ÁÀ â àíàìíåçå; ñòîéêàÿ ðåìèñ-ñèÿ ÁÀ; íîðìàëüíûå ïîêàçàòåëè ÔÂÄ;îòðèöàòåëüíûé òåñò íà îáðàòèìîñòüáðîíõèàëüíîé îáñòðóêöèè ñ β2-àãîíèñòîì;îòðèöàòåëüíûé ÁÏÒ ñ ìåòàõîëèíîì (ãèñòà-ìèíîì); îòðèöàòåëüíûé ÁÏÒ ñ ôèçè÷åñ-êîé íàãðóçêîé; ïîëîæèòåëüíàÿ êîæíàÿïðîáà ñ àëëåðãåíîì, ïðåäïîëàãàåìûìäëÿ ÁÏÒ è/èëè íàëè÷èå ñïåöèôè÷åñêèõIgE-àíòèòåë (íå íèæå 2-ãî êëàññà).

Ñóòü òåñòà çàêëþ÷àåòñÿ â òîì, ÷òîáîëüíîé âäûõàåò ñíà÷àëà êîíòðîëüíûéèíäèôôåðåíòíûé (ôèçèîëîãè÷åñêèé)ðàñòâîð, è ïðè îòñóòñòâèè ðåàêöèè íà íåãî– ðàñòâîðû àëëåðãåíà â ïîñëåäîâàòåëüíîâîçðàñòàþùåé êîíöåíòðàöèè. Ïîñëå êàæ-äîé èíãàëÿöèè àëëåðãåíà çàïèñûâàåòñÿñïèðîãðàììà ñ îïðåäåëåíèåì ÎÔÂ

1. Ïðî-

âîêàöèîííûé òåñò ñ÷èòàåòñÿ ïîëîæèòåëü-íûì ïðè ñíèæåíèè ïîêàçàòåëÿ áîëåå ÷åìíà 20% ïî ñðàâíåíèþ ñ èñõîäíûìè âåëè-÷èíàìè èëè ïîÿâëåíèè çàìåòíîé ðåàêöèèâ âèäå çàòðóäíåííîãî äûõàíèÿ.

Ïðè äèàãíîñòèêå áðîíõèàëüíîéàñòìû èíòåðìèòòèðóþùåãî òå÷åíèÿ ó ïà-öèåíòîâ ñ âûÿâëåííîé ñïåöèôè÷åñêîéãèïåð÷óâñòâèòåëüíîñòüþ íàèâûñøóþèíôîðìàöèîííóþ çíà÷èìîñòü èìååòèíãàëÿöèîííûé ïðîâîêàöèîííûé òåñòñ àëëåðãåíîì.

Çàêëþ÷åíèå. Íåñìîòðÿ íà íàëè÷èå ðàç-ëè÷íûõ ìåæäóíàðîäíûõ è ðîññèéñêèõäîêóìåíòîâ, ðåãëàìåíòèðóþùèõ âîïðîñûäèàãíîñòèêè ÁÀ, äèàãíîñòèêà ýòîé ïàòî-ëîãèè âñå ðàâíî îñòàåòñÿ çíà÷èòåëüíîéïðîáëåìîé. Áîëüøóþ ñîöèàëüíóþ çíà÷è-ìîñòü äèàãíîñòèêà çàáîëåâàíèÿ èìååò âþíîøåñêîì âîçðàñòå, ÷òî ñâÿçàíî ñ ìåäè-öèíñêèì îñâèäåòåëüñòâîâàíèåì ïðèçûâ-íèêîâ. Ñ ó÷åòîì îñîáåííîñòåé òå÷åíèÿ ÁÀâ ïîäðîñòêîâûé ïåðèîä (ïðåîáëàäàíèåëåãêèõ ôîðì, íàëè÷èå ÷àñòûõ è äëèòåëü-íûõ ðåìèññèé) ðàçðàáîòêà ðàöèîíàëüíîéïîñëåäîâàòåëüíîñòè äèàãíîñòè÷åñêèõìåðîïðèÿòèé, íàïðàâëåííûõ íà âåðè-ôèêàöèþ äèàãíîçà, ïðèîáðåòàåò îñîáîåçíà÷åíèå. Â ñâÿçè ñ ýòèì íåîáõîäèìîïðîäîëæåíèå îáåñïå÷åíèÿ ñîâðåìåííûìîñíàùåíèåì ïóëüìîíîëîãè÷åñêîé è àë-ëåðãîëîãè÷åñêîé ñëóæá âîåííî-ìåäèöèí-ñêèõ îðãàíèçàöèé ðåàêòèâàìè è àïïàðà-òóðîé äëÿ ïðîâåäåíèÿ êîæíûõ, èíãàëÿöè-îííûõ è ôóíêöèîíàëüíûõ íàãðóçî÷íûõïðîá, ðàñøèðåíèå âîçìîæíîñòåé ëàáî-ðàòîðèé ïî îïðåäåëåíèþ ñóììàðíûõè èíäèâèäóàëüíûõ ñïåöèôè÷åñêèõ IgE,÷òîáû ðàçðàáîòàííûé àëãîðèòì ìîã ïðè-ãîäèòüñÿ â ïîâñåäíåâíîé äåÿòåëüíîñòèâðà÷åé ïðè ïðîâåäåíèè ìåäèöèíñêîãî îá-ñëåäîâàíèÿ ãðàæäàí ïðèçûâíîãî âîçðàñòàñ ïîäîçðåíèåì íà áðîíõèàëüíóþ àñòìó.


1. Ãîðÿ÷êèíà Ë.À., Íåíàøåâà Í.Ì., Ãóñåâà À.Þ.Îñîáåííîñòè ôóíêöèîíàëüíîé äèàãíîñòèêèáðîíõèàëüíîé àñòìû ó ëèö ïðèçûâíîãî âîçðà-ñòà // Àëëåðãîëîãèÿ. – 2002. – ¹ 2. – Ñ. 21–26.

2. Ãîðÿ÷êèíà Ë.À., Íåíàøåâà Í.Ì., Ãóñåâà À.Þ.Ìåäèöèíñêîå îñâèäåòåëüñòâîâàíèå ïîäðîñò-êîâ è ïðèçûâíèêîâ ñ áðîíõèàëüíîé àñòìîé:ìåòîä. ðåê. – Ì., 2008. – 14 ñ.

3. Íàöèîíàëüíàÿ ïðîãðàììà «Áðîíõèàëü-íàÿ àñòìà ó äåòåé. Ñòðàòåãèÿ ëå÷åíèÿ è ïðîôè-ëàêòèêà». – 5-å èçä., ïåðåðàá. è äîï. – Ì., 2017.– 160 ñ.

4. Ëóíöîâ À.Â. Áðîíõèàëüíàÿ àñòìà ó ïîä-ðîñòêîâ è þíîøåé ïðèçûâíîãî âîçðàñòà:

àëãîðèòì äèàãíîñòèêè: Àâòîðåô. äèñ. ... êàíä.ìåä. íàóê. – Ì., 2008. – 24 ñ.

5. Î âîèíñêîé îáÿçàííîñòè è âîåííîéñëóæáå. Ôåäåðàëüíûé çàêîí îò 28.03.1998 ã.¹ 53-ÔÇ.

6. Îá óòâåðæäåíèè Ïîëîæåíèÿ î âîåííî-âðà÷åáíîé ýêñïåðòèçå. Ïîñòàíîâëåíèå Ïðàâè-òåëüñòâà ÐÔ îò 04.07.2013 ã. ¹ 565.

7. Ôåäåðàëüíûå êëèíè÷åñêèå ðåêîìåí-äàöèè ïî äèàãíîñòèêå è ëå÷åíèþ áðîíõè-àëüíîé àñòìû. Ðîññèéñêîå ðåñïèðàòîðíîåîáùåñòâî. – 2016. – 55 ñ.

8. Global Strategy for Asthma Managementand Prevention (GINA) Report, 2018. – 160 p.URL: www.Ginasthma.org/ (äàòà îáðàùåíèÿ:10.09.2018).


ÃÈÃÈÅÍÀ È ÔÈÇÈÎËÎÃÈß

ÂÎÅÍÍÎÃÎ ÒÐÓÄÀ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ 616-057.36:159.922

Îñîáåííîñòè ïñèõè÷åñêîãî çäîðîâüÿâîåííîñëóæàùèõ, ïðîõîäÿùèõ ñëóæáóâ çàãëóáëåííûõ êîìàíäíûõ ïóíêòàõ

ÀÁÐÈÒÀËÈÍ Å.Þ., äîêòîð ìåäèöèíñêèõ íàóê, äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà([email protected])1

ÆÎÂÍÅÐ×ÓÊ È.Þ., êàíäèäàò ìåäèöèíñêèõ íàóê ([email protected])2

ÆÎÂÍÅÐ×ÓÊ Å.Â., äîêòîð ìåäèöèíñêèõ íàóê, äîöåíò, ïîëêîâíèê âíóòðåííåé ñëóæáûâ îòñòàâêå3,4

1Ñåâåðî-Çàïàäíûé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò èì. È.È.Ìå÷íèêîâà, Ñàíêò-Ïåòåðáóðã; 2Ôèëèàë ¹ 1 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. À.À.Âèø-íåâñêîãî, ã. Êðàñíîãîðñê, Ìîñêîâñêàÿ îáëàñòü; 3Íàó÷íî-èññëåäîâàòåëüñêèé èíñòèòóò ìåäèöè-íû òðóäà èì. Í.Ô.Èçìåðîâà, Ìîñêâà; 4Èíñòèòóò ïîâûøåíèÿ êâàëèôèêàöèè ÔÌÁÀ Ðîññèè,Ìîñêâà

Àíàëèçèðóþòñÿ îñîáåííîñòè ïñèõè÷åñêîãî çäîðîâüÿ 150 âîåííîñëóæàùèõ (îïûòíàÿ ãðóïïà), ïðîõîäÿùèõâîåííóþ ñëóæáó â çàãëóáëåííûõ êîìàíäíûõ ïóíêòàõ, â ñðàâíåíèè ñ 60 âîåííîñëóæàùèìè, ÷üÿïðîôåññèîíàëüíàÿ äåÿòåëüíîñòü ïðîõîäèò âíå âëèÿíèÿ óñëîâèé ýòèõ ïóíêòîâ (êîíòðîëüíàÿ ãðóïïà).Óñòàíîâëåíî, ÷òî ïîêàçàòåëè ïñèõè÷åñêîãî çäîðîâüÿ ó âîåííîñëóæàùèõ îïûòíîé ãðóïïû îòëè÷àþòñÿâ õóäøóþ ñòîðîíó â ñðàâíåíèè ñ àíàëîãè÷íûìè ïîêàçàòåëÿìè â êîíòðîëüíîé ãðóïïå. Ñ óâåëè÷åíèåìïðîäîëæèòåëüíîñòè ñëóæáû â çàãëóáëåííûõ ïóíêòàõ ïîâûøàåòñÿ âûðàæåííîñòü ïñèõè÷åñêèõíàðóøåíèé è ñíèæàåòñÿ óðîâåíü ñîöèàëüíîé àäàïòàöèè, ÷òî îáóñëîâëèâàåò íåîáõîäèìîcòü ðàñøèðåíèÿîáúåìà ïñèõîïðîôèëàêòè÷åñêèõ ìåðîïðèÿòèé. Â ðàìêàõ ïñèõîïðîôèëàêòèêè öåëåñîîáðàçíî ïðîâîäèòüïñèõîêîððåêöèîííûå ìåðîïðèÿòèÿ ñ ïðèìåíåíèåì ìåòîäèê ïñèõè÷åñêîé ñàìîðåãóëÿöèè, ïîçâîëÿþùèåóëó÷øèòü íåðâíî-ïñèõè÷åñêóþ àäàïòàöèþ âîåííîñëóæàùèõ.

Ê ë þ ÷ å â û å ñ ë î â à: âîåííîñëóæàùèå, çàãëóáëåííûå êîìàíäíûå ïóíêòû, ïñèõè÷åñêîå çäîðîâüå,ïñèõè÷åñêàÿ ñàìîðåãóëÿöèÿ.

Abritalin E.Yu., Zhovnerchuk I.Yu., Zhovnerchuk E.V. – Peculiarities of the mental health of servicemenserving in submerged command posts. The features of the mental health of 150 servicemen (an experimentalgroup), who perform military service in submerged command posts, are analyzed in comparison with 60servicemen whose professional activities are outside the influence of the conditions of these points (controlgroup). It has been established that the mental health indicators of the military personnel of the experimentalgroup differ for the worse in comparison with the same indicators in the control group. With an increase in theduration of service in the buried points, the severity of mental disorders increases, and the level of socialadaptation decreases, which necessitates an expansion of the scope of psycho-preventive measures. Within theframework of psycho-prevention, it is advisable to conduct psychocorrectional measures with the use ofmethods of mental self-regulation, allowing to improve the neuro-psychological adaptation of military personnel.

K e y w o r d s: military personnel, deep command posts, mental health, mental self-regulation.

Íåáëàãîïðèÿòíûå ôàêòîðû âîåííîé ñëóæáû â çàãëóáëåííûõ êîìàíäíûõ

ïóíêòàõ (ÇÊÏ) – äëèòåëüíàÿ ãèïîäèíà-ìèÿ, ìîíîòîíèÿ, íàðóøåíèå ñóòî÷íûõáèîðèòìîâ, èíôîðìàöèîííîå âîçäåé-ñòâèå â óñëîâèÿõ äåôèöèòà âðåìåíè èäð. îêàçûâàþò íåãàòèâíîå âîçäåéñòâèåíà ïñèõè÷åñêîå çäîðîâüå âîåííîñëóæà-ùèõ [3, 4]. Äëÿ ñîõðàíåíèÿ è óêðåïëå-íèÿ ïñèõè÷åñêîãî çäîðîâüÿ âîåííûõ

ñïåöèàëèñòîâ óäåëÿåòñÿ áîëüøîå âíè-ìàíèå ìåäèêî-ïñèõîëîãè÷åñêîìó ñî-ïðîâîæäåíèþ èõ ïðîôåññèîíàëüíîéäåÿòåëüíîñòè [5], îäíàêî ñóùåñòâóþùàÿíà ñåãîäíÿøíèé äåíü ñèñòåìà äèñïàí-ñåðíîãî äèíàìè÷åñêîãî íàáëþäåíèÿíå ïîçâîëÿåò â ïîëíîé ìåðå îáåñïå÷èòüïðîôèëàêòèêó ïñèõè÷åñêèõ íàðóøåíèéó âîåííîñëóæàùèõ, ïðîõîäÿùèõ ñëóæ-áó â ÇÊÏ.


ÃÈÃÈÅÍÀ È ÔÈÇÈÎËÎÃÈßÂÎÅÍÍÎÃÎ ÒÐÓÄÀ

Çàêëþ÷åíèåÂ ðåçóëüòàòå ïðîâåäåííîãî èññëåäîâà-

íèÿ óñòàíîâëåíî, ÷òî ïñèõè÷åñêîå ñîñòîÿ-íèå âîåííîñëóæàùèõ, ïðîõîäÿùèõ ñëóæáóâ ÇÊÏ, õàðàêòåðèçóåòñÿ áîëåå âûñîêèìèïîêàçàòåëÿìè ïñèõàñòåíèè è èïîõîíäðèèïî îïðîñíèêó «Àäàïòèâíîñòü», à òàêæå ðå-àêòèâíîé òðåâîæíîñòè ïî òåñòó Ñïèëáåð-ãåðà–Õàíèíà ïî ñðàâíåíèþ ñ âîåííîñëó-æàùèìè, ñëóæáà êîòîðûõ íàõîäèòñÿ âíåâëèÿíèÿ ïðîôåññèîíàëüíî îáóñëîâëåííûõôàêòîðîâ ÇÊÏ. Ïðè ýòîì ÷åòâåðòàÿ ÷àñòüâîåííîñëóæàùèõ ÇÊÏ èìååò ïðåäïîñûë-êè ê ïîÿâëåíèþ ïñèõè÷åñêèõ ðàññòðîéñòâ(24,2% – ïî äàííûì ñêðèíèíãà è 23,9% –ïî äàííûì êëèíè÷åñêîãî îáñëåäîâàíèÿ),÷òî îáóñëîâëèâàåò íåîáõîäèìîñòü èõ äèñ-ïàíñåðíîãî äèíàìè÷åñêîãî íàáëþäåíèÿ.

Ó âîåííîñëóæàùèõ, ïðîõîäÿùèõ âî-åííóþ ñëóæáó â ÇÊÏ, ïðåîáëàäàþò áîëååâûðàæåííûå ïñèõè÷åñêèå íàðóøåíèÿ, ÷åìó âîåííîñëóæàùèõ, ïðîôåññèîíàëüíàÿäåÿòåëüíîñòü êîòîðûõ ïðîõîäèò âíå âëè-ÿíèÿ óñëîâèé ÇÊÏ, ïðè ýòîì ñ óâåëè÷å-


íèåì ïðîäîëæèòåëüíîñòè âîåííîé ñëóæ-áû â ÇÊÏ ïîâûøàåòñÿ âûðàæåííîñòü ïñè-õè÷åñêèõ ðàññòðîéñòâ. Òàê, ó âîåííîñëó-æàùèõ ñ ïðîäîëæèòåëüíîñòüþ âîåííîéñëóæáû â óñëîâèÿõ ÇÊÏ áîëåå 10 ëåò çíà-÷èòåëüíî ÷àùå (ð<0,05) âñòðå÷àþòñÿ äåç-àäàïòèâíûå ïñèõîëîãè÷åñêèå ðåàêöèè,ïñèõè÷åñêèå íàðóøåíèÿ ñèíäðîìàëüíîéè íîçîñïåöèôè÷åñêîé âûðàæåííîñòè,â òî âðåìÿ êàê ó âîåííîñëóæàùèõ ñ ïðî-äîëæèòåëüíîñòüþ âîåííîé ñëóæáû â ÇÊÏìåíåå 10 ëåò ïðåîáëàäàþò àäàïòèâíûåïñèõîëîãè÷åñêèå ðåàêöèè. Êðîìå òîãî,ñ óâåëè÷åíèåì ïðîäîëæèòåëüíîñòè âîåí-íîé ñëóæáû â óñëîâèÿõ ÇÊÏ óõóäøàþòñÿïîêàçàòåëè ñîöèàëüíîé àäàïòàöèè.

Òàêèì îáðàçîì, âîåííîñëóæàùèå ñïðîäîëæèòåëüíîñòüþ âîåííîé ñëóæáû âóñëîâèÿõ ÇÊÏ áîëåå 10 ëåò íóæäàþòñÿ âðàñøèðåíèè îáúåìà ïñèõîïðîôèëàêòè-êè, â ðàìêàõ êîòîðîé öåëåñîîáðàçíî ïðî-âîäèòü ïñèõîêîððåêöèîííûå ìåðîïðèÿ-òèÿ ñ ïðèìåíåíèåì ìåòîäèê ïñèõè÷åñêîéñàìîðåãóëÿöèè.


1. Ðóñòàíîâè÷ À.Â., Ôðîëîâ Á.Ñ. Ìíîãîîñå-âàÿ äèàãíîñòèêà ïñèõè÷åñêèõ ðàññòðîéñòâ óâîåííîñëóæàùèõ. – ÑÏá: ÂÌåäÀ, 2001. – 23 ñ.

2. Ñíåäêîâ Å.Â. Áîåâàÿ ïñèõè÷åñêàÿ òðàâ-ìà (êëèíèêî-ïàòîãåíåòè÷åñêàÿ äèíàìèêà,äèàãíîñòèêà, ëå÷åáíî-ðåàáèëèòàöèîííûåïðèíöèïû): Àâòîðåô. äèñ.… ... ä-ðà ìåä. íàóê. –ÑÏá, 1997. – 50 ñ.

3. Øàìðåé Â.Ê., Ìàð÷åíêî À.À., Àáðèòà-ëèí Å.Þ. è äð. Ðåçèäóàëüíî-äåôèöèòàðíûå ñî-ñòîÿíèÿ ïðè ðàññòðîéñòâàõ íåâðîòè÷åñêîãî

ñïåêòðà // Ñîöèàëüíàÿ è êëèíè÷åñêàÿ ïñèõè-àòðèÿ. – 2013. – Ò. 23, Âûï. 4. – Ñ. 14–18.

4. Øàìðåé Â.Ê., Ìàð÷åíêî À.À., Ïåðñòíåâ Ñ.Â.,Ëîáà÷åâ À.Â. Âîåííàÿ ïñèõèàòðèÿ // Â êí.:Ïñèõèàòðèÿ: íàöèîíàëüíîå ðóêîâîäñòâî /Ãë. ðåä. Þ.À.Àëåêñàíäðîâñêèé, Í.Ã.Íåçíàíîâ. –2-å èçä., ïåðåðàá. è äîï. – Ì.: ÃÝÎÒÀÐ-Ìåäèà,2018. – Ñ. 155–182.

5. Þñóïîâ Â.Â., Îâ÷èííèêîâ Á.Â., Êîðçóíèí Â.À.è äð. Ñîâðåìåííîå ñîñòîÿíèå è ïåðñïåêòèâûðàçâèòèÿ ìåäèêî-ïñèõîëîãè÷åñêîãî ñîïðîâîæ-äåíèÿ âîåííîñëóæàùèõ Âîîðóæåííûõ Ñèë //Âîåí.-ìåä. æóðí. – 2016. – Ò. 337, ¹ 1. – Ñ. 22–28.

Â îêðóæíîì âîåííîì êëèíè÷åñêîì ãîñïèòàëå Âîñòî÷íîãî âîåííîãî îêðóãà â Õàáàðîâñêåââåäåíà â ýêñïëóàòàöèþ íîâåéøàÿ ñèñòåìà òåëåìåäèöèíû. Óæå ñîñòîÿëèñü ïåðâûå êîíñóëüòà-öèè ïî ñòðàòåãèè ëå÷åíèÿ ñëîæíûõ çàáîëåâàíèé ñ âðà÷àìè âåäóùèõ âîåííûõ ãîñïèòàëåéÌèíèñòåðñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè.

Õàáàðîâñêèå âîåííûå âðà÷è, èñïîëüçóÿ íîâåéøåå îáîðóäîâàíèå, ïðè íåîáõîäèìîñòè ìîãóòïîëó÷èòü êîíñóëüòàöèè ïðîôåññîðîâ, âåäóùèõ ñïåöèàëèñòîâ Âîåííî-ìåäèöèíñêîé àêàäåìèèèìåíè Ñ.Ì.Êèðîâà.

Ïîìèìî òåõíè÷åñêèõ ñðåäñòâ äëÿ îðãàíèçàöèè âèäåîñâÿçè, â êîìïëåêò âõîäÿò àïïàðàòäëÿ ïðîâåäåíèÿ ýêñïðåññ-èññëåäîâàíèé, îáîðóäîâàíèå äëÿ óëüòðàçâóêîâîãî èññëåäîâàíèÿ,êàðäèîãðàô è ðåíòãåí.

Òåëåìåäèöèíñêèå êîìïëåêñû â êîíöå ìèíóâøåãî ãîäà òàêæå ïîñòóïèëè â âîåííûå ãîñïè-òàëè â Þæíî-Ñàõàëèíñêå è íà îñòðîâå Èòóðóï.

Ïðèìåíåíèå òåëåìåäèöèíñêèõ êîìïëåêñîâ çíà÷èòåëüíî ðàñøèðèò âîçìîæíîñòè âîåííî-ìåäèöèíñêèõ ñïåöèàëèñòîâ ïî ñâîåâðåìåííîìó ïîëó÷åíèþ êâàëèôèöèðîâàííûõ ìåäèöèíñêèõêîíñóëüòàöèé.

Ïðåññ-ñëóæáà Âîñòî÷íîãî âîåííîãî îêðóãà, 22 ÿíâàðÿ 2019 ã.https://function.mil.ru/news_page/country/more.htm?id=12213339@egNews

4


ÀÂÈÀÖÈÎÍÍÀß

È ÂÎÅÍÍÎ-ÌÎÐÑÊÀß ÌÅÄÈÖÈÍÀ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ 613.693(091)

Ïîó÷èòåëüíàÿ èñòîðèÿ îäíîãî âûñîòíîãî ïîëåòà:äåêîìïðåññèîííàÿ áîëåçíü ó ýêèïàæà ñàìîëåòàè åå ïîñëåäñòâèÿ

ÄÂÎÐÍÈÊÎÂ Ì.Â., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå ([email protected])ÂÎËÎÂÈÊ Þ.À., ìàéîð â îòñòàâêåÌÀÒÞØÅÂ Ò.Â., äîêòîð áèîëîãè÷åñêèõ íàóê, êàíäèäàò òåõíè÷åñêèõ íàóê

Íàó÷íî-èññëåäîâàòåëüñêèé èñïûòàòåëüíûé öåíòð (àâèàöèîííî-êîñìè÷åñêîé ìåäèöèíûè âîåííîé ýðãîíîìèêè) ÖÍÈÈ ÂÂÑ ÌÎ ÐÔ, Ìîñêâà

Ñòàòüÿ ïîñâÿùåíà ðåòðîñïåêòèâíîìó àíàëèçó ìåäèöèíñêèõ àñïåêòîâ ïðè÷èíû è ïîñëåäñòâèéâûñîòíîé äåêîìïðåññèîííîé áîëåçíè ó ýêèïàæà ñàìîëåòà Ñó-24Ì, âîçíèêøåé â óñëîâèÿõ âûíóæäåííîãîäëèòåëüíîãî ïîëåòà â ðàçãåðìåòèçèðîâàííîé êàáèíå íà áîëüøîé âûñîòå. Èçó÷åíû äîêóìåíòàëüíûåñâèäåòåëüñòâà íåïîñðåäñòâåííûõ ó÷àñòíèêîâ è î÷åâèäöåâ àâèàöèîííîãî ñîáûòèÿ, äàííûå òåõíè÷åñêîãîàíàëèçà ïðè÷èíû îòêàçà ñèñòåìû æèçíåîáåñïå÷åíèÿ àâèàòåõíèêè è ìàòåðèàëû êëèíè÷åñêîãîîáñëåäîâàíèÿ ëåò÷èêà. Âûÿâëåíû íåäîñòàòêè â óêàçàíèÿõ ýêèïàæó è ñïåöèàëèñòàì àâèàöèîííîéìåäèöèíû ïî äèàãíîñòèêå è îêàçàíèþ ïîìîùè ïîñòðàäàâøèì ñ óãðîçîé âîçíèêíîâåíèÿ äàííîéïàòîëîãèè, êîòîðûå ñòàëè ïðè÷èíîé ðàçâèòèÿ îñëîæíåíèÿ ó ëåò÷èêà, ïåðåíåñøåãî òÿæåëóþ ôîðìóâûñîòíîé äåêîìïðåññèîííîé áîëåçíè. Ñôîðìóëèðîâàíû ðåêîìåíäàöèè ïî ïðîôèëàêòèêå ýòîé áîëåçíèè åå ïîñëåäñòâèé, ïðèìåíèìûå â óñëîâèÿõ ñòðîåâûõ àâèàöèîííûõ ÷àñòåé â ñîâðåìåííûõ óñëîâèÿõ.

Ê ë þ ÷ å â û å ñ ë î â à: âûñîòíûé ïîëåò, äåêîìïðåññèÿ, âûñîòíàÿ äåêîìïðåññèîííàÿ áîëåçíü,ïðè÷èíû è ïîñëåäñòâèÿ, ðåêîìåíäàöèè ïî ïðîôèëàêòèêå.

Dvornikov M.V., Volovik Yu.A., Matyushev T.V. – Instructive story of one high-altitude flight: decompressionsickness in an aircraft crew and its consequences. The article is devoted to a retrospective analysis of themedical aspects of the cause and consequences of high-altitude decompression sickness in the crew of a Su-24Maircraft, which arose in conditions of a forced long flight in a depressurized cabin at high altitude. We studiedthe documentary evidence of the direct participants and witnesses of the aviation event, the data of thetechnical analysis of the cause of the failure of the life support system of aircraft and the clinical examinationmaterials of the pilot. The deficiencies in the instructions to the crew and aviation medicine specialists indiagnosing and assisting with the threat of this pathology, which caused the pilot to develop a severe form ofaltitude decompression sickness, were identified. Formulated recommendations for the prevention of thisdisease and its consequences, applicable in conditions of combat aviation units in modern conditions.

K e y w o r d s: altitude flight, decompression, altitude decompression sickness, causes and consequences,recommendations for prevention.

Îáåñïå÷åíèå áåçîïàñíîñòè âûñîòíûõ ïîëåòîâ àâèàöèè âîåííîãî íàçíà÷å-

íèÿ òðàäèöèîííî âõîäèò â çîíó îòâåò-ñòâåííîñòè íå òîëüêî èíæåíåðíî-òåõíè-÷åñêîãî ñîñòàâà, îáñëóæèâàþùåãî áîðòî-âûå ñèñòåìû îáåñïå÷åíèÿ æèçíåäåÿòåëü-íîñòè ýêèïàæà, íî è ñïåöèàëèñòîâ ìåäè-öèíñêîé ñëóæáû [8]. Íà ôîíå ïîâûøåíèÿíàäåæíîñòè áîðòîâûõ è èíäèâèäóàëüíûõâûñîòíûõ ñðåäñòâ çàùèòû àêòóàëüíûìèñòàíîâÿòñÿ ìåäèöèíñêèå àñïåêòû êà÷åñòâàè ñâîåâðåìåííîñòè ïðîâåäåíèÿ ïñèõî-

ôèçèîëîãè÷åñêîé ïîäãîòîâêè ëåòíîãî ñî-ñòàâà ê âûñîòíûì ïîëåòàì è ãîòîâíîñòèìåäèêîâ ê îêàçàíèþ ïîìîùè òåì, êòîîêàçàëñÿ â ýêñòðåìàëüíîé ñèòóàöèè [3].

Öåëü èññëåäîâàíèÿÏðîâåäåíèå ðåòðîñïåêòèâíîãî àíàëè-

çà ìåäèöèíñêèõ àñïåêòîâ ïðè÷èíû è ïî-ñëåäñòâèé âûñîòíîé äåêîìïðåññèîííîéáîëåçíè ó ýêèïàæà ñàìîëåòà, âîçíèêøåéïðè ðàçãåðìåòèçàöèè êàáèíû â ïðîöåññåâûïîëíåíèÿ âûñîòíîãî ïîëåòà.


ÀÂÈÀÖÈÎÍÍÀßÈ ÂÎÅÍÍÎ-ÌÎÐÑÊÀß ÌÅÄÈÖÈÍÀ

÷åíèÿ îáñòîÿòåëüñòâ ñ ïðèâëå÷åíèåìñïåöèàëèñòîâ àâèàöèîííîé ìåäèöèíû.

2. Ñóùåñòâóþùèå ðåêîìåíäàöèè ïîïðîôèëàêòèêå è îêàçàíèþ ïîìîùè ïðèóãðîçå ðàçâèòèÿ âûñîòíîé äåêîìïðåññèîí-íîé áîëåçíè, êîòîðûå âîçíèêàþò â ïðî-öåññå âûïîëíåíèÿ îñîáî âàæíûõ ïîëå-òîâ, ïðåðûâàíèå êîòîðûõ çàòðóäíåíî èëèíåâîçìîæíî, íóæäàþòñÿ â áîëåå äåòàëü-íîé ïðîðàáîòêå è îïèñàíèè âîçìîæíûõîñëîæíåíèé ñ êîíêðåòèçàöèåé âàðèàí-òîâ ïîìîùè ïîñòðàäàâøèì.

3. Ëåòíûé ñîñòàâ è ñïåöèàëèñòûàâèàöèîííîé ìåäèöèíû äîëæíû ó÷èòû-âàòü, ÷òî çàùèòíûå âîçìîæíîñòè áîðòî-âîé êèñëîðîäíî-äûõàòåëüíîé àïïàðàòó-

ðû è âûñîòíîãî ñíàðÿæåíèÿ îãðàíè÷å-íû è ïîëíîé ãàðàíòèè ïðåäîõðàíåíèÿîò âûñîòíîé äåêîìïðåññèîííîé áîëåç-íè íå îáåñïå÷èâàþò. Íåîáõîäèìî çíàòüè óìåëî èñïîëüçîâàòü ìåäèöèíñêèåòåõíîëîãèè è ðåêîìåíäàöèè ïî ïðîôè-ëàêòèêå è îêàçàíèþ ïîìîùè ïðè åå âîç-íèêíîâåíèè.

4. Âíåäðåíèå ìåäèöèíñêèõ òåõíîëî-ãèé ïî ïðîôèëàêòèêå è ëå÷åíèþ ÂÄÁòðåáóåò ïîâûøåíèÿ óðîâíÿ ïðîôåññèî-íàëüíîé ïîäãîòîâêè àâèàöèîííûõ ìåäè-êîâ, à òàêæå çàêóïêè è ïîñòàâêè ìåäè-öèíñêèõ òåõíè÷åñêèõ ñðåäñòâ äëÿ îêàçà-íèÿ ïîìîùè ïîñòðàäàâøèì â óñëîâèÿõàâèàöèîííûõ ñòðîåâûõ ÷àñòåé.


1. Áëàãèíèí À.À. Ê âîïðîñó î âûñîòíîéäåêîìïðåññèîííîé áîëåçíè è åå ëå÷åíèè// Âîåí.-ìåä. æóðí. – 2012. – Ò. 333, ¹ 5. –Ñ. 44–49.

2. Äâîðíèêîâ Ì.Â., Ìåäåíêîâ À.À., Ñòåïà-íîâ Â.Ê. Âûáîð è ïîäãîíêà çàùèòíîãî ñíàðÿ-æåíèÿ. Îáó÷åíèå äûõàíèþ ïîä èçáûòî÷íûìäàâëåíèåì. Ì.: Ïîëåò, 2001. – 160 ñ.

3. Äâîðíèêîâ Ì.Â., Ìåäåíêîâ À.À., Øèøîâ À.À.Ðàçâèòèå ìåòîäîëîãèè îáåñïå÷åíèÿ âûñîòíûõïîëåòîâ â àâèàöèè è êîñìîíàâòèêå. ×åëîâå-÷åñêèé ôàêòîð: Ïðîáëåìû ïñèõîëîãèè è ýðãî-íîìèêè / Ìàòåðèàëû íàó÷íîé êîíôåðåíöèè«×åëîâå÷åñêèé ôàêòîð â àâèàöèè è êîñìîíàâ-òèêå: ñòàíîâëåíèå è àêòóàëüíîñòü ó÷åòà»23–25 íîÿáðÿ 2017 ã. – Âûï. ¹ 3/1 (84). – Ì.,2017. – Ñ. 52–58.

4. Ìàòþøåâ Ò.Â., Äâîðíèêîâ Ì.Â., Êóêóø-êèí Þ.À., Áîãîìîëîâ À.Â. Óïðàâëåíèå äëèòåëü-íîñòüþ äåñàòóðàöèè ÷ëåíîâ ýêèïàæà ïèëîòè-ðóåìûõ êîñìè÷åñêèõ îáúåêòîâ ñ èñïîëüçîâà-íèåì ìàòåìàòè÷åñêîãî ìîäåëèðîâàíèÿ //Ìåõàòðîíèêà, Àâòîìàòèçàöèÿ, Óïðàâëåíèå. –2014. – ¹ 2. – Ñ. 45–52.

5. Ìåòîäèêè èññëåäîâàíèé â öåëÿõ âðà-÷åáíî-ëåòíîé ýêñïåðòèçû / Ïîä ðåä. Å.Ñ.Áå-ðåæíîâà, Ï.Ë.Ñëååíêîâà. – Ì.: Âîåíèçäàò, 1995.– 452 ñ.

6. Ðóêîâîäñòâî ïî ìåäèöèíñêîìó îáåñïå-÷åíèþ ïîëåòîâ. – Ì: Âîåíèçäàò, 1991.

7. Ñìîëèí Â.Â., Ñîêîëîâ Ã.Ì., Ïàâëîâ Á.Í.Äåêîìïðåññèîííàÿ áîëåçíü / Ïîä ðåä. Â.Ì.Áà-ðàíîâà. – Ì.: ÈÌÁÏ ÐÀÍ, 2010. – 314 ñ.

8. Ôåäåðàëüíûå àâèàöèîííûå ïðàâèëàïî ìåäèöèíñêîìó îáåñïå÷åíèþ ïîëåòîâ. –Ì., 2009.


Îäíà èç âàæíåéøèõ çàäà÷, êîòîðàÿ áûëà ðåøåíà â ïîñëåäíèå ãîäû, – îñíàùåíèå Âîîðó-æåííûõ Ñèë ñîâðåìåííîé ìåäèöèíñêîé ïîäâèæíîé òåõíèêîé è îáîðóäîâàíèåì.

Ìåäèöèíñêàÿ ñëóæáà â òå÷åíèå ïîñëåäíèõ ëåò ïîëó÷èëà íîâåéøåå ìåäèöèíñêîå îáîðóäî-âàíèå íà ñóììó áîëåå 70 ìëðä ðóá., ÷òî ïîâûñèëî îáåñïå÷åííîñòü ñîâðåìåííûìè îáðàçöàìèìåäèöèíñêîãî îáîðóäîâàíèÿ ïî÷òè â 2 ðàçà, à ïîäâèæíîé ìåäèöèíñêîé òåõíèêîé – â 7 ðàç.

Ýòî ïîçâîëèëî âûïîëíÿòü óíèêàëüíûå îïåðàöèè â âåäóùèõ ìåäèöèíñêèõ êëèíèêàõ Ìèí-îáîðîíû è ñîçäàòü ïåðåäîâóþ ñèñòåìó ëå÷åáíî-ýâàêóàöèîííûõ ìåðîïðèÿòèé ïðè ÷ðåçâû÷àé-íûõ ñèòóàöèÿõ ñ èñïîëüçîâàíèåì àâèàöèîííûõ ìîäóëåé, ìåäèöèíñêèõ êîìïëåêñîâ íà áàçåïíåâìîêàðêàñíûõ ñîîðóæåíèé, òàêæå ñèñòåìû óäàëåííûõ òåëåìåäèöèíñêèõ êîíñóëüòàöèé.

Ïðèñòàëüíîå âíèìàíèå óäåëÿëîñü âåòåðàíàì âîåííîé ñëóæáû, ÷ëåíàì èõ ñåìåé â ÷àñòèïîâûøåíèÿ äîñòóïíîñòè ñàíàòîðíî-êóðîðòíîãî ëå÷åíèÿ. Â ñâÿçè ñ âîçîáíîâëåíèåì ôóíêöèî-íèðîâàíèÿ âîåííûõ çäðàâíèö Êðûìà è Àáõàçèè, à òàêæå çàâåðøåíèåì ñòðîèòåëüñòâàíîâûõ ñïàëüíûõ êîðïóñîâ â äåéñòâóþùèõ ñàíàòîðèÿõ êîëè÷åñòâî îáåñïå÷åííûõ ñàíàòîðíî-êóðîðòíûì ëå÷åíèåì âûðîñëî áîëåå ÷åì íà 50 òûñ. ÷åëîâåê.

Äåïàðòàìåíò èíôîðìàöèè è ìàññîâûõ êîììóíèêàöèéÌèíèñòåðñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè, 6 ÿíâàðÿ 2019 ã.


55

ÂÎÅÍÍÀß ÔÀÐÌÀÖÈß

È ÌÅÄÈÖÈÍÑÊÀß ÒÅÕÍÈÊÀ


© Â.Â.ÑÒÅÖ, Ì.Ä.ËÞÁÈÌÎÂ, 2019ÓÄÊ 616-074/076:614.2

Ïðèìåíåíèå ëàáîðàòîðíîé ýêñïðåññ-äèàãíîñòèêèâ ìíîãîïðîôèëüíîì ìåäèöèíñêîì ñòàöèîíàðåè íà ýòàïàõ ýâàêóàöèè ïàöèåíòîâ

ÑÒÅÖ Â.Â., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû ([email protected])ËÞÁÈÌÎÂ Ì.Ä., ìàéîð ìåäèöèíñêîé ñëóæáû.

Ãëàâíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. Í.Í.Áóðäåíêî, Ìîñêâà.

Â ñòàòüå ïîêàçàíà öåëåñîîáðàçíîñòü âíåäðåíèÿ â ìåäèöèíñêóþ ïðàêòèêó «ëàáîðàòîðíîãî àíàëèçàïî ìåñòó îêàçàíèÿ ìåäèöèíñêîé ïîìîùè». Îñâåùåíû îñíîâíûå ïðåèìóùåñòâà ïðèìåíåíèÿòåõíîëîãèè «point-of-care testing» äëÿ âñåñòîðîííåé îöåíêè ñîñòîÿíèÿ ïàöèåíòîâ ñ ðàçëè÷íîéïàòîëîãèåé êàê â óñëîâèÿõ ñòàöèîíàðà, òàê è âî âðåìÿ òðàíñïîðòèðîâêè ïàöèåíòîâ â òÿæåëîìñîñòîÿíèè. Ïðèâåäåíû ïðèìåðû èñïîëüçîâàíèÿ ïðèáîðà i-Stat 300 G (Abbott) äëÿ îïðåäåëåíèÿòàêòèêè ëå÷åíèÿ â ðàçëè÷íûõ êëèíè÷åñêèõ ñèòóàöèÿõ. Ðåçóëüòàòû àíàëèçîâ, ïîëó÷àåìûåñ ïîìîùüþ äàííîãî àïïàðàòà, ñîîòâåòñòâóþò òàêîâûì ïðè èñïîëüçîâàíèè «êëàññè÷åñêîé»ëàáîðàòîðíîé òåõíèêè, à åãî ïðåèìóùåñòâà ìîãóò ñïîñîáñòâîâàòü óëó÷øåíèþ èñõîäîâ ëå÷åíèÿïàöèåíòîâ. Õàðàêòåðèñòèêè àïïàðàòà ïîçâîëÿþò ðåêîìåíäîâàòü åãî ïðèìåíåíèå â ðàçëè÷íûõóñëîâèÿõ äëÿ ëàáîðàòîðíîé äèàãíîñòèêè óãðîæàþùèõ æèçíè íàðóøåíèé ãîìåîñòàçà è êîððåêöèèëå÷åíèÿ ïàöèåíòîâ ñ ðàçíîîáðàçíîé ïàòîëîãèåé.

Ê ë þ ÷ å â û å ñ ë î â à: ëàáîðàòîðíàÿ ýêñïðåññ-äèàãíîñòèêà, ïðèáîð i-Stat 300 G (Abbott),ïðèìåíåíèå â ñòàöèîíàðå è íà ýòàïàõ ýâàêóàöèè.

Stets V.V., Lyubimov M.D. – Application of laboratory express diagnostics in a multidisciplinarymedical hospital and at the stages of the evacuation of patients. The article shows the reasonabilityof implementation of the «laboratory analysis at the place of delivery of medical care» into medicalpractice. The main advantages of using the «point-of-care testing» technology for a comprehensiveassessment of the condition of patients with various pathologies both in the hospital and duringtransportation of patients in serious condition are highlighted. Examples of using the i-STAT 300 G(Abbott) device to determine treatment tactics in various clinical situations are given. The resultsof analyzes obtained with the help of this apparatus correspond to those using the «classical» laboratoryequipment, and its advantages can help to improve the outcomes of treating patients. The characteristicsof the device make it possible to recommend its use in various conditions for the laboratory diagnosisof life-threatening disorders of homeostasis and correction of the treatment of patients with variouspathologies.

K e y w o r d s: laboratory express diagnostics, i-STAT 300 G (Abbott) device, use in the hospital andat the stages of evacuation.

Íåîòúåìëåìîé ÷àñòüþ êîíöåïöèè point-of-care testing (POCT), ò. å

ïðîâåäåíèÿ äèàãíîñòè÷åñêèõ ìåðîïðèÿ-òèé íåïîñðåäñòâåííî ðÿäîì ñ ïàöèåíòîìâ ðåæèìå ðåàëüíîãî âðåìåíè, ÿâëÿåòñÿëàáîðàòîðíàÿ äèàãíîñòèêà. Â ðóêàõ ñïå-öèàëèñòîâ ïîÿâèëñÿ èíñòðóìåíò, ïîçâî-ëÿþùèé íå òîëüêî îöåíèâàòü ñîñòîÿíèåïàöèåíòà äëÿ ïåðâîíà÷àëüíîé òåðàïèè,íî è ïðîâîäèòü ëàáîðàòîðíóþ äèàãíî-ñòèêó â äèíàìèêå. Ñîâðåìåííûå àíà-ëèçàòîðû îòâå÷àþò òàêèì ñïåöèàëüíûìòðåáîâàíèÿì, êàê:

– ïðîñòîòà â îáó÷åíèè, ïðèìåíåíèèè îáñëóæèâàíèè (â ò. ÷. è äèñòàíöèîííîì);

– îòñóòñòâèå íåîáõîäèìîñòè â ñïåöè-àëüíîì ëàáîðàòîðíîì îáðàçîâàíèè îïå-ðàòîðà, âûïîëíÿþùåãî èññëåäîâàíèÿ [3];

– ïîëó÷åíèå ðåçóëüòàòà èññëåäîâà-íèÿ â òå÷åíèå íåñêîëüêèõ ìèíóò, â çà-âèñèìîñòè îò âûïîëíÿåìîãî àíàëèçà;

– àâòîìàòèçèðîâàííûé êîíòðîëüêà÷åñòâà;

– âîçìîæíîñòü õðàíåíèÿ èíôîðìà-öèè è ïåðåäà÷è äàííûõ;

– ìàëûé îáúåì áèîïðîáû;


ÂÎÅÍÍÀß ÔÀÐÌÀÖÈßÈ ÌÅÄÈÖÈÍÑÊÀß ÒÅÕÍÈÊÀ

Îäíèì èç âàæíûõ ïðåèìóùåñòâ ðà-áîòû ñ àïïàðàòîì i-Stat ÿâëÿåòñÿ òåõ-íîëîãèÿ âûïîëíåíèÿ èññëåäîâàíèé, ïî-çâîëÿþùàÿ èñïîëüçîâàòü íåáîëüøîéîáúåì (îêîëî 95 ìêë) âåíîçíîé, àðòå-ðèàëüíîé è êàïèëëÿðíîé êðîâè, à òàêæåïðîáû êðîâè, âçÿòîé èç êîñòè ïðè èñ-ïîëüçîâàíèè âíóòðèêîñòíîãî äîñòóïà [6].Ó÷èòûâàÿ, ÷òî ìîæåò ïðèìåíÿòüñÿ íå-ãåïàðèíèçèðîâàííàÿ êðîâü, óìåíüøàåò-ñÿ ðèñê îøèáîê íà ïðåàíàëèòè÷åñêîìýòàïå, ÷òî âàæíî ïðè îöåíêå óðîâíÿãåìîãëîáèíà êðîâè. Áëàãîäàðÿ òîìó, ÷òîìèíèìèçèðîâàí âðåìåííîé èíòåðâàëìåæäó âçÿòèåì ïðîáû è ïîìåùåíèåì ååâ àíàëèçàòîð, îòñóòñòâóåò ýôôåêò âëèÿ-íèÿ äèôôóçèè ãàçîâ ÷åðåç ñòåíêó øïðè-öà. Àïïàðàò âñåãäà íàõîäèòñÿ â ãîòîâ-íîñòè ê âûïîëíåíèþ èññëåäîâàíèé, ò. ê.íå òðåáóåò ñïåöèàëüíîé ïàóçû â ðàáîòåäëÿ êàëèáðîâêè.

Îñíàùåíèå àíåñòåçèîëîãîâ-ðåàíè-ìàòîëîãîâ, ñïåöèàëèñòîâ îòäåëåíèÿ ãåìî-äèàëèçà äàííîé àïïàðàòóðîé ïîçâîëÿåò:

– ñíèçèòü çàâèñèìîñòü îò âîçìîæíî-ñòåé ëàáîðàòîðíîé ñëóæáû ñòàöèîíàðà;

– íå ïåðåãðóæàòü ëàáîðàòîðèþ ñòà-öèîíàðà ýêñïðåññ-èññëåäîâàíèÿìè;

– îïðåäåëèòü öåëåâóþ ãðóïïó íàèáî-ëåå òÿæåëûõ ïàöèåíòîâ è âûïîëíÿòü èìèññëåäîâàíèÿ, ñíèçèâ ðèñê îøèáîê íàâñåõ ýòàïàõ äèàãíîñòèêè;

– ñîêðàòèòü ïðîäîëæèòåëüíîñòü èññëå-äîâàíèé [4], à çíà÷èò, ñîêðàòèòü âðåìÿ

íà îöåíêó ñîñòîÿíèÿ ïàöèåíòà, íà÷àëà òå-ðàïèè èëè ïîäãîòîâêè ê ýâàêóàöèè;

– ïðîâîäèòü öåëåíàïðàâëåííóþ èí-òåíñèâíóþ òåðàïèþ [2];

– èìåòü èñõîäíûå äàííûå, ïîëó÷åí-íûå ìîáèëüíûì àïïàðàòîì i-Stat 300 G(Abbott), è ñðàâíèâàòü èõ ñ ïîñëåäóþùè-ìè ðåçóëüòàòàìè èññëåäîâàíèé, âûïîëíÿ-åìûõ íà òîì æå îáîðóäîâàíèè.

Îñîáîå âíèìàíèå ñëåäóåò îáðàòèòüíà òî, ÷òî â àïïàðàòå i-Stat ðåàëèçîâàíàñèñòåìà âûïîëíåíèÿ àâòîìàòè÷åñêîãîêîíòðîëÿ àíàëèçîâ. Ðåçóëüòàòû àíàëèçîâ,ïîëó÷àåìûå ñ åãî ïîìîùüþ, ñîîòâåòñòâó-þò òàêîâûì ïðè èñïîëüçîâàíèè «êëàññè-÷åñêîé» ëàáîðàòîðíîé òåõíèêè [2, 3, 5].

ßâëÿÿñü êîìïàêòíîé, «áûñòðîé»ëàáîðàòîðèåé ñ âîçìîæíîñòüþ ðàáîòû«â ëþáîå âðåìÿ â ëþáîì ìåñòå», äàííûéïðèáîð íåçàìåíèì â ñëîæíûõ óñëîâèÿõ,ïðè òðàíñïîðòèðîâêå, â ò. ÷. àâèàòðàíñ-ïîðòîì [1].

Ñî÷åòàíèå îïèñàííûõ ïðåèìóùåñòâïðèìåíåíèÿ àïïàðàòà i-Stat ìîæåò ñïî-ñîáñòâîâàòü óëó÷øåíèþ èñõîäîâ ëå÷åíèÿïàöèåíòîâ.

Òàêèì îáðàçîì, ìíîãîëåòíèé óñïåø-íûé îïûò èñïîëüçîâàíèÿ òåõíîëîãèè ëà-áîðàòîðíîé äèàãíîñòèêè ïî ìåñòó ëå÷å-íèÿ ïàöèåíòà â óñëîâèÿõ ìíîãîïðîôèëü-íîãî ìåäèöèíñêîãî ó÷ðåæäåíèÿ è íà ýòà-ïàõ ìåäèöèíñêîé ýâàêóàöèè ïîçâîëÿåòðåêîìåíäîâàòü äàííûå òèïû óñòðîéñòâê øèðîêîìó âíåäðåíèþ.


1. Burrit M.F., Santrach P.J., Hankins D.G.et al. Evaluetion of the i-Stat portable clinicalanalyzer for use in a helicopter // Scandinavianjournal of clininical and laboratory investigation.– 1996. – Vol. 56. – P. 121–128.

2. Ismail F., Mackay W.G., Kerry A. et al. Theaccuracy and timeliness of a Point Of Care lactatemeasurement in patients with Sepsis // Scandi-navian Journal of Trauma, Resuscitation AndEmergency Medicine. – 2015. – N 23. – P. 68.

3. Jacobs E., Vadasdi E., Sarkozi L. AnalyticalEvaluation of i-Stat Portable Clinical Analyzerand Use by Nonlaboratory Health-Care Profes-

sionals // Clinical Chemistry. – 1993. – Vol. 39,N. 6. – P. 1069–1074.

4. Larsson A., Greig-Pylypczuk R., Huisman A.The state of point-of-care testing: a europeanperspective // Upsala Journal of Medical Sciences.– 2015. – Vol. 120. – P. 1–10.

5. Sediame S., Zerah-Lancner F. Accuracyof the i-Stat bedside blood gas analyser // Euro-pean Respiratory Journal. – 1999. – Vol. 14. –P. 214–217.

6. Veldhoen E.S., de Vooght K.M., Slieker M.G.et al. Analysis of bloodgas, electrolytes and glucosefrom intraosseus samples using an i-Stat point-of-care analyser // Resuscitation. – 2014. – Vol. 85.– P. 359–363.


ÊÐÀÒÊÈÅ ÑÎÎÁÙÅÍÈß


Ïèí÷óê Î.Â. ([email protected]), Îáðàçöîâ À.Â., ßìåíñêîâ Â.Â., Ðàêîâ À.À.,Àáðîñèìîâ À.À – Ðåâàñêóëÿðèçàöèÿ íèæíåé êîíå÷íîñòè ïðè ìóëüòèñåãìåí-òàðíîì àòåðîñêëåðîòè÷åñêîì ïîðàæåíèè.

3-é Öåíòðàëüíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. À.À.Âèøíåâñêîãî, ã. Êðàñíîãîðñê,Ìîñêîâñêàÿ îáëàñòü

Ðàññìîòðåíû âîïðîñû õèðóðãè÷åñêîãî ëå÷åíèÿ ìóëüòèñåãìåíòàðíîãî àòåðîñêëåðîòè÷åñêîãîïîðàæåíèÿ àðòåðèé íèæíèõ êîíå÷íîñòåé. Ïðèâåäåíû äàííûå è àíàëèç ñîáñòâåííûõ íàáëþäåíèé.Îáîáùåí îïûò 9 ðåäêèõ øóíòèðóþùèõ îïåðàöèé «äëèííûõ» øóíòîâ. Ïîäîáíûå îïåðàöèè,êàê àëüòåðíàòèâà àìïóòàöèè, ìîãóò âûïîëíÿòüñÿ ïðè àäåêâàòíîé îöåíêå ñîñòîÿíèÿàðòåðèàëüíîãî ñîñóäèñòîãî ðóñëà è ñòðîãî èíäèâèäóàëüíîì ïîäõîäå. Â ðÿäå ñëó÷àåâ òàêèåñïîñîáû ðåâàñêóëÿðèçàöèè îáåñïå÷èâàþò íåïîñðåäñòâåííóþ êîìïåíñàöèþ êðîâîîáðàùåíèÿêîíå÷íîñòè ñ äëèòåëüíûì ïîëîæèòåëüíûì ðåçóëüòàòîì.

Ê ë þ ÷ å â û å ñ ë î â à: äëèííûé øóíò, ìíîãîóðîâíåâîå ïîðàæåíèå, îáëèòåðèðóþùèé àòåðî-ñêëåðîç, ðåâàñêóëÿðèçàöèÿ.

Pinchuk O.V., Obraztsov A.V., Yamenskov V.V., Rakov A.A., Abrosimov A.A. – Revascularization of thelower limb in multisegmental atherosclerotic lesions. The issues of surgical treatment of multisegmentalatherosclerotic lesions of lower limb arteries are considered. Data and analysis of own observations aregiven. The experience of 9 rare shunt operations of «long» shunts is summarized. Such operations, as analternative to amputation, can be performed with an adequate assessment of the state of the arterialvascular bed and a strictly individual approach. In some cases, such methods of revascularizationprovide direct compensation for the blood circulation of the limb with a long-term positive result.

K e y w o r d s: long shunt, multilevel lesion, atherosclerosis obliterans, revascularization.

Ïîðàæåíèÿ ñîñóäèñòîãî ðóñëà ïðè îá-ëèòåðèðóþùåì àòåðîñêëåðîçå àðòåðèé íèæ-íèõ êîíå÷íîñòåé ïðèíÿòî êëàññèôèöèðîâàòüïî àíàòîìè÷åñêîìó ïðèíöèïó íà àîðòî-áåä-ðåííûå, áåäðåííî-ïîäêîëåííûå è ïîäêîëåí-íî-òèáèàëüíûå îêêëþçèè (ñòåíîçû).

Íàöèîíàëüíûå ðåêîìåíäàöèè ïî âåäåíèþïàöèåíòîâ ñ çàáîëåâàíèÿìè àðòåðèé íèæíèõêîíå÷íîñòåé (2013) óêàçûâàþò íà íåäîïóñ-òèìîñòü ïðîâåäåíèÿ áîëüøèõ àìïóòàöèé ïà-öèåíòàì ñ êðèòè÷åñêîé èøåìèåé êîíå÷íîñòèäî òîãî, êàê ìíîãîïðîôèëüíàÿ ãðóïïà ñîñó-äèñòûõ ñïåöèàëèñòîâ íå ðàññìîòðèò âñå âîç-ìîæíîñòè ðåâàñêóëÿðèçàöèè. Ïðè ýòîì, åñëèèìååòñÿ ðàñïðîñòðàíåííîå ïîðàæåíèå è ïðî-òÿæåííûå îêêëþçèè, ÿâëÿåòñÿ îïðàâäàííûìôîðìèðîâàíèå äàæå äëèííûõ øóíòîâ. Âïîñëåäíèå ãîäû áîëüøèå íàäåæäû â ëå÷åíèèäàííîé êàòåãîðèè ïàöèåíòîâ ñâÿçûâàþòñÿ ñïðèìåíåíèåì ãèáðèäíûõ ìåòîäèê.

Îäíàêî â ðÿäå ñëó÷àåâ, ïðè ïðîòÿæåí-íîì ïîðàæåíèè àðòåðèàëüíîãî ðóñëà, ðàíååïåðåíåñåííûõ íåîäíîêðàòíûõ ïîïûòîê õè-ðóðãè÷åñêîé ðåâàñêóëÿðèçàöèè, «ñòàíäàðòíûå»âìåøàòåëüñòâà, íàïðàâëåííûå íà ñîõðàíåíèåêîíå÷íîñòè, âûïîëíèòü íå ïðåäñòàâëÿåòñÿâîçìîæíûì. Â ýòèõ óñëîâèÿõ ïðèõîäèòñÿâûïîëíÿòü ñëîæíûå, ïðîòÿæåííûå, êàæäûé ðàçñòðîãî èíäèâèäóàëüíûå ñîñóäèñòûå ðåêîí-

ñòðóêöèè. Ïóáëèêàöèè î ïîäîáíûõ âìåøà-òåëüñòâàõ åäèíè÷íû è ïðåäñòàâëÿþò çíà÷è-òåëüíûé èíòåðåñ.

Çà ïîñëåäíèå 10 ëåò â öåíòðå ñîñóäèñòîéõèðóðãèè 3 ÖÂÊÃ èì. À.À.Âèøíåâñêîãî íàìèâûïîëíåíû 9 õèðóðãè÷åñêèõ âìåøàòåëüñòâñ ôîðìèðîâàíèåì äëèííûõ àðòåðèàëüíûõ êîí-äóèòîâ ïðîòÿæåííîñòüþ äâà-òðè àðòåðèàëü-íûõ ñåãìåíòà. Âñå ïàöèåíòû áûëè ìóæ÷èíà-ìè â âîçðàñòå îò 61 äî 76 ëåò (ñðåäíèé âîç-ðàñò ñîñòàâèë 68,2±7,2 ãîäà) ñ àòåðîñêëåðî-òè÷åñêèì ïîðàæåíèåì àðòåðèàëüíîãî ðóñëà.Âîñåìü áîëüíûõ ðàíåå â ðàçëè÷íûå ñðîêèóæå ïåðåíîñèëè íåîäíîêðàòíûå ñîñóäèñòûåðåêîíñòðóêöèè ñ èñõîäàìè â òðîìáîçû.

Èñõîäíàÿ èøåìèÿ â 2 ñëó÷àÿõ áûëàIV ñòåïåíè è ó 6 áîëüíûõ – III ñòåïåíè,ò. å. êðèòè÷åñêàÿ èøåìèÿ äèàãíîñòèðîâàëàñüâî âñåõ íàáëþäåíèÿõ. Â ÷èñëå âûïîëíåííûõîïåðàöèé – 2 àîðòî-ïîäêîëåííûõ, 3 îáùå-ïîäâçäîøíî-ïîäêîëåííûõ è 4 íàðóæíîïîä-âçäîøíî-òèáèàëüíûõ øóíòèðîâàíèé. Â êà-÷åñòâå ñîñóäèñòûõ êîíäóèòîâ â 3 ñëó÷àÿõáûëè èñïîëüçîâàíû àóòîâåíû, 4 ïðîòåçà – èçñèíòåòè÷åñêèõ ìàòåðèàëîâ è â 2 íàáëþäåíè-ÿõ ïðèìåíåí áèîëîãè÷åñêèé ïðîòåç. Ðåøåíèåîá îáúåìå ïðåäïîëàãàåìîé ðåâàñêóëÿðèçàöèèïðèíèìàëîñü ñòðîãî èíäèâèäóàëüíî, â çíà-÷èòåëüíîé ñòåïåíè âûíóæäåííî, êàê àëü-

Ê ñòàòüå: Âåíãåðîâè÷ Í.Ã., Þäèí Ì.À., Êîíüøàêîâ Þ.Î., ×åïóð Ñ.Â., Èâàíîâ È.Ì. – Âåðîÿòíîñò-íàÿ ïðîãíîçíàÿ ìàòåìàòè÷åñêàÿ ìîäåëü õðîíè÷åñêèõ ðåñïèðàòîðíûõ ñîñòîÿíèé äëÿ ñíèæåíèÿðèñêà èíâàëèäèçàöèè ïðè îòðàâëåíèè âåùåñòâàìè ïóëüìîíîòîêñè÷åñêîãî äåéñòâèÿ

Èçìåíåíèÿ ñòðóêòóðûòêàíè ëåãêîãî êðûñêîíòðîëüíîé ãðóïïû÷åðåç 45 ñóò ïîñëå èíãà-ëÿöèîííîãî îòðàâëåíèÿôîñãåíîì â òîêñîäîçå1 LCt

50: À – ó÷àñòîê

ïàðåíõèìû ëåãêîãî.Îêðàñêà ãåìàòîêñèëèí-ýîçèíîì. Óâ.×40;Á – äåôîðìèðîâàííûéêðóïíûé áðîíõ. Îêðàñêàãåìàòîêñèëèí-ýîçèíîì.Óâ.×40; Â – ïðîñâåòàëüâåîë ñ ýêññóäàòîì.Îêðàñêà ãåìàòîêñèëèí-ýîçèíîì. Óâ.×400;Ã – ïëàçìàòè÷åñêîåïðîïèòûâàíèå ïåðè-áðîíõèàëüíîé ñîåäèíè-òåëüíîé òêàíè. Îêðàñêàãåìàòîêñèëèí-ýîçèíîì.Óâ.×200

Ðèñ. 2. ÊÒ-àíãèîãðàììà áîëüíîãî Ò., 68 ëåò.Ôóíêöèîíèðóþùèé îáùåïîäâçäîøíî-ïîäêîëåí-

íûé äèñòàëüíûé øóíò. Çîíà ïðîêñèìàëüíîãîàíàñòîìîçà ñèíòåòè÷åñêîãî ïðîòåçà ñ îáùåé

ïîäâçäîøíîé àðòåðèåé îòìå÷åíà ñòðåëêîé.Äèñòàëüíûé àíàñòîìîç àóòîâåíû ñ ïîäêîëåííîé

àðòåðèåé îáîçíà÷åí äâîéíîé ñòðåëêîé. Ìåñòîàíàñòîìîçà ñèíòåòè÷åñêîãî ïðîòåçà ñ àóòîâåíîé

îáîçíà÷åíî âåðòèêàëüíîé ñòðåëêîé

Ðèñ. 1. Ïîñëåîïåðàöèîííàÿ ÊÒ-àíãèîãðàììàáîëüíîãî Á., 61 ãîä. Ôóíêöèîíèðóþùèéíàðóæíîïîäâçäîøíî-çàäíåáîëüøåáåðöîâûéøóíò. Çîíû ïðîêñèìàëüíîãî ñ íàðóæíîé ïîä-âçäîøíîé àðòåðèåé (ñòðåëêà) è äèñòàëüíîãîñ çàäíåé áîëüøåáåðöîâîé àðòåðèåé (äâîéíàÿñòðåëêà) àíàñòîìîçîâ

Ê ñòàòüå: Ïèí÷óê Î.Â., Îáðàçöîâ À.Â., ßìåíñêîâ Â.Â., Ðàêîâ À.À., Àáðîñèìîâ À.À – Ðåâàñêó-ëÿðèçàöèÿ íèæíåé êîíå÷íîñòè ïðè ìóëüòèñåãìåíòàðíîì àòåðîñêëåðîòè÷åñêîì ïîðàæåíèè



òåðíàòèâà ïåðâè÷íîé âûñîêîé àìïóòàöèè íàóðîâíå áåäðà.

Ïðèâîäèì êëèíè÷åñêèå íàáëþäåíèÿ.Áîëüíîé Á., 61 ãîä, ïîñòóïèë ïî ïîâîäó

îáëèòåðèðóþùåãî àòåðîñêëåðîçà àðòåðèéíèæíèõ êîíå÷íîñòåé, îêêëþçèè ëåâîé ïî-âåðõíîñòíîé áåäðåííîé, ëåâîé ïîäêîëåííîéàðòåðèè. Â 2015 ã. ïåðåíåñ àóòîâåíîçíîå áåä-ðåííî-òèáèàëüíîå øóíòèðîâàíèå. Òÿæåñòü èñ-õîäíîé èøåìèè â âèäå òðîôè÷åñêîé ÿçâûòûëà ëåâîé ñòîïû, áîëåé ïîêîÿ áûëà îáóñ-ëîâëåíà òðîìáîçîì øóíòà. Ïî ðåçóëüòàòàìðåíòãåíîêîíòðàñòíîé àíãèîãðàôèè áûë âåðè-ôèöèðîâàí õàðàêòåð ïîðàæåíèÿ àðòåðèàëü-íîãî ðóñëà êîíå÷íîñòè: äèôôóçíîå ïîðàæå-íèå ëåâîé îáùåé áåäðåííîé àðòåðèè, ìíî-æåñòâåííîå ïðîòÿæåííîå ïîðàæåíèå ãëóáî-êîé àðòåðèè áåäðà, îêêëþçèè ïîâåðõíîñòíîéáåäðåííîé, ïîäêîëåííîé àðòåðèé, ïåðåäíåéáîëüøåáåðöîâîé è ìàëîáåðöîâîé àðòåðèé ñëå-âà. Êàê àëüòåðíàòèâà àìïóòàöèè, 02.10.2018 ã.ïðîâåäåíî àóòîâåíîçíîå íàðóæíîïîäâçäîø-íî-çàäíåáîëüøåáåðöîâîå øóíòèðîâàíèå. Èñ-ïîëüçîâàíà àóòîâåíà êîíòðëàòåðàëüíîé êî-íå÷íîñòè. Äîñòóï ê íàðóæíîé ïîäâçäîøíîéàðòåðèè äëÿ ôîðìèðîâàíèÿ ïðîêñèìàëüíîãîàíàñòîìîçà âûïîëíåí èç ðàíû ëåâîé ïàõî-âîé îáëàñòè ñ ïåðåñå÷åíèåì ïóïàðòîâîé ñâÿç-êè. Áëèæàéøèé ïîñëåîïåðàöèîííûé ïåðèîäáåç îñëîæíåíèé, êðîâîîáðàùåíèå êîíå÷íîñ-òè êîìïåíñèðîâàíî. Àðòåðèàëüíûé êðîâîòîêïî øóíòó áåç ãåìîäèíàìè÷åñêè çíà÷èìûõïðåïÿòñòâèé (ðèñ. 1, ñ. 4 âêëåéêè).

Áîëüíîé Ò., 68 ëåò, íåîäíîêðàòíî ëå÷èëñÿïî ïîâîäó îáëèòåðèðóþùåãî àòåðîñêëåðîçààðòåðèé íèæíèõ êîíå÷íîñòåé. Íà ïðîòÿæå-íèè 15 ëåò ïåðåíåñ ðÿä ýíäîâàñêóëÿðíûõ è«îòêðûòûõ» ðåêîíñòðóêöèé íà àðòåðèÿõ ëå-âîé íèæíåé êîíå÷íîñòè. Ïðîãðåññèðîâàíèåîñíîâíîãî çàáîëåâàíèÿ ïðèâåëî ê ðåòðîìáî-çàì ðàíåå âîññòàíîâëåííûõ õèðóðãè÷åñêèàðòåðèàëüíûõ ñåãìåíòîâ. Â ñåíòÿáðå 2016 ã.

ïî ïîâîäó èøåìè÷åñêèõ áîëåé ïîêîÿ, êàêàëüòåðíàòèâà àìïóòàöèè, íà óðîâíå áåäðàâûïîëíåíî îáùåïîäâçäîøíî-ïîäêîëåííîåäèñòàëüíîå øóíòèðîâàíèå ñëåâà êîìáèíèðî-âàííûì (àóòîâåíà+ñèíòåòè÷åñêèé ìàòåðèàë)ïðîòåçîì. Ïîñëåîïåðàöèîííûé ïåðèîä áåçîñëîæíåíèé. Êðîâîîáðàùåíèå ëåâîé íèæíåéêîíå÷íîñòè óäàëîñü êîìïåíñèðîâàòü. Ïðèêîíòðîëüíîì îáñëåäîâàíèè ÷åðåç äâà ãîäàïîñëå îïåðàöèè (ðèñ. 2, ñ. 4 âêëåéêè) øóíòôóíêöèîíèðóåò, êðîâîîáðàùåíèå êîíå÷íîñ-òè êîìïåíñèðîâàíî.

Èç 9 ïðèâåäåííûõ ñëó÷àåâ «äëèííûõ»øóíòîâ íà ìîìåíò âûïèñêè ôóíêöèîíèðî-âàëè 8 ðåêîíñòðóêöèé. Â îäíîì ñëó÷àå íà-áëþäàëñÿ ðàííèé ïîñëåîïåðàöèîííûé òðîì-áîç íàðóæíîïîäâçäîøíî-ìàëîáåðöîâîãîøóíòà ñ ïîñëåäóþùåé àìïóòàöèåé êîíå÷íî-ñòè. Â îòäàëåííûé ïåðèîä â ñðîêè äî 1 ãîäàïðîñëåæåíà ñóäüáà 7 áîëüíûõ, âûïèñàííûõ ñôóíêöèîíèðóþùèì øóíòîì. Ó âñåõ ôóíê-öèÿ øóíòà íå áûëà íàðóøåíà, èøåìè÷åñêèéáîëåâîé ñèíäðîì êóïèðîâàí èçëå÷åíèåì òðî-ôè÷åñêèõ ïîðàæåíèé ñòîïû è àêòèâíûìèðåïàðàòèâíûìè ïðîöåññàìè. Â ñðîêè äî 3 ëåòèçó÷åíû ðåçóëüòàòû ëå÷åíèÿ 5 ïàöèåíòîâ –îòìå÷åíî åùå äâà òðîìáîçà ðåêîíñòðóêöèè,â ò. ÷. ñ îäíîé àìïóòàöèåé. Â íàñòîÿùèé ìî-ìåíò ïîä íàøèì íàáëþäåíèåì íàõîäÿòñÿ äâàïàöèåíòà äàííîé ãðóïïû ñ ôóíêöèîíèðóþ-ùèìè áîëåå òðåõ ëåò ïîäîáíûìè ðåêîíñò-ðóêöèÿìè.

Òàêèì îáðàçîì, ïðè îäíîìîìåíòíîì ïî-ðàæåíèè äâóõ-òðåõ àðòåðèàëüíûõ ñåãìåíòîâïðèìåíåíèå «äëèííûõ» àðòåðèàëüíûõ øóí-òîâ ÿâëÿåòñÿ âûíóæäåííîé ïîïûòêîé àðòå-ðèàëüíîé ðåâàñêóëÿðèçàöèè êàê àëüòåðíàòè-âû ïåðâè÷íîé àìïóòàöèè. Ïðè àäåêâàòíîì èñòðîãî èíäèâèäóàëüíîì ïîäõîäå ê âûáîðóïîêàçàíèé ïîäîáíûå ðåêîíñòðóêöèè ìîãóòñïîñîáñòâîâàòü ñîõðàíåíèþ íèæíåé êîíå÷-íîñòè íà äîñòàòî÷íî äëèòåëüíûé ñðîê.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ 616.24-002-053.9-085.33.03

Êóëàãèíà È.Ö. ([email protected]), Ëèõîäèé Â.È., Çàéöåâ À.À. – Âíå-áîëüíè÷íàÿ ïíåâìîíèÿ ó ïîæèëûõ ïàöèåíòîâ: ýôôåêòèâíîñòü ðåæèìîâ àíòè-ìèêðîáíîé òåðàïèè.

Ãëàâíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. Í.Í.Áóðäåíêî, Ìîñêâà

Ïðîâåäåíà îöåíêà êëèíè÷åñêîé ýôôåêòèâíîñòè ïðèìåíåíèÿ «çàùèùåííûõ» àìèíîïåíèöèëëèíîâ(àìîêñèöèëëèí/êëàâóëàíàò, àìîêñèöèëëèí/ñóëüáàêòàì) è öåôàëîñïîðèíîâ 3-ãî ïîêîëåíèÿ ïðèëå÷åíèè íåòÿæåëîé âíåáîëüíè÷íîé ïíåâìîíèè ó ïàöèåíòîâ ñòàðøå 60 ëåò â óñëîâèÿõ ñòàöèîíàðà.Ïðîàíàëèçèðîâàíà 71 èñòîðèÿ áîëåçíè. Îöåíêà îñóùåñòâëÿëàñü íà îñíîâàíèè êîìïëåêñíîãîàíàëèçà êëèíè÷åñêèõ, ëàáîðàòîðíûõ è ðåíòãåíîëîãè÷åñêèõ äàííûõ. Ñðàâíèòåëüíûé àíàëèçêëèíè÷åñêîé ýôôåêòèâíîñòè è áåçîïàñíîñòè èññëåäóåìûõ ðåæèìîâ àíòèáèîòèêîòåðàïèèïðîäåìîíñòðèðîâàë î÷åâèäíîå ïðåèìóùåñòâî ïðèìåíåíèÿ «çàùèùåííûõ» àìèíîïåíèöèëëèíîâ ïåðåäñóùåñòâóþùåé ïðàêòèêîé ëå÷åíèÿ íåòÿæåëîé âíåáîëüíè÷íîé ïíåâìîíèè ó ïàöèåíòîâ ñòàðøèõâîçðàñòíûõ ãðóïï.

Ê ë þ ÷ å â û å ñ ë î â à: ïàöèåíòû ïîæèëîãî âîçðàñòà, âíåáîëüíè÷íàÿ ïíåâìîíèÿ, «çàùèùåí-íûå» àìèíîïåíèöèëëèíû, öåôàëîñïîðèíû 3-ãî ïîêîëåíèÿ, êëèíè÷åñêàÿ ýôôåêòèâíîñòü.



Kulagina I.Ts., Likhodii V.I., Zaitsev A.A. – Community-acquired pneumonia in elderly patients: theeffectiveness of antimicrobial therapy regimens. The clinical efficacy of using «protected» aminopenicillins(amoxicillin/clavulanate, amoxicillin/sulbactam) and the 3rd generation cephalosporins in the treatmentof mild community-acquired pneumonia in patients older than 60 years in hospital has been evaluated.Analyzed 71 case histories. The assessment was carried out on the basis of a comprehensive analysis ofclinical, laboratory and radiological data. A comparative analysis of the clinical efficacy and safety ofthe antibiotic regimens under study demonstrated the obvious advantage of using «protected»aminopenicillins over the existing practice of treating non-severe community-acquired pneumonia inpatients of older age groups.

K e y w o r d s: elderly patients, community-acquired pneumonia, «protected» aminopenicillins, 3rdgeneration cephalosporins, clinical efficacy.

Âíåáîëüíè÷íàÿ ïíåâìîíèÿ (ÂÏ) â ïîæè-ëîì âîçðàñòå ÿâëÿåòñÿ àêòóàëüíîé ïðîáëåìîéïðàêòè÷åñêîãî çäðàâîîõðàíåíèÿ â ñâÿçè ñâûñîêîé çàáîëåâàåìîñòüþ è ñìåðòíîñòüþ.Íàèáîëåå ÷àñòûì ìèêðîîðãàíèçìîì, âûçû-âàþùèì ÂÏ âî âñåõ âîçðàñòíûõ ãðóïïàõ,ÿâëÿåòñÿ Streptococcus pneumoniae (30–50%ñëó÷àåâ çàáîëåâàíèÿ). Â ïîæèëîì âîçðàñòå èó ëèö, ïîëó÷àâøèõ íåîäíîêðàòíûå êóðñûàíòèìèêðîáíûõ ïðåïàðàòîâ, êðîìå ïíåâìî-êîêêà âîçðàñòàåò ðîëü ãðàìîòðèöàòåëüíûõáàêòåðèé (ãåìîôèëüíàÿ ïàëî÷êà), â ò. ÷. îáëà-äàþùèõ àíòèáèîòèêîðåçèñòåíòíîñòüþ.

Ó ïîæèëûõ ïàöèåíòîâ íåðåäêî âûÿâëÿ-þòñÿ øòàììû ìèêðîîðãàíèçìîâ ñî ñíè-æåííîé ÷óâñòâèòåëüíîñòüþ ê àíòèáèîòèêàì(Îâ÷èííèêîâ Þ.Â. è äð., 2016; ×ó÷àëèí À.Ã.è äð., 2010). Ïî äàííûì ÍÈÈ àíòèìèêðîá-íîé õèìèîòåðàïèè (ã. Ñìîëåíñê, 2014), óðî-âåíü óñòîé÷èâîñòè ïíåâìîêîêêîâ ê ïåíè-öèëëèíó, öåôàëîñïîðèíàì III ïîêîëåíèÿ èýðèòðîìèöèíó â 2011–2012 ãã. ñîñòàâèë 3,8è 15,4% ñîîòâåòñòâåííî. Âàæíåéøèå ôàêòî-ðû ïîÿâëåíèÿ ïîëèðåçèñòåíòíûõ ïíåâìîêîê-êîâ – âîçðàñò ñòàðøå 65 ëåò, íåäàâíÿÿ (ìåíåå3 ìåñ) òåðàïèÿ àíòèáèîòèêàìè, õðîíè÷åñêèåñîïóòñòâóþùèå çàáîëåâàíèÿ, àëêîãîëèçì,èììóíîäåöèôèò. Â èññëåäîâàíèè Ìåæðåãèî-íàëüíîé àññîöèàöèÿ ïî êëèíè÷åñêîé ìèêðî-áèîëîãèè è àíòèìèêðîáíîé õèìèîòåðàïèè(ÏåÃÀñ-IV, 2014) óðîâåíü óñòîé÷èâîñòè ãåìî-ôèëüíîé ïàëî÷êè ê àìèíîïåíèöèëëèíàìîïðåäåëåí íà óðîâíå 10% íå÷óâñòâèòåëüíûõèçîëÿòîâ, òîãäà êàê ê «çàùèùåííûì» àìèíî-ïåíèöèëëèíàì ðåçèñòåíòíû 0,9%. Â Ðîññèèâ ñòàöèîíàðíûõ óñëîâèÿõ ÷àùå âñåãî ïðè-ìåíÿþòñÿ öåôàëîñïîðèíû III ïîêîëåíèÿ(öåôòðèàêñîí, öåôîòàêñèì), ÷òî ñâÿçàíî ñîñëîæèâøèìèñÿ «ñòåðåîòèïàìè», ñâÿçàííûìèñ óäîáñòâîì èõ ïðèìåíåíèÿ (âíóòðèìûøå÷-íîå ââåäåíèå) è ìåíüøèìè ýêîíîìè÷åñêè-ìè ïîêàçàòåëÿìè òåðàïèè.

Â öåëîì ðÿäå êëèíè÷åñêèõ ñèòóàöèé,â ïåðâóþ î÷åðåäü ñâÿçàííûõ ñ ëå÷åíèåì áîëü-íûõ ñòàðøèõ âîçðàñòíûõ ãðóïï, ïðåïàðàòàìèâûáîðà ÿâëÿþòñÿ èìåííî «çàùèùåííûå» àìè-íîïåíèöèëëèíû, ÷òî îáúÿñíÿåòñÿ âîçðàñòàíè-åì ðîëè ðåçèñòåíòíûõ øòàììîâ ïíåâìîêîêêà,Haemophilus influenzae, Staphylococcus aureus

è ãðàìîòðèöàòåëüíûõ áàêòåðèé ñåìåéñòâàEnterobacteriaceae â âîçíèêíîâåíèè ïíåâìîíèèó ïîäîáíîãî ðîäà ïàöèåíòîâ. Â òî æå âðåìÿîòå÷åñòâåííûõ èññëåäîâàíèé «ðåàëüíîé êëè-íè÷åñêîé ïðàêòèêè» è äîêàçàòåëüñòâýôôåêòèâíîñòè ðàçëè÷íûõ ðåæèìîâ òåðàïèèïîæèëûõ ïàöèåíòîâ ñ ÂÏ íåäîñòàòî÷íî.

Öåëü íàñòîÿùåãî èññëåäîâàíèÿ ñîñòîÿëàâ èçó÷åíèè êëèíè÷åñêîé ýôôåêòèâíîñòè«çàùèùåííûõ» àìèíîïåíèöèëëèíîâ (àìî-êñèöèëëèí/êëàâóëàíàò, àìîêñèöèëëèí/ñóëüáàêòàì) è öåôàëîñïîðèíîâ III ïîêîëå-íèÿ ïðè ëå÷åíèè íåòÿæåëîé ÂÏ ó ïàöèåí-òîâ ñòàðøå 60 ëåò â óñëîâèÿõ ñòàöèîíàðà.

Ïðîàíàëèçèðîâàíà 71 èñòîðèÿ áîëåç-íè. Â èññëåäîâàíèå âêëþ÷àëèñü ïàöèåíòû,êîòîðûå ïðè îöåíêå ïðîãíîçà ïî øêàëåSMRT-CO (Çàéöåâ À.À. è äð., 2014) íàáðàëèíå áîëåå äâóõ áàëëîâ. Êðèòåðèÿìè äèàãíîçàÂÏ ÿâëÿëèñü ðåíòãåíîëîãè÷åñêè ïîäòâåðæ-äåííàÿ èíôèëüòðàöèÿ ëåãî÷íîé òêàíè è íà-ëè÷èå íå ìåíåå äâóõ êëèíè÷åñêèõ/ëàáîðà-òîðíûõ ïðèçíàêîâ èç ÷èñëà ñëåäóþùèõ:à) ëèõîðàäêà 38 °Ñ è âûøå; á) ïðîäóêòèâ-íûé êàøåëü; â) ôèçè÷åñêèå ïðèçíàêè ïíåâ-ìîíèè (ôîêóñ êðåïèòàöèè è/èëè ìåëêîïó-çûð÷àòûõ õðèïîâ, ó÷àñòîê æåñòêîãî/áðîíõè-àëüíîãî äûõàíèÿ, óêîðî÷åíèå ïåðêóòîðíîãîçâóêà); ã) ëåéêîöèòîç áîëåå 10,0×109/ë è/èëèïàëî÷êîÿäåðíûé ñäâèã (áîëåå 10%).

Áûëè âûäåëåíû 2 ãðóïïû áîëüíûõ. Â 1-þ(îñíîâíóþ) ãðóïïó âîøëè 34 ïàöèåíòà(5 æåíùèí è 29 ìóæ÷èí, ñðåäíèé âîçðàñò67,7±5,1 ãîäà). 2-þ (ãðóïïó ñðàâíåíèÿ)ñîñòàâèëè 37 ïàöèåíòîâ (12 æåíùèíè 25 ìóæ÷èí, ñðåäíèé âîçðàñò 64,5±4,2 ãîäà).Îáñòîÿòåëüñòâà íàïðàâëåíèÿ áîëüíûõ îáåèõãðóïï íà ëå÷åíèå â ïóëüìîíîëîãè÷åñêèéñòàöèîíàð áûëè ñõîäíûìè.

Ñðåäè îáñëåäîâàííûõ ïàöèåíòîâ 18áûëè êóðèëüùèêàìè (â ñðåäíåì íå ìåíåå1 ïà÷êè ñèãàðåò â äåíü), èç íèõ 10 áîëüíûõâ 1-é ãðóïïå è 8 ïàöèåíòîâ âî 2-é ãðóïïå.

Ñðåäè ïàöèåíòîâ 1-é ãðóïïû ñî÷åòàíèåÂÏ ñ õðîíè÷åñêèìè áðîíõîëåãî÷íûìè çàáî-ëåâàíèÿìè áûëî âûÿâëåíî ó 16 (47%) ÷åëî-âåê, ñ çàáîëåâàíèÿìè ñåðäå÷íî-ñîñóäèñòîéñèñòåìû – ó 21 (61,8%), ñ çàáîëåâàíèÿìèìî÷åâûäåëèòåëüíîé ñèñòåìû – ó 12 (35,3%)



áîëüíûõ. Âî 2-é ãðóïïå ïîäîáíûå ñî÷åòàíèÿáûëè îòìå÷åíû â 18 (48,6%), 23 (62,2%)è 14 (37,8%) ñëó÷àÿõ ñîîòâåòñòâåííî.

Àíàëèç êëèíèêî-ëàáîðàòîðíûõ è ðåíò-ãåíîëîãè÷åñêèõ äàííûõ íå âûÿâèë êàêèõ-ëèáîñóùåñòâåííûõ ðàçëè÷èé ìåæäó ïàöèåíòàìèñðàâíèâàåìûõ ãðóïï. Îöåíêà êëèíè÷åñêîéýôôåêòèâíîñòè îñóùåñòâëÿëàñü íà îñíîâàíèèêîìïëåêñíîãî àíàëèçà êëèíè÷åñêèõ, ëàáîðà-òîðíûõ è ðåíòãåíîëîãè÷åñêèõ äàííûõ.

Â 1-é ãðóïïå çàâåðøèëè ëå÷åíèå 32 ïà-öèåíòà, â äâóõ ñëó÷àÿõ ïîòðåáîâàëîñü äîáàâ-ëåíèå ê òåðàïèè ëåâîôëîêñàöèíà. Òàêèì îá-ðàçîì, êëèíè÷åñêàÿ ýôôåêòèâíîñòü ïðèìåíå-íèÿ «çàùèùåííûõ» àìèíîïåíèöèëëèíîâ ñî-ñòàâèëà 94%. Äëèòåëüíîñòü ëå÷åíèÿ ñîñòàâèëàâ ñðåäíåì 8 äíåé (7,3±1,4), âðåìÿ ðåíòãåíî-ëîãè÷åñêîãî ðàçðåøåíèÿ ïíåâìîíèè –14,3±4,7 äíÿ, à ñðåäíÿÿ äëèòåëüíîñòü íàõîæ-äåíèÿ áîëüíîãî â ñòàöèîíàðå – 15,3±7,8 äíÿ.Íåæåëàòåëüíûå ðåàêöèè íàáëþäàëèñü â 23,5%ñëó÷àåâ: êàê ïðàâèëî, ýòî áûëè ïðåõîäÿùèåíàðóøåíèÿ ñî ñòîðîíû æåëóäî÷íî-êèøå÷íî-ãî òðàêòà, óìåðåííîå è òðàíçèòîðíîå ïîâû-øåíèå àêòèâíîñòè ïå÷åíî÷íûõ òðàíñàìèíàç

è ëèøü ó îäíîãî ïàöèåíòà ïðåïàðàò áûë îò-ìåíåí ââèäó ðàçâèâøåéñÿ äèàðåè.

Âî 2-é ãðóïïå èñïîëüçîâàíèå ðåñïè-ðàòîðíûõ ôòîðõèíîëîíîâ ïîòðåáîâàëîñüó 6 ïàöèåíòîâ, è, òàêèì îáðàçîì, êëèíè÷åñ-êàÿ ýôôåêòèâíîñòü ñòàðòîâîé òåðàïèè ñ ïðè-ìåíåíèåì öåôàëîñïîðèíîâ III ïîêîëåíèÿñîñòàâèëà 83,7%. Íåæåëàòåëüíûå ÿâëåíèÿîòìå÷àëèñü â 21,6% ñëó÷àåâ: ïîâûøåíèåàêòèâíîñòè òðàíñàìèíàç (ÀËÒ, ACT) èìåëîìåñòî ó ÷åòûðåõ ïàöèåíòîâ, ýîçèíîôèëèÿ –ó äâóõ, äèñïåïòè÷åñêèå ÿâëåíèÿ – òàêæåó äâóõ ïàöèåíòîâ.

Ñðàâíèòåëüíûé àíàëèç êëèíè÷åñêîéýôôåêòèâíîñòè è áåçîïàñíîñòè èññëåäóåìûõðåæèìîâ àíòèáèîòèêîòåðàïèè ïðîäåìîíñò-ðèðîâàë î÷åâèäíîå ïðåèìóùåñòâî «çàùèùåí-íûõ» àìèíîïåíèöèëëèíîâ ïåðåä ñóùåñòâó-þùåé ïðàêòèêîé ëå÷åíèÿ íåòÿæåëîé ÂÏó ïàöèåíòîâ ñòàðøå 60 ëåò. Òàêèì îáðàçîì,ýòè ïðåïàðàòû äîëæíû ðàññìàòðèâàòüñÿ â êà-÷åñòâå ëåêàðñòâåííûõ ñðåäñòâ ïåðâîãî ðÿäàïðè ëå÷åíèè âíåáîëüíè÷íîé ïíåâìîíèè óãîñïèòàëèçèðîâàííûõ ïàöèåíòîâ ñòàðøèõâîçðàñòíûõ ãðóïï.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ [616.98:378.833.2]-057.36-036.22(571.63)

Èóíèõèíà Î.Â.1, Êîìïàíåö Ã.Ã.1, Ñîëîâåé À.Ë.2, Ðûáàêîâà Í.À.2, Íàäóäà Å.À.3

– Ãåìîððàãè÷åñêàÿ ëèõîðàäêà ñ ïî÷å÷íûì ñèíäðîìîì ñðåäè âîåííîñëóæàùèõâ Ïðèìîðñêîì êðàå.1Íàó÷íî-èññëåäîâàòåëüñêèé èíñòèòóò ýïèäåìèîëîãèè è ìèêðîáèîëîãèè èì. Ã.Ï.Ñîìîâà,ã. Âëàäèâîñòîê; 21029-é Öåíòð ãîñóäàðñòâåííîãî ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî íàäçîðàÌÎ ÐÔ, ã. Óññóðèéñê, Ïðèìîðñêèé êðàé; 3439-é âîåííûé ãîñïèòàëü ÌÎ ÐÔ, ã. Óññóðèéñê,Ïðèìîðñêèé êðàé

Ïðîâåäåíî èçó÷åíèå îñîáåííîñòåé çàáîëåâàåìîñòè ãåìîððàãè÷åñêîé ëèõîðàäêîé ñ ïî÷å÷íûìñèíäðîìîì âîåííîñëóæàùèõ íà òåððèòîðèè Ïðèìîðñêîãî êðàÿ è ñâÿçü ïðîÿâëåíèé èíôåêöèèñ ýïèçîîòè÷åñêèì ïðîöåññîì ñðåäè ïðèðîäíûõ íîñèòåëåé õàíòàâèðóñà. Óñòàíîâëåíî, ÷òîçàáîëåâàåìîñòü âîåííîñëóæàùèõ ýòîé èíôåêöèåé ñ 2001 ïî 2015 ã. õàðàêòåðèçîâàëàñüïðåîáëàäàíèåì ëèö ñðåäíåãî âîçðàñòà, ñâÿçüþ òÿæåñòè êëèíè÷åñêîãî òå÷åíèÿ ñ óñëîâèÿìèçàðàæåíèÿ, ñåçîííûì è ìíîãîëåòíèì ðàñïðåäåëåíèåì ñëó÷àåâ è îñîáåííîñòÿìè ýïèçîîòè÷åñêîãîïðîöåññà ñðåäè ìûøåâèäíûõ ãðûçóíîâ – ïðèðîäíûõ íîñèòåëåé õàíòàâèðóñà. Çàðàæåíèåîðòîõàíòàâèðóñîì âîåííîñëóæàùèõ ïðîèñõîäèëî êàê â áûòîâûõ óñëîâèÿõ, òàê è â ïðîöåññåâîåííî-ïðîôåññèîíàëüíîé äåÿòåëüíîñòè. Âûÿâëåíû îáñòîÿòåëüñòâà íàèáîëåå ÷àñòîãîâîçíèêíîâåíèÿ ñïîðàäè÷åñêèõ è ãðóïïîâûõ ñëó÷àåâ çàáîëåâàíèé.

Ê ë þ ÷ å â û å ñ ë î â à: ãåìîððàãè÷åñêàÿ ëèõîðàäêà ñ ïî÷å÷íûì ñèíäðîìîì, âîåííîñëóæàùèå,Ïðèìîðñêèé êðàé, çàáîëåâàåìîñòü

Iunikhina O.V., Kompanets G.G., Solovei A.L., Rybakova N.A., Naduda E.A. – Hemorrhagic feverwith renal syndrome among military personnel in Primorsky Krai. A study was made of the specificfeatures of the incidence of hemorrhagic fever with renal syndrome among military personnel in theterritory of Primorsky Krai and the relationship between the manifestations of infection and the epizooticprocess among natural carriers of hantavirus. It was established that the incidence of this infection from2001 to 2015 was characterized by a predominance of middle-aged persons, a connection between theseverity of the clinical course and infection conditions, a seasonal and long-term distribution of casesand features of the epizootic process among murine rodents – natural carriers of hantavirus. Infectionwith ortho-hantavirus among military personnel took place both in domestic conditions and in theprocess of military professional activity. The circumstances of the most frequent occurrence of sporadicand group cases of diseases are revealed.

K e y w o r d s: hemorrhagic fever with renal syndrome, military, Primorsky Krai, incidence.



Ãåìîððàãè÷åñêàÿ ëèõîðàäêà ñ ïî÷å÷íûìñèíäðîìîì (ÃËÏÑ) – îñòðîå ïðèðîäíî-î÷à-ãîâîå çàáîëåâàíèå îðòîõàíòàâèðóñíîé ýòèî-ëîãèè, øèðîêî ðàñïðîñòðàíåííîå íà òåððè-òîðèè Åâðàçèè. Âàæíîñòü äàííîãî çàáîëåâà-íèÿ äëÿ çäðàâîîõðàíåíèÿ ìíîãèõ ñòðàí îáóñ-ëîâëåíà ïîâñåìåñòíûì îáèòàíèåì ìûøåâèä-íûõ ãðûçóíîâ – ïðèðîäíûõ íîñèòåëåé õàí-òàâèðóñîâ, â ò. ÷. ïàòîãåííûõ äëÿ ÷åëîâåêà,îòñóòñòâèåì âàêöèíû è ðàçíîîáðàçèåì êëè-íè÷åñêèõ ïðîÿâëåíèé èíôåêöèè, ñâÿçàííûìñ îïðåäåëåííûì ñåðîòèïîì âèðóñà.

Ïðîáëåìà ÃËÏÑ âåñüìà çíà÷èìà äëÿâîèíñêèõ êîíòèíãåíòîâ. Çàáîëåâàåìîñòü ðå-ãèñòðèðóåòñÿ íå òîëüêî ñðåäè âîåííîñëóæà-ùèõ, ïðèáûâøèõ â ýíäåìè÷åñêèå î÷àãèõàíòàâèðóñíîé èíôåêöèè èç òåððèòîðèé, ãäåîíà íå âñòðå÷àåòñÿ (McCormic Z.D. et al., 2013),íî è ñðåäè ëèö, ïðèçâàííûõ (ïðîõîäÿùèõâîåííóþ ñëóæáó) èç ÷èñëà ïîñòîÿííî ïðîæè-âàþùåãî çäåñü íàñåëåíèÿ (Ñèäåëüíèêîâ Þ.Í.è ñîàâò., 2014).

Îáùåïðèçíàííûì ÿâëÿåòñÿ âîçäóøíî-ïûëåâîé ïóòü çàðàæåíèÿ ëþäåé îðòîõàíòà-âèðóñàìè – ïðè âäûõàíèè ýêñêðåòîâ èí-ôèöèðîâàííûõ ìûøåâèäíûõ ãðûçóíîâ(Schmaljohn C., Hjelle B., 1997). Óñòàíîâëåíî,÷òî ê ñïîðàäè÷åñêîé è ãðóïïîâîé çàáîëåâàå-ìîñòè ÃËÏÑ ñðåäè âîåííîñëóæàùèõ ïðè-âîäèò íåâûïîëíåíèå ïðîòèâîýïèäåìè÷åñêèõìåð â ïðîöåññå îïðåäåëåííûõ âèäîâ äåÿòåëü-íîñòè – ïåðåäâèæåíèå íà áûñòðîõîäíîé òåõ-íèêå, àðòèëëåðèéñêèå ñòðåëüáû, ïðîæèâàíèåâ ïàëàòêàõ, èñïîëüçîâàíèå ñåíà èç ñòîãîâäëÿ íàñòèëà, îáîðóäîâàíèå îãíåâûõ ïîçèöèé(ðûòüå òðàíøåé, êàïîíèðîâ), ðàñ÷èñòêà ìåñò-íîñòè îò òðàâû è êóñòàðíèêîâ è ïðè äðóãèõðàáîòàõ, ñâÿçàííûõ ñ ïîâûøåííûì ïûëå-îáðàçîâàíèåì, îñîáåííî â ñåçîíû âûñîêîéèíôèöèðîâàííîñòè ïðèðîäíûõ íîñèòåëåéõàíòàâèðóñà (Êàëìûêîâ À.À. è ñîàâò., 2012).

Öåëü íàñòîÿùåãî èññëåäîâàíèÿ ñîñòîÿëàâ èçó÷åíèè îñîáåííîñòåé çàáîëåâàåìîñòèÃËÏÑ ó âîåííîñëóæàùèõ è ñâÿçè ïðîÿâëå-íèé èíôåêöèè ñ ýïèçîîòè÷åñêèì ïðîöåññîìñðåäè ïðèðîäíûõ íîñèòåëåé õàíòàâèðóñà íàòåððèòîðèè Ïðèìîðñêîãî êðàÿ.

Ïðîàíàëèçèðîâàíû ìíîãîëåòíèå äàííûåî çàáîëåâàåìîñòè ÃËÏÑ ñðåäè âîåííîñëóæà-ùèõ (n=69) ñ ëàáîðàòîðíî ïîäòâåðæäåííû-ìè ñëó÷àÿìè çàáîëåâàíèÿ. Âûÿâëåíèå àíòè-òåë ê õàíòàâèðóñàì â ñûâîðîòêàõ êðîâè áîëü-íûõ ÃËÏÑ ïðîâîäèëè íåïðÿìûì ìåòîäîìôëþîðåñöèðóþùèõ àíòèòåë ñ ïîìîùüþ êîì-ìåð÷åñêîãî «Äèàãíîñòèêóìà ãåìîððàãè÷åñêîéëèõîðàäêè ñ ïî÷å÷íûì ñèíäðîìîì êóëüòó-ðàëüíîãî, ïîëèâàëåíòíîãî». Äëÿ ïîäòâåðæ-äåíèÿ îñòðîãî ïåðèîäà çàáîëåâàíèÿ îïðå-äåëÿëè íàëè÷èå àíòèòåë êëàññà IgM, èñïîëü-çóÿ êîììåð÷åñêèé íàáîð ÂåêòîÕàíòà-IgMè ÂåêòîÕàíòà-IgG.

Äèêèõ ìûøåâèäíûõ ãðûçóíîâ îòëàâ-ëèâàëè ñ ïîìîùüþ ñòàíäàðòíîãî ìåòîäà ëî-âóøêî-ëèíèé îñåíüþ è âåñíîé–ëåòîì 2005–2015 ãã. Äåòåêöèþ îðòîõàíòàâèðóñíîãî àíòè-ãåíà â äåñÿòèïðîöåíòíîé ñóñïåíçèè òêàíèîðãàíîâ ãðûçóíîâ ïðîâîäèëè ñ ïîìîùüþèììóíîôåðìåíòíîãî àíàëèçà, èñïîëüçóÿêîììåð÷åñêóþ òåñò-ñèñòåìó «Õàíòàãíîñò».

Äëÿ îáðàáîòêè äàííûõ èñïîëüçîâàëèïàêåò ïðîãðàìì «Statistica 6.0». Îöåíêó äî-ñòîâåðíîñòè ïðîâîäèëè ïî t-êðèòåðèþ Ñòüþ-äåíòà, ðàçëè÷èÿ ñ÷èòàëè äîñòîâåðíûìè ïðèp≤0,05.

Ïðèìîðñêèé êðàé ÿâëÿåòñÿ ýíäåìè÷íîéïî ÃËÏÑ òåððèòîðèåé ñ åæåãîäíîé ðåãèñò-ðàöèåé ñëó÷àåâ ñðåäè íàñåëåíèÿ. Íåñìîòðÿ íàíåâûñîêèé óðîâåíü çàáîëåâàåìîñòè (ñðåäíå-ìíîãîëåòíèé ïîêàçàòåëü 3,4 íà 100 òûñ. íàñå-ëåíèÿ), äëÿ äàííîé èíôåêöèè õàðàêòåðíûòÿæåëîå òå÷åíèå è âûñîêàÿ ñìåðòíîñòü –â îòäåëüíûå ãîäû äî 9,2% ïðè ñðåäíåìíîãî-ëåòíèõ ïîêàçàòåëÿõ 2,2% (Êîìïàíåö Ã.Ã.è Èóíèõèíà Î.Â., 2014). Îñîáåííîñòè ýïè-äåìè÷åñêèõ ïðîÿâëåíèé ÃËÏÑ íà òåððèòî-ðèè êðàÿ îáóñëîâëåíû öèðêóëÿöèåé òðåõïàòîãåííûõ äëÿ ÷åëîâåêà ãåíîòèïîâ õàíòà-âèðóñà: ãåíîâàðèàíò Vladivostok (VDV) âè-ðóñà Seoul, îáóñëàâëèâàþùèé áîëüøóþ÷àñòü çàáîëåâàåìîñòè â ã. Âëàäèâîñòîêå, ãåíî-âàðèàíò Far East âèðóñà Hantaan è âèðóñAmur, ðàñïðîñòðàíåííûå íà òåððèòîðèè êðàÿ,îäíàêî âñòðå÷àþùèåñÿ è â êðàåâîì öåíòðå(ßøèíà Ë.Í., 2012).

Çà àíàëèçèðóåìûé ïåðèîä (2001–2015 ãã.)÷èñëî çàáîëåâàíèé âîåííîñëóæàùèõ ÃËÏÑâ Ïðèìîðñêîì êðàå ñîñòàâèëî â ãîðîäñêîìýïèäåìè÷åñêîì î÷àãå (ã. Âëàäèâîñòîê) 12 ñëó-÷àåâ, â ñåëüñêîì – 56. Èìåë ìåñòî åäèíè÷-íûé «çàâîçíîé» ñëó÷àé çàðàæåíèÿ âîåííî-ñëóæàùåãî, íàõîäèâøåãîñÿ íà îòäûõåâ åâðîïåéñêîé ÷àñòè Ðîññèè, õàíòàâèðó-ñîì Puumala, íå öèðêóëèðóþùèì íà òåððè-òîðèè êðàÿ.

Ñðåäè áîëüíûõ âîåííîñëóæàùèõ ïðå-îáëàäàëè ìóæ÷èíû (67 ñëó÷àåâ èç 68).Ñðåäíèé âîçðàñò ñîñòàâèë 31,08±3,27 è 27,73±1,25 ãîäà â ãîðîäñêîì è ñåëüñêîì î÷àãàõñîîòâåòñòâåííî (ðàçëè÷èÿ ñòàòèñòè÷åñêè íåçíà÷èìû – ð>0,05).

Ñðåäè âîåííîñëóæàùèõ ãàðíèçîíà Âëà-äèâîñòîê êîëè÷åñòâî ñëó÷àåâ ñðåäíåòÿæåëîéè òÿæåëîé èíôåêöèè áûëî áëèçêèì (6 è 5ñîîòâåòñòâåííî), îäèí ñëó÷àé ïðîòåêàë ëåãêî,ëåòàëüíûõ èñõîäîâ íå çàðåãèñòðèðîâàíî. Ñ÷è-òàåòñÿ, ÷òî â ãîðîäñêîì ýïèäåìè÷åñêîì î÷à-ãå, â àðåàëå öèðêóëÿöèè âèðóñà Seoul, ÷àùåâñòðå÷àþòñÿ ëåãêèå è ñðåäíåòÿæåëûå êëèíè-÷åñêèå ôîðìû èíôåêöèè, ÷òî ñâÿçàíî ñ áèî-ëîãè÷åñêèìè îñîáåííîñòÿìè âîçáóäèòåëÿ.Ïðåîáëàäàíèå áîëåå òÿæåëûõ ôîðì ÃËÏÑñðåäè âîåííîñëóæàùèõ, ïî ñðàâíåíèþ ñ ãðàæ-



äàíñêèì íàñåëåíèåì, ñâÿçàíî ñ ðàñïîëîæåíè-åì áîëüøèíñòâà âîèíñêèõ ÷àñòåé â ëåñíûõìàññèâàõ, ãäå ñôîðìèðîâàí ñìåøàííûé ãî-ðîäñêîé î÷àã ñ öèðêóëÿöèåé òðåõ ñåðîòèïîâîðòîõàíòàâèðóñîâ, îòëè÷àþùèõñÿ âûðà-æåííîñòüþ è ðàçíîîáðàçèåì ïðîÿâëåíèéèíôåêöèè. Âûïîëíåíèå ðàáîò â çàêðûòûõ,ïëîõî ïðîâåòðèâàåìûõ ïîìåùåíèÿõ èëè íàñóäàõ Òèõîîêåàíñêîãî ôëîòà, ïðèâîäÿùèõê âäûõàíèþ âûñîêîé äîçû ïàòîãåíà, îñîáåí-íî ïðè èíòåíñèâíîé ôèçè÷åñêîé íàãðóçêå,òàêæå ìîæåò âëèÿòü íà òÿæåñòü êëèíè÷åñêèõïðîÿâëåíèé ÃËÏÑ.

Â ñåëüñêîì î÷àãå ñòàòèñòè÷åñêè äîñòî-âåðíî ïðåîáëàäàëè ñðåäíåòÿæåëûå ôîðìûÃËÏÑ (58,9%, p≤0,05), òÿæåëûå ñîñòàâèëè33,9%, ëåãêèå – 7,1%. Ïîêàçàòåëü ëåòàëüíîñ-òè ñðåäè âîåííîñëóæàùèõ â ñåëüñêîì î÷àãåñîñòàâèë 5,4%.

Ñåçîííîå ðàñïðåäåëåíèå ñëó÷àåâ ÃËÏÑñðåäè âîåííîñëóæàùèõ ãàðíèçîíà Âëàäèâî-ñòîê õàðàêòåðíî äëÿ çàáîëåâàåìîñòè, îáóñëîâ-ëåííîé âèðóñîì Seoul (íîñèòåëü Rattusnorvegicus – ñåðàÿ êðûñà). Ñëó÷àè ðåãèñòðè-ðîâàëèñü ñ àïðåëÿ ïî íîÿáðü ñ ïèêîì â ìàå.Â ñåëüñêîì ýïèäåìè÷åñêîì î÷àãå çàáîëåâàå-ìîñòü âñòðå÷àëàñü êðóãëîãîäè÷íî ñ óâåëè÷å-íèåì â ëåòíå-îñåííèé ïåðèîä, ÷òî ñâÿçàíîíå òîëüêî ñ óñèëåíèåì ýïèçîîòè÷åñêîãî ïðî-öåññà â ïîïóëÿöèÿõ ïðèðîäíûõ õîçÿåâ îðòî-õàíòàâèðóñîâ, íî è ñ ïðîâåäåíèåì øèðîêî-ìàñøòàáíûõ âîåííûõ ó÷åíèé â ýïèäåìè÷åñ-êèõ î÷àãàõ èíôåêöèè â äàííûé ïåðèîä.

Àíàëèç ïðè÷èí âîçìîæíîãî çàðàæåíèÿâîåííîñëóæàùèõ ÃËÏÑ âûÿâèë, ÷òî â 78,3%ñëó÷àåâ èíôèöèðîâàíèå áûëî ñâÿçàíî ñ îñî-áåííîñòÿìè ïðîõîæäåíèÿ âîèíñêîé ñëóæáû(ó÷àñòèå â ïîëåâûõ ó÷åíèÿõ, ñëóæáà â ÷àñòÿõÒèõîîêåàíñêîãî ôëîòà è íà ïîãðàíè÷íûõ çà-ñòàâàõ, ðàáîòà â ãàðàæàõ è íà ïðîäîâîëüñòâåí-íûõ è âåùåâûõ ñêëàäàõ). 17,4% ñëó÷àåâ ïðè-õîäèëîñü íà çàðàæåíèÿ â áûòîâûõ óñëîâèÿõè 4,3% – ïðè âûåçäàõ â î÷àãè îðòîõàíòàâè-ðóñíîé èíôåêöèè ñ öåëüþ îòäûõà.

Âî âëàäèâîñòîêñêîì ãàðíèçîíå ãðóïïî-âûõ ñëó÷àåâ ÃËÏÑ ñðåäè âîåííîñëóæàùèõíå íàáëþäàëîñü.

Íà òåððèòîðèè Ïðèìîðñêîãî êðàÿ íà ôîíåñïîðàäè÷åñêîé çàáîëåâàåìîñòè óñòàíîâëåíîïÿòü ãðóïïîâûõ ñëó÷àåâ ÃËÏÑ ñðåäè âîåííî-ñëóæàùèõ. ×èñëî çàáîëåâøèõ ïðè ýòîì êîëå-áàëîñü îò äâóõ äî âîñüìè. Â òðåõ ñëó÷àÿõ çà-ðàæåíèå ïðîèçîøëî â äåêàáðå è áûëî ñâÿ-çàíî ñ ïîÿâëåíèåì èíôèöèðîâàííûõ îðòîõàí-òàâèðóñîì ìûøåâèäíûõ ãðûçóíîâ â æèëûõ èïðîèçâîäñòâåííûõ ïîìåùåíèÿõ (ïðîäóêòîâûåè âåùåâûå ñêëàäû, ãàðàæè) âîéñêîâûõ ÷àñòåé.Â äâóõ ñëó÷àÿõ çàáîëåâàíèå çàðåãèñòðèðîâà-íî íà ëåñîñòåïíîé òåððèòîðèè â Óññóðî-Õàí-êàéñêîé î÷àãîâîé ïðîâèíöèè íà ôîíå ïîäú-åìà àêòèâíîñòè ýïèçîîòè÷åñêîãî ïðîöåññà

(2010, 2013 ãã.) â ïîïóëÿöèè ïîëåâîé ìûøè,íîñèòåëÿ âèðóñà Hantaan (÷èñëåííîñòü12,1 îñîáè íà 100 ëîâóøêî/íî÷åé (100 ë/í),èíôèöèðîâàííîñòü 0,7 îñîáè íà 100 ë/í),à â 2005 ã. íà òåððèòîðèè Âîñòî÷íî-Ñèõîòý-Àëèíüñêîé î÷àãîâîé ïðîâèíöèè íà òàåæíîéòåððèòîðèè íà ôîíå ïèêà ýïèçîîòè÷åñêîãîïðîöåññà ñðåäè âîñòî÷íîàçèàòñêîé ìûøè, íî-ñèòåëÿ âèðóñà Amur (÷èñëåííîñòü 20,5 îñîáèíà 100 ë/í, èíôèöèðîâàííîñòü 5,6 îñîáèíà 100 ë/í). Êîëè÷åñòâî áîëüíûõ âî âñåõñëó÷àÿõ ñîñòàâèëî äâà ÷åëîâåêà.

Â äâóõ ñëó÷àÿõ ãðóïïîâàÿ çàáîëåâàåìîñòüðåãèñòðèðîâàëàñü â èþíå è àâãóñòå 2010 ã.ñðåäè âîåííîñëóæàùèõ, ó÷àñòâîâàâøèõâ ìàñøòàáíûõ ïîëåâûõ ó÷åíèÿõ íà ïîëèãîíàõÏðèìîðñêîãî êðàÿ (Õàíêàéñêèé è Ïîãðàíè÷-íûé ðàéîíû). Ïðè èçó÷åíèè íàèáîëåå ìíîãî-÷èñëåííîãî ñëó÷àÿ ãðóïïîâîé çàáîëåâàåìîñ-òè çà ïîñëåäíèå 15 ëåò íàáëþäåíèé (8 ÷åëî-âåê) óñòàíîâëåíî, ÷òî åãî ïðè÷èíîé ÿâèëîñüíåâûïîëíåíèå ïðîòèâîýïèäåìè÷åñêèõ ìåð,ïðåäóñìîòðåííûõ íîðìàòèâíûìè äîêóìåí-òàìè. Òàê, íå ïðîâîäèëîñü ïðåäâàðèòåëüíîåèçó÷åíèå ýïèçîîòè÷åñêîãî ïðîöåññà ñðåäèïðèðîäíûõ íîñèòåëåé õàíòàâèðóñà, îòñóòñòâî-âàëè çàùèòíûå ðâû âîêðóã ïàëàòîê, íå áûëèîáîðóäîâàíû ìåñòà ñáîðà áûòîâûõ îòõîäîâ,íå îñóùåñòâëÿëèñü äåðàòèçàöèîííûå ìåðî-ïðèÿòèÿ. Â íåïîñðåäñòâåííîé áëèçîñòè îò ðàñ-ïîëîæåíèÿ âîåííîñëóæàùèõ íàõîäèëîñü ïîëåíåóáðàííîé ñ ïðîøëîãî ãîäà êóêóðóçû. Âñåýòî, à òàêæå ïåðåäâèæåíèå òÿæåëîé âîåííîéòåõíèêè ñ îáðàçîâàíèåì ïûëåâîãî àýðîçîëÿ,èíôèöèðîâàííîãî õàíòàâèðóñîì, ïðèâåëîê ðîñòó çàáîëåâàåìîñòè ÃËÏÑ ñðåäè âîåííî-ñëóæàùèõ. Ïðè îáñëåäîâàíèè ìûøåâèäíûõãðûçóíîâ, îòëîâëåííûõ ÷åðåç ìåñÿö ïîñëåîêîí÷àíèÿ âîåííûõ ó÷åíèé â Õàíêàéñêîìðàéîíå, ïðè ÷èñëåííîñòè 19,1 îñîáèíà 100 ë/í è èíôèöèðîâàííîñòè 2,9 îñîáèíà 100 ë/í áûëî îáíàðóæåíî íàëè÷èå õàíòà-âèðóñíîãî àíòèãåíà â ëåãêèõ, ïî÷êàõ, ñëþí-íûõ æåëåçàõ, êèøå÷íèêå.

Èçó÷åíèå òåððèòîðèàëüíîãî ðàñïðåäåëå-íèÿ ñëó÷àåâ ÃËÏÑ ïîêàçàëî, ÷òî îíè èìåëèìåñòî âî âñåõ ðàéîíàõ Ïðèìîðñêîãî êðàÿ, íîáîëüøèíñòâî (29%) áûëî çàðåãèñòðèðîâàíîâ Óññóðèéñêîì, Õàíêàéñêîì è Ïîãðàíè÷íîì,ãäå áàçèðóþòñÿ íàèáîëåå êðóïíûå âîåííûåïîëèãîíû.

Â Û Â Î Ä Û1. Çàáîëåâàåìîñòü âîåííîñëóæàùèõ

ÃËÏÑ â Ïðèìîðñêîì êðàå â 2001–2015 ãã.õàðàêòåðèçîâàëàñü ïðåîáëàäàíèåì ëèö ñðåä-íåãî âîçðàñòà, ñâÿçüþ òÿæåñòè êëèíè÷åñêîãîòå÷åíèÿ ñ óñëîâèÿìè çàðàæåíèÿ, ñåçîííûìè ìíîãîëåòíèì ðàñïðåäåëåíèåì ñëó÷àåâè îñîáåííîñòÿìè ýïèçîîòè÷åñêîãî ïðîöåññàñðåäè ìûøåâèäíûõ ãðûçóíîâ – ïðèðîäíûõíîñèòåëåé õàíòàâèðóñà.



2. Çàðàæåíèå âîåííîñëóæàùèõ îðòî-õàíòàâèðóñîì ïðîèñõîäèëî ïðè íåâûïîëíå-íèè ïðîòèâîýïèäåìè÷åñêèõ ìåðîïðèÿòèéêàê â áûòîâûõ óñëîâèÿõ, òàê è â ïðîöåññåâîåííî-ïðîôåññèîíàëüíîé äåÿòåëüíîñòè.Íàèáîëåå ÷àñòî âîçíèêíîâåíèå ñïîðàäè÷åñ-

êèõ è ãðóïïîâûõ ñëó÷àåâ ÃËÏÑ ñâÿçàíîñ ïîëåâûìè ó÷åíèÿìè, ðàáîòîé â ïàðêàõ âî-åííîé òåõíèêè, íà ñêëàäàõ, à òàêæå ñ âû-ïîëíåíèåì çàäà÷ íà ïîãðàíè÷íûõ çàñòàâàõ,â âîèíñêèõ ÷àñòÿõ è íà ñóäàõ Òèõîîêåàí-ñêîãî ôëîòà.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ 616-036.82/85:614.2

Õìèëü À.ß.1, Ùåãîëüêîâ À.Ì.2, Áåëîâ Ä.Ô.1, Ìîë÷àíîâ Á.À.1 – Îñîáåííîñòèïðîâåäåíèÿ ìåäèöèíñêîé ðåàáèëèòàöèè â óñëîâèÿõ ìíîãîïðîôèëüíîãîñòàöèîíàðà.1Ëå÷åáíî-ðåàáèëèòàöèîííûé êëèíè÷åñêèé öåíòð ÌÎ ÐÔ, Ìîñêâà; 2Ôèëèàë Âîåííî-ìåäè-öèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà, Ìîñêâà

Îñâåùåí îïûò ðàáîòû Ëå÷åáíî-ðåàáèëèòàöèîííîãî êëèíè÷åñêîãî öåíòðà ÌÎ ÐÔ. Ýòîòìíîãîïðîôèëüíûé ðåàáèëèòàöèîííûé ñòàöèîíàð áëàãîäàðÿ øòàòíî-îðãàíèçàöèîííîé ñòðóêòóðå,îñíàùåííîñòè è óêîìïëåêòîâàííîñòè âûñîêîêâàëèôèöèðîâàííûìè ñïåöèàëèñòàìèèìååò âîçìîæíîñòü ïðîâîäèòü êîìïëåêñíóþ ìåäèöèíñêóþ ðåàáèëèòàöèþ áîëüíûì âñåõðåàáèëèòàöèîííûõ ïðîôèëåé. Â íåì ýôôåêòèâíî ðàáîòàþò ìóëüòèäèñöèïëèíàðíûå áðèãàäû,èñïîëüçóþòñÿ âñå ñîâðåìåííûå ìåòîäû ìåäèöèíñêîé ðåàáèëèòàöèè. Ïðåäñòàâëåíû ñâèäåòåëüñòâàâûñîêîé ðåçóëüòàòèâíîñòè ëå÷åáíî-ðåàáèëèòàöèîííûõ ìåðîïðèÿòèé, ÷åì îáåñïå÷èâàåòñÿñóùåñòâåííîå ïîïîëíåíèå ðåàáèëèòàöèîííîãî ïîòåíöèàëà âîåííî-ìåäèöèíñêîé ñëóæáû. Ïîêàçàíàíåîáõîäèìîñòü äàëüíåéøåãî ñîâåðøåíñòâîâàíèÿ îðãàíèçàöèè ìåäèöèíñêîé ðåàáèëèòàöèèâîåííîñëóæàùèõ ñ èñïîëüçîâàíèåì âîçìîæíîñòåé ñîâðåìåííîãî ìíîãîïðîôèëüíîãîðåàáèëèòàöèîííîãî öåíòðà â ñèñòåìå îêàçàíèÿ ìåäèöèíñêîé ïîìîùè ðàíåíûì è áîëüíûì.

Ê ë þ ÷ å â û å ñ ë î â à: ìåäèöèíñêàÿ ðåàáèëèòàöèÿ, ìíîãîïðîôèëüíûé ðåàáèëèòàöèîííûéñòàöèîíàð, ýôôåêòèâíîñòü ëå÷åáíî-ðåàáèëèòàöèîííûõ ìåðîïðèÿòèé.

Khmil A.Ya., Shchegolkov A.M., Belov D.F., Molchanov B.A. – Pecularities of medical rehabilitation ina multidisciplinary hospital. The experience of the Medical and Rehabilitation Clinical Center of theMinistry of Defense of the Russian Federation is highlighted. This multi-disci plinary rehabilitationhospital, due to its staffing and organizational structure, equipment and staffing with highly qualifiedspecialists, has the opportunity to conduct comprehensive medical rehabilitation for patients of allrehabilitation profiles. It effectively works multidisci plinary teams, using all modern methods of medicalrehabilitation. Evidence is presented of the high performance of medical rehabilitation measures, thusensuring a substantial replenishment of the rehabilitation potential of the military medical service.The necessity of further improving the organization of medical rehabilitation of military personnel usingthe capabilities of a modern multidisciplinary rehabilitation center in the system of medical care for thewounded and sick has been shown.

K e y w o r d s: medical rehabilitation, multidisci plinary rehabilitation hospital, the effectivenessof treatment and rehabilitation activities.

Ìåäèöèíñêàÿ ðåàáèëèòàöèÿ ÿâëÿåòñÿíåîòúåìëåìîé ñîñòàâíîé ÷àñòüþ ìåäèöèí-ñêîãî îáåñïå÷åíèÿ Âîîðóæåííûõ Ñèë. Îíàïðåäñòàâëÿåò ñîáîé äèôôåðåíöèðîâàííóþñèñòåìó ëå÷åáíî-ïðîôèëàêòè÷åñêèõ ìåðî-ïðèÿòèé ïî âîññòàíîâëåíèþ ôóíêöèîíàëü-íîãî ñîñòîÿíèÿ îðãàíèçìà ðàíåíûõ è áîëü-íûõ âîåííîñëóæàùèõ äî îïòèìóìà áîåñïî-ñîáíîñòè ïîñðåäñòâîì ïðååìñòâåííîãî è ïî-ñëåäîâàòåëüíîãî ïðèìåíåíèÿ èíäèâèäóàëè-çèðîâàííîãî êîìïëåêñà ìåäèêàìåíòîçíûõ,õèðóðãè÷åñêèõ, ôèçè÷åñêèõ, ïñèõîëîãè÷åñêèõ,ïñèõîôèçèîëîãè÷åñêèõ è èììóíîêîððèãèðó-þùèõ ìåòîäîâ âîçäåéñòâèÿ íà ôóíêöèîíàëü-íî èëè ïàòîëîãè÷åñêè èçìåíåííûå ñèñòåìûîðãàíèçìà.

Äàëüíåéøåå ðàçâèòèå ñèñòåìû ìåäèöèí-ñêîé ðåàáèëèòàöèè ñâÿçàíî ñ ôîðìèðîâàíè-

åì íîâûõ ñïåöèàëèçèðîâàííûõ ñîâðåìåííûõó÷ðåæäåíèé ðåàáèëèòàöèîííîãî ïðîôèëÿ.2 äåêàáðÿ 2013 ã. ìèíèñòðîì îáîðîíû ÐÔïîäïèñàí ïðèêàç ¹ 859 î ñîçäàíèè Ëå÷åáíî-ðåàáèëèòàöèîííîãî êëèíè÷åñêîãî öåíòðà Ìèí-îáîðîíû ÐÔ (ËÐÊÖ). Â åãî ñîñòàâ âîøëèêàê ñòðóêòóðíûå ïîäðàçäåëåíèÿ: ïîëèêëèíèêà(áûâøèé Ìåäèöèíñêèé öåíòð ÑïåöñòðîÿÐîññèè), ôèëèàë ¹ 1 (áûâøèé Öåíòðàëüíûéâîåííûé ãîñïèòàëü Ñïåöñòðîÿ Ðîññèè),ôèëèàë ¹ 2 (áûâøèé âîåííûé ñàíàòîðèé«Ôðåãàò»).

Ñòðóêòóðà ËÐÊÖ êàê ìíîãîïðîôèëü-íîãî ìåäèöèíñêîãî ó÷ðåæäåíèÿ, îñíà-ùåííîñòü è óêîìïëåêòîâàííîñòü âûñîêî-êâàëèôèöèðîâàííûìè ñïåöèàëèñòàìè äàþòâîçìîæíîñòü îêàçûâàòü íà ñîâðåìåííîìóðîâíå âñå âèäû ìåäèöèíñêîé ïîìîùè

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(ïåðâè÷íóþ ìåäèêî-ñàíèòàðíóþ è ñïåöèà-ëèçèðîâàííóþ âûñîêîòåõíîëîãè÷íóþ ïî-ìîùü, ìåäèöèíñêóþ ðåàáèëèòàöèþ) íà÷è-íàÿ ñ ýòàïà ñêîðîé è íåîòëîæíîé ïîìîùè,äàëåå – ïîëèêëèíèêà, ñòàöèîíàð ñ ðå-àáèëèòàöèîííûìè êîéêàìè è çàêàí÷èâàÿíàïðàâëåíèåì â ñàíàòîðèé.

Îñíîâíîé îáúåì ðåàáèëèòàöèîííîé ïî-ìîùè âûïîëíÿåò ôèëèàë ¹ 1 ËÐÊÖ (öåí-òðàëüíûé âîåííûé ãîñïèòàëü). Îí èìååò âñâîåì ñîñòàâå ìíîãîïðîôèëüíûé ñòàöèîíàðíà 500 êîåê, êîíñóëüòàòèâíîå îòäåëåíèå íà60 ïîñåùåíèé â ñìåíó, ãäå âåäåòñÿ ïðèåìïî 14 ñïåöèàëüíîñòÿì, öåíòð ðåàíèìàöèèè èíòåíñèâíîé òåðàïèè, îòäåëåíèå ôóíêöèî-íàëüíîé äèàãíîñòèêè, ýíäîñêîïè÷åñêîå îò-äåëåíèå, îòäåëåíèå ëó÷åâîé äèàãíîñòèêèñ ìàãíèòíî-ðåçîíàíñíîé è êîìïüþòåðíîéòîìîãðàôèåé, êëèíèêî-äèàãíîñòè÷åñêóþ ëà-áîðàòîðèþ. Â ãîñïèòàëå îñíîâíûì ïîäðàç-äåëåíèåì, ïðîâîäÿùèì ðåàáèëèòàöèþ, ÿâ-ëÿåòñÿ ëå÷åáíî-ðåàáèëèòàöèîííûé öåíòð,â ñîñòàâ êîòîðîãî âõîäÿò îòäåëåíèÿ ËÔÊ,ôèçèîòåðàïèè, ãèïåðáàðè÷åñêîé îêñèãåíà-öèè è êàáèíåòû ïñèõîòåðàïèè, ðåàáèëèòà-öèè çàáîëåâàíèé îïîðíî-äâèãàòåëüíîãî àï-ïàðàòà, íåéðîðåàáèëèòàöèè.

Ìåäèöèíñêàÿ ðåàáèëèòàöèÿ îñóùåñòâëÿ-åòñÿ â äâà ýòàïà:

– ïåðâûé ýòàï ïðîâîäèòñÿ â îñòðûé ïå-ðèîä çàáîëåâàíèÿ èëè òðàâìû â îòäåëåíèèðåàíèìàöèè è èíòåíñèâíîé òåðàïèè ïî ïðî-ôèëþ îñíîâíîãî çàáîëåâàíèÿ;

– âòîðîé ýòàï âûïîëíÿåòñÿ â ðàííèéâîññòàíîâèòåëüíûé ïåðèîä òå÷åíèÿ çàáîëå-âàíèÿ èëè òðàâìû, â ïåðèîä îñòàòî÷íûõ ÿâ-ëåíèé òå÷åíèÿ çàáîëåâàíèÿ, ïðè õðîíè÷åñ-êîì òå÷åíèè çàáîëåâàíèÿ âíå îáîñòðåíèÿ ïîïðîôèëÿì â îòäåëåíèÿõ, èìåþùèõ ðåàáèëè-òàöèîííûå êîéêè.

Â ïðîöåññå ïðàêòè÷åñêîé ðàáîòû îïðå-äåëåíû îñíîâíûå óñëîâèÿ óñïåøíîñòè ïðî-âåäåíèÿ êîìïëåêñíîé ìåäèöèíñêîé ðåàáè-ëèòàöèè:

1. Íàëè÷èå êîìàíäû âðà÷åé ðàçëè÷íî-ãî ïðîôèëÿ. Òàêîé ïîäõîä ê ðåàáèëèòàöèèíàçûâàþò ìóëüòèäèñöèïëèíàðíûì. Îí ïðåä-ïîëàãàåò êîìïëåêñíóþ îöåíêó ñîñòîÿíèÿïàöèåíòà â ñàìûå ðàçíûå ñðîêè ïàòîëîãè-÷åñêîãî ïðîöåññà, à òàêæå âûðàáîòêó ðåøå-íèÿ íà îñíîâå êîíñèëèóìà. Â ìóëüòèäèñ-öèïëèíàðíóþ áðèãàäó âõîäÿò ëå÷àùèé âðà÷ïî ïðîôèëþ çàáîëåâàíèÿ, âðà÷ ËÔÊ, âðà÷-ôèçèîòåðàïåâò, ëîãîïåä, ýðãîòåðàïåâò, ïñè-õîëîã, íåéðîïñèõîëîã, âðà÷ îòäåëåíèÿ ðåà-íèìàöèè è èíòåíñèâíîé òåðàïèè, ïðè íå-îáõîäèìîñòè – äðóãèå ñïåöèàëèñòû. Òàêàÿáðèãàäà ôóíêöèîíèðóåò â ãîñïèòàëå îò ïî-ñòóïëåíèÿ ïàöèåíòà â îòäåëåíèå ðåàíèìà-öèè è äî åãî âûïèñêè íà ñëåäóþùèé ýòàïðåàáèëèòàöèè.

2. Íàëè÷èå ñîâðåìåííîãî âûñîêîòåõíî-ëîãè÷íîãî ðåàáèëèòàöèîííîãî îáîðóäîâàíèÿ.ËÐÊÖ èìååò òðåíàæåðû ñ áèîëîãè÷åñêîéîáðàòíîé ñâÿçüþ äëÿ âîññòàíîâëåíèÿ ðàâíî-âåñèÿ è õîäüáû, ðîáîòèçèðîâàííîé ìåõàíî-òåðàïèè íèæíèõ è âåðõíèõ êîíå÷íîñòåé,àïïàðàòû äëÿ àêòèâíî-ïàññèâíîé ìåõàíî-òåðàïèè, êîìïüþòåðíûå ïðîãðàììû êîãíè-òèâíîé ðåàáèëèòàöèè, àïïàðàòû-êîìáàéíûäëÿ ôèçèîòåðàïèè, ïîäâîäíûå òðåíàæåðûâ áàññåéíå ëå÷åáíîãî ïëàâàíèÿ.

Â ãîñïèòàëå ðàçâåðíóòû ïðîôèëüíûåðåàáèëèòàöèîííûå êîéêè: íåâðîëîãè÷åñêèå– 30 êîåê, òåðàïåâòè÷åñêèå è òðàâìàòîëîãè-÷åñêèå – ïî 20 êîåê, íåéðîõèðóðãè÷åñêèå,ïóëüìîíîëîãè÷åñêèå, êàðäèîëîãè÷åñêèå,óðîëîãè÷åñêèå, ãàñòðîýíòåðîëîãè÷åñêèå, õè-ðóðãè÷åñêèå – ïî 5 êîåê.

Ñðåäè ïîñòóïèâøèõ ïàöèåíòîâ â 2017 ã.áûëî: òðàâìàòîëîãè÷åñêèõ – 477 (23,5%),íåâðîëîãè÷åñêèõ – 749 (36,9%), òåðàïåâ-òè÷åñêèõ – 539 (26,5%), õèðóðãè÷åñêèõ –45 (2,2%), äðóãèõ ïðîôèëåé – 221 (10,9%).

Ñòðóêòóðà êîíòèíãåíòà áîëüíûõ ïî íà-ïðàâëåíèÿì èç âîåííî-ìåäèöèíñêèõ îðãàíè-çàöèé â 2017 ã. áûëà ñëåäóþùåé:

– ÃÂÊÃ èì. Í.Í.Áóðäåíêî – 425 (20,8%);– 3 ÖÂÊÃ èì. À.À.Âèøíåâñêîãî –127

(6,2%);– äðóãèå âîåííûå ãîñïèòàëè – 172 (8,4%);– ïîëèêëèíèêè Ìèíîáîðîíû – 1125

(55,7%);– âîèíñêèå ÷àñòè – 182 (8,9%).Â ñòðóêòóðå áîëüíûõ â 2017 ã. áûëè

ïðåäñòàâëåíû ñëåäóþùèå êàòåãîðèè:– âîåííîñëóæàùèå ïî ïðèçûâó – 18,8%;– âîåííîñëóæàùèå ïî êîíòðàêòó – 25%;– îôèöåðû çàïàñà – 29,8%;– ÷ëåíû ñåìåé äåéñòâóþùèõ âîåííî-

ñëóæàùèõ è îôèöåðîâ çàïàñà – 16,2%;– ïðî÷èå – 10,2%.Îòìå÷àåòñÿ ñóùåñòâåííûé ðîñò ÷èñëà

ñëîæíûõ, òÿæåëûõ ïàöèåíòîâ, ïðîøåäøèõëå÷åíèå íà ðåàáèëèòàöèîííûõ êîéêàõ, à òàê-æå áîëüíûõ ïîñëå âûñîêîòåõíîëîãè÷íûõ ìå-òîäîâ ëå÷åíèÿ (îïåðàöèé). Óâåëè÷èâàåòñÿ÷èñëî ìàëîìîáèëüíûõ ïàöèåíòîâ: â 2015 ã.áûëî 118, â 2016 ã. – 132, â 2017 ã. – 165÷åëîâåê.

Èç âñåõ ëå÷èâøèõñÿ â ðåàáèëèòàöèîí-íîì öåíòðå â 2017 ã. çíà÷èòåëüíîå óëó÷øåíèåñîñòîÿíèÿ îòìå÷àëîñü ó 11,5% ïàöèåíòîâ,óëó÷øåíèå ñîñòîÿíèÿ – ó 80,5%, áåç äèíàìè-êè – 6%, óõóäøåíèå – ó 2% áîëüíûõ.

Ðåàáèëèòàöèîííîå ëå÷åíèå ïîëó÷àþòïàöèåíòû, ïåðåâåäåííûå èç âîåííûõ ãîñïè-òàëåé, è òå, êîòîðûå ëå÷àòñÿ íåïîñðåäñòâåííîâ ËÐÊÖ (ïîñëå îïåðàöèé, îñòðûõ ñîñòîÿíèé),â ò. ÷. ïîëó÷èâøèå ïëàíîâóþ âûñîêîòåõíî-ëîãè÷íóþ ïîìîùü (òðàâìàòîëîãèÿ, íåéðî-õèðóðãèÿ).



Â ãîñïèòàëå èñïîëüçóþòñÿ âîçìîæíîñòèìíîãîïðîôèëüíîãî ñòàöèîíàðà â ðåàáèëèòà-öèè íàèáîëåå òÿæåëûõ ïàöèåíòîâ ñ ïîñëåä-ñòâèÿìè òðàâì è çàáîëåâàíèé öåíòðàëüíîéíåðâíîé ñèñòåìû ñ ïðèâëå÷åíèåì ñïåöèàëè-ñòîâ ïî óðîëîãèè, ãíîéíîé õèðóðãèè, íåéðî-òðàâìàòîëîãèè, ïóëüìîíîëîãèè, ÷åëþñòíî-ëèöåâîé õèðóðãèè. Ãîñïèòàëü ÿâëÿåòñÿ êëè-íè÷åñêîé áàçîé ôèëèàëà Âîåííî-ìåäèöèíñ-êîé àêàäåìèè èì. Ñ.Ì.Êèðîâà. Åãî âîçìîæ-íîñòè èñïîëüçóþòñÿ â ñèñòåìå ïîñëåäèïëîì-íîãî îáðàçîâàíèÿ âðà÷åé è ñåñòðèíñêîãî ñî-ñòàâà ìåäèöèíñêîé ñëóæáû ÂÑ ÐÔ.

Îïûò ðàáîòû Ëå÷åáíî-ðåàáèëèòàöèîííî-ãî êëèíè÷åñêîãî öåíòðà ÌÎ ÐÔ ñâèäåòåëü-ñòâóåò î âûñîêîé ýôôåêòèâíîñòè ïðîâîäè-ìûõ ëå÷åáíî-ðåàáèëèòàöèîííûõ ìåðîïðèÿ-òèé, ÷åì ñóùåñòâåííî ïîïîëíÿþòñÿ ðåàáè-ëèòàöèîííûé ïîòåíöèàë è âîçìîæíîñòè ìå-äèöèíñêîé ñëóæáû ÂÑ ÐÔ. Íåîáõîäèìî äàëü-íåéøåå ñîâåðøåíñòâîâàíèå îðãàíèçàöèè ìå-äèöèíñêîé ðåàáèëèòàöèè âîåííîñëóæàùèõñ èñïîëüçîâàíèåì âîçìîæíîñòåé ñîâðåìåí-íîãî ìíîãîïðîôèëüíîãî ðåàáèëèòàöèîííîãîöåíòðà â ñèñòåìå îêàçàíèÿ ìåäèöèíñêîé ïî-ìîùè ðàíåíûì è áîëüíûì.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ 616.12-008.46-036.12-074

Ïîòåõèí Í.Ï., Ôóðñîâ À.Í. ([email protected]), Êàçàêîâ Ñ.Ï., Ïóòêîâ Ñ.Á.,Ïåñòîâñêàÿ Î.Ð., Ëÿïêîâà Í.Á., Çàõàðîâà Å.Ã., Ìàêååâà Ò.Ã. ([email protected]), Âåðåùàãèíà À.Â. – Ñîâðåìåííûå ïîäõîäû ê îöåíêå ýôôåêòèâíîñòèëå÷åíèÿ õðîíè÷åñêîé ñåðäå÷íîé íåäîñòàòî÷íîñòè.


Îöåíåíà ýôôåêòèâíîñòü òåðàïèè, ïðîâîäèìîé áîëüíûì ñ õðîíè÷åñêîé ñåðäå÷íîéíåäîñòàòî÷íîñòüþ, íîâûì êîìáèíèðîâàííûì ïðåïàðàòîì âàëñàðòàí/ñàêóáèòðèë ïî äàííûìóðîâíåé áèîìàðê¸ðîâ ST2 è NT-proBNP. Ó âñåõ áîëüíûõ èññëåäóåìîé ãðóïïû òåðàïèÿ âàëñàðòàíîì/ñàêóáèòðèëîì óëó÷øèëà ôóíêöèîíàëüíûé êëàññ ïî NYHA, â êîíòðîëüíîé ãðóïïå – ëèøü ó 75%.Äèíàìèêà ïîêàçàòåëåé áèîìàðê¸ðîâ ST2 è NT-proBNP ñîâïàäàëà ñ óëó÷øåíèåì êëèíè÷åñêîãîñîñòîÿíèÿ áîëüíûõ íà ôîíå ïðîâîäèìîé òåðàïèè, ïðè÷åì â áîëüøåé ñòåïåíè ýòó òåíäåíöèþîòðàæàåò ïîêàçàòåëü NT-proBNP.

Ê ë þ ÷ å â û å ñ ë î â à: õðîíè÷åñêàÿ ñåðäå÷íàÿ íåäîñòàòî÷íîñòü, òåðàïèÿ âàëñàðòàíîì/ñàêóáèòðèëîì, áèîìàðê¸ðû NT-proBNP è ST2.

Potekhin N.P., Fursov A.N., Kazakov S.P., Putkov S.B., Pestovskaya O.R., Lyapkova N.B., Zakharova E.G.,Makeeva T.G., Vereshchagina A.V. – Modern approaches to evaluating the effectiveness of treatmentof chronic heart failure. The efficacy of therapy for patients with chronic heart failure, a new combinationdrug valsartan/sacubitrile according to the levels of biomarkers ST2 and NT-proBNP was evaluated.In all patients of the study group, valsartan/sacubitrile therapy improved the NYHA functional class, inthe control group – only in 75%. The dynamics of indicators of biomarkers ST2 and NT-proBNPcoincided with the improvement of the clinical status of patients against the background of therapy, andto a greater extent this trend reflects the indicator NT-proBNP.

K e y w o r d s: chronic heart failure, valsartan/sacubitril therapy, NT-proBNP and ST2 biomarkers.

Õðîíè÷åñêàÿ ñåðäå÷íàÿ íåäîñòàòî÷-íîñòü (ÕÑÍ) ÿâëÿåòñÿ âåäóùåé ïðè÷èíîéãîñïèòàëèçàöèè ïàöèåíòîâ ñòàðøå 65 ëåò,ïðè÷åì ïîëîâèíå îò èõ ÷èñëà òðåáóåòñÿ ïî-âòîðíàÿ ãîñïèòàëèçàöèÿ óæå ÷åðåç 3–6 ìåñ.Íàçíà÷åíèå èíãèáèòîðà ðåöåïòîðîâ àíãè-îòåíçèí-íåïðèëèçèíà (ARNI), ñîãëàñíî ðå-êîìåíäàöèé ESC 2016 ã., ïîêàçàíî ïàöè-åíòàì ñ ÕÑÍ è íèçêîé ôðàêöèåé âûáðîñàäëÿ ñíèæåíèÿ ðèñêà ïîâòîðíûõ ãîñïèòàëè-çàöèé è ñìåðòíîñòè. ST2 – íîâûé áèî-ìàðê¸ð ñåðäå÷íîé íåäîñòàòî÷íîñòè, íå óñ-òóïàþùèé ïî çíà÷èìîñòè íàòðèéóðåòè÷åñ-êèì ïåïòèäàì (BNP, NT-proBNP). ST2 ýêñ-ïðåññèðóåòñÿ â ñåðäöå â îòâåò íà ïàòîëîãè-÷åñêèå èçìåíåíèÿ, âûçâàííûå õðîíè÷åñêè-ìè çàáîëåâàíèÿìè è/èëè îñòðûìè ïîâðåæ-äåíèÿìè. Óðîâåíü ST2 áûñòðî èçìåíÿåòñÿ

â îòâåò íà ëå÷åíèå, â ñâÿçè ñ ÷åì ïðåäëàãà-åòñÿ åãî èñïîëüçîâàíèå íàðÿäó ñ íàòðèé-óðåòè÷åñêèìè ïåïòèäàìè ïðè ìîíèòîðèí-ãå è êîððåêöèè òåðàïèè ÕÑÍ.

Â èíòåðåñàõ îïòèìèçàöèè ëå÷åáíûõ ïîä-õîäîâ ó áîëüíûõ ñ ÕÑÍ îöåíåíà ïî äàííûìóðîâíåé ST2 è proBNP ýôôåêòèâíîñòü ïðî-âîäèìîé ïàòîãåíåòè÷åñêîé òåðàïèè êîìáè-íèðîâàííûì ïðåïàðàòîì âàëñàðòàí/ñàêóáèò-ðèë.

Â èññëåäîâàíèå áûëî âêëþ÷åíî 30 áîëü-íûõ èøåìè÷åñêîé áîëåçíüþ ñåðäöà (ÈÁÑ) ñÕÑÍ II Á ñòàäèè, 3–4 ôóíêöèîíàëüíîãî êëàñ-ñà (ÔÊ) ïî NYHA, íàõîäèâøèõñÿ íà ëå÷å-íèè â êàðäèîëîãè÷åñêîì îòäåëåíèè ãîñïè-òàëÿ. Ñðåäíèé âîçðàñò 73,5±4,3 ãîäà, âñå ïà-öèåíòû – ìóæ÷èíû. Ôðàêöèÿ âûáðîñà ëåâîãîæåëóäî÷êà (ÔÂ ËÆ) ñîñòàâëÿëà 38,3±2,1%.



Áîëüíûå áûëè ðàçäåëåíû íà äâå ãðóïïû: 1-ÿãðóïïà (n=15) ñ ÔÂ ËÆ 39,3±2,1% ïîëó÷à-ëà ñòàíäàðòíóþ òåðàïèþ ÕÑÍ â âèäå èíãè-áèòîðà àíãèîòåíçèíïðåâðàùàþùåãî ôåðìåí-òà (èÀÏÔ), áåòà-àäðåíîáëîêàòîðà, áëîêàòîðàìèíåðàëîêîðòèêîèäíûõ ðåöåïòîðîâ, ïåòëåâî-ãî äèóðåòèêà, 2-ÿ ãðóïïà (n=15) ñ ÔÂ ËÆ37,3±2,2% ïîëó÷àëà íà ôîíå ñòàíäàðòíîéòåðàïèè ÕÑÍ âìåñòî èÀÏÔ íîâûé èííîâà-öèîííûé ïðåïàðàò âàëñàðòàí+ñàêóáèòðèë âäîçå 50–100 ìã 2 ðàçà â äåíü.

Áîëüíûì íàðÿäó ñ îáùåêëèíè÷åñêèìèàíàëèçàìè ïðîâîäèëîñü ýõîêàðäèîãðàôè÷åñ-êîå èññëåäîâàíèå, îïðåäåëÿëñÿ ðÿä áèîõèìè-÷åñêèõ ïîêàçàòåëåé ñûâîðîòêè êðîâè, â ò. ÷.ST2 è NT-proBNP, ðàññ÷èòûâàëàñü ñêîðîñòüêëóáî÷êîâîé ôèëüòðàöèè (ÑÊÔ). Ïîðîãîâûåçíà÷åíèÿ áèîìàðê¸ðîâ ST2 è NT-proBNP ïðèÕÑÍ ñîñòàâëÿëè 35 íã/ìë è 250 ïã/ìë ñîîò-âåòñòâåííî. Îöåíêà ýôôåêòèâíîñòè ïðîâîäè-ìîé òåðàïèè îñóùåñòâëÿëàñü íà îñíîâàíèèèçìåíåíèÿ ÔÊ ïî NYHA è äèíàìèêè ïîêà-çàòåëåé ST2, NT-proBNP è ÑÊÔ äî íà÷àëàëå÷åíèÿ è ÷åðåç 12 äíåé îò íà÷àëà ëå÷åíèÿ.

Â êà÷åñòâå ñòàòèñòè÷åñêèõ êðèòåðèåâäîñòîâåðíîñòè ðàçëè÷èé èñïîëüçîâàëè: ïà-ðàìåòðè÷åñêèå êðèòåðèè è íåïàðàìåòðè÷åñ-êèé êðèòåðèé Êðàñêåëà–Óîëëèñà äëÿ êîëè-÷åñòâåííûõ ïåðåìåííûõ, ðàçëè÷èÿ ñ÷èòàëèäîñòîâåðíûìè ïðè ð≤0,05.

Íà ôîíå òåðàïèè ó áîëüíûõ 2-é (èññëå-äóåìîé) ãðóïïû ê 12-ìó äíþ îòìå÷åíî èç-ìåíåíèå ÔÊ ïî NYHA ñ òðåòüåãî äî âòîðîãîó 75% ïàöèåíòîâ, â 25% ñëó÷àåâ – ñ ÷åòâåð-òîãî äî òðåòüåãî ÔÊ. Ó áîëüíûõ 1-é (êîíò-ðîëüíîé) ãðóïïû â 60% êîíñòàòèðîâàíî èç-ìåíåíèå ÔÊ ñ òðåòüåãî äî âòîðîãî, â 25%ÔÊ íå èçìåíèëñÿ – îñòàëñÿ òðåòüèì, â 15%

– ïåðåíîñèìîñòü íàãðóçîê âîçðîñëà ñ ÷åòâåð-òîãî äî òðåòüåãî ÔÊ.

Ïîëîæèòåëüíàÿ äèíàìèêà óëó÷øåíèÿñîñòîÿíèÿ áîëüíûõ ñîïðîâîæäàëàñü çíà÷è-ìûì ñíèæåíèåì ST2 âî 2-é ãðóïïå â 2 ðàçà(64,3±2,9 íã/ìë è 32,4±4,5 íã/ìë ñîîòâåò-ñòâåííî) è NT-proBNP – â 3,5 ðàçà(5950±143 ïã/ìë è 1710±127 ïã/ìë ñîîòâåò-ñòâåííî), ð<0,05. Â 1-é ãðóïïå ñíèæåíèå áèî-ìàðê¸ðîâ áûëî ìåíåå çíà÷èìûì: ST2 â 1,5ðàçà (72,5±4,8 íã/ìë è 48,7±6,8 íã/ìë ñîîò-âåòñòâåííî) è NT-proBNP â 1,3 ðàçà(5763±138 ïã/ìë è 4296±148 ïã/ìë ñîîòâåò-ñòâåííî), ð<0,05. Ðàñ÷åòíàÿ ÑÊÔ ïî ãðóïïàìäîñòîâåðíî ïîâûñèëàñü íà ôîíå ëå÷åíèÿ ñ56,4±6,1 äî 72,3±3,9 ìë/ìèí (ð<0,05), ÷òîêîñâåííî ìîæåò ñâèäåòåëüñòâîâàòü îá óëó÷-øåíèè ïî÷å÷íîé ïåðôóçèè íà ôîíå òåðàïèèÕÑÍ.

Òàêèì îáðàçîì, âî-ïåðâûõ, ïðèìåíåíèåíîâîãî ïðåïàðàòà âàëñàðòàí/ñàêóáèòðèë ñó-ùåñòâåííî óëó÷øàåò êëèíè÷åñêîå ñîñòîÿ-íèå áîëüíûõ ñ âûðàæåííîé ñòåïåíüþ ÕÑÍïî ñðàâíåíèþ ñ òðàäèöèîííîé ïàòîãåíåòè-÷åñêîé òåðàïèåé, âî-âòîðûõ, äèíàìèêà ïî-êàçàòåëåé áèîìàðê¸ðîâ ST2 è NT-proBNPñîâïàäàåò ñ óëó÷øåíèåì êëèíè÷åñêîãî ñî-ñòîÿíèÿ áîëüíûõ íà ôîíå ïðîâîäèìîé òå-ðàïèè, ïðè÷åì â áîëüøåé ñòåïåíè ýòó òåí-äåíöèþ îòðàæàåò ïîêàçàòåëü NT-proBNP,íåæåëè ST2, êîòîðûé äîñòèãàåò ïðàêòè÷å-ñêè íîðìàëüíûõ âåëè÷èí ïðè åùå ñîõðà-íÿþùèõñÿ êëèíè÷åñêèõ ïðîÿâëåíèÿõ ÕÑÍ,â-òðåòüèõ, ñíèæåíèå óðîâíÿ áèîìàðê¸ðîâNT-proBNP è ST2 â êðîâè íà ôîíå ëå÷å-íèÿ ÕÑÍ ñîâïàäàåò ñ óâåëè÷åíèåì ÑÊÔ,âåëè÷èíà êîòîðîé îòðàæàåò ñîñòîÿíèå ïî-÷å÷íîé ïåðôóçèè.


×óðêèí Ä.Â. ([email protected]), Ëàñòêîâ Ä.Î. ([email protected]), Äîëãî-øàïêî Î.Í., Àíòðîïîâà Î.Ñ. – Âëèÿíèå ïðåäøåñòâóþùåãî òðóäà â óñëîâèÿõïðîèçâîäñòâåííîãî øóìà íà ðàçâèòèå ñåíñîíåâðàëüíîé òóãîóõîñòè â èñõîäåâîåííîé òðàâìû.

Äîíåöêèé íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò èì. Ì.Ãîðüêîãî

Ïðåäñòàâëåíû ðåçóëüòàòû îáñëåäîâàíèÿ ó÷àñòíèêîâ áîåâûõ äåéñòâèé – ðàáî÷èõ ïðîìûøëåííûõïðåäïðèÿòèé 35–39 ëåò, ðàíåå ðàáîòàâøèõ â óñëîâèÿõ ïðîèçâîäñòâåííîãî øóìà. Â ðåçóëüòàòåâîåííîé òðàâìû (ñî÷åòàííàÿ ÷åðåïíî-ìîçãîâàÿ òðàâìà, àêóòðàâìà, áàðîòðàâìà) ó íèõ ðàçâèëàñüñåíñîíåâðàëüíàÿ òóãîóõîñòü. Óðîâåíü ñíèæåíèÿ ñëóõà è ñòåïåíü âîâëå÷åííîñòè âïàòîëîãè÷åñêèé ïðîöåññ çâóêîâîñïðèíèìàþùåãî àïïàðàòà ñâÿçàíû ñ äëèòåëüíîñòüþ ñòàæàðàáîòû â óñëîâèÿõ ïðîèçâîäñòâåííîãî øóìà. Ó ëèö, ðàáîòàâøèõ â óñëîâèÿõ ïîñòîÿííîãîíèçêîàìïëèòóäíîãî øèðîêîïîëîñíîãî øóìà (n=30), ñíèæåíèå ñëóõà áîëåå âûðàæåíî ïîñðàâíåíèþ ñ ëèöàìè (n=30), ðàáîòàâøèìè â óñëîâèÿõ èìïóëüñíîãî âûñîêî÷àñòîòíîãîâûñîêîàìïëèòóäíîãî øóìà. Ó ëèö êîíòðîëüíîé ãðóïïû (35–39 ëåò, n=30), ðàíåå ðàáîòàâøèõâíå ïðîèçâîäñòâåííîãî øóìà, óðîâåíü ñíèæåíèÿ ñëóõà îïðåäåëÿåòñÿ ÷àñòîòîé ÷åðåïíî-ìîçãîâîéòðàâìû è ñâÿçàí ñ ôîðìèðîâàíèåì ïîñòòðàâìàòè÷åñêîãî îñòåîõîíäðîçà ñ ÿâëåíèÿìèâåðòåáðîáàçèëÿðíîé íåäîñòàòî÷íîñòè.

Ê ë þ ÷ å â û å ñ ë î â à: ïðîèçâîäñòâåííûé øóì, âîåííàÿ òðàâìà, ñåíñîíåâðàëüíàÿ òóãîóõîñòü.



Churkin D.V., Lastkov D.O., Dolgoshapko O.N., Antropova O.S. – Impact of previous work in theconditions of industrial noise on the development of sensorineural hearing loss in the outcome ofa military injury. The results of a survey of militia members – industrial workers aged 35–39 yearswho had previously worked in the conditions of industrial noise are presented. As a result of a militarytrauma (combined head injury, acutrauma, barotrauma) they developed sensorineural hearing loss.The level of hearing loss and the degree of involvement in the pathological process of the sound-perceiving apparatus is related to the length of work experience in the conditions of industrial noise.For persons who worked in conditions of constant low-amplitude broadband noise (n=30), hearingloss is more pronounced compared to persons (n=30) who worked in conditions of pulsed high-frequency high-amplitude noise. In the control group (35–39 years, n=30), who previously workedoutside of industrial noise, the level of hearing loss is determined by the frequency of traumatic braininjury and is associated with the formation of post-traumatic osteochondrosis and vertebrobasilarinsufficiency.

K e y w o r d s: industrial noise, military trauma, sensorineural hearing loss.

Ïðîèçâîäñòâåííûé øóì óñëîâíî ìîæ-íî ðàçäåëèòü íà äâà òèïà. Ïåðâûé òèï – ïî-ñòîÿííûé, íèçêî÷àñòîòíûé, íèçêîàìïëèòóä-íûé øóì – ãåíåðèðóåòñÿ â ðàçëè÷íîãî ðîäàìåõàíèçìàõ (òðàíñïîðòíûå ñðåäñòâà, êîòëû,íàñîñíûå óñòàíîâêè, òóðáèíû, àïïàðàòû õè-ìè÷åñêîãî ïðîèçâîäñòâà). Ïðè ðàáîòå â óñ-ëîâèÿõ òàêîãî øóìà ñâûøå 10 ëåò ìîæåò ðàç-âèòüñÿ ñåíñîíåâðàëüíàÿ òóãîóõîñòü (ÑÍÒ),ïðè îòñóòñòâèè àäåêâàòíîãî ëå÷åíèÿ ðàçâè-âàåòñÿ ïðîôåññèîíàëüíàÿ íåïðèãîäíîñòü.Â óñëîâèÿõ âîåííîé ñëóæáû èñòî÷íèêîì òà-êîãî øóìà ÿâëÿåòñÿ êîëåñíàÿ è ãóñåíè÷íàÿâîåííàÿ òåõíèêà. Âòîðîé òèï ïðîèçâîäñòâåí-íîãî øóìà – èìïóëüñíûé, âûñîêî÷àñòîòíûé,âûñîêîàìïëèòóäíûé øóì – ãåíåðèðóåòñÿ èí-ñòðóìåíòàìè è ïðèñïîñîáëåíèÿìè (ïíåâìà-òè÷åñêèå ìîëîòêè, ïèëû, ñòðîèòåëüíûå èíñò-ðóìåíòû). Ïðè ðàáîòå â óñëîâèÿõ øóìà âòî-ðîãî òèïà ÑÍÒ ðàçâèâàåòñÿ ðåæå, ÷òî ñâÿçà-íî ñ åãî ýôôåêòèâíîé ïðîôèëàêòèêîé íàðàáî÷åì ìåñòå. Â óñëîâèÿõ âîåííîé ñëóæáûèñòî÷íèêîì øóìà âòîðîãî òèïà ÿâëÿåòñÿ ïðè-ìåíåíèå ñòðåëêîâîãî îðóæèÿ è àðòèëëåðèé-ñêèõ ñèñòåì. Ôîðìèðîâàíèå ÑÍÒ íà÷èíàåò-ñÿ íà ÷àñòîòàõ 4 êÃö è âûøå, ðàííèå ïðîÿâ-ëåíèÿ ÑÍÒ ÷àñòî ïðîòåêàþò íåçàìå÷åííû-ìè, ïîñêîëüêó ïðåäóñìîòðåííàÿ ïðîôèëàê-òè÷åñêèìè ìåäèöèíñêèìè îñìîòðàìè ïîðî-ãîâàÿ òîíàëüíàÿ àóäèîìåòðèÿ ïðîâîäèòñÿ íà÷àñòîòàõ 0,5, 1 è 2 êÃö è ïîçâîëÿåò óñòàíî-âèòü ïðîãðåññèðîâàíèå óæå ñôîðìèðîâàâøå-ãîñÿ çàáîëåâàíèÿ. Âîçäåéñòâèå íà âîåííî-ñëóæàùèõ øóìà âòîðîãî òèïà îñîáåííî îïàñ-íî äëÿ ëèö, ðàíåå äëèòåëüíî ðàáîòàâøèõ âóñëîâèÿõ ïðîèçâîäñòâåííîãî øóìà ïåðâîãîòèïà, ïîñêîëüêó ìîæåò ðàçâèòüñÿ ïðîãðåññè-ðîâàíèå ðàííèõ ôîðì ÑÍÒ. Ýòî ìîæåò ïðè-âåñòè ê èõ ïðîôåññèîíàëüíîé íåïðèãîäíî-ñòè ïî îñíîâíîé ãðàæäàíñêîé ïðîôåññèè.

Öåëü èññëåäîâàíèÿ: îöåíèòü âëèÿíèåïðåäøåñòâóþùåãî òðóäà â óñëîâèÿõ ïðîèç-âîäñòâåííîãî øóìà ïåðâîãî è âòîðîãî òèïàíà ðàçâèòèå ÑÍÒ â èñõîäå âîåííîé òðàâìû.

Èññëåäîâàíèå ïðîâåäåíî íà áàçå âîåííî-ãî ãîñïèòàëÿ. Ñðåäè ïîñòóïèâøèõ íà ëå÷åíèåñ èþíÿ 2014 ïî ÿíâàðü 2015 ã. ðàáî÷èõ ñ æà-

ëîáàìè íà îñòðî âîçíèêøåå ñíèæåíèå ñëóõàâ ñâÿçè ñ âîåííîé òðàâìîé äîëÿ ëèö â âîçðà-ñòå 35–39 ëåò ñîñòàâèëà 47,5%, ñòàæ ïðåäøå-ñòâóþùèõ ðàáîò (ñâûøå 10 ëåò) â óñëîâèÿõïðîèçâîäñòâåííîãî øóìà èìåëè 42,2% îáðà-òèâøèõñÿ. Îñíîâíóþ ãðóïïó 1 (ÎÃ-1) ñîñòà-âèëè 30 ó÷àñòíèêîâ áîåâûõ äåéñòâèé, ðàíååðàáîòàâøèõ â óñëîâèÿõ ïðîèçâîäñòâåííîãîøóìà ïåðâîãî òèïà íå ìåíåå 10 ëåò, îñíîâíóþãðóïïó 2 (ÎÃ-2) – 30 ó÷àñòíèêîâ, ðàíåå ðàáî-òàâøèõ íå ìåíåå 10 ëåò â óñëîâèÿõ ïðîèç-âîäñòâåííîãî øóìà âòîðîãî òèïà, êîíòðîëüíóþãðóïïó (ÊÃ) – 30 ó÷àñòíèêîâ áåç ïðåäøåñòâó-þùåãî ñòàæà ðàáîòû â óñëîâèÿõ ïðîèçâîä-ñòâåííîãî øóìà. Âîçðàñò îáñëåäîâàííûõ ñî-ñòàâèë 35–39 ëåò. Äî èþíÿ 2014 ã. âñå îíèïðîæèâàëè â ñõîäíûõ ñîöèàëüíî-áûòîâûõ èýêîëîãè÷åñêèõ óñëîâèÿõ, èìåëè ñîïîñòàâèìûéóðîâåíü äîõîäà, îäèíàêîâûé óðîâåíü ôèçè-÷åñêîãî ðàçâèòèÿ. Ïî ñòàæó ðàáîòû â óñëîâè-ÿõ øóìà ÎÃ-1 è ÎÃ-2 íå ðàçëè÷àëèñü.

Ñòàòèñòè÷åñêàÿ îáðàáîòêà äàííûõ ïîñëåóñòàíîâëåíèÿ íîðìàëüíîñòè ðàñïðåäåëåíèÿïðîâåäåíà ñ èñïîëüçîâàíèåì ïàðàìåòðè÷åñ-êèõ ìåòîäîâ, äîñòîâåðíîñòü ðàçëè÷èé îöåíè-âàëè ïî t-êðèòåðèþ Ñòüþäåíòà. Êîððåëÿöè-îííûå çàâèñèìîñòè ìåæäó óðîâíåì ñíèæå-íèÿ ñëóõà è ñòàæåì ðàáîòû â óñëîâèÿõ ïðî-èçâîäñòâåííîãî øóìà, à òàêæå ìåæäó óðîâ-íåì ñíèæåíèÿ ñëóõà è ÷àñòîòîé ×ÌÒ îöåíè-âàëè ïðè ïîìîùè êîýôôèöèåíòà êîððåëÿ-öèè Ïèðñîíà (r), äîñòîâåðíîñòü r – ïî ñòàí-äàðòíûì òàáëèöàì.

Ó âñåõ îáðàòèâøèõñÿ òðàâìà áûëà ïîëó-÷åíà ïðè íåïîñðåäñòâåííîì âûïîëíåíèè áî-åâûõ çàäà÷, ÷òî ïîçâîëèëî îöåíèòü ðàçâèâ-øååñÿ çàáîëåâàíèå êàê âîåííóþ òðàâìó. Ïðèïîñòóïëåíèè âñå ó÷àñòíèêè èññëåäîâàíèÿáûëè êîíñóëüòèðîâàíû íåâðîëîãîì è îòî-ðèíîëàðèíãîëîãîì (îòîñêîïèÿ, ïðîáà Âàëü-ñàëüâû, ïíåâìîìàíîìåòðèÿ ïî Ïîëèòöåðó),ïî ïîêàçàíèÿì ïðîâîäèëèñü êîíñóëüòàöèèäðóãèõ ñïåöèàëèñòîâ (íåéðîõèðóðã, îòî-íåâðîëîã). Âñåì ïîñòðàäàâøèì áûë óñòàíîâ-ëåí ïåðâè÷íûé äèàãíîç «Ñî÷åòàííàÿ ×ÌÒ.Îñòðàÿ ñåíñîíåâðàëüíàÿ òóãîóõîñòü (îäíî-ñòîðîííÿÿ)».



Òîíàëüíóþ ïîðîãîâóþ àóäèîìåòðèþ íà÷àñòîòàõ 0,5, 1, 2 è 4 êÃö ïðîâîäèëè ïðèîáðàùåíèè è ïðè âûïèñêå èç ãîñïèòàëÿ. Âñåïîñòóïèâøèå ïîëó÷àëè ëå÷åíèå â ñîîòâåò-ñòâèè ñ äåéñòâóþùèìè êëèíè÷åñêèìè ïðî-òîêîëàìè, óòâåðæäåííûìè Ìèíçäðàâ-ñîöðàçâèòèÿ Ðîññèè. Èçó÷åíû ðåçóëüòàòûïðîôèëàêòè÷åñêèõ ìåäèöèíñêèõ îñìîòðîâïîñòðàäàâøèõ çà 2013–2014 ãã., êîòîðûå ïðî-âîäèëèñü íà îñíîâàíèè ïðèêàçà ìèíçäðàâàÓêðàèíû îò 21.05.2007 ã. ¹ 246 (òîíàëüíàÿïîðîãîâàÿ àóäèîìåòðèÿ, ñîãëàñíî äàííîìóïðèêàçó, ïðîâîäèëàñü íà ÷àñòîòàõ 0,5, 1 è2 êÃö). Ïîñëå çàâåðøåíèÿ ëå÷åíèÿ â ãîñïè-òàëå âñå ó÷àñòíèêè èññëåäîâàíèÿ âîçâðàòè-ëèñü ê ðàáîòå ïî ãðàæäàíñêîé ñïåöèàëüíîñ-òè. Ïîâòîðíîå îáñëåäîâàíèå (êîíñóëüòàöèÿîòîðèíîëàðèíãîëîãà, òîíàëüíàÿ ïîðîãîâàÿàóäèîìåòðèÿ) âûïîëíÿëè ÷åðåç 3 è 6 ìåñïîñëå âûïèñêè èç ãîñïèòàëÿ.

Ó âñåõ ó÷àñòíèêîâ ïðè ïåðâè÷íîì èïîâòîðíûõ îñìîòðàõ îòîðèíîëàðèíãîëîãàèñêëþ÷åíà ïàòîëîãèÿ çâóêîïðîâîäÿùåãî àï-ïàðàòà, ÷òî ïîçâîëèëî ðàññìàòðèâàòü ñëîæèâ-øååñÿ ñíèæåíèå ñëóõà êàê ïàòîëîãèþ ïåð-öåïòèâíîãî àïïàðàòà. Ïðè èçó÷åíèè èòîãîâïðîôèëàêòè÷åñêèõ îñìîòðîâ (2013–2014) âÎÃ-1 è ÎÃ-2 ïàòîëîãèè ñëóõà íå âûÿâëåíî.Òàêæå îòñóòñòâîâàëà íåâðîëîãè÷åñêàÿ ïàòî-ëîãèÿ, ñïîñîáíàÿ â äàëüíåéøåì âûçâàòü ïî-ðàæåíèå çâóêîâîñïðèíèìàþùåãî àïïàðàòà.Ðåçóëüòàòû ïîðîãîâîé òîíàëüíîé àóäèîìåò-ðèè (òàáë. 1) òàêæå ïîçâîëÿþò ïîäòâåðäèòüó ïîñòðàäàâøèõ íàëè÷èå ïåðöåïòèâíîé ÑÍÒ(äëÿ óäîáñòâà îòîáðàæåíèÿ è àíàëèçà äàí-íûõ â òàáëèöå ïðåäñòàâëåíû òîëüêî óðîâíè

ñëóõà ïî êîñòè íà ÷àñòîòàõ 1, 2 è 4 êÃö äëÿáîëåå ïîðàæåííîãî óõà). Íå óäàëîñü âûïîë-íèòü îòîàêóñòè÷åñêóþ ýìèññèþ, õàðàêòåðè-çóþùóþ ôóíêöèþ âîëîñêîâûõ êëåòîê, ÷òîñâÿçàíî ñ îòñóòñòâèåì íåîáõîäèìîãî îáîðó-äîâàíèÿ è ñïåöèàëèñòîâ â ãîñïèòàëå è äðó-ãèõ îðãàíèçàöèÿõ çäðàâîîõðàíåíèÿ.

Ñíèæåíèå óðîâíÿ ñëóõà â ÎÃ-1 íà ÷à-ñòîòå 4 êÃö äî óðîâíÿ ÑÍÒ 1-é ñòåïåíèóêàçûâàåò íà ïðåäâàðèòåëüíîå ïîðàæåíèåçâóêîâîñïðèíèìàþùåãî àïïàðàòà, ñâÿçàííîåñ ïðåäøåñòâóþùèì òðóäîì â óñëîâèÿõ ïðî-èçâîäñòâåííîãî øóìà (íà ýòî òàêæå óêàçû-âàåò ðàçëè÷èå â èñõîäàõ ïîðàæåíèÿ ñëóõàíà ÷àñòîòå 4 êÃö ìåæäó ÎÃ-1 è ÎÃ-2 ïðèñîïîñòàâèìîì èñõîäíîì óðîâíå ïîðàæåíèÿñëóõà). Ñîõðàíÿþùèåñÿ îòíîñèòåëüíî ÊÃðàçëè÷èÿ íà ÷àñòîòàõ 1 è 2 êÃö â ÎÃ-2ñâÿçàíû ñ ïîâòîðÿþùèìèñÿ àêóòðàâìàìèè áàðîòðàâìàìè. Äîñòèãíóòûå ÷åðåç 6 ìåñóðîâíè ñëóõà ïîçâîëÿþò ïðîãíîçèðîâàòüáëàãîïðèÿòíûé èñõîä ïîðàæåíèÿ â ÎÃ-2äëÿ òðóäîâîé è ñîöèàëüíîé àêòèâíîñòè, íîâûñîêà âåðîÿòíîñòü ðàçâèòèÿ äâóñòîðîííåãîïîðàæåíèÿ.

Ñâÿçü ìåæäó ÷àñòîòîé ×ÌÒ è óðîâíåìñíèæåíèÿ ñëóõà, à òàêæå ìåæäó äëèòåëüíîñ-òüþ ïðåäøåñòâóþùåãî ñòàæà ðàáîòû â óñëî-âèÿõ ïðîèçâîäñòâåííîãî øóìà ïðåäñòàâëåíàâ òàáë. 2, äëÿ ÊÃ îïðåäåëÿëè ñâÿçü ìåæäóîáùèì ñòàæåì è óðîâíåì ñíèæåíèÿ ñëóõà.

Òàêèì îáðàçîì, ñóììàðíîå âëèÿíèåïðîèçâîäñòâåííîãî ñòàæà è ÷àñòîòû ×ÌÒâ ÎÃ-1 è ÎÃ-2 ñîõðàíÿåòñÿ íåèçìåííûì âíåçàâèñèìîñòè îò òèïà ïðîèçâîäñòâåííîãîøóìà. Ðîñò âëèÿíèÿ ñòàæà â ÎÃ-2 ìîæåò áûòü

Òàáëèöà 1

Ðåçóëüòàòû ïîðîãîâîé òîíàëüíîé àóäèîìåòðèè ïðè ïîñòóïëåíèè,ïðè âûïèñêå, ÷åðåç 3 è 6 ìåñ ïîñëå âûïèñêè èç ãîñïèòàëÿ

Ïðèìå÷àíèÿ: *ðàçëè÷èÿ çíà÷èìû ñ ïîêàçàòåëåì, îïðåäåëåííûì ïåðâè÷íî; Êðàçëè÷èÿ çíà÷è-ìû ñ ÊÃ; 2ðàçëè÷èÿ çíà÷èìû ñ ÎÃ-2, âñå p<0,05.



Òàáëèöà 2

Êîððåëÿöèîííûå ñâÿçè ìåæäó ÷àñòîòîé ×ÌÒ, äëèòåëüíîñòüþ òðóäàâ óñëîâèÿõ ïðîèçâîäñòâåííîãî øóìà è óðîâíåì ñíèæåíèÿ ñëóõà

Ïðèìå÷àíèå. *Êîýôôèöèåíò êîððåëÿöèè ÿâëÿåòñÿ äîñòîâåðíûì ñ 95% âåðîÿòíîñòüþ.

îáóñëîâëåí èçìåíèâøèìèñÿ óñëîâèÿìè òðóäàñ óâåëè÷åíèåì äîëè äðóãèõ âðåäíûõ ïðîèç-âîäñòâåííûõ ôàêòîðîâ (âûíóæäåííîå ïîëî-æåíèå òåëà, ëîêàëüíàÿ âèáðàöèÿ, ïåðåíîñ òÿ-æåñòåé). Ñîõðàíÿþùååñÿ âëèÿíèå ÷àñòîòû×ÌÒ â ÊÃ ìîæåò áûòü ñâÿçàíî ñ ôîðìèðî-âàíèåì ïîñòòðàâìàòè÷åñêîãî øåéíîãî îñòåî-õîíäðîçà ñ ÿâëåíèÿìè âåðòåáðîáàçèëÿðíîéíåäîñòàòî÷íîñòè.

Â îñòðûé ïåðèîä ñî÷åòàííîé ×ÌÒ ó ëèö,ðàáîòàâøèõ ðàíåå â óñëîâèÿõ èìïóëüñíîãîïðîèçâîäñòâåííîãî øóìà, óðîâåíü ñíèæåíèÿñëóõà îïðåäåëÿåòñÿ ÷àñòîòîé ïîâòîðíûõ ×ÌÒ,à ó ðàíåå ðàáîòàâøèõ â óñëîâèÿõ ïîñòîÿí-

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ 616.233-002.1

Çàéöåâ À.À. ([email protected]), Áóäîðàãèí È.Å., Ëèõîäèé Â.È., Ñàâóø-êèíà Î.È. – Îñòðûé áðîíõèò: îòâåòû íà êëþ÷åâûå âîïðîñû.


Ïóáëèêàöèÿ ïîñâÿùåíà âîïðîñàì ýòèîëîãèè è ôàðìàêîòåðàïèè îñòðîãî áðîíõèòà ó âçðîñëûõ.Àâòîðàìè ïîëó÷åíû äàííûå ïî ýòèîëîãèè çàáîëåâàíèÿ, ñâèäåòåëüñòâóþùèå î òîì, ÷òî âïîäàâëÿþùåì ÷èñëå ñëó÷àåâ îñòðûé áðîíõèò âûçûâàåòñÿ ðàçëè÷íûìè ðåñïèðàòîðíûìè âèðóñàìè(àäåíîâèðóñû, âèðóñû ãðèïïà è ïàðàãðèïïà è êîìáèíàöèè ðàçëè÷íûõ âèðóñîâ). Ðåçóëüòàòûèññëåäîâàíèÿ ïîêàçûâàþò, ÷òî ñòàðòîâîå íàçíà÷åíèå àíòèáàêòåðèàëüíûõ ïðåïàðàòîâ ïðèîñòðîì áðîíõèòå ÿâëÿåòñÿ íåöåëåñîîáðàçíûì, à ðåøåíèå îá èõ ïðèìåíåíèè äîëæíî îñíîâûâàòüñÿíà îáúåêòèâíûõ äàííûõ, ñâèäåòåëüñòâóþùèõ î ðàçâèòèè áàêòåðèàëüíîãî ïðîöåññà. Õîðîøèìèíñòðóìåíòîì «ðàçãðàíè÷åíèÿ» âèðóñíîé è áàêòåðèàëüíîé èíôåêöèè ÿâëÿåòñÿ êîëè÷åñòâåííîåîïðåäåëåíèå Ñ-ðåàêòèâíîãî áåëêà â ñûâîðîòêå êðîâè, óðîâåíü êîòîðîãî ìåíåå 20 ìã/ëñâèäåòåëüñòâóåò â ïîëüçó âèðóñíîé èíôåêöèè.

Ê ë þ ÷ å â û å ñ ë î â à: îñòðûé áðîíõèò, ðåñïèðàòîðíûå âèðóñû, Ñ-ðåàêòèâíûé áåëîê.

Zaitsev A.A., Budoragin I.E., Likhodii V.I., Savushkina O.I. – Acute bronchitis: answers to keyquestions. The publication is devoted to the etiology and pharmacotherapy of acute bronchitis in adults.The authors obtained data on the etiology of the disease, indicating that in the clear majority of casesacute bronchitis is caused by various respiratory viruses (adenoviruses, influenza viruses and parainfluenza,and combinations of different viruses). The results of the study show that the starting prescri ptionof antibacterial drugs for acute bronchitis is impractical, and the decision on their use should be basedon objective data indicating the development of the bacterial process. A good tool for «distinguishing»a viral and bacterial infection is the quantitative determination of C-reactive protein in serum, the levelof which is less than 20 mg/l, which is in favor of viral infection.

K e y w o r d s: acute bronchitis, respiratory viruses, C-reactive protein.

íîãî ïðîèçâîäñòâåííîãî øóìà – ïðîäîëæè-òåëüíîñòüþ ïðåäøåñòâóþùåãî ñòàæà. Ïðåä-øåñòâóþùèé ñòàæ ðàáîòû â óñëîâèÿõ íåïðå-ðûâíîãî íèçêîàìïëèòóäíîãî øóìà îêàçûâà-åò îòðèöàòåëüíîå âëèÿíèå íà èñõîä îñòðîéïîñòòðàâìàòè÷åñêîé ÑÍÒ è ñïîñîáñòâóåòôîðìèðîâàíèþ õðîíè÷åñêîé ñåíñîíåâðàëü-íîé òóãîóõîñòè. Ðàáîòà â óñëîâèÿõ èìïóëüñ-íîãî ïðîèçâîäñòâåííîãî øóìà íå îêàçûâàåòâëèÿíèÿ íà èñõîä îñòðîé ïîñòòðàâìàòè÷åñ-êîé ñåíñîíåâðàëüíîé òóãîóõîñòè, îäíàêî ìî-æåò ïðèâåñòè ê ðàçâèòèþ äâóñòîðîííåãî ïî-ðàæåíèÿ çâóêîâîñïðèíèìàþùåãî àïïàðàòàïðè ñîõðàíåíèè ïðîôåññèè.



Îñòðûé áðîíõèò (ÎÁ) – îñòðî èëè ïîä-îñòðî âîçíèêøåå âîñïàëåíèå áðîíõèàëüíîãîäåðåâà, âåäóùèì êëèíè÷åñêèì ñèìïòîìîìêîòîðîãî ÿâëÿåòñÿ êàøåëü (÷àùå ïðîäóêòèâ-íûé), àññîöèèðîâàííîå ñ õàðàêòåðíûìè ïðè-çíàêàìè èíôåêöèè íèæíèõ îòäåëîâ äûõàòåëü-íûõ ïóòåé (îäûøêà, õðèïû, äèñêîìôîðò â ãðóä-íîé êëåòêå) áåç âîçìîæíîñòè èõ àëüòåðíàòèâ-íîãî îáúÿñíåíèÿ â ðàìêàõ õðîíè÷åñêîãî áðîíõî-îáñòðóêòèâíîãî ïðîöåññà (õðîíè÷åñêèé áðîíõèò,áðîíõèàëüíàÿ àñòìà).

Çàáîëåâàåìîñòü ÎÁ äîñòèãàåò 30–40‰â çàâèñèìîñòè îò âðåìåíè ãîäà. Â ÐÔ ðåàëü-íûå ìàñøòàáû ðàñïðîñòðàíåííîñòè ýòîé áî-ëåçíè ó âçðîñëûõ îöåíèòü êðàéíå ñëîæíî,ò. ê. íåðåäêî íåòÿæåëûå êëèíè÷åñêèå ôîðìûïîïðîñòó íå ðåãèñòðèðóþòñÿ.

Â áîëüøèíñòâå ñëó÷àåâ ýòèîëîãè÷åñêè-ìè àãåíòàìè ÎÁ ó âçðîñëûõ ÿâëÿþòñÿ ðåñ-ïèðàòîðíûå âèðóñû – âèðóñû ãðèïïà À è Â,ïàðàãðèïïà, à òàêæå ðåñïèðàòîðíî-ñèíöèòè-àëüíûé âèðóñ – ÐÑÂ (êàê ïðàâèëî, âûçûâàåòïîðàæåíèå íèæíèõ îòäåëîâ ðåñïèðàòîðíîãîòðàêòà ó äåòåé), ÷åëîâå÷åñêèé ìåòàïíåâìîâè-ðóñ, ðåæå ÎÁ âûçûâàþò êîðîíàâèðóñû, àäå-íîâèðóñû è ðèíîâèðóñû. Íà äîëþ Mycoplasmaè Chlamydophila pneumoniae, Bordetella pertussisïðèõîäèòñÿ íå áîëåå 5–7% âñåõ ñëó÷àåâ çà-áîëåâàíèÿ.

Äèàãíîç îñòðîãî áðîíõèòà óñòàíàâëèâà-åòñÿ íà îñíîâàíèè êëèíè÷åñêèõ ñèìïòîìîâçàáîëåâàíèÿ. Â áîëüøèíñòâå ñëó÷àåâ ïîä-òâåðæäåíèå äèàãíîçà íå òðåáóåò ïðèâëå-÷åíèÿ ëàáîðàòîðíîé è èíñòðóìåíòàëüíîéäèàãíîñòèêè, à ïðîâîäèìûå èññëåäîâàíèÿíàïðàâëåíû íà èñêëþ÷åíèå àëüòåðíàòèâíîãîäèàãíîçà (âíåáîëüíè÷íàÿ ïíåâìîíèÿ, îáî-ñòðåíèå õðîíè÷åñêîãî áðîíõèòà èëè áðîíõè-àëüíîé àñòìû).

Ó ïàöèåíòà ñ ÎÁ êàêèõ-ëèáî èçìåíå-íèé ïðè ðåíòãåíîãðàôèè îðãàíîâ ãðóäíîéêëåòêè íå íàáëþäàåòñÿ. Ëåéêîöèòîç áîëåå 10–12×109/ë óêàçûâàåò íà âûñîêóþ âåðîÿòíîñòüáàêòåðèàëüíîé èíôåêöèè. Âàæíîå çíà÷åíèåâ ïîñëåäíèå ãîäû ïðèîáðåòàþò òåñòû, ïîçâî-ëÿþùèå ïðåäïîëîæèòü áàêòåðèàëüíóþ ïðè-ðîäó çàáîëåâàíèÿ. Â èõ ÷èñëå – êîëè÷åñòâåí-íîå îïðåäåëåíèå Ñ-ðåàêòèâíîãî áåëêà (ÑÐÁ).Ïðè çíà÷åíèè ÑÐÁ ìåíåå 20 ìã/ë â ïî-äàâëÿþùåì ÷èñëå ñëó÷àåâ ìîæíî ïðåä-ïîëîæèòü âèðóñíóþ ýòèîëîãèþ çàáîëåâàíèÿè îòêàçàòüñÿ îò ïðèìåíåíèÿ àíòèáèîòèêîâ.Â òî æå âðåìÿ ñëåäóåò ïðèçíàòü, ÷òî ðîñ-ñèéñêèõ äàííûõ îá óðîâíÿõ ïîâûøåíèÿêîíöåíòðàöèè áèîìàðê¸ðîâ â ïëàçìå êðîâèó áîëüíûõ ÎÁ íåäîñòàòî÷íî. Ïî äàííûìñïèðîìåòðèè âûÿâëÿþò ëåãêèå èëè óìåðåííûåíàðóøåíèÿ âåíòèëÿöèîííîé ñïîñîáíîñòèëåãêèõ ïî îáñòðóêòèâíîìó òèïó.

Ïðèìåíåíèå àíòèáàêòåðèàëüíûõ ïðåïàðà-òîâ ïðè ÎÁ äî íàñòîÿùåãî âðåìåíè ÿâëÿåòñÿêðàåóãîëüíûì êàìíåì ïðàêòè÷åñêîé ìåäèöè-íû. Àíòèáèîòèêè íå îêàçûâàþò íèêàêîãî âëè-ÿíèÿ íà óëó÷øåíèå ñîñòîÿíèÿ ïàöèåíòîâ, íîèõ èñïîëüçîâàíèå ñîïðîâîæäàåòñÿ âûñîêîé ÷à-ñòîòîé íåæåëàòåëüíûõ ðåàêöèé. Îäíèìè èçíàèáîëåå àêòóàëüíûõ âîçáóäèòåëåé ÎÁ ÿâëÿ-þòñÿ âèðóñû ãðèïïà À è Â, ÷òî â ðÿäå ñëó÷àåâòðåáóåò íàçíà÷åíèÿ ïðîòèâîâèðóñíîé òåðàïèè(èíãèáèòîðû íåéðàìèíèäàçû – îñåëüòàìèâèð,çàíàìèâèð). Èõ ïðèìåíåíèå íàèáîëåå ðåêîìåí-äîâàíî ó ïîæèëûõ ïàöèåíòîâ, ïðè íàëè÷èèôàêòîðîâ ðèñêà ðàçâèòèÿ áàêòåðèàëüíûõ îñ-ëîæíåíèé (ñàõàðíûé äèàáåò, ñåðäå÷íàÿ íåäî-ñòàòî÷íîñòü, èììóíîñóïðåññèè, çàáîëåâàíèÿïå÷åíè è ïî÷åê); â ñëó÷àå ïðåäïîëàãàåìîãî èí-ôèöèðîâàíèÿ âèðóñîì H5N1 (ïòè÷èé ãðèïï)è âèðóñîì H1N1.

Èíãèáèòîðû íåéðîìèíèäàçû îêàçûâàþòâëèÿíèå ëèøü íà âèðóñû ãðèïïà, â òî âðåìÿêàê ÷àñòûìè âîçáóäèòåëÿìè ÎÁ ÿâëÿþòñÿäðóãèå ðåñïèðàòîðíûå âèðóñû. Â ñâÿçè ñ ýòèìîñîáóþ àêòóàëüíîñòü ïðèîáðåòàþò ïðåïàðà-òû, îòíîñÿùèåñÿ ê ãðóïïå èíòåðôåðîíîâ èèíäóêòîðîâ ñèíòåçà èíòåðôåðîíà (ÈÔÍ).Îäíàêî ñëåäóåò ïðèçíàòü, ÷òî óáåäèòåëüíûõäàííûõ îá ýôôåêòèâíîñòè èíäóêòîðîâ ÈÔÍïðè ÎÁ íåäîñòàòî÷íî.

Ñ öåëüþ èçó÷åíèÿ ýòèîëîãèè îñòðîãîáðîíõèòà, óðîâíÿ ÑÐÁ ïðè äàííîì çàáîëåâà-íèè è ýôôåêòèâíîñòè ïðèìåíåíèÿ èíäóê-òîðîâ èíòåðôåðîíà (êàãîöåë) â ñðàâíåíèèñ òåðàïèåé, âêëþ÷àþùåé ïðèìåíåíèå àíòè-áàêòåðèàëüíûõ ïðåïàðàòîâ, íàìè áûëî ïðî-âåäåíî íàáëþäàòåëüíîå èññëåäîâàíèå.

Äëÿ àíàëèçà îòîáðàíî 87 èñòîðèé áîëåçíèïàöèåíòîâ ñ ÎÁ (84 – ìóæ÷èíû è 3 æåíùè-íû). Ñðåäíèé âîçðàñò áîëüíûõ ñîñòàâèë 22,5±5,7 ãîäà. Èç íèõ áûëè ñôîðìèðîâàíû îòäåëü-íûå ãðóïïû: 1-ÿ ãðóïïà – 42 áîëüíûõ ÎÁ,

Ýòèîëîãèÿ îñòðîãî áðîíõèòàïî äàííûì âèðóñîëîãè÷åñêîãî

èññëåäîâàíèÿ, n=50



êîòîðûå ïîëó÷àëè ôàðìàêîòåðàïèþ ñ èñïîëü-çîâàíèåì èíäóêòîðà ÈÔÍ (êàãîöåë) ñîãëàñ-íî èíñòðóêöèè, 2-ÿ ãðóïïà – 45 ïàöèåíòîâ,êîòîðûå, ïî ìíåíèþ âðà÷à, íóæäàëèñü â íà-çíà÷åíèè ñòàðòîâîé àíòèìèêðîáíîé òåðàïèè(öåôòðèàêñîí, àìîêñèöèëëèí, êëàðèòðîìèöèí).Âñå ïàöèåíòû òàêæå ïîëó÷àëè ñòàíäàðòíóþñèìïòîìàòè÷åñêóþ òåðàïèþ, âêëþ÷àþùóþìóêîàêòèâíûå ñðåäñòâà (àöåòèëöèñòåèí èëèêàðáîöèñòåèí), ïî ïîêàçàíèÿì – æàðîïîíè-æàþùèå ïðåïàðàòû, áðîíõîëèòèêè (ôåíîòå-ðîë/èïðàòðîïèÿ áðîìèä).

Äëÿ îïðåäåëåíèÿ ýòèîëîãèè ÎÁ â 56ñëó÷àÿõ áûëî ïðîâåäåíî âèðóñîëîãè÷åñêîåèññëåäîâàíèå ìåòîäîì ÎÒ-ÏÖÐ ñ ãèáðèäè-çàöèîííî-ôëóîðåñöåíòíîé äåòåêöèåé â ðå-àëüíîì âðåìåíè. Îöåíêó êëèíè÷åñêîé ýô-ôåêòèâíîñòè èññëåäóåìûõ ðåæèìîâ ôàðìà-êîòåðàïèè ÎÁ ïðîâîäèëè íà îñíîâàíèè àíà-ëèçà ñðîêîâ êóïèðîâàíèÿ âñåõ ñèìïòîìîâîñòðîãî áðîíõèòà, â ò. ÷. â âèäå ñóììàðíîéîöåíêè ïî øêàëå BSS (Bronchitis SeverityScore), ó÷èòûâàëîñü ðàçâèòèå îñëîæíåíèéçàáîëåâàíèÿ (ïíåâìîíèÿ), è îöåíèâàëèñü âñåíåæåëàòåëüíûå ÿâëåíèÿ â ïðîöåññå ëå÷åíèÿ.

×àùå âñåãî ïàöèåíòû ïðåäúÿâëÿëè æà-ëîáû íà ïîâûøåíèå òåìïåðàòóðû òåëà – 100%,ïðîäóêòèâíûé êàøåëü – 100%, îáùóþ ñëà-áîñòü è íåäîìîãàíèå – 89,7%, äèñêîìôîðò âãðóäíîé êëåòêå – 73,5%, îäûøêó ïðè ôèçè-÷åñêîé íàãðóçêå – 26,4%. Ó âñåõ ïàöèåíòîâîïðåäåëÿëèñü àóñêóëüòàòèâíûå ïðèçíàêè çà-áîëåâàíèÿ – æåñòêîå äûõàíèå èëè ñóõèå ñâè-ñòÿùèå/æóææàùèå õðèïû. Ñðåäíèé óðîâåíüÑÐÁ ñîñòàâèë 12,3±8,2 ìã/ë. Êîëè÷åñòâî ëåé-êîöèòîâ – 7,2±3,4 (×109/ë). Ó âñåõ ïàöèåíòîâñóììàðíûé áàëë ïî øêàëå BSS – 8,8±1,2(â ãðóïïå 1 – 8,8±1,3; â ãðóïïå 2 – 8,8±1,2).

Ïî ðåçóëüòàòàì ÏÖÐ-äèàãíîñòèêè â50 ñëó÷àÿõ (89,3%) áûëà îáíàðóæåíà ÐÍÊè ÄÍÊ ðàçëè÷íûõ ðåñïèðàòîðíûõ âèðó-ñîâ. Ýòèîëîãèÿ ÎÁ, ïî äàííûì âèðóñî-ëîãè÷åñêîãî èññëåäîâàíèÿ, ïðåäñòàâëåíà âòàáëèöå. Â 35 ñëó÷àÿõ îïðåäåëÿëàñü ìîíî-èíôåêöèÿ, â 15 ñëó÷àÿõ (30%) îïðåäåëÿ-ëèñü ÐÍÊ è ÄÍÊ äâóõ âèðóñîâ, íàèáîëåå÷àñòî: àäåíîâèðóñ + ðèíîâèðóñ, ÐÑÂè ðèíîâèðóñ, ÐÑÂ è ìåòàïíåâìîâèðóñ,ïàðàãðèïï + ðèíîâèðóñ.

Ïðè èñïîëüçîâàíèè ïðåïàðàòà «Êàãîöåë»(ãðóïïà 1) ñðåäíÿÿ ïðîäîëæèòåëüíîñòü ãèïåð-òåðìèè ñîñòàâèëà 4,1±0,9 ñóò, âî 2-é ãðóïïå4,3±1,2. Ñðîêè êóïèðîâàíèÿ êàøëÿ òàêæåáûëè ñðàâíèìûìè (âñå ïàöèåíòû ïîëó÷àëèàäåêâàòíóþ ìóêîàêòèâíóþ òåðàïèþ): â 1-éãðóïïå – 7,4±1,4 ñóò, âî 2-é – 7,7±1,3 ñóò.Ñðåäíÿÿ äëèòåëüíîñòü êóïèðîâàíèÿ ôèçè-

÷åñêèõ ïðèçíàêîâ â 1-é ãðóïïå ñîñòàâèëà6,3±1,5 ñóò, âî 2-é – 6,7±1,3 ñóò.

Ïðè àíàëèçå äèíàìèêè ñóììàðíîãî áàëëàïî øêàëå BSS îêàçàëîñü, ÷òî â ãðóïïå 1 ýòîòïîêàçàòåëü ê 6-ì ñóòêàì ñîñòàâèë – 3,1±0,9,â ãðóïïå 2 – 3,3±0,9 áàëëà.

Íàçíà÷åíèå äîïîëíèòåëüíîé àíòèáàêòåðè-àëüíîé òåðàïèè â 1-é ãðóïïå, ïî ìíåíèþ âðà÷à,ïîòðåáîâàëîñü â 28,6% ñëó÷àåâ (12 ïàöèåíòîâ).Îäíàêî àíàëèç êëèíèêî-ëàáîðàòîðíûõ äàííûõ,âêëþ÷àÿ óðîâåíü ÑÐÁ, ïîêàçàë, ÷òî â áîëüøèí-ñòâå ñëó÷àåâ íàçíà÷åíèå àíòèìèêðîáíûõ ïðå-ïàðàòîâ íå òðåáîâàëîñü. Â ãðóïïå 1 ó 2 ïàöèåí-òîâ (4,8%) íà 3–6-å ñóòêè äèàãíîñòèðîâàíàíåòÿæåëàÿ ïíåâìîíèÿ, â ãðóïïå 2 òàêæå ó 2 ïà-öèåíòîâ (4,5%) íàáëþäàëîñü ðàçâèòèå ïíåâ-ìîíèè. Ñðîêè âðåìåííîé íåòðóäîñïîñîáíîñòèïàöèåíòîâ áûëè ñðàâíèìû ïî ãðóïïàì – 9,7±1è 9,9±1,1 ñóò ñîîòâåòñòâåííî.

Â ïðîöåññå ëå÷åíèÿ â 1-é ãðóïïå ó äâóõáîëüíûõ (4,8%) íàáëþäàëèñü íåæåëàòåëüíûåÿâëåíèÿ ñî ñòîðîíû æåëóäî÷íî-êèøå÷íîãîòðàêòà: òîøíîòà, áîëè â ýïèãàñòðàëüíîé îá-ëàñòè. Íàïðîòèâ, â ãðóïïå 2 íåæåëàòåëüíûåÿâëåíèÿ áûëè çàðåãèñòðèðîâàíû ó 8 ïàöè-åíòîâ (17,8%), ïðè ýòîì ó 2 áîëüíûõ îòìå-÷åíî ðàçâèòèå àíòèáèîòèêîàññîöèèðîâàííîéäèàðåè, â îäíîì ñëó÷àå íàáëþäàëàñü àëëåð-ãè÷åñêàÿ ðåàêöèÿ ïî òèïó êðàïèâíèöû.

Òàêèì îáðàçîì, íà îñíîâàíèè âèðóñîëî-ãè÷åñêîãî èññëåäîâàíèÿ íàìè îïðåäåëåíà ýòè-îëîãèÿ çàáîëåâàíèÿ, ñâèäåòåëüñòâóþùàÿ îòîì, ÷òî â ïîäàâëÿþùåì áîëüøèíñòâå ñëó-÷àåâ ÎÁ âûçûâàåòñÿ ðàçëè÷íûìè ðåñïèðàòîð-íûìè âèðóñàìè. Íàèáîëüøóþ àêòóàëüíîñòüèìåþò âèðóñû ãðèïïà è ïàðàãðèïïà, àäåíî-âèðóñû è êîìáèíàöèè ðàçëè÷íûõ âèðóñîâ.Ó÷èòûâàÿ âèðóñíóþ ýòèîëîãèþ ÎÁ, ôàðìà-êîòåðàïèÿ ýòîãî çàáîëåâàíèÿ ñ èñïîëüçîâà-íèåì ñòàðòîâîãî íàçíà÷åíèÿ àíòèáàêòåðèàëü-íûõ ïðåïàðàòîâ ÿâëÿåòñÿ íåöåëåñîîáðàçíîéè ðåøåíèå îá èõ ïîäêëþ÷åíèè äîëæíî îñ-íîâûâàòüñÿ íà îáüåêòèâíûõ äàííûõ, ñâèäå-òåëüñòâóþùèõ î ðàçâèòèè áàêòåðèàëüíîãîïðîöåññà.

Ñ ïðàêòè÷åñêîé òî÷êè çðåíèÿ õîðîøèìèíñòðóìåíòîì «ðàçãðàíè÷åíèÿ» âèðóñíîé èáàêòåðèàëüíîé èíôåêöèè ÿâëÿåòñÿ êîëè÷å-ñòâåííîå îïðåäåëåíèå Ñ-ðåàêòèâíîãî áåëêà.Ïðèìåíåíèå èíäóêòîðîâ ÈÔÍ ïðè ÎÁ âè-ðóñíîé ýòèîëîãèè ïîçâîëÿåò äîáèâàòüñÿ êëè-íè÷åñêîãî âûçäîðîâëåíèÿ, ïðè ýòîì òàêàÿòåðàïèÿ ñîïðîâîæäàåòñÿ ìåíüøèì ÷èñëîìíåæåëàòåëüíûõ ÿâëåíèé, íåæåëè «ðåàëüíàÿ»êëèíè÷åñêàÿ ïðàêòèêà, âêëþ÷àþùàÿ â ïîäàâ-ëÿþùåì áîëüøèíñòâå ñëó÷àåâ èñïîëüçîâà-íèå àíòèìèêðîáíûõ ïðåïàðàòîâ.


ÈÇ ÈÑÒÎÐÈÈÂÎÅÍÍÎÉ ÌÅÄÈÖÈÍÛ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ [61:378.661](091)(470.311)

Ê 100-ëåòèþ îòêðûòèÿ Ãîñóäàðñòâåííîé âûñøåéìåäèöèíñêîé øêîëû â ñòåíàõ Ìîñêîâñêîãîâîåííîãî ãîñïèòàëÿ

ÊÐÞÊÎÂ Å.Â., çàñëóæåííûé âðà÷ ÐÔ, ÷ëåí-êîððåñïîíäåíò ÐÀÍ, ïðîôåññîð,ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáûÊÎÑÒÞ×ÅÍÊÎ Î.Ì., äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÁÎÁÛËÅÂ Â.À., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàÎÂ×ÈÍÍÈÊÎÂÀ Ì.Á. ([email protected])

Ãëàâíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. àêàäåìèêà Í.Í.Áóðäåíêî, Ìîñêâà

Ñòàòüÿ ïîñâÿùåíà Ãîñóäàðñòâåííîé âûñøåé ìåäèöèíñêîé øêîëå, îòêðûòîé â ìàðòå 1919 ã.â Ìîñêîâñêîì âîåííîì ãîñïèòàëå, ÷òî áûëî îáóñëîâëåíî ïîòðåáíîñòüþ íîâîãî ñîâåòñêîãî ãîñó-äàðñòâà â âûñîêîîáðàçîâàííûõ ìåäèöèíñêèõ êàäðàõ. Âûñøàÿ ìåäèöèíñêàÿ øêîëà ÿâèëàñü ñâîåãîðîäà ïðîäîëæàòåëåì òðàäèöèé ïîäãîòîâêè ìåäèöèíñêèõ êàäðîâ â Ìîñêîâñêîì ãîñïèòàëå ïîñëåìåäèêî-õèðóðãè÷åñêîé øêîëû è Ìîñêîâñêîé ìåäèêî-õèðóðãè÷åñêîé àêàäåìèè.Ê ë þ ÷ å â û å ñ ë î â à: Ìîñêîâñêèé âîåííûé ãîñïèòàëü, Ãîñóäàðñòâåííàÿ âûñøàÿ ìåäèöèíñêàÿøêîëà, ïîäãîòîâêà ìåäèöèíñêèõ êàäðîâ, ïîâûøåíèå êâàëèôèêàöèè âðà÷åé, èñòîðèÿ âîåííîé ìåäè-öèíû.

Kryukov E.V., Kostyuchenko O.M., Bobylev V.A., Ovchinnikova M.B. – To the 100th anniversary of theopening of the State Higher Medical School in the Moscow Military Hospital. The article is devotedto the State Higher Medical School, opened in March 1919 in the Moscow Military Hospital, which was dueto the need of the new Soviet state for highly educated medical personnel. The Higher Medical School wasa kind of continuation of the traditions of training medical personnel at the Moscow Hospital afterthe medical-surgical school and the Moscow Medical-Surgical Academy.K e y w o r d s: the Moscow Military Hospital, the State Higher Medical School, training of medicalpersonnel, advanced training of doctors, history of military medicine.

Â ìàðòå 2019 ã. èñïîëíÿåòñÿ 100 ëåò ñ íà÷àëà ðàáîòû Ãîñóäàðñòâåííîé

âûñøåé ìåäèöèíñêîé øêîëû, îðãàíèçî-âàííîé íà áàçå ñòàðåéøåãî ðîññèéñêîãîãîñóäàðñòâåííîãî ìåäèöèíñêîãî ó÷ðåæ-äåíèÿ – Ìîñêîâñêîãî âîåííîãî ãîñ-ïèòàëÿ.

Ýòîò þáèëåé ÿâëÿåòñÿ íàãëÿäíûìïðèìåðîì ïðååìñòâåííîñòè òðàäèöèé, çà-ëîæåííûõ îñíîâàòåëÿìè ãîñïèòàëÿ èì-ïåðàòîðîì Ïåòðîì I è ëåéá-ìåäèêîìÍèêîëàåì Áèäëîî. C ïåðâûõ äíåé ðàáî-òû Ìîñêîâñêèé ãîñïèòàëü ïðåäñòàâëÿëñîáîé êëèíè÷åñêîå ó÷ðåæäåíèå, îáúåäè-íÿÿ â ñâîåé ðàáîòå ïðîöåññû ëå÷åíèÿ èîáó÷åíèÿ â îðãàíèçîâàííîì â åãî ñòåíàõó÷åáíîì çàâåäåíèè – âíà÷àëå ìåäèêî-õèðóðãè÷åñêîé øêîëå, çàòåì Ìåäèêî-õè-ðóðãè÷åñêîé àêàäåìèè.

Ïîñëå Ôåâðàëüñêîãî ïåðåâîðîòà1917 ã. Ìîñêîâñêèé ãåíåðàëüíûé âîåí-íûé ãîñïèòàëü, èç íàçâàíèÿ êîòîðîãîáûëè èñêëþ÷åíû ñëîâà «èìåíè èìïåðà-òîðà Ïåòðà I», âìåñòå ñî âñåé Ðîññèåéâñòóïèë â ýïîõó ïîòðÿñåíèé. 14 ìàðòà1917 ã. íàñòîÿòåëåì ãîñïèòàëüíûõ öåðê-âåé ïðîòîèåðååì À.Êîïåöêèì áûë ïðî-÷èòàí «Àêò îá îòðå÷åíèè îò ïðåñòîëàÍèêîëàÿ II è îá îòêàçå âåëèêîãî êíÿçÿÌèõàèëà Àëåêñàíäðîâè÷à îò Èìïåðàòîð-ñêîãî òðîíà»1. 19 ìàðòà 1917 ã. â ãîñïè-òàëüíîé öåðêâè âî èìÿ «Âñåõ Ñêîðáÿ-ùèõ Ðàäîñòü» áûë ïðèâåäåí ê ïðèñÿãåíà âåðíîñòü ñëóæáå Âðåìåííîìó ïðàâè-òåëüñòâó âåñü ïåðñîíàë Ìîñêîâñêîãî ãîñ-

1 Ðîññèéñêèé ãîñóäàðñòâåííûé âîåííî-èñòîðè-÷åñêèé àðõèâ (ÐÃÂÈÀ), ô. 1714, îï. 1, ä. 6, ë. 4.



âîåíâðà÷åé, òîëüêî ÷òî îêîí÷èâøèõÂÌåäÀ. Ýòè âðà÷è ïðîõîäèëè (ïî î÷å-ðåäè) 4-ìåñÿ÷íûé ñòàæ â õèðóðãè÷åñ-êèõ îòäåëåíèÿõ» [1]. Êàê ïèøåò â ñâîèõâîñïîìèíàíèÿõ ïîìîùíèê ãëàâíîãî âðà-÷à (1926–1928) ïðîôåññîð Ã.Ì.Ïîïîâ,îðãàíèçàöèè ñòàæèðîâêè â ãîñïèòàëåóäåëÿë áîëüøîå âíèìàíèå íà÷àëüíèêñàíèòàðíîãî óïðàâëåíèÿ îêðóãà Í.Ñ.Äå-ðåâåíñêîâ, êîòîðûé ÷àñòî áûâàë â ãîñ-ïèòàëå è ïðîâîäèë êîíôåðåíöèè ñ âðà-÷àìè-ñòàæåðàìè.

Â ãîñïèòàëü íà äîëæíîñòè êîíñóëü-òàíòîâ ñòàëè ïðèãëàøàòüñÿ âûñîêîêâà-ëèôèöèðîâàííûå ñïåöèàëèñòû èç ìîñ-êîâñêèõ èíñòèòóòîâ è êëèíèê. Ýòî ïî-çâîëèëî â äàëüíåéøåì îðãàíèçîâàòü ïðèÌîñêîâñêîì êîììóíèñòè÷åñêîì âîåííîìãîñïèòàëå êóðñû óñîâåðøåíñòâîâàíèÿâðà÷åé, íà êîòîðûõ îáó÷àëèñü âðà÷è ãîñ-ïèòàëÿ è Ìîñêîâñêîãî ãàðíèçîíà.

«Èç îêîí÷èâøèõ ÃÂÌØ, – ïèøåòÈ.Ï.Íîâèêîâ, – íåêîòîðûå ñòàëè ïðîôåñ-ñîðàìè, êàíäèäàòàìè è äîêòîðàìè ìåäè-öèíñêèõ íàóê, íåêîòîðûå ðàáîòàëè íà ðó-êîâîäÿùåé ðàáîòå, à áîëüøèíñòâî òðóäÿò-ñÿ âðà÷àìè â âîåííûõ è ãðàæäàíñêèõëå÷åáíûõ ó÷ðåæäåíèÿõ, ïðèíîñÿ ëþäÿìïîëüçó ïî ìåðå ñâîèõ ñèë è çíàíèé»6.

Äóìàåòñÿ, îáùèé íàñòðîé è ñîòðóäíè-êîâ ãîñïèòàëÿ, è ïðåïîäàâàòåëåé ÃÂÌØ,è ñòóäåíòîâ – áóäóùèõ âðà÷åé, èñêðåííååñòðåìëåíèå äîñòîéíî èñïîëíèòü ñâîé äîëãäàæå â ñàìûå òÿæåëûå ìîìåíòû â æèçíèÎòå÷åñòâà ÿðêî è ëàêîíè÷íî âûðàæàþòñëîâà èç ïîñëåäíåãî ïðèêàçà ïî ãîñïèòà-ëþ ãëàâíîãî âðà÷à ãîñïèòàëÿ À.Â.Ëèâà-íîâà, ïîëó÷èâøåãî íàçíà÷åíèå íà äîëæ-íîñòü íà÷àëüíèêà ñàí÷àñòè 2-é Êîííîéàðìèè: «Áîëüøå ïîëóãîäà ÿ ñòîÿë âî ãëà-âå 1-ãî Êðàñíîàðìåéñêîãî Êîììóíèñòè-÷åñêîãî ãîñïèòàëÿ è ïåðåæèë ìíîãî òÿ-æåëûõ äíåé â áîðüáå çà âîññòàíîâëåíèåýòîãî ãîñïèòàëÿ èç ñîñòîÿíèÿ ðàçâàëà èàíàðõèè... Ïîëó÷èâ íàçíà÷åíèå íà äîëæ-íîñòü íà÷àëüíèêà ñàíèòàðíîé ÷àñòè àð-ìèè, ÿ ïîêèäàþ äîðîãîé ìíå ãîñïèòàëü,ïðèíîøó ñâîþ áëàãîäàðíîñòü âñåìó ïåð-ñîíàëó, ðàáîòàâøåìó ñî ìíîé ðóêà îá ðóêóâ áîðüáå çà ñòðîèòåëüñòâî è ñîçèäàíèåêðóïíåéøåãî âîåííî-ëå÷åáíîãî çàâåäåíèÿè äîêàçàâøåãî, ÷òî äðóæíîé ðàáîòîé ìîæ-íî ñîçäàòü â Ðåñïóáëèêå âåëè÷àéøèå öåí-íîñòè...»7


1. Ãóñåâ À.À. Âîñïîìèíàíèÿ (ê èñòîðèèÌîñêîâñêîãî Êîììóíèñòè÷åñêîãî âîåííîãîãîñïèòàëÿ) / Ìîñêîâñêèé Êîììóíèñòè÷åñêèéâîåííûé ãîñïèòàëü. – Ì., 1943. – Ñ. 141–150.

2. Çëîáèí À.Ð. Ê èñòîðèè ïàòîëîãî-àíàòî-ìè÷åñêîãî îòäåëåíèÿ Ìîñêîâñêîãî Êîììóíè-ñòè÷åñêîãî âîåííîãî ãîñïèòàëÿ / ÌîñêîâñêèéÊîììóíèñòè÷åñêèé âîåííûé ãîñïèòàëü. –Ì., 1943. – Ñ. 134–140.

3. Çëîáèí À.Ð. Êðàòêàÿ èñòîðèÿ Ìîñêîâ-ñêîãî Êîììóíèñòè÷åñêîãî âîåííîãî ãîñïèòà-ëÿ, áûâøåãî Ìîñêîâñêîãî ãåíåðàëüíîãî âîåí-íîãî ãîñïèòàëÿ èìåíè Ïåòðà I, 1707–1942/ Ìîñêîâñêèé Êîììóíèñòè÷åñêèé âîåííûéãîñïèòàëü. – Ì., 1943. – Ñ. 23–46.

4. Êëþæåâ Â.Ì., Àáàøèí Â.Ã., Èïàòîâ Ï.Â.Ãîñóäàðñòâåííàÿ âûñøàÿ ìåäèöèíñêàÿøêîëà â ñòåíàõ ãîñïèòàëÿ / Ðîäîíà÷àëüíèê

Ðîññèéñêîé ìåäèöèíû – Ãëàâíûé âîåííûéêëèíè÷åñêèé ãîñïèòàëü èìåíè àêàäåìèêàÍ.Í.Áóðäåíêî. – Ì., 2006. – Ò. I. – Ñ. 192–201.

5. Ìàãàçàíèê Ã.Ë. Í.Í.Áóðäåíêî î âîåííî-ìåäèöèíñêîé ïîäãîòîâêå âðà÷åé // Âîåí.-ìåä.æóðí. – 1958. – ¹ 12. – Ñ. 78.

6. Îò÷åò Ëèêâèäàöèîííîé êîìèññèèÌîñêîâñêîãî Ãåíåðàëüíîãî âîåííîãî ãîñïè-òàëÿ. – Ì.: òèïîãðàôèÿ Ìîñêîâñêîãî Ãåíåðàëü-íîãî âîåííîãî ãîñïèòàëÿ, 1918. – 348 c.

7. Ïîääóáíûé Ì.Â. Ãëàâíîå âîåííî-ñà-íèòàðíîå óïðàâëåíèå è Íàðêîìàò çäðàâî-îõðàíåíèÿ â 1918–1920 ãã. // Âîåí.-ìåä. æóðí.– 2018. – Ò. 339, ¹ 7. – Ñ. 86.

8. Ïîääóáíûé Ì.Â. Ãîñïèòàëü â ïåðèîäÃðàæäàíñêîé âîéíû / Ðîäîíà÷àëüíèê Ðîññèé-ñêîé ìåäèöèíû – Ãëàâíûé âîåííûé êëèíè-÷åñêèé ãîñïèòàëü èìåíè àêàäåìèêà Í.Í.Áóð-äåíêî. – Ì., 2006. – Ò. I. – Ñ. 185–191.

6 Òàì æå.7 Ðîññèéñêèé ãîñóäàðñòâåííûé âîåííûé àð-

õèâ, ô. 19032, îï. 1, ä. 85, ë. 106.



© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ [61:355](092 Øàéêîâ)

À.Ä.Øàéêîâ – âîåííûé âðà÷, ó÷åíûé, ðåêòîð

ÊÎÐÍÅÅÂ À.Ã., êàíäèäàò ìåäèöèíñêèõ íàóê, äîöåíò1

ÀÌÈÍÅÂ Ð.Ì., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèêìåäèöèíñêîé ñëóæáû2

ØÅÂËÞÊ Í.Í., çàñëóæåííûé ðàáîòíèê âûñøåé øêîëû ÐÔ, ïðîôåññîð1

ËÀÍÖÎÂ Å.Â., ìàéîð ìåäèöèíñêîé ñëóæáû ([email protected])2

1Îðåíáóðãñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò; 2Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿèì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã

Ñòàòüÿ ïîñâÿùåíà 100-ëåòèþ ñî äíÿ ðîæäåíèÿ îòå÷åñòâåííîãî ó÷åíîãî-ýïèäåìèîëîãà, áûâøåãîðåêòîðà Îðåíáóðãñêîãî ãîñóäàðñòâåííîãî ìåäèöèíñêîãî èíñòèòóòà, ïîäïîëêîâíèêà ìåäèöèíñêîéñëóæáû â îòñòàâêå Àíàòîëèÿ Äìèòðèåâè÷à Øàéêîâà. Îí îñòàâèë ñëåä â èñòîðèè âîåííî-ìîðñêîéìåäèöèíû, ïðîéäÿ ïóòü îò êàðàáåëüíîãî âðà÷à äî ôëàãìàíñêîãî ýïèäåìèîëîãà 7-ãî Òèõîîêåàíñêîãîâîåííî-ìîðñêîãî ôëîòà. Ïîä ðóêîâîäñòâîì À.Ä.Øàéêîâà â 1960-å ãîäû â Îðåíáóðãñêîì ìåäèöèí-ñêîì èíñòèòóòå áûëè ñîçäàíû ïåäèàòðè÷åñêèé ôàêóëüòåò, ïîäãîòîâèòåëüíîå îòäåëåíèå, áîëåå10 íîâûõ êàôåäð è 6 ëàáîðàòîðèé, ïîñòðîåíû è ðåêîíñòðóèðîâàíû íîâûå îáùåæèòèÿ è êîðïóñà,ñïîðòèâíàÿ áàçà è ëàãåðü îòäûõà. À.Ä.Øàéêîâ âíåñ âêëàä â íàó÷íóþ ðàçðàáîòêó ïðîáëåì âîåííîéýïèäåìèîëîãèè, ýïèäåìèîëîãèè êèøå÷íûõ èíôåêöèé, ïàðàçèòîëîãèè è äð.Ê ë þ ÷ å â û å ñ ë î â à: À.Ä.Øàéêîâ, âîåííàÿ ýïèäåìèîëîãèÿ, Îðåíáóðãñêèé ãîñóäàðñòâåííûéìåäèöèíñêèé èíñòèòóò.

Korneev A.G., Aminev R.M., Shevlyuk N.N., Lantsov E.V. – A.D.Shaikov – a military doctor, a scientist,a chancellor. The article is dedicated to the 100th anniversary of the birth of a prominent Russianepidemiologist and former rector of the Orenburg State Medical Institute, lieutenant colonel of the medicalservice of retired Anatoly Dmitrievich Shaikov. He left a bright trace in the history of naval medicine,having traveled from the ship doctor to the flagship epidemiologist of the 7th Pacific Navy. In the 1960s,under the direction of A.D.Shaikov, a pediatric faculty, a preparatory department, more than 10 newdepartments and 6 laboratories were created at the Orenburg Medical Institute; A.D.Shaikov madea significant contribution to the scientific development of the problems of military epidemiology, epidemiologyof intestinal infections, parasitology, etc.K e y w o r d s: A.D.Shaikov, military epidemiology, the Orenburg State Medical Institute.

Ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû (1949), êàíäèäàò ìåäèöèíñêèõ íàóê

(1951), äîöåíò êàôåäðû èíôåêöèîííûõáîëåçíåé Îðåíáóðãñêîãî ãîñóäàðñòâåí-íîãî ìåäèöèíñêîãî èíñòèòóòà (1960),ðåêòîð Îðåíáóðãñêîãî ãîñóäàðñòâåííîãîìåäèöèíñêîãî èíñòèòóòà (1963) Àíàòîëèé

Äìèòðèåâè÷ Øàéêîâ ðîäèëñÿ â ñåìüåôåëüäøåðà â êèòàéñêîì ãîðîäå Õàðáèíåáîëåå âåêà íàçàä – 15 ñåíòÿáðÿ 1918 ã.Â Ñîâåòñêèé Ñîþç ñåìüÿ Øàéêîâûõïåðååõàëà â 1929 ã. Ïóòü â ìåäèöèíó Àíà-òîëèé Äìèòðèåâè÷ íà÷àë ïîñëå îêîí÷à-íèÿ ðàáî÷åãî ôàêóëüòåòà ïðè 1-ì Ëåíèí-ãðàäñêîì ìåäèíñòèòóòå â 1933 ã., ãäå ó÷èë-ñÿ ïî ñïåöèàëüíîñòè «âðà÷-ëå÷åáíèê».Ñ 1936 ïî 1941 ã. îí îáó÷àëñÿ íà ëå÷åá-íîì ôàêóëüòåòå 1-ãî Ëåíèíãðàäñêîãî ìåä-èíñòèòóòà èìåíè àêàäåìèêà È.Ï.Ïàâëîâà.Ïàðàëëåëüíî ñ ó÷åáîé ðàáîòàë ôåëüä-øåðîì.

Â èþëå 1941 ã. À.Ä.Øàéêîâ áûëïðèçâàí íà âîåííóþ ñëóæáó íà ôëîò. Åãîñëóæáà íà÷àëàñü ñ äîëæíîñòè êîðàáåëü-íîãî âðà÷à â îòðÿäå òðàëåíèÿ Êðàñíî-çíàìåííîãî Áàëòèéñêîãî ôëîòà. Ñ 1942ïî 1943 ã. – âðà÷-ýïèäåìèîëîã ñàíèòàð-íî-ýïèäåìèîëîãè÷åñêîé ëàáîðàòîðèèÁàëòèéñêîãî ôëîòà. Â 1943–1946 ãã. –ïîìîùíèê íà÷àëüíèêà ñàíèòàðíî-ýïèäå-ìèîëîãè÷åñêîãî îòäåëåíèÿ ìåäèöèíñêîãîîòäåëà Áàëòôëîòà, à ñ 1946 ïî 1947 ã. –íà÷àëüíèê ñàíèòàðíî-ýïèäåìèîëîãè÷åñ-êîãî îòäåëåíèÿ ìåäèöèíñêîãî îòäåëàÞãî-Áàëòèéñêîãî ôëîòà. Ñ 1947 ïî 1948 ã.– íà÷àëüíèê ìåäèöèíñêîé ñëóæáûËèáàâñêîé âîåííî-ìîðñêîé áàçû. Â òå-÷åíèå äâóõ ëåò ÿâëÿëñÿ ñëóøàòåëåì ëå-÷åáíî-ïðîôèëàêòè÷åñêîãî ôàêóëüòåòàÂîåííî-ìîðñêîé ìåäèöèíñêîé àêàäåìèè,ïî îêîí÷àíèè êîòîðîé ïîëó÷èë ñïåöè-àëüíîñòü âðà÷à-ýïèäåìèîëîãà. Ñ 1951 ïî



àâòîð áîëåå 30 íàó÷íûõ ðàáîò ïî îðãà-íèçàöèè çäðàâîîõðàíåíèÿ, âîåííîé ýïè-äåìèîëîãèè è âûñøåìó îáðàçîâàíèþ*.

Íà ïëå÷àõ Àíàòîëèÿ Äìèòðèåâè÷àáûëà òàêæå áîëüøàÿ îáùåñòâåííàÿ ðà-áîòà. Îí ÷åòûðåæäû èçáèðàëñÿ ÷ëåíîìÎðåíáóðãñêîãî îáêîìà ÊÏÑÑ, äâàæäûíàãðàæäàëñÿ îðäåíîì Òðóäîâîãî Êðàñíî-ãî Çíàìåíè. Ñðåäè äðóãèõ åãî íàãðàä áûëèîðäåí Êðàñíîé Çâåçäû, ìåäàëè «Çà áîå-

* Ñì.: Ïàíüêîâ À.Ñ., Êîðíååâ À.Ã., Øåâëþê Í.Í.Èñòîðèÿ êàôåäðû ýïèäåìèîëîãèè è èíôåê-öèîííûõ áîëåçíåé. – Îðåíáóðã: ÎðÃÌÓ. –2018. – 88 ñ.

âûå çàñëóãè», «Çà îáîðîíó Ëåíèíãðàäà»,«Çà ïîáåäó íàä Ãåðìàíèåé â ÂåëèêîéÎòå÷åñòâåííîé âîéíå 1941–1945 ãã.» è äð.

Ïîñëå òÿæåëîé è ïðîäîëæèòåëüíîéáîëåçíè 28 ìàðòà 1980 ã. Àíàòîëèÿ Äìèò-ðèåâè÷à Øàéêîâà íå ñòàëî. Îí îáëàäàëâûñîêèì ïðîôåññèîíàëèçìîì, ëþáîâüþê ñîñëóæèâöàì, ãîòîâíîñòüþ ïîäåëèòüñÿîïûòîì. Ñâîèìè çíàíèÿìè è ïëîäàìèòîãî áîëüøîãî äàðà, êîòîðûì åãî ùåäðîíàäåëèëà ïðèðîäà, îí ñíèñêàë çàñëóæåí-íûé àâòîðèòåò è óâàæåíèå äðóçåé è ñî-ðàòíèêîâ, êîëëåã è ó÷åíèêîâ, ïðåïîäàâà-òåëåé èíñòèòóòà è ñòóäåíòîâ.


Ñáîð ñ äîëæíîñòíûìè ëèöàìè âîèíñêèõ ÷àñòåé è âîåííî-ìåäèöèíñêèõ îðãàíèçàöèé ïîâîïðîñàì ìåäèöèíñêîãî ñíàáæåíèÿ ïðîøåë â Öåíòðå ôàðìàöèè è ìåäèöèíñêîé òåõíèêè ÌÎÐÔ â êîíöå íîÿáðÿ 2018 ã.

Íà ìåðîïðèÿòèå ïðèáûëè 36 ïðåäñòàâèòåëåé îò 27 âîèíñêèõ ÷àñòåé, ñðåäè êîòîðûõíà÷àëüíèêè ìåäèöèíñêèõ ñëóæá âîèíñêèõ ÷àñòåé, ðÿäà âîåííûõ âóçîâ, Ìîñêîâñêîãî ñóâîðîâñ-êîãî ó÷èëèùà, çàìåñòèòåëè íà÷àëüíèêîâ ãîñïèòàëåé ïî ìåäèöèíñêîìó ñíàáæåíèþ, çàâåäóþ-

ùèå àïòåêàìè ñàíàòîðèåâ è âîèíñêèõ ÷àñòåé, à òàêæå èíæåíåðíî-òåõíè÷åñêèé ïåðñîíàë. Ãåî-ãðàôèÿ ó÷àñòíèêîâ îáøèðíà: Ìîñêâà è Ìîñêîâñêàÿ îáëàñòü, Ñåâàñòîïîëü, Òóëà, Èâàíîâî, Ïñêîâ,Àðõàíãåëüñêàÿ îáëàñòü.

Îñíîâíîå âíèìàíèå â õîäå ñáîðà óäåëÿëîñü âîïðîñàì ñèñòåìû ìåíåäæìåíòà êà÷åñòâà,ðàçðàáîòêå è âíåäðåíèþ ÑÎÏ â äåÿòåëüíîñòü àïòåê âîåííî-ìåäèöèíñêèõ îðãàíèçàöèé,êà÷åñòâó ëåêàðñòâåííûõ ñðåäñòâ. Òðàäèöèîííî íà äàííûõ ñáîðàõ ïðîâîäèòñÿ àíàëèç îøèáîê

ïðè ïðåäîñòàâëåíèè îò÷åòà-çàÿâêè ô. 14/ìåä.Èíòåðåñíûé è ïî-íàñòîÿùåìó æèâîé ïðåçåíòàöèîííûé ìàòåðèàë, ïîñâÿùåííûé êîñìî-

äðîìó «Ïëåñåöê», áûë ïðåäñòàâëåí îò îòäåëà ìåäèöèíñêîãî ñíàáæåíèÿ ôèëèàëà ¹ 9 ÔÃÊÓ

«1469 ÂÌÊÃ» Ìèíîáîðîíû Ðîññèè (Àðõàíãåëüñêàÿ îáë.).Ó÷àñòíèêè è âûñòóïàþùèå âûñêàçàëèñü î íåîáõîäèìîñòè ïîäîáíûõ ìåðîïðèÿòèé, ò. ê.

îíè ïîçâîëÿþò óñòàíîâèòü îáðàòíóþ ñâÿçü ñ äîëæíîñòíûìè ëèöàìè íà ìåñòàõ, îáñóäèòü

îáùèå ïðîáëåìû, íàéòè ïóòè ðåøåíèÿ, îáìåíÿòüñÿ îïûòîì è çíàíèÿìè, óáåðå÷ü îò âîçìîæíûõîøèáîê.

Å.À.Êîëåñîâà

Ïàðàäíûé ïîðòðåò èìïåðàòîðà Ïàâëà I âñêîðå óêðàñèò ñòåíû Âîåííî-ìåäèöèíñêîé àêàäå-ìèè èìåíè Ñ.Ì.Êèðîâà. Êàðòèíó, íà êîòîðîé Ïàâåë I èçîáðàæåí íà ôîíå ôàñàäà øòàáà Ìåäèêî-õèðóðãè÷åñêîé (Âîåííî-ìåäèöèíñêîé) àêàäåìèè, ðóêîâîäñòâó ÂÌÀ èì. Ñ.Ì.Êèðîâà ïîäàðèëà÷ëåí ñîþçà õóäîæíèêîâ Ñàíêò-Ïåòåðáóðãà, ÷ëåí îáùåñòâà àêâàðåëèñòîâ Ñàíêò-Ïåòåðáóðãà

Ëþäìèëà Êîâàëåâà-Êîíäóðîâà.Êàê ðàññêàçàëà ìàñòåð, îíà ðàáîòàëà íàä ýòèì ïîðòðåòîì ïî÷òè ãîä, ïûòàÿñü ïåðåäàòü

õàðàêòåð èìïåðàòîðà. Íà÷àëüíèê ÂÌÀ èì. Ñ.Ì.Êèðîâà Àëåêñàíäð Ôèñóí òåïëî ïîáëàãîäàðèë

õóäîæíèêà çà ñòîëü öåííûé äàð ê 220-ëåòèþ àêàäåìèè.18 äåêàáðÿ 1798 ã. Ïàâåë I ïîäïèñàë óêàç «Îá óñòðîåíèè ïðè ãëàâíûõ ãîñïèòàëÿõ îñîáîãî

çäàíèÿ äëÿ âðà÷åáíîãî ó÷èëèùà è ó÷åáíûõ òåàòðîâ». Ïî÷òè ñðàçó ãëàâíîå âðà÷åáíîå ó÷èëèùå

ñòàëî èìåíîâàòüñÿ Ìåäèêî-õèðóðãè÷åñêîé àêàäåìèåé.

Äåïàðòàìåíò èíôîðìàöèè è ìàññîâûõ êîììóíèêàöèé

Ìèíèñòåðñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè, 20 ÿíâàðÿ 2019 ã.



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© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ 61:614.2

Îòêðûòèå ãëàâíîãî ëå÷åáíîãî êîðïóñàâ Ôèëèàëå ¹ 1 3-ãî Öåíòðàëüíîãî âîåííîãîêëèíè÷åñêîãî ãîñïèòàëÿ èìåíè À.À.Âèøíåâñêîãî

ÌÅØÊÎÂ À.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÍÅÆÈÂÎÂ Ð.Í., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáûÃÀËÈÊ Â.Ï., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêåÌÓÑÀÈËÎÂ Â.À., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû([email protected])

Ôèëèàë ¹ 1 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. À.À.Âèøíåâñêîãî,Ìîñêâà

Â Ôèëèàëå ¹ 1 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èìåíè À.À.ÂèøíåâñêîãîÌèíîáîðîíû Ðîññèè â äåêàáðå 2018 ã. ñîñòîÿëîñü òîðæåñòâåííîå îòêðûòèå âíîâü ñîçäàííîãîîïåðàöèîííîãî áëîêà, îòäåëåíèÿ ðåàíèìàöèè è ãëàâíîãî ëå÷åáíîãî êîðïóñà ïîñëå ðåìîíòà.Ñ äîêëàäàìè âûñòóïèëè íà÷àëüíèê Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ Ìèíîáîðîíû ÐîññèèÄìèòðèé Òðèøêèí è íà÷àëüíèê ôèëèàëà ïîëêîâíèê ìåäèöèíñêîé ñëóæáû Àíäðåé Ìåøêîâ. Ââîäâ ýêñïëóàòàöèþ äàííûõ ïîäðàçäåëåíèé ïîçâîëèò çà êîðîòêèé ïåðèîä ðåàëèçîâàòü íîâûé ýòàïðàçâèòèÿ ãîñïèòàëÿ.

Ê ë þ ÷ å â û å ñ ë î â à: Ôèëèàë ¹ 1 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èìåíèÀ.À.Âèøíåâñêîãî, êîìïëåêñ ÷èñòûõ ïîìåùåíèé, âîåííàÿ ìåäèöèíà, ñòðàòåãèÿ ðàçâèòèÿ ãîñïèòàëÿ.

Meshkov A.V., Nezhivov R.N., Galik V.P., Musailov V.A. – Opening of main medical building in theBranch N 1 of the A.A.Vishnevsky 3rd Central Military Clinical Hospital of the Ministry of Defenseof the Russian Federation. In the Branch N 1 of the A.A.Vishnevsky 3rd Central Military ClinicalHospital of the Ministry of Defense of the Russian Federation in December 2018, the ceremonial openingof the newly created operating unit, the intensive care unit and the main medical building after the repairtook place. Presentations were made by the Head of the Main Military Medical Directorate of the Ministryof Defense of the Russian Federation Dmitry Trishkin and the head of the branch, Colonel of MedicalService Andrei Meshkov. The commissioning of new units after repair will allow for a short period torealize a new stage in the development of the hospital.

K e y w o r d s: Branch N 1 of the A.A.Vishnevsky 3rd Central Military Clinical Hospital, the Ministry ofDefense of the Russian Federation, clean room complex, military medicine, hospital development strategy.

Â Ôèëèàëå ¹ 1 3-ãî Öåíòðàëüíîãî âîåí- íîãî êëèíè÷åñêîãî ãîñïèòàëÿ èìåíèÀ.À.Âèøíåâñêîãî Ìèíîáîðîíû Ðîññèè19 äåêàáðÿ 2018 ã. ñîñòîÿëîñü òîðæåñòâåííîåîòêðûòèå âíîâü ñîçäàííîãî îïåðàöèîííîãîáëîêà, îòäåëåíèÿ ðåàíèìàöèè è ãëàâíîãî ëå-÷åáíîãî êîðïóñà ïîñëå ðåìîíòà. Íà öåðåìî-íèè ïðèñóòñòâîâàëè íà÷àëüíèê Ãëàâíîãî âî-åííî-ìåäèöèíñêîãî óïðàâëåíèÿ ÌÎ ÐÔÄìèòðèé Òðèøêèí, íà÷àëüíèê ÔÃÁÓ «3 ÖÂÊÃèì. À.À.Âèøíåâñêîãî» Ìèíîáîðîíû Ðîññèèãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû Àëåê-ñàíäð Åñèïîâ, ïðåäñòàâèòåëè Ãëàâíîãî âî-åííî-ìåäèöèíñêîãî óïðàâëåíèÿ ÌÎ ÐÔ,ïðîôåññîðñêî-ïðåïîäàâàòåëüñêèé ñîñòàâêàôåäðû õèðóðãèè íåîòëîæíûõ ñîñòîÿíèé

è îíêîëîãèè ìîñêîâñêîãî ôèëèàëà Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà,ïðåäñåäàòåëü ïðàâëåíèÿ îáúåäèíåíèÿ «Âî-åíìåä» ïî Ìîñêîâñêîé îáëàñòè ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû â îòñòàâêå ÞðèéÍåìûòèí, ïðåäñòàâèòåëè ôèðì – ïðîèçâî-äèòåëåé ìåäèöèíñêîãî îáîðóäîâàíèÿ è äð.

Ñ äîêëàäîì âûñòóïèë íà÷àëüíèê Ôèëèà-ëà ¹ 1 ÔÃÁÓ «3 Öåíòðàëüíûé âîåííûé êëè-íè÷åñêèé ãîñïèòàëü èì. À.À.Âèøíåâñêîãî»Ìèíîáîðîíû Ðîññèè ïîëêîâíèê ìåäèöèíñ-êîé ñëóæáû Àíäðåé Ìåøêîâ. Îí îòìåòèë, ÷òîîôèöèàëüíûì äíåì ôîðìèðîâàíèÿ ãîñïèòà-ëÿ ñ÷èòàåòñÿ 25 ìàÿ 1946 ã., êîãäà äèðåêòèâîéÃåíåðàëüíîãî øòàáà Âîîðóæåííûõ Ñèë áûëîïðåäïèñàíî îòêðûòü 114-é Öåíòðàëüíûé àâèà-

Â Ôèëèàëå ¹ 1 3-ãî Öåíòðàëüíîãî âîåííîãîêëèíè÷åñêîãî ãîñïèòàëÿ èìåíè À.À.Âèøíåâñêîãî

îòêðûëñÿ ãëàâíûé ëå÷åáíûé êîðïóñ

Â Ôèëèàëå ¹ 1 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èìåíè

À.À.Âèøíåâñêîãî â äåêàáðå 2018 ã. ñîñòîÿëîñü òîðæåñòâåííîå îòêðûòèå âíîâü

ñîçäàííîãî îïåðàöèîííîãî áëîêà, îòäåëåíèÿ ðåàíèìàöèè è ãëàâíîãî ëå÷åáíîãî

êîðïóñà ïîñëå ðåìîíòà. Ââîä â ñòðîé íîâûõ ïîäðàçäåëåíèé ïîçâîëèò ïîâûñèòü

ýôôåêòèâíîñòü äåÿòåëüíîñòè ãîñïèòàëÿ, îáåñïå÷èòü äîñòóïíîñòü è êà÷åñòâî ñïå-

öèàëèçèðîâàííîé ìåäèöèíñêîé ïîìîùè êàê â ðàìêàõ ãîñóäàðñòâåííîãî çàäàíèÿ,

òàê è ïî ïðîãðàììàì îáÿçàòåëüíîãî è äîáðîâîëüíîãî ìåäèöèíñêîãî ñòðàõîâàíèÿ,

ðàñøèðèòü âîçìîæíîñòè è êîíêóðåíòîñïîñîáíîñòü îðãàíèçàöèè ïî îêàçàíèþ

àêòóàëüíûõ è âîñòðåáîâàííûõ âèäîâ ìåäèöèíñêîé ïîìîùè.

Â íîâîì îïåðàöèîííîì áëîêå. Ñëåâà íàïðàâî: âåäóùèé õèðóðã Ôèëèàëà ¹ 1 ÔÃÁÓ «3 Öåíòðàëüíûéâîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. À.À.Âèøíåâñêîãî» ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáûÐîìàí Íåæèâîâ, íà÷àëüíèê Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ ÌÎ ÐÔ Äìèòðèé Òðèøêèí,íà÷àëüíèê 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èìåíè À.À.Âèøíåâñêîãîãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû Àëåêñàíäð Åñèïîâ, íà÷àëüíèê Ôèëèàëà ¹ 1 ÔÃÁÓ «3 Öåíòðàëüíûéâîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. À.À.Âèøíåâñêîãî» ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÀíäðåé Ìåøêîâ

Ãëàâíûé êîðïóñ è îïåðàöèîííûé áëîê (íà ôîòî ñëåâà) Ôèëèàëà ¹ 1 ÔÃÁÓ «3 Öåíòðàëüíûé âîåííûéêëèíè÷åñêèé ãîñïèòàëü èì. À.À.Âèøíåâñêîãî»

Ìàòåðèàë îá îòêðûòèè íîâûõ ïîäðàçäåëåíèé â Ôèëèàëå ¹ 1 3 ÖÂÊÃ èì. À.À.Âèøíåâñêîãî

îïóáëèêîâàí â ðóáðèêå «Õðîíèêà»


ÕÐÎÍÈÊÀ

öèîííûé ãîñïèòàëüèñòðåáèòåëüíîé àâèà-öèè âîéñê ÏÂÎ ñòðà-íû. Óæå 30 ìàÿ 1946 ã.íà îêðàèíå ã. Êðàñíî-ãîðñêà â äâóõ äâóõ-ýòàæíûõ êàçàðìàõ íà-÷àëîñü ôîðìèðîâàíèåãîñïèòàëÿ íà 200 êîåê.Íà ðàáîòó ïðèíèìà-ëèñü ñïåöèàëèñòû èçëå÷åáíî-ïðîôèëàêòè-÷åñêèõ ó÷ðåæäåíèéãðàæäàíñêîãî è âîåí-íîãî çäðàâîîõðàíåíèÿñ âûñîêèìè ïðîôåññè-îíàëüíûìè è ìîðàëü-íûìè êà÷åñòâàìè. Â1999 ã. ãîñïèòàëü áûëïåðåèìåíîâàí â 5-éÖåíòðàëüíûé âîåí-íûé êëèíè÷åñêèé ãîñ-ïèòàëü ÂÂÑ. Ñ 5 ìàðòà2010 ã. ó÷ðåæäåíèå ïðå-îáðàçîâàíî â Ôèëèàë¹ 1 Ãëàâíîãî âîåííî-ãî êëèíè÷åñêîãî ãîñ-ïèòàëÿ èìåíè àêàäåìèêà Í.Í.Áóðäåíêî,à ñ 10 ñåíòÿáðÿ 2013 ã. – â Ôèëèàë ¹ 1 ÔÃÁÓ«3 ÖÂÊÃ èì. À.À.Âèøíåâñêîãî» Ìèíîáîðî-íû Ðîññèè.

Ðåìîíòíûå ðàáîòû â ãîñïèòàëå ïðîâîäè-ëèñü ñ ÿíâàðÿ 2015 ã. Â íàñòîÿùåå âðåìÿ â ðàì-êàõ ãîñóäàðñòâåííîãî êîíòðàêòà çàâåðøåí ðå-ìîíò îñíîâíîãî ëå÷åáíîãî êîðïóñà, áîëüøèí-ñòâà êëèíè÷åñêèõ è èíôðàñòðóêòóðíûõ ïîä-ðàçäåëåíèé.

Îïåðàöèîííûé áëîê, âêëþ÷àþùèé øåñòüñïåöèàëèçèðîâàííûõ îïåðàöèîííûõ çàëîâ èîòäåëåíèå ðåàíèìàöèè, ñîçäàí ïî òåõíîëîãèè«÷èñòûõ ïîìåùåíèé». Êëþ÷åâûìè ïðèíöèïà-ìè äàííîé òåõíîëîãèè ÿâëÿþòñÿ:

– çîíèðîâàíèå ïîìåùåíèé ñ âûäåëåíè-åì çîí ðàçíîãî ñàíèòàðíîãî ðåæèìà è êëàññà÷èñòîòû;

– ñîçäàíèå îñîáûõ ñïåöèàëèçèðîâàííûõñèñòåì âåíòèëÿöèè äëÿ ïîääåðæàíèÿ ïàðàìåò-ðîâ ìèêðîêëèìàòà è ÷èñòîòû âîçäóõà;

– îïòèìèçàöèÿ ðàçãðàíè÷åíèÿ «÷èñòûõ»è «ãðÿçíûõ» ôóíêöèîíàëüíûõ ïîòîêîâ äâè-æåíèÿ ïåðñîíàëà, áîëüíûõ, ïèùè, áåëüÿ, èíñò-ðóìåíòîâ è îòõîäîâ.

Ââîä â ýêñïëóàòàöèþ ãëàâíîãî ëå÷åáíîãîêîðïóñà, îïåðàöèîííîãî áëîêà è îòäåëåíèÿ ðå-àíèìàöèè ïîñëå ðåìîíòà ïîçâîëèò çà êîðîò-êèé ïåðèîä ðåàëèçîâàòü êà÷åñòâåííî íîâûéýòàï ðàçâèòèÿ ãîñïèòàëÿ.

Â ñâîåì âûñòóïëåíèè íà÷àëüíèê Ãëàâíî-ãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ ÌÎ ÐÔÄìèòðèé Òðèøêèí îòìåòèë, ÷òî çà íåñêîëüêî

ïîñëåäíèõ ëåò â ëó÷øóþ ñòîðîíó èçìåíèëñÿîáëèê ãîñïèòàëÿ. Ñ ââîäîì â ýêñïëóàòàöèþïåðåîáîðóäîâàííîãî ãëàâíîãî êîðïóñà, îïåðà-öèîííîãî è ðåàíèìàöèîííîãî áëîêîâ äîëæ-íî ïîâûñèòüñÿ êà÷åñòâî îêàçàíèÿ ìåäèöèíñ-êîé ïîìîùè. Íåîáõîäèìî âíåäðåíèå íîâûõìåòîäèê ëå÷åíèÿ, ýôôåêòèâíîå èñïîëüçîâàíèåíîâîé àïïàðàòóðû è äàëüíåéøåå ñîâåðøåí-ñòâîâàíèå ðàáîòû ó÷ðåæäåíèÿ â ñèñòåìå îáÿ-çàòåëüíîãî è äîáðîâîëüíîãî ìåäèöèíñêîãîñòðàõîâàíèÿ.

Ðóêîâîäñòâî ãîñïèòàëÿ, ïîíèìàÿ âñþ îò-âåòñòâåííîñòü çà êðóïíûå êàïèòàëîâëîæåíèÿ,ïðîâåäåííûå Ìèíèñòåðñòâîì îáîðîíû è Ãëàâ-íûì âîåííî-ìåäèöèíñêèì óïðàâëåíèåì ÌÎÐÔ, ïëàíèðóåò ïåðåéòè îò ñòðàòåãèè ñòàáèëü-íîñòè ê ñòðàòåãèè ðàçâèòèÿ. Òàêàÿ ñòðàòåãèÿñâÿçàíà ñ îñâîåíèåì è âíåäðåíèåì ñîâðåìåí-íûõ ñèñòåì óïðàâëåíèÿ ìåäèöèíñêîé îðãàíè-çàöèè, ïåðåõîäîì îò ëèíåéíî-ôóíêöèîíàëüíîéê ïðîöåññíîé ñòðóêòóðå óïðàâëåíèÿ ñ öåíòðà-ìè ôèíàíñîâîé îòâåòñòâåííîñòè, ÷òî ïîçâîëèòâûéòè íà íîâûé óðîâåíü áþäæåòèðîâàíèÿ.

Âñå ýòî â èòîãå ïîçâîëèò ïîâûñèòü ýô-ôåêòèâíîñòü äåÿòåëüíîñòè ãîñïèòàëÿ, îáåñïå-÷èòü äîñòóïíîñòü è êà÷åñòâî ñïåöèàëèçèðî-âàííîé ìåäèöèíñêîé ïîìîùè êàê â ðàìêàõãîñóäàðñòâåííîãî çàäàíèÿ, òàê è ïî ïðîãðàì-ìàì îáÿçàòåëüíîãî è äîáðîâîëüíîãî ìåäèöèí-ñêîãî ñòðàõîâàíèÿ, ðàñøèðèòü âîçìîæíîñòè èêîíêóðåíòîñïîñîáíîñòü îðãàíèçàöèè ïî îêà-çàíèþ àêòóàëüíûõ è âîñòðåáîâàííûõ âèäîâìåäèöèíñêîé ïîìîùè.

Âî âðåìÿ îáõîäà íîâîãî îïåðàöèîííîãî áëîêà. Ñëåâà íàïðàâî: íà÷àëü-íèê Ôèëèàëà ¹ 1 ÔÃÁÓ «3 Öåíòðàëüíûé âîåííûé êëèíè÷åñêèéãîñïèòàëü èì. À.À.Âèøíåâñêîãî» ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÀíäðåé Ìåøêîâ, âåäóùèé õèðóðã ôèëèàëà ïîäïîëêîâíèê ìåäèöèíñêîéñëóæáû Ðîìàí Íåæèâîâ, íà÷àëüíèê Ãëàâíîãî âîåííî-ìåäèöèíñêîãîóïðàâëåíèÿ ÌÎ ÐÔ Äìèòðèé Òðèøêèí


ÕÐÎÍÈÊÀ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2019ÓÄÊ 617-089:355

Ïåðâûé â Ðîññèè ó÷åáíî-ïðàêòè÷åñêèé êóðñïî âîåííî-ïîëåâîé õèðóðãèè è õèðóðãèèïîâðåæäåíèé ÑÌÀÐÒ

ÑÀÌÎÕÂÀËÎÂ È.Ì., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûâ îòñòàâêå ([email protected])1

ÔÎÌÈÍ Í.Ô., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûâ îòñòàâêå1

ÃÎÍ×ÀÐÎÂ À.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

ÐÅÂÀ Â.À., êàíäèäàò ìåäèöèíñêèõ íàóê, ìàéîð ìåäèöèíñêîé ñëóæáû ([email protected])1

ÏÅÒÐÎÂ À.Í., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

ÊÀÑÈÌÎÂ Ð.Ð., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

ÍÎÑÎÂ À.Ì., êàíäèäàò ìåäèöèíñêèõ íàóê, êàïèòàí ìåäèöèíñêîé ñëóæáû1

ÊÎÑÊÈÍ Â.Ñ., êàíäèäàò ìåäèöèíñêèõ íàóê, êàïèòàí ìåäèöèíñêîé ñëóæáû1

1Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã; 2442-é Âîåííûé êëèíè-÷åñêèé ãîñïèòàëü, Ñàíêò-Ïåòåðáóðã

Â ïîñëåäíèå ãîäû ïðîèçîøåë ñóùåñòâåííûé ïðîãðåññ â ëå÷åíèè òÿæåëûõ ðàíåíèé è òðàâì. Â êðèòè÷åñ-êèõ ñèòóàöèÿõ ó ñàìîé òÿæåëîé êàòåãîðèè ðàíåíûõ èñõîä â çíà÷èòåëüíîé ñòåïåíè îïðåäåëÿåòñÿ âáëèæàéøèå ìèíóòû ïîñëå ïîñòóïëåíèÿ â ñòàöèîíàð. Åäèíñòâåííî âîçìîæíîé òàêòèêîé, äàþùåéøàíñ ñîõðàíèòü æèçíü òàêèì ïîñòðàäàâøèì, ÿâëÿåòñÿ òàêòèêà ìíîãîýòàïíîãî õèðóðãè÷åñêîãî ëå÷å-íèÿ (Damage control). Íèçêàÿ ýôôåêòèâíîñòü òðàäèöèîííûõ ìåòîäîâ ïîäãîòîâêè õèðóðãîâ îñíîâàì èòåõíè÷åñêèì ïðèåìàì ýòîé òàêòèêè çàñòàâëÿåò ðàçðàáàòûâàòü íîâûå ôîðìû îáó÷åíèÿ. Îäíîé èçíàèáîëåå ïðîãðåññèâíûõ è âîñòðåáîâàííûõ ÿâëÿåòñÿ ïðîâåäåíèå òðåíèíãîâ íà áèîëîãè÷åñêîì ìàòåðè-àëå (êðóïíûå æèâîòíûå èëè êàäàâåðíûé ìàòåðèàë), îäíàêî ìåòîäîëîãèÿ ïðîâåäåíèÿ ïîäîáíûõ çàíÿ-òèé ðàíåå íå îòðàáàòûâàëàñü. Âïåðâûå â Ðîññèè â íîÿáðå 2018 ã. áûë ïðîâåäåí óíèêàëüíûé ó÷åáíî-ïðàêòè÷åñêèé êóðñ ÑÌÀÐÒ (Ñîâðåìåííûå Ìåòîäû è Àëãîðèòìû ëå÷åíèÿ Ðàíåíèé è Òðàâì), ñî÷åòàþ-ùèé â ñåáå îáó÷åíèå êàê íà æèâûõ òêàíÿõ, òàê è íà êàäàâåðàõ. Ó÷àñòíèêàì áûëà ïðåäîñòàâëåíàâîçìîæíîñòü óâèäåòü è ñàìîñòîÿòåëüíî îòðàáîòàòü îñíîâíûå êîìáèíàöèè òèïîâûõ õèðóðãè÷åñêèõïðèåìîâ è ìàíåâðîâ, íàïðàâëåííûõ íà óñòðàíåíèå æèçíåóãðîæàþùèõ ïîñëåäñòâèé ðàíåíèé è òðàâì.Ê ë þ ÷ å â û å ñ ë î â à: âîåííî-ïîëåâàÿ õèðóðãèÿ, õèðóðãèÿ ïîâðåæäåíèé, damage control, îáó÷åíèåõèðóðãîâ, êóðñ ÑÌÀÐÒ.

Samokhvalov I.M., Fomin N.F., Goncharov A.V., Reva V.A., Petrov A.N., Kasimov R.R., Nosov A.M., Koskin V.S.– First training and practical course on field surgery and trauma surgery «SMART» in Russia.In recent years, significant progress has been made in the treatment of severe injuries and traumas.In critical situations, for the heaviest category of wounded, the outcome is largely determined in the next few minutesafter admission to the hospital. The only possible tactic that gives a chance to save the lives of such victims is thetactics of multi-stage surgical treatment (damage control). The low effectiveness of traditional methods of trainingsurgeons in the basics and techniques of this tactic makes it necessary to develop new forms of training. One of themost progressive and sought-after is training on biological material (large animals or cadaver material), but themethodology for conducting such studies has not been worked out before. For the first time in Russia in November2018, a unique training and practical course «SMART» (Modern Methods and Algorithms for the Treatment ofWounds and Traumas) was conducted, combining training in both living tissues and cadavers. Participants weregiven the opportunity to see and independently work out the basic combinations of typical surgical techniques andmaneuvers aimed at eliminating the life-threatening consequences of injuries and traumas.K e y w o r d s: military field surgery, damage surgery, damage control, training of surgeons, SMART course.

Êà÷åñòâåííàÿ ïîäãîòîâêà âðà÷åé-õèðóðãîâ ïî âîïðîñàì âîåííî-ïîëåâîé õèðóðãèè

è õèðóðãèè ïîâðåæäåíèé ÿâëÿåòñÿ çàëîãîì óñ-ïåõà â ëå÷åíèè íàèáîëåå òÿæåëîé êàòåãîðèèïàöèåíòîâ. Â òå÷åíèå ïîñëåäíåãî äåñÿòèëåòèÿïðîèçîøåë íàñòîÿùèé ïðîðûâ â îáëàñòè ëå-÷åíèÿ òÿæåëûõ ðàíåíèé è òðàâì, èçìåíèëèñüïîäõîäû ê îêàçàíèþ ïîìîùè êàê â ìèðíîåâðåìÿ, òàê è â õîäå áîåâûõ äåéñòâèé, ïðèâåä-øèå â êîíå÷íîì ñ÷åòå ê ñíèæåíèþ ëåòàëüíî-ñòè è èíâàëèäèçàöèè.

Ôîðìû îáó÷åíèÿ ñîâðåìåííûì ìåòîäàìè ïîäõîäàì ê ëå÷åíèþ òðàâì òàêæå ïðåòåð-ïåëè ñóùåñòâåííûå èçìåíåíèÿ. Ïðåïîäàâà-íèå õèðóðãèè ñåãîäíÿ âêëþ÷àåò íå òîëüêî÷òåíèå ëåêöèîííîãî ìàòåðèàëà, íî è ðàçëè÷-íûå ôîðìû ïðàêòè÷åñêèõ çàíÿòèé. Ê íàèáî-ëåå ïåðñïåêòèâíûì èç íèõ îòíîñÿòñÿ îòðà-áîòêà ïðàêòè÷åñêèõ íàâûêîâ íà ìàíåêåíàõ,òðåíàæåðàõ, ó÷àñòèå â ìàñòåð-êëàññàõ, ðàáîòàíà áèîëîãè÷åñêèõ ìîäåëÿõ. Íàèáîëåå îòëà-æåíî ïðîâåäåíèå òàêèõ çàíÿòèé â ðàçëè÷íûõ

Ïåðâûé â Ðîññèè ó÷åáíî-ïðàêòè÷åñêèé êóðñ ïî âîåííî-ïîëåâîé õèðóðãèè è õèðóðãèè ïîâðåæäåíèé ÑÌÀÐÒ

Ïðåïîäàâàòåëü êàôåäðûâîåííî-ïîëåâîé õèðóðãèèÂ.À.Ðåâà äåìîíñòðèðóåòñëóøàòåëÿì âîçìîæíîñòèñîêðàùåííîãî ÓÇÈ ïðè òðàâìå

Âñòóïèòåëüíîå ñëîâîçàìåñòèòåëÿ íà÷àëüíèêà

àêàäåìèè ïî ó÷åáíîéè íàó÷íîé ðàáîòå

ãåíåðàë-ìàéîðàìåäèöèícêîé

ñëóæáûÁ.Í.Êîòèâà

Äåìîíñòðàöèîííîå çàíÿòèåíà ðîáîòå-ñèìóëÿòîðå

Âûïîëíåíèå òîðàêîòîìèè ïðèðàíåíèè ñåðäöà íà æèâîì áèîîáúåêòå

ïîä ðóêîâîäñòâîì äîöåíòà êàôåäðûâîåííî-ïîëåâîé õèðóðãèè

À.Â.Ãîí÷àðîâà

Ìàòåðèàë îá ó÷åáíî-ïðàêòè÷åñêîì êóðñå ïî âîåííî-ïîëåâîé õèðóðãèè è õèðóðãèè ïîâðåæäåíèé

ÑÌÀÐÒ îïóáëèêîâàí â ðóáðèêå «Õðîíèêà»

Ó÷àñòíèêè è îðãàíèçàòîðû ïåðâîãî â Ðîññèè êóðñà ÑÌÀÐÒ

Áèëàòåðàëüíàÿ òîðàêîòîìèÿâ èñïîëíåíèè ñëóøàòåëåé ïîäðóêîâîäñòâîì íà÷àëüíèêà ÍÈË(âîåííîé õèðóðãèè)À.Ì.Íîñîâà

Äîöåíòû êàôåäðû âîåííî-ïîëåâîéõèðóðãèè À.Í.Ïåòðîâ è Â.Â.Ñóâîðîâ

êîíòðîëèðóþò ïðîöåññ âûïîëíåíèÿõèðóðãè÷åñêîãî ïîñîáèÿ


ÕÐÎÍÈÊÀ

íûì è ïîìîæåò ñäåëàòü îêîí÷àòåëüíûé âûáîðâ îïðåäåëåíèè ñâîåé áóäóùåé ñïåöèàëüíîñòè.

Ó÷èòûâàÿ íåñîìíåííóþ ïðàêòè÷åñêóþöåííîñòü è ïîëîæèòåëüíûå îòçûâû ó÷àñòíè-êîâ êóðñà ÑÌÀÐÒ, ïðèíÿòî ðåøåíèå î åãîïðîâåäåíèè íåñêîëüêî ðàç â ãîä. Ñëåäóþùåå

ñîáûòèå ïîäîáíîãî ìàñøòàáà ïëàíèðóåòñÿ22–23 ìàðòà 2019 ã. Ïîäðîáíàÿ èíôîðìàöèÿäëÿ çàïèñè íà ñëåäóþùèå êóðñû, çíàêîìñòâàñ ñîäåðæàíèåì «Ïðàêòè÷åñêîãî ðóêîâîäñòâàïî Damage control» äîñòóïíà íà îôèöèàëüíîìñàéòå êóðñà ÑÌÀÐÒ www.traumasmart.ru

© Ï.À.ÊÀËÈÍÈÍ, Ò.Â.ÊÎÂÀË¨ÂÀ, 2019ÓÄÊ [614.253.52:355](063)

Îïûò ïðîâåäåíèÿ ïåðâîãî ñáîðà ãëàâíûõè ñòàðøèõ ìåäèöèíñêèõ ñåñòåð Âîçäóøíî-äåñàíòíûõ âîéñê

ÊÀËÈÍÈÍ Ï.À., ãâàðäèè êàïèòàí ìåäèöèíñêîé ñëóæáû ([email protected])1

ÊÎÂÀË¨ÂÀ Ò.Â., ãâàðäèè ñòàðøèé ñåðæàíò2

1ÔÃÊÓ «36 Îòäåëüíûé ìåäèöèíñêèé îòðÿä (àýðîìîáèëüíûé) ÂÄÂ» ÌÎ ÐÔ, ã. Èâàíîâî;2ÔÃÊÓ «35 Îòäåëüíûé ìåäèöèíñêèé îòðÿä (àýðîìîáèëüíûé) ÂÄÂ» ÌÎ ÐÔ, ã. Ïñêîâ

Ïðåäñòàâëåí êðàòêèé îò÷åò î âïåðâûå ïðîâåäåííîì â Âîîðóæåííûõ Ñèëàõ Ðîññèéñêîé Ôåäåðàöèèó÷åáíî-ìåòîäè÷åñêîì ñáîðå ãëàâíûõ (ñòàðøèõ) ìåäèöèíñêèõ ñåñòåð ìåäèöèíñêèõ îðãàíèçàöèéè ïîäðàçäåëåíèé Âîçäóøíî-äåñàíòíûõ âîéñê. Ìåðîïðèÿòèå ñîñòîÿëîñü â ñåíòÿáðå 2018 ã.â ã. Èâàíîâî íà áàçå 36-ãî îòäåëüíîãî ìåäèöèíñêîãî îòðÿäà (àýðîìîáèëüíîãî). Ãðàìîòíîåïëàíèðîâàíèå è îðãàíèçàöèÿ ñáîðîâ ïîçâîëèëè äîñòè÷ü ïîñòàâëåííûõ öåëåé.

Ê ë þ ÷ å â û å ñ ë î â à: âîåííàÿ ìåäèöèíà, ñðåäíèé ìåäèöèíñêèé ïåðñîíàë, ìåäèöèíñêàÿ ñåñòðà,ó÷åáíî-ìåòîäè÷åñêèé ñáîð, ìåäèöèíñêèé ìîäóëü.

Kalinin P.A., Kovaleva T.V. – Experience of organization of the first meeting of chief and senior medicalnurses of the Airborne Forces. A brief report on the first training and methodological meeting of chief (senior)nurses of medical organizations and units of the Airborne Forces for the first time conducted in the Armed Forcesof the Russian Federation. The event was held in September 2018 in the city of Ivanovo based on the 36th separatemedical unit (airmobile). Competent planning and organization of fees allowed to achieve their goals.

K e y w o r d s: military medicine, nursing staff, nurse, educational and methodical collection, medical module.

Èñòîðèÿ ïðîôåññèè «ìåäèöèíñêàÿ ñåñòðà» âåäåò ñâîå íà÷àëî ñ Êðûìñêîé âîéíû

1853–1856 ãã., êîãäà âåëèêèé õèðóðã Í.È.Ïè-ðîãîâ îðãàíèçîâàë è ïðèìåíèë æåíñêèé óõîäçà ðàíåíûìè â ðàéîíå áîåâûõ äåéñòâèé. Ñ òåõïîð ïðîøëî íåìàëî ðåôîðì ìåäèöèíñêîãî îá-ñëóæèâàíèÿ, íî âàæíîñòü ïðèñóùèõ ïðîôåñ-ñèè ìåäñåñòðû êà÷åñòâ, òàêèõ êàê ãóìàíèçì,ñîñòðàäàòåëüíîñòü, âíèìàíèå ê áîëüíîìó, òðóä-íî ïåðåîöåíèòü è â íàøè äíè.

Âîçäóøíî-äåñàíòíûå âîéñêà âñåãäà îòëè-÷àëèñü ñïëî÷åííîñòüþ è êà÷åñòâîì âûïîëíå-íèÿ ïîñòàâëåííûõ çàäà÷. Äëÿ îðãàíèçàöèèîáìåíà îïûòîì è ïðååìñòâåííîñòè ñïåöèàëü-íûõ çíàíèé ñðåäíåãî ìåäèöèíñêîãî ïåðñîíàëàÂÄÂ 24–27 ñåíòÿáðÿ 2018 ã. ïðîâåäåí ó÷åáíî-ìåòîäè÷åñêèé ñáîð ãëàâíûõ (ñòàðøèõ) ìåäè-öèíñêèõ ñåñòåð ìåäèöèíñêèõ îðãàíèçàöèéè ïîäðàçäåëåíèé Âîçäóøíî-äåñàíòíûõ âîéñê.

Ñáîð ïëàíèðîâàëñÿ è îðãàíèçîâûâàëñÿïîä êîíòðîëåì è ïðè íåïîñðåäñòâåííîì ó÷à-ñòèè íà÷àëüíèêà ìåäèöèíñêîé ñëóæáû Êî-ìàíäîâàíèÿ Âîçäóøíî-äåñàíòíûõ âîéñê ïîë-êîâíèêà ìåäèöèíñêîé ñëóæáû Â.È.Áåðîâà.

Îñíîâíûìè öåëÿìè ñáîðà ÿâëÿëèñü:– äîâåäåíèå òðåáîâàíèé ðóêîâîäÿùèõ

äîêóìåíòîâ â ñôåðå ìåäèöèíñêîãî îáåñïå÷å-íèÿ ëè÷íîãî ñîñòàâà Âîçäóøíî-äåñàíòíûõâîéñê, íîâûõ ôóíêöèé è îðãàíèçàöèîííûõôîðì äåÿòåëüíîñòè ìåäèöèíñêèõ ñåñòåð;

– îáìåí ïðàêòè÷åñêèì îïûòîì ìåæäóó÷àñòíèêàìè ñáîðà;

– ðàññìîòðåíèå ïðîáëåìíûõ âîïðîñîâ,âîçíèêàþùèõ â õîäå ïîâñåäíåâíîé äåÿòåëü-íîñòè ìåäèöèíñêèõ ñåñòåð è îïðåäåëåíèå ïó-òåé èõ ðåøåíèÿ.

Â ðàáîòå ñáîðà ïðèíÿëè ó÷àñòèå áîëåå50 ÷åëîâåê, â ò. ÷. ãëàâíûå è ñòàðøèå ìåäèöèí-ñêèå ñåñòðû èç ðàçëè÷íûõ îðãàíèçàöèé è ïîä-ðàçäåëåíèé ÂÄÂ, ïðèáûâøèå èç Íîâîðîññèé-ñêà, Ïñêîâà, Èâàíîâî, Òóëû, Óëàí-Óäý, Óëüÿ-íîâñêà, Êàìûøèíà, Óññóðèéñêà, Êóáèíêè,Îìñêà, Ðÿçàíè, ïîñ. Ìåäâåæüè Îçåðà è äð.*

Â òå÷åíèå ÷åòûðåõ ðàáî÷èõ äíåé ó÷àñò-íèêàì ñáîðà áûëè ïðåäñòàâëåíû äîêëàäû

* Ôîòî ê ñòàòüå îïóáëèêîâàíû íà ñ. 3 îáëîæ-êè íîìåðà æóðíàëà.

Ñáîð ãëàâíûõ è ñòàðøèõ ìåäèöèíñêèõ ñåñòåðÂîçäóøíî-äåñàíòíûõ âîéñê

Ïðàêòè÷åñêîå çàíÿòèå íà ìåäèöèíñêîì ñàìîëåòíîì (âåðòîëåòíîì) ìîäóëå

Ìàòåðèàë î ñáîðå îïóáëèêîâàí â ðóáðèêå «Õðîíèêà»

Ó÷àñòíèêè ñáîðà ñ íà÷àëüíèêîì ìåäèöèíñêîé ñëóæáû Êîìàíäîâàíèÿ ÂÄÂïîëêîâíèêîì ìåäèöèíñêîé ñëóæáû Â.È.Áåðîâûì


ÕÐÎÍÈÊÀ

Çà ñîäåðæàíèå è äîñòîâåðíîñòü ñâåäåíèé â ðåêëàìíîì îáúÿâëåíèèîòâåòñòâåííîñòü íåñåò ðåêëàìîäàòåëü.

Îòïå÷àòàíî â ÀÎ «Êðàñíàÿ Çâåçäà», Ìîñêâà, Õîðîøåâñêîå øîññå, ä. 38, http://www.redstarprint.ruòåë. 8(499) 762 63 02, îòäåë ðàñïðîñòðàíåíèÿ – 8(495) 941 39 52. E-mail: [email protected]

Èçäàòåëü: ÔÃÁÓ «ÐÈÖ «Êðàñíàÿ çâåçäà» Ìèíîáîðîíû Ðîññèè, 125284, àäðåñ: Ìîñêâà,Õîðîøåâñêîå øîññå, äîì 38, òåë. 8(495) 941 23 80, e-mail: [email protected],

îòäåë ðåêëàìû – 8(495) 941 28 46, e-mail: [email protected]

Ó÷ðåäèòåëü – Ìèíèñòåðñòâî îáîðîíû Ðîññèéñêîé Ôåäåðàöèè.Çàðåãèñòðèðîâàí Ìèíèñòåðñòâîì ïå÷àòè è èíôîðìàöèè Ðîññèéñêîé Ôåäåðàöèè.Íîìåð ðåãèñòðàöèîííîãî ñâèäåòåëüñòâà 01975 îò 30.12.1992 ã.

Ñäàíî â íàáîð 22.01.19.Ôîðìàò 70½1081/

16

Óñë. ïå÷. ë. 8,4.Çàêàç ¹ 9-2019.

Ìàêåò è êîìïüþòåðíàÿ âåðñòêà Â.Â.ÌàòèèâàÏåðåâîä Â.Â.Ôåäîòîâîé

Ïå÷àòü îôñåòíàÿ.Óñë. êð.-îòò. 9,8.Òèðàæ 3327 ýêç.

Ïîäïèñàíî ê ïå÷àòè 19.02.19.Áóìàãà îôñåòíàÿ.Ó÷.-èçä. ë. 8,6.Öåíà ñâîáîäíàÿ.

è ïðîâåäåíû ïðàêòè÷åñêèå çàíÿòèÿ. Òåîðåòè-÷åñêèå çàíÿòèÿ îõâàòèëè âñå îñíîâíûå íà-ïðàâëåíèÿ äåÿòåëüíîñòè ãëàâíûõ è ñòàðøèõìåäèöèíñêèõ ñåñòåð ìåäèöèíñêèõ îðãàíè-çàöèé è ïîäðàçäåëåíèé ÂÑ ÐÔ, âêëþ÷àÿòàêèå, êàê «Îðãàíèçàöèÿ àäàïòàöèè ñðåäíåãîìåäèöèíñêîãî ïåðñîíàëà. Íàñòàâíè÷åñòâî»,«Èíñïåêöèÿ ïî òðóäó. Îñíîâíûå âîïðîñû, ïîä-ëåæàùèå ïðîâåðêå. Îáÿçàííîñòè ãëàâíîé(ñòàðøåé) ìåäèöèíñêîé ñåñòðû â îáëàñòè îõ-ðàíû òðóäà», «Ìåäèöèíñêèå îñìîòðû ãðàæäàí-ñêîãî ïåðñîíàëà ÂÑ ÐÔ», «Îðãàíèçàöèÿ ðà-áîòû ãëàâíîé (ñòàðøåé) ìåäèöèíñêîé ñåñò-ðû. Ïëàíèðîâàíèå ðàáîòû ãëàâíîé (ñòàðøåé)ìåäèöèíñêîé ñåñòðû», «Îðãàíèçàöèÿ ðàáîòûñðåäíåãî ìåäèöèíñêîãî ïåðñîíàëà ïðè âû-ïîëíåíèè ñïåöèàëüíûõ çàäà÷ â ñîñòàâå âíîâüñôîðìèðîâàííîãî ìåäèöèíñêîãî ïîäðàçäåëå-íèÿ. Îñîáåííîñòè ðàáîòû â ïíåâìîêàðêàñíûõñîîðóæåíèÿõ» è äð.

Îñîáîå âíèìàíèå ïðèâëåê äîêëàä çàâå-äóþùåé êàôåäðîé óïðàâëåíèÿ ñåñòðèíñêîéäåÿòåëüíîñòüþ ôèëèàëà Âîåííî-ìåäèöèíñêîéàêàäåìèè èì. Ñ.Ì.Êèðîâà (ã. Ìîñêâà) äîöåí-òà Ò.Á.Ñâèðèäîâîé «Ñèñòåìà íåïðåðûâíîãîìåäèöèíñêîãî îáðàçîâàíèÿ è ïîíÿòèå àêêðå-äèòàöèè ìåäèöèíñêèõ ñïåöèàëèñòîâ».

Ïðè ïðîâåäåíèè ñáîðà âåäóùàÿ ðîëü îò-âîäèëàñü ïðàêòè÷åñêèì çàíÿòèÿì. Íà áàçåÔÃÊÓ «36 îìåäî(à) ÂÄÂ» ó÷àñòíèêàì áûëàïðåäñòàâëåíà ðàáîòà êàáèíåòà íåîòëîæíîéïîìîùè, ïðîöåäóðíîãî è ïåðåâÿçî÷íîãî êà-áèíåòîâ, ïîðÿäîê äåéñòâèé ñðåäíåãî è ìëàä-øåãî ìåäïåðñîíàëà ïðè ïðèâåäåíèè ìåäè-öèíñêîãî ïîäðàçäåëåíèÿ â âûñøèå ñòåïåíèáîåâîé ãîòîâíîñòè, ðàáîòà ñîðòèðîâî÷íîéïëîùàäêè â ðàìêàõ óñëîâíîãî âîîðóæåííîãîêîíôëèêòà.

Òàêæå ó÷àñòíèêàì ñáîðà ïðîäåìîíñòðè-ðîâàí ïðîöåññ ïîäãîòîâêè ê ýâàêóàöèè è ñî-

ïðîâîæäåíèÿ ïîñòðàäàâøèõ íà ìåäèöèíñêîìñàìîëåòíîì (âåðòîëåòíîì) ìîäóëå. Äëÿ ïðî-âåäåíèÿ ýòîãî çàíÿòèÿ áûëî îðãàíèçîâàíîâçàèìîäåéñòâèå ñ Ôèëèàëîì ¹ 1 ÔÃÊÓ«422 âîåííûé ãîñïèòàëü» ÌÎ ÐÔ (ï. ÌóëèíîÍèæåãîðîäñêîé îáëàñòè) è âîåííûì àýðîäðî-ìîì «Èâàíîâî-Ñåâåðíûé» (ã. Èâàíîâî). Ìå-äèöèíñêèé ìîäóëü áûë óñòàíîâëåí â òÿæåëûéâîåííî-òðàíñïîðòíûé ñàìîëåò Èë-76, ó÷àñò-íèêàì ñáîðà íàãëÿäíî ïðîäåìîíñòðèðîâàíàïîäãîòîâêà ìîäóëÿ è ðàáîòà íà íåì ïðè ýâà-êóàöèè ïîñòðàäàâøèõ âîçäóøíûì òðàíñïîð-òîì. Ó êàæäîé ìåäñåñòðû áûëà âîçìîæíîñòüñàìîñòîÿòåëüíî ïîäãîòîâèòü ìåäèöèíñêóþàïïàðàòóðó äëÿ ðàáîòû íà óêàçàííîì ìîäóëåïðè ýâàêóàöèè óñëîâíî ïîñòðàäàâøèõ.

Ïðè ïîäãîòîâêå ó÷åáíîãî ìàòåðèàëààêòèâíî èñïîëüçîâàëñÿ áîåâîé îïûò ðóêîâî-äèòåëåé çàíÿòèé ïî îðãàíèçàöèè ðàáîòû ìå-äèöèíñêîãî îòðÿäà (àýðîìîáèëüíîãî) è åãîîòäåëüíûõ ôóíêöèîíàëüíûõ ïîäðàçäåëåíèéâ óñëîâèÿõ ïðèìåíåíèÿ ìåäèöèíñêîãî îòðÿ-äà (àýðîìîáèëüíîãî) ïî ïðåäíàçíà÷åíèþ.

Íåñìîòðÿ íà íåáîãàòûé îïûò ïðîâåäåíèÿñáîðîâ ñî ñðåäíèì ìåäèöèíñêèì ïåðñîíàëîìâ ìàñøòàáàõ îòäåëüíîãî ðîäà âîéñê Âîîðóæåí-íûõ Ñèë, âñå ìåðîïðèÿòèÿ ïðîøëè â ñîîòâåò-ñòâèè ñ óòâåðæäåííûì êîìàíäóþùèì ÂÄÂïëàíîì. Â ïîëíîé ìåðå áûëè ðàññìîòðåíûâîïðîñû ñïåöèàëüíîé ïîäãîòîâêè ãëàâíûõ(ñòàðøèõ) ìåäèöèíñêèõ ñåñòåð â îáúåìå çà-íèìàåìîé äîëæíîñòè, ôîðìû, ñïîñîáû, ìåòîäûè ìåòîäîëîãèÿ îáó÷åíèÿ ïî ñïåöèàëüíîñòèïîä÷èíåííîãî ñðåäíåãî è ìëàäøåãî ìåäèöèí-ñêîãî ïåðñîíàëà, à òàêæå äîâåäåíû íîâûå òðå-áîâàíèÿ ðóêîâîäÿùèõ äîêóìåíòîâ. Öåëè ñáîðàáûëè äîñòèãíóòû, ãëàâíûå çàäà÷è íà 2019 ã., íà-ïðàâëåííûå íà ñîâåðøåíñòâîâàíèå äåÿòåëüíî-ñòè ìåäèöèíñêèõ ïîäðàçäåëåíèé è îðãàíèçà-öèé Âîçäóøíî-äåñàíòíûõ âîéñê, îïðåäåëåíû.

¹ 3 Âîåííî-ìåäèöèíñêèé æóðíàë 3(1).pdfÊ ÌÅÆÄÓÍÀÐÎÄÍÎÌÓ...

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