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2013

Ê ÌÅÆÄÓÍÀÐÎÄÍÎÌÓ ÆÅÍÑÊÎÌÓ ÄÍÞ 8 ÌÀÐÒÀ

Ìàòåðèàë ê þáèëåþ 111-ãî Ãëàâíîãî ãîñóäàðñòâåííîãî öåíòðà ñóäåáíî-ìåäèöèíñêèõè êðèìèíàëèñòè÷åñêèõ ýêñïåðòèç ÌÎ ÐÔ îïóáëèêîâàí â ðóáðèêå

«Èç èñòîðèè âîåííîé ìåäèöèíû»

Âðà÷ – ñóäåáíî-ìåäèöèíñêèé ýêñïåðòîòäåëà ìåäèêî-êðèìèíàëèñòè÷åñêîéèäåíòèôèêàöèè Þ.Ï.Øàêèðüÿíîâàîñìàòðèâàåò áèîëîãè÷åñêèé îáúåêò,ïðåäñòàâëåííûé äëÿ èññëåäîâàíèÿ

Ñóäåáíûé ýêñïåðò îòäåëà êðèìèíàëèñ-òè÷åñêîé ýêñïåðòèçû Í.À.Ñêðèïèë¸âàèññëåäóåò ýêñïåðèìåíòàëüíûå îáðàçöûïîäïèñè ïðè ïðîâåäåíèè êðèìè-íàëèñòè÷åñêîé ïî÷åðêîâåä÷åñêîé ýêñ-ïåðòèçû

Çàâåäóþùàÿ ñóäåáíî-ãèñòîëîãè÷åñêèì îòäåëåíèåìÒ.È.Ðóñàêîâà èññëåäóåò ãèñòîëîãè÷åñêèå ïðåïàðàòû

Â íàøè äíè, êàê è ïðåæäå, æåíùèíû-ìåäèêè íàðàâíå ñ ìóæ÷èíàìè

äîáðîñîâåñòíî âûïîëíÿþò ñâîé âîèíñêèé è ïðîôåññèîíàëüíûé äîëã

â âîåííûõ ëå÷åáíî-ïðîôèëàêòè÷åñêèõ è ñàíèòàðíî-ýïèäåìèîëîãè÷åñêèõ

ó÷ðåæäåíèÿõ, ìåäèöèíñêèõ ïóíêòàõ, íà áàçàõ õðàíåíèÿ, â ëàáîðàòîðèÿõ.

Ñðåäè íèõ è æåíùèíû – ñïåöèàëèñòû 111-ãî Ãëàâíîãî ãîñóäàðñòâåí-

íîãî öåíòðà ñóäåáíî-ìåäèöèíñêèõ è êðèìèíàëèñòè÷åñêèõ ýêñïåðòèç

Ìèíîáîðîíû Ðîññèè. Èõ êàæäîäíåâíûé òðóä ïîìîãàåò ïîääåðæèâàòü

âûñîêèé óðîâåíü ýêñïåðòíûõ ðàáîò, ýôôåêòèâíî è êâàëèôèöèðîâàííî

ðåøàòü âîïðîñû âîåííîé ñóäåáíîé ìåäèöèíû è êðèìèíàëèñòèêè.

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.

Âðà÷ – ñóäåáíî-ìåäèöèíñêèé ýêñïåðò îòäåëåíèÿ ìîëå-êóëÿðíî-ãåíåòè÷åñêîé èäåíòèôèêàöèè È.Â.Âåð÷åíêîãîòîâèò ïðèáîð äëÿ ïðîâåäåíèÿ ðåàêöèè àìïëèôè-êàöèè ÄÍÊ

Àäðåñ ðåäàêöèè:194044, Ñàíêò-Ïåòåðáóðã,óë. Àêàäåìèêà Ëåáåäåâà, ä. 6Òåë. (812) 292-33-46

Êîðïóíêò â Ìîñêâå:119160, Ìîñêâà, ðåäàêöèÿ«Âîåííî-ìåäèöèíñêîãî æóðíàëà»Òåë./ôàêñ: (495) 656-33-41

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

Non scholae, sed vitae discimus!

ÐÅÄÀÊÖÈÎÍÍÀßÊÎËËÅÃÈß:

Ì.Â.Ïîääóáíûé (ãëàâíûéðåäàêòîð)À.Í.ÁåëüñêèõÂ.Â.Áóçóíîâ (îòâåòñòâåííûéñåêðåòàðü)À.Þ.ÂëàñîâË.Ë.Ãàëèí (çàìåñòèòåëüãëàâíîãî ðåäàêòîðà)À.Í.ÃðåáåíþêÂ.Â.ÈâàíîâÎ.Â.Êàëà÷åâÀ.À.ÊàëìûêîâÀ.Á.ËåîíèäîâÀ.Í.ÌèðîíåíêîÞ.Â.Ìèðîøíè÷åíêîÂ.À.ÍîâèêîâÈ.Ì.ÑàìîõâàëîâÀ.È.ÑåëèíÝ.Ï.ÑîëîâåéÀ.ß.ÔèñóíÞ.Ø.ÕàëèìîâÂ.Í.ÖûãàíÂ.Ê.ØàìðåéÀ.Ì.Øåëåïîâ

ÐÅÄÀÊÖÈÎÍÍÛÉÑÎÂÅÒ:

Èçäàåòñÿ ñ 1823 ãîäà

2013 * ÌÀÐÒ

Ò. 334 * ¹ 3

ÌÎÑÊÂÀÈÇÄÀÒÅËÜÑÊÈÉ ÄÎÌ«ÊÐÀÑÍÀß ÇÂÅÇÄÀ»

Ñ.À.Áåëÿêèí (Êðàñíîãîðñê)Ï.Ã.Áðþñîâ (Ìîñêâà)À.À.Áóäêî (Ñ.-Ïåòåðáóðã)Â.Â.Âàëåâñêèé (Ñ.-Ïåòåðáóðã)Ñ.Ô.Ãîí÷àðîâ (Ìîñêâà)Â.Â.Äîáðæàíñêèé (Ìîñêâà)Å.Â.Èâ÷åíêî (Ñ.-Ïåòåðáóðã)Þ.Â.Ëîáçèí (Ñ.-Ïåòåðáóðã)È.Á.Ìàêñèìîâ (Ìîñêâà)È.Ã.Ìîñÿãèí (Ñ.-Ïåòåðáóðã)Ý.À.Íå÷àåâ (Ìîñêâà)Ï.Â.Ïèí÷óê (Ìîñêâà)Â.Á.Ñèìîíåíêî (Ìîñêâà)È.Ì.×èæ (Ìîñêâà)

Àäðåñ â ñåòè Èíòåðíåò:http://sc.mil.ru/social/media/magazine/more.htm?id=8753@morfOrgInfo

Àìáóëàòîðíàÿ ñòîìàòîëîãè÷åñêàÿïîìîùü âîåííîñëóæàùèìèç ÷èñëà ìîëîäîãî ïîïîëíåíèÿ

Ìåäèêî-ýêîíîìè÷åñêîå îáîñíîâàíèåðàöèîíàëüíîé àíòèáàêòåðèàëüíîéòåðàïèè ó áîëüíûõ ýìïèåìîé ïëåâðû

Ïðîôèëàêòèêà àëêîãîëüíîãîöèððîçà ïå÷åíè

Îïðåäåëåíèå ïîòðåáíîñòè ëå÷åáíîãîó÷ðåæäåíèÿ â ìèîðåëàêñàíòàõ

Àíòèãèïåðòåíçèâíàÿ òåðàïèÿïðè ìåòàáîëè÷åñêîì ñèíäðîìå

Îðãàíèçàöèÿ íàó÷íîé è íàó÷íî-èññëåäîâàòåëüñêîé ðàáîòûâ ìåäèöèíñêîé ñëóæáå ôëîòà

Ïåðâûé ìåäèöèíñêèé ìóçåé Ðîññèè(Ê 150-ëåòèþ ñî äíÿ ñîçäàíèÿÕèðóðãè÷åñêîãî ìóçåÿ Èìïåðàòîðñêîéìåäèêî-õèðóðãè÷åñêîé àêàäåìèè)

© «Âîåííî-ìåäèöèíñêèé æóðíàë», 3’20132

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Ëå÷åáíî-ïðîôèëàêòè÷åñêèåâîïðîñû

Prophylaxis and treatment

Îðãàíèçàöèÿ ìåäèöèíñêîãîîáåñïå÷åíèÿ Âîîðóæåííûõ ñèë

Organization of medical supportof the Armed Forces

Ãèãèåíà è ôèçèîëîãèÿâîåííîãî òðóäà

Military physiologyand hygiene

Klimov A.S., Grebnev G.A., Slivkin A.A.,Iordanishvili A.K., Potrakhov N.N. – Aboutimprovement of outpatient dental healthservice for young serviceman

Belyakin S.A., Plyusnin S.V., Bobrov A.N. –Primary and secondary prevention of alco-holic cirrhosis

Shchegolev A.V., Levshankov A.I., Bogomo-lov B.N., Pereloma V.I., Dumnov A.G. – Evalu-ation of muscle relaxants requirement forarmy hospital anesthesia

Zaitseva I.P., Nasolodin V.V., Belyakov R.A.,Arshinov N.P., Zaitsev O.N., Meshcherya-kov S.I. – Balance of ferrum and copperin cadets of military school during physi-cal exercise and next-day rest at differenttimes of the year

Êëèìîâ À.Ñ., Ãðåáíåâ Ã.À., Ñëèâêèí À.À.,Èîðäàíèøâèëè À.Ê., Ïîòðàõîâ Í.Í. –Î ñîâåðøåíñòâîâàíèè àìáóëàòîðíîéñòîìàòîëîãè÷åñêîé ïîìîùè âîåííîñëó-æàùèì èç ÷èñëà ìîëîäîãî ïîïîëíåíèÿ

Áåëÿêèí Ñ.À., Ïëþñíèí Ñ.Â., Áîáðîâ À.Í.– Ïåðâè÷íàÿ è âòîðè÷íàÿ ïðîôèëàêòèêààëêîãîëüíîãî öèððîçà ïå÷åíè

Ùåãîëåâ À.Â., Ëåâøàíêîâ À.È., Áîãîìî-ëîâ Á.Í., Ïåðåëîìà Â.È., Äóìíîâ À.Ã. –Îïðåäåëåíèå ïîòðåáíîñòè â ìèîðåëàê-ñàíòàõ äëÿ îêàçàíèÿ àíåñòåçèîëîãè÷å-ñêîé ïîìîùè â ëå÷åáíîì ó÷ðåæäåíèè

Çàéöåâà È.Ï., Íàñîëîäèí Â.Â., Áåëÿêîâ Ð.À.,Àðøèíîâ Í.Ï., Çàéöåâ Î.Í., Ìåùåðÿêîâ Ñ.È.– Áàëàíñ æåëåçà è ìåäè ó êóðñàíòîââîåííîãî ó÷èëèùà ïðè ôèçè÷åñêîéíàãðóçêå è â ïîñëåäóþùèé äåíü îòäûõàâ ðàçíîå âðåìÿ ãîäà

Sergeyeva V.V., Rodionova A.Yu.,Bobyleva T.A.,Patsenko M.B., Popov A.P., Liferov R.A.,Mikhaylov A.A. – Antihypertensive therapyin the elderly with metabolic syndrome

Lyutov V.V., Rudakov Yu.V., Kharitonov M.A.,Shishkin M.K., Sergeyev S.M., Gribova L.N.,Zasimov V.S., Krasikov E.K. – Fatal treat-ment of VA-pneumonia in patient withinfluenza A(H1N1)

Àâèàöèîííàÿè âîåííî-ìîðñêàÿ ìåäèöèíà

Air and navy medicine

Ãàâðèëîâ Â.Â., Ìûçíèêîâ È.Ë., Êóçüìè-íîâ Î.Â., Øìåë¸â Ñ.Â., Îïàðèí Ì.Þ. –Îðãàíèçàöèÿ íàó÷íîé è íàó÷íî-èññëå-äîâàòåëüñêîé ðàáîòû â ìåäèöèíñêîéñëóæáå ôëîòà

Gavrilov V.V., Myznikov I.L., Kuzminov O.V.,Shmelyov S.V., Oparin M.Yu. – Organisa-tion of scientific and research work ofmedical service in the navy41

Èâàíîâ Ô.Â., Êîòèâ Á.Í., Áàðèíîâ Î.Â.,Ñóáîðîâà Ò.Í., Èâ÷åíêî Å.Â. – Ìåäèêî-ýêîíîìè÷åñêîå îáîñíîâàíèå ðàöèî-íàëüíîé àíòèáàêòåðèàëüíîé òåðàïèèó áîëüíûõ ýìïèåìîé ïëåâðû â óñëîâèÿõâîåííîãî ëå÷åáíîãî ó÷ðåæäåíèÿ

Ivanov F.V., Kotiv B.N., Barinov O.V., Subo-rova T.N., Ivchenko E.V. – Medical-and-economic substantiation of rational anti-bacterial therapy for patients with pleuralempyema in the conditions of the militarymedical institutions

Ñåðãååâà Â.Â., Ðîäèîíîâà À.Þ., Áîáûëåâà Ò.À.,Ïàöåíêî Ì.Á., Ïîïîâ À.Ï., Ëèôåðîâ Ð.À.,Ìèõàéëîâ À.À. – Àíòèãèïåðòåíçèâíàÿòåðàïèÿ ïðè ìåòàáîëè÷åñêîì ñèíäðîìåó ïàöèåíòîâ ñòàðøèõ âîçðàñòíûõ ãðóïï

Ëþòîâ Â.Â., Ðóäàêîâ Þ.Â., Õàðèòîíîâ Ì.À.,Øèøêèí Ì.Ê., Ñåðãååâ Ñ.Ì., Ãðèáîâà Ë.Í.,Çàñèìîâ Â.Ñ., Êðàñèêîâ Å.Ê. – Ôàòàëü-íîå òå÷åíèå âèðóñ-àññîöèèðîâàííîéïíåâìîíèè ó áîëüíîãî ãðèïïîì A(H1N1)

3«Âîåííî-ìåäèöèíñêèé æóðíàë», 3’2013

Îôèöèàëüíûé îòäåë Official communications

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Õðîíèêà Chronicle

Èç èñòîðèèâîåííîé ìåäèöèíû

From the historyof military medicine

83

Ëåíòà íîâîñòåé News feed 66, 84

Ïî ñòðàíèöàì çàðóáåæíîéìåäèöèíñêîé ïå÷àòè

From the foreignmedical publications

Êðàòêèå ñîîáùåíèÿ Brief reports48

Bolekhan V.N., Ivanov V.V., Ivchenko E.V.,Krassiy A.B., Morovikova T.V., Nagibovich O.A.,Rezvantsev M.V. – Military veterans healthcare abroad (On the basis of US andBritish models)

91

Budko A.A., Gribovskaya G.A., Zhurav-lyov D.A.– First medical museum ofRussia (150-anniversary of the Surgicalmuseum of the Imperial Medical-SurgicalAcademy)

Áîëåõàí Â.Í., Èâàíîâ Â.Â., Èâ÷åíêî Å.Â.,Êðàññèé À.Á., Ìîðîâèêîâà Ò.Â., Íàãèáî-âè÷ Î.À., Ðåçâàíöåâ Ì.Â. – Ìåäèöèíñ-êîå îáåñïå÷åíèå âåòåðàíîâ âîîðóæåí-íûõ ñèë çà ðóáåæîì (Íà ïðèìåðå ÑØÀè Âåëèêîáðèòàíèè)

Áóäêî À.À., Ãðèáîâñêàÿ Ã.À., Æóðàâë¸â Ä.À.–Ïåðâûé ìåäèöèíñêèé ìóçåé Ðîññèè(Ê 150-ëåòèþ ñî äíÿ ñîçäàíèÿ Õè-ðóðãè÷åñêîãî ìóçåÿ Èìïåðàòîðñêîéìåäèêî-õèðóðãè÷åñêîé àêàäåìèè)

Grebenyuk A.N., Kholikov I.V. – Chemical,biological, radiologic and nuclear counter-measures of NATO

76Êðèòèêà è áèáëèîãðàôèÿ Criticism and bibliography

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Ãðåáåíþê À.Í., Õîëèêîâ È.Â. – ÓñèëèÿÍÀÒÎ ïî ïðîòèâîäåéñòâèþ õèìè÷åñ-êèì, áèîëîãè÷åñêèì, ðàäèîëîãè÷åñêèìè ÿäåðíûì óãðîçàì

Reva V.A. – Research and practice course«Trauma and urgent surgery» in Salzburg

Ðåâà Â.À. – Íàó÷íî-ïðàêòè÷åñêèé êóðñ«Òðàâìà è íåîòëîæíàÿ õèðóðãèÿ» âÇàëüöáóðãå

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Ïèí÷óê Ï.Â., Ôîêèí À.À. – Ê 70-ëåòèþ111-ãî Ãëàâíîãî ãîñóäàðñòâåííîãî öåí-òðà ñóäåáíî-ìåäèöèíñêèõ è êðèìèíà-ëèñòè÷åñêèõ ýêñïåðòèç ÌèíîáîðîíûÐîññèè

Öûìáàë À.Í. – 75 ëåò íà ñòðàæå çäî-ðîâüÿ âîèíîâ Ñàíêò-Ïåòåðáóðãñêîãî(Ëåíèíãðàäñêîãî) ãàðíèçîíà

Pinchuk P.V., Fokin A.A. – 70th anniver-sary of 111th Main state center of medi-colegal and criminalistic examinationof the Ministry of Defence of the RussianFederation

Tsymbal A.N. – 75 years safeguardinghealth of warriors of Saint-Petersburg(Leningrad) garrison

«Âîåííî-ìåäèöèíñêèé æóðíàë», 3’20134

ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ

ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2013ÓÄÊ 616.31-057.36:614

Î ñîâåðøåíñòâîâàíèè àìáóëàòîðíîéñòîìàòîëîãè÷åñêîé ïîìîùè âîåííîñëóæàùèìèç ÷èñëà ìîëîäîãî ïîïîëíåíèÿ

ÊËÈÌÎÂ À.Ñ., çàñëóæåííûé âðà÷ ÐÔ, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

ÃÐÅÁÍÅÂ Ã.À., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà([email protected])2

ÑËÈÂÊÈÍ À.À., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû3

ÈÎÐÄÀÍÈØÂÈËÈ À.Ê., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà2

ÏÎÒÐÀÕÎÂ Í.Í., äîêòîð òåõíè÷åñêèõ íàóê4

1Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëåíèå ÌÎ ÐÔ, Ìîñêâà; 2Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿèì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã; 3442-é Âîåííûé êëèíè÷åñêèé ãîñïèòàëü ÇÂÎ, Ñàíêò-Ïåòåðáóðã; 4Ñàíêò-Ïåòåðáóðãñêèé ãîñóäàðñòâåííûé ýëåêòðîòåõíè÷åñêèé óíèâåðñèòåò «ËÝÒÈ»èì. Â.È.Óëüÿíîâà (Ëåíèíà)

Klimov A.S., Grebnev G.A., Slivkin A.A., Iordanishvili A.K., Potrakhov N.N. – About improvement ofoutpatient dental health service for young serviceman. The article gives a detailed account of results ofepidemiological survey of dental morbidity in young serviceman and different types of outpatient dentalhealth service needs. Medical norms for dispensary supply with all types of outpatient dental health servicefor young servicemen are estimated. Suggestions for improvement of organizational and staff structure ofdental office of medical company are formulated.

K e y w o r d s: conscripts, young replacement, dental health service, medical norms of dispensary supply.

Âîåííîñëóæàùèå èç ÷èñëà ìîëîäîãî ïîïîëíåíèÿ â îáùåâîéñêîâîé áðè-

ãàäå ñîñòàâëÿþò äî 30% ëè÷íîãî ñîñòàâàè ñ èçìåíåíèåì ñðîêà ñëóæáû ïî ïðè-çûâó äî 1 ãîäà ïðèáûâàþò â íåå êàæäûåïîëãîäà – â âåñåííþþ è îñåííþþ ïðè-çûâíóþ êàìïàíèþ.

Â ïîñëåäíèå ãîäû îòìå÷àåòñÿ óõóä-øåíèå ñîñòîÿíèÿ ñòîìàòîëîãè÷åñêîãîçäîðîâüÿ ëèö ïðèçûâíîãî âîçðàñòà, ñâÿ-çàííîå ñ íåóäîâëåòâîðèòåëüíûì ìåäè-öèíñêèì îáåñïå÷åíèåì èõ ïîäãîòîâêè êâîåííîé ñëóæáå [2, 8]. Áîëüøèíñòâî íî-âîáðàíöåâ íóæäàåòñÿ â ñòîìàòîëîãè÷åñ-êîé ïîìîùè, ÷òî îáóñëîâëèâàåò àêòóàëü-íîñòü ýòîãî íàïðàâëåíèÿ ðàáîòû âîé-ñêîâîé ìåäèöèíñêîé ñëóæáû [7, 9].

Ïðîáëåìà îêàçàíèÿ âîåííîñëóæàùèìïî ïðèçûâó àìáóëàòîðíîé ñòîìàòîëîãè-÷åñêîé ïîìîùè â íàñòîÿùåå âðåìÿ îñ-ëîæíÿåòñÿ íåõâàòêîé êàäðîâ âðà÷åé-ñòî-ìàòîëîãîâ. Ýòî ñòàëî ñëåäñòâèåì èçìå-íåíèÿ îðãàíèçàöèîííî-øòàòíîé ñòðóê-òóðû âîèíñêèõ ÷àñòåé è ñòîìàòîëîãè÷åñ-

êèõ ïîäðàçäåëåíèé ìåäèöèíñêîé ñëóæ-áû Âîîðóæåííûõ ñèë, ÷òî, â ÷àñòíîñòè,ïðèìåíèòåëüíî ê ìåäèöèíñêîé ðîòå áðè-ãàäû ïðèâåëî ê óâåëè÷åíèþ êîëè÷åñòâàâîåííîñëóæàùèõ è äðóãèõ ïðèêðåïëåí-íûõ ëèö, îáñëóæèâàåìûõ îäíèì ñòîìà-òîëîãîì.

Öåëü èññëåäîâàíèÿÈçó÷åíèå ñòîìàòîëîãè÷åñêîé çàáî-

ëåâàåìîñòè âîåííîñëóæàùèõ ìîëîäîãîïîïîëíåíèÿ, íàó÷íîå îáîñíîâàíèå âðà-÷åáíûõ íîðìàòèâîâ àìáóëàòîðíîé ñòîìà-òîëîãè÷åñêîé (òåðàïåâòè÷åñêîé, õèðóð-ãè÷åñêîé è îðòîïåäè÷åñêîé) ïîìîùè,íåîáõîäèìûõ äëÿ ñîâåðøåíñòâîâàíèÿîðãàíèçàöèîííî-øòàòíîé ñòðóêòóðû ñòî-ìàòîëîãè÷åñêîãî êàáèíåòà ìåäèöèíñêîéðîòû áðèãàäû.

Ìàòåðèàë è ìåòîäûÈññëåäîâàíèå ïðîâåäåíî íà áàçå ñòî-

ìàòîëîãè÷åñêîãî êàáèíåòà ìåäèöèíñêî-ãî ïóíêòà 56-ãî ãâàðäåéñêîãî îêðóæíîãî


ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË

âîåííîñëóæàùèõ, ëèöà ãðàæäàíñêîãî ïåð-ñîíàëà ÌÎ è äð. – îêîëî 2500 ÷åëîâåê),ìîæåò îáñëóæèâàòüñÿ ïî ïðèíöèïó îáðà-ùàåìîñòè, è ðàñ÷åò íåîáõîäèìîãî êîëè-÷åñòâà âðà÷åáíûõ äîëæíîñòåé ñëåäóåòïðîèçâîäèòü â ñîîòâåòñòâèè ñ äåéñòâóþ-ùèì ïðèêàçîì ÌèíçäðàâñîöðàçâèòèÿÐîññèè îò 7 äåêàáðÿ 2011 ã. ¹ 1496í [6],êîòîðûé ïðåäóñìàòðèâàåò ïðè îêàçàíèèàìáóëàòîðíîé ñòîìàòîëîãè÷åñêîé ïîìî-ùè íà òåðàïåâòè÷åñêîì è õèðóðãè÷åñêîìïðèåìå 5 äîëæíîñòåé âðà÷à-ñòîìàòîëîãàíà 10 000 íàñåëåíèÿ, èëè 1 âðà÷-ñòîìàòî-ëîã íà 2000 ÷åëîâåê.

Òàêèì îáðàçîì, ñóùåñòâóþùèé øòàòñòîìàòîëîãè÷åñêîãî êàáèíåòà ìåäèöèí-ñêîé ðîòû áðèãàäû íå ìîæåò îáåñïå÷è-âàòü ñòîìàòîëîãè÷åñêîé ïîìîùüþ âîåí-íîñëóæàùèõ áðèãàäû ïî äèñïàíñåðíîìóïðèíöèïó, è åãî íåîáõîäèìî ðàññ÷èòû-âàòü èñõîäÿ èç ÷èñëåííîñòè ëè÷íîãî ñî-ñòàâà è ïðèêðåïëåííîãî êîíòèíãåíòà âñîîòâåòñòâèè ñ òåððèòîðèàëüíîé ñèñòå-ìîé ìåäèöèíñêîãî îáåñïå÷åíèÿ.

Â ñóùåñòâóþùèé øòàò ñòîìàòîëîãè-÷åñêîãî êàáèíåòà ìåäèöèíñêîé ðîòû áðè-ãàäû, êðîìå âîåííîñëóæàùèõ – âðà÷à-ñòîìàòîëîãà è ìåäèöèíñêîé ñåñòðû, öå-ëåñîîáðàçíî äîïîëíèòåëüíî âêëþ÷èòüâðà÷åáíûå è ñåñòðèíñêèå äîëæíîñòè,êîìïëåêòóåìûå ëèöàìè ãðàæäàíñêîãîïåðñîíàëà ÌÎ â çàâèñèìîñòè îò ÷èñëåí-íîñòè âîåííîñëóæàùèõ áðèãàäû è ïðè-êðåïëåííîãî êîíòèíãåíòà èç ðàñ÷åòà:

– âðà÷-ñòîìàòîëîã – 1 äîëæíîñòü íà1000 âîåííîñëóæàùèõ;

– âðà÷-ñòîìàòîëîã – 1 äîëæíîñòüíà 2000 ÷åëîâåê ïðèêðåïëåííîãî êîí-òèíãåíòà;

– ìåäèöèíñêàÿ ñåñòðà – 1 äîëæíîñòüíà êàæäîãî âðà÷à-ñòîìàòîëîãà.

Âî âñÿêîì ñëó÷àå, ñëåäóåò âêëþ÷èòüíå ìåíåå 3 âðà÷åé-ñòîìàòîëîãîâ è 2 ìå-äèöèíñêèõ ñåñòåð èç ÷èñëà ãðàæäàíñêî-ãî ïåðñîíàëà äîïîëíèòåëüíî ê îñíîâíî-ìó øòàòó, êîìïëåêòóåìîìó âîåííîñëóæà-ùèìè. Ýòî ïîçâîëèò âðà÷ó-ñòîìàòîëîãó(âîåííîñëóæàùåìó) âûïîëíÿòü ñëóæåá-íûå îáÿçàííîñòè áåç óùåðáà äëÿ îêàçà-íèÿ ñòîìàòîëîãè÷åñêîé ïîìîùè ïðè-êðåïëåííîìó êîíòèíãåíòó.

Â Û Â Î Ä Û

1. Ðåçóëüòàòû îáñëåäîâàíèÿ âîåííî-ñëóæàùèõ èç ÷èñëà ìîëîäîãî ïîïîëíåíèÿâûÿâèëè ó íèõ âûñîêèé óðîâåíü ñòîìàòî-ëîãè÷åñêîé çàáîëåâàåìîñòè, ÷òî ñâèäå-òåëüñòâóåò î ïðîáëåìå â îêàçàíèè ñòî-ìàòîëîãè÷åñêîé ïîìîùè ëèöàì ïðèçûâ-íîãî âîçðàñòà ïðè ïîäãîòîâêå ê âîåííîéñëóæáå.

2. Ðàññ÷èòàííûå âðà÷åáíûå íîðìàòè-âû äëÿ äèñïàíñåðíîãî îáåñïå÷åíèÿ âñå-ìè âèäàìè àìáóëàòîðíîé ñòîìàòîëîãè-÷åñêîé ïîìîùè ëèö ìîëîäîãî ïîïîëíå-íèÿ ìîãóò áûòü èñïîëüçîâàíû ïðè îáî-ñíîâàíèè ñîâåðøåíñòâîâàíèÿ îðãàíèçà-öèîííî-øòàòíîé ñòðóêòóðû ñòîìàòîëî-ãè÷åñêîãî êàáèíåòà ìåäèöèíñêîé ðîòûáðèãàäû.

3. Ïðè ñêðèíèíãîâûõ èññëåäîâàíèÿõçóáî÷åëþñòíîé ñèñòåìû ó âîåííîñëóæà-ùèõ ðåêîìåíäóåòñÿ ïðîâåäåíèå âíóòðè-ðîòîâîé ïàíîðàìíîé ðåíòãåíîãðàôèèîòå÷åñòâåííûì ïðèöåëüíî-ïàíîðàìíûììèêðîôîêóñíûì ñòîìàòîëîãè÷åñêèì àï-ïàðàòîì «ÏÀÐÄÓÑ-02».

Ëèòåðàòóðà

1. Áàçèÿí Ã.Â., Íîâãîðîäöåâ Ã.À. Îñíîâûíàó÷íîãî ïëàíèðîâàíèÿ ñòîìàòîëîãè÷åñêîéïîìîùè. – Ì.: Ìåäèöèíà, 1968. – 240 ñ.

2. Áåëåâèòèí À.Á., Ïðîõâàòèëîâ Ã.È., Øå-ëåïîâ À.Ì. è äð. Âðà÷åáíûå íîðìàòèâû äèñ-ïàíñåðíîãî îáåñïå÷åíèÿ ëèö ïðèçûâíîãî âîç-ðàñòà àìáóëàòîðíîé ñòîìàòîëîãè÷åñêîé ïîìî-ùüþ // Âîåí.-ìåä. æóðí. – 2010. – Ò. 331, ¹ 9. –Ñ. 4–11.

3. Êóçüìèíà Ý.Ì. Ñîâðåìåííûå êðèòåðèèîöåíêè ñòîìàòîëîãè÷åñêîãî ñòàòóñà ïðè ïðî-âåäåíèè ýïèäåìèîëîãè÷åñêîãî îáñëåäîâàíèÿíàñåëåíèÿ: Ó÷åáíîå ïîñîáèå. – Ì.: Èçä.ÌÃÌÑÓ, 2007. – 31 ñ.

4. Ëåóñ Ï.À. Êîìïëåêñíûé ïåðèîäîíòàëü-íûé èíäåêñ ÊÏÈ // Ñòîìàòîëîãèÿ. – 1988. –Ò. 67, ¹ 1. – Ñ. 17–19.

5. Ïîòðàõîâ Í.Í. Ìèêðîôîêóñíàÿ ðåíòãå-íîãðàôèÿ â ñòîìàòîëîãèè è ÷åëþñòíî-ëèöå-âîé õèðóðãèè. – ÑÏá: ÎÎÎ «Òåõíîìåäèà», 2007.– 184 ñ.

6. Ïðèêàç Ìèíèñòåðñòâà çäðàâîîõðàíåíèÿè ñîöèàëüíîãî ðàçâèòèÿ ÐÔ îò 7 äåêàáðÿ 2011 ã.¹ 1496í «Îá óòâåðæäåíèè Ïîðÿäêà îêàçàíèÿìåäèöèíñêîé ïîìîùè âçðîñëîìó íàñåëåíèþïðè ñòîìàòîëîãè÷åñêèõ çàáîëåâàíèÿõ».

7. Ïðèêàç ìèíèñòðà îáîðîíû ÐÔ îò18 èþíÿ 2011 ã. ¹ 800 «Îá óòâåðæäåíèè Ðóêî-âîäñòâà ïî äèñïàíñåðèçàöèè âîåííîñëóæàùèõâ Âîîðóæåííûõ Ñèëàõ Ðîññèéñêîé Ôåäåðàöèè».



8. Ïðèêàç ìèíèñòðà îáîðîíû ÐÔ è Ìè-íèñòåðñòâà çäðàâîîõðàíåíèÿ ÐÔ îò 23 ìàÿ2001 ã. ¹ 240/168 «Îá îðãàíèçàöèè ìåäè-öèíñêîãî îáåñïå÷åíèÿ ïîäãîòîâêè ãðàæäàíÐîññèéñêîé Ôåäåðàöèè ê âîåííîé ñëóæáå»(â ðåä. îò 11 îêòÿáðÿ 2010 ã.).

9. Ïðîõâàòèëîâ Ã.È., ×åðíûø Â.Ô., Ãðåá-íåâ Ã.À. è äð. Îðãàíèçàöèÿ ðàáîòû ñòîìàòî-ëîãà âîèíñêîé ÷àñòè (êîðàáëÿ): Ìåòîäè÷åñêîåïîñîáèå. – Ì.: Èçä. ÂÌåäÀ, 2008. – 48 ñ.

10. Ðîçåíôåëüä È.È. Ïëàíèðîâàíèå ïîòðåá-íîñòè çäðàâîîõðàíåíèÿ âî âðà÷åáíûõ êàäðàõ.– Ì.: Ìåäãèç, 1961. – 203 ñ.

11. Ðóêîâîäñòâî ïî ìåòîäàì ðåãèñòðàöèèñòîìàòîëîãè÷åñêîãî ñòàòóñà íàñåëåíèÿ / ÂÎÇ.– Æåíåâà, 1995. – 28 ñ.

12. Ôåäîðîâ Þ.À., Áëîõèí Â.Ï., Äðîææèíà Â.À.è äð. Äèàãíîñòèêà çàáîëåâàíèé ïàðîäîíòàñ èñïîëüçîâàíèåì îáúåêòèâíûõ ìåòîäîâèññëåäîâàíèÿ: Ìåòîä. ðåêîìåíäàöèè. – Ë.: Èçä.ÃÈÄÓÂ, 1989. – 43 ñ.

13. ×åðíûø Â.Ô. Îðãàíèçàöèÿ ñòîìàòîëî-ãè÷åñêîé ïîìîùè ëè÷íîìó ñîñòàâó Âîåííî-Ìîðñêîãî Ôëîòà â ìèðíîå âðåìÿ è îñíîâíûåíàïðàâëåíèÿ åå ñîâåðøåíñòâîâàíèÿ: Äèñ. ...ä-ðà ìåä. íàóê. – Ë.: ÂÌåäÀ, 1989. – 277 ñ.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2013ÓÄÊ 616.25-002.3-057.36-085.281

Ìåäèêî-ýêîíîìè÷åñêîå îáîñíîâàíèå ðàöèîíàëüíîéàíòèáàêòåðèàëüíîé òåðàïèè ó áîëüíûõ ýìïèåìîéïëåâðû â óñëîâèÿõ âîåííîãî ëå÷åáíîãî ó÷ðåæäåíèÿ

ÈÂÀÍÎÂ Ô.Â., ñòàðøèé ëåéòåíàíò ìåäèöèíñêîé ñëóæáû ([email protected])ÊÎÒÈÂ Á.Í., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÁÀÐÈÍÎÂ Î.Â., äîêòîð ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáûÑÓÁÎÐÎÂÀ Ò.Í., äîêòîð áèîëîãè÷åñêèõ íàóêÈÂ×ÅÍÊÎ Å.Â., äîöåíò, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû

Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã

Ivanov F.V., Kotiv B.N., Barinov O.V., Suborova T.N., Ivchenko E.V. – Medical-and-economicsubstantiation of rational antibacterial therapy for patients with pleural empyema in the conditions ofthe military medical institutions. We have performed a post-hoc analysis of the results of using antibacterialtherapy in patients with pleural empyema. The cost-effectiveness analysis of rational and empiric antibacterialtherapies was performed. The cost-effectiveness ratio for rational antibacterial therapy was lower than forempiric one (2889 and 4480 rubles for 1 treated patient correspondingly). The use of the rules of rationalantibacterial therapy in practice leads to proved saving of economic costs.

K e y w o r d s: rational antimicrobial therapy, pleural empyema, empiric antibacterial therapy, microbiologicalmonitoring, economic effectiveness, cost-effectiveness analysis, cost of pleural empyema treatment, economiccosts.

Â ñòðóêòóðå ðàñõîäîâ ìíîãîïðîôèëü- íîãî ëå÷åáíîãî ó÷ðåæäåíèÿ íà ëå-

êàðñòâåííûå ñðåäñòâà äîëÿ àíòèáàêòå-ðèàëüíûõ ïðåïàðàòîâ (ÀÁÏ), ïî äàííûìðàçíûõ àâòîðîâ, ñîñòàâëÿåò îò 20 äî 40%[7, 8]. Âûáîð ÀÁÏ äëÿ ëå÷åíèÿ õèðóðãè-÷åñêîé èíôåêöèè, êàê ïðàâèëî, îñíîâû-âàåòñÿ íà ñîîòâåòñòâèè ñïåêòðà àêòèâ-íîñòè ÷óâñòâèòåëüíîñòè ìèêðîôëîðû,ïåðåíîñèìîñòè ïðåïàðàòà ïàöèåíòîìè ôàðìàêîêèíåòè÷åñêèõ ïàðàìåòðîâ.Ìåæäó òåì ïðè âûáîðå ÀÁÏ öåëåñîîá-ðàçíî ïðèìåíÿòü ìåòîä êëèíèêî-ýêîíî-ìè÷åñêîãî àíàëèçà «çàòðàòû – ýôôåêòèâ-íîñòü» [3]. Ïî äàííûì äîñòóïíîé ëèòå-ðàòóðû, ïî÷òè â 50% ñëó÷àåâ ÀÁÏ íàçíà-÷àþòñÿ íåîáîñíîâàííî, áåç ó÷åòà ðåçóëü-

òàòîâ áàêòåðèîëîãè÷åñêèõ èññëåäîâàíèé[4, 6]. Íåðåøåííûå ïðîáëåìû ýìïèðè÷åñ-êîé àíòèáàêòåðèàëüíîé òåðàïèè (ÀÁÒ),â ò. ÷. íåñâîåâðåìåííîå ïðîâåäåíèå ìèê-ðîáèîëîãè÷åñêèõ èññëåäîâàíèé, íåàäåê-âàòíûé âûáîð àíòèáèîòèêîâ äëÿ ñòàðòî-âîé òåðàïèè è äðóãèå [5], ïðèâîäÿò ê óâå-ëè÷åíèþ îáùåé ñòîèìîñòè ëå÷åíèÿ.

Ýìïèåìà ïëåâðû ÿâëÿåòñÿ îäíèì èçòÿæåëûõ ãíîéíûõ çàáîëåâàíèé, òðåáóþ-ùèõ ïðîâåäåíèÿ äëèòåëüíîé ÀÁÒ ïðåïà-ðàòàìè øèðîêîãî ñïåêòðà äåéñòâèÿ [1].Ïîýòîìó àêòóàëüíû êëèíèêî-ýêîíîìè-÷åñêèå àñïåêòû ïðîâåäåíèÿ ÀÁÒ, â ñâÿçèñ ÷åì ïîÿâëÿþòñÿ èññëåäîâàíèÿ ïî äàí-íîé òåìàòèêå. Ýòè îáñòîÿòåëüñòâà óêàçû-âàþò íà íåîáõîäèìîñòü ïðîâåäåíèÿ ýêî-



óñòàíîâëåíî, ÷òî ïðîâåäåíèå ðàöèîíàëü-íîé ÀÁÒ ïîçâîëÿåò ñîêðàòèòü ñðîêè ëå-÷åíèÿ.

Ïðèâåäåí ðàñ÷åò ýêîíîìè÷åñêîé öåëå-ñîîáðàçíîñòè ïðèìåíåíèÿ ñõåì ðàöèî-íàëüíîé ÀÁÒ â ñîñòàâå êîìïëåêñíîãîëå÷åíèÿ áîëüíûõ ýìïèåìîé ïëåâðû. Íàìèáûëà âûÿâëåíà âîçìîæíîñòü ñíèæåíèÿýêîíîìè÷åñêèõ çàòðàò íà ïðîâåäåíèåÀÁÒ ïóòåì ïåðåõîäà ñ ýìïèðè÷åñêîãîïîäõîäà íà ïðèíöèïû ðàöèîíàëüíîéòåðàïèè, ò. å. âûáîð ÀÁÏ íà îñíîâàíèèýòèîëîãè÷åñêè îáîñíîâàííûõ ñõåì ëå÷å-íèÿ è ðåçóëüòàòîâ ìèêðîáèîëîãè÷åñêîãîìîíèòîðèíãà [1].

Â äîñòóïíîé ëèòåðàòóðå íàì íåâñòðå÷àëîñü èññëåäîâàíèé, ïîñâÿùåííûõýêîíîìè÷åñêîé ýôôåêòèâíîñòè ÀÁÒáîëüíûõ ýìïèåìîé ïëåâðû. Â ñõîäíîìèññëåäîâàíèè Ãîñóäàðñòâåííîãî íàó÷íî-ãî öåíòðà ïî àíòèáèîòèêàì (Ìîñêâà)äàíà êëèíèêî-ýêîíîìè÷åñêàÿ îöåíêàðàçëè÷íûõ ñõåì ÀÁÒ èíòðààáäîìèíàëü-íûõ èíôåêöèé [2]. Â ðåçóëüòàòå äàííîãîèññëåäîâàíèÿ âûÿâëåíà âîçìîæíîñòüýêîíîìèè äî 12 000 ðóá. íà ëå÷åíèè îä-íîãî ïàöèåíòà ïðè ïåðåõîäå ñ ïðåïàðàòà«Ìåðîïåíåì» íà êîìáèíàöèþ «Öåôî-ïåðàçîí» è «Ñóëüáàêòàì», ÷òî ñîñòàâ-ëÿåò 40% îò ñòîèìîñòè êóðñà ëå÷åíèÿ«Ìåðîïåíåìîì».

Â íàñòîÿùåì èññëåäîâàíèè ïîêà-çàíî, ÷òî åñëè áû áîëüíûå II ãðóïïûïîëó÷àëè ÀÁÒ â ñîîòâåòñòâèè ñ ðàöèî-íàëüíûìè ñõåìàìè, òî çàòðàòû íà ÀÁÒñîñòàâèëè áû:

ÑÀÁÏ

= CEA 1 × Ef

2 = 2889 ðóá./÷åë. × 27 ÷åë.

= 78 003 ðóá.,ãäå Ñ

ÀÁÏ – ñòîèìîñòü ÀÁÏ äëÿ ïàöèåí-

òîâ II ãðóïïû â ñëó÷àå ïðèìåíåíèè ðà-öèîíàëüíûõ ñõåì ÀÁÒ, ðóá.; CEA

1 –

ñðåäíÿÿ ñòîèìîñòü êóðñà ÀÁÒ íà îäíîãîïàöèåíòà äëÿ I ãðóïïû, ðóá.; Ef

2 – êîëè-

÷åñòâî ïàöèåíòîâ âî II ãðóïïå.Ñëåäîâàòåëüíî, ýêîíîìèÿ äåíåæíûõ

ñðåäñòâ íà ïðîâåäåíèå ÀÁÒ ìîãëà áûñîñòàâèòü (120 954 ðóá. - 78 003 ðóá.) =42 951 ðóá., ÷òî ñîñòàâëÿåò 35,5% îò ñóììû,ïåðâîíà÷àëüíî çàòðà÷åííîé íà ëå÷åíèåII ãðóïïû ïàöèåíòîâ.

Â äàííîì èññëåäîâàíèè ó÷èòûâàëàñüòîëüêî ñòîèìîñòü ÀÁÏ. Çàòðàòû íà ïðî-âåäåíèå ÀÁÒ òàêæå âêëþ÷àþò ñòîèìîñòüâûïîëíåíèÿ èíúåêöèé, îïðåäåëåíèå ÷óâ-ñòâèòåëüíîñòè ê àíòèáèîòèêàì, ïîäñ÷åòóðîâíÿ ëåéêîöèòîâ è ðàñõîäû íà èçäåëèÿìåäèöèíñêîãî íàçíà÷åíèÿ.

Ðàííèå ñðîêè êóïèðîâàíèÿ âîñïàëè-òåëüíîãî ïðîöåññà ó áîëüíûõ, ïîëó÷àâ-øèõ ðàöèîíàëüíóþ ÀÁÒ, ñîçäàþò ïðåä-ïîñûëêè äëÿ ñîêðàùåíèÿ äðóãèõ âèäîâçàòðàò (ëàáîðàòîðíûå è èíñòðóìåíòàëü-íûå èññëåäîâàíèÿ, ðàáîòà ìåäèöèíñêîãîïåðñîíàëà, äëèòåëüíîñòü êîéêî-äíÿ è äð.).

Òàêèì îáðàçîì, ïðèìåíåíèå ñõåìðàöèîíàëüíîé àíòèáàêòåðèàëüíîé òåðà-ïèè â êîìïëåêñíîì ëå÷åíèè áîëüíûõñ ýìïèåìîé ïëåâðû ïðèâîäèò ê äîñòî-âåðíîìó ñîêðàùåíèþ ñðîêà èñïîëüçî-âàíèÿ àíòèáàêòåðèàëüíûõ ïðåïàðàòîâíà 4 ñóò è ïîçâîëÿåò äîñòè÷ü ñíèæåíèÿýêîíîìè÷åñêèõ çàòðàò.


1. Áàðèíîâ Î.Â. Ñîâðåìåííûå ïîäõîäûê ëå÷åíèþ ýìïèåìû ïëåâðû: Äèñ. ... ä-ðà ìåä.íàóê. – ÑÏá, 2010. – 265 ñ.

2. Áåêåòîâ À.Ñ. Êëèíèêî-ýêîíîìè÷åñêàÿîöåíêà àíòèáàêòåðèàëüíîé òåðàïèè èíòðààá-äîìèíàëüíûõ èíôåêöèé // Êà÷åñòâåííàÿ êëè-íè÷åñêàÿ ïðàêòèêà. – 2002. – ¹ 3. – Ñ. 12–25.

3. Áåëåâèòèí À.Á., Ðåóòñêèé È.À., Òåãçà Â.Þ.Ýêîíîìè÷åñêèå îöåíêè ýôôåêòèâíîñòè îêà-çàíèÿ ìåäèöèíñêîé ïîìîùè â êëèíèêàõÂîåííî-ìåäèöèíñêîé àêàäåìèè. – ÑÏá, 2006.– 42 ñ.

4. Ïåòðîâ Â.È. Ïðàêòè÷åñêàÿ ôàðìàêî-ýêîíîìèêà. – Ì.: ÃÝÎÒÀÐ-Ìåäèà, 2005. – 335 ñ.

5. Ðà÷èíà Ñ.À. Ôàðìàêîýïèäåìèîëîãè÷åñ-êèå, ôàðìàêîýêîíîìè÷åñêèå è ôàðìàêîòåðà-

ïåâòè÷åñêèå ïîäõîäû ê âåäåíèþ ïàöèåíòîâñ âíåáîëüíè÷íîé ïíåâìîíèåé â ñòàöèîíàðå:Àâòîðåô. äèñ. ... ä-ðà ìåä. íàóê. – Ñìîëåíñê,2010. – 48 ñ.

6. Ðåøåäüêî Ã.Ê., Êîçëîâ Ð.Ñ. Ñîñòîÿíèåðåçèñòåíòíîñòè ê àíòèèíôåêöèîííûì õèìè-îïðåïàðàòàì â Ðîññèè: Ïðàêòè÷åñêîå ðóêî-âîäñòâî ïî àíòèèíôåêöèîííîé õèìèîòåðàïèè/ Ïîä ðåä. Ë.Ñ.Ñòðà÷óíñêîãî. – Ñìîëåíñê, 2007.– Ñ. 32–46.

7. Ñû÷¸â È.Í., Êåòîâà Ã.Ã. Êëèíèêî-ýêîíîìè÷åñêèé àíàëèç àíòèáàêòåðèàëüíûõïðåïàðàòîâ, ïðèìåíÿåìûõ â õèðóðãè÷åñêîéïðàêòèêå // Ìåä. íàóêà è îáðàçîâàíèå Óðàëà.– 2007. – ¹ 6. – Ñ. 115–118.

8. ßãóäèíà Ð.È., Êóëèêîâ À.Þ. Ïðàêòè÷åñ-êàÿ ôàðìàêîýêîíîìèêà. Áðîíõîïóëüìîíîëîãèÿ(íàó÷íûé ñáîðíèê). – Ì.: Ðåìåäèóì, 2010. – 144 ñ.


ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ

ÂÎÏÐÎÑÛ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2013ÓÄÊ 616.36-004.4-084

Ïåðâè÷íàÿ è âòîðè÷íàÿ ïðîôèëàêòèêààëêîãîëüíîãî öèððîçà ïå÷åíè

ÁÅËßÊÈÍ Ñ.À., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû çàïàñà([email protected])ÏËÞÑÍÈÍ Ñ.Â., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàÁÎÁÐÎÂ À.Í., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà

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

Belyakin S.A., Plyusnin S.V., Bobrov A.N. – Primary and secondary prevention of alcoholic cirrhosis.Alcohol – is the main causative factor of cirrhosis among the population in Russia. The primary preventionmust be focused on exception of consumption of heavy doses of alcohol hepatitis and B vaccination. Thereare no healthy doses of alcohol. Secondary prevention means the use of the hepatoprotectors.List of hepatoprotectors and also amount of money spent to the purchase of these hepatoprotectors increaseconstantly. But,unfortunately, alongside with it, increases the mortality from hepatic disorders. Effectivenessof the most hepatoprotectors (such as Essential phospholi pids, milk thistle) equals to the effectivenessof placebo.

K e y w o r d s: alcohol, alcoholic cirrhosis, prevention

Â Ðîññèè åæåäíåâíî îò öèððîçà ïå÷å-

íè (ÖÏ) óìèðàåò 150 ÷åëîâåê, èçíèõ 100 – â òðóäîñïîñîáíîì âîçðàñòå [6].Âî âñåì ìèðå öèððîç ïå÷åíè êàê ïðè÷è-íà ñìåðòè çàíèìàåò 9-å ìåñòî ñðåäè âñåõïðè÷èí ñìåðòè, à â Ðîññèè – 6-å ìåñòî,«îáãîíÿÿ» ñìåðòíîñòü ïðè òàêèõ ãðîçíûõçàáîëåâàíèÿõ, êàê ðàê æåëóäêà, ðàê òîë-ñòîé êèøêè, èíôåêöèîííûå áîëåçíè [6].

Ýòèîëîãèÿ ÖÏ ðàçëè÷íà. Íî îñíîâ-íûì ýòèîëîãè÷åñêèì ôàêòîðîì ÖÏÿâëÿåòñÿ õðîíè÷åñêàÿ àëêîãîëüíàÿ èí-òîêñèêàöèÿ [1, 2].

Óñòàíîâëåíî, ÷òî óâåëè÷åíèå ïîòðåá-ëåíèÿ àëêîãîëÿ íà äóøó íàñåëåíèÿ â ãîäíà 1 ë âûçûâàåò óâåëè÷åíèå ñìåðòíîñòèîò öèððîçà ïå÷åíè ó ìóæ÷èí íà 32%,ó æåíùèí – íà 17% [13].

Âçàèìîñâÿçü ïîòðåáëåíèÿ àëêîãîëÿ èÖÏ ïîäòâåðæäàåòñÿ èññëåäîâàíèÿìè èç-âåñòíîãî îòå÷åñòâåííîãî òåðàïåâòà ïðî-ôåññîðà À.È.Õàçàíîâà, óñòàíîâèâøåãîñíèæåíèå ñìåðòíîñòè îò ÖÏ â 3 ðàçàâ ïåðèîä àíòèàëêîãîëüíîé êàìïàíèè,îñóùåñòâëÿâøåéñÿ â 1985–1989 ãã. [4].

Ïî íàøèì äàííûì, ïîëó÷åííûì âõîäå 15-ëåòíåãî èññëåäîâàíèÿ, ó 77% âñåõóìåðøèõ îò ÖÏ â òðóäîñïîñîáíîì âîç-ðàñòå èìåííî óïîòðåáëåíèå íåáåçîïàñ-íûõ äîç àëêîãîëÿ ïðèâåëî ê ðàçâèòèþñìåðòåëüíîãî ÖÏ. Âòîðûì ïî çíà÷èìî-ñòè ñòàë âèðóñ ãåïàòèòà Â – 12% [2].

Ñëåäîâàòåëüíî, îñíîâîé ïåðâè÷íîéïðîôèëàêòèêè ÖÏ âîîáùå, è àëêîãîëü-íîãî ÖÏ â ÷àñòíîñòè, äîëæíî áûòü óñò-ðàíåíèå ïðè÷èí è óñëîâèé õðîíè÷åñêîé

àëêîãîëüíîé èíòîêñèêàöèè (ÕÀÈ).Ïðè÷èíû ÕÀÈ ðàçíûå – ýêîíîìè÷å-

ñêèå, ñîöèàëüíûå, ìåäèöèíñêèå. Ñðåäèìåäèöèíñêèõ ïðè÷èí âàæíû ñëåäóþùèå:ïðèçíàíèå ÷àñòüþ ðîññèéñêèõ âðà÷åé íà-ëè÷èÿ ïîëåçíûõ äîç àëêîãîëÿ; îòñóòñòâèå÷åòêîé èíôîðìàöèè ó âðà÷åé è íàñåëåíèÿî áåçîïàñíûõ åæåäíåâíûõ è åæåíåäåëüíûõäîçàõ àëêîãîëÿ; óâåðåííîñòü ÷àñòè îáùå-ñòâà â òîì, ÷òî êà÷åñòâåííûé, îôèöèàëüíîïðîèçâåäåííûé àëêîãîëü áåçîïàñåí, à öèð-ðîç ïå÷åíè ìîæåò âîçíèêíóòü òîëüêî îòïîääåëüíîé âîäêè; îøèáî÷íîå ïðåäñòàâ-ëåíèå è âðà÷åé, è ïàöèåíòîâ î íàëè÷èè


ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅÂÎÏÐÎÑÛ

×åòâåðòàÿ ãðóïïà – àäåìåòèîíèí(ãåïòðàë, ãåïòîð). Â 1999 ã. áûëè îïóáëè-êîâàíû ðåçóëüòàòû ìóëüòèöåíòðîâîãîäâîéíîãî ñëåïîãî ïëàöåáîêîíòðîëèðóå-ìîãî èññëåäîâàíèÿ, ïðîâåäåííîãî ïîä ðó-êîâîäñòâîì èñïàíñêîãî ïðîôåññîðàÕ.Ìàòî. Ñîãëàñíî ðåçóëüòàòàì ýòîãî èñ-ñëåäîâàíèÿ, ïðèìåíåíèå àäåìåòèîíèíà âòå÷åíèå 24 ìåñ çíà÷èòåëüíî ïîâûøàåòâûæèâàåìîñòü áîëüíûõ àëêîãîëüíûì ÖÏêëàññà À è Â [10]. Èñïîëüçîâàíèå àäåìå-òèîíèíà ïðè àëêîãîëüíîé áîëåçíè öåëå-ñîîáðàçíî è èç-çà åãî àíòèäåïðåññèâíîéàêòèâíîñòè [11].

Ïÿòàÿ ãðóïïà – âñå îñòàëüíîå (àëëîõîë,ðîïðåí, ðåìàêñîë, ñèáåêòàí, òàíàöåõîë,ãåïàòîñàí è ò. ä.). Â ýòó ãðóïïó ìû îáú-åäèíèëè ïðåïàðàòû, ïî êîòîðûì íå áûëîïðîâåäåíî äîñòîâåðíûõ äâîéíûõ ñëåïûõïëàöåáîêîíòðîëèðóåìûõ êëèíè÷åñêèõ

èññëåäîâàíèé è êîòîðûå â áîëüøèíñòâåñâîåì, êðîìå Ðîññèè, íèãäå áîëüøå íåèñïîëüçóþòñÿ. Ïðè îòñóòñòâèè äîñòîâåð-íûõ èññëåäîâàíèé ñóäèòü î áåçîïàñíîñòèè ýôôåêòèâíîñòè äàííûõ ïðåïàðàòîâíå ïðåäñòàâëÿåòñÿ âîçìîæíûì. Îäèí èçïðåäñòàâèòåëåé äàííîé ãðóïïû ñèáåêòàí,ñîñòîÿùèé èç ëèñòüåâ áåðåçû è çâåðî-áîÿ, ìîæåò îêàçàòüñÿ ãåïàòîòîêñè÷íûì,ïîñêîëüêó ãåïàòîòîêñè÷íûì ÿâëÿåòñÿçâåðîáîé.

Òàêèì îáðàçîì, ëó÷øèé «ãåïàòî-ïðîòåêòîð» – ýòî âðà÷. Âðà÷, óáåæäåí-íûé â òîì, ÷òî ïîëåçíûõ äîç àëêîãîëÿ íåñóùåñòâóåò; âðà÷, ðåêîìåíäóþùèé âàê-öèíàöèþ ïðîòèâ ãåïàòèòà Â; âðà÷, îïè-ðàþùèéñÿ â ñâîåé ïðàêòè÷åñêîé äåÿòåëü-íîñòè íà ðåçóëüòàòû äîñòîâåðíûõ èññëå-äîâàíèé, à íå íà ìíåíèÿ ýêñïåðòîâ èñïåöèàëèñòîâ.


1. Áåëÿêèí Ñ.À., Áîáðîâ À.Í., Ïëþñíèí Ñ.Â.Âçàèìîçàâèñèìîñòü óïîòðåáëåíèÿ àëêîãîëÿè ñìåðòíîñòè îò öèððîçà ïå÷åíè // Âîåí.-ìåä.æóðí. – 2009. – Ò. 330, ¹ 9. – Ñ. 48–54.

2. Áîáðîâ À.Í., Áåëÿêèí Ñ.À., Ïëþñíèí Ñ.Â.Ýòèîëîãè÷åñêàÿ ñòðóêòóðà öèððîçîâ ïå÷åíèïî ðåçóëüòàòàì ïÿòíàäöàòèëåòíåãî íàáëþ-äåíèÿ // Âåñòí. Ðîñ. Âîåí.-ìåä. àêàä. – 2011.– ¹ 1. – Ñ. 76–81.

3. Áîòêèí Ñ.Ï. Êóðñ êëèíèêè âíóòðåííèõáîëåçíåé è êëèíè÷åñêèå ëåêöèè. – Ì.: Ìåäãèç,1950. – Ò. 1. – 181 ñ.

4. Õàçàíîâ À.È. Èç ïîëóâåêîâîãî îïûòàíàáëþäåíèÿ çà áîëüíûìè öèððîçîì ïå÷åíè// Ðîñ. æóðí. ãàñòðîýíòåðîë., ãåïàòîë., êîëî-ïðîêòîë. – 1998. – Ò. 8, ¹ 2. – Ñ. 50–60.

5. Edwards G., Anderson P., Babor T.F. et al.Alcohol Policy and the Public Good // OxfordUniversity Press, USA. – 1995. – P. 240.

6. European Detailed Mortality Database //Url: http://data.euro.who.int/dmdb/ (äàòà îáðà-ùåíèÿ 24 ôåâðàëÿ 2013 ã.).

7. Gluud C., Christensen E. Ursodeoxycholicacid for primary biliary cirrhosis // CochraneDatabase of Systematic Reviews. – 2001. – Issue 4.

8. Lieber C.S., Robins S.J., Li J. et al.Phosphatidylcholine protects against fibrosis andcirrhosis in the baboon // Gastroenterology. –1994. –Vol. 106. – P. 152–159.

9. Lieber C.S., Weiss D.G., Groszmann R. et al.Veterans affairs cooperative study of polyenyl-phosphatidylcholine in alcoholic liver disease// Alcohol. Clin. Exp. Res. – 2003. – Vol. 27, N 11.– P. 1765–1772.

10. Mato J.M., Camara J., Caballeria L. et al.S-adenosylmethionine in alcoholic liver cirrhosis:

placebo-controlled, double-blind, multicentreclinical trial // J. Hepatol. – 1999. – N 30. –P. 1081–1089.

11. Papakostas G.I., Mischoulon D., Shyu I. et al.S-Adenosyl methionine (SAMe) augmentati-on of serotonin reuptake inhibitors for anti-depressant nonresponders with major depressivedisorder: a double-blind, randomized clinicaltrial // Am. J. Psychiatry. – 2010. – N 167. –P. 942–948.

12. Pares À., Planas Ð., Òîððåñ Ì. et al. Effectsof silymarin in alcoholic patients with cirrhosisof the liver: Results of a controlled double-blindrandomized and multicenter trial // J. Hepatol. –1998. – Vol. 28. – P. 615–621.

13. Rambaldi A., Bradly P.J., Iaquinto G. et al.Milk thistle for alcoholic and/or hepatitis Bor C liver diseases – a systematic Cochranehepato-biliary group review with meta-analysesof randomized clinical trials // Am. J. Gastroenterol.– 2005. – Vol. 100, N 11. – P. 2583–2591.

14. Ramstedt M. Per capita alcohol consump-tion and liver cirrhosis mortality in 14 Europeancountries // Addiction. – 2001. – Vol. 96 (suppl. 1).– P. 19–33.

15. Saller R., Brignoli R., Melzer J., Meier R.An updated systematic review with meta-ana-lysis for the clinical evidence of silymarin //Forsch. Komplementmed. – 2008. – Vol. 15, N 1.– P. 9–20.

16. Saller R., Meier R., Brignoli R. The use ofsilymarin in the treatment of liver diseases// Drugs. – 2001. –Vol. 61, N 14. – P. 2035–2063.

17. Trinchet J.C., Coste T., Levy V.G. et al.Treatment of alcoholic hepatitis with silymarin.A double blind comparative study in 116 patients// Gastroenterol. Clin. Biol. – 1989. – Vol. 13, N 4.– P. 120–124.



© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2013ÓÄÊ 615.217.03:616-089.5

Îïðåäåëåíèå ïîòðåáíîñòè â ìèîðåëàêñàíòàõäëÿ îêàçàíèÿ àíåñòåçèîëîãè÷åñêîé ïîìîùèâ ëå÷åáíîì ó÷ðåæäåíèè

ÙÅÃÎËÅÂ À.Â., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

ËÅÂØÀÍÊÎÂ À.È., çàñëóæåííûé ðàáîòíèê âûñøåé øêîëû ÐÔ, ïðîôåññîð,ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå1

ÁÎÃÎÌÎËÎÂ Á.Í., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûâ îòñòàâêå ([email protected])1

ÏÅÐÅËÎÌÀ Â.È.1ÄÓÌÍÎÂ À.Ã., êàíäèäàò ìåäèöèíñêèõ íàóê, êàïèòàí ìåäèöèíñêîé ñëóæáû2

1Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã; 2Ôèëèàë ¹ 2 1586-ãîÂîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ ÌÎ ÐÔ, ã. Ñîëíå÷íîãîðñê, Ìîñêîâñêàÿ îáëàñòü

Shchegolev A.V., Levshankov A.I., Bogomolov B.N., Pereloma V.I., Dumnov A.G. – Evaluation of musclerelaxants requirement for army hospital anesthesia. The rationale for cost-effectiveness of modern musclerelaxants (MR) administration in general anesthesia was evaluated. New MRs are more expensive thantraditionally used pi pecuronium and succinylcholine. However, the old MRs are often required asa block reversion with anticholinesterase medicines at the end of surgery, the longer artificial lung ventilationand observation in patients during recovery in intensive care unit. It was found that the districtmilitary hospital had done an annual average of about 900 general anesthesia assisted with artificialventilation and muscle relaxation. About 2% of all anesthesias accrue to short-term anesthesia, the 27% tomedium-term and 71% to long-term. 81% of the medium-term anesthesia accrue small hospitals. Accordingto cost/effectiveness the most optimal muscle relaxants administration scheme for short-term(up to 30 min) anesthesia was mivacurium, for the operation of medium duration (30–120 min) – rocuronium,for long-term (120 min) – pipecuronium. An electronic form of annual report, which allows to obtainthe necessary data for calculation of annual muscle relaxants demand and costs both in hospital and inthe whole of the armed forces quickly, was developed.

K e y w o r d s: muscle relaxants, general anesthesia, cost-effectiveness, artificial lung ventilation, intensive care.

Íåäîñòàòî÷íîå ôèíàíñèðîâàíèå çäðàâîîõðàíåíèÿ îáóñëîâëèâàåò

íåîáõîäèìîñòü ïîèñêà ðàöèîíàëüíûõïóòåé ðàñõîäîâàíèÿ ñðåäñòâ. Äëÿ ðåøå-íèÿ ýòèõ àêòóàëüíûõ âîïðîñîâ ïðîâîäÿò-ñÿ ôàðìàêîýêîíîìè÷åñêèå èññëåäîâàíèÿ.Â Ðîññèè òàêèå ðàáîòû ñòàëè ïîÿâëÿòü-ñÿ òîëüêî â ïîñëåäíèå ãîäû [7, 9, 10]. Ýòèèññëåäîâàíèÿ ïîñâÿùåíû ðàöèîíàëüíî-ìó (ñ êëèíè÷åñêîé è ýêîíîìè÷åñêîé òî÷-êè çðåíèÿ) èñïîëüçîâàíèþ ëåêàðñòâåí-íûõ ñðåäñòâ [8, 9].

Â õèðóðãè÷åñêîé ïðàêòèêå ÷àñòîïðèìåíÿþòñÿ ìèîðåëàêñàíòû. Òàê, íà-ïðèìåð, ïî èòîãàì I êâàðòàëà 2009 ã.â Ñàíêò-Ïåòåðáóðãå îíè âõîäèëè â ïåð-âóþ äåñÿòêó ëåêàðñòâåííûõ ïðåïàðàòîâïî îáúåìó ãîñïèòàëüíûõ çàêóïîê [2].Â íàñòîÿùåå âðåìÿ äëÿ ìèîðåëàêñàöèèâî âðåìÿ àíåñòåçèè ñ èñêóññòâåííîé âåí-

òèëÿöèåé ëåãêèõ (ÈÂË) ïðè õèðóðãè-÷åñêèõ îïåðàöèÿõ ÷àùå âñåãî ïðèîáðå-òàþò íàèáîëåå äåøåâûå ìèîðåëàêñàíòû(ñóêñàìåòîíèé, ïèïåêóðîíèé), îðèåíòèðó-ÿñü íà ñòîèìîñòü áåç ó÷åòà èõ ýôôåê-òèâíîñòè. Ôàðìàêîýêîíîìè÷åñêèå àñ-ïåêòû èñïîëüçîâàíèÿ ìèîðåëàêñàíòîâèçó÷åíû íåäîñòàòî÷íî. Â îòå÷åñòâåííîéëèòåðàòóðå ìàëî òàêèõ ðàáîò [1, 9]. Ââå-äåíèå â íàøåé ñòðàíå â ïðàêòèêó ðîêó-ðîíèÿ ïîçâîëèëî ñîêðàòèòü ÷èñëî áîëü-íûõ ïîñëå ïëàíîâûõ îïåðàöèé, òðå-áóþùèõ íàáëþäåíèÿ èëè ïðîäëåííîéÈÂË, â ïàëàòå ïðîáóæäåíèÿ ñ 34,7äî 16,7% [8].

Ïî äàííûì Ì.Í.Çàìÿòèíà è äð.,êîýôôèöèåíò «çàòðàòû/ýôôåêòèâíîñòü»èñïîëüçîâàíèÿ ðîêóðîíèÿ âî âðåìÿ ïëàíî-âûõ ëàïàðîñêîïè÷åñêèõ õîëåöèñòýêòî-ìèé â 1,3 ðàçà âûøå, ÷åì ïèïåêóðîíèÿ.




1. Âåðøóòà Ä.Â. Ôàðìàêîêèíåòèêà è ôàð-ìàêîäèíàìèêà íîâîãî ñòåðîèäíîãî ìèîðåëàê-ñàíòà ýñìåðîíà (îáçîð ëèòåðàòóðû) // Âåñòí.èíòåíñèâ. òåðàïèè. – 2003. – ¹ 2. – C. 51–56.

2. Ãîñïèòàëüíûé ðûíîê Ñàíêò-Ïåòåðáóðãà:Èòîãè I êâàðòàëà 2009 ã. [Ýëåêòðîííûé ðåñóðñ].– Ðåæèì äîñòóïà: http://healtheconomics.ru/index.php?option=com_content&view=article&id=706:-i-2009-&catid=1:latest-news&Itemid=107

3. Äóìíîâ À.Ã. Ôàðìàêîýêîíîìè÷åñêèåàñïåêòû èñïîëüçîâàíèÿ ìèâàêóðèÿ è ñóêöè-íèëõîëèíà ïðè îïåðàöèÿõ êîðîòêîé ïðîäîë-æèòåëüíîñòè // Ýôôåðåíòíàÿ òåðàïèÿ. – 2009.– Ò. 15, ¹ 1–2. – Ñ. 47–49.

4. Äóìíîâ À.Ã. Ôàðìàêîýêîíîìè÷åñêîå îáî-ñíîâàíèå ðàöèîíàëüíîãî èñïîëüçîâàíèÿ ìè-îðåëàêñàíòîâ ïðè îêàçàíèè àíåñòåçèîëîãè÷åñ-êîé ïîìîùè: Àâòîðåô. äèñ.… ... êàíä. ìåä. íàóê. –ÑÏá, 2011. – 23 ñ.

5. Ëåâøàíêîâ À.È., Äóìíîâ À.Ã. Ôàðìàêî-ýêîíîìè÷åñêèå àñïåêòû èñïîëüçîâàíèÿ ïèïå-êóðîíèÿ è ïàíêóðîíèÿ áðîìèäà ïðè äëèòåëü-íûõ îïåðàöèÿõ â ñèñòåìå ìåäèöèíñêîãî îáåñ-ïå÷åíèÿ Âîîðóæåííûõ ñèë Ðîññèéñêîé Ôå-äåðàöèè // Âåñòí. Ðîñ. Âîåí.-ìåä. àêàä. – 2009.– ¹ 4 (28). – C. 28–33.

6. Ïàíîâ Ï.Á., Ïðîõâàòèëîâ Ã.È., Òåãçà Í.Â.Ìåäèêî-ýêîíîìè÷åñêîå îáîñíîâàíèå ïðèìå-íåíèÿ ñóõèõ ïèòàòåëüíûõ ñìåñåé â ñèñòåìåëå÷åáíîãî ïèòàíèÿ áîëüíûõ ñ òðàâìàìè èâîñïàëèòåëüíûìè çàáîëåâàíèÿìè ÷åëþñòíî-ëèöåâîé îáëàñòè // Âåñòí. Ðîñ. Âîåí.-ìåä. àêàä.– 2007. – ¹ 2 (18). – C. 95–99.

7. Ñîêîëîâà Î.Ï., Ëåáåäèíñêèé Ê.Ì., Áîÿð-êèí À.À. Ôàðìàêîýêîíîìè÷åñêèé àíàëèç áà-çîâûõ ãèïíîòèêîâ â àíåñòåçèîëîãè÷åñêîìîáåñïå÷åíèè õèðóðãè÷åñêèõ âìåøàòåëüñòâ //

Ñîâðåìåííûå íàïðàâëåíèÿ â äèàãíîñòèêå, ëå-÷åíèè è ïðîôèëàêòèêå çàáîëåâàíèé. – ÑÏá:ÃÏÌÀ, 2004. – Ñ. 144–145.

8. Ñðàâíèòåëüíàÿ îöåíêà ýôôåêòèâíîñòèñîâðåìåííûõ ìèîðåëàêñàíòîâ: Îò÷åò î ÍÈÐ¹ 4.99.267. ï. 12 / ÂÌåäÀ. – ÑÏá, 2000.

9. Òåãçà Â.Þ., Ðåóòñêèé È.À., Âåäìàíîâ Þ.Â.Ñðàâíèòåëüíàÿ îöåíêà ýêîíîìè÷åñêèõ çàòðàòíà îêàçàíèå ìåäèöèíñêîé ïîìîùè áîëüíûìõèðóðãè÷åñêîãî ïðîôèëÿ â àìáóëàòîðíûõè ñòàöèîíàðíûõ óñëîâèÿõ // Âåñòí. Ðîñ. Âîåí.-ìåä. àêàä. – 2009. – ¹ 2 (26). – C. 167–175.

10. Õóðöèëàâà Î.Ã., Áåëåâèòèí À.Á., Òû-ðåíêî Â.Â. Ìåäèêî-ýêîíîìè÷åñêèå àñïåêòûîïòèìèçàöèè äèàãíîñòèêè è ëå÷åíèÿ îñòðîãîêîðîíàðíîãî ñèíäðîìà â óñëîâèÿõ ìíîãî-ïðîôèëüíîãî ñòàöèîíàðà // Âåñòí. Ðîñ. Âîåí.-ìåä. àêàä. – 2008. – ¹ 2 (22). – C. 138–146.

11. DeMonaco H.J., Shah A.S. Economicconsiderations in the use of neuromuscularblocking drugs // J. Clin. Anesth. – 1994. – Vol. 6,N 5. – Ð. 383–387.

12. Holzman R.S., Yee P.S., Neuman G.G.Pharmacy saving in anesthesia: confessions ofa cost containment curmudgeon // Anesthesiology.– 1994. – Vol. 81, N 3A. – Ð. 42–44.

13. Kopman A.F. Relationship of the train-of-four fade ratio to clinical signs and symptoms ofresidual paralysis in awake volunteers //Anesthesiology. – 1997. – Vol. 86, N 4. – Ð. 765–771.

14. Szocik J.F., Learned D.W. Impact of a costcontainment program on the use of volatileanesthetics and neuromuscular blocking drugs //J. Clin. Anesth. – 1994. – Vol. 6, N 5. – Ð. 378–382.

15. Viby-Mogensen J. Are the new intermediateacting muscle relaxants worth the money? //Øåñòîé âñåðîññèéñêèé ñúåçä àíåñòåçèîëîãîâè ðåàíèìàòîëîãîâ: Òåç. äîêë. è ñîîáùåíèé. –Ì., 1998. – Ñ. 49–51.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2013ÓÄÊ [616.12-008.331.1-06:616-008.9]-085.225.2

Àíòèãèïåðòåíçèâíàÿ òåðàïèÿ ïðè ìåòàáîëè÷åñêîìñèíäðîìå ó ïàöèåíòîâ ñòàðøèõ âîçðàñòíûõ ãðóïï

ÑÅÐÃÅÅÂÀ Â.Â., ïðîôåññîð1

ÐÎÄÈÎÍÎÂÀ À.Þ. ([email protected])1

ÁÎÁÛËÅÂÀ Ò.À., êàíäèäàò ìåäèöèíñêèõ íàóê2

ÏÀÖÅÍÊÎ Ì.Á., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

ÏÎÏÎÂ À.Ï., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê,ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà3

ËÈÔÅÐÎÂ Ð.À., êàíäèäàò ìåäèöèíñêèõ íàóê2

ÌÈÕÀÉËÎÂ À.À., çàñëóæåííûé âðà÷ ÐÔ, äîêòîð ìåäèöèíñêèõ íàóê,ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå2

1Ñàíêò-Ïåòåðáóðãñêèé èíñòèòóò óñîâåðøåíñòâîâàíèÿ âðà÷åé-ýêñïåðòîâ Ôåäåðàëüíîãî ìåäè-êî-áèîëîãè÷åñêîãî àãåíòñòâà Ðîññèè; 2Ìåäèöèíñêèé ó÷åáíî-íàó÷íûé êëèíè÷åñêèé öåíòðèì. Ï.Â.Ìàíäðûêà, Ìîñêâà; 3Ôèëèàë ¹ 6 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãîãîñïèòàëÿ èì. À.À.Âèøíåâñêîãî, Ìîñêâà

Sergeyeva V.V., Rodionova A.Yu., Bobyleva T.A., Patsenko M.B., Popov A.P., Liferov R.A., Mikhailov A.A.– Antihypertensive therapy in the elderly with metabolic syndrome. The article is concerned withmodern methods of assessment of arterial hypertension in patients with metabolic syndrome and characteristicsof modern antihypertensive drugs and its combinations necessary for the elderly. The authors gave theirown example of treatment of more than 2000 patients with arterial hypertension and metabolic syndrome.

K e y w o r d s: metabolic syndrome, arterial hypertension, antihypertensive drugs, elderly



×àñòûå ñî÷åòàíèÿ àðòåðèàëüíîé ãè-ïåðòîíèè (ÀÃ) ñ èçáûòî÷íîé ìàññîé òåëà,àòåðîãåííîé äèñëèïèäåìèåé è íàðóøå-íèÿìè óãëåâîäíîãî îáìåíà, âêëþ÷àÿ ðàç-âèòèå ñàõàðíîãî äèàáåòà (ÑÄ) 2 òèïà,îòìå÷àëèñü äàâíî ìíîãèìè àâòîðàìè,â ò. ÷. âûäàþùèìè îòå÷åñòâåííûìèèíòåðíèñòàìè – Ã.Ô.Ëàíãîì, À.Ë.Ìÿñíè-êîâûì, Å.Ì.Òàðååâûì.

Â íà÷àëå 80-õ ãîäîâ XX â. áûë ïðåä-ëîæåí òåðìèí «ìåòàáîëè÷åñêèé ñèíäðîì»[18], à çàòåì óòî÷íåí êàê «ìåòàáîëè÷åñ-êèé ñèíäðîì Õ», êîìïîíåíòàìè êîòîðîãîÿâëÿþòñÿ èíñóëèíîðåçèñòåíòíîñòü (ÈÐ),ãèïåðèíñóëèíåìèÿ, íàðóøåíèÿ òîëåðàíò-íîñòè ê ãëþêîçå, äèñëèïîïðîòåèíåìèè,ãèïåðòðèãëèöåðèäåìèè è ÀÃ [20].

Â íàñòîÿùåå âðåìÿ èçâåñòíî áîëåå20 íàèìåíîâàíèé óêàçàííîãî ñèìïòîìîêîì-ïëåêñà, íî òåðìèí «ìåòàáîëè÷åñêèé ñèíäðîì»(ÌÑ) ÿâëÿåòñÿ íàèáîëåå óïîòðåáëÿåìûì.

Àêòóàëüíîñòü íàñòîÿùåé ñòàòüè, âïåðâóþ î÷åðåäü, ñâÿçàíà ñ òåì, ÷òî ïî-äîáíûå êëèíè÷åñêèå ñî÷åòàíèÿ áîëååõàðàêòåðíû äëÿ ëèö ñòàðøèõ âîçðàñòíûõãðóïï, êîòîðûå ñîñòàâëÿþò çíà÷èòåëüíóþ÷àñòü èç íàáëþäàåìûõ â âîåííî-ìåäè-öèíñêèõ ó÷ðåæäåíèÿõ [14].

Íà ñåãîäíÿøíèé äåíü ÀÃ ðàññìà-òðèâàåòñÿ ïðè ÌÑ êàê âàæíåéøèé åãîêîìïîíåíò [4]. Ñîãëàñíî ñîâðåìåííûìïðåäñòàâëåíèÿì ÀÃ ÿâëÿåòñÿ ÷àñòüþ ãå-òåðîãåííîãî ñîñòîÿíèÿ, òî÷íåå âñåãî îï-ðåäåëÿåìîãî êàê àòåðîñêëåðîòè÷åñêèéñèíäðîì ñ ãåíåòè÷åñêèìè è ïðèîáðåòåí-íûìè ñòðóêòóðíûìè è ìåòàáîëè÷åñêèìèíàðóøåíèÿìè [7]. Â 1991 ã. V.Drau èE.Braunwald ïðåäëîæèëè òåîðèþ ñåðäå÷-íî-ñîñóäèñòîãî êîíòèíóóìà, îñíîâíûìèôàêòîðàìè ðèñêà (ÔÐ) êîòîðîãî ÿâëÿ-þòñÿ ÀÃ, äèñëèïèäåìèÿ è ÑÄ [17].

Â íàøåé ñòðàíå ÷àñòîòà âñòðå÷àåìî-ñòè ÀÃ âûñîêà, îñîáåííî ó ëèö ïîæèëîãîâîçðàñòà, è äîñòèãàåò 75–80%, ïðè ýòîìáîëåå 20% ïîæèëûõ áîëüíûõ èìåþò èçîëè-ðîâàííóþ ñèñòîëè÷åñêóþ ÀÃ (ÈÑÀÃ) [6].

Óñòàíîâëåíî, ÷òî ó ëèö ñ ÀÃ â 60%ñëó÷àåâ îáíàðóæèâàþòñÿ ðàçëè÷íûåâàðèàíòû ÌÑ [1, 21].

Ïðè âûáîðå àíòèãèïåðòåíçèâíûõ ïðå-ïàðàòîâ (ÀÃÏ) äîëæíû ó÷èòûâàòüñÿ îñî-áåííîñòè ÀÃ ïðè ÌÑ, â ÷àñòíîñòè ó ïàöè-åíòîâ ñòàðøèõ âîçðàñòíûõ ãðóïï (ìû íà-áëþäàëè 2134 áîëüíûõ). Ó íèõ îòìå÷åíî:

1) ïðåîáëàäàíèå ÈÑÀÃ (61%);2) ìåíåå ÿðêàÿ êëèíè÷åñêàÿ êàðòèíà

è íåâûðàæåííîñòü îáúåêòèâíîé ñèìïòîìà-òèêè, â ò. ÷. ãèïåðòîíè÷åñêèõ êðèçîâ (37%);

3) íàëè÷èå àññîöèèðîâàííûõ êëèíè-÷åñêèõ ñîñòîÿíèé (ÀÊÑ), òàêèõ êàê èí-ôàðêò ìèîêàðäà (ÈÌ), èíñóëüò, õðîíè÷åñ-êàÿ ïî÷å÷íàÿ íåäîñòàòî÷íîñòü (100%);

4) ñî÷åòàíèå ÌÑ ñ ìóëüòèôàêòîðè-àëüíûìè çàáîëåâàíèÿìè (76%);

5) íàðóøåíèå ñóòî÷íîãî ðèòìà àðòå-ðèàëüíîãî äàâëåíèÿ (ÀÄ), ïðîÿâëÿþùåãîñÿ âïîâûøåííîé âàðèàáåëüíîñòè ÀÄ â òå÷åíèåñóòîê, íåäîñòàòî÷íûì ñíèæåíèåì ïîêàçà-òåëåé ÀÄ â íî÷íîå âðåìÿ («non-dipper»),íî÷íîé ãèïåðòåíçèåé («night-piker»), óâåëè-÷åíèåì ïóëüñîâîãî äàâëåíèÿ (62%);

6) ñòàáèëèçàöèÿ ÀÃ ñ âîçðàñòîì âû-çûâàëà òðóäíîñòè (54%);

7) äëèòåëüíûé àíàìíåç ÀÃ (÷àñòîáîëåå 20 ëåò) ïðèâîäèò ê òîìó, ÷òî ïî-âûøåííûå öèôðû ÀÄ ïàöèåíòû ñ÷èòà-þò äëÿ ñåáÿ «ðàáî÷èìè» è ïðè äîñòèæå-íèè öåëåâûõ çíà÷åíèé îòìå÷àþò óõóä-øåíèå ñàìî÷óâñòâèÿ (38%);

8) ñêëîííîñòü áîëüíûõ ê àããðàâàöèè âíåêîòîðûõ ñëó÷àÿõ ñïîñîáñòâóåò ïåðåîöåíêåâðà÷àìè èìåþùåéñÿ ñèìïòîìàòèêè è íà-çíà÷åíèþ «ëèøíèõ» ïðåïàðàòîâ (12%);

9) îñîáåííîñòüþ ñîñóäèñòîé ñòåíêèÿâëÿåòñÿ åå ðèãèäíîñòü, ÷òî òðåáóåò áîëü-øèõ óñèëèé ïðè èçìåðåíèè ÀÄ è ìîæåòïðèâåñòè ê çàâûøåíèþ öèôð ÀÄ (9%);

10) íèçêàÿ ïðèâåðæåííîñòü ïàöèåí-òîâ ê ëå÷åíèþ (26%) âñëåäñòâèå âûñî-êèõ çàòðàò íà ïðèîáðåòåíèå ìåäèêàìåí-òîâ è â ðÿäå ñëó÷àåâ â ñâÿçè ñ èõ îòñóò-ñòâèåì â ïðîäàæå (äëÿ âûäà÷è ïî áåñïëàò-íûì ðåöåïòàì), îòðèöàòåëüíîé ìîòèâàöèèîäíîâðåìåííîãî ïðèåìà íåñêîëüêèõ ïðå-ïàðàòîâ, íåäîñòàòî÷íîé èíôîðìèðîâàííî-ñòè î õàðàêòåðå ñâîåãî çàáîëåâàíèÿ.

Ñëåäóåò îòìåòèòü, ÷òî ìíîãî÷èñëåí-íûå îïðîñû, ïðîâîäèìûå ñðåäè áîëüíûõÀÃ, äåìîíñòðèðóþò íåçíàíèå ïàöèåíòàìèíîðìàëüíûõ öèôð ÀÄ, ïëîõîå âëàäåíèå íà-âûêàìè ñàìîêîíòðîëÿ, íåïîíèìàíèå îïàñ-íîñòè ïîâûøåííîãî ÀÄ è íåîáõîäèìîñ-òè ïîñòîÿííîé òåðàïèè çàáîëåâàíèÿ [5].

Öåëüþ àíòèãèïåðòåíçèâíîé òåðàïèè(ÀÃÒ) ïðè ÌÑ äîëæíî áûòü äîñòèæå-íèå ìàêñèìàëüíîé ñòåïåíè ñíèæåíèÿðèñêà ñåðäå÷íî-ñîñóäèñòûõ îñëîæíåíèé(ÑÑÎ) è ñìåðòíîñòè ïàöèåíòîâ.



Òàêèì îáðàçîì, ïðè íàçíà÷åíèè ÀÃÒïàöèåíòàì ñ ÌÑ íåîáõîäèì äèôôåðåí-öèðîâàííûé è ñòðîãî èíäèâèäóàëüíûéïîäõîä. Íàø îïûò ïîêàçàë, ÷òî ïðè ñî-áëþäåíèè ýòèõ ðåêîìåíäàöèé áëèæàéøèå

(êðàòêîñðî÷íûå) ïîëîæèòåëüíûå ýôôåê-òû îò ïðîâîäèìîé ÀÃÒ áûëè äîñòèãíóòûó 86% íàáëþäàåìûõ óæå ïðè íàõîæäåíèèâ ñòàöèîíàðå è ñîõðàíÿëèñü â òå÷åíèåáëèæàéøèõ 12 ìåñ â 78% ñëó÷àåâ.


1. Àëìàçîâ Â.À., Áëàãîñêëîííàÿ ß.Â., Øëÿõ-òî Å.Â., Êðàñèëüíèêîâà Å.È. Ìåòàáîëè÷åñêèéñåðäå÷íî-ñîñóäèñòûé ñèíäðîì. – ÑÏá: Èçä-âî ÑÏáÃÌÓ, 1999. – 208 c.

2. Áàðàíîâà Å.È., Áîëüøàêîâà Î.Î. Àíòè-ãèïåðòåíçèâíûå ïðåïàðàòû ñèìïàòîëèòè÷åñêîãîäåéñòâèÿ. Ñîâðåìåííûé âçãëÿä // Àðò. ãèïåðò. –2006. – Ò. 12, ¹ 2. – Ñ. 125–130.

3. Áàðñóêîâ À.Â. Êàðäèîìåòàáîëè÷åñêèéñèíäðîì: íàñêîëüêî âàæíà â ðåàëüíîé êëè-íè÷åñêîé ïðàêòèêå àêòèâàöèÿ PPAR- γ-ðåöåï-òîðîâ? // Àðò. ãèïåðò. – 2008. – Ò. 14, ¹ 1. –Ñ. 116–124.

4. Áëèíîâà Â.Â. Àðòåðèàëüíàÿ ãèïåðòåíçèÿñ ìåòàáîëè÷åñêèìè íàðóøåíèÿìè: òàêòèêàâåäåíèÿ áîëüíûõ â àìáóëàòîðíûõ óñëîâèÿõ:Àâòîðåô. äèñ. ...… êàíä. ìåä. íàóê. – Ñàðàòîâ, 2009.– 18 ñ.

5. Áîãóøåâè÷ À.Í., Ñåìåíîâà Î.Í., Ìàéîðî-âà È.Â. è äð. Ñîâðåìåííûå òåíäåíöèè àíòèãè-ïåðòåíçèâíîé òåðàïèè áîëüíûõ ãèïåðòîíè÷åñ-êîé áîëåçíüþ ïîæèëîãî è ñòàð÷åñêîãî âîçðà-ñòà // Îñîáåííîñòè òå÷åíèÿ è ëå÷åíèÿ çàáî-ëåâàíèé ó æèòåëåé áëîêàäíîãî Ëåíèíãðàäà,ëèö ïîæèëîãî è ñòàð÷åñêîãî âîçðàñòà. – Âûï.IV. – ÑÏá, 2008. – Ñ. 378–388.

6. Ãóðåâè÷ Ì.À. Âîïðîñû ïàòîãåíåçà è ëå-÷åíèÿ èçîëèðîâàííîé ñèñòîëè÷åñêîé àðòåðè-àëüíîé ãèïåðòîíèè ó ïîæèëûõ // Êëèí. ìåä. –2003. – ¹ 5. – Ñ. 56–58.

7. Äåìèí À.À. Ñîâðåìåííûå ïðèíöèïû ëå-÷åíèÿ àðòåðèàëüíîé ãèïåðòåíçèè // Êëèí. ìåä.– 2003. – ¹ 5. – Ñ. 4–9.

8. Êîáàëàâà Æ.Ä., Êîòîâñêàÿ Þ.Â. Çíà÷åíèåôèêñèðîâàííîé êîìáèíàöèè âåðàïàìèë ÑÐ/òðàíäîëàïðèë â ëå÷åíèè ïàöèåíòîâ ñ ìåòàáî-ëè÷åñêèì ñèíäðîìîì: ðåçóëüòàòû èññëåäîâàíèÿSTAR // Êàðäèîë. – 2007. – ¹ 9. – Ñ. 74–78.

9. Ìèò÷åíêî Å.È., Êîðïà÷åâ Â.Â., Ïóòàé Ì.È.è äð. Äèàãíîñòèêà è ëå÷åíèå ìåòàáîëè÷åñêîãîñèíäðîìà, ñàõàðíîãî äèàáåòà, ïðåäèàáåòà èñåðäå÷íî-ñîñóäèñòûõ çàáîëåâàíèé // Ìåæäó-íàð. ýíäîêðèí. æóðí. – 2008. – Ò. 3, ¹ 15. –Ñ. 21–29.

10. Ìîèñååâ Â.Ñ. Ýôôåêòû ðàìèïðèëà âëå÷åíèè è ïðîôèëàêòèêå çàáîëåâàíèé ñåðäå÷-íî-ñîñóäèñòîé ñèñòåìû è ïî÷åê // Êëèí. ôàðì.è òåðàïèÿ. – 2005. – ¹ 5. – Ñ. 52–58.

11. Ìû÷êà Â.Á., Äóèøâèëè Ä.Ý., Ìàìûðáàå-âà Ê.Ì. è äð. Ìåñòî òåëìèñàðòàíà â ëå÷åíèèìåòàáîëè÷åñêîãî ñèíäðîìà // Òåð. àðõ. – 2006.– Ò. 78, ¹ 8. – Ñ. 63–66.

12. Ìû÷êà Â.Á., ×àçîâà È.Å. Ìåòàáîëè÷åñ-êèé ñèíäðîì: Ðóêîâîäñòâî ïî âíóòðåííèì áî-ëåçíÿì äëÿ âðà÷à îáùåé ïðàêòèêè / Ïîä ðåä.Ô.È.Êîìàðîâà. – Ì., 2007. – Ñ. 628–636.

13. Îáðåçàí À.Ã., Çàãîðîäñêèé À.Í. Ñîâðå-ìåííûå ïðèíöèïû ëå÷åíèÿ ñåðäå÷íî-ñîñóäè-ñòîé ïàòîëîãèè ïðè ìåòàáîëè÷åñêîì ñèíäðîìå// Çàì. ãëàâ. âðà÷à: ëå÷. ðàáîòà è ìåä. ýêñïåðò. –2012. – ¹ 1. – Ñ. 32–37.

14. Ñèìîíåíêî Â.Á., Áðèæàí Ì.Â., Ôèñóí À.ß.Ìåòàáîëè÷åñêèé ñèíäðîì: ñîâðåìåííûå ïîä-õîäû ê äèàãíîñòèêå è ïðèíöèïû ëå÷åíèÿ //Âîåí.-ìåä. æóðí. – 2004. – Ò. 325, ¹ 7. – Ñ. 16–22.

15. ×àçîâà È.Å. Ëå÷åíèå àðòåðèàëüíîéãèïåðòîíèè: ñîâðåìåííûå ïðåäñòàâëåíèÿ// Òåð. àðõ. – 2007. – Ò. 79, ¹ 9. – Ñ. 5–8.

16. Berg A., Konig D. Aspekte zur Prvantionund Therapie von Fettstoffwelchselstrungen unterbesonderer Berucksichtigung des metabolischenSyndroms // Deutsche Zeitschrift fur Sport-medizin. – 2005. – Bd. 56, N 3. – S. 74–82.

17. Drau V., Braunwald E. Resolved andunresolved issues in the prevention and treatmentof coronary artery disease: a workshop consensusstatement // Am. Heart J. – 1991. – Vol. 121. –P. 1244–1263.

18. Hanefeld M., Leonardt W. Das metabolisheSyndrom // Dtsch. Gerundheitwesen. – 1981. –Bd. 36. – S. 545–551.

19. Hermann Ò. Das Metabolische Syndrom– ein hohes kardiovaskuläres Risiko? // ActaMedica Austriaca. – 2004. – Bd. 31. – S. 63–66.

20. Reaven G. Role of insulin resistancein human disease // Diabetes. – 1988. – Vol. 37. –P. 1595–1607.

21. Sander G.E. High blood pressure in thegeriatric population treatment considerations// Am. J. Geriatr. Cardiol. – 2002. – Vol. 11, N. 3. –P. 223–232.

22. Jakob S., Klimm H.-J., Rett K. et al. Ñðàâ-íåíèå ýôôåêòèâíîñòè ïðèìåíåíèÿ ìîêñîíè-äèíà è ìåòîïðîëîëà ó ïàöèåíòîâ ñ àðòåðè-àëüíîé ãèïåðòîíèåé è ñàõàðíûì äèàáåòîì2 òèïà (âëèÿíèå íà àðòåðèàëüíîå äàâëåíèå èìåòàáîëè÷åñêèå ïàðàìåòðû // Îáçîðû êëèíè÷.êàðäèîë. – 2009. – N 17. – Ñ. 20–29.

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© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2013ÓÄÊ 616.24-002-022

Ôàòàëüíîå òå÷åíèå âèðóñ-àññîöèèðîâàííîéïíåâìîíèè ó áîëüíîãî ãðèïïîì A(H1N1)

ËÞÒÎÂ Â.Â., çàñëóæåííûé âðà÷ ÐÔ, äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîéñëóæáû1

ÐÓÄÀÊÎÂ Þ.Â., êàíäèäàò ìåäèöèíñêèõ íàóê ([email protected])1

ÕÀÐÈÒÎÍÎÂ Ì.À., ïðîôåññîð2

ØÈØÊÈÍ Ì.Ê., äîöåíò2

ÑÅÐÃÅÅÂ Ñ.Ì., êàíäèäàò ìåäèöèíñêèõ íàóê3

ÃÐÈÁÎÂÀ Ë.Í.1ÇÀÑÈÌÎÂ Â.Ñ.1ÊÐÀÑÈÊÎÂ Å.Ê.1

1442-é Âîåííûé êëèíè÷åñêèé ãîñïèòàëü ÇÂÎ, Ñàíêò-Ïåòåðáóðã; 2Âîåííî-ìåäèöèíñêàÿàêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã; 3Ìåäèöèíñêàÿ ñëóæáà Çàïàäíîãî âîåííîãî îê-ðóãà, Ñàíêò-Ïåòåðáóðã

Lyutov V.V., Rudakov Yu.V., Kharitonov M.A., Shishkin M.K., Sergeyev S.M., Gribova L.N., Zasimov V.S.,Krasikov E.K. – Fatal treatment of VA-pneumonia in patient with influenza A(H1N1). In 2009 pandemiccaused by high-path fluenza A(H1N1), so called «swine» flu was registered in the world. Aphylaxisto this type of influenza lead to pandemic. The authors gave an example of fatal course of influenzaA(H1N1)S-OIV in young patient with severe VA-pneumonia, acute respiratory distress syndrome, disseminatedintravascular coagulation with progressive respiratory distress secondary to an metabolic syndrome. It ledto patient’s death. Patient was refractory to all modern methods of intensive therapy in conditions of multi-field specialized medical and preventive treatment facility.

K e y w o r d s: influenza A(H1N1), virus hemorrhagic pneumonia, acute respiratory distress syndrome,disseminated intravascular coagulation.

Ãðèïï èçâåñòåí ñî âðåìåí Ãèïïîêðàòà(412 ã. äî í. ý.). Ê êîíöó XII â. (1173 ã.)

îòíîñèòñÿ îïèñàíèå îäíîé èç ïåðâûõêðóïíûõ âñïûøåê ãðèïïîïîäîáíîãîçàáîëåâàíèÿ â Åâðîïå. Â ëåòîïèñÿõXIV–XV ââ. óïîìèíàåòñÿ óæå î âîñüìèïîäîáíûõ ýïèäåìèÿõ. Ñî âòîðîé ïîëîâè-íû XIX â. îíè ñòàëè íàçûâàòüñÿ «èíô-ëþýíöåé» (îò ëàòèíñêîãî influere – «âòîð-ãàòüñÿ»), à ñàìè ýïèäåìèè – ïî ìåñòóèõ âîçíèêíîâåíèÿ: «ðóññêàÿ áîëåçíü»,«êèòàéñêàÿ èíôëþýíöà», «èñïàíêà», «ãîí-êîíãñêèé èëè àçèàòñêèé ãðèïï» è ò. ï.Â Ðîññèè è â íåêîòîðûõ ñòðàíàõ Åâðîïûýòî çàáîëåâàíèÿ áûëî èçâåñòíî ïîäíàçâàíèåì «ãðèïï» (îò ôðàíöóçñêîãîgripper – «ñõâàòûâàòü») [1].

Ñ êîíöà XIX â. ÷åëîâå÷åñòâî ïåðå-æèëî 4 ïàíäåìèè ãðèïïà: â 1889–1890,1918–1920, 1957–1959, 1968–1969 ãã.Â 1918 ã. âîçíèêëà ïå÷àëüíî çíàìåíèòàÿïàíäåìèÿ ãðèïïà, èçâåñòíàÿ êàê «èñïàí-êà», êîòîðàÿ îáîøëà âåñü ìèð è óíåñëà20–40 ìëí ÷åëîâå÷åñêèõ æèçíåé. Â 1957–1959 ãã. îò «àçèàòñêîãî ãðèïïà» ïîãèáëî

îêîëî 1 ìëí ÷åëîâåê. Â ïðîìåæóòêàõìåæäó ïàíäåìèÿìè â ñðåäíåì êàæäûå2–3 ãîäà îòìå÷åíû ýïèäåìèè ãðèïïàñ ìåíüøèìè ïîêàçàòåëÿìè çàáîëåâàå-ìîñòè è ñìåðòíîñòè íàñåëåíèÿ [2].

Â 2009 ã. çàðåãèñòðèðîâàíû ñëó÷àè ìàñ-ñîâîãî çàáîëåâàíèÿ, âûçûâàåìûå íîâûìâûñîêîïàòîãåííûì âèðóñîì ãðèïïà òèïà Àïîäòèïà H1N1, íàçâàííûì «ñâèíîé» ãðèïï(â àíãëîÿçû÷íûõ èñòî÷íèêàõ ðàñïðîñòðà-íåíî ñîêðàùåíèå íîâîãî øòàììà ãðèïïàÀ(Í1N1)S-OIV: Swine-Origin InfluenzaA(H1N1) Viruses. Îòñóòñòâèå èììóíèòåòà êýòîé ðàçíîâèäíîñòè âèðóñà ãðèïïà ñîçäà-ëî óñëîâèÿ âîçíèêíîâåíèÿ øèðîêîìàñø-òàáíîé ýïèäåìèè ãðèïïà (ïàíäåìèè). Ñî-ãëàñíî ñâîäíûì äàííûì, ïðåäñòàâëåííûìÂÎÇ â 2009 ã., çàðåãèñòðèðîâàíû ýïèäåìèèïàíäåìè÷åñêîãî ãðèïïà À(Í1N1)S-OIV â206 ñòðàíàõ ñ ëåòàëüíîñòüþ äî 1,29% [3].Íî ïîñêîëüêó íåâîçìîæíî ïðîâåñòèïîëíîöåííûé ìîíèòîðèíã âñåõ ñëó÷àåâ çà-ðàæåíèÿ ãðèïïîì À(Í1N1)S-OIV, ðåàëüíîåêîëè÷åñòâî çàáîëåâøèõ è óìåðøèõ îòäàííîé èíôåêöèè íåèçâåñòíî.

Ê ñòàòüå: Ëþòîâ Â.Â., Ðóäàêîâ Þ.Â., Õàðèòîíîâ Ì.À., Øèøêèí Ì.Ê., Ñåðãååâ Ñ.Ì.,

Ãðèáîâà Ë.Í., Çàñèìîâ Â.Ñ., Êðàñèêîâ Å.Ê. – Ôàòàëüíîå òå÷åíèå âèðóñ-àññîöèèðîâàííîé ïíåâìîíèè ó áîëüíîãî ãðèïïîì À(H1N1)

Ðèñ. 4. Ìèêðîïðåïàðàò (îêðàñêà ãåìàòîêñèëè-íîì è ýîçèíîì; 20×10) ëåãêîãî: êàòàðàëüíûéòðàõåèò ïðè ãðèïïå ñ ïñåâäîïëîñêîêëåòî÷íîéìåòàïëàçèåé ðåñïèðàòîðíîãî ýïèòåëèÿ

Ðèñ. 5. Ìèêðîïðåïàðàò (îêðàñêà ãåìàòîêñèëè-íîì è ýîçèíîì; 10×10) ëåãêîãî: î÷àãè ãåìîð-ðàãè÷åñêîé âèðóñíîé ïíåâìîíèè ïðè ãðèïïå

Ðèñ. 6. Ìèêðîïðåïàðàò (îêðàñêà ãåìàòîêñèëè-íîì è ýîçèíîì; 2,5×10) ëåãêîãî: î÷àãè àòåëåê-òàçîâ è îñòðîé ýìôèçåìû ëåãêèõ ïðè ãðèïïå

Ðèñ. 7. Ìèêðîïðåïàðàò (îêðàñêà ãåìàòîêñèëèíîìè ýîçèíîì; 40×10) ëåãêîãî: äåñêâàìàòèâíûéàëüâåîëèò ñ ãèãàíòîêëåòî÷íûì ìåòàìîðôîçîìàëüâåîëîöèòîâ

Ðèñ. 9. Ìèêðîïðåïàðàò (îêðàñêàãåìàòîêñèëèíîì è ýîçèíîì;2,5×10) ëåãêîãî: òðîìáîýìáîëèÿñåãìåíòàðíîé âåòâè ëåãî÷íîéàðòåðèè

Ðèñ. 8. Ìèêðîïðåïàðàò (îêðàñêà ãåìàòîêñèëè-íîì è ýîçèíîì; 10×10) ëåãêîãî: ãèàëèíîâûåìåìáðàíû â ëåãêèõ ïðè ðåñïèðàòîðíîì äè-ñòðåññ-ñèíäðîìå

Ðèñ. 3. Ëåãêîå áîëüíîãî Í., 32 ëåò: ãåìîððàãè-÷åñêàÿ ïíåâìîíèÿ



òåðèàëüíàÿ ïíåâìîíèÿ, òÿæåëîå òå÷åíèå.Ðåñïèðàòîðíûé äèñòðåññ-ñèíäðîì. Äûõà-òåëüíàÿ íåäîñòàòî÷íîñòü – III ñòåïåíè.Îòåê ãîëîâíîãî ìîçãà».

Ó÷èòûâàÿ íàëè÷èå ýïèçîäîâ âûðà-æåííîé òàõèêàðäèè ñ ÷àñòîòîé ñåðäå÷-íûõ ñîêðàùåíèé äî 145 â 1 ìèíóòó, ãè-ïîòîíèè (ÀÄ 90/60 ìì ðò. ñò.), íàðàñòà-íèå öèàíîçà, ó áîëüíîãî áûëà çàïîäîçðå-íà òðîìáîýìáîëèÿ ëåãî÷íîé àðòåðèè(ÒÝËÀ).

Íåñìîòðÿ íà ïðîâîäèìóþ èíòåíñèâ-íóþ òåðàïèþ, ñìåíó àíòèáàêòåðèàëüíîéòåðàïèè: ïàðåíòåðàëüíî – òèåíàì 3 ã/ñóò,àâåëîêñ 400 ìã/ñóò; ïðîòèâîâèðóñíóþòåðàïèþ – òàìèôëþ 150 ìã/ñóò; èíôó-çèîííî-äåçèíòîêñèêàöèîííóþ òåðàïèþ(âíóòðèâåííîå ââåäåíèå ôèçèîëîãè÷åñ-êîãî ðàñòâîðà è 5% ðàñòâîðà ãëþêîçûâ îáúåìå èç ðàñ÷åòà 20 ìë/êã/ñóò ïîäêîíòðîëåì öåíòðàëüíîãî âåíîçíîãî äàâ-ëåíèÿ è äèóðåçà); èíîòðîïíóþ, ðåñïèðà-òîðíóþ ïîääåðæêó (êèñëîðîäîòåðàïèÿ ñîñðåäíåé ñêîðîñòüþ ïîòîêà êèñëîðîäà îò5–7 ë/ìèí äî 10 ë/ìèí â çàâèñèìîñòè îòóðîâíÿ îêñèãåíàöèè êðîâè; ïðèíóäèòåëü-íàÿ ÈÂË ñ óïðàâëåíèåì ïî äàâëåíèþ èâûñòàâëåíèåì àäåêâàòíîãî óðîâíÿ ïîëî-æèòåëüíîãî äàâëåíèÿ â êîíöå âûäîõà12–15 ñì âîäí. ñò. ïîä êîíòðîëåì ïîêàçà-òåëåé ãàçîîáìåíà è ìåõàíèêè äûõàíèÿ)è íóòðèòèâíóþ ïîääåðæêó (ýíòåðàëüíîåïèòàíèå); ýíäîáðîíõèàëüíîå ââåäåíèåñóðôàêòàíòà-ÁË ïî 150 ìã äâàæäû â ñóò-êè â òå÷åíèå äâóõ äíåé; ïðèìåíåíèå àíòè-êîàãóëÿíòîâ – ãåïàðèí ïî 20 òûñ. ÌÅ/ñóòè èììóíîêîððåãèðóþùèõ ïðåïàðàòîâ (ðå-àôåðîí â äîçå 1 ìëí ÌÅ â ñóòêè); ñèìï-òîìàòè÷åñêóþ òåðàïèþ, íà 8-å ñóòêè ãîñ-ïèòàëèçàöèè íàñòóïèëà ñìåðòü áîëüíîãî.

Ïî ðåçóëüòàòàì àóòîïñèè âûíåñåíîçàêëþ÷åíèå: ïðè÷èíîé ñìåðòè áîëüíîãî

Í., 32 ëåò, ÿâèëàñü âèðóñíàÿ äâóñòîðîí-íÿÿ ñóáòîòàëüíàÿ ãåìîððàãè÷åñêàÿ ïíåâ-ìîíèÿ (ðèñ. 3–6 íà 4-é ñ. âêëåéêè), âûç-âàííàÿ âèðóñîì ïàíäåìè÷åñêîãî ãðèïïàÀ(Í1N1)S-OIV, ïîäòâåðæäåííàÿ ïðèæèç-íåííûì ñåðîëîãè÷åñêèì èññëåäîâàíèåìòèòðà àíòèòåë (20) è ïîñìåðòíûì èññëå-äîâàíèåì ÏÖÐ ê ÐÍÊ âèðóñà ãðèïïàÀ(Í1N1)S-OIV.

Âèðóñíîå ïîðàæåíèå ëåãêèõ ïðîòå-êàëî ñ ðàçâèòèåì ðåñïèðàòîðíîãî äèñò-ðåññ-ñèíäðîìà âçðîñëûõ (ðèñ. 7, 8 íà 4-éñ. âêëåéêè) è îñòðîé äûõàòåëüíîé íåäî-ñòàòî÷íîñòüþ, ëîêàëüíîãî ÄÂÑ-ñèíäðî-ìà â ëåãêèõ ñ ÒÝËÀ (ðèñ. 9 íà 4-é ñ. âêëåé-êè), ÷òî è ÿâèëîñü íåïîñðåäñòâåííîé ïðè-÷èíîé ñìåðòè ïàöèåíòà. Ïðè ïðèæèçíåí-íîì ñåðîëîãè÷åñêîì èññëåäîâàíèè óáîëüíîãî òàêæå áûëè âûÿâëåíû àíòèòå-ëà ê ñåçîííîìó ãðèïïó À(Í3N2) – 80,÷òî ïðè îòñóòñòâèè àíòèãåííîãî ïîäòâåð-æäåíèÿ íàëè÷èÿ âèðóñà ìîæíî ðàñöåíè-âàòü êàê ñëåäñòâèå ïåðåíåñåííîãî èì âïðîøëîì ãðèïïà À(Í3N2) – â ìåäèöèí-ñêîé êíèæêå åñòü çàïèñè î çàáîëåâàíèèîñòðîé ðåñïèðàòîðíîé âèðóñíîé èíôåê-öèåé â ìàå 2007 ã.

Òàêèì îáðàçîì, ïðèâåäåí ïðèìåðôàòàëüíîãî òå÷åíèÿ ãðèïïà À(Í1N1)S-OIV ó ìîëîäîãî ÷åëîâåêà ñ ìåòàáîëè÷åñ-êèì ñèíäðîìîì, ó êîòîðîãî ðàçâèëèñüîñëîæíåíèÿ â âèäå òÿæåëîé âèðóñíîéïíåâìîíèè, îñòðîãî ðåñïèðàòîðíîãî äè-ñòðåññ-ñèíäðîìà è äèññåìèíèðîâàííîãîâíóòðèñîñóäèñòîãî ñâåðòûâàíèÿ ñ ïðî-ãðåññèðóþùåé äûõàòåëüíîé íåäîñòàòî÷-íîñòüþ, ÷òî ïðèâåëî ê ñìåðòè áîëüíîãî.Ïàöèåíò îñòàâàëñÿ ðåôðàêòåðíûì êîâñåì ñîâðåìåííûì ìåòîäàì èíòåíñèâíîéòåðàïèè â óñëîâèÿõ ìíîãîïðîôèëüíîãîñïåöèàëèçèðîâàííîãî ëå÷åáíî-ïðîôè-ëàêòè÷åñêîãî ó÷ðåæäåíèÿ.


1. Ãðèïï è ãðèïïîïîäîáíûå èíôåêöèè(âêëþ÷àÿ è îñîáî îïàñíûå ôîðìû). Ôóíäàìåí-òàëüíûå è ïðèêëàäíûå àñïåêòû èçó÷åíèÿ /Ïîä ðåä. Â.È.Ïîêðîâñêîãî, Ä.Ê.Ëüâîâà, Î.È.Êè-ñåëåâà è äð. – ÑÏá, 2008.–109 ñ.

2. Êèñåëåâ Î.È., Åðøîâ Ô.È., Ìàëûé Â.Ï. èäð. Ãðèïï êàê òèïè÷íàÿ ýìåðäæåíòíàÿ èíôåê-öèÿ (âèðóñîëîãè÷åñêèå, êëèíèêî-ýïèäåìèî-ëîãè÷åñêèå îñîáåííîñòè, âîïðîñû òåðàïèè è

ïðîôèëàêòèêà): Ïîñîáèå äëÿ âðà÷åé. – Ñàíêò-Ïåòåðáóðã – Õàðüêîâ – Óæãîðîä, 2009. – 44 ñ.

3. Ñèíîïàëüíèêîâ À.È., Ëåùåíêî È.Â., Êîç-ëîâ Ð.Â. è äð. Ìåòîäè÷åñêèå ðåêîìåíäàöèè ïîäèàãíîñòèêå, ëå÷åíèþ è ïðîôèëàêòèêå ãðèï-ïà, âûçûâàåìîãî ïàíäåìè÷åñêèì âèðóñîìÀ/H1N1/09. – Ì., 2009. – 30 ñ.

4. Ðàõìàíîâà À.Ã., Ïîëóøèí Þ.Ñ., ßêîâëåâ À.À.è äð. Ìåòîäè÷åñêèå ðåêîìåíäàöèè ïî ëå÷å-íèþ áîëüíûõ ãðèïïîì H1N1 (äëÿ âðà÷åé). –ÑÏá, 2009. – 29 ñ.


ÃÈÃÈÅÍÀ È ÔÈÇÈÎËÎÃÈß

ÂÎÅÍÍÎÃÎ ÒÐÓÄÀ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2013ÓÄÊ 612.015.31.014.47:613.67

Áàëàíñ æåëåçà è ìåäè ó êóðñàíòîââîåííîãî ó÷èëèùà ïðè ôèçè÷åñêîé íàãðóçêåè â ïîñëåäóþùèé äåíü îòäûõà â ðàçíîå âðåìÿ ãîäà

ÇÀÉÖÅÂÀ È.Ï., êàíäèäàò áèîëîãè÷åñêèõ íàóê ([email protected])1ÍÀÑÎËÎÄÈÍ Â.Â., çàñëóæåííûé ðàáîòíèê ôèçè÷åñêîé êóëüòóðû ÐÔ, ïðîôåññîðÁÅËßÊÎÂ Ð.À., êàïèòàí2

ÀÐØÈÍÎÂ Í.Ï., ñòàðøèé ëåéòåíàíò2

ÇÀÉÖÅÂ Î.Í., êàíäèäàò áèîëîãè÷åñêèõ íàóê3

ÌÅÙÅÐßÊÎÂ Ñ.È.1

1ßðîñëàâñêèé ãîñóäàðñòâåííûé óíèâåðñèòåò èì. Ï.Ã.Äåìèäîâà; 2ßðîñëàâñêèé ôèëèàë âîåííî-ó÷åáíîãî íàó÷íîãî öåíòðà Âîåííî-âîçäóøíûõ ñèë; 3ßðîñëàâñêèé ãîñóäàðñòâåííûé òåõíè÷åñ-êèé óíèâåðñèòåò

Zaitseva I.P., Nasolodin V.V., Belyakov R.A., Arshinov N.P., Zaitsev O.N., Meshcheryakov S.I. – Balanceof ferrum and copper in cadets of military school during physical exercise and next-day rest atdifferent times of the year. According to examination, with the help of emission spectrum analysis method,of 24 cadets-athletes of different specialization it was determined that during physical exercise in summerand in winter loss of ferrum and copper with excrements exceeded the intake if these microelements withfood. The next day rise of impaction of microelements and decrease of excretion. But despite the positivebalance of ferrum and copper, spend of these microelements during physical exercise wasn’t compensatedfor the day of rest. That is why there is a possibility of microelement deficit.

K e y w o r d s: cadets-athletes, physical exercise, balance, microelements, ferrum, copper, manganese,impaction, excretion.

Èçó÷åíèå îáåñïå÷åííîñòè ðàçëè÷íûõ ãðóïï íàñåëåíèÿ îñíîâíûìè ïèùå-

âûìè èíãðåäèåíòàìè, â ò. ÷. è ìèêðîýëåìåí-

òàìè (ÌÝ), áèîëîãè÷åñêàÿ ðîëü êîòîðûõ÷ðåçâû÷àéíî âàæíà è ìíîãîãðàííà, íå óòðà-òèëî ñâîåé àêòóàëüíîñòè è â íàñòîÿùååâðåìÿ. Íåäîñòàòî÷íàÿ îáåñïå÷åííîñòü îðãà-íèçìà òîëüêî îäíèì æåëåçîì ñîïðîâîæ-äàåòñÿ íàðóøåíèåì ôóíêöèîíèðîâàíèÿðÿäà ôèçèîëîãè÷åñêèõ ñèñòåì, â ÷àñòíîñòèêðîâåòâîðíîé, ïèùåâàðèòåëüíîé, íåðâíîé,èììóííîé, ñåðäå÷íî-ñîñóäèñòîé è äðóãèõ,âñëåäñòâèå ÷åãî ðåçêî ñíèæàåòñÿ óìñòâåí-íàÿ è ôèçè÷åñêàÿ ðàáîòîñïîñîáíîñòü ÷åëî-âåêà. Çíà÷èòåëüíûå íàðóøåíèÿ îòäåëüíûõôóíêöèé îðãàíèçìà âûçûâàþò è äåôèöèòòàêèõ ÌÝ, êàê ìåäü, öèíê, ìàðãàíåö,êîáàëüò, ìàãíèé, ñåëåí è äð.

Îáùåèçâåñòíî, ÷òî îäíèìè èç íàè-áîëåå îáúåêòèâíûõ ìåòîäîâ èçó÷åíèÿîáåñïå÷åííîñòè îðãàíèçìà ÌÝ ÿâëÿþò-ñÿ áàëàíñîâûå èññëåäîâàíèÿ, êîòîðûåäàþò âîçìîæíîñòü íå òîëüêî îáíàðóæèòü

íåäîñòàòîê èëè èçáûòîê òîãî èëè èíîãîýëåìåíòà, íî è óñòàíîâèòü ñóòî÷íóþïîòðåáíîñòü â íèõ [4].

Öåëü èññëåäîâàíèÿ

Îïðåäåëèòü ñóòî÷íûé áàëàíñ æåëåçàè ìåäè ó êóðñàíòîâ âîåííîãî ó÷èëèùàïîä âîçäåéñòâèåì ìûøå÷íîé íàãðóçêèè â ïîñëåäóþùèé äåíü îòäûõà ïîñëå íååâ ðàçíîå âðåìÿ ãîäà.

Ìàòåðèàë è ìåòîäû

Ïîä íàáëþäåíèåì íàõîäèëèñü24 êóðñàíòà-ñïîðòñìåíà ðàçëè÷íîé ñïå-öèàëèçàöèè I ðàçðÿäà è êàíäèäàòû â ìà-ñòåðà ñïîðòà â âîçðàñòå 18–22 ëåò. Ó÷è-òûâàÿ ñëîæíîñòü è òðóäîåìêîñòü áàëàí-ñîâûõ èññëåäîâàíèé, â êàæäóþ ãðóïïóâêëþ÷èëè íå áîëåå 6 êóðñàíòîâ áëèçêèõïî âîçðàñòó, ôèçè÷åñêîìó ðàçâèòèþ,ñïîðòèâíîé êâàëèôèêàöèè è ñ íîðìàëü-íîé ôóíêöèîíàëüíîé äåÿòåëüíîñòüþ æå-ëóäî÷íî-êèøå÷íîãî òðàêòà.


ÃÈÃÈÅÍÀ È ÔÈÇÈÎËÎÃÈßÂÎÅÍÍÎÃÎ ÒÐÓÄÀ

ïîòðåáíîñòè îðãàíèçìà â ýòèõ ÌÝ è óêà-çûâàåò íà íàëè÷èå ëàòåíòíîãî äåôèöèòàâ îðãàíèçìå êóðñàíòîâ, àêòèâíî çàíèìà-þùèõñÿ ñïîðòîì. Ïîâûøåííàÿ ðåòåíöèÿÌÝ èç ðàöèîíà ïèòàíèÿ èëè ñíèæåíèåýíäîãåííîãî èõ âûäåëåíèÿ â ïåðèîä îò-äûõà óæå óêàçûâàåò íà ñîêðàùåíèå ðå-çåðâîâ ýññåíöèàëüíûõ áèîýëåìåíòîâ [3].

Ïðè ñîïîñòàâëåíèè ðåçóëüòàòîâ äâóõáàëàíñîâûõ èññëåäîâàíèé ìîæíî çàìå-òèòü, ÷òî, íåñìîòðÿ íà ïîëîæèòåëüíûéáàëàíñ è çíà÷èòåëüíóþ çàäåðæêó ÌÝïèùåâîãî ðàöèîíà â äåíü îòäûõà ó êóð-ñàíòîâ-ñïîðòñìåíîâ, ïîäâåðãàâøèõñÿ âîç-äåéñòâèþ ôèçè÷åñêîé íàãðóçêè îñåíüþè ëåòîì, èõ ïîòåðè ñ ýêñêðåìåíòàìè âäåíü òðåíèðîâêè íå êîìïåíñèðîâàëèñüçà îäèí äåíü îòäûõà. Â ñâÿçè ñ ýòèì ñëå-äóåò îáðàùàòü îñîáîå âíèìàíèå íà äîñ-òàòî÷íóþ íàñûùåííîñòü ðàöèîíîâ ïèòà-íèÿ ÌÝ çà ñ÷åò ïðîäóêòîâ, íàèáîëåå áî-ãàòûõ èìè, èëè èñïîëüçîâàòü ðàçëè÷íûåâèòàìèíîìèíåðàëüíûå êîìïëåêñû â êà-÷åñòâå äîáàâîê ê ïèòàíèþ.

Ñðàâíèâàÿ îáùóþ ýêñêðåöèþ ÌÝ èçîðãàíèçìà ñ èõ êîíöåíòðàöèåé â ðàöèî-íàõ ïèòàíèÿ êóðñàíòîâ-ñïîðòñìåíîâ ðàç-ëè÷íûõ ñïåöèàëèçàöèé â îñåííèé è ëåò-íèé ïåðèîäû òðåíèðîâêè, ìîæíî çàêëþ-÷èòü, ÷òî ïîòðåáíîñòü â æåëåçå äîëæíàñîñòàâëÿòü ïðèìåðíî 20–25 ìã/ñóò, ìåäè– 2,5–3 ìã/ñóò. Ïðè ýòîì ñëåäóåò ó÷èòû-âàòü, ÷òî ïðè óâåëè÷åíèè îáúåìà è èí-òåíñèâíîñòè òðåíèðîâî÷íûõ è ñîðåâíî-âàòåëüíûõ íàãðóçîê ïîòðåáíîñòè â ÌÝìîãóò ñóùåñòâåííî âîçðàñòàòü.

Â Û Â Î Ä Û

1. Ïîä âîçäåéñòâèåì ìûøå÷íîé íà-ãðóçêè ïîòåðè æåëåçà è ìåäè ñ ýêñêðå-ìåíòàìè áûëè ïðèìåðíî îäèíàêîâûìèó ñïîðòñìåíîâ âñåõ ñïåöèàëèçàöèé è çíà-÷èòåëüíî ïðåâûøàëè ïîñòóïëåíèå èõ ñïèùåé êàê îñåíüþ, òàê è ëåòîì, ÷òî ñïî-ñîáñòâîâàëî ïðîÿâëåíèþ îòðèöàòåëüíî-ãî áàëàíñà ÌÝ â îðãàíèçìå.

2. Â ïîñëåäóþùèé ïîñëå òðåíèðîâêèäåíü îòäûõà îòìå÷àëàñü ïîâûøåííàÿ ðå-òåíöèÿ ÌÝ èç ðàöèîíà ïèòàíèÿ è ðåçêîñîêðàùàëàñü ýêñêðåöèÿ æåëåçà è ìåäè ñêàëîì è ìî÷îé ó âñåõ ñïîðòñìåíîâ, îä-íàêî ðàñõîäû ÌÝ â òðåíèðîâî÷íûé äåíüíå êîìïåíñèðîâàëèñü çà îäèí äåíü îò-äûõà, ÷òî óêàçûâàåò íà ñíèæåíèå ðåçåð-âîâ è âîçìîæíîñòü ðàçâèòèÿ ëàòåíòíîãîäåôèöèòà íàçâàííûõ ýëåìåíòîâ â îðãà-íèçìå.

3. Íàñûùåííîñòü ðàöèîíîâ ïèòà-íèÿ æåëåçîì è ìåäüþ â ëåòíèé ïåðè-îä òðåíèðîâêè ó êóðñàíòîâ-ñïîðòñìå-íîâ îêàçàëàñü çíà÷èòåëüíî íèæå ïîñðàâíåíèþ ñ îñåíüþ è â îáîèõ ñëó÷à-ÿõ íå ñîîòâåòñòâîâàëà íåîáõîäèìîéïîòðåáíîñòè.

4. Ïðè áîëüøèõ òðåíèðîâî÷íûõ èñîðåâíîâàòåëüíûõ ôèçè÷åñêèõ íàãðóçêàõíåîáõîäèìî îáîãàùàòü â ëþáîå âðåìÿãîäà ïèùåâûå ðàöèîíû ñïîðòñìåíîâ ÌÝ(â ïåðâóþ î÷åðåäü æåëåçîì) çà ñ÷åòïðàâèëüíîãî ïîäáîðà ïðîäóêòîâ ïèòàíèÿèëè ñïåöèàëüíûõ âèòàìèíîìèíåðàëüíûõêîìïëåêñîâ.


1. Êîðåãÿí Ñ.Ê. Ýìèññèîííûé ñïåêòðàëü-íûé àíàëèç íåôòåïðîäóêòîâ. – Ì.: Õèìèÿ, 1969.– 296 ñ.

2. Êóäðÿâöåâ Í.À. Ïðèìåíåíèå ìåòîäà ýìèñ-ñèîííîãî ñïåêòðàëüíîãî àíàëèçà äëÿ îïðåäå-ëåíèÿ äèíàìèêè æåëåçà â îðãàíèçìå â ïðî-öåññå ìûøå÷íîé äåÿòåëüíîñòè // Âåñòí. ßðîñ-ëàâñêîãî óí-òà. – 1973. – ¹ 2. – Ñ. 111–116.

3. Íàñîëîäèí Â.Â. Âëèÿíèå áîëüøèõ ìû-øå÷íûõ íàïðÿæåíèé íà áàëàíñ æåëåçà, ìåäèè ìàðãàíöà â îðãàíèçìå ëûæíèö // Ôèçèî-ëîãèÿ ÷åëîâåêà. – 1981. – ¹ 4. – Ñ. 710–715.

4. Íàñîëîäèí Â.Â. Îïðåäåëåíèå áàëàíñàíåêîòîðûõ ìèêðîýëåìåíòîâ ó ñïîðòñìåíîâ// Ãèã. è ñàí. – 1984. – ¹ 11. – Ñ. 78–80.

5. Íàñîëîäèí Â.Â., Ðóñèí Â.ß. Âçàèìîñâÿçüìåæäó íåêîòîðûìè ìèêðîýëåìåíòàìè â ïðîöåñ-ñå îáìåíà èõ â îðãàíèçìå // Âîïð. ïèòàíèÿ. –1986. – ¹ 5. – Ñ. 9–13.

6. Ñîáîëåâà Ì.Ê. Ýôôåêòèâíîñòü ôåððî-ïðåïàðàòîâ è èõ ïîáî÷íûå äåéñòâèÿ ïðè ëå-÷åíèè æåëåçîäåôèöèòíûõ ñîñòîÿíèé ó äåòåéðàííåãî âîçðàñòà // Ïåäèàòðèÿ. – 2004. – ¹ 1.– Ñ. 79–83.

7. Ñòàðîäóìîâ Â.Ë. Äåôèöèò íóòðèåíòîâêàê âîçìîæíîå óñëîâèå ðàçâèòèÿ èíòîêñèêàöèè,âûçâàííîé âîçäåéñòâèåì ìàëûõ äîç ñâèíöà //Ãèã. è ñàí. – 2003. – ¹ 3. – Ñ. 60–62.

8. Øèðèíà Ë.È., Ìàçî Â.Ê. Ìèíåðàëüíûåâåùåñòâà â ïèòàíèè ÷åëîâåêà. Ìàðãàíåö:âñàñûâàíèå è áèîäîñòóïíîñòü // Âîïð. ïèòàíèÿ. –2006. – ¹ 5. – Ñ. 4–14.


ÀÂÈÀÖÈÎÍÍÀß

È ÂÎÅÍÍÎ-ÌÎÐÑÊÀß ÌÅÄÈÖÈÍÀ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2013ÓÄÊ [61:355]:001.8

Îðãàíèçàöèÿ íàó÷íîé è íàó÷íî-èññëåäîâàòåëüñêîéðàáîòû â ìåäèöèíñêîé ñëóæáå ôëîòà

ÃÀÂÐÈËÎÂ Â.Â., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

ÌÛÇÍÈÊÎÂ È.Ë., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáûçàïàñà ([email protected])2ÊÓÇÜÌÈÍÎÂ Î.Â., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

ØÌÅË¨Â Ñ.Â., ìàéîð ìåäèöèíñêîé ñëóæáû1

ÎÏÀÐÈÍ Ì.Þ., ìàéîð ìåäèöèíñêîé ñëóæáû3

1Ìåäèöèíñêàÿ ñëóæáà Ñåâåðíîãî ôëîòà, ã. Ñåâåðîìîðñê, Ìóðìàíñêàÿ îáëàñòü; 21469-é Âîåí-íî-ìîðñêîé êëèíè÷åñêèé ãîñïèòàëü Ñåâåðíîãî ôëîòà, ã. Ñåâåðîìîðñê, Ìóðìàíñêàÿ îáëàñòü;31033-é Öåíòð ãîñóäàðñòâåííîãî ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî íàäçîðà Ñåâåðíîãî ôëîòà,ã. Ñåâåðîìîðñê, Ìóðìàíñêàÿ îáëàñòü

Gavrilov V.V., Myznikov I.L., Kuzminov O.V., Shmelyov S.V., Oparin M.Yu. – Organisation of scientificand research work of medical service in the navy. The main issues of organization of scientific andresearch work of medical service in the North Fleet are considered in the present article. Analysis ofsome paragraphs of documents, regulating this work at army level is given. The authors give an exampleof successful experience of such work in the North Fleet, table some suggestions which allow to improvethe administration of scientific and research work in the navy and also on the district scale.

K e y w o r d s: organization of research study, navy medicine, reform of the Armed Forces.

Íàó÷íàÿ è íàó÷íî-èññëåäîâàòåëüñêàÿ ðàáîòà (ÍÈÐ) â ìåäèöèíñêîé

ñëóæáå òðàäèöèîííî ðåãëàìåíòèðîâàëàñüÓñòàâîì âíóòðåííåé ñëóæáû ÂÑ ÐÔ (ÓÂÑÂÑ ÐÔ), ïðèêàçàìè ÌÎ ÐÔ, Ðóêîâîäñòâîìïî ìåäèöèíñêîìó îáåñïå÷åíèþ ÂÑ ÐÔ íàìèðíîå âðåìÿ (ÐÌÎ) è äîêóìåíòàìè ïîáîåâîé ïîäãîòîâêå, äèðåêòèâàìè êîìàí-äóþùèõ îêðóãîì (ôëîòîì), ïðèêàçàìè èóêàçàíèÿìè íà÷àëüíèêà ìåäèöèíñêîéñëóæáû (ÍÌÑ) îêðóãà (ôëîòà).

Â íàñòîÿùåå âðåìÿ îðãàíèçàöèÿ íà-ó÷íîé ðàáîòû â ñîîòâåòñòâèè ñî ñò. 85ÓÂÑ ÂÑ ÐÔ âìåíåíà êîìàíäèðó (íà-÷àëüíèêó), êîòîðûé îáÿçàí ðóêîâîäèòüíàó÷íîé, èçîáðåòàòåëüñêîé è ðàöèîíàëè-çàòîðñêîé ðàáîòîé, íàïðàâëÿòü òâîð÷å-ñòâî âîåííîñëóæàùèõ íà ðåøåíèå ïðî-áëåì, âîçíèêàþùèõ ïðè âûïîëíåíèè çà-äà÷, ñòîÿùèõ ïåðåä âîèíñêîé ÷àñòüþ, ïðè-íèìàòü â ýòîé ðàáîòå ëè÷íîå ó÷àñòèå èïîîùðÿòü ïîä÷èíåííûõ, äîáèâøèõñÿ íàè-ëó÷øèõ òâîð÷åñêèõ ðåçóëüòàòîâ. Ôîðìûíàó÷íîé ðàáîòû îòðàæåíû â Ðóêîâîäñòâåïî áîåâîé ïîäãîòîâêå íà Âîåííî-ìîðñêîìôëîòå (ÂÌÔ). Îäíàêî â äåéñòâóþùåì

ïðèêàçå ÌÎ ÐÔ îò 23 ìàðòà 2000 ã. ¹ 140«Î íàó÷íîé ðàáîòå â Âîîðóæåííûõ Ñè-ëàõ Ðîññèéñêîé Ôåäåðàöèè» ïðîâåäåíèåíàó÷íîé ðàáîòû â âîéñêîâîì çâåíå íåðàññìàòðèâàåòñÿ, óïóùåíà ýòà òåìà è âÐÌÎ ðåäàêöèè 2001 ã. (ÐÌÎ-2001).

Óïðàâëåíèå íàó÷íîé è ÍÈÐ â ñèñòå-ìå ìåäèöèíñêîé ñëóæáû ôëîòîâ íå äîë-æíî áûòü ôîðìàëüíûì. Ó÷àñòèå â íàó÷-íîé ðàáîòå ÿâëÿåòñÿ ïðÿìîé îáÿçàííî-ñòüþ âñåãî ëè÷íîãî ñîñòàâà ìåäèöèíñ-êîé ñëóæáû. Ýòà ðàáîòà ïðåäñòàâëÿåò ñî-áîé òâîð÷åñêóþ äåÿòåëüíîñòü ìåäèöèí-ñêèõ êàäðîâ, íàïðàâëåííóþ íà ñîâåðøåí-ñòâîâàíèå ìåäèöèíñêîãî îáåñïå÷åíèÿâîéñê è ïîâûøåíèå óðîâíÿ áîåâîé ãî-òîâíîñòè ìåäèöèíñêîé ñëóæáû ÂÑ ÐÔ.

Îñíîâíûìè çàäà÷àìè íàó÷íîé ðàáî-òû â âîéñêàõ è íà ôëîòàõ ÿâëÿþòñÿ:

– èçó÷åíèå è îáîáùåíèå îïûòà ìå-äèöèíñêîãî îáåñïå÷åíèÿ âîéñê è ñèëôëîòà â ìèðíîå è âîåííîå âðåìÿ è ðàç-ðàáîòêà íà ýòîé îñíîâå ýôôåêòèâíûõìåðîïðèÿòèé, íàïðàâëåííûõ íà ñîõðà-íåíèå è óêðåïëåíèå çäîðîâüÿ âîåííî-ñëóæàùèõ;


ÏÎ ÑÒÐÀÍÈÖÀÌ ÇÀÐÓÁÅÆÍÎÉÌÅÄÈÖÈÍÑÊÎÉ ÏÅ×ÀÒÈ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2013ÓÄÊ: 613.67(73)(410)

Ìåäèöèíñêîå îáåñïå÷åíèå âåòåðàíîââîîðóæåííûõ ñèë çà ðóáåæîì(Íà ïðèìåðå ÑØÀ è Âåëèêîáðèòàíèè)

ÁÎËÅÕÀÍ Â.Í., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÈÂÀÍÎÂ Â.Â., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàÈÂ×ÅÍÊÎ Å.Â., äîöåíò, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáûÊÐÀÑÑÈÉ À.Á., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîéñëóæáû â îòñòàâêå ([email protected])ÌÎÐÎÂÈÊÎÂÀ Ò.Â.ÍÀÃÈÁÎÂÈ× Î.À., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÐÅÇÂÀÍÖÅÂ Ì.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû


Bolekhan V.N., Ivanov V.V., Ivchenko E.V., Krassiy A.B., Morovikova T.V., Nagibovich O.A.,Rezvantsev M.V. – Military veterans health care abroad. The US and British models. The presentreview is dedicated to organization and management of military veteran’s health care system of theUS and UK. It is shown that despite the differences in health care systems of both countries theirveterans receive the stat-of-the-art medical service which is readily available and financiallyaffordable.

K e y w o r d s: military veterans, health care, «Tricare», US Army, British Army.

Íàñòîÿùèé îáçîð ïîñâÿùåí îðãàíè- çàöèè ìåäèöèíñêîãî îáåñïå÷åíèÿ

âîåííûõ ïåíñèîíåðîâ íà ïðèìåðå äâóõêðóïíåéøèõ ñòðàí Çàïàäà: ÑØÀ è Âå-ëèêîáðèòàíèè. È ýòîò âûáîð ñòðàí íå-ñëó÷àåí.

Ñ îäíîé ñòîðîíû, îáà ãîñóäàðñòâàâî ìíîãîì ïîõîæè. Âî-ïåðâûõ, ñòðàíû ÿâ-ëÿþòñÿ êðóïíûìè âîåííûìè äåðæàâàìè,âõîäÿùèìè â áëîê ÍÀÒÎ. Âî-âòîðûõ,ÑØÀ è Âåëèêîáðèòàíèÿ – ýòî ñòðàíûñ âûñîêîðàçâèòîé ýêîíîìèêîé è ìåäè-öèíîé. Â-òðåòüèõ, îíè èìåþò ïðèìåðíîîäèíàêîâóþ äîëþ ÂÂÏ, âûäåëÿåìóþ íàçäðàâîîõðàíåíèå: ÑØÀ – 7,4%, Âåëèêî-áðèòàíèÿ – 7,2% [16]. Äëÿ ñðàâíåíèÿ, äîëÿÂÂÏ, âûäåëÿåìàÿ íà çäðàâîîõðàíåíèåâ Ðîññèè, ñîñòàâëÿåò 5,2% [2].

Ñ äðóãîé ñòîðîíû, ñèñòåìû çäðàâî-îõðàíåíèÿ â ýòèõ ñòðàíàõ êàðäèíàëüíîîòëè÷àþòñÿ. Òàê, â ÑØÀ âîåííîå è ãðàæ-äàíñêîå çäðàâîîõðàíåíèå ôóíêöèîíèðó-þò ñðàâíèòåëüíî àâòîíîìíî, â òî âðåìÿêàê â Âåëèêîáðèòàíèè îíè â çíà÷èòåëü-íîé ìåðå âçàèìíî èíòåãðèðîâàíû.Êðîìå òîãî, â ÑØÀ ñèñòåìû ÷àñòíîãî ìå-

äèöèíñêîãî ñòðàõîâàíèÿ è áþäæåòíîãîôèíàíñèðîâàíèÿ ïî îáúåìó ïðèìåðíîîäèíàêîâû, â òî âðåìÿ êàê â Âåëèêîáðè-òàíèè ïîäàâëÿþùàÿ ÷àñòü çäðàâîîõðàíå-íèÿ ôèíàíñèðóåòñÿ èç áþäæåòà [15].Â ñâÿçè ñ ýòèì è ìåäèöèíñêîå îáåñïå÷å-íèå âîåííûõ ïåíñèîíåðîâ â îáåèõ ñòðà-íàõ îñóùåñòâëÿåòñÿ ïðèíöèïèàëüíî ðàç-íûìè ñïîñîáàìè. Ïî ñóòè, ðå÷ü èäåò î äâóõîñíîâíûõ ìîäåëÿõ îêàçàíèÿ ìåäèöèíñêîéïîìîùè âåòåðàíàì âîåííîé ñëóæáû1.

Ñèñòåìà ìåäèöèíñêîãî îáåñïå÷åíèÿâåòåðàíîâ âîîðóæåííûõ ñèë â ÑØÀ

Ñîãëàñíî äàííûì ïîñëåäíåãî èç äîñòóï-íûõ îôèöèàëüíûõ îò÷åòîâ ïðàâèòåëüñòâàÑØÀ, íà 30 ñåíòÿáðÿ 2010 ã. çà ìèíèñòåð-ñòâîì îáîðîíû ÑØÀ (ÌÎ ÑØÀ) ÷èñëèëîñü2 ìëí 77 òûñ. âîåííûõ ïåíñèîíåðîâ, èç íèõ190 òûñ. èíâàëèäîâ [18]. Ó÷èòûâàÿ, ÷òîîáùåå ÷èñëî ëè÷íîãî ñîñòàâà àêòèâíîãîñåãìåíòà âîîðóæåííûõ ñèë ÑØÀ íà òîò æå

1 Ñèñòåìû ìåäèöèíñêîãî îáåñïå÷åíèÿ âåòå-ðàíîâ âîåííîé ñëóæáû â äðóãèõ åâðîïåéñêèõñòðàíàõ, íàïðèìåð â Ãåðìàíèè è Ôðàíöèè,âî ìíîãîì àíàëîãè÷íû áðèòàíñêîé.



ñòîÿíèåì áîëüíîãî. Âûñîêèé óðîâåíü ìå-äèöèíû â ñî÷åòàíèè ñ ðàçâèòîé èíôðà-ñòðóêòóðîé çäðàâîîõðàíåíèÿ Âåëèêîáðè-òàíèè îáåñïå÷èâàþò íàäëåæàùåå êà÷åñòâîîêàçàíèÿ ìåäèöèíñêîé ïîìîùè âåòåðà-íàì âîåííîé ñëóæáû.

Çàêëþ÷åíèåÂ ÑØÀ ìåäèöèíñêîå îáåñïå÷åíèå

âîåííûõ ïåíñèîíåðîâ îðãàíèçîâàíî ïî-ñðåäñòâîì ãèáêîé ñèñòåìû èíäèâèäóàëü-íîãî ìåäèöèíñêîãî ñòðàõîâàíèÿ, ïðèýòîì ïåíñèîíåðû äîïëà÷èâàþò òîëüêî11% ðåàëüíîé ñòîèìîñòè ñòðàõîâêè[4, table 512]. Â Âåëèêîáðèòàíèè ìåäè-öèíñêîå îáåñïå÷åíèå âîåííûõ ïåíñèî-íåðîâ áåñïëàòíîå.

Íåñìîòðÿ íà êàðäèíàëüíûå ðàçëè÷èÿâ ñèñòåìàõ êàê âîåííîãî, òàê è ãðàæäàíñ-êîãî çäðàâîîõðàíåíèÿ, âåòåðàíû âîåííîéñëóæáû â ÑØÀ è â Âåëèêîáðèòàíèè ïî-ëó÷àþò ìåäèöèíñêóþ ïîìîùü âûñîêîãîêà÷åñòâà. Ìåäèöèíñêîå îáñëóæèâàíèå äëÿíèõ ñèòóàöèîííî äîñòóïíî è ôèíàíñîâîíåîáðåìåíèòåëüíî. Âîåííûå âåòåðàíû ñìîìåíòà óâîëüíåíèÿ è äî ïîñëåäíåãî äíÿæèçíè ïîääåðæèâàþòñÿ ñïåöèàëèçèðîâàí-íûìè ïðàâèòåëüñòâåííûìè àãåíòñòâàìè.

Êàê â ÑØÀ, òàê è â Âåëèêîáðèòàíèèñèñòåìà ìåäèöèíñêîãî îáåñïå÷åíèÿ âî-åííûõ ïåíñèîíåðîâ â íàñòîÿùåå âðåìÿíàõîäèòñÿ â ñòàäèè êîðåííûõ ðåôîðì.Â ÷àñòíîñòè, â õîäå ïðîøåäøåé â ÑØÀïðåçèäåíòñêîé êàìïàíèè ýòîò âîïðîñïîäíèìàëñÿ îáîèìè êàíäèäàòàìè â ïðå-çèäåíòû, êàê Á.Îáàìîé, òàê è Ì.Ðîìíè.Îäíàêî îáà îíè, õîòÿ è ðàçíûìè ìåòîäà-ìè, âûñòóïàþò çà äàëüíåéøåå ñîâåðøåíñòâî-âàíèå ýòîé ñèñòåìû, à íå çà åå óðåçàíèå èòåì áîëåå óïðàçäíåíèå [14]. Îòíîøåíèåâûñøåãî ïîëèòè÷åñêîãî ðóêîâîäñòâàñòðàíû ê ìåäèöèíñêîìó îáåñïå÷åíèþ âå-òåðàíîâ âîåííîé ñëóæáû îòðàæàåò çàÿâ-ëåíèå ìèíèñòðà îáîðîíû ÑØÀ ËåîíàÏàíåòòû (Leon Panetta), ñäåëàííîå èì âîâðåìÿ ñâîåãî âûñòóïëåíèÿ ïåðåä êîìè-òåòîì ïî äåëàì âîîðóæåííûõ ñèë è âå-òåðàíîâ ïàëàòû ïðåäñòàâèòåëåé êîíãðåñ-ñà ÑØÀ 25 èþëÿ 2012 ã., â êîòîðîì îíçàáîòó î çäîðîâüå âîåííûõ âåòåðàíîâ îõà-ðàêòåðèçîâàë êàê «ñâÿùåííóþ îáÿçàííîñòüâ îòíîøåíèè òåõ, êòî ñðàæàëñÿ çà íàøóñòðàíó»9 [17].


1. Àãàïèòîâ À.À., Áîëåõàí Â.Í., Èâ÷åíêî Å.Â.è äð. Ìåäèöèíñêàÿ ñëóæáà âîîðóæåííûõ ñèëÂåëèêîáðèòàíèè // Âîåí.-ìåä. æóðí. – 2012.– Ò. 333, ¹ 7. – Ñ. 65–78.

2. Îáùèé îáúåì ðàñõîäîâ íà îáðàçîâà-íèå è çäðàâîîõðàíåíèå. Òàáë. 5.19 // Ðîññèÿè ñòðàíû ìèðà – 2010 ã. / Ôåäåðàëüíàÿ ñëóæ-áà ãîñóäàðñòâåííîé ñòàòèñòèêè ÐÔ. URL:http://www.gks.ru/bgd/regl/b10_39/IssWWW.exe/Stg/05-19.htm (äàòà îáðàùåíèÿ: 11.09.2012).

3. About the NHS // The Official Web Siteof the National Health Service. URL: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx (äàòà îáðàùåíèÿ: 11.09.2012).

4. Advancing the health, safety, and well-beingof our people // The Official Web Site of theUS Department of Health and Human Services.114 p. PDF. URL: http://dhhs.gov/asfr/ob/docbudget/2011budgetinbrief.pdf (äàòà îáðàùå-íèÿ: 10.09.2012).

5. Among the most frequent illnesses/injuriesdiagnosed among retirees (more than 10,000retirees diagnosed during the surveillance period),percentages diagnosed for the «first time» withinsix months before retirement, active component,2003–2009 // Medical Surveillance MonthlyReport. Table 2 / US Forces Health SurveillanceCenter. 2010. Vol. 17, No 12. P. 3. URL: http://afhsc.

army.mil/viewMSMR?file=2010/v17_n12.pdf#Page=02 (äàòà îáðàùåíèÿ: 10.09.2012).

6. Civilian employment statistics. December2010 // The Official Web Site of the Officeof the Secretary of Defense. PDF. URL: http://siadapp.dmdc.osd.mil/personnel/CIVILIAN/fy2011/december2010/december2010.pdf (äàòàîáðàùåíèÿ: 10.09.2012).

7. Department of Defense Active DutyMilitary Personnel by Rank/Grade. September30, 2010. Military Personnel Statistics // DoDPersonnel & Procurement Statistics. URL: http://siadapp.dmdc.osd.mil/personnel/MILITARY/rg1009.pdf (äàòà îáðàùåíèÿ: 11.09.2012).

8. Department of Defense Active DutyMilitary Personnel by Rank/Grade. March 31, 2012// Military Personnel Statistics // DoD Personnel& Procurement Statistics. URL: http://siadapp.dmdc.osd.mil/personnel/MILITARY/rg1203.pdf(äàòà îáðàùåíèÿ: 08.09.2012).

9. FY 2013 Defense Budget. Overview //The Official site of the Under Secretary ofDefense (Comptroller). 143 p. PDF. URL: http://comptroller.defense.gov/defbudget/fy2013/FY2013_Budget_Request_Overview_Book.pdf(äàòà îáðàùåíèÿ: 10.09.2012).

10. FY2013 Department of Veterans AffairsBudget // The Official Web Site of the USDepartment of Veterans Affairs. 25 p. PDF. URL:http://www.va.gov/budget/docs/summary/

9 Sacred responsibility of caring for those whohave fought for our country.

5



Fy2013_Budget_Rollout.pdf (äàòà îáðàùåíèÿ:10.09.2012).

11. Health insurance. United Kingdom //Wikipedia. URL: http://en.wikipedia.org/wiki/Health_insurance#United_Kingdom (äàòà îáðà-ùåíèÿ: 11.09.2012).

12. Most frequent diagnoses during ambulatoryvisits by major diagnostic category, males, U.S.Armed Forces, 2010. Table 2 // Medicalsurveillance monthly report / The Armed ForcesHealth Surveillance Center. 2011. Vol 18, No4.P. 18. PDF. URL: http://afhsc.army.mil/viewMSMR?file=2011/v18_n04.pdf#Page=01(äàòà îáðàùåíèÿ: 10.09.2012).

13. Most frequent diagnoses during ambulatoryvisits by major diagnostic category, females, U.S.Armed Forces, 2010. Table 3 // Medical survei-llance monthly report / The Armed Forces HealthSurveillance Center. 2011. Vol 18, No 4. P. 19.PDF. URL: http://afhsc.army.mil/viewMSMR?file=2011/v18_n04.pdf#Page=01 (äàòà îáðàùå-íèÿ: 10.07.2012).

14. Philpott T. Military Update: TRICAREnetworks eyed to improve vets’ access tocare // Hanford Sentinel. 07 September 2012.URL: http://www.hanfordsentinel.com/news/opinion/todays_opinions/military-update-tricare-networks-eyed-to-improve-vets-access-to/article_cb5490ba-f917-11e1-9575-0019bb2963f4.html (äàòà îáðàùåíèÿ: 08.09.2012).

15. Public and Private Health Expendituresas a Percentage of GDP, U.S. and SelectedCountries, 2008 // KFF.org. URL: http://

facts.kff.org/chart.aspx?ch=1961 (äàòà îáðàùå-íèÿ: 14.09.2012).

16. Public Health Expenditure as a Percentageof GDP, U.S. and Selected Countries, 2008 //KFF.org. URL: http://facts.kff.org/chart.aspx?ch=1960 (äàòà îáðàùåíèÿ: 14.09.2012).

17. Submitted Statement on DOD-VACollaboration before the House Armed Servicesand Veterans Affairs Committees by Secretaryof Defense Leon E. Panetta, Washington D.C.,Wednesday, July 25, 2012 // The Official WebSite of the US Department of Defense. URL:http://www.defense.gov/speeches/speech.aspx?speechid=1711 (äàòà îáðàùåíèÿ: 08.09.2012).

18. Table 512. Military Retirement System:2010 // US Census Bureau. URL: http://www.census.gov/compendia/statab/2012/tables/12s0512.pdf (äàòà îáðàùåíèÿ: 13.09.2012).

19. TRICARE // Wikipedia. URL: http://en.wikipedia.org/wiki/TRICARE (äàòà îáðàùå-íèÿ: 10.09.2012).

20. TRICARE Prime Overview // MilitaryBenefits. URL: http://www.military.com/benefits/content/tricare/prime/tricare-prime-overview.html (äàòà îáðàùåíèÿ: 10.09.2012).

21. TRICARE Standard Overview // MilitaryBenefits. URL: http://www.military.com/benefits/content/tricare/standard/tricare-standard-overview.html#Features (äàòà îáðàùåíèÿ: 10.09.2012).

22. Who is a veteran? // The official WebSite of the UK Ministry of Defence. URL: http://www.mod.uk/DefenceInternet/DefenceFor/Veterans/ (äàòà îáðàùåíèÿ: 10.09.2012).

ËÅÍÒÀ ÍÎÂÎÑÒÅÉ

Ìàëÿðèÿ â âîîðóæåííûõ ñèëàõ ÑØÀ

Öåíòð íàáëþäåíèÿ çà çäîðîâüåì ÂÑ ÑØÀ1 â ÿíâàðñêîì íîìåðå çà 2013 ã. ñâîåãîæóðíàëà Åæåìåñÿ÷íûé äîêëàä ìåäèöèíñêîãî íàáëþäåíèÿ2 îïóáëèêîâàë îáçîð ïî ìàëÿ-ðèè â ÂÑ ÑØÀ çà 2012 ã. â ñðàâíåíèè ñ äàííûìè çà 2004–2011 ãã. [3]. Îòìå÷àåòñÿ, ÷òîìàëÿðèÿ ïî-ïðåæíåìó îñòàåòñÿ âåñüìà çíà÷èìûì äëÿ âîåííîé ìåäèöèíû, ÷àñòîñìåðòåëüíî îïàñíûì çàáîëåâàíèåì, ýíäåìè÷íûì â áîëåå ÷åì 100 ñòðàíàõ. Â 2010 ã.â ìèðå çàðåãèñòðèðîâàíî 219 ìëí ñëó÷àåâ ìàëÿðèè ñ 600 òûñ. ëåòàëüíûõ èñõîäîâ.Èç ÷åòûðåõ âèäîâ âîçáóäèòåëåé ìàëÿðèè ó ÷åëîâåêà íàèáîëåå ñìåðòîíîñíûì ÿâëÿ-åòñÿ Plasmodium falci parum (ýíäåìè÷åí â Àôðèêå), íàèáîëåå ÷àñòî âñòðå÷àþùèìñÿ– Plasmodium vivax (Þ.-Ç. è Ö. Àçèÿ è Ä. Âîñòîê).

Â 2012 ã. ñðåäè ëè÷íîãî ñîñòàâà ÂÑ ÑØÀ çàðåãèñòðèðîâàíî 38 ñëó÷àåâ ìàëÿðèè3.Ýòî ñàìûé íèçêèé ïîêàçàòåëü ñ 2004 ã. Äëÿ ñðàâíåíèÿ, â 2010 è 2011 ã. ðåãèñòðèðîâà-ëîñü ïî 120 ñëó÷àåâ ìàëÿðèè, à ìàêñèìàëüíîå ÷èñëî çàáîëåâøèõ – 159 – îòìå÷åíî

1 Armed Forces Health Surveillance Center (AFHSC), ãîëîâíîå ïîäðàçäåëåíèå ÌÎ ÑØÀ,îñóùåñòâëÿþùåå ìîíèòîðèíã ñîñòîÿíèÿ çäîðîâüÿ ëè÷íîãî ñîñòàâà ÂÑ ÑØÀ è àíàëèç ïîëó-÷åííûõ äàííûõ, øòàá-êâàðòèðà Ñèëâåð Ñïðèíã (Silver Spring), øòàò Ìýðèëåíä, äèðåêòîðïîëêîâíèê (captain) Êåâèí Ðàññåë (Kevin L. Russell), îôèöèàëüíûé ñàéò ïî ññûëêå [1].2 Medical Surveillance Monthly Report (MSMR), îñíîâíîå èçäàíèå AFHSC, âñå íîìåðà ñâîáîäíîäîñòóïíû ïî ññûëêå [4].3 Ýòà öèôðà âêëþ÷àåò òîëüêî ãîñïèòàëèçèðîâàííûõ áîëüíûõ, óêàçàííûõ â äîêóìåíòàõîôèöèàëüíîé îò÷åòíîñòè, ìíîãèå ñëó÷àè ëå÷èëèñü àìáóëàòîðíî è íå äåêëàðèðîâàëèñü [3, p. 5].

68

ÈÇ ÈÑÒÎÐÈÈÂÎÅÍÍÎÉ ÌÅÄÈÖÈÍÛ


© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2013ÓÄÊ 617:065.4/.5(470)

Ïåðâûé ìåäèöèíñêèé ìóçåé Ðîññèè(Ê 150-ëåòèþ ñî äíÿ ñîçäàíèÿ Õèðóðãè÷åñêîãî ìóçåÿ

Èìïåðàòîðñêîé ìåäèêî-õèðóðãè÷åñêîé àêàäåìèè)

ÁÓÄÊÎ À.À., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàÃÐÈÁÎÂÑÊÀß Ã.À., êàíäèäàò ìåäèöèíñêèõ íàóêÆÓÐÀÂË¨Â Ä.À., êàíäèäàò èñòîðè÷åñêèõ íàóê ([email protected])

Âîåííî-ìåäèöèíñêèé ìóçåé, Ñàíêò-Ïåòåðáóðã

Budko A.A., Gribovskaya G.A., Zhuravlyov D.A. – First medical museum of Russia (150-anniversary ofthe Surgical museum of the Imperial Medical-Surgical Academy). The opening in 1863 of the Surgicalmuseum of the Imperial Medical-Surgical Academy was the sign of a new age in the development ofmedical science. It became the first medical museum in our country. It was the period when similarmuseums appeared in Europe and America. Thus all over the world were formed the first museums thatamassed their collections, the later basis of modern medical museums.

K e y w o r d s: museum, Medical-Surgical Academy, traditions, professor, director, exhibit.

Ïðè Èìïåðàòîðñêîé ìåäèêî-õèðóð- ãè÷åñêîé àêàäåìèè 9 (21) ôåâðà-

ëÿ 1863 ã. áûë îòêðûò Õèðóðãè÷åñêèé ìó-çåé – ïåðâûé â Ðîññèè ìóçåé ìåäèöèíñ-êîãî ïðîôèëÿ, äîëãèå ãîäû ñëóæèâøèéñâîåîáðàçíûì ó÷åáíûì öåíòðîì, ñïîñîá-ñòâóþùèì ìåäèöèíñêîìó îáðàçîâàíèþáóäóùèõ âîåííûõ âðà÷åé. Ñîçäàíèå ìó-çåÿ ñâÿçàíî ñ ëè÷íîñòüþ âûäàþùåãîñÿïðåäñòàâèòåëÿ îòå÷åñòâåííîé ìåäèöèíû,ïðîôåññîðà Ìåäèêî-õèðóðãè÷åñêîé àêà-äåìèè Ïàâëà Ïàðôåíîâè÷à Çàáëîöêîãî-Äåñÿòîâñêîãî (1814–1882). Îí áûë ðàçíî-ñòîðîííå îáðàçîâàííûì ó÷åíûì, çàñëó-æåííûì ïðîôåññîðîì è àêàäåìèêîì, îñ-òàâèâøèì çàìåòíûé ñëåä â ðàçâèòèè îòå-÷åñòâåííîé õèðóðãèè, óðîëîãèè, äåðìàòî-ëîãèè, ãèãèåíû, àíåñòåçèîëîãèè, ñóäåáíîéìåäèöèíû.

Âåñíîé 1862 ã. Çàáëîöêèé-Äåñÿòîâñ-êèé ïîáûâàë â Ãåðìàíèè è âî Ôðàíöèè,ãäå îçíàêîìèëñÿ ñ ëó÷øèìè õèðóðãè÷åñ-êèìè êëèíèêàìè, îáðàòèâ îñîáîå âíèìà-íèå íà èìåâøèåñÿ ïðè íåêîòîðûõ èç íèõó÷åáíûå ìóçåè [3]. Òîãäà è âîçíèêëà ó íåãîìûñëü îñíîâàòü ïðè Ìåäèêî-õèðóðãè÷åñ-êîé àêàäåìèè áîëüøîé, õîðîøî îñíàùåí-íûé õèðóðãè÷åñêèé ìóçåé, â êîòîðîì«êðîìå óïîòðåáëÿåìûõ âîåííûìè âðà÷à-ìè íà âîéíå õèðóðãè÷åñêèõ èíñòðóìåí-

òîâ áûëè áû ïîìåùåíû âñå àïïàðàòû,ìàøèíû è ïîâÿçêè, óïîòðåáëÿåìûå äëÿëå÷åíèÿ ïåðåëîìîâ, âûâèõîâ è ðàíåíèé,ðàâíî êàê è äëÿ èñïðàâëåíèÿ ðàçëè÷íûõèñêðèâëåíèé è áåçîáðàçèé ÷åëîâå÷åñêî-

Ï.Ï.Çàáëîöêèé-Äåñÿòîâñêèé

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Ê ñîæàëåíèþ, äî íàøèõ äíåé íå óäà-ëîñü ñîõðàíèòü Õèðóðãè÷åñêèé ìóçåé âòîì âèäå, êàêèì îí áûë çàäóìàí. Ñ òå÷å-íèåì âðåìåíè ïîä âëèÿíèåì ðàçëè÷íûõîáñòîÿòåëüñòâ îí áûë ðàñôîðìèðîâàí,ìàòåðèàëû îêàçàëèñü íà ðàçíûõ êàôåä-ðàõ è â êëèíèêàõ àêàäåìèè. Â ñâÿçè ñ îò-ñóòñòâèåì äîëæíîãî êîíòðîëÿ çà ñîõðàí-íîñòüþ, áîëüøàÿ ÷àñòü ìóçåéíûõ ïðåä-ìåòîâ ïîñòåïåííî ïåðåõîäèëà â ÷àñòíûåêîëëåêöèè èëè óòðà÷èâàëàñü.

Â ñåðåäèíå XX â. ñîòðóäíèêàìèÂîåííî-ìåäèöèíñêîãî ìóçåÿ ïîä ðóêî-âîäñòâîì ïðîôåññîðà Âîåííî-ìåäèöèí-ñêîé àêàäåìèè Àëåêñåÿ Íèêîëàåâè÷àÌàêñèìåíêîâà áûëà ïðåäïðèíÿòà ñåðü-åçíàÿ ïîèñêîâàÿ ðàáîòà ïî ñáîðó óòðà-÷åííûõ ìóçåéíûõ ïðåäìåòîâ, â ðåçóëü-òàòå êîòîðîé óäàëîñü âîññòàíîâèòü÷àñòü êîëëåêöèè Õèðóðãè÷åñêîãî èÏèðîãîâñêîãî ìóçååâ. Â íàñòîÿùåå âðå-ìÿ ÷àñòü ìàòåðèàëîâ, êîòîðûå íà÷àëñîáèðàòü Ï.Ï.Çàáëîöêèé-Äåñÿòîâñêèé,

Çàëû Õèðóðãè÷åñêîãî ìóçåÿ

íàõîäèòñÿ íà ãîñóäàðñòâåííîì õðà-íåíèè â Âîåííî-ìåäèöèíñêîì ìóçåå,ÿâëÿþùåìñÿ ïðååìíèêîì ïåðâîãî ìå-äèöèíñêîãî ìóçåÿ Ðîññèè.

Â ôîíäàõ Âîåííî-ìåäèöèíñêîãî ìó-çåÿ õðàíèòñÿ «ïàñïîðò» Õèðóðãè÷åñêîãîìóçåÿ – øíóðîâàÿ êíèãà, â êîòîðóþ âêëþ-÷åíû ïðåäìåòû, âõîäèâøèå â åãî ñîñòàâ â1863 ã. Óíèêàëüíûå ïðåäìåòû èç ýòîãî ñî-áðàíèÿ ïðåäñòàâëåíû â ýêñïîçèöèè Âî-åííî-ìåäèöèíñêîãî ìóçåÿ, ðÿä âûñòàâîêðàçíîãî óðîâíÿ áûë ñîçäàí íà èõ îñíîâå.Òåì ñàìûì ñîõðàíÿåòñÿ ïàìÿòü î ïåðâîìâ Ðîññèè ìóçåå ìåäèöèíñêîãî ïðîôèëÿ,ïðåäñòàâèòåëÿõ àêàäåìèè, âèäíûõ ó÷åíûõ,ñîñòàâèâøèõ ñëàâó îòå÷åñòâåííîé ìåäè-öèíñêîé íàóêè.

Â ôåâðàëå ýòîãî ãîäà â Âîåííî-ìå-äèöèíñêîì ìóçåå áûëà îòêðûòà âûñòàâ-êà, ïîñâÿùåííàÿ 150-ëåòíåé èñòîðèèÕèðóðãè÷åñêîãî ìóçåÿ ÈÌÕÀ, ãäå ïðåä-ñòàâëåíû ýêñïîíàòû, âõîäèâøèå â ñîñòàâïåðâîãî ìåäèöèíñêîãî ìóçåÿ Ðîññèè.


1. Áóäêî À.À. Èñòîðèÿ ìåäèöèíû Ñàíêò-Ïåòåðáóðãà XIX – íà÷àëà XX ââ. – ÑÏá:Íåñòîð-Èñòîðèÿ, 2010. – Ñ. 317.

2. Áóäêî À.À., Áûêîâ È.Þ., Ñåëèâàíîâ Å.Ô.è äð. Èñòîðèÿ âîåííîé ìåäèöèíû Ðîññèè.XIX – íà÷àëî XX â. / Ïîä ðåä. È.Þ.Áûêîâàè Â.Â.Øàïïî. – Ò. 3. – 2-å èçä. èñïð. è äîï. –Ì.: Âîåíèçäàò, ÂÌÌ ÌÎ ÐÔ, 2007. – Ñ. 544.

3. Áóäêî À.À., Ãðèáîâñêàÿ Ã.À. Ï.Ï.Çàáëîö-êèé-Äåñÿòîâñêèé – ñîçäàòåëü Õèðóðãè÷åñêî-ãî ìóçåÿ Èìïåðàòîðñêîé ìåäèêî-õèðóðãè÷åñ-êîé àêàäåìèè // Ìåäèöèíñêàÿ ïðîôåññóðàÐîññèéñêîé èìïåðèè: Òåç. íàó÷. êîíô. 12 ìàðòà2004 ã. – Ì., 2004. – Ñ. 23–25.

4. Áóäêî À.À., Æóðàâë¸â Ä.À. Õðàíèòåëè òðà-äèöèé âîåííîé ìåäèöèíû (Ê 65-ëåòèþ Âî-åííî-ìåäèöèíñêîãî ìóçåÿ ÌÎ ÐÔ) // Âîåí.-èñòîðè÷. æóðí. – 2007. – ¹ 10. – Ñ. 37–40.

5. Èñòîðèÿ Èìïåðàòîðñêîé Âîåííî-ìå-äèöèíñêîé (áûâøåé Ìåäèêî-Õèðóðãè÷åñ-êîé) Àêàäåìèè çà ñòî ëåò. 1798–1898. – ÑÏá,1898. – Ñ. 203.

6. Êàòàëîã Õèðóðãè÷åñêîãî ìóçåÿ Èìïå-ðàòîðñêîé Ñàíêò-Ïåòåðáóðãñêîé ìåäèêî-õèðóðãè÷åñêîé àêàäåìèè. – ÑÏá, 1867. – Ñ.II, III, V.

7. Êóäðÿøîâ À.È. Èñòîðè÷åñêèé î÷åðê êà-ôåäðû äåñìóðãèè ïðè Èìïåðàòîðñêîé Âî-åííî-ìåäèöèíñêîé àêàäåìèè. – ÑÏá, 1898. –Ñ. 44–45.

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© Ï.Â.ÏÈÍ×ÓÊ, À.À.ÔÎÊÈÍ, 2013ÓÄÊ 340.6(091)(470)

Ê 70-ëåòèþ 111-ãî Ãëàâíîãî ãîñóäàðñòâåííîãîöåíòðà ñóäåáíî-ìåäèöèíñêèõ è êðèìèíàëèñòè÷åñêèõýêñïåðòèç Ìèíîáîðîíû Ðîññèè

ÏÈÍ×ÓÊ Ï.Â., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàÔÎÊÈÍ À.À., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà ([email protected])

111-é Ãëàâíûé ãîñóäàðñòâåííûé öåíòð ñóäåáíî-ìåäèöèíñêèõ è êðèìèíàëèñòè÷åñêèõ ýêñ-ïåðòèç Ìèíîáîðîíû Ðîññèè, Ìîñêâà

Pinchuk P.V., Fokin A.A. – 70th anniversary of 111th Main state center of medicolegal and criminalisticexamination of the Ministry of Defence of the Russian Federation. The article is devoted to 70thanniversary of the head state forensic expert institution of the Ministry of Defence of the RussianFederation – 111th Main state center of medicolegal and criminalistic examination of the Ministry ofDefence of the Russian Federation. Some information about historical aspects of functioning of theinstitution and its activity at the present stage and in conditions of the reform of the Armed Forces of theRussian Federation is given.

K e y w o r d s: Central forensic-medical laboratory, 111th Main state center of medicolegal andcriminalistic examination of the Ministry of Defence of the Russian Federation, forensic enquiry.

Â ìàðòå 2013 ã. èñïîëíÿåòñÿ 70 ëåò 111-ìó Ãëàâíîìó ãîñóäàðñòâåííîìó

öåíòðó ñóäåáíî-ìåäèöèíñêèõ è êðèìèíàëè-ñòè÷åñêèõ ýêñïåðòèç Ìèíîáîðîíû Ðîññèè(111 ÃÃÖÑÌèÊÝ ÌÎ ÐÔ), ÿâëÿþùåìóñÿñ ìîìåíòà ôîðìèðîâàíèÿ âåäóùèìãîñóäàðñòâåííûì ñóäåáíî-ýêñïåðòíûìó÷ðåæäåíèåì Ìèíèñòåðñòâà îáîðîíû.

Ñâîþ èñòîðèþ 111 ÃÃÖÑÌèÊÝ âå-äåò ñ 1943 ã., êîãäà íà îñíîâàíèè äèðåê-òèâû Ãåíåðàëüíîãî øòàáà îò 26 ìàðòà¹ îðã/6/133213 áûëà ñôîðìèðîâàíà Öåí-òðàëüíàÿ ñóäåáíî-ìåäèöèíñêàÿ ëàáîðàòî-ðèÿ (ÖÑÌË) Êðàñíîé àðìèè, ñ 31 ìàðòà1943 ã. íà÷àâøàÿ ðåøàòü âîçëîæåííûå íàíåå çàäà÷è ïî âûïîëíåíèþ ñóäåáíî-ìå-äèöèíñêèõ ýêñïåðòèç â èíòåðåñàõ âîåí-íûõ ïðîêóðàòóð è âîåííûõ òðèáóíàëîâ.

Ïåðâûì íà÷àëüíèêîì ÖÑÌË – ãëàâ-íûì ñóäåáíî-ìåäèöèíñêèì ýêñïåðòîìÊðàñíîé àðìèè áûë Ìèõàèë Èâàíîâè÷Àâäååâ, ñòàâøèé îñíîâîïîëîæíèêîì ñè-ñòåìû ñóäåáíîé ýêñïåðòèçû Âîîðóæåí-íûõ ñèë. Ïîä åãî íåïîñðåäñòâåííûì ðó-êîâîäñòâîì â êðàò÷àéøèé ñðîê áûëà ðàç-ðàáîòàíà ñòðóêòóðà ñóäåáíî-ìåäèöèíñ-êîé ñëóæáû Êðàñíîé àðìèè, îðãàíèçîâà-íà ïðàêòè÷åñêàÿ ýêñïåðòíàÿ ðàáîòàÖÑÌË è ñóäåáíî-ìåäèöèíñêèõ ëàáîðà-òîðèé ôðîíòîâ, îòëàæåíà ñèñòåìà ïîä-ãîòîâêè ýêñïåðòíûõ êàäðîâ.

Êðîìå ïðîèçâîäñòâà ñóäåáíî-ìåäè-öèíñêèõ ýêñïåðòèç, îñíîâíûìè çàäà÷àìèñëóæáû ÿâëÿëèñü èçó÷åíèå íåáîåâûõïîòåðü â àðìèè è íà ôëîòå, ðàçðàáîòêàðåêîìåíäàöèé ïî èõ ïðåäóïðåæäåíèþ,êîíòðîëü êà÷åñòâà ìåäèöèíñêîãî îáå-ñïå÷åíèÿ â âîéñêàõ è ìåäèöèíñêèõ

Ìèõàèë Èâàíîâè÷ Àâäååâ

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© À.Í.ÖÛÌÁÀË, 2013ÓÄÊ [61:355](470.23)

75 ëåò íà ñòðàæå çäîðîâüÿ âîèíîâ Ñàíêò-Ïåòåðáóðãñêîãî (Ëåíèíãðàäñêîãî) ãàðíèçîíà

ÖÛÌÁÀË À.Í., çàñëóæåííûé âðà÷ ÐÔ, äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà([email protected])

Êîíñóëüòàòèâíî-äèàãíîñòè÷åñêàÿ ïîëèêëèíèêà 442-ãî Âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ ÇÂÎ,Ñàíêò-Ïåòåðáóðã

Tsymbal A.N. – 75 years safeguarding health of warriors of Saint-Petersburg (Leningrad) garrison.The article is devoted to the anniversary of Consultation-and-diagnostic outpatient hospital of 442ndDistrict military clinical hospital in Saint-Petersburg. This outpatient hospital was founded in on the20th March 1938. Work of garrison outpatient hospital was especially difficult during the Great PatrioticWar. Employees of this hospital heroically fulfilled their duties in conditions of severe blocade winter1941–1942. The outpatient hospital was nominally garrison, in fact this hospital operated units ofLeningrad front-line. In 1993 the garrison outpatient hospital was renamed as 104th Consultation-and-diagnostic. The main branch of activity is health maintenance of partici pants in the rectification ofthe consequences of the accident at the Chernobyl Atomic Electric Power Station and veterans (casefollow up) belonging to special risk subunits. Nowadays there are 30 treatment-and-diagnostic departmentsincluding staff military physician board.

K e y w o r d s: outpatient industry, outpatient attendance, army physicians, morbidity, treatment,prevention, standard medical examination, safeguarding health of defenders of homeland.

Ñî âðåìåíè ñîçäàíèÿ Ïåòðîãðàä- ñêîãî âîåííîãî îêðóãà è âïëîòü

äî 1938 ã. ñàìîñòîÿòåëüíûõ âîåííî-ìå-äèöèíñêèõ ó÷ðåæäåíèé ïîëèêëèíè÷åñêî-ãî òèïà â Ñàíêò-Ïåòåðáóðãå – Ïåòðî-ãðàäå – Ëåíèíãðàäå íå ñóùåñòâîâàëî.Â íà÷àëå 1920-õ ãã. áîëüíûå Ëåíèíãðàäñ-êîãî è ïðèãîðîäíûõ ãàðíèçîíîâ, íóæäà-þùèåñÿ â êîíñóëüòàöèè âðà÷åé-ñïåöèà-ëèñòîâ, íàïðàâëÿëèñü íà ñòàöèîíàðíîåëå÷åíèå â Ëåíèíãðàäñêèé êðàñíîàðìåé-ñêèé âîåííûé ãîñïèòàëü (ËÊÂÃ), èç-çà÷åãî îí íåðåäêî áûë ïåðåãðóæåí.

Â 1925 ã. ïðè ãîñïèòàëå îòêðûëñÿ àì-áóëàòîðíûé ïðèåì áîëüíûõ, ñíà÷àëà ñêîæíûìè è âåíåðè÷åñêèìè áîëåçíÿìè,à çàòåì è ïî äðóãèì ñïåöèàëüíîñòÿì.Ôàêòè÷åñêè ïîëèêëèíè÷åñêîå îòäåëåíèåãîñïèòàëÿ âûïîëíÿëî ðàáîòó âðà÷åéâîèíñêèõ ÷àñòåé. Íå ñëó÷àéíî â 30-å ãã.ñïåöèàëèñòû ËÊÂÃ, îñíîâûâàÿñü íà ãëó-áîêîì àíàëèçå ëå÷åáíî-ïðîôèëàêòè÷åñ-êîé ðàáîòû â âîéñêàõ, â ñâîèõ íàó÷íûõòðóäàõ îáîñíîâàëè íåîáõîäèìîñòü ñî-çäàíèÿ â îêðóãå ñàìîñòîÿòåëüíîé øòàò-íîé ãàðíèçîííîé ïîëèêëèíèêè.Òàêîå ëå÷åáíîå ó÷ðåæäåíèå áûëî ñîçäà-íî è íà÷àëî ôóíêöèîíèðîâàòü ñ êîíöàìàðòà 1938 ã.

Â ñáîðíèêå íåñåêðåòíûõ ïðèêàçàíèéâîéñêàì Ëåíèíãðàäñêîãî âîåííîãî îêðó-ãà çà 1938 ã. èìååòñÿ ñëåäóþùèé äîêóìåíò:«Ïîëàãàòü ñôîðìèðîâàííîé ñ 20 ìàðòà1938 ã. ãàðíèçîííóþ ïîëèêëèíèêó ËÂÎ ïîøòàòíîìó ðàñ÷åòó ñ äèñëîêàöèåé – ã. Ëå-íèíãðàä, Èíæåíåðíàÿ óë., ä. 8»*.

Ìîæíî ñ ïîëíûì îñíîâàíèåì óòâåð-æäàòü, ÷òî ïîñëå ñîçäàíèÿ ãàðíèçîííîéïîëèêëèíèêè â Ëåíèíãðàäñêîì âîåííîìîêðóãå ïîÿâèëñÿ íîâûé âèä ìåäèöèíñêîéïîìîùè, êîòîðûé îôèöèàëüíî ïîëó÷èëïðàâî íà æèçíü, – ïîëèêëèíè÷åñêèé.

Â 1938 ã. óïðàâëåíèå è ôóíêöèîíàëü-íûå ïîäðàçäåëåíèÿ ïîëèêëèíèêè áûëèðàçìåùåíû â ëåâîì (çàïàäíîì) ïàâèëü-îíå êîðäåãàðäèè Ìèõàéëîâñêîãî (Èíæå-íåðíîãî) çàìêà. Â íåì ðàíåå ðàçìåùà-ëèñü ïîäðàçäåëåíèÿ Âîåííî-èíæåíåðíîéøêîëû, Èíæåíåðíî-àðòèëëåðèéñêîãîêîðïóñà, Ëåíèíãðàäñêèé äîì ÊðàñíîéÀðìèè, ïðîôèëàêòîðèé ËåíÂÎ. Çäàíèåïðåäñòàâëÿåò èñòîðè÷åñêóþ öåííîñòüè íàõîäèòñÿ ïîä îõðàíîé ãîñóäàðñòâà.

Âñêîðå ïîñëå ñâîåé îðãàíèçàöèèïîëèêëèíèêà ïåðåøëà ê îêàçàíèþ ñè-ñòåìàòè÷åñêîé ïîìîùè âîéñêîâîé ìåäè-

*Àðõèâ ËåíÂÎ, ô. 38, îï. 49530, ä. 154, ê. 112.

Â îáúåêòèâå âîéíà: íà ôîíå ñóãðîáîâ1

Õîòÿ Çèìíåé âîéíîé ïðèíÿòî íàçûâàòü Ñîâåòñêî-ôèíëÿíäñêóþ âîéíó1939–1940 ãã., Âåëèêàÿ Îòå÷åñòâåííàÿ âîéíà 1941–1945 ãã. ïðîòèâ ôàøèñòñ-êèõ çàõâàò÷èêîâ òàêæå áûëà â íåìàëîé ñòåïåíè çèìíåé. Íå ñëó÷àéíî ââîñïîìèíàíèÿõ åå ó÷àñòíèêîâ èç ÷èñëà âîåííûõ âðà÷åé èìåííî çèìíèìñþæåòàì ïðèíàäëåæèò ãëàâíîå ìåñòî. Ñíåæíûå ñóãðîáû ñëóæàò ôîíîì äåé-ñòâèÿ êàê â ìåìóàðàõ ñîâåòñêèõ âîåííûõ âðà÷åé Í.Àòðîøêèíà2 è Á.Ñïèâà-êà3 , òàê è íàõîäèâøèõñÿ ïî äðóãóþ ñòîðîíó ôðîíòà íåìåöêèõ õèðóðãîâÃ.Õààïå è ïðîôåññîðà Õ.Êèëëèàíà4.

Ïóáëèêóåìûå ôîòîäîêóìåíòû èçôîíäîâ Ðîññèéñêîãî ãîñóäàðñòâåííîãîàðõèâà êèíîôîòîäîêóìåíòîâ(ÐÃÀÊÔÄ) ñëó÷àéíû è ýïèçîäè÷íû.Îáùåå â íèõ òî, ÷òî ýòè ôîòî âïåð-âûå âûÿâëåíû íàìè â ôîíäàõ àðõèâàñðåäè ñîòåí ïîäîáíûõ ñþæåòîâ. Ñëó-÷àéíîñòü æå ïîäáîðêè ïîçâîëÿåò ñäå-ëàòü è îäèí îáùèé âûâîä: îêêóïàí-òàì íà Âîñòî÷íîì ôðîíòå áûëî êàêìèíèìóì íåêîìôîðòíî. Óæå ïåðâàÿâîåííàÿ çèìà 1941–42 ãã. çàñòàâèëà èõçàáûâàòü ñîáëþäåíèå ôîðìû îäåæ-äû: íåóäèâèòåëüíî âèäåòü íà ñíèì-êàõ íåìöåâ â ñòðàííûõ áîòàõ, ìåõî-âûõ øàïêàõ èëè áàáüèõ ïëàòêàõ.

Ìåäñåñòðà êîìñîìîëêà Íîâèêîâà îêàçûâàåòïåðâóþ ïîìîùü ðàíåíîìó áîéöó. Ôîòî ×åðíîâà.Çàïàäíûé ôðîíò, äåêàáðü 1941 ã. (ÐÃÀÊÔÄ,¹ Î-154292)

1Ïðîäîëæåíèå ðóáðèêè. Íà÷àëî ñì. íà âêëåéêåñåíòÿáðüñêîãî è îáëîæêå íîÿáðüñêîãî 2012 ã.íîìåðîâ æóðíàëà.

2Àòðîøêèí Í.Ò. Â áîÿõ çà ãîðîä Áåëûé // Âîåí.-ìåä. æóðí. – 2008. – Ò. 329, ¹ 5. – Ñ. 72–79.

3Ñïèâàê Á.À. Èç âîñïîìèíàíèé î âîéíå // Âîåí.-ìåä. æóðí. – 2010. – Ò. 331, ¹ 4. – Ñ. 79–85.

4Õààïå Ãåíðèõ. Îñêàë ñìåðòè. 1941 ãîä íà Âîñ-òî÷íîì ôðîíòå / Ïåð. ñ àíãë. À.Ìÿñíèêîâà. –Ì.: ßóçà-ïðåññ, 2009. – 576 ñ.; Êèëëèàí Õàíñ.Íåìåöêèé õèðóðã íà Âîñòî÷íîì ôðîíòå.1941–1943 ãã. / Ïåð. ñ àíãë. Ñ.Â.Áàáàê. –Ì.: ÇÀÎ Öåíòðïîëèãðàô, 2005. – 335 ñ.

Âûíîñðàíåíîãî

íà ñàíêàõ-âîëîêóøàõñ ïîëÿ áîÿ.

1944 ã.(ÐÃÀÊÔÄ,

îï. 2, ¹ 160,ñí. 3)

Â îáúåêòèâå âîéíà: íà ôîíå ñóãðîáîâ

Ñàíèíñòðóêòîð ãâàðäèèñåðæàíò Â.À.Ïîïîâ âûíîñèòîðóæèå ñ ïîëÿ áîÿ.Àâòîð Â.Ãðåáíåâ.Çàïàäíûé ôðîíò, 1941 ã.(ÐÃÀÊÔÄ, ¹ Î-286757)

Äîñòàâêà ðàíåíûõêðàñíîàðìåéöåâ â ëàçàðåò.Ñåâåðíûé ôðîíò, 1942 ã.(ÐÃÀÊÔÄ, ¹ Î-120106)

Íåìåöêèå ñîëäàòûó ìåñòíîãî ëàçàðåòà,ãäå îêàçûâàåòñÿ ïåðâàÿïîìîùü ðàíåíûì.Áîðèñîâ, ìàðò 1942 ã.(ÐÃÀÊÔÄ, îï. 2,¹ 512, ñí. 1)

Ñàìîäåëüíûå ñàíè-âîëîêóøè (äâóõ òèïîâ),

èñïîëüçóåìûå íåìåöêèìèñîëäàòàìè êàê ñðåäñòâî

òðàíñïîðòèðîâêè ðàíåíûõ(ÐÃÀÊÔÄ, îï. 3,¹ 260, ñí. 273)

Â îáúåêòèâå âîéíà: íà ôîíå ñóãðîáîâ

ÑàíèíñòðóêòîðÇîëîòàðåâíà ëèíèè îãíÿîêàçûâàåò ïåðâóþïîìîùü ðàíåíîìó áîéöó.Çàïàäíûé ôðîíò, 1942 ã.(ÐÃÀÊÔÄ, ¹ Î-57009)

ÑàíèíñòðóêòîðÒ.À.Ìèõàëåâ

âûâîçèò ðàíåíîãîñ ïîëÿ áîÿ. Àâòîð

À.Ñîëîâüåâ.Äåéñòâóþùàÿàðìèÿ, 1943 ã.

(ÐÃÀÊÔÄ,¹ Î-144792)

Íåìåöêèå ñîëäàòûâûâîçÿò ðàíåíîãîñ ïîëÿ áîÿ íà ñàíêàõ.Õàðüêîâñêàÿ îáëàñòü,ìàðò 1943 ã.(ÐÃÀÊÔÄ, îï 2,¹ 409, ñí. 5)

Íåìåöêèé êàïèòàíìåäèöèíñêîé ñëóæáû

ïðîâåðÿåò ó ñîëäàò,èäóùèõ íà ïåðåäíèé

êðàé îáîðîíû, íàëè÷èåïåðåâÿçî÷íûõ ïàêåòîâ.

Ðàéîí Êàíäàëàêøè,ìàðò 1944 ã.

(ÐÃÀÊÔÄ, îï. 2,¹ 186, ñí. 7)


ÎÔÈÖÈÀËÜÍÛÉ ÎÒÄÅË

Þ Á È Ë Å È

© Þ.Â.ÌÈÐÎØÍÈ×ÅÍÊÎ, Â.Í.ÊÎÍÎÍÎÂ, À.Á.ÃÎÐß×ÅÂ, 2013ÓÄÊ 616:355 (092 Áóíèí Ñ.À.)

10 ìàðòà 2013 ã. èñïîëíèëîñü 50 ëåò èñïîëíÿþùåìó îáÿçàííîñòèçàìåñòèòåëÿ íà÷àëüíèêà ÂÌåäÀ èì. Ñ.Ì.Êèðîâà, äîêòîðó ôàðìàöåâ-òè÷åñêèõ íàóê, äîöåíòó ïîëêîâíèêó ìåäèöèíñêîé ñëóæáû ÑåðãåþÀëåêñàíäðîâè÷ó Áóíèíó.

Ñ.À.Áóíèí ðîäèëñÿ â Êóðñêîé îáëàñòè. Ïîñëå îêîí÷àíèÿ ôàðìàöåâ-òè÷åñêîãî îòäåëåíèÿ ÂÌåäÔ ïðè Òîìñêîì ãîñóäàðñòâåííîì ìåäèöèí-ñêîãî èíñòèòóòå (1985) ñëóæèë â 332-ì îêðóæíîì ñêëàäå ÑÊÂÎâ ã. Íîâî÷åðêàññêå. Â 1994 ã. ñòàë íà÷àëüíèêîì ó÷åòíî-ïëàíîâîãî îòäåëå-íèÿ îòäåëà ìåäèöèíñêîãî ñíàáæåíèÿ ÂÌåäÀ. Â 1999 ã. îêîí÷èë ñ çîëîòîéìåäàëüþ Âîåííóþ àêàäåìèþ òûëà è òðàíñïîðòà, â 2001 ã. ïðîõîäèë îáó÷å-íèå â Ó÷åáíî-êîíñóëüòàöèîííîì öåíòðå Ñàíêò-Ïåòåðáóðãñêîãî àðõè-

òåêòóðíî-ñòðîèòåëüíîãî óíèâåðñèòåòà, â 2002 ã. îêîí÷èë Ñàíêò-Ïåòåðáóðãñêóþ þðèäè÷åñêóþàêàäåìèþ. Â 2003 ã. íàçíà÷åí çàìåñòèòåëåì íà÷àëüíèêà ÂÌåäÀ ïî ìåäèöèíñêîìó ñíàáæåíèþ,â íàñòîÿùåå âðåìÿ èñïîëíÿåò îáÿçàííîñòè çàìåñòèòåëÿ íà÷àëüíèêà ýòîé àêàäåìèè.

Ñ.À.Áóíèí íàãðàæäåí îðäåíîì Ïî÷åòà, ìåäàëüþ îðäåíà «Çà çàñëóãè ïåðåä Îòå÷åñòâîì»2 ñòåïåíè è ìíîãèìè äðóãèìè ìåäàëÿìè.

Êîìàíäîâàíèå Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ Ìèíèñòåðñòâà îáîðîíû ÐîññèéñêîéÔåäåðàöèè è Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà, ðåäàêöèîííàÿ êîëëåãèÿ «Âîåííî-ìåäèöèíñêîãî æóðíàëà», ó÷åíèêè, êîëëåãè è äðóçüÿ ñåðäå÷íî ïîçäðàâëÿþò Ñåðãåÿ Àëåêñàíäðîâè÷àÁóíèíà ñ þáèëååì, æåëàþò åìó êðåïêîãî çäîðîâüÿ, ñ÷àñòüÿ è äàëüíåéøèõ òâîð÷åñêèõ óñïåõîâ.

Îáðàùàåì âíèìàíèå àâòîðîâ æóðíàëà, ÷òî â ñîîòâåòñòâèè ñ òðåáîâàíè-ÿìè Âûñøåé àòòåñòàöèîííîé êîìèññèè, à òàêæå Ðîññèéñêîãî èíäåêñàíàó÷íîãî öèòèðîâàíèÿ äëÿ ïóáëèêàöèè â æóðíàëå íåîáõîäèìî ïðåäñòàâ-ëÿòü íà îòäåëüíîì ëèñòå ñëåäóþùèå ñâåäåíèÿ îá àâòîðàõ:

– ôàìèëèÿ, èìÿ, îò÷åñòâî âñåõ àâòîðîâ ïîëíîñòüþ (íà ðóññêîìè àíãëèéñêîì ÿçûêàõ);

– ïîëíîå íàçâàíèå îðãàíèçàöèè – ìåñòî ðàáîòû êàæäîãî àâòîðàâ èìåíèòåëüíîì ïàäåæå, ñòðàíà, ãîðîä (íà ðóññêîì è àíãëèéñêîì ÿçûêàõ).Åñëè âñå àâòîðû ðàáîòàþò â îäíîì ó÷ðåæäåíèè, ìîæíî íå óêàçûâàòü ìåñòîðàáîòû êàæäîãî àâòîðà îòäåëüíî;

– àäðåñ ýëåêòðîííîé ïî÷òû êàæäîãî àâòîðà;– êîððåñïîíäåíòñêèé ïî÷òîâûé àäðåñ è òåëåôîí äëÿ êîíòàêòîâ

ñ àâòîðàìè ñòàòüè (ìîæíî îäèí íà âñåõ àâòîðîâ).Íàçâàíèå ñòàòüè ïðèâîäèòñÿ íà ðóññêîì è àíãëèéñêîì ÿçûêàõ.Íàïîìèíàåì î íåîáõîäèìîñòè óêàçûâàòü íà òèòóëüíîì ëèñòå ñòàòüè

ïîëíîå íàçâàíèå è ìåñòîíàõîæäåíèå ó÷ðåæäåíèÿ (ãîñïèòàëÿ, âîèíñêîé ÷à-ñòè, èíñòèòóòà è ò. ä.), â êîòîðîì âûïîëíåíà ðàáîòà, à òàêæå ïðåäñòàâëåíèÿàâòîðñêîãî ðåçþìå (100–250 ñëîâ), êëþ÷åâûõ ñëîâ íà ðóññêîì è àíãëèé-ñêîì ÿçûêàõ.


ËÅÍÒÀ ÍÎÂÎÑÒÅÉ

27 ôåâðàëÿ ñîñòîÿëîñü ðàñøèðåííîå çàñå-äàíèå Êîëëåãèè Ìèíèñòåðñòâà îáîðîíûÐîññèéñêîé Ôåäåðàöèè.

Â åå ðàáîòå ïðèíÿë ó÷àñòèå ÏðåçèäåíòÐîññèéñêîé Ôåäåðàöèè – Âåðõîâíûé ãëàâíî-êîìàíäóþùèé Âîîðóæåííûìè ñèëàìè Ðîññèé-ñêîé Ôåäåðàöèè Âëàäèìèð Ïóòèí. Â ñâîåì âû-ñòóïëåíèè ïåðåä ó÷àñòíèêàìè çàñåäàíèÿ ãëàâàãîñóäàðñòâà çàÿâèë, ÷òî Âîîðóæåííûå ñèëûäîëæíû âûéòè íà íîâûé óðîâåíü âîçìîæíî-ñòåé óæå â ñàìîå áëèæàéøåå âðåìÿ.

Ñ îñíîâíûì äîêëàäîì âûñòóïèë ìèíèñòðîáîðîíû Ðîññèéñêîé Ôåäåðàöèè ãåíåðàë àðìèèÑåðãåé Øîéãó. Ãëàâà îáîðîííîãî âåäîìñòâàïîäâåë èòîãè äåÿòåëüíîñòè çà 2012 ãîä è îïðå-äåëèë çàäà÷è íà î÷åðåäíîé ïåðèîä.

«Íàðÿäó ñ âîïðîñàìè âîåííîãî ñòðîèòåëüñòâà, îäíèì èç ïðèîðèòåòîâ Ìèíèñòåðñòâàîáîðîíû ÿâëÿåòñÿ ðåøåíèå ñîöèàëüíûõ ïðîáëåì âîåííîñëóæàùèõ», – ïîä÷åðêíóë ìèíèñòðîáîðîíû. Ïðèíÿòû ðåøåíèÿ ïî ñîâåðøåíñòâîâàíèþ ñèñòåìû ìåäèöèíñêîãî îáåñïå÷åíèÿ âîåííî-ñëóæàùèõ, ÷ëåíîâ èõ ñåìåé è âîåííûõ ïåíñèîíåðîâ, óñêîðåíèþ òåìïîâ ðåøåíèÿ æèëèùíîéïðîáëåìû.

Â çàêëþ÷èòåëüíîé ÷àñòè äîêëàäà ìèíèñòð îáîðîíû îáîçíà÷èë ïðèîðèòåòû äåÿòåëüíîñòèâåäîìñòâà íà 2013 ãîä.

Óïðàâëåíèå ïðåññ-ñëóæáû è èíôîðìàöèèÌèíèñòåðñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè

http://function.mil.ru/news_page/country/more.htm?id=11650595@egNews

Â Êóëüòóðíîì öåíòðå Âîîðóæåííûõ ñèë ñî-ñòîÿëàñü âñòðå÷à íà÷àëüíèêà Ãåíåðàëüíîãîøòàáà Âîîðóæåííûõ ñèë Ðîññèéñêîé Ôåäåðà-öèè – ïåðâîãî çàìåñòèòåëÿ ìèíèñòðà îáîðîíûÐîññèè ãåíåðàëà àðìèè Âàëåðèÿ Ãåðàñèìîâà ñèíîñòðàííûìè âîåííûìè àòòàøå, àêêðåäèòî-âàííûìè â Ìîñêâå.

Ãëàâíîé òåìîé áðèôèíãà ñòàëè îñíîâíûåèòîãè ðàñøèðåííîãî çàñåäàíèÿ Êîëëåãèè Ìèíè-ñòåðñòâà îáîðîíû, ñîñòîÿâøåãîñÿ 27 ôåâðàëÿ ñ. ã.

Â öåëîì, ïî ñëîâàì íà÷àëüíèêà ðîññèéñ-êîãî Ãåíøòàáà, «îòìå÷àåòñÿ ïîçèòèâíàÿ äèíà-ìèêà, íàìåòèâøàÿñÿ íà ïóòè ìîäåðíèçàöèèÐîññèéñêîé àðìèè». Ó ðóêîâîäñòâà âîåííîãî âå-äîìñòâà Ðîññèè íåò ñîìíåíèÿ â ïðàâèëüíîñòèèçáðàííîãî êóðñà íà ïðèäàíèå Âîîðóæåííûì ñèëàì êà÷åñòâåííî íîâîãî ñîñòîÿíèÿ, îáåñïå-÷èâàþùåãî ïàðèðîâàíèå âñåãî ñïåêòðà óãðîç âîåííîé áåçîïàñíîñòè ãîñóäàðñòâà.

Âàæíûì èòîãîì ïðîøåäøåãî ãîäà ñòàëà ðàçðàáîòêà ïëàíà îáóñòðîéñòâà âîåííûõ ãîðîä-êîâ. Ýòîò äîêóìåíò óâÿçàí ïî ñðîêàì è ðåñóðñàì, ðàáîòà ïî åãî ðåàëèçàöèè óæå àêòèâíîïðîâîäèòñÿ.

Êðàéíå âàæíûì ñîöèàëüíûì âîïðîñîì ÿâëÿåòñÿ è ìåäèöèíñêîå îáåñïå÷åíèå âîåííîñëóæàùèõè ÷ëåíîâ èõ ñåìåé. Ïðèíÿòû ìåðû, íàïðàâëåííûå íà óòî÷íåíèå êîëè÷åñòâà è ñòðóêòóðû ìåä-ó÷ðåæäåíèé, îñîáåííî â îòäàëåííûõ ãàðíèçîíàõ, óëó÷øåíèå èõ ìàòåðèàëüíî-òåõíè÷åñêîãîñîñòîÿíèÿ, îáóñòðîéñòâî âîéñêîâîãî ìåäèöèíñêîãî çâåíà (ãîñïèòàëåé, ìåäèöèíñêèõ ðîòè ïóíêòîâ), ïîâûøåíèå ìîáèëüíîñòè âîåííîé ìåäèöèíû ïóòåì îñíàùåíèÿ åå àýðîìîáèëü-íûìè ãîñïèòàëÿìè.

Êîñíóëñÿ ãåíåðàë àðìèè Âàëåðèé Ãåðàñèìîâ è òåìû ïåðåõîäà íà ñèñòåìó àóòñîðñèíãà.Ïî åãî ñëîâàì, «ïåðåäà÷à íåñâîéñòâåííûõ Âîîðóæåííûì ñèëàì ôóíêöèé ñòîðîííèì îðãàíè-


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Ãîñóäàðñòâåííûé íàó÷íûé öåíòð – Èíñòèòóò ìåäèêî-áèîëîãè÷åñêèõ ïðîáëåì ÐÀÍ, Ìîñêâà

Â êîíöå 2012 ã. âûøëà â ñâåò ìîíî- ãðàôèÿ*, ïîñâÿùåííàÿ îäíîìó èç

íàèáîëåå ïåðñïåêòèâíûõ ñîâðåìåííûõðàäèîçàùèòíûõ ñðåäñòâ, ðåêîìáèíàíòíî-ìó èíòåðëåéêèíó-1. Àâòîðû ðåöåíçèðóå-ìîé ìîíîãðàôèè – ãëàâíûé òîêñèêîëîã-ðàäèîëîã ÌÎ ÐÔ, ïðîôåññîð ïîëêîâíèêìåäèöèíñêîé ñëóæáû À.Í.Ãðåáåíþê èëàóðåàò Ãîñóäàðñòâåííîé ïðåìèè ÑÑÑÐ,çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ïðîôåñ-ñîð ïîëêîâíèê ìåäèöèíñêîé ñëóæáû

â îòñòàâêå Â.È.Ëåãåçà – õîðîøî èçâåñòíûâîåííûì âðà÷àì ïî ìíîãî÷èñëåííûìæóðíàëüíûì ñòàòüÿì è êíèãàì, ïîñâÿùåí-íûì ïðîáëåìàì ðàäèîáèîëîãèè, ðàäèàöè-îííîé ìåäèöèíû è ìåäèöèíñêîé ïðîòè-âîðàäèàöèîííîé çàùèòû. Íîâàÿ êíèãàïîñâÿùåíà ýêñïåðèìåíòàëüíîìó èçó÷å-íèþ ïðîòèâîëó÷åâûõ ñâîéñòâ èíòåðëåé-êèíà-1, âûïîëíåííîìó â Âîåííî-ìåäè-öèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà è Èí-ñòèòóòå âîåííîé ìåäèöèíû ÌÎ ÐÔ.

Íå ïðåòåíäóÿ íà èñ÷åðïûâàþùóþõàðàêòåðèñòèêó âñåõ ïðîâåäåííûõ â íà-øåé ñòðàíå è çà ðóáåæîì èññëåäîâàíèé,êàñàþùèõñÿ ðàäèîçàùèòíîé è ëå÷åáíîéàêòèâíîñòè èíòåðëåéêèíà-1, àâòîðûòåì íå ìåíåå îáîáùèëè óíèêàëüíûé, ïî-÷òè 20-ëåòíèé îïûò ñîáñòâåííûõ èññëå-äîâàíèé è ðàáîò ñâîèõ ìíîãî÷èñëåííûõó÷åíèêîâ, ÷òî ïîçâîëèëî èì ïðîäåìîí-ñòðèðîâàòü øèðîêèå âîçìîæíîñòè öèòî-êèíà ïðè åãî èñïîëüçîâàíèè â êà÷åñòâåïåðñïåêòèâíîãî ëå÷åáíî-ïðîôèëàêòè÷åñ-êîãî ñðåäñòâà.

Ïåðâàÿ ãëàâà êíèãè ïîñâÿùåíà àíà-ëèçó áèîëîãè÷åñêèõ ñâîéñòâ öèòîêèíà.Â íåé â ñæàòîì âèäå ïðåäñòàâëåíû îñ-íîâíûå ñâåäåíèÿ îá èñòîðèè îòêðûòèÿèíòåðëåéêèíà-1, åãî ñòðóêòóðå, êëåòêàõ-ïðîäóöåíòàõ, ñòèìóëÿòîðàõ ñèíòåçà, òè-ïàõ ðåöåïòîðîâ, îñíîâíûõ ìåõàíèçìàõè ïðîÿâëåíèÿõ áèîëîãè÷åñêîãî äåéñòâèÿ.Îñîáîå âíèìàíèå àâòîðû óäåëÿþò âîï-ðîñàì äåéñòâèÿ öèòîêèíà íà ñèñòåìû,èãðàþùèå âåäóùóþ ðîëü â ðåàëèçàöèèýôôåêòîâ îáëó÷åíèÿ (íåéðîýíäîêðèí-íóþ, êðîâåòâîðíóþ è èììóííóþ), âïîë-íå îáîñíîâàííî ïîëàãàÿ, ÷òî ìîäóëÿöèÿàêòèâíîñòè ýòèõ ñèñòåì ÿâëÿåòñÿ îäíîéèç ãëàâíûõ ïðè÷èí ïðîÿâëåíèÿ åãî ïðî-òèâîëó÷åâûõ ñâîéñòâ. Îáñóæäåíèþ ïîñ-

* Ãðåáåíþê À.Í., Ëåãåçà Â.È. Ïðîòèâîëó÷åâûåñâîéñòâà èíòåðëåêèíà-1. – ÑÏá: ÎÎÎ«Èçäàòåëüñòâî «ÔÎËÈÀÍÒ», 2012. – 216 ñ.



òîãäà êàê ïðè ñî÷åòàííûõ ðàäèàöèîííûõâîçäåéñòâèÿõ åãî èñïîëüçîâàíèå ìîæåòáûòü ïîëåçíûì.

Øåñòàÿ ãëàâà ìîíîãðàôèè ïîñâÿùå-íà ÷ðåçâû÷àéíî àêòóàëüíîìó äëÿ ìåäè-öèíñêîé ñëóæáû Ìèíîáîðîíû è Ì×Ñâîïðîñó – îöåíêå âëèÿíèÿ èíòåðëåéêè-íà-1 íà ïðîòèâîëó÷åâóþ ýôôåêòèâíîñòüñðåäñòâ ïðîôèëàêòèêè ðàäèàöèîííûõïîðàæåíèé. Âàæíîñòü ïðîáëåìû îáóñëîâ-ëåíà òåì, ÷òî ðàäèîïðîòåêòîðû çàíèìà-þò âàæíîå ìåñòî â ñèñòåìå ïðîòèâîðà-äèàöèîííîé çàùèòû âîéñê è íàñåëåíèÿ,è ïðè âêëþ÷åíèè â ýòó ñèñòåìó ëþáîãîíîâîãî ïðåïàðàòà íåîáõîäèìî çíàòü, íà-ñêîëüêî îí ñîâìåñòèì ñ «òàáåëüíûìè»ðàäèîçàùèòíûìè ñðåäñòâàìè, ïðåæäå âñå-ãî ñ ïðåïàðàòîì Á-190 (èíäðàëèíîì) èöèñòàìèíîì.

Àâòîðàìè äîñòàòî÷íî óáåäèòåëüíîïîêàçàíî, ÷òî ïðîôèëàêòè÷åñêîå ïðèìå-íåíèå ïðåïàðàòà Á-190, êàê è öèñòàìèíà,â ñî÷åòàíèè ñ ðàííèì òåðàïåâòè÷åñêèìèñïîëüçîâàíèåì èíòåðëåéêèíà-1 ñïîñîá-ñòâóåò ñóùåñòâåííîìó óâåëè÷åíèþ âû-æèâàåìîñòè îáëó÷åííûõ æèâîòíûõ âñðàâíåíèè ñ èçîëèðîâàííûì ïðèìåíåíè-åì ïðåïàðàòîâ (ÔÈÄ âîçðàñòàåò ïî÷òèíà 20%). Ïðèâåäåí òàêæå îáøèðíûé ìà-òåðèàë, ðàñêðûâàþùèé ìåõàíèçìû àääè-òèâíîãî ýôôåêòà ðàäèîïðîòåêòîðîâ èèíòåðëåéêèíà-1.

Â çàêëþ÷èòåëüíîé (ñåäüìîé) ãëàâåêíèãè îïèñàíû ðåçóëüòàòû èçó÷åíèÿ ïåðå-íîñèìîñòè èíòåðëåéêèíà-1 ÷åëîâåêîì.Íàèáîëüøèé èíòåðåñ ïðåäñòàâëÿåò èçëî-æåíèå ïîäõîäà ê ðåøåíèþ îäíîé èç êëþ-÷åâûõ ïðîáëåì ðàäèàöèîííîé ôàðìàêî-ëîãèè – êëèíè÷åñêîé îöåíêå ñïåöèôè-÷åñêîé àêòèâíîñòè ïîòåíöèàëüíûõ ïðî-òèâîëó÷åâûõ ñðåäñòâ. Ñóùíîñòü ìåòîäà –

èçó÷åíèå âëèÿíèÿ îáëó÷åíèÿ ïåðèôåðè-÷åñêîé êðîâè in vitro íà ïîêàçàòåëè ãå-ìàòî-èììóííîãî ñòàòóñà, èíäóöèðîâàí-íûå ââåäåíèåì çäîðîâûì äîáðîâîëüöàìèíòåðëåéêèíà-1. Ïîêàçàíî, ÷òî öèòîêèíñóùåñòâåííî ìîäèôèöèðóåò ðåàêöèþêëåòîê ãåìàòîèììóííîé ñèñòåìû íà âîç-äåéñòâèå èîíèçèðóþùèõ èçëó÷åíèé è ýòîîáñòîÿòåëüñòâî, ïî-âèäèìîìó, ìîæåò îêà-çàòüñÿ ïåðñïåêòèâíûì äëÿ îðèåíòèðî-âî÷íîé îöåíêè ýôôåêòèâíîñòè ïîòåíöè-àëüíûõ ïðîòèâîëó÷åâûõ ñðåäñòâ ó ÷åëî-âåêà.

Â öåëîì ïðèâåäåííûå â êíèãå äàí-íûå óáåäèòåëüíî ñâèäåòåëüñòâóþò î áåç-óñëîâíîé ïåðñïåêòèâíîñòè èíòåðëåéêè-íà-1 â êà÷åñòâå ñðåäñòâà ïðîôèëàêòèêèè òåðàïèè ðàçëè÷íûõ ôîðì ðàäèàöèîí-íûõ ïîðàæåíèé ÷åëîâåêà.

Â çàêëþ÷åíèè ïðåäñòàâëåí àíàëèçèçó÷åííûõ àâòîðàìè è ïðåäñòàâëåííûõâ ëèòåðàòóðå ìåõàíèçìîâ ïðîòèâîëó÷å-âîé ýôôåêòèâíîñòè èíòåðëåéêèíà-1, ïðè-âåäåí îáøèðíûé ñïèñîê îòå÷åñòâåííûõè çàðóáåæíûõ ïóáëèêàöèé ïî âîïðîñàì,êàñàþùèìñÿ áèîëîãè÷åñêèõ ñâîéñòâ èí-òåðëåéêèíà-1 è åãî ïðîòèâîëó÷åâûõ ýô-ôåêòîâ ïðè ðàçëè÷íûõ âàðèàíòàõ ðàäèà-öèîííûõ ïîðàæåíèé â êëèíèêå è ýêñïå-ðèìåíòå.

Êíèãà ÷èòàåòñÿ ñ èíòåðåñîì, ñîäåð-æàòåëüíà, íàñûùåíà áîëüøèì îáúåìîìèíôîðìàöèè è áóäåò, áåçóñëîâíî, ïîëåç-íà êàê äëÿ ñïåöèàëèñòîâ â îáëàñòè ðàäè-àöèîííîé ôàðìàêîëîãèè, èììóíîëîãèèè ãåìàòîëîãèè, òàê è äëÿ êóðñàíòîâ Âî-åííî-ìåäèöèíñêîé àêàäåìèè è ñòóäåíòîâìåäèöèíñêèõ âóçîâ, à òàêæå äëÿ ñëóøà-òåëåé öèêëîâ ïîâûøåíèÿ êâàëèôèêàöèèïðè èçó÷åíèè âîïðîñîâ ðàäèîáèîëîãèèè ýêñòðåìàëüíîé ìåäèöèíû.

© Å.À.ÍÈÊÈÒÈÍ, 2013ÓÄÊ 617:355(07)

Ó÷åáíîå ïîñîáèå ïî õèðóðãè÷åñêèì çàáîëåâàíèÿìíà ôëîòå

ÍÈÊÈÒÈÍ Å.À., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîéñëóæáû â îòñòàâêå ([email protected])

Ìåæðåãèîíàëüíàÿ îáùåñòâåííàÿ îðãàíèçàöèÿ ëåíèíãðàäñêèõ âåòåðàíîâ âîéíû è âîåííîéñëóæáû – îäíîïîë÷àí, Ñàíêò-Ïåòåðáóðã



Âîåííî-ìîðñêàÿ õèðóðãèÿ ïðåäñòàâ-

ëÿåò ñîáîé ñëîæíûé è ìíîãîïëà-

íîâûé ðàçäåë âîåííîé õèðóðãèè. Âîçíèê-

íîâåíèå è ñòàíîâëåíèå õèðóðãè÷åñêîé

ïîìîùè íà ôëîòå òåñíî ñâÿçàíû êàê ñ

ðàçâèòèåì Âîåííî-ìîðñêîãî ôëîòà è åãî

òåõíè÷åñêîé îñíàùåííîñòüþ, òàê è ñ

èñòîðèåé âîåííîé ìåäèöèíû è âîåííîé

íàóêè â öåëîì.

Â 1939 ã., íàêàíóíå Âåëèêîé Îòå÷å-

ñòâåííîé âîéíû, ïîÿâèëàñü íåîáõîäè-

ìîñòü óëó÷øèòü ïîäãîòîâêó êîðàáåëüíûõ

âðà÷åé ïî õèðóðãèè, ÷òî ïîñëóæèëî ïðåä-

ïîñûëêîé ñîçäàíèÿ êàôåäðû âîåííî-ìîð-

ñêîé ãîñïèòàëüíîé õèðóðãèè. Â ãîäû âîé-

íû è â ïîñëåâîåííûé ïåðèîä, îñîáåííî

â ãîäû «õîëîäíîé âîéíû», ýòî íîâîââå-

äåíèå ñåáÿ ïîëíîñòüþ îïðàâäàëî.

Â íàñòîÿùåå âðåìÿ ïðîèñõîäèò âîç-

ðîæäåíèå Âîåííî-ìîðñêîãî ôëîòà Ðîñ-

ñèè ïîñëå òðóäíîãî «ïåðåñòðîå÷íîãî»

ïåðèîäà. Êîðàáëè âûõîäÿò â îòäàëåííûå

îêåàíñêèå çîíû íåñåíèÿ áîåâûõ äå-

æóðñòâ è ó÷åáíî-áîåâîé ïîäãîòîâêè.

È çäåñü ðîëü êàôåäðû â õèðóðãè÷åñêîé

ïîäãîòîâêå ìîðñêèõ âðà÷åé íåñîìíåí-

íî âîçðàñòàåò. Ôóíäàìåíòîì òàêîé ïîä-

ãîòîâêè, áåçóñëîâíî, ÿâëÿåòñÿ õîðîøèé

ó÷åáíèê.

Â Ñàíêò-Ïåòåðáóðãå â 2012 ã. âûøëî

â ñâåò «Ó÷åáíîå ïîñîáèå ê ïðàêòè÷åñêèì

çàíÿòèÿì ïî õèðóðãè÷åñêèì çàáîëåâà-

íèÿì», ïîäãîòîâëåííîå ïðîôåññîðàìè

êàôåäðû âîåííî-ìîðñêîé è ãîñïèòàëü-

íîé õèðóðãèè Âîåííî-ìåäèöèíñêîé

àêàäåìèè Ì.Þ.Êàáàíîâûì, È.À.Ñîëîâü-

¸âûì, Í.Â.Ðóõëÿäîé, À.Ï.Óòî÷êèíûì,

Ñ.È.Ñìèðíîâûì. Îïóáëèêîâàíî îíî èç-

äàòåëüñòâîì «ÌÎÐÑÀÐ ÀÂ», ïðåäíàçíà-

÷åíî äëÿ êóðñàíòîâ è ñëóøàòåëåé ôà-

êóëüòåòîâ ïîäãîòîâêè âðà÷åé (èçäàíèå

âòîðîå, ïåðåðàáîòàííîå è äîïîëíåííîå).

Ó÷åáíîå ïîñîáèå óòâåðæäåíî Ó÷åíûì

ñîâåòîì Âîåííî-ìåäèöèíñêîé àêàäåìèè,

ñîñòîèò èç äâóõ ÷àñòåé (òîìîâ), àâòîð-

ñêèé êîëëåêòèâ âêëþ÷àåò 26 âåäóùèõ

ñïåöèàëèñòîâ êàôåäðû*.

Ïîñîáèå ÿâëÿåòñÿ äîïîëíåíèåì ê

ó÷åáíèêàì ïî ÷àñòíîé õèðóðãèè è ïðåä-

íàçíà÷åíî äëÿ ñàìîñòîÿòåëüíîé ïîä-

ãîòîâêè ê ïðàêòè÷åñêèì çàíÿòèÿì ïî

õèðóðãèè íà 4–5-ì êóðñàõ. Ïåðâàÿ ÷àñòü

ïîñâÿùåíà âîïðîñàì ôàêóëüòåòñêîé

õèðóðãèè, âòîðàÿ – ãîñïèòàëüíîé õè-

ðóðãèè. Îñîáîå âíèìàíèå êóðñàíòîâ îá-

ðàùàåòñÿ íà äèàãíîñòèêó è ëå÷åáíóþ

òàêòèêó ïðè îñòðûõ õèðóðãè÷åñêèõ çà-

áîëåâàíèÿõ îðãàíîâ áðþøíîé ïîëîñòè

è òðàâìàõ íà êîðàáëÿõ è ïîäâîäíûõ

ëîäêàõ ÂÌÔ.

Â íîâîì ó÷åáíîì ïîñîáèè ïðåäñòàâ-

ëåíû íå òîëüêî ó÷åáíûé ìàòåðèàë äëÿ

ïîäãîòîâêè ê çàíÿòèÿì ïî èçó÷àåìûì

òåìàì, íî è êîíòðîëüíûå âîïðîñû, ïå-

ðå÷åíü îòðàáàòûâàåìûõ ïðàêòè÷åñêèõ

íàâûêîâ, ñèòóàöèîííûå çàäà÷è, çàäàíèÿ

äëÿ ñàìîñòîÿòåëüíîé ðàáîòû, âîïðîñû

ïî ñàìîêîíòðîëþ, óêàçàíà ëèòåðàòóðà

äëÿ ïîäãîòîâêè ê çàíÿòèÿì. Ïî îñíîâ-

íûì íîçîëîãè÷åñêèì ôîðìàì õèðóðãè-

÷åñêîé ïàòîëîãèè îòäåëüíî ðàññìàòðè-

âàþòñÿ âîïðîñû âîåííî-âðà÷åáíîé

ýêñïåðòèçû.

Ïîñîáèå âûïóùåíî òèðàæîì 1000

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êîððåêòîðàìè. Â êà÷åñòâå çàìå÷àíèÿ ïî

òåõíè÷åñêîìó îôîðìëåíèþ ìîæíî îò-

ìåòèòü îòñóòñòâèå àëôàâèòíîãî è òåìà-

òè÷åñêîãî óêàçàòåëåé, åäèíîãî îãëàâëå-

íèÿ, ÷òî çíà÷èòåëüíî îáëåã÷èëî áû

ïîëüçîâàíèå ó÷åáíèêîì. Íàäååìñÿ, ÷òî

ýòî ïîæåëàíèå áóäåò ó÷òåíî â ïîñëåäó-

þùèõ èçäàíèÿõ.

Â ïðåäèñëîâèè ê ïîñîáèþ çàìåñòè-

òåëü íà÷àëüíèêà Âîåííî-ìåäèöèíñêîé

àêàäåìèè èì. Ñ.Ì.Êèðîâà ïî ó÷åáíîé è

íàó÷íîé ðàáîòå ãåíåðàë-ìàéîð ìåäèöèí-

ñêîé ñëóæáû çàïàñà Î.Ë.Åâëàíîâ ïèøåò:

«Íàñòîÿùåå ïîñîáèå ìîæåò áûòü ïîëåç-

íî è äëÿ ìîëîäûõ ïðåïîäàâàòåëåé, ñïî-

ñîáñòâóÿ ïðàâèëüíîé îðãàíèçàöèè è óíè-

ôèêàöèè ïðîâåäåíèÿ çàíÿòèé, à ñëåäîâà-

òåëüíî, áîëåå ýôôåêòèâíîìó èçó÷åíèþ

õèðóðãèè íà IV–V êóðñàõ è â êîíå÷íîì

èòîãå – ïîäãîòîâêå âûñîêîêâàëèôèöèðî-

âàííûõ âðà÷åé äëÿ Âîåííî-ìîðñêîãî

ôëîòà». Ïîëíîñòüþ ïðèñîåäèíÿåìñÿ

ê ýòîìó âûñêàçûâàíèþ.

* Êàáàíîâ Ì.Þ., Ñîëîâü¸â È.À., Ðóõëÿäà Í.Â.,Óòî÷êèí À.Ï., Ñìèðíîâ Ñ.È. Ó÷åáíîå ïîñî-áèå ê ïðàêòè÷åñêèì çàíÿòèÿì ïî õèðóðãè-÷åñêèì çàáîëåâàíèÿì. – ×. I. – ÑÏá, 2012. –432 ñ.; ×. II. – ÑÏá, 2012. – 152 ñ. 1000 ýêç.


ÕÐÎÍÈÊÀ

© À.Í.ÃÐÅÁÅÍÞÊ, È.Â.ÕÎËÈÊÎÂ, 2013ÓÄÊ [61:355](063)(4)

Óñèëèÿ ÍÀÒÎ ïî ïðîòèâîäåéñòâèþ õèìè÷åñêèì,áèîëîãè÷åñêèì, ðàäèîëîãè÷åñêèì è ÿäåðíûì óãðîçàì

ÃÐÅÁÅÍÞÊ À.Í., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû ([email protected])ÕÎËÈÊÎÂ È.Â., ïðîôåññîð, ïîëêîâíèê


Ñ 22 ïî 26 îêòÿáðÿ 2012 ã. â Èïðå

(Áåëüãèÿ) ïðîõîäèëà Êîíôåðåíöèÿ

ïî ïðîáëåìàì ìåäèöèíñêîãî îáåñïå÷å-

íèÿ îïåðàöèé ÍÀÒÎ, ãëàâíîé òåìîé

êîòîðîé áûëî îáñóæäåíèå ñîâðåìåííûõ

õèìè÷åñêèõ, áèîëîãè÷åñêèõ, ðàäèîëîãè-

÷åñêèõ è ÿäåðíûõ óãðîç è îáîñíîâàíèå

ìåäèöèíñêèõ ìåðîïðèÿòèé ïî ïðîòèâî-

äåéñòâèþ ýòèì óãðîçàì.

Ìåñòî ïðîâåäåíèÿ Êîíôåðåíöèè

áûëî âûáðàíî íå ñëó÷àéíî, ïîòîìó ÷òî

èìåííî â ýòèõ ìåñòàõ 22 àïðåëÿ 1915 ã.

íåìåöêèå âîéñêà, àòàêóþùèå ïîçèöèè

ôðàíöóçîâ, âûïóñòèëè èç áàëëîíîâ îêî-

ëî 130 ò õëîðà. Â ðåçóëüòàòå ãàçîâîé àòà-

êè áûëî ïîðàæåíî îêîëî 15 òûñ. ÷åëîâåê,

èç êîòîðûõ áîëåå 5 òûñ. ïîãèáëè â òå÷å-

íèå ñëåäóþùèõ 1–2 ñóòîê. Èìåííî ýòî

âîåííîå èñïîëüçîâàíèå õëîðà ïðèíÿòî

ñ÷èòàòü íà÷àëîì õèìè÷åñêîé âîéíû, è

èìåííî ñ äàííîãî ìîìåíòà âåäåò îòñ÷åò

èñòîðèÿ ñîçäàíèÿ è ïðèìåíåíèÿ õèìè-

÷åñêîãî îðóæèÿ. Ñ ýòèìè æå ìåñòàìè ñâÿ-

çàíî è íàçâàíèå èïðèòà – îäíîãî èç íàè-

áîëåå ýôôåêòèâíûõ áîåâûõ îòðàâëÿþ-

ùèõ âåùåñòâ Ïåðâîé ìèðîâîé âîéíû.

Ñ âîåííûìè öåëÿìè èïðèò âïåðâûå áûë

ïðèìåíåí Ãåðìàíèåé â íî÷ü ñ 12 íà

13 èþíÿ 1917 ã. ïðè îáñòðåëå õèìè÷åñêè-

ìè ñíàðÿäàìè àíãëî-ôðàíöóçñêèõ âîéñê,

äèñëîöèðîâàííûõ â äîëèíå ðåêè Èïð.

Â ðàáîòå Êîíôåðåíöèè ïðèíÿëè ó÷à-

ñòèå 65 ïðåäñòàâèòåëåé ìåäèöèíñêèõ

ñëóæá âîîðóæåííûõ ñèë èç 23 ñòðàí,

âõîäÿùèõ â áëîê ÍÀÒÎ, è êàíäèäàòîâ

íà âõîæäåíèå: Áåëüãèè, Âåëèêîáðèòàíèè,

Ãåðìàíèè, Èñïàíèè, Èòàëèè, Êàíàäû,

Íèäåðëàíäîâ, Ïîëüøè, ÑØÀ, Ôðàíöèè,

×åõèè è äð. Ñðåäè ó÷àñòíèêîâ áûëè ïðåä-

ñòàâèòåëè âûñøåãî êîìàíäíîãî ñîñòàâà

ìåäèöèíñêîé ñëóæáû ñòðàí ÍÀÒÎ: áðè-

ãàäíûé ãåíåðàë Rob van der Meer (ïðåä-

ñåäàòåëü êîìèòåòà íà÷àëüíèêîâ ìåäè-

öèíñêèõ ñëóæá ñòðàí ÍÀÒÎ), ãåíåðàë-

ìàéîð Geert Laire (íà÷àëüíèê ìåäèöèí-

ñêîé ñëóæáû ÂÑ Áåëüãèè), áðèãàäèð Chris

Parker (ìåäèöèíñêèé ñîâåòíèê êîìàíäî-

âàíèÿ îáúåäèíåííîé ãðóïïèðîâêè ÍÀÒÎ

â Àôãàíèñòàíå), ïîëêîâíèê Jurgen

Brandenstein (ìåäèöèíñêèé ñîâåòíèê êî-

ìàíäîâàíèÿ îáúåäèíåííîé ãðóïïèðîâêè

ÍÀÒÎ â Àôãàíèñòàíå ñ 1 íîÿáðÿ), ïîë-

êîâíèê Michael Uhl (ìåäèöèíñêèé ñîâåò-

íèê êîìàíäîâàíèÿ îáúåäèíåííîé ãðóï-

ïèðîâêè ÍÀÒÎ â Êîñîâî), ïîëêîâíèê

Gerry Kerr (íà÷àëüíèê ìåäèöèíñêîé

ñëóæáû ÂÑ Èðëàíäèè), ìàéîð Cyrille

Dupont (íà÷àëüíèê ìåäèöèíñêîé ñëóæ-

áû ÂÑ Ëþêñåìáóðãà), ïîëêîâíèê çàïàñà

Francois Martelet (ãåíåðàëüíûé ñåêðåòàðü

êîíôåäåðàöèè îôèöåðîâ ìåäèöèíñêîé

ñëóæáû çàïàñà).

Ïðåäñåäàòåëåì Êîíôåðåíöèè áûë

áðèãàäíûé ãåíåðàë Frank Schindelhauer

(ìåäèöèíñêèé ñîâåòíèê ñîþçíè÷åñêîãî

îïåðàòèâíîãî êîìàíäîâàíèÿ ÍÀÒÎ), ñî-

ïðåäñåäàòåëÿìè – ïîëêîâíèê Wynand

Kortering (ìåäèöèíñêèé ñîâåòíèê ìåæ-

äóíàðîäíîãî âîåííîãî êîìàíäîâàíèÿ

ÍÀÒÎ) è êàïèòàí 1-ãî ðàíãà Rupert


ÕÐÎÍÈÊÀ

© Â.À.ÐÅÂÀ, 2013ÓÄÊ 616-001-089-083.98(436)

Íàó÷íî-ïðàêòè÷åñêèé êóðñ«Òðàâìà è íåîòëîæíàÿ õèðóðãèÿ» â Çàëüöáóðãå

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


Ñ 13 ïî 19 ÿíâàðÿ 2013 ã. â ã. Çàëüö- áóðãå (Àâñòðèÿ) ïðîõîäèë íàó÷íî-

ïðàêòè÷åñêèé êóðñ ïî ïðîáëåìàì ëå÷å-íèÿ ðàíåíûõ, ïîñòðàäàâøèõ è áîëüíûõñ îñòðîé õèðóðãè÷åñêîé ïàòîëîãèåé. Îáó-÷àþùèå êóðñû ïî ðàçíûì ìåäèöèíñêèìñïåöèàëüíîñòÿì ïðîâîäÿòñÿ â Çàëüöáóðãååæåãîäíî ñ 1993 ã. ïîä ýãèäîé Àìåðèêàíî-àâñòðèéñêîãî ôîíäà. Èõ îñíîâíàÿ èäåÿçàêëþ÷àåòñÿ â ïðåäîñòàâëåíèè íîâåéøåéèíôîðìàöèè ïî óêàçàííîé ïðîáëåìåâ âèäå ëåêöèé è äèñêóññèé ñ ó÷àñòèåì ïðî-ôåññîðîâ ÑØÀ è ñòðàí Åâðîïû.

Âîïðîñû, ðàññìàòðèâàåìûå â ðàìêàõêóðñà, çàòðàãèâàþò, ïîìèìî ïðî÷åãî, ïà-òîôèçèîëîãè÷åñêèå è ïàòîáèîõèìè÷åñêèåàñïåêòû ëå÷åíèÿ ïàöèåíòîâ, îñîáåííîñ-òè èõ ïîñëåîïåðàöèîííîãî âåäåíèÿ.Â äèñêóññèè îáúåäèíÿþòñÿ âçãëÿäû èìíåíèÿ âðà÷åé ðàçëè÷íûõ ñïåöèàëüíîñ-òåé – îáùèõ õèðóðãîâ, òðàâìàòîëîãîâ èîðòîïåäîâ, àíåñòåçèîëîãîâ-ðåàíèìàòîëî-ãîâ è äðóãèõ ñïåöèàëèñòîâ, ó÷àñòâóþùèõâ îêàçàíèè ïîìîùè äàííîé êàòåãîðèèïàöèåíòîâ. Îñîáîå âíèìàíèå óäåëÿåòñÿèíòåíñèâíîé òåðàïèè è îêàçàíèþ ðåàíè-ìàòîëîãè÷åñêîé ïîìîùè òÿæåëûì ðàíå-íûì è ïîñòðàäàâøèì.

Ïÿòèäíåâíûé êóðñ áûë ðàçäåëåí íàíåñêîëüêî ñåññèé, ïîñâÿùåííûõ ðàçëè÷-íûì àñïåêòàì òðàâìû è íåîòëîæíîé õè-ðóðãèè. Â îáùåé ñëîæíîñòè ïðî÷èòàíî20 ïîëíîöåííûõ ëåêöèé, ïîñòðîåííûõ âñòèëå ñâîáîäíîãî îáñóæäåíèÿ ïðîñëó-øàííîãî äîêëàäà. Â êóðñå ó÷àñòâîâàëî34 ìîëîäûõ ñïåöèàëèñòà, â îñíîâíîìèç ñòðàí Âîñòî÷íîé Åâðîïû. Ïîñëå âñòó-ïèòåëüíîãî ñëîâà ïðîâîäèëîñü òåñòèðî-âàíèå ó÷àñòíèêîâ íà ïðåäìåò áàçîâûõçíàíèé ïî îáñóæäàåìîé ïðîáëåìå, ñ êîí-òðîëüíûì ïðîõîæäåíèåì òåõ æå òåñòîâïî îêîí÷àíèè ñåìèíàðà.

Äëÿ êàæäîãî èç ïðîôåññîðîâ ïðåäóñ-ìàòðèâàëîñü ïðî÷òåíèå íåñêîëüêèõ ëåê-öèé. Îäèí èç äîêëàäîâ ïðîôåññîðàM.Øðåéáåðà (ÑØÀ) áûë ïîñâÿùåí êîí-öåïöèè «çîëîòîãî ÷àñà». Ñóùåñòâåííûìïðîãðåññîì â ïðèìåíåíèè ðàííåé òàêòè-êè ëå÷åíèÿ ïàöèåíòîâ ñ ïîëèòðàâìîé ÿâ-ëÿåòñÿ ïîÿâëåíèå êîíöåïöèè DamageControl Resuscitation (ðåàíèìàöèÿ), âêëþ-÷àþùåé êàê ìîæíî áîëåå ðàííþþ òðàíñ-ôóçèþ êîìïîíåíòîâ êðîâè â ñîîòíîøå-íèè 1:1:1 (ñâåæåçàìîðîæåííàÿ ïëàçìà :ýðèòðîöèòàðíàÿ âçâåñü : òðîìáîöèòàðíàÿìàññà). Òàêàÿ òàêòèêà ïîçâîëÿåò â 3 ðàçàñíèçèòü îáùóþ ëåòàëüíîñòü ïî ñðàâíå-íèþ ñ òðàíñôóçèåé â ñîîòíîøåíèè 1:4:1.Ââåäåíèå èçáûòî÷íîãî êîëè÷åñòâà ïëàç-ìîçàìåùàþùèõ ñðåä íåãàòèâíî ñêàçûâà-åòñÿ íà îáùåì ñîñòîÿíèè ðàíåíîãî, ïðè-âîäèò ê èììóíîñóïðåññèè, óâåëè÷èâàåòâðåìÿ òðàíñïîðòèðîâêè, óñóãóáëÿåò êîà-ãóëîïàòèþ. Äîêëàä÷èê îòìåòèë íå ìåíååöåííûé, à â ðÿäå ñëó÷àåâ äàæå áîëåå âû-ðàæåííûé ïîëîæèòåëüíûé ýôôåêò îò ïå-ðåëèâàíèÿ öåëüíîé êðîâè, íåæåëè åå êîì-ïîíåíòîâ. Òàêàÿ ïðàêòèêà áûëà íåîäíî-êðàòíî àïðîáèðîâàíà â óñëîâèÿõ áîåâûõäåéñòâèé â Èðàêå è Àôãàíèñòàíå.

Âòîðîå ñîîáùåíèå áûëî ïîñâÿùåíîïðîíèêàþùèì ðàíåíèÿì ðàçíûõ àíàòî-ìè÷åñêèõ îáëàñòåé. Ïðîô. Ì.Øðåéáåðâûäåëèë íåñêîëüêî èñòîðè÷åñêèõ ýòàïîâ,ïîäðàçäåëÿþùèõ ðàçëè÷íûå ïîäõîäû êëå÷åíèþ íîæåâûõ è îãíåñòðåëüíûõ ðà-íåíèé. Â êîíöå XIX â., êàê ïðàâèëî, ïðè-ìåíÿëàñü êîíñåðâàòèâíàÿ òàêòèêà â îò-íîøåíèè áîëüøèíñòâà ðàíåíèé, îäíàêîâ õîäå Ïåðâîé è Âòîðîé ìèðîâûõ âîéíêîíöåïöèÿ èçìåíèëàñü íà ïðÿìî ïðî-òèâîïîëîæíóþ, – ëþáûå ðàíåíèÿ ïîä-âåðãàëèñü õèðóðãè÷åñêîé ðåâèçèè ñ âû-ñîêîé ÷àñòîòîé íàïðàñíûõ îïåðàöèé.


ÕÐÎÍÈÊÀ

Çà ñîäåðæàíèå è äîñòîâåðíîñòü ñâåäåíèé â ðåêëàìíîì îáúÿâëåíèèîòâåòñòâåííîñòü íåñåò ðåêëàìîäàòåëü.

Ïîäïèñàíî ê ïå÷àòè 25.03.13.Áóìàãà îôñåòíàÿ.Ó÷.-èçä. ë. 8,6.Êàòàëîæíàÿ öåíà 54 ð. 00 ê.

Îòïå÷àòàíî â òèïîãðàôèè ÎÀÎ «Èçäàòåëüñêèé äîì «Êðàñíàÿ çâåçäà»123007, Ìîñêâà, Õîðîøåâñêîå øîññå, 38, http://www.redstarph.ru

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 27.02.13.Ôîðìàò 70½1081/

16.

Óñë. ïå÷. ë. 8,4.Çàêàç ¹ 1376.

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

Ïå÷àòü îôñåòíàÿ.Óñë. êð.-îòò. 9,8.Òèðàæ 2963 ýêç.

Â äîêëàäå ïðîôåññîðà Ñ.Ý÷åìïàòè(ÑØÀ) ðàññìàòðèâàëèñü âîïðîñû ïðîôè-ëàêòèêè è ëå÷åíèÿ õèðóðãè÷åñêîé èíôåê-öèè. Îí îáðàòèë âíèìàíèå íà ÷ðåçìåðíî÷àñòîå íàïðàñíîå ïðèìåíåíèå áîëüøîãî÷èñëà àíòèáèîòèêîâ, ÷òî ïðèâîäèò ê ïî-ÿâëåíèþ ðåçèñòåíòíûõ øòàììîâ. Â íàñòî-ÿùåå âðåìÿ äëÿ áîëüøèíñòâà ðàíåíûõñ÷èòàåòñÿ äîñòàòî÷íûì ïðèìåíåíèå àí-òèáèîòèêîâ â òå÷åíèå 24 ÷.

Ñîîáùåíèå Ð.Òîääà (ÑØÀ) áûëîïîñâÿùåíî êîíñåðâàòèâíîìó ëå÷åíèþçàêðûòûõ ïîâðåæäåíèé ïàðåíõèìàòîç-íûõ îðãàíîâ. Îñíîâíûìè êðèòåðèÿìè,îïðåäåëÿþùèìè âîçìîæíîñòü òàêîéòàêòèêè, ÿâëÿþòñÿ ñòàáèëüíîå ñîñòîÿ-íèå ïîñòðàäàâøåãî è âîçìîæíîñòü âû-ïîëíåíèÿ ÊÒ ñ àíãèîêîíòðàñòèðîâà-íèåì. ×èñëî óñïåøíûõ ñëó÷àåâ íåîïå-ðàòèâíîãî ëå÷åíèÿ ïîâðåæäåíèé ïå÷å-íè è ñåëåçåíêè ìîæåò áûòü óâåëè÷åíîïîñðåäñòâîì øèðîêîãî ïðèìåíåíèÿàíãèîýìáîëèçàöèé ïîâðåæäåííûõ ñîñó-äîâ, âûÿâëåííûõ ïðè ÊÒ. Ïðè òðàâìå ñå-ëåçåíêè èç 344 ñòàáèëüíûõ ïàöèåíòîâ,ëå÷åííûõ êîíñåðâàòèâíî, òîëüêî ó 7 âïîñëåäóþùåì ïîòðåáîâàëîñü âûïîëíå-íèå ëàïàðîòîìèè (2%). Ïðè ìåòààíàëèçåäàííûõ êîíñåðâàòèâíîãî ëå÷åíèÿ ïî-ñòðàäàâøèõ ñ çàêðûòîé òðàâìîé ïå÷å-íè 3–5 ñòåïåíè â 7 òðàâìîöåíòðàõ 1-ãîóðîâíÿ óñòàíîâëåíî, ÷òî 65% ïàöèåí-òîâ ìîãóò áûòü óñïåøíî âûëå÷åíû áåçîïåðàöèè.

Ð.Êîçèð (Àâñòðèÿ) â ñâîåì äîêëàäå,ïîñâÿùåííîì àáäîìèíàëüíîìó êîìïàðò-ìåíò-ñèíäðîìó, âûäåëèë îñíîâíîå ïî-êàçàíèå ê ïðèìåíåíèþ äåêîìïðåññèâ-íîé ëàïàðîòîìèè – ïîâûøåíèå âíóòðè-áðþøíîãî äàâëåíèÿ áîëåå 20 ìì ðò. ñò.ïðè íàëè÷èè ñîîòâåòñòâóþùèõ êëèíè-÷åñêèõ ïðèçíàêîâ. Áûëî îçâó÷åíî ìíîæå-ñòâî ðàçëè÷íûõ òåõíèê âðåìåííîãî çà-êðûòèÿ áðþøíîé ïîëîñòè – «Bogota Bag»,«Wittmann Patch», âàêóóìíîå äðåíèðîâà-íèå ðàíû, ðàçëè÷íûå íåàäãåçèâíûå ïëåí-êè, ñâåäåíèå êðàåâ ðàíû ñ ïîìîùüþ ïî-ñëàáëÿþùèõ ðàçðåçîâ àïîíåâðîçà ïðÿìîéè íàðóæíîé êîñîé ìûøöû æèâîòà.

Ðÿä äðóãèõ äîêëàäîâ áûë ïîñâÿùåíâàæíûì ÷àñòíûì âîïðîñàì, òàêèì êàêñïèíàëüíàÿ è ÷åðåïíî-ìîçãîâàÿ òðàâìà,ïîâðåæäåíèÿ ñâÿçî÷íîãî àïïàðàòà ñó-ñòàâîâ, ëå÷åíèå æåëóäî÷íî-êèøå÷íûõêðîâîòå÷åíèé è îñòðîé êèøå÷íîé íåïðî-õîäèìîñòè.

Â öåëîì íà ñåìèíàðå áûëè ïðåäñòàâ-ëåíû ëåêöèè âûñîêîãî óðîâíÿ îò âåäó-ùèõ ñïåöèàëèñòîâ â îáëàñòè òðàâìàòî-ëîãèè è íåîòëîæíîé õèðóðãèè. Êàæäàÿëåêöèÿ ñîïðîâîæäàëàñü äëèòåëüíûì îá-ñóæäåíèåì ñ îáîþäíûì îáìåíîì ìíå-íèÿìè è îïûòîì, ÷òî ñäåëàëî êóðñ îñî-áåííî ïîëåçíûì è ïðîäóêòèâíûì.

Çàêðûòèå ñåìèíàðà ïðîõîäèëî â âèäåïî÷åòíîãî ïðèåìà äëÿ ó÷àñòíèêîâ êóðñàè ëåêòîðîâ ñ êîíöåðòîì ñòóäåíòîâ ìåñò-íîé êîíñåðâàòîðèè.

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