Episodes of asthma during pregnancy – link with a viral infection and treatment approaches

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
ɍȾɄ 616.248-06:618.2:616.98-08

Ɍ.Ⱥ. ɉɟɪɰɟɜɚ,
Ɍ.ȼ. Ʉɢɪɟɟɜɚ,
ɇ.Ʉ. Ʉɪɚɜɱɟɧɤɨ

ɗɉɂɁɈȾɕ ȻɊɈɇɏɂȺɅɖɇɈɃ ȺɋɌɆɕ ɉɊɂ
ȻȿɊȿɆȿɇɇɈɋɌɂ – ɋȼəɁɖ ɋ ȼɂɊɍɋɇɈɃ
ɂɇɎȿɄɐɂȿɃ ɂ ɉɈȾɏɈȾɕ Ʉ Ʌȿɑȿɇɂɘ

Ƚɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ ɆɁ ɍɤɪɚɢɧɵ»
ɤɚɮɟɞɪɚ ɮɚɤɭɥɶɬɟɬɫɤɨɣ ɬɟɪɚɩɢɢ ɢ ɷɧɞɨɤɪɢɧɨɥɨɝɢɢ
(ɡɚɜ. – ɱɥɟɧ-ɤɨɪɪ. ɇȺɆɇ ɍɤɪɚɢɧɵ, ɞ. ɦɟɞ. ɧ., ɩɪɨɮ. Ɍ.Ⱥ. ɉɟɪɰɟɜɚ)
ɭɥ. Ȼɚɬɭɦɫɤɚɹ, 13, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49000, ɍɤɪɚɢɧɚ
SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine"
chair of medicine and endocrinology
Batumskaya str., 13, Dnepropetrovsk, 49000, Ukraine
e-mail: simmetrichno@gmail.com
Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɛɪɨɧɯɢɚɥɶɧɚɹ ɚɫɬɦɚ, ɛɟɪɟɦɟɧɧɨɫɬɶ, ɛɚɡɢɫɧɚɹ ɬɟɪɚɩɢɹ, ɨɛɨɫɬɪɟɧɢɟ
Key words: asthma, pregnancy, basic therapy, exacerbation
Ɋɟɮɟɪɚɬ. ȿɩɿɡɨɞɢ ɛɪɨɧɯɿɚɥɶɧɨʀ ɚɫɬɦɢ ɩɪɢ ɜɚɝɿɬɧɨɫɬɿ – ɡɜ'ɹɡɨɤ ɡ ɜɿɪɭɫɧɨɸ ɿɧɮɟɤɰɿɽɸ ɬɚ ɩɿɞɯɨɞɢ ɞɨ
ɥɿɤɭɜɚɧɧɹ. ɉɟɪɰɟɜɚ Ɍ.Ɉ., Ʉɿɪɟɽɜɚ Ɍ.ȼ., Ʉɪɚɜɱɟɧɤɨ ɇ.Ʉ. Ȼɪɨɧɯɿɚɥɶɧɚ ɚɫɬɦɚ (ȻȺ) – ɧɚɣɛɿɥɶɲ ɩɨɲɢɪɟɧɟ ɡɚɯɜɨɪɸɜɚɧɧɹ ɞɢɯɚɥɶɧɨʀ ɫɢɫɬɟɦɢ ɭ ɜɚɝɿɬɧɢɯ, ɩɪɢ ɰɶɨɦɭ 20% ɜɚɝɿɬɧɢɯ ɩɟɪɟɧɨɫɹɬɶ ɡɚɝɨɫɬɪɟɧɧɹ ȻȺ ɪɿɡɧɨɝɨ ɫɬɭɩɟɧɹ
ɬɹɠɤɨɫɬɿ ɿ 5,8% ɡ ɧɢɯ ɩɨɬɪɟɛɭɸɬɶ ɝɨɫɩɿɬɚɥɿɡɚɰɿʀ. Ɇɟɬɚ ɞɨɫɥɿɞɠɟɧɧɹ: ɜɢɜɱɢɬɢ ɩɟɪɟɛɿɝ ȻȺ ɩɪɢ ɜɚɝɿɬɧɨɫɬɿ
ɲɥɹɯɨɦ ɜɢɡɧɚɱɟɧɧɹ ɤɥɿɧɿɤɨ-ɮɭɧɤɰɿɨɧɚɥɶɧɢɯ ɨɫɨɛɥɢɜɨɫɬɟɣ ɩɟɪɟɛɿɝɭ ɡɚɯɜɨɪɸɜɚɧɧɹ, ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɧɚɹɜɧɨɫɬɿ
ɡɚɝɨɫɬɪɟɧɶ ɬɚ ɩɪɢɯɢɥɶɧɨɫɬɿ ɞɨ ɛɚɡɢɫɧɨʀ ɬɟɪɚɩɿʀ (ȻɌ). Ɇɚɬɟɪɿɚɥɢ ɿ ɦɟɬɨɞɢ: ɭ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɨ ɜɤɥɸɱɟɧɨ 35
ɜɚɝɿɬɧɢɯ ɭ ɜɿɰɿ (Me± SD) 31±5,28 ɪɨɤɭ, ɬɟɪɦɿɧ ɜɚɝɿɬɧɨɫɬɿ 34±6,69 ɬɢɠɧɹ. ɉɪɨɜɟɞɟɧɨ ɚɧɚɥɿɡ ɚɧɚɦɧɟɫɬɢɱɧɢɯ ɿ
ɮɿɡɢɤɚɥɶɧɢɯ ɞɚɧɢɯ, ɫɩɿɪɨɦɟɬɪɿɹ, ɨɰɿɧɤɚ ɪɿɜɧɹ ɤɨɧɬɪɨɥɸ ȻȺ ɡɚ ɞɨɩɨɦɨɝɨɸ ɬɟɫɬɭ ɤɨɧɬɪɨɥɸ ȻȺ (Ⱥsthma ɋontrol
Ɍest). Ɋɟɡɭɥɶɬɚɬɢ: ɭ ɞɨɫɥɿɞɠɭɜɚɧɿɣ ɝɪɭɩɿ 71% ɜɚɝɿɬɧɢɯ ɩɟɪɟɧɟɫɥɢ ɡɚɝɨɫɬɪɟɧɧɹ ɪɿɡɧɨɝɨ ɫɬɭɩɟɧɹ ɬɹɠɤɨɫɬɿ, ɹɤɿ
ɪɨɡɜɢɜɚɥɢɫɹ ɧɚ ɬɥɿ ɫɢɦɩɬɨɦɿɜ ȽɊȼȱ. ɉɪɢ ɰɶɨɦɭ ɩɪɢɯɢɥɶɧɿɫɬɶ ɞɨ ȻɌ ɞɨ ɿ ɩɿɞ ɱɚɫ ɜɚɝɿɬɧɨɫɬɿ ɞɨɫɬɨɜɿɪɧɨ ɧɟ
ɜɿɞɪɿɡɧɹɥɢɫɹ. ȼɢɹɜɥɟɧɨ ɧɟɜɿɞɩɨɜɿɞɧɿɫɬɶ ȻɌ ɫɬɭɩɟɧɸ ɬɹɠɤɨɫɬɿ ɡɚɯɜɨɪɸɜɚɧɧɹ ɭ 25% ɠɿɧɨɤ ɡ ɥɟɝɤɢɦ ɿ 36% ɡ
ɫɪɟɞɧɶɨɬɹɠɤɢɦ ɩɟɪɟɛɿɝɨɦ ɚɫɬɦɢ.
Abstract. Episodes of asthma during pregnancy – link with a viral infection and treatment approaches. Pertseva
T.A., Kireyeva T.V., Kravchenko N.K. Bronchial asthma (BA) is the most common respiratory disease in pregnancy.
About 20% of pregnant women experience asthma exacerbations of varying severity, while 5.8 % of them require
hospitalization. Objective: to study asthma course during pregnancy by determining clinical and functional characteristics of the disease, taking into account presence of exacerbations and adherence to basic therapy (BT).
Materials and methods: The study included 35 pregnant females (Me ± SD) aged 31±5,28 years, gestational age –
34±6,69 weeks. Anamnestic and physical data, spirometry and assessment of asthma control using Control Asthma Test
were conducted. Results: In the study group 71% of pregnant women suffered from aggravation of varying severity
developing on the background of symptoms of respiratory tract infection. Here with commitment to BT before and
during pregnancy significantly did not differ. Inconsistency of BT to severity of the disease in 25% of women with mild
and in 36% with moderate asthma course was detected.

Ȼɪɨɧɯɢɚɥɶɧɚɹ ɚɫɬɦɚ (ȻȺ) – ɧɚɢɛɨɥɟɟ ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɨɟ ɡɚɛɨɥɟɜɚɧɢɟ ɞɵɯɚɬɟɥɶɧɨɣ ɫɢɫɬɟɦɵ ɭ
ɛɟɪɟɦɟɧɧɵɯ ɢ, ɩɨ ɞɚɧɧɵɦ ɪɚɡɧɵɯ ɢɫɫɥɟɞɨɜɚɧɢɣ,
ɜɫɬɪɟɱɚɟɬɫɹ ɭ 8-13% ɠɟɧɳɢɧ [6, 7]. ɉɪɢ ɷɬɨɦ
20% ɛɟɪɟɦɟɧɧɵɯ ɩɟɪɟɧɨɫɹɬ ɨɛɨɫɬɪɟɧɢɹ ȻȺ ɪɚɡɧɨɣ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ ɢ 5,8% ɢɡ ɧɢɯ ɬɪɟɛɭɸɬ
ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ [4, 10].
ɉɪɟɞɫɤɚɡɚɬɶ, ɤɚɤ ɢɡɦɟɧɢɬɫɹ ɬɟɱɟɧɢɟ ȻȺ ɧɚ
ɮɨɧɟ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɧɚ ɫɟɝɨɞɧɹɲɧɟɣ ɞɟɧɶ ɧɟɜɨɡɦɨɠɧɨ, ɩɨɫɤɨɥɶɤɭ ɨɫɨɛɟɧɧɨɫɬɢ ɮɢɡɢɨɥɨɝɢɱɟɫɤɢɯ ɢɡɦɟɧɟɧɢɣ ɠɟɧɫɤɨɝɨ ɨɪɝɚɧɢɡɦɚ, ɜɥɢɹɸɳɢɟ ɧɚ ɬɟɱɟɧɢɟ ɡɚɛɨɥɟɜɚɧɢɹ, ɟɳɟ ɧɟ ɢɡɭɱɟɧɵ. ɇɨ
ɢɡɜɟɫɬɟɧ ɪɹɞ ɮɚɤɬɨɪɨɜ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɨɛɨɫɬɪɟɧɢɹ ɭ ɷɬɨɣ ɝɪɭɩɩɵ ɛɨɥɶɧɵɯ. ɇɚɢɛɨɥɟɟ ɡɧɚɱɢɦɵɦɢ ɹɜɥɹɸɬɫɹ: ɧɚɪɭɲɟɧɢɟ ɪɟɠɢɦɚ ɛɚɡɢɫɧɨɣ
ɬɟɪɚɩɢɢ ɢ ɨɛɨɫɬɪɟɧɢɹ ɧɚ ɮɨɧɟ ɜɢɪɭɫɧɨɣ ɢɧ-

14/ Ɍɨɦ ɏIX / 2

ɮɟɤɰɢɢ. Ɍɚɤ, Belanger K. et al., 2010 ɜɵɹɜɢɥɢ, ɱɬɨ
ɢɡɦɟɧɟɧɢɟ ɬɟɱɟɧɢɹ ȻȺ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ
ɞɨɫɬɨɜɟɪɧɨ ɫɜɹɡɚɧɨ ɫ ɬɹɠɟɫɬɶɸ ɡɚɛɨɥɟɜɚɧɢɹ ɞɨ
ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɫ ɩɪɢɜɟɪɠɟɧɧɨɫɬɶɸ ɤ ɛɚɡɢɫɧɨɣ
ɬɟɪɚɩɢɢ. Ɍɟɦ ɧɟ ɦɟɧɟɟ, Chambers K., 2003 ɩɪɢ
ɨɩɪɨɫɟ 500 ɠɟɧɳɢɧ ɞɟɬɨɪɨɞɧɨɝɨ ɜɨɡɪɚɫɬɚ ɫ ȻȺ
ɜɵɹɜɢɥ, ɱɬɨ 82% ɪɟɫɩɨɧɞɟɧɬɨɜ ɨɛɟɫɩɨɤɨɟɧɵ ɜɨɡɦɨɠɧɵɦ ɧɟɝɚɬɢɜɧɵɦ ɜɨɡɞɟɣɫɬɜɢɟɦ ɢɧɝɚɥɹɰɢɨɧɧɵɯ ɫɬɟɪɨɢɞɨɜ (ɢ ȽɄɋ) ɧɚ ɩɥɨɞ, ɚ 36 % ɧɚɦɟɪɟɧɵ
ɨɬɤɚɡɚɬɶɫɹ ɨɬ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ [5].
Ⱦɨ 80 % ɨɛɨɫɬɪɟɧɢɣ ȻȺ ɢɦɟɸɬ ɜɢɪɭɫɧɭɸ
ɷɬɢɨɥɨɝɢɸ [1, 8]. Murphy V. E. et al., 2006 ɩɨɤɚɡɚɥɢ, ɱɬɨ ɛɟɪɟɦɟɧɧɵɟ, ɜ ɨɫɨɛɟɧɧɨɫɬɢ ɫ ȻȺ, ɛɨɥɟɟ
ɜɨɫɩɪɢɢɦɱɢɜɵ ɤ ɪɟɫɩɢɪɚɬɨɪɧɵɦ ɜɢɪɭɫɚɦ ɜ ɜɢɞɭ
ɮɢɡɢɨɥɨɝɢɱɟɫɤɨɣ ɢɦɦɭɧɨɫɭɩɪɟɫɫɢɢ. Ɍɚɤ 34%

25

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
ɛɟɪɟɦɟɧɧɵɯ ɫ ɬɹɠɟɥɵɦ ɨɛɨɫɬɪɟɧɢɟɦ ȻȺ ɫɜɹɡɵɜɚɥɢ ɭɯɭɞɲɟɧɢɟ ɫɨɫɬɨɹɧɢɹ ɫ ɩɟɪɟɧɟɫɟɧɧɨɣ ɪɟɫɩɢɪɚɬɨɪɧɨɣ ɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɟɣ [11].
ɐɟɥɶ ɢɫɫɥɟɞɨɜɚɧɢɹ – ɢɡɭɱɢɬɶ ɬɟɱɟɧɢɟ ȻȺ ɩɪɢ
ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɭɬɟɦ ɨɩɪɟɞɟɥɟɧɢɹ ɤɥɢɧɢɤɨ-ɮɭɧɤɰɢɨɧɚɥɶɧɵɯ ɨɫɨɛɟɧɧɨɫɬɟɣ ɬɟɱɟɧɢɹ ɡɚɛɨɥɟɜɚɧɢɹ,
ɫ ɭɱɟɬɨɦ ɧɚɥɢɱɢɹ ɨɛɨɫɬɪɟɧɢɣ ɢ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ
ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ (ȻɌ).
Ɂɚɞɚɱɢ:

1. ɉɪɨɚɧɚɥɢɡɢɪɨɜɚɬɶ ɧɚɥɢɱɢɟ ɢ ɫɬɟɩɟɧɶ ɬɹɠɟɫɬɢ ɨɛɨɫɬɪɟɧɢɣ ɛɪɨɧɯɢɚɥɶɧɨɣ ɚɫɬɦɵ, ɢɯ ɫɜɹɡɶ
c ɢɧɮɟɤɰɢɟɣ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ.
2. Ɉɰɟɧɢɬɶ ɩɪɢɜɟɪɠɟɧɧɨɫɬɶ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɭ ɠɟɧɳɢɧ ɫ
ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ɚɫɬɦɨɣ.
3. Ɉɰɟɧɢɬɶ ɭɪɨɜɟɧɶ ɤɨɧɬɪɨɥɹ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɭ ɠɟɧɳɢɧ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ɢ
ɢɧɬɟɪɦɢɬɬɢɪɭɸɳɟɣ ɚɫɬɦɨɣ.

Ⱦɢɡɚɣɧ ɢɫɫɥɟɞɨɜɚɧɢɹ:
ɗɬɚɩ 1. Ⱥɧɚɥɢɡ ɧɚɥɢɱɢɹ ɢ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ ɨɛɨɫɬɪɟɧɢɹ ɭ ɛɟɪɟɦɟɧɧɵɯ ɫ ȻȺ
Ȼɟɪɟɦɟɧɧɵɟ ɫ ɨɛɨɫɬɪɟɧɢɟɦ ȻȺ
(n= 25)

ɂɫɤɥɸɱɟɧɵ (n=10)
Ȼɟɪɟɦɟɧɧɵɟ ɜɧɟ ɨɛɨɫɬɪɟɧɢɹ

Ƚɪɭɩɩɚ 1 ɥɟɝɤɨɟ
ɨɛɨɫɬɪɟɧɢɟ (n=8)

Ƚɪɭɩɩɚ 2 ɨɛɨɫɬɪɟɧɢɟ Ƚɪɭɩɩɚ 3 ɬɹɠɟɥɨɟ
ɫɪɟɞɧɟɣ ɬɹɠɟɫɬɢ
ɨɛɨɫɬɪɟɧɢɟ
(n=11)
(n=6)
ɗɬɚɩ 2. Ⱥɧɚɥɢɡ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ

Ȼɟɪɟɦɟɧɧɵɟ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ȻȺ (n=22)

Ʌɟɝɤɚɹ
(n=8; 36%)

ɋɪɟɞɧɟɣ ɬɹɠɟɫɬɢ
(n=11; 50%)

ɂɫɤɥɸɱɟɧɵ (n=13)

Ɍɹɠɟɥɚɹ
(n=3; 14%)

Ȼɟɪɟɦɟɧɧɵɟ ɫ ɢɧɬɟɪɦɢɬɬɢɪɭɸɳɟɣ ȻȺ (n=7); ɠɟɧɳɢɧɵ, ɤɨɬɨɪɵɦ
ɞɢɚɝɧɨɡ ȻȺ ɜɵɫɬɚɜɥɟɧ ɜɩɟɪɜɵɟ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ (n=6)

ɗɬɚɩ 3. Ɉɰɟɧɤɚ ɭɪɨɜɧɹ ɤɨɧɬɪɨɥɹ ȻȺ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ
Ȼɟɪɟɦɟɧɧɵɟ ɫ ɢɧɬɟɪɦɢɬɬɢɪɭɸɳɟɣ (n=7) ɢ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ȻȺ
(n=22)

ɂɫɤɥɸɱɟɧɵ (n=6)
ɀɟɧɳɢɧɵ, ɤɨɬɨɪɵɦ ɞɢɚɝɧɨɡ ȻȺ ɜɵɫɬɚɜɥɟɧ ɜɩɟɪɜɵɟ ɜɨ ɜɪɟɦɹ
ɛɟɪɟɦɟɧɧɨɫɬɢ

ɆȺɌȿɊɂȺɅɕ ɂ ɆȿɌɈȾɕ ɂɋɋɅȿȾɈȼȺɇɂɃ

Ȼɵɥɨ ɨɛɫɥɟɞɨɜɚɧɨ 35 ɛɟɪɟɦɟɧɧɵɯ ɜ ɜɨɡɪɚɫɬɟ
(Me±SD) 31 ± 5,28 ɝɨɞɚ, ɫɪɨɤ ɛɟɪɟɦɟɧɧɨɫɬɢ 34 ±
6,69 ɧɟɞɟɥɢ. ɍ 29 ɠɟɧɳɢɧ ȻȺ ɛɵɥɚ ɭɫɬɚɧɨɜɥɟɧɚ
ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɭ 6 – ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ
ɩɪɢ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ ɜ ɫɬɚɰɢɨɧɚɪ (n=2) ɢɥɢ ɨɬɞɟɥɟɧɢɟ ɪɟɚɧɢɦɚɰɢɢ ɢ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ
(ɈɊɂɌ) (n=4) ɫ ɜɵɪɚɠɟɧɧɵɦ ɛɪɨɧɯɨɨɛɫɬɪɭɤɬɢɜɧɵɦ ɫɢɧɞɪɨɦɨɦ ɧɚ ɮɨɧɟ ɢɧɮɟɤɰɢɢ ɜɟɪɯɧɢɯ
ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ (ɨɫɬɪɵɣ ɪɢɧɨɮɚɪɢɧɝɢɬ,
ɬɪɚɯɟɢɬ). Ⱥɧɚɥɢɡ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɪɨɜɨɞɢɥɫɹ
ɫɪɟɞɢ ɠɟɧɳɢɧ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ȻȺ ɪɚɡɧɨɣ
ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ, ɩɨɥɭɱɚɜɲɢɯ ɜ ɤɚɱɟɫɬɜɟ ȻɌ
ɢ ȽɄɋ. ɍ ɜɫɟɯ ɠɟɧɳɢɧ ɩɪɨɜɨɞɢɥɢɫɶ: ɚɧɚɥɢɡ
ɚɧɚɦɧɟɫɬɢɱɟɫɤɢɯ ɢ ɮɢɡɢɤɚɥɶɧɵɯ ɞɚɧɧɵɯ, ɫɩɢɪɨɦɟɬɪɢɹ, ɨɰɟɧɤɚ ɭɪɨɜɧɹ ɤɨɧɬɪɨɥɹ ȻȺ ɩɪɢ ɩɨɦɨɳɢ
Ⱥsthma ɋontrol Ɍest (ȺɋɌ) [3, 9].
ɂɫɫɥɟɞɨɜɚɧɢɟ ɩɪɨɜɨɞɢɥɨɫɶ ɧɚ ɛɚɡɟ ɨɬɞɟɥɟɧɢɹ
ɩɚɬɨɥɨɝɢɢ ɛɟɪɟɦɟɧɧɵɯ Ʉɍ «ɈɄȻɆ» ɢ ɞɢɚɝɧɨ-

26

ɫɬɢɱɟɫɤɨɝɨ ɤɚɛɢɧɟɬɚ «ɋɩɢɪɨ» ɜ ɩɟɪɢɨɞ ɫ ɨɤɬɹɛɪɹ
ɩɨ ɞɟɤɚɛɪɶ 2013 ɝɨɞɚ. ȼ ɢɫɫɥɟɞɨɜɚɧɢɟ ɜɤɥɸɱɚɥɢɫɶ ɛɟɪɟɦɟɧɧɵɟ ɫ ȻȺ, ɩɨɫɬɭɩɢɜɲɢɟ ɧɚ ɫɬɚɰɢɨɧɚɪɧɨɟ ɥɟɱɟɧɢɟ ɢɥɢ ɨɛɪɚɬɢɜɲɢɟɫɹ ɡɚ ɤɨɧɫɭɥɶɬɚɰɢɟɣ ɩɭɥɶɦɨɧɨɥɨɝɚ ɜ ɤɚɛɢɧɟɬ «ɋɩɢɪɨ».
Ɉɛɪɚɛɨɬɤɚ ɩɨɥɭɱɟɧɧɵɯ ɞɚɧɧɵɯ ɩɪɨɜɨɞɢɥɚɫɶ ɫ
ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɦɟɬɨɞɨɜ ɧɟɩɚɪɚɦɟɬɪɢɱɟɫɤɨɣ
ɫɬɚɬɢɫɬɢɤɢ ɜ ɩɪɨɝɪɚɦɦɟ STATISTICA 6.0 [2].
ɊȿɁɍɅɖɌȺɌɕ ɂ ɂɏ ɈȻɋɍɀȾȿɇɂȿ

ɂɡ 35 ɛɟɪɟɦɟɧɧɵɯ, ɜɤɥɸɱɟɧɧɵɯ ɜ ɢɫɫɥɟɞɨɜɚɧɢɟ, 10 (29%) ɤɨɧɫɭɥɶɬɢɪɨɜɚɧɵ ɩɥɚɧɨɜɨ ɩɨ ɧɚɩɪɚɜɥɟɧɢɸ ɚɤɭɲɟɪɚ-ɝɢɧɟɤɨɥɨɝɚ, ɢɡ ɧɢɯ ɩɹɬɟɪɨ,
ɩɨ ɞɚɧɧɵɦ ɚɧɚɦɧɟɡɚ, ɩɟɪɟɧɟɫɥɢ ɥɟɝɤɨɟ ɨɛɨɫɬɪɟɧɢɟ ȻȺ ɜ ɩɟɪɜɨɦ ɬɪɢɦɟɫɬɪɟ ɛɟɪɟɦɟɧɧɨɫɬɢ.
ɉɪɨɜɟɞɟɧɧɚɹ ɫɩɢɪɨɝɪɚɮɢɹ ɧɟ ɜɵɹɜɢɥɚ ɧɚɪɭɲɟɧɢɹ ɮɭɧɤɰɢɢ ɜɧɟɲɧɟɝɨ ɞɵɯɚɧɢɹ (ɎȼȾ), ɩɨɥɧɵɣ
ɤɨɧɬɪɨɥɶ ɚɫɬɦɵ ɛɵɥ ɞɨɫɬɢɝɧɭɬ ɭ ɜɨɫɶɦɢ ɠɟɧɳɢɧ
(ȺɋɌ 22±1,5 ɛɚɥɥɚ), ɱɚɫɬɢɱɧɵɣ – ɭ ɞɜɭɯ (ȺɋɌ 18
ɢ 19 ɛɚɥɥɨɜ).

ɆȿȾɂɑɇȱ ɉȿɊɋɉȿɄɌɂȼɂ

ɗɬɚɩ 1. Ⱥɧɚɥɢɡ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ ɨɛɨɫɬɪɟɧɢɣ ɭ ɛɟɪɟɦɟɧɧɵɯ ɫ ȻȺ.
ȼ ɚɧɚɥɢɡ ɛɵɥɢ ɜɤɥɸɱɟɧɵ 25 ɠɟɧɳɢɧ,
ɨɛɪɚɬɢɜɲɢɯɫɹ ɡɚ ɦɟɞɢɰɢɧɫɤɨɣ ɩɨɦɨɳɶɸ ɫ
ɨɛɨɫɬɪɟɧɢɟɦ ȻȺ ɢ, ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɟɝɨ ɫɬɟɩɟɧɢ
ɬɹɠɟɫɬɢ, ɪɚɡɞɟɥɟɧɵ ɧɚ ɬɪɢ ɝɪɭɩɩɵ (ɪɢɫ. 1):
Ƚɪɭɩɩɚ 1 (n=8) – ɥɟɝɤɨɟ ɨɛɨɫɬɪɟɧɢɟ, ɩɪɟɨɛɥɚɞɚɥɢ ɛɟɪɟɦɟɧɧɵɟ ɫ ɥɟɝɤɢɦ ɬɟɱɟɧɢɟɦ ȻȺ (n=5
(63%)). Ⱦɢɚɝɧɨɡ ɜɵɫɬɚɜɥɹɥɫɹ ɩɪɢ ɧɚɥɢɱɢɢ ɭɜɟɥɢɱɟɧɢɹ ɩɨɬɪɟɛɧɨɫɬɢ ɜ ȕ2-ɚɝɨɧɢɫɬɚɯ ɢ / ɢɥɢ
ɩɨɹɜɥɟɧɢɢ ɧɨɱɧɵɯ ɫɢɦɩɬɨɦɨɜ. ɇɚ ɩɟɪɜɨɦ ɦɟɫɬɟ
ɭ ɷɬɢɯ ɩɚɰɢɟɧɬɨɤ ɛɵɥɢ ɠɚɥɨɛɵ ɧɚ ɭɱɚɳɟɧɢɟ
ɩɪɢɫɬɭɩɨɜ ɤɚɲɥɹ, ɩɪɨɯɨɞɢɜɲɢɯ ɩɨɫɥɟ ɞɨɩɨɥɧɢɬɟɥɶɧɨɣ ɞɨɡɵ ȕ2-ɚɝɨɧɢɫɬɚ ɜ ɮɨɪɦɟ ɞɨɡɢɪɨɜɚɧɧɨɝɨ ɚɷɪɨɡɨɥɶɧɨɝɨ ɢɧɝɚɥɹɬɨɪɚ ɢɥɢ ɱɟɪɟɡ
ɧɟɛɭɥɚɣɡɟɪ ɧɚ ɮɨɧɟ ɧɨɪɦɚɥɶɧɵɯ ɩɨɤɚɡɚɬɟɥɟɣ
ɎȼȾ ɢ ɫɚɬɭɪɚɰɢɢ. ɋɨɝɥɚɫɧɨ ɫɬɚɧɞɚɪɬɚɦ ɜɟɞɟɧɢɹ
ɥɟɝɤɨɝɨ ɨɛɨɫɬɪɟɧɢɹ ȻȺ ɜɫɟ ɠɟɧɳɢɧɵ ɥɟɱɢɥɢɫɶ
ɚɦɛɭɥɚɬɨɪɧɨ, ɱɟɬɵɪɟɦ ɛɨɥɶɧɵɦ ɛɵɥɚ ɩɪɨɜɟɞɟɧɚ
ɤɨɪɪɟɤɰɢɹ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ.
Ƚɪɭɩɩɚ 2 (n=11) – ɨɛɨɫɬɪɟɧɢɟ ɫɪɟɞɧɟɣ ɬɹɠɟɫɬɢ, ɩɪɟɨɛɥɚɞɚɥɢ ɩɚɰɢɟɧɬɤɢ ɫɨ ɫɪɟɞɧɟɬɹɠɟɥɨɣ
ȻȺ (n=7 (64%)). Ⱦɢɚɝɧɨɡ ɜɵɫɬɚɜɥɹɥɫɹ ɩɪɢ ɧɚɥɢɱɢɢ ɨɞɵɲɤɢ ɩɪɢ ɨɛɵɱɧɨɣ ɮɢɡɢɱɟɫɤɨɣ ɧɚɝɪɭɡɤɟ,
ɭɱɚɳɟɧɢɹ ɷɩɢɡɨɞɨɜ ɫɜɢɫɬɹɳɟɝɨ ɞɵɯɚɧɢɹ ɢ ɧɚɪɭɲɟɧɢɹ ɎȼȾ (ɨɛɴɟɦ ɮɨɪɫɢɪɨɜɚɧɧɨɝɨ ɜɵɞɨɯɚ ɡɚ
ɩɟɪɜɭɸ ɫɟɤɭɧɞɭ (ɈɎȼ1) 78±1,2%).
ɇɚ ɦɨɦɟɧɬ ɩɨɫɬɭɩɥɟɧɢɹ ɜ ɫɬɚɰɢɨɧɚɪ ɫɚɬɭɪɚɰɢɹ •95%, ɚɭɫɤɭɥɶɬɚɬɢɜɧɚɹ ɤɚɪɬɢɧɚ ɫɤɭɞɧɚɹ
(ɟɞɢɧɢɱɧɵɟ ɫɭɯɢɟ ɯɪɢɩɵ), ɩɪɢ ɫɩɢɪɨɦɟɬɪɢɢ –
ɭɦɟɪɟɧɧɵɟ ɧɚɪɭɲɟɧɢɹ ɎȼȾ ɩɨ ɨɛɫɬɪɭɤɬɢɜɧɨɦɭ
ɬɢɩɭ. 9 ɛɟɪɟɦɟɧɧɵɯ (82%) ɢɦɟɥɢ ɤɥɢɧɢɱɟɫɤɢɟ
ɩɪɨɹɜɥɟɧɢɹ ɢɧɮɟɤɰɢɢ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ, ɚ ɬɚɤɠɟ ɨɬɹɝɨɳɟɧɧɵɣ ɷɩɢɞɟɦɢɨɥɨɝɢɱɟɫɤɢɣ
ɚɧɚɦɧɟɡ (ɤɨɧɬɚɤɬ ɫ ɛɨɥɶɧɵɦɢ ɨɫɬɪɵɦɢ ɪɟɫɩɢɪɚɬɨɪɧɵɦɢ ɡɚɛɨɥɟɜɚɧɢɹɦɢ, ɜ ɨɫɧɨɜɧɨɦ ɱɥɟɧɚɦɢ
ɫɟɦɶɢ). ɇɚɯɨɞɹɫɶ ɜ ɫɬɚɰɢɨɧɚɪɟ, ɜɫɟ ɠɟɧɳɢɧɵ
ɩɨɥɭɱɚɥɢ ɧɟɨɛɯɨɞɢɦɭɸ ɞɨɡɢɪɨɜɤɭ ɛɚɡɢɫɧɵɯ ɩɪɟɩɚɪɚɬɨɜ ɱɟɪɟɡ ɧɟɛɭɥɚɣɡɟɪ. Ⱦɜɭɦ ɛɟɪɟɦɟɧɧɵɦ
ɞɢɚɝɧɨɡ ɛɵɥ ȻȺ ɜɵɫɬɚɜɥɟɧ ɜɩɟɪɜɵɟ, ɧɚɡɧɚɱɟɧɚ
ɛɚɡɢɫɧɚɹ ɬɟɪɚɩɢɹ.
Ƚɪɭɩɩɚ 3 (n=6) – ɬɹɠɟɥɨɟ ɨɛɨɫɬɪɟɧɢɟ, ɩɪɟɨɛɥɚɞɚɥɢ ɛɟɪɟɦɟɧɧɵɟ ɫ ɪɚɧɟɟ ɧɟ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧɧɨɣ ȻȺ (n=4 (67%)). ȼ 100% ɫɥɭɱɚɟɜ ɨɫɬɪɵɣ
ɛɪɨɧɯɨɨɛɫɬɪɭɤɬɢɜɧɵɣ ɫɢɧɞɪɨɦ ɪɚɡɜɢɥɫɹ ɧɚ ɮɨɧɟ
ɫɢɦɩɬɨɦɨɜ ɢɧɮɟɤɰɢɢ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ. ɇɚ ɦɨɦɟɧɬ ɩɨɫɬɭɩɥɟɧɢɹ ɫɚɬɭɪɚɰɢɹ 92-94%,
ɩɪɢ ɧɨɪɦɟ ɞɥɹ ɛɟɪɟɦɟɧɧɵɯ •95%. ȼ ɤɥɢɧɢɱɟɫɤɨɣ
ɤɚɪɬɢɧɟ ɧɚ ɩɟɪɜɨɦ ɦɟɫɬɟ ɛɵɥɢ: ɨɞɵɲɤɚ ɩɪɢ
ɧɟɡɧɚɱɢɬɟɥɶɧɨɣ ɮɢɡɢɱɟɫɤɨɣ ɧɚɝɪɭɡɤɟ ɢ ɜ ɩɨɤɨɟ,
ɧɚɪɭɲɟɧɢɟ ɫɧɚ, ɫɭɯɨɣ ɦɭɱɢɬɟɥɶɧɵɣ ɤɚɲɟɥɶ.
Ⱥɭɫɤɭɥɶɬɚɬɢɜɧɨ ɧɚ ɦɨɦɟɧɬ ɩɨɫɬɭɩɥɟɧɢɹ – ɫɭɯɢɟ
ɪɚɫɫɟɹɧɧɵɟ ɫɜɢɫɬɹɳɢɟ ɯɪɢɩɵ. ȼɫɟɦ ɠɟɧɳɢɧɚɦ
ɩɪɨɜɨɞɢɥɚɫɶ ɫɬɚɧɞɚɪɬɧɚɹ ɬɟɪɚɩɢɹ: ɤɢɫɥɨɪɨɞ ɦɚ-

14/ Ɍɨɦ XIX / 2

ɫɨɱɧɵɦ ɫɩɨɫɨɛɨɦ, ɢ ȽɄɋ ɢ ȕ2-ɚɝɨɧɢɫɬɵ ɤɨɪɨɬɤɨɝɨ ɞɟɣɫɬɜɢɹ ɱɟɪɟɡ ɧɟɛɭɥɚɣɡɟɪ, ɫɢɫɬɟɦɧɵɟ ɝɥɸɤɨɤɨɪɬɢɤɨɫɬɟɪɨɢɞɵ ɩɚɪɟɧɬɟɪɚɥɶɧɨ. ɋɪɟɞɧɹɹ ɞɥɢɬɟɥɶɧɨɫɬɶ ɩɪɟɛɵɜɚɧɢɹ ɜ ɨɬɞɟɥɟɧɢɢ ɢɧɬɟɧɫɢɜɧɨɣ
ɬɟɪɚɩɢɢ 5±1,2 ɫɭɬɨɤ. ɑɟɬɵɪɟɦ ɠɟɧɳɢɧɚɦ ɩɪɟɞɜɚɪɢɬɟɥɶɧɵɣ ɞɢɚɝɧɨɡ – ɜɩɟɪɜɵɟ ɜɵɹɜɥɟɧɧɚɹ ȻȺ
ɛɵɥ ɩɨɞɬɜɟɪɠɞɟɧ ɩɨ ɞɚɧɧɵɦɢ ɫɩɢɪɨɝɪɚɮɢɢ
(ɈɎȼ1 76±1,2%, ɨɛɪɚɬɢɦɨɫɬɶ 21±1,8%), ɧɚɡɧɚɱɟɧɚ ɛɚɡɢɫɧɚɹ ɬɟɪɚɩɢɹ. ȼɢɪɭɫɨɥɨɝɢɱɟɫɤɢɟ ɢɫɫɥɟɞɨɜɚɧɢɹ, ɩɪɨɜɟɞɟɧɧɵɟ ɭ ɜɫɟɯ ɠɟɧɳɢɧ ɝɪɭɩɩɵ 3,
ɧɟ ɜɵɹɜɢɥɢ ɜɢɪɭɫɨɜ ɝɪɢɩɩɚ ɬɢɩɚ Ⱥ ɢɥɢ ȼ.

Ɋɢɫ. 1. Ɋɚɫɩɪɟɞɟɥɟɧɢɟ ɛɟɪɟɦɟɧɧɵɯ ɩɨ ɫɬɟɩɟɧɢ
ɬɹɠɟɫɬɢ ɨɛɨɫɬɪɟɧɢɣ ȻȺ

ɗɬɚɩ 2. Ⱥɧɚɥɢɡ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ.
ɇɚɪɭɲɟɧɢɟ ɪɟɠɢɦɚ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ – ɨɞɧɚ
ɢɡ ɝɥɚɜɧɵɯ ɩɪɢɱɢɧ ɧɚɪɭɲɟɧɢɹ ɤɨɧɬɪɨɥɹ ɢɥɢ ɨɛɨɫɬɪɟɧɢɹ ȻȺ, ɨɫɨɛɟɧɧɨ ɫɪɟɞɢ ɛɟɪɟɦɟɧɧɵɯ. ɗɬɚ
ɝɪɭɩɩɚ ɛɨɥɶɧɵɯ ɫɤɥɨɧɧɚ ɫɚɦɨɫɬɨɹɬɟɥɶɧɨ ɢɡɦɟɧɹɬɶ ɢɥɢ ɨɬɦɟɧɹɬɶ ɬɟɪɚɩɢɸ, ɪɭɤɨɜɨɞɫɬɜɭɹɫɶ ɫɨɛɫɬɜɟɧɧɵɦɢ ɩɪɟɞɫɬɚɜɥɟɧɢɹɦɢ ɨ ɛɟɡɨɩɚɫɧɨɫɬɢ
ɢɧɝɚɥɹɰɢɨɧɧɵɯ ɫɬɟɪɨɢɞɨɜ. ȼ ɧɚɲɟɦ ɢɫɫɥɟɞɨɜɚɧɢɢ ɤɚɤ ɩɪɢɜɟɪɠɟɧɧɨɫɬɶ ɤ ɥɟɱɟɧɢɸ ɪɚɫɰɟɧɢɜɚɥɨɫɶ ɫɨɛɥɸɞɟɧɢɟ ɧɚɡɧɚɱɟɧɧɵɯ ɜɪɚɱɨɦ ɞɨɡɢɪɨɜɤɢ ɢ ɤɪɚɬɧɨɫɬɢ ɩɪɢɟɦɚ ɢɧɝɚɥɹɰɢɨɧɧɵɯ ɫɬɟɪɨɢɞɨɜ (ɪɢɫ. 2). ȼɵɹɜɥɟɧɧɵɟ ɢɡɦɟɧɟɧɢɹ ɜ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ȻɌ ɨɤɚɡɚɥɢɫɶ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɧɟ
ɡɧɚɱɢɦɵɦɢ (ɪ>0,05). Ȼɨɥɶɲɢɧɫɬɜɨ ɠɟɧɳɢɧ, ɫɨɛɥɸɞɚɜɲɢɯ ɪɟɠɢɦ ɬɟɪɚɩɢɢ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ,
ɩɪɨɞɨɥɠɚɸɬ ɟɟ ɢ ɜ ɝɟɫɬɚɰɢɨɧɧɵɣ ɩɟɪɢɨɞ ɜ ɬɨɦ
ɠɟ ɨɛɴɟɦɟ.

27

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

Ɋɢɫ. 2. ɉɪɢɜɟɪɠɟɧɧɨɫɬɶ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɭ ɠɟɧɳɢɧ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ȻȺ

ɗɬɚɩ 3. Ɉɰɟɧɤɚ ɭɪɨɜɧɹ ɤɨɧɬɪɨɥɹ ȻȺ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ.
ɇɚ ɬɪɟɬɶɟɦ ɷɬɚɩɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɜɵɹɜɥɟɧɨ, ɱɬɨ
ɩɨɥɧɵɣ ɤɨɧɬɪɨɥɶ ɡɚɛɨɥɟɜɚɧɢɹ (ɛɚɥɥ ɩɨ ȺɋɌ •
20) ɫɪɟɞɢ ɛɟɪɟɦɟɧɧɵɯ ɫ ɩɟɪɫɢɫɬɢɪɭɸɳɟɣ ȻȺ
ɛɵɥ ɞɨɫɬɢɝɧɭɬ ɬɨɥɶɤɨ ɭ ɬɪɟɯ ɠɟɧɳɢɧ ɫ ɥɟɝɤɢɦ ɢ
ɭ ɞɜɭɯ – ɫɨ ɫɪɟɞɧɟɬɹɠɟɥɵɦ ɬɟɱɟɧɢɟɦ, ɩɪɨ-

ɞɨɥɠɚɜɲɢɯ ɩɪɢɟɦ ȻɌ ɜ ɩɨɥɧɨɦ ɨɛɴɟɦɟ. Ⱥɧɚɥɢɡ
ɫɨɨɬɜɟɬɫɬɜɢɹ ɞɨɡɢɪɨɜɤɢ ɛɚɡɢɫɧɵɯ ɩɪɟɩɚɪɚɬɨɜ
ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ ȻȺ ɩɨɤɚɡɚɥ, ɱɬɨ ɧɟɞɨɫɬɚɬɨɱɧɭɸ
ɞɨɡɢɪɨɜɤɭ ɛɚɡɢɫɧɨɝɨ ɩɪɟɩɚɪɚɬɚ ɜ ɝɪɭɩɩɟ ɥɟɝɤɨɣ
ȻȺ ɩɨɥɭɱɚɥɢ ɞɜɨɟ ɛɨɥɶɧɵɯ (25%), ɚ ɜ ɝɪɭɩɩɟ
ɫɪɟɞɧɟɬɹɠɟɥɨɣ ȻȺ – ɱɟɬɜɟɪɨ (36%), ɜ ɬɨ ɜɪɟɦɹ
ɤɚɤ ɠɟɧɳɢɧɵ ɫ ɬɹɠɟɥɵɦ ɬɟɱɟɧɢɟɦ ȻȺ ɜ 100%
ɫɥɭɱɚɟɜ ɩɨɥɭɱɚɥɢ ɞɨɫɬɚɬɨɱɧɭɸ ȻɌ (ɪɢɫ. 3).

Ɋɢɫ. 3. ɍɪɨɜɟɧɶ ɤɨɧɬɪɨɥɹ ɢ ɞɨɥɹ ɛɨɥɶɧɵɯ ɫ ɧɟɞɨɫɬɚɬɨɱɧɨɣ ɞɨɡɨɣ ɛɚɡɢɫɧɵɯ ɩɪɟɩɚɪɚɬɨɜ
ɫɪɟɞɢ ɛɟɪɟɦɟɧɧɵɯ ɫ ɥɟɝɤɨɣ ɢ ɫɪɟɞɧɟɬɹɠɟɥɨɣ ȻȺ

ɇɚɪɭɲɟɧɢɟ ɪɟɠɢɦɚ ȻɌ, ɚ ɬɚɤɠɟ ɷɩɢɡɨɞɵ ɪɟɫɩɢɪɚɬɨɪɧɨɣ ɢɧɮɟɤɰɢɢ ɩɪɢɜɨɞɹɬ ɤ ɜɨɡɧɢɤɧɨɜɟɧɢɸ ɧɟɫɤɨɥɶɤɢɯ ɨɛɨɫɬɪɟɧɢɣ ȻȺ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɱɬɨ ɛɭɞɟɬ ɩɨɤɚɡɚɧɨ ɧɚ ɫɥɟɞɭɸɳɟɦ
ɤɥɢɧɢɱɟɫɤɨɦ ɩɪɢɦɟɪɟ.
Ȼɟɪɟɦɟɧɧɚɹ Ɍ., 31 ɝɨɞ, ɛɵɥɚ ɝɨɫɩɢɬɚɥɢɡɢɪɨɜɚɧɚ ɜ ɨɬɞɟɥɟɧɢɟ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ ɫ ɞɢ-

28

ɚɝɧɨɡɨɦ: ɜɬɨɪɚɹ ɛɟɪɟɦɟɧɧɨɫɬɶ, 23 ɧɟɞɟɥɢ, ɛɪɨɧɯɢɚɥɶɧɚɹ ɚɫɬɦɚ ɫɪɟɞɧɟɣ ɬɹɠɟɫɬɢ, ɧɟɤɨɧɬɪɨɥɢɪɭɟɦɨɟ ɬɟɱɟɧɢɟ, ɬɹɠɟɥɨɟ ɨɛɨɫɬɪɟɧɢɟ, Ⱦɇ 1.
ɂɡ ɚɧɚɦɧɟɡɚ ɢɡɜɟɫɬɧɨ, ɱɬɨ ɞɢɚɝɧɨɡ ɛɪɨɧɯɢɚɥɶɧɚɹ ɚɫɬɦɚ ɛɵɥ ɭɫɬɚɧɨɜɥɟɧ ɜ 13 ɥɟɬ, ɛɚɡɢɫɧɵɟ
ɩɪɟɩɚɪɚɬɵ ɩɪɢɧɢɦɚɟɬ ɧɟɪɟɝɭɥɹɪɧɨ. ɉɪɟɞɵɞɭɳɚɹ
ɛɟɪɟɦɟɧɧɨɫɬɶ ɫɨɩɪɨɜɨɠɞɚɥɚɫɶ ɭɬɹɠɟɥɟɧɢɟɦ

ɆȿȾɂɑɇȱ ɉȿɊɋɉȿɄɌɂȼɂ

ɬɟɱɟɧɢɹ ȻȺ. ɍɯɭɞɲɟɧɢɟ ɫɨɫɬɨɹɧɢɹ ɩɪɨɢɡɨɲɥɨ ɡɚ
4 ɞɧɹ ɞɨ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ. ɇɚ ɮɨɧɟ ɩɨɜɵɲɟɧɢɹ
ɬɟɦɩɟɪɚɬɭɪɵ ɞɨ ɫɭɛɮɟɛɪɢɥɶɧɵɯ ɰɢɮɪ ɢ ɤɚɬɚɪɚɥɶɧɵɯ ɹɜɥɟɧɢɣ ɭɫɢɥɢɥɚɫɶ ɨɞɵɲɤɚ ɢ ɭɱɚɫɬɢɥɢɫɶ ɩɪɢɫɬɭɩɵ ɫɭɯɨɝɨ ɤɚɲɥɹ. ɉɪɢɟɦ ɜɟɧɬɨɥɢɧɚ
ɱɟɪɟɡ ɧɟɛɭɥɚɣɡɟɪ ɞɨ 6 ɪɚɡ ɜ ɞɟɧɶ ɧɟ ɞɚɜɚɥ ɨɠɢɞɚɟɦɨɝɨ ɤɥɢɧɢɱɟɫɤɨɝɨ ɷɮɮɟɤɬɚ.
ɇɚ ɦɨɦɟɧɬ ɩɨɫɬɭɩɥɟɧɢɹ ɜ ɨɬɞɟɥɟɧɢɟ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ ɫɨɫɬɨɹɧɢɟ ɬɹɠɟɥɨɟ, t 37,6°ɋ,
ɨɞɵɲɤɚ ɜ ɩɨɤɨɟ, ɫɚɬɭɪɚɰɢɹ 91%, ɱɚɫɬɨɬɚ ɞɵɯɚɬɟɥɶɧɵɯ ɞɜɢɠɟɧɢɣ 28 ɜ ɦɢɧ., ɬɚɯɢɤɚɪɞɢɹ (100 ɭɞ.
ɜ ɦɢɧ.). ɇɚɞ ɥɟɝɤɢɦɢ ɜɵɫɥɭɲɢɜɚɟɬɫɹ ɛɨɥɶɲɨɟ
ɤɨɥɢɱɟɫɬɜɨ ɫɭɯɢɯ ɫɜɢɫɬɹɳɢɯ ɯɪɢɩɨɜ. ȼ ɨɛɳɟɦ
ɚɧɚɥɢɡɟ ɤɪɨɜɢ ɥɟɣɤɨɰɢɬɨɡ 10 Ɍ/ɥ ɢ ɥɢɦɮɨɩɟɧɢɹ
6%. Ɋɟɧɬɝɟɧ ɝɪɭɞɧɨɣ ɤɥɟɬɤɢ ɜ ɩɪɹɦɨɣ ɢ ɛɨɤɨɜɨɣ
ɩɪɨɟɤɰɢɹɯ ɢɧɮɢɥɶɬɪɚɬɢɜɧɵɯ ɢɡɦɟɧɟɧɢɣ ɧɟ
ɜɵɹɜɢɥ.

ɉɚɰɢɟɧɬɤɚ Ɍ. ɧɚɯɨɞɢɥɚɫɶ ɜ ɪɟɚɧɢɦɚɰɢɨɧɧɨɦ
ɨɬɞɟɥɟɧɢɢ ɜ ɬɟɱɟɧɢɟ 5 ɞɧɟɣ. ɇɚ ɮɨɧɟ ɩɪɨɜɨɞɢɦɨɣ ɬɟɪɚɩɢɢ: ɤɢɫɥɨɪɨɞ ɦɚɫɨɱɧɵɦ ɫɩɨɫɨɛɨɦ
(ɮɪɚɤɰɢɹ ɤɢɫɥɨɪɨɞɚ ɜɨ ɜɞɵɯɚɟɦɨɣ ɫɦɟɫɢ 40%),
ɜɟɧɬɨɥɢɧ 2,5 ɦɝ ɢ ɩɭɥɶɦɢɤɨɪɬ 0,5 ɦɝ ɱɟɪɟɡ ɧɟɛɭɥɚɣɡɟɪ, «Ɇɟɞɪɨɥ» 32 ɦɝ/ɫɭɬɤɢ, ɫɨɫɬɨɹɧɢɟ ɡɧɚɱɢɬɟɥɶɧɨ ɭɥɭɱɲɢɥɨɫɶ. ɉɨɫɥɟ ɜɵɩɢɫɤɢ ɢɡ ɨɬɞɟɥɟɧɢɹ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ ɩɪɨɜɟɞɟɧɵ ɫɩɢɪɨɝɪɚɮɢɹ ɢ ɤɨɧɫɭɥɶɬɚɰɢɹ ɩɭɥɶɦɨɧɨɥɨɝɚ. ȼɵɫɬɚɜɥɟɧ
ɞɢɚɝɧɨɡ: ɩɟɪɫɢɫɬɢɪɭɸɳɚɹ ȻȺ, ɫɪɟɞɧɟɣ ɬɹɠɟɫɬɢ,
ɧɟɤɨɧɬɪɨɥɢɪɭɟɦɨɟ ɬɟɱɟɧɢɟ, ɭɦɟɪɟɧɧɵɟ ɧɚɪɭɲɟɧɢɹ ɎȼȾ ɩɨ ɨɛɫɬɪɭɤɬɢɜɧɨɦɭ ɬɢɩɭ. ɇɚɡɧɚɱɟɧɚ
ɬɟɪɚɩɢɹ: «ɋɢɦɛɢɤɨɪɬ ɬɭɪɛɭɯɚɣɥɟɪ» (ɛɭɞɟɫɨɧɢɞ
160 ɦɤɝ+ ɮɨɪɦɨɬɟɪɨɥ 4,5 ɦɤɝ) ɩɨ 1 ɜɞɨɯɭ ɞɜɚ
ɪɚɡɚ ɜ ɞɟɧɶ ɢ ɜɟɧɬɨɥɢɧ ɩɨ ɬɪɟɛɨɜɚɧɢɸ.

Ɋɢɫ. 3. ɋɩɢɪɨɝɪɚɦɦɚ ɩɚɰɢɟɧɬɤɢ Ɍ. ɩɨɫɥɟ 5 ɞɧɟɣ ɩɪɟɛɵɜɚɧɢɹ ɜ ɨɬɞɟɥɟɧɢɢ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ

ȼ ɬɟɱɟɧɢɟ ɫɥɟɞɭɸɳɟɝɨ ɦɟɫɹɰɚ ɩɚɰɢɟɧɬɤɚ Ɍ.
ɩɪɨɞɨɥɠɚɥɚ ɧɚɪɭɲɚɬɶ ɪɟɠɢɦ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɢ
ɩɟɪɟɧɟɫɥɚ ɟɳɟ ɨɞɧɨ ɨɛɨɫɬɪɟɧɢɟ ɫɪɟɞɧɟɣ ɬɹɠɟɫɬɢ.
Ɉɬ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ ɨɬɤɚɡɚɥɚɫɶ, ɥɟɱɢɥɚɫɶ ɚɦɛɭɥɚɬɨɪɧɨ: ɜɟɧɬɨɥɢɧ 2,5 ɦɝ ɢ ɩɭɥɶɦɢɤɨɪɬ 0,5 ɦɝ
ɱɟɪɟɡ ɧɟɛɭɥɚɣɡɟɪ 4 ɪɚɡɚ ɜ ɞɟɧɶ. ɇɚ ɫɟɞɶɦɨɣ ɞɟɧɶ
ɬɟɪɚɩɢɢ ɧɚ ɮɨɧɟ ɡɧɚɱɢɬɟɥɶɧɨɝɨ ɭɥɭɱɲɟɧɢɹ ɫɨɫɬɨɹɧɢɹ ɩɟɪɟɜɟɞɟɧɚ ɧɚ ɩɪɢɟɦ ɩɪɟɩɚɪɚɬɚ «ɋɢɦɛɢɤɨɪɬ» ɜ ɩɪɟɠɧɟɣ ɞɨɡɢɪɨɜɤɟ. ɑɟɪɟɡ 2 ɧɟɞɟɥɢ
ɩɨɫɥɟ ɩɟɪɟɧɟɫɟɧɧɨɝɨ ɨɛɨɫɬɪɟɧɢɹ, ɧɚ ɮɨɧɟ ɫɨɛɥɸɞɟɧɢɹ ɬɟɪɚɩɢɢ ɩɨɤɚɡɚɬɟɥɢ ɎȼȾ ɡɧɚɱɢɬɟɥɶɧɨ
ɭɥɭɱɲɢɥɢɫɶ (ɪɢɫ. 4).
Ⱦɚɥɶɧɟɣɲɟɟ ɧɚɛɥɸɞɟɧɢɟ ɩɨɤɚɡɚɥɨ, ɱɬɨ ɧɚ
ɮɨɧɟ ɚɞɟɤɜɚɬɧɨɣ ɞɨɡɵ ɛɚɡɢɫɧɨɝɨ ɩɪɟɩɚɪɚɬɚ ɭ
ɩɚɰɢɟɧɬɤɢ Ɍ. ɫ 28-ɣ ɧɟɞɟɥɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɧɟ ɛɵɥɨ ɧɢ ɨɞɧɨɝɨ ɨɛɨɫɬɪɟɧɢɹ, ɤ 34-ɣ ɧɟɞɟɥɟ –

14/ Ɍɨɦ XIX / 2

ɞɨɫɬɢɝɧɭɬ ɱɚɫɬɢɱɧɵɣ ɤɨɧɬɪɨɥɶ ɡɚɛɨɥɟɜɚɧɢɹ
(ȺɋɌ 17 ɛɚɥɥɨɜ), ɡɧɚɱɢɬɟɥɶɧɨ ɭɥɭɱɲɢɥɚɫɶ ɎȼȾ
(ɪɢɫ. 5).
Ɋɨɞɵ ɩɪɨɢɡɨɲɥɢ ɧɚ 38 ɧɟɞɟɥɟ ɛɟɪɟɦɟɧɧɨɫɬɢ
ɠɢɜɨɣ ɞɟɜɨɱɤɨɣ, ɜɟɫ 3,300 ɝ, ɪɨɫɬ 50 ɫɦ.
ɇɚɦɢ ɛɵɥ ɩɨɥɭɱɟɧ ɪɹɞ ɞɚɧɧɵɯ, ɤɨɬɨɪɵɟ
ɫɨɝɥɚɫɭɸɬɫɹ ɫ ɪɟɡɭɥɶɬɚɬɚɦɢ ɡɚɪɭɛɟɠɧɵɯ ɤɨɥɥɟɝ,
ɬɚɤ, ɩɨɤɚɡɚɧɚ ɫɜɹɡɶ ɨɛɨɫɬɪɟɧɢɣ ɚɫɬɦɵ ɫ ɩɟɪɟɧɟɫɟɧɧɨɣ ɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɟɣ, ɧɚɪɭɲɟɧɢɟɦ ɪɟɠɢɦɚ ɢɥɢ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶɸ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ.
ɉɪɢ ɷɬɨɦ, ɩɨ ɞɚɧɧɵɦ Murphy V. E. et al., 2006,
ɛɨɥɶɲɢɧɫɬɜɨ ɨɛɨɫɬɪɟɧɢɣ ȻȺ ɩɪɢɯɨɞɢɬɫɹ ɧɚ ɜɬɨɪɨɣ ɬɪɢɦɟɫɬɪ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɧɨ ɜ ɧɚɲɟɦ ɢɫɫɥɟɞɨɜɚɧɢɢ 18 (72%) ɠɟɧɳɢɧ ɫ ɨɛɨɫɬɪɟɧɢɟɦ
ɢɦɟɥɢ ɫɪɨɤ ɝɟɫɬɚɰɢɢ 28 ɧɟɞɟɥɶ ɢ ɛɨɥɟɟ.

29

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ

Ɋɢɫ. 4. 1 – ɫɩɢɪɨɝɪɚɦɦɚ ɜɨ ɜɪɟɦɹ ɨɛɨɫɬɪɟɧɢɹ; 2 – ɫɩɢɪɨɝɪɚɦɦɚ ɱɟɪɟɡ ɞɜɟ ɧɟɞɟɥɢ
ɩɨɫɥɟ ɜɨɡɨɛɧɨɜɥɟɧɢɹ ɩɪɢɟɦɚ ɛɚɡɢɫɧɵɯ ɩɪɟɩɚɪɚɬɨɜ

ɋɥɟɞɭɟɬ ɨɬɦɟɬɢɬɶ, ɱɬɨ ɭ 17 (68%) ɛɟɪɟɦɟɧɧɵɯ
ɨɛɨɫɬɪɟɧɢɟ ȻȺ ɩɪɨɬɟɤɚɥɨ ɧɚ ɮɨɧɟ ɫɢɦɩɬɨɦɨɜ
ɢɧɮɟɤɰɢɢ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɪɚɡɧɨɣ
ɫɬɟɩɟɧɢ ɜɵɪɚɠɟɧɧɨɫɬɢ. ɉɪɢ ɷɬɨɦ ɭ 70 % ɛɵɥ
ɨɬɹɝɨɳɟɧɧɵɣ ɷɩɢɞɟɦɢɨɥɨɝɢɱɟɫɤɢɣ ɚɧɚɦɧɟɡ ɜ
ɜɢɞɟ ɤɨɧɬɚɤɬɚ ɫ ɛɨɥɶɧɵɦɢ ɪɟɫɩɢɪɚɬɨɪɧɵɦɢ ɢɧ-

ɮɟɤɰɢɹɦɢ ɱɥɟɧɚɦɢ ɫɟɦɶɢ. ɇɢ ɨɞɧɚ ɛɟɪɟɦɟɧɧɚɹ,
ɩɟɪɟɧɟɫɲɚɹ ɨɛɨɫɬɪɟɧɢɟ ȻȺ, ɢɥɢ ɱɥɟɧɵ ɟɟ ɫɟɦɶɢ
ɧɟ ɛɵɥɢ ɜɚɤɰɢɧɢɪɨɜɚɧɵ ɨɬ ɝɪɢɩɩɚ. ɏɨɬɹ ɞɚɧɧɵɟ
Rastogi D. et al., 2006 ɩɨɤɚɡɚɥɢ, ɱɬɨ ɜɚɤɰɢɧɚɰɢɹ
ɩɪɨɬɢɜ ɝɪɢɩɩɚ ɫɪɟɞɢ ɛɟɪɟɦɟɧɧɵɯ ɫ ȻȺ ɫɧɢɠɚɟɬ
ɪɢɫɤ ɨɛɨɫɬɪɟɧɢɣ ɧɚ 50% [12].

Ɋɢɫ. 5. ɋɩɢɪɨɝɪɚɦɦɚ ɧɚ 32-ɣ ɧɟɞɟɥɟ ɛɟɪɟɦɟɧɧɨɫɬɢ

ȼ ɦɟɬɚɚɧɚɥɢɡɟ Murphy V. E. et al., 2011 ɨɛɟɫɩɨɤɨɟɧɧɨɫɬɶ ɠɟɧɳɢɧ ɨɬɧɨɫɢɬɟɥɶɧɨ ɛɟɡɨɩɚɫɧɨɫɬɢ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɥɹ ɩɥɨɞɚ ɪɚɫɫɦɚɬɪɢɜɚɟɬɫɹ ɤɚɤ ɨɫɧɨɜɧɚɹ ɩɪɢɱɢɧɚ ɫɧɢɠɟɧɢɹ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ɥɟɱɟɧɢɸ, ɨɞɧɚɤɨ ɜ ɧɚɲɟɦ ɢɫɫɥɟɞɨɜɚɧɢɢ ɢɡɦɟɧɟɧɢɹ ɜ ɩɪɢɜɟɪɠɟɧɧɨɫɬɢ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ

30

ɨɤɚɡɚɥɢɫɶ ɫɬɚɬɢɫɬɢɱɟɫɤɢ ɧɟ ɡɧɚɱɢɦɵɦɢ (ɪ> 0,05).
Ȼɨɥɶɲɢɧɫɬɜɨ ɠɟɧɳɢɧ, ɫɨɛɥɸɞɚɜɲɢɯ ɪɟɠɢɦ ɬɟɪɚɩɢɢ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɩɨɥɭɱɢɜɲɢɯ ɨɬ ɧɟɟ
ɨɠɢɞɚɟɦɵɣ ɤɥɢɧɢɱɟɫɤɢɣ ɷɮɮɟɤɬ, ɩɪɨɞɨɥɠɚɸɬ ɟɟ
ɢ ɜ ɝɟɫɬɚɰɢɨɧɧɵɣ ɩɟɪɢɨɞ ɜ ɬɨɦ ɠɟ ɨɛɴɟɦɟ. ɉɪɢ
ɷɬɨɦ ɧɚɢɛɨɥɶɲɚɹ ɩɪɢɜɟɪɠɟɧɧɨɫɬɶ ɤ ɬɟɪɚɩɢɢ ɜɵ-

ɆȿȾɂɑɇȱ ɉȿɊɋɉȿɄɌɂȼɂ

ɹɜɥɟɧɚ ɭ ɠɟɧɳɢɧ ɫ ɬɹɠɟɥɨɣ ɚɫɬɦɨɣ, ɩɨɥɭɱɚɸɳɢɯ
ɜɵɫɨɤɢɟ ɞɨɡɵ ɢɧɝɚɥɹɰɢɨɧɧɵɯ ɝɨɪɦɨɧɨɜ.
ȼɕȼɈȾɕ

1. 71% ɛɟɪɟɦɟɧɧɵɯ ɩɟɪɟɧɟɫɥɢ ɨɛɨɫɬɪɟɧɢɹ ɪɚɡɧɨɣ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ, ɤɨɬɨɪɵɟ ɪɚɡɜɢɜɚɥɢɫɶ ɧɚ
ɮɨɧɟ ɫɢɦɩɬɨɦɨɜ ɢɧɮɟɤɰɢɢ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ
ɩɭɬɟɣ. ɗɬɨ ɟɳɟ ɪɚɡ ɩɨɞɱɟɪɤɢɜɚɟɬ ɪɨɥɶ ɪɟɫɩɢɪɚɬɨɪɧɵɯ ɜɢɪɭɫɨɜ ɜ ɪɚɡɜɢɬɢɢ ɨɛɨɫɬɪɟɧɢɣ ɛɪɨɧɯɢɚɥɶɧɨɣ ɚɫɬɦɵ ɢ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɩɪɨɜɟɞɟɧɢɹ
ɫɩɟɰɢɮɢɱɟɫɤɨɣ ɩɪɨɮɢɥɚɤɬɢɤɢ (ɜɚɤɰɢɧɚɰɢɹ),
ɟɫɥɢ ɫɟɡɨɧɧɨɟ ɩɨɜɵɲɟɧɢɟ ɭɪɨɜɧɹ ɡɚɛɨɥɟɜɚɟɦɨɫɬɢ ɪɟɫɩɢɪɚɬɨɪɧɵɦɢ ɜɢɪɭɫɧɵɦɢ ɢɧɮɟɤɰɢɹɦɢ
ɫɨɜɩɚɞɚɟɬ ɫɨ ɜɬɨɪɵɦ ɢɥɢ ɬɪɟɬɶɢɦ ɬɪɢɦɟɫɬɪɚɦɢ
ɛɟɪɟɦɟɧɧɨɫɬɢ, ɨɫɨɛɟɧɧɨ ɭ ɠɟɧɳɢɧ ɫ ȻȺ.
2. ɉɨɥɭɱɟɧɵ ɞɚɧɧɵɟ ɨ ɬɨɦ, ɱɬɨ ɩɪɢɜɟɪɠɟɧɧɨɫɬɶ ɤ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ ɞɨ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟ-

ɦɟɧɧɨɫɬɢ ɜ ɢɫɫɥɟɞɭɟɦɨɣ ɝɪɭɩɩɟ ɧɟ ɢɦɟɥɚ
ɞɨɫɬɨɜɟɪɧɵɯ ɪɚɡɥɢɱɢɣ. Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɦɨɠɧɨ
ɩɪɟɞɩɨɥɨɠɢɬɶ, ɱɬɨ ɩɪɢɜɟɪɠɟɧɧɨɫɬɶ ɤ ɛɚɡɢɫɧɨɣ
ɬɟɪɚɩɢɢ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɟɟ ɫɨɨɬɜɟɬɫɬɜɢɟ ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ ɡɚɛɨɥɟɜɚɧɢɹ – ɫɩɨɫɨɛɫɬɜɭɸɬ ɞɨɫɬɢɠɟɧɢɸ ɤɨɧɬɪɨɥɹ ȻȺ ɜ ɝɟɫɬɚɰɢɨɧɧɵɣ ɩɟɪɢɨɞ.
3. ɍɯɭɞɲɟɧɢɟ ɤɨɧɬɪɨɥɹ ȻȺ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɦɨɠɟɬ ɛɵɬɶ ɨɛɭɫɥɨɜɥɟɧɨ ɧɟ ɬɨɥɶɤɨ
ɧɚɪɭɲɟɧɢɟɦ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ, ɧɨ ɢ ɟɟ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶɸ, ɧɚ ɮɨɧɟ ɮɢɡɢɨɥɨɝɢɱɟɫɤɢɯ ɢɡɦɟɧɟɧɢɣ.
ɗɬɨ ɝɨɜɨɪɢɬ ɨ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɤɨɧɬɪɨɥɹ ɬɟɱɟɧɢɹ
ɡɚɛɨɥɟɜɚɧɢɹ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɩɪɨɫɬɵɯ ɢ ɞɨɫɬɭɩɧɵɯ ɦɟɬɨɞɢɤ (ȺɋɌ ɢ ɫɩɢɪɨɦɟɬɪɢɹ) ɢ ɫɜɨɟɜɪɟɦɟɧɧɨɣ ɤɨɧɫɭɥɶɬɚɰɢɢ ɩɭɥɶɦɨɧɨɥɨɝɚ ɞɥɹ ɩɟɪɟɫɦɨɬɪɚ ɛɚɡɢɫɧɨɣ ɬɟɪɚɩɢɢ.

ɋɉɂɋɈɄ ɅɂɌȿɊȺɌɍɊɕ
1. ɉɟɪɰɟɜɚ Ɍ.Ⱥ. ɂɧɮɟɤɰɢɨɧɧɨɟ ɨɛɨɫɬɪɟɧɢɟ ɛɪɨɧɯɢɚɥɶɧɨɣ ɚɫɬɦɵ / Ɍ.Ⱥ. ɉɟɪɰɟɜɚ, ȼ.ȼ. Ⱦɦɢɬɪɟɱɟɧɤɨ //
Ɂɞɨɪɨɜɶɟ ɍɤɪɚɢɧɵ. – 2010. – ɬɟɦɚɬɢɱɟɫɤɢɣ ɧɨɦɟɪ. –
ɋ. 6.
2. Ɋɟɛɪɨɜɚ Ɉ.ɘ. ɋɬɚɬɢɫɬɢɱɟɫɤɢɣ ɚɧɚɥɢɡ ɦɟɞɢɰɢɧɫɤɢɯ ɞɚɧɧɵɯ. ɉɪɢɦɟɧɟɧɢɟ ɩɚɤɟɬɚ ɩɪɢɤɥɚɞɧɵɯ
ɩɪɨɝɪɚɦɦ STATISTICA / Ɉ. ɘ. Ɋɟɛɪɨɜɚ. – Ɇ.: Ɇɟɞɢɚ
ɋɮɟɪɚ, 2002. – 312 ɫ.
3. Ɍɟɫɬ ɩɨ ɤɨɧɬɪɨɥɸ ɧɚɞ ɚɫɬɦɨɣ (ACT). ȽɥɚɤɫɨɋɦɢɬɄɥɹɣɧ, 2010 [ɗɥɟɤɬɪɨɧɧɵɣ ɪɟɫɭɪɫ]. – Ɋɟɠɢɦ
ɞɨɫɬɭɩɚ: http://www.astmatest.ru /what_is_act.html.
4. Asthma morbidity during pregnancy can be predicted by severity classification / M. Schatz, M.P. Dombrowski, R. Wise, [et al.] // J. Allergy. Clin. Immunol. –
2003. – Vol. 112. – P. 283.
5. Chambers K. Asthma education and outcomes for
women of childbearing age / K. Chambers // Case Manager. – 2003. – Vol. 14.– P. 58-61.
6. Effects of asthma severity, exacerbations and oral
corticosteroids on perinatal outcomes / J.A. Namazy,
V.E. Murphy, H. Powell [et al] // Eur. Respir. J. – 2013.
– Vol. 41. – P. 1082-1090.

7. Enriquez R. Effect of maternal asthma and asthma
control during pregnancy and perinatal outcomes / R.
Enriquez, M.R. Griffen, K.N. Carroll [et al.] // J Allergy
Clin. Immunol. – 2007. – Vol. 120. – P. 625-628.
8. Exacerbations of asthma and chronic obstructive
pulmonary disease (COPD): focus on virus induced exacerbations / P. Mallia, M. Contoli, G. Caramori [et al.] //
Curr. Pharm. Des. – 2007. – Vol. 13, N 1. – P. 73-97.
9. Global strategy for asthma menegment and prevention report 2013 [Internet]. – Available from:
http://www.ginasthma.org.
10. Kwon H. L. Asthma prevalence among pregnant
and childbearing-aged women in the United States: Estimates from National Health Surveys / H.L. Kwon,
K. Belanger, M.B. Bracken // Ann. Epidemiology.– 2003.
– Vol. 13.– P. 317-324.
11. Severe asthma exacerbations during pregnancy /
V.E. Murphy, P. Gibson, P.I. Talbo [et al.] // Obstet Gynecol.– 2005.– Vol. 106. – P. 1046-8.
12. T-helper type 2 polarization among asthmatics during and following pregnancy / D. Rastogi, C. Wang, C. Lendor [et al.] // Clin. Exp. Allergy. – 2006. – Vol. 36. – P. 892.

REFERENCES
1. Pertseva TA, Dmitrichenko VV. [Infectious exacerbation of asthma]. Zdorov'e Ukrainy. 2010;6. Russian.
2. Rebrova OY. [Statistical analysis of medical data.
Application of software package STATISTICA]. Media
Sfera, 2002;312. Russian.
3. Asthma Control Test (ACT) [Internet]. GlaxosmithKline, 2010. Available from: http://www.astmatest.ru/what_is_act.html.
4. Schatz M, Dombrowski MP, Wise R. Asthma
morbidity during pregnancy can be predicted by severity
classification. J Allergy Clin Immunol. 2003;112:283.
5. Chambers K. Asthma education and outcomes for
women of childbearing age. Case Manager 2003;14:58.

14/ Ɍɨɦ XIX / 2

6. Namazy JA, Murphy VE, Powell H, Gibson PG,
Chambers C, Schatz M. Effects of asthma severity, exacerbations and oral corticosteroids on perinatal outcomes.
Eur Respir J 2013;41:1082–90.
7. Enriquez R, Griffen MR, Carroll KN, et al.
Effect of maternal asthma and asthma control during
pregnancy and perinatal outcomes. J Allergy Clin
Immunol. 2007;120:625.
8. Mallia P, Contoli M, Caramori G. Exacerbations
of asthma and chronic obstructive pulmonary disease
(COPD): focus on virus induced exacerbations. Curr
Pharm Des. 2007;13(1):73–97.

31

ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
9. Global strategy for asthma management and prevention, report 2013 [Internet]. GINA, 2013. Available
from: http://www.ginasthma.org.
10. Kwon HL, Belanger K, Bracken MB. Asthma
prevalence among pregnant and childbearing-aged women in the United States: Estimates from National Health
Surveys. Annals of Epidemiology 2003;13:317–24.

11. Murphy VE, Gibson P, Talbot PI, et al. Severe
asthma exacerbations during pregnancy. Obstet Gynecol
2005;106:1046.
12. Rastogi D, Wang C, Lendor C, et al. T-helper
type 2 polarization among asthmatics during and following pregnancy. Clin Exp Allergy. 2006;36:892.
ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ
13.03.2014

ɍȾɄ 616.24-002-036-08:615.33:330.133

ə.Ɉ. Ⱦɡɸɛɥɢɤ

ɈɉɌɂɆȱɁȺɐȱə ȺɇɌɂȻȺɄɌȿɊȱȺɅɖɇɈȲ
ɌȿɊȺɉȱȲ ɏȼɈɊɂɏ ɇȺ ɇȿȽɈɋɉȱɌȺɅɖɇɍ
ɉɇȿȼɆɈɇȱɘ ȱV ɄɅȱɇȱɑɇɈȲ ȽɊɍɉɂ

Ⱦɍ «ɇɚɰɿɨɧɚɥɶɧɢɣ ɿɧɫɬɢɬɭɬ ɮɬɢɡɿɚɬɪɿʀ ɿ ɩɭɥɶɦɨɧɨɥɨɝɿʀ
ɿɦ. Ɏ.Ƚ. əɧɨɜɫɶɤɨɝɨ ɇȺɆɇ ɍɤɪɚʀɧɢ»
ɜɭɥ. Ɇ. Ⱥɦɨɫɨɜɚ, 10, Ʉɢʀɜ, 03680, ɍɤɪɚʀɧɚ
SO “National institute of phthisiology and pulmonology
named after F.G. Yanovsky, NAMS of Ukraine”
M. Amosova str., 10, Kiev, 03680, Ukraine
e-mail: dzublik@yahoo.com
Ʉɥɸɱɨɜɿ ɫɥɨɜɚ: ɧɟɝɨɫɩɿɬɚɥɶɧɚ ɩɧɟɜɦɨɧɿɹ, ɚɧɬɢɛɿɨɬɢɤɢ, ɟɮɟɤɬɢɜɧɿɫɬɶ ɥɿɤɭɜɚɧɧɹ, ɜɚɪɬɿɫɬɶ
Key words: community-acquired pneumonia, antibiotics, effectiveness of treatment, cost
Ɋɟɮɟɪɚɬ. Ɉɩɬɢɦɢɡɚɰɢɹ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɨɣ ɬɟɪɚɩɢɢ ɛɨɥɶɧɵɯ ɜɧɟɛɨɥɶɧɢɱɧɨɣ ɩɧɟɜɦɨɧɢɟɣ ȱV ɤɥɢɧɢɱɟɫɤɨɣ ɝɪɭɩɩɵ. Ⱦɡɸɛɥɢɤ ə.Ⱥ. ɐɟɥɶ ɢɫɫɥɟɞɨɜɚɧɢɹ: ɢɡɭɱɟɧɢɟ ɤɥɢɧɢɱɟɫɤɨɣ ɢ ɷɤɨɧɨɦɢɱɟɫɤɨɣ ɷɮɮɟɤɬɢɜɧɨɫɬɢ
ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɧɧɵɯ ɪɟɠɢɦɨɜ ɷɦɩɢɪɢɱɟɫɤɨɣ ɫɬɭɩɟɧɱɚɬɨɣ ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɢ ɛɨɥɶɧɵɯ ɜɧɟɛɨɥɶɧɢɱɧɨɣ
ɩɧɟɜɦɨɧɢɟɣ (ȼɉ) ȱV ɤɥɢɧɢɱɟɫɤɨɣ ɝɪɭɩɩɵ. Ɇɚɬɟɪɢɚɥɵ ɢ ɦɟɬɨɞɵ. ȼ ɢɫɫɥɟɞɨɜɚɧɢɟ ɜɤɥɸɱɢɥɢ 42 ɩɚɰɢɟɧɬɚ ɫ ȼɉ
ɬɹɠɟɥɨɝɨ ɬɟɱɟɧɢɹ ɛɟɡ ɧɚɥɢɱɢɹ ɮɚɤɬɨɪɨɜ ɪɢɫɤɚ ɢɧɮɢɰɢɪɨɜɚɧɢɹ P. aeruginosa, ɤɨɬɨɪɵɟ ɛɵɥɢ ɝɨɫɩɢɬɚɥɢɡɢɪɨɜɚɧɵ ɜ ɨɬɞɟɥɟɧɢɟ ɢɧɬɟɧɫɢɬɜɧɨɣ ɬɟɪɚɩɢɢ ɩɨ ɦɟɞɢɰɢɧɫɤɢɦ ɩɨɤɚɡɚɧɢɹɦ. ɉɚɰɢɟɧɬɵ ɞɚɧɧɨɣ ɝɪɭɩɩɵ ɛɵɥɢ
ɪɚɧɞɨɦɢɡɢɪɨɜɚɧɵ ɩɪɨɫɬɵɦ ɦɟɬɨɞɨɦ ɜ ɫɨɨɬɧɨɲɟɧɢɢ 1:1:1 ɜ ɬɪɢ ɩɨɞɝɪɭɩɩɵ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɢɫɩɨɥɶɡɨɜɚɧɧɵɯ
ɫɯɟɦ ɷɦɩɢɪɢɱɟɫɤɨɣ ɫɬɭɩɟɧɱɚɬɨɣ ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɢ: ɜɧɭɬɪɢɜɟɧɧɨɟ ɩɪɢɦɟɧɟɧɢɟ ɚɦɨɤɫɢɰɢɥɥɢɧɚ/ɤɥɚɜɭɥɚɧɚɬɚ, ɥɢɛɨ ɰɟɮɬɪɢɚɤɫɨɧɚ, ɥɢɛɨ ɷɪɬɚɩɟɧɟɦɚ ɜ ɤɨɦɛɢɧɚɰɢɢ ɫ ɚɡɢɬɪɨɦɢɰɢɧɨɦ. ɉɨɫɥɟ ɫɬɚɛɢɥɢɡɚɰɢɢ ɫɨɫɬɨɹɧɢɹ
ɛɨɥɶɧɨɝɨ ɱɟɪɟɡ 3–4 ɞɧɹ ɬɟɪɚɩɢɹ ɡɚɦɟɧɹɥɚɫɶ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ ɧɚ ɩɟɪɨɪɚɥɶɧɵɣ ɩɪɢɟɦ ɚɦɨɤɫɢɰɢɥɥɢɧɚ/ɤɥɚɜɭɥɚɧɚɬɚ, ɰɟɮɭɪɨɤɫɢɦɚ ɚɤɫɟɬɢɥɚ ɜ ɤɨɦɛɢɧɚɰɢɢ ɫ ɚɡɢɬɪɨɦɢɰɢɧɨɦ, ɥɢɛɨ ɩɟɪɨɪɚɥɶɧɭɸ ɦɨɧɨɬɟɪɚɩɢɸ ɥɟɜɨɮɥɨɤɫɚɰɢɧɨɦ. ɋɪɚɜɧɢɬɟɥɶɧɚɹ ɨɰɟɧɤɚ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɪɟɠɢɦɨɜ ɚɧɬɢɛɢɨɬɢɤɨɬɟɪɚɩɢɢ ɩɪɨɜɨɞɢɥɚɫɶ ɩɨ ɤɥɢɧɢɤɨɥɚɛɨɪɚɬɨɪɧɵɦ ɢ ɮɚɪɦɚɤɨɷɤɨɧɨɦɢɱɟɫɤɢɦ ɩɨɤɚɡɚɬɟɥɹɦ. Ɋɟɡɭɥɶɬɚɬɵ. Ⱥɧɚɥɢɡ ɞɢɧɚɦɢɤɢ ɪɟɡɭɥɶɬɚɬɨɜ ɤɥɢɧɢɤɨɥɚɛɨɪɚɬɨɪɧɵɯ ɢ ɪɟɧɬɝɟɧɨɥɨɝɢɱɟɫɤɢɯ ɢɫɫɥɟɞɨɜɚɧɢɣ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ, ɱɬɨ ɩɪɨɜɟɞɟɧɧɚɹ ɷɦɩɢɪɢɱɟɫɤɚɹ
ɫɬɭɩɟɧɱɚɬɚɹ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɚɹ ɬɟɪɚɩɢɹ ɫɩɨɫɨɛɫɬɜɨɜɚɥɚ ɞɨɫɬɢɠɟɧɢɸ ɩɪɚɤɬɢɱɟɫɤɢ ɨɞɢɧɚɤɨɜɵɯ (ɪ>0,05)
ɩɨɡɢɬɢɜɧɵɯ ɪɟɡɭɥɶɬɚɬɨɜ ɜɨ ɜɫɟɯ ɩɨɞɝɪɭɩɩɚɯ: ɭ 78,6r11,0% ɛɨɥɶɧɵɯ 1-ɣ ɩɨɞɝɪɭɩɩɵ (ɜɵɡɞɨɪɨɜɥɟɧɢɟ – ɭ
28,6r12,1, ɭɥɭɱɲɟɧɢɟ – ɭ 49,4r13,2%), ɭ 71,4r12,1% ɛɨɥɶɧɵɯ 2-ɣ ɩɨɞɝɪɭɩɩɵ (ɜɵɡɞɨɪɨɜɥɟɧɢɟ ɢ ɭɥɭɱɲɟɧɢɟ – ɭ
35,7r 12,8%) ɢ ɭ 85,7r 9,4% ɛɨɥɶɧɵɯ 3-ɣ ɝɪɭɩɩɵ (ɜɵɡɞɨɪɨɜɥɟɧɢɟ ɢ ɭɥɭɱɲɟɧɢɟ ɭ 42,9r13,2%) (ɪ!0,05). ȼɵɜɨɞɵ.
Ɉɫɧɨɜɭ ɥɟɱɟɧɢɹ ɛɨɥɶɧɵɯ ȼɉ ɞɨɥɠɧɚ ɫɨɫɬɚɜɥɹɬɶ ɚɧɬɢɛɚɤɬɟɪɢɚɥɶɧɚɹ ɬɟɪɚɩɢɹ, ɤɨɬɨɪɚɹ ɜɫɟɝɞɚ ɹɜɥɹɟɬɫɹ

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