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 ÏÎÌÎÙÜ ÏÐÀÊÒÈ×ÅÑÊÎÌÓ ÂÐÀ×Ó
ʋ3x2009 iɬɨɦ 17
Ɇɉ. ɉɈɌȺɉɇȿȼ
ÊÎÌÏÎÍÅÍÒÛ ÄÎÍÎÐÑÊÎÉ ÊÐÎÂÈ È ÂÎÏÐÎÑÛ ÈÕ ÝÔÔÅÊÒÈÂÍÎÃÎ
ÊËÈÍÈ×ÅÑÊÎÃÎ ÏÐÈÌÅÍÅÍÈß
Ƚɍ «Ɋɟɫɩɭɛɥɢɤɚɧɫɤɢɣɧɚɭɱɧɨɩɪɚɤɬɢɱɟɫɤɢɣɰɟɧɬɪɝɟɦɚɬɨɥɨɝɢɢɢɬɪɚɧɫɮɭɡɢɨɥɨɝɢɢ»,
Ɋɟɫɩɭɛɥɢɤɚ Ȼɟɥɚɪɭɫɶ
ȼɫɬɚɬɶɟɨɫɜɟɳɟɧɵɨɫɧɨɜɧɵɟɜɨɩɪɨɫɵɩɟɪɟɥɢɜɚɧɢɹɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢ: ɷɪɢɬɪɨɰɢɬɧɨɣɦɚɫɫɵ,
ɫɜɟɠɟɡɚɦɨɪɨɠɟɧɧɨɣɩɥɚɡɦɵ, ɤɨɧɰɟɧɬɪɚɬɚɬɪɨɦɛɨɰɢɬɨɜ, ɤɪɢɨɩɪɟɰɢɩɢɬɚɬɚ. ɉɪɟɞɫɬɚɜɥɟɧɚɢɯɯɚɪɚɤɬɟɪɢɫɬɢɤɚɢɞɚɧɵɪɟɤɨɦɟɧɞɚɰɢɢ ɩɨɢɫɩɨɥɶɡɨɜɚɧɢɸɜɤɥɢɧɢɱɟɫɤɨɣɩɪɚɤɬɢɤɟ. Ɉɬɦɟɱɟɧɨ, ɱɬɨ
ɜɨɩɪɨɫɜɵɛɨɪɚɪɚɰɢɨɧɚɥɶɧɨɣɬɚɤɬɢɤɢɩɪɢɦɟɧɟɧɢɹɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢɩɪɢɢɯɞɨɫɬɚɬɨɱɧɨɦɧɚɥɢɱɢɢɜɚɪɫɟɧɚɥɟɦɟɞɢɰɢɧɫɤɨɣɩɨɦɨɳɢɫɬɚɧɨɜɢɬɫɹɜɧɚɫɬɨɹɳɟɟɜɪɟɦɹɚɤɬɭɚɥɶɧɵɦ. ȼɫɨɜɪɟɦɟɧɧɵɯ
ɭɫɥɨɜɢɹɯɞɨɥɠɧɨɜɵɪɚɛɚɬɵɜɚɬɶɫɹɛɟɪɟɠɧɨɟɢɧɚɫɬɨɪɨɠɟɧɧɨɟɨɬɧɨɲɟɧɢɟɤɢɫɩɨɥɶɡɨɜɚɧɢɸɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢ. ɉɪɢɨɩɪɟɞɟɥɟɧɢɢɩɨɤɚɡɚɧɢɣɤɢɯɩɪɢɦɟɧɟɧɢɸɫɥɟɞɭɟɬɨɩɢɪɚɬɶɫɹɧɚɥɚɛɨɪɚɬɨɪɧɵɟɩɨɤɚɡɚɬɟɥɢɤɪɨɜɢ.
Ʉɥɸɱɟɜɵɟɫɥɨɜɚ: ɤɨɦɩɨɧɟɧɬɵɤɪɨɜɢ, ɷɪɢɬɪɨɰɢɬɧɚɹɦɚɫɫɚ, ɫɜɟɠɟɡɚɦɨɪɨɠɟɧɧɚɹɩɥɚɡɦɚ,
ɤɨɧɰɟɧɬɪɚɬɬɪɨɦɛɨɰɢɬɨɜ, ɤɪɢɨɩɪɟɰɢɩɢɬɚɬ
The main questions concerning blood components transfusion (erythrocyte mass, fresh-frozen
plasma, thrombocyte concentrate, cryoprecipitate) are illustrated in the article. Their characteristics and
recommendations concerning their use in clinical practice are presented. It is pointed out that the question
of rational tactics choice in blood components application on condition of their sufficient availability is
becoming rather actual one now. Nowadays one must work out careful and watchful attitude to blood
components use. One has to take into account the laboratory blood indexes when determine indications
for their use.
Keywords: blood components, erythrocyte mass, fresh-frozen plasma, thrombocyte concentrate,
cryoprecipitate
Ʉɪɨɜɶɫɨɫɬɨɢɬɢɯɤɥɟɬɨɱɧɵɯɷɥɟɦɟɧɬɨɜ
ɷɪɢɬɪɨɰɢɬɵ, ɥɟɣɤɨɰɢɬɵ, ɬɪɨɦɛɨɰɢɬɵ) ɢ
ɠɢɞɤɨɣɱɚɫɬɢ, ɫɨɞɟɪɠɚɳɟɣ ɛɨɥɟɟ 100 ɜɢɞɨɜ ɛɟɥɤɨɜ, ɢɦɟɸɳɢɯ ɥɟɱɟɛɧɨɟ ɩɪɢɦɟɧɟɧɢɟ [1, 2]. ȾɨɧɨɪɫɤɚɹɤɪɨɜɶɡɚɝɨɬɚɜɥɢɜɚɟɬɫɹɜɊɟɫɩɭɛɥɢɤɟȻɟɥɚɪɭɫɶɫ 1928 ɝɨɞɚ, ɫ 2007
ɝɨɞɚɰɟɥɶɧɚɹɞɨɧɨɪɫɤɚɹ ɤɪɨɜɶɧɟ ɩɟɪɟɥɢɜɚɟɬɫɹ. ɉɨɫɥɟɞɧɢɟ 10–15 ɥɟɬ ɚɤɬɢɜɧɨ ɢɫɩɨɥɶɡɭɸɬɫɹɤɨɦɩɨɧɟɧɬɵɤɪɨɜɢ (ɷɪɢɬɪɨɰɢɬɧɚɹ ɦɚɫɫɚ, ɤɨɧɰɟɧɬɪɚɬ ɬɪɨɦɛɨɰɢɬɨɜ, ɫɜɟɠɟɡɚɦɨɪɨɠɟɧɧɚɹ ɩɥɚɡɦɚ). Ʉɪɢɨɩɪɟɰɢɩɢɬɚɬ, ɪɚɫɫɦɚɬɪɢɜɚɟɦɵɣɤɚɤɩɪɟɩɚɪɚɬɤɪɨɜɢ
ɥɟɤɚɪɫɬɜɟɧɧɨɟ ɫɪɟɞɫɬɜɨ, ɩɨɥɭɱɚɟɦɨɟ ɢɡ
ɞɨɧɨɪɫɤɨɣ ɤɪɨɜɢ ɱɟɥɨɜɟɤɚ) ɜ Ɋɟɫɩɭɛɥɢɤɟ
Ȼɟɥɚɪɭɫɶ, Ɋɨɫɫɢɣɫɤɨɣ Ɏɟɞɟɪɚɰɢɢ ɢ ɪɹɞɟ
ɫɬɪɚɧɋɇȽ, ɜɦɟɠɞɭɧɚɪɨɞɧɨɣɩɪɚɤɬɢɤɟɫɱɢɬɚɟɬɫɹɤɨɦɩɨɧɟɧɬɨɦɤɪɨɜɢ [2, 3, 4].
ɗɪɢɬɪɨɰɢɬɧɚɹɦɚɫɫɚ
ɗɪɢɬɪɨɰɢɬɧɚɹ ɦɚɫɫɚ (ɗɆ) ɹɜɥɹɟɬɫɹ
ɧɚɢɛɨɥɟɟɢɡɜɟɫɬɧɵɦɢɲɢɪɨɤɨɢɫɩɨɥɶɡɭɟɦɵɦɜɤɥɢɧɢɱɟɫɤɨɣɩɪɚɤɬɢɤɟɤɨɦɩɨɧɟɧɬɨɦ
ɤɪɨɜɢ. ɈɫɧɨɜɧɵɟɯɚɪɚɤɬɟɪɢɫɬɢɤɢɜɵɩɭɫɤɚɟɦɵɯɜɊɟɫɩɭɛɥɢɤɟȻɟɥɚɪɭɫɶɷɪɢɬɪɨɰɢɬɫɨɞɟɪɠɚɳɢɯɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢɩɪɟɞɫɬɚɜɥɟɧɵɜɬɚɛɥɢɰɟ.
Ʉɥɢɧɢɱɟɫɤɨɟ ɩɪɢɦɟɧɟɧɢɟ ɷɪɢɬɪɨɰɢɬɫɨɞɟɪɠɚɳɢɯɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢɨɩɪɟɞɟɥɹɟɬɫɹɟɝɨɡɚɦɟɫɬɢɬɟɥɶɧɨɣɮɭɧɤɰɢɟɣɭɩɚɰɢɟɧɬɨɜɫɚɧɟɦɢɟɣ, ɨɩɪɟɞɟɥɹɟɦɨɣɤɥɢɧɢɱɟɫɤɢɢɩɨɥɚɛɨɪɚɬɨɪɧɵɦɩɨɤɚɡɚɬɟɥɹɦɩɟɪɢɮɟɪɢɱɟɫɤɨɣ ɤɪɨɜɢ (ɫɨɞɟɪɠɚɧɢɸ ɝɟɦɨɝɥɨɛɢɧɚɢɭɪɨɜɧɸɝɟɦɚɬɨɤɪɢɬɚ). ɋɨɝɥɚɫɧɨɫɨɜɪɟɦɟɧɧɵɦ ɩɪɟɞɫɬɚɜɥɟɧɢɹɦ, ɨɫɧɨɜɚɧɢɟɦ
ɞɥɹɝɟɦɨɬɪɚɧɫɮɭɡɢɢɦɨɝɭɬɛɵɬɶɫɭɱɺɬɨɦ
ɤɥɢɧɢɱɟɫɤɢɯ ɩɪɢɡɧɚɤɨɜ ɚɧɟɦɢɡɚɰɢɢ, ɩɪɢ
ɨɫɬɪɨɣɤɪɨɜɨɩɨɬɟɪɟɭɪɨɜɟɧɶɝɟɦɨɝɥɨɛɢɧɚ
70 ɝɥ, ɚ ɩɪɢ ɯɪɨɧɢɱɟɫɤɨɣ ɤɪɨɜɨɩɨɬɟɪɟ –
80 ɝɥ ɩɪɢ ɝɟɦɚɬɨɤɪɢɬɟ ɧɢɠɟ 0,25 [5, 6].
195
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
ɗɪɢɬɪɨɰɢɬɧɚɹɦɚɫɫɚ
Ƚɟɦɚɬɨɤɪɢɬ
Ɇɢɧɢɦɚɥɶɧɨɟ
ɫɨɞɟɪɠɚɧɢɟ
ɝɟɦɨɝɥɨɛɢɧɚ ɝ)
ɇɚɢɦɟɧɨɜɚɧɢɟ
Ɉɛɴɺɦɨɞɧɨɣ
ɞɨɡɵ (ɦɥ)
Ɍɚɛɥɢɰɚ
ɏɚɪɚɤɬɟɪɢɫɬɢɤɚɷɪɢɬɪɨɰɢɬɫɨɞɟɪɠɚɳɢɯɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢ, ɜɵɩɭɫɤɚɟɦɵɯɜ
Ɋɟɫɩɭɛɥɢɤɟ Ȼɟɥɚɪɭɫɶ
Ɉɫɧɨɜɧɵɟɩɨɤɚɡɚɧɢɹɤɤɥɢɧɢɱɟɫɤɨɦɭ
ɩɪɢɦɟɧɟɧɢɸ
0,65-0,75 ɚɧɟɦɢɹ
ɗɆɈɅɌ
250±50
43 0,65-0,75 ɚɧɟɦɢɹ ɭ ɛɨɥɶɧɵɯ ɫ ɰɟɥɶɸ ɫɧɢɠɟɧɢɹ
ɚɥɥɨɫɟɧɫɢɛɢɥɢɡɚɰɢɢ
ɚɧɟɦɢɹ ɭ ɛɨɥɶɧɵɯ ɫ ɚɧɬɢɬɟɥɚɦɢ ɤ
ɗɪɢɬɪɨɰɢɬɧɚɹɦɚɫɫɚ
ɧɟ
ɢ
ɚɥɥɟɪɝɢɱɟɫɤɢɦɢ
40 0,65-0,75 ɷɪɢɬɪɨɰɢɬɚɦ
ɨɬɦɵɬɚɹ
ɨɩɪɟɞɟɥɟɧɚ
ɪɟɚɤɰɢɹɦɢ ɧɚ ɩɟɪɟɥɢɜɚɧɢɟ ɩɪɨɞɭɤɬɨɜ
ɤɪɨɜɢ
ɚɧɟɦɢɹɭɛɨɥɶɧɵɯɫɪɟɞɤɢɦ ɮɟɧɨɬɢɩɨɦ
ɗɪɢɬɪɨɰɢɬɧɚɹɦɚɫɫɚ
ɛɨɥɟɟ
ɢɥɢ
ɢɦɟɸɳɢɯ
36 0,65-0,75 ɷɪɢɬɪɨɰɢɬɨɜ
ɤɪɢɨɤɨɧɫɟɪɜɢɪɨɜɚɧɧɚɹ
185 ɦɥ
ɦɧɨɠɟɫɬɜɟɧɧɵɟ ɚɧɬɢɷɪɢɬɪɨɰɢɬɚɪɧɵɟ
ɚɧɬɢɬɟɥɚ, ɞɥɹɢɦɦɭɧɢɡɚɰɢɢ
ɗɪɢɬɪɨɰɢɬɧɚɹɦɚɫɫɚ,
ɚɧɟɦɢɹ ɭ ɛɨɥɶɧɵɯ, ɩɪɟɞɩɨɥɨɠɢɬɟɥɶɧɨ
ɧɟ
40 0,50-0,70 ɢɦɟɸɳɢɯ ɚɧɬɢɬɟɥɚ ɤ ɷɪɢɬɪɨɰɢɬɚɦ, ɫ
ɥɟɣɤɨɞɟɩɥɟɰɢɪɨɜɚɧɧɚɹ
ɨɩɪɟɞɟɥɟɧɚ
ɮɢɥɶɬɪɚɰɢɟɣ
ɰɟɥɶɸɫɧɢɠɟɧɢɹɚɥɥɨɫɟɧɫɢɛɢɥɢɡɚɰɢɢ
ɉɪɢɦɟɱɚɧɢɟ: ɟɫɥɢɞɨɡɚɤɪɨɜɢɭɤɚɡɚɧɚɤɚɤ «ɧɟɨɩɪɟɞɟɥɟɧɚ», ɪɟɚɥɶɧɵɣɨɛɴɺɦɷɪɢɬɪɨɰɢɬɫɨɞɟɪɠɚɳɟɝɨɤɨɦɩɨɧɟɧɬɚɪɚɫɫɱɢɬɵɜɚɟɬɫɹɩɪɢɟɝɨɩɨɥɭɱɟɧɢɢɢɡɩɨɥɧɨɣɞɨɡɵɞɨɧɨɪɫɤɨɣɤɪɨɜɢ (450 ɦɥ);
ɷɪɢɬɪɨɰɢɬɫɨɞɟɪɠɚɳɢɣɤɨɦɩɨɧɟɧɬɤɪɨɜɢɦɨɠɟɬɛɵɬɶ ɞɨɩɨɥɧɢɬɟɥɶɧɨɨɛɥɭɱɺɧɜɫɨɨɬɜɟɬɫɬɜɢɢɫ
ɩɪɨɬɨɤɨɥɨɦɜɟɞɟɧɢɹɩɚɰɢɟɧɬɨɜ
280±50
45
ɉɟɪɟɥɢɜɚɧɢɟ 1 ɞɨɡɵɗɆɞɨɥɠɧɨɩɪɢɜɟɫɬɢ
ɤɩɨɜɵɲɟɧɢɸɝɟɦɚɬɨɤɪɢɬɚɧɚ 3% (0,03) [7].
ȼɥɢɬɟɪɚɬɭɪɟɨɛɫɭɠɞɚɟɬɫɹɞɜɟɩɪɢɧɰɢɩɢɚɥɶɧɵɟɬɚɤɬɢɤɢɩɪɢɦɟɧɟɧɢɹɷɪɢɬɪɨɰɢɬɧɨɣ ɦɚɫɫɵ (ɗɆ) ɭ ɩɚɰɢɟɧɬɨɜ: ɨɝɪɚɧɢɱɢɬɟɥɶɧɚɹ (ɤɨɝɞɚɗɆɩɟɪɟɥɢɜɚɸɬɩɪɢɭɪɨɜɧɟ
ɝɟɦɨɝɥɨɛɢɧɚɜɩɟɪɢɮɟɪɢɱɟɫɤɨɣɤɪɨɜɢɦɟɧɟɟ 80 ɝɥ) ɢ «ɥɢɛɟɪɚɥɶɧɚɹ» (ɤɨɝɞɚɗɆɩɟɪɟɥɢɜɚɸɬɩɚɰɢɟɧɬɭɩɪɢɭɪɨɜɧɟɝɟɦɨɝɥɨɛɢɧɚ ɜ ɩɟɪɢɮɟɪɢɱɟɫɤɨɣ ɤɪɨɜɢ ɦɟɧɟɟ 100 ɝ/
ɥ), ɩɪɢ ɷɬɨɦ ɜɵɠɢɜɚɟɦɨɫɬɶɛɨɥɶɧɵɯ ɩɪɢ
ɷɬɨɦɦɨɠɟɬɛɵɬɶɨɞɢɧɚɤɨɜɨɣ [8]. ȼɬɨɠɟ
ɜɪɟɦɹ ɨɛɳɚɹ ɬɟɧɞɟɧɰɢɹ ɡɚɤɥɸɱɚɟɬɫɹ ɜ
ɫɞɟɪɠɚɧɧɨɣɬɚɤɬɢɤɟɩɪɢɦɟɧɟɧɢɹɚɥɥɨɝɟɧɧɨɣɞɨɧɨɪɫɤɨɣɤɪɨɜɢ, ɡɚɢɫɤɥɸɱɟɧɢɟɦɩɚɰɢɟɧɬɨɜɫɦɧɨɠɟɫɬɜɟɧɧɨɣɬɪɚɜɦɨɣ, ɩɨɠɢɥɵɯ, ɛɨɥɶɧɵɯɫɛɨɥɶɲɨɣɤɪɨɜɨɩɨɬɟɪɟɣ (ɛɨɥɟɟ 30–40% ɈɐɄ), ɛɨɥɶɧɵɯɫɨɬɹɝɨɳɟɧɧɵɦ
ɤɚɪɞɢɨɥɨɝɢɱɟɫɤɢɦɢɩɭɥɶɦɨɧɨɥɨɝɢɱɟɫɤɢɦ
196
ɚɧɚɦɧɟɡɨɦ, ɛɨɥɶɧɵɯɞɢɚɛɟɬɨɦ [5, 9]. ɗɬɨ
ɫɜɹɡɚɧɨ, ɩɪɟɠɞɟɜɫɟɝɨ, ɫɩɨɥɭɱɟɧɢɟɦɭɛɟɞɢɬɟɥɶɧɵɯɞɚɧɧɵɯɨɬɨɦ, ɱɬɨɢɡɛɵɬɨɱɧɨɟ
ɩɪɢɦɟɧɟɧɢɟ ɷɪɢɬɪɨɰɢɬɧɨɣ ɦɚɫɫɵ ɩɪɢɜɨɞɢɬɤɩɨɜɵɲɟɧɧɨɣɫɦɟɪɬɧɨɫɬɢɜ 20–50 ɪɚɡ
ɭɯɢɪɭɪɝɢɱɟɫɤɢɯɛɨɥɶɧɵɯ (ɛɟɡɭɱɺɬɚɛɨɥɶɧɵɯ ɫ ɢɧɮɟɤɰɢɹɦɢ, ɡɚɛɨɥɟɜɚɧɢɹɦɢ ɩɟɱɟɧɢɢɨɬɪɚɜɥɟɧɢɹɦɢ) [10] ɢɭɛɨɥɶɧɵɯ, ɩɟɪɟɧɺɫɲɢɯɤɚɪɞɢɨɯɢɪɭɪɝɢɱɟɫɤɢɟɨɩɟɪɚɰɢɢ
[11], ɭɠɟɧɳɢɧɩɨɫɥɟɨɩɟɪɚɰɢɣɧɚɫɟɪɞɰɟ
ɩɨɫɪɚɜɧɟɧɢɸɫɦɭɠɱɢɧɚɦɢ – ɜ 2 ɪɚɡɚ [12].
ɉɪɢɦɟɧɟɧɢɟɛɨɥɶɲɟɝɨɤɨɥɢɱɟɫɬɜɚɞɨɡɗɆ
ɛɨɥɟɟ 5) ɚɫɫɨɰɢɢɪɭɟɬɫɹ ɫ ɩɨɜɵɲɟɧɢɟɦ
ɭɪɨɜɧɹ ɫɦɟɪɬɧɨɫɬɢ ɩɚɰɢɟɧɬɨɜ ɜ ɬɟɱɟɧɢɟ
ɛɥɢɠɚɣɲɢɯ 2 ɦɟɫɹɰɟɜ ɥɟɱɟɧɢɹ ɧɟɡɚɜɢɫɢɦɨɨɬɧɨɡɨɥɨɝɢɱɟɫɤɨɣɮɨɪɦɵɡɚɛɨɥɟɜɚɧɢɹ
[13].
ɉɟɪɟɥɢɜɚɧɢɸ ɗɆ ɜ ɤɨɥɢɱɟɫɬɜɟ 1–2
ɞɨɡɚ ɨɛɵɱɧɨ ɩɪɟɞɲɟɫɬɜɭɟɬ ɩɪɢɦɟɧɟɧɢɟ ɭ
ʋ3x2009 iɬɨɦ 17
ɛɨɥɶɧɨɝɨɮɢɡɢɨɥɨɝɢɱɟɫɤɨɝɨɪɚɫɬɜɨɪɚɢɥɢ
ɞɪɭɝɢɯɤɪɢɫɬɚɥɥɨɢɞɧɵɯɤɪɨɜɟɡɚɦɟɳɚɸɳɢɯ
ɪɚɫɬɜɨɪɨɜ. ɉɪɢɩɪɢɦɟɧɟɧɢɢɛɨɥɶɲɟɝɨɤɨɥɢɱɟɫɬɜɚ ɞɨɡ ɗɆ ɨɞɧɨɜɪɟɦɟɧɧɨ ɛɨɥɶɧɨɣ
ɩɨɥɭɱɚɟɬ ɢ ɞɪɭɝɢɟ ɤɨɦɩɨɧɟɧɬɵ ɤɪɨɜɢ ɢ
ɩɪɟɩɚɪɚɬɵ ɩɥɚɡɦɵ (ɫɜɟɠɟɡɚɦɨɪɨɠɟɧɧɭɸ
ɩɥɚɡɦɭ, ɤɨɧɰɟɧɬɪɚɬɬɪɨɦɛɨɰɢɬɨɜ, ɤɪɢɨɩɪɟɰɢɩɢɬɚɬ). ɋɨɱɟɬɚɧɧɨɟ ɩɪɢɦɟɧɟɧɢɟ ɧɟɫɤɨɥɶɤɢɯ ɤɨɦɩɨɧɟɧɬɨɜ ɤɪɨɜɢ ɨɩɪɟɞɟɥɹɟɬɫɹɩɪɢɧɹɬɵɦɢɩɪɨɬɨɤɨɥɚɦɢɥɟɱɟɧɢɹɛɨɥɶɧɵɯ. ɉɪɢɫɪɚɜɧɟɧɢɢɢɫɩɨɥɶɡɨɜɚɧɢɹɪɚɡɥɢɱɧɨɝɨɫɨɨɬɧɨɲɟɧɢɹɞɨɡɗɆɢɫɜɟɠɟɡɚɦɨɪɨɠɟɧɧɨɣ ɩɥɚɡɦɵ ɩɨɤɚɡɚɧɨ, ɱɬɨ ɫɨɨɬɧɨɲɟɧɢɟ 2:1 ɛɨɥɟɟɷɮɮɟɤɬɢɜɧɨ (ɦɟɧɶɲɟɩɨɫɥɟɞɭɸɳɚɹɫɦɟɪɬɧɨɫɬɶɛɨɥɶɧɵɯ, ɱɟɦɩɪɢɢɫɩɨɥɶɡɨɜɚɧɢɢ ɫɬɚɧɞɚɪɬɧɨɝɨ ɫɨɨɬɧɨɲɟɧɢɹ
1:1) [14, 15]. ɉɪɢɧɟɨɛɯɨɞɢɦɨɫɬɢɛɨɥɶɲɢɯ
ɩɟɪɟɥɢɜɚɧɢɣɤɪɨɜɢ (ɛɨɥɟɟ 10 ɞɨɡɗɆ) ɞɥɹ
ɡɚɦɟɫɬɢɬɟɥɶɧɨɣɰɟɥɢɩɪɢɤɪɨɜɨɩɨɬɟɪɟɪɟɤɨɦɟɧɞɭɟɬɫɹɢɫɩɨɥɶɡɨɜɚɬɶ ɫɨɱɟɬɚɧɢɟɜɫɟɯ
ɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢ, ɧɚɩɪɢɦɟɪ: 19 ɞɨɡɗɆ
+ 11 ɞɨɡ ɩɥɚɡɦɵ + 4 ɞɨɡɵ ɤɨɧɰɟɧɬɪɚɬɚ
ɬɪɨɦɛɨɰɢɬɨɜ + 10 ɞɨɡɤɪɢɨɩɪɟɰɢɩɢɬɚɬɚɜ
ɬɟɱɟɧɢɟɩɟɪɜɵɯ 24 ɱɚɫɨɜɩɨɫɥɟɩɨɫɬɭɩɥɟɧɢɹ [15]. ɋɬɚɧɞɚɪɬɧɵɣ ɩɪɨɬɨɤɨɥ ɩɟɪɟɥɢɜɚɧɢɹɤɨɦɩɨɧɟɧɬɨɜ ɤɪɨɜɢɩɪɢ ɦɚɫɫɢɜɧɨɣ
ɤɪɨɜɨɩɨɬɟɪɟ (massive transfusion protocol)
ɩɪɢɬɪɚɜɦɚɯ, ɩɪɢɧɹɬɵɣɜɋɒȺ, ɜɤɥɸɱɚɟɬ
ɩɟɪɟɥɢɜɚɧɢɟ 6 ɞɨɡɗɆ + 4 ɞɨɡɩɥɚɡɦɵ + 4
ɞɨɡ ɬɪɨɦɛɨɰɢɬɨɜ ɜ ɩɟɪɜɵɟ 4 ɱɚɫɚ ɩɨɫɥɟ
ɩɨɫɬɭɩɥɟɧɢɹɛɨɥɶɧɨɝɨ. Ⱦɚɥɶɧɟɣɲɟɟɜɟɞɟɧɢɟɛɨɥɶɧɨɝɨ – ɩɨɞɤɨɧɬɪɨɥɟɦɥɚɛɨɪɚɬɨɪɧɵɯɩɨɤɚɡɚɬɟɥɟɣɤɪɨɜɢ [16].
Ⱥɞɟɤɜɚɬɧɨɫɬɶ ɩɪɢɦɟɧɟɧɢɹ ɗɆ ɜ ɤɥɢɧɢɤɟ ɡɚɜɢɫɢɬ ɨɬ ɤɜɚɥɢɮɢɤɚɰɢɢ ɜɪɚɱɟɛɧɨɝɨ ɩɟɪɫɨɧɚɥɚ, ɩɨɷɬɨɦɭɬɪɟɛɭɟɬɫɹɪɟɝɭɥɹɪɧɚɹɩɨɞɝɨɬɨɜɤɚɜɪɚɱɟɣɩɨɬɚɤɬɢɤɟɜɟɞɟɧɢɹ
ɛɨɥɶɧɵɯ, ɫɨɜɟɪɲɟɧɫɬɜɨɜɚɧɢɟɢɪɚɡɪɚɛɨɬɤɚ
ɧɨɜɵɯɩɪɨɬɨɤɨɥɨɜɥɟɱɟɧɢɹ, ɤɨɦɩɶɸɬɟɪɢɡɚɰɢɹ ɡɚɩɪɨɫɨɜ ɧɚɤɨɦɩɨɧɟɧɬɵ ɤɪɨɜɢ, ɭɱɟɬ
ɨɛɨɫɧɨɜɚɧɧɨɫɬɢ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɤɚɠɞɨɣ
ɞɨɡɵɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢ, ɩɪɟɠɞɟɜɫɟɝɨɗɆ
[7].
Ⱦɨ 20–25% ɡɚɝɨɬɨɜɥɟɧɧɨɣɗɆɢɫɩɨɥɶɡɭɟɬɫɹ ɜ ɤɥɢɧɢɤɚɯ ɧɟ ɩɨ ɩɨɤɚɡɚɧɢɹɦ ɢɥɢ
ɜɨɨɛɳɟɧɟɢɫɩɨɥɶɡɭɟɬɫɹ, ɱɬɨ, ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ, ɥɢɛɨɧɟɝɚɬɢɜɧɨɫɤɚɡɵɜɚɟɬɫɹɧɚɡɞɨɪɨɜɶɟɩɚɰɢɟɧɬɨɜ, ɥɢɛɨɜɥɟɱɺɬ ɡɚɫɨɛɨɣ ɷɤɨɧɨɦɢɱɟɫɤɢɟɩɨɬɟɪɢ. ɇɟ ɫɥɟɞɭɟɬɡɚɛɵɜɚɬɶ,
ɱɬɨɩɪɢɦɟɧɟɧɢɟɗɆɦɨɠɟɬɩɪɨɜɨɰɢɪɨɜɚɬɶ
ɩɨɫɬɬɪɚɧɫɮɭɡɢɨɧɧɵɟɨɫɥɨɠɧɟɧɢɹɝɟɦɨɥɢɬɢɱɟɫɤɨɝɨ ɬɢɩɚ, ɫɜɹɡɚɧɧɵɟ ɫ ɧɚɥɢɱɢɟɦ ɭ
ɩɚɰɢɟɧɬɨɜ ɚɧɬɢɷɪɢɬɪɨɰɢɬɚɪɧɵɯ ɚɧɬɢɬɟɥ.
ɍɞɚɥɟɧɢɟɞɨɧɨɪɫɤɢɯɚɧɬɢɬɟɥɜɞɨɡɚɯɩɟɪɟɥɢɜɚɟɦɨɣ ɗɆ ɞɨɫɬɢɝɚɟɬɫɹ ɩɪɢɦɟɧɟɧɢɟɦ
ɨɬɦɵɬɨɣ ɗɆ ɢɥɢ ɗɆɈɅɌ, ɩɨɷɬɨɦɭ ɨɧɢ
ɧɚɢɛɨɥɟɟ ɪɟɤɨɦɟɧɞɭɸɬɫɹ ɞɥɹ ɩɨɜɬɨɪɧɵɯ
ɩɟɪɟɥɢɜɚɧɢɣɗɆ. Ⱥɧɬɢɬɟɥɚɜɤɪɨɜɢɪɟɰɢɩɢɟɧɬɨɜ ɩɪɨɬɢɜ ɚɧɬɢɝɟɧɨɜ ȺȼɈ, Rh, Kell
ɧɚɷɪɢɬɪɨɰɢɬɚɯɞɨɧɨɪɨɜ, ɚɬɚɤɠɟɫɭɦɦɚɪɧɵɟɚɧɬɢɷɪɢɬɪɨɰɢɬɚɪɧɵɟɚɧɬɢɬɟɥɚ, ɜɵɹɜɥɹɸɬɫɹ ɩɪɢ ɛɢɨɥɨɝɢɱɟɫɤɨɦ ɬɟɫɬɢɪɨɜɚɧɢɢ
ɤɪɨɜɢ ɞɨɧɨɪɚ ɢ ɪɟɰɢɩɢɟɧɬɚ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɩɟɪɟɞ ɩɪɨɰɟɞɭɪɨɣ ɩɟɪɟɥɢɜɚɧɢɹ
ɗɆ. ɂɦɦɭɧɨɝɟɦɚɬɨɥɨɝɢɱɟɫɤɨɟɬɟɫɬɢɪɨɜɚɧɢɟɞɨɧɨɪɫɤɨɣɤɪɨɜɢɢɪɟɰɢɩɢɟɧɬɚɩɪɨɜɨɞɢɬɫɹ ɜ ɭɫɥɨɜɢɹɯ ɤɥɢɧɢɤɢ, ɢɧɞɢɜɢɞɭɚɥɶɧɵɣɩɨɞɛɨɪɤɪɨɜɢɩɪɨɜɨɞɢɬɫɹɜɭɫɥɨɜɢɹɯ
ɫɬɚɧɰɢɣɩɟɪɟɥɢɜɚɧɢɹɤɪɨɜɢ. Ɂɧɚɱɢɬɟɥɶɧɨ
ɦɟɧɶɲɟɪɟɚɤɰɢɣɭɪɟɰɢɩɢɟɧɬɨɜ ɧɚɛɥɸɞɚɟɬɫɹɩɪɢɩɟɪɟɥɢɜɚɧɢɢɗɆ, ɥɟɣɤɨɞɟɩɥɟɰɢɪɨɜɚɧɧɨɣɮɢɥɶɬɪɚɰɢɟɣɱɟɪɟɡɫɩɟɰɢɚɥɶɧɵɟ
ɮɢɥɶɬɪɵ. ȼɊɟɫɩɭɛɥɢɤɟȻɟɥɚɪɭɫɶɪɚɫɲɢɪɹɟɬɫɹɩɟɪɟɱɟɧɶɡɚɛɨɥɟɜɚɧɢɣɢɤɥɢɧɢɱɟɫɤɢɯ
ɫɨɫɬɨɹɧɢɣɞɥɹɢɯɩɪɢɦɟɧɟɧɢɹ.
ɋɜɟɠɟɡɚɦɨɪɨɠɟɧɧɚɹ ɩɥɚɡɦɚ
ɋɜɟɠɟɡɚɦɨɪɨɠɟɧɧɚɹɩɥɚɡɦɚ (ɋɁɉ) ɹɜɥɹɟɬɫɹ ɤɨɦɩɨɧɟɧɬɨɦ ɤɪɨɜɢ, ɩɪɢɦɟɧɟɧɢɟ
ɤɨɬɨɪɨɣɜɊɟɫɩɭɛɥɢɤɟȻɟɥɚɪɭɫɶɩɨɫɬɨɹɧɧɨ
ɪɚɫɬɟɬ. ɋɬɚɧɞɚɪɬɧɚɹ ɞɨɡɚ ɋɁɉ ɫɨɫɬɚɜɥɹɟɬ
200–300 ɦɥ. ɋɁɉɯɪɚɧɹɬɜɡɚɦɨɪɨɠɟɧɧɨɦ
ɫɨɫɬɨɹɧɢɢ, ɨɛɵɱɧɨɩɪɢɬɟɦɩɟɪɚɬɭɪɟɧɢɠɟ
-30ɨɋ ɜ ɬɟɱɟɧɢɟ 12 ɦɟɫɹɰɟɜ. ȻɢɨɥɨɝɢɱɟɫɤɚɹɰɟɧɧɨɫɬɶɋɁɉɫɜɹɡɚɧɚɫɫɨɞɟɪɠɚɧɢɟɦ
ɛɢɨɥɨɝɢɱɟɫɤɢ ɚɤɬɢɜɧɵɯ ɦɨɥɟɤɭɥ, ɩɪɟɠɞɟ
ɜɫɟɝɨɮɚɤɬɨɪɨɜɫɜɟɪɬɵɜɚɧɢɹ. Ʉɥɢɧɢɱɟɫɤɨɟ
ɩɪɢɦɟɧɟɧɢɟ ɋɁɉ ɨɩɪɟɞɟɥɹɟɬɫɹ ɤɨɪɪɟɤɰɢɟɣɧɚɪɭɲɟɧɢɣɜɫɢɫɬɟɦɟɫɜɟɪɬɵɜɚɧɢɢɤɪɨɜɢ, ɨɩɪɟɞɟɥɹɟɦɵɯ ɨɛɵɱɧɨ ɩɨ ɭɞɥɢɧɟɧɢɸ
ɩɪɨɬɪɨɦɛɢɧɨɜɨɝɨ ɜɪɟɦɟɧɢ ɢɢɥɢ ȺɑɌȼ ɜ
197
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
1,5 ɪɚɡɚɢɛɨɥɟɟɧɨɪɦɵ. (ȼɫɥɭɱɚɟɩɪɢɦɟɧɟɧɢɹ ɜɚɪɮɚɪɢɧɚ ɤɨɪɪɟɤɰɢɸ ɝɟɦɨɫɬɚɡɚ
ɫɥɟɞɭɟɬ ɩɪɨɜɨɞɢɬɶ ɫɧɚɱɚɥɚ ɩɪɟɩɚɪɚɬɚɦɢ
ɜɢɬɚɦɢɧɚɄ). Ɉɫɧɨɜɧɵɟɩɨɤɚɡɚɧɢɹɞɥɹɩɪɢɦɟɧɟɧɢɹ ɋɁɉ: ɫɢɧɞɪɨɦ ɞɢɫɫɟɦɢɧɢɪɨɜɚɧɧɨɝɨɜɧɭɬɪɢɫɨɫɭɞɢɫɬɨɝɨɫɜɟɪɬɵɜɚɧɢɹɤɪɨɜɢ (Ⱦȼɋɫɢɧɞɪɨɦ), ɨɫɬɪɚɹɦɚɫɫɢɜɧɚɹɤɪɨɜɨɩɨɬɟɪɹ (ɛɨɥɟɟ 30% ɨɛɴɺɦɚɰɢɪɤɭɥɢɪɭɸɳɟɣɤɪɨɜɢ, ɈɐɄ), ɛɨɥɟɡɧɢɩɟɱɟɧɢ, ɫɨɩɪɨɜɨɠɞɚɸɳɢɟɫɹɫɧɢɠɟɧɢɟɦɩɪɨɞɭɤɰɢɢɩɥɚɡɦɟɧɧɵɯɮɚɤɬɨɪɨɜɫɜɟɪɬɵɜɚɧɢɹ, ɩɟɪɟɞɨɡɢɪɨɜɤɚ ɚɧɬɢɤɨɚɝɭɥɹɧɬɨɜ ɧɟɩɪɹɦɨɝɨ ɞɟɣɫɬɜɢɹ (ɜɚɪɮɚɪɢɧ, ɞɢɤɭɦɚɪɢɧ ɢ ɞɪ.), ɬɟɪɚɩɟɜɬɢɱɟɫɤɢɣ ɩɥɚɡɦɚɮɟɪɟɡ ɢɥɢ ɩɥɚɡɦɨɨɛɦɟɧɩɪɢɬɪɨɦɛɨɬɢɱɟɫɤɨɣɬɪɨɦɛɨɰɢɬɨɩɟɧɢɱɟɫɤɨɣɩɭɪɩɭɪɟ, ɬɹɠɟɥɵɯɨɬɪɚɜɥɟɧɢɹɯ, ɫɟɩɫɢɫɟ, ɝɟɦɨɥɢɬɢɤɨɭɪɟɦɢɱɟɫɤɨɦ ɫɢɧɞɪɨɦɟ,
HELLP-ɫɢɧɞɪɨɦɟ ɢ ɞɪ., ɤɨɚɝɭɥɨɩɚɬɢɹɯ,
ɨɛɭɫɥɨɜɥɟɧɧɵɯ ɞɟɮɢɰɢɬɨɦ ɩɥɚɡɦɟɧɧɵɯ
ɮɚɤɬɨɪɨɜɫɜɟɪɬɵɜɚɧɢɹ [17].
ɇɟ ɪɟɤɨɦɟɧɞɭɟɬɫɹ ɩɟɪɟɥɢɜɚɬɶ ɋɁɉ ɫ
ɰɟɥɶɸ ɜɨɫɩɨɥɧɟɧɢɹ ɨɛɴɺɦɚ ɰɢɪɤɭɥɢɪɭɸɳɟɣɤɪɨɜɢ. ɋɨɫɬɨɪɨɠɧɨɫɬɶɸɫɥɟɞɭɟɬɩɟɪɟɥɢɜɚɬɶɋɁɉ ɭɥɢɰ ɫɩɪɟɞɲɟɫɬɜɭɸɳɢɦɢ
ɬɪɚɧɫɮɭɡɢɹɦɢɤɪɨɜɢɢɥɢɟɺɤɨɦɩɨɧɟɧɬɨɜ,
ɩɪɢ ɧɚɥɢɱɢɢ ɡɚɫɬɨɣɧɨɣ ɫɟɪɞɟɱɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ [17].
ɉɟɪɟɥɢɜɚɟɦɚɹɋɁɉɞɨɥɠɧɚɛɵɬɶɨɞɧɨɣ
ɫ ɪɟɰɢɩɢɟɧɬɨɦ ɝɪɭɩɩɵ ɤɪɨɜɢ ɩɨ ɫɢɫɬɟɦɟ
ȺȼɈ. ɊɚɡɪɟɲɚɟɬɫɹɩɟɪɟɥɢɜɚɧɢɟɋɁɉɛɨɥɶɧɵɦ ɛɟɡ ɭɱɟɬɚ Rh-ɫɨɜɦɟɫɬɢɦɨɫɬɢ, ɡɚ ɢɫɤɥɸɱɟɧɢɟɦ ɪɟɡɭɫɨɬɪɢɰɚɬɟɥɶɧɵɯ ɠɟɧɳɢɧ
[6]. ɋɁɉ ɨɬɬɚɢɜɚɸɬ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɩɟɪɟɞɢɫɩɨɥɶɡɨɜɚɧɢɟɦɩɪɢɬɟɦɩɟɪɚɬɭɪɟ +37ɨ,
ɩɟɪɟɥɢɜɚɸɬɫɦɢɤɪɨɮɢɥɶɬɪɨɦɫɬɪɭɣɧɨɢɥɢ
ɤɚɩɟɥɶɧɨ ɢɡ ɪɚɫɱɟɬɚ 5–10 ɦɥɤɝ [7], ɜ ɬɹɠɟɥɵɯɫɥɭɱɚɹɯ – 10–15 ɦɥɤɝ [6, 17].
ɋɥɟɞɭɟɬ ɨɬɦɟɬɢɬɶ, ɱɬɨ ɫ ɩɟɪɟɥɢɜɚɧɢɟɦ ɋɁɉ ɧɚɢɛɨɥɟɟɱɚɫɬɨ ɫɜɹɡɚɧɵ ɚɥɥɟɪɝɢɱɟɫɤɢɟ ɢ ɚɧɚɮɢɥɚɤɬɢɱɟɫɤɢɟ ɩɨɫɬɬɪɚɧɫɮɭɡɢɨɧɧɵɟ ɪɟɚɤɰɢɢ (0,2% ɪɟɰɢɩɢɟɧɬɨɜ),
ɰɢɪɤɭɥɹɬɨɪɧɚɹ ɩɟɪɟɝɪɭɡɤɚ ɩɪɢ ɩɟɪɟɥɢɜɚɧɢɢɛɨɥɶɲɢɯɨɛɴɟɦɨɜɋɁɉ, ɨɛɭɫɥɨɜɥɟɧɧɨɟ
ɬɪɚɧɫɮɭɡɢɟɣɨɫɬɪɨɟɩɨɪɚɠɟɧɢɟɥɟɝɤɢɯ, ɝɟɦɨɥɢɬɢɱɟɫɤɢɟɪɟɚɤɰɢɢɪɟɰɢɩɢɟɧɬɚɜɫɥɟɞ198
ɫɬɜɢɟ ɩɟɪɟɥɢɜɚɧɢɹ ɫ ɋɁɉ ɚɧɬɢɷɪɢɬɪɨɰɢɬɚɪɧɵɯɚɧɬɢɬɟɥ.
ɉɪɚɤɬɢɤɚɩɪɢɦɟɧɟɧɢɹɋɁɉɜɯɢɪɭɪɝɢɱɟɫɤɢɯɫɬɚɰɢɨɧɚɪɚɯɜɊɟɫɩɭɛɥɢɤɟȻɟɥɚɪɭɫɶ
ɞɨɫɬɚɬɨɱɧɨɲɢɪɨɤɚ. ȼɬɨɠɟɜɪɟɦɹ, ɩɨɧɚɲɢɦɩɪɟɞɜɚɪɢɬɟɥɶɧɵɦɞɚɧɧɵɦ, ɬɨɥɶɤɨɞɥɹ
25–40% ɫɥɭɱɚɟɜɟɝɨɩɪɢɦɟɧɟɧɢɹɛɵɥɢɭɛɟɞɢɬɟɥɶɧɵɟɤɥɢɧɢɱɟɫɤɢɟɞɚɧɧɵɟ, ɬɨɥɶɤɨ ɜ
15% ɫɥɭɱɚɟɜɩɪɢɫɭɬɫɬɜɨɜɚɥɢɤɨɚɝɭɥɨɝɢɱɟɫɤɢɟ ɞɚɧɧɵɟ ɥɚɛɨɪɚɬɨɪɧɨɝɨ ɨɛɫɥɟɞɨɜɚɧɢɹ
ɩɚɰɢɟɧɬɨɜ, ɨɛɨɫɧɨɜɵɜɚɜɲɢɟɤɥɢɧɢɱɟɫɤɨɟ
ɩɪɢɦɟɧɟɧɢɟɋɁɉ. ɉɨɨɛɴɺɦɚɦɩɪɢɦɟɧɟɧɢɹ
ɋɁɉ ɜ Ɋɟɫɩɭɛɥɢɤɟ Ȼɟɥɚɪɭɫɶ (9 ɥ ɧɚ 1000
ɧɚɫɟɥɟɧɢɹ) ɧɚɯɨɞɢɬɫɹɧɚɫɪɟɞɧɟɟɜɪɨɩɟɣɫɤɨɦɭɪɨɜɧɟ, ɫɨɨɬɜɟɬɫɬɜɭɸɳɟɦɭɪɨɜɧɸɩɨɬɪɟɛɥɟɧɢɹɜɉɨɥɶɲɟ, Ƚɨɥɥɚɧɞɢɢ, Ȼɟɥɶɝɢɢ.
ɉɨɬɪɟɛɥɟɧɢɟɋɁɉɨɪɝɚɧɢɡɚɰɢɹɦɢɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ ɝ. Ɇɢɧɫɤɚ ɭɜɟɥɢɱɢɥɨɫɶ ɫ 2004
ɩɨ 2007 ɝɝ. ɧɚ 29,6% ɢɩɪɨɞɨɥɠɚɟɬɪɚɫɬɢ.
ȼ ɞɚɥɶɧɟɣɲɟɦ ɩɪɚɤɬɢɤɚ ɩɪɢɦɟɧɟɧɢɹ
ɋɁɉɞɨɥɠɧɚɛɵɬɶɛɨɥɟɟɨɛɨɫɧɨɜɚɧɧɨɣ (ɥɚɛɨɪɚɬɨɪɧɨ), ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɧɧɨɣ (ɪɚɫɲɢɪɟɧɢɟɩɪɢɦɟɧɟɧɢɹɤɪɢɫɬɚɥɥɨɢɞɨɜ, ɤɨɥɥɨɢɞɨɜ, ɪɚɫɬɜɨɪɚɚɥɶɛɭɦɢɧɚ), ɧɚɫɬɨɪɨɠɟɧɧɨɣ
ɜɵɹɜɥɟɧɢɟ ɚɧɬɢɷɪɢɬɪɨɰɢɬɚɪɧɵɯ ɚɧɬɢɬɟɥ
ɜ ɋɁɉ ɩɪɟɠɞɟ ɜɫɟɝɨ ɭ ɞɨɧɨɪɨɜɠɟɧɳɢɧ,
ɩɪɢɦɟɧɟɧɢɟ ɋɁɉ ɨɬ ɨɞɧɨɝɨ ɞɨɧɨɪɚ ɩɪɢ
ɦɧɨɝɨɤɪɚɬɧɨɦ ɩɪɢɦɟɧɟɧɢɢ, ɩɨɫɬɚɧɨɜɤɚ
ɩɪɨɛɵ ɧɚ ɛɢɨɥɨɝɢɱɟɫɤɭɸ ɫɨɜɦɟɫɬɢɦɨɫɬɶ
ɩɟɪɟɞɩɟɪɟɥɢɜɚɧɢɟɦɋɁɉɪɟɰɢɩɢɟɧɬɭ, ɨɫɨɛɟɧɧɨ ɩɪɢ ɦɧɨɝɨɤɨɦɩɨɧɟɧɬɧɨɣ ɬɟɪɚɩɢɢ
ɤɨɦɩɨɧɟɧɬɚɦɢ ɤɪɨɜɢ). ɉɪɢ ɞɨɫɬɚɬɨɱɧɨɦ
ɨɛɟɫɩɟɱɟɧɢɢ ɥɟɤɚɪɫɬɜɟɧɧɵɦɢ ɩɪɟɩɚɪɚɬɚɦɢɫɜɟɪɬɵɜɚɧɢɹɤɪɨɜɢ, ɤɪɨɜɟɡɚɦɟɧɢɬɟɥɟɣ
ɩɨɬɪɟɛɧɨɫɬɶɜɋɁɉɪɟɡɤɨɫɧɢɠɚɟɬɫɹ.
Ʉɨɧɰɟɧɬɪɚɬɬɪɨɦɛɨɰɢɬɨɜ
Ʉɨɧɰɟɧɬɪɚɬ ɬɪɨɦɛɨɰɢɬɨɜ (ɄɌ) ɩɪɟɞɫɬɚɜɥɹɟɬɫɨɛɨɣɫɤɨɧɰɟɧɬɪɢɪɨɜɚɧɧɵɟɬɪɨɦɛɨɰɢɬɵ, ɩɨɥɭɱɟɧɧɵɟɢɡɞɨɡɵɤɪɨɜɢ (ɫɫɨɞɟɪɠɚɧɢɟɦɨɛɵɱɧɨ 55ɯ109ɬɪɨɦɛɨɰɢɬɨɜɧɚ
ɞɨɡɭ) ɢɥɢ ɚɩɩɚɪɚɬɧɵɦ ɦɟɬɨɞɨɦ (ɫ ɫɨɞɟɪɠɚɧɢɟɦ ɨɛɵɱɧɨ ɨɤɨɥɨ 3,0ɯ1011 «ɚɮɟɪɟɡɧɵɯ» ɬɪɨɦɛɨɰɢɬɨɜɧɚ «ɜɡɪɨɫɥɭɸ» ɞɨɡɭ). 1
ɜɡɪɨɫɥɚɹɞɨɡɚɷɤɜɢɜɚɥɟɧɬɧɚɩɨɫɨɞɟɪɠɚɧɢɸ
4–5 ɞɨɡɚɦ ɬɪɨɦɛɨɰɢɬɨɜ ɢɡ ɞɨɡɵ ɰɟɥɶɧɨɣ
ʋ3x2009 iɬɨɦ 17
ɤɪɨɜɢ. ȼ Ɋɟɫɩɭɛɥɢɤɟ Ȼɟɥɚɪɭɫɶ ɧɚɥɚɠɟɧ
ɜɵɩɭɫɤɨɛɨɢɯɬɢɩɨɜɞɨɡɬɪɨɦɛɨɰɢɬɨɜ. Ɂɚ
ɪɭɛɟɠɨɦɬɪɨɦɛɨɰɢɬɵ, ɩɨɥɭɱɟɧɧɵɟɢɡɞɨɡɵ
ɤɪɨɜɢ, ɫɬɚɧɞɚɪɬɧɨɨɛɴɟɞɢɧɹɸɬɨɬ 5 ɞɨɧɨɪɨɜ. ɋɪɨɤɝɨɞɧɨɫɬɢɬɪɨɦɛɨɰɢɬɨɜ, ɩɨɥɭɱɟɧɧɵɯɢɡɞɨɡɵɤɪɨɜɢ, ɫɨɫɬɚɜɥɹɟɬ 72 ɱɚɫɚ. ɋɪɨɤ
ɝɨɞɧɨɫɬɢɚɮɟɪɟɡɧɵɯɬɪɨɦɛɨɰɢɬɨɜɫɨɫɬɚɜɥɹɟɬ 5–7 ɞɧɟɣ [2, 18]. ɉɟɪɟɥɢɜɚɸɬɄɌɫɭɱɟɬɨɦȺȼɈ- ɢ Rh-ɫɨɜɦɟɫɬɢɦɨɫɬɢɤɪɨɜɢɞɨɧɨɪɚɢɪɟɰɢɩɢɟɧɬɚ. Ⱦɨɩɭɫɬɢɦɨɩɟɪɟɥɢɜɚɧɢɟ ɄɌ 0(I) ɝɪɭɩɩɵ ɤɪɨɜɢ ɪɟɰɢɩɢɟɧɬɚɦ
ɞɪɭɝɢɯ ɝɪɭɩɩ ɤɪɨɜɢ [19]. ɗɮɮɟɤɬɢɜɧɵɦ
ɫɱɢɬɚɸɬ ɩɟɪɟɥɢɜɚɧɢɟ ɧɟ ɦɟɧɟɟ 60ɯ10 9
ɬɪɨɦɛɨɰɢɬɨɜɧɚɤɚɠɞɵɟ 10 ɤɝɜɟɫɚ. ɄɪɢɬɟɪɢɟɦɷɮɮɟɤɬɢɜɧɨɝɨɩɪɢɦɟɧɟɧɢɹɄɌɹɜɥɹɟɬɫɹɧɨɪɦɚɥɢɡɚɰɢɹɭɪɨɜɧɹ (ɞɨ 50ɯ109ɬɪɨɦɛɨɰɢɬɨɜɥ) ɬɪɨɦɛɨɰɢɬɨɜɜɩɟɪɢɮɟɪɢɱɟɫɤɨɣ
ɤɪɨɜɢɩɚɰɢɟɧɬɚɭɠɟɱɟɪɟɡ 1 ɱɚɫɩɨɫɥɟɩɟɪɟɥɢɜɚɧɢɹ, ɧɨɜɚɠɧɟɟ ɨɰɟɧɢɬɶɩɨɞɞɟɪɠɚɧɢɟɭɪɨɜɧɹɬɪɨɦɛɨɰɢɬɨɜɱɟɪɟɡ 24 ɱɚɫɚɩɨɫɥɟ ɩɟɪɟɥɢɜɚɧɢɹ. ɉɪɢ ɫɨɞɟɪɠɚɧɢɢ ɭɪɨɜɧɹ
ɬɪɨɦɛɨɰɢɬɨɜɜɩɟɪɢɮɟɪɢɱɟɫɤɨɣɤɪɨɜɢɦɟɧɟɟ 10ɯ109ɬɪɨɦɛɨɰɢɬɨɜɥɄɌɩɪɢɦɟɧɹɸɬ
ɫɩɪɨɮɢɥɚɤɬɢɱɟɫɤɨɣɰɟɥɶɸɜɨɜɫɟɯɫɥɭɱɚɹɯ. ɉɪɢ ɭɪɨɜɧɟ 50ɯ109 ɬɪɨɦɛɨɰɢɬɨɜɥ ɢ
ɜɵɲɟɩɪɢɦɟɧɟɧɢɟɄɌɹɜɥɹɟɬɫɹɩɪɟɞɦɟɬɨɦ
ɜɵɛɨɪɚɢɩɪɢɦɟɧɹɟɬɫɹ, ɩɪɟɠɞɟɜɫɟɝɨ, ɩɪɢ
ɧɚɥɢɱɢɢ ɤɪɨɜɨɬɟɱɟɧɢɹ, ɡɧɚɱɢɬɟɥɶɧɵɯ ɯɢɪɭɪɝɢɱɟɫɤɢɯɨɩɟɪɚɬɢɜɧɵɯɜɦɟɲɚɬɟɥɶɫɬɜɚɯ,
ɥɟɤɚɪɫɬɜɟɧɧɨɢɧɞɭɰɢɪɨɜɚɧɧɵɯɬɪɨɦɛɨɰɢɬɨɩɟɧɢɹɯ [20]. ɑɚɳɟ ɜɫɟɝɨ ɩɪɢ ɬɚɤɢɯ ɫɨɫɬɨɹɧɢɹɯ ɤɥɢɧɢɱɟɫɤɢ ɜɵɹɜɥɹɟɬɫɹ ɩɟɬɟɯɢɚɥɶɧɚɹɫɵɩɶɧɚɤɨɠɟɢɫɥɢɡɢɫɬɵɯ, ɥɚɛɨɪɚɬɨɪɧɨɨɩɪɟɞɟɥɹɟɬɫɹɫɧɢɠɟɧɢɟɫɨɞɟɪɠɚɧɢɹ
ɬɪɨɦɛɨɰɢɬɨɜɜɩɟɪɢɮɟɪɢɱɟɫɤɨɣɤɪɨɜɢ.
ɉɟɪɟɥɢɜɚɸɬɬɪɨɦɛɨɰɢɬɵɜɤɨɦɩɥɟɤɫɟ
ɫ ɞɪɭɝɢɦɢ ɤɨɦɩɨɧɟɧɬɚɦɢ ɤɪɨɜɢ (ɫɦɨɬɪɢ
ɜɵɲɟ), ɥɢɛɨɩɪɢ (ɭɝɪɨɡɟ) ɩɚɬɨɥɨɝɢɱɟɫɤɨɣ
ɤɪɨɜɨɬɨɱɢɜɨɫɬɢ, ɫɜɹɡɚɧɧɨɣɫɨɫɧɢɠɟɧɢɟɦ
ɭɪɨɜɧɹɬɪɨɦɛɨɰɢɬɨɜɩɪɢɨɧɤɨɝɟɦɚɬɨɥɨɝɢɱɟɫɤɢɯ, ɨɧɤɨɥɨɝɢɱɟɫɤɢɯɡɚɛɨɥɟɜɚɧɢɹɯ, ɦɢɟɥɨɞɟɩɪɟɫɫɢɢɜɫɥɟɞɫɬɜɢɟɥɭɱɟɜɨɣɢɥɢɰɢɬɨɫɬɚɬɢɱɟɫɤɨɣɬɟɪɚɩɢɢ, ɨɩɟɪɚɬɢɜɧɵɯɜɦɟɲɚɬɟɥɶɫɬɜɚɯ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɚɩɩɚɪɚɬɚ
ɢɫɤɭɫɫɬɜɟɧɧɨɝɨɤɪɨɜɨɨɛɪɚɳɟɧɢɹ, ɬɪɨɦɛɨ-
ɰɢɬɨɩɟɧɢɹɯɪɚɡɥɢɱɧɨɝɨɝɟɧɟɡɚ [19].
Ʉɪɢɨɩɪɟɰɢɩɢɬɚɬ
Ʉɪɢɨɩɪɟɰɢɩɢɬɚɬ – ɥɟɤɚɪɫɬɜɟɧɧɨɟɫɪɟɞɫɬɜɨ, ɩɨɥɭɱɚɟɦɨɟɢɡ ɩɥɚɡɦɵ (ɋɁɉ) ɦɟɬɨɞɨɦɯɨɥɨɞɨɜɨɣɩɪɟɰɢɩɢɬɚɰɢɢ. ȼɵɩɭɫɤɚɟɬɫɹɜɡɚɦɨɪɨɠɟɧɧɨɦɢɥɢɥɢɨɮɢɥɢɡɢɪɨɜɚɧɧɨɦɜɢɞɟ. ɋɨɞɟɪɠɢɬɜɨɫɧɨɜɧɨɦɮɚɤɬɨɪɵ
ɫɜɟɪɬɵɜɚɧɢɹ (ɮɢɛɪɢɧɨɝɟɧ, ɮɚɤɬɨɪɚ VIII,
ɮɚɤɬɨɪ ȼɢɥɥɟɛɪɚɧɞɚ ɢ ɞɪɭɝɢɟ). ɉɨɷɬɨɦɭ
ɚɤɬɢɜɧɨɫɬɶɤɪɢɨɩɪɟɰɢɩɢɬɚɬɚɦɚɪɤɢɪɭɟɬɫɹ
ɩɨ ɚɤɬɢɜɧɨɫɬɢ VIII ɮɚɤɬɨɪɚ ɫɜɟɪɬɵɜɚɧɢɹ
ɤɪɨɜɢ. ȼ Ɋɟɫɩɭɛɥɢɤɟ Ȼɟɥɚɪɭɫɶ 1 ɮɚɫɨɜɤɚ
ɫɨɞɟɪɠɢɬ 2 ɞɨɡɵɤɪɢɨɩɪɟɰɢɩɢɬɚɬɚ, 200 Ɇȿ
ɚɤɬɢɜɧɨɫɬɢ VIII ɮɚɤɬɨɪɚ ɜɥɢɨɮɢɥɢɡɢɪɨɜɚɧɧɨɦɜɢɞɟɢɥɢ 180 Ɇȿɚɤɬɢɜɧɨɫɬɢ VIII
ɮɚɤɬɨɪɚɜɡɚɦɨɪɨɠɟɧɧɨɦɜɢɞɟ. Ɂɚɪɭɛɟɠɨɦ
ɢɫɩɨɥɶɡɭɟɬɫɹɤɪɢɨɩɪɟɰɢɩɢɬɚɬɬɨɥɶɤɨɜɡɚɦɨɪɨɠɟɧɧɨɦ ɜɢɞɟ. Ʉɪɢɨɩɪɟɰɢɩɢɬɚɬ ɯɪɚɧɢɬɫɹɜɡɚɦɨɪɨɠɟɧɧɨɦɜɢɞɟɩɪɢɬɟɦɩɟɪɚɬɭɪɟɧɢɠɟ -30ɨɋɜɬɟɱɟɧɢɟ 6 ɦɟɫɹɰɟɜ, ɜɥɢɨɮɢɥɢɡɢɪɨɜɚɧɧɨɦɜɢɞɟɩɪɢ +4ɨɋ – ɜɬɟɱɟɧɢɟ 12 ɦɟɫɹɰɟɜ. ɉɟɪɟɥɢɜɚɸɬ ɤɪɢɨɩɪɟɰɢɩɢɬɚɬɫɭɱɟɬɨɦȺȼɈɝɪɭɩɩɨɜɨɣɫɨɜɦɟɫɬɢɦɨɫɬɢ ɞɨɧɨɪɚ ɢ ɪɟɰɢɩɢɟɧɬɚ ɚɧɚɥɨɝɢɱɧɨ
ɋɁɉ. ɂɫɩɨɥɶɡɭɸɬ ɜ ɬɟɱɟɧɢɟ 1 ɱɚɫɚ ɩɨɫɥɟ
ɪɚɡɦɨɪɚɠɢɜɚɧɢɹ (ɡɚɦɨɪɨɠɟɧɧɨɝɨɤɪɢɨɩɪɟɰɢɩɢɬɚɬɚ) ɢɥɢɪɚɫɬɜɨɪɟɧɢɹ (ɥɢɨɮɢɥɢɡɢɪɨɜɚɧɧɨɝɨɤɪɢɨɩɪɟɰɢɩɢɬɚɬɚ).
Ʉɥɢɧɢɱɟɫɤɨɟɩɪɢɦɟɧɟɧɢɟ ɤɪɢɨɩɪɟɰɢɩɢɬɚɬɚɨɩɪɟɞɟɥɹɟɬɫɹɧɟɨɛɯɨɞɢɦɨɫɬɶɸɜɨɫɩɨɥɧɟɧɢɹɞɟɮɢɰɢɬɚɮɚɤɬɨɪɨɜɫɜɟɪɬɵɜɚɧɢɹ.
ɗɬɨɤɚɫɚɟɬɫɹɛɨɥɶɧɵɯɝɟɦɨɮɢɥɢɟɣȺ (ɩɪɢ
ɨɬɫɭɬɫɬɜɢɢɢɥɢɧɟɞɨɫɬɚɬɤɟɩɪɟɩɚɪɚɬɨɜɮɚɤɬɨɪɚ VIII ɫɜɟɪɬɵɜɚɧɢɹɤɪɨɜɢ), ɩɪɢɛɨɥɟɡɧɢ ȼɢɥɥɟɛɪɚɧɞɚ. Ɉɫɧɨɜɧɵɦ ɩɨɤɚɡɚɧɢɟɦ
ɞɥɹɩɪɢɦɟɧɟɧɢɹɤɪɢɨɩɪɟɰɢɩɢɬɚɬɚ, ɧɟɫɜɹɡɚɧɧɵɦɫɧɚɫɥɟɞɫɬɜɟɧɧɵɦɢɤɨɚɝɭɥɨɩɚɬɢɹɦɢ, ɹɜɥɹɟɬɫɹɝɢɩɨɮɢɛɪɢɧɨɝɟɧɷɦɢɹ (ɦɟɧɟɟ
1,0 ɝɥ) ɢɢɥɢ ɩɨɜɵɲɟɧɢɟ ȺɑɌȼ ɢɥɢ ɉȼ
ɛɨɥɟɟ 1,5 ɧɨɪɦɵ) ɩɟɪɟɞ ɯɢɪɭɪɝɢɱɟɫɤɢɦɢ
ɨɩɟɪɚɰɢɹɦɢ; ɦɚɫɫɢɜɧɵɟ ɤɪɨɜɨɩɨɬɟɪɢ, ɧɟ
ɤɭɩɢɪɭɟɦɵɟ ɩɟɪɟɥɢɜɚɧɢɟɦ ɋɁɉ [6, 20].
Ɉɛɳɢɦ ɩɪɚɜɢɥɨɦ ɹɜɥɹɟɬɫɹ ɩɪɢɦɟɧɟɧɢɟ
ɞɨɩɨɥɧɢɬɟɥɶɧɨ 1 ɞɨɡɵɤɪɢɨɩɪɟɰɢɩɢɬɚɬɚɧɚ
ɤɚɠɞɵɟ 2–3 ɞɨɡɵ ɩɟɪɟɥɢɜɚɟɦɨɣ ɋɁɉ ɩɨɞ
199
”ɇɨɜɨɫɬɢɯɢɪɭɪɝɢɢ
ɤɨɧɬɪɨɥɟɦɫɨɞɟɪɠɚɧɢɹɮɢɛɪɢɧɨɝɟɧɚ (ɧɨɪɦɚ – 1,8–3,5 ɝɥ) ɢȺɑɌȼ (ɧɨɪɦɚ 30–40 ɫɟɤ.)
ɩɪɢɦɚɫɫɢɜɧɵɯɩɟɪɟɥɢɜɚɧɢɹɯɩɥɚɡɦɵ. ɉɨɫɬɬɪɚɧɫɮɭɡɢɨɧɧɵɟ ɨɫɥɨɠɧɟɧɢɹ ɩɪɢɩɟɪɟɥɢɜɚɧɢɢ ɤɪɢɨɩɪɟɰɢɩɢɬɚɬɚ ɚɧɚɥɨɝɢɱɧɵ
ɩɪɢɦɟɧɟɧɢɸ ɋɁɉ, ɜɫɬɪɟɱɚɸɬɫɹ ɱɚɳɟ ɭ
ɛɨɥɶɧɵɯ ɫ ɦɧɨɠɟɫɬɜɟɧɧɵɦɢ ɬɪɚɧɫɮɭɡɢɹɦɢ, ɩɪɨɹɜɥɹɸɬɫɹɜɜɢɞɟɚɥɥɟɪɝɢɱɟɫɤɢɯɢɥɢ
ɚɧɚɮɢɥɚɤɬɢɱɟɫɤɢɯ ɪɟɚɤɰɢɣ.
ȼɨɩɪɨɫ ɜɵɛɨɪɚ ɬɚɤɬɢɤɢ ɩɪɢɦɟɧɟɧɢɹ
ɤɨɦɩɨɧɟɧɬɨɜ ɤɪɨɜɢ ɩɪɢ ɢɯ ɞɨɫɬɚɬɨɱɧɨɦ
ɧɚɥɢɱɢɢɜɚɪɫɟɧɚɥɟɦɟɞɢɰɢɧɫɤɨɣɩɨɦɨɳɢ
ɫɬɚɧɨɜɢɬɫɹɜɫɟɛɨɥɟɟɚɤɬɭɚɥɶɧɵɦ. ɉɪɨɜɟɞɟɧɧɵɟɜȻɟɥɶɝɢɢɦɧɨɝɨɰɟɧɬɪɨɜɵɟɢɫɫɥɟɞɨɜɚɧɢɹ ɩɨɬɪɟɛɥɟɧɢɹ ɤɨɦɩɨɧɟɧɬɨɜ ɤɪɨɜɢ
ɜ 128 ɛɨɥɶɧɢɰɚɯɫ 2000 ɩɨ 2005 ɝɨɞɵɩɨɤɚɡɚɥɢ, ɱɬɨ 18,6% ɯɢɪɭɪɝɢɱɟɫɤɢɯɛɨɥɶɧɵɯɢ
8,1% ɨɛɳɟɬɟɪɚɩɟɜɬɢɱɟɫɤɢɯɛɨɥɶɧɵɯɩɨɥɭɱɚɥɢ ɤɨɦɩɨɧɟɧɬɵ ɤɪɨɜɢ [21]. ɋɪɟɞɢ ɤɨɦɩɨɧɟɧɬɨɜ ɤɪɨɜɢ ɨɤɨɥɨ 60% ɫɨɫɬɚɜɥɹɥɚ
ɷɪɢɬɪɨɰɢɬɧɚɹ ɦɚɫɫɚ, ɨɤɨɥɨ 10% – ɋɁɉ,
ɨɤɨɥɨ 15% – ɤɨɧɰɟɧɬɪɚɬɬɪɨɦɛɨɰɢɬɨɜ (ɞɨ
40% – ɞɥɹɨɛɳɟɬɟɪɚɩɟɜɬɢɱɟɫɤɢɯɛɨɥɶɧɵɯ).
ɉɪɢɷɬɨɦɬɨɥɶɤɨ 3% ɯɢɪɭɪɝɢɱɟɫɤɢɯɛɨɥɶɧɵɯɩɨɬɪɟɛɢɥɢ 55,7% ɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢ
ɢɬɨɥɶɤɨ 3% ɨɛɳɟɬɟɪɚɩɟɜɬɢɱɟɫɤɢɯɛɨɥɶɧɵɯ
ɩɨɬɪɟɛɢɥɢ 80,2% ɤɨɦɩɨɧɟɧɬɨɜ ɤɪɨɜɢ
Ɉɛɴɺɦɩɟɪɟɥɢɬɵɯɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢɩɪɹɦɨɩɪɨɩɨɪɰɢɨɧɚɥɟɧɬɹɠɟɫɬɢɡɚɛɨɥɟɜɚɧɢɹ
ɢ ɜɨɡɪɚɫɬɭ ɩɚɰɢɟɧɬɨɜ. ɋɪɟɞɢ ɧɨɡɨɥɨɝɢɣ
ɨɫɧɨɜɧɵɦɢ ɩɨɬɪɟɛɢɬɟɥɹɦɢ ɤɨɦɩɨɧɟɧɬɨɜ
ɤɪɨɜɢ ɹɜɥɹɥɢɫɶ ɩɚɰɢɟɧɬɵ ɫ ɬɪɚɧɫɩɥɚɧɬɚɰɢɹɦɢ ɨɪɝɚɧɨɜ ɢ ɬɤɚɧɟɣ, ɩɨɥɢɬɪɚɜɦɨɣ,
ɨɛɴɺɦɧɵɦɢɯɢɪɭɪɝɢɱɟɫɤɢɦɢɨɩɟɪɚɰɢɹɦɢ.
Ⱥɧɚɥɢɡɨɛɨɫɧɨɜɚɧɧɨɫɬɢɩɪɢɦɟɧɟɧɢɹɤɨɦɩɨɧɟɧɬɨɜ ɤɪɨɜɢ ɩɨɤɚɡɵɜɚɟɬ, ɱɬɨ ɞɨ 70%
ɩɟɪɟɥɢɜɚɧɢɣ ɧɟ ɛɵɥɢ ɨɛɨɫɧɨɜɚɧɵ ɩɨ ɤɨɥɢɱɟɫɬɜɭɢɥɢɩɟɪɟɱɧɸɩɪɢɦɟɧɹɟɦɵɯɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢ, ɩɨɷɬɨɦɭɧɟɨɛɯɨɞɢɦɩɨɫɬɨɹɧɧɵɣɤɨɧɬɪɨɥɶɫɨɫɬɨɪɨɧɵɫɩɟɰɢɚɥɢɫɬɨɜ
ɤɚɛɢɧɟɬɚɬɪɚɧɫɮɭɡɢɨɥɨɝɢɱɟɫɤɨɣɩɨɦɨɳɢɜ
ɛɨɥɶɧɢɱɧɨɣɨɪɝɚɧɢɡɚɰɢɢ, ɩɪɟɠɞɟɜɫɟɝɨɧɚ
ɨɫɧɨɜɟɚɧɚɥɢɡɚɡɚɹɜɨɤɧɚɤɨɦɩɨɧɟɧɬɵɤɪɨɜɢ [7]. ɉɪɢ ɨɩɟɪɚɰɢɹɯ ɩɨ ɡɚɦɟɧɟ ɛɟɞɪɟɧɧɨɝɨɢɥɢɤɨɥɟɧɧɨɝɨɫɭɫɬɚɜɨɜ, ɚɨɪɬɨɤɨɪɨ200
ɧɚɪɧɨɦɲɭɧɬɢɪɨɜɚɧɢɢɨɤɨɥɨ 50% ɩɚɰɢɟɧɬɨɜ ɩɨɥɭɱɚɥɢ ɤɨɦɩɨɧɟɧɬɵ ɤɪɨɜɢ [22]. ɂɡ
ɧɢɯ ɛɨɥɟɟ ɩɨɥɨɜɢɧɵ (56%) ɩɨɥɭɱɢɥɢ 2
ɞɨɡɵɗɆ. ɉɪɢɚɨɪɬɨɤɨɪɨɧɚɪɧɨɦɲɭɧɬɢɪɨɜɚɧɢɢ ɩɚɰɢɟɧɬɵɩɨɥɭɱɚɥɢ ɢɧɬɪɚɨɩɟɪɚɰɢɨɧɧɨ ɚɥɥɨɝɟɧɧɭɸ ɢɥɢ ɚɭɬɨɥɨɝɢɱɧɭɸ ɗɆ.
ȼɚɠɧɨ, ɱɬɨ ɧɟ ɪɚɫɱɺɬɧɵɣ ɨɛɴɺɦ ɩɨɬɟɪɢ
ɤɪɨɜɢ, ɚ ɪɟɚɥɶɧɵɣ ɭɪɨɜɟɧɶ ɝɟɦɨɝɥɨɛɢɧɚ
ɩɟɪɢɮɟɪɢɱɟɫɤɨɣ ɤɪɨɜɢ ɹɜɢɥɫɹ ɧɚɢɛɨɥɟɟ
ɧɚɞɟɠɧɵɦ ɨɫɧɨɜɚɧɢɟɦ ɞɥɹ ɩɟɪɟɥɢɜɚɧɢɹ
ɗɆ. Ɉɝɪɚɧɢɱɟɧɧɨ, ɩɨɨɛɨɫɧɨɜɚɧɧɵɦɩɨɤɚɡɚɧɢɹɦɩɪɢɦɟɧɹɥɢɋɁɉ (455 ɞɨɡ 103 ɛɨɥɶɧɵɦ), ɤɨɧɰɟɧɬɪɚɬ ɬɪɨɦɛɨɰɢɬɨɜ (120 ɚɮɟɪɟɡɧɵɯɞɨɡ 61 ɛɨɥɶɧɨɦɭ), ɤɨɧɰɟɧɬɪɚɬɵɮɚɤɬɨɪɨɜɫɜɟɪɬɵɜɚɧɢɹ (ɤɪɢɨɩɪɟɰɢɩɢɬɚɬ). ɂɧɬɟɪɟɫɧɨ, ɱɬɨɢɡ 10 008 ɞɨɡɗɆ, ɡɚɤɚɡɚɧɧɵɯ
ɜɛɚɧɤɚɯɤɪɨɜɢ, ɜɝɨɫɩɢɬɚɥɹɯɛɵɥɢɩɟɪɟɥɢɬɵ ɩɚɰɢɟɧɬɚɦ ɬɨɥɶɤɨ 3 923 ɞɨɡɵ (39%).
ɂɦɟɧɧɨɩɨɷɬɨɦɭɭɩɪɚɜɥɟɧɢɟɩɨɬɪɟɛɧɨɫɬɶɸ
ɜɤɨɦɩɨɧɟɧɬɚɯɤɪɨɜɢ, ɜɬɨɦɱɢɫɥɟɫɢɫɩɨɥɶɡɨɜɚɧɢɟɦɤɨɦɩɶɸɬɟɪɧɵɯɬɟɯɧɨɥɨɝɢɣ, ɜɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹɩɪɢɞɚɺɬɫɹ ɛɨɥɶɲɨɟ ɡɧɚɱɟɧɢɟ [7].
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɤɨɦɩɨɧɟɧɬɵ ɤɪɨɜɢ
ɗɆ, ɋɁɉ, ɄɌ, ɤɪɢɨɩɪɟɰɢɩɢɬɚɬ), ɢɦɟɸɳɢɟ
ɪɚɡɧɵɟ ɩɨɤɚɡɚɧɢɹ ɞɥɹ ɩɪɢɦɟɧɟɧɢɹ, ɹɜɥɹɸɬɫɹɜɚɠɧɨɣɫɨɫɬɚɜɥɹɸɳɟɣɱɚɫɬɶɸɨɤɚɡɚɧɢɹɦɟɞɢɰɢɧɫɤɨɣɩɨɦɨɳɢɧɚɫɟɥɟɧɢɸ. Ɋɚɡɜɢɬɢɟɬɟɯɧɢɤɢɛɟɫɤɪɨɜɧɵɯɯɢɪɭɪɝɢɱɟɫɤɢɯ
ɨɩɟɪɚɰɢɣ, ɛɟɪɟɠɧɨɟɢɧɚɫɬɨɪɨɠɟɧɧɨɟɨɬɧɨɲɟɧɢɟ ɤ ɤɥɢɧɢɱɟɫɤɨɦɭ ɢɫɩɨɥɶɡɨɜɚɧɢɸ
ɤɨɦɩɨɧɟɧɬɨɜ ɤɪɨɜɢ, ɨɩɨɪɚ ɧɚ ɥɚɛɨɪɚɬɨɪɧɵɟɩɨɤɚɡɚɬɟɥɢɤɪɨɜɢɩɪɢɧɚɡɧɚɱɟɧɢɢɤɨɦɩɨɧɟɧɬɨɜ ɤɪɨɜɢ ɫɬɚɧɨɜɹɬɫɹ ɯɚɪɚɤɬɟɪɧɨɣ
ɱɟɪɬɨɣɫɨɜɪɟɦɟɧɧɨɝɨɩɨɞɯɨɞɚɤɩɟɪɟɥɢɜɚɧɢɸɤɪɨɜɢ (ɟɺɤɨɦɩɨɧɟɧɬɨɜ).
ɅɂɌȿɊȺɌɍɊȺ
1. Ɋɭɫɚɧɨɜ, ȼ. Ɇ. Ʌɟɱɟɛɧɵɟɩɪɟɩɚɪɚɬɵɤɪɨɜɢ / ȼ. Ɇ.
Ɋɭɫɚɧɨɜ, ɂ. Ʌɟɜɢɧ. – Ɇ.: ɂȾɦɟɞɩɪɚɤɬɢɤɚ, 2004. –
284 ɫ.
2. Guide to the preparation, use and quality assurance
of blood components. Recommendation No. R (95)
15, 14th edition // Council of Europe, France, 2008.
3. ȼɨɪɨɛɶɟɜ, ɉ. Ⱥ. Ɉɱɟɪɤɢɩɨɩɪɨɢɡɜɨɞɫɬɜɟɧɧɨɣɢ
ʋ3x2009 iɬɨɦ 17
ɤɥɢɧɢɱɟɫɤɨɣ ɬɪɚɧɫɮɭɡɢɨɥɨɝɢɢ / ɉ. Ⱥ. ȼɨɪɨɛɶɟɜ,
ɂ. Ʉ. ɇɢɤɢɬɢɧ, Ⱦ. ȼ. Ʌɭɤɶɹɧɰɟɜɚ; ɩɨɞɪɟɞ. Ⱥ. ɂ. ȼɨɪɨɛɶɟɜɚ. – Ɇ., 2006. – ɋ. 118-122.
4. Directory of Community Blood Centers and
Hospital Blood Banks. AABB. – 2nd Edition. – 2007.
5. Ʉɨɥɨɫɤɨɜ, Ⱥ. ȼ. ɋɨɜɪɟɦɟɧɧɨɟ ɩɪɟɞɫɬɚɜɥɟɧɢɟ ɨ
ɩɨɤɚɡɚɧɢɹɯɞɥɹɬɪɚɧɫɮɭɡɢɢɷɪɢɬɪɨɰɢɬɚɪɧɵɯɤɨɦɩɨɧɟɧɬɨɜɤɪɨɜɢ: ɥɟɤɰɢɹɞɥɹɜɪɚɱɟɣɢɫɬɭɞɟɧɬɨɜ / Ⱥ. ȼ.
Ʉɨɥɨɫɤɨɜ // Ƚɟɦɚɬɨɥɨɝɢɹ ɢ ɬɪɚɧɫɮɭɡɢɨɥɨɝɢɹ. –
2004. – Ɍ. 49, ʋ. 6. – ɋ. 38-42.
6. ɉɟɪɟɥɢɜɚɧɢɟɞɨɧɨɪɫɤɨɣɤɪɨɜɢɢɟɟɤɨɦɩɨɧɟɧɬɨɜ:
ɢɧɫɬɪɭɤɰɢɹɩɨɩɪɢɦɟɧɟɧɢɸ. – Ɇɢɧɫɤ, 2003. – 62 ɫ.
7. Assessment of education and computerized decision
support interventions for improving transfusion
practice / J. Rothschild [et al.] // Transfusion. – 2007.
– Vol. 47, N 2. – P. 228 – 239.
8. The effects of liberal versus restrictive transfusion
thresholds on ambulation after hip fracture surgery /
N. B. Foss [et al.] // Transfusion. – 2009. – Vol. 49, N
2. – P. 227-234.
9. Guidelines on the management of massive blood
loss / D. Stainsby [et al.] // Brit. J. Haematology. –
2006. – Vol. 135. – P. 634-641.
10. Red Blood Cell Transfusion to a Hemoglobin of
10 g / R. 1. Spence [et al.] // Transfusion. – 2008. –
Vol. 48. – Suppl. 2. – P. 2-020A.
11. Scott, B. H. Blood transfusion is associated with
increased resource utilisation, morbidity and mortality
in cardiac surgery / B. H. Scott, F. C. Seifert,
R. Grimson // Ann. Card Anaesth. – 2008. – Vol. 11, N
1. – P.15-19.
12. Increased Risk of Infection and Mortality in
Women after Cardiac Surgery Related to Allogeneic
Blood Transfusion / A. M. Mary Rogers [et al.] // J.
Womens Health (Larchmt). – 2007. – Vol. 16, N 10.
– P. 1412-1420.
13. Survival after blood transfusion / M. KamperJorgensen [et al.] // Transfusion. – 2008. – Vol 48, N
12. – P. 2577-2584.
14. Red-blood-cell to plasma ratios transfused during
massive transfusion are associated with mortality in
severe multiple injury: a retrospective analysis from
the Trauma Registry of the Deutsche Gesellschaft fɶr
Unfallchirurgie / M. Maegele [et al.] // Vox Sanguinus.
– 2008. – Vol. 95, N 2. – P. 112-119.
15. Transfused improves mortality in trauma patients
/ B. Shaz [et al.] // Transfusion. – 2008. – Vol. 48, – P.
25A-26A.
16. How we treat: management of life-threatening
primary postpartum hemorrhage with a standardized
massive transfusion protocol / M. Burtelow [et al.] //
Transfusion, 2007. – Vol.47, N 9. – P. 1564-1572.
17. Ƚɨɪɨɞɟɰɤɢɣ, ȼ. Ɇ. Ɉɱɟɪɤɢɩɨɩɪɨɢɡɜɨɞɫɬɜɟɧɧɨɣ
ɢɤɥɢɧɢɱɟɫɤɨɣɬɪɚɧɫɮɭɡɢɨɥɨɝɢɢ / ȼ. Ɇ. Ƚɨɪɨɞɟɰɤɢɣ;
ɩɨɞɪɟɞ. Ⱥ. ɂ. ȼɨɪɨɛɶɟɜɚ. – Ɇ., 2006. – ɋ. 216-220.
18. Ɉɛ ɭɬɜɟɪɠɞɟɧɢɢɂɧɫɬɪɭɤɰɢɢɨɩɨɪɹɞɤɟɦɟɞɢɰɢɧɫɤɨɝɨɨɫɦɨɬɪɚɞɨɧɨɪɨɜ, ɜɡɹɬɢɹɭɧɢɯɤɪɨɜɢɢɟɟ
ɤɨɦɩɨɧɟɧɬɨɜ: ɉɨɫɬɚɧɨɜɥɟɧɢɟ Ɇɢɧɢɫɬɟɪɫɬɜɚ ɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ Ɋɟɫɩɭɛɥɢɤɢ Ȼɟɥɚɪɭɫɶ ɨɬ 28 ɚɩɪɟɥɹ
2006 ɝ., ʋ 32.
19. Ƚɨɪɨɞɟɰɤɢɣ, ȼ. Ɇ. Ɉɱɟɪɤɢɩɨɩɪɨɢɡɜɨɞɫɬɜɟɧɧɨɣ
ɢɤɥɢɧɢɱɟɫɤɨɣɬɪɚɧɫɮɭɡɢɨɥɨɝɢɢ / ȼ. Ɇ. Ƚɨɪɨɞɟɰɤɢɣ,
ȼ. ȼ. Ɋɵɠɤɨ; ɩɨɞɪɟɞ. Ⱥ. ɂ. ȼɨɪɨɛɶɟɜɚ. – Ɇ., 2006.
– ɋ. 223-230.
20. Petrides, M. Practical guide to transfusion
medicine / M. Petrides; eds. M. Petrides [et al.]. – 2nd
ed. – AABB Press, 2007. – 485 p.
21. Concentration of transfusion resources on a few
pathologies and a few patients: analysis of the
comprehensive in-hospital patient database / C. Beguin
[et al.] // Transfusion. – 2007. – Vol.47, N 2. – P.217227.
22. Blood use in elective surgery: the Austrian
benchmark study / H. Gombotz [et al.] // Transfusion.
– 2007. – Vol. 47, N 8. – P. 1468-1480.
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