ЛЕЧЕНРЕ НЕРР`РќР

advertisement
Ʌȿɑȿɇɂȿ ɇȿɊȼɇɕɏ ɂ ɉɋɂɏɂɑȿɋɄɂɏ ɁȺȻɈɅȿȼȺɇɂɃ
ɂɫɩɨɥɶɡɨɜɚɧɢɟ ɧɨɪɦɨɛɚɪɢɱɟɫɤɨɣ ɝɢɩɨɤɫɢɢ ɩɪɢ ɥɟɱɟɧɢɢ
ɷɩɢɥɟɩɫɢɢ
ȿ.ȼ. ɋɌȺɊɕɏ, Ⱥ.ɂ. ɎȿȾɂɇ
The use of normobaric hypoxia in the therapy of epilepsy
E.V. STARYKH, A.I. FEDIN
Ʉɚɮɟɞɪɚ ɧɟɜɪɨɥɨɝɢɢ ɮɚɤɭɥɶɬɟɬɚ ɭɫɨɜɟɪɲɟɧɫɬɜɨɜɚɧɢɹ ɜɪɚɱɟɣ Ɋɨɫɫɢɣɫɤɨɝɨ ɝɨɫɭɞɚɪɫɬɜɟɧɧɨɝɨ ɦɟɞɢɰɢɧɫɤɨɝɨ ɭɧɢɜɟɪɫɢɬɟɬɚ, Ɇɨɫɤɜɚ
ɋɬɚɬɶɹ ɩɨɫɜɹɳɟɧɚ ɢɫɩɨɥɶɡɨɜɚɧɢɸ ɜ ɥɟɱɟɧɢɢ ɷɩɢɥɟɩɫɢɢ ɩɪɟɪɵɜɢɫɬɨɣ ɧɨɪɦɨɛɚɪɢɱɟɫɤɨɣ ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ ɤɚɤ ɫɩɨɫɨɛɚ
ɩɨɜɵɲɟɧɢɹ ɧɟɫɩɟɰɢɮɢɱɟɫɤɨɣ ɪɟɡɢɫɬɟɧɬɧɨɫɬɢ ɨɪɝɚɧɢɡɦɚ. ɉɨɤɚɡɚɧɨ ɨɩɬɢɦɢɡɢɪɭɸɳɟɟ ɜɥɢɹɧɢɟ ɝɢɩɨɤɫɢɢ ɧɚ ɮɢɡɢɨɥɨɝɢɱɟɫɤɢɟ
ɮɭɧɤɰɢɢ ɨɪɝɚɧɢɡɦɚ ɛɨɥɶɧɵɯ ɷɩɢɥɟɩɫɢɟɣ: ɩɨɜɵɲɟɧɢɟ ɫɨɞɟɪɠɚɧɢɹ ɝɟɦɨɝɥɨɛɢɧɚ ɢ ɷɪɢɬɪɨɰɢɬɨɜ ɜ ɤɪɨɜɢ, ɭɦɟɧɶɲɟɧɢɟ ɱɚɫɬɨɬɵ
ɫɟɪɞɟɱɧɵɯ ɫɨɤɪɚɳɟɧɢɣ, ɩɨɧɢɠɟɧɢɟ ɫɢɫɬɨɥɢɱɟɫɤɨɝɨ ɢ ɞɢɚɫɬɨɥɢɱɟɫɤɨɝɨ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ, ɭɜɟɥɢɱɟɧɢɟ ɜɪɟɦɟɧɢ
ɡɚɞɟɪɠɤɢ ɞɵɯɚɧɢɹ ɩɪɢ ɩɪɨɛɟ ɒɬɚɧɝɟ. ɇɚ ɮɨɧɟ ɷɬɢɯ ɢɡɦɟɧɟɧɢɣ ɩɪɨɢɫɯɨɞɹɬ ɭɪɟɠɟɧɢɟ ɷɩɢɥɟɩɬɢɱɟɫɤɢɯ ɩɪɢɫɬɭɩɨɜ ɢ
ɧɨɪɦɚɥɢɡɚɰɢɹ ɩɨɜɟɞɟɧɱɟɫɤɢɯ ɪɟɚɤɰɢɣ.
The article concerns the usage of discrete normobaric hypoxic therapy as a way to enhance non-specific resistance in epilepsy
treatment. The optimising effect of hypoxia on physiological functions of the patients with epilepsy consists in an increase of
haemoglobin and erythrocytes in blood, less systole frequency, a systolic and diaslolic pressure reduction, prolongation of a breathing
hold during a Stange's test). As a result of these changes, the frequency of epileptic attacks decrease and normalization of behavioural
responses was observed.
Zh Nevrol Psikhiatr Im SS Korsakova 2002; 1: 46—48
ɉɪɨɝɧɨɡ ɷɩɢɥɟɩɫɢɢ ɜɨ ɦɧɨɝɨɦ ɡɚɜɢɫɢɬ ɨɬ ɡɚɳɢɬɧɨɤɨɦɩɟɧɫɚɬɨɪɧɵɯ ɜɨɡɦɨɠɧɨɫɬɟɣ ɨɪɝɚɧɢɡɦɚ, ɤɨɬɨɪɵɟ ɜ ɫɜɨɸ
ɨɱɟɪɟɞɶ ɨɩɪɟɞɟɥɹɸɬɫɹ ɟɝɨ ɜɡɚɢɦɨɞɟɣɫɬɜɢɟɦ ɫ ɨɤɪɭɠɚɸɳɟɣ
ɫɪɟɞɨɣ ɢ ɜ ɱɚɫɬɧɨɫɬɢ ɜɥɢɹɧɢɟɦ ɦɟɬɟɨɪɨɥɨɝɢɱɟɫɤɢɯ ɢ
ɫɨɰɢɚɥɶɧɵɯ ɮɚɤɬɨɪɨɜ. Ƚ. ɋɟɥɶɟ [11] ɩɨɤɚɡɚɥ, ɱɬɨ ɞɥɢɬɟɥɶɧɵɣ
ɫɬɪɟɫɫ ɜɫɥɟɞɫɬɜɢɟ ɜɨɡɞɟɣɫɬɜɢɹ ɝɨɪɦɨɧɨɜ, ɭɱɚɫɬɜɭɸɳɢɯ ɜ
ɮɨɪɦɢɪɨɜɚɧɢɢ ɫɬɪɟɫɫɨɜɨɣ ɪɟɚɤɰɢɢ, ɜɵɡɵɜɚɟɬ ɫɟɪɶɟɡɧɵɟ
ɧɚɪɭɲɟɧɢɹ ɨɛɦɟɧɚ ɥɢɩɢɞɨɜ, ɭɝɥɟɜɨɞɨɜ ɢ ɷɥɟɤɬɪɨɥɢɬɨɜ. ɉɪɢ
ɷɬɨɦ ɧɟɨɛɯɨɞɢɦɵɦ ɭɫɥɨɜɢɟɦ ɞɥɹ ɩɪɟɨɞɨɥɟɧɢɹ ɫɬɪɟɫɫɨɪɧɵɯ
ɜɥɢɹɧɢɣ ɹɜɥɹɟɬɫɹ ɫɩɨɫɨɛɧɨɫɬɶ ɨɪɝɚɧɢɡɦɚ ɦɨɛɢɥɢɡɨɜɚɬɶ
ɮɭɧɤɰɢɨɧɚɥɶɧɵɟ ɪɟɡɟɪɜɵ ɜɫɟɯ ɫɢɫɬɟɦ ɢ ɨɪɝɚɧɨɜ ɜ ɰɟɥɹɯ
ɩɨɞɞɟɪɠɚɧɢɹ ɝɨɦɟɨɫɬɚɡɚ.
ɋ ɞɪɭɝɨɣ ɫɬɨɪɨɧɵ, ɢɡɜɟɫɬɧɨ, ɱɬɨ ɷɩɢɥɟɩɫɢɹ ɫɚɦɚ ɫɨɩɪɨɜɨɠɞɚɟɬɫɹ ɫɬɨɣɤɢɦɢ ɧɚɪɭɲɟɧɢɹɦɢ ɷɧɟɪɝɟɬɢɱɟɫɤɨɝɨ ɨɛɦɟɧɚ ɦɨɡɝɚ [10]. Ⱦɟɹɬɟɥɶɧɨɫɬɶ ɧɟɣɪɨɧɨɜ ɪɟɚɥɢɡɭɟɬɫɹ ɜ ɭɫɥɨɜɢɹɯ ɧɟɭɫɬɨɣɱɢɜɨɝɨ ɦɟɬɚɛɨɥɢɱɟɫɤɨɝɨ ɪɚɜɧɨɜɟɫɢɹ [4, 9].
Ɉɛɵɱɧɨ
ɧɚɡɧɚɱɚɟɦɚɹ
ɩɪɨɬɢɜɨɫɭɞɨɪɨɠɧɚɹ
ɬɟɪɚɩɢɹ
ɭɫɭɝɭɛɥɹɟɬ
ɧɚɪɭɲɟɧɢɹ
ɦɟɬɚɛɨɥɢɡɦɚ,
ɜɵɡɵɜɚɟɦɵɟ
ɩɨɜɬɨɪɹɸɳɢɦɢɫɹ ɩɪɢɫɬɭɩɚɦɢ ɫɭɞɨɪɨɝ.
ȼ ɫɜɹɡɢ ɫ ɜɵɲɟɢɡɥɨɠɟɧɧɵɦ ɨɩɪɟɞɟɥɟɧɧɵɣ ɢɧɬɟɪɟɫ
ɩɪɟɞɫɬɚɜɥɹɟɬ ɢɡɭɱɟɧɢɟ ɜɥɢɹɧɢɹ ɧɚ ɷɩɢɥɟɩɬɢɱɟɫɤɢɣ ɩɪɨɰɟɫɫ
ɫɪɟɞɫɬɜ,
ɩɨɜɵɲɚɸɳɢɯ
ɨɛɳɭɸ
ɧɟɫɩɟɰɢɮɢɱɟɫɤɭɸ
ɪɟɡɢɫɬɟɧɬɧɨɫɬɶ ɨɪɝɚɧɢɡɦɚ. Ɉɞɧɢɦ ɢɡ ɧɚɢɛɨɥɟɟ ɱɚɫɬɨ
ɢɫɩɨɥɶɡɭɟɦɵɯ ɞɥɹ ɷɬɨɝɨ ɫɩɨɫɨɛɨɜ ɦɨɠɟɬ ɹɜɥɹɬɶɫɹ ɚɞɚɩɬɚɰɢɹ
ɤ ɝɢɩɨɤɫɢɢ [1, 3, 8, 12, 15], ɤɨɬɨɪɚɹ ɧɟ ɬɨɥɶɤɨ ɨɛɟɫɩɟɱɢɜɚɟɬ
ɩɪɢɫɩɨɫɨɛɥɟɧɢɟ ɨɪɝɚɧɢɡɦɚ ɤ ɧɟɞɨɫɬɚɬɤɭ ɤɢɫɥɨɪɨɞɚ, ɧɨ ɢ
ɜɵɡɵɜɚɟɬ ɲɢɪɨɤɢɣ ɫɩɟɤɬɪ ɡɚɳɢɬɧɵɯ ɩɟɪɟɤɪɟɫɬɧɵɯ
ɷɮɮɟɤɬɨɜ.
ɉɨɥɨɠɢɬɟɥɶɧɨɟ ɜɥɢɹɧɢɟ ɝɢɩɨɤɫɢɢ ɧɚ ɫɭɞɨɪɨɠɧɵɟ ɪɟɚɤɰɢɢ ɛɵɥɨ ɨɬɦɟɱɟɧɨ ɟɳɟ ɜ ɧɚɱɚɥɟ XX ɜɟɤɚ. ȼ 1932 ɝ. Ⱥ.
Loewy [14] ɨɛɧɚɪɭɠɢɥ ɭ ɚɞɚɩɬɢɪɨɜɚɧɧɵɯ ɤ ɝɢɩɨɤɫɢɢ ɦɵɲɟɣ
ɛɨɥɟɟ ɜɵɫɨɤɭɸ ɭɫɬɨɣɱɢɜɨɫɬɶ ɤ ɨɬɪɚɜɥɟɧɢɸ ɫɬɪɢɯɧɢɧɨɦ.
ɋ.Ⱥ. Ⱦɨɥɢɧɨɣ [6] ɭɫɬɚɧɨɜɥɟɧɨ, ɱɬɨ ɩɪɢ ɩɨɞɴɟɦɟ ɧɚ ɜɵɫɨɬɭ
46
1500 — 8000 ɦ ɭɦɟɧɶɲɚɟɬɫɹ ɱɚɫɬɨɬɚ ɫɭɞɨɪɨɠɧɵɯ ɪɟɚɤɰɢɣ ɧɚ
ɜɜɟɞɟɧɢɟ ɤɨɪɚɡɨɥɚ. ɋɨɝɥɚɫɧɨ ɞɚɧɧɵɦ I. Baumel ɢ ɫɨɚɜɬ. [13],
ɝɢɩɨɛɚɪɢɱɟɫɤɚɹ ɝɢɩɨɤɫɢɹ ɫɩɨɫɨɛɧɚ ɩɪɟɞɨɬɜɪɚɳɚɬɶ ɫɭɞɨɪɨɝɢ,
ɜɵɡɵɜɚɟɦɵɟ ɜɜɟɞɟɧɢɟɦ ɦɟɬɨɤɫɢɫɭɥɶɮɨɤɫɢɥɢɧɚ. ȼ ɛɨɥɟɟ
ɩɨɡɞɧɢɯ ɪɚɛɨɬɚɯ ɨɛɧɚɪɭɠɟɧɨ, ɱɬɨ ɭ ɚɞɚɩɬɢɪɨɜɚɧɧɵɯ ɤ
ɝɢɩɨɤɫɢɢ ɠɢɜɨɬɧɵɯ ɜɵɲɟ ɪɟɡɢɫɬɟɧɬɧɨɫɬɶ ɤ ɚɭɞɢɨɝɟɧɧɨɦɭ
ɪɚɡɞɪɚɠɢɬɟɥɸ [7], ɩɟɧɢɰɢɥɥɢɧɭ [2]. ɉɪɢ ɷɬɨɦ ɭ ɠɢɜɨɬɧɵɯ ɫ
ɛɨɥɟɟ ɜɵɫɨɤɨɣ ɭɫɬɨɣɱɢɜɨɫɬɶɸ ɤ ɝɢɩɨɤɫɢɢ ɫɭɞɨɪɨɠɧɚɹ
ɝɨɬɨɜɧɨɫɬɶ ɦɨɡɝɚ ɧɢɠɟ, ɱɟɦ ɩɪɢ ɧɢɡɤɨɣ ɭɫɬɨɣɱɢɜɨɫɬɢ [5].
ɐɟɥɶɸ ɞɚɧɧɨɝɨ ɫɨɨɛɳɟɧɢɹ ɹɜɢɥɨɫɶ ɢɡɭɱɟɧɢɟ
ɞɟɣɫɬɜɢɹ ɩɪɟɪɵɜɢɫɬɨɣ ɧɨɪɦɨɛɚɪɢɱɟɫɤɨɣ ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ
(ɉɇȽ) ɭ ɛɨɥɶɧɵɯ ɫ ɩɚɪɰɢɚɥɶɧɨɣ ɢ ɜɬɨɪɢɱɧɨɝɟɧɟɪɚɥɢɡɨɜɚɧɧɨɣ ɮɨɪɦɚɦɢ ɷɩɢɥɟɩɫɢɢ. ɍ 51 ɛɨɥɶɧɨɝɨ ɢ ɜɨɡɪɚɫɬɟ 16—55 ɥɟɬ ɧɚ ɮɨɧɟ ɩɪɢɟɦɚ ɩɪɨɬɢɜɨɷɥɢɩɬɢɱɟɫɤɢɯ
ɩɪɟɩɚɪɚɬɨɜ
ɩɪɨɜɨɞɢɥɚɫɶ
ɬɪɟɧɢɪɨɜɤɚ
ɨɪɝɚɧɢɡɦɚ:
ɝɢɩɨɤɫɢɱɟɫɤɢɟ ɜɨɡɞɟɣɫɬɜɢɹ ɱɟɪɟɞɨɜɚɥɢɫɶ ɫ ɩɟɪɢɨɞɚɦɢ
ɪɟɨɤɫɢɝɟɧɚɰɢɢ. Ⱦɵɯɚɧɢɟ ɨɫɭɳɟɫɬɜɥɹɥɨɫɶ ɫ ɩɨɦɨɳɶɸ
ɝɢɩɨɤɫɢɤɚɬɨɪɚ Ȼɢɨ-ɇɨɜɚ-204 ɜ ɰɢɤɥɢɱɧɨ-ɮɪɚɤɰɢɨɧɧɨɦ
ɪɟɠɢɦɟ: ɞɵɯɚɧɢɟ ɫɦɟɫɹɦɢ 5 ɦɢɧ, ɡɚɬɟɦ ɞɵɯɚɧɢɟ
ɚɬɦɨɫɮɟɪɧɵɦ ɜɨɡɞɭɯɨɦ («ɩɟɪɟɪɵɜ») ɬɚɤɠɟ ɜ ɬɟɱɟɧɢɟ 5 ɦɢɧ
(1 ɰɢɤɥ). Ɉɞɢɧ ɫɟɚɧɫ ɫɨɫɬɚɜɥɹɥɢ 6 ɰɢɤɥɨɜ. ȼ ɩɟɪɜɵɟ 2 ɞɧɹ
ɚɞɚɩɬɚɰɢɢ ɫɭɦɦɚɪɧɨɟ ɜɪɟɦɹ ɞɵɯɚɧɢɹ ɚɬɦɨɫɮɟɪɧɵɦ
ɜɨɡɞɭɯɨɦ ɧɚ ɩɪɨɬɹɠɟɧɢɢ ɨɞɧɨɝɨ ɫɟɚɧɫɚ ɛɵɥɨ ɧɟɫɤɨɥɶɤɨ
ɭɜɟɥɢɱɟɧɨ. Ʉɭɪɫ ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ — 20 ɫɟɚɧɫɨɜ,
ɩɪɨɜɨɞɢɜɲɢɯɫɹ ɟɠɟɞɧɟɜɧɨ.
Ⱦɨ ɢ ɩɨɫɥɟ ɚɞɚɩɬɚɰɢɢ ɤ ɝɢɩɨɤɫɢɢ ɭ ɛɨɥɶɧɵɯ ɨɩɪɟɞɟɥɹɥɢ
ɦɢɧɢɦɚɥɶɧɭɸ
ɢ
ɦɚɤɫɢɦɚɥɶɧɭɸ
ɤɨɧɰɟɧɬɪɚɰɢɸ
ɤɚɪɛɚɦɚɡɟɩɢɧɚ, ɞɟɩɚɤɢɧɚ ɢ ɮɟɧɨɛɚɪɛɢɬɚɥɚ ɜ ɤɪɨɜɢ ɦɟɬɨɞɨɦ
ɬɜɟɪɞɨɮɚɡɧɨɝɨ ɢɦɦɭɧɨɮɟɪɦɟɧɬɧɨɝɨ ɚɧɚɥɢɡɚ. Ɇɢɧɢɦɚɥɶɧɭɸ
ɤɨɧɰɟɧɬɪɚɰɢɸ ɨɰɟɧɢɜɚɥɢ ɜ ɩɨɪɰɢɢ ɤɪɨɜɢ, ɜɡɹɬɨɣ ɭɬɪɨɦ ɞɨ
ɩɪɢɟɦɚ ɥɟɤɚɪɫɬɜɚ, ɦɚɤɫɢɦɚɥɶɧɭɸ — ɫɩɭɫɬɹ 2 ɱ ɩɨɫɥɟ ɟɝɨ
ɩɪɢɟɦɚ. Ⱦɨ ɢ ɩɨɫɥɟ ɚɞɚɩɬɚɰɢɢ ɨɩɪɟɞɟɥɹɥɢ ɫɨɞɟɪɠɚɧɢɟ
ɝɟɦɨɝɥɨɛɢɀɍɊɇȺɅ ɇȿȼɊɈɅɈȽɂɂ ɂ ɉɋɂɏɂȺɌɊɂɂ, I, 2002
ɇɈɊɆɈȻȺɊɂɑȿɋɄȺə ȽɂɉɈɄɋɂə ɉɊɂ ɗɉɂɅȿɉɋɂɂ
Ɍɚɛɥɢɰɚ 1. ɂɡɦɟɧɟɧɢɟ ɩɚɪɚɦɟɬɪɨɜ
ɤɚɪɞɢɨɪɟɫɩɢɪɚɬɨɪɧɨɣ ɫɢɫɬɟɦɵ ɢ ɝɟɦɚɬɨɥɨɝɢɱɟɫɤɢɯ
ɩɨɤɚɡɚɬɟɥɟɣ ɩɨɞ ɜɥɢɹɧɢɟɦ ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ
ɉɚɪɚɦɟɬɪ
Ⱦɨ ɚɞɚɩɬɚɰɢɢ
ɉɨɫɥɟ ɤɭɪɫɚ
ɚɞɚɩɬɚɰɢɢ
ɋɨɞɟɪɠɚɧɢɟ
ɝɟɦɨɝɥɨɛɢɧɚ, ɝ/ɥ
132,9±2,5
144,5±3,9*
Ʉɨɥɢɱɟɫɬɜɨ
ɷɪɢɬɪɨɰɢɬɨɜ. 1012/ɥ
4,07±0,07
4,5+0.12*
ɉɪɨɛɚ ɒɬɚɧɝɟ, ɫ
41,6±4,8
56,5±4,9*
ɑɚɫɬɨɬɚ ɫɟɪɞɟɱɧɵɯ
ɫɨɤɪɚɳɟɧɢɣ ɜ ɦɢɧɭɬɭ
74,7±2,3
67,3±1,6*
129,4±4,4
88,7±3,15
119,7±2,4
79,1±2,9*
Ⱥɪɬɟɪɢɚɥɶɧɨɟ ɞɚɜɥɟɧɢɟ,
ɦɦ ɪɬ.ɫɬ.:
ɫɢɫɬɨɥɢɱɟɫɤɨɟ
ɞɢɚɫɬɨɥɢɱɟɫɤɨɟ
ɉɪɢɦɟɱɚɧɢɟ. * — ɞɨɫɬɨɜɟɪɧɵɟ ɪɚɡɥɢɱɢɹ ɩɨɤɚɡɚɬɟɥɟɣ (p<0,05).
ɧɚ ɢ ɷɪɢɬɪɨɰɢɬɨɜ ɜ ɤɪɨɜɢ, ɩɪɨɜɨɞɢɥɢ ɩɪɨɛɭ ɒɬɚɧɝɟ
(ɦɚɤɫɢɦɚɥɶɧɨɟ ɜɪɟɦɹ ɡɚɞɟɪɠɤɢ ɞɵɯɚɧɢɹ ɧɚ ɜɞɨɯɟ,
ɯɚɪɚɤɬɟɪɢɡɭɸɳɟɟ ɭɫɬɨɣɱɢɜɨɫɬɶ ɨɪɝɚɧɢɡɦɚ ɤ ɧɟɞɨɫɬɚɬɤɭ
ɤɢɫɥɨɪɨɞɚ), ɢɡɦɟɪɹɥɢ ɚɪɬɟɪɢɚɥɶɧɨɟ ɞɚɜɥɟɧɢɟ ɢ ɱɚɫɬɨɬɭ
ɫɟɪɞɟɱɧɵɯ ɫɨɤɪɚɳɟɧɢɣ.
ɉɚɰɢɟɧɬɨɜ, ɩɪɨɲɟɞɲɢɯ ɤɭɪɫ ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ, ɭɫɥɨɜɧɨ
ɪɚɡɞɟɥɢɥɢ ɧɚ 5 ɝɪɭɩɩ. ȼ 1-ɸ ɝɪɭɩɩɭ ɜɤɥɸɱɢɥɢ 10 ɩɚɰɢɟɧɬɨɜ
ɫ ɱɚɫɬɨɬɨɣ ɩɪɢɫɬɭɩɨɜ ɩɪɢɦɟɪɧɨ ɨɞɢɧ ɜ 6 ɦɟɫ, ɜɨ 2-ɸ — 19
ɛɨɥɶɧɵɯ ɫ ɱɚɫɬɨɬɨɣ ɩɪɢɫɬɭɩɨɜ ɞɨ ɨɞɧɨɝɨ ɜ 1 ɦɟɫ, ɜ 3-ɸ — 10
ɛɨɥɶɧɵɯ ɫ ɱɚɫɬɨɬɨɣ ɩɪɢɫɬɭɩɨɜ ɞɨ ɨɞɧɨɝɨ ɪɚɡɚ ɜ ɧɟɞɟɥɸ, ɜ 4ɸ — 10 ɛɨɥɶɧɵɯ ɫ ɱɚɫɬɨɬɨɣ ɩɪɢɫɬɭɩɨɜ ɞɨ ɨɞɧɨɝɨ ɜ ɞɟɧɶ ɢ ɜ
5-ɸ — 2 ɛɨɥɶɧɵɯ ɫ ɟɠɟɞɧɟɜɧɵɦɢ ɩɨɜɬɨɪɹɸɳɢɦɢɫɹ
ɩɪɢɫɬɭɩɚɦɢ.
ȼ ɩɪɨɰɟɫɫɟ ɝɢɩɨɤɫɢɱɟɫɤɢɯ ɬɪɟɧɢɪɨɜɨɤ ɭ ɛɨɥɶɧɵɯ
ɷɩɢɥɟɩɫɢɟɣ ɞɨɫɬɨɜɟɪɧɨ ɭɜɟɥɢɱɢɜɚɥɨɫɶ ɜɪɟɦɹ ɜɵɩɨɥɧɟɧɢɹ
ɩɪɨɛɵ ɒɬɚɧɝɟ, ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ ɨ ɫɨɜɟɪɲɟɧɫɬɜɨɜɚɧɢɢ
ɪɟɝɭɥɹɰɢɢ ɚɥɶɜɟɨɥɹɪɧɨɣ ɚɷɪɚɰɢɢ ɢ ɤɚɩɢɥɥɹɪɧɨɝɨ ɥɟɝɨɱɧɨɝɨ
ɤɪɨɜɨɬɨɤɚ (ɬɚɛɥ. 1). Ⱦɨɫɬɨɜɟɪɧɨ ɩɨɜɵɫɢɥɨɫɶ ɫɨɞɟɪɠɚɧɢɟ
ɝɟɦɨɝɥɨɛɢɧɚ ɢ ɷɪɢɬɪɨɰɢɬɨɜ ɜ ɤɪɨɜɢ; ɬɨɥɶɤɨ ɭ 3 ɛɨɥɶɧɵɯ ɷɬɨɬ
ɩɨɤɚɡɚɬɟɥɶ ɫɭɳɟɫɬɜɟɧɧɨ ɧɟ ɭɜɟɥɢɱɢɥɫɹ, ɚ ɭ ɨɞɧɨɝɨ ɨɤɚɡɚɥɫɹ
ɧɟɦɧɨɝɨ ɧɢɠɟ ɮɨɧɨɜɵɯ ɡɧɚɱɟɧɢɣ. ɑɚɫɬɨɬɚ ɫɟɪɞɟɱɧɵɯ ɫɨɤɪɚɳɟɧɢɣ ɢɦɟɥɚ ɬɟɧɞɟɧɰɢɸ ɤ ɫɧɢɠɟɧɢɸ. Ɉɞɧɨɜɪɟɦɟɧɧɨ ɫ
ɷɬɢɦ ɭ ɛɨɥɶɲɢɧɫɬɜɚ ɛɨɥɶɧɵɯ ɫɭɳɟɫɬɜɟɧɧɨ ɩɨɧɢɡɢɥɨɫɶ
ɞɢɚɫɬɨɥɢɱɟɫɤɨɟ ɚɪɬɟɪɢɚɥɶɧɨɟ ɞɚɜɥɟɧɢɟ (p<0,05); ɜ ɦɟɧɶɲɟɣ
ɫɬɟɩɟɧɢ ɫɧɢɠɚɥɨɫɶ ɫɢɫɬɨɥɢɱɟɫɤɨɟ.
ȼ ɰɟɥɨɦ ɨɛɧɚɪɭɠɟɧɧɵɟ ɢɡɦɟɧɟɧɢɹ ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɬ ɨ
ɬɨɦ, ɱɬɨ ɚɞɚɩɬɚɰɢɹ ɤ ɩɪɟɪɵɜɢɫɬɨɣ ɧɨɪɦɨɛɚɪɢɱɟɫɤɨɣ
ɝɢɩɨɤɫɢɢ ɫɩɨɫɨɛɫɬɜɭɟɬ ɛɨɥɟɟ ɷɤɨɧɨɦɧɨɦɭ ɢɫɩɨɥɶɡɨɜɚɧɢɸ
ɨɪɝɚɧɢɡɦɨɦ ɤɢɫɥɨɪɨɞɚ ɢ ɩɨɜɵɲɚɟɬ ɬɨɥɟɪɚɧɬɧɨɫɬɶ ɤ
ɧɟɞɨɫɬɚɬɤɭ ɤɢɫɥɨɪɨɞɚ.
ɉɨɞ ɜɥɢɹɧɢɟɦ ɬɪɟɧɢɪɨɜɨɤ ɫɧɢɠɚɥɚɫɶ ɤɚɤ ɦɢɧɢɦɚɥɶɧɚɹ,
ɬɚɤ ɢ ɦɚɤɫɢɦɚɥɶɧɚɹ ɤɨɧɰɟɧɬɪɚɰɢɹ ɩɪɨɬɢɜɨɷɩɢɥɟɩɬɢɱɟɫɤɢɯ
ɩɪɟɩɚɪɚɬɨɜ ɜ ɤɪɨɜɢ. Ɍɚɤ, ɦɢɧɢɦɚɥɶɧɚɹ ɤɨɧɰɟɧɬɪɚɰɢɹ
ɤɚɪɛɚɦɚɡɟɩɢɧɚ, ɫɨɫɬɚɜɥɹɜɲɚɹ ɞɨ ɧɚɱɚɥɚ ɤɭɪɫɚ ɉɇȽ 3,7±0,3
ɦɤɝ/ɦɥ, ɩɨ ɨɤɨɧɱɚɧɢɢ ɟɝɨ ɫɧɢɡɢɥɚɫɶ ɞɨ 2,5±0,3 ɦɤɝ/ɦɥ
(ɪ<0,05), ɦɚɤɫɢɦɚɥɶɧɚɹ ɤɨɧɰɟɧɬɪɚɰɢɹ — ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ ɫ
5,3±0,4 ɞɨ 3,8±0,3 ɦɤɝ/ɦɥ (p<0,05). ɂɡ 16 ɩɚɰɢɟɧɬɨɜ,
ɩɨɥɭɱɚɜɲɢɯ ɤɚɪɛɚɦɚɡɟɩɢɧ, ɬɨɥɶɤɨ ɭ 3 ɨɛɧɚɪɭɠɢɜɚɥɨɫɶ
ɧɟɡɧɚɱɢɬɟɥɶɧɨɟ ɩɨɜɵɲɟɧɢɟ ɟɝɨ ɤɨɧɰɟɧɬɪɚɰɢɢ ɜ ɤɪɨɜɢ (ɥɢɛɨ
ɦɢɧɢɦɚɥɶɧɨɣ, ɥɢɛɨ ɦɚɤɫɢɦɚɥɶɧɨɣ) ɩɨɫɥɟ ɤɭɪɫɚ ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ, ɬɨɝɞɚ ɤɚɤ ɭ 13 ɤɚɤ ɦɢɧɢɦɚɥɶɧɚɹ, ɬɚɤ ɢ
ɦɚɤɫɢɦɚɥɶɧɚɹ ɤɨɧɰɟɧɬɪɚɰɢɹ ɩɪɟɩɚɪɚɬɚ ɜ ɤɪɨɜɢ ɩɨɞ ɜɥɢɹɧɢɟɦ
ɬɪɟɧɢɪɨɜɨɤ ɩɨɧɢɠɚɥɚɫɶ.
ɍ ɛɨɥɶɧɵɯ, ɩɪɢɧɢɦɚɜɲɢɯ ɮɟɧɨɛɚɪɛɢɬɚɥ, ɟɝɨ ɤɨɧɰɟɧɬɪɚɰɢɸ ɜ ɤɪɨɜɢ ɨɩɪɟɞɟɥɹɥɢ ɨɞɧɨɤɪɚɬɧɨ — ɫɩɭɫɬɹ 2 ɱ
ɩɨɫɥɟ ɩɪɢɟɦɚ. Ⱦɨ ɧɚɱɚɥɚ ɉɇȽ ɨɧɚ ɫɨɫɬɚɜɥɹɥɚ 13,6±1,3
ɦɤɝ/ɦɥ, ɩɨɫɥɟ ɟɟ ɨɤɨɧɱɚɧɢɹ — 9,5±0,7 ɦɤɝ/ɦɥ (p<0,05).
Ɍɨɥɶɤɨ ɭ 1 ɢɡ 10 ɩɚɰɢɟɧɬɨɜ ɜ ɩɪɨɰɟɫɫɟ ɬɪɟɧɢɪɨɜɨɤ ɩɪɨɢɡɨɲɥɨ ɧɟɤɨɬɨɪɨɟ ɩɨɜɵɲɟɧɢɟ ɷɬɨɝɨ ɩɚɪɚɦɟɬɪɚ.
ɂɡ ɩɪɢɧɢɦɚɜɲɢɯ ɞɟɩɚɤɢɧ ɭ ɜɫɟɯ ɛɨɥɶɧɵɯ ɩɨɫɥɟ ɤɭɪɫɚ
ɉɇȽ ɧɚɛɥɸɞɚɥɚɫɶ ɬɟɧɞɟɧɰɢɹ ɤ ɩɨɧɢɠɟɧɢɸ ɤɚɤ ɦɢɧɢɦɚɥɶɧɨɣ
(ɫ 52,5±13,1 ɞɨ 42,0±10,01 ɦɤɝ/ɦɥ), ɬɚɤ ɢ ɦɚɤɫɢɦɚɥɶɧɨɣ (ɫ
63,3+15,5 ɞɨ 51,8±13,2 ɦɤɝ/ɦɥ) ɟɝɨ ɤɨɧɰɟɧɬɪɚɰɢɢ.
ɂɡ 2 ɛɨɥɶɧɵɯ, ɩɪɢɧɢɦɚɜɲɢɯ ɞɢɮɟɧɢɧ, ɟɝɨ ɦɢɧɢɦɚɥɶɧɚɹ
ɤɨɧɰɟɧɬɪɚɰɢɹ ɜ ɤɪɨɜɢ ɩɨɞ ɜɥɢɹɧɢɟɦ ɥɟɱɟɧɢɹ ɭ ɨɞɧɨɝɨ
ɫɧɢɡɢɥɚɫɶ ɫ 10 ɞɨ 4,3 ɦɤɝ/ɦɥ, ɦɚɤɫɢɦɚɥɶɧɚɹ — ɫ 14 ɞɨ 7,0
ɦɤɝ/ɦɥ, ɭ ɞɪɭɝɨɝɨ — ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ ɫ 26,5 ɞɨ 18,2 ɢ ɫ 29,4 ɞɨ
20 ɦɤɝ/ɦɥ. ɍ ɛɨɥɶɧɨɝɨ, ɥɟɱɢɜɲɟɝɨɫɹ ɛɟɧɡɨɧɚɥɨɦ, ɟɝɨ
ɦɢɧɢɦɚɥɶɧɚɹ ɤɨɧɰɟɧɬɪɚɰɢɹ ɫɧɢɡɢɥɚɫɶ ɫ 18,7 ɦɤɝ/ɦɥ ɞɨ
ɥɟɱɟɧɢɹ ɢ ɞɨ 10 ɦɤɝ/ɦɥ ɩɨɫɥɟ ɟɝɨ ɨɤɨɧɱɚɧɢɹ, ɦɚɤɫɢɦɚɥɶɧɚɹ
— ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ ɫ 24,3 ɞɨ 12,2 ɦɤɝ/ɦɥ.
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɩɪɢ ɧɟɢɡɦɟɧɧɨɦ ɪɟɠɢɦɟ ɩɪɢɟɦɚ
ɩɪɨɬɢɜɨɷɩɢɥɟɩɬɢɱɟɫɤɢɯ ɩɪɟɩɚɪɚɬɨɜ ɫɧɢɠɟɧɢɟ ɢɯ ɤɨɧɰɟɧɬɪɚɰɢɢ ɜ ɤɪɨɜɢ ɦɨɠɧɨ ɨɛɴɹɫɧɢɬɶ ɚɤɬɢɜɚɰɢɟɣ ɷɧɟɪɝɟɬɢɱɟɫɤɢɯ ɩɪɨɰɟɫɫɨɜ ɜ ɪɟɡɭɥɶɬɚɬɟ ɩɪɨɜɟɞɟɧɧɨɝɨ ɥɟɱɟɧɢɹ,
ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ ɨ ɟɝɨ ɷɮɮɟɤɬɢɜɧɨɫɬɢ.
ɉɨɫɥɟ ɨɤɨɧɱɚɧɢɹ ɤɭɪɫɚ ɉɇȽ ɭɫɬɚɧɨɜɥɟɧɨ ɭɪɟɠɟɧɢɟ
ɩɪɢɫɬɭɩɨɜ, ɭɦɟɧɶɲɟɧɢɟ ɢɯ ɞɥɢɬɟɥɶɧɨɫɬɢ ɢ ɬɹɠɟɫɬɢ. ɂɡ ɬɚɛɥ.
2 ɫɥɟɞɭɟɬ, ɱɬɨ ɜ ɝɪɭɩɩɟ ɫ ɧɚɢɦɟɧɶɲɟɣ ɩɨɜɬɨɪɹɟɦɨɫɬɶɸ
ɩɚɪɨɤɫɢɡɦɨɜ (1-ɹ) ɧɢ ɡɚ ɜɪɟɦɹ ɚɞɚɩɬɚɰɢɢ ɤ ɝɢɩɨɤɫɢɢ, ɧɢ ɜ
ɬɟɱɟɧɢɟ ɩɨɫɥɟɞɭɸɳɢɯ 6 ɦɟɫ ɩɪɢɫɬɭɩɵ ɧɢ ɭ ɨɞɧɨɝɨ ɩɚɰɢɟɧɬɚ
ɧɟ ɪɚɡɜɢɥɢɫɶ.
ȼɨ 2-ɣ ɝɪɭɩɩɟ ɩɚɰɢɟɧɬɨɜ — ɫ ɱɚɫɬɨɬɨɣ ɩɪɢɫɬɭɩɨɜ ɞɨ
ɨɞɧɨɝɨ ɜ ɦɟɫɹɰ ɡɚ ɩɪɟɞɲɟɫɬɜɨɜɚɜɲɢɟ ɚɞɚɩɬɚɰɢɢ 30 ɞɧɟɣ
ɧɚɛɥɸɞɚɥɨɫɶ ɜ ɫɪɟɞɧɟɦ 12 ɩɚɪɨɤɫɢɡɦɨɜ, ɡɚ ɜɪɟɦɹ ɬɪɟɧɢɪɨɜɨɤ
ɛɵɥɨ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɨ 7 ɩɚɪɨɤɫɢɡɦɨɜ, ɧɚ ɩɪɨɬɹɠɟɧɢɢ 5 ɦɟɫ
ɩɨɫɥɟ ɉɇȽ ɪɟɝɢɫɬɪɢɪɨɜɚɥɨɫɶ ɡɧɚɱɢɬɟɥɶɧɨɟ ɭɪɟɠɟɧɢɟ
ɩɪɢɩɚɞɤɨɜ ɢ ɬɨɥɶɤɨ ɧɚ 6-ɦ ɦɟɫɹɰɟ ɢɯ ɱɚɫɬɨɬɚ ɧɚɱɚɥɚ
ɩɨɜɵɲɚɬɶɫɹ. Ɍɟɦ ɧɟ ɦɟɧɟɟ ɜ ɬɟɱɟɧɢɟ 6-ɝɨ ɦɟɫɹɰɚ ɜ ɷɬɨɣ
Ɍɚɛɥɢɰɚ 2. ɂɡɦɟɧɟɧɢɟ ɱɚɫɬɨɬɵ ɷɩɢɥɟɩɬɢɱɟɫɤɢɯ ɩɪɢɫɬɭɩɨɜ ɜ ɪɟɡɭɥɶɬɚɬɟ ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ
Ƚɪɭɩɩɚ ɩɚɰɢɟɧɬɨɜ
1-ɹ
2-ɹ
ȼ ɬɟɱɟɧɢɟ 1 ɦɟɫ
ɞɨ ɚɞɚɩɬɚɰɢɢ
—
12
ȼ ɬɟɱɟɧɢɟ 1 ɦɟɫ
ɚɞɚɩɬɚɰɢɢ
—
7
Ɇɟɫɹɰ ɩɨɫɥɟ ɨɤɨɧɱɚɧɢɹ
ɉɇȽ
1-ɣ
2-ɣ
3-ɣ
4-ɣ
5-ɢ
6-Ƀ
—
1
—
3
—
2
—
2
—
1
—
6
3-ɹ
21
16
6
—
3
5
9
11
4-ɹ
210
93
55
57
56
62
67
104
5-ɹ
159
111
115
39
63
85
127
114
ɀɍɊɇȺɅ ɇȿȼɊɈɅɈȽɂɂ ɂ ɉɋɂɏɂȺɌɊɂɂ, 1, 2002
47
Ʌȿɑȿɇɂȿ ɇȿɊȼɇɕɏ ɂ ɉɋɂɏɂɑȿɋɄɂɏ ɁȺȻɈɅȿȼȺɇɂɃ
ɝɪɭɩɩɟ ɛɵɥɨ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɨ ɜ 2 ɪɚɡɚ ɦɟɧɶɲɟɟ ɱɢɫɥɨ
ɩɪɢɩɚɞɤɨɜ, ɱɟɦ ɞɨ ɧɚɱɚɥɚ ɥɟɱɟɧɢɹ. ɍ 7 ɛɨɥɶɧɵɯ ɷɬɨɣ ɝɪɭɩɩɵ
ɧɚ ɩɪɨɬɹɠɟɧɢɢ ɜɫɟɝɨ ɤɭɪɫɚ ɉɇȽ ɢ ɜ ɬɟɱɟɧɢɟ ɩɨɫɥɟɞɭɸɳɢɯ 6
ɦɟɫ ɩɪɢɫɬɭɩɵ ɧɟ ɜɨɡɧɢɤɚɥɢ, ɭ 3 ɛɵɥ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧ ɥɢɲɶ
ɨɞɢɧ ɡɚ ɩɟɪɢɨɞ ɢɫɫɥɟɞɨɜɚɧɢɹ, ɭ 7 — ɞɜɚ ɢ ɭ 2 — ɬɪɢ.
ȼ 3-ɣ ɝɪɭɩɩɟ ɛɨɥɶɧɵɯ — ɫ ɱɚɫɬɨɬɨɣ ɷɩɢɥɟɩɬɢɱɟɫɤɢɯ
ɩɚɪɨɤɫɢɡɦɨɜ ɞɨ ɨɞɧɨɝɨ ɜ ɧɟɞɟɥɸ ɡɚ ɩɪɟɞɲɟɫɬɜɨɜɚɜɲɢɣ
ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ ɦɟɫɹɰ ɨɩɪɟɞɟɥɹɥɫɹ 21 ɩɪɢɫɬɭɩ. Ɂɚ ɜɪɟɦɹ
ɬɪɟɧɢɪɨɜɨɤ ɢɯ ɤɨɥɢɱɟɫɬɜɨ ɭɦɟɧɶɲɢɥɨɫɶ ɞɨ 16. ȼ ɩɟɪɜɵɣ
ɦɟɫɹɰ ɩɨɫɥɟ ɤɭɪɫɚ ɥɟɱɟɧɢɹ ɛɵɥɨ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɨ 6
ɩɚɪɨɤɫɢɡɦɨɜ, ɜ ɬɟɱɟɧɢɟ 2-ɝɨ ɦɟɫɹɰɚ ɬɚɤɨɜɵɯ ɧɟ ɛɵɥɨ, ɧɚ 3-ɦ
ɦɟɫɹɰɟ ɜɨɡɧɢɤɥɨ 3, ɧɚ 4-ɦ — 5, ɧɚ 5-ɦ — 9 ɢ ɧɚ 6-ɦ — 11
ɩɪɢɫɬɭɩɨɜ. ɋɥɟɞɨɜɚɬɟɥɶɧɨ, ɢ ɜ ɷɬɨɣ ɝɪɭɩɩɟ ɨɛɳɟɟ
ɤɨɥɢɱɟɫɬɜɨ ɩɪɢɫɬɭɩɨɜ ɩɨ ɩɪɨɲɟɫɬɜɢɢ ɩɨɥɭɝɨɞɚ ɛɵɥɨ ɧɢɠɟ
ɩɟɪɜɨɧɚɱɚɥɶɧɨɝɨ ɩɪɢɦɟɪɧɨ ɜ 2 ɪɚɡɚ. ɍ 4 ɛɨɥɶɧɵɯ ɩɨɫɥɟ
ɤɭɪɫɚ ɉɇȽ ɦɟɠɩɪɢɫɬɭɩɧɵɟ ɢɧɬɟɪɜɚɥɵ ɭɞɥɢɧɢɥɢɫɶ ɞɨ 2 ɦɟɫ,
ɭ 2 — ɞɨ 3 ɦɟɫ ɢ ɭ 4 — ɞɨ 4 ɢ 5 ɦɟɫ.
ɍ ɛɨɥɶɧɵɯ 4-ɣ ɝɪɭɩɩɵ ɡɚ ɩɪɟɞɲɟɫɬɜɨɜɚɜɲɢɣ ɚɞɚɩɬɚɰɢɢ
ɦɟɫɹɰ ɨɛɳɟɟ ɱɢɫɥɨ ɩɪɢɫɬɭɩɨɜ ɫɨɫɬɚɜɥɹɥɨ 210. ɇɚ
ɩɪɨɬɹɠɟɧɢɢ ɤɭɪɫɚ ɉɇȽ ɧɚɛɥɸɞɚɥɨɫɶ 93 ɩɪɢɩɚɞɤɚ. ȼ ɬɟɱɟɧɢɟ
1-ɝɨ ɦɟɫɹɰɚ ɩɨɫɥɟ ɥɟɱɟɧɢɹ ɨɛɳɟɟ ɤɨɥɢɱɟɫɬɜɨ ɩɚɪɨɤɫɢɡɦɨɜ
ɭɦɟɧɶɲɢɥɨɫɶ ɩɨɱɬɢ ɜ 4 ɪɚɡɚ — ɞɨ 55. ȼ ɩɨɫɥɟɞɭɸɳɢɟ 2 ɦɟɫ
ɱɚɫɬɨɬɚ ɷɩɢɥɟɩɬɢɱɟɫɤɢɯ ɪɟɚɤɰɢɣ ɨɫɬɚɜɚɥɚɫɶ ɩɪɚɤɬɢɱɟɫɤɢ
ɧɟɢɡɦɟɧɧɨɣ. ɇɚ 4-ɦ ɦɟɫɹɰɟ ɩɨɫɥɟ ɨɤɨɧɱɚɧɢɹ ɬɪɟɧɢɪɨɜɨɤ
ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɨ 62 ɩɪɢɩɚɞɤɚ, ɧɚ 5-ɦ — 67, ɚ ɧɚ 6-ɦ ɢɯ
ɤɨɥɢɱɟɫɬɜɨ ɜɨɡɪɨɫɥɨ ɞɨ 104, ɱɬɨ ɩɪɢɦɟɪɧɨ ɜɞɜɨɟ ɦɟɧɶɲɟ
ɩɟɪɜɨɧɚɱɚɥɶɧɵɯ ɞɚɧɧɵɯ. ɍ ɨɞɧɨɣ ɛɨɥɶɧɨɣ ɷɬɨɣ ɝɪɭɩɩɵ ɫ
ɟɠɟɞɧɟɜɧɵɦɢ ɞɨ ɥɟɱɟɧɢɹ ɩɪɢɫɬɭɩɚɦɢ ɩɨɫɥɟ ɤɭɪɫɚ ɉɇȽ ɧɚ
ɩɪɨɬɹɠɟɧɢɢ ɩɨɥɭɝɨɞɚ ɜɨɡɧɢɤɥɨ ɥɢɲɶ 5 ɩɚɪɨɤɫɢɡɦɨɜ. ɍ
ɞɪɭɝɨɝɨ ɛɨɥɶɧɨɝɨ ɩɪɢ ɮɨɧɨɜɨɣ ɱɚɫɬɨɬɟ ɩɚɪɨɤɫɢɡɦɨɜ ɞɨ 2 ɜ
ɦɟɫɹɰ ɩɨɫɥɟ ɥɟɱɟɧɢɹ ɧɚ ɩɪɨɬɹɠɟɧɢɢ 6 ɦɟɫ ɨɬɦɟɱɟɧɨ ɬɨɥɶɤɨ 6
ɩɪɢɫɬɭɩɨɜ.
ȼ 5-ɣ ɝɪɭɩɩɟ, ɧɚɫɱɢɬɵɜɚɜɲɟɣ ɜɫɟɝɨ 2 ɛɨɥɶɧɵɯ, ɨɛɳɟɟ
ɤɨɥɢɱɟɫɬɜɨ ɩɪɢɫɬɭɩɨɜ ɡɚ ɦɟɫɹɰ ɞɨ ɥɟɱɟɧɢɹ ɫɨɫɬɚɜɥɹɥɨ 159.
ɉɨɜɬɨɪɹɸɳɢɟɫɹ ɩɪɢɫɬɭɩɵ ɧɚɛɥɸɞɚɥɢɫɶ ɭ ɷɬɢɯ ɩɚɰɢɟɧɬɨɜ
ɟɠɟɞɧɟɜɧɨ. Ɂɚ ɜɪɟɦɹ ɩɪɨɜɟɞɟɧɢɹ ɉɇȽ ɜ ɷɬɨɣ ɝɪɭɩɩɟ ɛɵɥɨ
ɡɚɮɢɤɫɢɪɨɜɚɧɨ 111 ɩɪɢɩɚɞɤɨɜ. ȼ ɬɟɱɟɧɢɟ 1-ɝɨ ɦɟɫɹɰɚ ɩɨɫɥɟ
ɨɤɨɧɱɚɧɢɹ ɬɪɟɧɢɪɨɜɨɤ ɨɛɳɟɟ ɤɨɥɢɱɟɫɬɜɨ ɩɪɢɫɬɭɩɨɜ
ɫɨɯɪɚɧɹɥɨɫɶ ɧɚ ɭɪɨɜɧɟ
115. ɇɚ 2-ɦ ɦɟɫɹɰɟ ɢɯ ɱɚɫɬɨɬɚ ɡɧɚɱɢɬɟɥɶɧɨ ɫɧɢɡɢɥɚɫɶ, ɧɚ 3-ɦ
ɩɪɢɫɬɭɩɵ ɜɧɨɜɶ ɧɚɱɚɥɢ ɭɱɚɳɚɬɶɫɹ. ȼ ɷɬɨɣ ɝɪɭɩɩɟ ɨɛɳɟɟ
ɱɢɫɥɨ ɩɪɢɫɬɭɩɨɜ ɡɚ ɦɟɫɹɰ ɫɨɤɪɚɬɢɥɨɫɶ ɩɪɢɦɟɪɧɨ ɧɚ 1/3, ɧɨ
ɩɨ-ɩɪɟɠɧɟɦɭ ɨɫɬɚɜɚɥɨɫɶ ɡɧɚɱɢɬɟɥɶɧɵɦ.
ɍ ɨɞɧɨɝɨ ɛɨɥɶɧɨɝɨ ɫ ɩɨɜɬɨɪɹɟɦɨɫɬɶɸ ɩɪɢɫɬɭɩɨɜ ɞɨ 3 ɜ
ɧɟɞɟɥɸ ɢɯ ɱɚɫɬɨɬɚ ɩɨɫɥɟ ɤɭɪɫɚ ɝɢɩɨɤɫɢɬɟɪɚɩɢɢ ɧɟ
ɢɡɦɟɧɢɥɚɫɶ, ɨɞɧɚɤɨ ɨɧɢ ɫɬɚɥɢ ɦɟɧɟɟ ɩɪɨɞɨɥɠɢɬɟɥɶɧɵɦɢ ɢ
ɩɪɨɬɟɤɚɥɢ ɜ ɛɨɥɟɟ ɥɟɝɤɨɣ ɮɨɪɦɟ (ɫɭɞɨɪɨɠɧɵɟ ɪɟɚɤɰɢɢ ɧɟ
ɧɨɫɢɥɢ ɜɵɪɚɠɟɧɧɨɝɨ ɯɚɪɚɤɬɟɪɚ, ɧɟ ɧɚɛɥɸɞɚɥɨɫɶ ɩɪɢɤɭɫɚ
ɹɡɵɤɚ). Ⱦɪɭɝɢɟ ɛɨɥɶɧɵɟ ɬɚɤɠɟ ɨɛɪɚɳɚɥɢ ɜɧɢɦɚɧɢɟ ɧɚ ɛɨɥɟɟ
ɤɨɪɨɬɤɢɟ ɩɪɢɩɚɞɤɢ, ɢ ɜ ɪɹɞɟ ɫɥɭɱɚɟɜ ɩɚɪɰɢɚɥɶɧɵɣ ɩɪɢɫɬɭɩ
ɧɟ ɩɟɪɟɪɚɫɬɚɥ ɜ ɝɟɧɟɪɚɥɢɡɨɜɚɧɧɵɣ ɬɨɧɢɤɨ-ɤɥɨɧɢɱɟɫɤɢɣ.
Ȼɨɥɟɟ ɹɜɧɨɣ ɫɬɚɥɚ ɚɭɪɚ, ɢ ɛɨɥɶɲɟɟ ɱɢɫɥɨ ɛɨɥɶɧɵɯ (6) ɩɨɫɥɟ
ɤɭɪɫɚ ɉɇȽ ɭɫɩɟɜɚɥɢ ɩɪɢɧɹɬɶ ɭɩɪɟɠɞɚɸɳɢɟ ɦɟɪɵ ɩɟɪɟɞ
ɩɪɢɫɬɭɩɨɦ. ȼ ɩɨɹɜɥɟɧɢɢ ɩɪɢɩɚɞɤɨɜ ɩɨɫɥɟ ɥɟɱɟɧɢɹ ɫɬɚɥɚ
ɨɩɪɟɞɟɥɹɬɶɫɹ ɧɟɤɨɬɨɪɚɹ ɡɚɤɨɧɨɦɟɪɧɨɫɬɶ: ɨɧɢ ɧɟ ɜɨɡɧɢɤɚɥɢ
ɛɟɫɩɨɪɹɞɨɱɧɨ, ɚ ɪɚɡɜɢɜɚɥɢɫɶ ɛɨɥɟɟ ɤɨɦɩɚɤɬɧɨ (9 ɛɨɥɶɧɵɯ), ɜ
ɛɨɥɶɲɟɦ ɱɢɫɥɟ ɫɥɭɱɚɟɜ ɜɵɹɜɥɹɥɚɫɶ ɩɪɢɭɪɨɱɟɧɧɨɫɬɶ ɤ
ɨɩɪɟɞɟɥɟɧɧɨɦɭ ɜɪɟɦɟɧɢ ɫɭɬɨɤ (12 ɛɨɥɶɧɵɯ). ɂɧɵɦɢ
ɫɥɨɜɚɦɢ, ɜ ɬɟɱɟɧɢɢ ɩɚɪɨɤɫɢɡɦɨɜ ɩɨɹɜɢɥɚɫɶ ɨɩɪɟɞɟɥɟɧɧɚɹ
ɭɩɨɪɹɞɨɱɟɧɧɨɫɬɶ.
ɍ ɜɫɟɯ ɛɨɥɶɧɵɯ, ɩɪɨɲɟɞɲɢɯ ɤɭɪɫ ɉɇȽ, ɜɵɹɜɥɹɥɚɫɶ
ɧɨɪɦɚɥɢɡɚɰɢɹ
ɩɨɜɟɞɟɧɱɟɫɤɢɯ
ɪɟɚɤɰɢɣ.
ɉɚɰɢɟɧɬɵ
ɫɬɚɧɨɜɢɥɢɫɶ ɛɨɥɟɟ ɭɪɚɜɧɨɜɟɲɟɧɧɵɦɢ, ɦɟɧɟɟ ɤɨɧɮɥɢɤɬɧɵɦɢ
ɢ ɚɝɪɟɫɫɢɜɧɵɦɢ, ɜ ɪɹɞɟ ɫɥɭɱɚɟɜ ɧɚɥɚɠɢɜɚɥɢɫɶ ɨɬɧɨɲɟɧɢɹ ɜ
ɫɟɦɶɟ. ɇɨɪɦɚɥɢɡɨɜɚɥɫɹ ɫɨɧ, ɩɨɜɵɲɚɥɚɫɶ ɪɚɛɨɬɨɫɩɨɫɨɛɧɨɫɬɶ,
ɛɨɥɶɧɵɟ ɨɛɪɚɳɚɥɢ ɜɧɢɦɚɧɢɟ ɧɚ ɬɨ, ɱɬɨ ɭ ɧɢɯ ɩɨɹɜɢɥɢɫɶ
ɧɨɜɵɟ ɢɧɬɟɪɟɫɵ.
ɋɥɟɞɭɟɬ ɨɫɨɛɨ ɨɬɦɟɬɢɬɶ, ɱɬɨ ɧɢ ɨɞɢɧ ɢɡ ɛɨɥɶɧɵɯ ɧɟ
ɩɨɠɚɥɨɜɚɥɫɹ ɧɚ ɭɯɭɞɲɟɧɢɟ ɫɨɫɬɨɹɧɢɹ ɜ ɩɪɨɰɟɫɫɟ ɡɚɧɹɬɢɣ
ɢɥɢ ɧɚ ɩɪɨɬɹɠɟɧɢɢ ɩɨɫɥɟɞɭɸɳɢɯ 6 ɦɟɫ.
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɩɨɥɭɱɟɧɧɵɟ ɜ ɧɚɲɢɯ ɢɫɫɥɟɞɨɜɚɧɢɹɯ
ɞɚɧɧɵɟ ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɬ ɨ ɜɚɠɧɨɫɬɢ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɜ
ɤɨɦɩɥɟɤɫɧɨɦ ɥɟɱɟɧɢɢ ɛɨɥɶɧɵɯ ɷɩɢɥɟɩɫɢɟɣ ɫɪɟɞɫɬɜ,
ɨɩɬɢɦɢɡɢɪɭɸɳɢɯ ɮɭɧɤɰɢɨɧɚɥɶɧɨɟ ɫɨɫɬɨɹɧɢɟ ɨɪɝɚɧɢɡɦɚ.
Ɉɞɧɢɦ ɢɡ ɧɢɯ ɦɨɠɟɬ ɹɜɥɹɬɶɫɹ ɉɇȽ, ɷɮɮɟɤɬɵ ɤɨɬɨɪɨɣ
ɩɨɞɬɜɟɪɠɞɚɸɬɫɹ
ɩɨɜɵɲɟɧɢɟɦ
ɪɟɡɭɥɶɬɚɬɢɜɧɨɫɬɢ
ɩɪɨɬɢɜɨɷɩɢɥɟɩɬɢɱɟɫɤɢɯ ɩɪɟɩɚɪɚɬɨɜ ɩɪɢ ɨɞɧɨɜɪɟɦɟɧɧɨɦ
ɩɨɧɢɠɟɧɢɢ ɢɯ ɤɨɧɰɟɧɬɪɚɰɢɢ ɜ ɤɪɨɜɢ ɛɨɥɶɧɵɯ.
ɅɂɌȿɊȺɌɍɊȺ
1. Ⱥɝɚɞɠɚɧɹɧ ɇ.Ⱥ., ȿɥɮɢɦɨɜ Ⱥ. ɂ. Ɏɭɧɤɰɢɢ ɨɪɝɚɧɢɡɦɚ ɜ ɭɫɥɨɜɢɹɯ
ɝɢɩɨɤɫɢɢ ɢ ɝɢɩɟɪɤɚɩɧɢɢ. Ɇ: Ɇɟɞɢɰɢɧɚ, 1986.
2. Ⱥɝɚɞɠɚɧɹɧ ɇ.Ⱥ., Ɍɨɪɲɢɧ ȼ.ɂ. ȼɥɢɹɧɢɟ ɚɞɚɩɬɚɰɢɢ ɤ ɝɢɩɨɤɫɢɢ ɧɚ
ɪɟɡɢɫɬɟɧɬɧɨɫɬɶ ɤɪɵɫ ɤ ɷɩɢɥɟɩɬɨɝɟɧɧɨɦɭ ɞɟɣɫɬɜɢɸ ɩɟɧɢɰɢɥɥɢɧɚ. Ȼɸɥ ɷɤɫɩɟɪ ɛɢɨɥ 1986;12: 683—685.
3. Ȼɚɪɛɚɲɨɜɚ Ɂ.ɂ. Ⱥɤɤɥɢɦɚɬɢɡɚɰɢɹ ɤ ɝɢɩɨɤɫɢɢ ɢ ɟɟ ɮɢɡɢɨɥɨɝɢɱɟɫɤɢɟ ɦɟɯɚɧɢɡɦɵ. Ɇ—Ʌ: ɂɡɞɚɧɢɟ Ⱥɇ ɋɋɋɊ 1960.
4. Ȼɟɪɟɡɨɜɫɤɢɣ ȼ.Ⱥ., ɇɚɡɚɪɟɧɤɨ Ⱥ.ɂ. ɇɚɩɪɹɠɟɧɢɟ ɤɢɫɥɨɪɨɞɚ ɢ ɬɟɦɩɟɪɚɬɭɪɚ ɤɨɪɵ ɝɨɥɨɜɧɨɝɨ ɦɨɡɝɚ ɫɨɛɚɤɢ ɩɪɢ ɷɤɫɩɟɪɢɦɟɧɬɚɥɶɧɵɯ
ɫɭɞɨɪɨɠɧɵɯ ɩɪɢɩɚɞɤɚɯ. ɉɚɬ ɮɢɡɢɨɥ 1965; 9: 38—43.
5. Ȼɟɪɟɡɨɜɫɤɢɣ ȼ.Ⱥ. Ƚɢɩɨɤɫɢɹ ɢ ɢɧɞɢɜɢɞɭɚɥɶɧɵɟ ɨɫɨɛɟɧɧɨɫɬɢ
ɪɟɚɤɬɢɜɧɨɫɬɢ. Ʉɢɟɜ: ɇɚɭɤɨɜɚ ɞɭɦɤɚ 1978.
6. Ⱦɨɥɢɧɚ ɋ.Ⱥ. Ʉ ɮɢɡɢɨɥɨɝɢɱɟɫɤɨɦɭ ɚɧɚɥɢɡɭ ɫɨɫɬɨɹɧɢɹ ɫɭɞɨɪɨɠɧɨɣ ɝɨɬɨɜɧɨɫɬɢ: Ⱥɜɬɨɪɟɮ. ɞɢɫ. ... ɤɚɧɞ. ɦɟɞ. ɧɚɭɤ. Ɇ 1963.
7. Ʉɨɲɟɥɟɜ ȼ.Ȼ., Ʉɪɭɲɢɧɫɤɢɣ Ⱥ.Ʌ., Ɋɹɫɢɧɚ Ɍ.ȼ. ȼɥɢɹɧɢɟ ɤɪɚɬɤɨɜɪɟɦɟɧɧɨɣ ɚɞɚɩɬɚɰɢɢ ɤ ɝɢɩɨɤɫɢɢ ɧɚ ɪɚɡɜɢɬɢɟ ɨɫɬɪɵɯ ɧɚɪɭɲɟɧɢɣ
ɦɨɡɝɨɜɨɝɨ ɤɪɨɜɨɨɛɪɚɳɟɧɢɹ ɭ ɤɪɵɫ, ɝɟɧɟɬɢɱɟɫɤɢ ɩɪɟɞɪɚɫɩɨɥɨɠɟɧɧɵɯ ɤ ɷɩɢɥɟɩɫɢɢ. Ȼɸɥ ɷɤɫɩɟɪ ɛɢɨɥ 1987;103: 3: 363—376.
48
8. Ɇɟɟɪɫɨɧ Ɏ.Ɂ. Ɉɛɳɢɣ ɦɟɯɚɧɢɡɦ ɚɞɚɩɬɚɰɢɢ ɢ ɩɪɨɮɢɥɚɤɬɢɤɢ. Ɇ:
Ɇɟɞɢɰɢɧɚ 1973.
9. ɉɟɧɮɢɥɞ ɍ., Ⱦɠɚɫɩɟɪ Ƚ. ɗɩɢɥɟɩɫɢɹ ɢ ɮɭɧɤɰɢɨɧɚɥɶɧɚɹ ɚɧɚɬɨɦɢɹ
ɝɨɥɨɜɧɨɝɨ ɦɨɡɝɚ. Ɇ: Ɇɟɞɢɰɢɧɚ 1958.
10. ɉɨɝɨɞɚɟɜ Ʉ.ɂ. ɗɩɢɥɟɩɬɨɥɨɝɢɹ ɢ ɩɚɬɨɯɢɦɢɹ ɦɨɡɝɚ (ɤ ɬɟɨɪɢɢ
ɷɬɢɨɥɨɝɢɢ, ɩɚɬɨɝɟɧɟɡɚ ɢ ɥɟɱɟɧɢɹ ɷɩɢɥɟɩɫɢɢ). Ɇ: Ɇɟɞɢɰɢɧɚ
1986.
11. ɋɟɥɶɟ Ƚ. Ɉɱɟɪɤɢ ɨɛ ɚɞɚɩɬɚɰɢɨɧɧɨɦ ɫɢɧɞɪɨɦɟ. Ɇ: Ɇɟɞɝɢɡ 1960.
12. ɋɬɪɟɥɤɨɜ Ɋ.Ȼ., Ȼɟɥɵɯ Ⱥ.Ƚ., Ʉɚɪɚɲ ɘ.Ɇ. ɢ ɞɪ. ȼɟɫɬɧ ȺɆɇ ɋɋɋɊ
1988; 5: 77-80.
13. Baumel I., Schatz R., De Feo J.J., Lal H. Hypoxia and methionine
sulphosimine seizures in mice. J Pharm Pharmacol 1969, 21: 10:703-704.
14. Loewy A. Physiologie des Hohenklimas. Berlin 1932.
15. West J.B. High living: lesson from extreme altitude the 1984. Am Rev
Resp Dis 1984; 130: 5: 917-923.
ɉɨɫɬɭɩɢɥɚ 26.01.01
ɀɍɊɇȺɅ ɇȿȼɊɈɅɈȽɂɂ ɂ ɉɋɂɏɂȺɌɊɂɂ, 1, 2002
Download