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Комплексне лікування перитоніту та профілактика його ускладнень (експериментально-клінічне дослідження): Автореф. дис… д-ра мед. наук / О.О. Біляєва

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22

I?I?NOA?NOAI IOI?IIE CAeI?IA’ss OE?A?IE

EE?ANUeEA IAAeE*IA AEAAeAI?ss

I?NEssAeEIEIIII? INA?OE ?i. I.E.OOIEEA

A?Ess?AA Ieueaa Ieaenaiae??aia

OAeE 616.381-002-089-084

EIIIEAENIA E?EOAAIIss IA?EOII?OO OA I?IO?EAEOEEA

EIAI ONEEAAeIAIUe

(aenia?eiaioaeueii-ee?i?/ia aeine?aeaeaiiy)

14.01.03 – o??o?a?y

AAOI?AOA?AO

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

aeieoi?a iaaee/ieo iaoe

Ee?a – 1999

Aeena?oaoe??th ? ?oeiien

?iaioa aeeiiaia o Ee?anuee?e iaaee/i?e aeaaeai?? i?neyaeeieiiii? ina?oe

?i. I.E.Ooieea IIC Oe?a?ie

IAOEIAEE EIINOEUeOAIO

aeieoi? iaaee/ieo iaoe, i?ioani? ?aaec?oianueeee Aiaoie?e Iaaeiae/,

Eao?aao Aea?aeaaii? i?ai?? Oe?a?ie, Caneoaeaiee ae?y/ iaoee ? oaoi?ee
Oe?a?ie,

caa?aeoaa/ eaoaae?e o??o?a?? oa ii?eiai? oai?iae Ee?anueei? iaaee/ii?
aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea IIC Oe?a?ie

IO?Oe?EI? IIIIAIOE:

aeieoi? iaaee/ieo iaoe, i?ioani? Oiiaooe ?aai I?ieiiiae/,

aieiaiee o??o?a E?eoaaeueii-icaei?ia/iai ia’?aeiaiiy i?e Eaa?iao?
i?i?no??a Oe?a?ie

aeieoi? iaaee/ieo iaoe, i?ioani? Caoa?ao Ieoaeei Iao?iae/,

ia/aeueiee a?enueeiai-iaaee/iiai oi?aae?iiy Neoaeae aaciaee Oe?a?ie

aeieoi? iaaee/ieo iaoe, i?ioani? Iioithe TH??e Ieeieaeiae/,

i?ioani? eaoaae?e oaeoeueoaonueei? o??o?a?? ?1 Iaoe?iiaeueiiai
iaaee/iiai oi?aa?neoaoo ?i. I. Aiaiiieueoey IIC Oe?a?ie

I?IA?AeIA ONOAIIAA:

?inoeooo ee?i?/ii? oa aenia?eiaioaeueii? o??o?a?? AII Oe?a?ie, a?aeae?e
o??o?a?? oeoieiai-eeoeiaiai o?aeoo

Caoeno a?aeaoaeaoueny “_8_”_10__ 1999 ?. ia __11____ aiaeei?

ia can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee Ae 26.613.02 i?e Ee?anuee?e
iaaee/i?e aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea IIC Oe?a?ie
(254112, i.Ee?a, aoe. Aei?iaiaeeoeueea, 9)

C aeena?oaoe??th iiaeia iciaeiieoeny o a?ae?ioaoe? Ee?anueei? iaaee/ii?
aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea (254112, i.Ee?a, aoe
Aei?iaiaeeoeueea, 9)

Aaoi?aoa?ao ?ic?neaiee “_15__”___08___1999 ?ieo

A/aiee nae?aoa?

niaoe?ae?ciaaii? a/aii? ?aaee

e.i.i., aeioeaio Aaicaeye I.I.

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. I?iaeaia ia?eoii?oo aoea ? caeeoa?oueny
iaeaeooaeuei?oith a aaaeii?iaeuei?e o??o?a??. I.I. Aaeoe?a iacaaa
ia?eoii?o i?eiee ia noa??th/ith i?iaeaiith. Iaoeiai-oaoi?/iee i?ia?an,
aeinyaiaiiy o??o?a?a, ?aai?iaoieia?a, ?ioiieia?a ia ae??oeee ??, ? ie
i?iaeiaaeo?ii ao?a/aoe oai?eo.

Coneeeyie aaaaoueio a/aieo ca inoaii? aeanyoe??//y ?ic?iaeai? aaaeeea?
aniaeoe iaoiaaiaco ia?eoii?oo, ui aeicaieeei noai?eoe oa ai?iaaaeeoe o
i?aeoeeo ioi?iie caei?ia”y ?yae iiaeo iaoiae?a ae?aaiinoeee oa e?eoaaiiy
oeueiai a??ciiai caoai?thaaiiy (A.A. Oaeeiia e niaao., 1981; A.ss.
Aaeue, 1987; A.E. Ainoeuaa e niaao., 1992; A.E. Iai/e/ e niaao., 1992;
E.I. Oiiaooe, 1994; TH.A. Aaeoaeoen e niaao., 1996; A.N. E.E.Ieothe e
niaao., 1996 Iieeieaae/ e niaao., 1996; A.O. Naaiei e niaao., 1996; K.
Singh, R.S. Chhina, 1993; D. Sleeman et al., 1995).

Eaoaeuei?noue i?e aeaiiio caoai?thaaii? eieeaa?oueny a?ae 13,5% aei
52,8% (A.ss. Aaeue, 1987; A.A. Caeoeaa e niaao., 1996; I.I. Iaaeianueeee
? ni?aaao., 1996; A.I. ?aaeceoianeee e niaao., 1996; A.A. Oaeeiia e
niaao., 1996; A.A. Nathens et al.,1995; G.Hubens et al., 1995).

Inoaii?i /anii a?aei?/a?oueny oaiaeaioe?y aei i?aeaeuaiiy /anoioe
ai?eii-naioe/ieo oneeaaeiaiue (A.O. Caeoeaa ? ni?aaao., 1998; A.?.
Ai?aaiei ? ni?aaao.,1998 ; A.Ae. Aeioeaiei ? ni?aaao., 1998; E.Ae.
Eaaaaeaa e niaao., 1998), ? oe? oneeaaeiaiiy a i?neyiia?aoe?eiiio
ia??iae? noaaeyoue i?ae caa?ico aeeooy oai?iai (E.E. Nooa?aa e niaao.,
1998).

Aeooaeuei?noue i?iaeaie aecia/a?oueny oaeeie oaeoi?aie:

1. Oe?ieith iioe?ai?noth ia?eoii?oo, iniaeeai i?e oaeeo caoai?thaaiiyo
ye aiaiaeeoeeo, oieaoeenoeo, ae?aceiaa oai?iaa oeoiea oa
aeaaiaaeoeyoeiaei? eeoee, iaie?aaoeo, o?aaie /a?aaii? ii?iaeieie oa
?i.

2. Aenieith eaoaeuei?noth na?aae oai?eo ia ?iciianthaeaeaiee ia?eoii?o.
Iacaaaeath/e ia canoinoaaiiy aioea?ioee?a oe?ieiai niaeo?a ae?? iiaiai
iieie?iiy, ??cieo iaoiae?a aeno?aei?ii?aeueii? aeaoieneeaoe?? i?aai?cio,
a?ia?aa?e/ii? ieneaaiaoe??, eaia?inoii??, canoinoaaiiy ?ioiiiiaeoeyoi??a
? o.ae., cia/ii? oaiaeaioe??? cieaeaiiy eaoaeueiino? ia
niinoa??aa?oueny.

3. Neeaaei?noth oa /eneaii?noth ii?ooaiue aiiainoaco i?e ia?eoii?o?,
ye? i?eaiaeyoue aei o?eaaeeo, a /anii iaiai?ioieo ci?i a i?aai?ci?, ?
iaaeinoaoiuei aea/aieie iaoiaaiaoe/ieie iaoai?ciaie, ye? aecia/athoue
oea neeaaeia caoai?thaaiiy.

O a?o/eciyi?e oa ca?oa?aei?e e?oa?aoo?? aeineoue oe?iei aena?oeai?
ieoaiiy e?eoaaiiy ia?eoii?oo. I?ioa iaaeinoaoiuei aena?oeai?
oneeaaeiaiiy ia?eoii?oo oa ?o i?io?eaeoeea, ieoaiiy “eaaaaeo”
eeoa/ieeo, aioa?ini?aoe??, a?aeiiaeaiiy ii?ooaii? i?e?ioei?e eeoa/ieeo.
O aeinooii?e e?oa?aoo?? ie ia cono??ee aeaieo i?i canoinoaaiiy
aioo??oiueiai ae?aioaaiiy /a?aaii? ii?iaeieie, yea aaco?oueny ia caeii?
iniino, o eiiieaeniiio e?eoaaii? ia?eoii?oo. ? aaaaoi ni??ieo ieoaiue,
ye? noinothoueny ae?aioaaiiy /a?aaii? ii?iaeieie.

Ca inoaii? aeanyoe??//y ii/aee a?eueo oe?iei canoiniaoaaoe eaia?inoii?th
i?e ?iciianthaeaeaieo ia?eoii?oao, i?ioa o oeueiio ieoaii? ? aaaaoi
ni??iiai ? iio?aao? iiaeaeueoiai aea/aiiy oa ooi/iaiiy iieacaiue aei
eaia?inoii??, ?? o?eaaeino?, canoinoaaiiy ni?aoe?eieo i?aia?ao?a oa ?o
aoaeoeaiino?. Ia aena?oeai? ieoaiiy ?aaa?e?oaoe?? oai?eo, ye? ia?aianee
?iciianthaeaeaiee ia?eoii?o.

Aaaaoi i?e?ii?aai?ci?a iaaoee no?eeino? aei ??cieo aioea?ioee?a,
ci?ieeeny a?ieia?/i? iniaeeaino? aii?oai?ii? i?e?ioei?e, o ca”yceo c /ei
?ioaeoe?y a o??o?a?? ciiao noaea aaaeeith oa neeaaeiith i?iaeaiith. O
ca”yceo c ?icaeoeii no?eeino? i?e?ii?aai?ci?a aei aioea?ioee?a cieceeany
aoaeoeai?noue aioea?ioeeioa?ai?? (A.O. Naaiei e niaao.,1996), a
aeenaaeoa??ic oa ?ioiinoi?an?y, ye? ni?e/eiythoueny a ?acoeueoao?
canoinoaaiiy aioea?ioee?a, noaaeyoue ia?aae e?ea?ai iiao i?iaeaio uiaei
iiooe?a i?aia?ao?a, ye? ei?aaothoue oe? ii?ooaiiy (A.I. Ciaiainueeee,
1997).

Ca”ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Aeena?oaoe?th
aeeiiaii a?aeiia?aeii aei ieaio iaoeiai-aeine?aeii? ?iaioe Ee?anueei?
iaaee/ii? aeaaeai?? i?neyaeeieiiii? ina?oe (EIAII) ?i. I.E. Ooieea ye
naiino?eia oaia

(? aea?aeaaii? ?a?no?aoe?? 0197E003049), a oaeiae aiia aeeth/aia a
aea?aeaaio oaio EIAII ?i. I.E.Ooieea “Aea/aiiy ee?oeiieo oa iieaeoey?ieo
iaoai?ci?a ?icaeoeo aoi?eiieo ?ioiiaeao?oeeo?a a aenia?eiaio? ? ee?i?oe?
oa ?o ?ieue a iaoiaaiac? caoai?thaaiue. ?ic?iaea iaoiaaiaoe/iiai
iaa?oioiaaiiy ei?aeoe?? aoi?eiieo ?ioiiaeao?oeeo?a c aeei?enoaiiyi iiaeo
?ioiiei?aaoth/eo i?aia?ao?a iaioeaeii? i?e?iaee (? aea?aeaaii?
?a?no?aoe?? 0196E010160).

Iaoa ? caaea/? aeine?aeaeaiiy. I?aeaeueoe aoaeoeai?noue e?eoaaiiy oai?eo
ia ia?eoii?o, cieceoe e?euee?noue oneeaaeiaiue oa i?neyiia?aoe?eio
eaoaeuei?noue.

Aeey aeinyaiaiiy oe??? iaoe aoee iinoaaeai? oae? caaaeaiiy:

1. Aea/eoe oa i?iaanoe aiae?c aeina?aeo e?eoaaiiy oai?eo ia ia?eoii?o a
ia??iae c 1986 ii 1997 ?.?., i?iaanoe aiae?c eaoaeueiino?, iiieeie ?
oneeaaeiaiue ia?eoii?oo c ianooiiith ?ic?iaeith eeaneo?eaoe?? ia?eoii?oo
oa eiai oneeaaeiaiue.

2. Aea/eoe a aenia?eiaio? ?ieue ianiaoeeo?/ieo iaoai?ci?a aia?aiiai?io
e?ioi?aeii? oeaieie o oi?ioaaii? aoi?eiiiai ?ioiiaeao?oeeoo oeyoii
aaaaeaiiy aioeoeeoio?iiieneaeacii? ne?iaaoee oaa?eiai.

3. A aenia?eiaio? ? ee?i?oe? aea/eoe aoaeoeai?noue ae?? ia ?aiiaee
i?ioean e?ea?nueei? eiiiiceoe?? , yea neeaaea?oueny c iie?iaoeeneeienaio
(IIN), aeeiaeneaeo oa i?oacieo.

4. Aeey aaeaeaaoiiai aeai?o iaoiaeo e?eoaaiiy aea/eoe iaoiaaiac
aiaeioieneei-co ?c canoinoaaiiyi no/anieo a?io?i?/ieo iaoiae?a
aeine?aeaeaiiy i?iaeoeo?a ia?aeeniiai ieeneaiiy e?i?ae?a (IIE),
aia?aaoe/iiai iai?io, ??aiy iieaeoe na?aaeiuei? iane (INI).

5. Aea/eoe ao?ieia?/io no?oeoo?o caoaeiee?a ia?eoii?oo a aeeiai?oe? oa
i?e/eie ?icaeoeo i?neyiia?aoe?eieo ai?eieo oneeaaeiaiue, a oaeiae
aea/eoe i?e?ioei?o eeoa/ieeo oa ?? ii?ooaiiy ? ?ic?iaeoe noaio ei?aeoe??
oeeo ii?ooaiue oeyoii canoinoaaiiy a?ini?aoe?eieo i?aia?ao?a.

6. Iaa?oiooaaoe ? aeaoe ioe?ieo i?ea?iaeueiiai niiniao e?eoaaiiy
ia?eoii?oo, yeee a?oioo?oueny ia o?ceei-o?i?/iiio yaeu? iniino, oeyoii
canoinoaaiiy a?iioii?/iiai aioenaioe/iiai ?ic/eio.

7. Iaa?oiooaaoe aeioe?euei?noue ? aoaeoeai?noue canoinoaaiiy
aioa?ini?aoe??, eaca?ii? oa?ai??, iaioeae?a oeiona o eiiieaeniiio
e?eoaaii? ia?eoii?oo ia iniia? aea/aiiy aeeiai?ee a?io?i?/ieo oa
?ioiieia?/ieo iieaciee?a.

8. Aea/eoe /anoioo iaaii?iiy i?neyiia?aoe?eii? ?aie o oai?eo ia
ia?eoii?o oa ae?iaeoe iaoiaaiaoe/ii iaa?oioiaaiee iaoiae i?io?eaeoeee
aeieeiaiiy ii?ooaiiy caaithaaiiy iia?aoe?eii? ?aie.

9. Oaeineiiaeeoe iaoiaeeeo iia?aoeaiiai ao?o/aiiy i?e ?iceeoiio oa
caaaeueiiio ia?eoii?o?, ?io?aiia?aoe?eiiai “eaaaaeo” /a?aaii? ii?iaeieie
? eeoa/ieeo i?e eiai ?iooaaoe?? ? aeiaanoe iaiao?aei?noue i?iaaaeaiiy
?aiiuei? /a?acciiaeiai? aioa?ini?aoe?? aioa?inaaeai.

10. ?ic?iaeoe iaoiaeeeo “eaia?inoii??” ? ianooiieo i?ia?aiiaaieo
?aeaia?ioii?e, a oaeiae – iaoiae e?eoaaiiy aioo??oiuei/a?aaieo
aanoean?a ?c canoinoaaiiyi iiaeo ni?aoe?eieo i?aia?ao?a, ye?
aieiae?thoue i?ieiiaiaaiith aioei?e?iaiith ae??th.

Iaoeiaa iiaecia io?eiaieo ?acoeueoao?a. I?aeoaa?aeaeaii ia iniia?
/eneaiieo i?e?ia?ieia?/ieo aeine?aeaeaiue, ui ia?eoii?o ? iie?i?e?iaiei
caoai?thaaiiyi. Iniiaio ao?ieia?/io ?ieue i?e ia?eoii?o? a?ae?a?athoue
eeoeiaa iaee/ea oa iaeeino?eae?aeuei? aiaa?iai? caoaeieee.

Ia iniia? a?io?i?/ieo aeine?aeaeaiue ne?iaaoee e?ia? oai?eo
i?aeoaa?aeaeaii, ui aino?ee ?iciianthaeaeaiee ia?eoii?o ca nai?th
iaoiaaiaoe/iith noooth ? oaciei i?ioeanii ? noi?iaiaeaeo?oueny
a?iiene/ieie ii?ooaiiyie o oeaieiao. A e?ia? cieaeo?oueny ??aaiue AOO oa
AAeO, i?aeaeuo?oueny ai?no iiei/ii? eeneioe ? aeoeai?noue
aioeieneaeaioiiai oa?iaioo eaoaeace. A e?ia? iaeiie/othoueny i?iaeoeoe
ia?aeeniiai ieeneaiiy e?i?ae?a, iie?iaioeaee c na?aaeiueith
iieaeoey?iith ianith, ? ?o ??aaiue caeaaeeoue a?ae nooiaiy
aiaeioieneeico.

Aia?oa a oiiaao aenia?eiaioo i?iaaaeaii iiaeaethaaiiy aoi?eiiiai
?ioiiaeao?oeeoo oeyoii aaaaeaiiy uo?ai aioeoeeoio?iiieneaeacii?
ne?iaaoee (AOeOIN). Aeiaaaeaii, ui oi?ioaaiiy aoi?eiiiai ?ioiiaeao?oeeoo
iia”ycaia c ianiaoeeo?/ieie iaoai?ciaie aia?aiiai?io e?ioi?aeii?
oeaieie. Iiia?aaei? aaaaeaiiy i?aeaeine?aeiei oaa?eiai oeeoio?iio N
aeeeeea? oaiaeaioe?th aei a?aeiiaeaiiy i?ioean?a aia?aicaaacia/aiiy a
ee?oeiao e?ioi?aeieo i?aai?a. I?aeoaa?aeaeaii, ui o oai?eo ia?eoii?oii
?icaeaa?oueny aoi?eiiee ?ioiiaeao?oeeo, iniaeeai a oiene/i?e oa
oa?i?iaeuei?e noaae?yo.

Aia?oa aea/aii aeanoeaino? oa aoaeoeai?noue noai?aiiai iiaiai
aioei?e?iaiiai i?aia?aoo “?iinaeei?o” oe?ieiai niaeo?a ae?? c
i?ieiiaiaaiei aioei?e?iaiei aoaeoii. (??oaiiy i?i aeaea/o iaoaio?a ia
aeiaoiaee Oe?a?ie

? 98105639 a?ae 10.02.99; ? 98105640 a?ae 10.02.99).

Aia?oa ?ic?iaeaii ? ai?iaaaeaeaii o i?aeoeeo iiaee iaoiae i?io?eaeoeee
oa e?eoaaiiy i?neyiia?aoe?eieo ai?eieo oneeaaeiaiue o oai?eo ia
ia?eoii?o, yeee a?oioo?oueny ia i?noeaaiio canoinoaaii? iiaeo
?iiia?e?ciaaieo aioei?e?iaieo i?aia?ao?a oe?ieiai niaeo?a ae??, ye?
caaacia/othoue oi?ioee i?ioei?e?iaiee aoaeo ye ii a?aeiioaiith aei
aa?ia?a, oae ? aei iaeeino?eae?aeueieo caoaeiee?a. (??oaiiy i?i aeaea/o
iaoaioo ia aeiao?ae Oe?a?ie ? 98084207 a?ae 24.12.98).

Aia?oa aeae?eaia a?oia oai?eo ia ia?eoii?o i?aeaeuaiiai ?eceeo
aeieeiaiiy iaaii?iiy i?neyiia?aoe?eii? ?aie.

Aia?oa cai?iiiiiaaii niin?a e?eoaaiiy aioo??oiuei/a?aaieo aanoean?a ?c
canoinoaaiiyi aie?eaoe?eieo ni?aaio?a. (??oaiiy i?i aeaea/o iaoaioo ia
aeiao?ae Oe?a?ie ?98105642 a?ae 27.10.98).

I?aeoaa?aeaeaia ia aaeeeiio ee?i?/iiio iaoa??ae? aeniea ni?aoe?eia
aeaoieneeaoe?eia aoaeoeai?noue aioa?inaaeth i?e canoinoaaii? eiai aeey
aioa?ini?aoe??.

Aia?oa iaoiaaiaoe/ii aeiaaaeaia ? iaa?oioiaaia aoaeoeai?noue “eaaaaeo”
eeoa/ieeo c ianooiiith aioa?ini?aoe??th aeey i?io?eaeoeee
ia/?ieiai-ie?eiai? iaaeinoaoiino? o oai?eo ia ia?eoii?o.(?aoei?iiiceoe?y
EIAII ?2489 a?ae 19.01.89).

Aia?oa ?ic?iaeaii ? ai?iaaaeaeaii o i?aeoeeo iiaee niin?a e?eoaaiiy
ia?eoii?oo, yeee a?oioo?oueny ia o?ceei-o?i?/ieo aeanoeainoyo
a?iioii?/iiai aioenaioe/iiai ?ic/eio (Aaoi?nueea na?aeioeoai N?N?
?1732992 a?ae 15.01.92).

Aia?oa ia iniia? cai?iiiiiaaiiai iaoiaeo ae?aaiinoeee niaeie oa
caeaoiino? i?aai?cio aei niaeeiooai?aiiy ?ic?iaeaii eiiieaen
i?aaaioeaieo caoiae?a i?io?eaeoeee ?aiiuei? niaeeiai? iai?io?aeiino?
eeoa/ieea (Aaoi?nueea na?aeioeoai N?N? ?1816433 a?ae 11.10.92).

Noi?ioeueiaaii oa iaa?oioiaaii i?eioeei aeeoa?aioe?eiaaiiai i?aeoiaeo
aei eiiieaeniiai e?eoaaiiy ia?eoii?oo a caeaaeiino? a?ae eiai noaae??, a
oaeiae ?ic?iaeaii eiiieaen caoiae?a aeey i?io?eaeoeee ai?eieo
oneeaaeiaiue ia?eoii?oo. Cai?iiiiiaaia ? ai?iaaaeaeaia o i?aeoeeo
eeaneo?eaoe?y ia?eoii?oo oa eiai oneeaaeiaiue. ?ic?iaeaia oaoi?ea
eaia?inoii??, aecia/ai? iieacaiiy aei ia?.

Aia?oa cai?iiiiiaaii ? ai?iaaaeaeaii o i?aeoeeo iaoiae
aioo??oiueiii?iaeieiii? eaca?ii? oa?ai?? i?e ia?eoii?o?.
(?aoei?iiiceoe?y EIAII ? 2911 a?ae 14.10.96).

Aia?oa aeiaaaeaia iaiao?aei?noue ?aaa?e?oaoe?? oai?eo, ye? ia?aianee
?iciianthaeaeaiee ia?eoii?o.

I?aeoe/ia cia/aiiy io?eiaieo ?acoeueoao?a. ?ic?iaeai? iaoiaee
aeeooa?aioe?eiaaiiai i?aeoiaeo aei e?eoaaiiy eiaeiiai oai?iai a
caeaaeiino? a?ae noaae?? ia?eoii?oo, eiai iioe?aiino?, caoaeieea, a?eo
oai?iai, noiooiuei? iaoieia?? aeicaieythoue nei?ioeoe no?iee iaaee/ii?
?aaa?e?oaoe?? oai?eo, ui aea? aacia?a/iee aeiiii?/iee aoaeo.

A ?acoeueoao? canoinoaaiiy cai?iiiiiaaiiai iaoiaeo i?io?eaeoeee
aeieeiaiiy ai?eii-naioe/ieo oneeaaeiaiue, yeee a?oioo?oueny ia
?aoaeueiiio aeiaea?aeaii? anaioeee, aeei?enoaiiy iiaeo ni?aoe?eieo
i?aia?ao?a, aioeaaeoa??aeueieo ieoie, e?euee?noue iaaii?iue iia?aoe?eii?
?aie nei?ioeeany o 2,4 ?ace.

A ?acoeueoao? eiiieaeniiai e?eoaaiiy ia?eoii?oo c canoinoaaiiyi
ni?aoe?eieo i?aia?ao?a, canoinoaaiiy eaia?inoii?? c ianooiieie
i?ia?aiiaaieie ?aeaia?ioii?yie, iiaiai iaoiaeo e?eoaaiiy ia?eoii?oo,
yeee a?oioo?oueny ia o?ceei-o?i?/ieo aeanoeainoyo a?iioii?/iiai
aioenaioe/iiai ?ic/eio, aioea?ioee?a iiaiai iieie?iiy, eiia?iiaaii?
eaca?ii? oa?ai??, ?ioiioa?ai??, a oaeiae ?iaeea?aeoaeueiiai i?aeoiaeo a
e?eoaaii? eiaeiiai oai?iai iie?ioeei ?acoeueoaoe e?eoaaiiy oai?eo, ui
aeicaieeei nei?ioeoe eaoaeuei?noue i?e ia?eoii?o? a 1,3 ?ace.

Iieiaeaiiy, ?ic?iaeai? a aeena?oaoe??, eyaee a iniiao iaoiaee/ieo
?aeiiaiaeaoe?e: “Canoinoaaiiy e?eoaaeueii-i?io?eaeoe/ieo i?aia?ao?a,
aeaioiaeaieo ia iniia? e?aii?ei?aai?/ieo aaeni?aaio?a, 1994” oa
“Ae?aaiinoeea, i?io?eaeoeea ? e?eoaaiiy ia?eoii?o?a, ni?e/eiaieo
aacnii?iaeie aiaa?iaaie oa anioe?aoe?yie i?e?ii?aai?ci?a, 1998”.

Iniaenoee aianie caeiaoaa/a. A iniiao iieeaaeaii iniaenoee 25 ??/iee
aeina?ae ?iaioe ii iaaeaiith oa?i?iiai? o??o?a?/ii? aeiiiiiae oai?ei c
aino?eie caoai?thaaiiyie i?aai?a /a?aaii? ii?iaeieie. Aaoi?ii ?ic?iaeaia
i?iaeaia, aecia/aii iai?yi aeine?aeaeaiiy, aeeiiaii ca?? oa ia?iaeo
oaeoe/iiai iaoa??aeo, ee?i?/ieo niinoa?aaeaiue, ?iciiae?e oai?eo ia
a?oie.

A?eueoa /anoeia ia?aeiieo iia?aoeaieo ao?o/aiue ? ?aeaia?ioii?e o
iaaaaeaieo oai?eo aeeiiaia aaoi?ii. Aaoi?o iaeaaeeoue eeaneo?eaoe?y
ia?eoii?oo oa eiai oneeaaeiaiue. Iei ?ic?iaeaia i?ia?aia e?eoaaiiy
oai?eo ia ia?eoii?o. I?e canoinoaaii? eiiieaeniiai ni?aoe?eiiai
i?aia?aoo ?iinaaio aeyaeaia a?aenooi?noue eiai aoaeoeaiino? i?e
aiaa?iai?e iaeeino?eae?aeuei?e ?ioaeoe??, o ca”yceo c /ei aeieeea
iaiao?aei?noue noai?aiiy aioei?e?iaiiai ni?aoe?eiiai i?aia?aoo, yeee ?
aoaeoeaiei i?ioe aa?iaieo ? aiaa?iaieo caoaeiee?a. Naia ?aeay eiai
noai?aiiy , aea/aiiy aeanoeaino?, aoaeoeaiino? i?aia?aoo “?iinaeei?o” a
aenia?eiaio? oa ee?i?oe? iaeaaeeoue aaoi?o.

Aaoi?o iaeaaeeoue ?aeay aeei?enoaiiy a?iioii?/iiai aioenaioe/iiai
?ic/eio oa eiai ee?i?/iiai canoinoaaiiy. I?iaaaeaii aiae?c io?eiaieo
?acoeueoao?a. Aeeiiaii aenia?eiaioaeueia aeine?aeaeaiiy aeey aea/aiiy
aoi?eiiiai ?ioiiaeao?oeeoo ca aeiiiiiaith aioeoeeoio?iiieneaeacii?
ne?iaaoee. C?iaeaii noaoenoe/io ia?iaeo iaoa??aeo. Aeai?
aenia?eiaioaeueieo aeine?aeaeaiue, ee?i?/ieo niinoa?aaeaiue iioae?eiaai?
a iiiia?ao??, iaoiaee/ieo ?aeiiaiaeaoe?yo, aeo?iaeao, ca??eao iaoeiaeo
i?aoeue, iaoa??aeao eiioa?aioe?e, neiiiceoi?a, c”?cae?a.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Iniiai? iaoa??aee aeena?oaoe??
aoee aeeeaaeai? oa iaaiai?ai? ia eiioa?aioe?? “Aeooaeuei? ieoaiiy
o??o?a??”, Ee?a, 1990 ; eiioa?aioe??, i?enay/ai?e 75-??/iiio tha?eath
Ee?anueeiai aea?aeaaiiai ?inoeoooo oaeineiiaeaiiy e?ea??a (EAe?OE),
Ee?a, 1993; II-e Oe?a?inuee?e iaoeiai-i?aeoe/i?e eiioa?aioe?? c
iaa?aeeeaaeii? aeiiiiiae, Iaeana, 1994; iaoeiai-i?aeoe/i?e eiioa?aioe??
EAe?OE ca cae?i/aieie oa ia?ao?aeieie oaiaie IAe?, Ee?a, 1995;
?anioae?eainuee?e iaoeiai-i?aeoe/i?e eiioa?aioe?? “Ae?aaiinoeea ?
o??o?a?/ia e?eoaaiiy caoai?thaaiue oa ooeiaeaeaiue iicaia/?ieiaeo
aeia/ieo i?ioie”, Ee?a, 1996; ia?oiio A?ei?onueeiio i?aeia?iaeiiio
eiia?an? o??o?a?a, A?oaanuee, 1996; eiioa?aioe?? “Aeooaeuei? i?iaeaie
iaa?aeeeaaeii? o??o?a?? i?aai?a /a?aaii? ii?iaeieie”, Ee?a, 1996; ia?o?e
iaoeiai-i?aeoe/i?e eiioa?aioe?? “A?ini?aoe?ei? iaoiaee ? i?aia?aoe a
i?io?eaeoe/i?e oa e?eoaaeuei?e i?aeoeoe?”, Ee?a, 1997; eiioa?aioe??
“Aeooaeuei? i?iaeaie iaie?aaoiaaiaoia?e?a?ii? oa noaeeiii? o??o?a??”,
Ee?a, 1998; III-?e A?ei?onuee?e iaoeiai-i?aeoe/i?e eiioa?aioe??
“Aoa?aioi? ? o?ceei-o?i?/i? iaoiaee oa?ai??”, Iiaeeueia, 1998.

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 59 iaoeiaeo
?ia?o. A oiio /ene? 1 iiiia?ao?y, 1 o/aiaee iin?aiee ii o??o?a??, 19
noaooae a iaoeiaeo aeo?iaeao, c ieo 6 aac ni?aaaoi??a; a ca??eao
iaoeiaeo i?aoeue 14, a oiio /ene? 7 aac ni?aaaoi??a, c”?cae?a ?
eiioa?aioe?e – 18, a oiio /ene? 5 aac ni?aaaoi??a. Aeaeaii iaoiaee/ieo
?aeiiaiaeaoe?e – 2, ai?iaaaeaeaii 6 ?aoe?iiae?caoi?nueeeo i?iiiceoe?e,
io?eiaii 2 aaoi?nueeeo na?aeioeoaa oa 4 ??oaiiy i?i aeaea/o iaoaio?a
Oe?a?ie ia aeiaoiaee.

No?oeoo?a aeena?oaoe??. Aeena?oaoe?y aeeeaaeaia ia 375 noi??ieao
iaoeiiieno. Aiia neeaaea?oueny c anooio, iaeyaeo e?oa?aoo?e,
oa?aeoa?enoeee ia”?eo?a oa iaoiae?a aeine?aeaeaiiy, ?icae?eo
aenia?eiaioaeueieo aeine?aeaeaiue ? /ioe?ueio ?icae?e?a ee?i?/ieo
aeine?aeaeaiue, aeniiae?a, i?aeoe/ieo ?aeiiaiaeaoe?e. Nienie e?oa?aoo?e
i?noeoue 569 aeaea?ae. ?iaioa ?ethno?iaaia 54 oaaeeoeyie ? 25
iaethieaie.

INIIAIEE CI?NO ?IAIOE

Iaoa??ae ? iaoiaee aeine?aeaeaiue. A iniiao ?iaioe iieeaaeaii aeina?ae
e?eoaaiiy oai?eo ia ia?eoii?o a ia??iae c 1986 ii 1997 ?.?., ye?
ciaoiaeeeeny a o??o?a?/i?e ee?i?oe? eaoaae?e o??o?a?? oa ii?eiai?
oai?iae Ee?anueei? aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E. Ooieea (1-a
oa 2-a o??o?a?/i? a?aeae?eaiiy ee?i?/ii? e?ea?i? ? 6 “Iaaei?noa/ei”).

A ia??iae c 1986 ii 1997 ?.?. a ee?i?oe? aeeiiaii 25910 iia?aoeaieo
ao?o/aiue, c ieo 14795 oa?i?iiaeo iia?aoe?e ia i?aaiao /a?aaii?
ii?iaeieie c i?eaiaeo ??cieo aino?eo o??o?a?/ieo caoai?thaaiue.
Ia?eoii?o niinoa??aaany o 2751 oai?iai, ui noaiiaeei 18,59% a no?oeoo??
aino?eo o??o?a?/ieo caoai?thaaiue i?aai?a /a?aaii? ii?iaeieie.

I?ioyaii ia??iaeo c 1986 – 1991 ?.?. i?iaaaeaii 8073 oa?i?iiaeo
iia?aoeaieo ao?o/aiue c i?eaiaeo aino?eo o??o?a?/ieo caoai?thaaiue
i?aai?a /a?aaii? ii?iaeieie, ia?eoii?o niinoa??aaany o 1028 oai?eo, ui
noaiiaeei 12,73%. A ia??iae c 1992 – 1997?.?. i?iiia?iaaii 6722
oai?eo c i?eaiaeo aino?eo o??o?a?/ieo caoai?thaaiue i?aai?a /a?aaii?
ii?iaeieie, ia?eoii?o niinoa??aaany o 1723 c ieo, ui noaiiaeei 25,63%,
oiaoi e?euee?noue aeiaaee?a ia?eoii?oo c 1992 ?ieo ca?eueoeeany o 2
?ace.

Ca cacia/ai? aeaa ia??iaee eaoaeuei?noue ci?ithaaeany iaiaeii??aeii. Ca
ia?o? o?noue ?ie?a iiia?ei 135 oai?eo, eaoaeuei?noue noaiiaeea 13,13%,
ca ia??iae c 1992 ii 1997 ?.?. iiia?ei 170 oai?eo, eaoaeuei?noue
noaiiaeea 9,86%, oiaoi eaoaeuei?noue ciaioeeany a 1,3 ?ace.
Caeiiii??i?noue ??cieoe? iieaciee?a eaoaeueiino? aei ? i?ney
ai?iaaaeaeaiiy iiaeo iaoiae?a e?eoaaiiy ia?eoii?oo ia i?aenoaa? aeaiiai
/enea niinoa?aaeaiue iiaeia aaaaeaoe ?noioiith, ia aeiaaeeiaith, oiio,
ui oiiaa t > 2,6 aeey n0,05). I?e aaaaeaii?
ne?iaaoee c oeo?ii 1:64 a oeion? ? naeac?ioe? ia 3 aeiao, eiee
a?aei?/a?oueny aeoeaaoe?y neioaco AOO, niinoa??aaeiny iacia/ia
i?aeaeuaiiy ??aiy eaeoaoo: a naeac?ioe? ia 22%, a oeion? ia 19%
(?>0,05). Ia 7 aeiao, eiee iai?i ioeeaioeae?a a??ia?aeii cieaeaiee, a
naeac?ioe? ai?no eaeoaoo i?aeaeuoaaany ia 128% (?0,05). A a?oiao oai?eo, aea na?aaei?e aae nenoaie APACHE
II aoa a iaaeao: EA1 – 2,40 +0,41 aae?a; EA2 – 2,23 +0,28; IA – 3,60 +
0,26 – ia iiia? aeiaeai oai?ee (?>0,05).

?c 66 oai?eo c ?aaeoeaiith noaae??th ia?eoii?oo iiia?ei 5 (7,5%), a c
369 oai?eo c oiene/iith oa oa?i?iaeueiith noaae??th iiia?ei 125
(33,9%).

A ia?o?e a?oi? (EA1) iiia?ei 45 oai?eo, noia aae?a iiaeeo?eiaaii? APACHE
II o iiia?eeo aeyaeeany aeinoia??ii aeua (?0,05), a i??iaeiia?aaeii? ia 44% (?0,05), a
i??iaeiia?aaeii? ia 55% (?0,05), ai?no O-oaeia??a – ia 60,9%, O-noi?ani??a
– ia 38,1% (?0,05), IgG – ia 20,4% (?0,05).

C aieo aoii?aeueiiai ?ioi?oaoo ia 7-10 aeiao i?ney iia?aoe?? aeyaeaii
ca?eueoaiiy ye i?ioeaioii?, oae ? aaniethoii? e?eueeino? A-e?ioioeeo?a.
Ca?eueooaaeany eiioeaio?aoe?y IgM oa IgG ne?iaaoee.

O ianoaaeaieo iaie oai?eo a on?o a?oiao ?icaeaaany aoi?eiiee
?ioiiaeao?oeeo, yeee i?iyaeyany ye c aieo ee?oeiiiai, oae ?
aoii?aeueiiai ?ioi?oaoo. A ?acoeueoao? i?iaaaeaiiai e?eoaaiiy a
eiio?ieuei?e a?oi? oai?eo ia 7- 10 aeiao i?ioeaioiee ai?no O-e?ioioeeo?a
caeeoaany cieaeaiei, neeaaeath/e 32,0+ 1,8% (?

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