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Післяопераційна інтенсивна терапія та абдомінальна імуномодуляція у хворих на поширений перитоніт (Клініко-експериментальне дослідження): Автореф. дис

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16

Aei?i?iiao?ianueea aea?aeaaia iaaee/ia aeaaeai?y

Eaoeia ??eia Ieoaee?aia

OAeE 616-089.168.1+616.381-002

I?neyiia?aoe?eia ?ioaineaia oa?ai?y

oa aaaeii?iaeueia ?ioiiiiaeoeyoe?y o

oai?eo ia iioe?aiee ia?eoii?o

(Ee?i?ei-aenia?eiaioaeueia aeine?aeaeaiiy)

14.01.30 – aianoac?ieia?y oa ?ioaineaia oa?ai?y

Aaoi?aoa?ao

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

Aei?i?iiao?ianuee

1999

Aeena?oaoe??th ? ?oeiien.

?iaioa aeeiiaia o Eoaainueeiio aea?aeaaiiio iaaee/iiio oi?aa?neoao? IIC
Oe?a?ie.

Iaoeiaee ea??aiee: aeieoi? iaaee/ieo iaoe, i?ioani? Ni?oeei Ieaa
Ieeieaeiae/,

caa?aeoth/ee eaoaae?ith aianoac?ieia??, aeno?aiaeueii? oa a?enueeiai?

iaaeeoeeie Eoaainueeiai
aea?aeaaiiai iaaee/iiai oi?aa?neoaoo.

Io?oe?ei? iiiiaioe: aeieoi? iaaee/ieo iaoe, i?ioani?, Eao?aao
Aea?aeaaii?

i?ai?? Oe?a?ie, Caneoaeaiee ae?y/ iaoee ? oaoi?ee

*aie?e Eaiia?ae Iao?iae/, i?ioani? eaoaae?e

aianoac?ieia?? oa ?aai?iaoieia?? Iaoe?iiaeueiiai

iaaee/iiai oi?aa?neoaoo,

aeieoi? iaaee/ieo iaoe, i?ioani?

Oaii Aaeaioeia Iao??aia, i?ioani?

eaoaae?e aianoac?ieia??, ?ioaineaii? oa?ai??

oa iaaeeoeeie iaa?aeeeaaeieo noai?a OII Aeiiaoeueeiai

aea?aeaaiiai iaaee/iiai oi?aa?neoaoo ?i. I. Ai?ueeiai.

I?ia?aeia onoaiiaa: Oa?e?anueeee aea?aeaaiee iaaee/iee oi?aa?neoao,
eaoaae?a iaaeeoeeie iaa?aeeeaaeieo noai?a oa aianoac?ieia??, IIC
Oe?a?ie i. Oa?e?a

Caoeno a?aeaoaeaoueny “26”_aeiaoiy_1999?. i 13_aiaeei? ia can?aeaii?
niaoe?ae?ciaaii? a/aii? ?aaee Ae08.601.01 o Aei?i?iiao?ianuee?e
aea?aeaai?e iaaee/i?e aeaaeai??, ca aae?anith:

320044, i. Aei?i?iiao?ianuee, aoe. Aeca?aeeinueeiai, 9.

C aeena?oaoe??th iiaeia iciaeiieoeny o a?ae?ioaoe? Aei?i?iiao?ianueei?
aea?aeaaii? iaaee/ii? aeaaeai?? ca aae?anith: i. Aei?i?iiao?ianuee,

aoe. Aeca?aeeinueeiai, 9.

Aaoi?aoa?ao ?ic?neaiee “_14_”__aa?aniy__1999?.

A/aiee nae?aoa?

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

aeioeaio Oea/aiei A.I.

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. Aino?ee ia?eoii?o – iaeia c iaea?eueo aeooaeueieo
i?iaeai iaaaeii? o??o?a??. Iacaaaeath/e ia oaeineiiaethaaiiy o??o?a?/ii?
oaoi?ee, aeei?enoaiiy no/anieo iaoiae?a aeaoieneeaoe?? e
aioe?ioaeoe?eii? oa?ai??, eaoaeuei?noue i?e iioe?aieo oi?iao ia?eoii?oo
aei oaia??oiueiai /ano caeeoa?oueny aeineoue aenieith oa neeaaea? ca
aeaieie ??cieo aaoi??a a?ae 45,4% aei 92,8% (Aiiaea??a A.?. oa ni?aaao.,
1990; Ainoeuaa A.E., 1992; Aeaea? A.A. oa ni?aaao., 1995). E?euee?noue
?ioaeoe?eieo oneeaaeiaiue oaeiae ia ia? oaiaeaioe?? aei cieaeaiiy.

Iaeiie/aiiy a i?aai?ci? aaeoa??aeueieo oienei?a, i?iaeoeo?a oeaieiiiai
?iciaaeo, naia aaeoa??e, a oaeiae ?yaeo a?ieia?/ii-aeoeaieo ?a/iaei ?
iaoaaie?o?a ci?iththoue o?ceei-o?i?/i? yeino? e?ia?.

C? ci?iith iniiaiiai na?aaeiaeua ooieoe?iioaaiiy ?ioiieiiiaoaioieo
ee?oei ci?ith?oueny ooieoe?iiaeueiee noai ee?oeiieo ? aoii?aeueieo
/eiiee?a ?ioi?oaoo, ii?ooo?oueny oaaioeeoic oa ae?i?iaoe?y
oee?eoethth/eo ?ioiieo eiiieaen?a (Iieoaeoia E.A. oa ni?aaao., 1992;
Iiaea?a A.I., 1995, 1998).

I?ioa, ceiye?niee ia?aa?a aeayeeo oi?i ia?eoii?oo i?eiooo? aeoiaoe i?i
i?ia?aeio ?ieue o ?o ?icaeoeo oa i?aeo?eioe? i?noeaaiai
aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? /a?aaii? ii?iaeieie
(*a?iooaiei ?.O., 1988; No?o/eia A.?. oa ni?aaao., 1991).

Naia a?ae ooieoe?iiaeueiiai noaio nenoaie oaaioeeooth/eo iiiiioeeaa??a,
e?ioioeeo?a, iaeo?io?eueieo eaeeioeeo?a, ??aiy ?ioiiaeiaoe?i?a,
e?cioeeio e eiiieaiaioo caeaaea nooi?iue aniieooaaiiy o caaaeueiee iio?e
e?ia? aaeoa??aeueieo aaaio?a, ?icaeoie naioe/iiai noaio ? i?eai?/aiiy
nenoaiiiai ?ioi?oaoo.

Aea, o?aaeeoe?ei? iaoiaee ?ioaineaii? oa?ai?? iioe?aieo ia?eoii?o?a ia
aeyaeythoue aeaaiae?eiiai aieeao ia oaeoi?e aioe?ioaeoe?eiiai caoenoo oa
?ioiieia?/ii? ?aaeoeaiino? i?aai?cio a oe?eiio oa /a?aaii? ii?iaeieie
cie?aia.

O ca’yceo c aeuacacia/aiei, aeieeea iaiao?aei?noue aea/eoe noai
i?noeaaiai aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? /a?aaii?
ii?iaeieie i?e iioe?aieo ia?eoii?oao. Ia iniia? oeeo aeine?aeaeaiue
?ic?iaeoe oa canoinoaaoe niin?a ni?yiiaaii? ?ioiiei?aeoe??, ui
aeicaieeoue iie?aueoe ?acoeueoaoe e?eoaaiiy oa cieceoe eaoaeuei?noue i?e
aeai?e iaoieia??.

Ca’ycie ?iaioe ?c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Aeena?oaoe?eia
?iaioa “I?neyiia?aoe?eia ?ioaineaia oa?ai?y oa aaaeii?iaeueia
?ioiiiiaeoeyoe?y o oai?eo ia iioe?aiee ia?eoii?o” yaey? niaith o?aaiaio
ieaiiai? eaoaae?aeueii? ?iaioe “?ic?iaea ?aa?iia?ieo iaoiae?a
aeaoieneeaoe?? i?e e?eoe/ieo noaiao, iaoiiaeaieo ?ioaeoe?eii-caiaeueieie
oneeaaeiaiiyie c aieo i?aai?a aeeoaiiy oa /a?aaii? ii?iaeieie” (?
aea?ae?a?no?aoe?? 019500070035, oeo? ?I-9.95).

Iaoa oa caaea/? aeine?aeaeaiiy. I?aeaeueoe aoaeoeai?noue ?ioaineaii?
i?neyiia?aoe?eii? oa?ai?? oai?eo iioe?aieie ia?eoii?oaie oeyoii
aeei?enoaiiy i?noeaai? ?ioiiei?aeoe??, a?aoiaoth/e ci?ie
aioe?ioaeoe?eiiai caoenoo oa ?ioiieia?/ii? ?aaeoeaiino? /a?aaii?
ii?iaeieie.

Aeey aeinyaiaiiy iaoe aoee iinoaaeai? oae? caaea/?:

1. A oiiaao aenia?eiaioo oa ee?i?ee aea/eoe noai i?noeaaiai
aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? /a?aaii? ii?iaeieie
i?e iioe?aieo ia?eoii?oao.

2. Aea/eoe aaeoa??ieia?/iee iaecaae /a?aaii? ii?iaeieie oa ??aaiue
aiaeioieneeico o oai?eo ia iioe?aiee ia?eoii?o.

3. ?ic?iaeoe ? oi?iaaaeeoe niin?a ni?yiiaaii? ei?aeoe?? ii?ooaiue o
nenoai? i?noeaaiai ?ioi?oaoo /a?aaii? ii?iaeieie.

4. Aecia/eoe aieea i?noeaai? ?ioiiei?aeoe?? ia noai /eiiee?a
aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? /a?aaii? ii?iaeieie.

5. Aeine?aeeoe aoaeoeai?noue eiiieaenii? oa?ai?? c canoinoaaiiyi
i?noeaai? ?ioiiei?aeoe?? a ii??aiyii? c caaaeueii i?eeiyoith
?ioaineaiith i?neyiia?aoe?eiith oa?ai??th iioe?aieo ia?eoii?o?a.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a. Aia?oa a aenia?eiaio? ?
ee?i?oe? anoaiiaeaii, ui a i?ioean? ?icaeoeo iioe?aiiai ia?eoii?oo
a?aeaoaa?oueny ii?ooaiiy i?noeaaiai aioe?ioaeoe?eiiai caoenoo oa ?ioiii?
?aaeoeaiino? /a?aaii? ii?iaeieie. Oea aeyaey?oueny i?eai?/aiiyi
ooieoe?iiaeueieo iiaeeeainoae ia?eoii?aeueieo iae?ioaa?a ? eaeeioeeo?a,
?icaeoeii ee?oeiiiai ? aoii?aeueiiai ?ioiiaeao?oeeoo. Aeiaaaeaii, ui
aeai? ii?ooaiiy i?ia?anothoue o oiae? ?icaeoeo iaoieia?/iiai i?ioeano ?
noi?iaiaeaeothoueny ?inoii ??aiy aiaeioieneeico. Anoaiiaeaii, ui o
oaa?ei oyaee?noue i?noeaaeo ii?ooaiue a?aeiia?aea? nooiaith ae?aciino?
ii?oieia?/ieo ci?i o aioo??oi?o i?aaiao.

?ic?iaeaii iiaee niin?a ni?yiiaaii? ei?aeoe?? aeyaeaieo ii?ooaiue. Nooue
niiniao i?noeoueny o aaaaeaii? o /a?aaio ii?iaeieio o?iae?io oa
ethaenueeiai ?ioiiaeiaoe?io. Aeiaaaeaii a aenia?eiaio? ? o ee?i?oe?, ui
aeaiee niin?a aeicaiey? iiiiaieoe aeao?oeeo ee?oeiieo ? aoii?aeueieo
oaeoi??a ?ioi?oaoo, aeoea?coaaoe ooieoe?iiaeueio cae?ai?noue
ia?eoii?aeueieo iae?ioaa?a ? iaeo?io?eueieo iie?ii?oii-yaea?ieo
eaeeioeeo?a, iineeeoe caoeno na?icii? iaieiiee /a?aaii? ii?iaeieie a?ae
?iaac?? i?e?ii?aai?ci?a.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. ?ic?iaeaiee oa
ai?iaaaeaeaiee a ee?i?/io i?aeoeeo niin?a ni?yiiaaii? ei?aeoe??
ii?ooaiue o nenoai? i?noeaaiai aioe?ioaeoe?eiiai caoenoo oa ?ioiii?
?aaeoeaiino? /a?aaii? ii?iaeieie. Oaeee niin?a aaaeii?iaeueii?
?ioiiei?aeoe?? aeeeeea? aeoea?caoe?th i?noeaaiai ?ioi?oaoo, ci?ith?
aaeoa??aeueiee iaecaae /a?aaii? ii?iaeieie, ni?ey? ciaioaiith ee?i?/ieo
? eaai?aoi?ieo iciae aiaeioieneeico. Oea, o naith /a?ao, ni?ey?
ii?iae?caoe?? o?ceei-o?i?/ieo aeanoeainoae e?ia?, a?aeiiaeaiith
ia?enoaeueoeee eeoa/ieeo, ciaioaiith /enea eaaaaeae /a?aaii? ii?iaeieie,
ui a inoaoi/iiio i?aenoieo i?eaiaeeoue aei nei?i/aiiy oa?i?i?a e?eoaaiiy
ia 3,5 aeiae, cieaeaiiy eaoaeueiino? ia 10%.

Eiiieaenia oa?ai?y c i?noeaaith ?ioiiiiaeoeyoe??th ia? i?aeoe/io
oe?ii?noue oa ai?iaaaeaeaia o a?aeae?eaiiyo aianoac?ieia?? oa
?aai?iaoe?? i. N?ioa?iiieue (aeo ai?iaaaeaeaiiy a?ae 24.12.98), o
a?aeae?eaii? aianoac?ieia?? oa ?aai?iaoe?? 3-i? OeIE i.Eoaainueea (aeo
ai?iaaaeaeaiiy a?ae 23.01.97 ?.) oa aeei?enoiao?oueny a ?ioeo
e?eoaaeueieo ?inoeoooe?yo i.Eoaainueea.

Iniaenoee aianie caeiaoaa/a. Aeena?oaoe?eia ?iaioa aeeiiaia iniaenoi
aaoi?ii. Iaoeiaee ea??aiee, i?ioani? eaoaae?e aianoac?ieia??,
aeno?aiaeueii? oa a?enueeiai? iaaeeoeeie EAeIO, aeieoi? iaaee/ieo iaoe
Ni?oeei Ieaa Ieeieaeiae/ cai?iiiioaaa iai?yiie iaoeiaiai iiooeo.
Aenia?eiaioaeuei? aeine?aeaeaiiy aeeiiai? aaoi?ii ia aac? a?aa??th
eaoaae?e ii?iaeueii? aiaoii?? EAeIO (caa. eao. – aeieoi? iaae.iaoe,
i?ioani? Eiaaoi?eia A.A.). Ii?oieia?/i? aeine?aeaeaiiy aeeiiai? ca
o/anoth aaoi?a a a?noieia?/i?e eaai?aoi??? a?aeae?eaiiy iaoaiaoii?? EIEE
(caa.a?aeae?eaiiyi – Oaiiaaeia A.E.). Eaai?aoi?i? aeine?aeaeaiiy – ia
aac? ?ioiieia?/ii? eaai?aoi??? eaoaae?e iaae?ao??? EAeIO
(caa.eaai?aoi???th -Naa?i N.I.). ?aeay canoinoaaiiy ni?yiiaaii?
aaaeii?iaeueii? ?ioiiei?aeoe?? iaeaaeeoue iaoeiaiio ea??aieeo, aeieoi?o
iaae. iaoe Ni?oeeio I.I.

Aaoi?ii ni?eueii c iaoeiaei ea??aieeii aoea ?ic?iaeaia noaia
aaaeii?iaeueii? ?ioiiei?aaoth/i? oa?ai??. O ee?i?/iiio ianoaaeaii? aaoi?
i?eeiaa aaciina?aaeith o/anoue, e?eoaaiiy i?iaiaeeeinue ni?eueii c?
ni?a?ia?oieeaie ?aai?iaoe?eieo a?aeae?eaiue EIEE ? 3-i? i?nueei?
e?ea?i?.

O ni?eueieo ae?oeiaaieo ?iaioao aaoi?o iaeaaeeoue 80% ?aeae oa ?ic?iaie.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Iniiai? iieiaeaiiy ?iaioe
aeeeaaeai? oa iaaiai?ai? ia ?? Oe?a?inuee?e iaoeiai-i?aeoe/i?e
eiioa?aioe?? c iaaaeii? aeiiiiiae (Iaeana, 1994), ia ?? c’?cae?
aianoac?ieia?a Oe?a?ie (Oa?e?a, 1996), ia can?aeaii? Eoaainueei?
iaeanii? anioe?aoe?? aianoac?ieia?a (Eoaainuee, 1998), ni?eueii?
eiioa?aioe?? eaoaae? aianoac?ieia??, aeno?aiaeueii? oa a?enueeiai?
iaaeeoeeie, aini?oaeueii? o??o?a?? oa oaeoeueoaonueei? o??o?a?? EAeIO.

Aeena?oaoe?y i?ieoea ai?iaaoe?th ia oaoiaiio nai?ia?? c? niaoe?aeueiino?
14.01.30 niaoe?aaee Ae.08.601.01 Aei?i?iiao?ianueei? aea?aeaaii?
iaaee/ii? aeaaeai??.

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 6 iaoeiaeo ?ia?o,
?c ieo 3 noaoo? o oaoiaeo iaoeiaeo aeaeaiiyo.

Ianya oa no?oeoo?a aeena?oaoe??. Aeena?oaoe?y aeeeaaeaia ia 137
noi??ieao iaoeiiieno, ?ethno?iaaia 34 oaaeeoeyie, 16 ?enoieaie, ye?
caeiathoue 17 noi??iie. Neeaaea?oueny ?c anooio, 4 ?icae?e?a (iaeyae
e?oa?aoo?e, iaoa??aee oa iaoiaee aeine?aeaeaiue, 2 ?icae?ee ?acoeueoao?a
aeanieo aeine?aeaeaiue), aiae?co ? ocaaaeueiaiiy ?acoeueoao?a
aeine?aeaeaiue, aeniiae?a, i?aeoe/ieo ?aeiiaiaeaoe?e, iieaae/eea
e?oa?aoo?e, yeee aeeth/a? 208 iaeiaioaaiue aeei?enoaieo aeaea?ae, c yeeo
149 – ee?eeeoeath oa 59 – eaoeieoeath.

INIIAIA *ANOEIA

Iaoa??aee ? iaoiaee aeine?aeaeaiiy.

Aeey oiai, uia i?inoaaeeoe on? noaae?? i?noeaaeo ?ioiieia?/ieo ?aaeoe?e
i?e iioe?aiiio ia?eoii?o? iaie aoa i?iaaaeaiee aenia?eiaio ia 50 a?eeo
uo?ao ?c iiaeaethaaiiyi eaeiaiai ia?eoii?oo. ?c caaaeueii? e?eueeino?
uo??a aoei aeae?eaii 3 a?oie. O ia?oo aa?eoee 20 oaa?ei, o yeeo
iiaeaethaaany aino?ee ia?eoii?o ? /a?ac 6 aiaeei c iiiaioo ?iaac??
eaeiai? noniaic?? aoei ae?iaeaii iia?aoeaia ao?o/aiiy c iaoith
a?aeaeaeaiiy aeaea?aea ia?eoii?oo oa naiaoe?? /a?aaii? ii?iaeieie. Aiie
neoaeeee e?eoa???i aoaeoeaiino? canoiniaaii? oa?ai??. Ae?oao a?oio
neeaee oaeiae 20 uo??a. ?i i?ney a?aeaeaeaiiy aeaea?aea ia?eoii?oo
aaiaeeee o /a?aaio ii?iaeieio ?ioiiiiaeoeyoi?e. Eiio?ieai neoaoaaee 10
?ioaeoieo iaeiia?eiaeo oaa?ei. Ia’?eoii aeine?aeaeaiiy aoea ia?eoa?e/ia
e?ia, ia?eoii?aeueiee aenoaeao, o?aaiaioe i/a?aaeie oa oiieiai
eeoa/ieeo, ia/?iee oa naeac?iee, iacie-a?aeaeoie i/a?aaeie.

Iniiao i?aoe? neeaaeaei aea/aiiy iaoai?ci?a aaeoa?eoeeaeiino?,
oa?iaioaoeaii? aeoeaiino? oa iiaeeiaeueii? cae?aiino? ia?eoii?aeueieo
iae?ioaa?a ? eaeeioeeo?a, a oaeiae ??aiy ee?oeiieo ? aoii?aeueieo
oaeoi??a i?noeaaiai ?ioi?oaoo /a?aaii? ii?iaeieie o 40 oai?eo iioe?aieie
ia?eoii?oaie. On? oai?? i?aeeyaaee iia?aoeaiiio ao?o/aiith c onoiaiiyi
aeaea?aea ia?eoii?oo, naiaoe?? /a?aaii? ii?iaeieie, ooaaaeo eeoa/ieeo oa
ae?aioaaiith /a?aaii? ii?iaeieie. Cae?enithaaany aanue eiiieaen
o?aaeeoe?eii? ?ioaineaii? oa?ai?? c aeei?enoaiiyi aeno?aei?ii?aeueieo
iaoiae?a aeaoieneeaoe??.

A caeaaeiino? a?ae ianyao i?iaaaeaii? oa?ai?? oai?? aoee ?iciiae?eai? ia
2 a?oie. Ia?oo a?oio neeaee 20 oai?eo, ye? o i?ioean? e?eoaaiiy
io?eioaaee o?aaeeoe?eio oa?ai?th. O ae?oao a?oio oa?eoee 20 iaoe??io?a,
o yeeo oa?ai?y aeiiiaithaaeany aaaaeaiiyi ?ioiiei?eaoaaeueieo i?aia?ao?a
o /a?aaio ii?iaeieio.

Aeey ioe?iee aoaeoeaiino? aeei?enoaieo iaoiae?a e?eoaaiiy aoei
aeine?aeaeaii ia?eoii?aeueiee aenoaeao. Aecia/aee oaaioeeoa?ia /enei
(O*), oaaioeeoa?iee ?iaeaen (O?), eoaeio oinoaoaco (EO), na?aaei?e
oeeoio?i?/iee eiao?oe??io ia?eoii?aeueieo iae?ioaa?a (NOeOE),
e?euee?noue O- ? A-e?ioioeeo?a, ??aaiue ?ioiiaeiaoe?i?a eean?a A, oa I.
E??i ee?i?ei-a?io?i?/iiai iii?oi?eiao, a e?ia? aeyaeyany noai /eiiee?a
caaaeueiiai ?ioi?oaoo oa ??aaiue aiaeioieneeico: ?iaeaen aiaeiaaiii?
?ioieneeaoe?? (?A?), eiioeaio?aoe?y na?aaeiueiiieaeoey?ieo iaioeae?a
(NII), eaeeioeeoa?iee ?iaeaen ?ioieneeaoe?? (E??). Aoei aea/aii
ia?eoii?aeueiee iaecaae /a?aaii? ii?iaeieie. Aeine?aeaeaiiy i?iaiaeeee a
o?e aoaie: 1-3 aeiaa (1 aoai), 3-5 aeiaa (2 aoai), 5-7 aeiaa (3 aoai).

Eiio?ieai neoaoaaee 20 oai?eo, ui aoee i?iiia?iaai? c i?eaiaeo
o??o?a?/ii? iaoieia?? i?aai?a /a?aaii? ii?iaeieie a oiiaao a?aenooiino?
aeiioo. I?ney ?ic??co ia?aaeiuei? /a?aaii? no?iee oa ?ice?eooy i/a?aaeie
o oeeo oai?eo a?aee aeey aeine?aeaeaiiy cieae c /a?aaii? ii?iaeieie.
Caeiaoo? iieacieee aoee acyo? iaie ca eiio?ieuei?. ?acoeueoaoe
aeine?aeaeaiue aoee ia?iaeai? iaoiaeaie aa??aoe?eii? noaoenoeee ia
ia?niiaeueiiio eiii’thoa?? ?N AO 286 “?AI”.

?acoeueoaoe aeanieo aeine?aeaeaiue.

I?iaaaeaiee aiae?c caeiaooeo ?acoeueoao?a iieacaa, ui o oaa?ei ? ethaeae
i?e iioe?aiiio ia?eoii?o? c’yaeythoueny aeeaie? ci?ie o i?noeaaiio
aioe?ioaeoe?eiiio caoeno? oa ?ioii?e ?aaeoeaiino? /a?aaii? ii?iaeieie.

I?e aenia?eiaioaeueiiio ia?eoii?o? o oaa?ei ia?oi? a?oie o
ia?eoii?aeueiiio aenoaeao? ia oii? cia/ii? aeoea?caoe?? iaoai?ci?a
aaeoa?eoeeaeiino? (NOeOE) ii?oooaaeinue ni?aa?aeiioaiiy
?ioiieiiiaoaioieo ee?oei. Iacaaaeath/e ia oa, ui a?aenioie
ia?eoii?aeueieo iae?ioaa?a oa iaeo?io?eioeeo?a, ui i?eeiaee o/anoue o
oaaioeeoic? (O?), ca?eueooaaany, i?eai?/oaaeanue ?o iiaeeiaeueia oa
ia?aaa?thth/a cae?ai?noue (O*). Ciaiooaaeany iaoaaie?/ia aeoeai?noue
oaaioeeooth/eo ee?oei. Iaeii/anii c oeei ia?inoaee ee?i?/i? ?
eaai?aoi?i? iciaee aiaeioieneeico.

O ae?oa?e a?oi? oaa?ei i?ney i?iaaaeaii? ?ioiiei?eaoaaeueii? oa?ai??
aeyaeaii ua a?eueoa iineeaiiy iaoai?ci?a aaeoa?eoeeaeiino?, iie?ioaiiy
ooieoe?iiaeueii? cae?aiino? ia?eoii?aeueieo iae?ioaa?a oa
iaeo?io?eioeeo?a, aeoea?caoe?y ee?oeiieo oaeoi??a ?ioi?oaoo,
iiieaeaiiy ??aiy aiaeioieneeico (?en. 1).

I?e ii?oia?noieia?/iiio aeine?aeaeaii? aoei aeyaeaii, ui aeoea?caoe?y
oaaioeeoico ni?e/eieea aei oiia?eueiaiiy oace aenoaeaoe?? caiaeueiiai
i?ioeano ia noaae?? ai?a?aoe?? ee?oei e?ia?. Eaoaeuei?noue o oae?e a?oi?
oaa?ei cieceeanue ia 40%.

?en. 1. Noai i?noeaaiai aioe?ioaeoe?eiiai caoenoo o uo??a c iioe?aiei
ia?eoii?oii.

Iniiaiee eiioeiaaio ethaeae, oai?eo iioe?aiei ia?eoii?oii, neeaaeaee
iniae i?aoeacaeaoiiai a?eo a?ae 17 aei 63 ?ie?a. *ieia?ee neeaaeaee 65%,
ae?iee – 35%. I?e/eiith iioe?aieo ia?eoii?o?a aoee: aeano?oeoeai? oi?ie
aiaiaeeoeeoo a 27,5% (11 /ie.) niinoa?aaeaiue, iaie?aiiae?ic – 20% (8
/ie.), i?i?eaia ae?acea oeoiea ? aeaaiaaeoeyoeiaei? eeoee a 17,5% (7
/ie.), aeano?oeoeaiee oieaoeenoeo 12,5% (5 /ie.), o?aaia i?aai?a
/a?aaii? ii?iaeieie – 10% (4 /ie.), ?io? i?e/eie – 7,5% (3 /ie.),
iaoieia?y c aieo aai?oae?e – 5% (2 /ie.).

O ?iaio? aeei?enoaia eeaneo?eaoe?y ia?eoii?o?a E.N. Neiiiyia a
iiaeeo?eaoe?? A.Ae. Naa/oea, ca?aeii c yeith ia iiiaio iaaeoiaeaeaiiy o
37,5% oai?eo aoea ?aaeoeaia noaae?y caoai?thaaiiy, o 35% – oiene/ia,
27,5% iaoe??io?a ciaoiaeeeenue o oa?i?iaeuei?e noaae?? caoai?thaaiiy.
Oyaee?noue noaio iaoe??io?a, ci?ie iaea?eueo aaaeeeaeo iieaciee?a
aiiainoaco i?aeoaa?aeaeoaaeeny ee?i?ei-a?io?i?/ieie ?acoeueoaoaie. O
oai?eo ia?oi? a?oie, ye? neeaaeaee 30%, ia aoei a?aecia/aii iiceoeaiiai
ee?i?/iiai aoaeoo a?ae i?iaaaeaii? oa?ai?? ? ia?aa?a caoai?thaaiiy
cae?i/eany eaoaeueiei e?ioeai. O?eaae?noue e?eoaaiiy o 14 oai?eo (70%)
neeaea 24,01,2 aeiae ? cae?i/eeanue aeaeoaeoaaiiyi.

Aiae?c aoaeoeaiino? i?neyiia?aoe?eii? ?ioaineaii? oa?ai?? o oai?eo
iioe?aiei ia?eoii?oii aeicaieea iai aeneiaeoe i?eiouaiiy, ui ??
iaaeinoaoiy aoaeoeai?noue aaaaoi a /iio caeaaeeoue a?ae noaio i?noeaaiai
aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? /a?aaii? ii?iaeieie.
I?e oeueiio /anoa naiaoe?y /a?aaii? ii?iaeieie iiaea ni?eyoe ua
a?eueoiio cieaeaiith oeeo aaaeeeaeo caoenieo iaoai?ci?a. Aiae?coth/e
noai i?noeaaiai aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? o
oai?eo ia?oi? a?oie, iiaeia a?aecia/eoe, ui o iiiaio i?iaaaeaiiy
iia?aoeaiiai ao?o/aiiy, o oai?eo iioe?aieie ia?eoii?oaie a?aeaoaaeany
cia/ia aeoea?caoe?y iaoai?ci?a aaeoa?eoeeaeiino?, aeeeeeaia, ia iao
iiaeyae, i?aeaeuaiith nae?aoe??th o aeai?e oac? caiaeaiiy e?cioeeio oa
?ioa?oa?iio. A?aecia/aeinue iineeaiiy a aeaa c eeoeii ?ace aeoeaiino?
eoaeii? oinoaoace eaeeioeeo?a, yea iaoiiaeth? o? ae oaeoi?e. Ii?yae c
oeei a?aecia/aeinue ciaioaiiy aaniethoii? e?eueeino? ?ioiieiiiaoaioieo
ee?oei oa ?ioiiaeiaoe?i?a, ui iiaeia iiynieoe aeieeiaiiyi ina?aaeeo
caiaeaiiy o /a?aai?e ii?iaeiei?.

Noai i?noeaaiai aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino?
aea/aany ia 1-3 aeiao (1 aoai), 3-5 aeiao (2 aoai), 5-7 aeiao (3 aoai)
i?neyiia?aoe?eiiai ia??iaeo a i?ioean? i?iaaaeaiiy ?ioaineaii? oa?ai??.
O ii??aiyii? noaio oaeoi??a aioe?ioaeoe?eiiai caoenoo o oai?eo ? a?oie o
aeeiai?oe? a?aecia/aeinue a??ia?aeia cieaeaiiy ia 3 aoai? na?aaeiueiai
oeeoio?i?/iiai eiao?oe??ioo (c 0,450,08 aei 0,350,01 o.i., ?0,05), ui
na?ae/eei i?i i?eai?/aiiy iaoai?ci?a aaeoa?eoeeaeiino?. A?aenioie
ia?eoii?aeueieo iae?ioaa?a, ui i?eeiaee o/anoue o oaaioeeoic? (O?),
ca?eueooaaany ia 3 aoai? c 45,632,81% aei 50,001,59%, ?0,05.
Iiaeeiaeueia cae?ai?noue ee?oei (O*) ciaiooaaeanue ia ae?oaiio aoai?
ii??aiyii c ia?oei. I?ioa, iaaeae?, ia 5-7 aeiao e?eoaaiiy aiia
ca?eueooaaeanue, ?? eieeaaiiy a?aeiia?aeii neeaaeaee 3,950,38; 3,810,20
oa 3,910,36 o.i, ?0,05. Oa?iaioaoeaia aeoeai?noue ia?eoii?aeueieo
iae?ioaa?a o i?ioean? i?iaaaeaiiy ?ioaineaii? oa?ai?? iaea oaiaeaioe?th
aei ca?eueoaiiy ia ae?oaiio aoai? aeine?aeaeaiiy oa ciaioaiiy ia
o?aoueiio. Ii i??? ?icaeoeo iaoieia?/iiai i?ioeano e?euee?noue
oee?eoethth/eo ?ioiieo eiiieaen?a, iacaaaeath/e ia i?iaaaeaio
?ioaineaio oa?ai?th, a??ia?aeii c?inoaea a 1,89 ?ace (?en. 2).

?en. 2. Noai oaeoi??a aioe?ioaeoe?eiiai caoenoo /a?aaii? ii?iaeieie o

oai?eo ? ? ?? a?oi.

Aiae?coth/e noai oaeoi??a ee?oeiiiai oa aoii?aeueiiai ?ioi?oaoo /a?aaii?
ii?iaeieie, iiaeia a?aecia/eoe oaiaeaioe?th aei cieaeaiiy e?eueeino?
O-e?ioioeeo?a o ia?eoii?aeueiiio aenoaeao? ia ae?oaiio oa o?aoueiio
aoaiao aeine?aeaeaiiy ii??aiyii c 1 aoaiii. Ia iao iiaeyae, oea iiaea
aooe iaoiiaeaii ye i?eai?/aiiyi i?ie?oa?aoe?? ia?eoa?e/ieo i?aai?a
?ioiiaaiaco ii i??? ?icaeoeo aiaeioieneeico, oae ? c a?aeaeaeaiiyi ?o ?c
/a?aaii? ii?iaeieie i?ae /an eaaaaeoaaiiy. ??aaiue A-e?ioioeeo?a iaa
o?eueee oaiaeaioe?th aei i?aeaeuaiiy ia ae?oaiio aoai? ? aei cieaeaiiy –
ia o?aoueiio.

Aeyaeeinue, ui ??aaiue ?ioiiaeiaoe?io A a??ia?aeii cieaeoaaany ia
ae?oaiio aoai? aeine?aeaeaiiy (c 0,370,04 aei 0,190,03 a/eeceia, ?0,01)
? caeeoaany i?aeoe/ii ia oiio ae ??ai? aei o?aoueiai aoaio
aeine?aeaeaiiy. Ci?no ?ioiiaeiaoe?i?a oa I iaa oaiaeaioe?th aei
i?aeaeuaiiy ia 3-5 aeiao e?eoaaiiy oa cieaeaiiy ia 5-7 aeiao. Oae? ci?ie
ia 2 aoai? aeine?aeaeaiiy, ia iao iiaeyae, iiaeooue aooe iaoiiaeai?
i?aeaeuaiith o?ainoaeaoe??th oeeo ?ioiiaeiaoe?i?a, a ia 3 aoai? –
i?eai?/aiiyi aioeo?eiooai?thth/i? ooieoe?? A-e?ioioeeo?a c iaeiiai aieo
oa a?aeae?eaiiyi ?ioiiaeiaoe?i?a ?acii c ia?eoii?aeueiei aenoaeaoii i?e
eaaaaeao /a?aaii? ii?iaeieie – c ae?oaiai (?en. 3).

?en. 3. Noai oaeoi??a ?ioiii? ?aaeoeaiino? /a?aaii? ii?iaeieie o oai?eo
? ? ?? a?oi.

Oaeei /eiii, iiaeia aaaaeaoe, ui ?icaeoie caiaeueiiai i?ioeano o
/a?aai?e ii?iaeiei? noi?iaiaeaeo?oueny i?noeaaei ee?oeiiei oa
aoii?aeueiei ?ioiiaeao?oeeoii. E??i oiai, aoee aeyaeai? ii?ooaiiy o
o?ceei-o?i?/ieo yeinoyo e?ia?, ui iio?aaothoue caoiae?a, ni?yiiaaieo ia
cieaeaiiy ??aiy aiaeioieneeico ca aeiiiiiaith i?e?iaeii? oa
aeno?aei?ii?aeueii? aeaoieneeaoe??, onoiaiiy ii?ooaiue o
aiaeii-aeaeo?ie?oiiio iai?i? oa eeneioii-iniiaiiio noai?. Aei cae?i/aiiy
e?eoaaiiy ciaiooaaeenue ee?i?/i? oa eaai?aoi?i? iciaee aiaeioieneeico. O
i?ioean? e?eoaaiiy ciaioeeany e?euee?noue oai?eo, o yeeo aen?thaaee
anioe?aoe?? i?e?ii?aai?ci?a, cieaeoaaany a?aenioie a?ai-iaaaoeaieo
iin?a?a.

I?ioa, aeeiai?ea ee?i?/ii? ea?oeie caoai?thaaiiy a ?yae? niinoa?aaeaiue
aoea, ia aeaeue, iaaaoeaiith: i?ia?anoaaea iie?i?aaiia iaaeinoaoi?noue,
iineethaaeeny ii?ooaiiy a aaciiai?i? oa i?e?ioee?eoeyoe??, ca?eueooaaany
ia?ac eeoee, ae?inoaea e?euee?noue aeae?eaiiai ii ciiaeao ? ae?aiaaeao,
i?ia?anoaaee aiaeioieneeic ? ii?ooaiiy o aiaeii-aeaeo?ie?oiiio iai?i? oa
eeneioii-iniiaiiio noai?. O?noue oai?eo aeaii? a?oie caaeioee, ui
noaiiaeoue 30% eaoaeueiino?.

Ia i?aenoaa? iaaaaeaieo aeua aeaieo iiaeia eiinoaooaaoe, ui iniiaiith
i?e/eiith ?icaeoeo oa i?ia?anoaaiiy iioe?aiiai ia?eoii?oo ? ii?ooaiiy o
i?noeaaeo caoenieo iaoai?ciao /a?aaii? ii?iaeieie. A naith /a?ao, ca
?aooiie aniieooaaiiy aaeoa??e oa i?iaeoeo?a caiaeaiiy o caaaeueiee
e?iaiia?a aaea oae?oaa aeieeathoue ii?ooaiiy o nenoai? caaaeueiiai
aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? i?aai?cio c ?icaeoeii
ia oeueiio oii? naioe/ieo noai?a.

Oaeei /eiii, aeiaaaeaii, ui ca?eueoaiith aoaeoeaiino? ?ioaineaii?
oa?ai?? o oai?eo iiaea ni?eyoe aeeth/aiiy a ?? eiiieaen iaoiae?a, ui
aeicaieythoue i?aeneethaaoe aai cai?uaoe ao?a/ai? ooieoe?? i?noeaaiai
aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? /a?aaii? ii?iaeieie.

O ca’yceo c oeei iaie a oiiaao aenia?eiaioo aoa ?ic?iaeaiee ?
canoiniaaiee iaoiae ni?yiiaaii? ei?aeoe?? aeyaeaieo ii?ooaiue o nenoai?
i?noeaaiai ?ioi?oaoo. I?ney ioe?iee aoaeoeaiino? aeaiiai iaoiaeo ie
aeciaee aeioe?eueiei canoinoaaoe eiai o ethaeae, oai?eo iioe?aieie
ia?eoii?oaie.

Nooue niiniao i?noeeanue o aaaaeaii? o /a?aaio ii?iaeieio o?iae?io oa
ethaenueeiai ?ioiiaeiaoe?io. Canoiniaoaaeenue caaaeueiiaeciai?
aeicoaaiiy, ui neeaaeaee aeey o?iae?io – 10 ia, ?ioiiaeiaoe?io – 5 aeic.
Aaaaeaiiy i?aia?ao?a a?aeaoaaeiny ia ?cioii?/iiio ?ic/ei? iao??th
oei?eaeo iaoiaeii c?ioaiiy /a?aaii? ii?iaeieie i?ney ?? eaaaaeoaaiiy aai
iaeii?aciai ca aeiao ii ae?aiaaeai i?e a?aenooiino? ia??oii?inoiie.

A?oio oai?eo, ye? ii?yae c o?aaeeoe?eiith i?neyiia?aoe?eiith oa?ai??th
iaea?aeoaaee i?noeaao ?ioiiiiaeoeyoe?th, neeaaeaee 20 /ieia?e.

I?e aiae?c? i?e/ei, noaae?e iioe?aieo ia?eoii?o?a, ee?i?ei-a?io?i?/iiio
aeine?aeaeaii? iaoe??io?a ?noioii? ??cieoe? i?ae oai?eie ia?oi? oa
ae?oai? a?oie aeyaeaii ia aoei.

Aeine?aeaeaiiy i?noeaaiai ?ioi?oaoo ?iaeee oaeiae a 3 aoaie.

Aiae?coth/e noai i?noeaaiai aioe?ioaeoe?eiiai caoenoo o oai?eo aeaii?
a?oie, iiaeia a?aecia/eoe, ui ia 2 aoai? a?aeaoaaeinue ca?eueoaiiy
na?aaeiueiai oeeoio?i?/iiai eiao?oe??ioo c 0,450,03 aei 0,520,02 o.i,
?0,05. Ia 3 aoai? a?i iiieaeoaaany, aea ana ae oaee aaee/eia eiai aoea
a?eueoa, i?ae ia 1 aoai? (0,490,03 o.i., ?0,05). I?ioeaio ee?oei, ye?
i?eeiathoue o/anoue o oaaioeeoic? (O?), o i?ioean? i?iaaaeaiiy
?ioaineaii? oa?ai?? c i?noeaaith ?ioiiiiaeoeyoe??th ae??n c 45,102,62%
aei 53,143,13%, ?0,05 ia 2 aoai? e?eoaaiiy oa aeine?aeaeaiiy, ?
i?aeoe/ii ia ci?ieany ia 3 aoai? (52,833,29). Iiaeeiaeueia oa
ia?aaa?thth/a cae?ai?noue ee?oei (O*) ia ci?ithaaeanue.

Oa?iaioaoeaia aeoeai?noue ia?eoii?aeueieo iae?ioaa?a ? eaeeioeeo?a iaea
oaiaeaioe?th aei ca?eueoaiiy i?ioyaii anueiai e?eoaaiiy. E?euee?noue
oee?eoethth/eo ?ioiieo eiiieaen?a cieaeoaaeanue.

Aiae?coth/e ??aaiue ee?oeiieo oa aoii?aeueieo /eiiee?a ?ioi?oaoo, iiaeia
eiinoaooaaoe, ui ia 3-5 aeiao ?icaeoeo iaoieia?/iiai i?ioeano o oai?eo
ae?oai? a?oie ia niinoa??aa?oueny iai?oaeaiiy nenoaie i?noeaaiai
?ioi?oaoo. Iai?ioe, ca?eueoo?oueny c 31,150,83 aei 37,001,67%, ?0,05
??aaiue O-e?ioioeeo?a, c 10,250,47 aei 15,730,66%, ?0,05 –
A-e?ioioeeo?a. Ai?no ?ioiiaeiaoe?i?a eean?a A, ? I i?aeoe/ii ia
ci?ith?oueny. Caeiaoo? aeai? i?aeoaa?aeaeothoue aaeaeaaoi?noue
cai?iiiiiaaii? ?ioiiiiaeoethth/i? oa?ai??.

Aiaeia?/io ea?oeio ie caeiaoee i?e aea/aii? aeaieo iieaciee?a ? ia 3
aoai? aeine?aeaeaiiy ? e?eoaaiiy. I?e ii??aiyeuei?e ioe?ioe?
ia?eoii?aeueiiai aenoaeaoo oai?eo ? oa ?? a?oi iiaeia a?aecia/eoe
iineeaiiy aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? /a?aaii?
ii?iaeieie o oai?eo, ye? ii?yae ?c o?aaeeoe?eiith ?ioaineaiith oa?ai??th
io?eioaaee ?ioiiiiaeoeyoi?e o /a?aaio ii?iaeieio.

Oae, ia 2 aoai? na?aaei?e oeeoio?i?/iee eiao?oe??io c??n ia 0,07 o.i.
Oaaioeeoa?iee ?iaeaen ? oaaioeeoa?ia /enei ca?eueoeeenue a?aeiia?aeii a
1,2 ? 1,4 ?ace. Oa?iaioaoeaia aeoeai?noue oaeiae iaea oaiaeaioe?th aei
ca?eueoaiiy. Ii?o/ c oeei o?ioe cieceany ??aaiue oee?eoethth/eo ?ioiieo
eiiieaen?a. ??aaiue O-e?ioioeeo?a ca?eueoeany a 1,2 ?ace, A-e?ioioeeo?a
– a 1,4 ?ace. Ci?no IgA c??n a 1,7 ?ace, e?euee?noue IgG iaea
oaiaeaioe?th aei cieaeaiiy, a ??aaiue IgM ia ci?ieany (?en.4).

?en. 4. Aioe?ioaeoe?eiee caoeno oa ?ioiia ?aaeoeai?noue oai?eo ? ? ??
a?oi ia 2 aoai? e?eoaaiiy oa aeine?aeaeaiiy.

??aaiue aioe?ioaeoe?eiiai caoenoo /a?aaii? ii?iaeieie o oai?eo, ui
io?eioaaee i?noeaao ?ioiiiiaeoeyoe?th ia 5-7 aeiao ia?aa?ao caiaeueiiai
i?ioeano a /a?aai?e ii?iaeiei? oaeiae caeeoaany aeinoaoiuei aenieei, ?
ye eieenue aoa aeua, i?ae o oai?eo eiio?ieueii? a?oie. A oie aea /an
??aaiue oee?eoethth/eo ?ioiieo eiiieaen?a o ia?eoii?aeueiiio aenoaeao?
iiieceany a 1,8 ?ace.

Ia o?aoueiio aoai? aeine?aeaeaiiy oaeiae a?aecia/aeenue ??cieoe? o noai?
i?noeaaiai ?ioi?oaoo /a?aaii? ii?iaeieie. Oae, ??aaiue O-e?ioioeeo?a o
oai?eo aeaii? a?oie a 1,13 ?ace, a A-e?ioioeeo?a – a 1,2 ?ace aoa
a?eueoa, i?ae o oai?eo ? a?oie. Iaeii/anii a 1,5 ?ace c?inoaea
eiioeaio?aoe?y IgA o oai?eo, ye? io?eioaaee i?noeaao ?ioiiei?aeoe?th.
?acii c oei, ??aaiue ?ioiiaeiaoe?io G ca?eueoeany iacia/ii,
?ioiiaeiaoe?io I – i?aeoe/ii ia ci?ieany (?en. 5).

?en. 5. Aioe?ioaeoe?eiee caoeno oa ?ioiia ?aaeoeai?noue oai?eo ? ? ??
a?oi ia 3 aoai? e?eoaaiiy oa aeine?aeaeaiiy.

I?aeaiaey/e i?aenoiee aeuacaaaeaiiio, iiaeia eiinoaooaaoe, ui o oai?eo
ia iioe?aiee ia?eoii?o, ye? o i?ioean? e?eoaaiiy ii?yae c o?aaeeoe?eieie
iaoiaeaie ?ioaineaii? oa?ai?? io?eioaaee i?noeaao ?ioiiiiaeoeyoe?th,
a?aecia/aeinue iineeaiiy iaoai?ci?a aioe?ioaeoe?eiiai caoenoo oa
oa?iaioaoeaii? aeoeaiino? ia?eoii?aeueieo iae?ioaa?a ? eaeeioeeo?a.
Nenoaia i?noeaaiai ?ioi?oaoo /a?aaii? ii?iaeieie ooieoe?iioaaea a aeai?e
a?oi? oai?eo aac ae?aaeaiiai iai?oaeaiiy, a?eueo oiai, eiioeaio?aoe?? O-
? A-e?ioioeeo?a ? IgA o ieo ca?eueooaaeenue. I?e oeueiio ??aaiue
oee?eoethth/eo ?ioiieo eiiieaen?a cieaeaany a i?aoi?a ?ace.

Aeai? ci?ie ooieoe?iioaaiiy nenoaie aioe?ioaeoe?eiiai caoenoo oa ?ioiii?
?aaeoeaiino? /a?aaii? ii?iaeieie noi?iaiaeaeoaaeenue ci?iith ee?i?/iiai
ia?aa?ao caoai?thaaiiy o aeaieo oai?eo. A a?eueo ?ai? no?iee (ia 3-4
aeiae ?ai?oa, i?ae o oai?eo eiio?ieueii? a?oie) ciaiooaaeenue ee?i?/i?
iciaee aiaeioieneeico, a?aeiiaethaaeenue o?ceei-o?i?/i? yeino? e?ia?. O
aeai?e a?oi? oai?eo iaoaaie?/iee aoeeaeic aaeaeiny onoiooe a 70%
niinoa?aaeaiue, a a 75% – ieaciiao ? ee?oeiio a?iieae??i?th,
a?iioei?ai?th. I?e aiae?c? eaai?aoi?ieo iieaciee?a ??aiy aiaeioieneeico
iiaeia a?aecia/eoe, ui o i?ioean? i?iaaaeaii? oa?ai?? ??aaiue Oe?E
cieaeoaaany a 3,2 ?ace, ?A? – a 2,1 ?ace, NII – a 1,8, a E?? – a 2,4
?ace. I?e ii??aiyii? oeeo iieaciee?a o oai?eo aeaii? a?oie ?
eiio?ieueii? a?aecia/aeenue aeaye? ??cieoe?, ye? na?ae/eee i?i a?eueo
aenieee ??aaiue aiaeioieneeico o oai?eo, ui io?eioaaee o?aaeeoe?eio
?ioaineaio oa?ai?th aac i?noeaai? ?ioiiei?aeoe?? (?en 6).

O oai?eo aeaii? a?oie ciaiooaaeany e?euee?noue i?e?iaieo anioe?aoe?e o
/a?aai?e ii?iaeiei?, cieaeoaaany ??aaiue a?ai-iaaaoeaieo aaeoa??e.
I?ioa, ii??aiyiiy aaeoa??aeueieo aen?a?a /a?aaii? ii?iaeieie o oai?eo
aeaii? ? eiio?ieueii? a?oi ia iiaea aooe noaoenoe/ii a??ia?aeiei, oiio
ui o 11 (55%) oai?eo ?? a?oie /a?aaia ii?iaeieia aoea ca/eiaia,
ae?aiaae? aoee a?aenooi? oa aen?ae ia?eoii?aeueiiai aenoaeaoo ia
i?iaiaeeeenue.

?en. 6. Iieacieee aiaeioieneeico o oai?eo iioe?aiei ia?eoii?oii o

i?ioean? ?ioaineaii? oa?ai?? oa i?noeaai? ?ioiiei?aeoe??.

O oai?eo aeaii? a?oie ia 2-3 aei? ?ai?oa a?aeiiaethaaeanue
ia?enoaeueoeea eeoee, ciaiooaaeany e?euee?noue aeae?eaiue ii ae?aiaaeao,
/enei eaaaaeae aoei iaioa.

Oai?? aeaii? a?oie ia 3-4 aeiae ?ai?oa aoee ia?aaaaeai? aeey
iiaeaeueoiai e?eoaaiiy a o??o?a?/i? a?aeae?eaiiy. Ciaioeeany caaaeueia
o?eaae?noue e?eoaaiiy ia 3,5 aeiae. Eaoaeuei?noue cieceeanue ia 10%.

AENIIAEE

1. Ia?aa?a aenia?eiaioaeueiiai ia?eoii?oo a uo??a noi?iaiaeaeo?oueny
ii?ooaiiyi ooieoe?iiaeueiiai noaio i?noeaaiai ?ioi?oaoo /a?aaii?
ii?iaeieie: ciaioo?oueny e?euee?noue ?ioiieiiiaoaioieo ee?oei ia
iiaa?oi? i/a?aaeie; a?aenioie ee?oei, ui aa?ooue o/anoue o oaaioeeoic?
ca?eueoo?oueny, a ?oiy iiaeeiaeueia ni?iiiaei?noue cieaeo?oueny.

O ethaeae ?c iioe?aieie oi?iaie ia?eoii?oo a /a?aai?e ii?iaeiei?
ciaioo?oueny ??aaiue ee?oeiieo ? aoii?aeueieo /eiiee?a i?noeaaiai
?io?oaoo, i?eai?/o?oueny oaaioeeoa?ia ? oa?iaioaoeaia aeoeai?noue
ia?eoii?aeueieo iae?ioaa?a oa eaeeioeeo?a.

2. O aaeoa??aeueieo iin?aao /a?aaii? ii?iaeieie aeii?iothoue i?e?iai?
anioe?aoe??, eeoeiaa ? neiueiai?eia iaee/ee, i?ioae. I?eai?/aiiy nenoaie
aioe?ioaeoe?eiiai caoenoo e ?ioiii? ?aaeoeaiino? /a?aaii? ii?iaeieie
noi?iaiaeaeo?oueny ?inoii ??aiy eaai?aoi?ieo ia?ea??a aiaeioieneeico:
ca?eueoo?oueny ??aaiue na?aaeiueiiieaeoey?ieo iaioeae?a, oee?eoethth/eo
?ioiieo eiiieaen?a, ?iaeaen aiaeiaaiii? ?ioieneeaoe?? oa eaeeioeeoa?iee
?iaeaen ?ioieneeaoe??.

3. A oiiaao aenia?eiaioo ? ee?i?ee anoaiiaeaii iie?ioaiiy iieaciee?a
i?noeaaiai ?ioi?oaoo /a?aaii? ii?iaeieie aiane?aeie canoinoaaiiy niiniao
i?noeaai? ?ioiiei?aeoe??, nooi?noue yeiai iieyaa? o aaaaeaii? a /a?aaio
ii?iaeieio o?iae?io oa ethaenueeiai ?ioiiaeiaoe?io.

4. I?noeaaa canoinoaaiiy ?ioiiei?aeoi??a caaacia/o? ca?eueoaiiy, o
ii??aiyii? c aeo?aeieie iecueeeie, eiioeaio?aoe?e O- ? A- e?ioioeeo?a oa
?ioiiaeiaoe?io A; iineeaiiy iaoai?ci?a aioe?ioaeoe?eiiai caoenoo
ia?eoii?aeueieo iae?ioaa?a ? eaeeioeeo?a.

5. Aeeth/aiiy a eiiieaen i?neyiia?aoe?eii? ?ioaineaii? oa?ai?? i?noeaai?
?ioiiei?aeoe?? aeicaiey? cieceoe ??aaiue ee?i?/ieo, a?io?i?/ieo ?
?ioiieia?/ieo ia?ea??a aiaeioieneeico. I?e oeueiio ci?ith?oueny
aaeoa??ieia?/iee iaecaae ia?eoii?aeueiiai aenoaeaoo: ciaioo?oueny
e?euee?noue i?e?iaieo anioe?aoe?e, cieaeo?oueny ??aaiue a?aiiaaaoeaieo
aaeoa??e.

I?AEOE*I? ?AEIIAIAeAOe??

1. O oai?eo ia iioe?aiee ia?eoii?o aeioe?eueii aeine?aeaeoaaoe
iieacieee aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? /a?aaii?
ii?iaeieie: iaoai?cie aaeoa?eoeeaeiino? ii INO-oanoo, O?, O*
ia?eoii?aeueieo iae?ioaa?a, ai?no ?ioiieiiiaoaioieo ee?oei o
ia?eoii?aeueiiio aenoaeao?, ??aaiue ?ioiiaeiaoe?i?a A, G, I.

2. I?aeaeuaiith aoaeoeaiino? i?neyiia?aoe?eii? ?ioaineaii? oa?ai??
iiaea ni?eyoe aeeth/aiiy o ?? eiiieaen i?noeaai? ?ioiiei?eaoaaeueii?
oa?ai??, ni?yiiaaii? ia a?aeiiaeaiiy aioe?ioaeoe?eiiai caoenoo oa
?ioiii? ?aaeoeaiino? /a?aaii? ii?iaeieie.

3. I?noeaaa aeei?enoaiiy o eiiieaen? e?eoaaiiy oai?eo ia iioe?aiee
ia?eoii?o o?iae?io oa ethaenueeiai ?ioiiaeiaoe?io aeioe?eueii a
aeicoaaiiyo: aeey o?iae?io – 10 ia, aeey ?ioiiaeiaoe?io – 5 aeic.
I?aia?aoe iaiao?aeii aaiaeeoe ia ?cioii?/iiio ?ic/ei? iao??th oei?eaeo
oeyoii c?ioaiiy /a?aaii? ii?iaeieie i?ney ?? naiaoe?? i?ae /an eaaaaea
aai ii ae?aiaaeao i?e a?aenooiino? ia?eoii?inoiie uiaeiy i?ioyaii 7
aei?a.

NIENIE IIOAE?EIAAIEO I?AOeUe CA OAIITH AeENA?OAOe??

1. Nieoeui I.I., Aiiaea?aa A.E., Eaoeia E.I. Ninoiyiea ianoiie
aioeeioaeoeeiiiie caueou e eiioiiie ?aaeoeaiinoe i?e yenia?eiaioaeueiii
ia?eoiieoa e a? eciaiaiea a i?ioeanna eiioiiiiaeoeyoeee //Ee?i?/ia
o??o?a?y. – 1996. – ?2-3. – N.51-52.

2. Eaoeia ?.I. Ci?ie i?noeaaiai aioe?ioaeoe?eiiai caoenoo oa ?ioiii?
?aaeoeaiino? i?e ia?eoii?o? oa iaoiaee ?o ei?aeoe?? a aenia?eiaio?
//Oe?a?inueeee iaaee/iee aeueiaiao. – 1998. – O.1, ?4. – N.96-99.

3. Eaoeia ?.I., Ni?oeei I.I. I?noeaaa canoiniaoaaiiy o?iae?io, /eaa?io
oa ?ioiiaeiaoe?io i?e aino?eo iioe?aieo ia?eoii?oao //Oe?a?inueeee
iaaee/iee aeueiaiao. – 1999. – O. 2, ?1. – N. 63-66.

4. Eaoeia ?.I., ?iuoie?ia N.E., Iao??/ei N.I. Aeina?ae i?noeaaiai
aeei?enoaiiy ?ioiiei?aeoi??a i?e aenia?eiaioaeueiiio ia?eoii?o? //Ca.oac
aeii. ?? Oe?a?inueei? iaoeiai-i?aeoe/ii? eiioa?aioe?? c iaa?aeeeaaeii?
aeiiiiiae. – Iaeana. – 1994. – N.91.

5. Nieoeui I.I., Aiiaea?aa A.E., Eaoeia E.I., Iaiaiei A.A. Aaiini?aoeey
e eiioiiiiaeoee?othuay oa?aiey a ei??aeoeee yiaeioieneeica o aieueiuo
ino?ui ?aceeoui ia?eoiieoii //Iaoa??aee 2 iaoe?iiaeueiiai eiia?ano
aianoac?ieia?a Oe?a?ie. – Oa?e?a. – 1996. – N.124-125.

6. Eaoeia E.I. Aeeyiea ianoiie eiioiiiiaeoeyoeee ia yooaeoeaiinoue
iineaiia?aoeeiiiie eioaineaiie oa?aiee aieueiuo ino?uie ?aceeouie
ia?eoiieoaie // Iaoa??aee 2 iaoe?iiaeueiiai eiia?ano aianoac?ieia?a
Oe?a?ie. – Oa?e?a. – 1996. – N.182-183.

AIIOAOe?ss

Eaoeia ?.I. I?neyiia?aoe?eia ?ioaineaia oa?ai?y oa aaaeii?iaeueia
?ioiiiiaeoeyoe?y o oai?eo ia iioe?aiee ia?eoii?o
(ee?i?ei-aenia?eiaioaeueia aeine?aeaeaiiy). – ?oeiien.

Aeena?oaoe?y ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe
ca niaoe?aeuei?noth 14.01.30- aianoac?ieia?y oa ?ioaineaia oa?ai?y. –
Aei?i?iiao?ianueea aea?aeaaia iaaee/ia aeaaeai?y, Aei?i?iiao?ianuee,
1999.

Aeena?oaoe?th i?enay/aii ieoaiiyi ?ioaineaii? oa?ai?? iioe?aieo
ia?eoii?o?a.

A oiiaao aenia?eiaioo ? ee?i?ee aea/aii noai i?noeaaiai
aioe?ioaeoe?eiiai caoenoo oa ?ioiii? ?aaeoeaiino? /a?aaii? ii?iaeieie
i?e iioe?aiiio ia?eoii?o?. Aeyaeaii, ui a?aeaoaa?oueny i?eai?/aiiy
oaaioeeoa?ii? oa oa?iaioaoeaii? aeoeaiino? ia?eoii?aeueieo iae?ioaa?a,
iiieaeo?oueny ??aaiue ee?oeiieo ? aoii?aeueieo oaeoi??a ?ioi?oaoo.
Iaa?oioiaaii, ?ic?iaeaii ? canoiniaaii niin?a ni?yiiaaii? ei?aeoe??
aeyaeaieo ii?ooaiue.

Aeiaaaeaii, ui canoinoaaiiy aeaiiai niiniao i?aeaeuo? aoaeoeai?noue
i?neyiia?aoe?eii? ?ioaineaii? oa?ai?? o aeaieo oai?eo. A??ia?aeii
cieaeo?oueny ??aaiue aiaeioieneeico, ci?ith?oueny aaeoa??aeueiee iaecaae
/a?aaii? ii?iaeieie.

Eaoaeuei?noue i?e canoinoaaii? aeaiiai niiniao cieceeanue ia 10%, no?iee
e?eoaaiiy – ia 3,5 aeiae ii??aiyii c caaaeueiii?eeiyoith eiiieaeniith
oa?ai??th.

Eeth/ia? neiaa: iioe?aiee ia?eoii?o, i?noeaaee ?ioi?oao, ia?eoii?aeuei?
iae?ioaae, o?iae?i, ?ioiiaeiaoe?i.

Aiiioaoeey

Eaoeia E.I. Iineaiia?aoeeiiiay eioaineaiay oa?aiey e aaaeiieiaeueiay
eiioiiiiaeoeyoeey o aieueiuo ?ani?ino?ai?iiui ia?eoiieoii
(eeeieei-yenia?eiaioaeueiia enneaaeiaaiea). – ?oeiienue.

Aeenna?oaoeey ia nieneaiea o/?iie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe
ii niaoeeaeueiinoe 14.01.30 – aianoaceieiaey e eioaineaiay oa?aiey. –
Aeiai?iiao?ianeay ainoaea?noaaiiay iaaeeoeeineay aeaaeaiey,
Aeiai?iiao?iane, 1999.

Aeenna?oaoeey iinayuaia aeooaeueiui aii?inai eioaineaiie oa?aiee ino?uo
?ani?ino?ai?iiuo ia?eoiieoia.

A oneiaeyo yenia?eiaioa n iiaeaee?iaaieai eaeiaiai ia?eoiieoa ia aaeuo
e?unao eco/aii ninoiyiea ianoiie aioeeioaeoeeiiiie caueou a?thoiie
iieinoe i?e ?ani?ino?ai?iiii ia?eoiieoa. Iauaeoii enneaaeiaaiey
yaeeenue: ia?eoa?e/aneay e?iaue, ia?eoiiaaeueiue yennoaeao, o?aaiaiou
a?thoeiu, oiieiai eeoa/ieea, ia/aie, naeac?iee, iacie-ioia/aoie
a?thoeiu.

Iniiao ?aaiou ninoaaeei eco/aiea iaoaieciia aaeoa?eoeeaeiinoe,
oa?iaioaoeaiie aeoeaiinoe e iiaeioeoaeueiie niiniaiinoe ia?eoiiaaeueiuo
iae?ioaaia e eaeeioeeoia, a oaeaea o?iaiy eeaoi/iuo e aoii?aeueiuo
oaeoi?ia ianoiiai eiioieoaoa a?thoiie iieinoe o ethaeae, aieueiuo
?ani?ino?ai?iiuie ia?eoiieoaie. A e?iae, iiieii eeeieei- aeioeie/aneiai
iiieoi?eiaa, ii?aaeaeyeenue oaeoi?u nenoaiiiai eiioieoaoa, ia?ea?u
yiaeioieneeica. Eco/ai aaeoa?eaeueiue iaecaae a?thoiie iieinoe.

Iieo/aiiua aeaiiua naeaeaoaeuenoaiaaee, /oi i?e ?ani?ino?ai?iiii
ia?eoiieoa i?ienoiaeeo oaiaoaiea ooieoeeiiaeueiuo aiciiaeiinoae
ia?eoiiaaeueiuo iae?ioaaia e eaeeioeeoia, ?acaeaaaony ianoiue eeaoi/iue
e aoii?aeueiue eiioiiaeaoeoeeo, ?ano?o o?iaaiue yiaeioieneeica.

Ia iniiaa aiaeeca auyaeaiiuo ia?ooaiee iainiiaai, ?ac?aaioai e i?eiai?i
niinia eo iai?aaeaiiie ei??aeoeee. Nooue aai caeeth/aaony ai aaaaeaiee a
a?thoioth iieinoue oeiaeeia e /aeiaa/aneiai eiioiiaeiaoeeia.

O aeeaioiuo, eioi?ua iieo/aee ianoioth eiioiiei??aae?othuoth oa?aieth,
iaia?oaeaii oneeaiea iaoaieciia aaeoa?eoeeaeiinoe, aeoeaecaoeey
oaaioeeoica, nieaeaiea o?iaiy yiaeioieneeica. Ii?oiaenoieiae/aneeie
enneaaeiaaieyie onoaiiaeaii, /oi aeoeaecaoeey ianoiiai eiioieoaoa
a?thoiie iieinoe i?eaaea e caiaaeeaieth oacu yennoaeaoeee
ainiaeeoaeueiiai i?ioeanna ia noaaeee iea?aoeee eeaoie e?iae.
Eaoaeueiinoue aeaiiie a?oiiu aeeaioiuo nieceeanue ia 40%.

Aeeth/aiea ianoiie eiioiiei??aeoeee a eiiieaen o?aaeeoeeiiiie
eioaineaiie iineaiia?aoeeiiiie oa?aiee o ethaeae, aieueiuo ino?uie
?ani?ino?ai?iiuie ia?eoiieoaie, aeinoiaa?ii iiauneei a? yooaeoeaiinoue.

I?e enneaaeiaaiee ia?eoiiaaeueiiai yennoaeaoa o aieueiuo
?ani?ino?ai?iiuie ia?eoiieoaie iaia?oaeaii oneeaiea aaeoa?eoeeaeiie e
oa?iaioaoeaiie aeoeaiinoe ia?eoiiaaeueiuo iae?ioaaia e eaeeioeeoia,
aeoeaecaoeeth oaeoi?ia ianoiiai eeaoi/iiai e aoii?aeueiiai eiioieoaoa.
Nieceeny o?iaaiue eaai?aoi?iuo ia?ea?ia yiaeioieneeica a e?iae e
ia?eoiiaaeueiii yennoaeaoa, eciaieeny aaeoa?eaeueiue iaecaae a?thoiie
iieinoe a noi?iio oiaiueoaiey eiee/anoaa iee?iaiuo annioeeaoeee,
nieaeaiey o?iaiy a?aii-io?eoeaoaeueiuo aaeoa?ee.

Eaai?aoi?iua iieacaoaee nii?iaiaeaeaeenue aieaa ?aiiei eoie?iaaieai
eeeie/aneeo i?eciaeia yiaeioieneeica, ainnoaiiaeaieai ia?enoaeueoeee
eeoa/ieea. Eaoaeueiinoue i?e i?eiaiaiee ianoiie eiioiiei??aeoeee
nieceeanue ia 10%, n?iee ea/aiey – ia 3,5 nooie a n?aaiaiee n
iauai?eiyoie eiiieaeniie oa?aieae.

Eeth/aaua neiaa: ?ani?ino?aiaiiue ia?eoiieo, ianoiue eiioieoao,
ia?eoiiaaeueiua iae?ioaae, oeiaeei, eiioiiaeiaoeei.

Annotation

Lashina I.M. The after-operation intensive therapy and abdominal
immunomodulation of sick with the wide-spread peritonitis
(experimental-clinical research). – Manuscript.

The thesis for submission for a Candidates degree sciences in
specialities 14.01.30 – anaesthesiology and intensive therapy.
Dnepropetrovsk State Medical Academy, Dnepropetrovsk, 1999.

The dissertation is devoted to the problems of intensive care of the
wide-spread peritonitis.

In conditions of the experiment and clinic was made a careful study of
state of local anti-infections protection and immunity reaction of
abdominal cavity with the wide-spread peritonitis. It was brought to
right that oppression of phagocytary and fermentative activity of
peritonial macrophages happens, the level of cellular and humoral
factors of immunity lowers. It was based, worked-out and employed the
way of orientative correction of breaches, which were brought to light.

It was proved, that application of given way raises the efficiency of
the after-operation intensive therapy of given sick. For sure, the level
of the endotoxicosis lowers, the bacterial view of abdominal cavity
changes.

Lethality was lowered by 10%, when the given way was employed, duration
of treatment – by 3,5 days being compared with generally accepted
therapy.

Key word: wide-spread peritonitis, local immunity, peritonial
macrophages, timaline, immunoglobuline.

I?aeienaii aei ae?oeo 12.07.99 ?. Oi?iao 60o90/16

Oi. ae?oe. a?e. 1,0. Oe?aae – 100 i?ei. Cai. ?47

Aeaeaaie/ee oeaio? EAeIO

i. Eoaainuee, ea. 50-??//y iai?iie Eoaainueea, 1

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