186 Ɂɚɤɥɸɱɟɧɢɟ
1.ɀɟɧɳɢɧɵɫɪɭɛɰɨɦɧɚɦɚɬɤɟɬɪɟɛɭɸɬɩɪɢɫɬɚɥɶɧɨɝɨɜɧɢɦɚɧɢɹɤɚɤɧɚɷɬɚ ɩɟɩɨɞɝɨɬɨɜɤɢɤɛɟɪɟɦɟɧɧɨɫɬɢɬɚɤɢɧɚɜɫɟɦɟɟɩɪɨɬɹɠɟɧɢɢɜɤɥɸɱɚɹɪɨɞɵȻɟ ɪɟɦɟɧɧɨɫɬɶɞɨɥɠɧɚɛɵɬɶɩɥɚɧɢɪɭɟɦɨɣ
2.ɋɨɝɥɚɫɧɨ ɥɢɬɟɪɚɬɭɪɧɵɦ ɞɚɧɧɵɦ ɱɬɨ ɩɨɞɬɜɟɪɠɞɚɸɬ ɩɪɨɜɟɞɟɧɧɵɟ ɧɚɦɢ ɢɫɫɥɟɞɨɜɚɧɢɹɩɪɢɬɪɚɧɫɜɚɝɢɧɚɥɶɧɨɦɍɁɂɬɨɥɳɢɧɚɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɝɨɪɭɛɰɚɧɚ ɦɚɬɤɟɦɟɧɶɲɟɩɨɫɪɚɜɧɟɧɢɸɫɬɪɚɧɫɚɛɞɨɦɢɧɚɥɶɧɵɦɍɁɂɱɬɨɧɟɝɨɜɨɪɢɬɨɧɟɫɨ ɫɬɨɹɬɟɥɶɧɨɫɬɢɪɭɛɰɚɩɪɢɟɝɨɪɚɜɧɨɦɟɪɧɨɣɬɨɥɳɢɧɟɢɨɬɫɭɬɫɬɜɢɢɷɯɨɩɨɡɢɬɢɜɧɵɯ ɜɤɥɸɱɟɧɢɣ
3.ɊɨɞɵɩɨɫɥɟɨɞɧɨɝɨɄɋɜɚɧɚɦɧɟɡɟɩɪɢɨɬɫɭɬɫɬɜɢɢɷɤɫɬɪɚɝɟɧɢɬɚɥɶɧɨɣɩɚɬɨ ɥɨɝɢɢ ɨɫɥɨɠɧɟɧɢɣ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɪɨɞɨɥɶɧɨɦ ɩɨɥɨɠɟɧɢɢ ɩɥɨɞɚ ɬɨɥɳɢɧɟ ɪɭɛɰɚ ɦɦɢɛɨɥɟɟɩɪɢɬɪɚɧɫɜɚɝɢɧɚɥɶɧɨɦɨɛɫɥɟɞɨɜɚɧɢɢɢɪɚɫɩɨɥɨɠɟɧɢɢɩɥɚɰɟɧɬɵɩɨ ɡɚɞɧɟɣɫɬɟɧɤɟɦɚɬɤɢɦɨɝɭɬɛɵɬɶɩɪɨɜɟɞɟɧɵɱɟɪɟɡɟɫɬɟɫɬɜɟɧɧɵɟɪɨɞɨɜɵɟɩɭɬɢ
4.ȼɟɞɟɧɢɟ ɪɨɞɨɜ ɱɟɪɟɡ ɟɫɬɟɫɬɜɟɧɧɵɟ ɪɨɞɨɜɵɟ ɩɭɬɢ ɩɪɢ ɧɚɥɢɱɢɢ ɪɭɛɰɚ ɧɚ ɦɚɬɤɟ ɫɜɹɡɚɧɨ ɫ ɜɵɫɨɤɢɦ ɪɢɫɤɨɦ ɨɫɥɨɠɧɟɧɢɣ ɜɨ ɜɪɟɦɹ ɪɨɞɨɜ ɢ ɜ ɩɨɫɥɟɪɨɞɨɜɨɦ ɩɟɪɢɨɞɟɩɨɷɬɨɦɭɨɧɢɞɨɥɠɧɵɩɪɨɜɨɞɢɬɶɫɹɜɫɬɚɰɢɨɧɚɪɟɩɨɞɩɨɫɬɨɹɧɧɵɦɦɨɧɢ ɬɨɪɢɪɨɜɚɧɢɟɦɢɤɨɧɬɪɨɥɟɦɜɢɬɚɥɶɧɵɯɮɭɧɤɰɢɣ
5.ɉɪɨɮɢɥɚɤɬɢɤɚɧɟɫɨɫɬɨɹɬɟɥɶɧɨɫɬɢɪɭɛɰɚɞɨɥɠɧɚɩɪɨɜɨɞɢɬɶɫɹɫɧɚɱɚɥɚɛɟ ɪɟɦɟɧɧɨɫɬɢɧɚɩɪɨɬɹɠɟɧɢɢɜɫɟɣɛɟɪɟɦɟɧɧɨɫɬɢɢɜɩɨɫɥɟɪɨɞɨɜɨɦɩɟɪɢɨɞɟ
6.ɍɁɂɦɨɧɢɬɨɪɢɪɨɜɚɧɢɟɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɝɨɪɭɛɰɚɞɨɥɠɧɨɩɪɨɜɨɞɢɬɶɫɹɜ 1-ɦ ɢ2-ɦ ɬɪɢɦɟɫɬɪɟɛɟɪɟɦɟɧɧɨɫɬɢɪɚɡɜɦɟɫɹɰɩɪɢɨɬɫɭɬɫɬɜɢɢɩɨɤɚɡɚɧɢɣɞɥɹ ɩɨɜɬɨɪɧɨɝɨɢɫɫɥɟɞɨɜɚɧɢɹɜ3-ɟɦɬɪɢɦɟɫɬɪɟ—ɤɚɠɞɵɟ7–ɞɧɟɣ
7.ɋɨɝɥɚɫɧɨɞɚɧɧɵɦɥɢɬɟɪɚɬɭɪɵɢɩɪɨɜɟɞɟɧɧɵɦɧɚɦɢɢɫɫɥɟɞɨɜɚɧɢɹɦɫɭɳɟ ɫɬɜɭɟɬɜɵɫɨɤɚɹɫɬɟɩɟɧɶɤɨɪɪɟɥɹɰɢɢɦɟɠɞɭɮɨɪɦɢɪɨɜɚɧɢɟɦɧɟɩɨɥɧɨɰɟɧɧɨɝɨɪɭɛ ɰɚɦɢɨɩɢɟɣɢɉɆɄ
Ʌɢɬɟɪɚɬɭɪɚ
ȺɧɚɧɶɟɜȼȺɉɨɛɟɞɢɧɫɤɢɣɇɆȺɤɭɲɟɪɫɬɜɨɢɝɢɧɟɤɨɥɨɝɢɹ— 2003. —ʋ
—ɋ1–63.
ȽɚɛɢɞɭɥɥɢɧɚɊɂɊɭɛɟɰɧɚɦɚɬɤɟɩɨɫɥɟɤɟɫɚɪɟɜɚɫɟɱɟɧɢɹȺɜɬɨɪɟɮɞɢɫ«ɞ-ɪɚ
ɦɟɞɧɚɭɤ—Ɇ
ɇɨɪɜɢɬɰɗɪɪɨɥɊɒɨɪɞɠȾɠɨɧɈɇɚɝɥɹɞɧɵɟɚɤɭɲɟɪɫɬɜɨɢɝɢɧɟɤɨɥɨɝɢɹɗɪ ɪɨɥɊɇɨɪɜɢɬɰȾɠɨɧɈɒɨɪɞɠɉɟɪɫɚɧɝɥɆȽɗɈɌȺɊ-ɆȿȾɋ2–133.
ɋɬɪɢɠɚɤɨɜȺɇȾɚɜɵɞɨɜȺɂɄɭɡɶɦɢɧɚɌȿȻɟɪɟɦɟɧɧɨɫɬɶɢɪɨɞɵɩɨɫɥɟɤɟɫɚ ɪɟɜɚɫɟɱɟɧɢɹ—Ɇ
ɋɚɜɟɥɶɟɜɚȽɆɄɭɪɰɟɪɆȺɄɥɢɦɟɧɤɨɉȺɢ ɞɪȺɤɭɲɟɪɫɬɜɨɢɝɢɧɟɤɨɥɨɝɢɹ
— 2005. —ʋ—ɋ3–7.
DURING PREGNANCY AND DELIVERY IN WOMEN WITH A UTERINE SCAR
187
ɄɅɂɇɂɄɈ-ɅȺȻɈɊȺɌɈɊɇɕȿɈɋɈȻȿɇɇɈɋɌɂɉɊȿɗɄɅȺɆɉɋɂɂ ɋɊȿȾɇȿɃɂɌəɀȿɅɈɃɋɌȿɉȿɇɂ
ɋɟɦɟɧɱɭɤȼɅȼɚɳɢɥɢɧɚɌɉ
Ɋɟɫɩɭɛɥɢɤɚɧɫɤɢɣɧɚɭɱɧɨ-ɩɪɚɤɬɢɱɟɫɤɢɣɰɟɧɬɪ©Ɇɚɬɶɢɞɢɬɹª, ɝɆɢɧɫɤɊɟɫɩɭɛɥɢɤɚȻɟɥɚɪɭɫɶ
Ɋɟɡɸɦɟɉɪɟɷɤɥɚɩɫɢɹ ɹɜɥɹɟɬɫɹ ɨɞɧɢɦ ɢɡ ɧɚɢɛɨɥɟɟ ɬɹɠɟɥɵɯ ɢ ɪɚɫɩɪɨɫɬɪɚɧɟɧ ɧɵɯɜɢɞɨɜɚɤɭɲɟɪɫɤɨɣɩɚɬɨɥɨɝɢɢ ɐɟɥɶɸɧɚɫɬɨɹɳɟɝɨɢɫɫɥɟɞɨɜɚɧɢɹɹɜɥɹɥɫɹɚɧɚɥɢɡ ɨɫɨɛɟɧɧɨɫɬɟɣ ɬɟɱɟɧɢɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɭ ɠɟɧɳɢɧ ɫ ɩɪɟɷɤɥɚɩɫɢɟɣ Ɉɛɫɥɟɞɨɜɚɧɨ ɠɟɧɳɢɧ ɫ ɩɨɡɞɧɢɦ ɝɟɫɬɨɡɨɦ ɬɹɠɟɥɨɣ ɫɬɟɩɟɧɢ ɢ ɠɟɧɳɢɧ ɤɨɧɬɪɨɥɶɧɨɣ ɝɪɭɩɩɵ ȼɫɟɦ ɠɟɧɳɢɧɚɦ ɩɪɨɜɟɞɟɧɨ ɩɨɥɧɨɟ ɤɥɢɧɢɤɨ-ɥɚɛɨɪɚɬɨɪɧɨɟ ɨɛɫɥɟɞɨɜɚɧɢɟ ɍɫɬɚɧɨɜ ɥɟɧɨɱɬɨɩɪɟɷɤɥɚɦɩɫɢɹɫɪɟɞɧɟɣɢɬɹɠɟɥɨɣɫɬɟɩɟɧɢɪɚɡɜɢɜɚɟɬɫɹɱɚɳɟɜɫɟɝɨɧɚɮɨɧɟ ɡɚɛɨɥɟɜɚɧɢɣ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣ ɫɢɫɬɟɦɵ ɢ ɷɧɞɨɤɪɢɧɧɨɣ ɩɚɬɨɥɨɝɢɢ ɉɪɢ ɩɪɟɷɤ ɥɚɦɩɫɢɢɪɚɡɜɢɜɚɟɬɫɹɞɢɫɛɚɥɚɧɫɜɫɢɫɬɟɦɟɝɟɦɨɫɬɚɡɚɩɪɨɹɜɥɹɸɳɢɣɫɹɢɡɦɟɧɟɧɢɹɦɢɜ ɨɛɳɟɦɚɧɚɥɢɡɟɤɪɨɜɢ ɤɨɚɝɭɥɨɝɪɚɦɦɟ ɚɬɚɤɠɟɜɛɢɨɯɢɦɢɱɟɫɤɨɦɚɧɚɥɢɡɟɤɪɨɜɢ
Ʉɥɸɱɟɜɵɟɫɥɨɜɚɩɪɟɷɤɥɚɦɩɫɢɹɝɟɦɨɫɬɚɡɝɨɦɟɨɫɬɚɡɩɚɬɨɥɨɝɢɹɛɟɪɟɦɟɧɧɨɫɬɶ ȼɜɟɞɟɧɢɟɉɪɟɷɤɥɚɦɩɫɢɹ ɹɜɥɹɟɬɫɹ ɨɞɧɢɦ ɢɡ ɧɚɢɛɨɥɟɟ ɬɹɠɟɥɵɯ ɢ ɪɚɫɩɪɨ ɫɬɪɚɧɟɧɧɵɯɜɢɞɨɜɚɤɭɲɟɪɫɤɨɣɩɚɬɨɥɨɝɢɢɉɪɟɷɤɥɚɦɩɫɢɹɢɝɢɩɟɪɬɟɧɡɢɜɧɵɣɫɢɧ ɞɪɨɦɭɛɟɪɟɦɟɧɧɵɯɹɜɥɹɸɬɫɹɜɬɨɪɵɦɢɩɨɱɚɫɬɨɬɟɫɪɟɞɢɚɤɭɲɟɪɫɤɢɯɩɪɢɱɢɧɩɟ ɪɢɧɚɬɚɥɶɧɨɣɫɦɟɪɬɧɨɫɬɢɜ ɫɬɪɚɧɚɯȿɜɪɨɩɵ>].
ɉɨɫɨɜɪɟɦɟɧɧɵɦɩɪɟɞɫɬɚɜɥɟɧɢɹɦɩɪɟɷɤɥɚɦɩɫɢɹ—ɷɬɨɢɦɦɭɧɨɤɨɦɩɥɟɤɫɧɚɹ ɩɚɬɨɥɨɝɢɹɪɚɡɜɢɜɚɸɳɚɹɫɹɜɨɬɜɟɬɧɚɩɪɨɧɢɤɧɨɜɟɧɢɟɚɧɬɢɝɟɧɨɜɧɟɣɪɨɫɩɟɰɢɮɢɱɟ ɫɤɢɯɛɟɥɤɨɜɦɨɡɝɚɩɥɨɞɚɱɟɪɟɡɧɚɪɭɲɟɧɧɵɣɦɚɬɨɱɧɨ-ɩɥɚɰɟɧɬɚɪɧɵɣɛɚɪɶɟɪɜɦɚ ɬɟɪɢɧɫɤɢɣɤɪɨɜɨɬɨɤ>@ɇɟɣɪɨɫɩɟɰɢɮɢɱɟɫɤɢɟɛɟɥɤɢɫɩɨɫɨɛɧɵɡɚɩɭɫɤɚɬɶɢɦɦɭ ɧɨɤɨɦɩɥɟɤɫɧɵɣɩɪɨɰɟɫɫɗɬɢɛɟɥɤɢɨɬɧɨɫɹɬɫɹɤɫɬɚɞɢɟɫɩɟɰɢɮɢɱɟɫɤɢɦɢɨɪɝɚɧɨɫ ɩɟɰɢɮɢɱɟɫɤɢɦɢɨɛɪɚɡɭɸɬɫɹɜɨɜɬɨɪɨɣɩɨɥɨɜɢɧɟɛɟɪɟɦɟɧɧɨɫɬɢ—ɩɟɪɢɨɞɢɧɬɟɧ ɫɢɜɧɨɝɨɪɚɡɜɢɬɢɹɦɨɡɝɚɩɥɨɞɚȺɧɬɢɬɟɥɚɩɪɨɞɭɰɢɪɭɟɦɵɟɜɨɬɜɟɬɧɚɚɧɬɢɝɟɧɩɥɨ ɞɚ ɨɛɥɚɞɚɸɬ ɬɪɨɩɧɨɫɬɶɸ ɤ ɬɤɚɧɢɦɨɡɝɚɦɚɬɟɪɢ >@ ɉɪɢ ɩɪɟɷɤɥɚɦɩɫɢɢ ɪɚɡɜɢ ɜɚɸɬɫɹ ɢɦɦɭɧɨɥɨɝɢɱɟɫɤɢɟɧɚɪɭɲɟɧɢɹɱɬɨɜɟɞɟɬɤɫɧɢɠɟɧɢɸɩɥɚɰɟɧɬɚɪɧɨɣɩɟɪ ɮɭɡɢɢ>@ɉɪɟɷɤɥɚɦɩɫɢɹɧɟɹɜɥɹɟɬɫɹɫɚɦɨɫɬɨɹɬɟɥɶɧɵɦɡɚɛɨɥɟɜɚɧɢɟɦɗɬɨɫɢɧ ɞɪɨɦɨɛɭɫɥɨɜɥɟɧɧɵɣɧɟɜɨɡɦɨɠɧɨɫɬɶɸɚɞɚɩɬɚɰɢɨɧɧɵɯɫɢɫɬɟɦɦɚɬɟɪɢɨɛɟɫɩɟɱɢɬɶ ɩɨɬɪɟɛɧɨɫɬɢɪɚɫɬɭɳɟɝɨɩɥɨɞɚ>@
ɐɟɥɶ Ⱥɧɚɥɢɡ ɤɥɢɧɢɤɨ-ɥɚɛɨɪɚɬɨɪɧɵɯ ɨɫɨɛɟɧɧɨɫɬɟɣ ɬɟɱɟɧɢɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɪɢɪɚɡɜɢɬɢɢɩɪɟɷɤɥɚɦɩɫɢɢ
ɆɚɬɟɪɢɚɥɢɦɟɬɨɞɵɢɫɫɥɟɞɨɜɚɧɢɹɁɚ—ɝɨɞɨɛɫɥɟɞɨɜɚɧɨɩɚ ɰɢɟɧɬɨɤɫɞɢɚɝɧɨɡɨɦɩɪɟɷɤɥɚɦɩɫɢɹɫɪɟɞɧɟɣɢɬɹɠɟɥɨɣɫɬɟɩɟɧɢɨɫɧɨɜɧɚɹɝɪɭɩɩɚ ɢɠɟɧɳɢɧɫɮɢɡɢɨɥɨɝɢɱɟɫɤɢɩɪɨɬɟɤɚɸɳɟɣɛɟɪɟɦɟɧɧɨɫɬɶɸɤɨɧɬɪɨɥɶɧɚɹɝɪɭɩ ɩɚȼɫɟɦɠɟɧɳɢɧɚɦɩɪɨɜɨɞɢɥɨɫɶɩɨɥɧɨɟɤɥɢɧɢɤɨ-ɥɚɛɨɪɚɬɨɪɧɨɟɨɛɫɥɟɞɨɜɚɧɢɟ
Ⱥɧɚɥɢɡ ɩɨɥɭɱɟɧɧɵɯ ɞɚɧɧɵɯ ɨɫɭɳɟɫɬɜɥɹɥɫɹ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɫɬɚɬɢɫɬɢɱɟ ɫɤɢɯ ɩɪɨɝɪɚɦɦMicrosoft Excel, BIOSTAT [Primer of Biostatistics, S.A.Glantz] i STATISTICA.
ɋɪɟɞɧɢɣ ɜɨɡɪɚɫɬ Ɇɟ 5– ɛɟɪɟɦɟɧɧɵɯ ɠɟɧɳɢɧ ɫ ɩɪɟɷɤɥɚɦɩɫɢɟɣ ɫɨ ɫɬɚɜɢɥ 6– ɥɟɬ ɛɟɪɟɦɟɧɧɵɯ ɠɟɧɳɢɧ ɛɟɡ ɩɪɟɷɤɥɚɦɩɫɢɢ— 26 (24 — 30).
ɂɆɌ0H(25–ɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧɫɝɟɫɬɨɡɨɦɫɨɫɬɚɜɢɥ25 (19 —ɩɪɢ ɷɬɨɦɩɪɢɛɚɜɤɚɦɚɫɫɵɬɟɥɚɡɚɛɟɪɟɦɟɧɧɨɫɬɶɫɨɫɬɚɜɢɥɚ—ɤɝɱɬɨɫɨɨɬ ɜɟɬɫɬɜɭɟɬɩɪɢɧɹɬɵɦɧɨɪɦɚɦɋɪɨɤɛɟɪɟɦɟɧɧɨɫɬɢɩɪɢɤɨɬɨɪɨɦɪɚɡɜɢɜɚɥɫɹɝɟɫɬɨɡ
ɫɨɫɬɚɜɢɥ—ɧɟɞɟɥɢ
ɍɞɟɥɶɧɵɣ ɜɟɫ ɷɤɫɬɪɚɝɟɧɢɚɥɶɧɨɣ ɩɚɬɨɥɨɝɢɢ ɭ ɩɚɰɢɟɧɬɨɤ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɵ ɩɪɟɞɫɬɚɜɥɟɧɜɬɚɛɥɢɰɟ
188
Ɍɚɛɥɢɰɚ—ɍɞɟɥɶɧɵɣɜɟɫɷɤɫɬɪɚɝɟɧɢɬɚɥɶɧɨɣɩɚɬɨɥɨɝɢɢɭɩɚɰɢɟɧɬɨɤɨɫɧɨɜɧɨɣ ɝɪɭɩɩɵ
ɗɤɫɬɪɚɝɟɧɢɬɚɥɶɧɚɹ ɩɚɬɨɥɨɝɢɹɦɚɬɟɪɢ
Ɉɫɧɨɜɧɚɹ ɝɪɭɩɩɚn=85 Ʉɨɧɬɪɨɥɶɧɚɹɝɪɭɩɩɚn=40
ɚɛɫ % ɚɛɫ %
Ɂɚɛɨɥɟɜɚɧɢɹɩɟɱɟɧɢ
ɢɠɟɥɱɟɜɵɜɨɞɹɳɢɯɩɭɬɟɣ 7 8,6 3 6,7
ɗɧɞɨɤɪɢɧɧɚɹɩɚɬɨɥɨɝɢɹ 36 42,9* 7 16,7
Ȼɨɥɟɡɧɢɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣɫɢɫɬɟɦɵ 54 62,9* – –
ɂɡɧɢɯɚɪɬɟɪɢɚɥɶɧɚɹ
ɝɢɩɟɪɬɟɧɡɢɹ 39 45,7* – –
Ȼɨɥɟɡɧɢɦɨɱɟɩɨɥɨɜɨɣ
ɫɢɫɬɟɦɵ 17 20* 3 6,7
ɉɪɢɦɟɱɚɧɢɟ
* —ɫɬɚɬɢɫɬɢɱɟɫɤɢɡɧɚɱɢɦɵɟɪɚɡɥɢɱɢɹɜɝɪɭɩɩɚɯɪ
ɇɚɢɛɨɥɟɟɱɚɫɬɨɜɫɬɪɟɱɚɟɦɨɣɩɚɬɨɥɨɝɢɟɣɧɚɮɨɧɟɤɨɬɨɪɨɣɪɚɡɜɢɜɚɥɫɹɝɟɫɬɨɡ ɛɵɥɚɩɚɬɨɥɨɝɢɹɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣɫɢɫɬɟɦɵ—ɩɪɢɷɬɨɦɱɢɫɥɨɫɥɭ ɱɚɟɜɚɪɬɟɪɢɚɥɶɧɨɣɝɢɩɟɪɬɟɧɡɢɢɪɚɡɥɢɱɧɨɣɫɬɟɩɟɧɢɬɹɠɟɫɬɢɫɨɫɬɚɜɢɥɨ ȼ ɤɨɧɬɪɨɥɶɧɨɣ ɝɪɭɩɩɟ ɠɟɧɳɢɧ ɫ ɡɚɛɨɥɟɜɚɧɢɹɦɢ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣ ɫɢɫɬɟɦɵ ɜɵɹɜɥɟɧɨ ɧɟ ɛɵɥɨ ɇɚ ɜɬɨɪɨɦ ɦɟɫɬɟ ɜ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɟ—ɷɧɞɨɤɪɢɧɧɚɹ ɩɚɬɨɥɨ ɝɢɹɤɨɬɨɪɚɹɛɵɥɚɜɵɹɜɥɟɧɚɭɠɟɧɳɢɧɚɜɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɟ—ɭ ɍ ɠɟɧɳɢɧ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɵ ɧɚɛɥɸɞɚɥɨɫɶ ɫɨɱɟɬɚɧɢɟ ɷɧɞɨɤ ɪɢɧɧɨɣ ɩɚɬɨɥɨɝɢɢ ɢ ɡɚɛɨɥɟɜɚɧɢɣ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣ ɫɢɫɬɟɦɵɇɚ ɡɚɛɨɥɟɜɚɧɢɹ ɩɟɱɟɧɢ ɢ ɠɟɥɱɟɜɵɜɨɞɹɳɢɯ ɩɭɬɟɣ ɢ ɦɨɱɟɩɨɥɨɜɨɣ ɫɢɫɬɟɦɵ ɩɪɢɯɨɞɢɥɨɫɶ ɩɨ ɢɫɥɭɱɚɹɜɵɹɜɥɟɧɧɨɣɩɚɬɨɥɨɝɢɢɜɨɫɧɨɜɧɨɣɢɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩ ɩɚɯɫɨɨɬɜɟɬɫɬɜɟɧɧɨ
Ɋɟɡɭɥɶɬɚɬɵ ɢɫɫɥɟɞɨɜɚɧɢɹ ɢ ɨɛɫɭɠɞɟɧɢɟ. ɉɪɢ ɚɧɚɥɢɡɟ ɫɭɬɨɱɧɨɝɨ ɦɨɧɢɬɨ ɪɢɪɨɜɚɧɢɹ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ ɭ ɩɚɰɢɟɧɬɨɤ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɵ ɭɫɬɚɧɨɜɥɟɧɨ ɱɬɨ ɫɪɟɞɧɟɟ ɫɢɫɬɨɥɢɱɟɫɤɨɟ ɞɚɜɥɟɧɢɟ Ɇɟ — ɫɨɫɬɚɜɢɥɨ ɜ ɫɪɟɞɧɟɦ (141 —ɦɦɪɬɫɬɚɫɪɟɞɧɟɟɞɢɚɫɬɨɥɢɱɟɫɤɨɟ— 100 (90 —ɦɦɪɬɫɬɱɬɨ ɞɨɫɬɨɜɟɪɧɨɜɵɲɟɧɨɪɦɚɥɶɧɨɝɨɭɪɨɜɧɹȺȾɪ
ɉɨɤɚɡɚɬɟɥɢ ɨɛɳɟɝɨ ɚɧɚɥɢɡɚ ɤɪɨɜɢ ɭ ɠɟɧɳɢɧ ɫ ɩɪɟɷɤɥɚɦɩɫɢɟɣ ɨɫɧɨɜɧɚɹ ɝɪɭɩɩɚɢɠɟɧɳɢɧɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɵɨɬɪɚɠɟɧɵɜ ɬɚɛɥɢɰɟ
Ɍɚɛɥɢɰɚ—ɉɨɤɚɡɚɬɟɥɢɨɛɳɟɝɨɚɧɚɥɢɡɚɤɪɨɜɢɭɠɟɧɳɢɧɫɩɪɟɷɤɥɚɦɩɫɢɟɣɨɫ ɧɨɜɧɚɹɝɪɭɩɩɚɢɠɟɧɳɢɧɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɵ
ɉɨɤɚɡɚɬɟɥɢɈȺɄ ȽɪɭɩɩɵɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧɆɟ— 75%)) Ɉɫɧɨɜɧɚɹɝɪɭɩɩɚn=85 Ʉɨɧɬɪɨɥɶɧɚɹɝɪɭɩɩɚ, n=40 ɗɪɢɬɪɨɰɢɬɵ 4,08 (3,8 — 4,27)* 3,76 (3,4 — 4,1) Ƚɟɦɨɝɥɨɛɢɧ 135 (124 — 148)* 112 (107 — 125) Ƚɟɦɚɬɨɤɪɢɬ 39 (35,8 — 42,2)* 35 (31 — 36) Ɍɪɨɦɛɨɰɢɬɵ 279 (203 — 312)* 211 (189 — 233) Ʌɟɣɤɨɰɢɬɵ 10,1 (8,3 — 12,1) 9,5 (7,9 — 11,4)
ɋɈɗ 31 (25 — 42)* 22 (20 — 35)
ɉɪɢɦɟɱɚɧɢɹ* —ɞɨɫɬɨɜɟɪɧɵɟɪɚɡɥɢɱɢɹɩɨɫɪɚɜɧɟɧɢɸɫɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɨɣɪ n —ɤɨɥɢɱɟɫɬɜɨɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧɜɢɫɫɥɟɞɭɟɦɵɯɝɪɭɩɩɚɯ
189
ɂɡɚɧɚɥɢɡɚɞɚɧɧɵɯɩɨɤɚɡɚɬɟɥɟɣɨɛɳɟɝɨɚɧɚɥɢɡɚɤɪɨɜɢɜɢɞɧɨɱɬɨɱɢɫɥɨɜɵɟ ɡɧɚɱɟɧɢɹ ɩɨɤɚɡɚɬɟɥɟɣ ɷɪɢɬɪɨɰɢɬɨɜ ɝɟɦɨɝɥɨɛɢɧɚ ɝɟɦɚɬɨɤɪɢɬɚ ɬɪɨɦɛɨɰɢɬɨɜ ɢ ɋɈɗ ɜ ɝɪɭɩɩɟɠɟɧɳɢɧ ɫ ɝɟɫɬɨɡɨɦ ɛɵɥɢɞɨɫɬɨɜɟɪɧɨ ɜɵɲɟ ɡɧɚɱɟɧɢɣ ɩɨɤɚɡɚɬɟɥɟɣ ɨɛɳɟɝɨɚɧɚɥɢɡɚɤɪɨɜɢɠɟɧɳɢɧɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɵɪɗɬɨɫɜɢɞɟɬɟɥɶɫɬɜɭ ɟɬ ɨɛ ɢɡɦɟɧɟɧɢɢ ɨɛɴɟɦɚ ɰɢɪɤɭɥɢɪɭɸɳɟɣ ɤɪɨɜɢ ɭ ɠɟɧɳɢɧ ɫ ɩɪɟɷɤɥɚɦɩɫɢɟɣ ɚ ɬɚɤɠɟɨɧɚɪɭɲɟɧɢɹɯɜɫɢɫɬɟɦɟɝɟɦɨɫɬɚɡɚ
ɉɨɤɚɡɚɬɟɥɢɤɨɚɝɭɥɨɝɪɚɦɦɵɭɠɟɧɳɢɧɫɩɪɟɷɤɥɚɦɩɫɢɟɣɨɫɧɨɜɧɚɹɝɪɭɩɩɚɢ ɠɟɧɳɢɧɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɵɨɬɪɚɠɟɧɵɜɬɚɛɥɢɰɟ
Ɍɚɛɥɢɰɚ —ɉɨɤɚɡɚɬɟɥɢ ɤɨɚɝɭɥɨɝɪɚɦɦɵ ɭ ɠɟɧɳɢɧ ɫ ɩɪɟɷɤɥɚɦɩɫɢɟɣ ɨɫɧɨɜɧɚɹ ɝɪɭɩɩɚɢɠɟɧɳɢɧɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɵ
ɉɨɤɚɡɚɬɟɥɢɤɨɚɝɭɥɨɝɪɚɦɦɦɵ ȽɪɭɩɩɵɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧɆɟ— 75%)) Ɉɫɧɨɜɧɚɹɝɪɭɩɩɚn=85 Ʉɨɧɬɪɨɥɶɧɚɹɝɪɭɩɩɚ,n=40 ɉɌȼ ɫɟɤ 12,2 (11,9 — 12,8)* 13,2 (10,4 — 14,4)
ɆɇɈ 0,85 (0,83 — 0,90)* 0,98 (0,92 — 1,06)
Ɏɢɛɪɢɧɨɝɟɧɝɥ 5,5 (5,0 — 6,2) 6,1 (5,0 — 6,6)
ȺɉɌɄ 131(117 — 140)* 89 (76,4 — 109,2)
ȺɑɌȼɫɟɤ 26,6 (25,8 — 30,3) 26,0 (24,0 — 29,0) Ɍȼɫɟɤ 14,3 (13,6 — 14,7) 14,9 (14,0 — 16,0)
D-ɞɢɦɟɪ 418 (335 — 644) 456 (401— 489)
ɉɪɢɦɟɱɚɧɢɹ
* —ɞɨɫɬɨɜɟɪɧɵɟɪɚɡɥɢɱɢɹɩɨɫɪɚɜɧɟɧɢɸɫɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɨɣɪ n —ɤɨɥɢɱɟɫɬɜɨɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧɜɢɫɫɥɟɞɭɟɦɵɯɝɪɭɩɩɚɯ
ɉɪɢ ɚɧɚɥɢɡɟ ɤɨɚɝɭɥɨɝɪɚɦɦɵ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɨ ɞɨɫɬɨɜɟɪɧɨɟ ɭɤɨɪɨɱɟɧɢɟ ɆɇɈɢɩɪɨɬɪɨɦɛɢɧɨɜɨɝɨɜɪɟɦɟɧɢɉɌȼɭɜɟɥɢɱɟɧɢɟȺɉɌɄɪɭɛɟɪɟɦɟɧ ɧɵɯ ɠɟɧɳɢɧɨɫɧɨɜɧɨɣ ɝɪɭɩɩɵ ɉɨɥɭɱɟɧɧɵɟ ɪɟɡɭɥɶɬɚɬɵɯɚɪɚɤɬɟɪɧɵ ɞɥɹ ɚɤɬɢɜɚ ɰɢɢ ɩɥɚɡɦɟɧɧɨɝɨ ɡɜɟɧɚ ɫɜɟɪɬɵɜɚɸɳɟɣ ɫɢɫɬɟɦɵ ɤɪɨɜɢ ɩɪɢɜɨɞɹɳɚɹ ɤ ɫɨɫɬɨɹɧɢɸ ɝɢɩɟɪɤɨɚɝɭɥɹɰɢɢɫɢɫɬɟɦɵɝɟɦɨɫɬɚɡɚɭɠɟɧɳɢɧɨɫɧɨɜɧɨɣɝɪɭɩɩɵ
ɉɨɤɚɡɚɬɟɥɢ ɛɢɨɯɢɦɢɱɟɫɤɨɝɨ ɚɧɚɥɢɡɚ ɤɪɨɜɢ ɭ ɠɟɧɳɢɧ ɫ ɩɪɟɷɤɥɚɦɫɢɟɣ ɨɫ ɧɨɜɧɚɹɝɪɭɩɩɚɢɠɟɧɳɢɧɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɵɩɪɢɜɟɞɟɧɵɜɬɚɛɥɢɰɟ
Ɍɚɛɥɢɰɚ —ɉɨɤɚɡɚɬɟɥɢ ɛɢɨɯɢɦɢɱɟɫɤɨɝɨ ɚɧɚɥɢɡɚ ɤɪɨɜɢ ɭ ɠɟɧɳɢɧ ɫ ɝɟɫɬɨɡɨɦ ɨɫɧɨɜɧɚɹɝɪɭɩɩɚɢɠɟɧɳɢɧɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɵ
ɉɨɤɚɡɚɬɟɥɢȻȺɄ ȽɪɭɩɩɵɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧɆɟ–75%)) Ɉɫɧɨɜɧɚɹɝɪɭɩɩɚn=85 Ʉɨɧɬɪɨɥɶɧɚɹɝɪɭɩɩɚ, n=40
Ɉɛɳɢɣɛɟɥɨɤ 66 (58–69)* 60 (54,5–64)
ȺɋɌ 30 (20–43)* 19 (12–25)
ȺɅɌ 22 (17–36)* 20 (16–22)
Ƚɥɸɤɨɡɚ 4,8 (4,1–5,2)* 3,7 (3,68–3,74)
Ɉɛɳɛɢɥɢɪɭɛɢɧ 7,7 (4,9–10,8) 10,2 (7,8–13)
Ʉɪɟɚɬɢɧɢɧ 66 (54–76) 62 (54–71)
Ɇɨɱɟɜɢɧɚ 3,5(3–5,2) 3,7 (3,3–4,7)
ɉɪɢɦɟɱɚɧɢɹ
* —ɞɨɫɬɨɜɟɪɧɵɟɪɚɡɥɢɱɢɹɩɨɫɪɚɜɧɟɧɢɸɫɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɨɣɪ n —ɤɨɥɢɱɟɫɬɜɨɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧɜɢɫɫɥɟɞɭɟɦɵɯɝɪɭɩɩɚɯ
190
ɉɨ ɚɧɚɥɢɡɭ ɛɢɨɯɢɦɢɱɟɫɤɨɝɨ ɫɨɫɬɚɜɚ ɤɪɨɜɢ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɨ ɞɨɫɬɨɜɟɪɧɨɟ ɩɨɜɵɲɟɧɢɟɮɟɪɦɟɧɬɨɜȺɫɌȺɥɌɨɛɳɟɝɨɛɟɥɤɚɢɝɥɸɤɨɡɵɭɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧ ɨɫɧɨɜɧɨɣɝɪɭɩɩɵ ɩɨɫɪɚɜɧɟɧɢɸɫɝɪɭɩɩɨɣɤɨɧɬɪɨɥɹɪ! ɉɨɥɭɱɟɧɧɵɟɞɚɧɧɵɟ ɦɨɝɭɬɫɜɢɞɟɬɟɥɶɫɬɜɨɜɚɬɶɨɞɢɫɛɚɥɚɧɫɟɜ ɫɢɫɬɟɦɟɝɨɦɟɨɫɬɚɡɚɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧ ɫɩɪɟɷɤɥɚɦɩɫɢɟɣ
ɍ ɠɟɧɳɢɧ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɵ ɜ ɫɥɭɱɚɹɯ ɛɵɥɢ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧɵ ɫɥɟɞɵɛɟɥɤɚɜɦɨɱɟɜ ɫɥɭɱɚɹɯɤɨɧɰɟɧɬɪɚɰɢɹɛɟɥɤɚɜɦɨɱɟɫɨɫɬɚɜɢɥɚɨɬ ɞɨɝɥɚɜɫɥɭɱɚɹɯɩɨɤɚɡɚɬɟɥɢɤɨɧɰɟɧɬɪɚɰɢɢɛɟɥɤɚɜɦɨɱɟɤɨ ɥɟɛɚɥɢɫɶɨɬɞɨɝɥɍɠɟɧɳɢɧɤɨɧɬɪɨɥɶɧɨɣɝɪɭɩɩɵɛɟɥɤɚɜɦɨɱɟɧɟɜɵɹɜ ɥɟɧɨ
ȼɵɜɨɞɵ
1. ɉɪɟɷɤɥɚɦɩɫɢɹ ɫɪɟɞɧɟɣ ɢ ɬɹɠɟɥɨɣ ɫɬɟɩɟɧɢ ɱɚɳɟ ɜɫɟɝɨ ɮɨɪɦɢɪɭɟɬɫɹ ɧɚ ɮɨɧɟɡɚɛɨɥɟɜɚɧɢɣɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɣɫɢɫɬɟɦɵɚɪɬɟɪɢɚɥɶɧɨɣɝɢɩɟɪɬɟɧɡɢɢɪɚɡ ɥɢɱɧɨɣɫɬɟɩɟɧɢɬɹɠɟɫɬɢɢɡɚɛɨɥɟɜɚɧɢɣɷɧɞɨɤɪɢɧɧɨɣɫɢɫɬɟɦɵ
2. ɉɪɢ ɪɚɡɜɢɬɢɢ ɩɪɟɷɤɥɚɦɩɫɢɢ ɪɚɡɜɢɜɚɟɬɫɹ ɞɢɫɛɚɥɚɧɫ ɜ ɫɢɫɬɟɦɟ ɝɟɦɨɫɬɚɡɚ ɩɪɨɹɜɥɹɸɳɢɣɫɹ ɢɡɦɟɧɟɧɢɹɦɢɜɨɛɳɟɦɚɧɚɥɢɡɟɤɪɨɜɢɤɨɚɝɭɥɨɝɪɚɦɦɟɚɬɚɤɠɟɜ ɛɢɨɯɢɦɢɱɟɫɤɨɦɚɧɚɥɢɡɟɤɪɨɜɢ
Ʌɢɬɟɪɚɬɭɪɚ
1.Ɇɚɪɤɨɜ ɏɆ Ɇɨɥɟɤɭɥɹɪɧɵɟ ɦɟɯɚɧɢɡɦɵ ɞɢɫɮɭɧɤɰɢɢ ɫɨɫɭɞɢɫɬɨɝɨ ɷɧɞɨɬɟɥɢɹ ɆɚɪɤɨɜɏɆɄɚɪɞɢɨɥɨɝɢɹ— 2005. —ʋ—ɋ–72.
2. ɉɪɨɤɨɩɟɧɤɨȼɆɊɨɥɶɨɤɢɫɥɢɬɟɥɶɧɨɝɨɫɬɪɟɫɫɚɜɩɚɬɨɝɟɧɟɡɟɝɟɫɬɨɡɚȼɆɉɪɨɤɨ ɩɟɧɤɨɀɭɪɧɚɥɚɤɭɲɟɪɫɬɜɚɢɠɟɧɫɤɢɯɛɨɥɟɡɧɟɣ— 2007. —Ɍɨɦʋ—ɋ
3.ɋɚɥɨɜ ɂȺ ɢ ɞɪ Ⱦɢɫɮɭɧɤɰɢɹ ɷɧɞɨɬɟɥɢɹ ɤɚɤ ɨɞɢɧ ɢɡ ɩɚɬɨɝɟɧɟɬɢɱɟɫɤɢɯ ɮɚɤɬɨɪɨɜ ɪɚɫɫɬɪɨɣɫɬɜ ɦɢɤɪɨɰɢɪɤɭɥɹɰɢɢ ɩɪɢ ɝɟɫɬɨɡɟ ɂȺ ɋɚɥɨɜ Ɍɇ Ƚɥɭɯɨɜɚ ɇɉ ɑɟɫɧɨɤɨɜɚ Ɋɨɫɫɢɣɫɤɢɣɜɟɫɬɧɢɤɚɤɭɲɟɪɚ–ɝɢɧɟɤɨɥɨɝɚ— 2006. —Ɍɨɦʋ—ɋ–9.
4.ɋɢɞɨɪɨɜɚɂɋȽɟɫɬɨɡɂɋɋɢɞɨɪɨɜɚɆɆɟɞɢɰɢɧɚ— 2006. —ɋ THE COURSE OF PREGNANCY IN THE DEVELOPMENT OF LATE
PREECLAMPSIA Semenchuk V.L., Vaschilina T.P.
Republican Scientific Practical Centre «Mother and Child», Minsk, Belarus Summery. Preeclampsia is one of the most common types of heavy and obstetric pathology. The aim of this study was to analyze the characteristics of the course of pregnancy in women with late severe preeclampsia. We examined 85 women with late severe preeclampsia and 40 women in the control group. All women held full clinical and laboratory examination. It was established that develops severe preeclampsia often amid cardiovascular system and endocrine pathology. If eclampsia develops severe im-balance in the hemostatic system, manifested changes in the blood count, coagulation, as well as biochemical analysis of blood.
Keywords:preeclampsia, hemostasis, homeostasis, pathology, pregnancy.
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ɌȿɑȿɇɂȿȻȿɊȿɆȿɇɇɈɋɌɂɍɀȿɇɓɂɇ
ɉȿɊȿɇȿɋɒɂɏȼɇɍɌɊɂɍɌɊɈȻɇɍɘɄɈɊɊȿɄɐɂɘȺɇɌȿɇȺɌȺɅɖɇɈɃ ɉȺɌɈɅɈȽɂɂɉɅɈȾȺ
ɋɟɦɟɧɱɭɤȼɅȻɟɥɭɝɚɆȼȼɚɳɢɥɢɧɚɌɉ ȽɍɊɇɉɐ©Ɇɚɬɶɢɞɢɬɹª,ɝɆɢɧɫɤɊɟɫɩɭɛɥɢɤɚȻɟɥɚɪɭɫɶ
Ɋɟɡɸɦɟȼɧɚɫɬɨɹɳɟɟɜɪɟɦɹɜɫɟɲɢɪɟɢɫɩɨɥɶɡɭɸɬɫɹɢɷɧɞɨɫɤɨɩɢɱɟɫɤɢɟɜɦɟ ɲɚɬɟɥɶɫɬɜɚɧɚɩɥɨɞɟɩɪɨɢɫɯɨɞɢɬɫɬɚɧɨɜɥɟɧɢɟɮɟɬɚɥɶɧɨɣɯɢɪɭɪɝɢɢɤɚɤɫɚɦɨɫɬɨɹ ɬɟɥɶɧɨɝɨɤɥɢɧɢɱɟɫɤɨɝɨɪɚɡɞɟɥɚɜɥɟɱɟɧɢɢɩɥɨɞɨɜɐɟɥɶɸɧɚɫɬɨɹɳɟɝɨɢɫɫɥɟɞɨɜɚɧɢɹ ɹɜɥɹɥɚɫɶ ɨɰɟɧɤɚ ɢɫɯɨɞɨɜ ɛɟɪɟɦɟɧɧɨɫɬɢ ɭ ɠɟɧɳɢɧ ɩɟɪɟɧɟɫɲɢɯ ɜɧɭɬɪɢɭɬɪɨɛɧɭɸ ɤɨɪɪɟɤɰɢɸɚɧɬɟɧɚɬɚɥɶɧɨɣɩɚɬɨɥɨɝɢɢɭɩɥɨɞɚɩɪɢɝɟɦɨɥɢɬɢɱɟɫɤɨɣɛɨɥɟɡɧɢɩɥɨɞɚ ȽȻɉ ɩɪɢ ɫɢɧɞɪɨɦɟ ɮɟɬɨ-ɮɟɬɚɥɶɧɨɣ ɬɪɚɧɫɮɭɡɢɢ ɎɎɌɋ ɩɪɢ ɦɨɧɨɯɨɪɢɚɥɶɧɨɣ ɞɜɨɣɧɟ ɩɪɢ ɦɧɨɝɨɜɨɞɢɢ Ɉɛɫɥɟɞɨɜɚɧɨ ɛɟɪɟɦɟɧɧɵɯ ɠɟɧɳɢɧ ɭ ɤɨɬɨɪɵɯ ɛɵɥɢ ɜɵɹɜɥɟɧɵɨɫɥɨɠɧɟɧɢɹɝɟɫɬɚɰɢɢɬɪɟɛɭɸɳɢɟɜɧɭɬɪɢɭɬɪɨɛɧɨɣɤɨɪɪɟɤɰɢɢɫɢɫɩɨɥɶ ɡɨɜɚɧɢɟɦɜɵɫɨɤɨɬɟɯɧɨɥɨɝɢɱɧɵɯɦɟɬɨɞɨɜɍɫɬɚɧɨɜɥɟɧɨɱɬɨɫɜɨɟɜɪɟɦɟɧɧɚɹɞɢɚɝɧɨ ɫɬɢɤɚɢɩɪɨɜɟɞɟɧɢɟɚɞɟɤɜɚɬɧɨɣɤɨɪɪɟɤɰɢɢɜɧɭɬɪɢɭɬɪɨɛɧɨɣɩɚɬɨɥɨɝɢɢɩɪɢɎɎɌɋɢ ȽȻɉɩɨɡɜɨɥɹɟɬɭɜɟɥɢɱɢɬɶɫɪɨɤɢɜɵɧɚɲɢɜɚɧɢɹɛɟɪɟɦɟɧɧɨɫɬɢ
Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚɩɥɨɞ ɛɟɪɟɦɟɧɧɨɫɬɶ ɝɟɦɨɥɢɬɢɱɟɫɤɚɹ ɛɨɥɟɡɧɶ ɫɢɧɞɪɨɦ ɮɟɬɨ-ɮɟɬɚɥɶɧɨɣɬɪɚɧɫɮɭɡɢɢɦɧɨɝɨɜɨɞɢɟ
ȼɜɟɞɟɧɢɟɈɫɧɨɜɧɨɣɡɚɞɚɱɟɣɚɤɭɲɟɪɫɬɜɚɢɩɟɪɢɧɚɬɨɥɨɝɢɢɹɜɥɹɟɬɫɹɪɟɚɥɢɡɚ ɰɢɹ ɪɟɩɪɨɞɭɤɬɢɜɧɨɣ ɮɭɧɤɰɢɢ ɤɚɠɞɨɣ ɠɟɧɳɢɧɵ ɢ ɪɨɠɞɟɧɢɟ ɡɞɨɪɨɜɨɝɨ ɪɟɛɟɧɤɚ
>@ɉɨɫɥɟɞɧɢɟɞɨɫɬɢɠɟɧɢɹɧɚɭɤɢɢɬɟɯɧɢɤɢɜɨɛɥɚɫɬɢɚɤɭɲɟɪɫɬɜɚɢɝɢɧɟɤɨɥɨɝɢɢ ɜɧɟɞɪɟɧɢɟ ɭɥɶɬɪɚɡɜɭɤɨɜɵɯ ɢɫɫɥɟɞɨɜɚɧɢɣ ɜɵɫɨɤɨɝɨ ɪɚɡɪɟɲɟɧɢɹ ɢ ɲɢɪɨɤɨɟ SDFɩɪɨɫɬɪɚɧɟɧɢɟ ɩɪɨɝɪɚɦɦ ɩɪɟɧɚɬɚɥɶɧɨɝɨ ɫɤɪɢɧɢɧɝɚ ɡɧɚɱɢɬɟɥɶɧɨ ɢɡɦɟɧɢɥɢ ɫɨ ɜɪɟɦɟɧɧɨɟ ɫɨɫɬɨɹɧɢɟ ɩɪɨɛɥɟɦɵ >@ Ȼɥɚɝɨɞɚɪɹ ɫɜɨɟɣ ɜɵɫɨɤɨɣ ɢɧɮɨɪɦɚɬɢɜɧɨɫɬɢ ɷɬɢɦɟɬɨɞɵɞɟɥɚɸɬɧɟɪɨɞɢɜɲɢɣɫɹɩɥɨɞɪɟɚɥɶɧɵɦɩɚɰɢɟɧɬɨɦ>@
ȼɧɚɫɬɨɹɳɟɟɜɪɟɦɹɜɫɟɲɢɪɟɢɫɩɨɥɶɡɭɸɬɫɹɢɷɧɞɨɫɤɨɩɢɱɟɫɤɢɟɜɦɟɲɚɬɟɥɶɫɬ ɜɚɧɚɩɥɨɞɟɩɪɨɢɫɯɨɞɢɬɫɬɚɧɨɜɥɟɧɢɟɮɟɬɚɥɶɧɨɣɯɢɪɭɪɝɢɢɤɚɤɫɚɦɨɫɬɨɹɬɟɥɶɧɨɝɨ ɤɥɢɧɢɱɟɫɤɨɝɨɪɚɡɞɟɥɚɜɥɟɱɟɧɢɢɩɥɨɞɨɜ[4].
Ʉɪɭɩɧɵɦ ɩɪɨɪɵɜɨɦ ɜ ɮɟɬɚɥɶɧɨɣ ɦɟɞɢɰɢɧɟ ɫɬɚɥɚ ɜɨɡɦɨɠɧɨɫɬɶ ɞɢɚɝɧɨɫɬɢ ɪɨɜɚɬɶɝɟɦɨɥɢɬɢɱɟɫɤɭɸɛɨɥɟɡɧɶɩɥɨɞɚɫɩɨɦɨɳɶɸɦɟɬɨɞɚɤɨɪɞɨɰɟɧɬɟɡɚɢɧɟɩɨ ɫɪɟɞɫɬɜɟɧɧɨɝɨ ɜɡɹɬɢɹ ɩɪɨɛɵ ɤɪɨɜɢ ɩɥɨɞɚ ɚ ɬɚɤɠɟ ɩɪɨɜɨɞɢɬɶ ɥɟɱɟɛɧɵɟ ɦɟɪɨ ɩɪɢɹɬɢɹ[5].
ɐɟɥɶɈɰɟɧɢɬɶ ɢɫɯɨɞɵ ɛɟɪɟɦɟɧɧɨɫɬɢ ɭ ɠɟɧɳɢɧ ɩɟɪɟɧɟɫɲɢɯ ɜɧɭɬɪɢɭɬɪɨɛ ɧɭɸɤɨɪɪɟɤɰɢɸɚɧɬɟɧɚɬɚɥɶɧɨɣɩɚɬɨɥɨɝɢɢɭɩɥɨɞɚɩɪɢȽȻɉɩɪɢɫɢɧɞɪɨɦɟɮɟɬɨ-ɮɟɬɚɥɶɧɨɣɬɪɚɧɫɮɭɡɢɢɩɪɢɦɨɧɨɯɨɪɢɚɥɶɧɨɣɞɜɨɣɧɟɩɪɢɦɧɨɝɨɜɨɞɢɢ
Ɇɚɬɟɪɢɚɥɢɦɟɬɨɞɵ.Ɉɛɫɥɟɞɨɜɚɧɨɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧɭɤɨɬɨɪɵɯɛɵɥɢ ɜɵɹɜɥɟɧɵ ɨɫɥɨɠɧɟɧɢɹ ɝɟɫɬɚɰɢɢ ɬɪɟɛɭɸɳɢɟ ɜɧɭɬɪɢɭɬɪɨɛɧɨɣ ɤɨɪɪɟɤɰɢɢ ɫ ɢɫ ɩɨɥɶɡɨɜɚɧɢɟɦɜɵɫɨɤɨɬɟɯɧɨɥɨɝɢɱɧɵɯɦɟɬɨɞɨɜ
Ɇɟɬɨɞɵɢɫɫɥɟɞɨɜɚɧɢɹ Ʉɥɢɧɢɱɟɫɤɢɟ
Ɉɛɳɢɟ ɤɥɢɧɢɤɨ-ɚɧɚɦɧɟɫɬɢɱɟɫɤɢɣ ɨɫɦɨɬɪ ɩɚɥɶɩɚɰɢɹ ɚɭɫɤɭɥɶɬɚɰɢɹ ɚɧɬɪɨɩɨɦɟɬɪɢɹ
ɋɩɟɰɢɚɥɶɧɵɟ
Ⱥɤɭɲɟɪɫɤɢɟɚɤɭɲɟɪɫɤɢɣɨɫɦɨɬɪɧɚɪɭɠɧɨɟɢɜɧɭɬɪɟɧɧɟɟɚɤɭɲɟɪɫɤɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟɩɟɥɶɜɢɨɦɟɬɪɢɹɚɭɫɤɭɥɶɬɚɰɢɹɫɟɪɞɰɟɛɢɟɧɢɣɩɥɨɞɚ
192
ɂɧɫɬɪɭɦɟɧɬɚɥɶɧɵɟ ɍɁɂ ɦɚɬɤɢ ɩɥɨɞɚ ɮɟɬɨɦɟɬɪɢɹ ɞɨɩɩɥɟɪɨɦɟɬɪɢɹ ɦɚ ɬɨɱɧɨ-ɩɥɨɞɨɜɨ-ɩɥɚɰɟɧɬɚɪɧɨɝɨɤɪɨɜɨɬɨɤɚɤɚɪɞɢɨɬɨɤɨɝɪɚɮɢɹ
Ʌɚɛɨɪɚɬɨɪɧɵɟ ɨɩɪɟɞɟɥɟɧɢɟ ɨɛɳɟɝɨ ɚɧɚɥɢɡɚ ɤɪɨɜɢ ɛɢɨɯɢɦɢɱɟɫɤɨɝɨ ɚɧɚ ɥɢɡɚ ɤɪɨɜɢ ɪɚɫɲɢɪɟɧɧɨɣ ɤɨɚɝɭɥɨɝɪɚɦɦɵ ɨɛɳɟɝɨ ɚɧɚɥɢɡɚ ɦɨɱɢ Ɉɛɨɪɭɞɨɜɚɧɢɟ ɭɥɶɬɪɚɡɜɭɤɨɜɨɣɚɩɩɚɪɚɬMedison Accuvixɮɟɬɨɫɤɨɩɢɝɥɵ0–22 G.
Ɋɟɡɭɥɶɬɚɬɵɢɫɫɥɟɞɨɜɚɧɢɹɢɨɛɫɭɠɞɟɧɢɟ.Ɂɚɩɟɪɢɨɞ4–20ɝɨɞɵɩɪɨɜɟ ɞɟɧɚɧɚɥɢɡɬɟɱɟɧɢɹɛɟɪɟɦɟɧɧɨɫɬɢɢɪɨɞɨɜɭɛɟɪɟɦɟɧɧɵɯɠɟɧɳɢɧɩɟɪɟɧɟɫɲɢɯ ɜɧɭɬɪɢɭɬɪɨɛɧɭɸ ɤɨɪɪɟɤɰɢɸ ɚɧɬɟɧɚɬɚɥɶɧɨɣ ɩɚɬɨɥɨɝɢɢ ɜɤɥɸɱɚɹ ɤɨɪɞɨɰɟɧɬɟɡ ȼɍȽɌɚɦɧɢɨɞɪɟɧɢɪɨɜɚɧɢɟɮɟɬɨɫɤɨɩɢɱɟɫɤɭɸɥɚɡɟɪɧɭɸɤɨɚɝɭɥɹɰɢɸɚɧɚɫɬɨɦɨɡɨɜ ɩɥɚɰɟɧɬɵ ɎɅɄɉȺ ɩɪɢ ɎɎɌɋ ɋɪɟɞɧɢɣ ɜɨɡɪɚɫɬ ɜɤɥɸɱɟɧɧɵɯ ɜ ɢɫɫɥɟɞɨɜɚɧɢɟ ɛɟɪɟɦɟɧɧɵɯ ɠɟɧɳɢɧ ɨɛɫɥɟɞɭɟɦɨɣ ɝɪɭɩɩɵ ɫɨɫɬɚɜɢɥ — ɥɟɬ Ɇɟ 5–
ɋɪɟɞɧɢɣɜɨɡɪɚɫɬɦɟɧɚɪɯɟɫɨɫɬɚɜɢɥ—ɥɟɬɊɨɫɬɠɟɧɳɢɧɜɝɪɭɩɩɟ ɢɫɫɥɟɞɨɜɚɧɢɹɫɨɫɬɚɜɢɥ—ɫɦɦɚɫɫɚɬɟɥɚɞɨɛɟɪɟɦɟɧɧɨɫɬɢɫɨɫɬɚɜɢɥɚ 60,0 (55,8 —ɤɝɩɪɢɷɬɨɦɡɧɚɱɟɧɢɹɢɧɞɟɤɫɚɦɚɫɫɵɬɟɥɚɜɝɪɭɩɩɟɨɛɫɥɟɞɨɜɚ ɧɢɹ ɫɨɫɬɚɜɢɥ — ɉɚɪɢɬɟɬ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɪɨɞɨɜ ɭ ɠɟɧɳɢɧ ɝɪɭɩɩɵɢɫɫɥɟɞɨɜɚɧɢɹɩɪɟɞɫɬɚɜɥɟɧɵɜɬɚɛɥɢɰɟ
Ɍɚɛɥɢɰɚ—ɉɚɪɢɬɟɬɛɟɪɟɦɟɧɧɨɫɬɢɢɪɨɞɨɜɭɠɟɧɳɢɧɝɪɭɩɩɵɢɫɫɥɟɞɨɜɚɧɢɹ ɉɚɪɢɬɟɬ Ƚɪɭɩɩɚɨɛɫɥɟɞɨɜɚɧɢɹn=34
ɉɟɪɜɨɛɟɪɟɦɟɧɧɵɟ 14 (42%)
ɉɨɜɬɨɪɧɨɛɟɪɟɦɟɧɧɵɟ 20 (58%)
ɂɡɧɢɯɜɚɧɚɦɧɟɡɟ
ɫɚɦɨɩɪɨɢɡɜɨɥɶɧɵɣɜɵɤɢɞɵɲ 4 (18,2%)
ȼɚɤɭɭɦ-ɚɫɩɢɪɚɰɢɹɢɦɟɞɢɰɢɧɫɤɢɣɚɛɨɪɬ 11 (54,5%)
ȼɧɟɦɚɬɨɱɧɚɹɛɟɪɟɦɟɧɧɨɫɬɶ 4 (18,2%)
Ɋɨɞɵ 11 (54,2%)
ɉɪɢɚɧɚɥɢɡɟɩɚɪɢɬɟɬɚɛɟɪɟɦɟɧɧɨɫɬɟɣɠɟɧɳɢɧɫɚɧɬɟɧɚɬɚɥɶɧɨɣɩɚ ɬɨɥɨɝɢɟɣɩɥɨɞɚɛɵɥɢɩɟɪɜɨɛɟɪɟɦɟɧɧɵɦɢɩɨɜɬɨɪɧɚɹɛɟɪɟɦɟɧɧɨɫɬɶɜɫɬɪɟɱɚɥɚɫɶɭ ɩɚɰɢɟɧɬɨɤɢɡɧɢɯɜɚɧɚɦɧɟɡɟɫɚɦɨɩɪɨɢɡɜɨɥɶɧɵɣɜɵɤɢɞɵɲɜ ɫɥɭɱɚɹɯɭ ɠɟɧɳɢɧɧɚɫɬɨɹɳɟɣɛɟɪɟɦɟɧɧɨɫɬɢɩɪɟɞɲɟɫɬɜɨɜɚɥɚɜɚɤɭɭɦ-ɚɫɩɢɪɚɰɢɹɢɥɢɦɟɞɢɰɢɧɫɤɢɣɚɛɨɪɬȼɧɟɦɚɬɨɱɧɚɹɛɟɪɟɦɟɧɧɨɫɬɶɜɚɧɚɦɧɟɡɟɜɫɬɪɟ
ɱɚɥɚɫɶɭɠɟɧɳɢɧɪɨɞɵ—ɭɩɚɰɢɟɧɬɨɤ
ɍɞɟɥɶɧɵɣ ɜɟɫ ɷɤɫɬɪɚɝɟɧɢɬɚɥɶɧɨɣ ɩɚɬɨɥɨɝɢɢ ɭ ɩɚɰɢɟɧɬɨɤ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɵ ɩɪɟɞɫɬɚɜɥɟɧɜɬɚɛɥɢɰɟ
Ɍɚɛɥɢɰɚ—ɗɤɫɬɪɚɝɟɧɢɬɚɥɶɧɚɹɩɚɬɨɥɨɝɢɹ ɜɝɪɭɩɩɟɢɫɫɥɟɞɨɜɚɧɢɹ
ɗɤɫɬɪɚɝɟɧɢɬɚɥɶɧɚɹɩɚɬɨɥɨɝɢɹ ȽɪɭɩɩɚɢɫɫɥɟɞɨɜɚɧɢɹQ ɋɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɚɹɩɚɬɨɥɨɝɢɹ 7 (21,1%)
ɉɚɬɨɥɨɝɢɹɅɈɊ—ɨɪɝɚɧɨɜ 23 (68,4%)
ɉɚɬɨɥɨɝɢɹɦɨɱɟɜɵɞɟɥɢɬɟɥɶɧɨɣɫɢɫɬɟɦɵ 2(5,3 %)
ɗɧɞɨɤɪɢɧɧɚɹɩɚɬɨɥɨɝɢɹ 7 (21,1%)
ɁɚɛɨɥɟɜɚɧɢɹɀɄɌɢɩɟɱɟɧɢɠɟɥɱɟɜɵɜɨɞɹɳɢɯɩɭɬɟɣ 7 (21,1%)
193
ɉɪɢ ɚɧɚɥɢɡɟ ɷɤɫɬɪɚɝɟɧɢɬɚɥɶɧɨɣ ɩɚɬɨɥɨɝɢɢ ɨɛɫɥɟɞɭɟɦɵɯ ɝɪɭɩɩ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɚɹ ɩɚɬɨɥɨɝɢɹ ɜɵɹɜɥɟɧɚ ɭ 7 (21,1%), ɩɚɬɨɥɨɝɢɹ ɅɈɊ-ɨɪɝɚɧɨɜ ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɚ ɭ23 ɠɟɧɳɢɧ ɩɚɬɨɥɨɝɢɹ ɦɨɱɟɜɵɞɟɥɢɬɟɥɶɧɨɣ ɫɢɫɬɟɦɵ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧɚ ɭ2 ɛɟɪɟɦɟɧɧɵɯ ɗɧɞɨɤɪɢɧɧɚɹ ɩɚɬɨɥɨɝɢɹ ɤɚɤ ɢ ɡɚɛɨɥɟɜɚɧɢɹ ɠɟɥɭɞɨɱɧɨ-ɤɢɲɟɱɧɨɝɨɬɪɚɤɬɚɩɟɱɟɧɢɢɠɟɥɱɟɜɵɜɨɞɹɳɢɯɩɭɬɟɣ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧɵ ɭ7ɠɟɧɳɢɧɋɨɱɟɬɚɧɢɟɷɤɫɬɪɚɝɟɧɢɬɚɥɶɧɨɣɩɚɬɨɥɨɝɢɢɡɚɮɢɤɫɢɪɨɜɚɧɨɭ12 (31,6%)ɩɚɰɢɟɧɬɨɤ.ɋɬɪɭɤɬɭɪɚɝɢɧɟɤɨɥɨɝɢɱɟɫɤɨɣɩɚɬɨɥɨɝɢɢɨɬɪɚɠɟɧɚɜɬɚɛɥɢɰɟ Ɍɚɛɥɢɰɚ—ɋɬɪɭɤɬɭɪɚɝɢɧɟɤɨɥɨɝɢɱɟɫɤɨɣɩɚɬɨɥɨɝɢɢ ɜɨɛɫɥɟɞɭɟɦɨɣɝɪɭɩɩɟ
Ƚɢɧɟɤɨɥɨɝɢɱɟɫɤɚɹɩɚɬɨɥɨɝɢɹ ȽɪɭɩɩɚɢɫɫɥɟɞɨɜɚɧɢɹQ
ɗɪɨɡɢɹɲɟɣɤɢɦɚɬɤɢ 11 (31,5%)
Ʉɢɫɬɚɹɢɱɧɢɤɚ 2 (5,3%)
ɏɪɨɧɢɱɟɫɤɢɣɫɚɥɶɩɢɧɝɨɨɮɨɪɢɬ 2 (5,3%)
ɇɚɢɛɨɥɶɲɟɟ ɱɢɫɥɨ ɫɥɭɱɚɟɜ ɝɢɧɟɤɨɥɨɝɢɱɟɫɤɨɣ ɩɚɬɨɥɨɝɢɢ ɩɪɢɯɨɞɢɬɫɹ ɧɚ ɷɪɨɡɢɸ ɲɟɣɤɢ ɦɚɬɤɢ — 11 ɤɢɫɬɵ ɹɢɱɧɢɤɨɜ ɢ ɯɪɨɧɢɱɟɫɤɢɣ ɫɚɥɶɩɢɧɝɨɨɮɨɪɢɬɜɵɹɜɥɟɧɵɩɨ2ɫɥɭɱɚɹ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ
ɋ ɰɟɥɶɸ ɚɧɚɥɢɡɚ ɬɟɱɟɧɢɹ ɝɟɫɬɚɰɢɨɧɧɨɝɨ ɩɪɨɰɟɫɫɚ ɢ ɪɨɞɨɜ ɜɫɟ ɩɚɰɢɟɧɬɤɢ ɛɵɥɢ ɪɚɡɞɟɥɟɧɵ ɧɚ ɬɪɢ ɩɨɞɝɪɭɩɩɵ ɩɨɞɝɪɭɩɩɭ—ɫɨɫɬɚɜɢɥɢ15 ɛɟɪɟɦɟɧɧɵɯ ɠɟɧɳɢɧɫȽȻɉɩɟɪɟɧɟɫɲɢɟɤɨɪɞɨɰɟɧɬɟɡ ɢȼɍȽɌ ɩɨɞɝɪɭɩɩɭ— 16ɛɟɪɟɦɟɧɧɵɯ ɠɟɧɳɢɧɫɎɎɌɋɩɟɪɟɧɟɫɲɢɟɎɅɄɉȺ ɩɨɞɝɪɭɩɩɭ— 3ɛɟɪɟɦɟɧɧɵɯ ɠɟɧɳɢɧɵ ɫ ɦɧɨɝɨɜɨɞɢɟɦɤɨɬɨɪɵɦɩɨɬɪɟɛɨɜɚɥɨɫɶɚɦɧɢɨɞɪɟɧɢɪɨɜɚɧɢɟ.
Ɍɚɛɥɢɰɚ 5 — Ɉɫɥɨɠɧɟɧɢɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɜ ɢɫɫɥɟɞɭɟɦɵɯ ɩɨɞɝɪɭɩɩɚɯ ɩɨ ɬɪɢɦɟɫɬɪɚɦ ɛɟɪɟɦɟɧɧɨɫɬɢ
Ɍɪɢɦɟɫɬɪ
ɛɟɪɟɦɟɧɧɨɫɬɢ Ɉɫɥɨɠɧɟɧɢɹ ɉɨɞɝɪɭɩɩɚ 1, n=15
ɉɨɞɝɪɭɩɩɚ 2, n=16
ɉɨɞɝɪɭɩɩɚ 3, n=3 I ɍɝɪɨɡɚɩɪɟɪɵɜɚɧɢɹɛɟɪɟɦɟɧɧɨɫɬɢ 4 (26,7%) 9 (56,3%)* 1 (33,3%) II ɍɝɪɨɡɚɩɪɟɪɵɜɚɧɢɹ 4 (26,7%) 12 (75%)* 2(66,7%)
ɏɎɉɇ 3 (20%) 16(100%)* 2 (66,7%)
III ɍɝɪɨɡɚɩɪɟɠɞɟɜɪɟɦɟɧɧɵɯɪɨɞɨɜ 2 (13,3%) 12 (75%)* 2 (66,7%)
Ƚɟɫɬɨɡ 2 (13,3%) 4 (25%) 1 (33,3%)
ɏɎɉɇ 3 (20%) 16 (100%)* 3 (100%)
ɉɪɢɦɟɱɚɧɢɟ— * —ɫɬɚɬɢɫɬɢɱɟɫɤɢɡɧɚɱɢɦɵɟɪɚɡɥɢɱɢɹɜɝɪɭɩɩɚɯɪ
Ⱥɧɚɥɢɡ ɬɟɱɟɧɢɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɪɨɞɨɜ ɭ ɠɟɧɳɢɧ ɝɪɭɩɩɵ ɨɛɫɥɟɞɨɜɚɧɢɹ ɩɨɤɚɡɚɥɱɬɨɜɩɟɪɜɨɦɬɪɢɦɟɫɬɪɟɭɜɫɟɯɩɨɞɝɪɭɩɩɜɟɞɭɳɢɦɨɫɥɨɠɧɟɧɢɟɦ ɝɟɫɬɚɰɢɢ ɹɜɥɹɥɚɫɶ ɭɝɪɨɡɚ ɩɪɟɪɵɜɚɧɢɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɜ ɩɨɞɝɪɭɩɩɟ ɛɵɥɚ ɜɵɹɜɥɟɧɚ ɜ (26,7 ɫɥɭɱɚɹɯ ɜɨ ɜɬɨɪɨɣ ɩɨɞɝɪɭɩɩɟ — ɜ9 (56,3%) ɫɥɭɱɚɹɯ ɢ ɜ ɬɪɟɬɶɟɣ ɩɨɞɝɪɭɩɩɟ—ɜ1 (33,3ɫɥɭɱɚɟ
ȼɨ ɜɬɨɪɨɦ ɬɪɢɦɟɫɬɪɟ ɜɟɞɭɳɢɦ ɨɫɥɨɠɧɟɧɢɟɦ ɛɟɪɟɦɟɧɧɨɫɬɢ ɜɨ ɜɬɨɪɨɣ ɢ ɬɪɟɬɶɟɣ ɩɨɞɝɪɭɩɩɟ ɹɜɥɹɥɚɫɶ ɭɫɭɝɭɛɥɟɧɢɟ ɯɪɨɧɢɱɟɫɤɨɣ ɮɟɬɨɩɥɚɰɟɧɬɚɪɧɨɣ ɧɟɞɨɫ ɬɚɬɨɱɧɨɫɬɢ ɜ ɜɨ ɜɬɨɪɨɣ ɩɨɞɝɪɭɩɩɟ ɨɧɚ ɛɵɥɚ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧɚ ɭ ɜɫɟɯ ɠɟɧɳɢɧ ɝɪɭɩɩɵɨɛɫɥɟɞɨɜɚɧɢɹɚɜɬɪɟɬɶɟɣɩɨɞɝɪɭɩɩɟɭɠɟɧɳɢɧɵ
ȼ ɬɪɟɬɶɟɦ ɬɪɢɦɟɫɬɪɟ ɯɪɨɧɢɱɟɫɤɚɹ ɮɟɬɨɩɥɚɰɟɧɬɚɪɧɚɹ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶ (ɏɎɉɇ) ɩɪɨɞɨɥɠɚɟɬ ɡɚɧɢɦɚɬɶ ɜ ɝɪɭɩɩɚɯ ɢɫɫɥɟɞɨɜɚɧɢɹ ɥɢɞɢɪɭɸɳɟɟ ɦɟɫɬɨ ɩɨ
194
ɚɤɭɲɟɪɫɤɢɦ ɨɫɥɨɠɧɟɧɢɹɦ ȼ ɩɟɪɜɨɣ ɩɨɞɝɪɭɩɩɟ ɏɎɉɇ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧɚ ɜ3 (20%)ɫɥɭɱɚɹɯɜɨɜɬɨɪɨɣɩɨɞɝɪɭɩɩɟ—ɜ16 (100%)ɫɥɭɱɚɹɯɜɬɪɟɬɶɟɣɩɨɞɝɪɭɩɩɟ
—ɜ3 (100%)ɫɥɭɱɚɹɯ
Ʉɪɨɦɟɭɝɪɨɡɵɩɪɟɪɵɜɚɧɢɹ ɢɭɫɭɝɭɛɥɟɧɢɹɯɪɨɧɢɱɟɫɤɨɣɮɟɬɨɩɥɚɰɟɧɬɚɪɧɨɣɧɟɞɨɫ ɬɚɬɨɱɧɨɫɬɢ ɤ ɨɫɥɨɠɧɟɧɢɹɦ ɛɟɪɟɦɟɧɧɨɫɬɢ ɜ ɬɪɟɬɶɟɦ ɬɪɢɦɟɫɬɪɟ ɩɪɢɫɨɟɞɢɧɢɥɫɹ ɝɟɫɬɨɡȼɩɟɪɜɨɣɩɨɞɝɪɭɩɩɟɝɟɫɬɨɡɛɵɥɞɢɚɝɧɨɫɬɢɪɨɜɚɧɭɠɟɧɳɢɧ
ȼɫɟɢɫɫɥɟɞɭɟɦɵɟɝɪɭɩɩɵɯɚɪɚɤɬɟɪɢɡɨɜɚɥɢɫɶɡɧɚɱɢɬɟɥɶɧɨɣɱɚɫɬɨɬɨɣ ɩɚɬɨɥɨ ɝɢɢɝɟɫɬɚɰɢɢɱɬɨɭɤɚɡɵɜɚɟɬɧɚɧɟɨɛɯɨɞɢɦɨɫɬɶɬɳɚɬɟɥɶɧɨɝɨɧɚɛɥɸɞɟɧɢɹɩɚɰɢɟɧ ɬɨɤɞɚɧɧɨɝɨɤɨɧɬɢɧɝɟɧɬɚɢɩɪɨɮɢɥɚɤɬɢɱɟɫɤɭɸɧɚɩɪɚɜɥɟɧɧɨɫɬɶɬɟɪɚɩɢɢ
ɋɪɨɤɛɟɪɟɦɟɧɧɨɫɬɢ,ɩɪɢɤɨɬɨɪɨɦɛɵɥɚɞɢɚɝɧɨɫɬɢɪɨɜɚɧɚɚɧɟɦɢɹɩɥɨɞɚɢȽȻɉ ɫɨɫɬɚɜɢɥ 27,3 ± 6,3 Ɇı)ɧɟɞɟɥɶ. ɋɪɟɞɧɟɟ ɱɢɫɥɨ ɤɨɪɞɨɰɟɧɬɟɡɨɜ ɜ ɩɨɞɝɪɭɩɩɟ ɫɨɫɬɚɜɢɥɨ ɪɚɡɚ
ȼɨɜɬɨɪɨɣɩɨɞɝɪɭɩɩɟ ɫɪɨɤɛɟɪɟɦɟɧɧɨɫɬɢ,ɩɪɢɤɨɬɨɪɨɦɛɵɥɜɵɹɜɥɟɧ ɎɎɌɋ, ɫɨɫɬɚɜɢɥɧɟɞɟɥɶ
ȼ ɬɪɟɬɶɟɣ ɝɪɭɩɩɟ ɦɧɨɝɨɜɨɞɢɟ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧɨ ɜ ɫɪɨɤɟ ɛɟɪɟɦɟɧɧɨɫɬɢ 31,3±2,5ɧɟɞɟɥɹ
ɋɪɨɤ ɪɨɞɨɪɚɡɪɟɲɟɧɢɹ ɜ ɤɚɠɞɨɣ ɢɡ ɩɨɞɝɪɭɩɩ ɫɨɫɬɚɜɢɥ ɜ ɩɟɪɜɨɣ— 36,5 ± ɜɨɜɬɨɪɨɣ—ɜɬɪɟɬɶɟɣ— 35,2ɧɟɞɟɥɶ
ȼɬɚɛɥɢɰɟ6ɩɪɟɞɫɬɚɜɥɟɧɚɧɚɥɢɡɦɟɬɨɞɚ ɪɨɞɨɪɚɡɪɟɲɟɧɢɹɩɨɩɨɞɝɪɭɩɩɚɦ Ɍɚɛɥɢɰɚ—Ɇɟɬɨɞ ɪɨɞɨɪɚɡɪɟɲɟɧɢɹɩɨɩɨɞɝɪɭɩɩɚɦ
Ɇɟɬɨɞɪɨɞɨɪɚɡɪɟɲɟɧɢɹ ɉɨɞɝɪɭɩɩɚn=15 ɉɨɞɝɪɭɩɩɚn=16 ɉɨɞɝɪɭɩɩɚ, n=3 Ɋɨɞɵ ɱɟɪɟɡ ɟɫɬɟɫɬɜɟɧ
ɧɵɟɪɨɞɨɜɵɟɩɭɬɢ 7 (46,7%) 4 (25%) –
Ʉɟɫɚɪɟɜɨɫɟɱɟɧɢɟ 8 (53,3%) 12 (75%) 3 (100%)*
ɉɪɢɦɟɱɚɧɢɟ
* —ɫɬɚɬɢɫɬɢɱɟɫɤɢɡɧɚɱɢɦɵɟɪɚɡɥɢɱɢɹɜɝɪɭɩɩɚɯɪ
ɋɪɟɞɢ ɠɟɧɳɢɧ ɩɨɞɝɪɭɩɩɵ ɱɟɪɟɡ ɟɫɬɟɫɬɜɟɧɧɵɟ ɪɨɞɨɜɵɟ ɩɭɬɢ ɛɵɥɨ ɪɨɞɨ ɪɚɡɪɟɲɟɧɨ ɠɟɧɳɢɧ ɩɭɬɟɦ ɨɩɟɪɚɰɢɢ ɤɟɫɚɪɟɜɨ ɫɟɱɟɧɢɟ— 8 (53,3%) ɠɟɧɳɢɧȼɨɜɬɨɪɨɣɩɨɞɝɪɭɩɩɟɭɩɚɰɢɟɧɬɨɤɪɨɞɵɩɪɨɜɟɞɟɧɵɱɟɪɟɡɟɫɬɟ ɫɬɜɟɧɧɵɟɪɨɞɨɜɵɟɩɭɬɢɩɭɬɟɦɨɩɟɪɚɰɢɢɤɟɫɚɪɟɜɨɫɟɱɟɧɢɟ—ɭɜɩɨɞ ɝɪɭɩɩɟɜɫɟɪɨɞɵɡɚɜɟɪɲɟɧɵɩɭɬɟɦɨɩɟɪɚɰɢɢɤɟɫɚɪɟɜɨɫɟɱɟɧɢɟɪ
ȼɵɜɨɞɵ
1. Ȼɟɪɟɦɟɧɧɨɫɬɶ ɭ ɩɚɰɢɟɧɬɨɤ ɝɪɭɩɩɵ ɢɫɫɥɟɞɨɜɚɧɢɹ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɜɵɫɨ ɤɨɣɱɚɫɬɨɬɨɣɩɚɬɨɥɨɝɢɢɝɟɫɬɚɰɢɢɭɝɪɨɡɚɩɪɟɪɵɜɚɧɢɹɛɟɪɟɦɟɧɧɨɫɬɢɯɪɨɧɢɱɟɫɤɚɹ ɮɟɬɨɩɥɚɰɟɧɬɚɪɧɚɹɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶɨɫɥɨɠɧɢɜɲɚɹɋɁɊɉɱɬɨɭɤɚɡɵɜɚɟɬɧɚɧɟɨɛ ɯɨɞɢɦɨɫɬɶ ɬɳɚɬɟɥɶɧɨɝɨ ɨɛɫɥɟɞɨɜɚɧɢɹ ɧɚɛɥɸɞɟɧɢɹ ɩɚɰɢɟɧɬɨɤ ɞɚɧɧɨɝɨ ɤɨɧɬɢɧ ɝɟɧɬɚɢɩɪɨɮɢɥɚɤɬɢɱɟɫɤɭɸɧɚɩɪɚɜɥɟɧɧɨɫɬɶɬɟɪɚɩɢɢ
2. ɋɜɨɟɜɪɟɦɟɧɧɚɹɞɢɚɝɧɨɫɬɢɤɚɢɩɪɨɜɟɞɟɧɢɟɚɞɟɤɜɚɬɧɨɣɤɨɪɪɟɤɰɢɢɜɧɭɬɪɢ ɭɬɪɨɛɧɨɣɩɚɬɨɥɨɝɢɢɩɪɢɎɎɌɋɢȽȻɉɩɨɡɜɨɥɹɟɬɭɜɟɥɢɱɢɬɶɫɪɨɤɢɜɵɧɚɲɢɜɚɧɢɹ ɛɟɪɟɦɟɧɧɨɫɬɢ
3. Ʉɚɠɞɵɣɜɬɨɪɨɣɪɟɛɟɧɨɤɪɨɞɢɥɫɹɨɬɬɪɟɬɶɟɣɢɛɨɥɟɟɛɟɪɟɦɟɧɧɨɫɬɢɢɜɬɨ ɪɵɯɪɨɞɨɜȻɨɥɶɲɢɧɫɬɜɨɦɥɚɞɟɧɰɟɜɪɨɞɢɥɢɫɶɩɪɢɚɛɞɨɦɢɧɚɥɶɧɨɦɪɨɞɨɪɚɡɪɟɲɟ ɧɢɢɜɩɥɚɧɨɜɨɦɩɨɪɹɞɤɟ
Ʌɢɬɟɪɚɬɭɪɚ
195
1. ȺɤɭɲɟɪɫɬɜɨɇɚɰɢɨɧɚɥɶɧɨɟɪɭɤɨɜɨɞɫɬɜɨɉɨɞɪɟɞɚɤɚɞɊȺɆɇɗɄȺɣɥɚɦɚɡɹɧɚ ɚɤɚɞ ɊȺɆɇ ȼɂ Ʉɭɥɚɤɨɜɚ ɚɤɚɞ ɊȺɆɇ ȽɆ ɋɚɜɟɥɶɟɜɨɣ— Ɇ ɂɡɞ-ɜɨ
©ȽɗɈɌȺɊ-Ɇɟɞɢɚª—ɫ
2. Xiangqun Li1, Prognosis and long-term neurodevelopmental outcome in conservatively treated twin-to-twin transfusion syndrome /Xiangqun Li1, Seiichi Morokuma, Kotaro Fukushima, Yuka Otera, Yasuo Yumoto, Kiyomi Tsukimori //Pregnancy and Childbirth. — 2011. — P. — 11:32/
3. Harper, D.C. Long-term neurodevelopmental outcome and brain volume after treatment for hydrops fetalis by in utero intravascular transfusions / D.C. Harper [et al.] // Am. J. Obstet.
Gynecol. — 2006. — Vol. 195. — P. 192–196.
4. Banek CS, Hecher K, Hackeloer BJ, Bartmann P: long-term neuordevelopmental out-come after intrauterine laser treatment for severe twin-twin transfusion syndrome. Am J Obstet Gynecol 2003, 188:876–80.
5. Ʉɨɧɨɩɥɹɧɧɢɤɨɜ ȺȽ ɇɨɜɵɟ ɬɟɯɧɨɥɨɝɢɢ ɜ ɞɢɚɝɧɨɫɬɢɤɟ ɥɟɱɟɧɢɢ ɢ ɩɪɨɮɢɥɚɤɬɢɤɢ ɝɟɦɨɥɢɬɢɱɟɫɤɨɣ ɛɨɥɟɡɧɢ ɩɥɨɞɚ ɢ ɧɨɜɨɪɨɠɞɟɧɧɨɝɨ ɚɜɬɨɪɟɮ ɞɢɫ «ɞɨɤɬ ɦɟɞ ɧɚɭɤ ȺȽ ɄɨɧɨɩɥɹɧɧɢɤɨɜɆɢɧɡɞɪɚɜɢɫɨɰɪɚɡɜɊɎ—Ɇ—ɫ
PREGNANCY IN WOMEN UNDERGOING INTRAUTERINE CORRECTION ANTENATAL PATHOLOGY OF FETUS