2012 ¹ 9 Âîåííî-ìåäèöèíñêèé æóðíàë
ÑÅÍÒßÁÐÜ
2012
 ãîä ñâîåãî 190-ëåòèÿ «Âîåííî-ìåäèöèíñêèé æóðíàë» îòêðûâàåò íîâóþ
ðóáðèêó, ïîñâÿùåííóþ ìåäèöèíñêîé ñëóæáå íà âîéíå, – «Â îáúåêòèâå âîéíà».
Ýòî áóäóò ôîòîäîêóìåíòû âîåííîãî âðåìåíè, íå âñåãäà êà÷åñòâåííûå è ñ òî÷íûìè
ïîäïèñÿìè, ÷àñòü èç íèõ ïîÿâèòñÿ â ïå÷àòè âïåðâûå. Ïîäîáíàÿ âîçìîæíîñòü
ïîÿâèëàñü ó íàñ áëàãîäàðÿ äëèòåëüíîé ïîèñêîâîé ðàáîòå â ôîíäàõ Ðîññèéñêîãî
ãîñóäàðñòâåííîãî àðõèâà êèíîôîòîäîêóìåíòîâ (ÐÃÀÊÔÄ), â ò. ÷. è ñ íåäàâíî
ðàññåêðå÷åííûìè ìàòåðèàëàìè.  ÷àñòíîñòè, ìû âïåðâûå ïîçíàêîìèì ÷èòàòåëåé
ñ íåêîòîðûìè ôîòîãðàôèÿìè, êàñàþùèìèñÿ òàêîé ìàëîèçâåñòíîé òåìû, êàê
âîåííàÿ ìåäèöèíà ãèòëåðîâñêîé Ãåðìàíèè íà Âîñòî÷íîì ôðîíòå.
È ðàçâå ïåðâîå æå òðîôåéíîå ôîòî èç ïîäáîðêè – íåìåöêèå ñàíèòàðíûå
ìàøèíû íà øîññå – íå íàïîëíåíî ñêðûòûì ñìûñëîì? Íà äâîðå – ñàìûå
òÿæå-ëûå äëÿ íàøåé Ðîäèíû çà âåñü âåê ëåòíèå ìåñÿöû 1941 ã., êîãäà àðìèè âåðìàõòà,
ïîñòàâèâøåãî ñåáå íà ñëóæáó âñå ðåñóðñû «îáúåäèíåííîé Åâðîïû», óïîðíî è,
êàçàëîñü, íåóêðîòèìî äâèíóëèñü íà âîñòîê. Ýòè ñàíèòàðíûå àâòîìîáèëè ìîãëè
áûòü êàê íåìåöêèìè, òàê è ôðàíöóçñêèìè, èòàëüÿíñêèìè, ÷åøñêèìè èëè
òðîôåéíûìè, áðîøåííûìè àíãëè÷àíàìè ó Äþíêåðêà.
Íî â òå äíè íàøè ñîîòå÷åñòâåííèêè ïðîòèâîïîñòàâèëè íàïîðó çàâîåâàòåëåé
ðåøèìîñòü è ìóæåñòâî, çàïå÷àòëåííûå ôîòîãðàôèÿìè â âûðàæåíèÿõ ëèö
ñàí-èíñòðóêòîðîâ è áîéöîâ Êðàñíîé Àðìèè. Ñîâñåì èíûå ëèöà ó ðàíåíûõ
îêêó-ïàíòîâ íà ñíèìêå, ñäåëàííîì â âîåííîì ãîñïèòàëå ïîä Ïñêîâîì. Ýòè ìîëîäûå
íåìöû-èíâàëèäû åùå íåïëîõî îòäåëàëèñü – êóäà ãîðøå ïðèäåòñÿ èõ ñîñëóæèâöàì
ñïóñòÿ íåñêîëüêî ìåñÿöåâ ïîä Ìîñêâîé.
Äðóãîé ñíèìîê – «Ïðàêòè÷åñêèå ó÷åíèÿ ñëóøàòåëüíèö øêîë ìåäñåñòåð» –
íå ëó÷øàÿ ëè èëëþñòðàöèÿ òîòàëüíîé ìîáèëèçàöèè, â òå äíè îõâàòèâøåé ñòðàíó
è ñòàâøåé îäíîé èç ïðåäïîñûëîê Ïîáåäû?..
À âîò ñîâñåì íåïàðàäíîå è âïåðâûå ïóáëèêóåìîå ôîòî ãåíåðàë-ïîëêîâíèêà
Àíäðåÿ Èâàíîâè÷à Åð¸ìåíêî â îêðóæåíèè âîåííûõ âðà÷åé. Êàçàëîñü áû,
ìèðíàÿ ñöåíà, åñëè íå çíàòü, ÷òî ýòî ðàíåíèå ïîëêîâîäöà 13 îêòÿáðÿ 1941 ã. áûëî
óæå âòîðûì ñ íà÷àëà âîéíû è ïîëó÷èë åãî êîìàíäóþùèé Áðÿíñêèì ôðîíòîì,
ëè÷íî âîçãëàâëÿÿ ïðîðûâ èç îêðóæåíèÿ.
 ïëàíàõ ðåäàêöèè –
è â äàëüíåéøåì
çíàêî-ìèòü ÷èòàòåëåé ñ
ôîòî-ëåòîïèñüþ èñòîðèè
âîåí-íîé ìåäèöèíû èç
ôîí-äîâ ÐÃÀÊÔÄ, ïîëüçóÿñü
ïðàâîì íà ýòî,
ïðåäîñòàâ-ëåííûì
«Âîåííî-ìåöèíñêîìó æóðíàëó»
äè-ðåêöèåé àðõèâà. Íà íàøèõ
ñòðàíèöàõ áóäóò âïåðâûå
ïðåäñòàâëåíû àðõèâíûå
ôîòî êàê ïåðèîäà
Âåëè-êîé Îòå÷åñòâåííîé
âîé-íû 1941–1945 ãã., òàê è
Ïåðâîé ìèðîâîé âîéíû
1914–1918 ãã.
Êîëîííà íåìåöêèõ ñàíèòàðíûõ ìàøèí íà øîññå. Âîñòî÷íûé ôðîíò,èþíü 1941 ã. Ôîòîãðàô Çèëüáåðìàí (ÐÃÀÊÔÄ, îï. 3, ¹ 160, ñí. 1) îáúåêòèâå âîéíà: ëåòî–îñåíü 1941 ãîäà
Ïðàêòè÷åñêèå ó÷åíèÿ ñëóøàòåëüíèö øêîë ìåäñåñòåð. Äîíáàññ, 1941 ã. (ÐÃÀÊÔÄ, ¹ 0-256261) Ñàíèòàðû Ç.Ì.Áîíôìàí è À.Ñ.Áåëÿí÷èêîâ ïðîáèðàþòñÿ ê ðàíåíîìó. Äåéñòâóþùàÿ àðìèÿ, èþëü 1941 ã. (ÐÃÀÊÔÄ, ¹ 0-221017) Ñàíäðóæèííèöû Âåðà Ñàðàåâà è Òàíÿ Ãîëóáåíêîâà ïåðåâÿçûâàþò ðàíåíîãî. Ôîòî Â.Òàðàñåâè÷à. Äåéñòâóþùàÿ àðìèÿ, ñåíòÿáðü 1941 ã.Ïåðåâÿçêà ðàíåíîãî íà áàòàëüîííîì ïóíêòå ïåðâîé ïîìîùè. Äåéñòâóþùàÿ àðìèÿ, àâãóñò 1941 ã. (ÐÃÀÊÔÄ, ¹ 0-255802) Ñàíèòàð-áîåö Äîäîõàí Íàñèìîâ îêàçûâàåò ïîìîùü ðàíåíîìó áîéöó. Ñåíòÿáðü 1941 ã. (ÐÃÀÊÔÄ, ¹ 0-225108) Âîåíâðà÷ 1 ðàíãà À.È.Ðîãîâñêèé, âîåíâðà÷ 1 ðàíãà Í.Ï.Ðóäàêîâ, ãåíåðàë-ïîëêîâíèê À.È.Åð¸ìåíêî, âîåíâðà÷ I ðàíãà õèðóðã À.Â.Êàïëàí, 1941 ã. (ÐÃÀÊÔÄ, ¹ 0-271794)
Ñàíèòàðêà Ê.Îðëîâà îêàçûâàåò ïåðâóþ ïîìîùü ðàíåíîìó íà ïîëå áîÿ. Ôîòîãðàô Ìàçåëåâ. Äåéñòâóþùàÿ àðìèÿ, 1941 ã. (ÐÃÀÊÔÄ, ¹ 0-157428) Ñàíèíñòðóêòîð Ë.Êèñëÿêîâà ïåðåâÿçûâàåò ðàíåíîãî íà ïîëå áîÿ. Áåëîðóññêèé ôðîíò, 1941 ã. (ÐÃÀÊÔÄ, ¹ 0-256622) Âðà÷åáíûé îáõîä â îäíîì èç íåìåöêèõ àðìåéñêèõ âîåííûõ ãîñïèòàëåé. Ïñêîâñêàÿ îáëàñòü, àâãóñò 1941 ã. Ôîòîãðàô Øþðåð (ÐÃÀÊÔÄ, îï. 2, ¹ 73, ñí. 12)
 îáúåêòèâå âîéíà: ëåòî–îñåíü 1941 ãîäà
Àäðåñ ðåäàêöèè: 194044, Ñàíêò-Ïåòåðáóðã, óë. Àêàäåìèêà Ëåáåäåâà, ä. 6 Òåë. (812) 292-33-46 Êîðïóíêò â Ìîñêâå: 119160, Ìîñêâà, ðåäàêöèÿ «Âîåííî-ìåäèöèíñêîãî æóðíàëà» Òåë./ôàêñ: (495) 656-33-41 ÒÅÎÐÅÒÈ×ÅÑÊÈÉ È ÍÀÓ×ÍÎ-ÏÐÀÊÒÈ×ÅÑÊÈÉ ÆÓÐÍÀË ÌÈÍÈÑÒÅÐÑÒÂÀ ÎÁÎÐÎÍÛ ÐÎÑÑÈÉÑÊÎÉ ÔÅÄÅÐÀÖÈÈ ÐÅÄÀÊÖÈÎÍÍÀß ÊÎËËÅÃÈß: Ì.Â.Ïîääóáíûé (ãëàâíûé ðåäàêòîð) Â.Â.Áóçóíîâ (îòâåòñòâåííûé ñåêðåòàðü) À.Þ.Âëàñîâ Ë.Ë.Ãàëèí (çàìåñòèòåëü ãëàâíîãî ðåäàêòîðà) Â.Â.Èâàíîâ Î.Â.Êàëà÷åâ À.À.Êàëìûêîâ À.Á.Ëåîíèäîâ Þ.Â.Ëîáçèí Þ.Â.Ìèðîøíè÷åíêî Â.À.Íîâèêîâ Â.Å.Ïàðô¸íîâ È.Â.Ïåòðååâ È.Ì.Ñàìîõâàëîâ Ý.Ï.Ñîëîâåé Þ.Ø.Õàëèìîâ Â.Í.Öûãàí Â.Ê.Øàìðåé À.Ì.Øåëåïîâ Â.Â.ßìåíñêîâ ÐÅÄÀÊÖÈÎÍÍÛÉ ÑÎÂÅÒ:
Èçäàåòñÿ ñ 1823 ãîäà
2012 * ÑÅÍÒßÁÐÜ
Ò. 333 * ¹ 9
ÌÎÑÊÂÀ ÈÇÄÀÒÅËÜÑÊÈÉ ÄÎÌ «ÊÐÀÑÍÀß ÇÂÅÇÄÀ» Ñ.À.Áåëÿêèí (Êðàñíîãîðñê) Ï.Ã.Áðþñîâ (Ìîñêâà) À.À.Áóäêî (Ñ.-Ïåòåðáóðã) Ñ.Ô.Ãîí÷àðîâ (Ìîñêâà) Â.Â.Äîáðæàíñêèé (Ìîñêâà) Å.Â.Èâ÷åíêî (Ñ.-Ïåòåðáóðã) È.Á.Ìàêñèìîâ (Ìîñêâà) È.Ã.Ìîñÿãèí (Êàëèíèíãðàä) Ý.À.Íå÷àåâ (Ìîñêâà) Ï.Â.Ïèí÷óê (Ìîñêâà) Â.Á.Ñèìîíåíêî (Ìîñêâà) À.ß.Ôèñóí (Ìîñêâà) È.Ì.×èæ (Ìîñêâà) Àäðåñ â ñåòè Èíòåðíåò: http://sc.mil.ru/social/media/ magazine/more.htm?id=8753 @morfOrgInfoÔîðìèðîâàíèå ñàíèòàðíûõ ïîòåðü
òåðàïåâòè÷åñêîãî ïðîôèëÿ
â îãðàíè÷åííûõ âîåííûõ êîíôëèêòàõ
Î ìåäèöèíñêîé ðåàáèëèòàöèè
ðàíåíûõ ñ ïîñëåäñòâèÿìè áîåâîé
òðàâìû âåðõíèõ êîíå÷íîñòåé
Äèàãíîñòèêà è ëå÷åíèå
ïàöèåíòîâ ñ ñàðêîèäîçîì
â âîåííîì ñòàöèîíàðå
Îñîáåííîñòè àäàïòàöèè
âîåííîñëóæàùèõ ñðî÷íîé ñëóæáû
Çðèòåëüíûå èëëþçèè è àâèàãîðèçîíòû
Î ïîääåðæàíèè ðàáîòîñïîñîáíîñòè
ìîðÿêîâ â ïîõîäå íàäâîäíîãî êîðàáëÿ
â óñëîâèÿõ Çàïîëÿðüÿ
Ìåäèöèíñêîå îáåñïå÷åíèå
Ðóññêîé àðìèè â Îòå÷åñòâåííîé
âîéíå 1812 ãîäà
ÑONTENTS
4
Ëå÷åáíî-ïðîôèëàêòè÷åñêèå
âîïðîñû Prophylaxis and treatment
Îðãàíèçàöèÿ ìåäèöèíñêîãî îáåñïå÷åíèÿ Âîîðóæåííûõ ñèë
Organization of medical support of the Armed Forces
17 35 41 Ìåäèöèíà ýêñòðåìàëüíûõ ñèòóàöèé Medicine of extreme situations 12 22 27 Ãèãèåíà è ôèçèîëîãèÿ âîåííîãî òðóäà Military physiology and hygiene Õàëèìîâ Þ.Ø., Òêà÷óê Í.À., Æåêàëîâ À.Í. – Ôîðìèðîâàíèå ñàíèòàðíûõ ïîòåðü òå-ðàïåâòè÷åñêîãî ïðîôèëÿ â ëîêàëüíûõ âîéíàõ è âîîðóæåííûõ êîíôëèêòàõ Èâ÷åíêî Å.Â., ×åðíûé Â.Ñ., Òîïîðêîâ Ì.Ò., Àëåêñàíäðîâ Ì.Â. – Íàïðàâëåíèÿ ìåæ-âåäîìñòâåííîãî âçàèìîäåéñòâèÿ ïðè îêàçàíèè ìåäèöèíñêîé ïîìîùè ïîñòðà-äàâøèì â ðåçóëüòàòå ÷ðåçâû÷àéíûõ ñèòóàöèé â ïóíêòàõ áàçèðîâàíèÿ ôëîòà Äðåìîâ Â.Â., Îäèíàê Ì.Ì., Áðîâêèí Ñ.Ã., Åìåëèí À.Þ., ×óðèëîâ Þ.Ê. – Àíàëèç ÷àñòîòû è ñòðóêòóðû öåðåáðîâàñêóëÿð-íûõ çàáîëåâàíèé ó âîåííîñëóæàùèõ ïðè ïðîâåäåíèè âîåííî-âðà÷åáíîé ýêñ-ïåðòèçû Øåëåïîâ À.Ì., Ñìàãóëîâ Í.Ê., Ìóõàìåò-æàíîâ À.Ì. – Îñîáåííîñòè àäàïòàöèè âîåííîñëóæàùèõ ñðî÷íîé ñëóæáû (Îáçîð ëèòåðàòóðû) 31
Khalimov Yu. Sh., Tkachuk N.A., Zhekalov A.N. – Formation of sanitary losses of thera-peutic profile in local wars and military conflicts Áåëÿêèí Ñ.À., Áóðëàê À.Ì. – Îðãàíèçà-öèîííî-ìåòîäè÷åñêèå ïîäõîäû ê ìå-äèöèíñêîé ðåàáèëèòàöèè ðàíåíûõ ñ ïîñëåäñòâèÿìè áîåâîé òðàâìû âåðõíèõ êîíå÷íîñòåé â óñëîâèÿõ ðåàáèëèòàöè-îííîãî öåíòðà Êóçüìèí Ñ.À. – Àíàëèç ñîñòîÿíèÿ çäî-ðîâüÿ ãðàæäàí ïðèçûâíîãî âîçðàñòà Îðåíáóðãñêîé îáëàñòè
Belyakin S.A., Burlak A.M. – Organizational and methodological approaches to the medical rehabilitation of the wounded from the consequences of combat trauma in the upper limb rehabilitation center
Êuzmin S.A. – Analysis of the health
of citizens of military age in Orenburg region
Ivchenko E.V., Cherny V.S., Toporkov M.T., Aleksandrov M.V. – Directions of inter-departmental interaction in case of deli-very of health care for injured in emer-gency situations in stationing sites of navy
Dremov V.V., Odinak M.M., Brovkin S.G., Emelin A.Yu., Churilov Yu.K. – Analysis of frequency and structure of cerebrovascu-lar diseases in servicemen during the mili-tary physician expertise
Plekhanov V.N. – About the causes of
cystitis progression in young women Zaytsev A.A., Anti pushina D.N., Sivoko-zov I.V., Chernov S.A. – Diagnostics and treatment of patients with sarcoidosis in multidisciplinary hospital Ïëåõàíîâ Â.Í. – Î ïðè÷èíàõ ðàçâèòèÿ õðîíè÷åñêîãî öèñòèòà ó æåíùèí ìî-ëîäîãî âîçðàñòà Çàéöåâ À.À., Àíòèïóøèíà Ä.Í., Ñèâîêî-çîâ È.Â., ×åðíîâ Ñ.À. – Äèàãíîñòèêà è ëå÷åíèå ïàöèåíòîâ ñ ñàðêîèäîçîì â ìíîãîïðîôèëüíîì âîåííîì ñòàöèîíàðå
Shelepov A.M., Smagulov N.K., Mukhamet-zhanov A.M. – Peculiarities of adaptation of servicemen service (Review of literature)
3
«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2012 ÑONTENTS Êðàòêèå ñîîáùåíèÿ Brief reports Õðîíèêà Chronicle Îôèöèàëüíûé îòäåë Official communications 92 46 90 62 77 Èç èñòîðèè âîåííîé ìåäèöèíûFrom the history of military medicine 87 52 83 68 Àâèàöèîííàÿ
è âîåííî-ìîðñêàÿ ìåäèöèíà Air and navy medicine
êî À.Â., Áàëàáàí È.Â., Êëþåâà Í.Í., Ïøå-íè÷íàÿ À.Ã., Áåçíèí Ã.Â., Ëåé÷èíñêèé Ñ.Â. – Îöåíêà íàðóøåíèé ìåòàáîëèçìà ó âî-åííîñëóæàùèõ ñ ïñèõîñîìàòè÷åñêèìè íàðóøåíèÿìè â îòäàëåííûé ïåðèîä âèòàëüíîãî ñòðåññà Æäàíüêî È.Ì., ×óëàåâñêèé À.Î., Êîâàëåí-êî Ï.À. – Çðèòåëüíûå èëëþçèè è àâèà-ãîðèçîíòû Æèëüöîâà È.È., ßðêîâ À.Ì., Ìÿñíèêîâ À.À. – Î ïîääåðæàíèè ðàáîòîñïîñîáíîñòè ìîðÿêîâ â ïîõîäå íàäâîäíîãî êîðàáëÿ â óñëîâèÿõ Çàïîëÿðüÿ Áóäêî À.À., Æóðàâë¸â Ä.À. – Ìåäèöèí-ñêîå îáåñïå÷åíèå Ðóññêîé àðìèè â Îòå÷åñòâåííîé âîéíå 1812 ãîäà Íàõàïåòîâ Á.À. – Ïîäâèã ëåéá-ìåäèêà Þñòóñà Ëîäåðà Êàðïåíêî È.Â. – Ãîñïèòàëüíûå øêîëû â ïåðèîä Ðóññêî-òóðåöêîé âîéíû 1735– 1739 ãã. Îãàðêîâ Ï.È., Êóçèí À.À. – Âñåðîññèé-ñêèé íàó÷íûé ôîðóì ïî ýïèäåìèîëîãèè
Balaban I.V., Klyueva N.N., Pshenichna-ya A.G., Beznin G.V., Leychinsky S.V. – Analysis of infringements of exchange processes in combatatnts with psycho-somatic disorders in the period after par-ticipation in operations
Zhdanko I.M., Chulayevsky A.O.,
Kovalen-ko P.A. – Visual illusions and moving
horizon
Zhiltsova I.I., Yarkov A.M., Myasnikov A.A. – About the fitness to work of sailors during the campaign of surface vessel in conditions of Polar Region
Budko A.A., Zhuravlyov D.A. – Medical
supply of the Russian army during the Patriotic War in 1812
Nakhapetov B.A. – Act of bravy of
Sur-geon in ordinary to the King Yustus Loder
Karpenko I.V. – Hospital schools during
the Russian-Turkish War 1735–1739
Ogarkov P.I., Kuzin A.A. – All-russian
ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ
ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË
© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2012 ÓÄÊ 61:355Ôîðìèðîâàíèå ñàíèòàðíûõ ïîòåðü
òåðàïåâòè÷åñêîãî ïðîôèëÿ â ëîêàëüíûõ âîéíàõ
è âîîðóæåííûõ êîíôëèêòàõ
ÕÀËÈÌΠÞ.Ø., çàñëóæåííûé âðà÷ ÐÔ, äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû ÒÊÀ×ÓÊ Í.À., êàíäèäàò ìåäèöèíñêèõ íàóê ÆÅÊÀËΠÀ.Í., äîêòîð ìåäèöèíñêèõ íàóê Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-ÏåòåðáóðãKhalimov Yu.Sh.,Tkachuk N.A., Zhekalov A.N. – Formation of therapeutic group of casualties in local wars and armed conflicts. The necessity of improvement of the therapeutic care organization in the RF Armed Forces is dictated by the existing military threats. Conflicts between states or within a single country along with inefficiency of di plomatic, social and political efforts may lead to armed conflicts or local wars. Analysis of medical support results shows the consistent prevalence of therapeutic group of casualties in the overall structure of medical losses. 35–50% of all sanitary losses is accounted for by somatic diseases. Moreover, their structure is similar to the structure of the army’s peacetime morbidity rate. Respiratory diseases head the list of somatic diseases in military personnel. Next – diseases of the digestive and circulatory systems. One of the most important tasks for physicians in wartime is early diagnosis and treatment of visceral pathology in the wounded. An additional point is that the use of tactical nuclear weapons during the armed conflict or local war cannot be completely excluded. There is also a real risk of nuclear and chemical facilities damage, with consequences that are comparable to the use of nuclear or chemical weapons. Thus, in the course of armed conflict or local war, military physicians can meet all possible therapeutic spectrum of pathology: from visceral pathology of peace and wartime to combat related therapeutic pathology.
K e y w o r d s: armed conflict, local war, therapeutic group of casualties, combat related therapeutic pathology, rendering therapeutic care.
Ê
ñîæàëåíèþ, ìèð XXI âåêà íå ñòàë áîëåå áåçîïàñíûì.  ñëîæíûõ óñëî-âèÿõ ñîâðåìåííîé ìåæäóíàðîäíîé îá-ñòàíîâêè è âíóòðèïîëèòè÷åñêîé æèçíè ïî-ïðåæíåìó ñîõðàíÿþòñÿ èñòî÷íèêè âî-åííîé îïàñíîñòè.  èõ îñíîâå ëåæàò ðàç-ëè÷íîãî ðîäà ïðîòèâîðå÷èÿ, âîçíèêàþùèå ìåæäó ãîñóäàðñòâàìè èëè âíóòðè îòäåëü-íîé ñòðàíû íà ïîëèòè÷åñêîé, òåððèòîðè-àëüíîé, ðåëèãèîçíîé, íàöèîíàëüíî-ýòíè-÷åñêîé è äðóãèõ îñíîâàõ, ÷òî ïðè íåýô-ôåêòèâíîñòè äèïëîìàòè÷åñêèõ, ñîöèàëü-íî-ïîëèòè÷åñêèõ óñèëèé ìîæåò ïðèâî-äèòü ê âîçíèêíîâåíèþ ëîêàëüíûõ âîéí (ËÂ) è âîîðóæåííûõ êîíôëèêòîâ (ÂÊ). Ïîä ÂÊ ïðèíÿòî ïîíèìàòü ëþáîå ñòîëêíîâåíèå, ïðîòèâîáîðñòâî êàê ñïî-ñîá ðàçðåøåíèÿ ïðîòèâîðå÷èé ìåæäó ãîñóäàðñòâàìè, íàðîäàìè, ñîöèàëüíûìè ãðóïïàìè ñ ïðèìåíåíèåì âîåííîé ñèëû. Ýòî îäíà èç ôîðì ðàçðåøåíèÿ íàöèî-íàëüíî-ýòíè÷åñêèõ, ðåëèãèîçíûõ è äðó-ãèõ íåêîðåííûõ ïðîòèâîðå÷èé ñ ïðèìå-íåíèåì ñðåäñòâ âîîðóæåííîãî íàñèëèÿ, ïðè êîòîðîé ãîñóäàðñòâî (ãîñóäàðñòâà) íå ïåðåõîäÿò â îñîáîå ñîñòîÿíèå, îïðå-äåëÿåìîå êàê âîéíà. Ê ÂÊ îòíîñÿòñÿ âî-åííûå èíöèäåíòû, âîâî-åííûå àêöèè è äðóãèå âîîðóæåííûå ñòîëêíîâåíèÿ íå-çíà÷èòåëüíîãî ìàñøòàáà ñ ïðèìåíåíè-åì ðåãóëÿðíûõ èëè èððåãóëÿðíûõ âîî-ðóæåííûõ ôîðìèðîâàíèé, ïðè êîòîðûõ àêò ôîðìàëüíîãî îáúÿâëåíèÿ âîéíû îò-ñóòñòâóåò, à âîîðóæåííàÿ áîðüáà îãðà-íè÷èâàåòñÿ ïðåäåëàìè îïåðàòèâíîãî íàïðàâëåíèÿ. Ë – ýòî îãðàíè÷åííûé, êàê ïðàâè-ëî, äâóñòîðîííèé âîåííûé êîíôëèêò,11
«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2012 ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË íåííî âàæíûõ ôóíêöèé, ò. å. â ïðîâåäå-íèè ìåðîïðèÿòèé ðåàíèìàöèè è èíòåí-ñèâíîé òåðàïèè. Ñðåäè ïîðàæåííûõ èîíèçèðóþùèìè èçëó÷åíèÿìè â íå-îòëîæíûõ ìåðîïðèÿòèÿõ ïåðâîé âðà÷åá-íîé ïîìîùè áóäóò íóæäàòüñÿ ïîëîâèíà ïîðàæåííûõ, à ñðåäè ïîðàæåííûõ ÔΠè áîòóëîòîêñèíîì – áîëåå äâóõ òðåòåé, ïðè÷åì â ïîñëåäíèõ äâóõ ãðóïïàõ ïîðà-æåíèé ýòà ïîìîùü äîëæíà áûòü îêàçàíà â ïåðâûå äâà ÷àñà; – ÷àñòîå âîçíèêíîâåíèå ðàííèõ è ïî-çäíèõ îñëîæíåíèé, óãðîæàþùèõ æèçíè; – íóæäàåìîñòü â äëèòåëüíîì ãîñïè-òàëüíîì ëå÷åíèè çíà÷èòåëüíîãî ÷èñëà ïîðàæåííûõ; – íåäîñòàòî÷íàÿ èçó÷åííîñòü ïàòî-ãåíåçà, êëèíèêè, äèàãíîñòèêè è ìåòîäîâ ëå÷åíèÿ îñíîâíûõ âèäîâ áîåâîé òåðàïåâ-òè÷åñêîé ïàòîëîãèè â ñâÿçè ñ îòñóòñòâè-åì åå â óñëîâèÿõ ìèðíîãî âðîòñóòñòâè-åìåíè. Òàêèì îáðàçîì, â ñîâðåìåííûõ Ë èëè ÂÊ âîçìîæåí âåñü ñïåêòð òåðàïåâ-òè÷åñêîé ïàòîëîãèè: – âèñöåðàëüíàÿ ïàòîëîãèÿ âîåííîãî âðåìåíè; – âèñöåðàëüíàÿ ïàòîëîãèÿ ó ðàíåíûõ è îáîææåííûõ; – çàáîëåâàíèÿ âîåííîñëóæàùèõ, ñâÿ-çàííûå ñ âîçäåéñòâèåì íåáëàãîïðèÿòíûõ ïðîôåññèîíàëüíûõ ôàêòîðîâ; – áîåâàÿ òåðàïåâòè÷åñêàÿ ïàòîëîãèÿ, â ñòðóêòóðå êîòîðîé íàèáîëüøèé óäåëü-íûé âåñ ñîñòàâÿò ïîðàæåíèÿ îòðàâëÿ-þùèìè âåùåñòâàìè è îñòðàÿ ëó÷åâàÿ áîëåçíü. Íî åñëè âîçìîæíî ïðèìåíåíèå îðó-æèÿ ìàññîâîãî ïîðàæåíèÿ, ïîðàæåíèå ëè÷íîãî ñîñòàâà â ðåçóëüòàòå ðàçðóøåíèÿ îáúåêòîâ õèìè÷åñêîé è àòîìíîé ïðîìûø-ëåííîñòè, òî çàáîëåâàíèÿ âîåííîñëóæàùèõ, âèñöåðàëüíàÿ ïàòîëîãèÿ ó ðàíåíûõ ÿâëÿ-åòñÿ ïîâñåäíåâíîé ðåàëüíîñòüþ è èìååò íàèáîëüøóþ àêòóàëüíîñòü äëÿ âîåííûõ òåðàïåâòîâ â ñîâðåìåííûõ Ë è ÂÊ. Íà îñíîâå ïðèîáðåòåííîãî ìåäè-öèíñêîé ñëóæáîé áîåâîãî îïûòà, îïûòà ó÷åíèé è äàííûõ, ïîëó÷åííûõ â õîäå èñ-ñëåäîâàíèé, ìîæíî ñäåëàòü âûâîä î òîì, ÷òî â ñîâðåìåííûõ Ë èëè ÂÊ âîçìî-æåí âåñü ñïåêòð òåðàïåâòè÷åñêîé ïàòî-ëîãèè. Âåëè÷èíà è ñòðóêòóðà ñàíèòàðíûõ ïîòåðü òåðàïåâòè÷åñêîãî ïðîôèëÿ çàâè-ñÿò îò êîëè÷åñòâåííîãî è êà÷åñòâåííîãî ñîñòàâà âîéñê, ñîñòîÿíèÿ çäîðîâüÿ ëè÷-íîãî ñîñòàâà, ïîðàæàþùèõ ñðåäñòâ âåäå-íèÿ âîéíû, ïðîäîëæèòåëüíîñòè, õàðàêòå-ðà è èíòåíñèâíîñòè áîåâûõ äåéñòâèé, êëèìàòîãåîãðàôè÷åñêèõ óñëîâèé è ñàíè-òàðíî-ýïèäåìèîëîãè÷åñêîãî ñîñòîÿíèÿ â ðåãèîíå, îðãàíèçàöèè ïèòàíèÿ, âîäîñíàá-æåíèÿ, ðàçìåùåíèÿ âîåííîñëóæàùèõ è äðóãèõ óñëîâèé, êîòîðûå íåîáõîäèìî ó÷è-òûâàòü ïðè ïëàíèðîâàíèè ìåäèöèíñêî-ãî îáåñïå÷åíèÿ êîíêðåòíîìåäèöèíñêî-ãî ÂÊ èëè ËÂ. Çíàíèå ïðèíöèïîâ, ôàêòîðîâ è óñëî-âèé ôîðìèðîâàíèÿ ñàíèòàðíûõ ïîòåðü òåðàïåâòè÷åñêîãî ïðîôèëÿ â ñîâðåìåí-íûõ ÂÊ è Ë áóäåò ñïîñîáñòâîâàòü ñâîå-âðåìåííîìó è êà÷åñòâåííîìó ðåøåíèþ çàäà÷ ïî îêàçàíèþ ìåäèöèíñêîé ïîìî-ùè âîåííîñëóæàïîìî-ùèì ÂÑ ÐÔ.Ëèòåðàòóóðà
1. Êîðíþøêî È.Ã., ßêîâëåâ Ñ.Â., Âëàäèìè-ðîâ Å.Â. Îïûò ïðèìåíåíèÿ ìîáèëüíûõ ôîð-ìèðîâàíèé Ñëóæáû ìåäèöèíû êàòàñòðîô Ìèíîáîðîíû Ðîññèè â ëîêàëüíûõ âîéíàõ è âîîðóæåííûõ êîíôëèêòàõ // Âîåí.-ìåä. æóðí. – 2011. – Ò. 332, ¹ 9. – Ñ. 12–20. 2. Îïûò ìåäèöèíñêîãî îáåñïå÷åíèÿ âîéñê â Àôãàíèñòàíå. 1979–1989 ãã.:  5 ò. / Ïîä ðåä. È.Â.Ñèíîïàëüíèêîâà. – Ì.: ÃÂÊà èì. Í.Í.Áóð-äåíêî, 2003. – Ò. I. – 468 ñ. 3. Îïûò ìåäèöèíñêîãî îáåñïå÷åíèÿ âîéñê â Àôãàíèñòàíå. 1979–1989 ãã.:  5 ò. / Ïîä ðåä. È.Â.Ñèíîïàëüíèêîâà, Ê.Ñ.Èâàíîâà, Â.Ã.Íîâîæåíîâà. – Ì.: ÃÂÊà èì. Í.Í.Áóðäåí-êî, 2004. – Ò. IV. – 454 ñ. 4. Îñîáåííîñòè îðãàíèçàöèè è îêàçàíèÿ òåðàïåâòè÷åñêîé ïîìîùè ðàíåíûì è áîëüíûì â Ðåñïóáëèêå Äàãåñòàí è ×å÷åíñêîé Ðåñïóá-ëèêå. Ñîâåðøåíñòâîâàíèå ëå÷åáíî-ïðîôè-ëàêòè÷åñêèõ àëãîðèòìîâ: Îò÷åò î ÍÈÐ ïî òåìå 2.00.062.ï.4. – ÑÏá, 2003. – 285 ñ. 5. Ñîñþêèí À.Å., Æåêàëîâ À.Í., Ðåçíè÷åê Â.Ô. è äð. Ïàòîëîãèÿ îðãàíîâ äûõàíèÿ ó ðàíåíûõ // Òåðàïåâòè÷åñêàÿ ïîìîùü â ýêñòðåìàëüíûõ ñèòóàöèÿõ: Ìàòåðèàëû Âñåàðì. íàó÷.-ïðàêò. êîíô. 27–28 ìàðòà 2003 ã. – ÑÏá, 2003. – Ñ. 20–27. 6. Òåðàïåâòè÷åñêàÿ ïàòîëîãèÿ ó âîåííî-ñëóæàùèõ â óñëîâèÿõ ëîêàëüíûõ âîéí è êîí-ôëèêòîâ: Îò÷åò î ÍÈÐ ïî òåìå 2.96.100.ï.5. – ÑÏá, 1998. – 88 ñ. 7. ×èæ È.Ì. Íåêîòîðûå èòîãè è âûâîäû èç îïûòà ìåäèöèíñêîãî îáåñïå÷åíèÿ âîéñê â âîîðóæåííûõ êîíôëèêòàõ // Âîåí.-ìåä. æóðí. – 2000. – Ò. 321, ¹ 6. – Ñ. 4–15.ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË © Ñ.À.ÁÅËßÊÈÍ, À.Ì.ÁÓÐËÀÊ, 2012 ÓÄÊ 617.57-001.45-036.86
Îðãàíèçàöèîííî-ìåòîäè÷åñêèå ïîäõîäû
ê ìåäèöèíñêîé ðåàáèëèòàöèè ðàíåíûõ
ñ ïîñëåäñòâèÿìè áîåâîé òðàâìû âåðõíèõ
êîíå÷íîñòåé â óñëîâèÿõ ðåàáèëèòàöèîííîãî
öåíòðà
ÁÅËßÊÈÍ Ñ.À., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû çàïàñà (3hospital@mail.ru)1 ÁÓÐËÀÊ À.Ì., êàíäèäàò ïåäàãîãè÷åñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà2 13-é Öåíòðàëüíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. À.À.Âèøíåâñêîãî, ã. Êðàñíîãîðñê, Ìîñêîâñêàÿ îáëàñòü; 2Ôèëèàë ¹ 2 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. À.À.Âèøíåâñêîãî, ÌîñêâàBelyakin S.A., Burlak A.M. – Organizational and methodological approaches to the medical rehabilitation of the wounded from the consequences of combat trauma in the upper limb in rehabilitation center. This article discusses the possibility of optimizing the organizational and methodological approaches to the medical rehabilitation of the wounded from the consequences of combat trauma of the upper extremities in rehabilitation center. Clearly the implementation of organizational measures and technologies optimized medical rehabilitation, restoration of function provided the injured extremity: total of 152 (64%) injuries, partial in 26 (11%) injuries, as well as the stability of long-term results. Optimization using the traditional methods of treatment (biomehanoterapiya, chiropractic, massage, acupuncture, integrated technology) has increased the effectiveness of medical rehabilitation at 35%.
K e y w o r d s: organizational and methodological approaches of organizational activities, the wounded, the upper limbs, medical rehabilitation.
Á
îåâûå ïîâðåæäåíèÿ âåðõíèõ íîñòåé ó âîåííîñëóæàùèõ ñîñòàâëÿ-ëè â ðàçñîñòàâëÿ-ëè÷íûõ âîéíàõ îò 23,1 äî 68,6% âñåõ áîåâûõ ïîâðåæäåíèé [4, 6]. Óñèëèÿ-ìè âîåííî-ìåäèöèíñêîé íàóêè è ïðàê-òèêè äîñòèãíóòû çíà÷èòåëüíûå óñïåõè â ëå÷åíèè íåïîñðåäñòâåííî ðàíåíèé âåðõ-íèõ êîíå÷íîñòåé [1–3, 9].  òî æå âðåìÿ íàðóøåíèå àëãîðèòìà ôóíêöèîíèðîâàíèÿ ìûøå÷íûõ ïàòòåðíîâ ïðè òðàâìàõ âåðõ-íèõ êîíå÷íîñòåé [8, 13, 14] âûçûâàåò äå-êîìïåíñàöèþ çàùèòíî-ïðèñïîñîáèòåëü-íûõ ìåõàíèçìîâ ïîçâîíî÷íèêà, ÷òî ñïî-ñîáñòâóåò ïðîÿâëåíèþ âåðòåáðîãåííûõ ðàññòðîéñòâ ó ðàíåíûõ. Èõ ðàçâèòèå â çíà-÷èòåëüíîé ñòåïåíè îñëîæíÿåò ìåäèöèí-ñêóþ ðåàáèëèòàöèþ.  ïåðèîä âîññòàíîâëåíèÿ çäîðîâüÿ ðàíåíûõ ñ ïîñëåäñòâèÿìè áîåâîé òðàâ-ìû âåðõíèõ êîíå÷íîñòåé íà ïîçäíåì ãîñ-ïèòàëüíîì ýòàïå äîìèíèðóþò âåðòåáðî-ãåííûå îñëîæíåíèÿ, õàðàêòåðèçóþùèåñÿ ðàçâèòèåì íåâðîëîãè÷åñêèõ ñèíäðîìîâ îñòåîõîíäðîçà ïîçâîíî÷íèêà.  îñíîâå ôîðìèðîâàíèÿ àñèììåòðèè â øåéíî-ãðóäíîé çîíå ëåæàò öåðåáðîâàñêóëÿðíûå îñëîæíåíèÿ øåéíîãî îñòåîõîíäðîçà âñëåäñòâèå àñèììåòðè÷íîé íàãðóçêè íà ýòîò îòäåë ïîçâîíî÷íèêà [2, 9]. Îïðåäåëÿþùèì ôàêòîðîì, âûçûâàþ-ùèì ïðîÿâëåíèå âåðòåáðîãåííûõ îñëîæ-íåíèé áîåâîé òðàâìû âåðõíèõ êîíå÷íî-ñòåé, ÿâëÿþòñÿ ñòàòîêèíåòè÷åñêèå íàðó-øåíèÿ â èõ ìûøå÷íî-ñîñóäèñòûõ ñòðóê-òóðàõ, ñîïðîâîæäàþùèåñÿ àñèììåòðèåé ïîçâîíî÷íèêà [5, 9]. Ñèñòåìà ìåäèöèíñêîé ðåàáèëèòà-öèè ðàíåíûõ ðàçðàáîòàíà â ðÿäå òðóäîâ, îòðàæåíà â îôèöèàëüíûõ äîêóìåíòàõ [7, 8, 10–12]. Îäíàêî ïðè îðãàíèçàöèè ìåäèöèíñêîé ðåàáèëèòàöèè ðàíåíûõ ñ âåðòåáðîãåííûìè îñëîæíåíèÿìè âñëåä-ñòâèå áîåâîé òðàâìû âåðõíèõ êîíå÷-íîñòåé â óñëîâèÿõ ðåàáèëèòàöèîííîãî«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2012
16
ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË ôðîíòàëüíîé ïëîñêîñòè â Îà çíà÷åíèÿ ñîîòâåòñòâóþùèõ ïîêàçàòåëåé âîçðîñëè ñ 61,3±1,2 äî 70,5±1,7° (15%), â ÊÃ-1 – ñ 59,1±1,5 äî 62±1,4° (5%). Îáùàÿ ïîäâèæíîñòü â òðàíñâåðçàëü-íîé îáëàñòè óâåëè÷èëàñü â Îà íà 25%, â Êà – íà 5%. Ïîäâèæíîñòü øåéíîãî îòäåëà ïîçâîíî÷íèêà â ñàãèòòàëüíîé, ôðîíòàëüíîé è òðàíñâåðçàëüíîé ïëîñ-êîñòÿõ ó ðàíåíûõ Îà óâåëè÷èëàñü íà 25, 15, 20%, â ÊÖ íà 5, 5 è 5% ñîîò-âåòñòâåííî. Ó ðàíåíûõ Îà ñóùåñòâåííî âîçðîñëà èçîìåòðè÷åñêàÿ ìàêñèìàëüíàÿ ñèëà ìûøö: ñãèáàòåëåé ïîÿñíèöû íà 30%, ðàçãèáàòå-ëåé ïîÿñíèöû – íà 25%, ìûøö, âðàùàþùèõ ïîçâîíî÷íèê, – íà 35%, ñãèáàòåëåé è ðàç-ãèáàòåëåé øåè – íà 25%.  òî æå âðåìÿ ó ðàíåíûõ Êà çíà÷èìûõ èçìåíåíèé ñèëîâûõ ïîêàçàòåëåé íå âûÿâëåíî. Ïîëíîå âîññòàíîâëåíèå ôóíêöèè òðàâìèðîâàííîé êîíå÷íîñòè ïðîèçîøëî ó 64% ðàíåíûõ ÎÃ, ÷àñòè÷íîå – ó 11%, ó 45 è 7% ðàíåíûõ ÊÃ-1, ó 39 è 5% ðàíå-íûõ ÊÃ-2 ñîîòâåòñòâåííî. Ñîâåðøåíñòâîâàíèå ìåäèöèíñêîé ðåàáèëèòàöèè ñ ïîìîùüþ ñèñòåìû îðãàíèçàöèîííûõ ìåðîïðèÿòèé è îïòè-ìèçèðîâàííûõ òåõíîëîãèé: áèîìåõàíî-òåðàïèè, èíòåãðàëüíûõ òåõíîëîãèé è òðàäèöèîííûõ ìåòîäîâ ëå÷åíèÿ (ìàíó-àëüíàÿ òåðàïèÿ, ìàññàæ, èãëîðåôëåêñî-òåðàïèÿ) ïîçâîëèëî óâåëè÷èòü ýôôåê-òèâíîñòü ìåäèöèíñêîé ðåàáèëèòàöèè íà 35%. Òàêèì îáðàçîì, ïðîâåäåííûå èññëå-äîâàíèÿ óñòàíîâèëè, ÷òî ïðèìåíåíèå íîâûõ îðãàíèçàöèîííî-ìåòîäè÷åñêèõ ïîäõîäîâ çíà÷èòåëüíî ïîâûøàåò ýôôåê-òèâíîñòü ìåäèöèíñêîé ðåàáèëèòàöèè.Ëèòåðàòóðà
1. Áåëÿêèí Ñ.À., Þäèí Â.Å., Ùåãîëüêîâ À.Ì. Ôîðìèðîâàíèå ñîâðåìåííîé ñèñòåìû ìåäè-öèíñêîé ðåàáèëèòàöèè âîåííîñëóæàùèõ // Âåñòí. âîññò. ìåä. – 2011. – ¹ 1. – Ñ. 2–5. 2. Áóðëàê À.Ì., Þäèí Â.Å., Íåáîðñêèé Ñ.À., Àçàðîâà Å.Ê. Âîññòàíîâèòåëüíîå ëå÷åíèå ðà-íåíûõ ñ äîðñîïàòèÿìè ïðè áîåâîé òðàâìå âåðõíèõ êîíå÷íîñòåé // Òðàäèöèîí. ìåä. – 2012. – ¹ 1. – Ñ. 19–24. 3. Åð¸ìóøêèí Ì.À. Ìàíóàëüíûå ìåòîäû ëå÷åíèÿ â êîìïëåêñå ðåàáèëèòàöèîííûõ ìå-ðîïðèÿòèé ïðè ïàòîëîãèè îïîðíî-äâèãàòåëü-íîãî àïïàðàòà: Àâòîðåô. ... äèñ. ä-ðà ìåä. íàóê. – Ì., 2006. – 47 ñ. 4. Èâàíîâ Ñ.Î. Ê ðåàáèëèòàöèè ðàíåíûõ â êèñòü // Âîåí.-ìåä. æóðí. – 1991. – ¹ 8. – Ñ. 36–37. 5. Êëþêâèí È.Þ., Ìèãóëåâà È.Þ., Îõîò-ñêèé Â.Ï. Òðàâìû êèñòè. – Ì.: ÃÝÎÒÀÐ-Ìåäèà, 2009. – 192 ñ. 6. Ìåäèöèíñêàÿ ðåàáèëèòàöèÿ â Âîîðó-æåííûõ Ñèëàõ Ðîññèéñêîé Ôåäåðàöèè: Ìå-òîä. ïîñîáèå äëÿ âðà÷åé / Ïîä ðåä. Â.À.Ãóëÿå-âà. – ×. 1–3. – Ì.: Âîåíèçäàò, 2004. – 416 ñ. 7. Îïûò ìåäèöèíñêîãî îáåñïå÷åíèÿ âîéñê â Àôãàíèñòàíå 1979–1989 ãã.:  5 ò. – Ò. II : Îðãàíèçàöèÿ è îáúåì õèðóðãè÷åñêîé ïîìîùè ðàíåíûì / Ïîä ðåä. È.À.Åðþõèíà, Â.È.Õðóïêèíà. – Ì.: ÃÂÊà èì. àêàä. Í.Í.Áóð-äåíêî. – 2002. – 400 ñ. 8. Ïàíàñåíêî Ñ.Ë. Ðàçðàáîòêà è íàó÷íîå îáîñíîâàíèå ñèñòåìû ìåäèêî-ñîöèàëüíîé ðå-àáèëèòàöèè èíâàëèäîâ âñëåäñòâèå âîåííîé òðàâìû îïîðíî-äâèãàòåëüíîé ñèñòåìû â óñ-ëîâèÿõ âåäîìñòâåííîãî çäðàâîîõðàíåíèÿ (ÌÂÄ Ðîññèè): Àâòîðåô. ... äèñ. ä-ðà ìåä. íàóê. – Ì., 2009. – 57 ñ. 9. Ïàðõîòèê È.È. Ôèçè÷åñêàÿ ðåàáèëè-òàöèÿ ïðè òðàâìàõ âåðõíèõ êîíå÷íîñòåé. – Êèåâ: Îëèìï. ëèò., 2007. – 282 ñ. 10. Ðóêîâîäñòâî ïî îðãàíèçàöèè ðàáîòû öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïè-òàëÿ. – ×. 1. – Ì.: ÃÂÌÓ ÌÎ ÐÔ, 2007. – 415 ñ. 11. Ôèñóí À.ß., Ùåãîëüêîâ A.M., Þäèí Â.Å. è äð. Ïðèîðèòåòíûå çàäà÷è ìåäèöèíñêîé ñëóæáû Âîîðóæåííûõ Ñèë ÐÔ ïî ðåàëèçàöèè ôåäåðàëüíîé öåëåâîé ïðîãðàììû ðåàáèëèòà-öèè èíâàëèäîâ âñëåäñòâèå áîåâûõ äåéñòâèé è âîåííîé òðàâìû è èõ èñïîëíåíèå: Àêòóàëü-íûå ïðîáëåìû ìåäèöèíñêîé ðåàáèëèòàöèè / Ñá. íàó÷. òðóäîâ. – Ì., 2008. – Ñ. 37–39. 12. Ùåãîëüêîâ À.Ì., Ñèíîïàëüíèêîâ È.Â., Ãîðøêîëåïîâ Î.È. è äð. Ìåäèöèíñêàÿ ðåàáè-ëèòàöèÿ ó÷àñòíèêîâ âîéíû â Àôãàíèñòàíå. – Ì.: Ïÿòèãîðñê, 2005. – 199 ñ.13. Lewit K. Mani pulative therapy in Rehabi-litation of the locomotor system. – Butterworth., Heinemann, 1999. – 346 p.
14. Travell Janet G., Simons Lois S. Myofascial pain and dysfunction. The trigger point manual. The lower extremities. Williams and Wilkins, 1992. – 599 p.
ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË © Ñ.À.ÊÓÇÜÌÈÍ, 2012 ÓÄÊ 613.67.057.36 (470.56)
Àíàëèç ñîñòîÿíèÿ çäîðîâüÿ ãðàæäàí ïðèçûâíîãî
âîçðàñòà Îðåíáóðãñêîé îáëàñòè
ÊÓÇÜÌÈÍ Ñ.À., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà Âîåííûé êîìèññàðèàò Îðåíáóðãñêîé îáëàñòè, ã. ÎðåíáóðãÊuzmin S.A. – Analysis of the health of citizens of military age in Orenburg region. Results of medical examination of citizens of military age living in the Orenburg region for a decade are given. Noted that over the study period in the region have been positive changes: performance fitness for military service on health increased from 62,9% in 2000 to 67,7% in 2009 and projected to the positive dynamics in 2020 also marked improvement in physical fitness and the citizens of military age, a significant reduction in the number of recruits with poor and low power.
K e y w o r d s: recruit, health, physical fitness, medical examinations.
Â
ñîîòâåòñòâèè ñ òðåáîâàíèÿìè ñòíîãî ïðèêàçà ÌÎ ÐÔ è ÌÇ ÐÔ îò 23.05.2001 ã. ¹ 240/168 «Îá îðãàíèçàöèè ìåäèöèíñêîãî îáåñïå÷åíèÿ ïîäãîòîâêè ãðàæäàí ÐÔ ê âîåííîé ñëóæáå» çàâåð-øàþùèì ýòàïîì ìåäèöèíñêîãî îáåñïå-÷åíèÿ ÿâëÿåòñÿ ïðèçûâ ãðàæäàí íà âî-åííóþ ñëóæáó [3]. Ñîãëàñíî çàêîíîäàòåëüñòâó ÐÔ ïðè-çûâó íà âîåííóþ ñëóæáó ïîäëåæàò ãðàæ-äàíå ìóæñêîãî ïîëà â âîçðàñòå îò 18 äî 27 ëåò, ñîñòîÿùèå íà âîèíñêîì ó÷åòå, íå ïðåáûâàþùèå â çàïàñå è íå èìåþùèå ïðàâà íà îòñðî÷êó îò ïðèçûâà íà âîåí-íóþ ñëóæáó [5].  êàæäîì ñóáúåêòå ÐÔ ìåäèöèíñêîå îñâèäåòåëüñòâîâàíèå ãðàæäàí ïðèçûâíî-ãî âîçðàñòà îñóùåñòâëÿþò ïðèçûâíûå êîìèññèè ìóíèöèïàëüíûõ îáðàçîâàíèé [6]. Ñ öåëüþ êîíòðîëÿ îáîñíîâàííîñòè ïðèíÿòûõ ðåøåíèé îá îòñðî÷êå èëè îñ-âîáîæäåíèè îò ïðèçûâà íà âîåííóþ ñëóæáó ïî ñîñòîÿíèþ çäîðîâüÿ ïðîâîäÿò-ñÿ êîíòðîëüíûå ìåäèöèíñêèå îñâèäå-òåëüñòâîâàíèÿ ëèö, ïîëó÷èâøèõ îòñðî÷-êó èëè îñâîáîæäåíèå îò ïðèçûâà íà âî-åííóþ ñëóæáó ïî ñîñòîÿíèþ çäîðîâüÿ [2]. Óñòàíîâëåíî, ÷òî â òå÷åíèå ïîñëåäíèõ ëåò â Îðåíáóðãñêîé îáëàñòè â ðåçóëüòàòå êîíòðîëüíûõ ìåäèöèíñêèõ îñâèäåòåëü-ñòâîâàíèé ëèö ïðèçûâíîãî âîçðàñòà áûëè ïðèçíàíû ãîäíûìè ê âîåííîé ñëóæáå îò 2,2 äî 8,3% ãðàæäàí â ðàçíûå ãîäû. Ýòî äîêàçûâàåò âàæíîñòü ïðîâåäåíèÿ òàêèõ êîíòðîëüíûõ îñâèäåòåëüñòâîâàíèé, à òàê-æå äèêòóåò íåîáõîäèìîñòü ïîâûøåíèÿ èõ êà÷åñòâà. Ðåçóëüòàòû êîíòðîëüíûõ ìåäèöèíñêèõ îñâèäåòåëüñòâîâàíèé ãðàæäàí â âîçðàñòå 18–27 ëåò ïðåäñòàâëåíû â òàáë. 1. Îòìå÷å-íî, ÷òî çà ïðîøåäøèé ïåðèîä ÷èñëî ïðè-çûâíèêîâ, êîòîðûì ïðîâåäåíî êîíòðîëüíîå îñâèäåòåëüñòâîâàíèå, ñ 13 084 ÷åëîâåê â 2000 ã. ñíèçèëîñü äî 10 619 ÷åëîâåê â 2009 ã., ÷òî â áîëüøåé ñòåïåíè ñâÿçàíî ñ óìåíüøåíèåì îáùåé ÷èñëåííîñòè ëèö ïðèçûâíîãî âîçðàñòà â ðåãèîíå. Äîëÿ ãðàæäàí ïðèçûâíîãî âîçðàñòà, êîòîðûå ïîñëå êîíòðîëüíîãî ìåäèöèíñ-êîãî îñâèäåòåëüñòâîâàíèÿ áûëè ïðèçíà-íû ãîäïðèçíà-íûìè ê âîåííîé ñëóæáå (ñ ó÷åòîì ñóììû êàòåãîðèé «À» – ãîäåí ê âîåííîé ñëóæáå è «Á» – ãîäåí ê âîåííîé ñëóæáå ñ íåçíà÷èòåëüíûìè îãðàíè÷åíèÿìè), ìè-íèìàëüíî ñîñòàâèëà 2,2% â 2008 ã. è ìàê-ñèìàëüíî – 8,3% â 2002 ã. Çàêëþ÷àþùèì ýòàïîì ìåäèöèíñêîé ïîäãîòîâêè ãðàæäàí ê ïðèçûâó íà âîåí-íóþ ñëóæáó ÿâëÿåòñÿ ïðîâåäåíèå èõ ìå-äèöèíñêîãî îñìîòðà ïåðåä íàïðàâëåíè-åì èõ ê íåïîñðåäñòâåííîìó ìåñòó ñëóæ-áû, êîòîðîå îñóùåñòâëÿåòñÿ íà îáëàñò-íîì ñáîðîáëàñò-íîì ïóíêòå [1]. Àíàëèç ðåçóëüòàòîâ ìåäèöèíñêîãî îñ-âèäåòåëüñòâîâàíèÿ ãðàæäàí ïðè ïðèçûâå íà âîåííóþ ñëóæáó ïîêàçàë, ÷òî çà èçó-÷àåìûé ïåðèîä â Îðåíáóðãñêîé îáëàñòè ÷èñëåííîñòü ïðèçûâíèêîâ ïîñòåïåííî ñíèæàëàñü è çà äåñÿòèëåòíèé ïåðèîä íàáëþäåíèÿ èõ ñòàëî íà 17% ìåíüøå.21
«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2012 ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË – îñóùåñòâëåíèå ìåäèêî-ñîöèàëüíîãî ìîíèòîðèíãà ëèö ïðèçûâíîãî âîçðàñòà; – ñîáëþäåíèå ïîðÿäêà ìåæâåäîì-ñòâåííîãî âçàèìîäåéñòâèÿ îðãàíîâ èñ-ïîëíèòåëüíîé è çàêîíîäàòåëüíîé âëàñ-òè, ó÷ðåæäåíèé çäðàâîîõðàíåíèÿ, îáðàçî-âàíèÿ, êóëüòóðû, ôèçêóëüòóðû è ñïîðòà, âîåííûõ êîìèññàðèàòîâ, äðóãèõ âåäîìñòâ è îáùåñòâåííûõ îðãàíèçàöèé; – âíåäðåíèå íàó÷íî îáîñíîâàííûõ êðèòåðèåâ ýôôåêòèâíîñòè è êà÷åñòâà ïðè îöåíêå îðãàíèçàöèè ìåäèöèíñêîãî îáåñ-ïå÷åíèÿ ïîäãîòîâêè ãðàæäàí ê âîåííîé ñëóæáå.Ëèòåðàòóðà
1. Îñíîâû âîåííî-âðà÷åáíîé ýêñïåðòèçû / Ïîñîáèå äëÿ âðà÷åé. – Ì.: 12-ÿ öåíòðàëüíàÿ òèïîãðàôèÿ ÌÎ ÐÔ, 2001. – 48 ñ. 2. Ïîñòàíîâëåíèå Ïðàâèòåëüñòâà ÐÔ îò 25.02.2003 ã. ¹ 123 «Îá óòâåðæäåíèè Ïîëîæå-íèÿ î âîåííî-âðà÷åáíîé ýêñïåðòèçå». – Ì.: 12-ÿ öåíòðàëüíàÿ òèïîãðàôèÿ ÌÎ ÐÔ, 2003. – 179 ñ. 3. Ïðèêàç ÌÎ ÐÔ è ÌÇ ÐÔ îò 23 ìàÿ 2001 ã. ¹ 240/168 «Îá îðãàíèçàöèè ìåäèöèí-ñêîãî îáåñïå÷åíèÿ ïîäãîòîâêè ãðàæäàí ÐÔ ê âîåííîé ñëóæáå. – Ì.: Âîåíèçäàò, 2001. – 62 ñ. 4. Ðåøåòíèêîâ À.Â. Ìåäèêî-ñîöèîëîãè÷åñ-êèé ìîíèòîðèíã: Ðóêîâîäñòâî. – Ì.: Ìåäè-öèíà, 2003. – 1048 ñ. 5. Ôåäåðàëüíûé Çàêîí ÐÔ îò 28.03.1998 ã. ¹ 53-ÔÇ «Î âîèíñêîé îáÿçàííîñòè è âîåí-íîé ñëóæáå». – Íîâîñèáèðñê: Ñèáèðñêîå óíè-âåðñèòåòñêîå èçäàòåëüñòâî, 2007. – 72 ñ. 6. Ôåäåðàëüíûé Çàêîí ÐÔ îò 30.06.2003 ã. ¹ 86-ÔÇ «Îñíîâû çàêîíîäàòåëüñòâà ÐÔ îá îõðàíå çäîðîâüÿ ãðàæäàí». – Ì.: ÈÍÔÐÀ, 2004. – 46 ñ. Òàáëèöà 5Äèíàìè÷åñêèé ðÿä ïîêàçàòåëÿ ãîäíîñòè ê âîåííîé ñëóæáå ëèö ïðèçûâíîãî
âîçðàñòà, ïðîæèâàþùèõ â Îðåíáóðãñêîé îáëàñòè
ÌÅÄÈÖÈÍÀ
ÝÊÑÒÐÅÌÀËÜÍÛÕ ÑÈÒÓÀÖÈÉ
© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2012 ÓÄÊ 61:355Íàïðàâëåíèÿ ìåæâåäîìñòâåííîãî âçàèìîäåéñòâèÿ
ïðè îêàçàíèè ìåäèöèíñêîé ïîìîùè
ïîñòðàäàâøèì â ðåçóëüòàòå ÷ðåçâû÷àéíûõ
ñèòóàöèé â ïóíêòàõ áàçèðîâàíèÿ ôëîòà
ÈÂ×ÅÍÊÎ Å.Â., äîöåíò, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû1 ×ÅÐÍÛÉ Â.Ñ., äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû1 ÒÎÏÎÐÊΠÌ.Ò., çàñëóæåííûé ðàáîòíèê âûñøåé øêîëû ÐÔ, äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà1 ÀËÅÊÑÀÍÄÐΠÌ.Â., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà2 1Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã; 2 Íàó÷íî-èññëåäîâàòåëü-ñêèé èíñòèòóò ñêîðîé ïîìîùè èì. È.È.Äæàíåëèäçå, Ñàíêò-ÏåòåðáóðãIvchenko E.V., Cherny V.S., Toporkov M.T., Aleksandrov M.V. – Directions of interdepartmental interaction in case of delivery of health care for injured in emergency situations in stationing sites of navy. In points basing of navy will remain probability of emergence of emergency situations which is connected with existence of the enterprises of the industry and objects of navy. As a result of emergency situations in places of basing of navy discrepancy of prospective sanitary losses to possibilities of forces and means of a health service of fleet that demands interaction with health services of other ministries and departments is probable. Criterion of need of interaction is the ratio of quantity struck and possibilities of a health service of navy. Plans of interaction of a health service of fleet with medical institutions of other departments should provide options of use of available forces and means of medical institutions in garrisons for joint assistance struck in an emergency situation. The questions solved during interaction should become: radiation, chemical, biological survey; allocation of forces and means for rendering of medical care; use of sanitary transport; organization of sanitary processing, etc. K e y w o r d s: emergency situation, medical ensuring elimination of consequences, interaction, medicine of accidents, health service of navy.
Â
ïóíêòàõ áàçèðîâàíèè ôëîòà íÿåòñÿ âåðîÿòíîñòü âîçíèêíîâåíèÿ ÷ðåçâû÷àéíûõ ñèòóàöèé (×Ñ), êîòîðàÿ ñâÿ-çàíà ñ íàëè÷èåì ïîòåíöèàëüíî îïàñíûõ ïðîìûøëåííûõ è ôëîòñêèõ îáúåêòîâ. Êàê ïîêàçûâàåò àíàëèç, îñíîâíûìè ïðè÷èíàìè ×Ñ ñ âåðîÿòíûì ìàññîâûì ïîðàæåíèåì ëè÷íîãî ñîñòàâà ôëîòà è íà-ñåëåíèÿ ôëîòñêèõ ãàðíèçîíîâ ìîãóò áûòü: – àâàðèè íà êîðàáëÿõ ñ àòîìíûìè ýíåðãåòè÷åñêèìè óñòàíîâêàìè; – àâàðèè ïðè õðàíåíèè, òðàíñïîðòè-ðîâêå è ïîãðóçêå ðàêåò ñ ïðîëèâîì êîì-ïîíåíòîâ ðàêåòíîãî òîïëèâà; – ðàçðóøåíèå îáúåêòîâ ñ òîêñè÷åñêè-ìè õèòîêñè÷åñêè-ìè÷åñêèòîêñè÷åñêè-ìè âåùåñòâàòîêñè÷åñêè-ìè â ðåçóëüòàòå ïðèðîäíûõ èëè òåõíîãåííûõ êàòàñòðîô; – ïîæàðû, âçðûâû è âîçãîðàíèÿ íà îáúåêòàõ è äð. Ëå÷åáíî-ýâàêóàöèîííîå îáåñïå÷å-íèå ïðè âîçíèêàþùèõ âî ôëîòñêîì ãàð-íèçîíå ×Ñ ïðåäñòàâëÿåò ñîáîé ñèñòåìó ìåðîïðèÿòèé ïî îêàçàíèþ ïîìîùè è ýâà-êóàöèè ïîðàæåííûõ â ëå÷åáíûå ó÷ðåæ-äåíèÿ.  ðåçóëüòàòå ×Ñ â ìåñòàõ áàçèðî-âàíèÿ ôëîòà âåðîÿòíûì ÿâëÿåòñÿ íåñî-îòâåòñòâèå ïðåäïîëàãàåìûõ ñàíèòàðíûõ ïîòåðü âîçìîæíîñòÿì ìåäèöèíñêèõ ñèë è ñðåäñòâ, ÷òî òðåáóåò âçàèìîäåéñòâèÿ ìåäèöèíñêîé ñëóæáû ôëîòà ñ àíàëîãè÷-íûìè ñëóæáàìè äðóãèõ ìèíèñòåðñòâ è âåäîìñòâ. Ñïåöèôèêîé ôëîòñêèõ ãàðíè-çîíîâ ÿâëÿåòñÿ òî, ÷òî îñíîâíóþ ÷àñòü èõ æèòåëåé ñîñòàâëÿåò ãðàæäàíñêîå íà-ñåëåíèå, ìåäèöèíñêîå îáñëóæèâàíèå êî-òîðîãî îñóùåñòâëÿåòñÿ ó÷ðåæäåíèÿìè ñèñòåìû Ìèíçäðàâà ÐÔ.  ýòèõ îáñòîÿ-òåëüñòâàõ íåîáõîäèìà îðãàíèçàöèÿìåæ-«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2012
26
ÝÊÑÒÐÅÌÀËÜÍÛÕ ÑÈÒÓÀÖÈÉËèòåðàòóðà
1. Âàëüñêèé Â.Â., Õàíêåâè÷ Þ.Ð., Ìîñê-âèí À.Â. è äð. Îïûò âçàèìîäåéñòâèÿ ìåäè-öèíñêîé ñëóæáû Ñåâåðíîãî ôëîòà è ñëóæ-áû ìåäèöèíû êàòàñòðîô Ìóðìàíñêîé îá-ëàñòè â ñèñòåìå ëèêâèäàöèè ìåäèêî-ñàíè-òàðíûõ ïîñëåäñòâèé ÷ðåçâû÷àéíûõ ñèòóà-öèé // Âîåí.-ìåä. æóðí. – 2008. – Ò. 329, ¹ 7. – Ñ. 17–20. 2. Ãðèùóê À.Â., Öûìáàë À.Í. Îïûò ïðî-âåäåíèÿ òàêòèêî-ñïåöèàëüíîãî ó÷åíèÿ «ÀÒÎÌ-2009» ñîâìåñòíî ñ ñèëîâûìè ñòðóê-òóðàìè Ñåâåðî-Çàïàäà Ðîññèè // Âîåí.-ìåä. æóðí. – 2010. – Ò. 331, ¹ 1. – Ñ. 92–96. 3. Èñàåâà È.Â. Ðîëü ñëóæáû ìåäèöèíû êàòàñòðîô ïðè óãðîçå è âîçíèêíîâåíèè ÷ðåç-âû÷àéíûõ ñèòóàöèé // Êàçàíñêèé ìåä. æóðí. – 2011. – Ò. 92, ¹ 1. – Ñ. 82–85. 4. Ôèñóí À.ß., Ôåäîòêèí Î.Â., Ñóõîðóêîâ À.À. Ëèêâèäàöèÿ ìåäèêî-ñàíèòàðíûõ ïîñëåäñòâèé ÷ðåçâû÷àéíîé ñèòóàöèè â Ïåðìè: óðîêè è âûâîäû // Ìåäèöèíà êàòàñòðîô. – 2010. – ¹ 1 (69). – Ñ. 10–12. 5. Õîëèêîâ È.Â., Øàôàëèíîâ Â.À., Âîëãèí À.Ð., ßêîâëåâ Ñ.Â. Äåÿòåëüíîñòü ñèë è ñðåäñòâ ìå-äèöèíñêîé ñëóæáû â óñëîâèÿõ ëèêâèäàöèè ïîñëåäñòâèé ÷ðåçâû÷àéíîé ñèòóàöèè (Îïûò ðàáîòû ðîññèéñêîãî âîåííî-ìåäèöèíñêîãî êîíòèíãåíòà â Ðåñïóáëèêå Èíäîíåçèÿ) // Âîåí.-ìåä. æóðí. – 2007. – Ò. 328, ¹ 3. – Ñ. 10–12.  öåëÿõ ñîâåðøåíñòâîâàíèÿ ïîä-ãîòîâêè ñïåöèàëèñòîâ âîéñêîâîãî çâåíà ìåäèöèíñêîé ñëóæáû Âîîðóæåííûõ ñèë Ðîññèéñêîé Ôåäåðàöèè, à òàêæå äëÿ îáåñ-ïå÷åíèÿ åäèíûõ ïîäõîäîâ ê îáó÷åíèþ âñåõ êàòåãîðèé âîåííîñëóæàùèõ â ñèñ-òåìå âîåííî-ìåäèöèíñêîé ïîäãîòîâêè, àâòîðñêèì êîëëåêòèâîì, â êîòîðûé âõî-äèë ðÿä ãëàâíûõ ìåäèöèíñêèõ ñïåöèàëè-ñòîâ ÌÎ ÐÔ, à òàêæå ñîòðóäíèêîâ Âîåí-íî-ìåäèöèíñêîé àêàäåìèè èìåíè Ñ.Ì.Êèðîâà (ïðîôåññîð Þ.Â.Ìèðîøíè-÷åíêî – ðóêîâîäèòåëü, ïîëêîâíèê ìåäè-öèíñêîé ñëóæáû ïðîôåññîð À.Í.Ãðåáå-íþê, ïðîôåññîð È.Ì.Ñàìîõâàëîâ, ïîëêîâ-íèê ìåäèöèíñêîé ñëóæáû ïðîôåññîð Þ.Ø.Õàëèìîâ, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû äîöåíò Â.Í.Êîíîíîâ, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû äîöåíò Ä.À.Ñèäî-ðîâ è äð.), ðàçðàáîòàíû èíñòðóêöèè-ïà-ìÿòêè ïî èñïîëüçîâàíèþ àïòå÷êè ïåðâîé ïîìîùè èíäèâèäóàëüíîé ÀÏÏÈ1, àïòå÷êè ïåðâîé ïîìîùè ãðóïïîâîé ÀÏÏÃ2, ñóìêè ïåðâîé ïîìîùè ÑÏÏ3, ñóìêè ôåëüäøåðà âîéñêîâîé ÑÔÂ4, ñóìêè âðà÷à âîéñêîâîé ÑÂÂ5. Óêàçàííûå îáðàçöû êîìïëåêòíî-òàáåëüíîãî îñíàùåíèÿ ïðèíÿòû íà ñíàá-æåíèå ÂÑ ÐÔ ïðèêàçîì ÌÎ ÐÔ îò 21 ìàÿÍ Î Â À ß Ê Í È Ã À
2011 ã. ¹ 744, à èõ îïèñè óòâåðæäåíû ïðèêàçîì íà÷àëüíèêà ÃÂÌÓ ÌÎ ÐÔ îò 12 èþëÿ 2011 ã. ¹ 77.  èíñòðóêöèÿõ-ïàìÿòêàõ äàíà ïîä-ðîáíàÿ õàðàêòåðèñòèêà ïåðå÷èñëåííûõ âûøå àïòå÷åê è ñóìîê ìåäèöèíñêèõ, ïðåäñòàâëåí äåòàëüíûé ïîðÿäîê ïðè-ìåíåíèÿ íà ïîëå áîÿ è ïåðåäîâûõ ýòà-ïàõ ìåäèöèíñêîé ýâàêóàöèè ëåêàðñòâåí-íûõ ïðåïàðàòîâ è ìåäèöèíñêèõ èçäåëèé, âõîäÿùèõ â èõ ñîñòàâ. Ïðè ýòîì îñîáîå âíèìàíèå óäåëåíî ñîâðåìåííûì èíäè-âèäóàëüíûì ñðåäñòâàì ìåäèöèíñêîé çà-ùèòû, àíòèäîòàì, ðàäèîïðîòåêòîðàì, îáåçáîëèâàþùèì ïðåïàðàòàì, à òàêæå ïåðåâÿçî÷íûì ñðåäñòâàì, â ò. ÷. èííîâà-öèîííûì îòå÷åñòâåííûì ðàçðàáîòêàì (ñðåäñòâî ïåðåâÿçî÷íîå «ÃåìîñòîïÒÌ ™», ñðåäñòâî ïåðåâÿçî÷íîå ãèäðîãåëåâîå «Ëèîêñàçèí-ÑÏ» è äð.). Ïîìèìî ýòîãî, â èíñòðóêöèÿõ-ïàìÿòêàõ ïðèâåäåíû íîðìàòèâû èñïîëüçîâàíèÿ ïðè îêàçàíèè ïîìîùè íåêîòîðûõ îáðàçöîâ ìåäèöèí-ñêîãî èìóùåñòâà (ïàêåòà ïåðåâÿçî÷íîãî èíäèâèäóàëüíîãî, æãóòà êðîâîîñòàíàâëè-âàþùåãî, ëåêàðñòâåííûõ ïðåïàðàòîâ â øïðèö-òþáèêàõ è äð.). Èíñòðóêöèè-ïàìÿòêè îäîáðåíû Ó÷å-íûì ñîâåòîì ÂÌåäÀ, óòâåðæäåíû è ââåäå-íû â äåéñòâèå íà÷àëüíèêîì ÃÂÌÓ ÌÎ ÐÔ.  íàñòîÿùåå âðåìÿ îíè íàïðàâëåíû â âîéñêà äëÿ èñïîëüçîâàíèÿ â ñèñòåìå âîåííî-ìåäèöèíñêîé ïîäãîòîâêè. 1Ì.: ÃÂÌÓ ÌÎ ÐÔ, 2012. – 26 ñ. 2Ì.: ÃÂÌÓ ÌÎ ÐÔ, 2012. – 29 ñ. 3Ì.: ÃÂÌÓ ÌÎ ÐÔ, 2012. – 41 ñ. 4Ì.: ÃÂÌÓ ÌÎ ÐÔ, 2012. – 46 ñ. 5Ì.: ÃÂÌÓ ÌÎ ÐÔ, 2012. – 37 ñ.ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ
ÂÎÏÐÎÑÛ
© ÊÎËËÅÊÒÈ ÀÂÒÎÐÎÂ, 2012 ÓÄÊ 616.831-005-057.36-036.86Àíàëèç ÷àñòîòû è ñòðóêòóðû öåðåáðîâàñêóëÿðíûõ
çàáîëåâàíèé ó âîåííîñëóæàùèõ ïðè ïðîâåäåíèè
âîåííî-âðà÷åáíîé ýêñïåðòèçû
ÄÐÅÌΠÂ.Â., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû (dremov29@mail.ru)1 ÎÄÈÍÀÊ Ì.Ì., çàñëóæåííûé âðà÷ ÐÔ, ÷ëåí-êîððåñïîíäåíò ÐÀÌÍ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå2 ÁÐÎÂÊÈÍ Ñ.Ã., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû3 ÅÌÅËÈÍ À.Þ., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû2 ×ÓÐÈËΠÞ.Ê., çàñëóæåííûé âðà÷ ÐÔ, äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå1 1Ôèëèàë ¹ 3 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. À.À.Âèøíåâñêîãî, Ìîñêâà; 2Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã; 3Öåíòðàëüíàÿ âî-åííî-âðà÷åáíàÿ êîìèññèÿ Ãëàâíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. Í.Í.Áóðäåíêî, Ìîñêâà Dremov V.V., Odinak M.M., Brovkin S.G., Emelin A.Yu., Churilov Yu.K. – Analysis of frequency and structure of cerebrovascular diseases in servicemen during the military physician expertise.Analysis of the results of medical inspection of soldiers under contract taken place in 2005–2009 is given. In 48,9% of cases was revealed diseases of blood circulatory system. In patients with cardiovascular events in 42,2% of cases different forms of cerebrovascular diseases were diagnosed. It shows high level of these diseases and its early progression among the servicemen. According to the authors, specific peculiarities of intensive military service provide the early progression of diseases. In such a case, presence of cerebrovascular diseases influences on expert decisions about professional suitability of servicemen for some military specialties including the level of suitability for military service. K e y w o r d s: morbidity of servicemen, cardiovascular diseases,cerebrovascular diseases, medical inspection
Ñ
åðäå÷íî-ñîñóäèñòûå çàáîëåâàíèÿ (ÑÑÇ) ÿâëÿþòñÿ âåäóùåé ïðè÷èíîé ñìåðòè íàñåëåíèÿ ÐÔ, ñîñòàâëÿÿ 56,8% â îáùåé ñòðóêòóðå ñìåðòíîñòè. Òîëüêî â 2010 ã. îò ÑÑÇ óìåðëî áîëåå 1 ìëí 152 òûñ. ÷åëîâåê, â ò. ÷. îò öåðåáðîâàñêó-ëÿðíîé áîëåçíè (ÖÂÁ) 372 òûñ. [2]. Íàðÿ-äó ñ âûñîêîé ñìåðòíîñòüþ ÑÑÇ ÿâëÿ-þòñÿ ÷àñòîé ïðè÷èíîé ãîñïèòàëèçàöèè è ïîòåðü òðóäîñïîñîáíîñòè.  ãðóïïå ÑÑÇ çíà÷èòåëüíîå ìåñòî çàíèìàþò õðî-íè÷åñêèå ôîðìû öåðåáðîâàñêóëÿðíûõ çàáîëåâàíèé (ÖÂÇ).  ñòðàíå íàñ÷èòûâà-åòñÿ íå ìåíåå 1,5 ìëí ÷åëîâåê, ñòðàäà-þùèõ õðîíè÷åñêèìè ôîðìàìè ÖÂÇ, îñëîæíåííûìè ðàçâèòèåì ñîñóäèñòîé äåìåíöèè [1, 5].  íàñòîÿùåå âðåìÿ ïðîáëåìà ñîñó-äèñòûõ ïîðàæåíèé ãîëîâíîãî ìîçãà ïðè-îáðåòàåò âñå áîëüøåå çíà÷åíèå è äëÿ âî-åííîé ìåäèöèíû â ñâÿçè ñ óâåëè÷åíèåì ðàñïðîñòðàíåííîñòè öåðåáðîâàñêóëÿð-íîé ïàòîëîãèè ñðåäè ëèö ìîëîäîãî è ñðåäíåãî âîçðàñòà [3]. Êàê ñâèäåòåëüñòâó-þò èòîãè ðàáîòû âîåííî-âðà÷åáíûõ êî-ìèññèé Âîîðóæåííûõ ñèë Ðîññèéñêîé Ôåäåðàöèè ïî ìåäèöèíñêîìó îñâèäå-òåëüñòâîâàíèþ âîåííîñëóæàùèõ â 2005– 2009 ãã., ÑÑÇ íà ïðîòÿæåíèè ïîñëåäíèõ ëåò çàíèìàþò ëèäèðóþùåå ïîëîæåíèå ñðåäè çàáîëåâàíèé âíóòðåííèõ îðãàíîâ, ÿâëÿþùèõñÿ ïðè÷èíîé óâîëüíåíèÿ èç Âîîðóæåííûõ ñèë ÐÔ ïî ñîñòîÿíèþ çäîðîâüÿ.«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2012
30
ÂÎÏÐÎÑÛ òâåðæäåíèÿ íàëè÷èÿ ïàòîëîãè÷åñêèõ èç-ìåíåíèé ìîçãîâîãî êðîâîòîêà. Ñ äðóãîé ñòîðîíû, ó 37% ïàöèåíòîâ ñ âûðàæåííîé ñåðäå÷íî-ñîñóäèñòîé ïàòîëîãèåé ÖÂÇ íå äèàãíîñòèðîâàëèñü. Ïî ðåçóëüòàòàì îñâè-äåòåëüñòâîâàíèÿ âîåííîñëóæàùèå ñ ÖÂÇ ïðèçíàíû íåãîäíûìè è îãðàíè÷åííî íûìè ê âîåííîé ñëóæáå â 17% ñëó÷àåâ, ãîä-íûìè ê âîåííîé ñëóæáå ñ íåçíà÷èòåëü-íûìè îãðàíè÷åíèÿìè – â 74,4%. Ïðåäñòàâëåííûå ïîêàçàòåëè ÷àñòî-òû è ñòðóêòóðû ÖÂÇ ïðè ìåäèöèíñêîì îñâèäåòåëüñòâîâàíèè âîåííîñëóæàùèõ óêàçûâàþò íà èõ îòíîñèòåëüíî âûñîêèé óðîâåíü (42,2%) â ãðóïïå ñåðäå÷íî-ñî-ñóäèñòûõ çàáîëåâàíèé.  ñòðóêòóðå ÖÂÇ ïðåîáëàäàþò õðîíè÷åñêèå ôîðìû â âèäå íà÷àëüíûõ ïðîÿâëåíèé íåäîñòàòî÷íî-ñòè ìîçãîâîãî êðîâîñíàáæåíèÿ (14,8%), ä è ñ ö è ð ê ó ë ÿ ò î ð í î é ý í ö å ô à ë î ï à ò è è I–II ñòàäèé (73,8%), êîòîðûå íàèáîëåå ÷àñòî èñïîëüçóþòñÿ â êà÷åñòâå îñíîâ-íîãî èëè ñîïóòñòâóþùåãî äèàãíîçîâ â ýêñïåðòíîé ïðàêòèêå. Ïðè ýòîì íàëè-÷èå öåðåáðîâàñêóëÿðíîé ïàòîëîãèè ÷à-ñòî îêàçûâàåò ñóùåñòâåííîå âëèÿíèå íà ðåøåíèå ýêñïåðòíûõ âîïðîñîâ î ïðî-ôåññèîíàëüíîé ïðèãîäíîñòè âîåííî-ñëóæàùèõ ïî îïðåäåëåííûì âîåííûì ñïåöèàëüíîñòÿì è â ò. ÷. ñòåïåíè ãîä-íîñòè ê âîåííîé ñëóæáå. Äî íàñòîÿùåãî âðåìåíè ïðîáëåìà õðîíè÷åñêèõ ôîðì ÖÂÁ íàõîäèòñÿ â òåíè èçó÷åíèÿ èíñóëüòîâ, ñîïðîâîæäàþùèõñÿ âûñîêîé ñìåðòíîñòüþ è èíâàëèäèçàöè-åé âûæèâøèõ áîëüíûõ. Ïðè ýòîì íå âû-çûâàåò ñîìíåíèé, ÷òî íåñâîåâðåìåííîå âûÿâëåíèå, íåàäåêâàòíûå ïðîôèëàêòèêà è ëå÷åíèå ÄÝ òàêæå çàêîíîìåðíî ñîïðî-âîæäàþòñÿ ïðîãðåññèðîâàíèåì çàáîëåâà-íèÿ è ðàçâèòèåì âûðàæåííûõ íàðóøå-íèé ôóíêöèé ãîëîâíîãî ìîçãà, ïðèâîäÿ-ùèõ ê òðóäîâîé è ñîöèàëüíîé äèçàäàï-òàöèè ïàöèåíòîâ. Ñ äðóãîé ñòîðîíû, îòñóòñòâèå ÷åòêèõ êðèòåðèåâ ïîñòàíîâêè äèàãíîçà ñïîñîá-ñòâóåò ãèïåðäèàãíîñòèêå ÄÝ ó ïàöèåí-òîâ, íå èìåþùèõ çàáîëåâàíèé, ñïîñîá-íûõ âûçâàòü ñîñóäèñòîå ïîðàæåíèå ãî-ëîâíîãî ìîçãà, ÷òî çíà÷èòåëüíî çàòðóä-íÿåò ðåøåíèå ýêñïåðòíûõ âîïðîñîâ. Êðîìå òîãî, ñëåäóåò âñåãäà ó÷èòûâàòü, ÷òî óñòàíîâëåíèå ýêñïåðòíîãî äèàãíîçà ÄÝ, ÿäðîì êëèíè÷åñêîé êàðòèíû êîòîðîé ÿâëÿþòñÿ íàðóøåíèÿ ïîçíàâàòåëüíûõ (êîãíèòèâíûõ) ôóíêöèé, îêàæåò îïðå-äåëåííîå íåãàòèâíîå âëèÿíèå íà ñîöè-àëüíóþ àäàïòàöèþ (òðóäîóñòðîéñòâî) âîåííîñëóæàùèõ ïðè óâîëüíåíèè èç Âîîðóæåííûõ ñèë.  ñâÿçè ñ ýòèì â ýêñïåðòíîé ïðàê-òèêå äèàãíîñòèêà óêàçàííûõ õðîíè÷åñ-êèõ ôîðì öåðåáðîâàñêóëÿðíîé ïàòîëî-ãèè òðåáóåò ÷åòêî àðãóìåíòèðîâàííûõ ìåòîäè÷åñêèõ ïîäõîäîâ è èñïîëüçîâàíèÿ íàèáîëåå ýôôåêòèâíûõ ìåòîäîâ èññëå-äîâàíèÿ. Ïîñòàíîâêà äèàãíîçà äèñöèðêó-ëÿòîðíîé ýíöåôàëîïàòèè äîëæíà âêëþ-÷àòü òùàòåëüíûé ñáîð æàëîá è àíàìíåçà, ñîìàòè÷åñêèé è íåâðîëîãè÷åñêèé îñìîòð ïî ñòàíäàðòíîé ìåòîäèêå, íåéðîïñèõîëî-ãè÷åñêîå òåñòèðîâàíèå, ëàáîðàòîðíóþ è èíñòðóìåíòàëüíóþ äèàãíîñòèêó, ðåíòãå-íîëîãè÷åñêîå îáñëåäîâàíèå ñ èñïîëüçî-âàíèåì ìåòîäîâ íåéðîâèçóàëèçàöèè (êîìïüþòåðíîé è ìàãíèòíî-ðåçîíàíñíîé òîìîãðàôèè) ñ ïîñëåäóþùèì óñòàíîâ-ëåíèåì ïðè÷èííî-ñëåäñòâåííûõ ñâÿçåé êëèíè÷åñêèõ äàííûõ è ýòèîëîãè÷åñêîãî ñîñóäèñòîãî ôàêòîðà ðèñêà.Ëèòåðàòóðà
1. Åìåëèí À.Þ. Êîãíèòèâíûå íàðóøåíèÿ ïðè öåðåáðîâàñêóëÿðíîé áîëåçíè (ïàòîãåíåç, êëèíèêà, äèôôåðåíöèàëüíàÿ äèàãíîñòèêà): Àâòîðåô. äèñ. ... ä-ðà ìåä. íàóê. – ÑÏá, 2010. – 37 ñ. 2. Çäðàâîîõðàíåíèå â Ðîññèè. 2011/ Ñòàò. ñá. – Ì.: Ðîññòàò, 2011. – 326 ñ. 3. Îäèíàê Ì.Ì., Åìåëèí À.Þ., Êîâàëåíêî Ï.À., Ëîáçèí Â.Þ. Íàðóøåíèå êîãíèòèâíûõ ôóíê-öèé ïðè ñîñóäèñòûõ ïîðàæåíèÿõ ãîëîâíîãî ìîçãà â ïðàêòèêå âîåííîãî íåâðîëîãà // Âîåí.-ìåä. æóðí. – 2009. – Ò. 330, ¹ 4. – Ñ. 32–40. 4. Îäèíàê Ì.Ì., Åìåëèí À.Þ., Ëîáçèí Â.Þ. Íàðóøåíèå êîãíèòèâíûõ ôóíêöèé ïðè öå-ðåáðîâàñêóëÿðíîé ïàòîëîãèè. – ÑÏá: ÂÌåäÀ, 2006. – 158 ñ. 5. Ñóñëèíà Ç.À., Âàðàêèí Þ.ß. Ýïèäåìèî-ëîãè÷åñêèå àñïåêòû èçó÷åíèÿ èíñóëüòà. Âðå-ìÿ ïîäâîäèòü èòîãè // Àííàëû êëèí. è ýêñïåð. íåâðîë. – 2007 – Ò. 1, ¹ 2. – Ñ. 22–28.ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ ÂÎÏÐÎÑÛ © Â.Í.ÏËÅÕÀÍÎÂ, 2012 ÓÄÊ 616.62-002.2-055.2
Î ïðè÷èíàõ ðàçâèòèÿ õðîíè÷åñêîãî öèñòèòà
ó æåíùèí ìîëîäîãî âîçðàñòà
ÏËÅÕÀÍΠÂ.Í., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû (plechanov67@mail.ru) Âîåííûé ãîñïèòàëü ÔÁÓ «442-é Îêðóæíîé âîåííûé êëèíè÷åñêèé ãîñïèòàëü» ÌÎ ÐÔ, ã. Ìèðíûé, Àðõàíãåëüñêàÿ îáëàñòüPlekhanov V.N. – About the causes of inveterate cystitis in young women. 16 female patients,aged 28,6±3,2 years, with recrudescent inveterate cystitis were examined for the purpose of improvement of treatment of chronic cystitis. The examined patients noted relapse of disease after sex intercourse. Spectrum of diagnosed uropathogens in female patients corresponds to the structure of bacterio from urina taken after prostate milking and prostatic fluid of patients’ intercourse partners. The given uropathogens also corresponds to the structure of contagium of urinary tract in young men. Connection between urogenital biotope and biotope of prostate as a vessel of persistence infection is related. Recrudescent inveterate cystitis in young women may be result from latent inveterate bacteritic prostatitis in their intercourse partners. Effectiveness of treatment and prophylaxis of recrudescence of inveterate cystitis in young women depends on timely diagnostics, treatment, and prophylaxis of inveterate bacteritic prostatitis in their intercourse partners.
K e y w o r d s: recrudescent inveterate cystitis, women, whence, intercourse partners, prostatitis.
