2011
¹ 12
Âîåííî-ìåäèöèíñêèé
æóðíàë
ÄÅÊÀÁÐÜ
2011
Ñ Íîâûì ãîäîì,
äîðîãèå ÷èòàòåëè!
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 ÅÆÅÌÅÑß×ÍÛÉ ÒÅÎÐÅÒÈ×ÅÑÊÈÉ È ÍÀÓ×ÍÎ-ÏÐÀÊÒÈ×ÅÑÊÈÉ ÆÓÐÍÀË ÌÈÍÈÑÒÅÐÑÒÂÀ ÎÁÎÐÎÍÛ ÐÎÑÑÈÉÑÊÎÉ ÔÅÄÅÐÀÖÈÈ
Non scholae, sed vitae discimus!
ÐÅÄÀÊÖÈÎÍÍÀß ÊÎËËÅÃÈß: Ì.Â.Ïîääóáíûé (ãëàâíûé ðåäàêòîð) À.Á.Áåëåâèòèí 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 À.Ý.Íèêèòèí 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
2011 * ÄÅÊÀÁÐÜ
Ò. 332 * ¹ 12
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) Þ.Â.Ñàáàíèí (Ìîñêâà) Â.Á.Ñèìîíåíêî (Ìîñêâà) È.Ì.×èæ (Ìîñêâà) Àäðåñ â ñåòè Èíòåðíåò: http://sc.mil.ru/social/media/ magazine/more.htm?id=8753 @morfOrgInfoÈñïîëüçîâàíèå ïîëåâûõ ìåäèöèíñêèõ
ôîðìèðîâàíèé â àðìèÿõ ñòðàí ÍÀÒÎ
è Âîîðóæåííûõ Ñèëàõ ÐÔ
Ïðîáëåìû ïîñëåäèïëîìíîãî îáó÷åíèÿ
âðà÷åáíûõ êàäðîâ ñëóæáû ìåäèöèíû
êàòàñòðîô
Äåÿòåëüíîñòü âîåííîãî
àìáóëàòîðíî-ïîëèêëèíè÷åñêîãî ó÷ðåæäåíèÿ
ïî îáåñïå÷åíèþ
ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî áëàãîïîëó÷èÿ
íàñåëåíèÿ
Ñòåíòèðîâàíèå áèôóðêàöèîííûõ
ñòåíîçîâ êîðîíàðíûõ àðòåðèé
ñ ïðèìåíåíèåì âíóòðèñîñóäèñòûõ
ìåòîäîâ äèàãíîñòèêè
Ê ïðîáëåìå ñîâåðøåíñòâîâàíèÿ
óðîëîãè÷åñêîé ïîìîùè âîåííîñëóæàùèì
Óðîêè îðãàíèçàöèè ìåäèöèíñêîãî
îáåñïå÷åíèÿ â õîäå Ìîñêîâñêîé áèòâû
ÑONTENTS
4
Ëå÷åáíî-ïðîôèëàêòè÷åñêèå
âîïðîñû Prophylaxis and treatment Îðãàíèçàöèÿ ìåäèöèíñêîãî
îáåñïå÷åíèÿ Âîîðóæåííûõ Ñèë
Organization of medical support of the Armed Forces
23 Ìåäèöèíà ýêñòðåìàëüíûõ ñèòóàöèé Medicine of extreme situations 15 30 20 Êîðíþøêî È.Ã., ßêîâëåâ Ñ.Â., Ìóðàøåâ Í.Â., Ñèäîðîâ Â.À., Ìåäâåäåâ Â.Ð., Ìàòâååâ À.Ã. – Àíàëèç èñïîëüçîâàíèÿ ïîëåâûõ ìåäèöèíñêèõ ôîðìèðîâàíèé â àðìèÿõ ñòðàí ÍÀÒÎ è Âîîðóæåííûõ Ñèëàõ Ðîññèéñêîé Ôåäåðàöèè Ðÿáèíêèí Â.Â. – Ñîñòîÿíèå è ïðîáëåìû ïîñëåäèïëîìíîãî îáó÷åíèÿ âðà÷åáíûõ êàäðîâ cëóæáû ìåäèöèíû êàòàñòðîô Èâàíîâ Â.À., Áåëÿêèí Ñ.À., Ìàéñêîâ Â.Â., Èâàíîâ À.Â., Ñìèðíîâ Â.Ë., Ïåðìÿêîâ Ñ.Â. – Ñòåíòèðîâàíèå áèôóðêàöèîííûõ ñòåíîçîâ êîðîíàðíûõ àðòåðèé ñ ïðèìåíåíèåì âíóòðèñîñóäèñòûõ ìåòîäîâ äèàãíîñòèêè Ìåðåæêèí À.Ì., Çîòêèí À.Â., Ìèöü Í.Í., Ðîæíîâ Þ.À. – Äåÿòåëüíîñòü âîåííîãî àìáóëàòîðíî-ïîëèêëèíè÷åñêîãî ó÷ðåæ-äåíèÿ ïî îáåñïå÷åíèþ ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî áëàãîïîëó÷èÿ íà-ñåëåíèÿ Êðàòêèå ñîîáùåíèÿ 19, Brief reports 34
Kornyushko I.G., Yakovlev S.V., Murashev N.V., Sidorov V.A., Medvedev V.R., Matveyev A.G. – Analysis of the use of field medical units in the armies of NATO and Russian Armed Forces
Ryabinkin V.V. – Status and Problems of postgraduate training of medical staff of Disaster Medicine Service
Ivanov V.A., Belyakin S.A., Mayskov V.V., Ivanov A.V., Smirnov V.L., Permyakov S.V. – Bifurcation coronari stenting guided bi intravascular diagnosnic tools
Shestayev A.Yu., Savchenko I.F., Kushni-renko N.P., KushniKushni-renko Ê.N., Pitomtsev I.M., Skiba Ì.O., Jancev A.A. – About the improve-ment of urologic care for soldiers with erectile dysfunction Øåñòàåâ À.Þ., Ñàâ÷åíêî È.Ô., Êóøíè-ðåíêî Í.Ï., ÊóøíèÊóøíè-ðåíêî Ê.Í., Ïèòîì-öåâ È.Ì., Ñêèáà Ì.Î., ßíÏèòîì-öåâ À.À. – Î ñîâåðøåíñòâîâàíèè óðîëîãè÷åñêîé ïîìîùè âîåííîñëóæàùèì ñ ýðåêòèëü-íîé äèñôóíêöèåé
Merezhkin A.M., Zotkin A.V., Mits N.N., Rozhnov Yu.A. – Military activities of outpatient clinics to ensure the sanitary-epidemiological welfare of the population Ýïèäåìèîëîãèÿ
è èíôåêöèîííûå áîëåçíè
Epidemiology
and infectious diseases
Ïî ñòðàíèöàì çàðóáåæíîé ìåäèöèíñêîé ïå÷àòè
From the foreign medical publications 55
3
«Âîåííî-ìåäèöèíñêèé æóðíàë», 12’2011
ÑONTENTS
Èç èñòîðèè âîåííîé ìåäèöèíû
From the history of military medicine
Îôèöèàëüíûé îòäåë Official communications 63
57
76
Êðèòèêà è áèáëèîãðàôèÿ Criticism and bibliography
78 Ïåðå÷åíü ñòàòåé, íàïå÷àòàííûõ â 2011 ã.
â «Âîåííî-ìåäèöèíñêîì æóðíàëå» List of the articles, printed in «Military-Medical magazine» in 2011 Àëôàâèòíûé èìåííîé óêàçàòåëü 92 Alphabetic list of autor
75 Øåëåïîâ À.Ì., Êðþ÷êîâ Î.À. – Óðîêè îðãàíèçàöèè ìåäèöèíñêîãî îáåñïå÷åíèÿ â õîäå Ìîñêîâñêîé áèòâû Íèêîëàåâ Â.Ð. – Ôðîíòîâûå äîðîãè ïðî-ôåññîðà Ì.Ê.Êóçüìèíà (Ê 70-ëåòèþ Ìîñêîâñêîé áèòâû) Êîòèâ Á.Í., Êàðïîâè÷ Â.Â. – Èâàí Ñòå-ïàíîâè÷ Êîëåñíèêîâ – «ãåíåðàë õèðóð-ãèè» (Ê 110-ëåòèþ ñî äíÿ ðîæäåíèÿ) Áåëîâ À.Á., Èøêèëüäèí Ì.È., Îãàðêîâ Ï.È. – Âêëàä àêàäåìèêà Â.Ä.Áåëÿêîâà â ðàç-âèòèå ýïèäåìèîëîãè÷åñêîé íàóêè è âûñ-øåãî ìåäèöèíñêîãî îáðàçîâàíèÿ
Shelepov A.M., Kryuchkov O.A. – Lessons from the organization of medical support during the Battle for Moscow
Nikolayev V.R. – Front Roads of Profes-sor Kuzmin M.K. (the 70th anniversary of the Battle for Moscow)
Kotiv B.N., Karpovich V.V. – Ivan Stepano-vich Kolesnikov – «General of Surgery» (the 110th anniversary of his birth) Belov A.B., Ishkildin M.I., Ogarkov P.I. – Contribution of Academician V.D.Belya-kov to the development of epidemiological science and medical education
70 68 76 Íàïîìèíàåì, ÷òî íàø æóðíàë âõîäèò â Ïåðå÷åíü âåäóùèõ ðåöåíçèðóåìûõ íàó÷íûõ æóðíàëîâ è èçäàíèé, â êîòîðûõ ïóáëèêóþòñÿ çíà÷èìûå ðåçóëüòàòû äèññåðòàöèé íà ñîèñêàíèå ó÷åíîé ñòåïåíè äîêòîðà è êàíäèäàòà íàóê. «Âîåííî-ìåäèöèíñêèé æóðíàë» ïðåäñòàâëåí â ìåæäóíàðîäíûõ
èíôîðìàöèîííî-ñïðàâî÷íûõ èçäàíèÿõ Index Medicus, Current Work in the History of Medicine, Ulrich’s International Periodicals Directory,
âõîäèò â ñèñòåìû öèòèðîâàíèÿ PubMed, Scopus è äð. Îáðàùàåì âíèìàíèå àâòîðîâ æóðíàëà íà íåîáõîäèìîñòü óêàçûâàòü íà òèòóëüíîì ëèñòå ïîëíîå íàçâàíèå è ìåñòîíàõîæäåíèå ó÷ðåæäåíèÿ (ãîñïèòàëÿ, âîéñêîâîé ÷àñòè, èíñòèòóòà è ò. ä.), â êîòîðîì âûïîëíåíà ðàáîòà, à òàêæå ïðåä-ñòàâëåíèÿ êðàòêîãî ðåçþìå íà ðóññêîì è àíãëèéñêîì ÿçûêàõ ê îðèãèíàëüíûì ñòàòüÿì. Ñîãëàñíî íîâûì òðåáîâàíèÿì ÂÀÊà, äëÿ ïóáëèêàöèè â æóðíàëå ïðîñüáà ïðåäñòàâëÿòü íà îòäåëüíîì ëèñòå ñâåäåíèÿ î êàæäîì àâòîðå: 1) ôàìèëèþ, èìÿ è îò÷åñòâî; 2) äîëæíîñòü; 3) ïîëíûé ïî÷òîâûé ñëóæåáíûé àäðåñ è e-mail; 4) íîìåð ñëóæåáíîãî òåëåôîíà è ôàêñà.
ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ
ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË
© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011 ÓÄÊ [61:355] (470)Àíàëèç èñïîëüçîâàíèÿ ïîëåâûõ ìåäèöèíñêèõ
ôîðìèðîâàíèé â àðìèÿõ ñòðàí ÍÀÒÎ
è Âîîðóæåííûõ Ñèëàõ Ðîññèéñêîé Ôåäåðàöèè
ÊÎÐÍÞØÊÎ È.Ã., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû â îòñòàâêå1 ßÊÎÂËÅ Ñ.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû2 ÌÓÐÀØÅ Í.Â., çàñëóæåííûé âîåííûé ñïåöèàëèñò ÐÔ, êàíäèäàò òåõíè÷åñêèõ íàóê, ïîëêîâíèê3 ÑÈÄÎÐΠÂ.À., ïîëêîâíèê â îòñòàâêå3 ÌÅÄÂÅÄÅ Â.Ð., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà3 ÌÀÒÂÅÅ À.Ã., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå4 1Ãîñóäàðñòâåííûé èíñòèòóò óñîâåðøåíñòâîâàíèÿ âðà÷åé ÌÎ ÐÔ, Ìîñêâà; 2Ãëàâíîå ìåäèöèí-ñêîå óïðàâëåíèå ÌÎ ÐÔ, Ñàíêò-Ïåòåðáóðã; 3Íàó÷íî-èññëåäîâàòåëüñêèé èñïûòàòåëüíûé èí-ñòèòóò (âîåííîé ìåäèöèíû) Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåð-áóðã; 4Ôèëèàë ¹ 3 Ãëàâíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. Í.Í.Áóðäåíêî, ÌîñêâàKornyushko I.G., Yakovlev S.V., Murashev N.V., Sidorov V.A., Medvedev V.R., Matveyev A.G. – Analysis of the use of field medical units in the armies of NATO and Russian Armed Forces. An analysis of medical services of NATO and the Medical Service of the Armed Forces of the Russian Federation of modern technology deployment stages of medical evacuation (tents, inflatable structures, shelters, containers, medical armored vehicles, cars, etc.) is presented. Examples of their usage in isolated employment, usage in the group as a mobile medical stations and field hospitals in various conditions, the prospects and directions of development of technical means deployment of medical service are given.
K e y w o r d s: Field medical units, facilities, medical services, medical evacuation deployment stages, tents, shelters, containers, modules, medical stations, field hospitals and medical facilities.
À
íàëèç ðåçóëüòàòîâ ðàáîòû, íîé ñïåöèàëèñòàìè âîåííî-ìåäè-öèíñêèõ âåäîìñòâ áîëüøèíñòâà ñòðàí ÍÀÒÎ ïî ïîèñêó íîâûõ, ýôôåêòèâíûõ è ýêîíîìè÷åñêè âûãîäíûõ ïîäõîäîâ ê îðãàíèçàöèè îêàçàíèÿ ìåäèöèíñêîé ïî-ìîùè ðàíåíûì â õîäå áîåâûõ äåéñòâèé, ñâèäåòåëüñòâóåò, ÷òî ïðèìåíåíèå cîâðå-ìåííûõ âèäîâ îðóæèÿ è óñëîæíåíèå áîåâîé ïàòîëîãèè òðåáóþò îêàçàíèÿ õè-ðóðãè÷åñêîé ïîìîùè íà ïåðåäîâûõ ýòà-ïàõ.  ñâÿçè ñ ýòèì ðåàëèçàöèÿ íîâûõ êîí-öåïöèé äåÿòåëüíîñòè ìåäèöèíñêèõ ñëóæá àðìèé âåäóùèõ çàðóáåæíûõ ñòðàí íàøëà îòðàæåíèå â èçìåíåíèÿõ ñòðóêòóðû è òåõ-íè÷åñêîãî îñíàùåíèÿ ñðåäñòâ äëÿ ðàç-âåðòûâàíèÿ ìåäèöèíñêèõ ôîðìèðîâàíèé, è â ïåðâóþ î÷åðåäü, îïåðàòèâíî-òàêòè÷å-ñêîãî çâåíà [8]. Òàê, â íàñòîÿùåå âðåìÿ è â äàëüíåé-øåé ïåðñïåêòèâå íåîáõîäèìû âûñîêîìî-áèëüíûå õèðóðãè÷åñêèå áðèãàäû, ñïîñîá-íûå îêàçàòü ðåàíèìàòîëîãè÷åñêóþ ïî-ìîùü ðàíåíûì, íóæäàþùèìñÿ â ñòàáè-ëèçàöèè ñîñòîÿíèÿ äî íà÷àëà ýâàêóàöèè. Òàêèì áðèãàäàì òðåáóþòñÿ íàäåæíûå ïå-ðåäâèæíûå óêðûòèÿ (êàê ïðàâèëî, áðî-íèðîâàííûå), ïîä çàùèòîé êîòîðûõ õè-ðóðãè ñìîãóò îêàçûâàòü ðàíåíîìó ìåäè-öèíñêóþ ïîìîùü, è ñðåäñòâà ñâÿçè äëÿ âîçìîæíîãî òåëåäèàãíîñòèðîâàíèÿ. Êîí-öåïöèÿ âûäâèæåíèÿ õèðóðãè÷åñêîé ïî-ìîùè íåïîñðåäñòâåííî ê ïåðåäîâîé óæå îäîáðåíà êîìàíäîâàíèåì áîëüøèíñòâà ìåäèöèíñêèõ ñëóæá. Âìåñòå ñ òåì îêàçà-íèå õèðóðãè÷åñêîé ïîìîùè íåïîñðåä-ñòâåííî íà ïîëå áîÿ çàòðóäíåíî ââèäó îòñóòñòâèÿ ïîðòàòèâíîé àïïàðàòóðû, ñÌàòåðèàë î òåõíè÷åñêèõ ñðåäñòâàõ ðàçâåðòûâàíèÿ ýòàïîâ ìåäèöèíñêîé ýâàêóàöèè îïóáëèêîâàí â ðóáðèêå «Îðãàíèçàöèÿ ìåäèöèíñêîãî îáåñïå÷åíèÿ Âîîðóæåííûõ Ñèë»
Çàðóáåæíûå è îòå÷åñòâåííûå ñðåäñòâà ðàçâåðòûâàíèÿ
ýòàïîâ ìåäèöèíñêîé ýâàêóàöèè
Ïíåâìîêàðêàñíîå óêðûòèå (Trell Tent, Øâåöèÿ) Ïíåâìîêàðêàñíàÿ ïàëàòêà ñ íàðóæíûì êàðêàñîì è ñîëíöåçàùèòíûì òåíòîì (EADS, Ãåðìàíèÿ) Ïíåâìîêàðêàñíîå óêðûòèå (Zeppelin, Ãåðìàíèÿ) Âíóòðåííèé âèä ïíåâìîêàðêàñíîãî óêðûòèÿ (Zeppelin, Ãåðìàíèÿ) Êàðêàñíî-òåíòîâàÿ ïàëàòêà ñ íàðóæíûì êàðêàñîì è ñîëíöåçàùèòíûì òåíòîì («ÎÌÍÈÌÅÄ», Ðîññèÿ) Êàðêàñíî-òåíòîâîå óêðûòèå ñ ñîëíöå-çàùèòíûì òåíòîì ãîñïèòàëÿ (Íîðâåãèÿ) Âíóòðåííèé âèä ïíåâìîêàðêàñíîãî ñîîðóæåíèÿ ÏÑÌ-6 Ïíåâìîêàðêàñíîå ñîîðóæåíèå ÏÑÌ-6 ñ âíóòðåííèì êàðêàñîì (Ðîññèÿ)Çàðóáåæíûå è îòå÷åñòâåííûå ñðåäñòâà ðàçâåðòûâàíèÿ
ýòàïîâ ìåäèöèíñêîé ýâàêóàöèè
Ìîáèëüíàÿ ñêîðàÿ ïîìîùü â êîíòåéíåðå ïîñòî-ÿííîãî îáúåìà (Zeppelin, Ãåðìàíèÿ) Êîíòåéíåð ïåðåìåííîãî îáúåìà ðàçäâèæíîãî òèïà (2:1) â îäíó ñòîðîíó (Zeppelin, Ãåðìàíèÿ) Êîíòåéíåð ïåðåìåííîãî îáúåìà ðàçäâèæíîãî òèïà (3:1) â äâå ñòîðîíû (Zeppelin, Ãåðìàíèÿ) Êîíòåéíåð ïåðåìåííîãî îáúåìà ðàçäâèæíîãî òèïà (Ãåðìàíèÿ) Êóçîâ-êîíòåéíåð ïîñòîÿííîãî îáúåìà (ÍÏÏ «Ïðîåêò-òåõíèêà», Ðîññèÿ) Êóçîâ-êîíòåéíåð ïåðåìåííîãî îáúåìà ðàñêëàäíîãî òèïà (ÍÏÏ «Ïðîåêò-òåõíèêà», Ðîññèÿ)Çàðóáåæíûå è îòå÷åñòâåííûå ñðåäñòâà ðàçâåðòûâàíèÿ
ýòàïîâ ìåäèöèíñêîé ýâàêóàöèè
Ìîáèëüíàÿ ñïàñàòåëüíàÿ ñòàíöèÿ ÍÀÒÎ (EADS, Ãåðìàíèÿ) Ìîáèëüíûé êîìïëåêñ (Zeppelin, Ãåðìàíèÿ) Êîìïëåêñ îïåðàöèîííî-ðåàíèìàöèîííûé ïîäâèæíûé ÊÎÐÏ-01 (Ðîññèÿ) Ìîáèëüíûé ñïàñàòåëüíûé öåíòð ÍÀÒÎ (EADS, Ãåðìàíèÿ) Ïîëåâîé ëàçàðåò áóíäåñâåðà äëÿ äî-ãîñïèòàëüíîé ìåäèöèíñêîé ïîìîùè Ïîäâèæíûé êîìïëåêñ âðà÷åáíîé ïî-ìîùè ÏÊ ÂÏ 01 (ÍÏÏ «Ïðîåêò-òåõ-íèêà», Ðîññèÿ) îïóáëèêîâàí â ðóáðèêå «Îðãàíèçàöèÿ ìåäèöèíñêîãî îáåñïå÷åíèÿ Âîîðóæåííûõ Ñèë»Çàðóáåæíûå è îòå÷åñòâåííûå ñðåäñòâà ðàçâåðòûâàíèÿ
ýòàïîâ ìåäèöèíñêîé ýâàêóàöèè
Ìàòåðèàë î òåõíè÷åñêèõ ñðåäñòâàõ ðàçâåðòûâàíèÿ ýòàïîâ ìåäèöèíñêîé ýâàêóàöèè Ìîáèëüíûé ïîëåâîé ãîñïèòàëü ÍÀÒÎ (EADS, Ãåðìàíèÿ) Ìåäèöèíñêèé îòðÿä ñïåöèàëüíîãî íàçíà÷åíèÿ (ÍÏÏ «Ïðîåêò-òåõíèêà», Ðîññèÿ) Ìîáèëüíûé ìíîãîïðîôèëüíûé ãîñïèòàëü (ñîâìåñòíàÿ ðàçðàáîòêà Ðîññèÿ – Ãåðìàíèÿ) Ïîëåâîé ãîñïèòàëü (Zeppelin, Ãåðìàíèÿ) Ìîáèëüíûé ïîëåâîé ãîñïèòàëü (Schall, Ãåðìàíèÿ) Ïîëåâîé ãîñïèòàëü (Ôðàíöèÿ) Ïîëåâîé ãîñïèòàëü (Íîðâåãèÿ) Ïîëåâîé ãîñïèòàëü (Øâåöèÿ)15
«Âîåííî-ìåäèöèíñêèé æóðíàë», 12’2011ÌÅÄÈÖÈÍÀ
ÝÊÑÒÐÅÌÀËÜÍÛÕ ÑÈÒÓÀÖÈÉ
© Â.Â.ÐßÁÈÍÊÈÍ, 2011 ÓÄÊ [614.8:614.25](07.07)Ñîñòîÿíèå è ïðîáëåìû ïîñëåäèïëîìíîãî îáó÷åíèÿ
âðà÷åáíûõ êàäðîâ ñëóæáû ìåäèöèíû êàòàñòðîô
ÐßÁÈÍÊÈÍ Â.Â., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå ÔÃÓ «Âñåðîññèéñêèé öåíòð ìåäèöèíû êàòàñòðîô «Çàùèòà» Ìèíçäðàâñîöðàçâèòèÿ Ðîññèè, ÌîñêâàRyabinkin V.V. – Status and Problems of postgraduate training of medical staff of Disaster Medicine Service. An analysis of the postgraduate training of doctors of Disaster Medicine Service in the central and local training bases in the federal districts of Russian Federation in 2010 is performed. It was concluded that the existing Department of Emergency Medicine and mobilization training and health education can not reach those who need further training. It was proposed to create on the basis of a FSI VTSMK «Protection» Institute of Emergency Medicine to improve the training of doctors, training and methodological support of teaching and training of the teaching staff.
K e y w o r d s: National Service of Emergency Medicine, postgraduate training of medical staff, the Institute of Emergency Medicine.
Ñ
îäåðæàíèå çàäà÷, âîçëîæåííûõ íà ñëóæáó ìåäèöèíû êàòàñòðîô (ÑÌÊ), ñïåöèôè÷åñêèå óñëîâèÿ èõ ðåøåíèÿ, ó÷à-ñòèå â ëèêâèäàöèè ìåäèêî-ñàíèòàðíûõ ïîñëåäñòâèé ÷ðåçâû÷àéíûõ ñèòóàöèé (×Ñ) âðà÷åé ðàçëè÷íûõ ñïåöèàëüíîñòåé ïðåäúÿâëÿþò âûñîêèå òðåáîâàíèÿ ê èõ ïîñëåäèïëîìíîé ïîäãîòîâêå ñ ó÷åòîì íîâûõ äîñòèæåíèé ìåäèöèíñêîé íàóêè è ïðàêòèêè. Àíàëèç ôàêòè÷åñêîãî îõâàòà âðà÷åé, çàäåéñòâîâàííûõ â ñèñòåìå ÑÌÊ ðàçëè÷-íûìè âèäàìè ïîñëåäèïëîìíîãî îáó÷å-íèÿ íà öåíòðàëüíûõ (àêàäåìèè è èíñòè-òóòû óñîâåðøåíñòâîâàíèÿ âðà÷åé, ôà-êóëüòåòû óñîâåðøåíñòâîâàíèÿ âðà÷åé ìåäèöèíñêèõ âóçîâ) è íà ìåñòíûõ áàçàõ â 2010 ã., ïðîâåäåí ïî îêðóãàì, â öåëîì ïî âñåé ñëóæáå â ÐÔ è îòäåëüíûì âðà÷åá-íûì ñïåöèàëüíîñòÿì. Ñîãëàñíî äàííûì îòðàñëåâîé îò÷åò-íîñòè, íà 31.12.2010 ã. â ÑÌÊ Ìèíçäðàâ-ñîöðàçâèòèÿ Ðîññèè áûëî çàäåéñòâîâàíî 58 384 âðà÷à. Èç íèõ ïðîøëè îáó÷åíèå 14 528 âðà÷åé, èëè 24,9%, ò. å. êàæäûé ÷åòâåðòûé âðà÷ ÑÌÊ (òàáë. 1). Îáíàðóæåíî ñóùåñòâåííîå ðàçëè÷èå â îõâàòå âðà÷åé ÑÌÊ ïîñëåäèïëîìíûì îáó÷åíèåì íà öåíòðàëüíûõ áàçàõ. Òàê, áîëü-øå âñåãî áûëè îõâà÷åíû îáó÷åíèåì âðà-÷è, çàäåéñòâîâàííûå â ÑÌÊ Ïðèâîëæñêîãî (34,08%), Ñåâåðî-Çàïàäíîãî (27,61%), Äàëüíåâîñòî÷íîãî (25,35%), Ñåâåðî-Êàâ-êàçñêîãî (25,23%) è Öåíòðàëüíîãî îêðó-ãîâ (25,11%). À ìåíüøå áûëè îõâà÷åíû îáó÷åíèåì íà öåíòðàëüíûõ áàçàõ âðà÷è Ñèáèðñêîãî (18,47%), Óðàëüñêîãî (19,23%) è Þæíîãî (20,10%) îêðóãîâ. Åñëè ó÷åñòü ðåãëàìåíòèðîâàííóþ ïåðèîäè÷íîñòü ïðîõîæäåíèÿ âðà÷àìè îáó-÷åíèÿ â ïîñëåäèïëîìíûé ïåðèîä 1 ðàç â 5 ëåò, òî ìîæíî îöåíèòü ñîñòîÿíèå íåïðåðûâíîãî îáó÷åíèÿ âðà÷åé â 2010 ã. ïî îñíîâíîé ñïåöèàëüíîñòè êàê «óäîâëå-òâîðèòåëüíîå». Óãëóáëåííóþ îöåíêó ñîñòîÿíèÿ ïîñ-ëåäèïëîìíîé ïîäãîòîâêè âðà÷åé ÑÌÊ äàåò ïîêàçàòåëü, õàðàêòåðèçóþùèé ïðî-õîæäåíèå ýòèìè âðà÷àìè îáó÷åíèå ïî ìåäèöèíå êàòàñòðîô (ÌÊ). Ýòîò ïîêàçà-òåëü äåìîíñòðèðóåò ñåðüåçíûé äåôèöèò â îáó÷åíèè âðà÷åé ñëóæáû. Òàê, òîëüêî 8,3%ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ
ÂÎÏÐÎÑÛ
© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011 ÓÄÊ 616.132.2-089Ñòåíòèðîâàíèå áèôóðêàöèîííûõ ñòåíîçîâ
êîðîíàðíûõ àðòåðèé ñ ïðèìåíåíèåì
âíóòðèñîñóäèñòûõ ìåòîäîâ äèàãíîñòèêè
ÈÂÀÍΠÂ.À., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð ÁÅËßÊÈÍ Ñ.À., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû çàïàñà ÌÀÉÑÊΠÂ.Â. ÈÂÀÍΠÀ.Â. ÑÌÈÐÍΠÂ.Ë. ÏÅÐÌßÊΠÑ.Â. 3-é Öåíòðàëüíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. À.À.Âèøíåâñêîãî, ã. Êðàñíîãîðñê, Ìîñêîâñêàÿ îáëàñòüIvanov V.A., Belyakin S.A., Mayskov V.V., Ivanov A.V., Smirnov V.L., Permyakov S.V. – Bifurcation coronari stenting guided by intravascular diagnosnic tools. Results of coronary bifurcation stenting guided by intravascular diagnostic tools were searched. 85 patients took part in the study, there were generated two groups. In the research group intravascular ultrasound of main vessel has revealed stent malapposition in 97,6%. Fractional flow reserve of jailed side branch ostium is less then 0,75 in 7,1% only, despite of the average 78±4% narrowing. Severe cardiac events in research group during long term clinical follow-up were better in research group: 6,9% vs 32,5% (p<0,05).
K e y w or d s: limitations of coronary angiography, bifurcation coronary lesions, intravascular ultrasound study, fractional flow reserve, drug eluting stent.
Ý
íäîâàñêóëÿðíîå ëå÷åíèå áîëüíûõ èøåìè÷åñêîé áîëåçíüþ ñåðäöà (ÈÁÑ) ñ áèôóðêàöèîííûìè ñòåíîçàìè (ÁÑ) êî-ðîíàðíûõ àðòåðèé ÿâëÿåòñÿ îäíèì èç ñàìûõ ñëîæíûõ è äèñêóòàáåëüíûõ ðàç-äåëîâ èíòåðâåíöèîííîé êàðäèîëîãèè. Íåñìîòðÿ íà ÷àñòóþ âñòðå÷àåìîñòü, ìíîãîîáðàçèå àíàòîìè÷åñêèõ êëàññèôè-êàöèé òèïîâ ÁÑ è ìåòîäèê ñòåíòèðîâà-íèÿ, à òàêæå èñïîëüçîâàíèå ñòåíòîâ ñ ëåêàðñòâåííûì ïîêðûòèåì (ÑËÏ), íå-ïîñðåäñòâåííûå è îòäàëåííûå ðåçóëü-òàòû âìåøàòåëüñòâà õóæå, ÷åì íà ïðî-ñòûõ äèñêðåòíûõ ñòåíîçàõ [2, 7].  ïîñëåäíåå âðåìÿ â ëèòåðàòóðå ïî-ÿâèëèñü ðàáîòû, ïîñâÿùåííûå èñïîëü-çîâàíèþ ðàçëè÷íûõ ìåòîäîâ âíóòðèñîñó-äèñòîé âèçóàëèçàöèè è îöåíêè ôóíêöè-îíàëüíûõ ïàðàìåòðîâ êðîâîòîêà ïðè ñòåíòèðîâàíèè êîðîíàðíûõ àðòåðèé [1, 3]. Ðåçóëüòàòû íåäàâíî çàâåðøåííûõ êëèíè-÷åñêèõ èññëåäîâàíèé ïîçâîëèëè óæå ñå-ãîäíÿ îáîñíîâàòü íåîáõîäèìîñòü áîëåå øèðîêîãî ïðèìåíåíèÿ â ïîâñåäíåâíîé ðóòèííîé ïðàêòèêå âíóòðèñîñóäèñòîãî óëüòðàçâóêîâîãî èññëåäîâàíèÿ (ÂÑÓÇÈ) è èçìåðåíèÿ ôðàêöèîííîãî ðåçåðâà êðîâî-òîêà (ÔÐÊ) [5]. Êàæäûé èç ýòèõ ìåòîäîâ äîïîëíÿåò ïîëèïðîåêöèîííàÿ êîðîíàðíàÿ àíãèî-ãðàôèÿ êà÷åñòâåííî íîâîé èíôîðìàöèåé, ïîçâîëÿåò áîëåå äåòàëüíî èçó÷èòü ïðî-ñòðàíñòâåííóþ ìîäåëü ÁÑ, îïðåäåëèòü ôóíêöèîíàëüíóþ çíà÷èìîñòü ñòåíîçà, âûáðàòü îïòèìàëüíóþ òàêòèêó è ìèíè-ìàëüíî äîñòàòî÷íûé îáúåì ýíäîâàñêóëÿð-íîãî âìåøàòåëüñòâà, ïîäîáðàòü îïòèìàëü-íûå äëèíó è äèàìåòð ñòåíòà, îñóùåñòâèòü êîíòðîëü íàä åãî èìïëàíòàöèåé íà ðàç-ëè÷íûõ ýòàïàõ ïðîöåäóðû è òåì ñàìûì óëó÷øèòü ðåçóëüòàòû ëå÷åíèÿ [6]. Öåëü èññëåäîâàíèÿ Èçó÷èòü íåïîñðåäñòâåííûå è îòäà-ëåííûå ðåçóëüòàòû ïðèìåíåíèÿ âíóòðè-ñîñóäèñòûõ ìåòîäîâ èññëåäîâàíèÿ ïðè ñòåíòèðîâàíèè áèôóðêàöèîííûõ ñòå-íîçîâ êîðîíàðíûõ àðòåðèé.23
«Âîåííî-ìåäèöèíñêèé æóðíàë», 12’2011 ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ ÂÎÏÐÎÑÛ ó âñåõ áîëüíûõ (òàáë. 2). Ëåòàëüíûõ èñõîäîâ íå áûëî. ×àñòîòà ðàçâèòèÿ çíà÷èìûõ íåáëàãîïðèÿòíûõ êîðîíàðíûõ ñîáûòèé äîñòîâåðíî âûøå â ãðóïïå êîíòðîëÿ. Òàêèì îáðàçîì, ïîëèïðîåêöèîííàÿ êîðîíàðíàÿ àíãèîãðàôèÿ, äîëãîå âðåìÿ ñ÷èòàâøàÿñÿ çîëîòûì ñòàíäàðòîì â äè-àãíîñòèêå êîðîíàðíîãî àòåðîñêëåðîçà, èìååò ñóùåñòâåííûå îãðàíè÷åíèÿ ó áîëüíûõ ñ áèôóðêàöèîííûìè ñòåíîçà-ìè êîðîíàðíûõ àðòåðèé. Ìåòîä íå äàåò ïîëíîãî ïðîñòðàíñòâåííîãî ïðåäñòàâ-ëåíèÿ îá àíàòîìèè áèôóðêàöèè è åå ìîðôîìåòðè÷åñêèõ õàðàêòåðèñòèêàõ, íå ó÷èòûâàåò ôóíêöèîíàëüíóþ çíà÷èìîñòü ñòåíîçîâ óñòüåâ áîêîâûõ âåòâåé, ïî ñóòè ÿâëÿÿñü ëèøü ìåòîäîì ñèëóýòíîé âèçó-àëèçàöèè, íå ïîçâîëÿÿ îñóùåñòâèòü àäåêâàòíûé êîíòðîëü íà ðàçíûõ ýòàïàõ ñòåíòèðîâàíèÿ. Ïðèìåíåíèå äîïîëíè-òåëüíûõ ìåòîäîâ âíóòðèñîñóäèñòîé äèàãíîñòèêè ïðè ýíäîâàñêóëÿðíîì ëå-÷åíèè áîëüíûõ ÈÁÑ ñ áèôóðêàöèîí-íûìè ïîðàæåíèÿìè ïîçâîëÿåò îïòèìè-çèðîâàòü íåïîñðåäñòâåííûå è óëó÷øèòü îòäàëåííûå ðåçóëüòàòû ëå÷åíèÿ, òåì ñàìûì áëàãîïðèÿòíî âëèÿÿ íà îòäàëåí-íûé ïðîãíîç ó ïàöèåíòîâ.Ëèòåðàòóðà
1. Äåìèí Â.Â. Êëèíè÷åñêîå ðóêîâîäñòâî ïî âíóòðèñîñóäèñòîìó óëüòðàçâóêîâîìó èññëåäîâà-íèþ. – Îðåíáóðã: Ãàçïðîìïå÷àòü, 2005. – 400 ñ. 2. Äåìèí Â.Â., ×åâû÷àëîâ À.Ì. Âíóòðè-ñîñóäèñòûé óëüòðàçâóê ïðè êîðîíàðíûõ îïå-ðàöèÿõ: â÷åðà, ñåãîäíÿ, çàâòðà // Ìàòåðèàëû êîíôåðåíöèè «Ðåíòãåíýíäîâàñêóëÿðíîå ëå÷å-íèå ñåðäå÷íî-ñîñóäèñòûõ çàáîëåâàíèé: â÷åðà, ñåãîäíÿ, çàâòðà. Âíóòðèñîñóäèñòûå ìåòîäû äèàãíîñòèêè». – Îðåíáóðã: Ãàçïðîìïå÷àòü, 2010. – Ñ. 502–512. 3. Èâàíîâ Â.À., Ìîâñåñÿíö Ì.Þ., Òðóíèí È.Â. Âíóòðèñîñóäèñòûå ìåòîäû èññëåäîâàíèÿ â èíòåðâåíöèîííîé êàðäèîëîãèè. – Ì.: Ìåä-ïðàêòèêà, 2009. – 210 ñ.4. Bon-Kwon K. Physiologic Assessment of Jailed Side Branch Lesions Using Fractional Flow
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6. Fitzgerald P.J. Akio O., Motoya H. et al. Final Results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) Study // Circulation. – 2000. – Vol. 102. – P. 523–530.
7. Lefevre T., Louvard Y., Morice M.C. et al. Stenting of bifurcation lesions classification, treatment, and results // Catheter Cardiovascular Intervention. – 2000. – Vol. 18. – P. 199–204.
8. Medina A., Surez de Lezo J., Pan M. A new classification of coronary bifurcation lesions // Rev. Esp. cardiol. – 2006. – Vol. 59, N 2. – P. 183–184. © ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011 ÓÄÊ 616.69-008.1-057.36-08
Î ñîâåðøåíñòâîâàíèè óðîëîãè÷åñêîé ïîìîùè
âîåííîñëóæàùèì ñ ýðåêòèëüíîé äèñôóíêöèåé
ØÅÑÒÀÅ À.Þ., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû ÑÀÂ×ÅÍÊÎ È.Ô., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà ÊÓØÍÈÐÅÍÊÎ Í.Ï., äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå ÊÓØÍÈÐÅÍÊÎ Ê.Í., ìàéîð ìåäèöèíñêîé ñëóæáû ÏÈÒÎÌÖÅ È.Ì., ìàéîð ìåäèöèíñêîé ñëóæáû ÑÊÈÁÀ Ì.Î., ìàéîð ìåäèöèíñêîé ñëóæáû ßÍÖÅ À.À., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-ÏåòåðáóðãShestayev A.Y., Savchenko I.F., Kushnirenko N.P., Kushnirenko Ê.N., Pitomtsev I.M., Skiba Ì.O., Yantsev A.A. – About the improvement of urologic care for soldiers with erectile dysfunction. Organizational concepts of improvement of urological aid given to military men with erectile dysfunction. The reasons for insufficiency of urological aid rendered to military men with erectile dysfunction were established. The algorithm of its diagnostics was developed. Complete and reduced volume of urological aid with reference to the existing medical and diagnostic capacities of military medical and preventive treatment facilities has been developed. Organizational concepts of improvement of urological aid given to the patients with erectile dysfunction have been determined.
ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ ÂÎÏÐÎÑÛ
K e y w o r d s: military men, military medical and preventive treatment facilities, erectile dysfunction, organization of urological aid, complete and reduced volumes of diagnostic and remedial measures, algorithm of diagnostics, methods of treatment, concepts to improvement.
Ï
ðîâîäèìûå â Âîîðóæåííûõ Ñèëàõ ÐÔ ðåôîðìû íåèçáåæíî âåäóò ê ïå-ðåñìîòðó è ïîâûøåíèþ ïðîôåññèîíàëü-íûõ òðåáîâàíèé ê ñîñòîÿíèþ çäîðîâüÿ âîåííîñëóæàùèõ. Ïðè ñîêðàùåíèè øòàò-íîãî ñîñòàâà è êîëè÷åñòâà âîåííûõ ëå÷åá-íî-ïðîôèëàêòè÷åñêèõ ó÷ðåæäåíèé (ÂËÏÓ) ýòî îáóñëîâëèâàåò íåîáõîäè-ìîñòü ðàöèîíàëüíîãî èçìåíåíèÿ ïîäõî-äîâ ê îêàçàíèþ ðàçëè÷íûõ âèïîäõî-äîâ ñïåöèà-ëèçèðîâàííîé ìåäèöèíñêîé ïîìîùè (ÑÌÏ) êàê â àìáóëàòîðíûõ, òàê è ñòàöèîíàðíûõ óñëîâèÿõ [1, 3, 7, 10]. Îäíàêî, ïî äàííûì àâòîðîâ, ïðè ýòîì âûÿâëÿåòñÿ öåëûé ðÿä âàæíûõ ïðîáëåì, êîòîðûå ìîãóò ïðèâåñòè ê çíà÷èòåëüíîìó ñíèæåíèþ ýôôåêòèâ-íîñòè ÑÌÏ. Ê ýòèì ïðîáëåìàì îòíî-ñÿòñÿ: 1) îðãàíèçàöèîííûå, ñîñòîÿùèå â íåîáõîäèìîñòè ðàçðàáîòêè îïòèìàëü-íîãî îáúåìà ñïåöèàëèçèðîâàííîé ìå-äèöèíñêîé ïîìîùè è îïðåäåëåíèÿ ìåñòà åå îêàçàíèÿ â çàâèñèìîñòè îò ëå÷åáíî-äèàãíîñòè÷åñêèõ âîçìîæíîñ-òåé ÂËÏÓ; 2) ñíàáæåí÷åñêèå, çàêëþ-÷àþùèåñÿ â íåäîñòàòî÷íî äèôôåðåí-öèðîâàííîì è ðåãóëÿðíîì îáåñïå÷åíèè ÂËÏÓ íåîáõîäèìûì îáîðóäîâàíèåì è ì å ä è ê à ì å í ò î ç í û ì è ñ ð å ä ñ ò â à ì è ; 3) êàäðîâûå, ñâÿçàííûå ñ óñêîðåííûì óâîëüíåíèåì â çàïàñ âûñîêîêâàëè-ôèöèðîâàííûõ îôèöåðîâ – íà÷àëüíè-êîâ ñïåöèàëèçèðîâàííûõ îòäåëåíèé âîåííûõ ãîñïèòàëåé è çàìåùåíèåì èõ äîëæíîñòåé ìåíåå ïîäãîòîâëåííûìè ñòàðøèìè îðäèíàòîðàìè è ëèöàìè ãðàæäàíñêîãî ïåðñîíàëà.  ýòèõ óñëîâèÿõ îáùèìè íàïðàâëåíè-ÿìè äàëüíåéøåãî ïîâûøåíèÿ ýôôåêòèâ-íîñòè ÑÌÏ â ÂËÏÓ ÿâëÿþòñÿ: 1) ñî-âåðøåíñòâîâàíèå îðãàíèçàöèè îêàçàíèÿ ÑÌÏ â ÂËÏÓ â ñîîòâåòñòâèè ñ óðîâíåì èõ ëå÷åáíî-äèàãíîñòè÷åñêèõ âîçìîæíî-ñòåé; 2) ïëàíîâîå äèôôåðåíöèðîâàííîå ñíàáæåíèå ÂËÏÓ ñïåöèàëèçèðîâàííûì äèàãíîñòè÷åñêèì îáîðóäîâàíèåì è ëå-÷åáíûìè ñðåäñòâàìè; 3) îáåñïå÷åíèå âûñîêîãî óðîâíÿ îáó÷åíèÿ è óñîâåðøåí-ñòâîâàíèÿ ñïåöèàëèñòîâ ÂËÏÓ ïî àêòó-àëüíûì àñïåêòàì ÑÌÏ.  êà÷åñòâå îñíîâíîãî íàïðàâëåíèÿ ïî óëó÷øåíèþ îðãàíèçàöèè è îáåñïå÷åíèÿ ñîîòâåòñòâóþùåãî îáúåìà ÑÌÏ ðàññìàò-ðèâàåòñÿ íåîáõîäèìîñòü âûäåëåíèÿ íå-ñêîëüêèõ óðîâíåé (îáúåìîâ) åå îêàçàíèÿ â çàâèñèìîñòè îò ëå÷åáíî-äèàãíîñòè÷å-ñêèõ âîçìîæíîñòåé ÂËÏÓ [1]. Ýòè ïîëîæåíèÿ â ïîëíîé ìåðå îòíî-ñÿòñÿ è ê ëå÷åáíî-äèàãíîñòè÷åñêîé ïî-ìîùè, îêàçûâàåìîé âîåííîñëóæàùèì ñ ýðåêòèëüíîé äèñôóíêöèåé (ÝÄ). Íàðÿäó ñ íèìè èìåþòñÿ íåêîòîðûå îñîáåííîñòè óðîëîãè÷åñêîé ïîìîùè ïðè ÝÄ. Îíè ñî-ñòîÿò â òîì, ÷òî ýòà ïàòîëîãèÿ íå âûäå-ëÿåòñÿ ðóêîâîäÿùèìè äîêóìåíòàìè â âèäå íîçîëîãè÷åñêîé ôîðìû çàáîëåâàíèÿ, ñëåäîâàòåëüíî, ó÷åò è àíàëèç ýòîé çà-áîëåâàåìîñòè â ÂËÏÓ íå ÿâëÿåòñÿ îáÿ-çàòåëüíûì è îäíîçíà÷íî íåäîñòàòî÷åí.  òî æå âðåìÿ îñíîâàíèåì äëÿ ðàçâåð-òûâàíèÿ ñïåöèàëèçèðîâàííîé àìáóëà-òîðíî-ïîëèêëèíè÷åñêîé è ñòàöèîíàðíîé ïîìîùè òîãî èëè èíîãî ïðîôèëÿ, â ò. ÷. è óðîëîãè÷åñêîãî, â îêðóãàõ è ôëîòàõ ÿâëÿþòñÿ ïîêàçàòåëè ñîîòâåòñòâóþùåé çàáîëåâàåìîñòè è åå ñòðóêòóðû ñðåäè âîåííîñëóæàùèõ [2]. Ñëåäîâàòåëüíî, îáîñíîâàíèå íåîá-õîäèìîñòè âûäåëåíèÿ ñèë è ñðåäñòâ äëÿ áîëåå ýôôåêòèâíîãî îêàçàíèÿ óðîëîãè-÷åñêîé ïîìîùè áîëüíûì àíäðîëîãè-÷åñêîãî ïðîôèëÿ èç ðåçåðâîâ ìåäèöèí-ñêîé ñëóæáû ÂÑ ÐÔ, à â ïîñëåäóþùåì – è âîçìîæíîãî ôîðìèðîâàíèÿ ñîîò-âåòñòâóþùèõ øòàòíî-îðãàíèçàöèîííûõ àíäðîëîãè÷åñêèõ è ñåêñîëîãè÷åñêèõ ñòðóêòóð, íåðàçðûâíî ñâÿçàíî ñ ðåçóëü-òàòàìè èçó÷åíèÿ ïîêàçàòåëåé çàáîëåâà-åìîñòè ÝÄ ñðåäè âîåííîñëóæàùèõ âñåõ âèäîâ ÂÑ ÐÔ. Îäíàêî êîìïëåêñíûå èññëåäîâàíèÿ ðàñïðîñòðàíåííîñòè ÝÄ ñðåäè ðàçëè÷íûõ êîíòèíãåíòîâ âîåííîñëóæàùèõ íå ïðî-âîäèëèñü, íå îöåíèâàëàñü ÷àñòîòà îáðà-ùåíèé áîëüíûõ ÝÄ, íå àíàëèçèðîâàëèñü ðåçóëüòàòû èõ îáñëåäîâàíèÿ è ëå÷åíèÿ.  ñâÿçè ñ ýòèì äî íàñòîÿùåãî âðåìåíè îòñóòñòâóþò îáîñíîâàííûå ïîêàçàòåëè, ïîçâîëÿþùèå îöåíèòü çàáîëåâàåìîñòü âîåííîñëóæàùèõ ÝÄ, îïðåäåëèòüñïåöè-«Âîåííî-ìåäèöèíñêèé æóðíàë», 12’2011
30
ÝÏÈÄÅÌÈÎËÎÃÈß
È ÈÍÔÅÊÖÈÎÍÍÛÅ ÁÎËÅÇÍÈ
© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011 ÓÄÊ 614.4:355Äåÿòåëüíîñòü âîåííîãî
àìáóëàòîðíî-ïîëèêëèíè÷åñêîãî ó÷ðåæäåíèÿ ïî îáåñïå÷åíèþ
ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî áëàãîïîëó÷èÿ
íàñåëåíèÿ
ÌÅÐÅÆÊÈÍ À.Ì., çàñëóæåííûé âðà÷ ÐÔ, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà ÇÎÒÊÈÍ À.Â., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà ÌÈÖÜ Í.Í., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà ÐÎÆÍΠÞ.À., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà Ôèëèàë ¹ 6 Ãëàâíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. Í.Í.Áóðäåíêî, ÌîñêâàMerezhkin A.M., Zotkin A.V., Mits N.N., Rozhnov Yu.A. – Military activities of outpatient clinics to ensure the sanitary-epidemiological welfare of the population. The article describes the experience of the military outpatient institutions in providing sanitary-epidemiological welfare of the attached troops and medical staff. The list of activities implemented in practice of this trend is lead up, suggestions for the improvement are given.
K e y w o r d s: outpatient clinics, preventive work in the clinic, sanitary-epidemiological welfare of patients and medical staff.
Ñ
îâðåìåííîå ÷åñêîå (ïîëèêëèíè÷åñêîå) ó÷ðåæäåíèå (ÏÓ) – ìíîãîïðîôèëüíîå ëå÷åáíî-ïðî-ôèëàêòè÷åñêîå ó÷ðåæäåíèå (ËÏÓ), ïðåäíàç-íà÷åííîå äëÿ îêàçàíèÿ ïðèêðåïëåííûì äëÿ ìåäèöèíñêîãî îáñëóæèâàíèÿ êîíòèí-ãåíòàì âûñîêîêâàëèôèöèðîâàííîé ìå-äèöèíñêîé ïîìîùè íà äîãîñïèòàëüíîì ýòàïå [3, 5]. Ïðè îöåíêå åãî äåÿòåëüíîñòè, êàê ïðàâèëî, àíàëèçèðóþòñÿ óðîâåíü ëå-÷åáíî-äèàãíîñòè÷åñêîé ðàáîòû, êà÷åñòâî îêàçàíèÿ òåõ èëè èíûõ âèäîâ ìåäèöèí-ñêîé ïîìîùè, à òàêæå ìåðîïðèÿòèÿ ïî ïðåäóïðåæäåíèþ îáîñòðåíèÿ õðîíè÷åñêèõ çàáîëåâàíèé ó ïàöèåíòîâ è ïî ïðîôè-ëàêòèêå âíóòðèãîñïèòàëüíûõ (âíóòðè-ïîëèêëèíè÷åñêèõ) èíôåêöèé [1, 2]. Òàêîé ïîäõîä íå îòðàæàåò âñåé ïîë-íîòû äåÿòåëüíîñòè ÏÓ (â ò. ÷. è âîåííîãî), ò. ê. íå ó÷èòûâàåò åãî ðàáîòó ïî ïåðâè÷íîé ìåäèöèíñêîé ïðîôèëàêòèêå. Ïîñëåäíÿÿ ñó-ùåñòâåííî îòëè÷àåòñÿ îò òàêîâîé â ËÏÓ ãîñïèòàëüíîãî ïðîôèëÿ. Åñëè ïðîôèëàê-òè÷åñêàÿ äåÿòåëüíîñòü ãîñïèòàëÿ îãðàíè-÷èâàåòñÿ â îñíîâíîì ðåøåíèåì âíóòðè-ãîñïèòàëüíûõ ïðîáëåì, òî â ÏÓ îíà çíà-÷èòåëüíî âûõîäèò çà åãî ïðåäåëû, ÷òî îáó-ñëîâëåíî íàëè÷èåì ó íåãî ïðèêðåïëåííûõ êîíòèíãåíòîâ.  ñîîòâåòñòâèè ñ çàêîíîäàòåëüñòâîì Ðîññèéñêîé Ôåäåðàöèè ïðàâî íà ìåäèöèí-ñêóþ ïîìîùü â ìåäèöèíñêèõ ó÷ðåæäåíèÿõ Ìèíèñòåðñòâà îáîðîíû ÐÔ èìåþò: – âîåííîñëóæàùèå, ïðîõîäÿùèå ñëóæ-áó ïî êîíòðàêòó â âîèíñêèõ ÷àñòÿõ, ó÷ðåæ-äåíèÿõ è îðãàíèçàöèÿõ Ìèíèñòåðñòâà îáîðîíû ÐÔ, íå èìåþùèõ øòàòíîé ìåäèöèíñêîé ñëóæáû è çàêðåïëåííûõ íà ìåäèöèíñêîå îáåñïå÷åíèå çà ÏÓ, à òàêæå ÷ëåíû èõ ñåìåé; – âîåííîñëóæàùèå, ïðîõîäÿùèå ñëóæ-áó ïî ïðèçûâó è ïîëó÷àþùèå â äàííîì ÏÓ êîíñóëüòàòèâíóþ ìåäèöèíñêóþ ïî-ìîùü; – îôèöåðû, íàõîäÿùèåñÿ â çàïàñå èëè îòñòàâêå, è ÷ëåíû èõ ñåìåé, ïðîæèâàþ-ùèå òåððèòîðèàëüíî â çîíå ìåäèöèíñêîé îòâåòñòâåííîñòè ÏÓ;ÏÎ ÑÒÐÀÍÈÖÀÌ ÇÀÐÓÁÅÆÍÎÉ
ÌÅÄÈÖÈÍÑÊÎÉ ÏÅ×ÀÒÈ
Çàùèòà îò ñóèöèäà. – Èâàíîâ Â. – Íåçàâèñèìîå âîåííîå îáîçðåíèå. – 2011.
– ¹ 42 (íîÿáðü). – Ñ. 10
Êîëè÷åñòâî ñàìîóáèéñòâ â àìåðèêàíñêîé àðìèè íå ñíèæàåòñÿ, – îòìå÷àåò â ñâîåé ñòà-òüå îáîçðåâàòåëü «Íåçàâèñèìîãî âîåííîãî îáîçðåíèÿ» Âëàäèìèð Èâàíîâ. Çà ïîñëåäíèå ãîäû ÷èñëî ñàìîóáèéñòâ â ñóõîïóòíûõ âîéñ-êàõ (ÑÂ) ÑØÀ çíà÷èòåëüíî âîçðîñëî. Åñëè â 2004 ã. ïîêîí÷èëè ñ ñîáîé 67 ÷åëîâåê, òî ñïóñòÿ òðè ãîäà óæå 115.  2008 ã. äîáðîâîëü-íî çàâåðøèëè ñâîþ æèçíü 128 âîåííûõ.  ñîîòâåòñòâèè ñ äàííûìè ÌÎ ÑØÀ, â ïðî-øëîì ãîäó ñðåäíåå êîëè÷åñòâî ñóèöèäîâ â âîéñêàõ ñîñòàâèëî 12,5 ÷åëîâåêà íà 100 òûñ. âîåííîñëóæàùèõ (ñðåäè ãðàæäàíñêîãî íàñå-ëåíèÿ – 11,1). Ñïåöèàëèñòû ñêëîíÿþòñÿ ê ìíåíèþ, ÷òî òàêîå ïîëîæåíèå âåùåé îáóñëîâëåíî ãëàâíûì îáðàçîì ÷àñòîé ðîòàöèåé àìåðèêàíñêèõ âîéñê, èõ ïîñòîÿííûì ó÷àñòèåì â âîéíàõ â Èðàêå è Àôãàíèñòàíå è â âîîðóæåííûõ êîíôëèêòàõ â äðóãèõ ãîðÿ÷èõ òî÷êàõ ïëàíåòû. Âñå ýòî âåäåò ê íàðóøåíèþ ïñèõèêè âîåííîñëóæàùèõ, ÷òî óñóãóáëÿåòñÿ ìíîãèìè òðóäíîñòÿìè, ñâÿçàí-íûìè ñ ïåðåõîäîì ê ìèðíîé æèçíè è ïîèñ-êîì â íåé ñâîåãî ìåñòà. Ñàìîå áîëüøîå çà ïîñëåäíèå äâà ãîäà êîëè÷åñòâî ñàìîóáèéñòâ â Ñ îòìå÷åíî â èþëå 2011 ã.: áûëî çàðåãèñòðèðîâàíî 32 ñëó-÷àÿ ãèáåëè ñîëäàò, ïîõîæèõ íà äîáðîâîëüíîå ñâåäåíèå ñ÷åòîâ ñ æèçíüþ. Íåâîçìîæíîñòü îñòàíîâèòü òåíäåíöèþ ðîñòà ÷èñëà ñàìîóáèéñòâ ñðåäè äåéñòâóþùèõ è áûâøèõ âîåííîñëóæàùèõ âûçûâàåò êðàé-íþþ îçàáî÷åííîñòü Ïåíòàãîíà è ðóêîâîäè-òåëåé ìèíèñòåðñòâ âèäîâ ÂÑ ÑØÀ.  êîíöå èþëÿ ïðîøëîãî ãîäà ïî óêàçà-íèþ áûâøåãî òîãäà ìèíèñòðîì îáîðîíû Ðîáåðòà Ãåéòñà Ìèíèñòåðñòâî àðìèè âûïó-ñòèëî äîêëàä «Óêðåïëåíèå çäîðîâüÿ, ñîêðà-ùåíèå ðèñêà è ïðåäîòâðàñîêðà-ùåíèå ñàìî-óáèéñòâ» (Health Promotion, Risk Reduction, and Suicide Prevention). Àðìåéñêèå ñïåöèà-ëèñòû èññëåäîâàëè ýòè ïðîáëåìû â òå÷å-íèå 15 ìåñ. Íà 359 ñòðàíèöàõ äàííîãî äîêóìåíòà òùàòåëüíî ïðîàíàëèçèðîâàíû ïðè÷èíû, âå-äóùèå ê ðîñòó ÷èñëà ñàìîóáèéñòâ, ìåðîïðè-ÿòèÿ ïî ïîääåðæàíèþ ôèçè÷åñêîãî çäîðî-âüÿ âîåííîñëóæàùèõ è ñïîñîáû ñíèæåíèÿ ðèñêà ïîòåðè ñîëäàòàìè íîðìàëüíîãî îòíî-øåíèÿ ê ñëóæáå è æèçíåííûì îáñòîÿòåëü-ñòâàì. Ïî ðåçóëüòàòàì ïðîâåäåííîãî àíàëèçà ýêñïåðòû ñôîðìóëèðîâàëè 67 ðåêîìåíäàöèé ðóêîâîäñòâó ïî îñòàíîâêå ðîñòà ñóèöèäîâ è óêðåïëåíèþ ìîðàëüíîãî äóõà âîåííîñëó-æàùèõ, íà÷èíàÿ ñ ïðîâåäåíèÿ âñåõ íåîáõî-äèìûõ äîïîëíèòåëüíûõ èññëåäîâàíèé â ýòîé ñôåðå è êîí÷àÿ ñîâåðøåíñòâîâàíèåì îðãàíè-çàöèîííûõ ñòðóêòóð, çàíÿòûõ ðåøåíèåì äàí-íûõ ïðîáëåì. Ñåãîäíÿ ñîëäàòû àðìèè ÑØÀ è ÷ëåíû èõ ñåìåé â êðèçèñíûõ ñèòóàöèÿõ ìîãóò îáðà-òèòüñÿ çà ïîìîùüþ â Íàöèîíàëüíóþ ñëóæ-áó ïðåäîòâðàùåíèÿ ñàìîóáèéñòâ (National Suicide Prevention Lifeline) no òåëåôîíó èëè ÷åðåç ñàéò â Èíòåðíåòå. Äîëæíûì îáðàçîì ïîäãîòîâëåííûå êîíñóëüòàíòû ýòîé ñëóæáû â ëþáîå âðåìÿ ñóòîê îêàçûâàþò íåîáõîäè-ìóþ ïîìîùü âñåì îáðàòèâøèìñÿ. Äëÿ ðóêîâîäèòåëåé âîèíñêèõ ïîäðàçäå-ëåíèé íåäàâíî áûëè îòêîððåêòèðîâàíû òà-êèå äîêóìåíòû, êàê íàñòàâëåíèå 600-63 «Ñî-õðàíåíèå çäîðîâüÿ» (Army Regulation 600-63, Health Promotion) è èíñòðóêöèÿ 600-64 «Ñî-õðàíåíèå çäîðîâüÿ, ñîêðàùåíèå ðèñêà è ïðå-äîòâðàùåíèå ñàìîóáèéñòâ» (Army Pamphlet 600-24, Health Promotion, Risk Reduction and Suicide Prevention).  ýòèõ äîêóìåíòàõ ïîäðîá-íî ðàñïèñàíû âñå äåéñòâèÿ, êîòîðûå äîëæíû ïðåäïðèíèìàòü êîìàíäèðû â îòíîøåíèè ñâî-èõ ïîä÷èíåííûõ, íàõîäÿùñâî-èõñÿ â ñëîæíûõ ñèòóàöèÿõ.  àðìèè ÑØÀ äåéñòâóåò òàêæå îáøèð-íàÿ «Ïðîãðàììà ïðåäîòâðàùåíèÿ ñàìî-óáèéñòâ» (Suicide Prevention Program). ×ëåíû ñåìåé âîåííîñëóæàùèõ èìåþò âîçìîæíîñòü ïîëó÷èòü íåîáõîäèìûå ìàòåðèàëû, êîòîðûå ïîìîãóò èì ñïðàâèòüñÿ ñ æåëàíèåì ïîêè-íóòü ýòîò ìèð, ñ àðìåéñêîãî ñàéòà âî Âñå-ìèðíîé ïàóòèíå, íà êîòîðîì ñîäåðæèòñÿ âñÿ ìåòîäè÷åñêàÿ ëèòåðàòóðà, íåîáõîäèìàÿ â ïî-äîáíûõ ñëó÷àÿõ.  Èíòåðíåòå òàêæå ðàçìåùåíû ñàéòû Àìåðèêàíñêîãî ôîíäà ïðåäîòâðàùåíèÿ ñàìî-óáèéñòâ (American Foundation for Suicide Prevention), Ñîâåòà ïî ñïîñîáàì ïðåäîòâðà-ùåíèÿ ñóèöèäîâ (Suicide Prevention Resource Council), Ïðîãðàììû ïîìîùè âûæèâøèì â òðàãè÷åñêèõ îáñòîÿòåëüñòâàõ (Tragedy Assistance Program for Survivors) è ñàéòû öå-ëîãî ðÿäà äðóãèõ ñòðóêòóð, çàíèìàþùèõñÿ âîïðîñàìè ðåàáèëèòàöèè âîåííîñëóæàùèõ, âåòåðàíîâ è èõ ðîäñòâåííèêîâ.57
«Âîåííî-ìåäèöèíñêèé æóðíàë», 12’2011ÈÇ ÈÑÒÎÐÈÈ
ÂÎÅÍÍÎÉ ÌÅÄÈÖÈÍÛ
© À.Ì.ØÅËÅÏÎÂ, Î.À.ÊÐÞ×ÊÎÂ, 2011 ÓÄÊ [61:355](470.311) «1941–1945»Óðîêè îðãàíèçàöèè ìåäèöèíñêîãî îáåñïå÷åíèÿ
â õîäå Ìîñêîâñêîé áèòâû
ØÅËÅÏΠÀ.Ì., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû çàïàñà ÊÐÞ×ÊΠÎ.À., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-ÏåòåðáóðãShelepov A.M., Kryuchkov O.A. – Lessons from the organization of medical support during the Battle for Moscow. Covered and analyzed the state of medical support during the Battle for Moscow. The problems of organizing of medical support for troops during all stages of this war – defensive operations and counter-offensive strategic operations are considered. Analyzed errors and mistakes made in the course of medical support of combat operations of the fronts that partici pated in the battle for Moscow. The article traces the solutions of the problems encountered and assess the results of translating these decisions into practice. Particular attention is paid to problems of organization of work as a hospital base fronts and armies, and the medical units and divisional managers, as well as management of medical service, evacuate the wounded and sick, the dynamics of formation of the provision of specialized medical care and anti security forces.
K e y w o r d s: military medicine during World War II, Battle for Moscow in 1941–1942, organization of medical support for the troops.
Ó
æå ê îñåíè 1941 ã. ïîòåðè íåìåöêî-ôàøèñòñêèõ âîéñê çíà÷èòåëüíî ïðå-âûñèëè ïðåäóñìîòðåííûå ïëàíîì «Áàð-áàðîññà» è âûíóäèëè àðìèþ àãðåññîðà ïå-ðåéòè îò íàñòóïëåíèÿ ïî âñåìó ôðîíòó ê óäàðàì íà âàæíåéøèõ îïåðàòèâíî-ñòðàòå-ãè÷åñêèõ íàïðàâëåíèÿõ. Ñàìûì ïðèîðèòåò-íûì èç íèõ ãèòëåðîâñêîå êîìàíäîâàíèå ñ÷èòàëî ìîñêîâñêîå, ïîýòîìó 30 ñåíòÿá-ðÿ 1941 ã. íà÷àëîñü ìàññèðîâàííîå íàñòóï-ëåíèå ãðóïïû àðìèé «Öåíòð» ñ öåëüþ äî íà÷àëà çèìû çàõâàòèòü Ìîñêâó. Ñîáûòèÿ, ðàçâèâàâøèåñÿ íà äàííîì ñòðàòåãè÷åñêîì íàïðàâëåíèè ñ êîíöà ñåíòÿáðÿ 1941 ã. ïî íà÷àëî ÿíâàðÿ 1942 ã. â îòå÷åñòâåííîé èñòîðèîãðàôèè ïîëó÷èëè íàçâàíèå Ìîñ-êîâñêîé áèòâû. Ïî ñâîåìó õàðàêòåðó áîå-âûå äåéñòâèÿ ìîæíî ðàçäåëèòü íà äâà ýòà-ïà: ïåðâûé – îáîðîíèòåëüíîå ñðàæåíèå (îêòÿáðü – íîÿáðü 1941 ã.) è âòîðîé – êîíòðíàñòóïëåíèå íàøèõ âîéñê (äåêàáðü 1941 ã. – ÿíâàðü 1942 ã.) [8].  õîäå îáîðîíèòåëüíîãî ýòàïà áèòâû çà Ìîñêâó àðìèè âðàãà óäàëîñü äîñòè÷ü îïðåäåëåííûõ óñïåõîâ, â ðåçóëüòàòå ÷åãî ìåíåå ÷åì ÷åðåç íåäåëþ ïîñëå íà÷àëà ñðàæåíèÿ òðè àðìèè Çàïàäíîãî è äâå Ðåçåðâíîãî ôðîíòîâ îêàçàëèñü â îêðóæå-íèè. Îäíàêî ê íà÷àëó äåêàáðÿ òåìï íà-ñòóïëåíèÿ ãèòëåðîâñêèõ âîéñê ðåçêî ñíè-çèëñÿ, ÷òî ïîçâîëèëî Êðàñíîé Àðìèè ïåðåéòè â êîíòðíàñòóïëåíèå. Òàêîâ áûë îïåðàòèâíûé ôîí, íà êîòîðîì îñóùåñò-âëÿëàñü äåÿòåëüíîñòü ìåäèöèíñêîé ñëóæ-áû Çàïàäíîãî ôðîíòà. Ê ìîìåíòó íà÷àëà áèòâû çà Ìîñêâó ñîñòîÿíèå îðãàíèçàöèè ìåäèöèíñêîãî îáåñïå÷åíèÿ Êðàñíîé Àðìèè áûëî âåñü-ìà ñëîæíûì. Ìíîãèå ìåäèöèíñêèå ÷àñòè è ëå÷åáíûå ó÷ðåæäåíèÿ âñëåäñòâèå áûñ-òðîãî ïðîäâèæåíèÿ ïðîòèâíèêà áûëè ëèáî çàõâà÷åíû, ëèáî óíè÷òîæåíû. Çäàíèÿ ãîñ-ïèòàëåé è áîëüíèö ïîäìîñêîâíîãî ðåãè-îíà â áîëüøèíñòâå ñâîåì áûëè ðàçðóøå-íû íåïðåêðàùàþùèìèñÿ áîìáîâûìè óäà-ðàìè è àðòèëëåðèéñêèìè íàëåòàìè, ÷òî ñïîñîáñòâîâàëî äàëüíåéøåìó ðîñòó íå-êîìïëåêòà ìåäèöèíñêèõ ó÷ðåæäåíèé àð-ìèé è ñîåäèíåíèé è ìåäèöèíñêîãî èìó-ùåñòâà. Ñèñòåìà ëå÷åáíî-ýâàêóàöèîííûõ ìåðîïðèÿòèé â âîéñêàõ íà òîò ìîìåíò íå ôóíêöèîíèðîâàëà. Ïîâñåìåñòíî áûëàðàñ-ÈÇ ÈÑÒÎÐÈÈ ÂÎÅÍÍÎÉ ÌÅÄÈÖÈÍÛ Îïðåäåëåííûå òðóäíîñòè â ñôåðå ìåäèöèíñêîãî îáåñïå÷åíèÿ èìåëè ìåñòî è â âîéñêîâîì çâåíå ìåäèöèíñêîé ñëóæ-áû. Íà ýòîì óðîâíå òàêæå áûëà âåñüìà àêòóàëüíà ïðîáëåìà ñ ïåðåãðóçêîé ðàíå-íûìè äèâèçèîííûõ ìåäèöèíñêèõ ïóíêòîâ, ïîýòîìó, ÷òîáû íå îòñòàâàòü îò íàñòóïà-þùèõ âîéñê, èì ïðèõîäèëîñü ðàçäåëÿòüñÿ íà 2–3 ÷àñòè, ÷òî ðåçêî ñîêðàùàëî îáúåì îêàçûâàåìîé ïîìîùè. Ñðåäè òèïè÷íûõ íåäîñòàòêîâ â îðãàíèçàöèè èõ ðàáîòû ñëå-äóåò îòìåòèòü íåáðåæíîå îòíîøåíèå ê âåäåíèþ ìåäèöèíñêîé äîêóìåíòàöèè è ïðåæäå âñåãî çàïîëíåíèþ êàðòî÷åê ïåðå-äîâîãî ðàéîíà, à òàêæå íåâûäåëåíèå ñðå-äè îáùåãî ïîòîêà ýâàêóèðóåìûõ îòäåëü-íîãî ïîòîêà ëåãêîðàíåíûõ [7]. Îòìåòèì, ÷òî ïðè âñåõ íåäîñòàòêàõ â ìåäèöèíñêîì îáåñïå÷åíèè âîéñê, ó÷à-ñòâîâàâøèõ â áèòâå çà Ìîñêâó (èìåâ-øèõ êàê îáúåêòèâíûå, òàê è ñóáúåêòèâ-íûå ïðè÷èíû), ýòà áèòâà èìåëà ðåøàþ-ùåå çíà÷åíèå äëÿ ìåäèöèíñêîé ñëóæ-áû Êðàñíîé Àðìèè. Âïåðâûå íà ïðàê-òèêå áûë ïîëó÷åí öåííûé îïûò ìåäè-öèíñêîãî îáåñïå÷åíèÿ îïåðàöèé ïðè ïå-ðåõîäå îò îáîðîíèòåëüíûõ äåéñòâèé ê ïðîâåäåíèþ íàñòóïàòåëüíîé îïåðàöèè ñòðàòåãè÷åñêîãî ìàñøòàáà. Áûëè íàéäå-íû íîâûå ôîðìû è ìåòîäû ìåäèöèíñ-êîãî îáåñïå÷åíèÿ, ïðî÷íî âîøåäøèå â ïðàêòèêó â õîäå ïîñëåäóþùèõ îïåðàöèé Âåëèêîé Îòå÷åñòâåííîé âîéíû 1941– 1945 ãã.
Ëèòåðàòóðà
1. Áóðíàçÿí À.È. Áîðüáà çà æèçíü ðàíåíûõ è áîëüíûõ íà Êàëèíèíñêîì – 1-ì Ïðèáàëòèé-ñêîì ôðîíòå. – Ì.: Ìåäèöèíà, 1982. – 304 ñ. 2. Âîéòåíêî Ì.Ô. Èñòîðè÷åñêèé î÷åðê ðàçâèòèÿ îðãàíèçàöèîííûõ ôîðì ñïåöèàëè-çèðîâàííîé ìåäèöèíñêîé ïîìîùè ïîðàæåí-íûì è áîëüïîðàæåí-íûì íà âîéíå. – Ë., 1966. – 42 ñ. 3. Ãëàäêèõ Ï.Ô., Ëîêòåâ À.Å. Ñëóæáà çäî-ðîâüÿ â Âåëèêîé Îòå÷åñòâåííîé âîéíå 1941– 1945 ãã. – ÑÏá: Äìèòðèé Áóëàíèí, 2005. – 718 ñ. 4. Ãëàäêèõ Ï.Ô., Ïåðåëûãèí Â.Â. Î÷åðêè èñòîðèè îòå÷åñòâåííîé âîåííîé ìåäèöèíû. Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëåíèå ÌÎ ÐÔ. 1805–1998 ãã. – ÑÏá, 2003. – 130 ñ. 5. Ãóðâè÷ Ì.Ì. Îðãàíèçàöèÿ ìåäèöèí-ñêîãî îáåñïå÷åíèÿ ñîâåòñêèõ âîéñê â áèòâå ïîä Ìîñêâîé // Âîåí.-ìåä. æóðí. – 1971. – ¹ 12. – Ñ. 10–16. 6. Äðîíîâ Â.Í., Äåíåùóê Þ.Ñ., Òðåéñòåð Ã.Í. Ñàìîîòâåðæåííûé òðóä ìåäèêîâ Çàïàäíîãî ôðîíòà // Âîåí.-ìåä. æóðí. – 1986. – ¹ 12. – Ñ. 10–11. 7. Ìåäèöèíñêîå îáåñïå÷åíèå Ñîâåòñêîé Àðìèè â îïåðàöèÿõ Âåëèêîé Îòå÷åñòâåííîé âîéíû 1941–1945 ãã. / Ïîä ðåä. Ý.À.Íå÷àåâà. – Ì.: Âîåíèçäàò, 1993. – Ò. 1 – 343 ñ. 8. Ñáîðíèê ìàòåðèàëîâ ïî èñòîðèè âî-åííîãî èñêóññòâà â Âåëèêîé Îòå÷åñòâåííîé âîéíå / Ïîä ðåä. À.È.Ãîòîâöåâà. – Ì.: Âîåí-èçäàò, 1955. – Âûï. V, ò. 1. – Ñ. 97–144. 9. Ñìèðíîâ Å.È. Âîåííàÿ ìåäèöèíà â Âåëèêîé Îòå÷åñòâåííîé âîéíå / Òðóäû ïÿ-òîãî ïëåíóìà ó÷åíîãî ìåäèöèíñêîãî ñîâåòà ïðè íà÷àëüíèêå ÃÂÑÓ ÊÀ: ìàòåðèàëû ïëå-íóìà. – Ì.: Ìåäãèç, 1942. – Ñ. 20. 10. Ñìèðíîâ Å.È. Ôðîíòîâîå ìèëîñåðäèå. – Ì.: Âîåíèçäàò, 1991. – 430 ñ. 11. ßðîâèíñêèé Ì.ß. Çäðàâîîõðàíåíèå Ìîñêâû. – Ì.: Ìåäèöèíà, 1988. – 272 ñ. © Â.Ð.ÍÈÊÎËÀÅÂ, 2011 ÓÄÊ [61:355](470.311)(092 Êóçüìèí) «1941–1945»Ôðîíòîâûå äîðîãè ïðîôåññîðà Ì.Ê.Êóçüìèíà
(Ê 70-ëåòèþ Ìîñêîâñêîé áèòâû)
ÍÈÊÎËÀÅ Â.Ð. Ïåðâûé Ìîñêîâñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò èì. È.Ì.Ñå÷åíîâà, ÌîñêâàNikolayev V.R. – Front Roads of Professor M.K.Kuzmin (the 70th anniversary of the Battle for Moscow). The article is a biographical sketch about the veteran and invalid of Great Patriotic War, the holder of many military decorations, honorary citizen of several cities in the battles for which he was involved, a prominent historian of medicine, doctor of medical sciences, professor Mikhail Kuzmin (1920– 2010). Over the years of scientific and teaching life professor M.K.Kuzmin published over 300 scientific publications, including 9 monographs, textbook of the history of medicine, published lectures, and manuals.
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ÈÇ ÈÑÒÎÐÈÈ ÂÎÅÍÍÎÉ ÌÅÄÈÖÈÍÛ «Âîåííî-ìåäèöèíñêèé æóðíàë», 12’2011Â
ãîä 70-ëåòèÿ Ìîñêîâñêîé áèòâû õî÷åòñÿ ïîâåäàòü îá îäíîì èç åå ãå-ðîè÷åñêèõ ó÷àñòíèêîâ – âåòåðàíå è èí-âàëèäå Âåëèêîé Îòå÷åñòâåííîé âîéíû, êàâàëåðå ìíîãèõ áîåâûõ íàãðàä, ïî÷åòíîì ãðàæäàíèíå ðÿäà ãîðîäîâ, â áîÿõ çà êîòî-ðûå îí ó÷àñòâîâàë, âèäíîì èñòîðèêå ìå-äèöèíû, äîêòîðå ìåäèöèíñêèõ íàóê, ïðî-ôåññîðå Ìèõàèëå Êóçüìè÷å Êóçüìèíå. Ì.Ê.Êóçüìèí ðîäèëñÿ 31 äåêàáðÿ 1920 ã. â äåðåâíå Êîëåñíèêè Õèñëàâè÷-ñêîãî ðàéîíà, ÷òî íà Ñìîëåíùèíå, â ìíî-ãîäåòíîé êðåñòüÿíñêîé ñåìüå. Ïîñëå îêîí÷àíèÿ ñåëüñêîé øêîëû îí íåêîòî-ðîå âðåìÿ ðàáîòàë â êîëõîçå, à çàòåì ïî êîìñîìîëüñêîé ïóòåâêå óåõàë â Êðîí-øòàäò, ãäå ïîñòóïèë ó÷èòüñÿ â ôàáðè÷íî-çàâîäñêîå ó÷èëèùå, ïîñëå îêîí÷àíèÿ êî-òîðîãî ñ 1936 ïî 1938 ã. ðàáîòàë ñóäîðå-ìîíòíèêîì íà âîåííî-ìîðñêîì çàâîäå. Îäíàêî òÿãà ê çíàíèÿì, æåëàíèå ó÷èòüñÿ ïðèâåëè åãî â Ëåíèíãðàäñêîå âîåííî-ìåäèöèíñêîå ó÷èëèùå. Ê ñîæàëå-íèþ, â íà÷àëå 1940 ã. ó÷åáó ïðèøëîñü ïðå-ðâàòü: ïîñëå äâóõ ëåò îáó÷åíèÿ åìó áûëî äîñðî÷íî ïðèñâîåíî çâàíèå «âîåííûé ôåëüäøåð» è ìîëîäîãî ìåäèêà íàïðàâè-ëè íà ôðîíò Ñîâåòñêî-ôèíëÿíäñêîé âîé-íû. Óæå òîãäà, â òÿæåëåéøåé áîåâîé îá-ñòàíîâêå, âîåíôåëüäøåð ïðîÿâèë ìóæå-ñòâî è ãåðîèçì.  òå÷åíèå òðåõ ìåñÿöåâ ñðàæåíèé íà Êàðåëüñêîì ôðîíòå ïðè ñîðîêàãðàäóñíîì ìîðîçå Ì.Ê.Êóçüìèí îêàçûâàë ïîìîùü ðàíåíûì áîéöàì, íåâçèðàÿ íà òî, ÷òî è ñàì áûë íå ðàç îáìîðîæåí. Ïîñëå çàâåðøåíèÿ ýòîé âîéíû Ì.Ê.Êóçüìèí âåðíóëñÿ ê ó÷åáå.  îêòÿá-ðå 1940 ã. ó÷èëèùå áûëî îêîí÷åíî è íà-÷àëàñü ñëóæáà â Ïðèáàëòèéñêîì îñîáîì âîåííîì îêðóãå. Âåëèêàÿ Îòå÷åñòâåííàÿ âîéíà 1941– 1945 ãã. äëÿ Ìèõàèëà Êóçüìè÷à íà÷àëàñü ðàííèì óòðîì 22 èþíÿ 1941 ã. íà ëèòîâ-ñêî-ãåðìàíñêîé ãðàíèöå. Ïîñëå óðàãàí-íîãî àðòîáñòðåëà è íàñòóïëåíèÿ íåìåö-êèõ çàõâàò÷èêîâ ïîÿâèëîñü áîëüøîå ÷èñ-ëî ðàíåíûõ, êîòîðûì ìåäèêè, ðèñêóÿ ñîá-ñòâåííîé æèçíüþ, ñòàëè îêàçûâàòü ïî-ìîùü. À íà 13-é äåíü óïîðíûõ áîåâ ïîëó-÷èë òÿæåëåéøåå ÷åëþñòíî-ëèöåâîå ðà-íåíèå è ñàì âîåíôåëüäøåð Ìèõàèë Êóçüìèí. Ê ñîæàëåíèþ, îêàçàòü ñâîåâðå-ìåííóþ è êâàëèôèöèðîâàííóþ ïîìîùü íà ìåñòå áûëî íåêîìó, à ïîòîìó íà÷à-ëèñü îñëîæíåíèÿ... Çàòåì ïîñëåäîâàëî äëèòåëüíîå ëå÷åíèå â ñïåöèàëèçèðîâàí-íîì ãîñïèòàëå, îäíàêî øðàìû íà ëèöå è äåôåêòû ðå÷è îñòàëèñü íà âñþ æèçíü. Ïîñëå ãîñïèòàëÿ Ì.Ê.Êóçüìèí áûë íàïðàâëåí â ñôîðìèðîâàííóþ íà Óðàëå â ñåíòÿáðå 1941 ã. 363-þ ñòðåëêîâóþ äè-âèçèþ, êîòîðàÿ çà ïðîÿâëåííûå îòâàãó è ãåðîèçì â áîÿõ ñ íåìåöêèìè çàõâàò÷èêà-ìè îäíîé èç ïåðâûõ áûëà ïðåîáðàçîâàíà â 22-þ ãâàðäåéñêóþ, à ïîçäíåå ñîñòàâèëà ÿäðî 2-ãî ãâàðäåéñêîãî ìåõàíèçèðîâàí-íîãî êîðïóñà, ïîëó÷èâøåãî íàçâàíèå Íèêîëàåâñêî-Áóäàïåøòñêîãî. Ñî äíÿ îñ-íîâàíèÿ ýòîãî áîåâîãî ïîäðàçäåëåíèÿ èì êîìàíäîâàë Ãåðîé Ñîâåòñêîãî Ñîþçà ãå-íåðàë-ëåéòåíàíò Êàðï Âàñèëüåâè÷ Ñâè-ðèäîâ – ó÷àñòíèê Ïàðàäà Ïîáåäû 1945 ã.  ñîñòàâå 33-ãî ãâàðäåéñêîãî ìåäèêî-ñàíèòàðíîãî áàòàëüîíà ýòîé ëåãåíäàð-íîé äèâèçèè ïðîøåë ñâîé áîåâîé ïóòü è ãâàðäèè ñòàðøèé ëåéòåíàíò ìåäèöèí-ñêîé ñëóæáû Ì.Ê.Êóçüìèí – ó÷àñòíèê îæåñòî÷åííîé Ìîñêîâñêîé áèòâû.  êîíöå íîÿáðÿ è íà÷àëå äåêàáðÿ 1941 ã. ïîä Ìîñêâîé øëà óïîðíåéøàÿ áîðüáà çà ñòðàòåãè÷åñêóþ èíèöèàòèâó: ê ýòîìó âðåìåíè ñîâåòñêèì âîéñêàì óäà-Ì.Ê.Êóçüìèí. Ôîòî âòîðîé ïîëîâèíû 1940-õ ãã.ÈÇ ÈÑÒÎÐÈÈ ÂÎÅÍÍÎÉ ÌÅÄÈÖÈÍÛ © Á.Í.ÊÎÒÈÂ, Â.Â.ÊÀÐÏÎÂÈ×, 2011 ÓÄÊ [617:355](092 Êîëåñíèêîâ)
Èâàí Ñòåïàíîâè÷ Êîëåñíèêîâ – «ãåíåðàë
õèðóðãèè»
(Ê 110-ëåòèþ ñî äíÿ ðîæäåíèÿ)
ÊÎÒÈ Á.Í., ïðîôåññîð ÊÀÐÏÎÂÈ× Â.Â., êóðñàíò 4-ãî êóðñà 3-ãî ôàêóëüòåòà Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-ÏåòåðáóðãKotiv B.N., Karpovich V.V. – Ivan Stepanovich Kolesnikov – «General of Surgery» (the 110th anniversary of his birth). The article is devoted to the 110th anniversary of outstanding surgeon, scientist and educator, academician of the USSR Ivan Stepanovich Kolesnikov. During the Great Patriotic War – he was an army surgeon on the Central Front, and then – in Leningrad. As one of the pioneers of thoracic surgery, the first in the Soviet Union began to apply the resection of pulmonary tuberculosis, cancer, and acute and chronic suppurative diseases of the lung and pleura, reflecting the experience of more than 4,000 thousand operations in numerous monographs and published in 1960, major work, «Resection light». On his initiative in 1961 was the first in the Soviet Union an independent chair of the thermal lesions, and in 1964 – the country’s first intensive care unit and intensive care. He published over 200 papers on topical issues of surgery, including 28 monographs. Under his leadershi p were trained 25 Ph.D. and 43 master’s theses. K e y w o r d s: history of surgery in the USSR and Russia, Professor Kolesnikov, military surgery, thoracic surgery. 15 äåêàáðÿ 2011 ã. èñïîëíèëîñü 110 ëåò ñî äíÿ ðîæäåíèÿ âûäàþùåãîñÿ õè-ðóðãà, ó÷åíîãî è ïåäàãîãà, àêàäåìèêà ÀÌÍ ÑÑÑÐ Èâàíà Ñòåïàíîâè÷à Êîëåñíèêîâà. Îí ðîäèëñÿ â ä. Ïîäîñèíîâêå Âîðîíåæ-ñêîé ãóáåðíèè â ñåìüå áåäíîãî êðåñòüÿ-íèíà, â ïåðèîä Ãðàæäàíñêîé âîéíû âñòó-ïèë â ðÿäû Êðàñíîé Àðìèè è ó÷àñòâî-âàë â áîÿõ â êà÷åñòâå ðîòíîãî ñàíèòàðà.  1926 ã. È.Ñ.Êîëåñíèêîâ ïîñòóïèë â Âîåííî-ìåäèöèíñêóþ àêàäåìèþ, ïîñ-ëå îêîí÷àíèÿ êîòîðîé ïðîõîäèë äâóõ-ãîäè÷íóþ âîåííóþ ñëóæáó âîéñêîâûì âðà÷îì. Ïî âîçâðàùåíèè â alma mater Èâàí Ñòåïàíîâè÷ ñòàíîâèòñÿ àäúþíê-òîì ïðè ãîñïèòàëüíîé õèðóðãè÷åñêîé êëèíèêå, â òî âðåìÿ âîçãëàâëÿåìîé Ñ.Ï.Ô¸äîðîâûì. Çäåñü îí ïîä ðóêîâîä-ñòâîì Í.Í.Åëàíñêîãî áëåñòÿùå çàùè-òèë êàíäèäàòñêóþ äèññåðòàöèþ íà òåìó «Ïåðåëèâàíèå êîíñåðâèðîâàííîé êðî-âè» è ðàçðàáîòàë ïðîñòîé ìåòîä îïðå-äåëåíèÿ ñêðûòîãî ãåìîëèçà, íàçâàííûé «ïðîáîé Êîëåñíèêîâà».  1938–1939 ãã. Èâàí Ñòåïàíîâè÷ äîá-ðîâîëüöåì ðàáîòàë â Èñïàíèè â êà÷åñòâå îïåðèðóþùåãî õèðóðãà Êàòàëîíñêîãî ôðîíòà. Ñ ýòîãî ìîìåíòà íà÷àëñÿ îäèí èç ýòàïîâ åãî áèîãðàôèè êàê âûäàþùå-ãîñÿ âîåííî-ïîëåâîãî õèðóðãà.  Èñïàíèè È.Ñ.Êîëåñíèêîâ ïîçíàêîìèëñÿ ñî ñâîå-îáðàçíîé îðãàíèçàöèåé ïîìîùè ðàíåíûì – ôîðìèðîâàíèåì òàê íàçûâàåìûõ «ýêè-ïîâ», à òàêæå ñ óíèêàëüíîé ìåòîäèêîé óäàëåíèÿ èíîðîäíûõ òåë èç ãðóäíîé ïî-ëîñòè, â áóäóùåì ïîëó÷èâøåé ðàçâèòèå â åãî äîêòîðñêîé äèññåðòàöèè.
