2014
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îåííî-ìåäèöèíñêèé
æóðíàë
ÀÂÃÓÑÒ
2014
Àäðåñà ðåäàêöèè: 119160, Ìîñêâà, ðåäàêöèÿ «Âîåííî-ìåäèöèíñêîãî æóðíàëà» Òåë./ôàêñ: (495) 656-33-41 194044, Ñàíêò-Ïåòåðáóðã, óë. Àêàäåìèêà Ëåáåäåâà, ä. 6 Òåë. (812) 292-33-46 ÅÆÅÌÅÑß×ÍÛÉ ÒÅÎÐÅÒÈ×ÅÑÊÈÉ È ÍÀÓ×ÍÎ-ÏÐÀÊÒÈ×ÅÑÊÈÉ ÆÓÐÍÀË ÌÈÍÈÑÒÅÐÑÒÂÀ ÎÁÎÐÎÍÛ ÐÎÑÑÈÉÑÊÎÉ ÔÅÄÅÐÀÖÈÈ Ôóíêöèÿ ó÷ðåäèòåëÿ – Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëå-íèå ÌÎ ÐÔ
Non scholae, sed vitae discimus!
ÐÅÄÀÊÖÈÎÍÍÀß ÊÎËËÅÃÈß: Ì.Â.Ïîääóáíûé (ãëàâíûé ðåäàêòîð) È.È.Àçàðîâ À.Í.Áåëüñêèõ À.Þ.Âëàñîâ Ë.Ë.Ãàëèí (çàìåñòèòåëü ãëàâíîãî ðåäàêòîðà) Ã.Â.Äþìèí Í.À.Åôèìåíêî Â.Â.Èâàíîâ Î.Â.Êàëà÷¸â À.À.Êàëìûêîâ Á.Í.Êîòèâ Ê.Ý.Êóâøèíîâ À.Á.Ëåîíèäîâ Þ.Â.Ìèðîøíè÷åíêî Þ.Â.Îâ÷èííèêîâ Í.Í.Ðûæìàí Ä.Â.Òðèøêèí À.ß.Ôèñóí Â.Í.Öûãàí Â.Ê.Øàìðåé À.Ì.Øåëåïîâ ÐÅÄÀÊÖÈÎÍÍÛÉ ÑÎÂÅÒ:
Èçäàåòñÿ ñ 1823 ãîäà
2014 * ÀÂÃÓÑÒ
Ò. 335 * ¹ 8
ÌÎÑÊÂÀ ÎÀÎ «ÊÐÀÑÍÀß ÇÂÅÇÄÀ» Ï.Ã.Áðþñîâ (Ìîñêâà) À.À.Áóäêî (Ñ.-Ïåòåðáóðã) È.Þ.Áûêîâ (Ìîñêâà) Â.Â.Âàëåâñêèé (Ñ.-Ïåòåðáóðã) Ñ.Ô.Ãîí÷àðîâ (Ìîñêâà) Â.Â.Äîáðæàíñêèé (Ìîñêâà) À.Â.Åñèïîâ (Êðàñíîãîðñê) Å.Â.Èâ÷åíêî (Ñ.-Ïåòåðáóðã) Å.Â.Êðþêîâ (Ìîñêâà) Þ.Â.Ëîáçèí (Ñ.-Ïåòåðáóðã) È.Ã.Ìîñÿãèí (Ñ.-Ïåòåðáóðã) Ý.À.Íå÷àåâ (Ìîñêâà) Ñ.Â.Ïàïêî (Ðîñòîâ-íà-Äîíó) Ï.Â.Ïèí÷óê (Ìîñêâà) Â.Á.Ñèìîíåíêî (Ìîñêâà) È.Ì.×èæ (Ìîñêâà) Â.Â.Øàïïî (Ìîñêâà)Ñîñòîÿíèå è ïåðñïåêòèâû
ìåäèöèíñêîé ðåàáèëèòàöèè
â Âîîðóæåííûõ Ñèëàõ
Îêàçàíèå òåðàïåâòè÷åñêîé ïîìîùè
â ñîâðåìåííûõ ëîêàëüíûõ âîéíàõ
è âîîðóæåííûõ êîíôëèêòàõ
Ñîâåðøåíñòâîâàíèå ìåäèöèíñêîé
ðåàáèëèòàöèè âîåííîñëóæàùèõ
ïîñëå êàðäèîõèðóðãè÷åñêèõ
âìåøàòåëüñòâ
Ïåðñïåêòèâû îðãàíèçàöèè ðàáîòû
ðåãèñòðà èíôåêöèîííîé ïàòîëîãèè
è ÂÈ×-èíôèöèðîâàííûõ
âîåííîñëóæàùèõ
Áîåâàÿ îæîãîâàÿ òðàâìà:
îïûò Àôãàíî-èðàêñêîé êàìïàíèè
Ðîññèéñêèå âðà÷è â íà÷àëå
Ïåðâîé ìèðîâîé âîéíû
© «Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014
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ÑONTENTS Êðàòêèå ñîîáùåíèÿ 50 Brief reports Ïî ñòðàíèöàì çàðóáåæíîé ìåäèöèíñêîé ïå÷àòèFrom the foreign medical publications
66 Èâ÷åíêî Å.Â., Ãîëîòà À.Ñ., Êîíäðàòåíêî Ä.Ã., Êðàññèé À.Á. – Áîåâàÿ îæîãîâàÿ òðàâìà: îïûò Àôãàíî-èðàêñêîé êàìïàíèè
Ivchenko E.V., Golota A.S., Kondratenko D.G., Krassii A.B. – Combat burn injury. The Afghanistan and Iraq military campaign experience
45 Ýïèäåìèîëîãèÿ
è èíôåêöèîííûå áîëåçíè
Epidemiology
and infectious diseases Áîëåõàí Â.Í., Çàãîðîäíèêîâ Ã.Ã., Ãîðè÷íûé Â.À.,
Îðëîâà Å.Ñ., Íèêîëàåâ Ï.Ã. – Ïðîáëåìû è ïåðñïåêòèâû îðãàíèçàöèè ðàáîòû ðå-ãèñòðà èíôåêöèîííîé ïàòîëîãèè è ÂÈ×-èíôèöèðîâàííûõ âîåííîñëóæàùèõ
Bolekhan V.N., Zagorodnikov G.G., Gorich-ny V.A., Orlova E.S., Nikolaev P.G. – Prob-lems and prospects of infectious diseases and HIV-infected military personnel re-gister organization
37 Ëå÷åáíî-ïðîôèëàêòè÷åñêèå
âîïðîñû Prophylaxis and treatment Ëèòâèíöåâ Á.Ñ., Îäèíàê Ì.Ì., Êîâàëåí-êî À.Ï., Åôèìöåâ À.Þ., Òàðóìîâ Ä.À., Ïåòðîâ À.Ä., Ëèñÿíñêèé Ä.À. – Ïàòîëî-ãèÿ íåðâíîé ñèñòåìû ó âîåííîîáÿçàí-íûõ ëèö ñ íàðêîìàíèåé â àíàìíåçå: ñèìïòîìàòèêà, ìåòîäû äèàãíîñòèêè Ãðèøàåâ Ñ.Ë., Øàðîâà Í.Â., Ìîèñååâ Ý.Â., Áóëàíüêîâ Þ.È., Îðëîâà Å.Ñ. – Îñîáåí-íîñòè áðîíõîëåãî÷íîé ïàòîëîãèè ó ÂÈ×-èíôèöèðîâàííûõ ïàöèåíòîâ 32
Litvintsev B.S., Odinak M.M., Kovalenko A.P., Efimtsev A.Yu., Tarumov D.A., Petrov A.D., Lisyanskii D.A. – Pathology of the ner-vous system in conscripts with drug abuse in past medical history: symptomatology, diagnostics methods
Grishaev S.L., Charova N.V., Moiseev E.V., Bulankov Yu.I., Orlova E.S. – Peculiarities of bronchopulmonary pathology in HIV-patients 4 25 16 Ôèñóí À.ß., Ùåãîëüêîâ À.Ì., Þäèí Â.Å., Ïîíîìàðåíêî Ã.Í. – Ìåäèöèíñêàÿ ðåàáè-ëèòàöèÿ â Âîîðóæåííûõ Ñèëàõ: èñòîêè, ñîâðåìåííîå ñîñòîÿíèå è ïåðñïåêòèâû Õàëèìîâ Þ.Ø., Òêà÷óê Í.À., Æåêàëîâ À.Í. – Îðãàíèçàöèÿ è îêàçàíèå òåðàïåâòè÷åñ-êîé ïîìîùè â ñîâðåìåííûõ ëîêàëüíûõ âîéíàõ è âîîðóæåííûõ êîíôëèêòàõ Þäèí Â.Å., Êëèìêî Â.Â., Øêàðóïà Î.Ô., Ãóçåíêî È.Å.– Îñíîâíûå íàïðàâëåíèÿ ñîâåðøåíñòâîâàíèÿ ñèñòåìû ìåäèöèí-ñêîé ðåàáèëèòàöèè âîåííîñëóæàùèõ ïîñëå êàðäèîõèðóðãè÷åñêèõ âìåøà-òåëüñòâ Îðãàíèçàöèÿ ìåäèöèíñêîãî îáåñïå÷åíèÿ Âîîðóæåííûõ ñèë
Organization of medical support of the Armed Forces
Fisun A.Ya., Shchegolkov A.M., Yudin V.E., Ponomarenko G.N. – Medical rehabilita-tion in the armed forces: history, current state and prospects
Khalimov Yu.Sh., Tkachuk N.A., Zhekalov A.N. – Organization and delivery of therapeutic care in modern local wars and armed conflicts
Yudin V.E., Klimko V.V., Shkarupa O.F., Guzenko I.E. – Main ways of improve-ments of the system of medical rehabilita-tion of military servicemen after cardio-vascular surgery
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«Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014 ÑONTENTS Îôèöèàëüíûé îòäåë 88 Official communications Ëåíòà íîâîñòåé 31, 49, News feed 90 92 Õðîíèêà Chronicle Ìàêèåâ Ð.Ã. – Âåêòîð ðàçâèòèÿ âîåí-íîé ìåäèöèíû îïðåäåëåí (Çàñåäàíèå Îáùåñòâåííîãî ñîâåòà ïðè Ìèíèñòåð-ñòâå îáîðîíû Ðîññèéñêîé Ôåäåðàöèè)Makiev R.G. – The vector of military medi-cine development is defined (Meeting of Public Council of the Ministry of defence of the Russian Federation)
76 71 Èç èñòîðèè
âîåííîé ìåäèöèíû
From the history of military medicine Ãðèáîâñêàÿ Ã.À. – Ðîññèéñêèå âðà÷è â ïåðâûå ìåñÿöû áîëüøîé âîéíû (Ê 100-ëåòèþ íà÷àëà Ïåðâîé ìèðîâîé âîéíû) Þäèí Â.Å., Áóäêî À.À., Îâå÷êèí È.Ã., ßðî-øåíêî Â.Ï. – Ôèëèàëó ¹ 2 3-ãî Öåí-òðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èìåíè À.À.Âèøíåâñêîãî – 25 ëåò
Gribovskaya G.A. – Russian physicians during first months of the great war. (To 100 anniversary of the beginning of the First World War)
Yudin V.E., Budko A.A., Ovechkin I.G., Yaroshenko V.P. – Branch N 2 of the Vish-nevskiy Central Military Clinical Hospital N 3 celebrates the 25th anniversary
81
Pokrovskii B.L. – Professional psycho-logical selection system in the Air Force – 50 years
Ïîêðîâñêèé Á.Ë. – Ñèñòåìå ïðîôåññè-îíàëüíîãî ïñèõîëîãè÷åñêîãî îòáîðà â Âîåííî-âîçäóøíûõ ñèëàõ – 50 ëåò
«Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014
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ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ
ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË
© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2014 ÓÄÊ 616-036.86:355Ìåäèöèíñêàÿ ðåàáèëèòàöèÿ â Âîîðóæåííûõ
Ñèëàõ: èñòîêè, ñîâðåìåííîå ñîñòîÿíèå
è ïåðñïåêòèâû
ÔÈÑÓÍ À.ß., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû1 ÙÅÃÎËÜÊΠÀ.Ì., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå2 ÞÄÈÍ Â.Å., çàñëóæåííûé âðà÷ ÐÔ, äîêòîð ìåäèöèíñêèõ íàóê, äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà (6_gospital@mail.ru)3 ÏÎÍÎÌÀÐÅÍÊÎ Ã.Í., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà4 1Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëåíèå ÌÎ ÐÔ, Ìîñêâà; 2Èíñòèòóò óñîâåðøåíñòâîâàíèÿ âðà÷åé ÌÓÍÊÖ èì. Ï.Â.Ìàíäðûêà, Ìîñêâà; 3Ôèëèàë ¹ 2 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷å-ñêîãî ãîñïèòàëÿ èì. À.À.Âèøíåâêëèíè÷å-ñêîãî, Ìîñêâà; 4Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã Ïðîàíàëèçèðîâàíû èñòîêè, ñîâðåìåííîå ñîñòîÿíèå è ïåðñïåêòèâû ìåäèöèíñêîé ðåàáèëèòàöèè â Âîîðóæåííûõ Ñèëàõ (ÂÑ) ÐÔ. Ñóùåñòâóþùàÿ ñåãîäíÿ â ÂÑ ñèñòåìà ìåäèöèíñêîé ðåàáèëèòàöèè è âîññòàíîâèòåëüíîãî ëå÷åíèÿ îáåñïå÷èâàåò ïðîâåäåíèå â ïîëíîì îáúåìå ðåàáèëèòàöèîííî-âîññòàíî-âèòåëüíûõ ìåðîïðèÿòèé âñåì êàòåãîðèÿì âîåííîñëóæàùèõ è ÷ëåíàì èõ ñåìåé. Èíòåãðàöèÿ îïûòà ìåäèöèíñêîé ñëóæáû ÂÑ ÐÔ ïî ðåàáèëèòàöèè ðàíåíûõ è áîëüíûõ â ãîñóäàðñòâåííóþ ñèñòåìó ìåäèöèíñêîé ðåàáèëèòàöèè, àêòèâíîå ó÷àñòèå ìåäèöèíñêîé ñëóæáû ÂÑ ÐÔ â ðàáîòå íàöèîíàëüíîé àññîöèàöèè ñïåöèàëèñòîâ ìåäèöèíñêîé ðåàáèëèòàöèè è âîññòàíîâèòåëüíîé ìåäèöèíû ïîçâîëÿò ñóùåñòâåííî ïîâûñèòü ýôôåêòèâíîñòü âñåé ñèñòåìû ðåàáèëèòàöèîííûõ ìåðîïðèÿòèé â ÂÑ. Ê ë þ ÷ å â û å ñ ë î â à: ìåäèöèíñêàÿ ðåàáèëèòàöèÿ è âîññòàíîâèòåëüíîå ëå÷åíèå âîåííîñëóæà-ùèõ, ñàíàòîðíî-êóðîðòíîå ëå÷åíèå, ìåäèêî-ïñèõîëîãè÷åñêàÿ ðåàáèëèòàöèÿ âîåííîñëóæàùèõ. Fisun A.Ya., Shchegolkov A.M., Yudin V.E., Ponomarenko G.N. – Medical rehabilitation in the Armed Forces: history, current state and prospects. Authors analyzed history, current state and prospects of medical rehabilitation in the Armed Forces of the Russian Federation. Current system of medical rehabilitation in the Armed Forces provides all categories of military personnel and members of their families complete rehabilitative and remedial measures. An integration of rehabilitative experience of the medical service of the Armed Forces of the Russian Federation into the State system of medical rehabilitation, active partici pation of the medical service of the Armed Forces of the Russian Federation in activity of National association of specialists of medical rehabilitation and regenerative medicine will allow to increase the effectiveness of the rehabilitation system of the Armed Forces.K e y w o r d s: military rehabilitation and regenerative treatment of military personnel, health resort treatment, medical-and-psychological rehabilitation of military personnel.
Â
ðîññèéñêîé âîåííîé ìåäèöèíå ïðèíöèïû ðåàáèëèòàöèè âîåííîñëó-æàùèõ ñêëàäûâàëèñü íà÷èíàÿ ñ XVIII â.  Ïîëîæåíèè î âîåííî-âðåìåííûõ ãîñ-ïèòàëÿõ 1812 ã., ðàçðàáîòàííîì ß.Â.Âèë-ëèå, ïðåäóñìàòðèâàëîñü â ãëàâíûõ è ïîä-âèæíûõ ãîñïèòàëÿõ èìåòü îñîáûå ïàëà-òû äëÿ âûçäîðàâëèâàþùèõ. Âî âðåìÿ Ïåðâîé ìèðîâîé âîéíû â Ðóññêîé àð-ìèè ôîðìèðîâàëèñü êîìàíäû âûçäîðàâ-ëèâàþùèõ ðàíåíûõ è áîëüíûõ ïðè âî-èíñêèõ ÷àñòÿõ è ýâàêîïóíêòàõ. Ñ íà÷àëîì Âåëèêîé Îòå÷åñòâåííîé âîéíû ïîÿâèëàñü íåîáõîäèìîñòü ðàçâåð-òûâàíèÿ øèðîêîé ñåòè áàòàëüîíîâ âûç-äîðàâëèâàþùèõ. Áûëè âíåñåíû ñóùå-ñòâåííûå èçìåíåíèÿ â øòàòíî-îðãàíè-çàöèîííóþ ñòðóêòóðó ìåäèöèíñêîé ñëóæ-áû, çàêëþ÷àâøèåñÿ â ñîçäàíèè copòèðî-âî÷íî-ýâàêóàöèîííûõ ãîñïèòàëåé è ãîñ-ïèòàëåé äëÿ ëåãêîðàíåíûõ, ñûãðàâøèõ çíà÷èòåëüíóþ ðîëü â äåëå ñòàíîâëåíèÿ ìåäèöèíñêîé ðåàáèëèòàöèè (ÌÐ). Ñ 1942 ã. â Êðàñíîé àðìèè ïðèìåäèêî-ñàíèòàð-«Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014
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ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË © ÊÎËËÅÊÒÈ ÀÂÒÎÐÎÂ, 2014 ÓÄÊ 616-08:355Îðãàíèçàöèÿ è îêàçàíèå òåðàïåâòè÷åñêîé
ïîìîùè â ñîâðåìåííûõ ëîêàëüíûõ âîéíàõ
è âîîðóæåííûõ êîíôëèêòàõ
ÕÀËÈÌΠÞ.Ø., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû (yushkha@gmail.com) ÒÊÀ×ÓÊ Í.À., êàíäèäàò ìåäèöèíñêèõ íàóê, äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà (tkachuk_nik@mail.ru) ÆÅÊÀËΠÀ.Í., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã Ñòðîéíàÿ ñèñòåìà îêàçàíèÿ òåðàïåâòè÷åñêîé ïîìîùè, â ðàìêàõ åäèíîé ñèñòåìû ýòàïíîãî ëå÷å-íèÿ ðàíåíûõ è áîëüíûõ ñ èõ ýâàêóàöèåé ïî íàçíà÷åíèþ, ñëîæèëàñü â õîäå Âåëèêîé Îòå÷åñòâåííîé âîéíû 1941–1945 ãã. è îáåñïå÷èëà âîçâðàò â ñòðîé 90,6% áîëüíûõ.  óñëîâèÿõ ëîêàëüíûõ âîéí è âîîðóæåííûõ êîíôëèêòîâ âàæíåéøåé çàäà÷åé âîåííî-ïîëåâîé òåðàïèè ÿâëÿåòñÿ ñîâåðøåíñòâîâà-íèå ñèñòåìû îêàçàíèÿ òåðàïåâòè÷åñêîé ïîìîùè íà îñíîâå ðåãèîíàëüíîãî è òåððèòîðèàëüíîãî ïðèíöèïîâ, ýøåëîíèðîâàíèÿ ñèë è ñðåäñòâ, îïòèìàëüíîé ëîêàëèçàöèè ëå÷åáíûõ ó÷ðåæäåíèé ñ ó÷å-òîì èõ âîçìîæíîñòåé, ïóòåé ýâàêóàöèè è ò. ï. Ïðè îðãàíèçàöèè òåðàïåâòè÷åñêîé ïîìîùè ñëåäó-åò ðóêîâîäñòâîâàòüñÿ â ïåðâóþ î÷åðåäü âåëè÷èíîé è ñòðóêòóðîé ñàíèòàðíûõ ïîòåðü.  ñîâðåìåí-íûõ ëîêàëüñîâðåìåí-íûõ âîéíàõ íåëüçÿ èñêëþ÷èòü âîçíèêíîâåíèå ìàññîâûõ ñàíèòàðñîâðåìåí-íûõ ïîòåðü ïðè îãðàíè-÷åííîì ïðèìåíåíèè îðóæèÿ ìàññîâîãî ïîðàæåíèÿ, â ðåçóëüòàòå ðàçðóøåíèÿ (ïðè ïðèìåíåíèè îáû÷-íîãî îðóæèÿ èëè â ðåçóëüòàòå äèâåðñèîííûõ àêöèé) îáúåêòîâ ÿäåðíîé ýíåðãåòèêè, õèìè÷åñêèõ ïðåäïðèÿòèé, òðàíñïîðòíûõ åìêîñòåé, ñîäåðæàùèõ òîêñè÷íûå õèìè÷åñêèå âåùåñòâà. Ê ë þ ÷ å â û å ñ ë î â à: ëîêàëüíàÿ âîéíà, ñàíèòàðíûå ïîòåðè òåðàïåâòè÷åñêîãî ïðîôèëÿ, áîåâàÿ òåðàïåâòè÷åñêàÿ ïàòîëîãèÿ, îðãàíèçàöèÿ è îêàçàíèå òåðàïåâòè÷åñêîé ïîìîùè.Khalimov Yu.Sh., Tkachuk N.A., Zhekalov A.N. – Organization and delivery of therapeutic care in modern local wars and armed conflicts. The system of providing therapeutic care within a united system of staged treatment of wounded and sick and evacuation was established during the Great Patriotic War of 1941–1945 and helped to return 90,6% of casualties to duty. In terms of local wars and armed conflicts the most important task of military field therapy is to improve the provision of therapeutic support through regional and territorial princi ples, echeloning of forces and facilities, optimization of allocation of medical institutions in accordance with their capabilities, evacuation routes, etc. The organization of therapeutic assistance should be guided primarily by the size and structure of sanitary losses. In modern local wars cannot exclude the occurrence of massive sanitary losses with limited use of weapons of mass destruction, as a result of failure (with a conventional weapon or as a result of sabotage) of nuclear power plants, chemical plants, and transport containers containing toxic chemicals.
K e y w o r d s: local war, sanitary therapeutic losses, military therapeutic pathology, organization and delivery of medical care.
Â
îåííî-ïîëåâàÿ òåðàïèÿ êàê îäèí èç âàæíåéøèõ ðàçäåëîâ âîåííîé ìåäè-öèíû ïîëó÷èëà ñâîå îðãàíèçàöèîííîå îôîðìëåíèå çíà÷èòåëüíî ïîçæå, ÷åì âî-åííî-ïîëåâàÿ õèðóðãèÿ. Ïîýòîìó íå óäè-âèòåëüíî, ÷òî èñêëþ÷èòåëüíî öåííûå óêàçàíèÿ ïî îðãàíèçàöèè òåðàïåâòè÷åñ-êîé ïîìîùè â âîéñêàõ è îñîáåííîñòÿõ ïàòîëîãèè âîåííîãî âðåìåíè áûëè ñäå-ëàíû âûäàþùèìñÿ îòå÷åñòâåííûì õè-ðóðãîì Í.È.Ïèðîãîâûì. Îí íåîäíîêðàò-íî óêàçûâàë, ÷òî «÷èñëî âûáûâàþùèõ èç ñòðîÿ âî âðåìÿ âîéí, âñëåäñòâèå áîëåç-íåé êàê â ïðîøëûõ, òàê è â îñîáåííîñòè â íûíåøíèõ âîéíàõ, ãîðàçäî çíà÷èòåëü-íåå óáûëè óáèòûìè è ðàíåíûìè», è äà-ëåå: «åùå ñ áîëüøèìè òðóäíîñòÿìè, ÷åì äèàãíîç, ñîåäèíåíî ëå÷åíèå âíóòðåííèõ áîëåçíåé â ãîñïèòàëÿõ íà òåàòðå âîéíû. Ýòî ëå÷åíèå ãîðàçäî ðàçíîîáðàçíåå è òðåáóåò áîëåå èíäèâèäóàëèçèðîâàíèÿ áîëüíûõ ñî ñòîðîíû âðà÷à, ÷åì íàðóæ-íûå ïîâðåæäåíèÿ». Í.È.Ïèðîãîâ íà îñíîâå ñâîåãî îïû-òà îêàçàíèÿ ïîìîùè ðàíåíûì è áîëü-íûì ñôîðìóëèðîâàë, ïîæàëóé, ãëàâíîå«Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014
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ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË ôèëÿ ïî âîïðîñàì âîåííî-ïîëåâîé òå-ðàïèè. Îò âðà÷à, êðîìå çíàíèé ïî âèñöå-ðàëüíîé ïàòîëîãèè âîåííîé âðåìåíè è âèñöåðàëüíûõ îñëîæíåíèé ó ðàíåíûõ, ñîâðåìåííàÿ âîéíà òðåáóåò ïîäãîòîâêè ïî òîêñèêîëîãèè è ðàäèîëîãèè. Êàê óæå îòìå÷àëîñü, â ñëó÷àå ïðèìå-íåíèÿ ÎÌÏ èëè ðàçðóøåíèÿ îáúåêòîâ ÿäåðíîé ýíåðãåòèêè, õèìè÷åñêèõ ïðåäïðè-ÿòèé è ò. ï. íà ïåðåäîâûå ýòàïû ìåäèöèí-ñêîé ýâàêóàöèè îäíîìîìåíòíî ïîñòóïèò áîëüøîå êîëè÷åñòâî ïîðàæåííûõ, ÷òî ñèëüíî îñëîæíèò ðàáîòó âðà÷åé-òåðàïåâ-òîâ.  ýòèõ óñëîâèÿõ èì íåîáõîäèìî â êðàò÷àéøèå ñðîêè ïðîâåñòè ìåäèöèíñêóþ ñîðòèðîâêó, ñàíèòàðíóþ îáðàáîòêó ïîñòó-ïàþùèõ, îïðåäåëèòü õàðàêòåð è òÿæåñòü ïîðàæåíèÿ, îêàçàòü íóæäàþùèìñÿ íå-îòëîæíóþ òåðàïåâòè÷åñêóþ ïîìîùü, ýâàêóèðîâàòü èõ íà ïîñëåäóþùèå ýòàïû îêàçàíèÿ ìåäèöèíñêîé ïîìîùè. Óêàçàííûå òðóäíîñòè óñóãóáëÿþòñÿ è òåì, ÷òî äëÿ óñòàíîâëåíèÿ äèàãíîçà çäåñü ìîãóò áûòü èñïîëüçîâàíû â îñ-íîâíîì äàííûå ñóáúåêòèâíîãî è îáû÷-íîãî îáúåêòèâîáû÷-íîãî îáñëåäîâàíèÿ áîëü-íîãî (îñìîòð, ïàëüïàöèÿ, ïåðêóññèÿ, àóñ-êóëüòàöèÿ), ïðîñòåéøèå èíñòðóìåíòàëü-íûå èññëåäîâàíèÿ (èçìåðåíèå àðòåðè-àëüíîãî äàâëåíèÿ) ñ îãðàíè÷åííûì ïðèìåíåíèåì äîïîëíèòåëüíûõ ìåòîäîâ (ëàáîðàòîðíûõ, èíñòðóìåíòàëüíûõ è äð.). Òåðàïåâòó íåîáõîäèìî íå òîëüêî ïîñòà-âèòü äèàãíîç, íî è óñòàíîïîñòà-âèòü ëå÷åáíî-ýâàêóàöèîííûé ïðîãíîç, ò. å. îïðåäåëèòü òîò ýòàï ìåäèöèíñêîé ýâàêóàöèè, ãäå ëå-÷åíèå îêàæåòñÿ íàèáîëåå ýôôåêòèâíûì, à åãî ñðîêè îïòèìàëüíûìè. Óñòàíàâëè-âàÿ äèàãíîç çàáîëåâàíèÿ, âðà÷ äîëæåí íàçíà÷èòü áîëüíîìó ëå÷åíèå, ó÷èòûâàÿ öåëåñîîáðàçíîñòü è âîçìîæíîñòü åãî ïðîâåäåíèÿ â òîé îáñòàíîâêå, â êîòî-ðîé áóäåò ïðîõîäèòü ýâàêóàöèÿ çàáîëåâ-øåãî. Èç ñêàçàííîãî ñëåäóåò, ÷òî âîåííî-ïîëåâîé òåðàïåâò äîëæåí èìåòü ñïåöè-àëüíóþ ïîäãîòîâêó ïî äèàãíîñòèêå è ëå-÷åíèþ âèñöåðàëüíîé ïàòîëîãèè âîåííî-ãî âðåìåíè, âèñöåðàëüíûõ îñëîæíåíèé ó ðàíåíûõ, à òàêæå ïîðàæåííûõ ñ áîåâîé òåðàïåâòè÷åñêîé ïàòîëîãèåé. Òàêèì îáðàçîì, ñîâåðøåíñòâîâàíèå ïðèíöèïîâ îðãàíèçàöèè îêàçàíèÿ òåðà-ïåâòè÷åñêîé ïîìîùè, îñóùåñòâëåíèå âçà-èìîäåéñòâèÿ ñïåöèàëèñòîâ òåðàïåâòè÷åñ-êîãî è õèðóðãè÷åñòåðàïåâòè÷åñ-êîãî ïðîôèëåé, â ò. ÷. ïî ðàííåìó âûÿâëåíèþ è ëå÷åíèþ âèñ-öåðàëüíûõ îñëîæíåíèé ó ðàíåíûõ, ñîâåð-øåíñòâîâàíèå ñïåöèàëüíîé ïîäãîòîâêè âðà÷åé-òåðàïåâòîâ áóäóò ñïîñîáñòâîâàòü ñâîåâðåìåííîìó è êà÷åñòâåííîìó ðåøå-íèþ çàäà÷ ïî îêàçàðåøå-íèþ òåðàïåâòè÷åñêîé ïîìîùè â ñîâðåìåííûõ ëîêàëüíûõ âîé-íàõ è âîîðóæåííûõ êîíôëèêòàõ.Ëèòåðàòóðà
1. Âàñèëü÷åíêî À.Ä., Ðóñåâ È.Ò. Ñèñòåìà ãîñïèòàëüíîãî ëå÷åíèÿ ðàíåíûõ è áîëüíûõ, ïðèíÿòàÿ â ÑØÀ íà âîåííîå âðåìÿ // Âîåí.-ìåä. æóðí. – 2008. – Ò. 329, ¹ 1. – Ñ. 62–65. 2. 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. 3. Íå÷àåâ Ý.À., Ëîáàñòîâ Î.Ñ. Ñèñòåìà ëå÷åáíî-ýâàêóàöèîííîãî îáåñïå÷åíèÿ âîéñê íà ñîâðåìåííîì ýòàïå ðàçâèòèÿ âîåííîé ìå-äèöèíû // Âîåí.-ìåä. æóðí. – 1991. – ¹ 9. – Ñ. 4–7. 4. Îïûò ìåäèöèíñêîãî îáåñïå÷åíèÿ âîéñê â Àôãàíèñòàíå. 1979–1989 ãã.:  5 ò. / Ïîä ðåä. È.Â.Ñèíîïàëüíèêîâà. – Ì.: ÃÂÊà èì. Í.Í.Áóðäåíêî, 2003. – Ò. I. – 468 ñ. 5. 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. 6. Îñîáåííîñòè îðãàíèçàöèè è îêàçàíèÿ òåðàïåâòè÷åñêîé ïîìîùè ðàíåíûì è áîëüíûì â Ðåñïóáëèêå Äàãåñòàí è ×å÷åíñêîé Ðåñïóá-ëèêå. Ñîâåðøåíñòâîâàíèå ëå÷åáíî-ïðîôèëàê-òè÷åñêèõ àëãîðèòìîâ: Îò÷åò î ÍÈÐ ïî òåìå 2.00.062. ï.4. / ÂÌåäÀ èì. Ñ.Ì.Êèðîâà. – ÑÏá, 2003. – 285 ñ. 7. Õàëèìîâ Þ.Ø., Òêà÷óê Í.À., Æåêàëîâ À.Í. Ôîðìèðîâàíèå ñàíèòàðíûõ ïîòåðü òåðàïåâ-òè÷åñêîãî ïðîôèëÿ â ëîêàëüíûõ âîéíàõ è âî-îðóæåííûõ êîíôëèêòàõ // Âîåí.-ìåä. æóðí. – 2012. – Ò. 333, ¹ 9. – Ñ. 4–11. 8. ×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. 9. ×èæ È.Ì. Îðãàíèçàöèîííûå îñíîâû ïîñòðîåíèÿ òåððèòîðèàëüíîé ñèñòåìû ìåäè-öèíñêîãî îáåñïå÷åíèÿ Âîîðóæåííûõ Ñèë // Âîåí.-ìåä. æóðí. – 1995. – ¹ 4. – Ñ. 18–25.25
«Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014 ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË © ÊÎËËÅÊÒÈ ÀÂÒÎÐÎÂ, 2014 ÓÄÊ 616.12-089-057.36-036.86Îñíîâíûå íàïðàâëåíèÿ ñîâåðøåíñòâîâàíèÿ
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âîåííîñëóæàùèõ ïîñëå êàðäèîõèðóðãè÷åñêèõ
âìåøàòåëüñòâ
ÞÄÈÍ Â.Å., çàñëóæåííûé âðà÷ ÐÔ, äîêòîð ìåäèöèíñêèõ íàóê, äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà (6_gospital@mail.ru)1 ÊËÈÌÊÎ Â.Â., çàñëóæåííûé âðà÷ ÐÔ, äîêòîð ìåäèöèíñêèõ íàóê, äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû2 ØÊÀÐÓÏÀ Î.Ô., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà1 ÃÓÇÅÍÊÎ È.Å., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà1 1Ôèëèàë ¹ 2 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. À.À.Âèøíåâñêîãî, Ìîñêâà; 2Èíñòèòóò óñîâåðøåíñòâîâàíèÿ âðà÷åé ÌÓÍÊÖ èì. Ï.Â.Ìàíäðûêà, Ìîñêâà  öåëÿõ ñîâåðøåíñòâîâàíèÿ ïðîöåññà ìåäèöèíñêîé ðåàáèëèòàöèè, íàïðàâëåííîé íà ïîâûøåíèå ýôôåêòèâíîñòè âîññòàíîâëåíèÿ ôóíêöèîíàëüíîãî ñîñòîÿíèÿ âîåííîñëóæàùèõ ïîñëå êàðäèî-õèðóðãè÷åñêèõ âìåøàòåëüñòâ â ðåàáèëèòàöèîííîì öåíòðå íåîáõîäèìû âíåäðåíèå ñòàíäàðòîâ ìåäèöèíñêîé ðåàáèëèòàöèè íà âñåõ ýòàïàõ, ñèíäðîìî-ïàòîãåíåòè÷åñêîãî ïðèíöèïà ôîðìèðîâàíèÿ âõîäÿùåãî ïîòîêà, ìóëüòèäèñöèïëèíàðíàÿ îðãàíèçàöèÿ ðàáîòû ñïåöèàëèñòîâ â ñîñòàâå: êàðäèî-ëîã – ëå÷àùèé âðà÷, âðà÷ ôóíêöèîíàëüíîé äèàãíîñòèêè, âðà÷ ëå÷åáíîé ôèçêóëüòóðû, ôèçèîòåðàïåâò, ïñèõîòåðàïåâò, õèðóðã è èíñòðóêòîð ïî ïðîôåññèîíàëüíîé ðåàáèëèòàöèè. Îñíîâó ðàçðàáîòàííûõ íàïðàâëåíèé ñîâåðøåíñòâîâàíèÿ ñèñòåìû ìåäèöèíñêîé ðåàáèëèòàöèè ñîñòàâèëè îðãàíèçàöèîííûå òåõíîëîãèè âçàèìîäåéñòâèÿ ðàííåãî è ïîçäíåãî ýòàïîâ ðåàáèëèòàöèè è íåïðåðûâíûé (òåêóùèé è çàêëþ÷èòåëüíûé) êîíòðîëü êà÷åñòâà è ýôôåêòèâíîñòè ðåàáèëèòàöèè. Îïòèìèçàöèÿ îðãàíèçàöèè ðàáîòû íà ïîçäíåì ãîñïèòàëüíîì ýòàïå ïîçâîëèëà â öåëîì ñíèçèòü ïðîäîëæèòåëüíîñòü ñòàöèîíàðíîé ðåàáèëèòàöèè íà 33,3% ïðè äîñòèæåíèè ëó÷øèõ ðåçóëüòàòîâ ìåäèöèíñêîãî îáñëóæèâàíèÿ. Ê ë þ ÷ å â û å ñ ë î â à: âîåííîñëóæàùèå, êàðäèîõèðóðãè÷åñêèå âìåøàòåëüñòâà, ìåäèöèíñêàÿ ðåàáèëèòàöèÿ, ìóëüòèäèñöèïëèíàðíàÿ îðãàíèçàöèÿ ðàáîòû ñïåöèàëèñòîâ, ïîçäíèé ãîñïèòàëüíûé ýòàï.Yudin V.E., Klimko V.V., Shkarupa O.F., Guzenko I.E. – Main ways of improvements of the system of medical rehabilitation of military servicemen after cardiovascular surgery. For better improvement of medical rehabilitation referred to effective restoration of functional status of servicemen after cardiovascular surgery it is necessary to introduce standards of medical rehabilitation at all stages of rehabilitation, syndrome-pathologic princi ple of grouping patients, multidisci plinary organisation of medical activity: cardiologist-physician, specialist of functional diagnostics, specialist of physical therapy, psychotherapist, physical therapeutic, surgeon and specialist of professional rehabilitation. Basic ways of improvement of the system of rehabilitation were organisational technologies of interaction during early and late stages of rehabilitation and persistent control of quality and effectiveness of rehabilitation. Optimization of organisation of late stage of hospitalisation allowed to reduce the average time of rehabilitation to 33,3% and at the same time to improve effectiveness of rehabilitation.
K e y w o r d s: servicemen, cardiovascular surgery, medical rehabilitation, multidisci plinary organisation of therapeutic activity, late stage of hospitalisation.
Ì
åäèöèíñêàÿ ðåàáèëèòàöèÿ (ÌÐ) ëÿåòñÿ îäíèì èç ïðèîðèòåòíûõ íà-ïðàâëåíèé âîåííîãî çäðàâîîõðàíåíèÿ, ñâÿçàííûì ñ âîïðîñàìè âîññòàíîâëåíèÿ áîåãîòîâíîñòè âîåííûõ ñïåöèàëèñòîâ è èõ ïðîôåññèîíàëüíûì äîëãîëåòèåì [9, 10]. Âûïîëíåíèå ïðîôåññèîíàëüíûõ îáÿ-çàííîñòåé âîåííîñëóæàùèìè â ïîâñå-äíåâíîé áîåâîé äåÿòåëüíîñòè íåðåäêî îñóùåñòâëÿåòñÿ ñ ðèñêîì äëÿ èõ æèçíè è çäîðîâüÿ, âûñîêèì ôèçè÷åñêèì è ïñèõî-ýìîöèîíàëüíûì íàïðÿæåíèåì, âîçäåé-ñòâèåì áîëüøîãî êîëè÷åñòâà âðåäíûõ ôàêòîðîâ ïðîôåññèîíàëüíîé äåÿòåëüíî-ñòè. Ìåäèöèíñêàÿ ðåàáèëèòàöèÿ, êàê ñî-ñòàâíàÿ ÷àñòü ëå÷åáíîãî ïðîöåññà, îáå-ñïå÷èâàåò íàèáîëåå ïîëíîå âîññòàíîâëå-íèå íàðóøåííûõ áîåñïîñîáíîñòè è31
«Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014 ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈËËèòåðàòóðà
1. Áåëÿêèí Ñ.À., Þäèí Â.Å., Ùåãîëüêîâ À.Ì. Ôîðìèðîâàíèå ñîâðåìåííîé ñèñòåìû ìåäè-öèíñêîé ðåàáèëèòàöèè âîåííîñëóæàùèõ // Âåñòí. âîññòàíîâèò. ìåäèöèíû. – 2011. – ¹ 1. – Ñ. 2–5. 2. Áåëÿêèí Ñ.À., Þäèí Â.Å., Ùåãîëüêîâ À.Ì. è äð. Ñîâåðøåíñòâîâàíèå ñèñòåìû ìåäèöèí-ñêîé ðåàáèëèòàöèè ðàíåíûõ è áîëüíûõ íà ïîçäíåì ãîñïèòàëüíîì ýòàïå // Âîåí.-ìåä. æóðí. – 2012. – Ò. 333, ¹ 11. – Ñ. 4–13. 3. Áåëÿêèí Ñ.À., Þäèí Â.Å., Ùåãîëüêîâ À.Ì., Øêàðóïà Î.Ô. Ñòàíäàðòèçàöèÿ êàê ðåàëüíûé ìåõàíèçì óïðàâëåíèÿ êà÷åñòâîì ìåäèöèíñêîé ðåàáèëèòàöèè íà ïîçäíåì ãîñïèòàëüíîì ýòà-ïå // Âåñòí. âîññòàíîâ. ìåäèöèíû. – 2012. – ¹ 6. – Ñ. 30–32. 4. Áåëÿêèí Ñ.À., Þäèí Â.Å., Øêàðóïà Î.Ô. Ïðîáëåìû ïîâûøåíèÿ êà÷åñòâà ìåäèöèíñêîé ðåàáèëèòàöèè âîåííîñëóæàùèõ, áîëüíûõ èøå-ìè÷åñêîé áîëåçíüþ ñåðäöà, ïîñëå êîðîíàðíîãî øóíòèðîâàíèÿ, íà ïîçäíåì ãîñïèòàëüíîì ýòà-ïå // Âåñòí. Ðîñ. Âîåí.-ìåä. àêàä. – 2012. – ¹ 3. – Ñ. 97–101. 5. Ãîñóäàðñòâåííàÿ ïðîãðàììà Ðîññèé-ñêîé Ôåäåðàöèè «Ðàçâèòèå çäðàâîîõðàíåíèÿ» // Ðàñïîðÿæåíèå Ïðàâèòåëüñòâà Ðîññèéñêîé Ôåäåðàöèè îò 24.12.2012 ã. ¹ 2511-ð. 6. Èâàíîâ Â.Í., Ãóëÿåâ Â.À., Ãîëîâ Þ.Ñ. Ìåòîäîëîãè÷åñêèå àñïåêòû îïòèìèçàöèè ìå-äèöèíñêîãî îáåñïå÷åíèÿ âîéñê ñ ïîçèöèé òåîðèè ôóíêöèîíàëüíûõ ñèñòåì // Âîåí.-ìåä. æóðí. – 2000. – Ò. 321, ¹ 1. – Ñ. 15–19. 7. Êàëìûêîâ À.À. Ìåäèöèíñêîå îáåñïå÷å-íèå Âîîðóæåííûõ ñèë Ðîññèè: èòîãè äåÿòåëü-íîñòè è îñíîâíûå çàäà÷è íà 2012 ãîä // Âîåí.-ìåä. æóðí. – 2012. – Ò. 333, ¹ 1. – Ñ. 4–11. 8. Îá îñíîâàõ îõðàíû çäîðîâüÿ ãðàæäàí â Ðîññèéñêîé Ôåäåðàöèè. Ôåäåðàëüíûé çàêîí îò 21.11.2011 ã. ¹ 323-ÔÇ // «Ðû – Ôåäåðàëü-íûé âûïóñê. – 23 íîÿáðÿ 2011 ã. – ¹ 5639. 9. Ôèñóí À.ß. Ìåäèöèíñêîå îáåñïå÷åíèå Âîîðóæåííûõ Ñèë Ðîññèéñêîé Ôåäåðàöèè: ñîñòîÿíèå è ïóòè ñîâåðøåíñòâîâàíèÿ // Âîåí.-ìåä. æóðí. – 2014. – Ò. 335, ¹ 1. – Ñ. 4–16. 10. Ôèñóí À.ß., Ùåãîëüêîâ À.Ì., Þäèí Â.Å. è äð. Ñèñòåìà ìåäèöèíñêîé ðåàáèëèòàöèè â Âîîðóæåííûõ Ñèëàõ: èñòîðèÿ, ñîâðåìåííîñòü è ïåðñïåêòèâû ðàçâèòèÿ // Âîåí.-ìåä. æóðí. – 2009. – Ò. 330, ¹ 8. – Ñ. 11–15.ËÅÍÒÀ ÍÎÂÎÑÒÅÉ
 Êàëèíèíãðàäå íà áàçå âîåííî-ìîð-ñêîãî êëèíè÷åâîåííî-ìîð-ñêîãî ãîñïèòàëÿ Áàëòèéâîåííî-ìîð-ñêîãî ôëîòà (ÁÔ) ïðîâåäåíî òàêòèêî-ñïåöèàëü-íîå ó÷åíèå ïî îðãàíèçàöèè ìàññîâîãî ïðè-åìà ðàíåíûõ è áîëüíûõ.  êà÷åñòâå íàãëÿäíîñòè áûëî èìèòè-ðîâàíî ïîñòóïëåíèå 40 ïîñòðàäàâøèõ âî-åííîñëóæàùèõ òåðàïåâòè÷åñêîãî è õèðóð-ãè÷åñêîãî ïðîôèëåé. Ïîêàçíîå ìåðîïðèÿ-òèå áûëî íàïðàâëåíî íà îòðàáîòêó ïðàêòè-÷åñêèõ äåéñòâèé ìåäèöèíñêîãî ïåðñîíàëà â óñëîâèÿõ ÷ðåçâû÷àéíûõ ïðîèñøåñòâèé, à òàêæå ïðè ïåðåâîäå â âûñøèå ñòåïåíè áîåâîé ãîòîâíîñòè.  õîäå ïðàêòè÷åñêèõ çàíÿòèé äåìîí-ñòðèðîâàëèñü ïðîâåäåíèå äîçèìåòðè÷åñêîãî êîíòðîëÿ, îáðàáîòêà ñàíèòàðíîãî òðàíñïîðòà è ïîñòðàäàâøèõ, äåéñòâèÿ ïåðñîíàëà ãîñïèòàëÿ íà ïëîùàäêàõ ìåäèöèíñêîé ñîðòèðîâêè è ñàíèòàðíîé îáðàáîòêè áîëüíûõ è ðàíåíûõ. Çàêëþ÷èòåëüíûì ýòàïîì ÒÑÓ ñòàëî óñëîâíîå âîçãîðàíèå íà îäíîì èç âåðõíèõ ýòàæåé ãîñïèòàëÿ. Äëÿ ëîêàëèçàöèè ïîæàðà è ýâàêóàöèè áîëüíûõ áûëè çàäåéñòâîâàíû ïîæàðíûå ñèëû ôëîòà è ñïåöèàëèñòû Ì×Ñ. Ïî ñëîâàì ðóêîâîäèòåëÿ ó÷åíèÿ – íà÷àëüíèêà ìåäèöèíñêîé ñëóæáû ÁÔ ïîëêîâíèêà ìå-äèöèíñêîé ñëóæáû Íèêîëàÿ Êàðïóíà, ïðîâåäåííîå ïðàêòè÷åñêîå ìåðîïðèÿòèå áûëî íàöåëåíî íà ïîâûøåíèå óðîâíÿ áîåãîòîâíîñòè âñåãî ìåäèöèíñêîãî ñîñòàâà ôëîòà – ñàíèòàðíûõ èíñò-ðóêòîðîâ, ìåäñåñòåð è âðà÷åé. Ïðåññ-ñëóæáà Çàïàäíîãî âîåííîãî îêðóãà, 23 èþëÿ 2014 ã. http://function.mil.ru/news_page/country/more.htm?id=11970877@egNews«Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014
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© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2014 ÓÄÊ [616.89-008.441.33-06:616.83]-057.36Ïàòîëîãèÿ íåðâíîé ñèñòåìû ó âîåííîîáÿçàííûõ
ëèö ñ íàðêîìàíèåé â àíàìíåçå: ñèìïòîìàòèêà,
ìåòîäû äèàãíîñòèêè
ËÈÒÂÈÍÖÅ Á.Ñ., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû (litvintsevs@yandex.ru) ÎÄÈÍÀÊ Ì.Ì., ÷ëåí-êîððåñïîíäåíò ÐÀÌÍ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå (odinak@rambler.ru) ÊÎÂÀËÅÍÊÎ À.Ï., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû ÅÔÈÌÖÅ À.Þ. ÒÀÐÓÌΠÄ.À., êàíäèäàò ìåäèöèíñêèõ íàóê, ìàéîð ìåäèöèíñêîé ñëóæáû ÏÅÒÐΠÀ.Ä. ËÈÑßÍÑÊÈÉ Ä.À., ëåéòåíàíò ìåäèöèíñêîé ñëóæáû Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã Îáñëåäîâàíî 60 ïàöèåíòîâ ìóæñêîãî è æåíñêîãî ïîëà (ñðåäíèé âîçðàñò 25,8±2,7 ãîäà) ñ ïîäòâåð-æäåííûì äèàãíîçîì íàðêîòè÷åñêîé çàâèñèìîñòè. Äëèòåëüíîñòü õðîíè÷åñêîé íàðêîòèçàöèè áûëà ïðèáëèçèòåëüíî îäèíàêîâà è ñîñòàâëÿëà 9±3,3 ãîäà. Ó îáñëåäîâàííûõ áîëüíûõ íà ìîìåíò îñìîòðà îòìå÷àëàñü ðåìèññèÿ íå ìåíåå 3 íåä. Âñåì ïàöèåíòàì ïðîâåäåíû ñòèìóëÿöèîííàÿ ýëåêòðîíåéðî-ìèîãðàôèÿ è ìàãíèòíî-ðåçîíàíñíàÿ òîìîãðàôèÿ ãîëîâíîãî ìîçãà. Ïîëó÷åííûå ðåçóëüòàòû ñâèäå-òåëüñòâóþò î òîì, ÷òî óïîòðåáëåíèå íàðêîòè÷åñêèõ ïðåïàðàòîâ ñïîñîáñòâóåò äèôôóçíîìó ïî-ðàæåíèþ íåðâíîé ñèñòåìû, êîòîðîå â îñíîâíîì ïðîÿâëÿåòñÿ âåãåòàòèâíûìè ðàññòðîéñòâàìè, ðàññåÿííîé íåâðîëîãè÷åñêîé ñèìïòîìàòèêîé è ïîëèíåâðîïàòèåé. Ïðèâåäåíû ðåêîìåíäàöèè â îáëà-ñòè âîåííî-âðà÷åáíîé ýêñïåðòèçû ñ öåëüþ âûÿâëåíèÿ íåâðîëîãè÷åñêèõ íàðóøåíèé, âûçâàííûõ íàð-êîòèçàöèåé. Ê ë þ ÷ å â û å ñ ë î â à: âîåííîîáÿçàííûå, íàðêîìàíèÿ, ïñèõîàêòèâíûå âåùåñòâà, ïàòîëîãèÿ íåðâíîé ñèñòåìû, âåãåòàòèâíûå ðàññòðîéñòâà, ïîëèíåâðîïàòèÿ, âîåííî-âðà÷åáíàÿ ýêñïåðòèçà. Litvintsev B.S., Odinak M.M., Kovalenko A.P., Efimtsev A.Yu., Tarumov D.A., Petrov A.D., Lisyanskii D.A. – Pathology of the nervous system in conscripts with drug abuse in past medical history: symptomatology, diagnostics methods. Authors examined 60 female and male patients (average age 25,8±2,7 years) with confirmed diagnosis – drug abuse. Average duration of drug abuse was approximately 9±3,3 years. At the moment of examination patients had been fully in remission for 3 weeks. The following non-invasive procedures were undertaken: stimulation electroneuromyogrphy and brain MRI. Received results showed that drug abuse leads to diffuse lesion of the nervous system, which manifests itself as vegetative disorders, scattered neurological symptoms, polyneuropathy. Authors gave recommendations in the field of military examination with the aim of detection of nervous disorders caused by drug abuse.K e y w o r d s: conscri pts, drug abuse, pathology of the nervous system, vegetative disorders, military-medical examination, polyneuropathy.
Ñ
îãëàñíî îôèöèàëüíûì äàííûì, â Ðîññèè çàðåãèñòðèðîâàíû îêîëî 5 ìëí áîëüíûõ àëêîãîëèçìîì è íàðêî-ìàíèåé. Íà îôèöèàëüíîì ñàéòå Ôåäå-ðàëüíîé ñëóæáû ãîñóäàðñòâåííîé ñòàòè-ñòèêè ðàçìåùåíà èíôîðìàöèÿ î çàáîëå-âàåìîñòè íàðêîìàíèåé â 2012 ã. – ÷èñëî çàðåãèñòðèðîâàííûõ íàðêîçàâèñèìûõ ëèö â Ðîññèè ïðåâûøàåò 315 òûñ. ÷åëî-âåê. Áîëüøàÿ ÷àñòü íàðêîçàâèñèìûõ ïî ðàçíûì ïðè÷èíàì íå ñîñòîèò íà ó÷åòå â íàðêîëîãè÷åñêèõ äèñïàíñåðàõ, ïîýòîìó öèôðû íåîôèöèàëüíîé ñòàòèñòèêè âàðü-èðóþò â ïðåäåëàõ îò 1,5 äî 2 ìëí ïîòðå-áèòåëåé ïñèõîàêòèâíûõ âåùåñòâ (ÏÀÂ). Ïîäàâëÿþùåå áîëüøèíñòâî íàðêîòèçè-ðóþùèõñÿ – ýòî ëèöà ìîëîäîãî âîçðàñòà èç ÷èñëà ïîòåíöèàëüíîãî âîèíñêîãî êîí-òèíãåíòà, ÷òî, áåçóñëîâíî, èìååò íåãàòèâ-íîå âëèÿíèå íà îáîðîíîñïîñîáíîñòü37
«Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014 ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ ÂÎÏÐÎÑÛËèòåðàòóðà
1. Àáðèòàëèí Å.Þ., Êîðçåíåâ À.Â., Òàðóìîâ Ä.À. Ïåðñïåêòèâû ïðèìåíåíèÿ ìåòîäîâ íåéðîâè-çóàëèçàöèè â ïñèõèàòðèè // Âñåðîñ. íàó÷.-ïðàêò. êîíô. «Àêòóàëüíûå ïðîáëåìû êëèíè÷åñ-êîé, ñîöèàëüíîé è âîåííîé ïñèõèàòðèè», ÑÏá, 22–23 îêòÿáðÿ 2009. – ÑÏá, 2009. – Ñ. 96. 2. Êèì À.Â. ÂÈ×-èíôåêöèÿ è âèðóñíûå ãåïàòèòû  è Ñ êàê ìåäèêî-ñîöèàëüíàÿ ïðî-áëåìà ïðèçûâíèêîâ ìåãàïîëèñà // ÂÈ×-èí-ôåêöèÿ è èììóíîñóïðåññèè. – 2011. – Ò. 3, ¹ 4. – Ñ. 71–74. 3. Ëåâèí Î.Ñ. Ýôåäðîíîâàÿ ýíöåôàëîïà-òèÿ // Æóðí. íåâðîë. è ïñèõèàòð. èì. Ñ.Ñ.Êîð-ñàêîâà. – 2005. – Ò. 105, ¹ 7. – Ñ. 12–20. 4. Ëèòâèíåíêî È.Â., Îäèíàê Ì.Ì., Ñàõà-ðîâñêàÿ À.À. Öåðåáðàëüíûå ñîñóäèñòûå èç-ìåíåíèÿ ïðè áîëåçíè Ïàðêèíñîíà: íåéðî-âèçóàëèçàöèîííûå è ïàòîãåíåòè÷åñêèå âàðèàíòû // Íåâðîë. æóðí. – 2010. – ¹ 3. – Ñ. 25–34. 5. Ëèòâèíöåâ Ñ.Â., Ñíåäêîâ Å.Â., Ðåçíèê À.Ì. Áîåâàÿ ïñèõè÷åñêàÿ òðàâìà: Ðóêîâîäñòâî äëÿ âðà÷åé. – Ì.: Ìåäèöèíà. – 2005. – 432 ñ. 6. Ëîáçèí Â.Þ., Îäèíàê Ì.Ì., Åìåëèí À.Þ. Ñîñóäèñòàÿ äåìåíöèÿ // Âåñòí. Ðîñ. Âîåí.-ìåä. àêàäåìèè. – 2004. – ¹ 1 (11). – Ñ. 120–124. 7. Íèêèòèí À.Ý., Êîñòèí Ä.Â., Øàìðåé Â.Ê. è äð. Ñîñòîÿíèå ïñèõè÷åñêîãî çäîðîâüÿ ëèö ïðèçûâíîãî âîçðàñòà // Âîåí.-ìåä. æóðí. – 2010. – Ò. 331, ¹ 6. – Ñ. 17–20. 8. Îäèíàê Ì.Ì., Ãàéêîâà Î.Í., Ëèòâèíöåâ Á.Ñ., Îíèùåíêî Ë.Ñ. Ìîðôîëîãè÷åñêèå èçìåíåíèÿ ãî-ëîâíîãî ìîçãà ïðè ÂÈ×-èíôåêöèè íà ôîíå íàð-êîìàíèè // ÂÈ×-èíôåêöèÿ è èììóíîñóïðåññèè. – 2013. – Ò. 5, ¹ 1. – Ñ. 65–75. 9. Ïëåøàêîâ À.À., ×åðêóäèíîâ Ä.À. Î íåêî-òîðûõ àñïåêòàõ ðàñïðîñòðàíåíèÿ íàðêîìàíèè è íàðêîïðåñòóïíîñòè ñðåäè âîåííîñëóæàùèõ, ïðîõîäÿùèõ âîåííóþ ñëóæáó ïî êîíòðàêòó // Àëüìàíàõ ñîâðåìåííîé íàóêè è îáðàçîâàíèÿ. – Òàìáîâ: Ãðàìîòà, 2010. – ¹ 11 (42): â 2 ÷., ÷. I. – Ñ. 108–109. 10. Ðîõëèíà Ì.Ë. Íàðêîìàíèè. Òîêñèêîìàíèè: ïñèõè÷åñêèå ðàññòðîéñòâà è ðàññòðîéñòâà ïîâå-äåíèÿ, ñâÿçàííûå ñ óïîòðåáëåíèåì ïñèõîàêòèâ-íûõ âåùåñòâ. – Ì.: Ëèòòåððà. – 2010. – 256 ñ. 11. Òðîôèìîâà Ò.Í., Ñàôðîíîâ Ã.À., Áåëÿ-êîâ Í.À., Ìåäâåäåâ Ñ.Â. Ëó÷åâàÿ äèàãíîñòèêà òîêñè÷åñêèõ ïîðàæåíèé ãîëîâíîãî ìîçãà // Ëó÷åâàÿ äèàãíîñòèêà è òåðàïèÿ. – 2011. – ¹ 1 (2). – Ñ. 37–46. 12. Óëàíîâà Â.È. Èíôåêöèîííûé ýíäîêàð-äèò ó ëèö ñ íàðêîòè÷åñêîé çàâèñèìîñòüþ: Àâ-òîðåô. äèñ. ... ä-ðà ìåä. íàóê. – ÑÏá, 2011. – 39 ñ. 13. Ôåäîðîâà Í.Â., Èñìàèëîâà Ò.Ô., Àìîñî-âà Í.À. è äð. Òîêñè÷åñêàÿ ýíöåôàëîïàòèÿ, âûç-âàííàÿ óïîòðåáëåíèåì ñóððîãàòíûõ íàðêîòè-êîâ, ñîäåðæàùèõ ìàðãàíåö: îñîáåííîñòè êëè-íè÷åñêîé êàðòèíû è äèàãíîñòèêà // Íåâðîë. æóðí. – 2005. – Ò. 10, ¹ 3. – Ñ. 17–22.14. Guyer S. et al. Pattern of regional cerebral blood-flow changes induced by acute heroin administration – a perfusion MRI study // J. of neurorad. – 2007. – Vol. 34 (5). – P. 9–332.
15. Smoski M.J. et al. Functional imaging of emotion reactivity in opiate-dependent borderline personality disorder // Pers. Dis. – 2011. – Vol. 2 (3). – P. 41–230. © ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2014 ÓÄÊ 616.233/24-06:[616.98:578.828.6]
Îñîáåííîñòè áðîíõîëåãî÷íîé ïàòîëîãèè
ó ÂÈ×-èíôèöèðîâàííûõ ïàöèåíòîâ
ÃÐÈØÀÅ Ñ.Ë., äîöåíò, äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû (grishaev_med@mail.ru) ØÀÐÎÂÀ Í.Â., êàíäèäàò ìåäèöèíñêèõ íàóê ÌÎÈÑÅÅ Ý.Â. ÁÓËÀÍÜÊΠÞ.È., äîöåíò, äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå (dr.bulankov@mail.ru) ÎÐËÎÂÀ Å.Ñ., êàíäèäàò ìåäèöèíñêèõ íàóê (oes17@yandex.ru) Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã Ïðîâåäåí àíàëèç ïðè÷èí ãîñïèòàëèçàöèè ÂÈ×-èíôèöèðîâàííûõ ïàöèåíòîâ ïðè îêàçàíèè ìåäè-öèíñêîé ïîìîùè â ìíîãîïðîôèëüíîì ëå÷åáíîì ó÷ðåæäåíèè (Âîåííî-ìåäèìåäè-öèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà). Ãëàâíûìè ïðè÷èíàìè ñìåðòè ÂÈ×-èíôèöèðîâàííûõ ëèö â óñëîâèÿõ ìíîãîïðîôèëüíî-ãî ëå÷åáíîìíîãîïðîôèëüíî-ãî ó÷ðåæäåíèÿ íà ñåìíîãîïðîôèëüíî-ãîäíÿøíèé äåíü ÿâëÿþòñÿ çàáîëåâàíèÿ, íå ñâÿçàííûå ñ ÂÈ×-èíôåê-öèåé: îæîãè, êîìáèíèðîâàííûå òðàâìû, îòðàâëåíèÿ òîêñè÷åñêèìè âåùåñòâàìè. Óñòàíîâëåíî, ÷òî ÂÈ×-èíôåêöèÿ óõóäøàåò ïðîãíîç áîëüíûõ, ãîñïèòàëèçèðîâàííûõ c çàáîëåâàíèÿìè îðãàíîâ äûõàíèÿ, ñïîñîáñòâóÿ áîëåå ðàííåìó ðàçâèòèþ ãîñïèòàëüíûõ èíôåêöèé, îáîñòðåíèþ áðîíõîëåãî÷íûõ çàáîëå-âàíèé è êðàòêîñðî÷íîé ëåòàëüíîñòè. Ê ë þ ÷ å â û å ñ ë î â à: ÂÈ×-èíôåêöèÿ, áðîíõîëåãî÷íàÿ ïàòîëîãèÿ, ãîñïèòàëüíàÿ ïíåâìîíèÿ.«Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014
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ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ ÂÎÏÐÎÑÛ
Grishaev S.L., Sharova N.V., Moiseev E.V., Bulankov Yu.I., Orlova E.S. – Peculiarities of bronchopulmonary pathology in HIV-patients. The causes of hospitalization of HIV-infected patients during of medical treatment in a multidisci plinary health care setting (Military Medical Academy) are analyzed. Leading causes of death in medical institutions among patients with HIV are diseases, which are not associated with HIV infection: burns, combined injuries, toxic substances poisoning. It was found that HIV infection worsens prognosis for patients hospitalized with respiratory diseases and leads to earlier development of nosocomial infections, exacerbation of bronchopulmonary diseases and short-term mortality.
K e y w o r d s: HIV, bronchopulmonary pathology, nosocomial pneumonia.
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÷èñëî 10 òåððèòîðèé Ðîññèéñêîé Ôåäåðàöèè ñ íàèáîëüøåé ðàñïðî-ñòðàíåííîñòüþ ÂÈ×-èíôåêöèè âõîäèò Ñàíêò-Ïåòåðáóðã. Ïîêàçàòåëü ïîðàæåííî-ñòè íàñåëåíèÿ ýòîé èíôåêöèåé çäåñü ñî-ñòàâëÿåò 0,78%, ïî÷òè â äâà ðàçà ïðåâû-øàÿ ñîîòâåòñòâóþùèé ïîêàçàòåëü ïî ñòðàíå (0,4%). Ïîðàæåííîñòü âçðîñëîãî íàñåëåíèÿ ãîðîäà â âîçðàñòå 15–49 ëåò â íàñòîÿùèé ìîìåíò ñîñòàâëÿåò 1,4%, ÷òî ìîæåò ñâèäåòåëüñòâîâàòü î ïîñòåïåííîì âûõîäå ýïèäåìèè ÂÈ× çà ðàìêè êîíöåí-òðèðîâàííîé. Çà âåñü ïåðèîä ýïèäåìèè ÂÈ×-èí-ôåêöèè, íà÷èíàÿ ñ 1987 ã., â ãîðîäå áûëî âûÿâëåíî áîëåå 42 000 èíôèöèðîâàííûõ æèòåëåé ãîðîäà, óìåðëî 6165 ÷åëîâåê [5]. Îäíà èç îñíîâíûõ ïðè÷èí ãîñïèòàëèçà-öèè òàêèõ áîëüíûõ – ïîðàæåíèå îðãà-íîâ äûõàíèÿ. Òÿæåëàÿ ëåãî÷íàÿ ïàòîëî-ãèÿ ó ýòîé êàòåãîðèè ïàöèåíòîâ ïðåèìó-ùåñòâåííî îáóñëîâëåíà òóáåðêóëåçîì, à òàêæå áàêòåðèàëüíûìè, ãðèáêîâûìè è âèðóñíûìè ïíåâìîíèÿìè [5, 8–10]. Íà àìáóëàòîðíîì ïðèåìå è â ñòàöèîíàðàõ âðà÷è ðàçëè÷íûõ ñïåöèàëüíîñòåé, ïðåæ-äå âñåãî òåðàïåâòû, âñòðå÷àþòñÿ ñ ðàçíî-îáðàçíîé ëåãî÷íîé ïàòîëîãèåé ó ïàöè-åíòîâ ñ åùå íåâûÿâëåííîé ÂÈ×-èíôåê-öèåé. Àêòóàëüíûì ïðåäñòàâëÿåòñÿ çíàíèå õàðàêòåðà ïîðàæåíèÿ íèæíèõ äûõàòåëü-íûõ ïóòåé, ýòèîëîãè÷åñêîãî ñïåêòðà ïðè âîçìîæíîé ÂÈ×-èíôåêöèè â çàâèñèìî-ñòè îò ãëóáèíû èììóíîñóïðåññèè. Åæåãîäíî óâåëè÷èâàåòñÿ ïîòîê ÂÈ×-èíôèöèðîâàííûõ ïàöèåíòîâ, ãîñïèòàëè-çèðóåìûõ â ðàçëè÷íûå ëå÷åáíî-ïðîôè-ëàêòè÷åñêèå ó÷ðåæäåíèÿ ïî ïðè÷èíå èíòåðêóððåíòíîé ïàòîëîãèè [5]. Ðàñøè-ðÿåòñÿ êðóã ñïåöèàëèñòîâ, ïðèíèìàþùèõ ó÷àñòèå â îêàçàíèè êîìïëåêñíîé ìåäè-öèíñêîé ïîìîùè äàííîé êàòåãîðèè áîëü-íûõ, ÷òî òðåáóåò îò íèõ ïîñòîÿííîãî ïî-âûøåíèÿ óðîâíÿ çíàíèé ïî âîïðîñàì êëèíèêè, äèàãíîñòèêè è ïðîôèëàêòèêè ÂÈ×-èíôåêöèè [3, 7]. Çíà÷èòåëüíî óâå-ëè÷èâàåòñÿ ïðîäîëæèòåëüíîñòü æèçíè ëèö íà âûñîêîàêòèâíîé àíòèðåòðîâèðóñ-íîé òåðàïèè, ÷òî ñïîñîáñòâóåò óâåëè÷å-íèþ ðåçåðâóàðà èíôåêöèè. Äîëÿ óìåðøèõ ÂÈ×-èíôèöèðîâàííûõ áîëüíûõ îò çàáî-ëåâàíèé, íå îáóñëîâëåííûõ äàííîé èí-ôåêöèåé, âîçðîñëà ñ 13,1% â ýðó äî íà-çíà÷åíèÿ àíòèðåòðîâèðóñíîé òåðàïèè (äî 1996 ã.), äî 45,2% ïðè åå àêòèâíîì èñïîëüçîâàíèè [10]. Öåëü èññëåäîâàíèÿ Íà îñíîâàíèè êëèíè÷åñêèõ è ëàáî-ðàòîðíî-èíñòðóìåíòàëüíûõ äàííûõ, ìà-òåðèàëîâ ñóäåáíî-ìåäèöèíñêèõ âñêðûòèé ïðîâåñòè àíàëèç ïðè÷èí ãîñïèòàëèçàöèè ÂÈ×-èíôèöèðîâàííûõ ïàöèåíòîâ, ïîñòó-ïèâøèõ â êëèíèêè Âîåííî-ìåäèöèíñêîé àêàäåìèÿ èì. Ñ.Ì.Êèðîâà. Ìàòåðèàë è ìåòîäû Ïðîâåäåí ðåòðîñïåêòèâíûé îïèñà-òåëüíûé àíàëèç 1665 èñòîðèé áîëåçíè ÂÈ×-èíôèöèðîâàííûõ ïàöèåíòîâ, ïîñòó-ïèâøèõ íà ëå÷åíèå â êëèíèêè ÂÌåäÀ èì. Ñ.Ì.Êèðîâà, è ïðîòîêîëîâ ñóäåáíî-ìåäèöèíñêèõ âñêðûòèé 20 óìåðøèõ èç äàííîé êàòåãîðèè áîëüíûõ. Êëèíè÷åñêèé äèàãíîç îñíîâíîé è ñîïóòñòâóþùåé ïà-òîëîãèè óñòàíàâëèâàëñÿ ïî ðåçóëüòàòàì ñòàíäàðòíûõ àíàìíåñòè÷åñêèõ, êëèíèêî-ëàáîðàòîðíûõ è èíñòðóìåíòàëüíûõ îá-ñëåäîâàíèé. Ïðè÷èíû ñìåðòè îïðåäåëÿ-ëèñü ïî ïîñìåðòíûì êëèíè÷åñêèì è ïà-òîìîðôîëîãè÷åñêèì ýïèêðèçàì è ñîîò-âåòñòâîâàëè êîäàì ÌÊÁ-10. ÂÈ×-èíôåê-öèÿ ïðèæèçíåííî äîêóìåíòèðîâàëàñü ïî ðåçóëüòàòàì âûÿâëåíèÿ ñïåöèôè÷åñêèõ àíòèòåë ê ÂÈ×-1/2 ìåòîäîì èììóíîôåð-ìåíòíîãî àíàëèçà. Èñïîëüçîâàëèñü òåñò-ñèñòåìû: Êîìáè-òåñò-àíòè ÂÈ×-1/2 (ÇÀÎ «Âåêòîð-Áåñò», Íîâîñèáèðñê), Determine HIV-1/2 (Alere Medical, ßïî-íèÿ), Genscreen ULTRO – HIV Ag-Ab (Bio-Rad, Ôðàíöèÿ), Vironostica HIV MIXT (Organon Texnika, Ôðàíöèÿ). Ýêñïåðòíàÿ«Âîåííî-ìåäèöèíñêèé æóðíàë», 8’2014
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ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ ÂÎÏÐÎÑÛ Ïðèíèìàÿ âî âíèìàíèå ìàëûå ñðî-êè ïðåáûâàíèÿ ÂÈ×-èíôèöèðîâàííûõ áîëüíûõ â ñòàöèîíàðå â ñâÿçè ñ êðàòêî-ñðî÷íîé ëåòàëüíîñòüþ, ðàííåå ðàçâèòèå ãîñïèòàëüíûõ ïíåâìîíèé è ñåïòè÷åñêèõ îñëîæíåíèé, à òàêæå îòÿãîùåíèå èìåâ-øèõñÿ ó íèõ áðîíõîëåãî÷íûõ çàáîëåâà-íèé, ìîæíî óòâåðæäàòü, ÷òî ÂÈ×-èíôåê-öèÿ îêàçûâàåò äîïîëíèòåëüíîå îòðèöà-òåëüíîå âëèÿíèå íà ïðîãíîç òå÷åíèÿ è èñõîäîâ îñíîâíîé ïàòîëîãèè, ÿâèâøåéñÿ ïðè÷èíîé ãîñïèòàëèçàöèè. Â Û Â Î Ä Û 1. Ó 15% óìåðøèõ ÂÈ×-èíôèöèðî-âàííûõ áîëüíûõ çàáîëåâàíèÿ áðîíõîëå-ãî÷íîé ñèñòåìû ïðåäøåñòâîâàëè ìîìåí-òó ïîñìîìåí-òóïëåíèÿ â ñòàöèîíàð. Áðîíõîëå-ãî÷íàÿ ïàòîëîãèÿ íà ãîñïèòàëüíîì ýòà-ïå ïðèæèçíåííî áûëà äèàãíîñòèðîâàíà ó 60% áîëüíûõ, íà ñåêöèè – ó 75% óìåð-øèõ.  ñïåêòðå áðîíõîëåãî÷íûõ çàáîëå-âàíèé ïðåîáëàäàëè ïíåâìîíèè (80%). 2. Íàèáîëåå ÷àñòîé íåïîñðåäñòâåí-íîé ïðè÷èíåïîñðåäñòâåí-íîé ñìåðòè äàííåïîñðåäñòâåí-íîé êàòåãîðèè áîëüíûõ (â 50% ñëó÷àåâ) ÿâèëàñü ëåãî÷-íî-ñåðäå÷íàÿ íåäîñòàòî÷íîñòü, ðàçâèâ-øàÿñÿ íà ôîíå ðàííåé ãîñïèòàëüíîé ïíåâìîíèè, îòëè÷àþùåéñÿ äâóñòîðîí-íîñòüþ âîñïàëèòåëüíîãî ïðîöåññà, åãî ãíîéíî-äåñòðóêòèâíûì õàðàêòåðîì, ÷à-ñòûì è ðàííèì ðàçâèòèåì ñåïñèñà, ïî-ÿâëåíèåì âíåëåãî÷íûõ î÷àãîâ èíôåêöèè, íàëè÷èåì êîìàòîçíîãî ñîñòîÿíèÿ, íå-îáõîäèìîñòüþ ïðîâåäåíèÿ èñêóññòâåí-íîé âåíòèëÿöèè ëåãêèõ, êðàòêîñðî÷èñêóññòâåí-íîé ëåòàëüíîñòüþ. 3. ÂÈ×-èíôåêöèÿ óõóäøàåò ïðîãíîç ó áîëüíûõ, ñïîñîáñòâóÿ áîëåå ðàííåìó ðàçâèòèþ ãîñïèòàëüíûõ èíôåêöèé è îáî-ñòðåíèþ áðîíõîëåãî÷íûõ çàáîëåâàíèé. 4. Äëÿ ñîâåðøåíñòâîâàíèÿ ìåòîäîâ ëå÷åíèÿ ÂÈ×-èíôèöèðîâàííûõ áîëüíûõ òðåáóåòñÿ ïðîäîëæåíèå ñðàâíèòåëüíûõ èññëåäîâàíèé õàðàêòåðà òå÷åíèÿ îñíîâ-íîãî çàáîëåâàíèÿ íà ôîíå ÂÈ×-èíôåê-öèè è áåç íåå.Ëèòåðàòóðà
1. Àçîâöåâà Î.Â., Àðõèïîâ Ã.Ñ., Àðõèïîâà Å.È. è äð. Îñîáåííîñòè ïîðàæåíèÿ îðãàíîâ äûõà-íèÿ ó ÂÈ×/ÑÏÈÄ áîëüíûõ íà ðàçíûõ ñòàäè-ÿõ èììóíîñóïðåññèè // ÂÈ×-èíôåêöèÿ è èì-ìóíîñóïðåññèè. – 2011. – Ò. 3, ¹ 4. – Ñ. 62–67. 2. Áàãíåíêî Ñ.Ô., Äóáèêàéòèñ Ï.À., Ìèíàå-âà Í.Â. è äð. Ñòðóêòóðà îáðàùåíèé ÂÈ×-èí-ôèöèðîâàííûõ áîëüíûõ â ñòàöèîíàð ñêîðîé ïîìîùè // ÂÈ×-èíôåêöèÿ è èììóíîñóïðåñ-ñèè. – 2011. – Ò. 3, ¹ 3.– Ñ. 81–87. 3. Áóëàíüêîâ Þ.È., Âàñèëüåâ Â.Â., Îðëîâà Å.Ñ. Ïîâûøåíèå óðîâíÿ çíàíèé ìåäèöèíñ-êèõ ðàáîòíèêîâ – àêòóàëüíîå íàïðàâëåíèå ïðîòèâîäåéñòâèÿ ÂÈ×-èíôåêöèè // Ñèáèðñê. ìåä. æóðí. – 2008. – Ò. 82, ¹ 7. – Ñ. 140–142. 4. Âàñèëüåâà Ò.Å., Ëèòâèíîâà Í.Ã., Øàõãèëü-äÿí Â.È. è äð. Ëåãî÷íàÿ ïàòîëîãèÿ ó áîëüíûõ ÂÈ×-èíôåêöèåé // Òåðàïåâòè÷. àðõèâ. – 2007. – ¹ 3. – Ñ. 33–35. 5. ÂÈ×-èíôåêöèÿ â Ñàíêò-Ïåòåðáóðãå / Ïîä ðåä. Í.À.Áåëÿêîâà, Â.Â.Ðàññîõèíà. – ÂÈ×/ ÑÏÈÄ-èíôîðìàöèîííî-àíàëèòè÷åñêèé áþë-ëåòåíü. – ÑÏá. – 2012. – ¹ 1. – 80 ñ. 6. Âîéíî-ßñåíåöêèé Ì.Â. Áèîëîãèÿ è ïàòî-ìîðôîëîãèÿ èíôåêöèîííîãî ïðîöåññà. – Ë.: Ìåäèöèíà. – 1981. – 207 ñ. 7. Âîëæàíèí Â.Ì., Áóëàíüêîâ Þ.È., Áîëå-õàí Â.Í. è äð. Ñîñòîÿíèå äèàãíîñòèêè è ïðî-ôèëàêòèêè ÂÈ×-èíôåêöèè â âîåííûõ ëå÷åá-íî-ïðîôèëàêòè÷åñêèõ ó÷ðåæäåíèÿõ è çàäà÷è ïîäãîòîâêè ìåäèöèíñêîãî ïåðñîíàëà ïî ýòîé ïðîáëåìå // Âîåí.-ìåä. æóðí. – 2009. – Ò. 330, ¹ 6. – Ñ. 13–18. 8. Åâñòèãíååâ È.Å., Ìàõîâà È.Á., Âàñèëåí-êî Ï.È. è äð. Ëåãî÷íàÿ ïàòîëîãèÿ ó ÂÈ×-èí-ôèöèðîâàííûõ â ïðàêòèêå òåðàïåâòà // Óêðà-èí. òåðàï. æóðí. – 2011. – ¹ 1. – Ñ. 70–75. 9. Æîëîáîâ Â.Å., Áåëÿêîâ Í.À., Ñòåïàíîâà Å.Â. è äð. Ðàçâèòèå ýïèäåìèè ÂÈ×-èíôåêöèè â Ñàíêò-Ïåòåðáóðãå // ÂÈ×-èíôåêöèÿ è èì-ìóíîñóïðåññèè. – 2009. – Ò. 1, ¹ 1.– Ñ. 68–77. 10. Çàãäàí Ç.Ì., Êîâåëåíîâ À.Þ., Õàéìåð Ð. Ñîïóòñòâóþùèå çàáîëåâàíèÿ è ïðè÷èíû ñìåð-òè ñðåäè áîëüíûõ ÂÈ×-èíôåêöèåé â Ñàíêò-Ïåòåðáóðãå è Ëåíèíãðàäñêîé îáëàñòè // Æóðí. èíôåêòîëîãèè. – 2011. – Ò. 3, ¹ 1. – Ñ. 39–44. 11. Êîðîëåâà È.Ì. Ïíåâìîíèè ó ëèö ñ èì-ìóíîäåôèöèòîì (âðîæäåííûì è ïðèîáðåòåí-íûì) // Ñonsilium medicum. Áîëåçíè îðãàíîâ äûõàíèÿ. – 2010. – ¹ 1. – Ñ. 16–17. 12. Ëîáçèí Þ.Â., Áóëàíüêîâ Þ.È., Áîëåõàí Â.Í. è äð. ÂÈ×-èíôåêöèÿ â ìíîãîïðîôèëüíîì ñòà-öèîíàðå // Ýïèäåìèîë. è èíôåêö. áîëåçíè. – 2010. – ¹ 5. – Ñ. 32–34. 13. Îíèùåíêî Ã.Ã. ÂÈ×-èíôåêöèÿ – ïðî-áëåìà ÷åëîâå÷åñòâà // ÂÈ×-èíôåêöèÿ è èì-ìóíîñóïðåññèÿ. – 2009. – Ò. 1, ¹ 1. – Ñ. 5–9. 14. Ïíåâìîöèñòîç: Ó÷åáíîå ïîñîáèå. – ÑÏá: Èçä. ÑÇÃÌÓ, 2012. – 24 ñ. 15. Ïîêðîâñêèé Â.Â. ÂÈ×/ÑÏÈÄ â Ðîññèè: ñèòóàöèÿ è ïðîãíîç // Ýïèäåìèîë. è èíôåêö. áîëåçíè. – 2008. – ¹ 6. – Ñ. 44–48.45
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ðåãèñòðà èíôåêöèîííîé ïàòîëîãèè
è ÂÈ×-èíôèöèðîâàííûõ âîåííîñëóæàùèõ
ÁÎËÅÕÀÍ Â.Í., äîêòîð ìåäèöèíñêèõ íàóê, äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû (v.bolekhan1962@yandex.ru)1 ÇÀÃÎÐÎÄÍÈÊΠÃ.Ã., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû (gen73zag@mail.ru )1 ÃÎÐÈ×ÍÛÉ Â.À., êàïèòàí ìåäèöèíñêîé ñëóæáû (garik1501@mail.ru)1 ÎÐËÎÂÀ Å.Ñ., êàíäèäàò ìåäèöèíñêèõ íàóê (oes17@yandex.ru)1 ÍÈÊÎËÀÅ Ï.Ã., êàïèòàí ìåäèöèíñêîé ñëóæáû (npetro80@mail.ru)2 1Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã; 2736-é Ãëàâíûé öåíòð ãîñóäàðñòâåííîãî ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî íàäçîðà ÌÎ ÐÔ, Ìîñêâà Ïðîâåäåí àíàëèç äåéñòâóþùèõ íîðìàòèâíûõ äîêóìåíòîâ Ìèíèñòåðñòâà çäðàâîîõðàíåíèÿ Ðîññèéñêîé Ôåäåðàöèè è Ìèíèñòåðñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè ïî ïðîôèëàêòèêå ÂÈ×-èíôåêöèè. Äàíà îöåíêà ñóùåñòâóþùåé ñèñòåìû âûÿâëåíèÿ è ó÷åòà ÂÈ×-èíôèöèðîâàííûõ ãðàæäàíñêèõ ëèö è âîåííîñëóæàùèõ. Îáñóæäåíû ïðîáëåìû è ïåðñïåêòèâû ðàáîòû íàó÷íî-èññëåäîâàòåëüñêîé ëàáîðàòîðèè (ðåãèñòð èíôåêöèîííîé ïàòîëîãèè è ÂÈ×-èíôèöèðîâàííûõ âîåííî-ñëóæàùèõ) íàó÷íî-èññëåäîâàòåëüñêîãî öåíòðà Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà. Îñíîâíûì íàïðàâëåíèåì åå äåÿòåëüíîñòè ñòàíåò âîññòàíîâëåíèå îïåðàòèâíîãî ó÷åòà ÂÈ×-èí-ôèöèðîâàííûõ âîåííîñëóæàùèõ, à òàêæå îáåñïå÷åíèå ñîîòâåòñòâóþùèõ ìåäèöèíñêèõ ñïåöèàëèñ-òîâ Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ ÌÎ ÐÔ è 736-ãî Ãëàâíîãî öåíòðà ãîññàíýïèäíàäçîðà ÌÎ ÐÔ èíôîðìàöèåé, íåîáõîäèìîé äëÿ îñóùåñòâëåíèÿ ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî íàäçîðà è ïðèíÿòèÿ öåëåíàïðàâëåííûõ è ýêîíîìè÷åñêè îáîñíîâàííûõ ðåøåíèé ïî ïðîôèëàêòèêå èíôåêöèîí-íûõ çàáîëåâàíèé ó âîåííîñëóæàùèõ. Ê ë þ ÷ å â û å ñ ë î â à: ÂÈ×-èíôåêöèÿ, ðåãèñòð, âîåííîñëóæàùèå, îïåðàòèâíûé ó÷åò, îáìåí èíôîðìàöèåé.Bolekhan V.N., Zagorodnikov G.G., Gorichny V.A., Orlova E.S., Nikolaev P.G. – Problems and prospects of infectious diseases and HIV-infected military personnel register organization. An analysis of regulatory documents of the Ministry of Healthcare and the Ministry of Defence of the Russian Federation related to HIV/AIDS prevention was carried out. The current system of HIV/AIDS detection and registration among military and civil personnel was assessed. Problems and prospects of scientific-and-research laboratory (the register of infectious disease pathology and HIV-infected military personnel) of Scientific-and-research centre at the Kirov Military medical academy were discussed. It is proposed that the main direction of the laboratory activity will be the restoration of up-to-date records of military personnel with HIV/AIDS. This activity will provide the necessary information to responsible specialists of the Main state sanitary and epidemiological surveillance centre and the Main military medical department of the Ministry of Defence of the Russian Federation for the sanitary and epidemiological surveillance for purposeful and economically feasible management decisions in the field of military personnel infection diseases prevention.
K e w w o r d s: HIV-infection, information exchange, military personnel, operative registration, registry, sanitary and epidemiological surveillance.
