2015
¹ 9
Â
îåííî-ìåäèöèíñêèé
СЕНТЯБРЬ
2015
1-é Âîåííî-ìîðñêîé êëèíè÷åñêèé ãîñïèòàëü: 1715–2015 ãã.Àäðåñà ðåäàêöèè: 119160, Ìîñêâà, óë. Çíàìåíêà, 19, ðåäàêöèÿ «Âîåííî-ìåäèöèíñêîãî æóðíàëà» Òåë./ôàêñ (495) 656-33-41 194044, Ñàíêò-Ïåòåðáóðã, óë. Àêàäåìèêà Ëåáåäåâà, ä. 6 Òåë. (812) 292-33-46 ÒÅÎÐÅÒÈ×ÅÑÊÈÉ È ÍÀÓ×ÍÎ-ÏÐÀÊÒÈ×ÅÑÊÈÉ ÆÓÐÍÀË ÌÈÍÈÑÒÅÐÑÒÂÀ ÎÁÎÐÎÍÛ ÐÎÑÑÈÉÑÊÎÉ ÔÅÄÅÐÀÖÈÈ Ôóíêöèÿ ó÷ðåäèòåëÿ – Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëå-íèå ÌÎ ÐÔ ÐÅÄÀÊÖÈÎÍÍÀß ÊÎËËÅÃÈß: Ì.Â.Ïîääóáíûé (ãëàâíûé ðåäàêòîð) È.È.Àçàðîâ À.Í.Áåëüñêèõ À.Þ.Âëàñîâ Ë.Ë.Ãàëèí (çàìåñòèòåëü ãëàâíîãî ðåäàêòîðà) 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 À.Ã.Ñòàâèëà Ä.Â.Òðèøêèí À.ß.Ôèñóí Â.Í.Öûãàí Â.Ê.Øàìðåé À.Ì.Øåëåïîâ ÐÅÄÀÊÖÈÎÍÍÛÉ ÑÎÂÅÒ:
Èçäàåòñÿ ñ 1823 ãîäà
2015 * ÑÅÍÒßÁÐÜ
Ò. 336 * ¹ 9
ÌÎÑÊÂÀ ÀÎ «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) Ï.Å.Êðàéíþêîâ (Ìîñêâà) 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)Îêàçàíèå ìåäèöèíñêîé ïîìîùè ãðàæäàíàì,
ïîëüçóþùèìñÿ ïðàâîì íà åå ïîëó÷åíèå
â âîåííî-ìåäèöèíñêèõ îðãàíèçàöèÿõ
Ìèíîáîðîíû
Íàïðàâëåíèÿ äåÿòåëüíîñòè ñïåöèàëèñòîâ
ìåäèêî-ïðîôèëàêòè÷åñêîãî ïðîôèëÿ
â âîåííûõ ãîñïèòàëÿõ
Ñîâðåìåííûå àñïåêòû îðãàíèçàöèè
ìåäèöèíñêîãî ñíàáæåíèÿ
Âîîðóæåííûõ Ñèë
Ïðîáëåìíûå âîïðîñû
ìåäèêî-ïñèõîëîãè÷åñêîé ðåàáèëèòàöèè ýêèïàæåé
êîðàáëåé â ïîñëåïîõîäîâûé ïåðèîä
Êëåòî÷íûå òåõíîëîãèè â íåôðîëîãèè –
ïåðñïåêòèâû äëÿ âîåííîé ìåäèöèíû
Îñîáåííîñòè
ñàíèòàðíî-ïðîòèâîýïèäåìè÷åñêèõ (ïðîôèëàêòè÷åñêèõ)
ìåðîïðèÿòèé ïî ïðåäóïðåæäåíèþ
âîçíèêíîâåíèÿ è ðàñïðîñòðàíåíèÿ áîëåçíè,
âûçâàííîé âèðóñîì Ýáîëà
4
13 Îðãàíèçàöèÿ ìåäèöèíñêîãî
îáåñïå÷åíèÿ Âîîðóæåííûõ Ñèë
Organization of medical support of the Armed Forces
Ëå÷åáíî-ïðîôèëàêòè÷åñêèå
âîïðîñû Prophylaxis and treatment
Àâèàöèîííàÿ
è âîåííî-ìîðñêàÿ ìåäèöèíà Air and navy medicine 40
Ýïèäåìèîëîãèÿ
è èíôåêöèîííûå áîëåçíè
Epidemiology
and infectious diseases 33 24 45 Ôèñóí À.ß., Êóâøèíîâ Ê.Ý., Ïàñòóõîâ À.Ã., Çåìëÿêîâ Ñ.Â. – Îðãàíèçàöèÿ îêàçàíèÿ ìåäèöèíñêîé ïîìîùè ãðàæäàíàì, ïîëüçóþùèìñÿ ïðàâîì íà åå ïîëó÷åíèå â âîåííî-ìåäèöèíñêèõ îðãàíèçàöèÿõ Ìèíîáîðîíû Ðîññèè Àêèìêèí Â.Ã., Àçàðîâ È.È., Âîëûíêîâ È.Î., Áîáûëåâ Â.À. – Îñíîâíûå íàïðàâëåíèÿ äåÿòåëüíîñòè ñïåöèàëèñòîâ ìåäèêî-ïðîôèëàêòè÷åñêîãî ïðîôèëÿ â âîåííûõ ãîñïèòàëÿõ Ñîëîâü¸â È.À., Âàñèëü÷åíêî Ì.Â., Ëû÷åâ À.Á., Àìáàðöóìÿí Ñ.Â., Àëåêñååâ Â.Â. – Ñîâðå-ìåííûå àñïåêòû õèðóðãè÷åñêîãî ëå÷åíèÿ ìåñòíî ðàñïðîñòðàíåííîãî ðàêà îðãàíîâ ìàëîãî òàçà Îãàðêîâ Ï.È., Âàëåâñêèé Â.Â., Ñìèðíîâ À.Â., Êîòîâ Ñ.Ñ., Ãîëóáêîâ À.Â., Ñâèñòóíîâ Ñ.À., Êîëåñíèêîâ Â.Â. – Îñîáåííîñòè ñàíèòàð-íî-ïðîòèâîýïèäåìè÷åñêèõ (ïðîôèëàêòè-÷åñêèõ) ìåðîïðèÿòèé ïî ïðåäóïðåæäåíèþ âîçíèêíîâåíèÿ è ðàñïðîñòðàíåíèÿ áî-ëåçíè, âûçâàííîé âèðóñîì Ýáîëà Ëèñååíêî À.Í., Àðò¸ìåíêî Å.Ñ., Äåìå-åâ ß.À., Ùóð Ì.Ñ. – Ïðîáëåìíûå âî-ïðîñû ìåäèêî-ïñèõîëîãè÷åñêîé ðåàáè-ëèòàöèè ýêèïàæåé êîðàáëåé â ïîñëå-ïîõîäîâûé ïåðèîä 17
Fisun A.Ya., Kuvshinov K.Å., Pastukhov A.G., Zemlyakov S.V. – Organisation of medi-cal care delivery to citizens, enjoying the right to get medical care at military-me-dical organisations of the Ministry of de-fence of the Russian Federation
Akimkin V.G., Azarov I.I., Volynkov I.O., Bobylev V.A. – Main types of activity of specialists of medical and preventive pro-file in military hospitals
Solovyov I.A., Vasilchenko M.V., Lychev A.B., Ambartsumyan S.V., Alekseev V.V. – Modern aspects of surgical treatment of locally advanced pelvic cancer
Simonenko V.B., Hubulava G.G., Chaplyuk A.L., Steklov V.I., Morozov D.A., Emelyanenko M.V. – A new light on professional fitness ex-pertise of patients with highly curable arrhythmia after hi-tech methods of treatment
Andriyanov A.I., Kirichenko N.N., Yaremko V.I., Nikitin E.A., Ermakov R.A. – The use of a «buffet» style meals in the system of health-resort treatment Ñèìîíåíêî Â.Á., Õóáóëàâà Ã.Ã., ×àïëþê À.Ë., Ñòåêëîâ Â.È., Ìîðîçîâ Ä.À., Åìåëüÿíåíêî Ì.Â. – Íîâûé âçãëÿä íà ýêñïåðòèçó ïðî-ôåññèîíàëüíîé ïðèãîäíîñòè áîëüíûõ ñ âûñîêîêóðàáåëüíûìè àðèòìèÿìè ïîñëå âûñîêîòåõíîëîãè÷íûõ ìåòîäîâ ëå÷åíèÿ Àíäðèÿíîâ À.È., Êèðè÷åíêî Í.Í., ßðåìêî Â.È., Íèêèòèí Å.À., Åðìàêîâ Ð.À. – Ïåðñïåê-òèâû ïðèìåíåíèÿ «øâåäñêîãî ñòîëà» â ñàíàòîðíî-êóðîðòíîì ëå÷åíèè
Ogarkov P.I., Valevskii V.V., Smirnov A.V., Kotov S.S., Golubkov A.V., Svistunov S.A., Kolesnikov V.V. – Peculiarities of sa-nitary and epidemiological (preventive) measures aimed at contraction and spread control of Ebola virus disease
Liseenko A.N., Artemenko E.S., Demeev Ya.A., Shchur M.S. – Problematic medical and psychological issues concerning rehabili-tation of crews during the after-sea-duty-men period
3
«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2015 Êðàòêèå ñîîáùåíèÿ 61 Brief reports Ëåíòà íîâîñòåé 16, 69, News feed 81, 83, 84 Îôèöèàëüíûé îòäåë 82 Official communications Õðîíèêà Chronicle 89 74 70è ìåäèöèíñêàÿ òåõíèêà and medical technique
49 55 Ñòàâèëà À.Ã., Êðàñàâèí Ê.Ä., Ëåâ÷åíêî Â.Í., Ëåìåøêî À.Ë., Ðîåíêî À.Ñ. – Ñîâðåìåí-íûå àñïåêòû îðãàíèçàöèè ìåäèöèíñêîãî ñíàáæåíèÿ Âîîðóæåííûõ Ñèë Ïî ñòðàíèöàì çàðóáåæíîé ìåäèöèíñêîé ïå÷àòè
From the foreign medical publications Áåëüñêèõ À.Í., Ãîëîòà À.Ñ., Êðàññèé À.Á., Íàãèáîâè÷ Î.À. – Êëåòî÷íûå òåõíîëîãèè â íåôðîëîãèè: ñîâðåìåííîå ñîñòîÿíèå è ïåðñïåêòèâû äëÿ âîåííîé ìåäèöèíû Èç èñòîðèè âîåííîé ìåäèöèíû
From the history of military medicine Áóçîâ Å.ß., Êàñàòêèí Â.È., Ìàêàðåí-êî Á.Ã., Øèëîâ Ñ.À. – Òðè âåêà ñ ôëî-òîì (Ê 300-ëåòèþ Ñàíêò-Ïåòåðáóðã-ñêîãî âîåííî-ìîðÑàíêò-Ïåòåðáóðã-ñêîãî ãîñïèòàëÿ) Êîñòþê À.Â. – Ñàíèòàðíîå ñîñòîÿíèå êîðàáëåé Áàëòèéñêîãî ôëîòà è ðàçâè-òèå âîåííî-ìîðñêîé ãèãèåíû â XVIII âåêå Îâ÷èííèêîâ Þ.Â., Òûðåíêî Â.Â. – Íàó÷-íî-ïðàêòè÷åñêàÿ êîíôåðåíöèÿ «Îðãàíè-çàöèÿ ñèñòåìû ïðîôèëàêòèêè è ðåàáè-ëèòàöèè áîëüíûõ ñåðäå÷íî-ñîñóäèñòûìè çàáîëåâàíèÿìè ñðåäè âîåííîñëóæàùèõ Âîîðóæåííûõ Ñèë ÐÔ è ÷ëåíîâ èõ ñåìåé» Ñòàðèêîâ Ñ.Ì., Æèãàëîâ À.À. – Ðîáîòî-òåõíè÷åñêèå òåõíîëîãèè îêàçàíèÿ ìåäè-öèíñêîé ïîìîùè ÑONTENTS
Ovchinnikov Yu.V., Tyrenko V.V. – Theo-retical and practical conference «Organi-zation of the preventive and rehabilitation system for patients with cardiovascular diseases among military servicemen of the Armed Forces of the Russian Federation and members of their families»
Starikov S.M., Zhigalov A.A. – Robot-tech-nical technologies of medical care deliv-ery
93
Buzov E.Ya., Kasatkin V.I., Makarenko B.G., Shilov S.A. – Three centuries with the Fleet (To the 300th anniversary of the
Saint-Petersburg naval hospital)
Kostyuk A.V. – Sanitary state of the ships of the Baltic fleet and development of the navy hygiene in the 18th century
Bel’skih A.N., Golota A.S., Krassii A.B., Nagi-bovich O.A. – Ñell engineering in nephro-logy: the current state and prospectives from the point of view of military medicine Stavila A.G., Krasavin K.D., Levchenko V.N., Lemeshko A.L., Roenko A.S. – Modern aspects of organization of medical sup-port for the Armed Forces
ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË
© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2015 ÓÄÊ [61:355]-082(470)Îðãàíèçàöèÿ îêàçàíèÿ ìåäèöèíñêîé ïîìîùè
ãðàæäàíàì, ïîëüçóþùèìñÿ ïðàâîì íà åå ïîëó÷åíèå
â âîåííî-ìåäèöèíñêèõ îðãàíèçàöèÿõ
Ìèíîáîðîíû Ðîññèè
ÔÈÑÓÍ À.ß., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû ÊÓÂØÈÍΠÊ.Ý., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû ÏÀÑÒÓÕΠÀ.Ã., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû ÇÅÌËßÊΠÑ.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû (medrabotaupr20152@yandex.ru) Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëåíèå ÌÎ ÐÔ, Ìîñêâà Ðåàëèçàöèÿ ïðàâ âîåííîñëóæàùèõ, ãðàæäàí, óâîëåííûõ ñ âîåííîé ñëóæáû, à òàêæå ÷ëåíîâ èõ ñåìåé íà áåñïëàòíóþ ìåäèöèíñêóþ ïîìîùü ÿâëÿåòñÿ ïðèîðèòåòíîé çàäà÷åé ìåäèöèíñêîé ñëóæáû Âîîðóæåííûõ Ñèë Ðîññèéñêîé Ôåäåðàöèè.  ýòèõ öåëÿõ ñôîðìèðîâàíà ýôôåêòèâíàÿ ñèñòåìà îðãàíèçàöèè îêàçàíèÿ ìåäèöèíñêîé ïîìîùè â âîåííî-ìåäèöèíñêèõ ïîäðàçäåëåíèÿõ, ÷àñòÿõ è îðãàíèçàöèÿõ Ìèíèñòåðñòâà îáîðîíû ÐÔ, îñíîâàííàÿ íà òåððèòîðèàëüíîì ïðèíöèïå ìåäèöèíñêîãî îáåñïå÷åíèÿ.  öåëÿõ ïîâûøåíèÿ äîñòóïíîñòè è êà÷åñòâà ìåäèöèíñêîé ïîìîùè îïðåäåëåí ïîðÿäîê áåñïëàòíîãî îêàçàíèÿ ìåäèöèíñêîé ïîìîùè âîåííîñëóæàùèì è ãðàæäàíàì, óâîëåííûì ñ âîåííîé ñëóæáû, â ìåäèöèíñêèõ îðãàíèçàöèÿõ ãîñóäàðñòâåííîé è ìóíèöèïàëüíîé ñèñòåì çäðàâîîõðàíåíèÿ. Ê ë þ ÷ å â û å ñ ë î â à: îðãàíèçàöèÿ îêàçàíèÿ ìåäèöèíñêîé ïîìîùè, âîåííî-ìåäèöèíñêèå îðãàíèçàöèè, èçãîòîâëåíèå è ðåìîíò çóáíûõ ïðîòåçîâ.Fisun A.Ya., Kuvshinov K.Ye., Pastukhov A.G., Zemlyakov S.V. – Organisation of medical care delivery to citizens, enjoying a right to get medical care at military-medical organisations of the Ministry of Defence of the Russian Federation. One of the main priorities of the medical service of the armed forces of the Russian federation is a realization of rights for military retirees and members of their families to free medical care. For this purpose was founded a system of organization of medical care delivery at military-medical subdivisions, units and organizations of the ministry of defence of the Russian federation, based on territorial princi ple of medical support. In order to improve availability and quality of medical care was determined the order of free medical care delivery to military servicemen and military retirees in medical organizations of state and munici pal systems of the health care.
K e y w o r d s: organization of medical care delivery, military-medical organizations, bridgework.
Ñ
îöèàëüíàÿ çàùèòà âîåííîñëóæàùèõ, ãðàæäàí, óâîëåííûõ ñ âîåííîé ñëóæ-áû, è ÷ëåíîâ èõ ñåìåé ÿâëÿåòñÿ ôóíêöè-åé ãîñóäàðñòâà è ïðåäóñìàòðèâàåò ðåàëè-çàöèþ â îòíîøåíèè óêàçàííûõ ëèö êîì-ïëåêñà ìåðîïðèÿòèé ñîöèàëüíîé íàïðàâ-ëåííîñòè, â ò. ÷. ïî îõðàíå èõ æèçíè è çäîðîâüÿ [2]. Ïðè ýòîì îêàçàíèå ìåäè-öèíñêîé ïîìîùè íàäëåæàùåãî êà÷åñòâà ÿâëÿåòñÿ îäíîé èç îñíîâíûõ öåëåé ìåð ïî îõðàíå çäîðîâüÿ óêàçàííûõ ãðàæäàí. Ìåäèöèíñêàÿ ïîìîùü ïðåäñòàâëÿåò ñîáîé êîìïëåêñ ìåðîïðèÿòèé, íàïðàâëåí-íûõ íà ïîääåðæàíèå è (èëè) âîññòàíîâ-ëåíèå çäîðîâüÿ è âêëþ÷àþùèõ â ñåáÿ ïðåäîñòàâëåíèå ìåäèöèíñêèõ óñëóã. Ïîä ìåäèöèíñêîé óñëóãîé ïîíèìàåòñÿ ìåäè-öèíñêîå âìåøàòåëüñòâî èëè êîìïëåêñ ìåäèöèíñêèõ âìåøàòåëüñòâ, íàïðàâëåí-íûõ íà ïðîôèëàêòèêó, äèàãíîñòèêó è ëå-÷åíèå çàáîëåâàíèé, ìåäèöèíñêóþ ðåàáè-ëèòàöèþ è èìåþùèõ ñàìîñòîÿòåëüíîå çàêîí÷åííîå çíà÷åíèå [5]. Ñòàòüåé 16 Ôåäåðàëüíîãî çàêîíà îò 27.05.1998 ã. ¹ 76-ÔÇ «Î ñòàòóñå âî-åííîñëóæàùèõ» (äàëåå – Ôåäåðàëüíûé çàêîí) óñòàíîâëåíû ïðàâà âîåííîñëó-æàùèõ, ãðàæäàí, óâîëåííûõ ñ âîåííîéÐèñ. 2. Êîëè÷åñòâî è ñòðóêòóðà ïàöèåíòîâ, ïîëó÷èâøèõ ìåäèöèíñêóþ ïîìîùü â ñòàöèîíàðíûõ óñëîâèÿõ â âîåííûõ ãîñïèòàëÿõ (ïî ãîäàì, òûñÿ÷ ÷åëîâåê)
Ê ñòàòüå: Ôèñóí À.ß., Êóâøèíîâ Ê.Ý., Ïàñòóõîâ À.Ã., Çåìëÿêîâ Ñ.Â.– Îðãàíèçàöèÿ îêàçàíèÿ ìåäèöèíñêîé ïîìîùè ãðàæäàíàì, ïîëüçóþùèìñÿ ïðàâîì íà åå ïîëó÷åíèå â âîåííî-ìåäèöèíñêèõ îðãàíèçàöèÿõ Ìèíîáîðîíû Ðîññèè
ñòâåííîñòè, ïðè ñîñòîÿíèÿõ, òðåáóþùèõ ñðî÷íîãî ìåäèöèíñêîãî âìåøàòåëüñòâà (íåñ÷àñòíûå ñëó÷àè, òðàâìû, îòðàâëåíèÿ, äðóãèå ñîñòîÿíèÿ è çàáîëåâàíèÿ). Ïðî-âåäåíèå âçàèìîðàñ÷åòîâ îñóùåñòâëÿåòñÿ ñ ìîìåíòà, êîãäà óñòðàíåíà íåïîñðåä-ñòâåííàÿ óãðîçà æèçíè áîëüíîãî, çäîðî-âüþ îêðóæàþùèõ è âîçìîæíà åãî òðàíñ-ïîðòèðîâêà. Âçàèìîðàñ÷åòû çà ìåäèöèíñêóþ ïî-ìîùü, îêàçàííóþ îôèöåðàì (ïðàïîðùè-êàì), óâîëåííûì ñ âîåííîé ñëóæáû, â ðàìêàõ òåððèòîðèàëüíîé ïðîãðàììû îáÿ-çàòåëüíîãî ìåäèöèíñêîãî ñòðàõîâàíèÿ, íå ïðîèçâîäÿòñÿ.  öåëÿõ ïîâûøåíèÿ ñîöèàëüíîé çà-ùèùåííîñòè âîåííîñëóæàùèõ è ãðàæ-äàí, ïðèçâàííûõ íà âîåííûå ñáîðû, 27.03.2015 ã. Ïðàâèòåëüñòâîì ÐÔ èçäàíî ïîñòàíîâëåíèå ¹ 282, óñòàíàâëèâàþùåå ïîðÿäîê áåñïëàòíîãî îáåñïå÷åíèÿ âîåí-íîñëóæàùèõ è ãðàæäàí, ïðèçâàííûõ íà âîåííûå ñáîðû, ëåêàðñòâåííûìè ïðåïà-ðàòàìè è ìåäèöèíñêèìè èçäåëèÿìè â ôàðìàöåâòè÷åñêèõ îðãàíèçàöèÿõ ïðè îò-ñóòñòâèè ïî ìåñòó âîåííîé ñëóæáû èëè ìåñòó æèòåëüñòâà âîåííîñëóæàùèõ ëèáî ïî ìåñòó ïðîõîæäåíèÿ âîåííûõ ñáîðîâ ãðàæäàíàìè, ïðèçâàííûìè íà âîåííûå ñáîðû, âîåííî-ìåäèöèíñêèõ îðãàíèçàöèé. Áåñïëàòíûé îòïóñê ëåêàðñòâåííûõ ïðåïàðàòîâ è ìåäèöèíñêèõ èçäåëèé âî-åííîñëóæàùèì è ãðàæäàíàì, ïðèçâàí-íûì íà âîåííûå ñáîðû, ïðè àìáóëàòîð-íîì ëå÷åíèè îñóùåñòâëÿåòñÿ ôàðìàöåâ-òè÷åñêèìè îðãàíèçàöèÿìè ïî ðåöåïòàì, âûäàííûì âðà÷àìè ìåäèöèíñêèõ îðãà-íèçàöèé, îêàçûâàþùèõ ìåäèöèíñêóþ ïîìîùü óêàçàííûì âîåííîñëóæàùèì è ãðàæäàíàì â ñîîòâåòñòâèè ñ äîãîâîðàìè îá îêàçàíèè ìåäèöèíñêîé ïîìîùè, çàê-ëþ÷åííûìè ìåæäó ýòèìè ìåäèöèíñêè-ìè îðãàíèçàöèÿìåäèöèíñêè-ìè è âîåííûìåäèöèíñêè-ìè îêðóãà-ìè. Ïðè ýòîì ðàñõîäû ôàðìàöåâòè÷åñ-êèõ îðãàíèçàöèé íà îáåñïå÷åíèå ëåêàð-ñòâåííûìè ïðåïàðàòàìè âîåííîñëóæà-ùèõ è ãðàæäàí, ïðèçâàííûõ íà âîåííûå ñáîðû, âîçìåùàþòñÿ Ìèíîáîðîíû Ðîñ-ñèè (åãî óïîëíîìî÷åííûìè îðãàíàìè) â ñîîòâåòñòâèè ñ äîãîâîðàìè ìåæäó ôàð-ìàöåâòè÷åñêèìè îðãàíèçàöèÿìè è Ìèí-îáîðîíû Ðîññèè (åãî óïîëíîìî÷åííû-ìè îðãàíàóïîëíîìî÷åííû-ìè) îá îáåñïå÷åíèè ëåêàð-ñòâåííûìè ïðåïàðàòàìè óêàçàííûõ âî-åííîñëóæàùèõ è ãðàæäàí. Ïðè ïîëó÷åíèè ëåêàðñòâåííûõ ïðå-ïàðàòîâ è ìåäèöèíñêèõ èçäåëèé âîåííî-ñëóæàùèé èëè ãðàæäàíèí, ïðèçâàííûé íà âîåííûå ñáîðû, ïðåäñòàâëÿåò â ôàðìàöåâ-òè÷åñêóþ îðãàíèçàöèþ ðåöåïò (ðåöåïòû) è ïðåäúÿâëÿåò ïàñïîðò èëè äîêóìåíò, ïîäòâåðæäàþùèé åãî ñòàòóñ. Òàêèì îáðàçîì, â íàñòîÿùåå âðåìÿ â Âîîðóæåííûõ Ñèëàõ ñôîðìèðîâàíà ýôôåêòèâíàÿ ñèñòåìà îêàçàíèÿ ìåäè-öèíñêîé ïîìîùè âîåííîñëóæàùèì, ãðà-æäàíàì, óâîëåííûì ñ âîåííîé ñëóæáû, ÷ëåíàì èõ ñåìåé è ëèöàì ãðàæäàíñêîãî ïåðñîíàëà.  öåëÿõ ïîâûøåíèÿ äîñòóïíîñòè è êà÷åñòâà ìåäèöèíñêîé ïîìîùè âîåííî-ñëóæàùèì, ãðàæäàíàì, óâîëåííûì ñ âî-åííîé ñëóæáû, è ÷ëåíàì èõ ñåìåé ñëåäó-åò îñîáîå âíèìàíèå óäåëèòü âçàèìîäåé-ñòâèþ íà÷àëüíèêîâ ìåäèöèíñêîé ñëóæ-áû âîåííûõ îêðóãîâ, ôëîòîâ è âîåííî-ìåäèöèíñêèõ îðãàíèçàöèé Ìèíîáîðîíû Ðîññèè ñ èñïîëíèòåëüíûìè îðãàíàìè ãîñóäàðñòâåííîé âëàñòè ñóáúåêòîâ Ðîñ-ñèéñêîé Ôåäåðàöèè.
Ëèòåðàòóðà
1. Î ïîðÿäêå îêàçàíèÿ ìåäèöèíñêîé ïî-ìîùè, ñàíàòîðíî-êóðîðòíîãî îáåñïå÷åíèÿ è îñóùåñòâëåíèÿ îòäåëüíûõ âûïëàò íåêîòîðûì êàòåãîðèÿì âîåííîñëóæàùèõ, ñîòðóäíèêîâ ïðàâîîõðàíèòåëüíûõ îðãàíîâ è ÷ëåíàì èõ ñå-ìåé, à òàêæå îòäåëüíûì êàòåãîðèÿì ãðàæäàí, óâîëåííûõ ñ âîåííîé ñëóæáû. Ïîñòàíîâëåíèå Ïðàâèòåëüñòâà Ðîññèéñêîé Ôåäåðàöèè îò 31.12.2004 ã. ¹ 911. 2. Î ñòàòóñå âîåííîñëóæàùèõ. Ôåäåðàëü-íûé çàêîí îò 27.05.1998 ã. ¹ 76-ÔÇ. 3. Îá îáÿçàòåëüíîì ìåäèöèíñêîì ñòðàõî-âàíèè â Ðîññèéñêîé Ôåäåðàöèè. Ôåäåðàëüíûé çàêîí îò 29.11.2010 ã. ¹ 326-ÔÇ. 4. Îá îïëàòå ìåäèöèíñêîé ïîìîùè, îêà-çàííîé âîåííîñëóæàùèì, ñîòðóäíèêàì ìèëèöèè, îðãàíîâ íàëîãîâîé ïîëèöèè è óãîëîâíî-èñïîëíèòåëüíîé ñèñòåìû. Ïèñüìî Ôåäåðàëüíîãî ôîíäà îáÿçàòåëüíîãî ìå-äèöèíñêîãî ñòðàõîâàíèÿ îò 03.03.2000 ã. ¹ 1089/30-3è. 5. Îá îñíîâàõ îõðàíû çäîðîâüÿ ãðàæäàí â Ðîññèéñêîé Ôåäåðàöèè. Ôåäåðàëüíûé çàêîí îò 21.11.2011 ã. ¹ 323-ÔÇ.13
«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2015 © ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2015 ÓÄÊ 614.25:355Îñíîâíûå íàïðàâëåíèÿ äåÿòåëüíîñòè ñïåöèàëèñòîâ
ìåäèêî-ïðîôèëàêòè÷åñêîãî ïðîôèëÿ
â âîåííûõ ãîñïèòàëÿõ
ÀÊÈÌÊÈÍ Â.Ã., ÷ëåí-êîððåñïîíäåíò ÐÀÍ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà1 ÀÇÀÐΠÈ.È., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû2 ÂÎËÛÍÊΠÈ.Î., ìàéîð ìåäèöèíñêîé ñëóæáû (gvkgsed@rambler.ru)3 ÁÎÁÛËÅ Â.À., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà3 1Íàó÷íî-èññëåäîâàòåëüñêèé èíñòèòóò äåçèíôåêòîëîãèè Ðîñïîòðåáíàäçîðà, Ìîñêâà; 2Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëåíèå ÌÎ ÐÔ, Ìîñêâà; 3Ãëàâíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. Í.Í.Áóðäåíêî, Ìîñêâà Ïðîáëåìà ïåðåäà÷è áîëåçíè îò îäíîãî áîëüíîãî ê äðóãîìó âîçíèêëà ñ ïîÿâëåíèåì ïåðâûõ ìåäèöèíñêèõ ñòàöèîíàðîâ. Ïðîôèëàêòèêà èíôåêöèé, ñâÿçàííûõ ñ îêàçàíèåì ìåäèöèíñêîé ïîìîùè, ÿâëÿåòñÿ âàæíåéøåé ñîñòàâëÿþùåé îáåñïå÷åíèÿ êà÷åñòâà ëå÷åíèÿ è ñîçäàíèÿ áåçîïàñíîé ñðåäû ïðåáûâàíèÿ ïàöèåíòîâ è ðàáîòû ïåðñîíàëà â îðãàíèçàöèÿõ, îñóùåñòâëÿþùèõ ìåäèöèíñêóþ äåÿòåëüíîñòü. Îñíîâíàÿ äåÿòåëüíîñòü ñïåöèàëèñòà ìåäèêî-ïðîôèëàêòè÷åñêîãî ïðîôèëÿ â ãîñïèòàëå íàïðàâëåíà íà ïîääåðæàíèå ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî áëàãîïîëó÷èÿ è îñóùåñòâëåíèå êîíòðîëÿ çà âûïîëíåíèåì êîìïëåêñà ïðåäóïðåäèòåëüíûõ ìåðîïðèÿòèé. Äëÿ äîñòèæåíèÿ ýòèõ öåëåé îñóùåñòâëÿåòñÿ ýïèäåìèîëîãè÷åñêèé è ìèêðîáèîëîãè÷åñêèé ìîíèòîðèíã ðåàëèçàöèè è ýôôåêòèâíîñòè ìåð ïðåäóïðåæäåíèÿ çàíîñà â ãîñïèòàëü è âûíîñà çà åãî ïðåäåëû âîçáóäèòåëåé èíôåêöèîííûõ çàáîëåâàíèé, âîçíèêíîâåíèÿ è ðàñïðîñòðàíåíèÿ î÷àãîâ èíôåêöèè. Âàæíûì íàïðàâëåíèåì äåÿòåëüíîñòè ñïåöèàëèñòà ìåäèêî-ïðîôèëàêòè÷åñêîãî äåëà ÿâëÿåòñÿ íàó÷íî-ìåòîäè÷åñêàÿ ðàáîòà. Ê ë þ ÷ å â û å ñ ë î â à: âíóòðèáîëüíè÷íûå èíôåêöèè, ìèêðîáèîëîãè÷åñêèé ìîíèòîðèíã, ýïèäåìèî-ëîãè÷åñêèé êîíòðîëü, ñàíèòàðíî-ïðîòèâîýïèäåìè÷åñêèå (ïðîôèëàêòè÷åñêèå) ìåðîïðèÿòèÿ, äåçèíôèöèðóþùèå ñðåäñòâà.Akimkin V.G., Azarov I.I., Volynkov I.O., Bobylev V.A. – Main types of activity of specialists of medical and preventive profile in military hospitals. Infection prevention in medical organizations is an essential task to ensure quality of medical care and create a safe environment for patients and medical staff. The main task of a specialist of medical and preventive profile in the hospital is to maintain sanitary and epidemiological safety and control fulfillment of a complex of preventive measures. To achieve these goals specialists monitor epidemiological and microbiological fulfilment of the implementation and effectiveness of preventive measures, which allow to except infection entry to the hospital and possible carrying out beyond the hospital, occurrence and spread of disease. An obligatory activity of the specialist of medical and preventive profile in the hospital is a scientific and methodical work. The authors propose adoption of preventive structural subdivisions to the state largest diversified military hospitals.
K e y w o r d s: nosocomial infections, microbiological monitoring, epidemiological surveillance, sanitary-epidemiological (preventive) measures, disinfectants.
Ï
ðîôèëàêòèêà èíôåêöèé, ñâÿçàííûõ ñ îêàçàíèåì ìåäèöèíñêîé ïîìîùè (ÈÑÌÏ), ÿâëÿåòñÿ âàæíåéøåé ñîñòàâëÿ-þùåé îáåñïå÷åíèÿ êà÷åñòâà ëå÷åíèÿ è ñîçäàíèÿ áåçîïàñíîé ñðåäû ïðåáûâàíèÿ ïàöèåíòîâ è ðàáîòû ïåðñîíàëà â îðãà-íèçàöèÿõ, îñóùåñòâëÿþùèõ ìåäèöèíñêóþ äåÿòåëüíîñòü [4].  ÷èñëî ÈÑÌÏ âõîäÿò âíóòðèáîëüíè÷íûå (ãîñïèòàëüíûå, íîçîêî-ìèàëüíûå) èíôåêöèè (ÂÁÈ) – ëþáûå êëèíè÷åñêè âûðàæåííûå çàáîëåâàíèÿ ìèêðîáíîãî ïðîèñõîæäåíèÿ, âîçíèêàþ-ùèå ó áîëüíîãî â ðåçóëüòàòå åãî ãîñïè-òàëèçàöèè èëè ïîñåùåíèÿ ëå÷åáíîãî ó÷-ðåæäåíèÿ, à òàêæå ó áîëüíè÷íîãî ïåðñî-íàëà íåçàâèñèìî îò òîãî, ïðîÿâëÿþòñÿ ëè ñèìïòîìû ýòîãî çàáîëåâàíèÿ âî âðåìÿ íàõîæäåíèÿ äàííûõ ëèö â ñòàöèîíàðå èëè ïîçæå. Ïî äàííûì îôèöèàëüíîé ñòàòèñòè-êè, ñðåäè ïàöèåíòîâ ëå÷åáíî-ïðîôèëàêòè-÷åñêèõ îðãàíèçàöèé (ËÏÎ) â Ðîññèéñêîé Ôåäåðàöèè åæåãîäíî ðåãèñòðèðóåòñÿ îêîëî 25–30 òûñ. çàáîëåâàíèé ÈÑÌÏ, îä-íàêî ðåàëüíîå èõ êîëè÷åñòâî ìîæåò ñî-ñòàâëÿòü äî 2–2,5 ìëí ñëó÷àåâ. Ñëåäóåò ó÷åñòü, ÷òî ìåäèöèíñêàÿ ñòàòèñòèêà â Ðîññèè ðåãèñòðèðóåò ëèøü 97 íîçîôîðìïîä÷èíèòü ëàáîðàòîðèè áàêòåðèîëîãè-÷åñêîé è èíôåêöèîííîé èììóíîëîãèè òàêæå ýïèäåìèîëîãó ãîñïèòàëÿ. Ðåàëèçàöèÿ ïðåäëàãàåìûõ èçìåíåíèé â ñòðóêòóðå ìåäèêî-ïðîôèëàêòè÷åñêèõ ïîäðàçäåëåíèé è âûïîëíÿåìûõ èìè çà-äà÷ ïîçâîëèò îáåñïå÷èòü äàëüíåéøåå ñîâåðøåíñòâîâàíèå ïðîôèëàêòèêè ÈÑÌÏ â êðóïíûõ ìíîãîïðîôèëüíûõ âîåííûõ ãîñïèòàëÿõ.
Ëèòåðàòóðà
1. Àêèìêèí Â.Ã. Îðãàíèçàöèîííûå îñíîâû è ôóíêöèîíàëüíûå íàïðàâëåíèÿ äåÿòåëüíîñ-òè ãîñïèòàëüíîãî ýïèäåìèîëîãà // Âîåí.-ìåä. æóðí. – 1997. – Ò. 318, ¹ 7. – Ñ. 45–50. 2. Àêèìêèí Â.Ã. Ñòðóêòóðà âíóòðèáîëüíè÷-íûõ èíôåêöèé â êðóïâíóòðèáîëüíè÷-íûõ ãîñïèòàëÿõ // Âîåí.-ìåä. æóðí. – 1997. – Ò. 318, ¹ 2. – Ñ. 42–46. 3. Ìåòîäè÷åñêèå ðåêîìåíäàöèè «Ìåòîäû îöåíêè ÷óâñòâèòåëüíîñòè ìèêðîîðãàíèçìîâ, öèðêóëèðóþùèõ â ëå÷åáíî-ïðîôèëàêòè÷åñêèõ îðãàíèçàöèÿõ, ê äåçèíôèöèðóþùèì ñðåä-ñòâàì». URL: http://www.niid.ru/s/210/files/ documents/niid/69403_485.doc (äàòà îáðàùå-íèÿ: 30.07.2015). 4. Ïîêðîâñêèé Â.È., Àêèìêèí Â.Ã., Áðèêî Í.È. Íàöèîíàëüíàÿ êîíöåïöèÿ ïðîôèëàêòèêè èí-ôåêöèé, ñâÿçàííûõ ñ îêàçàíèåì ìåäèöèíñêîé ïîìîùè (óòâ. Ãëàâíûì ãîñóäàðñòâåííûì ñà-íèòàðíûì âðà÷îì ÐÔ 6 íîÿáðÿ 2011 ã.). URL: www. garant.ru (äàòà îáðàùåíèÿ: 30.07.2015). 5. Ïîêðîâñêèé Â.È., Ïàê Ñ.Ã., Áðèêî Í.È. Èíôåêöèîííûå áîëåçíè è ýïèäåìèîëîãèÿ. – Ì.: ÃÝÎÒÀÐ-Ìåäèà, 2007. – Ñ. 63–67. 6. Ñàâåëüåâ Â.Ñ., Ãåëüôàíä Á.Ð., ßêîâëåâ Ñ.Â. è äð. Ñòðàòåãèÿ è òàêòèêà ïðèìåíåíèÿ àíòè-ìèêðîáíûõ ñðåäñòâ â ëå÷åáíûõ ó÷ðåæäåíèÿõ Ðîññèè. – Ì.: Ðîññèéñêèå íàöèîíàëüíûå ðå-êîìåíäàöèè, 2012. – 96 ñ. 7. Òèìîôååâà Ò.Â., Àêàøêèíà Ë.Â., Èãîíèíà Å.Ï. è äð. Ïðàêòè÷åñêîå ðóêîâîäñòâî ïî îðãàíèçà-öèè ó÷àñòêà îáåççàðàæèâàíèÿ ìåäèöèíñêèõ îòõîäîâ êëàññîâ Á è  â ìåäèöèíñêèõ îðãà-íèçàöèÿõ ãîñóäàðñòâåííîé ñèñòåìû çäðàâîîõ-ðàíåíèÿ Äåïàðòàìåíòà çäðàâîîõçäðàâîîõ-ðàíåíèÿ ãî-ðîäà Ìîñêâû / Ïîä ðåä. Â.Ã.Àêèìêèíà. – Ì.: Èçä. öåíòð «Ìîñêâîâåäåíèå», 2014. – 48 ñ. 8. ßêîâëåâ Ñ.Â. Èññëåäîâàíèå ÝÐÃÈÍÈ: ãëàâíûå ðåçóëüòàòû. 2014. URL: http:// w w w . n i i d . r u / s / 2 1 0 / f i l e s / p r e s s / r e l e a s e / 125429_480.pdf (äàòà îáðàùåíèÿ: 30.07.2015). Íàêàíóíå ïðàçäíîâàíèÿ 85-é ãîäîâùèíû ñî äíÿ îáðàçîâàíèÿ Âîçäóøíî-äåñàíò-íûõ âîéñê êîìàíäóþùèé ÂÄ ãåíåðàë-ïîëêîâíèê Âëàäèìèð Øàìàíîâ ïîñåòèë 3-é Öåíòðàëüíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. À.À.Âèøíåâñêîãî Ìèíèñòåðñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè.  õîäå âèçèòà êîìàíäóþùèé ëè÷íî ïîçäðàâèë äåñàíòíèêîâ, íàõîäÿùèõñÿ íà ëå÷åíèè è íå èìåþùèõ âîçìîæíîñòè ïîñåòèòü ïðàçäíè÷íûå ìåðîïðèÿòèÿ, ïîñâÿ-ùåííûå Äíþ ÂÄÂ. Íà÷àëüíèê ãîñïèòàëÿ ïîëêîâíèê ìåäèöèíñêîé ñëóæáû Àëåêñàíäð Åñèïîâ ïðè âñòðå÷å ñ êîìàíäóþùèì ÂÄ äîëîæèë, ÷òî áîëåå ïîëîâèíû äåñàíòíèêîâ óæå îò-ïðàâëåíû äëÿ ïðîõîæäåíèÿ êóðñà ìåäèöèíñêîé ðåàáèëèòàöèè, îñòàëüíûå ïîëó÷àþò ëå÷åíèå ïî íàçíà÷åíèÿì âðà÷åé è äîñòîéíûé ìåäèöèíñêèé óõîä. Ïî ñëîâàì ëå÷àùèõ âðà÷åé, ãîñïèòàëèçèðîâàííûå äåñàíòíèêè èäóò íà ïîïðàâêó, áîëüøàÿ ÷àñòü óæå ïåðåâåäåíà â Ñîëíå÷íîãîðñê äëÿ ïðîâåäåíèÿ ðåàáèëèòàöèîííûõ ìåðîïðèÿòèé, à ñ îñòàëüíûìè ïðîâîäÿòñÿ íåîáõîäèìûå ëå÷åáíûå ïðîöåäóðû. Ñîñòîÿíèå çäîðîâüÿ ãîñïèòàëèçèðîâàííûõ âîåííîñëóæàùèõ èìååò ïîëîæèòåëüíóþ äèíàìèêó. Îäíîâðåìåííî äðóãàÿ äåëåãàöèÿ ïðåäñòàâèòåëåé Âîçäóøíî-äåñàíòíûõ âîéñê ïîä ðóêîâîäñòâîì íà÷àëüíèêà øòàáà ÂÄ ãåíåðàë-ëåéòåíàíòà Íèêîëàÿ Èãíàòîâà ïîñåòèëà Ãëàâíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. Í.Í.Áóðäåíêî, ãäå òàêæå ïîçäðàâèëà äåñàíòíèêîâ, íàõîäÿùèõñÿ íà èçëå÷åíèè. Óïðàâëåíèå ïðåññ-ñëóæáû è èíôîðìàöèè Ìèíèñòåðñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè, 1 àâãóñòà 2015 ã. http://function.mil.ru/news_page/country/more.htm?id=12047088@egNewsË Å Í Ò À Í Î Â Î Ñ Ò Å É
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«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2015ÂÎÏÐÎÑÛ
© ÊÎËËÅÊÒÈ ÀÂÒÎÐÎÂ, 2015 ÓÄÊ [616-006.6:617.559]-089Ñîâðåìåííûå àñïåêòû õèðóðãè÷åñêîãî ëå÷åíèÿ
ìåñòíî ðàñïðîñòðàíåííîãî ðàêà îðãàíîâ
ìàëîãî òàçà
ÑÎËÎÂܨ È.À., äîêòîð ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû ÂÀÑÈËÜ×ÅÍÊÎ Ì.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû (maxvasilchenko@inbox.ru) ËÛ×Å À.Á., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû ÀÌÁÀÐÖÓÌßÍ Ñ.Â., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû ÀËÅÊÑÅÅ Â.Â., ñòàðøèé ëåéòåíàíò ìåäèöèíñêîé ñëóæáû Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã Îáúåêòîì èññëåäîâàíèÿ áûëè 186 áîëüíûõ ìåñòíî ðàñïðîñòðàíåííûì ðàêîì îðãàíîâ ìàëîãî òàçà. Ñðåäíèé âîçðàñò ïàöèåíòîâ ñîñòàâèë 65,2±5,2 ãîäà (îò 43,7 äî 88,4 ãîäà). Âñåì áîëüíûì ñ 2010 ïî 2015 ã. â êëèíèêå âîåííî-ìîðñêîé õèðóðãèè Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà âûïîëíåíû ðàçëè÷íûå ïî îáúåìó êîìáèíèðîâàííûå (101 áîëüíîé) è ðàñøèðåííûå (85 áîëüíûõ) îïåðàòèâíûå âìåøàòåëüñòâà, ïðè ýòîì ýâèñöåðàöèè îðãàíîâ ìàëîãî òàçà âûïîëíåíû â 63 ñëó÷àÿõ. 54 áîëüíûì âûïîëíåíà ïëàñòèêà òàçîâîé áðþøèíû. Ïîêàçàíèÿìè ê ïëàñòèêå òàçîâîé áðþøèíû áûëè òîòàëüíàÿ èíôðàëåâàòîðíàÿ ýâèñöåðàöèÿ îðãàíîâ ìàëîãî òàçà (9 áîëüíûõ), çàäíÿÿ èíôðàëåâàòîðíàÿ ýâèñöåðàöèÿ îðãàíîâ ìàëîãî òàçà (11 áîëüíûõ) è ðàñøèðåííàÿ áðþøíî-ïðîìåæíîñòíàÿ ýêñòèðïàöèÿ ïðÿìîé êèøêè (34 áîëüíûõ). Ïëàñòèêà àóòîòêàíÿìè âûïîëíåíà 43 áîëüíûì, ñåò÷àòûìè ýêñïëàíòàòàìè – 11 áîëüíûì. Ñ öåëüþ ïðîôèëàêòèêè ìåñòíîãî ðåöèäèâà 2 ïàöèåíòàì âûïîëíåíà èçîëèðîâàííàÿ ñîñóäèñòàÿ ãèïåðòåðìè÷åñêàÿ õèìèîïåðôóçèÿ ìàëîãî òàçà. Ïîñëåîïåðàöèîííûå îñëîæíåíèÿ âûÿâëåíû â 40,2% ñëó÷àåâ. Ïîñëåîïåðàöèîííàÿ ëåòàëüíîñòü – 8%. Íà îñíîâàíèè ðåçóëüòàòîâ èññëåäîâàíèÿ ñäåëàíû âûâîäû, ÷òî ðàñøèðåííûå è êîìáèíèðîâàííûå îïåðàöèè íà îðãàíàõ ìàëîãî òàçà ó áîëüíûõ, ñòðàäàþùèõ ìåñòíî ðàñïðîñòðàíåííûì ðàêîì, ïðè îòñóòñòâèè àáñîëþòíûõ ïðîòèâîïîêàçàíèé ìîãóò áûòü âûïîëíåíû íåçàâèñèìî îò âîçðàñòà. Ïëàñòèêà òàçîâîé áðþøèíû ïîñëå èíôðàëåâàòîðíûõ ýâèñöåðàöèé îðãàíîâ ìàëîãî òàçà è ðàñøèðåííûõ áðþøíî-ïðîìåæíîñòíûõ ýêñòèðïàöèé ïðÿìîé êèøêè ïîêàçàíà âî âñåõ ñëó÷àÿõ. Íàèáîëåå ïðîñòûìè ìåòîäàìè ÿâëÿþòñÿ ïëàñòèêà áîëüøèì ñàëüíèêîì èëè ìåñòíûìè òêàíÿìè. Ïðè íåâîçìîæíîñòè àóòîïëàñòèêè ïîêàçàíà ïëàñòèêà ñåò÷àòûìè ýêñïëàíòàòàìè. Ê ë þ ÷ å â û å ñ ë î â à: îïóõîëè ìàëîãî òàçà, ìåñòíî ðàñïðîñòðàíåííûé ðàê, ýâèñöåðàöèÿ îðãàíîâ ìàëîãî òàçà.Solovyov I.A., Vasilchenko M.V., Lychev A.B., Ambartsumyan S.V., Alekseev V.V.– Modern aspects of surgical treatment of locally advanced pelvic cancer. The aim of investigation is to improve surgical treatment of patients with locally advanced pelvic cancer. The basis of investigation is 186 patients with locally advanced pelvic cancer. The average age of patients is 65,2±5,2 years (from 43,7 to 88,4 years). Among them are 112 women and 74 men. In the period from 2007 to 2015 they were carried out combined (101 patients) and expanded (85 patients) surgical intervention in the department of naval surgery of the Military medical academy after S.M.Kirov. Pelvic evisceration was performed in 63 cases. Both patients were performed isolated vascular hyperthermic chemical pelvic perfusion. Indications for plastic surgery of peritoneum pelvic were: total infralitoral pelvic evisceration (9 patients), dorsal infralitoral pelvic evisceration (11 cases) and expanded abdominoperineal rectum extirpation (34 patients). Plastic surgery with autogenouse tissues was performed to 43 patients, with reticulate explants – to 11 patients. The rate of postoperative complications was 40,2%. The rate of postoperative lethality was 8%. Expanded and combined operations of pelvic at patients with locally advanced cancer without absolute contra-indications can be performed irrespective of age. Plastic surgery of peritoneum pelvic after total and dorsal infralitoral pelvic evisceration and expanded abdominoperineal rectum extirpation indicated in all cases. The easiest method is plastic surgery with greater omentum or peritoneum pelvic. Plastic surgery with reticulate explants is performed when autoplastic is impossible.
K e y w o r d s: cancer pelvic, locally advanced cancer, pelvic evisceration. 2
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Ê ñòàòüå: Ñîëîâü¸â È.À., Âàñèëü÷åíêî Ì.Â., Ëû÷åâ À.Á., Àìáàðöóìÿí Ñ.Â., Àëåêñååâ Â.Â. – Ñîâðåìåííûå
Ðèñ. 2. Ðåêîíñòðóêöèÿ òàçîâîé áðþøèíû ïîëèòåòðàôòîðýòèëåíîâûì ýêñïëàíòàòîì ïîñëå âûïîëíåíèÿ ðàñøèðåííîé áðþøíî-ïðîìåæíîñòíîé ýêñòèðïàöèè ïðÿìîé êèøêè
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«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2015 êèøêè îïåðàöèÿ çàâåðøàåòñÿ ôîðìèðîâà-íèåì ñèãìî-ðåêòîàíàñòîìîçà è ìî÷åâîãî ðåçåðâóàðà ïî òèïó Øòóäåðà. Àëüòåðíàòèâ-íûì ñïîñîáîì îòâåäåíèÿ ìî÷è, íî ñ áîëåå íèçêèì êà÷åñòâîì æèçíè, ÿâëÿåòñÿ ñîçäà-íèå êèøå÷íûõ ìî÷åâûõ ðåçåðâóàðîâ ñ «âëàæíûìè ñòîìàìè», ïî òèïó Áðèêåðà. Íàëè÷èå îòäàëåííûõ åäèíè÷íûõ ìåòàñòà-çîâ ïðè îòñóòñòâèè êëèíè÷åñêèõ è ëàáî-ðàòîðíî-èíñòðóìåíòàëüíûõ äàííûõ î ïå-÷åíî÷íîé íåäîñòàòî÷íîñòè íå ÿâëÿåòñÿ ïðîòèâîïîêàçàíèåì äëÿ ïðîâåäåíèÿ îïå-ðàöèé ïðè ìåñòíî ðàñïðîñòðàíåííîì ðàêå îðãàíîâ ìàëîãî òàçà â ïîëíîì îáúåìå è íå óâåëè÷èâàåò êîëè÷åñòâî ïîñëåîïåðàöèîí-íûõ îñëîæíåíèé. Ïðè âûïîëíåíèè êîìáèíèðîâàííûõ è ðàñøèðåííûõ îïåðàöèé ó áîëüíûõ ÌÐÐÎÌÒ, ñîïðîâîæäàþùèõñÿ øèðîêèì èññå÷åíèåì òàçîâîé áðþøèíû è ìûøö òàçîâîãî äíà (èíôðàëåâàòîðíàÿ ýâèñöå-ðàöèÿ îðãàíîâ ìàëîãî òàçà è ðàñøèðåí-íàÿ áðþøíî-ïðîìåæíîñòðàñøèðåí-íàÿ ýêñòèðïà-öèÿ ïðÿìîé êèøêè) ñ öåëüþ ïðîôèëàê-òèêè ðàçâèòèÿ îñòðîé ñïàå÷íîé êèøå÷-íîé íåïðîõîäèìîñòè, ýâåíòðàöèè ÷åðåç ïðîìåæíîñòíóþ ðàíó è òîíêîêèøå÷íîé äèàðåè ïðè ïðîâåäåíèè àäúþâàíòíîé ëó÷åâîé òåðàïèè ïîêàçàíà ïëàñòèêà òà-çîâîé áðþøèíû âî âñåõ ñëó÷àÿõ. Íàèáî-ëåå òåõíè÷åñêè ïðîñòûìè ìåòîäàìè ðå-êîíñòðóêöèè òàçîâîé áðþøèíû ÿâëÿþò-ñÿ ïëàñòèêà ñ ïîìîùüþ àóòîòêàíåé: áîëü-øîãî ñàëüíèêà èëè òàçîâîé áðþøèíû. Ïðè íåâîçìîæíîñòè âûïîëíåíèÿ äàííûõ ìåòîäîâ ðåêîíñòðóêöèè ïëàñòèêà ðàçëè÷-íûìè íåàäãåçèâðàçëè÷-íûìè òðàíñïëàíòàòàìè ÿâëÿåòñÿ ïåðñïåêòèâíîé àëüòåðíàòèâîé çàìåùåíèÿ òàçîâîé áðþøèíû. Èçîëèðîâàííàÿ ãèïåðòåðìè÷åñêàÿ ñî-ñóäèñòàÿ ïåðôóçèÿ îðãàíîâ ìàëîãî òàçà ïîçâîëÿåò ëîêàëüíî ñîçäàòü ìàêñèìàëü-íóþ êîíöåíòðàöèþ õèìèîïðåïàðàòà â îáëàñòè îïóõîëåâîãî ïîðàæåíèÿ è èçáå-æàòü ñèñòåìíîãî âîçäåéñòâèÿ åãî íà îðãà-íèçì ó áîëüíûõ ÌÐÐÎÌÒ. Îíà ìîæåò áûòü ïðèìåíåíà êàê â ïðåäîïåðàöèîííûé ïåðèîä ïîä ðåíòãåíêîíòðîëåì ñ öåëüþ óìåíüøåíèÿ ðàçìåðîâ îïóõîëè, òàê è âî âðåìÿ îïåðàöèè äëÿ ïðîôèëàêòèêè ðàç-âèòèÿ ìåñòíîãî ðåöèäèâà. Èçîëèðîâàííàÿ ñîñóäèñòàÿ ïåðôóçèÿ îðãàíîâ ìàëîãî òàçà ïî ïðåäëîæåííîé ìåòîäèêå òåõíè÷åñêè îñóùåñòâèìà è ïðåäñòàâëÿåòñÿ äîñòóïíîé ïðè ñîîòâåòñòâóþùåì îáåñïå÷åíèè è ïîä-ãîòîâëåííîñòè îïåðàöèîííîé áðèãàäû. Ðåçóëüòàòû åå ïðèìåíåíèÿ ñâèäåòåëüñòâó-þò îá îòñóòñòâèè óâåëè÷åíèÿ ïîñëåîïå-ðàöèîííûõ îñëîæíåíèé è ïðèçíàêîâ òîê-ñè÷íîñòè, îáóñëîâëåííûõ ïðèìåíåíèåì âûñîêèõ äîç õèìèîïðåïàðàòà. Îäíàêî îò-äàëåííûå ðåçóëüòàòû ïðèìåíåíèÿ èçîëè-ðîâàííîé ãèïåðòåðìè÷åñêîé ñîñóäèñòîé ïåðôóçèè îðãàíîâ ìàëîãî òàçà êàê «çàê-ðûòûì», òàê è «îòêðûòûì» ñïîñîáîì òðå-áóþò èçó÷åíèèÿ.Ëèòåðàòóðà
1. Áîéêî Â.Â., Êðèâîðîòüêî È.Â. 10-ëåòíèé îïûò ïðèìåíåíèå êîìáèíèðîâàííûõ îïåðà-öèé ïðè ìåñòíî ðàñïðîñòðàíåííîì ðàêå ïðÿ-ìîé êèøêè // Ìåæäóíàðîäíûé ìåäèöèíñêèé æóðíàë. – 2009. – ¹ 1. – Ñ. 50–57. 2. Ãàòàóëëèí È.Ã., Àãëóëëèí È.Ð., Øàêèðîâ Ð.Ê. Ñîâðåìåííûå òåõíîëîãèè â äèàãíîñòèêå è ëå÷åíèè áîëüíûõ ðàêîì ïðÿìîé êèøêè // Ïðàêòè÷åñêàÿ ìåäèöèíà. – 2012. – ¹ 5. – Ñ. 40–43. 3. Äàâûäîâ Ì.È., Îäàðþê Ò.Ñ., Íå÷óøêèí Ì.È. è äð. Òàêòèêà îïåðàòèâíîãî ëå÷åíèÿ ïðè ìåñòíî ðàñïðîñòðàíåííûõ îïóõîëÿõ îðãàíîâ ìàëîãî òàçà ñ ïîðàæåíèåì ìî÷åâîãî ïóçûðÿ // Îíêî-óðîëîãèÿ. – 2006. – ¹ 2. – Ñ. 26–30. 4. Êàëèíèí Å.Â., Àíòèïîâà Ñ.Â., Êàëèíèí À.Å. Âîçìîæíîñòè õèðóðãè÷åñêîãî ëå÷åíèÿ áîëü-íûõ ìåñòíî ðàñïðîñòðàíåííûì ðàêîì ïðÿìîé êèøêè ñ âîâëå÷åíèåì çàäíåé ñòåíêè ìî÷åâîãî ïóçûðÿ // Îíêîëîãè÷åíñêàÿ êîëîïðîêòîëîãèÿ. – 2012. – ¹ 1. – Ñ. 18–23. 5. Ìàéñòðåíêî Í.À., Õâàòîâ À.À., Ó÷âàòêèí Ã.Â. è äð. Ýêçåíòåðàöèÿ ìàëîãî òàçà â ëå÷åíèè ìåñòíî ðàñïðîñòðàíåííûõ îïóõîëåé // Âåñòí. õèðóðãèè.– 2014. – Ò. 173, ¹ 6. – Ñ. 37–42. 6. Òèëëÿøàéõîâ Ì.Í., Þëäàøåâà Í.Ø., Àáäó-ðàõìàíîâ Ä.Ê. è äð. Ðàçëè÷íûå âàðèàíòû äå-ðèâàöèè ìî÷è ïîñëå ýâèñöåðàöèè îðãàíîâ ìàëîãî òàçà // Îíêîóðîëîãèÿ. – 2011. – ¹ 4. – Ñ. 47–49. 7. Òèìîôååâ Þ.Ì., Ìàòâååâ Â.Á., Áàðñóêîâ Þ.À. è äð. Îïûò òîòàëüíûõ ýâèñöåðàöèé ìàëîãî òàçà ïðè ðàêå ïðÿìîé êèøêè // Âåñòíèê ÐÎÍÖ èì. Í.Í.Áëîõèíà ÐÀÌÍ. – 2004. – Ò. 15, ¹ 3. – Ñ. 58–60. 8. Öàðüêîâ Ï.Â., Âîðîáüåâ Ã.È., Îäàðþê Ò.Ñ. Ìåñòî è ðîëü ðàñøèðåííîé àîðòîïîäâçäîø-íî-òàçîâîé ëèìôàäåíýêòîìèè â ëå÷åíèè ðàêà íèæíåàìïóëÿðíîãî îòäåëà ïðÿìîé êèøêè // Ïðàêòè÷. îíêîëîãèÿ. – 2002. – Ò. 3, ¹ 2. – Ñ. 82–92. 9. Øèðîêîðàä Â.È. Õèðóðãè÷åñêîå ëå÷åíèå ìåñòíî ðàñïðîñòðàíåííûõ îïóõîëåé îðãàíîâ ìàëîãî òàçà. – Ì.: Ìåäèöèíà, 2008. – 192 ñ. 10. Øèðîêîðàä Â.È., Ìèíàåâ È.È., Äåìèí Ä.È. è äð. Ìåòîä õèðóðãè÷åñêîé ðåàáèëèòàöèè áîëü-íûõ ïîñëå êîìáèíèðîâàíáîëü-íûõ îïåðàöèé íà îðãàíàõ ìàëîãî òàçà // Áþëëåòåíü ÑÎ ÐÀÌÍ. – 2003. – Ò. 110, ¹ 4. – Ñ. 82–87.11. Wanebo H. J. Isolated chemotherapeutic perfusion of the pelvis for advanced rectal cancer // Colorectal Disease. – 2003. – Vol. 5. – P. 508–514.
© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2015 ÓÄÊ 616.12-008.318-036.86
Íîâûé âçãëÿä íà ýêñïåðòèçó ïðîôåññèîíàëüíîé
ïðèãîäíîñòè áîëüíûõ ñ âûñîêîêóðàáåëüíûìè
àðèòìèÿìè ïîñëå âûñîêîòåõíîëîãè÷íûõ
ìåòîäîâ ëå÷åíèÿ
ÑÈÌÎÍÅÍÊÎ Â.Á., ÷ëåí-êîððåñïîíäåíò ÐÀÍ, çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû â îòñòàâêå1 ÕÓÁÓËÀÂÀ Ã.Ã., ÷ëåí-êîððåñïîíäåíò ÐÀÍ, çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà2 ×ÀÏËÞÊ À.Ë., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû3 ÑÒÅÊËΠÂ.È., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû (vsteklov@yandex.ru)1 ÌÎÐÎÇΠÄ.À., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà1 ÅÌÅËÜßÍÅÍÊÎ Ì.Â., êàïèòàí ìåäèöèíñêîé ñëóæáû çàïàñà1 1Ìåäèöèíñêèé ó÷åáíî-íàó÷íûé êëèíè÷åñêèé öåíòð èì. Ï.Â.Ìàíäðûêà, Ìîñêâà; 2 Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã; 3Ãëàâíûé öåíòð âîåííî-âðà÷åáíîé ýêñïåðòèçû ÌÎ ÐÔ, Ìîñêâà Ïðîàíàëèçèðîâàíû îñîáåííîñòè êëèíè÷åñêîãî òå÷åíèÿ, ðåçóëüòàòû ôàðìàêîëîãè÷åñêèõ è èíòåð-âåíöèîííûõ ìåòîäîâ ëå÷åíèÿ ó 447 áîëüíûõ ñ íåêîðîíàðîãåííûìè àðèòìèÿìè ñåðäöà. Ââåäåíî ïî-íÿòèå «âûñîêîêóðàáåëüíûå àðèòìèè ñåðäöà». Ïîêàçàíà âûñîêàÿ ýôôåêòèâíîñòü è áåçîïàñíîñòü ìåòîäà ðàäèî÷àñòîòíîé àáëÿöèè ó áîëüíûõ ñ âûñîêîêóðàáåëüíûìè àðèòìèÿìè ñåðäöà, ÷òî ïîçâî-ëÿåò îñòàâëÿòü âîåííîñëóæàùèõ íà âîåííîé ñëóæáå, à òàêæå ïîñòóïèòü íà âîåííóþ ñëóæáó ïî êîíòðàêòó. Ïðåäëîæåíî îñóùåñòâëåíèå êîíòðîëüíîãî ìåäèöèíñêîãî îáñëåäîâàíèÿ ñ ïðîâåäåíèåì ýíäîêàðäèàëüíîãî ýëåêòðîôèçèîëîãè÷åñêîãî èññëåäîâàíèÿ è ïîñëåäóþùèì ìåäèöèíñêèì îñâèäåòåëü-ñòâîâàíèåì äëÿ îïðåäåëåíèÿ êàòåãîðèè ãîäíîñòè ê âîåííîé ñëóæáå íå ðàíåå 6 ìåñ ïîñëå îïåðàöèè. Ê ë þ ÷ å â û å ñ ë î â à: âûñîêîêóðàáåëüíûå àðèòìèè ñåðäöà, ðàäèî÷àñòîòíàÿ àáëÿöèÿ, âîåííî-âðà÷åáíàÿ ýêñïåðòèçà.Simonenko V.B., Hubulava G.G., Chaplyuk A.L., Steklov V.I., Morozov D.A., Emelyanenko M.V. – A new light on professional fitness expertise of patients with highly curable arrhythmia after hi-tech methods of treatment. The peculiarities of a clinical course, results of pharmacological and interventional treatment in 447 patients with noncoronary cardiac arrhythmias were analyzed. A definition highly curable cardiac arrhythmia is introduced. The high efficiency and safety of the method of radiofrequency ablation in patients with highly curable cardiac arrhythmias that allows soldiers to leave the military service, as well as to enter military service under the contract. Proposed implementation of the control medical examination to conduct endocardial electrophysiological study and the subsequent medical examination to determine the category of fitness for military service not earlier than 6 months after surgery.
K e y w o r d s: highly curable cardiac arrhythmia, radiofrequency ablation, military medical examination.
Ê
íàèáîëåå ÷àñòî âñòðå÷àþùèìñÿ âèäàì àðèòìèè ó ëèö þíîøåñêîãî è çðåëîãî âîçðàñòà îòíîñÿòñÿ (â ïîðÿäêå óáûâàíèÿ ïî âñòðå÷àåìîñòè): ñóïðàâåíò-ðèêóëÿðíûå ðåöèïðîêíûå òàõèêàðäèè ñ ó÷àñòèåì ÀÂ-ñîåäèíåíèÿ – àòðèîâåí-òðèêóëÿðíàÿ óçëîâàÿ ðåöèïðîêíàÿ òàõè-êàðäèÿ (ÀÂÓÐÒ) è àòðèîâåíòðèêóëÿðíàÿ ðåöèïðîêíàÿ òàõèêàðäèÿ (ÀÂÐÒ) ñ ó÷àñ-òèåì äîïîëíèòåëüíîãî àòðèîâåíòðèêóëÿð-íîãî ñîåäèíåíèÿ (ÄÀÂÑ) ïðè ñèíäðîìå Âîëüôà–Ïàðêèíñîíà–Óàéòà (WPW); íåêîðîíàðîãåííûå æåëóäî÷êîâûå àðèòìèè ñåðäöà (ÍÊÆÀÑ), òèïè÷íîå èñòìóñ-çà-âèñèìîå òðåïåòàíèå ïðåäñåðäèé (ÒÏ) [1, 2, 9, 10, 12, 13, 17]. Ñëåäóåò îòìåòèòü, ÷òî ó áîëüøèíñòâà ýòèõ ïàöèåíòîâ îòñóòñòâóþò îðãàíè÷åñ-êèå çàáîëåâàíèÿ ñåðäöà. Çíàÿ îáùóþ ýïèäåìèîëîãèþ óêàçàííûõ àðèòìèé (â ñðåäíåì â ïîïóëÿöèè ëþäåé), íåòðóä-íî ðàññ÷èòàòü îæèäàåìîå êîëè÷åñòâî áîëüíûõ ñ ïåðå÷èñëåííûìè àðèòìèÿìè ñðåäè âîåííîñëóæàùèõ è ëèö ïðèçûâíî-ãî âîçðàñòà. Àêòóàëüíîñòü è ìàñøòàá ïðî-áëåìû ñóùåñòâåííî âîçðàñòåò, åñëè ñþäà«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2015
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âîåííóþ ñëóæáó ïî ïðèçûâó, ïðè íàëè-÷èè ïåðå÷èñëåííûõ ÂÊÔÐÑÐ äàæå ïîñ-ëå óñïåøíîé îïåðàöèè Ð×À ïðèçíàþòñÿ îãðàíè÷åííî ãîäíûìè ëèáî íå ãîäíûìè ê âîåííîé ñëóæáå ïî âîåííî-ó÷åòíîé ñïåöèàëüíîñòè [5]. Ìíîãîëåòíèé îïûò èíòåðâåíöèîííîãî ëå÷åíèÿ áîëüíûõ â ìåäèöèíñêèõ ó÷ðåæäåíèÿõ Ìèíçäðàâà, ÐÀÍ, Ìèíèñòåðñòâà îáîðîíû ÐÔ ñ ÂÊÔÐÑÐ äîêàçàë ñâîþ âûñîêóþ ýôôåê-òèâíîñòü (áîëåå 95%) è áåçîïàñíîñòü. Ñëåäîâàòåëüíî, ñåãîäíÿ åñòü âñå îñíîâà-íèÿ ïåðåñìîòðåòü ñòàðûå ïîäõîäû ê îöåíêå ïðîôåññèîíàëüíîé ãîäíîñòè òà-êèõ áîëüíûõ. Ïîýòîìó ìû ñ÷èòàåì, ÷òî âîåííîñëó-æàùèé èëè ãðàæäàíèí, ïðèçûâàþùèéñÿ íà âîåííóþ ñëóæáó, êîòîðîìó áûëà óñ-ïåøíî âûïîëíåíà îïåðàöèÿ ïî ïîâîäó ÂÊÔÐÑÐ, ìîæåò â ïîëíîé ìåðå èñïîë-íÿòü ñâîè ñëóæåáíûå îáÿçàííîñòè. Ìû ïðåäëàãàåì ïðîâîäèòü êîíòðîëüíîå ìå-äèöèíñêîå îáñëåäîâàíèå, â ò. ÷. ñ îáÿçà-òåëüíûì ïðîâåäåíèåì ýíäî-ÝÔÈ ñ ïîñ-ëåäóþùèì ìåäèöèíñêèì îñâèäåòåëüñòâî-âàíèåì ÷åðåç 6 ìåñ. Ê ïðèìåðó, â àðìèè ÑØÀ ïàöèåíò ïîñëå óñïåøíîé îïåðàöèè Ð×À ïî ïîâîäó ÀÂÐÒ/ÀÂÓÐÒ ïðèçíàåò-ñÿ ãîäíûì ê âîåííîé ñëóæáå (ïðè îòñóò-ñòâèè ðåöèäèâà òàõèàðèòìèè â òå÷åíèå 3 ìåñ ïîñëå îïåðàöèè) [18]. Â Û Â Î Ä Û 1. Çíà÷èòåëüíàÿ ÷àñòü ïàöèåíòîâ ñ âûñîêîêóðàáåëüíûìè àðèòìèÿìè – ýòî ëèöà ìîëîäîãî è òðóäîñïîñîáíîãî âîç-ðàñòà, íå èìåþùèå äðóãèõ îðãàíè÷åñêèõ çàáîëåâàíèé ñåðäöà. Îíè îòíîñÿòñÿ ê íàèáîëåå òðóäîñïîñîáíîé ÷àñòè íàñåëå-íèÿ. Ïðåäîñòàâëåíèå èì ïîñëå óñïåøíîé Ð×À âîçìîæíîñòè áûòü ïðèçâàííûìè íà âîåííóþ ñëóæáó, ò. å. âûïîëíèòü ñâîé êîíñòèòóöèîíàëüíûé äîëã ëèáî ïðîäîë-æèòü âîåííóþ ñëóæáó, ìîæåò ñïîñîáñòâî-âàòü ïîâûøåíèþ îáîðîíîñïîñîáíîñòè ñòðàíû. 2. Ðàäèî÷àñòîòíàÿ êàòåòåðíàÿ àáëÿöèÿ óÿçâèìîãî çâåíà àðèòìèè ïðè ÀÂÓÐÒ, ñèíäðîìå WPW, íåêîðîíàðîãåííûõ æå-ëóäî÷êîâûõ àðèòìèÿõ è òèïè÷íîì òðå-ïåòàíèè ïðåäñåðäèé ÿâëÿåòñÿ âûñîêîýô-ôåêòèâíûì è áåçîïàñíûì ìåòîäîì ëå-÷åíèÿ, ïîçâîëÿþùèì ïîëíîñòüþ âîññòà-íîâèòü ðàáîòîñïîñîáíîñòü ó áîëüøèíñòâà (áîëåå 90%) ïàöèåíòîâ. Êîíòðîëüíîå ìåäèöèíñêîå îáñëåäîâàíèå ñ ïðîâåäåíè-åì ýíäî-ÝÔÈ è ïîñëåäóþùåå ìåäèöèí-ñêîå îñâèäåòåëüñòâîâàíèå ñ öåëüþ îïðå-äåëåíèÿ êàòåãîðèè ãîäíîñòè ê âîåííîé ñëóæáå íåîáõîäèìî ïðîâîäèòü íå ðàíåå 6 ìåñ ïîñëå îïåðàöèè. 3. Îñíîâíûìè ôàêòîðàìè ðèñêà ðàç-âèòèÿ ÔÏ ïîñëå Ð×À ÊÒÏ ó áîëüíûõ ñ èñòìóñ-çàâèñìûì ÒÏ ÿâëÿþòñÿ èíòðà-îïåðàöèîííàÿ èíäóöèðóåìîñòü ÔÏ, äëè-òåëüíîñòü àðèòìè÷åñêîãî ñèíäðîìà, íà-ëè÷èå ÔÏ â àíàìíåçå, äëèòåëüíîñòü è ñòåïåíü àðòåðèàëüíîé ãèïåðòåíçèè, íà-ëè÷èå ñòðóêòóðíûõ èçìåíåíèé ñåðäöà. ×óâñòâèòåëüíîñòü ïðèçíàêà «èíòðàîïåðà-öèîííàÿ èíäóöèðóåìîñòü ôèáðèëëÿöèè ïðåäñåðäèé» ñîñòàâëÿåò 87,5%; ñïåöè-ôè÷íîñòü – 80,8%.Ëèòåðàòóðà
1. Âîëîøêî Ñ.Â. Íîâûå ïîäõîäû ê îöåí-êå êàòåãîðèè ãîäíîñòè ê âîåííîé ñëóæáå ó âîåííîñëóæàùèõ ñ ñóïðàâåíòðèêóëÿðíûìè ðåöèïðîêíûìè òàõèêàðäèÿìè ïîñëå ðàäèî-÷àñòîòíîé àáëÿöèè: Àâòîðåô. äèñ. ... êàíä. ìåä. íàóê. – Ì., 2008. – 29 ñ. 2. Ãîðáàòîâ Å.À. Êà÷åñòâî æèçíè, ýõî-êàðäèîãðàôè÷åñêèå ïîêàçàòåëè è âàðèà-áåëüíîñòü ñåðäå÷íîãî ðèòìà ïàöèåíòîâ ñ àòðèîâåíòðèêóëÿðíûìè óçëîâûìè ðåöè-ïðîêíûìè òàõèêàðäèÿìè äî è â òå÷åíèå 1 ãîäà ïîñëå ìîäèôèêàöèè ìåäëåííîé ÷à-ñòè àòðèîâåíòðèêóëÿðíîãî ñîåäèíåíèÿ: Àâ-òîðåô. äèñ. ... êàíä. ìåä. íàóê. – Ì., 2004. – 32 ñ. 3. Ìàêñèìîâ Ä.Á., Äóðìàíîâ Ñ.Ñ., Êîçëîâ Ñ.Ñ. è äð. Àíàëèç îñëîæíåíèé ðàäèî÷àñòîòíûõ êà-òåòåðíûõ àáëÿöèé // Âåñòí. àðèòìîëîãèè. – 2012. – ¹ 69. – Ñ. 11–15. 4. Ïîëîâèíêà Â.Ñ., Äåìüÿíåíêî À.Â., Ñòåê-ëîâ Â.È. è äð. Èííîâàöèîííûå ìåòîäû ëå÷å-íèÿ æåëóäî÷êîâûõ àðèòìèé ñåðäöà // Âîåí.-ìåä. æóðí. – 2014. – Ò. 335, ¹ 11. – Ñ. 44–53. 5. Ïîëîæåíèå î âîåííî-âðà÷åáíîé ýêñ-ïåðòèçå, óòâåðæäåííîå ïîñòàíîâëåíèåì Ïðà-âèòåëüñòâà ÐÔ îò 04.07.2013 ã. ¹ 565. 6. Ðåâèøâèëè À.Ø., Àðòþõèíà Å.À., Ðçàåâ Ô.Ã., Íîñêîâà Ì.Â. Ýëåêòðîôèçèîëîãè÷åñêèå ìåõà-íèçìû è ðåçóëüòàòû ðàäèî÷àñòîòíîé àáëÿöèè æåëóäî÷êîâûõ àðèòìèé èç âûâîäíîãî îòäåëà ëåâîãî æåëóäî÷êà // Àííàëû àðèòìîëîãèè. – 2005. – ¹ 1. – Ñ. 44–51.7. Ðåâèøâèëè À.Ø., Ðçàåâ Ô.Ã., Äæåòûáà-åâà Ñ.Ê. Òîïè÷åñêàÿ äèàãíîñòèêà è ëå÷åíèå ñëîæíûõ ôîðì àðèòìèé ñåðäöà ñ èñïîëüçî-âàíèåì íåôëþîðîñêîïè÷åñêîé ñèñòåìû òðåõ-ìåðíîãî êàðòèðîâàíèÿ // Àííàëû àðèòìîëî-ãèè. – 2005. – ¹ 1. – Ñ. 60–69. 8. Ðåâèøâèëè À.Ø., Ñåðãóëàäçå Ñ.Þ., Øìó-ëü À.Â. è äð. Âàðèàíòíàÿ àíàòîìèÿ íèæíèõ ïå-ðåøåéêîâ ñåðäöà // Àííàëû àðèòìîëîãèè. – 2007. – ¹ 3. – Ñ. 16–22. 9. Ðûáà÷åíêî Ì.Ñ. Êà÷åñòâî æèçíè, ýõî-êàðäèîãðàôè÷åñêèå ïîêàçàòåëè è âàðèàáåëü-íîñòü ñåðäå÷íîãî ðèòìà ó ïàöèåíòîâ ñ ñèíä-ðîìîì Âîëüôà–Ïàðêèíñîíà–Óàéòà äî è â òå÷åíèå îäíîãî ãîäà ïîñëå ðàäèî÷àñòîòíîé êàòåòåðíîé àáëÿöèè äîïîëíèòåëüíîãî àòðèî-âåíòðèêóëÿðíîãî ñîåäèíåíèÿ: Àâòîðåô. äèñ. ... êàíä. ìåä. íàóê. – Ì., 2007. – 29 ñ. 10. Ñèìîíåíêî Â.Á., Êóâøèíîâ Ê.Ý., Ñòåê-ëîâ Â.È. è äð. Î âîåííî-âðà÷åáíîé ýêñïåðòèçå ó áîëüíûõ ñ ïàðîêñèçìàëüíûìè íàäæåëóäî÷êî-âûìè ðåöèïðîêíûìè òàõèêàðäèÿìè // Âîåí.-ìåä. æóðí. – 2013. – Ò. 334, ¹ 11.– Ñ. 40–48. 11. Ñèìîíåíêî Â.Á., Ñòåêëîâ Â.È. Èññëåäî-âàíèå êà÷åñòâà æèçíè ó êàðäèîëîãè÷åñêèõ áîëüíûõ // Êëèí. ìåä. – 2007. – ¹ 3. – Ñ. 11–15. 12. Ñòåêëîâ Â.È. Îöåíêà ôàêòîðîâ ðèñêà ðàçâèòèÿ ôèáðèëëÿöèè ïðåäñåðäèé ó áîëüíûõ ñ òèïè÷íûì òðåïåòàíèåì ïðåäñåðäèé ïîñëå ðàäèî÷àñòîòíîé àáëÿöèè êàâîòðèêóñïèäàëü-íîãî ïåðåøåéêà // Âîåí.-ìåä. æóðí. –2013. – Ò. 334, ¹ 2. – Ñ. 30–37.
13. Bourke J.P., Doig J.C. Ventricular tachyarrhythmias in the normal heart. – New York, 1998. – 107 p.
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15. Calkins H., Yong P., Miller J. et al. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial // Circulation. – 1999. – Vol. 99, N 2. – P. 262–270.
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Ïåðñïåêòèâû ïðèìåíåíèÿ «øâåäñêîãî ñòîëà»
â ñàíàòîðíî-êóðîðòíîì ëå÷åíèè
ÀÍÄÐÈßÍΠÀ.È., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû (airdoktor@mail.ru) 1 ÊÈÐÈ×ÅÍÊÎ Í.Í., ìàéîð ìåäèöèíñêîé ñëóæáû1 ßÐÅÌÊÎ Â.È., çàñëóæåííûé âðà÷ ÐÔ, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà2 ÍÈÊÈÒÈÍ Å.À., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå2 ÅÐÌÀÊΠÐ.À., êàïèòàí ìåäèöèíñêîé ñëóæáû çàïàñà2 1 Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã; 2 Ñàíàòîðíî-êóðîðòíûé êîìïëåêñ «Çàïàäíûé», Ñàíêò-Ïåòåðáóðã Îáîáùåíû ëèòåðàòóðíûå èñòî÷íèêè ïî ñîâðåìåííûì ïðåäñòàâëåíèÿì î ðîëè ëå÷åáíîãî ïèòàíèÿ â ñàíàòîðíî-êóðîðòíîì ëå÷åíèè. Èçó÷åíà ëèòåðàòóðà î ïèòàíèè ïàöèåíòîâ ïî ïðåäâàðèòåëüíîé «çàêàçíîé» ñèñòåìå è ñ îðãàíèçàöèåé ïèòàíèÿ ïî òèïó «øâåäñêèé ñòîë». Íà áàçå ñàíàòîðíî-êóðîðòíûõ ó÷ðåæäåíèé Ìèíèñòåðñòâà îáîðîíû îáîáùåí îïûò ïðèìåíåíèÿ ëå÷åáíîãî ïèòàíèÿ ðàçëè÷íûõ âîçðàñòíûõ ãðóïï è êàòåãîðèé. Íà îñíîâàíèè ñîâðåìåííûõ íîðìàòèâíî-ïðàâîâûõ àêòîâ îïðåäåëåíû ôîðìû è ìåòîäû îðãàíèçàöèè îáùåñòâåííîãî ïèòàíèÿ â Ðîññèéñêîé Ôåäåðàöèè. Ðåçóëüòàòû èññëåäîâàíèÿ ÿâëÿþòñÿ íàó÷íîé ïðåäïîñûëêîé ê îáîñíîâàíèþ ïðèíÿòèé óïðàâëåí÷åñêèõ ðåøåíèé, ïîçâîëÿþùèõ ïîâûñèòü ýôôåêòèâíîñòü ñàíàòîðíî-êóðîðòíîãî ëå÷åíèÿ çà ñ÷åò ëå÷åáíîãî ïèòàíèÿ. Ê ë þ ÷ å â û å ñ ë î â à: ëå÷åáíîå ïèòàíèå, äèåòîëîãèÿ, øâåäñêèé ñòîë, ñàíàòîðíî-êóðîðòíîå ëå÷åíèå, óäîâëåòâîðåííîñòü ïèòàíèåì.Andriyanov A.I., Kirichenko N.N., Yaremko V.I., Nikitin E.A., Ermakov R.A. – The use of a «buffet» style meals in the system of health-resort treatment. The authors summarized literature sources, concerning modern ideas about the role of nutritional therapy in the system of health-resort treatment. The authors also made a research on the basis of literature, concerning health-resort nutrition divided into two systems – buffet system and special-order system. On the basis of sanatorium establishments of the Ministry of Defense
«Âîåííî-ìåäèöèíñêèé æóðíàë», 9’2015
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authors summarized an experience of clinical nutrition in different age groups and categories of patients. On the basis of current regulatory acts were defined forms and methods of meal catering in the Russian Federation. The results of the study are a scientific supposition for substantiation of management decision-making process, which allows to increase an efficiency of health-resort treatment via nutrition therapy.
K e y w o r d s: nutrition therapy, nutritional science, buffet, health-resort treatment, satisfaction with nutrition.
