ɍɇɂȼȿɊɁɂɌȿɌ ɍ ɄɊȺȽɍȳȿȼɐɍ ɎȺɄɍɅɌȿɌ ɆȿȾɂɐɂɇɋɄɂɏ ɇȺɍɄȺ Ⱦɪ ȼɨʁɢɫɥɚɜ Ћɭɩɭɪɞɢʁɚ ȾȿɌȿɊɆИɇȺɇɌȿ ɌɊɈɒɄɈȼȺ ɅȿɑȿЊȺ ȼȺɇȻɈɅɇИɑɄȿ ɉɇȿɍɆɈɇИЈȿ ɞɨɤɬɨɪɫɤɚ ɞɢɫɟɪɬɚɰɢʁɚ Kɪɚɝɭʁɟɜɚɰ, 2015. ɝɨɞɢɧɟ ɍɇɂȼȿɊɁɂɌȿɌ ɍ ɄɊȺȽɍȳȿȼɐɍ ɎȺɄɍɅɌȿɌ ɆȿȾɂɐɂɇɋɄɂɏ ɇȺɍɄȺ Ⱦɪ ȼɨʁɢɫɥɚɜ Ћɭɩɭɪɞɢʁɚ ȾȿɌȿɊɆИɇȺɇɌȿ ɌɊɈɒɄɈȼȺ ɅȿɑȿЊȺ ȼȺɇȻɈɅɇИɑɄȿ ɉɇȿɍɆɈɇИЈȿ ɞɨɤɬɨɪɫɤɚ ɞɢɫɟɪɬɚɰɢʁɚ Ɇɟɧɬɨɪ: ɉɪɨɮ. ɞɪ Ɇɢɯɚʁɥɨ ȳɚɤɨɜʂɟɜɢʄ Kɪɚɝɭʁɟɜɚɰ, 2015. ɝɨɞɢɧɟ 8.6 ИȾȿɇɌИɎИɄȺɐИɈɇȺ ɋɌɊȺɇИɐȺ ȾɈɄɌɈɊɋɄȿ ȾИɋȿɊɌȺɐИЈȿ I. Аɭɬɨɪ ɂɦɟ ɢ ɩɪɟɡɢɦɟ: ȼɨʁɢɫɥɚɜ Ћɭɩɭɪɞɢʁɚ Ⱦɚɬɭɦ ɢ ɦɟɫɬɨ ɪɨђɟʃɚ: 20.01.1976. ɝɨɞɢɧɟ ɭ Ʉɪɚɝɭʁɟɜɰɭ ɋɚɞɚɲʃɟ ɡɚɩɨɫɥɟʃɟ: Ʉɥɢɧɢɤɚ ɡɚ ɩɭɥɦɨɥɨɝɢʁɭ, Ʉɥɢɧɢɱɤɢ ɰɟɧɬɚɪ Ʉɪɚɝɭʁɟɜɚɰ ɢ Ʉɚɬɟɞɪɚ ɡɚ ɂɧɬɟɪɧɭ ɦɟɞɢɰɢɧɭ, Ɏɚɤɭɥɬɟɬ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤɚ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ II. Дɨкɬɨɪɫкɚ ɞиɫɟɪɬɚцијɚ ɇɚɫɥɨɜ: Ⱦɟɬɟɪɦɢɧɚɧɬɟ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ Ȼɪɨʁ ɫɬɪɚɧɢɰɚ: 145 Ȼɪɨʁ ɫɥɢɤɚ: 0, ɬɚɛɟɥɚ 33, ɝɪɚɮɢɤɨɧɚ 11 Ȼɪɨʁ ɛɢɛɥɢɨɝɪɚɮɫɤɢɯ ɩɨɞɚɬɚɤɚ: 133 ɍɫɬɚɧɨɜɚ ɢ ɦɟɫɬɨ ɝɞɟ ʁɟ ɪɚɞ ɢɡɪɚђɟɧ: Ʉɥɢɧɢɤɚ ɡɚ ɩɭɥɦɨɥɨɝɢʁɭ, Ʉɐ Ʉɪɚɝɭʁɟɜɚɰ Ɏɚɤɭɥɬɟɬ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤɚ, Ʉɪɚɝɭʁɟɜɚɰ ɇɚɭɱɧɚ ɨɛɥɚɫɬ (ɍȾɄ): Ɇɟɞɢɰɢɧɚ (Ɂɞɪɚɜɫɬɜɟɧɚ ɟɤɨɧɨɦɢʁɚ) Ɇɟɧɬɨɪ: ɉɪɨɮ. ɞɪ Ɇɢɯɚʁɥɨ ȳɚɤɨɜʂɟɜɢʄ III. Оцɟɧɚ и ɨɛɪɚɧɚ Ⱦɚɬɭɦ ɩɪɢʁɚɜɟ ɬɟɦɟ: 27.03.2012. Ȼɪɨʁ ɨɞɥɭɤɟ ɢ ɞɚɬɭɦ ɩɪɢɯɜɚɬɚʃɚ ɞɨɤɬɨɪɫɤɟ ɞɢɫɟɪɬɚɰɢʁɟ: 589/12 ɨɞ 17.10.2012. Ʉɨɦɢɫɢʁɚ ɡɚ ɨɰɟɧɭ ɩɨɞɨɛɧɨɫɬɢ ɬɟɦɟ ɢ ɤɚɧɞɢɞɚɬɚ: ɉɪɨɮ. ɞɪ Ɂɨɪɢɰɚ Ʌɚɡɢʄ ɉɪɨɮ. ɞɪ Ɇɚɪɢʁɚ Ɇɢɬɢʄ Ɇɢɥɢɤɢʄ ɉɪɨɮ. ɞɪ ɇɚɬɚɲɚ Ђɨɪђɟɜɢʄ Ʉɨɦɢɫɢʁɚ ɡɚ ɨɰɟɧɭ ɩɨɞɨɛɧɨɫɬɢ ɬɟɦɟ ɢ ɤɚɧɞɢɞɚɬɚ: ɉɪɨɮ. ɞɪ Ɂɨɪɢɰɚ Ʌɚɡɢʄ ɉɪɨɮ. ɞɪ Ɇɚɪɢʁɚ Ɇɢɬɢʄ Ɇɢɥɢɤɢʄ ɉɪɨɮ. ɞɪ ɇɚɬɚɲɚ Ђɨɪђɟɜɢʄ Ʉɨɦɢɫɢʁɚ ɡɚ ɨɰɟɧɭ ɞɨɤɬɨɪɫɤɟ ɞɢɫɟɪɬɚɰɢʁɟ: ɉɪɨɮ. ɞɪ Ɂɨɪɢɰɚ Ʌɚɡɢʄ ɉɪɨɮ. ɞɪ ȼɢɤɬɨɪɢʁɚ Ⱦɪɚɝɨʁɟɜɢʄ ɋɢɦɢʄ ɉɪɨɮ. ɞɪ Ɇɚɪɢɧɚ ɉɟɬɪɨɜɢʄ Ʉɨɦɢɫɢʁɚ ɡɚ ɨɞɛɪɚɧɭ ɞɨɤɬɨɪɫɤɟ ɞɢɫɟɪɬɚɰɢʁɟ: ɉɪɨɮ. ɞɪ Ɂɨɪɢɰɚ Ʌɚɡɢʄ ɉɪɨɮ. ɞɪ ȼɢɤɬɨɪɢʁɚ Ⱦɪɚɝɨʁɟɜɢʄ ɋɢɦɢʄ ɉɪɨɮ. ɞɪ Ɇɚɪɢɧɚ ɉɟɬɪɨɜɢʄ Ⱦɚɬɭɦ ɨɞɛɪɚɧɟ ɞɢɫɟɪɬɚɰɢʁɟ: ɋȺȾɊɀȺЈ : 1. ɍȼɈȾ....................................................................................................................1 1.1 Ʉɥɚɫɢɮɢɤɚɰɢʁɚ ɩɧɟɭɦɨɧɢʁɚ....................................................................2 1.2 ȼɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ – ɟɩɢɞɟɦɢɨɥɨɲɤɢ ɢ ɤɥɢɧɢɱɤɢ ɚɫɩɟɤɬɢ.....5 1.3 ȼɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ - ɟɤɨɧɨɦɫɤɢ ɚɫɩɟɤɬɢ....................................7 2. ɐɂȴȿȼɂ ɋɌɍȾɂȳȿ.........................................................................................20 3. ɏɂɉɈɌȿɁȿ ɋɌɍȾɂȳȿ......................................................................................21 4. ɆȺɌȿɊɂȳȺɅ......................................................................................................22 4.1 ɉɨɩɭɥɚɰɢʁɚ ɤɨʁɚ ɫɟ ɢɫɬɪɚɠɭʁɟ.................................................................22 4.2 ɍɡɨɪɤɨɜɚʃɟ..............................................................................................22 4.3 ȼɚɪɢʁɚɛɥɟ ɤɨʁɟ ɫɭ ɦɟɪɟɧɟ ɭ ɫɬɭɞɢʁɢ ......................................................23 5. ɆȿɌɈȾɈɅɈȽɂȳȺ..............................................................................................24 5.1 Ⱦɢɡɚʁɧ, ɫɧɚɝɚ ɫɬɭɞɢʁɟ ɢ ɜɟɥɢɱɢɧɚ ɭɡɨɪɤɚ..............................................24 5.2 ɋɬɚɬɢɫɬɢɱɤɚ ɨɛɪɚɞɚ ɩɨɞɚɬɚɤɚ................................................................24 6. ɊȿɁɍɅɌȺɌɂ........................................................................................................28 6.1 Ⱦɟɦɨɝɪɚɮɫɤɚ ɢ ɦɟɞɢɰɢɧɫɤɚ ɫɬɪɭɤɬɭɪɚ ɭɡɨɪɤɚ.....................................29 6.2 ɉɪɨɰɟɧɚ ɭɫɩɟɯɚ ɤɥɢɧɢɱɤɨɝ ɨɞɝɨɜɨɪɚ....................................................40 6.3 ȿɤɨɧɨɦɫɤɟ ɩɨɫɥɟɞɢɰɟ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ.....................51 7. ȾɂɋɄɍɋɂȳȺ.....................................................................................................104 8. ɁȺɄȴɍɑȺɄ.......................................................................................................125 9. ɅɂɌȿɊȺɌɍɊȺ....................................................................................................131 1 1. ɍȼɈȾ ɉɧɟɭɦɨɧɢʁɚ ɩɪɟɞɫɬɚɜʂɚ ɢɧɮɥɚɦɚɰɢʁɭ ɩɥɭʄɧɨɝ ɩɚɪɟɧɯɢɦɚ, ɞɢɫɬɚɥɧɨ ɨɞ ɬɟɪɦɢɧɚɥɧɢɯ ɛɪɨɧɯɢɨɥɚ, ɤɨʁɚ ɨɛɭɯɜɚɬɚ ɪɟɫɩɢɪɚɬɨɪɧɟ ɛɪɨɧɯɢɨɥɟ, ɚɥɜɟɨɥɚɪɧɟ ɞɭɤɬɭɫɟ, ɫɚɤɭɥɭɫɟ, ɚɥɜɟɨɥɟ ɢɥɢ ɩɥɭʄɧɢ ɢɧɬɟɪɫɬɢɰɢʁɭɦ. Ɇɨɠɟ ɛɢɬɢ ɭɡɪɨɤɨɜɚɧɚ ɢɧɮɟɤɬɢɜɧɢɦ (ɛɚɤɬɟɪɢʁɟ, ɜɢɪɭɫɢ, ɝʂɢɜɢɰɟ, ɪɢɤɟɰɢʁɟ, ɩɚɪɚɡɢɬɢ) ɢɥɢ ɧɟɢɧɮɟɤɬɢɜɧɢɦ ɚɝɟɧɫɢɦɚ (ɯɟɦɢʁɫɤɟ ɢ ɮɢɡɢɱɤɟ ɧɨɤɫɟ), ɚ ɤɚɪɚɤɬɟɪɢɲɟ ɫɟ ɤɥɢɧɢɱɤɢɦ ɢ ɪɚɞɢɨɥɨɲɤɢɦ ɡɧɚɰɢɦɚ ɤɨɧɫɨɥɢɞɚɰɢʁɟ (ɤɨɧɞɟɧɡɚɰɢʁɟ) ɩɥɭʄɧɨɝ ɩɚɪɟɧɯɢɦɚ. ɉɨʁɚɜɚ ɟɤɫɭɞɚɬɚ ɢ ɢɧɮɥɚɦɚɬɨɪɧɢɯ ʄɟɥɢʁɚ ɭ ɚɥɜɟɨɥɚɦɚ ɢ ɢɧɬɟɪɫɬɢɰɢʁɭɦɭ ʁɚɜʂɚ ɫɟ ɤɚɨ ɨɞɝɨɜɨɪ ɧɚ ɪɚɡɦɧɨɠɚɜɚʃɟ ɦɢɤɪɨɨɪɝɚɧɢɡɚɦɚ ɭ ɞɨ ɬɚɞɚ ɡɞɪɚɜɨɦ ɩɥɭʄɧɨɦ ɩɚɪɟɧɯɢɦɭ1,2. ɂɫɬɭ ɢ ɫɥɢɱɧɭ ɤɥɢɧɢɱɤɭ, ɩɚɬɨɯɢɫɬɨɥɨɲɤɭ ɢ ɪɚɞɢɨɥɨɲɤɭ ɫɥɢɤɭ ɦɨɝɭ ɭɡɪɨɤɨɜɚɬɢ ɢ ɞɪɭɝɢ ɱɢɧɢɨɰɢ (ɯɟɦɢʁɫɤɢ, ɮɢɡɢɱɤɢ ɢ ɦɟɬɚɛɨɥɢɱɤɢ) ɢ ɬɚɞɚ ɝɨɜɨɪɢɦɨ ɨ ɢɧɮɢɥɬɪɚɬɢɦɚ3. Ɂɛɨɝ ɫɜɨʁɟ ɭɱɟɫɬɚɥɨɫɬɢ, ɪɚɡɧɨɜɪɫɧɟ ɟɬɢɨɥɨɝɢʁɟ, ɬɟɠɢɧɟ ɤɥɢɧɢɱɤɟ ɫɥɢɤɟ, ɚ ɩɨɧɟɤɚɞ ɡɛɨɝ ɥɨɲɟɝ ɬɨɤɚ ɢ ɢɫɯɨɞɚ, ɨɜɚʁ ɨɛɥɢɤ ɢɧɮɥɚɦɚɰɢʁɟ ɩɥɭʄɧɨɝ ɩɚɪɟɧɯɢɦɚ ɢ ɞɚɧɚɫ ɩɪɟɞɫɬɚɜʂɚ ɡɧɚɱɚʁɚɧ ɞɢʁɚɝɧɨɫɬɢɱɤɢ, ɬɟɪɚɩɢʁɫɤɢ ɢ ɩɪɨɝɧɨɫɬɢɱɤɢ ɩɪɨɛɥɟɦ ɭ ɩɭɥɦɨɥɨɝɢʁɢ. ɉɧɟɭɦɨɧɢʁɟ ɫɭ ɱɟɫɬɚ ɨɛɨʂɟʃɚ ɭ ɫɜɢɦ ɭɡɪɚɫɬɢɦɚ, ɩɨɫɟɛɧɨ ɤɨɞ ɨɫɨɛɚ ɦɥɚђɟ ɢ ɫɬɚɪɢʁɟ ɠɢɜɨɬɧɟ ɞɨɛɢ. ɑɟɲʄɟ ɫɟ ʁɚɜʂɚʁɭ ɬɨɤɨɦ ɡɢɦɟ ɢ ɩɪɨɥɟʄɚ ɡɛɨɝ ɜɟʄɢɯ ɤɨɥɟɛɚʃɚ ɬɟɦɩɟɪɚɬɭɪɟ ɤɨʁɟ ɩɨɝɨɞɭʁɭ ɢɧɮɟɤɰɢʁɚɦɚ ɢ ɟɩɢɞɟɦɢʁɚɦɚ ɝɪɢɩɚ3,4. ɍɱɟɫɬɚɥɨɫɬ ʁɟ ɜɟʄɚ ɤɨɞ ɨɫɨɛɚ ɦɭɲɤɨɝ ɩɨɥɚ. Ɉɫɨɛɟ ɨɛɨɥɟɥɟ ɨɞ ɯɪɨɧɢɱɧɟ ɨɩɫɬɪɭɤɬɢɜɧɟ ɛɨɥɟɫɬɢ ɩɥɭʄɚ (ɏɈȻɉ), ɫɪɱɚɧɟ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɟ, ɛɨɥɟɫɬɢ ʁɟɬɪɟ ɢ ɛɭɛɪɟɝɚ, Ⱥɥɰɯɚʁɦɟɪɨɜɟ ɛɨɥɟɫɬɢ, ɰɢɫɬɢɱɧɟ ɮɢɛɪɨɡɟ, ɩɭɲɚɱɢ, ɩɨɬɚɬɨɪɢ ɢ ɨɫɨɛɟ ɫɚ ɢɦɭɧɨɞɟɮɢɰɢʁɟɧɬɧɢɦ ɫɬɚʃɢɦɚ ɭ ɩɨɜɟʄɚɧɨɦ ɫɭ ɪɢɡɢɤɭ ɨɞ ɨɛɨɥɟɜɚʃɚ ɨɞ ɨɜɟ ɛɨɥɟɫɬɢ5,6. ɉɪɢɛɥɢɠɧɨ 1% ɩɨɩɭɥɚɰɢʁɟ, ɨɞɧɨɫɧɨ 0,1-1,5% ɨɫɨɛɚ ɫɪɟɞʃɟ ɠɢɜɨɬɧɟ ɞɨɛɢ ɝɨɞɢɲʃɟ ɨɛɨɥɢ ɨɞ ɧɟɤɨɝ ɨɛɥɢɤɚ ɩɧɟɭɦɨɧɢʁɟ. ɂɡɦɟђɭ 5 ɢ 11 ɨɫɨɛɚ ɧɚ 1000 ɫɬɚɧɨɜɧɢɤɚ ɨɛɨɥɢ ɨɞ ɜɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɟ ɩɧɟɭɦɨɧɢʁɟ. ɋɦɚɬɪɚ ɫɟ ɞɚ ɢɧɰɢɞɟɧɰɚ ɛɟɥɟɠɢ ɩɨɪɚɫɬ, ɱɚɤ ɞɨ 35 ɧɚ 1000 ɫɬɚɧɨɜɧɢɤɚ, ɤɨɞ ɨɫɨɛɚ ɦɥɚђɢɯ ɨɞ 5 ɝɨɞɢɧɚ ɢ ɫɬɚɪɢʁɢɯ ɨɞ 75 ɝɨɞɢɧɚ. ɂɡɦɟђɭ 22 ɢ 42% 2 ɨɛɨɥɟɥɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɦɚ ɩɨɬɪɟɛɭ ɡɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɨɦ, ɨɞ ɱɟɝɚ 5-10% ɭ ʁɟɞɢɧɢɰɚɦɚ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ2,7. ɂ ɩɨɪɟɞ ɩɪɢɦɟɧɟ ɟɮɢɤɚɫɧɢɯ ɚɧɬɢɦɢɤɪɨɛɧɢɯ ɥɟɤɨɜɚ, ɩɧɟɭɦɨɧɢʁɟ ɫɟ ɭ ɢɡɜɟɫɧɢɦ ɫɥɭɱɚʁɟɜɢɦɚ ɡɚɜɪɲɚɜɚʁɭ ɥɟɬɚɥɧɨ. ɍ ȼɟɥɢɤɨʁ Ȼɪɢɬɚɧɢʁɢ ɫɦɪɬɧɨɫɬ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢɯ ɭɫɥɟɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡɧɨɫɢ 5,7-12%, ɚ ɭ ɫɥɭɱɚʁɭ ɪɚɡɜɨʁɚ ɤɨɦɩɥɢɤɚɰɢʁɚ ɢ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɭ ʁɟɞɢɧɢɰɢ ɢɧɬɟɧɡɢɜɧɟ ɧɟɝɟ ɫɦɪɬɧɨɫɬ ɫɟ ɤɪɟʄɟ ɢ ɞɨ 50%7. ɉɪɟɦɚ ɫɬɚɬɢɫɬɢɱɤɢɦ ɩɨɞɚɰɢɦɚ ɢɡ 2007. ɝɨɞɢɧɟ, ɩɧɟɭɦɨɧɢʁɟ ɫɭ ɛɢɥɟ ɨɫɦɢ ɜɨɞɟʄɢ ɭɡɪɨɱɧɢɤ ɫɦɪɬɧɨɫɬɢ ɭ ɋȺȾ8. ɍɱɟɫɬɚɥɨɫɬ ɭɡɪɨɱɧɢɤɚ, ɚ ɩɨɫɟɛɧɨ ʃɢɯɨɜɚ ɨɫɟɬʂɢɜɨɫɬ ɧɚ ɚɧɬɢɛɢɨɬɢɤɟ ʁɟ ɪɚɡɥɢɱɢɬɚ ɭ ɡɚɜɢɫɧɨɫɬɢ ɨɞ ɩɨɞɧɟɛʂɚ9. 1.1 Ʉɥɚɫɢɮɢɤɚɰɢʁɚ ɩɧɟɭɦɨɧɢʁɚ Ȼɪɨʁɧɟ ɫɭ ɤɥɚɫɢɮɢɤɚɰɢʁɟ ɩɧɟɭɦɨɧɢʁɚ ɤɨɪɢɲʄɟɧɟ ɢɥɢ ɫɟ ʁɨɲ ɭɜɟɤ ɤɨɪɢɫɬɟ ɭ ɩɪɚɤɫɢ, ɡɚɫɧɨɜɚɧɟ ɧɚ ɟɩɢɞɟɦɢɨɥɨɝɢʁɢ, ɬɨɤɭ ɧɚɫɬɚɧɤɚ ɛɨɥɟɫɬɢ, ɤɥɢɧɢɱɤɢɦ ɨɫɨɛɟɧɨɫɬɢɦɚ, ɫɬɚʃɭ ɩɥɭʄɚ ɩɪɟ ɛɨɥɟɫɬɢ, ɚɧɚɬɨɦɫɤɨʁ ɥɨɤɚɥɢɡɚɰɢʁɢ ɢ ɪɚɞɢɨɥɨɲɤɨʁ ɫɥɢɰɢ. ɉɪɟɦɚ ɬɨɤɭ ɧɚɫɬɚɧɤɚ ɩɧɟɭɦɨɧɢʁɟ ɫɟ ɞɟɥɟ ɧɚ ɚɤɭɬɧɟ ɢ ɯɪɨɧɢɱɧɟ2,6. ɉɪɟɦɚ ɟɬɢɨɥɨɝɢʁɢ ɩɧɟɭɦɨɧɢʁɟ ɫɟ ɞɟɥɟ ɧɚ ɛɚɤɬɟɪɢʁɫɤɟ ɢ ɧɟɛɚɤɬɟɪɢʁɫɤɟ. Ȼɚɤɬɟɪɢʁɫɤɟ ɦɨɝɭ ɛɢɬɢ ɭɡɪɨɤɨɜɚɧɟ Ƚɪɚɦ-ɩɨɡɢɬɢɜɧɢɦ (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis), Ƚɪɚɦ-ɧɟɝɚɬɢɜɧɢɦ (Escherichia, Enterobacter, Proteus, Klebsiella pneumoniae) ɢ ɚɧɚɟɪɨɛɧɢɦ ɛɚɤɬɟɪɢʁɚɦɚ. ɇɟɛɚɤɬɟɪɢʁɫɤɟ ɩɧɟɭɦɨɧɢʁɟ ɫɭ ɭɡɪɨɤɨɜɚɧɟ ɜɢɪɭɫɢɦɚ, ɛɚɤɬɟɪɢʁɚɦɚ ɫɥɢɱɧɢɦ ɨɪɝɚɧɢɡɦɢɦɚ (Mycoplasma pneumoniae, Chlamydia psittaci, Legionella), ɪɢɤɟɰɢʁɚɦɚ, ɝʂɢɜɢɰɚɦɚ, ɩɚɪɚɡɢɬɢɦɚ, ɚɤɬɢɧɨɦɢɰɟɬɚɦɚ. ɇɟɛɚɤɬɟɪɢʁɫɤɟ ɩɧɟɭɦɨɧɢʁɟ ɦɨɝɭ ɛɢɬɢ ɢɡɚɡɜɚɧɟ ɢ ɧɟɢɧɮɟɤɬɢɜɧɢɦ ɚɝɟɧɫɢɦɚ: ɯɟɦɢʁɫɤɢ ɚɝɟɧɫɢ (ɥɟɤɨɜɢ, ɭʂɚ, ɦɚɫɬɢ) ɢ ɮɢɡɢɱɤɢ ɚɝɟɧɫɢ (ʁɨɧɢɡɭʁɭʄɟ ɡɪɚɱɟʃɟ). ɋɦɚɬɪɚ ɫɟ ɞɚ ʁɟ 60-80% ɫɜɢɯ ɩɧɟɭɦɨɧɢʁɚ ɤɨɞ ɨɞɪɚɫɥɢɯ ɢɡɚɡɜɚɧɨ ɛɚɤɬɟɪɢʁɚɦɚ10. 3 ɉɪɟɦɚ ɫɬɚʃɭ ɩɥɭʄɚ ɩɪɟ ɛɨɥɟɫɬɢ, ɩɧɟɭɦɨɧɢʁɟ ɦɨɝɭ ɛɢɬɢ ɩɪɢɦɚɪɧɟ (ɭ ɩɪɟɬɯɨɞɧɨ ɢɧɬɚɤɬɧɢɦ ɩɥɭʄɢɦɚ) ɢ ɫɟɤɭɧɞɚɪɧɟ (ɭ ɩɪɟɬɯɨɞɧɨ ɨɛɨɥɟɥɢɦ ɩɥɭʄɢɦɚ, ɤɨɞ ɯɪɨɧɢɱɧɟ ɨɩɫɬɪɭɤɬɢɜɧɟ ɛɨɥɟɫɬɢ ɩɥɭʄɚ, ɨɩɫɬɪɭɤɰɢʁɟ ɢɥɢ ɫɬɟɧɨɡɟ ɛɪɨɧɯɚ, ɛɪɨɧɯɢɟɤɬɚɡɢʁɚ, ɯɢɩɨɫɬɚɬɫɤɢɯ ɩɪɨɦɟɧɚ ɧɚɫɬɚɥɢɯ ɭɫɥɟɞ ɩɥɭʄɧɟ ɫɬɚɡɟ, ɩɨɪɟɦɟʄɚʁɚ ɩɥɭʄɧɟ ɰɢɪɤɭɥɚɰɢʁɟ). ɉɪɟɦɚ ɤɥɢɧɢɱɤɢɦ ɨɫɨɛɟɧɨɫɬɢɦɚ, ɩɧɟɭɦɨɧɢʁɟ ɫɟ ɞɟɥɟ ɧɚ ɬɢɩɢɱɧɟ (ɛɚɤɬɟɪɢʁɫɤɟ) ɢ ɚɬɢɩɢɱɧɟ (ɢɡɚɡɜɚɧɟ ɢɧɬɪɚɰɟɥɭɥɚɪɧɢɦ ɩɚɬɨɝɟɧɢɦɚ, ɛɚɤɬɟɪɢʁɚɦɚ ɫɥɢɱɧɢɦ ɨɪɝɚɧɢɡɦɢɦɚ). Ɍɢɩɢɱɧɟ ɩɧɟɭɦɨɧɢʁɟ ɩɨɱɢʃɭ ɚɤɭɬɧɨ, ɫɚ ɜɢɫɨɤɨɦ ɮɟɛɪɢɥɧɨɲʄɭ, ɩɪɨɞɭɤɬɢɜɧɢɦ ɤɚɲʂɟɦ, ɢɡɪɚɠɟɧɨɦ ɥɟɭɤɨɰɢɬɨɡɨɦ ɢ ɩɪɟɞɨɦɢɧɚɰɢʁɨɦ ɧɟɭɬɪɨɮɢɥɧɢɯ ɝɪɚɧɭɥɨɰɢɬɚ. Ʉɨɞ ʃɢɯ ɫɟ ɧɚʁɱɟɲʄɟ ʁɚɜʂɚ ɪɚɞɢɨɥɨɲɤɢ ɯɨɦɨɝɟɧɚ ɫɟɧɤɚ ɩɧɟɭɦɨɧɢɱɧɟ ɢɧɮɢɥɬɪɚɰɢʁɟ. Ⱥɬɢɩɢɱɧɟ ɩɧɟɭɦɨɧɢʁɟ ɧɚʁɱɟɲʄɟ ɩɨɱɢʃɭ ɩɨɫɬɟɩɟɧɨ, ɫɚ ɩɪɟɬɯɨɞɧɨɦ ɢɧɮɟɤɰɢʁɨɦ ɝɨɪʃɢɯ ɞɢɫɚʁɧɢɯ ɩɭɬɟɜɚ, ɩɨɧɟɤɚɞ ɩɪɚɬɟ ɟɩɢɞɟɦɢʁɭ ɝɪɢɩɚ. ɍ ɤɥɢɧɢɱɤɨʁ ɫɥɢɰɢ ɞɨɦɢɧɢɪɚʁɭ ɨɩɲɬɢ ɫɢɦɩɬɨɦɢ, ɫɭɛɮɟɛɪɢɥɧɨɫɬ, ɫɭɜ ɤɚɲɚʂ, ɭɦɟɪɟɧɚ ɥɟɭɤɨɰɢɬɨɡɚ ɢ ɩɪɟɞɨɦɢɧɚɰɢʁɚ ɥɢɦɮɨɰɢɬɚ. Ɋɚɞɢɨɥɨɲɤɢ ɫɟ ɭɨɱɚɜɚʁɭ ɪɚɫɬɪɟɫɢɬɢ ɢɧɮɢɥɬɪɚɬɢ ɢɡɝɥɟɞɚ ɦɥɟɱɧɨɝ ɫɬɚɤɥɚ2,11. ɉɪɟɦɚ ɚɧɚɬɨɦɫɤɨʁ ɥɨɤɚɥɢɡɚɰɢʁɢ ɢ ɪɚɞɢɨɥɨɲɤɨʁ ɫɥɢɰɢ ɩɧɟɭɦɨɧɢʁɟ ɫɭ ɩɨɞɟʂɟɧɟ ɧɚ ɥɨɛɚɪɧɟ, ɫɟɝɦɟɧɬɧɟ, ɫɭɛɫɟɝɦɟɧɬɧɟ, ɛɪɨɧɯɨɩɧɟɭɦɨɧɢʁɟ, ɚɥɜɟɨɥɚɪɧɟ ɢ ɢɧɬɟɪɫɬɢɰɢʁɫɤɟ, ɩɧɟɭɦɨɧɢʁɟ ɫɚ ɯɢɥɭɫɧɨɦ ɚɞɟɧɨɩɚɬɢʁɨɦ ɢ ɩɪɚɬɟʄɢɦ ɩɥɟɭɪɚɥɧɢɦ ɢɡɥɢɜɨɦ2. ɇɚʁɱɟɲʄɟ ɤɨɪɢɲʄɟɧɚ, ɟɩɢɞɟɦɢɨɥɨɲɤɚ ɩɨɞɟɥɚ ɩɧɟɭɦɨɧɢʁɚ, ɛɚɡɢɪɚ ɫɟ ɧɚ ɭɫɥɨɜɢɦɚ ɨɤɨɥɢɧɟ ɩɨɞ ɤɨʁɢɦɚ ʁɟ ɩɧɟɭɦɨɧɢʁɚ ɫɬɟɱɟɧɚ ɢ ɤɥɢɧɢɱɤɨɦ ɫɬɚʃɭ ɛɨɥɟɫɧɢɤɚ. ɉɪɟɦɚ ɨɜɨʁ ɤɥɚɫɢɮɢɤɚɰɢʁɢ, ɩɧɟɭɦɨɧɢʁɟ ɫɟ ɞɟɥɟ ɧɚ: 1. ȼɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (CШЦЦuЧТtв AМquТrОН PЧОuЦШЧТК - CAP) Ɉɜɟ ɩɧɟɭɦɨɧɢʁɟ ɧɚɫɬɚʁɭ ɭ ɭɫɥɨɜɢɦɚ ɧɨɪɦɚɥɧɨɝ ɠɢɜɨɬɧɨɝ ɨɤɪɭɠɟʃɚ ɤɨɞ ɞɨ ɬɚɞɚ ɡɞɪɚɜɢɯ ʂɭɞɢ. ɉɪɟɞɫɬɚɜʂɚʁɭ ɚɤɭɬɧɭ ɢɧɮɟɤɰɢʁɭ ɩɥɭʄɧɨɝ ɩɚɪɟɧɯɢɦɚ, ɤɨʁɚ ʁɟ ɭɞɪɭɠɟɧɚ ɫɚ ɫɢɦɩɬɨɦɢɦɚ ɚɤɭɬɧɟ ɢɧɮɟɤɰɢʁɟ, ɭɡ ɩɨʁɚɜɭ ɢɧɮɢɥɬɪɚɬɢɜɧɟ ɩɧɟɭɦɨɧɢɱɧɟ ɫɟɧɤɟ ɧɚ ɪɚɞɢɨɝɪɚɮɢʁɢ ɩɥɭʄɚ, ɢ/ɢɥɢ ɩɨʁɚɜɭ ɚɭɫɤɭɥɬɚɬɨɪɧɨɝ ɧɚɥɚɡɚ (ɩɪɨɦɟɧɚ ɞɢɫɚʁɧɨɝ ɲɭɦɚ ɢ/ɢɥɢ ɩɨʁɚɜɚ ɢɧɫɩɢɪɢʁɭɦɫɤɢɯ ɩɭɤɨɬɚ), ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɤɨʁɢ ɧɢɫɭ ɛɢɥɢ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢ ɭ ɩɨɫɥɟɞʃɢɯ 14 ɞɚɧɚ ɩɪɟ ɩɨʁɚɜɟ ɫɢɦɩɬɨɦɚ ɛɨɥɟɫɬɢ12. 4 2. Ȼɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (HШspТtКХ AМquТrОН PЧОuЦШЧТК – HAP) Ɉɜɟ ɩɧɟɭɦɨɧɢʁɟ ɩɪɟɞɫɬɚɜʂɚʁɭ ɢɧɬɪɚɯɨɫɩɢɬɚɥɧɭ ɢɧɮɟɤɰɢʁɭ, ɤɨʁɚ ɫɟ ɪɚɡɜɢʁɚ ɭ ɜɪɟɦɟɧɫɤɨɦ ɨɤɜɢɪɭ ɨɞ ɜɢɲɟ ɨɞ 48 ɫɚɬɢ ɨɞ ɩɨɱɟɬɤɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɚ ɱɢʁɢ ɡɧɚɰɢ ɢ ɫɢɦɩɬɨɦɢ ɧɢɫɭ ɛɢɥɢ ɩɪɢɫɭɬɧɢ ɩɪɢɥɢɤɨɦ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ. ɍɤɨɥɢɤɨ ʁɟ ɛɨɥɟɫɧɢɤ ɛɢɨ ɭ ɢɧɤɭɛɚɰɢɨɧɨɦ ɩɟɪɢɨɞɭ ɭ ɜɪɟɦɟ ɤɚɞɚ ʁɟ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧ, ɬɚɤɜɚ ɩɧɟɭɦɨɧɢʁɚ ɫɟ ɧɟ ɫɦɚɬɪɚ ɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ. Ɉɜɟ ɩɧɟɭɦɨɧɢʁɟ ɨɛɭɯɜɚɬɚʁɭ ɩɨɫɬɨɩɟɪɚɬɢɜɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ ɩɧɟɭɦɨɧɢʁɟ ɤɨʁɟ ɫɟ ɪɚɡɜɢʁɚʁɭ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɤɨʁɢ ɫɭ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢ, ɚɥɢ ɧɢɫɭ ɧɚ ɦɟɯɚɧɢɱɤɨʁ ɜɟɧɬɢɥɚɰɢʁɢ. Ɇɨɪɬɚɥɢɬɟɬ ɫɟ ɤɪɟʄɟ ɭ ɪɚɫɩɨɧɭ ɨɞ 30 ɞɨ 70%13. Ɋɚɧɢʁɟ ɫɭ ɨɜɨʁ ɝɪɭɩɢ ɩɧɟɭɦɨɧɢʁɚ ɩɪɢɩɚɞɚɥɟ ɢ ɩɧɟɭɦɨɧɢʁɟ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɧɚ ɦɟɯɚɧɢɱɤɨʁ ɜɟɧɬɢɥɚɰɢʁɢ, ɤɨʁɟ ɫɭ ɫɚɞɚ ɢɡɞɜɨʁɟɧɟ ɭ ɩɨɫɟɛɚɧ ɟɩɢɞɟɦɢɨɥɨɲɤɢ ɟɧɬɢɬɟɬ. 3. ɉɧɟɭɦɨɧɢʁɟ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɧɚ ɦɟɯɚɧɢɱɤɨʁ ɜɟɧɬɢɥɚɰɢʁɢ (VОЧtТХКtШr-Associated Pneumonia - VAP) ɉɪɟɞɫɬɚɜʂɚʁɭ ɬɟɠɚɤ ɨɛɥɢɤ ɩɧɟɭɦɨɧɢʁɚ ɤɨʁɟ ɫɟ ʁɚɜʂɚʁɭ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɤɨʁɢ ɫɭ ɧɚ ɦɟɯɚɧɢɱɤɨʁ ɜɟɧɬɢɥɚɰɢʁɢ ɞɭɠɟ ɨɞ 24-48 ɫɚɬɢ14,15. Ⱥɧɚɥɢɡɟ ɭɤɚɡɭʁɭ ɞɚ ɫɟ ʁɚɜʂɚʁɭ ɤɨɞ 28% ɛɨɥɟɫɧɢɤɚ ɧɚ ɦɟɯɚɧɢɱɤɨʁ ɜɟɧɬɢɥɚɰɢʁɢ. Ɇɨɪɬɚɥɢɬɟɬ ɫɟ ɤɪɟʄɟ ɭ ɪɚɫɩɨɧɭ ɨɞ 27 ɞɨ 76%14. 4. ɉɧɟɭɦɨɧɢʁɟ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɩɨɞ ɡɞɪɚɜɫɬɜɟɧɢɦ ɧɚɞɡɨɪɨɦ (HОКХtСМКrО-Associated Pneumonia – HCAP) Ɉɜɟ ɩɧɟɭɦɨɧɢʁɟ ɫɭ ɪɚɧɢʁɟ ɩɪɢɩɚɞɚɥɟ ɝɪɭɩɢ ɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɢɯ ɩɧɟɭɦɨɧɢʁɚ ɡɛɨɝ ɩɨɫɬɨʁɚʃɚ ɜɢɫɨɤɨɝ ɪɢɡɢɤɚ ɨɞ ɢɧɮɟɤɰɢʁɟ ɦɭɥɬɢɪɟɡɢɫɬɟɧɬɧɢɦ ɫɨʁɟɜɢɦɚ ɛɚɤɬɟɪɢʁɚ (MDЊ), ɤɚɨ ɢ ɡɛɨɝ ɜɟɥɢɤɨɝ ɩɪɟɤɥɚɩɚʃɚ ɭ ɬɟɪɚɩɢʁɫɤɨɦ ɩɪɢɫɬɭɩɭ13. Ɂɛɨɝ ɱɢʃɟɧɢɰɟ ɞɚ ɫɭ ʃɢɦɚ ɨɛɭɯɜɚʄɟɧɟ ɢ ɩɧɟɭɦɨɧɢʁɟ ɤɨʁɟ ɫɟ ʁɚɜʂɚʁɭ ɤɨɞ ɨɫɨɛɚ ɤɨʁɟ ɛɨɪɚɜɟ ɭ ɭɫɬɚɧɨɜɚɦɚ ɬɪɚʁɧɨɝ ɫɦɟɲɬɚʁɚ ɢ ɡɛɪɢʃɚɜɚʃɚ, ɞɨɦɨɜɢɦɚ ɡɚ ɫɬɚɪɚ ɥɢɰɚ, ɧɟɤɢ ɚɭɬɨɪɢ ɫɭ ɢɯ ɫɜɪɫɬɚɥɢ ɭ ɝɪɭɩɭ ɜɚɧɛɨɥɧɢɱɤɢɯ ɩɧɟɭɦɨɧɢʁɚ, ɢɥɢ ɭ ɩɨɫɟɛɧɭ ɝɪɭɩɭ „ɩɧɟɭɦɨɧɢʁɚ ɤɨʁɟ ɫɟ ʁɚɜʂɚʁɭ ɭ ɞɨɦɨɜɢɦɚ ɡɚ ɫɬɚɪɟ“2. ɉɨ ɧɨɜɢʁɨʁ ɤɥɚɫɢɮɢɤɚɰɢʁɢ, ɩɧɟɭɦɨɧɢʁɟ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɩɨɞ ɡɞɪɚɜɫɬɜɟɧɢɦ ɧɚɞɡɨɪɨɦ ɩɪɟɞɫɬɚɜʂɚʁɭ ɩɨɫɟɛɧɭ ɝɪɭɩɭ ɩɧɟɭɦɨɧɢʁɚ ɤɨʁɟ ɢɦɚʁɭ ɬɟɠɭ ɤɥɢɧɢɱɤɭ ɫɥɢɤɭ ɨɞ ɜɚɧɛɨɥɧɢɱɤɢɯ, ɞɭɠɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɭ ɢ ɜɟʄɢ ɦɨɪɬɚɥɢɬɟɬ (ɢ ɞɨ 17,8%16), ɚ ɫɚ ɞɪɭɝɟ ɫɬɪɚɧɟ ɫɥɢɱɚɧ ɬɟɪɚɩɢʁɫɤɢ ɩɪɢɫɬɭɩ ɤɚɨ ɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. ɉɧɟɭɦɨɧɢʁɟ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɩɨɞ 5 ɡɞɪɚɜɫɬɜɟɧɢɦ ɧɚɞɡɨɪɨɦ ɫɟ ʁɚɜʂɚʁɭ ɤɨɞ ɨɫɨɛɚ ɤɨʁɢ ɠɢɜɟ ɭ ɭɫɬɚɧɨɜɚɦɚ ɤɨɥɟɤɬɢɜɧɨɝ ɫɦɟɲɬɚʁɚ, ɤɨɞ ɲɬɢʄɟɧɢɤɚ ɞɨɦɨɜɚ ɡɚ ɫɬɚɪɟ, ɛɨɥɟɫɧɢɤɚ ɤɨʁɢ ɫɭ ɭ ɩɪɨɬɟɤɥɢɯ 90 ɞɚɧɚ ɛɢɥɢ ɞɭɠɟ ɨɞ 5 ɞɚɧɚ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢ, ɤɨʁɢ ɫɭ ɤɨɞ ɤɭʄɟ ɢɥɢ ɚɦɛɭɥɚɧɬɧɨ ɭ ɛɨɥɧɢɰɢ ɞɨɛɢʁɚɥɢ ɢɧɮɭɡɢɨɧɭ ɬɟɪɚɩɢʁɭ (ɭɤʂɭɱɭʁɭʄɢ ɢ ɚɧɬɢɛɢɨɬɢɤɟ), ɤɨʁɢ ɫɭ ɧɚ ɯɪɨɧɢɱɧɨɦ ɩɪɨɝɪɚɦɭ ɞɢʁɚɥɢɡɟ ɢɥɢ ɫɭ ɩɪɢɦɚɥɢ ɯɟɦɢɨɬɟɪɚɩɢʁɭ ɢɥɢ ɞɪɭɝɭ ɢɦɭɧɨɫɭɩɪɟɫɢɜɧɭ ɬɟɪɚɩɢʁɭ ɭ ɬɨɤɭ ɩɪɟɬɯɨɞɧɢɯ 30 ɞɚɧɚ; ɤɨʁɢ ɫɭ ɧɨɫɢɨɰɢ ɪɚɡɥɢɱɢɬɢɯ ɤɚɬɟɬɟɪɚ ɢ/ɢɥɢ ɢɦɚʁɭ ɭɝɪɚђɟɧɟ ɦɟɞɢɰɢɧɫɤɟ ɚɩɚɪɚɬɟ/ɭɪɟђɚʁɟ; ɤɨʁɢ ɫɭ ɤɨɞ ɤɭʄɟ ɥɟɱɟɧɢ ɡɛɨɝ ɩɨɫɬɨʁɚʃɚ ɪɚɧɚ; ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɤɨʁɢ ɭ ɫɜɨɦ ɨɤɪɭɠɟʃɭ ɢɦɚʁɭ ɨɫɨɛɭ ɤɨʁɚ ʁɟ ɥɟɱɟɧɚ ɨɞ ɢɥɢ ʁɟ ɧɨɫɢɥɚɰ ɢɧɮɟɤɰɢʁɟ ɢɡɚɡɜɚɧɟ ɦɭɥɬɢɪɟɡɢɫɬɟɧɬɧɢɦ (multi drug resistant-MDR) ɤɥɢɰɚɦɚ14,15,17. 1.2 ȼɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ (Community-Acquired Pneumonia - CAP) – ɟɩɢɞɟɦɢɨɥɨɲɤɢ ɢ ɤɥɢɧɢɱɤɢ ɚɫɩɟɤɬɢ ȼɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ ɫɟ ɞɟɮɢɧɢɲɟ ɤɚɨ ɩɨɬɟɧɰɢʁɚɥɧɨ ɨɡɛɢʂɧɚ ɛɨɥɟɫɬ ɫɚ ɜɢɫɨɤɨɦ ɢɧɰɢɞɟɧɰɨɦ ɢ ɡɧɚɱɚʁɧɢɦ ɟɤɨɧɨɦɫɤɢɦ ɭɬɢɰɚʁɟɦ. ɒɢɪɨɤɨ ɪɚɫɩɪɨɫɬɪɚʃɟɧɚ ɡɥɨɭɩɨɬɪɟɛɚ ɚɧɬɢɛɢɨɬɢɤɚ, ɩɨɫɟɛɧɨ ɩɟɧɢɰɢɥɢɧɚ, ɚɥɢ ɢ ɦɚɤɪɨɥɢɞɚ ɢ ɮɥɭɨɪɨɯɢɧɨɥɨɧɚ, ɞɨɜɨɞɢ ɞɨ ɪɚɫɬɭʄɟ ɪɟɡɢɫɬɟɧɰɢʁɟ ɧɚ ɚɧɬɢɦɢɤɪɨɛɧɭ ɬɟɪɚɩɢʁɭ18. ɉɪɨɰɟɧɚ ɢɧɰɢɞɟɧɰɟ ɨɜɟ ɛɨɥɟɫɬɢ ɜɚɪɢɪɚ ɨɞ 1,6 ɞɨ 13,4 ɫɥɭɱɚʁɟɜɚ ɧɚ 1000 ɫɬɚɧɨɜɧɢɤɚ ɝɨɞɢɲʃɟ, ɚ ɜɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ ɫɟ ɫɦɚɬɪɚ ɡɚ ɲɟɫɬɢ ɩɨ ɭɱɟɫɬɚɥɨɫɬɢ ɭɡɪɨɤ ɫɦɪɬɧɨɫɬɢ ɭ ɋȺȾ. ɍ ɩɟɪɢɨɞɭ ɨɞ 1979. ɞɨ 1994. ɝɨɞɢɧɟ, ɭɤɭɩɧɚ ɫɬɨɩɚ ɫɦɪɬɧɨɫɬɢ ɨɞ ɩɧɟɭɦɨɧɢʁɟ ɢ ɝɪɢɩɚ ʁɟ ɩɨɪɚɫɥɚ ɡɚ 59% (ɧɚ ɨɫɧɨɜɭ ICD–9 ɤɥɚɫɢɮɢɤɚɰɢʁɟ ɩɨɞɚɬɚɤɚ ɨ ɦɨɪɬɚɥɢɬɟɬɭ, ɩɪɟɦɚ ɞɨɤɭɦɟɧɬɚɰɢʁɢ ɨ ɭɡɪɨɰɢɦɚ ɫɦɪɬɢ) ɭ ɋȺȾ- ɭ19. Ɂɧɚɱɚʁɚɧ ɞɟɨ ɨɜɨɝ ɩɨɪɚɫɬɚ ɬɭɦɚɱɢ ɫɟ ɞɚ ʁɟ ɧɚɫɬɚɨ ɭɫɥɟɞ ɜɟʄɟɝ ɩɪɨɩɨɪɰɢɨɧɚɥɧɨɝ ɭɱɟɲʄɚ ɨɫɨɛɚ ɫɬɚɪɢʁɢɯ ɨɞ 65 ɝɨɞɢɧɚ ɭ ɩɨɩɭɥɚɰɢʁɢ; ɩɚ ɢɩɚɤ ɢ ɩɨɞɚɰɢ ɚɧɚɥɢɡɢɪɚɧɢ ɩɨ ɩɨʁɟɞɢɧɚɱɧɢɦ ɫɬɚɪɨɫɧɢɦ ɝɪɭɩɚɦɚ ɬɚɤɨђɟ ɭɤɚɡɭʁɭ ɧɚ ɩɨɪɚɫɬ ɨɞ 22%, ɲɬɨ ɭɩɭʄɭʁɟ ɧɚ ɬɨ ɞɚ ɫɭ ɢ ɞɪɭɝɢ ɱɢɧɢɨɰɢ ɞɨɩɪɢɧɟɥɢ ɩɪɨɦɟɧɢ ɟɩɢɞɟɦɢɨɥɨɲɤɢɯ ɤɚɪɚɤɬɟɪɢɫɬɢɤɚ ɩɧɟɭɦɨɧɢʁɚ, ɭɤʂɭɱɭʁɭʄɢ ɢ ɩɨɜɟʄɚɧ ɩɪɨɰɟɧɬɭɚɥɧɢ ɭɞɟɨ ɩɨɩɭɥɚɰɢʁɟ ɫɚ ɩɪɢɫɭɬɧɢɦ ɤɨɦɨɪɛɢɞɢɬɟɬɢɦɚ ɢ ɩɨɜɟʄɚɧɢɦ ɪɢɡɢɤɨɦ ɨɞ ɧɚɫɬɚɧɤɚ ɪɟɫɩɢɪɚɬɨɪɧɟ ɢɧɮɟɤɰɢʁɟ20. 6 ɍ ȿɜɪɨɩɢ, ɩɨɞɚɰɢ ɨ ɢɧɰɢɞɟɧɰɢ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɫɭ ɩɨɡɧɚɬɢ ɫɚɦɨ ɡɚ ɢɡɜɟɫɧɚ ɩɨɞɪɭɱʁɚ ɬɪɢ ɞɪɠɚɜɟ (ɒɩɚɧɢʁɚ, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɢʁɚ ɢ Ɏɢɧɫɤɚ) ɢ ɡɚ ɧɟɲɬɨ ɪɟɩɪɟɡɟɧɬɚɬɢɜɧɢʁɢ ɭɡɨɪɚɤ ɱɢɬɚɜɟ ɞɪɠɚɜɟ ɭ ɂɬɚɥɢʁɢ ɢ ɇɟɦɚɱɤɨʁ. ɂɩɚɤ, ɢɡ ɪɚɫɩɨɥɨɠɢɜɢɯ ɩɨɞɚɬɚɤɚ ɫɟ ɭɨɱɚɜɚ ɞɚ ɭ ȿɜɪɨɩɢ ɩɨɫɬɨʁɢ ɝɪɚɞɢʁɟɧɬ ɢɧɰɢɞɟɧɰɟ ɨɞ ɫɟɜɟɪɚ ɤɚ ʁɭɝɭ, ɨɞ 11 ɨɛɨɥɟɥɢɯ ɧɚ 1000 ɫɬɚɧɨɜɧɢɤɚ ɭ Ɏɢɧɫɤɨʁ21 ɞɨ 1,6 ɧɚ 1000 ɫɬɚɧɨɜɧɢɤɚ ɭ ɒɩɚɧɢʁɢ22 ɢ ɂɬɚɥɢʁɢ23. Ɂɚɧɢɦʂɢɜɨ ʁɟ ɩɪɢɦɟɬɢɬɢ ɞɚ ʁɟ ɭ ɂɬɚɥɢʁɢ ɢɫɬɢ ɝɪɚɞɢʁɟɧɬ ɨɞ ɫɟɜɟɪɚ ɩɪɟɦɚ ʁɭɝɭ ɩɪɢɫɭɬɚɧ ɢ ɢɡɦɟђɭ ɪɚɡɥɢɱɢɬɢɯ ɨɛɥɚɫɬɢ ɢɫɬɟ ɡɟɦʂɟ. Ɉɫɢɦ ɬɨɝɚ, ɢɧɰɢɞɟɧɰɚ ɩɧɟɭɦɨɧɢʁɚ ɫɟ ɩɨɜɟʄɚɜɚ ɫɚ ɫɬɚɪɨɫɧɨɦ ɞɨɛɢ ɨɛɨɥɟɥɢɯ, ɲɬɨ ɤɨɧɡɢɫɬɟɧɬɧɨ ɩɨɬɜɪђɭʁɭ ɩɨɞɚɰɢ ɢɡ ɫɜɢɯ ɡɟɦɚʂɚ. ɉɨɞɚɰɢ ɨ ɢɧɰɢɞɟɧɰɢ ɭɤɚɡɭʁɭ ɧɚ ɭɱɟɫɬɚɥɨɫɬ ɨɞ 1 ɞɨ 5 ɫɥɭɱɚʁɟɜɚ ɧɚ 1000 ɫɬɚɧɨɜɧɢɤɚ ɝɨɞɢɲʃɟ, ɦɚɞɚ ɩɨɫɬɨʁɟ ɡɧɚɱɚʁɧɟ ɜɚɪɢʁɚɰɢʁɟ ɭ ɩɪɨɰɟɧɢ ɢɧɰɢɞɟɧɰɟ ɨɛɨɥɟɜɚʃɚ ɨɞ ɨɜɟ ɛɨɥɟɫɬɢ24. ɉɨɞɚɰɢ ɢɡ ɪɟɬɪɨɫɩɟɤɬɢɜɧɟ ɫɬɭɞɢʁɟ EаТРК25 ɢ ɫɚɪɚɞɧɢɤɚ, ɩɭɛɥɢɤɨɜɚɧɟ 2009, ɤɨʁɨɦ ʁɟ ɛɢɥɨ ɨɛɭɯɜɚʄɟɧɨ 388.406 ɩɚɰɢʁɟɧɚɬɚ ɩɪɚʄɟɧɢɯ ɭ ɬɨɤɭ 2 ɝɨɞɢɧɟ ɭ ɨɤɜɢɪɭ ɩɪɨʁɟɤɬɚ ɩɪɨɰɟɧɟ ɤɜɚɥɢɬɟɬɚ ɡɞɪɚɜɫɬɜɟɧɟ ɧɟɝɟ ɭ ɇɟɦɚɱɤɨʁ, ɭɤɚɡɭʁɭ ɧɚ ɢɧɰɢɞɟɧɰɭ ɨɛɨɥɟɜɚʃɚ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɤɨʁɚ ʁɟ ɢɡɧɨɫɢɥɚ 2,75/2,96 ɧɚ 1000 ɫɬɚɧɨɜɧɢɤɚ/ɝɨɞɢɲʃɟ (ɩɨɞɚɰɢ ɡɚ 2005/2006. ɝɨɞɢɧɭ) ɢ ɛɢɥɚ ɧɟɲɬɨ ɜɢɲɚ ɤɨɞ ɦɭɲɤɚɪɚɰɚ ɭ ɨɞɧɨɫɭ ɧɚ ɠɟɧɟ (3,21 ɩɪɟɦɚ 2,52 ɧɚ 1000 ɫɬɚɧɨɜɧɢɤɚ/ɝɨɞɢɲʃɟ). ɉɨɫɬɨʁɢ ɧɟɞɜɨɫɦɢɫɥɟɧɢ ɩɨɪɚɫɬ ɫɬɨɩɟ ɨɛɨɥɟɜɚʃɚ ɨɞ ɨɜɟ ɛɨɥɟɫɬɢ ɭ ɫɬɚɪɢʁɟɦ ɠɢɜɨɬɧɨɦ ɞɨɛɭ, ɧɚ ɧɚɜɟɞɟɧɨɦ ɭɡɨɪɤɭ ɫɬɨɩɚ ɢɧɰɢɞɟɧɰɟ ɤɨɞ ɨɫɨɛɚ ɫɬɚɪɢʁɢɯ ɨɞ 60 ɝɨɞɢɧɚ ʁɟ ɢɡɧɨɫɢɥɚ ɱɚɤ 7,65 ɧɚ 1000 ɫɬɚɧɨɜɧɢɤɚ/ɝɨɞɢɲʃɟ. ɋɬɨɩɚ ɦɨɪɬɚɥɢɬɟɬɚ ʁɟ ɛɢɥɚ ɧɟɲɬɨ ɜɟʄɚ ɧɟɝɨ ɲɬɨ ʁɟ ɪɚɧɢʁɢɦ ɫɥɢɱɧɢɦ ɫɬɭɞɢʁɚɦɚ ɞɨɤɚɡɚɧɨ ɢ ɢɡɧɨɫɢɥɚ ʁɟ 13,43%/14,44% (2005/2006. ɝɨɞɢɧɚ). ɍɬɜɪђɟɧɨ ʁɟ ɬɚɤɨђɟ ɞɚ ʁɟ CЊB-65 ɛɢɨ ɜɪɥɨ ɩɨɭɡɞɚɧ ɩɪɟɞɢɤɬɨɪ ɦɨɪɬɚɥɢɬɟɬɚ ɤɨɞ ɨɜɢɯ ɩɚɰɢʁɟɧɚɬɚ. ɉɪɟɰɢɡɧɨ ɭɬɜɪђɢɜɚʃɟ ɢɧɰɢɞɟɧɰɟ ɨɛɨɥɟɜɚʃɚ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ʁɟ ɬɟɲɤɨ ʁɟɪ ɨɜɨ ɫɬɚʃɟ ɧɢʁɟ ʁɟɞɧɨɫɬɚɜɧɨ ɞɟɮɢɧɢɫɚɬɢ ɛɟɡ ɩɪɢɫɬɭɩɚ ɪɚɞɢɨɝɪɚɮɢʁɢ ɝɪɭɞɧɨɝ ɤɨɲɚ. ɋɬɨɝɚ, ɜɟɥɢɤɢ ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɛɢɜɚ ɞɢʁɚɝɧɨɫɬɢɤɨɜɚɧ ɢ ɥɟɱɟɧ ɛɟɡ ɪɚɞɢɨɝɪɚɮɫɤɟ ɩɨɬɜɪɞɟ. ȼɪɥɨ ɫɭ ɱɟɫɬɟ ɝɪɟɲɤɟ, ɝɞɟ ɞɪɭɝɟ ɛɨɥɟɫɬɢ ɩɥɭʄɚ ɛɢɜɚʁɭ ɩɪɟɩɨɡɧɚɬɟ ɤɚɨ ɜɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ, ɭɤɨɥɢɤɨ ɫɟ ɧɟ ɩɪɚɬɟ ɞɨ ɫɜɨɝ ɤɨɧɚɱɧɨɝ ɢɫɯɨɞɚ. ȼɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɨɛɭɯɜɚɬɚʁɭ ɜɪɥɨ ɲɢɪɨɤ ɞɢʁɚɩɚɡɨɧ ɪɚɡɥɢɱɢɬɢɯ ɨɛɥɢɤɚ ɛɨɥɟɫɬɢ, ɨɞ ɛɥɚɝɟ ɞɨ ɠɢɜɨɬɧɨ ɭɝɪɨɠɚɜɚʁɭʄɟ. Ɇɧɨɝɢ ɫɥɭɱɚʁɟɜɢ ɫɭ ɛɥɚɝɢ ɢ ɡɛɪɢʃɚɜɚʁɭ ɫɟ ɭ ɭɫɥɨɜɢɦɚ ɝɞɟ ɪɚɞɢɨɝɪɚɮɢʁɟ ɩɥɭʄɚ ɧɢɫɭ ɩɪɢɫɬɭɩɚɱɧɟ. Ȼɨɥɟɫɬ ʁɟ ɭɱɟɫɬɚɥɢʁɚ ɭ ɫɬɚɪɨɫɧɨʁ ɝɪɭɩɢ ɞɟɰɟ ɞɨ 5 ɝɨɞɢɧɚ ɚ ɧɚʁɦɚʃɟ ɭɱɟɫɬɚɥɚ ɤɨɞ ɨɫɨɛɚ 7 ɫɬɚɪɨɫɬɢ 15 ɞɨ 29 ɝɨɞɢɧɚ26. Ɉɞ ɫɪɟɞɢɧɟ ɱɟɬɪɞɟɫɟɬɢɯ, ɭɱɟɫɬɚɥɨɫɬ ɩɨɧɨɜɨ ɪɚɫɬɟ ɫɜɟ ɞɨɤ ɧɟ ɩɨɫɬɚɧɟ ɜɪɥɨ ɡɧɚɱɚʁɧɚ ɤɨɞ ɨɫɨɛɚ ɫɬɚɪɢʁɟ ɠɢɜɨɬɧɟ ɞɨɛɢ. ɉɪɟɰɢɡɧɟ ɩɨɞɚɬɤɟ ɨ ɨɩɬɟɪɟʄɟʃɭ ɡɞɪɚɜɫɬɜɟɧɢɯ ɫɥɭɠɛɢ ɢ ɟɤɨɧɨɦɫɤɨɦ ɨɩɬɟɪɟʄɟʃɭ ɭɡɪɨɤɨɜɚɧɨɦ ɨɜɨɦ ɛɨɥɟɲʄɭ ʁɟ ɬɟɲɤɨ ɭɬɜɪɞɢɬɢ. Ɉɜɨ ʁɟ ɭɫɥɟɞ ɬɨɝɚ ɲɬɨ ɫɭ ɨɜɢ ɩɨɞɚɰɢ ɭ ɞɢɪɟɤɬɧɨʁ ɜɟɡɢ ɫɚ ɢɧɰɢɞɟɧɰɨɦ, ɤɨʁɚ ɧɢʁɟ ɭ ɩɨɬɩɭɧɨɫɬɢ ɩɨɡɧɚɬɚ, ɤɚɨ ɢ ɭɫɥɟɞ ɪɚɡɥɢɤɟ ɭ ɧɚɱɢɧɭ ɧɚ ɤɨʁɢ ɨɜɨ ɫɬɚʃɟ ɢɧɬɟɪɮɟɪɢɪɚ ɫɚ ɡɞɪɚɜɫɬɜɟɧɢɦ ɫɢɫɬɟɦɢɦɚ, ɲɬɨ ɫɟ ɪɚɡɥɢɤɭʁɟ ɨɞ ɡɟɦʂɟ ɞɨ ɡɟɦʂɟ. ɉɪɨɫɩɟɤɬɢɜɧɟ ɫɬɭɞɢʁɟ ɭɤɚɡɭʁɭ ɞɚ ɫɬɨɩɟ ɦɨɪɬɚɥɢɬɟɬɚ ɜɚɪɢɪɚʁɭ ɨɞ 1 ɞɨ 5% ɡɚ ɩɚɰɢʁɟɧɬɟ ɥɟɱɟɧɟ ɤɨɞ ɤɭʄɟ, ɞɨ 15,8% ɡɚ ɩɚɰɢʁɟɧɬɟ ɥɟɱɟɧɟ ɭ ɛɨɥɧɢɰɢ, ɩɚ ɫɜɟ ɞɨ 50% ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɭ ʁɟɞɢɧɢɰɚɦɚ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ22, 26-31. 1.3 ȼɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ - ɟɤɨɧɨɦɫɤɢ ɚɫɩɟɤɬɢ ȼɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ ɫɟ ɞɨɜɨɞɢ ɭ ɜɟɡɭ ɫɚ ɜɢɫɨɤɢɦ ɦɨɪɛɢɞɢɬɟɬɨɦ, ɦɨɪɬɚɥɢɬɟɬɨɦ ɢ ɜɟɥɢɤɨɦ ɩɨɬɪɨɲʃɨɦ ɪɟɫɭɪɫɚ ɡɞɪɚɜɫɬɜɟɧɢɯ ɫɥɭɠɛɢ ɲɢɪɨɦ ɫɜɟɬɚ. ɑɟɲʄɟ ɫɟ ʁɚɜʂɚ ɤɨɞ ɫɬɚɪɢʁɢɯ ɩɚɰɢʁɟɧɚɬɚ, ɫɚ ɩɪɢɫɭɬɧɢɦ ɤɨɦɨɪɛɢɞɢɬɟɬɢɦɚ, ɲɬɨ ɭ ɭɫɥɨɜɢɦɚ ɩɪɨɝɪɟɫɢɜɧɨɝ ɫɬɚɪɟʃɚ ɩɨɩɭɥɚɰɢʁɟ ɞɨɜɨɞɢ ɞɨ ɞɭɠɟɝ ɩɪɨɫɟɱɧɨɝ ɬɪɚʁɚʃɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɢ ɩɨɜɟʄɚɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɢ ɦɟɞɢɰɢɧɫɤɟ ɧɟɝɟ. ɋɬɚɪɟʃɟ ɩɨɩɭɥɚɰɢʁɟ ɢ ɩɪɨɞɭɠɟʃɟ ɨɱɟɤɢɜɚɧɨɝ ɬɪɚʁɚʃɚ ɠɢɜɨɬɚ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɯɪɨɧɢɱɧɢɦ ɛɨɥɟɫɬɢɦɚ, ɤɚɨ ɢ ɪɚɫɬɭʄɚ ɪɟɡɢɫɬɟɧɰɢʁɚ ɧɚ ɚɧɬɢɦɢɤɪɨɛɧɟ ɥɟɤɨɜɟ ɞɨɜɨɞɟ ɞɨ ɩɨʁɚɜɟ ɤɨɦɩɥɢɤɨɜɚɧɢɯ ɫɥɭɱɚʁɟɜɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɲɬɨ ɡɧɚɱɢ ɞɚ ʄɟ ɢ ɭ ɛɭɞɭʄɧɨɫɬɢ ɨɩɬɟɪɟʄɟʃɟ ɨɜɨɦ ɛɨɥɟɲʄɭ ɢ ɬɪɨɲɤɨɜɢ ɤɨʁɢ ɩɪɨɢɡɢɥɚɡɟ ɢɡ ʃɟɧɨɝ ɥɟɱɟʃɚ ɪɚɫɬɢ. Ⱦɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɛɨɥɟɫɬɢ ɫɟ ɝɟɧɟɪɢɲɭ ɤɪɨɡ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɭ ɩɚɰɢʁɟɧɬɚ ɢ ɦɨɝɭ ɢɡɧɨɫɢɬɢ ɱɚɤ ɞɨ 90% ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɩɨɜɟɡɚɧɢɯ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ. ɇɚʁɜɚɠɧɢʁɟ ɤɨɦɩɨɧɟɧɬɟ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɧɚʁɱɟɲʄɟ ɱɢɧɟ ɬɪɨɲɚɤ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɞɢʁɚɝɧɨɫɬɢɤɟ ɢ ɬɟɪɚɩɢʁɟ. ɇɚ ɨɜɟ ɤɨɦɩɨɧɟɧɬɟ ɡɧɚɱɚʁɧɨ ɭɬɢɱɟ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɚ ɬɟɠɢɧɚ ɛɨɥɟɫɬɢ ɢ ɫɚɦ ɬɨɤ ɛɨɥɟɫɬɢ ɬɨɤɨɦ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ. ɉɪɢɫɭɫɬɜɨ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɢ ɩɨʁɚɜɚ ɤɨɦɩɥɢɤɚɰɢʁɚ ɬɨɤɨɦ ɥɟɱɟʃɚ ɢɦɚʁɭ ɜɟɥɢɤɢ ɭɬɢɰɚʁ ɧɚ ɭɤɭɩɧɟ ɬɪɨɲɤɨɜɟ ɛɨɥɟɫɬɢ. 8 ɂɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɨɛɭɯɜɚɬɚʁɭ ɝɭɛɢɬɚɤ ɪɚɞɧɢɯ ɞɚɧɚ ɢɥɢ ɩɚɰɢʁɟɧɬɨɜɟ ɫɩɨɫɨɛɧɨɫɬɢ ɞɚ ɫɩɪɨɜɨɞɢ ɫɜɨʁɟ ɪɟɞɨɜɧɟ ɚɤɬɢɜɧɨɫɬɢ, ɚ ɛɭɞɭʄɢ ɞɚ ʁɟ ɜɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ ɩɨɬɟɧɰɢʁɚɥɧɨ ɮɚɬɚɥɧɚ ɛɨɥɟɫɬ, ɢ ɩɨɬɟɧɰɢʁɚɥɧɢ ɝɭɛɢɬɚɤ ɝɨɞɢɧɚ ɠɢɜɨɬɚ. „ɇɟɞɨɞɢɪʂɢɜɟ ɬɪɨɲɤɨɜɟ“ ɬɪɟɛɚ ɬɚɤɨђɟ ɭɡɟɬɢ ɭ ɨɛɡɢɪ, ɦɚɞɚ ɫɟ ɫɦɚɬɪɚʁɭ ɦɚʃɟ ɡɧɚɱɚʁɧɢɦɚ, ɛɭɞɭʄɢ ɞɚ ʁɟ ɜɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ ɚɤɭɬɧɚ ɛɨɥɟɫɬ. Ɉɧɢ ɨɛɭɯɜɚɬɚʁɭ ɝɭɛɢɬɚɤ ɫɩɨɫɨɛɧɨɫɬɢ ɡɚ ɜɨђɟʃɟ ɛɪɢɝɟ ɨ ɫɟɛɢ, ɲɬɨ ʁɟ ɨɞ ɩɨɫɟɛɧɨɝ ɡɧɚɱɚʁɚ ɭ ɩɨɩɭɥɚɰɢʁɢ ɫɬɚɪɢʁɢɯ. ɂɞɟɧɬɢɮɢɤɚɰɢʁɚ ɞɟɬɟɪɦɢɧɚɧɬɢ ɤɨʁɟ ɨɞɪɟђɭʁɭ ɜɢɫɢɧɭ ɬɪɨɲɤɨɜɚ ɦɨɠɟ ɛɢɬɢ ɨɞ ɩɨɦɨʄɢ ɭ ɞɟɮɢɧɢɫɚʃɭ ɫɬɪɚɬɟɝɢʁɚ ʃɢɯɨɜɨɝ ɫɦɚʃɟʃɚ ɢ ɟɮɢɤɚɫɧɢʁɟ ɭɩɨɬɪɟɛɟ ɩɨɫɬɨʁɟʄɢɯ ɪɟɫɭɪɫɚ. ɍ ɦɟɞɢɰɢɧɫɤɢɦ ɤɪɭɝɨɜɢɦɚ ɲɢɪɨɦ ɫɜɟɬɚ ɪɚɫɬɭʄɚ ʁɟ ɫɜɟɫɬ ɨ ɨɝɪɚɧɢɱɟɧɨɫɬɢ ɪɟɫɭɪɫɚ ɡɞɪɚɜɫɬɜɟɧɢɯ ɫɥɭɠɛɢ ɢ ɫɢɫɬɟɦɚ, ɩɚ ɫɟ ɛɪɨʁ ɫɬɭɞɢʁɚ ɤɨʁɢ ɫɟ ɛɚɜɟ ɩɪɨɛɥɟɦɨɦ ɤɨɪɢɲʄɟʃɚ ɨɜɢɯ ɪɟɫɭɪɫɚ, ɱɟɫɬɨ ɜɟɡɚɧɢɯ ɡɚ ɨɞɪɟђɟɧɟ ɛɨɥɟɫɬɢ, ɩɨɜɟʄɚɜɚ ɢɡ ɝɨɞɢɧɟ ɭ ɝɨɞɢɧɭ. ɉɪɨɬɟɤɥɢɯ ɧɟɤɨɥɢɤɨ ɞɟɰɟɧɢʁɚ ɞɢɧɚɦɢɱɧɨɝ ɪɚɡɜɨʁɚ ɡɞɪɚɜɫɬɜɟɧɟ ɟɤɨɧɨɦɢɤɟ ɲɢɪɨɦ ɫɜɟɬɚ ɫɭ ɞɨɧɟɥɟ ɧɨɜɟ ɦɟɬɨɞɨɥɨɲɤɟ ɩɪɢɫɬɭɩɟ ɭ ɩɪɨɰɟɧɢ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɢ ɦɟɞɢɰɢɧɫɤɟ ɧɟɝɟ. CШst-of-illness ɚɧɚɥɢɡɚ ɫɟ ɛɚɡɢɪɚ ɧɚ ɞɟɫɤɪɢɩɬɢɜɧɨʁ ɩɪɨɰɟɧɢ ɫɯɟɦɟ ɬɪɨɲɤɨɜɚ ɭ „ɪɟɚɥɧɨɦ ɫɜɟɬɭ“, ɩɨɜɟɡɚɧɢɯ ɫɚ ɨɞɪɟђɟɧɢɦ ɡɞɪɚɜɫɬɜɟɧɢɦ ɫɬɚʃɢɦɚ. Ɉɜɟ ɫɬɭɞɢʁɟ ɫɟ ɦɨɝɭ ɞɢɡɚʁɧɢɪɚɬɢ ɤɚɨ ɩɪɨɫɩɟɤɬɢɜɧɟ ɢ ɪɟɬɪɨɫɩɟɤɬɢɜɧɟ. ɋɭɲɬɢɧɫɤɢ, ɨɧɟ ɭɝɥɚɜɧɨɦ ɨɛɟɡɛɟђɭʁɭ ɩɨɦɧɨ ɩɪɚʄɟʃɟ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ɩɚɬɟ ɨɞ ɨɞɪɟђɟɧɢɯ ɛɨɥɟɫɬɢ ɢɥɢ ɩɨɪɟɦɟʄɚʁɚ. ɇɚ ɬɚʁ ɧɚɱɢɧ ɫɬɢɱɟɦɨ ɭɜɢɞ ɤɚɤɨ ɭ ɞɢɪɟɤɬɧɟ, ɬɚɤɨ ɢ ɭ ɢɧɞɢɪɟɤɬɧɟ ɬɪɨɲɤɨɜɟ ɥɟɱɟʃɚ (ɧɩɪ. ɝɭɛɢɬɚɤ ɩɪɨɞɭɤɬɢɜɧɨɫɬɢ). ɍ ɡɚɜɢɫɧɨɫɬɢ ɨɞ ɨɞɚɛɪɚɧɟ ɩɟɪɫɩɟɤɬɢɜɟ ɩɨɫɦɚɬɪɚʃɚ (ɝɪɚђɚɧɢɧ, ɞɪɭɲɬɜɨ, ɨɫɨɛɚ ɤɨʁɚ ɩɥɚʄɚ ɭɫɥɭɝɭ) ɦɧɨɝɟ ɫɬɭɞɢʁɟ ɫɟ ɫɭɫɪɟʄɭ ɫɚ ɬɟɲɤɨʄɚɦɚ ɭ ɩɨɤɭɲɚʁɭ ɞɚ ɨɛɭɯɜɚɬɟ ɫɜɟ ɬɪɨɲɤɨɜɟ ɩɨɜɟɡɚɧɟ ɫɚ ɛɨɥɟɲʄɭ. ɍ ɩɨɤɭɲɚʁɭ ɪɚɡɪɟɲɟʃɚ ɨɜɢɯ ɦɟɬɨɞɨɥɨɲɤɢɯ ɩɪɨɛɥɟɦɚ, ɚɧɚɥɢɡɟ ɬɪɨɲɤɨɜɚ ɫɭ ɭɡ ɤɥɢɧɢɱɤɟ ɫɬɭɞɢʁɟ ɟɮɢɤɚɫɧɨɫɬɢ ɩɨɫɬɚɥɢ ɧɚʁɲɢɪɟ ɩɪɢɦɟʃɢɜɚɧɢ ɞɢɡɚʁɧ ɫɬɭɞɢʁɚ ɤɨʁɟ ɨɛɟɡɛɟђɭʁɭ ɞɟɬɚʂɧɢ ɭɜɢɞ ɭ ɫɥɢɤɭ ɩɨʁɟɞɢɧɚɱɧɟ ɩɨɬɪɨɲʃɟ ɧɚ ɦɟɞɢɰɢɧɫɤɟ ɭɫɥɭɝɟ ɢ ɥɟɱɟʃɟ, ɩɨ ɩɚɰɢʁɟɧɬɭ. Ɋɚɫɩɨɥɨɠɢɜɢ ɩɨɞɚɰɢ ɨ ɮɚɪɦɚɤɨɟɤɨɧɨɦɫɤɢɦ ɫɬɭɞɢʁɚɦɚ ɜɟɡɚɧɢɦ ɡɚ ɩɪɟɜɟɧɰɢʁɭ, ɞɢʁɚɝɧɨɡɭ ɢ ɥɟɱɟʃɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɩɭɛɥɢɤɨɜɚɧɢɦ ɭ ɫɜɟɬɭ ɪɟɥɚɬɢɜɧɨ ɫɭ ɪɟɬɤɢ ɚɥɢ ɩɪɢɥɢɱɧɨ ɢɧɞɢɤɚɬɢɜɧɢ (Ɍɚɛɟɥɚ 1). ɋɜɢ ɭɤɚɡɭʁɭ ɧɚ ɜɢɫɨɤɟ ɬɪɨɲɤɨɜɟ ɤɨʁɢ ɩɪɨɢɡɢɥɚɡɟ ɢɡ ɥɟɱɟʃɚ ɨɜɟ 9 ɛɨɥɟɫɬɢ, ɤɚɨ ɢ ɧɚ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ ɢɡɦɟђɭ ɬɪɨɲɤɨɜɚ ɤɨɞ ɛɨɥɧɢɱɤɢɯ ɢ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟɧɢɯ ɛɨɥɟɫɧɢɤɚ. ɉɪɟɦɚ ɢɡɜɟɲɬɚʁɭ GuОst-ɚ ɢ MШrrТs-ɚ, ɨɛʁɚɜʂɟɧɨɦ 1997. ɝɨɞɢɧɟ26, Ȼɪɢɬɚɧɫɤɚ ɧɚɰɢɨɧɚɥɧɚ ɡɞɪɚɜɫɬɜɟɧɚ ɫɥɭɠɛɚ (NКtТШЧКХ HОКХtС ЋОrvТМО - NHЋ) ʁɟ ɩɨɬɪɨɲɢɥɚ 1,36 ɦɢɥɢʁɚɪɞɢ ɛɪɢɬɚɧɫɤɢɯ ɮɭɧɬɢ ɡɚ ɥɟɱɟʃɟ 16,3 ɦɢɥɢɨɧɚ ɟɩɢɡɨɞɚ ɜɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɢɯ ɢɧɮɟɤɰɢʁɚ ɞɨʃɟɝ ɪɟɫɩɢɪɚɬɨɪɧɨɝ ɬɪɚɤɬɚ, ɨɞ ɱɟɝɚ ʁɟ 32% (440,7 ɦɢɥɢɨɧɚ ɛɪɢɬɚɧɫɤɢɯ ɮɭɧɬɢ) ɩɨɬɪɨɲɟɧɨ ɧɚ ɥɟɱɟʃɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. Ɉɜɚ ɫɭɦɚ (440,7 ɦɢɥɢɨɧɚ ɛɪɢɬɚɧɫɤɢɯ ɮɭɧɬɢ) ʁɟ ɩɨɬɪɨɲɟɧɚ ɧɚ ɥɟɱɟʃɟ 261.000 ɟɩɢɡɨɞɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɝɨɞɢɲʃɟ; 32% ɨɜɢɯ ɟɩɢɡɨɞɚ ɫɭ ɥɟɱɟɧɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ, ɲɬɨ ʁɟ ɭɡɪɨɤɨɜɚɥɨ 96% ɨɞ ɭɤɭɩɧɢɯ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢ 87% ɭɤɭɩɧɢɯ ɝɨɞɢɲʃɢɯ ɬɪɨɲɤɨɜɚ. Ɍɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɚɦɛɭɥɚɧɬɧɢɯ ɩɚɰɢʁɟɧɚɬɚ (ɤɨʁɢ ɫɭ ɱɢɧɢɥɢ 68% ɫɜɢɯ ɫɥɭɱɚʁɟɜɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ) ɭɡɪɨɤɨɜɚɥɢ ɫɭ ɫɚɦɨ 4% ɭɤɭɩɧɢɯ ɝɨɞɢɲʃɢɯ ɬɪɨɲɤɨɜɚ. Ɉɜɚ ɚɧɚɥɢɡɚ ʁɟ ɩɨɤɚɡɚɥɚ ɞɚ ɩɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɡɛɪɢʃɚɜɚʃɚ ɩɧɟɭɦɨɧɢʁɟ ɭ ȼɟɥɢɤɨʁ Ȼɪɢɬɚɧɢʁɢ, ɭ ɚɦɛɭɥɚɧɬɧɢɦ ɭɫɥɨɜɢɦɚ, ɢɡɧɨɫɢ 100 ɮɭɧɬɢ ɩɨ ɟɩɢɡɨɞɢ, ɞɨɤ ʁɟ ɬɪɨɲɚɤ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɜɚɪɢɪɚɨ ɨɞ 1700 ɞɨ 5100 ɮɭɧɬɢ ɩɨ ɟɩɢɡɨɞɢ, ɭ ɡɚɜɢɫɧɨɫɬɢ ɨɞ ɞɭɠɢɧɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɤɨɦɩɥɢɤɚɰɢʁɚ. ɋɜɢ ɩɪɨɰɟʃɟɧɢ ɬɪɨɲɤɨɜɢ ɫɭ ɢɡɪɚɱɭɧɚɬɢ ɩɪɟɦɚ ɰɟɧɚɦɚ ɢɡ 1992/1993. ɝɨɞɢɧɟ. ɉɪɟɦɚ ɰɟɧɚɦɚ ɢɡ 1995/1996, ɬɪɨɲɤɨɜɢ ɫɭ ɜɟʄ ɩɨɪɚɫɥɢ ɫɚ 440,7 ɧɚ 480,4 ɦɢɥɢɨɧɚ ɛɪɢɬɚɧɫɤɢɯ ɮɭɧɬɢ. Niederman ɢ ɫɚɪɚɞɧɢɰɢ32 ɫɭ 1998. ɝɨɞɢɧɟ ɩɭɛɥɢɤɨɜɚɥɢ ɪɟɬɪɨɫɩɟɤɬɢɜɧɭ ɫɬɭɞɢʁɭ, ɤɨʁɚ ʁɟ ɩɨɤɚɡɚɥɚ ɞɚ ʁɟ ɩɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɤɨɞ ɛɨɥɧɢɱɤɢ ɥɟɱɟɧɢɯ ɩɚɰɢʁɟɧɚɬɚ ɭ ɋȺȾ ɢɡɧɨɫɢɨ 7166 ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ, ɡɚ ɩɚɰɢʁɟɧɬɟ ɫɬɚɪɢʁɟ ɨɞ 65 ɝɨɞɢɧɚ, ɫɚ ɩɪɨɫɟɱɧɨɦ ɞɭɠɢɧɨɦ ɬɪɚʁɚʃɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɨɞ 7,8 ɞɚɧɚ. Ʉɨɞ ɩɚɰɢʁɟɧɚɬɚ ɦɥɚђɢɯ ɨɞ 65 ɝɨɞɢɧɚ, ɩɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ʁɟ ɢɡɧɨɫɢɨ 6042 ɞɨɥɚɪɚ, ɞɨɤ ʁɟ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢɡɧɨɫɢɥɚ 5,8 ɞɚɧɚ. Ⱥɭɬɨɪɢ ɫɭ ɩɪɨɰɟɧɢɥɢ ɭɤɭɩɧɢ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɢɯ ɩɧɟɭɦɨɧɢʁɚ ɭ ɋȺȾ ɧɚ 8,4 ɦɢɥɢʁɚɪɞɟ ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ (4,8 ɦɥɪɞ ɡɚ ɥɟɱɟʃɟ ɩɚɰɢʁɟɧɚɬɚ ɫɬɚɪɢʁɢɯ ɨɞ 65 ɝɨɞɢɧɚ ɢ 3,6 ɦɥɪɞ ɡɚ ɥɟɱɟʃɟ ɩɚɰɢʁɟɧɚɬɚ ɦɥɚђɢɯ ɨɞ 65 ɝɨɞɢɧɚ). ɋɦɚɬɪɚ ɫɟ ɞɚ ɫɟ 95% ɫɜɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɫɬɚɪɢʁɢɯ ɨɞ 65 ɝɨɞɢɧɚ ɢ 81%, ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɦɥɚђɢɯ ɨɞ 65 ɝɨɞɢɧɚ, ɝɟɧɟɪɢɲɟ ɤɪɨɡ ɛɨɥɧɢɱɤɨ ɥɟɱɟʃɟ. OrrТМФ ɢ ɫɚɪɚɞɧɢɰɢ33 ɫɭ ɨɛʁɚɜɢɥɢ ɪɟɡɭɥɬɚɬɟ ɫɜɨʁɟ ɮɚɪɦɚɤɨɟɤɨɧɨɦɫɤɟ ɫɬɭɞɢʁɟ 2004. ɝɨɞɢɧɟ, ɫɚ 99 ɩɚɰɢʁɟɧɚɬɚ ɨɛɨɥɟɥɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɥɟɱɟɧɢɯ ɭ ɛɨɥɧɢɰɚɦɚ ɭ ɋȺȾ. 10 ɉɪɟɦɚ ɪɟɡɭɥɬɚɬɢɦɚ, ɩɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɩɨ ɩɪɢʁɟɦɭ ʁɟ ɢɡɧɨɫɢɨ 3490 ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ, ɝɞɟ ʁɟ ɧɚʁɜɟʄɢ ɭɞɟɨ ɭ ɫɬɪɭɤɬɭɪɢ ɬɪɨɲɤɨɜɚ ɱɢɧɢɨ ɫɦɟɲɬɚʁ ɭ ɛɨɥɧɢɰɢ (83,7%), ɩɨɬɨɦ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɚɧɚɥɢɡɟ (8,1%), ɚɧɬɢɦɢɤɪɨɛɧɚ ɬɟɪɚɩɢʁɚ (4,6%), ɪɚɞɢɨɥɨɲɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ (2,6%) ɢ ɬɪɨɲɤɨɜɢ ɪɟɫɩɢɪɚɬɨɪɧɟ ɩɨɬɩɨɪɟ (0,9%). Ƚɪɭɩɚ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɚ ɩɪɟɦɚ ɬɚɞɚ ɚɤɬɭɟɥɧɢɦ ɫɦɟɪɧɢɰɚɦɚ Ⱥɦɟɪɢɱɤɨɝ ɭɞɪɭɠɟʃɚ ɡɚ ɥɟɱɟʃɟ ɢɧɮɟɤɬɢɜɧɢɯ ɛɨɥɟɫɬɢ (Infectious Diseases Society of America - IDЋA) ɢɡ 1998. ɝɨɞɢɧɟ ʁɟ ɢɦɚɥɚ ɤɪɚʄɭ ɩɪɨɫɟɱɧɭ ɞɭɠɢɧɭ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ (4,5 ɞɚɧɚ), ɧɢɠɟ ɭɤɭɩɧɟ ɬɪɨɲɤɨɜɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ (3009 ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ), ɢ ɧɢɠɟ ɬɪɨɲɤɨɜɟ ɚɧɬɢɦɢɤɪɨɛɧɟ ɬɟɪɚɩɢʁɟ (117 ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ), ɭ ɩɨɪɟђɟʃɭ ɫɚ ɝɪɭɩɨɦ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ɧɢɫɭ ɥɟɱɟɧɢ ɭ ɫɤɥɚɞɭ ɫɚ ɫɦɟɪɧɢɰɚɦɚ (ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ʁɟ ɢɡɧɨɫɢɥɚ 6,8 ɞɚɧɚ, ɩɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ 4992 ɞɨɥɚɪɚ, ɚ ɚɧɬɢɦɢɤɪɨɛɧɚ ɬɟɪɚɩɢʁɚ 301 ɞɨɥɚɪ). BКrtШХШЦО ɢ ɫɚɪɚɞɧɢɰɢ27 ɫɭ ɨɛʁɚɜɢɥɢ ɪɟɡɭɥɬɚɬɟ ɢɡ ɩɨɩɭɥɚɰɢɨɧɟ ɫɬɭɞɢʁɟ ɫɩɪɨɜɟɞɟɧɟ ɭ ɒɩɚɧɢʁɢ 2004. ɝɨɞɢɧɟ. ɉɪɟɦɚ ɨɜɢɦ ɪɟɡɭɥɬɚɬɢɦɚ, ɩɪɨɫɟɱɧɢ ɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ɫɭ ɢɡɧɨɫɢɥɢ 1553 ɟɜɪɚ, ɚ ɫɬɪɭɤɬɭɪɨɦ ɬɪɨɲɤɨɜɚ ʁɟ ɞɨɦɢɧɢɪɚɥɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ, ɤɨʁɚ ʁɟ ɩɪɟɞɫɬɚɜʂɚɥɚ 84,4% ɫɜɢɯ ɬɪɨɲɤɨɜɚ. Ɍɪɨɲɚɤ ɥɟɱɟʃɚ ɢɫɬɟ ɛɨɥɟɫɬɢ ɤɨɞ ɚɦɛɭɥɚɧɬɧɢɯ ɩɚɰɢʁɟɧɚɬɚ ʁɟ ɭ ɩɪɨɫɟɤɭ ɢɡɧɨɫɢɨ 196 ɟɜɪɚ. Ⱦɭɛʂɚ ɚɧɚɥɢɡɚ ɞɨɛɢʁɟɧɢɯ ɪɟɡɭɥɬɚɬɚ ɢ ɦɨɝɭʄɧɨɫɬɢ ɪɟɞɭɤɰɢʁɟ ɬɪɨɲɤɨɜɚ ʁɟ ɭɤɚɡɚɥɚ ɧɚ ɬɨ ɞɚ ʁɟ 15,7% ɛɨɥɧɢɱɤɢɯ ɩɪɢʁɟɦɚ ɨɰɟʃɟɧɨ ɤɚɨ ɧɟɚɞɟɤɜɚɬɧɨ/ɧɟɩɨɬɪɟɛɧɨ, ɬɟ ɞɚ ɫɭ ɨɜɢ ɩɚɰɢʁɟɧɬɢ ɦɨɝɥɢ ɛɢɬɢ ɭ ɩɨɬɩɭɧɨɫɬɢ ɥɟɱɟɧɢ ɤɚɨ ɚɦɛɭɥɚɧɬɧɢ, ɞɨɤ ʁɟ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ (10,8 ɞɚɧɚ) ɦɨɝɥɚ ɛɢɬɢ ɫɦɚʃɟɧɚ ɡɚ 3,5 ɞɚɧɚ, ɤɨɞ ɧɚʁɬɟɠɢɯ ɫɥɭɱɚʁɟɜɚ ɛɨɥɟɫɬɢ. ɋɦɚʃɟʃɟ ɛɪɨʁɚ ɧɟɩɨɬɪɟɛɧɢɯ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ ɢ ɞɭɠɢɧɟ ɬɪɚʁɚʃɚ ɢɫɬɟ ɛɢ ɜɨɞɢɥɨ ɫɜɟɭɤɭɩɧɨɦ ɫɦɚʃɟʃɭ ɬɪɨɲɤɨɜɚ ɡɚ 17,4%. ɍ ɡɚɤʂɭɱɤɭ ɫɜɨʁɟ ɚɧɚɥɢɡɟ, ɚɭɬɨɪɢ ɫɭ ɢɡɧɟɥɢ ɞɚ ʁɟ 22% ɩɚɰɢʁɟɧɚɬɚ ɦɨɝɥɨ ɛɢɬɢ ɨɬɩɭɲɬɟɧɨ ɫɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɭ ɬɨɤɭ ɩɪɜɚ 3 ɞɚɧɚ ɨɞ ɩɪɢʁɟɦɚ, ɢ ɢɫɬɨɜɪɟɦɟɧɨ ɫɭɝɟɪɢɫɚɥɢ ɤɚɤɨ ɬɪɟɛɚ ɨɯɪɚɛɪɢɜɚɬɢ ɫɩɪɨɜɨђɟʃɟ ɤɪɚɬɤɢɯ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ ɩɪɚʄɟɧɢɯ ɩɪɨɞɭɠɟɬɤɨɦ ɥɟɱɟʃɚ ɧɚ ɞɪɭɝɢɦ ɧɢɜɨɢɦɚ ɡɞɪɚɜɫɬɜɟɧɨɝ ɫɢɫɬɟɦɚ (ɩɪɢɦɚɪɧɚ ɡɞɪɚɜɫɬɜɟɧɚ ɡɚɲɬɢɬɚ, ɚɦɛɭɥɚɧɬɧɚ ɬɟɪɚɩɢʁɚ, ɤɭʄɧɚ ɧɟɝɚ ɢ ɥɟɱɟʃɟ). ɂɫɬɟ ɝɨɞɢɧɟ (2004.), CШХТМО ɢ ɫɚɪɚɞɧɢɰɢ28 ɫɭ ɨɛʁɚɜɢɥɢ ɪɟɡɭɥɬɚɬɟ ɢɫɬɪɚɠɢɜɚʃɚ ɭ ɤɨʁɟɦ ɫɭ ɢɡɪɚɱɭɧɚɥɢ ɫɬɨɩɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ ɭ ɭɡɨɪɤɭ ɨɞ 7249 ɟɩɢɡɨɞɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɡɚɛɟɥɟɠɟɧɢɯ ɤɨɞ 6415 ɩɚɰɢʁɟɧɚɬɚ, ɪɟɝɪɭɬɨɜɚɧɢɯ ɢɡ ɩɨɩɭɥɚɰɢʁɟ ɡɚɩɨɫɥɟɧɢɯ. ɂɡɪɚɱɭɧɚɬɚ ɫɬɨɩɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ ʁɟ ɢɡɧɨɫɢɥɚ 19,6%, ɚ ɫɬɨɩɚ ɦɨɪɬɚɥɢɬɟɬɚ ɤɨɞ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢɯ 11 ɩɚɰɢʁɟɧɚɬɚ 9,1%. ɋɪɟɞʃɚ ɜɪɟɞɧɨɫɬ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɩɨ ɟɩɢɡɨɞɢ (ɭɤʂɭɱɭʁɭʄɢ ɬɪɨɲɤɨɜɟ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɢ ɟɜɟɧɬɭɚɥɧɟ ɬɪɨɲɤɨɜɟ ɩɪɟɬɯɨɞɧɨɝ ɚɦɛɭɥɚɧɬɧɨɝ ɥɟɱɟʃɚ) ʁɟ ɢɡɧɨɫɢɥɚ 10.227 ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ, ɞɨɤ ʁɟ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɡɚ ɚɦɛɭɥɚɧɬɧɟ ɩɚɰɢʁɟɧɬɟ ɢɡɧɨɫɢɥɚ 466 ɞɨɥɚɪɚ. Ɉɜɢ ɬɪɨɲɤɨɜɢ ɫɭ ɛɢɥɢ ɡɧɚɱɚʁɧɨ ɜɢɲɢ ɨɞ ɩɪɟɬɯɨɞɧɢɯ ɩɪɟɞɜɢђɚʃɚ. Ƚɨɞɢɲʃɢ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɢɯ ɩɧɟɭɦɨɧɢʁɚ ɭ ɋȺȾ ʁɟ ɩɪɨɰɟʃɟɧ ɧɚ 12,2 ɦɢɥɢʁɚɪɞɟ ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ. Bauer34 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɚɧɚɥɢɡɢɪɚɥɢ ɬɪɨɲɤɨɜɟ ɩɪɨɢɡɚɲɥɟ ɢɡ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡ ɛɨɥɧɢɱɤɟ ɩɟɪɫɩɟɤɬɢɜɟ. Ɋɟɡɭɥɬɚɬɢ ʃɢɯɨɜɟ ɫɬɭɞɢʁɟ ɫɭ ɩɭɛɥɢɤɨɜɚɧɢ 2005. ɝɨɞɢɧɟ ɢ ɨɛɭɯɜɚɬɚʁɭ ɩɨɞɚɬɤɟ ɢɡ 22 ɛɨɥɧɢɰɟ ɭ ɇɟɦɚɱɤɨʁ, ɫɚ 580 ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɫɬɚɧɞɚɪɞɧɨɦ ɬɟɪɚɩɢʁɨɦ (ɮɥɭɨɪɨɯɢɧɨɥɨɧɢɦɚ) ɢ ɧɟɫɬɚɧɞɚɪɞɧɨɦ (ɛɟɬɚ-ɥɚɤɬɚɦɫɤɢ ɚɧɬɢɛɢɨɬɢɰɢ ɢ ɦɚɤɪɨɥɢɞɢ). ɉɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ʁɟ ɢɡɧɨɫɢɥɚ 10,8 ɞɚɧɚ (10,0 ɞɚɧɚ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɫɬɚɧɞɚɪɞɧɨɦ ɬɟɪɚɩɢʁɨɦ ɢ 11,5 ɞɚɧɚ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɧɟɫɬɚɧɞɚɪɞɧɨɦ ɬɟɪɚɩɢʁɨɦ). ɉɪɨɫɟɱɧɚ ɜɪɟɞɧɨɫɬ ɫɜɢɯ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ʁɟ ɢɡɧɨɫɢɥɚ 1250 ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ (ɭ ɩɪɜɨʁ ɝɪɭɩɢ) ɢ 1409 ɞɨɥɚɪɚ (ɭ ɞɪɭɝɨʁ ɝɪɭɩɢ), ɩɨ ɟɩɢɡɨɞɢ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. ɍ 1997. ɝɨɞɢɧɢ, ɞɢɪɟɤɬɧɢ ɢ ɢɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɇɟɦɚɱɤɨʁ ɫɭ ɩɪɨɰɟʃɟɧɢ ɧɚ 1,64 ɦɢɥɢʁɚɪɞɟ ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ, ɨɞ ɱɟɝɚ ɫɭ 983 ɦɢɥɢɨɧɚ ɢɡɧɨɫɢɥɢ ɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɢ 656 ɦɢɥɢɨɧɚ ɢɧɞɢɪɟɤɬɧɢ (ɩɪɨɢɫɬɟɤɥɢ ɢɡ ɝɭɛɢɬɤɚ ɩɪɨɞɭɤɬɢɜɧɨɫɬɢ ɧɚ ɩɨɫɥɭ). Ɍɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɚɦɛɭɥɚɧɬɧɢɯ ɩɚɰɢʁɟɧɚɬɚ (32,8 ɦɢɥɢɨɧɚ ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ ɡɚ ɥɟɤɨɜɟ ɢ 45,9 ɡɚ ɞɪɭɝɟ ɬɪɨɲɤɨɜɟ ɥɟɱɟʃɚ) ɫɭ ɛɢɥɢ ɪɟɥɚɬɢɜɧɨ ɧɢɫɤɢ, ɞɨɤ ɫɭ ɬɪɨɲɤɨɜɢ ɧɚɫɬɚɥɢ ɭɫɥɟɞ ɥɟɱɟʃɚ ɨɜɢɯ ɩɚɰɢʁɟɧɚɬɚ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ɩɪɨɰɟʃɟɧɢ ɧɚ 896 ɦɢɥɢɨɧɚ ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ (90% ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ) ɢ ɨɧɢ ɩɪɟɞɫɬɚɜʂɚʁɭ ɡɧɚɱɚʁɧɨ ɨɩɬɟɪɟʄɟʃɟ ɡɚ ɡɞɪɚɜɫɬɜɟɧɢ ɫɢɫɬɟɦ ɭ ɰɟɥɢɧɢ ɢ ɫɢɫɬɟɦɟ ɡɞɪɚɜɫɬɜɟɧɨɝ ɨɫɢɝɭɪɚʃɚ. Reyes29 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ 2008. ɝɨɞɢɧɟ ɨɛʁɚɜɢɥɢ ɫɬɭɞɢʁɭ ɭ ɤɨʁɨʁ ɫɭ ɚɧɚɥɢɡɢɪɚɥɢ ɞɟɬɟɪɦɢɧɚɧɬɟ ɬɪɨɲɤɨɜɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɒɩɚɧɢʁɢ. ɋɬɭɞɢʁɚ ʁɟ ɭɤʂɭɱɢɥɚ 271 ɩɚɰɢʁɟɧɬɚ, ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɨɝ ɭɫɥɟɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. ɉɪɟɦɚ ɪɚɫɩɨɥɨɠɢɜɢɦ ɩɨɞɚɰɢɦɚ ɢ ɩɪɨɪɚɱɭɧɭ, ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɩɨ ɩɚɰɢʁɟɧɬɭ ʁɟ ɢɡɧɨɫɢɥɚ 1683 ɟɜɪɚ, ɩɪɢ ɱɟɦɭ ɫɭ ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɞɨɦɢɧɢɪɚɥɢ ɫɬɪɭɤɬɭɪɨɦ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ (1286 ɟɜɪɚ), ɢɡɚ ɤɨʁɢɯ ɫɭ ɭɫɥɟɞɢɥɢ ɬɪɨɲɤɨɜɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɢɯ ɚɧɚɥɢɡɚ (212 ɟɜɪɚ), ɬɟɪɚɩɢʁɟ (187 ɟɜɪɚ) ɢ ɞɢʁɚɝɧɨɫɬɢɱɤɢɯ ɩɪɨɰɟɞɭɪɚ (58 ɟɜɪɚ). ɉɨʁɚɜɚ ɤɨɦɩɥɢɤɚɰɢʁɚ 12 ɢ ɜɟʄɢ ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ - PЋI (PЧОuЦШЧТК ЋОvОrТtв IЧНОб) ɫɭ ɭɬɢɰɚɥɢ ɧɚ ɩɨɜɟʄɚʃɟ ɬɪɨɲɤɨɜɚ, ɞɨɤ ɫɬɚɪɨɫɬ ɢ ɤɨɦɨɪɛɢɞɢɬɟɬɢ ɧɢɫɭ. ɍ ɡɚɤʂɭɱɤɭ, ɤɨɦɩɥɢɤɚɰɢʁɟ – ɩɨɫɟɛɧɨ ɯɢɩɨɚɥɛɭɦɢɧɟɦɢʁɚ ɢ ɩɪɟɬɯɨɞɧɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɫɭ ɛɢɥɟ ɝɥɚɜɧɟ ɞɟɬɟɪɦɢɧɚɧɬɟ ɜɢɫɨɤɢɯ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɭɫɥɟɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. Yu35 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ 2012. ɝɨɞɢɧɟ ɨɛʁɚɜɢɥɢ ɪɟɡɭɥɬɚɬɟ ɫɬɭɞɢʁɟ ɤɨʁɨɦ ʁɟ ɨɛɭɯɜɚʄɟɧɨ 65.800 ɟɩɢɡɨɞɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɨɞ ɤɨʁɢɯ ʁɟ 39% ɥɟɱɟɧɨ ɭ ɯɨɫɩɢɬɚɥɧɢɦ ɭɫɥɨɜɢɦɚ. ɍɬɜɪђɟɧɨ ʁɟ ɞɚ ʁɟ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɟɩɢɡɨɞɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡɧɨɫɢɥɚ 32,8 ɞɚɧɚ ɡɚ ɛɨɥɧɢɱɤɢ ɥɟɱɟɧɟ ɢ 12,4 ɞɚɧɚ ɡɚ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟɧɟ ɛɨɥɟɫɧɢɤɟ, ɞɨɤ ʁɟ ɭɤɭɩɧɚ ɢɧɰɢɞɟɧɰɚ ɩɪɨɰɟʃɟɧɚ ɧɚ 4482/100.000 ɨɫɨɛɚ ɝɨɞɢɲʃɟ. Ɇɨɪɬɚɥɢɬɟɬ ɧɚɤɨɧ ɦɟɫɟɰ ɞɚɧɚ ʁɟ ɢɡɧɨɫɢɨ 8,5% ɡɚ ɯɨɫɩɢɬɚɥɧɨ ɥɟɱɟɧɟ ɢ 3,8% ɡɚ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟɧɟ ɛɨɥɟɫɧɢɤɟ. ɉɪɨɫɟɱɧɢ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɟɩɢɡɨɞɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ʁɟ ɢɡɧɨɫɢɨ 8606 ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ (18.670 ɡɚ ɯɨɫɩɢɬɚɥɧɨ ɥɟɱɟɧɟ ɢ 2394 ɡɚ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟɧɟ ɛɨɥɟɫɧɢɤɟ). ɋɜɟɭɤɭɩɧɨ ɫɟ ɩɪɨɰɟʃɭʁɟ ɞɚ ɫɟ ɝɨɞɢɲʃɟ ɞɟɫɢ 1,3 ɦɢɥɢɨɧɚ ɫɥɭɱɚʁɟɜɚ ɜɚɧɛɨɥɧɢɱɤɢɯ ɩɧɟɭɦɨɧɢʁɚ ɭ ɋȺȾ ɢ ɪɟɝɢɫɬɪɭʁɟ 74.000 ɫɦɪɬɧɢɯ ɢɫɯɨɞɚ ɤɚɨ ɩɨɫɥɟɞɢɰɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɲɬɨ ɩɪɟɞɫɬɚɜʂɚ ɟɤɨɧɨɦɫɤɨ ɨɩɬɟɪɟʄɟʃɟ ɭ ɢɡɧɨɫɭ ɨɞ 13 ɦɢɥɢʁɚɪɞɢ ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ ɝɨɞɢɲʃɟ. ɍ Јɭɠɧɨʁ Ʉɨɪɟʁɢ ʁɟ ɭ ɩɟɪɢɨɞɭ ɨɞ 2008. ɞɨ 2010. ɝɨɞɢɧɟ ɫɩɪɨɜɟɞɟɧɚ ɟɩɢɞɟɦɢɨɥɨɲɤɨ- ɮɚɪɦɚɤɨɟɤɨɧɨɦɫɤɚ ɫɬɭɞɢʁɚ ɜɚɧɛɨɥɧɢɱɤɢɯ ɩɧɟɭɦɨɧɢʁɚ ɥɟɱɟɧɢɯ ɭ ɯɨɫɩɢɬɚɥɧɢɦ ɭɫɥɨɜɢɦɚ, ɤɨɞ ɨɫɨɛɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ, ɤɨʁɨɦ ʁɟ ɛɢɥɨ ɨɛɭɯɜɚʄɟɧɨ 693 ɩɚɰɢʁɟɧɬɚ ɥɟɱɟɧɢɯ ɭ 11 ɛɨɥɧɢɰɚ ɢ ɤɥɢɧɢɱɤɢɯ ɰɟɧɬɚɪɚ ɢ ɱɢʁɟ ɫɭ ɪɟɡɭɥɬɚɬɟ 2013. ɝɨɞɢɧɟ ɨɛʁɚɜɢɥɢ ВШШ KH36 ɢ ɫɚɪɚɞɧɢɰɢ. ɉɪɟɦɚ ɬɢɦ ɪɟɡɭɥɬɚɬɢɦɚ, ɩɪɨɫɟɱɧɚ ɜɪɟɞɧɨɫɬ CUЊB-65 ɫɤɨɪɚ ɧɚ ɩɪɢʁɟɦɭ ʁɟ ɢɡɧɨɫɢɥɚ 1,16, ɩɚɬɨɝɟɧ-ɩɪɨɭɡɪɨɤɨɜɚɱ ɛɨɥɟɫɬɢ ʁɟ ɢɞɟɧɬɢɮɢɤɨɜɚɧ ɭ 32,9% ɫɥɭɱɚʁɟɜɚ (ɭ 22,4% ɫɥɭɱɚʁɟɜɚ ɬɨ ʁɟ ɛɢɨ Streptococcus pneumoniae). Ɇɨɪɬɚɥɢɬɟɬ ʁɟ ɩɪɨɰɟʃɟɧ ɧɚ 3,2%, ɞɨɤ ʁɟ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɢɡɧɨɫɢɥɚ 9 ɞɚɧɚ. ɉɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɨɜɟ ɛɨɥɟɫɬɢ ʁɟ ɢɡɪɚɱɭɧɚɬ ɧɚ 1782 ɚɦɟɪɢɱɤɚ ɞɨɥɚɪɚ ɩɨ ɩɚɰɢʁɟɧɬɭ, ɚ ɭ ɫɥɭɱɚʁɟɜɢɦɚ ɩɧɟɭɦɨɤɨɤɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡɧɨɫɢɨ ʁɟ 2049 ɞɨɥɚɪɚ. ɉɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɚɧɬɢɛɢɨɬɫɤɟ ɬɟɪɚɩɢʁɟ ʁɟ ɛɢɥɚ 22,3 ɞɚɧɚ (ɤɨɞ ɧɟ-ɩɧɟɭɦɨɤɨɤɧɟ ɩɧɟɭɦɨɧɢʁɟ), ɨɞɧɨɫɧɨ 19,7 ɞɚɧɚ (ɤɨɞ ɩɧɟɭɦɨɤɨɤɧɟ ɩɧɟɭɦɨɧɢʁɟ). ɍ ɫɬɪɭɤɬɭɪɢ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɞɨɦɢɧɢɪɚʁɭ ɬɪɨɲɤɨɜɢ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ (28,1% ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ), ɥɟɤɨɜɚ (22%) ɢ ɞɢʁɚɝɧɨɫɬɢɤɟ (15,5%). ɉɧɟɭɦɨɧɢʁɟ ɫɭ ɢɞɟɧɬɢɮɢɤɨɜɚɧɟ ɤɚɨ ɲɟɫɬɢ ɭɡɪɨɱɧɢɤ ɫɦɪɬɧɨɫɬɢ ɭ Јɭɠɧɨʁ Ʉɨɪɟʁɢ. 13 Tichopad37 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ 2013. ɝɨɞɢɧɟ ɨɛʁɚɜɢɥɢ ɪɟɡɭɥɬɚɬɟ ɫɬɭɞɢʁɟ ɭ ɤɨʁɨʁ ɫɭ ɢɡɜɪɲɢɥɢ ɩɪɨɰɟɧɭ ɢ ɨɩɢɫ ɫɬɨɩɚ ɢɧɰɢɞɟɧɰɟ, ɦɨɪɬɚɥɢɬɟɬɚ ɢ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɛɨɥɧɢɱɤɢɦ ɢ ɚɦɛɭɥɚɧɬɧɢɦ ɭɫɥɨɜɢɦɚ, ɭ ɑɟɲɤɨʁ Ɋɟɩɭɛɥɢɰɢ, ɋɥɨɜɚɱɤɨʁ, ɉɨʂɫɤɨʁ ɢ Ɇɚђɚɪɫɤɨʁ. Ɋɟɬɪɨɫɩɟɤɬɢɜɧɚ ɚɧɚɥɢɡɚ ʁɟ ɫɩɪɨɜɟɞɟɧɚ ɩɪɟɦɚ ɚɞɦɢɧɢɫɬɪɚɬɢɜɧɢɦ ɩɨɞɚɰɢɦɚ ɦɢɧɢɫɬɚɪɫɬɚɜɚ ɡɞɪɚɜʂɚ ɢ ɮɨɧɞɨɜɚ ɡɞɪɚɜɫɬɜɟɧɨɝ ɨɫɢɝɭɪɚʃɚ ɧɚɜɟɞɟɧɢɯ ɡɟɦɚʂɚ, ɡɚ ɩɚɰɢʁɟɧɬɟ ɫɚ ɩɪɢɦɚɪɧɨɦ ɞɢʁɚɝɧɨɡɨɦ ɩɧɟɭɦɨɧɢʁɟ ɭ 2009. ɝɨɞɢɧɢ, ɤɨɞ ɨɫɨɛɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ. Ɇɟђɭ ɨɫɨɛɚɦɚ ɧɚɜɟɞɟɧɟ ɫɬɚɪɨɫɧɟ ɞɨɛɢ, ɢɧɰɢɞɟɧɰɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɥɟɱɟɧɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ʁɟ ɛɢɥɚ, ɧɚ 100.000 ɨɫɨɛɚ ɝɨɞɢɲʃɟ: 456,6 (ɭ ɑɟɲɤɨʁ), 504,6 (ɭ ɋɥɨɜɚɱɤɨʁ), 363,9 (ɭ ɉɨʂɫɤɨʁ) ɢ 845,3 (ɭ Ɇɚђɚɪɫɤɨʁ). ɉɪɨɫɟɱɧɚ ɫɬɨɩɚ ɦɨɪɬɚɥɢɬɟɬɚ ɭ ɧɚɜɟɞɟɧɨʁ ɫɬɚɪɨɫɧɨʁ ɝɪɭɩɢ ʁɟ ɢɡɧɨɫɢɥɚ 19,1%, ɚ ɩɨ ɡɟɦʂɚɦɚ ɩɨʁɟɞɢɧɚɱɧɨ: 21,7% (ɑɟɲɤɚ), 20,9% (ɋɥɨɜɚɱɤɚ), 18,6% (ɉɨʂɫɤɚ), 17,8% (Ɇɚђɚɪɫɤɚ). Ⱦɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɩɨ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɢ ɭɫɥɟɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɜɚɪɢɪɚɥɢ ɫɭ ɨɞ 432 ɟɜɪɚ (ɡɚ ɫɬɚɪɨɫɧɭ ɝɪɭɩɭ 50–64 ɝɨɞɢɧɚ, ɉɨʂɫɤɚ) ɞɨ 1045 ɟɜɪɚ (ɡɚ ɫɬɚɪɨɫɧɭ ɝɪɭɩɭ 50–64 ɝɨɞɢɧɚ, ɋɥɨɜɚɱɤɚ), ɩɨ ɫɥɭɱɚʁɭ. Ⱦɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɤɨɞ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟɧɢɯ ɩɚɰɢʁɟɧɚɬɚ ɫɭ ɢɡɧɨɫɢɥɢ ɭ ɩɪɨɫɟɤɭ ɦɚʃɟ ɨɞ 10% ɨɞ ɢɡɧɨɫɚ ɩɪɨɫɟɱɧɢɯ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɩɨ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɨɦ ɩɚɰɢʁɟɧɬɭ, ɜɚɪɢɪɚʁɭʄɢ ɨɞ 4 ɟɜɪɚ (ɫɬɚɪɨɫɧɚ ɝɪɭɩɚ 50–64 ɝɨɞɢɧɚ, Ɇɚђɚɪɫɤɚ) ɞɨ 71 ɟɜɪɚ (ɫɬɚɪɨɫɧɚ ɝɪɭɩɚ 50–64 ɝɨɞɢɧɚ, ɑɟɲɤɚ). ɇɢ ɭ ʁɟɞɧɨʁ ɡɟɦʂɢ ɧɢʁɟ ɡɚɛɟɥɟɠɟɧɚ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ ɭ ɜɢɫɢɧɢ ɬɪɨɲɤɨɜɚ ɢɡɦɟђɭ ɚɧɚɥɢɡɢɪɚɧɢɯ ɫɬɚɪɨɫɧɢɯ ɝɪɭɩɚ. Ⱦɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢɯ ɩɚɰɢʁɟɧɚɬɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ ɫɭ ɛɢɥɢ ɞɨ ɨɫɚɦ ɩɭɬɚ ɜɟʄɢ ɨɞ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ (ɋɥɨɜɚɱɤɚ, ɉɨʂɫɤɚ, Ɇɚђɚɪɫɤɚ), ɞɨɤ ɫɭ ɢɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢɯ ɩɚɰɢʁɟɧɚɬɚ ɛɢɥɢ ɞɨ 40 ɩɭɬɚ ɜɟʄɢ ɨɞ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɤɨɞ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟɧɢɯ ɩɚɰɢʁɟɧɚɬɚ (Ɇɚђɚɪɫɤɚ). ɍɤɭɩɧɨ ɟɤɨɧɨɦɫɤɨ ɨɩɬɟɪɟʄɟʃɟ ɢɡɚɡɜɚɧɨ ɜɚɧɛɨɥɧɢɱɤɢɦ ɩɧɟɭɦɨɧɢʁɚɦɚ ɤɨɞ ɨɫɨɛɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ ʁɟ ɢɡɧɨɫɢɥɨ 12.579.543 ɟɜɪɚ (ɑɟɲɤɚ); 9.160.774 ɟɜɪɚ (ɋɥɨɜɚɱɤɚ); 22.409.085 ɟɜɪɚ (ɉɨʂɫɤɚ) ɢ 18.298.449 ɟɜɪɚ (Ɇɚђɚɪɫɤɚ), ɝɨɞɢɲʃɟ. ɂɧɰɢɞɟɧɰɚ, ɜɟɪɨɜɚɬɧɨʄɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɦɨɪɬɚɥɢɬɟɬ ɫɭ ɫɟ ɩɨɜɟʄɚɜɚɥɢ ɫɚ ɫɬɚɪɨɲʄɭ. Ɍɪɨɲɚɤ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ʁɟ ɱɢɧɢɨ ɩɪɟɤɨ 90% ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ. ȿɤɨɧɨɦɫɤɨ ɨɩɬɟɪɟʄɟʃɟ ɢɡɚɡɜɚɧɨ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ ɪɚɫɬɟ ɫɚ ɫɬɚɪɟʃɟɦ ɩɨɩɭɥɚɰɢʁɟ ɭ ɱɟɬɢɪɢ ɩɨɫɦɚɬɪɚɧɟ ɡɟɦʂɟ ȿɜɪɨɩɫɤɟ ɍɧɢʁɟ, ɩɪɢ ɱɟɦɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ ɧɚʁɡɧɚɱɚʁɧɢʁɟ ɩɨɞɢɠɟ ɬɪɨɲɤɨɜɟ ɥɟɱɟʃɚ ɭ ɩɨɩɭɥɚɰɢʁɢ ɫɬɚɪɢʁɢɯ. ɉɪɢɦɟʄɟɧɨ ʁɟ ɢ ɞɚ ɫɭ ɡɚɛɟɥɟɠɟɧɟ ɫɬɨɩɟ ɦɨɪɬɚɥɢɬɟɬɚ ɝɟɧɟɪɚɥɧɨ ɜɢɲɟ ɨɞ ɨɧɢɯ ɩɪɢʁɚɜʂɟɧɢɯ ɭ ɡɟɦʂɚɦɚ ɡɚɩɚɞɚ ȿɜɪɨɩɫɤɟ ɍɧɢʁɟ. 14 Ɋɚɫɩɨɥɨɠɢɜɢ ɩɨɞɚɰɢ ɭɤɚɡɭʁɭ ɞɚ ɩɪɨɰɟɧɚɬ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ ɥɟɱɟɧɢɯ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ɜɚɪɢɪɚ ɢɡɦɟђɭ 18 ɢ 60%27. Ȼɪɨʁɧɢ ɫɭ ɢ ɪɚɡɥɢɱɢɬɢ ɱɢɧɢɨɰɢ ɤɨʁɢ ɢɦɚʁɭ ɭɬɢɰɚʁɚ ɧɚ ɨɜɨ, ɤɚɨ ɲɬɨ ɫɭ: ɫɬɚɪɨɫɬ, ɤɨɦɨɪɛɢɞɢɬɟɬɢ, ɪɚɫɩɨɥɨɠɢɜɨɫɬ ɢ ɛɥɢɡɢɧɚ ɛɨɥɧɢɰɟ, ɫɨɰɢʁɚɥɧɢ ɪɚɡɥɨɡɢ, ɦɚʃɚɤ ɩɨɜɟɪɟʃɚ ɭ ɤɨɦɩɥɢʁɚɧɫɭ ɩɚɰɢʁɟɧɬɚ ɢ ɞɪɭɝɢ ɫɭɛʁɟɤɬɢɜɧɢ ɤɪɢɬɟɪɢʁɭɦɢ ɫɚ ɤɪɭɰɢʁɚɥɧɢɦ ɭɬɢɰɚʁɟɦ ɭ ɬɪɟɧɭɬɤɭ ɞɨɧɨɲɟʃɚ ɨɞɥɭɤɟ ɞɚ ɥɢ ʄɟ ɩɚɰɢʁɟɧɬ ɛɢɬɢ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧ ɢɥɢ ɧɟ. Ʉɥɢɧɢɱɚɪɢ ɬɟɠɟ ɤɚ ɛɨɥɧɢɱɤɨɦ ɥɟɱɟʃɭ ɤɚɞ ɝɨɞ ɩɨɫɬɨʁɢ ɫɭɦʃɚ ɭ ɩɨɡɢɬɢɜɚɧ ɢɫɯɨɞ ɚɦɛɭɥɚɧɬɧɨɝ ɥɟɱɟʃɚ38. Ɋɟɡɭɥɬɚɬɢ ɫɬɭɞɢʁɚ ɬɚɤɨђɟ ɭɤɚɡɭʁɭ ɧɚ ɬɨ ɞɚ ɤɪɚʄɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɧɟ ɩɨɜɟʄɚɜɚʁɭ ɫɬɟɩɟɧ ɦɨɪɬɚɥɢɬɟɬɚ ɩɨ ɨɬɩɭɫɬɭ ɢɡ ɛɨɥɧɢɰɟ ɧɢɬɢ ɫɬɨɩɭ ɩɨɧɨɜɧɢɯ ɩɪɢʁɟɦɚ ɭ ɛɨɥɧɢɰɭ, ɚɥɢ ɧɟ ɩɨɫɬɨʁɢ ʁɟɞɢɧɫɬɜɟɧɨ ɦɢɲʂɟʃɟ ɭ ɩɨɝɥɟɞɭ ɨɩɬɢɦɚɥɧɟ ɞɭɠɢɧɟ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɡɚ ɩɚɰɢʁɟɧɬɟ ɨɛɨɥɟɥɟ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ39. ɉɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɚɧɬɢɛɢɨɬɫɤɟ ɬɟɪɚɩɢʁɟ ɤɨɞ ɚɦɛɭɥɚɧɬɧɢɯ ɩɚɰɢʁɟɧɚɬɚ ɬɪɟɛɚ ɞɚ ʁɟ ɢɡɦɟђɭ 8 ɢ 10 ɞɚɧɚ, ɡɚ ɩɚɰɢʁɟɧɬɟ ɫɚ ɧɢɫɤɢɦ ɪɢɡɢɤɨɦ40, ɚɥɢ ɧɚʁɜɟʄɢ ɛɪɨʁ ɩɨɞɚɬɚɤɚ ɢɡ ɥɢɬɟɪɚɬɭɪɟ ɭɤɚɡɭʁɟ ɧɚ ɚɧɬɢɛɢɨɬɫɤɭ ɬɟɪɚɩɢʁɭ ɭ ɬɪɚʁɚʃɭ ɨɞ 14 ɞɚɧɚ27. ɉɪɟɦɚ ɧɟɤɢɦ ɫɬɭɞɢʁɚɦɚ, ɢɧɬɪɚɜɟɧɫɤɚ ɩɪɢɦɟɧɚ ɚɧɬɢɛɢɨɬɢɤɚ ɬɪɚʁɚɥɚ ʁɟ 6 ɞɨ 7 ɞɚɧɚ27,41. ɂɩɚɤ, ɢɧɬɪɚɜɟɧɫɤɚ ɚɧɬɢɛɢɨɬɫɤɚ ɬɟɪɚɩɢʁɚ ɭ ɬɪɚʁɚʃɭ ɨɞ 2 ɞɨ 3 ɞɚɧɚ ɛɢ ɦɨɝɥɚ ɛɢɬɢ ɩɨɞʁɟɞɧɚɤɨ ɟɮɢɤɚɫɧɚ ɢ ɦɨɝɥɚ ɛɢ ɪɟɞɭɤɨɜɚɬɢ ɞɭɠɢɧɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɬɪɨɲɤɨɜɟ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɧɢɫɤɢɦ ɪɢɡɢɤɨɦ40. ɉɪɟɦɚ ɩɨɞɚɰɢɦɚ ɢɡ ɥɢɬɟɪɚɬɭɪɟ, ɜɪɟɦɟɧɫɤɢ ɩɟɪɢɨɞ ɨɞ ɤɥɢɧɢɱɤɟ ɪɟɡɨɥɭɰɢʁɟ ɞɨ ɩɨɜɪɚɬɤɚ ɧɨɪɦɚɥɧɢɦ ɩɨɫɥɨɜɧɢɦ ɚɤɬɢɜɧɨɫɬɢɦɚ ʁɟ ɬɪɚʁɚɨ ɱɚɤ ɞɨ 22 ɢɥɢ 25 ɞɚɧɚ27,42, ɲɬɨ ɫɟ ɞɨɜɨɞɢɥɨ ɭ ɜɟɡɭ ɫɚ ɨɞɪɠɚɜɚʃɟɦ ɧɟɤɢɯ ɫɢɦɩɬɨɦɚ ɤɚɨ ɲɬɨ ɫɭ ɡɚɦɨɪ ɢ ɦɚɥɚɤɫɚɥɨɫɬ, ɫɬɚɪɨɲʄɭ ɩɚɰɢʁɟɧɬɚ ɚɥɢ ɢ ɫɚ ɜɪɟɦɟɧɨɦ ɱɟɤɚʃɚ ɞɨ ɤɨɦɩɥɟɬɧɟ ɪɚɞɢɨɝɪɚɮɫɤɟ ɪɟɡɨɥɭɰɢʁɟ. ɍ ɭɤɭɩɧɨʁ ɫɬɪɭɤɬɭɪɢ ɬɪɨɲɤɨɜɚ, ɬɟɪɚɩɢʁɚ ɱɢɧɢ 10 ɞɨ 15% ɫɜɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ27,29,35,39. ɋɚ ɞɪɭɝɟ ɫɬɪɚɧɟ, ɩɪɟɦɚ ЊОвОs ɢ ɫɚɪɚɞɧɢɰɢɦɚ29, ɱɚɤ 79% ɬɪɨɲɤɨɜɚ ɬɟɪɚɩɢʁɟ ɨɞɝɨɜɚɪɚ ɚɧɬɢɛɢɨɬɫɤɨʁ ɬɟɪɚɩɢʁɢ, ɝɞɟ ɩɪɨɰɟɧɚɬ ɡɚɜɢɫɢ ɨɞ ɜɪɫɬɟ ɤɨɪɢɲʄɟɧɨɝ ɚɧɬɢɛɢɨɬɢɤɚ, ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɢ ɩɪɨɰɟɧɟ ɦɨɝɭʄɢɯ ɤɨɦɩɥɢɤɚɰɢʁɚ. BКuОr ɢ ɫɚɪɚɞɧɢɰɢ34 ɫɭ ɭɤɚɡɚɥɢ ɞɚ ɭɩɨɬɪɟɛɚ ɫɤɭɩʂɢɯ ɚɧɬɢɛɢɨɬɢɤɚ, ɤɚɨ ɲɬɨ ɫɭ ɮɥɭɨɪɨɯɢɧɨɥɨɧɢ, ɦɨɠɟ ɛɢɬɢ ɩɨɜɟɡɚɧɚ ɫɚ ɤɪɚʄɢɦ ɬɪɚʁɚʃɟɦ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɧɟ ɞɨɜɨɞɢ ɞɨ ɩɪɨɦɟɧɚ ɭ ɭɤɭɩɧɢɦ ɬɪɨɲɤɨɜɢɦɚ. 15 Ɂɚɧɢɦʂɢɜɨ ʁɟ ɭɩɨɪɟɞɢɬɢ ɪɚɡɥɢɤɟ ɭ ɰɟɧɢ ɛɨɥɧɢɱɤɨɝ ɢ ɚɦɛɭɥɚɧɬɧɨɝ (ɜɚɧɛɨɥɧɢɱɤɨɝ) ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɟ ɩɧɟɭɦɨɧɢʁɟ. BКrtШХШЦО ɢ ɫɚɪɚɞɧɢɰɢ27 ɭɤɚɡɭʁɭ ɞɚ ɫɭ ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ 7,9 ɩɭɬɚ ɜɟʄɢ ɨɞ ɬɪɨɲɤɨɜɚ ɚɦɛɭɥɚɧɬɧɨɝ ɥɟɱɟʃɚ ɢɫɬɟ ɛɨɥɟɫɬɢ, ɚ ɭ ɫɥɭɱɚʁɭ ɤɨɦɩɥɢɤɚɰɢʁɚ ɢ ɩɪɨɞɭɠɟɬɤɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɨɜɚ ɪɚɡɥɢɤɚ ɦɨɠɟ ɛɢɬɢ ɱɚɤ 17 ɞɨ 51 ɩɭɬ ɜɟʄɚ26,43,44. ɍɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɩɪɨɢɫɬɟɤɥɢ ɢɡ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɋȺȾ (ɭɤʂɭɱɭʁɭʄɢ ɢɧɞɢɪɟɤɬɧɟ) ɞɨɫɬɢɠɭ 12,2 ɦɢɥɢʁɚɪɞɟ ɞɨɥɚɪɚ, ɨɞ ɱɟɝɚ ʁɟ ɩɪɨɰɟʃɟɧɨ ɞɚ ɫɟ 10,3 ɦɢɥɢʁɚɪɞɟ ɬɪɨɲɢ ɧɚ ɥɟɱɟʃɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ (ɦɢɥɢɨɧ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ ɯ 10.233 ɞɨɥɚɪɚ, ɲɬɨ ɩɪɟɞɫɬɚɜʂɚ ɩɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɩɨ ɩɚɰɢʁɟɧɬɭ) ɢ 1,9 ɦɢɥɢʁɚɪɞɟ, ɤɨʁɟ ɫɟ ɬɪɨɲɟ ɧɚ ɥɟɱɟʃɟ ɚɦɛɭɥɚɧɬɧɢɯ ɩɚɰɢʁɟɧɚɬɚ (4,1 ɦɢɥɢɨɧ ɫɥɭɱɚʁɟɜɚ ɯ 466 ɞɨɥɚɪɚ, ɲɬɨ ʁɟ ɩɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɩɨ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟɧɨɦ ɩɚɰɢʁɟɧɬɭ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ)28. ɇɚ ɜɚɪɢʁɚɛɢɥɧɨɫɬ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɭ ɧɚʁɜɟʄɨʁ ɦɟɪɢ ɭɬɢɱɟ ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ. Cortoos45 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɧɚ ɝɪɭɩɢ ɨɞ 803 ɩɚɰɢʁɟɧɚɬɚ, ɥɟɱɟɧɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɞɜɟɦɚ ɛɨɥɧɢɰɚɦɚ ɭ Ȼɟɥɝɢʁɢ ɭ ɩɟɪɢɨɞɭ ɨɞ 2007. ɞɨ 2010. ɝɨɞɢɧɟ, ɱɢʁɢ ʁɟ ɩɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɢɡɧɨɫɢɨ 4794 ɚɦɟɪɢɱɤɚ ɞɨɥɚɪɚ ɩɨ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɢ, ɭɤɚɡɚɥɢ ɞɚ ɧɚʁɜɟʄɢ ɭɬɢɰɚʁ ɧɚ ɭɤɭɩɧɢ ɢɡɧɨɫ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɢɦɚ ɞɭɠɢɧɚ ɛɨɪɚɜɤɚ ɭ ɛɨɥɧɢɰɢ ɧɚɤɨɧ ɩɨɫɬɢɡɚʃɚ ɤɥɢɧɢɱɤɟ ɫɬɚɛɢɥɢɡɚɰɢʁɟ, ɢ ɬɨ 6,3% ɨɞɧɨɫɧɨ 4,9% ɜɢɲɟ (ɭ ɡɚɜɢɫɧɨɫɬɢ ɨɞ ɚɧɚɥɢɡɢɪɚɧɟ ɭɫɬɚɧɨɜɟ/ɛɨɥɧɢɰɟ), ɩɨ ɞɨɞɚɬɧɨɦ ɞɚɧɭ ɛɨɪɚɜɤɚ ɭ ɛɨɥɧɢɰɢ. Ⱦɪɭɝɢ, ɢɩɚɤ ɦɚʃɟ ɜɚɠɧɢ ɱɢɧɢɨɰɢ ɤɨʁɢ ɫɭ ɭɬɢɰɚɥɢ ɧɚ ɞɭɠɢɧɭ ɬɪɚʁɚʃɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɫɭ ɛɢɥɢ: ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɬɟɪɚɩɢʁɟ, ɜɪɟɞɧɨɫɬ PЋI ɫɤɨɪɚ ɧɚ ɩɪɢʁɟɦɭ, ɫɬɚɪɨɫɬ ɛɨɥɟɫɧɢɤɚ ɢ ɩɪɢʁɟɦ ɭ ʁɟɞɢɧɢɰɭ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ. Ɋɟɝɢɫɬɪɨɜɚɧɢ ɫɭ ɧɟɲɬɨ ɧɢɠɢ ɬɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɦɨɤɫɢɮɥɨɤɫɚɰɢɧɨɦ, ɞɨɤ ɫɭ ɦɚɥɨ ɭɬɢɰɚʁɚ ɢɦɚɥɢ ɤɨɦɩɥɢʁɚɧɫɚ ɢ ɫɩɪɨɜɨђɟʃɟ ɚɧɬɢɛɢɨɬɫɤɟ ɬɟɪɚɩɢʁɟ ɩɪɟɦɚ ɫɦɟɪɧɢɰɚɦɚ, ɤɚɨ ɢ ɦɨɞɢɮɢɤɨɜɚʃɟ ɚɧɬɢɛɢɨɬɫɤɟ ɬɟɪɚɩɢʁɟ ɩɪɟɦɚ ɪɟɡɭɥɬɚɬɢɦɚ ɚɧɬɢɛɢɨɝɪɚɦɚ. ɍ ɡɚɤʂɭɱɤɭ ɚɭɬɨɪɢ ɧɚɜɨɞɟ ɞɚ ʁɟ ɧɚʁɜɚɠɧɢʁɢ ɱɢɧɢɥɚɰ ɭ ɮɨɪɦɢɪɚʃɭ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ ɭɩɪɚɜɨ ɞɨɞɚɬɧɨ (ɢ ɛɟɫɩɨɬɪɟɛɧɨ) ɜɪɟɦɟ ɤɨʁɟ ɩɚɰɢʁɟɧɬ ɩɪɨɜɟɞɟ ɭ ɛɨɥɧɢɰɢ ɧɚɤɨɧ ɩɨɫɬɢɡɚʃɚ ɤɥɢɧɢɱɤɟ ɫɬɚɛɢɥɢɡɚɰɢʁɟ ɞɨ ɨɬɩɭɫɬɚ ɢɡ ɛɨɥɧɢɰɟ, ɤɚɨ ɢ ɞɚ ɛɢ ɫɦɚʃɟʃɟ ɨɜɨɝ ɩɟɪɢɨɞɚ ɞɨɜɟɥɨ ɞɨ ɡɧɚɱɚʁɧɟ ɪɟɞɭɤɰɢʁɟ ɬɪɨɲɤɨɜɚ ɩɪɨɢɫɬɟɤɥɢɯ ɢɡ ɥɟɱɟʃɚ ɨɜɟ ɛɨɥɟɫɬɢ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ. 16 Ƚɪɭɩɚ ɲɜɚʁɰɚɪɫɤɢɯ ɢɫɬɪɚɠɢɜɚɱɚ (Suter-Widmer ɢ ɫɚɪɚɞɧɢɰɢ46) ʁɟ ɧɚɤɨɧ ɫɩɪɨɜɟɞɟɧɟ ɩɪɨɫɩɟɤɬɢɜɧɟ ɦɭɥɬɢɰɟɧɬɪɢɱɧɟ ɫɬɭɞɢʁɟ ɭ 6 ɬɟɪɰɢʁɚɪɧɢɯ ɛɨɥɧɢɰɚ ɭ ɒɜɚʁɰɚɪɫɤɨʁ ɭ ɩɟɪɢɨɞɭ ɨɞ 2006. ɞɨ 2008. ɝɨɞɢɧɟ ɭɬɜɪɞɢɥɚ ɞɚ ʁɟ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɭɫɥɟɞ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡɧɨɫɢɥɚ 9,8 ɞɚɧɚ (ɧɚ ɝɪɭɩɢ ɨɞ 875 ɩɚɰɢʁɟɧɚɬɚ). Ʉɚɨ ɧɚʁɜɚɠɧɢʁɢ ɱɢɧɢɨɰɢ – ɩɪɟɞɢɤɬɨɪɢ ɞɭɠɢɧɟ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɢɞɟɧɬɢɮɢɤɨɜɚɧɢ ɫɭ: ɫɬɚɪɨɫɬ ɛɨɥɟɫɧɢɤɚ, ɪɟɫɩɢɪɚɬɨɪɧɚ ɮɪɟɤɜɟɧɰɚ ɜɟʄɚ ɨɞ 20 ɪɟɫɩɢɪɚɰɢʁɚ ɭ ɦɢɧɭɬɢ ɧɚ ɩɪɢʁɟɦɭ, ɩɪɟɬɯɨɞɧɢ ɛɨɪɚɜɚɤ ɭ ɭɫɬɚɧɨɜɢ ɬɪɚʁɧɨɝ ɤɨɥɟɤɬɢɜɧɨɝ ɫɦɟɲɬɚʁɚ/ɞɨɦɭ ɡɚ ɫɬɚɪɟ, ɯɪɨɧɢɱɧɚ ɨɩɫɬɪɭɤɬɢɜɧɚ ɛɨɥɟɫɬ ɩɥɭʄɚ, ɞɢʁɚɛɟɬɟɫ, ɦɭɥɬɢɥɨɛɚɪɧɚ ɩɧɟɭɦɨɧɢʁɚ ɢ PЋI ɫɤɨɪ ɧɚ ɩɪɢʁɟɦɭ. Ⱦɪɭɝɢ, ɧɟɡɚɜɢɫɧɢ ɱɢɧɢɨɰɢ ɤɨʁɢ ɡɧɚɱɚʁɧɨ ɭɬɢɱɭ ɧɚ ɞɭɠɢɧɭ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ, ɭɡɢɦɚʁɭʄɢ ɭ ɨɛɡɢɪ ɢɧɮɨɪɦɚɰɢʁɟ ɞɨɛɢʁɟɧɟ ɭ ɬɨɤɭ ɫɚɦɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɫɭ: ɧɢɡɚɤ ɧɢɜɨ ɫɟɪɭɦɫɤɢɯ ɚɥɛɭɦɢɧɚ, ɩɪɟɜɨɞ ɭ ʁɟɞɢɧɢɰɭ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ ɢ ɪɚɡɜɨʁ ɤɨɦɩɥɢɤɚɰɢʁɚ ɛɨɥɟɫɬɢ. ɇɚɜɨɞɟʄɢ ɧɚɜɟɞɟɧɟ ɱɢɧɢɨɰɟ, ɭ ɡɚɤʂɭɱɤɭ ɬɟɤɫɬɚ ɩɨɧɨɜɨ ɭɤɚɡɭʁɭ ɧɚ ɡɧɚɱɚʁ ɨɬɩɭɫɬɚ ɩɚɰɢʁɟɧɬɚ ɢɡ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɨɞɦɚɯ ɧɚɤɨɧ ɩɨɫɬɢɡɚʃɚ ɤɥɢɧɢɱɤɟ ɫɬɚɛɢɥɧɨɫɬɢ, ɨɞɧɨɫɧɨ ɲɬɨ ʁɟ ɩɪɟ ɦɨɝɭʄɟ, ɛɟɡ ɧɟɩɨɬɪɟɛɧɨɝ ɢɡɥɚɝɚʃɚ ɛɨɥɟɫɧɢɤɚ ɪɢɡɢɤɭ ɩɨɝɨɪɲɚʃɚ ɛɨɥɟɫɬɢ ɢɥɢ ɪɟɤɭɪɟɧɬɧɢɦ ɢɧɮɟɤɰɢʁɚɦɚ. Ⱥɭɬɨɪɢ ɫɟ ɫɥɚɠɭ ɭ ɦɢɲʂɟʃɭ ɞɚ ɫɟ ɡɧɚɱɚʁɚɧ ɛɪɨʁ ɟɩɢɡɨɞɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɦɨɠɟ ɥɟɱɢɬɢ ɚɦɛɭɥɚɧɬɧɨ, ɬɟ ɞɚ ɫɟ ɧɚ ɬɚʁ ɧɚɱɢɧ ɦɨɠɟ ɢɡɛɟʄɢ ɜɟɥɢɤɢ ɛɪɨʁ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ27, ɲɬɨ ɛɢ ɦɨɝɥɨ ɞɨɜɟɫɬɢ ɞɨ ɫɦɚʃɟʃɚ ɬɪɨɲɤɨɜɚ ɤɨʁɢ ɧɚɫɬɚʁɭ ɭɫɥɟɞ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɛɨɪɚɜɤɚ ɭ ɛɨɥɧɢɰɢ. ɋɬɪɢɤɬɧɨ ɩɪɢɞɪɠɚɜɚʃɟ ɫɦɟɪɧɢɰɚ ɛɢ ɛɢɨ ɡɧɚɱɚʁɚɧ ɤɨɪɚɤ ɭ ɪɟɞɭɤɰɢʁɢ ɬɪɨɲɤɨɜɚ, ɩɪɟ ɫɜɟɝɚ ɭ ɩɨɝɥɟɞɭ ɩɪɢɦɟɧɟ ɢɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ (PЧОuЦШЧТК ЋОvОrТtв IЧНОб – PSI), ɤɨʁɢ ɨɦɨɝɭʄɚɜɚ ɫɬɪɚɬɢɮɢɤɚɰɢʁɭ ɩɚɰɢʁɟɧɚɬɚ ɭ ɤɚɬɟɝɨɪɢʁɟ ɪɢɡɢɤɚ ɧɚ ɩɪɢʁɟɦɭ ɢ ɨɥɚɤɲɚɜɚ ɩɪɨɰɟɫ ɞɨɧɨɲɟʃɚ ɨɞɥɭɤɚ ɭ ɩɨɝɥɟɞɭ ɦɟɫɬɚ ɥɟɱɟʃɚ ɢ ɬɟɪɚɩɢʁɟ ɤɨʁɚ ʄɟ ɛɢɬɢ ɭɜɟɞɟɧɚ. Ɋɟɡɭɥɬɚɬɢ ɧɟɞɚɜɧɢɯ ɫɬɭɞɢʁɚ ɭɤɚɡɭʁɭ ɧɚ ɬɨ ɞɚ ʁɟ ɦɨɝɭʄɟ ɫɤɪɚɬɢɬɢ ɞɭɠɢɧɭ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɛɟɡ ɭɝɪɨɠɚɜɚʃɚ ɡɞɪɚɜʂɚ ɩɚɰɢʁɟɧɬɚ ɢɥɢ ɭɬɢɰɚʃɚ ɧɚ ɢɫɯɨɞ ɛɨɥɟɫɬɢ. Ɍɚɤɨ, CКpОХКstОРuТ ɢ ɫɚɪɚɞɧɢɰɢ47 ɫɭ ɭ ɪɟɡɭɥɬɚɬɢɦɚ ɫɜɨɝ ɪɚɞɚ ɭɤɚɡɚɥɢ ɞɚ ʁɟ ɛɢɥɨ ɦɨɝɭʄɟ ɫɤɪɚɬɢɬɢ ɩɪɨɫɟɱɧɭ ɞɭɠɢɧɭ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɫɚ 5,6 ɞɚɧɚ ɭ 2000. ɢ 2001. ɧɚ 3,7 ɞɚɧɚ ɭ 2006. ɢ 2007. ɝɨɞɢɧɢ, ɲɬɨ ɧɢʁɟ ɛɢɥɨ ɩɪɚʄɟɧɨ ɩɨɪɚɫɬɨɦ ɫɬɨɩɟ ɦɨɪɬɚɥɢɬɟɬɚ ɭɫɥɟɞ ɨɜɟ ɛɨɥɟɫɬɢ, ɧɢɬɢ ɩɨɜɟʄɚɧɨɦ ɫɬɨɩɨɦ ɩɨɧɨɜɧɢɯ ɩɪɢʁɟɦɚ ɭ ɛɨɥɧɢɰɭ. ȼɪɥɨ ɫɭ ɢɧɞɢɤɚɬɢɜɧɟ ɩɨɞɚɰɢ ɩɪɟɦɚ ɤɨʁɢɦɚ 22% ɩɚɰɢʁɟɧɚɬɚ ɦɨɠɟ ɛɢɬɢ ɨɬɩɭɲɬɟɧɨ ɧɚ ɤɭʄɧɨ ɥɟɱɟʃɟ (ɚɦɛɭɥɚɧɬɧɨ) ɬɨɤɨɦ ɩɪɜɚ ɬɪɢ ɞɚɧɚ ɨɞ ɩɪɢʁɟɦɚ ɭ ɛɨɥɧɢɰɭ, ɤɚɨ ɢ ɞɚ ɤɪɚɬɤɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢɡɚ ɤɨʁɢɯ ɛɢ ɭɫɥɟɞɢɨ ɧɚɫɬɚɜɚɤ ɬɟɪɚɩɢʁɟ ɢ ɩɪɨɞɭɠɟɬɚɤ ɧɟɝɟ ɧɚ ɞɪɭɝɢɦ ɧɢɜɨɢɦɚ ɡɞɪɚɜɫɬɜɟɧɟ ɡɚɲɬɢɬɟ (ɩɪɢɦɚɪɧɚ 17 ɡɞɪɚɜɫɬɜɟɧɚ ɡɚɲɬɢɬɚ, ɤɭʄɧɨ ɥɟɱɟʃɟ) ɬɪɟɛɚ ɨɡɛɢʂɧɨ ɭɡɢɦɚɬɢ ɭ ɨɛɡɢɪ27. ɇɚʁɜɟʄɢ ɬɪɨɲɤɨɜɢ ɧɚɫɬɚʁɭ ɬɨɤɨɦ ɩɪɜɚ 2 ɢɥɢ 3 ɞɚɧɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ, ɢɡɚ ɱɟɝɚ ɫɥɟɞɢ ʃɢɯɨɜɨ ɨɩɚɞɚʃɟ39. ɉɨɫɬɨʁɢ ɢɡɜɟɫɧɚ ɩɨɫɟɛɧɨɫɬ ɫɢɫɬɟɦɚ ɡɞɪɚɜɫɬɜɚ ɭ ɋɪɛɢʁɢ ɭ ɩɨɝɥɟɞɭ ɪɟɫɩɢɪɚɬɨɪɧɢɯ ɛɨɥɟɫɬɢ. ɋɪɛɢʁɚ ɩɪɟɞɫɬɚɜʂɚ ɦɚɥɨ, ɩɨɫɬ-ɫɨɰɢʁɚɥɢɫɬɢɱɤɨ, ɬɪɚɧɡɢɰɢɨɧɨ ɬɪɠɢɲɬɟ ɫɚ ɬɟɲɤɢɦ ɧɚɫɥɟђɟɦ ɰɟɧɬɪɚɥɧɨ ɩɥɚɧɢɪɚɧɟ ɟɤɨɧɨɦɢʁɟ ɭ ɩɪɨɲɥɨɫɬɢ. Ɍɨ ɧɚɫɥɟђɟ ɫɟ ɢ ɫɚɞɚ ɨɞɪɚɠɚɜɚ ɧɚ ɧɚɱɢɧɟ ɛɭџɟɬɢɪɚʃɚ ɢ ɭɩɪɚɜʂɚʃɚ ɫɪɟɞɫɬɜɢɦɚ ɤɨʁɚ ɫɟ ɨɞɜɚʁɚʁɭ ɡɚ ɡɞɪɚɜɫɬɜɟɧɭ ɡɚɲɬɢɬɭ48. ɇɟ ɫɦɟ ɫɟ ɡɚɛɨɪɚɜɢɬɢ ɧɚ ɲɢɪɨɤɭ ɪɚɲɢɪɟɧɨɫɬ ɡɚɜɢɫɧɨɫɬɢ ɨɞ ɞɭɜɚɧɚ ɭ ɋɪɛɢʁɢ, ɫɚ ɫɬɨɩɚɦɚ ɤɨʁɟ ɫɭ ɜɢɲɟ ɧɟɝɨ ɭ ɞɪɭɝɢɦ ɡɟɦʂɚɦɚ, ɲɬɨ ɬɚɤɨђɟ ɢɦɚ ɭɬɢɰɚʁɚ ɧɚ ɢɧɰɢɞɟɧɰɭ ɛɨɥɟɫɬɢ ɪɟɫɩɢɪɚɬɨɪɧɨɝ ɬɪɚɤɬɚ, ɚ ɦɟђɭ ʃɢɦɚ ɢ ɧɚ ɢɧɰɢɞɟɧɰɭ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ49. ɉɨɪɟɞ ɬɨɝɚ, ɋɪɛɢʁɚ ʁɟ ʁɟɞɧɚ ɨɞ ɪɟɬɤɢɯ ɟɜɪɨɩɫɤɢɯ ɡɟɦɚʂɚ ɤɨʁɚ ɩɪɢʁɚɜʂɭʁɟ ɩɨɪɚɫɬ ɢɧɰɢɞɟɧɰɟ ɤɚɪɰɢɧɨɦɚ ɩɥɭʄɚ50. Ɂɜɚɧɢɱɧɢ ɫɬɚɬɢɫɬɢɱɤɢ ɩɨɞɚɰɢ ɨ ɢɧɰɢɞɟɧɰɢ ɢ ɦɨɪɬɚɥɢɬɟɬɭ ɭɫɥɟɞ ɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɋɪɛɢʁɢ ɧɟ ɩɨɫɬɨʁɟ, ɩɚ ɫɟ ɩɪɟɬɩɨɫɬɚɜɤɟ ɢɡɧɟɬɟ ɭ ɨɜɨɦ ɪɚɞɭ ɛɚɡɢɪɚʁɭ ɧɚ ɨɫɤɭɞɧɢɦ ɩɨɞɚɰɢɦɚ ɨ ɢɧɞɢɰɟɧɰɢ ɭ ɦɟɞɢɬɟɪɚɧɫɤɢɦ ɡɟɦʂɚɦɚ ɫɚ ɫɥɢɱɧɢɦ ɧɚɱɢɧɨɦ ɠɢɜɨɬɚ ɢ ɩɪɢɫɭɬɧɢɦ ɪɢɡɢɰɢɦɚ ɭ ɩɨɧɚɲɚʃɭ, ɤɚɨ ɢ ɩɨɞɚɰɢɦɚ ɢɡ ɞɪɭɝɢɯ ɞɪɠɚɜɚ ɢɡ ɪɟɝɢɨɧɚ, ɫɚ ɫɥɢɱɧɢɦ ɫɨɰɢɨ- ɟɤɨɧɨɦɫɤɢɦ ɩɪɢɥɢɤɚɦɚ ɢ ɤɭɥɬɭɪɨɥɨɲɤɢɦ ɧɚɫɥɟђɟɦ (ɂɬɚɥɢʁɚ, ɒɩɚɧɢʁɚ, ɇɟɦɚɱɤɚ, ɑɟɲɤɚ, ɋɥɨɜɚɱɤɚ, ɉɨʂɫɤɚ, Ɇɚђɚɪɫɤɚ)22,23,29,34,37. ɂɡɞɜɚʁɚʃɚ ɢɡ ɛɭџɟɬɚ ɭ ɋɪɛɢʁɢ ɡɚ ɮɢɧɚɧɫɢɪɚʃɟ ɡɞɪɚɜɫɬɜɟɧɟ ɡɚɲɬɢɬɟ ɢɡ ɭɤɭɩɧɨɝ ɞɪɭɲɬɜɟɧɨɝ ɩɪɨɢɡɜɨɞɚ ɫɟ ɩɪɨɰɟʃɭʁɭ ɧɚ ɧɟɤɢɯ 10,5% ɢ 343 ɚɦɟɪɢɱɤК ɞɨɥɚɪɚ ɩɨ ɫɬɚɧɨɜɧɢɤɭ ɝɨɞɢɲʃɟ, ɩɪɟɦɚ ɪɚɫɩɨɥɨɠɢɜɢɦ ɢ ɡɜɚɧɢɱɧɢɦ ɫɬɚɬɢɫɬɢɱɤɢɦ ɩɨɞɚɰɢɦɚ ɋɜɟɬɫɤɟ Ɂɞɪɚɜɫɬɜɟɧɟ Ɉɪɝɚɧɢɡɚɰɢʁɟ (ɋɁɈ, АШrХН HОКХtС Organization - АHO) ɡɚ 2012. ɝɨɞɢɧɭ24. ȼɪɟɞɧɨɫɬɢ ɩɪɨɰɟɧɚ ɬɪɨɲɤɨɜɚ ɛɨɥɟɫɬɢ ɡɚ ɧɟɤɟ ɨɞ ɧɚʁɭɱɟɫɬɚɥɢʁɢɯ (ɞɢʁɚɛɟɬɟɫ ɬɢɩ 2, ɛɨɥɟɫɬɢ ɡɚɜɢɫɧɨɫɬɢ, ɤɚɪɰɢɧɨɦ, ɪɢɡɢɱɧɟ ɬɪɭɞɧɨʄɟ)51-54 ɭɤɚɡɭʁɭ ɧɚ ɬɨ ɞɚ ɩɨɬɪɨɲʃɚ ɢɡ џɟɩɚ ɫɚɦɨɝ ɝɪɚђɚɧɢɧɚ ɡɚ ɡɞɪɚɜɫɬɜɟɧɭ ɡɚɲɬɢɬɭ ɡɧɚɱɚʁɧɨ ɩɪɟɜɚɡɢɥɚɡɢ ɞɪɠɚɜɧɟ ɫɭɛɜɟɧɰɢʁɟ. ȼɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ ɧɟ ɩɪɟɞɫɬɚɜʂɚ ɢɡɭɡɟɬɚɤ. ɇɚ ɨɫɧɨɜɭ ɢɫɤɭɫɬɚɜɚ ɢɡ ɡɟɦɚʂɚ ɫɚ ɜɢɫɨɤɢɦ ɫɬɚɧɞɚɪɞɨɦ ɠɢɜʂɟʃɚ, ɩɪɨɰɟʃɭʁɟ ɫɟ ɞɚ ʄɟ ɭɬɢɰɚʁ ɜɚɧɛɨɥɧɢɱɤɢɯ ɩɧɟɭɦɨɧɢʁɚ ɧɚ ɛɭџɟɬ ɭ ɋɪɛɢʁɢ ɪɚɫɬɢ ɢ ɞɚʂɟ ɭ ɧɚɪɟɞɧɢɦ ɝɨɞɢɧɚɦɚ. Ɋɚɡɥɨɡɢ ɡɚ ɨɜɚʁ ɬɪɟɧɞ ɥɟɠɟ ɭ ɩɨɜɟʄɚɧɨʁ ɩɨɬɪɨɲʃɢ ɡɚ ɡɞɪɚɜɫɬɜɨ ɢ ɜɟʄɨʁ ɪɚɫɩɨɥɨɠɢɜɨɫɬɢ ɭɫɥɭɝɚ ɤɨʁɟ ʄɟ ɭɬɢɰɚɬɢ ɧɚ ɜɟʄɭ ɩɨɬɪɚɠʃɭ ɡɚ ɤɜɚɥɢɬɟɬɧɨɦ ɦɟɞɢɰɢɧɫɤɨɦ ɡɚɲɬɢɬɨɦ ɢ ɥɟɱɟʃɟɦ ɦɟђɭ ɨɛɢɱɧɢɦ ɝɪɚђɚɧɢɦɚ48. 18 ȼɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ ɨɫɬɚʁɟ ɢ ɞɚʂɟ ɢɡɚɡɨɜ ɡɚ ɩɭɥɦɨɥɨɲɤɟ ɤɥɢɧɢɤɟ ɢ ʁɟɞɢɧɢɰɟ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ ɲɢɪɨɦ ɫɜɟɬɚ55. ȵɟɧɚ ɬɟɪɚɩɢʁɚ ʁɟ ɤɨɦɩɥɟɤɫɧɚ ɚ ɢɫɯɨɞ ɱɟɫɬɨ ɧɟɩɪɟɞɜɢɞɢɜ ɭɩɪɤɨɫ ɩɪɨɰɜɚɬɭ ɢ ɢɧɨɜɚɰɢʁɚɦɚ ɭ ɚɧɬɢɦɢɤɪɨɛɧɨʁ ɬɟɪɚɩɢʁɢ56. ɍ ɫɜɟɬɥɭ ɩɨɜɟʄɚɧɢɯ ɨɱɟɤɢɜɚʃɚ ɨɞ ɫɬɪɚɧɟ ɡɞɪɚɜɫɬɜɟɧɢɯ ɫɢɫɬɟɦɚ ɞɚ ɩɪɭɠɟ ɟɮɢɤɚɫɧɭ ɢ ɪɚɰɢɨɧɚɥɧɭ ɬɟɪɚɩɢʁɭ, ɮɢɧɚɧɫɢʁɫɤɨ ɨɩɬɟɪɟʄɟʃɟ ɤɨʁɟ ɧɚɦɟʄɟ ɜɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ ɩɪɢɜɥɚɱɢ ɩɚɠʃɭ ɟɤɫɩɟɪɚɬɚ57. Ɋɚɡɥɢɱɢɬɟ ɦɟɪɟ ɫɭ ɩɪɟɞɥɚɝɚɧɟ ɢ ɢɦɩɥɟɦɟɧɬɢɪɚɧɟ ɫɚ ɰɢʂɟɦ ɫɦɚʃɟʃɚ ɬɪɨɲɤɨɜɚ ɦɟɞɢɰɢɧɫɤɟ ɧɟɝɟ ɢ ɥɟɱɟʃɚ ɭɡ ɢɫɬɨɜɪɟɦɟɧɨ ɡɚɞɪɠɚɜɚʃɟ ɧɢɜɨɚ ɡɚɞɨɜɨʂɚɜɚʁɭʄɢɯ ɤɥɢɧɢɱɤɢɯ ɢɫɯɨɞɚ58. Ɇɟђɭ ɧɚʁɭɫɩɟɲɧɢʁɢɦ ʁɟ ɩɪɢɨɪɢɡɚɰɢʁɚ ɚɦɛɭɥɚɧɬɧɟ ɞɢʁɚɝɧɨɫɬɢɤɟ ɢ ɥɟɱɟʃɚ ɭɦɟɫɬɨ ɛɨɥɧɢɱɤɨɝ ɩɪɢʁɟɦɚ ɢ ɥɟɱɟʃɚ. Ⱦɨɞɚɬɧɢ ɪɟɡɭɥɬɚɬɢ ɩɪɢɦɟɧɟ ɨɜɟ ɫɬɪɚɬɟɝɢʁɟ ɨɛɭɯɜɚɬɚʁɭ ɧɢɠɭ ɭɱɟɫɬɚɥɨɫɬ ɛɨɥɧɢɱɤɢɯ ɢɧɮɟɤɰɢʁɚ ɦɭɥɬɢɪɟɡɢɫɬɟɧɬɧɢɦ ɫɨʁɟɜɢɦɚ ɛɚɤɬɟɪɢʁɚ ɢ ɦɚʃɟ ɪɟɫɭɪɫɚ ɩɨɬɪɨɲɟɧɢɯ ɧɚ ɞɢʁɚɝɧɨɫɬɢɤɭ ɢ ɥɟɱɟʃɟ ɩɪɢɞɪɭɠɟɧɢɯ ɛɨɥɟɫɬɢ, ɨɞɧɨɫɧɨ ɤɨɦɨɪɛɢɞɢɬɟɬɚ59. ɉɨɫɟɛɧɨɫɬ ɋɪɛɢʁɟ, ɤɚɨ ɧɚʁɜɟʄɟɝ ɬɪɠɢɲɬɚ ɡɞɪɚɜɫɬɜɟɧɢɯ ɭɫɥɭɝɚ ɡɚɩɚɞɧɨɝ Ȼɚɥɤɚɧɚ, ʁɟ ɢɫɬɨɜɪɟɦɟɧɨ ɬɢɩɢɱɧɚ ɡɚ ɲɢɪɢ ɢɫɬɨɱɧɨɟɜɪɨɩɫɤɢ ɤɨɧɬɟɤɫɬ60. Ɂɞɪɚɜɫɬɜɟɧɚ ɩɨɬɪɨɲʃɚ ɧɚɫɬɚɜʂɚ ɞɚ ɪɚɫɬɟ ɛɪɠɟ ɨɞ ɛɪɭɬɨ ɞɪɭɲɬɜɟɧɨɝ ɩɪɨɢɡɜɨɞɚ ɪɚɫɩɨɥɨɠɢɜɨɝ ɭ ɟɤɨɧɨɦɢʁɚɦɚ ɡɟɦɚʂɚ ɪɟɝɢɨɧɚ61. ɇɚɫɬɚɜʂɚ ɫɟ ɫɬɚɪɟʃɟ ɩɨɩɭɥɚɰɢʁɟ ɞɨɤ ɫɬɨɩɟ ɢɧɰɢɞɟɧɰɟ ɢ ɩɪɟɜɚɥɟɧɰɟ ɧɚʁɭɱɟɫɬɚɥɢʁɢɯ ɯɪɨɧɢɱɧɢɯ ɧɟɡɚɪɚɡɧɢɯ ɛɨɥɟɫɬɢ ɧɚɫɬɚɜʂɚʁɭ ɞɚ ɪɚɫɬɭ62. Ʌɨɤɚɥɧɢ ɩɨɞɚɰɢ ɨ ɮɢɧɚɧɫɢʁɫɤɨɦ ɨɩɬɟɪɟʄɟʃɭ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ ɫɭ ɢ ɞɚʂɟ ɪɟɬɤɢ ɭ ɱɢɬɚɜɨɦ ɪɟɝɢɨɧɭ63. Ɇɧɨɝɢ ɤɪɟɚɬɨɪɢ ɡɞɪɚɜɫɬɜɟɧɟ ɩɨɥɢɬɢɤɟ ɩɨɱɢʃɭ ɞɚ ɫɯɜɚɬɚʁɭ ɧɟɨɩɯɨɞɧɨɫɬ ɫɬɜɚɪɚʃɚ ɞɨɦɚʄɟ ɛɚɡɟ ɩɨɞɚɬɚɤɚ ɤɚɤɨ ɛɢ ɫɟ ɨɥɚɤɲɚɥɨ ɞɨɧɨɲɟʃɟ ɨɞɥɭɤɚ ɨ ɚɥɨɤɚɰɢʁɢ ɪɟɫɭɪɫɚ ɡɚɫɧɨɜɚɧɢɯ ɧɚ ɱɢʃɟɧɢɰɚɦɚ. ɍ ɫɜɟɬɥɭ ɚɤɬɭɟɥɧɢɯ ɫɥɚɛɨɫɬɢ ɥɨɤɚɥɧɨɝ ɮɢɧɚɧɫɢɪɚʃɚ, ɩɨɡɧɚɜɚʃɟ ɞɟɬɟɪɦɢɧɚɧɬɢ ɢ ɢɧɞɢɤɚɬɨɪɚ ɬɪɨɲɤɨɜɚ ɧɚʁɭɱɟɫɬɚɥɢʁɢɯ ɤɥɢɧɢɱɤɢɯ ɟɧɬɢɬɟɬɚ ɩɪɟɞɫɬɚɜʂɚ ɜɚɠɧɭ ɢɧɜɟɫɬɢɰɢʁɭ ɭ ɛɭɞɭʄɧɨɫɬ ɪɚɫɬɭʄɢɯ ɬɪɠɢɲɬɚ64. Ⱦɭɝɨɪɨɱɧɢ ɩɪɨɛɥɟɦ ɭɩɪɚɜʂɚʃɚ ɡɞɪɚɜɫɬɜɟɧɢɦ ɫɟɤɬɨɪɨɦ ɨɫɬɚʁɟ ɤɚɤɨ ɨɛɟɡɛɟɞɢɬɢ ɨɩɬɢɦɚɥɧɭ ɡɞɪɚɜɫɬɜɟɧɭ ɡɚɲɬɢɬɭ ɭɡ ɨɝɪɚɧɢɱɟɧɚ ɫɪɟɞɫɬɜɚ ɢ ɪɟɫɭɪɫɟ. 19 Ɍɚɛɟɥɚ 1. ɉɪɟɝɥɟɞ ɪɟɡɭɥɬɚɬɚ ɫɬɭɞɢʁɚ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ Ⱦɪɠɚɜɚ ȼɪɫɬɚ ɫɬɭɞɢʁɟ Ɋɟɡɭɥɬɚɬ ɂɡɧɨɫ ɬɪɨɲɤɨɜɚ Ⱥɭɬɨɪ/ɝɨɞɢɧɚ ɩɭɛɥɢɤɨɜɚʃɚ ȼɟɥɢɤɚ Ȼɪɢɬɚɧɢʁɚ Ⱥɧɚɥɢɡɚ ɮɢɧɚɧɫɢʁɫɤɨɝ ɨɩɬɟɪɟʄɟʃɚ ɛɨɥɟɲʄɭ ɩɪɟɦɚ ɩɪɟɜɚɥɟɧɰɢʁɢ ɍɤɭɩɧɢ ɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɩɨ ɚɦɛɭɥɚɧɬɧɨ/ɛɨɥɧɢɱɤɢ ɥɟɱɟɧɨɦ ɩɚɰɢʁɟɧɬɭ 100/1700-5000 GBP Guest et al, 1997.26 ɋȺȾ Ɋɟɬɪɨɫɩɟɤɬɢɜɧɚ ɚɧɚɥɢɡɚ ɢɧɰɢɞɟɧɰɢʁɟ ɢ ɬɪɨɲɤɨɜɚ ɉɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɡɚ ɛɨɥɧɢɱɤɟ ɩɚɰɢʁɟɧɬɟ ≥65/<65 ɝɨɞɢɧɚ 7166/ 6042 USD Niederman et al, 1998.32 ɋȺȾ Ɇɭɥɬɢɰɟɧɬɪɢɱɧɚ ɨɩɫɟɪɜɚɰɢɨɧɚ ɫɬɭɞɢʁɚ ɉɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɩɨ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɢ 3490 USD Orrick et al, 2004. 33 ɒɩɚɧɢʁɚ ɉɪɨɫɩɟɤɬɢɜɧɚ ɫɬɭɞɢʁɚ ɚɧɚɥɢɡɟ ɬɪɨɲɤɨɜɚ ɉɪɨɫɟɱɧɢ ɞɢɪɟɤɬ. ɬɪɨɲɤɨɜɢ ɩɨ ɚɦɛɭɥɚɧɬɧɨ/ɛɨɥɧɢɱɤɢ ɥɟɱɟɧɨɦ ɩɚɰɢʁɟɧɬɭ 196/1553 EUR Bartholome et al, 2004.27 ɋȺȾ Ɋɟɬɪɨɫɩɟɤɬɢɜɧɚ ɫɬɭɞɢʁɚ ɚɧɚɥɢɡɟ ɬɪɨɲɤɨɜɚ ɉɪɨɫɟɱɧɢ ɞɢɪɟɤɬ. ɬɪɨɲɤɨɜɢ ɩɨ ɚɦɛɭɥɚɧɬɧɨ/ɛɨɥɧɢɱɤɢ ɥɟɱɟɧɨɦ ɩɚɰɢʁɟɧɬɭ 466/10277 USD Colice et al, 2004.28 ɇɟɦɚɱɤɚ Ɋɟɬɪɨɫɩɟɤɬɢɜɧɚ ɫɬɭɞɢʁɚ ɚɧɚɥɢɡɟ ɬɪɨɲɤɨɜɚ ɉɪɨɫɟɱɧɢ ɞɢɪ. ɬɪɨɲɤɨɜɢ ɩɨ ɩɚɰɢʁɟɧɬɭ ɧɚ ɫɬɚɧɞ./ɧɟɫɬɚɧɞ. ɬɟɪɚɩɢʁɢ 1250/1409 USD Bauer et al, 2005.34 ɒɩɚɧɢʁɚ ɉɪɨɫɩɟɤɬɢɜɧɚ ɨɩɫɟɪɜɚɰɢɨɧɚ ɫɬɭɞɢʁɚ ɚɧɚɥɢɡɟ ɬɪɨɲɤɨɜɚ ɉɪɨɫɟɱɧɢ ɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɩɨ ɩɚɰɢʁɟɧɬɭ 1683 EUR Reyes et al, 2008.29 ɋȺȾ Ɋɟɬɪɨɫɩɟɤɬɢɜɧɚ ɫɬɭɞɢʁɚ ɩɪɨɰɟɧɟ ɢɧɰɢɞɟɧɰɟ ɢ ɟɤɨɧɨɦɫɤɨɝ ɨɩɬɟɪɟʄɟʃɚ ɉɪɨɫɟɱɧɢ ɭɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɩɨ ɚɦɛɭɥɚɧɬɧɨ/ɛɨɥɧɢɱɤɢ ɥɟɱɟɧɨɦ ɩɚɰɢʁɟɧɬɭ 2394/18670 USD Yu et al, 2012.35 ȳɭɠɧɚ Ʉɨɪɟʁɚ Ɋɟɬɪɨɫɩɟɤɬɢɜɧɚ, ɨɩɫɟɪɜɚɰɢɨɧɚ ɫɬɭɞɢʁɚ ɚɧɚɥɢɡɟ ɬɪɨɲɤɨɜɚ ɉɪɨɫɟɱɧɢ ɞɢɪ. ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɡɚ ɧɟ- ɩɧɟɭɦɨɤɨɤɧɭ/ɩɧɟɭɦɨɤɨɤɧɭ 1782/2049 USD Yoo et al, 2013.36 ɑɟɲɤɚ Ɋɟɬɪɨɫɩɟɤɬɢɜɧɚ ɚɧɚɥɢɡɚ ɩɪɟɦɚ ɚɞɦ. ɩɨɞɚɰɢɦɚ ɍɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɡɚ ɩɚɰɢʁɟɧɬɟ <65/≥65 ɝɨɞɢɧɚ 1073/706 EUR Tichopad et al, 2013.37 ɋɥɨɜɚɱɤɚ Ɋɟɬɪɨɫɩɟɤɬɢɜɧɚ ɚɧɚɥɢɡɚ ɩɪɟɦɚ ɚɞɦ. ɩɨɞɚɰɢɦɚ ɍɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɡɚ ɩɚɰɢʁɟɧɬɟ <65/≥65 ɝɨɞɢɧɚ 1479/975 EUR Tichopad et al, 2013.37 ɉɨʂɫɤɚ Ɋɟɬɪɨɫɩɟɤɬɢɜɧɚ ɚɧɚɥɢɡɚ ɩɪɟɦɚ ɚɞɦ. ɩɨɞɚɰɢɦɚ ɍɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɡɚ ɩɚɰɢʁɟɧɬɟ <65/≥65 ɝɨɞɢɧɚ 652/431 EUR Tichopad et al, 2013.37 Ɇɚђɚɪɫɤɚ Ɋɟɬɪɨɫɩɟɤɬɢɜɧɚ ɚɧɚɥɢɡɚ ɩɪɟɦɚ ɚɞɦ. ɩɨɞɚɰɢɦɚ ɍɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɡɚ ɩɚɰɢʁɟɧɬɟ <65/≥65 ɝɨɞɢɧɚ 877/597 EUR Tichopad et al, 2013.37 Ȼɟɥɝɢʁɚ ɉɪɨɫɩɟɤɬɢɜɧɚ ɨɩɫɟɪɜɚɰɢɨɧɚ ɫɬɭɞɢʁɚ ɚɧɚɥɢɡɟ ɬɪɨɲɤɨɜɚ ɍɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɩɨ ɩɚɰɢʁɟɧɬɭ 4794 USD Cortoos et al, 2013.45 20 2. ɐɂȴȿȼɂ ɋɌɍȾɂȳȿ 1. ɍɬɜɪђɢɜɚʃɟ ɭɤɭɩɧɢɯ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ɭ Ʉɐ Ʉɪɚɝɭʁɟɜɚɰ, ɩɨ ɩɚɰɢʁɟɧɬɭ, ɢ ɩɪɨɰɟɧɚ ɢɧɞɢɪɟɤɬɧɢɯ 2. ɍɬɜɪђɢɜɚʃɟ ɭɞɟɥɚ ɩɨʁɟɞɢɧɚɱɧɢɯ ɬɪɨɲɤɨɜɚ (ɛɨɪɚɜɚɤ, ɞɢʁɚɝɧɨɫɬɢɤɚ,ɭɫɥɭɝɟ, ɦɟɞɢɰɢɧɫɤɚ ɫɪɟɞɫɬɜɚ, ɥɟɤɨɜɢ...) ɭ ɭɤɭɩɧɢɦ ɞɢɪɟɤɬɧɢɦ ɬɪɨɲɤɨɜɢɦɚ. 3. Ⱥɧɚɥɢɡɚ ɞɨɛɢʁɟɧɢɯ ɪɟɡɭɥɬɚɬɚ ɩɪɟɦɚ ɫɬɚɪɨɫɬɢ, ɩɨɥɭ, ɫɬɟɩɟɧɭ ɢɧɢɰɢʁɚɥɧɟ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ, ɩɪɢɫɭɫɬɜɭ ɤɨɦɨɪɛɢɞɢɬɟɬɚ, ɩɭɲɚɱɤɨɦ ɫɬɚɬɭɫɭ... 4. ɉɪɨɰɟɧɚ ɤɨɦɩɥɢɤɚɰɢʁɚ ɢ ʃɢɯɨɜɨɝ ɭɬɢɰɚʁɚ ɧɚ ɞɭɠɢɧɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɬɪɨɲɤɨɜɟ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ 5. ɍɩɨɪɟђɢɜɚʃɟ ɞɨɛɢʁɟɧɢɯ ɪɟɡɭɥɬɚɬɚ ɫɚ ɪɟɡɭɥɬɚɬɢɦɚ ɞɨɛɢʁɟɧɢɦ ɭ ɪɚɫɩɨɥɨɠɢɜɢɦ ɫɬɭɞɢʁɚɦɚ ɫɥɢɱɧɨɝ ɬɢɩɚ 21 3. ɏɂɉɈɌȿɁȿ ɋɌɍȾɂȳȿ 1. Ⱦɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɢɯ ɩɧɟɭɦɨɧɢʁɚ ɩɪɟɞɫɬɚɜʂɚʁɭ ɡɧɚɱɚʁɚɧ ɟɥɟɦɟɧɬ ɭ ɦɚɫɢ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɤɨʁɢ ɨɩɬɟɪɟʄɭʁɭ ɡɞɪɚɜɫɬɜɟɧɢ ɮɨɧɞ. 2. Ɂɧɚɱɚʁɚɧ ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ɫɟ ɯɨɫɩɢɬɚɥɢɡɭʁɭ ɧɟ ɢɫɩɭʃɚɜɚʁɭ ɤɪɢɬɟɪɢʁɭɦɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɤɨʁɚ ɡɚɯɬɟɜɚ ɛɨɥɧɢɱɤɨ ɥɟɱɟʃɟ. 3. ɉɨɫɬɨʁɚʃɟ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɢ ɩɨʁɚɜɚ ɤɨɦɩɥɢɤɚɰɢʁɚ ɡɧɚɱɚʁɧɨ ɩɨɜɟʄɚɜɚ ɞɭɠɢɧɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɞɢɪɟɤɬɧɟ ɬɪɨɲɤɨɜɟ ɥɟɱɟʃɚ 4. ɍɬɜɪђɢɜɚʃɟ ɤɨɦɩɥɢɤɚɰɢʁɚ ɢ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɤɨʁɢ ɢɦɚʁɭ ɧɚʁɜɟʄɢ ɭɬɢɰɚʁ ɧɚ ɭɤɭɩɧɟ ɬɪɨɲɤɨɜɟ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɢɯ ɩɧɟɭɦɨɧɢʁɚ, ɚ ɤɨʁɢ ɧɚʁɱɟɲʄɟ ɩɪɨɢɫɬɢɱɭ ɢɡ ɨɞɦɚɤɥɟ ɠɢɜɨɬɧɟ ɞɨɛɢ ɩɚɰɢʁɟɧɚɬɚ 5.ɉɚɪɟɧɬɟɪɚɥɧɚ ɩɪɢɦɟɧɚ ɚɧɬɢɛɢɨɬɫɤɟ ɬɟɪɚɩɢʁɟ ɱɟɫɬɨ ɬɪɚʁɟ ɩɪɟɞɭɝɨ, ɨɞɧɨɫɧɨ ɩɚɰɢʁɟɧɬɢ ɫɟ ɧɟ ɩɪɟɜɨɞɟ ɧɚ ɩɟɪɨɪɚɥɧɭ ɚɧɬɢɛɢɨɬɫɤɭ ɬɟɪɚɩɢʁɭ ɧɚɤɨɧ ɩɨɫɬɢɡɚʃɚ ɤɥɢɧɢɱɤɟ ɫɬɚɛɢɥɧɨɫɬɢ ɛɨɥɟɫɬɢ, ɚ ɱɟɫɬɨ ɫɟ ɩɚɪɟɧɬɟɪɚɥɧɚ ɬɟɪɚɩɢʁɚ ɩɪɢɦɟʃɭʁɟ ɞɨ ɤɪɚʁɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ. 22 4. ɆȺɌȿɊɂȳȺɅ 4.1 ɉɨɩɭɥɚɰɢʁɚ ɤɨʁɚ ɫɟ ɢɫɬɪɚɠɭʁɟ ɉɨɩɭɥɚɰɢʁɚ ɩɚɰɢʁɟɧɚɬɚ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢɯ ɭ ɩɪɨɫɬɨɪɭ Ʉɥɢɧɢɤɟ ɡɚ ɩɭɥɦɨɥɨɝɢʁɭ Ʉɥɢɧɢɱɤɨɝ ɰɟɧɬɪɚ Ʉɪɚɝɭʁɟɜɚɰ, ɫɚ ɤɥɢɧɢɱɤɢɦ ɡɧɚɰɢɦɚ ɢ ɫɢɦɩɬɨɦɢɦɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɫɤɥɚɞɭ ɫɚ ɫɚɜɪɟɦɟɧɢɦ ɜɨɞɢɱɢɦɚ ɡɚ ɞɢʁɚɝɧɨɫɬɢɤɭ ɢ ɥɟɱɟʃɟ ɢɧɮɟɤɰɢʁɟ ɞɨʃɢɯ ɪɟɫɩɢɪɚɬɨɪɧɢɯ ɩɭɬɟɜɚ (Guidelines for the management of adult lower respiratory tract infections - Clinical Microbiology and Infection 2011 European Society of Clinical Microbiology and Infectious Diseases)65 4.2 ɍɡɨɪɤɨɜɚʃɟ ɉɚɰɢʁɟɧɬɢ ɫɬɚɪɢʁɢ ɨɞ 18 ɝɨɞɢɧɚ, ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢ ɡɛɨɝ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɬɪђɟɧɨ ɩɪɢɫɭɫɬɜɨ ɧɨɜɢɯ ɩɥɭʄɧɢɯ ɢɧɮɢɥɬɪɚɬɚ ɧɚ ɪɚɞɢɨɝɪɚɮɢʁɢ ɝɪɭɞɧɨɝ ɤɨɲɚ ɢ ɩɨʁɚɜɚ ɧɚʁɦɚʃɟ ʁɟɞɧɨɝ ɨɞ ɫɥɟɞɟʄɢɯ ɫɢɦɩɬɨɦɚ/ɡɧɚɤɨɜɚ: 1) ɧɨɜ ɢɥɢ ɩɨʁɚɱɚɧ ɤɚɲɚʂ, 2) ɚɛɧɨɪɦɚɥɧɚ ɬɟɥɟɫɧɚ ɬɟɦɩɟɪɚɬɭɪɚ (<35.6њɋ ɢɥɢ >37.5њɋ) ɢ 3) ɚɛɧɨɪɦɚɥɧɢ ɛɪɨʁ ɥɟɭɤɨɰɢɬɚ (ɥɟɭɤɨɰɢɬɨɡɚ, ɩɨɦɚɤ ɭɥɟɜɨ ɢɥɢ ɥɟɭɤɨɩɟɧɢʁɚ). ɍ ɫɬɭɞɢʁɭ ɧɢɫɭ ɛɢɥɢ ɭɤʂɭɱɢɜɚɧɢ ɩɚɰɢʁɟɧɬɢ ɭɤɨɥɢɤɨ ɫɭ ɦɥɚђɢ ɨɞ 18 ɝɨɞɢɧɚ, ɭɤɨɥɢɤɨ ɫɭ ɛɢɥɢ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢ ɭ ɬɨɤɭ ɩɪɟɬɯɨɞɧɢɯ 15 ɞɚɧɚ, ɭɤɨɥɢɤɨ ɫɟ ɫɭɦʃɚɥɨ ɧɚ ɩɨɫɬɨʁɚʃɟ ɬɭɛɟɪɤɭɥɨɡɟ ɩɥɭʄɚ ɢɥɢ ɫɭ ɢɦɚɥɢ ɬɟɠɚɤ ɨɛɥɢɤ ɩɧɟɭɦɨɧɢʁɟ ɤɨʁɢ ʁɟ ɡɚɯɬɟɜɚɨ ɩɪɢʁɟɦ ɭ ʁɟɞɢɧɢɰɭ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ ɢ ɚɫɢɫɬɢɪɚɧɭ ɦɟɯɚɧɢɱɤɭ ɜɟɧɬɢɥɚɰɢʁɭ. Ɂɚɬɪɚɠɟɧɚ ʁɟ ɫɚɝɥɚɫɧɨɫɬ ɥɨɤɚɥɧɨɝ ȿɬɢɱɤɨɝ ɨɞɛɨɪɚ Ʉɥɢɧɢɱɤɨɝ ɰɟɧɬɪɚ Ʉɪɚɝɭʁɟɜɚɰ ɡɚ ɢɡɜɨђɟʃɟ ɫɬɭɞɢʁɟ 29.02.2012., ɫɚɝɥɚɫɧɨɫɬ ɞɨɛɢʁɟɧɚ (ɪɟɲɟʃɟ ɨ ɨɞɨɛɪɟʃɭ ɢɫɬɪɚɠɢɜɚʃɚ ɢɡɞɚɬɨ 05.03.2012. ɩɨɞ ɛɪɨʁɟɦ 01-2349). 23 4.3 ȼɚɪɢʁɚɛɥɟ ɤɨʁɟ ɫɭ ɦɟɪɟɧɟ ɭ ɫɬɭɞɢʁɢ ɉɪɢɤɭɩʂɚɧɢ ɫɭ ɫɥɟɞɟʄɢ ɩɨɞɚɰɢ ɨ ɩɚɰɢʁɟɧɬɢɦɚ: ɝɟɧɟɪɚɥɢʁɟ, ɩɨɥ, ɫɬɚɪɨɫɬ, ɜɢɫɢɧɚ, ɬɟɠɢɧɚ, ɩɭɲɚɱɤɢ ɫɬɚɬɭɫ ɢ ɧɚɜɢɤɟ, ɤɨɧɡɭɦɚɰɢʁɚ ɚɥɤɨɯɨɥɚ, ɟɜɟɧɬɭɚɥɧɢ ɛɨɪɚɜɚɤ ɭ ɭɫɬɚɧɨɜɢ ɤɨɥɟɤɬɢɜɧɨɝ ɬɪɚʁɧɨɝ ɫɦɟɲɬɚʁɚ (ɞɨɦ ɫɬɚɪɢɯ, ɡɚɜɨɞ ɡɚ ɡɛɪɢʃɚɜɚʃɟ ɨɞɪɚɫɥɢɯ ɥɢɰɚ), ɩɨɞɚɰɢ ɨ ɜɚɤɰɢɧɚɰɢʁɚɦɚ ɢ ɩɪɟɬɯɨɞɧɢɦ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚɦɚ, ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɤɥɢɧɢɱɤɢɯ ɫɢɦɩɬɨɦɚ ɩɪɟ ɨɛɪɚʄɚʃɚ ɥɟɤɚɪɭ, ɩɨɞɚɰɢ ɨ ɤɨɦɨɪɛɢɞɢɬɟɬɢɦɚ, ɤɥɢɧɢɱɤɢ ɫɢɦɩɬɨɦɢ, ɜɢɬɚɥɧɢ ɡɧɚɰɢ ɢ ɮɢɡɢɤɚɥɧɢ ɧɚɥɚɡ ɧɚ ɩɪɢʁɟɦɭ. Ȼɟɥɟɠɟɧɢ ɫɭ ɥɚɛɨɪɚɬɨɪɢʁɫɤɢ ɩɚɪɚɦɟɬɪɢ ɧɚ ɩɨɱɟɬɤɭ ɢ ɤɪɚʁɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɢ ɟɜɟɧɬɭɚɥɧɨ ɭ ɬɨɤɭ ɢɫɬɟ (ɤɪɜɧɚ ɫɥɢɤɚ ɫɚ ɥɟɭɤɨɰɢɬɚɪɧɨɦ ɮɨɪɦɭɥɨɦ, ɚɡɨɬɧɟ ɦɚɬɟɪɢʁɟ, ʁɨɧɨɝɪɚɦ, ɯɟɩɚɬɨɝɪɚɦ, ɩɪɨɬɟɢɧɢ, CЊP, ɚɧɚɥɢɡɟ ɪɟɫɩɢɪɚɰɢʁɫɤɢɯ ɝɚɫɨɜɚ ɚɪɬɟɪɢʁɫɤɟ ɤɪɜɢ ɭ ɫɥɭɱɚʁɭ ɢɡɦɟɪɟɧɟ ɫɚɬɭɪɚɰɢʁɟ < 94%, ɧɚ ɫɨɛɧɨɦ ɜɚɡɞɭɯɭ). ɂɧɢɰɢʁɚɥɧɚ ɬɟɠɢɧɚ ɛɨɥɟɫɬɢ ʁɟ ɛɢɥɚ ɩɪɨɰɟʃɢɜɚɧɚ ɧɚ ɨɫɧɨɜɭ PЋI (PЧОuЦШЧТК ЋОvОrТtв IЧНОб, ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ, Ɍɚɛɟɥɚ 2) ɢ CUЊB-65 ɫɤɚɥɟ (Ɍɚɛɟɥɚ 3), ɤɨʁɟ ɫɭ ɛɢɥɟ ɛɨɞɨɜɚɧɟ ɡɚ ɫɜɚɤɨɝ ɩɚɰɢʁɟɧɬɚ. Ɍɨɤɨɦ ɯɨɫɩɢɬɚɥɧɨɝ ɥɟɱɟʃɚ ɫɭ ɛɢɥɢ ɩɪɨɰɟʃɢɜɚɧɢ ɟɜɨɥɭɬɢɜɧɢ ɩɚɪɚɦɟɬɪɢ: ɩɨʁɚɜɚ ɤɨɦɩɥɢɤɚɰɢʁɚ, ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɧɨɝ ɥɟɱɟʃɚ (LOЋ-LenРtС ШП ЋtКв) ɤɚɨ ɢ ɦɨɪɬɚɥɢɬɟɬ ɧɚɤɨɧ 30 ɞɚɧɚ. Ɍɪɨɲɤɨɜɢ ɫɭ ɢɡɪɚɱɭɧɚɬɢ ɢɡ ɞɪɭɲɬɜɟɧɟ ɩɟɪɫɩɟɤɬɢɜɟ. Ⱥɧɚɥɢɡɢɪɚɧɢ ɫɭ ɫɜɢ ɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ, ɜɟɡɚɧɢ ɡɚ ɩɨɬɪɨɲʃɭ ɪɟɫɭɪɫɚ ɭɫɬɚɧɨɜɟ, ɞɢʁɚɝɧɨɫɬɢɱɤɢ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɢ ɬɟɫɬɨɜɢ, ɬɟɪɚɩɢʁɚ ɢ ɞɭɠɢɧɚ ɛɨɪɚɜɤɚ ɭ ɭɫɬɚɧɨɜɢ. ɂɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɜɟɡɚɧɢ ɡɚ ɨɞɫɭɫɬɜɨɜɚʃɟ ɫɚ ɩɨɫɥɚ ɢ ɬɪɚɧɫɩɨɪɬ ɭ/ɢɡ ɡɞɪɚɜɫɬɜɟɧɭ ɭɫɬɚɧɨɜɭ ɫɭ ɛɢɥɢ ɪɟɤɨɧɫɬɪɭɢɫɚɧɢ ɩɭɬɟɦ „ɩɪɢɫɬɭɩɚ ʂɭɞɫɤɨɝ ɤɚɩɢɬɚɥɚ“. Ʌɚɛɨɪɚɬɨɪɢʁɫɤɢ ɢ ɞɢʁɚɝɧɨɫɬɢɱɤɢ ɬɟɫɬɨɜɢ ɤɨʁɢ ɫɭ ɛɢɥɢ ɭɱɢʃɟɧɢ ɬɨɤɨɦ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɫɭ ɛɢɥɢ ɤɥɚɫɢɮɢɤɨɜɚɧɢ ɭ 5 ɝɪɭɩɚ: 1) ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɚɧɚɥɢɡɟ ɤɪɜɢ, ɭɤʂɭɱɭʁɭʄɢ ɢ ɚɧɚɥɢɡɟ ɪɟɫɩɢɪɚɰɢʁɫɤɢɯ ɝɚɫɨɜɚ ɚɪɬɟɪɢʁɫɤɟ ɤɪɜɢ; 2) ɦɢɤɪɨɛɢɨɥɨɲɤɟ ɚɧɚɥɢɡɟ (ɤɭɥɬɭɪɟ ɫɩɭɬɭɦɚ, ɯɟɦɨɤɭɥɬɭɪɟ, ɤɭɥɬɭɪɟ ɩɥɟɭɪɚɥɧɨɝ ɩɭɧɤɬɚɬɚ); 3) ɪɚɞɢɨɥɨɲɤɚ ɢɫɩɢɬɢɜɚʃɚ (ɪɚɞɢɨɝɪɚɮɢʁɟ, ɤɨɦɩʁɭɬɟɪɢɡɨɜɚɧɚ ɬɨɦɨɝɪɚɮɢʁɚ); 4) ɟɧɞɨɫɤɨɩɫɤɟ ɢ ɢɧɜɚɡɢɜɧɟ ɬɟɯɧɢɤɟ (ɛɪɨɧɯɨɫɤɨɩɢʁɚ, ɬɨɪɚɤɨɰɟɧɬɟɡɚ), 5) ȿɄȽ ɢ 6) ɢɫɩɢɬɢɜɚʃɟ ɩɥɭʄɧɟ ɮɭɧɤɰɢʁɟ. Ɍɪɨɲɤɨɜɢ ɬɟɪɚɩɢʁɟ ɫɭ ɢɡɪɚɱɭɧɚɬɢ ɤɚɨ ɚɧɬɢɛɢɨɬɫɤɚ ɬɟɪɚɩɢʁɚ ɢ ɨɫɬɚɥɚ ɦɟɞɢɰɢɧɫɤɚ ɫɪɟɞɫɬɜɚ (ɥɟɱɟʃɟ ɤɨɦɨɪɛɢɞɢɬɟɬɚ, ɤɨɧɤɨɦɢɬɚɧɬɧɚ ɬɟɪɚɩɢʁɚ ɢ ɥɟɱɟʃɟ ɤɨɦɩɥɢɤɚɰɢʁɚ). Ⱦɭɠɢɧɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ʁɟ ɢɡɪɚɱɭɧɚɬɚ ɤɚɨ ɛɪɨʁ ɞɚɧɚ ɨɞ ɩɪɢʁɟɦɚ ɭ ɭɫɬɚɧɨɜɭ ɞɨ ɞɚɧɚ ɨɬɩɭɫɬɚ. 24 5. ɆȿɌɈȾɈɅɈȽɂȳȺ 5.1 Ⱦɢɡɚʁɧ, ɫɧɚɝɚ ɫɬɭɞɢʁɟ ɢ ɜɟɥɢɱɢɧɚ ɭɡɨɪɤɚ ɋɬɭɞɢʁɚ ʁɟ ɫɩɪɨɜɟɞɟɧɚ ɤɚɨ ɩɪɨɫɩɟɤɬɢɜɧɚ ɤɥɢɧɢɱɤɚ ɨɩɫɟɪɜɚɰɢɨɧɚ ɫɬɭɞɢʁɚ, ɤɨɯɨɪɬɧɨɝ ɬɢɩɚ. Ɇɨɞɟɥ ɨɛʁɚɜʂɟɧɟ ɫɬɭɞɢʁɟ ɫɥɢɱɚɧ ɩɥɚɧɢɪɚɧɨʁ ɩɨɫɬɨʁɢ ɭ ɪɟɚɥɢɡɚɰɢʁɢ ЊОвОs Ћ. ɢ ɫɚɪ.29. Ⱥɧɚɥɢɡɨɦ ɢ ɨɩɢɫɨɦ ɞɟɬɟɪɦɢɧɚɧɬɢ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɩɪɨɧɚђɟɧɚ ʁɟ ɪɚɡɥɢɤɚ ɭ ɫɤɨɪɭ PЧОuЦШЧТК ЋОvОrТtв IЧНОб (PЋI) ɨɞ 22/36/53/113/47 ɧɚ ɨɫɧɨɜɭ ɱɟɝɚ ɫɭ ɤɥɚɫɢɮɢɤɨɜɚɧɢ ɩɪɟɦɚ ɧɢɜɨɭ ɪɢɡɢɤɚ ɨɞ 1-5. ɋɯɨɞɧɨ ɬɨɦɟ ɜɟɥɢɱɢɧɚ ɭɡɨɪɤɚ ɧɚɲɟ ɫɬɭɞɢʁɫɤɟ ɩɨɩɭɥɚɰɢʁɟ ɨɞɪɟђɟɧɚ ʁɟ ɭɡ ɩɨɦɨʄ ɩɪɨɝɪɚɦɚ G-PШаОr 3.1.2 ɧɚ ɫɥɟɞɟʄɢ ɧɚɱɢɧ: ɡɚ ɡɚɞɚɬɭ ɜɟɪɨɜɚɬɧɨʄɭ ɝɪɟɲɤɟ ɩɪɜɨɝ ɬɢɩɚ ɨɞ 0,05, ɫɧɚɝɭ ɫɬɭɞɢʁɟ ɨɞ 0,8 ɬʁ. 80%, ɢ ɞɜɨɫɦɟɪɧɨ ɬɟɫɬɢɪɚʃɟ ɧɭɥɬɟ ɯɢɩɨɬɟɡɟ ɏ2 ɬɟɫɬɨɦ ɢ ɪɚɡɥɢɤɟ ɭ ɜɪɟɞɧɨɫɬɢɦɚ ɩɨɫɦɚɬɪɚɧɟ ɩɪɨɦɟɧʂɢɜɟ (ɫɤɨɪ PЋI) ɨɞ 0,20 ɚ ɧɚ ɨɫɧɨɜɭ ɜɟʄ ɨɛʁɚɜʂɟɧɢɯ ɧɚɥɚɡɚ ɢɡ ɨɜɟ ɨɛɥɚɫɬɢ (ЊОвОs) ɩɪɨɪɚɱɭɧɚɬɚ ʁɟ ɤɚɨ ɡɚɞɨɜɨʂɚɜɚʁɭʄɚ ɦɢɧɢɦɚɥɧɚ ɜɟɥɢɱɢɧɚ ɭɡɨɪɤɚ ɨɞ 100 ɩɚɰɢʁɟɧɚɬɚ. Ȼɭɞɭʄɢ ɞɚ ʁɟ ɭ ɩɢɬɚʃɭ ɫɬɭɞɢʁɚ ɬɪɨɲɤɨɜɚ ɛɨɥɟɫɬɢ, ɭɡɨɪɚɤ ɩɨɩɭɥɚɰɢʁɟ ɨɛɨɥɟɥɢɯ Уɟ ɩɨɫɦɚɬɪɚɧ ɤɚɨ ɰɟɥɢɧɚ. 5.2 ɋɬɚɬɢɫɬɢɱɤɚ ɨɛɪɚɞɚ ɩɨɞɚɬɚɤɚ ɋɬɚɬɢɫɬɢɱɤɚ ɨɛɪɚɞɚ ɩɨɞɚɬɚɤɚ ɭɪɚђɟɧɚ ʁɟ ɭ ɪɚɱɭɧɚɪɫɤɨɦ ɩɪɨɝɪɚɦɭ IBM SPSS Statistics 19. ɇɟɩɪɟɤɢɞɧɟ ɜɚɪɢʁɚɛɥɟ ɫɭ ɩɪɟɞɫɬɚɜʂɟɧɟ ɭ ɨɛɥɢɤɭ ɫɪɟɞʃɟ ɜɪɟɞɧɨɫɬɢ ± ɫɬɚɧɞɚɪɞɧɟ ɞɟɜɢʁɚɰɢʁɟ, ɦɢɧɢɦɚɥɧɢɯ ɢ ɦɚɤɫɢɦɚɥɧɢɯ ɜɪɟɞɧɨɫɬɢ ɢ 95% ɢɧɬɟɪɜɚɥɚ ɩɨɜɟɪɟʃɚ, ɚ ɚɬɪɢɛɭɬɢɜɧɟ ɜɚɪɢʁɚɛɥɟ ɩɪɨɰɟɧɬɭɚɥɧɨɦ ɭɱɟɫɬɚɥɨɲʄɭ ɩɨʁɟɞɢɧɢɯ ɤɚɬɟɝɨɪɢʁɚ. Ɂɚ ɪɚɡɥɢɤɟ ɭ ɧɟɩɪɟɤɢɞɧɢɦ ɢɫɬɢɦ ɜɚɪɢʁɚɛɥɚɦɚ ɤɨʁɟ ɫɭ ɦɟɪɟɧɟ ɩɪɟ ɢ ɩɨɫɥɟ ɧɟɤɟ ɢɧɬɟɪɜɟɧɰɢʁɟ ɤɨɪɢɲʄɟɧɢ ɫɭ Student t ɬɟɫɬ ɡɚ ɡɚɜɢɫɧɟ ɭɡɨɪɤɟ ɢ Wilcoxon Signed Ranks ɬɟɫɬ, ɭ ɡɚɜɢɫɧɨɫɬɢ ɞɚ ɥɢ ʁɟ ɪɚɫɩɨɞɟɥɚ ɛɢɥɚ ɧɨɪɦɚɥɧɚ ɢɥɢ ɧɟ ɧɚ ɨɫɧɨɜɭ Kolmogorov-Smirnov ɬɟɫɬɚ. Ɂɚ ɪɚɡɥɢɤɟ ɭ ɧɟɩɪɟɤɢɞɧɢɦ ɜɚɪɢʁɚɛɥɚɦɚ ɤɨʁɟ ɫɭ ɦɟɪɟɧɟ ɭ ɞɜɚ ɧɟɡɚɜɢɫɧɚ ɭɡɨɪɤɚ ɤɨɪɢɲʄɟɧɢ ɫɭ Student t ɬɟɫɬ ɡɚ ɧɟɡɚɜɢɫɧɟ ɭɡɨɪɤɟ ɢ Mann-Whytney U ɬɟɫɬ, ɭ ɡɚɜɢɫɧɨɫɬɢ ɞɚ ɥɢ ʁɟ ɪɚɫɩɨɞɟɥɚ ɛɢɥɚ ɧɨɪɦɚɥɧɚ ɢɥɢ ɧɟ ɧɚ ɨɫɧɨɜɭ Kolmogorov-Smirnov ɬɟɫɬɚ. Ɂɚ ɧɟɩɪɟɤɢɞɧɟ ɩɪɨɦɟʂɢɜɟ ɫɚ ɜɢɲɟ ɨɞ ɬɪɢ ɝɪɭɩɚ ɡɚ ɩɨɪɟђɟʃɟ ʁɟ ɤɨɪɢɲʄɟɧɚ ʁɟɞɧɨɮɚɤɬɨɪɫɤɚ ȺɇɈȼȺ ɪɚɡɥɢɱɢɬɢɯ ɝɪɭɩɚ ɫ 25 ɧɚɤɧɚɞɧɢɦ ɬɟɫɬɨɜɢɦɚ ɢɥɢ Kruskal-Wallis ɬɟɫɬ, ɭ ɡɚɜɢɫɧɨɫɬɢ ɞɚ ɥɢ ɫɭ ɩɨɞɚɰɢ ɧɨɪɦɚɥɧɨ ɪɚɫɩɨɪɟђɟɧɢ ɢɥɢ ɧɟ. ɍɪɚђɟɧɚ ʁɟ ɢ ɤɨɪɟɥɚɰɢʁɚ ɢɡɦɟђɭ ɜɚɪɢʁɚɛɥɢ ɨɞ ɢɧɬɟɪɟɫɚ, ɩɪɢ ɱɟɦɭ ʁɟ ɤɨɪɢɲʄɟɧ ɥɢɧɟɚɪɧɢ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ Spearman's rho ɢ Pearson's rho, ɚ ɜɟɥɢɱɢɧɚ ɤɨɪɟɥɚɰɢʁɟ ʁɟ ɩɪɨɰɟʃɟɧɚ ɩɪɟɦɚ Ʉɨɯɟɧɨɜɢɦ ɤɪɢɬɟɪɢʁɭɦɢɦɚ ɝɞɟ ɫɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ ɜɟʄɢ ɨɞ 0,50 ɫɦɚɬɪɚ ɢɡɭɡɟɬɧɨ ʁɚɤɨɦ ɤɨɪɟɥɚɰɢʁɨɦ, ɨɞ 0,30 ɞɨ 0,49 ɫɪɟɞʃɟ ʁɚɤɨɦ ɤɨɪɟɥɚɰɢʁɨɦ, ɞɨɤ ʁɟ ɢɫɩɨɞ 0,29 ɫɥɚɛɚ ɤɨɪɟɥɚɰɢʁɚ. Ɍɚɤɨђɟ ʁɟ ɭɪɚђɟɧɚ ɢ ɛɢɧɚɪɧɚ ɥɨɝɢɫɬɢɱɤɚ ɪɟɝɪɟɫɢɨɧɚ ɚɧɚɥɢɡɚ ɭɬɢɰɚʁɚ ɩɪɟɞɢɤɬɨɪɚ ɧɚ ɢɫɯɨɞ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɟ, ɚ ɢɡɪɚɠɟɧɚ ʁɟ ɭɡ ɩɨɦɨʄ odds ratio. ɋɜɟ ɚɧɚɥɢɡɟ ɫɭ ɩɪɨɰɟʃɢɜɚɧɟ ɧɚ ɧɢɜɨɭ ɫɬɚɬɢɫɬɢɱɤɟ ɡɧɚɱɚʁɧɨɫɬɢ ɨɞ p<0,05. ɇɚɤɨɧ ɫɬɚɬɢɫɬɢɱɤɟ ɨɛɪɚɞɟ ɩɨɞɚɬɚɤɚ ɪɟɡɭɥɬɚɬɢ ɫɭ ɩɪɢɤɚɡɚɧɢ ɝɪɚɮɢɱɤɢ ɢ ɬɚɛɟɥɚɪɧɨ. 26 Ɍɚɛɟɥɚ 2. ЈORT/ЈSI ɫɤɨɪ, ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ ɢɧɬɟɪɩɪɟɬɚɰɢʁɚ Ʉɚɪɚɤɬɟɪɢɫɬɢɤɚ Ȼɪɨʁ ɛɨɞɨɜɚ Сɬɚɪɨɫɬ (ɝɨɞɢɧɟ) Ɇɭɲɤɚɪɰɢ ɛɪɨʁ ɝɨɞɢɧɚ = ɀɟɧɟ ɛɪɨʁ ɝɨɞɢɧɚ – 10 = ɋɬɚɧɨɜɧɢɤ ɭɫɬɚɧɨɜɟ ɬɪɚʁɧɨɝ ɫɦɟɲɬɚʁɚ +10 Ʉɨɦɨɪɛɢɞɢɬɟɬɢ ɇɟɨɩɥɚɡɦɚ +30 Ȼɨɥɟɫɬ ʁɟɬɪɟ +20 Ʉɨɧɝɟɫɬɢɜɧɚ ɫɪɱɚɧɚ ɫɥɚɛɨɫɬ +10 ɐɟɪɟɛɪɨɜɚɫɤɭɥɚɪɧɚ ɛɨɥɟɫɬ +10 Ȼɨɥɟɫɬ ɛɭɛɪɟɝɚ +10 Ɏɢɡɢɤɚɥɧɢ ɧɚɥɚɡ ɉɪɨɦɟʃɟɧɢ ɦɟɧɬɚɥɧɢ ɫɬɚɬɭɫ +20 Ɋɟɫɩɢɪɚɬɨɪɧɚ ɮɪɟɤɜɟɧɰɚ ≥ 30 ɭɞɚɯɚ/ɦɢɧ +20 ɋɢɫɬɨɥɧɢ ɩɪɢɬɢɫɚɤ < 90 ЦЦHР +20 Ɍɟɦɩɟɪɚɬɭɪɚ < 35њC ɢɥɢ ≥ 40њC +15 ɋɪɱɚɧɚ ɮɪɟɤɜɟɧɰɚ ≥ 125/ɦɢɧ +10 Ʌɚɛɨɪɚɬɨɪɢјɫɤɢ ɢ ɞɢјɚɝɧɨɫɬɢчɤɢ ɧɚɥɚɡɢ pH ɚɪɬɟɪɢʁɫɤɟ ɤɪɜɢ < 7.35 +30 ɍɪɟɚ ≥ 9 ЦЦШХ/L +20 Na < 130 mEq/L +20 Ƚɥɭɤɨɡɚ ≥ 14 ЦЦШХ/L +10 ɏɟɦɚɬɨɤɪɢɬ < 30% +10 pO2 < 8 ФPК ɢɥɢ ЋAT < 90% +10 ɉɥɟɭɪɚɥɧɚ ɟɮɭɡɢʁɚ +10 ɍɤɭɩɧɢ ɫɤɨɪ 27 ɂɧɬɟɪɩɪɟɬɚɰɢʁɚ: ɍɤɭɩɧɢ ɫɤɨɪ Ʉɥɚɫɚ ≤ 50 I > 50 ɚɥɢ ≤ 70 II > 70 ɚɥɢ ≤ 90 III > 90 ɚɥɢ ≤ 130 IV > 130 V Ɍɚɛɟɥɚ 3. CURB – 65 ɫɤɚɥɚ ɢ ɢɧɬɟɪɩɪɟɬɚɰɢʁɚ Ʉɚɪɚɤɬɟɪɢɫɬɢɤɚ Бɨɞɨɜɢ Ʉɨɧɮɭɡɢʁɚ 1 ɍɪɟɚ >7 ЦЦШХ/L 1 Ɋɟɫɩɢɪɚɬɨɪɧɚ ɮɪɟɤɜɟɧɰɚ > 30/ɦɢɧ 1 ɋɢɫɬɨɥɧɢ < 90 ЦЦHР, ɞɢʁɚɫɬɨɥɧɢ <60 ЦЦHР 1 ɋɬɚɪɨɫɬ ≥65 ɝɨɞɢɧɚ 1 ɍɤɭɩɧɢ ɫɤɨɪ ɂɧɬɟɪɩɪɟɬɚɰɢʁɚ: 0-1 Ʉɥɚɫɚ I – ɥɚɤɟ (Ⱥɦɛɭɥɚɧɬɧɨ ɥɟɱɟʃɟ) 2 Ʉɥɚɫɚ II – ɭɦɟɪɟɧɨ ɬɟɲɤɟ (Ɋɚɡɦɨɬɪɢɬɢ ɛɨɥɧɢɱɤɨ ɥɟɱɟʃɟ) 3-5 Ʉɥɚɫɚ III – ɬɟɲɤɟ (Ɉɛɚɜɟɡɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ) 28 6. ɊȿɁɍɅɌȺɌɂ 29 6.1 Ⱦɟɦɨɝɪɚɮɫɤɚ ɢ ɦɟɞɢɰɢɧɫɤɚ ɫɬɪɭɤɬɭɪɚ ɭɡɨɪɤɚ Ɍɚɛɟɥɚ 4. ɋɨɰɢɨ-ɞɟɦɨɝɪɚɮɫɤɟ ɤɚɪɚɤɬɟɪɢɫɬɢɤɟ ɩɚɰɢʁɟɧɚɬɚ ɉɨɥ Ɇɭɲɤɚɪɰɢ 46 (48,5%) ɀɟɧɟ 49 (51,5%) ɍɤɭɩɧɨ 95 (100%) ɋɬɚɪɨɫɬ (ɝɨɞɢɧɟ ɠɢɜɨɬɚ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 63,46±14,83 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 23-92 ȼɢɫɢɧɚ (ɰɦ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 168,92±8,61 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 149-186 Ɍɟɠɢɧɚ (ɤɝ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 70,35±16,38 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 40-112 ɂɧɞɟɤɫ ɬɟɥɟɫɧɟ ɦɚɫɟ (ɰɦ/ɦ2) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 24,58±5,36 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 13,84-41,40 Ɋɚɞɧɢ ɫɬɚɬɭɫ ɧɟɩɨɡɧɚɬɨ 19 (20,0%) ɧɟɡɚɩɨɫɥɟɧ 7 (7,4%) ɞɨɦɚʄɢɰɚ 3 (3,2%) ɩɟɧɡɢɨɧɟɪ 50 (52,6%) ɪɚɞɧɢɤ 11 (11,6%) ɲɬɢʄɟɧɢɤ Ɂɚɜɨɞɚ ɡɚ ɦɟɧɬɚɥɧɨ ɨɛɨɥɟɥɟ 1 (1,1%) ɡɟɦʂɨɪɚɞɧɢɤ 1 (1,1%) ɡɚɩɨɫɥɟɧ 3 (3,2%) ɉɨɥɧɚ ɫɬɪɭɤɬɭɪɚ ɚɧɚɥɢɡɢɪɚɧɢɯ ɩɚɰɢʁɟɧɚɬɚ ʁɟ ɛɢɥɚ ɪɚɜɧɨɩɪɚɜɧɚ, ɫɚ ɝɨɬɨɜɨ ɩɨɞʁɟɞɧɚɤɨɦ ɡɚɫɬɭɩʂɟɧɨɲʄɭ ɠɟɧɚ ɢ ɦɭɲɤɚɪɚɰɚ. ȼɟʄɢɧɚ ɨɛɨɥɟɥɢɯ ʁɟ ɛɢɥɚ ɫɬɚɪɢʁɟ ɠɢɜɨɬɧɟ ɞɨɛɢ. 30 Ɍɚɛɟɥɚ 5. Ɇɨɝɭʄɢ ɮɚɤɬɨɪɢ ɪɢɡɢɤɚ ɥɨɲɢʁɟɝ ɢɫɯɨɞɚ ɥɟɱɟʃɚ ɨɛɨɥɟɥɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ ɉɭɲɚɱɤɢ ɫɬɚɬɭɫ ɞɚ 44 (46,3%) ɧɟ 51 (53,7%) ɀɢɜɨɬ ɭ ɫɬɚɪɚɱɤɨɦ ɞɨɦɭ ɞɚ 2 (2,1%) ɧɟ 93 (97,9%) Ʉɨɧɡɭɦɢɪɚʃɟ ɰɢɝɚɪɟɬɚ (ɛɪɨʁ ɩɚɤɥɢ/ɝɨɞɢɧɢ)- ɧɚ ɧɢɜɨɭ ɰɟɥɨɝ ɭɡɨɪɤɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 18,32±22,85 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 0-100 Ʉɨɧɡɭɦɢɪɚʃɟ ɰɢɝɚɪɟɬɚ (ɛɪɨʁ ɩɚɤɥɢ/ɝɨɞɢɧɢ)- ɫɚɦɨ ɡɚ ɩɭɲɚɱɟ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 37,05±19,49 ɉɪɟɬɯɨɞɧɚ ɜɚɤɰɢɧɚɰɢʁɚ ɩɪɨɬɢɜ ɜɢɪɭɫɚ ɝɪɢɩɚ ɞɚ 1 (1,1%) ɧɟ 94 (98,9%) ɉɪɟɬɯɨɞɧɚ ɜɚɤɰɢɧɚɰɢʁɚ ɩɪɨɬɢɜ ɩɧɟɭɦɨɤɨɤɚ ɞɚ 1 (1,1%) ɧɟ 94 (98,9%) ɉɪɟɬɯɨɞɧɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɡɛɨɝ ɩɧɟɭɦɨɧɢʁɚ ɞɚ 14 (14,7%) ɧɟ 81 (85,3%) Ʉɨɧɡɭɦɢɪɚʃɟ ɚɥɤɨɯɨɥɚ ɞɚ 10 (10,5%) ɧɟ 85 (89,5%) ɍ ɫɬɪɭɤɬɭɪɢ ɚɧɚɥɢɡɢɪɚɧɢɯ ɛɨɥɟɫɧɢɤɚ ɝɨɬɨɜɨ ɩɨɞʁɟɞɧɚɤɨ ɫɭ ɛɢɥɢ ɡɚɫɬɭɩʂɟɧɢ ɧɟɩɭɲɚɱɢ ɢ ɩɭɲɚɱɢ, ɫɚ ɛɥɚɝɨɦ ɩɪɟɞɨɦɢɧɚɰɢʁɨɦ ɧɟɩɭɲɚɱɚ. ɍ ɩɨɩɭɥɚɰɢʁɢ ɩɭɲɚɱɚ, ɜɟʄɢɧɚ ɫɭ ɨɫɨɛɟ ɫɚ ɞɭɝɢɦ ɩɭɲɚɱɤɢɦ ɫɬɚɠɨɦ. ɂɡ ɭɫɬɚɧɨɜɟ ɬɪɚʁɧɨɝ ɫɦɟɲɬɚʁɚ ɢ ɡɛɪɢʃɚɜɚʃɚ ɫɬɚɪɢʁɢɯ ɨɫɨɛɚ ɫɭ ɞɨɲɥɚ 2 ɛɨɥɟɫɧɢɤɚ (2,1%), ɞɨɤ ɨɫɬɚɥɢ ɩɨɬɢɱɭ ɢɡ ɫɬɚɧɞɚɪɞɧɨɝ ɜɚɧɛɨɥɧɢɱɤɨɝ ɨɤɪɭɠɟʃɚ. ȿɤɫɰɟɫɢɜɧɚ ɤɨɧɡɭɦɚɰɢʁɚ ɚɥɤɨɯɨɥɚ ɤɚɨ ɮɚɤɬɨɪ ɪɢɡɢɤɚ ɛɢɥɚ ʁɟ ɩɪɢɫɭɬɧɚ ɤɨɞ ɱɚɤ 10 ɛɨɥɟɫɧɢɤɚ. 31 Ɍɚɛɟɥɚ 6. Ʉɥɢɧɢɱɤɚ ɫɥɢɤɚ ɨɛɨɥɟɥɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ Ɍɪɚʁɚʃɟ ɤɥɢɧɢɱɤɢɯ ɫɢɦɩɬɨɦɚ ɢ ɡɧɚɤɨɜɚ ɨɛɨʂɟʃɚ (ɞɚɧɚ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 6,44±5,60 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 1-30 Ɍɟɥɟɫɧɚ ɬɟɦɩɟɪɚɬɭɪɚ (ɋ0) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 38,19±0,94 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 36-40 ɛɪɨʁ ɛɨɥɟɫɧɢɤɚ ɫɚ ɬɟɦɩɟɪɚɬɭɪɨɦ >37њɋ 85 (89,47%) Ʉɚɲɚʂ ɞɚ 80 (84,2%) ɧɟ 15 (15,8%) ɉɪɨɞɭɤɬɢɜɚɧ ɤɚɲɚʂ ɞɚ 49 (51,6%) ɧɟ 46 (48,4%) Ⱦɢɫɩɧɨʁɚ ɞɚ 55 (57,9%) ɧɟ 40 (42,1%) Ȼɨɥ ɭ ɝɪɭɞɢɦɚ ɞɚ 44 (46,3%) ɧɟ 51 (53,7%) Ɋɟɫɩɢɪɚɬɨɪɧɚ ɮɪɟɤɜɟɧɰɚ (ɛɪɨʁ ɞɢɫɚʁɧɢɯ ɰɢɤɥɭɫɚ/ɦɢɧɭɬɭ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 19,61±4,73 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 12-36 ɋɪɱɚɧɚ ɮɪɟɤɜɟɧɰɚ (ɛɪɨʁ ɨɬɤɭɰɚʁɚ ɫɪɰɚ/ɦɢɧɭɬɭ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 94,45±18,58 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 55-150 ɋɢɫɬɨɥɧɢ ɤɪɜɧɢ ɩɪɢɬɢɫɚɤ (mmHg) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 124,37±19,16 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 75-170 32 Ⱦɢʁɚɫɬɨɥɧɢ ɤɪɜɧɢ ɩɪɢɬɢɫɚɤ (mmHg) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 75,05±10,30 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 55-110 Ⱦɟɡɨɪɢʁɟɧɬɢɫɚɧɨɫɬ ɩɪɟɦɚ ɞɪɭɝɢɦ ɨɫɨɛɚɦɚ ɞɚ 11 (11,6%) ɧɟ 84 (88,4%) Ⱦɟɡɨɪɢʁɟɧɬɢɫɚɧɨɫɬ ɭ ɩɪɨɫɬɨɪɭ ɞɚ 11 (11,6%) ɧɟ 84 (88,4%) Ⱦɟɡɨɪɢʁɟɧɬɢɫɚɧɨɫɬ ɭ ɜɪɟɦɟɧɭ ɞɚ 11 (11,6%) ɧɟ 84 (88,4%) ɉɪɢʁɟɦ ɭ ʁɟɞɢɧɢɰɭ ɢɧɬɟɧɡɢɜɧɟ ɧɟɝɟ ɞɚ 9 (9,5%) ɧɟ 86 (90,5%) ɍɩɨɬɪɟɛɚ ɦɟɯɚɧɢɱɤɟ ɜɟɧɬɢɥɚɰɢʁɟ ɧɟ 95 (100%) ɋɢɦɩɬɨɦɢ ɫɭ ɩɪɟ ɩɨɱɟɬɤɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɭ ɩɪɨɫɟɤɭ ɬɪɚʁɚɥɢ 6 ɢ ɩɨ ɞɚɧɚ, ɚ ɧɚʁɱɟɲʄɟ ɫɭ ɛɢɥɢ ɩɪɢɫɭɬɧɢ, ɩɨ ɭɱɟɫɬɚɥɨɫɬɢ: ɮɟɛɪɢɥɧɨɫɬ, ɤɚɲɚʂ, ɤɨʁɢ ʁɟ ɛɢɨ ɩɪɨɞɭɤɬɢɜɚɧ ɭ ɜɢɲɟ ɨɞ ɩɨɥɨɜɢɧɟ ɛɨɥɟɫɧɢɤɚ, ɞɢɫɩɧɟʁɚ ɢ ɛɨɥ ɭ ɝɪɭɞɢɦɚ. ɍ ʁɟɞɢɧɢɰɭ ɢɧɬɟɧɡɢɜɧɟ ɧɟɝɟ ʁɟ ɩɪɢɦʂɟɧɨ 9 ɛɨɥɟɫɧɢɤɚ. 33 Ɍɚɛɟɥɚ 7. Ɋɚɧɢʁɢ ɤɨɦɨɪɛɢɞɢɬɟɬɢ ɤɨɞ ɨɛɨɥɟɥɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ Ɉɛɨʂɟʃɟ ɤɨɪɨɧɚɪɧɢɯ ɤɪɜɧɢɯ ɫɭɞɨɜɚ ɞɚ 17 (17,9%) ɧɟ 78 (82,1%) ɋɪɱɚɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɞɚ 21 (22,1%) ɧɟ 74 (77,9%) Ȼɨɥɟɫɬ ɫɪɱɚɧɢɯ ɜɚɥɜɭɥɚ ɞɚ 4 (4,2%) ɧɟ 91 (95,8%) ɉɨɜɢɲɟɧ ɤɪɜɧɢ ɩɪɢɬɢɫɚɤ ɞɚ 58 (61,1%) ɧɟ 37 (38,9%) Ⱥɫɬɦɚ ɞɚ 10 (10,5%) ɧɟ 85 (89,5%) ɏɪɨɧɢɱɧɚ ɨɩɫɬɪɭɤɬɢɜɧɚ ɛɨɥɟɫɬ ɩɥɭʄɚ ɞɚ 21 (22,1%) ɧɟ 74 (77,9%) Ȼɭɛɪɟɠɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɞɚ 11 (11,6%) ɧɟ 84 (88,4%) ɂɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ʁɟɬɪɟ ɞɚ 2 (2,1%) ɧɟ 93 (97,9%) ȿɧɰɟɮɚɥɨɩɚɬɢʁɚ ɞɚ 4 (4,2%) ɧɟ 91 (95,8%) 34 Ⱦɢʁɚɛɟɬɟɫ ɦɟɥɢɬɭɫ ɞɚ 29 (30,5%) ɧɟ 66 (69,5%) Ɇɚɥɢɝɧɢɬɟɬ ɞɚ 6 (6,3%) ɧɟ 89 (93,7%) Ɉɞ ɩɪɟɩɨɫɬɨʁɟʄɢɯ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɤɨɞ ɛɨɥɟɫɧɢɤɚ, ɧɚʁɭɱɟɫɬɚɥɢʁɢ ɫɭ ɛɢɥɢ: ɯɢɩɟɪɬɟɧɡɢʁɚ, ɞɢʁɚɛɟɬɟɫ ɦɟɥɢɬɭɫ, ɯɪɨɧɢɱɧɚ ɨɩɫɬɪɭɤɬɢɜɧɚ ɛɨɥɟɫɬ ɩɥɭʄɚ, ɫɪɱɚɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ, ɨɛɨʂɟʃɟ ɤɨɪɨɧɚɪɧɢɯ ɤɪɜɧɢɯ ɫɭɞɨɜɚ, ɛɭɛɪɟɠɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ, ɚɫɬɦɚ, ɢɡɚ ɤɨʁɢɯ ɫɭ ɫɥɟɞɢɥɢ, ɩɨ ɭɱɟɫɬɚɥɨɫɬɢ: ɦɚɥɢɝɧɢɬɟɬɢ, ɟɧɰɟɮɚɥɨɩɚɬɢʁɚ, ɛɨɥɟɫɬ ɫɪɱɚɧɢɯ ɜɚɥɜɭɥɚ ɢ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ʁɟɬɪɟ. 35 Ɍɚɛɟɥɚ 8. ɉɨɤɚɡɚɬɟʂɢ ɬɟɠɢɧɟ ɤɥɢɧɢɱɤɟ ɫɥɢɤɟ ɨɛɨɥɟɥɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 85,08±33,95 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 13-182 ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɤɥɚɫɚ 1: ɫɤɨɪ ≤50 15 (15,8%) ɤɥɚɫɚ 2: ɫɤɨɪ 50-70 18 (18,9%) ɤɥɚɫɚ 3: ɫɤɨɪ 70-90 22 (23,2%) ɤɥɚɫɚ 4: ɫɤɨɪ 90-130 32 (33,7%) ɤɥɚɫɚ 5: ɫɤɨɪ >130 8 (8,4%) CURB-65 ɫɤɚɥɚ ɤɥɚɫɚ I, ɥɚɤɟ: ɫɤɨɪ 0-1 58 (61,1%) ɤɥɚɫɚ II, ɭɦɟɪɟɧɨ ɬɟɲɤɟ: ɫɤɨɪ 2 29 (30,5%) ɤɥɚɫɚ III, ɬɟɲɤɟ: ɫɤɨɪ 3-5 8 (8,4%) Ⱦɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ (ɞɚɧɚ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 14,62±7,081 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 3-48 Ⱦɚ ɥɢ ʁɟ ɭɤʂɭɱɟɧɚ ɧɟɝɚ ɨɞ ɫɬɪɚɧɟ ɱɥɚɧɨɜɚ ɩɨɪɨɞɢɰɟ ɞɚ 52 (54,7%) ɧɟ 43 (45,3%) ɂɫɯɨɞ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɟ ɩɪɟɠɢɜɟɨ 90 (94,7%) ɫɦɪɬɧɢ ɢɫɯɨɞ 5 (5,3%) 36 Ƚɪɚɮɢɤɨɧ 1. Ⱦɢɫɬɪɢɛɭɰɢʁɚ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ ɩɪɟɦɚ ɢɧɞɟɤɫɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ 37 Ƚɪɚɮɢɤɨɧ 2. Ⱦɢɫɬɪɢɛɭɰɢʁɚ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ ɩɪɟɦɚ CURB-65 ɫɤɚɥɢ ɋɬɪɚɬɢɮɢɤɚɰɢʁɚ ɪɢɡɢɤɚ, ɨɞɧɨɫɧɨ ɢɧɢɰɢʁɚɥɧɚ ɩɪɨɰɟɧɚ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ, ɧɚ ɩɪɢʁɟɦɭ ʁɟ ɜɪɲɟɧɚ ɩɨɦɨʄɭ ɞɜɚ ɫɢɫɬɟɦɚ ɛɨɞɨɜɚʃɚ, ɂɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ (PЧОuЦШЧТК ЋОvОrТtв IЧНОб – PЋI) ɢ CURB-65 ɫɤɚɥɟ (Ɍɚɛɟɥɚ 8, Ƚɪɚɮɢɤɨɧ 1 ɢ 2). ɋɪɟɞʃɚ ɜɪɟɞɧɨɫɬ ɂɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɡɚ ɫɜɟ ɩɚɰɢʁɟɧɬɟ ɭɤʂɭɱɟɧɟ ɭ ɢɫɬɪɚɠɢɜɚʃɟ ɢɡɧɨɫɢɥɚ ʁɟ 85,08. ɇɚʁɜɢɲɟ ɛɨɥɟɫɧɢɤɚ ʁɟ ɩɪɢɩɚɞɚɥɨ ɤɥɚɫɢ 4 ɢ ɤɥɚɫɢ 3 ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ, ɚ ɧɚʁɦɚʃɟ ɤɥɚɫɢ 5. ɉɪɟɦɚ CUЊB-65 ɫɢɫɬɟɦɭ ɛɨɞɨɜɚʃɚ, ɧɚʁɜɢɲɟ ɛɨɥɟɫɧɢɤɚ ʁɟ ɢɦɚɥɨ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɭ ɬɟɠɢɧɭ ɛɨɥɟɫɬɢ ɤɨʁɚ ʁɟ ɫɜɪɫɬɚɧɚ ɭ ɤɚɬɟɝɨɪɢʁɭ ɥɚɤɢɯ ɩɧɟɭɦɨɧɢʁɚ, ɞɨɤ ʁɟ ɧɚʁɦɚʃɟ ɢɦɚɥɨ ɬɟɠɚɤ ɨɛɥɢɤ ɛɨɥɟɫɬɢ. 38 Ɍɚɛɟɥɚ 9. ɉɨɤɚɡɚɬɟʂɢ ɬɟɠɢɧɟ ɤɥɢɧɢɱɤɟ ɫɥɢɤɟ ɨɛɨɥɟɥɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ ɭ ɨɞɧɨɫɭ ɧɚ ɩɨɞɟɥɭ ɩɚɰɢʁɟɧɚɬɚ ɭ ɫɬɚɪɨɫɧɟ ɤɚɬɟɝɨɪɢʁɟ, ɩɚɰɢʁɟɧɬɢ ɫɚ ɦɚʃɟ ɢɥɢ 50 ɝɨɞɢɧɚ ɫɬɚɪɨɫɬɢ ɢ ɩɚɰɢʁɟɧɬɢ ɫɚ ɜɢɲɟ ɨɞ 50 ɝɨɞɢɧɚ ɫɬɚɪɨɫɧɟ ɤɚɬɟɝɨɪɢʁɟ ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ# ≤50 >50 ɫɬɚɬɢɫɬɢɱɤɚ ɡɧɚɱɚʁɧɨɫɬ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 45,41±17,69 93,73±30,32 p<0,0001* ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ## ɤɥɚɫɚ 1: ɫɤɨɪ ≤50 11 (64,7%) 4 (5,1%) p<0,0001* ɤɥɚɫɚ 2: ɫɤɨɪ 50-70 5 (29,4%) 13 (16,7%) ɤɥɚɫɚ 3: ɫɤɨɪ 70-90 1 (5,9%) 21 (26,9%) ɤɥɚɫɚ 4: ɫɤɨɪ 90-130 - 32 (41,0%) ɤɥɚɫɚ 5: ɫɤɨɪ >130 - 8 (10,3%) CURB-65 ɫɤɚɥɚ# ɤɥɚɫɚ I, ɥɚɤɟ: ɫɤɨɪ 0-1 17 (100%) 41 (52,6%) p=0,001* ɤɥɚɫɚ II, ɭɦɟɪɟɧɨ ɬɟɲɤɟ: ɫɤɨɪ 2 - 29 (37,2%) ɤɥɚɫɚ III, ɬɟɲɤɟ: ɫɤɨɪ 3-5 - 8 (10,3%) Ⱦɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ (ɞɚɧɚ)## ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 14,12±6,89 14,73±7,16 p=0,606 ɂɫɯɨɞ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɟ# ɩɪɟɠɢɜɟɨ 17 (100%) 73 (93,6%) p=0,636 ɫɦɪɬɧɢ ɢɫɯɨɞ - 5 (6,4%) *- ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ; #- Mann-Whytnei ɬɟɫɬ; ##- chi square ɬɟɫɬ ɍɤɨɥɢɤɨ ɫɟ ɢɧɢɰɢʁɚɥɧɚ ɩɪɨɰɟɧɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɚɧɚɥɢɡɢɪɚ ɬɚɤɨ ɲɬɨ ɫɟ ɝɪɭɩɚ ɛɨɥɟɫɧɢɤɚ ɩɨɞɟɥɢ ɭ ɞɜɟ ɝɪɭɩɟ, ɦɥɚђɟ ɢ ɫɬɚɪɢʁɟ ɨɞ 50 ɝɨɞɢɧɚ, ʁɚɫɧɨ ɫɟ ɭɨɱɚɜɚ ɜɟɥɢɱɢɧɚ ɭɬɢɰɚʁɚ ɝɨɞɢɧɚ ɫɬɚɪɨɫɬɢ ɧɚ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɭ ɬɟɠɢɧɭ ɛɨɥɟɫɬɢ. 39 ɍ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɦɥɚђɢɯ ɨɞ 50 ɝɨɞɢɧɚ, ɧɚʁɜɢɲɟ ɛɨɥɟɫɧɢɤɚ ʁɟ ɫɜɪɫɬɚɧɨ ɭ ɤɥɚɫɭ 1 ɢɧɢɰɢʁɚɥɧɨ ɩɪɟɰɟʃɟɧɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ, ɞɨɤ ʁɟ ɫɚɦɨ 1 ɛɨɥɟɫɧɢɤ (5,9%) ɫɜɪɫɬɚɧ ɭ ɤɚɬɟɝɨɪɢʁɭ 3. ɍ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɦɥɚђɢɯ ɨɞ 50 ɝɨɞɢɧɚ, ɧɢʁɟ ɛɢɥɨ ɨɧɢɯ ɤɨʁɢ ɫɭ ɩɨ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɨʁ ɬɟɠɢɧɢ ɛɨɥɟɫɬɢ ɫɜɪɫɬɚɧɢ ɭ ɤɚɬɟɝɨɪɢʁɟ 4 ɢɥɢ 5. ɍ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ, ɧɚʁɜɢɲɟ ɛɨɥɟɫɧɢɤɚ ʁɟ ɤɥɚɫɢɮɢɤɨɜɚɧɨ ɭ ɤɥɚɫɟ 4 ɢ 3, ɞɨɤ ɢɯ ʁɟ ɭ ɞɪɭɝɟ ɤɥɚɫɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɛɢɥɨ ɫɜɪɫɬɚɧɨ ɦɚʃɟ. ɍ ɩɨɝɥɟɞɭ CUЊB-65 ɫɢɫɬɟɦɚ ɛɨɞɨɜɚʃɚ, ɫɜɢ ɛɨɥɟɫɧɢɰɢ ɦɥɚђɢ ɨɞ 50 ɝɨɞɢɧɚ ɫɭ ɫɜɪɫɬɚɧɢ ɭ ɤɚɬɟɝɨɪɢʁɭ I, ɥɚɤɢɯ ɩɧɟɭɦɨɧɢʁɚ, ɞɨɤ ʁɟ ɭ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ ɧɚʁɜɟʄɢ ɛɪɨʁ ɬɚɤɨђɟ ɛɢɨ ɫɜɪɫɬɚɧ ɭ ɤɚɬɟɝɨɪɢʁɭ I, ɥɚɤɢɯ ɩɧɟɭɦɨɧɢʁɚ. ɉɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ʁɟ ɢɡɧɨɫɢɥɚ 14,62±7,081 ɞɚɧɚ ɢ ɛɟɡ ɪɟɝɢɫɬɪɨɜɚɧɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ ɭɤɨɥɢɤɨ ɫɟ ɩɨɪɟɞɢ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɭ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɦɥɚђɢɯ ɨɞ 50 ɝɨɞɢɧɚ (14,12±6,89) ɢ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ (14,73±7,16). 40 6.2 ɉɪɨɰɟɧɚ ɭɫɩɟɯɚ ɤɥɢɧɢɱɤɨɝ ɨɞɝɨɜɨɪɚ Ɍɚɛɟɥɚ 10. Ʉɪɜɧɚ ɫɥɢɤɚ ɧɚ ɩɨɱɟɬɤɭ ɢ ɤɪɚʁɭ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɟ ɇɚ ɩɨɱɟɬɤɭ ɥɟɱɟʃɚ ɇɚ ɤɪɚʁɭ ɥɟɱɟʃɚ ɋɬɚɬɢɫɬɢɱɤɚ ɡɧɚɱɚʁɧɨɫɬ ȿɪɢɬɪɨɰɢɬɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 4,02±0,61 4,00±0,56 p=0,759 Ʌɟɭɤɨɰɢɬɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 12,39±6,79 9,71±5,24 #p<0,001* ɇɟɭɬɪɨɮɢɥɢ (%) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 78,82±12,55 70,79±11,94 #p<0,001* Ʌɢɦɮɨɰɢɬɢ (%) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 13,22±9,30 17,49±8,65 #p=0,003* Ɇɨɧɨɰɢɬɢ (%) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 6,28±3,79 7,71±3,79 #p=0,035* ȿɨɡɢɧɨɮɢɥɢ (%) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 1,41±1,79 2,52±2,11 #p=0,001* Ȼɚɡɨɮɢɥɢ (%) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 0,60±1,04 0,66±0,56 #p=0,252 Ɍɪɨɦɛɨɰɢɬɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 268,18±122,95 339,46±114,99 #p<0,001* ɏɟɦɨɝɥɨɛɢɧ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 121,19±18,96 119,43±16,61 #p=0,368 *- ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ; t ɬɟɫɬ ɡɚ ɭɩɚɪɟɧɟ ɭɡɨɪɤɟ ɝɞɟ ɫɭ ɢɫɩɭʃɟɧɢ ɭɫɥɨɜɢ ɡɚ ɧɨɪɦɚɥɧɭ ɪɚɫɩɨɞɟɥɭ ɢɥɢ Wilcoxon Signed Ranks ɬɟɫɬ (#) ɝɞɟ ɧɢɫɭ ɢɫɩɭʃɟɧɢ ɭɫɥɨɜɢ ɡɚ ɧɨɪɦɚɥɧɭ ɪɚɫɩɨɞɟɥɭ 41 Ɍɚɛɟɥɚ 11. ɏɟɩɚɬɨɝɪɚɦ ɧɚ ɩɨɱɟɬɤɭ ɢ ɤɪɚʁɭ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɟ ɇɚ ɩɨɱɟɬɤɭ ɥɟɱɟʃɚ ɇɚ ɤɪɚʁɭ ɥɟɱɟʃɚ ɋɬɚɬɢɫɬɢɱɤɚ ɡɧɚɱɚʁɧɨɫɬ Ⱥɫɩɚɪɬɚɬ-ɚɦɢɧɨɬɪɚɧɫɮɟɪɚɡɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 30,01±20,91 27,70±12,60 #p=0,022* Ⱥɥɚɧɢɧ-ɚɦɢɧɨɬɪɚɧɫɮɟɪɚɡɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 36,08±32,99 38,15±28,73 #p=0,247 Ƚɚɦɚ-ɝɥɭɬɚɦɢɥ-ɬɪɚɧɫɩɟɩɬɢɞɚɡɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 95,00±38,18 79,00±29,70 p=0,228 Ȼɢɥɢɪɭɛɢɧ ɭɤɭɩɧɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 11,92±5,92 11,34±7,06 #p=0,013* Ȼɢɥɢɪɭɛɢɧ ɞɢɪɟɤɬɧɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 2,92±2,73 2,70±3,13 #p=0,024* ɉɪɨɬɟɢɧɢ ɭɤɭɩɧɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 64,88±8,01 69,63±7,15 p=0,190 Ⱥɥɛɭɦɢɧɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 29,13±6,71 31,25±6,04 p=0,303 Ƚɥɨɛɭɥɢɧɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 31,80±3,11 35,20±2,78 p=0.258 *- ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ; t ɬɟɫɬ ɡɚ ɭɩɚɪɟɧɟ ɭɡɨɪɤɟ ɝɞɟ ɫɭ ɢɫɩɭʃɟɧɢ ɭɫɥɨɜɢ ɡɚ ɧɨɪɦɚɥɧɭ ɪɚɫɩɨɞɟɥɭ ɢɥɢ Wilcoxon Signed Ranks ɬɟɫɬ (#) ɝɞɟ ɧɢɫɭ ɢɫɩɭʃɟɧɢ ɭɫɥɨɜɢ ɡɚ ɧɨɪɦɚɥɧɭ ɪɚɫɩɨɞɟɥɭ 42 Ɍɚɛɟɥɚ 12. Ʌɚɛɨɪɚɬɨɪɢʁɫɤɢ ɩɨɤɚɡɚɬɟʂɢ ɧɚ ɩɨɱɟɬɤɭ ɢ ɤɪɚʁɭ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɟ ɇɚ ɩɨɱɟɬɤɭ ɥɟɱɟʃɚ ɇɚ ɤɪɚʁɭ ɥɟɱɟʃɚ ɋɬɚɬɢɫɬɢɱɤɚ ɡɧɚɱɚʁɧɨɫɬ Ƚɥɢɤɟɦɢʁɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 7,62±3,49 6,20±1,68 #p=0,001* Ʉɪɟɚɬɢɧɢɧ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 115,88±112,42 107,95±139,76 #p<0,001* ɍɪɟɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 9,32±7,47 7,12±5,49 #p<0,001* ɂɇɊ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 1,89±2,14 2,23±1,12 #p=0,600 Ƚɜɨɠђɟ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 6,88±3,39 2,93±0,94 - ɍɂȻɐ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 27,33±9,71 41,00±8,54 - ɌɂȻɐ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 36,00±11,53 44,00±8,00 - ɇɚɬɪɢʁɟɦɢʁɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 137,91±5,58 138,46±3,65 #p=0,002* Ʉɚɥɢʁɟɦɢʁɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 4,83±4,43 4,39±0,77 #p=0,434 Ʉɚɥɰɢʁɟɦɢʁɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 1,61±0,69 1,32±0,48 #p=0,854 *- ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ; t ɬɟɫɬ ɡɚ ɭɩɚɪɟɧɟ ɭɡɨɪɤɟ ɝɞɟ ɫɭ ɢɫɩɭʃɟɧɢ ɭɫɥɨɜɢ ɡɚ ɧɨɪɦɚɥɧɭ ɪɚɫɩɨɞɟɥɭ ɢɥɢ Wilcoxon Signed Ranks ɬɟɫɬ (#) ɝɞɟ ɧɢɫɭ ɢɫɩɭʃɟɧɢ ɭɫɥɨɜɢ ɡɚ ɧɨɪɦɚɥɧɭ ɪɚɫɩɨɞɟɥɭ 43 Ɍɚɛɟɥɚ 13. Ƚɚɫɧɟ ɚɧɚɥɢɡɟ ɢ ɦɚɪɤɟɪɢ ɡɚɩɚʂɟʃɚ ɧɚ ɩɨɱɟɬɤɭ ɢ ɤɪɚʁɭ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɟ ɇɚ ɩɨɱɟɬɤɭ ɥɟɱɟʃɚ ɇɚ ɤɪɚʁɭ ɥɟɱɟʃɚ ɋɬɚɬɢɫɬɢɱɤɚ ɡɧɚɱɚʁɧɨɫɬ pH ɤɪɜɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 7,45±0,06 7,42±0,09 #p=0,068 PaO2 ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 7,98±2,10 9,24±1,71 #p<0,001* PaCO2 ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 4,88±1,10 5,57±1,20 #p<0,001* ɋɚɬɭɪɚɰɢʁɚ O2 ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 90,89±7,23 93,98±4,23 #p<0,001* HCO3 ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 26,00±4,05 27,26±4,42 #p=0,024* Ʌɚɤɬɚɬɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 1,39±0,66 1,55±0,81 #p=0,731 ɐ-ɪɟɚɤɬɢɜɧɢ ɩɪɨɬɟɢɧ (CRЈ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 163,68±100,18 27,08±31,39 #p<0,001* Ɏɢɛɪɢɧɨɝɟɧ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 5,55±2,12 4,67±1,17 #p=0,026* Ⱦ-ɞɢɦɟɪ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 3970,33±3356,00 2189,33±577,98 p=0,460 Ɍɪɨɩɨɧɢɧ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 0,06±0,11 0,03±0,02 #p=0,655 ɉɪɨɤɚɥɰɢɬɨɧɢɧ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 4,56±7,04 0,33±0,21 #p=0,046* *- ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ; t ɬɟɫɬ ɡɚ ɭɩɚɪɟɧɟ ɭɡɨɪɤɟ ɝɞɟ ɫɭ ɢɫɩɭʃɟɧɢ ɭɫɥɨɜɢ ɡɚ ɧɨɪɦɚɥɧɭ ɪɚɫɩɨɞɟɥɭ ɢɥɢ Wilcoxon Signed Ranks ɬɟɫɬ (#) ɝɞɟ ɧɢɫɭ ɢɫɩɭʃɟɧɢ ɭɫɥɨɜɢ ɡɚ ɧɨɪɦɚɥɧɭ ɪɚɫɩɨɞɟɥɭ 44 Ⱥɧɚɥɢɡɚ ɥɚɛɨɪɚɬɨɪɢʁɫɤɢɯ ɪɟɡɭɥɬɚɬɚ ɫɚ ɩɨɱɟɬɤɚ ɢ ɤɪɚʁɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ (Ɍɚɛɟɥɟ 10, 11, 12, 13.) ɧɟɞɜɨɫɦɢɫɥɟɧɨ ɩɨɤɚɡɭʁɟ ɞɚ ʁɟ ɭ ɧɚʁɜɟʄɟɦ ɛɪɨʁɭ ɫɥɭɱɚʁɟɜɚ ɢ ɚɧɚɥɢɡɚ ɞɨɲɥɨ ɞɨ ɡɧɚɱɚʁɧɨɝ ɩɨɩɪɚɜʂɚʃɚ ʃɢɯɨɜɢɯ ɜɪɟɞɧɨɫɬɢ ɧɚ ɤɪɚʁɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɫɚ ɩɪɢɫɭɬɧɨɦ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɨɦ ɪɚɡɥɢɤɨɦ, ɤɚɤɨ ɭ ɩɨɝɥɟɞɭ ɫɬɚɧɞɚɪɞɧɢɯ ɯɟɦɚɬɨɥɨɲɤɢɯ ɚɧɚɥɢɡɚ, ɯɟɩɚɬɨɝɪɚɦɚ, ɛɢɨɯɟɦɢʁɫɤɢɯ ɚɧɚɥɢɡɚ, ɩɚɪɚɦɟɬɚɪɚ ɛɢɨɯɭɦɨɪɚɥɧɨɝ ɡɚɩɚʂɟɧɫɤɨɝ ɫɢɧɞɪɨɦɚ, ɬɚɤɨ ɢ ɭ ɜɢɞɭ ɪɟɡɭɥɬɚɬɚ ɩɚɪɰɢʁɚɥɧɢɯ ɩɪɢɬɢɫɚɤɚ ɪɟɫɩɢɪɚɰɢʁɫɤɢɯ ɝɚɫɨɜɚ ɚɪɬɟɪɢʁɫɤɟ ɤɪɜɢ. 45 Ɍɚɛɟɥɚ 14. Ʉɨɦɩɥɢɤɚɰɢʁɟ ɬɨɤɨɦ ɥɟɱɟʃɚ ɩɚɰɢʁɟɧɚɬɚ ɨɛɨɥɟɥɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ Ɋɟɫɩɢɪɚɬɨɪɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ Ȼɭɛɪɟɠɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɞɚ 39 (41,1%) ɞɚ 15 (15,8%) ɧɟ 56 (58,9%) ɧɟ 80 (84,2%) Ⱥɪɬɟɪɢʁɫɤɚ ɨɤɫɢɝɟɧɚɰɢʁɚ <7,98Ʉɉɚ Ȼɨɥ ɭ ɩɪɟɞɟɥɭ ɛɭɛɪɟɝɚ ɞɚ 32 (33,7%) ɞɚ - ɧɟ 63 (66,3%) ɧɟ 95 (100%) ɉɥɟɭɪɚɥɧɚ ɟɮɭɡɢʁɚ ȿɧɞɨɤɚɪɞɢɬɢɫ ɞɚ 23 (24,2%) ɞɚ - ɧɟ 72 (75,8%) ɧɟ 95 (100%) ȿɦɛɨɥɢʁɚ ɩɥɭʄɚ Ⱥɪɬɪɢɬɢɫ ɞɚ 1 (1,1%) ɞɚ - ɧɟ 94 (98,9%) ɧɟ 95 (100%) ɉɧɟɭɦɨɬɨɪɚɤɫ Ɇɟɧɢɧɝɢɬɢɫ ɞɚ - ɞɚ - ɧɟ 95 (100%) ɧɟ 95 (100%) ɋɪɱɚɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ Ʌɟɭɤɨɩɟɧɢʁɚ ɞɚ 17 (17,9%) ɞɚ 2 (2,1%) ɧɟ 78 (82,1%) ɧɟ 93 (97,9%) ɉɟɪɢɤɚɪɞɢɬɢɫ Ⱥɧɟɦɢʁɚ ɞɚ - ɞɚ 28 (29,5%) ɧɟ 95 (100%) ɧɟ 67 (70,5%) Ʉɪɜɚɪɟʃɚ ɭ ɞɢɝɟɫɬɢɜɧɨɦ ɬɪɚɤɬɭ Ɍɪɨɦɛɨɰɢɬɨɩɟɧɢʁɚ ɞɚ 1 (1,1%) ɞɚ 2 (2,1%) ɧɟ 94 (98,9%) ɧɟ 93 (97,9%) 46 Ⱦɢʁɚɪɟʁɚ ɐɟɪɟɛɪɨɜɚɫɤɭɥɚɪɧɢ ɢɧɡɭɥɬ ɞɚ 21 (22,1%) ɞɚ 2 (2,1%) ɧɟ 74 (77,9%) ɧɟ 93 (97,9%) ɏɟɦɨɩɬɢɡɢʁɟ Ⱥɩɫɰɟɫ ɞɚ 9 (9,5%) ɞɚ 3 (3,2%) ɧɟ 86 (90,5%) ɧɟ 92 (96,8%) ȿɦɩɢʁɟɦ ɞɚ 1 (1,1%) ɧɟ 94 (98,9%) Ⱥɧɚɥɢɡɢɪɚʁɭʄɢ ɤɨɦɩɥɢɤɚɰɢʁɟ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ, ɞɨɥɚɡɢ ɫɟ ɞɨ ɡɚɤʂɭɱɤɚ ɞɚ ʁɟ ɧɚʁɱɟɲʄɚ ɛɢɥɚ ɪɟɫɩɢɪɚɬɨɪɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ, ɢɡɚ ɤɨʁɟ ɫɥɟɞɟ ɚɧɟɦɢʁɚ, ɩɥɟɭɪɚɥɧɚ ɟɮɭɡɢʁɚ, ɞɢʁɚɪɟʁɚ, ɫɪɱɚɧɚ ɢ ɛɭɛɪɟɠɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ, ɯɟɦɨɩɬɢɡɢʁɟ ɢ ɩɨʁɚɜɚ ɚɩɫɰɟɫɚ. Ɂɚɛɟɥɟɠɟɧɢ ɫɭ ɢ ɩɨʁɟɞɢɧɚɱɧɢ ɫɥɭɱɚʁɟɜɢ ɞɪɭɝɢɯ ɤɨɦɩɥɢɤɚɰɢʁɚ ɥɟɱɟʃɚ ɨɜɟ ɛɨɥɟɫɬɢ, ɤɚɨ ɲɬɨ ɫɭ ɥɟɭɤɨɩɟɧɢʁɚ, ɬɪɨɦɛɨɰɢɬɨɩɟɧɢʁɚ, ɰɟɪɟɛɪɨɜɚɫɤɭɥɚɪɧɢ ɢɧɡɭɥɬ, ɤɪɜɚɪɟʃɟ ɭ ɞɢɝɟɫɬɢɜɧɨɦ ɬɪɚɤɬɭ, ɟɦɛɨɥɢʁɚ ɩɥɭʄɚ ɢ ɟɦɩɢʁɟɦ ɩɥɟɭɪɟ. 47 Ɍɚɛɟɥɚ 15. Ⱦɢʁɚɝɧɨɫɬɢɱɤɢ ɬɟɫɬɨɜɢ ɩɪɟɞɭɡɟɬɢ ɬɨɤɨɦ ɥɟɱɟʃɚ ɩɚɰɢʁɟɧɚɬɚ ɨɛɨɥɟɥɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ (ɩɪɜɢ ɞɟɨ) ȿɄȽ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 2,92±2,56 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-14 ɫɭɦɚ 277 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 94 (98,9%) Ȼɪɨɧɯɨɫɤɨɩɢʁɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 0,18±0,39 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-1 ɫɭɦɚ 17 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 17 (17,9%) Ɍɨɪɚɤɨɰɟɧɬɟɡɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 0,09±0,39 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-2 ɫɭɦɚ 9 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 6 (6,4%) Ƚɪɭɞɧɚ ɞɪɟɧɚɠɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 0,01±0,10 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-1 ɫɭɦɚ 1 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 1 (1,1%) ɋɩɢɪɨɦɟɬɪɢʁɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 1,12±1,47 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-7 ɫɭɦɚ 106 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 52 (54,6%) 48 Ʉɨɦɩʁɭɬɟɪɢɡɨɜɚɧɚ ɬɨɦɨɝɪɚɮɢʁɚ (ɐɌ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 0,27±0,45 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-1 ɫɭɦɚ 26 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 26 (27,4%) Ɋɚɞɢɨɝɪɚɮɢʁɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 4,08±2,42 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-20 ɫɭɦɚ 388 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 95 (100%) Ɍɚɛɟɥɚ 16. Ⱦɢʁɚɝɧɨɫɬɢɱɤɢ ɬɟɫɬɨɜɢ ɩɪɟɞɭɡɟɬɢ ɬɨɤɨɦ ɥɟɱɟʃɚ ɩɚɰɢʁɟɧɚɬɚ ɨɛɨɥɟɥɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ (ɞɪɭɝɢ ɞɟɨ) Ɇɢɤɪɨɛɢɨɥɨɲɤɚ ɚɧɚɥɢɡɚ ɤɪɜɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 0,26±0,64 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-2 ɫɭɦɚ 25 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 15 (15,8%) Ɇɢɤɪɨɛɢɨɥɨɲɤɚ ɚɧɚɥɢɡɚ ɫɩɭɬɭɦɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 0,94±1,45 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-6 ɫɭɦɚ 89 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 40 (42,1%) 49 ɏɟɦɚɬɨɥɨɲɤɨ ɢɫɩɢɬɢɜɚʃɟ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 2,35±1,16 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-8 ɫɭɦɚ 223 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 93 (97,9%) Ȼɢɨɯɟɦɢʁɫɤɚ ɢɫɩɢɬɢɜɚʃɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 2,34±1,23 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-8 ɫɭɦɚ 222 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 92 (96,8%) ɂɫɩɢɬɢɜɚʃɟ ɤɨɚɝɭɥɚɰɢʁɟ ɤɪɜɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 0,46±1,13 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ ɩɨ ɩɚɰɢʁɟɧɬɭ 0-9 ɫɭɦɚ 44 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 26 (27,4%) ȼɢɪɭɫɨɥɨɲɤɚ ɢɫɩɢɬɢɜɚʃɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 0,07±0,26 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 0-1 ɫɭɦɚ 7 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 7 (7,4%) Ƚɚɫɧɟ ɚɧɚɥɢɡɟ ɤɪɜɢ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ 2,20±3,64 ɦɢɧɢɦɭɦ-ɦɚɤɫɢɦɭɦ 0-19 ɫɭɦɚ 209 ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨɞ ɤɨʁɢɯ ʁɟ ɭɪɚђɟɧ ɬɟɫɬ 54 (56,8%) 50 ɍ ɩɨɝɥɟɞɭ ɫɩɪɨɜɟɞɟɧɢɯ ɞɢʁɚɝɧɨɫɬɢɱɤɢɯ ɩɨɫɬɭɩɚɤɚ ɢ ɦɟɬɨɞɚ ɭ ɬɨɤɭ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (Ɍɚɛɟɥɟ 15, 16), ɤɨɞ ɫɜɢɯ ɛɨɥɟɫɧɢɤɚ ʁɟ ɭɱɢʃɟɧɚ ɪɚɞɢɨɝɪɚɮɢʁɚ ɝɪɭɞɧɨɝ ɤɨɲɚ, ɭɤɭɩɧɨ 388, ɨɞɧɨɫɧɨ 4,08 ɩɨ ɛɨɥɟɫɧɢɤɭ. Ʉɨɦɩʁɭɬɟɪɢɡɨɜɚɧɚ ɬɨɦɨɝɪɚɮɢʁɚ (ɋɌ) ʁɟ ɭɱɢʃɟɧɚ ɤɨɞ ɧɟɲɬɨ ɜɢɲɟ ɨɞ ɱɟɬɜɪɬɢɧɟ ɛɨɥɟɫɧɢɤɚ. Ⱥɧɚɥɢɡɟ ɤɪɜɢ ɫɭ ɬɚɤɨђɟ ɭɱɢʃɟɧɟ ɤɨɞ ɝɨɬɨɜɨ ɫɜɢɯ ɛɨɥɟɫɧɢɤɚ. Ƚɚɫɧɟ ɚɧɚɥɢɡɟ ɫɭ ɭɱɢʃɟɧɟ ɤɨɞ ɜɢɲɟ ɨɞ ɩɨɥɨɜɢɧɟ ɛɨɥɟɫɧɢɤɚ. Ɇɢɤɪɨɛɢɨɥɨɲɤɟ ɚɧɚɥɢɡɟ ɫɩɭɬɭɦɚ ɫɭ ɭɱɢʃɟɧɟ ɤɨɞ 40 ɛɨɥɟɫɧɢɤɚ, ɚ ɦɢɤɪɨɛɢɨɥɨɲɤɚ ɚɧɚɥɢɡɚ ɤɪɜɢ ɤɨɞ 15 ɩɚɰɢʁɟɧɚɬɚ. ȼɢɪɭɫɨɥɨɲɤɟ ɚɧɚɥɢɡɟ ɫɭ ɭɱɢʃɟɧɟ ɤɨɞ 7 ɛɨɥɟɫɧɢɤɚ, ɚ ɛɪɨɧɯɨɫɤɨɩɢʁɚ ɤɨɞ 17 ɛɨɥɟɫɧɢɤɚ. ȿɥɟɤɬɪɨɤɚɪɞɢɨɝɪɚɮɫɤɢ ɡɚɩɢɫ ʁɟ ɧɚɱɢʃɟɧ ɤɨɞ 94 ɩɚɰɢʁɟɧɬɚ, ɚ ɫɩɢɪɨɦɟɬɪɢʁɚ ʁɟ ɭɱɢʃɟɧɚ ɤɨɞ 52. 51 6.3 ȿɤɨɧɨɦɫɤɟ ɩɨɫɥɟɞɢɰɟ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ Ɍɚɛɟɥɚ 17. Ʉɥɚɫɢɮɢɤɚɰɢʁɚ ɩɪɨɫɟɱɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɢ ɛɪɨʁɚ ɩɪɭɠɟɧɢɯ ɦɟɞɢɰɢɧɫɤɢɯ ɭɫɥɭɝɚ ɩɨ ɩɚɰɢʁɟɧɬɭ ɢ ɫɭɦɚ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɧɚ ɧɢɜɨɭ ɰɟɥɨɝ ɭɡɨɪɤɚ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (ɫɜɢ ɬɪɨɲɤɨɜɢ ɭ ɞɢɧɚɪɢɦɚ- ɊɋȾ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ (95% ɢɧɬɟɪɜɚɥ ɩɨɜɟɪɟʃɚ) ɛɪɨʁ ɩɪɭɠɟɧɢɯ ɭɫɥɭɝɚ ɮɢɧɚɧɫɢʁɫɤɚ ɜɪɟɞɧɨɫɬ ɩɪɭɠɟɧɢɯ ɭɫɥɭɝɚ ɩɨ ɩɚɰɢʁɟɧɬɭ ɍɤɭɩɧɨ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭɤɭɩɧɨ Ʌɟɤɨɜɢ, ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɞɟɪɢɜɬɢ ɤɪɜɢ 12.210,25±27.894,40 (6.601,02-17.819,48) 1.159.973,35 20.725,10±24.629,03 (15.772,50-25.677,71) 1.968.884,82 Ⱥɧɬɢɢɧɮɟɤɬɢɜɧɢ ɥɟɤɨɜɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ 14,62±19,80 (10,64-18,60) 1.389,00 19.273,04±23.202,30 (14.607,33-23.938,74) 1.830.938,44 Ʉɪɜ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ 11,47±111,83 (-11,01-33,96) 1.090,00 125,87±1226,79 (-120,83-372,56) 11.957,30 Ⱥɧɬɢɫɟɩɬɢɰɢ ɢ ɞɟɡɢɧɮɢɰɢʁɟɧɫɢ 30,89±56,10 (19,61-42,17) 2.934,35 38,38±44,05 (29,52-47,24) 3.646,36 Ⱥɧɬɢɥɢɩɟɦɢɰɢ ɢ ɞɨɞɚɰɢ ɢɫɯɪɚɧɢ 1,28±5,34 (0,21-2,36) 122,00 25,43±115,99 (2,11-48,76) 2.416,18 Ɇɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɯɨɪɦɨɧɫɤɢ ɩɪɟɩɚɪɚɬɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ 12.151,98±27.856,40 (6.550,39-17.753,57) 1.154.438,00 1.262,38±2.649,94 (729,51-1.795,26) 119.926,54 ȼɢɡɭɚɥɢɡɚɰɢɨɧɚ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ 18,00±14,37 (15,11-20,89) 1.710,00 6.119,94±6.130,88 (4.887,10-7.352,79) 581.394,68 Ʌɚɛɨɪɚɬɨɪɢʁɫɤɟ ɚɧɚɥɢɡɟ 10,59±11,28 1.006,00 3.478,58±3.475,62 330.465,35 52 (8,32-12,86) (2.779,68-4.177,49) Ʉɥɚɫɢɱɧɚ ɞɢʁɚɝɧɨɫɬɢɱɤɚ ɪɚɞɢɨɥɨɝɢʁɚ 3,82±2,95 (3,23-4,41) 363,00 401,32±309,28 (339,13-463,52) 38.125,84 ɇɭɤɥɟɚɪɧɚ ɦɟɞɢɰɢɧɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ 0,02±0,14 (-0,01-0,05) 2,00 31,59±216,56 (-11,96-75,14) 3.001,04 Ʉɚɪɞɢɨɜɚɫɤɭɥɚɪɧɚ ɢɧɬɟɪɜɟɧɬɧɚ ɪɚɞɢɨɥɨɝɢʁɚ 0,37±0,84 (0,20-0,54) 35,00 1.438,69±4.154,06 (603,35-2.274,02) 136.675,08 Ɋɚɞɢɨɥɨɲɤɢ ɩɨɬɪɨɲɧɢ ɦɚɬɟɪɢʁɚɥ 3,13±2,51 (2,62-3,63) 297,00 712,42±1.022,74 (506,76-918,08) 67.679,62 ɂɧɫɬɪɭɦɟɧɬɢ ɢ ɞɪɭɝɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɨʁɢ ɫɟ ɤɨɪɢɫɬɢ ɩɪɢɥɢɤɨɦ ɩɪɭɠɚʃɚ ɭɫɥɭɝɚ ɢɧɬɟɪɜɟɧɬɧɟ ɪɚɞɢɨɥɨɝɢʁɟ 0,02±0,21 (-0,02-0,06) 2,00 48,77±475,36 (-46,82-144,36) 4.633,20 ɂɧɫɬɪɭɦɟɧɬɢ ɢ ɞɪɭɝɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɨʁɢ ɫɟ ɤɨɪɢɫɬɢ ɩɪɢɥɢɤɨɦ ɩɪɭɠɚʃɚ ɭɫɥɭɝɚ ɧɭɤɥɟɚɪɧɟ ɦɟɞɢɰɢɧɟ 0,05±0,37 (-0,02-0,13) 5,00 8,57±60,10 (-3,51-20,66) 814,55 ɉɪɟɝɥɟɞɢ ɥɟɤɚɪɚ ɢ ɯɢɪɭɪɲɤɟ ɭɫɥɭɝɟ 4,39±5,15 (3,35-5,43) 417,00 3.505,85±4.439,71 (2.613,07-4.398,62) 333.055,48 Ʌɟɤɚɪɫɤɢ ɩɪɟɝɥɟɞɢ 3,19±3,62 (2,46-3,92) 303,00 3.350,18±4.342,21 (2.477,01-4.223,35) 318.267,02 ɏɢɪɭɪɲɤɟ ɭɫɥɭɝɟ 0,40±1,52 (0,09-0,71) 38,00 110,23±458,36 (18,06-202,40) 10.471,66 53 ɍɫɥɭɝɟ ɞɢʁɚɥɢɡɟ ɢ ɮɢɡɢɤɚɥɧɟ ɦɟɞɢɰɢɧɟ 0,80±2,89 (0,22-1,38) 76,00 45,44±163,95 (12,47-78,41) 4.316,80 Ɂɞɪɚɜɫɬɜɟɧɚ ɧɟɝɚ 299,86±256,38 (248,30-351,41) 28.486,43 3.786,25±3703,98 (3.041,42-4.531,07) 359.693,46 Ɇɟɞɢɰɢɧɫɤɚ ɧɟɝɚ ɬɟɯɧɢɱɚɪɚ 16,21±18,17 (12,56-19,86) 1.540,00 1.407,20±1.417,42 (1.122,17-1.692,22) 133.683,62 ɉɨɬɪɨɲɧɢ ɪɭɬɢɧɫɤɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ 283,65±242,51 (234,88-332,41) 26.946,43 2.379,05±2.441,93 (1.888,01-2.870,09) 226.009,84 Ⱥɞɦɢɧɢɫɬɪɚɬɢɜɧɢ ɢ ɩɪɚɬɟʄɢ ɬɪɨɲɤɨɜɢ 14.642,99±14.374,33 (11.752,48-7.533,49) 1.391.083,60 46.967,98±35.458,88 (39.837,62-4.098,34) 4.461.958,00 Ɉɫɬɚɥɟ ɭɫɥɭɝɟ: ɫɨɰɢʁɚɥɧɚ ɛɪɢɝɚ, ɬɪɚɧɫɩɨɪɬ, ɨɛɭɤɚ, ɤɨɦɢɫɢʁɟ, ɫɚɜɟɬɨɜɚʃɟ, ɫɦɟɲɬɚʁ ɩɚɰɢʁɟɧɬɚ, ɟɤɫɩɟɪɬɢɡɚ ɢ ɦɢɲʂɟʃɟ 3,05±29,75 (-2,93-9,04) 290,00 235,05±2.291,01 (-225,64-695,75) 22.330,00 Ɍɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɤɨɦɨɪɛɢɞɢɬɟɬɚ 14.639,93±14.375,79 (11.749,13-7.530,73) 1.390.793,60 46.732,93±35.397,19 (39.614,97-53.850,88) 4.439.628,00 Ⱦɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ 27.175,48±38.783,51 (19.376,58-4.974,38) 2.581.670,37 81.105,12±61.947,64 (68.648,19-3.562,05) 7.704.986,44 ɂɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ 47.820,08±33.030,82 (41.177,98-54.462,19) 4.542.907,77 ɋɭɦɚ ɫɜɢɯ ɬɪɨɲɤɨɜɚ 128.925,20±76.564,39 (113.529,02-144.321,39) 12.247.894,22 54 Ƚɪɚɮɢɤɨɧ 3. ɉɪɨɫɟɱɧɢ ɞɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ, ɢɧɞɢɪɟɤɬɧɢ ɢ ɭɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɩɨ ɩɚɰɢʁɟɧɬɭ (ɫɜɢ ɬɪɨɲɤɨɜɢ ɫɭ ɩɪɢɤɚɡɚɧɢ ɭ ɞɢɧɚɪɢɦɚ- ɊɋȾ) ɍɤɭɩɧɢ ɞɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ ɩɨ ɩɚɰɢʁɟɧɬɭ ɧɚ ɧɢɜɨɭ ɰɟɥɨɝ ɭɡɨɪɤɚ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡɧɨɫɟ 81.105,12±61.947,64 ɞɢɧɚɪɚ, ɞɨɤ ɫɭ ɢɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɩɪɨɰɟʃɟɧɢ ɧɚ 47.820,08±33.030,82 ɞɢɧɚɪɚ, ɲɬɨ ɭ ɫɭɦɢ ɫɜɢɯ ɬɪɨɲɤɨɜɚ ɱɢɧɢ ɡɛɢɪ ɞɢɪɟɤɬɧɢɯ ɢ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɭ ɢɡɧɨɫɭ ɨɞ 128.925,20±76.564,39 ɞɢɧɚɪɚ (Ɍɚɛɟɥɚ 17, Ƚɪɚɮɢɤɨɧ 3). ɋɬɪɭɤɬɭɪɨɦ ɞɨɦɢɧɢɪɚʁɭ „ɚɞɦɢɧɢɫɬɪɚɬɢɜɧɢ ɢ ɩɪɚɬɟʄɢ ɬɪɨɲɤɨɜɢ“. ɇɚɜɟɞɟɧɢ ɬɪɨɲɤɨɜɢ ɨɛɭɯɜɚɬɚʁɭ ɬɪɨɲɚɤ ɫɦɟɲɬɚʁɚ ɩɚɰɢʁɟɧɬɚ, ɫɨɰɢʁɚɥɧɭ ɛɪɢɝɭ, ɬɪɚɧɫɩɨɪɬ ɢ ɝɪɭɩɭ ɬɪɨɲɤɨɜɚ ɤɨʁɢ ɩɪɟɞɫɬɚɜʂɚʁɭ ɞɢʁɚɝɧɨɫɬɢɤɭ ɢ ɥɟɱɟʃɟ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɢ ɤɨʁɢ ɱɢɧɟ ɧɚʁɜɟʄɢ ɞɟɨ ɫɭɦɟ ɨɛɭɯɜɚʄɟɧɟ ɨɜɨɦ ɝɪɭɩɨɦ ɬɪɨɲɤɨɜɚ. ɋɥɟɞɟʄɭ ɤɚɬɟɝɨɪɢʁɭ ɭ ɫɬɪɭɤɬɭɪɢ ɬɪɨɲɤɨɜɚ ɱɢɧɟ „ɥɟɤɨɜɢ, ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ“, ɝɞɟ ɧɚʁɜɟʄɢ ɞɟɨ ɨɜɟ ɤɚɬɟɝɨɪɢʁɟ ɱɢɧɟ ɚɧɬɢɢɧɮɟɤɬɢɜɧɢ ɥɟɤɨɜɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ ɢɡɚ ɤɨʁɢɯ ɫɥɟɞɟ „ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɯɨɪɦɨɧɫɤɢ ɩɪɟɩɚɪɚɬɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ“. ɍ ɤɚɬɟɝɨɪɢʁɢ „ɜɢɡɭɟɥɢɡɚɰɢɨɧɚ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ“, ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɚɧɚɥɢɡɟ ɫɭ ɱɢɧɢɥɟ ɧɚʁɜɟʄɢ ɞɟɨ ɨɜɢɯ ɬɪɨɲɤɨɜɚ. 55 Ɍɚɛɟɥɚ 18. Ʉɥɚɫɢɮɢɤɚɰɢʁɚ ɩɪɨɫɟɱɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɩɨ ɩɚɰɢʁɟɧɬɭ ɢ ɫɭɦɚ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɭ ɨɞɧɨɫɭ ɧɚ ɬɟɠɢɧɭ ɤɥɢɧɢɱɤɟ ɫɥɢɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡɪɚɠɟɧО ɭɡ ɩɨɦɨʄ CURB-65 ɫɤɚɥɟ (ɫɜɢ ɬɪɨɲɤɨɜɢ ɫɭ ɩɪɢɤɚɡɚɧɢ ɭ ɞɢɧɚɪɢɦɚ- ɊɋȾ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ (95% ɢɧɬɟɪɜɚɥ ɩɨɜɟɪɟʃɚ) ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟʃɟ: ɫɤɨɪ 0-1 ɪɚɡɦɨɬɪɢɬɢ ɛɨɥɧɢɱɤɨ ɥɟɱɟʃɟ: ɫɤɨɪ 2 ɛɨɥɧɢɱɤɨ ɥɟɱɟʃɟ: ɫɤɨɪ 3-5 ɫɬɚɬɢɫɬɢɱɤɚ ɡɧɚɱɚʁɧɨɫɬ ɩɨ ɩɚɰɢʁɟɧɬɭ ɍɤɭɩɧɨ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭɤɭɩɧɨ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭɤɭɩɧɨ Ʌɟɤɨɜɢ, ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɞɟɪɢɜɬɢ ɤɪɜɢ 22.292,03±28.046,97 (14.917,45-29.666,60) 1.292.937,69 18.874,76±19.409,31 (11.491,85-26.257,67) 547.368,10 16.072,38±13.192,22 (5.043,40-27.101,35) 128.579,03 p=0,987 Ⱥɧɬɢɢɧɮɟɤɬɢɜɧɢ ɥɟɤɨɜɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ 20.991,93±26.117,32 (14.124,73-27.859,13) 1.217.531,80 17.138,39±19.066,58 (9.885,85-24.390,93) 497.013,30 14.549,17±12.323,50 (4.246,46-24.851,87) 116.393,35 p=0,887 Ʉɪɜ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ 206,16±1.570,07 (-206,67-618,99) 11.957,00 - - - - p=0,727 Ⱥɧɬɢɫɟɩɬɢɰɢ ɢ ɞɟɡɢɧɮɢɰɢʁɟɧɫɢ 34,98±40,19 (24,41-45,54) 2.028,71 36,11±28,67 (25,20-47,01) 1.047,10 71,32±90,89 (-4,66-147,30) 570,55 p=0,605 Ⱥɧɬɢɥɢɩɟɦɢɰɢ ɢ ɞɨɞɚɰɢ ɢɫɯɪɚɧɢ 6,37±40,30 (-4,22-16,97) 370,00 70,57±197,00 (-4,37-145,50) 2.046,00 - - p=0,044* Ɇɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɯɨɪɦɨɧɫɤɢ ɩɪɟɩɚɪɚɬɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ 1.052,59±2.984,49 (267,86-1.837,32) 61.050,00 1.629,70±2.132,17 (818,67-2.440,73) 47.261,00 1.451,89±1.618,30 (98,96-2.804,83) 11.615,13 p=0,003* ȼɢɡɭɚɥɢɡɚɰɢɨɧɚ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ 6.531,22±6.784,53 (4.747,32-8.315,12) 378.810,62 5.029,70±4.487,05 (3.322,92-6.736,49) 145.861,40 7.090,33±6.480,64 (1.672,38-12.508,28) 56.722,66 p=0,534 Ʌɚɛɨɪɚɬɨɪɢʁɫɤɟ ɚɧɚɥɢɡɟ 3.592,03±3.609,60 (2.642,93-4.541,13) 208.337,80 2.942,58±2.674,48 (1.925,26-3.959,90) 85.334,76 4.599,10±4.977,77 (437,58-8.760,62) 36.792,79 p=0,647 56 Ʉɥɚɫɢɱɧɚ ɞɢʁɚɝɧɨɫɬɢɱɤɚ ɪɚɞɢɨɥɨɝɢʁɚ 415,83±352,59 (323,12-508,54) 24.118,30 370,44±202,24 (293,51-447,36) 10.742,60 408,12±320,63 (140,06-676,17) 3.264,92 p=1,000 ɇɭɤɥɟɚɪɧɚ ɦɟɞɢɰɢɧɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ 25,87±197,03 (-25,93-77,68) 1.501,00 51,74±278,64 (-54,25-157,73) 1.501,00 - - p=0,794 Ʉɚɪɞɢɨɜɚɫɤɭɥɚɪɧɚ ɢɧɬɟɪɜɟɧɬɧɚ ɪɚɞɢɨɥɨɝɢʁɚ 1.640,89±4.664,18 (414,51-2.867,28) 95.172,00 1.073,36±3.170,56 (-132,66-2.279,38) 31.127,00 1.296,98±3.668,41 (-1.769,89-4.363,85) 10.375,83 p=0,629 Ɋɚɞɢɨɥɨɲɤɢ ɩɨɬɪɨɲɧɢ ɦɚɬɟɪɢʁɚɥ 771,17±1.081,28 (486,86-1.055,48) 44.728,00 574,58±911,80 (227,75-921,41) 16.663,00 786,14±1.042,59 (-85,48-1.657,76) 6.289,12 p=0,897 ɂɧɫɬɪɭɦɟɧɬɢ ɢ ɞɪɭɝɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɨʁɢ ɫɟ ɤɨɪɢɫɬɢ ɩɪɢɥɢɤɨɦ ɩɪɭɠɚʃɚ ɭɫɥɭɝɚ ɢɧɬɟɪɜɟɧɬɧɟ ɪɚɞɢɨɥɨɝɢʁɟ 79,88±608,37 (-80,08-239,85) 4.633,00 - - - - p=0,727 ɂɧɫɬɪɭɦɟɧɬɢ ɢ ɞɪɭɝɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɨʁɢ ɫɟ ɤɨɪɢɫɬɢ ɩɪɢɥɢɤɨɦ ɩɪɭɠɚʃɚ ɭɫɥɭɝɚ ɧɭɤɥɟɚɪɧɟ ɦɟɞɢɰɢɧɟ 5,54±42,18 (-5,55-16,63) 321,00 17,01±91,60 (-17,83-51,85) 493,00 - - p=0,787 ɉɪɟɝɥɟɞɢ ɥɟɤɚɪɚ ɢ ɯɢɪɭɪɲɤɟ ɭɫɥɭɝɟ 4.164,07±5.112,12 (2.819,91-5.508,24) 241.516,00 2.598,87±2.603,71 (1.608,47-3.589,26) 75.367,09 2.021,52±3.905,68 (-1.243,71-5.286,74) 16.172,13 p=0,071 Ʌɟɤɚɪɫɤɢ ɩɪɟɝɥɟɞɢ 3.948,99±4.996,75 (2.635,16-5.262,82) 229.041,00 2.542,60±2.572,22 (1.564,17-3.521,02) 73.735,00 1.936,32±3.932,26 (-1.351,14-5.223,77) 15.490,53 p=0,071 ɏɢɪɭɪɲɤɟ ɭɫɥɭɝɟ 172,98±576,97 (21,27-324,68) 10.033,00 15,14±81,52 (-15,87-46,15) 439,00 - - p=0,126 ɍɫɥɭɝɟ ɞɢʁɚɥɢɡɟ ɢ ɮɢɡɢɤɚɥɧɟ ɦɟɞɢɰɢɧɟ 42,11±170,09 (-2,61-86,83) 2.442,00 41,13±127,82 (-7,49-89,75) 1.193,00 85,20±240,98 (-116,27-286,67) 681,60 p=0,559 57 Ɂɞɪɚɜɫɬɜɟɧɚ ɧɟɝɚ 3.683,71±4.305,36 (2.551,67-4.815,75) 213.655,06 3.671,37±2.250,32 (2.815,39-4.527,35) 106.469,75 4.946,08±3.370,49 (2.128,28-7.763,88) 39.568,65 p=0,160 Ɇɟɞɢɰɢɧɫɤɚ ɧɟɝɚ ɬɟɯɧɢɱɚɪɚ 1.406,11±1.676,25 (965,36-1.846,86) 81.554,30 1.315,45±777,40 (1.019,74-1.611,16) 38.148,00 1.747,66±1.230,55 (718,90-2.776,43) 13.981,30 p=0,241 ɉɨɬɪɨɲɧɢ ɪɭɬɢɧɫɤɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ 2.277,60±2.763,67 (1.550,93-3.004,27) 132.100,72 2.355,92±1.650,86 (1.727,97-2.983,88) 68.321,77 3.198,42±2.474,87 (1.129,37-5.267,46) 25.587,35 p=0,181 Ⱥɞɦɢɧɢɫɬɪɚɬɢɜɧɢ ɢ ɩɪɚɬɟʄɢ ɬɪɨɲɤɨɜɢ 46.868,40±40.484,88 (36.223,44-57.513,36) 2.718.367,22 43.096,84±23.503,81 (34.156,46-52.037,21) 1.249.808,27 61.722,81±31.892,61 (35.059,93-88.385,70) 493.782,52 p=0,311 Ɉɫɬɚɥɟ ɭɫɥɭɝɟ: ɫɨɰɢʁɚɥɧɚ ɛɪɢɝɚ, ɬɪɚɧɫɩɨɪɬ, ɨɛɭɤɚ, ɤɨɦɢɫɢʁɟ, ɫɚɜɟɬɨɜɚʃɟ, ɫɦɟɲɬɚʁ ɩɚɰɢʁɟɧɬɚ, ɟɤɫɩɟɪɬɢɡɚ ɢ ɦɢɲʂɟʃɟ 385,00±2.932,07 (-385,95-1.155,95) 22.330,00 - - - - p=0,727 Ɍɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɤɨɦɨɪɛɢɞɢɬɟɬɚ 46.483,40±40.394,06 (35.862,32-57.104,48) 2.696.037,22 43.096,84±23.503,81 (34.156,46-52.037,21) 1.249.808,27 61.722,82±31.892,61 (35.059,93-88.385,70) 493.782,52 p=0,308 Ⱦɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ 83.539,43±72.979,14 (64.350,54-102.728,31) 4.845.286,85 73.271,54±36.634,50 (59.336,52-87.206,56) 2.124.874,61 91.853,12±48.580,84 (51.238,52-132.467,72) 734.824,99 p=0,651 ɂɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ 55.988,40±35.987,98 (46.525,85-65.450,96) 3.247.327,44 36.972,57±25.554,51 (27.252,15-46.692,98) 1.072.204,42 27.921,99±0,00 (27.921,99-27.921,99) 223.375,92 p=0,002* ɋɭɦɚ ɫɜɢɯ ɬɪɨɲɤɨɜɚ 139.527,83±89.065,77 (116.109,18-162.946,48) 8.092.614,29 110.244,10±48.196,89 (91.910,99-128.577,22) 3.197.079,02 119.775,11±48.580,84 (79.160,51-160.389,71) 958.200,91 p=0,351 *- ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ; Kruskal-Wallis ɬɟɫɬ 58 ɍɤɨɥɢɤɨ ɫɟ ɧɚɜɟɞɟɧɢ ɬɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɩɨ ɩɚɰɢʁɟɧɬɭ ɚɧɚɥɢɡɢɪɚʁɭ ɭ ɨɞɧɨɫɭ ɧɚ ɬɟɠɢɧɭ ɤɥɢɧɢɱɤɟ ɫɥɢɤɟ ɩɧɟɭɦɨɧɢʁɟ ɩɪɨɰɟʃɟɧɟ ɩɨɦɨʄɭ CUЊB-65 ɫɤɚɥɟ (Ɍɚɛɟɥɚ 18, Ƚɪɚɮɢɤɨɧɢ 4, 5), ɡɚɩɚɠɚ ɫɟ ɞɚ ɫɭ ɧɚʁɜɟʄɢ ɭɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɛɢɥɢ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ɫɭ ɫɜɪɫɬɚɧɢ ɭ ɤɚɬɟɝɨɪɢʁɭ I, ɩɨɬɨɦ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ɫɭ ɩɪɨɰɟʃɟɧɢ ɤɚɨ ɧɚʁɬɟɠɢ, ɭ ɤɚɬɟɝɨɪɢʁɢ III, ɞɨɤ ɫɭ ɧɚʁɧɢɠɢ ɛɢɥɢ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ɫɭ ɛɢɥɢ ɫɜɪɫɬɚɧɢ ɭ ɤɚɬɟɝɨɪɢʁɭ II, ɩɪɢ ɱɟɦɭ ɢɩɚɤ ɩɨɫɬɨʁɚʃɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ ɧɢʁɟ ɭɫɬɚɧɨɜʂɟɧɨ. ɇɚʁɜɟʄɢ ɞɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ ɫɭ ɡɚɛɟɥɟɠɟɧɢ ɭ ɤɚɬɟɝɨɪɢʁɢ III, ɚ ɩɨɬɨɦ ɭ ɤɚɬɟɝɨɪɢʁɢ I, ɞɨɤ ɫɭ ɧɚʁɦɚʃɢ ɡɚɛɟɥɟɠɟɧɢ ɭ ɤɚɬɟɝɨɪɢʁɢ II. ɇɚ ɢɡɧɨɫ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɢ ɬɚɤɚɜ ɩɨɪɟɞɚɤ ɦɟђɭ ɤɚɬɟɝɨɪɢʁɚɦɚ ɬɟɠɢɧɟ ɩɨ CUЊB-65 ɫɤɚɥɢ ɭ ɧɚʁɜɟʄɨʁ ɦɟɪɢ ɫɭ ɡɚɫɥɭɠɧɢ ɢɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ, ɤɨʁɢ ɫɭ ɛɢɥɢ ɧɚʁɜɟʄɢ ɭ ɤɚɬɟɝɨɪɢʁɢ I, ɩɨɬɨɦ ɭ ɤɚɬɟɝɨɪɢʁɢ II ɢ ɧɚʁɧɢɠɢ ɭ ɤɚɬɟɝɨɪɢʁɢ III, ɩɪɢ ɱɟɦɭ ʁɟ ɢɡɦɟђɭ ɨɜɢɯ ɢɡɧɨɫɚ ɪɟɝɢɫɬɪɨɜɚɧɨ ɩɨɫɬɨʁɚʃɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ (p=0,002*). 59 Ɍɚɛɟɥɚ 19. Ʉɥɚɫɢɮɢɤɚɰɢʁɚ ɩɪɨɫɟɱɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɩɨ ɩɚɰɢʁɟɧɬɭ ɢ ɫɭɦɚ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɭ ɨɞɧɨɫɭ ɧɚ ɬɟɠɢɧɭ ɤɥɢɧɢɱɤɟ ɫɥɢɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡɪɚɠɟɧО ɭɡ ɩɨɦɨʄ ɢɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ (ɫɜɢ ɬɪɨɲɤɨɜɢ ɫɭ ɩɪɢɤɚɡɚɧɢ ɭ ɞɢɧɚɪɢɦɚ- ɊɋȾ) ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ (95% ɢɧɬɟɪɜɚɥ ɩɨɜɟɪɟʃɚ) ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭɤɭɩɧɨ ɫɬɚɬɢɫɬɢɱɤɚ ɡɧɚɱɚʁɧɨɫɬ Ʌɟɤɨɜɢ, ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɞɟɪɢɜɬɢ ɤɪɜɢ ɤɥɚɫɚ 1 11.834,19±13.836,53 (4.171,77-19.496,60) 177.512,81 p=0,088 ɤɥɚɫɚ 2 29.118,71±27.240,26 (15.572,45-42.664,97) 524.136,77 ɤɥɚɫɚ 3 12.788,56±15.835,28 (5.767,59-19.809,53) 281.348,31 ɤɥɚɫɚ 4 25.390,27±31.630,64 (13.986,21-36.794,33) 812.488,71 ɤɥɚɫɚ 5 21.674,78±11.338,77 (12.195,33-31.154,23) 173.398,22 Ⱥɧɬɢɢɧɮɟɤɬɢɜɧɢ ɥɟɤɨɜɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ ɤɥɚɫɚ 1 11.695,92±13.839,61 (4.031,80-19.360,04) 175.438,80 p=0,080 ɤɥɚɫɚ 2 27.228,61±25.718,91 (14.438,90-40.018,32) 490.114,97 ɤɥɚɫɚ 3 11.900,70±15.973,97 (4.818,24-18.983,16) 261.815,43 ɤɥɚɫɚ 4 23.438,72±29.403,80 750.038,91 60 (12.837,52-34.039,92) ɤɥɚɫɚ 5 19.191,29±10.461,76 (10.445,04-27.937,54) 153.530,33 Ʉɪɜ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ ɤɥɚɫɚ 1 - - p=0,370 ɤɥɚɫɚ 2 664,29±2.818,36 (-737,24-2.065,83) 11.957,30 ɤɥɚɫɚ 3 - - ɤɥɚɫɚ 4 - - ɤɥɚɫɚ 5 - - Ⱥɧɬɢɫɟɩɬɢɰɢ ɢ ɞɟɡɢɧɮɢɰɢʁɟɧɫɢ ɤɥɚɫɚ 1 25,62±22,05 (13,42-37,83) 384,35 p=0,062 ɤɥɚɫɚ 2 32,80±42,07 (11,88-53,72) 590,45 ɤɥɚɫɚ 3 34,87±31,79 (20,78-48,97) 767,16 ɤɥɚɫɚ 4 38,61±48,68 (21,06-56,16) 1.235,45 ɤɥɚɫɚ 5 83,62±66,73 (27,83-139,41) 668,95 Ⱥɧɬɢɥɢɩɟɦɢɰɢ ɢ ɞɨɞɚɰɢ ɢɫɯɪɚɧɢ ɤɥɚɫɚ 1 - - p=0,373 ɤɥɚɫɚ 2 - - 61 ɤɥɚɫɚ 3 20,90±71,04 (-10,60-52,40) 459,88 ɤɥɚɫɚ 4 49,41±178,84 (-15,07-113,89) 1.581,10 ɤɥɚɫɚ 5 46,90±132,65 (-64,00-157,80) 375,20 Ɇɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɯɨɪɦɨɧɫɤɢ ɩɪɟɩɚɪɚɬɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ ɤɥɚɫɚ 1 112,64±312,79 (-60,57-285,86) 1.690,00 p=0,003* ɤɥɚɫɚ 2 1.193,00±3.316,09 (-456,05-2.842,06) 21.474,05 ɤɥɚɫɚ 3 832,08±1.678,11 (88,05-1.576,11) 18.305,84 ɤɥɚɫɚ 4 1.863,54±3.291,89 (676,69-3.050,39) 59.633,25 ɤɥɚɫɚ 5 2.352,97±2.125,99 (575,60-4.130,34) 18.823,74 ȼɢɡɭɚɥɢɡɚɰɢɨɧɚ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ ɤɥɚɫɚ 1 3.982,05±3.880,96 (1.832,84-6.131,26) 59.730,73 p=0,483 ɤɥɚɫɚ 2 7.130,78±7.077,27 (3.611,34-10.650,23) 128.354,12 ɤɥɚɫɚ 3 6.093,05±7.148,19 134.047,02 62 (2.923,72-9.262,38) ɤɥɚɫɚ 4 6.688,60±5.996,57 (4.526,61-8.850,59) 214.035,19 ɤɥɚɫɚ 5 5.653,45±5.128,09 (1.366,26-9.940,64) 45.227,62 Ʌɚɛɨɪɚɬɨɪɢʁɫɤɟ ɚɧɚɥɢɡɟ ɤɥɚɫɚ 1 2.043,29±2.223,82 (811,78-3.274,80) 30.649,31 p=0,103 ɤɥɚɫɚ 2 4.209,60±4.021,36 (2.209,82-6.209,37) 75.772,73 ɤɥɚɫɚ 3 2.390,96±1.882,39 (1.556,35-3.225,56) 52.601,05 ɤɥɚɫɚ 4 4.087,62±3.735,86 (2.740,68-5.434,53) 130.803,42 ɤɥɚɫɚ 5 5.079,86±5.146,06 (777,64-9.382,07) 40.638,84 Ʉɥɚɫɢɱɧɚ ɞɢʁɚɝɧɨɫɬɢɱɤɚ ɪɚɞɢɨɥɨɝɢʁɚ ɤɥɚɫɚ 1 315,96±267,03 (168,08-463,84) 4.739,40 p=0,575 ɤɥɚɫɚ 2 473,94±396,14 (276,95-670,93) 8.530,92 ɤɥɚɫɚ 3 378,20±341,91 (226,60-529,79) 8.320,28 63 ɤɥɚɫɚ 4 441,03±281,13 (339,67-542,39) 14.112,88 ɤɥɚɫɚ 5 302,80±104,38 (215,54-390,06) 2.422,36 ɇɭɤɥɟɚɪɧɚ ɦɟɞɢɰɢɧɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ ɤɥɚɫɚ 1 - - p=0,709 ɤɥɚɫɚ 2 83,36±353,68 (-92,52-259,24) 1.500,52 ɤɥɚɫɚ 3 - - ɤɥɚɫɚ 4 46,89±265,26 (-48,74-142,53) 1.500,52 ɤɥɚɫɚ 5 - - Ʉɚɪɞɢɨɜɚɫɤɭɥɚɪɧɚ ɢɧɬɟɪɜɟɧɬɧɚ ɪɚɞɢɨɥɨɝɢʁɚ ɤɥɚɫɚ 1 731,48±2.723,92 (-776,97-2.239,94) 10.972,00 p=0,439 ɤɥɚɫɚ 2 1.740,35±3.974,73 (-236,23-3.716,93) 31.326,30 ɤɥɚɫɚ 3 2.829,77±6.488,62 (-47,12-5.706,66) 62.254,98 ɤɥɚɫɚ 4 1.003,80±3.064,70 (-101,15-2.108,74) - ɤɥɚɫɚ 5 - - Ɋɚɞɢɨɥɨɲɤɢ ɩɨɬɪɨɲɧɢ ɦɚɬɟɪɢʁɚɥ ɤɥɚɫɚ 1 891,32±1.179,63 13.370,00 p=0,361 64 (238,06-1.544,57) ɤɥɚɫɚ 2 605,69±509,90 (352,12-859,26) 10.902,40 ɤɥɚɫɚ 3 494,12±963,79 (66,80-921,44) 10.870,71 ɤɥɚɫɚ 4 949,07±1.266,45 (492,47-1.405,68) 30.370,33 ɤɥɚɫɚ 5 270,80±125,35 (166,01-375,60) 2.166,42 ɂɧɫɬɪɭɦɟɧɬɢ ɢ ɞɪɭɝɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɨʁɢ ɫɟ ɤɨɪɢɫɬɢ ɩɪɢɥɢɤɨɦ ɩɪɭɠɚʃɚ ɭɫɥɭɝɚ ɢɧɬɟɪɜɟɧɬɧɟ ɪɚɞɢɨɥɨɝɢʁɟ ɤɥɚɫɚ 1 - - p=0,742 ɤɥɚɫɚ 2 - - ɤɥɚɫɚ 3 - - ɤɥɚɫɚ 4 144,79±819,04 (-150,51-440,08) 4.633,20 ɤɥɚɫɚ 5 - - ɂɧɫɬɪɭɦɟɧɬɢ ɢ ɞɪɭɝɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɨʁɢ ɫɟ ɤɨɪɢɫɬɢ ɩɪɢɥɢɤɨɦ ɩɪɭɠɚʃɚ ɭɫɥɭɝɚ ɧɭɤɥɟɚɪɧɟ ɦɟɞɢɰɢɧɟ ɤɥɚɫɚ 1 - - p=0,713 ɤɥɚɫɚ 2 17,85±75,72 (-19,81-55,50) 321,25 ɤɥɚɫɚ 3 - - ɤɥɚɫɚ 4 15,42±87,20 (-16,02-46,86) 493,30 65 ɤɥɚɫɚ 5 - - ɉɪɟɝɥɟɞɢ ɥɟɤɚɪɚ ɢ ɯɢɪɭɪɲɤɟ ɭɫɥɭɝɟ ɤɥɚɫɚ 1 2.431,69±2.380,55 (1.113,38-3.749,99) 36.475,00 p=0,751 ɤɥɚɫɚ 2 3.950,26±4.412,81 (1.755,82-6.144,70) 71.104,75 ɤɥɚɫɚ 3 4.109,79±5.354,71 (1.735,64-6.483,94) 90.415,38 ɤɥɚɫɚ 4 3.773,20±4.909,71 (2.003,06-5.543,34) 120.742,38 ɤɥɚɫɚ 5 1.789,71±2.339,93 (-166,53-3.745,94) 14.317,64 Ʌɟɤɚɪɫɤɢ ɩɪɟɝɥɟɞɢ ɤɥɚɫɚ 1 2.361,48±2.325,67 (1.073,57-3.649,39) 35.422,00 p=0,826 ɤɥɚɫɚ 2 3.705,83±4.378,12 (1.528,64-5.883,02) 66.704,94 ɤɥɚɫɚ 3 3.874,25±5.341,31 (1.506,04-6.242,45) 85.233,48 ɤɥɚɫɚ 4 3.671,80±4.716,63 (1.971,27-5.372,33) 117.497,61 ɤɥɚɫɚ 5 1.676,11±2.180,84 (-147,12-3,499,33) 13.408,84 66 ɏɢɪɭɪɲɤɟ ɭɫɥɭɝɟ ɤɥɚɫɚ 1 70,21±271,93 (-80,38-220,80) 1.053,00 p=0,400 ɤɥɚɫɚ 2 200,26±405,96 (-1,62-402,13) 3.604,61 ɤɥɚɫɚ 3 196,81±830,36 (-171,35-564,98) 4.329,90 ɤɥɚɫɚ 4 46,37±167,51 (-14,02-106,77) 1.483,97 ɤɥɚɫɚ 5 - - ɍɫɥɭɝɟ ɞɢʁɚɥɢɡɟ ɢ ɮɢɡɢɤɚɥɧɟ ɦɟɞɢɰɢɧɟ ɤɥɚɫɚ 1 - - p=0,481 ɤɥɚɫɚ 2 44,18±173,77 (-42,24-130,59) 795,20 ɤɥɚɫɚ 3 38,73±146,01 (-26,01-103,47) 852,00 ɤɥɚɫɚ 4 55,02±190,57 (-13,68-123,73) 1.760,80 ɤɥɚɫɚ 5 113,60±229,22 (-78,03-305,23) 908,80 Ɂɞɪɚɜɫɬɜɟɧɚ ɧɟɝɚ ɤɥɚɫɚ 1 2.200,35±1.216,61 (1.526,62-2.874,09) 33.005,30 p=0,099 ɤɥɚɫɚ 2 4.310,72±5.534,69 77.592,93 67 (1.558,38-7.063,05) ɤɥɚɫɚ 3 2.819,08±1.597,66 (2.110,71-3.527,44) 62.019,67 ɤɥɚɫɚ 4 4.736,27±4.232,81 (3.210,18-6.262,36) 151.560,59 ɤɥɚɫɚ 5 4.439,37±2.495,09 (2.353,42-6.525,32) 35.514,97 Ɇɟɞɢɰɢɧɫɤɚ ɧɟɝɚ ɬɟɯɧɢɱɚɪɚ ɤɥɚɫɚ 1 833,99±499,53 (557,36-1.110,62) 12.509,90 p=0,083 ɤɥɚɫɚ 2 1.468,84±1.929,34 (509,40-2.428,28) 26.439,07 ɤɥɚɫɚ 3 1.141,00±707,34 (827,38-1.454,62) 25.101,98 ɤɥɚɫɚ 4 1.753,16±1.728,95 (1.129,81-2.376,51) 56.101,02 ɤɥɚɫɚ 5 1.691,46±1.060,49 (804,87-2.578,06) 13.531,70 ɉɨɬɪɨɲɧɢ ɪɭɬɢɧɫɤɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɥɚɫɚ 1 1.366,36±829,82 (906,83-1.825,90) 20.495,45 p=0,124 ɤɥɚɫɚ 2 2.841,88±3.777,85 (963,20-4.720,56) 51.153,86 68 ɤɥɚɫɚ 3 1.678,08±1.065,09 (1.205,84-2.150,31) 36.917,69 ɤɥɚɫɚ 4 2.983,11±2.678,24 (2.017,50-3.948,72) 95.459,57 ɤɥɚɫɚ 5 2.747,91±1.658,74 (1.361,17-4.134,65) 21.983,27 Ⱥɞɦɢɧɢɫɬɪɚɬɢɜɧɢ ɢ ɩɪɚɬɟʄɢ ɬɪɨɲɤɨɜɢ ɤɥɚɫɚ 1 32.248,46±28.330,89 (16.559,33-47.937,58) 483.726,84 p=0,187 ɤɥɚɫɚ 2 50.403,31±43.990,70 (28.527,25-72.279,37) 907.259,65 ɤɥɚɫɚ 3 43.019,40±32.313,61 (28.692,35-57.346,45) 946.426,87 ɤɥɚɫɚ 4 54.415,23±36.629,77 (41.208,78-67.621,67) 1.741.287,20 ɤɥɚɫɚ 5 47.907,18±26.580,01 (25.685,73-70.128,63) 383.257,44 Ɉɫɬɚɥɟ ɭɫɥɭɝɟ: ɫɨɰɢʁɚɥɧɚ ɛɪɢɝɚ, ɬɪɚɧɫɩɨɪɬ, ɨɛɭɤɚ, ɤɨɦɢɫɢʁɟ, ɫɚɜɟɬɨɜɚʃɟ, ɫɦɟɲɬɚʁ ɩɚɰɢʁɟɧɬɚ, ɟɤɫɩɟɪɬɢɡɚ ɢ ɦɢɲʂɟʃɟ ɤɥɚɫɚ 1 - - p=0,370 ɤɥɚɫɚ 2 1.240,56±5.263,23 (-1.376,79-3.857,90) 22.330,00 ɤɥɚɫɚ 3 - - ɤɥɚɫɚ 4 - - 69 ɤɥɚɫɚ 5 - - Ɍɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɤɥɚɫɚ 1 32.248,46±28.330,89 (16.559,33-47.937,58) 483.726,84 p=0,187 ɤɥɚɫɚ 2 49.162,76±43.803,15 (27.379,97-70.945,55) 884.929,65 ɤɥɚɫɚ 3 43.019,40±32.313,61 (28.692,35-57.346,45) 946.426,87 ɤɥɚɫɚ 4 54.415,23±36.629,77 (41.208,78-67.621,67) 1.741.287,20 ɤɥɚɫɚ 5 47.907,18±26.580,01 (25.685,73-70.128,63) 383.257,44 Ⱦɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ ɤɥɚɫɚ 1 52.696,73±38.666,09 (31.284,17-74.109,30) 790.451,01 p=0,088 ɤɥɚɫɚ 2 94.913,79±72.817,60 (58.702,45-131.125,13) 1.708.448,22 ɤɥɚɫɚ 3 68.829,88±48.227,88 (47.446,83-90.212,92) 1.514.257,26 ɤɥɚɫɚ 4 95.003,56±73.078,36 (68.656,01-121.351,12) 3.040.114,07 ɤɥɚɫɚ 5 81.464,49±38.211,26 (49.519,07-113.409,90) 651.715,89 70 ɂɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɤɥɚɫɚ 1 55.099,39±31.439,34 (37.688,87-72.509,92) 826.490,90 p=0,001* ɤɥɚɫɚ 2 68.253,75±24.514,96 (56.062,75-80.444,76) 1.228.567,56 ɤɥɚɫɚ 3 39.598,46±34.860,03 (24.142,39-55.054,53) 871.166,09 ɤɥɚɫɚ 4 41.621,22±34.761,58 (29.088,33-54.154,10) 1.331.878,92 ɤɥɚɫɚ 5 35.600,54±21.718,21 (17.443,66-53.757,42) 284.804,30 ɋɭɦɚ ɫɜɢɯ ɬɪɨɲɤɨɜɚ ɤɥɚɫɚ 1 107.796,13±39.452,00 (85.948,34-129.643,92) 1.616.941,92 p=0,069 ɤɥɚɫɚ 2 163.167,54±72.265,20 (127.230,91-199.104,18) 2.937.015,78 ɤɥɚɫɚ 3 108.428,33±64.156,43 (79.982,97-136.873,70) 2.385.423,34 ɤɥɚɫɚ 4 136.624,78±97.315,48 (101.538,81-171.710,75) 4.371.992,99 ɤɥɚɫɚ 5 117.065,02±53.964,84 (71.949,28-162.180,76) 936.520,18 71 *-ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ; Kruskal-Wallis ɬɟɫɬ; ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ: ɤɥɚɫɚ 1 (ɫɤɨɪ ≤50), ɤɥɚɫɚ 2 (ɫɤɨɪ 50-70), ɤɥɚɫɚ 3 (ɫɤɨɪ 70-90), ɤɥɚɫɚ 4 (ɫɤɨɪ 90-130) ɢ ɤɥɚɫɚ 5 (ɫɤɨɪ >130) Ⱥɧɚɥɢɡɚ ɩɪɨɫɟɱɧɢɯ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɩɨ ɩɚɰɢʁɟɧɬɭ ɢ ʃɢɯɨɜɟ ɫɬɪɭɤɬɭɪɟ, ɩɪɟɦɚ ɂɧɞɟɤɫɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɚ (PЧОuЦШЧТК ЋОvОrТtв IЧНОб – PЋI) ɞɨɧɨɫɢ ɪɟɡɭɥɬɚɬɟ (Ɍɚɛɟɥɚ 19, Ƚɪɚɮɢɤɨɧɢ 6 ɢ 7), ɩɪɟɦɚ ɤɨʁɢɦɚ ʁɟ ɭɤɭɩɚɧ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɧɚʁɜɟʄɢ ɭ ɤɥɚɫɢ 2 ɢ ɤɥɚɫɢ 4, ɞɨɤ ʁɟ ɭ ɤɥɚɫɢ 1 ɧɚʁɧɢɠɢ. Ʉɚɞɚ ʁɟ ɪɟɱ ɨ ɞɢɪɟɤɬɧɢɦ ɦɟɞɢɰɢɧɫɤɢɦ ɬɪɨɲɤɨɜɢɦɚ, ɧɚʁɜɢɲɢ ɫɭ ɛɢɥɢ ɭ ɤɥɚɫɢ 4, ɩɨɬɨɦ ɭ ɤɥɚɫɢ 2, ɤɥɚɫɢ 5, ɚ ɡɚɬɢɦ ɭ ɤɥɚɫɢ 3 ɢ ɧɚʁɧɢɠɢ ɭ ɤɥɚɫɢ 1. ɂɡɦɟђɭ ɜɪɟɞɧɨɫɬɢ ɭɤɭɩɧɢɯ ɢ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɩɨ ɤɥɚɫɚɦɚ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɩɪɟɦɚ ɂɧɞɟɤɫɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɧɢʁɟ ɭɨɱɟɧɨ ɩɨɫɬɨʁɚʃɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ (p=0,069) ɡɚ ɭɤɭɩɧɟ, ɨɞɧɨɫɧɨ (p=0,088) ɡɚ ɞɢɪɟɤɬɧɟ ɬɪɨɲɤɨɜɟ. ɍ ɩɨɝɥɟɞɭ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ, ɨɩɢɫɚɧɢ ɬɪɟɧɞ ɫɬɪɭɤɬɭɪɟ ɬɪɨɲɤɨɜɚ ɫɟ ɞɨɧɟɤɥɟ ɦɟʃɚ, ɩɚ ɫɭ ɧɚʁɜɢɲɢ ɬɪɨɲɤɨɜɢ ɪɟɝɢɫɬɪɨɜɚɧɢ ɭ ɤɥɚɫɢ 2, ɩɨɬɨɦ ɭ ɤɥɚɫɢ 1, ɤɥɚɫɢ 4, ɤɥɚɫɢ 3 ɢ ɧɚʁɡɚɞ ɤɥɚɫɢ 5. 72 Ɍɚɛɟɥɚ 20. Ⱥɧɚɥɢɡɚ ɬɪɨɲɤɨɜɚ ɭ ɨɞɧɨɫɭ ɧɚ ɩɨɞɟɥɭ ɩɚɰɢʁɟɧɚɬɚ ɭ ɫɬɚɪɨɫɧɟ ɤɚɬɟɝɨɪɢʁɟ, ɩɚɰɢʁɟɧɬɢ ɫɚ ɦɚʃɟ ɢɥɢ 50 ɝɨɞɢɧɚ ɫɬɚɪɨɫɬɢ ɢ ɩɚɰɢʁɟɧɬɢ ɫɚ ɜɢɲɟ ɨɞ 50 ɝɨɞɢɧɚ (ɫɜɢ ɬɪɨɲɤɨɜɢ ɫɭ ɩɪɢɤɚɡɚɧɢ ɭ ɞɢɧɚɪɢɦɚ- ɊɋȾ) ɫɬɚɪɨɫɧɟ ɤɚɬɟɝɨɪɢʁɟ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ (95% ɢɧɬɟɪɜɚɥ ɩɨɜɟɪɟʃɚ) ≤50 >50 ɫɬɚɬɢɫɬɢɱɤɚ ɡɧɚɱɚʁɧɨɫɬ ɩɨ ɩɚɰɢʁɟɧɬɭ ɍɤɭɩɧɨ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭɤɭɩɧɨ Ʌɟɤɨɜɢ, ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ 16.674,00±18.545,31 (7.858,28-25.489,71) 283.457,95 21.608,04±25.780,47 (15.886,78-27.329,30) 1.685.426,87 p=0,651 ȼɢɡɭɚɥɢɡɚɰɢɨɧɚ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ 4.225,61±2.638,27 (2.971,48-5.479,74) 71.835,42 6.532,81±6.593,56 (5.069,55-7.996,07) 509.559,26 p=0,560 ɉɪɟɝɥɟɞɢ ɥɟɤɚɪɚ ɢ ɯɢɪɭɪɲɤɟ ɭɫɥɭɝɟ 2.036,17±2.299,66 (943,00-3.129,34) 34.614,86 3.826,16±4.731,08 (2.776,23-4.876,09) 298.440,62 p=0,217 Ɂɞɪɚɜɫɬɜɟɧɚ ɧɟɝɚ 3.093,27±2.770,82 (1.776,13-4.410,41) 52.585,60 3.937,28±3.876,08 (3.077,09-4.797,47) 307.107,85 p=0,317 Ⱥɞɦɢɧɢɫɬɪɚɬɢɜɧɢ ɢ ɩɪɚɬɟʄɢ ɬɪɨɲɤɨɜɢ - Ɍɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɤɨɦɨɪɛɢɢɞɢɬɟɬɚ 36.849,21±25.905,71 (24.534,65-49.163,78) 626.436,61 49.173,35±36.985,71 (40.965,40-57.381,30) 3.835.521,39 p=0,217 Ⱦɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ 62.878,26±40.628,20 (43.565,20-82.191,33) 1.068.930,45 85.077,64±65.210,64 (70.605,95-99.549,33) 6.636.056,00 p=0,145 73 ɂɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ 62.249,61±34.463,65 (45.866,93-78.632,29) 1.058.243,42 44.675,18±32.079,92 (37.555,94-51.794,43) 3.484.664,35 p=0,023* ɋɭɦɚ ɫɜɢɯ ɬɪɨɲɤɨɜɚ 125.127,87±39.560,10 (106.322,54-143.933,21) 2.127.173,87 129.752,83±82.627,26 (111.416,00-148.089,65) 10.120.720,35 p=0,877 *- ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ; Mann-Whytnei U ɬɟɫɬ 74 ɍɤɨɥɢɤɨ ɫɟ ɧɚɜɟɞɟɧɢ ɩɨɞɚɰɢ ɨ ɬɪɨɲɤɨɜɢɦɚ ɚɧɚɥɢɡɢɪɚʁɭ ɩɪɟɦɚ ɞɜɟɦɚ ɫɬɚɪɨɫɧɢɦ ɝɪɭɩɚɦɚ ɛɨɥɟɫɧɢɤɚ (ɦɥɚђɢ ɢ ɫɬɚɪɢʁɢ ɨɞ 50 ɝɨɞɢɧɚ) (Ɍɚɛɟɥɚ 20), ɭɨɱɚɜɚ ɫɟ ɞɚ ɫɭ ɬɪɨɲɤɨɜɢ ɭ ɫɜɢɦ ɤɚɬɟɝɨɪɢʁɚɦɚ ɜɟʄɢ ɭ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ, ɚɥɢ ɛɟɡ ɩɨɫɬɨʁɚʃɚ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ ɢɡɦɟђɭ ɝɪɭɩɚ ɬɪɨɲɤɨɜɚ ɩɪɟɦɚ ɫɬɚɪɨɫɬɢ. Јɟɞɢɧɚ ɤɚɬɟɝɨɪɢʁɚ ɬɪɨɲɤɨɜɚ ɤɨʁɚ ʁɟ ɜɟʄɚ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɦɥɚђɢɯ ɨɞ 50 ɝɨɞɢɧɚ ɫɭ ɢɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ, ɝɞɟ ʁɟ ɢ ɪɟɝɢɫɬɪɨɜɚɧɨ ɩɨɫɬɨʁɚʃɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ (p=0,023*). ɋɭɦɚ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ʁɟ ɩɪɢɛɥɢɠɧɨ ɢɫɬɚ ɭ ɨɛɟɦɚ ɩɨɫɦɚɬɪɚɧɢɦ ɫɬɚɪɨɫɧɢɦ ɝɪɭɩɚɦɚ. 75 Ƚɪɚɮɢɤɨɧ 4. ɉɪɨɫɟɱɧɢ ɞɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ, ɢɧɞɢɪɟɤɬɧɢ ɢ ɭɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭ ɨɞɧɨɫɭ ɧɚ CURB-65 ɫɤɚɥɭ (ɫɜɢ ɬɪɨɲɤɨɜɢ ɫɭ ɩɪɢɤɚɡɚɧɢ ɭ ɞɢɧɚɪɢɦɚ- ɊɋȾ) 76 Ƚɪɚɮɢɤɨɧ 5. ɉɪɨɫɟɱɧɢ ɬɪɨɲɤɨɜɢ ɩɪɟɦɚ ɩɨɞɝɪɭɩɚɦɚ ɩɨɬɪɨɲʃɟ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭ ɨɞɧɨɫɭ ɧɚ CURB-65 ɫɤɚɥɭ (ɫɜɢ ɬɪɨɲɤɨɜɢ ɫɭ ɩɪɢɤɚɡɚɧɢ ɭ ɞɢɧɚɪɢɦɚ- ɊɋȾ) 77 Ƚɪɚɮɢɤɨɧ 6. ɉɪɨɫɟɱɧɢ ɞɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ, ɢɧɞɢɪɟɤɬɧɢ ɢ ɭɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭ ɨɞɧɨɫɭ ɧɚ ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ (ɫɜɢ ɬɪɨɲɤɨɜɢ ɫɭ ɩɪɢɤɚɡɚɧɢ ɭ ɞɢɧɚɪɢɦɚ- ɊɋȾ) 78 Ƚɪɚɮɢɤɨɧ 7. ɉɪɨɫɟɱɧɢ ɬɪɨɲɤɨɜɢ ɩɪɟɦɚ ɩɨɞɝɪɭɩɚɦɚ ɩɨɬɪɨɲʃɟ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭ ɨɞɧɨɫɭ ɧɚ ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ (ɫɜɢ ɬɪɨɲɤɨɜɢ ɫɭ ɩɪɢɤɚɡɚɧɢ ɭ ɞɢɧɚɪɢɦɚ- ɊɋȾ) 79 Ɍɚɛɟɥɚ 21. Ʉɨɪɟɥɚɰɢʁɚ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɫɚ ɢɧɞɟɤɫɨɦ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ CURB-65 ɫɤɚɥɨɦ ɂɧ ɞɟɤ ɫ ɬ ɟɠ ɢɧ ɟ ɩɧ ɟɭɦ ɨɧ ɢʁɟ CU RB - 65 ɫɤɚ ɥɚ Ⱦɢ ɪɟɤ ɬɧɢ ɦɟ ɞɢ ɰɢ ɧɫɤ ɢ ɬɪɨ ɲɤ ɨɜɢ ɂɧ ɞɢ ɪɟɤ ɬɧɢ ɬɪɨ ɲɤ ɨɜɢ ɋɭ ɦɚ ɫɜ ɢɯ ɬɪɨ ɲɤ ɨɜɚ ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,663* 0,191 -0,339* -0,005 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,000 0,063 0,001 0,965 CURB-65 ɫɤɚɥɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,663* 0,059 -0,360* -0,120 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,000 0,571 0,000 0,247 *- ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ; Spearman's rho ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ Ɂɚɩɚɠɚ ɫɟ ɞɚ ʁɟ ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ, ɜɟɨɦɚ ʁɚɤɚ ɢ ɩɨɡɢɬɢɜɧɚ, ɧɚђɟɧɚ ɢɡɦɟђɭ ɞɜɟʁɭ ɫɤɚɥɚ, ɢɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ-PЋI ɢ CUЊB-65 ɫɤɚɥɟ (0,663*) (Ɍɚɛɟɥɚ 21, Ƚɪɚɮɢɤɨɧ 8). ɒɬɨ ɫɟ ɬɢɱɟ ɤɨɪɟɥɚɰɢʁɟ ɜɢɫɢɧɟ ɬɪɨɲɤɨɜɚ ɫɚ ɨɜɢɦ ɫɤɚɥɚɦɚ, ɧɚђɟɧɚ ʁɟ ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ ɢɡɦɟђɭ ɜɢɫɢɧɟ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɢ ɨɛɟ ɫɤɚɥɟ, ɲɬɨ ɭɤɚɡɭʁɟ ɧɚ ʃɢɯɨɜ ɤɚɩɚɰɢɬɟɬ ɩɪɟɞɢɤɰɢʁɟ ɜɢɫɢɧɟ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɭɡɪɨɤɨɜɚɧɢɯ ɨɜɨɦ ɛɨɥɟɲʄɭ. 80 Ɍɚɛɟɥɚ 22. Ʉɨɪɟɥɚɰɢʁɚ ɫɜɢɯ ɤɚɬɟɝɨɪɢʁɚ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɫɚ ɢɧɞɟɤɫɨɦ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ CURB-65 ɫɤɚɥɨɦ Ʌɟ ɤɨɜ ɢ, ɦɟ ɞɢ ɰɢ ɧɫɤ ɢ ɤɢ ɫɟɨ ɧɢ ɤ ɢ ɞɟ ɪɢ ɜɚɬ ɢ ɤɪɜ ɢ ȼɢ ɡɭɚ ɥɢ ɡɚɰ ɢɨ ɧɚ ɢ ɥɚɛ ɨɪ ɚɬɨ ɪɢ ʁɫɤ ɚ ɞɢ ʁɚɝ ɧɨ ɫɬɢ ɤɚ ɉɪ ɟɝɥ ɟɞɢ ɥɟ ɤɚɪ ɚ ɢ ɯɢ ɪɭɲ ɤɟ ɭɫɥ ɭɝɟ Ɂɞ ɪɚɜ ɫɬɜ ɟɧɚ ɧɟ ɝɚ Ⱥɞ ɦɢ ɧɢ ɫɬɪ ɚɬɢ ɜɧɢ ɢ ɩɪ ɚɬɟ ʄɢ ɬɪ ɨɲ ɤɨɜ ɢ ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,151 0,096 -0,061 0,284 * 0,188 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,143 0,357 0,555 0,005 0,068 CURB-65 ɫɤɚɥɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,002 -0,038 -0,189 0,194 0,105 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,986 0,712 0,066 0,059 0,313 *- ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ; Spearman's rho ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ Ʉɨɪɟɥɚɰɢʁɟ ɩɨʁɟɞɢɧɢɯ ɩɨɞɝɪɭɩɚ ɬɪɨɲɤɨɜɚ ɫɚ ɫɤɚɥɚɦɚ ɫɭ ɭɝɥɚɜɧɨɦ ɫɥɚɛɟ (Ɍɚɛɟɥɚ 22). 81 Ƚɪɚɮɢɤɨɧ 8. Ʉɨɪɟɥɚɰɢʁɚ CURB-65 ɫɤɚɥО ɢ ɢɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ Јɟɞɧɚɱɢɧɚ ɥɢɧɟɚɪɧɟ ɤɨɪɟɥɚɰɢʁɟ: в=1.159151193633952 * б + 1.291777188328913; ʁɚɤɚ ɩɨɡɢɬɢɜɧɚ ɤɨɪɟɥɚɰɢʁɢ 82 Ɍɚɛɟɥɚ 23. Ⱥɧɚɥɢɡɚ ɬɪɨɲɤɨɜɚ ɭ ɨɞɧɨɫɭ ɧɚ ɢɫɯɨɞ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɟ (ɫɜɢ ɬɪɨɲɤɨɜɢ ɫɭ ɩɪɢɤɚɡɚɧɢ ɭ ɞɢɧɚɪɢɦɚ- ɊɋȾ) ɂɫɯɨɞ ɥɟɱɟʃɚ ɫɪɟɞʃɚ ɜɪɟɞɧɨɫɬ±ɫɬɚɧɞɚɪɞɧɚ ɞɟɜɢʁɚɰɢʁɚ (95% ɢɧɬɟɪɜɚɥ ɩɨɜɟɪɟʃɚ) ɩɪɟɠɢɜɟɥɢ (90 ɩɚɰɢʁɟɧɚɬɚ) ɭɦɪɥɢ (5 ɩɚɰɢʁɟɧɚɬɚ) ɫɬɚɬɢɫɬɢɱɤɚ ɡɧɚɱɚʁɧɨɫɬ ɩɨ ɩɚɰɢʁɟɧɬɭ ɍɤɭɩɧɨ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭɤɭɩɧɨ Ʌɟɤɨɜɢ, ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɞɟɪɢɜɬɢ ɤɪɜɢ 20.719,14±25.145,97 (15.452,42-25.985,86) 1.864.722,59 20.832,45±13.627,71 (3.911,41-37.753,48) 104.162,23 p=0,537 ȼɢɡɭɚɥɢɡɚɰɢɨɧɚ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ 6.341,29±6.209,96 (5.040,64-7.641,94) 570.716,36 2.135,66±2.080,26 (-447,33-4.718,65) 10.678,32 p=0,049* ɉɪɟɝɥɟɞɢ ɥɟɤɚɪɚ ɢ ɯɢɪɭɪɲɤɟ ɭɫɥɭɝɟ 3.692,31±4.488,69 (2.752,17-4.632,44) 332.307,58 149,58±214,47 (-116,72-415,88) 747,90 p=0,004* Ɂɞɪɚɜɫɬɜɟɧɚ ɧɟɝɚ 3.711,59±3.733,71 (2.929,58-4.493,60) 334.043,24 5.130,04±3.137,91 (1.233,81-9.026,28) 25.650,21 p=0,194 Ⱥɞɦɢɧɢɫɬɪɚɬɢɜɧɢ ɢ ɩɪɚɬɟʄɢ ɬɪɨɲɤɨɜɢ – Ɍɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɤɨɦɨɪɛɢɞɢɬɟɬɚ 46.763,30±35.573,09 (39.312,66-54.213,94) 4.208.697,02 50.652,20±37.057,42 (4.639,34-96.665,05) 253.260,98 p=0,841 Ⱦɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ 81.227,63±62.709,99 (68.093,28-94.361,98) 7.310.486,80 78.899,92±51.729,96 (14.668,69-143.131,16) 394.499,64 p=0,920 ɂɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ 48.925,53±33.598,36 (41.888,49-55.962,57) 4.403.297,82 27.921,99±0,00 (27.921,99-27.921,99) 139.609,95 p=0,129 83 ɋɭɦɚ ɫɜɢɯ ɬɪɨɲɤɨɜɚ 130.153,16±77.731,57 (113.872,60-146.433,72) 11.713.784,63 106.821,92±51.729,96 (42.590,68-171.053,15) 534.109,59 p=0,527 *- ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ; Mann-Whytnei U ɬɟɫɬ ɂɫɯɨɞ ɥɟɱɟʃɚ ʁɟ ɭ ɤɨɪɟɥɚɰɢʁɢ ɫɚ ɫɤɚɥɚɦɚ. ɉɪɨɫɟɱɧɢ ɬɪɨɲɤɨɜɢ ɫɭ ɜɟʄɢ ɤɨɞ ɩɪɟɠɢɜɟɥɢɯ ɩɚɰɢʁɟɧɚɬɚ, ɭɝɥɚɜɧɨɦ ɭ ɫɜɢɦ ɤɚɬɟɝɨɪɢʁɚɦɚ, ɚ ɡɧɚɱɚʁɧɨ ɫɭ ɜɟʄɢ ɭ ɝɪɭɩɢ ɜɢɡɭɚɥɢɡɚɰɢɨɧɟ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɞɢʁɚɝɧɨɫɬɢɤɟ ɢ ɩɪɟɝɥɟɞɚ ɥɟɤɚɪɚ ɢ ɯɢɪɭɪɲɤɢɯ ɭɫɥɭɝɚ. Ȼɨɥɟɫɧɢɰɢ ɤɨʁɢ ɫɭ ɭɦɪɥɢ ɫɭ ɩɪɨɫɟɱɧɨ ɛɨɪɚɜɢɥɢ ɤɪɚʄɟ ɭ ɛɨɥɧɢɰɢ, ɲɬɨ ʁɟ ɩɨɜɟɡɚɧɨ ɫɚ ɦɚʃɢɦ ɬɪɨɲɤɨɜɢɦɚ. (Ɍɚɛɟɥɚ 23, Ƚɪɚɮɢɤɨɧ 9). 84 Ƚɪɚɮɢɤɨɧ 9. ɉɪɨɫɟɱɧɨ ɬɪɚʁɚʃɟ ɛɨɪɚɜɤɚ ɭ ɛɨɥɧɢɰɢ ɭ ɨɞɧɨɫɭ ɧɚ ɢɫɯɨɞ ɥɟɱɟʃɚ ɉɚɰɢʁɟɧɬɢ ɤɨʁɢ ɫɭ ɩɪɟɠɢɜɟɥɢ ɥɟɱɟʃɟ ɩɪɨɫɟɱɧɨ ɫɭ ɛɢɥɢ 14,93±7,08 ɞɚɧɚ, ɞɨɤ ɫɭ ɨɧɢ ɤɨʁɢ ɫɭ ɭɦɪɥɢ 9,00±4,64 ɞɚɧɚ, ɲɬɨ ʁɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɨ ɤɪɚʄɟ (Mann-Whytnei U ɬɟɫɬ; p=0,05). 85 Ɍɚɛɟɥɚ 24. Ʉɨɪɟɥɚɰɢʁɚ ɞɭɠɢɧɟ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɢɫɯɨɞɚ ɥɟɱɟʃɚ ɫɚ ɢɧɞɟɤɫɨɦ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ CURB-65 ɫɤɚɥɨɦ ɂɫ ɯɨɞ ɥɟɱ ɟʃ ɚ Ⱦɭ ɠɢ ɧɚ ɬɪɚ ʁɚʃ ɚ ɯɨɫ ɩɢ ɬɚɥ ɢɡɚ ɰ ɢʁɟ ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,280* 0,098 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,006 0,343 CURB-65 ɫɤɚɥɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,360* -0,039 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,000 0,708 *- ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ; Spearman's rho ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ Јɚɤɚ ɢ ɩɨɡɢɬɢɜɧɚ ɤɨɪɟɥɚɰɢʁɚ ɧɚђɟɧɚ ʁɟ ɢɡɦɟђɭ ɢɫɯɨɞɚ ɥɟɱɟʃɚ ɢ ɞɭɠɢɧɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɢɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ CURB-65 ɫɤɚɥɟ (Ɍɚɛɟɥɚ 24) 86 Ɍɚɛɟɥɚ 25. Ʉɨɪɟɥɚɰɢʁɚ ɞɭɠɢɧɟ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɢɫɯɨɞɚ ɥɟɱɟʃɚ ɫɚ ɬɪɨɲɤɨɜɢɦɚ ɥɟɱɟʃɚ Ⱦɢ ɪɟɤ ɬɧɢ ɦɟ ɞɢ ɰɢ ɧɫɤ ɢ ɬɪɨ ɲɤ ɨɜɢ ɂɧ ɞɢ ɪɟɤ ɬɧɢ ɬɪɨ ɲɤ ɨɜɢ ɋɭ ɦɚ ɫɜ ɢɯ ɬɪɨ ɲɤ ɨɜɚ ɂɫɯɨɞ ɥɟɱɟʃɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,010 -0,156 -0,065 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,921 0,130 0,529 Ⱦɭɠɢɧɚ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,493* 0,307* 0,531* ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,000 0,002 0,000 *- ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ; Spearman's rho ɢɥɢ Pearson's rho ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ Јɚɤɚ ɢ ɩɨɡɢɬɢɜɧɚ ɤɨɪɟɥɚɰɢʁɚ ɧɚђɟɧɚ ʁɟ ɢɡɦɟђɭ ɢɫɯɨɞɚ ɥɟɱɟʃɚ, ɞɭɠɢɧɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɞɢɪɟɤɬɧɢɯ ɦɟɞɢɰɢɧɫɤɢɯ, ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɢ ɫɭɦɟ ɫɜɢɯ ɬɪɨɲɤɨɜɚ (Ɍɚɛɟɥɚ 25). 87 Ɍɚɛɟɥɚ 26. Ʉɨɪɟɥɚɰɢʁɚ ʁɟɞɢɧɢɱɧɟ ɩɨɬɪɨɲʃɟ ɫɚ ɢɧɞɟɤɫɨɦ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ CURB-65 ɫɤɚɥɨɦ Ʌɟ ɤɨɜ ɢ, ɦɟ ɞɢ ɰɢ ɧɫɤ ɢ ɤɢ ɫɟɨ ɧɢ ɤ ɢ ɞɟɪ ɢɜɚ ɬɢ ɤɪɜ ɢ ȼɢ ɡɭɚ ɥɢ ɡɚɰ ɢɨ ɧɚ ɢ ɥɚɛ ɨɪɚ ɬɨɪ ɢʁɫ ɤɚ ɞɢ ʁɚɝ ɧɨ ɫɬɢ ɤɚ ɉɪ ɟɝɥ ɟɞɢ ɥɟ ɤɚɪ ɚ ɢ ɯɢ ɪɭɲ ɤɟ ɭɫɥ ɭɝɟ Ɂɞ ɪɚɜ ɫɬɜ ɟɧɚ ɧɟ ɝɚ Ⱥɞ ɦɢ ɧɢ ɫɬɪ ɚɬɢ ɜɧɢ ɢ ɩ ɪɚɬ ɟʄɢ ɬɪɨ ɲɤ ɨɜɢ ɍɤ ɭɩ ɚɧ ɛɪɨ ʁ ɫɜ ɢɯ ɭɫɥ ɭɝɚ ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,347* 0,239* -0,033 0,169 0,201 0,354* ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,001 0,019 0,749 0,102 0,050 0,000 CURB-65 ɫɤɚɥɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,256* 0,028 -0,169 0,102 0,123 0,251* ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,012 0,787 0,102 0,327 0,233 0,014 *- ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ; Spearman's rho ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ʁɟ ɭ ɤɨɪɟɥɚɰɢʁɢ ɢ ɫɚ ɭɤɭɩɧɢɦ ɛɪɨʁɟɦ ɩɪɭɠɟɧɢɯ ɭɫɥɭɝɚ (Ɍɚɛɟɥɚ 26). 88 Ɍɚɛɟɥɚ 27. Ʉɨɪɟɥɚɰɢʁɚ ɛɪɨʁɚ ɞɢʁɚɝɧɨɫɬɢɱɤɢɯ ɩɪɨɰɟɞɭɪɚ ɫɚ ɢɧɞɟɤɫɨɦ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ CURB-65 ɫɤɚɥɨɦ ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ CURB-65 ɫɤɚɥɚ Ȼɪɨɧɯɨɫɤɨɩɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,097 -0,264* ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,349 0,010 Ɍɨɪɚɤɨɰɟɧɬɟɡɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,006 0,033 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,955 0,750 Ƚɪɭɞɧɚ ɞɪɟɧɚɠɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,091 -0,081 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,379 0,437 ɋɩɢɪɨɦɟɬɪɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,091 -0,157 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,382 0,128 Ʉɨɦɩʁɭɬɟɪɢɡɨɜɚɧɚ ɬɨɦɨɝɪɚɮɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,095 -0,096 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,359 0,355 Ɋɚɞɢɨɝɪɚɮɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,089 0,042 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,390 0,690 Ɇɢɤɪɨɛɢɨɥɨɲɤɚ ɚɧɚɥɢɡɚ ɤɪɜɢ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,184 0,139 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,075 0,180 Ɇɢɤɪɨɛɢɨɥɨɲɤɚ ɚɧɚɥɢɡɚ ɫɩɭɬɭɦɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,096 -0,187 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,354 0,070 ɏɟɦɚɬɨɥɨɲɤɚ ɢɫɩɢɬɢɜɚʃɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,140 0,011 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,178 0,914 Ȼɢɨɯɟɦɢʁɫɤɚ ɢɫɩɢɬɢɜɚʃɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,204* 0,072 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,047 0,487 ɂɫɩɢɬɢɜɚʃɚ ɤɨɚɝɭɥɚɰɢʁɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,213* 0,024 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,038 0,821 ȼɢɪɭɫɨɥɨɲɤɚ ɢɫɩɢɬɢɜɚʃɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,055 -0,072 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,594 0,486 Ƚɚɫɧɟ ɚɧɚɥɢɡɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,458* 0,349* ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,000 0,001 89 *- ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ; Spearman's rho ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ Ʉɨɪɟɥɚɰɢʁɚ ɛɪɨʁɚ ɞɢʁɚɝɧɨɫɬɢɱɤɢɯ ɩɪɨɰɟɞɭɪɚ ɫɚ ɢɧɞɟɤɫɨɦ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ CUЊB-65 ɫɤɚɥɨɦ ɭɝɥɚɜɧɨɦ ʁɟ ɧɟɡɧɚɱɚʁɧɚ ɢ ɫɥɚɛɚ (Ɍɚɛɟɥɚ 27). 90 Ɍɚɛɟɥɚ 28. Ʉɨɪɟɥɚɰɢʁɚ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɫɚ ɤɨɦɩɥɢɤɚɰɢʁɚɦɚ ɬɨɤɨɦ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɚ Ⱦɢ ɪɟɤ ɬɧɢ ɦɟ ɞɢ ɰɢ ɧɫɤ ɢ ɬɪɨ ɲɤ ɨɜɢ ɂɧ ɞɢ ɪɟɤ ɬɧɢ ɬɪ ɨɲ ɤɨɜ ɢ ɋɭ ɦɚ ɫɜ ɢɯ ɬɪ ɨɲ ɤɨɜ ɚ Ʌɟ ɤɨɜ ɢ, ɦɟ ɞɢ ɰɢ ɧɫɤ ɢ ɤɢ ɫɟɨ ɧɢ ɤ ɢ ɞɟ ɪɢ ɜɚɬ ɢ ɤɪɜ ɢ ȼɢ ɡɭɚ ɥɢ ɡɚɰ ɢɨ ɧɚ ɢ ɥɚɛ ɨɪ ɚɬɨ ɪɢ ʁɫɤ ɚ ɞɢ ʁɚɝ ɧɨ ɫɬɢ ɤɚ ɉɪ ɟɝɥ ɟɞɢ ɥɟ ɤɚɪ ɚ ɢ ɯɢ ɪɭɲ ɤɟ ɭɫɥ ɭɝɟ Ɂɞ ɪɚɜ ɫɬɜ ɟɧɚ ɧɟ ɝɚ Ⱥɞ ɦɢ ɧɢ ɫɬɪ ɚɬɢ ɜɧɢ ɢ ɩɪ ɚɬɟ ʄɢ ɬɪ ɨɲ ɤɨɜ ɢ Ɍɪɨɦɛɨɰɢɬɨɩɟɧɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,045 -0,007 0,037 0,016 -0,021 -0,062 0,040 0,099 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,662 0,947 0,719 0,877 0,837 0,553 0,700 0,340 ɐɟɪɟɛɪɨɜɚɫɤɭɥɚɪɧɢ ɢɧɫɭɥɬ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,099 0,068 0,134 0,110 0,032 -0,078 0,102 0,118 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,340 0,512 0,196 0,290 0,758 0,454 0,327 0,256 ɏɟɦɨɩɬɢɡɢʁɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,026 0,095 0,097 -0,060 0,010 0,044 0,031 0,108 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,801 0,357 0,350 0,561 0,925 0,672 0,762 0,300 Ⱥɩɫɰɟɫ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,018 0,246* 0,147 0,042 0,070 0,099 -0,004 0,046 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,866 0,016 0,155 0,688 0,499 0,340 0,966 0,657 ȿɦɩɢʁɟɦ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,094 0,158 0,053 -0,098 0,000 -0,034 -0,098 -0,023 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,365 0,125 0,612 0,346 10,000 0,744 0,346 0,828 Ɇɟɧɢɧɝɢɬɢɫ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ Ʌɟɭɤɨɩɟɧɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,021 -0,007 -0,003 -0,112 0,061 -0,225* 0,048 0,123 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,837 0,947 0,979 0,278 0,554 0,028 0,643 0,235 91 Ⱥɧɟɦɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,190 0,038 0,220* 0,156 0,195 0,067 0,192 0,238* ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,065 0,714 0,032 0,130 0,058 0,516 0,062 0,020 Ⱥɪɬɪɢɬɢɫ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ Ȼɨɥ ɭ ɩɪɟɞɟɥɭ ɛɭɛɪɟɝɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ ȿɧɞɨɤɚɪɞɢɬɢɫ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ Ƚɚɫɬɪɨɢɧɬɟɫɬɢɧɚɥɧɨ ɤɪɜɚɪɟʃɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,041 -0,068 -0,079 0,030 -0,015 -0,060 -0,120 -0,075 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,691 0,510 0,447 0,772 0,885 0,562 0,245 0,469 Ⱦɢʁɚɪɟʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,096 0,007 0,073 0,103 -0,038 -0,021 0,099 0,070 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,354 0,945 0,482 0,322 0,712 0,837 0,338 0,498 Ȼɭɛɪɟɠɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,052 -0,244* -0,083 0,031 0,038 -0,161 0,163 0,023 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,620 0,017 0,423 0,765 0,712 0,118 0,114 0,824 ɉɧɟɭɦɨɬɨɪɚɤɫ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ ɋɪɱɚɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,068 -0,037 0,043 0,031 0,127 0,115 0,087 0,086 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,512 0,722 0,679 0,769 0,221 0,265 0,404 0,406 ɉɟɪɢɤɚɪɞɢɬɢɫ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 92 Ⱥɪɬɟɪɢʁɫɤɚ ɨɤɫɢɝɟɧɚɰɢʁɚ < 7,98 kPa ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,085 -0,079 0,026 0,013 0,193 -0,089 0,303* 0,134 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,411 0,444 0,803 0,904 0,061 0,390 0,003 0,195 ɉɥɟɭɪɚɥɧɚ ɟɮɭɡɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,096 -0,015 0,091 0,033 -0,046 0,080 0,127 0,084 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,355 0,886 0,378 0,753 0,657 0,439 0,221 0,417 ɉɭɥɦɨɧɚɪɧɢ ɟɦɛɨɥɢɡɚɦ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,154 -0,068 -0,162 -0,160 -0,145 -0,066 -0,152 -0,162 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,136 0,510 0,117 0,122 0,161 0,525 0,141 0,117 Ɋɟɫɩɢɪɚɬɨɪɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,133 -0,128 0,047 -0,009 0,211* -0,050 0,346* 0,211* ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,197 0,215 0,652 0,928 0,040 0,633 0,001 0,040 *- ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ; Spearman's rho ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ Ʉɨɪɟɥɚɰɢʁɚ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɫɚ ɩɨʁɚɜɨɦ ɤɨɦɩɥɢɤɚɰɢʁɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭɝɥɚɜɧɨɦ ʁɟ ɧɟɡɧɚɱɚʁɧɚ ɢ ɫɥɚɛɚ (Ɍɚɛɟɥɚ 28). 93 Ɍɚɛɟɥɚ 29. Ʉɨɪɟɥɚɰɢʁɚ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɫɚ ɤɨɦɨɪɛɢɞɢɬɟɬɧɢɦ ɫɬɚʃɢɦɚ ɢ ɮɚɤɬɨɪɢɦɚ ɪɢɡɢɤɚ (ɩɭɲɟʃɟ ɢ ɚɥɤɨɯɨɥɢɡɚɦ) ɬɨɤɨɦ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɚ Ⱦɢ ɪɟɤ ɬɧɢ ɦɟ ɞɢ ɰɢ ɧɫɤ ɢ ɬɪɨ ɲɤ ɨɜɢ ɂɧ ɞɢ ɪɟɤ ɬɧɢ ɬɪ ɨɲ ɤɨɜ ɢ ɋɭ ɦɚ ɫɜ ɢɯ ɬɪ ɨɲ ɤɨɜ ɚ Ʌɟ ɤɨɜ ɢ, ɦɟ ɞɢ ɰɢ ɧɫɤ ɢ ɤɢ ɫɟɨ ɧɢ ɤ ɢ ɞɟ ɪɢ ɜɚɬ ɢ ɤ ɪɜɢ ȼɢ ɡɭɚ ɥɢ ɡɚɰ ɢɨ ɧɚ ɢ ɥɚɛ ɨɪ ɚɬɨ ɪɢ ʁɫɤ ɚ ɞ ɢʁɚ ɝɧɨ ɫɬɢ ɤɚ ɉɪ ɟɝɥ ɟɞɢ ɥɟ ɤɚɪ ɚ ɢ ɯɢ ɪɭ ɲɤ ɟ ɭɫɥ ɭɝɟ Ɂɞ ɪɚɜ ɫɬɜ ɟɧɚ ɧɟ ɝɚ Ⱥɞ ɦɢ ɧɢ ɫɬɪ ɚɬɢ ɜɧɢ ɢ ɩɪ ɚɬɟ ʄɢ ɬɪɨ ɲɤ ɨɜɢ ɉɪɟɬɯɨɞɧɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɡɛɨɝ ɩɧɟɭɦɨɧɢʁɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,102 0,120 -0,091 -0,080 -0,109 -0,042 -0,179 -0,119 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,326 0,247 0,381 0,440 0,291 0,688 0,082 0,250 Ɉɛɨʂɟʃɟ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,254* -0,068 0,174 0,181 0,200 0,243* 0,136 0,131 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,013 0,511 0,091 0,079 0,052 0,017 0,190 0,205 ɋɪɱɚɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,084 -0,174 0,007 0,015 0,151 0,115 0,170 0,077 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,417 0,092 0,943 0,887 0,145 0,265 0,100 0,459 Ȼɨɥɟɫɬ ɫɪɱɚɧɢɯ ɡɚɥɢɫɬɚɤɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,187 -0,037 0,109 0,134 0,092 0,105 0,054 0,174 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,069 0,723 0,293 0,196 0,377 0,310 0,606 0,092 ɏɢɩɟɪɬɟɧɡɢʁɚ ɚɪɬɟɪɢʁɚɥɢɫ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,035 -0,292* -0,154 0,070 0,091 0,109 0,041 -0,096 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,739 0,004 0,138 0,502 0,379 0,292 0,694 0,354 Ⱥɫɬɦɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,005 0,175 0,041 -0,041 0,019 0,036 -0,073 -0,015 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,962 0,090 0,691 0,696 0,852 0,727 0,485 0,885 ɏɪɨɧɢɱɧɚ ɨɛɫɬɪɭɤɬɢɜɧɚ ɛɨɥɟɫɬ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,157 -0,071 0,112 0,085 0,161 0,200 0,200 0,169 94 ɩɥɭʄɚ ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,128 0,493 0,280 0,412 0,119 0,052 0,052 0,101 Ȼɭɛɪɟɠɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,128 -0,016 0,089 0,104 0,211* 0,096 0,166 0,106 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,215 0,881 0,392 0,317 0,041 0,357 0,108 0,308 Јɟɬɪɢɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,032 0,050 0,035 -0,013 0,021 -0,024 0,021 0,075 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,758 0,630 0,738 0,898 0,837 0,817 0,837 0,471 ȿɧɰɟɮɚɥɨɩɚɬɢʁɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,055 -0,065 0,021 -0,002 0,041 -0,107 0,141 0,069 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,594 0,534 0,840 0,985 0,693 0,301 0,172 0,507 Ⱦɢʁɚɛɟɬɟɫ ɦɟɥɢɬɭɫ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,031 -0,151 -0,120 -0,038 0,030 0,058 -0,005 -0,047 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,767 0,144 0,247 0,712 0,776 0,576 0,965 0,653 Ʉɨɧɡɭɦɢɪɚʃɟ ɚɥɤɨɯɨɥɚ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,218* -0,004 0,204* 0,140 0,261* 0,203* 0,175 0,168 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,034 0,970 0,048 0,177 0,010 0,048 0,090 0,104 Ɇɚɥɢɝɧɢɬɟɬ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ -0,150 -0,043 -0,118 -0,059 -0,117 -0,142 -0,039 -0,145 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,147 0,681 0,253 0,569 0,260 0,169 0,704 0,160 ɉɭɲɟʃɟ ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 0,074 0,103 0,143 -0,005 0,055 0,199 0,050 0,098 ɡɧɚɱɚʁɧɨɫɬ ɩɨɜɟɡɚɧɨɫɬɢ 0,477 0,319 0,166 0,962 0,594 0,054 0,630 0,346 *- ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ; Spearman's rho ɤɨɟɮɢɰɢʁɟɧɬ ɤɨɪɟɥɚɰɢʁɟ 95 ɍ ɚɧɚɥɢɡɢ ɤɨɪɟɥɚɰɢʁɟ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɫɚ ɤɨɦɨɪɛɢɞɢɬɟɬɢɦɚ ɢ ɮɚɤɬɨɪɢɦɚ ɪɢɡɢɤɚ (Ɍɚɛɟɥɚ 29), ɡɚɩɚɠɚ ɫɟ ɩɨɫɬɨʁɚʃɟ ɡɧɚɱɚʁɧɟ ɤɨɪɟɥɚɰɢʁɟ ɢɡɦɟђɭ ɨɛɨʂɟʃɚ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɢʁɚ ɢ ɜɢɫɢɧɟ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ (0,254*), ɤɚɨ ɢ ɬɪɨɲɤɨɜɚ ɩɪɟɝɥɟɞɚ ɥɟɤɚɪɚ (0,243*). Ʉɨɞ ɛɨɥɟɫɧɢɤɚ ɫɚ ɩɪɟɩɨɫɬɨʁɟʄɨɦ ɛɭɛɪɟɠɧɨɦ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɨɦ, ɩɨɫɬɨʁɢ ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ ɫɚ ɧɢɜɨɨɦ ɬɪɨɲɤɨɜɚ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɢ ɜɢɡɭɟɥɢɡɚɰɢɨɧɟ ɞɢʁɚɝɧɨɫɬɢɤɟ (0,211*), ɞɨɤ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɫɚ ɚɪɬɟɪɢʁɫɤɨɦ ɯɢɩɟɪɬɟɧɡɢʁɨɦ, ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ ɩɨɫɬɨʁɢ ɫɚ ɜɢɫɢɧɨɦ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ (-0,292*). Ɉɧɨ ɲɬɨ ɫɟ ʁɚɫɧɨ ɡɚɩɚɠɚ ʁɟ ɞɚ ɭ ɤɚɬɟɝɨɪɢʁɢ ɩɚɰɢʁɟɧɚɬɚ, ɤɨɧɡɭɦɟɧɚɬɚ ɚɥɤɨɯɨɥɚ ɭ ɟɤɫɰɟɫɢɜɧɢɦ ɤɨɥɢɱɢɧɚɦɚ, ɩɨɫɬɨʁɢ ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ ɭ ɜɢɲɟ ɤɚɬɟɝɨɪɢʁɚ: ɜɢɫɢɧɟ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ (0,218*), ɫɭɦɟ ɫɜɢɯ ɬɪɨɲɤɨɜɚ (0,204*), ɚɥɢ ɢ ɭ ɤɚɬɟɝɨɪɢʁɚɦɚ ɬɪɨɲɤɨɜɚ ɜɢɡɭɟɥɢɡɚɰɢɨɧɟ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɞɢʁɚɝɧɨɫɬɢɤɟ (0,261*) ɢ ɬɪɨɲɤɨɜɚ ɩɪɟɝɥɟɞɚ ɥɟɤɚɪɚ ɢ ɯɢɪɭɪɲɤɢɯ ɭɫɥɭɝɚ (0,203*). 96 TКɛɟɥɚ 30. ȳɟɞɢɧɢɱɧɚ ɩɨɬɪɨɲʃɚ ɥɟɤɨɜɚ ɬɨɤɨɦ ɥɟɱɟʃɚ ɩɚɰɢʁɟɧɚɬɚ ɨɛɨɥɟɥɢɯ ɨɞ ɩɧɟɭɦɨɧɢʁɟ ɋɩɢɫɚɤ ɤɨɪɢɲʄɟɧɢɯ ɥɟɤɨɜɚ ɧ ɍɤɭɩɚɧ ɛɪɨʁ ȾȾȾ Ȼɪɨʁ ȾȾȾ ɩɨ ɩɚɰɢʁɟɧɬɭ ɧɚ ɧɢɜɨɭ ɰɟɥɨɝ ɭɡɨɪɤɚ ɉɪɟɞɧɢɡɨɧ 2 40 0,421053 Ⱥɦɢɧɨɮɢɥɢɧ 60 449,5 4,731579 Ɍɟɨɮɢɥɢɧ 4 58,75 0,618421 Ɍɢɨɬɪɨɩɢɭɦ ɛɪɨɦɢɞ 6 89 0,936842 Ɏɟɧɨɬɟɪɨɥ + ɢɩɚɬɪɨɩɢʁɭɦ ɛɪɨɦɢɞ 31 72,58 + 152,43 0,764 + 1,604526 Ȼɭɞɟɫɨɧɢɞ + ɮɨɪɦɨɬɟɪɨɥ-ɮɭɦɚɪɚɬ-ɞɢɯɢɞɪɚɬ 3 10,4 + 19,5 0,109474 + 0,205263 Ɏɥɭɬɢɤɚɡɨɧ + ɫɚɥɦɟɬɟɪɨɥ 14 69,67 + 209 0,733368 + 2,2 Ⱥɦɨɤɫɢɰɢɥɢɧ + ɤɥɚɜɭɥɨɧɫɤɚ ɤɢɫɟɥɢɧɚ 12 153,6 1,616842 ɐɟɮɨɬɚɤɫɢɦ 11 84 0,884211 ɐɟɮɬɪɢɚɤɫɨɧ 21 336 3,536842 ɉɢɩɟɪɚɰɢɥɢɧ + ɬɚɡɨɛɚɤɬɚɦ 2 33,43 0,351895 ɐɟɮɚɥɟɤɫɢɧ 1 13 0,136842 ɐɟɮɬɚɡɢɞɢɦ 26 235 2,473684 Ɍɪɢɦɟɬɨɩɪɢɦ-ɫɭɥɮɨɦɟɬɨɤɫɚɡɨɥ 1 8 + 0,32 0,084211 + 0,033684 Ⱥɡɢɬɪɨɦɢɰɢɧ 30 163 1,715789 Ʉɥɢɧɞɚɦɢɰɢɧ 6 60 0,631579 ɐɢɩɪɨɮɥɨɤɫɚɰɢɧ 20 118,8 1,250526 Ʌɟɜɨɮɥɨɤɫɚɰɢɧ 66 814 8,568421 Ɏɥɭɤɨɧɚɡɨɥ 4 32 0,336842 ȼɚɧɤɨɦɢɰɢɧ 7 79 0,831579 Ʉɥɚɪɢɬɪɨɦɢɰɢɧ 8 91 0,957895 Ⱥɦɢɤɚɰɢɧ 21 193 2,031579 Ɇɟɬɪɨɧɢɞɚɡɨɥ 18 19,104 0,201095 Ɇɟɪɨɩɟɧɟɦ 4 67,25 0,707895 ȿɪɬɚɩɟɧɟɦ 21 174 1,831579 97 ɐɟɮɭɪɨɤɫɢɦ 1 10,5 0,110526 ɐɟɮɢɤɫɢɦ 3 18 0,189474 Ⱥɰɟɬɢɥɰɢɫɬɟɢɧ 16 171,6 1,806316 Ɋɚɧɢɬɢɞɢɧ 24 103,5 1,089474 Ɇɟɬɢɥɩɪɟɞɧɢɡɨɥɨɧ 29 479 5,042105 ɉɚɧɬɨɩɪɚɡɨɥ 3 26 0,273684 Ɉɦɟɩɪɚɡɨɥ 7 55 0,578947 Ⱦɢɤɥɨɮɟɧɚɤ 26 148,25 1,560526 ɂɛɭɩɪɨɮɟɧ 2 5333,33 56,14032 Ʉɟɬɨɪɨɥɚɤ + ɬɪɚɦɚɞɨɥ 3 16 0,168421 0,9% ɪɚɫɬɜɨɪ ɧɚɬɪɢʁɭɦ-ɯɥɨɪɢɞɚ 72 1100600ɦɥ 11585,26ɦɥ 5% ɪɚɫɬɜɨɪ ɝɥɭɤɨɡɟ 6 26500ɦɥ 278,9474ɦɥ Ɋɢɧɝɟɪɨɜ ɪɚɫɬɜɨɪ 7 17000ɦɥ 178,9474ɦɥ Mɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ 39 - - ɧ- ɛɪɨʁ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ʁɟ ɩɪɢɦɚɨ ɥɟɤ; ȾȾȾ- ɞɟɮɢɧɢɫɚɧɚ ɞɧɟɜɧɚ ɞɨɡɚ Ⱥɤɨ ɫɟ ɚɧɚɥɢɡɢɪɚ ɩɨɬɪɨɲʃɚ ɥɟɤɨɜɚ ɢɡɪɚɠɟɧɚ ɭɡ ɩɨɦɨʄ ɞɟɮɢɧɢɫɚɧɢɯ ɞɧɟɜɧɢɯ ɞɨɡɚ (Ɍɚɛɟɥɚ 30), ɨɧɞɚ ʁɟ ɧɚʁɜɟʄɚ ɩɨɬɪɨɲʃɚ ɚɦɢɧɨɮɢɥɢɧɚ, ɰɟɮɬɚɡɢɞɢɦɚ, ɥɟɜɨɮɥɨɤɫɚɰɢɧɚ, ɚɡɢɬɪɨɦɢɰɢɧɚ, ɚɦɢɤɚɰɢɧɚ, ɟɪɬɚɩɟɧɟɦɚ, ɦɟɬɢɥɩɪɟɞɧɢɡɨɥɨɧɚ ɢ ɢɛɭɩɪɨɮɟɧɚ. ȼɟɥɢɤɚ ʁɟ ɩɨɬɪɨɲʃɚ ɢ ɩɚɪɟɧɬɟɪɚɥɧɢɯ ɪɚɫɬɜɨɪɚ ɧɚɬɪɢʁɭɦ-ɯɥɨɪɢɞɚ, ɝɥɭɤɨɡɟ ɢ ɪɢɧɝɟɪ-ɥɚɤɬɚɬɚ. 98 Ƚɪɚɮɢɤɨɧ 10. ɉɪɨɫɟɱɧɢ ɞɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ ɩɨ ɩɚɰɢʁɟɧɬɭ ɡɚ ɨɫɧɨɜɧɟ ɤɚɬɟɝɨɪɢʁɟ ɭɫɥɭɝɚ ɭ ɨɞɧɨɫɭ ɧɚ CURB-65 ɫɤɚɥɭ 1. Ɍɪɨɲɤɨɜɢ ɞɢʁɚɝɧɨɫɬɢɤɟ ɢ ɥɟɱɟʃɚ ɤɨɦɨɪɛɢɞɢɬɟɬɚ; 2. Ⱥɧɬɢɫɟɩɬɢɰɢ ɢ ɞɟɡɢɧɮɢɰɢʁɟɧɫɢ; 3. Ʉɪɜ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ; 4. Ʌɟɤɚɪɫɤɢ ɩɪɟɝɥɟɞɢ; 5. Ɋɚɞɢɨɥɨɲɤɢ ɩɨɬɪɨɲɧɢ ɦɚɬɟɪɢʁɚɥ; 6. Ⱥɧɬɢɥɢɩɟɦɢɰɢ ɢ ɞɨɞɚɰɢ ɢɫɯɪɚɧɢ; 7. Ɇɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɯɨɪɦɨɧɫɤɢ ɩɪɟɩɚɪɚɬɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ; 8. Ʉɥɚɫɢɱɧɚ ɞɢʁɚɝɧɨɫɬɢɱɤɚ ɪɚɞɢɨɥɨɝɢʁɚ; 9. Ⱥɧɬɢɢɧɮɟɤɬɢɜɧɢ ɥɟɤɨɜɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ; 10. Ʉɚɪɞɢɨɜɚɫɤɭɥɚɪɧɚ ɢɧɬɟɪɜɟɧɬɧɚ ɪɚɞɢɨɥɨɝɢʁɚ; 11. Ʌɚɛɨɪɚɬɨɪɢʁɫɤɟ ɚɧɚɥɢɡɟ; 12. Ɇɟɞɢɰɢɧɫɤɚ ɧɟɝɚ ɬɟɯɧɢɱɚɪɚ; 13. ɇɭɤɥɟɚɪɧɚ ɦɟɞɢɰɢɧɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ; 14. Ɉɫɬɚɥɟ ɭɫɥɭɝɟ: ɫɨɰɢʁɚɥɧɚ ɛɪɢɝɚ, ɬɪɚɧɫɩɨɪɬ, ɨɛɭɤɚ, ɤɨɦɢɫɢʁɟ, ɫɚɜɟɬɨɜɚʃɟ, ɫɦɟɲɬɚʁ ɩɚɰɢʁɟɧɬɚ, ɟɤɫɩɟɪɬɢɡɚ ɢ ɦɢɲʂɟʃɟ; 15. ɏɢɪɭɲɤɟ ɭɫɥɭɝɟ; 16. ɍɫɥɭɝɟ ɞɢʁɚɥɢɡɟ ɢ ɮɢɡɢɤɚɥɧɟ ɦɟɞɢɰɢɧɟ; 17. ɂɧɫɬɪɭɦɟɧɬɢ ɢ ɞɪɭɝɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɨʁɢ ɫɟ ɤɨɪɢɫɬɢ ɩɪɢɥɢɤɨɦ ɩɪɭɠɚʃɚ ɭɫɥɭɝɚ ɢɧɬɟɪɜɟɧɬɧɟ ɪɚɞɢɨɥɨɝɢʁɟ; 18. ɂɧɫɬɪɭɦɟɧɬɢ ɢ ɞɪɭɝɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɨʁɢ ɫɟ ɤɨɪɢɫɬɢ ɩɪɢɥɢɤɨɦ ɩɪɭɠɚʃɚ ɭɫɥɭɝɚ ɧɭɤɥɟɚɪɧɟ ɦɟɞɢɰɢɧɟ; 19. ɉɨɬɪɨɲɧɢ ɪɭɬɢɧɫɤɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ 99 Ƚɪɚɮɢɤɨɧ 11. ɉɪɨɫɟɱɧɢ ɞɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ ɩɨ ɩɚɰɢʁɟɧɬɭ ɡɚ ɨɫɧɨɜɧɟ ɤɚɬɟɝɨɪɢʁɟ ɭɫɥɭɝɚ ɭ ɨɞɧɨɫɭ ɧɚ ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ 1. Ɍɪɨɲɤɨɜɢ ɞɢʁɚɝɧɨɫɬɢɤɟ ɢ ɥɟɱɟʃɚ ɤɨɦɨɪɛɢɞɢɬɟɬɚ; 2. Ⱥɧɬɢɫɟɩɬɢɰɢ ɢ ɞɟɡɢɧɮɢɰɢʁɟɧɫɢ; 3. Ʉɪɜ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ; 4. Ʌɟɤɚɪɫɤɢ ɩɪɟɝɥɟɞɢ; 5. Ɋɚɞɢɨɥɨɲɤɢ ɩɨɬɪɨɲɧɢ ɦɚɬɟɪɢʁɚɥ; 6. Ⱥɧɬɢɥɢɩɟɦɢɰɢ ɢ ɞɨɞɚɰɢ ɢɫɯɪɚɧɢ; 7. Ɇɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɯɨɪɦɨɧɫɤɢ ɩɪɟɩɚɪɚɬɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ; 8. Ʉɥɚɫɢɱɧɚ ɞɢʁɚɝɧɨɫɬɢɱɤɚ ɪɚɞɢɨɥɨɝɢʁɚ; 9. Ⱥɧɬɢɢɧɮɟɤɬɢɜɧɢ ɥɟɤɨɜɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ; 10. Ʉɚɪɞɢɨɜɚɫɤɭɥɚɪɧɚ ɢɧɬɟɪɜɟɧɬɧɚ ɪɚɞɢɨɥɨɝɢʁɚ; 11. Ʌɚɛɨɪɚɬɨɪɢʁɫɤɟ ɚɧɚɥɢɡɟ; 12. Ɇɟɞɢɰɢɧɫɤɚ ɧɟɝɚ ɬɟɯɧɢɱɚɪɚ; 13. ɇɭɤɥɟɚɪɧɚ ɦɟɞɢɰɢɧɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ; 14. Ɉɫɬɚɥɟ ɭɫɥɭɝɟ: ɫɨɰɢʁɚɥɧɚ ɛɪɢɝɚ, ɬɪɚɧɫɩɨɪɬ, ɨɛɭɤɚ, ɤɨɦɢɫɢʁɟ, ɫɚɜɟɬɨɜɚʃɟ, ɫɦɟɲɬɚʁ ɩɚɰɢʁɟɧɬɚ, ɟɤɫɩɟɪɬɢɡɚ ɢ ɦɢɲʂɟʃɟ; 15. ɏɢɪɭɲɤɟ ɭɫɥɭɝɟ; 16. ɍɫɥɭɝɟ ɞɢʁɚɥɢɡɟ ɢ ɮɢɡɢɤɚɥɧɟ ɦɟɞɢɰɢɧɟ; 17. ɂɧɫɬɪɭɦɟɧɬɢ ɢ ɞɪɭɝɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɨʁɢ ɫɟ ɤɨɪɢɫɬɢ ɩɪɢɥɢɤɨɦ ɩɪɭɠɚʃɚ ɭɫɥɭɝɚ ɢɧɬɟɪɜɟɧɬɧɟ ɪɚɞɢɨɥɨɝɢʁɟ; 18. ɂɧɫɬɪɭɦɟɧɬɢ ɢ ɞɪɭɝɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ ɤɨʁɢ ɫɟ ɤɨɪɢɫɬɢ ɩɪɢɥɢɤɨɦ ɩɪɭɠɚʃɚ ɭɫɥɭɝɚ ɧɭɤɥɟɚɪɧɟ ɦɟɞɢɰɢɧɟ; 19. ɉɨɬɪɨɲɧɢ ɪɭɬɢɧɫɤɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ 100 Ⱥɤɨ ɫɟ ɚɧɚɥɢɡɢɪɚ ɭɞɟɨ ɩɪɨɫɟɱɧɢɯ ɬɪɨɲɤɨɜɚ ɩɨ ɩɚɰɢʁɟɧɬɭ, ɩɪɟɦɚ ɤɨɪɢɲʄɟɧɢɦ ɫɤɚɥɚɦɚ, ɨɧɞɚ ɫɟ ɜɢɞɢ ɞɚ ɫɭ ɧɚʁɜɟʄɢ ɬɪɨɲɤɨɜɢ ɢɡ ɝɪɭɩɚ ɧɟɤɥɚɫɢɮɢɤɨɜɚɧɢɯ ɭɫɥɭɝɚ ɤɨʁɟ ɫɭ ɩɨɜɟɡɚɧɟ ɫɚ ɥɟɱɟʃɟɦ ɩɧɟɭɦɨɧɢʁɟ (ɞɢʁɚɝɧɨɫɬɢɤɚ ɢ ɥɟɱɟʃɟ ɤɨɦɨɪɛɢɞɢɬɟɬɚ) ɢ ɚɧɬɢɢɧɮɟɤɬɢɜɧɢɯ ɥɟɤɨɜɚ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ, ɢ ɬɨ ɭ ɫɜɢɦ ɤɚɬɟɝɨɪɢʁɚɦɚ ɩɪɟɦɚ ɨɛɟ ɫɤɚɥɟ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɤɥɢɧɢɱɤɟ ɫɥɢɤɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (Ƚɪɚɮɢɤɨɧɢ 10, 11). 101 Ɍɚɛɟɥɚ 31. Ɋɟɝɪɟɫɢɨɧɚ ɚɧɚɥɢɡɚ ɩɪɟɞɢɤɬɨɪɚ ɫɦɪɬɧɨɝ ɢɫɯɨɞɚ ɤɨɞ ɩɧɟɭɦɨɧɢʁɟ B Wald Sig. Exp(B) 95% CI for EXP(B) Lower Upper ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ 1,932 2,575 0,109 6,901 0,652 73,055 CURB-65 ɫɤɚɥɚ 2,535 4,949 0,026* 12,620 1,352 117,774 ɇɚ ɨɫɧɨɜɭ ɪɟɝɪɟɫɢɨɧɟ ɚɧɚɥɢɡɟ ɞɨɛɢɥɢ ɫɦɨ ɞɚ ɡɧɚɱɚʁɧɨ ɭɬɢɱɟ ʁɟɞɚɧ ɮɚɤɬɨɪ ɧɚ ɢɫɯɨɞ ɥɟɱɟʃɚ ɨɛɨɥɟɥɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɚ ɬɨ ʁɟ CURB-65 ɫɤɚɥɚ. ɋɜɢ ɤɨʁɢ ɫɭ ɭɦɪɥɢ ɛɢɥɢ ɫɭ ɢɥɢ ɤɚɧɞɢɞɚɬɢ ɡɚ ɛɨɥɧɢɱɤɨ ɥɟɱɟʃɟ ɢɥɢ ɫɭ ɛɨɥɧɢɱɤɢ ɥɟɱɟɧɢ. 102 Ɍɚɛɟɥɚ 32. Ɋɟɝɪɟɫɢɨɧɚ ɚɧɚɥɢɡɚ ɩɪɟɞɢɤɬɨɪɚ ɫɦɪɬɧɨɝ ɢɫɯɨɞɚ ɤɨɞ ɩɧɟɭɦɨɧɢʁɟ B Wald Sig. Exp(B) 95% CI for EXP(B) Lower Upper Ⱦɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ 0,002 0,000 0,991 1,002 0,720 1,395 ɂɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ 0,000 0,000 0,998 1,000 0,749 1,334 Ʌɟɤɨɜɢ, ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ -0,001 0,000 0,993 0,999 0,720 1,386 ȼɢɡɭɚɥɢɡɚɰɢɨɧɚ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ -0,019 0,000 0,992 0,981 0,021 46,918 ɉɪɟɝɥɟɞɢ ɥɟɤɚɪɚ ɢ ɯɢɪɭɲɤɟ ɭɫɥɭɝɟ -0,006 0,000 0,997 0,994 0,030 32,730 Ɂɞɪɚɜɫɬɜɟɧɚ ɧɟɝɚ -0,002 0,000 1,000 0,998 0,001 1315,504 Ⱦɭɠɢɧɚ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ -7,314 0,000 0,996 0,001 0,000 0,000 ɇɚ ɨɫɧɨɜɭ ɪɟɝɪɟɫɢɨɧɟ ɚɧɚɥɢɡɟ ɧɢɫɦɨ ɞɨɛɢɥɢ ɡɧɚɱɚʁɚɧ ɦɨɞɟɥ, ɧɢɬɢ ʁɟɞɚɧ ɮɚɤɬɨɪ, ɞɚ ɡɧɚɱɚʁɧɨ ɭɬɢɱɟ ɧɚ ɢɫɯɨɞ ɥɟɱɟʃɚ ɨɛɨɥɟɥɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (ɚɧɚɥɢɡɢɪɚɧɢ ɮɚɤɬɨɪɢ ɫɭ ɛɢɥɢ ɫɜɟ ɝɥɚɜɧɟ ɤɚɬɟɝɨɪɢʁɟ ɢ ɩɨɞɤɚɬɟɝɨɪɢʁɟ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɢ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ). 103 Ɍɚɛɟɥɚ 33. Ɋɟɝɪɟɫɢɨɧɚ ɚɧɚɥɢɡɚ ɩɪɟɞɢɤɬɨɪɚ ɫɦɪɬɧɨɝ ɢɫɯɨɞɚ ɤɨɞ ɩɧɟɭɦɨɧɢʁɟ B Wald Sig. Exp(B) 95% CI for EXP(B) Lower Upper ɉɭɲɚɱɤɢ ɫɬɚɬɭɫ -0,749 .345 0,557 0,473 0,039 5,769 ɀɢɜɨɬ ɭ ɫɬɚɪɚɱɤɨɦ ɞɨɦɭ 4,763 4,034 0,045 117,109 1,122 12223,098 ȼɚɤɰɢɧɚɰɢʁɚ ɩɪɨɬɢɜ ɜɢɪɭɫɚ ɝɪɢɩɚ -16,796 0,000 1,000 0,000 0,000 - ȼɚɤɰɢɧɚɰɢʁɚ ɩɪɨɬɢɜ ɩɧɟɭɦɨɤɨɤɚ -0,048 0,000 1,000 0,954 0,000 - ɉɪɟɬɯɨɞɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ ɡɛɨɝ ɩɧɟɭɦɨɧɢʁɚ -17,917 0,000 0,999 0,000 0,000 - Ⱦɭɠɢɧɚ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ -0,292 3,394 0,065 0,747 0,547 1,019 ɇɚ ɨɫɧɨɜɭ ɪɟɝɪɟɫɢɨɧɟ ɚɧɚɥɢɡɟ ɧɢɫɦɨ ɞɨɛɢɥɢ ɡɧɚɱɚʁɚɧ ɦɨɞɟɥ, ɧɢɬɢ ʁɟɞɚɧ ɮɚɤɬɨɪ, ɞɚ ɡɧɚɱɚʁɧɨ ɭɬɢɱɟ ɧɚ ɢɫɯɨɞ ɥɟɱɟʃɚ ɨɛɨɥɟɥɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (ɩɭɲɚɱɢ ɫɬɚɬɭɫ, ɜɚɤɰɢɧɚɰɢʁɚ ɩɪɨɬɢɜ ɜɢɪɭɫɚ ɝɪɢɩɚ ɢ ɩɧɟɭɦɨɤɨɤɚ, ɠɢɜɨɬ ɭ ɫɬɚɪɚɱɤɨɦ ɞɨɦɭ ɢ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ). 104 7. ȾɂɋɄɍɋɂȳȺ ɋɬɭɞɢʁɨɦ ɫɭ ɨɛɭɯɜɚʄɟɧɚ 103 ɩɚɰɢʁɟɧɬɚ, ɤɨʁɢ ɫɭ ɭ ɩɟɪɢɨɞɭ ɨɞ ɨɤɬɨɛɪɚ 2012. ɝɨɞɢɧɟ ɞɨ ʁɚɧɭɚɪɚ 2014. ɝɨɞɢɧɟ ɛɢɥɢ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢ ɭ Ʉɥɢɧɢɰɢ ɡɚ ɩɭɥɦɨɥɨɝɢʁɭ Ʉɥɢɧɢɱɤɨɝ ɰɟɧɬɪɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ ɡɛɨɝ ɡɧɚɤɨɜɚ ɢ ɫɢɦɩɬɨɦɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. Ɂɚ ɫɬɚɬɢɫɬɢɱɤɭ ɢ ɮɚɪɦɚɤɨɟɤɨɧɨɦɫɤɭ ɚɧɚɥɢɡɭ ɛɢɥɨ ʁɟ ɪɚɫɩɨɥɨɠɢɜɨ 95 ɩɚɰɢʁɟɧɚɬɚ, ʁɟɪ ʁɟ ɭɬɜɪђɟɧɨ ɞɚ ɡɚ 8 ɩɚɰɢʁɟɧɚɬɚ ɩɨɫɬɨʁɟ ɧɟɞɨɫɬɚʁɭʄɢ, ɧɟɚɞɟɤɜɚɬɧɢ ɢɥɢ ɧɟɪɟɩɪɟɡɟɧɬɚɬɢɜɧɢ ɩɨɞɚɰɢ, ɬɟ ɫɭ ɨɧɢ ɛɢɥɢ ɢɫɤʂɭɱɟɧɢ ɢɡ ɚɧɚɥɢɡɟ ɤɨʁɚ ʁɟ ɭɫɥɟɞɢɥɚ. ɉɨɥɧɚ ɫɬɪɭɤɬɭɪɚ ɚɧɚɥɢɡɢɪɚɧɢɯ ɩɚɰɢʁɟɧɚɬɚ ʁɟ ɛɢɥɚ ɪɚɜɧɨɩɪɚɜɧɚ, ɫɚ ɝɨɬɨɜɨ ɩɨɞʁɟɞɧɚɤɨɦ ɡɚɫɬɭɩʂɟɧɨɲʄɭ ɠɟɧɚ ɢ ɦɭɲɤɚɪɚɰɚ (49 ɠɟɧɚ, ɨɞɧɨɫɧɨ 51,5% ɩɪɟɦɚ 46 ɦɭɲɤɚɪɚɰɚ, ɨɞɧɨɫɧɨ 48,5%). ȼɟʄɢɧɚ ɨɛɨɥɟɥɢɯ ʁɟ ɛɢɥɚ ɫɬɚɪɢʁɟ ɠɢɜɨɬɧɟ ɞɨɛɢ, ɩɪɨɫɟɱɧɚ ɫɬɚɪɨɫɬ ʁɟ ɢɡɧɨɫɢɥɚ 63,46±14,83, ɚ ɭ ɨɩɫɟɝɭ ɨɞ 23 ɞɨ 92 ɝɨɞɢɧɟ ɠɢɜɨɬɚ. ɍ ɞɢɪɟɤɬɧɨʁ ɜɟɡɢ ɫɚ ɫɬɚɪɨɲʄɭ ɛɨɥɟɫɧɢɤɚ ʁɟ ɢ ʃɢɯɨɜ ɪɚɞɧɢ ɫɬɚɬɭɫ, ɜɢɲɟ ɨɞ ɩɨɥɨɜɢɧɟ ɛɨɥɟɫɧɢɤɚ ʁɟ ɫɩɚɞɚɥɨ ɭ ɝɪɭɩɭ ɩɟɧɡɢɨɧɟɪɚ (50, ɨɞɧɨɫɧɨ 52,6%), ɢɡɚ ɤɨʁɟ ʁɟ ɫɥɟɞɢɥɚ ɤɚɬɟɝɨɪɢʁɚ „ɧɟɩɨɡɧɚɬɨ“ ɭ ɤɨʁɭ ʁɟ ɫɜɪɫɬɚɧɨ ɱɚɤ 19 ɛɨɥɟɫɧɢɤɚ (20,0%). (Ɍɚɛɟɥɚ 4) Ʉɚɞɚ ɫɟ ɪɚɡɦɚɬɪɚʁɭ ɮɚɤɬɨɪɢ ɪɢɡɢɤɚ ɤɨʁɢ ɛɢ ɦɨɝɥɢ ɞɚ ɩɨɬɟɧɰɢɪɚʁɭ ɥɨɲɢʁɢ ɢɫɯɨɞ ɥɟɱɟʃɚ ɨɛɨɥɟɥɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (Ɍɚɛɟɥɚ 5), ɚɧɚɥɢɡɢɪɚʁɭʄɢ ɩɭɲɚɱɤɢ ɫɬɚɬɭɫ ɡɚɩɚɠɚ ɫɟ ɞɚ ɫɭ ɭ ɫɬɪɭɤɬɭɪɢ ɚɧɚɥɢɡɢɪɚɧɢɯ ɛɨɥɟɫɧɢɤɚ ɝɨɬɨɜɨ ɩɨɞʁɟɞɧɚɤɨ ɛɢɥɢ ɡɚɫɬɭɩʂɟɧɢ ɧɟɩɭɲɚɱɢ ɢ ɩɭɲɚɱɢ, ɫɚ ɛɥɚɝɨɦ ɩɪɟɞɨɦɢɧɚɰɢʁɨɦ ɧɟɩɭɲɚɱɚ (51 ɧɟɩɭɲɚɱ, ɨɞɧɨɫɧɨ 53,7% ɩɪɟɦɚ 44 ɩɭɲɚɱɚ, ɨɞɧɨɫɧɨ 46,3%). ɍ ɩɨɝɥɟɞɭ ʃɢɯɨɜɨɝ ɩɭɲɚɱɤɨɝ ɫɬɚɠɚ, ʁɚɫɧɨ ʁɟ ɞɚ ɫɭ ɭ ɩɢɬɚʃɭ ɨɫɨɛɟ ɤɨʁɟ ɫɭ ɞɭɠɢ ɧɢɡ ɝɨɞɢɧɚ ɢɥɢ ɞɟɰɟɧɢʁɚ ɩɭɲɚɱɢ, ʃɢɯɨɜ ɩɪɨɫɟɱɚɧ ɩɭɲɚɱɤɢ ɫɬɚɠ ɢɡɧɨɫɢ 37,05 ± 19,49, ɲɬɨ ɧɟ ɩɪɟɞɫɬɚɜʂɚ ɢɡɧɟɧɚђɟʃɟ, ɩɪɟ ɫɜɟɝɚ ɢɦɚʁɭʄɢ ɭ ɜɢɞɭ ɩɪɨɫɟɱɧɭ ɠɢɜɨɬɧɭ ɞɨɛ ɚɧɚɥɢɡɢɪɚɧɢɯ ɛɨɥɟɫɧɢɤɚ. ɂɡ ɭɫɬɚɧɨɜɟ ɬɪɚʁɧɨɝ ɫɦɟɲɬɚʁɚ ɢ ɡɛɪɢʃɚɜɚʃɚ ɫɬɚɪɢʁɢɯ ɨɫɨɛɚ ɫɭ ɞɨɲɥɚ 2 ɛɨɥɟɫɧɢɤɚ (2,1%), ɞɨɤ ɨɫɬɚɥɢ ɩɨɬɢɱɭ ɢɡ ɫɬɚɧɞɚɪɞɧɨɝ ɜɚɧɛɨɥɧɢɱɤɨɝ ɨɤɪɭɠɟʃɚ. Ɂɚɧɢɦʂɢɜ ʁɟ ɩɨɞɚɬɚɤ ɞɚ ʁɟ ɟɤɫɰɟɫɢɜɧɚ ɤɨɧɡɭɦɚɰɢʁɚ ɚɥɤɨɯɨɥɚ ɤɚɨ 105 ɮɚɤɬɨɪ ɪɢɡɢɤɚ ɛɢɥɚ ɩɪɢɫɭɬɧɚ ɤɨɞ ɱɚɤ 10 ɛɨɥɟɫɧɢɤɚ (10,5%), ɲɬɨ ʁɟ ʁɚɫɚɧ ɢɧɞɢɤɚɬɨɪ ɨ ɡɧɚɱɚʁɭ ɢ ɭɱɟɫɬɚɥɨɫɬɢ ɨɜɟ ɛɨɥɟɫɬɢ ɡɚɜɢɫɧɨɫɬɢ ɭ ɧɚɲɨʁ ɩɨɩɭɥɚɰɢʁɢ, ɢɚɤɨ ɫɟ ɩɪɟɰɢɡɧɨɫɬ ɨɜɨɝ ɩɨɞɚɬɤɚ ɦɨɠɟ ɫɬɚɜɢɬɢ ɩɨɞ ɫɭɦʃɭ, ʁɟɪ ɫɭ ɚɭɬɨɚɧɚɦɧɟɫɬɢɱɤɢ ɩɨɞɚɰɢ ɨ ɨɜɨɦɟ ɱɟɫɬɨ ɫɚɤɪɢɜɟɧɢ ɢ/ɢɥɢ ɧɟɩɨɭɡɞɚɧɢ, ɞɨɤ ɯɟɬɟɪɨɚɧɚɦɧɟɫɬɢɱɤɢ ɞɨ ɢɡɜɟɫɧɟ ɦɟɪɟ ɩɨɩɪɚɜʂɚʁɭ ɩɨɭɡɞɚɧɨɫɬ ɚɥɢ ɧɟ ɭ ɩɨɬɩɭɧɨɫɬɢ. Ȼɪɨʁɧɢ ɫɭ ɪɚɡɥɨɡɢ ɡɚ ɬɨ, ɢɡɦɟђɭ ɨɫɬɚɥɢɯ ɢ ɪɚɲɢɪɟɧɚ ɞɪɭɲɬɜɟɧɚ ɬɨɥɟɪɚɧɰɢʁɚ ɤɨʁɚ ɩɪɚɬɢ ɨɜɚʁ ɩɨɪɟɦɟʄɚʁ, ɨɞɧɨɫɧɨ ɛɨɥɟɫɬ ɡɚɜɢɫɧɨɫɬɢ. ɉɪɟɬɯɨɞɧɨ ʁɟ, ɭɫɥɟɞ ɪɚɧɢʁɢɯ ɟɩɢɡɨɞɚ ɩɧɟɭɦɨɧɢʁɚ, ɛɢɥɨ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɨ 14 ɛɨɥɟɫɧɢɤɚ (14,7%), ɚ ɡɚɧɢɦʂɢɜ ʁɟ ɢ ɢɧɞɢɤɚɬɢɜɚɧ ɩɨɞɚɬɚɤ ɨ ɧɢɫɤɨʁ ɭɱɟɫɬɚɥɨɫɬɢ ɜɚɤɰɢɧɚɰɢʁɟ, ɤɚɤɨ ɩɪɨɬɢɜ ɜɢɪɭɫɚ ɝɪɢɩɚ, ɬɚɤɨ ɢ ɩɪɨɬɢɜ ɩɧɟɭɦɨɤɨɤɚ. ɋɚɦɨ 1 ɛɨɥɟɫɧɢɤ ʁɟ ɛɢɨ ɜɚɤɰɢɧɢɫɚɧ ɢ ɬɨ ɨɛɟɦɚ ɜɚɤɰɢɧɚɦɚ (1,1%). Ɉɜɚʁ ɩɨɞɚɬɚɤ ɢɦɚ ɜɟʄɢ ɡɧɚɱɚʁ ɭɤɨɥɢɤɨ ɫɟ ɫɬɚɜɢ ɭ ɤɨɧɬɟɤɫɬ ɩɪɨɫɟɱɧɟ ɫɬɚɪɨɫɬɢ ɛɨɥɟɫɧɢɤɚ ɢ ɩɨɜɟʄɚɧɟ ɜɟɪɨɜɚɬɧɨʄɟ ɪɢɡɢɤɚ ɨɞ ɤɨɦɩɥɢɤɚɰɢʁɚ ɩɧɟɭɦɨɧɢʁɚ ɢ ɦɨɝɭʄɟɝ ɧɟɩɨɜɨʂɧɨɝ ɢɫɯɨɞɚ ɥɟɱɟʃɚ ɨɜɟ ɛɨɥɟɫɬɢ, ɚ ɤɨʁɢ ɦɨɝɭ ɛɢɬɢ ɪɟɞɭɤɨɜɚɧɢ ɩɪɚɜɨɜɪɟɦɟɧɨɦ ɢ ɪɟɞɨɜɧɨɦ ɜɚɤɰɢɧɚɰɢʁɨɦ ɩɪɨɬɢɜ ɜɢɪɭɫɚ ɝɪɢɩɚ, ɤɚɨ ɢ ɩɪɨɬɢɜ ɩɧɟɭɦɨɤɨɤɚ, ɭ ɩɪɢɫɭɫɬɜɭ ɨɞɝɨɜɚɪɚʁɭʄɢɯ ɢɧɞɢɤɚɰɢʁɚ. ɇɚɜɟɞɟɧɢ ɩɨɞɚɬɚɤ ɭɤɚɡɭʁɟ ɧɚ ɱɢʃɟɧɢɰɭ ɧɢɫɤɟ ɫɬɨɩɟ ɜɚɤɰɢɧɚɰɢʁɟ ɩɪɨɬɢɜ ɝɪɢɩɚ ɭ ɧɚɲɨʁ ɩɨɩɭɥɚɰɢʁɢ, ɩɨɫɟɛɧɨ ɤɚɞ ɫɟ ɭɩɨɪɟɞɢ ɫɚ ɪɚɫɩɨɥɨɠɢɜɢɦ ɩɨɞɚɰɢɦɚ ɨ ɩɨɤɪɢɜɟɧɨɫɬɢ ɢɦɭɧɢɡɚɰɢʁɨɦ ɩɪɨɬɢɜ ɝɪɢɩɚ ɭ ɨɩɲɬɨʁ ɢ ɩɨɥɭɥɚɰɢʁɢ ɫɬɚɪɢʁɢɯ ɨɫɨɛɚ ɭ ɞɪɭɝɢɦ ɡɟɦʂɚɦɚ ɨɤɪɭɠɟʃɚ ɢ ȿɜɪɨɩɫɤɟ ɍɧɢʁɟ. ɉɪɟɦɚ ɩɨɞɚɰɢɦɚ EurШstКt-ɚ66, ɩɨɤɪɢɜɟɧɨɫɬ ɜɚɤɰɢɧɚɰɢʁɨɦ ɫɬɚɪɢʁɟ ɩɨɩɭɥɚɰɢʁɟ (ɤɨʁɚ ɫɟ ɞɟɮɢɧɢɰɢʁɨɦ ɪɚɡɥɢɤɭʁɟ ɨɞ ɞɪɠɚɜɟ ɞɨ ɞɪɠɚɜɟ ɢ ɨɛɭɯɜɚɬɚ ɫɬɚɪɨɫɧɟ ɝɪɭɩɟ ≥50, ≥55, ≥59, ≥60 ɢɥɢ ≥65 ɝɨɞɢɧɚ) ʁɟ ɜɚɪɢɪɚɥɚ ɨɞ 1% ɭ ȿɫɬɨɧɢʁɢ ɞɨ 82% ɭ ɏɨɥɚɧɞɢʁɢ ɭ ɫɟɡɨɧɢ ɝɪɢɩɚ 2008/09. ɇɚʁɜɟʄɚ ɫɬɨɩɚ ɩɨɤɪɢɜɟɧɨɫɬɢ ɢɦɭɧɢɡɚɰɢʁɨɦ ʁɟ ɡɚɛɟɥɟɠɟɧɚ ɭ ɏɨɥɚɧɞɢʁɢ ɢ ɧɟɤɢɦ ɞɟɥɨɜɢɦɚ ȼɟɥɢɤɟ Ȼɪɢɬɚɧɢʁɟ (ȿɧɝɥɟɫɤɚ, ɋɟɜɟɪɧɚ ɂɪɫɤɚ ɢ ɒɤɨɬɫɤɚ), ɝɞɟ ɫɭ ɩɨɫɬɢɝɧɭɬɢ ɭ ɩɨɬɩɭɧɨɫɬɢ ɢɥɢ ɭ ɡɧɚɱɚʁɧɨʁ ɦɟɪɢ ɰɢʂɟɜɢ ȿɜɪɨɩɫɤɟ ɍɧɢʁɟ ɡɚ 2014/15. ɝɨɞɢɧɭ, ɤɨʁɢɦ ʁɟ ɩɪɟɞɜɢђɟɧɚ ɫɬɨɩɚ ɩɨɤɪɢɜɟɧɨɫɬɢ ɢɦɭɧɢɡɚɰɢʁɨɦ ɩɪɨɬɢɜ ɝɪɢɩɚ ɜɟʄɚ ɨɞ 80%. ɉɟɬ ɞɪɠɚɜɚ (Ɏɪɚɧɰɭɫɤɚ, ɇɟɦɚɱɤɚ, ɂɪɫɤɚ, ɂɬɚɥɢʁɚ ɢ ɒɩɚɧɢʁɚ) ɫɭ ɩɪɢʁɚɜɢɥɟ ɩɨɤɪɢɜɟɧɨɫɬ ɨɞ ɨɤɨ 60% ɭ ɨɜɨʁ ɫɬɚɪɨɫɧɨʁ ɝɪɭɩɢ. ɍ Ⱦɚɧɫɤɨʁ, Ɏɢɧɫɤɨʁ, Ʌɭɤɫɟɦɛɭɪɝɭ, Ɇɚɥɬɢ, ɇɨɪɜɟɲɤɨʁ, ɉɨɪɬɭɝɚɥɢʁɢ ɢ ɒɜɟɞɫɤɨʁ ɨɜɚ ɩɨɤɪɢɜɟɧɨɫɬ ʁɟ ɢɡɧɨɫɢɥɚ ɨɤɨ 50%. ɍ ɲɟɫɬ ɞɪɠɚɜɚ (Ɇɚђɚɪɫɤɚ, ɂɫɥɚɧɞ, Ʌɢɬɜɚɧɢʁɚ, Ɋɭɦɭɧɢʁɚ, ɋɥɨɜɚɱɤɚ ɢ ɋɥɨɜɟɧɢʁɚ) ɛɢɥɚ ʁɟ ɢɫɩɨɞ 50%. ɍ ɩɪɟɨɫɬɚɥɟ ɬɪɢ ɩɨɫɦɚɬɪɚɧɟ ɞɪɠɚɜɟ, ɡɚ ɤɨʁɟ ɩɨɫɬɨʁɟ ɩɨɞɚɰɢ EurШstКt-ɚ (ȿɫɬɨɧɢʁɚ, Ʌɟɬɨɧɢʁɚ ɢ 106 ɉɨʂɫɤɚ), ɩɨɤɪɢɜɟɧɨɫɬ ɢɦɭɧɢɡɚɰɢʁɨɦ ʁɟ ɢɡɧɨɫɢɥɚ ɨɤɨ 10% ɢɥɢ ɢɫɩɨɞ. Јɚɫɧɨ ʁɟ ɞɚ ɫɬɨɩɚ ɢɦɭɧɢɡɚɰɢʁɟ ɩɪɨɬɢɜ ɝɪɢɩɚ ɤɨɞ ɧɚɫ ɡɧɚɱɚʁɧɨ ɡɚɨɫɬɚʁɟ ɡɚ ɫɜɢɦ ɧɚɜɟɞɟɧɢɦ ɞɪɠɚɜɚɦɚ. ɍ ɩɨɝɥɟɞɭ ɤɥɢɧɢɱɤɟ ɫɥɢɤɟ ɛɨɥɟɫɧɢɤɚ (Ɍɚɛɟɥɚ 6), ɫɢɦɩɬɨɦɢ ɫɭ ɩɪɟ ɩɨɱɟɬɤɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɭ ɩɪɨɫɟɤɭ ɬɪɚʁɚɥɢ 6 ɢ ɩɨ ɞɚɧɚ, ɚ ɧɚʁɱɟɲʄɟ ɫɭ ɛɢɥɢ ɩɪɢɫɭɬɧɢ, ɩɨ ɭɱɟɫɬɚɥɨɫɬɢ: ɮɟɛɪɢɥɧɨɫɬ (ɤɨɞ 85 ɛɨɥɟɫɧɢɤɚ, 89,47%), ɤɚɲɚʂ (ɤɨɞ 80 ɛɨɥɟɫɧɢɤɚ, 84,2%), ɤɨʁɢ ʁɟ ɛɢɨ ɩɪɨɞɭɤɬɢɜɚɧ ɭ ɜɢɲɟ ɨɞ ɩɨɥɨɜɢɧɟ ɛɨɥɟɫɧɢɤɚ (ɤɨɞ 49 ɛɨɥɟɫɧɢɤɚ, 51,6%), ɞɢɫɩɧɟʁɚ (ɤɨɞ 55 ɛɨɥɟɫɧɢɤɚ, 57,9%) ɢ ɛɨɥ ɭ ɝɪɭɞɢɦɚ (ɤɨɞ 44 ɛɨɥɟɫɧɢɤɚ, 46,3%). Ⱦɟɡɨɪɢʁɟɧɬɢɫɚɧɨɫɬ ɩɪɟɦɚ ɫɜɢɦ ɦɨɞɚɥɢɬɟɬɢɦɚ ʁɟ ɛɢɥɚ ɩɪɢɫɭɬɧɚ ɤɨɞ 11 ɛɨɥɟɫɧɢɤɚ (11,6%). ɍ ʁɟɞɢɧɢɰɭ ɢɧɬɟɧɡɢɜɧɟ ɧɟɝɟ ʁɟ ɩɪɢɦʂɟɧɨ 9 ɛɨɥɟɫɧɢɤɚ (9,5%). Ɉɞ ɩɪɟɩɨɫɬɨʁɟʄɢɯ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɤɨɞ ɛɨɥɟɫɧɢɤɚ (Ɍɚɛɟɥɚ 7), ɧɚʁɭɱɟɫɬɚɥɢʁɢ ɫɭ ɛɢɥɢ: ɯɢɩɟɪɬɟɧɡɢʁɚ (58 ɛɨɥɟɫɧɢɤɚ, 61,1%), ɞɢʁɚɛɟɬɟɫ ɦɟɥɢɬɭɫ (29 ɛɨɥɟɫɧɢɤɚ, 30,5%), ɯɪɨɧɢɱɧɚ ɨɩɫɬɪɭɤɬɢɜɧɚ ɛɨɥɟɫɬ ɩɥɭʄɚ (21 ɛɨɥɟɫɧɢɤ, 22,1%), ɫɪɱɚɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ (21 ɛɨɥɟɫɧɢɤ, 22,1%), ɨɛɨʂɟʃɟ ɤɨɪɨɧɚɪɧɢɯ ɤɪɜɧɢɯ ɫɭɞɨɜɚ (17 ɛɨɥɟɫɧɢɤɚ, 17,9%), ɛɭɛɪɟɠɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ (11 ɛɨɥɟɫɧɢɤɚ, 11,6%), ɚɫɬɦɚ (10 ɛɨɥɟɫɧɢɤɚ, 10,5%) ɢɡɚ ɤɨʁɢɯ ɫɭ ɫɥɟɞɢɥɢ, ɩɨ ɭɱɟɫɬɚɥɨɫɬɢ: ɦɚɥɢɝɧɢɬɟɬɢ, ɟɧɰɟɮɚɥɨɩɚɬɢʁɚ, ɛɨɥɟɫɬ ɫɪɱɚɧɢɯ ɜɚɥɜɭɥɚ ɢ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ʁɟɬɪɟ. ɍ ɫɬɭɞɢʁɢ PШХsФв-ɨɝ, ɨɛʁɚɜʂɟɧɨʁ 2012. ɝɨɞɢɧɟ, ɤɨʁɚ ɫɟ ɛɚɜɢɥɚ ɭɬɢɰɚʁɟɦ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɧɚ ɬɪɨɲɤɨɜɟ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɟ ɩɧɟɭɦɨɧɢʁɟ, ɭɬɜɪђɟɧɨ ʁɟ ɧɚ 402.831 ɟɩɢɡɨɞɚ ɩɧɟɭɦɨɧɢʁɟ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɩɪɚʄɟɧɢɯ ɭ ɋȺȾ ɭ ɩɟɪɢɨɞɭ ɨɞ 2003. ɞɨ 2007. ɝɨɞɢɧɟ, ɞɚ ɫɭ ɧɚʁɩɪɟɜɚɥɟɧɬɧɢʁɚ ɤɨɦɨɪɛɢɞɢɬɟɬɧɚ ɫɬɚʃɚ ɤɚɪɞɢɨɜɚɫɤɭɥɚɪɧɟ ɛɨɥɟɫɬɢ (22,2%), ɞɢʁɚɛɟɬɟɫ (8,1%), ɚɫɬɦɚ (6,3%), ɤɚɪɰɢɧɨɦ (6,0%) ɢ ɯɪɨɧɢɱɧɚ ɨɩɫɬɪɭɤɬɢɜɧɚ ɛɨɥɟɫɬ ɩɥɭʄɚ67. Ⱦɨɞɚɬɧɢ ɬɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɦɨɝɭ ɛɢɬɢ ɢ ɞɨ ɬɪɢ ɩɭɬɚ ɜɟʄɢ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɫɪɱɚɧɨɦ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɨɦ ɢ ɡɚ ɨɤɨ 75% ɜɟʄɢ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɯɪɨɧɢɱɧɨɦ ɨɩɫɬɪɭɤɬɢɜɧɨɦ ɛɨɥɟɲʄɭ ɩɥɭʄɚ ɢ ɞɢʁɚɛɟɬɟɫɨɦ. ɋɬɨɝɚ, ɤɚɞɚ ɫɟ ɪɚɡɦɚɬɪɚ ɪɟɞɭɤɰɢʁɚ ɨɩɬɟɪɟʄɟʃɚ ɬɪɨɲɤɨɜɢɦɚ ɤɨʁɟ ɩɪɨɢɫɬɢɱɟ ɢɡ ɩɪɟɜɟɧɰɢʁɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɦɨɪɚ ɫɟ ɭɡɟɬɢ ɭ ɨɛɡɢɪ ɢ ɱɢʃɟɧɢɰɚ ɞɚ ɬɪɨɲɤɨɜɢ ɩɨ ɛɨɥɟɫɧɢɤɭ ɦɨɝɭ ɡɧɚɱɚʁɧɨ ɜɚɪɢɪɚɬɢ ɦɟђɭ ɪɚɡɥɢɱɢɬɢɦ ɝɪɭɩɚɦɚ ɭ ɡɚɜɢɫɧɨɫɬɢ ɨɞ ɪɢɡɢɤɚ, ɨɞɧɨɫɧɨ ɩɪɢɫɭɬɧɢɯ ɤɨɦɨɪɛɢɞɢɬɟɬɚ. ȼɢɲɢ ɬɪɨɲɤɨɜɢ, ɧɚɪɨɱɢɬɨ ɭ ɫɥɭɱɚʁɟɜɢɦɚ ɩɪɢɫɭɫɬɜɚ ɫɪɱɚɧɟ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɟ, ɩɚ ɱɚɤ ɢ ɏɈȻɉ-ɚ ɦɨɝɭ ɫɟ ɨɛʁɚɫɧɢɬɢ ɤɥɢɧɢɱɤɢɦ ɞɨɤɚɡɢɦɚ ɤɨʁɢ ɭɤɚɡɭʁɭ ɧɚ ɬɨ ɞɚ ɤɨɦɨɪɛɢɞɢɬɟɬɧɚ ɫɬɚʃɚ ɢɦɚʁɭ ɧɟɩɨɜɨʂɚɧ ɭɬɢɰɚʁ ɧɚ ɩɪɨɝɧɨɡɭ ɩɧɟɭɦɨɧɢʁɟ68,69, ɚɥɢ ɩɨɫɬɨʁɟ ɢ ɞɨɤɚɡɢ ɞɚ ɫɚɦɚ ɩɧɟɭɦɨɧɢʁɚ 107 ɞɨɩɪɢɧɨɫɢ ɩɨɝɨɪɲɚʃɭ ɤɨɦɨɪɛɢɞɢɬɟɬɧɨɝ ɫɬɚʃɚ70,71. Ɉɜɟ ɩɪɨɰɟɧɟ ɫɟ ɦɨɝɭ ɤɨɪɢɫɬɢɬɢ ɭ ɰɢʂɭ ɛɨʂɟɝ ɪɚɡɭɦɟɜɚʃɚ ɡɧɚɱɚʁɚ ɢ ɨɛɢɦɚ ɪɟɞɭɤɰɢʁɟ ɬɪɨɲɤɨɜɚ ɤɨʁɢ ɛɢ ɩɪɨɢɡɚɲɥɢ ɢɡ ɩɪɟɜɟɧɰɢʁɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɤɨʁɢ ɛɢ ɛɢɥɢ ɡɧɚɱɚʁɧɨ ɜɢɲɢ ɦɟђɭ ɩɚɰɢʁɟɧɬɢɦɚ ɫɚ ɫɪɱɚɧɨɦ ɫɥɚɛɨɲʄɭ ɭ ɨɞɧɨɫɭ ɧɚ ɩɚɰɢʁɟɧɬɟ ɛɟɡ ɤɨɦɨɪɛɢɞɢɬɟɬɧɢɯ ɫɬɚʃɚ67. ɋɬɪɚɬɢɮɢɤɚɰɢʁɚ ɪɢɡɢɤɚ, ɨɞɧɨɫɧɨ ɢɧɢɰɢʁɚɥɧɚ ɩɪɨɰɟɧɚ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ, ɧɚ ɩɪɢʁɟɦɭ ʁɟ ɜɪɲɟɧɚ ɩɨɦɨʄɭ ɞɜɚ ɫɢɫɬɟɦɚ ɛɨɞɨɜɚʃɚ (Ɍɚɛɟɥɚ 8, Ƚɪɚɮɢɤɨɧɢ 1,2), ɂɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ (PЧОuЦШЧТК ЋОvОrТtв IЧНОб – PЋI) ɢ CUЊB-65 ɫɤɚɥɟ. ɋɪɟɞʃɚ ɜɪɟɞɧɨɫɬ ɂɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɡɚ ɫɜɟ ɩɚɰɢʁɟɧɬɟ ɭɤʂɭɱɟɧɟ ɭ ɢɫɬɪɚɠɢɜɚʃɟ ɢɡɧɨɫɢɥɚ ʁɟ 85,08, ɭɡ ɜɚɪɢʁɚɰɢʁɭ ɨɞ 13 ɞɨ 182. ɇɚʁɜɢɲɟ ɛɨɥɟɫɧɢɤɚ ʁɟ ɩɪɢɩɚɞɚɥɨ ɤɥɚɫɢ 4 (32 ɛɨɥɟɫɧɢɤɚ, 33,7%) ɢ ɤɥɚɫɢ 3 ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ (22 ɛɨɥɟɫɧɢɤɚ, 23,2%), ɚ ɧɚʁɦɚʃɟ ɤɥɚɫɢ 5 (8 ɛɨɥɟɫɧɢɤɚ, 8,4%). ɍ ɤɥɚɫɭ 1 ʁɟ ɛɢɥɨ ɫɜɪɫɬɚɧɨ 15 ɛɨɥɟɫɧɢɤɚ (15,8%), ɚ ɭ ɤɥɚɫɭ 2, 18 ɛɨɥɟɫɧɢɤɚ (18,9%). ɉɪɟɦɚ CUЊB-65 ɫɢɫɬɟɦɭ ɛɨɞɨɜɚʃɚ, ɧɚʁɜɢɲɟ, ɨɞɧɨɫɧɨ 58 ɛɨɥɟɫɧɢɤɚ (61,1%) ʁɟ ɢɦɚɥɨ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɭ ɬɟɠɢɧɭ ɛɨɥɟɫɬɢ ɤɨʁɚ ʁɟ ɫɜɪɫɬɚɧɚ ɭ ɤɚɬɟɝɨɪɢʁɭ ɥɚɤɢɯ ɩɧɟɭɦɨɧɢʁɚ, 29 ɛɨɥɟɫɧɢɤɚ (30,5%) ʁɟ ɢɦɚɥɨ ɬɟɠɢɧɭ ɛɨɥɟɫɬɢ ɤɨʁɚ ʁɟ ɩɪɨɰɟʃɟɧɚ ɤɚɨ ɫɪɟɞʃɟ ɬɟɲɤɚ, ɞɨɤ ʁɟ ɧɚʁɦɚʃɟ, ɨɞɧɨɫɧɨ 8 ɛɨɥɟɫɧɢɤɚ (8,4%) ɢɦɚɥɨ ɬɟɠɚɤ ɨɛɥɢɤ ɛɨɥɟɫɬɢ, ɩɪɟɦɚ ɢɧɢɰɢʁɚɥɧɨʁ ɩɪɨɰɟɧɢ ɩɨɦɨʄɭ ɧɚɜɟɞɟɧɨɝ ɫɢɫɬɟɦɚ ɛɨɞɨɜɚʃɚ. ɍɤɨɥɢɤɨ ɫɟ ɢɧɢɰɢʁɚɥɧɚ ɩɪɨɰɟɧɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ, ɫɚɱɢʃɟɧɚ ɩɨɦɨʄɭ ɨɛɚ ɫɢɫɬɟɦɚ ɛɨɞɨɜɚʃɚ (ɂɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɚ (PЧОuЦШЧТК ЋОvОrТtв IЧНОб – PЋI) ɢ CUЊB-65 ɫɤɚɥɟ) ɚɧɚɥɢɡɢɪɚ ɬɚɤɨ ɲɬɨ ɫɟ ɱɢɬɚɜɚ ɝɪɭɩɚ ɛɨɥɟɫɧɢɤɚ ɩɨɞɟɥɢ ɭ ɞɜɟ ɝɪɭɩɟ, ɦɥɚђɟ ɢ ɫɬɚɪɢʁɟ ɨɞ 50 ɝɨɞɢɧɚ (Ɍɚɛɟɥɚ 9), ʁɚɫɧɨ ɫɟ ɭɨɱɚɜɚ ɜɟɥɢɱɢɧɚ ɭɬɢɰɚʁɚ ɝɨɞɢɧɚ ɫɬɚɪɨɫɬɢ ɧɚ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɭ ɬɟɠɢɧɭ ɛɨɥɟɫɬɢ. ɉɪɨɫɟɱɚɧ ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ʁɟ ɭ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɦɥɚђɢɯ ɨɞ 50 ɝɨɞɢɧɚ ɢɡɧɨɫɢɨ 45,41±17,69, ɞɨɤ ʁɟ ɭ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ ɢɡɧɨɫɢɨ 93,73±30,32. ɍ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɦɥɚђɢɯ ɨɞ 50 ɝɨɞɢɧɚ, ɤɨʁɢɯ ʁɟ ɛɢɥɨ ɭɤɭɩɧɨ 17, ɧɚʁɜɢɲɟ ɛɨɥɟɫɧɢɤɚ (ʃɢɯ 11, 64,7%) ʁɟ ɫɜɪɫɬɚɧɨ ɭ ɤɥɚɫɭ 1 ɢɧɢɰɢʁɚɥɧɨ ɩɪɟɰɟʃɟɧɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ, ɭ ɤɥɚɫɭ 2 ʁɟ ɫɜɪɫɬɚɧɨ 5 ɛɨɥɟɫɧɢɤɚ (29,4%), ɞɨɤ ʁɟ ɫɚɦɨ 1 ɛɨɥɟɫɧɢɤ (5,9%) ɫɜɪɫɬɚɧ ɭ ɤɚɬɟɝɨɪɢʁɭ 3. ɍ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɦɥɚђɢɯ ɨɞ 50 ɝɨɞɢɧɚ, ɧɢʁɟ ɛɢɥɨ ɨɧɢɯ ɤɨʁɢ ɫɭ ɩɨ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɨʁ ɬɟɠɢɧɢ ɛɨɥɟɫɬɢ ɫɜɪɫɬɚɧɢ ɭ ɤɚɬɟɝɨɪɢʁɟ 4 ɢɥɢ 5. ɍ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ, 108 ɧɚʁɜɢɲɟ ɛɨɥɟɫɧɢɤɚ ʁɟ ɤɥɚɫɢɮɢɤɨɜɚɧɨ ɭ ɤɥɚɫɟ 4 (32 ɛɨɥɟɫɧɢɤɚ, 41,0%) ɢ 3 (21 ɛɨɥɟɫɧɢɤ, 26,9%), ɞɨɤ ɢɯ ʁɟ ɭ ɞɪɭɝɟ ɤɥɚɫɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɛɢɥɨ ɫɜɪɫɬɚɧɨ ɦɚʃɟ, ɭ ɧɚʁɬɟɠɭ, ɤɥɚɫɭ 5 ʁɟ ɫɜɪɫɬɚɧɨ 8 ɛɨɥɟɫɧɢɤɚ (10,3%), ɚ ɭ ɤɥɚɫɟ 1 ɢ 2 ʁɟ ɫɜɪɫɬɚɧɨ 4 (5,1%), ɨɞɧɨɫɧɨ 13 (16,7%) ɛɨɥɟɫɧɢɤɚ. ɍ ɩɨɝɥɟɞɭ CUЊB-65 ɫɢɫɬɟɦɚ ɛɨɞɨɜɚʃɚ, ɫɜɢ ɛɨɥɟɫɧɢɰɢ ɦɥɚђɢ ɨɞ 50 ɝɨɞɢɧɚ ɫɭ ɫɜɪɫɬɚɧɢ ɭ ɤɚɬɟɝɨɪɢʁɭ I, ɥɚɤɢɯ ɩɧɟɭɦɨɧɢʁɚ, ɞɨɤ ʁɟ ɭ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ ɧɚʁɜɟʄɢ ɛɪɨʁ ɬɚɤɨђɟ ɛɢɨ ɫɜɪɫɬɚɧ ɭ ɤɚɬɟɝɨɪɢʁɭ I, ɥɚɤɢɯ ɩɧɟɭɦɨɧɢʁɚ, (41 ɛɨɥɟɫɧɢɤ, 52,6%), ɭ ɤɚɬɟɝɨɪɢʁɢ II, ɫɪɟɞʃɟ ɬɟɲɤɢɯ ɩɧɟɭɦɨɧɢʁɚ, ʁɟ ɛɢɥɨ 29 ɛɨɥɟɫɧɢɤɚ (37,2%), ɚ ɭ ɤɚɬɟɝɨɪɢʁɢ III, ɬɟɲɤɢɯ ɩɧɟɭɦɨɧɢʁɚ, ʁɟ ɛɢɥɨ 8 ɛɨɥɟɫɧɢɤɚ (10,3%). ɉɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ʁɟ ɢɡɧɨɫɢɥɚ 14,62±7,081 ɞɚɧɚ ɭɡ ɜɚɪɢʁɚɰɢʁɟ ɨɞ 3 ɞɨ 48 ɞɚɧɚ ɢ ɛɟɡ ɪɟɝɢɫɬɪɨɜɚɧɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ ɭɤɨɥɢɤɨ ɫɟ ɩɨɪɟɞɢ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɭ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɦɥɚђɢɯ ɨɞ 50 ɝɨɞɢɧɚ (14,12±6,89) ɢ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ (14,73±7,16). Ɍɚʁ ɩɨɞɚɬɚɤ ɭɤɚɡɭʁɟ ɧɚ ɱɢʃɟɧɢɰɭ ɞɚ ʁɟ ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɨɩɫɟɪɜɢɪɚɧɢɯ ɭ ɫɬɭɞɢʁɢ ɞɭɠɚ ɭ ɩɨɪɟђɟʃɭ ɫɚ ɩɨɞɚɰɢɦɚ ɢɡ ɫɥɢɱɧɢɯ ɫɬɭɞɢʁɚ ɤɨʁɟ ɫɭ ɫɩɪɨɜɟɞɟɧɟ ɭ ɪɚɡɥɢɱɢɬɢɦ ɡɟɦʂɚɦɚ, ɝɞɟ ʁɟ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɚɞɭɥɬɧɢɯ ɛɨɥɟɫɧɢɤɚ ɥɟɱɟɧɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡɧɨɫɢɥɚ ɨɞ 3,6 ɞɚɧɚ47 ɞɨ 14,50 ɞɚɧɚ25, ɤɚɨ ɢ ɞɚ ɫɟ ɝɨɬɨɜɨ ɩɨɞʁɟɞɧɚɤɨ ɞɭɝɨ ɥɟɱɟ ɛɨɥɟɫɧɢɰɢ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɛɟɡ ɨɛɡɢɪɚ ɧɚ ɫɬɚɪɨɫɬ ɢ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɭ ɬɟɠɢɧɭ ɛɨɥɟɫɬɢ. ɉɪɟɦɚ ɫɬɭɞɢʁɢ ЋКtШ-К ɢ ɫɚɪɚɞɧɢɤɚ72 ɢɡ 2013. ɝɨɞɢɧɟ ɢɡ ɋȺȾ-ɚ,ɫɩɪɨɜɟɞɟɧɨʁ ɧɚ 27.659 ɛɨɥɟɫɧɢɤɚ ɫɚ 28.575 ɟɩɢɡɨɞɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɩɨ ɟɩɢɡɨɞɢ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ʁɟ ɢɡɧɨɫɢɥɚ 7,1 ɞɚɧɚ, ɢ ɛɢɥɚ ʁɟ ɞɭɠɚ ɭ ɫɥɭɱɚʁɭ ɩɨɜɟʄɚɧɨɝ ɪɢɡɢɤɚ (4,8 ɞɚɧɚ, 6,8 ɞɚɧɚ ɢ 9,5 ɞɚɧɚ ɡɚ ɛɨɥɟɫɧɢɤɟ ɫɜɪɫɬɚɧɟ ɭ ɝɪɭɩɟ ɧɢɫɤɨɝ, ɭɦɟɪɟɧɨɝ ɢ ɜɢɫɨɤɨɝ ɪɢɡɢɤɚ, ɫɬɚɪɢʁɟ ɨɞ 50 ɝɨɞɢɧɚ). ɋɚ ɞɪɭɝɟ ɫɬɪɚɧɟ, ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɬɪɚʁɚʃɚ ɟɩɢɡɨɞɟ ɩɧɟɭɦɨɧɢʁɟ ʁɟ ɢɡɧɨɫɢɥɚ 31,8 ɞɚɧɚ ɡɚ ɛɨɥɟɫɧɢɤɟ ɥɟɱɟɧɟ ɭ ɯɨɫɩɢɬɚɥɧɢɦ ɭɫɥɨɜɢɦɚ, ɨɞɧɨɫɧɨ 24,7 ɞɚɧɚ, 30,5 ɞɚɧɚ ɢ 39,5 ɞɚɧɚ, ɭ ɡɚɜɢɫɧɨɫɬɢ ɨɞ ɝɪɭɩɟ ɪɢɡɢɤɚ ɭ ɤɨʁɭ ʁɟ ɩɚɰɢʁɟɧɬ ɫɜɪɫɬɚɧ. ɉɨɞɚɰɢ ɢɡ ɇɟɦɚɱɤɟ, ɩɪɟɦɚ ɫɬɭɞɢʁɢ EаТР-ɚ ɢ ɫɚɪɚɞɧɢɤɚ25 ɢɡ 2009. ɝɨɞɢɧɟ ɤɨʁɚ ʁɟ ɨɛɭɯɜɚɬɚɥɚ ɩɨɞɚɬɤɟ ɨɞ 388.406 ɛɨɥɟɫɧɢɤɚ ɥɟɱɟɧɢɯ ɭ ɜɢɲɟ ɨɞ 1300 ɛɨɥɧɢɰɚ ɭ ɇɟɦɚɱɤɨʁ, ɭɤɚɡɭʁɭ ɞɚ ʁɟ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɛɨɥɟɫɧɢɤɚ ɥɟɱɟɧɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ 109 ɢɡɧɨɫɢɥɚ 9,45 ɞɚɧɚ, ɡɚ ɩɪɜɭ ɤɚɬɟɝɨɪɢʁɭ ɪɢɡɢɤɚ, 12,39 ɞɚɧɚ ɡɚ ɞɪɭɝɭ ɚ 14,50 ɞɚɧɚ ɡɚ ɬɪɟʄɭ ɤɚɬɟɝɨɪɢʁɭ ɪɢɡɢɤɚ, ɨɞɧɨɫɧɨ ɡɚ ɛɨɥɟɫɧɢɤɟ ɤɨʁɢ ɫɭ ɧɚ ɩɪɢʁɟɦɭ ɩɪɨɰɟʃɟɧɢ ɤɚɨ ɧɚʁɬɟɠɢ. ɉɨɞɚɰɢ BКuОr-К ɢ ɫɚɪɚɞɧɢɤɚ34, ɢɡ ɫɬɭɞɢʁɟ ɬɚɤɨђɟ ɫɩɪɨɜɟɞɟɧɟ ɭ ɇɟɦɚɱɤɨʁ, ɧɚ 580 ɛɨɥɟɫɧɢɤɚ ɥɟɱɟɧɢɯ ɭ 22 ɛɨɥɧɢɰɟ, ɭɤɚɡɭʁɭ ɧɚ ɩɪɨɫɟɱɧɭ ɞɭɠɢɧɭ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɨɞ 10,8 ɞɚɧɚ, ɩɪɢ ɱɟɦɭ ɫɭ ɭɬɜɪɞɢɥɢ ɢ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɭ ɪɚɡɥɢɤɭ ɭ ɞɭɠɢɧɢ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢɡɦɟђɭ ɛɨɥɟɫɧɢɤɚ ɤɨʁɢ ɫɭ ɛɢɥɢ ɥɟɱɟɧɢ ɢɧɬɪɚɜɟɧɫɤɢ ɚɞɦɢɧɢɫɬɪɢɪɚɧɢɦ ɦɨɤɫɢɮɥɨɤɫɚɰɢɧɨɦ (10,0 ɞɚɧɚ) ɭ ɨɞɧɨɫɭ ɧɚ ɛɨɥɟɫɧɢɤɟ ɤɨʁɢ ɫɭ ɛɢɥɢ ɥɟɱɟɧɢ ɧɟɫɬɚɧɞɚɪɞɧɨɦ ɬɟɪɚɩɢʁɨɦ (11,5 ɞɚɧɚ). ɍ ɥɢɬɟɪɚɬɭɪɢ ʁɟ ɞɨɫɬɭɩɧɨ ɜɢɲɟ ɫɬɭɞɢʁɚ ɲɩɚɧɫɤɢɯ ɚɭɬɨɪɚ: CКpОХКstОРuТ47 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ 2008. ɝɨɞɢɧɟ ɨɛʁɚɜɢɥɢ ɩɨɞɚɬɤɟ ɨ ɞɭɠɢɧɢ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɤɨɞ 1886 ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɭ ʁɟɞɧɨʁ ɛɨɥɧɢɰɢ ɭ Ȼɚɫɤɢʁɢ, ɭ ɩɟɪɢɨɞɭ ɨɞ 2000. ɞɨ 2007. ɝɨɞɢɧɟ, ɤɚɞɚ ʁɟ ɡɚɛɟɥɟɠɟɧɨ ɞɚ ʁɟ ɞɨɲɥɨ ɞɨ ɫɤɪɚʄɟʃɚ ɩɪɨɫɟɱɧɟ ɞɭɠɢɧɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɫɚ 5,6 ɞɚɧɚ ɭ 2001. ɝɨɞɢɧɢ ɧɚ 3,6 ɞɚɧɚ ɭ 2007. ɝɨɞɢɧɢ. ЊОyes29 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ 2007. ɝɨɞɢɧɟ ɨɛʁɚɜɢɥɢ ɫɬɭɞɢʁɭ ɭ ɤɨʁɨʁ ɫɭ ɭɬɜɪђɢɜɚɥɢ ɞɟɬɟɪɦɢɧɚɧɬɟ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ɢ ɭɫɬɚɧɨɜɢɥɢ ɞɚ ʁɟ ɡɚ 271 ɛɨɥɟɫɧɢɤɚ ɩɪɚʄɟɧɨɝ ɭ ɫɬɭɞɢʁɢ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢɡɧɨɫɢɥɚ 9 ɞɚɧɚ, ɚ ɞɟɬɚʂɧɚ ɚɧɚɥɢɡɚ ʁɟ ɩɨɤɚɡɚɥɚ ɞɚ ʁɟ ɭɩɪɚɜɨ ɞɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɧɚʁɜɟʄɢ ɝɟɧɟɪɚɬɨɪ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ (69,3%). ɒɜɚʁɰɚɪɫɤɢ ɚɭɬɨɪɢ (ЋutОr-Widmer46 ɢ ɫɚɪɚɞɧɢɰɢ) ɫɭ ɭ ɪɟɡɭɥɬɚɬɢɦɚ ɫɜɨʁɟ ɚɧɚɥɢɡɟ ɢɡ 2012. ɝɨɞɢɧɟ, ɫɩɪɨɜɟɞɟɧɟ ɭ ɲɟɫɬ ɬɟɪɰɢʁɚɪɧɢɯ ɡɞɪɚɜɫɬɜɟɧɢɯ ɭɫɬɚɧɨɜɚ ɧɚ 875 ɛɨɥɟɫɧɢɤɚ, ɩɪɢʁɚɜɢɥɢ ɩɪɨɫɟɱɧɭ ɞɭɠɢɧɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɨɞ 9,8 ɞɚɧɚ. Yoo KH36 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɭ Јɭɠɧɨʁ Ʉɨɪɟʁɢ ɫɩɪɨɜɟɥɢ ɟɩɢɞɟɦɢɨɥɨɲɤɨ-ɮɚɪɦɚɤɨɟɤɨɧɨɦɫɤɭ ɫɬɭɞɢʁɭ ɜɚɧɛɨɥɧɢɱɤɢɯ ɩɧɟɭɦɨɧɢʁɚ ɤɨɞ ɨɫɨɛɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ, ɤɨʁɨɦ ɫɭ ɛɢɥɚ ɨɛɭɯɜɚʄɟɧɚ 693 ɩɚɰɢʁɟɧɬɚ ɥɟɱɟɧɚ ɭ 11 ɛɨɥɧɢɰɚ ɢ ɤɥɢɧɢɱɤɢɯ ɰɟɧɬɚɪɚ ɢ ɱɢʁɟ ɫɭ ɪɟɡɭɥɬɚɬɟ 2013. ɝɨɞɢɧɟ ɨɛʁɚɜɢɥɢ, ɝɞɟ ʁɟ ɩɪɨɫɟɱɧɚ ɞɭɠɢɧɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɢɡɧɨɫɢɥɚ 9 ɞɚɧɚ. Јɚɫɧɨ ʁɟ ɭɨɱʂɢɜɚ ɱɢʃɟɧɢɰɚ ɞɚ ʁɟ ɬɪɚʁɚʃɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢɡɦɟɪɟɧɨ ɭ ɨɜɨʁ ɫɬɭɞɢʁɢ ɞɭɠɟ ɭ ɩɨɪɟђɟʃɭ ɫɚ ɪɟɡɭɥɬɚɬɢɦɚ ɫɜɢɯ ɧɚɜɟɞɟɧɢɯ ɫɬɭɞɢʁɚ. ɉɪɢɛɥɢɠɧɢ ɫɭ ʁɟɞɢɧɨ ɪɟɡɭɥɬɚɬɢɦɚ Ewig-ɚ ɢ ɫɚɪɚɞɧɢɤɚ25 (14,50 ɞɚɧɚ ɡɚ ɬɪɟʄɭ ɤɚɬɟɝɨɪɢʁɭ ɪɢɡɢɤɚ, ɨɞɧɨɫɧɨ ɡɚ ɛɨɥɟɫɧɢɤɟ ɤɨʁɢ ɫɭ ɧɚ ɩɪɢʁɟɦɭ ɩɪɨɰɟʃɟɧɢ ɤɚɨ ɧɚʁɬɟɠɢ), ɚɥɢ ɪɚɡɥɨɡɢ ɡɚ ɬɨ ɧɢɫɭ ʁɚɫɧɨ ɩɪɟɩɨɡɧɚɬʂɢɜɢ, ɛɭɞɭʄɢ 110 ɞɚ ʁɟ ɪɟɥɚɬɢɜɧɨ ɦɚɥɢ, ɨɞɧɨɫɧɨ ɧɚʁɦɚʃɢ ɛɪɨʁ ɛɨɥɟɫɧɢɤɚ ɫɜɪɫɬɚɧ ɭ ɤɚɬɟɝɨɪɢʁɭ ɧɚʁɜɟʄɟɝ ɪɢɡɢɤɚ, ɩɪɟɦɚ ɢɧɢɰɢʁɚɥɧɨʁ ɩɪɨɰɟɧɢ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɧɚ ɩɪɢʁɟɦɭ ɭ ɛɨɥɧɢɱɤɨ ɥɟɱɟʃɟ. Ⱦɭɠɢɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢɦɚ ɜɟɥɢɤɢ ɭɬɢɰɚʁ ɧɚ ɢɡɧɨɫ ɞɢɪɟɤɬɧɢɯ ɢ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɛɨɥɟɫɧɢɤɚ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ. Ɂɚɧɢɦʂɢɜɢ ɫɭ ɢ ɜɪɥɨ ɢɧɞɢɤɚɬɢɜɧɢ ɪɟɡɭɥɬɚɬɢ ɫɬɭɞɢʁɚ ɤɨʁɟ ɫɭ ɫɟ ɛɚɜɢɥɟ ɨɜɨɦ ɤɨɪɟɥɚɰɢʁɨɦ. FТЧО39 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ 2000. ɝɨɞɢɧɟ ɭɬɜɪɞɢɥɢ ɞɚ ɫɭ ɩɪɨɫɟɱɧɢ ɬɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɟ ɩɧɟɭɦɨɧɢʁɟ 282% ɜɢɲɢ ɩɪɜɨɝ ɞɚɧɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ, 59% ɜɢɲɢ ɞɪɭɝɨɝ ɞɚɧɚ, ɚ 19% ɜɢɲɢ ɬɪɟʄɟɝ ɞɚɧɚ, ɭ ɨɞɧɨɫɭ ɧɚ ɩɪɨɫɟɱɚɧ ɞɧɟɜɧɢ ɬɪɨɲɚɤ ɬɨɤɨɦ ɱɢɬɚɜɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɞɨɤ ɫɭ ɧɚɜɟɞɟɧɢ ɬɪɨɲɤɨɜɢ ɛɢɥɢ ɧɢɠɢ ɡɚ 14% ɞɨ 72% ɬɨɤɨɦ ɩɨɫɥɟɞʃɚ ɬɪɢ ɞɚɧɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ. ɉɪɨʁɟɤɬɨɜɚɧɚ ɩɪɨɫɟɱɧɚ ɭɲɬɟɞɚ ɤɨʁɚ ɛɢ ɩɪɨɢɫɬɟɤɥɚ ɢɡ ɫɤɪɚʄɟʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɡɚ ʁɟɞɚɧ ɞɚɧ ʁɟ ɢɡɧɨɫɢɥɚ 680 ɚɦɟɪɢɱɤɢɯ ɞɨɥɚɪɚ. Cortoos45 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɭ ɢɫɩɢɬɢɜɚʃɭ ɫɩɪɨɜɟɞɟɧɨɦ ɭ ɞɜɟ ɛɟɥɝɢʁɫɤɟ ɛɨɥɧɢɰɟ, ɧɚ 803 ɛɨɥɟɫɧɢɤɚ, ɭɬɜɪɞɢɥɢ ɞɚ ʁɟ ɞɭɠɢɧɚ ɛɨɪɚɜɤɚ ɩɚɰɢʁɟɧɚɬɚ ɭ ɛɨɥɧɢɰɢ ɩɨɫɥɟ ɩɨɫɬɢɡɚʃɚ ɤɥɢɧɢɱɤɟ ɫɬɚɛɢɥɢɡɚɰɢʁɟ ɢ ɜɪɟɦɟ ɞɨ ɩɨɫɬɢɡɚʃɚ ɤɥɢɧɢɱɤɟ ɫɬɚɛɢɥɢɡɚɰɢʁɟ ɢɦɚɥɨ ɧɚʁɜɟʄɢ ɭɬɢɰɚʁ ɧɚ ɭɤɭɩɧɟ ɬɪɨɲɤɨɜɟ (+6.3% ɢ +4.9% ɩɨ ɞɨɞɚɬɧɨɦ ɞɚɧɭ, ɭ ɡɚɜɢɫɧɨɫɬɢ ɨɞ ɛɨɥɧɢɰɟ). Suter-АТНЦОr ɢ ɫɚɪɚɞɧɢɰɢ46 ɫɭ ɤɚɨ ɧɚʁɜɚɠɧɢʁɟ ɩɪɟɞɢɤɬɨɪɟ ɞɭɠɢɧɟ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɢɞɟɧɬɢɮɢɤɨɜɚɥɢ: ɫɬɚɪɨɫɬ ɛɨɥɟɫɧɢɤɚ, ɪɟɫɩɢɪɚɬɨɪɧɭ ɮɪɟɤɜɟɧɰɭ ɜɟʄɚ ɨɞ 20 ɪɟɫɩɢɪɚɰɢʁɚ ɭ ɦɢɧɭɬɢ ɧɚ ɩɪɢʁɟɦɭ, ɩɪɟɬɯɨɞɧɢ ɛɨɪɚɜɚɤ ɭ ɭɫɬɚɧɨɜɢ ɬɪɚʁɧɨɝ ɤɨɥɟɤɬɢɜɧɨɝ ɫɦɟɲɬɚʁɚ/ɞɨɦɭ ɡɚ ɫɬɚɪɟ, ɯɪɨɧɢɱɧɭ ɨɩɫɬɪɭɤɬɢɜɧɭ ɛɨɥɟɫɬ ɩɥɭʄɚ, ɞɢʁɚɛɟɬɟɫ, ɦɭɥɬɢɥɨɛɚɪɧɭ ɩɧɟɭɦɨɧɢʁɭ ɢ PЋI ɫɤɨɪ ɧɚ ɩɪɢʁɟɦɭ. Ɉɧɨ ɭ ɱɟɦɭ ɫɟ ɛɪɨʁɧɢ ɚɭɬɨɪɢ ɫɥɚɠɭ39,42,45,46,47 ʁɟ ɞɚ ɫɭ ɢɫɯɨɞɢ ɥɟɱɟʃɚ ɢɡɦɟђɭ ɛɨɥɟɫɧɢɤɚ ɥɟɱɟɧɢɯ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ɧɚʁɤɪɚʄɢ ɩɟɪɢɨɞ ɜɪɟɦɟɧɚ ɢ ɨɧɢɯ ɥɟɱɟɧɢɯ ɭ ɛɨɥɧɢɰɚɦɚ ɬɨɤɨɦ ɞɭɠɟɝ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɛɢɥɢ ɜɪɥɨ ɫɥɢɱɧɢ, ɲɬɨ ɫɭɝɟɪɢɪɚ ɞɚ ɨɧɟ ɛɨɥɧɢɰɟ ɭ ɤɨʁɢɦɚ ʁɟ ɩɪɨɫɟɱɧɨ ɜɪɟɦɟ ɯɨɫɩɢɬɚɥɧɨɝ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɟ ɩɧɟɭɦɨɧɢʁɟ ɞɭɝɨ ɦɨɝɭ ɫɦɚʃɢɬɢ ɫɪɟɞʃɭ ɞɭɠɢɧɭ ɬɪɚʁɚʃɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɭɫɥɟɞ ɨɜɟ ɛɨɥɟɫɬɢ ɛɟɡ ɧɟɩɨɜɨʂɧɨɝ ɭɬɢɰɚʁɚ ɧɚ ɢɫɯɨɞ ɥɟɱɟʃɚ ɨɜɢɯ ɛɨɥɟɫɧɢɤɚ. Ɉɞ 95 ɛɨɥɟɫɧɢɤɚ ɩɪɚʄɟɧɢɯ ɭ ɨɜɨɦ ɢɫɬɪɚɠɢɜɚʃɭ, 5 ʁɟ ɭɦɪɥɨ (5,3%). ɋɜɢ ɭɦɪɥɢ ɛɨɥɟɫɧɢɰɢ ɫɭ ɩɪɢɩɚɞɚɥɢ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ. 111 ȼɪɥɨ ɫɟ ɪɚɡɥɢɤɭʁɭ ɢ ɩɨɞɚɰɢ ɨ ɦɨɪɬɚɥɢɬɟɬɭ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɯɨɫɩɢɬɚɥɧɢɦ ɭɫɥɨɜɢɦɚ. ɍ ɋȺȾ, JКМФsШЧ73 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɭ ɪɟɡɭɥɬɚɬɢɦɚ ɫɬɭɞɢʁɟ ɭ ɤɨʁɢɦɚ ɫɭ ɩɪɚɬɢɥɢ 46.237 ɛɨɥɟɫɧɢɤɚ ɭ ɬɨɤɭ ɬɪɨɝɨɞɢɲʃɟɝ ɩɟɪɢɨɞɚ ɪɟɝɢɫɬɪɨɜɚɥɢ ɫɬɨɩɭ ɦɨɪɬɚɥɢɬɟɬɚ ɨɞ 12,5%, ɭ ɬɨɤɭ 30 ɞɚɧɚ ɨɞ ɩɪɢʁɟɦɚ ɭ ɛɨɥɧɢɰɭ. Ɇɟђɭ ɛɨɥɟɫɧɢɰɢɦɚ ɤɨʁɢ ɫɭ ɥɟɱɟɧɢ ɚɦɛɭɥɚɧɬɧɨ, ɬɚ ɫɬɨɩɚ ʁɟ ɢɡɧɨɫɢɥɚ 0,4% ɭ ɬɨɤɭ 30 ɞɚɧɚ ɨɞ ɩɨɫɬɚɜʂɚʃɚ ɞɢʁɚɝɧɨɡɟ. ɍɤɭɩɧɚ ɫɬɨɩɚ ɦɨɪɬɚɥɢɬɟɬɚ ɭ ɱɢɬɚɜɨʁ ɤɨɯɨɪɬɢ ɭ ɬɨɤɭ 30 ɞɚɧɚ ɩɨɫɥɟ ɩɨɫɬɚɜʂɚʃɚ ɞɢʁɚɝɧɨɡɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ʁɟ ɢɡɧɨɫɢɥɚ 3,6%. ɉɪɨɰɟɧɟ ɝɨɜɨɪɟ ɞɚ ɫɟ ɨɤɨ 915.000 ɫɥɭɱɚʁɟɜɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɝɨɞɢɲʃɟ ɞɟɫɢ ɦɟђɭ ɩɨɩɭɥɚɰɢʁɨɦ ɫɬɚɪɢʁɢɯ ɭ ɋȺȾ, ɤɚɨ ɢ ɞɚ ʄɟ ɫɜɚɤɚ ɞɜɚɞɟɫɟɬɚ ɨɫɨɛɚ ɫɬɚɪɢʁɚ ɨɞ 85 ɝɨɞɢɧɚ ɢɦɚɬɢ ɧɨɜɭ ɟɩɢɡɨɞɭ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɫɜɚɤɟ ɝɨɞɢɧɟ. Yoo KH36 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɭ ɪɟɡɭɥɬɚɬɢɦɚ ɫɬɭɞɢʁɟ ɫɩɪɨɜɟɞɟɧɟ ɭ Јɭɠɧɨʁ Ʉɨɪɟʁɢ ɩɪɢʁɚɜɢɥɢ ɫɬɨɩɭ ɦɨɪɬɚɥɢɬɟɬɚ ɨɞ 3,2% ɭ ɝɪɭɩɢ ɚɧɚɥɢɡɢɪɚɧɢɯ ɛɨɥɟɫɧɢɤɚ, ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ. EаТР ɢ ɫɚɪɚɞɧɢɰɢ25 ɞɚʁɭ ɩɨɞɚɬɚɤ ɞɚ ʁɟ ɫɬɨɩɚ ɦɨɪɬɚɥɢɬɟɬɚ ɢɡɪɚɱɭɧɚɬɚ ɭ ʃɢɯɨɜɨʁ ɫɬɭɞɢʁɢ ɢɡɧɨɫɢɥɚ 2,40%, ɡɚ ɩɪɜɭ ɤɚɬɟɝɨɪɢʁɭ ɪɢɡɢɤɚ, 13,43% ɡɚ ɞɪɭɝɭ ɚ 34,39% ɡɚ ɬɪɟʄɭ ɤɚɬɟɝɨɪɢʁɭ ɪɢɡɢɤɚ, ɨɞɧɨɫɧɨ ɡɚ ɧɚʁɬɟɠɟ ɛɨɥɟɫɧɢɤɟ ɩɪɟɦɚ ɢɧɢɰɢʁɚɥɧɨʁ ɩɪɨɰɟɧɢ ɪɢɡɢɤɚ. ɉɨɞɚɰɢ BКuОr-К ɢ ɫɚɪɚɞɧɢɤɚ34, ɬɚɤɨђɟ ɢɡ ɫɬɭɞɢʁɟ ɫɩɪɨɜɟɞɟɧɟ ɭ ɇɟɦɚɱɤɨʁ, ɩɪɢʁɚɜʂɭʁɭ ɭɤɭɩɧɭ ɫɬɨɩɭ ɦɨɪɬɚɥɢɬɟɬɚ ɨɞ 8,3%, ɧɚ ɱɢɬɚɜɨʁ ɝɪɭɩɢ ɩɨɫɦɚɬɪɚɧɢɯ ɛɨɥɟɫɧɢɤɚ, ɭɡ ɪɟɝɢɫɬɪɨɜɚɧɭ ɡɧɚɱɚʁɧɭ ɪɚɡɥɢɤɭ ɭ ɦɨɪɬɚɥɢɬɟɬɭ ɢɡɦɟђɭ ɝɪɭɩɟ ɛɨɥɟɫɧɢɤɚ ɤɨʁɢ ɫɭ ɛɢɥɢ ɥɟɱɟɧɢ ɦɨɤɫɢɮɥɨɤɫɚɰɢɧɨɦ (5%) ɢ ɝɪɭɩɟ ɛɨɥɟɫɧɢɤɚ ɤɨʁɢ ɫɭ ɛɢɥɢ ɥɟɱɟɧɢ ɧɟɫɬɚɧɞɚɪɞɧɨɦ ɬɟɪɚɩɢʁɨɦ (11,3%). Suter-АТНЦОr ɢ ɫɚɪɚɞɧɢɰɢ46 ɫɭ ɦɟђɭ ɪɟɡɭɥɬɚɬɢɦɚ ɲɜɚʁɰɚɪɫɤɟ ɦɭɥɬɢɰɟɧɬɪɢɱɧɟ ɫɬɭɞɢʁɟ ɩɪɢʁɚɜɢɥɢ ɢɡɪɚɱɭɧɚɬɭ ɫɬɨɩɭ ɦɨɪɬɚɥɢɬɟɬɚ ɨɞ 5,4%. Reyes29 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɩɪɢʁɚɜɢɥɢ ɫɬɨɩɭ ɦɨɪɬɚɥɢɬɟɬɚ ɨɞ 11,1%, ɞɨɤ ɫɭ CТХХóЧТг74 ɢ ɫɚɪɚɞɧɢɰɢ 2013. ɝɨɞɢɧɟ ɨɛʁɚɜɢɥɢ ɪɟɡɭɥɬɚɬɟ ɫɬɭɞɢʁɟ ɫɩɪɨɜɟɞɟɧɟ ɬɚɤɨђɟ ɭ ɒɩɚɧɢʁɢ, ɨ ɭɬɢɰɚʁɭ ɫɬɚɪɨɫɬɢ ɢ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɧɚ ɭɡɪɨɤ ɢ ɢɫɯɨɞ ɜɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɟ ɩɧɟɭɦɨɧɢʁɟ. ɍ ɫɬɭɞɢʁɭ ʁɟ ɛɢɥɨ ɭɤʂɭɱɟɧɨ 2149 ɛɨɥɟɫɧɢɤɚ, ɪɚɡɥɢɱɢɬɢɯ ɫɬɚɪɨɫɧɢɯ ɞɨɛɚ ɢ ɨɩɢɫɚɧ ʁɟ ɩɨɪɚɫɬ ɦɨɪɬɚɥɢɬɟɬɚ ɩɨɜɟɡɚɧ ɫɚ ɫɬɚɪɨɲʄɭ (65-74 ɝɨɞɢɧɚ, 6.9%; 75-84 ɝɨɞɢɧɚ, 8.9%; > 85 ɝɨɞɢɧɚ, 17.1%), ɩɨɜɟʄɚɧɨɦ ɭɱɟɫɬɚɥɨɲʄɭ ɤɨɦɨɪɛɢɞɢɬɟɬɚ, PЋI (PЧОuЦШЧТК ЋОvОrТtв IЧНОб-ɨɦ) ɤɥɚɫɚɦɚ IV ɢɥɢ V, ɛɚɤɬɟɪɢʁɟɦɢʁɨɦ, ɩɪɢɫɭɫɬɜɨɦ ɩɨɬɟɧɰɢʁɚɥɧɢɯ ɦɭɥɬɢɪɟɡɢɫɬɟɧɬɧɢɯ 112 ɩɚɬɨɝɟɧɚ (MDЊ, MuХtТ DruР Resistant - Ћ. КurОus, P. КОruРТЧШsК, EЧtОrШЛКМtОrТКМОКО) ɢ ɩɪɢʁɟɦɨɦ ɭ ʁɟɞɢɧɢɰɭ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ. Tichopad37 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɭ ɪɟɡɭɥɬɚɬɢɦɚ ɫɬɭɞɢʁɟ, ɫɩɪɨɜɟɧɟ ɭ ɑɟɲɤɨʁ Ɋɟɩɭɛɥɢɰɢ, ɋɥɨɜɚɱɤɨʁ, ɉɨʂɫɤɨʁ ɢ Ɇɚђɚɪɫɤɨʁ ɪɟɝɢɫɬɪɨɜɚɥɢ ɫɬɨɩɭ ɦɨɪɬɚɥɢɬɟɬɚ ɤɨʁɚ ʁɟ ɭ ɩɪɨɫɟɤɭ ɞɭɩɥɨ ɜɟʄɚ ɭ ɨɜɟ ɱɟɬɢɪɢ ɡɟɦʂɟ ɭ ɨɞɧɨɫɭ ɧɚ ɡɚɩɚɞɧɢ ɞɟɨ ȿɜɪɨɩɟ21, 75-78. ɋɬɨɩɟ ɫɦɪɬɧɨɫɬɢ ɡɚ ɩɚɰɢʁɟɧɬɟ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɟ ɭɫɥɟɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɫɭ ɢɡɧɨɫɢɥɟ: 25% ɭ ɑɟɲɤɨʁ Ɋɟɩɭɛɥɢɰɢ, 22% ɭ ɋɥɨɜɚɱɤɨʁ, 21% ɭ ɉɨʂɫɤɨʁ ɢ 21% ɭ Ɇɚђɚɪɫɤɨʁ, ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɫɬɚɪɢʁɢɯ ɨɞ 65 ɝɨɞɢɧɚ. ɍ ɩɨɪɟђɟʃɭ ɫɚ ɨɜɢɦ ɩɨɞɚɰɢɦɚ, ɫɬɨɩɚ ɦɨɪɬɚɥɢɬɟɬɚ ɨɞ 10,3% ɞɨ 14% ʁɟ ɩɪɢʁɚɜʂɟɧɚ ɭ ɇɟɦɚɱɤɨʁ25,26, 11,6% ɭ ɒɩɚɧɢʁɢ76, 13,8% ɭ ɂɬɚɥɢʁɢ77 ɢ 11,5% ɭ ɂɪɫɤɨʁ78, ɡɚ ɢɫɬɟ ɫɬɚɪɨɫɧɟ ɝɪɭɩɟ ɢ ɡɚ ɢɫɬɟ ɞɢʁɚɝɧɨɡɟ ɩɨɫɬɚɜʂɟɧɟ ɩɪɟɦɚ ɦɟђɭɧɚɪɨɞɧɨʁ ɤɥɚɫɢɮɢɤɚɰɢʁɢ ɛɨɥɟɫɬɢ ICD-9, ɢɡ ɛɚɡɚ ɩɨɞɚɬɚɤɚ ɟɜɪɨɩɫɤɢɯ ɛɨɥɧɢɰɚ. Ɏɢɧɫɤɚ ɫɬɭɞɢʁɚ ʁɟ ɩɪɢʁɚɜɢɥɚ ɫɬɨɩɭ ɦɨɪɬɚɥɢɬɟɬɚ ɨɞ 11% ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɫɬɚɪɢʁɢɯ ɨɞ 60 ɝɨɞɢɧɚ21. ɍ ɫɜɟɨɛɭɯɜɚɬɧɨɦ ɟɜɪɨɩɫɤɨɦ ɩɪɟɝɥɟɞɭ ɢɡ 2012. ɝɨɞɢɧɟ, ɫɬɨɩɚ ɦɨɪɬɚɥɢɬɟɬɚ ʁɟ ɜɚɪɢɪɚɥɚ ɢɡɦɟђɭ 1% ɢ 48% ɢ ɛɢɥɚ ɩɨɜɟɡɚɧɚ ɫɚ ɫɬɚɪɨɲʄɭ, ɩɪɢɫɭɬɧɢɦ ɤɨɦɨɪɛɢɞɢɬɟɬɢɦɚ ɢ ɬɟɠɢɧɨɦ ɛɨɥɟɫɬɢ79. Ⱥɧɚɥɢɡɚ ɥɚɛɨɪɚɬɨɪɢʁɫɤɢɯ ɪɟɡɭɥɬɚɬɚ ɫɚ ɩɨɱɟɬɤɚ ɢ ɤɪɚʁɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ (Ɍɚɛɟɥɟ 10, 11, 12, 13) ɧɟɞɜɨɫɦɢɫɥɟɧɨ ɩɨɤɚɡɭʁɟ ɞɚ ʁɟ ɭ ɧɚʁɜɟʄɟɦ ɛɪɨʁɭ ɫɥɭɱɚʁɟɜɚ ɢ ɚɧɚɥɢɡɚ ɞɨɲɥɨ ɞɨ ɡɧɚɱɚʁɧɨɝ ɩɨɩɪɚɜʂɚʃɚ ʃɢɯɨɜɢɯ ɜɪɟɞɧɨɫɬɢ ɧɚ ɤɪɚʁɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɫɚ ɩɪɢɫɭɬɧɨɦ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɨɦ ɪɚɡɥɢɤɨɦ, ɤɚɤɨ ɭ ɩɨɝɥɟɞɭ ɫɬɚɧɞɚɪɞɧɢɯ ɯɟɦɚɬɨɥɨɲɤɢɯ ɚɧɚɥɢɡɚ, ɯɟɩɚɬɨɝɪɚɦɚ, ɛɢɨɯɟɦɢʁɫɤɢɯ ɚɧɚɥɢɡɚ, ɩɚɪɚɦɟɬɚɪɚ ɛɢɨɯɭɦɨɪɚɥɧɨɝ ɡɚɩɚʂɟɧɫɤɨɝ ɫɢɧɞɪɨɦɚ, ɬɚɤɨ ɢ ɭ ɜɢɞɭ ɪɟɡɭɥɬɚɬɚ ɩɚɪɰɢʁɚɥɧɢɯ ɩɪɢɬɢɫɚɤɚ ɪɟɫɩɢɪɚɰɢʁɫɤɢɯ ɝɚɫɨɜɚ ɚɪɬɟɪɢʁɫɤɟ ɤɪɜɢ. Ⱥɧɚɥɢɡɢɪɚʁɭʄɢ ɤɨɦɩɥɢɤɚɰɢʁɟ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ (Ɍɚɛɟɥɚ 14), ɞɨɥɚɡɢ ɫɟ ɞɨ ɡɚɤʂɭɱɤɚ ɞɚ ʁɟ ɧɚʁɱɟɲʄɚ ɛɢɥɚ ɪɟɫɩɢɪɚɬɨɪɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ, ɤɨʁɚ ʁɟ ɪɟɝɢɫɬɪɨɜɚɧɚ ɤɨɞ 39 ɛɨɥɟɫɧɢɤɚ (41,1%), ɢɡɚ ɤɨʁɟ ɫɥɟɞɟ ɚɧɟɦɢʁɚ ɤɨɞ 28 ɛɨɥɟɫɧɢɤɚ (29,5%), ɩɥɟɭɪɚɥɧɚ ɟɮɭɡɢʁɚ ɤɨɞ 23 ɛɨɥɟɫɧɢɤɚ (24,2%), ɞɢʁɚɪɟʁɚ ɤɨɞ 21 ɛɨɥɟɫɧɢɤɚ (22,1%), ɫɪɱɚɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɤɨɞ 17 ɛɨɥɟɫɧɢɤɚ (17,9%), ɛɭɛɪɟɠɧɚ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɚ ɤɨɞ 15 ɛɨɥɟɫɧɢɤɚ (15,8%), ɯɟɦɨɩɬɢɡɢʁɟ ɤɨɞ 9 ɛɨɥɟɫɧɢɤɚ (9,5%) ɢ ɚɩɫɰɟɫ ɤɨɞ 3 ɛɨɥɟɫɧɢɤɚ (3,2%). Ɂɚɛɟɥɟɠɟɧɢ ɫɭ ɢ ɩɨʁɟɞɢɧɚɱɧɢ ɫɥɭɱɚʁɟɜɢ ɞɪɭɝɢɯ ɤɨɦɩɥɢɤɚɰɢʁɚ ɥɟɱɟʃɚ ɨɜɟ ɛɨɥɟɫɬɢ, ɤɚɨ ɲɬɨ ɫɭ ɥɟɭɤɨɩɟɧɢʁɚ (ɤɨɞ 2 ɛɨɥɟɫɧɢɤɚ), ɬɪɨɦɛɨɰɢɬɨɩɟɧɢʁɚ (ɤɨɞ 2 ɛɨɥɟɫɧɢɤɚ), ɰɟɪɟɛɪɨɜɚɫɤɭɥɚɪɧɢ ɢɧɡɭɥɬ (ɤɨɞ 2 ɛɨɥɟɫɧɢɤɚ), ɤɪɜɚɪɟʃɟ ɭ ɞɢɝɟɫɬɢɜɧɨɦ ɬɪɚɤɬɭ (ɤɨɞ 1 ɛɨɥɟɫɧɢɤɚ), ɟɦɛɨɥɢʁɚ ɩɥɭʄɚ (ɤɨɞ 1 ɛɨɥɟɫɧɢɤɚ) ɢ ɟɦɩɢʁɟɦ ɩɥɟɭɪɟ ɤɨɞ 1 ɛɨɥɟɫɧɢɤɚ. 113 ɍ ɩɨɝɥɟɞɭ ɫɩɪɨɜɟɞɟɧɢɯ ɞɢʁɚɝɧɨɫɬɢɱɤɢɯ ɩɨɫɬɭɩɚɤɚ ɢ ɦɟɬɨɞɚ ɭ ɬɨɤɭ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (Ɍɚɛɟɥɟ 15, 16), ɤɨɞ ɫɜɢɯ ɛɨɥɟɫɧɢɤɚ ʁɟ ɭɱɢʃɟɧɚ ɪɚɞɢɨɝɪɚɮɢʁɚ ɝɪɭɞɧɨɝ ɤɨɲɚ, ɭɤɭɩɧɨ 388, ɨɞɧɨɫɧɨ 4,08 ɩɨ ɛɨɥɟɫɧɢɤɭ. Ʉɨɦɩʁɭɬɟɪɢɡɨɜɚɧɚ ɬɨɦɨɝɪɚɮɢʁɚ (ɋɌ) ʁɟ ɭɱɢʃɟɧɚ ɤɨɞ 26 ɛɨɥɟɫɧɢɤɚ (27,4%). Ⱥɧɚɥɢɡɟ ɤɪɜɢ ɫɭ ɬɚɤɨђɟ ɭɱɢʃɟɧɟ ɤɨɞ ɝɨɬɨɜɨ ɫɜɢɯ ɛɨɥɟɫɧɢɤɚ: ɯɟɦɚɬɨɥɨɲɤɟ ɤɨɞ 93 ɛɨɥɟɫɧɢɤɚ (97,9%), ɛɢɨɯɟɦɢʁɫɤɟ ɤɨɞ 92 (96,8%) ɚ ɚɧɚɥɢɡɟ ɤɨɚɝɭɥɚɰɢʁɟ ɤɪɜɢ ɤɨɞ 26 ɛɨɥɟɫɧɢɤɚ (27,4%). Ƚɚɫɧɟ ɚɧɚɥɢɡɟ ɫɭ ɭɱɢʃɟɧɟ ɤɨɞ 54 ɛɨɥɟɫɧɢɤɚ. ɍɤɭɩɧɨ ʁɟ ɭɱɢʃɟɧɨ 209 ɚɧɚɥɢɡɚ, ɲɬɨ ɱɢɧɢ ɭ ɩɪɨɫɟɤɭ 2,2 ɚɧɚɥɢɡɟ ɩɨ ɯɨɫɩɢɬɚɥɧɨ ɥɟɱɟɧɨɦ ɛɨɥɟɫɧɢɤɭ, ɨɞɧɨɫɧɨ 3,87 ɩɨ ɛɨɥɟɫɧɢɤɭ ɤɨɞ ɤɨʁɟɝ ʁɟ ɩɪɚʄɟɧɚ ɝɚɫɧɚ ɪɚɡɦɟɧɚ ɭɫɥɟɞ ɩɪɟɬɯɨɞɧɨ, ɧɚ ɩɪɢʁɟɦɭ, ɪɟɝɢɫɬɪɨɜɚɧɨɝ ɩɚɞɚ ɢɫɬɟ. Ɇɢɤɪɨɛɢɨɥɨɲɤɟ ɚɧɚɥɢɡɟ ɫɩɭɬɭɦɚ ɫɭ ɭɱɢʃɟɧɟ ɤɨɞ 40 ɛɨɥɟɫɧɢɤɚ, ɭɤɭɩɧɨ 89 ɚɧɚɥɢɡɚ, 0,94 ɩɨ ɛɨɥɟɫɧɢɤɭ ɚɧɚɥɢɡɢɪɚɧɨɦ ɭ ɢɫɬɪɚɠɢɜɚʃɭ, ɨɞɧɨɫɧɨ 2,22 ɩɨ ɛɨɥɟɫɧɢɤɭ ɤɨɞ ɤɨɝɚ ʁɟ ɨɛɚɜʂɟɧɨ ɭɡɨɪɤɨɜɚʃɟ ɫɩɭɬɭɦɚ. Ɇɢɤɪɨɛɢɨɥɨɲɤɚ ɚɧɚɥɢɡɚ ɤɪɜɢ ʁɟ ɭɱɢʃɟɧɚ 25 ɩɭɬɚ, ɤɨɞ 15 ɩɚɰɢʁɟɧɚɬɚ, 0,26 ɩɨ ɛɨɥɟɫɧɢɤɭ ɚɧɚɥɢɡɢɪɚɧɨɦ ɭ ɢɫɬɪɚɠɢɜɚʃɭ, ɨɞɧɨɫɧɨ 1,66 ɩɨ ɛɨɥɟɫɧɢɤɭ ɤɨɞ ɤɨɝɚ ʁɟ ɜɪɲɟɧɨ ɭɡɨɪɤɨɜɚʃɟ ɤɪɜɢ ɡɚ ɦɢɤɪɨɛɢɨɥɨɲɤɟ ɚɧɚɥɢɡɟ - ɯɟɦɨɤɭɥɬɭɪɚ. ȼɢɪɭɫɨɥɨɲɤɟ ɚɧɚɥɢɡɟ ɫɭ ɭɱɢʃɟɧɟ ɤɨɞ 7 ɛɨɥɟɫɧɢɤɚ (7,4%). Ȼɪɨɧɯɨɫɤɨɩɢʁɚ ʁɟ ɭɱɢʃɟɧɚ ɤɨɞ 17 ɛɨɥɟɫɧɢɤɚ (17,9%), ɬɨɪɚɤɨɰɟɧɬɟɡɟ (ɭɤɭɩɧɨ 9) ɤɨɞ 6 ɩɚɰɢʁɟɧɚɬɚ (6,4%), ɨɞɧɨɫɧɨ 1,5 ɩɨ ɛɨɥɟɫɧɢɤɭ ɤɨɞ ɤɨɝɚ ʁɟ ɨɜɚ ɦɟɬɨɞɚ ɩɪɢɦɟʃɢɜɚɧɚ. Ƚɪɭɞɧɚ ɞɪɟɧɚɠɚ ʁɟ ɭɱɢʃɟɧɚ ɤɨɞ 1 (1,1%) ɩɚɰɢʁɟɧɬɚ ɫɚ ɟɦɩɢʁɟɦɨɦ ɩɥɟɭɪɟ. ȿɥɟɤɬɪɨɤɚɪɞɢɨɝɪɚɮɫɤɢ ɡɚɩɢɫ ʁɟ ɧɚɱɢʃɟɧ ɤɨɞ 94 ɩɚɰɢʁɟɧɬɚ (98,9%), ɭɤɭɩɧɨ 277 ɡɚɩɢɫɚ, ɨɞɧɨɫɧɨ 2,92 ɩɨ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɨɦ ɛɨɥɟɫɧɢɤɭ. ɋɩɢɪɨɦɟɬɪɢʁɚ ʁɟ ɭɱɢʃɟɧɚ ɤɨɞ 52 ɩɚɰɢʁɟɧɬɚ (54,6%), ɭɤɭɩɧɨ 106 ɬɟɫɬɨɜɚ, ɭ ɩɪɨɫɟɤɭ 2,04 ɬɟɫɬɚ ɩɨ ɛɨɥɟɫɧɢɤɭ ɤɨɞ ɤɨɝɚ ʁɟ ɫɩɢɪɨɦɟɬɪɢʁɫɤɨ ɢɫɩɢɬɢɜɚʃɟ ɫɩɪɨɜɟɞɟɧɨ, ɨɞɧɨɫɧɨ 1,12 ɬɟɫɬɨɜɚ ɩɨ ɩɚɰɢʁɟɧɬɭ ɢɡ ɱɢɬɚɜɟ ɚɧɚɥɢɡɢɪɚɧɟ ɝɪɭɩɟ. ɍɤɭɩɧɢ ɞɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ ɩɨ ɩɚɰɢʁɟɧɬɭ ɧɚ ɧɢɜɨɭ ɰɟɥɨɝ ɭɡɨɪɤɚ ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡɧɨɫɟ 81.105,12±61.947,64 ɞɢɧɚɪɚ, ɞɨɤ ɫɭ ɢɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɩɪɨɰɟʃɟɧɢ ɧɚ 47.820,08±33.030,82 ɞɢɧɚɪɚ, ɲɬɨ ɭ ɫɭɦɢ ɫɜɢɯ ɬɪɨɲɤɨɜɚ ɱɢɧɢ ɡɛɢɪ ɞɢɪɟɤɬɧɢɯ ɢ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɭ ɢɡɧɨɫɭ ɨɞ 128.925,20±76.564,39 ɞɢɧɚɪɚ (Ɍɚɛɟɥɚ 17, Ƚɪɚɮɢɤɨɧ 3). ɍ ɩɨɝɥɟɞɭ ɫɬɪɭɤɬɭɪɟ ɞɨɛɢʁɟɧɢɯ ɪɟɡɭɥɬɚɬɚ, ʁɚɫɧɨ ɫɟ ɭɨɱɚɜɚ ɞɚ ɫɬɪɭɤɬɭɪɨɦ ɞɨɦɢɧɢɪɚʁɭ „ɚɞɦɢɧɢɫɬɪɚɬɢɜɧɢ ɢ ɩɪɚɬɟʄɢ ɬɪɨɲɤɨɜɢ“ ɭ ɢɡɧɨɫɭ ɨɞ 46.967,98±35.458,88 ɞɢɧɚɪɚ. 114 ɇɚɜɟɞɟɧɢ ɬɪɨɲɤɨɜɢ ɨɛɭɯɜɚɬɚʁɭ ɬɪɨɲɚɤ ɫɦɟɲɬɚʁɚ ɩɚɰɢʁɟɧɬɚ, ɫɨɰɢʁɚɥɧɭ ɛɪɢɝɭ, ɬɪɚɧɫɩɨɪɬ ɢ ɝɪɭɩɭ ɬɪɨɲɤɨɜɚ ɤɨʁɢ ɩɪɟɞɫɬɚɜʂɚʁɭ ɞɢʁɚɝɧɨɫɬɢɤɭ ɢ ɥɟɱɟʃɟ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɢ ɤɨʁɢ ɱɢɧɟ ɧɚʁɜɟʄɢ ɞɟɨ ɫɭɦɟ ɨɛɭɯɜɚʄɟɧɟ ɨɜɨɦ ɝɪɭɩɨɦ ɬɪɨɲɤɨɜɚ. ɋɥɟɞɟʄɭ ɤɚɬɟɝɨɪɢʁɭ ɭ ɫɬɪɭɤɬɭɪɢ ɬɪɨɲɤɨɜɚ ɱɢɧɟ „ɥɟɤɨɜɢ, ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ“, ɭ ɭɤɭɩɧɨɦ ɢɡɧɨɫɭ ɨɞ 20.725,10±24.629,03, ɝɞɟ ɧɚʁɜɟʄɢ ɞɟɨ ɨɜɟ ɤɚɬɟɝɨɪɢʁɟ ɱɢɧɟ ɚɧɬɢɢɧɮɟɤɬɢɜɧɢ ɥɟɤɨɜɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ ɭ ɢɡɧɨɫɭ ɨɞ 19.273,04±23.202,30 ɞɢɧɚɪɚ ɢɡɚ ɤɨʁɢɯ ɫɥɟɞɟ „ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɯɨɪɦɨɧɫɤɢ ɩɪɟɩɚɪɚɬɢ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ“ ɭ ɢɡɧɨɫɭ ɨɞ 1.262,38±2.649,94 ɞɢɧɚɪɚ, ɚ ɩɨɬɨɦ ɢ ɞɪɭɝɟ ɤɚɬɟɝɨɪɢʁɟ: „ɤɪɜ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ“, „ɚɧɬɢɫɟɩɬɢɰɢ ɢ ɞɟɡɢɧɮɢɰɢʁɟɧɫɢ“ ɢ „ɚɧɬɢɥɢɩɟɦɢɰɢ ɢ ɞɨɞɚɰɢ ɢɫɯɪɚɧɢ“. Ʉɚɬɟɝɨɪɢʁɚ „ɜɢɡɭɟɥɢɡɚɰɢɨɧɚ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ“ ʁɟ ɢɡɢɫɤɢɜɚɥɚ ɭ ɩɪɨɫɟɤɭ 6.119,94±6130,88 ɞɢɧɚɪɚ, ɝɞɟ ɫɭ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɚɧɚɥɢɡɟ ɱɢɧɢɥɟ ɧɚʁɜɟʄɢ ɞɟɨ ɨɜɢɯ ɬɪɨɲɤɨɜɚ, ɱɚɤ 3.478,58±3.475,62 ɞɢɧɚɪɚ ɩɨ ɩɚɰɢʁɟɧɬɭ. Ʉɚɬɟɝɨɪɢʁɚ ɬɪɨɲɤɨɜɚ „ɡɞɪɚɜɫɬɜɟɧɚ ɧɟɝɚ“, ɤɨʁɚ ɨɛɭɯɜɚɬɚ ɦɟɞɢɰɢɧɫɤɭ ɧɟɝɭ ɬɟɯɧɢɱɚɪɚ ɢ ɪɭɬɢɧɫɤɢ ɩɨɬɪɨɲɧɢ ɫɚɧɢɬɟɬɫɤɢ ɦɚɬɟɪɢʁɚɥ, ɩɪɨɫɟɱɧɨ ʁɟ ɢɡɧɨɫɢɥɚ 3.786,25±3.703,98 ɞɢɧɚɪɚ, ɞɨɤ ɫɭ „ɩɪɟɝɥɟɞɢ ɥɟɤɚɪɚ ɢ ɯɢɪɭɪɲɤɟ ɭɫɥɭɝɟ“ ɭɱɟɫɬɜɨɜɚɥɢ ɭ ɭɤɭɩɧɨʁ ɫɭɦɢ ɫɚ 3.505,85±4.439,71 ɞɢɧɚɪɚ ɩɨ ɩɚɰɢʁɟɧɬɭ. ɍɤɨɥɢɤɨ ɫɟ ɧɚɜɟɞɟɧɢ ɬɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɩɨ ɩɚɰɢʁɟɧɬɭ ɚɧɚɥɢɡɢɪɚʁɭ ɭ ɨɞɧɨɫɭ ɧɚ ɬɟɠɢɧɭ ɤɥɢɧɢɱɤɟ ɫɥɢɤɟ ɩɧɟɭɦɨɧɢʁɟ ɩɪɨɰɟʃɟɧɟ ɩɨɦɨʄɭ CUЊB-65 ɫɤɚɥɟ (Ɍɚɛɟɥɚ 18, Ƚɪɚɮɢɤɨɧɢ 4,5), ɡɚɩɚɠɚ ɫɟ ɞɚ ɫɭ ɧɚʁɜɟʄɢ ɭɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɛɢɥɢ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ɫɭ ɫɜɪɫɬɚɧɢ ɭ ɤɚɬɟɝɨɪɢʁɭ I (139.527,83±89.065,77), ɩɨɬɨɦ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ɫɭ ɩɪɨɰɟʃɟɧɢ ɤɚɨ ɧɚʁɬɟɠɢ, ɭ ɤɚɬɟɝɨɪɢʁɢ III (119.775,11±48.580,84), ɞɨɤ ɫɭ ɧɚʁɧɢɠɢ ɛɢɥɢ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ɫɭ ɛɢɥɢ ɫɜɪɫɬɚɧɢ ɭ ɤɚɬɟɝɨɪɢʁɭ II (110.224,10±48.196,89), ɩɪɢ ɱɟɦɭ ɢɩɚɤ ɩɨɫɬɨʁɚʃɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ ɧɢʁɟ ɭɫɬɚɧɨɜʂɟɧɨ. ɇɚʁɜɟʄɢ ɞɢɪɟɤɬɧɢ ɦɟɞɢɰɢɧɫɤɢ ɬɪɨɲɤɨɜɢ ɫɭ ɡɚɛɟɥɟɠɟɧɢ ɭ ɤɚɬɟɝɨɪɢʁɢ III (91.853,12±48.580,84), ɲɬɨ ɫɟ ɦɨɠɟ ɨɛʁɚɫɧɢɬɢ ɧɚʁɬɟɠɢɦ ɫɬɟɩɟɧɨɦ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɟ ɛɨɥɟɫɬɢ, ɚ ɩɨɬɨɦ ɭ ɤɚɬɟɝɨɪɢʁɢ I (83.539,43±72.979,14), ɞɨɤ ɫɭ ɧɚʁɦɚʃɢ ɡɚɛɟɥɟɠɟɧɢ ɭ ɤɚɬɟɝɨɪɢʁɢ II (73.271,54±36.634,50). ɇɚ ɢɡɧɨɫ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɢ ɬɚɤɚɜ ɩɨɪɟɞɚɤ ɦɟђɭ ɤɚɬɟɝɨɪɢʁɚɦɚ ɬɟɠɢɧɟ ɩɨ CUЊB-65 ɫɤɚɥɢ ɭ ɧɚʁɜɟʄɨʁ ɦɟɪɢ ɫɭ ɡɚɫɥɭɠɧɢ ɢɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ, ɤɨʁɢ ɫɭ ɛɢɥɢ ɧɚʁɜɟʄɢ ɭ ɤɚɬɟɝɨɪɢʁɢ I (55.988,40±35.989,98), ɩɨɬɨɦ ɭ ɤɚɬɟɝɨɪɢʁɢ II (36.972,57±25.554,51) ɢ ɧɚʁɧɢɠɢ ɭ ɤɚɬɟɝɨɪɢʁɢ III (37.921,99±0,00), ɩɪɢ ɱɟɦɭ ʁɟ ɢɡɦɟђɭ ɨɜɢɯ ɢɡɧɨɫɚ ɪɟɝɢɫɬɪɨɜɚɧɨ ɩɨɫɬɨʁɚʃɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ 115 (p=0,002*). ɉɨɫɬɨʁɚʃɟ ɨɜɟ ɪɚɡɥɢɤɟ ɢ ɧɚʁɜɟʄɢ ɢɡɧɨɫ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɭ ɤɚɬɟɝɨɪɢʁɢ I ɫɟ, ɭ ɢɡɜɟɫɧɨʁ ɦɟɪɢ, ɦɨɝɭ ɨɛʁɚɫɧɢɬɢ ɱɢʃɟɧɢɰɨɦ ɞɚ ɫɭ ɭ ɨɜɭ ɤɚɬɟɝɨɪɢʁɭ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɫɜɪɫɬɚɧɢ ɩɪɟɬɟɠɧɨ ɦɥɚђɢ, ɪɚɞɧɨ ɫɩɨɫɨɛɧɢ ɛɨɥɟɫɧɢɰɢ, ɤɨɞ ɤɨʁɢ ʁɟ ɬɪɨɲɚɤ ɚɩɫɟɧɬɢɡɦɚ ɢ ɩɪɨɰɟʃɟɧɢ ɝɭɛɢɬɚɤ ɩɪɨɞɭɤɬɢɜɧɨɫɬɢ ɧɚʁɜɟʄɢ. Ⱥɧɚɥɢɡɚ ɩɪɨɫɟɱɧɢɯ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɩɨ ɩɚɰɢʁɟɧɬɭ ɢ ʃɢɯɨɜɟ ɫɬɪɭɤɬɭɪɟ, ɩɪɟɦɚ ɂɧɞɟɤɫɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ (Pneumonia Severity Index – PЋI) ɞɨɧɨɫɢ ɫɥɢɱɧɟ ɢ ɞɨɧɟɤɥɟ ɧɟɨɱɟɤɢɜɚɧɟ ɪɟɡɭɥɬɚɬɟ (Ɍɚɛɟɥɚ 19, Ƚɪɚɮɢɤɨɧɢ 6,7), ɩɪɟɦɚ ɤɨʁɢɦɚ ʁɟ ɭɤɭɩɚɧ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɧɚʁɜɟʄɢ ɭ ɤɥɚɫɢ 2 (163.167,54±72.265,20) ɢ ɤɥɚɫɢ 4 (136.624,78±97.315,48), ɢ ɞɨɤ ʁɟ ɞɟɥɢɦɢɱɧɨ ʁɚɫɧɨ ɢ ɨɱɟɤɢɜɚɧɨ ɡɚɲɬɨ ʁɟ ɭɤɭɩɧɢ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɩɨ ɛɨɥɟɫɧɢɤɭ ɫɜɪɫɬɚɧɨɦ ɭ ɤɥɚɫɭ 5 ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɧɟɲɬɨ ɧɢɠɢ (117.065,02±53.964,84) ɚ ɭ ɤɥɚɫɢ 1 ɧɚʁɧɢɠɢ (107.796,13±39.452,00), ɧɟʁɚɫɧɨ ʁɟ ɡɚɲɬɨ ʁɟ ɬɪɨɲɚɤ ɩɨ ɛɨɥɟɫɧɢɤɭ ɭ ɤɥɚɫɢ 3 (108.428,33±64.156,43) ɦɚɥɨ ɜɢɲɢ, ɨɞɧɨɫɧɨ ɝɨɬɨɜɨ ɢɡʁɟɞɧɚɱɟɧ ɫɚ ɬɪɨɲɤɨɜɢɦɚ ɥɟɱɟʃɚ ɛɨɥɟɫɧɢɤɚ ɤɥɚɫɟ 1. ɂɞɟɧɬɢɱɚɧ ɬɪɟɧɞ ɫɬɪɭɤɬɭɪɟ ɬɪɨɲɤɨɜɚ ɩɨɫɬɨʁɢ ɢ ɤɚɞɚ ʁɟ ɪɟɱ ɨ ɞɢɪɟɤɬɧɢɦ ɦɟɞɢɰɢɧɫɤɢɦ ɬɪɨɲɤɨɜɢɦɚ, ɧɚʁɜɢɲɢ ɫɭ ɛɢɥɢ ɭ ɤɥɚɫɢ 4 (95.003,56±73.078,), ɩɨɬɨɦ ɭ ɤɥɚɫɢ 2 (94.913,79±72.817,60), ɤɥɚɫɢ 5 (81.464,49±38.211,26), ɚ ɡɚɬɢɦ ɭ ɤɥɚɫɢ 3 (68.829,88±48.227,88) ɢ ɧɚʁɧɢɠɢ ɭ ɤɥɚɫɢ 1 (52.696,73±38.666,09). ɂɡɦɟђɭ ɜɪɟɞɧɨɫɬɢ ɭɤɭɩɧɢɯ ɢ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɩɨ ɤɥɚɫɚɦɚ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɩɪɟɦɚ ɂɧɞɟɤɫɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɧɢʁɟ ɭɨɱɟɧɨ ɩɨɫɬɨʁɚʃɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ (p=0,069) ɡɚ ɭɤɭɩɧɟ, ɨɞɧɨɫɧɨ (p=0,088) ɡɚ ɞɢɪɟɤɬɧɟ ɬɪɨɲɤɨɜɟ. ɍ ɩɨɝɥɟɞɭ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ, ɨɩɢɫɚɧɢ ɬɪɟɧɞ ɫɬɪɭɤɬɭɪɟ ɬɪɨɲɤɨɜɚ ɫɟ ɞɨɧɟɤɥɟ ɦɟʃɚ, ɩɚ ɫɭ ɧɚʁɜɢɲɢ ɬɪɨɲɤɨɜɢ ɪɟɝɢɫɬɪɨɜɚɧɢ ɭ ɤɥɚɫɢ 2 (68.253,75±24.514,96), ɩɨɬɨɦ ɭ ɤɥɚɫɢ 1 (55.099,39±31.439,34), ɤɥɚɫɢ 4 (41.621,22±34.761,58), ɤɥɚɫɢ 3 (39.598,46±34.860,03) ɢ ɧɚʁɡɚɞ ɤɥɚɫɢ 5 (35.600,54±21.718,21). ɍɤɨɥɢɤɨ ɫɟ ɧɚɜɟɞɟɧɢ ɩɨɞɚɰɢ ɨ ɬɪɨɲɤɨɜɢɦɚ ɚɧɚɥɢɡɢɪɚʁɭ ɩɪɟɦɚ ɞɜɟɦɚ ɫɬɚɪɨɫɧɢɦ ɝɪɭɩɚɦɚ ɛɨɥɟɫɧɢɤɚ (ɦɥɚђɢ ɢ ɫɬɚɪɢʁɢ ɨɞ 50 ɝɨɞɢɧɚ) (Ɍɚɛɟɥɚ 20), ɭɨɱɚɜɚ ɫɟ ɞɚ ɫɭ ɬɪɨɲɤɨɜɢ ɭ ɫɜɢɦ ɤɚɬɟɝɨɪɢʁɚɦɚ ɜɟʄɢ ɭ ɝɪɭɩɢ ɛɨɥɟɫɧɢɤɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ, ɚɥɢ ɛɟɡ ɩɨɫɬɨʁɚʃɚ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ ɢɡɦɟђɭ ɝɪɭɩɚ ɬɪɨɲɤɨɜɚ ɩɪɟɦɚ ɫɬɚɪɨɫɬɢ. Јɟɞɢɧɚ ɤɚɬɟɝɨɪɢʁɚ ɬɪɨɲɤɨɜɚ ɤɨʁɚ ʁɟ ɜɟʄɚ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɦɥɚђɢɯ ɨɞ 50 ɝɨɞɢɧɚ ɫɭ ɢɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ, ɝɞɟ ʁɟ 116 ɢ ɪɟɝɢɫɬɪɨɜɚɧɨ ɩɨɫɬɨʁɚʃɟ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɟ ɪɚɡɥɢɤɟ (p=0,023*). ɇɚɜɟɞɟɧɚ ɪɚɡɥɢɤɚ ɩɪɨɢɫɬɢɱɟ ɢɡ ɱɢʃɟɧɢɰɟ ɞɚ ɫɟ ɨɫɨɛɟ ɦɥɚђɟ ɨɞ 50 ɝɨɞɢɧɚ ɧɚɥɚɡɟ ɭ ɤɚɬɟɝɨɪɢʁɢ ɪɚɞɧɨ ɫɩɨɫɨɛɧɟ ɩɨɩɭɥɚɰɢʁɟ, ɬɟ ɬɪɨɲɤɨɜɢ ʃɢɯɨɜɨɝ ɚɩɫɟɧɬɢɡɦɚ ɡɧɚɱɚʁɧɨ ɭɬɢɱɭ ɧɚ ɢɡɧɨɫ ɭɤɭɩɧɢɯ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ. ɋɭɦɚ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ʁɟ ɩɪɢɛɥɢɠɧɨ ɢɫɬɚ ɭ ɨɛɟɦɚ ɩɨɫɦɚɬɪɚɧɢɦ ɫɬɚɪɨɫɧɢɦ ɝɪɭɩɚɦɚ (125.127,87±39.560,10 ɤɨɞ ɛɨɥɟɫɧɢɤɚ ≤50 ɝɨɞɢɧɚ, 129.752,83±82.627,26 ɤɨɞ ɛɨɥɟɫɧɢɤɚ > 50 ɝɨɞɢɧɚ). Ⱥɧɚɥɢɡɢɪɚʁɭʄɢ ɩɨʁɟɞɢɧɟ, ɧɚʁɡɧɚɱɚʁɧɢʁɟ ɤɨɦɩɨɧɟɧɬɟ ɬɪɨɲɤɨɜɚ (Ɍɚɛɟɥɚ 19), ɡɚɩɚɠɚ ɫɟ ɞɚ ʁɟ ɬɪɨɲɚɤ ɚɧɬɢɢɮɟɤɬɢɜɧɢɯ ɥɟɤɨɜɚ ɧɚʁɜɢɲɢ ɭ ɤɥɚɫɢ 2 (27.228,61±25.718,91) ɢ ɤɥɚɫɢ 4 (23.438,72±29.403,80), ɚ ɧɚʁɧɢɠɢ ɭ ɤɥɚɫɢ 1 (11.695,92±13.839,61), ɞɨɤ ʁɟ ɬɪɨɲɚɤ ɥɟɱɟʃɚ ɢ ɞɢʁɚɝɧɨɫɬɢɤɟ ɤɨɦɨɪɛɢɞɢɬɟɬɚ ɛɢɨ ɧɚʁɜɢɲɢ ɭ ɤɥɚɫɢ 4 (54.415,23±36.629,77) ɢ ɤɥɚɫɢ 2 (49.162,76±43.803,15), ɚ ɧɚʁɧɢɠɢ ɭ ɤɥɚɫɢ 1 (32.248,46±28.330,89). ɂɡɦɟђɭ ɧɚɜɟɞɟɧɢɯ ɤɥɚɫɚ ɧɢʁɟ ɪɟɝɢɫɬɪɨɜɚɧɚ ɫɬɚɬɢɫɬɢɱɤɢ ɡɧɚɱɚʁɧɚ ɪɚɡɥɢɤɚ. Ɉɛʁɚɲʃɢɜɨ ʁɟ ɞɚ ɫɭ ɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɤɥɚɫɟ 4 ɧɚʁɜɢɲɢ, ɡɛɨɝ ɱɢʃɟɧɢɰɟ ɞɚ ɫɟ ɪɚɞɢ ɨ ɛɨɥɟɫɧɢɰɢɦɚ ɫɚ ɢɧɢɰɢʁɚɥɧɨ ɬɟɲɤɨ ɩɪɨɰɟʃɟɧɨɦ ɛɨɥɟɲʄɭ ɢ ɧɚʁɤɨɦɩɥɟɤɫɧɢʁɨɦ ɢ ɧɚʁɨɛɢɥɧɢʁɨɦ ɞɢʁɚɝɧɨɫɬɢɤɨɦ ɢ ɬɟɪɚɩɢʁɨɦ, ɤɨʁɭ ʁɟ ɡɚɯɬɟɜɚɥɚ ɤɚɤɨ ɨɫɧɨɜɧɚ ɛɨɥɟɫɬ ɡɛɨɝ ɤɨʁɟ ɫɭ ɯɨɫɩɢɬɚɥɢɡɢɜɚɧɢ, ɬɚɤɨ ɢ ɤɨɦɨɪɛɢɞɢɬɟɬɢ. ɋɜɟ ɧɚɜɟɞɟɧɨ ɫɟ ɨɞɧɨɫɢ ɢ ɧɚ ɛɨɥɟɫɧɢɤɟ ɤɥɚɫɟ 5, ɭɡ ɭɡɢɦɚʃɟ ɭ ɨɛɡɢɪ ɱɢʃɟɧɢɰɟ ɞɚ ɫɟ ɪɚɞɢ ɨ ɧɚʁɬɟɠɟ ɩɪɨɰɟʃɟɧɢɦ ɛɨɥɟɫɧɢɰɢɦɚ ɧɚ ɩɪɢʁɟɦɭ, ɝɞɟ ʁɟ ɢ ɫɦɪɬɧɨɫɬ ɛɢɥɚ ɧɚʁɜɟʄɚ, ɲɬɨ ʁɟ ɢ ɭɬɢɰɚɥɨ ɧɚ ɞɭɠɢɧɭ ʃɢɯɨɜɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɚ ɫɚɦɢɦ ɬɢɦ ɢ ɧɚ ɫɬɚɬɢɫɬɢɤɭ ɢ ɜɪɟɞɧɨɫɬɢ ɞɨɛɢʁɟɧɢɯ ɪɟɡɭɥɬɚɬɚ. ɇɚʁɜɢɲɢ ɢɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɫɭ ɡɚɛɟɥɟɠɟɧɢ ɭ ɤɥɚɫɚɦɚ 2 ɢ 1, ɡɚ ɲɬɚ ɫɟ ɦɨɠɟ ɧɚʄɢ ɨɛʁɚɲʃɟʃɟ ɭ ɱɢʃɟɧɢɰɢ ɞɚ ɫɟ ɪɚɞɢ ɨ ɦɥɚђɨʁ, ɪɚɞɧɨ ɫɩɨɫɨɛɧɨʁ ɩɨɩɭɥɚɰɢʁɢ, ɬɟ ɞɚ ʁɟ ɤɨɞ ʃɢɯ ɜɢɲɢ ɬɪɨɲɚɤ ɚɩɫɟɧɬɢɡɦɚ ɢ ɩɪɨɰɟʃɟɧɢ ɝɭɛɢɬɚɤ ɭɫɥɟɞ ɫɦɚʃɟɧɟ ɩɪɨɞɭɤɬɢɜɧɨɫɬɢ ɧɚ ɪɚɞɧɨɦ ɦɟɫɬɭ, ɢ ɩɨɪɟɞ ɱɢʃɟɧɢɰɟ ɞɚ ʁɟ ɨɜɢɦ ɛɨɥɟɫɧɢɰɢɦɚ ɪɟђɟ ɢ ɤɪɚʄɟ ɩɨɬɪɟɛɧɚ ɧɟɝɚ ɱɥɚɧɚ ɩɨɪɨɞɢɰɟ, ɩɪɟ ɫɜɟɝɚ ɡɛɨɝ ɛɨʂɟɝ ɨɩɲɬɟɝ ɫɬɚʃɚ ɢ ɛɪɠɟɝ ɨɩɨɪɚɜɤɚ. Ɉɫɬɚʁɟ ɩɢɬɚʃɟ ɧɟɨɱɟɤɢɜɚɧɨ ɧɢɠɢɯ ɞɢɪɟɤɬɧɢɯ, ɢɧɞɢɪɟɤɬɧɢɯ ɢ, ɩɨɫɥɟɞɢɱɧɨ ɭɤɭɩɧɢɯ, ɬɪɨɲɤɨɜɚ ɭ ɤɥɚɫɢ 3, ɨɞɧɨɫɧɨ ɜɢɲɢɯ ɫɜɢɯ ɤɚɬɟɝɨɪɢʁɚ ɬɪɨɲɤɨɜɚ ɭ ɤɥɚɫɢ 2, ɭ ɨɞɧɨɫɭ ɧɚ ɨɱɟɤɢɜɚɧɟ ɬɪɟɧɞɨɜɟ ɤɪɟɬɚʃɚ ɬɪɨɲɤɨɜɚ ɭ ɚɧɚɥɢɡɢɪɚɧɨʁ ɫɬɪɭɤɬɭɪɢ. ɋɥɢɱɧɟ ɪɟɡɭɥɬɚɬɟ ɫɭ ɭ ɫɜɨɦ ɪɚɞɭ ɢɦɚɥɢ ɢ BКuОr34 ɢ ɫɚɪɚɞɧɢɰɢ, ɝɞɟ ɫɭ ɭɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɪɚɫɥɢ ɨɞ ɤɥɚɫɟ 1 ɞɨ ɤɥɚɫɟ 3 ɩɪɟɦɚ ɂɧɞɟɤɫɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ, ɞɨɫɬɢɠɭʄɢ ɦɚɤɫɢɦɭɦ ɭ 117 ɤɥɚɫɢ 3, ɢ ɩɨɬɨɦ ɨɩɚɞɚʁɭʄɢ ɭ ɤɥɚɫɢ 4 ɢ ɤɥɚɫɢ 5. Ɋɚɡɥɨɝɟ ɡɚ ɨɜɚɤɜɭ ɪɚɫɩɨɞɟɥɭ ɫɭ ɧɚɲɥɢ ɭ ɱɢʃɟɧɢɰɢ ɞɚ ɫɭ ɛɨɥɟɫɧɢɰɢ ɤɨʁɢ ɧɢɫɭ ɩɪɟɠɢɜɟɥɢ ɢɦɚɥɢ ɤɪɚʄɟ ɜɪɟɦɟ ɞɭɠɢɧɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢ ɬɪɚʁɚʃɚ ɬɟɪɚɩɢʁɟ, ɚɥɢ ɢ ɭ ɧɟɫɚɜɪɲɟɧɨɫɬɢ ɫɤɚɥɚ/ɫɢɫɬɟɦɚ ɛɨɞɨɜɚʃɚ PЋI ɢ CURB-65. ɇɚɜɟɞɟɧɟ ɫɤɚɥɟ ɫɭ ɟɮɢɤɚɫɧɢ ɢɧɫɬɪɭɦɟɧɬɢ ɤɨʁɢ ɥɟɤɚɪɢɦɚ ɩɨɦɚɠɭ ɭ ɩɪɨɰɟɧɢ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɢ ɨɥɚɤɲɚɜɚʁɭ ɞɨɧɨɲɟʃɟ ɨɞɥɭɤɟ ɨ ɦɟɫɬɭ ɞɚʂɟɝ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɚɥɢ ɧɢɫɭ ɢɞɟɚɥɧɢ. ɉɪɟɞɫɬɚɜʂɚʁɭ ɧɟɤɟ ɨɞ ɫɤɚɥɚ, ɤɨʁɟ ɫɭ ɬɪɟɧɭɬɧɨ ɭ ɧɚʁɲɢɪɨʁ ɩɪɢɦɟɧɢ ɭ ɫɜɟɬɭ, ɧɨ ɢ ɩɨɪɟɞ ɬɨɝɚ ɩɪɟɞɥɨɡɢ ɡɚ ɭɜɨђɟʃɟ ɧɨɜɢɯ ɫɭ ɛɪɨʁɧɢ, ɤɚɨ ɢ ɫɭɝɟɫɬɢʁɟ ɤɨʁɟ ɛɢ ɩɚɪɚɦɟɬɪɟ ɬɟ ɫɤɚɥɟ ɦɨɝɥɟ ɨɛɭɯɜɚɬɚɬɢ, ɚ ɤɨʁɢ ɛɢ ɦɨɝɥɢ ɛɢɬɢ ɢɡɨɫɬɚɜʂɟɧɢ ɡɛɨɝ ɦɚɥɨɝ ɡɧɚɱɚʁɚ ɤɨʁɢ ɢɦɚʁɭ ɧɚ ɢɫɯɨɞ ɥɟɱɟʃɚ ɛɨɥɟɫɬɢ. ɍ ɥɢɬɟɪɚɬɭɪɢ ɫɭ ɞɚɧɚɫ ɞɨɫɬɭɩɧɢ ɛɪɨʁɧɢ ɪɚɞɨɜɢ ɢ ɚɧɚɥɢɡɟ ɧɚ ɬɟɦɭ ɩɪɟɰɢɡɧɨɫɬɢ, ɟɮɢɤɚɫɧɨɫɬɢ ɢ ɡɧɚɱɚʁɚ ɫɤɚɥɚ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ, ɤɨʁɢ ɫɭ ɤɪɨɡ ɪɟɬɪɨɫɩɟɤɬɢɜɧɟ, ɩɪɨɫɩɟɤɬɢɜɧɟ, ɭɧɢ ɢɥɢ ɦɭɥɬɢɰɟɧɬɪɢɱɧɟ ɫɬɭɞɢʁɟ ɢɫɬɚɤɥɟ ɞɨɛɪɟ ɢ ɥɨɲɟ ɫɬɪɚɧɟ ʃɢɯɨɜɟ ɩɪɢɦɟɧɟ80,81,82,83,84,85,86. CСКХЦОrs ɢ ЊutСОrПШrН87 ɫɭ ɫɟ ɛɚɜɢɥɢ ɚɧɚɥɢɡɨɦ ɡɧɚɱɚʁɚ ɫɤɚɥɚ ɡɚ ɢɧɢɰɢʁɚɥɧɭ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ ɩɨɭɡɞɚɧɨɫɬɢ ɭɩɭɬɫɬɚɜɚ ɤɨʁɟ ɨɧɟ ɩɪɭɠɚʁɭ, ɩɪɟ ɫɜɟɝɚ ɭ ɩɨɝɥɟɞɭ ɦɟɫɬɚ ɡɛɪɢʃɚɜɚʃɚ ɢ ɥɟɱɟʃɚ ɛɨɥɟɫɧɢɤɚ. ɉɪɟɦɚ ʃɢɯɨɜɨʁ ɚɧɚɥɢɡɢ, ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ (Pneumonia Severity Index – PЋI) ʁɟ ɪɟɥɚɬɢɜɧɨ ɤɨɦɩɥɟɤɫɚɧ, ʁɟɪ ɡɚɯɬɟɜɚ ɭɜɢɞ ɭ 20 ɪɚɡɥɢɱɢɬɢɯ ɜɚɪɢʁɚɛɥɢ, ɭɤʂɭɱɭʁɭʄɢ ɞɟɦɨɝɪɚɮɫɤɟ ɩɨɞɚɬɤɟ, ɤɨɦɨɪɛɢɞɢɬɟɬɟ ɢ ɤɥɢɧɢɱɤɟ ɜɚɪɢʁɚɛɥɟ, ɫɜɚɤɭ ɫɚ ɪɚɡɥɢɱɢɬɨɦ ɬɟɠɢɧɨɦ88, ɲɬɨ ɡɚ ɩɨɫɥɟɞɢɰɭ ɢɦɚ ɧɟɪɚɞɨ ɢ ɬɟɲɤɨ ɩɪɢɯɜɚɬɚʃɟ ɪɭɬɢɧɫɤɟ ɩɪɢɦɟɧɟ ɨɜɟ ɫɤɚɥɟ ɭ ɪɟɞɨɜɧɨʁ ɤɥɢɧɢɱɤɨʁ ɩɪɚɤɫɢ ɨɞ ɫɬɪɚɧɟ ɥɟɤɚɪɚ ɢ ɦɟɞɢɰɢɧɫɤɨɝ ɨɫɨɛʂɚ89. Ɉɧ ɩɚɰɢʁɟɧɬɟ ɫɜɪɫɬɚɜɚ ɭ ɩɟɬ ɤɥɚɫɚ ɩɪɟɦɚ ɪɢɡɢɤɭ. Ʉɥɚɫɟ I ɢ II ɫɭ ɭ ɧɢɫɤɨɦ ɪɢɡɢɤɭ (0.1–0.7% ɪɢɡɢɤɚ ɦɨɪɬɚɥɢɬɟɬɚ ɭ ɩɟɪɢɨɞɭ ɨɞ 30 ɞɚɧɚ) ɢ ɨɧɢ ɫɟ ɩɪɟɩɨɪɭɱɭʁɭ ɡɚ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟʃɟ, ɩɚɰɢʁɟɧɬɢ ɭ ɤɥɚɫɢ III ɫɭ ɬɚɤɨђɟ ɭ ɪɟɥɚɬɢɜɧɨ ɦɚɥɨɦ ɪɢɡɢɤɭ ɫɦɪɬɧɨɫɬɢ (0.9–2.8%) ɢ ɞɚɬɚ ʁɟ ɩɪɟɩɨɪɭɤɚ ɞɚ ɫɟ ɩɚɰɢʁɟɧɬɢ ɤɥɚɫɟ III ɛɟɡ ɞɨɤɚɡɚ ɨ ɩɨɪɟɦɟʄɚʁɭ ɝɚɫɧɟ ɪɚɡɦɟɧɟ ɬɚɤɨђɟ ɦɨɝɭ ɥɟɱɢɬɢ ɚɦɛɭɥɚɧɬɧɨ90. ɉɚɰɢʁɟɧɬɢ ɤɥɚɫɟ IV ɢɦɚʁɭ ɩɨɜɟʄɚɧ ɪɢɡɢɤ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ (4–10%), ɞɨɤ ɫɭ ɩɚɰɢʁɟɧɬɢ ɤɥɚɫɟ V ɭ ɧɚʁɜɟʄɟɦ ɪɢɡɢɤɭ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ ɭ ɩɟɪɢɨɞɭ ɨɞ 30 ɞɚɧɚ (27%)88. 118 ɉɚɰɢʁɟɧɬɟ ɫɜɪɫɬɚɧɟ ɭ ɜɢɲɟ ɤɥɚɫɟ ɬɪɟɛɚ ɥɟɱɢɬɢ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ɭ ɧɚʁɜɟʄɟɦ ɛɪɨʁɭ ɫɥɭɱɚʁɟɜɚ. ɇɚ ɜɪɟɞɧɨɫɬ PЋI ɫɤɨɪɚ ɭ ɡɧɚɱɚʁɧɨʁ ɦɟɪɢ ɭɬɢɱɭ ɤɨɦɨɪɛɢɞɢɬɟɬɢ, ɬɚɤɨ ɞɚ ʁɟ ɪɟɰɢɦɨ, ɦɨɝɭʄɟ ɩɨɫɬɢʄɢ ɧɚʁɜɢɲɭ ɤɥɚɫɭ PЋI ɫɤɨɪɚ (ɤɥɚɫɭ V) ɫɚɦɨ ɧɚ ɨɫɧɨɜɭ ɫɬɚɪɨɫɬɢ ɢ ɤɨɦɨɪɛɢɞɢɬɟɬɚ. Ɍɚɤɚɜ ɩɚɰɢʁɟɧɬ ɧɚ ɨɫɧɨɜɭ ɜɪɟɞɧɨɫɬɢ ɢɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɧɢɤɚɞɚ ɧɟ ɛɢ ɞɨɛɢɨ ɩɪɟɩɨɪɭɤɭ ɡɚ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟʃɟ, ɱɚɤ ɢ ɚɤɨ ɩɧɟɭɦɨɧɢʁɚ ɨɞ ɤɨʁɟ ʁɟ ɨɛɨɥɟɨ ɢɦɚ ɦɚɥɨ ɢɥɢ ɧɢɦɚɥɨ ɭɬɢɰɚʁɚ ɧɚ ʃɟɝɨɜɨ ɚɤɬɭɟɥɧɨ ɫɬɚʃɟ. MКrrТО ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɩɨɤɚɡɚɥɢ ɞɚ ɫɟ ɡɧɚɱɚʁɚɧ ɩɪɨɰɟɧɚɬ ɛɨɥɟɫɧɢɤɚ ɫɜɪɫɬɚɧɢɯ ɭ ɤɥɚɫɟ IV ɢ V ɩɪɟɦɚ ɢɧɞɟɤɫɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɦɨɠɟ ɭɫɩɟɲɧɨ ɥɟɱɢɬɢ ɚɦɛɭɥɚɧɬɧɨ, ɦɨɠɞɚ ɛɚɲ ɢɡ ɧɚɜɟɞɟɧɨɝ ɪɚɡɥɨɝɚ91. ɋɭɩɪɨɬɧɨ ɧɚɜɟɞɟɧɨɦ ɩɪɢɦɟɪɭ, ɦɥɚɞɢ ɩɚɰɢʁɟɧɬ ɫɚ ɡɧɚɱɚʁɧɨɦ ɪɟɫɩɢɪɚɬɨɪɧɨɦ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɨɦ ɢɥɢ ɫɟɩɬɢɱɤɢɦ ɲɨɤɨɦ, ɲɬɨ ɛɢ ɡɚɯɬɟɜɚɥɨ ɩɪɢʁɟɦ ɭ ʁɟɞɢɧɢɰɭ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ, ɦɨɝɚɨ ɛɢ ɞɚ ɛɭɞɟ ɤɥɚɫɢɮɢɤɨɜɚɧ ɤɚɨ ɩɚɰɢʁɟɧɬ ɧɢɫɤɨɝ ɪɢɡɢɤɚ, ɩɪɟɦɚ ɢɧɞɟɤɫɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ (PЋI ɤɥɚɫɚ II–III). PЋI ɢɦɚ ɬɟɧɞɟɧɰɢʁɭ ɩɨɬɰɟʃɢɜɚʃɚ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɤɨɞ ɦɥɚђɢɯ ɩɚɰɢʁɟɧɚɬɚ ɢ ɧɟ ɬɪɟɛɚ ɝɚ ɩɪɢɦɟʃɢɜɚɬɢ ɭ ɫɦɢɫɥɭ ɞɨɧɨɲɟʃɚ ɨɞɥɭɤɟ ɨ ɩɪɢʁɟɦɭ ɭ ʁɟɞɢɧɢɰɟ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ92-94. ɉɪɨɛɥɟɦɢ ɤɚɨ ɲɬɨ ɫɭ ɧɟɦɨɝɭʄɧɨɫɬ ɨɪɚɥɧɟ ɩɪɢɦɟɧɟ ɥɟɤɨɜɚ, ɯɢɩɨɤɫɟɦɢʁɚ ɤɨʁɚ ɡɚɯɬɟɜɚ ɨɤɫɢɝɟɧɨɬɟɪɚɩɢʁɭ ɢ ɫɨɰɢʁɚɥɧɚ ɩɢɬɚʃɚ ɧɢɫɭ ɨɛɭɯɜɚʄɟɧɢ ɢɧɞɟɤɫɨɦ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ, ɩɚ ʄɟ ɩɚɰɢʁɟɧɬɢ ɤɨʁɢ ɢɯ ɢɦɚʁɭ ɫɜɚɤɚɤɨ ɡɚɯɬɟɜɚɬɢ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɭ, ɧɟɡɚɜɢɫɧɨ ɨɞ ɢɡɪɚɱɭɧɚɬɨɝ PЋI ɫɤɨɪɚ95. CURB-65 ʁɟ ɫɤɚɥɚ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɩɪɟɩɨɪɭɱɟɧɚ ɨɞ ɫɬɪɚɧɟ ɫɦɟɪɧɢɰɚ Ȼɪɢɬɚɧɫɤɨɝ ɭɞɪɭɠɟʃɚ ɩɭɥɦɨɥɨɝɚ - BrТtТsС TСШrКМТМ ЋШМТОtв (BTЋ) ɢ Ⱥɦɟɪɢɱɤɨɝ ɭɞɪɭɠɟʃɚ ɡɚ ɢɧɮɟɤɬɢɜɧɟ ɛɨɥɟɫɬɢ - IЧПОМtТШus DТsОКsО ЋШМТОtв ШП AЦОrТМК (IDЋA) ɢ Ⱥɦɟɪɢɱɤɨɝ ɬɨɪɚɤɚɥɧɨɝ ɭɞɪɭɠɟʃɚ – American Thoracic Society (ATS)96,97. CURB-65 ɩɚɰɢʁɟɧɬɟ ɫɜɪɫɬɚɜɚ ɭ 3 ɝɪɭɩɟ ɩɪɟɦɚ ɩɪɨɰɟʃɟɧɨɦ ɪɢɡɢɤɭ: ɫɤɨɪ 0-1, ɧɢɡɚɤ ɪɢɡɢɤ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ ɭ ɩɟɪɢɨɞɭ ɨɞ 30 ɞɚɧɚ (0.7–3.2%); ɫɤɨɪ 2, ɫɪɟɞʃɢ ɪɢɡɢɤ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ ɭ ɩɟɪɢɨɞɭ ɨɞ 30 ɞɚɧɚ (13%); ɫɤɨɪ 3–5, ɜɢɫɨɤ ɪɢɡɢɤ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ ɭ ɩɟɪɢɨɞɭ ɨɞ 30 ɞɚɧɚ (17%–57%)82. CURB-65 ɫɤɚɥɚ ʁɟ ɜɟɪɢɮɢɤɨɜɚɧɚ ɧɚ ɜɢɲɟ ɨɞ 15.000 ɩɚɰɢʁɟɧɚɬɚ ɢ ɩɨɤɚɡɚɥɚ ʁɟ ɫɥɢɱɧɭ ɟɮɢɤɚɫɧɨɫɬ ɭ ɩɨɪɟђɟʃɭ ɫɚ PЋI ɫɤɚɥɨɦ ɭ ɩɪɟɞɜɢђɚʃɭ ɦɨɪɬɚɥɢɬɟɬɚ ɭ ɩɟɪɢɨɞɭ ɨɞ 30 ɞɚɧɚ86,98,99,100. 119 ɉɪɟɩɨɪɭɤɚ ʁɟ ɞɚ ɫɟ ɩɚɰɢʁɟɧɬɢ ɫɚ ɫɤɨɪɨɦ 0 ɢɥɢ 1 ɥɟɱɟ ɚɦɛɭɥɚɧɬɧɨ, ɩɚɰɢʁɟɧɬɢ ɫɚ ɫɤɨɪɨɦ 2 ɡɚɯɬɟɜɚʁɭ ɤɪɚɬɤɨɬɪɚʁɧɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɭ, ɞɨɤ ɩɚɰɢʁɟɧɬɢ ɫɚ ɫɤɨɪɨɦ 3 ɢɥɢ ɜɢɲɟ ɡɚɯɬɟɜɚʁɭ ɨɛɚɜɟɡɧɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɭ96,97. Ɇɚɞɚ ɫɭ ɤɚɪɚɤɬɟɪɢɫɬɢɤɟ ɩɟɪɮɨɪɦɚɧɫɢ CUЊB-65 ɢ PЋI ɫɥɢɱɧɟ, PЋI ɢɦɚ ɬɟɧɞɟɧɰɢʁɭ ɞɚ ɜɟʄɢ ɩɪɨɰɟɧɚɬ ɩɚɰɢʁɟɧɚɬɚ ɢɞɟɧɬɢɮɢɤɭʁɟ ɤɚɨ ɩɚɰɢʁɟɧɬɟ ɧɢɫɤɨɝ ɪɢɡɢɤɚ86, ɞɨɤ ɫɭ ɩɪɢʁɚɜʂɟɧɟ ɫɬɨɩɟ ɦɨɪɬɚɥɢɬɟɬɚ ɡɚ ɝɪɭɩɟ ɧɢɫɤɨɝ ɪɢɡɢɤɚ ɬɚɤɨђɟ ɧɢɠɟ ɡɚ PЋI ɫɤɚɥɭ ɭ ɨɞɧɨɫɭ ɧɚ CUЊB-6586. ɋɬɨɝɚ ʁɟ ɩɪɟɞɥɨɠɟɧɨ ɞɚ ʁɟ CUЊB-65 ɩɨɝɨɞɧɢʁɢ ɡɚ ɢɞɟɧɬɢɮɢɤɚɰɢʁɭ ɩɚɰɢʁɟɧɚɬɚ ɜɢɫɨɤɨɝ ɪɢɡɢɤɚ, ɞɨɤ PЋI ɢɦɚ ɦɚɥɭ ɩɪɟɞɧɨɫɬ ɭ ɢɞɟɧɬɢɮɢɤɚɰɢʁɢ ɩɚɰɢʁɟɧɚɬɚ ɧɢɫɤɨɝ ɪɢɡɢɤɚ86. CURB-65 ʁɟ ɫɬɜɨɪɟɧ ɫɚ ɧɚɦɟɪɨɦ ɞɚ ɩɪɟɞɜɢɞɢ ɦɨɪɬɚɥɢɬɟɬ ɭ ɩɟɪɢɨɞɭ ɨɞ 30 ɞɚɧɚ, ɢ ɫɬɨɝɚ ʁɟ, ɤɚɨ ɢ PЋI, ɦɚʃɟ ɟɮɢɤɚɫɚɧ ɭ ɩɪɟɞɜɢђɚʃɭ ɩɪɢʁɟɦɚ ɭ ʁɟɞɢɧɢɰɟ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ94 ɢɥɢ ɞɪɭɝɢɯ ɧɟɠɟʂɟɧɢɯ ɞɨɝɚђɚʁɚ ɩɨɜɟɡɚɧɢɯ ɫɚ ɩɧɟɭɦɨɧɢʁɨɦ, ɧɩɪ. ɤɨɦɩɥɢɤɨɜɚɧɟ ɩɚɪɚɩɧɟɭɦɨɧɢɱɧɟ ɟɮɭɡɢʁɟ/ɟɦɩɢʁɟɦɚ101. CURB-65 ɱɢɧɢ ɫɟ ɞɚ ɩɨɬɰɟʃɭʁɟ ɬɟɠɢɧɭ ɛɨɥɟɫɬɢ ɤɨɞ ɦɥɚɞɢɯ ɛɨɥɟɫɧɢɤɚ ɢ ɧɟ ɨɛɭɯɜɚɬɚ ɩɪɨɰɟɧɭ ɨɤɫɢɝɟɧɚɰɢʁɟ92. Ɉɜɚ ɞɜɚ ɨɝɪɚɧɢɱɟʃɚ ɨɜɟ ɫɤɚɥɟ ɫɭ ɛɢɥɚ ɭɨɱɟɧɚ ɬɨɤɨɦ ɩɚɧɞɟɦɢʁɟ ɜɢɪɭɫɚ ɝɪɢɩɚ Ⱥ H1N1, ɝɞɟ ɫɭ ɜɟɥɢɤɢ ɛɪɨʁ ɬɟɲɤɢɯ ɫɥɭɱɚʁɟɜɚ ɱɢɧɢɥɢ ɦɥɚɞɢ ɩɚɰɢʁɟɧɬɢ ɫɚ ɚɤɭɬɧɨ ɧɚɫɬɚɥɨɦ ɪɟɫɩɢɪɚɬɨɪɧɨɦ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɨɦ102,103. Ɉɜɢ ɩɚɰɢʁɟɧɬɢ ɫɭ ɢɦɚɥɢ ɧɢɡɚɤ CURB-65 ɫɤɨɪ ɢ ɫɬɨɝɚ ɛɢ ɛɢɥɢ ɩɪɟɩɨɪɭɱɟɧɢ ɡɚ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟʃɟ103. ɍ ɫɬɭɞɢʁɚɦɚ ɭ ɤɨʁɢɦɚ ʁɟ ɚɧɚɥɢɡɢɪɚɧɚ ɩɪɢɦɟɧɚ CUЊB-65 ɭ ɤɥɢɧɢɱɤɨʁ ɩɪɚɤɫɢ, ɡɚɩɚɠɟɧɨ ʁɟ ɞɚ ɦɧɨɝɨ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɧɢɫɤɢɦ ɜɪɟɞɧɨɫɬɢɦɚ CUЊB-65 ɫɤɨɪɚ ɧɢʁɟ ɩɨɞɟɫɧɨ ɡɚ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟʃɟ ɡɛɨɝ ɪɚɡɥɢɱɢɬɢɯ ɮɚɤɬɨɪɚ ɤɨʁɢ ɧɢɫɭ ɨɛɭɯɜɚʄɟɧɢ ɫɤɚɥɨɦ ɩɪɨɰɟɧɟ. Ɉɜɢ ɮɚɤɬɨɪɢ ɩɪɟ ɫɜɟɝɚ ɨɛɭɯɜɚɬɚʁɭ ɯɢɩɨɤɫɟɦɢʁɭ ɤɨʁɚ ɡɚɯɬɟɜɚ ɨɤɫɢɝɟɧɨɬɟɪɚɩɢʁɭ, ɧɟɫɬɚɛɢɥɧɟ ɤɨɦɨɪɛɢɞɢɬɟɬɟ, ɫɨɰɢʁɚɥɧɟ ɩɨɬɪɟɛɟ, ɤɚɨ ɢ ɡɧɚɱɚʁɚɧ ɛɪɨʁ ɛɨɥɟɫɧɢɤɚ ɫɚ ɩɪɢɫɭɬɧɢɦ ɦɚɪɤɟɪɢɦɚ ɬɟɲɤɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (ɬɟɲɤɢ ɦɟɬɚɛɨɥɢɱɤɢ ɩɨɪɟɦɟʄɚʁɢ, ɫɟɩɫɚ ɢ ɟɦɩɢʁɟɦ) ɲɬɨ ɫɜɟ ɧɢʁɟ ɨɛɭɯɜɚʄɟɧɨ CUЊB-65 ɫɤɨɪɨɦ104,105. ɉɪɨɦɨɜɢɫɚʃɟ ɚɦɛɭɥɚɧɬɧɨɝ ɥɟɱɟʃɚ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ ɢɦɚ ɜɢɲɟ ɩɨɬɟɧɰɢʁɚɥɧɢɯ ɩɪɟɞɧɨɫɬɢ. Ɍɪɨɲɤɨɜɢ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɱɢɧɟ ɧɚʁɜɟʄɢ ɞɟɨ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɩɨɜɟɡɚɧɢɯ ɫɚ ɥɟɱɟʃɟɦ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. ɍ ɢɫɬɪɚɠɢɜɚʃɭ ɫɩɪɨɜɟɞɟɧɨɦ ɭ ȼɟɥɢɤɨʁ Ȼɪɢɬɚɧɢʁɢ, GuОst26 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɢɡɧɟɥɢ ɩɨɞɚɬɚɤ ɞɚ ʁɟ ɫɚɦɨ 32% ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɜɚɧɛɨɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ ɡɚɯɬɟɜɚɥɨ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɭ, ɚɥɢ ɞɚ ʁɟ ɨɜɚ ɝɪɭɩɚ ɛɢɥɚ ɨɞɝɨɜɨɪɧɚ 120 ɡɚ 96% ɭɤɭɩɧɢɯ ɝɨɞɢɲʃɢɯ ɬɪɨɲɤɨɜɚ ɩɨɜɟɡɚɧɢɯ ɫɚ ɥɟɱɟʃɟɦ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. ɋɥɢɱɧɟ ɪɟɡɭɥɬɚɬɟ ɫɭ ɢɡɧɟɥɢ ЊКut ɢ ɫɚɪɚɞɧɢɰɢ ɭ ɋȺȾ106. ɋɬɭɞɢʁɚ ɫɩɪɨɜɟɞɟɧɚ ɭ ȼɟɥɢɤɨʁ Ȼɪɢɬɚɧɢʁɢ ʁɟ ɞɚɥɚ ɩɨɞɚɬɚɤ ɞɚ ʁɟ ɩɪɨɫɟɱɚɧ ɬɪɨɲɚɤ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ £1700–£5100 ɩɨ ɩɚɰɢʁɟɧɬɭ, ɭ ɩɨɪɟђɟʃɭ ɫɚ £100 ɩɨ ɟɩɢɡɨɞɢ, ɡɚ ɩɚɰɢʁɟɧɬɟ ɥɟɱɟɧɟ ɚɦɛɭɥɚɧɬɧɨ26. ɉɨɪɟɞ ɟɤɨɧɨɦɫɤɢɯ ɩɪɟɞɧɨɫɬɢ, ȼɟɥɢɤɚ Ȼɪɢɬɚɧɢʁɚ ɢ ɦɧɨɝɟ ɞɪɭɝɟ ɪɚɡɜɢʁɟɧɟ ɡɟɦʂɟ ɫɭ ɩɨɫɥɟɞʃɢɯ ɝɨɞɢɧɚ ɢɫɤɭɫɢɥɟ ɟɩɢɞɟɦɢʁɭ ɛɨɥɧɢɱɤɢɯ ɢɧɮɟɤɰɢʁɚ, ɤɚɨ ɲɬɨ ɫɭ ɢɧɮɟɤɰɢʁɟ ɭɡɪɨɤɨɜɚɧɟ ɦɟɬɢɰɢɥɢɧ-ɪɟɡɢɫɬɟɧɬɧɢɦ ЋtКpСвХШМШММus КurОus-ɨɦ (MЊЋA) ɢ CХШstrТНТuЦ-ɨɦ difficile107. ɍɬɜɪђɟɧɨ ʁɟ ɞɚ ʁɟ ɥɟɱɟʃɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ɝɥɚɜɧɢ ɩɨɤɪɟɬɚɱ ɨɜɢɯ ɢɧɮɟɤɰɢʁɚ, ɤɚɨ ɢ ɞɚ ɧɚʁɟɮɢɤɚɫɧɢʁɢ ɧɚɱɢɧ ʃɢɯɨɜɨɝ ɫɩɪɟɱɚɜɚʃɚ ɩɪɟɞɫɬɚɜʂɚ ɫɦɚʃɟʃɟ ɢɡɥɨɠɟɧɨɫɬɢ ɛɨɥɟɫɧɢɤɚ ɛɨɥɧɢɱɤɨɦ ɨɤɪɭɠɟʃɭ, ɝɞɟ ɫɟ ɨɧɟ ɧɚʁɥɚɤɲɟ ɫɬɢɱɭ107. ȼɚɠɧɚ ʁɟ ɢ ɱɢʃɟɧɢɰɚ ɞɚ, ɩɪɟɦɚ ɩɨɞɚɰɢɦɚ ɧɟɤɢɯ ɫɬɭɞɢʁɚ, ɜɟʄɢɧɚ ɩɚɰɢʁɟɧɚɬɚ (60–75%) ɛɢɪɚ ɥɟɱɟʃɟ ɭ ɤɭʄɧɢɦ ɭɫɥɨɜɢɦɚ/ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟʃɟ, ɭɤɨɥɢɤɨ ɢɦ ɫɟ ɨɫɬɚɜɢ ɦɨɝɭʄɧɨɫɬ ɢɡɛɨɪɚ108,109. ɍ ʁɟɞɧɨɦ ɢɫɬɪɚɠɢɜɚʃɭ, ɨɞ 292 ɥɟɤɚɪɚ ʁɟ ɡɚɬɪɚɠɟɧɨ ɞɚ ɩɪɨɰɟɧɟ ɪɢɡɢɤ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ, ɤɨʁɢ ɫɭ ɫɜɢ ɩɪɟɦɚ ɨɛʁɟɤɬɢɜɧɢɦ ɫɤɚɥɚɦɚ ɩɪɨɰɟɧɟ ɢɦɚɥɢ ɦɨɪɬɚɥɢɬɟɬ ɦɚʃɢ ɨɞ 4% ɢ ɛɢɥɢ ɩɨɬɟɧɰɢʁɚɥɧɨ ɩɨɝɨɞɧɢ ɡɚ ɚɦɛɭɥɚɧɬɧɨ ɥɟɱɟʃɟ. ɇɚɤɨɧ ɭɜɢɞɚ ɭ ɫɚɦɟ ɩɚɰɢʁɟɧɬɟ, ɥɟɤɚɪɢ ɭɤʂɭɱɟɧɢ ɭ ɢɫɬɪɚɠɢɜɚʃɟ ɫɭ ɩɪɨɰɟɧɢɥɢ ɞɚ 41% ɩɚɰɢʁɟɧɚɬɚ ɢɦɚ ɪɢɡɢɤ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ ɜɟʄɢ ɨɞ 5% ɢ ɞɚ ʁɟ ɫɬɨɝɚ ɧɟɨɩɯɨɞɧɨ ɛɨɥɧɢɱɤɨ ɥɟɱɟʃɟ110. ɍ ɢɫɬɪɚɠɢɜɚʃɭ ɫɩɪɨɜɟɞɟɧɨɦ ɭ ȼɟɥɢɤɨʁ Ȼɪɢɬɚɧɢʁɢ, ɫɚɦɨ 7% ɥɟɤɚɪɚ ʁɟ ɫɚɦɨɫɬɚɥɧɨ ɛɢɥɨ ɭ ɫɬɚʃɭ ɞɚ ɧɚɩɪɚɜɢ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɫɥɢɱɧɨ ɪɟɡɭɥɬɚɬɢɦɚ ɨɛʁɟɤɬɢɜɧɢɯ ɫɤɚɥɚ ɩɪɨɰɟɧɟ111. Ɉɜɚ ɢɫɬɪɚɠɢɜɚʃɚ ɭɤɚɡɭʁɭ ɞɚ, ɭ ɦɧɨɝɢɦ ɫɥɭɱɚʁɟɜɢɦɚ, ɥɟɤɚɪɢ ɩɪɟɰɟʃɭʁɭ ɪɢɡɢɤ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ ɩɨɜɟɡɚɧɨɝ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ, ɲɬɨ ɦɨɠɟ ɞɨɜɟɫɬɢ ɞɨ ɧɟɩɨɬɪɟɛɧɢɯ ɩɪɢʁɟɦɚ ɭ ɛɨɥɧɢɰɭ. ɋɤɚɥɟ ɡɚ ɢɧɢɰɢʁɚɥɧɭ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɫɟ ɫɬɨɝɚ ɤɨɪɢɫɬɟ ɤɚɨ ɢɧɫɬɪɭɦɟɧɬɢ ɤɨʁɢ ɩɨɦɚɠɭ ɭ ɫɬɪɚɬɢɮɢɤɚɰɢʁɢ ɪɢɡɢɤɚ ɢ ɫɚɦɢɦ ɬɢɦ ɩɨɦɚɠɭ ɭ ɞɨɧɨɲɟʃɭ ɨɞɥɭɤɟ ɭ ɩɨɝɥɟɞɭ ɦɟɫɬɚ ɥɟɱɟʃɚ ɛɨɥɟɫɧɢɤɚ ɫɚ ɨɜɨɦ ɛɨɥɟɲʄɭ. 121 ɂɩɚɤ, ɧɚ ɢɧɞɢɜɢɞɭɚɥɧɨɦ ɧɢɜɨɭ ɢɦɚ ɦɧɨɝɨ ɪɚɡɥɨɝɚ, ɨɫɢɦ ɪɢɡɢɤɚ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ, ɤɨʁɢ ɦɨɝɭ ɢɡɢɫɤɢɜɚɬɢ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɭ, ɭɤʂɭɱɭʁɭʄɢ ɫɨɰɢʁɚɥɧɟ ɨɤɨɥɧɨɫɬɢ, ɩɨɬɪɟɛɭ ɡɚ ɨɤɫɢɝɟɧɨɬɟɪɚɩɢʁɨɦ ɢɥɢ ɧɟɦɨɝɭʄɧɨɫɬ ɭɡɢɦɚʃɚ ɨɪɚɥɧɟ ɬɟɪɚɩɢʁɟ112. Јɚɫɧɨ ʁɟ ɞɚ ɦɥɚɞɢɦ, ɢɧɚɱɟ ɡɞɪɚɜɢɦ ɩɚɰɢʁɟɧɬɢɦɚ ɦɨɠɟ ɛɢɬɢ ɧɟɨɩɯɨɞɚɧ ɩɪɢʁɟɦ ɭ ʁɟɞɢɧɢɰɭ ɢɧɬɟɧɡɢɜɧɨɝ ɥɟɱɟʃɚ ɡɛɨɝ ɪɟɫɩɢɪɚɬɨɪɧɟ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɟ, ɞɨɤ ʁɟ ʃɢɯɨɜ ɪɢɡɢɤ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ ɢ ɞɚʂɟ ɩɪɨɰɟʃɟɧ ɤɚɨ ɧɢɠɢ ɭ ɨɞɧɨɫɭ ɧɚ ɫɬɚɪɢʁɟɝ ɩɚɰɢʁɟɧɬɚ ɫɚ ɦɭɥɬɢɩɥɢɦ ɤɨɦɨɪɛɢɞɢɬɟɬɢɦɚ, ɩɪɢɦʂɟɧɨɝ ɧɚ ɛɨɥɧɢɱɤɨ ɥɟɱɟʃɟ, ɛɟɡ ɪɟɫɩɢɪɚɬɨɪɧɟ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɟ113. Ɇɚʃɟ ɩɪɨɰɟʃɟɧɚ ɫɬɨɩɚ ɦɨɪɬɚɥɢɬɟɬɚ ɧɟ ɡɧɚɱɢ ɞɚ ɦɥɚђɟɝ ɩɚɰɢʁɟɧɬɚ ɬɪɟɛɚ ɩɨ ɫɜɚɤɭ ɰɟɧɭ ɡɛɪɢʃɚɜɚɬɢ ɚɦɛɭɥɚɧɬɧɨ. ɍ ɭɬɜɪђɢɜɚʃɭ ɞɚ ɥɢ ʁɟ ɫɢɫɬɟɦ/ɫɤɚɥɚ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɩɨɝɨɞɧɚ ɡɚ ɩɪɢɦɟɧɭ ɭ ɤɥɢɧɢɱɤɨɦ ɨɤɪɭɠɟʃɭ, ɬɪɟɛɚ ɢɦɚɬɢ ɭ ɜɢɞɭ ɜɢɲɟ ɱɢʃɟɧɢɰɚ114: ɫɢɫɬɟɦ ɩɪɨɰɟɧɟ/ɩɪɟɞɜɢђɚʃɚ ɬɪɟɛɚ ɞɚ ʁɟ ɬɚɤɚɜ ɞɚ ɦɨɠɟ ɩɪɟɰɢɡɧɨ ɞɚ ɩɪɟɞɜɢɞɢ ɢɫɯɨɞ ɨɞ ɢɧɬɟɪɟɫɚ. ɍ ɜɟʄɢɧɢ ɫɬɭɞɢʁɚ ɭ ɤɨʁɢɦɚ ɫɭ ɩɪɨɰɟʃɢɜɚɧɟ ɫɤɚɥɟ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ, ɦɨɪɬɚɥɢɬɟɬ ɭ ɩɟɪɢɨɞɭ ɨɞ 30 ɞɚɧɚ ʁɟ ɫɦɚɬɪɚɧ ɡɚ ɢɫɯɨɞ ɨɞ ɧɚʁɜɟʄɟɝ ɢɧɬɟɪɟɫɚ, ɨɞɧɨɫɧɨ ɡɧɚɱɚʁɚ. Ɉɫɢɦ ɬɨɝɚ, ɬɚɤɚɜ ɫɢɫɬɟɦ ɦɨɪɚ ɛɢɬɢ ɩɪɢɦɟʃɢɜ ɭ ɤɥɢɧɢɱɤɨʁ ɩɪɚɤɫɢ, ɲɬɨ ɡɧɚɱɢ ɞɚ ɦɨɪɚ ɞɚ ɤɥɚɫɢɮɢɤɭʁɟ ɩɚɰɢʁɟɧɬɟ ɭ ɤɥɢɧɢɱɤɢ ɩɪɢɦɟʃɢɜɟ ɝɪɭɩɟ (ɝɪɭɩɟ ɧɢɫɤɨɝ, ɫɪɟɞʃɟɝ ɢ ɜɢɫɨɤɨɝ ɪɢɡɢɤɚ). Јɟɞɧɨɫɬɚɜɧɢ ɫɢɫɬɟɦɢ ɫɟ ɥɚɤɲɟ ɤɨɪɢɫɬɟ ɭ ɤɥɢɧɢɱɤɨʁ ɩɪɚɤɫɢ ɨɞ ɤɨɦɩɥɢɤɨɜɚɧɢɯ ɢ ɫɬɨɝɚ ʁɟ ɜɟʄɚ ɜɟɪɨɜɚɬɧɨʄɚ ɞɚ ʄɟ ɛɢɬɢ ɲɢɪɨɤɨ ɢ ɱɟɫɬɨ ɩɪɢɦɟʃɢɜɚɧɢ114,115. Ɉɩɫɟɪɜɚɰɢɨɧɚ ɫɬɭɞɢʁɚ Renaud116 ɢ ɫɚɪɚɞɧɢɤɚ, ɩɨɪɟɞɢɥɚ ʁɟ ɩɚɰɢʁɟɧɬɟ ɨɛɨɥɟɥɟ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢɡ ɦɟɞɢɰɢɧɫɤɢɯ ɭɫɬɚɧɨɜɚ ɭɪɝɟɧɬɧɨɝ ɡɛɪɢʃɚɜɚʃɚ ɭ ɤɨʁɢɦɚ ʁɟ ɤɨɪɢɲʄɟɧ PЋI - ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ, ɫɚ ɩɚɰɢʁɟɧɬɢɦɚ ɢɡ ɭɫɬɚɧɨɜɚ ɤɨʁɟ ɧɢɫɭ ɤɨɪɢɫɬɢɥɟ PЋI. 42,8% ɩɚɰɢʁɟɧɚɬɚ ɧɢɫɤɨɝ ɪɢɡɢɤɚ ʁɟ ɥɟɱɟɧɨ ɚɦɛɭɥɚɧɬɧɨ ɢɡ ɭɫɬɚɧɨɜɚ ɭ ɤɨʁɢɦɚ ʁɟ PЋI ɤɨɪɢɲʄɟɧ ɭ ɩɨɪɟђɟʃɭ ɫɚ ɫɚɦɨ 23,9% ɭ ɭɫɬɚɧɨɜɚɦɚ ɤɨʁɟ ɧɢɫɭ ɤɨɪɢɫɬɢɥɟ PЋI. Ɍɚɤɨђɟ ʁɟ ɩɨɤɚɡɚɧɨ ɞɚ ɫɭ ɫɬɨɩɟ ɦɨɪɬɚɥɢɬɟɬɚ ɛɢɥɟ ɧɢɠɟ ɭ ɭɫɬɚɧɨɜɚɦɚ ɭ ɤɨʁɢɦɚ ʁɟ PЋI ɤɨɪɢɲʄɟɧ116. ȿɜɚɥɭɚɰɢɨɧɚ ɫɬɭɞɢʁɚ ɫɩɪɨɜɟɞɟɧɚ ɭ Јɭɠɧɨʁ Ʉɨɪɟʁɢ ʁɟ ɩɨɤɚɡɚɥɚ ɡɧɚɱɚʁɧɨ ɫɦɚʃɟʃɟ ɫɬɨɩɚ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ, ɫɚ 68,2% ɧɚ 30,4%, ɧɚɤɨɧ ɭɜɨђɟʃɚ PЋI ɭ ɪɭɬɢɧɫɤɭ ɤɥɢɧɢɱɤɭ ɩɪɚɤɫɭ ɭ ɭɫɬɚɧɨɜɟ ɭɪɝɟɧɬɧɨɝ ɥɟɱɟʃɚ ɢ ɡɛɪɢʃɚɜɚʃɚ117. ɍ ɦɟɬɚ-ɚɧɚɥɢɡɢ ɭɬɢɰɚʁɚ ɨɜɢɯ ɢɧɬɟɪɜɟɧɰɢʁɚ, ɢɦɩɥɟɦɟɧɬɚɰɢʁɚ PЋI ʁɟ ɪɟɡɭɥɬɢɪɚɥɚ ɡɧɚɱɚʁɧɢɦ ɩɨɪɚɫɬɨɦ ɛɪɨʁɚ ɩɚɰɢʁɟɧɚɬɚ ɤɨʁɢ ɫɭ ɥɟɱɟɧɢ ɚɦɛɭɥɚɧɬɧɨ (OЊ 2.31 95%, CI 2.03–2.63, p<0.0001). Ɉɜɨ ɧɢʁɟ ɞɨɜɟɥɨ ɞɨ ɩɨɜɟʄɚʃɚ ɫɬɨɩɟ ɦɨɪɬɚɥɢɬɟɬɚ (OЊ 0.83 95%, CI 0.59–1.17, 122 p=0.3), ɩɨɧɨɜɧɢɯ ɩɪɢʁɟɦɚ ɭ ɛɨɥɧɢɰɭ (OЊ 1.08 95%, CI 0.82–1.42, p=0.6) ɢɥɢ ɛɢɥɨ ɤɚɤɜɟ ɩɪɨɦɟɧɟ ɭ ɡɚɞɨɜɨʂɫɬɜɭ ɩɚɰɢʁɟɧɚɬɚ ɩɪɭɠɟɧɨɦ ɧɟɝɨɦ ɢ ɥɟɱɟʃɟɦ (OЊ 1.21 95%, CI 0.97– 1.49, p=0.09)118. Ⱦɚ ɛɢ ɫɢɫɬɟɦ/ɫɤɚɥɚ ɩɪɨɰɟɧɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɛɢɨ ɤɨɪɢɫɬɚɧ, ɦɨɪɚ ɫɟ ɩɪɢɦɟʃɢɜɚɬɢ ɭɫɩɟɲɧɨ ɭ ɤɥɢɧɢɱɤɨʁ ɩɪɚɤɫɢ ɚ ɧɟ ɫɚɦɨ ɭ ɤɨɧɬɟɤɫɬɭ ɤɥɢɧɢɱɤɟ ɫɬɭɞɢʁɟ ɢɥɢ ɢɫɩɢɬɢɜɚʃɚ. ɂɡɜɟɲɬɚʁɢ ɨ ɩɪɢɦɟɧɢ ɨɜɢɯ ɫɢɫɬɟɦɚ/ɫɤɚɥɚ ɭ ɞɨɧɨɲɟʃɭ ɨɞɥɭɤɟ ɨ ɦɟɫɬɭ ɥɟɱɟʃɚ ɭ ɤɥɢɧɢɱɤɨʁ ɩɪɚɤɫɢ ɫɭ ɪɟɬɤɢ, ɚɥɢ ɫɭɝɟɪɢɲɭ ɧɚ ɧɟɞɨɜɨʂɧɨ ɤɨɪɢɲʄɟʃɟ ɨɜɢɯ ɫɢɫɬɟɦɚ. ɍ ɢɫɬɪɚɠɢɜɚʃɭ BКrХШа119 ɢ ɫɚɪɚɞɧɢɤɚ, ɦɥɚɞɢ ɥɟɤɚɪɢ ɭ ɛɨɥɧɢɰɢ ɭ ɤɨʁɨʁ ɫɟ ɤɨɪɢɫɬɢ CUЊB- 65 ɫɭ ɚɧɤɟɬɢɪɚɧɢ ɨ ɭɥɨɡɢ ɫɢɫɬɟɦɚ/ɫɤɚɥɚ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ119. ɋɚɦɨ 4% ɚɧɤɟɬɢɪɚɧɢɯ ɥɟɤɚɪɚ ʁɟ ɧɚɜɟɥɨ CUЊB-65, ɤɚɞɚ ɫɭ ɭɩɢɬɚɧɢ ɞɚ ɧɚɜɟɞɭ ɤɪɢɬɟɪɢʁɭɦɟ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ, ɞɨɤ ʁɟ ɫɚɦɨ 7% ɦɨɝɥɨ ɞɚ ɫɟ ɫɟɬɢ ɜɚɪɢʁɚɛɥɢ ɤɨʁɟ CUЊB-65 ɨɛɭɯɜɚɬɚ ɢ ɞɚ ɝɚ ɩɪɢɦɟɧɢ ɧɚ ɫɰɟɧɚɪɢɨ ɪɟɚɥɧɨɝ ɩɚɰɢʁɟɧɬɚ119. ɍ ɚɧɚɥɢɡɢ ɤɨʁɭ ɫɭ ɫɩɪɨɜɟɥɢ LОО ɢ ɫɚɪɚɞɧɢɰɢ ɭ Ⱥɭɫɬɪɚɥɢʁɢ, ɭ ɛɨɥɧɢɰɢ ɤɨʁɚ ɩɪɢɦɟʃɭʁɟ PЋI, PЋI ʁɟ ɩɪɢɦɟʃɢɜɚɧ ɫɚɦɨ ɭ 1/3 ɫɥɭɱɚʁɟɜɚ, ɚ ɤɚɞɚ ʁɟ ɩɪɢɦɟʃɢɜɚɧ ɩɨɝɪɟɲɧɨ ʁɟ ɤɚɥɤɭɥɢɫɚɧ ɭ 42% ɫɥɭɱɚʁɟɜɚ82. Ⱥɭɬɨɪɢ ɡɚɤʂɭɱɭʁɭ ɞɚ ɤɨɦɩɥɟɤɫɧɨɫɬ PЋI ɱɢɧɢ ɬɟɲɤɢɦ ɡɚ ɩɪɢɦɟɧɭ ɭ ɤɥɢɧɢɱɤɨʁ ɩɪɚɤɫɢ. ɋɜɟ ɨɜɟ ɫɬɭɞɢʁɟ ɭɤɚɡɭʁɭ ɧɚ ɧɟɞɨɜɨʂɧɭ ɩɪɢɦɟɧɭ ɫɤɚɥɚ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɭ ɫɜɚɤɨɞɧɟɜɧɨʁ ɤɥɢɧɢɱɤɨʁ ɩɪɚɤɫɢ. Ⱥɤɬɭɟɥɧɢ ɩɨɞɚɰɢ ɭɤɚɡɭʁɭ ɧɚ ɬɨ ɞɚ ɛɢ ɢɦɩɥɟɦɟɧɬɚɰɢʁɚ ɫɢɫɬɟɦɚ/ɫɤɚɥɚ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɭ ɭɫɬɚɧɨɜɚɦɚ ɭɪɝɟɧɬɧɨɝ ɡɛɪɢʃɚɜɚʃɚ ɢ ɥɟɱɟʃɚ ɤɨʁɟ ɢɯ ʁɨɲ ɭɜɟɤ ɧɟ ɤɨɪɢɫɬɟ, ɫɚ ɰɢʂɟɦ ɢɞɟɧɬɢɮɢɤɚɰɢʁɟ ɩɚɰɢʁɟɧɚɬɚ ɧɢɫɤɨɝ ɪɢɡɢɤɚ, ɪɟɡɭɥɬɢɪɚɥɚ ɡɧɚɱɚʁɧɢɦ ɩɨɪɚɫɬɨɦ ɫɬɨɩɟ ɛɟɡɛɟɞɧɢɯ ɨɬɩɭɫɬɚ ɫɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ118. ɍ ɭɫɬɚɧɨɜɚɦɚ ɤɨʁɟ ɜɟʄ ɩɪɢɦɟʃɭʁɭ ɨɜɟ ɫɢɫɬɟɦɟ/ɫɤɚɥɟ, ɪɟɡɭɥɬɚɬɢ ɫɬɭɞɢʁɚ ɭɤɚɡɭʁɭ ɞɚ ɛɢ 5-20% ɨɞ ɬɪɟɧɭɬɧɨ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢɯ ɩɚɰɢʁɟɧɚɬɚ ɧɢɫɤɨɝ ɪɢɡɢɤɚ ɦɨɝɥɨ ɛɢɬɢ ɥɟɱɟɧɨ ɚɦɛɭɥɚɧɬɧɨ, ɭɡ ɞɨɫɥɟɞɧɭ ɩɪɢɦɟɧɭ ɚɤɬɭɟɥɧɢɯ ɫɦɟɪɧɢɰɚ ɡɚ ɥɟɱɟʃɟ ɜɚɧɛɨɥɧɢɱɤɢɯ ɩɧɟɭɦɨɧɢʁɚ95,104,105,112. ɋɜɢ ɫɢɫɬɟɦɢ/ɫɤɚɥɟ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɢɦɚʁɭ ɫɜɨʁɚ ɨɝɪɚɧɢɱɟʃɚ ɢ ɬɪɟɛɚ ɢɯ ɩɪɢɦɟʃɢɜɚɬɢ ɫɚɦɨ ɭɡ ɤɥɢɧɢɱɤɭ ɩɪɨɰɟɧɭ ɩɚɰɢʁɟɧɬɚ. 123 Schuetz120 ɢ ɫɚɪɚɞɧɢɰɢ ɫɭ ɫɟ ɬɚɤɨђɟ ɛɚɜɢɥɢ ɚɧɚɥɢɡɨɦ ɫɢɫɬɟɦɚ/ɫɤɚɥɚ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ, ɢ ɭɜɢɞɟɜɲɢ ʃɢɯɨɜɚ ɨɝɪɚɧɢɱɟʃɚ ɩɪɟɞɥɨɠɢɥɢ ɦɟɬɨɞɟ ɪɟɤɚɥɢɛɪɚɰɢʁɟ ɫɚ ɧɚɦɟɪɨɦ ʃɢɯɨɜɨɝ ɩɪɢɥɚɝɨђɚɜɚʃɚ ɨɤɨɥɧɨɫɬɢɦɚ ɢ ɭɫɬɚɧɨɜɢ ɭ ɤɨʁɨʁ ɫɟ ɩɪɢɦɟʃɭʁɭ. ɋɦɟɪɧɢɰɟ ɡɚ ɥɟɱɟʃɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɩɪɟɞɥɚɠɭ ɩɪɢɦɟɧɭ ɦɟɬɨɞɚ ɡɚ ɫɬɪɚɬɢɮɢɤɚɰɢʁɭ ɪɢɡɢɤɚ, ɬɚɤɨђɟ ɢ ɭ ɭɫɬɚɧɨɜɚɦɚ ɭɪɝɟɧɬɧɨɝ ɡɛɪɢʃɚɜɚʃɚ ɢ ɥɟɱɟʃɚ, ɚɥɢ ɧɟ ɩɪɟɰɢɡɢɪɚʁɭ ɦɟɫɬɨ ɝɞɟ ʁɟ ʃɢɯɨɜɚ ɩɪɢɦɟɧɚ ɢɧɞɢɤɨɜɚɧɚ ɢɥɢ ɧɟ. ɍ ɩɨɩɭɥɚɰɢʁɢ ɜɢɫɨɤɨɝ ɪɢɡɢɤɚ, ɤɚɤɜɢ ɫɭ ɩɚɰɢʁɟɧɬɢ ɫɚ ɛɪɨʁɧɢɦ ɤɨɦɨɪɛɢɞɢɬɟɬɢɦɚ, ɫɤɚɥɟ ɡɚ ɩɪɨɰɟɧɭ ɪɢɡɢɤɚ ɦɨɝɭ ɩɨɬɰɟɧɢɬɢ ɪɢɡɢɤ ɨɞ ɦɨɪɬɚɥɢɬɟɬɚ, ɞɨɤ ɭ ɨɤɪɭɠɟʃɭ ɩɚɰɢʁɟɧɚɬɚ ɧɢɫɤɨɝ ɪɢɡɢɤɚ (ɩɪɢɦɚɪɧɚ ɡɞɪɚɜɫɬɜɟɧɚ ɡɚɲɬɢɬɚ), ɩɪɟɞɜɢђɚʃɟ ɪɢɡɢɤɚ ɦɨɠɟ ɛɢɬɢ ɧɟɚɞɟɤɜɚɬɧɨ ɜɢɫɨɤɨ. Ɉɧɨ ɲɬɨ ʁɟ ɩɨɫɟɛɧɨ ɛɢɬɧɨ, ɧɟɚɞɟɤɜɚɬɧɨ ɤɥɚɫɢɮɢɤɨɜɚɧɢ ɩɚɰɢʁɟɧɬɢ ɫɭ ɦɥɚђɢ ɭ ɨɞɧɨɫɭ ɧɚ ɤɨɪɟɤɬɧɨ ɤɥɚɫɢɮɢɤɨɜɚɧɟ ɩɚɰɢʁɟɧɬɟ. Ʉɚɤɨ ʁɟ, ɢ ɩɪɟɦɚ ɨɜɨʁ ɚɧɚɥɢɡɢ, ɫɬɚɪɨɫɬ ɧɚʁʁɚɱɢ ɩɪɟɞɢɤɬɨɪ ɭ ɫɤɨɪɨɜɢɦɚ ɪɢɡɢɤɚ, ɪɢɡɢɤ ɤɨɞ ɦɥɚђɢɯ ɛɨɥɟɫɧɢɤɚ ɦɨɠɟ ɛɢɬɢ ɡɧɚɱɚʁɧɨ ɩɨɬɰɟʃɟɧ ɭ ɨɤɪɭɠɟʃɭ ɩɚɰɢʁɟɧɚɬɚ ɜɢɫɨɤɨɝ ɪɢɡɢɤɚ. Ⱥɭɬɨɪɢ ɫɭ ɨɜɨɦ ɚɧɚɥɢɡɨɦ ɨɛɭɯɜɚɬɢɥɢ ɪɟɩɪɟɡɟɧɬɚɬɢɜɧɭ ɩɨɩɭɥɚɰɢʁɭ ɩɚɰɢʁɟɧɚɬɚ ɢɡ ɬɟɪɰɢʁɚɪɧɢɯ ɡɞɪɚɜɫɬɜɟɧɢɯ ɭɫɬɚɧɨɜɚ ɡɚɩɚɞɧɟ ȿɜɪɨɩɟ ɢ ɩɨɤɚɡɚɥɢ ɞɚ ʁɟ ɩɪɢɦɟɧɚ ɪɟɤɚɥɢɛɪɢɫɚɧɨɝ PЋI ɫɤɨɪɚ ɞɨɜɟɥɚ ɞɨ ɬɨɝɚ ɞɚ ʁɟ 11% ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɨ ɚɦɛɭɥɚɧɬɧɨ, ɩɪɟɦɚ ɩɪɢɦɟɧɢ ɪɟɤɚɥɢɛɪɢɫɚɧɨɝ PЋI ɫɤɨɪɚ, ɭ ɩɨɪɟђɟʃɭ ɫɚ 5% ɩɚɰɢʁɟɧɚɬɚ ɥɟɱɟɧɢɯ ɚɦɛɭɥɚɧɬɧɨ, ɤɨʁɢ ɫɭ ɩɪɟɞɨɦɢɧɚɧɬɧɨ ɛɢɥɢ ɝɪɭɩɢɫɚɧɢ ɭ ɤɥɚɫɟ ɧɚʁɦɚʃɟɝ ɪɢɡɢɤɚ ɩɪɟɦɚ PЋI ɢ CUЊB-65 ɫɤɨɪɨɜɢɦɚ, ɲɬɨ ɝɨɜɨɪɢ ɭ ɩɪɢɥɨɝ ɩɨɫɬɨʁɚʃɚ ɦɨɝɭʄɧɨɫɬɢ ɪɚɰɢɨɧɚɥɧɢʁɟɝ ɡɛɪɢʃɚɜɚʃɚ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ. Ɉɧɨ ɲɬɨ ʁɟ ɧɟɨɩɯɨɞɧɨ ɩɨɧɨɜɨ ɧɚɝɥɚɫɢɬɢ ʁɟ ɱɢʃɟɧɢɰɚ ɞɚ ɫɤɚɥɟ ɡɚ ɫɬɪɚɬɢɮɢɤɚɰɢʁɭ ɪɢɡɢɤɚ ɬɪɟɛɚ ɩɪɢɦɟʃɢɜɚɬɢ ɫɚɦɨ ɤɚɨ ɩɨɞɪɲɤɭ, ɚ ɧɟ ɡɚɦɟɧɭ ɡɚ ɞɨɧɨɲɟʃɟ ɨɞɥɭɤɟ ɥɟɤɚɪɚ ɨ ɦɟɫɬɭ ɡɛɪɢʃɚɜɚʃɚ ɢ ɥɟɱɟʃɚ ɩɚɰɢʁɟɧɬɚ, ɤɨʁɚ ɢ ɞɚʂɟ ɨɫɬɚʁɟ „ɭɦɟɬɧɨɫɬ ɦɟɞɢɰɢɧɟ“121,122. ɂ ɩɨɪɟɞ ɪɟɥɚɬɢɜɧɨ ɦɚɥɨɝ ɛɪɨʁɚ ɞɨɝɚђɚʁɚ ɡɚ ɫɩɪɨɜɨђɟʃɟ ɟɤɫɬɟɪɧɟ ɜɚɥɢɞɚɰɢʁɟ ɪɟɤɚɥɢɛɪɢɫɚɧɢɯ ɫɤɨɪɨɜɚ123 ɢ ɩɪɨɫɩɟɤɬɢɜɧɨɝ ɩɪɚʄɟʃɚ ɩɚɰɢʁɟɧɚɬɚ, ɲɬɨ ɩɪɟɞɫɬɚɜʂɚʁɭ ɨɝɪɚɧɢɱɟʃɚ ɨɜɢɯ ɫɬɭɞɢʁɚ, ʁɚɫɧɨ ɫɟ ɢɫɬɢɱɟ ɡɚɤʂɭɱɚɤ ɞɚ ɫɭ PЋI ɢ CUЊB-65 ɫɤɨɪɨɜɢ ɢɦɚɥɢ ɬɟɧɞɟɧɰɢʁɭ ɞɚ ɩɨɝɪɟɲɧɨ ɤɥɚɫɢɮɢɤɭʁɭ ɩɚɰɢʁɟɧɬɟ ɫɚ ɡɧɚɱɚʁɧɢɦ ɦɨɪɬɚɥɢɬɟɬɨɦ ɭ ɝɪɭɩɭ ɩɚɰɢʁɟɧɚɬɚ ɧɢɫɤɨɝ ɪɢɡɢɤɚ, ɭ ɬɟɪɰɢʁɚɪɧɢɦ ɡɞɪɚɜɫɬɜɟɧɢɦ ɭɫɬɚɧɨɜɚɦɚ ɡɚɩɚɞɧɟ ȿɜɪɨɩɟ. ɉɪɟɞɥɨɠɟɧɚ ɪɟɤɚɥɢɛɪɚɰɢʁɚ, ɢɚɤɨ ɞɨɫɬɚ ɤɨɦɥɟɤɫɧɚ, ɢɫɩɪɚɜɢɥɚ ʁɟ ɩɨɝɪɟɲɧɭ ɤɥɚɫɢɮɢɤɚɰɢʁɭ ɭ ɫɜɢɦ 124 ɦɨɞɟɥɢɦɚ, ɚɥɢ ʁɟ ɫɚɦɨ ɡɚ PЋI ɭɬɜɪђɟɧɨ ɞɚ ʁɟ ɞɨɜɨʂɧɨ ɫɟɧɡɢɬɢɜɚɧ ɞɚ ɩɪɟɰɢɡɧɨ ɢɞɟɧɬɢɮɢɤɭʁɟ ɩɚɰɢʁɟɧɬɟ ɧɢɫɤɨɝ ɪɢɡɢɤɚ. ɋɬɨɝɚ ɫɟ ɦɨɠɟ ɞɚɬɢ ɩɪɟɩɨɪɭɤɚ ɡɚ ɩɪɢɦɟɧɭ PЋI ɫɤɨɪɚ ɡɚ ɩɪɨɰɟɧɭ ɪɢɡɢɤɚ ɢ ɪɚɡɦɚɬɪɚʃɟ ɚɦɛɭɥɚɧɬɧɨɝ ɥɟɱɟʃɚ ɤɨɞ ɩɚɰɢʁɟɧɚɬɚ ɫɜɪɫɬɚɧɢɯ ɭ ɤɥɚɫɭ I ɩɪɟɦɚ PЋI ɫɤɨɪɭ. ɂɩɚɤ, ɢ ɪɟɤɚɥɢɛɪɢɫɚɧɟ ɩɪɨɰɟɧɟ ɡɚɯɬɟɜɚʁɭ ɞɚʂɟ ɜɚɥɢɞɚɰɢʁɟ ɢ ɭɧɚɩɪɟђɢɜɚʃɟ. ɍɤɨɥɢɤɨ ɫɟ ɜɪɚɬɢɦɨ ɚɧɚɥɢɡɢ ɤɨɪɟɥɚɰɢʁɚ ɭ ɧɚɲɨʁ ɫɬɭɞɢʁɢ, ɡɚɩɚɠɚ ɫɟ ɞɚ ʁɟ ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ, ɜɟɨɦɚ ʁɚɤɚ ɢ ɩɨɡɢɬɢɜɧɚ, ɧɚђɟɧɚ ɢɡɦɟђɭ ɞɜɟʁɭ ɫɤɚɥɚ, ɢɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ-PЋI ɢ CUЊB-65 ɫɤɚɥɟ (0,663*) (Ɍɚɛɟɥɚ 21, Ƚɪɚɮɢɤɨɧ 8). ɒɬɨ ɫɟ ɬɢɱɟ ɤɨɪɟɥɚɰɢʁɟ ɜɢɫɢɧɟ ɬɪɨɲɤɨɜɚ ɫɚ ɨɜɢɦ ɫɤɚɥɚɦɚ, ɧɚђɟɧɚ ʁɟ ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ ɢɡɦɟђɭ ɜɢɫɢɧɟ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɢ ɨɛɟ ɫɤɚɥɟ, ɲɬɨ ɭɤɚɡɭʁɟ ɧɚ ʃɢɯɨɜ ɤɚɩɚɰɢɬɟɬ ɩɪɟɞɢɤɰɢʁɟ ɜɢɫɢɧɟ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɭɡɪɨɤɨɜɚɧɢɯ ɨɜɨɦ ɛɨɥɟɲʄɭ. Ʉɨɪɟɥɚɰɢʁɟ ɩɨʁɟɞɢɧɢɯ ɩɨɞɝɪɭɩɚ ɬɪɨɲɤɨɜɚ ɫɚ ɫɤɚɥɚɦɚ ɫɭ ɭɝɥɚɜɧɨɦ ɫɥɚɛɟ (Ɍɚɛɟɥɚ 22). ɂɫɯɨɞ ɥɟɱɟʃɚ ʁɟ ɭ ɤɨɪɟɥɚɰɢʁɢ ɫɚ ɫɤɚɥɚɦɚ. ɉɪɨɫɟɱɧɢ ɬɪɨɲɤɨɜɢ ɫɭ ɜɟʄɢ ɤɨɞ ɩɪɟɠɢɜɟɥɢɯ ɩɚɰɢʁɟɧɚɬɚ, ɭɝɥɚɜɧɨɦ ɭ ɫɜɢɦ ɤɚɬɟɝɨɪɢʁɚɦɚ, ɚ ɡɧɚɱɚʁɧɨ ɫɭ ɜɟʄɢ ɭ ɝɪɭɩɢ ɜɢɡɭɚɥɢɡɚɰɢɨɧɟ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɞɢʁɚɝɧɨɫɬɢɤɟ ɢ ɩɪɟɝɥɟɞɚ ɥɟɤɚɪɚ ɢ ɯɢɪɭɪɲɤɢɯ ɭɫɥɭɝɚ. Ȼɨɥɟɫɧɢɰɢ ɤɨʁɢ ɫɭ ɭɦɪɥɢ ɫɭ ɩɪɨɫɟɱɧɨ ɛɨɪɚɜɢɥɢ ɤɪɚʄɟ ɭ ɛɨɥɧɢɰɢ (9,00±4,64 ɞɚɧɚ ɩɪɟɦɚ 14,93±7,08 ɞɚɧɚ, ɤɨɞ ɩɪɟɠɢɜɟɥɢɯ ɩɚɰɢʁɟɧɚɬɚ), ɲɬɨ ʁɟ ɩɨɜɟɡɚɧɨ ɫɚ ɦɚʃɢɦ ɬɪɨɲɤɨɜɢɦɚ (ɭɤɭɩɚɧ ɬɪɨɲɚɤ ʁɟ ɢɡɧɨɫɢɨ 130.153,16±77.731,57 ɩɨ ɩɪɟɠɢɜɟɥɨɦ ɩɚɰɢʁɟɧɬɭ, ɞɨɤ ʁɟ ɢɫɬɢ ɬɪɨɲɚɤ ɩɨ ɩɚɰɢʁɟɧɬɭ ɭɦɪɥɨɦ ɭ ɬɨɤɭ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ ɢɡɧɨɫɢɨ 106.821,92±51.729,96) (Ɍɚɛɟɥɚ 23, Ƚɪɚɮɢɤɨɧ 9). Јɚɤɚ ɢ ɩɨɡɢɬɢɜɧɚ ɤɨɪɟɥɚɰɢʁɚ ɧɚђɟɧɚ ʁɟ ɢɡɦɟђɭ ɢɫɯɨɞɚ ɥɟɱɟʃɚ, ɞɭɠɢɧɟ ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɟ (Ɍɚɛɟɥɚ 24) ɢ ɞɢɪɟɤɬɧɢɯ ɦɟɞɢɰɢɧɫɤɢɯ, ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɢ ɫɭɦɟ ɫɜɢɯ ɬɪɨɲɤɨɜɚ (Ɍɚɛɟɥɚ 25). ɂɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɬɚɤɨђɟ ɤɨɪɟɥɢɪɚ ɢ ɫɚ ɝɥɚɜɧɢɦ ɩɨɞɝɪɭɩɚɦɚ ɬɪɨɲɤɨɜɚ (ɥɟɤɨɜɢ, ɦɟɞɢɰɢɧɫɤɢ ɤɢɫɟɨɧɢɤ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ ɢ ɜɢɡɭɚɥɢɡɚɰɢɨɧɚ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɚ ɞɢʁɚɝɧɨɫɬɢɤɚ). Ɍɚɤɨђɟ ʁɟ ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɤɨɪɟɥɚɰɢʁɢ ɢ ɫɚ ɭɤɭɩɧɢɦ ɛɪɨʁɟɦ ɩɪɭɠɟɧɢɯ ɭɫɥɭɝɚ (Ɍɚɛɟɥɚ 26). Ʉɨɪɟɥɚɰɢʁɚ ɛɪɨʁɚ ɞɢʁɚɝɧɨɫɬɢɱɤɢɯ ɩɪɨɰɟɞɭɪɚ ɫɚ ɢɧɞɟɤɫɨɦ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ ɢ CUЊB-65 ɫɤɚɥɨɦ ɭɝɥɚɜɧɨɦ ʁɟ ɧɟɡɧɚɱɚʁɧɚ ɢ ɫɥɚɛɚ (Ɍɚɛɟɥɚ 27), ɚ ɬɚɤɨђɟ ɢ ɫɚ ɤɨɦɩɥɢɤɚɰɢʁɚɦɚ (Ɍɚɛɟɥɚ 28). Ⱥɧɚɥɢɡɢɪɚʁɭʄɢ ɤɨɦɩɥɢɤɚɰɢʁɟ, ɡɚɩɚɠɚ ɫɟ ɢɩɚɤ ɞɚ ɩɨɫɬɨʁɢ ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ ɢɡɦɟђɭ ɩɨʁɚɜɟ ɚɩɫɰɟɫɚ ɩɥɭʄɚ ɢ ɫɭɦɟ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ (0,246*), ʁɟɪ ʁɟ ɩɨɡɧɚɬɨ ɞɚ ɥɟɱɟʃɟ 125 ɚɩɫɰɟɫɚ ɩɥɭʄɚ ɞɭɝɨ ɬɪɚʁɟ ɢ ɡɚɯɬɟɜɚ ɩɪɨɞɭɠɟɧɨ ɥɟɱɟʃɟ ɚɧɬɢɛɢɨɬɢɰɢɦɚ ɢ ɩɪɨɞɭɠɟɧɭ ɧɟɝɭ, ɤɚɨ ɢ ɞɭɠɢ ɩɟɪɢɨɞ ɨɞɫɭɫɬɜɨɜɚʃɚ ɛɨɥɟɫɧɢɤɚ ɫɚ ɩɨɫɥɚ ɢ ɫɚɦɢɦ ɬɢɦ, ɩɨɜɟʄɚɧɟ ɢɧɞɢɪɟɤɬɧɟ ɬɪɨɲɤɨɜɟ. ɋɥɢɱɧɚ ɫɢɬɭɚɰɢʁɚ ʁɟ ɢ ɫɚ ɛɭɛɪɟɠɧɨɦ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɨɦ (-0,244*), ɞɨɤ ʁɟ ɡɚɩɚɠɟɧɚ ɢ ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ ɢɡɦɟђɭ ɩɪɢɫɭɫɬɜɚ ɚɪɬɟɪɢʁɫɤɟ ɨɤɫɢɝɟɧɚɰɢʁɟ <7,98 ФPК, ɨɞɧɨɫɧɨ ɪɟɫɩɢɪɚɬɨɪɧɟ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɟ ɢ ɢɡɧɨɫɚ ɬɪɨɲɤɨɜɚ ɡɞɪɚɜɫɬɜɟɧɟ ɧɟɝɟ (0,303*), ɨɞɧɨɫɧɨ (0,346*), ɲɬɨ ʁɟ ʁɚɫɧɨ ɨɛʁɚɲʃɢɜɨ ɱɢʃɟɧɢɰɨɦ ɞɚ ɫɭ ɭ ɩɢɬɚʃɭ ɧɚʁɬɟɠɢ ɛɨɥɟɫɧɢɰɢ ɤɨʁɢ ɢ ɢɡɢɫɤɭʁɭ ɧɚʁɜɟʄɭ ɢ ɧɚʁɤɨɦɩɥɟɤɫɧɢʁɭ ɧɟɝɭ ɨɞ ɫɬɪɚɧɟ ɡɞɪɚɜɫɬɜɟɧɨɝ ɨɫɨɛʂɚ. ɍɤɨɥɢɤɨ ɫɟ ɚɧɚɥɢɡɢɪɚ ɤɨɪɟɥɚɰɢʁɚ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɫɚ ɤɨɦɨɪɛɢɞɢɬɟɬɢɦɚ ɢ ɮɚɤɬɨɪɢɦɚ ɪɢɡɢɤɚ (Ɍɚɛɟɥɚ 29), ɡɚɩɚɠɚ ɫɟ ɩɨɫɬɨʁɚʃɟ ɡɧɚɱɚʁɧɟ ɤɨɪɟɥɚɰɢʁɟ ɢɡɦɟђɭ ɨɛɨʂɟʃɚ ɤɨɪɨɧɚɪɧɢɯ ɚɪɬɟɪɢʁɚ ɢ ɜɢɫɢɧɟ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ (0,254*), ɤɚɨ ɢ ɬɪɨɲɤɨɜɚ ɩɪɟɝɥɟɞɚ ɥɟɤɚɪɚ (0,243*). Ʉɨɞ ɛɨɥɟɫɧɢɤɚ ɫɚ ɩɪɟɩɨɫɬɨʁɟʄɨɦ ɛɭɛɪɟɠɧɨɦ ɢɧɫɭɮɢɰɢʁɟɧɰɢʁɨɦ, ɩɨɫɬɨʁɢ ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ ɫɚ ɧɢɜɨɨɦ ɬɪɨɲɤɨɜɚ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɢ ɜɢɡɭɟɥɢɡɚɰɢɨɧɟ ɞɢʁɚɝɧɨɫɬɢɤɟ (0,211*), ɞɨɤ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɫɚ ɚɪɬɟɪɢʁɫɤɨɦ ɯɢɩɟɪɬɟɧɡɢʁɨɦ, ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ ɩɨɫɬɨʁɢ ɫɚ ɜɢɫɢɧɨɦ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ (-0,292*). Ɉɧɨ ɲɬɨ ɫɟ ʁɚɫɧɨ ɡɚɩɚɠɚ ʁɟ ɞɚ ɭ ɤɚɬɟɝɨɪɢʁɢ ɩɚɰɢʁɟɧɚɬɚ, ɤɨɧɡɭɦɟɧɚɬɚ ɚɥɤɨɯɨɥɚ ɭ ɟɤɫɰɟɫɢɜɧɢɦ ɤɨɥɢɱɢɧɚɦɚ, ɩɨɫɬɨʁɢ ɡɧɚɱɚʁɧɚ ɤɨɪɟɥɚɰɢʁɚ ɭ ɜɢɲɟ ɤɚɬɟɝɨɪɢʁɚ: ɜɢɫɢɧɟ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ (0,218*), ɫɭɦɟ ɫɜɢɯ ɬɪɨɲɤɨɜɚ (0,204*), ɚɥɢ ɢ ɭ ɤɚɬɟɝɨɪɢʁɚɦɚ ɬɪɨɲɤɨɜɚ ɜɢɡɭɟɥɢɡɚɰɢɨɧɟ ɢ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɞɢʁɚɝɧɨɫɬɢɤɟ (0,261*) ɢ ɬɪɨɲɤɨɜɚ ɩɪɟɝɥɟɞɚ ɥɟɤɚɪɚ ɢ ɯɢɪɭɪɲɤɢɯ ɭɫɥɭɝɚ (0,203*), ɲɬɨ ʁɨɲ ʁɟɞɧɨɦ ɭɤɚɡɭʁɟ ɧɚ ɜɢɲɟɫɬɪɭɤɢ ɧɟɝɚɬɢɜɧɢ ɭɬɢɰɚʁ ɤɨʁɢ ɨɜɚ ɛɨɥɟɫɬ ɡɚɜɢɫɧɨɫɬɢ ɧɨɫɢ ɫɚ ɫɨɛɨɦ. Ⱥɤɨ ɫɟ ɚɧɚɥɢɡɢɪɚ ɩɨɬɪɨɲʃɚ ɥɟɤɨɜɚ ɢɡɪɚɠɟɧɚ ɭɡ ɩɨɦɨʄ ɞɟɮɢɧɢɫɚɧɢɯ ɞɧɟɜɧɢɯ ɞɨɡɚ (Ɍɚɛɟɥɚ 30), ɨɧɞɚ ʁɟ ɧɚʁɜɟʄɚ ɩɨɬɪɨɲʃɚ ɚɦɢɧɨɮɢɥɢɧɚ, ɰɟɮɬɚɡɢɞɢɦɚ, ɥɟɜɨɮɥɨɤɫɚɰɢɧɚ, ɚɡɢɬɪɨɦɢɰɢɧɚ, ɚɦɢɤɚɰɢɧɚ, ɟɪɬɚɩɟɧɟɦɚ, ɦɟɬɢɥɩɪɟɞɧɢɡɨɥɨɧɚ ɢ ɢɛɭɩɪɨɮɟɧɚ. ȼɟɥɢɤɚ ʁɟ ɩɨɬɪɨɲʃɚ ɢ ɩɚɪɟɧɬɟɪɚɥɧɢɯ ɪɚɫɬɜɨɪɚ ɧɚɬɪɢʁɭɦ-ɯɥɨɪɢɞɚ, ɝɥɭɤɨɡɟ ɢ ɪɢɧɝɟɪ-ɥɚɤɬɚɬɚ. ɂ ɞɨɤ ɫɟ ɭɱɟɫɬɚɥɚ ɩɪɢɦɟɧɚ ɧɚɜɟɞɟɧɢɯ ɥɟɤɨɜɚ ɭ ɜɟʄɢɧɢ ɫɥɭɱɚʁɟɜɚ ɦɨɠɟ ɨɩɪɚɜɞɚɬɢ ɨɛʁɟɤɬɢɜɧɨ ɩɪɢɫɭɬɧɢɦ ɢɧɞɢɤɚɰɢʁɚɦɚ ɡɚ ʃɢɯɨɜɭ ɩɪɢɦɟɧɭ, ɬɟɲɤɨ ɫɟ ɦɨɠɟ ɨɩɪɚɜɞɚɬɢ ɭɱɟɫɬɚɥɚ ɩɪɢɦɟɧɚ ɰɟɮɬɚɡɢɞɢɦɚ, ɤɨʁɢ ɩɪɢɩɚɞɚ ɝɪɭɩɢ ɰɟɮɚɥɨɫɩɨɪɢɧɚ ɬɪɟʄɟ ɝɟɧɟɪɚɰɢʁɟ ɫɚ ɚɧɬɢɩɫɟɭɞɨɦɨɧɚɫɧɨɦ ɚɤɬɢɜɧɨɲʄɭ, ɬɟ ʁɟ ɪɟɡɟɪɜɧɢ ɚɧɬɢɛɢɨɬɢɤ ɱɢʁɚ ʁɟ ɩɪɢɦɟɧɚ ɨɩɪɚɜɞɚɧɚ ɭ ɫɥɭɱɚʁɟɜɢɦɚ ɢɧɮɟɤɰɢʁɚ ɤɨʁɟ ɨɫɬɚʁɭ ɛɟɡ ɡɚɞɨɜɨʂɚɜɚʁɭʄɟɝ ɤɥɢɧɢɱɤɨɝ ɨɞɝɨɜɨɪɚ ɧɚ ɩɪɢɦɟɧɭ ɢɧɰɢʁɚɥɧɨ ɭɜɟɞɟɧɟ ɚɧɬɢɛɢɨɬɫɤɟ ɬɟɪɚɩɢʁɟ, ɢɥɢ ɡɚ ɩɪɢɦɟɧɭ ɩɪɟɦɚ ɚɧɬɢɛɢɨɝɪɚɦɭ ɞɨɛɢʁɟɧɨɦ ɤɭɥɬɢɜɚɰɢʁɨɦ ɛɢɨɥɨɲɤɨɝ ɭɡɨɪɤɚ, ɚɥɢ ɧɟ ɢ ɡɚ ɢɧɢɰɢʁɚɥɧɨ ɭɜɟɞɟɧɭ ɟɦɩɢɪɢʁɫɤɭ ɬɟɪɚɩɢʁɭ. 126 Ⱥɤɨ ɫɟ ɚɧɚɥɢɡɢɪɚ ɭɞɟɨ ɩɪɨɫɟɱɧɢɯ ɬɪɨɲɤɨɜɚ ɩɨ ɩɚɰɢʁɟɧɬɭ, ɩɪɟɦɚ ɤɨɪɢɲʄɟɧɢɦ ɫɤɚɥɚɦɚ, ɨɧɞɚ ɫɟ ɜɢɞɢ ɞɚ ɫɭ ɧɚʁɜɟʄɢ ɬɪɨɲɤɨɜɢ ɢɡ ɝɪɭɩɚ ɧɟɤɥɚɫɢɮɢɤɨɜɚɧɢɯ ɭɫɥɭɝɚ ɤɨʁɟ ɫɭ ɩɨɜɟɡɚɧɟ ɫɚ ɥɟɱɟʃɟɦ ɩɧɟɭɦɨɧɢʁɟ (ɞɢʁɚɝɧɨɫɬɢɤɚ ɢ ɥɟɱɟʃɟ ɤɨɦɨɪɛɢɞɢɬɟɬɚ) ɢ ɚɧɬɢɢɧɮɟɤɬɢɜɧɢɯ ɥɟɤɨɜɚ ɡɚ ɫɢɫɬɟɦɫɤɭ ɩɪɢɦɟɧɭ, ɢ ɬɨ ɭ ɫɜɢɦ ɤɚɬɟɝɨɪɢʁɚɦɚ ɩɪɟɦɚ ɨɛɟ ɫɤɚɥɟ ɡɚ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɤɥɢɧɢɱɤɟ ɫɥɢɤɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ (Ƚɪɚɮɢɤɨɧɢ 10, 11). ɇɚ ɨɫɧɨɜɭ ɪɟɝɪɟɫɢɨɧɟ ɚɧɚɥɢɡɟ ɧɢʁɟ ɞɨɛɢʁɟɧ ɡɧɚɱɚʁɚɧ ɦɨɞɟɥ, ɞɚ ɛɢɥɨ ɤɨʁɢ ɮɚɤɬɨɪ ɡɧɚɱɚʁɧɨ ɭɬɢɱɟ ɧɚ ɢɫɯɨɞ ɥɟɱɟʃɚ ɨɛɨɥɟɥɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. Јɟɞɢɧɢ ɡɧɚɱɚʁɧɢ ɮɚɤɬɨɪ ɤɨʁɢ ʁɟ ɩɨɜɟɡɚɧ ɫɚ ɢɫɯɨɞɨɦ ɥɟɱɟʃɚ ʁɟɫɬɟ ɪɟɡɭɥɬɚɬ ɢɧɢɰɢʁɚɥɧɟ ɩɪɨɰɟɧɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɩɪɟɦɚ CURB-65 ɫɤɚɥɢ (odds ratio 12,60). ɋɜɢ ɭɦɪɥɢ ɫɭ ɛɢɥɢ ɫɜɪɫɬɚɧɢ ɭ ɤɚɬɟɝɨɪɢʁɟ 2 ɢ 3, ɨɞɧɨɫɧɨ ɛɢɥɢ ɫɭ ɩɪɨɰɟʃɟɧɢ ɤɚɨ ɫɪɟɞʃɟ ɬɟɲɤɢ ɢ ɬɟɲɤɢ ɛɨɥɟɫɧɢɰɢ (Ɍɚɛɟɥɚ 31). ɇɚ ɨɫɧɨɜɭ ɪɟɝɪɟɫɢɨɧɟ ɚɧɚɥɢɡɟ ɧɢʁɟ ɞɨɛɢʁɟɧ ɡɧɚɱɚʁɚɧ ɦɨɞɟɥ, ɧɢɬɢ ʁɟɞɚɧ ɮɚɤɬɨɪ, ɞɚ ɡɧɚɱɚʁɧɨ ɭɬɢɱɟ ɧɚ ɢɫɯɨɞ ɥɟɱɟʃɚ ɨɛɨɥɟɥɢɯ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɧɢ ɭ ɝɪɭɩɢ ɝɥɚɜɧɢɯ ɤɚɬɟɝɨɪɢʁɚ ɢ ɩɨɞɤɚɬɟɝɨɪɢʁɚ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɢ ɞɭɠɢɧɟ ɬɪɚʁɚʃɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ (Ɍɚɛɟɥɚ 32), ɤɚɨ ɧɢ ɭ ɤɚɬɟɝɨɪɢʁɚɦɚ ɩɭɲɚɱɤɨɝ ɫɬɚɬɭɫɚ, ɜɚɤɰɢɧɚɰɢʁɟ ɩɪɨɬɢɜ ɜɢɪɭɫɚ ɝɪɢɩɚ ɢ ɩɧɟɭɦɨɤɨɤɚ, ɠɢɜɨɬɚ ɭ ɫɬɚɪɚɱɤɨɦ ɞɨɦɭ ɢ ɞɭɠɢɧɟ ɬɪɚʁɚʃɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ (Ɍɚɛɟɥɚ 33). 127 8. ɁȺɄȴɍɑȺɄ ɉɪɟɞɫɬɚɜʂɟɧɢ ɪɟɡɭɥɬɚɬɢ ɫɭ ɩɪɜɢ ɩɢɨɧɢɪɫɤɢ ɩɨɤɭɲɚʁ ɫɚ ɰɢʂɟɦ ɚɧɚɥɢɡɟ ɤɨɪɢɲʄɟʃɚ ɪɟɫɭɪɫɚ, ɬɪɨɲɤɨɜɚ ɢ ɤɥɢɧɢɱɤɟ ɩɪɚɤɫɟ ɭ ɥɟɱɟʃɭ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɋɪɛɢʁɢ63. Ɍɚɤɜɢ ɩɨɞɚɰɢ ɜɟʄ ɩɨɫɬɨʁɟ ɭ ɧɟɤɢɦ ɪɚɡɜɢʁɟɧɢɦ ɡɟɦʂɚɦɚ26. Ɂɚɫɚɞ ɩɨɫɬɨʁɢ ɫɚɦɨ ɧɟɤɨɥɢɤɨ ɥɨɤɚɥɧɨ ɩɭɛɥɢɤɨɜɚɧɢɯ ɫɬɭɞɢʁɚ ɨ ɬɪɨɲɤɨɜɢɦɚ ɛɨɥɟɫɬɢ, ɤɨʁɟ ɫɭ ɫɟ ɛɚɜɢɥɟ ɯɪɨɧɢɱɧɨɦ ɨɩɫɬɪɭɤɬɢɜɧɨɦ ɛɨɥɟɲʄɭ ɩɥɭʄɚ (ɏɈȻɉ), ɩɨɬɜɪɞɢɜɲɢ ɜɟɥɢɤɢ ɡɧɚɱɚʁ ɢ ɭɬɢɰɚʁ ɤɨʁɢ ɢɦɚʁɭ ɬɪɨɲɤɨɜɢ ɪɟɫɩɢɪɚɬɨɪɧɢɯ ɢɧɮɟɤɰɢʁɚ. Ɍɚɤɨђɟ ʁɟ ɩɨɬɜɪђɟɧɨ ɢ ɞɚ ɫɬɚɞɢʁɭɦ ɛɨɥɟɫɬɢ ɩɨ GOLD ɤɥɚɫɢɮɢɤɚɰɢʁɢ ɢɦɚ ɭɬɢɰɚʁɚ ɧɚ ɜɢɫɢɧɭ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɛɨɥɟɫɬɢ124. Ɂɚɫɚɞ ɫɭ, ʁɨɲ ɭɜɟɤ ɪɟɬɤɚ ɩɨɪɟђɟʃɚ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɯɪɨɧɢɱɧɟ ɨɩɫɬɪɭɤɬɢɜɧɟ ɛɨɥɟɫɬɢ ɩɥɭʄɚ ɢɡɦɟђɭ ɞɪɠɚɜɚ, ɤɨʁɚ ɛɢ ɨɦɨɝɭʄɢɥɚ ɭɜɢɞ ɭ ɝɥɚɜɧɟ ɞɟɬɟɪɦɢɧɚɧɬɟ ɬɪɨɲɤɨɜɚ ɢ ʁɟɞɢɧɫɬɜɟɧɚ ɧɚɰɢɨɧɚɥɧɚ ɡɞɪɚɜɫɬɜɟɧɨ-ɫɢɫɬɟɦɫɤɚ ɨɤɪɭɠɟʃɚ125. ɍ ɩɨɪɟђɟʃɭ ɫɚ ɪɟɡɭɥɬɚɬɢɦɚ ɪɚɫɩɨɥɨɠɢɜɢɯ ɫɬɭɞɢʁɚ ɫɩɪɨɜɟɞɧɢɯ ɭ ȿɜɪɨɩɢ ɢ ɫɜɟɬɭ, ɞɢɪɟɤɬɧɢ ɢ ɭɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɤɨɞ ɧɚɫ ɫɭ ɧɢɠɢ26,27,28,29,32,33,34,35,36,45. Ʉɨɧɜɟɪɬɨɜɚɧɢ ɭ ɟɭɪɨ, ɩɪɟɦɚ ɫɪɟɞʃɟɦ ɤɭɪɫɭ ɇȻɋ ɡɚ ɚɧɚɥɢɡɢɪɚɧɢ ɩɟɪɢɨɞ, ɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɩɨ ɩɚɰɢʁɟɧɬɭ ɫɭ ɢɡɧɨɫɢɥɢ 696 ± 531 ɟɜɪɚ (30-589) (M+/-ɋȾ; CI 95%); ɢɧɞɢɪɟɤɬɧɢ 410 ± 283 ɟɜɪɚ (353-467), ɞɨɤ ɫɭ ɩɪɨɫɟɱɧɢ ɭɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ɢɡɧɨɫɢɥɢ 1,106 ± 657 ɟɜɪɚ (974-1,238). Ʉɨɦɛɢɧɨɜɚɧɢ ɭɤɭɩɧɢ ɬɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɱɢɬɚɜɟ ɚɧɚɥɢɡɢɪɚɧɟ ɝɪɭɩɟ ɩɚɰɢʁɟɧɚɬɚ ɫɭ ɢɡɧɨɫɢɥɢ 105.087 ɟɜɪɚ (66,109 ɞɢɪɟɤɬɧɢɯ ɢ 38,979 ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ). ɍɤɨɥɢɤɨ ɫɟ ɞɨɛɢʁɟɧɢ ɪɟɡɭɥɬɚɬɢ ɭɩɨɪɟɞɟ ɫɚ ɪɟɡɭɥɬɚɬɢɦɚ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɢɫɬɟ ɛɨɥɟɫɬɢ 2009. ɝɨɞɢɧɟ ɭ ɑɟɲɤɨʁ, ɋɥɨɜɚɱɤɨʁ, ɉɨʂɫɤɨʁ ɢ Ɇɚђɚɪɫɤɨʁ, ɨɛʁɚɜʂɟɧɢɦ ɭ ɫɬɭɞɢʁɢ TТМСШpКНК ɢ ɫɚɪɚɞɧɢɤɚ37 2013. ɝɨɞɢɧɟ, ʁɚɫɧɨ ɫɟ ɭɨɱɚɜɚ ɞɚ ɫɭ ɭ ɫɜɢɦ ɧɚɜɟɞɟɧɢɦ ɡɟɦʂɚɦɚ ɬɢ ɬɪɨɲɤɨɜɢ ɧɢɠɢ ɭ ɩɨɪɟђɟʃɭ ɫɚ ɧɚɲɢɦ ɪɟɡɭɥɬɚɬɢɦɚ, ɢɡɭɡɟɜ ɋɥɨɜɚɱɤɟ, ɝɞɟ ɫɭ ɧɟɲɬɨ ɜɢɲɢ (ɭɤɭɩɧɢ 1479 ɟɜɪɚ, ɞɢɪɟɤɬɧɢ 1044 ɟɜɪɚ). Ȼɭɞɭʄɢ ɞɚ ɫɚ ɧɚɜɟɞɟɧɢɦ ɞɪɠɚɦɚ ɢɦɚɦɨ ɛɪɨʁɧɟ ɛɥɢɫɤɨɫɬɢ, ɡɧɚɱɚʁɧɨ ɜɢɲɟ ɧɟɝɨ ɫɚ ɧɟɤɢɦ ɞɪɭɝɢɦ ɞɪɠɚɜɚɦɚ ȿɜɪɨɩɟ ɢ ɫɜɟɬɚ, ɱɢʁɢ ɫɭ ɧɚɦ ɪɟɡɭɥɬɚɬɢ ɫɥɢɱɧɢɯ ɫɬɭɞɢʁɚ ɞɨɫɬɭɩɧɢ, ɩɪɟ ɫɜɟɝɚ ɭ ɩɨɝɥɟɞɭ ɝɟɨɝɪɚɮɫɤɟ ɛɥɢɡɢɧɟ, ɩɨɥɢɬɢɱɤɨ- 128 ɟɤɨɧɨɦɫɤɨɝ ɫɢɫɬɟɦɚ ɤɨʁɢ ʁɟ ɩɨɫɬɨʁɚɨ ɜɢɲɟ ɨɞ ɩɨɥɚ ɜɟɤɚ ɢ ɭ ɤɨɦɟ ɥɟɠɟ ɤɨɪɟɧɢ ɭɫɬɪɨʁɫɬɜɚ ɫɢɫɬɟɦɚ ɡɞɪɚɜɫɬɜɟɧɟ ɡɚɲɬɢɬɟ ɢ ɨɪɝɚɧɢɡɚɰɢʁɟ ɡɞɪɚɜɫɬɜɟɧɟ ɫɥɭɠɛɟ ɢ ɞɚɧɚɫ, ɚɥɢ ɢ ɩɨɫɬɬɪɚɧɡɢɰɢɨɧɟ ɬɟɲɤɨʄɟ ɢ ɪɟɫɬɪɢɤɰɢʁɟ ɭ ɢɡɞɜɚʁɚʃɢɦɚ ɡɚ ɡɞɪɚɜɫɬɜɨ, ɤɚɨ ɢ ɧɭɠɧɨɫɬ ɞɚ ɫɟ ɫɜɢ ɨɜɢ ɫɢɫɬɟɦɢ ɢ ɨɪɝɚɧɢɡɚɰɢɨɧɨ ɢ ɮɢɧɚɧɫɢʁɫɤɢ ɯɚɪɦɨɧɢɡɭʁɭ ɢ ɲɬɨ ɜɢɲɟ ɩɪɢɛɥɢɠɟ ɛɨɝɚɬɢʁɢɦ ɱɥɚɧɢɰɚɦɚ ȿɜɪɨɩɫɤɟ ɍɧɢʁɟ, ʁɚɫɧɨ ɫɟ ɧɚɦɟʄɟ ɡɚɤʂɭɱɚɤ ɞɚ ɫɭ ɬɪɨɲɤɨɜɢ ɯɨɫɩɢɬɚɥɧɨɝ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɤɨɞ ɧɚɫ ɧɟɨɩɪɚɜɞɚɧɨ ɜɢɫɨɤɢ ɢ ɞɚ ɦɨɪɚʁɭ ɩɨɫɬɨʁɚɬɢ ɧɚɱɢɧɢ ɡɚ ʃɢɯɨɜɨ ɫɦɚʃɟʃɟ. ɍɬɢɰɚʁ ɞɭɠɢɧɟ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ ɧɚ ɢɡɧɨɫ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ʁɟ ɩɨɬɜɪђɟɧ ɞɨɛɪɨ ɞɨɤɭɦɟɧɬɨɜɚɧɢɦ ɞɨɤɚɡɢɦɚ ɢɡ ɫɥɢɱɧɢɯ ɫɬɭɞɢʁɚ ɫɩɪɨɜɟɞɟɧɢɯ ɲɢɪɨɦ ɫɜɟɬɚ126. ɉɨʁɟɞɢɧɚɱɧɨ ɩɨɫɦɚɬɪɚɧɨ, ɧɚʁʁɚɱɢ ɭɬɢɰɚʁ ɧɚ ɧɢɜɨ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɢɦɚʁɭ ɬɪɨɲɤɨɜɢ ɚɩɫɟɧɬɢɡɦɚ. ɂ, ɦɚɞɚ ʁɟ ɬɚɤɜɚ ɫɬɪɭɤɬɭɪɚ ɬɪɨɲɤɨɜɚ ɱɟɫɬɚ ɭ ɩɨɝɥɟɞɭ ɜɟʄɢɧɟ ɧɟɡɚɪɚɡɧɢɯ ɛɨɥɟɫɬɢ ɭ ɪɚɡɜɢʁɟɧɢɦ ɡɟɦʂɚɦɚ127, ɦɚʃɟ ʁɟ ɱɟɫɬɚ ɤɨɞ ɡɚɪɚɡɧɢɯ ɛɨɥɟɫɬɢ ɤɪɚʄɟɝ ɬɪɚʁɚʃɚ128. ɋɥɟɞɟʄɚ ɡɧɚɱɚʁɧɚ ɫɬɚɜɤɚ ɩɪɟɦɚ ɪɟɡɭɥɬɚɬɢɦɚ ɨɜɨɝ ɢɫɬɪɚɠɢɜɚʃɚ: „ɬɪɨɲɤɨɜɢ ɞɢʁɚɝɧɨɫɬɢɤɟ ɢ ɥɟɱɟʃɚ ɤɨɦɨɪɛɢɞɢɬɟɬɚ“, ɦɨɝɭ ɫɟ ɨɛʁɚɫɧɢɬɢ ɪɚɫɬɭʄɨɦ ɢɧɰɢɞɟɧɰɨɦ ɢ ɮɢɧɚɧɫɢʁɫɤɢɦ ɨɩɬɟɪɟʄɟʃɟɦ ɯɪɨɧɢɱɧɢɦ ɧɟɡɚɪɚɡɧɢɦ ɛɨɥɟɫɬɢɦɚ ɭ ɂɫɬɨɱɧɨʁ ȿɜɪɨɩɢ. Ʌɨɤɚɥɧɢ ɩɨɞɚɰɢ ɨ ɞɢʁɚɛɟɬɟɫɭ129, ɏɈȻɉ-ɭ, ɛɨɥɟɫɬɢɦɚ ɡɚɜɢɫɧɨɫɬɢ130, ɤɚɪɰɢɧɨɦɢɦɚ131 ʁɟɞɧɨɡɧɚɱɧɨ ɭɤɚɡɭʁɭ ɧɚ ɬɨ. ɇɚɲɢ ɩɨɞɚɰɢ ɞɨɛɢʁɟɧɢ ɩɪɨɫɩɟɤɬɢɜɧɨɦ ɫɬɭɞɢʁɨɦ ɭ ɦɟɬɨɞɨɥɨɲɤɢ ɨɞɝɨɜɚɪɚʁɭʄɟɦ ɨɤɪɭɠɟʃɭ ɩɨɤɚɡɭʁɭ ɞɚ ɫɚɦɨ ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ – PЋI ɩɨɤɚɡɭʁɟ ɨɝɪɚɧɢɱɟɧɭ ɫɩɨɫɨɛɧɨɫɬ ɩɪɟɞɜɢђɚʃɚ ɜɟɪɨɜɚɬɧɨɝ ɨɛɢɦɚ ɤɨɪɢɲʄɟɧɢɯ ɭɫɥɭɝɚ. ɋɚ ɞɪɭɝɟ ɫɬɪɚɧɟ, ɢ CUЊB-65 ɢ PЋI ɩɨɤɚɡɭʁɭ ɡɚɞɨɜɨʂɚɜɚʁɭʄɭ ɩɪɟɞɢɤɬɢɜɧɭ ɜɪɟɞɧɨɫɬ ɜɨɥɭɦɟɧɚ ɬɪɨɲɤɨɜɚ ɧɚɫɬɚɥɢɯ ɭɫɥɟɞ ɢɡɝɭɛʂɟɧɟ ɩɪɨɞɭɤɬɢɜɧɨɫɬɢ. ɂɩɚɤ, ɧɢɫɦɨ ɭɫɩɟɥɢ ɞɚ ɩɨɬɜɪɞɢɦɨ ɩɨɫɬɨʁɚʃɟ ɛɢɥɨ ɤɚɤɜɟ ɩɨɭɡɞɚɧɟ ɜɟɡɟ ɢɡɦɟђɭ ɨɜɢɯ ɢɧɞɟɤɫɚ/ɫɤɚɥɚ ɡɚ ɢɧɢɰɢʁɚɥɧɭ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɢ ɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ. Ɉɜɚ ɱɢʃɟɧɢɰɚ ʁɟ, ɫɚɦɚ ɩɨ ɫɟɛɢ, ɡɚɩɪɚɜɨ ɞɨɤɚɡ ɧɟɞɨɜɨʂɧɨɝ ɩɪɢɞɪɠɚɜɚʃɚ ɫɦɟɪɧɢɰɚ ɨɞ ɫɬɪɚɧɟ ɥɟɤɚɪɚ132. ɑɢɧɢ ɫɟ ɞɚ ʁɟ ɩɪɟɤɨɦɟɪɧɚ ɭɩɨɬɪɟɛɚ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɢ ɜɢɡɭɟɥɢɡɚɰɢɨɧɟ ɞɢʁɚɝɧɨɫɬɢɤɟ, ɤɚɨ ɢ ɫɚɦɢɯ ɥɟɤɨɜɚ ɩɪɢɫɭɬɧɚ ɭ ɛɥɚɠɢɦ ɨɛɥɢɰɢɦɚ ɛɨɥɟɫɬɢ. ɍɩɨɬɪɟɛɚ ɪɚɫɩɨɥɨɠɢɜɢɯ ɪɟɫɭɪɫɚ ɢ ɜɢɫɢɧɚ ɬɪɨɲɤɨɜɚ ɭ ɬɟɠɢɦ ɫɥɭɱɚʁɟɜɢɦɚ ɛɨɥɟɫɬɢ ɫɚ ɧɟɩɪɟɞɜɢɞɢɜɢɦ ɢɫɯɨɞɢɦɚ ɥɟɱɟʃɚ ɩɪɟɱɟɫɬɨ ɫɟ ɩɪɢɛɥɢɠɚɜɚ ɩɪɟɬɯɨɞɧɢɦ. Ɍɚɤɨђɟ, ɭɤɭɩɧɢ 129 ɬɪɨɲɤɨɜɢ ɥɟɱɟʃɚ ɛɨɥɟɫɧɢɤɚ ɦɥɚђɢɯ ɨɞ 50 ɝɨɞɢɧɚ ɝɨɬɨɜɨ ɫɭ ʁɟɞɧɚɤɢ ɬɪɨɲɤɨɜɢɦɚ ɥɟɱɟʃɚ ɛɨɥɟɫɧɢɤɚ ɫɬɚɪɢʁɢɯ ɨɞ 50 ɝɨɞɢɧɚ. Ɉɜɚ ɫɟ ɱɢʃɟɧɢɰɚ ɜɟɪɨɜɚɬɧɨ ɦɨɠɟ ɞɨɜɟɫɬɢ ɭ ɜɟɡɭ ɫɚ ɞɭɝɢɦ ɩɟɪɢɨɞɢɦɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ, ɪɭɬɢɧɫɤɢɦ ɩɪɨɩɢɫɢɜɚʃɟɦ ɞɜɚ ɢɥɢ ɜɢɲɟ ɚɧɬɢɛɢɨɬɢɤɚ, ɧɟɡɚɜɢɫɧɨ ɨɞ ɫɬɟɩɟɧɚ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɢ ɩɪɢɛɟɝɚɜɚʃɟɦ ɫɤɭɩʂɨʁ, ɩɚɪɟɧɬɟɪɚɥɧɨʁ ɩɪɢɦɟɧɢ ɥɟɤɨɜɚ. CURB-65 ɢ PЋI ɫɤɚɥɟ ɡɚ ɢɧɢɰɢʁɚɥɧɭ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɫɟ ɩɪɢɦɟʃɭʁɭ ɭɝɥɚɜɧɨɦ ɫɚɦɨ ɭ ɫɤɥɨɩɭ ɧɚɭɱɧɢɯ ɢ ɫɬɪɭɤɬɭɪɢɫɚɧɢɯ ɢɫɬɪɚɠɢɜɚʃɚ, ɞɨɤ ʁɟ ʃɢɯɨɜɚ ɪɭɬɢɧɫɤɚ ɩɪɢɦɟɧɚ ɜɪɥɨ ɪɟɬɤɚ ɢ ɫɩɨɪɚɞɢɱɧɚ. Јɚɫɧɨ ɫɟ ɡɚɩɚɠɚ ɢ ɞɚ ʁɟ ɤɚɭɡɚɥɧɚ ɚɧɬɢɦɢɤɪɨɛɧɚ ɬɟɪɚɩɢʁɚ ɦɚɥɨ ɡɚɫɬɭɩʂɟɧɚ, ɛɭɞɭʄɢ ɞɚ ʁɟ ɤɨɞ ɪɟɥɚɬɢɜɧɨ ɦɚɥɨɝ ɛɪɨʁɚ ɩɚɰɢʁɟɧɚɬɚ ɜɪɲɟɧɨ ɭɡɢɦɚʃɟ ɭɡɨɪɚɤɚ ɡɚ ɦɢɤɪɨɛɢɨɥɨɲɤɭ ɚɧɚɥɢɡɭ (ɫɩɭɬɭɦ ɤɨɞ 42% ɩɚɰɢʁɟɧɚɬɚ, ɭɡɨɪɰɢ ɤɪɜɢ ɡɚ ɯɟɦɨɤɭɥɬɭɪɭ ɤɨɞ 26% ɩɚɰɢʁɟɧɚɬɚ). ɇɚɦɟʄɟ ɫɟ ɡɚɤʂɭɱɚɤ ɞɚ ʁɟ, ɫɚɦɢɦ ɬɢɦ, ɢ ɦɚɥɢ ɛɪɨʁ ɦɢɤɪɨɛɢɨɥɨɲɤɢɯ ɢɡɨɥɚɬɚ, ɩɚ ʁɟ ɞɨɦɢɧɚɧɬɧɚ ɚɧɬɢɦɢɤɪɨɛɧɚ ɬɟɪɚɩɢʁɚ ɟɦɩɢɪɢʁɫɤɚ. Ɉɫɢɦ ɬɨɝɚ, ɩɚɪɟɧɬɟɪɚɥɧɚ ɬɟɪɚɩɢʁɚ ɱɟɫɬɨ ɧɟɨɩɪɚɜɞɚɧɨ ɞɭɝɨ ɬɪɚʁɟ, ɨ ɱɟɦɭ ɝɨɜɨɪɢ ɩɨɞɚɬɚɤ ɨ ɜɟɥɢɤɨɦ ɛɪɨʁɭ ɩɨɬɪɨɲɟɧɢɯ ɢɧɮɭɡɢɨɧɢɯ ɪɚɫɬɜɨɪɚ, ɭ ɧɟɤɢɦ ɫɥɭɱɚʁɟɜɢɦɚ ɞɨ ɫɚɦɨɝ ɡɚɜɪɲɟɬɤɚ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ. Ʌɟɤɚɪɢ ɧɟɜɨʂɧɨ ɩɪɟɜɨɞɟ ɩɚɰɢʁɟɧɬɟ ɧɚ ɩɟɪɨɪɚɥɧɭ ɬɟɪɚɩɢʁɭ, ɱɚɤ ɢ ɭ ɫɥɭɱɚʁɟɜɢɦɚ ɤɚɞɚ ʁɟ ɢɫɬɢ ɚɧɬɢɛɢɨɬɢɤ ɭ ɨɛɥɢɤɭ ɤɨʁɢ ɨɦɨɝɭʄɚɜɚ ɨɜɚɤɜɭ ɩɪɢɦɟɧɭ ɪɚɫɩɨɥɨɠɢɜ. ɉɪɢɦɟɬɧɨ ʁɟ ɢ ɞɚ ɞɢʁɚɝɧɨɫɬɢɤɚ, ɩɨɫɟɛɧɨ ɪɚɞɢɨɥɨɲɤɚ ɭ ɧɟɤɢɦ ɫɥɭɱɚʁɟɜɢɦɚ ɛɢɜɚ ɡɥɨɭɩɨɬɪɟɛʂɟɧɚ (ɩɪɨɫɟɱɧɨ 4 ɪɚɞɢɨɝɪɚɮɢʁɟ ɩɨ ɩɚɰɢʁɟɧɬɭ), ɜɟɪɨɜɚɬɧɨ ɭ ɨɱɟɤɢɜɚʃɭ ɩɨɬɩɭɧɟ ɪɚɞɢɨɝɪɚɮɫɤɟ ɪɟɡɨɥɭɰɢʁɟ ɧɚɥɚɡɚ ɩɪɢɥɢɤɨɦ ɨɬɩɭɫɬɚ ɩɚɰɢʁɟɧɬɚ, ɚ ɡɚ ɤɨʁɭ ʁɟ ɭ ɧɟɤɢɦ ɫɥɭɱɚʁɟɜɢɦ ɩɨɬɪɟɛɧɨ ɢ 4 ɞɨ 6 ɫɟɞɦɢɰɚ. ɉɨɪɟɞ ɧɚɜɟɞɟɧɨɝ, ɨɧɨ ɫɚ ɱɢɦɟ ɫɟ ɥɟɤɚɪɢ ɤɨɞ ɧɚɫ ɱɟɫɬɨ ɫɭɨɱɚɜɚʁɭ ʁɟ ɢ ɧɟɪɚɡɭɦɟɜɚʃɟ ɨɞ ɫɬɪɚɧɟ ɩɨɪɨɞɢɰɟ ɛɨɥɟɫɧɢɤɚ, ɧɟɩɪɢɯɜɚɬɚʃɟ ʃɟɧɟ ɚɤɬɢɜɧɟ ɭɥɨɝɟ ɭ ɩɪɨɰɟɫɭ ɥɟɱɟʃɚ ɢ ɧɟɝɟ ɛɨɥɟɫɧɢɤɚ, ɤɚɨ ɢ ɱɟɫɬɢ ɩɪɢɬɢɫɰɢ ɞɚ ɫɟ ɛɨɥɟɫɧɢɤ ɡɚɞɪɠɢ ɲɬɨ ɞɭɠɟ ɧɚ ɛɨɥɧɢɱɤɨɦ ɥɟɱɟʃɭ, ɲɬɨ ʁɟ ɩɨɫɟɛɧɨ ɢɡɪɚɠɟɧɨ ɭ ɫɥɭɱɚʁɟɜɢɦɚ ɫɬɚɪɢʁɢɯ ɨɫɨɛɚ ɢ ɬɟɠɢɯ ɛɨɥɟɫɧɢɤɚ, ɫɚ ɧɚʁɱɟɲʄɟ ɩɪɢɞɪɭɠɟɧɢɦ ɛɪɨʁɧɢɦ ɤɨɦɨɪɛɢɞɢɬɟɬɢɦɚ ɢ ɧɚɝɥɚɲɟɧɨɦ ɩɨɬɪɟɛɨɦ ɡɚ ɫɬɚɥɧɨɦ ɢ ɬɪɚʁɧɨɦ ɧɟɝɨɦ. Ɍɚɤɢɦ ɩɪɢɬɢɫɰɢɦɚ ʁɟ ɱɟɫɬɨ ɬɟɲɤɨ ɨɞɭɩɪɟɬɢ ɫɟ, ɧɚɪɨɱɢɬɨ ɭ ɫɢɬɭɚɰɢʁɢ ɤɨʁɚ ʁɟ ɩɪɢɫɭɬɧɚ ɤɨɞ ɧɚɫ, ɛɟɡ ʁɚɫɧɢɯ ɫɦɟɪɧɢɰɚ ɢ ɭɩɭɬɫɬɚɜɚ ɨ ɧɚɱɢɧɭ ɢ ɦɟɫɬɭ ɡɛɪɢʃɚɜɚʃɚ ɢ ɥɟɱɟʃɚ 130 ɨɜɚɤɜɢɯ ɛɨɥɟɫɧɢɤɚ, ɚ ɭɡ ɫɬɚɥɧɨ ɩɪɢɫɭɬɧɟ ɦɟɞɢɰɢɧɫɤɟ ɢɧɞɢɤɚɰɢʁɟ ɡɚ ʃɢɯɨɜ ɩɪɢʁɟɦ ɢ ɡɚɞɪɠɚɜɚʃɟ ɧɚ ɛɨɥɧɢɱɤɨɦ ɥɟɱɟʃɭ, ɭ ɧɚʁɜɟʄɨʁ ɦɟɪɢ ɡɛɨɝ ɨɞɦɚɤɥɟ ɠɢɜɨɬɧɟ ɞɨɛɢ ɢ ɩɪɢɫɭɬɧɢɯ ɛɪɨʁɧɢɯ ɤɨɦɨɪɛɢɬɢɬɟɬɚ ɤɨʁɢ ɡɚɯɬɟɜɚʁɭ ɦɭɥɬɢɞɢɫɰɢɩɥɢɧɚɪɧɢ ɩɪɢɫɬɭɩ ɢ ɤɨɦɩɥɟɤɫɧɨ ɢ ɫɤɭɩɨ ɥɟɱɟʃɟ ɢ ɧɟɝɭ. ɍɡɪɨɤ ɫɜɟɦɭ ɧɚɜɟɞɟɧɨɦ ɭ ɢɡɜɟɫɧɨʁ ɦɟɪɢ ɥɟɠɢ ɢ ɭ ɱɢʃɟɧɢɰɢ ɞɚ ɫɭ ɤɨɞ ɧɚɫ ɦɟɞɢɰɢɧɫɤɟ ɭɫɬɚɧɨɜɟ, ɩɨɤɪɢɜɟɧɟ ɮɢɧɚɧɫɢɪɚʃɟɦ ɢɡ ɛɭџɟɬɚ ɡɚ ɡɞɪɚɜɫɬɜɨ Ɋɟɩɭɛɥɢɤɟ ɋɪɛɢʁɟ, ɚ ɤɨʁɟ ɫɟ ɛɚɜɟ ɡɛɪɢʃɚɜɚʃɟɦ ɝɟɪɢʁɚɬɪɢʁɫɤɢɯ ɩɚɰɢʁɟɧɚɬɚ ʁɨɲ ɭɜɟɤ ɜɪɥɨ ɪɟɬɤɟ ɢ ɦɚɥɢɯ ɤɚɩɚɰɢɬɟɬɚ, ɚɩɫɨɥɭɬɧɨ ɧɟɞɨɜɨʂɧɢɯ ɭ ɭɫɥɨɜɢɦɚ ɪɚɩɢɞɧɨ ɫɬɚɪɟʄɟ ɩɨɩɭɥɚɰɢʁɟ. ɇɟɲɬɨ ɫɭ ɛɪɨʁɧɢʁɟ ɭɫɬɚɧɨɜɟ ɬɪɚʁɧɨɝ ɡɛɪɢʃɚɜɚʃɚ ɫɬɚɪɢɯ ɥɢɰɚ, ɤɨʁɟ ɫɭ ɩɪɟ ɫɜɟɝɚ ɨɪɢʁɟɧɬɢɫɚɧɟ ɭ ɩɪɚɜɰɭ ɩɪɭɠɚʃɚ ɧɟɨɩɯɨɞɧɨɝ ɫɦɟɲɬɚʁɚ ɢ ɧɟɝɟ ɨɜɢɦ ɥɢɰɢɦɚ, ɚɥɢ ɫɭ ɨɧɟ ɩɪɟ ɫɜɟɝɚ ɟɤɨɧɨɦɫɤɢ ɨɪɢʁɟɧɬɢɫɚɧɟ ɢ, ɫɚɦɢɦ ɬɢɦ ɧɟɞɨɫɬɭɩɧɟ ɜɟɥɢɤɨʁ ɜɟʄɢɧɢ ɫɬɚɪɢɯ ɨɫɨɛɚ ɤɨʁɟ ɫɭ ɭ ɫɬɚʃɭ ɩɨɬɪɟɛɟ, ɤɚɨ ɢ ʃɢɯɨɜɢɦ ɩɨɪɨɞɢɰɚɦɚ. ɇɚɲɢ ɧɚɥɚɡɢ ɭɤɚɡɭʁɭ ɧɚ ɧɟɨɩɯɨɞɧɨɫɬ ɤɪɟɢɪɚʃɚ ɩɨɥɢɬɢɤɟ ɫɬɪɨɠɢʁɟɝ ɧɚɞɡɨɪɚ ɧɚɞ ɨɩɲɬɟɩɪɢɯɜɚʄɟɧɨɦ ɤɥɢɧɢɱɤɨɦ ɩɪɚɤɫɨɦ. Ɍɪɟɧɭɬɧɚ ɩɪɚɤɫɚ ɧɚ ɧɚʁɜɟʄɟɦ ɬɪɠɢɲɬɭ Ɂɚɩɚɞɧɨɝ Ȼɚɥɤɚɧɚ ɭ ɩɨɝɥɟɞɭ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ ɭɤɚɡɭʁɟ ɧɚ ɧɟɟɮɢɤɚɫɧɨ ɤɨɪɢɲʄɟʃɟ ɪɟɫɭɪɫɚ. ɉɪɭɠɚʃɟ ɜɢɲɟ ɤɨɧɤɪɟɬɧɢɯ ɞɨɤɚɡɚ ɥɟɤɚɪɢɦɚ ɭ ɩɨɝɥɟɞɭ ɟɤɨɧɨɦɫɤɢ ɟɮɢɤɚɫɧɢɯ ɦɟɞɢɰɢɧɫɤɢɯ ɢɧɬɟɪɜɟɧɰɢʁɚ ɫɚ ɰɢʂɟɦ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɟ ɛɢ ɡɧɚɱɚʁɧɨ ɩɨɛɨʂɲɚɥɨ ɤɥɢɧɢɱɤɟ ɢɫɯɨɞɟ ɢ ɢɧɞɭɤɨɜɚɥɨ ɭɲɬɟɞɟ133. ɇɟɤɢ ɨɞ ɩɪɟɞɥɨɝɚ ɱɢʁɚ ɛɢ ɩɪɢɦɟɧɚ ɞɨɧɟɥɚ ɭɲɬɟɞɟ ɭ ɩɪɨɰɟɫɭ ɥɟɱɟʃɚ ɢ ɡɛɪɢʃɚɜɚʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɛɢ ɛɢɥɢ ɫɥɟɞɟʄɢ:  ɫɬɪɨɝɚ ɫɟɥɟɤɰɢʁɚ ɛɨɥɟɫɧɢɤɚ ɤɨʁɢ ʄɟ ɛɢɬɢ ɥɟɱɟɧɢ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ, ɭɡɢɦɚʁɭʄɢ ɭ ɨɛɡɢɪ ɩɪɟ ɫɜɟɝɚ ɦɟɞɢɰɢɧɫɤɟ ɤɪɢɬɟɪɢʁɭɦɟ, ɤɚɞɚ ɝɨɞ ʁɟ ɬɨ ɦɨɝɭʄɟ. ɉɪɢɦɟɧɚ ɫɤɚɥɚ ɡɚ ɢɧɢɰɢʁɚɥɧɭ ɩɪɨɰɟɧɭ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ (CURB-65 ɢ PSI) ɛɢ ɛɢɥɚ ɨɞ ɜɟɥɢɤɟ ɩɨɦɨʄɢ ɭ ɞɨɧɨɲɟʃɭ ɨɞɥɭɤɟ ɨ ɦɟɫɬɭ ɥɟɱɟʃɚ ɛɨɥɟɫɧɢɤɚ;  ɚɤɬɢɜɧɨ ɭɤʂɭɱɢɜɚʃɟ ɞɪɭɝɢɯ ɧɢɜɨɚ ɨɪɝɚɧɢɡɚɰɢʁɟ ɡɞɪɚɜɫɬɜɟɧɟ ɫɥɭɠɛɟ ɭ ɩɪɨɰɟɫ ɥɟɱɟʃɚ ɢ ɧɟɝɟ ɛɨɥɟɫɧɢɤɚ; 131  ɩɪɢɦɟɧɚ ɚɦɛɭɥɚɧɬɧɨɝ ɥɟɱɟʃɚ, ɤɚɞɚ ɝɨɞ ʁɟ ɬɨ ɦɨɝɭʄɟ ɢ ɤɚɞɚ ɬɨ ɧɟ ɧɨɫɢ ɩɨɜɟʄɚɧɢ ɪɢɡɢɤ ɨɞ ɧɟɠɟʂɟɧɨɝ ɢɫɯɨɞɚ ɥɟɱɟʃɚ;  ɭɩɨɬɪɟɛɚ ɫɚɦɨ ɧɟɨɩɯɨɞɧɟ, ɦɢɧɢɦɚɥɧɨ ɧɭɠɧɟ ɞɢʁɚɝɧɨɫɬɢɤɟ, ɤɚɤɨ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɬɚɤɨ ɢ ɪɚɞɢɨɥɨɲɤɟ, ɜɢɡɭɟɥɢɡɚɰɢɨɧɟ;  ɫɬɪɨɝɨ ɩɨɲɬɨɜɚʃɟ ɫɦɟɪɧɢɰɚ ɡɚ ɩɪɢɦɟɧɭ ɚɧɬɢɦɢɤɪɨɛɧɟ ɬɟɪɚɩɢʁɟ, ɥɚɤɲɟ ɨɛɥɢɤɟ ɛɨɥɟɫɬɢ ɥɟɱɢɬɢ ʁɟɞɧɢɦ, ɚ ɧɟ ɞɜɚ ɢɥɢ ɜɢɲɟ ɚɧɬɢɛɢɨɬɢɤɚ;  ɦɚɤɫɢɦɚɥɧɨ ɪɟɞɭɤɨɜɚɬɢ ɩɚɪɟɧɬɟɪɚɥɧɭ ɩɪɢɦɟɧɭ ɬɟɪɚɩɢʁɟ, ɭɤɨɥɢɤɨ ɫɟ ɚɧɬɢɛɢɨɬɫɤɚ ɬɟɪɚɩɢʁɚ ɧɟ ɡɚɩɨɱɧɟ ɤɚɨ ɩɟɪɨɪɚɥɧɚ, ɢɧɫɢɫɬɢɪɚɬɢ ɧɚ ɩɪɟɜɨђɟʃɟ ɬɟɪɚɩɢʁɟ ɫɚ ɩɚɪɟɧɬɟɪɚɥɧɟ ɧɚ ɩɟɪɨɪɚɥɧɭ ɲɬɨ ɩɪɟ, ɭɤɨɥɢɤɨ ʁɟ ɩɚɰɢʁɟɧɬ ɭ ɫɬɚʃɭ ɞɚ ɭɡɢɦɚ ɩɟɪɨɪɚɥɧɭ ɬɟɪɚɩɢʁɭ;  ɩɨɜɟʄɚɬɢ ɭɡɨɪɤɨɜɚʃɟ ɡɚ ɦɢɤɪɨɛɢɨɥɨɲɤɟ ɚɧɚɥɢɡɟ, ɩɨ ɩɪɢɫɬɢɡɚʃɭ ɢɡɨɥɚɬɚ ɢ ɚɧɬɢɛɢɨɝɪɚɦɚ ɭɜɟɞɟɧɭ ɟɦɩɢɪɢʁɫɤɭ ɚɧɬɢɦɢɤɪɨɛɧɭ ɬɟɪɚɩɢʁɭ ɩɪɟɭɫɦɟɪɢɬɢ ɭ ɤɚɭɡɚɥɧɭ;  ɪɟɞɭɤɨɜɚɬɢ ɞɭɠɢɧɭ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ, ɛɨɥɟɫɧɢɤɟ ɩɨ ɫɬɚɛɢɥɢɡɚɰɢʁɢ ɫɬɚʃɚ ɢ ɩɪɟɫɬɚɧɤɭ ɮɟɛɪɢɥɧɨɫɬɢ, ɤɚɨ ɢ ɭ ɩɪɢɫɭɫɬɜɭ ɩɪɜɢɯ ɧɟɞɜɨɫɦɢɫɥɟɧɢɯ ɡɧɚɤɨɜɚ ɩɨɛɨʂɲɚʃɚ ɫɬɚʃɚ ɭɩɭɬɢɬɢ ɧɚ ɧɚɫɬɚɜɚɤ ɥɟɱɟʃɚ ɭ ɤɭʄɧɢɦ/ɚɦɛɭɥɚɧɬɧɢɦ ɭɫɥɨɜɢɦɚ, ɭɡ ɡɚɤɚɡɢɜɚʃɟ ɪɟɞɨɜɧɢɯ ɤɨɧɬɪɨɥɚ ɤɨɞ ɥɟɱɟʄɟɝ ɥɟɤɚɪɚ ɢ ɫɩɪɨɜɨђɟʃɟ ɤɨɧɬɪɨɥɧɟ ɥɚɛɨɪɚɬɨɪɢʁɫɤɟ ɢ ɪɚɞɢɨɥɨɲɤɟ ɞɢʁɚɝɧɨɫɬɢɤɟ ɚɦɛɭɥɚɧɬɧɨ. Ɉɜɚ ɫɬɭɞɢʁɚ ɨɬɤɪɢɜɚ ɧɟɞɨɫɬɚɬɚɤ ʁɚɫɧɟ ɤɨɪɟɥɚɰɢʁɟ ɢɡɦɟђɭ ɢɧɢɰɢʁɚɥɧɨ ɩɪɨɰɟʃɟɧɟ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɢ ɩɨɫɥɟɞɢɱɧɨɝ ɤɨɪɢɲʄɟʃɚ ɪɟɫɭɪɫɚ ɢ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ. ɍɡɪɨɤɟ ɬɚɤɜɨɝ ɬɪɟɧɞɚ ɭɝɥɚɜɧɨɦ ɬɪɟɛɚ ɬɪɚɠɢɬɢ ɭ ɩɪɢʁɟɦɢɦɚ ɭ ɛɨɥɧɢɰɭ ɤɨɞ ɛɨɥɟɫɧɢɤɚ ɝɞɟ ɬɨ ɧɢʁɟ ɧɟɨɩɯɨɞɧɨ, ɤɨɞ ɥɚɤɲɢɯ ɨɛɥɢɤɚ ɛɨɥɟɫɬɢ ɢ ɩɪɟɤɨɦɟɪɧɨʁ ɢ ɩɪɟɞɭɝɚɱɤɨʁ ɩɪɢɦɟɧɢ ɚɧɬɢɛɢɨɬɢɤɚ, ɩɨɫɟɛɧɨ ɭ ɩɚɪɟɧɬɟɪɚɥɧɨɦ ɨɛɥɢɤɭ, ɤɚɨ ɢ ɞɭɝɨɦ ɬɪɚʁɚʃɭ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ. Ɉɜɟ ɱɢʃɟɧɢɰɟ ɭɤɚɡɭʁɭ ɧɚ ɧɟɞɨɜɨʂɧɨ ɩɪɢɞɪɠɚɜɚʃɟ ɫɦɟɪɧɢɰɚ ɦɟђɭ ɥɟɤɚɪɢɦɚ, ɲɬɨ ɭɬɢɱɟ ɧɚ ɡɧɚɱɚʁɧɨ ɩɨɜɟʄɚʃɟ ɦɟɞɢɰɢɧɫɤɟ ɩɨɬɪɨɲʃɟ ɢ ɭɤɭɩɧɢɯ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ, ɚ ɤɨʁɢ ɫɭ ɦɨɝɥɢ 132 ɛɢɬɢ ɢɡɛɟɝɧɭɬɢ. Ⱦɨɦɢɧɚɧɬɧɟ ɫɬɚɜɤɟ ɭ ɭɤɭɩɧɨʁ ɫɬɪɭɤɬɭɪɢ ɬɪɨɲɤɨɜɚ ɨɫɬɚʁɭ: ɥɟɱɟʃɟ ɤɨɦɨɪɛɢɞɢɬɟɬɚ, ɤɥɢɧɢɱɤɢɯ ɤɨɦɩɥɢɤɚɰɢʁɚ ɢ ɬɪɨɲɤɨɜɢ ɧɚɫɬɚɥɢ ɭɫɥɟɞ ɝɭɛɢɬɤɚ ɩɪɨɞɭɤɬɢɜɧɨɫɬɢ. ɂɦɚʁɭʄɢ ɭ ɜɢɞɭ ɜɢɫɨɤɭ ɢɧɰɢɞɟɧɰɭ ɪɟɫɩɢɪɚɬɨɪɧɢɯ ɢɧɮɟɤɰɢʁɚ, ɨɪɝɚɧɢ ɞɪɠɚɜɟ ɫɟ ɦɨɪɚʁɭ ɬɪɭɞɢɬɢ ɞɚ ɩɨɛɨʂɲɚʁɭ ɩɪɚɤɫɭ ɢ ɢɧɫɢɫɬɢɪɚʁɭ ɧɚ ɨɞɝɨɜɨɪɧɨɦ ɢ ɟɤɨɧɨɦɫɤɢ ɪɚɰɢɨɧɚɥɧɨɦ ɩɨɧɚɲɚʃɭ ɥɟɤɚɪɚ ɩɪɢɥɢɤɨɦ ɩɪɨɩɢɫɢɜɚʃɚ ɥɟɤɨɜɚ. ɍɫɜɚʁɚʃɟ ɞɭɝɨɪɨɱɧɢɯ ɫɬɪɚɬɟɝɢʁɚ ɫɚ ɰɢʂɟɦ ɩɪɟɨɛɥɢɤɨɜɚʃɚ ɧɚɱɢɧɚ ɪɚɡɦɢɲʂɚʃɚ ɦɟɞɢɰɢɧɫɤɨɝ ɨɫɨɛʂɚ ɛɢ ɩɨɦɨɝɥɨ ɭ ɫɦɚʃɟʃɭ ɬɪɨɲɤɨɜɚ ɢ ɩɨɛɨʂɲɚʃɭ ɤɥɢɧɢɱɤɢɯ ɢɫɯɨɞɚ ɥɟɱɟʃɚ. 133 9. ɅɂɌȿɊȺɌɍɊȺ 1. ɉɟʁɱɢʄ Ɍ. Ȼɨɥɟɫɬɢ ɩɥɭʄɚ ɭɞɪɭɠɟɧɟ ɫɚ ɢɧɮɟɤɰɢʁɨɦ. ɍ: ɂɥɢʄ ɋ. (ɭɪɟɞ) ɂɧɬɟɪɧɚ ɦɟɞɢɰɢɧɚ. Пɪɨɫɜɟɬɚ, ɇɢɲ, 2004: 88-94. 2. ɋɟɤɭɥɢʄ ɋ. ɉɧɟɭɦɨɧɢʁɟ. ɍ: ɋɟɤɭɥɢʄ ɋ. (ɭɪɟɞ) Пɥɭʄɧɟ ɛɨɥɟɫɬɢ. ȿlТt-MeНТМa Ȼɟɨɝɪɚɞ, 2000: 282-98 3. ɀɢɜɤɨɜɢʄ Ђ. ȼɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɟ ɩɧɟɭɦɨɧɢʁɟ. ɍ: Пɟјɱɢʄ Ɍ. (ɭɪɟɞ). ɋɚɜɪɟɦɟɧɢ ɚɫɩɟɤɬ ɢ ɥɟɱɟʃɟ ɩɧɟɭɦɨɧɢјɚ. Ɂɛɨɪɧɢɤ ɪɚɞɨɜɚ ɫɚ ɪɟɰɟɧɡɢјɨɦ, Ɇɟɞɢɰɢɧɫɤɢ ɮɚɤɭɥɬɟɬ, ɇɢɲ, 2006: 15-19 4. Rello J. 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Chest 2001, 119 (5), 1439-1448 146 10. ɉɊɂɅɈȽ 10.1 ɄȴɍɑɇȺ ȾɈɄɍɆȿɇɌȺɐɂȳɋɄȺ ɂɇɎɈɊɆȺɌɂɄȺ ɍɇɂȼȿɊɁɂɌȿɌ ɍ ɄɊȺȽɍȳȿȼɐɍ ɆȿȾɂɐɂɇɋɄɂ ɎȺɄɍɅɌȿɌ ɍ ɄɊȺȽɍȳȿȼɐɍ Ɋɟɞɧɢ ɛɪɨʁ: ɊȻ ɂɞɟɧɬɢɮɢɤɚɰɢɨɧɢ ɛɪɨʁ: ɂȻɊ Ɍɢɩ ɞɨɤɭɦɟɧɬɚɰɢʁɟ: Ɇɨɧɨɝɪɚɮɫɤɚ ɩɭɛɥɢɤɚɰɢʁɚ ɌȾ Ɍɢɩ ɡɚɩɢɫɚ: Ɍɟɤɫɬɭɚɥɧɢ ɲɬɚɦɩɚɧɢ ɦɚɬɟɪɢʁɚɥ ɌɁ ȼɪɫɬɚ ɪɚɞɚ: Ⱦɨɤɬɨɪɫɤɚ ɞɢɫɟɪɬɚɰɢʁɚ ȼɊ Ⱥɭɬɨɪ: Ⱦɪ ȼɨʁɢɫɥɚɜ Ћɭɩɭɪɞɢʁɚ Ⱥɍ Ɇɟɧɬɨɪ/ɤɨɦɟɧɬɨɪ: ɉɪɨɮ. ɞɪ sМТ ЦОН Ɇɢɯɚʁɥɨ ȳɚɤɨɜʂɟɜɢʄ Ɇɇ ɇɚɫɥɨɜ ɪɚɞɚ: ɇɊ Ⱦɟɬɟɪɦɢɧɚɧɬɟ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ 147 ȳɟɡɢɤ ɩɭɛɥɢɤɚɰɢʁɟ: ɋɪɩɫɤɢ (ʄɢɪɢɥɢɰɚ) ȳɉ ȳɟɡɢɤ ɢɡɜɨɞɚ: ɋɪɩɫɤɢ/ɟɧɝɥɟɫɤɢ ȳɂ Ɂɟɦʂɚ ɩɭɛɥɢɤɨɜɚʃɚ: ɋɪɛɢʁɚ Ɂɉ ɍɠɟ ɝɟɨɝɪɚɮɫɤɨ ɩɨɞɪɭɱʁɟ: ɒɭɦɚɞɢʁɚ ɍȽɉ Ƚɨɞɢɧɚ: 2015 ȽɈ ɂɡɞɚɜɚɱ: Ⱥɭɬɨɪɫɤɢ ɪɟɩɪɢɧɬ ɂɁ Ɇɟɫɬɨ ɢ ɚɞɪɟɫɚ: 34000 Ʉɪɚɝɭʁɟɜɚɰ Ɇɋ ɋɜɟɬɨɡɚɪɚ Ɇɚɪɤɨɜɢʄɚ 69 Ɏɢɡɢɱɤɢ ɨɩɢɫ ɪɚɞɚ: ɎɈ Ⱦɢɫɟɪɬɚɰɢʁɚ ɢɦɚ 145 ɫɬɪɚɧɚ, 9 ɩɨɝɥɚɜʂɚ, 33 ɬɚɛɟɥɟ, 11 ɝɪɚɮɢɤɨɧɚ ɢ 133 ɰɢɬɢɪɚɧɟ ɛɢɛɥɢɨɝɪɚɮɫɤɟ ʁɟɞɢɧɢɰɟ ɇɚɭɱɧɚ ɨɛɥɚɫɬ: Ɇɟɞɢɰɢɧɚ ɇɚɭɱɧɚ ɞɢɫɰɢɩɥɢɧɚ: Ɏɚɪɦɚɤɨɥɨɝɢʁɚ / Ɂɞɪɚɜɫɬɜɟɧɚ ɟɤɨɧɨɦɢʁɚ / Ⱦɂ ɂɧɬɟɪɧɚ ɦɟɞɢɰɢɧɚ / ɉɭɥɦɨɥɨɝɢʁɚ ɉɪɟɞɦɟɬɧɚ ɨɞɪɟɞɧɢɰɚ/ ɤʂɭɱɧɟ ɪɟɱɢ: ȼɚɧɛɨɥɧɢɱɤɢ ɫɬɟɱɟɧɚ ɩɧɟɭɦɨɧɢʁɚ, ɬɪɨɲɚɤ ɉɈ ɥɟɱɟʃɚ, ɬɪɨɲɤɨɜɢ ɢ ɚɧɚɥɢɡɚ ɬɪɨɲɤɨɜɚ, ɯɨɫɩɢɬɚɥɢɡɚɰɢʁɚ, ɢɧɞɟɤɫ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɍȾɄ ɑɭɜɚ ɫɟ: ɍ ɛɢɛɥɢɨɬɟɰɢ Ɏɚɤɭɥɬɟɬɚ ɦɟɞɢɰɢɧɫɤɢɯ ɑɍ ɧɚɭɤɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ, 34000 Ʉɪɚɝɭʁɟɜɚɰ, ɋɪɛɢʁɚ, ɋɜɟɬɨɡɚɪɚ Ɇɚɪɤɨɜɢʄɚ 69 ȼɚɠɧɚ ɧɚɩɨɦɟɧɚ: Ɇɇ 148 ɂɡɜɨɞ: ɂȾ ȼɚɧɛɨɥɧɢɱɤɚ ɩɧɟɭɦɨɧɢʁɚ ɫɟ ɞɟɮɢɧɢɲɟ ɤɚɨ ɩɨɬɟɧɰɢʁɚɥɧɨ ɨɡɛɢʂɧɚ ɛɨɥɟɫɬ ɫɚ ɜɢɫɨɤɨɦ ɢɧɰɢɞɟɧɰɨɦ ɢ ɡɧɚɱɚʁɧɢɦ ɟɤɨɧɨɦɫɤɢɦ ɭɬɢɰɚʁɟɦ. Ɉɜɚ ɫɬɭɞɢʁɚ ɫɟ ɛɚɜɢɥɚ ɭɬɜɪђɢɜɚʃɟɦ ɩɪɨɫɟɱɧɨɝ ɬɪɨɲɤɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɭ ɛɨɥɧɢɱɤɢɦ ɭɫɥɨɜɢɦɚ, ɩɨ ɩɚɰɢʁɟɧɬɭ, ɭ Ʉɐ Ʉɪɚɝɭʁɟɜɚɰ, ɭɡ ɩɪɢɤɚɡ ɢ ɚɧɚɥɢɡɭ ɫɜɢɯ ɞɟɬɟɪɦɢɧɚɧɬɢ ɤɨʁɟ ɭɬɢɱɭ ɧɚ ʃɟɝɨɜ ɭɤɭɩɚɧ ɢɡɧɨɫ ɢ ɭɩɨɪɟђɟʃɟ ɞɨɛɢʁɟɧɢɯ ɩɨɞɚɬɚɤɚ ɫɚ ɪɟɡɭɥɬɚɬɢɦɚ ɞɨɛɢʁɟɧɢɯ ɢɡ ɫɥɢɱɧɢɯ ɫɬɭɞɢʁɚ ɭ ȿɜɪɨɩɢ ɢ ɫɜɟɬɭ. ɉɥɚɧɢɪɚɧɚ ʁɟ ɢ ɫɩɪɨɜɟɞɟɧɚ ɤɚɨ ɩɪɨɫɩɟɤɬɢɜɧɚ ɫɬɭɞɢʁɚ. ɉɪɨɰɟɧɚ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɢ ɪɢɡɢɤ ɦɨɪɬɚɥɢɬɟɬɚ ɫɭ ɩɪɨɰɟʃɢɜɚɧɢ ɭɡ ɩɨɦɨʄ ɢɧɞɟɤɫɚ ɬɟɠɢɧɟ ɩɧɟɭɦɨɧɢʁɟ (pneumonia severity index - PSI) ɢ CURB-65 (Confusion – Urea - Respiratory rate - Blood pressure - age ≥ 65 years) ɫɤɚɥɟ. ɍɡɨɪɚɤ ɫɟ ɫɚɫɬɨʁɚɨ ɨɞ 95 ɩɚɰɢʁɟɧɚɬɚ ɯɨɫɩɢɬɚɥɢɡɨɜɚɧɢɯ ɡɛɨɝ ɞɢʁɚɝɧɨɫɬɢɤɨɜɚɧɟ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. Ⱥɧɚɥɢɡɚ ɬɪɨɲɤɨɜɚ ʁɟ ɫɩɪɨɜɟɞɟɧɚ ɢɡ ɞɪɭɲɬɜɟɧɟ ɩɟɪɫɩɟɤɬɢɜɟ, ɫɚ ɜɪɟɦɟɧɫɤɨɦ ɨɞɪɟɞɧɢɰɨɦ ɨɞ ʁɟɞɧɟ ɝɨɞɢɧɟ. Ⱦɢɪɟɤɬɧɢ ɢ ɢɧɞɢɪɟɤɬɧɢ ɬɪɨɲɤɨɜɢ ɩɨ ɩɚɰɢʁɟɧɬɭ ɥɟɱɟɧɨɦ ɨɞ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɫɭ ɢɡɧɨɫɢɥɢ 696 ± 531 ɢ 410 ± 283 ɟɜɪɚ, ɤɨʁɢ ɫɭ ɡɚʁɟɞɧɨ ɫɚɱɢʃɚɜɚɥɢ ɭɤɭɩɧɟ ɬɪɨɲɤɨɜɟ ɭ ɢɡɧɨɫɭ ɨɞ 1,106 ± 657 ɟɜɪɚ. ɍɤɭɩɧɢ ɟɤɨɧɨɦɫɤɢ ɭɬɢɰɚʁ ɱɢɬɚɜɟ ɤɨɯɨɪɬɟ ɩɚɰɢʁɟɧɚɬɚ ʁɟ ɢɡɧɨɫɢɨ 105,087 ɟɜɪɚ (66,109 ɞɢɪɟɤɬɧɢɯ ɢ 38,979 ɟɜɪɚ ɢɧɞɢɪɟɤɬɧɢɯ ɬɪɨɲɤɨɜɚ). ɇɚʁɡɧɚɱɚʁɧɢʁɟ ɫɬɚɜɤɟ ɭ ɭɤɭɩɧɨʁ ɫɬɪɭɤɬɭɪɢ ɬɪɨɲɤɨɜɚ ɫɭ ɛɢɥɟ: ɬɪɨɲɤɨɜɢ ɚɩɫɟɧɬɢɡɦɚ, ɬɪɨɲɤɨɜɢ ɞɢʁɚɝɧɨɡɟ ɢ ɥɟɱɟʃɚ ɤɨɦɨɪɛɢɞɢɬɟɬɚ, ɥɟɤɨɜɢ, ɤɢɫɟɨɧɢɤ ɢ ɞɟɪɢɜɚɬɢ ɤɪɜɢ. ȼɪɟɞɧɨɫɬɢ CURB-65 ɢ PSI ɫɤɨɪɚ ɫɭ ɛɢɥɢ ɭ ɤɨɪɟɥɚɰɢʁɢ ɫɚ ɢɧɞɢɪɟɤɬɧɢɦ ɬɪɨɲɤɨɜɢɦɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. ȼɪɟɞɧɨɫɬ PSI ɫɤɨɪɚ ʁɟ ɛɢɥɚ ɭ ɩɨɡɢɬɢɜɧɨʁ ɤɨɪɟɥɚɰɢʁɢ ɫɚ ɭɤɭɩɧɢɦ ɬɪɨɲɤɨɜɢɦɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. ɇɢʁɟɞɚɧ ɫɤɨɪ ɧɢʁɟ ɩɨɤɚɡɚɨ ʁɚɫɧɭ ɩɨɜɟɡɚɧɨɫɬ ɫɚ ɞɢɪɟɤɬɧɢɦ ɬɪɨɲɤɨɜɢɦɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ. ɉɪɨɰɟɧɚ ɬɟɠɢɧɟ ɛɨɥɟɫɬɢ ɧɚ ɩɪɢʁɟɦɭ ɧɟ ɩɨɤɚɡɭʁɟ ɩɨɜɟɡɚɧɨɫɬ ɫɚ ɬɪɨɲɤɨɜɢɦɚ ɥɟɱɟʃɚ ɛɨɥɟɫɬɢ. Ɉɜɚ ɱɢʃɟɧɢɰɚ ɫɟ ɧɚʁɜɟɪɨɜɚɬɧɢʁɟ ɦɨɠɟ ɞɨɜɟɫɬɢ ɭ ɜɟɡɭ ɫɚ ɧɟɩɨɬɪɟɛɧɢɦ ɩɪɢʁɟɦɢɦɚ ɧɚ ɛɨɥɧɢɱɤɨ ɥɟɱɟʃɟ ɩɚɰɢʁɟɧɚɬɚ ɫɚ ɜɚɧɛɨɥɧɢɱɤɨɦ ɩɧɟɭɦɨɧɢʁɨɦ ɤɨʁɢ ɫɟ ɦɨɝɭ ɥɟɱɢɬɢ ɚɦɛɭɥɚɧɬɧɨ ɢɥɢ ɞɭɝɢɦ ɬɪɚʁɚʃɟɦ ɛɨɥɧɢɱɤɨɝ ɥɟɱɟʃɚ, ɤɚɨ ɢ ɫɚ ɩɪɟɤɨɦɟɪɧɢɦ ɩɪɨɩɢɫɢɜɚʃɟɦ ɚɧɬɢɛɢɨɬɢɤɚ. ɉɪɭɠɚʃɟ ɜɢɲɟ ɤɨɧɤɪɟɬɧɢɯ ɞɨɤɚɡɚ ɥɟɤɚɪɢɦɚ ɭ ɩɨɝɥɟɞɭ ɟɤɨɧɨɦɫɤɢ ɟɮɢɤɚɫɧɢɯ ɦɟɞɢɰɢɧɫɤɢɯ ɢɧɬɟɪɜɟɧɰɢʁɚ ɫɚ ɰɢʂɟɦ ɥɟɱɟʃɚ ɩɧɟɭɦɨɧɢʁɟ ɛɢ ɡɧɚɱɚʁɧɨ ɩɨɛɨʂɲɚɥɨ ɤɥɢɧɢɱɤɟ ɢɫɯɨɞɟ ɢ ɢɧɞɭɤɨɜɚɥɨ ɭɲɬɟɞɟ, ɩɚ ɫɟ ɫɚɦɢɦ ɬɢɦ ɭɫɜɚʁɚʃɟ ɞɭɝɨɪɨɱɧɢɯ ɫɬɪɚɬɟɝɢʁɚ ɫɚ ɰɢʂɟɦ ɩɪɟɨɛɥɢɤɨɜɚʃɚ ɧɚɱɢɧɚ ɪɚɡɦɢɲʂɚʃɚ ɦɟɞɢɰɢɧɫɤɨɝ ɨɫɨɛʂɚ ɧɚɦɟʄɟ ɤɚɨ ɧɟɨɩɯɨɞɧɨɫɬ. Ⱦɚɬɭɦ ɩɪɢɯɜɚɬɚʃɚ ɬɟɦɟ ɨɞ ɫɬɪɚɧɟ ɇɇȼ: 17.10.2012. Ⱦɉ Ⱦɚɬɭɦ ɨɞɛɪɚɧɟ: ȾɈ 149 ɑɥɚɧɨɜɢ ɤɨɦɢɫɢʁɟ: ɄɈ ɉɪɟɞɫɟɞɧɢɤ ɩɪɨɮ. ɞɪ Ɂɨɪɢɰɚ Ʌɚɡɢʄ Ɏɚɤɭɥɬɟɬ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤɚ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ ɑɥɚɧ ɩɪɨɮ. ɞɪ ȼɢɤɬɨɪɢʁɚ Ⱦɪɚɝɨʁɟɜɢʄ ɋɢɦɢʄ Ɇɟɞɢɰɢɧɫɤɢ ɮɚɤɭɥɬɟɬ ȼɆȺ ɍɧɢɜɟɪɡɢɬɟɬɚ ɨɞɛɪɚɧɟ ɭ Ȼɟɨɝɪɚɞɭ ɑɥɚɧ ɩɪɨɮ. ɞɪ Ɇɚɪɢɧɚ ɉɟɬɪɨɜɢʄ Ɏɚɤɭɥɬɟɬ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤɚ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ 150 10.2 ɄȿВ АORDS DOCUMENTATION UNIVERSITY OF KRAGUJEVAC FACULTY OF MEDICINE KRAGUJEVAC Accession number: ANO Identification number: INO Documentation type: Monographic publication DT Type of record: Textual printed material TR Contents code: PhD thesis CC Author: VШУТsХКv ĆupurНТУК AU Menthor/co-mentor ЈrШП Нr MТСКУХШ JКФШvХУОvТć MN Title: Determinants of cost of illness of TI Community-acquired pneumonia 151 Language of text: Serbian (Cyrillic)/English LT Language of abstract: Serbian (Cyrillic)/English LA Country of publication: Serbia CP Locality of publication: Sumadija municipality LP Publication year: 2015 PY Publisher: Author reprint PU Publication place: 34000 Kragujevac, Serbia PP Svetozara Markovica 69 Physical description: Thesis contains 145 pages, 9 chapters, PD 33 tables, 11 graphs and 133 citations Scientific field: Medicine SF Scientific discipline: Pharmacology/Health economy/ SD Internal medicine/Pulmonology Subject/key words: Community-acquired pneumonia, SKW Cost of illness, Costs and cost analysis, Hospitalization, Disease severity index UDC Holding data: Library of Faculty of Medical Sciences Kragujevac, 34000 Kragujevac, Serbia Svetozara Markovica 69 Note: N 152 Abstract: AB Community-acquired pneumonia is defined as a potentially severe illness with high incidence and significant economic impact. The objective of this study was to assess the direct and indirect costs of diagnosing and treating community-acquired pneumonia (CAP), correlating those costs with CAP severity at diagnosis and identifying the major cost drivers which determinate average cost of illness, per patient, in Clinical center Kragujevac, with comparison of results obtained with results from similar trials conducted in Europe and worldwide. This was a prospective cost analysis study using bottom-up costing. Clinical severity and mortality risk were assessed with the pneumonia severity index (PSI) and the mental Confusion-Urea-Respiratory rate-Blood pressure-age ≥ 65 years (CURB-65) scale, respectively. The sample comprised 95 inpatients hospitalized for newly diagnosed CAP. The analysis was run from a societal perspective with a time horizon of one year. Expressed as mean ± standard deviation, in Euros, the direct and indirect medical costs per CAP patient were 696 ± 531 and 410 ± 283, respectively, the total per-patient cost therefore being 1,106 ± 657. The combined budget impact of our patient cohort, in Euros, was 105,087 (66,109 and 38,979 in direct and indirect costs, respectively). The major cost drivers, in descending order, were the opportunity cost (lost productivity); diagnosis and treatment of comorbidities; and administration of medications, oxygen, and blood derivatives. The CURB-65 and PSI scores both correlated with the indirect costs of CAP treatment. The PSI score correlated positively with the overall frequency of use of health care services. Neither score showed any clear relationship with the direct costs of CAP treatment. Clinical severity at admission appears to be unrelated to the costs of CAP treatment. This is mostly attributable to unwarranted hospital admission (or unnecessarily long hospital stays) in cases of mild pneumonia, as well as to over-prescription of antibiotics. Authorities should strive to improve adherence to guidelines and promote cost-effective prescribing practices among physicians. Providing more concrete evidence to medical workers aiming at economically efficient medical interventions with the purpose of treating pneumonia would improve clinical outcomes significantly and induce savings. Accepted by the Scientic Board on: 17.10.2012. ASB Defended on: DE 153 Thesis defended board (Degree/name/surname/title/faculty) DB Chairman Prof ГШrТМК LКгТć MD ЈСD Faculty of Medical Sciences, University in Kragujevac Member ЈrШП VТФtШrТУК DrКРШУОvТć SТЦТć MD ЈСD Medical Faculty MMA, University of Defence in Belgrade Member Prof Marina ЈОtrШvТć MD ЈСD Faculty of Medical Sciences, University in Kragujevac 154 10.3 Ȼɢɨɝɪɚɮɢʁɚ ɚɭɬɨɪɚ Ⱦɪ ȼɨʁɢɫɥɚɜ ȶɭɩɭɪɞɢʁɚ ʁɟ ɪɨђɟɧ ɭ Ʉɪɚɝɭʁɟɜɰɭ 20. ʁɚɧɭɚɪɚ 1976. ɝɨɞɢɧɟ, ɝɞɟ ʁɟ ɡɚɜɪɲɢɨ ɨɫɧɨɜɧɭ ɲɤɨɥɭ ɢ ɉɪɜɭ ɤɪɚɝɭʁɟɜɚɱɤɭ ɝɢɦɧɚɡɢʁɭ, ɫɚ ɨɞɥɢɱɧɢɦ ɭɫɩɟɯɨɦ. Ɇɟɞɢɰɢɧɫɤɢ ɮɚɤɭɥɬɟɬ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ ɭɩɢɫɚɨ ʁɟ ɲɤɨɥɫɤɟ 1994/95. ɝɨɞɢɧɟ ɢ ɞɢɩɥɨɦɢɪɚɨ 2001. ɝɨɞɢɧɟ, ɫɚ ɩɪɨɫɟɱɧɨɦ ɨɰɟɧɨɦ 9,51. ɍ ɬɨɤɭ ɫɬɭɞɢʁɚ ɭɱɟɫɬɜɨɜɚɨ ʁɟ ɭ ɢɡɜɨђɟʃɭ ɧɚɫɬɚɜɟ ɤɚɨ ɫɬɭɞɟɧɬ ɞɟɦɨɧɫɬɪɚɬɨɪ ɧɚ ɩɪɟɞɦɟɬɭ ɏɢɫɬɨɥɨɝɢʁɚ ɫɚ ɟɦɛɪɢɨɥɨɝɢʁɨɦ. ɉɨɫɥeɞɢɩɥɨɦɫɤɟ, ɦɚɝɢɫɬɚɪɫɤɟ ɫɬɭɞɢʁɟ je ɭɩɢɫɚɨ ɧɚ Ɇɟɞɢɰɢɧɫɤɨɦ ɮɚɤɭɥɬɟɬɭ ɭ Ʉɪɚɝɭʁɟɜɰɭ ɲɤɨɥɫɤɟ 2002/03. ɝɨɞɢɧɟ, a 2006. ɝɨɞɢɧɟ ʁɟ ɩɪɟɲɚɨ ɧɚ Ⱦɨɤɬɨɪɫɤɟ ɚɤɚɞɟɦɫɤɟ ɫɬɭɞɢʁɟ, ɫɦɟɪ Ʉɥɢɧɢɱɤɚ ɢ ɟɤɫɩɟɪɢɦɟɧɬɚɥɧɚ ɮɚɪɦɚɤɨɥɨɝɢʁɚ. ɍɫɦɟɧɢ ɞɨɤɬɨɪɚɧɬɫɤɢ ɢɫɩɢɬ ʁɟ ɩɨɥɨɠɢɨ ɭ ɨɤɬɨɛɪɭ 2011. ɝɨɞɢɧɟ ɫɚ ɨɰɟɧɨɦ 9. Ɋɚɞɧɢ ɨɞɧɨɫ ʁɟ ɡɚɫɧɨɜɚɨ ɧɚ Ɇɟɞɢɰɢɧɫɤɨɦ ɮɚɤɭɥɬɟɬɭ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ ɭ ɦɚʁɭ 2004. ɝɨɞɢɧɟ ɤɚɨ ɚɫɢɫɬɟɧɬ-ɩɪɢɩɪɚɜɧɢɤ ɧɚ ɤɚɬɟɞɪɢ Ɇɟɞɢɰɢɧɫɤɟ ɛɢɨɯɟɦɢʁɟ, ɝɞɟ ʁɟ ɪɚɞɢɨ ɞɨ ɧɨɜɟɦɛɪɚ 2006. ɝɨɞɢɧɟ, ɨɞ ɤɚɞɚ ʁɟ ɡɚɩɨɫɥɟɧ ɭ Ʉɐ Ʉɪɚɝɭʁɟɜɚɰ. ɋɩɟɰɢʁɚɥɢɡɚɰɢʁɭ ɢɡ ɂɧɬɟɪɧɟ ɦɟɞɢɰɢɧɟ ʁɟ ɭɩɢɫɚɨ ɭ ɧɨɜɟɦɛɪɭ 2006. ɝɨɞɢɧɟ, a ʁɚɧɭɚɪɚ 2011. ʁɟ ɩɨɥɨɠɢɨ ɫɩɟɰɢʁɚɥɢɫɬɢɱɤɢ ɢɫɩɢɬ ɫɚ ɨɰɟɧɨɦ „ɨɞɥɢɱɚɧ“. Ɋɚɞɢ ɭ Ʉɥɢɧɢɰɢ ɡɚ ɩɭɥɦɨɥɨɝɢʁɭ Ʉɐ Ʉɪɚɝɭʁɟɜɚɰ. Ɂɚɩɨɫɥɟɧ ʁɟ ɤɚɨ ɫɚɪɚɞɧɢɤ ɭ ɧɚɫɬɚɜɢ ɧɚ ɤɚɬɟɞɪɢ ɂɧɬɟɪɧɟ ɦɟɞɢɰɢɧɟ ɎɚɤɭɥɬɟɬК ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤɚ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ ɨɞ ʁɭɧɚ 2014. ɝɨɞɢɧɟ. ɉɨɡɧɚʁɟ ɪɚɞ ɧɚ ɪɚɱɭɧɚɪɭ ɢ ɝɨɜɨɪɢ ɟɧɝɥɟɫɤɢ ʁɟɡɢɤ, ɫɥɭɠɢ ɫɟ ɮɪɚɧɰɭɫɤɢɦ ɢ ɲɩɚɧɫɤɢɦ ʁɟɡɢɤɨɦ. ɇɚ ȿɤɨɧɨɦɫɤɨɦ ɮɚɤɭɥɬɟɬɭ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ȼɟɨɝɪɚɞɭ ɡɚɜɪɲɢɨ ʁɟ ɫɩɟɰɢʁɚɥɢɫɬɢɱɤɢ ɬɪɟɧɢɧɝ ɡɚ ɨɪɝɚɧɢɡɚɰɢɨɧɢ ɪɚɡɜɨʁ ɲɤɨɥɫɤɟ 2001/2002. ɝɨɞɢɧɟ. Ⱥɭɬɨɪ ʁɟ ɢ ɤɨɚɭɬɨɪ 11 ɪɚɞɨɜɚ ɢɡ ɨɛɥɚɫɬɢ ɩɭɥɦɨɥɨɝɢʁɟ ɢ ɮɚɪɦɚɤɨɥɨɝɢʁɟ ɨɞ ɱɟɝɚ ɫɭ 4 ɩɭɛɥɢɤɨɜɚɧɚ ɭ ɱɚɫɨɩɢɫɢɦɚ ɨɞ ɦɟђɭɧɚɪɨɞɧɨɝ ɡɧɚɱɚʁɚ. Ⱥɭɬɨɪ ʁɟ ɢ ɞɜɚ ɩɨɝɥɚɜʂɚ ɭ ɭџɛɟɧɢɤɭ „Ɂɞɪɚɜɫɬɜɟɧɚ ɟɤɨɧɨɦɢʁɚ ɫɚ ɮɚɪɦɚɤɨɟɤɨɧɨɦɢʁɨɦ ɡɚ ɫɬɭɞɟɧɬɟ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤɚ“, ɭɪɟɞɧɢɤɚ ɩɪɨɮ. ɞɪ Ɇɢɯɚʁɥɚ Јɚɤɨɜʂɟɜɢʄɚ, ɨɛʁɚɜʂɟɧɨɦ 2014. ɝɨɞɢɧɟ. ɇɚ ɩɨʂɭ ɫɜɨɝ ɤɨɧɬɢɧɭɢɪɚɧɨɝ ɫɬɪɭɱɧɨɝ ɭɫɚɜɪɲɚɜɚʃɚ ɞɪ ȼɨʁɢɫɥɚɜ ȶɭɩɭɪɞɢʁɚ ʁɟ ɛɢɨ ɚɤɬɢɜɧɢ ɭɱɟɫɧɢɤ ɧɚ ɛɪɨʁɧɢɦ ɞɨɦɚʄɢɦ, ɪɟɝɢɨɧɚɥɧɢɦ ɢ ɦɟђɭɧɚɪɨɞɧɢɦ ɫɢɦɩɨɡɢʁɭɦɢɦɚ ɢ ɤɨɧɝɪɟɫɢɦɚ ɩɨɫɜɟʄɟɧɢɦ ɬɟɦɚɬɢɰɢ ɭ ɨɛɥɚɫɬɢ ɩɭɥɦɨɥɨɝɢʁɟ ɢ ɮɚɪɦɚɤɨɥɨɝɢʁɟ. 155 10.4 Ȼɢɛɥɢɨɝɪɚɮɢʁɚ ɪɚɞɨɜɚ ɚɭɬɨɪɚ Ɋɚɞɨɜɢ ɨɛʁɚɜʂɟɧɢ ɭ ɧɚɭɱɧɢɦ ɱɚɫɨɩɢɫɢɦɚ ɦɟђɭɧɚɪɨɞɧɨɝ ɡɧɚɱɚʁɚ 1. 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MКФsТЦШvТć M, ĆupurНТУК V, VušКЧШvТć A, JКЧФШvТć Ћ. PШtrШšЧУК ХОФШvК ЧК IЧtОrЧШУ klinici u Kragujevcu od 1997. do 1999., 42. Kongres studenata medicine i stШЦКtШХШРТУО JuРШsХКvТУО sК ЦОđuЧКrШНЧТЦ učОšćОЦ, 17-21. april 2001., Lepenski Vir, ГЛШrЧТФ sКžОtКФК, 86 158 ɈȻɊȺɁȺɐ 1. ɂɡʁɚɜɚ ɨ ɚɭɬɨɪɫɬɜɭ ɉɨɬɩɢɫɚɧɢ-ɚ: ȼɨʁɢɫɥɚɜ ȶɭɩɭɪɞɢʁɚ Ȼɪɨʁ ɭɩɢɫɚ: ɂɡʁɚɜʂɭʁɟɦ Ⱦɚ ʁɟ ɞɨɤɬɨɪɫɤɚ ɞɢɫɟɪɬɚɰɢʁɚ ɩɨɞ ɧɚɫɥɨɜɨɦ: Ⱦɟɬɟɪɦɢɧɚɧɬɟ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɪɟɡɭɥɬɚɬ ɫɨɩɫɬɜɟɧɨɝ ɢɫɬɪɚɠɢɜɚɱɤɨɝ ɪɚɞɚ, ɞɚ ɩɪɟɞɥɨɠɟɧɚ ɞɢɫɟɪɬɚɰɢʁɚ ɭ ɰɟɥɢɧɢ ɧɢ ɭ ɞɟɥɨɜɢɦɚ ɧɢʁɟ ɛɢɥɚ ɩɪɟɞɥɨɠɟɧɚ ɡɚ ɞɨɛɢʁɚʃɟ ɛɢɥɨ ɤɨʁɟ ɞɢɩɥɨɦɟ ɩɪɟɦɚ ɫɬɭɞɢʁɫɤɢɦ ɩɪɨɝɪɚɦɢɦɚ ɞɪɭɝɢɯ ɜɢɫɨɤɨɲɤɨɥɫɤɢɯ ɭɫɬɚɧɨɜɚ, ɞɚ ɫɭ ɪɟɡɭɥɬɚɬɢ ɤɨɪɟɤɬɧɨ ɧɚɜɟɞɟɧɢ ɢ ɞɚ ɧɢɫɚɦ ɤɪɲɢɨ/ɥɚ ɚɭɬɨɪɫɤɚ ɩɪɚɜɚ ɢ ɤɨɪɢɫɬɢɨ ɢɧɬɟɥɟɤɬɭɚɥɧɭ ɫɜɨʁɢɧɭ ɞɪɭɝɢɯ ɥɢɰɚ ɉɨɬɩɢɫ ɚɭɬɨɪɚ ɍ Ʉɪɚɝɭʁɟɜɰɭ, ИИИИИИИИИИИИИИИИИИИИИИИ ________________________________ 159 ɈȻɊȺɁȺɐ 2. ɂɡʁɚɜɚ ɨ ɢɫɬɨɜɟɬɧɨɫɬɢ ɲɬɚɦɩɚɧɟ ɢ ɟɥɟɤɬɪɨɧɫɤɟ ɜɟɪɡɢʁɟ ɞɨɤɬɨɪɫɤɨɝ ɪɚɞɚ ɂɦɟ ɢ ɩɪɟɡɢɦɟ ɚɭɬɨɪɚ: ȼɨʁɢɫɥɚɜ ȶɭɩɭɪɞɢʁɚ Ȼɪɨʁ ɭɩɢɫɚ: ɋɬɭɞɢʁɫɤɢ ɩɪɨɝɪɚɦ: Ⱦɨɤɬɨɪɫɤɟ ɚɤɚɞɟɦɫɤɟ ɫɬɭɞɢʁɟ ɇɚɫɥɨɜ ɪɚɞɚ: Ⱦɟɬɟɪɦɢɧɚɧɬɟ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ Ɇɟɧɬɨɪ: ɩɪɨɮ. ɞɪ Ɇɢɯɚʁɥɨ Јɚɤɨɜʂɟɜɢʄ ɉɨɬɩɢɫɚɧɢ : ȼɨʁɢɫɥɚɜ ȶɭɩɭɪɞɢʁɚ ɂɡʁɚɜʂɭʁɟɦ ɞɚ ʁɟ ɲɬɚɦɩɚɧɚ ɜɟɪɡɢʁɚ ɦɨɝ ɞɨɤɬɨɪɫɤɨɝ ɪɚɞɚ ɢɫɬɨɜɟɬɧɚ ɟɥɟɤɬɪɨɧɫɤɨʁ ɜɟɪɡɢʁɢ ɤɨʁɭ ɫɚɦ ɩɪɟɞɚɨ/ɥɚ ɡɚ ɨɛʁɚɜʂɢɜɚʃɟ ɧɚ ɩɨɪɬɚɥɭ Ⱦɢɝɢɬɚɥɧɨɝ ɪɟɩɨɡɢɬɨɪɢʁɭɦɚ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ. Ⱦɨɡɜɨʂɚɜɚɦ ɞɚ ɫɟ ɨɛʁɚɜɟ ɦɨʁɢ ɥɢɱɧɢ ɩɨɞɚɰɢ ɜɟɡɚɧɢ ɡɚ ɞɨɛɢʁɚʃɟ ɚɤɚɞɟɦɫɤɨɝ ɡɜɚʃɚ ɞɨɤɬɨɪɚ ɧɚɭɤɚ, ɤɚɨ ɲɬɨ ɫɭ ɢɦɟ ɢ ɩɪɟɡɢɦɟ, ɝɨɞɢɧɚ ɢ ɦɟɫɬɨ ɪɨђɟʃɚ ɢ ɞɚɬɭɦ ɨɞɛɪɚɧɟ ɪɚɞɚ. Ɉɜɢ ɥɢɱɧɢ ɩɨɞɚɰɢ ɦɨɝɭ ɫɟ ɨɛʁɚɜɢɬɢ ɧɚ ɦɪɟɠɧɢɦ ɫɬɪɚɧɢɰɚɦɚ ɞɢɝɢɬɚɥɧɟ ɛɢɛɥɢɨɬɟɤɟ, ɭ ɟɥɟɤɬɪɨɧɫɤɨɦ ɤɚɬɚɥɨɝɭ ɢ ɭ ɩɭɛɥɢɤɚɰɢʁɚɦɚ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ. ɉɨɬɩɢɫ ɚɭɬɨɪɚ ɍ Ʉɪɚɝɭʁɟɜɰɭ, ИИИИИИИИИИИИИИИИИИИ __________________________ 160 ɈȻɊȺɁȺɐ 3. ɂɡʁɚɜɚ ɨ ɤɨɪɢɲʄɟʃɭ Ɉɜɥɚɲʄɭʁɟɦ ɍɧɢɜɟɪɡɢɬɟɬɫɤɭ ɛɢɛɥɢɨɬɟɤɭ ɞɚ ɭ Ⱦɢɝɢɬɚɥɧɢ ɪɟɩɨɡɢɬɨɪɢʁɭɦ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ ɭɧɟɫɟ ɦɨʁɭ ɞɨɤɬɨɪɫɤɭ ɞɢɫɟɪɬɚɰɢʁɭ ɩɨɞ ɧɚɫɥɨɜɨɦ: Ⱦɟɬɟɪɦɢɧɚɧɬɟ ɬɪɨɲɤɨɜɚ ɥɟɱɟʃɚ ɜɚɧɛɨɥɧɢɱɤɟ ɩɧɟɭɦɨɧɢʁɟ ɤɨʁɟ ʁɟ ɦɨʁɟ ɚɭɬɨɪɫɤɨ ɞɟɥɨ. Ⱦɢɫɟɪɬɚɰɢʁɭ ɫɚ ɫɜɢɦ ɩɪɢɥɨɡɢɦɚ ɩɪɟɞɚɨ/ɥɚ ɫɚɦ ɭ ɟɥɟɤɬɪɨɧɫɤɨɦ ɮɨɪɦɚɬɭ ɩɨɝɨɞɧɨɦ ɡɚ ɬɪɚʁɧɨ ɚɪɯɢɜɢɪɚʃɟ. Ɇɨʁɭ Ⱦɨɤɬɨɪɫɤɭ ɞɢɫɟɪɬɚɰɢʁɭ ɩɨɯɪɚʃɟɧɭ ɭ Ⱦɢɝɢɬɚɥɧɢ ɪɟɩɨɡɢɬɨɪɢʁɭɦ ɍɧɢɜɟɪɡɢɬɟɬɚ ɭ Ʉɪɚɝɭʁɟɜɰɭ ɦɨɝɭ ɞɚ ɤɨɪɢɫɬɟ ɫɜɢ ɤɨʁɢ ɩɨɲɬɭʁɭ ɨɞɪɟɞɛɟ ɫɚɞɪɠɚɧɟ ɭ ɨɞɚɛɪɚɧɨɦ ɬɢɩɭ ɥɢɰɟɧɰɟ Ʉɪɟɚɬɢɜɧɟ ɡɚʁɟɞɧɢɰɟ (CrОКtТvО CШЦЦШЧs) ɡɚ ɤɨʁɭ ɫɚɦ ɫɟ ɨɞɥɭɱɢɨ/ɥɚ. 1. Ⱥɭɬɨɪɫɬɜɨ 2. Ⱥɭɬɨɪɫɬɜɨ – ɧɟɤɨɦɟɪɰɢʁɚɥɧɨ 3. Ⱥɭɬɨɪɫɬɜɨ – ɧɟɤɨɦɟɪɰɢʁɚɥɧɨ – ɛɟɡ ɩɪɟɪɚɞɟ 4. Ⱥɭɬɨɪɫɬɜɨ – ɧɟɤɨɦɟɪɰɢʁɚɥɧɨ – ɞɟɥɢɬɢ ɩɨɞ ɢɫɬɢɦ ɭɫɥɨɜɢɦɚ 5. Ⱥɭɬɨɪɫɬɜɨ – ɛɟɡ ɩɪɟɪɚɞɟ 6. Ⱥɭɬɨɪɫɬɜɨ – ɞɟɥɢɬɢ ɩɨɞ ɢɫɬɢɦ ɭɫɥɨɜɢɦɚ (Ɇɨɥɢɦɨ ɞɚ ɡɚɨɤɪɭɠɢɬɟ ɫɚɦɨ ʁɟɞɧɭ ɨɞ ɲɟɫɬ ɩɨɧɭђɟɧɢɯ ɥɢɰɟɧɰɢ, ɱɢʁɢ ʁɟ ɤɪɚɬɚɤ ɨɩɢɫ ɞɚɬ ɧɚ ɨɛɪɚɫɰɭ ɛɪɨʁ 4.) ɉɨɬɩɢɫ ɚɭɬɨɪɚ ɍ Ʉɪɚɝɭʁɟɜɰɭ, ИИИИИИИИИИИИИИИИИИИ __________________________