Функціональні стани кровообігу в ранньому післяопераційному періоді при протезуванні клапанів серця та аорто-коронарному шунтуванні: Автореф. дис… к

2

I?i?noa?noai ioi?iie caei?ia’y Oe?a?ie

Ee?anueea iaaee/ia aeaaeai?y i?neyaeeieiiii? ina?oe

?i. I.E.Ooieea

EINEOOIA IEAA AIAOIE?EIAE*

OAeE 616.1-089:616-036.828-08

OOIEOe?IIAEUeI? NOAIE E?IAIIA?AO A ?AIIUeIIO I?NEssIIA?AOe?EIIIO
IA??IAe? I?E I?IOACOAAII? EEAIAI?A NA?Oess

OA AI?OI-EI?IIA?IIIO OOIOOAAII?

14.01.30- aianoac?ieia?y oa ?ioaineaia oa?ai?y

Aaoi?aoa?ao

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

Ee?a – 1999

Aeena?oaoe??th ? ?oeiien

?iaioa aeeiiaia a ?inoeooo? na?oeaai-noaeeiii? o??o?a?? AII Oe?a?ie
(i.Ee?a)

IAOEIAEE EA??AIEE:

aeieoi? iaaee/ieo iaoe Iaeneiaiei A?oae?e Ai?eniae/, cai. aee?aeoi?a c
iaoeiai? ?iaio? ?inoeoooo na?oeaai — noaeeiii? o??o?a?? AII Oe?a?ie

IO?Oe?EI? IIIIAIOE:

aeieoi? iaaee/ieo iaoe, noa?oee iaoeiaee ni?a?ia?oiee Noa??eia Aiaoie?e
Aieiaeeie?iae/, caa?aeoaa/ a?aeae?eo ?ioaineaii? oa?ai?? Ee?anueeiai
iaoeiai-aeine?aeiiai ?inoeoooo aaiaoieia?? oa ia?aeeaaiiy e?ia? IIC
Oe?a?ie

aeieoi? iaaee/ieo iaoe *aieee Eaiia?ae Iao?iae/, i?ioani? eaoaae?e
aianoac?ieia??, ?aai?iaoieia?? oa iaaeeoeeie eaoano?io Iaoe?iiaeueiiai
iaaee/iiai oi?aa?neoaoo ?i. I.I.Aiaiiieueoea IIC Oe?a?ie

I?IA?AeIA ONOAIIAA:

Aei?i?iiao?ianueea aea?aeaaia iaaee/ia aeaaeai?y IIC Oe?a?ie,

eaoaae?a aianoac?ieia?? oa ?aai?iaoieia??

Caoeno a?aeaoaeaoueny 22.09.99. i_14:30_aiaeei? ia can?aeaii?
niaoe?ae?ciaaii? a/aii? ?aaee Ae 26.613.02 i?e Ee?anuee?e iaaee/i?e
aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E. Ooieea I?i?noa?noaa ioi?iie
caei?ia’y Oe?a?ie (254112, i.Ee?a, aoe. Aei?iaiaeeoeueea,9)

C aeena?oaoe??th iiaeia iciaeiieoeny a a?ae?ioaoe? Ee?anueei? iaaee/ii?
aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E. Ooieea (254112, i.Ee?a, aoe.
Aei?iaiaeeoeueea,9)

Aaoi?aoa?ao ?ic?neaiee «_22__»___08______ 1999?.

A/aiee nae?aoa?

niaoe?ae?ciaaii? a/aii? ?aaee

eaiaeeaeao iaaee/ieo iaoe, aeioeaio
Aaicaeye I.I.

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. I?ia?aeia i?noea na?aae i?e/ei nia?o? ianaeaiiy
Oe?a?ie caeiathoue caoai?oaaiiy nenoaie e?iaiia?ao, ieoiia aaaa yeeo a
no?oeoo?? caaaeueii? eaoaeueiino? neeaaea? 64%, a a i?aoeacaeaoiiio
a?oe? – 29,3% (I.O.Aic?aiia, 1996). Aei oiai ae c?inoaiiy nia?oiino?
a?ae ?ON a 1,5 ?ace ca inoaii? 10 ?ie?a noi?iaiaeaeoaaeiny ca?eueoaiiyi
caoai?thaaiino? a 3,5 ?ace ? ?iciianthaeaeoaai?noth o 7 ?ac?a
(A.A.Eieoia, ss.A.Aaiaeao 1996). Oaeei /eiii, e?eoaaiiy caoai?thaaiue
na?oey ? iniiaiei ieoaiiyi no/anii? ea?ae?ieia??.

Aea, iacaaaeath/e ia cia/i? oni?oe o??o?a?/iiai e?eoaaiiy caoai?thaaiue
na?oey, oaeineiiaeaiiy oe?iei a?aeiieo iia?aoe?e, iaeiei c aieiaieo
ieoaiue caeeoaaoueny e?eoaaiiy oai?eo o ?aiiueiio i?neyiia?aoe?eiiio
ia??iae? (A.?.Ao?aeianueeee,1989; J.K.Kirklin, 1984). Ca aeaieie
iaoeiai? e?oa?aoo?e eaoaeuei?noue na?aae ea?ae?io??o?a?/ieo oai?eo a
oaia??oi?e /an noaiiaeoue a?ae 2,7 aei 30% (J.Herlits,1987;
I.I.Aiinia,1980; A.?.Ao?aeianueeee,1994). Aino?a na?oeaaa
iaaeinoaoi?noue (ANI) a ?aiiueiio i?neyiia?aoe?eiiio ia??iae? (?II) a
no?oeoo?? oneeaaeiaiue caeiaa ia?oa i?noea ? noaiiaeoue 15,4% o oai?eo
i?ney i?ioacoaaiiy eeaiai?a na?oey oa 4,5% o oai?eo, iia?iaaieo c
i?eaiaeo ?ON. ?aiiy ae?aaiinoeea ANI oneeaaeiaia oei, ui a?eueo?noue ??
ee?i?/ieo neiioii?a iathoue i?eoiaaiee oa?aeoa? aiane?aeie ianeaii?
iaaeeeaiaioicii? oa o?ainooc?eii? oa?ai?? (S.Tarhan,1989; J. Waldhausen,
1991).

Iaoiaee i?neyiia?aoe?eiiai niinoa?aaeaiiy ca oai?eie oa ?ioaineaia
oa?ai?y a no/ani?e ea?ae?io??o?a?? aacothoueny ia aeei?enoaii?
noaiaea?oieo aeai?eoi?a, ye? ia a?aoiaothoue an?o iniaeeainoae
iaoiaaiaco ANI i?ney ?aaeeeaeueii? ei?aeoe?? iaaooeo aaae na?oey oa ?ON.
Ae?aaiinoeea na?oeaai? iaaeinoaoiino? a oiiaao no/anii? ?ioaineaii?
oa?ai?? iio?aao? ai?iaaaeaeaiiy aenieioi/ieo oa aeinooiieo o uiaeaii?e
i?aeoeoe? iaoiae?a aeine?aeaeaiiy, aea??o iioeiaeueii? oa?ai??,
aeoiaey/e ?c aeyaeaieo iaoio?c?ieia?/ieo c?ooaiue oa i?iaiico iiaeeeaiai
ia?aa?ao ANI. Ae??oaiy oeeo ieoaiue ? iaoith aeena?oaoe?eiiai
aeine?aeaeaiiy.

Io?eiai? ?acoeueoaoe iiaeooue aeei?enoiaoaaoeny a yeino? i?aeoe/ieo
?aeiiaiaeaoe?e ii oaeineiiaeaiith ae?aaiinoeee oa e?eoaaiiy
i?neyiia?aoe?eii? aino?i? na?oeaai? iaaeinoaoiino? i?e i?ioacoaaii?
eeaiai?a na?oey oa ai?oi-ei?iia?iiio ooiooaaii?.

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. ?iaioa aeeiiaia
o a?aeiia?aeiino? c iniiaieie iai?yieaie iaoeiai- aeine?aeii? ?iaioe
?inoeoooo na?oeaai-noaeeiii? o??o?a?? AII Oe?a?ie ? ? o?aaiaioii
eiiieaenii? oaie, yea ?ic?iaeyeany ?inoeoooii a 1994-1996 ?ieao:
«?ic?iaea ? noaiaea?oecaoe?y no/anieo iaaee/ieo oaoiieia?e ae?aaiinoeee
? e?eoaaiiy iaea?eueo iioe?aieo caoai?thaaiue Oe?a?ie ia i?eeeaae?
ea?ae?io??o?a??». Oeo? oaie AeE.94.01.066. Iiia? aea?aeaaii? ?a?no?aoe??
0194V042406.

Iaoa ? caaea/? aeine?aeaeaiiy. Iaoa ?iaioe iieyaaea o i?aeaeuaii?
aoaeoeaiino? ?ioaineaii? oa?ai?? o ?aiiueiio i?neyiia?aoe?eiiio ia??iae?
ia iniia? aeeoa?aioe?eii? ae?aaiinoeee ??ciiiai?oieo oei?a
ooieoe?iiaeueiiai noaio e?iaiia?ao o oai?eo, ye? ia?aianee i?ioacoaaiiy
eeaiai?a na?oey ? ai?oi-ei?iia?ia ooiooaaiiy.

Aeinyaiaiiy oe??? iaoe aeiiaaei ae??oaiiy ianooiieo caaaeaiue:

1) ii??aiyeueia ioe?iea ?ioii?iaoeaiino? iieaciee?a, ye?
oa?aeoa?ecothoue noai nenoaiii? aaiiaeeiai?ee;

2) ?ic?iaea ? oaeineiiaeaiiy iaoiae?a ae?aaiinoeee ??cieo
ooieoe?iiaeueieo noai?a nenoaiii? aaiiaeeiai?ee o ?aiiueiio
i?neyiia?aoe?eiiio ia??iae?;

3) canoinoaaiiy iaoiaeo iaoaiaoe/iiai iiaeaethaaiiiy aeey aecia/aiiy
aeeiai?ee ooieoe?iiaeueieo noai?a e?iaiia?ao;

4) nenoaiaoecaoe?y aaiiaeeiai?/ieo ii?ooaiue, ui ?a?no?othoueny a
?aiiueiio i?neyiia?aoe?eiiio ia??iae? o ea?ae?io??o?a?/ieo oai?eo c
iaaooeie aaaeaie na?oey oa ?ON;

5) aeyaeaiiy oi?i ? aa??aio?a ?icaeoeo oee?eoeyoi?ii? iaaeinoaoiino?, ui
iaea?eueo /anoi cono??/athoueny;

6) aea?? iioeiaeueieo iaoiae?a ei?aeoe?? ia?aiao??a e?iaiia?ao o oai?eo,
ui iia?oaaeeny c i?eaiaeo iaaooeo aaae na?oey oa ?oai?/ii? oai?iae
na?oey c o?aooaaiiyi aecia/aieo ooieoe?iiaeueieo noai?a.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a. Iaoeiaa iiaecia ?iaioe iieyaa?
o nenoaiaoecaoe?? aino?eo aaiiaeeiai?/ieo ii?ooaiue ?aiiueiai
i?neyiia?aoe?eiiai ia??iaeo ia iniia? iaoio?c?ieia?/ieo iaoai?ci?a
aeeiai?ee nenoaiiiai e?iaiia?ao. A aeaii?e ?iaio? aia?oa iaaaaeai?
iaea?eueo oeiia? ooieoe?iiaeuei? noaie nenoaiii? aaiiaeeiai?ee ?aiiueiai
i?neyiia?aoe?eiiai ia??iaeo aeey oai?eo, ui ia?aianee iia?aoe??
i?ioacoaaiiy eeaiai?a na?oey ? ai?oi-ei?iia?iiai ooiooaaiiy a oiiaao
ooo/iiai e?iaiia?ao.

Aia?oa aecia/aii ? iienaii ?aii?, iaea?eueo oa?aeoa?i? ci?ie, nenoaiii?
aaiiaeeiai?ee i?e aeieeiaii? o oai?eo ii?ooaiue iiceiaiai e?iaiia?ao
i?ney iia?aoe?e ia «a?aee?eoiio» na?oe?.

Aia?oa ?ic?iaeaii iaoaiaoe/i? iiaeae?, ui a?aeia?aaeothoue
ooieoe?iiaeuei? noaie e?iaiia?ao ? ?o iineyiia?aoe?eio aeeiai?eo, ye?
aeicaieythoue i?iaiicoaaoe ?icaeoie iiaeeeaeo oneeaaeiaiue ? nei?ioeoe
/an i?eeiyooy oa?aiaaoe/ieo ??oaiue a oiiaao ?ioaineaii? oa?ai??.

Aaeineiiaeaii eiiieaen e?eoaaeueii — i?io?eaeoe/ieo caoiae?a aeey
iiia?aaeaeaiiy ? e?eoaaiiy aino?i? na?oeaai? iaaeinoaoiino? i?e
i?ioacoaaii? eeaiai?a na?oey oa ai?oi-ei?iia?iiio ooiooaaii? ia
i?aenoaa? io?eiaii? nenoaie ae?aaiinoeee ??ciiiai?oieo ooieoe?iiaeueieo
noai?a e?iaiia?ao oa ni?aa?aeiioaiue iniiaieo aaiiaeeiai?/ieo
iieaciee?a.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. A ?acoeueoao? i?iaaaeaieo
aeine?aeaeaiue aaeineiiaeaia iaoiaeeea i?neyiia?aoe?eiiai aaaeaiiy
ea?ae?io??o?a?/ieo oai?eo c iaaooeie aaaeaie na?oey oa ?ON. ?ic?iaeai?
i?ea?iaeuei? aeai?eoie i?eeiyooy oa?aiaaoe/ieo ??oaiue i?e ??cieo
iaea?eueo iioe?aieo i?neyiia?aoe?eieo ?iceaaeao e?iaiia?ao. Aea/aii
aaiiaeeiai?/iee noai oai?eo oa /anoioo aeieeiaiiy oneeaaeiaiue i?ney
iia?aoe??, io?eiai? aaiiaeeiai?/i? oa?aeoa?enoeee i?neyiia?aoe?eieo
a?oi, aea/ai? ni?aa?aeiioaiiy oa?aeoa?enoee e?iaiia?ao i?ae on?ia
io?eiaieie a?oiaie. ?acoeueoaoe oeueiai aeine?aeaeaiy iieeaaeai? a
iniiao nenoaie e?eoaaiiy oai?eo i?ney i?ioacoaaiiy eeaiai?a na?oey oa
ai?oi-ei?iia?iiai ooiooaaiiy,i?e ?aai?iaoe?eiiio caaacia/aii? yeeo aoee
ai?iaaaeaeai? io?eiai? ?acoeueoaoe o e?eoaaii? aino?i? na?oeaai?
iaaeinoaoiino?.

Aeiaaaeaii, ui aeei?anoaiiy ?ic?iaeaieo i?aeoiae?a aeicaieya ciaioeoe
eaoaeuei?noue a?ae aino?i? na?oeaai? oa na?oeaai-noaeeii? iaaeinoaoiino?
c 11% aei 7%. A ?acoeueoao? aeine?aeaeaiiy ?ic?iaeaiee eiiieaen
e?eoaaeueii — i?io?eaeoe/ieo caoiae?a aeey iiia?aaeaeaiiy aeieeiaiiy ?
e?eoaaiiy aino?i? na?oeaai? iaaeinoaoiino? ai?iaaaeaeaiee o ?iaioo
a?aeae?eaiue ?aai?iaoe?? ?NNO AII Oe?a?ie, a?aeae?eaiiy aianoac?ieia??
oa ?ioaineaii? oa?ai?? Aeiiaoeueeiai iaeaniiai e?eoaaeueii-ee?i?/iiai
ia’?aeiaiiy, a?aeae?eaiiy aianoac?ieia?? oa ?ioaineaii? oa?ai??
Eoaainueeiai iaeaniiai ea?ae?io??o?a?/iiai oeaio?o, a?aeae?eaiiy
ea?ae?io??o?a?? Euea?anueei? iaeanii? ee?i?/ii? e?ea?i?.

Iniaenoee aianie caeiaoaa/a. Aeena?oaoe?eia ?iaioa ? aeaniith i?aoeath
iiooeoaa/a, aaoi? naiino?eii aeeiiaa iaoaioiee iiooe, aea/ea e?oa?aoo?o
ii aeai?e oai?. Aeena?oaioii i?iaaaeaii ee?i?ei-noaoenoe/ia ianoaaeaiiy
352 oai?eo ia iaaoo? aaaee na?oey oa ?ON o a?oe? a?ae 25 aei 56 ?ie?a,
yeei aoea i?iaaaeaia ?aaeeeaeueia ei?aeoe?y aaaee. ?i ai?iaaaeaeoaaany
iniaenoi ?ic?iaeaiee oa iaoeiai iaa?oioiaaiee eiiieaen e?eoaaeueii —
i?io?eaeoe/ieo caoiae?a aeey iiia?aaeaeaiiy aeieeiaiiy ? e?eoaaiiy
aino?i? na?oeaai? iaaeinoaoiino?. I?iaaaeaii aiae?c an?o io?eiaieo
?acoeueoao?a oa ?o noaoenoe/ia ia?iaea. ?ic?iaeai? i?ea?iaeuei?
iaoaiaoe/i? iiaeae? ye? a?ao?/ii a?aeia?aaeothoue noai nenoaiii?
aaiiaeeiai?ee a eiaeiiio ie?aiiio aeiaaeeo ? ni?eythoue i?eeiyooth
aaeaeaaoieo oa?aiaaoe/ieo ??oaiue. Ia?iaea, aiae?c oa ?ioa?i?aoaoe?y
ee?i?/iiai iaoa??aeo iaeaaeeoue aaoi?o i?aaenoaaeaii? aeena?oaoe??.
Iiooeoaa/ai iaienai? an? ?icae?ee ?iaioe, aecia/aii oa?aeoa?, ianya ?
?iciiae?e ?ethno?aoeaiiai iaoa??aeo. Aaoi? i?eeiaa aaciina?aaeith
o/anoue o iia?aoe?yo oa i?neyiia?aoe?eiiio e?eoaaii? oai?eo, ui iei
ianoaaeoaaeeny. Ai?iaaaeaeaiiy ?ic?iaeaieo iei ?ino?oeoe?e aeicaieeei
ciaioeoe i?neyiia?aoe?eio eaoaeuei?noue ia 4%.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Iniiai? iieiaeaiiy aeena?oaoe??
aoee ii?eethaeiai? oa iaaiai?ai? ia : V (a 1997 ?.), VII (a 1999?.)
iaoeiaeo eiioa?aioe?yo anioe?aoe?? na?oeaai-noaeeiieo o??o?a?a Oe?a?ie a
Ee?a?. Ai?iaaoe?y aeena?oaoe?? aoea i?iaaaeaia ia ia’?aeiaiiio
can?aeaii? a?aeae?eaiue oa eaai?aoi??e ?inoeoooo na?oeaai-noaeeiii?
o??o?a?? AII Oe?a?ie a 1998?.

Ioae?eaoe?. Ca ?acoeueoaoaie aeena?oaoe?? iioae?eiaaii 5 iaoeiaeo
i?aoeue, ?c ieo 2 noaoo? o ca??ieeao iaoeiaeo i?aoeue oa 3 noaoo? a
oeaio?aeueieo iaoeiaeo iaaee/ieo aeo?iaeao. Nienie iioae?eiaaieo i?aoeue
aeiaea?oueny.

No?oeoo?a aeena?oaoe??. Aeena?oaoe?y neeaaea?oueny ?c anooio, 5
?icae?e?a iniiaii? /anoeie, aeniiae?a, i?aeoe/ieo ?aeiiaiaeaoe?e, nienea
aeei?enoaieo aeaea?ae oa 6 aeiaeaoe?a ? aeeth/a? a naaa 23 oaaeeoe?, 6
iaethie?a, 17 noai, 185 aeaea?ae aea/aii? e?oa?aoo?e, ?c ieo ?iicaiieo —
91.

INIIAIEE CI?NO ?IAIOE

Iaoa??ae ? iaoiaee aeine?aeaeaiiy. A iniiao aeena?oaoe?eii? ?iaioe
iieeaaeai? ?acoeueoaoe ianoaaeaiue oai?eo c iaaooeie aaaeaie ?
?oai?/iith oai?iaith na?oey. Ianoaaeaiiy i?iaiaeeeenue i?ioyaii 1-5 ae?a
i?ney iia?aoe?e i?ioacoaaiiy eeaiai?a na?oey ? ai?oiei?iia?iiai
ooiooaaiiy, aeeiiaieo a oiiaao ooo/iiai e?iaiia?ao.

Aoei ianoaaeaii 352 oai?eo a?eii a?ae 25 aei 56 ?ie?a. ?c ieo 45% —
ae?iee ? 55% /ieia?ee. I?iaaaeaii 2115 ianoaaeaiue.

Aeey anaa?/ii? ioe?iee ?o noaio aoee aeei?enoai? oae? iaoiaee
ianoaaeaiiy: ee?i?/i? niinoa?aaeaiiy; iii?oi?eia nenoaiieo iieaciee?a
e?iaiia?ao; iie?ea?ae?ia?ao?y (IEA); oeueo?acaoeiaa oeioiao??y;
aoiea?ae?ia?ao?y;.

Aeine?aeaeoaaeenue aaiiaeeiai?/i? iieacieee, ui a?aeia?aaeaee :

1) iniiai? oa?aeoa?enoeee nenoaiiiai e?iaiia?ao — *NN, OIE, N?, OeAO,
/an aeaiaiiy oaeeeiiiai ia’?io e?ia? (*AOIE), AOn, AOae, AOn?, ?CII;

2) aieiai? oa?aeoa?enoeee oaciai? no?oeoo?e ea?ae?ioeeeeo — oaca
aneio?iiiiai nei?i/aiiy (AN), oaca ?ciiao?e/iiai nei?i/aiiy (?N),
ia??iae aeaiaiiy (A), iaoai?/ia nenoiea (Sm), aeaeo?iiaoai?/ia nenoiea
(So), ae?anoiea (D);

3) nei?i/oaaeueio aeoeai?noue — eiao?oe??io nei?i/oaaiino? (T/E),
nei?i/oaai?noue (O-2), iaeneiaeueia nei?i/oaai?noue (Vmax),
aioo??oiueinenoie?/iee iieaciee (ANI), ?iaeaen iai?oae i?iea?aea (?II);

4) oa?aeoa?enoeee ianinii? ooieoe?? na?oey — oaea?iee ia’?i na?oey (OI),
oaea?iee ?iaeaen (O?), o?aeoe?y aeeeaeo (OA), e?ioeaai-ae?anoie?/iee
?iaeaen (EAe?), na?aaeiy oaeaee?noue aeaiaiiy e?ia? (Ve).

Ca aeaieie eaai?aoi?ieo ianoaaeaiue aecia/aee iieacieee
eeneioii-eoaeiiai noaio (EEN) oa aaciaiai neeaaeo e?ia?, aaiaoie?eo,
aaiiaeia?i, aeaeo?ie?oe oa a?eee e?ia?.

Ia?a?aoiaai? oa?aeoa?enoeee aeei?enoiaoaaeenue aeey ae?iaeaiiy ee?i?/ieo
aeniiae?a ui aei ooieoe?iioaaiiy na?oey oa e?iaiia?ao a oe?eiio.

Ia eiaeiiio aoai? ?ic?aoiaoaaeenue noaoenoe/i? iieacieee aeai?ee.
Iiiiaiaiiy ianeao niinoa?aaeaiue aoei i?eieiaii eiee aeiaeaaaiiy
ianooiii? a?oie oai?eo ii/aei iaei aieeaaoe ia ia?aiao?e na?aaei?o oa
na?aaeiuei-eaaae?aoe/ieo a?aeo?eaiue. C iaoith io?eiaiiy ei?aeoieo
iaoeiaeo ?acoeueoao?a aanue ianea niinoa?aaeaiue aoei ?iciiae?eaii ca
caaaeueii-ee?i?/ieie iciaeaie ia ianoa?e/i? eeanoa?e, oa aoea
aeine?aeaeaia aioo??oiy iaeii??aei?noue a?oi ca aeiiiiiaith i?ioeaaeo?e
eeanoa?iiai aiae?co.

Aeey eiaeii? a?oie oai?eo aoea iiaoaeiaaia a?aeiia?aeia eiii’thoa?ia
iiaeaeue, ui a?aeoai?th? c aeineoue aenieith oi/i?noth oa?aeoa?enoeee
aaiiaeeiai?ee.

Noaoenoe/ia aeinoia??i?noue ??cieoe? ia?aiao??a o a?oiao ioe?ithaaeanue
ca e?eoa???i Nouethaeaioa. Aeinoia??i?noue /anoioe iiyae iciae
aecia/aeanue ca e?eoa???i I??niia. Noaoenoe/ia iiaeaethaaiiy ia?aiao??a
i?iaiaeeeinue ca aeiiiiiaith noaiaea?oii? i?ioeaaeo?e ia/eneaiiy
eiao?oe??io?a ??aiyiue ia?ii? e?i?eii? ?aa?an??, a oaeiae aeai?eoi?a
iae?i?eiiai iiaeaethaaiiy ii iaoiaeo A?aiaeiia.

?acoeueoaoe aeanieo aeine?aeaeaiue. Iniiaieie e?eoa??yie iiae?eo
ea?ae?io??o?a?/ieo oai?eo ia a?oie aoee aeinoia??i? ?ica?aeiino? i?ae
ieie ca iieacieeaie *NN, O?, eiao?oe??ioo nei?i/oaaiino? (O/A), ?iaeaeno
caaaeueiiia?eoa??eiiai iii?o (?CII), ?iaeaeno oaea?ii? ?iaioe e?aiai
oeoii/ea (?O?EO), na?aaeiuei? oaeaeeino? i?aeaeuaiiy
aioo??oiueioeoii/eiaiai oeneo (NOIAO), ?iaeaeno nenoaiiiai iiaeeiaiiy
eenith (?NII2), eiao?oe??ioo oeaieiii? aeno?aeoe?? eenith (EOAI2),
oeaio?aeueiiai aaiiciiai oeneo (OeAO), ?iaeaeno aeeoo?caeaoiino?
aiaeiea?aea (?AEA), ?iaeaeno ia?aaaioaaeaiiy i?iea?aea (?II).

A ?acoeueoao? oaeiai iiae?eo aoee io?eiai? 3 iniiai? a?oie
aaiiaeeiai?/ieo noai?a (oaae.):

I a?oia — oai?? c ii?iiooieoe??th nenoaiii? aaiiaeeiai?ee;

?? a?oia — oai?? c a?ia?ooieoe??th nenoaiii? aaiiaeeiai?ee;

??? a?oia — oai?? c a?iiooieoe??th nenoaiii? aaiiaeeiai?ee.

I?ney iaoaiaoe/iiai aiae?co iieaciee?a iniiaieo aaiiaeeiai?/ieo a?oi
aeyaeeinue, ui eiaeia c ieo i?noeoue a?eueoa iaeiiai eeanoa?a, a naia ?
aioo??oi? ia iaeii??aeiith. A ?acoeueoao? o eiaei?e a?oi? aoee aeae?eai?
ooieoe?iiaeueii iaeii??aei? i?aea?oie. Oe? i?aea?oie ca nai?ie
oa?aeoa?enoeeaie oa a?aeoeeaiiyi iniiaieo iieaciee?a ia aeoiaeeee ca
iaae? eiaeii? c a?oi. A oie aea /an, a na?aaeei? a?oie a?aei?iiino? i?ae
oeeie i?aea?oiaie aecia/aeenue ca i??ith ?o a?aeoeeaiiy a?ae i?aea?oie c
iaoneeaaeiaiei ia?aa?aii. Oea aeaei iiaeeea?noue aeae?eeoe a eiaei?e
a?oi? aei o?ueio i?aea?oi. Ieae/a iaaaaeaii ?o oa?aeoa?enoeeo.

Oaaeeoey

Iniiai? aaiiaeeiaie/i? iieacieee ii a?oiai nenoaiiiai e?iaiia?ao o
ea?ae?io??o?a?/ieo oai?eo a ?aiiueiio i?neyiia?aoe?eiiio ia??iae?
iia?iaaieo c i?eaiaeo IAN oa ?ON

Iieacieee nenoaiiiai e?iaiia?aoIi?iiooieoe?iiaeue-iee noai nenoaiiiai
e?iaiia?ao

(n = 106)A?ia?ooieoe?iiaeue-iee noai nenoai- iiai e?iaiia?ao

(n = 77)A?iiooieoe?iiaeueiee noai nenoaiiiai e?iaiia?ao

(n = 169)MMM*NN oae/oa.88*10113*79713AOn ii ?o no1008109158614AOae ii ?o
no60*6721348*10OeAO ii ?o no6,10,67,42,87,32,3O?
ie/i223,3*1,337,1*7,920,3*2,5NOIAO ii ?o no/n1400*2001969467889*304EN
a?aei. iae.0,8*0,040,750,190,64*0,14?CII aeei·n·ni- 5·i2

2500*

490

2493

858

2882*

966Iieacieee nenoaiiiai e?iaiia?aoIi?iiooieoe?iiaeue-iee noai nenoaiiiai
e?iaiia?ao

(n = 106)A?ia?ooieoe?iiaeue-iee noai nenoaiiiai e?iaiia?ao

(n = 77)A?iiooieoe?iiaeueiee noai nenoaiiiai e?iaiia?ao

(n = 169)MMM?O?EO a·i/i2

23*1,232,3*8,0519*2,2?NII2 ie/i2

94,5*17224*38,58013?AEA a?aei. iae.1,13*0,130,86*0,330,83*0,13?II a?aei.
iae.1,22*0,221,9*0,641,59*0,32

I?ei?oee: n – e?euee?noue iia?iaaieo; * — ? < 0,05 o an?o i?aea?oiao o ii??aiyii? c i?aea?oiith c iaoneeaaeiaiei ia?aa?aii ?II. . O a?oie oai?eo c ii?iiooieoe??th nenoaiii? aaiiaeeiai?ee (iae. 1): Ia?oa i?aea?oia (n = 63) - oai?? c noaeiiiainiaaiith ii?iiooieoe??th. A aeai?e i?aea?oi? aoee ca?a?no?iaai? ci?ie oaeeo iieaciee?a: *NN - a?eueoa ca 13-15 oae./oa.; OeAO - aeua ia 0,7 ii ?o.no.; a?aenioie eenith, ui iio??aii niiaeeoe (% NiI2) - aeua ia 7%; ?II - aeua ia 0,17 a?aei.iae.; ?CII - ia 637 aeei ·n ·ni-5 ·i2; NOIAO - ia 222 ii ?o.no.; ?AEA - ieae/a ia 0,05-0,17 a?aei.iae. Oaeei /eiii, o oai?eo oe??? i?aea?oie aoee cao?eniaai? ci?ie ooieoe?iiaeueiiai noaio na?oey, ui oa?aeoa?ecothoueny iaa?aeiia?aei?noth ei?iia?iiai e?iaiia?ao aia?aicao?aoai i?iea?aea. Ae?oaa i?aea?oia (n = 4) - oai?? c noaeiiiainiaaiith ii?iiooieoe??th a ii?aeiaii? c aino?eie ii?ooaiyie iiceiaiai e?iaiia?ao (AIIE). Aeey oe??? i?aea?oie aoei oa?aeoa?ii i?aeaeuaiiy O? ia 1,3 ie/i2; cieaeaiiy NOIAO ia (304±20) ii ?o.no./n; cieaeaiiy ?CII ia (1000±55) aeei·n·ni-5·i2; i?aeaeuaiiy a?aenioeo NiI2 ia 9,6%. Oaeei /eiii, ci?ie nenoaiii? aaiiaeeiai?ee a aeaii?e i?aea?oi? i?ioiaeeee ca oeiii noaeeiii? iaaeinoaoiino?. ?u????y?u? ???$?u?y?u?w?u?w?u?y????w?u????s?u? ???$?u?s?u?q?u?q?u?s????q?u????m?o? ???$?o?m?o?k?u?k?u?m????k?o????l?o????-????-????l?o??? ?m?o????-????-? ???$?o?l?u?j?u?k?u?m????k?u????h?u? ???$?u?g?ue?e?y?f?ue?h????f?ue????b?th? ???$?th?a?y?_??`?y?b????`?y????]? ???$?Z?[?]????[????W? ???$?V?U?V?W????V????R? ???$?R?Q?Q?R????Q????R????-????-????R??? ?R????-????-? ???$?R?Q? R?S????Q? ???P? ???$? P?O?P?Q????O????N? ???$?N?M?N?O????M????L? ???$?L?K?L?M????K????J?  ???$?J?I? J? K????I? ???H?#???H?#???-????-????:?#???N?B???l?O??? ??E???F?4???¤????…????k?o????U? ???-????'yy??? ????-?????AAA???? ???????e?—?°????-????'yy??? ????-?????AAA???? ???????KT???????-????'yy??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????)?[?$???????? ???2?(???*NN*???-?????-????'yy??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????E?‹ ?^???????? ???2)?b???OeAO????-?????-????'yy??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????‰?’d?w???????????2m????O????-?????-????'yy ??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????E??¤?Z???????????2?^???NOIAO*???-?????-????' yy??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????u?„O?H???????????2TH?L????CII*????-?????-??? ?'yy??? ????-?????AAA???? ???????KT???????-????-?????-????-?????-????'yy??? ????-?????AAA???? ???????i?th?C??????-????-?????????????2N?1/2?????NII*? ???-????2O?o????2????-?????-????'yy??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????¬?O?‡?c????????? ???2?u????y?u? ???$?u?y?u?w?u?w?u?y????w?u????s?u? ???$?u?s?u?q?u?q?u?s????q?u????m?o? ???$?o?m?o?k?u?k?u?m????k?o????l?o????-????-????l?o??? ?m?o????-????-? ???$?o?l?u?j?u?k?u?m????k?u????h?u? ???$?u?g?ue?e?y?f?ue?h????f?ue????b?th? ???$?th?a?y?_??`?y?b????`?y????]? ???$?Z?[?]????[????W? ???$?V?U?V?W????V????R? ???$?R?Q?Q?R????Q????R????-????-????R??? ?R????-????-? ???$?R?Q? R?S????Q? ???P? ???$? P?O?P?Q????O????N? ???$?N?M?N?O????M????L? ???$?L?K?L?M????K????J?  ???$?J?I? J? K????I? ???H?#???H?#???-????-????:?#???N?B???l?O??? ??E???F?4???¤????…????k?o????U? ???-????'yy??? ????-?????AAA???? ???????e?—?°????-????'yy??? ????-?????AAA???? ???????KT???????-????'yy??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????)?[?$???????? ???2?(???*NN*???-?????-????'yy??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????E?‹ ?^???????? ???2)?b???OeAO????-?????-????'yy??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????‰?’d?w???????????2m????O????-?????-????'yy ??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????E??¤?Z???????????2?^???NOIAO*???-?????-????' yy??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????u?„O?H???????????2TH?L????CII*????-?????-??? ?'yy??? ????-?????AAA???? ???????KT???????-????-?????-????-?????-????'yy??? ????-?????AAA???? ???????i?th?C??????-????-?????????????2N?1/2?????NII*? ???-????2O?o????2????-?????-????'yy??? ????-?????AAA???? ???????KT???????-?????-?????-????'yy??? ????-?????AAA???? ???????¬?O?‡?c????????? ???2 Iae. 1 - Ni?aa?aeiioaiiy iieaciee?a nenoaiii? aaiiaeeiai?ee aeinoaaee oa iiaeeiaiiy eenith o oai?eo c ii?iiooieoe??th. * - ?icoiaeaeaiiy iieaciee?a aeinoia??ia, ? < 0,05. O a?oi? oai?eo c a?ia?ooieoe?ath nenoaiii? aaiiaeeiai?ee (iae. 2): Ia?oa i?aea?oia (n = 59) - oai??, aaiiaeeiai?ea yeeo ciaoiaeeeanue o noai? eiiiainiaaii? a?ia?ooieoe??. Aeey ia? oa?aeoa?ii: i?aeaeuaiiy *NN ia (35±5) oae./oa.; i?aeaeuaiiy OeAO ia (3±0,23) ii ?o.no.; i?aeaeuaiiy ?O?EO ia (4±1,4) a·i/i2; i?aeaeuaiiy ?NII2 ia (33±5) ie/i2; i?aeaeuaiiy ?II ia (0,22± 0,08) a?aei.iae.; cieaeaiiy NOIAO ia (300±20) ii ?o.no./n; cieaeaiiy ?AEA ia (0,2±0,02) a?aei.iae. Aeey oe??? i?aea?oie oai?eo aoee oa?aeoa?i? ci?ie ooieoe?iiaeueiiai noaio na?oey - i?aeaeuaiiy ciai?oiuei? ?iaioe na?oey ia oii? cieaeaii? aeinoaaee eenith. Ae?oaa i?aea?oia (n = 4) - oai?? c aeaeiiiainiaaiith a?ia?ooieoe??th aac noaeeiii? iaaeinoaoiino?. A aeai?e i?aea?oi? niinoa??aaeenue i?aeaeuaiiy OeAO ia 1,3 ii ?o.no; ?CII ia 260 aeei·n·ni-5 ·i2; O? - ia 11,4 ie/i2; cieaeaiiy NOIAO ia 184 ii ?o.no./n; cieaeaiiy ?AEA ia 0,3 a?aei.iae. Aeaeiiiainaoe?y o oai?eo oe??? i?aea?oie ca/?iaea a?eueo ae?aaeaio a c??aiyii? c iiia?aaei?th i?aea?oiith iaa?aeiia?aei?noue ei?iia?iiai e?iaiia?ao i?aeaeuai?e ciai?oi?e ?iaio? na?oey, ui aeyaeyeiny o c?inoaii? ?II oa cieaeaii? ?AE?. O?aoy i?aea?oia (n = 14) - oai?? c aeaeiiiainiaaiith a?ia?ooieoe??th c noaeeiiith iaaeinoaoi?noth. A ii??aiyii? c oai?eie ae?oai? i?aea?oie OeAO ciaiueooaaany ia 3,6 ii ?o.no.; NOIAO - ia 114 ii ?o.no./n; ?CII - ia 1900 aeei·n·ni-5 ·i2; ?O?EO ia 10,7 a·i/i2; ?NII2 - i?aeaeuoaaany ia 150 ie/i2; ?II i?aeaeuoaaany ia 0,96 a?aei.iae. Aeey oe??? i?aea?oie oa?aeoa?i? oaeiae ci?ie ooieoe?iiaeueiiai noaio na?oey, ye o iiia?aaei?o aeaio i?aea?oiao, aea aiie aoee ii?aeiai? c noaeeiiith iaaeinoaoi?noth. Iae.2. – Ni?aa?aeiioaiiy iieaciee?a nenoaiii? aaiiaeeiai?ee, aeinoaaee oa iiaeeiaiiy eenith o oai?eo c a?ia?ooieoe?ath * - ?icoiaeaeaiiy iieaciee?a aeinoia??ia, ? < 0,05. O a?oi? oai?eo c a?iiooieoe??th nenoaiii? aaiiaeeiaieee (iae. 3): Ia?oa i?aea?oia (n = 69) - oai?? c eiiiainiaaiith a?iiooieoe??th. A aeaii?e i?aea?oi? niinoa??aaeenue i?aeaeuaiiy *NN ia (13±3) oae./oa.; OeAO ia (2,5±0,5) ii ?o.no.; ?II ia (0,2±0,07) a?aei.iae.; cieaeaiiy O? ia (4±0,5) ie/i2; NOIAO ia (340±145) ii ?o.no./n; ?AEA ia (0,13±0,03) a?aei.iae. Aeey oe??? i?aea?oie aoee oa?aeoa?i? ci?ie o aeaeyae? cieaeaiiy nei?i/oaaiino? i?iea?aeo, ui aoei eiiiainiaaii i?aeaeuaiiyi ia?aaeiaaaioaaeaiiy oa ii?aeioaaeinue ?c ciaioaiiyi ??aith aeinoaaee eenith. Ae?oaa i?aea?oia (n = 27) - oai?? c aeaeiiiainiaaiith a?iiooieoe??th ii a?iiaieai?/iiio oeio. Aeey oai?eo aeaii? i?aea?oie aoei o?aeoa?ii i?aeaeuaiiy *NN aei (100±10) oae./oa.; cieaeaiiy OeAO aei (5±1) ii ?o.no.; O?± aei (19+1,1) ie/i2; NOIAO aei (1000±90) ii ?o.no./n; ?O?EO aei (20,3±1,5) a·i/i2; ?NII2 aei (90±14) ie/i2; ?AEA aei (0,6±0,1) a?ae.iae. ? i?aeaeuaiiy ?II aei (1,52±0,09) a?aei.iae. Oaeei /eiii, o oai?eo oe??? i?aea?oie niinoa??aaany a?iiaieai?/iee oei NINA, ui oa?aeoa?ecoaaeiny ciaioaiiyi ia?aaeiaaaioaaeaiiy oa O? ia oii? iacia/ii ii?ooaii? nei?ioeeaino?. O?aoy i?aea?oia (n = 73) - oai?? c aeaeiiiainiaaiith a?iiooieoe??th ii a?iinenoie?/iiio oeio. A aeaii?e i?aea?oi? niinoa??aaeenue cieaeaiiy O? aei (20±1,4) ie/i2; EN aei (0,64±0,14) a?aei.iae.; NOIAO aei (648±59) ii ?o.no.; ?NII2 aei (88±20) ie/i2; ?AEA - aei (0,72±0,02) a?aei. iae.; i?aeaeuaiiy OeAO aei (10±1,66) ii ?o.no.; ?CII aei (3005±289) aeei ·n ·ni-5 ·i2; ?II aei (1,44±0,17) a?aei.iae. Aeaeiiiainaoe?y o oai?eo aeaiii? i?aea?oie aeieeaea ia oii? ??cei cieaeaii? nei?ioeeaino?, ca?eueoaiiy ia?aae- ? iinoiaaaioaaeaiiy, ui iaaeeaeaei noai aaiiaeeiai?ee aei oiia ea?ae?iaaiiiai oieo. ?E?Ht?H???F????F|????-????-????Fh????.? ???2M??.???- aeaeiiiainiaaia a?iiooieoe?y ii a?iineno. oeio???.?????-????'yy??? ????-?????AAA???? ????????E?Ht?H???F????F|????-????-????Fh????. ? ???2M??.???- aeaeiiiainiaaia a?iiooieoe?y ii a?iineno. oeio???.?????-????'yy??? ????-?????AAA???? ??????? Iae. 3. – Ni?aa?aeiioaiiy iieaciee?a nenoaiii? aaiiaeeiai?ee, aeinoaaee oa iiaeeiaiiy eenith o oai?eo c a?iiooieoe?ath * - ?icoiaeaeaiiy iieaciee?a aeinoia??ia, ? < 0,05. A oiae? aeine?aeaeaiue aeey on?o a?oi oai?eo aoee aeyaeai? i?e/eii? oaeoi?e ci?i o ooieoe?iiaeueiiio noai? aaiiaeeiai?ee a ?II: 1) oaeoi?e na?oeaaiai aaiaco (o 60% aeiaaee?a) - a?ia?o?io?y, iaaeinoaoiy aoaeoeai?noue ei?aeoe?? aaaee, ia a?aeiia?aei?noue ei?iia?iiai e?iaioieo aia?aiao?aoai i?iea?aea (?AEA, ?NII2, ?AeI2, ?II), o?iiio?iii? ii?ooaiiy (a?eoi??, iani?eyoeea? oacia? ni?aa?aeiioaiiy (So/D, ?AEA)), iani?eyoeeaa ia?aaeiaaaioaaeaiiy (OeAO); 2) oaeoi?e noaeeiiiai iioiaeaeaiiy (o 30% aeiaaee?a) - ci?ie caaaeueiiia?eoa??eiiai iii?o - ?CII (oa?iaeieia?/iee aieea, aino?a ii?ooaiy iicaiaiai e?iaiia?ao); 3) oaeoi?e, iaoiiaeai? aieeaii nenoaie e?ia? (o 10% aeiaaee?a) - ci?ia neeaaeo e?ia? (cieaeaiiy iniiey?iino?, iieioe/iai oeneo), ciaioaiiyi eeniaai? ?ieino? e?ia? (??aaiue Ia). I?e aea/aii? nenoaiii? aaiiaeeiai?ee o ea?ae?io??o?a?/ieo oai?eo i?e a?ia?aeeiai?/iiio oei? e?iaiia?ao a ?II aoei anoaiiaeaii, ui oai?? c ee?i?/ieie iciaeaie aino?iai ii?ooaiiy iiceiaiai e?iaiia?ao (AIIE) o aeaeyae? noaeo?aeueieo aaiaoii, ui ?icoaoiaai?o o?i'yi?e,aai iioeei/i?e ae?eyioe?, oa o aeaeyae? ianneaii? iia?o?yii? aiaie?? a ae?eyioe? na?aaeiueiiiceiai? a?oa???, iathoue ?yae niaoeeo?/ieo aaiiaeeiai?/ieo a?aeoeeaiue (iae.2): - cieaeaiiy ?CII aei (900±205) aeei·n·ni-5 ·i2 ; - ??cea ca?eueoaiiy % NiI2 a 2-2,5 ?ace ? ca?eueoaiiy eiao?oe??ioa oeaieiii? aeno?aeoe?? eenith (EOAI2) a na?aaeiueiio ia 20%; - aeinoia??ia cieaeaiiy ?AEA ia 10-25%, ??no ?II ia 60-70%. Oeae neiioiiieiiieaen ca iaoeie niinoa?aaeaiiyie iiaea ?icoe?ithaaoeny ye niaoeeo?/ia iciaea AIIE. Aoei aecia/aii, ui iioeiaeueiee ??aaiue ia?aaeiaaaioaaeaiiy o ea?ae?io??o?a?/ieo oai?eo c IAN ? ?ON aecia/a?oueny o iaaeao OeAO=[(7±0,4)-(9±0,25)] ii ?o.no. Aei oiai ae, ?aaoeyoe?th ia?aaeiaaaioaaeaiiy iio??aii i?iaiaeeoe c o?aooaaiiyi ia o?eueee caaaeueiii?eeiyoeo aaiiaeeiaie/ieo ia?aiao??a (*NN, AO,OeAO), aea oaeiae ? EN, ?II, NOIAO, ?O?EO, ?AEA. C o?aooaaiiyi aeae?eaieo iaie ooieoe?iiaeueieo noai?a nenoaiii? aaiiaeeiai?ee iioeiaeuei? cia/aiiy OeAO caeaaeaoue a?ae oeio aaiiaeeiai?/ii? ?aaoeyoe??. I?iaaaeai? iaie aeine?aeaeaiiy aaiiaeeiai?/ieo c?ooaiue aeacothoue ia oa, ui cia/aiiy OeAO o iaaeao 9±0,25 ii ?o no iiaeooue aooe ?aeiiaiaeiaai? ye aaciaee ??aaiue ia?aaeiaaaioaaeaiiy aeey an?o aeine?aeaeaieo a?oi oai?eo. I?e iaiao?aeiino? iiaeaeueoi? iioei?caoe?? aaiiaeeiai?ee aeey ooieoe?iiaeueieo noai?a, oaeeo ye noaeiiiainiaaia ii?iiooieoe?y, noaeiiiainiaaia ii?iiooieoe?y a niieo/aii? c AIIE, aeaeiiiainiaaia a?ia?ooieoe?y, a?eueo ni?eyoeeaith ? oaiaeaioe?y aei cieaeaiiy OeAO aei cia/aiue 8-9 ii ?o no. A aeey oaeeo noai?a ye eiiiainiaaia a?ia?ooieoe?y, aeaeiiiainiaaia a?iiooieoe?y ii a?iiaieai?/iiio oeio iiaea aooe ?aeiiaiaeiaaia i?aeo?eiea a?eueo aenieeo cia/aiue OeAO (aei 10 ii ?o no). Oeth oaiaeaioe?th ne?ae a?aoiaoaaoe a ?ioaineai?e oa?ai?? ?II. ?aaoethaaoe OeAO a on?o iaaaaeaieo a?oiao ne?ae oaeiae c o?aooaaiyi aei iia?aoe?eieo cia/aiue EAeI EO: yeui a?i aoa ieae/a 45 ie/i2, oi OeAO aeioe?eueii i?aeo?eioaaoe ia ??ai? 7-8 ii ?o.no., a yeui oeae iieaciee aoa aeua 45 ie/i2, oi OeAO aeioe?eueii i?aeo?eioaaoe ia ??ai? 9-10 ii ?o.no. Aeine?aeaeoth/e aieea noaeeiiiai oaeoi?o ia i?aeo?eieo aaeaeaaoiiai N? i?e ??cieo ooieoe?iiaeueieo noaiao nenoaiii? aaiiaeeiai?ee, ie aecia/eee, ui ?aaoeyoe?y iinoiaaaioaaeaiiy iniaeeai iaiao?aeia i?aea?oiai ea?ae?io??o?a?/ieo oai?eo c noaeeiiith iaaeinoaoi?noth, a naia: c noaeiiiainiaaiith ii?iiooieoe??th c iciaeaie AIIE, c aeaeiiiainiaaiith a?ia?ooieoe??th c noaeeiiith iaaeinoaoi?noth; oaeiae i?aea?oia c aeaeiiiainiaaiith a?iiooieoe??th ii a?iinenoie?/iiio oeio. Iaea?eueo ni?eyoeeaa cia/aiiy ?CII aeey oeeo i?aea?oi iiaeii? ciaoiaeeoeny a iaaeao 1600 - 2400 aeei·n·ni-5·i2, ui aeinyaa?oueny ?aaoeyoe?ath IOeE, oa noaeeiiiai oiiona. Noiniaii aecia/aieo iaie ooieoe?iiaeueieo noai?a nenoaiii? aaiiaeeiai?ee ? iieaciee?a nei?i/oaaiino? na?oey oa?iaeieia?/io ?aaoeyoe?th ii?ooaiue e?iaiia?ao ca aeiiiiiaith ea?ae?ioii?/ieo cania?a ?aeiiaiaeiaaii i?iaiaeeoe oaeei /eiii: 1) aeey oai?eo c eiiiainiaaiith a?iiooieoe??th ii?yae c ?ioeie caniaaie, ui aeei?enoiaothoueny a ?ioaineai?e oa?ai??, iieacaii canoinoaaiiy Aeiaooai?ia (5-7 iea/ea/oa.) i?e cia/aiiyo ?CII > 2400 aeei·n·ni-5·i2 ,
aai Aeiiai?ia (3-5 iea/ea/oa.) a on?o ?ioeo aeiaaeeao. Oea a 65-68%
aeiaaee?a iaoiiaethaaei ia?ao?ae a a?eueo ni?eyoeeao aaiiaeeiai?/io
a?oio;

2) aeey oai?eo c aeaeiiiainiaaiith a?iiooieoe??th ii a?iinenoie?/iiio
oeio iaea?eueo aoaeoeaia niieo/aiiy a/a ?iooc?? aei OeAO=9 ii ?o.no. ?
Aeiaooai?ia (5-8 iea/ea/oa.), aai niieo/aiiy a iniaeeai oyaeeeo
aeiaaeeao Aeiiai?ia (5-7 iea/ea/oa.), Aae?aiae?ia (0,02-0,03 iea/ea/oa.)
? Iai?i?ona (1-2 iea/ea/oa.). Iiae?aia oa?ai?y a 65-75% aeiaaee?a
iaoiiaethaaea ia?ao?ae a a?eueo ni?eyoeeao aaiiaeeiai?/io a?oio;

3) aeey oai?eo c aeaeiiiainiaaiith a?iiooieoe??th ii a?iiaieai?/iiio
oeio iieacaii canoinoaaiiy a/a ?iooooc?? aei OeAO=9-10 ii ?o.no. a
niieo/aii? c Aeiiai?iii (4-5 iea/ea/oa.). Oea a 75% aeiaaee?a
aeiiiiaaaei ia?aoiaeo aaiiaeeiai?ee oai?iai a a?eueo ni?eyoeeao
aaiiaeeiai?/io a?oio;

4) aeey oai?eo c aeaeiiiainiaaiith a?ia?ooieoe??th c noaeeiiith
iaaeinoaoi?noth canoinoaaiiy Ii?aae?aiae?ia (0,03-0,04 iea/ea/oa.) ?
Aeiaooai?ia (3-4 iea/ea/oa.) a niieo/aii? c i?aeo?eieith
ia?aaeiaaaioaaeaiiy aei OeAO=8 ii ?o.no. ni?eyei a 80% aeiaaee?a
ia?aoiaeo aaiiaeeiai?ee o ooieoe?iiaeueii a?eueo ni?eyoeeao i?aea?oio.

I?ae /an iaoeo aeine?aeaeaiue ii ee?i?/i?e aac? aeaieo c aeei?enoaiiyi
iaoiaeo eeanoa?-aiae?ca aoa onoaiiaeaiee ?yae caaaeueieo caeiiii??iinoae
?aaoeyoe?? aaiiaeeiai?ee oa ia?ai?uaiiy aaiiaeeiai?/ieo iieaciee?a a
iaaeao aieiaieo ooieoe?iiaeueieo caeaaeiinoae (N?/(OeAO)) oa
(?CII/(OeAO)). A?ao?/ia i?aaenoaaeaiiy n?iaenoaa oeeo oa?aeoa?enoee
aeei?enoiaoaaeinue a yeino? iiiia?ai, ia ye? a i?ioean?
i?neyiia?aoe?eiiai aaaeaiiy oai?iai iine?aeiaii iaiineeenue e?aiee, ui
a?aeiia?aeaee iioi/iei cia/aiiyi iieaciee?a aaiiaeeiai?ee (iae. 4).

C?, e/iei/i2
?CII, aeei·n·ni-5·i2 ·103

6

65544332211

0 2 4 6 8 10 12

OeAO, ii

?o no

0 2 4 6 8 10 12 1 — a?ia?ooieoeey;
4 — eiiianiaaia a?iiooieoe?y;

2 — eiiiainiaaia ii?iiooieoe?y; 5 — aeaeiiianiaaia
a?iiooieoe?y;

3 — noaeiiianiaaia ii?iiooieoe?y; 6 — oa?i?iaeueiee noai

Iae. 4 — N?iaenoaa ooieoe?iiaeueieo caeaaeiinoae N?/OeAO, ?CII/OeAO ia
i?eeeaae? oai?iai, iia?iaaiiiai c i?eaiaeo ieo?aeueiiai noaiico

sse i?eeeaae ei?aeoe?? aaiiaeeiaieee ia oeueiio iaethieo ioieoe?ii
cia?aaeaii ia?ai?uaiiy eiie?aoiiai oai?iai c iaeiiai ooieoe?iiaeueiiai
eeano aei ?ioiai.

Ci?ie ?icoaooaaiiy e?aiie ii a?aeiioaiith aei ooieoe?iiaeueieo
oa?aeoa?enoee ?ioa?i?aooaaeenue aeey eiie?aoiiai oai?iai a iiiyooyo ci?i
ianinii? caeaoiino? na?oey, aaiiaeeiai?/ieo iaaaioaaeaiue,
aiiainoaoe/ieo ?aaeoe?e ? a?aoiaoaaeenue i?e aeai?? e?eoaaeueieo
caoiae?a, oa aeicaieyee aeine?aeaeoaaoe aeeiai?eo ? iai?aaeai?noue
i?ioean?a oa?ai?? oa ?aaoeyoe?? e?iaiia?ao o ?II.

Cia?aaeai? ia iae.4. ooieoe?iiaeuei? caeaaeiino? oaeoe/ii ?
iaoaiaoe/ieie iiaeaeyie aea/aieo iaie ooieoe?iiaeuei?o noai?a, ui
iiaeooue aooe iieeaaeai? a iniiao i?iaiicoaaiiy ia?aa?ao oa ei?aeoe??
aaiiaeeiai?/ieo c?ooaiue.

Aaaeeeaei ? aecia/ai? iaie ca’ycee oeeo iiaeaeae c iniaeeainoyie
na?oeaaeo aaae.

O oai?eo, i?iiia?iaaieo c i?eaiaeo iaaeinoaoiino? ai?oaeueiiai eeaiaio,
a ?II niinoa??aaeenue ca?eueoaiiy ia?aae- ? iinoiaaaioaaeaiiy, i?e/iio
c??no ?o noaa iane?aeeii iaaeeeoeiaiai ia?aaeiaaaioaaeaiiy. I?e oeueiio
ianinia caeaoi?noue na?oey aoea ii?iaeueiith aai ciaoiaeeeanue a iaeano?
aenieeo oa?aeoa?enoee. Caa?oa? ia naaa oaaao oie oaeo, ui ?icoaooaaiiy
e?aiie ia iiiia?ai? N?/OeAO na?ae/eoue ia ei?enoue i?yii? caeaaeiino?
i?ae oeeie iieacieeaie aeey an?o oai?eo c aeaiith iaoieia??th na?oey.

O oai?eo, i?iiia?iaaieo c i?eaiaeo ai?oaeueiiai noaiico, niinoa??aaeanue
aeniea ianinia caeaoi?noue na?oey, a?ia?aieai?y, i?aeaeuaiiy ?CII. Ci?ie
ooieoe?iiaeueiiai noaio aaiiaeeiai?ee o aeaii? eaoaai??? oai?eo
oa?aeoa?ecoaaeenue ci?iaie na?oeaaiai oaeoi?a, oiaoi ciaioaiiyi
nei?i/oaaiino?.

O oai?eo, i?iiia?iaaieo c i?eaiaeo iaaeinoaoiino? i?o?aeueiiai eeaiaio
oa i?ney AEO, ii/aoeiaee noai oa?aeoa?ecoaaany nooo?aei iia??oaiiyi
ianinii? ooieoe?? na?oey, i?aeaeuaiiyi ?CII ? OeAO.

O oai?eo, i?iiia?iaaieo c i?eaiaeo noaiica i?o?aeueiiai eeaiaio, a ?II
ianinia caeaoi?noue na?oey aoea cia/ii cieaeaia, niinoa??aaeinue cia/ia
ia?aaaioaaeaiiy iii?o.

?ic?iaeaiee iaie i?aeo?ae cia/ii ni?iuo? ioe?ieo aaiiaeeiai?/ieo noai?a
o oai?eo oa oeyoe ei??aeoe?? aaiiaeeiai?/ieo ii?ooaiue.

AENIIAEE

1. I?neyiia?aoe?ei? ii?ooaiiy aaiiaeeiai?ee i?e iia?aoe?yo c i?eaiaeo
?oai?/ii? oai?iae na?oey oa iaaooeo aaae cono??/athony o 70% oai?eo,
i?iiia?iaaieo c aeei?enoaiiyi ooo/iiai e?iaiia?ao.

Iae/ano?oei oneeaaeiaiiyi a oeueiio ia??iae? ? aino?a na?oeaaa
iaaeinoaoi?noue, yea aeieea? o 15,4% oai?eo, ui ia?aianee i?ioacoaaiiy
eeaiai?a na?oey, ? o 4,5% oai?eo i?ney ai?oi-ei?iia?iiai ooiooaaiiy.

2. Aeine?aeaeaiy iieaciee?a ia?aae- ? i?neyiaaaioaaeaiiy, ianinii?
ooieoe??, nei?i/oaaiino?, ?iaioe e?aiai oeoii/ea, oiia caaacia/aiiy
ei?iia?iiai e?iaioieo, noaio noaeeiiiai ?onea oa oiia nenoaiii?
aeinoaaee ? iiaeeiaiiy eenith, aeicaieeee aecia/eoe no?oeoo?o
i?neyiia?aoe?eieo oei?a aaiiaeeiai?ee, eio?? aoee eeaneo?eiaai? ye
ii?iiooieoe?iiaeueiee noai (o 30% oai?eo), aeia?ooieoe?iiaeueiee noai
(20%), aeiiooieoe?iiaeueiee noai (50%).

3. Aiae?c iieaciee?a nenoaiii? aaiiaeeiai?ee ? ooieoe?iiaeueiiai noaio
na?oey aeicaieea iaoeiai iaa?oiooaaoe iayai?noue o ea?ae?io??o?a?/ieo
oai?eo aa??aio?a ee?i?/iiai ia?aa?ao aeey eiaeiiai oeio aaiiaeeiai?ee, a
naia: — eiiiainiaaia ii?iiooieoe?y (10% niinoa?aaeaiue);
noaeiiiainiaaia ii?iiooieoe?y (20%); — eiiiainiaaia aeia?ooieoe?y (15%);
— aeaeiiiainiaaia a?ia?ooieoe?y c noaeeiiith iaaeinoaoi?noth (4%);
aeaeiiiainiaaia a?ia?ooieoe?y aac noaeeiii? iaaeinoaoiino? (1%);
eiiianiaaia a?iiooieoe?y (30%); — aeaeiiiainiaaia a?iiooieoe?y ii
a?iinenoie?/iiio oeio (12%); — aeaeiiiainiaaia a?iiooieoe?y ii
a?iiaieai?/iiio oeio (8%).

4. A?ia?aeeiai?/iee noai nenoaiii? aaiiaeeiai?ee o noi?iaiaeaeoaaiinoe
c noaeeiiith iaaeinoaoi?noth ?c cieaeaiiyi ?iaeaeno caaaeueiiai
ia?eoa??eiiai iii?o ia 50%, ca?eueoaiiyi iieaciee?a iiaeeiaiiy eenith a
2-2,5 ?ac? oa ca?eueoaiiyi eiao?oe??ioo oeaieiii? aeno?aeoe?? eenith ia
20%, aeinoia??iei cieaeaiiyi ?AEA ia 10-25%, c?inoii ?II ia 60-70% ?
iaeiei c e??oa???a ae?aaiinoeee iaa?ieia?/ieo oneeaaeiaiue
(i?neyiia?aoe?ei?o ?iceaaeao iiceiaiai e?iaiia?ao) o ea?ae?io??o?a?/ieo
oai?eo, iia?iaaieo a oiiaao ooo/iiai e?iaiia?ao.

5. Aecia/ai? aieiai? iai?yiee ia?aoiae?a noaio nenoaiii? aaiiaeeiai?ee
a?ae iaei??? a?oie (i?aea?oie) aei ?ioi? iaoiiaeai? aieeaii oaeoi??a
na?oeaaiai (o 60% aeiaaee?a) ? noaeeiiiai iioiaeaeaiiy (30% aeiaaee?a),
oa neeaaeii e?ia? (10%).

6. Aeyaeai? caeiiii??iino? ?aaoeyoe?? e?iaiia?ao aoee iieeaaeai? a
iniiao aeai?eoi?a ?ioaineaii? oa?ai??, ye? a?aoiaoaaee nei?ioeea?noue
na?oey, ia?aae- oa i?neyiaaaioaaeaiiy, oiiae ei?iia?iiai e?iaiia?ao,
eeniaai-o?ainii?oio ooieoe?th e?ia? ? aoee ni?yiiaai? ia ei?aeoe?th
iniiaieo iieaciee?a e?iaiia?ao.

I?e ae?iaeaii? ee?i?/ieo ??oaiue ne?ae a?aoe aei oaaae iai?aaeai?noue
i?ioean?a oa?ai??, aeey /iai aeioe?eueii aeei?enoiaoaaoe iiiia?aie, ye?
a?aeia?aaeothoue caeaaei?noue N?/OeAO, ?CII/OeAO, ui ? aoaeoeaiei
caniaii ioe?iee aeeiai?ee ?aaoeyoe?? e?iaiia?ao, aaeaeaaoiino? IOeE ?
aeai?o iaaeeeaiaioiciiai aieeao i?e i?ecia/aii? ea?ae?ioii?/ieo ?
aaciaeoeaieo i?aia?ao?a.

7. ?ic?iaeaia iaoiaeeea ioe?iee ? ?aaoeyoe?? aaiiaeeiai?ee c
aeei?enoaiiyi i?ea?iaeueieo iiiia?ai oa aaeineiiaeai? aeai?eoie
?ioaineaii? oa?ai??, ia?aa??ai? ia ee?i?/iiio iaoa??ae? 352 iia?aoe?e.
?? aoaeoeai?noue i?aeoaa?aeaeaia cieaeaiiyi eaoaeueiino? a?ae aino?i?
na?oeaai? iaaeinoaoiino? o oai?eo c IAN oa ?ON c 11% aei 7%.

Nienie iioae?eiaaieo i?aoeue ca oaiith aeena?oaoe??.

1. Eiuoia A.A., Iaeneiaiei A.A., Iaeaoe A.E., Ianoaiei A.A., Aiiniaa
A.I., Eineooia I.A., Ao?eio A.I. Oa?aeoa?enoeee ianiniie ooieoeee
na?aeoea e nenoaiiie ?aaoeyoeee e?iaiia?auaiey i?e ino?ie na?aea/iie
iaaeinoaoi/iinoe o ea?aeeioe?o?ae/aneeo aieueiuo // Oe?a?inueeee
eaae?ieia?/iee aeo?iae.-1996.-N 1.-N.21-26.

2. Eiuoia A.A., Iaeneiaiei A.A., Iaeaoe A.E., Ianoaiei A.A., Aiaaiei
A.A., Aaiaeao ss.A., Eineooia I.A., Ao?eio A.I. Aiaeec e aiciiaeiinoe
ei??aeoeee ia?ooaiee ia iniiaa eco/aiey aaiiaeeiaieee a ?aiiai
iineaiia?aoeeiiiii ia?eiaea iinea i?ioace?iaaiey eeaiaiia na?aeoea
//Oe?a?inueeee ea?ae?ieia?/iee aeo?iae.-1997.-N 4. -N.36-42.

3. Eiuoia A.A., Iaeneiaiei A.A., Iaeaoe A.E., Ianoaiei A.A., Aaiaeao
ss.A., Eineooia I.A., Ao?eio A.I., Iaeaoe E.Ae. Eiaeaen
aeecianiiniaiinoe ieiea?aea o aieueiuo iinea i?ioace?iaaiey eeaiaiia
na?aeoea e iia?aoeee ai?oiei?iia?iiai ooioe?iaaiey //Oe?a?inueeee
ea?ae?ieia?/iee aeo?iae.-1998.-N 10. -N.37-42.

4. Eiuoia A.A., Ianoaiei ?.A., Iaeaoe A.E., Iaeneiaiei A.A., Aaiaeao
ss.A., Aoaiaithe I.TH., ?aniooiye I.A., Aaoeyaa A.I., Aa?e/ I.I.,
Eineooia I.A., Ao?eio A.I., Iioithe TH.I. ?ieue aeeanoiee/aneie ooieoeee
na?aeoea a oa/aiee iineaiia?aoeeiiiiai ia?eiaea o aieueiuo n
i?ioace?iaaieai ieo?aeueiiai eeaiaia i?e ieo?aeueiie iaaeinoaoi/iinoe //
Oace aeiiia?aeae V iaoeiai? eiioa?aioe?? anioe?aoe?? na?oeaai-noaeeiieo
o??o?a?a Oe?a?ie.-Eeia: ?inoeooo na?oeaai-noaeeiii? o??o?a?? AII
Oe?a?ie.- 1997.- N.92.

5. Eiuoia A.A., Iaeneiaiei A.A., Iaeaoe A.E., Ianoaiei A.A., Aaiaeao
ss.A., Eineooia I.A., Ao?eio A.I., Iaeaoe E.Ae. I?eioeei “Cieioiai
na/aiey” a oi?ie?iaaiee aiieeooaeiuo iieacaoaeae a?oa?eaeueiiai
aeaaeaiey.//Oace aeiiia?aeae VII iaoeiai? eiioa?aioe?? anioe?aoe??
na?oeaai-noaeeiieo o??o?a?a Oe?a?ie.-Eeia: ?inoeooo na?oeaai-noaeeiii?
o??o?a?? AII Oe?a?ie.- 1999.- N.138.

AIIOAOe?ss

Eineooia I.A. Ooieoe?iiaeuei? noaie e?iaiia?ao a ?aiiueiio
i?neyiia?aoe?eiiio ia??iae? i?e i?ioacoaaii? eeaiai?a na?oey oa
ai?oi-ei?iia?iiio ooiooaaii?.-?oeiien.

Aeena?oaoe?y ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe
ca niaoe?aeuei?noth 14.01.30 — aianoaciieiaiy oa ?ioaineaia oa?aiiy.-
Ee?anueea iaaee/ia aeaaeai?y i?neyaeeieiiii? ina?oe ?i.I.E.Ooieea
I?i?noa?noaa ioi?iie caei?ia’y Oe?a?ie, Ee?a, 1999.

Aeena?oaoe?th i?enay/aii ieoaiiyi i?iaiicoaaiiy, i?io?eaeoeee oa
e?eoaaiiy aino?i? na?oeaai? iaaeinoaoiinoi, yea aeieea? i?ney iia?aoe?e
i?ioacoaaiiy eeaiai?a na?oey ? ai?oi-ei?iia?iiai ooiooaaiiy. C
aeei?enoaiiyi iaoiaeo eeanoa?iiai aiae?co aoei aea/aii iiiaae 36
oa?aeoa?enoee nenoaiiiai e?iaiia?ao, aeyaeai? ? iienai? ??ci? aa??aioe
ooieoe?iiaeueiiai noaio nenoaiii? aaiiaeeiai?ee. Aeine?aeaeaii
i?e/eiii-iane?aeeiaee ca’ycie ia?aoiae?a aa??aio?a e?iaiia?ao a?ae
iaeiiai aaiiaeeiai?/iai noaio aei ?ioiai. ?icaeyiooi aieea aino?i?
iaaeinoaoiino? iiceiaiai e?iaiia?ao ia iniiai? iieacieee
ooieoe?iiaeueiiai noaio na?oey, oeaio?aeueiiai e?iaiia?ao oa nenoaiiiai
o?ainii?ooaaiiy eenith a ?aiiueiio i?neyiia?aoe?eiiio ia??iae?. Noai?ai?
oaeoe/i? aeai?eoie ? iiiia?aie ui aei i?eeiyooy oa?aiaaoe/ieo ??oaiue,
eio?? aecia/athoue iai?aaeai?noue e?eoaaeueieo caoiae?a ?
oaeineiiaeththoue oaeoeeo aaaeaiiy oai?eo. *anoioa eaoaeueieo aeiaaee?a
a?ae aino?i? na?oeaai? iaaeinoaoiino? i?e aeei?enoaii? ?ic?iaeaieo
iaoiaeee, cieaeo?oueny c 11% (o eiio?ieueii? a?oie) aei 7% (a iniiaii?
a?oi? oai?eo).

Eeth/ia? neiaa: i?neyiia?aoe?eiee ia??iae, iaaoo? aaaee na?oey, aino?a
na?oeaaa iaaeinoaoi?noue, ae?aaiinoeea, ?ioaineaia oa?ai?y.

SUMMARY

Loskutov O.A. Functional state of the blood circulation in an early
postoperative period after valve reflacement and aorta-coronary arteries
bypass gratting. — Manuscript.

The dissertation on submit the scientific degree of the candidate of the
medical sciences as to speciality 14.01.30 — anesthesiology and
intensive therapy.-The P.L.Shupik Kiev Medical Academy for Post-Graduate
Education of Ministry of Health of Ukraine, Kiev, 1999.

The dissertation is devoted to the questions of the prognosis, that
appears after the operative treamen of acquired hear lesions. A differen
variants of the functional state of a systemic hemodynamics were
described with help of the claster analysis method after operations of
the valve replacement and after aorta-coronary arteries bypass grufting.
Casual consequential tipes of a mutual transition of a different
hemodynamic status were studied. The influence of a different
hemodynamic states factors (acute insufficiency of a cerebral blood
circulation) on the main indices of blood circulation and systemic
oxygen transport in an early postoperative period was examined.This
permitted to create a tactical haracteristics fo decision making in
therapy, to determine targeting of therapevtical measuds and to improve
tactics of patients cure. Mortality rate was decreused from 11% to 7%.

Key word: postoperative period, acqured heart lesions, acute heart
failure, diagnostics, intensive care.

AIIIOAOeEss

Eineooia I.A. Ooieoeeiiaeueiua ninoiyiey e?iaiia?auaiey a ?aiiai
iineaiia?aoeeiiiii ia?eiaea i?e i?ioace?iaaiee eeaiaiia na?aeoea e
ai?oi-ei?iia?iii ooioe?iaaiee.-?oeiienue.

Aeenna?oaoeey ia nieneaiea iao/iie noaiaie eaiaeeaeaoa iaaeeoeeineeo
iaoe ii niaoeeaeueiinoe 14.01.30 — aianoaceieiaey e eioaineaiay
oa?aiey.-Eeaaneay iaaeeoeeineay aeaaeaiey iineaaeeieiiiiai ia?aciaaiey
ei.I.E.Ooieea Ieienoa?noaa cae?aaiio?aiaiey Oe?aeiu, Eeaa, 1999.

Aeenna?oaoeey iinayuaia aii?inai i?iaiice?iaaiey, i?ioeeaeoeee e ea/aiey
ino?ie na?aea/iie iaaeinoaoi/iinoe aicieeathuae a ?aiiai ia?eiaea iinea
iia?aoeee i?ioace?iaaiey eeaiaiia na?aeoea e ai?oi-ei?iia?iiai
ooioe?iaaiey.

Iniiauaaynue ia aeaiiuo nenoaiaoecaoeee 36-oe aaiiaeeiaie/aneeo
iieacaoaeae auee auaeaeaiu o?e iniiaiua a?oiiu: — aieueiua n
ii?iiooieoeeae nenoaiiie aaiiaeeiaieee (30%), — aieueiua n
aeia?ooieoeeae nenoaiiie aaiiaeeiaieee (20%), — aieueiua n aeiiooieoeeae
nenoaiiie aaiiaeeiaieee (50%). A eaaeaeie a?oiia niioaaonoaaiii auee
auaeaeaiu iiaea?oiiu n: eiiiane?iaaiiie ii?iiooieoeeae (10%);
noaeiiiaine?iaaiiie ii?iiooieoeeae (20%); eiiiaine?iaaiiie
aeia?ooieoeeae (15%) aeaeiiiaine?iaaiiie aeia?ooieoeeae n ninoaeenoie
iaaeinoaoi/iinoueth (4%); aeaeiiiaine?iaaiiie aeia?ooieoeeae aac
ninoaeenoie iaaeinoaoi/iinoe (1%); eiiiaine?iaaiiie aeiiooieoeeae (30%);
aeaeiiiaine?iaaiiie aeiiooieoeeae ii aeiiaieaie/aneiio oeio (8%);
aeaeiiiaine?iaaiiie aeiiooieoeeae ii aeiinenoiee/aneiio oeio (12%).

A oiaea enneaaeiaaiee auaeaeaiu iniiaiua aaiiaeeiaie/aneea
oa?aeoa?enoeee, aeinoiaa?ii eciaiythueany i?e iaee/ee o aieueiuo a
iineaiia?aoeeiiiii ia?eiaea ino?ie iaaeinoaoi/iinoe iicaiaiai
e?iaiia?auaiey (IIIE) a aeaea noaaeo?aeueiuo aaiaoii n eieaeecaoeeae a
oaiaiiie, eee caouei/iie iaeanoyo, a oaeaea i?e iaee/ee ianneaiie
aicaeooiie yiaieee a iaeanoe n?aaeiaiicaiaie a?oa?ee: nieaeaiea EIIN aei
(900±205) aeei·n·ni-5·i2; oaaee/aiea aieaa /ai a 2 ?aca eiaeaena
nenoaiiiai iio?aaeaiey eenei?iaea; nieaeaiea EAEY ia 15-25%, ?ino EII ia
60-70%. Aeaiiue neiioiiieiiieaen iiaeao ?anoeaieaaoueny eae
niaoeeoe/aneee i?eciae IIIE.

Auyaeaiu i?e/eiiua oaeoi?u, ii?aaeaeythuea aiciiaeiua eciaiaiey a
ooieoeeiiaeueiii ninoiyiee nenoaiiie aaiiaeeiaieee: oaeoi?u na?aea/iiai
(a 60% neo/aaa) e ninoaeenoiai i?ienoiaeaeaiey (a 30%), a oaeaea
iaoneiaeaiiua ninoaaii e?iae (a 10%).

A oiaea ?aaiou ii?aaeaeaiu cia/aiey OeAAe 90,25 ii ?o no, eioi?ua iiaoo
auoue ?aeiiaiaeiaaiu eae aaciaue o?iaaiue i?aaeiaa?ocee aeey anao
enneaaeiaaiiuo a?oii aieueiuo. Aeey oaeeo iiaea?oii eae
noaeiiiaine?iaaiiay ii?iiooieoeey, aeaeiiiaine?iaaiiay aeia?ooieoeey,
aieaa aeaaii?eyoiu cia/aiey OeAAe8-9 ii ?o no. Aeey iiaea?oii
eiiiane?iaaiiie aeia?ooieoeee, aeaeiiiaine?iaaiiie aeiiooieoeee ii
aeiiaieaie/aneiio oeio OeAAe10 ii ?o no. I?e aeiiia?aoeeiiiuo cia/aieo
EAeI eaaiai aeaeoaei/ea ieaea 45 ie/i2 ?aeiiaiaeoaiue o?iaaiue OeAAe 7 —
8,5 ii ?o no, e anee ii auoa 45 ie/i2, oi OeAAe ?aeiiaeoaony iiauoaoue
aei 10 ii ?o no.

?aaoeyoeey iinoiaa?ocee iniaaiii iaiaoiaeeia aieueiui n
noaeiiiaine?iaaiiie ii?iiooieoeeae n i?eciaeaie IIIE, n
aeaeiiiaine?iaaiiie aeia?ooieoeeae n ninoaeenoie iaaeinoaoii/iinoueth, n
aeaeiiiaine?iaaiiie aeiiooieoeeae ii aeiinenoiee/aneiio oeio. Iaeaieaa
aeaaii?eyoiua cia/aiey EIIN aeey ieo iaoiaeyony a i?aaeaeao 1600-2400
aeei·n·ni-5·i2 .

Ii?aaeaeaiu eiiaeiaoeee ea?aeeioiie/aneeo n?aaenoa aeey eaaeaeie
auaeaeaiiie aaiiaeeiaie/aneie a?oiiu e iiaea?oiiu: aeey aieueiuo n
eiiiaine?iaaiiie aeiiooieoeeae — Aeiaooaiei (5-7 iea/ea/iei.) i?e
cia/aieyo EIIN2400 aeei·n·ni-5·i2, eee Aeiiaiei (3-5 iea/ea/iei.); aeey
aieueiuo n aeaeiiiaine?iaaiiie aeiiooieoeeae ii aeiinenoiee/aneiio oeio
— Aeiaooaiei (5-8 iea/ea/iei.) a ni/aoaiee n a/a eiooceae aei OeAAe9 ii
?o no, eee Aeiiaiei (5-7 iea/ea/iei.) a ni/aoaiee n Aae?aiaeeiii
(0,02-0,03 iea/ea/iei.) e Iaiei?onnii (1-2 iea/ea/iei.); aeey aieueiuo n
aeaeiiiaine?iaaiiie aeia?ooieoeeae n ninoaeenoie iaaeinoaoi/iinoueth —
ni/aoaiea Ii?aae?aiaeeia (0,03-0,04 iea/ea/iei.) n Aeiaooaieiii (3-4
iea/ea/iei.) n iiaeaea?aeaieai OeAAe8 ii ?o no.

Iino?iaiu iaoaiaoe/aneea iiaeaee, ioia?aaeathuea ooieoeeiiaeueiia
ninoiyiea e?iaiia?auaiey iooai a?aoe/aneie caaeneiinoe NE/OeAAe,
EIIN/OeAAe.. Yoi iicaieyao ii?aaeaeyoue aeeiaieeo yoeo iieacaoaeae,
iai?aaeaiiinoue i?ioeannia oa?aiee e ?acaeoea aiciiaeiuo ineiaeiaiee.

A ?acoeueoaoa i?aeoe/aneiai i?eiaiaiey ?ac?aaioaiiuo iaoiaeia ioeaiee e
?aaoeyoeee aaiiaeeiaieee, n eniieueciaaieai i?eaeiaeueiuo iiiia?aii e
oniaa?oainoaiaaiiuo aeai?eoiia eioaineaiie oa?aiee eaoaeueiinoue io
ino?ie na?aea/iie iaaeinoaoi/iinoe n?aaee aieueiuo n IIN e EAN a ?aiiai
iineaiia?aoeeiiiii ia?eiaea niece n 11% (a eiio?ieueiie a?oiia) aei 7%
(a iniiaiie a?oiia aieueiuo).

Eeth/aaua neiaa: iineaii?aoeeiiiue ia?eiae, i?eia?aoaiiua ii?iee
na?aeoea,ino?ay na?aea/iay iaaeinoaoi/iinoue, aeeaaiinoeea,eioaineaiay
oa?aiey.

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