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Діагностика, тактика хірургічного лікування виразкових гастродуоденальних кровотеч у осіб похилого та старечого віку з супутньою серцево-судинною пато

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I?i?noa?noai ioi?iie caei?iay Oe?a?ie

Ee?anueea iaaee/ia aeaaeai?y i?neyaeeieiiii? ina?oe ?i. I.E. Ooieea

IA?AO ?AAAI ?AAAIIAE*

OAeE
616.33-002.44-005.1-053-07-089:616.12/.14

Ae?AAIINOEEA, OAEOEEA O??O?A?*IIAI E?EOAAIIss AE?ACEIAEO
AANO?IAeOIAeAIAEUeIEO E?IAIOA* O IN?A IIOEEIAI OA NOA?A*IAI A?EO C
NOIOOIUeITH NA?OeAAI – NOAeEIIITH IAOIEIA??TH.

14.01.03 – o??o?a?y

AAOI?AOA?AO

aeena?oaoe?? ia caeiaoooy iaoeiaiai

nooiaith eaiaeeaeaoa iaaee/ieo iaoe

Ee?a – 1999
Aeena?oaoe??th ? ?oeiien.

?iaioa aeeiiaia a Oaeai?iaenueeiio aea?aeaaiiio oi?aa?neoao?
I?i?noa?noaa ina?-oe Oe?a?ie oa Iaoe?iiaeueiiio iaaee/iiio oi?aa?neoao?
?i. I.I. Aiaiiieueoey IIC Oe?a?ie.

Iaoeiaee ea??aiee:

aeieoi? iaaee/ieo iaoe, i?ioani? OII?I IAO?I AeIEO?IAE*, caa?aeoaa/
eaoaae?e oaeoeueoaonueei? o??o?a?? ?2 Iaoe?iiaeueiiai iaaee/iiai
oi?aa?neoaoo ?i. I.I.Aiaiiieueoey IIC Oe?a?ie.

Io?oe?ei? iiiiiaioe:

aeieoi? iaaee/ieo iaoe, i?ioani? ?AAeC?OIANUeEEE AIAOIE?E IAAEIAE*,
caa?aeoaa/ eaoaae?e o??o?a?? oa ii?eiai? oai?iae Ee?anueei? iaaee/ii?
aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea IIC Oe?a?ie;

aeieoi? iaaee/ieo iaoe, i?ioani? AeCTHAAIIANUeEEE ?AI? ssEIAE*,
caa?aeoaa/ eaoaae?e o??o?a?? oaeoeueoaoo i?neyaeeieiiii? ina?oe
Oa?iii?euenueei? aea?aeaaii? iaaee/ii? aeaaeai?? ?i. ?.ss.
Ai?aa/aanueeiai IIC Oe?a?ie.

I?ia?aeia onoaiiaa: ?inoeooo ee?i?/ii? oa aenia?eiaioaeueii? o??o?a??
AII Oe?a?ie, a?aeae?e o??o?a?? oeoieiai – eeoeiaiai o?aeoo.

Caoeno a?aeaoaeaoueny “22” aa?aniy 1999 ?. i 11 aiaeei? ia
can?aeaii? nia-oe?ae?ciaaii? a/aii? ?aaee Ae 26.613.02 i?e Ee?anuee?e
iaaee/i?e aeaaeai?? i?neyaeeieii-ii? ina?oe ?i. I. E. Ooieea IIC
Oe?a?ie (254112, i. Ee?a, aoe. Aei?iaiaeeoeueea, 9).

C aeena?oaoe??th iiaeia iciaeiieoenue o a?ae?ioaoe? Ee?anueei? iaaee/ii?
aeaaeai?? i?-neyaeeieiiii? ina?oe ?i. I. E. Ooieea IIC Oe?a?ie (i.
Ee?a, aoe. Aei?iaiaeeoeueea, 9).

Aaoi?aoa?ao ?ic?neaiee “12” na?iiy 1999 ?.

A/aiee nae?aoa?

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

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

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. Ae?aceiaa oai?iaa oeoiea oa aeaaiaaeoeyoeiaei?
eeoee (AeIE) caeia? iaeia c ia?oeo i?noeue o caaaeuei?e
no?oeoo?? caoai?thaaiino? ianaeaiiy. Ca aeaieie ??cieo aaoi??a, a?ae
19,4 aei 39,3% oai?eo ia ae?aceiao oai?iao neeaaeathoue iniae iioeeiai
oa noa?a/iai a?eo (A.Ae.A?aoonue ,1991 ; A.O. Na?iei c ni?aaao,1997;
Soplepman J. et.al.1997), a 80% nia?oaeueieo aeiaaee?a a?ae oneeaaeiaiue
oeueiai caoai?thaaiiy i?eiaaea? ia iaoe??io?a a?eii 65 ?ie?a ? noa?oeo
(D. McFadden, M.J. Zinner ,1994).

Iacaaaeath/e ia canoinoaaiiy no/anieo i?ioeae?aceiaeo iaaeeeaiaioicieo
cania?a, aaii??aa?y ? iaea?eueo /anoei (10 – 20%) oneeaaeiaiiyi
ae?aceiai? oai?iae na?aae iaoe??io?a iioeeiai oa noa?a/iai a?eo (A.Ae.
A?aoonue , 1991; A.O. Na-?iei c ni?aaao, 1997; Ishikawam et. al., 1995;
Soplepman J. et.al., 1997) oa noi?i-aiaeaeo?oueny iaaecae/aeii aenieith
(15 – 25%) eaoaeuei?noth (?.ss. Aecthaaiianueeee, 1984; I.?. Aea?iai,
1990 ; Hasselgren G. et. al.,1998; Andersen Ib et.al, 1998 oa ?i.).

Aino?ie?iaioi/ea? aano?iaeoiaeaiaeuei? ae?acee (AEAAeA) o in?a iioeeiai
oa noa?a/iai a?eo i?io?eathoue ia oe? aaaeei? noiooiuei? , ia?aaaaeii
na?oeaai – noaeeiii? iaoieia??, ui aiineoue nai? iniaeeaino? o ee?i?/io
ea?oeio aaii??aa?? (A.I. Iaoeeaiue, 1986; I.?. Aea?iai, 1990; Andersen
Ib et.al, 1998 oa ?i.). O iaaaaaoi/enaeueieo ioae?eaoe?yo c oeueiai
i?eaiaeo iaia? iaeiinoaeii? aeoiee uiaei iieacaiue aei iia?aoe??, no?ieo
?? aeeiiaiiy oa aeaeo ao?o/aiiy. I?e aeai?? o??o?a?/ii? oaeoeee ia
a?aoiao?oueny oei ae?aceiai? aeano?oeoe?? oa aaaee?noue noiooiuei?
iaoieia??.

Oiio, aea/aiiy iniaeeainoae i?io?eaiiy ae?aceiai? e?iaioa/? o in?a
iioeeiai oa noa?a/iai a?eo, ?ic?iaea e?eoa???a aeai?o o??o?a?/ii?
oaeoeee c o?aooaaiiyi oeio ae?acee oa aaaeeino? noiooiuei? iaoieia??
aeey iie?auaiiy aaciina?aaei?o oa a?aeaeaeaieo ?acoeueoao?a e?eoaaiiy
iaaoaa? iniaeeai? aeooaeueiino?.

Caycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Aeena?oaoe?y ?
o?aaiaioii IAe? eaoaae?e oaeoeueoaonueei? o??o?a?? ? 2 Iaoe?iiaeueiiai
iaaee/iiai oi?aa?neoaoo ?iai? I.I. Aiaiiieueoey: ,,?ic?iaea e?eoa???a
aeai?o iaoiaeo iia?aoe?? , nooiaith ?eceeo ? aoaeoeaiino? o??o?a?/iiai
e?eoaaiiy aino?ie?iaioi/eaeo aano?iaeoiaeaiaeueieo ae?acie oa iooeei
oeoieo ia ?aiiueiio aini?oaeueiiio aoai? aeey iie?auaiiy aaciina?aaei?o
oa a?aeaeaeaieo ?acoeueoao?a” (? Aea?ae?a?no?aoe?? – 0186.0117978 ).

Iaoa ? caaea/? aeine?aeaeaiiy. Iaoith iaoiai aeine?aeaeaiiy ? aea/eoe
iniaeeaino? ee?i?ee, ae?aaiinoeee aino?ie?iaioi/eaeo
aano?iaeoiaeaiaeueieo ae?acie o in?a iioeeiai oa noa?a/iai a?eo ia
oii? noiooi?o na?oeaai – noaeeiieo caoai?thaaiue, oa ?ic?iaeoe
aeai?eoi o??o?a?/ii? oaeoeee a caeaaeiino? a?ae oeio ae?acee oa
aaaeeino? noiooiuei? iaoieia?? aeey iie?auaiiy aaciina?aaei?o oa
a?aeaeaeaieo ?acoeueoao?a e?eoaaiiy oai?eo.

Aeey aeinyaiaiiy oe??? iaoe iaie aoee iinoaaeai? oae? caaaeaiiy:

1.Aea/eoe /anoioo, no?oeoo?o oa iniaeeaino? ee?i?ee ,,canoa??eeo” oa
,,noa?a/eo” AEAAeA, aeyaeoe oa i?iaiae?coaaoe ?o aiaeineii?/i?,
iaoiii?oieia?/i? iniaeeaino?.

2.I?iaiae?coaaoe aaciina?aaei? oa a?aeaeaeai? ?acoeueoaoe ??cieo
iaoiae?a eii-na?aaoeaiiai e?eoaaiiy ,,canoa??eeo” oa ,.noa?a/eo”
aino?ie?iaioi/eaeo aano?i-aeoiaeaiaeueieo ae?acie o in?a iioeeiai oa
noa?a/iai a?eo ia oii? noiooiuei? na?oeaai – noaeeiii? iaoieia??.

3.Aea/eoe oa i?iaiae?coaaoe aaciina?aaei? oa a?aeaeaeai? ?acoeueoaoe
??cieo aeae?a iia?aoeaieo ao?o/aiue i?e ,,canoa??eeo” oa ,,noa?a/eo”
AEAAeA o iaoe??io?a, noa?oeo 60 ?ie?a ia oe? noiooi?o na?oeaai –
noaeeiieo caoai?thaaiue.

4.?ic?iaeoe aeai?eoi aeai?o o??o?a?/ii? oaeoeee oa aecia/eoe iieacaiiy
aei iia?aoeaiiai oa eiina?aaoeaiiai iaoiae?a e?eoaaiiy
aino?ie?iaioi/eaeo aano?i-aeoiaeaiaeueieo ae?acie o in?a iioeeiai oa
noa?a/iai a?eo c o?aooaaiiyi aaaeeino? noiooi?o caoai?thaaiue oa oeio
ae?aceiai? aeano?oeoe??.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a. Anoaiiaeaii ee?i?/i?,
aiaeinei-i?/i? oa iaoiii?oieia?/i? iniaeeaino? ,,canoa??eeo” oa
,,noa?a/eo” AEAAeA o in?a iioeeiai oa noa?a/iai a?eo c noiooi?ie
na?oeaai – noaeeiieie caoai?thaaiiyie. Aeyaeaii iniaeeaino? nooiaith
aaaeeino? e?iaiao?aoe oa /anoioo ?aii?o ?aoeeaeea?a e?iaioa/? (??E) i?e
,,canoa??eeo” oa ,,noa?a/eo” aino?ie?iaioi/eaeo aano?i-aeoiaeaiaeueieo
ae?aceao a caeaaeiino? a?ae eieae?caoe??, ?ici???a ae?aceiai?
aeano?oeoe?? oa iayaiino? noiooi?o caoai?thaaiue.

Aea/aii aieea canoinoaaiiy ??cieo i?ioeae?aceiaeo i?aia?ao?a ia
aeeiai?eo caai?iiy AEAAeA o in?a iioeeiai oa noa?a/iai a?eo.

Aia?oa o aeai?e a?eia?e a?oi? iaoe??io?a canoiniaaii neioaoe/iee aiaeia
ni-iaoinoaoeio ,,no?eai?i” oa aea/aii aoaeoeai?noue eiai aioenae?aoi?ii?
ae?? oa aieea ia /anoioo aeieeiaiiy ??E o ii??aiyii? ?c ,,?ai?aa?eii”
(?ai?o?ae?iii), ?ic?iaeaii ,,Niin?a e?eoaaiiy ae?aceiaeo
aano?iaeoiaeaiaeueieo e?iaioa/ o in?a iioeeiai oa noa?a/iai a?eo “
(cayaea ia aeaea/o iaoaioo Oe?a?ie ia aeiao?ae ? 99042371 a?ae 24. 04.
1999 ?.)

I?iaiae?ciaaii aaciina?aaei? oa a?aeaeaeai? ?acoeueoaoe ??cieo iaoiae?a
eii-na?aaoeaiiai oa aeae?a iia?aoeaiiai e?eoaaiiy ,,canoa??eeo” oa
,,noa?a/eo” AEAAeA o in?a iioeeiai oa noa?a/iai a?eo c noiooi?ie
na?oeaai-noaeeiieie caoai-?thaaiiyie, /anoioo oa oa?aeoa?
i?neyiia?aoe?eieo oneeaaeiaiue, i?e/eie eaoaeueiino?. ?ic?iaeaii
aeai?eoi aeai?o o??o?a?/ii? oaeoeee c o?aooaaiiyi oeio ae?acee oa
aaaeeino? noiooiuei? iaoieia??.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. Aeyaeaiiy ee?i?/ieo,
aiaeineii?/ieo oa iaoiii?oieia?/ieo iniaeeainoae ,,canoa??eeo” oa
,,noa?a/eo” AEAAeA oa aiae?c canoiniaaieo eiina?aaoeaieo oa iia?aoeaieo
iaoiae?a e?eoaaiiy ni?eyee ?ic?iaeaiith e?eoa???a aeai?o iaoiaeo
e?eoaaiiy, aeaeo, ia”?io oa /ano aeeiiaiiy iia?aoe?? a caeaaeiino?
a?ae oeio ae?aceiai? aeano?oeoe??, aaaeeino? na?oeaai-noaeeiii?
iaoieia?? ? aeicaieeee ae?iaeoe ?aoe?iiaeueio e?eoaaeueio oaeoeeo o
oai?eo iioeeiai oa noa?a/iai a?eo.

Cai?iiiiiaai? ?aeiiaiaeaoe?? aecia/athoue o?eaae?noue oa ia”?i
ia?aaeiia?aoe?eii? i?aeaioiaee, iniaeeaino? ?io?a – oa
i?neyiia?aoe?eiiai aaaeaiiy oai?eo o caeaaeiino? a?ae nooiaith
eiiiainaoe?? noiooiuei? na?oeaai-noaeeiii? iaoieia??.

Niin?a eiina?aaoeaiiai e?eoaaiiy c aeei?enoaiiyi no?eai?io aeicaiey?
ciaioeoe a 3 ?ace /anoioo ?icaeoeo ?aoeeaeeao e?iaioa/?.

Canoinoaaiiy ?ic?iaeaiiai aeai?eoio o??o?a?/ii? oaeoeee cieceei c 9,7%
aei 6,2% i?neyiia?aoe?eio oa c 19,4% aei 7,2% caaaeueio eaoaeuei?noue
o oai?eo iioeeiai oa noa?a/iai a?eo c ii?aeiaiiyi AEAAeA oa na?oeaai –
noaeeiieo caoai?thaaiue.

Iniaenoee aianie caeiaoaa/a. O i?ioean? aeeiiaiiy aeena?oaoe?? aaoi?
a?ae?a?aa oa i?iaiae?coaaa e?oa?aoo?o, i?ia?a ee?i?/i? niinoa?aaeaiiy,
cae?eniea aiae?c oaeoe/iiai iaoa??aeo aeey iniiaii? a?oie oai?eo, i?ia?a
eiai noaoenoe/io ia?iaeo oa ii??aiya c io?eiaieie ?acoeueoaoaie o
eiio?ieuei?e a?oi?. Aaoi? i?eeiaa aaciina?aaeith o/anoue o aeeiiaii?
iia?aoeaieo ao?o/aiue oa cae?eniaii? eiiieaeno eiina?aaoeaieo
e?eoaaeueieo caoiae?a, aiae?c? oa ocaaaeueiaii? ?acoeueoao?a
aeine?aeaeaiiy, i?aeaioiaoe? iaoeiaeo iaoa??ae?a aei ioae?eaoe?e oa
aeiiia?aeae ia eiioa?aioe?yo. Aeniiaee oa iieiaeaiiy ?iaioe, aeianai? ia
caoeno, noi?ioeueiaai? ?acii c iaoeiaei ea??aieeii.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Iniiai? iieiaeaiiy ?iaioe
aeiiia?aeaeeny ? iaaiai?thaaeeny ia iaoeiai – i?aeoe/ieo
?anioae?eainueeeo eiioa?aioe?yo ,,Ae?aaiinoeea oa o??o?a?/ia e?eoaaiiy
caoai?thaaiue ? iioeiaeaeaiue iicaia/?ieiaeo aeia/ieo oiae?a” (Ee?a,
1996), ,,Aeooaeuei? i?iaeaie iaa?aeeeaaeii? o??o?a?? i?aai?a /a?aaii?
ii?iaeieie oa o?iaai?oaeueiiai o?aeoo” (Ee?a, 1996), ia e?oaeiio noie?
,,No?eai?i – iaa?aeeeaaeia aeiiiiiaa o aano?iaioa?ieia??” (Ee?a, 1997),
ia 5- io i?aeia?iaeiiio o??o?a?/iiio eiia?an? ,,?aie, ii?ee, iia”ycee”
(Oaeue – Aa?a, 1998), ia i?aeia?iaeiiio neiiic?oi? ,,Ae?aaiinoe/ia oa
e?eoaaeueia aiaeineii?y” (Ao?coo, 1998), ia ?icoe?aiiio can?aeaii?
eaoaae?e oaeoeueoaonueei? o??o?a?? OaeAeO (Oaeai?iae, 1998),
i?aeia?iaei?e eiioa?aioe?? ,,Aeooaeuei? ieoaiiy aini?oaeueii? o??o?a??”
(Oaeai?iae, 1999).

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 14 iaoeiaeo
i?aoeue, a oiio /ene? – 6 noaooae o iaoeiaeo oaoiaeo aeo?iaeao, 8 oac o
ca??ieeao iaoa??ae?a eiia?an?a, neiiic?oi?a oa iaoeiai – i?aeoe/ieo
eiioa?aioe?e.

No?oeoo?a aeena?oaoe??. Aeena?oaoe?y neeaaea?oueny ?c anooio, iaeyaeo
e?oa?aoo?e, 5 oaiaoe/ieo ?icae?e?a, caeeth/aiiy, aeniiae?a, i?aeoe/ieo
?aeiiaiaeaoe?e, nieneo e?oa?aoo?e. ?iaioa aeeeaaeaia ia 142 noi??ieao
iaoeiiieniiai oaenoo, ?ethno?iaaia 23 oaaeeoeyie, 10 ?enoieaie.
Iieaae/ee e?oa?aoo?e aeeth/a? 180 aeaea?ae, a oiio /ene? – 60
?iicaiieo.

INIIAIEE CI?NO ?IAIOE

Iaoa??aee oa iaoiaee aeine?aeaeaiue. A iniiao ?iaioe iieeaaeai?
?acoeueoaoe ?aoaeueiiai ianoaaeaiiy , o??o?a?/iiai oa eiina?aaoeaiiai
e?eoaaiiy 461 oai?iai iioeeiai oa noa?a/iai a?eo (iniiaia a?oia), ui
neeaaea? 24,6% a?ae caaaeueiiai /enea 1872 iaoe??io?a, ye? e?eoaaeeny c
i?eaiaeo ae?aceiaeo e?iaioa/ o Ee?anueeiio oeaio?? iaa?aeeeaaeii?
aeiiiiiae oai?ei c oeoieiai – eeoeiaith e?iaioa/ath c 1994 ii 1996 ?iee.
A?oio ii??aiyiiy neeaee 1411 iaoe??io?a c AEAAeA iieiaeiai oa
na?aaeiueiai a?eo.

Iniiaia a?oia oai?eo aoea iiae?eaia ia aea? i?aea?oie: ia?oa – 344
iaoe??ioe c oae caaieie ,,canoa??eeie” ae?aceaie, eio?? o?eaaeee /an
oai??ee ia ae?aceiao oai?iao, ae?oaa – 117 in?a c ,,noa?a/eie”
ae?aceaie, o yeeo caoai?thaaiiy aia?oa aeieeei i?ney 60 ?ie?a. Iniiaith
aeey oaeiai iiae?eo iineoaeeee ee?i?ei – aiaeineii?/i? oa ii?-oieia?/i?
aeai?.

A i?ioean? ianoaaeaiiy aea/aeeny aiaiianoe/i? aeai? oa i?iaiaeeeeny
ee?i?/i? aeine?aeaeaiiy. Ca caaaeueii a?aeiieie iaoiaeeeaie
(A.A.Iaiueoeeia, 1987) i?iaaaeaii 53311 eaai?aoi?ieo aeine?aeaeaiue 25
iieaciee?a aiiainoaco a aeeiai?oe?.

Ianya e?iaiao?aoe ioe?ithaaee ca aeao?oeeoii oee?eoethth/i? e?ia? ca
aeiiiiiaith ,,?iaeeeaoi?a AeOeE” o??ie ,,R&C” (Naia?a, ?O). Nooi?iue
aaaeeino? e?iaioa/? (ii-i??iee na?aaei?e oa aaaeeee) ioe?ithaaee ca?aeii
c eeaneo?eaoe??th A.Ae. A?aoony (1991).

Aeey aa?eo?eaoe?? aeaea?aea e?iaioa/?, eiai eieae?caoe??, ?ici??o, noaio
aaiinoaco i?iaaaeaii 1432 ae?aaiinoe/ieo oa e?eoaaeueieo (aaiinoac,
ei?aeoe?y aianoiiiceo?a) aiaeineii?/ieo aeine?aeaeaiiy aia?aoaie
OLYMPUS GIF1T aai GIFK .

?aioaaieiio?anoia aeine?aeaeaiy oeoieo canoiniaaii 38 iaoe??ioai aei oa
i?ney iia?aoe??, 56 – o a?aeaeaeaiiio ia??iae?.

Aeey aea/aiiy iaoiii?oieia?/ieo iniaeeainoae AEAAeA i?iaaaeaii
a?noieia?/-ia aeine?aeaeaiiy ?acaeiaaieo ae?eyiie oeoieo (55) oa
aeaaiaaeoeyoeiaei? eeoee (36). Iaoa??aee a?aee c o?ueio ae?eyiie: ciie
ae?aceiaiai aeaoaeoo, ciie ?io?eueo?aoo oa a?aeaeaeaii? ae?eyiee.
Caaaeii, aea/aii 273 (165 – ueoieo oa 108 – AeIE) i?aia?aoe.

Aaaeeeaa cia/aiiy iaaeaaaee aeyaeaiith noiooi?o, iniaeeai na?oeaai –
noaeeiieo caoai?thaaiue. Ae?aaiinoeea ?o cae?enithaaeany ia i?aenoaa?
nea?a, aiaiiaco, aeaieo ia?eoeaiiai oa aeiaeaoeiaiai ianoaaeaiue,
eiinoeueoaoe?e noi?aeieo niaoe?ae?no?a. Caaaeii, i?iaaaeaii 1823
aeaeo?iea?ae?ia?ao?/i? aeine?aeaeaiiy 18 aoiea?ae?ineii?e, 571
?aioaaiia?ao?th i?aai?a a?oaeii? ee?oee .

Aea/aii e a?aeaeaeai? iane?aeee e?eoaaiiy 278 oai?eo, ye? ioe?ithaaee
ca nenoaiith Visick (1948), iiaeeo?eiaaiith Goligher J.C.(1968).

C iaoith ii??aiyiiy o aeaio a?oiao ii 12 in?a aea/aee aioenae?aoi?i?
aeanoeaino? ,,?ai?aa?eo” oa ,,no?eai?io”. Aecia/aee ia”?i nae?aoo, ai?no
o iueiio a?eueii? nieyii? eeneioe oa caaaeueio eeneioi?noue
(A.A.Iaiueoeeia,1987).

Io?eiai? aeai? ?aoaeueii i?iaiae?ciaai?, noaoenoe/ii ia?iaeai? ia AII.
Ii??aiyiiy aaee/eie aeenia?n?? o aea/aieo a?oiao i?iaiaeeee ca e?eoa???i
O?oa?a, a na?aaei?o aaee/ei – ca e?eoa???i Nothaeaioa. ?ic?aooiee
i?iaiaeeee, aeei?enoiaoth/e niaoe?aeueii ?ic?iaeaio o EXCELL aeey
WINDOWS 95 i?ia?aio.

?acoeueoaoe aeine?aeaeaiue. A?aei?/aii oaiaeaioe?th aei c?inoaiiy
e?eueeino? iaoe??io?a iioeeiai oa noa?a/iai a?eo c AEAAeA na?aae an?o
oai?eo c ae?aceiaeie e?iaioa/aie c 17,5% (Iaoeeaiue, 1986) aei 24,5 ii
iaoei aeaiei o 1996 ?ioe?.

O iniiai?e a?oi? (/ieia?e?a – 262 (56,8%), ae?iie – 199 (43,2%))
?iciiae?e iaoe??io?a ca a?eii ca?aeii c eeaneo?eaoe??th AIC (1963) aoa:
60-74 ?ie?a (iioeeee a?e) – 333 (72,2%), noa?oeo 75 ?ie?a (iniae
noa?a/iai a?eo oa aeiaaiaeeoae?) — 128 (27,8%) oai?eo.

A?aeiia?aeii aei i?eeiyoi? eeaneo?eaoe?? ae?aceiai? oai?iae o aeaii?e
a?eia?e eaoaai??? (Ae.O. *aaioa?ueia, 1976, 1990; ?.ss.
Aecthaaiianueeee, 1984 oa ?i.) ia iniia? iniaeeainoae
ee?i?ei-aiaeineii?/ieo oa ii?oieia?/ieo oa?aeoa?enoee iaie o 117
(25,4%) oai?eo aeyaeaii ,,noa?a/o”, a o 344 (74,7%) – ,,canoa??eo”
aino?ie?iaioi/ea? ae?acee.

Na?aae 117 iaoe??io?a c aino?ie?iaioi/eaeie ,,noa?a/eie” ae?aceaie oae
caaiee ,,aano?eoe/iee” aiaiiac ia ia?aaeuoaaa 2 i?nyoe?a o 94 (80,3%),
e?iaioa/a aoea ia?oei i?iyaii iaioe/ii? ae?acee o 23 (19,7%) oai?eo.

?c 344 in?a ?c ,,canoa??eeie” aino?ie?iaioi/eaeie ae?aceaie
aeaai?noue ,,ae?ac-eiaiai” /e ,,aano?eoe/iiai” aiaiiaco noaiiaeea 5 – 25
?ie?a. E??i oiai, 135 (39,2%) in?a oe??? a?oie ?ai?oa iaee ai?ciaee (46—
iaiaeii?aciai), ae?aceiai? e?iaioa/?, a 28 ( 8,1%) iaoe??io?a iia?iaai?
(10 – 20 ?ie?a oiio) c i?eaiaeo ae?aceiai? oai?iae oa ?? oneeaaeiaiue.

Aeey i?aea?oie iaoe??io?a c ,,canoa??eeie” ae?aceaie oa?aeoa?iei aoei
ii?aeiaiiy oneeaaeiaiue ae?aceiai? oai?iae: ii?yae c e?iaioa/ath,
ae?aceiaee noaiic aeyaeaii o 169 (49,1%) in?a, iaiao?aoe?th — o 23
(6,7%) iaoe??io?a, ia?oi?aoe?y aino?ie?iaioi/eai? ae?acee — o 4 (1,2%),
ii?aeiaiiy e?iaioa/? c noaiicii oa iaiaio?aoe??th – o 16 (4,7%) oai?eo
?c ,,canoa??eeie” AEAAeA, /iai ia niinoa??aaeiny o in?a ?c
,,canoa??eeie” AEAAeA.

I?iaaaeai? iaoiii?oieia?/i? aeine?aeaeaiiy iieacaee, ui ,,noa?a/?”
ae?acee oeoiea oa AeIE ?icaeaathoueny ia oii? ao?io?/iiai aano?eoo.
Neeciaa iaieiiea i?e oeueiio aeoii/aia, e?euee?noue caeic cieaeaia, ia?
i?noea aiaieuaaa ,,eeoeiaa” iaoaieac?y ai?oae?th. Ciia iae?ico ia
ae?aaeaia, oa? o?a?eii?aeiiai iae?ico iacia/ii? aeeaeie, ia ae?aceia?e
iiaa?oi? niinoa??aa?oueny oa? eie?eaaoe?eiiai iae?ico c eaeeioeeoa?iith
?io?eueo?aoe??th. Iniaeea?noth ,,noa?a/eo” ae?acie i?e ii?aeiaii?
aoa?ineea?ico c a?ia?oii?/iith oai?iaith ? oa, ui o no?ieao ae??aieo
a?oa??e oa a?oa??ie oeoieo oa AeIE iathoue i?noea iciaee a?ae?iico; a
a?noieia?/ia ea?oeia ,,noa?a/eo” ae?acie ia oii? noiooiuei? eaaaiaai?
iaoieia?? oa?aeoa?eco?oueny ea?oeiith o?ii?/iiai aaiiciiai iiaiie??a’y.

,,Canoa??e?” ae?acee oeoiea oa AeIE aeieeathoue, ye i?aaeei, ia oii?
o?ii?/iiai a?ia?ieanoe/iiai aano?eoo. O neecia?e iaieiioe? i?e oeueiio
niinoa??aa?oueny ii?aeiaiiy aeeno?io?/ieo ci?i yii/iiai ai?oae?y oa
ai?oae?y caeic c a?ia?ieanoe/ieie i?ioeanaie. Niinoa??aathoueny
ae?aaeai? caiaeuei? ci?ie ye o iiaa?oiaaeo oae ? a aeeaieeo oa?ao. Ciia
iae?ico o ia??iae caaino?aiiy ae?aaeaia, oa? o?a?eii?aeieo ci?i a
iaeano? aeia ae?acee cia/ii? aeeaeie, aeaia?eaoe?eiee aae aac /?oeeo
ia?en?a. I?e ,,canoa??eeo” ae?aceao ae?aaeai? iciaee ?ioiiiai caiaeaiiy
a neecia?e iaieiioe? oa ia?eoeueoea?ici?e cii?, aea niinoa??aa?oueny
ooai?aiiy e?ioi?aeieo neiie/aiue oa aaeeei? e?eueeino? e?ioi?aeieo
oie?eoe?a ?c na?oeeie oeaio?aie. A?aei?/a?oueny oaeiae cia/ia
?io?eueo?aoe?y oeaiei ieaciaoe/ieie ee?oeiaie oa aiceiio?eaie.

Oa?aeoa?iith iniaeea?noth iaoe??io?a iioeeiai oa noa?a/iai a?eo ? ? oa,
ui e?iaioa/a o ieo i?io?ea? ia oii? ae?aaeaii? noiooiuei? iaoieia??.
Oae, ia 461 oai?iai i?eiaaeaei 973 noiooi? caoai?thaaiiy (?iaeaen
iie?ii?a?aeiino? 2,2). Aeey ii??aiyiiy o iaoe??io?a eiio?ieueii? a?oie
a?i aoa 1,5. ?iaeaen iie?ii?a?aeiino? (2,4) o iaoe??io?a ?c ,,noa?a/eie”
ae?aceaie ia?aeuo? inoaii?e (2,0) o oai?eo ?c ,,canoa??eeie”.

Ia?aaaaeio a?eueo?noue na?aae noiooi?o caoai?thaaiue (647) noaiiaeee
oai?iae na?oeaai-noaeeiii? nenoaie, ui noi?iaiaeaeoaaeeny
iaaeinoaoi?noth e?iaiia?ao ia?oi? noaae?? o 118 , 2 A — o 297 , 2 A – 3
– o 41 oai?iai.

Aeyaeaii, ui o iniiai?e a?oi? a?eueoa /anoeia iaoe??io?a — 265 (61,8%)
iinoo-ieea i?ney 24 aiaeei c ii/aoeo e?iaioa/?, a o eiio?ieuei?e a?oi?
?o aoei 516 (36,6%).

E?iaiao?aoa aaaeeiai nooiaith noaoenoe/ii aeinoia??ii (? 0,05). I?e oeoieia?e eieae?caoe?? ae?acee ?E aoa a 1,4 ?aca /ano?oa,
i?ae i?e aeoiaeaiaeuei?e. Oaeiae, anoaiiaeaii, ui o ii??aiyii? ?c
ae?aceaie aei 1 ni, na?aae iaoe??io?a c aaee/eiith aeano?oeoe?? 1-2,9 ni
?E niinoa??aaany o 1,9 ?ac?a, a c aaee/eiith ae?acee 3 ni ? a?eueoa — a
2,7 ?ace /ano?oa (?

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