EUeA?ANUeEEE AeA?AEAAIEE IAAeE*IEE OI?AA?NEOAO

ii. AeAIEEA Aaeeoeueeiai

Aa?aiinueea Aiia Noaiaiiaia

OAeE: 616.37 — 002 — 036.11 — 092: 612.115

Ooieoeiiiaeueiee noai cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai o
oai?eo ia aino?ee iaie?aaoeo

14.01.03 — O??O?A?ss

Aaoi?aoa?ao

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

EUeA?A — 1999

Aeena?oaoe??th ? ?oeiien.

?iaioa aeeiiaia o Euea?anueeiio aea?aeaaiiio iaaee/iiio oi?aa?neoao?

ii. Aeaieea Aaeeoeueeiai I?i?noa?noaa
ioi?iie caei?ia’y Oe?a?ie

Iaoeiaee ea?iaiee — aeieoi? iaaee/ieo iaoe, i?ioani?

Iaea?
Aeieo?i A?naiiae/

i?ioani? eaoaae?e
oaeoeueoaonueei? oa caaaeueii?
o??o?a?? Euea?aueeiai aea?aeaaiiai iaaee/iiai

oi?aa?neoaoo ii. Aeaieea Aaeeoeueeiai

Io?oe?ei? iiiiaioe: — aeieoi? iaaee/ieo iaoe,
i?ioani?

Ea/i?ianueeee Aiaaeai Aieiaeeie?iae/

caa.
a?aeae?eaiiy o??o?a?? oa ee?i?/ii? o?ainooc?ieia??

Euea?anueeiai iaoeiai-aeine?aeiiai ?inoeoooo

iaoieia?? e?ia? ? o?ainooc?eii? iaaeeoeeie


aeieoi? iaaee/eieo iaoe, i?ioani?,

cane.
aeiy/ iaoee Oe?a?ie

Oaa/oe Ieoaeei A?eai?i?ae/

caa.
eaoaae?e oieoaeueii? o??o?a??

?aaii-O?aie?anueei? aea?aeaaii? iaaee/ii? aeaaeai??

I?ia?aeia onoaiiaa — ?inoeooo ee?i?/ii?
oa aenia?eiaioaeueii? o??o?a??

AII
Oe?a?ie, a?aeae?e o??o?a?? i?aeoeoieiai?

caeice i aeia/ieo oeyoia

Caoeno aeena?oaoe?? a?aeaoaeaoueny “ 26 ” aa?aciy 1999 ?ieo i
13 00 aiaeei? ia can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee Ae 35.600.01.
o Euea?anueeiio aea?aeaaiiio iaaee/iiio oi?aa?neoao? ii. Aeaieea
Aaeeoeueeiai (290010, i. Euea?a, aoe. Iaea?nueea, 69).

C aeena?oaoe??th iiaeia iciaeiieoeny a iaoeia?e a?ae?ioaoe?
Euea?anueeiai aea?aeaaiiai iaaee/iiai oi?aa?neoaoo ii. Aeaieea
Aaeeoeueeiai (290000, i. Euea?a, aoe. N?/iaeo No??eueoe?a, 6).

Aaoi?aoa?ao ?ic?neaiee “ 20 ” ethoiai 1999 ?ieo.

A/aiee nae?aoa?

niaoe?ae?ciaaii? a/aii? ?aaee
*oee?i N.I.

Caaaeueia oa?aeoa?enoeea ?iaioe

Aeooaeueiinoue oaie. Aino?ee iaie?aaoeo (AI) ca /anoioith aeieeiaiiy,
ao?ieia??th oa iaoiaaiacii, aaaeeinoth ee?i?/iiai ia?aa?ao, neeaaeiiuaie
ae?aaiinoeee ? iacaaeiaieueieie ?acoeueoaoaie e?eoaaiiy caeia? iaeia c
i?iaiaeieo i?noeue na?aae iecee no/anieo i?iaeai iaaiaeeeaaeii?
oi?o?ai?. sse na?ae/aoue aeai? e?oa?aoo?e AI caeia? o?aoth noiaeeio a
no?oeoo?? iaa?aeeeaaeieo aaaeii?iaeueieo iicieia?e [Caeoeaa A.O. e
niaao., 1991; Iaiei A.A. e niaao., 1993; Artaza Varasa T. et al., 1994].
A Oe?a?ii iieacieee caoai?thaaiino? ia AI iacia/ii ia?aaeuothoue
naioiai ?iaii e neeaaeathoue 4,0-4,2 aeiaaeeia ia 10 oeny/ ianaeaiiy
[Iiiiia?aiei A.I. ? ni?aaao., 1994].

Ia caaaeath/e ia iaaiee i?ia?an o ae?aaiinoeoe? oa e?eoaaii? AI, ?yae
aniaeo?a eiai iaoiaaiaco caeeoathoueny inoaoi/ii ia ?ice?eoeie. Aiaeoae
i?ia?aia e?eoaaeueii-oaeoe/ieo ae?e i?e oeie iaoieiai? iineoue
caeaa?eueoiai neiioiiaoe/iee oa?aeoa?. Oea ii?yae c ?ioeie
aeaoa?i?ioth/eie oaeoi?aie iicia/a?oueny ia iieacieeao eaoaeueiino?, yei
eieeaathoueny a iaaeao aiae 5,1-14,9 % caaaeii [Aeaee?ei A.I., 1990;
Banerjee A.K. et al., 1995; Lankisch P.G. et al., 1996] aei 80 % i?e
aeano?oeoeaieo oi?iao caoai?thaaiiy [Caeoeaa A.O. e niaao., 1991;
Oaeeiia N.A. e niaao., 1992; Aaa?eeaiei A.A. e niaao., 1996; Fagniez
P.L. et al., 1994; Padillo F.J. et al., 1995]. ?c iaaaaeaieo oaeo?a
neiaeo?, ui iiooe oeyo?a iieiioaiiy ?acoeueoao?a oi?o?ai/iiai e?eoaaiiy
AI ioneoue ??oiooaaoeny ia iiaeeaeaiiio aea/aiii eiai iaoiaaiaco.

I?iaiaeia cia/aiiy a ?icaeoeo AI iaeaaeeoue aeoeaaoe?? i?ioa?iac ?
e?iace [Gabryelewicz A. et al., 1993]. Oei oa?iaioe ia?aeiii
ooeiaeaeothoue aoeeia?i? ee?oeie, a ioaea ca?eueiythoue /eneaiii
iaae?aoi?e caiaeaiiy. Ca o/anoth o?iiaioeeo?a ? oaaioeeo?a
aiaeaoaa?oueny aeeth/aiiy a iaoieiai/iee i?ioean i?e?ioee?eoeyoi?iiai
?onea oa niieo/ii? oeaieie i?aeoeoieiai? caeice. Aeaye? aeine?aeieee
[Dominguez-Munoz J.E. et al., 1995] oa?aeoa?ecothoue AI, ye caiaeueia
caoai?thaaiiy c nenoaiiith a?aeiia?aeaeth, yea iieyaa? o aca?iiaei?
eaeeioeeo?a, aiaeioae?ioeeo?a, o?a?iaeano?a i ??cieo i?ioaie?oe/ieo
nenoai (eiaaoeyoe??, o?a?eiie?co, eae?e?a?iiai?, eiiieaiaioa?ii? oa
ii.). Oaeoe/ii aiieiai/iith noooth iaoiaaiaoe/iiai eaioethaa oeueiai
caoai?thaaiiy ? aiaeioieneeic, yeee na?aae iioiai aeanoaaieico?
?iaiiaaao i cn?aeaeueii-i?ioecn?aeaeueii? nenoaie e?ia?. Ii?ooaiiy
o?c?ieia?/iiai aaeaino i?ae i?ioeanaie cn?aeaiiy ? i?ioecn?aeaiiy ?
iaia“yceiaei eiiiiiaioii aiaeioieneeico aoaeue-yeiai aaiaco, a oiio
/ene?, i iaie?aaoiaaiiiai. sse aeaco? iecea aaoi??a [Iaaeianeee Ae.I.,
1987; Iaaeianueeee I.I. ? ni?aaao., 1997; Oeeei A.E. e niaao., 1997] ia
iaaiiio aoai? ia?aa?ao aeania oei ?iceaaee iiaeooue aecia/aoe
iani?eyoeeaee i?iaiic caoai?thaaiiy.

Ia caaaeath/e ia iaaaaeaia, aeioaia?ioiie noai ?ic?iaee i?iaeaie AI ia
aiaeiiaiaea? ?aaeueiei aeiiaai no/anii? iaaeeoeeie. Aeini, aieiaiee
iai?yiie aeineiaeaeaiue iaiaaeoaaany aea/aiiyi ciii
cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai i?e ie?aieo oi?iao AI
[Iaaeianeee Ae.I., 1987; Iao?ooiaa E.Ae., 1988; Eoeueyiia E.A. e
niaao., 1991; Eoiaeueoeaa A.E. e niaao., 1991; Iaaeianueeee I.I. ?
ni?aaao., 1997; Lasson A. et al., 1986; Gabryelewicz A. et al., 1993].
Iayai? ioae?eaoe?? iathoue caeaa?eueoiai o?aaiaioa?iee oa?aeoa? ? ia
aeathoue oe?e?niiai oyaeaiiy i?i oeae aniaeo iaoiaaiaco AI. O a?eueoino?
c ieo a?aenooi?e nenoaiaoeciaaiee i?aeo?ae aei aeeiai?ee caaaeaieo
ii?ooaiue a?aeiia?aeii aei ia?aa?ao caoai?thaaiiy, ia ?nio?
ae?aaiinoe/ii-i?iaiinoe/ieo i?ia?ai, ui aeeth/aee a aaiinoac?ieia?/i?
oanoe, ia ?ic?iaeaia e?eoaaeueii-oaeoe/ia i?ia?aia ae?e c o?aooaaiiyi
ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai.

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Aeeiiaia
aeineiaeaeaiiy ? o?aaiaioii iaoeiai-aeineiaeii? ?iaioe eaoaae?e
caaaeueii? oi?o?ai? Eueaianueeiai aea?aeaaiiai iaaee/iiai oiiaa?neoaoo
ii. Aeaieea Aaeeoeueeiai (EAeIO) ?01930009040 ca oaiith: “?ic?iaea
aeiaaiinoe/ii? oa eieoaaeueii? oaeoeee i?e aino?iio iaie?aaoeoi,
iniiaaii? ia canoinoaaiii aeiaaiinoe/iiai aeai?eoio, iioeiaeueieo
oi?o?ai/ieo ao?o/aiue ia i?aaiao aieia?iiai o?aeoo i iiaeoeoieiai?
caeice, a oaeiae iaoiaeao ?aaiiia?ii? oa?aii?”.

Iaoa i caaea/i aeineiaeaeaiiy. Iaoa — iieiioaiiy ?acoeueoao?a
oi?o?ai/iiai e?eoaaiiy aino?iai iaie?aaoeoo oeyoii iioeiicaoei?
aeiaaiinoe/ieo oa eieoaaeueii-oaeoe/ieo i?ia?ai ia iiaenoaai aea/aiiy
ooieoe?iiaeueieo ciii cn?aeaeueii-i?ioecn?aeaeueii? nenoaie e?ia?.

Caaea/i aeineiaeaeaiiy:

1. Aecia/eoe ca iaoieiaiaiaoiii/ieie iaoa?iaeaie ieoiio aaao
o?iiaiaaii?aai/ieo oneeaaeiaiue i?e AI oa ?o aieea ia iacaaeiaieueii
aeneiaee eieoaaiiy.

2. C’ynoaaoe aeeiaiieo ooieoeiiiaeueieo ciii
cn?aeaeueii-i?ioecn?aeaeueii? nenoaie e?ia? caeaaeii a?ae oi?ie oa
ia??iae?a ee?i?/iiai ia?aa?ao AI.

3. Ioeiieoe ae?aaiinoe/io ?ioi?iaoeai?noue aaiinoac?ieia?/ieo oano?a i?e
AI, ?ici?aoethaaoe oa aaeineiiaeeoe iaoiaee ae?aaiinoeee ii?ooaiue
cn?aeaeueii-i?ioecn?aeaeueii? nenoaie e?ia?.

4. Iioeiicoaaoe i?eioeeiiai e?eoaaeueii-oaeoe/ii i?ia?aie aeey oai?eo
iaa?yeiaith oa aeano?oeoeaiith oi?iaie AI c o?aooaaiiyi iaoiaaiaoe/ieo
iaoai?ci?a ii?ooaiue aaiinoaco. ?ic?iaeoe noaie iioaineaii? oa?aii? i?e
noaeeiii/ieo ii?ooaiiyo cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai.

5. C“ynoaaoe aieea iia?aoe?eii? o?aaie ia o?a?eiie?oe/io aeoeai?noue
e?ia? o ??ci? ia??iaee eeiii/iiai ia?aaiao iaie?aiiae?ico, ii?aoethaaoe
iioeiaeuei? canaaee ?o i?ioieaeoeee oa aei- i iineyiia?aoeieii?
ei?aeoei?.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoaoia. Aia?oa nenoaiaoeciaaii
iaoieiaiaiaoii?/ii iciaee ii?ooaiue cniaeaeueii-i?ioecniaeaeueii?
nenoaie i?e ??cieo oi?iao AI aiaeiiaiaeii aei ee?i?/iiai ia?aa?ao
caoai?thaaiiy, noaa?aeaeaii aca?iica’ycie ?o eaai?aoi?ieo, eeiii/ieo i
iaoieiaiaiaoiii/ieo i?iyaia. Cai?iiiiiaaii i?eioeei noaeeiii/ii?
aa?eoieaoei? ii?ooaiue aaiinoaco. Aaeineiiaeaii aeiaaiinoeeo ii?ooaiue
cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai. C“yniaaii aeeiaiieo anio
eaiie aaiinoaco i?e iaa?yeiaiio iaie?aaoeoi; eiinoaoiaaii, ui i?e oeie
oi?ii caoai?thaaiiy iathoue iinoea ii?ooaiiy
cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai, a oiio /enei AeAC-neiae?ii.
Ie?aneaii ii?ooaiiy eiaeii? c eaiie aaiinoaco aiaeiiaiaeii aei ia?iiaeia
eeiii/iiai ia?aaiao iaie?aiiae?ico, a oaeiae aeeiaiieo oeeo ciii o
ia?iiae aiieii-naioe/ieo oneeaaeiaiue. Iioeiiciaaii i?ia?aio
eieoaaeueii-oaeoe/ieo aeie. Aia?oa c“yniaaii aieea iia?aoe?eii? o?aaie
ia o?a?eiie?oe/io aeoeai?noue e?ia? o ??ci? ia??iaee iaie?aiiae?ico ?
?ic?iaeaii iioeiaeueii canaaee ?o i?ioieaeoeee oa aei — i
i?neyiia?aoe?eii? ?ioaineaii? oa?ai??.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoaoia. Iaoeia? iieiaeaiiy oa
aeniiaee aeena?oaoe?eii? ?iaioe aaeaioiaaii aeey ai?iaaaeaeaiiy oa
canoinoaaiiy a i?aeoe/iie ioi?iii caei?ia’y.

Ia??oioiaaii aeioe?euei?noue o?aeooaaiiy ii?ooaiue
cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai ye iaeiiai c i?iaiaeieo
iaoiaaiaoe/ieo iaoaiiciia AI. Ie?aneaii ieceo ae?aaiinoe/ieo e?eoa???a
ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai; aecia/aii
iioeiaeueiee aeiaaiinoe/iee eiiieaen aeey noaeeiii/ii? aa?eoieaoei?
oei?? iaoieiai?, ui nooo?ai i?aeaeuo? aoaeoeai?noue ae?aaiinoeee
ii?ooaiue aaiinoaco (iina?ae/aiiy ia ?aoe?iiae?caoi?nueeo i?iiiceoe?th ?
610, aeaeaia 10.10.1991 ?. A??Aii aiaeaeieo ioi?iie caei?ia’y
Eueaianueeiai iaeaeeiieiio; iinaiae/aiiy ia ?aoeiiiaeicaoi?nueeo
i?iiiceoeith ? 708, aeaeaia 15.07.1997 ?. A?IAii aieiaiiai oi?aaeiiiy
ioi?iie caei?ia’y Eueaianueei? iaeaea?aeaaeiiiino?aoei?). Aaeineiiaeaii
niinia eieoaaiiy AeAC-neiae?iio o oai?eo ia AI (iina?ae/aiiy ia
?aoe?iiae?caoi?nueeo i?iiiceoe?th ? 707, aeaeaia 15.07.1997 ?. A??Aii
aieiaiiai oi?aaeiiiy ioi?iie caei?ia’y Eueaianueei?
iaeaea?aeaaeiiiino?aoei?). Aaeineiiaeaii niinia aioeo?iiaioe/ii?
oa?aii? a eiiieaeniiio eieoaaiii AI (iina?ae/aiiy ia
?aoe?iiae?caoi?nueeo i?iiiceoe?th ? 706, aeaeaia 15.07.1997 ?. A??Aii
aieiaiiai oi?aaeiiiy ioi?iie caei?ia’y Eueaianueei?
iaeaea?aeaaeiiiino?aoei?). Aiaeiiaiaeii aei aeyaeaieo aiaeoeeaiue o
oia?eiieioe/iie aeoeaiinoi e?iai o ?icii ia?iiaee eeiii/iiai ia?aaiao
caoai?thaaiiy iioeiiciaaii aei — i iineyiia?aoeieio iioaineaio oa?aiith.

?acoeueoaoe aeine?aeaeaiue c iiceoeaiei aoaeoii ai?iaaaeaeaii o
i?aeoe/io aeiyeueiinoue o??o?a?/ieo, ?aaiiiaoeieieo i aeiaaiinoe/ieo
a?aeae?eia Euea?anueei? i?nueei? ee?i?/ii? e?ea?i? oaeaeei? iaaee/ii?
aeiiiiiae (EIEEOIAe), A?iieoeueei? i?nueei? ee?i?/ii? e?ea?ii,
Oo?eianueei? oeaio?aeueii? ?aeiiii? eiea?ii, *a?aiiia?aaenueei?
oeaio?aeueii? iinueei? eiea?ii.

Iniiai? iaoeiai iieiaeaiiy aeena?oaoe?? aeeth/ai? a iaoa??aee eaeoeie oa
i?aeoe/ieo caiyoue c eiea?yie-iioa?iaie oa eo?naioaie ia eaoaae?ao
o??o?a?? oa eeiii/ii? eaai?aoi?ii? aeiaaiinoeee oaeoeueoaoo
iineyaeeieiiii? inaioe EAeIO.

Ca iaoa??aeaie aeine?aeaeaiue aeaeaii 2 ?ioi?iaoe?ei? eenoe IIC
Oe?a?ie, io?eiaii 4 iina?ae/aiiy ia ?aoe?iiae?caoi?nuee? i?iiiceoe??.

Iniaenoee aianie caeiaoaa/a. Iniaenoee aianie aaoi?a iieyaa? a ioeiioei
aeooaeueiinoi oa no/aniiai noaio aea/aiiy i?iaeaie; aeai?i oa
ii?aoethaaiii iaoiaeee aeine?aeaeaiiy; oi?ioaaiii ee?i?/ieo a?oi
iaoe??io?a, aiaeici oa ocaaaeueiaiii io?eiaieo ?acoeueoaoia;
oi?ioethaaiii aeniiaeia oa iaoeiaeo iieiaeaiue aeena?oaoei?. Oni
aaiinoaciieiai/ii ianoaaeaiiy oai?eo i?iaaaeaii aeena?oaioii naiinoieii,
?aooa — ca o/anoth i?aeoe/ieo e?ea??a, i?aoe?aiee?a ? aeiiii?aeieo
i?ae?icae?e?a EAeIO oa EIEEOIAe. Ni?aaaoi?noai ?ioeo aeine?aeiee?a o 10
c 22 iaoeiaeo ?ia?o, iioae?eiaaieo ca iaoa??aeaie aeena?oaoe??,
a?aeaeca?eaeth? ?o eiinoeueoaoeaio aeiiiiiao oa ni?ao/anoue o
ae?aaiinoe/ii-e?eoaaeueiiio i?ioean?.

Ai?iaaoeiy ?acoeueoaoia aeena?oaoei?. ?acoeueoaoe aeine?aeaeaiiy ?
iniiai? iieiaeaiiy aeena?oaoe?? aena?oeai? o aeiiia?aeyo ia can?aeaiiyo
eaoaae?e caaaeueii? oi?o?ai? (1993-1997 ??.), eaoaae?e oaeoeueoaonueei?
i caaaeueii? o??o?a?? c eo?nii i?ieoieiai? (1997-1998 ??.),
iaoeiai-i?aeoe/iie eiioa?aioei? niiai?aoeiaieeia niaoeiaeiciaaii?
aaaaoii?ioieueii? eeiii/ii? eiea?ii oaeaeei? iaaee/ii? aeiiiiiae c
iaaiaee 10-?i//y aiaee?eooy (Eueaia, 1992), OOOVI iiaenoieiaie
nooaeaionueeie iaoeiaie eiioa?aioei? c o/anoth iieiaeeo a/aieo
(Oa?iiiieue, 1993), ?anioaeieainueeie iaa/aeueii-iaoiaee/iie iaoeiaie
eiioa?aioei? caaiaeoaa/ia eaoaae? caaaeueii? oi?o?ai? iaaee/ieo aocia
Oe?a?ie (*a?iiaoei, 1995), Oaeuee-neiiicioii ? 92 “Iiai iai?yiee o
aaiaoieiai?” (?iniy, 1996), thaieaeiie iaoeiai-i?aeoe/i?e eiioa?aioe??
“No/ani? aniaeoe iaa?aeeeaaeii? iaaee/ii? aeiiiiiae”, i?enay/ai?e
25-??//th noai?aiiy EIEEOIAe (Euea?a, 1997), Oaeuee-neiiicioii “Iiai
iai?yiee o aeiaaiinoeoei oa eieoaaiii caoai?thaaiue ia/iiee i oianoi?
eeoee” (Eueaia, 1997).

Ioae?eaoe??. Ca iaoa??aeaie aeena?oaoe?? iioae?eiaaii 22 ae?oeiaaii
i?aoei (a o./. 5 — o oi?ii noaooae a iaoeiaeo aeo?iaeao, 6 — a ?iaioao o
cai?ieeao iaoeiaeo i?aoeue, 11 — o iaoa??aeao ? oacao eiioa?aioe?e),
aeaa ?ioi?iaoe?ei? eenoe.

No?oeoo?a ? ianya aeena?oaoe??. Aeena?oaoe?y neeaaea?oueny c? anooio,
oanoe ?icae?e?a, aeniiae?a, nieneo aeei?enoaieo e?oa?aoo?ieo aeaea?ae
? aeiaeaoeo c eii?yie aeo?a ai?iaaaeaeaiiy. Iiaiee ianya aeena?oaoe??
neeaaea? 213 noi??iie. ?enoiee (10), oaaeeoe? (43), aeienee c ?noi??e
oai?ia (4), aeiaeaoie c eii?yie aeo?a ai?iaaaeaeaiiy (1) oa nienie
aeei?enoaieo e?oa?aoo?ieo aeaea?ae (303) caeiathoue 82 noi??iee.

INIIAIEE CI?NO ?IAIOE

Iaoa??ae ? iaoiaee aeine?aeaeaiiy

Ee?i?/iee iaoa??ae neeaee 272 iniae, na?aae yeeo: 122 — a?oia
?ao?iniaeoeaiiai aiaeico (ca iaoa?iaeaie iaoieiaiaiaoiii/iiai aiaeaeieo
EIEEOIAe), 130 — i?iniaeoeaii ianoaaeaii oai?i ia AI i 20 — caei?ia?
ethaee. Aeine?aeaeaiiy i?iaiaeeeeny ai?iaeiaae 1992-1996 ??. ? aeeth/aee
aiae?oe/io ioe?ieo oa noaoenoe/ia ii?aoethaaiiy ee?i?/ieo aeaieo,
?acoeueoao?a o?ceeaeueieo oa ?icieo aeiiiiiaeieo
(caaaeueii-eaai?aoi?ieo, a?io?i?/ieo, iaoiii?oieia?/ieo,
?ino?oiaioaeueieo) ianoaaeaiue. Ee?i?ei-ii?oieia?/ii oi?ie AI
eeaneoieoaaee caiaeii Oaeeiiaa N.A. ? ni?aaao. (1990). Aeey ?iciiaeieo
ee?i?/iiai ia?aa?ao AI ca ia?iiaeaie aeei?enoaee eeaneoieaoeith
Naaaeueaaa A.N. (1986). Nenoaiaoecaoeith oneeaaeiaiue AI caeienieee ca
aoiiiaoiaaiaoe/ieie i?eioeeiaie Oeeeia A.E. ? ni?aaao. (1994).
Aaiinoaciieiai/ii oace AeAC-neiae?iio oa?aeoa?ecoaaee caiaeii c
iaoiaee/ieie ?aeiiaiaeaoeiyie Caoa?i? E.A. oa niiaaao. (1988).
Iieacieee cn?aeaeueii-i?ioecniaeaeueii? nenoaie e?ia? aea/aee oeyoii
ii??aiyeueii? ioe?iee ?acoeueoao?a “o?aaeeoe?eii?” eiaaoeia?aie (?iaaiue
oia?eiiaaio, aeoeaiaaiee /an ?aeaeueoeeoieaoei?, i?io?iiaiiiaee /an,
i?io?iiaiiiaee iiaeaen, oiea?aioiinoue ieacie aei aaia?eio, ?iaaiue
oia?eiiaaio A) ? ?ici?aoeueiaaii? o eeiiioei ?icoe?aii? aaiinoac?ia?aie:
aaoieiaaoeyoe?eiee oano ca Berkarda A. et al. (1965) a iiaeeo?eaoe??
Aa?eaaaia E.C. (1972), ?aaiiaa ?.I. (1977); ia?aeiaaoeyoe?ei? oanoe
[a-iaooieiao i?iao ca Commine I., Lyons A. (1948), Aaeoaea A.I. ?
ni?aaao. (1980), aoaiieiao i?iao ca Godal H.C. et al. (1971) a
iiaeeo?eaoe?? Eu/aaa A.A. (1975), i?ioai?i-noeueoaoio i?iao ca
Latallo Z. et al. (1971) a iiaeeo?eaoe?? Eu/aaa A.A. (1975)]; ??aaiue
i?iaeoeo?a aeaa?aaeaoe?? o?a?eio ? o?a?eiiaaio; ??aaiue o?a?eiiaaio ca
?ooaa?a ?.A. (1961); aeoeaiaaiee /an ?aeaeueoeeo?eaoe?? ca
Bergerhof I., Roka L. (1954); /an e?ceno aoaeiaoe?i?a ca Kowalski A. et
al. (1954) a iiaeeo?eaoe?? Aaeoaea A.I., Aa?eaaai E.C. (1980); aaiiciee
aaiaoie?eo; /an cn?aeaiiy e?ia? ca Ei-Aaeo, ?ao?aeoe?y e?ia’yiiai
caonoea ? niiioaiiee o?a?eiie?c ca ?aaiiaei ?.I. (1983).

?ACOEUeOAOE AeINEIAeAEAIUe

Iaoiii?oieiai/iee noano?ao ii?ooaiue cniaeaeueii-i?ioecniaeaeueii?
nenoaie e?iai o oai?eo ia AI. Ii?oieiai/ii i?iyae ii?ooaiiy
cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai aeyaeee o 80 (65,6 %)
iiia?eeo. I?e ni?iai ?o aiaeico caiaeii c i?eeiyoeie eeaneoieaoeiyie
/anoeia i?iyaia aeoiaeeea iica iaaei o?aaeeoeieieo e?eoa?i?a aiaeai?o.
Oea coiiaeei iaiaoiaeiinoue ?ic?iaee aeanii? nenoaiaoecaoei? ii?ooaiue
cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai aeey oai?eo ia AI, yea
ia?aaeaa/aea ie?aneaiiy o?iiaioe/iiai, aaii?aa?/iiai i
o?iiaiaaii?aa?/iiai neiae?iiia. Ii?oieiai/ieie iciaeaie o?iiaioe/iiai
neiae?iio aecia/aii o?iiaice, o?iiaiaiaie?? oa o?iiaioeaa?oe;
aaii?aa?/iiai — e?iaioa/? oa e?iaiaeeeae. Ca oiiae iaeii/aniiai
aeyaeaiiy iciae o?iiaioe/iiai ? aaii?aa?/iiai neiae?ii?a noaa?aeaeoaaee
o?iiaiaaii?aai/iee neiae?ii: aeania AeAC-neiae?ii (ca aiaeiieie
aaniethoieie iciaeaie oa iae?ineii?/ieie ci?iaie) /e neiae?ii
iie?eiaaoeyoe?eieo ii?ooaiue (i?e aiaenooiinoi aaniethoieo e?eoa???a
AeAC-neiae?iio, aea iayaiinoi iaeii/anii o?iiaioe/ieo oa aaii?aa?/ieo
i?iyaia).

C o?aooaaiiyi iaaaaeaiiai ?iciiaeieo o?iiaioe/iee neiae?ii noaa?aeaeaii
o 13 (10,7 %) oai?eo, aaii?aai/iee neiae?ii — o 35 (28,6 %),
o?iiaiaaii?aai/iee neiae?ii — o 32 (26,2 %). Ia aeyaeaii caeaaeiinoi
iiae eeiiiei-ii?oieiai/iith oi?iith AI oa neiae?iiaie ii?ooaiiy
cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai. Oiaoi i?e eiaeiie c
eeiiiei-ii?oieiai/ieo oi?i AI (iaa?yeiaiio iaie?aaoeoi, aaii?aai/iiio,
aee?iaiio i ciioaiiio iaie?aiiae?ici, aiieiiio iaie?aaoeoi) /anoea
ii?ooaiue aaiinoaco aoea iaeaea iaeiaeiaith ((2 <2,9; p>0,05).

Ca ?acoeueoaoaie aiaeico iioeeaeaioiinoi ii?ooaiue
cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai noiniaii ia?iiaeia
eeiii/iiai ia?aaiao AI noaa?aeaeaii c?inoaiiy /anoioe oneeaaeiaiue a
ii?o aaainoaaiiy i?ioeano. O ia?oiio ia?iiaei oai?iae ii?ooaiiy
aaiinoaco eiinoaoiaaii a 6 (42,9 %) iaoei?ioia, o ae?oaiio — a
33 (63,5 %), o o?aoueiio — a 41 (73,2 %). Iii?e ?icio /anoeo ii?ooaiue
aaiinoaco a eiaeiee c ia?iiaeia caoai?thaaiiy noaa?aeaeaii oaeiae i
?iciee oa?aeoa? oeeo ciii. O aieueoinoi iiia?eeo (57,1 %) o ia?oiio
ia?iiaei o?iiaiaaii?aai/ieo oneeaaeiaiue ia aoei. Oeae oaiiiai iiaeia
iiynieoe ?aiiueith iiioeiaoei?th iaoiaaiaoe/iiai eaioethaa ii?ooaiue
aaiinoaco (a ia?oiio ia?iiaei oai?iae). O ae?oaiio ia?iiaei aeiiiioaaa
o?iiaiaaii?aai/iee neiae?ii ((2=8,5; p<0,005), o o?aoueiio ia?iiaei - aaii?aai/iee neiae?ii ((2=5,0; p<0,05). Oaeei /eiii, ?acoeueoaoe ?ao?iniaeoeaiiai aiaeico canaiae/eee, ui o?iiaice oa aaii?aai? ? /anoei oneeaaeiaiiyi AI i neeaaeathoue aaaiio eaieo oaiaoiaaiaco caoai?thaaiiy. C iaeyaeo ia iaaaoeaio naeaeoeith ?ao?iniaeoeaii? a?oie (iiia?ei) aeyaeaii caeiiiii?iinoi ia neiae iaoaii/ii aeno?aiiethaaoe ia caaae oai?eo c AI. Oiio ae?oaee aoai aeineiaeaeaiiy aeeth/aa i?iniaeoeaia aea/aiiy eaai?aoi?ieo i eeiii/ieo aeaieo. Cn?aeaeueii-i?ioecn?aeaeueia nenoaia e?ia? i?e iaa?yeia?e oi?i? AI. I?e iaa?yeia?e oi?i? AI o 36 (72 %) oai?eo aeyaeaii eaai?aoi?ii iciaee ii?ooaiue cn?aeaeueii-i?ioecn?aeaeueii? nenoaie e?ia?, c ieo o 9 (25 %) - e?eoa?i? AeAC-neiae?iio. Aeeiai?eo oeeo ciii ocaaaeueiaii a oaaeeoei 1. I?ieiaaoeyioia aeoeaiinoue aoea iiaeaeuaiith c 2-ai ii 5-e aeaiue caoai?thaaiiy i ii?iaeicoaaeany c 7-ai aeiy; o oei ae oa?iiie aoea ?icei i?eaii/aiith oia?eiieioe/ia aeoeaiinoue. Aioeeiaaoeyioia aeoeaiinoue caeeoaeany ?iaiiii?ii cieaeaiith ai?iaeiaae onueiai eeiii/iiai ia?aa?ao caoai?thaaiiy. Oaaeeoey 1 Aeeiaiiea ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai o oai?eo iaa?yeiaith oi?iith AI Aeii caoai?thaaiiy 1 2 3 4 5 7 9 > 10

I?ieiaaoeyioia aeoeaiinoue ( ((( (( ( ( N N N

Aioeeiaaoeyioia aeoeaiinoue ( ( ( ( ( ( ( (

Oia?eiieioe/ia aeoeaiinoue N ( (( (( (( N N N

Cniaeaeueii-i?ioecniaeaeueia nenoaia e?iai i?e aeano?oeoeaiie oi?ii AI.
I?e aeano?oeoeaiie oi?ii AI ii?ooaiiy cniaeaeueii-i?ioecniaeaeueii?
nenoaie e?iai noaa?aeaeaii o 72 (90 %) oai?eo; c ieo o 59 (73,8 %) —
eaai?aoi?ii iciaee AeAC-neiae?iio. A eiaeiee c ia?iiaeia iaie?aiiae?ico
niinoa?iaaeeny iaaii caeiiiii?iinoi ii?ooaiue
cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai. Oae, i?ieiaaoeyioia
aeoeaiinoue aoea iaeneiaeueii iiaeaeuaiith a ia?oee ia?iiae
iaie?aiiae?ico i iinooiiai ciaiooaaeany aae aei i?eaii/aiiy ia noaaei?
iiciio i?iyaia o?aoueiai ia?iiaeo caoai?thaaiiy. Aiaeii/an
oia?eiieioe/ia aeoeaiinoue aoea ?icei cieaeaiith a ia?oee i ae?oaee
ia?iiaee, oiaei ye o o?aoueiio ia?iiaei oai?iae aiaeaoaaeany
ii?iaeicaoeiy ?? iieacieeia. Aiaeiai/ii aei ia?aaiao iaa?yeiai? oi?ie AI
aioeeiaaoeyioia aeoeaiinoue aoea cieaeaiith (oaae.2).

Oaaeeoey 2

Aeeiaiiea ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai o oai?eo
aeano?oeoeaiith oi?iith AI

Ia?iiaee caoai?thaaiiy I II IIIa IIIa aeienea

I?ieiaaoeyioia aeoeaiinoue ((( (( ( ( N

Aioeeiaaoeyioia aeoeaiinoue ( ( ( ( (

Oia?eiieioe/ia aeoeaiinoue (( ( N N (

C iaeyaeo ia aiaeiii aeaii i?i aieea iia?aoeieii? o?aaie, oa?iaioaii? oa
aioeoa?iaioieo i?aia?aoia ia oia?eiieioe/io aeoeaiinoue e?iai iaeiei ic
caaaeaiue aeineiaeaeaiiy aoei aea/aiiy aieeao iia?aoeieii? o?aaie oa
aioei?ioaac ia oia?eiieioe/io aeoeaiinoue e?iai o ?icii ia?iiaee
iaie?aiiae?ico. O ca’ceo c oei, ui /anoeii iaoe??io?a ia i?iaiaeeeany
aioeoa?iaioia oa?ai?y, ie ii??aiyee o?a?eiie?oe/io aeoeai?noue e?ia? o
ieo (i?aea?oia A — 36 (45 %) inia), oa o oai?eo (iiaea?oia A — 44 (55 %)
inia), yei io?eioaaee caaaeaia e?eoaaiiy.

O iaoe??io?a iiaea?oie A aeyaeaii aeoeaiaaiee oia?eiieic ai?iaeiaae
onueiai ia?aaiao caoai?thaaiiy. O oai?eo iiaea?oie A iia?aoeieia o?aaia
ia aeeeeeaea aiaeoeeaiiy oia?eiieioe/ii? aeoeaiinoi, ui iiaeia iiynieoe
aieeaii ?ia?a?oi??a i?ioaac (oaae.3).

Aeyaeaia caeiiiii?iinoue ia??oiooaaea aeioeieueiinoue aiaeiiaiaeii?
ei?aeoei? ii?ooaiue oia?eiieico aioeoa?iaioieie i?aia?aoaie iiney
iia?aoei? a ae?oaiio oa o?aoueiio ia?iiaeao caoai?thaaiiy. Aiaeii/an o
ia?iiae oienaii?, eiee oia?eiieioe/ia nenoaia i?eaii/o?oueny niiioaiii,
i?ecia/aiiy caaaeaieo iaaeeeaiaioicieo na?aaeieeia iiaea ni?e/eieoe
o?iiaioe/ii oneeaaeiaiiy. Oea aecia/a? iaia“yceiaei eiiiiiaioii
aeiaaiinoe/ii-eieoaaeueieo caoiaeia uiaeaiiee eaai?aoi?iee eiio?ieue
aeoeaiinoi oia?eiieico.

Oaaeeoey 3

Aieea iia?aoeieii? o?aaie oa aioeoa?iaioii? oa?aii? ia oia?eiieioe/io
aeoeaiinoue e?iai o ?icii ia?iiaee iaie?aiiae?ico

Ia?iiaee Oia?eiieioe/ia aeoeaiinoue

Iiaea?oia A Iiaea?oia A

Aei iia?aoei? Iiney iia?aoei? Aei iia?aoei? Iiney iia?aoei?

I (( N (( (

II ( ( ( (

III N (( (( ((

Iioi?iaoeaiinoue aaiinoaciieiai/ieo oanoia. Aeey ioeiiee iioi?iaoeaiinoi
aaiinoaciieiai/ieo oanoia o oai?eo ia AI ia/enethaaee ?o caaaeueio
/ooeeainoue, niaoeeoi/iinoue oa aeiaaiinoe/io aoaeoeaiinoue, ie?aii
?ic?aoiaoth/e cacia/aii iieacieee uiaei a?oi iaoei?ioia c iaa?yeiaith
oa aeano?oeoeaiith oi?iith caoai?thaaiiy. Io?eiaii ?acoeueoaoe
ii?iaithaaee c aeaieie aiaeiai/ieo ianoaaeaiue 13 oai?eo c iioith
aaaeiiiiaeueiith iaoieiai?th.

“O?aaeeoeieia eiaaoeia?aia” aeyaeeany i?eaeaoiith oieueee aeey
iaaaoeaii? naeaeoei?, oiaoi aeey caia?a/aiiy yaeu aiia?eiaaoeyoei? /e
aiiieiaaoeyoei?. Caaaeii oeae aeiaaiinoe/iee eiiieaen aeyaeany
iecueeiiioi?iaoeaiei.

Caaeiaieueio aeiaaiinoe/io aoaeoeaiinoue (84,5-91,0 %) o aieueoinoi
eeiii/ieo aeiaaeeia iaee oanoe ?icoe?aii? aaiinoaciia?aie. A?aoiaoth/e
iieacieee /ooeeainoi (*) oa niaoeeoi/iinoi (N) eiaeiiai c ieo, iniiao
aeiaaiinoeee ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai o
oai?eo c AI iiaeiii neeaaeaoe: aaoieiaaoeyoeieiee oano (* — 65,7-83,3
%; N — 76,9-100,0 %), /an Ei-Aaeoa (*=82,3 %; N=76,9 %), aeoeaiaaiee
/an ?aeaeueoeeoieaoei? (*=80,8 %; N=84,6 %), eieueeinoue oia?eiiaaio
(*=91,7 %; N=30,8 %), aeoeaiinoue aioeo?iiaiio III (*=84,8 %; N=84,6 %),
eicen aoaeiaoeiiia (*=86,1 %; N=76,9 %), aeey caia?a/aiiy
AeAC-neiae?iio — ia?aeiaaoeyoeieii oanoe (* — 37,1-51,4 %; N — 84,6-92,3
%) oa ?iaaiue IAeO (*=54,5 %; N=84,6 %).

AeAC-neiae?ii o oai?eo ia AI. Aeeiaiiea eaai?aoi?ieo iciae
AeAC-neiae?iio iaea i?eoaiaiio aoaiiinoue. Oae, eaai?aoi?ii eiinoaoiaaia
i?e iinooieaiii aiia?eiaaoeyoeieia oaca AeAC-neiae?iio caa?iaaeany o
iiaeaeueoiio o eiaeiiai /aoaa?oiai iaoei?ioa, o iieiaeie oai?eo c oei??
a?oie iieacieee aaiinoaco ii?iaeicoaaeeny. Noaa?aeaeaiiy
aaeiaaoeyoeieii? oa aiiieiaaoeyoeieii? oace AeAC-neiae?iio i?e
ainiioaeicaoei? aoei iani?eyoeeaith i?iaiinoe/iith iciaeith,
ii?iaeicaoeiy iieacieeia aiaeaoaaeany eeoa o 14-30 % oai?eo.

O 34 (45,3 %) c 75 oai?eo c eaai?aoi?ii eiinoaoiaaiei AeAC-neiae?iiii
aeyaeaii eeiii/ii i?iyae ii?ooaiue cniaeaeueii-i?ioecniaeaeueii?
nenoaie. Aiaeii/an a a?oii c eaai?aoi?ii caia?a/aiei AeAC-neiae?iiii
caaaeaii eeiii/ii neiioiie noaa?aeaeaii eeoa o 2 (3,6 %) c 55 iaoei?ioia
((2 = 25,5; ?<0,0001). Caeiiiii?ii, ui aeieeiaiiy o?iiaicia oa aaii?aaie, aeania AeAC-neiae?iio iaaaoeaii aieeioee ia iieacieee eaoaeueiinoi i?e AI. Oae, eaoaeueiinoue o a?oii c iiceoeaieie eaai?aoi?ieie e?eoa?iyie AeAC-neiae?iio nyaaea 48 % (iiia?ei 36 c 75 iaoei?ioia), a a a?oii aac eaai?aoi?ii noaa?aeaeaiiai AeAC-neiae?iio - 12,7 % (iiia?ei 7 c 55 oai?eo) ((2 = 16,3; ?<0,0001). Eaoaeueiinoue o iiaea?oii c aeiaaiinoiaaiith i?e ainiioaeicaoei? aiia?eiaaoeyoeieiith oacith AeAC-neiae?iio noaiiaeea 31 % (iiia?ei 14 c 45), c aaeiaaoeyoeieiith oacith - 60 % (iiia?ei 6 c 10), c aiiieiaaoeyoeieiith oacith - 100 % aiaeiiaiaeii. Iaoiii?oieiai/ii o oai?eo c eaai?aoi?ii iiaeoaa?aeaeaiei AeAC-neiae?iiii aecia/aii: aaii?aai/iee neiae?ii - o 8 (22,2 %), o?iiaioe/iee neiae?ii - o 4 (11,1 %), o?iiaiaaii?aai/iee neiae?ii - o 20 (55,6 %); ia aeyaeaii o?iiaiaaii?aai/ieo iciae - o 4 (11,1 %) oai?eo. Eeoa a iaeii? c naie iaoei?ioia (14,3 %) a a?oii aac eaai?aoi?ieo iciae AeAC-neiae?iio noaa?aeaeaii o?iiaiaaii?aai/iee neiae?ii ((2 = 16,5; ?<0,0001). Oaeei /eiii, eeiii/ia iaiioanoaoeiy AeAC-neiae?iio iiaeiia ?icoeiithaaoenue ye caaaainiaaiee i?ioean, ui caa?iaeo? aeeooth iaoei?ioa. Canoinoaaiiy ?icoe?aii? aaiinoaciia?aie oiiaeeeaethth? noaeeiii/io aeiaaiinoeeo ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai. Aiaeiiaiaeii i?ii?eoaoii eieoaaeueii? oaeoeee iiaeiii aooe iaaeiiouaiiy ia?aoiaeo ii?ooaiue aaiinoaco c noaeeiii/iiai eaai?aoi?iiai ?iaiy o o?iiaiaaii?aai/ii oneeaaeiaiiy, oiaoi ia ?iaaiue eeiii/ii? iaiioanoaoei?. Eieoaaeueia oaeoeea i?e AI c o?aooaaiiyi ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai. Aea/aiiy caeiiiii?iinoae ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai i?e AI, niianoaaeaiiy eeiii/iiai ia?aaiao caoai?thaaiiy, eaai?aoi?ieo i iaoieiaiaiaoiii/ieo aeaieo aeicaieeee iioeiicoaaoe iiaeoiaee aei eieoaaiiy aeaiiai eiioeiaaioo oai?eo oa i?ioieaeoeee o ieo o?iiaiaaii?aai/ieo oneeaaeiaiue. ?icaeoie AeAC-neiae?iio oa iioeo o?iiaiaaii?aai/ieo oneeaaeiaiue neiae o?aeooaaoe ye ianeiaeie aeenaaeaino i?aaii/ii iia’ycaieo iiae niaith cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai, ?? ?aieiai/ieo aeanoeainoae oa iie?ioee?eoeyoi?iiai ?onea. Ianya i?ioieaeoeee oa eieoaaiiy AeAC-neiae?iio o oai?eo ia AI iiaeiai aiaeiiaiaeaoe ye oacai eiai ?icaeoeo, oae i iaoiaaiaoe/iei iniaeeainoyi ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai o eiaeiee c ia?iiaeia eeiii/iiai ia?aaiao caoai?thaaiiy. Iniiaieie neeaaeiaeie aaeaeaaoii? ei?aeoei? ii?ooaiue aaiinoaco ? aioeo?iiaioe/ia oa?aiiy, iiaaethaaiiy iaaaoeaiiai aieeao iiaiaioi?ia i?ioaac, eiiiainaoeiy iecueei? aioeo?iiaiiiai? aeoeaiinoi, aaiinoaoe/ia eieoaaiiy, iieiioaiiy iie?ioee?eoeyoei? oa ?aieiai? e?iai, eieaiaeaoeiy aiiiaieaii?. I?e iaa?yeiaie oi?ii AI oa?iiie i?ecia/aiiy iaaeeeaiaioicieo na?aaeieeia aecia/athoueny caeiiiii?iinoyie ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai: aeoeaaoe?y i?ieiaaoeyioii? eaiee aaiinoaco c 2-ai ii 5-e aeaiue caoai?thaaiiy ? iieacii aei aiaeiiaiaeii? aioeeiaaoeyioii? oa?aii?, aeai?an?y o?a?eiie?co o oeae aea /an aecia/a? iaiaoiaeiinoue i?ecia/aiiy iai?yieo aeoeaaoi?ia oia?eiieioe/ii? nenoaie. Ei?aeoeiy iecueei? aioeo?iia?iiai? aeoeaiinoi ? ia oieueee neeaaeiaith iaoiaaiaoe/iiai eieoaaiiy AeAC-neiae?iio, a e caaacia/o? aioeo?iiaioe/iee aoaeo aioeeiaaoeyioia - aiaeiii, aeayei c oeeo na?aaeieeia ia ? aei?aeie i?e iecueeiio ?iaii aioeo?iiaiio III. I?e aeano?oeoeaiie oi?ii AI ciiie cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai iathoue caaaainiaaiioee oa?aeoa?, a ioaea aeiaaathoue aaaaoiieaiiai? ei?aeoei?. ?icea aeoeaaoeiy i?ieiaaoeyioii? eaiee aaiinoaco, i?eaii/aiiy oia?eiieioe/ii? aeoeaiinoi e?iai a ia?iiaee oienaii? oa iaiioanoaoei? iaie?aiiae?ico aeiaaathoue aioeeiaaoeyioii? oa?aii? oa iaeii/aniiai i?ecia/aiiy iai?yieo aeoeaaoi?ia oia?eiieico. Inoaiii iieacaii iiae /an aioeoa?iaioii? oa?aii? o ia?iiae oienaii?. Iiaiaioi?e i?ioaac neiae canoiniaoaaoe o eiiieaeniie iineyiia?aoeieiie oa?aii? o ae?oaiio i o?aoueiio ia?iiaeao caoai?thaaiiy. I?eaii/aiiy aioeeiaaoeyioii? aeoeaiinoi aeiaaa? aaeaeaaoii? ei?aeoei? ca aiaeiai/ieie ye i?e iaa?yeiaiio iaie?aaoeoi iieacaie. Noaeeiii/ia aa?eoieaoeiy AeAC-neiae?iio a aieueoinoi iaoei?ioia, ye iaa?yeiaith, oae i aeano?oeoeaiith oi?iith caoai?thaaiiy, aecia/a? aieiaia caaaeaiiy iioaineaii? oa?aii? - i?ioieaeoeea ia?aoiaeo AeAC-neiae?iio c noaeeiii/iiai ?iaiy o eeiii/ii iaiioanoio oi?io. C o?aooaaiiy iaaaaeaieo iaoeiaeo iieiaeaiue ?ici?aoeueiaaii noaio iioeiicaoei? eieoaaeueii-oaeoe/ieo aeie c a?aooaaiiyi ia?iiaeia iaie?aiiae?ico oa iniaeeainoae ia?aaiao ?icieo oac AeAC-neiae?iio (oaae.4). Canoinoaaiiy ?ic?iaeaieo aeiaaiinoe/ieo oa eieoaaeueii-oaeoe/ieo iiaeoiaeia ni?eyei caieueoaiith i?aoeecieiinoi aeiaaiinoeee ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai ia 20 - 38 %, iieiioaiith ?acoeueoaoia oi?o?ai/iiai eieoaaiiy oai?eo ia AI - ciaioaiith o?iiaiaaii?aai/ieo oneeaaeiaiue ia 1,5 - 2,5%, cieaeaiith iineyiia?aoeieii? eaoaeueiinoi c 28,6 % aei 24,5 %. Oaaeeoey 4 Eieoaaeueia oaeoeea i?e AI c o?aooaaiiyi ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai Neeaaeia? aoaie oa?ai?? Caniae ei?aeoe?? ?aeiiaieiaaiee aa??aio oa?ai?? Iieace I?io?eaeoeea/e?eoaaiiy a?ia?eiaaoeyoe?eii? oace AeAC-neiae?iio, i?aaethaaiiy aioeo?a?eiie?o/iiai aoaeoo ?ia?a?oi??a i?ioaac i?yi? aioeeiaaoeyioe iai?yi? aeoeaaoi?e o?a?eiie?co aaia?ei ii 5 oen. iae. 4 ?ace ia aeiao i?aeoe??ii, o?aen?ia??i ii 0,3 ie ia aeiao i?aeoe??ii ?ic/ei i?eioeiiai? eeneioe 1% 2 ie 2 ?ace ia aeiao aeii‘yciai ia??iae iaie?aoe/ii? oienai?? ia??iae iai?oanoaoe?? iaie?aiiae?ico E?eoaaiiy a?ia?eiaaoeyoe?eii? oace AeAC-neiae?iio i?yi? aioeeiaaoeyioe aaia?ei ii 5 oen. iae. 4 ?ace ia aeiao i?aeoe??ii, o?aen?ia??i ii 0,3 ie ia aeiao i?aeoe??ii ia??iae ai?eii-naioe/ieo oneeaaeiaiue E?eoaaiiy aaeiaaoeyoe?eii? oace AeAC-neiae?iio i?yi? aioeeiaaoeyioe aaia?ei ii 2,5 oen. iae. 4 ?ace ia aeiao i?aeoe??ii, o?aen?ia??i ii 0,3 ie ia aeiao i?aeoe??ii ia??iae iai?oanoaoe?? iaie?aiiae?ico ia??iae ai?eii-naioe/ieo oneeaaeiaiue E?eoaaiiy a?iieiaaoeyoe?eii? oace AeAC-neiae?iio e?iainieii? i?aia?aoe a?eanie 1% ii 2 ie aeii‘yciai 3 ?ace ia aeiao, ae?oeeiii 12,5% ii 2 ie aeii‘yciai 2 ?ace ia aeiao ia??iae ai?eii-naioe/ieo oneeaaeiaiue E?eoaaiiy AeAC-neiae?iio (eiiiainaoe?y iecueei? aioeo?iia?iiai? aeoeaiino?) i?aia?aoe – aeaea?aea aioeo?iia?io ??? na?aeicaii?iaeaia ieacia 250–400 ie aeiaaiii e?aiaeueii *ca?eueoaiiy aeice ieacie aei 1000 ie a ia??iae ai?eii-naioe/ieo oneeaaeiaiue *e??ii?aoeei?oao, aioeaaiio?eueia ieacia a ia??iae ai?eii-naioe/ieo oneeaaeiaiue ai?iaeaae onueiai ee?i?/iiai ia?aa?ao iaie?aiiae?ico E?ea?aeaoe?y i?aeaeuaii? o?a?eiie?o/ii? aeoeaiino? ?ia?a?oi?e i?ioaac eiio?eeae 40 oen. iae. aeiaaiii e?aiaeueii i?neyiia?aoe?eia ?ioaineaia oa?ai?y a ae?oaiio oa o?aoueiio ia??iaeao ee?i?/iiai ia?aa?ao iaie?aiie?ico Iie?ioaiiy ?aieia?/ieo aeanoeainoae e?ia?, i?e?ioee?eoeyoe??, e?ea?aeaoe?y ao?iiaieai?? a?ia?aieai?/ia aaiiaeeethoe?y, aioeaa?aaaioe, i?aia?aoe aeaeno?aio, niaciie?oeee ?aiiie?aethe?i 400 ie aeiaaiii e?aiaeueii, o?aioae 2% ii 5 ie aeiaaiii e?aiaeueii, eiiieai?i 15% ii 2 ie aeii‘yciai, eiiaaioe?ei? ?ic/eie eiei?aeieo oa e?enoaei?aeieo i?aia?ao?a eo?aioee 0,5% ii 2 ie aeii‘yciai ia??iae iaie?aoe/ii? oienai?? ia??iae iai?oanoaoe?? iaie?aiiae?ico AENIIAEE 1. Ii?ooaiiy cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai ? aaaeeeaith eaieith iaoiaaiaco i oaiaoiaaiaco AI. 2. O 65,6 % iiia?eeo c AI, ia caeaaeii aiae eiai eeiiiei-ii?oieiai/ii? oi?ie, aeieeathoue o?iiaiaaii?aai/ii oneeaaeiaiiy (o?iiaioe/iee, aaii?aai/iee i o?iiaiaaii?aai/iee neiae?ii), yei ei?aeththoue c ia?iiaeaie eeiii/iiai ia?aaiao caoai?thaaiiy. 3. I?e iaa?yeia?e oi?i? AI o 72 % iaoei?ioia eaai?aoi?ii aecia/athoueny ii?ooaiiy cn?aeaeueii-i?ioecn?aeaeueii? nenoaie e?ia? (o eiaeiiai /aoaa?oiai c ieo - iciaee AeAC-neiae?iio): c 2-ai ii 5-e aeaiue caoai?thaaiiy iiaeaeuaiiy i?ieiaaoeyioii? aeoeaiinoi oa i?eaii/aiiy oia?eiieico, ai?iaeiaae onueiai eeiii/iiai ia?aaiao caoai?thaaiiy - cieaeaiiy aioeeiaaoeyioii? aeoeaiinoi. 4. I?e aeano?oeoeaiie oi?ii AI o 90 % iaoei?ioia noaa?aeaeothoueny eaai?aoi?ii iciaee ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai (o 4/5 c ieo - AeAC-neiae?ii): o ia?iiae oienaii? oa iaiioanoaoei? iaie?aiiae?ico niinoa?iaa?oueny ?icea aeoeaaoeiy i?ieiaaoeyioii? nenoaie oa i?eaii/aiiy oia?eiieioe/ii? nenoaie, aioeeiaaoeyioia aeoeaiinoue caeeoa?oueny cieaeaiith ai?iaeiaae onueiai eeiii/iiai ia?aaiao; o 2/3 iaoei?ioia eiinoaoo?oueny noaeeiii/iee ia?aaia iaaaaeaieo ii?ooaiue. 5. “O?aaeeoeieia eiaaoeia?aia” ia aeicaiey? ioeiieoe ciiie cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai o oai?eo ia AI. C iaeyaeo ia aeniei /ooeeainoue oa niaoeeoi/iinoue oanoaie aeai?o aeey iiaiioeiiii? oa?aeoa?enoeee oeeo ciii ? aaoieiaaoeyoeieiee oano, /an Ei-Aaeoa, aeoeaiaaiee /an ?aeaeueoeeoieaoei?, eieueeinoue oia?eiiaaio, aeoeaiinoue aioeo?iiaiio III, eicen aoaeiaoeiiia, aeey caia?a/aiiy AeAC-neiae?iio - ia?aeiaaoeyoeieii oanoe oa ?iaaiue IAeO. Iaia`yceiaei eiiiiiaioii aeiaaiinoe/ieo caoiaeia iiaeiii aooe aeeiaii/ia niinoa?aaeaiiy oa noaeeiii/ia aeyaeaiiy ii?iaeicaoei? iieacieeia /e i?ia?anoaaiiy AeAC-neiae?iio. 6. Aecia/aii aieea iia?aoeieii? o?aaie ia oia?eiieioe/io aeoeaiinoue e?iai o eiaeiee c ia?iiaeia iaie?aiiae?ico, ia oiii ?icii? oa?iaioii? aeoeaiinoi. O ia?oiio ia??iae? iaiao?aeia noeioeyoe?y o?a?eiie?oe/ii? aeoeaiino?. I?ecia/aiiy aioeoa?iaioieo i?aia?ao?a neiae ii?aeioaaoe c iai?yieie aeoeaaoi?aie o?a?eiie?co ? aioeeiaaoeyioaie, iaa?oue o aeiaaeeo iia?aoeaiiai e?eoaaiiy. O ae?oaiio ? o?aoueiio ia??iaeao iaie?aiiae?ico ?ia?a?oi?e i?ioaac ne?ae canoiniaoaaoe o?eueee a i?neyiia?aoe?eiiio ia??iae?. 7. Canoinoaaiiy ?ic?iaeaieo aeiaaiinoe/ieo oa eieoaaeueii-oaeoe/ieo iiaeoiaeia ni?eyei caieueoaiith i?aoeecieiinoi aeiaaiinoeee ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai ia 20-38 %, iieiioaiith ?acoeueoaoia oi?o?ai/iiai eieoaaiiy oai?eo ia aino?ee iaie?aaoeo - ciaioaiith o?iiaiaaii?aai/ieo oneeaaeiaiue ia 1,5 - 2,5 %, cieaeaiith iineyiia?aoeieii? eaoaeueiinoi c 28,6 % aei 24,5 %. Nienie ?iaio, iioaeieiaaieo ca oaiith aeena?oaoei? 1. Aa?aiinueea A.N. Aeeiaiiea ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai o oai?eo ia iaa?yeiao oi?io aino?iai iaie?aaoeoo // I?aeoe/ia iaaeeoeeia.- 1997.- ? 7-8.- N.103-107. 2. Aa?aiinueea A.N. Neiae?ii aeenaiiiiaaiiai aioo?ioiueinoaeeiiiai cniaeaiiy e?iai o oai?eo ia aino?ee iaie?aaoeo // Ainiee iaoeiaeo aeineiaeaeaiue.- 1997.- ? 6-7.- N.37-39. 3. Aa?aiinueea A.N. Oia?eiieioe/ia aeoeaiinoue e?iai o oai?eo ia aino?ee iaie?aaoeo // I?aeoe/ia iaaeeoeeia.- 1998.- ? 3-4.- N.143-145. 4. Aa?aiinueea A.N., Eenthe TH.N. Iioi?iaoeaiinoue aaoieiaaoeyoeieiiai oanoo (AEO) a oai?eo ia aino?ee iaie?aaoeo // I?aeoe/ia iaaeeoeeia.- 1998.- ? 5-6.- N.127-128. 5. Aiae?thuaiei A.I., Eenthe TH.N., Aa?aiinueea A.N. Aeiaaiinoe/ia oa i?iaiinoe/ia cia/aiiy aeyaeaiiy aiieaco?i? i?e aino?iio aieia?iiio iaie?aaoeoi // Eeiii/ia oi?o?aiy.- 1998.- ? 3.- N.17-18. 6. Eiiao I.A., Aa?aiinueea A.N. Niinia i?eaiooaaiiy noano?aoo aeey ne?iaaoeiai? oinoieiiace: Iioi?i. eeno / Eueaia. iaae. oi-o; OOeIII.- E., 1997.- Aei. 1.- ? 11.- 2 n. 7. Eiiao I.A., Aa?aiinueea A.N. Niinia aeiaaiinoeee AeAC-neiae?iio o oai?eo ia aino?ee iaie?aaoeo: Iioi?i. eeno / Eueaia. iaae. oi-o; OOeIII.- E., 1997.- Aei. 1.- ? 14.- 2 n. 8. Iaea? Ae.A., Aa?aiinueea A.N., Iaea?a A.C. Eeiiiei-iaoieiaiaiaoiii/ii ia?aeaei ii?ooaiue nenoaie aaiinoaco o oai?eo aino?ei iaie?aaoeoii // Aeooaeueii ieoaiiy i?aeoe/ii? iaaeeoeeie: Ca. iaoe. i?aoeue, i?enay/aieo 10-?i//th thaieath eaoaae?e oa?aii? ? 2 oaeoeueoaoo oaeineiiaeaiiy eiea?ia i i?iaici?ia Eueaianueeiai aea?aeaaiiai iaaee/iiai iinoeoooo.- Eueaia, 1995.- N.97-99. 9. Aa?aiinueea A.N. Aioeeiaaoeyioia aeoeaiinoue e?iai o oai?eo ia aino?ee iaie?aaoeo // Aeooaeueii ieoaiiy i?aeoe/ii? iaaeeoeeie: Uieaa?o. ca. iaoe. i?aoeue / Oe?. aeaae. iaae. oa aiie. iaoe.- Eueaia: Aneoeai, 1996.- Aei. 1-2.- N.4-5. 10. Aa?aiinueea A.N., Iaea?a A.C., Ieoaeeeoei I.ss. Ii?oieiaiy ooieoeiiiaeueieo ciii nenoaie aaiinoaco a oai?eo ia aino?ee iaie?aaoeo // Aeooaeueii ieoaiiy i?aeoe/ii? iaaeeoeeie: uieaa?o. ca. iaoe. i?aoeue / Oe?. aeaae. iaae. oa aiie. iaoe.- Eueaia: Aneoeai, 1996.- Aei. 3-4.- N.3-5. 11. Aa?aiinueea A.N. Ioeiiea iioi?iaoeaiinoi eaai?aoi?ieo e?eoa?i?a neiae?iio aeenaiiiiaaiiai aioo?ioiueinoaeeiiiai cniaeaiiy e?iai o oai?eo ia aino?ee iaie?aaoeo // Aeooaeueii ieoaiiy i?aeoe/ii? iaaeeoeeie: uieaa?o. ca. iaoe. i?aoeue / Oe?. aeaae. iaae. oa aiie. iaoe.- Eueaia: Aneoeai, 1996.- Aei. 3-4.- N.28-29. 12. Aa?aiinueea A.N., Iaco?ee I.?. Aieea iia?aoeieii? o?aaie ia oia?eiieic o ?icii ia?iiaee eeiii/iiai ia?aaiao aino?iai iaie?aaoeoo // Eeiii/ia oa aenia?eiaioaeueia iaaeeoeeia: Iaoe.-i?aeo. uieaa?o. /aniien / Oe?. aeaae. iaae. oa aiie. iaoe.- Eueaia: Aneoeai, 1997.- Aei. 1-2.- N. 4-6. 13. Aa?aiinueea A.N., Eenthe TH.N. Aaoieiaaoeyoeieiee oano, ye iioi?iaoeaiee iaoiae ioeiiee ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai a oai?eo ia aino?ee iaie?aaoeo // Eeiii/ia oa aenia?eiaioaeueia iaaeeoeeia: Iaoe.-i?aeo. uieaa?o. /aniien / Oe?. aeaae. iaae. oa aiie. iaoe.- Eueaia: Aneoeai, 1997.- Aei. 1-2.- N. 10-12. 14. Aa?aiinueea A.N., Eiiao I.A. Iieacieee ia?aeeniiai ieeneaiiy eiiiaeia i aeoeaiinoue ne?iaaoeiai? oinoieiiace o oai?eo aino?ei iaie?aaoeoii // Ieoaiiy i?aeoe/ii? iaaeeoeeie: Oac. aeiiiaiae. iaoe.-i?aeo. eiio. niiai?aoeiaieeia niaoeiaeiciaaii? aaaaoii?ioieueii? eeiii/ii? eiea?ii oaeaeei? iaaee/ii? aeiiiiiae c iaaiaee 10-?i//y aiaee?eooy.- Eueaia, 1992.- N. 40-41. 15. Eiiao I.A., Aa?aiinueea A.N. Iieacieee ia?aeeniiai ieeneaiiy eiiiaeia ye aeiaaiinoe/iee i i?iaiinoe/iee e?eoa?ie aeey ioeiiee aaaeeinoi aino?iai iaie?aaoeoo // Iaaee/ia aeiaaiinoeea (i?aaiicaoeiy i oi?aaeiiiy, iaoiaee i caniae, aeai?eoie i iaa/aiiy, oaoiieiai? i eiii’thoa?ecaoeiy): Iao. Anaoe?. iaoe. i?aeo. eiio.- Ee?a-Eueaia, 1992.- N.228. 16. Aa?aiinueea A.N. Oia?eiieioe/ia nenoaie e?iai oa ?? iiaiaioi?e o oai?eo aino?ei iaie?aaoeoii // OOOOI nooae. iaoe. eiio. ca o/. iieiaeeo a/aieo: Oac. aeiiiaiae.- Oa?iiiieue, 1993.- N.5-6. 17. Barwinska A. DIC-syndrome in patients with acute pancreatitis // Fortschritte in hepatobiliaren und pankreatischen Erkrankungen - Klinische Aspekte: Abstracts.- Falk Symposium Nr. 83.- Bozen, 1995.- S.100. 18. Kinakh M., Barwinska A. Coagulation and fibrinolytic activity, functional propriety of platelets in patients with DIC-syndrome // Fr?hjahrestagung der ™sterreichischen Gesellschaft fur H„matologie und Onkologie: Kurzfassungen der freien Vortraege und Posters.- Klagenfurt, 1995.- S.15. 19. Aa?aeineay A.N., Aauoe An.A. ?ieue iaoieiaee ia/aie a ?acaeoee o?iiaiaaii??aae/aneeo ineiaeiaiee o aieueiuo ino?ui iaie?aaoeoii // Iiaua iai?aaeaiey a aaiaoieiaee: Oac. aeiee.- Oaeuee-neiiiceoi ? 92.- Naieo-Iaoa?ao?a, 1996.- N.39. 20. Lysiuk Y., Andriushchenko V., Barwinska A. Timing of surgical treatment for acute biliary pancreatitis // HPB Surgery.- 1996.- Vol.9, Suppl.- P. 257. 21. Lysiuk Y., Andriushchenko V., Barwinska A., Bidiuk D. Acute biliary pancreatitis (ABP): a question of timing for surgery // Magyar Sebeszet.- 1996.- Vol. XLIX, ? 6, Suppl.- P.236. 22. Iaea? Ae.A., Aa?aiinueea A.N., Iaea?a A.C., Ieoaeeeoei I.ss. Aeeiaiiea iaoiii?oieiai/ieo ciii cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai o oai?eo aino?ei iaie?aaoeoii // No/anii aniaeoe iaaiaeeeaaeii? iaaee/ii? aeiiiiiae: Iao. thaieaeii? iaoe.-i?aeo. eiio. i?enay/aii? 25-?i//th noai?iaiiy Eueaianueei? iinueei? eeiii/ii? eiea?ii oaeaeei? iaaee/ii? aeiiiiiae.- Eueaia, 1997.- Ei. 1.- N. 134-135. 23. Vashchuk V., Geritch I., Barwinska A., Stoyanovsky I. The significance of microbiotic proteases for pathogenesis of the purulent complications of acute pancreatitis // 37th World Congress of Surgery: Abstracts.- Acapulco, 1997.- P.518. 24. Barwinska A. Gastrointestinal complications in patients with acute pancreatitis // New trends in diagnosis and treatment of liver and colonic diseases: Poster Abstracts.- Belorusian-Polish-Ukranian Falk Symposium.- Lviv, 1997.- P.332. AIIOAOeIss Aa?aiinueea A.N. Ooieoeiiiaeueiee noai cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai o oai?eo ia aino?ee iaie?aaoeo.- ?oeiien. Aeena?oaoeiy ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe ca niaoeiaeueiinoth 14.01.03 - oi?o?aiy.- Eueaianueeee aea?aeaaiee iaaee/iee oiiaa?neoao ii. Aeaieea Aaeeoeueeiai, Eueaia, 1999 ?. Nenoaiaoeciaaii ii?oieiai/ii i?iyae ii?ooaiue cniaeaeueii-i?ioecniaeaeueii? nenoaie e?iai i?e ??cieo oi?iao aino?iai iaie?aaoeoo a ie?aieo ia?iiaeao ee?i?/iiai ia?aa?ao, noaa?aeaeaii aca?iica’ycie ?o eaai?aoi?ieo, eeiii/ieo i iaoieiaiaiaoiii/ieo iciae. Ia/eneaii iioi?iaoeaiinoue iaoiaeia eaai?aoi?ii? aa?eoieaoei? ii?ooaiue aaiinoaco oa aaeineiiaeaii ?o aeiaaiinoeeo. Aecia/aii aeeiaiieo anio eaiie aaiinoaco a oai?eo iaa?yeiaei oa aeano?oeoeaiei iaie?aaoeoii, aieea iia?aoe?eii? o?aaie ia oia?eiieioe/io aeoeaiinoue. ?ic?iaeaii i?ia?aio eieoaaeueii-oaeoe/ieo aeie oa i?ioieaeoe/ieo caoiaeia. Eeth/iai neiaa: aino?ee iaie?aaoeo, cniaeaeueii-i?ioecniaeaeueia nenoaia e?iai, AeAC-neiae?ii, iioi?iaoeaiinoue aeiaaiinoe/ieo iaoiaeia, aaiinoaciia?aia, eieoaaeueia oaeoeea. AIIIOAOeEss Aa?aeineay A.N. Ooieoeeiiaeueiia ninoiyiea nenoaiu aaiinoaca o aieueiuo ino?ui iaie?aaoeoii.- ?oeiienue. Aeenna?oaoeey ia nieneaiea o/aiie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe ii niaoeeaeueiinoe 14.01.03 - oe?o?aey.- Eueaianeee ainoaea?noaaiiue iaaeeoeeineee oieaa?neoao ei. Aeaieea Aaeeoeeiai, Eueaia, 1999?. Nenoaiaoece?iaaii ii?oieiae/aneea i?eciaee ia?ooaiee nenoaiu aaiinoaca i?e ?aciuo oi?iao ino?iai iaie?aaoeoa a eaaeaeii ia?eiaea caaieaaaiey, eiinoaoe?iaaii acaeiinaycue eo eaai?aoi?iuo, eeeie/aneeo e iaoieiaiaiaoiie/aneeo neiioiiia. Ii?aaeaeaii eioi?iaoeaiinoue iaoiaeia eaai?aoi?iie aa?eoeeaoeee ia?ooaiee aaiinoaca oa oniaa?oainoaiaaii eo aeeaaiinoeeo. Eco/aii aeeiaieeo anao caai aaiinoaca o aieueiuo ioa/iui e aeano?oeoeaiui iaie?aaoeoii, aeeyiea iia?aoeeiiiie o?aaiu ia oea?eiieeoe/aneoth aeoeaiinoue. ?ac?aaioaii i?ia?aiio ea/aaii-oaeoe/aneeo aeaenoaee e i?ioeeaeoe/aneeo ia?ii?eyoee. Eeth/aaua neiaa: ino?ue iaie?aaoeo, nenoaia aaiinoaca, AeAN-neiae?ii, eioi?iaoeaiinoue aeeaaiinoe/aneeo iaoiaeia, aaiinoaceia?aiia, ea/aaiay oaeoeea. SUMMARY Barwinska A.S. Functional status of haemostasis in patients with acute pancreatitis.- Manuscript. Thesis for the scientific degree of Candidate of Medical Sciences by speciality 14.01.03 - surgery.- Lviv State Medical University by name Danylo Halycky, Lviv, 1999. The research concerns the acute pancreatitis, a pathology occupying one of the main places among the modern problems of urgent abdominal surgery. The disturbance of the physiological balance in the coagulation processes is an inevitable component of the pathogenetical chain of this disease. At certain stage such disorders may determine an unfavourable prognosis of the disease. The research was aimed at the improvement of the results of surgical treatment of acute pancreatitis by means of optimization of diagnostic and therapy programs on the principles of investigation of functional changes of haemostasis. Clinical material includes 272 cases; among them: 122 cases from retrospective analysis group; 130 cases are prospectively examined patients with acute pancreatitis; 20 cases are healthy people. According the results of the retrospective analysis the morphological signs of haemostasis disorders have been found in 65,6 % of the deceased. They were systematized into thrombotic, haemorrhagic, thrombohaemorrhagic syndromes; the latter was conditionally divided into properly DIC-syndrome and syndrome of polycoagulation disorders. The incidence of the adduced syndromes does not depend on the clinically morphological form of acute pancreatitis, but it correlates with periods of the clinical course of the disease. The correlation of laboratory, clinical and pathological signs haemostasis disorders have been confirmed. The informative value of the methods of the laboratory verification of haemostasis` disturbances has been calculated by means of mathematical characteristics (sensitivity, specific features, diagnostic efficiency). Precision of diagnostics of haemostasis disorders has been increased by 20-38 % with the help of extended haemostasiogram, improved laboratory program. The principle of subclinical diagnostics of haemostasis disorders in patients with acute pancreatitis has been suggested. In case of oedematiens pancreatitis haemostasis disorders are discovered in 72 % of patients, every fourth of them having DIC-syndrome. The increasing of the procoagulant activity and suppression of the fibrinolysis are found from the 2nd up to the 5th day of the disease course; the antithrombin activity is low during the whole clinical course of the disease. In case of the necrotic pancreatitis laboratory symptoms of haemostasis disorders are confirmed in 90 % of patients, 4/5 of them having DIC-syndrome. Sudden activation of procoagulant system and suppression of fibrinolytic system are observed during the period of the toxemia and manifestation of pancreonecrosis; antithrombin system remains reduced throughout the whole clinical course of the disease. Subclinical course of haemostasis disorders is determined in 2/3 of cases. Fibrinolytic activity of blood is changed in every period of clinical course of pancreonecrosis depending on the different ferment activity, under the influence of surgical intervention trauma and of application of antiferment medicine. During the first period of clinical course of the disease antiferment medicine should be prescribed in combination with indirect activators of fibrinilyses and anticoagulants, even in case of surgical intervention. During the second and third periods of the disease inhibitors of ferments should be prescribed only during the postoperation period. The expediency of the interpretation of haemostasis disorders as one of the pathogenetical mechanisms of acute pancreatitis has been substantiated, and it determined the development of new therapeutic approaches. The approaches to treatment of patients with acute pancreatitis and prophylaxis of thrombohaemorrhagic complications have been optimized. The scope of prophylaxis and treatment for DIC-syndrome in patients with acute pancreatitis should correspond to the phases of its development as well as to the pathogenetic peculiarities of haemostasis disorders during every period of the clinical course of the disease. The main components of adequate correction are antithrombotic therapy, levelling of the negative influence of inhibitors of ferments, compensation of low antithrombin activity, haemostatic treatment, improvement of microcirculation and blood rheology, liquidation of hypovolemy. Application of the developed diagnostic and therapeutic approaches promoted improvement of the results of surgical treatment of patients with acute pancreatitis, reduction of thrombohaemorrhagic complications by 1,5 - 2,5 %, decrease of the postoperation mortality rate from 28,6 % to 24,5 %. Key words: acute pancreatitis, coagulation system, DIC-syndrome, informativity of diagnostic tests, haemostasiogram, treatment tactic.

Похожие записи