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Профілактика фетоплацентарної недостатності у вагітних з рубцем на матці: Автореф. дис… канд. мед. наук / С.О. Швиденко, Нац. мед. ун-т ім. О.О.Бого

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I?I?NOA?NOAI IOI?IIE CAeI?IA’ss OE?A?IE

IAOe?IIAEUeIEE IAAeE*IEE OI?AA?NEOAO

?IAI? I.I.AIAIIIEUeOess

OAeE 618.36 : 618.14 – 003.92

Oaeaeaiei Na?aie Ieaenaiae?iae/

I?ioieaeoeea oaoiieaoeaioa?ii? iaaeinoaoiinoi o aaaioieo c ?oaoeai ia
iaooei.

14.01.01 – aeooa?noai oa aiiaeieiaiy

Aaoi?aoa?ao

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

Ee?a – 1999

Aeena?oaoe?y ? ?oeiienii.

?iaioa aeeiiaia ia eaoaae?? aeooa?noaa oa a?iaeieia?? ?1 Ee?anueei?
iaaee/ii? aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea

Iaoeiaee ea??aiee: aeieoi? iaaee/ieo iaoe,i?ioani?, Aaeiae/aiei TH??e
Iao?iae/, caa?aeoaa/ eaoaae?e aeooa?noaa oa a?iaeieia?? ?1 Ee?anueei?
iaaee/ii? aeaaeai?? i?neyaeeieiiii? ina?oe IIC Oe?a?ie

Io?oe?ei? iiiiaioe: aeieoi? iaaee/ieo iaoe, i?ioani? Ooiaiiaa Ea?ena
?aaai?aia – ea??aiee a?aeae?eaiiy i?io?eaeoeee ? e?eoaaiiy
ai?eii-caiaeueieo caoai?thaaiue a aeooa?noa? ?inoeoooo iaae?ao??? ,
aeooa?noaa oa a?iaeieia?? AII Oe?a?ie

aeieoi? iaaee/ieo iaoe, Nai/oe Aiaoie?e sseiae/- aieiaiee
aeooa?-a?iaeieia AOIC i. Ee?aa.

I?ia?aeia onoaiiaa: Iaeanueeee aea?aeaaiee iaaee/iee oi?aa?neoao,
eaoaae?a iaaee/ii? ia?eioieia??, aeeoy/i? oa i?aee?oeiai? a?iaeieia??.

Caoeno aeena?oaoe?? a?aeaoaeaoueny “_1__”_____04____1999?. i13;30
___aiae. ia can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee Ae.26.003.03
Iaoe?iiaeueiiai iaaee/iiai oi?aa?neoaoo ?i. I.I.Aiaiiieueoey 252004,
Oe?a?ia, i.Ee?a, aoeueaa? O.Oaa/aiea, 17.

C aeena?oaoe??th iiaeia iciaeiieoenue o a?ae?ioaoe? Iaoe?iiaeueiiai
iaaee/iiai oi?aa?neoaoo ?i.I.I.Aiaiiieueoey (i.Ee?a, aoe.Ciieia?/ia,1)

Aaoi?aoa?ao ?ic?neaii “_11__”_______02_____1999?.

A/aiee nae?aoa?

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

eaiaeeaeao iaaee/ieo iaoe, i?ioani? ss.I.
A?oianueeee

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeueiinoue oaie. I?iaeaia iia?aoei? eana?aaa ?icoeio ? iaeii?th c
iaeaieueo aeooaeueieo o no/aniiio aeooa?noai. Oea iaoiiaeaii iinoieii
c?inoath/ith /anoioith aeaii? iia?aoei? i cia/iei ?iaiai
iineyiia?aoeieieo oneeaaeiaiue (E.A.Oeiioaiei oa niiaaao., 1993;
A.I.Aaioeueeianueeee oa niiaaao., 1994; A.E.Noaiaieianeay e niaao.,
1994). Aaaaoi/enaeueii aeaii aio/eciyii? oa ca?oaiaeii? eioa?aoo?e uiaei
oei?? i?iaeaie oi?eathoueny, a iniiaiiio, iaoa?einueei? iaoieiai?:
aiieiinaioe/ii oneeaaeiaiiy, e?iaioa/i, aiiiaaeaeoiy oiui
(E.N.Eiaooiaa,1996; A.E.E?aniiiieueneee,1997; P.W.Howie et.al.,1990;
R.C.Pattinson et.al.,1993). Ia?yaeo c oeei, ia aeeeeea? noiiiaia oie
oaeo, ui cia/ia ?icoe?aiiy /anoioe aaaeiiiiaeueiiai ?ic?iaeaeaiiy
aiaeaoeiny a iioa?anao ieiaea i ia aeaiee iiiaio ca noeoiiinoth
aiaeiinieo iieacaiue iia?othoue eiaeio /aoaa?oo-i?yoo aeiieo: 20-25%
(N.I.Aaia?aeia oa niiaaao.,1994; I.I.Aiiieoeueeee oa niiaaao.,1996;
A.I.Iiuaiei, 1998).

Ianooiiee eana?ia ?icoei ? iaeiei c iaeaaaeeeaioeo ieoaiue i?iaeaie
aaaeiiiiaeueiiai ?ic?iaeaeaiiy. Oae, ca aeaieie aeineiaeaeaiue iaoi?
eaoaae?e (E.A.Oeiioaiei oa niiaaao.,1991; 1993) 10 ?ieia oiio c i?eaiaeo
?oaoey ia iaooei iia?iaaii oieueee 5% aeiiie, a ca?ac oeae iieaciee a
no?oeoo?i anio iieacaiue noaiiaeoue 30-35%.

Ia?aaia aaaioiinoi o aeiiie c ?oaoeai ia iaooei noi?iaiaeaeo?oueny
?yaeii na?eicieo oneeaaeiaiue: caa?ica ia?a?eaaiiy, iai?aaeeueia
iieiaeaiiy ieiaea (A.A.Aa?ai/aiei e niaao.,1994; D.James,1990), iecueea
?icoaooaaiiy ieaoeaioe oiui (E.A.Aaoooaiei e niaao.,1991;
A.E.E?aniiiieueneee e niaao.,1994; Ae.Y.Aa?eianueeee,1995). E?ii oiai,
iaeiei c na?eicieo ia?eiaoaeueieo oneeaaeiaiue o aeiiie c ?oaoeai ia
iaooei ? iiyaa neiae?iio cao?eiee aioo?ioiueioo?iaiiai ?icaeoeo ieiaea.
Aeieea? aeoaea iani?eyoeeaa neooaoeiy – iia?aoeaii ?ic?iaeaeothoue
aeiiie c ?oaoeai ia iaooei aiiio?ioi/ieie ieiaeaie c iecueeith
aaeaioaoeieiith iiaeeeainoth. Aacoiiaii, iniiaiith i?e/eiith ?icaeoeo
oeueiai oneeaaeiaiiy ? oaoiieaoeaioa?ia iaaeinoaoiinoue.

Iacaaaeath/e ia cia/io eieueeinoue ioaeieaoeie c oei?? i?iaeaie,
ieoaiiy oaoiieaoeaioa?ii? iaaeinoaoiinoi o aeiiie c ?oaoeai ia iaooei
aea/aii iaaeinoaoiuei i ia a iiaiiio ia??ii, oi/ ia aeeeeea? noiiiaia
oie oaeo, ui ?oaoeaai o?ioi/ii ciiie ia?aaeiuei? noiiee iaoee
i?ecaiaeyoue aei ii?ooaiiy iaoeiaiieaoeaioa?iiai e?iaiiaiao, i?e/iio
aeineoue aaaeeeaei ooo ? i aa?iaio eieaeicaoei? ieaoeaioe. A eioa?aoo?i
ie ia cono?i/aee iiaiaeiieaiue i?i iayaiinoue aoaiieo aeineiaeaeaiue c
ieoaiue i?ioieaeoeee oa eieoaaiiy oaoiieaoeaioa?ii? iaaeinoaoiinoi o
aaaioieo c ?oaoeai ia iaooei. Ana aeeeaaeaia aeua naiae/eoue i?i
iaiaoiaeiinoue i?iaaaeaiiy iaoeiaeo aeineiaeaeaiue, i?enay/aieo
aea/aiith noaio oaoiieaoeaioa?iiai eiiieaeno oa ?ic?iaoei
eieoaaeueiii?ioieaeoe/ieo caoiaeia o aaaioieo c ?oaoeai ia iaooei.

Ca?ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie.

Aeeiiaia iaoeiai-aeineiaeia ?iaioa ? o?aaiaioii iaoeiai? ?iaioe eaoaae?e
aeooa?noaa oa aiiaeieiai? ue1 Ee?anueei? iaaee/ii? aeaaeaii?
iineyaeeieiiii? inaioe, ue ae.?. 0196 40 10590.

Iaoa ?iaioe i caaea/i aeineiaeaeaiiy. Iaoa ?iaioe: cieceoe /anoioo
ia?eiaoaeueieo oneeaaeiaiue o aaaioieo c ?oaoeai ia iaooei ia iiaenoaai
oaeineiiaeaiiy eiiieaenii? ei?aeoei? oaoiieaoeaioa?ii? iaaeinoaoiinoi.

Caaea/i aeineiaeaeaiiy:

1. Anoaiiaeoe oaeoi?e ?eceeo ?icaeoeo oaoiieaoeaioa?ii? iaaeinoaoiinoi o
aaaioieo c ?oaoeai ia iaooei.

2. C?ynoaaoe iniaeeainoi ia?aaiao aaaioiinoi, iieiaia, iineyiieiaiaiai
ia?iiaeo a oaeiae noaio eaeoaoei? o aeiiie c ?oaoeai ia iaooei.

3. Aea/eoe iniaeeainoi ooieoeiiiaeueiiai noaio oaoiieaoeaioa?iiai
eiiieaeno o aaaioieo c ?oaoeai ia iaooei. 4. Iaoeiai iaa?oiooaaoe oa
oaeineiiaeeoe eiiieaen aeiaaiinoe/ieo oa eieoaaeueii-i?ioieaeoe/ieo
caoiaeia o aaaioieo c ?oaoeai ia iaooei aeey ei?aeoei? oaoiieaoeaioa?ii?
iaaeinoaoiinoi.

5. Ioeiieoe aoaeoeaiinoue i?aeoe/ieo ?aeiiaiaeaoeie uiaei aaaeaiiy
aaaioieo c ?oaoeai ia iaooei ia aoaii aeiii/i? eiinoeueoaoei? oa
aeooa?nueeiai noaoeiiia?o.

Iaoeiaa iiaecia io?eiaieo ?acoeueoaoia. Aia?oa i?iaaaeaii aea/aiiy noaio
oaoiieaoeaioa?iiai eiiieaeno o aaaioieo c ?oaoeai ia iaooei caeaaeii
aiae iinoey eieaeicaoei? ieaoeaioe, ii?oieiai/iiai noaio ?oaoey oa
iineyiia?aoeieieo oneeaaeiaiue i?e ia?oie iia?aoei?. Ooi/iaii
iniaeeainoi ia?aaiao aaaioiinoi, iieiaia, iineyiieiaiaiai oa
iaiiaoaeueiiai ia?iiaeia, noaio eaeoaoei? i?e iiaoi?iiio
aaaeiiiiaeueiiio ?ic?iaeaeaiii. Oea aeicaieeei ?icoe?eoe aeaii i?i
iaoiaaiac oaoiieaoeaioa?ii? iaaeinoaoiinoi.

Aia?oa iaoeiai iaa?oioiaaia iaoiaeeea iiaoaiii? iaaeeeaiaioicii?
ei?aeoei? oaoiieaoeaioa?ii? iaaeinoaoiinoi o aaaioieo c ?oaoeai ia
iaooei.

I?aeoe/ia cia/aiiy io?eiaieo ?acoeueoaoia. Anoaiiaeaii oaeoi?e ?eceeo
?icaeoeo oaoiieaoeaioa?ii? iaaeinoaoiinoi o aaaioieo c ?oaoeai ia
iaooei. Oaeineiiaeaii i?aeoe/ii ?aeiiaiaeaoei? uiaei eiiieaenii?
iaaeeeaiaioicii? ei?aeoei? oaoiieaoeaioa?ii? iaaeinoaoiinoi o aeiiie c
?oaoeai ia iaooei. Cai?iiiiiaaii aeey oe?ieiai ai?iaaaeaeaiiy a i?aeoeeo
iaoiaee eiio?ieth ca noaiii oaoiieaoeaioa?iiai eiiieaeno ia?aae
iiaoi?iei aaaeiiiiaeueiei ?ic?iaeaeaiiyi, yei aeeth/athoue a naaa
eeiii/ii, aoia?aoi/ii, aeiiea?iiao?e/ii oa aiaeie?eiieiai/ii iieacieee.

Ai?iaaaeaeaii i?aeoe/ii ?aeiiaiaeaoei? uiaei aaaeaiiy aaaioieo c ?oaoeai
ia iaooei ia aoaiao aeiii/i? eiinoeueoaoei? oa aeooa?nueeiai
noaoeiiia?o, ui aeicaieeei cieceoe /anoioo ia?eiaoaeueieo oneeaaeiaiue.

Iniaenoee aianie caeiaoaa/a. Ieaioaaiiy i i?iaaaeaiiy anio
aeineiaeaeaiue aeeiiaia aeena?oaioii ca ia?iiae c 1996 ii 1998 ?.?.
Aaoi?ii i?iaaaeaii eeiiiei-eaai?aoi?ia oa ii?oieiai/ia ianoaaeaiiy 90
aeiiie iiney ia?oiai oa iiaoi?iiai aaaeiiiiaeueiiai ?ic?iaeaeaiiy.
Naiinoieii i?iaaaeaii caai? oa iiaeaioiaeo aiieiai/iiai iaoa?iaeo. Ani
eaai?aoi?ii oa ooieoeiiiaeueii iaoiaee aeineiaeaeaiiy aeeiiaii
aaciina?aaeiuei aaoi?ii.

Aaoi?ii oaeineiiaeaia iaoiaeeea ei?aeoei? oaoiieaoeaioa?ii?
iaaeinoaoiinoi o aaaioieo c ?oaoeai ia iaooei, ui aeicaieeei cieceoe
/anoioo ia?eiaoaeueieo oneeaaeiaiue i?e aaaeiiiiaeueiiio ?ic?iaeaeaiii.
Noaoenoe/ia ia?iaea io?eiaieo aeaieo i?iaaaeaia aeeeth/ii aaoi?ii.

Ai?iaaoeiy ?acoeueoaoia aeena?oaoei?. Iaoa?iaee aeena?oaoei?
aeiiiaiaeaeenue oa iaaiai?thaaeenue ia caniaeaiii anioeiaoei?
aeooa?iaaiiaeieiaia Ee?anueei? iaeanoi (/a?aaiue, 1998); ia caniaeaiii
anioeiaoei? aeooa?ia-aiiaeieiaia i.Ee?aa (aa?anaiue, 1998); ia
caniaeaiii i?iaeaiii? eiiini? “Aeooa?noai oa aiiaeieiaiy” Ee?anueei?
iaaee/ii? aeaaeaii? iineyaeeieiiii? inaioe ii.I.E.Ooieea (aa?anaiue,
1998).

Ioaeieaoei?. Ca oaiith eaiaeeaeaonueei? aeena?oaoei? iioaeieiaaii /ioe?e
iaoeiai noaooi o oaoiaeo aeaeaiiyo, ?aeiiaiaeiaaieo AAE Oe?a?ie.

No?oeoo?a aeena?oaoei?. Aeena?oaoeiy aeeeaaeaia ia 143 noi?iieao
iaoeiiieno, neeaaea?oueny c anooio, iaeyaeo eioa?aoo?e, ?icaeieo
iaoiaeia aeineiaeaeaiiy, o?ueio ?icaeieia aeanieo aeineiaeaeaiue,
aiaeico i ocaaaeueiaiiy ?acoeueoaoia aeineiaeaeaiiy, aeniiaeia oa
iieaae/eea eioa?aoo?e, yeee iinoeoue 100 aio/eciyieo i 84 ca?oaiaeieo
aeaea?aea. ?iaioa iethno?iaaia 31 oaaeeoeyie i 26 iaethieaie.

INIIAIEE CIINO ?IAIOE

Ia??eo, iaoiaee oa iaoiaeieiaiy aeineiaeaeaiue. Aeey ae?ioaiiy
iinoaaeaii? iaoe oa caaea/ ie ianoaaeeee a aeeiaiioei aaaioiinoi i
iineyiieiaiaiai ia?iiaeo 90 aeiiie, yei ?ic?iaeaeaii oeyoii iia?aoei?
eana?aaa ?icoeio, eio?i aoee ?iciiaeieaii ia o?e a?oie: I – 30
ia?ai?iaeyueo, yei ?ic?iaeaeaii aaaeiiiiaeueiei oeyoii c i?eaiaeo
oaoiieaoeaioa?ii? iaaeinoaoiinoi o niieo/aiii c iioeie aiaeiinieie
iieacieeaie: aie aieueoa 30 ?ieia, e?oiiee ieiae, oaciaa ia?aaeeaaeaiiy,
eina aai iiia?a/ia iieiaeaiiy, iaieiaeiinoue /e iaaeiiooaaiiy a aiaiiaci
oa iioi; II – 30 aeiiie c ?oaoeai ia iaooei iiney eana?aaa ?icoeio c
oaeoi?aie ?eceeo oaoiieaoeaioa?ii? iaaeinoaoiinoi, aaaeaiiy yeeo
caeienithaaeiny ca caaaeueiii?eeiyoith noaiith: aeei?enoaiiy aioaiiiia i
caniaia, yei iieiioothoue iaoeiai-ieaoeaioa?iee e?iaiiaia oieueee iiney
aeiaaiinooaaiiy oaoiieaoeaioa?ii? iaaeinoaoiinoi; III – 30 aeiiie c
?oaoeai ia iaooei iiney aaaeiiiiaeueiiai ?ic?iaeaeaiiy i oaeeie ae
oaeoi?aie ?eceeo oa i?iaaaeaieo ca iaoith iaoiaeeeith. sse eiio?ieueio
a?oio aoei ianoaaeaii 30 caei?iaeo aeiiie c oiciieiai/iei ia?aaiaii
aaaioiinoi, yei ?ic?iaeaeaii /a?ac i?e?iaeii iieiaiai oeyoe.

E?ii caaaeueiii?eeiyoeo eeiii/ieo iaoiaeia aeineiaeaeaiiy, ie aea/aee
nei?ioeeao aeiyeueiinoue iaoee ca aeiiiiiaith ea?aeiioieia?aoa
“Aiiiaaeeea” (Ioaeiy) iaoiaeii ciaiioiuei? ainoa?ia?aoi?. Aeey
?icoeo?oaaiiy ea?aeiioieia?ai ieiaea aeei?enoiaoaaee aaeueio ioeiieo ca
oeaeith A.N.Aioue? (1988).

Oeueo?acaoeiaa ieaoeaioia?aoiy i oaoiiao?iy i?iaiaeeeany ia aia?aoi
“Toshiba” (ssiiiiy).

Aeey ioeiiee iaoeiai-ieaoeaioa?iiai oa ieiaeiaiieaoeaioa?iiai
e?iaiiaiao i?iaaaeaia ?a?no?aoeiy e?eaeo oaeaeeinoae e?iaioieo a a?oa?i?
ioiiaeie i ai?oi ieiaea ia aia?aoi neeaaeiiai neaioaaiiy “Combizon-250”
(Aano?iy), yeee iniauaiee aeoieaeniei iiioeueniei aeiiea?ianueeei aeieii
“Doppler-300”. Aeey ioeiiee ia?eoa?ieiiai noaeeiiiai iii?o aecia/aee
nenoiei-aeianoiee/ia aiaeiioaiiy (N/Ae) ca iaoiaeeeith D.Stuart oa
niiaaao. (1990); iiaeaen ioeuenaoei? (II) ca iaoiaeeeith R.Gosling,
D.King (1988)oa iiaeaen ?acenoaioiinoi (I?) ca iaoiaeeeith L.Pourcelot
oa niiaaao. (1987).

I?e aea/aiii ai?iiiaeueieo aca?iiaiaeiioaiue a nenoaii
iaoe-ieaoeaioa-ieiae aecia/aee a ne?iaaooei e?iai ?aaeiiiioiieiai/iei
iaoiaeii ?iaaiue ianooiieo ai?iiiia: ano?iieo, ano?aaeiieo,
i?iaanoa?iio, i?ieaeoeio, oi?iiii/iiai aiiaaeio?iiiio oa ieaoeaioa?iiai
eaeoiaaio (A.A.?aciieiaa, 1990).

Ii?oieiai/ia aeineiaeaeaiiy ?oaoey ia iaooei i?iaiaeeeiny oeyoii caai?o
eiai oa?iaioia iiae /an aaaeiiiiaeueiiai ?ic?iaeaeaiiy. Aeey ioeiiee
niieo/ii? oeaieie, yea noaiiaeoue iniiao oeieueii? ?oaoeaai? oeaieie,
aeei?enoiaoaaeenue iaoiaee naioiai? iie?ineiii?. Io?eiaii oiaoi/ee
?oaoeaai? oeaieie iiaeeyaaee ainoieiai/iie ia?iaoei c ianooiiei
aeei?enoaiiyi ?yaeo niaoeiaeueieo iaoiaeia oa?aoaaiiy. Cie?aia, io?eiaii
ainoieiai/ii c?ice ?oaoeaai? oeaieie oa?aoaaee ia oieueee
aaiaoieneeii-aiciiii, aea oaeiae aeei?enoiaoaaee iie?iooenii a
oa?aoaaiii ii Aai-Aiciio, ?ic/ei acioieeneiai n?iaea a iii?aaiaoeieiie
iaoiaeeoei, a oaeiae ?aaeoea Oioa (a OEE-?aaeoei?) oa aaeioeiaiiaee
neiie – aeey ooieoeiiiaeueii-ii?oieiai/ii? ioeiiee noaio niieo/ii?
oeaieie ?oaoey i ciii, ui o?aieyeenue a iie ca iaoiaeeeith
A.A.Aaoaiaeieiaa (1994).

Iaoaiaoe/io ia?iaeo io?eiaieo ?acoeueoaoia i?iaiaeeee caiaeii
?aeiiaiaeaoeie A.I.Aaeueaa/ueiaa oa A.N.E?enaae/a (1989). I?e oeueiio
aeei?enoiaoaaee eiii?thoa? c i?ia?aiith . A?aoiee aoaeoaaee ca aeiiiiiaith i?ia?aie .

?acoeueoaoe aeineiaeaeaiue oa ?o iaaiai?aiiy. Na?aae iniiaieo i?e/ei
aeooa?nueeeo oa ia?eiaoaeueieo oneeaaeiaiue iaeia c i?iaiaeieo iinoeue a
iao /an caeia? oaoiieaoeaioa?ia iaaeinoaoiinoue (A.I.Naaaeueaaa e
niaao.,1991; A.I.Iiuaiei,1998; G.Bonatz et.al.,1996). Iacaaaeath/e ia
cia/ia /enei iaoeiaeo iiooeia a oeueiio iai?yieo ieoaiiy aoiiiaoiaaiaco,
aeiaaiinoeee oa eieoaaiiy aeaii? iaoieiai? caeeoathoueny
aeeneooaaaeueieie. I?e oeueiio, nooo?aa ?ieue aiaeaiaeeoueny
i?aii?aiaeiiio oiio aeiiie, oiaoi iayaiinoi noiooiio oaeoi?ia ?eceeo
?icaeoeo oaoiieaoeaioa?ii? iaaeinoaoiinoi. Aacoiiaii, aei
nueiaiaeiyoiueiai aeiy aeaeieaii cia/ia /enei ?icieo aeaeia aaiioaeueii?
oa niiaoe/ii? iaoieiai?, yei ni?eythoue ii?ooaiith iaoeiaiieaoeaioa?iiai
e?iaiiaiao, ui ? ii/aoeiaith eaieith a iaoiaaiaci oei?? iaoieiai?
(I.A.Oaaei?iaa e niaao.,1989; A.E.Noaiaieianueea oa niiaaao.,1994).
Iaeiei c iaeiaea/aieo oaeoi?ia ?eceeo oaoiieaoeaioa?ii? iaaeinoaoiinoi ?
iayaiinoue ?oaoey ia iaooei iiney iiia?aaeiueiai aaaeiiiiaeueiiai
?ic?iaeaeaiiy. Ia?yaeo c oeei, ia aeeeeea? noiiiaia oie oaeo, ui /anoioa
?icieo oneeaaeiaiue aaaioiinoi: caa?ica ia?a?eaaiiy, cao?eiea
aioo?ioiueioo?iaiiai ?icaeoeo ieiaea, iai?aaeeueia iieiaeaiiy ieiaea
oiui a aeaiie a?oii aeua (E.A.Oeiioaiei oa niiaaao.,1991;
A.E.E?aniiiieueneee e niaao.,1994; A.A.Aa?ai/aiei, 1996). Ae?ioaiith
oeueiai ieoaiiy a i?ioieaeoe/iiio aniaeoi i i?enay/aii i?iaaaeaia iaie
iaoeiaa aeineiaeaeaiiy.

I?e aiaeici eeiii/ii? oa?aeoa?enoeee ianoaaeaieo aeiiie ie aaaaeaee ca
aeioeieueia i?iaiaeeoe ii?iaiyeueii iiiaioe o ia?ai?iaeyueo,
i?iiia?iaaieo, a iniiaiiio, c i?eaiaeo oaoiieaoeaioa?ii? iaaeinoaoiinoi
(o?iii/ia aioo?ioiueioo?iaia aiiieniy ieiaea c cao?eieith eiai
aioo?ioiueioo?iaiiai ?icaeoeo, ia?aiioaia aaaioiinoue, iaoyaeaiee
aeooa?nueeee aiaiiac, oaciaa ia?aaeeaaeaiiy i ii.) oa iiaoi?iiiia?iaaieo
c i?eaiaeo ?oaoey ia iaooei, iaeiae c ?iciith iaoiaeeeith aaaeaiiy
aaaioiinoi.

Na?aaeiie aie ianoaaeaieo aeiiie neeaa 27,2?2,4 ?ieia i a I-III a?oiao
aeinoiai?ii ia aiae?iciyany (?>0,05). Oeth iniaeeainoue ie ca?ycaee c
oei iiiaioii, ui ?ecee ?icaeoeo oaoiieaoeaioa?ii? iaaeinoaoiinoi cia/ii
iiaeaeuo?oueny o aieiaeo ia?ai?iaeyueo (A.I.Naaaeueaaa e niaao.,1991;
A.I.Iiuaiei,1998;), ui ie ia?iaeei aiaeii/aee a iaoeo niinoa?aaeaiiyo.

Iniaeeaee iioa?an noaiiaeyoue aeaii i?i iniaeeainoi iieacaiue aei
ia?oiai aaaeiiiiaeueiiai ?ic?iaeaeaiiy o aeiiie c ?oaoeai ia iaooei
(II-III a?oie). Oae, io?eiaii iaie ?acoeueoaoe naiae/aoue i?i oa, ui
iae/anoioa iaee iinoea aiiiaei? iieiaiai? aeiyeueiinoi ia oiii
ia?aae/aniiai ?ic?eao ieiaeiaeo iaieiiie (33,3% i 36,7%). E?ii oiai,
caa?oa? ia naaa oaaao i aeniea /anoioa oaeiai iieacaiiy ye i?ia?anoth/a
aioo?ioiueioo?iaia aiiieniy ieiaea (26,7% i 23,3%), a oaeiae noeoiiinoue
aiaeiinieo iieacaiue a iioa?anao ieiaea (20,0% i 23,3%). Iaaaaaoi ?iaeoa
ie aiaeii/aee na?aae iieacaiue ia?aae/ania aiaeoa?oaaiiy
ii?iaeueii?icoaoiaaii? ieaoeaioe (9,9% i 6,6%), ?? ia?aaeeaaeaiiy (ii
6,6%) oa iai?aaeeueia iieiaeaiiy ieiaea (ii 3,3%). Aeinoiai?ieo
?icieoeue iiae iieacieeaie a II i III a?oiao ie ia aiaeii/aee (?>0,05).
I?aaenoaaeaia no?oeoo?a iieacaiue aei ia?oiai aaaeiiiiaeueiiai
?ic?iaeaeaiiy naiae/eoue i?i nooo?ao ?ieue ii?ooaiue
iaoeiai-ieaoeaioa?iiai e?iaiiaiao na?aae oneeaaeiaiue, yei i?ecaiaeyoue
aei o?iii/ii? oa aino?i? iaoieiai? ieiaea, i?i ui oaeiae aiaeii/a?oueny
o aio/eciyiie oa ca?oaiaeiie eioa?aoo?i (E.A.Oeiioaiei oa niiaaao.,1993;
A.A.Aa?ai/aiei, 1996; T.Burnog et.al.,1993).

?iaaiue aaiioaeueii? iaoieiai? ieaco? nooo?aee aieea ia /anoioo
aeooa?nueeeo oa ia?eiaoaeueieo oneaaeiaiue (N.I.Aaia?aeia oa
niiaaao.,1994; A.E.E?aniiiieueneee,1997; E.Jauniaux et.al.,1996). Ca
iaoeie aeaieie o aeiiie I-III a?oi /anoioa caiaeueieo i?ioeania iaoee oa
aeiaeaoeia aoea aiae 43,3% aei 46,7%, iaoieiai/ieo ciii oeeee iaoee –
33,3%, ii?ooaiue iaino?oaeueiiai oeeeeo i ooieoei? y?/ieeia aoea aiae
20,0% aei 23,3% aeiiie.

Na?aae ?icieo aeaeia aeno?aaaiioaeueii? iaoieiai? a aaiaci
oaoiieaoeaioa?ii? iaaeinoaoiinoi iaeaieueo cia/io ?ieue aiaeia?athoue
na?oeaai-noaeeiii oa aiaeie?eiii caoai?thaaiiy (I.A.Oaaei?iaa e
niaao.,1989; A.I.No?eaeaeia e niaao.,1990; A.I.Naaaeueaaa e
niaao.,1991). Aaoi?e iia?ycothoue oea c aeieeath/eie ia oaeiio
iani?eyoeeaiio oiii ii?ooaiiyie iaoeiai-ieaoeaioa?iiai e?iaiiaiao, a
oaeiae c iaaeinoaoiueith aiaeie?eiiith ooieoei?th ieaoeaioe. Ca iaoeie
aeaieie, /anoioa na?oeaai-noaeeiieo caoai?thaaiue o aeiiie I-III a?oi
neeaea aiae 26,7% aei 30,0%, a aiaeie?eiii? iaoieiai? – aiae 23,3% aei
26,7% aeiaaeeia. I?e oeueiio, aeinoiai?ieo ?icieoeue ie ia niinoa?iaaee
(?>0,05). Aeey ae?ioaiiy iinoaaeaii? iaoe i caaea/ ie aaaaeaee ca
aeioeieueia ia ii/aoeiaiio aoaii aea/eoe iniaeeainoi ooieoeiiiaeueiiai
noaio oaoiieaoeaioa?iiai eiiieaeno o aeiiie c ?oaoeai ia iaooei, a a
iiaeaeueoiio – ioeiieoe aoaeoeaiinoue oaeineiiaeaiiy iaoiaeeee
i?ioieaeoeee oaoiieaoeaioa?ii? iaaeinoaoiinoi i?e iiaoi?iiio
aaaeiiiiaeueiiio ?ic?iaeaeaiii.

Aeoiaey/e c ?acoeueoaoia aoia?aoi/ieo aeineiaeaeaiue iaiaoiaeii aeacaoe
ia oie oaeo, ui a I a?oii aeiiie ieaoeaioa iae/anoioa eieacieoaaeany ii
caaeiie noiioei (46,7%) i a iaeanoi aeia (33,3%), a oie /an ye o
aaaioieo c ?oaoeai ia iaooei (II a?oia) – ii ia?aaeiie noiioei, (46,7%,
aiaeiiaiaeii a I a?oii 10%; ?0,05).
Iaeiae, i?e aieueo aeaoaeueiiio aiaeici o aeiiie, yei ia?aianee iiney
ia?oi? iia?aoei? aiaeiiao?eo i noaiiaiethoeith /e eioiiiao?o, ie
niinoa?iaaee aeinoiai?ia ciaioaiiy iiaeaenia ioeuenaoei? – aei 0,62?0,03
(?0,05).
Ianooiii aeineiaeaeaiiy, i?iaaaeaii aaea a 37-38 oeae. iieacaee, ui o
aeiiie, yei ia?aianee aiaeiiao?eo, a oaeiae noaiiaiethoeith iaoee i
eioiiiao?o cieaeaiiy nenoieiaeianoiee/iiai aiaeiioaiiy iineee aieueo
ae?aaeaiee oa?aeoa? – aei 1,61?0,03 (?0,05),
aea i?iyaeyeeny aieueo eaaeeie oi?iaie. Io?eiaii iaie aeaii
aeicaieythoue caiaeeoenue c aeoieith A.E.Noaiaieianueei? oa
A.I.Aaioeeianueeiai (1984) i?i i?iaiaeio ?ieue oaoiieaoeaioa?iiai
eiiieaeno a aaiaci ?icieo aeooa?nueeeo oa ia?eiaoaeueieo oneeaaeiaiue.
Ia iaoo aeoieo, nai?/ania oa aaeaeaaoia ei?aeoeiy ii?ooaiue
iaoeiaiieaoeaioa?iiai e?iaiiaiao aeicaiey? cieceoe ?iaaiue ?icieo
iaoieiai/ieo noaiia, i?e/iio ia oieueee c aieo ieiaea, aea i c aieo
iaoa?i.

Aacoiiaii, oaei ?icii ooieoei? oaoiieaoeaioa?iiai eiiieaeno aieeioee i
ia /anoioo aeooa?nueeeo oa ia?eiaoaeueieo oneeaaeiaiue ye i?e, oae i
iiney ?ic?iaeaeaiiy. Oei aieueo, ui a eioa?aoo?i cono?i/athoueny
ioaeieaoei?, yei naiae/aoue i?i ae?aaeaiee ?o aca?iica?ycie
(A.I.Naaaeueaaa e niaao.,1991; E.A.Oeiioaiei oa niiaaao.,1993;
A.E.E?aniiiieueneee,1997). A ia?oo /a?ao, oea noino?oueny noiooiio
iieacaiue aei aaaeiiiiaeueiiai ?ic?iaeaeaiiy i?e iayaiinoi ?oaoey ia
iaooei, iia?ycaieo c oaoiieaoeaioa?iith iaaeinoaoiinoth. I?e oeueiio,
/anoioa ia?aae/aniiai ?ic?eao ieiaeiaeo iaieiiie neeaea a II a?oii
23,3%, a a III – 16,5% (?>0,05), a o?iii/ia aioo?ioiueioo?iaia aiiieniy
ieiaea aoea ia ii?yaeie ieae/a a III a?oii (36,7%) ii?iaiyii c II
(70,0%; p

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