¹ 11 Âîåííî-ìåäèöèíñêèé æóðíàësc.mil.ru/files/morf/military/archive/N11_2011_ноябрь.pdf · 14 «Âîåííî-ìåäèöèíñêèé æóðíàë», 11’2011

2011 �

¹ 1

1Â

îåííî-ì

åäèöèíñêèé æ

óðíàë

ÍÎßÁÐÜ

2011

Àäðåñ ðåäàêöèè:194044, Ñàíêò-Ïåòåðáóðã,óë. Àêàäåìèêà Ëåáåäåâà, ä. 6Òåë. (812) 329-71-94

Êîðïóíêò â Ìîñêâå:119160, Ìîñêâà, ðåäàêöèÿ«Âîåííî-ìåäèöèíñêîãî æóðíàëà»Òåë./ôàêñ: (495) 656-33-41

ÅÆÅÌÅÑß×ÍÛÉÒÅÎÐÅÒÈ×ÅÑÊÈÉÈ ÍÀÓ×ÍÎ-ÏÐÀÊÒÈ×ÅÑÊÈÉÆÓÐÍÀËÌÈÍÈÑÒÅÐÑÒÂÀ ÎÁÎÐÎÍÛÐÎÑÑÈÉÑÊÎÉ ÔÅÄÅÐÀÖÈÈ

Non scholae, sed vitae discimus!

ÐÅÄÀÊÖÈÎÍÍÀßÊÎËËÅÃÈß:

Ì.Â.Ïîääóáíûé (ãëàâíûéðåäàêòîð)À.Á.ÁåëåâèòèíÂ.Â.Áóçóíîâ (îòâåòñòâåííûéñåêðåòàðü)È.Â.ÁóõòèÿðîâÀ.Þ.ÂëàñîâË.Ë.Ãàëèí (çàìåñòèòåëüãëàâíîãî ðåäàêòîðà)Â.Â.ÆèäèêÂ.Â.ÈâàíîâÎ.Â.Êàëà÷åâÀ.À.ÊàëìûêîâÀ.Á.ËåîíèäîâÞ.Â.ËîáçèíÞ.Â.Ìèðîøíè÷åíêîÀ.Ý.ÍèêèòèíÂ.À.ÍîâèêîâÂ.Å.Ïàðô¸íîâÈ.Â.ÏåòðååâÈ.Ì.ÑàìîõâàëîâÝ.Ï.ÑîëîâåéÞ.Ø.ÕàëèìîâÂ.Í.ÖûãàíÂ.Ê.ØàìðåéÀ.Ì.ØåëåïîâÂ.Â.ßìåíñêîâ

ÐÅÄÀÊÖÈÎÍÍÛÉÑÎÂÅÒ:

Èçäàåòñÿ ñ 1823 ãîäà

2011 * ÍÎßÁÐÜ

Ò. 332 * ¹ 11

ÌÎÑÊÂÀÈÇÄÀÒÅËÜÑÊÈÉ ÄÎÌ«ÊÐÀÑÍÀß ÇÂÅÇÄÀ»

Ñ.À.Áåëÿêèí (Êðàñíîãîðñê)Ï.Ã.Áðþñîâ (Ìîñêâà)À.À.Áóäêî (Ñ.-Ïåòåðáóðã)Ñ.Ô.Ãîí÷àðîâ (Ìîñêâà)Â.Â.Äîáðæàíñêèé (Ìîñêâà)È.Á.Ìàêñèìîâ (Ìîñêâà)È.Ã.Ìîñÿãèí (Êàëèíèíãðàä)Ý.À.Íå÷àåâ (Ìîñêâà)Þ.Â.Ñàáàíèí (Ìîñêâà)Â.Á.Ñèìîíåíêî (Ìîñêâà)Þ.Ð.Õàíêåâè÷ (Ñåâåðîìîðñê)È.Ì.×èæ (Ìîñêâà)

Àäðåñ â ñåòè Èíòåðíåò:http://sc.mil.ru/social/media/magazine/more.htm?id=8753@morfOrgInfo

Êîíöåïöèÿ ðàçâèòèÿîòîðèíîëàðèíãîëîãè÷åñêîé ïîìîùèâ Âîîðóæåííûõ Ñèëàõ ÐÔ

Ïðèíöèïû ëå÷åíèÿ ìèííî-âçðûâíûõðàíåíèé ËÎÐ-îðãàíîâ

Âíåáîëüíè÷íàÿ ïíåâìîíèÿó âîåííîñëóæàùèõ âíóòðåííèõ âîéñêÌÂÄ Ðîññèè â 2000–2010 ãã.

Ãèãèåíè÷åñêàÿ îöåíêà ñî÷åòàííîãîâîçäåéñòâèÿ øóìà è èíôðàçâóêàíà îðãàíèçì âîåííîñëóæàùèõ

Íîâûå òåõíîëîãèè â ðàçðàáîòêå,ïðîèçâîäñòâå è èñïîëüçîâàíèèòåõíè÷åñêèõ ñðåäñòâ ðàçâåðòûâàíèÿïîëåâûõ ìåäèöèíñêèõ ÷àñòåéè ó÷ðåæäåíèé

Âîåííî-ìîðñêèå ãîñïèòàëèâ Ðîññèè XVIII ñòîëåòèÿ

© «Âîåííî-ìåäèöèíñêèé æóðíàë», 11’20112

ÑONTENTS

4

Ëå÷åáíî-ïðîôèëàêòè÷åñêèåâîïðîñû

Prophylaxis and treatment

Îðãàíèçàöèÿ ìåäèöèíñêîãîîáåñïå÷åíèÿ Âîîðóæåííûõ Ñèë

Organization of medical supportof the Armed Forces

20

29

36

40

14

24

Ýïèäåìèîëîãèÿè èíôåêöèîííûå áîëåçíè

Epidemiologyand infectious diseases

Govorun M.I., Kokorina O.V. – Conceptof development of the provision of oto-rhinolaryngological care in the ArmedForces of the Russian Federation

Popov A.P., Lanovenko Yu.P., Pavlova I.V.– Some aspects of outpatient work inmodern conditions

Belyakin S.A., Egorov V.I., Lukyanenko A.V.– General principles of treatment of mine-explosive wounds of upper respiratory tract

Plekhanov V.N. – About the diagnosticsignificance of asymptomatic bacteriuriaamong the conscripts

Khubulava G.G., Ivchenko E.V., Payvin A.A.,Kravchuk V.N., Yurchenko D.L., Ivashchen-ko A.I., Didenko M.V., Lukyanov N.G., Pele-shok A.S. , Tsygan N.V., Lubimov A.I., Nau-mov A.B., Shorokhov K.N., Sukharev A.E.,Knyazev E.A., Porembskaya I.A. – Expe-rience of left ventricular assist device«Incor» as «bridge to recovery» implanta-tion in patients with end stage congestiveheart failure

Shilov V.V., Batotsyrenov B.V., Vasilyev S.A.,Shikalova I.A., Loladze A.T. – Correctionof nonspecific damages in acute poisoningof substance from the group of opiate drugin patients in critical condition

Yaroslavtsev V.V., Sabanin Yu.V., Kaskov O.V.,Rybin V.V., Rikhter V.V., Zavolozhin V.A. –Community-acquired pneumonia amongthe conscripts of Interior Forces inRussia: characteristics of the epidemicprocess

Ãîâîðóí Ì.È., Êîêîðèíà Î.Â. – Êîíöåï-öèÿ ðàçâèòèÿ ñèñòåìû îêàçàíèÿ îòî-ðèíîëàðèíãîëîãè÷åñêîé ïîìîùè â Âî-îðóæåííûõ Ñèëàõ ÐÔ

Ïîïîâ À.Ï., Ëàíîâåíêî Þ.Ï., Ïàâëîâà È.Â.– Íåêîòîðûå àñïåêòû àìáóëàòîðíî-ïîëèêëèíè÷åñêîé ðàáîòû â ñîâðåìåí-íûõ óñëîâèÿõ

Áåëÿêèí Ñ.À., Åãîðîâ Â.È., Ëóêüÿíåíêî À.Â.– Îáùèå ïðèíöèïû ëå÷åíèÿ ìèííî-âçðûâíûõ ðàíåíèé ËÎÐ-îðãàíîâ

Ïëåõàíîâ Â.Í. – Î äèàãíîñòè÷åñêîìçíà÷åíèè áåññèìïòîìíîé áàêòåðèóðèèó âîåííîñëóæàùèõ ïî ïðèçûâó

Õóáóëàâà Ã.Ã., Èâ÷åíêî Å.Â., Ïàéâèí À.À.,Êðàâ÷óê Â.Í., Þð÷åíêî Ä.Ë., Èâàùåíêî À.È.,Äèäåíêî Ì.Â., Ëóêüÿíîâ Í.Ã., Ïåëåøîê À.Ñ.,Öûãàí Í.Â., Ëþáèìîâ À.È., Íàóìîâ À.Á.,Øîðîõîâ Ê.Í., Ñóõàðåâ À.Å., Êíÿçåâ Å.À.,Ïîðåìáñêàÿ È.À. – Îïûò ïðèìåíåíèÿ ñè-ñòåìû ìåõàíè÷åñêîé ïîääåðæêè êðîâî-îáðàùåíèÿ «Incor» â êà÷åñòâå «ìîñòàê âîññòàíîâëåíèþ» ó áîëüíûõ ñ òåðìè-íàëüíîé ñåðäå÷íîé íåäîñòàòî÷íîñòüþ

Øèëîâ Â.Â., Áàòîöûðåíîâ Á.Â., Âàñèëüåâ Ñ.À.,Øèêàëîâà È.À., Ëîëàäçå À.Ò. – Êîððåê-öèÿ íåñïåöèôè÷åñêèõ ïîðàæåíèé ïðèîñòðûõ îòðàâëåíèÿõ íàðêîòè÷åñêèìè âå-ùåñòâàìè èç ãðóïïû îïèàòíûõ íàðêîòè-êîâ ó áîëüíûõ â êðèòè÷åñêîì ñîñòîÿíèè

ßðîñëàâöåâ Â.Â., Ñàáàíèí Þ.Â., Êàñüêîâ Î.Â.,Ðûáèí Â.Â., Ðèõòåð Â.Â., Çàâîëîæèí Â.À. –Âíåáîëüíè÷íàÿ ïíåâìîíèÿ ó âîåííî-ñëóæàùèõ âíóòðåííèõ âîéñê ÌÂÄÐîññèè: îñîáåííîñòè ýïèäåìè÷åñêîãîïðîöåññà

Ãèãèåíà è ôèçèîëîãèÿâîåííîãî òðóäà

Military physiologyand hygiene

44

Akhmetzyanov I.M., Zinkin V.N., Petreyev I.V.,Dragan S.P. – Hygienic estimation of com-bined influence of noise and infrasoundon the organism of military men

Àõìåòçÿíîâ È.Ì., Çèíêèí Â.Í., Ïåòðååâ È.Â.,Äðàãàí Ñ.Ï. – Ãèãèåíè÷åñêàÿ îöåíêà ñî-÷åòàííîãî âîçäåéñòâèÿ øóìà è èíôðà-çâóêà íà îðãàíèçì âîåííîñëóæàùèõ

3«Âîåííî-ìåäèöèíñêèé æóðíàë», 11’2011

ÑONTENTS

Êðàòêèå ñîîáùåíèÿ Brief reports

Àâèàöèîííàÿè âîåííî-ìîðñêàÿ ìåäèöèíà

Air and navy medicine

Îôèöèàëüíûé îòäåë Official communications93

55

75

Âîåííàÿ ôàðìàöèÿè ìåäèöèíñêàÿ òåõíèêà

Military pharmacyand medical technique

89

51

Êðèòèêà è áèáëèîãðàôèÿ Criticism and bibliography

Blaginin A.A., Lizogub I.N. – The profileof aviation training doctors

Yakovlev S.V., Sidorov V.A., Kornyushko I.G.,Medvedev V.R., Matveyev A.G. – Applica-tion of new technologies in the design,manufacture and use of technology de-ployment of field medical units and estab-lishments

63

Chizh I.M., Putilo V.M., Tregubov V.N., Ti-makov V.V. – The history of military trai-ning at the First Moscow State MedicalUniversity n. a. I.M.Sechenov

79

84

Áëàãèíèí À.À., Ëèçîãóá È.Í. – Ïðîôèëü-íàÿ ïîäãîòîâêà àâèàöèîííûõ âðà÷åé

ßêîâëåâ Ñ.Â., Ñèäîðîâ Â.À., Êîðíþøêî È.Ã.,Ìåäâåäåâ Â.Ð., Ìàòâååâ À.Ã. – Ïðèìåíå-íèå íîâûõ òåõíîëîãèé â ðàçðàáîòêå,ïðîèçâîäñòâå è èñïîëüçîâàíèè òåõíè-÷åñêèõ ñðåäñòâ ðàçâåðòûâàíèÿ ïîëåâûõìåäèöèíñêèõ ÷àñòåé è ó÷ðåæäåíèé

×èæ È.Ì., Ïóòèëî Â.Ì., Òðåãóáîâ Â.Í.,Òèìàêîâ Â.Â. – Ê èñòîðèè âîåííîãîîáó÷åíèÿ â Ïåðâîì Ìîñêîâñêîì ãîñó-äàðñòâåííîì ìåäèöèíñêîì óíèâåðñèòåòåèìåíè È.Ì.Ñå÷åíîâà

Kornyushko I.G., Yakovlev S.V., Medvedev V.R.,Sidorov V.A. – Experience in developmentof deployment tools of medical evacuationstages.

Kostyuk A.V. – Establishment of nationalnaval hospitals in the XVIII century

Domogarova S.V. – Syzran Military Hos-pital

Êîðíþøêî È.Ã., ßêîâëåâ Ñ.Â., Ìåäâåäåâ Â.Ð.,Ñèäîðîâ Â.À. – Îïûò ðàçâèòèÿ òåõíè-÷åñêèõ ñðåäñòâ ðàçâåðòûâàíèÿ ýòàïîâìåäèöèíñêîé ýâàêóàöèè

Êîñòþê À.Â. – Ó÷ðåæäåíèå îòå÷åñòâåí-íûõ âîåííî-ìîðñêèõ ãîñïèòàëåé â XVIIIñòîëåòèè

Äîìîãàðîâà Ñ.Â. – Ñûçðàíñêèé âîåííûéãîñïèòàëü

95

Èç èñòîðèèâîåííîé ìåäèöèíû

From the historyof military medicine

Ïî ñòðàíèöàì çàðóáåæíîéìåäèöèíñêîé ïå÷àòè

From the foreignmedical publications

19,4350,5462

Myznikov I.L. – New book about thescreening diagnostic of health level

Ìûçíèêîâ È.Ë. – Íîâàÿ êíèãà î ñêðè-íèíãîâîé äèàãíîñòèêå óðîâíÿ çäîðîâüÿ

«Âîåííî-ìåäèöèíñêèé æóðíàë», 11’20114

ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎ

ÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË

© Ì.È.ÃÎÂÎÐÓÍ, Î.Â.ÊÎÊÎÐÈÍÀ, 2011ÓÄÊ 616.21:355

Êîíöåïöèÿ ðàçâèòèÿ ñèñòåìû îêàçàíèÿîòîðèíîëàðèíãîëîãè÷åñêîé ïîìîùèâ Âîîðóæåííûõ Ñèëàõ ÐÔ

ÃÎÂÎÐÓÍ Ì.È., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÊÎÊÎÐÈÍÀ Î.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû

Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã

Govorun M.I., Kokorina O.V. – Concept of development of the provision of otorhinolaryngologicalcare in the Armed Forces of the Russian Federation. Discussed the necessity of development of theConcept of otorhinolaryngology in the Armed Forces in 2020, aims and objectives of the concept,the proposed solutions for implementation of the proposed concepts: standardization and differentiationof specialized otorhinolaryngological care; development of hospital-replace technologies, the introductionof innovative methods, development of monitoring and evaluation of care quality; staffing; optimization ofmedical supplies; improving of material and technical base; reform of medical records; creation of unifiedinformation and communication infrastructure; conduction of preventative works for healthy lifestyles.

K e y w o r d s: Russian Armed Forces, otorhinolaryngological support the concept of ENT care.

I. Íåîáõîäèìîñòü ðàçðàáîòêè êîí-öåïöèè

Íàñòîÿùàÿ Êîíöåïöèÿ ðàçâèòèÿ îòî-ðèíîëàðèíãîëîãèè â Âîîðóæåííûõ Ñè-ëàõ Ðîññèéñêîé Ôåäåðàöèè íà ïåðèîä äî2020 ã. (äàëåå – Êîíöåïöèÿ) ðàçðàáîòà-íà â ñîîòâåòñòâèè ñ îñíîâíûìè çàäà÷à-ìè, ñòîÿùèìè ïåðåä ìåäèöèíñêîé ñëóæ-áîé ÂÑ ÐÔ, Ñòðàòåãèåé ñîöèàëüíîãî ðàç-âèòèÿ Âîîðóæåííûõ Ñèë Ðîññèéñêîé Ôå-äåðàöèè íà ïåðèîä äî 2020 ã., ïîëîæåíè-ÿìè Âîåííîé äîêòðèíû Ðîññèéñêîé Ôå-äåðàöèè 2010 ã., ñ Êîíöåïöèåé ðàçâèòèÿçäðàâîîõðàíåíèÿ Ðîññèéñêîé Ôåäåðàöèèäî 2020 ã., ñ Ïîñëàíèåì Ïðåçèäåíòà Ðîñ-ñèéñêîé Ôåäåðàöèè Ôåäåðàëüíîìó Ñî-áðàíèþ Ðîññèéñêîé Ôåäåðàöèè 2010 ã.,Êîíöåïöèåé äîëãîñðî÷íîãî ñîöèàëüíî-ýêîíîìè÷åñêîãî ðàçâèòèÿ ÐîññèéñêîéÔåäåðàöèè íà ïåðèîä äî 2020 ã., Ñòðà-òåãèåé íàöèîíàëüíîé áåçîïàñíîñòèÐîññèéñêîé Ôåäåðàöèè äî 2020 ã.

Ïðèîðèòåòíûìè çàäà÷àìè ïðîâîäè-ìûõ âîåííûõ ðåôîðì ÿâëÿþòñÿ ïîâûøå-íèå áîåãîòîâíîñòè âîéñê, îïòèìèçàöèÿ èõîðãàíèçàöèîííî-øòàòíîé ñòðóêòóðû è÷èñëåííîñòè, ðåøåíèå ñîöèàëüíûõ ïðî-

áëåì âîåííîñëóæàùèõ. Îíè çàòðàãèâàþòèçìåíåíèå êîëè÷åñòâà è ñòðóêòóðû ñåòèâîåííûõ ëå÷åáíî-ïðîôèëàêòè÷åñêèõ ó÷-ðåæäåíèé (ËÏÓ); èçìåíåíèå ñîñòàâà è÷èñëåííîñòè ëè÷íîãî ñîñòàâà ìåäèöèí-ñêîé ñëóæáû. Ïðîâîäèòñÿ óòî÷íåíèå êî-ëè÷åñòâà è ñòðóêòóðû ïðèêðåïëåííûõêîíòèíãåíòîâ, èõ ïåðåðàñïðåäåëåíèå (ïå-ðåçàêðåïëåíèå) [1].

Âàæíûì óñëîâèåì ïðîèçâîäèìûõ ïå-ðåìåí ÿâëÿþòñÿ ñîõðàíåíèå êà÷åñòâà èäîñòóïíîñòè ìåäèöèíñêîé ïîìîùè. Çà-êîííûì ïðàâîì íà ìåäèöèíñêîå îáåñ-ïå÷åíèå â âîåííî-ìåäèöèíñêèõ ó÷ðåæ-äåíèÿõ ÂÑ ÐÔ ïîëüçóþòñÿ îêîëî 7 ìëí÷åëîâåê: âîåííîñëóæàùèå, ïåíñèîíåðûÌÎ ÐÔ, ÷ëåíû èõ ñåìåé. Ïðè ýòîì áîëååïîëîâèíû âîåííîñëóæàùèõ íå óäîâëåò-âîðåíû äîñòóïíîñòüþ, îáúåìîì, êà÷å-ñòâîì îêàçûâàåìûõ ìåäèöèíñêèõ óñëóã èìåäèöèíñêîãî îáåñïå÷åíèÿ â öåëîì. Ñâû-øå ÷åòâåðòè âîåííîñëóæàùèõ îòìå÷àþòèçíîøåííîñòü ìàòåðèàëüíî-òåõíè÷åñêîéáàçû âîåííî-ìåäèöèíñêèõ ó÷ðåæäåíèé,íåõâàòêó ñîâðåìåííîãî ìåäèöèíñêîãîîáîðóäîâàíèÿ. Òðåòü âîåííîñëóæàùèõ èáîëåå 40% ëèö ãðàæäàíñêîãî ïåðñîíàëà


ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË

ïèòàíèÿ è îáó÷åíèÿ âîåííîñëóæàùèõ,ïðîïàãàíäû çäîðîâîãî îáðàçà æèçíè.

Íåîáõîäèìî îñóùåñòâëÿòü îáó÷åíèåãèãèåíè÷åñêèì íàâûêàì ïî ñîáëþäåíèþïðàâèë ãèãèåíû òðóäà, ðåæèìà òðóäà

(â ò. ÷. ó÷åáû) è îòäûõà, ðåæèìà è ñòðóê-òóðû ïèòàíèÿ, ñâîåâðåìåííîãî îáðàùå-íèÿ çà ìåäèöèíñêîé ïîìîùüþ è èíûõíîðì ïîâåäåíèÿ, ïîääåðæèâàþùèõ çäî-ðîâüå âîåííîñëóæàùèõ.

Ëèòåðàòóðà

1. Áåëåâèòèí À.Á. Âîåííàÿ ìåäèöèíà ïðè-îáðåòàåò äîïîëíèòåëüíûå ôóíêöèè // Ìåäè-öèíñêèé âåñòíèê. – 2010. – ¹ 6 (511) // [Ýëåê-òðîííûé ðåñóðñ]. URL: http://medvestnik.ru/archive/2010/6/2822.html (äàòà îáðàùåíèÿ07.02.2011).

2. Áåëåâèòèí À. Á., Ãîâîðóí Ì. È., Ñûðîåæ-êèí Ô.À. Äèñïàíñåðèçàöèÿ âîåííîñëóæàùèõñ çàáîëåâàíèÿìè ËÎÐ-îðãàíîâ // Âîåí.-ìåä.æóðí. – 2010. – Ò. 331, ¹ 11. – Ñ. 4–7.

3. Áåëåâèòèí À.Á., Øåëåïîâ À.Ì., Ñàâ÷åíêî È.Ô.,Íèêèòèí À.Ý. Îñíîâíûå íàïðàâëåíèÿ â ðàç-âèòèè ñïåöèàëèçèðîâàííîé ìåäèöèíñêîéïîìîùè â Âîîðóæåííûõ Ñèëàõ ÐîññèéñêîéÔåäåðàöèè // Âîåí.-ìåä. æóðí. – 2009. – Ò. 330,¹ 12. – Ñ. 15–23.

4. Ãîâîðóí Ì.È., Ãîôìàí Â.Ð., Êîêîðèíà Î.Â.Ñòàíäàðòû îðãàíèçàöèè îòîðèíîëàðèíãîëîãè-÷åñêîé ïîìîùè â Âîîðóæåííûõ Ñèëàõ ÐÔ:Ó÷åá.-ìåòîä. ïîñîáèå / Ïîä ðåä. À.Á.Áåëåâè-òèíà. – ÑÏá: ÂÌåäÀ, 2010. – 225 ñ.

5. Î ñîâåðøåíñòâîâàíèè ñèñòåìû óïðàâ-ëåíèÿ êà÷åñòâîì ìåäèöèíñêîé ïîìîùè â Âî-îðóæåííûõ Ñèëàõ Ðîññèéñêîé Ôåäåðàöèè:

Äèðåêòèâà íà÷àëüíèêà ÃÂÌÓ ÌÎ ÐÔ îò16.05.2003 ã. ¹ 161/2/2379. – Ì., 2003. – 22 ñ.

6. Îá óòâåðæäåíèè Êîíöåïöèè ðàçâèòèÿòåëåìåäèöèíñêèõ òåõíîëîãèé â ÐîññèéñêîéÔåäåðàöèè è ïëàíà åå ðåàëèçàöèè: Ïðè-êàç Ìèíçäðàâà ÐÔ, ÐÀÌÍ îò 27.08.2001 ã.¹ 344/76 // [Ýëåêòðîííûé ðåñóðñ]. URL: http://www. voennoepravo.ru/node/3023 (äàòà îáðàùå-íèÿ 08.02.2011).

7. Ñòðàòåãèÿ ñîöèàëüíîãî ðàçâèòèÿ Âî-îðóæåííûõ Ñèë Ðîññèéñêîé Ôåäåðàöèèíà ïåðèîä äî 2020 ã. / Óòâ. ðåøåíèåì Êîëëå-ãèè Ìèíèñòåðñòâà îáîðîíû ÐÔ 28.03.2008// [Ýëåêòðîííûé ðåñóðñ]. URL: http://www.zdrav.ru/library/regulations/detail.php?ID=26161(äàòà îáðàùåíèÿ 08.02.2011)

8. Øàïïî Â.Â. Ïåðñïåêòèâû ñîâåðøåí-ñòâîâàíèÿ ìåäèöèíñêîé ñëóæáû ÂîîðóæåííûõÑèë Ðîññèéñêîé Ôåäåðàöèè // Âîåí.-ìåä.æóðí. – 2008. – Ò. 329, ¹ 8. – Ñ. 4–11.

9. Øàïïî Â.Â., Ñòîëÿð Â.Ï., Çóáêîâ À.Ä.Î ðàçðàáîòêå åäèíîãî èíôîðìàöèîííîãî ïðî-ñòðàíñòâà ìåäèöèíñêîé ñëóæáû ÂîîðóæåííûõÑèë è ñîâåðøåíñòâîâàíèè èíôîðìàöèîííîãîîáåñïå÷åíèÿ ñèñòåìû åå óïðàâëåíèÿ // Âîåí.-ìåä. æóðí. – 2007. – Ò. 328, ¹ 12. – Ñ. 4–11.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 614.2:355

Íåêîòîðûå àñïåêòû àìáóëàòîðíî-ïîëèêëèíè÷åñêîéðàáîòû â ñîâðåìåííûõ óñëîâèÿõ

ÏÎÏÎÂ À.Ï., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàËÀÍÎÂÅÍÊÎ Þ.Ï., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêåÏÀÂËÎÂÀ È.Â.

3-é Öåíòðàëüíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. À.À.Âèøíåâñêîãî, ã. Êðàñíîãîðñê,Ìîñêîâñêàÿ îáëàñòü

Popov A.P., Lanovenko Yu.P., Pavlova I.V. – Some aspects of outpatient care in the modern world.The problems of improvement of outpatient care are considered, methodology of more active implementationof hospitalization technologies, the use of day care, hospital at home is proposed. It is emphasized thatthe introduction of hospitalization technology makes it less than treatment in hospital costs to improvequality of life for huge numbers of patients.

K e y w o r d s: outpatient care, day care, hospitalization technology.

Îäíèì èç ãëàâíûõ íàïðàâëåíèé ðå- ôîðìèðîâàíèÿ çäðàâîîõðàíåíèÿ

â Ðîññèè ÿâëÿåòñÿ ïåðåîðèåíòàöèÿ ñ äî-ðîãîñòîÿùåé ñòàöèîíàðíîé ìåäèöèíñêîéïîìîùè íà àìáóëàòîðíûé ýòàï ïðè ïî-

âûøåíèè êà÷åñòâà ìåäèöèíñêîé ïîìî-ùè â öåëîì (1, 5–8, 12). Àìáóëàòîðíî-ïîëèêëèíè÷åñêîå îáñëóæèâàíèå – ýòîâåäóùèé è ñàìûé ìàññîâûé âèä ìåäè-öèíñêîé ïîìîùè, çäåñü íà÷èíàþò è çà-


ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË

êàí÷èâàþò ëå÷åíèå ñâûøå 80% áîëüíûõ,à âûäåëÿëîñü äëÿ ýòîãî âñåãî 1/

5 ÷àñòü âñåõ

ìàòåðèàëüíî-òåõíè÷åñêèõ ðåñóðñîâ çäðà-âîîõðàíåíèÿ.

Íàèáîëåå ðàöèîíàëüíûì ïåðåðàñïðå-äåëåíèåì ýòèõ ñðåäñòâ ÿâëÿåòñÿ âíåäðå-íèå íà áàçå ïîëèêëèíè÷åñêîãî çâåíà ñòà-öèîíàðîçàìåùàþùèõ òåõíîëîãèé [7, 8].Ðåñòðóêòóðèçàöèÿ ñòàöèîíàðíîãî øòàò-íîãî è êîå÷íîãî ôîíäà, ïåðåðàñïðåäåëå-íèå íåêîòîðîãî îáúåìà ìåäèöèíñêîé ïî-ìîùè èç ñòàöèîíàðà â ïîëèêëèíèêó äèê-òóåòñÿ è ýêîíîìè÷åñêîé, è ìåäèêî-ñîöè-àëüíîé öåëåñîîáðàçíîñòüþ.

Ìåòîäîëîãèÿ ïåðåâîäà ÷àñòè îáñëó-æèâàåìîãî êîíòèíãåíòà ïàöèåíòîâ ñáîëüíè÷íîãî çâåíà íà ïîëèêëèíè÷åñêèéïðåäóñìàòðèâàåò äâà ìîìåíòà:

– óâåëè÷èòü âîçìîæíîñòè ïîëèêëèíè-êè ïî îêàçàíèþ ìåäèöèíñêîé ïîìîùè;

– ïåðåíàïðàâèòü èç áîëüíè÷íîãî çâå-íà ïàöèåíòîâ, ïîìîùü êîòîðûì ìîæåòáûòü îêàçàíà â ïîëèêëèíèêå. Òàêèõ áîëü-íûõ â ñòàöèîíàðàõ 20–50%, à ïðè÷èíàìèñëîæèâøåãîñÿ ïîëîæåíèÿ ÿâëÿþòñÿ óñ-òîÿâøèåñÿ ïîíÿòèÿ, ÷òî «â áîëüíèöå(ãîñïèòàëå) ëó÷øå», æåëàíèå ïîëèêëèíè-÷åñêîãî âðà÷à ñíÿòü ñ ñåáÿ îòâåòñòâåí-íîñòü è äð.

Ñëîìàòü òàêîé ñòåðåîòèï ïóòåì ïðè-äàíèÿ ïîëèêëèíèêå ðîëè ðàâíîãî â çâå-íå «ïîëèêëèíèêà – áîëüíèöà», ïåðåîñ-ìûñëèòü çíà÷åíèå âòîðè÷íîé ïðîôèëàê-òèêè, âíåäðèòü ýêîíîìè÷åñêè öåëåñîîá-ðàçíûå ñòàöèîíàðîçàìåùàþùèå òåõíîëî-ãèè ìîæíî, ðåøèâ ñëåäóþùèå çàäà÷è:

– ðàñøèðèòü ïåðå÷åíü íîçîëîãè÷å-ñêèõ ôîðì, ïîäëåæàùèõ âåäåíèþ â àìáó-ëàòîðíûõ óñëîâèÿõ;

– óâåëè÷èòü è îïòèìèçèðîâàòü îáúåìñïåöèàëèçèðîâàííîé ìåäèöèíñêîé ïî-ìîùè â ïîëèêëèíè÷åñêîì çâåíå;

– çàêîíîäàòåëüíî âíåäðèòü ñòàöèî-íàðîçàìåùàþùèå ôîðìû îðãàíèçàöèè èîêàçàíèÿ ìåäèöèíñêîé ïîìîùè;

– áîëåå øèðîêî ïðèìåíÿòü ìåæ-ïîëèêëèíè÷åñêóþ èíòåãðàöèþ ïî ïîä-ãîòîâêå áîëüíûõ ê ïëàíîâîìó ñòàöèîíàð-íîìó ëå÷åíèþ;

– êîðåííûì îáðàçîì óëó÷øèòü ìå-äèöèíñêîå ñíàáæåíèå ïîëèêëèíèê.

Êàòåãîðèÿ áîëüíûõ, ïîìîùü êîòîðûììîæåò áûòü îêàçàíà â àìáóëàòîðíûõ óñ-ëîâèÿõ, óòâåðæäàåòñÿ ñîîòâåòñòâóþùèì

«Ïîëîæåíèåì…» êîíêðåòíîãî ó÷ðåæäåíèÿ.Íîçîëîãè÷åñêèå ôîðìû, «ñíèìàåìûå ñãîñïèòàëèçàöèè», îáåñïå÷èâàþòñÿ â ïîëè-êëèíèêå äèàãíîñòè÷åñêèìè, ëå÷åáíûìè,ìàòåðèàëüíûìè, ïðàâîâûìè óñëîâèÿìè.

Îáúåì è óðîâåíü ñïåöèàëèçèðîâàí-íîé ìåäèöèíñêîé ïîìîùè äëÿ êàæäîéïîëèêëèíèêè ðàçëè÷íû è îïðåäåëÿþòñÿêîëè÷åñòâîì âðà÷åé, ìàòåðèàëüíî-òåõíè-÷åñêèì îñíàùåíèåì, ïðîôåññèîíàëüíîéïîäãîòîâêîé ìåäèöèíñêîãî ïåðñîíàëà.

Äëÿ ïîâûøåíèÿ êà÷åñòâà ëå÷åáíî-äèàãíîñòè÷åñêîé ðàáîòû â óñëîâèÿõ ñî-âðåìåííîãî ôèíàíñèðîâàíèÿ àêòóàëüíîâçàèìíîå èñïîëüçîâàíèå èìåþùèõñÿ ìå-äèöèíñêèõ òåõíîëîãèé â îäíîé òåððèòî-ðèàëüíîé ñèñòåìå

Êàê ïðàâèëî, ëå÷åáíî-ïðîôèëàêòè-÷åñêèå ó÷ðåæäåíèÿ îäíîãî ðåãèîíà èìå-þò ðàçíûå äèàãíîñòè÷åñêèå áàçû è ïà-öèåíòû íàïðàâëÿþòñÿ â ñòàöèîíàð, ãäåèìååòñÿ òîò èëè èíîé âèä èññëåäîâàíèé(êîìïüþòåðíàÿ òîìîãðàôèÿ, ìàãíèòíî-ðåçîíàíñíàÿ òîìîãðàôèÿ, êîðîíàðîãðà-ôèÿ, âåíîãðàôèÿ è ò. ï.). Ïðè íàëè÷èèñèñòåìû âçàèìíîãî èñïîëüçîâàíèÿ äèàã-íîñòè÷åñêîé áàçû áîëüøèíñòâî ýòèõ èñ-ñëåäîâàíèé ìîæíî ïðîâîäèòü àìáóëàòîð-íî. Äëÿ òàêèõ èññëåäîâàíèé, êàê êîðîíà-ðîãðàôèÿ, íåîáõîäèìî ïðåäóñìîòðåòüíîâóþ ôîðìó – êðàòêîñðî÷íîå ïðåáûâà-íèå áîëüíîãî â ñòàöèîíàðå.

Íàïðèìåð, òîëüêî àìáóëàòîðíàÿ ïîä-ãîòîâêà áîëüíîãî õèðóðãè÷åñêîãî ïðîôè-ëÿ ê ïëàíîâîé ãîñïèòàëèçàöèè íåñåòîùóòèìûé ýêîíîìè÷åñêèé ýôôåêò çàñ÷åò ñîêðàùåíèÿ ïðåäîïåðàöèîííîãîïåðèîäà, à ó áîëüíûõ òåðàïåâòè÷åñêîãîïðîôèëÿ çà ñ÷åò óñòàíîâëåíèÿ äîñòîâåð-íîãî äèàãíîçà [7, 9].

Ïàöèåíò, íóæäàþùèéñÿ â ïëàíîâîéîïåðàöèè, ïîëó÷àåò êàðòó ïðåäîïåðàöè-îííîãî îáñëåäîâàíèÿ (âêëàäûø â áóäó-ùóþ èñòîðèþ áîëåçíè) è â óñòàíîâëåí-íûå ñðîêè àìáóëàòîðíî îáñëåäóåòñÿ. Ïðèîòñóòñòâèè ìåäèöèíñêèõ ïðîòèâîïîêàçà-íèé ê õèðóðãè÷åñêîìó âìåøàòåëüñòâóáîëüíîãî ñ çàïîëíåííîé êàðòîé íàïðàâ-ëÿþò íà ñòàöèîíàðíîå ëå÷åíèå.

Îäíèì èç ãëàâíûõ íàïðàâëåíèé ðà-áîòû, ñïîñîáñòâóþùèõ óìåíüøåíèþ âõî-äÿùåãî ïîòîêà ïàöèåíòîâ íà ñòàöèîíàð-íîå ëå÷åíèå, ÿâëÿåòñÿ ðàñøèðåíèå êðóãàïàòîëîãèè, ïîäëåæàùåé îïåðàòèâíîìó


ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅ

ÂÎÏÐÎÑÛ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 616.21-001.4-08

Îáùèå ïðèíöèïû ëå÷åíèÿ ìèííî-âçðûâíûõðàíåíèé ËÎÐ-îðãàíîâ

ÁÅËßÊÈÍ Ñ.À., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû çàïàñàÅÃÎÐÎÂ Â.È., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûËÓÊÜßÍÅÍÊÎ À.Â., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû

3-é Öåíòðàëüíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. À.À.Âèøíåâñêîãî, ã. Êðàñíîãîðñê,Ìîñêîâñêàÿ îáëàñòü

Belyakin S.A., Egorov V.I., Lukyanenko A.V. – General principles of treatment of mine-explosivewounds of ENT-organs. The relevance of diagnosis and treatment of mine-explosive wounds ENT high.Treatment of explosives, Russian Academy of Sciences-the challenge and consists of a series of sequentialsteps that need to be applied, taking into account all the particularities of each injury. Concepts of specializedsurgical care of the wounded are formulated. The main are: 1) one-stage surgical treatment of comprehensiveprimary wounds with detent of bone fragments, reconstruction of defects of soft tissue with positive woundand related fascial spatium drainage; 2) general intensive care during the postoperative period, includingwater-electrolytic balance correction, sympathetic block, controlled hemodilution and adequate analgesia;3) intensive therapy of postoperative wounds, aimed at creating favorable conditions for its healing andincludes targeted selective influence on hemophoresis in the wound and the local proteoclastic processes.

K e y w o r d s: mine explosion wounds, surgical treatment of wounds, fixation of bone fragments, draining,suturing, intensive care.

Ñîâðåìåííàÿ ýïîõà, ê ñîæàëåíèþ, îòëè÷àåòñÿ óâåëè÷åíèåì êîëè÷åñòâà

òåððîðèñòè÷åñêèõ àêòîâ è âîåííûõ äåé-ñòâèé ëîêàëüíîãî õàðàêòåðà. Ýòèì îá-óñëîâëåíà àêòóàëüíîñòü äèàãíîñòèêèè ëå÷åíèÿ ìèííî-âçðûâíûõ ðàíåíèéËÎÐ-îðãàíîâ íå òîëüêî äëÿ âîåííûõ îòî-ðèíîëàðèíãîëîãîâ, íî è äëÿ ãðàæäàíñêèõâðà÷åé, êîòîðûå íåðåäêî ïåðâûìè íà-÷èíàþò îêàçûâàòü ïîìîùü.

Ðàíåíèÿ ïîäðàçäåëÿþòñÿ íà èçîëè-ðîâàííûå, ìíîæåñòâåííûå è ñî÷åòàííûå.Ïðè ìèííî-âçðûâíûõ ïîðàæåíèÿõ, êàêïðàâèëî, íàáëþäàþòñÿ ïîñëåäíèå äâåãðóïïû. Ïîä èçîëèðîâàííûìè ïîíèìàþò-ñÿ ðàíåíèÿ îäíîãî àíàòîìè÷åñêîãî îðãà-íà (â ËÎÐ-ñïåöèàëüíîñòè ðåäêè). Ê ìíî-æåñòâåííûì îòíîñÿòñÿ ðàíåíèÿ äâóõ è áî-ëåå ËÎÐ-îðãàíîâ. Â ñî÷åòàííûõ âûäåëÿþò-ñÿ äâå ãðóïïû. Ê ïåðâîé ãðóïïå îòíîñÿòñÿðàíåíèÿ ËÎÐ-îðãàíîâ, ñîïðîâîæäàþùè-åñÿ ðàíåíèÿìè ñìåæíûõ îáëàñòåé (÷åëþ-ñòíî-ëèöåâîé îáëàñòè, îðáèòû, ÷åðåïà).Ïî äàííûì Â.Ð.Ãîðìàê è ñîàâò. (1994), ïî-âðåæäåíèÿ ËÎÐ-îðãàíîâ â 33,6% ñî÷åòà-

ëèñü ñ òðàâìîé ãëàç, â 21,8% – ñ òðàâìîé÷åëþñòåé. Âî âòîðîé ãðóïïå ðàññìàòðèâà-þòñÿ ðàíåíèÿ ËÎÐ-îðãàíîâ, ñîïðîâîæäàþ-ùèåñÿ ðàíåíèÿìè äðóãèõ îáëàñòåé òåëà(òóëîâèùà, êîíå÷íîñòåé, ãðóäíîé è áðþø-íîé ïîëîñòè, ïîëîñòè ÷åðåïà).

Ëå÷åíèå ìèííî-âçðûâíûõ ðàí ïðåä-ñòàâëÿåò ñîáîé ñëîæíóþ çàäà÷ó è ñëàãà-åòñÿ èç ðÿäà ïîñëåäîâàòåëüíûõ ïðèåìîâ,êîòîðûå íóæíî ïðèìåíÿòü ñ ó÷åòîì âñåõîñîáåííîñòåé êàæäîãî ðàíåíèÿ. Ïîä÷åðê-íåì, ÷òî î÷åíü æåëàòåëåí õèðóðãè÷åñêèéêîíñåíñóñ èç îòîðèíîëàðèíãîëîãà, ÷åëþ-ñòíî-ëèöåâîãî õèðóðãà è, ÷àñòî, îôòàëü-ìîëîãà, íåðåäêî – íåéðîõèðóðãà.

Èñõîäÿ èç ñêàçàííîãî, íàìè ñôîðìó-ëèðîâàíû ñëåäóþùèå ïðèíöèïû ñïåöè-àëèçèðîâàííîé õèðóðãè÷åñêîé ïîìîùèäàííîé êàòåãîðèè ðàíåíûõ.

1. Îäíîìîìåíòíàÿ èñ÷åðïûâàþùàÿïåðâè÷íàÿ õèðóðãè÷åñêàÿ îáðàáîòêà ðàíûñ ôèêñàöèåé îòëîìêîâ êîñòåé, âîññòà-íîâëåíèåì äåôåêòîâ ìÿãêèõ òêàíåé, ïðè-òî÷íî-îòòî÷íûì äðåíèðîâàíèåì ðàíûè ñìåæíûõ êëåò÷àòî÷íûõ ïðîñòðàíñòâ.


ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅÂÎÏÐÎÑÛ

Â íàøåì ñîîáùåíèè ìû íà îñíîâà-íèè ñîáñòâåííîãî îïûòà ëå÷åíèÿ ëèöñ îãíåñòðåëüíûìè ðàíåíèÿìè ËÎÐ-îð-ãàíîâ (ìèííî-âçðûâíûå ïîðàæåíèÿÿâëÿþòñÿ íàèáîëåå ÷àñòûìè è òÿæåëû-

ìè) õîòåëè íàïîìíèòü óçëîâûå ìîìåí-òû îêàçàíèÿ õèðóðãè÷åñêîé ïîìîùèïðè ýòîé ïàòîëîãèè è ïîä÷åðêíóòü îáÿ-çàòåëüíóþ íåîáõîäèìîñòü èõ âûïîë-íåíèÿ.


1. Áåéêåð Ó., Êîêñ Ï., Óýñòàéí Ï. Âçðûâ-íûå ÿâëåíèÿ. Îöåíêà è ïîñëåäñòâèÿ: Ïåð.ñ àíãë. – Ì.: Ìèð, 1986. – Êí. 2. – 382 ñ.

2. Áèñåíêîâ Ë.Í., Ãóìàíåíêî Å.Ê. Õèðóðãè-÷åñêàÿ òàêòèêà ïðè ìèííî-âçðûâíûõ ðàíåíèÿõ// Âåñòí. õèð. – 1990. – Ò. 145, ¹ 10. – Ñ. 51–55.

3. Áóçèíîâñêèé È.Ï. Êëèíè÷åñêèå è ñòðóê-òóðíûå îñîáåííîñòè ñèñòåìû ñïåöèàëèçèðî-âàííîé îòîðèíîëàðèíãè÷åñêîé ïîìîùè â âî-îðóæåííîì êîíôëèêòå: Àâòîðåô. äèñ. …... êàíä.ìåä. íàóê. – ÑÏá: ÂÌåäÀ, 2004. – 16 ñ.

4. Ãîôìàí Â.Ð., ßíîâ Þ.Ê., Äèñêàëåíêî Â.Â.Ñòðóêòóðà ñëóõîâûõ íàðóøåíèé è îáúåì ñïå-öèàëèçèðîâàííîé ìåäèöèíñêîé ïîìîùè ïðèìèííî-âçðûâíîé òðàâìå // Ñïåöèàëèçèðîâàí-íàÿ ìåäèöèíñêàÿ ïîìîùü ïðè áîåâîé ïàòî-ëîãèè. – Ì., 1991. – Ñ. 84–85.

5. Äåäóøêèí Â.Ñ., Êîñà÷åâ È.Ä., Òêà÷åíêî Ñ.Ñ.Îêàçàíèå ìåäèöèíñêîé ïîìîùè è îáúåì ëå-÷åíèÿ ïîñòðàäàâøèõ ñ âçðûâíûìè ïîâðåæ-äåíèÿìè // Âîåí.-ìåä. æóðí. – 1992. – ¹ 1. –Ñ. 11–14.

6. Íå÷àåâ Ý.À., Ãðèöàíîâ À.È., Ôîìèí Í.Ô.,Ìèííóëëèí È.Ï. Ìèííî-âçðûâíàÿ òðàâìà. –ÑÏá: Àëüä, 1994. – 487 ñ.

7. Ôîêèí Þ.Í. Îñíîâíûå íàïðàâëåíèÿñîâåðøåíñòâîâàíèÿ êâàëèôèöèðîâàííîéè íåîòëîæíîé ñïåöèàëèçèðîâàííîé õèðóðãè-÷åñêîé ïîìîùè â âîîðóæåííîì êîíôëèêòå:Àâòîðåô. äèñ. ... ä-ðà ìåä. íàóê.

8. ßíîâ Þ.Ê., Ãðå÷êî À.Ò. Áîåâûå ïî-âðåæäåíèÿ â ëîêàëüíûõ âîéíàõ. Òðàâìà ãîëîâ-íîãî ìîçãà, ñëóõîâîé è âåñòèáóëÿðíîéñèñòåìû ïðè âçðûâàõ (ýòèîëîãèÿ, ïàòîãåíåç,êëèíèêà, äèàãíîñòèêà, ëå÷åíèå). – ÑÏá:ÝËÁÈ-ÑÏá, 2001.

© Â.Í.ÏËÅÕÀÍÎÂ, 2011ÓÄÊ 616.637-057.36

Î äèàãíîñòè÷åñêîì çíà÷åíèè áåññèìïòîìíîéáàêòåðèóðèè ó âîåííîñëóæàùèõ ïî ïðèçûâó

ÏËÅÕÀÍÎÂ Â.Í., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû

Âîåííûé ãîñïèòàëü êîñìîäðîìà «Ïëåñåöê», ã. Ìèðíûé, Àðõàíãåëüñêàÿ îáëàñòü

Plekhanov V.N. – About the diagnostic significance of asymptomatic bacteriuria among the conscripts.For determinination of the significance of asymptomatic bacteriuria (AB) among the conscripts in the Northwas performed a comparative study of 101 volunteers who had no complaints and urinary tract infection(UTI) and a history of 206 patients treated at the stationary UTI. Diagnostically important AB in soldierswas 3% and corresponded to inflammation of the urethra and prostate. Negative impact of subextremeconditions of service in the development of AB from the soldiers in the 12 months has not been established.AB in young men in 27% of such cases was accompanied by leukocyturia, in 36% with bacteriuria, determinedby the overall analysis of urine, which is a comprehensive method of identifying the primary UTI.

K e y w o r d s: asymptomatic bacteriuria, conscripts, North.

Äî íàñòîÿùåãî âðåìåíè åäèíñòâåííûì ïîâñåìåñòíî ïðèìåíÿåìûì è îáÿ-

çàòåëüíûì äëÿ âñåõ, ïîçâîëÿþùèì ñîñòà-âèòü êîñâåííîå ïðåäñòàâëåíèå î íàëè÷èèèíôåêöèé ìî÷åâûâîäÿùèõ ïóòåé (ÈÌÏ)ó ìóæ÷èí ìîëîäîãî âîçðàñòà êàê ïðè ïðè-çûâå íà âîåííóþ ñëóæáó, òàê è âî âðåìÿíåå, ìåòîäîì äèàãíîñòèêè ÿâëÿåòñÿ îá-ùèé àíàëèç ìî÷è. Â 1960 ã. Å.Í.Kass ïðåä-

ëîæèë êîíöåïöèþ «êëèíè÷åñêè çíà÷è-ìîé» áàêòåðèóðèè, êîòîðàÿ ïðèâåëà ê èñ-ïîëüçîâàíèþ êîëè÷åñòâåííûõ ìèêðîáè-îëîãè÷åñêèõ ìåòîäîâ â äèàãíîñòèêå ÈÌÏ[3]. Ïîíÿòèå ÈÌÏ ïðåäïîëàãàåò íàëè÷èåëþáûõ ìèêðîîðãàíèçìîâ â ìî÷åâûõ ïó-òÿõ, â íîðìå ÿâëÿþùèõñÿ ñòåðèëüíûìè[6, 8]. Èç ÈÌÏ âûäåëÿþò áåññèìïòîìíóþáàêòåðèóðèþ (ÁÁ) – îáíàðóæåíèå îïðå-



äåëåííîãî êîëè÷åñòâà áàêòåðèé èç ïðà-âèëüíî ñîáðàííîãî àíàëèçà ìî÷è, ïîëó-÷åííîãî îò ëèö, íå èìåþùèõ ñèìïòîìîâÈÌÏ [1, 7].

ÁÁ ÷àñòî âûÿâëÿþò ó ëþäåé ïîæè-ëîãî âîçðàñòà, áåðåìåííûõ æåíùèí, ïà-öèåíòîâ ñ ïîñòîÿííûì ìî÷åâûì êàòåòå-ðîì, áîëüíûõ ñàõàðíûì äèàáåòîì. Ðàñïðî-ñòðàíåííîñòü ÁÁ ó çäîðîâûõ æåíùèí óâå-ëè÷èâàåòñÿ ñ âîçðàñòîì (îò 1% ñðåäèøêîëüíèö äî 20% è áîëåå ó æåíùèí 80ëåò è ñòàðøå), ó ìóæ÷èí ñòàðøå 60 ëåòîíà ñîñòàâëÿåò 6–15%, ñâåäåíèé î ðàñ-ïðîñòðàíåííîñòè ÁÁ ó çäîðîâûõ ìóæ÷èíìîëîäîãî âîçðàñòà íå èìååòñÿ [7].

Äî íàñòîÿùåãî âðåìåíè íåò îäíî-çíà÷íîãî ìíåíèÿ î âëèÿíèè ÁÁ íà ðàç-âèòèå äðóãèõ ÈÌÏ è öåëåñîîáðàçíîñòèàíòèáèîòèêîòåðàïèè ÁÁ. Îäíè àâòîðûñ÷èòàþò, ÷òî ÁÁ çíà÷èòåëüíî óñóãóáëÿåòðèñê ðàçâèòèå ÈÌÏ, îñîáåííî ïðè ñî-ñòîÿíèÿõ, ñîïðîâîæäàþùèõñÿ ñíèæåíè-åì èììóíîðåçèñòåíòíîñòè îðãàíèçìà,äðóãèå ïîëàãàþò, ÷òî ÁÁ ðåäêî àññîöèè-ðóåòñÿ ñ íåáëàãîïðèÿòíûìè ïîñëåäñòâè-ÿìè è íåíàçíà÷åíèå àíòèáèîòèêîâ íåñîïðîâîæäàåòñÿ ïîâûøåííûì ðèñêîìðàçâèòèÿ èíôåêöèé ó áîëüøèíñòâà ïà-öèåíòîâ. Àíòèáàêòåðèàëüíàÿ òåðàïèÿ ðå-êîìåíäóþòñÿ òîëüêî â îòíîøåíèè áåðå-ìåííûõ æåíùèí, ìóæ÷èí ïåðåä òðàíñ-óðåòðàëüíîé ðåçåêöèåé ïðîñòàòû, à òàêæåáîëüíûõ ïåðåä äðóãèìè òðàâìàòè÷åñêèìèóðîëîãè÷åñêèìè âìåøàòåëüñòâàìè [6].

Ó ïàöèåíòîâ ïîæèëîãî âîçðàñòà ñ ÁÁàíòèìèêðîáíàÿ òåðàïèÿ íå ïðåäîòâðàùà-åò ðàçâèòèå ñèìïòîìîâ ÈÌÏ è íå óâå-ëè÷èâàåò âûæèâàåìîñòü, íî àññîöèèðó-åòñÿ ñ âûñîêîé ÷àñòîòîé ïîáî÷íûõ ðå-àêöèé è ïîâûøåííûì ðèñêîì ðàçâèòèÿóñòîé÷èâûõ ìèêðîîðãàíèçìîâ. Êðîìå òîãî,îíà ñîïðÿæåíà ñ íåîáîñíîâàííûìè ôè-íàíñîâûìè ðàñõîäàìè [2, 4].

Äèàãíîñòè÷åñêè çíà÷èìûì óðîâíåìÁÁ ñ÷èòàþò âûäåëåíèå îäíîãî øòàììàóðîïàòîãåíà (â áîëüøèíñòâå ñëó÷àåâ îä-íîãî ðîäà áàêòåðèé) â êîëè÷åñòâå ≥105

ÊÎÅ/ìë â äâóõ îáðàçöàõ ìî÷è, ñîáðàí-íûõ ñ èíòåðâàëîì ≥24 ÷ [5]. Ñîãëàñíîïðàêòè÷åñêèì ðåêîìåíäàöèÿì Àìåðè-êàíñêîãî îáùåñòâà èíôåêöèîííûõ áîëåç-íåé ïî äèàãíîñòèêå è ëå÷åíèþ ÁÁó âçðîñëûõ, äèàãíîç ÁÁ ó ìóæ÷èí áåç ñèì-ïòîìîâ ÈÌÏ ìîæåò áûòü óñòàíîâëåí ïðè

îäíîêðàòíîì âûäåëåíèè â àíàëèçå ìî÷èóðîïàòîãåíà â êîëè÷åñòâå ≥105 ÊÎÅ/ìë(êàòåãîðèÿ äîêàçàòåëüíîñòè – B-III).Áåññèìïòîìíàÿ áàêòåðèóðèÿ ñîïðîâîæ-äàåòñÿ ëåéêîöèòóðèåé ó ≈32% ìîëîäûõæåíùèí, â îòíîøåíèè ìóæ÷èí ìîëîäîãîâîçðàñòà äàííûõ íåò [7].

Ðàññìàòðèâàÿ ïàòîãåíåç ÈÌÏ â êîí-òåêñòå âçàèìîäåéñòâèÿ ìèêðî- è ìàêðî-îðãàíèçìà, íåëüçÿ íå ó÷èòûâàòü ñîñòîÿ-íèå åñòåñòâåííîãî èììóíèòåòà îðãàíèç-ìà áîëüíîãî, îñîáåííî êîãäà ðå÷ü èäåò îìóæ÷èíàõ ìîëîäîãî âîçðàñòà, ïðîõîäÿùèõâîåííóþ ñëóæáó â ìåñòíîñòè, ïðèðàâíåí-íîé ê ðàéîíàì Êðàéíåãî Ñåâåðà. Íàëè-÷èå ÁÁ â óêàçàííûõ óñëîâèÿõ ìîæåò ñòàòüïðè÷èíîé ðàçâèòèÿ áîëåå òÿæåëûõ ÈÌÏ,â ñâÿçè ñ ÷åì åå èçó÷åíèå ó âîåííîñëó-æàùèõ, ïðîõîäÿùèõ âîåííóþ ñëóæáó ïîïðèçûâó, ïðåäñòàâëÿåòñÿ àêòóàëüíûì.

Öåëüþ èññëåäîâàíèÿ ñòàëî îïðåäåëå-íèå çíà÷èìîñòè ÁÁ ó âîåííîñëóæàùèõ,ïðîõîäÿùèõ âîåííóþ ñëóæáó ïî ïðèçû-âó â óñëîâèÿõ Ñåâåðà. Äëÿ äîñòèæåíèÿïîñòàâëåííîé öåëè íåîáõîäèìî ðåøèòüñëåäóþùèå çàäà÷è.

1. Óñòàíîâèòü ÷àñòîòó âñòðå÷àåìîñòèÁÁ ó óêàçàííîãî êîíòèíãåíòà â óñëîâèÿõÑåâåðà.

2. Îöåíèòü âëèÿíèå ñóáýêñòðåìàëüíûõóñëîâèé âîåííîé ñëóæáû íà ðàçâèòèå ÁÁó âîåííîñëóæàùèõ ïî ïðèçûâó.

3. Èçó÷èòü ñâÿçü ÁÁ è ëåéêîöèòóðèè,èõ èíôîðìàòèâíîñòü â äèàãíîñòèêå ÈÌÏó ìóæ÷èí ìîëîäîãî âîçðàñòà.

Ìàòåðèàë è ìåòîäûÑðåäè âîåííîñëóæàùèõ ïî ïðèçûâó,

âîçðàñò êîòîðûõ ñîñòàâèë 20,3±0,5 ãîäà,ïðîâåäåíî ñðàâíèòåëüíîå èññëåäîâàíèå101 äîáðîâîëüöà, íå èìåþùåãî æàëîáè ÈÌÏ â àíàìíåçå è 206 ïàöèåíòîâ,ïðîõîäèâøèõ ïî ïîâîäó ÈÌÏ ëå÷åíèå âóðîëîãè÷åñêîì îòäåëåíèè âîåííîãî ãîñ-ïèòàëÿ êîñìîäðîìà «Ïëåñåöê» â 1998–2009 ãã.

Âñåì èññëåäóåìûì-äîáðîâîëüöàì1-é ãðóïïû â àìáóëàòîðíûõ óñëîâèÿõ ñÿíâàðÿ 2010 ã. ïî ìàé 2011 ã. òðåõêðàòíîñ èíòåðâàëîì 24–72 ÷ âûïîëíÿëè îáùèåàíàëèçû è áàêòåðèîëîãè÷åñêîå èññëåäî-âàíèå ìî÷è. Èäåíòèôèêàöèþ âîçáóäèòå-ëåé ÈÌÏ ïðîâîäèëè ïóòåì ïîñåâà ìî÷èíà 5% êðîâÿíîé àãàð ñ îïðåäåëåíèåì




1. Èðåìàøâèëè Â.Â. Èíôåêöèè ìî÷å-âûâîäÿùèõ ïóòåé: ñîâðåìåííûé âçãëÿä íàïðîáëåìó // Ðóñ. ìåä. æóðí. – 2007. – Ò. 15,¹ 29. – Ñ. 2231–2237.

2. Óøêàëîâà Å.À. Ôòîðõèíîëîíû â ëå÷å-íèè èíôåêöèé ìî÷åâûâîäÿùèõ ïóòåé: ñîâðå-ìåííîå ñîñòîÿíèå âîïðîñà // Ôàðìàòåêà. –2005. – ¹ 16 (111). – Ñ. 15–21.

3. Kass E.H. Bacteriuria and pyelonephritisof pregnancy // Arch. Intern. Med. – 1960. –N 105. – Ð. 194–198.

4. McMurdo Met. Urinary tract infection in oldage // Age Ageing. – 2000. – N 29. – Ð. 297–298.

5. Naber K.G., Bishop M.C., Bjerklund-

Johansen Ò.Å. et al. Guidelines on the managementof urinary and male genital tract infections// European Association of Urology (update 2006).– 2006. – Ð. 12.

6. Nicolle L.E. A practical guide toantimicrobial management of complicated urinarytract infections // Eur. Urol. – 2001. – N 40. –Ð. 576–588.

7. Nicolle L.E., Bradley S., Colgan R. et al.Infectious diseases society of America guidelinesfor the diagnosis and treatment of asymptomaticbacteriuria in adults // Clin. Infect. Dis. – 2005. –N 40. – Ð. 643–654.

8. Stamm W.E. Scientific and clinical chal-lenges in the management of urinary tract infec-tions // Am. J. Med. – Vol. 113 (1A). – P. 1–4.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 616.12-008.46-08

Îïûò ïðèìåíåíèÿ ñèñòåìû ìåõàíè÷åñêîéïîääåðæêè êðîâîîáðàùåíèÿ «Incor» â êà÷åñòâå«ìîñòà ê âîññòàíîâëåíèþ» ó áîëüíûõñ òåðìèíàëüíîé ñåðäå÷íîé íåäîñòàòî÷íîñòüþ

ÕÓÁÓËÀÂÀ Ã.Ã., ëàóðåàò Ãîñóäàðñòâåííîé ïðåìèè ÐÔ, ïðîôåññîð,ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàÈÂ×ÅÍÊÎ Å.Â., äîöåíò, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáûÏÀÉÂÈÍ À.À., ïðîôåññîðÊÐÀÂ×ÓÊ Â.Í., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáûÞÐ×ÅÍÊÎ Ä.Ë., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàÈÂÀÙÅÍÊÎ À.È., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàÄÈÄÅÍÊÎ Ì.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàËÓÊÜßÍÎÂ Í.Ã., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÏÅËÅØÎÊ À.Ñ., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáûÖÛÃÀÍ Í.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ìàéîð ìåäèöèíñêîé ñëóæáûËÞÁÈÌÎÂ À.È., êàíäèäàò ìåäèöèíñêèõ íàóê, ìàéîð ìåäèöèíñêîé ñëóæáûÍÀÓÌÎÂ À.Á., êàíäèäàò ìåäèöèíñêèõ íàóêØÎÐÎÕÎÂ Ê.Í., êàíäèäàò ìåäèöèíñêèõ íàóêÑÓÕÀÐÅÂ À.Å., ìàéîð ìåäèöèíñêîé ñëóæáûÊÍßÇÅÂ Å.À., êàïèòàí ìåäèöèíñêîé ñëóæáûÏÎÐÅÌÁÑÊÀß È.À.


Khubulava G.G., Ivchenko E.V., Payvin A.A., Kravchuk V.N., Yurchenko D.L., Ivaschenko A.I., Didenko M.V.,Lukyanov N.G., Peleshok A.S. , Tsygan N.V., Lubimov A.I., Naumov A.B., Shorokhov K.N., Sukharev A.E.,Knyazev E.A., Porembskaya I.A. – Experience of left ventricular assist device «Incor» as «bridge torecovery» implantation in patients with end stage congestive heart failure. – Left ventricular assistdevice «Incor» («Berlinhear», Germany) implantation experience in patient with ischemic cardiomiopathyand severe congestive heart failure is presented. Left ventricular assist device implantation was followed bycoronary artery bypass grafting simultaneously. Total assist time was 211 days. Complications developedduring assisting time are shown. After Left ventricular assist device explantation three chamber pacemakerwas implanted as cardiac resynchronization therapy. Left ventricular end diastolic size decreased (from 78to 70 mm), ejection fraction increased (from 19 to 35%) during assist time.

K e y w o r d s: congestive heart failure, left ventricle assist device, «Incor», surgical treatment of congestiveheart failure.

Ââåäåíèå. Õðîíè÷åñêàÿ ñåðäå÷íàÿ íåäî-

ñòàòî÷íîñòü (ÕÑÍ), ïî îïðåäåëåíèþÅâðîïåéñêîãî îáùåñòâà êàðäèîëîãîâ, –

ýòî ïàòîôèçèîëîãè÷åñêèé ñèíäðîì, ïðèêîòîðîì â ðåçóëüòàòå òîãî èëè èíîãî çà-áîëåâàíèÿ ñåðäå÷íî-ñîñóäèñòîé ñèñòåìû



ïðîèñõîäèò ñíèæåíèå íàñîñíîé ôóíêöèè,÷òî ïðèâîäèò ê íåñîîòâåòñòâèþ ìåæäó ãå-ìîäèíàìè÷åñêîé ïîòðåáíîñòüþ îðãàíèç-ìà è âîçìîæíîñòÿìè ñåðäöà [1].

Îñíîâíûìè ïðè÷èíàìè, ïðèâîäÿùè-ìè ê ðàçâèòèþ ýòîãî ñîñòîÿíèÿ, ñëóæàòèøåìè÷åñêàÿ áîëåçíü ñåðäöà è èíôàðêòìèîêàðäà êàê åå îñëîæíåíèå. Äî 70% ïà-öèåíòîâ ñ ÕÑÍ ñòðàäàþò èìåííî ýòèìèíîçîëîãè÷åñêèìè ôîðìàìè. Äðóãèìèïðè÷èíàìè, ïðèâîäÿùèìè ê ðàçâèòèþÕÑÍ, ÿâëÿþòñÿ äèëàòàöèîííàÿ êàðäèî-ìèîïàòèÿ, ðåâìàòè÷åñêèå ïîðîêè ñåðäöà,àðòåðèàëüíàÿ ãèïåðòåíçèÿ (ÀÃ), ñàõàðíûéäèàáåò [1]. Â íàñòîÿùåå âðåìÿ â Ðîññèèîêîëî 8 ìëí ÷åëîâåê èìåþò ÷åòêèå ïðè-çíàêè ÕÑÍ, èç êîòîðûõ îêîëî 3,4 ìëí –â åå òåðìèíàëüíîé ñòàäèè. Ñìåðòíîñòüáîëüíûõ ñ íàëè÷èåì êëèíè÷åñêè âûðà-æåííîé ÕÑÍ â òå÷åíèå 1 ãîäà ñîñòàâëÿ-åò ïðèìåðíî 26–29%, ò. å. çà 1 ãîä â Ðîñ-ñèè âñëåäñòâèå ïðîãðåññèðîâàíèÿ ÕÑÍóìèðàþò îêîëî 1 ìëí ÷åëîâåê [2].

Ñòðàòåãèÿ ëå÷åíèÿ ÕÑÍ çàêëþ÷àåò-ñÿ â óìåíüøåíèè åå âûðàæåííîñòè, çà-ìåäëåíèè ïðîãðåññèðîâàíèÿ è óëó÷øå-íèè ïðîãíîçà äëÿ æèçíè áîëüíîãî. Ïðèýòîì ïðèìåíÿþò ðàçëè÷íûå âèäû ëå÷å-íèÿ â çàâèñèìîñòè îò òÿæåñòè ñåðäå÷íîéíåäîñòàòî÷íîñòè (ÑÍ). Ñîãëàñíî ðåêî-ìåíäàöèÿì Âñåðîññèéñêîãî íàó÷íîãîîáùåñòâà êàðäèîëîãîâ è îáùåñòâà ñïå-öèàëèñòîâ ïî ñåðäå÷íîé íåäîñòàòî÷íî-ñòè, ìåäèêàìåíòîçíîå ëå÷åíèå ÕÑÍíà÷èíàþò ñ èíãèáèòîðîâ àíãèîòåíçèí-ïðåâðàùàþùåãî ôåðìåíòà (è-ÀÏÔ). Ïðå-ïàðàòû ýòîãî êëàññà íàçíà÷àþò âñåì ïà-öèåíòàì ñ ÕÑÍ íåçàâèñèìî îò ôóíêöè-îíàëüíîãî êëàññà ïðè îòñóòñòâèè ïðîòè-âîïîêàçàíèé. Äàííûå ëåêàðñòâåííûåñðåäñòâà ñíèæàþò âûðàæåííîñòü ñèìï-òîìîâ ÕÑÍ, óëó÷øàþò êà÷åñòâî æèçíè,çàìåäëÿþò ïðîãðåññèðîâàíèå çàáîëåâà-íèÿ è óëó÷øàþò ïðîãíîç [3].

Ïðè äàëüíåéøåì ðàçâèòèè ÕÑÍ, íà-÷èíàÿ ñî II ôóíêöèîíàëüíîãî êëàññà (ÔÊ),ê ïðîâîäèìîé òåðàïèè öåëåñîîáðàçíî äî-áàâèòü β-àäðåíîáëîêàòîðû (β-ÀÁ). Îíèáëîêèðóþò âëèÿíèå êàòåõîëàìèíîâ íàβ-àäðåíåðãè÷åñêèå ðåöåïòîðû, óìåíüøàÿãèïåðàêòèâàöèþ ðåíèíàíãèîòåíçèíàëüäî-

ñòåðîíîâîé ñèñòåìû (ÐÀÀÑ), óìåíüøàþòîáúåì ãèáåðíèðîâàííîãî ìèîêàðäà, ñòå-ïåíü èøåìèè ìèîêàðäà â ïîêîå è ïðè

ôèçè÷åñêîé íàãðóçêå. Â öåëîì áûëî ïî-êàçàíî, ÷òî íàçíà÷åíèå β-ÀÁ ñíèæàåòñìåðòíîñòü áîëüíûõ ñ äåêîìïåíñàöèåéíà 29%.

Òðåòüÿ ãðóïïà ïðåïàðàòîâ, ïðèìåíÿ-åìûõ äëÿ êîððåêöèè ÕÑÍ, – ýòî àíòàãî-íèñòû àëüäîñòåðîíà. Èõ öåëåñîîáðàçíîíàçíà÷àòü ê è-ÀÏÔ è β-ÀÁ ïðè III–IV ÔÊ ÕÑÍ â êà÷åñòâå íåéðîãóìîðàëü-íîãî ðåãóëÿòîðà, áîëåå ïîëíî áëîêèðóþ-ùåãî ÐÀÀÑ, óëó÷øàþùåãî ïðîãíîç ïàöè-åíòîâ ñ ÕÑÍ. Â èññëåäîâàíèè RandomizedAldactone Evaluation Study (RALES)ïîêàçàíî, ÷òî íàçíà÷åíèå âåðîøïèðîíàê è-ÀÏÔ è β-ÀÁ ñíèæàëî ðèñê êàêâíåçàïíîé ñìåðòè, òàê è ñâÿçàííîé ñ ðàç-âèòèåì äåêîìïåíñàöèè ÕÑÍ íà 27%.Â íàñòîÿùåå âðåìÿ ñî÷åòàíèå è-ÀÏÔ,β-ÀÁ è àíòàãîíèñòîâ àëüäîñòåðîíà ñëó-æèò íàèáîëåå ðàöèîíàëüíîé ñõåìîéëå÷åíèÿ ïàöèåíòîâ ñ òÿæåëîé ÕÑÍ.

Ñëåäóþùåé ëèíèåé â ëå÷åíèè òÿæå-ëîé ÕÑÍ ÿâëÿþòñÿ äèóðåòèêè. Îíè ïðè-ìåíÿþòñÿ â êîìïëåêñíîé òåðàïèè ÕÑÍñîâìåñòíî ñ è-ÀÏÔ, β-ÀÁ è àíòàãîíè-ñòàìè àëüäîñòåðîíà ïðè íåäîñòàòî÷íîéèõ ýôôåêòèâíîñòè è ðàçâèòèè îòå÷íîãîñèíäðîìà.

Ñåðäå÷íûå ãëèêîçèäû íàçíà÷àþò ïðèíàëè÷èè ìåðöàòåëüíîé àðèòìèè (ÌÀ)èëè ñíèæåíèè ñîêðàòèòåëüíîé ñïîñîá-íîñòè ìèîêàðäà – ôðàêöèÿ âûáðîñà (ÔÂ)<30%.

Â ñëó÷àå íåäîñòàòî÷íîé ýôôåêòèâ-íîñòè ìàêñèìàëüíîé ìåäèêàìåíòîçíîéòåðàïèè âûïîëíÿþò õèðóðãè÷åñêèå ìå-òîäû êîððåêöèè ÕÑÍ (ñì. òàáëèöó). Îíèâêëþ÷àþò â ñåáÿ îïåðàöèè ïî ðåâàñêó-ëÿðèçàöèè ìèîêàðäà, ïðèìåíåíèå óñò-ðîéñòâ äëÿ ñåðäå÷íîé ðåñèíõðîíèçè-ðóþùåé òåðàïèè, èìïëàíòàöèþ ñèñòåììåõàíè÷åñêîé ïîääåðæêè êðîâîîáðàùåíèÿ(ÌÏÊ), òðàíñïëàíòàöèþ ñåðäöà [4, 5].

Öåëü èññëåäîâàíèÿÏðîäåìîíñòðèðîâàòü âûøåóêàçàííóþ

ëå÷åáíóþ ñòðàòåãèþ íà ïðèìåðå êëèíè-÷åñêîãî ñëó÷àÿ êîððåêöèè òåðìèíàëüíîéÕÑÍ èøåìè÷åñêîãî ãåíåçà.

Ìàòåðèàë è ìåòîäûÏàöèåíò Ê., 50 ëåò, ïîñòóïèë â 1-þ

êëèíèêó õèðóðãèè (ÕÓÂ-1) Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà



© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 615.211.7.099

Êîððåêöèÿ íåñïåöèôè÷åñêèõ ïîðàæåíèéïðè îñòðûõ îòðàâëåíèÿõ íàðêîòè÷åñêèìèâåùåñòâàìè èç ãðóïïû îïèàòíûõ íàðêîòèêîâó áîëüíûõ â êðèòè÷åñêîì ñîñòîÿíèè

ØÈËÎÂ Â.Â., ïðîôåññîðÁÀÒÎÖÛÐÅÍÎÂ Á.Â., äîêòîð ìåäèöèíñêèõ íàóêÂÀÑÈËÜÅÂ Ñ.À., äîêòîð ìåäèöèíñêèõ íàóêØÈÊÀËÎÂÀ È.À.ËÎËÀÄÇÅ À.Ò.

Íàó÷íî-èññëåäîâàòåëüñêèé èíñòèòóò ñêîðîé ïîìîùè èì. È.È.Äæàíåëèäçå, Ñàíêò-Ïåòåðáóðã

Shilov V.V., Batotsyrenov B.V., Vasilyev S.A., Shikalova I.A., Loladze A.T. – Correction of nonspecificdamages in acute poisoning of substance from the group of opiate drug in patients in critical condition.The obtained materials were received in the process of examination and treatment of 134 patients in theearly phase of severe acute poisoning with the development of opiate toxicohypoxic encephalopathy using acorrector of tissue metabolism Cytoflavinum. Positive clinical results were achieved: reduction of length ofstay of patients in a comatose state, reduction of incidence of pulmonary complications and mortality. Theresults of immunological studies have established immunomodulatory effects of cytoflavinum in patientswith severe acute poisoning opiates. These biochemical studies have shown that the effects cytoflavinumrealized largely due to its ability correct the effects of tissue hypoxia.

K e y w o r d s: acute poisoning opiates, toxicohypoxic encephalopathy, cytoflavinum.

Òÿæåñòü ñîñòîÿíèÿ áîëüíûõ, íàõîäÿ-ùèõñÿ â êðèòè÷åñêîì ñîñòîÿíèè,

îáóñëîâëåíà ãèïîêñèåé, ýíäîòîêñèêîçîìè èììóíîñóïðåññèåé [5]. Ýòî ïîëîæåíèåñïðàâåäëèâî è äëÿ áîëüíûõ ðåàíèìàöè-îííîãî ïðîôèëÿ ñ îñòðûìè òÿæåëûìè îò-ðàâëåíèÿìè. Ñëåäóåò äîáàâèòü, ÷òî âûøå-ïåðå÷èñëåííûå íàðóøåíèÿ ðàçâèâàþòñÿíà ôîíå ñïåöèôè÷åñêèõ ìåõàíèçìîâ äåé-ñòâèÿ ÿäîâ [4]. Êîððåêöèÿ íåñïåöèôè-÷åñêèõ ïîðàæåíèé â ðàííåé ôàçå îñòðûõîòðàâëåíèé íàðêîòè÷åñêèìè âåùåñòâàìèèç ãðóïïû îïèàòíûõ íàðêîòèêîâ ïðåäñòàâ-ëÿåò àêòóàëüíóþ çàäà÷ó êëèíè÷åñêîé òîê-ñèêîëîãèè.

Îäíèì èç ïåðñïåêòèâíûõ íàïðàâëåíèéâ ýòîé îáëàñòè ÿâëÿåòñÿ èñïîëüçîâàíèåêîððåêòîðîâ òêàíåâîãî ìåòàáîëèçìà èçãðóïïû ñóêöèíàòîâ, íàïðèìåð öèòîôëàâèíà[2, 3, 6]. Êîìïëåêñíûé ìåòàáîëè÷åñêèéàíòèãèïîêñàíò öèòîôëàâèí ïðåäñòàâëÿåòñîáîé ñáàëàíñèðîâàííûé êîìïëåêñ èç äâóõìåòàáîëèòîâ (ÿíòàðíàÿ êèñëîòà, ðèáîêñèí)è äâóõ êîôåðìåíòîâ-âèòàìèíîâ – ðèáî-ôëàâèíà-ìîíîíóêëåîòèäà (âèòàìèí Â

2) è

íèêîòèíàìèäà (âèòàìèí ÐÐ). Ïîêàçàíèåìê íàçíà÷åíèþ öèòîôëàâèíà ÿâëÿåòñÿ òÿ-æåëîå ñîñòîÿíèå áîëüíûõ, îáóñëîâëåííîå

îñòðûì îòðàâëåíèåì íàðêîòè÷åñêèì âåùå-ñòâîì ñ ÿâëåíèÿìè îñòðîé äûõàòåëüíîé íå-äîñòàòî÷íîñòè, âñëåäñòâèå ÷åãî âñåì áîëü-íûì ïðîâîäèòñÿ èñêóññòâåííàÿ âåíòèëÿ-öèÿ ëåãêèõ.

Öåëü èññëåäîâàíèÿÎöåíèòü ðåçóëüòàòû èñïîëüçîâàíèÿ

öèòîôëàâèíà â èíòåíñèâíîé òåðàïèè âðàííåé ôàçå îñòðûõ îòðàâëåíèé íàðêî-òè÷åñêèìè âåùåñòâàìè èç ãðóïïû îïè-àòíûõ íàðêîòèêîâ.

Ìàòåðèàë è ìåòîäûÈññëåäîâàíèå ïðîâåäåíî â îòäåëå-

íèè ðåàíèìàöèè Öåíòðà ëå÷åíèÿ îñò-ðûõ îòðàâëåíèé ÍÈÈ ñêîðîé ïîìîùèèì. È.È.Äæàíåëèäçå â ïðîöåññå ëå÷åíèÿ134 áîëüíûõ â òÿæåëîì è êðàéíå òÿæå-ëîì ñîñòîÿíèè. Ðàñïðåäåëåíèå áîëüíûõïî ãðóïïàì îñóùåñòâëÿëè ñëåäóþùèìîáðàçîì: 1-ÿ – áîëüíûå, â èíòåíñèâíóþ.òåðàïèþ êîòîðûõ áûë âêëþ÷åí öèòî-ôëàâèí (95 ÷åëîâåê); 2-ÿ – ïîëó÷àâøèåòðàäèöèîííóþ èíòåíñèâíóþ òåðàïèþ(39 ÷åëîâåê). Âîçðàñò ïàöèåíòîâ 1-éãðóïïû ñîñòàâèë 35,6±3,0 ãîäà, 2-é –36,3±3,3 ãîäà.


ÝÏÈÄÅÌÈÎËÎÃÈß

È ÈÍÔÅÊÖÈÎÍÍÛÅ ÁÎËÅÇÍÈ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 616.24-002-057.36-036.22

Âíåáîëüíè÷íàÿ ïíåâìîíèÿ ó âîåííîñëóæàùèõâíóòðåííèõ âîéñê ÌÂÄ Ðîññèè: îñîáåííîñòèýïèäåìè÷åñêîãî ïðîöåññà

ßÐÎÑËÀÂÖÅÂ Â.Â., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

ÑÀÁÀÍÈÍ Þ.Â., çàñëóæåííûé âðà÷ ÐÔ, äîêòîð ìåäèöèíñêèõ íàóê,ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû2

ÊÀÑÜÊÎÂ Î.Â., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

ÐÛÁÈÍ Â.Â., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

ÐÈÕÒÅÐ Â.Â., çàñëóæåííûé âðà÷ ÐÔ, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå1

ÇÀÂÎËÎÆÈÍ Â.À., êàíäèäàò ìåäèöèíñêèõ íàóê, êàïèòàí ìåäèöèíñêîé ñëóæáû1

1Ãëàâíûé öåíòð ãîñóäàðñòâåííîãî ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî íàäçîðà âíóòðåííèõ âîéñêÌÂÄ Ðîññèè, Ìîñêâà; 2Âîåííî-ìåäèöèíñêîå óïðàâëåíèå Ãëàâíîãî êîìàíäîâàíèÿ âíóòðåííèõâîéñê ÌÂÄ Ðîññèè, Ìîñêâà

Yaroslavtsev V.V., Sabanin Yu.V., Kaskov O.V., Rybin V.V., Rikhter V.V., Zavolozhin V.A. – Community-acquired pneumonia among the conscripts of Interior Forces in Russia: characteristics of the epidemicprocess. The dynamics of the incidence and characteristics of community-acquired pneumonia amongthe servicemen at the call of Interior Forces of Russia during the period 2000–2010 is analyzed.High frequency of pneumonia among the conscripts is provided by a number of factors: immunodepressionduring the period of adaptation to military service, the presence of a substantial portion of chronic respiratorydisease, chill, overcrowded accommodation in the barracks and the «mixing factor».In recent years the level of this disease has had a positive effect of specific prophylaxis of pneumococcalinfections and the transition period of one year of compulsory military service.

K e y w o r d s: community-acquired pneumonia, especially in the epidemiology of community-acquiredpneumonia troops, the incidence of community-acquired pneumonia conscripts.

Âíóòðåííèå âîéñêà ÌÂÄ Ðîññèè â ñî- ñòàâå 7 ðåãèîíàëüíûõ êîìàíäîâàíèé

(ÐÊ) äèñëîöèðîâàíû íà òåððèòîðèÿõÐîññèéñêîé Ôåäåðàöèè, ðàçëè÷àþùèõñÿïî óðîâíþ ñîöèàëüíî-ýêîíîìè÷åñêîãîðàçâèòèÿ è êëèìàòè÷åñêèì óñëîâèÿì, ÷òîâî ìíîãîì îïðåäåëÿåò èíòåíñèâíîñòüñëóæåáíî-áîåâîé äåÿòåëüíîñòè è óñëî-âèÿ ðàçìåùåíèÿ ëè÷íîãî ñîñòàâà. Ýòè îá-ñòîÿòåëüñòâà âëèÿþò íà çäîðîâüå âîåííî-ñëóæàùèõ, â ò. ÷. íà çàáîëåâàåìîñòü âíå-áîëüíè÷íîé ïíåâìîíèåé (ÂÏ), êîòîðàÿïðåäñòàâëÿåò îäíó èç àêòóàëüíûõ ïðîáëåìèç-çà çíà÷èòåëüíîãî óùåðáà çäîðîâüþ,äëèòåëüíîé ãîñïèòàëèçàöèè è âîçìîæíûõîñëîæíåíèé.

Çàáîëåâàåìîñòü ÂÏ âîåííîñëóæàùèõïî ïðèçûâó ñóùåñòâåííî âûøå, ÷åì âî-åííîñëóæàùèõ ïî êîíòðàêòó (ðèñ. 1).

Âûñîêîé ÷àñòîòå ÂÏ ó ëè÷íîãî ñî-ñòàâà ýòîé êàòåãîðèè ñïîñîáñòâóåò ðÿäôàêòîðîâ, â ò. ÷. èììóíîñóïðåññèÿ â ïå-ðèîä àäàïòàöèè ê âîåííîé ñëóæáå, íàëè-÷èå ó çíà÷èòåëüíîé ÷àñòè õðîíè÷åñêîéïàòîëîãèè îðãàíîâ äûõàíèÿ, ïåðåîõëà-æäåíèå îðãàíèçìà, ïåðåóïëîòíåííîåðàçìåùåíèå â êàçàðìàõ è «ôàêòîð ïåðå-ìåøèâàíèÿ».

Â ïîñëåäíèå ãîäû íà óðîâåíü çàáîëå-âàåìîñòè ÂÏ âîåííîñëóæàùèõ ïî ïðè-çûâó îêàçàëà âëèÿíèå ñïåöèôè÷åñêàÿïðîôèëàêòèêà ïíåâìîêîêêîâîé èíôåê-öèè è ïåðåõîä ýòîãî êîíòèíãåíòà íà îäèíãîä ñëóæáû.

Âûäåëåíû äâà ïåðèîäà ðàçâèòèÿýïèäåìè÷åñêîãî ïðîöåññà ÂÏ ó ýòîãîêîíòèíãåíòà. Ïåðâûé ïåðèîä – äîâàê-öèíàëüíûé (2000–2001 ãã.), âòîðîé – ïå-


ÃÈÃÈÅÍÀ È ÔÈÇÈÎËÎÃÈß

ÂÎÅÍÍÎÃÎ ÒÐÓÄÀ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 613.644.057.36

Ãèãèåíè÷åñêàÿ îöåíêà ñî÷åòàííîãî âîçäåéñòâèÿøóìà è èíôðàçâóêà íà îðãàíèçì âîåííîñëóæàùèõ

ÀÕÌÅÒÇßÍÎÂ È.Ì., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà1

ÇÈÍÊÈÍ Â.Í., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå1

ÏÅÒÐÅÅÂ È.Â., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà1

ÄÐÀÃÀÍ Ñ.Ï., êàíäèäàò òåõíè÷åñêèõ íàóê2

1Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã; 2Ôåäåðàëüíûé ìåäèöèí-ñêèé áèîôèçè÷åñêèé öåíòð èì. À.È.Áóðíàçÿíà, Ìîñêâà

Akhmetzyanov I.M., Zinkin V.N., Petreyev I.V., Dragan S.P. – Hygienic estimation of combined influenceof noise and infrasound on the organism of military men. Combined influence of noise and infrasound isaccompanied by essential increase of risk of development neurosensory deafness and hypertensive illness.At combined influence of noise and infrasound with a maximum of a spectrum in the field of a sound rangethe probability of development neurosensory deafness will prevail. Thus probability of developmentof pathology of ear above the values established ISO 1999:1990. In a case if the spectrum maximumis necessary on an infrasonic range the probability of development of a hypertensive illness.

K e y w o r d s: combined influence of noise and infrasound, risk of hearing loss, hypertensive illness.

Èíòåíñèâíûå àêóñòè÷åñêèå êîëåáà- íèÿ, âîçíèêàþùèå ïðè ýêñïëóàòà-

öèè áîëüøèíñòâà òåõíè÷åñêèõ ñðåäñòâ, –îäèí èç âåäóùèõ ôàêòîðîâ âîèíñêîãîòðóäà, êîòîðûé òðåáóåò åãî àäåêâàòíîéãèãèåíè÷åñêîé îöåíêè.

Äåéñòâèå íà îðãàíèçì àêóñòè÷åñêèõêîëåáàíèé, â ñïåêòðå êîòîðûõ ïðåîáëà-äàþò ÷àñòîòû çâóêîâîãî (ñëûøèìîãî)äèàïàçîíà, ò. å. øóìà, îáóñëîâëèâàåò ðàç-âèòèå ñïåöèôè÷åñêîé (ïðîôåññèîíàëü-íîé) ïàòîëîãèè ñëóõîâîãî àíàëèçàòîðà– íåéðîñåíñîðíîé òóãîóõîñòè (ÍÑÒ)è íåñïåöèôè÷åñêîé (ïðîèçâîäñòâåííîîáóñëîâëåííîé) ïàòîëîãèè â âèäå àðòå-ðèàëüíîé ãèïåðòåíçèè (ÀÃ) è âåãåòîñîñó-äèñòîé äèñòîíèè [1, 3, 6]. Èíôðàçâóê(àêóñòè÷åñêèå êîëåáàíèÿ ñ ÷àñòîòàìèíèæå ñëûøèìûõ ÷åëîâåêîì) ñïîñîáñò-âóåò ôîðìèðîâàíèþ ó ðàáîòíèêîâ çà-áîëåâàíèé îðãàíîâ äûõàíèÿ, ñåðäå÷íî-ñîñóäèñòîé è íåðâíîé ñèñòåì, à òàêæåîðãàíà ñëóõà [5]. Èçâåñòíî, ÷òî îäíîâðå-ìåííîå äåéñòâèå àêóñòè÷åñêèõ êîëåáàíèéðàçíûõ ÷àñòîòíûõ äèàïàçîíîâ ìîæåòïðèâîäèòü ê èçìåíåíèþ êëèíè÷åñêèõïðîÿâëåíèé øóìîâîé ïàòîëîãèè.

Öåëü ðàáîòûÈññëåäîâàòü óñëîâèÿ òðóäà âîåííî-

ñëóæàùèõ, ïîäâåðãàþùèõñÿ âîçäåéñòâèþàêóñòè÷åñêèõ êîëåáàíèé, è âûÿâèòü îñî-áåííîñòè ñî÷åòàííîãî äåéñòâèÿ øóìà èèíôðàçâóêà.

Ìàòåðèàë è ìåòîäûÈññëåäîâàíà àêóñòè÷åñêàÿ îáñòàíîâ-

êà è óñëîâèÿ òðóäà òðåõ ãðóïï âîåííûõñïåöèàëèñòîâ: 1-ÿ ãðóïïà – èíæåíåðíî-òåõíè÷åñêèé ñîñòàâ (ÈÒÑ) àâèàöèè,2-ÿ – âîäèòåëè òÿæåëûõ íàçåìíûõ òðàíñ-ïîðòíûõ ñðåäñòâ, 3-ÿ – ÷ëåíû ýêèïàæåéêîðàáëåé íà âîçäóøíîé ïîäóøêå (ÊÂÏ).

Èçìåðåíèÿ øóìà è èíôðàçâóêà âû-ïîëíåíû â ñîîòâåòñòâèè ñ äåéñòâóþùè-ìè íîðìàòèâíûìè äîêóìåíòàìè [2, 10, 11]íà ðàáî÷èõ ìåñòàõ ÈÒÑ ïðè ïîäãîòîâêåëåòàòåëüíûõ àïïàðàòîâ (ñàìîëåòîâ, âåð-òîëåòîâ) ê ïîëåòàì íà àýðîäðîìå, â êà-áèíàõ íàçåìíûõ òðàíñïîðòíûõ ñðåäñòâïðè ñòîÿíêå è äâèæåíèè òåõíèêè, íà áî-åâûõ ïîñòàõ è â îáèòàåìûõ ïîìåùåíèÿõÊÂÏ âî âðåìÿ âûõîäîâ â ìîðå. Ïðè îöåí-êå óñëîâèé òðóäà íà ðàáî÷èõ ìåñòàõ îñî-áîå âíèìàíèå óäåëÿëîñü ìàêñèìàëüíûì


ÀÂÈÀÖÈÎÍÍÀß

È ÂÎÅÍÍÎ-ÌÎÐÑÊÀß ÌÅÄÈÖÈÍÀ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 613.693:614.25

Ïðîôèëüíàÿ ïîäãîòîâêà àâèàöèîííûõ âðà÷åé

ÁËÀÃÈÍÈÍ À.À., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàËÈÇÎÃÓÁ È.Í., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå


Blaginin A.A., Lizogub I.N. – The profile training of aviation doctors. Authors consider the trendsof training doctors in the specialty «physician in aerospace medicine». First level is initial training forfaculty training of doctors. The higher level is vocational retraining and advanced training in thedepartments of postgraduate and further education. It solved the issues of preparation of specialists invarious areas of aviation medicine: medical-chairman of the Flight Commission, an expert medicaldoctor-flight expert committee, a specialist laboratory (Cabinet) of Aviation Medicine, the MedicalDirector of Aviation (enterprise, organization), etc. The highest level of training is residency. The necessityof legislative consolidation of an independent direction for the organization of training and medicalsupport of aviation operations is proved.

K e y w o r d s: aviation medicine, training of aviation doctors, the stages of preparation.

Ìàñøòàáíûå ïðåîáðàçîâàíèÿ â âîåí- íîé îðãàíèçàöèè ãîñóäàðñòâà, ñâÿ-

çàííûå ñ ôîðìèðîâàíèåì ïåðñïåêòèâíî-ãî îáëèêà Âîîðóæåííûõ Ñèë ÐîññèéñêîéÔåäåðàöèè (ÂÑ ÐÔ), âåäóò ê ïðèíöèïèàëü-íûì ïðåîáðàçîâàíèÿì â ïîäãîòîâêå âî-åííûõ êàäðîâ, â ò. ÷. è äëÿ Âîåííî-âîçäóø-íûõ ñèë (ÂÂÑ). Çà ïîñëåäíåå âðåìÿ ñóùå-ñòâåííîé êîððåêòèðîâêå ïîäâåðãëàñü èñèñòåìà ïîäãîòîâêè ìåäèöèíñêèõ ñïåöèà-ëèñòîâ äëÿ ãîñóäàðñòâåííîé àâèàöèè ÐÔ.

Îñíîâó ïðîôèëüíîé ïîäãîòîâêè âðà-÷åé-ñïåöèàëèñòîâ äëÿ ìåäèöèíñêîãîîáåñïå÷åíèÿ ïîëåòîâ àâèàöèè ñîñòàâëÿ-åò àâèàöèîííàÿ ìåäèöèíà – êîìïëåêñ-íàÿ íàóêà, âêëþ÷àþùàÿ êàê ïðîôèëàê-òè÷åñêèå, òàê è ëå÷åáíûå ó÷åáíûå äèñ-öèïëèíû. Âîçíèêíóâ áîëåå ñòà ëåò íàçàäèç íåîáõîäèìîñòè ìåäèöèíñêîãî îñâè-äåòåëüñòâîâàíèÿ âîçäóõîïëàâàòåëåéíà ïðåäìåò èõ ïðèãîäíîñòè ïî ñîñòîÿíèþçäîðîâüÿ ê ëåòíîé äåÿòåëüíîñòè, àâèà-öèîííàÿ ìåäèöèíà âêëþ÷àëà òàêèå êëè-íè÷åñêèå äèñöèïëèíû, êàê òåðàïèÿ,õèðóðãèÿ, íåâðîëîãèÿ, îòîðèíîëàðèíãî-ëîãèÿ, îôòàëüìîëîãèÿ.

Ðàçâèòèå àâèàöèîííîé òåõíèêè èïðàêòèêà ìåäèöèíñêîãî îáåñïå÷åíèÿïîëåòîâ ïîòðåáîâàëè ðàçâèòèÿ íå òîëü-

êî êëèíè÷åñêèõ íàïðàâëåíèé àâèàöèîí-íîé ìåäèöèíû, íî è ïðîôèëàêòè÷åñêèõ –àâèàöèîííîé ôèçèîëîãèè, ãèãèåíû, òîêñè-êîëîãèè, à òàêæå ñìåæíûõ äèñöèïëèí –àâèàöèîííîé ïñèõîëîãèè, ýðãîíîìèêè,àâàðèîëîãèè. Îáúåäèíÿåò âñå ýòè íàïðàâ-ëåíèÿ ðàçäåë àâèàöèîííîé ìåäèöèíû –ôèçèîëîãèÿ ëåòíîãî òðóäà.

Ôèçèîëîãèÿ ëåòíîãî òðóäà ÿâëÿåò-ñÿ ôóíäàìåíòàëüíûì çâåíîì àâèàöèîí-íîé ìåäèöèíû è êàñàåòñÿ, ïðåæäå âñåãî,ïîáóäèòåëüíûõ ìîòèâîâ åå ðàçâèòèÿ, ñïðèêëàäíîé îáëàñòüþ çíàíèé, ñâÿçàí-íîé ñ íàñòîÿòåëüíîé íåîáõîäèìîñòüþìåäèöèíñêîãî îáåñïå÷åíèÿ ïîëåòîâ.Ýòà íåîáõîäèìîñòü äèêòóåòñÿ ñëîæíî-ñòüþ è îïàñíîñòüþ ïðîôåññèîíàëüíîéäåÿòåëüíîñòè ëåòíîãî ñîñòàâà, óñïåø-íîñòü îñóùåñòâëåíèÿ êîòîðîé íàïðÿ-ìóþ ñâÿçàíà ñ ñîñòîÿíèåì çäîðîâüÿ.Èç-çà âîçäåéñòâèÿ ñîâîêóïíîñòè íå-áëàãîïðèÿòíûõ ôàêòîðîâ ïðîôåññèî-íàëüíîé äåÿòåëüíîñòè íà ÷ëåíîâ ýêè-ïàæåé âîçäóøíûõ ñóäîâ ëåòíûé òðóäîòíåñåí ê êàòåãîðèè îïàñíîãî, íàïðÿ-æåííîãî è òÿæåëîãî, èìåþùåãî îñîáûéõàðàêòåð, ÷òî òðåáóåò ñïåöèàëüíûõìåòîäîâ êîíòðîëÿ çà ñîñòîÿíèåì çäî-ðîâüÿ ëåòíîãî ñîñòàâà.


ÂÎÅÍÍÀß ÔÀÐÌÀÖÈß

È ÌÅÄÈÖÈÍÑÊÀß ÒÅÕÍÈÊÀ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 615.47:355

Ïðèìåíåíèå íîâûõ òåõíîëîãèé â ðàçðàáîòêå,ïðîèçâîäñòâå è èñïîëüçîâàíèè òåõíè÷åñêèõñðåäñòâ ðàçâåðòûâàíèÿ ïîëåâûõ ìåäèöèíñêèõ÷àñòåé è ó÷ðåæäåíèé

ßÊÎÂËÅÂ Ñ.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

ÑÈÄÎÐÎÂ Â.À., ïîëêîâíèê â îòñòàâêå2

ÊÎÐÍÞØÊÎ È.Ã., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê,ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû â îòñòàâêå3

ÌÅÄÂÅÄÅÂ Â.Ð., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê,ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà2

ÌÀÒÂÅÅÂ À.Ã., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå4

1Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëåíèå ÌÎ ÐÔ, Ñàíêò-Ïåòåðáóðã; 2Íàó÷íî-èññëåäîâàòåëüñêèéèñïûòàòåëüíûé èíñòèòóò (âîåííîé ìåäèöèíû) Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà,Ñàíêò-Ïåòåðáóðã; 3Ãîñóäàðñòâåííûé èíñòèòóò óñîâåðøåíñòâîâàíèÿ âðà÷åé ÌÎ ÐÔ, Ìîñêâà;4Ôèëèàë ¹ 3 Ãëàâíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. Í.Í.Áóðäåíêî, Ìîñêâà

Yakovlev S.V., Sidorov V.A., Kornyushko I.G., Medvedev V.R., Matveyev A.G. – Application of newtechnologies in the design, manufacture and use of technology deployment of field medical unitsand establishments. Presented data is about attendance means of deployment of field medical unitsand pieces of army-level medical services and disaster medicine Defense Ministry did not ensure compliancewith requirements to create optimal conditions for highly effective work of the medical staff, placing thewounded, the use of modern aids and appliances. The prospects of creation of mobile unit for high-availability modular pre-fabricated on the basis of tent structures, pneumoconstructions and removablehabitable bodies, containers, tents, pneumocovers till 2020 are analyzed. Livelihood systems providearmor protection against fragments, bullets, flames, damaging factors of chemical and biological weapons.

K e y w o r d s: Emergency Medicine Service of the Russian Federation Ministry of Defense, the fieldof medical, technical, deployment tools, modules based on body-containers, Inflatable structures.

Â ïåðèîä ôîðìèðîâàíèÿ íîâîãî îá- ëèêà Âîîðóæåííûõ Ñèë ÐÔ, â ò. ÷. è

ìåäèöèíñêîé ñëóæáû, âåäóòñÿ ðàáîòû ïîïîèñêó íîâûõ, ýêîíîìè÷åñêè âûãîäíûõïîäõîäîâ ê îðãàíèçàöèè îêàçàíèÿ ìåäè-öèíñêîé ïîìîùè ðàíåíûì â õîäå áîå-âûõ äåéñòâèé è ìèðîòâîð÷åñêèõ îïåðàöèé,à òàêæå ïîñòðàäàâøèì â ÷ðåçâû÷àéíûõñèòóàöèÿõ ìèðíîãî âðåìåíè è ðàçâèòèÿñîâðåìåííûõ ñðåäñòâ ðàçâåðòûâàíèÿ ìå-äèöèíñêèõ ïîäðàçäåëåíèé, ÷àñòåé è ïîëå-âûõ ãîñïèòàëåé.

Â íàñòîÿùåå âðåìÿ ïðè îðãàíèçàöèèëå÷åáíî-ýâàêóàöèîííîãî îáåñïå÷åíèÿáîåâûõ äåéñòâèé âîéñê â ëîêàëüíûõ âîé-íàõ, âîîðóæåííûõ êîíôëèêòàõ è ìèðî-òâîð÷åñêèõ îïåðàöèÿõ, à òàêæå ïðè ëèêâè-

äàöèè ïîñëåäñòâèé êðóïíûõ êàòàñòðîô èñòèõèéíûõ áåäñòâèé ïåðâàÿ âðà÷åáíàÿ ïî-

ìîùü (ÏÂÏ) è êâàëèôèöèðîâàííàÿìåäèöèíñêàÿ ïîìîùü (ÊÌÏ) ðàíåíûì,áîëüíûì è ïîðàæåííûì (äàëåå – ðàíå-íûì) â ïîëåâûõ óñëîâèÿõ îêàçûâàþòñÿâðà÷àìè-ñïåöèàëèñòàìè â ìåäèöèíñêèõðîòàõ áðèãàä, îòäåëüíûõ ìåäèöèíñêèõîòðÿäàõ (îìåäî) àðìåéñêèõ ìåäèöèíñêèõáðèãàä, ìåäèöèíñêèõ îòðÿäàõ ñïåöèàëüíîãî

íàçíà÷åíèÿ – ìåäîÑïÍ – âîåííûõ îêðó-ãîâ, îòäåëüíûõ ìåäèöèíñêèõ îòðÿäàõ âîç-äóøíî-äåñàíòíûõ äèâèçèé (îìåäî âää) èâîåííûõ ïîëåâûõ ãîñïèòàëÿõ ñ ïðèìå-íåíèåì òàáåëüíîãî ìåäèöèíñêîãî èìóùå-ñòâà ñ öåëüþ óñòðàíåíèÿ òÿæåëûõ, óãðî-æàþùèõ æèçíè ïîñëåäñòâèé è îñëîæíå-

Ìîáèëüíûå ëå÷åáíî-äèàãíîñòè÷åñêèå ñèñòåìûäëÿ ðàçâåðòûâàíèÿ ýòàïîâ ìåäèöèíñêîé ýâàêóàöèè

Åäèíàÿ òåõíîëîãè÷åñêàÿ ñèñòåìà äëÿ îêàçàíèÿ êâàëèôèöèðîâàííîé ìåäèöèíñêîé ïîìîùè

Ðàáîòà â îïåðàöèîííîì ìîäóëå îïåðàöèîííî-ðåàíèìàöèîííîãî îòäåëåíèÿ

Ìîäóëü èíòåíñèâíîé òåðàïèè (âèä èçíóòðè)

Âíóòðåííåå ïðîñòðàíñòâî ñîïðÿæåííûõñòûêîâî÷íûõ ìîäóëåé îïåðàöèîííî-

ðåàíèìàöèîííîãî îòäåëåíèÿ

Âûïîëíåíèå ìåðîïðèÿòèéèíòåíñèâíîé òåðàïèè

Ìàòåðèàë î òåõíè÷åñêèõ ñðåäñòâàõ ðàçâåðòûâàíèÿ ýòàïîâ ìåäèöèíñêîé ýâàêóàöèèîïóáëèêîâàí â ðóáðèêå «Âîåííàÿ ôàðìàöèÿ è ìåäèöèíñêàÿ òåõíèêà»


Ïîäâèæíûé êîìïëåêñ çàãîòîâêè êðîâè Ðàáîòà â äîíîðñêîì îòäåëåíèè êîìïëåêñà

Ñòåðèëèçàöèîííîå îòäåëåíèå ìîäóëÿêîìïëåêñíîãî òåõíè÷åñêîãî îáåñïå÷åíèÿ

Ïîëåâîé ïîäâèæíûé ñòîìàòîëîãè÷åñêèéêîìïëåêñ

Ïàëàòà èíòåíñèâíîé òåðàïèè â ïíåâìî-êàðêàñíîì ìåäèöèíñêîì ñîîðóæåíèè

Ìåäèöèíñêàÿ òåõíîëîãè÷åñêàÿ ñèñòåìà â íîâûõ ñðåäñòâàõ ðàçâåðòûâàíèÿ ïàëàòî÷íîãî òèïà,ñîïðÿæåííàÿ ñ ôóíêöèîíàëüíûìè ìîäóëÿìè â êóçîâàõ-êîíòåéíåðàõ


Ìîáèëüíûå ìåäèöèíñêèå êîìïëåêñûäëÿ ðàçâåðòûâàíèÿ ýòàïîâ ìåäèöèíñêîé ýâàêóàöèè

Êîìïëåêñ âðà÷åáíîé ïîìîùè ïîäâèæíîé:à – ðàçâåðòûâàíèå íà ìåñòíîñòè,á – ïåðåâÿçî÷íàÿ (âèä èçíóòðè)

á

à

Ïîäâèæíûé ðåíòãåíîäèàãíîñòè÷åñêèéêîìïëåêñ (âèä ñâåðõó)

Ìîáèëüíûé ïîëåâîé ìîäóëü óïðàâëåíèÿ ìåäèöèíñêîãî îòðÿäà ñïåöèàëüíîãî íàçíà÷åíèÿ:à – ðàçâåðòûâàíèå íà ìåñòíîñòè, á è â – âèä èçíóòðè

á

à

â

Ìàòåðèàë î òåõíè÷åñêèõ ñðåäñòâàõ ðàçâåðòûâàíèÿ ýòàïîâ ìåäèöèíñêîé ýâàêóàöèèîïóáëèêîâàí â ðóáðèêå «Âîåííàÿ ôàðìàöèÿ è ìåäèöèíñêàÿ òåõíèêà»


ÈÇ ÈÑÒÎÐÈÈÂÎÅÍÍÎÉ ÌÅÄÈÖÈÍÛ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ [61:355](091)(07.07)

Ê èñòîðèè âîåííîãî îáó÷åíèÿ â ÏåðâîìÌîñêîâñêîì ãîñóäàðñòâåííîì ìåäèöèíñêîìóíèâåðñèòåòå èìåíè È.Ì.Ñå÷åíîâà

×ÈÆ È.Ì., çàñëóæåííûé âðà÷ ÐÔ, ÷ëåí-êîððåñïîíäåíò ÐÀÌÍ, ïðîôåññîð,ãåíåðàë-ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêåÏÓÒÈËÎ Â.Ì., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÒÐÅÃÓÁÎÂ Â.Í., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÒÈÌÀÊÎÂ Â.Â., ïîëêîâíèê ìåäèöèíñêîé ñëóæáû

Ïåðâûé Ìîñêîâñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò èì. È.Ì.Ñå÷åíîâà, Ìîñêâà

Chizh I.M., Putilo V.M., Tregubov V.N., Timakov V.V. – The history of military training at theFirst Moscow State Medical University n. a I.M.Sechenov. In 2011, the oldest medical educationalinstitution of Russia – the First Moscow State Medical University n. a. I.M.Sechenov celebrates85 years of military training. Passing not easy, but at the same time, glorious path of military trainingin First MGMU n. a. I.M.Sechenov today occupies a key place in the training of military physicians.

K e y w o r d s: academic military center, military training, First MGMU n. a I.M.Sechenov.

Â 2011 ã. èñïîëíèëîñü 85 ëåò âîåííîìó îáó÷åíèþ â ñòàðåéøåì ìåäèöèí-

ñêîì îáðàçîâàòåëüíîì ó÷ðåæäåíèèÐîññèè – Ïåðâîì Ìîñêîâñêîì ãîñóäàð-ñòâåííîì ìåäèöèíñêîì óíèâåðñèòåòåèì. È.Ì.Ñå÷åíîâà (Ïåðâûé ÌÃÌÓèì. È.Ì.Ñå÷åíîâà). Ñîãëàñíî ïîñòàíîâ-ëåíèþ Öåíòðàëüíîãî èñïîëíèòåëüíîãîêîìèòåòà è Ñîâåòà íàðîäíûõ êîìèññàðîâÑÑÑÐ îò 20 àâãóñòà 1926 ã., óòâåðäèâøåìó«Ïîëîæåíèå î ïîðÿäêå ïðîõîæäåíèÿâûñøåé äîïðèçûâíîé âîåííîé ïîäãîòîâ-êè è äåéñòâèòåëüíîé ñëóæáû â Ðàáî÷å-Êðåñòüÿíñêîé Êðàñíîé Àðìèè ãðàæäà-íàìè, îáó÷àþùèìèñÿ â âóçàõ è òåõíèêó-ìàõ è îêîí÷èâøèõ èõ», â 1926/27 ó÷åáíîìãîäó âïåðâûå â ó÷åáíûå ïëàí è ïðîãðàì-ìû ìåäèöèíñêîãî ôàêóëüòåòà Ìîñêîâ-ñêîãî óíèâåðñèòåòà áûëè âêëþ÷åíûâîåííî-ñàíèòàðíûå ïðåäìåòû.

Ñòàíîâëåíèå âîåííîãî îáó÷åíèÿáûëî íåïðîñòûì – íå õâàòàëî ïðîôåñ-ñîðñêî-ïðåïîäàâàòåëüñêîãî ñîñòàâà, ïî-ìåùåíèé, áîåâîé òåõíèêè è îðóæèÿ, ó÷åá-íèêîâ, íàãëÿäíûõ ïîñîáèé. Ïåðâîíà÷àëü-íî äëÿ âîåííîãî êàáèíåòà áûëà âûäåëå-

íà ëèøü íåáîëüøàÿ êîìíàòà, ïîëîâèíóêîòîðîé çàíèìàëà êðóãëàÿ æåëåçíàÿ ïå÷ü.Íåñìîòðÿ íà òðóäíîñòè, óæå 1 îêòÿáðÿ1926 ã. íà÷àëèñü ïëàíîâûå çàíÿòèÿ ñî ñòó-äåíòàìè ïî âîåííî-ñàíèòàðíûì äèñöèï-ëèíàì.

Ïðîéäÿ íåëåãêèé, íî ñëàâíûé ïóòüðàçâèòèÿ, âîåííîå îáó÷åíèå â ÏåðâîìÌÃÌÓ èì. È.Ì.Ñå÷åíîâà ñåãîäíÿ çàíè-ìàåò âàæíîå ìåñòî â ñèñòåìå ïîäãîòîâ-êè âðà÷åé. Çíà÷èòåëüíàÿ ðîëü â îáùåìðóêîâîäñòâå âîåííî-ìåäèöèíñêèì îáó÷å-íèåì ïðèíàäëåæàëà íà÷àëüíèêàì ó÷åá-íûõ ïîäðàçäåëåíèé, â ðàçíûå ãîäû âîç-ãëàâëÿâøèì: âîåííûé êàáèíåò ìåäèöèí-ñêîãî ôàêóëüòåòà Ìîñêîâñêîãî óíèâåð-ñèòåòà – ñ 1926 ïî 1930 ã. À.À.Ñàìîéëî,âîåííûé êàáèíåò 1-ãî Ìîñêîâñêîãî ìå-äèöèíñêîãî èíñòèòóòà – ñ 1930 ïî 1936 ã.ïðîôåññîð Â.È.Åãîðüåâ, ñàíèòàðíî-îáî-ðîííóþ êàôåäðó 1-ãî Ìîñêîâñêîãî ìå-äèöèíñêîãî èíñòèòóòà – ñ 1936 ïî 1938 ã.äîöåíò À.È.Áóðíàçÿí, ñ 1939 ïî 1955 ã. –ïðîôåññîð Ã.Ì.Ïîïîâ. Â 1940 ã. êàôåäðàïåðåèìåíîâûâàåòñÿ â âîåííóþ êàôåäðó1-ãî Ìîñêîâñêîãî îðäåíà Ëåíèíà ìå-

Îôèöåðû ó÷åáíîãîâîåííîãî öåíòðàïðè Ïåðâîì ÌÃÌÓèì. È.Ì.Ñå÷åíîâàíà ïðàçäíîâàíèèÄíÿ Ïîáåäûâ Âåëèêîé Îòå÷åñòâåííîéâîéíå 1941–1945 ãã.Íà ïåðåäíåì ïëàíåâ öåíòðå ðåêòîð÷ëåí-êîððåñïîíäåíò ÐÀÌÍÏ . Â . Ã ë û á î ÷ ê î

è ïðîðåêòîð ïî ñâÿçÿìñ îáùåñòâåííîñòüþè âîñïèòàòåëüíîé ðàáîòå÷ëåí-êîððåñïîíäåíò ÐÀÌÍãåíåðàë-ïîëêîâíèêìåäèöèíñêîé ñëóæáûâ îòñòàâêå È . Ì . × è æ

Ìàòåðèàë îá èñòîðèè âîåííîãî îáó÷åíèÿ â Ïåðâîì ÌÃÌÓ èì. È.Ì.Ñå÷åíîâà ÷èòàéòå

â ýòîì íîìåðå æóðíàëà

Âîåííîå îáó÷åíèå â Ïåðâîì Ìîñêîâñêîì ãîñóäàðñòâåííîììåäèöèíñêîì óíèâåðñèòåòå èìåíè È.Ì.Ñå÷åíîâà

Îòðàáîòêà ñòóäåíòàìè Ïåðâîãî ÌÃÌÓèì. È.Ì.Ñå÷åíîâà ýâàêóàöèè ðàíåíûõ

ñ ïîëÿ áîÿ íà ó÷åáíîì ñáîðå â âîéñêàõ

Ïðîâåäåíèå ñòóäåíòàìè ñàíèòàðíîéîáðàáîòêè ïîðàæåííûõ â õîäå ó÷åíèÿ

Ó÷åáíûé ñáîð â âîéñêàõ: îòðàáîòêàîêàçàíèÿ ïåðâîé ïîìîùè ðàíåíûì

79



îáó÷åíèÿ, ïðàêòè÷åñêîé íàïðàâëåííî-ñòüþ îáó÷åíèÿ, â ò. ÷. àóäèòîðíûìè çàíÿ-òèÿìè â ó÷åáíîé ìåäèöèíñêîé ðîòå, ïðî-õîæäåíèåì ñòóäåíòàìè ïîñëå 4-ãî êóðñàó÷åáíîãî ñáîðà â âîéñêàõ, à ïîñëå 5-ãîêóðñà – âîéñêîâîé ñòàæèðîâêè.

Ïîñòóïëåíèå ñòóäåíòîâ â ÓÂÖ îñó-ùåñòâëÿåòñÿ â äîáðîâîëüíîì ïîðÿäêå íàîñíîâàíèè äîãîâîðà ìåæäó ãðàæäàíèíîìè Ìèíèñòåðñòâîì îáîðîíû ÐÔ î äîïîë-íèòåëüíîì èçó÷åíèè èì ïðîãðàììû âî-åííîé ïîäãîòîâêè â îáúåìå 1500 ó÷åá-íûõ ÷àñîâ ñ ïîñëåäóþùåì ïðîõîæäåíè-åì âûïóñêíèêîì âîåííîé ñëóæáû ïîêîíòðàêòó â Âîîðóæåííûõ Ñèëàõ ÐÔ,äðóãèõ âîéñêàõ, âîèíñêèõ ôîðìèðîâàíè-ÿõ è îðãàíàõ â òå÷åíèå òðåõ ëåò.

Ïîäâîäÿ èòîã èñòîðèè âîåííîãî îáó-÷åíèÿ â Ïåðâîì ÌÃÌÓ èì. È.Ì.Ñå÷åíîâà

íåîáõîäèìî îòìåòèòü, ÷òî çà ïðîéäåííûåãîäû áûëî ïîäãîòîâëåíî îêîëî 80 òûñ.îôèöåðîâ ìåäèöèíñêîé ñëóæáû çàïàñà,êîòîðûå ïðîôåññèîíàëüíî ïðèìåíÿëèïîëó÷åííûå çíàíèÿ è íàâûêè êàê â ìèð-íîå, òàê è â âîåííîå âðåìÿ.

Ñåãîäíÿ ó÷åáíûé âîåííûé öåíòð ïðèÏåðâîì ÌÃÌÓ èì. È.Ì.Ñå÷åíîâà è ðàáî-òàþùèé â íåì ïðîôåññîðñêî-ïðåïîäàâà-òåëüñêîãî ñîñòàâ îáåñïå÷èâàþò ïðîâåäå-íèå ó÷åáíûõ çàíÿòèé ñî ñòóäåíòàìè íàâûñîêîì êà÷åñòâåííîì óðîâíå, ðàçðàáîòêóó÷åáíî-ìåòîäè÷åñêèõ êîìïëåêñîâ, äîñòóï-íûõ êàæäîìó ñòóäåíòó íà èíòåðíåò-ñàéòåè â ó÷åáíûõ îòäåëàõ, ïðîâåäåíèå âîñïèòà-òåëüíîé ðàáîòû è âûïîëíåíèå íàó÷íûõðàáîò ïî ñîâåðøåíñòâîâàíèþ îáðàçîâà-òåëüíîãî ïðîöåññà è îïòèìèçàöèè ìåäè-öèíñêîãî îáåñïå÷åíèÿ âîèíñêîé ÷àñòè.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ [61:355](091)

Îïûò ðàçâèòèÿ òåõíè÷åñêèõ ñðåäñòâðàçâåðòûâàíèÿ ýòàïîâ ìåäèöèíñêîé ýâàêóàöèè

ÊÎÐÍÞØÊÎ È.Ã., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê,ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû â îòñòàâêå1

ßÊÎÂËÅÂ Ñ.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

ÌÅÄÂÅÄÅÂ Â.Ð., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà3

ÑÈÄÎÐÎÂ Â.À., ïîëêîâíèê â îòñòàâêå3

1Ãîñóäàðñòâåííûé èíñòèòóò óñîâåðøåíñòâîâàíèÿ âðà÷åé ÌÎ ÐÔ, Ìîñêâà; 2Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëåíèå ÌÎ ÐÔ, Ñàíêò-Ïåòåðáóðã; 3Íàó÷íî-èññëåäîâàòåëüñêèé èñïûòà-òåëüíûé èíñòèòóò (âîåííîé ìåäèöèíû) Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà,Ñàíêò-Ïåòåðáóðã

Kornyushko I.G., Yakovlev S.V., Medvedev V.R., Sidorov V.A. – Experience in development of deploymenttools of medical evacuation stages. Paper is devoted to the history of creation of various types of fieldinstallations of the tent, mobile medical units and facilities, the experience of their usage in combat.An analysis of approaches to medical support of troops and equi pment of the medical servicein accordance with the changing nature of military operations in the XX–XI centuries is performed.Description of several generations of means taken to supply is given.

K e y w o r d s: deployment tools, tents, mobile medical installations and facilities, ambulances, medicalevacuation, medical care, the wounded, sick.

Â ãîäû Ïåðâîé ìèðîâîé âîéíû âîåííàÿ ìåäèöèíà Ðîññèè ïðîâîäèëà ëå÷åáíî-

ýâàêóàöèîííûå ìåðîïðèÿòèÿ, èñïîëüçóÿäëÿ ìåäèöèíñêîé ýâàêóàöèè ðàíåíûõâ îñíîâíîì ñàíèòàðíûå äâóêîëêè, ñàíè,ïîâîçêè ñ òåíòîì èëè îòêðûòîãî òèïà íàêîííîé òÿãå, à äëÿ îêàçàíèÿ ìåäèöèíñêîéïîìîùè – ìà÷òîâûå òêàíåâûå ïàëàòêè

ñ äåðåâÿííîé ìåäèöèíñêîé ïîëåâîé ìå-áåëüþ äëÿ ðàçâåðòûâàíèè äèâèçèîííûõìåäèöèíñêèõ ïóíêòîâ (ÄÌÏ) è ïîëåâûõïîäâèæíûõ ãîñïèòàëåé. Ýòè æå ñðåäñòâàýâàêóàöèè è ðàçâåðòûâàíèÿ äîñòàëèñü â íà-ñëåäñòâî Êðàñíîé Àðìèè è ïðèìåíÿëèñüâ ïåðèîä Ãðàæäàíñêîé âîéíû, â 20-å ãîäûè âîåííûõ êîíôëèêòîâ 30-õ ãîäîâ XX âåêà.

80



Âî âðåìÿ ñîáûòèé íà Õàëõèí-Ãîëå,íà Êèòàéñêî-âîñòî÷íîé æåëåçíîé äîðî-ãå è âî âðåìÿ Ñîâåòñêî-ôèíëÿíäñêîéâîéíû ñóùåñòâåííóþ ðîëü ñòàëè èãðàòüñàíèòàðíûå àâòîìîáèëè ñ êóçîâàìè-ôóð-ãîíàìè íà øàññè ïåðâûõ ãðóçîâûõ îòå÷å-ñòâåííûõ àâòîìîáèëåé ÃÀÇ-ÀÀ è ÇÈÑ.

Äëÿ ïðîâåäåíèÿ ëå÷åáíî-äèàãíîñòè-÷åñêèõ ìåðîïðèÿòèé è â öåëÿõ ïîâûøå-íèÿ ìîáèëüíîñòè â Êðàñíîé Àðìèè ïîïðèìåðó ìåäèöèíñêèõ ñëóæá àðìèé âåäó-ùèõ çàðóáåæíûõ ñòðàí (ÂÇÑ) ñîâåòñêàÿâîåííàÿ ìåäèöèíà íà÷àëà ïîèñê íîâûõñðåäñòâ ðàçâåðòûâàíèÿ ïàëàòî÷íîãî òèïàè ïîäâèæíîé ñàíèòàðíîé ñïåöèàëüíîéòåõíèêè (ïîäâèæíûõ ïåðåâÿçî÷íûõ, îïå-ðàöèîííûõ, ðåíòãåíîâñêèõ ëàáîðàòîðèé,ñàíèòàðíî-áàêòåðèîëîãè÷åñêèõ êàáèíå-òîâ, äóøåâûõ è äåçèíôåêöèîííûõ ñðåäñòâñàíèòàðíîé îáðàáîòêè âîéñê â ìèðíîå èâîåííîå âðåìÿ). Áûëè ñîçäàíû ïåðâûåàâòîõèðóðãè÷åñêèå îòðÿäû (ÀÕÎ).

Ê ñðåäñòâàì ðàçâåðòûâàíèÿ ìåäè-öèíñêèõ ïîäðàçäåëåíèé, ÷àñòåé è ó÷ðåæ-äåíèé â ïîëåâûõ óñëîâèÿõ îòíîñÿòñÿáûñòðîâîçâîäèìûå ñáîðíî-ðàçáîðíûåèëè æåñòêîîáúåìíûå òðàíñïîðòàáåëüíûåìîáèëüíûå ñîîðóæåíèÿ òèïà ìà÷òîâûõèëè êàðêàñíûõ ïàëàòîê, ïíåâìîêàðêàñ-íûõ èëè ùèòîâûõ ñîîðóæåíèé, êóçîâà-ôóðãîíû, êóçîâà-êîíòåéíåðû, áëèíäàæèèëè áëî÷íûå çàãëóáëÿåìûå ñîîðóæåíèÿè äðóãèå êîíñòðóêöèè îáúåìíîãî òèïàïðîìûøëåííîãî èçãîòîâëåíèÿ, à òàêæåñâîáîäíûå æèëûå ïîìåùåíèÿ.

Ñðåäñòâà ðàçâåðòûâàíèÿ äîëæíûìàêñèìàëüíî ñîîòâåòñòâîâàòü ñëåäóþ-ùèì ìåäèêî-òåõíè÷åñêèì è ñïåöèàëü-íûì òðåáîâàíèÿì ïîâûøåííîãî óðîâíÿäëÿ ñîçäàíèÿ îïòèìàëüíîé ñðåäû îáèòà-íèÿ ðàíåíûì, áîëüíûì è ìåäèöèíñêîìóïåðñîíàëó:

– èìåòü îïòèìàëüíûå îáúåìíî-ãàáà-ðèòíûå ðàçìåðû ïðè ìèíèìàëüíîé ìàñ-ñå è ýíåðãîïîòðåáëåíèè;

– áûòü ïðî÷íûìè è ñòîéêèìè ê óñ-ëîâèÿì òðàíñïîðòèðîâêè è ìíîãîêðàò-íûõ ðàçâåðòûâàíèé;

– ñîîòâåòñòâîâàòü íîðìàòèâàì ïîâðåìåíè ðàçâåðòûâàíèÿ, ñâåðòûâàíèÿè ãîòîâíîñòè ê ïðèìåíåíèþ ïî íàçíà-÷åíèþ;

– áûòü âûñîêîíàäåæíûìè â çàäàí-íûõ óñëîâèÿõ;

– èìåòü âûñîêèå ýðãîíîìè÷åñêèåõàðàêòåðèñòèêè;

– îáëàäàòü âûñîêîé àâòîíîìíîñòüþïðèìåíåíèÿ;

– òðàíñïîðòèðîâàòüñÿ âñåìè âèäàìèòðàíñïîðòà;

– âûäåðæèâàòü óäàðíûå íàãðóçêè ïðèòðàíñïîðòèðîâêå, âëèÿíèå íèçêèõ è âû-ñîêèõ òåìïåðàòóð ñ ñîõðàíåíèåì îñíîâ-íûõ òàêòèêî-òåõíè÷åñêèõ õàðàêòåðè-ñòèê (ÒÒÕ);

– áûòü ïðèñïîñîáëåííûìè ê òåõíè-÷åñêîìó îáñëóæèâàíèþ, òåêóùåìó ðå-ìîíòó è ñïåöèàëüíîé îáðàáîòêå;

– ñîõðàíÿòü ÒÒÕ ïðè êðàòêîâðåìåí-íîì è äëèòåëüíîì õðàíåíèè;

– ñîïðÿãàòüñÿ ñ ïîäîáíûìè è äðó-ãèìè ñðåäñòâàìè ðàçâåðòûâàíèÿ;

– îáåñïå÷èâàòü èçáûòî÷íîå äàâëåíèåâîçäóõà äëÿ ïðîòèâîäåéñòâèÿ ïðîíèêíî-âåíèþ ïûëè, ÎÂ, ÐÂ è ÁÑ;

– âûäåðæèâàòü çàäàííîå ÷èñëî ðàçâåð-òûâàíèé (ñâåðòûâàíèé), ìíîãîêðàòíóþñïåöèàëüíóþ îáðàáîòêó, âëàæíóþ óáîðêóè âîçäåéñòâèå äåçèíôèöèðóþùèõ ñðåäñòâ;

– îáåñïå÷èâàòü íå ìåíåå ÷åì 5-êðàò-íûé îáìåí âîçäóõà â ïîìåùåíèè;

– èìåòü ïîëû, îáåñïå÷èâàþùèå çàùè-òó îò âíåøíèõ òåìïåðàòóð è âëàãè, à òàê-æå ïîâåðõíîñòü, ñîõðàíÿþùóþ óñòîé÷è-âîñòü ïîëåâîé ìåáåëè;

– íàëè÷èå ïðîòèâîìîñêèòíûõ ñåòîê;– èìåòü â êîìïëåêòå ñðåäñòâà îáî-

ãðåâà, êîíäèöèîíèðîâàíèÿ âîçäóõà, øàí-öåâûé èíñòðóìåíò, êîìïëåêò ÇÈÏ;

– èìåòü âñòðîåííóþ ýëåêòðîïðîâîä-êó è îáúåìíûå ñâåòèëüíèêè;

– èìåòü ïðèñïîñîáëåíèÿ äëÿ ðàçãî-ðàæèâàíèÿ ìåäèöèíñêèõ ïîìåùåíèé,êðåïëåíèÿ äëÿ óñòàíîâêè è íàâåøèâàíèÿìåäèöèíñêîãî îñíàùåíèÿ è èìóùåñòâà.

Îïûò ó÷àñòèÿ ñèë è ñðåäñòâ ìåäè-öèíñêîé ñëóæáû Ìèíèñòåðñòâà îáîðîíûÐÔ â ëå÷åáíî-ýâàêóàöèîííîì îáåñïå÷å-íèè âîéñê â ëîêàëüíûõ âîéíàõ è âîîðó-æåííûõ êîíôëèêòàõ, ïðè ìèðîòâîð÷åñêèõìèññèÿõ è ëèêâèäàöèè ìåäèêî-ñàíèòàð-íûõ ïîñëåäñòâèé ÷ðåçâû÷àéíûõ ñèòóàöèéðàçëè÷íîãî ïðîèñõîæäåíèÿ ïîçâîëèëîïðåäåëèòü ôàêòîðû, îáóñëîâëèâàþùèåâ ïîñëåäíèå äåñÿòèëåòèÿ îñîáåííîñòèôóíêöèîíèðîâàíèÿ ïîäðàçäåëåíèé âî-åííî-ìåäèöèíñêîé ñëóæáû:

– ìàíåâðåííûé õàðàêòåð, äèíàìè÷-íîñòü áîåâûõ äåéñòâèé, îòñóòñòâèå ÷åòêèõáîåâûõ ïîçèöèé;

– ïðèðîäíî-êëèìàòè÷åñêèå óñëîâèÿ(ãîðíàÿ ìåñòíîñòü, îòñóòñòâèå äîðîæíîé

84



© À.Â.ÊÎÑÒÞÊ, 2011ÓÄÊ [61:355](091)

Ó÷ðåæäåíèå îòå÷åñòâåííûõ âîåííî-ìîðñêèõãîñïèòàëåé â XVIII ñòîëåòèè

ÊÎÑÒÞÊ À.Â.

Ñàíêò-Ïåòåðáóðãñêèé ãîñóäàðñòâåííûé óíèâåðñèòåò

Kostyuk A.V. – Establishment of national naval hospitals in the XVIII century. The first navalhospitals were established in St. Petersburg, Revel and Kronstadt, Kazan, Revel, Astrakhan and Archangel.The question when the first hospitals were opened is still controversial because of the lack of manydocuments of those years. Researchers disagree, probably because of the fact that they take intoaccount different timeframes for the project of a hospital corps. Regardless of whether you will findunequivocal, direct evidence for their discoveries in a given year, the value of the old hospital asmedical institutions will not change. Much more important is the fact of their education because ofintense activity of the domestic fleet. In the creation of naval hospitals as in anything else to take careof the state of preservation, strengthening and restoring the health of personnel, of which largelydepended on the readiness of the fleet.

K e y w o r d s: history of the naval hospitals in Russia, military medicine of the Russian Navy in the18th century.

Äåÿòåëüíîñòè Ïåòðà Âåëèêîãî îòå÷å- ñòâåííûé Áàëòèéñêèé ôëîò îáÿçàí

íå òîëüêî ñâîèì ñîçäàíèåì, íî è îñíî-âàíèåì ëå÷åáíî-ïðîôèëàêòè÷åñêèõ ó÷-ðåæäåíèé äëÿ ìåäèöèíñêîãî îáñëóæèâà-íèÿ åãî ëè÷íîãî ñîñòàâà. Òîëüêî â ãîäûïðàâëåíèÿ Ïåòðà I â Ðîññèè îòêðûëèñü10 ãîñïèòàëåé è 500 ëàçàðåòîâ [24].

Ïåðâûå âîåííî-ìîðñêèå ãîñïèòàëèáûëè çàëîæåíû â Ñàíêò-Ïåòåðáóðãå,Ðåâåëå, Êðîíøòàäòå, Êàçàíè, Òàâðîâå,Àñòðàõàíè è Àðõàíãåëüñêå. Çàòåì èõ íà-÷àëè ñòðîèòü âî âñåõ êðóïíûõ ïîðòîâûõãîðîäàõ – ìåñòàõ äèñëîêàöèè ðîññèéñêî-ãî ôëîòà. Ñ ñîçäàíèåì ôëîòà íà ×åðíîììîðå ãîñïèòàëè ïîÿâèëèñü â Ñåâàñòîïîëåè Õåðñîíå [5].

Âîïðîñ î òîì, êîãäà èìåííî îòêðû-ëèñü ïåðâûå ãîñïèòàëè, äî ñèõ ïîð ÿâëÿ-åòñÿ äèñêóññèîííûì. Èññëåäîâàòåëè ðàñ-õîäÿòñÿ âî ìíåíèÿõ, âîçìîæíî èç-çà òîãî,÷òî ïî-ðàçíîìó ó÷èòûâàþò ñðîêè îêîí-÷àíèÿ ñòðîèòåëüñòâà òîãî èëè èíîãî ãîñ-ïèòàëüíîãî çäàíèÿ.

Òàê, ñïîðíîé äëÿ ìíîãèõ èñòîðèêîâìåäèöèíû îñòàåòñÿ äàòà îòêðûòèÿ ãåíå-ðàëüíîãî àäìèðàëòåéñêîãî ãîñïèòàëÿ âÑàíêò-Ïåòåðáóðãå. Åäèíñòâåííîå, ÷òî íåâûçûâàåò ðàçíîãëàñèé, – ýòî ìåñòî åãîðàñïîëîæåíèÿ. Äîïîäëèííî èçâåñòíî, ÷òî

Ñàíêò-Ïåòåðáóðãñêèé ìîðñêîé ãîñïè-òàëü íàõîäèëñÿ íà ïðàâîì áåðåãó Íåâû,íà Âûáîðãñêîé ñòîðîíå, à åãî ñêëàäû(«ìàãàçèíû», êàê èõ òîãäà íàçûâàëè) ðàç-ìåùàëèñü íà îñòðîâêå Áîëüøîé Íåâêè.7 èþíÿ 1714 ã. Ïåòð I, êðàéíå îáåñïîêî-åííûé ìàññîâûìè æåëóäî÷íî-êèøå÷íû-ìè çàáîëåâàíèÿìè íèæíèõ ÷èíîâ íà êî-ðàáëÿõ ðåâåëüñêîé ýñêàäðû, ïèñàë àäìè-ðàëòåéñòâ-ñîâåòíèêó À.Â.Êèêèíó îá îñ-òðåéøåé íåîáõîäèìîñòè ñòðîèòåëüñòâàãîñïèòàëÿ, êîòîðûé «çåëî íóæåí äëÿ áîëü-íûõ ñîëäàò è ìàòðîñîâ». Â òîò æå äåíüñâåòëåéøèé êíÿçü À.Ä.Ìåíøèêîâ ïîëó-÷èë ðàñïîðÿæåíèå ïîñòðîèòü «ãîøïèòàëüêàìåííûé íà Âûáîðãñêîé ñòîðîíå» [8].

Ôàêò ñòðîèòåëüñòâà ãîñïèòàëÿ â 1715 ã.íàøåë îòðàæåíèå â «Æóðíàëå, èëè Ïî-äåííîé çàïèñêå, Ïåòðà Âåëèêîãî» [4].Â îêòÿáðå òîãî æå ãîäà ãåíåðàë-ìàéîðÃ.Ï.×åðíûøåâ ïðèêàçàë «îáúÿâèòü âñåì,îáðåòàþùèìñÿ ïðè Àäìèðàëòåéñòâå, êàêñîëäàòàì, òàê ìàñòåðîâûì è ðàáîòíûìëþäÿì, åæåëè êòî çàáîëååò, ÷òîá òàêèõîòâîäèëè â Àäìèðàëòåéñêèé ãîñïèòàëü»[18]. Òàêèì îáðàçîì, ê êîíöó 1715 ã. Ñàíêò-Ïåòåðáóðãñêèé ìîðñêîé ãîñïèòàëü áûëãîòîâ ê ïðèåìó áîëüíûõ è ðàíåíûõ.

Îäíàêî íå âñå èññëåäîâàòåëè åäèíî-ãëàñíî ïðèíÿëè ýòîò ãîä çà äàòó íà÷àëà

89



9. Èâàíîâ Å.Ì. Ðîëü Êðîíøòàäòñêîãî âî-åííî-ìîðñêîãî îðäåíà Ëåíèíà ãîñïèòàëÿâ ðàçâèòèè âîåííî-ìîðñêîé ìåäèöèíû //Ìàòåðèàëû íàó÷íîé êîíôåðåíöèè, ïîñâÿùåí-íîé 250-ëåòèþ Êðîíøòàäòñêîãî âîåííî-ìîð-ñêîãî îðäåíà Ëåíèíà ãîñïèòàëÿ. – Êðîíø-òàäò, 1967. – Ñ. 3.

10. Èñòîðèÿ 1-ãî Âîåííî-ìîðñêîãî îð-äåíà Ëåíèíà ãîñïèòàëÿ / Ñîñò. Â.Â.Ñîñèí. –ÑÏá, 1993. – Ñ. 10.

11. Êâèöèíñêèé Ì.È. Êðàòêèé èñòîðè÷å-ñêèé î÷åðê Êàëèíêîâñêîãî (íûíå Ñàíêò-Ïåòåðáóðãñêîãî) ìîðñêîãî ãîñïèòàëÿ çà ïåð-âîå ïÿòèäåñÿòèëåòèå åãî ñóùåñòâîâàíèÿ// Ìåäèöèíñêèå ïðèáàâëåíèÿ ê «Ìîðñêîìóñáîðíèêó». – 1893. – Èþëü. – Ñ. 77.

12. Êíèãà óñòàâ ìîðñêîé î âñåì, ÷òî êà-ñàåòñÿ äîáðîìó óïðàâëåíèþ â áûòíîñòè ôëîòàíà ìîðå. – ÑÏá, 1720. – Êí. IV. – Ãë. I. –Àðò. 7, 9, 15; Êí. V. – Ãë. XIV. – Àðò. 104.

13. Êóïðèÿíîâ Â.Â. Èç èñòîðèè ìåäèöèí-ñêîé ñëóæáû íà ðóññêîì ôëîòå (Ïî ìàòåðèà-ëàì àðõèâîâ è ïî ñòðàíèöàì òðóäîâ äîêòîðàôëîòà À.Ã.Áàõåðàõòà). – Ì., 1963. – Ñ. 54–55.

14. Ëàõòèí Ì.Þ. Ýòþäû ïî èñòîðèè ìå-äèöèíû. – Ì., 1902. – Ñ. 111.

15. Ìàòåðèàëû äëÿ èñòîðèè ðóññêîãî ôëî-òà. – ÑÏá, 1867. – ×. IV. – Ñ. 465.

16. Íèêèòèí À.Í. Êðàòêèé îáçîð ñîñòî-ÿíèÿ ìåäèöèíû â Ðîññèè â öàðñòâîâàíèåèìïåðàòðèöû Åêàòåðèíû II. – ÑÏá, 1855. –Ñ. 20.

17. Ïîëíîå ñîáðàíèå çàêîíîâ Ðîññèé-ñêîé èìïåðèè. – Ò. VII. – Ñ. 499 (¹ 4728);Ò. X. – Ñ. 179–180 (¹ 7285).

18. Ïðîòîêîëû çàñåäàíèé Îáùåñòâà ìîð-ñêèõ âðà÷åé Ñàíêò-Ïåòåðáóðãñêîãî ïîðòàâ 1911–1913 ãã. // Ìîðñêîé âðà÷. – 1914. –Àïðåëü. – Ñ. 9.

19. Ðåãëàìåíò î ãîñïèòàëÿõ è î äîëæíî-ñòÿõ îïðåäåëåííûõ ïðè íèõ êîìèññàðîâ, äîê-òîðîâ, ïèñàðåé è ïðî÷èõ. – ÑÏá, 1722. – Ãë. I.– Àðò. 14.

20. Ðåãëàìåíò î óïðàâëåíèè Àäìèðàëòåé-ñòâà è âåðôè. – ÑÏá, 1722. – Ãë. I. – Àðò. 34.

21. Ðåãëàìåíò î óïðàâëåíèè àäìèðàë-òåéñòâ è ôëîòîâ, ñ ïðèëîæåíèåì äîëæíîñòåéèíòåíäàíòñêîãî è ýêèïàæñêîãî äåïàðòàìåí-òîâ è ñ÷åòíîé ýêñïåäèöèè. – ÑÏá, 1765. –×. I. – Ãë. IV. – § 9.

22. Ðèõòåð Â.Ì. Èñòîðèÿ ìåäèöèíû âÐîññèè. – Ì., 1820. – ×. 3. – Ñ. 18–19.

23. Ðîçàíîâ Ï.Ì. Áàõåðàõò // Ýíöèêëî-ïåäè÷åñêèé ñëîâàðü âîåííîé ìåäèöèíû. – Ì.,1946. – Ò. 1. – Ñ. 434.

24. Ñòîëåòèå Âîåííîãî ìèíèñòåðñòâà:Èìïåðàòîðñêàÿ âîåííî-ìåäèöèíñêàÿ (Ìåäè-êî-õèðóðãè÷åñêàÿ) àêàäåìèÿ: Èñòîðè÷åñêèéî÷åðê / Ñîñò. Ã.Ã.Ñêîðè÷åíêî. – ÑÏá, 1902. –×. 1. – Ñ. 8.

25. Òèìîôååâñêèé Ô.À. Êðàòêèé èñòîðè-÷åñêèé î÷åðê äâóõñîòëåòèÿ ãîðîäà Êðîíø-òàäòà. – Êðîíøòàäò, 1913. – Ñ. 173.

26. ×èñòîâè÷ ß.À. Èñòîðèÿ ïåðâûõ ìåäè-öèíñêèõ øêîë â Ðîññèè. – ÑÏá, 1883. –Ñ. 542.

27. Õìûðîâ Ì.Ä. Ðóññêàÿ âîåííî-ìåäèöèí-ñêàÿ ñòàðèíà (1616–1762): èñòîðèêî-õàðàê-òåðèñòè÷åñêèé î÷åðê ïî äîêóìåíòàì // Âîåí.-ìåä. æóðí. – 1869. – Ôåâðàëü. – Ñ. 109.

© Ñ.Â.ÄÎÌÎÃÀÐÎÂÀ, 2011ÓÄÊ [61:355](091)

Ñûçðàíñêèé âîåííûé ãîñïèòàëü

ÄÎÌÎÃÀÐÎÂÀ Ñ.Â.

Óëüÿíîâñêèé ãîñóäàðñòâåííûé óíèâåðñèòåò

Domogarova S.V. – Syzran Military Hospital. In 2011 Central Military Hospital Syzran MilitaryDistrict – the former 417-th Syzransky garrison military hospital Russian Defense Ministry – celebratedthe 65th anniversary. At different periods in the hospital were deployed 50, 100 and 150 beds in 3, 4 and6 units, respectively. Currently Syzran Military Hospital, part of the Federal State Institution«354 District Military Clinical Hospital», the Russian Defense Ministry – a multi-facility consistingof 6 diagnostic and treatment departments and offices.

K e y w o r d s: Syzran military hospital, medical care for the wounded and sick in the Russian Armed Forces.

Â 2011 ã. ñâîå 65-ëåòèå îòìåòèë âîåí- íûé ãîñïèòàëü â Ñûçðàíè – íûíå

ñòðóêòóðíîå ïîäðàçäåëåíèå 354-ãî Îêðóæ-íîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿÌèíèñòåðñòâà îáîðîíû ÐÔ. Àâòîðèòåòýòîãî ëå÷åáíîãî ó÷ðåæäåíèÿ âñåãäà ñòî-ÿë âûñîêî, à åãî ñïåöèàëèñòû ñ ÷åñòüþñïðàâëÿëèñü ñ âîçëîæåííûìè íà íèõ çà-

äà÷àìè. Äàæå â ïåðèîä ðåôîðìèðîâàíèÿÂîîðóæåííûõ Ñèë ñûçðàíñêèé ãîñïèòàëüíå òîëüêî íå ïåðåñòàë ñóùåñòâîâàòü, íî,íàîáîðîò, ðàñøèðèëñÿ. Ê òðåì îòäåëåíè-ÿì – òåðàïåâòè÷åñêîìó, õèðóðãè÷åñêîìó,èíôåêöèîííîìó – äîáàâèëèñü òðàâìàòî-ëîãè÷åñêîå, íåâðîëîãè÷åñêîå, êîæíî-âåíåðîëîãè÷åñêîå è ãîñïèòàëüíîå.

Â ÑÛÇÐÀÍÑÊÎÌ ÂÎÅÍÍÎÌ ÃÎÑÏÈÒÀËÅ

Ìàòåðèàë î ãîñïèòàëå îïóáëèêîâàí â ðóáðèêå «Èç èñòîðèè âîåííîé ìåäèöèíû»

Ñâîå 65-ëåòèå îòìåòèë âîåííûé ãîñïèòàëü â Ñûçðàíè – íûíå ñòðóêòóðíîå

ïîäðàçäåëåíèå 354-ãî Îêðóæíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ ÌÎ ÐÔ. Îïûò

ðàáîòû ãîñïèòàëÿ, åãî çíà÷èòåëüíûå ëå÷åáíî-äèàãíîñòè÷åñêèå âîçìîæíîñòè

â óñëîâèÿõ ðåôîðìèðîâà-

íèÿ Âîîðóæåííûõ Ñèë ÐÔ

ñïîñîáñòâóþò óñïåøíîé

ðåàëèçàöèè çàäà÷ ïî ìåäè-

öèíñêîìó îáåñïå÷åíèþ

âîéñê, ñâîåâðåìåííîé è

êà÷åñòâåííîé ìåäèöèí-

ñêîé ïîìîùè âîåííîñëó-

æàùèì è ÷ëåíàì èõ ñåìåé.

Îñìîòð óñëîâíî ðàíåíûõíà ïëàíîâîì ó÷åíèè

Íà÷àëüíèêìåäèöèíñêîé

÷àñòè ãîñïèòàëÿïîäïîëêîâíèê

ìåäèöèíñêîé ñëóæáûÎ . Ï . ß í ê î â è ÷

ïðèíèìàåò äîêëàäíà÷àëüíèêà îïåðáëîêà

Î . À . Ñ ê à ÷ ê î â à

î õîäåïðîâîäèìîãî

ó÷åíèÿ

Îôèöåðñêèé ñîñòàâ ãîñïèòàëÿ

90



Ôîðìèðîâàíèå âîåííîãî ãîñïèòàëÿâ Ñûçðàíè íà÷àëîñü â ôåâðàëå 1946 ã. îä-íîâðåìåííî ñ ïðèáûòèåì åãî íà÷àëüíè-êà ïîäïîëêîâíèêà ìåäèöèíñêîé ñëóæáûÞ.Ë.Øåïåëåâà, íàçíà÷åííîãî íà ýòó äîë-æíîñòü ïðèêàçîì êîìàíäóþùåãî âîéñêà-ìè ÏðèÂÎ.

Ñ ïåðâûõ äíåé ãîñïèòàëü äèñëîöè-ðîâàëñÿ â Ñûçðàíè ïî óë. Âîëîäàðñêîãî.Ïåðåîáîðóäîâàíèå íåïðèñïîñîáëåííûõïîìåùåíèé ïðîèçâîäèëîñü ñèëàìè ïåð-ñîíàëà, óæå â èþíå 1946 ã. ãîñïèòàëü áûëðàçâåðíóò íà 50 êîåê â ñîñòàâå òðåõ îò-äåëåíèé (õèðóðãè÷åñêîãî, òåðàïåâòè÷å-ñêîãî, êîæíî-âåíåðîëîãè÷åñêîãî) è ïðè-íÿë ïåðâûõ ïàöèåíòîâ. Ñ ôåâðàëÿ 1953 ã.ââåäåí øòàò íà 100 êîåê, ê òðåì èìåâ-øèìñÿ îòäåëåíèÿì äîáàâèëîñü èí-ôåêöèîííîå.

Â ïîñëåäóþùèå ãîäû ãîñïèòàëü áëà-ãîóñòðàèâàëñÿ, óëó÷øàëàñü ìàòåðèàëüíî-òåõíè÷åñêàÿ áàçà, óâåëè÷èâàëàñü êîå÷íàÿåìêîñòü (â îêòÿáðå 1993 ã. ïåðåâåäåí íà150-êîå÷íûé øòàò), ñîâåðøåíñòâîâàëñÿëå÷åáíî-äèàãíîñòè÷åñêèé ïðîöåññ.

Â ðàçíîå âðåìÿ ãîñïèòàëåì ðóêî-âîäèëè ìàéîð ìåäèöèíñêîé ñëóæáûÅ.À.Ëèìàíîâñêèé, ïîäïîëêîâíèêè ìåäè-öèíñêîé ñëóæáû Â.ß.Êðóòüêî, Ê.Ñ.Òþ-ðÿåâ, È.Ì.Ãðåéñóõ, Ñ.Ã.Êàðàñ¸â, Á.È.Âà-âèëèí, Ñ.À.Ïëåøèâöåâ, ìàéîð ìåäèöèí-ñêîé ñëóæáû Ð.Ã.Ìèíãàëèåâ, ïîëêîâíèêìåäèöèíñêîé ñëóæáû Þ.Ï.Ñòåïàíîâ,ïîäïîëêîâíèêè ìåäèöèíñêîé ñëóæáûÎ.Ï.Çàãóáèæåíêî, À.Ã.Ôèíàãååâ, ïîëêîâ-íèê ìåäèöèíñêîé ñëóæáû Ñ.Ñ.Äàâèä÷óê*.

Ïåðâûì íà÷àëüíèêîì ìåäèöèíñêîé÷àñòè ãîñïèòàëÿ áûë ïîäïîëêîâíèê ìå-äèöèíñêîé ñëóæáû Å.Ì.Ñàìîéëîâ. Â ïî-ñëåäóþùåì ýòó äîëæíîñòü çàíèìàëè ïîä-ïîëêîâíèêè ìåäèöèíñêîé ñëóæáûÑ.Ã.Êàðàñ¸â, Ñ.À.Ïëåøèâöåâ, Ë.Í.Ãîðáó-íîâ, Â.Â.Çîëîòàð¸â, Â.Ï.Êàðïîâ, À.Ã.Ôè-íàãååâ, Â.Â.Ëàâðèê, À.È.Ëûñóí, Â.Ð.Èøó-òîâ, Ñ.À.Êîòþ÷èé, Â.Â.Áîãîñëîâ, À.À.Ñèá-ðÿåâ. Â íàñòîÿùåå âðåìÿ íà÷àëüíèêîììåäèöèíñêîé ÷àñòè ãîñïèòàëÿ ÿâëÿåòñÿâðà÷ âûñøåé êàòåãîðèè ïîäïîëêîâíèêìåäèöèíñêîé ñëóæáû Îêñàíà Ïåòðîâíàßíêîâè÷.

Ñ 1960 ã. â ñîñòàâ ìåäèöèíñêîé ÷àñòèáûëà ââåäåíà äîëæíîñòü ãëàâíîé ìåäè-öèíñêîé ñåñòðû. Ïåðâîé ãëàâíîé ìåäè-öèíñêîé ñåñòðîé áûëà Ë.È.Áðþõîâè÷,âïîñëåäñòâèè – Â.À.Æàáîòèíñêàÿ,Í.Â.×óëàíîâà, Ý.Â.Ñàõàöêàÿ.

Â 1998 ã. â ñûçðàíñêîì ãàðíèçîííîìãîñïèòàëå áûëî îðãàíèçîâàíî îòäåëåíèåàíåñòåçèîëîãèè è ðåàíèìàöèè, ïåðâûìíà÷àëüíèêîì êîòîðîãî ñòàë ïîäïîëêîâ-íèê ìåäèöèíñêîé ñëóæáû À.À.Ôåäîòîâ.

Ñ 1996 ã. ãîñïèòàëü ðàáîòàåò â ñèñòå-ìå îáÿçàòåëüíîãî ìåäèöèíñêîãî ñòðà-õîâàíèÿ, îêàçûâàÿ íåîòëîæíóþ ìåäè-öèíñêóþ ïîìîùü íàñåëåíèþ ãîðîäà,ðàéîíà, ïðèëåãàþùèõ íàñåëåííûõ ïóí-êòîâ äðóãèõ ñóáúåêòîâ ôåäåðàöèè. Ìå÷-òà âñåõ æèòåëåé Ñûçðàíè – äîâåðèòüñâîå çäîðîâüå ñïåöèàëèñòàì èìåííîýòîãî âîåííîãî ëå÷åáíîãî ó÷ðåæäåíèÿ,êîòîðîå èìååò äâà óðãåíòíûõ äíÿ â íå-äåëþ ïî îêàçàíèþ íåîòëîæíîé õèðóð-ãè÷åñêîé ïîìîùè ïî ã. Ñûçðàíè è Ñûç-ðàíñêîìó ðàéîíó. Ëå÷åíèå â ãîñïèòàëåïðîõîäÿò âîåííîñëóæàùèå íå òîëüêîÐîññèéñêîé àðìèè, íî è äðóãèõ ãîñó-äàðñòâ, â ÷àñòíîñòè îáó÷àþùèåñÿ âÑûçðàíñêîì âûñøåì âîåííîì àâèàöè-îííîì ó÷èëèùå ëåò÷èêîâ.

Â ñâÿçè ñ ðåôîðìèðîâàíèåì Âîîðó-æåííûõ Ñèë íà ìåäèöèíñêîì îáåñïå÷å-íèè â ãîñïèòàëå íàõîäÿòñÿ âîèíñêèå ÷à-ñòè ñûçðàíñêîãî, òîëüÿòòèíñêîãî è óëüÿ-íîâñêîãî ãàðíèçîíîâ (ïðèêðåïëåííûéêîíòèíãåíò áîëåå 20 òûñ. ÷åëîâåê). Íàãîñïèòàëü âîçëîæåíû çàäà÷è ïî äàëüíåé-øåìó ñîâåðøåíñòâîâàíèþ ëå÷åáíî-ïðî-ôèëàêòè÷åñêèõ ìåðîïðèÿòèé â âîéñêàõ,ñîõðàíåíèþ ãàðàíòèðîâàííîãî óðîâíÿîêàçàíèÿ êâàëèôèöèðîâàííîé è ýëåìåí-òîâ ñïåöèàëèçèðîâàííîé ìåäèöèíñêîéïîìîùè âñåì êîíòèíãåíòàì, èìåþùèìïðàâî íà ìåäèöèíñêîå îáåñïå÷åíèå çàñ÷åò ñðåäñòâ Ìèíîáîðîíû Ðîññèè â ñî-îòâåòñòâèè ñ äåéñòâóþùèì çàêîíîäà-òåëüñòâîì ÐÔ.

Ñåãîäíÿ ñûçðàíñêèé âîåííûé ãîñ-ïèòàëü – ñîâðåìåííîå ëå÷åáíî-ïðîôè-ëàêòè÷åñêîå ó÷ðåæäåíèå Öåíòðàëüíîãîâîåííîãî îêðóãà, îñíàùåííîå íîâåéøåéìåäèöèíñêîé àïïàðàòóðîé: óëüòðàçâóêî-âûìè è ëàçåðíûìè óñòàíîâêàìè, öèôðî-âûì ôëþîðîãðàôîì, ýíäîñêîïè÷åñêîéñòîéêîé, ýëåêòðîêàðäèîãðàôîì, ëàáîðà-

*Ñ äåêàáðÿ 2009 ã. êîëëåêòèâ ãîñïèòàëÿ âîçãëàâ-ëÿåò ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáûÀíäðåé Àíàòîëüåâè÷ Ñèáðÿåâ. – Ðåä.


ÎÔÈÖÈÀËÜÍÛÉ ÎÒÄÅË

Þ Á È Ë Å È

© Ñ.Í.ÁÓÍÈÍ, Â.Ð.ÃÎÔÌÀÍ, 2011ÓÄÊ 61:355 (092 Ãîâîðóí Ì.È.)

15 íîÿáðÿ 2011 ã. èñïîëíèëîñü 60 ëåò íà÷àëüíèêó êàôåäðû îòî-ëàðèíãîëîãèè Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà – ãëàâ-íîìó îòîðèíîëàðèíãîëîãó ÌÎ ÐÔ, çàñëóæåííîìó âðà÷ó ÐÔ, äîêòîðóìåäèöèíñêèõ íàóê, ïðîôåññîðó ïîëêîâíèêó ìåäèöèíñêîé ñëóæáûÌèõàèëó Èâàíîâè÷ó Ãîâîðóíó.

Ì.È.Ãîâîðóí ðîäèëñÿ â Êèðîâîãðàäñêîé îáëàñòè. Â 1970 ã. îêîí÷èëìåäèöèíñêîå ó÷èëèùå, ïîñëå ÷åãî ðàáîòàë ôåëüäøåðîì â äåðåâíå. Ïîñòó-ïèâ â ×åðíîâèöêèé ìåäèöèíñêèé èíñòèòóò, â 1974 ã. ïåðåâåëñÿ íà Âîåííî-ìåäèöèíñêèé ôàêóëüòåò ïðè Ñàðàòîâñêîì ãîñóäàðñòâåííîì ìåäèöèíñêîìèíñòèòóòå. Ïîñëå åãî îêîí÷àíèÿ â 1976 ã. áûë íàïðàâëåí â Ìîñêîâñêèéâîåííûé îêðóã íà äîëæíîñòü âðà÷à ÷àñòè – íà÷àëüíèêà ìåäèöèíñêîãî ïóíêòà.

Ïîñëå îáó÷åíèÿ â êëèíè÷åñêîé îðäèíàòóðå ÂÌåäÀ Ìèõàèë Èâàíîâè÷ áûë íàçíà÷åíñòàðøèì îðäèíàòîðîì êëèíèêè îòîðèíîëàðèíãîëîãèè àêàäåìèè (1985), à â 1987 ã. – ïðå-ïîäàâàòåëåì ýòîé êàôåäðû. Íàïðàâëÿëñÿ â àðìåéñêèé ãîñïèòàëü âî âðåìÿ âîéíû â Àôãàíè-ñòàíå, äëÿ ëèêâèäàöèè ïîñëåäñòâèé çåìëåòðÿñåíèÿ â Àðìåíèè, ëè÷íî ïðîîïåðèðîâàë ñîòíèðàíåíûõ è áîëüíûõ.

Â 1997 ã. Ì.È.Ãîâîðóíà íàçíà÷èëè ïîìîùíèêîì íà÷àëüíèêà êëèíèêè ïî ëå÷åáíîé ðàáî-òå, à â 2003 ã. – íà÷àëüíèêîì êàôåäðû îòîëàðèíãîëîãèè àêàäåìèè – ãëàâíûì îòîðèíîëàðèíãî-ëîãîì ÌÎ ÐÔ.

Ìèõàèë Èâàíîâè÷ – àâòîð è ñîàâòîð áîëåå 360 íàó÷íûõ ðàáîò, 6 ìîíîãðàôèé, 3 ðóêî-âîäñòâ äëÿ âðà÷åé, 23 ó÷åáíûõ ïîñîáèé, 3 çàÿâîê íà ïàòåíòû, áîëåå 70 ðàöèîíàëèçàòîðñêèõïðåäëîæåíèé. Ïîä åãî ðóêîâîäñòâîì çàùèùåíî 12 êàíäèäàòñêèõ äèññåðòàöèé.

Ì.È.Ãîâîðóí èçáèðàëñÿ ïðåäñåäàòåëåì Îáùåñòâà îòîðèíîëàðèíãîëîãîâ Ñàíêò-Ïåòåð-áóðãà, âõîäèò â ñîñòàâ ïðàâëåíèÿ Îáùåñòâà ðèíîëîãîâ Ðîññèè, Ó÷åíîãî ñîâåòà ÂÌåäÀè õèðóðãè÷åñêîãî äèññåðòàöèîííîãî ñîâåòà àêàäåìèè, ãîðîäñêîé êîìèññèè ïî àòòåñòàöèèâðà÷åé-îòîëàðèíãîëîãîâ.

Âêëàä Ìèõàèëà Èâàíîâè÷à â ñîõðàíåíèå çäîðîâüÿ âîåííîñëóæàùèõ îòìå÷åí ìåäàëüþ«Çà áîåâûå çàñëóãè», çíàêîì «Îòëè÷íèêó çäðàâîîõðàíåíèÿ» è ìíîãèìè äðóãèìè íàãðàäàìè.

Êîìàíäîâàíèå Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ Ìèíèñòåðñòâà îáîðîíû Ðîñ-ñèéñêîé Ôåäåðàöèè, ðóêîâîäñòâî è ñîòðóäíèêè Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðî-âà, ðåäàêöèîííàÿ êîëëåãèÿ «Âîåííî-ìåäèöèíñêîãî æóðíàëà», ó÷åíèêè è äðóçüÿ ñåðäå÷íî ïî-çäðàâëÿþò Ìèõàèëà Èâàíîâè÷à Ãîâîðóíà ñ þáèëååì, æåëàþò åìó êðåïêîãî çäîðîâüÿ, ñ÷àñòüÿè óñïåõîâ â òðóäå.

© À.Ê.ÑÎÁÎËÅÍÊÎ, Â.Ð.ÌÅÄÂÅÄÅÂ, Ë.Ë.ÃÀËÈÍ, 2011ÓÄÊ 61:355 (092 Äðàêèí È.Ñ.)

2 îêòÿáðÿ 2011 ã. èñïîëíèëîñü 75 ëåò âåòåðàíó Âîîðóæåííûõ Ñèë,áûâøåìó íà÷àëüíèêó îòäåëà – çàìåñòèòåëþ ïðåäñåäàòåëÿ Íàó÷íî-òåõíè÷åñêîãî êîìèòåòà ÖÂÌÓ ÌÎ, ëàóðåàòó Ãîñóäàðñòâåííîé ïðåìèèÑÑÑÐ, ïîëêîâíèêó ìåäèöèíñêîé ñëóæáû â îòñòàâêå Èâàíó Ñåðãååâè÷óÄðàêèíó.

È.Ñ.Äðàêèí ðîäèëñÿ â ã. Îìñêå. Îêîí÷èë Âîåííî-ìîðñêîå àâèà-öèîííî-òåõíè÷åñêîå ó÷èëèùå, çàòåì Âîåííî-ìåäèöèíñêóþ àêàäåìèþèì. Ñ.Ì.Êèðîâà. Â 1966–1971 ãã. ñëóæèë â Þæíîé ãðóïïå âîéñê íà-÷àëüíèêîì ìåäèöèíñêîãî ïóíêòà îòäåëüíîãî áàòàëüîíà, îôèöåðîì, ñòàð-øèì îôèöåðîì ìåäèöèíñêîãî îòäåëà ÞÃÂ. Â 1968 ã. â ñîñòàâå ïåðå-äîâîé ãðóïïû ïðè îïåðàòèâíîì êîìàíäîâàíèè ÞÃÂ îñóùåñòâëÿë ìå-

äèöèíñêîå îáåñïå÷åíèå ââîäà îãðàíè÷åííîãî êîíòèíãåíòà ñîâåòñêèõ âîéñê íà òåððèòîðèþ×åõîñëîâàêèè. Â 1971 ã. íàçíà÷åí ñòàðøèì îôèöåðîì îðãàíèçàöèîííî-ìîáèëèçàöèîííîãî


ÎÔÈÖÈÀËÜÍÛÉ ÎÒÄÅË

© Ì.Â.ÏÎÄÄÓÁÍÛÉ, Ë.Ë.ÃÀËÈÍ, Â.Â.ÁÓÇÓÍÎÂ, 2011ÓÄÊ 61:355 (092 Ìàêñèìîâ Þ.À.)

13 íîÿáðÿ 2011 ã. èñïîëíèëîñü 75 ëåò áûâøåìó çàìåñòèòåëþãëàâíîãî ðåäàêòîðà «Âîåííî-ìåäèöèíñêîãî æóðíàëà», âîåííîìó ïñèõî-ôèçèîëîãó, êàíäèäàòó ìåäèöèíñêèõ íàóê ïîëêîâíèêó ìåäèöèíñêîéñëóæáû â îòñòàâêå Þðèþ Àíàòîëüåâè÷ó Ìàêñèìîâó.

Þ.À.Ìàêñèìîâ ðîäèëñÿ â Ìîñêâå â ñåìüå âîåííîãî âðà÷à. Ïîñëåîêîí÷àíèÿ â 1961 ã. 1-ãî Ìîñêîâñêîãî ìåäèöèíñêîãî èíñòèòóòàèì. È.Ì.Ñå÷åíîâà áûë ïðèçâàí â Âîîðóæåííûå Ñèëû íà äîëæíîñòüìëàäøåãî âðà÷à ìåäèöèíñêîãî ïóíêòà ïîëêà.

Â îêòÿáðå 1962 ã. îí áûë íàçíà÷åí ìëàäøèì íàó÷íûì ñîòðóä-íèêîì Ãîñóäàðñòâåííîãî íàó÷íî-èññëåäîâàòåëüñêîãî èñïûòàòåëüíîãîèíñòèòóòà àâèàöèîííîé è êîñìè÷åñêîé ìåäèöèíû ÌÎ. Â 1970 ã.

Þ.À.Ìàêñèìîâ ïåðåõîäèò íà ïîïðèùå ìåäèöèíñêîé íàó÷íîé æóðíàëèñòèêè â êà÷åñòâåñòàðøåãî îôèöåðà îòäåëà ðåäàêöèè «Âîåííî-ìåäèöèíñêîãî æóðíàëà», à â 1974 ã. íàçíà÷àåòñÿîòâåòñòâåííûì ñåêðåòàðåì, ÷ëåíîì ðåäàêöèîííîé êîëëåãèè æóðíàëà.

Ñ èþëÿ 1978 ïî ÿíâàðü 1992 ã. Þðèé Àíàòîëüåâè÷ – çàìåñòèòåëü ãëàâíîãî ðåäàêòîðà«Âîåííî-ìåäèöèíñêîãî æóðíàëà». Â ýòîò ïåðèîä îí âíåñ âåñîìûé âêëàä â ïîâûøåíèå òåîðåòè-÷åñêîãî óðîâíÿ è íàó÷íî-ïðàêòè÷åñêîãî çíà÷åíèÿ æóðíàëà, áîåâîé ãîòîâíîñòè ìåäèöèíñêîéñëóæáû àðìèè è ôëîòà.

Ðàòíûé è òðóäîâîé ïóòü Þ.À.Ìàêñèìîâà îòìå÷åí îðäåíîì «Çà ñëóæáó Ðîäèíå â Âîîðó-æåííûõ Ñèëàõ ÑÑÑÐ» III ñòåïåíè, ìíîãèìè ìåäàëÿìè, â ò. ÷. 6 ìåäàëÿìè Âûñòàâêè äîñòèæå-íèé íàðîäíîãî õîçÿéñòâà ÑÑÑÐ, è çíàêîì «Îòëè÷íèêó çäðàâîîõðàíåíèÿ».

Êîìàíäîâàíèå Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ Ìèíèñòåðñòâà îáîðîíû Ðîñ-ñèéñêîé Ôåäåðàöèè, ðåäàêöèîííàÿ êîëëåãèÿ «Âîåííî-ìåäèöèíñêîãî æóðíàëà» ñåðäå÷íîïîçäðàâëÿþò Þðèÿ Àíàòîëüåâè÷à Ìàêñèìîâà ñ þáèëååì, æåëàþò åìó êðåïêîãî çäîðîâüÿè ñ÷àñòüÿ.

Êîëëåêòèâ ðåäàêöèè «Âîåííî-ìåäèöèíñêîãî æóðíàëà» ñ ãëóáîêèì ïðèñêîðáèåì èç-âåùàåò, ÷òî 4 íîÿáðÿ 2011 ã. íà 91-ì ãîäó æèçíè ñêîí÷àëñÿ áûâøèé ãëàâíûé ðåäàêòîðæóðíàëà (1968–1978), âåòåðàí Âåëèêîé Îòå÷åñòâåííîé âîéíû, ÷ëåí Ñîþçà æóðíàëèñòîâÌîñêâû, êàíäèäàò ìåäèöèíñêèõ íàóê ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå

ÂÎÐÎÏÀÉÀëåêñàíäð Âàñèëüåâè÷,

è âûðàæàåò ñîáîëåçíîâàíèå ðîäíûì è áëèçêèì ïîêîéíîãî.

îòäåëà Øòàáà Òûëà ÂÑ ÑÑÑÐ. Â 1979 ã. ïåðåâåäåí íà äîëæíîñòü íà÷àëüíèêà îòäåëà – çàìåñòè-òåëÿ ïðåäñåäàòåëÿ Íàó÷íî-òåõíè÷åñêîãî êîìèòåòà, ãäå ïðîñëóæèë ïî 1992 ã. È.Ñ.Äðàêèí –ó÷àñòíèê áîåâûõ äåéñòâèé â Àôãàíèñòàíå, ãäå íåïîñðåäñòâåííî ïðîâîäèë äîîñíàùåíèå40-é àðìèè íîâûìè ìåäèöèíñêèìè èçäåëèÿìè, îòðàáàòûâàë âîïðîñû îêàçàíèÿ ïîìîùèè ýâàêóàöèè ðàíåíûõ â ãîðíûõ óñëîâèÿõ, ñîçäàíèÿ ñïåöèàëüíûõ òåõíè÷åñêèõ ñðåäñòâ è êîì-ïëåêòîâ äëÿ ýòèõ öåëåé.

Èâàí Ñåðãååâè÷ áûë ÷ëåíîì êîìèññèè Êîìèòåòà ïî íîâîé ìåäèöèíñêîé òåõíèêåÌÇ ÐÔ è ÷ëåíîì Ñîâåòà ïî íîâûì òåõíîëîãèÿì Ìèíèñòåðñòâà íàóêè. Ñ 1993 ïî 1997 ã.îí – ãåíåðàëüíûé äèðåêòîð ÍÏÖ «Ðåñóðñ», ñ 1998 ã. – ðóêîâîäèòåëü àïïàðàòà ïðåçèäèóìàìåæðåãèîíàëüíîé îáùåñòâåííîé îðãàíèçàöèè Àêàäåìèè ìåäèêî-òåõíè÷åñêèõ íàóê.

Çàñëóãè È.Ñ.Äðàêèíà îòìå÷åíû îðäåíîì «Çà ñëóæáó Ðîäèíå â Âîîðóæåííûõ Ñèëàõ ÑÑÑÐ»III ñòåïåíè è ìíîãèìè ìåäàëÿìè.

Êîìàíäîâàíèå Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ Ìèíèñòåðñòâà îáîðîíûÐîññèéñêîé Ôåäåðàöèè, ðóêîâîäñòâî Àêàäåìèè ìåäèêî-òåõíè÷åñêèõ íàóê, ðåäàêöèîííàÿêîëëåãèÿ «Âîåííî-ìåäèöèíñêîãî æóðíàëà», äðóçüÿ è òîâàðèùè ñåðäå÷íî ïîçäðàâëÿþò ÈâàíàÑåðãååâè÷à Äðàêèíà ñ þáèëååì, æåëàþò åìó êðåïêîãî çäîðîâüÿ, ñ÷àñòüÿ è íîâûõ óñïåõîâ.

* * *


ÊÐÈÒÈÊÀ È ÁÈÁËÈÎÃÐÀÔÈß

© È.Ë.ÌÛÇÍÈÊÎÂ, 2011ÓÄÊ 616-057.36-07

Íîâàÿ êíèãà î ñêðèíèíãîâîé äèàãíîñòèêåóðîâíÿ çäîðîâüÿ

ÌÛÇÍÈÊÎÂ È.Ë., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà

Ìåäèöèíñêàÿ ñëóæáà Ñåâåðíîãî ôëîòà, ã. Ñåâåðîìîðñê

Âûøëà â ñâåò êíèãà «Èíäèâèäóàëüíûå

ïîêàçàòåëè ñèñòåìû êðîâîîáðàùåíèÿ»1,

ðóêîïèñü êîòîðîé áûëà îêîí÷àòåëüíî ïîäãî-

òîâëåíà äëÿ ïå÷àòè Ëüâîì Èãîðåâè÷åì Ãëèêî.

Êíèãà îðèãèíàëüíî è èíòåðåñíî ñêîìïî-

íîâàíà. Ïåðâûå ñòðàíèöû èçäàíèÿ ïîñâÿùå-

íû ïàìÿòè òîâàðèùà è íàó÷íîãî ñîðàòíèêà

Ë.È.Ãëèêî, ñ êîòîðûì îíè íà ïðîòÿæåíèè

äîëãîãî âðåìåíè ðàçðàáàòûâàëè àêòóàëüíóþ

äëÿ âîåííî-ìîðñêîé ìåäèöèíû òåìàòèêó.

Ñêîí÷àâøèéñÿ â èþëå 2010 ã. Âëàäèìèð

Ãðèãîðüåâè÷ Ðåøåòíåâ – äîöåíò êàôåäðû

âîåííî-ìîðñêîé è ãîñïèòàëüíîé òåðàïèè

Âîåííî-ìåäèöèíñêîé àêàäåìèè áûë ÿðêèì

ïðåäñòàâèòåëåì ðóññêîé êëèíè÷åñêîé øêî-

ëû òåðàïåâòîâ.

Â ïðåäèñëîâèè àâòîð êðàòêî çíàêîìèò

÷èòàòåëåé ñ ïðè÷èíàìè, ïîáóäèâøèìè

ðàçðàáîòàòü ýòî ìåòîäè÷åñêîå íàïðàâëåíèå,

íå èìåþùåå àíàëîãîâ â ïîäõîäå ê ýêñïðåññ-

äèàãíîñòèêå íåíîçîëîãè÷åñêèõ ñîñòîÿíèé

ó ÷åëîâåêà, äîñòóïíîå â ïðèìåíåíèè è ïî-

òðåáíîå âîéñêîâîìó çâåíó òàêòè÷åñêîãî è îïå-

ðàòèâíîãî óðîâíÿ.

Ïîâåñòâóÿ î ôèçèîëîãè÷åñêèõ ïðåä-

ïîñûëêàõ äëÿ òîãî èëè èíîãî äèàãíîñòè÷å-

ñêîãî ïðèåìà, àâòîð çíàêîìèò ÷èòàòåëÿ ñ ïåð-

ñîíàëèÿìè, ÷üè òðóäû «êèðïè÷èêàìè» âû-

ñòðàèâàëè ñòðîéíóþ òåîðèþ ìàòåìàòè÷åñêîãî

ïîäõîäà â ïðàêòè÷åñêîé ìåäèöèíå.

Èìåÿ îïûò íàó÷íûõ èññëåäîâàíèé ïî

âîïðîñàì ïðîãíîçèðîâàíèÿ ïðîåêòíûõ è ýêñ-

ïëóàòàöèîííûõ õàðàêòåðèñòèê îáèòàåìîñòè

áîåâûõ îáúåêòîâ Âîåííî-ìîðñêîãî ôëîòà,

Ë.È.Ãëèêî ðåàëèçîâàë â êëèíè÷åñêîì àñïåêòå

õîðîøî èçâåñòíûé âðà÷àì-ãèãèåíèñòàì è ôè-çèîëîãàì ïðèíöèï ñèãìàëüíîãî ìîäåëèðî-âàíèÿ ôèçèîëîãè÷åñêèõ ïàðàìåòðîâ â ðàìêàõòåîðèè âåðîÿòíîñòè, ÷òî ïîçâîëÿåò âûíîñèòüèòîãîâóþ ñðàâíèòåëüíóþ îöåíêó ñòàòóñà ìî-ðÿêà îòíîñèòåëüíî ãðóïïîâîé, ïîïóëÿöèîí-íîé èëè ýòàïíîé «ñðåäíåé âåëè÷èíû».

Ýòî íå ïðîñòî êà÷åñòâåííàÿ ìîíîãðàôèÿ,íî è ïîëíîâåñíûé ó÷åáíèê, ðàñêðûâàþùèéìàëåíüêèå òàéíû áîëüøèõ äèàãíîñòè÷åñêèõâîçìîæíîñòåé, êîòîðûå ïðèìåíèìû è â íà-ó÷íîì ýêñïåðèìåíòå, è â êëèíè÷åñêîé ïðàê-òèêå, è â ýêñïåðòíîé ðàáîòå, ïðè äèñïàíñå-ðèçàöèè è ðåàáèëèòàöèè âîåííîñëóæàùèõ,ñîçäàíèè àëãîðèòìîâ îïåðàòèâíîãî êîíòðî-ëÿ çà ôóíêöèÿìè îïåðàòîðîâ â ñëîæíûõ áîå-âûõ ñèñòåìàõ.

Â êíèãå ñîáðàíû è êðèòè÷åñêè ïðåäñòàâ-ëåíû 76 ñïîñîáîâ ñêðèíèíãîâîé äèàãíîñòèêèóðîâíÿ çäîðîâüÿ ÷åëîâåêà, èõ ïðàêòè÷åñêîåïðèìåíåíèå ïðè îáñëåäîâàíèè áîëüøèõ ãðóïïíàñåëåíèÿ, à òàêæå â âîéñêàõ è íà ñèëàõ ôëîòà,ïîêàçàíû êîíòðîëüíûå ïðèìåðû, ïîçâîëÿþ-ùèå ïðåäåëüíî ÿñíî ïðîäåìîíñòðèðîâàòü ÷è-òàòåëþ ïîðÿäîê èñïîëüçîâàíèÿ òîé èëè èíîéìåòîäèêè â ðàçëè÷íûõ óñëîâèÿõ.

Â ïðèëîæåíèÿ âêëþ÷åíû òàáëèöû, óäîá-

íûå äëÿ ïðèìåíåíèÿ â ðàáîòå.Ðàíåå àâòîðàìè áûëè îïóáëèêîâàíû ïî-

ñîáèÿ è ñòàòüè ïî ïðîáëåìàì ýêñïðåññ-ìî-

äåëèðîâàíèÿ ôóíêöèîíàëüíûõ ñîñòîÿíèéñïåöèàëèñòîâ ÂÌÔ, â ðåöåíçèðóåìîì èçäà-íèè ñîáðàííûå âîåäèíî.

Ìû óæå íåîäíîêðàòíî îòìå÷àëè, â ò. ÷. íàñòðàíèöàõ «Âîåííî-ìåäèöèíñêîãî æóðíàëà»2,÷òî â ñâÿçè ñ ïîâûøåíèåì ðîëè ïðîôèëàêòè-

÷åñêîé íàïðàâëåííîñòè âîåííîé ìåäèöèíû1Ðåøåòíåâ Â.Ã., Ãëèêî Ë.È. Èíäèâèäóàëüíûå

ïîêàçàòåëè ñèñòåìû êðîâîîáðàùåíèÿ / Ïîäðåä. ÷ë.-êîð. ÐÀÌÍ, çàñëóæåííîãî äåÿòåëÿíàóêè ÐÔ ïðîô. Â.Á.Ñèìîíåíêî. – Ì.: Ýêî-Ïðåññ, 2011. – 208 ñ.

2Âîåí.-ìåä. æóðí. – 2003. – Ò. 324, ¹ 10. –Ñ. 53–57; 2008. – Ò. 329, ¹ 7 – Ñ. 30–33;2009. – Ò. 330, ¹ 10. – Ñ. 46–53.


ÊÐÈÒÈÊÀ È ÁÈÁËÈÎÃÐÀÔÈß

Çà ñîäåðæàíèå è äîñòîâåðíîñòü ñâåäåíèé â ðåêëàìíîì îáúÿâëåíèèîòâåòñòâåííîñòü íåñåò ðåêëàìîäàòåëü.

Ïå÷àòü îôñåòíàÿ.Óñë. êð.-îòò. 9,8.Òèðàæ 2438 ýêç.

Ïîäïèñàíî ê ïå÷àòè 22.11.11.Áóìàãà îôñåòíàÿ.Ó÷.-èçä. ë. 8,6.Êàòàëîæíàÿ öåíà 54 ð. 00 ê.

Îòïå÷àòàíî â òèïîãðàôèè ÎÀÎ «Èçäàòåëüñêèé äîì «Êðàñíàÿ çâåçäà»123007, ã. Ìîñêâà, Õîðîøåâñêîå øîññå, 38, http://www.redstarph.ru

Ó÷ðåäèòåëü – Ìèíèñòåðñòâî îáîðîíû Ðîññèéñêîé Ôåäåðàöèè.Çàðåãèñòðèðîâàí Ìèíèñòåðñòâîì ïå÷àòè è èíôîðìàöèè Ðîññèéñêîé Ôåäåðàöèè.Íîìåð ðåãèñòðàöèîííîãî ñâèäåòåëüñòâà 01975 îò 30.12.1992 ã.

Ñäàíî â íàáîð 27.10.11.Ôîðìàò 70½1081/

16.

Óñë. ïå÷. ë. 8,4.Çàêàç ¹ 5239.

Ìàêåò è êîìïüþòåðíàÿ âåðñòêà Â.Â.ÌàòèèâàÏåðåâîä Â.Â.Ôåäîòîâîé

íåîáõîäèìî âêëþ÷èòü ñàìîñòîÿòåëüíûì ðàç-

äåëîì â ïëàíû áîåâîé ïîäãîòîâêè è â îò÷åò-íûå äîêóìåíòû ïî íèì îöåíêó âëèÿíèÿ ïðî-âåäåííîãî ìåðîïðèÿòèÿ íà ñîñòîÿíèå çäîðî-

âüÿ âîåííîñëóæàùèõ èç ÷èñëà ïðèâëåêàåìûõñèë ñ ó÷åòîì âñåõ ôàêòîðîâ, êîòîðûå âîçäåé-ñòâîâàëè íà ÷åëîâåêà â ïåðèîä ïîäãîòîâêè

è àêòèâíîé ôàçû ñîáûòèÿ. Äàííûé ðàçäåëïëàíà è îò÷åòà ìîæåò áûòü ïîèìåíîâàí êàê«ìåäèêî-ôèçèîëîãè÷åñêîå ñîïðîâîæäåíèå

ñèë (âîéñê)» è îñíîâûâàòüñÿ íà ðàçðàáîòêàõË.È.Ãëèêî è Â.Ã.Ðåøåòíåâà.

Àâòîðîì ýòèõ ñòðîê ðàíåå îòìå÷àëàñü

íåîáõîäèìîñòü âêëþ÷åíèÿ íåêîòîðûõ èç íà-çâàííûõ ïîäõîäîâ â êà÷åñòâå ïðèëîæåíèÿê ðàçäåëó V Ðóêîâîäñòâà ïî ìåäèöèíñêîìóîáåñïå÷åíèþ Âîîðóæåííûõ Ñèë ÐîññèéñêîéÔåäåðàöèè íà ìèðíîå âðåìÿ («Ìåäèöèíñêèéêîíòðîëü çà ó÷åáíî-áîåâîé ïîäãîòîâêîé âî-åííîñëóæàùèõ»).

Íàøà ïîçèöèÿ îñíîâàíà íà ïðàêòè÷å-ñêîì ïðèìåíåíèè ìåòîäèê Ë.È.Ãëèêî íà äî-âðà÷åáíîì ýòàïå ïðè äèñïàíñåðèçàöèè ïîä-âîäíèêîâ èç ñîñòàâà ýêèïàæåé àòîìíîé ïîä-âîäíîé ëîäêè îäíîãî èç ñîåäèíåíèé è âî-åííîñëóæàùèõ áåðåãîâûõ âîèíñêèõ ÷àñòåéâ âîåííîé ïîëèêëèíèêå ãàðíèçîíà Âèäÿåâîâ 2001–2009 ãã.

Â çàêëþ÷åíèå õî÷åòñÿ ñêàçàòü òàêæå íå-ìíîãî ëè÷íîãî îá îäíîì èç àâòîðîâ êíèãè.

Ë.È.Ãëèêî â 1958 ã. îêîí÷èë ôàêóëüòåòïîäãîòîâêè âðà÷åé äëÿ ÂÌÔ Âîåííî-ìåäè-öèíñêîé àêàäåìèè, ïîñëå âûïóñêà ñóäüáà çà-áðîñèëà åãî â ìîðñêóþ àâèàöèþ Áàëòèéñêîãîôëîòà, ãäå îí ñëóæèë â ïåðèîä 1960-õ ãã.,çàòåì – â 1970-õ – ðàêåòíî-çåíèòíûå ÷àñòèÒèõîîêåàíñêîãî ôëîòà, â 1980-õ – Ëåíèíãðàä-ñêèé âîåííûé îêðóã. Ñ 1990-õ – ðàáîòà â ñèñ-

òåìå íàó÷íî-èññëåäîâàòåëüñêèõ èíñòèòóòîâ

Ìèíèñòåðñòâà îáîðîíû ÐÔ.Â ñòåíû 1-ãî ÍÈÈ (êîðàáëåñòðîåíèÿ)

ÂÌÔ îí ïðèøåë, èìåÿ îãðîìíûé îïûò ìå-

äèöèíñêîãî îáåñïå÷åíèÿ âîéñê, âîïëîùàÿñâîè èäåè ïðè ðàçðàáîòêå ñëîæíûõ îáèòàå-ìûõ òåõíè÷åñêèõ ñèñòåì. Èìåííî çäåñü ïðè

îáñóæäåíèè ïðîáëåì êîíòðîëÿ çà ôóíêöè-ÿìè îïåðàòîðîâ ñî ñïåöèàëèñòàìè ïî îáèòà-åìîñòè êîðàáëåé ìíå äîâåëîñü ïîçíàêîìèòü-

ñÿ ñ ýòèì íåîðäèíàðíûì ó÷åíûì. Â õîäå òîéäèñêóññèè ìíå ïðèøëîñü çàäóìàòüñÿ íàäìíîãèìè ïðàêòè÷åñêèìè è òåîðåòè÷åñêèìè

ïðîáëåìàìè ïðîåêòèðîâàíèÿ ýêñïåðèìåíòà,íåîáõîäèìîñòè è äîñòàòî÷íîñòè îáúåìà è ñïå-öèôè÷íîñòè èñïîëüçóåìûõ ìåòîäèê ïðè îïðå-äåëåíèè äèíàìèêè ôóíêöèîíàëüíûõ èçìå-íåíèé â îðãàíèçìå ìîðÿêà, ÷òî ñûãðàëî ñâîþðîëü â ôîðìèðîâàíèè ìîåãî íàó÷íîãî ìèðî-âîççðåíèÿ.

Îáëàäàþùèé ýíöèêëîïåäè÷åñêèìè çíà-íèÿìè, Ë.È.Ãëèêî â ñâîè ãîäû åùå ïî-þíî-øåñêè àçàðòíûé èññëåäîâàòåëü, óìååò ìåòî-äè÷åñêè ãðàìîòíî è ïîñëåäîâàòåëüíî èçëà-ãàòü ñâîþ ïîçèöèþ, áûñòðî ñõâàòûâàòü ïðî-áëåìíûå âîïðîñû è âûíîñèòü ïî íèì êâàëè-ôèöèðîâàííîå ñóæäåíèå.

«Èíäèâèäóàëüíûå ïîêàçàòåëè ñèñòåìûêðîâîîáðàùåíèÿ» – íå ïðîñòî êíèãà, ïîëîæå-íèÿ êîòîðîé âûâåðåíû âðåìåíåì, íî è ïàìÿò-íèê äðóæáå òàëàíòëèâûõ è ñêðîìíûõ ëþäåé,âîåííî-ìîðñêèõ âðà÷åé.

Ìíå êàæåòñÿ, ÷òî ó ýòîé êíèãè äîëæåíáûòü ìíîãîêðàòíî áîëüøèé òèðàæ, ò. ê. îíàìîæåò ñòàòü ó÷åáíûì ïîñîáèåì ïðîôèëüíûõêàôåäð ïî ïðîãðàììàì ïîäãîòîâêè âðà÷åé äëÿÂîîðóæåííûõ Ñèë ÐÔ êàê êëèíè÷åñêîãî, òàêè ãèãèåíè÷åñêîãî ïðîôèëÿ.

Documents

¹ 11 Âîåííî-ìåäèöèíñêèé æóðíàësc.mil.ru/files/morf/military/archive/N11_2011_ноябрь.pdf · 14 «Âîåííî-ìåäèöèíñêèé æóðíàë», 11’2011