Клинические формы воспаления. Учебно-методическое пособие

ɗɤɫɫɭɞɚɰɢɹ

ɗɤɫɫɭɞɚɰɢɹ ɛɵɫɬɪɨ ɫɥɟɞɭɟɬ ɡɚ ɚɥɶɬɟɪɚɰɢɟɣ ɢ ɜɵɛɪɨɫɨɦ ɦɟɞɢɚɬɨɪɨɜ ɂɦɟɧɧɨ ɷɤɫɫɭɞɚɰɢɹ ɢɝɪɚɟɬ ɨɝɪɨɦɧɭɸ ɪɨɥɶ ɜ ɪɚɡɜɟɪɬɵɜɚɧɢɢ ɜɫɟɝɨ ɤɨɦɩɥɟɤɫɚ ɬɤɚɧɟɜɵɯ ɢɡɦɟɧɟɧɢɣ ɩɪɢ ɜɨɫɩɚɥɟɧɢɢ ȼ ɩɪɨɰɟɫɫɟ ɷɤɫɫɭɞɚɰɢɢ ɪɚɡɥɢɱɚɸɬ

Ɋɟɚɤɰɢɸ ɦɢɤɪɨɰɢɪɤɭɥɹɬɨɪɧɨɝɨ ɪɭɫɥɚ ɫ ɧɚɪɭɲɟɧɢɟɦ ɪɟɨɥɨɝɢɱɟɫɤɢɯ ɫɜɨɣɫɬɜ ɤɪɨɜɢ

ɉɪɨɹɜɥɟɧɢɟ ɩɨɜɵɲɟɧɧɨɣ ɫɨɫɭɞɢɫɬɨɣ ɩɪɨɧɢɰɚɟɦɨɫɬɢ ɧɚ ɭɪɨɜɧɟ ɦɢɤɪɨɰɢɪɤɭɥɹɬɨɪɧɨɝɨ ɪɭɫɥɚ

ɗɤɫɫɭɞɚɰɢɸ ± ɜɵɯɨɞ ɠɢɞɤɨɣ ɱɚɫɬɢ ɤɪɨɜɢ ɡɚ ɩɪɟɞɟɥɵ ɫɨɫɭɞɚɗɦɢɝɪɚɰɢɸ ɤɥɟɬɨɤ ɤɪɨɜɢ ɜ ɩɟɪɜɭɸ ɨɱɟɪɟɞɶ ɥɟɣɤɨɰɢɬɨɜ ɜ

ɨɤɪɭɠɚɸɳɢɟ ɬɤɚɧɢ

Ɋɟɚɤɰɢɹ ɦɢɤɪɨɰɢɪɤɭɥɹɬɨɪɧɨɝɨ ɪɭɫɥɚ - ɧɚɢɛɨɥɟɟ ɹɪɤɢɣ ɦɨɪɮɨɥɨɝɢɱɟɫɤɢɣ ɩɪɢɡɧɚɤ ɜɨɫɩɚɥɟɧɢɹ ɂɡɦɟɧɟɧɢɹ ɜ ɫɨɫɭɞɚɯ ɜɨɫɩɚɥɟɧɧɨɝɨ ɭɱɚɫɬɤɚ ɧɚɱɢɧɚɟɬɫɹ ɩɨɞ ɞɟɣɫɬɜɢɟɦ ɝɢɫɬɚɦɢɧɚ ɫ ɪɟɮɥɟɤɬɨɪɧɨɝɨ ɫɩɚɡɦɚ ɦɢɤɪɨɫɨɫɭɞɨɜ ɉɪɨɫɜɟɬɚɪɬɟɪɢɨɥ ɩɪɟɤɚɩɢɥɥɹɪɨɜ ɤɚɩɢɥɥɹɪɨɜ ɭɦɟɧɶɲɚɟɬɫɹ ɇɚɛɥɸɞɚɟɬɫɹ ɫɩɚɡɦ ɫɨɫɭɞɨɜ ɦɢɤɪɨɰɢɪɤɭɥɹɬɨɪɧɨɝɨ ɪɭɫɥɚ Ɋɚɡɜɢɜɚɟɬɫɹ ɚɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɟɦɢɹ ɇɨ ɱɭɬɶ ɩɨɡɠɟ ɜɨɡɧɢɤɚɟɬ ɪɟɥɚɤɫɚɰɢɹ ɫɨɫɭɞɨɜ ɩɪɨɢɫɯɨɞɢɬ ɪɚɫɲɢɪɟɧɢɟ ɢɯ ɩɪɨɫɜɟɬɚ ɨɫɨɛɟɧɧɨ ɭ ɜɟɧɭɥ ɢ ɩɟɪɟɩɨɥɧɟɧɢɟ ɷɬɢɯ ɫɨɫɭɞɨɜ ɤɪɨɜɶɸ Ɋɚɡɜɢɜɚɟɬɫɹ ɜɟɧɨɡɧɚɹ ɝɢɩɟɪɟɦɢɹ ɜ ɨɱɚɝɟ ɜɨɫɩɚɥɟɧɢɹ Ɂɚɬɟɦ ɪɚɡɜɢɜɚɟɬɫɹ ɫɬɚɡ ɇɚɛɥɸɞɚɟɬɫɹ ɤɪɚɟɜɨɟ ɫɬɨɹɧɢɟ ɥɟɣɤɨɰɢɬɨɜ ɦɚɪɝɢɧɚɰɢɹ

ɉɨɜɵɲɟɧɢɟ ɫɨɫɭɞɢɫɬɨɣ ɩɪɨɧɢɰɚɟɦɨɫɬɢ ɧɚɛɥɸɞɚɟɬɫɹ ɧɚ ɭɪɨɜɧɟ ɦɢɤɪɨɰɢɪɤɭɥɹɬɨɪɧɨɝɨ ɪɭɫɥɚ əɜɥɹɟɬɫɹ ɨɞɧɢɦ ɢɡ ɫɭɳɟɫɬɜɟɧɧɟɣɲɢɯ ɩɪɢɡɧɚɤɨɜɜɨɫɩɚɥɟɧɢɹɬɚɤɤɚɤɜɫɹɝɚɦɦɚɬɤɚɧɟɜɵɯɢɡɦɟɧɟɧɢɣɫɜɨɟɨɛɪɚɡɢɟ ɪɚɡɥɢɱɧɵɯ ɮɨɪɦ ɜɨɫɩɚɥɟɧɢɟ ɨɩɪɟɞɟɥɹɟɬɫɹ ɫɬɟɩɟɧɶɸ ɫɨɫɭɞɢɫɬɨɣ ɩɪɨɧɢɰɚɟɦɨɫɬɢ ɉɨɜɵɲɟɧɢɟ ɩɪɨɧɢɰɚɟɦɨɫɬɢ ɨɩɪɟɞɟɥɹɟɬɫɹ ɜɟɧɨɡɧɵɦ ɡɚɫɬɨɟɦ ɢ ɧɚɤɨɩɥɟɧɢɟɦ ɤɢɫɥɵɯ ɩɪɨɞɭɤɬɨɜ ɦɟɬɚɛɨɥɢɡɦɚ ɋ ɩɨɜɵɲɟɧɢɟɦ ɫɨɫɭɞɢɫɬɨɣ ɩɪɨɧɢɰɚɟɦɨɫɬɢ ɫɜɹɡɚɧɚ ɬɪɟɬɶɹ ɢ ɱɟɬɜɟɪɬɚɹ ɮɚɡɵ ɷɤɫɫɭɞɚɰɢɢ ± ɬɨ ɟɫɬɶ ɫɨɛɫɬɜɟɧɧɨ ɷɤɫɫɭɞɚɰɢɹ ɢ ɷɦɢɝɪɚɰɢɹ

11

ɗɤɫɫɭɞɚɰɢɹ ɢ ɷɦɢɝɪɚɰɢɹ ȼ ɩɟɪɜɭɸ ɨɱɟɪɟɞɶ ɡɚ ɩɪɟɞɟɥɵ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɜɵɯɨɞɢɬ ɠɢɞɤɚɹ ɱɚɫɬɶ ɤɪɨɜɢ ɬɨ ɟɫɬɶ ɠɢɞɤɨɫɬɶ ɜɨɞɚ ɢ ɛɟɥɤɢ ɩɥɚɡɦɵ ɉɪɢ ɷɬɨɦ ɮɨɪɦɢɪɭɟɬɫɹ ɠɢɞɤɢɣ ɷɤɫɫɭɞɚɬ ɉɨ ɦɟɪɟ ɩɨɜɵɲɟɧɢɹ ɫɨɫɭɞɢɫɬɨɣ ɩɪɨɧɢɰɚɟɦɨɫɬɢ ɡɚ ɩɪɟɞɟɥɵ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɜɵɯɨɞɹɬ ɤɥɟɬɤɢ ɤɪɨɜɢ ± ɪɚɡɜɢɜɚɟɬɫɹ ɷɦɢɝɪɚɰɢɹ ɢ ɮɨɪɦɢɪɭɸɬɫɹ ɛɨɥɟɟ ɩɥɨɬɧɵɟ ɜɢɞɵ ɷɤɫɫɭɞɚɬɚ ɇɚɪɹɞɭ ɫ ɷɬɢɦɢ ɩɪɨɰɟɫɫɚɦɢ ɛɭɞɟɬ ɮɨɪɦɢɪɨɜɚɬɶɫɹ ɢ ɬɚɤ ɧɚɡɵɜɚɟɦɵɣ ɤɥɟɬɨɱɧɵɣ ɢɧɮɢɥɶɬɪɚɬ ɤɨɬɨɪɵɣ ɫɨɫɬɨɢɬ ɢɡ ɤɥɟɬɨɤ ɭɫɥɨɜɧɨ ɝɟɦɚɬɨɝɟɧɧɨɝɨ ɢ ɝɢɫɬɨɝɟɧɧɨɝɨ ɬɤɚɧɟɜɨɝɨ ɩɪɨɢɫɯɨɠɞɟɧɢɹ

ɉɪɨɥɢɮɟɪɚɰɢɹ

ɉɪɨɥɢɮɟɪɚɰɢɹ ɢɥɢ ɪɚɡɦɧɨɠɟɧɢɟ ɜ ɨɱɚɝɟ ɜɨɫɩɚɥɟɧɢɹ ɤɥɟɬɨɤ ɹɜɥɹɟɬɫɹ ɫɜɨɟɨɛɪɚɡɧɨɣ ɡɚɜɟɪɲɚɸɳɟɣ ɫɬɚɞɢɟɣ ɜɨɫɩɚɥɟɧɢɹ ɤɨɝɞɚ ɩɪɨɢɫɯɨɞɢɬ ɨɝɪɚɧɢɱɟɧɢɟ ɨɱɚɝɚ ɜɨɫɩɚɥɟɧɢɹ ɨɬ ɨɤɪɭɠɚɸɳɟɣ ɨɬɧɨɫɢɬɟɥɶɧɨ ɡɞɨɪɨɜɨɣ ɬɤɚɧɢ ɉɪɨɥɢɮɟɪɚɰɢɹ ɜ ɨɱɚɝɟ ɜɨɫɩɚɥɟɧɢɹ ɧɚɛɥɸɞɚɟɬɫɹ ɧɚ ɜɫɟɦ ɩɪɨɬɹɠɟɧɢɢ ɜɨɫɩɚɥɢɬɟɥɶɧɨɣ ɪɟɚɤɰɢɢ ɧɨ ɷɬɨɬ ɩɪɨɰɟɫɫ ɦɨɠɟɬ ɛɵɬɶ ɜɵɪɚɠɟɧ ɩɨ ɪɚɡɧɨɦɭ ȼ ɨɱɚɝɟ ɜɨɫɩɚɥɟɧɢɹ ɪɚɡɦɧɨɠɚɸɬɫɹ ɦɟɡɟɧɯɢɦɚɥɶɧɵɟ ɤɚɦɛɢɚɥɶɧɵɟ ɚɞɜɟɧɬɢɰɢɚɧɚɥɶɧɵɟ ɪɟɬɢɤɭɥɹɪɧɵɟ ɷɧɞɨɬɟɥɢɚɥɶɧɵɟ ɤɥɟɬɤɢ ɚ ɬɚɤɠɟ ɪɚɡɦɧɨɠɚɸɬɫɹ Ɍ ɢ ȼ ɥɢɦɮɨɰɢɬɵ ɦɨɧɨɰɢɬɵ ȼɵɲɟɭɤɚɡɚɧɧɵɟ ɤɥɟɬɤɢ ɨɫɨɛɟɧɧɨ ɧɟɡɪɟɥɵɟ ɦɨɝɭɬ ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɬɶɫɹ ɜ ɪɚɡɥɢɱɧɵɟ ɤɥɟɬɤɢ ɧɨ

ɱɚɳɟ ɜɫɟɝɨ ɨɧɢ ɞɢɮɮɟɪɟɧɰɢɪɭɸɬɫɹ ɜ ɷɥɟɦɟɧɬɵ ɫɨɟɞɢɧɢɬɟɥɶɧɨɣ ɬɤɚɧɢ Ɍɚɤ ɞɢɮɮɟɪɟɧɰɢɪɭɹɫɶ ɦɟɡɟɧɯɢɦɚɥɶɧɵɟ ɢ ɤɚɦɛɢɚɥɶɧɵɟ ɤɥɟɬɤɢ

ɩɪɟɜɪɚɳɚɸɬɫɹ ɜ ɷɩɢɬɟɥɢɨɢɞɧɵɟ ɤɥɟɬɤɢ

Ƚɢɫɬɢɨɰɢɬɵ ɦɚɤɪɨɮɚɝɢ ȼ ɥɢɦɮɨɰɢɬɵ ɩɪɟɜɪɚɳɚɸɬɫɹ ɜ ɩɥɚɡɦɨɰɢɬɵ ɢɥɢ

ɩɥɚɡɦɚɬɢɱɟɫɤɢɟ ɤɥɟɬɤɢ

Ɇɨɧɨɰɢɬɵ ɩɪɟɜɪɚɳɚɸɬɫɹ ɜ ɦɚɤɪɨɮɚɝɢ ȼ ɢɬɨɝɟ ɜɫɟ ɷɬɢ ɤɪɭɝɥɨɤɥɟɬɨɱɧɵɟ ɷɥɟɦɟɧɬɵ ɮɨɪɦɢɪɭɸɬ ɡɪɟɥɭɸ

ɜɨɥɨɤɧɢɫɬɭɸ ɫɨɟɞɢɧɢɬɟɥɶɧɭɸ ɬɤɚɧɶ ɤɨɬɨɪɚɹ ɢ ɛɭɞɟɬ ɨɝɪɚɧɢɱɢɜɚɬɶ ɜɨɫɩɚɥɢɬɟɥɶɧɵɣ ɨɱɚɝ ɨɬ ɨɤɪɭɠɚɸɳɟɣ ɬɤɚɧɢ

12

Ⱦɢɚɝɧɨɫɬɢɤɚ ɢ ɞɢɮɮɟɪɟɧɰɢɚɥɶɧɚɹ ɞɢɚɝɧɨɫɬɢɤɚ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɨɜ ɨɛɳɢɟ ɜɨɩɪɨɫɵ

ɋɢɦɩɬɨɦɵ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɨɜ ɦɨɝɭɬ ɛɵɬɶ ɫɯɨɠɢ ɫ ɚɥɥɟɪɝɢɱɟɫɤɨɣ ɪɟɚɤɰɢɟɣ ɧɟɨɩɥɚɡɢɟɣ ɞɢɫɬɪɨɮɢɟɣ ɨɬɟɤɚɦɢ ɧɟ ɜɨɫɩɚɥɢɬɟɥɶɧɨɣ ɩɪɢɪɨɞɵ Ⱦɢɮɮɟɪɟɧɰɢɚɥɶɧɚɹ ɞɢɚɝɧɨɫɬɢɤɚ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɨɜ ɨɬ ɞɪɭɝɢɯ ɫɯɨɠɢɯ ɩɪɨɰɟɫɫɨɜ ɹɜɥɹɟɬɫɹ ɨɞɧɢɦ ɢɡ ɨɫɧɨɜɧɵɯ ɷɬɚɩɨɜ ɭɫɩɟɲɧɨɣ ɞɢɚɝɧɨɫɬɢɤɢ ɡɚɛɨɥɟɜɚɧɢɹ ɭ ɩɚɰɢɟɧɬɚ

Ɉɫɧɨɜɧɵɟ ɷɬɚɩɵ ɞɢɚɝɧɨɫɬɢɤɢ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɨɜ

ɋɛɨɪ ɚɧɚɦɧɟɡɚ ;ɨɫɬɪɨɟ ɧɚɱɚɥɨ ɹɜɧɚɹ ɩɪɢɱɢɧɚ ɬɪɚɜɦɚ

ɩɪɨɢɫɲɟɫɬɜɢɟ ɢɡɛɵɬɨɱɧɚɹ ɧɚɝɪɭɡɤɚ ɩɟɪɟɧɟɫɟɧɧɵɟ ɩɪɨɰɟɞɭɪɵ ɩɨɜɵɲɟɧɧɨɟ

ɜɧɢɦɚɧɢɟ ɤ ɨɩɪɟɞɟɥɟɧɧɨɣ ɡɨɧɟ

Ʉɥɢɧɢɱɟɫɤɚɹ ɞɢɚɝɧɨɫɬɢɤɚ ɧɚɥɢɱɢɟ ɩɟɧɬɚɞɵ UXERU WXPRU FRORU GRORU IXQFWLR ODHVD ɥɨɤɚɥɢɡɚɰɢɹ ɩɪɨɰɟɫɫɚ ɫɬɚɞɢɹ ɜɨɫɩɚɥɟɧɢɹ ɯɚɪɚɤɬɟɪ ɬɟɱɟɧɢɹ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ

ȼɢɡɭɚɥɶɧɚɹ ɞɢɚɝɧɨɫɬɢɤɚ ɍɁɂ Ɋɟɧɬɝɟɧ ɗɧɞɨɫɤɨɩɢɹ ɉɪɢ ɜɢɡɭɚɥɶɧɨɣ ɞɢɚɝɧɨɫɬɢɤɟ ɪɚɡɧɵɟ ɫɬɚɞɢɢ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ

ɦɨɠɧɨ ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɬɶ ɞɪɭɝ ɨɬ ɞɪɭɝɚ ɩɨ ɫɥɟɞɭɸɳɢɦ ɩɪɢɡɧɚɤɚɦ ɪɚɡɪɟɠɟɧɢɟ ɬɤɚɧɢ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ ɨɛ ɨɬɟɤɟ ɢɧɮɢɥɶɬɪɚɬ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɨɬɟɱɧɨɣ ɬɤɚɧɶɸ ɪɚɡɦɵɬɵɦ ɪɢɫɭɧɤɨɦ ɫ ɩɥɨɬɧɨɫɬɶɸ ɱɭɬɶ ɜɵɲɟ ɧɨɪɦɵ ɩɪɢ ɩɪɨɥɢɮɟɪɚɬɟ ɩɥɨɬɧɨɫɬɶ ɬɤɚɧɢ ɛɭɞɟɬ ɩɨɜɵɲɟɧɧɚɹ

ɨɛɳɟɤɥɢɧɢɱɟɫɤɢɣ ɚɧɚɥɢɡ ɤɪɨɜɢ ɈɄȺ ɤɪɨɜɢ ɛɢɨɯɢɦɢɱɟɫɤɢɣ ɚɧɚɥɢɡ ɤɪɨɜɢ

ȻȺɄ ɫɩɟɰɢɚɥɶɧɚɹ ɞɢɚɝɧɨɫɬɢɤɚ ± ɰɢɬɨɥɨɝɢɱɟɫɤɢɣ ɢ ɝɢɫɬɨɥɨɝɢɱɟɫɤɢɣ ɚɧɚɥɢɡ

ɜɢɞɨɢɡɦɟɧɟɧɧɨɣ ɬɤɚɧɢ Ɉɛɳɟɤɥɢɧɢɱɟɫɤɢɟ ɚɧɚɥɢɡɵ ɢɫɩɨɥɶɡɭɸɬɫɹ ɧɚ ɩɟɪɜɨɧɚɱɚɥɶɧɨɦ ɷɬɚɩɟ

ɞɢɚɝɧɨɫɬɢɤɢ ȼ ɈɄȺ ɤɪɨɜɢ ɧɚɛɥɸɞɚɟɬɫɹ ɥɟɣɤɨɰɢɬɨɡ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɧɟɣɬɪɨɮɢɥɶɧɵɣ ɉɪɢ ɨɫɬɪɨɦ ɬɟɱɟɧɢɟ ± ɛɟɡ ɫɞɜɢɝɚ ɩɪɢ ɯɪɨɧɢɱɟɫɤɨɦ ɬɟɱɟɧɢɢ

13

ɧɚɛɥɸɞɚɟɬɫɹ ɫɞɜɢɝ ɜɥɟɜɨ ɏɪɨɧɢɱɟɫɤɨɟ ɧɟɛɥɚɝɨɩɪɢɹɬɧɨɟ ɬɟɱɟɧɢɟ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ ɨɫɨɛɟɧɧɨ ɜ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ ɯɚɪɚɤɬɟɪɢɡɭɟɬ ɦɨɧɨɰɢɬɨɡ ɭɜɟɥɢɱɟɧɢɟ ɭɪɨɜɧɹ ɦɨɧɨɰɢɬɨɜ ɧɟ ɦɟɧɟɟ ɱɟɦ ɜ ɪɚɡɚ ɨɬ ɜɟɪɯɧɟɝɨ ɭɪɨɜɧɹ ɧɨɪɦɵ

ɇɚ ɷɬɚɩɟ ɜɵɡɞɨɪɨɜɥɟɧɢɹ ɧɚɛɥɸɞɚɟɬɫɹ ɧɟɛɨɥɶɲɨɟ ɩɨɜɵɲɟɧɢɟ ɦɨɧɨɰɢɬɨɜ

ɩɨɧɢɠɟɧɢɟ ɧɟɣɬɪɨɮɢɥɨɜ

Ɋɟɡɭɥɶɬɚɬɵ ɰɢɬɨɥɨɝɢɱɟɫɤɨɝɨ ɢ ɢɥɢ ɝɢɫɬɨɥɨɝɢɱɟɫɤɨɝɨ ɚɧɚɥɢɡɨɜ ɝɨɜɨɪɹɬ ɨ ɩɪɢɫɭɬɫɬɜɢɢ ɤɥɟɬɨɤ ɧɟɣɬɪɨɮɢɥɶɧɨɝɨ ɪɹɞɚ ɝɢɫɬɢɨɰɢɬɨɜ ɮɢɛɪɨɛɥɚɫɬɨɜ ɚ ɬɚɤɠɟ ɥɢɦɮɨɰɢɬɨɜ ɢ ɦɨɧɨɰɢɬɨɜ ɇɚɛɨɪ ɢ ɫɨɨɬɧɨɲɟɧɢɟ ɤɥɟɬɨɤ ɡɚɜɢɫɢɬ ɨɬ ɫɬɚɞɢɢɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨɩɪɨɰɟɫɫɚȼɛɢɨɩɬɚɬɟɨɬɫɭɬɫɬɜɭɸɬɩɚɬɨɥɨɝɢɱɟɫɤɢɟ ɤɥɟɬɤɢ ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɳɢɟ ɨ ɧɟɨɩɥɚɡɢɢ

14

Ʉɥɢɧɢɱɟɫɤɢɟ ɩɪɢɡɧɚɤɢ ɜɨɫɩɚɥɟɧɢɹ

Ʉɥɢɧɢɱɟɫɤɢ ɜɨɫɩɚɥɟɧɢɟ ɩɪɨɹɜɥɹɟɬɫɹ ɤɪɚɫɧɨɬɨɣ ɩɪɢɩɭɯɥɨɫɬɶɸ ɛɨɥɶɸ

ɩɨɜɵɲɟɧɢɟɦ ɦɟɫɬɧɨɣ ɬɟɦɩɟɪɚɬɭɪɵ ɧɚɪɭɲɟɧɢɟɦ ɮɭɧɤɰɢɢ

Ʉɪɚɫɧɨɬɚ (rubor). ɉɨɤɪɚɫɧɟɧɢɟ ɜɨɫɩɚɥɟɧɧɨɝɨ ɭɱɚɫɬɤɚ ɫɜɹɡɚɧɨ ɫ ɪɚɡɜɢɬɢɟɦ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɟɦɢɢ ɩɪɢ ɤɨɬɨɪɨɣ ɩɪɨɢɫɯɨɞɢɬ ɪɚɫɲɢɪɟɧɢɟ ɚɪɬɟɪɢɣ ɢ ɭɜɟɥɢɱɟɧɢɟ ɢɯ ɤɨɥɢɱɟɫɬɜɚ ɜɨɡɪɚɫɬɚɟɬ ɩɪɢɬɨɤ ɛɨɝɚɬɨɣ ɤɢɫɥɨɪɨɞɨɦ ɚɥɨɣ ɤɪɨɜɢ ɉɪɢ ɪɚɡɜɢɬɢɢ ɦɨɳɧɨɣ ɜɟɧɨɡɧɨɣ ɝɢɩɟɪɟɦɢɢ ɤɪɚɫɧɨɬɚ ɦɨɠɟɬ ɩɟɪɟɯɨɞɢɬɶ ɜ ɫɢɧɸɲɧɨɫɬɶ

ɇɚɢɛɨɥɟɟ ɹɪɤɨ ɤɪɚɫɧɨɬɚ ɡɚɦɟɬɧɚ ɧɚ ɜɢɞɢɦɵɯ ɫɥɢɡɢɫɬɵɯ ɨɛɨɥɨɱɤɚɯ ɱɭɬɶ ɫɥɚɛɟɟ ± ɧɚ ɤɨɠɟ Ɉɫɬɚɥɶɧɵɟ ɬɤɚɧɢ ɞɨɫɬɭɩɧɵ ɨɛɡɨɪɭ ɬɨɥɶɤɨ ɩɪɢ ɷɧɞɨɫɤɨɩɢɱɟɫɤɢɯ ɢɫɫɥɟɞɨɜɚɧɢɹɯ ɢ ɜ ɩɪɨɰɟɫɫɟ ɯɢɪɭɪɝɢɱɟɫɤɨɣ ɨɩɟɪɚɰɢɢ ɇɚɢɦɟɧɟɟ ɹɪɤɨ ɝɢɩɟɪɟɦɢɹ ɜɵɪɚɠɟɧɚ ɧɚ ɩɥɨɬɧɵɯ ɫɨɟɞɢɧɢɬɟɥɶɧɵɯ ɬɤɚɧɹɯ Ɇɵɲɟɱɧɚɹ ɬɤɚɧɶ ɢ ɩɚɪɟɧɯɢɦɚ ɜɧɭɬɪɟɧɧɢɯ ɨɪɝɚɧɨɜ ɜ ɫɢɥɭ ɫɜɨɟɝɨ ɬɟɦɧɨ ɤɪɚɫɧɨɝɨ ɰɜɟɬɚ ɧɟ ɩɪɨɹɜɥɹɸɬ ɞɨɩɨɥɧɢɬɟɥɶɧɨɣ ɤɥɢɧɢɱɟɫɤɨɣ ɤɚɪɬɢɧɵ ɝɢɩɟɪɟɦɢɢ

ɉɪɢɩɭɯɥɨɫɬɶ (tumor). ɍɜɟɥɢɱɟɧɢɟ ɜɨɫɩɚɥɟɧɧɨɝɨ ɭɱɚɫɬɤɚ ɜ ɨɛɴɟɦɟ ɫɜɹɡɚɧɨ ɫ ɪɚɡɜɢɬɢɟɦ ɷɤɫɫɭɞɚɰɢɢ ɢ ɨɬɟɤɚ ɧɚɛɭɯɚɧɢɹ ɬɤɚɧɟɜɵɯ ɷɥɟɦɟɧɬɨɜ ɭɜɟɥɢɱɟɧɢɹ ɫɭɦɦɚɪɧɨɝɨ ɞɢɚɦɟɬɪɚ ɫɨɫɭɞɢɫɬɨɝɨ ɪɭɫɥɚ ɜ ɨɱɚɝɟ ɜɨɫɩɚɥɟɧɢɹ

ɑɟɦ ɛɨɥɟɟ ɫɢɥɶɧɨ ɜɚɫɤɭɥɹɪɢɡɨɜɚɧɚ ɜɨɫɩɚɥɟɧɧɚɹ ɬɤɚɧɶ ɬɟɦ ɛɨɥɟɟ ɹɪɤɨ ɜɵɪɚɠɟɧɚ ɩɪɢɩɭɯɥɨɫɬɶ Ɍɚɤɠɟ ɧɚ ɨɛɴɺɦ ɩɪɢɩɭɯɥɨɫɬɢ ɜɥɢɹɟɬ ɨɛɴɺɦ ɩɨɜɪɟɠɞɟɧɢɹ ɟɝɨ ɯɚɪɚɤɬɟɪ ɨɫɬɪɨɬɚ ɢ ɫɢɥɚ ɨɬɜɟɬɧɨɣ ɜɨɫɩɚɥɢɬɟɥɶɧɨɣ ɪɟɚɤɰɢɢ ɇɚɢɦɟɧɟɟ ɹɪɤɨ ɞɚɠɟ ɩɪɢ ɨɫɬɪɨɦ ɝɧɨɣɧɨɦ ɜɨɫɩɚɥɟɧɢɢ ɜɵɪɚɠɟɧɚ ɩɪɢɩɭɯɥɨɫɬɶɜɩɥɨɬɧɨɣɫɨɟɞɢɧɢɬɟɥɶɧɨɣɬɤɚɧɢɦɹɤɢɲɟɣɩɚɥɶɰɟɜɞɨɜɨɥɶɧɨ ɹɪɤɨ ± ɜ ɝɥɭɛɨɤɢɯ ɫɥɨɹɯ ɤɨɠɢ ɜ ɧɚɞɤɨɫɬɧɢɰɟ ɤɚɩɫɭɥɟ ɫɭɫɬɚɜɨɜ ɦɨɥɨɱɧɵɯ ɠɟɥɟɡɚɯ ɢ ɬ ɩ

ɀɚɪ (calor). ɉɨɜɵɲɟɧɢɟ ɬɟɦɩɟɪɚɬɭɪɭ ɜɨɫɩɚɥɟɧɧɨɝɨ ɭɱɚɫɬɤɚ ɨɛɭɫɥɨɜɥɟɧɨ ɪɹɞɨɦ ɮɚɤɬɨɪɨɜ ȼɨ ɩɟɪɜɵɯ ɨɧɨ ɫɜɹɡɚɧɨ ɫ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɟɦɢɟɣ ɬɨ ɟɫɬɶ ɫ ɩɪɢɬɨɤɨɦ ɛɨɥɟɟ ɬɟɩɥɨɣ ɤɪɨɜɢ ȼɨ ɜɬɨɪɵɯ ɫɪɟɞɢ

15

ɛɢɨɥɨɝɢɱɟɫɤɢ ɚɤɬɢɜɧɵɯ ɩɨɥɢɩɟɩɬɢɞɨɜ ɨɛɪɚɡɭɸɳɢɯɫɹ ɜ ɨɱɚɝɟ ɜɨɫɩɚɥɟɧɢɹ ɢɦɟɸɬɫɹ ɢ ɬɚɤɢɟ ɤɨɬɨɪɵɟ ɩɪɟɞɫɬɚɜɥɹɸɬ ɫɨɛɨɣ ɩɢɪɨɝɟɧɧɵɟ ɮɚɤɬɨɪɵ ɜɵɡɵɜɚɸɳɢɟ ɥɢɯɨɪɚɞɤɭ ȼ ɬɪɟɬɶɢɯ ɭɫɢɥɟɧɢɟ ɨɛɦɟɧɧɵɯ ɩɪɨɰɟɫɫɨɜ ɢɧɬɟɧɫɢɮɢɤɚɰɢɹ ɪɹɞɚ ɷɤɡɨɬɟɪɦɢɱɟɫɤɢɯ ɪɟɚɤɰɢɣ ɬɚɤɠɟ ɩɪɢɜɨɞɢɬ ɤ ɥɨɤɚɥɶɧɨɦɭ ɩɨɜɵɲɟɧɢɸ ɬɟɦɩɟɪɚɬɭɪɵ

ɉɚɥɶɩɚɬɨɪɧɨ ɢɥɢ ɫ ɩɨɦɨɳɶɸ ɬɟɩɥɨɜɢɡɨɪɚ ɠɚɪ ɦɨɠɧɨ ɜɵɹɜɢɬɶ ɜ ɡɨɧɟ ɨɱɚɝɨɜ ɢɧɮɟɤɰɢɨɧɧɵɯ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɨɜ ɩɪɨɬɟɤɚɸɳɢɯ ɜ ɤɨɠɟ ɢ ɩɨɞ ɤɨɠɟɣ ɚ ɬɚɤɠɟ ɜ ɨɛɥɚɫɬɢ ɤɨɧɟɱɧɨɫɬɟɣ ɧɚɩɪɢɦɟɪ ɩɪɢ ɜɨɫɩɚɥɟɧɢɢ ɬɤɚɧɟɣ ɤɨɩɵɬɚ Ɉɫɬɚɥɶɧɵɟ ɡɨɧɵ ɞɥɹ ɩɚɥɶɩɚɰɢɢ ɜ ɛɨɥɶɲɢɧɫɬɜɟ ɫɥɭɱɚɟɜ ɧɟɞɨɫɬɭɩɧɵ ɯɨɬɹ ɠɚɪ ɧɚɛɥɸɞɚɟɬɫɹ ɩɪɚɤɬɢɱɟɫɤɢ ɜ ɥɸɛɨɣ ɬɤɚɧɢ ɩɪɢ ɟɺ ɜɨɫɩɚɥɟɧɢɢ

Ȼɨɥɶ (dolor). Ȼɨɥɟɡɧɟɧɧɨɫɬɶ ɜɨɫɩɚɥɟɧɧɨɝɨ ɭɱɚɫɬɤɚ ɜɵɡɵɜɚɟɬɫɹ ɪɚɡɞɪɚɠɟɧɢɟɦ ɛɨɥɟɜɵɯ ɪɟɰɟɩɬɨɪɨɜ ɛɢɨɥɨɝɢɱɟɫɤɢ ɚɤɬɢɜɧɵɦɢ ɜɟɳɟɫɬɜɚɦɢ ɝɢɫɬɚɦɢɧ ɫɟɪɨɬɨɧɢɧ ɛɪɚɞɢɤɢɧɢɧ ɚ ɬɚɤɠɟ ɜ ɪɟɡɭɥɶɬɚɬɟ ɢɯ ɫɞɚɜɥɟɧɢɹ ɜɨɫɩɚɥɢɬɟɥɶɧɵɦ ɨɬɟɤɨɦ

ɑɟɦ ɛɨɥɶɲɟ ɪɟɰɟɩɬɨɪɨɜ ɜ ɡɨɧɟ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ ɢ ɱɟɦ ɩɨɞɜɢɠɧɟɟ ɡɨɧɚ ɜɨɫɩɚɥɟɧɢɹ ɬɟɦ ɛɨɥɶɧɟɟ ɩɚɰɢɟɧɬɭ Ȼɨɥɟɜɚɹ ɪɟɚɤɰɢɹ ɧɚ ɜɨɫɩɚɥɟɧɢɟ ɡɚɜɢɫɢɬ ɨɬ ɢɧɞɢɜɢɞɭɚɥɶɧɵɯ ɨɫɨɛɟɧɧɨɫɬɟɣ ɩɚɰɢɟɧɬɚ Ɍɚɤ ɩɪɢ ɜɨɫɩɚɥɟɧɢɢ ɨɞɢɧɚɤɨɜɨɝɨ ɤɚɱɟɫɬɜɚ ɨɞɢɧɚɤɨɜɨɣ ɫɬɟɩɟɧɢ ɨɫɬɪɨɬɵ ɢ ɢɧɬɟɧɫɢɜɧɨɫɬɢ ɛɨɥɟɜɚɹ ɪɟɚɤɰɢɹ ɭ ɪɚɡɧɵɯ ɩɚɰɢɟɧɬɨɜ ɦɨɠɟɬ ɫɭɳɟɫɬɜɟɧɧɨ ɨɬɥɢɱɚɬɶɫɹ

Ʉɪɨɦɟ ɬɨɝɨ ɫɢɥɶɧɵɟ ɛɨɥɢ ɧɚɛɥɸɞɚɸɬɫɹ ɩɪɢ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɚɯ ɜ ɧɟɪɜɧɨɣ ɬɤɚɧɢ ȼ ɷɬɨɦ ɫɥɭɱɚɟ ɛɨɥɶ ɦɨɠɟɬ ɧɚɛɥɸɞɚɬɶɫɹ ɩɨ ɜɫɟɣ ɢɧɧɟɪɜɢɪɭɟɦɨɣ ɨɛɥɚɫɬɢ Ɍɚɤɚɹ ɛɨɥɶ ɦɨɠɟɬ ɛɵɬɶ ɧɚɫɬɨɥɶɤɨ ɫɢɥɶɧɨ ɜɵɪɚɠɟɧɧɨɣ ɱɬɨ ɦɨɠɟɬ ɩɪɢɜɟɫɬɢ ɤ ɫɚɦɨɬɪɚɜɦɢɪɨɜɚɧɢɸ ɩɚɰɢɟɧɬɚ

Ⱥɛɞɨɦɢɧɚɥɶɧɵɟ ɛɨɥɢ ɩɪɢ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɚɯ ɧɚɛɥɸɞɚɸɬɫɹ ɬɨɥɶɤɨ ɜ ɬɨɦ ɫɥɭɱɚɟ ɤɨɝɞɚ ɜɨɫɩɚɥɢɬɟɥɶɧɵɣ ɩɪɨɰɟɫɫ ɜɵɡɵɜɚɟɬ ɨɫɬɪɵɣ ɨɬɟɤ ɫɟɪɨɡɧɵɯ ɨɛɨɥɨɱɟɤ ɜɧɭɬɪɟɧɧɢɯ ɨɪɝɚɧɨɜ ɛɪɸɲɢɧɚ ɚɞɜɟɧɬɢɰɢɹ

ɇɚɪɭɲɟɧɢɟ ɮɭɧɤɰɢɢ (function laesa). ȿɫɥɢ ɜ ɤɚɤɨɦ ɥɢɛɨ ɨɪɝɚɧɟ ɢɦɟɟɬɫɹ ɢɫɬɨɱɧɢɤ ɛɨɥɟɜɨɝɨ ɪɚɡɞɪɚɠɟɧɢɹ ɬɨ ɞɥɹ ɭɦɟɧɶɲɟɧɢɹ ɢɧɬɟɧɫɢɜɧɨɫɬɢ ɛɨɥɢ ɪɟɮɥɟɤɬɨɪɧɨ ɫɧɢɠɚɟɬɫɹ ɧɚɝɪɭɡɤɚ ɜɵɡɵɜɚɸɳɚɹ ɛɨɥɟɜɭɸ ɪɟɚɤɰɢɸ ɢ

16

ɮɭɧɤɰɢɹ ɜɨɫɩɚɥɟɧɧɨɝɨ ɨɪɝɚɧɚ ɛɭɞɟɬ ɩɨɧɢɠɟɧɧɨɣ Ʉ ɫɧɢɠɟɧɢɸ ɮɭɧɤɰɢɢ ɩɪɢɜɨɞɢɬ ɜɨɫɩɚɥɢɬɟɥɶɧɵɣ ɨɬɟɤ ɫɞɚɜɥɢɜɚɸɳɢɣ ɨɪɝɚɧ ɢ ɚɥɶɬɟɪɚɰɢɹ ɬɤɚɧɢ ɇɚɩɪɢɦɟɪ ɩɪɢ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɚɯ ɨɩɨɪɧɨ ɞɜɢɝɚɬɟɥɶɧɨɝɨ ɚɩɩɚɪɚɬɚɜɨɡɧɢɤɚɟɬɯɪɨɦɨɬɚɩɪɢɜɨɫɩɚɥɟɧɢɢɠɟɥɭɞɨɱɧɨ ɤɢɲɟɱɧɨɝɨ ɬɪɚɤɬɚ ɜɨɡɧɢɤɚɟɬɭɫɢɥɟɧɢɟɢɥɢɱɚɳɟɫɧɢɠɟɧɢɟɩɟɪɢɫɬɚɥɶɬɢɤɢɜɩɥɨɬɶɞɨɩɚɪɟɡɚ ɤɢɲɟɱɧɢɤɚ ɉɪɢ ɬɪɚɜɦɚɯ ɝɪɭɞɧɨɣ ɤɥɟɬɤɢ ɞɵɯɚɧɢɟ ɫɬɚɧɨɜɢɬɫɹ

ɩɨɜɟɪɯɧɨɫɬɧɵɦ ɱɚɳɟ ɚɛɞɨɦɢɧɚɥɶɧɨɝɨ ɬɢɩɚ

17

Ʉɥɚɫɫɢɮɢɤɚɰɢɹ ɜɨɫɩɚɥɢɬɟɥɶɧɵɯ ɩɪɨɰɟɫɫɨɜ

Ʉɥɚɫɫɢɮɢɤɚɰɢɹ ɜɢɞɨɜ ɜɨɫɩɚɥɟɧɢɹ

,, ɉɨ ɢɧɬɟɧɫɢɜɧɨɫɬɢ ɩɪɨɹɜɥɟɧɢɹ ɢ ɭɱɚɫɬɢɹ ɢɦɦɭɧɨɤɨɦɩɟɬɟɧɬɧɨɣ ɫɢɫɬɟɦɵ

ɚ Ƚɢɩɟɪɟɪɝɢɱɟɫɤɨɟ ɩɪɢ ɧɚɪɭɲɟɧɢɢ ɚɞɚɩɬɚɰɢɨɧɧɨ ± ɬɪɨɮɢɱɟɫɤɨɣ ɮɭɧɤɰɢɢ ɇɋ ɢɥɢ ɩɪɢ ɚɥɥɟɪɝɢɱɟɫɤɨɦ ɫɨɫɬɨɹɧɢɢ ɨɪɝɚɧɢɡɦɚ ɩɪɨɬɟɤɚɟɬ ɛɨɥɟɡɧɟɧɧɨ ɫɜɟɪɯɨɫɬɪɨ ɢ ɧɟɚɞɟɤɜɚɬɧɨ ɛ Ƚɢɩɨɷɪɝɢɱɟɫɤɨɟ ɧɟɫɨɨɬɜɟɬɫɬɜɟɧɧɨ ɫɥɚɛɚɹ ɪɟɚɤɰɢɹ ɨɪɝɚɧɢɡɦɚ

ɢɦɦɭɧɨɞɟɮɢɰɢɬ ɩɟɪɟɭɬɨɦɥɟɧɢɟ ɡɚɦɟɞɥɟɧɢɟ ɫɬɚɞɢɣɧɨɫɬɢ ɩɪɨɰɟɫɫɚ

ɜ Ⱥɧɷɪɝɢɱɟɫɤɨɟ ɜɨɫɩɚɥɢɬɟɥɶɧɚɹ ɪɟɚɤɰɢɹ ɨɬɫɭɬɫɬɜɭɟɬ

ɝ ɇɨɪɦɟɪɝɢɱɟɫɤɨɟ ɨɬɜɟɬ ɨɪɝɚɧɢɡɦɚ ɚɞɟɤɜɚɬɟɧ ɩɨɜɪɟɠɞɟɧɢɸ

,,, ɉɨ ɩɪɟɜɚɥɢɪɨɜɚɧɢɸ ɬɨɝɨ ɢɥɢ ɢɧɨɝɨ ɤɨɦɩɨɧɟɧɬɚ ɜɨɫɩɚɥɟɧɢɹ ɧɚɞ ɞɪɭɝɢɦ Ⱥɥɶɬɟɪɚɬɢɜɧɨɟ ɜ ɨɱɚɝɟ ɜɨɫɩɚɥɟɧɢɹ ɩɪɟɨɛɥɚɞɚɟɬ ɩɨɜɪɟɠɞɟɧɢɟ ɤɥɟɬɨɤ

ɚ ɨɫɬɪɨɟ ± ɜ ɨɱɚɝɟ ɜɨɫɩɚɥɟɧɢɹ ɩɪɟɨɛɥɚɞɚɟɬ ɧɟɤɪɨɡ ɢ ɞɢɫɬɪɨɮɢɹ

ɛ ɯɪɨɧɢɱɟɫɤɨɟ ± ɩɪɟɨɛɥɚɞɚɟɬ ɚɬɪɨɮɢɹ ɗɤɫɫɭɞɚɬɢɜɧɨɟ ɧɚɢɛɨɥɟɟ ɟɦɤɢɣ ɬɢɩ ɜɨɫɩɚɥɟɧɢɹ

ɚ ɫɟɪɨɡɧɨɟ ± ɩɪɟɨɛɥɚɞɚɟɬ ɠɢɞɤɢɣ ɷɤɫɫɭɞɚɬ

ɫɟɪɨɡɧɨ ɜɨɫɩɚɥɢɬɟɥɶɧɵɣ ɨɬɟɤ

ɫɟɪɨɡɧɨ ɜɨɫɩɚɥɢɬɟɥɶɧɚɹ ɜɨɞɹɧɤɚ

ɛɭɥɥɟɡɧɨɟ ɜɨɫɩɚɥɟɧɢɟ ɛ ɮɢɛɪɢɧɨɡɧɨɟ ± ɜ ɨɱɚɝɟ ɜɨɫɩɚɥɟɧɢɹ ɧɚɤɚɩɥɢɜɚɟɬɫɹ ɷɤɫɫɭɞɚɬ ɫ

ɩɪɢɦɟɫɶɸ ɛɟɥɤɚ ɮɢɛɪɢɧɚ

ɤɪɭɩɨɡɧɨɟ ɩɨɜɟɪɯɧɨɫɬɧɨɟ

ɞɢɮɬɟɪɢɬɢɱɟɫɤɨɟ ɝɥɭɛɨɤɨɟ

18

ɜ ɝɧɨɣɧɨɟ ± ɫ ɮɨɪɦɢɪɨɜɚɧɢɟɦ ɝɭɫɬɨɝɨ ɫɦɟɬɚɧɨ ɢɥɢ ɫɥɢɜɤɨɩɨɞɨɛɧɨɝɨ ɷɤɫɫɭɞɚɬɚ ɝɧɨɹ

ɚɛɫɰɟɫɫ ɩɨɥɨɫɬɶ ɡɚɩɨɥɧɟɧɧɚɹ ɝɧɨɟɦ

ɮɥɟɝɦɨɧɚ ɪɚɡɥɢɬɨɟ ɝɧɨɣɧɨɟ ɜɨɫɩɚɥɟɧɢɟ ɜ ɪɵɯɥɨɣ ɤɥɟɬɱɚɬɤɟ

ɷɦɩɢɟɦɚ ɝɧɨɣɧɨɟ ɜɨɫɩɚɥɟɧɢɟ ɟɫɬɟɫɬɜɟɧɧɵɯ ɩɨɥɨɫɬɟɣ

ɝ ɝɟɦɨɪɪɚɝɢɱɟɫɤɨɟ ɜ ɷɤɫɫɭɞɚɬɟ ɧɚɛɥɸɞɚɟɬɫɹ ɤɪɨɜɶ ɞ ɢɯɨɪɨɡɧɨɟ ɝɧɢɥɨɫɬɧɨɟ ɝɚɧɝɪɟɧɨɡɧɨɟ ɩɪɢɫɨɟɞɢɧɹɟɬɫɹ ɝɧɢɥɨɫɬɧɚɹ ɦɢɤɪɨɮɥɨɪɚ

ɟ ɤɚɬɚɪɚɥɶɧɨɟ ɜɨɫɩɚɥɟɧɢɟ ɫɥɢɡɢɫɬɵɯ ɨɛɨɥɨɱɟɤ Ɇɨɠɟɬ ɛɵɬɶ ɥɸɛɵɦ ɤɪɨɦɟ ɮɢɛɪɢɧɨɡɧɨɝɨ

ɉɪɨɥɢɮɟɪɚɬɢɜɧɨɟ ɚ ɢɧɬɟɪɫɬɢɰɢɚɥɶɧɨɟ ɜɨɫɩɚɥɟɧɢɟ ɦɟɠɭɬɨɱɧɨɟ ɛ ɝɪɚɧɭɥɟɦɚɬɨɡɧɨɟ ɜ ɜɨɫɩɚɥɟɧɢɟ ɜɨɤɪɭɝ ɢɧɨɪɨɞɧɵɯ ɩɪɟɞɦɟɬɨɜ ɝ ɜɨɫɩɚɥɟɧɢɟ ɜɨɤɪɭɝ ɝɟɥɶɦɢɧɬɨɜ ɢ ɢɯ ɥɢɱɢɧɨɤ ɞ ɜɨɫɩɚɥɟɧɢɟ ɫ ɨɛɪɚɡɨɜɚɧɢɟɦ ɩɨɥɢɩɨɜ ɢ ɤɨɧɞɢɥɨɦ ɟ ɝɢɩɟɪɩɥɚɫɬɢɱɟɫɤɨɟ ɜɨɫɩɚɥɟɧɢɟ ɜ ɥɢɦɮɨɢɞɧɨɣ ɬɤɚɧɢ

,9 ɉɨ ɧɚɥɢɱɢɸ ɢɧɮɟɤɰɢɨɧɧɨɝɨ ɚɝɟɧɬɚ ɚɫɟɩɬɢɱɟɫɤɨɟ ɢɧɮɟɤɰɢɨɧɧɨɟ ɢ

ɫɟɩɬɢɱɟɫɤɨɟ ɝɧɨɣɧɨɟ

9 ɉɨ ɯɚɪɚɤɬɟɪɭ ɷɤɫɫɭɞɚɬɚ ɚ ɫɟɪɨɡɧɨɟ ɤɚɬɚɪɚɥɶɧɨɟ ± ɯɚɪɚɤɬɟɪɧɨ ɞɥɹ ɫɨɛɚɤɢ ɥɨɲɚɞɢ

ɱɟɥɨɜɟɤɚ ± ɛɨɥɶɧɨ ɩɪɢ ɩɪɢɤɨɫɧɨɜɟɧɢɢ ɩɨɫɬɨɹɧɧɨ

ɛ ɫɟɪɨɡɧɨ ɮɢɛɪɢɧɨɡɧɨɟ ± ɤɨɲɤɢ ɄɊɋ

ɜ ɮɢɛɪɢɧɨɡɧɨɟ ɤɪɭɩɨɡɧɨɟ ± ɩɬɢɰɵ ɝɪɵɡɭɧɵ

ɝ ɮɢɛɪɢɧɨɡɧɨɟ ɮɢɛɪɨɡɧɨɟ

ɞ ɨɫɫɢɮɢɰɢɪɭɸɳɟɟ

19

ɂɧɬɟɧɫɢɜɧɨɫɬɶ ɜɨɫɩɚɥɟɧɢɹ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɫɨɫɬɨɹɧɢɹ ɪɟɚɤɬɢɜɧɨɫɬɢ ɨɪɝɚɧɢɡɦɚ

ȼ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɫɨɫɬɨɹɧɢɹ ɪɟɚɤɬɢɜɧɨɫɬɢ ɨɪɝɚɧɢɡɦɚ ɬɨ ɟɫɬɶ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɨɬɧɨɲɟɧɢɹ ɩɪɢɱɢɧɵ ɜɵɡɜɚɜɲɟɣ ɜɨɫɩɚɥɟɧɢɟ ɤɚɤ ɪɟɚɤɰɢɢ ɨɪɝɚɧɢɡɦɚ ɧɚ ɷɬɨ ɩɨɜɪɟɠɞɟɧɢɟ ɪɚɡɥɢɱɚɸɬ

ɇɨɪɦɨɷɪɝɢɱɟɫɤɨɟ ɧɨɪɦɟɪɝɢɱɟɫɤɨɟɤɨɝɞɚ ɫɢɥɚ ɩɨɜɪɟɠɞɟɧɢɹ ɢ ɨɬɜɟɬ ɧɚ ɩɨɜɪɟɠɞɟɧɢɟ ɚɞɟɤɜɚɬɧɵ ɇɚɛɥɸɞɚɸɬ ɩɪɢ ɩɟɪɜɢɱɧɨɦ ɤɨɧɬɚɤɬɟ ɮɥɨɝɨɝɟɧɧɨɝɨ ɚɝɟɧɬɚ ɫ ɨɪɝɚɧɢɡɦɨɦ ɠɢɜɨɬɧɨɝɨ ɉɪɢɡɧɚɤɢ ɜɨɫɩɚɥɟɧɢɹ ɩɪɨɹɜɥɹɸɬɫɹ ɭɦɟɪɟɧɧɨ

Ⱥɧɷɪɝɢɱɟɫɤɨɟ ɤɨɝɞɚ ɨɪɝɚɧɢɡɦ ɮɚɤɬɢɱɟɫɤɢ ɧɟ ɪɟɚɝɢɪɭɟɬ ɧɚ ɩɨɜɪɟɠɞɟɧɢɟ ɗɬɨ ɦɨɠɟɬ ɩɪɨɢɡɨɣɬɢ ɟɫɥɢ ɨɪɝɚɧɢɡɦ ɱɟɦ ɬɨ ɨɫɥɚɛɥɟɧ ɬɹɠɟɥɵɟ ɮɨɪɦɵ ɚɜɢɬɚɦɢɧɨɡɨɜ ɢɫɬɨɳɟɧɢɟ ɛɟɥɤɨɜɨɟ ɝɨɥɨɞɚɧɢɟ ɞɟɣɫɬɜɢɟ ɢɨɧɢɡɢɪɭɸɳɟɝɨ ɢɡɥɭɱɟɧɢɹ ɤɨɬɨɪɨɟ ɩɨɞɚɜɥɹɟɬ ɢɦɦɭɧɢɬɟɬ ɞɥɢɬɟɥɶɧɵɟ ɬɹɠɟɥɵɟ ɡɚɛɨɥɟɜɚɧɢɹ

Ƚɢɩɟɪɟɪɝɢɱɟɫɤɨɟ ɜɨɫɩɚɥɟɧɢɟ ɤɨɝɞɚ ɨɬɜɟɬɧɚɹ ɪɟɚɤɰɢɹ ɨɪɝɚɧɢɡɦɚ ɩɪɟɜɵɲɚɟɬ ɧɟɨɛɯɨɞɢɦɭɸ ɫɬɟɩɟɧɶ ɪɟɚɤɰɢɢ ɧɚ ɞɚɧɧɨɟ ɩɨɜɪɟɠɞɟɧɢɟ ɉɪɢ ɫɪɚɜɧɟɧɢɢ ɫ ɧɨɪɦɟɪɝɢɱɟɫɤɢɦ ɜɨɫɩɚɥɟɧɢɟɦ ɜɵɹɜɥɹɟɬɫɹ ɧɟɫɨɨɬɜɟɬɫɬɜɢɟ ɦɟɠɞɭ ɫɢɥɨɣ ɪɚɡɞɪɚɠɢɬɟɥɹ ɦɟɫɬɧɨɣ ɢ ɨɛɳɟɣ ɪɟɚɤɰɢɟɣ ɗɬɨ ɜɨɫɩɚɥɟɧɢɟ ɜɨɡɧɢɤɚɟɬ ɧɚ ɢɦɦɭɧɧɨɣ ɨɫɧɨɜɟ ɢ ɩɪɟɞɫɬɚɜɥɟɧɨ ɪɟɚɤɰɢɟɣ ɝɢɩɟɪɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢ ɧɟɦɟɞɥɟɧɧɨɝɨ ɢ ɡɚɦɟɞɥɟɧɧɨɝɨ ɬɢɩɨɜ

Ƚɢɩɨɷɪɝɢɱɟɫɤɨɟɜɨɫɩɚɥɟɧɢɟ ɉɨɥɧɨɟɨɬɫɭɬɫɬɜɢɟɪɟɚɤɰɢɢ ɚɧɟɪɝɢɹ ɜɫɬɪɟɱɚɟɬɫɹ ɪɟɞɤɨ ɥɭɱɟɜɚɹ ɛɨɥɟɡɧɶ ɜɨ ɜɫɟɯ ɨɫɬɚɥɶɧɵɯ ɨɫɬɚɥɶɧɵɯ ɫɥɭɱɚɹɯ ɜɫɬɪɟɱɚɟɬɫɹ ɝɢɩɨɟɪɝɢɹ

ȼɢɞɵ ɜɨɫɩɚɥɟɧɢɹ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɫɤɨɪɨɫɬɢ ɬɟɱɟɧɢɹ

Ɉɫɬɪɨɟ ɜɨɫɩɚɥɟɧɢɟ ɉɪɨɞɨɥɠɚɟɬɫɹ ɜ ɬɟɱɟɧɢɟ ɧɟɫɤɨɥɶɤɢɯ ɞɧɟɣ ɢɥɢ ɧɟɞɟɥɶ Ɉɬɥɢɱɚɟɬɫɹ ɜɵɫɨɤɨɣ ɢɧɬɟɧɫɢɜɧɨɫɬɶɸ ɫ ɩɪɟɨɛɥɚɞɚɧɢɟɦ ɫɨɫɭɞɢɫɬɨ ɷɤɫɫɭɞɚɬɢɜɧɵɯ ɩɪɨɰɟɫɫɨɜ ɢ ɷɦɢɝɪɚɰɢɢ ɤɥɟɬɨɤ ɡɚ ɩɪɟɞɟɥɵ ɫɨɫɭɞɨɜ əɪɤɨ

20