Опыт бронхологического пособия пациентам с новой коронавирусной инфекцией COVID-19. Монография
.pdfɛɪɨɧɯɢɚɥɶɧɵɦ ɫɟɤɪɟɬɨɦ ɜɨ ɜɬɨɪɨɦ ɜɪɟɦɟɧɧɨɦ ɩɟɪɢɨɞɟ ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɩɟɪɜɵɦ ɞɨɫɬɢɝɥɨ ɭɪɨɜɧɹ ɫɬɚɬɢɫɬɢɱɟɫɤɨɣ ɡɧɚɱɢɦɨɫɬɢ.
Ȼɨɥɟɟ ɜɵɫɨɤɚɹ ɩɨɬɪɟɛɧɨɫɬɶ ɜ ɛɪɨɧɯɨɥɨɝɢɱɟɫɤɨɦ ɩɨɫɨɛɢɢ ɜ ɭɫɥɨɜɢɹɯ ɈɊɂɌ ɜ ɩɟɪɜɵɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ ɩɨ-ɜɢɞɢɦɨɦɭ ɨɬɪɚɠɚɟɬ ɨɛɳɭɸ ɨɫɨɛɟɧɧɨɫɬɶ ɲɬɚɦɦɨɜ ɤɨɪɨɧɚɜɢɪɭɫɚ ɩɟɪɢɨɞɚ ɩɪɟɞɲɟɫɬɜɭɸɳɟɦɭ ɝɨɫɩɨɞɫɬɜɭ ɲɬɚɦɦɚ ɨɦɢɤ ɪɨɧ ɜɵɡɵɜɚɬɶ ɛyɥɶɲɢɣ ɩɪɨɰɟɧɬ ɬɹɠɺɥɵɯ ɫɥɭɱɚɟɜ ɧɭɠɞɚɸɳɢɯɫɹ ɜ ɪɟɚɧɢɦɚɰɢ ɨɧɧɨɦ ɩɨɫɨɛɢɢ ɉɪɢ ɷɬɨɦ ɜɟɞɭɳɟɣ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨɣ ɩɪɢɱɢɧɨɣ ɝɨɫɩɢɬɚɥɢɡɚ ɰɢɢ ɜ ɈɊɂɌ ɹɜɥɹɥɚɫɶ ɜɵɪɚɠɟɧɧɚɹ ɞɵɯɚɬɟɥɶɧɚɹ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶ ɧɟɪɟɞɤɨ ɬɪɟ ɛɭɸɳɚɹ ɫɥɨɠɧɵɯ ɜɚɪɢɚɧɬɨɜ ɪɟɫɩɢɪɚɬɨɪɧɨɣ ɩɪɨɬɟɤɰɢɢ ɜɩɥɨɬɶ ɞɨ ɢɫɩɨɥɶɡɨɜɚ ɧɢɹ ɂȼɅ ɗɬɨ ɜ ɫɜɨɸ ɨɱɟɪɟɞɶ ɩɪɟɞɩɨɥɚɝɚɥɨ ɲɢɪɨɤɨɟ ɢɫɩɨɥɶɡɨɜɚɧɢɟ ɛɪɨɧɯɨ ɥɨɝɢɱɟɫɤɨɝɨ ɩɨɫɨɛɢɹ ɩɨɫɤɨɥɶɤɭ ɞɥɹ ɭɫɩɟɲɧɨɝɨ ɜɟɞɟɧɢɹ ɩɚɰɢɟɧɬɨɜ ɧɚɯɨɞɹ ɳɢɯɫɹ ɤɚɤ ɧɚ ɂȼɅ ɬɚɤ ɢ ɧɚ ɪɚɡɥɢɱɧɵɯ ɜɚɪɢɚɧɬɚɯ ɧɟɢɧɜɚɡɢɜɧɨɣ ɜɟɧɬɢɥɹɰɢɢ ɥɺɝɤɢɯ ɧɟɨɛɯɨɞɢɦɨ ɨɛɟɫɩɟɱɟɧɢɟ ɚɞɟɤɜɚɬɧɨɣ ɩɪɨɯɨɞɢɦɨɫɬɢ ɜɨɡɞɭɯɨɩɪɨɜɨɞɹ ɳɢɯ ɩɭɬɟɣ ɉɨ ɬɨɣ ɠɟ ɩɪɢɱɢɧɟ ɭɞɟɥɶɧɵɣ ɜɟɫ ɛɪɨɧɯɨɫɤɨɩɢɣ ɩɪɨɜɟɞɺɧɧɵɯ ɜ ɭɫɥɨɜɢɹɯ ɷɧɞɨɫɤɨɩɢɱɟɫɤɨɝɨ ɤɚɛɢɧɟɬɚ ɜ ɩɟɪɜɵɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ ɨɤɚɡɚɥɫɹ ɧɢɠɟ ɧɟɠɟɥɢ ɜɨ ɜɬɨɪɨɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ
ɒɬɚɦɦ ɨɦɢɤɪɨɧ ɚɫɫɨɰɢɢɪɭɟɬɫɹ ɫ ɛɨɥɟɟ ɜɵɫɨɤɨɣ ɤɨɧɬɚɝɢɨɡɧɨɫɬɶɸ ɩɪɢ ɫɧɢɠɟɧɢɢ ɭɞɟɥɶɧɨɝɨ ɜɟɫɚ ɬɹɠɺɥɵɯ ɫɥɭɱɚɟɜ ɉɪɢɦɟɧɢɬɟɥɶɧɨ ɤ ɛɪɨɧɯɨɫɤɨɩɢɱɟ ɫɤɨɦɭ ɩɨɫɨɛɢɸ ɷɬɨ ɧɚɲɥɨ ɨɬɪɚɠɟɧɢɟ ɜ ɛɨɥɟɟ ɜɵɫɨɤɨɦ ɭɞɟɥɶɧɨɦ ɜɟɫɟ ɩɪɨɜɟɞɺɧ ɧɵɯ ɛɪɨɧɯɨɫɤɨɩɢɣ ɜ ɭɫɥɨɜɢɹɯ ɷɧɞɨɫɤɨɩɢɱɟɫɤɨɝɨ ɤɚɛɢɧɟɬɚ ɬ ɟ ɧɟɬɹɠɺɥɵɦ ɩɚ ɰɢɟɧɬɚɦ ɉɪɢ ɷɬɨɦ ɟɫɥɢ ɜ ɚɛɫɨɥɸɬɧɨɦ ɜɵɪɚɠɟɧɢɢ ɤɨɥɢɱɟɫɬɜɨ ɛɪɨɧɯɨɫɤɨɩɢɣ ɩɪɨɜɟɞɺɧɧɵɯ ɜ ɈɊɂɌ ɨɤɚɡɚɥɢɫɶ ɨɱɟɧɶ ɛɥɢɡɤɢɦɢ ɜ ɨɛɨɢɯ ɜɪɟɦɟɧɧɵɯ ɩɟɪɢɨɞɚɯ ɬɨ ɢɯ ɭɞɟɥɶɧɵɣ ɜɟɫ ɨɤɚɡɚɥɫɹ ɡɧɚɱɢɬɟɥɶɧɨ ɧɢɠɟ ɜɨ ɜɬɨɪɨɦ ɜɪɟɦɟɧɧɨɦ ɩɟɪɢɨɞɟ ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ ɩɟɪɜɵɦ
ȼɨ ɜɬɨɪɨɦ ɜɪɟɦɟɧɧɨɦ ɩɟɪɢɨɞɟ ɡɧɚɱɢɬɟɥɶɧɨ ɱɚɳɟ ɩɪɨɜɨɞɢɥɢɫɶ ɩɨɜɬɨɪɧɵɟ ɛɪɨɧɯɨɫɤɨɩɢɢ ɜ ɭɫɥɨɜɢɹɯ ɷɧɞɨɫɤɨɩɢɱɟɫɤɨɝɨ ɤɚɛɢɧɟɬɚ Ʉɚɤ ɩɪɚɜɢɥɨ ɷɬɨ ɛɵɥɨ ɫɜɹɡɚɧɨ ɫ ɭɩɨɪɧɵɦ ɬɟɱɟɧɢɟɦ ɛɪɨɧɯɨɨɛɫɬɪɭɤɬɢɜɧɨɝɨ ɫɢɧɞɪɨɦɚ ɧɚ ɮɨɧɟ ɧɟɷɮ ɮɟɤɬɢɜɧɨɣ ɷɤɫɩɟɤɬɨɪɚɰɢɢ ɱɬɨ ɬɪɟɛɨɜɚɥɨ ɢɧɫɬɪɭɦɟɧɬɚɥɶɧɨɣ ɷɜɚɤɭɚɰɢɢ ɢɡɛɵ ɬɨɱɧɨɝɨ ɤɨɥɢɱɟɫɬɜɚ ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ ɉɪɢ ɷɬɨɦ ɛɪɨɧɯɢɚɥɶɧɚɹ ɨɛɫɬɪɭɤɰɢɹɚ ɬɚɤɠɟ ɟɺ ɤɥɢɧɢɱɟɫɤɢɟ ɢ ɢɧɫɬɪɭɦɟɧɬɚɥɶɧɵɟ ɷɤɜɢɜɚɥɟɧɬɵ – ɨɞɵɲɤɚ ɢ ɫɧɢɠɟ
41
ɧɢɟ ɫɚɬɭɪɚɰɢɢ ɤɢɫɥɨɪɨɞɚ ɫɨɯɪɚɧɹɥɚɫɶ ɞɨɫɬɚɬɨɱɧɨ ɞɨɥɝɨ ɞɚɠɟ ɧɚ ɮɨɧɟ ɩɨɥɨ ɠɢɬɟɥɶɧɨɣ ɥɭɱɟɜɨɣ ɢ ɥɚɛɨɪɚɬɨɪɧɨɣ ɞɢɧɚɦɢɤɢ ɩɪɨɰɟɫɫɚ ɉɪɢ ɷɬɨɦ ɩɚɰɢɟɧɬɵ ɱɚɳɟ ɜɫɟɝɨ ɧɟ ɧɭɠɞɚɥɢɫɶ ɜ ɪɟɚɧɢɦɚɰɢɨɧɧɨɦ ɩɨɫɨɛɢɢ ɢ ɪɨɫɬ ɭɞɟɥɶɧɨɝɨ ɜɟɫɚ ɩɨɜɬɨɪɧɵɯ ɛɪɨɧɯɨɫɤɨɩɢɣ ɩɪɨɢɡɨɲɺɥ ɜ ɨɫɧɨɜɧɨɦ ɡɚ ɫɱɺɬ ɛɪɨɧɯɨɥɨɝɢɱɟɫɤɨɝɨ ɩɨɫɨɛɢɹ ɜɵɩɨɥɧɟɧɧɨɝɨ ɜ ɭɫɥɨɜɢɹɯ ɷɧɞɨɫɤɨɩɢɱɟɫɤɨɝɨ ɤɚɛɢɧɟɬɚ
Ɉɬɥɢɱɢɟ ɤɥɢɧɢɱɟɫɤɨɣ ɫɢɬɭɚɰɢɢ ɜ ɪɚɡɧɵɟ ɜɪɟɦɟɧɧɵɟ ɩɟɪɢɨɞɵ ɩɪɢɦɟɧɢ ɬɟɥɶɧɨ ɤ ɛɪɨɧɯɨɫɤɨɩɢɢ ɩɪɨɫɥɟɠɢɜɚɥɨɫɶ ɭɠɟ ɧɚ ɷɬɚɩɟ ɩɪɢɧɹɬɢɹ ɪɟɲɟɧɢɹ ɨ ɟɺ ɩɪɨɜɟɞɟɧɢɢ ɬ ɟ ɧɚ ɨɰɟɧɤɟ ɩɨɤɚɡɚɧɢɣ ɤ ɢɫɩɨɥɶɡɨɜɚɧɢɸ ɦɟɬɨɞɚ
42
ȽɅȺȼȺ ɈɋɈȻȿɇɇɈɋɌɂ ɗɇȾɈȻɊɈɇɏɂȺɅɖɇɈɃ ɄȺɊɌɂɇɕ ɍ ɉȺɐɂȿɇɌɈȼ ɋ ɇɈȼɈɃ ɄɈɊɈɇȺȼɂɊɍɋɇɈɃ ɂɇɎȿɄɐɂȿɃ
COVID-19
Ɉɩɢɫɚɧɢɟ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɯ ɢɡɦɟɧɟɧɢɣ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ɧɨɜɨɣ ɤɨɪɨɧɚɜɢ ɪɭɫɧɨɣ ɢɧɮɟɤɰɢɟɣ &29,'- ɧɚɥɢɱɢɟ ɨɬɺɤɚ ɜɵɪɚɠɟɧɧɨɫɬɢ ɝɢɩɟɪɟɦɢɢ ɫɨɫɬɨ ɹɧɢɟ ɫɨɫɭɞɢɫɬɨɝɨ ɪɢɫɭɧɤɚ ɫɨɫɬɨɹɧɢɟ ɭɫɬɶɟɜ ɛɪɨɧɯɢɚɥɶɧɵɯ ɠɟɥɺɡ ɩɨɞɱɺɪɤɧɭ ɬɨɫɬɶ ɢɥɢ ɫɦɚɡɚɧɧɨɫɬɶ ɯɪɹɳɟɜɨɝɨ ɤɚɪɤɚɫɚ ɬɪɚɯɟɢ ɢ ɤɪɭɩɧɵɯ ɛɪɨɧɯɨɜ ɫɨɫɬɨɹɧɢɟ ɦɟɠɛɪɨɧɯɢɚɥɶɧɵɯ ɲɩɨɪ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɭɩɨɦɹɧɭɬɨɣ ɜɵɲɟ ɤɥɚɫɫɢɮɢɤɚɰɢɢ ɷɧɞɨɛɪɨɧɯɢɬɨɜ ɡɚɬɪɭɞɧɟɧɢɣ ɧɟ ɜɵɡɵɜɚɥɨ ɱɬɨ ɛɵɥɨ ɜɩɨɥɧɟ ɩɪɟɞɫɤɚɡɭɟɦɨ Ɉɞ ɧɚɤɨ ɛɵɥɢ ɜɵɹɜɥɟɧɵ ɪɚɡɥɢɱɢɹ ɩɨ ɞɨɦɢɧɢɪɨɜɚɧɢɸ ɬɨɣ ɢɥɢ ɢɧɨɣ ɷɧɞɨɛɪɨɧɯɢ ɚɥɶɧɨɣ ɫɢɦɩɬɨɦɚɬɢɤɢ ɜ ɪɚɡɧɵɟ ɜɪɟɦɟɧɧɵɟ ɩɟɪɢɨɞɵ
ȼ ɩɟɪɜɵɣ ɜɪɟɦɟɧɧɨɣ ɢɧɬɟɪɜɚɥ ɩɪɢ ɩɪɨɜɟɞɟɧɢɢ ɩɟɪɜɢɱɧɵɯ ɛɪɨɧɯɨɫɤɨɩɢɣ ɨɱɟɧɶ ɱɚɫɬɨ ɜɵɹɜɥɹɥɫɹ ɝɟɦɨɪɪɚɝɢɱɟɫɤɢɣ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɣ ɫɢɧɞɪɨɦ ɜ ɪɚɡɥɢɱ ɧɵɯ ɩɪɨɹɜɥɟɧɢɹɯ ɫɥɢɜɧɚɹ ɢ ɬɨɱɟɱɧɚɹ ɩɟɬɟɯɢɚɥɶɧɚɹ ɫɵɩɶ ɨɝɪɚɧɢɱɟɧɧɵɟ ɩɨ ɞɥɢɧɟ ɥɢɧɟɣɧɵɟ ɪɚɡɪɵɜɵ ɫɥɢɡɢɫɬɨɣ – ɦɦ ɝɟɦɨɪɪɚɝɢɱɟɫɤɨɟ ɩɪɨɤɪɚɲɢɜɚɧɢɟ ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ ɫɨɱɟɬɚɧɧɵɟ ɩɨɪɚɠɟɧɢɹ) ɬɚɛɥ 19).
ȼɟɫɶɦɚ ɱɚɫɬɨ ɭ ɬɚɤɢɯ ɩɚɰɢɟɧɬɨɜ ɨɬɦɟɱɚɥɨɫɶ ɤɪɨɜɨɯɚɪɤɚɧɶɟ ɥɺɝɨɱɧɨɟ ɤɪɨɜɨɬɟɱɟɧɢɟ ɫɬɟɩɟɧɢ IȺ ɪɟɠɟ ɢɦɟɥɢ ɦɟɫɬɨ ɫɥɭɱɚɢ ɛɨɥɟɟ ɜɵɪɚɠɟɧɧɨɝɨ ɥɺɝɨɱ ɧɨɝɨ ɤɪɨɜɨɬɟɱɟɧɢɹ IIȺ ɱɬɨ ɢ ɫɥɭɠɢɥɨ ɩɨɤɚɡɚɧɢɟɦ ɤ ɛɪɨɧɯɨɫɤɨɩɢɢ ɂɧɬɟɪɟɫ ɧɨ ɱɬɨ ɩɨ ɩɨɤɚɡɚɧɢɹɦ ɤ ɩɟɪɜɢɱɧɵɦ ɛɪɨɧɯɨɫɤɨɩɢɹɦ ɫɜɹɡɚɧɧɵɯ ɫ ɪɚɡɥɢɱɧɵɦɢ ɫɬɟɩɟɧɹɦɢ ɥɺɝɨɱɧɨɝɨ ɤɪɨɜɨɬɟɱɟɧɢɹ ɜ ɩɟɪɜɵɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ ɜɵɩɨɥɧɟɧɨ ɜɫɟɝɨ ɛɪɨɧɯɨɫɤɨɩɢɣ ɚ ɝɟɦɨɪɪɚɝɢɱɟɫɤɢɣ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɣ ɫɢɧ ɞɪɨɦ ɜ ɪɚɡɥɢɱɧɵɯ ɩɪɨɹɜɥɟɧɢɹɯ ɨɬɦɟɱɟɧ ɜ ɫɥɭɱɚɹɯ ɬ ɟ ɭ ɩɚɰɢ ɟɧɬɨɜ ɩɟɪɜɢɱɧɵɯ ɛɪɨɧɯɨɫɤɨɩɢɣ ɝɟɦɨɪɪɚɝɢɱɟɫɤɢɣ ɷɧɞɨɛɪɨɧɯɢɚɥɶ ɧɵɣ ɫɢɧɞɪɨɦ ɧɟ ɢɦɟɥ ɤɥɢɧɢɱɟɫɤɨɝɨ ɷɤɜɢɜɚɥɟɧɬɚ ɢ ɜɵɹɜɥɟɧ ɤɚɤ ɧɚɯɨɞɤɚ
43
Ɍɚɛɥɢɰɚ 19*
ɉɪɨɹɜɥɟɧɢɹ ɝɟɦɨɪɪɚɝɢɱɟɫɤɨɝɨ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɢɧɞɪɨɦɚ ɭ ɩɚɰɢɟɧɬɨɜ ɤɨɪɨɧɚɜɢɪɭɫɧɨɝɨ ɝɨɫɩɢɬɚɥɹ ɜ ɩɟɪɜɵɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ
ɉɪɨɹɜɥɟɧɢɹ |
Ⱦɚɧɧɵɟ ɛɪɨɧɯɨɫɤɨɩɢɣ |
Ⱦɚɧɧɵɟ ɛɪɨɧɯɨɫɤɨɩɢɣ |
|
ɝɟɦɨɪɪɚɝɢɱɟɫɤɨɝɨ |
ɩɪɨɜɟɞɺɧɧɵɯ ɜ ɭɫɥɨɜɢɹɯ |
ɩɪɨɜɟɞɺɧɧɵɯ ɜ ɭɫɥɨɜɢɹɯ |
|
ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɢɧɞɪɨɦɚ |
ɷɧɞɨɫɤɨɩɢɱɟɫɤɨɝɨ ɤɚɛɢɧɟɬɚ |
ɈɊɂɌ |
|
|
ɉɟɪɜɢɱɧɵɟ ɛɪɨɧɯɨɫɤɨɩɢɢ |
|
|
Ɉɞɢɧɨɱɧɵɟ ɢ ɦɧɨɠɟɫɬɜɟɧɧɵɟ |
32 (3,048%) |
26 (2,476%) |
|
ɩɟɬɟɯɢɚɥɶɧɵɟ ɤɪɨɜɨɢɡɥɢɹɧɢɹ |
|||
|
|
||
Ʉɪɨɜɨɢɡɥɢɹɧɢɹ ɢɡ ɨɝɪɚɧɢ |
10 (0,952%) |
4 (0,381%) |
|
ɱɟɧɧɵɯ ɪɚɡɪɵɜɨɜ ɫɥɢɡɢɫɬɨɣ |
|||
|
|
||
|
I-ɹ ɫɬɟɩɟɧɶ 1 (0,095%) |
I-ɹ ɫɬɟɩɟɧɶ – |
|
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II1): 41 |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II1): 31 |
|
Ƚɟɦɨɪɪɚɝɢɱɟɫɤɢɣ ɤɨɦɩɨɧɟɧɬ |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II2): 1 |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II2): 1 |
|
ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ |
(0,095%) |
(0,095%) |
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II3): 1 |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II3): 3 |
||
|
|||
|
(0,095%) |
(0,286%) |
|
|
III-ɹ ɫɬɟɩɟɧɶ |
III-ɹ ɫɬɟɩɟɧɶ (0,381%) |
|
ɋɨɱɟɬɚɧɧɵɟ ɝɟɦɨɪɪɚɝɢɱɟɫɤɢɟ |
32 (3,048%) |
36 (3,429%) |
|
ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɟɩɪɨɹɜɥɟɧɢɹ |
|||
|
|
||
|
ɉɨɜɬɨɪɧɵɟ ɛɪɨɧɯɨɫɤɨɩɢɢ |
|
|
Ɉɞɢɧɨɱɧɵɟ ɢ ɦɧɨɠɟɫɬɜɟɧɧɵɟ |
– |
4 (0,381%) |
|
ɩɟɬɟɯɢɚɥɶɧɵɟ ɤɪɨɜɨɢɡɥɢɹɧɢɹ |
|||
|
|
||
Ʉɪɨɜɨɢɡɥɢɹɧɢɹ ɢɡ ɨɝɪɚɧɢ |
1 (0,095%) |
4 (0,381%) |
|
ɱɟɧɧɵɯ ɪɚɡɪɵɜɨɜ ɫɥɢɡɢɫɬɨɣ |
|||
|
|
||
|
I-ɹ ɫɬɟɩɟɧɶ – |
I-ɹ ɫɬɟɩɟɧɶ – |
|
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II1): – |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II1): 7 |
|
|
(0,667%) |
||
Ƚɟɦɨɪɪɚɝɢɱɟɫɤɢɣ ɤɨɦɩɨɧɟɧɬ |
|
||
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II2): 1 |
||
ɛɪɨɧ-ɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II2): – |
||
(0,095%) |
|||
|
|
||
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II3): – |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II3): – |
|
|
III-ɹ ɫɬɟɩɟɧɶ 1 (0,095%) |
III-ɹ ɫɬɟɩɟɧɶ 1 (0,095%) |
|
ɋɨɱɟɬɚɧɧɵɟ ɝɟɦɨɪɪɚɝɢɱɟɫɤɢɟ |
– |
3 (0,286%) |
|
ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɟɩɪɨɹɜɥɟɧɢɹ |
|||
|
|
||
|
|
|
ɉɨɞɪɨɛɧɚɹ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚ ɝɟɦɨɪɪɚɝɢɱɟɫɤɢɣ ɤɨɦɩɨɧɟɧɬ ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ ɩɪɢɜɟɞɟɧɚ ɜ ɬɚɛɥ 6.
ɋɥɟɞɭɟɬ ɫɤɚɡɚɬɶ ɱɬɨ ɢɦɟɥɚ ɦɟɫɬɨ ɢ ɨɛɪɚɬɧɚɹ ɫɢɬɭɚɰɢɹ ɧɚɥɢɱɢɟ ɤɪɨɜɨ ɯɚɪɤɚɧɶɟ ɧɟ ɜɫɟɝɞɚ ɚɜɬɨɦɚɬɢɱɟɫɤɢ ɨɡɧɚɱɚɥɨ ɧɚɥɢɱɢɟ ɩɪɨɹɜɥɟɧɢɣ ɝɟɦɨɪɪɚɝɢɱɟ ɫɤɨɝɨ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɢɧɞɪɨɦɚ ɉɪɢ ɷɬɨɦ ɭɦɟɪɟɧɧɵɣ ɨɬɺɤ ɧɟɹɪɤɚɹ ɝɢɩɟ ɪɟɦɢɹ ɧɟɛɨɥɶɲɚɹ ɫɦɚɡɚɧɧɨɫɬɶ ɫɨɫɭɞɢɫɬɨɝɨ ɪɢɫɭɧɤɚ ɫɥɢɡɢɫɬɵɣ ɯɚɪɚɤɬɟɪ ɥɟɝɤɨ
44
ɨɬɞɟɥɹɟɦɨɝɨ ɢ ɧɟɛɨɥɶɲɨɝɨ ɩɨ ɨɛɴɺɦɭ ɫɟɤɪɟɬɚ ɭɤɥɚɞɵɜɚɥɢɫɶ ɜ I-ɸ ɫɬɟɩɟɧɶ ɢɧ ɬɟɧɫɢɜɧɨɫɬɢ ɜɨɫɩɚɥɟɧɢɹ ɩɨ Ʌɟɦɭɚɧɭ ɪɢɫ 4, 5, 6).
Ɋɢɫ 4. ɋɥɢɜɚɸɳɚɹɫɹ ɩɟɬɟɯɢɚɥɶɧɚɹ ɫɵɩɶ ɩɨ ɦɟɞɢɚɥɶɧɨɣ ɫɬɟɧɤɟ ɥɟɜɨɝɨ ɝɥɚɜɧɨɝɨ ɛɪɨɧɯɚ ɭ ɩɚɰɢɟɧɬɚ ɫ ɩɨɞɬɜɟɪɠɞɺɧɧɵɦ ɫɥɭɱɚɟɦ ɧɨɜɨɣ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɟɣ COVID-19ɩɟɪɜɵɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ
Ɋɢɫ 5. ɋɥɢɜɚɸɳɢɟɫɹ ɝɟɦɨɪɪɚɝɢɢ ɫɥɢɡɢɫɬɨɣ ɜ ɨɛɥɚɫɬɢ ɩɪɚɜɵɯ ɩɪɨɦɟɠɭɬɨɱɧɨɝɨ ɢ ɧ ɞɨɥɟɜɨɝɨ ɛɪɨɧɯɨɜ ɭ ɩɚɰɢɟɧɬɚ ɫ ɜɵɫɨɤɢɦ ɪɢɫɤɨɦ ɧɨɜɨɣ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɟɣ COVID-19ɩɟɪɜɵɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ
45
Ɋɢɫ 6. ɋɥɢɜɚɸɳɚɹɫɹ ɢ ɬɨɱɟɱɧɚɹ ɩɟɬɟɯɢɚɥɶɧɚɹ ɫɵɩɶ ɜ ɨɛɥɚɫɬɢ ɧɢɠɧɟɣ ɬɪɟɬɢ ɬɪɚɯɟɢ ɢ ɥɟɜɨɝɨ ɝɥɚɜɧɨɝɨ ɛɪɨɧɯɚ ɭ ɩɚɰɢɟɧɬɤɢ ɫ ɩɨɞɬɜɟɪɠɞɺɧɧɵɦ ɫɥɭɱɚɟɦ ɧɨɜɨɣ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɟɣ COVIDɩɟɪɜɵɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ
Ƚɧɨɣɧɵɣ ɤɨɦɩɨɧɟɧɬ ɫɟɤɪɟɬɚ ɡɧɚɦɟɧɭɸɳɢɣ ɩɟɪɟɯɨɞ ɤ ɛɨɥɟɟ ɜɵɪɚɠɟɧɧɨ ɦɭ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɨɦɭ ɜɨɫɩɚɥɟɧɢɸ ɫɥɢɡɢɫɬɨ-ɝɧɨɣɧɵɣ ɫɟɤɪɟɬ II-ɹ ɫɬɟɩɟɧɶ ɢɧ ɬɟɧɫɢɜɧɨɫɬɢ ɜɨɫɩɚɥɟɧɢɹ ɝɧɨɣɧɵɣ ɫɟɤɪɟɬ III-ɹ ɫɬɟɩɟɧɶ ɢɧɬɟɧɫɢɜɧɨɫɬɢ ɜɨɫɩɚ ɥɟɧɢɹ ɜɫɬɪɟɱɚɥɢɫɶ ɡɧɚɱɢɬɟɥɶɧɨ ɪɟɠɟ ɉɪɢ ɩɪɨɜɟɞɟɧɢɢ ɩɟɪɜɢɱɧɵɯ ɛɪɨɧɯɨɫɤɨ ɩɢɣ ɜ ɭɫɥɨɜɢɹɯ ɷɧɞɨɫɤɨɩɢɱɟɫɤɨɝɨ ɤɚɛɢɧɟɬɚ ɨɧ ɨɬɦɟɱɟɧ ɜ ɫɥɭɱɚɹɯ ɉɪɢ ɷɬɨɦ ɜɨ ɜɫɟɯ ɫɥɭɱɚɹɯ ɭ ɩɚɰɢɟɧɬɨɜ ɨɬɦɟɱɚɥɫɹ ɮɨɧɨɜɵɣ ɯɪɨɧɢɱɟɫɤɢɣ ɨɛ ɫɬɪɭɤɬɢɜɧɵɣ ɩɪɨɰɟɫɫ ɜ ɥɺɝɤɢɯ ɪɚɧɟɟ ɞɢɚɝɧɨɫɬɢɪɨɜɚɧɧɵɣ ɍɩɨɪɧɵɣ ɛɪɨɧɯɨɨɛ ɫɬɪɭɤɬɢɜɧɵɣ ɫɢɧɞɪɨɦ ɭ ɬɚɤɢɯ ɩɚɰɢɟɧɬɨɜ ɜ ɪɹɞɟ ɫɥɭɱɚɟɜ ɫɬɚɧɨɜɢɥɫɹ ɩɨɤɚɡɚɧɢɟɦ ɤ ɩɪɨɜɟɞɟɧɢɸ ɩɨɜɬɨɪɧɨɣ ɛɪɨɧɯɨɫɤɨɩɢɢ ȼɹɡɤɨɫɬɶ ɫɟɤɪɟɬɚ ɛɵɥɚ ɩɨɜɵɲɟɧɚ ɢ ɜ ɰɟɥɨɦ ɧɟ ɢɦɟɥɚ ɤɚɤɢɯ-ɥɢɛɨ ɨɫɨɛɟɧɧɨɫɬɟɣ ɨɬɥɢɱɚɸɳɢɯ ɟɺ ɨɬ ɢɡɦɟɧɟɧɢɣ ɜɹɡɤɨ ɫɬɢ ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ ɜ ɮɚɡɭ ɨɛɨɫɬɪɟɧɢɹ ɯɪɨɧɢɱɟɫɤɨɝɨ ɨɛɫɬɪɭɤɬɢɜɧɨɝɨ ɩɪɨɰɟɫɫɚ ɜ ɥɺɝɤɢɯ ɂɧɨɝɞɚ ɢɦɟɥɨ ɦɟɫɬɨ ɫɨɱɟɬɚɧɢɟ ɢɡɛɵɬɨɱɧɨɝɨ ɤɨɥɢɱɟɫɬɜɚ ɩɚ ɬɨɥɨɝɢɱɟɫɤɢ ɢɡɦɟɧɺɧɧɨɝɨ ɫɟɤɪɟɬɚ ɫ ɩɪɨɹɜɥɟɧɢɹɦɢ ɝɟɦɨɪɪɚɝɢɱɟɫɤɨɝɨ ɷɧɞɨɛɪɨɧ ɯɢɚɥɶɧɨɝɨ ɫɢɧɞɪɨɦɚ ɢɥɢ ɟɝɨ ɢɫɯɨɞɚ ɪɢɫ 7).
46
Ɋɢɫ 7. ɇɚ ɷɧɞɨɮɨɬɨ ɭ ɩɚɰɢɟɧɬɚ ɛɪɨɧɯɨɷɤɬɚɬɢɱɟɫɤɨɣ ɛɨɥɟɡɧɶɸ ɫ ɩɨɞɬɜɟɪɠɞɺɧɧɵɦ ɫɥɭɱɚɟɦ ɧɨɜɨɣ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɢ COVIDɨɬɦɟɱɚɟɬɫɹ ɩɨɥɧɚɹ ɨɛɬɭɪɚɰɢɹ ɩɪɚɜɨɝɨ ɧɢɠɧɟɞɨɥɟɜɨɝɨ ɛɪɨɧɯɚ ɨ ɭɫɬɨɣɱɢɜɨɣ ɝɧɨɣɧɨɣ ɩɪɨɛɤɨɣ ɞɟɥɚɸɳɟɣ ɧɟɜɨɡɦɨɠɧɨɣ ɜɢɡɭɚɥɢɡɚɰɢɸ ɫɟɝɦɟɧɬɚɪɧɵɯ ɛɪɨɧɯɨɜ ɩɪɚɜɨɣ ɛɚɡɚɥɶɧɨɣ ɩɢɪɚɦɢɞɵ ɛɪɨɧɯɢ ȼ8 ȼ9 ɢ ȼ10). ɋɪɟɞɧɟɞɨɥɟɜɨɣ ɛɪɨɧɯ ɱɚɫɬɢɱɧɨ ɨɛɬɭɪɢɪɨɜɚɧ ɫɬɚɪɵɦɢ ɬɪɨɦɛɨɬɢɱɟɫɤɢɦɢ ɦɚɫɫɚɦɢ ɋɟɝɦɟɧɬɚɪɧɵɟ ɛɪɨɧɯɢ ȼ4 ɢ ȼ5 ɫɪɟɞɧɟɣ ɞɨɥɢ ɧɟ ɜɢɡɭɚɥɢɡɢɪɭɸɬɫɹ
ȼ ɩɟɪɜɵɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ ɜ -ɯ ɫɥɭɱɚɹɯ ɛɵɥɢ ɜɵɹɜɥɟɧɵ ɫɨɥɢ ɬɚɪɧɵɟ ɹɡɜɵ ɛɪɨɧɯɨɜ Ɉɧɢ ɛɵɥɢ ɩɥɨɫɤɢɦɢ ɩɪɢɤɪɵɬɵɦɢ ɮɢɛɪɢɧɧɨɣ ɩɥɺɧɤɨɣ ɫ ɩɥɨɫɤɢɦɢ ɤɪɚɹɦɢ Ɋɚɡɦɟɪɵ ɤɨɥɟɛɚɥɢɫɶ ɨɬ × ɫɦ ɞɨ × ɫɦ ɂɫɩɨɥɶɡɨ ɜɚɧɧɵɣ ɧɚɛɨɪ ɞɨɩɨɥɧɢɬɟɥɶɧɵɯ ɞɢɚɝɧɨɫɬɢɱɟɫɤɢɯ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɯ ɦɚɧɢɩɭɥɹ ɰɢɣ ɩɨɡɜɨɥɢɥ ɢɫɤɥɸɱɢɬɶ ɬɭɛɟɪɤɭɥɺɡɧɵɣ ɢ ɧɟɨɩɥɚɫɬɢɱɟɫɤɢɣ ɝɟɧɟɡ ɹɡɜɟɧɧɵɯ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɯ ɩɪɨɰɟɫɫɨɜ Ɉɰɟɧɤɚ ɞɢɧɚɦɢɤɢ ɹɡɜɟɧɧɨɝɨ ɩɪɨɰɟɫɫɚ ɹɜɢɥɚɫɶ ɫɚɦɨɫɬɨɹɬɟɥɶɧɵɦ ɩɨɤɚɡɚɧɢɟɦ ɞɥɹ ɩɨɜɬɨɪɧɵɯ ɩɥɚɧɨɜɵɯ ɛɪɨɧɯɨɫɤɨɩɢɣ ɇɚ ɮɨɧɟ ɩɨɥɨɠɢɬɟɥɶɧɨɣ ɤɥɢɧɢɤɨ-ɥɚɛɨɪɚɬɨɪɧɨɣ ɞɢɧɚɦɢɤɢ ɜ -ɯ ɫɥɭɱɚɹɯ 0 ɨɬɦɟ ɱɟɧɚ ɩɨɥɧɚɹ ɢɧɜɟɪɫɢɹ ɹɡɜɟɧɧɵɯ ɩɨɪɚɠɟɧɢɣ ɛɟɡ ɤɚɤɢɯ-ɥɢɛɨ ɪɭɛɰɨɜɵɯ ɢɫɯɨɞɨɜ ɜ -ɯ ɫɥɭɱɚɹɯ ɛɵɥɚ ɨɬɦɟɱɟɧɚ ɜɵɪɚɠɟɧɧɚɹ ɩɨɥɨɠɢɬɟɥɶɧɚɹ ɞɢɧɚɦɢɤɚ ɜɵɪɚɠɚɸ ɳɚɹɫɹ ɜ ɜɢɞɢɦɨɦ ɭɦɟɧɶɲɟɧɢɢ ɩɥɨɳɚɞɢ ɞɟɮɟɤɬɚ
ȼɨ ɜɬɨɪɨɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ ɩɪɨɹɜɥɟɧɢɹ ɝɟɦɨɪɪɚɝɢɱɟɫɤɨɝɨ ɷɧɞɨɛɪɨɧɯɢ ɚɥɶɧɨɝɨ ɫɢɧɞɪɨɦɚ ɤɚɤ ɦɚɫɫɨɜɵɟ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɟ ɫɢɦɩɬɨɦɵ ɩɪɚɤɬɢɱɟɫɤɢ ɢɫ ɱɟɡɥɢ ɬɚɛɥ 20).
47
Ɍɚɛɥɢɰɚ 20
ɉɪɨɹɜɥɟɧɢɹ ɝɟɦɨɪɪɚɝɢɱɟɫɤɨɝɨ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɢɧɞɪɨɦɚ ɭ ɩɚɰɢɟɧɬɨɜ ɤɨɪɨɧɚɜɢɪɭɫɧɨɝɨ ɝɨɫɩɢɬɚɥɹ ɜɨ ɜɬɨɪɨɣ ɜɪɟɦɟɧɧɨɣ ɩɟɪɢɨɞ
ɉɪɨɹɜɥɟɧɢɹ ɝɟɦɨɪɪɚɝɢɱɟɫɤɨɝɨ Ⱦɚɧɧɵɟ ɛɪɨɧɯɨɫɤɨɩɢɣ Ⱦɚɧɧɵɟ ɛɪɨɧɯɨɫɤɨɩɢɣ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɢɧɞɪɨɦɚ ɩɪɨɜɟɞɺɧɧɵɯ ɜ ɭɫɥɨɜɢɹɯ ɩɪɨɜɟɞɺɧɧɵɯ ɜ ɭɫɥɨɜɢɹɯ
ɷɧɞɨɫɤɨɩɢɱɟɫɤɨɝɨ ɤɚɛɢɧɟɬɚ ɈɊɂɌ
ɉɟɪɜɢɱɧɵɟ ɛɪɨɧɯɨɫɤɨɩɢɢ
Ɉɞɢɧɨɱɧɵɟ ɢ ɦɧɨɠɟɫɬɜɟɧɧɵɟ |
|
1 (0,095%) |
– |
ɩɟɬɟɯɢɚɥɶɧɵɟ ɤɪɨɜɨɢɡɥɢɹɧɢɹ |
|
||
|
|
|
|
Ʉɪɨɜɨɢɡɥɢɹɧɢɹ ɢɡ ɨɝɪɚɧɢɱɟɧɧɵɯ |
|
– |
– |
ɪɚɡɪɵɜɨɜ ɫɥɢɡɢɫɬɨɣ |
|
||
|
|
|
|
|
|
I-ɹ ɫɬɟɩɟɧɶ – |
I-ɹ ɫɬɟɩɟɧɶ – |
|
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II1): – |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II1): – |
Ƚɟɦɨɪɪɚɝɢɱɟɫɤɢɣ ɤɨɦɩɨɧɟɧɬ |
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II2): 2 |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II2): 2 |
|
(0,190%) |
(0,190%) |
|
ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ |
|
||
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II3): 2 |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II3): 1 |
|
|
|
||
|
|
(0,190%) |
(0,095%) |
|
|
III-ɹ ɫɬɟɩɟɧɶ – |
III-ɹ ɫɬɟɩɟɧɶ – |
ɋɨɱɟɬɚɧɧɵɟ ɝɟɦɨɪɪɚɝɢɱɟɫɤɢɟ |
|
|
– |
ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɟ ɩɪɨɹɜɥɟɧɢɹ |
|
|
|
|
|
|
|
|
|
ɉɨɜɬɨɪɧɵɟ ɛɪɨɧɯɨɫɤɨɩɢɢ |
|
Ɉɞɢɧɨɱɧɵɟ ɢ ɦɧɨɠɟɫɬɜɟɧɧɵɟ |
|
– |
– |
ɩɟɬɟɯɢɚɥɶɧɵɟ ɤɪɨɜɨɢɡɥɢɹɧɢɹ |
|
||
|
|
|
|
Ʉɪɨɜɨɢɡɥɢɹɧɢɹ ɢɡ ɨɝɪɚɧɢɱɟɧɧɵɯ |
|
– |
– |
ɪɚɡɪɵɜɨɜ ɫɥɢɡɢɫɬɨɣ |
|
||
|
|
|
|
|
|
I-ɹ ɫɬɟɩɟɧɶ |
I-ɹ ɫɬɟɩɟɧɶ – |
|
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II1): – |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II1): 1 |
Ƚɟɦɨɪɪɚɝɢɱɟɫɤɢɣ ɤɨɦɩɨɧɟɧɬ |
|
|
(0,095%) |
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II2): 1 |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II2): 2 |
|
ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ |
|
||
|
(0,095%) |
(0,190%) |
|
|
|
||
|
|
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II3): – |
II-ɹ ɫɬɟɩɟɧɶ ɜɚɪɢɚɧɬ II3): – |
|
|
III-ɹ ɫɬɟɩɟɧɶ |
III-ɹ ɫɬɟɩɟɧɶ – |
ɋɨɱɟɬɚɧɧɵɟ ɝɟɦɨɪɪɚɝɢɱɟɫɤɢɟ |
|
– |
– |
ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɟ ɩɪɨɹɜɥɟɧɢɹ |
|
||
|
|
|
ɉɨɞɪɨɛɧɚɹ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚ ɝɟɦɨɪɪɚɝɢɱɟɫɤɢɣ ɤɨɦɩɨɧɟɧɬ ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ ɩɪɢɜɟɞɟɧɚ ɜ ɬɚɛɥ 6.
Ʉɪɨɜɨɯɚɪɤɚɧɶɟ ɢɥɢ ɥɺɝɨɱɧɨɟ ɤɪɨɜɨɬɟɱɟɧɢɟ ɛɨɥɟɟ ɜɵɫɨɤɢɯ ɝɪɚɞɚɰɢɢ ɨɬɦɟ ɱɟɧɨ ɥɢɲɶ ɜ ɫɥɭɱɚɹɯ ɩɪɨɜɟɞɟɧɢɹ ɩɟɪɜɢɱɧɵɯ ɛɪɨɧɯɨɫɤɨɩɢɣ ɷɬɨ ɩɨ ɤɚɡɚɧɢɟ ɨɬɦɟɱɟɧɨ ɜ ɷɩɢɡɨɞɚɯ ɩɪɨɜɟɞɟɧɢɹ ɛɪɨɧɯɨɫɤɨɩɢɢ ɜ ɭɫɥɨɜɢɹɯ ɷɧɞɨɫɤɨ ɩɢɱɟɫɤɨɝɨ ɤɚɛɢɧɟɬɚ ɢ ɜ -ɯ ɫɥɭɱɚɹɯ ɩɪɨɜɟɞɟɧɢɹ ɛɪɨɧɯɨɫɤɨɩɢɢ ɜ ɈɊɂɌ
(0,286%).
48
ɇɚ ɩɟɪɜɵɣ ɩɥɚɧ ɜɵɲɥɢ ɩɚɬɨɥɨɝɢɱɟɫɤɢɟ ɢɡɦɟɧɟɧɢɹ ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟ ɬɚ ɩɪɨɹɜɥɹɸɳɢɟɫɹ ɩɪɢɫɨɟɞɢɧɟɧɢɟɦ ɝɧɨɣɧɨɝɨ ɤɨɦɩɨɧɟɧɬɚ ɋɟɤɪɟɬ ɱɚɳɟ ɜɫɟɝɨ ɧɨɫɢɥ ɫɥɢɡɢɫɬɨ-ɝɧɨɣɧɵɣ ) ɢɥɢ ɝɧɨɣɧɵɣ ɯɚɪɚɤɬɟɪ )). ɉɪɢ ɷɬɨɦ ɡɚɱɚɫɬɭɸ ɩɨɹɜɥɟɧɢɟ ɝɧɨɣɧɨɝɨ ɤɨɦɩɨɧɟɧɬɚ ɧɟ ɩɪɢɜɨɞɢɥɚ ɚɜɬɨɦɚɬɢɱɟ ɫɤɢ ɤ ɨɳɭɬɢɦɨɦɭ ɩɨɜɵɲɟɧɢɸ ɜɹɡɤɨɫɬɢ ɫɟɤɪɟɬɚ ɫɟɤɪɟɬ ɧɟɪɟɞɤɨ ɛɵɥ ɩɟɧɢɫɬɵɦ ɱɬɨ ɛɨɥɶɲɟ ɯɚɪɚɤɬɟɪɧɨ ɞɥɹ ɫɨɫɬɨɹɧɢɹ ɨɬɺɤɚ ɥɺɝɤɢɯ ɤɚɤ ɤɚɪɞɢɚɥɶɧɨɝɨ ɝɟɧɟɡɚ ɬɚɤ ɢ ɢɧɮɟɤɰɢɨɧɧɨɝɨ. ɂɧɨɝɞɚ ɨɧ ɨɱɟɧɶ ɧɚɩɨɦɢɧɚɥ ɯɚɪɚɤɬɟɪ ɫɟɤɪɟɬɚ ɩɪɢ ɨɬɺɤɟ ɥɺɝɤɢɯ ɧɚ ɮɨɧɟ ɬɹɠɺɥɨɝɨ ɝɪɢɩɩɚ ɧɨ ɩɪɢ ɷɬɨɦ ɜɦɟɫɬɨ ɪɨɡɨɜɚɬɨɝɨ ɢɥɢ ɤɪɚɫɧɨɜɚ ɬɨɝɨ ɨɬɬɟɧɤɚ ɩɟɧɢɫɬɨɝɨ ɫɟɤɪɟɬɚ ɩɪɢ ɝɪɢɩɩɟ ɡɚ ɫɱɺɬ ɝɟɦɨɪɪɚɝɢɱɟɫɤɨɝɨ ɤɨɦɩɨ ɧɟɧɬɚ ɠɟɥɬɨɜɚɬɵɣ ɨɬɬɟɧɨɤ ɫɟɤɪɟɬɚ ɢɧɨɝɞɚ ɞɨɫɬɚɬɨɱɧɨ ɧɚɫɵɳɟɧɧɨɝɨ ɰɜɟɬɚ ɜɵɞɚɜɚɥ ɧɚɥɢɱɢɟ ɝɧɨɣɧɨɝɨ ɤɨɦɩɨɧɟɧɬɚ ɑɚɫɬɨ ɷɬɭ ɛɪɨɧɯɨɨɛɫɬɪɭɤɰɢɸ ɧɟ ɭɞɚɜɚ ɥɨɫɶ ɪɚɡɪɟɲɢɬɶ ɦɟɞɢɤɚɦɟɧɬɨɡɧɨ ɧɨ ɩɪɢ ɩɪɨɜɟɞɟɧɢɢ ɛɪɨɧɯɨɫɤɨɩɢɢ ɫɟɤɪɟɬ ɞɨ ɫɬɚɬɨɱɧɨ ɥɟɝɤɨ ɷɜɚɤɭɢɪɨɜɚɥɫɹ ɞɥɹ ɷɬɨɝɨ ɯɜɚɬɚɥɨ ɧɟɛɨɥɶɲɢɯ ɨɛɴɺɦɨɜ ɥɚɜɚɠɧɨɣ ɫɪɟɞɵ ɉɪɢ ɷɬɨɦ ɭ ɛɨɥɶɲɢɧɫɬɜɚ ɩɚɰɢɟɧɬɨɜ ɮɨɧɨɜɵɣ ɨɛɫɬɪɭɤɬɢɜɧɵɣ ɩɪɨɰɟɫɫ ɜ ɥɺɝɤɢɯ ɭ ɛɨɥɶɲɢɧɫɬɜɚ ɩɚɰɢɟɧɬɨɜ ɜɵɹɜɥɟɧ ɧɟ ɛɵɥ ɪɢɫ 8, 9).
Ɋɢɫ 8. ɇɚ ɷɧɞɨɮɨɬɨ ɫɥɢɡɢɫɬɨ-ɝɧɨɣɧɵɣ ɫɟɤɪɟɬ ɭɦɟɪɟɧɧɨɣ ɜɹɡɤɨɫɬɢ ɜɵɩɨɥɧɹɸɳɢɣ ɭɫɬɶɟ ɥɟɜɨɝɨɜɟɪɯɧɟɞɨɥɟɜɨɝɨ ɛɪɨɧɯɚ ɭ ɩɚɰɢɟɧɬɤɢ ɫ ɩɨɞɬɜɟɪɠɞɺɧɧɵɦ ɫɥɭɱɚɟɦ ɧɨɜɨɣɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɢ COVIDɎɨɧɨɜɵɣ ɯɪɨɧɢɱɟɫɤɢɣ ɨɛɫɬɪɭɤɬɢɜɧɵɣ ɩɪɨɰɟɫɫ ɜ ɥɺɝɤɢɯ ɨɬɫɭɬɫɬɜɭɟɬ
49
Ɋɢɫ 9. ɇɚ ɷɧɞɨɮɨɬɨ ɫɥɢɡɢɫɬɨ-ɝɧɨɣɧɵɣ ɫɟɤɪɟɬ ɩɨɥɧɨɫɬɶɸɨɛɬɭɪɢɪɭɸɳɢɣɩɪɚɜɵɣɩɪɨɦɟɠɭɬɨɱ ɧɵɣ ɛɪɨɧɯ ɭ ɩɚɰɢɟɧɬɚ ɫɩɨɞɬɜɟɪɠɞɺɧɧɵɦ ɫɥɭɱɚɟɦɧɨɜɨɣ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɢ COVID-19. ɉɪɢ ɩɪɨɜɟɞɟɧɢɢɤɨɧɬɪɨɥɶɧɨɣ ɪɟɧɬɝɟɧɨɝɪɚɮɢɢɝɪɭɞɧɨɣɤɥɟɬɤɢ ɜɵɩɨɥɧɹɥɚɫɶ ɜ ɈɊɂɌ ɨɬɦɟɱɟɧɨ ɮɨɪɦɢɪɨɜɚɧɢɟɚɬɟɥɟɤɬɚɡɚɧɢɠɧɟɣɞɨɥɢɩɪɚɜɨɝɨɥɺɝɤɨɝɨ ɤɨɬɨɪɵɣɨɬɫɭɬɫɬɜɨɜɚɥɩɪɢɩɨɫɬɭɩɥɟɧɢɢ Ɏɨɧɨɜɵɣɯɪɨɧɢɱɟɫɤɢɣ ɨɛɫɬɪɭɤɬɢɜɧɵɣɩɪɨɰɟɫɫɜɥɺɝɤɢɯɜɵɹɜɥɟɧɧɟ ɛɵɥ
ɋɜɨɞɧɵɟ ɞɚɧɧɵɟ ɨɛ ɷɬɢɨɥɨɝɢɱɟɫɤɨɣ ɩɪɢɧɚɞɥɟɠɧɨɫɬɢ ɛɪɨɧɯɨɨɛɫɬɪɭɤɬɢɜ ɧɨɝɨ ɫɢɧɞɪɨɦɚ ɧɚ ɮɨɧɟ ɨɛɫɬɪɭɤɰɢɢ ɧɢɠɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɛɪɨɧɯɢɚɥɶɧɵɦ ɫɟɤɪɟɬɨɦ ɩɪɟɞɫɬɚɜɥɟɧɚ ɜ ɬɚɛɥ 21.
Ɉɬɦɟɱɚɟɬɫɹ ɡɧɚɱɢɬɟɥɶɧɨɟ ɤɨɥɢɱɟɫɬɜɨ ɩɚɰɢɟɧɬɨɜ ɜɨ ɜɬɨɪɨɦ ɜɪɟɦɟɧɧɨɦ ɩɟ ɪɢɨɞɟ ɭ ɤɨɬɨɪɵɯ ɜɵɪɚɠɟɧɧɚɹ ɨɛɫɬɪɭɤɰɢɹ ɧɢɠɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɫɬɚɜɲɚɹ ɩɨɤɚɡɚɧɢɟɦ ɞɥɹ ɩɪɨɜɟɞɟɧɢɹ ɛɪɨɧɯɨɫɤɨɩɢɢ ɧɟ ɢɦɟɥɚ ɩɨɞɬɜɟɪɠɞɺɧɧɨɝɨ ɪɚɧɟɟ ɯɪɨɧɢɱɟɫɤɨɝɨ ɨɛɫɬɪɭɤɬɢɜɧɨɝɨ ɩɪɨɰɟɫɫɚ ɜ ɥɺɝɤɢɯ
ȼɵɹɜɥɟɧɧɚɹ ɜ ɩɪɨɰɟɫɫɟ ɩɟɪɜɢɱɧɵɯ ɥɟɱɟɛɧɨ-ɞɢɚɝɧɨɫɬɢɱɟɫɤɢɯ ɛɪɨɧɯɨɫɤɨ ɩɢɣ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɚɹ ɩɚɬɨɥɨɝɢɹ ɧɚɲɟɞɲɚɹ ɨɬɪɚɠɟɧɢɟ ɜ ɷɧɞɨɫɤɨɩɢɱɟɫɤɢɯ ɡɚ ɤɥɸɱɟɧɢɹɯ ɩɪɟɞɫɬɚɜɥɟɧɚ ɜ ɬɚɛɥ
50