Опыт бронхологического пособия пациентам с новой коронавирусной инфекцией COVID-19. Монография

ȽɅȺȼȺ ɈɌȾȿɅɖɇɕȿ ɌȿɏɇɂɑȿɋɄɂȿ ȼɈɉɊɈɋɕ ɉɊɈȼȿȾȿɇɂə ȻɊɈɇɏɈɋɄɈɉɂɂ ɉȺɐɂȿɇɌȺɆ ɋ ɇɈȼɈɃ ɄɈɊɈɇȺȼɂɊɍɋɇɈɃ ɂɇɎȿɄɐɂȿɃ COVIDɇȺɏɈȾəɓɂɏɋə ɇȺ ɂɋɄɍɋɋɌȼȿɇɇɈɃ ȼȿɇɌɂɅəɐɂɂ ɅȬȽɄɂɏ

Ⱦɨɫɬɚɬɨɱɧɨ ɛɨɥɶɲɨɟ ɤɨɥɢɱɟɫɬɜɨ ɩɚɰɢɟɧɬɨɜ ɤɨɪɨɧɚɜɢɪɭɫɧɨɝɨ ɝɨɫɩɢɬɚɥɹ (ɟɫɥɢ ɧɟ ɜ ɨɬɧɨɫɢɬɟɥɶɧɨɦ ɬɨ ɜ ɚɛɫɨɥɸɬɧɨɦ ɜɵɪɚɠɟɧɢɢ ɧɚɯɨɞɢɥɢɫɶ ɜ ɈɊɂɌ ɢ ɛɪɨɧɯɨɥɨɝɢɱɟɫɤɨɟ ɩɨɫɨɛɢɟ ɨɫɭɳɟɫɬɜɥɹɥɨɫɶ ɢɦ ɧɚ ɦɟɫɬɟ ɉɪɢ ɷɬɨɦ ɨɱɟɧɶ ɱɚɫɬɨ ɩɚɰɢɟɧɬɵ ɧɚɯɨɞɢɥɢɫɶ ɜ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ ɩɨɥɨɠɟɧɢɟ ɥɟɠɚ ɧɚ ɠɢɜɨɬɟ . ɂɦɟɧɧɨ ɬɚɤɚɹ ɩɨɡɢɰɢɹ ɹɜɥɹɥɚɫɶ ɩɪɢɨɪɢɬɟɬɧɨɣ ɢ ɞɥɹ ɢɧɬɭɛɢɪɨɜɚɧɧɵɯ ɩɚɰɢɟɧ ɬɨɜ ɧɨɜɨɣ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɢ COVIDɤɨɬɨɪɵɟ ɜɵɧɭɠɞɟɧɧɨ ɩɟɪɟɜɨ ɞɢɥɢɫɶ ɧɚ ɢɫɤɭɫɫɬɜɟɧɧɭɸ ɜɟɧɬɢɥɹɰɢɸ ɥɺɝɤɢɯ

ɉɪɟɢɦɭɳɟɫɬɜɚ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ ɛɵɥɢ ɢɡɜɟɫɬɧɵ ɟɳɺ ɞɨ ɧɚɱɚɥɚ ɩɨ ɫɥɟɞɧɟɣ ɩɚɧɞɟɦɢɢ Ɉɬɦɟɱɟɧɨ ɜ ɱɚɫɬɧɨɫɬɢ ɡɧɚɱɢɬɟɥɶɧɨɟ ɭɥɭɱɲɟɧɢɟ ɩɟɪɮɭɡɢɢ ɢ ɜɟɧɬɢɥɹɰɢɢ ɭɦɟɧɶɲɟɧɢɟ ɜɧɭɬɪɢɛɪɸɲɧɨɝɨ ɞɚɜɥɟɧɢɹ >88, 89, 90, 91@ ɉɪɨɧɚɥɶ ɧɚɹ ɩɨɡɢɰɢɹ ɜɨ ɦɧɨɝɨɦ ɩɪɨɮɢɥɚɤɬɢɪɭɟɬ ɫɬɚɡ ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ ɜ ɷɬɢɯ ɨɬ ɞɟɥɚɯ ɡɚ ɫɱɺɬ ɩɨɫɬɭɪɚɥɶɧɨɝɨ ɜɵɯɨɞɚ ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɟɤɪɟɬɚ ɢɡ ɛɪɨɧɯɨɜ ɞɢ ɫɬɚɥɶɧɵɯ ɝɟɧɟɪɚɰɢɣ ɜ ɞɨɪɫɚɥɶɧɵɯ ɨɬɞɟɥɚɯ >92, 93, 94].

Ɉɞɧɚɤɨ ɬɨɥɶɤɨ ɫ ɧɚɱɚɥɨɦ ɩɚɧɞɟɦɢɢ ɧɨɜɨɣ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɢ COVIDɷɬɨɦɭ ɫɬɚɥɢ ɩɪɢɞɚɜɚɬɶ ɨɫɨɛɟɧɧɨ ɛɨɥɶɲɨɟ ɡɧɚɱɟɧɢɟ ɍ ɩɚɰɢɟɧɬɨɜ ɫ COVIDɮɨɪɦɢɪɭɸɬɫɹ ɚɬɟɥɟɤɬɚɡɵ ɜ ɞɨɪɫɚɥɶɧɵɯ ɨɬɞɟɥɚɯ ɥɺɝɤɢɯ ɜ ɫɜɹɡɢ ɫ ɱɟɦ ɫɚɦɨɫɬɨɹɬɟɥɶɧɚɹ ɩɪɨɧɚɥɶɧɚɹ ɩɨɡɢɰɢɹ ɜɵɫɨɤɨɷɮɮɟɤɬɢɜɧɚ ɢ ɭ ɧɟɢɧɬɭɛɢɪɨɜɚɧɧɵɯ ɩɚɰɢɟɧɬɨɜ ɤɨɬɨɪɵɟ ɩɨɥɭɱɚɸɬ ɤɢɫɥɨɪɨɞɨɬɟɪɚɩɢɸ ɢɥɢ ɧɟɢɧɜɚɡɢɜɧɭɸ ɜɟɧɬɢɥɹ ɰɢɸ ɥɺɝɤɢɯ ɇɂȼɅ) ɂɦɟɟɬɫɹ ɦɧɨɝɨ ɩɭɛɥɢɤɚɰɢɣ ɨ ɩɨɡɢɬɢɜɧɨɣ ɪɨɥɢ ɩɪɨɧɚɥɶ ɧɨɣ ɩɨɡɢɰɢɢ ɭ ɤɨɜɢɞɧɵɯ ɩɚɰɢɟɧɬɨɜ ɪɚɫɩɪɚɜɥɟɧɢɟ ɝɪɚɜɢɬɚɰɢɨɧɧɨ-ɡɚɜɢɫɢɦɵɯ ɚɬɟɥɟɤɬɚɡɚɯ ɭɥɭɱɲɟɧɢɟ ɜɟɧɬɢɥɹɰɢɨɧɧɨ-ɩɟɪɮɭɡɢɨɧɧɵɯ ɫɨɨɬɧɨɲɟɧɢɣ ɢ ɞɪɟɧɚɠɚ ɫɟɤɪɟɬɚ ɧɢɠɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɛyɥɶɲɚɹ ɷɮɮɟɤɬɢɜɧɨɫɬɶ ɋɊȺɊ-ɜɟɧɬɢɥɹɰɢɢ ɫɜɹɡɚɧɧɚɹ ɫ ɛɨɥɟɟ ɪɚɜɧɨɦɟɪɧɵɦ ɪɚɫɩɪɟɞɟɥɟɧɢɟɦ >93, 95, 96].

71

ɉɪɢ ɂȼɅ ɭ ɩɚɰɢɟɧɬɨɜ ɫ &29,'- ɪɟɤɨɦɟɧɞɨɜɚɧɨ ɩɨɥɨɠɟɧɢɟ ɥɟɠɚ ɧɚ ɠɢɜɨɬɟ ɜ ɬɟɱɟɧɢɟ ɧɟ ɦɟɧɟɟ ɱ ɜ ɫɭɬɤɢ ɞɥɹ ɭɥɭɱɲɟɧɢɹ ɨɤɫɢɝɟɧɚɰɢɢ ɢ ɜɨɡɦɨɠ ɧɨɝɨ ɫɧɢɠɟɧɢɹ ɥɟɬɚɥɶɧɨɫɬɢ ɉɚɰɢɟɧɬɚ ɫɥɟɞɭɟɬ ɩɨɥɨɠɢɬɶ ɧɚ ɠɢɜɨɬ ɩɪɟɞɜɚɪɢ ɬɟɥɶɧɨ ɩɨɞɥɨɠɢɜ ɜɚɥɢɤɢ ɩɨɞ ɝɪɭɞɧɭɸ ɤɥɟɬɤɭ ɢ ɬɚɡ ɚ ɬɚɤɠɟ ɩɨɞɭɲɤɭ ɞɥɹ ɥɢɰɚɠɟɥɚɬɟɥɶɧɨ ɢɫɩɨɥɶɡɨɜɚɬɶ ɫɩɟɰɢɚɥɶɧɵɟ ɩɨɞɭɲɤɢ ɞɥɹ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ ɫ ɬɚɤɢɦ ɪɚɫɱɟɬɨɦ ɱɬɨɛɵ ɠɢɜɨɬ ɧɟ ɨɤɚɡɵɜɚɥ ɢɡɛɵɬɨɱɧɨɝɨ ɞɚɜɥɟɧɢɹ ɧɚ ɞɢɚɮɪɚɝɦɭ ɚ ɬɚɤɠɟ ɧɟ ɫɨɡɞɚɜɚɥɨɫɶ ɭɫɥɨɜɢɣ ɞɥɹ ɪɚɡɜɢɬɢɹ ɩɪɨɥɟɠɧɟɣ ɥɢɰɚ

ɋɭɳɟɫɬɜɭɸɬ ɢ ɨɩɪɟɞɟɥɺɧɧɵɟ ɨɫɥɨɠɧɟɧɢɹ ɩɪɢ ɜɟɧɬɢɥɹɰɢɢ ɜ ɩɨɥɨɠɟɧɢɢ ɥɟɠɚ ɧɚ ɠɢɜɨɬɟ ɩɟɪɟɝɢɛɵ ɢ ɞɢɫɥɨɤɚɰɢɢ ɢɧɬɭɛɚɰɢɨɧɧɵɯ ɬɪɭɛɨɤ ɢ ɜɟɧɨɡɧɵɯ ɤɚ ɬɟɬɟɪɨɜ ɬɟɯɧɢɱɟɫɤɢɟ ɬɪɭɞɧɨɫɬɢ ɜɵɩɨɥɧɟɧɢɹ ɫɟɪɞɟɱɧɨ-ɥɺɝɨɱɧɨɣ ɪɟɚɧɢɦɚɰɢɢ ɪɚɡɜɢɬɢɟ ɧɟɜɪɢɬɨɜ ɩɟɪɢɮɟɪɢɱɟɫɤɢɯ ɧɟɪɜɨɜ ɜɟɪɯɧɢɯ ɤɨɧɟɱɧɨɫɬɟɣ ɩɪɨɥɟɠɧɟɜɵɟ ɩɪɨɰɟɫɫɵ [97, 98, 99, 100].

Ⱦɨɩɨɥɧɢɬɟɥɶɧɨɣ ɫɥɨɠɧɨɫɬɶɸ ɨɤɚɡɚɥɨɫɶ ɩɪɨɜɟɞɟɧɢɟ ɛɪɨɧɯɨɥɨɝɢɱɟɫɤɨɝɨ ɩɨɫɨɛɢɹ ɬɚɤɢɦ ɩɚɰɢɟɧɬɚɦ

ɂɡɜɟɫɬɧɵ ɞɜɚ ɛɚɡɨɜɵɯ ɩɨɥɨɠɟɧɢɹ ɩɚɰɢɟɧɬɨɜ ɤɨɬɨɪɵɦ ɩɪɨɜɨɞɢɬɫɹ ɝɢɛɤɚɹ ɛɪɨɧɯɨɫɤɨɩɢɹ ɩɨɥɨɠɟɧɢɟ ɩɚɰɢɟɧɬɚ ɫɢɞɹ ɧɚɩɪɨɬɢɜ ɜɪɚɱɚ-ɷɧɞɨɫɤɨɩɢɫɬɚ ɢ ɩɨ ɥɨɠɟɧɢɟ ɥɺɠɚ ɧɚ ɫɩɢɧɟ ɩɪɢ ɷɬɨɦ ɜɪɚɱ-ɷɧɞɨɫɤɨɩɢɫɬ ɧɚɯɨɞɢɬɫɹ ɧɚɩɪɨɬɢɜ ɩɚɰɢ ɟɧɬɚ ɫ ɩɪɚɜɨɣ ɢɥɢ ɥɟɜɨɣ ɫɬɨɪɨɧɵ ɉɪɢ ɥɸɛɨɦ ɢɡ ɞɜɭɯ ɩɨɥɨɠɟɧɢɣ ɷɧɞɨɫɤɨɩɢɫɬ ɜɢɞɢɬ ɨɛɪɚɬɧɨɟ ɢɡɨɛɪɚɠɟɧɢɟ ɬɪɚɯɟɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɞɟɪɟɜɚ ɜ ɨɬɥɢɱɢɟ ɨɬ ɪɢɝɢɞ ɧɨɣ ɩɨɞɧɚɪɤɨɡɧɨɣ ɛɪɨɧɯɨɫɤɨɩɢɢ ɝɞɟ ɢɡɨɛɪɚɠɟɧɢɟ ɹɜɥɹɟɬɫɹ ɩɪɹɦɵɦ ɢ ɜɪɚɱɷɧɞɨɫɤɨɩɢɫɬ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɩɪɢ ɷɬɨɦ ɡɚ ɝɨɥɨɜɨɣ ɩɚɰɢɟɧɬɚ ɥɟɠɚɳɟɝɨ ɧɚ ɫɩɢɧɟ Ɍɟɯɧɢɤɚ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɪɢ ɥɸɛɨɦ ɢɡ ɷɬɢɯ ɩɨɥɨɠɟɧɢɣ ɨɫɬɚɺɬɫɹ ɢɞɟɧɬɢɱɧɨɣ >41, 61, 101, 102, 103, 104, 105, 106].

ɉɨɥɨɠɟɧɢɟ ɩɚɰɢɟɧɬɚ ɫɢɞɹ ɧɚɩɪɨɬɢɜ ɜɪɚɱɚ-ɷɧɞɨɫɤɨɩɢɫɬɚ, ɩɨɞɯɨɞɢɬ ɞɥɹ ɩɚɰɢɟɧɬɨɜ ɧɚɯɨɞɹɳɢɯɫɹ ɜ ɫɨɡɧɚɧɢɢ ȼ ɩɨɥɨɠɟɧɢɢ ɫɢɞɹ ɫɭɛɴɟɤɬɢɜɧɚɹ ɩɟɪɟɧɨ ɫɢɦɨɫɬɶ ɩɚɰɢɟɧɬɨɦ ɩɪɨɰɟɞɭɪɵ ɡɧɚɱɢɬɟɥɶɧɨ ɥɟɝɱɟ ɨɫɨɛɟɧɧɨ ɩɪɢ ɢɫɯɨɞɧɨɣ ɞɵ ɯɚɬɟɥɶɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ >107].

ɇɟɞɨɫɬɚɬɤɨɦ ɷɬɨɝɨ ɩɨɥɨɠɟɧɢɹ ɹɜɥɹɟɬɫɹ ɧɟɜɨɡɦɨɠɧɨɫɬɶ ɜɨɫɩɨɥɶɡɨɜɚɬɶɫɹ ɢɦ ɭ ɩɚɰɢɟɧɬɨɜ ɜ ɜɵɪɚɠɟɧɧɨɣ ɭɬɪɚɬɨɣ ɫɨɡɧɚɧɢɹ ɩɪɢ ɧɚɥɢɱɢɢ ɤɨɦɵ ɨɫɬɪɵɯ

72

ɧɚɪɭɲɟɧɢɣ ɦɨɡɝɨɜɨɝɨ ɤɪɨɜɨɨɛɪɚɳɟɧɢɹ ɜ ɫɨɫɬɨɹɧɢɢ ɦɟɞɢɤɚɦɟɧɬɨɡɧɨɣ ɫɟɞɚɰɢɢ ɩɚɰɢɟɧɬɨɜ ɧɚɯɨɞɹɳɢɯɫɹ ɧɚ ɢɫɤɭɫɫɬɜɟɧɧɨɣ ɜɟɧɬɢɥɹɰɢɢ ɥɺɝɤɢɯ

ȼɬɨɪɨɟ ɪɚɫɩɪɨɫɬɪɚɧɺɧɧɨɟ ɩɨɥɨɠɟɧɢɟ ɩɚɰɢɟɧɬɨɜ – ɩɨɥɨɠɟɧɢɟ ɥɺɠɚ ɧɚ ɫɩɢɧɟ ɩɪɢ ɷɬɨɦ ɜɪɚɱ-ɷɧɞɨɫɤɨɩɢɫɬ ɧɚɯɨɞɢɬɫɹ ɧɚɩɪɨɬɢɜ ɩɚɰɢɟɧɬɚ ɫ ɩɪɚɜɨɣ ɢɥɢ ɥɟɜɨɣ ɫɬɨɪɨɧɵ ɭ ɩɨɫɬɟɥɢ Ɍɚɤɢɦ ɨɛɪɚɡɨɦ ɢɡɨɛɪɚɠɟɧɢɟ ɬɪɚɯɟɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɞɟɪɟɜɚ ɨɫɬɚɺɬɫɹ ɨɛɪɚɬɧɵɦ ɗɬɨɬ ɦɟɬɨɞ ɹɜɥɹɟɬɫɹ ɦɟɬɨɞɨɦ ɜɵɛɨɪɚ ɭ ɜɵɲɟɩɟɪɟ ɱɢɫɥɟɧɧɨɣ ɝɪɭɩɩɵ ɩɚɰɢɟɧɬɨɜ >102, 103,106, 108, 109, 110].

ɍ ɷɬɨɝɨ ɩɨɥɨɠɟɧɢɹ ɹɜɥɹɸɳɟɝɨɫɹ ɞɨɥɝɨɟ ɜɪɟɦɹ ɛɟɡɚɥɶɬɟɪɧɚɬɢɜɧɵɦ ɭ ɨɩɪɟɞɟɥɺɧɧɨɣ ɝɪɭɩɩɵ ɩɚɰɢɟɧɬɨɦ ɜɵɹɜɢɥɢɫɶ ɧɟɞɨɫɬɚɬɤɢ ɫɜɹɡɚɧɧɵɟ ɫ ɩɪɟɢɦɭ ɳɟɫɬɜɟɧɧɵɦ ɩɨɥɨɠɟɧɢɟɦ ɩɚɰɢɟɧɬɨɜ ɜ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ ɉɨɩɵɬɤɢ ɩɪɨɜɟɞɟ ɧɢɹ ɛɪɨɧɯɨɫɤɨɩɢɢ ɬɚɤɢɦ ɩɚɰɢɟɧɬɨɦ ɜ ɬɪɚɞɢɰɢɨɧɧɨɦ ɩɨɥɨɠɟɧɢɢ ɥɺɠɚ ɧɚ ɫɩɢɧɟ ɧɟɪɟɞɤɨ ɨɤɚɡɵɜɚɟɬɫɹ ɩɪɨɫɬɨ ɧɟɜɵɩɨɥɧɢɦɵɦɢ ɍ ɩɚɰɢɟɧɬɨɜ ɪɟɡɤɨ ɫɧɢɠɚɟɬɫɹ ɧɚɫɵɳɟɧɢɟ ɤɪɨɜɶɸ ɤɢɫɥɨɪɨɞɨɦ ɫɚɬɭɪɚɰɢɹ ɤɢɫɥɨɪɨɞɚ ɭɠɟ ɜɨ ɜɪɟɦɹ ɫɚɦɨɝɨ ɦɚ ɧɺɜɪɚ ɩɟɪɟɜɨɞɚ ɩɚɰɢɟɧɬɨɜ ɢɡ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ ɜ ɩɨɥɨɠɟɧɢɟ ɥɺɠɚ ɧɚ ɫɩɢɧɟ ɗɬɨ ɧɟ ɝɨɜɨɪɹ ɭɠɟ ɨ ɬɟɯɧɢɱɟɫɤɢɯ ɪɢɫɤɚɯ ɬɚɤɨɝɨ ɦɚɧɺɜɪɚ ɧɚɩɪɢɦɟɪ ɫɥɭɱɚɣɧɨɣ ɷɤɫɬɭɛɚɰɢɢ Ɏɨɪɫɢɪɨɜɚɧɧɵɣ ɜɨɡɞɭɲɧɵɣ ɩɨɬɨɤ ɞɚɥɟɤɨ ɧɟ ɜɫɟɝɞɚ ɦɨɝ ɜɵɩɪɚɜɢɬɶ ɫɢɬɭɚɰɢɸ ȼɨ ɦɧɨɝɢɯ ɫɥɭɱɚɹɯ ɩɪɢɯɨɞɢɥɨɫɶ ɨɬɤɚɡɵɜɚɬɶɫɹ ɨɬ ɩɪɨɜɟɞɟɧɢɹ ɛɪɨɧ ɯɨɫɤɨɩɢɢ ȿɫɥɢ ɠɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɜɫɺ-ɬɚɤɢ ɩɪɨɜɨɞɢɥɨɫɶ ɨɬɦɟɱɚɥɨɫɶ ɪɟɡɤɨɟ ɫɧɢɠɟɧɢɟ ɤɢɫɥɨɪɨɞɧɵɯ ɪɟɡɟɪɜɨɜ ɨɪɝɚɧɢɡɦɚ ɩɚɰɢɟɧɬɚ ɗɬɨ ɱɚɫɬɨ ɜɥɟɤɥɨ ɞɨ ɫɪɨɱɧɨɟ ɩɪɟɤɪɚɳɟɧɢɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɧɟɪɟɞɤɨ ɬɚɤɢɟ ɫɢɬɭɚɰɢɢ ɢɦɟɥɢ ɩɨɜɵɲɟɧ ɧɭɸ ɨɩɚɫɧɨɫɬɶ ɞɥɹ ɩɚɰɢɟɧɬɨɜ

ȼ ɝ ɫɬɚɥɨ ɢɡɜɟɫɬɧɨ ɨ ɩɪɨɜɟɞɟɧɢɢ ɝɢɛɤɨɣ ɛɪɨɧɯɨɫɤɨɩɢɢ ɧɟɩɨɫɪɟɞ ɫɬɜɟɧɧɨ ɜ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ ɩɚɰɢɟɧɬɨɜ ɧɚɯɨɞɹɳɢɯɫɹ ɧɚ ɢɫɤɭɫɫɬɜɟɧɧɨɣ ɜɟɧ ɬɢɥɹɰɢɢ ɥɺɝɤɢɯ Ȼɪɨɧɯɨɫɤɨɩ ɩɪɢ ɷɬɨɦ ɩɪɨɜɨɞɢɥɫɹ ɱɟɪɟɡ ɷɧɞɨɬɪɚɯɟɚɥɶɧɭɸ ɬɪɭɛɤɭ >113@ ɗɬɨ ɩɨɥɨɠɟɧɢɟ ɩɚɰɢɟɧɬɚ ɩɨɡɜɨɥɹɥɨ ɦɚɤɫɢɦɚɥɶɧɨ ɢɡɛɟɝɚɬɶ ɩɨɜɵ ɲɟɧɧɨɝɨ ɪɚɫɯɨɞɚ ɤɢɫɥɨɪɨɞɧɵɯ ɪɟɡɟɪɜɨɜ ɨɪɝɚɧɢɡɦɚ ɷɩɢɡɨɞɨɜ ɨɩɚɫɧɨɣ ɞɟɫɚɬɭ ɪɚɰɢɢ ȼɦɟɫɬɟ ɫ ɬɟɦ ɛɵɥ ɫɟɪɶɺɡɧɨ ɡɚɬɪɭɞɧɺɧ ɨɫɦɨɬɪ ɜɟɪɯɧɟɞɨɥɟɜɵɯ ɛɪɨɧɯɢ ɚɥɶɧɵɯ ɛɚɫɫɟɣɧɨɜ ɧɚ ɫɬɨɪɨɧɟ ɪɚɡɜɺɪɧɭɬɨɝɨ ɦɨɛɢɥɶɧɨɝɨ ɪɚɛɨɱɟɝɨ ɦɟɫɬɚ ɜɪɚɱɚɷɧɞɨɫɤɨɩɢɫɬɚ

73

Ɇɵ ɢɫɩɨɥɶɡɨɜɚɥɢ ɫɨɛɫɬɜɟɧɧɭɸ ɦɨɞɢɮɢɤɚɰɢɸ ɷɬɨɝɨ ɜɚɪɢɚɧɬɚ ɩɪɨɜɟɞɹ ɛɪɨɧɯɨɥɨɝɢɱɟɫɤɨɟ ɩɨɫɨɛɢɟ ɜ ɫɥɭɱɚɹɯ ɩɚɰɢɟɧɬɚɦ ɧɚɯɨɞɹɳɢɦɫɹ ɧɚ ɂȼɅ ɜ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ [34]. ɉɪɢ ɷɬɨɦ ɛɪɨɧɯɨɫɤɨɩɢɹ ɛɵɥɚ ɪɚɡɞɟɥɟɧɚ ɧɚ ɧɟ ɫɤɨɥɶɤɨ ɷɬɚɩɨɜ

ȼɧɚɱɚɥɟ ɜɪɚɱ-ɷɧɞɨɫɤɨɩɢɫɬ ɪɚɫɩɨɥɚɝɚɥɫɹ ɭ ɩɨɫɬɟɥɢ ɛɨɥɶɧɨɝɨ ɫɨ ɫɬɨɪɨɧɵ ɩɨɜɺɪɧɭɬɨɣ ɝɨɥɨɜɵ ɩɚɰɢɟɧɬɚ ɫɩɪɚɜɚ ɢɥɢ ɫɥɟɜɚ ɉɨɫɥɟ ɧɚɱɚɥɚ ɛɪɨɧɯɨɫɤɨɩɢɢ ɛɪɨɧɯɨɫɤɨɩ ɩɪɨɜɨɞɢɥɫɹ ɱɟɪɟɡ ɢɧɬɭɛɚɰɢɨɧɧɭɸ ɬɪɭɛɤɭ ɢ ɨɫɭɳɟɫɬɜɥɹɥɫɹ ɨɫɦɨɬɪ ɫɚɧɚɰɢɨɧɧɵɟ ɦɟɪɨɩɪɢɹɬɢɹ ɢ ɧɟɨɛɯɨɞɢɦɵɟ ɞɨɩɨɥɧɢɬɟɥɶɧɵɟ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɟ ɜɦɟɲɚɬɟɥɶɫɬɜɚ ɇɨ ɩɪɢ ɷɬɨɦ ɜ ɫɢɥɭ ɨɩɪɟɞɟɥɺɧɧɨɝɨ ɜɟɤɬɨɪɚ ɧɚɩɪɚɜɥɟɧɢɹ ɛɪɨɧ ɯɨɫɤɨɩɚ ɚ ɬɚɤɠɟ ɭɝɥɚ ɨɬɯɨɠɞɟɧɢɹ ɜɟɪɯɧɟɞɨɥɟɜɵɯ ɛɪɨɧɯɨɜ ɜ ɡɧɚɱɢɬɟɥɶɧɨɣ ɦɟɪɟ ɛɵɥ ɡɚɬɪɭɞɧɺɧ ɨɫɦɨɬɪ ɜɟɪɯɧɟɞɨɥɟɜɵɯ ɛɪɨɧɯɢɚɥɶɧɵɯ ɛɚɫɫɟɣɧɨɜ ɧɚ ɫɬɨɪɨɧɟ ɪɚɡ ɜɺɪɧɭɬɨɝɨ ɦɨɛɢɥɶɧɨɝɨ ɪɚɛɨɱɟɝɨ ɦɟɫɬɚ ɜɪɚɱɚ-ɷɧɞɨɫɤɨɩɢɫɬɚ ɉɨɷɬɨɦɭ ɩɨɫɥɟ ɩɪɨ ɜɟɞɟɧɢɹ ɨɫɦɨɬɪɚ ɫɚɧɚɰɢɨɧɧɵɯ ɦɟɪɨɩɪɢɹɬɢɣ ɢ ɜɵɩɨɥɧɟɧɢɹ ɧɟɨɛɯɨɞɢɦɨɝɨ ɨɛɴ ɺɦɚ ɞɨɩɨɥɧɢɬɟɥɶɧɵɯ ɜɦɟɲɚɬɟɥɶɫɬɜ ɜ ɨɬɞɟɥɚɯ ɬɪɚɯɟɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɞɟɪɟɜɚɛɪɨɧɯɢɚɥɶɧɚɹ ɫɢɫɬɟɦɚ ɩɪɨɬɢɜɨɩɨɥɨɠɧɨɝɨ ɥɺɝɤɨɝɨ ɩɨɥɧɨɫɬɶɸ ɢ ɧɢɠɧɟɞɨɥɟɜɚɹ ɛɪɨɧɯɢɚɥɶɧɚɹ ɫɢɫɬɟɦɚ ɧɚ ɫɬɨɪɨɧɟ ɩɨɪɚɠɟɧɢɹ ɚ ɜ ɫɥɭɱɚɟ ɩɨɥɨɠɟɧɢɹ ɜɪɚɱɚɷɧɞɨɫɤɨɩɢɫɬɚ ɫɩɪɚɜɚ – ɢ ɫɪɟɞɧɟɞɨɥɟɜɨɣ ɛɚɫɫɟɣɧ ɩɪɚɜɨɝɨ ɥɺɝɤɨɝɨ ɞɨɫɬɭɩɧɵɯ ɩɨɥɧɨɰɟɧɧɨɦɭ ɨɫɦɨɬɪɭ ɢɫɫɥɟɞɨɜɚɧɢɟ ɩɪɟɪɵɜɚɥɨɫɶ

Ⱦɚɥɟɟ ɫ ɩɨɦɨɳɶɸ ɪɟɚɧɢɦɚɬɨɥɨɝɢɱɟɫɤɨɣ ɛɪɢɝɚɞɵ ɩɚɰɢɟɧɬ ɚɤɤɭɪɚɬɧɨ ɩɨ ɜɨɪɚɱɢɜɚɥɫɹ ɧɚ ɛɨɤ ɥɢɰɨɦ ɤ ɦɨɛɢɥɶɧɨɦɭ ɪɚɛɨɱɟɦɭ ɦɟɫɬɭ ɇɚɩɪɢɦɟɪ ɩɪɢ ɪɚɫ ɩɨɥɨɠɟɧɢɢ ɦɨɛɢɥɶɧɨɝɨ ɪɚɛɨɱɟɝɨ ɦɟɫɬɚ ɷɧɞɨɫɤɨɩɢɫɬɚ ɫɩɪɚɜɚ ɩɚɰɢɟɧɬ ɪɚɡɜɨɪɚ ɱɢɜɚɥɫɹ ɧɚ ɥɟɜɵɣ ɛɨɤ ȼɪɚɱ-ɷɧɞɨɫɤɨɩɢɫɬ ɩɪɢ ɷɬɨɦ ɪɚɫɩɨɥɚɝɚɥɫɹ ɧɚ ɫɬɨɪɨɧɟ ɪɚ ɛɨɱɟɝɨ ɦɟɫɬɚ ɩɨɞ ɭɝɥɨɦ ɤ ɞɥɢɧɧɢɤɭ ɮɭɧɤɰɢɨɧɚɥɶɧɨɣ ɤɪɨɜɚɬɢ ɩɚɰɢɟɧɬɚ.

ɗɬɚ ɩɟɪɟɦɟɧɚ ɜɡɚɢɦɧɨɝɨ ɩɨɥɨɠɟɧɢɹ ɞɚɜɚɥɚ ɜɨɡɦɨɠɧɨɫɬɶ ɩɨɥɧɨɰɟɧɧɨɝɨ ɨɫɦɨɬɪɚ ɜɟɪɯɧɟɞɨɥɟɜɨɝɨ ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɛɚɫɫɟɣɧɚ ɧɚ ɫɬɨɪɨɧɟ ɦɨɛɢɥɶɧɨɝɨ ɪɚɛɨ ɱɟɝɨ ɦɟɫɬɚ ɜɪɚɱɚ-ɷɧɞɨɫɤɨɩɢɫɬɚ ɜɵɩɨɥɧɟɧɢɹ ɫɚɧɚɰɢɨɧɧɵɯ ɦɟɪɨɩɪɢɹɬɢɣ ɢ ɩɪɨ ɜɟɞɟɧɢɹ ɜ ɷɬɨɣ ɚɧɚɬɨɦɢɱɟɫɤɨɣ ɨɛɥɚɫɬɢ ɧɟɨɛɯɨɞɢɦɨɝɨ ɨɛɴɺɦɚ ɞɨɩɨɥɧɢɬɟɥɶɧɵɯ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɯ ɦɚɧɢɩɭɥɹɰɢɣ Ɉɞɧɚɤɨ ɫɧɢɠɟɧɢɟ ɫɚɬɭɪɚɰɢɢ ɩɪɢ ɬɚɤɨɦ ɩɨɜɨ ɪɨɬɟ ɯɨɬɶ ɢ ɧɟ ɧɨɫɢɥɨ ɮɚɬɚɥɶɧɵɣ ɯɚɪɚɤɬɟɪ ɧɨ ɜɫɺ ɠɟ ɩɪɨɢɫɯɨɞɢɥɨ Ʉɪɨɦɟ ɬɨɝɨ ɧɟɨɛɯɨɞɢɦɨ ɛɵɥɨ ɩɪɢɜɥɟɤɚɬɶ ɦɥɚɞɲɢɣ ɢ ɫɪɟɞɧɢɣ ɦɟɞɢɰɢɧɫɤɢɣ ɩɟɪɫɨɧɚɥ ɨɬɞɟ

74

ɥɟɧɢɹ ɪɟɚɧɢɦɚɰɢɢ ɧɟɨɛɯɨɞɢɦɨ ɛɵɥɨ ɧɟ ɬɨɥɶɤɨ ɩɨɜɟɪɧɭɬɶ ɩɚɰɢɟɧɬɚ ɧɨ ɢ ɩɪɨ ɮɢɥɚɤɬɢɪɨɜɚɬɶ ɩɪɢ ɷɬɨɦ ɚɜɚɪɢɣɧɭɸ ɷɤɫɬɭɛɚɰɢɸ ɚɜɚɪɢɣɧɭɸ ɞɟɤɚɧɸɥɹɰɢɸɩɪɚɤɬɢɱɟɫɤɢ ɜɫɟɦ ɩɚɰɢɟɧɬɚɦ ɛɵɥɚ ɭɫɬɚɧɨɜɥɟɧɵ ɢɧɬɪɚɜɟɧɨɡɧɵɟ ɩɟɪɢɮɟɪɢɱɟ ɫɤɢɟ ɢɥɢ ɩɨɞɤɥɸɱɢɱɧɵɟ ɤɚɬɟɬɟɪɵ

Ɂɚɞɚɱɚ ɩɪɟɞɥɚɝɚɟɦɨɝɨ ɜɚɪɢɚɧɬɚ ɩɨɥɨɠɟɧɢɹ ɩɚɰɢɟɧɬɨɜ ɜɨ ɜɪɟɦɹ ɛɪɨɧ ɯɨɫɤɨɩɢɢ – ɫɨɯɪɚɧɢɜ ɜɨɡɦɨɠɧɨɫɬɢ ɩɨɥɧɨɰɟɧɧɨɝɨ ɨɛɪɚɬɧɨɝɨ ɜɢɡɭɚɥɶɧɨɝɨ ɨɫɦɨɬɪɚ ɬɪɚɯɟɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɞɟɪɟɜɚ ɞɨ ɛɪɨɧɯɨɜ IV-V-ɝɨ ɩɨɪɹɞɤɨɜ ɩɨɥɧɨ ɰɟɧɧɨɝɨ ɩɪɨɜɟɞɟɧɢɹ ɧɟɨɛɯɨɞɢɦɵɯ ɥɟɱɟɛɧɵɯ ɩɪɨɰɟɞɭɪ ɚ ɬɚɤɠɟ ɞɨɩɨɥɧɢɬɟɥɶ ɧɵɯ ɞɢɚɝɧɨɫɬɢɱɟɫɤɢɯ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɯ ɦɚɧɢɩɭɥɹɰɢɣ ɢɡɛɟɠɚɬɶ ɢɡɛɵɬɨɱɧɨɝɨ ɪɚɫɯɨɞɚ ɤɢɫɥɨɪɨɞɧɵɯ ɪɟɡɟɪɜɨɜ ɨɪɝɚɧɢɡɦɚ ɧɟɢɡɛɟɠɧɨɝɨ ɩɪɢ ɩɟɪɟɜɨɞɟ ɩɚɰɢɟɧɬɚ ɢɡ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ ɜ ɩɨɥɨɠɟɧɢɟ ɥɺɠɚ ɧɚ ɫɩɢɧɟ ɢ ɢɡɛɟɠɚɬɶ ɩɨɬɟɧɰɢɚɥɶɧɵɯ ɚɜɚɪɢɣɧɵɯ ɪɢɫɤɨɜ ɫɜɹɡɚɧɧɵɯ ɫ ɧɟɡɚɩɥɚɧɢɪɨɜɚɧɧɨɣ ɷɤɫɬɭɛɚɰɢɟɣ ɢɥɢ ɞɟɤɚɧɸɥɹ ɰɢɟɣ ɩɚɰɢɟɧɬɨɜ

Ɍɟɯɧɢɱɟɫɤɢɣ ɪɟɡɭɥɶɬɚɬ – ɭɞɟɪɠɚɧɢɟ ɫɚɬɭɪɚɰɢɢ ɤɢɫɥɨɪɨɞɚ ɢɧɬɭɛɢɪɨɜɚɧ ɧɨɝɨ ɩɚɰɢɟɧɬɚ ɜɨ ɜɪɟɦɹ ɩɪɨɜɟɞɟɧɢɹ ɛɪɨɧɯɨɫɤɨɩɢɢ ɧɚ ɩɪɢɟɦɥɟɦɨɦ ɭɪɨɜɧɟ ɢɫ ɤɥɸɱɚɸɳɢɦ ɫɬɪɟɦɢɬɟɥɶɧɨɟ ɧɚɪɚɫɬɚɧɢɟ ɝɢɩɨɤɫɢɢ ɍɤɚɡɚɧɧɵɣ ɬɟɯɧɢɱɟɫɤɢɣ ɪɟ ɡɭɥɶɬɚɬ ɞɨɫɬɢɝɚɥɫɹ ɫɥɟɞɭɸɳɢɦ ɨɛɪɚɡɨɦ

ɉɚɰɢɟɧɬ ɧɚɯɨɞɢɬɫɹ ɜ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ ɩɪɢ ɷɬɨɦ ɟɝɨ ɝɨɥɨɜɚ ɩɨɜɺɪɧɭɬɚ ɧɚ ɢɡ-ɡɚ ɜɫɬɚɜɥɟɧɧɨɣ ɜ ɬɪɚɯɟɸ ɢɧɬɭɛɚɰɢɨɧɧɨɣ ɬɪɭɛɤɢ ɫɨɟɞɢɧɺɧɧɨɣ ɱɟɪɟɡ ɢɫɤɭɫɫɬɜɟɧɧɵɟ ɜɨɡɞɭɯɨɩɪɨɜɨɞɹɳɢɟ ɩɭɬɢ ɫ ɚɩɩɚɪɚɬɨɦ ɢɫɤɭɫɫɬɜɟɧɧɨɣ ɜɟɧɬɢɥɹ ɰɢɢ ɥɺɝɤɢɯ Ȼɪɨɧɯɨɫɤɨɩɢɸ ɨɫɭɳɟɫɬɜɥɹɸɬ ɧɚ ɮɨɧɟ ɧɟɩɪɟɪɵɜɧɨɣ ɜɟɧɬɢɥɹɰɢɢ ɥɺɝɤɢɯ ɢ ɩɨɥɢɮɭɧɤɰɢɨɧɚɥɶɧɨɝɨ ɦɨɧɢɬɨɪɢɧɝɚ ɜɤɥɸɱɚɸɳɟɝɨ ɜ ɫɟɛɹ ɨɩɪɟɞɟɥɟɧɢɟ ɫɚɬɭɪɚɰɢɢ ɤɢɫɥɨɪɨɞɚ ɜ ɪɟɠɢɦɟ ɪɟɚɥɶɧɨɝɨ ɜɪɟɦɟɧɢ

ɇɚ ɩɟɪɜɨɦ ɷɬɚɩɟ ɜɪɚɱ-ɷɧɞɨɫɤɨɩɢɫɬ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɭ ɩɨɫɬɟɥɢ ɛɨɥɶɧɨɝɨ ɫɨ ɫɬɨɪɨɧɵ ɩɨɜɺɪɧɭɬɨɣ ɝɨɥɨɜɵ ɩɚɰɢɟɧɬɚ ɫɩɪɚɜɚ ɢɥɢ ɫɥɟɜɚ ɉɨɫɥɟ ɧɚɱɚɥɚ ɛɪɨɧ ɯɨɫɤɨɩɢɢ ɛɪɨɧɯɨɫɤɨɩ ɩɪɨɜɨɞɹɬ ɱɟɪɟɡ ɢɧɬɭɛɚɰɢɨɧɧɭɸ ɬɪɭɛɤɭ ɢ ɨɫɭɳɟɫɬɜɥɹɸɬ ɨɫɦɨɬɪ ɢ ɧɟɨɛɯɨɞɢɦɵɟ ɞɨɩɨɥɧɢɬɟɥɶɧɵɟ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɟ ɜɦɟɲɚɬɟɥɶɫɬɜɚ ɉɨ ɫɥɟ ɩɪɨɜɟɞɟɧɢɹ ɨɫɦɨɬɪɚ ɢ ɜɵɩɨɥɧɟɧɢɹ ɧɟɨɛɯɨɞɢɦɨɝɨ ɨɛɴɺɦɚ ɞɨɩɨɥɧɢɬɟɥɶɧɵɯ ɜɦɟɲɚɬɟɥɶɫɬɜ ɨɬɞɟɥɨɜ ɬɪɚɯɟɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɞɟɪɟɜɚ ɞɨɫɬɭɩɧɵɯ ɩɨɥɧɨɰɟɧɧɨɦɭ ɨɫɦɨɬɪɭ ɢɫɫɥɟɞɨɜɚɧɢɟ ɩɪɟɪɵɜɚɸɬ

75

ɇɚ ɜɬɨɪɨɦ ɷɬɚɩɟ ɩɪɨɜɨɞɹɬ ɩɟɪɟɞɢɫɥɨɤɚɰɢɸ ɦɨɛɢɥɶɧɨɝɨ ɪɚɛɨɱɟɝɨ ɦɟɫɬɚ ɜɪɚɱɚ-ɷɧɞɨɫɤɨɩɢɫɬɚ ɧɚ ɩɪɨɬɢɜɨɩɨɥɨɠɧɭɸ ɩɨ ɨɬɧɨɲɟɧɢɸ ɤ ɩɚɰɢɟɧɬɭ ɫɬɨɪɨɧɭ Ɉɞɧɨɜɪɟɦɟɧɧɨ ɪɟɚɧɢɦɚɬɨɥɨɝɢɱɟɫɤɚɹ ɛɪɢɝɚɞɚ ɧɟ ɩɪɟɪɵɜɚɹ ɧɟɩɪɟɪɵɜɧɨɣ ɜɟɧɬɢ ɥɹɰɢɢ ɥɺɝɤɢɯ ɪɚɡɜɨɪɚɱɢɜɚɟɬ ɝɨɥɨɜɭ ɩɚɰɢɟɧɬɚ ɫ ɭɫɬɚɧɨɜɥɟɧɧɨɣ ɢɧɬɭɛɚɰɢɨɧɧɨɣ ɬɪɭɛɤɨɣ ɧɚ Ɍɚɤɢɦ ɨɛɪɚɡɨɦ ɜɪɚɱ-ɷɧɞɨɫɤɨɩɢɫɬ ɢ ɢɧɬɭɛɚɰɢɨɧɧɚɹ ɬɪɭɛɤɚ ɱɟɪɟɡ ɤɨɬɨɪɭɸ ɩɪɨɜɨɞɹɬ ɛɪɨɧɯɨɫɤɨɩ ɜɧɨɜɶ ɨɤɚɡɵɜɚɸɬɫɹ ɧɚ ɨɞɧɨɣ ɫɬɨɪɨɧɟ ɉɨ ɫɥɟ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɩɪɢɟɦɥɟɦɵɯ ɰɢɮɪ ɫɚɬɭɪɚɰɢɢ ɤɢɫɥɨɪɨɞɚ ɩɪɢɫɬɭɩɚɸɬ ɤ ɫɥɟ ɞɭɸɳɟɦɭ ɷɬɚɩɭ

ɇɚ ɬɪɟɬɶɟɦ ɷɬɚɩɟ ɱɟɪɟɡ ɢɧɬɭɛɚɰɢɨɧɧɭɸ ɬɪɭɛɤɭ ɩɪɨɜɨɞɹɬ ɛɪɨɧɯɨɫɤɨɩ ɜ ɩɪɨɬɢɜɨɩɨɥɨɠɧɵɣ ɨɬ ɜɪɚɱɚ ɜɟɪɯɧɟɞɨɥɟɜɨɣ ɛɪɨɧɯɢɚɥɶɧɵɣ ɛɚɫɫɟɣɧ ɨɫɭɳɟɫɬɜɥɹɹ ɩɪɢ ɷɬɨɦ ɧɟɨɛɯɨɞɢɦɵɣ ɜɢɡɭɚɥɶɧɵɣ ɨɫɦɨɬɪ ɫɚɧɚɰɢɨɧɧɵɟ ɦɟɪɨɩɪɢɹɬɢɹ ɢ ɩɪɨɜɟ ɞɟɧɢɟ ɞɨɩɨɥɧɢɬɟɥɶɧɵɯ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɯ ɦɚɧɢɩɭɥɹɰɢɣ

ɉɪɟɞɥɚɝɚɟɦɵɣ ɜɚɪɢɚɧɬ ɩɨɥɨɠɟɧɢɹ ɩɚɰɢɟɧɬɨɜ ɫ ɧɨɜɨɣ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɟɣ &29,'- ɧɚɯɨɞɹɳɢɯɫɹ ɧɚ ɂȼɅ ɩɨɡɜɨɥɹɟɬ ɩɪɨɜɨɞɢɬɶ ɩɨɥɧɨɰɟɧɧɨɟ ɛɪɨɧɯɨɥɨɝɢɱɟɫɤɨɟ ɜɦɟɲɚɬɟɥɶɫɬɜɨ ɛɟɡ ɤɪɢɬɢɱɟɫɤɨɣ ɩɨɬɟɪɢ ɤɢɫɥɨɪɨɞɧɵɯ ɪɟɡɟɪ ɜɨɜ ɨɪɝɚɧɢɡɦɚ ɛɨɥɶɧɨɝɨ ɉɪɢɜɨɞɢɦ ɫɨɛɫɬɜɟɧɧɨɟ ɧɚɛɥɸɞɟɧɢɟ

ɉɚɰɢɟɧɬ ȼ ɥɟɬ ɛɵɥ ɝɨɫɩɢɬɚɥɢɡɢɪɨɜɚɧ ɜ ɨɬɞɟɥɟɧɢɟ ɫɬɚɰɢɨɧɚɪɚ ɤɨɪɨ ɧɚɜɢɪɭɫɧɨɝɨ ɝɨɫɩɢɬɚɥɹ ɜ ɷɤɫɬɪɟɧɧɨɦ ɩɨɪɹɞɤɟ ɧɚ ɛɵɫɬɪɨ ɩɪɨɝɪɟɫɫɢɪɭɸɳɟɣ ɞɵ ɯɚɬɟɥɶɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ ɋɨ ɫɥɨɜ ɠɟɧɵ ɩɚɰɢɟɧɬ ɛɨɥɟɧ ɞɧɟɣ ɤɨɝɞɚ ɩɨɜɵ ɫɢɥɚɫɶ ɬɟɦɩɟɪɚɬɭɪɚ ɬɟɥɚ ɞɨ ɋ ɩɨɹɜɢɥɚɫɶ ɪɟɡɤɚɹ ɫɥɚɛɨɫɬɶ ɚɧɨɫɦɢɹ Ⱦɨ ɷɬɨ ɝɨ ɤɨɧɬɚɤɬɢɪɨɜɚɥ ɫ ɛɨɥɶɧɵɦ &29,'- ɫɨɫɟɞ ɩɨ ɥɟɫɬɧɢɱɧɨɣ ɤɥɟɬɤɟ ɉɚɰɢɟɧɬ ɫɬɪɚɞɚɟɬ ɬɹɠɺɥɨɣ ɏɈȻɅ ɨɬɦɟɱɚɟɬ ɩɨɫɬɨɹɧɧɭɸ ɭɦɟɪɟɧɧɭɸ ɨɞɵɲɤɭ ɜ ɬ ɱ ɢ ɜɧɟ ɨɛɨɫɬɪɟɧɢɹ Ɉɬ ɩɥɚɧɨɜɨɣ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ ɞɧɹ ɧɚɡɚɞ ɨɬɤɚɡɚɥɫɹ ɨɞɧɚɤɨ ɪɟɡɤɨɟ ɧɚɪɚɫɬɚɧɢɟ ɨɞɵɲɤɢ ɜɵɧɭɞɢɥɨ ɜɵɡɜɚɬɶ ɛɪɢɝɚɞɭ ɫɤɨɪɨɣ ɩɨɦɨɳɢ

ȼ ɩɪɢɺɦɧɨɦ ɨɬɞɟɥɟɧɢɢ ɩɚɰɢɟɧɬ ɡɚɬɨɪɦɨɠɟɧ ɰɢɚɧɨɬɢɱɟɧ ɫɚɬɭɪɚɰɢɹ ɤɢɫ ɥɨɪɨɞɚ ɧɚ ɩɨɫɬɨɹɧɧɨɣ ɩɨɞɚɱɟ ɤɢɫɥɨɪɨɞɚ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɧɟɜɨɡɜɪɚɬɧɨɣ ɦɚ ɫɨɱɧɨɣ ɫɢɫɬɟɦɵ ɫɨɫɬɚɜɢɥɚ Ȼɨɥɶɧɨɣ ɢɡ ɩɪɢɺɦɧɨɝɨ ɨɬɞɟɥɟɧɢɹ ɧɚɩɪɚɜɥɟɧ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɜ ɨɬɞɟɥɟɧɢɟ ɪɟɚɧɢɦɚɰɢɢ ɢ ɢɧɬɟɧɫɢɜɧɨɣ ɬɟɪɚɩɢɢ ɝɞɟ ɛɵɥɨ ɩɪɢɧɹɬɨ ɪɟɲɟɧɢɟ ɨ ɩɟɪɟɜɨɞɟ ɛɨɥɶɧɨɝɨ ɧɚ ɪɟɠɢɦ ɂȼɅ

76

ɇɚ ɂȼɅ ɫɚɬɭɪɚɰɢɹ ɭɞɟɪɠɢɜɚɥɚɫɶ ɧɚ –94%; ɞɥɹ ɥɭɱɲɟɣ ɨɤɫɢɝɟɧɚɰɢɢ ɩɚɰɢɟɧɬ ɜɫɺ ɜɪɟɦɹ ɧɚɯɨɞɢɥɫɹ ɜ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ Ⱦɥɹ ɫɚɧɚɰɢɢ ɬɪɚɯɟɨɛɪɨɧ ɯɢɚɥɶɧɨɝɨ ɞɟɪɟɜɚ ɛɵɥɚ ɧɚɡɧɚɱɟɧɚ ɛɪɨɧɯɨɫɤɨɩɢɹ Ȼɪɨɧɯɨɫɤɨɩɢɹ ɛɵɥɚ ɜɵɩɨɥɧɟ ɧɚ ɩɪɢ ɫɨɯɪɚɧɟɧɢɢ ɩɨɥɨɠɟɧɢɹ ɩɚɰɢɟɧɬɚ ɜ ɩɪɨɧɚɥɶɧɨɣ ɩɨɡɢɰɢɢ ɩɨ ɜɵɲɟɭɤɚɡɚɧ ɧɨɣ ɦɟɬɨɞɢɤɟ Ɇɨɛɢɥɶɧɨɟ ɪɚɛɨɱɟɟ ɦɟɫɬɨ ɜɪɚɱɚ-ɷɧɞɨɫɤɨɩɢɫɬɚ ɛɵɥɨ ɪɚɡɜɺɪɧɭɬɨ ɫɩɪɚɜɚ ɨɬ ɮɭɧɤɰɢɨɧɚɥɶɧɨɣ ɤɪɨɜɚɬɢ ɇɚ ɩɟɪɜɨɦ ɷɬɚɩɟ ɛɵɥ ɜɵɩɨɥɧɟɧ ɜɢɡɭɚɥɶɧɵɣ ɨɫɦɨɬɪ ɫɚɧɚɰɢɨɧɧɵɟ ɦɟɪɨɩɪɢɹɬɢɹ ɢ ɧɟɨɛɯɨɞɢɦɵɣ ɨɛɴɺɦ ɞɨɩɨɥɧɢɬɟɥɶɧɵɯ ɷɧɞ ɨɛɪɨɧɯɢɚɥɶɧɵɯ ɦɚɧɢɩɭɥɹɰɢɣ ɡɚɛɨɪ ɛɪɨɧɯɢɚɥɶɧɨɝɨ ɫɨɞɟɪɠɢɦɨɝɨ ɞɥɹ ɩɨɫɥɟɞɭ ɸɳɟɝɨ ɨɩɪɟɞɟɥɟɧɢɹ ɤɢɫɥɨɬɨɭɫɬɨɣɱɢɜɵɯ ɦɢɤɨɛɚɤɬɟɪɢɣ ɦɟɬɨɞɚɦɢ ɩɨɫɟɜɚ ɢ ɛɚɤ ɬɟɪɢɨɫɤɨɩɢɢ ɨɫɚɞɤɚ ɩɨ ɐɢɥɸ-ɇɢɥɶɫɟɧɭ ɚ ɬɚɤɠɟ ɞɥɹ ɨɩɪɟɞɟɥɟɧɢɹ ɛɚɤɬɟɪɢɚɥɶ ɧɨɣ ɮɥɨɪɵ ɢ ɟɺ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢ ɤ ɚɧɬɢɛɢɨɬɢɤɚɦ ɜ ɛɪɨɧɯɢɚɥɶɧɨɣ ɫɢɫɬɟɦɟ ɥɟ ɜɨɝɨ ɥɺɝɤɨɝɨ ɚ ɬɚɤɠɟ ɜ ɧɢɠɧɟ- ɢ ɫɪɟɞɧɟɞɨɥɟɜɨɦ ɛɪɨɧɯɢɚɥɶɧɵɯ ɛɚɫɫɟɣɧɚɯ ɩɪɚ ɜɨɝɨ ɥɺɝɤɨɝɨ I-ɣ ɷɬɚɩ ɞɚɥɟɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɛɵɥɨ ɩɪɟɪɜɚɧɨ ɢ ɦɨɛɢɥɶɧɨɟ ɪɚɛɨ ɱɟɟ ɦɟɫɬɨ ɜɪɚɱɚ-ɷɧɞɨɫɤɨɩɢɫɬɚ ɩɟɪɟɞɢɫɥɨɰɢɪɨɜɚɧɨ ɜ ɩɨɥɨɠɟɧɢɟ ɫɥɟɜɚ ɨɬ ɮɭɧɤ ɰɢɨɧɚɥɶɧɨɣ ɤɪɨɜɚɬɢ ɩɚɰɢɟɧɬɚ II-ɣ ɷɬɚɩ Ⱦɚɥɟɟ ɛɪɨɧɯɨɥɨɝɢɱɟɫɤɨɟ ɜɦɟɲɚɬɟɥɶ ɫɬɜɨ ɛɵɥɨ ɜɨɡɨɛɧɨɜɥɟɧɨ ɢ ɜɵɩɨɥɧɟɧ ɜɢɡɭɚɥɶɧɵɣ ɨɫɦɨɬɪ ɧɟɨɛɯɨɞɢɦɵɟ ɫɚɧɚɰɢ ɨɧɧɵɟ ɦɟɪɨɩɪɢɹɬɢɹ ɢ ɧɟɨɛɯɨɞɢɦɵɣ ɨɛɴɺɦ ɞɨɩɨɥɧɢɬɟɥɶɧɵɯ ɞɢɚɝɧɨɫɬɢɱɟɫɤɢɯ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɵɯ ɦɚɧɢɩɭɥɹɰɢɣ ɜ ɨɛɥɚɫɬɢ ɩɪɚɜɨɝɨ ɜɟɪɯɧɟɞɨɥɟɜɨɝɨ ɛɪɨɧɯɚ ɢ ɫɟɝɦɟɧɬɚɪɧɵɯ ɛɪɨɧɯɨɜ ɜɟɪɯɧɟɣ ɞɨɥɢ ɩɪɚɜɨɝɨ ɥɺɝɤɨɝɨ III-ɣ ɷɬɚɩ ɇɚ ɮɨɧɟ ɢɫ ɫɥɟɞɨɜɚɧɢɹ ɤɪɢɬɢɱɟɫɤɨɝɨ ɫɧɢɠɟɧɢɹ ɫɚɬɭɪɚɰɢɢ ɧɟ ɩɪɨɢɫɯɨɞɢɥɨ ɨɧɚ ɧɟ ɨɩɭɫɤɚ ɥɚɫɶ ɧɢɠɟ Ɍɚɤɢɦ ɨɛɪɚɡɨɦ ɛɪɨɧɯɨɥɨɝɢɱɟɫɤɨɟ ɩɨɫɨɛɢɟ ɛɵɥɨ ɨɤɚɡɚɧɨ ɜ ɧɟ ɨɛɯɨɞɢɦɨɦ ɨɛɴɺɦɟ

77

ɁȺɄɅɘɑȿɇɂȿ

ɑɟɥɨɜɟɱɟɫɬɜɨ ɧɟ ɜ ɩɟɪɜɵɣ ɪɚɡ ɫɬɚɥɤɢɜɚɟɬɫɹ ɫ ɤɨɪɨɧɚɜɢɪɭɫɚɦɢ Ⱦɨɫɬɚɬɨɱ ɧɨ ɝɪɨɡɧɵɦɢ ɩɪɟɞɨɫɬɟɪɟɠɟɧɢɹɦɢ ɧɚ ɩɪɨɬɹɠɟɧɢɢ XXI-ɝɨ ɜɟɤɚ ɹɜɢɥɢɫɶ ɬɹɠɺɥɵɣ ɨɫɬɪɵɣ ɪɟɫɩɢɪɚɬɨɪɧɵɣ ɫɢɧɞɪɨɦ ɜɵɡɜɚɧɧɵɣ ɤɨɪɨɧɚɜɢɪɭɫɨɦ 6$56-&R9 ɜ ɝɨɞɭ ɢ ɛɥɢɠɧɟɜɨɫɬɨɱɧɵɣ ɪɟɫɩɢɪɚɬɨɪɧɵɣ ɫɢɧɞɪɨɦ ɜɵɡɜɚɧɧɵɣ ɤɨɪɨɧɚɜɢɪɭɫɨɦ MERS-&R9 ɜ ɝ ɫɩɨɪɚɞɢɱɟɫɤɢɟ ɫɥɭɱɚɢ ɡɚɪɚɠɟɧɢɹ ɜɢɪɭɫɨɦ 0(56-&R9 ɧɚ ɬɟɪɪɢɬɨɪɢɢ Ⱥɪɚɜɢɣɫɤɨɝɨ ɩɨɥɭɨɫɬɪɨɜɚ ɨɬɦɟɱɚɸɬɫɹ ɞɨ ɫɢɯ ɩɨɪ ɇɨ ɟɫɥɢ ɷɬɢ ɜɫɬɪɟɱɢ ɨɝɪɚɧɢɜɚɥɢɫɶ ɥɨɤɚɥɶɧɵɦɢ ɜɫɩɵɲɤɚɦɢ ɬɨ ɜɫɬɪɟɱɚ ɫ ɧɨɜɵɦ ɤɨɪɨɧɚɜɢ ɪɭɫɨɦ 6$56-CoV- ɩɪɢɜɟɥɚ ɤ ɟɝɨ ɝɥɨɛɚɥɶɧɨɦɭ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɸ. ɉɚɧɞɟɦɢɹ ɩɪɨɞɥɢɥɚɫɶ ɛɨɥɟɟ -ɯ ɥɟɬ ɧɨ ɧɟ ɩɨɜɥɟɤɥɚ ɢɫɱɟɡɧɨɜɟɧɢɹ ɜɢɪɭɫɚ Ɉɧ ɯɨɬɹ ɢ ɜɨ ɦɧɨɝɨɦ ɭɬɪɚɬɢɜ ɫɜɨɢ ɪɚɡɪɭɲɢɬɟɥɶɧɵɟ ɤɚɱɟɫɬɜɚ ɡɚɧɹɥ ɫɜɨɸ ɧɢɲɭ ɜ ɫɬɪɭɤɬɭɪɟ ɨɫɬɪɵɯ ɪɟɫɩɢɪɚɬɨɪɧɵɯ ɜɢɪɭɫɧɵɯ ɢɧɮɟɤɰɢɣ ɇɚɫɤɨɥɶɤɨ ɭɫɬɨɣɱɢɜɚ ɛɭɞɟɬ ɷɬɚ ɫɢ ɬɭɚɰɢɹ ɫɟɣɱɚɫ ɩɪɟɞɫɤɚɡɚɬɶ ɧɟɜɨɡɦɨɠɧɨ ȼɨ ɜɫɹɤɨɦ ɫɥɭɱɚɟ ɛɨɥɟɟ ɱɟɦ ɫɬɨɥɟɬɧɢɣ ɨɩɵɬ ɤɨɧɬɚɤɬɚ ɱɟɥɨɜɟɱɟɫɬɜɚ ɫ ɜɢɪɭɫɨɦ ɝɪɢɩɩɚ ɩɪɟɞɨɫɬɟɪɟɝɚɟɬ ɨɬ ɢɡɥɢɲɧɟɝɨ ɨɩ ɬɢɦɢɡɦɚ

ɋɢɫɬɟɦɵ ɡɞɪɚɜɨɨɯɪɚɧɟɧɢɹ ɜɨ ɦɧɨɝɢɯ ɫɬɪɚɧɚɯ ɦɢɪɚ ɩɟɪɟɫɬɪɚɢɜɚɥɢɫɶ ɛɭɤ ɜɚɥɶɧɨ ɧɚ ɯɨɞɭ ɢɫɩɨɥɶɡɭɸ ɭɠɟ ɢɦɟɸɳɭɸɫɹ ɫɟɬɶ ɫɬɚɰɢɨɧɚɪɨɜ ɪɚɡɧɨɝɨ ɩɪɨɮɢɥɹɚ ɜ ɪɹɞɟ ɫɥɭɱɚɟɜ ɢ ɧɟɦɟɞɢɰɢɧɫɤɢɯ ɭɱɪɟɠɞɟɧɢɣ ɞɥɹ ɪɚɡɜɨɪɚɱɢɜɚɧɢɹ ɫɟɬɢ ɤɨɪɨ ɧɚɜɢɪɭɫɧɵɯ ɝɨɫɩɢɬɚɥɟɣ Ⱦɨɩɭɳɟɧɧɵɟ ɩɪɢ ɷɬɨɦ ɨɲɢɛɤɢ ɢ ɩɪɨɫɱɺɬɵ ɛɭɞɭɬ ɟɳɺ ɚɧɚɥɢɡɢɪɨɜɚɬɶɫɹ ɨɱɟɧɶ ɞɨɥɝɨ ȿɫɥɢ ɢɫɤɥɸɱɢɬɶ ɮɚɪɦɚɤɨɬɟɪɚɩɟɜɬɢɱɟɫɤɢɣ ɚɫɩɟɤɬ ɛɨɪɶɛɵ ɫ ɧɨɜɚɹ ɤɨɪɨɧɚɜɢɪɭɫɧɚɹ ɢɧɮɟɤɰɢɹ &29,'- ɚ ɩɨɡɞɧɟɟ ɢ ɫɩɟɰɢɮɢɱɟ ɫɤɭɸ ɜɚɤɰɢɧɚɰɢɸ ɬɨ ɞɥɹ ɜɟɞɟɧɢɹ ɷɬɢɯ ɩɚɰɢɟɧɬɨɜ ɛɵɥɢ ɩɨɜɫɟɦɟɫɬɧɨ ɩɪɢɜɥɟɱɟ ɧɵ ɭɠɟ ɢɡɜɟɫɬɧɵɟ ɢɧɫɬɪɭɦɟɧɬɚɥɶɧɵɟ ɦɟɬɨɞɢɤɢ ɞɢɚɝɧɨɫɬɢɤɢ ɢ ɥɟɱɟɧɢɹ Ɋɚɡɭɦɟ ɟɬɫɹ ɩɨɫɬɟɩɟɧɧɨ ɛɵɥɚ ɩɪɨɜɟɞɟɧɚ ɩɟɪɟɨɰɟɧɤɚ ɢɯ ɡɧɚɱɢɦɨɫɬɢ ɢ ɨɛɴɺɦɚ ɢɫɩɨɥɶ ɡɨɜɚɧɢɹ ɜ ɧɨɜɵɯ ɭɫɥɨɜɢɹɯ ɗɬɨ ɤɨɫɧɭɥɨɫɶ ɢ ɛɪɨɧɯɨɫɤɨɩɢɱɟɫɤɨɝɨ ɩɨɫɨɛɢɹ

ȼ ɩɪɟɞɥɚɝɚɟɦɨɣ ɱɢɬɚɬɟɥɹɦ ɧɚɫɬɨɹɳɟɟ ɦɨɧɨɝɪɚɮɢɢ ɦɵ ɩɨɩɵɬɚɥɢɫɶ ɨɛɨɛ ɳɢɬɶ ɫɨɛɫɬɜɟɧɧɵɣ ɨɩɵɬ ɩɪɨɜɟɞɟɧɢɹ ɛɪɨɧɯɨɫɤɨɩɢɢ ɬɚɤɢɦ ɩɚɰɢɟɧɬɚɦ Ɇɵ ɧɚɦɟ ɪɟɧɧɨ ɭɞɟɥɢɥɢ ɛɨɥɶɲɨɟ ɜɧɢɦɚɧɢɟ ɨɛɳɟɣ ɨɪɝɚɧɢɡɚɰɢɢ ɪɚɛɨɬɵ ɷɧɞɨɫɤɨɩɢɱɟɫɤɨɣ

78

ɫɥɭɠɛɵ ɜɤɥɸɱɚɹ ɜɨɩɪɨɫɵ ɥɨɝɢɫɬɢɤɢ ɭɱɺɬɚ ɷɩɢɞɟɦɢɱɟɫɤɢɯ ɪɢɫɤɨɜ, ɪɟɝɥɚɦɟɧɬɚ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɞɨɩɨɥɧɢɬɟɥɶɧɵɯ ɞɢɚɝɧɨɫɬɢɱɟɫɤɢɯ ɦɚɧɢɩɭɥɹɰɢɣ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɤɨɧɤɪɟɬɧɨɣ ɷɩɢɞɟɦɢɨɥɨɝɢɱɟɫɤɨɣ ɫɢɬɭɚɰɢɢ ɜ ɱɚɫɬɧɨɫɬɢ, ɨɫɨɛɟɧɧɨɫɬɹɦ ɫɛɨɪɚ ɠɢɞɤɨɫɬɢ ɛɪɨɧɯɨɚɥɶɜɟɨɥɹɪɧɨɝɨ ɥɚɜɚɠɚ ɢ ɟɺ ɥɚɛɨɪɚɬɨɪɧɨɣ ɨɰɟɧɤɟ

ɇɚɭɱɧɚɹ ɫɨɫɬɚɜɥɹɸɳɚɹ ɦɨɧɨɝɪɚɮɢɢ ɩɨɫɜɹɳɟɧɚ ɨɫɨɛɟɧɧɨɫɬɢ ɚɥɝɨɪɢɬɦɚ ɩɪɢɦɟɧɟɧɢɹ ɛɪɨɧɯɨɫɤɨɩɢɢ ɜ ɭɫɥɨɜɢɹɯ ɤɨɪɨɧɚɜɢɪɭɫɧɨɝɨ ɝɨɫɩɢɬɚɥɹ ɨɫɨɛɟɧɧɨ ɫɬɹɦ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɨɣ ɤɚɪɬɢɧɵ ɢ ɟɺ ɫɜɹɡɢ ɫ ɤɥɢɧɢɤɨɣ ɉɪɟɞɫɬɚɜɥɹɟɬɫɹ ɩɪɢɧ ɰɢɩɢɚɥɶɧɨ ɜɚɠɧɵɦ ɱɬɨ ɷɬɢ ɩɚɪɚɦɟɬɪɵ ɧɟ ɩɪɟɞɫɬɚɜɥɹɥɢ ɫɨɛɨɣ ɧɟɱɬɨ ɡɚɫɬɵɜ ɲɟɟ ɫɢɬɭɚɰɢɹ ɦɟɧɹɥɚɫɶ ɫɢɧɯɪɨɧɧɨ ɫɨ ɫɦɟɧɚɦɢ ɷɩɢɞɟɦɢɨɥɨɝɢɱɟɫɤɨɣ ɫɢɬɭɚɰɢɢ.

Ⱥɜɬɨɪɵ ɧɚɞɟɸɬɫɹ ɱɬɨ ɢɦ ɭɞɚɥɨɫɶ ɜɵɹɜɢɬɶ ɫɜɹɡɶ ɢɡɦɟɧɟɧɢɣ ɚɥɝɨɪɢɬɦɚ ɢɫɩɨɥɶ ɡɨɜɚɧɢɹ ɛɪɨɧɯɨɫɤɨɩɢɢ ɷɧɞɨɛɪɨɧɯɢɚɥɶɧɨɣ ɤɚɪɬɢɧɵ ɱɚɫɬɨɬɵ ɜɵɹɜɥɟɧɢɹ ɥɚɬɟɧɬ ɧɵɯ ɚɧɚɬɨɦɢɱɟɫɤɢɯ ɚɧɨɦɚɥɢɣ ɬɪɚɯɟɨɛɪɨɧɯɢɚɥɶɧɨɝɨ ɞɟɪɟɜɚ ɫ ɝɨɫɩɨɞɫɬɜɨɦ ɬɨɝɨ ɢɥɢ ɢɧɨɝɨ ɲɬɚɦɦɚ ɲɬɚɦɦɨɜ ɤɨɪɨɧɚɜɢɪɭɫɚ ɜ ɞɚɧɧɵɣ ɦɨɦɟɧɬ ɜɪɟɦɟɧɢ

Ȼɢɛɥɢɨɝɪɚɮɢɱɟɫɤɢɣ ɫɩɢɫɨɤ ɞɥɹ ɭɞɨɛɫɬɜɚ ɜɨɫɩɪɢɹɬɢɹ ɛɵɥ ɫɨɫɬɚɜɥɟɧ ɧɟ ɩɨ ɚɥɮɚɜɢɬɭ ɚ ɩɨ ɦɟɪɟ ɭɩɨɦɢɧɚɧɢɹ ɜ ɬɟɤɫɬɟ ɫɬɚɬɶɢ

Ⱥɜɬɨɪɵ ɧɚɞɟɸɬɫɹ ɱɬɨ ɫɜɟɞɟɧɢɹ, ɩɪɢɜɨɞɢɦɵɟ ɜ ɷɬɨɣ ɦɨɧɨɝɪɚɮɢɢ ɛɭɞɭɬ ɩɨɥɟɡɧɵ ɜɪɚɱɚɦ ɪɚɡɥɢɱɧɵɯ ɫɩɟɰɢɚɥɶɧɨɫɬɟɣ ɜ ɢɯ ɬɹɠɺɥɨɣ ɩɨɜɫɟɞɧɟɜɧɨɣ ɪɚɛɨɬɟ

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ȻɂȻɅɂɈȽɊȺɎɂɑȿɋɄɂɃ ɋɉɂɋɈɄ

1.URL: https://www.who.int/dg/speeches/detail/who-director-general-s- opening-remarks-atthemedia- briefing-on-covid-19-11-march-2020

2.Coronavirus disease (COVID-19) Pandemic. URL: https:// www.who.int/emergencies/diseases/novel-coronavirus-2019

3.Phelan A.L., Katz R., Gostin L.O. The novel coronavirus originating in Wuhan, China: challenges for global health governance // JAMA. – 2020. – Vol. 323

(8). – Ɋ. 709–710. http://doi.org/10.1001/jama.2020.1097

4.World Health Organization. URL: text/health/2023/05/05/72281687/

5.ȼɪɟɦɟɧɧɵɟ ɦɟɬɨɞɢɱɟɫɤɢɟ ɪɟɤɨɦɟɧɞɚɰɢɢ ɉɪɨɮɢɥɚɤɬɢɤɚ ɞɢɚɝɧɨ ɫɬɢɤɚ ɢ ɥɟɱɟɧɢɟ ɧɨɜɨɣ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɢ &29,'- ȼɟɪɫɢɹ (26.10.2023). – Ɇɨɫɤɜɚ Ɇɢɧɡɞɪɚɜ ɊɎ – 249 ɫ.

6.ȼɥɚɫɟɧɤɨ Ⱥ ȼ ȿ ɉ ȿɜɞɨɤɢɦɨɜ Ɋɨɞɢɨɧɨɜ ȿ ɉ ɋɨɜɪɟɦɟɧɧɵɟ ɩɪɢɧ ɰɢɩɵ ɤɨɪɪɟɤɰɢɢ ɝɢɩɨɤɫɢɢ ɩɪɢ ɈɊȾɋ ɪɚɡɥɢɱɧɨɝɨ ɝɟɧɟɡɚ ɑɚɫɬɶ I // ȼɟɫɬɧɢɤ ɚɧɟ ɫɬɟɡɢɨɥɨɝɢɢ ɢ ɪɟɚɧɢɦɚɬɨɥɨɝɢɢ – 2020. – Ɍɨɦ ʋ 3. – ɋ –78. http://doi.org/10.21292/2078-5658-2020-17-3-61-782020-4-0-1

7.ɉɟɬɪɨɜɢɱɟɜ ȼ ɋ. Ɇɟɥɟɯɨɜ Ⱥ ȼ ɋɚɣɮɭɥɥɢɧ Ɇ Ⱥ ɇɢɤɢɬɢɧ ɂ Ƚ Ʉɨɦɩɶɸɬɟɪɧɚɹ ɬɨɦɨɝɪɚɮɢɹ ɩɪɢ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧɮɟɤɰɢɢ ɞɢɮɮɟɪɟɧɰɢɚɥɶɧɵɣ ɞɢɚɝɧɨɡ ɧɚ ɤɥɢɧɢɱɟɫɤɢɯ ɩɪɢɦɟɪɚɯ // Ⱥɪɯɢɜɴ ɜɧɭɬɪɟɧɧɟɣ ɦɟɞɢɰɢɧɵ – 2020. – ʋ 10 (5). – ɋ –371. http://doi.org/10.20514/2226-6704-2020-10-5-357-371

8.ɉɟɪɟɜɟɡɟɧɰɟɜ Ɉ Ⱥ ɏɨɥɨɞɧɚɹ Ɍ Ɉ ɋɚɦɫɨɧɨɜ Ⱥ ɗ Ȼɭɪɰɟɜ Ⱦ ȼ Ɇɟ ɬɨɞɵ ɫɩɟɰɢɮɢɱɟɫɤɨɝɨ ɥɚɛɨɪɚɬɨɪɧɨɝɨ ɬɟɫɬɢɪɨɜɚɧɢɹ ɧɨɜɨɣ ɤɨɪɨɧɚɜɢɪɭɫɧɨɣ ɢɧ ɮɟɤɰɢɢ // Ɇɟɞɢɰɢɧɫɤɢɣ ɜɟɫɬɧɢɤ ɘɝɚ Ɋɨɫɫɢɢ – 2020. – Ɍɨɦ ʋ 3. – ɋ –33. https://doi.org/10.21886/2219-8075-2020-11-3-27-33

9.Bein B., Bachmann M., Huggett S., Wegermann Ɋ. SARS CoV- 2/COVID-19: evidence-based recommendation on diagnosis and therapy // Anasthesiol. Intensivmed Notfallmed. Schmerzther. – 2020. – Vol. 55 (4). – Ɋ. 257–265. http://doi.org/10.1055/a-1146-8674

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