Частная микробиология. Учебное пособие
.pdfȺɇɌɂȽȿɇɇȺə ɋɌɊɍɄɌɍɊȺ. ɋɬɪɟɩɬɨɤɨɤɤɢ ɢɦɟɸɬ ɝɪɭɩɩɨɜɨɣ ɩɨɥɢɫɚ ɯɚɪɢɞɧɵɣ ɋ-ɚɧɬɢɝɟɧ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɨɫɨɛɟɧɧɨɫɬɟɣ ɫɬɪɨɟɧɢɹ ɤɨɬɨɪɨɝɨ ɫɬɪɟɩ ɬɨɤɨɤɤɢ ɪɚɡɞɟɥɟɧɵ ɧɚ ɫɟɪɨɝɪɭɩɩɵ ɋ-ɚɧɬɢɝɟɧ ɥɨɤɚɥɢɡɭɟɬɫɹ ɜ ɤɥɟɬɨɱɧɨɣ ɫɬɟɧɤɟ ɫɬɪɟɩɬɨɤɨɤɤɨɜ ɇɟɤɨɬɨɪɵɟ ɜɢɞɵ ɫɬɪɟɩɬɨɤɨɤɤɨɜ ɧɟ ɢɦɟɸɬ ɋ-ɚɧɬɢɝɟɧɚ ȼ ɤɥɟɬɨɱ ɧɨɣ ɫɬɟɧɤɟ ɫɬɪɟɩɬɨɤɨɤɤɨɜ ɥɨɤɚɥɢɡɭɟɬɫɹ ɬɚɤɠɟ ɛɟɥɤɨɜɵɣ Ɇ-ɚɧɬɢɝɟɧ Ɉɧ ɨɛɥɚ ɞɚɟɬ ɬɢɩɨɜɨɣ ɫɩɟɰɢɮɢɱɧɨɫɬɶɸ ɋɬɪɭɤɬɭɪɧɨ Ɇ-ɛɟɥɨɤ ɩɪɟɞɫɬɚɜɥɹɟɬ ɮɢɥɚɦɟɧɬɵɩɢɥɢ ɮɢɦɛɪɢɢ ɉɨ ɫɬɪɨɟɧɢɸ Ɇ-ɚɧɬɢɝɟɧɚ ɫɬɪɟɩɬɨɤɨɤɤɢ ɝɪɭɩɩɵ Ⱥ ɩɨɞɪɚɡɞɟɥɹ ɸɬɫɹ ɧɚ ɫɟɪɨɜɚɪɵ ɛɨɥɟɟ ɫɟɪɨɜɚɪɨɜ ɋɬɪɟɩɬɨɤɨɤɤɢ ɢɦɟɸɬ ɬɚɤ ɧɚɡɵɜɚɟɦɵɟ ɩɟɪɟɤɪɟɫɬɧɨ ɪɟɚɝɢɪɭɸɳɢɟ ɚɧɬɢɝɟɧɵ Ⱥɧɬɢɬɟɥɚ ɤ ɬɚɤɢɦ ɚɧɬɢɝɟɧɚɦ ɜɡɚɢɦɨɞɟɣ ɫɬɜɭɸɬ ɩɟɪɟɤɪɟɫɬɧɨ ɪɟɚɝɢɪɭɸɬ ɫ ɬɤɚɧɹɦɢ ɦɢɨɤɚɪɞɚ ɫɤɟɥɟɬɧɵɯ ɦɵɲɰ ɩɨɱɟɤ
ɎȺɄɌɈɊɕɉȺɌɈȽȿɇɇɈɋɌɂ. Ɏɢɦɛɪɢɢɢɤɚɩɫɭɥɚ– ɡɚɳɢɳɚɸɬɨɬɮɚ ɝɨɰɢɬɨɡɚ Ȼɟɥɨɤ 0 – ɩɪɟɩɹɬɫɬɜɭɟɬ ɨɩɫɨɧɢɡɚɰɢɢ ɢ ɤɨɦɩɥɟɦɟɧɬ-ɨɩɨɫɪɟɞɨɜɚɧɧɨɦɭ ɥɢɡɢɫɭ. ɗɪɢɬɪɨɝɟɧɧɵɣ ɬɨɤɫɢɧ 6 S\RJHQHV – ɜɵɡɵɜɚɟɬ ɫɤɚɪɥɚɬɢɧɭ ɋɬɪɟɩɬɨ ɥɢɡɢɧɵ 2 ɢ 6 – ɪɚɡɪɭɲɚɸɬ ɷɪɢɬɪɨɰɢɬɵ ɢ ɥɟɣɤɨɰɢɬɵ Ƚɢɚɥɭɪɨɧɢɞɚɡɚ ɫɬɪɟɩɬɨ ɤɢɧɚɡɚ ȾɇɄɚɡɚ – ɫɩɨɫɨɛɫɬɜɭɸɬ ɢɧɜɚɡɢɢ ɉɧɟɜɦɨɥɢɡɢɧ 6 SQHXPRQLDH – ɪɚɡ ɪɭɲɚɟɬ ɤɥɟɬɤɢ.
ɊȿɁɂɋɌȿɇɌɇɈɋɌɖ. ȼɨ ɜɧɟɲɧɟɣ ɫɪɟɞɟ ɫɬɪɟɩɬɨɤɨɤɤɢ ɫɨɯɪɚɧɹɸɬɫɹ ɜ ɬɟ ɱɟɧɢɟ ɧɟɫɤɨɥɶɤɢɯ ɞɧɟɣ Ɉɧɢ ɜɵɞɟɪɠɢɜɚɸɬ ɧɚɝɪɟɜɚɧɢɟ ɞɨ –70 qɋ ɜ ɬɟɱɟɧɢɟɦɢɧɭɬ ɯɨɪɨɲɨ ɩɟɪɟɧɨɫɹɬ ɧɢɡɤɢɟ ɬɟɦɩɟɪɚɬɭɪɵ ɋɬɪɟɩɬɨɤɨɤɤɢ ɩɪɨɞɨɥɠɢɬɟɥɶ ɧɨɟ ɜɪɟɦɹ ɫɨɯɪɚɧɹɸɬɫɹ ɧɚ ɩɪɟɞɦɟɬɚɯ ɨɤɪɭɠɚɸɳɢɯ ɛɨɥɶɧɨɝɨ ɜ ɩɵɥɢ ȼ ɝɧɨɟ ɦɨɤɪɨɬɟ ɫɬɪɟɩɬɨɤɨɤɤɢ ɫɨɯɪɚɧɹɸɬɫɹ ɦɟɫɹɰɚɦɢ ɑɭɜɫɬɜɢɬɟɥɶɧɵ ɤ ɞɟɡɢɧɮɢɰɢɪɭɸ ɳɢɦ ɜɟɳɟɫɬɜɚɦ ɧɚɩɪɢɦɟɪ ɜ ɮɟɧɨɥɟ ɨɧɢ ɩɨɝɢɛɚɸɬ ɱɟɪɟɡ ɦɢɧɭɬ ɋɬɪɟɩ ɬɨɤɨɤɤɢ ɱɭɜɫɬɜɢɬɟɥɶɧɵ ɤ ɩɟɧɢɰɢɥɥɢɧɭ ɭɫɬɨɣɱɢɜɨɫɬɶ ɤ ɩɟɧɢɰɢɥɥɢɧɭ ɭ ɧɢɯ ɜɨɡ ɧɢɤɚɟɬ ɨɱɟɧɶ ɪɟɞɤɨ Ʉ ɞɪɭɝɢɦ ɠɟ ɚɧɬɢɛɢɨɬɢɤɚɦ ɢ ɫɭɥɶɮɚɧɢɥɚɦɢɞɚɦ ɭ ɫɬɪɟɩɬɨ ɤɨɤɤɨɜ ɱɚɫɬɨ ɪɚɡɜɢɜɚɟɬɫɹ ɪɟɡɢɫɬɟɧɬɧɨɫɬɶ
ɗɉɂȾȿɆɂɈɅɈȽɂə. ɋɬɪɟɩɬɨɤɨɤɤɢ ɹɜɥɹɸɬɫɹ ɨɛɢɬɚɬɟɥɹɦɢ ɫɥɢɡɢɫɬɵɯ ɨɛɨɥɨɱɟɤ ɜɟɪɯɧɢɯ ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ ɩɢɳɟɜɚɪɢɬɟɥɶɧɨɝɨ ɢ ɦɨɱɟɩɨɥɨɜɨɝɨ ɬɪɚɤ ɬɨɜ ɉɨɷɬɨɦɭɜɵɡɵɜɚɟɦɵɟɢɦɢɡɚɛɨɥɟɜɚɧɢɹɦɨɝɭɬɛɵɬɶɷɧɞɨɝɟɧɧɨɝɨɢɥɢɷɤɡɨɝɟɧ ɧɨɝɨ ɯɚɪɚɤɬɟɪɚ Ɉɫɧɨɜɧɨɣ ɢɫɬɨɱɧɢɤ ɷɤɡɨɝɟɧɧɨɣ ɢɧɮɟɤɰɢɢ – ɛɨɥɶɧɨɣ ɱɟɥɨɜɟɤ ɢɥɢ ɛɚɤɬɟɪɢɨɧɨɫɢɬɟɥɶ ɗɧɞɨɝɟɧɧɨɟ ɢɧɮɢɰɢɪɨɜɚɧɢɟ ɜɨɡɧɢɤɚɟɬ ɩɪɢ ɫɧɢɠɟɧɢɹ ɟɫɬɟɫɬɜɟɧɧɨɣ ɪɟɡɢɫɬɟɧɬɧɨɫɬɢ ɨɪɝɚɧɢɡɦɚ Ɇɟɯɚɧɢɡɦɵ ɢ ɩɭɬɢ ɩɟɪɟɞɚɱɢ ɢɧɮɟɤ ɰɢɢ ɚɷɪɨɝɟɧɧɵɣ ɩɭɬɶ ɩɟɪɟɞɚɱɢ – ɜɨɡɞɭɲɧɨ-ɤɚɩɟɥɶɧɵɣ ɤɨɧɬɚɤɬɧɵɣ ɩɭɬɢ ɩɟ ɪɟɞɚɱɢ – ɩɪɹɦɨɣ ɤɨɧɬɚɤɬ ɢ ɨɩɨɫɪɟɞɨɜɚɧɧɵɣ ɤɨɧɬɚɤɬ ɱɟɪɟɡ ɛɵɬɨɜɵɟ ɩɪɟɞɦɟɬɵ ȼɨɡɦɨɠɧɵ ɫɥɭɱɚɢ ɜɧɭɬɪɢɛɨɥɶɧɢɱɧɵɯ ɫɬɪɟɩɬɨɤɨɤɤɨɜɵɯ ɢɧɮɟɤɰɢɣ ɢɧɮɟɤɰɢɣ ɫɜɹɡɚɧɧɵɯ ɫ ɨɤɚɡɚɧɢɟɦ ɦɟɞɢɰɢɧɫɤɨɣ ɩɨɦɨɳɢ
31
ɉȺɌɈȽȿɇȿɁ. ɋɬɪɟɩɬɨɤɨɤɤɢ ɜɵɡɵɜɚɸɬ ɨɫɬɪɵɟ ɢ ɯɪɨɧɢɱɟɫɤɢɟ ɝɧɨɣɧɨɜɨɫɩɚɥɢɬɟɥɶɧɵɟ ɩɪɨɰɟɫɫɵ ɜ ɪɚɡɥɢɱɧɵɯ ɨɪɝɚɧɚɯ ɜ ɬɨɦ ɱɢɫɥɟ ɫɟɩɫɢɫɢ ɫɟɩɬɢɤɨɩɢ ɟɦɢɸ Ⱥɞɝɟɡɢɹ ɤ ɷɩɢɬɟɥɢɸ ɤɨɥɨɧɢɡɚɰɢɹ ɪɚɡɪɭɲɟɧɢɟ ɬɤɚɧɟɣ ɮɟɪɦɟɧɬɚɦɢ. Ɍɨɤɫɢɧɵ ɜɵɡɵɜɚɸɬ ɫɢɫɬɟɦɧɵɟ ɪɟɚɤɰɢɢ ɥɢɯɨɪɚɞɤɚ ɜɨɫɩɚɥɟɧɢɟ ɬɨɤɫɢɤɨɡ . ȼɨɡ ɦɨɠɧɵ ɚɭɬɨɢɦɦɭɧɧɵɟ ɨɫɥɨɠɧɟɧɢɹ ɪɟɜɦɚɬɢɡɦ ɝɥɨɦɟɪɭɥɨɧɟɮɪɢɬ .
ɄɅɂɇɂɑȿɋɄȺə ɄȺɊɌɂɇȺ. ȼɵɞɟɥɹɸɬ ɨɫɬɪɵɟ ɫɬɪɟɩɬɨɤɨɤɤɨɜɵɟ ɡɚɛɨ ɥɟɜɚɧɢɹ ɩɢɨɞɟɪɦɢɹ ɪɨɠɢɫɬɨɟ ɜɨɫɩɚɥɟɧɢɟ ɮɥɟɝɦɨɧɚ ɚɧɝɢɧɚ ɫɤɚɪɥɚɬɢɧɚ ɨɫɬ ɪɵɣ ɝɥɨɦɟɪɭɥɨɧɟɮɪɢɬ ɢ ɯɪɨɧɢɱɟɫɤɢɟ ɫɬɪɟɩɬɨɤɨɤɤɨɜɵɟ ɡɚɛɨɥɟɜɚɧɢɹ ɪɟɜɦɚɬɢɡɦ ɢɥɢɨɫɬɪɚɹɪɟɜɦɚɬɢɱɟɫɤɚɹɥɢɯɨɪɚɞɤɚ ɯɪɨɧɢɱɟɫɤɢɣɬɨɧɡɢɥɥɢɬ Ʉɥɢɧɢɱɟɫɤɚɹɤɚɪ ɬɢɧɚ ɡɚɜɢɫɢɬ ɨɬ ɜɢɞɚ ɫɬɪɟɩɬɨɤɨɤɤɚ 6 S\RJHQHV ɚɧɝɢɧɚ ɫɤɚɪɥɚɬɢɧɚ ɪɨɠɢɫɬɨɟ ɜɨɫɩɚɥɟɧɢɟ ɪɟɜɦɚɬɢɡɦ ɝɥɨɦɟɪɭɥɨɧɟɮɪɢɬ, 6 SQHXPRQLDH ɩɧɟɜɦɨɧɢɹ ɦɟɧɢɧɝɢɬ ɨɬɢɬ ɫɟɩɫɢɫ, 6 DJDODFWLDH ɧɟɨɧɚɬɚɥɶɧɵɣ ɫɟɩɫɢɫ ɦɟɧɢɧɝɢɬ.
ɆȿɌɈȾɕ ȾɂȺȽɇɈɋɌɂɄɂ. ɂɫɫɥɟɞɭɟɦɵɦ ɦɚɬɟɪɢɚɥɨɦ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɥɨɤɚɥɢɡɚɰɢɢ ɩɨɪɚɠɟɧɢɹ ɫɥɭɠɚɬ ɤɪɨɜɶ ɝɧɨɣ ɫɥɢɡɶ ɢɡ ɡɟɜɚ ɧɚɥɟɬ ɫ ɦɢɧɞɚɥɢɧ: ɚ ɛɚɤɬɟɪɢɨɥɨɝɢɱɟɫɤɢɣ ɩɨɫɟɜ ɧɚ ɤɪɨɜɹɧɨɣ ɚɝɚɪ ɢɞɟɧɬɢɮɢɤɚɰɢɹ ɩɨ ɬɢɩɭ ɝɟ ɦɨɥɢɡɚ Ɉɩɪɟɞɟɥɟɧɢɟ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɢ ɤ ɚɧɬɢɛɢɨɬɢɤɚɦ; ɛ ɛɚɤɬɟɪɢɨɫɤɨɩɢɱɟ ɫɤɢɣ ɨɤɪɚɫɤɚ ɩɨ Ƚɪɚɦɭ ɝɪɚɦɩɨɥɨɠɢɬɟɥɶɧɵɟ ɤɨɤɤɢ ɜ ɰɟɩɨɱɤɚɯ ; ɜ ɫɟɪɨɥɨɝɢɱɟ ɫɤɢɣ ɪɟɚɤɰɢɹ ɫɜɹɡɵɜɚɧɢɹ ɤɨɦɩɥɟɦɟɧɬɚ ɊɋɄ ɪɟɚɤɰɢɹ ɚɝɝɥɸɬɢɧɚɰɢɢ Ɉɩɪɟɞɟ ɥɟɧɢɟ ɚɧɬɢɫɬɪɟɩɬɨɥɢɡɢɧɚ-Ɉ ȺɋɅ-Ɉ ɝ ɦɨɥɟɤɭɥɹɪɧɨ-ɛɢɨɥɨɝɢɱɟɫɤɢɣ ɉɐɊ ɞɥɹ ɨɛɧɚɪɭɠɟɧɢɹ ɫɩɟɰɢɮɢɱɟɫɤɢɯ ɝɟɧɨɜ ɫɬɪɟɩɬɨɤɨɤɤɨɜ.
Ʌȿɑȿɇɂȿ. 6 S\RJHQHV ɚɧɬɢɛɢɨɬɢɤɢ ɩɟɧɢɰɢɥɥɢɧɨɜɨɝɨ ɪɹɞɚ ɚɦɨɤɫɢɰɢɥ ɥɢɧ ɛɟɧɡɢɥɩɟɧɢɰɢɥɥɢɧ 6 SQHXPRQLDH ɩɟɧɢɰɢɥɥɢɧɵ ɰɟɮɚɥɨɫɩɨɪɢɧɵ ,,, ɩɨɤɨ ɥɟɧɢɹ ɦɚɤɪɨɥɢɞɵ 6 DJDODFWLDH ɚɦɩɢɰɢɥɥɢɧ ɝɟɧɬɚɦɢɰɢɧ ɭ ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɉɪɢ ɚɥɥɟɪɝɢɢ ɡɚɦɟɧɹɸɬ ɧɚ ɦɚɤɪɨɥɢɞɵ ɚɡɢɬɪɨɦɢɰɢɧ ɤɥɚɪɢɬɪɨɦɢɰɢɧ . Ɉɫɥɨɠ ɧɟɧɢɹ ɫɬɪɟɩɬɨɤɨɤɤɨɜɨɣ ɢɧɮɟɤɰɢɢ ɉɨɫɥɟ ɨɫɬɪɨɣ ɢɧɮɟɤɰɢɢ ɜɵɡɜɚɧɧɨɣ ɫɬɪɟɩ ɬɨɤɨɤɤɚɦɢ ɝɪɭɩɩɵ Ⱥ ɭ ɱɚɫɬɢ ɛɨɥɶɧɵɯ ɪɚɡɜɢɜɚɟɬɫɹ ɪɟɜɦɚɬɢɱɟɫɤɚɹ ɥɢɯɨɪɚɞɤɚ ɢ ɩɨɫɬɫɬɪɟɩɬɨɤɨɤɤɨɜɵɣ ɝɥɨɦɟɪɭɥɨɧɟɮɪɢɬ Ɋɟɜɦɚɬɢɱɟɫɤɚɹ ɥɢɯɨɪɚɞɤɚ ɪɚɡɜɢɜɚɟɬɫɹ ɬɨɥɶɤɨ ɩɨɫɥɟ ɨɫɬɪɨɝɨ ɬɨɧɡɢɥɥɢɬɚ ɢ ɮɚɪɢɧɝɢɬɚ ɚ ɩɨɫɬɫɬɪɟɩɬɨɤɨɤɤɨɜɵɣ ɝɥɨɦɟɪɭ ɥɨɧɟɮɪɢɬ ɪɚɡɜɢɜɚɟɬɫɹ ɤɚɤ ɩɨɫɥɟ ɬɨɧɡɢɥɥɢɬɚ ɬɚɤ ɢ ɩɨɫɥɟ ɢɧɮɟɤɰɢɣ ɤɨɠɢ Ɉɫɬɪɚɹ ɪɟɜɦɚɬɢɱɟɫɤɚɹ ɥɢɯɨɪɚɞɤɚ ɪɚɡɜɢɜɚɟɬɫɹ ɱɟɪɟɡ – ɧɟɞɟɥɢ ɩɨɫɥɟ ɮɚɪɢɧɝɢɬɚ ɉɪɢ ɷɬɨɦ Ɇ-ɛɟɥɨɤ ɩɪɨɜɨɰɢɪɭɟɬ ɨɛɪɚɡɨɜɚɧɢɟ ɚɭɬɨɚɧɬɢɬɟɥ ɤ ɬɤɚɧɹɦ ɫɟɪɞɰɚ ɢ ɫɭɫɬɚɜɨɜ Ƚɥɨɦɟɪɭɥɨɧɟɮɪɢɬ ɪɚɡɜɢɜɚɟɬɫɹ ɱɟɪɟɡ ɧɟɞɟɥɸ ɩɨɫɥɟ ɢɦɩɟɬɢɝɨ ɢɥɢ ɮɚɪɢɧɝɢɬɚ Ⱦɥɹ ɩɪɨɮɢɥɚɤɬɢɤɢ ɪɟɜɦɚɬɢɱɟɫɤɨɣ ɥɢɯɨɪɚɞɤɢ ɢ ɝɥɨɦɟɪɭɥɨɧɟɮɪɢɬɚ ɢɫɩɨɥɶɡɭɸɬ ɚɧɬɢɛɢɨɬɢɤɢ ɩɟɧɢɰɢɥɥɢɧɨɜɨɝɨ ɪɹɞɚ
ɉɊɈɎɂɅȺɄɌɂɄȺ. ɋɩɟɰɢɮɢɱɟɫɤɚɹ ɜɚɤɰɢɧɚ ɩɪɨɬɢɜ 6 SQHXmoniae
ɉɧɟɜɦɨ- ɉɪɟɜɟɧɚɪ-13). ɉɟɪɫɩɟɤɬɢɜɧɵɟ ɪɚɡɪɚɛɨɬɤɢ ɜɚɤɰɢɧ ɩɪɨɬɢɜ
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S. Pyogenes. ɇɟɫɩɟɰɢɮɢɱɟɫɤɚɹ ɫɨɛɥɸɞɟɧɢɟ ɝɢɝɢɟɧɵ ɢɡɨɥɹɰɢɹ ɛɨɥɶɧɵɯ ɋɚɧɢ ɬɚɪɧɵɣ ɤɨɧɬɪɨɥɶ ɜ ɪɨɞɞɨɦɚɯ ɢ ɛɨɥɶɧɢɰɚɯ
ɂɆɆɍɇɂɌȿɌ. ɉɨɫɥɟ ɩɟɪɟɧɟɫɟɧɧɨɣ ɫɬɪɟɩɬɨɤɨɤɤɨɜɨɣ ɢɧɮɟɤɰɢɢ ɪɚɡɜɢɜɚ ɟɬɫɹɧɟɫɬɨɣɤɢɣɤɥɟɬɨɱɧɵɣɢɝɭɦɨɪɚɥɶɧɵɣɬɢɩɨɫɩɟɰɢɮɢɱɟɫɤɢɣɢɦɦɭɧɢɬɟɬ ɡɚɢɫ ɤɥɸɱɟɧɢɟɦ ɫɤɚɪɥɚɬɢɧɵ ɩɨɫɥɟ ɤɨɬɨɪɨɣ ɪɚɡɜɢɜɚɟɬɫɹ ɧɚɩɪɹɠɟɧɧɵɣ ɚɧɬɢɬɨɤɫɢɱɟ ɫɤɢɣ ɢɦɦɭɧɢɬɟɬ
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3.Ʉɂɒȿɑɇɕȿ ɂɇɎȿɄɐɂɂ
3.1.ɄɈɅɂɗɇɌȿɊɂɌɕ ɗɒȿɊɂɏɂɈɁɕ
ɄɅȺɋɋɂɎɂɄȺɐɂə Ⱦɨɦɟɧ %DFWHULD ɨɬɞɟɥ *UDFLOLFXWHV ɫɟɦɟɣɫɬɜɨ (QWHUREDFWHULDFHDH ɪɨɞ (VFKHULFKLD ɜɢɞ E. coli
ɆɈɊɎɈɅɈȽɂə ɂ ɌɂɇɄɌɈɊɂȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ. ɗɲɟɪɢɯɢɢ ɩɪɟɞɫɬɚɜɥɹɸɬ ɫɨɛɨɣ ɩɨɥɢɦɨɪɮɧɵɟ ɩɪɹɦɵɟ ɢɥɢ ɫɥɟɝɤɚ ɢɡɨɝɧɭɬɵɟ ɩɚɥɨɱɤɢ ɫ ɡɚ ɤɪɭɝɥɟɧɧɵɦɢ ɤɨɧɰɚɦɢ ɫɪɟɞɧɢɯ ɪɚɡɦɟɪɨɜ ɞɥɢɧɚ – ɦɤɦ ɢ ɲɢɪɢɧɚ – ɦɤɦ ɉɚɥɨɱɤɢ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɨɞɢɧɨɱɧɨ ɪɟɠɟ – ɩɨɩɚɪɧɨ ɋɩɨɪ ɧɟ ɨɛɪɚɡɭɸɬ Ʉɥɟɬɤɢ ( FROL ɢɦɟɸɬ ɩɢɥɢ ɮɢɦɛɪɢɢ ɢ ɨɛɥɚɞɚɸɬ ɩɨɞɜɢɠɧɨɫɬɶɸ ɛɥɚɝɨɞɚɪɹ ɩɟɪɢɬɪɢɯɢ ɚɥɶɧɨ ɪɚɫɩɨɥɨɠɟɧɧɵɦ ɠɝɭɬɢɤɚɦ ɉɨ ɦɟɬɨɞɭ Ƚɪɚɦɚ ɷɲɟɪɢɯɢɢ ɨɤɪɚɲɢɜɚɸɬɫɹ ɜ ɪɨɡɨɜɵɣ ɰɜɟɬ ɝɪɚɦɨɬɪɢɰɚɬɟɥɶɧɵɟ ȼ ɦɚɡɤɚɯ ɩɨɞ ɦɢɤɪɨɫɤɨɩɨɦ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɛɟɫɩɨɪɹɞɨɱɧɨ Ɇɧɨɝɢɟ ɲɬɚɦɦɵ ɷɲɟɪɢɯɢɣ ɢɦɟɸɬ ɦɢɤɪɨɤɚɩɫɭɥɭ
ɄɍɅɖɌɍɊȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ ɗɲɟɪɢɯɢɢ ɹɜɥɹɸɬɫɹ ɚɷɪɨɛɚɦɢ ɢɥɢ ɮɚɤɭɥɶɬɚɬɢɜɧɵɦɢ ɚɧɚɷɪɨɛɚɦɢ Ɉɩɬɢɦɚɥɶɧɚɹ ɬɟɦɩɟɪɚɬɭɪɚ ɪɨɫɬɚ –37 qɋ ɏɨ ɪɨɲɨ ɪɚɫɬɭɬ ɧɚ ɩɪɨɫɬɵɯ ɩɢɬɚɬɟɥɶɧɵɯ ɫɪɟɞɚɯ ɇɚ ɆɉȺ ɷɲɟɪɢɯɢɢ ɨɛɪɚɡɭɸɬ ɤɨ ɥɨɧɢɢ ɫɪɟɞɧɢɯ ɪɚɡɦɟɪɨɜ ɫɟɪɨ-ɛɟɥɵɟ ɝɥɚɞɤɢɟ ɜɥɚɠɧɵɟ ɛɥɟɫɬɹɳɢɟ ɫ ɪɨɜɧɵɦɢ ɤɪɚɹɦɢ 6-ɮɨɪɦɚ ȼ ɠɢɞɤɢɯ ɫɪɟɞɚɯ ɜɵɡɵɜɚɸɬ ɪɚɜɧɨɦɟɪɧɨɟ ɩɨɦɭɬɧɟɧɢɟ ɢɧɨɝɞɚ ɨɛɪɚɡɭɸɬ ɧɟɡɧɚɱɢɬɟɥɶɧɵɣ ɨɫɚɞɨɤ Ʌɚɤɬɨɡɨɩɨɡɢɬɢɜɧɵɟ ( FROL – ɨɛɪɚɡɭɸɬ ɪɨɡɨ ɜɵɟ ɤɨɥɨɧɢɢ ɧɚ ɗɧɞɨ Ʌɚɤɬɨɡɨɧɟɝɚɬɢɜɧɵɟ 6DOPRQHOOD 6KLJHOOD <HUVLQLD) – ɛɟɫ ɰɜɟɬɧɵɟ ɤɨɥɨɧɢɢ
ȺɇɌɂȽȿɇɇȺə ɋɌɍɄɌɍɊȺ E. coli: O-ɚɧɬɢɝɟɧ ɫɨɦɚɬɢɱɟɫɤɢɣ +-ɚɧɬɢ ɝɟɧ ɠɝɭɬɢɤɨɜɵɣ .-ɚɧɬɢɝɟɧ ɤɚɩɫɭɥɶɧɵɣ . Salmonella: O-ɚɧɬɢɝɟɧ +-ɚɧɬɢɝɟɧɮɚɡɨɜɵɣ 9L-ɚɧɬɢɝɟɧ ɭ 6 typhi). Shigella: O-ɚɧɬɢɝɟɧ – ɨɫɧɨɜɧɨɣ ɞɥɹ ɫɟɪɨɬɢɩɢ ɪɨɜɚɧɢɹ <HUVLQLD 9 ɢ : ɚɧɬɢɝɟɧɵ – ɜɚɠɧɵɟ ɮɚɤɬɨɪɵ ɜɢɪɭɥɟɧɬɧɨɫɬɢ
ɎȺɄɌɈɊɕ ɉȺɌɈȽȿɇɇɈɋɌɂ. Ⱥɞɝɟɡɢɧɵ – ɩɨɦɨɝɚɸɬ ɩɪɢɤɪɟɩɥɹɬɶɫɹ ɤ ɷɩɢɬɟɥɢɸ ɤɢɲɟɱɧɢɤɚ ɮɢɦɛɪɢɢ ɢɧɬɢɦɢɧ ɭ (+(& . ɗɧɬɟɪɨɬɨɤɫɢɧɵ – ɜɵɡɵɜɚɸɬ ɞɢɚɪɟɸ ɬɟɪɦɨɥɚɛɢɥɶɧɵɣ ɢ ɬɟɪɦɨɫɬɚɛɢɥɶɧɵɣ ɬɨɤɫɢɧɵ (7(& ɲɢɝɚɬɨɤɫɢɧ EHEC). ɗɧɞɨɬɨɤɫɢɧ Ʌɉɋ – ɩɪɢɜɨɞɢɬ ɤ ɜɨɫɩɚɥɟɧɢɸ ɢ ɥɢɯɨɪɚɞɤɟ ɂɧɜɚɡɢɜɧɵɟ ɫɜɨɣɫɬɜɚ – ɯɚɪɚɤɬɟɪɧɵ ɞɥɹ 6KLJHOOD ɢ (,(& ɪɚɡɪɭɲɚɸɬ ɷɩɢɬɟɥɢɣ ɤɢɲɟɱɧɢɤɚ. ɐɢ ɬɨɬɨɤɫɢɧɵ – ɲɢɝɚɬɨɤɫɢɧ 6KLJHOOD G\VHQWHULDH (+(& ɜɵɡɵɜɚɟɬ ɝɟɦɨɥɢɬɢɤɨ-ɭɪɟ ɦɢɱɟɫɤɢɣ ɫɢɧɞɪɨɦ Ƚɍɋ .
ɊȿɁɂɋɌȿɇɌɇɈɋɌɖ ɍɫɬɨɣɱɢɜɵ ɜ ɨɤɪɭɠɚɸɳɟɣ ɫɪɟɞɟ ɫɨɯɪɚɧɹɸɬɫɹ ɜ ɜɨɞɟ ɩɢɳɟ. ɑɭɜɫɬɜɢɬɟɥɶɧɵ ɤ ɜɵɫɨɤɨɣ ɬɟɦɩɟɪɚɬɭɪɟ ɢ ɞɟɡɢɧɮɢɰɢɪɭɸɳɢɦ ɫɪɟɞ ɫɬɜɚɦ. ɑɚɫɬɨ ɮɨɪɦɢɪɭɸɬ ɭɫɬɨɣɱɢɜɨɫɬɶ ɤ ɚɧɬɢɛɢɨɬɢɤɚɦ ɨɫɨɛɟɧɧɨ ɭ 6KLJHOOD ɢ ( FROL ɫ ɩɥɚɡɦɢɞɚɦɢ ɪɟɡɢɫɬɟɧɬɧɨɫɬɢ .
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ɗɉɂȾȿɆɂɈɅɈȽɂə. ɂɫɬɨɱɧɢɤ ɢɧɮɟɤɰɢɢ – ɛɨɥɶɧɵɟ ɢ ɧɨɫɢɬɟɥɢ ɉɭɬɢ ɩɟɪɟɞɚɱɢ Ɏɟɤɚɥɶɧɨ-ɨɪɚɥɶɧɵɣ ɡɚɝɪɹɡɧɟɧɧɵɟ ɜɨɞɚ ɩɢɳɚ ɪɭɤɢ Ʉɨɧɬɚɤɬɧɨ-ɛɵ ɬɨɜɨɣ ɱɟɪɟɡ ɩɪɟɞɦɟɬɵ ɢɝɪɭɲɤɢ ȼɨɞɧɵɣ ɩɭɬɶ ɨɫɨɛɟɧɧɨ ɞɥɹ ( FROL Salmonella). ȼɵɫɨɤɚɹ ɜɨɫɩɪɢɢɦɱɢɜɨɫɬɶ ɭ ɞɟɬɟɣ ɩɨɠɢɥɵɯ ɢɦɦɭɧɨɤɨɦɩɪɨɦɟɬɢ ɪɨɜɚɧɧɵɯ ɥɢɰ
ɉȺɌɈȽȿɇȿɁ. Ɋɚɡɥɢɱɚɸɬɫɥɟɞɭɸɳɢɟɝɪɭɩɩɵɤɢɲɟɱɧɵɯɩɚɥɨɱɟɤ ɚ ɧɟɩɚ ɬɨɝɟɧɧɵɟ ɪɟɡɢɞɟɧɬɧɵɟ ɷɲɟɪɢɯɢɢ; ɛ ɷɲɟɪɢɯɢɢ ɜɵɡɵɜɚɸɳɢɟ ɜɧɟɤɢɲɟɱ ɧɵɟ ɡɚɛɨɥɟɜɚɧɢɹ ɢ ɢɦɟɸɳɢɟ ɷɧɞɨɝɟɧɧɨɟ ɩɪɨɢɫɯɨɠɞɟɧɢɟ; ɜ ɞɢɚɪɟɟɝɟɧɧɵɟ
ɷɲɟɪɢɯɢɢ ɷɤɡɨɝɟɧɧɨɝɨ ɩɪɨɢɫɯɨɠɞɟɧɢɹ
Ⱥ ɧɟɩɚɬɨɝɟɧɧɵɟ ɪɟɡɢɞɟɧɬɧɵɟ ɷɲɟɪɢɯɢɢ ɹɜɥɹɸɬɫɹ ɩɪɟɞɫɬɚɜɢɬɟɥɹɦɢ ɧɨɪɦɚɥɶɧɨɝɨ ɦɢɤɪɨɛɢɨɰɟɧɨɡɚ ɤɢɲɟɱɧɢɤɚ ɱɟɥɨɜɟɤɚ Ɉɧɢ ɫɨɜɦɟɫɬɧɨ ɫ ɞɪɭɝɢɦɢ ɩɪɟɞɫɬɚɜɢɬɟɥɹɦɢ ɧɨɪɦɚɥɶɧɨɝɨ ɦɢɤɪɨɛɢɨɰɟɧɨɡɚ ɤɢɲɟɱɧɢɤɚ ɨɛɟɫɩɟɱɢɜɚɸɬ ɤɨɥɨ ɧɢɡɚɰɢɨɧɧɭɸ ɪɟɡɢɫɬɟɧɬɧɨɫɬɶ ɨɪɝɚɧɢɡɦɚ Ɍɢɩɢɱɧɵɦ ɩɪɟɞɫɬɚɜɢɬɟɥɟɦ ɧɟɩɚɬɨɝɟɧ ɧɵɯ ɤɢɲɟɱɧɵɯ ɩɚɥɨɱɟɤ ɹɜɥɹɟɬɫɹ ɲɬɚɦɦ ( FROL 2 Ʉ ɇ 1LVVOH ɧɚ ɨɫɧɨɜɟ ɤɨɬɨɪɨɝɨɫɟɥɟɤɰɢɨɧɢɪɨɜɚɧɜɚɪɢɚɧɬ( FROLɆɢɫɩɨɥɶɡɭɟɦɵɣɩɪɢɩɪɨɢɡɜɨɞɫɬɜɟ ɩɪɨɛɢɨɬɢɤɨɜ
Ȼ ɤ ɩɚɬɨɝɟɧɧɵɦ ɷɲɟɪɢɯɢɹɦ ɨɬɧɨɫɹɬɫɹ ɜɨɡɛɭɞɢɬɟɥɢ ɩɚɪɟɧɬɟɪɚɥɶɧɵɯ ɷɲɟɪɢɯɢɨɡɨɜ ɢɥɢ ɷɤɫɬɪɚɢɧɬɟɫɬɢɧɚɥɶɧɵɟ ɩɚɬɨɝɟɧɧɵɟ ɷɲɟɪɢɯɢɢ Extraintestinal pathogenic E. coli – ɜɨɡɛɭɞɢɬɟɥɢ ɜɧɟɤɢɲɟɱɧɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɢ ɞɢɚɪɟɟɝɟɧɧɵɟ ɢɧ ɬɟɫɬɢɧɚɥɶɧɵɟ ɷɲɟɪɢɯɢɢ Diarheagenic E. coli – ɜɨɡɛɭɞɢɬɟɥɢ ɨɫɬɪɵɯ ɤɢɲɟɱɧɵɯ ɢɧɮɟɤɰɢɣ ɉɚɬɨɝɟɧɧɵɟ ɷɲɟɪɢɯɢɢ ɢɦɟɸɬ ɷɤɡɨɝɟɧɧɨɟ ɩɪɨɢɫɯɨɠɞɟɧɢɟ Ʉ ɜɨɡɛɭ ɞɢɬɟɥɹɦ ɩɚɪɟɧɬɟɪɚɥɶɧɵɯ ɷɲɟɪɢɯɢɨɡɨɜ ɨɬɧɨɫɹɬɫɹ ɭɪɨɩɚɬɨɝɟɧɧɵɟ ɷɲɟɪɢɯɢɢ (UPEC – 8URSDWKRJHQLF ( FROL ɷɲɟɪɢɯɢɢ ɜɵɡɵɜɚɸɳɢɟ ɦɟɧɢɧɝɢɬɵ ɧɨɜɨɪɨɠɞɟɧ ɧɵɯ 10(& – Neonatal Meningitis E. colL ɚɫɫɨɰɢɢɪɨɜɚɧɧɵɟ ɫ ɫɟɩɫɢɫɨɦ ɩɚɬɨɝɟɧ ɧɵɟ ɷɲɟɪɢɯɢɢ 6H3(& – Sepsis associated pathogenic E. coli).
ȼ ɞɢɚɪɟɟɝɟɧɧɵɟ ɷɲɟɪɢɯɢɢ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɧɚɥɢɱɢɹ ɬɟɯ ɢɥɢ ɢɧɵɯ ɮɚɤ ɬɨɪɨɜ ɩɚɬɨɝɟɧɧɨɫɬɢ ɢ ɩɚɬɨɝɟɧɟɬɢɱɟɫɤɢɯ ɨɫɨɛɟɧɧɨɫɬɟɣ ɡɚɛɨɥɟɜɚɧɢɹ ɩɨɞɪɚɡɞɟɥɹ ɸɬɫɹ ɧɚ ɫɥɟɞɭɸɳɢɟ ɝɪɭɩɩɵ ɷɧɬɟɪɨɬɨɤɫɢɝɟɧɧɵɟ ( ɫROL ɷɧɬɟɪɨɢɧɜɚɡɢɜɧɵɟ ( ɋROL ɷɧɬɟɪɨɩɚɬɨɝɟɧɧɵɟ ( ɫROL ɷɧɬɟɪɨɝɟɦɨɪɪɚɝɢɱɟɫɤɢɟ ( ɋROL ɷɧɬɟɪɨɚɝ ɪɟɝɚɬɢɜɧɵɟ ɤɢɲɟɱɧɵɟ ɩɚɥɨɱɤɢ ɞɢɮɮɭɡɧɨ-ɚɞɝɟɪɟɧɬɧɵɟ ɤɢɲɟɱɧɵɟ ɩɚɥɨɱɤɢ. Ɇɟɯɚɧɢɡɦ ɪɚɡɜɢɬɢɹ ɡɚɛɨɥɟɜɚɧɢɹ ɩɨɩɚɞɚɧɢɟ ɜɨɡɛɭɞɢɬɟɥɹ ɱɟɪɟɡ ɪɨɬ ɞɚɥɟɟ ɤɨ ɥɨɧɢɡɚɰɢɹ ɫɥɢɡɢɫɬɨɣ ɤɢɲɟɱɧɢɤɚ ȼɵɪɚɛɨɬɤɚ ɬɨɤɫɢɧɨɜ ɝɢɩɟɪɫɟɤɪɟɰɢɹ ɠɢɞɤɨ ɫɬɢ ɞɢɚɪɟɹ ɂɧɜɚɡɢɜɧɵɟɮɨɪɦɵ 6KLJHOOD (,(& ɪɚɡɪɭɲɚɸɬɷɩɢɬɟɥɢɣ ɜɵɡɵɜɚɹ ɜɨɫɩɚɥɟɧɢɟ ɢ ɤɪɨɜɚɜɵɣ ɩɨɧɨɫ. Ɍɹɠɟɥɵɟ ɨɫɥɨɠɧɟɧɢɹ ɫɟɩɫɢɫ ɬɨɤɫɢɱɟɫɤɢɣ ɲɨɤ
ɄɅɂɇɂɑȿɋɄȺə ɄȺɊɌɂɇȺ. ɗɧɬɟɪɨɬɨɤɫɢɝɟɧɧɵɟ ɤɨɥɢɷɧɬɟɪɢɬɵ
(ETEC) – ɜɨɞɹɧɢɫɬɚɹ ɞɢɚɪɟɹ ɪɜɨɬɚ ɩɨɯɨɠɢ ɧɚ ɯɨɥɟɪɭ ɗɧɬɟɪɨɢɧɜɚɡɢɜɧɵɟ ɤɨ
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ɥɢɷɧɬɟɪɢɬɵ (EIEC, Shigella) – ɤɪɨɜɚɜɚɹ ɞɢɚɪɟɹ ɬɟɧɟɡɦɵ ɥɢɯɨɪɚɞɤɚ; ɗɧɬɟɪɨɝɟ ɦɨɪɪɚɝɢɱɟɫɤɢɟ ɤɨɥɢɷɧɬɟɪɢɬɵ (EHEC, shiga-toxin) – ɝɟɦɨɤɨɥɢɬ Ƚɍɋ ɩɨɱɟɱɧɚɹ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶ.
ɆȿɌɈȾɕȾɂȺȽɇɈɋɌɂɄɂ.Ȼɚɤɬɟɪɢɨɥɨɝɢɱɟɫɤɢɣ ɩɨɫɟɜɤɚɥɚɧɚɫɪɟɞɵ ɗɧɞɨ Ʌɟɜɢɧɚ ɜɢɫɦɭɬ-ɫɭɥɶɮɢɬɧɵɣ ɚɝɚɪ Ɉɩɪɟɞɟɥɟɧɢɟ ɮɟɪɦɟɧɬɚɰɢɢ ɫɚɯɚɪɨɜ ɫɟ ɪɨɥɨɝɢɱɟɫɤɚɹ ɢɞɟɧɬɢɮɢɤɚɰɢɹ Ȼɚɤɬɟɪɢɨɫɤɨɩɢɱɟɫɤɢɣ Ɉɤɪɚɫɤɚ ɩɨ Ƚɪɚɦɭ ɝɪɚ ɦɨɬɪɢɰɚɬɟɥɶɧɵɟ ɩɚɥɨɱɤɢ . ɋɟɪɨɥɨɝɢɱɟɫɤɢɣ ɪɟɚɤɰɢɹ ɚɝɝɥɸɬɢɧɚɰɢɢ ɊɇȽȺ ɫ Ɉ- ɢ +-ɚɧɬɢɝɟɧɚɦɢ ɂɎȺ ɧɚ ɷɧɬɟɪɨɬɨɤɫɢɧɵ ( Coli. Ɇɨɥɟɤɭɥɹɪɧɨ-ɛɢɨɥɨɝɢɱɟ ɫɤɢɣ ɉɐɊ ɧɚ ɝɟɧɵ ɬɨɤɫɢɧɨɜ /7 67 VKLJD WR[LQ
Ʌȿɑȿɇɂȿ Ɋɟɝɢɞɪɚɬɚɰɢɹ ɨɪɚɥɶɧɵɟ ɪɚɫɬɜɨɪɵ ɩɪɢ ɬɹɠɟɥɵɯ ɫɥɭɱɚɹɯ – ɜɧɭɬɪɢɜɟɧɧɨ Ⱥɧɬɢɛɢɨɬɢɤɢ ɩɪɢ ɬɹɠɟɥɨɦ ɬɟɱɟɧɢɢ 6KLJHOOD ɮɬɨɪɯɢɧɨɥɨɧɵ ɰɢ ɩɪɨɮɥɨɤɫɚɰɢɧ ɚɡɢɬɪɨɦɢɰɢɧ 6DOPRQHOOD ɢɧɜɚɡɢɜɧɵɟ ɮɨɪɦɵ ɰɟɮɚɥɨɫɩɨɪɢɧɵ
,,, ɩɨɤɨɥɟɧɢɹ ( FROL (,(& (+(& ɫɩɨɪɧɨ ɬɚɤ ɤɚɤ ɚɧɬɢɛɢɨɬɢɤɢ ɦɨɝɭɬ ɭɫɢɥɢɬɶ ɜɵɛɪɨɫ ɬɨɤɫɢɧɚ, <HUVLQLD ɞɨɤɫɢɰɢɤɥɢɧ ɰɟɮɚɥɨɫɩɨɪɢɧɵ
ɉɊɈɎɂɅȺɄɌɂɄȺ. ɋɩɟɰɢɮɢɱɟɫɤɚɹ ɜɚɤɰɢɧɵ ɪɚɡɪɚɛɚɬɵɜɚɸɬɫɹ ɨɫɨ ɛɟɧɧɨ ɩɪɨɬɢɜ 6KLJHOOD ɢ ( FROL . ɇɟɫɩɟɰɢɮɢɱɟɫɤɚɹ: ɫɚɧɢɬɚɪɧɵɣ ɤɨɧɬɪɨɥɶ ɜɨɞɵ ɢ ɩɢɳɢ Ʌɢɱɧɚɹ ɝɢɝɢɟɧɚ ɦɵɬɶɟ ɪɭɤ ɨɛɪɚɛɨɬɤɚ ɩɪɨɞɭɤɬɨɜ ɋɨɛɥɸɞɟɧɢɟ ɫɚɧɢ ɬɚɪɧɵɯ ɧɨɪɦ ɜ ɛɨɥɶɧɢɰɚɯ ɢ ɞɟɬɫɤɢɯ ɭɱɪɟɠɞɟɧɢɹɯ
ɂɆɆɍɇɂɌȿɌ ɉɨɫɥɟɡɚɛɨɥɟɜɚɧɢɹ ɜɵɡɜɚɧɧɨɝɨɩɚɬɨɝɟɧɧɵɦɢɲɬɚɦɦɚɦɢɤɢ ɲɟɱɧɨɣɩɚɥɨɱɤɢ ɪɚɡɜɢɜɚɟɬɫɹɧɟɧɚɩɪɹɠɟɧɧɵɣ ɫɟɪɨɜɚɪɨɫɩɟɰɢɮɢɱɟɫɤɢɣɢɦɦɭɧɢɬɟɬ
3.2. ȾɂɁȿɇɌȿɊɂə
ɄɅȺɋɋɂɎɂɄȺɐɂə ɩɨɪɹɞɨɤ (QWHUREDFWHUDOHV ɫɟɦɟɣɫɬɜɨ (QWHUREDFWHULDFHDH ɪɨɞ 6KLJHOOD ɜɢɞ 6 G\VHQWHULDH 6 IOH[QHUL 6 ER\GLL 6 VRQQHL
ɆɈɊɎɈɅɈȽɂɑȿɋɄɂȿ ɂ ɌɂɇɄɌɈɊɂȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ. ɒɢ ɝɟɥɥɵ ɩɪɟɞɫɬɚɜɥɹɸɬ ɫɨɛɨɣ ɩɪɹɦɵɟ ɩɚɥɨɱɤɢ ɫ ɡɚɤɪɭɝɥɟɧɧɵɦɢ ɤɨɧɰɚɦɢ ɪɚɡɦɟɪɨɦ 0,5–0,7×2– ɦɤɦ ɒɢɝɟɥɥɵ ɝɪɚɦɨɬɪɢɰɚɬɟɥɶɧɵɟ - ɨɤɪɚɲɢɜɚɸɬɫɹ ɜ ɤɪɚɫɧɵɣ ɰɜɟɬ ɩɪɢ ɢɫɩɨɥɶɡɨɜɚɧɢɢ ɦɟɬɨɞɚ Ƚɪɚɦɚ ɇɟɩɨɞɜɢɠɧɵɟ ɨɬɫɭɬɫɬɜɭɸɬ ɠɝɭɬɢɤɢ ɂɦɟɸɬ ɩɢɥɢ ɋɩɨɪ ɢ ɤɚɩɫɭɥ ɧɟ ɨɛɪɚɡɭɸɬ Ɇɨɝɭɬ ɮɨɪɦɢɪɨɜɚɬɶ ɦɢɤɪɨɤɚɩɫɭɥɭ ȼ ɦɚɡɤɚɯ ɪɚɫɩɨɥɚɝɚɸɬɫɹ ɛɟɫɩɨɪɹɞɨɱɧɨ ɨɞɢɧɨɱɧɨ
ɄɍɅɖɌɍɊȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ ɒɢɝɟɥɥɵ ɹɜɥɹɸɬɫɹ ɮɚɤɭɥɶɬɚɬɢɜ ɧɵɦɢ ɚɧɚɷɪɨɛɚɦɢ ɯɨɪɨɲɨ ɪɚɫɬɭɬ ɧɚ ɨɛɵɱɧɵɯ ɩɢɬɚɬɟɥɶɧɵɯ ɫɪɟɞɚɯ ɩɪɢ & ɇɚ ɫɪɟɞɟ ɗɧɞɨ ɨɛɪɚɡɭɸɬ ɛɥɟɞɧɨ-ɪɨɡɨɜɵɟ ɤɨɥɨɧɢɢ ɢɡ-ɡɚ ɨɬɫɭɬɫɬɜɢɹ ɮɟɪɦɟɧɬɚɰɢɢ ɥɚɤɬɨɡɵ ɧɚ ɫɪɟɞɟ ɉɥɨɫɤɢɪɟɜɚ – ɛɟɫɰɜɟɬɧɵɟ ɤɨɥɨɧɢɢ Ɉɩɬɢɦɚɥɶɧɚɹ ɬɟɦɩɟɪɚɬɭɪɚ ɪɨɫɬɚ – 37 °ɋ ɪɇ – 6,7– ɇɚ ɩɥɨɬɧɵɯ ɫɪɟɞɚɯ ɲɢɝɟɥɥɵ ɨɛɪɚɡɭɸɬ ɤɨɥɨɧɢɢ
36
S-ɮɨɪɦɵ 6 VRQQHLɦɨɠɟɬɮɨɪɦɢɪɨɜɚɬɶɤɨɥɨɧɢɢ R-ɮɨɪɦɵ Ʉɨɥɨɧɢɢ6-ɮɨɪɦɵ ɹɜ ɥɹɸɬɫɹ ɦɟɥɤɢɦɢ ɝɥɚɞɤɢɦɢ ɛɥɟɫɬɹɳɢɦɢ ɩɨɥɭɩɪɨɡɪɚɱɧɵɦɢ ɤɭɩɨɥɨɨɛɪɚɡɧɵɦɢ Ʉɨɥɨɧɢɢ 5-ɮɨɪɦɵ – ɩɥɨɫɤɢɟ ɬɭɫɤɥɵɟ ɫ ɲɟɪɨɯɨɜɚɬɨɣ ɩɨɜɟɪɯɧɨɫɬɶɸ ɢ ɢɡɪɟɡɚɧ ɧɵɦɢ ɤɪɚɹɦɢ ɇɚ ɤɪɨɜɹɧɨɦ ɚɝɚɪɟ ɲɢɝɟɥɥɵ ɨɛɪɚɡɭɸɬ ɝɥɚɞɤɢɟ ɤɨɥɨɧɢɢ ɛɟɡ ɡɨɧɵ ɝɟɦɨɥɢɡɚ
ȺɇɌɂȽȿɇɇȺə ɋɌɊɍɄɌɍɊȺ Ɉɛɥɚɞɚɸɬ 2-ɚɧɬɢɝɟɧɚɦɢ ɤɨɬɨɪɵɟ ɨɩɪɟ ɞɟɥɹɸɬ ɫɟɪɨɝɪɭɩɩɭ ɚ ɬɚɤɠɟ ɢɦɟɸɬ ɪɨɞɨɫɩɟɰɢɮɢɱɟɫɤɢɣ ɛɟɥɤɨɜɵɣ ɚɧɬɢɝɟɧ
ɎȺɄɌɈɊɕ ɉȺɌɈȽȿɇɇɈɋɌɂ ɗɧɞɨɬɨɤɫɢɧ ɥɢɩɨɩɨɥɢɫɚɯɚɪɢɞ ɤɥɟɬɨɱ ɧɨɣ ɫɬɟɧɤɢ – ɜɵɡɵɜɚɟɬ ɥɢɯɨɪɚɞɤɭ ɢ ɜɨɫɩɚɥɟɧɢɟ ɒɢɝɚ-ɬɨɤɫɢɧ ɭ 6 G\VHQWHULDe) – ɩɨɜɪɟɠɞɚɟɬ ɤɢɲɟɱɧɵɣ ɷɩɢɬɟɥɢɣ ɢ ɜɵɡɵɜɚɟɬ ɝɟɦɨɥɢɬɢɤɨ-ɭɪɟɦɢɱɟɫɤɢɣ ɫɢɧɞɪɨɦ ɂɧɜɚɡɢɧɵ – ɩɨɦɨɝɚɸɬ ɛɚɤɬɟɪɢɹɦ ɩɪɨɧɢɤɚɬɶ ɜ ɤɥɟɬɤɢ ɤɢɲɟɱɧɨɝɨ ɷɩɢɬɟɥɢɹ Ȼɟɥɤɢ ɫɟɤɪɟɰɢɢ ,,, ɬɢɩɚ – ɫɩɨɫɨɛɫɬɜɭɸɬ ɜɧɭɬɪɢɤɥɟɬɨɱɧɨɦɭ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɸ
ɊȿɁɂɋɌȿɇɌɇɈɋɌɖ ȼɨ ɜɧɟɲɧɟɣ ɫɪɟɞɟ ɢ ɧɚ ɩɪɟɞɦɟɬɚɯ ɨɛɢɯɨɞɚ ɲɢ ɝɟɥɥɵ ɜɵɠɢɜɚɸɬ ɨɬ ɧɟɫɤɨɥɶɤɢɯ ɞɧɟɣ ɞɨ ɧɟɫɤɨɥɶɤɢɯ ɦɟɫɹɰɟɜ Ɉɧɢ ɯɨɪɨɲɨ ɩɟɪɟ ɧɨɫɹɬ ɜɵɫɭɲɢɜɚɧɢɟ ɢ ɧɢɡɤɢɟ ɬɟɦɩɟɪɚɬɭɪɵ ɧɨ ɛɵɫɬɪɨ ɩɨɝɢɛɚɸɬ ɩɨɞ ɜɨɡɞɟɣ ɫɬɜɢɟɦɩɪɹɦɵɯɫɨɥɧɟɱɧɵɯɥɭɱɟɣɢɩɪɢɧɚɝɪɟɜɚɧɢɢ ɉɪɹɦɵɟɫɨɥɧɟɱɧɵɟɥɭɱɢɭɛɢ ɜɚɸɬ ɛɚɤɬɟɪɢɢ ɜ ɬɟɱɟɧɢɟ ɦɢɧɭɬ ɉɪɢ ɬɟɦɩɟɪɚɬɭɪɟ ɋ ɲɢɝɟɥɥɵ ɩɨɝɢɛɚɸɬ ɱɟɪɟɡ ɦɢɧɭɬ ɩɪɢ ɋ – ɦɝɧɨɜɟɧɧɨ ɇɚ ɯɥɨɩɱɚɬɨɛɭɦɚɠɧɨɣ ɬɤɚɧɢ ɨɧɢ ɜɵɠɢ ɜɚɸɬ ɜ ɬɟɱɟɧɢɟ – ɞɧɟɣ ȼ ɩɪɨɛɚɯ ɮɟɤɚɥɢɣ ɲɢɝɟɥɥɵ ɫɨɯɪɚɧɹɸɬɫɹ ɧɟ ɛɨɥɟɟ 6– ɱɚɫɨɜ ɜ ɜɵɫɨɯɲɢɯ ɢɫɩɪɚɠɧɟɧɢɹɯ – ɞɨ – ɦɟɫɹɰɟɜ
ɗɉɂȾȿɆɂɈɅɈȽɂə ɂɫɬɨɱɧɢɤ ɢɧɮɟɤɰɢɢ – ɛɨɥɶɧɨɣ ɱɟɥɨɜɟɤ ɢɥɢ ɛɚɤɬɟ ɪɢɨɧɨɫɢɬɟɥɶ ɉɭɬɢ ɩɟɪɟɞɚɱɢ – ɮɟɤɚɥɶɧɨ-ɨɪɚɥɶɧɵɣ ɱɟɪɟɡ ɜɨɞɭ ɩɢɳɭ ɝɪɹɡɧɵɟ ɪɭɤɢ ȼɫɩɵɲɤɢ ɱɚɳɟ ɫɥɭɱɚɸɬɫɹ ɜ ɬɟɩɥɨɟ ɜɪɟɦɹ ɝɨɞɚ
ɉȺɌɈȽȿɇȿɁ. ɒɢɝɟɥɥɵ ɩɪɨɧɢɤɧɭɜ ɜ ɨɪɝɚɧɢɡɦ ɱɟɪɟɡ ɪɨɬ ɱɚɫɬɢɱɧɨ ɪɚɡ ɪɭɲɚɸɬɫɹ ɜ ɠɟɥɭɞɤɟ ɫ ɜɵɫɜɨɛɨɠɞɟɧɢɟɦ ɷɧɞɨɬɨɤɫɢɧɚ Ɉɫɬɚɜɲɢɟɫɹ ɜ ɠɢɜɵɯ ɛɚɤ ɬɟɪɢɢ ɞɨɫɬɢɝɚɸɬ ɬɨɥɫɬɨɝɨ ɤɢɲɟɱɧɢɤɚ ɝɞɟ ɤɨɥɨɧɢɡɢɪɭɸɬ ɫɥɢɡɢɫɬɭɸ ɨɛɨɥɨɱɤɭ ɗɬɨɦɭ ɫɩɨɫɨɛɫɬɜɭɸɬ ɩɢɥɢ ɦɢɤɪɨɤɚɩɫɭɥɚ ɮɟɪɦɟɧɬɵ ɚɝɪɟɫɫɢɢ ɲɢɝɟɥɥ ɦɭɰɢ ɧɚɡɚ ɧɟɣɪɚɦɢɧɢɞɚɡɚ ɝɢɚɥɭɪɨɧɢɞɚɡɚ Ɉɫɧɨɜɧɨɣ ɩɚɬɨɥɨɝɢɱɟɫɤɢɣ ɩɪɨɰɟɫɫ ɩɪɢ ɲɢɝɟɥɥɟɡɚɯ ɪɚɡɜɢɜɚɟɬɫɹ ɜ ɞɢɫɬɚɥɶɧɨɦ ɨɬɞɟɥɟ ɬɨɥɫɬɨɝɨ ɤɢɲɟɱɧɢɤɚ – ɜ ɫɢɝɦɨɜɢɞ ɧɨɣ ɢ ɩɪɹɦɨɣ ɤɢɲɤɚɯ ȼ ɬɨɥɫɬɨɣ ɤɢɲɤɟ ɲɢɝɟɥɥɵ ɩɪɢɤɪɟɩɥɹɸɬɫɹ ɤ Ɇ-ɤɥɟɬɤɚɦ ɢ ɩɪɨɧɢɤɚɸɬ ɜ ɧɢɯ ɩɭɬɟɦ ɷɧɞɨɰɢɬɨɡɚ ɉɪɢ ɷɬɨɦ ɲɢɝɟɥɥɚ ɜɵɡɵɜɚɟɬ ɨɛɪɚɡɨɜɚɧɢɟ ɧɚ ɩɥɚɡɦɚɬɢɱɟɫɤɨɣ ɦɟɦɛɪɚɧɟ ɷɩɢɬɟɥɢɚɥɶɧɨɣ ɤɥɟɬɤɢ ɦɚɤɪɨɩɢɧɨɰɢɬɨɡɧɵɯ ɹɦɨɤ Ɋɚɡ ɜɢɬɢɟ ɜɨɫɩɚɥɟɧɢɹ ɨɛɪɚɡɨɜɚɧɢɟ ɹɡɜ ɢ ɷɪɨɡɢɣ ȼɵɞɟɥɟɧɢɟ ɬɨɤɫɢɧɨɜ ɞɢɚɪɟɹ ɢɧ ɬɨɤɫɢɤɚɰɢɹ ɝɟɦɨɥɢɬɢɤɨ-ɭɪɟɦɢɱɟɫɤɢɣ ɫɢɧɞɪɨɦ
37
ɄɅɂɇɂɑȿɋɄȺə ɄȺɊɌɂɇȺ ɂɧɤɭɛɚɰɢɨɧɧɵɣ ɩɟɪɢɨɞ – ɞɧɟɣ ɋɢɦɩ ɬɨɦɵ ɥɢɯɨɪɚɞɤɚ ɫɥɚɛɨɫɬɶ Ɍɟɧɟɡɦɵ ɛɨɥɟɡɧɟɧɧɵɟ ɩɨɡɵɜɵ ɧɚ ɞɟɮɟɤɚɰɢɸ ɀɢɞ ɤɢɣ ɫɬɭɥ ɫ ɩɪɢɦɟɫɶɸ ɫɥɢɡɢ ɢ ɤɪɨɜɢ Ȼɨɥɢ ɜɧɢɡɭ ɠɢɜɨɬɚ ɉɪɢ ɬɹɠɟɥɵɯ ɮɨɪɦɚɯ ɜɨɡɦɨɠɧɵ ɨɫɥɨɠɧɟɧɢɹ ɩɟɪɢɬɨɧɢɬ ɬɨɤɫɢɱɟɫɤɢɣ ɲɨɤ ɩɨɪɚɠɟɧɢɟ ɐɇɋ
ɆȿɌɈȾɕ ȾɂȺȽɇɈɋɌɂɄɂ Ȼɚɤɬɟɪɢɨɥɨɝɢɱɟɫɤɢɣ ɩɨɫɟɜ ɤɚɥɚ ɧɚ ɞɢɮ ɮɟɪɟɧɰɢɚɥɶɧɵɟ ɩɢɬɚɬɟɥɶɧɵɟ ɫɪɟɞɵ ɗɧɞɨ ɉɥɨɫɤɢɪɟɜɚ Ʌɟɜɢɧɚ Ȼɚɤɬɟɪɢɨɫɤɨ ɩɢɱɟɫɤɢɣ Ɉɤɪɚɲɢɜɚɧɢɟ ɦɚɡɤɨɜ ɩɨ Ƚɪɚɦɭ ɝɪɚɦɨɬɪɢɰɚɬɟɥɶɧɵɟ ɩɚɥɨɱɤɢ ɋɟɪɨ ɥɨɝɢɱɟɫɤɢɣ ɊɇȽȺ ɪɟɚɤɰɢɹ ɧɟɩɪɹɦɨɣ ɝɟɦɚɝɝɥɸɬɢɧɚɰɢɢ ɂɎȺ ɢɦɦɭɧɨɮɟɪ ɦɟɧɬɧɵɣ ɚɧɚɥɢɡ ɞɥɹ ɜɵɹɜɥɟɧɢɹ ɚɧɬɢɬɟɥ Ɇɨɥɟɤɭɥɹɪɧɨ-ɛɢɨɥɨɝɢɱɟɫɤɢɣ ɉɐɊɩɨɥɢɦɟɪɚɡɧɚɹ ɰɟɩɧɚɹ ɪɟɚɤɰɢɹ ɞɥɹ ɜɵɹɜɥɟɧɢɹ ȾɇɄ 6KLJHOOD
Ʌȿɑȿɇɂȿ Ⱥɧɬɢɛɚɤɬɟɪɢɚɥɶɧɚɹ ɬɟɪɚɩɢɹ Ɏɬɨɪɯɢɧɨɥɨɧɵ ɰɢɩɪɨɮɥɨɤɫɚ ɰɢɧ Ⱥɡɢɬɪɨɦɢɰɢɧ ɩɪɢ ɭɫɬɨɣɱɢɜɨɫɬɢ ɤ ɞɪɭɝɢɦ ɩɪɟɩɚɪɚɬɚɦ Ɋɟɝɢɞɪɚɬɚɰɢɹ ɨɪɚɥɶɧɵɟ ɫɨɥɟɜɵɟ ɪɚɫɬɜɨɪɵ ɜɧɭɬɪɢɜɟɧɧɵɟ ɢɧɮɭɡɢɢ ɩɪɢ ɬɹɠɟɥɨɦ ɨɛɟɡɜɨɠɢɜɚ ɧɢɢ ɋɢɦɩɬɨɦɚɬɢɱɟɫɤɨɟ ɥɟɱɟɧɢɟ ɫɩɚɡɦɨɥɢɬɢɤɢ ɫɨɪɛɟɧɬɵ ɷɧɬɟɪɨɫɝɟɥɶ ɚɤɬɢɜɢ ɪɨɜɚɧɧɵɣ ɭɝɨɥɶ
ɉɊɈɎɂɅȺɄɌɂɄȺ ɋɩɟɰɢɮɢɱɟɫɤɚɹ ɜɚɤɰɢɧɚɰɢɹ ɧɟ ɲɢɪɨɤɨ ɢɫɩɨɥɶɡɭ ɟɬɫɹ ɧɨ ɜɟɞɭɬɫɹ ɪɚɡɪɚɛɨɬɤɢ ɨɪɚɥɶɧɵɯ ɜɚɤɰɢɧ ɇɟɫɩɟɰɢɮɢɱɟɫɤɚɹ ɫɨɛɥɸɞɟɧɢɟ ɝɢɝɢɟɧɵ ɪɭɤ Ȼɟɡɨɩɚɫɧɨɫɬɶ ɜɨɞɵ ɢ ɩɪɨɞɭɤɬɨɜ ɩɢɬɚɧɢɹ Ʉɨɧɬɪɨɥɶ ɡɚ ɛɨɥɶɧɵɦɢ ɢ ɛɚɤɬɟɪɢɨɧɨɫɢɬɟɥɹɦɢ
ɂɆɆɍɇɂɌȿɌ ȼ ɡɚɳɢɬɟ ɨɬ ɲɢɝɟɥɥɟɡɧɨɣ ɢɧɮɟɤɰɢɢ ɨɫɧɨɜɧɚɹ ɪɨɥɶ ɩɪɢ ɧɚɞɥɟɠɢɬ ɮɚɤɬɨɪɚɦ ɦɟɫɬɧɨɝɨ ɢɦɦɭɧɢɬɟɬɚ ɫɥɢɡɢɫɬɨɣ ɤɢɲɟɱɧɢɤɚ ɫɟɤɪɟɬɨɪɧɵɦ ,J$ Ɍ-ɥɢɦɮɨɰɢɬɚɦ ɧɟɣɬɪɨɮɢɥɚɦ ɗɬɢ ɮɚɤɬɨɪɵ ɩɪɟɩɹɬɫɬɜɭɸɬ ɚɞɝɟɡɢɢ ɲɢɝɟɥɥ ɧɚ ɷɧɬɟɪɨɰɢɬɚɯ ɢ ɫɩɨɫɨɛɫɬɜɭɸɬ ɢɯ ɭɧɢɱɬɨɠɟɧɢɸ ɂɫɫɥɟɞɨɜɚɧɢɹ ɩɨɫɥɟɞɧɢɯ ɥɟɬ ɩɨɤɚɡɚɥɢ ɱɬɨ ɧɟɣɬɪɨɮɢɥɵ «ɜɵɛɪɚɫɵɜɚɸɬ» ɫɟɬɟɜɢɞɧɵɟ ɨɛɪɚɡɨɜɚɧɢɹ ɜ ɤɨɬɨɪɵɯ ɡɚɞɟɪɠɢɜɚɸɬɫɹ ɢ ɩɨɝɢɛɚɸɬ ɦɢɤɪɨɨɪɝɚɧɢɡɦɵ ɗɬɢ ɧɨɜɵɟ ɫɬɪɭɤɬɭɪɵ ɩɨɥɭɱɢɥɢ ɧɚɡɜɚɧɢɟɧɟɣɬɪɨɮɢɥɶɧɵɯɷɤɫɬɪɚɰɟɥɥɸɥɹɪɧɵɯɥɨɜɭɲɟɤ – ɇɗɅ ɉɨɫɥɟɩɟɪɟɧɟɫɟɧ ɧɨɝɨ ɡɚɛɨɥɟɜɚɧɢɹ ɮɨɪɦɢɪɭɟɬɫɹ ɧɟɩɪɨɞɨɥɠɢɬɟɥɶɧɵɣ ɜɢɞɨ- ɢ ɬɢɩɨɫɩɟɰɢɮɢɱɟɫɤɢɣ ɢɦɦɭɧɢɬɟɬ ȼɨɡɦɨɠɧɵ ɩɨɜɬɨɪɧɵɟ ɡɚɛɨɥɟɜɚɧɢɹ
3.3. ȻɊɘɒɇɈɃ ɌɂɎ ɂ ɉȺɊȺɌɂɎ Ⱥ ɢ ȼ
ɄɅȺɋɋɂɎɂɄȺɐɂə ɩɨɪɹɞɨɤ (QWHUREDFWHUDOHV ɫɟɦɟɣɫɬɜɨ (QWHUREDFWHULDFHDH ɪɨɞ 6DOPRQHOOD ɜɢɞ 6 7\SKL – ɜɨɡɛɭɞɢɬɟɥɶ ɛɪɸɲɧɨɝɨ ɬɢɮɚ S. Paratyphi A – ɜɨɡɛɭɞɢɬɟɥɶ ɩɚɪɚɬɢɮɚ Ⱥ 6 3DUDW\SKL % – ɜɨɡɛɭɞɢɬɟɥɶ ɩɚɪɚɬɢɮɚ ȼ
ɆɈɊɎɈɅɈȽɂə ɂ ɌɂɇɄɌɈɊɂȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ ɋɚɥɶɦɨɧɟɥɥɵ ɩɪɟɞɫɬɚɜɥɹɸɬ ɫɨɛɨɣ ɤɨɪɨɬɤɢɟ ɝɪɚɦɨɬɪɢɰɚɬɟɥɶɧɵɟ ɩɚɥɨɱɤɢ ɫ ɡɚɤɪɭɝɥɟɧɧɵɦɢ ɤɨɧɰɚɦɢ ɪɚɡɦɟɪɨɦ –1,5×2– ɦɤɦ ɇɚ ɩɨɜɟɪɯɧɨɫɬɢ ɫɚɥɶɦɨɧɟɥɥ ɪɚɫɩɨɥɚɝɚɸɬɫɹ
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ɩɢɥɢ ɜɨɪɫɢɧɤɢ ɮɢɦɛɪɢɢ ɫɥɭɠɚɳɢɟ ɞɥɹ ɚɞɝɟɡɢɢ ɛɚɤɬɟɪɢɣ ɤ ɤɥɟɬɤɚɦ ɦɚɤɪɨɨɪ ɝɚɧɢɡɦɚ ɋɚɥɶɦɨɧɟɥɥɵ ɩɨɞɜɢɠɧɵ ɡɚ ɫɱɟɬ ɩɟɪɢɬɪɢɯɢɚɥɶɧɨ ɪɚɫɩɨɥɨɠɟɧɧɵɯ ɠɝɭ ɬɢɤɨɜ ɋɚɥɶɦɨɧɟɥɥɵ ɢɦɟɸɬ ɧɟɫɤɨɥɶɤɨ ɪɚɡɥɢɱɧɵɯ ɤɥɚɫɫɨɜ ɮɢɦɛɪɢɣ ɜ ɬɨɦ ɱɢɫɥɟ ɞɥɢɧɧɵɟ ɩɨɥɹɪɧɵɟ ɢɥɢ ɩɨɥɸɫɧɵɟ ɮɢɦɛɪɢɢ /SI ɬɨɧɤɢɟ ɮɢɦɛɪɢɢ 3HI ɢ ɮɢɦɛɪɢɢ )LP Ʉɚɠɞɵɣ ɤɥɚɫɫ ɮɢɦɛɪɢɣ ɨɛɟɫɩɟɱɢɜɚɟɬ ɩɪɢɤɪɟɩɥɟɧɢɟ ɫɚɥɶɦɨɧɟɥɥ ɤ ɪɚɡɧɵɦ ɜɢɞɚɦ ɤɥɟɬɨɤ ɦɚɤɪɨɨɪɝɚɧɢɡɦɚ ɋɚɥɶɦɨɧɟɥɥɵ ɧɟ ɨɛɪɚɡɭɸɬ ɫɩɨɪ ɇɟɤɨɬɨɪɵɟ ɜɢɞɵ ɫɚɥɶɦɨɧɟɥɥ ɜ ɱɚɫɬɧɨɫɬɢ 6 W\SKL ɢ 6 SDUDW\SKL & ɢɦɟɸɬ ɦɢɤɪɨɤɚɩɫɭɥɭ Ɉɤɪɚ ɲɢɜɚɸɬɫɹ ɩɨȽɪɚɦɭ – ɝɪɚɦɨɬɪɢɰɚɬɟɥɶɧɵɟ ɂɫɩɨɥɶɡɭɟɬɫɹɨɤɪɚɫɤɚɩɨ ɐɢɥɸ-ɇɢɥɶ ɫɟɧɭ ɞɥɹ ɜɵɹɜɥɟɧɢɹ ɜɧɭɬɪɢɤɥɟɬɨɱɧɨɝɨ ɪɚɫɩɨɥɨɠɟɧɢɹ
ɄɍɅɖɌɍɊȺɅɖɇɕȿ ɋȼɈɃɋɌȼȺ ɋɚɥɶɦɨɧɟɥɥɵ ɹɜɥɹɸɬɫɹ ɮɚɤɭɥɶɬɚɬɢɜ ɧɵɦɢ ɚɧɚɷɪɨɛɚɦɢ Ɉɧɢ ɯɨɪɨɲɨ ɪɚɫɬɭɬ ɜ ɚɷɪɨɛɧɵɯ ɭɫɥɨɜɢɹɯ ɧɚ ɩɪɨɫɬɵɯ ɩɢɬɚ ɬɟɥɶɧɵɯ ɫɪɟɞɚɯ ɩɪɢ ɬɟɦɩɟɪɚɬɭɪɟ ɨɬ qɋ ɞɨ qɋ ɢ ɪɇ – Ɉɩɬɢɦɚɥɶɧɚɹ ɬɟɦ ɩɟɪɚɬɭɪɚ ɞɥɹ ɪɨɫɬɚ ɫɚɥɶɦɨɧɟɥɥ ɪɚɜɧɚ 37 °ɋ ɇɚ ɆɉȺ ɫɚɥɶɦɨɧɟɥɥɵ ɨɛɪɚɡɭɸɬ ɫɟɪɨ-ɛɟɥɵɟ ɫɥɟɝɤɚ ɜɵɩɭɤɥɵɟ ɤɨɥɨɧɢɢ 5- ɢ 6-ɮɨɪɦɵ ɫ ɝɨɥɭɛɨɜɚɬɵɦ ɨɬɬɟɧɤɨɦ ɞɢɚɦɟɬɪɨɦ – ɦɦ ɇɚ ɫɪɟɞɟ ɉɥɨɫɤɢɪɟɜɚ – ɛɟɫɰɜɟɬɧɵɟ ɤɨɥɨɧɢɢ ɨɬɪɢɰɚɬɟɥɶɧɵɣ ɥɚɤɬɨɡɧɵɣ ɬɟɫɬ ɇɚ ɜɢɫɦɭɬ-ɫɭɥɶɮɢɬɧɨɦ ɚɝɚɪɟ – ɱɟɪɧɵɟ ɢɥɢ ɬɟɦɧɨ-ɤɨɪɢɱɧɟɜɵɟ ɤɨɥɨɧɢɢ
ȺɇɌɂȽȿɇɇȺəɋɌɊɍɄɌɍɊȺ Ɉ-ɚɧɬɢɝɟɧ ɫɨɦɚɬɢɱɟɫɤɢɣ – ɥɢɩɨɩɨɥɢɫɚ ɯɚɪɢɞ ɨɩɪɟɞɟɥɹɟɬ ɫɟɪɨɝɪɭɩɩɭ ɇ-ɚɧɬɢɝɟɧ ɠɝɭɬɢɤɨɜɵɣ – ɛɟɥɤɨɜɵɣ ɢɡɦɟɧɱɢ ɜɵɣ Vi-ɚɧɬɢɝɟɧ ɜɢɪɢɨɧɧɵɣ ɤɚɩɫɭɥɶɧɵɣ – ɜɫɬɪɟɱɚɟɬɫɹ ɭ 6 7\SKL ɨɩɪɟɞɟɥɹɟɬ ɜɢɪɭɥɟɧɬɧɨɫɬɶ
ɎȺɄɌɈɊɕ ɉȺɌɈȽȿɇɇɈɋɌɂ Ʉ ɮɚɤɬɨɪɚɦ ɩɚɬɨɝɟɧɧɨɫɬɢ ɫɚɥɶɦɨɧɟɥɥ ɨɬɧɨɫɹɬɫɹ ɬɨɤɫɢɧɵ ɩɢɥɢ ɛɟɥɤɢ ɧɚɪɭɠɧɨɣ ɦɟɦɛɪɚɧɵ ɪɟɡɢɫɬɟɧɬɧɨɫɬɶ ɤ ɮɚɝɨɰɢ ɬɨɡɭ ɢ 9L-ɚɧɬɢɝɟɧ ɋɚɥɶɦɨɧɟɥɥɵ ɪɚɡɧɵɯ ɜɢɞɨɜ ɢ ɩɨɞɜɢɞɨɜ ɨɛɥɚɞɚɸɬ ɪɚɡɧɵɦ ɧɚɛɨɪɨɦ ɬɨɤɫɢɧɨɜ ɗɧɞɨɬɨɤɫɢɧ ɜɵɞɟɥɹɟɬɫɹ ɩɪɢ ɪɚɡɪɭɲɟɧɢɢ ɛɚɤɬɟɪɢɚɥɶɧɨɣ ɤɥɟɬɤɢ ɐɢɬɨɬɨɤɫɢɧɵ ɲɢɝɚ-ɩɨɞɨɛɧɵɟ ɬɨɤɫɢɧɵ ɭɝɧɟɬɚɸɬ ɫɢɧɬɟɡ ɛɟɥɤɚ ɧɚ ɪɢ ɛɨɫɨɦɚɯ ɷɧɬɟɪɨɰɢɬɨɜ ɉɢɥɢ ɜɨɪɫɢɧɤɢ ɮɢɦɛɪɢɢ ɫɩɨɫɨɛɫɬɜɭɸɬ ɚɞɝɟɡɢɢ ɛɚɤɬɟ ɪɢɣ ɧɚ ɤɥɟɬɤɚɯ ɫɥɢɡɢɫɬɨɣ ɨɛɨɥɨɱɤɢ ɤɢɲɟɱɧɢɤɚ ɍ ɫɚɥɶɦɨɧɟɥɥ ɢɞɟɧɬɢɮɢɰɢɪɨ ɜɚɧɨ ɧɟɫɤɨɥɶɤɨ ɬɢɩɨɜ ɮɢɦɛɪɢɣ ɭɱɚɫɬɜɭɸɳɢɯ ɜ ɚɞɝɟɡɢɢ ɢ ɤɨɥɨɧɢɡɚɰɢɢ Ɏɢɦ ɛɪɢɢ -ɝɨ ɬɢɩɚ )LP ɫɜɹɡɵɜɚɸɬɫɹ ɫ '-ɦɚɧɧɨɡɧɵɦɢ ɪɟɰɟɩɬɨɪɚɦɢ ɧɚ ɩɨɜɟɪɯɧɨɫɬɢ ɪɚɡɧɵɯ ɤɥɟɬɨɤ Ⱦɥɢɧɧɵɟ ɩɨɥɹɪɧɵɟ ɮɢɦɛɪɢɢ /SI ɫɜɹɡɵɜɚɸɬɫɹ ɫ ɩɨɜɟɪɯɧɨɫɬɶɸ ɤɥɟɬɨɤ ɩɟɣɟɪɨɜɵɯ ɛɥɹɲɟɤ Ɍɨɧɤɢɟ ɮɢɦɛɪɢɢ 3HI ɫɜɹɡɵɜɚɸɬɫɹ ɫ ɜɨɪɫɢɧɤɚɦɢ ɷɧɬɟ ɪɨɰɢɬɨɜ Ɏɚɤɬɨɪɵ ɢɧɜɚɡɢɢ ɛɟɥɤɢ ɧɚɪɭɠɧɨɣ ɦɟɦɛɪɚɧɵ ɨɛɟɫɩɟɱɢɜɚɸɬ ɫɚɥɶɦɨ ɧɟɥɥɚɦ ɬɪɚɧɫɰɢɬɨɡ ɱɟɪɟɡ Ɇ-ɤɥɟɬɤɢ ɫɥɢɡɢɫɬɨɣ ɨɛɨɥɨɱɤɢ ɤɢɲɟɱɧɢɤɚ Ɋɟɡɢɫɬɟɧɬ ɧɨɫɬɶ ɤ ɮɚɝɨɰɢɬɨɡɭ ɩɨɡɜɨɥɹɟɬ ɫɚɥɶɦɨɧɟɥɥɚɦ ɫɨɯɪɚɧɹɬɶɫɹ ɢ ɪɚɡɦɧɨɠɚɬɶɫɹ ɜɧɭɬɪɢ ɮɚɝɨɰɢɬɨɜ ɍɫɬɨɣɱɢɜɨɫɬɶ ɤ ɮɚɝɨɰɢɬɨɡɭ ɨɛɭɫɥɨɜɥɟɧɚ ɜ ɩɟɪɜɭɸ ɨɱɟɪɟɞɶ ɧɚɥɢɱɢɟɦ Vi-ɚɧɬɢɝɟɧɚ.
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ɊȿɁɂɋɌȿɇɌɇɈɋɌɖ ɍɫɬɨɣɱɢɜɵ ɜɨ ɜɧɟɲɧɟɣ ɫɪɟɞɟ ɜɨɞɟ – ɞɨ ɦɟɫɹɰɚ ɜ ɦɨɥɨɤɟ – ɧɟɫɤɨɥɶɤɨ ɧɟɞɟɥɶ ɑɭɜɫɬɜɢɬɟɥɶɧɵ ɤ ɞɟɡɢɧɮɟɤɬɚɧɬɚɦ ɯɥɨɪɫɨɞɟɪɠɚ ɳɢɟ ɫɩɢɪɬɵ ɍɫɬɨɣɱɢɜɵ ɤ ɡɚɦɨɪɚɠɢɜɚɧɢɸ
ɗɉɂȾȿɆɂɈɅɈȽɂə Ȼɪɸɲɧɨɣ ɬɢɮ ɢ ɩɚɪɚɬɢɮɵ ɪɚɫɩɪɨɫɬɪɚɧɟɧɵ ɩɨɜɫɟ ɦɟɫɬɧɨ Ɂɚɛɨɥɟɜɚɧɢɹ ɱɚɳɟ ɪɟɝɢɫɬɪɢɪɭɸɬɫɹ ɜ ɥɟɬɧɟ-ɨɫɟɧɧɟɟ ɜɪɟɦɹ ɢɸɥɶ - ɫɟɧ ɬɹɛɪɶ Ȼɪɸɲɧɨɣ ɬɢɮ ɩɪɨɬɟɤɚɟɬ ɜ ɜɢɞɟ ɷɩɢɞɟɦɢɣ ɜɫɩɵɲɟɤ ɢɥɢ ɫɩɨɪɚɞɢɱɟɫɤɢɯ ɫɥɭɱɚɟɜ ɂɫɬɨɱɧɢɤɨɦ ɢɧɮɟɤɰɢɢ ɩɪɢ ɛɪɸɲɧɨɦ ɬɢɮɟ ɢ ɩɚɪɚɬɢɮɚɯ Ⱥ ɢ ȼ ɹɜɥɹɟɬɫɹ ɛɨɥɶɧɨɣ ɱɟɥɨɜɟɤ ɢɥɢ ɛɚɤɬɟɪɢɨɧɨɫɢɬɟɥɶ ɤɨɬɨɪɵɟ ɜɵɞɟɥɹɸɬ ɜɨɡɛɭɞɢɬɟɥɹ ɜɨ ɜɧɟɲɧɸɸ ɫɪɟɞɭ ɍ ɛɚɤɬɟɪɢɨɧɨɫɢɬɟɥɟɣ ɜɨɡɛɭɞɢɬɟɥɶ ɨɛɢɬɚɟɬ ɜ ɤɨɫɬɧɨɦ ɦɨɡɝɟ ɠɟɥɱɢ ɜ ɬɨɦ ɱɢɫɥɟ ɜɧɭɬɪɢ ɤɚɦɧɟɣ ɩɪɢ ɠɟɥɱɧɨɤɚɦɟɧɧɨɣ ɛɨɥɟɡɧɢ Ɇɟɯɚɧɢɡɦ ɩɟ ɪɟɞɚɱɢ – ɮɟɤɚɥɶɧɨ-ɨɪɚɥɶɧɵɣ ɉɭɬɢ ɩɟɪɟɞɚɱɢ – ɜɨɞɧɵɣ ɨɫɧɨɜɧɨɣ ɚɥɢɦɟɧɬɚɪ ɧɵɣ ɢ ɪɟɞɤɨ – ɤɨɧɬɚɤɬɧɨ-ɛɵɬɨɜɨɣ
ɉȺɌɈȽȿɇȿɁ ȼ ɪɚɡɜɢɬɢɢ ɛɪɸɲɧɨɝɨ ɬɢɮɚ ɢ ɩɚɪɚɬɢɮɨɜ ɜɵɞɟɥɹɸɬ ɫɥɟɞɭ ɸɳɢɟ ɷɬɚɩɵ ȼɧɟɞɪɟɧɢɟ ɜɨɡɛɭɞɢɬɟɥɹ ɜ ɨɪɝɚɧɢɡɦ Ɋɚɡɜɢɬɢɟ ɥɢɦɮɚɞɟɧɢɬɚɎɨɪɦɢɪɨɜɚɧɢɟ ɛɚɤɬɟɪɢɟɦɢɢ ɢ ɢɧɬɨɤɫɢɤɚɰɢɢ ɨɪɝɚɧɢɡɦɚ ɉɚɪɟɧɯɢɦɚɬɨɡɧɚɹ ɞɢɮɮɭɡɢɹ ɜɨɡɛɭɞɢɬɟɥɹ ȼɵɞɟɥɟɧɢɟ ɜɨɡɛɭɞɢɬɟɥɹ ɢɡ ɨɪɝɚɧɢɡɦɚ ɢ ɪɚɡɜɢɬɢɟ ɢɦ ɦɭɧɧɨɝɨ ɨɬɜɟɬɚ
ɄɅɂɇɂɑȿɋɄȺə ɄȺɊɌɂɇȺ ɂɧɤɭɛɚɰɢɨɧɧɵɣ ɩɟɪɢɨɞ ɩɪɢ ɛɪɸɲɧɨɦ ɬɢɮɟ ɫɨɫɬɚɜɥɹɟɬ ɜ ɫɪɟɞɧɟɦ ɞɧɟɣ ɩɪɢ ɩɚɪɚɬɢɮɚɯ – ɞɧɟɣ Ʉɥɢɧɢɤɚ ɛɪɸɲɧɨɝɨ ɬɢɮɚ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɨɫɬɪɵɦ ɧɚɱɚɥɨɦ ɢ ɰɢɤɥɢɱɟɫɤɢɦ ɬɟɱɟɧɢɟɦ ȼ ɩɟɪɜɭɸ ɧɟ ɞɟɥɸ ɡɚɛɨɥɟɜɚɧɢɹ ɨɬɦɟɱɚɸɬɫɹ ɩɨɜɵɲɟɧɢɟ ɬɟɦɩɟɪɚɬɭɪɵ ɬɟɥɚ ɞɨ –40 °ɋ ɫɥɚ ɛɨɫɬɶ ɝɨɥɨɜɧɚɹ ɛɨɥɶ ɧɟɞɨɦɨɝɚɧɢɟ ȼ ɤɨɧɰɟ ɩɟɪɜɨɣ ɧɟɞɟɥɢ ɩɨɹɜɥɹɸɬɫɹ ɚɛɞɨɦɢ ɧɚɥɶɧɵɟ ɛɨɥɢ ɨɬɦɟɱɚɟɬɫɹ ɜɡɞɭɬɢɟ ɠɢɜɨɬɚ ɠɢɞɤɢɣ ɫɬɭɥ ɇɚ ɜɬɨɪɨɣ ɧɟɞɟɥɟ ɛɨ ɥɟɡɧɢ ɫɨɯɪɚɧɹɟɬɫɹ ɩɨɜɵɲɟɧɧɚɹ ɬɟɦɩɟɪɚɬɭɪɚ ɩɪɢɫɨɟɞɢɧɹɸɬɫɹ ɹɜɥɟɧɢɹ ɢɧɬɨɤɫɢ ɤɚɰɢɢ ȼ ɪɟɡɭɥɶɬɚɬɟ ɷɬɨɝɨ ɪɚɡɜɢɜɚɟɬɫɹ ɬɢɮɨɢɞɧɨɟ ɫɨɫɬɨɹɧɢɟ ɬɢɮɨɡɧɵɣ ɫɬɚ ɬɭɫ ɞɥɹ ɤɨɬɨɪɨɝɨ ɯɚɪɚɤɬɟɪɧɵ ɜɹɥɨɫɬɶ ɚɩɚɬɢɹ ɨɰɟɩɟɧɟɧɢɟ ɛɟɡɪɚɡɥɢɱɢɟ ɡɚɬɭ ɦɚɧɟɧɧɨɟ ɫɨɡɧɚɧɢɟ ɩɪɨɫɬɪɚɰɢɹ ɛɪɟɞ ɝɚɥɥɸɰɢɧɚɰɢɢ ɩɚɞɟɧɢɟ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ ɇɚ – ɞɟɧɶ ɛɨɥɟɡɧɢ ɧɚ ɤɨɠɟ ɠɢɜɨɬɚ ɝɪɭɞɢ ɫɩɢɧɵ ɛɟɞɟɪ ɦɨɠɟɬ ɩɨɹɜɢɬɶɫɹ ɪɨɡɟɨɥɟɡɧɚɹ ɫɵɩɶ ɪɨɡɟɨɥɵ – ɩɹɬɧɚ ɞɢɚɦɟɬɪɨɦ ɦɟɧɟɟ ɫɦ ɗɥɟɦɟɧɬɨɜ ɫɵɩɢ ɧɟɦɧɨɝɨ ɇɚ ɬɪɟɬɶɟɣ ɧɟɞɟɥɟ ɡɚɛɨɥɟɜɚɧɢɹ ɬɟɦɩɟɪɚɬɭɪɚ ɬɟɥɚ ɩɨɫɬɟɩɟɧɧɨ ɫɧɢ ɠɚɟɬɫɹ ɇɚɱɢɧɚɟɬɫɹɜɵɡɞɨɪɨɜɥɟɧɢɟ ȼɛɨɥɶɲɢɧɫɬɜɟɫɥɭɱɚɟɜɛɚɤɬɟɪɢɢɩɨɥɧɨɫɬɶɸ ɷɥɢɦɢɧɢɪɭɸɬɫɹ ɢɡ ɨɪɝɚɧɢɡɦɚ Ɉɞɧɚɤɨ ɜ –5 ɫɥɭɱɚɟɜ ɮɨɪɦɢɪɭɟɬɫɹ ɛɚɤɬɟɪɢɨɧɨ ɫɢɬɟɥɶɫɬɜɨ ɩɪɢ ɤɨɬɨɪɨɦ ɫɚɥɶɦɨɧɟɥɥɵ ɨɫɬɚɸɬɫɹ ɜ ɤɨɫɬɧɨɦ ɦɨɡɝɟ ɠɟɥɱɧɨɦ ɩɭ ɡɵɪɟ ɢɥɢ ɜ ɦɨɱɟɜɵɜɨɞɹɳɟɣ ɫɢɫɬɟɦɟ ɢ ɩɨɫɬɨɹɧɧɨ ɢɥɢ ɩɟɪɢɨɞɢɱɟɫɤɢ ɜɵɞɟɥɹɸɬɫɹ ɫ ɤɚɥɨɦ ɢɥɢ ɦɨɱɨɣ Ȼɚɤɬɟɪɢɨɧɨɫɢɬɟɥɶɫɬɜɨ ɦɨɠɟɬ ɩɪɨɞɨɥɠɚɬɶɫɹ ɜ ɬɟɱɟɧɢɟ ɧɟ
40