Заболевания ЩЖ у беременных

Ʉɚɮɟɞɪɚ Ⱥɤɭɲɟɫɬɜɚ ɢ Ƚɢɧɟɤɨɥɨɝɢɢ əȽɆȺ, 200

ɭɪɨɜɧɟ. ɗɬɨ ɨɩɚɫɧɨ, ɩɨɫɤɨɥɶɤɭ ɩɪɟɩɚɪɚɬ ɞɨɫɬɚɬɨɱɧɨ ɥɟɝɤɨ ɩɪɨɧɢɤɚɟɬ ɱɟɪɟɡ ɩɥɚɰɟɧɬɭ ɢ ɨɤɚɡɵɜɚɟɬ ɚɧɚɥɨɝɢɱɧɵɣ ɬɢɪɟɨɫɬɚɬɢɱɟɫɤɢɣ ɷɮɮɟɤɬ ɧɚ ɓɀ ɩɥɨɞɚ.

•ɉɪɨɩɪɚɧɨɥɨɥ ɦɨɠɟɬ ɛɵɬɶ ɢɫɩɨɥɶɡɨɜɚɧ ɭ ɛɟɪɟɦɟɧɧɵɯ ɞɥɹ ɩɨɞɞɟɪɠɚɧɢɹ ɑɋɋ ɦɟɧɟɟ 00 ɭɞ/ɦɢɧ ɜ ɞɨɡɟ 20-40 ɦɝ ɱɟɪɟɡ 6-8 ɱɚɫɨɜ ɜɧɭɬɪɶ. Ʉɪɨɦɟ ɬɨɝɨ ɩɪɟɩɚɪɚɬ ɛɥɨɤɢɪɭɟɬ ɩɟɪɢɮɟɪɢɱɟɫɤɭɸ ɤɨɧɜɟɪɫɢɸ Ɍ4 ɜ Ɍ3.

•Ʌɟɱɟɧɢɟ ɝɢɩɟɪɬɟɪɦɢɢ ɩɪɨɜɨɞɢɬɫɹ ɚɰɟɬɚɦɢɧɨɮɟɧɨɦ (ɩɚɧɚɞɨɥ) ɜ ɫɜɟɱɚɯ. ɇɚɡɧɚɱɟɧɢɟ ɚɫɩɢɪɢɧɚ ɫɥɟɞɭɟɬ ɢɡɛɟɝɚɬɶ, ɬ.ɤ. ɨɧ ɦɨɠɟɬ «ɜɵɬɟɫɧɹɬɶ» ɬɢɪɨɤɫɢɧ ɢɡ ɟɝɨ ɫɨɟɞɢɧɟɧɢɹ ɫ ɬɢɪɨɤɫɢɧɫɜɹɡɵɜɚɸɳɢɦ ɛɟɥɤɨɦ.

Ɉɫɧɨɜɧɵɟ ɩɪɢɧɰɢɩɵ ɥɟɱɟɧɢɹ ȾɌɁ ɩɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ:

•ɂɫɫɥɟɞɨɜɚɧɢɟ ɩɭɥɶɫɚ, ɜɡɜɟɲɢɜɚɧɢɟ, ɨɛɴɟɦɚ ɓɀ, ɭɪɨɜɧɹ ɫɜɨɛɨɞɧɨɝɨ Ɍ4, Ɍ3 ɢ ɌɌȽ ɟɠɟɦɟɫɹɱɧɨ.

•ɂɫɩɨɥɶɡɨɜɚɧɢɟ ɦɢɧɢɦɚɥɶɧɵɯ ɞɨɡ ɬɢɪɟɨɫɬɚɬɢɤɨɜ, ɤɨɬɨɪɵɟ ɨɛɟɫɩɟɱɢɜɚɸɬ ɩɨɞɞɟɪɠɚɧɢɟ ɭ ɩɚɰɢɟɧɬɤɢ ɭɪɨɜɧɹ Ɍ4 ɢ Ɍ3 ɧɚ ɜɟɪɯɧɟɣ ɝɪɚɧɢɰɟ ɧɨɪɦɚɥɶɧɵɯ ɡɧɚɱɟɧɢɣ ɢɥɢ ɧɟɫɤɨɥɶɤɨ ɜɵɲɟ ɧɨɪɦɵ.

•ɉɪɨɩɢɥɬɢɨɭɪɚɰɢ (ɩɪɨɩɢɰɢɥ) ɜ ɞɨɡɟ ɧɟ ɛɨɥɟɟ 300 ɦɝ ɢɥɢ ɧɟ ɛɨɥɟɟ 20 ɦɝ ɦɟɬɢɦɚɡɨɥɚ (ɬɢɪɨɡɨɥɚ) ɩɪɢ ɞɥɢɬɟɥɶɧɨɣ ɬɟɪɚɩɢɢ.

•Ɋɟɝɭɥɹɪɧɵɣ ɤɨɧɬɪɨɥɶ ɫɨɫɬɨɹɧɢɹ ɩɥɨɞɚ: ɄɌȽ ɜ ɜɢɞɟ ɇɌ - ɟɠɟɧɟɞɟɥɶɧɨ ɫ 28-30 ɧɟɞ, ɫɚɦɨɤɨɧɬɪɨɥɶ ɛɟɪɟɦɟɧɧɨɣ ɞɜɢɝɚɬɟɥɶɧɨɣ ɚɤɬɢɜɧɨɫɬɢ ɩɥɨɞɚ ɫ 28 ɧɟɞ., ɍɁ ɨɰɟɧɤɚ ɪɨɫɬɚ ɩɥɨɞɚ ɜ 30-32 ɧɟɞ ɢ ɛɢɨɮɢɡɢɱɟɫɤɢɣ ɩɪɨɮɢɥɶ ɩɥɨɞɚ.

•Ⱦɨɛɢɜɚɬɶɫɹ ɩɨɥɧɨɣ ɧɨɪɦɚɥɢɡɚɰɢɢ ɭɪɨɜɧɹ ɌɌȽ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɧɟɬ. Ɋɟɤɨɦɟɧɞɭɟɬɫɹ ɩɨɞɞɟɪɠɚɧɢɟ ɭɪɨɜɧɹ ɌɌȽ ɦɟɠɞɭ 0, ɢ 0,4 ɦɆȿ/ɥ.

•ɉɪɨɩɢɰɢɥ ɢɦɟɟɬ ɩɪɟɞɩɨɱɬɟɧɢɟ ɩɟɪɟɞ ɦɟɬɢɦɚɡɨɥɨɦ, ɧɨ ɦɨɠɧɨ ɢɫɩɨɥɶɡɨɜɚɬɶ ɢ ɬɨɬ ɢ ɞɪɭɝɨɣ ɩɪɟɩɚɪɚɬɵ.

•ɇɚɡɧɚɱɟɧɢɟ ɩɪɟɩɚɪɚɬɨɜ ɣɨɞɚ ɩɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɧɟ ɩɨɤɚɡɚɧɨ, ɡɚ ɢɫɤɥɸɱɟɧɢɟɦ ɫɥɭɱɚɟɜ, ɤɨɝɞɚ ɢɞɟɬ ɩɨɞɝɨɬɨɜɤɚ ɤ ɨɩɟɪɚɬɢɜɧɨɦɭ ɥɟɱɟɧɢɸ, ɬ. ɤ. ɫɜɹɡɚɧɨ ɫ ɮɨɪɦɢɪɨɜɚɧɢɟɦ ɡɨɛɚ ɭɩɥɨɞɚ.

•Ⱦɨɡɭ ɬɢɪɟɨɫɬɚɬɢɤɨɜ ɜɨ ɜɬɨɪɨɦ ɬɪɢɦɟɫɬɪɟ, ɤɚɤ ɩɪɚɜɢɥɨ, ɩɪɢɯɨɞɢɬɫɹ ɫɧɢɠɚɬɶ, ɚ ɜ ɬɪɟɬɶɟɦ - ɧɟɪɟɞɤɨ ɩɨɥɧɨɫɬɶɸ ɨɬɦɟɧɹɬɶ ɩɪɟɩɚɪɚɬɵ.

•Ⱦɨɫɬɢɱɶ ɷɭɬɢɪɢɨɢɞɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɨɛɵɱɧɨ ɭɞɚɟɬɫɹ ɜ ɬɟɱɟɧɢɟ 2-4 ɦɟɫ.

•ɉɪɢɦɟɧɟɧɢɟ ɚɧɬɢɬɢɪɟɨɢɞɧɵɯ ɩɪɟɩɚɪɚɬɨɜ ɭ ɛɪɟɦɟɧɧɵɯ ɧɟ ɹɜɥɹɟɬɫɹ ɚɛɫɨɥɸɬɧɵɦ ɩɪɨɬɢɜɨɩɨɤɚɡɚɧɢɟɦ ɤ ɝɪɭɞɧɨɦɭ ɜɫɤɚɪɦɥɢɜɚɧɢɸ. Ⱥɦɟɪɢɤɚɧɫɤɚɹ Ⱥɤɚ-

ɞɟɦɢɹ ɉɟɞɢɚɬɪɢɢ ɭɬɜɟɪɠɞɚɟɬ, ɱɬɨ ɧɢ ɨɞɢɧ ɢɡ ɩɪɢɦɟɧɹɟɦɵɯ ɩɪɟɩɚɪɚɬɨɜ ɧɟ ɹɜɥɹɟɬɫɹ ɩɪɨɬɢɜɨɩɨɤɚɡɚɧɢɟɦ ɞɥɹ ɤɨɪɦɥɟɧɢɹ ɪɟɛɺɧɤɚ ɝɪɭɞɶɸ. ȼ ɬɨ ɠɟ ɜɪɟɦɹ ɮɭɧɤɰɢɹ ɓɀ ɧɨɜɨɪɨɠɞɟɧɧɨɝɨ ɬɪɟɛɭɟɬ ɩɨɫɬɨɹɧɧɨɝɨ ɤɨɧɬɪɨɥɹ.

•ɉɪɢɦɟɧɟɧɢɟ ɚɧɬɢɬɢɪɟɨɢɞɧɵɯ ɩɪɟɩɚɪɚɬɨɜ ɩɪɢɦɟɪɧɨ ɭ 3-5% ɩɚɰɢɟɧɬɨɜ ɫɨɩɪɨɜɨɠɞɚɟɬɫɹ ɩɨɛɨɱɧɵɦɢ ɷɮɮɟɤɬɚɦɢ: ɡɭɞ, ɫɵɩɶ ɜ ɜɢɞɟ ɩɭɪɩɭɪɵ, ɚɪɬɪɚɥɝɢɢ, ɥɢɯɨɪɚɞɤɚ. ɇɚɢɛɨɥɟɟ ɫɟɪɶɺɡɧɵɦ ɨɫɥɨɠɧɟɧɢɟɦ ɥɟɱɟɧɢɹ ɹɜɥɹɟɬɫɹ ɚɝɪɚɧɭɥɨɰɢɬɨɡ ɫ ɱɚɫɬɨ-

ɬɨɣ :300.

Ɍɚɛɥɢɰɚ 9. ɉɨɤɚɡɚɬɟɥɢ ɮɭɧɤɰɢɢ ɳɢɬɨɜɢɞɧɨɣ ɠɟɥɟɡɵ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ.

ɋɬɪɚɧɢɰɚ 20 ɢɡ 27

Ʉɚɮɟɞɪɚ Ⱥɤɭɲɟɫɬɜɚ ɢ Ƚɢɧɟɤɨɥɨɝɢɢ əȽɆȺ, 200

ɏɢɪɭɪɝɢɱɟɫɤɨɟ ɥɟɱɟɧɢɟ ɩɨɤɚɡɚɧɨ ɜ ɢɫɤɥɸɱɢɬɟɥɶɧɵɯ ɫɥɭɱɚɹɯ: ɩɪɢ ɧɟɩɟɪɟɧɨɫɢɦɨɫɬɢ ɦɟɞɢɤɚɦɟɧɬɨɡɧɨɣ ɬɟɪɚɩɢɢ, ɬɹɠɟɥɨɣ ɥɟɤɚɪɫɬɜɟɧɧɨɣ ɚɥɥɟɪɝɢɢ, ɨɱɟɧɶ ɛɨɥɶɲɨɦ ɡɨɛɟ, ɫɨɩɪɨɜɨɠɞɚɸɳɟɦɫɹ ɫɞɚɜɥɟɧɢɟɦ ɬɪɚɯɟɢ, ɫɨɱɟɬɚɧɢɢ ɫɨ ɡɥɨɤɚɱɟɫɬɜɟɧɧɵɦ ɩɪɨɰɟɫɫɨɦ ɜ ɓɀ ɢɥɢ ɩɪɢ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɢɫɩɨɥɶɡɨɜɚɧɢɹ ɛɨɥɶɲɢɯ ɞɨɡ ɬɢɪɟɨɫɬɚɬɢɤɨɜ ɞɥɹ ɩɨɞɞɟɪɠɤɢ ɷɭɬɢɪɟɨɡɚ. ɇɚɢɛɨɥɟɟ ɛɟɡɨɩɚɫɧɵɦ ɫɪɨɤɨɦ ɞɥɹ ɜɵɩɨɥɧɟɧɢɹ ɫɭɛɬɨɬɚɥɶɧɨɣ ɪɟɡɟɤɰɢɢ ɓɀ ɹɜɥɹɟɬɫɹ II ɬɪɢɦɟɫɬɪ ɛɟɪɟɦɟɧɧɨɫɬɢ.

Ⱦɢɫɤɭɬɚɛɟɥɶɧɵɦ ɹɜɥɹɟɬɫɹ ɜɨɩɪɨɫ ɨ ɩɥɚɧɢɪɨɜɚɧɢɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɩɨɞɝɨɬɨɜɤɟ ɤ ɧɟɣ ɭ ɠɟɧɳɢɧ ɫ ȾɌɁ. ɉɨ ɦɧɟɧɢɸ ɪɹɞɚ ɚɜɬɨɪɨɜ, ɩɪɟɞɩɨɱɬɟɧɢɟ ɫɥɟɞɭɟɬ ɨɬɞɚɜɚɬɶ ɫɭɛɬɨɬɚɥɶɧɨɣ ɬɢɪɟɨɢɞɷɤɬɨɦɢɢ ɜɜɢɞɭ ɛɨɥɟɟ ɛɵɫɬɪɨɝɨ ɧɚɫɬɭɩɥɟɧɢɹ ɷɭɬɢɪɟɨɢɞɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɩɨɫɥɟ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ ɥɟɱɟɧɢɹ. ɇɟɤɨɬɨɪɵɟ ɚɜɬɨɪɵ ɩɨɥɚɝɚɸɬ, ɱɬɨ ɩɨɫɥɟ ɥɟɱɟɧɢɹ ɚɧɬɢɬɢɪɟɨɢɞɧɵɦɢ ɩɪɟɩɚɪɚɬɚɦɢ ɩɪɢ ɩɨɞɞɟɪɠɚɧɢɢ ɦɢɧɢɦɚɥɶɧɵɦɢ ɢɯ ɞɨɡɚɦɢ ɷɭɬɢɪɟɨɢɞɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɦɨɠɧɨ ɪɚɡɪɟɲɢɬɶ ɛɟɪɟɦɟɧɧɨɫɬɶ. Ⱦɪɭɝɨɣ ɜɚɪɢɚɧɬ ɩɪɟɞɩɨɥɚɝɚɟɬ ɩɪɟɞɲɟɫɬɜɭɸɳɟɟ ɥɟɱɟɧɢɟ ɪɚɞɢɨɚɤɬɢɜɧɵɦ ɣɨɞɨɦ. ɉɪɢ ɭɫɥɨɜɢɢ ɧɨɪɦɚɥɢɡɚɰɢɢ ɮɭɧɤɰɢɢ ɓɀ ɪɚɡɪɟɲɚɟɬɫɹ ɧɚɫɬɭɩɥɟɧɢɟ ɛɟɪɟɦɟɧɧɨɫɬɢ ɱɟɪɟɡ ɝɨɞ ɩɨɫɥɟ ɬɟɪɚɩɢɢ. ɇɟɬ ɞɚɧɧɵɯ, ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɳɢɯ ɨ ɩɨɜɵɲɟɧɢɢ ɱɚɫɬɨɬɵ ɚɧɨɦɚɥɢɣ ɪɚɡɜɢɬɢɹ ɩɨɫɥɟ ɥɟɱɟɧɢɹ I 3 .

D. Ƚɢɩɨɬɢɪɟɨɡ.

ɉɨɫɤɨɥɶɤɭ ɩɪɢ ɝɢɩɨɬɢɪɟɨɡɟ ɫɧɢɠɚɟɬɫɹ ɮɟɪɬɢɥɶɧɨɫɬɶ, ɜ ɨɬɫɭɬɫɬɜɢɟ ɥɟɱɟɧɢɹ ɧɚɫɬɭɩɥɟɧɢɟ ɛɟɪɟɦɟɧɧɨɫɬɢ ɤɪɚɣɧɟ ɦɚɥɨɜɟɪɨɹɬɧɨ, ɢ ɫɥɭɱɚɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɪɨɠɞɟɧɢɹ ɡɞɨɪɨɜɨɝɨ ɪɟɛɟɧɤɚ ɭ ɧɟɥɟɱɟɧɨɣ ɛɨɥɶɧɨɣ ɫ ɝɢɩɨɬɢɪɟɨɡɨɦ ɨɩɢɫɵɜɚɸɬɫɹ ɤɚɤ ɤɚɡɭɢɫɬɢɤɚ. Ɍɚɤ ɤɚɤ ɪɚɧɧɢɟ ɫɬɚɞɢɢ ɷɦɛɪɢɨɝɟɧɟɡɚ ɞɨ 6 - 8-ɣ ɧɟɞɟɥɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɪɨɬɟɤɚɸɬ ɩɨɞ ɤɨɧɬɪɨɥɟɦ ɦɚɬɟɪɢɧɫɤɢɯ Ƚɓɀ, ɢ ɩɪɢ ɜɵɪɚɠɟɧɧɨɦ ɞɟɮɢɰɢɬɟ ɢɯ ɚɛɫɨɥɸɬɧɨ ɧɟɜɨɡɦɨɠɧɚ ɧɢ ɝɟɫɬɚɰɢɹ, ɧɢ ɪɚɡɜɢɬɢɟ ɷɦɛɪɢɨɧɚ. ȼ ɬɨ ɠɟ ɜɪɟɦɹ, ɟɫɥɢ ɝɢɩɨɬɢɪɟɨɡ ɧɟ ɝɪɭɛɵɣ, ɢ ɞɨ 6 - 8-ɣ ɧɟɞɟɥɢ ɤ ɩɥɨɞɭ ɩɨɫɬɭɩɚɟɬ ɯɨɬɹ ɛɵ ɜ ɞɨɫɬɚɬɨɱɧɨɦ ɤɨɥɢɱɟɫɬɜɟ ɬɪɢɣɨɞɬɢɪɨɧɢɧ, ɬɨ ɜ ɞɚɥɶɧɟɣɲɟɦ ɓɀ ɩɥɨɞɚ ɭɠɟ ɧɚɱɢɧɚɟɬ ɮɭɧɤɰɢɨɧɢɪɨɜɚɬɶ ɫɚɦɨɫɬɨɹɬɟɥɶɧɨ. ɋɭɛɤɥɢɧɢɱɟɫɤɢɣ ɝɢɩɨɬɢɪɟɨɡ (4,0 < ɌɌȽ < 0 mU/ ) ɪɟɝɢɫɬɪɢɪɭɟɬɫɹ ɭ 5% ɩɨɩɭɥɹɰɢɢ ȿɜɪɨɩɵ ɢ 2% ɛɟɪɟɦɟɧɧɵɯ ɜ ɋɒȺ. ɗɬɨ ɫɨɫɬɨɹɧɢɟ ɜɫɬɪɟɱɚɟɬɫɹ ɢ ɜ ɪɟɝɢɨɧɚɯ ɫ ɣɨɞɞɟɮɢɰɢɬɨɦ, ɢ ɜ ɪɟɝɢɨɧɚɯ ɫ ɞɨɫɬɚɬɨɱɧɵɦ ɩɨɫɬɭɩɥɟɧɢɟɦ ɣɨɞɚ, ɝɞɟ ɷɬɨ, ɜɟɪɨɹɬɧɨ, ɫɜɹɡɚɧɨ ɫ ɚɭɬɨɢɦɦɭɧɧɵɦ ɩɪɨɰɟɫɫɨɦ. Ⱦɥɹ ɩɪɨɮɢɥɚɤɬɢɤɢ ɨɫɥɨɠɧɟɧɢɣ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ (ɪɢɫɤ ɫɚɦɨɩɪɨɢɡɜɨɥɶɧɨɝɨ ɚɛɨɪɬɚ, ɝɢɛɟɥɢ ɩɥɨɞɚ, ɜɪɨɠɞɟɧɧɵɯ ɩɨɪɨɤɨɜ ɪɚɡɜɢɬɢɹ) ɩɟɪɟɞ ɧɚɫɬɭɩɥɟɧɢɟɦ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɨɤɚɡɚɧɚ ɬɟɪɚɩɢɹ ɥɟɜɨɬɢɪɨɤɫɢɧɨɦ.

. ɗɬɢɨɥɨɝɢɹ. ɋɚɦɚɹ ɪɚɫɩɨɫɬɪɚɧɟɧɧɚɹ ɩɪɢɱɢɧɚ ɝɢɩɨɬɢɪɟɨɡɚ - ɯɪɨɧɢɱɟɫɤɢɣ ɥɢɦɮɨɰɢɬɚɪɧɵɣ ɬɢɪɟɨɢɞɢɬ (ɬɢɪɟɨɢɞɢɬ ɏɚɫɢɦɨɬɨ). Ⱦɪɭɝɢɟ ɩɪɢɱɢɧɵ - ɪɟɡɟɤɰɢɹ ɓɀ, ɩɪɢɦɟɧɟɧɢɟ I- 3 , ɩɪɢɟɦ ɩɪɨɩɢɥɬɢɨɭɪɚɰɢɥɚ ɢ ɦɟɬɢɦɚɡɨɥɚ.

2.Ʉɥɢɧɢɤɚ. ɀɚɥɨɛɵ ɧɚ ɭɬɨɦɥɹɟɦɨɫɬɶ, ɡɹɛɤɨɫɬɶ ɤɨɧɟɱɧɨɫɬɟɣ, ɭɜɟɥɢɱɟɧɢɟ ɜɟɫɚ, ɫɭɯɨɫɬɶ ɤɨɠɢ ɢ ɡɚɩɨɪɵ. ɉɪɢ ɮɢɡɢɤɚɥɶɧɨɦ ɢɫɫɥɟɞɨɜɚɧɢɢ ɨɬɦɟɱɚɟɬɫɹ ɫɭɯɨɫɬɶ ɢ ɲɟɥɭɲɟɧɢɟ ɤɨɠɢ, ɨɯɪɢɩɥɨɫɬɶ ɝɨɥɨɫɚ, ɨɞɭɬɥɨɜɚɬɨɫɬɶ ɥɢɰɚ. ɉɪɢ ɩɟɪɜɢɱɧɨɦ ɝɢɩɨɬɢɪɟɨɡɟ ɨɛɵɱɧɨ ɢɦɟɟɬɫɹ ɡɨɛ. Ɏɚɡɚ ɪɚɫɫɥɚɛɥɟɧɢɹ ɫɭɯɨɠɢɥɶɧɵɯ ɪɟɮɥɟɤɫɨɜ ɡɚɦɟɞɥɟɧɚ.

3.Ⱦɢɚɝɧɨɫɬɢɤɚ. ɇɚɢɛɨɥɟɟ ɱɭɜɫɬɜɢɬɟɥɶɧɵɦ ɢɧɞɢɤɚɬɨɪɨɦ ɩɟɪɜɢɱɧɨɝɨ ɝɢɩɨɬɢɪɟɨɡɚ ɹɜɥɹɟɬ-

ɫɹ ɩɨɜɵɲɟɧɢɟ ɭɪɨɜɧɹ ɌɌȽ ɜ ɫɵɜɨɪɨɬɤɟ ɤɪɨɜɢ ɧɚ ɮɨɧɟ ɫɧɢɠɟɧɢɹ ɨɛɳɟɝɨ ɫɨɞɟɪɠɚɧɢɹ Ɍ4 ɢ ɫɜɨɛɨɞɧɨɝɨ Ɍ4 . ɍɪɨɜɟɧɶ Ɍ 3 , ɤɚɤ ɩɪɚɜɢɥɨ, ɫɧɢɠɟɧ, ɧɨ ɦɨɠɟɬ ɨɫɬɚɜɚɬɶɫɹ ɜ ɩɪɟɞɟɥɚɯ ɧɨɪɦɵ. ɉɪɢ ɯɪɨɧɢɱɟɫɤɨɦ ɥɢɦɮɨɰɢɬɚɪɧɨɦ ɬɢɪɟɨɢɞɢɬɟ ɨɛɧɚɪɭɠɢɜɚɟɬɫɹ ɜɵɫɨɤɢɣ ɬɢɬɪ ɚɧɬɢɬɟɥ ɤ ɬɢɪɟɨɝɥɨɛɭɥɢɧɭ. ɉɪɢ ɜɬɨɪɢɱɧɨɦ ɝɢɩɨɬɢɪɟɨɡɟ ɫɨɞɟɪɠɚɧɢɟ ɫɜɨɛɨɞɧɨɝɨ Ɍ 4 ɫɧɢɠɟɧɨ, ɚ ɭɪɨɜɟɧɶ ɌɌȽ ɧɟ ɩɨɜɵɲɟɧ.

4.Ɉɫɥɨɠɧɟɧɢɹ ɭ ɦɚɬɟɪɢ ɢ ɩɥɨɞɚ. ɑɚɳɟ ɨɬɦɟɱɚɸɬɫɹ ɫɥɭɱɚɢ ɫɭɛɤɥɢɧɢɱɟɫɤɨɣ ɝɢɩɨɮɭɧɤɰɢɢ ɓɀ, ɯɚɪɚɤɬɟɪɢɡɭɟɦɵɟ ɨɬɫɭɬɫɬɜɢɟɦ ɤɥɢɧɢɱɟɫɤɢɯ ɫɢɦɩɬɨɦɨɜ ɢ, ɤɚɤ ɩɪɚɜɢɥɨ, ɛɥɚɝɨɩɪɢɹɬɧɵɦ ɬɟɱɟɧɢɟɦ ɛɟɪɟɦɟɧɧɨɫɬɢ. ȼɵɫɨɤɚɹ ɱɚɫɬɨɬɚ ɫɭɛɤɥɢɧɢɱɟɫɤɢɯ ɮɨɪɦ ɡɚɛɨɥɟɜɚɧɢɹ ɨɬɦɟɱɚɟɬɫɹ ɭ ɠɟɧɳɢɧ ɫ ɫɚɯɚɪɧɵɦ ɞɢɚɛɟɬɨɦ I ɬɢɩɚ. ɇɟɛɥɚɝɨɩɪɢɹɬɧɨɟ ɜɥɢɹɧɢɟ ɝɢɩɨɮɭɧɤɰɢɢ ɓɀ ɦɚɬɟɪɢ ɧɚ ɬɟɱɟɧɢɟ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɧɚ ɩɥɨɞ ɢ ɧɨɜɨɪɨɠɞɟɧɧɨɝɨ ɧɚɛɥɸɞɚɟɬɫɹ ɩɪɢ

ɋɬɪɚɧɢɰɚ 2 ɢɡ 27

Ʉɚɮɟɞɪɚ Ⱥɤɭɲɟɫɬɜɚ ɢ Ƚɢɧɟɤɨɥɨɝɢɢ əȽɆȺ, 200

ɤɥɢɧɢɱɟɫɤɢ ɜɵɪɚɠɟɧɧɵɯ ɫɨɫɬɨɹɧɢɹɯ ɢ, ɨɫɨɛɟɧɧɨ, ɩɪɢ ɬɹɠɟɥɵɯ ɫɬɟɩɟɧɹɯ ɝɢɩɨɮɭɧɤɰɢɢ ɓɀ:

•ȼɨɡɪɚɫɬɚɟɬ ɪɢɫɤ ɫɚɦɨɩɪɨɢɡɜɨɥɶɧɵɯ ɚɛɨɪɬɨɜ ɢ ɦɟɪɬɜɨɪɨɠɞɟɧɢɣ.

•ɍ ɦɚɬɟɪɢ ɫ ɜɵɪɚɠɟɧɧɵɦ ɝɢɩɨɬɢɪɟɨɡɨɦ ɜ 3 ,5% ɫɥɭɱɚɟɜ ɪɚɡɜɢɜɚɟɬɫɹ ɚɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ. ɗɬɢ ɰɢɮɪɵ ɭɦɟɧɶɲɚɸɬɫɹ ɞɨ 20%, ɟɫɥɢ ɞɨɫɬɢɝɚɬɫɹ ɷɭɬɢɪɟɨɡɚ ɩɨɫɥɟ 20-ɣ ɧɟɞɟɥɢ.

•ɑɚɳɟ ɪɚɡɜɢɜɚɟɬɫɹ ɩɪɟɷɤɥɚɦɩɫɢɹ ɢ ɫɟɪɞɟɱɧɚɹ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɶ.

•ɑɚɳɟ ɩɪɨɢɫɯɨɞɹɬ ɩɪɟɠɞɟɜɪɟɦɟɧɧɵɟ ɪɨɞɵ.

•ɑɚɳɟ ɧɚɛɥɸɞɚɸɬɫɹ ɨɬɫɥɨɣɤɚ ɩɥɚɰɟɧɬɵ ɢ ɩɨɫɥɟɪɨɞɨɜɵɟ ɤɪɨɜɨɬɟɱɟɧɢɹ.

•ɑɚɳɟ ɪɨɠɞɚɸɬɫɹ ɦɚɥɨɜɟɫɧɵɟ ɞɟɬɢ.

•ɋɭɳɟɫɬɜɭɟɬ ɧɟɛɨɥɶɲɚɹ ɜɟɪɨɹɬɧɨɫɬɶ ɪɚɡɜɢɬɢɹ ɝɢɩɨɬɢɪɟɨɡɚ ɭɩɥɨɞɚ- :4000.

•ȼ ɰɟɥɹɯ ɫɜɨɟɜɪɟɦɟɧɧɨɝɨ ɪɚɫɩɨɡɧɚɜɚɧɢɹ ɜɪɨɠɞɟɧɧɨɝɨ ɝɢɩɨɬɢɪɟɨɡɚ ɢ ɧɚɱɚɥɚ ɧɟɨɛɯɨɞɢɦɨɝɨ ɥɟɱɟɧɢɹ, ɱɬɨ ɨɩɪɟɞɟɥɹɟɬ ɞɚɥɶɧɟɣɲɢɣ ɩɪɨɝɧɨɡ, ɞɟɬɢ ɧɭɠɞɚɸɬɫɹ ɜ ɞɢɫɩɚɧɫɟɪɧɨɦ ɧɚɛɥɸɞɟɧɢɢ ɫ ɩɨɜɬɨɪɧɵɦɢ ɪɚɞɢɨɢɦɦɭɧɨɥɨɝɢɱɟɫɤɢɦɢ ɨɩɪɟɞɟɥɟɧɢɹɦɢ ɬɢɪɟɨɢɞɧɵɯ ɝɨɪɦɨɧɨɜ ɢ ɌɌȽ. Ɋɟɤɨɦɟɧɞɭɟɬɫɹ ɨɛɫɥɟɞɨɜɚɧɢɟ ɜɫɟɯ ɧɨɜɨɪɨɠɞɟɧɧɵɯ (ɫɤɪɢɧɢɧɝ).

•ɂɫɫɥɟɞɨɜɚɧɢɹ ɩɨɫɥɟɞɧɢɯ ɥɟɬ ɧɟ ɩɨɞɬɜɟɪɞɢɥɢ ɩɨɜɵɲɟɧɢɹ ɱɚɫɬɨɬɵ ɜɪɨɠɞɺɧɧɵɯ ɚɧɨɦɚɥɢɣ ɪɚɡɜɢɬɢɹ ɢ ɩɟɪɢɧɚɬɚɥɶɧɨɣ ɫɦɟɪɬɧɨɫɬɢ.

•Ȼɨɥɶɲɢɧɫɬɜɨ ɞɟɬɟɣ ɨɬ ɠɟɧɳɢɧ ɫ ɝɢɩɨɬɢɪɟɨɢɞɢɡɦɨɦ ɪɨɠɞɚɸɬɫɹ ɡɞɨɪɨ-

ɜɵɦɢ, ɯɨɬɹ ɜ ɜɨɡɪɚɫɬɟ ɞɨ 7 ɥɟɬ ɭ ɧɢɯ ɪɟɝɢɫɬɪɢɪɭɟɬɫɹ ɛɨɥɟɟ ɧɢɡɤɢɣ ɢɧɬɟɥɥɟɤɬ. Ɋɚɡɭɦɟɟɬɫɹ, ɟɫɥɢ ɢɦɟɟɬɫɹ ɞɟɮɢɰɢɬ ɣɨɞɚ, ɬɨ ɜɟɥɢɤɚ ɜɟɪɨɹɬɧɨɫɬɶ ɪɚɡɜɢɬɢɹ ɜ ɩɨɫɥɟɞɭɸɳɟɦ ɝɪɭɛɵɯ ɧɚɪɭɲɟɧɢɣ ɜ ɢɧɬɟɥɥɟɤɬɭɚɥɶɧɨɣ ɫɮɟɪɟ ɛɭɞɭɳɟɝɨ ɪɟɛɟɧɤɚ.

5.Ʌɟɱɟɧɢɟ. Ʌɟɱɟɧɢɟ ɝɢɩɨɬɢɪɟɨɡɚ ɩɪɨɜɨɞɢɬɫɹ ɫ ɩɨɦɨɳɶɸ ɡɚɦɟɫɬɢɬɟɥɶɧɨɣ ɬɟɪɚɩɢɢ ɩɪɟɩɚɪɚɬɚɦɢ ɥɟɜɨɬɢɪɨɤɫɢɧɚ. Ɂɚɦɟɫɬɢɬɟɥɶɧɚɹ ɬɟɪɚɩɢɹ, ɩɪɨɜɨɞɢɦɚɹ ɞɨ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɞɨɥɠɧɚ ɛɵɬɶ ɩɪɨɞɨɥɠɟɧɚ ɢ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ. ɉɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɤɨɪɦɥɟɧɢɢ ɝɪɭɞɶɸ ɫɥɟɞɭɟɬ ɪɚɫɫɱɢɬɵɜɚɬɶ ɞɨɡɭ ɜ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɩɨɜɵɲɟɧɧɨɣ ɩɨɬɪɟɛɧɨɫɬɶɸ ɜ ɩɪɟɩɚɪɚɬɟ. Ⱦɚɠɟ ɟɫɥɢ ɛɟɪɟɦɟɧɧɚɹ ɩɨɥɭɱɚɟɬ ɥɟɜɨɬɢɪɨɤɫɢɧ ɩɨ ɩɨɜɨɞɭ ɝɢɩɨɬɢɪɟɨɢɞɧɨɝɨ ɡɨɛɚ, ɧɨ ɠɢɜɟɬ ɜ ɷɧɞɟɦɢɱɧɨɣ ɦɟɫɬɧɨɫɬɢ, - ɷɬɨ ɧɟ ɢɫɤɥɸɱɚɟɬ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɩɪɢɟɦɚ ɣɨɞɢɞɚ ɤɚɥɢɹ. ɇɚɡɧɚɱɚɸɬ ɥɟɜɨɬɢɪɨɤɫɢɧ ɜ ɧɚɱɚɥɶɧɨɣ ɞɨɡɟ 0,075-0, ɦɝ/ɫɭɬ ɜɧɭɬɪɶ. Ⱦɥɹ ɨɰɟɧɤɢ ɪɟɡɭɥɶɬɚɬɨɜ ɥɟɱɟɧɢɹ ɤɚɠɞɵɟ 4 ɧɟɞ ɨɩɪɟɞɟɥɹɸɬ ɭɪɨɜɟɧɶ ɫɜɨɛɨɞɧɨɝɨ Ɍ4 ɢ ɌɌȽ. Ⱦɨɡɭ ɥɟɜɨɬɢɪɨɤɫɢɧɚ ɩɨɞɛɢɪɚɸɬ ɬɚɤ, ɱɬɨɛɵ ɩɨɞɞɟɪɠɢɜɚɬɶ ɭɪɨɜɟɧɶ ɌɌȽ ɜ ɩɪɟɞɟɥɚɯ ɧɨɪɦɵ.

Ⱦɨɤɚɡɚɧɨ, ɱɬɨ ɧɚɡɧɚɱɟɧɢɟ ɫɭɥɶɮɚɬɚ ɠɟɥɟɡɚ ɫɧɢɠɚɟɬ ɷɮɮɟɤɬɢɜɧɨɫɬɶ ɬɢɪɟɨɢɞɧɵɯ ɝɨɪɦɨɧɨɜ, ɜɢɞɢɦɨ, ɜɜɢɞɭ ɫɜɹɡɵɜɚɧɢɹ ɠɟɥɟɡɚ ɫ ɬɢɪɨɤɫɢɧɨɦ. ɉɨɷɬɨɦɭ ɪɟɤɨɦɟɧɞɭɟɬɫɹ ɧɚɡɧɚɱɚɬɶ ɷɬɢ ɦɟɞɢɤɚɦɟɧɬɵ ɫ ɩɟɪɟɪɵɜɨɦ ɧɟ ɦɟɧɟɟ ɱɟɦ ɜ 2 ɱɚɫɚ.

E.Ȼɟɪɟɦɟɧɧɨɫɬɶ ɢ ɚɧɬɢɬɟɥɚ ɤ ɓɀ.

•ɍ ɞɟɬɟɣ ɨɬ ɦɚɬɟɪɟɣ ɫ ɩɨɜɵɲɟɧɧɵɦ ɭɪɨɜɧɟɦ ɚɧɬɢɬɟɥ ɤ ɬɢɪɟɨɢɞɧɨɣ ɩɟɪɨɤɫɢɞɚɡɟ ɞɚɠɟ ɩɪɢ ɧɨɪɦɚɥɶɧɨɣ ɮɭɧɤɰɢɢ ɓɀ ɢɦɟɟɬɫɹ ɩɨɜɵɲɟɧɧɵɣ ɪɢɫɤ ɡɚɞɟɪɠɤɢ ɭɦɫɬɜɟɧɧɨɝɨ ɪɚɡɜɢɬɢɹ (ɭɱɢɬɵɜɚɹ ɜɨɡɦɨɠɧɵɣ ɬɪɚɧɫɩɥɚɰɟɧɬɚɪɧɵɣ ɩɟɪɟɧɨɫ ɚɧɬɢɬɢɪɟɨɢɞɧɵɯ ɚɧɬɢɬɟɥ).

•ɉɪɢɪɨɫɬ ɦɚɫɫɵ ɬɟɥɚ ɭɷɬɢɯ ɧɨɜɨɪɨɠɞɟɧɧɵɯ ɡɧɚɱɢɬɟɥɶɧɨ ɦɟɧɶɲɟ.

•ɍɫɬɚɧɨɜɥɟɧɨ, ɱɬɨ ɭɜɟɥɢɱɟɧɢɟ ɤɨɧɰɟɧɬɪɚɰɢɢ ɚɧɬɢɬɟɥ ɤ ɓɀ ɨɬɦɟɱɚɟɬɫɹ ɭ ɠɟɧɳɢɧ ɫ ɩɪɢɜɵɱɧɵɦ ɧɟɜɵɧɚɲɢɜɚɧɢɟɦ.

•Ʉɪɨɦɟ ɬɨɝɨ, ɨɛɧɚɪɭɠɟɧɢɟ ɚɧɬɢɬɟɥ ɤ ɓɀ (ɢɦɦɭɧɨɝɥɨɛɭɥɢɧɨɜ, ɢɧɝɢɛɢɪɭɸɳɢɯ ɫɜɹɡɵɜɚɧɢɟ ɌɌȽ ɫ ɪɟɰɟɩɬɨɪɚɦɢ, ɚɧɬɢɬɟɥ, ɫɬɢɦɭɥɢɪɭɸɳɢɯ ɮɭɧɤɰɢɸ ɓɀ, ɚɧɬɢɬɟɥ ɤ ɬɢɪɟɨɢɞɧɨɣ ɩɟɪɨɤɫɢɞɚɡɟ) ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢɦɟɟɬ ɩɪɨ-

ɋɬɪɚɧɢɰɚ 22 ɢɡ 27

Ʉɚɮɟɞɪɚ Ⱥɤɭɲɟɫɬɜɚ ɢ Ƚɢɧɟɤɨɥɨɝɢɢ əȽɆȺ, 200

ɝɧɨɫɬɢɱɟɫɤɢ ɜɚɠɧɨɟ ɡɧɚɱɟɧɢɟ, ɬɚɤ ɤɚɤ ɭ ɤɚɠɞɨɣ ɬɪɟɬɶɟɣ ɠɟɧɳɢɧɵ ɩɪɢ ɧɚɥɢɱɢɢ ɢɯ ɜ ɤɪɨɜɢ ɜɨɡɧɢɤɚɟɬ ɩɨɫɥɟɪɨɞɨɜɵɣ ɬɢɪɟɨɢɞɢɬ, ɞɥɹ ɤɨɬɨɪɨɝɨ ɯɚɪɚɤɬɟɪɧɨ ɩɨɫɥɟɪɨɞɨɜɨɟ ɬɪɚɧɡɢɬɨɪɧɨɟ ɧɚɪɭɲɟɧɢɟ ɮɭɧɤɰɢɢ ɓɀ.

F.Ɋɚɤ ɓɀ.

•ɉɪɢ ɪɚɤɟ ɓɀ ɜɨɩɪɨɫ ɩɥɚɧɢɪɨɜɚɧɢɹ ɢ ɫɨɯɪɚɧɟɧɢɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɪɢɨɛɪɟɬɚɟɬ ɨɫɨɛɨɟ ɡɧɚɱɟɧɢɟ, ɬɚɤ ɤɚɤ ɩɨɞɚɜɥɹɸɳɟɟ ɱɢɫɥɨ ɛɨɥɶɧɵɯ ɫ ɬɢɪɟɨɢɞɧɵɦɢ ɧɟɨɩɥɚɡɢɹɦɢ - ɷɬɨ ɠɟɧɳɢɧɵ ɜ ɜɨɡɪɚɫɬɟ ɞɨ 25 ɥɟɬ. ȼɨɩɪɨɫ ɨ ɜɨɡɦɨɠɧɨɫɬɢ ɧɚɫɬɭɩɥɟɧɢɹ ɢ ɫɨɯɪɚɧɟɧɢɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɩɨɫɥɟ ɨɩɟɪɚɬɢɜɧɨɝɨ ɥɟɱɟɧɢɹ ɪɚɤɚ ɓɀ ɞɨɥɠɟɧ ɪɟɲɚɬɶɫɹ ɢɧɞɢɜɢɞɭɚɥɶɧɨ. ɇɟɨɛɯɨɞɢɦɨ ɭɱɢɬɵɜɚɬɶ ɩɪɢ ɷɬɨɦ ɦɨɪɮɨɥɨɝɢɱɟɫɤɨɟ ɫɬɪɨɟɧɢɟ ɢ ɫɬɚɞɢɸ ɨɩɭɯɨɥɢ, ɯɚɪɚɤɬɟɪ ɩɪɨɜɟɞɟɧɧɨɣ ɨɩɟɪɚɰɢɢ, ɜɪɟɦɹ, ɩɪɨɲɟɞɲɟɟ ɩɨɫɥɟ ɨɩɟɪɚɬɢɜɧɨɝɨ ɥɟɱɟɧɢɹ, ɜɨɡɪɚɫɬ ɢ ɠɟɥɚɧɢɟ ɫɚɦɨɣ ɠɟɧɳɢɧɵ ɪɨɞɢɬɶ ɡɞɨɪɨɜɨɝɨ ɪɟɛɟɧɤɚ.

•Ɋɚɡɪɟɲɢɬɶ ɧɚɫɬɭɩɥɟɧɢɟ ɢ ɫɨɯɪɚɧɟɧɢɟ ɛɟɪɟɦɟɧɧɨɫɬɢ ɦɨɠɧɨ ɛɨɥɶɧɵɦ, ɪɚɞɢɤɚɥɶɧɨ ɨɩɟɪɢɪɨɜɚɧɧɵɦ ɩɨ ɩɨɜɨɞɭ ɞɢɮɮɟɪɟɧɰɢɪɨɜɚɧɧɵɯ ɤɚɪɰɢɧɨɦ ɓɀ (ɩɪɟɠɞɟ ɜɫɟɝɨ - ɩɚɩɩɢɥɹɪɧɵɣ ɪɚɤ) ɩɪɢ ɞɥɢɬɟɥɶɧɨɫɬɢ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɨɝɨ ɩɟɪɢɨɞɚ ɛɨɥɟɟ ɝɨɞɚ, ɩɪɢ ɨɬɫɭɬɫɬɜɢɢ ɪɟɰɢɞɢɜɨɜ ɡɚɛɨɥɟɜɚɧɢɹ ɢ ɧɟ ɦɟɧɟɟ, ɱɟɦ ɝɨɞ ɫɩɭɫɬɹ ɩɨɫɥɟ ɨɛɥɭɱɟɧɢɹ ɣɨɞɨɦ - 3 ɜ ɞɨɡɚɯ ɞɨ 250 ɦɄɸɪɢ. ɇɟɛɥɚɝɨɩɪɢɹɬɧɨɟ ɪɚɡɜɢɬɢɟ ɢ ɬɟɱɟɧɢɟ ɛɟɪɟɦɟɧɧɨɫɬɢ ɜɫɬɪɟɱɚɟɬɫɹ ɫ ɨɞɢɧɚɤɨɜɨɣ ɞɥɹ ɨɛɳɟɣ ɩɨɩɭɥɹɰɢɢ ɱɚɫɬɨɬɨɣ, ɩɪɨɰɟɫɫ ɝɟɫɬɚɰɢɢ ɧɟ ɜɥɢɹɟɬ ɧɚ ɷɜɨɥɸɰɢɸ ɤɚɪɰɢɧɨɦɵ. ɂɫɯɨɞ ɛɟɪɟɦɟɧɧɨɫɬɢ ɧɟ ɡɚɜɢɫɢɬ ɨɬ ɩɪɟɞɲɟɫɬɜɨɜɚɜɲɟɝɨ ɛɨɥɟɟ ɝɨɞɚ ɧɚɡɚɞ ɨɛɥɭɱɟɧɢɹ ɣɨɞɨɦ - 3 ɢ ɧɟ ɫɜɹɡɚɧ ɫ ɨɬɞɚɥɟɧɧɵɦ ɪɢɫɤɨɦ ɪɚɡɜɢɬɢɹ ɛɟɫɩɥɨɞɢɹ ɢ ɩɨɪɨɤɨɜ ɪɚɡɜɢɬɢɹ. Ɋɢɫɤ ɪɟɰɢɞɢɜɚ ɩɨɜɵɲɚɟɬɫɹ, ɟɫɥɢ ɩɟɪɜɚɹ ɛɟɪɟɦɟɧɧɨɫɬɶ ɨɤɨɧɱɢɥɚɫɶ ɜɵɤɢɞɵɲɟɦ ɢɥɢ ɜ ɚɧɚɦɧɟɡɟ ɭ ɠɟɧɳɢɧɵ ɢɦɟɟɬɫɹ ɛɨɥɟɟ 4 ɛɟɪɟɦɟɧɧɨɫɬɟɣ.

•ɉɪɢ ɧɟɞɢɮɮɟɪɟɧɰɢɪɨɜɚɧɧɵɯ ɤɚɪɰɢɧɨɦɚɯ ɧɚɫɬɭɩɥɟɧɢɟ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɟɟ ɩɪɨɥɨɧɝɢɪɨɜɚɧɢɟ ɚɛɫɨɥɸɬɧɨ ɩɪɨɬɢɜɨɩɨɤɚɡɚɧɨ.

•ȼ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɧɚɢɦɟɧɟɟ ɢɡɭɱɟɧ ɜɨɩɪɨɫ ɫɨɱɟɬɚɧɢɹ ɦɟɞɭɥɥɹɪɧɨɣ ɤɚɪɰɢɧɨɦɵ ɓɀ ɢ ɛɟɪɟɦɟɧɧɨɫɬɢ. ɉɨ-ɜɢɞɢɦɨɦɭ, ɜ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɞɚɧɧɚɹ ɮɨɪɦɚ ɪɚɤɚ, ɨɫɨɛɟɧɧɨ ɟɟ ɫɟɦɟɣɧɵɟ ɮɨɪɦɵ, ɬɚɤɠɟ ɹɜɥɹɸɬɫɹ ɫɨɫɬɨɹɧɢɟɦ, ɩɪɢ ɤɨɬɨɪɨɦ ɛɟɪɟɦɟɧɧɨɫɬɶ ɩɪɨɬɢɜɨɩɨɤɚɡɚɧɚ.

•ȿɫɥɢ ɞɢɚɝɧɨɫɬɢɪɭɟɬɫɹ ɪɚɤ ɓɀ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ, ɬɨ ɨɩɟɪɚɬɢɜɧɨɟ ɜɦɟɲɚɬɟɥɶɫɬɜɨ ɜɨ II ɬɪɢɦɟɫɬɪɟ ɢ ɩɪɢɰɟɥɶɧɚɹ ɛɢɨɩɫɢɹ ɜ ɥɸɛɵɟ ɫɪɨɤɢ ɛɟɡɨɩɚɫɧɵ ɞɥɹ ɛɟɪɟɦɟɧɧɨɣ ɢ ɩɥɨɞɚ.

•ɇɚɛɥɸɞɟɧɢɹ ɡɚ ɛɨɥɶɧɵɦɢ ɫ ɞɢɚɝɧɨɡɨɦ ɪɚɤɚ ɓɀ ɩɨɤɚɡɚɥɢ, ɱɬɨ ɛɨɥɶɲɨɣ ɩɪɨɰɟɧɬ ɷɬɢɯ ɠɟɧɳɢɧ (24 ɢɡ 0 3) ɜ ɬɟɱɟɧɢɟ ɛɥɢɠɚɣɲɢɯ 2 ɥɟɬ ɩɨɫɥɟ ɭɫɬɚɧɨɜɥɟɧɢɹ ɞɢɚɝɧɨɡɚ ɢ ɨɩɟɪɚɰɢɢ ɢɦɟɸɬ ɪɚɤ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ. Ɍɚɤɢɦ ɨɛɪɚɡɨɦ,

ɫɞɟɥɚɧ ɜɵɜɨɞ ɨ ɧɟɨɛɯɨɞɢɦɨɫɬɢ ɨɛɫɥɟɞɨɜɚɧɢɹ ɦɨɥɨɱɧɵɯ ɠɟɥɟɡ ɜ ɬɟɱɟɧɢɟ ɛɥɢɠɚɣɲɢɯ 2 ɥɟɬ ɩɨɫɥɟ ɬɢɪɟɨɢɞɷɤɬɨɦɢɢ. ȼ ɫɜɨɸ ɨɱɟɪɟɞɶ ɢɡ 8 9 ɠɟɧ-

ɳɢɧ ɫ ɞɢɚɝɧɨɡɨɦ ɪɚɤɚ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ ɬɨɥɶɤɨ ɭ ɪɚɡɜɢɜɚɥɫɹ ɪɚɤ ɓɀ.

G. ɉɨɫɥɟɪɨɞɨɜɵɣ ɬɢɪɟɨɢɞɢɬ.

ɉɨɫɥɟɪɨɞɨɜɨɣ ɬɢɪɟɨɢɞɢɬ (ɉɌ) ɹɜɥɹɟɬɫɹ ɞɨɫɬɚɬɨɱɧɨ ɱɚɫɬɵɦ ɡɚɛɨɥɟɜɚɧɢɟɦ: ɨɧ ɧɚɛɥɸɞɚɟɬɫɹ ɭ 6 - 8 % ɜɫɟɯ ɠɟɧɳɢɧ ɋɒȺ, ɭ , % ɠɟɧɳɢɧ ɜ Ɍɚɢɥɚɧɞɟ, ɞɨ 6,7 % ɭ ɠɟɧɳɢɧ ɜ ȼɟɥɢɤɨɛɪɢɬɚɧɢɢ. ɗɩɢɞɟɦɢɨɥɨɝɢɱɟɫɤɢɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɭɫɬɚɧɨɜɢɥɢ ɫɪɟɞɧɸɸ ɱɚɫɬɨɬɭ ɨɤɨɥɨ 5% ɜɧɟ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɣɨɞɧɨɝɨ ɨɛɟɫɩɟɱɟɧɢɹ. ɉɌ - ɚɭɬɨɢɦɭɧɧɨɟ ɧɚɪɭɲɟɧɢɟ, ɯɚɪɚɤɬɟɪɢɡɭɸɳɟɟɫɹ ɪɚɡɪɭɲɢɬɟɥɶɧɨɣ ɥɢɦɮɨɰɢɬɚɪɧɨɣ ɢɧɮɢɥɶɬɪɚɰɢɟɣ ɓɀ. ɗɬɢɨɥɨɝɢɹ ɧɟɢɡɜɟɫɬɧɚ. ɉɪɢ ɉɌ, ɤɚɤ ɩɪɚɜɢɥɨ, ɱɟɪɟɡ 8 - 2 ɧɟɞ ɩɨɫɥɟ ɪɨɞɨɜ ɪɚɡɜɢɜɚɟɬɫɹ ɬɪɚɧɡɢɬɨɪɧɵɣ ɬɢɪɟɨɬɨɤɫɢɤɨɡ, ɜɩɨ-

ɋɬɪɚɧɢɰɚ 23 ɢɡ 27

Ʉɚɮɟɞɪɚ Ⱥɤɭɲɟɫɬɜɚ ɢ Ƚɢɧɟɤɨɥɨɝɢɢ əȽɆȺ, 200

ɫɥɟɞɫɬɜɢɢ ɝɢɩɨɬɢɪɟɨɡ (ɩɪɢɦɟɪɧɨ ɜ ɫɟɪɟɞɢɧɟ 9-ɣ ɧɟɞɟɥɢ), ɚ ɱɟɪɟɡ 6 - 8 ɦɟɫ ɜɨɫɫɬɚɧɚɜɥɢɜɚɟɬɫɹ ɷɭɬɢɪɟɨɡ. ɋɪɟɞɢ ɫɢɦɩɬɨɦɨɜ ɝɢɩɨɬɢɪɟɨɡɚ ɱɚɳɟ ɜɫɟɝɨ ɜɫɬɪɟɱɚɸɬɫɹ ɩɨɜɵɲɟɧɧɚɹ ɭɬɨɦɥɹɟɦɨɫɬɶ, ɞɟɩɪɟɫɫɢɹ, ɫɧɢɠɟɧɢɟ ɩɚɦɹɬɢ, ɪɚɡɞɪɚɠɢɬɟɥɶɧɨɫɬɶ, ɫɭɯɨɫɬɶ ɤɨɠɢ. Ɉɱɟɧɶ ɪɟɞɤɨ ɝɢɩɨɬɢɪɟɨɡ ɩɪɟɞɲɟɫɬɜɭɟɬ ɬɢɪɟɨɬɨɤɫɢɤɨɡɭ. ɉɨɜɵɲɟɧɢɟ ɬɢɬɪɚ ɚɧɬɢɬɟɥ ɤ ɬɢɪɟɨɢɞɧɨɣ ɩɟɪɨɤɫɢɞɚɡɟ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ ɹɜɥɹɟɬɫɹ ɮɚɤɬɨɪɨɦ ɪɢɫɤɚ ɟɝɨ ɪɚɡɜɢɬɢɹ. ȼ ɫɪɟɞɧɟɦ ɭ 20 % ɩɚɰɢɟɧɬɨɤ ɫ ɉɌ ɪɚɡɜɢɜɚɟɬɫɹ ɩɨɫɬɨɹɧɧɵɣ ɝɢɩɨɬɢɪɟɨɡ ɜ ɩɪɟɞɟɥɚɯ 5 ɥɟɬ.

ɉɪɨɮɢɥɚɤɬɢɤɚ ɢ ɫɜɨɟɜɪɟɦɟɧɧɨ ɧɚɱɚɬɨɟ ɥɟɱɟɧɢɟ ɬɢɪɟɨɢɞɧɨɣ ɩɚɬɨɥɨɝɢɢ ɭ ɛɟɪɟɦɟɧɧɵɯ ɩɨɡɜɨɥɹɬ ɡɧɚɱɢɬɟɥɶɧɨ ɫɧɢɡɢɬɶ ɱɚɫɬɨɬɭ ɡɚɛɨɥɟɜɚɧɢɣ ɓɀ ɤɚɤ ɭ ɦɚɬɟɪɢ, ɬɚɤ ɢ ɭ ɪɟɛɟɧɤɚ ɢ ɛɭɞɭɬ ɫɩɨɫɨɛɫɬɜɨɜɚɬɶ ɜ ɡɧɚɱɢɬɟɥɶɧɨɣ ɫɬɟɩɟɧɢ ɩɨɜɵɲɟɧɢɸ ɩɨɤɚɡɚɬɟɥɟɣ ɡɞɨɪɨɜɶɹ ɢ ɢɧɬɟɥɥɟɤɬɭɚɥɶɧɨɝɨ ɩɨɬɟɧɰɢɚɥɚ ɧɚɰɢɢ.

IV. Ʌɢɬɟɪɚɬɭɪɚ:

. ɗɧɤɢɧ Ɇ., Ʉɟɣɪɫ Ɇ., Ɋɟɧɮɶɸ Ɇ., Ⱦɠ. ɇɟɣɥɫɨɧ. Ɋɭɤɨɜɨɞɫɬɜɨ ɩɨ ɷɮɮɟɤɬɢɜɧɨɣ ɩɨɦɨɳɢ ɩɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ ɢ ɪɨɞɚɯ. ɉɟɪɟɜɨɞ ɫ ɚɧɝɥ. ɩɨɞ ɪɟɞɚɤɰ. ɗ. ɗɧɤɢɧ. ɋ-ɉɟɬɟɪɛɭɪɝ, 999.

2.ɇɢɫɜɚɧɞɟɪ Ʉ., ɗɜɚɧɫ Ⱥ. Ⱥɤɭɲɟɪɫɬɜɨ. ɋɩɪɚɜɨɱɧɢɤ Ʉɚɥɢɮɨɪɧɢɣɫɤɨɝɨ ɭɧɢɜɟɪɫɢɬɟɬɚ. ɉɟɪɟɜɨɞ ɫ ɚɧɝɥ. ɉɪɚɤɬɢɤɚ. Ɇ. 999.

3.ɗɧɞɨɤɪɢɧɨɥɨɝɢɹ. ɉɨɞ ɪɟɞ. ɇ. Ʌɚɜɢɧɚ. ɉɟɪ. ɫ ɚɧɝɥ. Ɇ. ɉɪɚɤɬɢɤɚ. 999.

4.Ɇɟɥɶɧɢɱɟɧɤɨ Ƚ.Ⱥ, Ʌɟɫɧɢɤɨɜɚ ɋ.ȼ. Ɉɫɨɛɟɧɧɨɫɬɢ ɮɭɧɤɰɢɨɧɢɪɨɜɚɧɢɹ ɳɢɬɨɜɢɞɧɨɣ ɠɟɥɟɡɵ ɜɨ ɜɪɟɦɹ ɛɟɪɟɦɟɧɧɨɫɬɢ. ɉɪɚɤɬɢɱɟɫɤɚɹ ɝɢɧɟɤɨɥɨɝɢɹ. 999. Ɍɨɦ I. N 2.

5.Ƚɟɪɚɫɢɦɨɜ Ƚ. Ⱥ. ȼɫɟɨɛɳɟɟ ɣɨɞɢɪɨɜɚɧɢɟ ɩɢɳɟɜɨɣ ɩɨɜɚɪɟɧɧɨɣ ɫɨɥɢ ɞɥɹ ɩɪɨɮɢɥɚɤɬɢɤɢ ɣɨɞɞɟɮɢɰɢɬɧɵɯ ɡɚɛɨɥɟɜɚɧɢɣ: ɩɪɟɢɦɭɳɟɫɬɜɚ ɡɧɚɱɢɬɟɥɶɧɨ ɩɪɟɜɵɲɚɸɬ ɪɢɫɤ. Ɍɢɪɨɧɟɬ

2000. N4.

6.Ɏɚɞɟɟɜ ȼ.ȼ. Ƀɨɞ, ɷɧɞɟɦɢɱɟɫɤɢɣ ɡɨɛ ɢ ɣɨɞɞɟɮɢɰɢɬɧɵɟ ɡɚɛɨɥɟɜɚɧɢɹ. http://thyronet.rusmedserv.com

7.ɏɨɫɬɚɥɟɤ ɍ. Ɂɚɛɨɥɟɜɚɧɢɹ ɳɢɬɨɜɢɞɧɨɣ ɠɟɥɟɡɵ ɢ ɜɨɡɦɨɠɧɨɫɬɢ ɢɯ ɷɮɮɟɤɬɢɜɧɨɝɨ ɥɟɱɟɧɢɹ.- Ɍɢɪɨɢɞ Ɋɨɫɫɢɹ.- ɋɛɨɪɧɢɤ ɥɟɤɰɢɣ.- Ɇɨɫɤɜɚ.- 997;6- 2.

8.WHO, UNICEF, ICCIDD. Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness. Geneva: WHO/NUT/96. 3

9.Mahomed K. Maternal iodine supplements in areas of deficiency (Cochrane Review). In: The Cochrane Library, Issue 3, 999. Oxford: Update Software.

0. Mestman J .H. Thyroid Diseases in Pregnancy. Other than Graves' Disease and Postpartum Thyroid Dysfunction. Endocrinologist. 999. Jul. 9(4). Ɋ. 294-307.

. Amino N., Tada H., Hidaka Y., et all. Screening for postpartum thyroiditis. J. Clin. Endocrinol. Metab. 999. 84(6). P. 8 3- 820.

2. Achiron R., Sivan E., Dolizki M., et all. Serial in-utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy. Ultrasound in Obstetrics and Gynecology. 2000. Vol. 6, Issue s , P. 8.

3. Glinoer D. Maternal and neonatal thyroid function in mild iodine deficiency. Merck European Thyroid Symposium "The Thyroid and Iodine". Warsaw. 996. 2942.

4. Glinoer D. et al. A randomized trial for the treatment of mild iodine deficiency during pregnancy: maternal and neonatal effects. J. Clin. Endocrinol. Metab. 995. (80) ʋ .258-269.

5. Glinoer D. Maternal and fetal impact of chronic iodine deficiency. Clinical Obstetrics And Gynecology. 997.(40) ʋ .Ɋ. 02- 6.

6. Goodwin T.M., Hershman J.M. Hyperthyrodism due to inappropriate production of human chorionic gonadotropin. Clinical Obstetrics And Gynecology. 997.(40) ʋ . Ɋ.32-44.

7. Porterfield S.P, Hendrich C.E. The role of thyroid hormones in prenatal and neonatal neurological development - current perspectives. Endocrine Reviews. 993. 4. .Ɋ.9403.

8. Smith M.B. et al. Thyroid cancer in pregnant women: diagnostic and therapeutic management.- Thyroid.- 994;Winter.- V.4. Ɋ.433-435.

ɋɬɪɚɧɢɰɚ 24 ɢɡ 27

Ʉɚɮɟɞɪɚ Ⱥɤɭɲɟɫɬɜɚ ɢ Ƚɢɧɟɤɨɥɨɝɢɢ əȽɆȺ, 200

V.ɉɪɢɥɨɠɟɧɢɟ.

Ⱥɥɝɨɪɢɬɦ ɨɰɟɧɤɢ ɮɭɧɤɰɢɢ ɳɢɬɨɜɢɞɧɨɣ ɠɟɥɟɡɵ ɩɪɢ ɛɟɪɟɦɟɧɧɨɫɬɢ

ɂɁɆȿɊȿɇɂȿ ɌɌȽ ȼ ɄɊɈȼɂ ȻȿɊȿɆȿɇɇɈɃ

ɫɭɛɤɥɢɧɢɱɟɫɤɢɣ

ɝɢɩɟɪɬɢɪɟɨɡ

ɋɬɪɚɧɢɰɚ 25 ɢɡ 27

Ʉɚɮɟɞɪɚ Ⱥɤɭɲɟɫɬɜɚ ɢ Ƚɢɧɟɤɨɥɨɝɢɢ əȽɆȺ, 200

Ʉɨɷɮɮɢɰɢɟɧɬɵ ɩɟɪɟɫɱɟɬɚ ɥɚɛɨɪɚɬɨɪɧɵɯ ɩɨɤɚɡɚɬɟɥɟɣ Ƚɓɀ.

µg/dL ɯ ,29 = ɩɦɨɥɶ/ɥ

µU/mL ɯ 0,00 = ɦɆȿ/ɦɥ

ng/dL x 0,0 54 = ɧɦɨɥɶ/ɥ

ɏɚɪɚɤɬɟɪɢɫɬɢɤɚ ɦɢɧɟɪɚɥɶɧɨ-ɜɢɬɚɦɢɧɧɵɯ ɤɨɦɩɥɟɤɫɨɜ ɫ ɭɱɟɬɨɦ ɫɨɞɟɪɠɚɧɢɹ ɣɨɞɚ.

ɋɬɪɚɧɢɰɚ 26 ɢɡ 27