АПРЕЛЬ 2011 - Ministry of Defencesc.mil.ru/files/morf/military/archive/042011.pdf · 2011 ¹...

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åäèöèíñêèé æ

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АПРЕЛЬ

2011

12 àïðåëÿ 1961 ã.

Ã Î ÄÐ Î Ñ Ñ È É Ñ Ê Î É

Ê Î Ñ Ì Î Í À Â Ò È Ê È ÏÎÅÕÀËÈ!

ÂÊËÀÄ ÂÎÅÍÍÎÉ ÌÅÄÈÖÈÍÛÂ ÊÎÑÌÈ×ÅÑÊÈÉ ÒÐÈÓÌÔ ÐÎÑÑÈÈ

Ïîëâåêà íàçàä, 12 àïðåëÿ 1961 ã., íàø ñîîòå÷åñòâåííèê ÞðèéÀëåêñååâè÷ Ãàãàðèí ïåðâûì â ìèðå ïðîëîæèë äîðîãó â êîñìîñ,îòêðûâ òåì ñàìûì êà÷åñòâåííî íîâûé ýòàï îñâîåíèÿ êîñìè÷åñêîãîïðîñòðàíñòâà. Íàøè ñïåöèàëèñòû íà ïåðâîì ýòàïå âîïëîòèëèñìåëóþ ìå÷òó ñíà÷àëà â áåñïðåöåäåíòíûé òåõíîëîãè÷åñêèé íàó÷íûéïðîåêò, à çàòåì è â ïîäëèííûé îáùåíàöèîíàëüíûé òðèóìô.

Îäíèì èç ñëàãàåìûõ ýòîãî âåëè÷àé-øåãî ïðîðûâà ñòàëè äîñòèæåíèÿ âîåí-íîé ìåäèöèíû, ïðåäñòàâèòåëè êîòîðîéçàäîëãî äî Ãàãàðèíñêîãî ñòàðòà ðàçðà-áîòàëè íàó÷íûå îñíîâû ïèëîòèðóåìîéêîñìîíàâòèêè, îïðåäåëèëè òðåáîâàíèÿ,ïðåäúÿâëÿåìûå ê ëåò÷èêàì-êîñìîíàâòàì,ïðîâåëè æåñòêèé îòáîð êàíäèäàòîâíà ïîëåòû è îñóùåñòâèëè ìåäèöèíñêîåñîïðîâîæäåíèå èõ ïîäãîòîâêè.

Êîñìîíàâò ¹ 100ïîëêîâíèê ìåäèöèíñêîé ñëóæáû

Î.Â.Êîòîâ è ÷ëåíû ñîâåòà Âîåííî-ìåäèöèíñêîé àêàäåìèè ïî çàùèòå

êàíäèäàòñêèõ è äîêòîðñêèõ äèññåðòàöèé

Âûñòóïëåíèå Þ.À.Ãàãàðèíà ïåðåäêîëëåêòèâîì ÃîñÍÈÈÈ àâèàöèîííîéè êîñìè÷åñêîé ìåäèöèíû

Ïàìÿòíèê ñîáàêå Ëàéêåïåðåä âõîäîì â ÍÈÈÈ âîåííîé ìåäèöèíûÂîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà

Àäðåñ ðåäàêöèè:194044, Ñàíêò-Ïåòåðáóðã,óë. Àêàäåìèêà Ëåáåäåâà, ä. 6Òåë. (812) 329-71-94

Êîðïóíêò â Ìîñêâå:119160, Ìîñêâà, ðåäàêöèÿ«Âîåííî-ìåäèöèíñêîãî æóðíàëà»Òåë./ôàêñ: (495) 656-33-41

ÅÆÅÌÅÑß×ÍÛÉÒÅÎÐÅÒÈ×ÅÑÊÈÉÈ ÍÀÓ×ÍÎ-ÏÐÀÊÒÈ×ÅÑÊÈÉÆÓÐÍÀËÌÈÍÈÑÒÅÐÑÒÂÀ ÎÁÎÐÎÍÛÐÎÑÑÈÉÑÊÎÉ ÔÅÄÅÐÀÖÈÈ

Non scholae, sed vitae discimus!

ÐÅÄÀÊÖÈÎÍÍÀßÊÎËËÅÃÈß:

Ì.Â.Ïîääóáíûé (ãëàâíûéðåäàêòîð)À.Á.ÁåëåâèòèíÂ.Â.Áóçóíîâ (îòâåòñòâåííûéñåêðåòàðü)È.Â.ÁóõòèÿðîâÀ.Þ.ÂëàñîâË.Ë.Ãàëèí (çàìåñòèòåëüãëàâíîãî ðåäàêòîðà)Â.Â.ÈâàíîâÎ.Â.Êàëà÷åâÀ.À.ÊàëìûêîâÀ.Í.Êó÷ìèíÞ.Â.ËîáçèíÞ.Â.Ìèðîøíè÷åíêîÀ.Ý.ÍèêèòèíÂ.Å.ÏàðôåíîâÈ.Â.ÏåòðååâÈ.Ì.ÑàìîõâàëîâÝ.Ï.ÑîëîâåéÞ.Ø.ÕàëèìîâÂ.Í.ÖûãàíÂ.Ê.ØàìðåéÀ.Ì.ØåëåïîâÂ.Â.ßìåíñêîâ

ÐÅÄÀÊÖÈÎÍÍÛÉÑÎÂÅÒ:

Èçäàåòñÿ ñ 1823 ãîäà

2011 * ÀÏÐÅËÜ

Ò. 332 * ¹ 4

ÌÎÑÊÂÀÈÇÄÀÒÅËÜÑÊÈÉ ÄÎÌ«ÊÐÀÑÍÀß ÇÂÅÇÄÀ»

Ñ.À.Áåëÿêèí (Êðàñíîãîðñê)Å.Â.Áîÿðñêèõ (Åêàòåðèíáóðã)Ï.Ã.Áðþñîâ (Ìîñêâà)À.À.Áóäêî (Ñ.-Ïåòåðáóðã)Ñ.Ô.Ãîí÷àðîâ (Ìîñêâà)Â.Â.Äîáðæàíñêèé (Ìîñêâà)È.Á.Ìàêñèìîâ (Ìîñêâà)È.Ã.Ìîñÿãèí (Êàëèíèíãðàä)Ý.À.Íå÷àåâ (Ìîñêâà)Â.À.Íîâèêîâ (Ðîñòîâ-íà-Äîíó)Â.Þ.Ïåòðèùåâ (Õàáàðîâñê)Þ.Â.Ñàáàíèí (Ìîñêâà)Â.Á.Ñèìîíåíêî (Ìîñêâà)Þ.Ð.Õàíêåâè÷ (Ñåâåðîìîðñê)È.Ì.×èæ (Ìîñêâà)

Àäðåñ â ñåòè Èíòåðíåò:www.mil.ru/info/1070/11618

Âêëàä âîåííîé àâèàöèîííîéè êîñìè÷åñêîé ìåäèöèíû â ìåäèêî-áèîëîãè÷åñêîå îáåñïå÷åíèå ïåðâîãîïîëåòà ÷åëîâåêà â êîñìîñ

Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿè îñâîåíèå êîñìîñà

Èñòîðè÷åñêèå àñïåêòû ôîðìèðîâàíèÿÑëóæáû ìåäèöèíû êàòàñòðîôÌèíèñòåðñòâà îáîðîíû ÐÔ

Âîçäóøíî-êàïåëüíûå èíôåêöèèâ âîéñêàõ (íà ôëîòå)

Ôàãîïðîôèëàêòèêà è ôàãîòåðàïèÿõèðóðãè÷åñêèõ èíôåêöèé

Ìåòîäû õèðóðãè÷åñêîãî ëå÷åíèÿáîëüíûõ ñ ïåðåëîìàìè ïðîêñèìàëüíîãîîòäåëà áåäðåííîé è ïëå÷åâîé êîñòåé

Àâèàöèîííàÿ ìåäèöèíà: â÷åðà,ñåãîäíÿ, çàâòðà

© «Âîåííî-ìåäèöèíñêèé æóðíàë», 4’20112

ÑONTENTS

4

Ëå÷åáíî-ïðîôèëàêòè÷åñêèåâîïðîñû

Prophylaxis and treatment

Îðãàíèçàöèÿ ìåäèöèíñêîãîîáåñïå÷åíèÿ Âîîðóæåííûõ Ñèë

Organization of medical supportof the Armed Forces

10

34

40

47

Ìåäèöèíà ýêñòðåìàëüíûõñèòóàöèé

Medicine of extremesituations

Âîéñêîâàÿ ìåäèöèíà Army health Service

51

Belevitin A.B., Bukhtiyarov I.V., Zhdan’ko I.M.,Bednenko V.S., Khomenko M.N. – The con-tribution of military aviation and spacemedicine in the biomedical support of thefirst human flight into space

Belevitin A.B., Kornyushko I.G., Yakovlev S.V.– Historical aspects of formation of Dis-aster Medicine Service of the Ministry ofDefenñe of the Russian Federation

Belov A.B., Ogarkov P.I. – Current issuesof epidemiology and vaccinal prevention«children’s» airborne infections in themilitary (navy)

Bryusov P.G., Zubritsky V.F., Islamov R.N.,Nizovoy A.V., Fominykh E.M. – Phago-prophylaxis and bacteriophage treatmentof surgical infections

Shapovalov V.M., Khominets V.V., Mikhay-lov S.V., Shakun D.A. – Selection of arational method of surgical treatment ofpatients with fractures of the proximalfemur

Kovalyov P.V., Dubrovin G.M., Gorban E.V.– Biomechanical rationale of the tensescrewpin osteosynthesis of the proximal hu-merus

28

16

Áåëåâèòèí À.Á., Áóõòèÿðîâ È.Â., Æäàíü-êî È.Ì., Áåäíåíêî Â.Ñ., Õîìåíêî Ì.Í. –Âêëàä âîåííîé àâèàöèîííîé è êîñìè÷å-ñêîé ìåäèöèíû â ìåäèêî-áèîëîãè÷åñêîåîáåñïå÷åíèå ïåðâîãî ïîëåòà ÷åëîâåêàâ êîñìîñ

Áåëåâèòèí À.Á., Êîðíþøêî È.Ã., ßêîâëåâ Ñ.Â.– Èñòîðè÷åñêèå àñïåêòû ôîðìèðîâàíèÿÑëóæáû ìåäèöèíû êàòàñòðîô Ìèíèñòåð-ñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè

Áåëîâ À.Á., Îãàðêîâ Ï.È. – Àêòóàëüíûåâîïðîñû ýïèäåìèîëîãèè è âàêöèíîïðî-ôèëàêòèêè «äåòñêèõ» âîçäóøíî-êàïåëü-íûõ èíôåêöèé â âîéñêàõ (íà ôëîòå)

Áðþñîâ Ï.Ã., Çóáðèöêèé Â.Ô., Èñëà-ìîâ Ð.Í., Íèçîâîé À.Â., Ôîìèíûõ Å.Ì. –Ôàãîïðîôèëàêòèêà è ôàãîòåðàïèÿõèðóðãè÷åñêèõ èíôåêöèé

Øàïîâàëîâ Â.Ì., Õîìèíåö Â.Â., Ìèõàé-ëîâ Ñ.Â., Øàêóí Ä.À. – Âûáîð ðàöèî-íàëüíîé ìåòîäèêè õèðóðãè÷åñêîãî ëå-÷åíèÿ áîëüíûõ ñ ïåðåëîìàìè ïðîêñè-ìàëüíîãî îòäåëà áåäðåííîé êîñòè

Êîâàë¸â Ï.Â., Äóáðîâèí Ã.Ì., Ãîðáàíü Å.Â.– Áèîìåõàíè÷åñêîå îáîñíîâàíèå íà-ïðÿæåííîãî ñïèöåâèíòîâîãî îñòåî-ñèíòåçà ïåðåëîìîâ ïðîêñèìàëüíîãîîòäåëà ïëå÷åâîé êîñòè

Ñèìîíåíêî Â.Á., ×àïëþê À.Ë., Òåñëÿ À.Í.,Ïîòàïåíêî Â.Í. – Äèàãíîñòèêà áîëå-âîãî ñèíäðîìà â ãðóäíîé êëåòêå â óñ-ëîâèÿõ ìíîãîïðîôèëüíîãî ëå÷åáíî-ïðîôèëàêòè÷åñêîãî ó÷ðåæäåíèÿ

Simonenko V.B., Chaplyuk A.L., Teslya A.N.,Potapenko V.N. – The diagnosis of painsyndrome in the chest in a multidisciplinarymedical and prophylactic facility

12

Áåëåâèòèí À.Á., Öûãàí Â.Í., Áëàãèíèí À.À.,Êàëòûãèí Ì.Â. – Âêëàä Âîåííî-ìåäèöèíñêîé àêàäåìèè â îñâîåíèåêîñìîñà

Belevitin A.B., Tsygan V.N., Blaginin A.A.,Kaltygin M.V. – The contribution of theMilitary Medical Academy in space ex-ploration

3«Âîåííî-ìåäèöèíñêèé æóðíàë», 4’2011

ÑONTENTS

Îôèöèàëüíûé îòäåë Official communications

Àâèàöèîííàÿè âîåííî-ìîðñêàÿ ìåäèöèíà

Air and navy medicine

80

Êðàòêèå ñîîáùåíèÿ Brief reports 61,62

Èç èñòîðèèâîåííîé ìåäèöèíû

From the historyof military medicine

59

87

Êðèòèêà è áèáëèîãðàôèÿ Criticism and bibliography

92

Yamenskov V.V., Khafizov N.N., Morozov A.V.– Aviation medicine: yesterday, today andtomorrow

Ïî ñòðàíèöàì çàðóáåæíîéìåäèöèíñêîé ïå÷àòè

From the foreignmedical publications

Êàìåíñêîâ Í.Í., Êîâàëüñêèé Î.Í. – Ýòà-ïû ðàçâèòèÿ îòå÷åñòâåííîé âîåííî-âðà÷åáíîé ýêñïåðòèçû (Ê 90-ëåòèþñîçäàíèÿ øòàòíûõ âîåííî-âðà÷åáíûõêîìèññèé)

ßìåíñêîâ Â.Â., Õàôèçîâ Í.Í., Ìîðîçîâ À.Â.– Àâèàöèîííàÿ ìåäèöèíà: â÷åðà, ñåãîäíÿ,çàâòðà

78

Kamenskov N.N., Koval’sky O.N. – Stagesof development of native military-medicalexamination (To the 90 anniversaryof establishment of permanent militarymedical commissions)

Ïîääóáíûé Ì.Â. – Ôóíäàìåíòàëüíûéòðóä ïî èñòîðèè Êèåâñêîãî âîåííîãîãîñïèòàëÿ

Poddubny M.V. – The fundamental workon the history of Kiev Military Hospital

Ãîëóáåâà À.À. – Âûñîêîå ïðåäíàçíà-÷åíèå Âðà÷à (Èíòåðâüþ ñ ãåíåðàë-ìàéîðîì ìåäèöèíñêîé ñëóæáû çàïàñàÞ.Â.Ëîáçèíûì)

Golubyeva A.A. – High mission of theDoctor (Interview to the major-generalof medical service of a stock Yu.V.Lobzin)90

«Âîåííî-ìåäèöèíñêèé æóðíàë», 4’20114

ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 613.693

Âêëàä âîåííîé àâèàöèîííîé è êîñìè÷åñêîéìåäèöèíû â ìåäèêî-áèîëîãè÷åñêîå îáåñïå÷åíèåïåðâîãî ïîëåòà ÷åëîâåêà â êîñìîñ

ÁÅËÅÂÈÒÈÍ À.Á., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû1

ÁÓÕÒÈßÐÎÂ È.Â., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

ÆÄÀÍÜÊÎ È.Ì., äîêòîð ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

ÁÅÄÍÅÍÊÎ Â.Ñ., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ïðîôåññîð, ïîëêîâíèê â îòñòàâêå2

ÕÎÌÅÍÊÎ Ì.Í., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð,ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå2

1Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëåíèå, Ñàíêò-Ïåòåðáóðã; 2ÍÈÈÈ âîåííîé ìåäèöèíûÂîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã

Belevitin A.B., Bukhtiyarov I.V., Zhdan’ko I.M., Bednenko V.S., Khomenko M.N. – The contributionof military aviation and space medicine in the biomedical support of the first flight into space.April 12, 2011 Humanity celebrated 50 years of one of the greatest achievements of the twentieth century– the legendary flight of Y.Gagarin into space. In this study are highlighted the role and importanceof military aviation and space medicine, and in particular, the State Scientific Research Testing Instituteof Aviation and Space Medicine, Ministry of Defence of the USSR (now – the State Scientific ResearchTesting Institute of Military Medicine, Military Medical Academy named after S.M.Kirov) in the preparationand conduct of flight of Yu.A.Gagarin.

K e y w o r d s: human space flight, aviation and space medicine, the first cosmonaut Yuri Gagarin.

12 àïðåëÿ 2011 ã. ÷åëîâå÷åñòâî îòìå-òèëî 50-ëåòèå îäíîãî èç âåëè÷àéøèõ äî-ñòèæåíèé ÕÕ ñòîëåòèÿ – ëåãåíäàðíîãîïîëåòà Þ.À. Ãàãàðèíà â êîñìè÷åñêîå ïðî-ñòðàíñòâî. Â íàñòîÿùåé ðàáîòå ìû õîòåëèáû îñòàíîâèòüñÿ íà èçëîæåíèè ðîëè èçíà÷åíèè âîåííîé àâèàöèîííîé è êîñ-ìè÷åñêîé ìåäèöèíû, è â ÷àñòíîñòè,Ãîñóäàðñòâåííîãî íàó÷íî-èññëåäîâà-òåëüñêîãî èñïûòàòåëüíîãî èíñòèòóòààâèàöèîííîé è êîñìè÷åñêîé ìåäèöèíû(ÃÍÈÈÈ ÀèÊÌ) Ìèíîáîðîíû ÑÑÑÐ(â íàñòîÿùåå âðåìÿ – ÍÈÈÈ âîåííîéìåäèöèíû Âîåííî-ìåäèöèíñêîé àêà-äåìèè èì. Ñ.Ì.Êèðîâà), â ïîäãîòîâêåè ïðîâåäåíèè ïîëåòà ïåðâîãî â ìèðå êîñ-ìîíàâòà.

Êîñìè÷åñêèì ïîëåòàì ÷åëîâåêàïðåäøåñòâîâàë ïåðèîä ïîäãîòîâêè èîñóùåñòâëåíèÿ áèîëîãè÷åñêèõ èññëåäî-âàíèé â ïåðâûõ ïîëåòàõ ñ æèâîòíûìè

â 50-å ãîäû ÕÕ ñòîëåòèÿ íà ãåîôèçè÷å-ñêèõ ðàêåòàõ, èñêóññòâåííûõ ñïóòíèêàõ

Çåìëè (ÈÑÇ) è êîñìè÷åñêèõ êîðàáëÿõ-

ñïóòíèêàõ (ÊÊÑ). Ê ýòèì èññëåäîâàíèÿìåùå â 1948–1949 ãã. áûë ïðèâëå÷åíÍàó÷íî-èññëåäîâàòåëüñêèé èíñòèòóò

àâèàöèîííîé ìåäèöèíû (ÍÈÈÀÌ)ÌÎ ÑÑÑÐ, êîòîðûé âîçãëàâëÿë ïîëêîâ-íèê ìåäèöèíñêîé ñëóæáû À.Â.Ïîêðîâ-ñêèé, à íåïîñðåäñòâåííûì ðóêîâîäèòåëåìïî îðãàíèçàöèè è ïðîâåäåíèþ áèîëîãè-÷åñêèõ èññëåäîâàíèé ÿâëÿëñÿ ïîäïîëêîâ-íèê ìåäèöèíñêîé ñëóæáû Â.È.ßçäîâñêèé.

Ïåðåä ó÷åíûìè èíñòèòóòà áûëà ïî-ñòàâëåíà çàäà÷à ïî ôèçèîëîãî-ãèãèå-íè÷åñêîìó îáîñíîâàíèþ âîçìîæíîñòèïîëåòà â îñîáûõ óñëîâèÿõ, êîòîðàÿ áûëàóñïåøíî ðåøåíà íà ïðîòÿæåíèè 1948–1961 ãã. ïðè ïîäãîòîâêå è ïðîâåäåíèèáèîëîãè÷åñêèõ ýêñïåðèìåíòîâ ñ ó÷àñòèåì42 ñîáàê è äðóãèõ áèîëîãè÷åñêèõ îáú-

Âêëàä âîåííîé ìåäèöèíû â îñâîåíèå êîñìîñà

Þ.À.Ãàãàðèí ïåðåäó÷åáíî-òðåíèðîâî÷íûìïàðàøþòíûì ïðûæêîì

Ñîòðóäíèêè ÃîñÍÈÈÈàâèàöèîííîé è êîñìè÷åñêîé

ìåäèöèíû À.Àôàíàñüåâ, Â.Ïîïîâ,À.Ñåðÿïèí, Â.ßçäîâñêèé

äîêëàäûâàþò àêàäåìèêàìÑ.Êîðîë¸âó è À.Áëàãîíðàâîâó

î ïðèçåìëåíèè ïåðâûõ÷åòâåðîíîãèõ «êîñìîíàâòîâ»

Çàìåñòèòåëü íà÷àëüíèêà ÖÏÊïîëêîâíèê Þ.À.Ãàãàðèíâðó÷àåò ïðàâèòåëüñòâåííóþíàãðàäó âðà÷ó ïåðâîãî îòðÿäàêîñìîíàâòîâ È.À.Êîëîñîâó

È.À.Êîëîñîâ ïðîâîäèòïñèõîëîãè÷åñêîå èññëåäîâàíèå

Â.È.Òåðåøêîâîé ïåðåä ïîëåòîìíà íåâåñîìîñòü


Ïîñåùåíèå âûïóñêíèêîì Âîåííî-ìåäèöèíñêîé àêàäåìèè ÃåðîåìÐîññèè êîñìîíàâòîì Î.Â.ÊîòîâûìAlma Mater è âñòðå÷à ñ íà÷àëüíèêîìÂîåííî-ìåäèöèíñêîé àêàäåìèèãåíåðàë-ìàéîðîì ìåäèöèíñêîéñëóæáû À.Á.Áåëåâèòèíûì

Ìåäèöèíñêèé îñìîòð êîñìîíàâòàÂ.Ô.Áûêîâñêîãî ïåðåä

òðåíèðîâêîé ïî âûæèâàíèþâ óñëîâèÿõ ëåñèñòî-

áîëîòèñòîé ìåñòíîñòè

È.À.Êîëîñîâíà òðåíèðîâêå ïî ñîçäàíèþ íåâåñîìîñòè

Îòðÿä èñïûòàòåëåé ÃîñÍÈÈÈ àâèàöèîííîé è êîñìè÷åñêîé ìåäèöèíû ñ êîñìîíàâòàìèÞ.À.Ãàãàðèíûì, Â.Ô.Áûêîâñêèì, Â.Ì.Êîìàðîâûì


Â àâèàöèîííîì ãîñïèòàëå.Þ.À.Ãàãàðèí, Ã.Ñ.Òèòîâ,Ã.Ã.Íåëþáîâ, Å.Â.Õðóíîâ,Â.Â.Ãîðáàòêî, Ã.È.Øîíèí,À.À.Ëåîíîâ, Ï.Ð.Ïîïîâè÷ ïåðåäâñòðå÷åé ñ êîìàíäîâàíèåì ÂÂÑ

Âûïóñêíèê Âîåííî-ìåäèöèíñêîé àêàäåìèè

Å.Á.Øóñòîâ ñ êîñìîíàâòàìèíà òðåíèðîâêå ïî âûæèâàíèþ

Ñîòðóäíèêè ÃîñÍÈÈÈàâèàöèîííîé è êîñìè÷åñêîéìåäèöèíû È.Ò.Àêóëèíè÷åâ,À.Ð.Êîòîâñêàÿ, Ô.Ä.Ãîðáîâîöåíèâàþò ñîñòîÿíèå êîñìîíàâòàÞ.À.Ãàãàðèíà ïåðåä ïîëåòîì â êîñìîñ

ÏðîôåññîðÂ.È.Êîïàíåâ

ñ âûïóñêíèêàìèÂîåííî-ìåäèöèíñ-

êîé àêàäåìèèâ Çâåçäíîì ãîðîäêå


Ñïåöèàëèñò ÃîñÍÈÈÈàâèàöèîííîé è êîñìè÷åñêîé

ìåäèöèíû Â.Ã.Âîëîâè÷ (ñëåâà)ïðè ñîïðîâîæäåíèè ïåðâîãî

êîñìîíàâòà Þ.À.Ãàãàðèíàïîñëå çàâåðøåíèÿ ïîëåòà

â ñàìîëåòå ÈË-14

Òðåíèðîâêè â óñëîâèÿõêðàòêîâðåìåííîé íåâåñîìîñòèíà ñàìîëåòå ÒÓ-104

Ñíàðÿæåíèå êîñìîíàâòà Þ.À.Ãàãàðèíà ïåðåäïîñàäêîé â êàáèíó öåíòðèôóãè (ìåõàíèê èíñòèòóòà

À.Ô.Ìèõàëèí ïðîâåðÿåò ýëåêòðè÷åñêèå ðàçúåìû)

Ïåðâûé îòðÿäêîñìîíàâòîâ âî âðåìÿïàðàøþòíîé ïîäãîòîâêè(ã. Êèðæà÷)

Çà óñïåøíîå âûïîëíåíèå çàäàíèéïðàâèòåëüñòâà ïî èñïûòàíèþñïåöèàëüíîé òåõíèêè ãåíåðàë-ïîëêîâíèê Ô.À.Àãàëüöîââðó÷àåò íà÷àëüíèêó ÃîñÍÈÈÈàâèàöèîííîé è êîñìè÷åñêîéìåäèöèíû ãåíåðàë-ëåéòåíàíòóÞ.Ì.Âîëûíêèíó Êðàñíîå çíàìÿè îðäåí Êðàñíîé Çâåçäû


ÎÐÃÀÍÈÇÀÖÈß ÌÅÄÈÖÈÍÑÊÎÃÎÎÁÅÑÏÅ×ÅÍÈß ÂÎÎÐÓÆÅÍÍÛÕ ÑÈË

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 613.693

Âêëàä Âîåííî-ìåäèöèíñêîé àêàäåìèèâ îñâîåíèå êîñìîñà

ÁÅËÅÂÈÒÈÍ À.Á., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáûÖÛÃÀÍ Â.Í., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàÁËÀÃÈÍÈÍ À.À., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñàÊÀËÒÛÃÈÍ Ì.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ìàéîð ìåäèöèíñêîé ñëóæáû

Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ èì. Ñ.Ì.Êèðîâà, Ñàíêò-Ïåòåðáóðã

Belevitin A.B., Tsygan V.N., Blaginin A.A., Kaltygin M.V. – The contribution of the Military MedicalAcademy in space exploration. The article examines the contribution of the Military Medical Academyas an educational, research and medical institutions in the establishment and development of the nationalRussian manned spaceflight. Lists the names of the Academy’s scientists, working in laboratories and in theCosmonaut Training Center. In 1958 the academy was formed Department of Aviation Medicine from theresearch laboratories of aviationmedicine, psychophysiology, and encephalography, a division of pressurechambersand furnaces. Direct contribution to the preparation of the first manned space flightmadeby graduates of the academy, E.A.Karpov (the first chief of Cosmonauts Training Center. Yuri Gagarin)and I.A.Kolosov. Over the half century history of the Russian SpaceMilitary Medical Academy, preparedand sent to the CPC Gagarin more than 110 of its graduates.

K e y w o r d s: medical support of space flight, the Military Medical Academy, Department of Aviation Medicine.

Âîåííî-ìåäèöèíñêàÿ àêàäåìèÿ, êàêêðóïíîå ó÷åáíîå, íàó÷íî-èññëåäîâà-

òåëüñêîå è ëå÷åáíîå ó÷ðåæäåíèå ñòðàíûâíåñëà çíà÷èòåëüíûé âêëàä â ñòàíîâëå-íèå è ðàçâèòèå íàöèîíàëüíîé ðîññèé-ñêîé ïèëîòèðóåìîé êîñìîíàâòèêè.

Åùå íà çàðå ìèðîâîé àâèàöèè, ïîñëåïåðâûõ ïîïûòîê ÷åëîâåêà ñ ïîìîùüþâîçäóøíîãî øàðà îòîðâàòüñÿ îò çåìíîéïîâåðõíîñòè, ñâÿçàííûõ ñ ïðîáëåìîéæèçíåîáåñïå÷åíèÿ íà âûñîòå, îñíîâî-ïîëîæíèê îòå÷åñòâåííîé ôèçèîëîãèèÈ.Ì.Ñå÷åíîâ ñôîðìóëèðîâàë çàêîíîòíîñèòåëüíîãî ïîñòîÿíñòâà ãàçîâîãîñîñòàâà àëüâåîëÿðíîãî âîçäóõà, êîòîðûéÿâëÿåòñÿ êðàåóãîëüíûì êàìíåì âûñîò-íîé ôèçèîëîãèè.

Îñíîâàòåëåì ôèçèîëîãè÷åñêîé øêî-ëû àâèàêîñìè÷åñêîé ìåäèöèíû ïî ïðà-âó ñ÷èòàåòñÿ êðóïíåéøèé ôèçèîëîã àêà-äåìèê Ëåîí Àáãàðîâè÷ Îðáåëè. Îí èïðåäñòàâèòåëè åãî íàó÷íîé øêîëû ãëó-áîêî èññëåäîâàëè ïðîáëåìó êèñëîðîäíî-ãî ãîëîäàíèÿ, âêëþ÷àÿ îöåíêó ñîñòîÿíèÿêðîâåòâîðåíèÿ (Ï.È.Åãîðîâ, À.Ä.Êóäðèí),îáìåííûõ ïðîöåññîâ (Å.Ã.Âëàäèìèðîâ,À.Ô.Ïàíèí), ñåêðåòîðíîé ôóíêöèè æå-ëóäî÷íûõ æåëåç (Ì.Ï.Áðåñòêèí), êðîâî-îáðàùåíèÿ (Å.Ñ.Ìîë÷àíîâ), ôóíêöèéöåíòðàëüíîé íåðâíîé ñèñòåìû (Ë.À.Îð-áåëè, È.Ð.Ïåòðîâ, Â.Ï.Êóðêîâñêèé).

Çíà÷èòåëüíûé âêëàä â ðàçðàáîòêóâîïðîñîâ îáåñïå÷åíèÿ êîñìè÷åñêèõ ïî-ëåòîâ âíåñëè òàêèå âûäàþùèåñÿ ó÷åíûåÂîåííî-ìåäèöèíñêîé àêàäåìèè, êàêÊ.Ì.Áûêîâ, Í.Í.Ñèðîòèíèí, À.Í.Êðåñ-òîâíèêîâ, Ã.Å.Âëàäèìèðîâ, ñôîðìèðîâàâ-øèå ïðåäñòàâëåíèÿ î âëèÿíèè íà îðãà-íèçì ÷åëîâåêà ôàêòîðîâ âûñîêîãîðüÿ,ôèçèîëîãè÷åñêèõ è áèîõèìè÷åñêèõ ìåõà-íèçìàõ àäàïòàöèè ê íèì. Â.Â.Ñòðåëüöîâ,À.Â.Ëåáåäèíñêèé, Ã.Ã.Êóëèêîâñêèé,Ì.Ï.Áðåñòêèí, À.Ï.Àïîëëîíîâ è äð. èñ-ñëåäîâàëè îñíîâíûå ôèçèîëîãè÷åñêèåìåõàíèçìû íåáëàãîïðèÿòíîãî âëèÿíèÿãèïîêñèè, óñêîðåíèé, ïîâûøåííîãîè ïîíèæåííîãî áàðîìåòðè÷åñêîãî äàâëå-íèÿ íà îðãàíèçì ÷åëîâåêà. Íåñîìíåííûéâêëàä â èçó÷åíèå ïðîáëåì óñêîðåíèéè ïåðåãðóçîê âíåñëè Í.Î.Öèáóëüñêèé,Ã.Ë.Êîìåíäàíòîâ, Â.Â.Ëåâàøîâ, Ì.Ï.Áðå-ñòêèí, Á.Ì.Ñàâèí è äð. Ïðîáëåìàìèäåêîìïðåññèîííûõ ðàññòðîéñòâ â ñòåíàõÂîåííî-ìåäèöèíñêîé àêàäåìèè çàíèìà-ëèñü Ï.Ì.Ãðàìèíèöêèé, Ì.Ï.Áðåñòêèí,Ï.Â.Îáëàïåíêî è Ì.Ä.Äðàãóçÿ. Ôîðìè-ðîâàíèþ îñíîâ àâèàöèîííîé è êîñìè-÷åñêîé ìåäèöèíû ñïîñîáñòâîâàëè òàêæåðàçðàáîòàííûå Â.È.Âîÿ÷åêîì, È.Ê.Ñî-áåííèêîâûì è Ê.Ë.Õèëîâûì òåîðåòè÷å-ñêèå ïðèíöèïû âðà÷åáíîé ýêñïåðòèçûëåòíîãî ñîñòàâà.


Êîñìîíàâò ¹ 100Î.Â.Êîòîâ íà çàùèòå

êàíäèäàòñêîé äèññåðòàöèèâ Âîåííî-ìåäèöèíñêîé

àêàäåìèè

Êàôåäðà àâèàöèîííîéè êîñìè÷åñêîé ìåäèöèíû

Âîåííî-ìåäèöèíñêîé àêàäåìèèèì. Ñ.Ì.Êèðîâà – åäèíñòâåííîåó÷åáíîå ïîäðàçäåëåíèå ñòðàíû,îñóùåñòâëÿþùåå ïðîôèëüíóþ

ïîäãîòîâêó âðà÷åéïî àâèàöèîííîé

è êîñìè÷åñêîéìåäèöèíå


ÌÅÄÈÖÈÍÀÝÊÑÒÐÅÌÀËÜÍÛÕ ÑÈÒÓÀÖÈÉ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 614.8:355(470)

Èñòîðè÷åñêèå àñïåêòû ôîðìèðîâàíèÿ Ñëóæáûìåäèöèíû êàòàñòðîô Ìèíèñòåðñòâà îáîðîíûÐîññèéñêîé Ôåäåðàöèè

ÁÅËÅÂÈÒÈÍ À.Á., çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû1

ÊÎÐÍÞØÊÎ È.Ã., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê,ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû â îòñòàâêå2

ßÊÎÂËÅÂ Ñ.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

1Ãëàâíîå âîåííî-ìåäèöèíñêîå óïðàâëåíèå ÌÎ ÐÔ, Ñàíêò-Ïåòåðáóðã; 2Ãîñóäàðñòâåííûéèíñòèòóò óñîâåðøåíñòâîâàíèÿ âðà÷åé ÌÎ ÐÔ, Ìîñêâà

Belevitin A.B., Kornyushko I.G., Yakovlev S.V. – Historical aspects of formation of Disaster MedicineService of the Ministry of Defenñe of the Russian Federation. International and domestic experienceof recent years is convincing evidence that military medical staff can and should be an important partof the national system of emergency medical assistance in emergency situations. The article is concernedwith the participation of military medical personnel in Russia and the USSR in the aftermath of naturaland technological disasters in the twentieth and twenty-first century. historical background and 20 yearsof experience in the formation of Disaster Medicine Service of the Ministry of Defense of the RussianFederation.

K e y w o r d s: Service for Disaster Medicine of the Ministry of Defense of the Russian Federation,military medicine, history of medicine.

Àêòóàëüíîñòü ïðîáëåìû «Êàòàñòðîôû è ÷åëîâå÷åñòâî» âñëåäñòâèå åå ïëà-

íåòàðíîãî ìàñøòàáà, ÷ðåçâû÷àéíîéñîöèàëüíî-ýêîíîìè÷åñêîé çíà÷èìîñòè,ãëóáîêîãî ãóìàíèòàðíîãî ñîäåðæàíèÿ ïå-ðåîöåíèòü íåâîçìîæíî. Çà ðåøåíèåì ýòîéïðîáëåìû ñòîèò ñàìàÿ áîëüøàÿ öåííîñòüíà Çåìëå – æèçíü ÷åëîâåêà, ãàðàíòèÿåãî çàùèòû îò ðàçðóøèòåëüíûõ ïîñëåä-ñòâèé ïðèðîäíûõ è ïðîìûøëåííûõêàòàêëèçìîâ.

Ìèð æèâåò â ýïîõó êàòàñòðîô. Êàêïîêàçûâàåò ïðîâåäåííûé àíàëèç, ïðîñëå-æèâàåòñÿ òåíäåíöèÿ ê ðîñòó ÷èñëà çàðå-ãèñòðèðîâàííûõ êàòàñòðîô ðàçëè÷íîéýòèîëîãèè è óâåëè÷åíèþ òÿæåñòè èõ ïî-ñëåäñòâèé.

Èññëåäîâàíèÿ, ïðîâåäåííûå ïî ëèíèèÂñåìèðíîé îðãàíèçàöèè çäðàâîîõðàíå-íèÿ, ïîêàçàëè, ÷òî óùåðá, íàíîñèìûéìèðîâîé ýêîíîìèêå òîëüêî ñòèõèéíûìèáåäñòâèÿìè, ñîñòàâëÿåò åæåãîäíî áîëåå30 ìëðä äîë. è óíîñèò äî 250 òûñ. æèçíåé.

Âàæíîñòü çàùèòû íàñåëåíèÿ è òåð-ðèòîðèé îò ÷ðåçâû÷àéíûõ ñèòóàöèé è èõïîñëåäñòâèé ïîä÷åðêèâàåòñÿ òåì, ÷òî ýòàïðîáëåìà ÿâëÿåòñÿ îäíèì èç ïðèîðèòåò-íûõ íàïðàâëåíèé ãîñóäàðñòâåííîé ïîëè-òèêè â îáëàñòè íàöèîíàëüíîé áåçîïàñ-íîñòè ìíîãèõ ñòðàí ìèðà, â ò. ÷. è Ðîññèé-ñêîé Ôåäåðàöèè.

Òåíäåíöèÿ ê ðîñòó ÷èñëà è óâåëè÷å-íèþ òÿæåñòè ïîñëåäñòâèé çàðåãèñòðèðî-âàííûõ êàòàñòðîô ðàçëè÷íîé ýòèîëîãèèïîäòâåðæäàåòñÿ ïîñòîÿííî ïðîâîäèìûìàíàëèçîì ñèòóàöèè.

Íàèáîëåå âûðàæåí ðîñò òåõíîãåííûõêàòàñòðîô, ÷òî ÿâëÿåòñÿ îáðàòíîé ñòî-ðîíîé íàó÷íî-òåõíè÷åñêîãî ïðîãðåññà.Ýòî êàòàñòðîôû ýêîëîãè÷åñêèå, ðàäèàöè-îííûå, õèìè÷åñêèå, òðàíñïîðòíûå è äð.Òîëüêî çà ïîñëåäíèå 20 ëåò îíè ñòàëèïðè÷èíîé ãèáåëè áîëåå 3 ìëí ÷åëîâåê.

Íàó÷íî-òåõíè÷åñêàÿ ðåâîëþöèÿ âòî-ðîé ïîëîâèíû XX â., ðåçêî óñêîðèâ òåì-ïû ðàçâèòèÿ ìàòåðèàëüíîãî ïðîèçâîäñòâà,


ÂÎÉÑÊÎÂÀß ÌÅÄÈÖÈÍÀ

© À.Á.ÁÅËÎÂ, Ï.È.ÎÃÀÐÊÎÂ, 2011ÓÄÊ 616.98-057.36-085.37

Àêòóàëüíûå âîïðîñû ýïèäåìèîëîãèèè âàêöèíîïðîôèëàêòèêè «äåòñêèõ» âîçäóøíî-êàïåëüíûõ èíôåêöèé â âîéñêàõ (íà ôëîòå)

ÁÅËÎÂ À.Á., çàñëóæåííûé ðàáîòíèê âûñøåé øêîëû ÐÔ, äîöåíò,ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêåÎÃÀÐÊÎÂ Ï.È., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà


Belov A.B., Ogarkov P.I. – Current issues of epidemiology and vaccinal prevention «children’s» airborneinfections in the armies (navy). It highlights the problems associated with the epidemiological situation ofthe morbidity of the population and the military personnel with infections, which recently were «infant» –measles, mumps, rubella, diphtheria and other infections, controlled now by means of immunization. Thereis no alternative to the mass immunization of children and adolescents to achieve highly efficient vaccine-resistant sporadic incidence of these infections. However, amid the successes achieved, regular «grow-up»disease causes these infections spread vaccination for adults who are at risk. In military units thereare similar conditions, they increase the risk of both infection and disease, especially among conscripts.The ways to improve vaccination calendars troops are discussed, including held for epidemical indications,the need for immunization of groups at risk of chicken pox, and in the future – and against other «childhood»diseases.

K e y w o r d s: military collectives, controlled respiratory infection, epidemiology and specific prophylaxis.

Ìíîãèå èç òàê íàçûâàåìûõ äåòñêèõâîçäóøíî-êàïåëüíûõ èíôåêöèé â

ñîâðåìåííûõ óñëîâèÿõ âñå ÷àùå âîçíè-êàþò ó âçðîñëûõ ëþäåé [12, 13, 19]. Ñêëîí-íîñòü äèôòåðèè, êîðè, ýïèäåìè÷åñêîãî ïà-ðîòèòà, êðàñíóõè, âåòðÿíîé îñïû, êîêëþ-øà è äðóãèõ âîçäóøíî-êàïåëüíûõ èíôåê-öèé (ÂÊÈ) ê èçáèðàòåëüíîìó èíôèöè-ðîâàíèþ äåòåé ðàííåãî âîçðàñòà â ïîë-íîé ìåðå ïðîÿâëÿëàñü â äîâàêöèíàëüíûéïåðèîä èç-çà îòñóòñòâèÿ ñðåäñòâ ïîâûøå-íèÿ èììóíèòåòà ê óïîìÿíóòûì áîëåçíÿì.Ñ ýòèì æå îáñòîÿòåëüñòâîì îò÷àñòè ñâÿ-çàíû ïîäúåìû çàáîëåâàåìîñòè ÂÊÈ ñðå-äè ïîäðîñòêîâ è ìîëîäåæè, íàõîäÿùèõñÿíà îïðåäåëåííûõ ýòàïàõ æèçíè â óñëîâè-ÿõ òåñíîãî îáùåíèÿ â îðãàíèçîâàííûõêîëëåêòèâàõ. Òàê ñêàçûâàåòñÿ âëèÿíèå íàýïèäåìè÷åñêèé ïðîöåññ ÂÊÈ ôàêòîðà«ïåðåìåøèâàíèÿ» è àêòèâíîñòè ìåõàíèç-ìà ïåðåäà÷è âîçáóäèòåëåé. Â ðåçóëüòàòå çà-áîëåâàþò ëþäè, ó êîòîðûõ ñíèçèëñÿ èì-ìóíèòåò, ïðèîáðåòåííûé â õîäå ïðåäøå-

ñòâóþùèõ èíôèöèðîâàíèé, èëè òå, êòî íåêîíòàêòèðîâàë ðàíüøå ñ âîçáóäèòåëåì,«óêîðåíèâøèìñÿ» â êîëëåêòèâå ëèáî çà-íåñåííûì â íåãî èçâíå. Ýòè çàêîíîìåð-íîñòè, â òîé èëè èíîé ñòåïåíè õàðàêòåð-íûå òàêæå è äëÿ ìíîãèõ àêòóàëüíûõ â òóïîðó àíòðîïîíîçíûõ èíôåêöèé ñ èíûìèìåõàíèçìàìè ïåðåäà÷è, ïðîÿâëÿþòñÿ èñåé÷àñ, åñëè ýôôåêòèâíûå âàêöèíû èñ-ïîëüçóþòñÿ â îãðàíè÷åííûõ ìàñøòàáàõèëè îíè ïîêà íå ðàçðàáîòàíû [3, 8, 20].

Â äîâàêöèíàëüíûé ïåðèîä â ýïèäå-ìè÷åñêèõ î÷àãàõ äèôòåðèè, ñêàðëàòèíû,êîðè ó 5–8% ïåðåáîëåâøèõ ïîäðîñòêîâ èìîëîäûõ ëþäåé (à ñðåäè âîåííîñëóæà-ùèõ-íîâîáðàíöåâ è ÷àùå) ðåãèñòðèðîâà-ëèñü ïîâòîðíûå ñëó÷àè ýòèõ çàáîëåâàíèé.Ïîäîáíîå ÿâëåíèå èìååò ìåñòî è â íàøèäíè, ÷òî ïîäòâåðæäàåòñÿ íîâåéøèìèìåòîäàìè ñïåöèôè÷åñêîé äèàãíîñòèêè.Òåïåðü ÿñíî, ÷òî äàæå ïåðåíåñåíèå åñòå-ñòâåííîé èíôåêöèè (äàæå â âèäå òÿæåëîéáîëåçíè), íå âñåãäà ãàðàíòèðóåò ïîëíî-


ËÅ×ÅÁÍÎ-ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÅÂÎÏÐÎÑÛ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 616-001-002.3-085.37

Ôàãîïðîôèëàêòèêà è ôàãîòåðàïèÿõèðóðãè÷åñêèõ èíôåêöèé

ÁÐÞÑÎÂ Ï.Ã., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, ëàóðåàò Ãîñóäàðñòâåííûõ ïðåìèéÑÑÑÐ è ÐÔ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû â îòñòàâêå1

ÇÓÁÐÈÖÊÈÉ Â.Ô., ïðîôåññîð, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå3

ÈÑËÀÌÎÂ Ð.Í., ìàéîð ìåäèöèíñêîé ñëóæáû4

ÍÈÇÎÂÎÉ À.Â., äîöåíò, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå 2

ÔÎÌÈÍÛÕ Å.Ì., äîöåíò, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå 2

1Ãëàâíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. Í.Í.Áóðäåíêî, Ìîñêâà; 2ÃîñóäàðñòâåííûéÈíñòèòóò óñîâåðøåíñòâîâàíèÿ âðà÷åé ÌÎ ÐÔ, Ìîñêâà; 3Íàöèîíàëüíûé Ìåäèêî-õèðóðãè÷åñêèéÖåíòð èì. Í.È.Ïèðîãîâà, Ìîñêâà; 4Âîåííûé ãîñïèòàëü âíóòðåííèõ âîéñê ÌÂÄ ÐÔ,ã. Íîâî÷åðêàññê

Bryusov P.G., Zubritsky V.F., Islamov R.N., Nizovoy A.V., Fominykh E.M. – Phagoprophylaxis andbacteriophage treatment of surgical infections. Due to the constant formation of the antibiotic resistanceof pathogens the search for alternative and synergistic ways antibiotic prophylaxis and treatment of infectiouscomplications of wounds becomes current. This article is devoted to various aspects of the use of bacteriophages.The historical background of these drugs, and the biological properties are given. The authors assessed thecapabilities of phage preparations for treatment and prevention of infectious complications of wounds. It isnoted that for these purposes most suitable preparations containing several phages active against majorpathogens of surgical infections. The authors assessed the properties piobacteriofag polyvalent «Sekstafag»in vitro and its efficacy in clinical practice. Based on analysis of published data and own investigations wemay conclude that the of using piobacteriofag for the prevention and treatment of infectious complicationsof wounds may be perspective.

K e y w o r d s: bacteriophage, wound infection, prophylaxis.

Ôóíäàìåíòàëüíûå èññëåäîâàíèÿ â áèîëîãèè îòêðûâàþò íîâûå ãî-

ðèçîíòû è ïåðñïåêòèâû â ìåäèöèíå, à çà-÷àñòóþ âîçâðàùàþò ê æèçíè è çàáûòûåìåòîäû ëå÷åíèÿ èíôåêöèîííûõ çàáîëå-âàíèé. Ýòè èññëåäîâàíèÿ àêòóàëüíû, ò. ê.ïî íåêîòîðûì ïðîáëåìàì â áëèæàéøååâðåìÿ ñîâðåìåííóþ ìåäèöèíó ìîæåò îæè-äàòü êðèçèñ. Îäíèì èç òàêèõ ïðîáëåìíûõâîïðîñîâ ÿâëÿåòñÿ âûáîð ñðåäñòâ äëÿ õè-ìèîòåðàïèè íîçîêîìèàëüíûõ èíôåêöèé.Ðå÷ü èäåò î áûñòðîì ôîðìèðîâàíèè óñ-òîé÷èâîñòè ïàòîãåííûõ ìèêðîîðãàíèçìîâê àíòèáèîòèêàì èç-çà øèðîêîãî, à íåðåä-êî è áåñêîíòðîëüíîãî èõ èñïîëüçîâàíèÿâ ìåäèöèíå. Ñëåäóåò îòìåòèòü, ÷òî ýòîòïðîöåññ ïðîèñõîäèò íà ôîíå ñîêðàùåíèÿðàçðàáîòêè íîâûõ àíòèáèîòèêîâ â òå÷å-íèå ïîñëåäíèõ äåñÿòèëåòèé. Èçâåñòíî, ÷òîàíòèáèîòèêè ïîäàâëÿþò íîðìàëüíóþìèêðîôëîðó â åñòåñòâåííûõ áèîöåíîçàõ

÷åëîâåêà, ïðàêòè÷åñêè âñåãäà îêàçûâàþòòåðàòîãåííûé ýôôåêò, à áîëüøèíñòâî àí-òèáèîòèêîâ òîêñè÷íû, ÷òî ñóùåñòâåííîóâåëè÷èâàåò ïåðå÷åíü ïðîòèâîïîêàçàíèéê èõ èñïîëüçîâàíèþ [2, 3].

Ïî ýòîé ïðè÷èíå ñîçäàþòñÿ ñèòóà-öèè, êîãäà ïðàêòèêóþùèå âðà÷è, èñïîëü-çóÿ àíòèáèîòèêè, âûíóæäåíû èñêàòüêîìïðîìèññ ìåæäó èõ àíòèìèêðîáíûìäåéñòâèåì è âûðàæåííîñòüþ ïîáî÷íûõýôôåêòîâ. Îñîáåííî àêòóàëåí âîïðîñïðîâåäåíèÿ õèìèîïðîôèëàêòèêè ïîñëå-îïåðàöèîííîé èíôåêöèè. Ñ îäíîé ñòî-ðîíû, ñîâðåìåííûå è âûñîêîàêòèâíûåàíòèáèîòèêè äî ðàçâèòèÿ èíôåêöèîííî-ãî ïðîöåññà èñïîëüçîâàòü íåæåëàòåëüíî,à ñ äðóãîé – âîçíèêàåò ïðîáëåìà áîðü-áû ñ âîçáóäèòåëÿìè ðàíåâîé èíôåêöèè,ñðåäè êîòîðûõ ÷àùå âñåãî âûñòóïàþò ãîñ-ïèòàëüíûå, ïîëèàíòèáèîòèêîóñòîé÷èâûåøòàììû áàêòåðèé [2, 3].



© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 616.718.4-001.5-089.84

Âûáîð ðàöèîíàëüíîé ìåòîäèêè õèðóðãè÷åñêîãîëå÷åíèÿ áîëüíûõ ñ ïåðåëîìàìè ïðîêñèìàëüíîãîîòäåëà áåäðåííîé êîñòè

ØÀÏÎÂÀËÎÂ Â.Ì., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, çàñëóæåííûé âðà÷ ÐÔ, ïðîôåññîð,ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû â îòñòàâêåÕÎÌÈÍÅÖ Â.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÌÈÕÀÉËÎÂ Ñ.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáûØÀÊÓÍ Ä.À., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû


Shapovalov V.M., Khominets V.V., Mikhaylov S.V., Shakun D.A. – Selection of a rational methodof surgical treatment of patients with fractures of the proximal femur. In the military hospital of traumatologyand orthopaedics, Military Medical Academy from 2007 to 2009, was operated on 88 patients with fracturesof the proximal femur, whose average age was 77,4±3,8 years. Selection of the optimal surgical procedurewas performed according to the type of fracture of the proximal femur and bone quality (presenceor absence of osteoporosis and its degree of severity). In addition, when choosing a surgical treatmentto take into account patients’ age, time elapsed since injury, general condition, the presence and severityof manifestations related diseases, as well as the patient’s request for quality of life. Excellent functionalresults in this clinical group were obtained in 19,4% patients, good – in 16,1% patients, satisfactory –in 25,8% cases and 38,7% victims were regarded as unsatisfactory.

K e y w o r d s: fracture, proximal femur, the tactics of treatment.

Àêòóàëüíîñòü ïðîáëåìû ëå÷åíèÿ ïî- ñòðàäàâøèõ ñ ïåðåëîìàìè ïðîêñèìàëü-

íîãî îòäåëà áåäðåííîé êîñòè (ÏÏÎÁÊ)îáóñëîâëåíà, ïðåæäå âñåãî, âûñîêîé ÷àñ-òîòîé èõ âîçíèêíîâåíèÿ, à òàêæå âñòðå-÷àåìîñòüþ ïðåèìóùåñòâåííî ó ëþäåé ïî-æèëîãî âîçðàñòà íà ôîíå îñòåîïîðîçàè òÿæåëîé ñîïóòñòâóþùåé ïàòîëîãèè.Ëå÷åíèå òàêèõ áîëüíûõ âåñüìà ñëîæíîåè òðóäîåìêîå, à ïðîöåíò íåóäîâëåòâîðè-òåëüíûõ àíàòîìî-ôóíêöèîíàëüíûõ ðå-çóëüòàòîâ è ëåòàëüíûõ èñõîäîâ ïî îáúåê-òèâíûì ïðè÷èíàì îñòàåòñÿ äîñòàòî÷íîâûñîêèì [4, 5, 7, 12].

Íà ñåãîäíÿøíèé äåíü â ìèðå åæå-ãîäíî äèàãíîñòèðóþò îò 1,2 äî 1,7 ìëíñëó÷àåâ ÏÏÎÁÊ, ïðè÷åì áîëåå ïîëîâè-íû èç íèõ ïðèõîäèòñÿ íà äîëþ ýêîíî-ìè÷åñêè ðàçâèòûõ ñòðàí. Ñîãëàñíî ïðî-ãíîçó, ê 2025 ã. èõ ÷èñëî íà ïëàíåòå óâå-ëè÷èòñÿ äî 3,94 ìëí, à ê 2050 ã. äîñòèãíåò4,5–6,3 ìëí â ãîä [12]. Â Ðîññèè, ïî äàí-íûì ýïèäåìèîëîãè÷åñêèõ èññëåäîâàíèé,ïðîâîäèâøèõñÿ â 16 êðóïíûõ ãîðîäàõ,÷àñòîòà ÏÏÎÁÊ ñîñòàâëÿåò 100,9 â ãîäíà 100 òûñ. íàñåëåíèÿ, à îáùåå èõ êîëè-÷åñòâî íåóêëîííî ðàñòåò [11].

Ñîöèàëüíàÿ çíà÷èìîñòü ïåðåëîìîâýòîé ëîêàëèçàöèè âî ìíîãîì îáóñëîâëåíàâûñîêîé ñìåðòíîñòüþ áîëüíûõ, êîòîðàÿ, ïîäàííûì ÂÎÇ, äîñòèãàåò 15% [9, 10]. Ïî ðå-çóëüòàòàì èññëåäîâàíèÿ M.vonFriesendorff[15, 17], ñìåðòíîñòü â ïåðâûé ãîä æèçíèïîñëå òàêîãî ïåðåëîìà âàðüèðóåò îò 7 äî33%. Â Ðîññèè æå ëåòàëüíîñòü â òå÷åíèåïåðâîãî ãîäà æèçíè ïîñëå òàêîé òðàâìûêîëåáëåòñÿ â ðàçëè÷íûõ ãîðîäàõ îò 21,7äî 35,1% [1, 2, 15].

Ñóùåñòâåííî ñíèçèòü ëåòàëüíîñòü èïîâûñèòü êà÷åñòâî æèçíè áîëüíûõ ñÏÏÎÁÊ ïîçâîëÿåò àäåêâàòíîå õèðóðãè-÷åñêîå ëå÷åíèå, ïðåäïîëàãàþùåå âûïîë-íåíèå âíóòðåííåãî ñòàáèëüíî-ôóíêöèî-íàëüíîãî îñòåîñèíòåçà èëè ýíäîïðîòåçè-ðîâàíèå òàçîáåäðåííîãî ñóñòàâà [5, 14, 18].Îäíàêî äî íàñòîÿùåãî âðåìåíè íåò åäè-íîãî ìíåíèÿ îòíîñèòåëüíî òàêòèêè ëå-÷åíèÿ ïðè ðàçëè÷íûõ òèïàõ ïåðåëîìîâ[5, 8]. Áîëüøîå êîëè÷åñòâî ðàçíîîáðàçíûõôèêñàòîðîâ äëÿ îñòåîñèíòåçà, íåîäíî-çíà÷íûå àíàòîìî-ôóíêöèîíàëüíûå ðå-çóëüòàòû ïðè ïðèìåíåíèè îäèíàêîâûõêîíñòðóêöèé ó ðàçíûõ àâòîðîâ òðåáóþòîïðåäåëåíèÿ áîëåå ÷åòêèõ è îáîñíîâàí-



ìåíåíèåì ñîâðåìåííûõ ôèêñàòîðîâ // Õèðóð-ãèÿ. – 2008. – ¹ 6. – Ñ. 67–72.

4. Åðøîâà Î.Á., Ñåìåíîâà Î.Â., Äåãòÿðåâ À.À.Ðåçóëüòàòû ïðîñïåêòèâíîãî èçó÷åíèÿ èñõîäîâïåðåëîìîâ ïðîêñèìàëüíîãî îòäåëà áåäðà ó ëèöïîæèëîãî âîçðàñòà // Îñòåîïîðîç è îñòåîïàòèè.– 2000. – ¹ 1. – C. 9–10.

5. Çàãîðîäíèé Í.Â., Æàðìóõàìáåòîâ Å.À.Õèðóðãè÷åñêîå ëå÷åíèå âåðòåëüíûõ ïåðåëîìîâáåäðåííîé êîñòè // Ðîñ. ìåä. æóðí. – 2006. –¹ 2. – Ñ. 18–19.

6. Èâàíîâ Â.Ì., Æàä¸íîâ È.È., Ìèòðî-ôàíîâ Â.À. Íîâûé ñïîñîá õèðóðãè÷åñêîãî ëå-÷åíèÿ âåðòåëüíûõ ïåðåëîìîâ áåäðà íà ôîíåîñòåîïîðîçà ó áîëüíûõ ïðåêëîííîãî âîçðàñòà// Òåç. äîêë. I Ðîñ. ñèìïîç. ïî îñòåîïîðîçó. –Ì., 1995. – Ñ. 83.

7. Êîòåëüíèêîâ Ã.Ï., Áåçðóêîâ À.Å., Íà-ãîòà À.Ã. Íîâîå â õèðóðãè÷åñêîì ëå÷åíèè ïå-ðåëîìîâ âåðòåëüíîé îáëàñòè ó ëèö ïîæèëîãîè ñòàð÷åñêîãî âîçðàñòà // Âåñòí. òðàâìàòîë.è îðòîïåä. èì. Í.Í.Ïðèîðîâà. – 2000 – ¹ 4. –Ñ. 13–17.

8. Êóçüìèí È.È., Êèñëèöûí Ì.À. Ýíäîïðî-òåçèðîâàíèå òàçîáåäðåííîãî ñóñòàâà ïðè îñ-êîëü÷àòûõ ïåðåëîìàõ ïðîêñèìàëüíîãî îòäåëàáåäðà // ×åëîâåê è åãî çäîðîâüå: Òåç. äîêë.XIV Ðîñ. íàöèîí. êîíãð. – Ì., 2009. – Ñ. 29.

9. Ëèðöìàí Â.Ì. Ïåðåëîìû áåäðåííîéêîñòè ó ëèö ïîæèëîãî è ñòàð÷åñêîãî âîçðàñòàè èõ ëå÷åíèå: Äèñ. ... ä-ðà ìåä. íàóê. – Ì., 1972.– 568 ñ.

10. Ëèðöìàí Â.Ì., Çîðÿ Â.È., Ãíåòåöêèé Ñ.Ô.Ïðîáëåìà ëå÷åíèÿ ïåðåëîìîâ øåéêè áåäðà íàðóáåæå ñòîëåòèé // Âåñòí. òðàâìàòîë. è îðòîïåä.èì. Í.Í.Ïðèîðîâà. – 1997. – ¹ 2. – C. 12–18.

11. Ìèõàéëîâ Å.Å., Áåíåâîëåíñêàÿ Ë.È., Àíè-êèí Ñ.Ã. ×àñòîòà ïåðåëîìîâ ïðîêñèìàëüíîãîîòäåëà áåäðà è äèñòàëüíîãî îòäåëà ïðåäïëå-÷üÿ ñðåäè ãîðîäñêîãî íàñåëåíèÿ Ðîññèè

// Îñòåîïîðîç è îñòåîïàòèè. – 1999. – ¹ 3. –Ñ. 2–6.

12. Íóðëûãàÿíîâ, Ð.Ç., Õàôèçîâ Í.Õ., Ôàé-çóëëèí À.À. ×àñòîòà ïåðåëîìîâ ïðîêñèìàëüíîãîîòäåëà áåäðåííîé êîñòè ñðåäè æèòåëåé ãîðî-äà Óôû (ðåòðîñïåêòèâíîå ýïèäåìèîëîãè÷å-ñêîå èññëåäîâàíèå) // Îñòåîïîðîç è îñòåî-ïàòèè. – 2009. – ¹ 1. – Ñ. 7–9.

13. Ïðîíñêèõ À.À., Àãàäæàíÿí Â.Â. Îøèáêèè îñëîæíåíèÿ â ýíäîïðîòåçèðîâàíèè òàçîáåä-ðåííûõ ñóñòàâîâ // Ñîâðåìåííûå òåõíîëîãèèâ òðàâìàòîëîãèè è îðòîïåäèè: îøèáêè è îñ-ëîæíåíèÿ – ïðîôèëàêòèêà, ëå÷åíèå: Òåç. äîêë.ìåæäóíàð. êîíãð. – Ì., 2004. – Ñ. 135–136.

14. Ñòàäíèêîâ Â.Â., Ðóñàíîâ À.Ã. Ïðèìåíå-íèå âèíòîâûõ óñòðîéñòâ äëÿ îñòåîñèíòåçà ïå-ðåëîìîâ ïðîêñèìàëüíîãî îòäåëà áåäðåííîéêîñòè // Ïîëèòðàâìà. – 2009. – ¹ 2. – Ñ. 22–27.

15. Òèõèëîâ P.M., Êî÷èø À.Þ., Ìèðîíåíêî À.Í.è äð. Ñîâðåìåííîå ñîñòîÿíèå ïðîáëåìû ëå÷å-íèÿ áîëüíûõ ñ âíåñóñòàâíûìè ïåðåëîìàìèïðîêñèìàëüíîãî îòäåëà áåäðåííîé êîñòè (îáçîðëèòåðàòóðû) // Òðàâìàòîë. è îðòîïåä. Ðîññèè. –2009. – Ò. 54, ¹ 4. – Ñ. 113–118.

16. Øàïîâàëîâ Â.Ì., Ìèõàéëîâ Ñ.Â., Õîìè-íåö Â.Â. è äð. Ñðàâíèòåëüíûé àíàëèç ðàç-ëè÷íûõ ìåòîäîâ ëå÷åíèÿ áîëüíûõ ñ ïåðå-ëîìàìè âåðòåëüíîé îáëàñòè áåäðåííîé êîñòè// Òðàâìàòîë. è îðòîïåä. Ðîññèè. – 2006. – Ò. 40,¹ 2. – Ñ. 311.

17. von Friesendorff M., Besjakov J., Åkesson K.Long-term survival and fracture risk after hip frac-ture: a 22-year follow-up in women // J. BoneMiner. Res. – 2008. – Vol. 23. – Ð. 1832–1841.

18. Geiger F., Schreiner K., Schneider S. et al.Die proximale Femurfraktur des alteren Patienten.Einfluss von operativer versorgung und pati-entencharakteristika auf die postoperative leta-litat // Der Orthopade. – 2006. – Bd. 35, N 6. –S. 651–657.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 616.717.4-001.5-089.84

Áèîìåõàíè÷åñêîå îáîñíîâàíèå íàïðÿæåííîãîñïèöåâèíòîâîãî îñòåîñèíòåçà ïåðåëîìîâïðîêñèìàëüíîãî îòäåëà ïëå÷åâîé êîñòè

ÊÎÂÀË¨Â Ï.Â., êàíäèäàò ìåäèöèíñêèé íàóê1

ÄÓÁÐÎÂÈÍ Ã.Ì., ïðîôåññîð1

ÃÎÐÁÀÍÜ Å.Â., ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

1Êóðñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò; 2Ôèëèàë ¹ 8 ÔÃÓ «1586 ÎÂÊÃ ÌÎ ÐÔ»,ã. Êóðñê

Kovalyov P.V., Dubrovin G.M., Gorban E.V. – Biomechanical rationale of the tense screwpin osteosynthesisof the proximal humerus. This article developed the question of biomechanical studies of new low-impactmethod of surgical treatment of fractures of the proximal humerus. Designed latch consists of standard



needles with a diameter 2 mm cortical screws with diameter 4,5 mm and fixing washers original design.With the puck all the components are combined into a single release of elastic-strained system thatprovides sufficient strength fixation of fragments. In the postoperative period, patients did not require rigidimmobilization more. Application of the new implant reduces the metal contact with bone tissue, does notrequire an additional detachment of the periosteum and other soft tissues, provides the necessary micromobilityfor the consolidation of fragments.

K e y w o r d s: Surgical treatment of fractures, humerus, screwpin osteosynthesis.

Ïåðåëîìû ïðîêñèìàëüíîãî îòäåëàïëå÷åâîé êîñòè (ÏÊ) ñîñòàâëÿþò äî

5% îò âñåõ ïåðåëîìîâ êîñòåé ñêåëåòà, çà-íèìàÿ ïî ìåäèêî-ñîöèàëüíîé çíà÷èìî-ñòè âòîðîå ìåñòî ïîñëå ïåðåëîìîâ øåé-êè áåäðà [1, 5]. Ïðèìåíåíèå ðàçëè÷íûõêîíñòðóêöèé ó áîëüíûõ, îñîáåííî íàôîíå îñòåîïîðîçà, íå âñåãäà îáåñïå÷èâà-åò ñòàáèëüíîñòü êîñòíûõ ôðàãìåíòîâ è,ñëåäîâàòåëüíî, íå ñîçäàåò óñëîâèé äëÿ èõñðàùåíèÿ [2–4].

Öåëü èññëåäîâàíèÿÐàçðàáîòàòü ìàëîòðàâìàòè÷íûå, ñòà-

áèëüíûå ìåòîäû õèðóðãè÷åñêîãî ëå÷åíèÿïðîêñèìàëüíîãî îòäåëà ÏÊ äëÿ ñîêðà-ùåíèÿ êîëè÷åñòâà íåóäîâëåòâîðèòåëüíûõèñõîäîâ ëå÷åíèÿ.

Ìàòåðèàë è ìåòîäûÏðåäëîæåí íîâûé ñïîñîá ñïèöåâèí-

òîâîé ôèêñàöèè íåñòàáèëüíûõ ïåðåëî-ìîâ ïðîêñèìàëüíîãî êîíöà ÏÊ (ïàòåíò¹ 2253395, ðåãèñòð. 10.06.05 ã.). Ôèêñà-öèþ ôðàãìåíòîâ îñóùåñòâëÿëè ïóòåì÷ðåñêîñòíîãî ïðîâåäåíèÿ ñïèö äèàìåò-ðîì 2,0 ìì ñ íàðóæíîé ïîâåðõíîñòè ãî-ëîâêè ÏÊ â ìåòàäèàôèçàðíóþ ÷àñòü äè-ñòàëüíîãî ôðàãìåíòà ÏÊ íèæå ëèíèè

ïåðåëîìà íà 1,5–2 ñì. Ñïèöû, âûñòîÿùèåâ îáëàñòè ïðîêñèìàëüíîãî ôðàãìåíòà,èçãèáàëè è ìîäåëèðîâàëè ïî íàðóæíîéïîâåðõíîñòè ÏÊ, ïåðåêðûâàÿ ëèíèþ ïå-ðåëîìà, ñ ïîñëåäóþùåé ôèêñàöèåé çàã-íóòûõ êîíöîâ ñïèö øàéáîé è êîðòèêàëü-íûì âèíòîì íà äèñòàëüíîì ôðàãìåíòåïëå÷à (ðèñ. 1, à). Ïðè íàëè÷èè íåñêîëü-êèõ îñêîëêîâ äèñòàëüíåå õèðóðãè÷åñêîéøåéêè êîíöû ñïèö ïîñëå ïðîâåäåíèÿ÷åðåç ãîëîâêó ïëå÷à ââîäèëè â êîñòíî-ìîçãîâîé êàíàë äèñòàëüíîãî ôðàãìåíòàñ óïîðîì â êîðòèêàëüíóþ ÷àñòü íà ïðî-òèâîïîëîæíîé ñòîðîíå îò ââåäåíèÿ ñïèö,à çàãíóòûå êîíöû óêðåïëÿëè øàéáàìèêàê íàä îáëàñòüþ îñêîëêîâ, òàê è íà êîð-òèêàëüíîì ñëîå äèñòàëüíîãî ôðàãìåíòà(ðèñ. 1, á).

Ïðè ýòîì îäíó èç øàéá â îáÿçàòåëü-íîì ïîðÿäêå óñòàíàâëèâàëè íà ãîëîâêóÏÊ (ïðîêñèìàëüíûé ôðàãìåíò), äèñòàëü-íóþ øàéáó (âîçìîæíî äâå) – íà äèñ-òàëüíîì îòëîìêå íèæå ëèíèè ïåðåëîìàïðèìåðíî íà 2–3 ñì. Ïðîìåæóòî÷íûåøàéáû äâèãàëè ïî ñïèöàì êàê ïî ðåëü-ñàì è óñòàíàâëèâàëè â íàèáîëåå âûãîä-íîì ïîëîæåíèè ÷òîáû âèíò ÷åðåç íèõïðîøåë â ïðîìåæóòî÷íûé îñêîëîê èëèôðàãìåíò. Ïîñëåäíèå íå òðåáóþò òî÷íîéàäàïòàöèè, åñëè ýòî ñâÿçàíî ñ îòäåëå-íèåì ìÿãêèõ òêàíåé äëÿ èõ ìîáèëèçà-öèè. Ïîñëå íåïîëíîãî ââåäåíèÿ âèíòîâñïèöû èçãèáàëè è îòêóñûâàëè íàä «óø-êàìè» øàéá è âèíòû îêîí÷àòåëüíî ââèí-÷èâàëè â êîñòü. Óñèëåíèå æåñòêîñòèôèêñàöèè ñïèöàìè äîñòèãàëè çà ñ÷åòïðèìåíåíèÿ ôèêñèðóþùåé øàéáû(ðèñ. 2, à, á, â). Íàïðÿæåííîñòü ñèñòåìûäîñòèãàëè çà ñ÷åò èçãèáà ñïèö â ðåçóëü-òàòå ââåäåíèÿ âèíòà (ðèñ. 2, ã).

Ñ öåëüþ èçó÷åíèÿ ïðî÷íîñòè ôèêñà-öèè ïåðåëîìà â çàâèñèìîñòè îò ñèëû ìå-õàíè÷åñêîãî âîçäåéñòâèÿ â ñèñòåìå «ôèê-ñàòîð – êîñòü» ñîçäàíû ìîäåëè ïåðåëî-ìîâ õèðóðãè÷åñêîé øåéêè ïëå÷à èç íå-êîíñåðâèðîâàííîé òðóïíîé êîñòè. Ãðóï-

Ðèñ. 1. Âàðèàíòû ôèêñàöèè: à – îäíîðû÷à-ãîâîãî íåîñêîëü÷àòîãî ïåðåëîìà; á – äâóõ-ðû÷àãîâîãî îñêîëü÷àòîãî ïåðåëîìà



Ëèòåðàòóðà

1. Àëü-Íàõàðè Ðàäìàí Àõìåä. Íàïðÿæåí-íûé ñïèöåâèíòîâîé îñòåîñèíòåç â õèðóðãè-÷åñêîì ëå÷åíèè ïåðåëîìîâ ïðîêñèìàëüíîãîîòäåëà ïëå÷åâîé êîñòè: Àâòîðåô. äèñ. ... êàíä.ìåä. íàóê. – Êóðñê, 2005. – 22 ñ.

2. Àíêèí Ë.Í. Òðàäèöèîííûé è ìàëîèíâà-çèâíûé îñòåîñèíòåç â òðàâìàòîëîãèè: Àâòîðåô.äèñ. ... ä-ðà ìåä. íàóê. – Õàðüêîâ, 2005. – 34 ñ.

3. Àíêèí Ë.Í., Ëåâèöêèé Â.Á. Ïðèíöèïûñòàáèëüíî ôóíêöèîíàëüíîãî îñòåîñèíòåçà. –Ì., 1991. – 143 ñ.

4. Àíòèïåíêî B.C. Âîññòàíîâèòåëüíûåîïåðàöèè ïðè òðàâìàõ êîíå÷íîñòåé. – Ì.: Ìå-äèöèíà, 1975. – 167 ñ.

5. Ëàçàðåâ À.Ô., Ñîëîä Ý.È. Áèîëîãè÷åñ-êèé íàðóæíûé îñòåîñèíòåç íà ñîâðåìåííîìýòàïå // Âåñòí. òðàâìàòîëîãèè è îðòîïåäèè. –2003. – ¹ 3. – Ñ. 20–26.

6. Òåíüêîâ À.À., Òåëþê Â.Â. Îöåíêà ïàðà-ìåòðîâ ìåõàíè÷åñêîãî âîçäåéñòâèÿ â ñóäåá-íî-ìåäèöèíñêîé ïðàêòèêå: Ó÷åáíî-ñïðàâî÷-íîå ïîñîáèå. – Êóðñê: Èçä-âî Êóðñêîãî ìåä.óíèâåðñèòåòà, 2002. – 40 ñ.

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 617.541-009.7-07

Äèàãíîñòèêà áîëåâîãî ñèíäðîìà â ãðóäíîéêëåòêå â óñëîâèÿõ ìíîãîïðîôèëüíîãîëå÷åáíî-ïðîôèëàêòè÷åñêîãî ó÷ðåæäåíèÿ

ÑÈÌÎÍÅÍÊÎ Â.Á., çàñëóæåííûé äåÿòåëü íàóêè ÐÔ, çàñëóæåííûé âðà÷ ÐÔ,÷ëåí-êîððåñïîíäåíò ÐÀÌÍ, ïðîôåññîð, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû â îòñòàâêå×ÀÏËÞÊ À.Ë., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÒÅÑËß À.Í., çàñëóæåííûé âðà÷ ÐÔ, êàíäèäàò ìåäèöèíñêèõ íàóê,ïîëêîâíèê ìåäèöèíñêîé ñëóæáûÏÎÒÀÏÅÍÊÎ Â.Í., çàñëóæåííûé âðà÷ ÐÔ, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà

2-é Öåíòðàëüíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. Ï.Â.Ìàíäðûêè, Ìîñêâà

Simonenko V.B., Chaplyuk A.L., Teslya A.N., Potapenko V.N. – The diagnosis of pain in the chestin medical and prophylactic facility. A retrospective analysis of 12 658 records of patients with painsyndrome in the chest was studied. Part of the patients was held multispiral computed tomography of theheart and coronary angiography. Used omeprazole test for differential diagnosis of coronary heart diseaseand gastroesophageal reflux disease, evaluated the criterion of cost-effectiveness.

K e y w o r d s: coronary heart disease, multispiral computed tomography, coronary angiography, omeprazoletest, gastroesophageal reflux disease.

Ïðîâåäåí ðåòðîñïåêòèâíûé àíàëèçìåäèöèíñêîé äîêóìåíòàöèè ïàöè-

åíòîâ ñ áîëåâûì ñèíäðîìîì â ãðóäíîéêëåòêå, íàõîäèâøèõñÿ íà ñòàöèîíàðíîìëå÷åíèè â 2000–2009 ãã. (n=12 658). Âû-ïîëíåíà ìóëüòèñïèðàëüíàÿ êîìïüþòåðíàÿòîìîãðàôèÿ (ÌÑÊÒ) ñåðäöà äëÿ âûÿâ-ëåíèÿ ñòåíîçèðóþùåãî àòåðîñêëåðîçà êî-ðîíàðíûõ àðòåðèé è êîðîíàðîàíãèîãðàôèÿ– ÊÀÃ (n=70). Ïðîâåäåíà îöåíêà ñ ïîçè-öèè «çàòðàòû–ýôôåêòèâíîñòü» îìåïðî-çîëîâîãî òåñòà â äèôôåðåíöèàëüíîé äè-àãíîñòèêå èøåìè÷åñêîé áîëåçíè ñåðäöà(ÈÁÑ) è ãàñòðîýçîôàãåàëüíîé ðåôëþêñ-íîé áîëåçíè (ÃÝÐÁ).

Â ïðàêòè÷åñêîé äåÿòåëüíîñòè âðà-÷àì ðàçíûõ ñïåöèàëüíîñòåé ÷àñòî ïðè-

õîäèòñÿ âñòðå÷àòüñÿ ñ áîëüíûìè,ïðåäúÿâëÿþùèìè æàëîáû íà áîëè âãðóäíîé êëåòêå, òàêàÿ áîëü àññîöèèðó-åòñÿ ó íèõ ñ ïàòîëîãèåé ñåðäöà. Âðà÷äîëæåí îïðåäåëèòü àëãîðèòì äèàãíîñ-òèêè äëÿ îòâåòà íà âîïðîñ, ÿâëÿþòñÿ ëèýòè áîëè êîðîíàðîãåííîãî èëè ýêñòðà-êàðäèàëüíîãî ïðîèñõîæäåíèÿ, è áîëü âãðóäíîé êëåòêå íîñèò îñòðûé èëè õðî-íè÷åñêèé õàðàêòåð. Îò ýòîãî çàâèñÿòîáúåì è ñðîêè îêàçàíèÿ íåîòëîæíîé ìå-äèöèíñêîé ïîìîùè.

Íàèáîëåå íåáëàãîïðèÿòíà â ïðîãíî-ñòè÷åñêîì îòíîøåíèè áîëü â ãðóäíîéêëåòêå ïðè èøåìè÷åñêîé áîëåçíè ñåðä-öà, èìåííî åå âåðèôèêàöèÿ – îïðåäåëÿ-þùèé ôàêòîð â äèôôåðåíöèàëüíîé äè-



àãíîñòèêå çàáîëåâàíèé, âûçûâàþùèõ áîëèâ ãðóäíîé êëåòêå [5]. Íàçðåëà íåîáõîäè-ìîñòü âíåäðåíèÿ â ïðàêòè÷åñêóþ äåÿòåëü-íîñòü âîåííûõ ëå÷åáíî-ïðîôèëàêòè÷åñ-êèõ ó÷ðåæäåíèé ìåäèêî-ýêîíîìè÷åñêèõïîäõîäîâ äëÿ îöåíêè ðåçóëüòàòîâ [1].

Öåëü èññëåäîâàíèÿ

Àíàëèç ïðè÷èí è ðàçðàáîòêà ïðåä-ëîæåíèé ïî ñîâåðøåíñòâîâàíèþ äèôôå-ðåíöèàëüíîé äèàãíîñòèêè áîëåâîãî ñèí-äðîìà â ãðóäíîé êëåòêå ó áîëüíûõ â óñ-ëîâèÿõ ìíîãîïðîôèëüíîãî ëå÷åáíî-ïðî-ôèëàêòè÷åñêîãî ó÷ðåæäåíèÿ.

Ìàòåðèàë è ìåòîäû

Ðåòðîñïåêòèâíî ïðîàíàëèçèðîâàíàìåäèöèíñêàÿ äîêóìåíòàöèÿ áîëüíûõ ñáîëåâûì ñèíäðîìîì â ãðóäíîé êëåòêå,íàõîäèâøèõñÿ íà ñòàöèîíàðíîì ëå÷åíèèâ 2000–2009 ãã. (n=12 658). Ìóæ÷èí áûëî5456 (43,1%), ñðåäíèé âîçðàñò 66,3±8,7ãîäà, æåíùèí – 7202 (56,9%), ñðåäíèéâîçðàñò 69,6±11,9 ãîäà. Óñòàíîâëåíû çà-áîëåâàíèÿ, íàèáîëåå ÷àñòî âûçûâàþùèåêàðäèàëãèè. Äëÿ ïîäòâåðæäåíèÿ äèàãíî-ñòè÷åñêîé äîñòîâåðíîñòè ìàëîèíâàçèâ-íîãî ìåòîäà îöåíêè ñòåïåíè ñòåíîçèðî-âàíèÿ êîðîíàðíûõ àðòåðèé (ÊÀ) ïðîâå-äåíî ñîïîñòàâëåíèå ïîëó÷åííûõ ïðèÌÑÊÒ ñåðäöà äàííûõ íà 64-ñðåçîâîìêîìïüþòåðíîì òîìîãðàôå «Aquilion»

(Toshiba) ó 70 áîëüíûõ è êîðîíàðîàíãè-îãðàôèè. Ïî ðåçóëüòàòàì îìåïðîçîëîâî-ãî òåñòà îöåíåí ïîêàçàòåëü «çàòðàòû–ýôôåêòèâíîñòü» â äèôôåðåíöèàëüíîéäèàãíîñòèêå ÈÁÑ è ÃÝÐÁ.

Ðåçóëüòàòû è îáñóæäåíèå

Ðàñïðåäåëåíèå îáñëåäîâàííûõ áîëü-íûõ ïî îñíîâíûì ãðóïïàì çàáîëåâàíèéïðåäñòàâëåíî â òàáë. 1.

Îñíîâíûìè ïðè÷èíàìè áîëåâîãîñèíäðîìà â ãðóäíîé êëåòêå ñòàëè â 43,3%ñëó÷àåâ êîðîíàðîãåííûå ïðè÷èíû (ÈÁÑ),â 22,7% – ïàòîëîãèÿ êîñòíî-ìûøå÷íîéñèñòåìû (âåðòåáðîãåííûå êàðäèàëãèè), â15,4% – ïàòîëîãèÿ æåëóäî÷íî-êèøå÷íî-ãî òðàêòà (â ò. ÷. 12,1% – ÃÝÐÁ), â 10,5%– êëèìàêòåðè÷åñêèé ñèíäðîì.

Ñïåöèàëèçèðîâàííàÿ ìåäèöèíñêàÿïîìîùü ïàöèåíòàì ñ îñòðûì êîðîíàðíûì

ñèíäðîìîì (ÎÊÑ) îêàçûâàåòñÿ êîìïëåê-ñíî ñ ïðèâëå÷åíèåì âðà÷åé ìíîãèõ ñïå-öèàëüíîñòåé (êàðäèîëîã, êàðäèîõèðóðã,êàðäèîðåàíèìàòîëîã, ýíäîâàñêóëÿðíûéõèðóðã è äð.), äëÿ ýôôåêòèâíîé ïîìîùèíåîáõîäèìà ñîãëàñîâàííîñòü èõ äåéñòâèé.Ñ ýòîé öåëüþ ñîçäàþòñÿ âíóòðèãîñïè-òàëüíûå îáúåäèíåíèÿ, âêëþ÷àþùèå âñåáÿ âðà÷åé òåðàïåâòè÷åñêîãî, õèðóðãè-÷åñêîãî è ëå÷åáíî-äèàãíîñòè÷åñêîãîïðîôèëÿ äëÿ îáåñïå÷åíèÿ ìàêñèìàëüíîïîëíîãî îáúåìà ìåäèöèíñêîé ïîìîùè.

Òàáëèöà 1

Ðàñïðåäåëåíèå áîëüíûõ ñ áîëåâûì ñèíäðîìîì â ãðóäíîé êëåòêå ïî îñíîâíûìãðóïïàì çàáîëåâàíèé


ÀÂÈÀÖÈÎÍÍÀß

È ÂÎÅÍÍÎ-ÌÎÐÑÊÀß ÌÅÄÈÖÈÍÀ

© ÊÎËËÅÊÒÈÂ ÀÂÒÎÐÎÂ, 2011ÓÄÊ 613.693(091)

Àâèàöèîííàÿ ìåäèöèíà: â÷åðà, ñåãîäíÿ, çàâòðà

ßÌÅÍÑÊÎÂ Â.Â., çàñëóæåííûé âðà÷ ÐÔ, äîêòîð ìåäèöèíñêèõ íàóê,ïîëêîâíèê ìåäèöèíñêîé ñëóæáû1

ÕÀÔÈÇÎÂ Í.Í., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû2

ÌÎÐÎÇÎÂ À.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîäïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà3

1Ñëóæáà àâèàöèîííîé ìåäèöèíû Ãëàâíîãî êîìàíäîâàíèÿ ÂÂÑ, Ìîñêîâñêàÿ îáëàñòü;21082-é Öåíòð àâèàöèîííîé ìåäèöèíû Âîåííî-âîçäóøíûõ ñèë, Ìîñêîâñêàÿ îáëàñòü;3Íàöèîíàëüíûé ÍÈÈ îáùåñòâåííîãî çäîðîâüÿ ÐÀÌÍ, Ìîñêâà

Yamenskov V.V., Khafizov N.N., Morozov A.V. – Aviation medicine: yesterday, today and tomorrow.The article describes the history and current state of medical support of the Air Force. On December 1,2009 Air Force Medical Service was renamed into the service of aviation medicine of Command AirForces, and many of the functions of medical support of the Air Force transferred to the newly formedAir Force Center of Aviation Medicine. April 29, 2011 office of Aviation Medicine of the High Commandof the Air Force has stepped 95-year milestone. The changes affected all structures entrusted with theissues of medical support of the Air Force. Today, the medical service of the Air Force faces challenges– ensuring safety, the study of flight conditions and their impact on health, job performance andpsychological characteristics of flight personnel.

K e y w o r d s: medical support of military flights, the history of military medicine, aviation medicine.

Ïåðâûå ïîïûòêè îâëàäåíèÿ ÷åëîâå- êîì ïîëåòàìè íà áîëüøèõ âûñîòàõ

â Ðîññèè îòíîñÿòñÿ ê íà÷àëó XIX â., êîã-äà, íàïðèìåð, ß.Ä.Çàõàðîâ ïî çàäàíèþÑàíêò-Ïåòåðáóðãñêîé àêàäåìèè íàóêâ 1804 ã. ïîäíèìàëñÿ íà âîçäóøíîì øàðåñ öåëüþ èçó÷åíèÿ âëèÿíèÿ ðàçðåæåííîéàòìîñôåðû íà ÷åëîâå÷åñêèé îðãàíèçì [1].

Èñïîëüçîâàíèå ëåòàòåëüíûõ àïïàðàòîââ Ïåðâóþ ìèðîâóþ âîéíó ïîñòàâèëî ïðî-áëåìó ïðèâëå÷åíèÿ â àâèàöèþ çíà÷èòåëü-íîãî ÷èñëà ëþäåé è îòáîðà ïðèãîäíûõ ïîñîñòîÿíèþ çäîðîâüÿ ê ñëóæáå â íåé.

Íà÷àëî ôîðìèðîâàíèÿ ïåðâûõ ìåäè-öèíñêèõ îðãàíîâ â ñòðóêòóðå öåíòðàëü-íîãî àïïàðàòà ÂÂÑ áûëî ïîëîæåíî ñ ñî-çäàíèåì ïðè âîåííîì ìèíèñòðå óïðàâ-ëåíèÿ âîåííîãî âîçäóøíîãî ôëîòà (ÂÂÔ,ðåøåíèå âîåííîãî ñîâåòà îò 29 àïðåëÿ1916 ã. è ïðèêàç ïî âîåííîìó âåäîìñòâóîò 13 ìàÿ 1916 ã.).

Â ñîîòâåòñòâèè ñî øòàòîì óïðàâëå-íèÿ ââîäèëàñü äîëæíîñòü âðà÷à, ïåðâîíà-÷àëüíî çàêðåïëåííàÿ çà êàíöåëÿðèåéóïðàâëåíèÿ (ïî ñòàòóñó âðà÷ áûë ãðàæ-äàíñêèì ÷èíîâíèêîì). Òàêèì îáðàçîì, âÐîññèè áûëî äàíî íà÷àëî ñîçäàíèþ ìå-äèöèíñêîé ñëóæáû öåíòðàëüíîãî àïïà-ðàòà Âîåííî-âîçäóøíûõ ñèë. Íà 1 íîÿá-ðÿ 1917 ã. äîëæíîñòü âðà÷à óïðàâëåíèÿ

ÂÂÔ èñïîëíÿë äîêòîð ìåäèöèíû êîë-ëåæñêèé àñåññîð À.Âàñèëüåâ [2].

Íà çàñåäàíèè êîëëåãèè «êðàñíîãî»ÂÂÔ 29 àïðåëÿ 1918 ã. áûëî ðàññìîòðåíîè óäîâëåòâîðåíî õîäàòàéñòâî À.Âàñèëü-åâà î åãî óâîëüíåíèè [3]. Â ìàå 1918 ã.âðà÷îì â Ãëàâíîì óïðàâëåíèè ÂÂÔáûë íàçíà÷åí ä-ð Ìîãèëåâñêèé [4].

Âî âðåìåííîì øòàòå Ãëàâíîãî óï-ðàâëåíèÿ ÂÂÔ, óòâåðæäåííîì íàðêîìîìïî âîåííûì äåëàì 30 ñåíòÿáðÿ 1918 ã., âñîñòàâå àäìèíèñòðàòèâíî-õîçÿéñòâåííîé÷àñòè ïðåäóñìàòðèâàëàñü àìáóëàòîðèÿ âñîñòàâå äâóõ ÷åëîâåê (ñòàðøèé ëåêàðñ-êèé ïîìîùíèê è ñëóæèòåëü), íàõîäÿùèõ-ñÿ â ïîä÷èíåíèè âðà÷à ãëàâíîãî óïðàâ-ëåíèÿ [5]. Â ïîñëåäóþùèå ãîäû àìáóëàòî-ðèÿ îñòàâàëàñü â öåíòðàëüíîì àïïàðàòåÂîåííî-âîçäóøíûõ ñèë.

Îäíîé èç îñíîâíûõ çàäà÷, âîçëîæåí-íûõ íà âðà÷à Ãëàâíîãî óïðàâëåíèÿ Ðàáî-÷å-êðåñòüÿíñêîãî êðàñíîãî ÂÂÔ â íà÷à-ëå 20-õ ãîäîâ áûëà êîîðäèíàöèÿ ðàáîòûëåòíûõ øêîë ïî ìåäèöèíñêîìó îòáîðóïîñòóïàþùèõ íà îáó÷åíèå. Â ýòîò ïåðèîäîñîáîå âíèìàíèå óäåëÿëîñü èçó÷åíèþïñèõîëîãèè âîåííûõ àâèàòîðîâ äëÿ ïðå-äóïðåæäåíèÿ àâèàöèîííûõ ïðîèñøå-ñòâèé. Ïî ðåçóëüòàòàì ïðîâîäèìîé ðà-áîòû áûëà îïóáëèêîâàíà îäíà èç ïåðâûõ


ÏÎ ÑÒÐÀÍÈÖÀÌ ÇÀÐÓÁÅÆÍÎÉÌÅÄÈÖÈÍÑÊÎÉ ÏÅ×ÀÒÈ

Ìåäèöèíñêèå ñèëû Åâðîïåéñêîãî ñîþçà Battlegroup 1/2010 (The MedicalTask Force of the European Union Battlegroup 1/2010). – J.Meyr. – Medical CorpsInternational Forum. – 2010. – N 3/4. – P. 28–30 (àíãë.)

Èíèöèàòèâà ñîçäàíèÿ âîåííîé ãðóïïèðîâ-êè Åâðîïåéñêîãî ñîþçà îòíîñèòñÿ ê 1999 ã.,îêîí÷àòåëüíî êîíöåïöèÿ ýòîé ãðóïïèðîâêèáûëà ñôîðìèðîâàíà â 2004 ã. ïðåäñòàâèòåëÿ-ìè Ôðàíöèè, Ãåðìàíèè è Âåëèêîáðèòàíèè.Â åå ñîñòàâ âõîäÿò îêîëî 1500 âîåííîñëóæà-ùèõ. Ãðóïïèðîâêà ïðåäíàçíà÷åíà äëÿ âûïîë-íåíèÿ ãóìàíèòàðíûõ ìèññèé, ïîääåðæàíèÿìèðà, óðåãóëèðîâàíèÿ êðèçèñíûõ ñèòóàöèé,îïåðàöèé ðàçîðóæåíèÿ, áîðüáû ñ òåððîðèç-ìîì. Â åå ñîñòàâ âõîäÿò è ìåäèöèíñêèå ïîä-ðàçäåëåíèÿ.

Êàê ñîîáùàåò àâòîð, îñíîâíàÿ ðîëü âìåäèöèíñêîì îáåñïå÷åíèè îòâîäèòñÿ Ãåð-ìàíèè è Ïîëüøå. Ìåäèöèíñêîå ñîåäèíå-íèå èìååò äâå ìîáèëüíûå áðèãàäû âðà÷åé,äâå àýðîìîáèëüíûå áðèãàäû âðà÷åé è 12ñàíèòàðíûõ ìàøèí. Ïðè íåîáõîäèìîñòèäîïîëíèòåëüíûå ñèëû âûäåëÿþòñÿ Ëàòâè-åé, Ëèòâîé, Ïîëüøåé è Ñëîâàêèåé. Òåõíè-÷åñêàÿ îñíàùåííîñòü ïîäðàçäåëåíèé îáåñ-

ïå÷èâàåò èõ äåÿòåëüíîñòü â òå÷åíèå 30 äíåé.Ïî ìíåíèþ àâòîðà, ðåøàþùèì ôàêòîðîì

óñïåõà âûïîëíåíèÿ ïðåäñòîÿùèõ îïåðàöèé ÿâ-ëÿåòñÿ âçàèìíàÿ ïðîçðà÷íîñòü ìíîãîíàöèî-íàëüíûõ âêëàäîâ â ýòî ìåäèöèíñêîå îïåðàòèâ-íîå ñîåäèíåíèå. ×åì áîëüøèìè âîçìîæíîñòÿ-ìè áóäåò îáëàäàòü ãðóïïèðîâêà, òåì áîëüøåãîóñïåõà ìîæíî îæèäàòü îò ïðîâîäèìûõ âîåí-íûõ îïåðàöèé. Êàæäàÿ èç ó÷àñòâóþùèõ ñòîðîíäîëæíà âíîñèòü ñâîé âêëàä â çàâèñèìîñòè îòñîçäàâøåéñÿ ñèòóàöèè è èìåþùèõñÿ ðåñóðñîâ.Ïëàíèðîâàíèå è êîîðäèíàöèÿ ìåäèöèíñêîãîîáåñïå÷åíèÿ îñóùåñòâëÿþòñÿ ïóòåì ïåðåãîâî-ðîâ. Ýòîò «óðîê èäåíòèôèêàöèè» äîëæåí áûòüïðåîáðàçîâàí â «óðîê îáó÷åíèÿ» äëÿ áóäóùèõâîåííûõ ôîðìèðîâàíèé, è òîãäà äàæå ôèíàí-ñîâûå îãðàíè÷åíèÿ íå áóäóò ïîìåõîé äëÿ óñ-ïåøíîãî ìåäèöèíñêîãî îáåñïå÷åíèÿ ïëàíèðó-åìûõ âîåííûõ îïåðàöèé.

(Ìåäèöèíñêàÿ ñëóæáàáóíäåñâåðà, Ìþíõåí)

«Ãîðÿ÷èå ëàïêè íà êàìóôëÿæå» («Heisse Fusse auf Flecktarn»). –Wehrmedizinische Monatsschrift. – 2009. – Hf. 9. – S. 285 (íåì.)

Êëåùè ÿâëÿþòñÿ ïåðåíîñ÷èêàìè òàêèõñìåðòåëüíî îïàñíûõ èíôåêöèé, êàê âåñåí-íå-ëåòíèé ìåíèíãîýíöåôàëèò è áîððåëèîç.Ñ öåëüþ çàùèòû âîåííîñëóæàùèõ áûë ðàç-ðàáîòàí ñïåöèàëüíûé ïðîïèòûâàþùèé ñî-ñòàâ äëÿ óíèôîðìû. Ïîäïîëêîâíèê çàïàñà ïðî-ôåññîð Ìèõàýëü Ôàóëäå ïðîâåðèë íîâóþ ðàç-ðàáîòêó íà ýôôåêòèâíîñòü.

«Êëåùè ðîäà Hyalomma î÷åíü ïðîâîðíûè â Àôãàíèñòàíå ÿâëÿþòñÿ ïåðåíîñ÷èêàìèñòðàøíûõ áîëåçíåé, òàêèõ, êàê êðûìñêàÿ ãå-ìîððàãè÷åñêàÿ ëèõîðàäêà», – îáúÿñíÿåò Ôà-óëäå. Íà âèäåî, ñíÿòîì â Àôãàíèñòàíå, îí äå-ìîíñòðèðóåò, êàê îäèí èç êðîâîñîñóùèõ ýê-çåìïëÿðîâ íà åãî áîòèíêå ïðîâîðíî ïåðåäâè-ãàåòñÿ ê áðþêàì óíèôîðìû. Îäíàêî êëåù âíå-çàïíî îñòàíàâëèâàåòñÿ è ïîäíèìàåò ëàïêè. «Ýòîíàçûâàþò ýôôåêòîì “ãîðÿ÷èõ ëàïîê”», – ïî-ÿñíÿåò áèîëîã. Â êîíöå êîíöîâ ïàðàçèò ñïðû-ãèâàåò è ñêðûâàåòñÿ, ÷òî ÿâëÿåòñÿ äîêàçàòåëü-ñòâîì ýôôåêòèâíîñòè ðàçðàáîòêè.

Ïåðìåòðèí (Permethrin) – èçìåíåííûéôåðìåíò (áèîêàòàëèçàòîð) õðèçàíòåìû, îáëà-äàåò ñèëüíîé èíñåêòèöèäíîé àêòèâíîñòüþ,ò. å. ÿâëÿåòñÿ ýôôåêòèâíûì ñðåäñòâîì äëÿáîðüáû ïðîòèâ íàñåêîìûõ è êëåùåé, íî ýòîò

ïðåïàðàò äåéñòâåíåí òîëüêî ïðè íåïîñðåä-ñòâåííîì êîíòàêòå ñ êîæåé. Íàøà óíèôîðìàñî ñïåöèàëüíûì âøèòûì ñèíòåòè÷åñêèì ïî-êðûòèåì àáñîëþòíî áåçîïàñíà äëÿ ÷åëîâåêà»,– îáúÿñíÿåò Ôàóëäå. Ìàòåðèàë ïðîïèòûâàåò-ñÿ ñïåöèàëüíûì ñîñòàâîì â õîäå ïðîèçâîä-ñòâà è íå òåðÿåò ñâîè çàùèòíûå ñâîéñòâà äàæåïîñëå 100 ñòèðîê. Íàó÷íûå èññëåäîâàíèÿ òàê-æå ñâèäåòåëüñòâóþò î õîðîøåì ðåçóëüòàòå:îáðàáîòàííàÿ ôîðìà çàùèùàåò íà 95,5%.

Îò ìíîãèõ èíôåêöèé, ïåðåíîñèìûõ êëå-ùàìè, íå ñóùåñòâóåò âàêöèí, ê ïðèìåðó îò áîð-ðåëèîçà, è ñàìàÿ ëó÷øàÿ çàùèòà, ïî ñëîâàìíàó÷íîãî ðàáîòíèêà èç âîåííî-ìåäèöèíñêîãîèíñòèòóòà â Êîáëåíöå, ä-ðà Ôàóëäå, ýòî ïðåä-ïðèíÿòü âñå ìåðû ïî ïðåäóïðåæäåíèþ óêóñà.Ìíîãèå ñðåäñòâà îò íàñåêîìûõ äëÿ êîæè ÿâëÿ-þòñÿ âåñüìà óñëîâíîé çàùèòîé, ïîýòîìó ýêñ-ïåðò ñîâåòóåò: «Ðåãóëÿðíûé îñìîòð âñåãî òåëàíà ïðåäìåò íàëè÷èÿ êëåùåé, îäåæäà, ïðîïè-òàííàÿ ñïåöèàëüíûì ñîñòàâîì ïëþñ íàíåñå-íèå ñðåäñòâ îò íàñåêîìûõ íà îòêðûòûå ó÷àñòêèòåëà ÿâëÿþòñÿ ñàìîé ïðîñòîé è ëó÷øåé çàùè-òîé ïðîòèâ êëåùåé».

(Èíôîðìàöèîííûé ïðåññ-öåíòðìåäèöèíñêîé ñëóæáû áóíäåñâåðà, Ìþíõåí)

80

ÈÇ ÈÑÒÎÐÈÈÂÎÅÍÍÎÉ ÌÅÄÈÖÈÍÛ


© Í.Í.ÊÀÌÅÍÑÊÎÂ, Î.Í.ÊÎÂÀËÜÑÊÈÉ, 2011ÓÄÊ [61:355](091)

Ýòàïû ðàçâèòèÿ îòå÷åñòâåííîé âîåííî-âðà÷åáíîé ýêñïåðòèçû (Ê 90-ëåòèþ ñîçäàíèÿ øòàòíûõ

âîåííî-âðà÷åáíûõ êîìèññèé)

ÊÀÌÅÍÑÊÎÂ Í.Í., çàñëóæåííûé âðà÷ ÓçÑÑÐ, ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû â îòñòàâêåÊÎÂÀËÜÑÊÈÉ Î.Í., çàñëóæåííûé âðà÷ ÐÔ, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû â îòñòàâêå

Ãëàâíûé âîåííûé êëèíè÷åñêèé ãîñïèòàëü èì. Í.Í.Áóðäåíêî, Ìîñêâà

Kamenskov N.N., Koval’sky O.N. – Stages of development of military medical examination (To the 90anniversary of establishment of permanent military medical commissions). The article is devoted to thehistory of formation and development of military medical expertise in Russia. The basic regularities of thesystem respectively, the medical examination as a separate section of medical support of troops, its role andplace of the main stages of military development are presented. A brief description of the status of militarymedical expertise in modern conditions is given; it is showed the prospects for improvement.

K e y w o r d s: medical support of troops, military-medical examination, the history of military medicalexpertise in Russia.

Âîåííî-âðà÷åáíàÿ ýêñïåðòèçà â Ðîñ- ñèè ïðîøëà ñëîæíûé è òðóäíûé ïóòü

îò ýìïèðè÷åñêèõ ñïîñîáîâ îïðåäåëåíèÿãîäíîñòè ê âîåííîé ñëóæáå ðåêðóòîâ ïîñîñòîÿíèþ çäîðîâüÿ è ôèçè÷åñêîìó ðàç-âèòèþ äî ñîâðåìåííîé íàó÷íî îáîñíîâàí-íîé ñèñòåìû ìåäèöèíñêîãî îñâèäåòåëü-ñòâîâàíèÿ ãðàæäàí, îáåñïå÷èâàþùåé êîì-ïëåêòîâàíèå çäîðîâûì è ôèçè÷åñêè êðåï-êèì ïîïîëíåíèåì Âîîðóæåííûõ Ñèë èôåäåðàëüíûõ îðãàíîâ èñïîëíèòåëüíîéâëàñòè, ãäå ïðåäóñìîòðåíà âîåííàÿ ñëóæáà.

Â èñòîðè÷åñêîì ðàçâèòèè îòå÷åñòâåí-íîé âîåííî-âðà÷åáíîé ýêñïåðòèçû (ÂÂÝ)óñëîâíî ìîæíî âûäåëèòü ïÿòü îñíîâíûõýòàïîâ:

– ïîÿâëåíèå ýëåìåíòîâ ÂÂÝ â äî-ðåâîëþöèîííîé Ðîññèè;

– ÂÂÝ â ïåðèîä 1917–1941 ãã.;– ÂÂÝ âî âðåìÿ Âåëèêîé Îòå÷åñòâåí-

íîé âîéíû (1941–1945 ãã.);– ÂÂÝ â ÑÑÑÐ (1946–1991 ãã.);– ñîâåðøåíñòâîâàíèå ñèñòåìû ÂÂÝ

â ñîâðåìåííîé Ðîññèè (ñ 1992 ã. ïîíàñòîÿùåå âðåìÿ).

Åùå â ïåðèîä Ñåìèëåòíåé âîéíû(1756–1762) ïðè îòáîðå ðåêðóòîâ â ñëó÷à-ÿõ ñîìíåíèé â îöåíêå ñîñòîÿíèÿ èõ çäîðî-âüÿ äëÿ îñâèäåòåëüñòâîâàíèÿ ïðèâëåêàëèñü

ìåäèöèíñêèå ÷èíû, â îñíîâíîì ãîðîäîâûåëåêàðè. Îäíàêî îêîí÷àòåëüíîå ðåøåíèå îãîäíîñòè ê âîåííîé ñëóæáå ïðèíèìàëèøòàá- è îáåð-îôèöåðû, êîìàíäèðîâàííûåäëÿ ýòîé öåëè Âîåííîé êîëëåãèåé.

Ïðèîðèòåò â íàó÷íîì îáîáùåíèè îïû-òà ìåäèöèíñêîãî îñâèäåòåëüñòâîâàíèÿ îò-áèðàåìûõ íà âîåííóþ ñëóæáó ïðèíàäëå-æèò øòàá-ëåêàðþ È.Â.Ïðîòàñîâó, êîòîðûéâ 1801 ã. èçäàë «Íà÷åðòàíèå âðà÷åáíîãîîñìîòðà ðåêðóò, ïðèòâîðíûõ è óòàåâàåìûõíåäóãîâ è èõ îáíàðóæèâàíèÿ â 4-õ ÷àñòÿõ».

Ïðèâëå÷åíèå âðà÷åé ê îòáîðó íîâî-áðàíöåâ ñòàëî îáÿçàòåëüíûì â ïåðèîäïðåáûâàíèÿ íà ïîñòó ãëàâíîãî ìåäè-öèíñêîãî èíñïåêòîðà Ðóññêîé àðìèèß.Â.Âèëëèå. Èì áûëè ñîñòàâëåíû «Íà-ñòàâëåíèå, ñëóæàùåå ðóêîâîäñòâîì âðà-÷àì ïðè íàáîðå ðåêðóò íàõîäÿùèìñÿ»(1806) è «Íàñòàâëåíèå äëÿ ðóêîâîäñòâàïðè íàçíà÷åíèè íèæíèõ âîèíñêèõ ÷èíîâèç ãîñïèòàëåé â íåñïîñîáíûå» (1808).

Â ïåðâîì Íàñòàâëåíèè ïåðå÷èñëÿëèñü(â ôîðìóëèðîâêàõ òîãî âðåìåíè):

– áîëåçíè, ïî êîòîðûì ðåêðóò ê âî-åííîé ñëóæáå áûâàåò íå ñïîñîáíûì;

– ïðèòâîðíûå áîëåçíè;– óòàèâàåìûå áîëåçíè è ñïîñîá óç-

íàâàòü îíûå.


ÎÔÈÖÈÀËÜÍÛÉ ÎÒÄÅË

Þ Á È Ë Å È

© À.Á.ÁÅËÅÂÈÒÈÍ, 2011ÓÄÊ 616:355 (092 Øàïïî Â.Â.)

22 àïðåëÿ 2011 ã. èñïîëíèëîñü 60 ëåò áûâøåìó íà÷àëüíèêóÃëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ Ìèíèñòåðñòâà îáîðîíûÐîññèéñêîé Ôåäåðàöèè – íà÷àëüíèêó ìåäèöèíñêîé ñëóæáû Âîîðó-æåííûõ Ñèë ÐÔ, çàñëóæåííîìó âðà÷ó ÐÔ, êàíäèäàòó ìåäèöèíñêèõ íàóêãåíåðàë-ëåéòåíàíòó ìåäèöèíñêîé ñëóæáû çàïàñà Âëàäèìèðó Âëàäèìè-

ðîâè÷ó Øàïïî.Â.Â.Øàïïî ðîäèëñÿ â ã. Âèòåáñêå Áåëîðóññêîé ÑÑÐ. Â 1968 ã. ïîñòó-

ïèë â Âèòåáñêèé ìåäèöèíñêèé èíñòèòóò, â 1972 ã. çà÷èñëåí ñëóøàòåëåìÂîåííî-ìåäèöèíñêîãî ôàêóëüòåòà ïðè Êóéáûøåâñêîì ìåäèöèíñêîìèíñòèòóòå èì. Ä.È.Óëüÿíîâà, ïîñëå îêîí÷àíèÿ êîòîðîãî ñ 1974 ïî 1982 ã.ñëóæèë â Áåëîðóññêîì âîåííîì îêðóãå íà÷àëüíèêîì ìåäèöèíñêîé

ñëóæáû ïîëêà. Ñ 1979 ïî 1981 ã. íàõîäèëñÿ â ñïåöêîìàíäèðîâêå (Ðåñïóáëèêà Ìîçàìáèê).Îêîí÷èâ â 1984 ã. ôàêóëüòåò ðóêîâîäÿùåãî ìåäèöèíñêîãî ñîñòàâà ÂÌåäÀ èì. Ñ.Ì.Êèðîâà,

áûë íàçíà÷åí íà÷àëüíèêîì ìåäèöèíñêîé ñëóæáû ó÷åáíîé òàíêîâîé äèâèçèè ÄÂÎ. Ñ 1988 ïî2005 ã. â óïðàâëåíèè ìåäèöèíñêîé ñëóæáû ÄÂÎ ïðîøåë ñòóïåíè îò ñòàðøåãî îôèöåðà ëå÷åáíîãîîòäåëà äî ðóêîâîäèòåëÿ ìåäèöèíñêîé ñëóæáû îêðóãà (ýòó äîëæíîñòü îí çàíèìàë ñ 1999 ã.).

Â Äàëüíåâîñòî÷íîì âîåííîì îêðóãå Â.Â.Øàïïî ïðîÿâèë ÿðêèå îðãàíèçàòîðñêèåñïîñîáíîñòè, íàëàäèâ òåñíîå âçàèìîäåéñòâèå îòäåëîâ ìåäèöèíñêîé ñëóæáû îáúåäèíåíèéè ñîåäèíåíèé, ìåäèöèíñêèõ ÷àñòåé è ó÷ðåæäåíèé, ÷òî çíà÷èòåëüíî óëó÷øèëî óïðàâëÿåìîñòüìåäèöèíñêîé ñëóæáîé.

Ïðèäÿ â ìåäèöèíñêóþ ñëóæáó ÄÂÎ â ñëîæíîå äëÿ Âîîðóæåííûõ Ñèë âðåìÿ, ÂëàäèìèðÂëàäèìèðîâè÷ ñóìåë íå òîëüêî ñîõðàíèòü âñå ëó÷øåå, ÷òî áûëî ñîçäàíî ïðåæäå, íî è ðàçâèòü,çàêðåïèòü è ïðèóìíîæèòü óñïåõè. Îí äîáèëñÿ ñóùåñòâåííîãî ïîâûøåíèÿ áîåâîé è ìîáèëèçà-öèîííîé ãîòîâíîñòè ìåäèöèíñêèõ ÷àñòåé è ó÷ðåæäåíèé, çàâåðøèë èõ ëèöåíçèðîâàíèå, ÷òîïîçâîëèëî ïîäíÿòü íà êà÷åñòâåííî íîâûé óðîâåíü ìåäèöèíñêîå îáåñïå÷åíèå â îêðóãå.

Çàêîíîìåðíûì ðåçóëüòàòîì áîëåå ÷åì 20-ëåòíåé ñëóæåáíîé äåÿòåëüíîñòè Â.Â.Øàïïîâ Äàëüíåâîñòî÷íîì ðåãèîíå ñòàëî åãî íàçíà÷åíèå íà äîëæíîñòü íà÷àëüíèêà îðãàíèçàöèîííî-ïëàíîâîãî óïðàâëåíèÿ – çàìåñòèòåëÿ íà÷àëüíèêà Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿÌèíèñòåðñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè.

Â íîÿáðå 2007 ã. Âëàäèìèð Âëàäèìèðîâè÷ áûë íàçíà÷åí íà÷àëüíèêîì Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ Ìèíèñòåðñòâà îáîðîíû Ðîññèéñêîé Ôåäåðàöèè – íà÷àëüíèêîììåäèöèíñêîé ñëóæáû ÂÑ ÐÔ è çàíèìàë ýòó äîëæíîñòü äî èþíÿ 2009 ã.

Áîãàòûé îïûò, ãëóáîêèå çíàíèÿ, îðãàíèçàòîðñêèå è òâîð÷åñêèå ñïîñîáíîñòè ïîçâîëèëèÂëàäèìèðó Âëàäèìèðîâè÷ó â ýòîò íåïðîñòîé ïåðèîä óñïåøíî ðåøàòü ñòîÿùèå ïåðåä ìåäèöèí-ñêîé ñëóæáîé Âîîðóæåííûõ Ñèë ÐÔ çàäà÷è.

Â.Â.Øàïïî – àâòîð ðÿäà íàó÷íûõ ðàáîò îá ó÷àñòèè ìåäèöèíñêîé ñëóæáû â ðåàëèçàöèèÑòðàòåãèè ñîöèàëüíîãî ðàçâèòèÿ Âîîðóæåííûõ Ñèë, ïî îðãàíèçàöèè è òàêòèêå ìåäèöèíñêîéñëóæáû íà Äàëüíåâîñòî÷íîì òåàòðå âîåííûõ äåéñòâèé è äð.

Çà çàñëóãè ïåðåä Îòå÷åñòâîì è âûñîêèå ëè÷íûå ïîêàçàòåëè â ñëóæåáíîé äåÿòåëüíîñòèÂ.Â.Øàïïî íàãðàæäåí îðäåíàìè Ïî÷åòà, «Çà ñëóæáó Ðîäèíå â Âîîðóæåííûõ Ñèëàõ ÑÑÑÐ»III ñòåïåíè è ìíîãèìè ìåäàëÿìè.

Êîìàíäîâàíèå Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ Ìèíèñòåðñòâà îáîðîíû Ðîññèé-

ñêîé Ôåäåðàöèè è Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà, ñîâåò Îáúåäèíåíèÿ âåòåðàíîâ

âîåííî-ìåäèöèíñêîé ñëóæáû, ðåäàêöèîííàÿ êîëëåãèÿ «Âîåííî-ìåäèöèíñêîãî æóðíàëà», äðóçüÿ

è êîëëåãè ñåðäå÷íî ïîçäðàâëÿþò Âëàäèìèðà Âëàäèìèðîâè÷à Øàïïî ñ þáèëååì, æåëàþò åìó

êðåïêîãî çäîðîâüÿ, ëè÷íîãî ñ÷àñòüÿ è äàëüíåéøèõ òâîð÷åñêèõ äîñòèæåíèé.



88

© Þ.Â.ÌÈÐÎØÍÈ×ÅÍÊÎ, Ñ.À.ÁÓÍÈÍ, Ê.Ä.ÊÐÀÑÀÂÈÍ, 2011ÓÄÊ 616:355 (092 Ãîðÿ÷åâ À.Á.)

28 àïðåëÿ 2011 ã. èñïîëíèëîñü 50 ëåò íà÷àëüíèêó öåíòðà ôàðìàöèèè ìåäèöèíñêîé òåõíèêè (Ìèíèñòåðñòâà îáîðîíû ÐÔ) Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà, çàñëóæåííîìó ðàáîòíèêóçäðàâîîõðàíåíèÿ ÐÔ, êàíäèäàòó ôàðìàöåâòè÷åñêèõ íàóê ïîëêîâíèêóìåäèöèíñêîé ñëóæáû Àíäðåþ Áîðèñîâè÷ó Ãîðÿ÷åâó.

À.Á.Ãîðÿ÷åâ ðîäèëñÿ â ã. Ïÿòèãîðñêå Ñòàâðîïîëüñêîãî êðàÿ. Ïîñëåîêîí÷àíèÿ â 1983 ã. Âîåííî-ìåäèöèíñêîãî ôàêóëüòåòà ïðè Òîìñêîìãîñóäàðñòâåííîì ìåäèöèíñêîì èíñòèòóòå ñëóæèë íà Áàëòèéñêîìôëîòå íà÷àëüíèêîì îòäåëà õðàíåíèÿ, çàìåñòèòåëåì íà÷àëüíèêà ìåäè-öèíñêîãî ñêëàäà ôëîòà (ã. Êàëèíèíãðàä). Ïîñëå îêîí÷àíèÿ ôàêóëüòåòàðóêîâîäÿùåãî ìåäèöèíñêîãî ñîñòàâà ÂÌåäÀ (1991) íàçíà÷åí ïðåïîäà-

âàòåëåì êàôåäðû âîåííî-ìåäèöèíñêîãî ñíàáæåíèÿ è ôàðìàöèè ÂÌåäÔ ïðè Ñèáèðñêîììåäèöèíñêîì óíèâåðñèòåòå.

Ñ îêòÿáðÿ 1993 ã. è ïî íàñòîÿùåå âðåìÿ ñëóæåáíàÿ äåÿòåëüíîñòü À.Á.Ãîðÿ÷åâà ñâÿçàíàñ Öåíòðîì ôàðìàöèè è ìåäèöèíñêîé òåõíèêè (Ìèíèñòåðñòâà îáîðîíû ÐÔ), ãäå îí ïðîõîäèë

© Ñ.À.ÁÅËßÊÈÍ, 2011ÓÄÊ 616:355 (092 Êîõàí Å.Ï.)

28 àïðåëÿ 2011 ã. èñïîëíèëîñü 80 ëåò âåòåðàíó Âîîðóæåííûõ Ñèë,ëàóðåàòó Ãîñóäàðñòâåííîé ïðåìèè ÑÑÑÐ, çàñëóæåííîìó âðà÷ó ÐÔ,äîêòîðó ìåäèöèíñêèõ íàóê, ïðîôåññîðó ïîëêîâíèêó ìåäèöèíñêîéñëóæáû â îòñòàâêå Åâãåíèþ Ïàâëîâè÷ó Êîõàíó.

Å.Ï.Êîõàí ðîäèëñÿ â äåðåâíå Êðóòîé Áåðåã Ìèíñêîé îáëàñòè.Ïîñëå 4-ãî êóðñà Ìèíñêîãî ãîñóäàðñòâåííîãî ìåäèöèíñêîãî èíñòè-òóòà ïåðåâåäåí íà ÂÌåäÔ ïðè Êóéáûøåâñêîì ìåäèöèíñêîì èíñòè-òóòå èì. Ä.È.Óëüÿíîâà, ïî îêîí÷àíèè êîòîðîãî (1954) áûë âðà÷îììåäèöèíñêîãî ïóíêòà âîåííî-ñòðîèòåëüíîãî îòðÿäà, õèðóðãîì êîìàíäûíåîòëîæíîé ìåäèöèíñêîé ïîìîùè ïðè Îêðóæíîì âîåííîì ãîñïè-òàëå ÓðÂÎ. Â 1962 ã. îêîí÷èë êëèíè÷åñêóþ îðäèíàòóðó íà êàôåäðå

îáùåé õèðóðãèè ÂÌåäÀ èì. Ñ.Ì.Êèðîâà, ñëóæèë â ÑèáÂÎ íà÷àëüíèêîì õèðóðãè÷åñêîãîîòäåëåíèÿ ãàðíèçîííîãî ãîñïèòàëÿ. Â 1964 ã. ïåðåâåäåí âî 2 ÖÂÊÃ èì. Ï.Â.Ìàíäðûêèíà äîëæíîñòü ñòàðøåãî îðäèíàòîðà õèðóðãè÷åñêîãî îòäåëåíèÿ. Ñ 1968 ã. ïî íàñòîÿùåå âðåìÿâðà÷åáíàÿ è íàó÷íàÿ äåÿòåëüíîñòü Å.Ï.Êîõàíà ñâÿçàíà ñ 3 ÖÂÊÃ èì. À.À.Âèøíåâñêîãî, ãäåîí ïðîøåë ïóòü îò ïåðâîãî íà÷àëüíèêà îòäåëåíèÿ ñîñóäèñòîé õèðóðãèè äî íà÷àëüíèêàñåðäå÷íî-ñîñóäèñòîãî öåíòðà.

Åâãåíèé Ïàâëîâè÷ ÿâëÿåòñÿ ïðîôåññîðîì êàôåäðû õèðóðãèè ÃÈÓÂ ÌÎ ÐÔ, ïîäãîòîâèëñâûøå 450 ñîñóäèñòûõ õèðóðãîâ. Îí àêòèâíî ó÷àñòâîâàë â îðãàíèçàöèè 15 ñîñóäèñòûõ îòäåëå-íèé îêðóæíûõ âîåííûõ ãîñïèòàëåé. Â 1989 ã. âîçãëàâëÿë ãðóïïó õèðóðãîâ ïî îêàçàíèþ ïîìîùèïîñòðàäàâøèì ïðè çåìëåòðÿñåíèè â Àðìåíèè.

Å.Ï.Êîõàí – àâòîð 7 ìîíîãðàôèé, 10 íàó÷íî-ïðàêòè÷åñêèõ ðåêîìåíäàöèé è áîëåå350 íàó÷íûõ ïóáëèêàöèé. Ïîä åãî ðóêîâîäñòâîì çàùèùåíû 7 äîêòîðñêèõ è 28 êàíäèäàòñêèõäèññåðòàöèé.

Ïîñëå óâîëüíåíèÿ èç Âîîðóæåííûõ Ñèë (1992) Å.Ï.Êîõàí òðóäèòñÿ êîíñóëüòàíòîìñåðäå÷íî-ñîñóäèñòîãî öåíòðà 3 ÖÂÊÃ èì. À.À.Âèøíåâñêîãî, âåäåò áîëüøóþ îáùåñòâåííóþè íàó÷íóþ äåÿòåëüíîñòü, ÿâëÿåòñÿ ÷ëåíîì ó÷åíûõ ñîâåòîâ ÃÈÓÂ ÌÎ ÐÔ, Ðîññèéñêîãî ãîñó-äàðñòâåííîãî ìåäèöèíñêîãî óíèâåðñèòåòà, ÷ëåíîì ïðàâëåíèÿ Àññîöèàöèè àíãèîëîãîâ è ñîñóäè-ñòûõ õèðóðãîâ ÐÔ, Îáúåäèíåíèÿ âåòåðàíîâ âîåííî-ìåäèöèíñêîé ñëóæáû, ìíîãî ëåò ðàáîòàëâ Âûñøåé àòòåñòàöèîííîé êîìèññèè Ðîññèè.

Çàñëóãè Å.Ï.Êîõàíà îòìå÷åíû îðäåíàìè Òðóäîâîãî Êðàñíîãî Çíàìåíè, «Çà ñëóæáó Ðîäèíåâ Âîîðóæåííûõ Ñèëàõ ÑÑÑÐ» III ñòåïåíè è ìíîãèìè ìåäàëÿìè.

Êîìàíäîâàíèå Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ Ìèíèñòåðñòâà îáîðîíû Ðîññèé-ñêîé Ôåäåðàöèè, 3-ãî Öåíòðàëüíîãî âîåííîãî êëèíè÷åñêîãî ãîñïèòàëÿ èì. À.À.Âèøíåâñêîãîè Ãîñóäàðñòâåííîãî èíñòèòóòà óñîâåðøåíñòâîâàíèÿ âðà÷åé ÌÎ ÐÔ, ñîâåò Îáúåäèíåíèÿ âåòå-ðàíîâ âîåííî-ìåäèöèíñêîé ñëóæáû, ðåäàêöèîííàÿ êîëëåãèÿ «Âîåííî-ìåäèöèíñêîãî æóðíàëà»,ñîñëóæèâöû è ó÷åíèêè ñåðäå÷íî ïîçäðàâëÿþò Åâãåíèÿ Ïàâëîâè÷à Êîõàíà ñ þáèëååì, æåëàþòåìó äîáðîãî çäîðîâüÿ, ñ÷àñòüÿ è òâîð÷åñêèõ óñïåõîâ.



ñëóæáó íà÷àëüíèêîì ïëàíîâî-ýêîíîìè÷åñêîãî îòäåëà, çàìåñòèòåëåì íà÷àëüíèêà è óæå áîëåå10 ëåò ÿâëÿåòñÿ íà÷àëüíèêîì öåíòðà. Ñ èþíÿ 2010 ã. âîçãëàâëÿåò öåíòð ôàðìàöèè è ìåäèöèí-ñêîé òåõíèêè ÂÌåäÀ (Ìîñêâà).

Â 2002 ã. À.Á.Ãîðÿ÷åâ ïðèíèìàë ó÷àñòèå â êîíòðòåððîðèñòè÷åñêîé îïåðàöèè íà ÑåâåðíîìÊàâêàçå.

Íàó÷íàÿ äåÿòåëüíîñòü Àíäðåÿ Áîðèñîâè÷à ïîñâÿùåíà ðåøåíèþ ïðîáëåì îðãàíèçàöèèè óïðàâëåíèÿ ñèñòåìîé ìåäèöèíñêîãî ñíàáæåíèÿ âîéñê (ñèë), ïðîãíîçèðîâàíèþ ïîòðåáíîñòèâ ìåäèöèíñêîì èìóùåñòâå â ìèðíîå è âîåííîå âðåìÿ, ñîâåðøåíñòâîâàíèþ îðãàíèçàöèèëåêàðñòâåííîé ïîìîùè â âîåííîì çäðàâîîõðàíåíèè. Îí àâòîð (ñîàâòîð) áîëåå 110 îïóáëèêî-âàííûõ ðàáîò, â ò. ÷. ìîíîãðàôèé, ó÷åáíûõ è ó÷åáíî-ìåòîäè÷åñêèõ ïîñîáèé.

Çàñëóãè À.Á.Ãîðÿ÷åâà îòìå÷åíû îðäåíîì Ïî÷åòà è ìíîãèìè ìåäàëÿìè.Êîìàíäîâàíèå Ãëàâíîãî âîåííî-ìåäèöèíñêîãî óïðàâëåíèÿ Ìèíèñòåðñòâà îáîðîíû Ðîññèéñêîé

Ôåäåðàöèè è Âîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà, ðåäàêöèîííàÿ êîëëåãèÿ «Âîåííî-ìåäèöèíñêîãî æóðíàëà», êîëëåãè è äðóçüÿ ñåðäå÷íî ïîçäðàâëÿþò Àíäðåÿ Áîðèñîâè÷à Ãîðÿ÷åâàñ þáèëååì, æåëàþò åìó êðåïêîãî çäîðîâüÿ, ñ÷àñòüÿ è äàëüíåéøèõ òâîð÷åñêèõ óñïåõîâ.

Ñ î ê ó ð î â à À. Ì. Ðàçðàáîòêà òåñò-ñèñòåìû íà îñíîâå æåëòî÷íûõ èììóíîãëîáóëèíîâèììóíèçèðîâàííûõ ïåðåïåëîâ äëÿ èíäèêàöèè HBsAg: Àâòîðåô. äèñ. ... êàíä. ìåä. íàóê: 03.00.06 –âèðóñîëîãèÿ, 14.00.46 – êëèíè÷åñêàÿ ëàáîðàòîðíàÿ äèàãíîñòèêà / Íàó÷. ðóêîâîäèòåëèÂ.Á.Ñáîé÷àêîâ, Ñ.Â.Áîðèñåíêî; Îôèö. îïïîíåíòû Î.Ê.Êóçíåöîâ, Ò.Í.Ñóáîðîâà; ÍÈÈ ýïè-äåìèîë. è ìèêðîáèîë. èì. Ïàñòåðà; ÂÌåäÀ èì. Ñ.Ì.Êèðîâà. – ÑÏá, 2009. – 20 ñ.: èë.

Ñ î ð î ê è í à Þ. Ñ. Ñîñòîÿíèå ñåðäå÷íî-ñîñóäèñòîé ñèñòåìû è íåêîòîðûõ ôàêòîðîâ íåéðî-ãóìîðàëüíîé ðåãóëÿöèè ó ïîæèëûõ áîëüíûõ õðîíè÷åñêèìè îáñòðóêòèâíûìè çàáîëåâàíèÿìè ëåãêèõ:Àâòîðåô. äèñ. ... êàíä. ìåä. íàóê: 14.00.43 – ïóëüìîíîëîãèÿ, 14.00.06 – êàðäèîëîãèÿ / Íàó÷. ðóêîâîäèòåëèÌ.À.Õàðèòîíîâ, Î.Ã.Õóðöèëàâà; Îôèö. îïïîíåíòû Ñ.À.Ñîá÷åíêî, Î.Ã.Îáðåçàí; Ñ.-Ïåòåðáóðã. ãîñ.ìåä. óíèâåðñèòåò èì. È.Ï.Ïàâëîâà; ÂÌåäÀ èì. Ñ.Ì.Êèðîâà. – ÑÏá, 2009. – 26 ñ.: èë.

Ò ð ó ô à í î â À. Ã. Ìàãíèòíî-ðåçîíàíñíàÿ ñïåêòðîñêîïèÿ â äèàãíîñòèêå ìåòàáîëè÷åñêèõèçìåíåíèé ãîëîâíîãî ìîçãà ïðè èøåìè÷åñêîì èíñóëüòå: Àâòîðåô. äèñ. ... êàíä. ìåä. íàóê: 14.00.13 –íåðâíûå áîëåçíè / Íàó÷. ðóê. Ì.Ì.Îäèíàê; Îôèö. îïïîíåíòû Ñ.Â.Ëîáçèí, Í.Å.Èâàíîâà;Ñ.-Ïåòåðáóðã. ãîñ. ìåä. óíèâåðñèòåò èì. È.Ï.Ïàâëîâà; ÂÌåäÀ èì. Ñ.Ì.Êèðîâà. – ÑÏá, 2009. – 28 ñ.

Ô å ä î ð î â Ê. Â. Êëèíèêî-ýëåêòðîôèçèîëîãè÷åñêèå îñîáåííîñòè è êîððåêöèÿ íàðóøåíèéíåâðàëüíîé ïðîâîäèìîñòè ïðè êîìïðåññèîííî-èøåìè÷åñêèõ íåâðîïàòèÿõ (êëèíè÷åñêîå è ýêñïå-ðèìåíòàëüíîå èññëåäîâàíèå): Àâòîðåô. äèñ. ... êàíä. ìåä. íàóê: 14.00.13 – íåðâíûå áîëåçíè/ Íàó÷. ðóê. Ñ.À.Æèâîëóïîâ; Îôèö. îïïîíåíòû Í.Â.Ñêðèï÷åíêî, Ñ.Â.Ëîáçèí; Ñ.-Ïåòåðáóðã.ãîñ. ìåä. óíèâåðñèòåò èì. È.Ï.Ïàâëîâà; ÂÌåäÀ èì. Ñ.Ì.Êèðîâà. – ÑÏá, 2009. – 26 ñ.

Ô å ê ë þ ø è í À. À. Õèðóðãè÷åñêàÿ òàêòèêà ïðè õðîíè÷åñêîì êàëüêóëåçíîì õîëåöèñòèòåó ïàöèåíòîâ ïîæèëîãî è ñòàð÷åñêîãî âîçðàñòîâ: Àâòîðåô. äèñ. ... êàíä. ìåä. íàóê: 19.00.02 –õèðóðãèÿ / Íàó÷. ðóê. Â.Ñ.Äîâãàíþê; Îôèö. îïïîíåíòû Ã.È.Ñèíåí÷åíêî, Ë.Â.Ïîòàøîâ;Ñ.-Ïåòåðáóðã. ìåä. àêàäåìèÿ ïîñëåäèïëîìíîãî îáðàçîâàíèÿ; ÂÌåäÀ èì. Ñ.Ì.Êèðîâà. – ÑÏá,2009. – 26 ñ.: èë.

Ù å ð á à ò þ ê Î. Â. Îöåíêà ýôôåêòèâíîñòè ìåäèêàìåíòîçíîãî è õèðóðãè÷åñêîãî ëå÷åíèÿõðîíè÷åñêîé ñåðäå÷íîé íåäîñòàòî÷íîñòè ó áîëüíûõ èøåìè÷åñêîé áîëåçíüþ ñåðäöà: Àâòîðåô.äèñ. ... êàíä. ìåä. íàóê: 14.00.06 – êàðäèîëîãèÿ, 14.00.44 – ñåðäå÷íî-ñîñóäèñòàÿ õèðóðãèÿ/ Íàó÷. ðóêîâîäèòåëè Â.Â.Òûðåíêî, Î.Ã.Õóðöèëàâà; Îôèö. îïïîíåíòû À.Ñ.Ñâèñòîâ,Ñ.Ì.Ëàçàðåâ; Ñ.-Ïåòåðáóðã. ãîñ. ìåä. óíèâåðñèòåò èì. È.Ï.Ïàâëîâà; ÂÌåäÀ èì. Ñ.Ì.Êèðîâà. –ÑÏá, 2009. – 26 ñ.: èë.

ß ê î â å í ê î Ò. Â. Íîçîãåííûå ïñèõè÷åñêèå ðåàêöèè ó áîëüíûõ ñ ôèáðèëëÿöèåé ïðåäñåðäèé:Àâòîðåô. äèñ. ... êàíä. ìåä. íàóê: 14.00.18 – ïñèõèàòðèÿ, 14.00.06 – êàðäèîëîãèÿ / Íàó÷. ðóêîâîäè-òåëè Ã.Ï.Êîñòþê, Þ.Â.Øóáèê; Îôèö. îïïîíåíòû Þ.Â.Ïîïîâ, Ñ.À.Áîëäóåâà; Ñ.-Ïåòåðáóðã.ãîñ. óíèâåðñèòåò; ÂÌåäÀ èì. Ñ.Ì.Êèðîâà. – ÑÏá, 2009. – 18 ñ.: èë.

ÓÄÊ 61 (043.3/5)

ÄÈÑÑÅÐÒÀÖÈÈ Â ÎÁËÀÑÒÈ ÂÎÅÍÍÎÉ ÌÅÄÈÖÈÍÛ,ÏÐÅÄÑÒÀÂËÅÍÍÛÅ Ê ÇÀÙÈÒÅ Â 2009 ÃÎÄÓ*

* Íà÷àëî îáçîðà ñì. Âîåí.-ìåä. æóðí. – 2009, ¹ 5, ñ. 57; ¹ 6, ñ. 21, 55, 59, 65; ¹ 8, ñ. 19;¹ 9, ñ. 82; ¹ 11, ñ. 14; ¹ 12, ñ. 14, 77; 2010, ¹ 3, ñ. 60; ¹ 4, ñ. 45; ¹ 5, ñ. 16, 33; ¹ 10, ñ. 58;¹ 11, ñ. 7, 14, 36, 48, 96; ¹ 12, ñ. 35, 73; 2011, ¹ 1, ñ. 83, 87; ¹ 2, ñ. 88.

Îáçîð ïîäãîòîâèë êàíäèäàò ìåäèöèíñêèõ íàóê Â.À.Âàðôîëîìååâ



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«Âîåííî-ìåäèöèíñêèé æóðíàë» ïðîäîëæàåò ñåðèþ

àêòóàëüíûõ èíòåðâüþ ñ âèäíûìè äåÿòåëÿìè âîåííîãî

çäðàâîîõðàíåíèÿ. Íàø ñîáåñåäíèê – âûäàþùèéñÿ ñïå-

öèàëèñò â îáëàñòè áîðüáû ñ èíôåêöèîííûìè çàáîëåâà-

íèÿìè, îðãàíèçàòîð çäðàâîîõðàíåíèÿ, çàñëóæåííûé

äåÿòåëü íàóêè ÐÔ, àêàäåìèê ÐÀÌÍ, äîêòîð ìåäèöèí-

ñêèõ íàóê, ïðîôåññîð ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû

çàïàñà Þðèé Âëàäèìèðîâè÷ Ëîáçèí. Ìû ïîïðîñèëè

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ñòàíîâëåíèè, êàêèå òðóäíîñòè ïðèøëîñü ïðåîäîëåòü íà

ñâîåì ïóòè, î ïðîáëåìàõ, ñòîÿùèõ ïåðåä ñîâðåìåííîé

ìåäèöèíîé â äåëå áîðüáû ñ èíôåêöèîííûìè çàáîëåâàíèÿìè.

– Þðèé Âëàäèìèðîâè÷, ïî÷åìó âàìè èçíà÷àëüíî áûëî âûáðàíî òàêîå íàïðàâëåíèå ìåäèöèíû,êàê èíôåêöèîííûå áîëåçíè?

– Ýòî ïîëó÷èëîñü ñòèõèéíî, æèçíü ñàìà óâåëà ìåíÿ â îáëàñòü èíôåêöèîííûõ áîëåçíåé. Ïî-ñòóïèâ â 1968 ãîäó â Âîåííî-ìåäèöèíñêóþ àêàäåìèþ, ÿ âûáðàë êàôåäðó íåðâíûõ áîëåçíåé. Óâëå-êàëñÿ íàóêîé, ïîñåùàë âñåâîçìîæíûå êðóæêè, ñåìèíàðû. Íà îäíîì èç òàêèõ çàíÿòèé ÿ óçíàë, ÷òîèäåò ìîùíàÿ ýïèäåìèÿ, ïàíäåìèÿ ìåíèíãîêîêêîâîé èíôåêöèè. Çàíÿâøèñü ýòîé òåìîé, ÿ ìíîãîîáùàëñÿ ñ áîëüíûìè, êîòîðûå ëå÷èëèñü â èíôåêöèîííûõ îòäåëåíèÿõ. Â èòîãå ïîëó÷èëîñü, ÷òî ÿñòàë âðà÷îì-èíôåêöèîíèñòîì, î ÷åì íå æàëåþ. Ýòî èíòåðåñíîå íàïðàâëåíèå, ðîìàíòè÷íîå. Êîãäàÿ íà÷èíàë ðàáîòàòü â îáëàñòè èíôåêöèîííûõ çàáîëåâàíèé, ñ÷èòàëîñü, ÷òî ìîæíî ïîáåäèòü ìèê-ðîáîâ. Ñåãîäíÿ ïîíÿòíî, ÷òî ýòî ïðàêòè÷åñêè íåâûïîëíèìàÿ çàäà÷à. Êðîìå òîãî, ðàáîòà âðà÷à-èíôåêöèîíèñòà ïîçâîëèëà ìíå îáúåõàòü ïî÷òè âñþ Ðîññèþ – Äàëüíèé Âîñòîê, Êðàéíèé Ñåâåð,Ñåâåðíûé Êàâêàç. À åùå âåäü áûë è Àôãàíèñòàí...…

– Ïðåäóïðåæäåíèå èíôåêöèîííûõ çàáîëåâàíèé ó âîåííîñëóæàùèõ – ïðèîðèòåòíàÿ çàäà÷àìåäèöèíñêîé ñëóæáû Âîîðóæåííûõ Ñèë. Êàê âñå ýòî ðåàëèçóåòñÿ íà ïðàêòèêå?

– Îäèí èç âàæíåéøèõ ïóòåé â áîðüáå ñ èíôåêöèîííûìè çàáîëåâàíèÿìè – âàêöèíîïðî-ôèëàêòèêà. Íàäî ïîíèìàòü: ýòî íàïðàâëåíèå, ãäå âëîæåíèå 1 ðóáëÿ îáîðà÷èâàåòñÿ 10 ðóáëÿìèýêîíîìè÷åñêîé ïðèáûëè. Â íàñòîÿùåå âðåìÿ Ðîññèéñêèé íàöèîíàëüíûé êàëåíäàðü ïðåäóñìà-òðèâàåò 11 ïðèâèâîê. Îäíàêî ïðîáëåìà â òîì, ÷òî ìèêðîáû íà÷èíàþò ïðèñïîñàáëèâàòüñÿê ïðåïàðàòàì, âûðàáàòûâàþò óñòîé÷èâîñòü. Àíòèáèîòèêè òåðÿþò ýôôåêòèâíîñòü, à ñîçäàíèåíîâûõ çà ïîñëåäíåå âðåìÿ ðåçêî ñîêðàòèëîñü. Ýòî ñòàëî ýêîíîìè÷åñêè íåâûãîäíî, âåäü íàñîçäàíèå íîâûõ àíòèáèîòèêîâ çà÷àñòóþ óõîäèò 300–500 ìëí äîëëàðîâ, èíîãäà ñóììà äîñòèãàåòè ìèëëèàðäà. Áèçíåñìåíàì îò ìåäèöèíû âûãîäíåå ïðîèçâîäèòü ïðåïàðàòû, êîòîðûå áîëüíîéäîëæåí óïîòðåáëÿòü äëèòåëüíî, òîãäà êàê êóðñû àíòèáèîòèêîâ ÷àùå âñåãî íå ïðîäîëæèòåëüíûïî âðåìåíè. Çà ïîñëåäíèå 5 ëåò, óâû, áûëî ñîçäàíî òîëüêî òðè íîâûõ àíòèáèîòèêà.

– Êàê âñå ýòî ìîæåò áûòü ðåàëèçîâàíî â ïîâñåäíåâíîé æèçíè, â ãðàæäàíñêîì çäðàâîîõðà-íåíèè? Ïðîèñõîäèò îáìåí îïûòîì ìåæäó ðàçëè÷íûìè ñòðàíàìè â ñôåðå ïðåäóïðåæäåíèÿè áîðüáû ñ èíôåêöèîííûìè çàáîëåâàíèÿìè?

– Êîíå÷íî, îáìåí îïûòîì ìåæäó ñòðàíàìè èäåò, îäíàêî ñèòóàöèÿ íà Çàïàäå íè÷åì íåîòëè÷àåòñÿ îò ñèòóàöèè â Ðîññèè, âåäü èíôåêöèè íå çíàþò ãðàíèö. Â êà÷åñòâå ïðèìåðàìîæíî ïðèâåñòè ñëåäóþùèå äàííûå: íàñåëåíèå Çåìëè ñîñòàâëÿåò 7 ìèëëèàðäîâ ÷åëîâåê,èç íèõ 1,5–2 ìèëëèàðäà åå æèòåëåé åæåãîäíî áîëåþò èíôåêöèîííûìè çàáîëåâàíèÿìè,à ó 17 ìèëëèîíîâ îíè çàêàí÷èâàþòñÿ ëåòàëüíûì èñõîäîì. Âîò ïî÷åìó òàê âàæíà âàêöèíî-ïðîôèëàêòèêà.

Â ýòîé ñâÿçè íå ìîãó íå çàòðîíóòü àêòóàëüíåéøóþ ïðîáëåìó. Ñ íà÷àëà 90-õ ãîäîâ ÑÌÈðàçâåðíóëè îòêðîâåííóþ àíòèâàêöèíàëüíóþ ïðîïàãàíäó, ÷åì íàíåñëè íåïîïðàâèìûéâðåä çäîðîâüþ íàñåëåíèÿ, à ïî ñóòè – íàöèîíàëüíîé áåçîïàñíîñòè. Ïðèçûâàëè, íàïðèìåð,ê îòêàçó îò âàêöèíàöèè, ÷òî ïðèâîäèëî ê ðîñòó íåèììóííîé ïðîñëîéêè ñðåäè íàñåëåíèÿ.Ìåæäó òåì çà ïåðèîä 1990-õ ãîäîâ, êîãäà ñòàëà äàâàòü ñáîè ñèñòåìà âàêöèíàöèè îò äèô-òåðèè, òîëüêî â Ïåòåðáóðãå ïîãèáëî îêîëî 300 äåòåé. Ïî îáúåêòèâíûì äàííûì, 85% çàáî-ëåâàíèé ïðèõîäèòñÿ íà èíôåêöèè. Âûñîêàÿ ëåòàëüíîñòü îò èíôåêöèîííûõ çàáîëåâàíèé –ýòî, ê ñîæàëåíèþ, âòîðàÿ ñåðüåçíàÿ ïðîáëåìà, âåäü îêîëî ïîëîâèíû ñìåðòåé ñðåäè äåòåéñâÿçàíû ñ èíôåêöèÿìè.

© À.À.ÃÎËÓÁÅÂÀ, 2011ÓÄÊ 61:355

Âûñîêîå ïðåäíàçíà÷åíèå Âðà÷à


ÊÐÈÒÈÊÀ È ÁÈÁËÈÎÃÐÀÔÈß

© Ì.Â.ÏÎÄÄÓÁÍÛÉ, 2011ÓÄÊ [614.25:355](091)(477.41)

Ôóíäàìåíòàëüíûé òðóä ïî èñòîðèèÊèåâñêîãî âîåííîãî ãîñïèòàëÿ

ÏÎÄÄÓÁÍÛÉ Ì.Â., êàíäèäàò ìåäèöèíñêèõ íàóê, ïîëêîâíèê ìåäèöèíñêîé ñëóæáû çàïàñà


Âûõîä â ñâåò çàâåðøàþùåé êíèãè 6-òîìíîãî èññëåäîâàíèÿ Ì.Ï.Áîé÷àêà, ïîñâÿ- ùåííîãî Êèåâñêîìó ãîñïèòàëþ, ïîçâîëÿåò íàì ãîâîðèòü î íåêîåì ñîáûòèè

â îáëàñòè èñòîðèîãðàôèè âîåííîé ìåäèöèíû. Ñêàæåì ñðàçó – ñîáûòèè áåçóñëîâíîïîçèòèâíîì, èáî ìû çàòðóäíÿåìñÿ íàçâàòü ðàáîòó ìîíîãðàôè÷åñêîãî ïëàíà, â êîòî-ðîé èñòîðèÿ è ñåãîäíÿøíÿÿ æèçíü âîåííî-ëå÷åáíîãî ó÷ðåæäåíèÿ áûëà îõàðàêòåðè-çîâàíà ñî ñòîëü èñ÷åðïûâàþùåé ïîëíîòîé. Êèåâñêèé 6-òîìíèê òðóäíî ñðàâíèâàòüäàæå ñ îáúåìèñòûì òðóäîì À.Í.Àëåëåêîâà (1907) ïî èñòîðèè Ìîñêîâñêîãî ãîñïèòàëÿ,â êîòîðîì àâòîð ñîñðåäîòî÷èëñÿ â îñíîâíîì íà XVIII ñòîëåòèè è, â ñîîòâåòñòâèèñ óñòàíîâêàìè ñâîåãî âðåìåíè, íå äàë òî÷íûõ ññûëîê íà ìåñòà õðàíåíèÿ öèòèðó-åìûõ äîêóìåíòîâ. Ðàáîòà æå Ì.Ï.Áîé÷àêà, ïî îáèëèþ èñïîëüçîâàííûõ èñòî÷íèêîâè õàðàêòåðó èõ ïîäáîðà, ñïîñîáíà óäîâëåòâîðèòü ñàìîãî âçûñêàòåëüíîãî ÷èòàòåëÿ-èñòîðèêà.

Ïðè ýòîì â ëèöå àâòîðà ïåðåä íàìè íå ïðîñòî äîáðîñîâåñòíûé è êâàëèôè-öèðîâàííûé èññëåäîâàòåëü. Ãåíåðàë-ìàéîð ìåäèöèíñêîé ñëóæáû Ìèõàèë Ïåòðîâè÷Áîé÷àê – ïðîôåññîð, çàñëóæåííûé âðà÷ Óêðàèíû – âîçãëàâëÿåò Ãëàâíûé âîåííûéêëèíè÷åñêèé ãîñïèòàëü ÌÎ Óêðàèíû â òå÷åíèå óæå áîëåå 15 ëåò, íà÷àâ ñëóæèòü â íåìâ 1991 ã. â äîëæíîñòè âåäóùåãî òåðàïåâòà.

Èçäàíèå ïîñâÿùåíî íå òîëüêî èñòîðèè îòäåëüíî âçÿòîãî (õîòÿ è îäíîãî èç êðóï-íåéøèõ) ãîñïèòàëÿ, íûíå íàõîäÿùåãîñÿ çà ðóáåæàìè Ðîññèè. Âåäü äî ñôîðìèðî-âàíèÿ â 1992 ã. Óïðàâëåíèÿ ìåäèöèíñêîãî îáåñïå÷åíèÿ øòàáà òûëà ÂÑ Óêðàèíûè ðåîðãàíèçàöèè 408-ãî îêðóæíîãî âîåííîãî ãîñïèòàëÿ Êèåâñêîãî âîåííîãî îêðóãàâ ÃÂÊÃ ÌÎ Óêðàèíû (îôèöåðû ãîñïèòàëÿ ïðèâåäåíû ê ïðèñÿãå â ÿíâàðå 1992 ã.)ãîñïèòàëü ÿâëÿëñÿ îäíèì èç êðóïíåéøèõ âîåííî-ëå÷åáíûõ ó÷ðåæäåíèé Ðóññêîé,Êðàñíîé è Ñîâåòñêîé àðìèè. Íå ñëó÷àéíî â øåñòèòîìíèêå òàê ìíîãî ìàòåðèàëîâ,ïîñâÿùåííûõ ñàìîìó øèðîêîìó êðóãó âîïðîñîâ èñòîðèè îòå÷åñòâåííîéâîåííîé ìåäèöèíû: ó÷àñòèå âîåííûõ ìåäèêîâ â âîéíàõ (íà÷èíàÿ ñ Ðóññêî-òóðåöêîéâîéíû 1735–1739 ãã. è êîí÷àÿ âîéíîé â Àôãàíèñòàíå), ïîäãîòîâêà ëåêàðåéâ XVIII âåêå, áîðüáà ñ ýïèäåìèÿìè è ò. ä. Íà ìíîãèõ ôîòîãðàôèÿõ (îñîáåííî â êí. III)ìû âèäèì íûíå çäðàâñòâóþùèõ ðîññèéñêèõ âîåííûõ âðà÷åé, â ò. ÷. ñîòðóäíèêîâÂîåííî-ìåäèöèíñêîé àêàäåìèè èì. Ñ.Ì.Êèðîâà.

Ê äàòå 250-ëåòèÿ Êèåâñêîãî âîåííîãî ãîñïèòàëÿ (2005) áûë ïðèóðî÷åí âûõîäâ ñâåò òîìà, ïîñâÿùåííîãî Êèåâñêîìó ãîñïèòàëþ êàê ó÷åáíîé è íàó÷íîé áàçåìåäèöèíñêîãî ôàêóëüòåòà Óíèâåðñèòåòà Ñâ. Âëàäèìèðà è Êèåâñêîãî ìåäèöèíñêîãîèíñòèòóòà1 . Íà îáøèðíîì àðõèâíîì è ëèòåðàòóðíîì ìàòåðèàëå èçëîæåíû âîïðîñûñòàíîâëåíèÿ è ðàçâèòèÿ ñîòðóäíè÷åñòâà ìåæäó ìåäèöèíñêèìè âóçàìè Êèåâà

1 Áîé÷àê Ì.Ï. Èñòîðèÿ Êèåâñêîãî âîåííîãî ãîñïèòàëÿ. Êèåâñêèé ãîñïèòàëü – ó÷åáíàÿ è íàó÷íàÿáàçà ìåäèöèíñêîãî ôàêóëüòåòà Óíèâåðñèòåòà Ñâ. Âëàäèìèðà è Êèåâñêîãî ìåäèöèíñêîãîèíñòèòóòà. – Êèåâ: Ïðåññà Óêðàèíû, 2005. – 752 ñ.


ÊÐÈÒÈÊÀ È ÁÈÁËÈÎÃÐÀÔÈß

âîçëîæèë íà ×åðíîáàåâà âðåìåííîå èñïîëíåíèå îáÿçàííîñòåé ãëàâíîãî äîêòîðàÊèåâñêîãî ãîñïèòàëÿ7 , â êîòîðûé îí ïðèáûë âå÷åðîì 7 ñåíòÿáðÿ. Íà ñëåäóþùèé äåíüáûëî îáúÿâëåíî î ïðèåçäå èìïåðàòîðà â Êèåâ. Óçíàâ îá ýòîì, Àäàìîâè÷ îòêàçàëñÿñäàâàòü äîëæíîñòü (!), ñïåøíî ñîñòàâèâ íà èìÿ ×åðíîáàåâà «îòíîøåíèå». Ïðèâîäèì÷àñòü ýòîãî îò÷àÿííîãî, êðàñíîðå÷èâîãî è ðàíåå íå ïóáëèêîâàâøåãîñÿ äîêóìåíòà:«ß ïðèãîòîâèë óæå ââåðåííûé ìíå ãîñïèòàëü äëÿ ïðåäñòàâëåíèÿ Åãî ÈìïåðàòîðñêîìóÂåëè÷åñòâó, è Âàøå Âûñîêîðîäèå â îäèí äåíü íå ìîæåòå óæå èçìåíèòü íè ïîðÿäêà, íèáëàãîóñòðîéñòâà, ìíîþ ê Âûñî÷àéøåìó ñìîòðó óñòðîåííîãî, òî ÿ ïîêîðíåéøå ïðîøó Âàñ,Ìèëîñòèâûé ãîñóäàðü, íå ïðåïÿòñòâîâàòü ìíå ïðåäñòàâèòü Ãîñóäàðþ Èìïåðàòîðó ãîñïè-òàëü ìíå ââåðåííûé â òîì âèäå, â êàêîì ÿ óæå ìíîãîêðàòíî è â òå÷åíèå 40-ëåòíåé ñëóæáûìîåé èìåë ùàñòèå ïðåäñòàâëÿòü. Òåì áîëåå ÷òî Âû, ïðèáûâøè òîëüêî â÷åðà âå÷åðîì, íåìîæåòå ïðèíÿòü íà ñåáÿ è îòâåòñòâåííîñòè ïî âñåì îòíîøåíèÿì òàêîãî îãðîìíîãî çàâå-äåíèÿ, à òîëüêî íåóìåñòíûìè, áåçïîëåçíûìè íè÷òîæíûìè ïðèäèðêàìè ðàññòðîèòå ìåíÿ,à ìíå ïðè ñòîëü âåëèêîâàæíîì ñëó÷àå, ò. å. ïðè ïðåäñòàâëåíèè ÷àñòè ìíå ââåðåííîé ÑàìîìóÂåëèêîìó Ìîíàðõó, ñïîêîéñòâèå äóõà íåîáõîäèìî...»8 Â èòîãå, íåñìîòðÿ íà ìîíàðøèéãíåâ è ìíîãî÷èñëåííûå «áåçïîðÿäêè», íàéäåííûå ðåâèçîðàìè, ñ Àäàìîâè÷åì îáîøëèñüìÿãêî. Äîæäàâøèñü, êîãäà áóðÿ óòèõíåò, åãî â ìàå 1848 ã. ðàñïîðÿæåíèåì Ìåäèöèíñêîãîäåïàðòàìåíòà ïåðåâåëè ñòàðøèì îðäèíàòîðîì â Ìîñêîâñêèé ãîñïèòàëü «ñ îñòàâëåíè-åì ïîëó÷àåìîãî èì äåíåæíîãî ñîäåðæàíèÿ»9 . Äàííûé ïðèìåð äåìîíñòðèðóåò, ÷òî îäèííîâûé äîêóìåíò ñïîñîáåí ìåíÿòü óñòîÿâøèéñÿ â èñòîðèîãðàôèè âçãëÿä.

Â ïðåäèñëîâèè ê ïåðâîé êíèãå Ì.Ï.Áîé÷àê îáúÿñíÿåò, ÷òî ïîáóäèëî åãî âçÿòüñÿçà òðóä: «Íàì ïðèõîäèëîñü çíàêîìèòüñÿ ñ ðàáîòîé ìíîãèõ êðóïíûõ âîåííûõ ãîñïèòà-ëåé Åâðîïû, Ñîåäèíåííûõ Øòàòîâ Àìåðèêè; âåçäå ê èõ èñòîðèè îòíîñÿòñÿ ñ òðîãà-òåëüíîé çàáîòîé è äîëæíûì ïî÷òåíèåì: îòêðûòû ãîñïèòàëüíûå ìóçåè, ãäå ñ âíèìà-íèåì è ëþáîâüþ ñîáðàíû è ñîõðàíåíû ñòàðèííûå ôîòîãðàôèè, àðõèâíûå äîêóìåí-òû è ëè÷íûå âåùè âðà÷åé, äíåâíèêè ñ âîñïîìèíàíèÿìè ïåðñîíàëà... Êðîìå òîãî,â åâðîïåéñêèõ ñòðàíàõ è ÑØÀ õðîíèêàì æèçíè ãîñïèòàëåé ïîñâÿùåíû ìíîãèå ïóá-ëèêàöèè, ìîíîãðàôèè è îòäåëüíûå ñîëèäíûå èçäàíèÿ». È äàëåå, ñëîâíî âñòóïàÿâ äèàëîã ñ âåëèêèì Í.È.Ïèðîãîâûì è öèòèðóÿ åãî âîïðîñ: «Ïî÷åìó ìû òàê ìàëîçíàåì î íàøåì ïðîøåäøåì, òàê ñêîðî åãî çàáûâàåì?» – àâòîð äàåò ñâîé îòâåò:«Ìû áóäåì çíàòü ñâîþ èñòîðèþ è âñå ñäåëàåì, ÷òîáû ïðèâèòü ýòè çíàíèÿ è ëþáîâü êñâîåé ñòðàíå, ê ñâîåìó ó÷ðåæäåíèþ íàøèì ïîòîìêàì» (êí. I, ñ. 3–4). Íå ìîæåòáûòü ñîìíåíèÿ, ÷òî çàâåðøåííûé òðóä Ìèõàèëà Ïåòðîâè÷à Áîé÷àêà ïî èñòîðèèÊèåâñêîãî âîåííîãî ãîñïèòàëÿ áóäåò ñëóæèòü îñóùåñòâëåíèþ ýòîé áëàãîðîäíîé öåëè.

7 Ðîññèéñêèé ãîñóäàðñòâåííûé âîåííî-èñòîðè÷åñêèé àðõèâ, ô. 879, îï. 2, ä. 862, ë. 16.8 Òàì æå, ë. 40 îá.9 Òàì æå, ë. 76–79.

Çà ñîäåðæàíèå è äîñòîâåðíîñòü ñâåäåíèé â ðåêëàìíîì îáúÿâëåíèèîòâåòñòâåííîñòü íåñåò ðåêëàìîäàòåëü.

Ïå÷àòü îôñåòíàÿ.Óñë. êð.-îòò. 9,8.Òèðàæ 3224 ýêç.

Ïîäïèñàíî ê ïå÷àòè 29.04.11.Áóìàãà îôñåòíàÿ.Ó÷.-èçä. ë. 8,6.Êàòàëîæíàÿ öåíà 54 ð. 00 ê.

Îòïå÷àòàíî â òèïîãðàôèè ÎÀÎ «Èçäàòåëüñêèé äîì «Êðàñíàÿ çâåçäà»123007, ã. Ìîñêâà, Õîðîøåâñêîå øîññå, 38, http://www.redstarph.ru

Ó÷ðåäèòåëü – Ìèíèñòåðñòâî îáîðîíû Ðîññèéñêîé Ôåäåðàöèè.Çàðåãèñòðèðîâàí Ìèíèñòåðñòâîì ïå÷àòè è èíôîðìàöèè Ðîññèéñêîé Ôåäåðàöèè.Íîìåð ðåãèñòðàöèîííîãî ñâèäåòåëüñòâà 01975 îò 30.12.1992 ã.

Ñäàíî â íàáîð 07.04.11.Ôîðìàò 70½1081/

16.

Óñë. ïå÷. ë. 8,4.Çàêàç ¹ 1890.

Ìàêåò è êîìïüþòåðíàÿ âåðñòêà Â.Â.ÌàòèèâàÏåðåâîä Â.Â.Ôåäîòîâîé

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